spring2005-165_page167 spring2005-166_page168 spring2005-167_page169 spring2005-168_page170 spring2005-169_page171 spring2005-170_page172 spring2005-171_page173 spring2005-172_page174 spring2005-173_page175 spring2005-174_page176 spring2005-175_page177 spring2005-176_page178 spring2005-177_page179 spring2005-178_page180 spring2005-179_page181 spring2001-080_page 75 spring2001-081_page 76 spring2001-082_page 77 spring2001-083_page 78 spring2001-084_page 79 spring2001-085_page 80 spring2001-086_page 81 spring2005-130_page132 spring2005-131_page133 spring2005-132_page134 spring2005-133_page135 spring2005-134_page136 spring2005-135_page137 spring2005-136_page138 spring2005-137_page139 spring2005-138_page140 spring2005-139_page141 spring2005-140_page142 spring2005-141_page143 spring2005-142_page144 spring2005-208_page210 spring2005-209_page211 spring2005-210_page212 spring2005-211_page213 spring2005-212_page214 spring2005-213_page215 spring2005-214_page216 spring2005-215_page217 spring2005-216_page218 spring2005-217_page219 spring2005-218_page220 spring2005-005_page7 spring2005-006_page8 spring2005-007_page9 spring2005-008_page10 spring2005-009_page11 spring2005-010_page12 spring2005-011_page13 spring2005-012_page14 spring2005-013_page15 spring2005-014_page16 spring2000-008_vii advances vol. 3, no. 2 i editorial james g. daley iam humbled and energized as i take the reins as editor of this wonderful journal. advances in social work, now in its third year of publication, has firmly created its place as a source of scholarly excellence in the growing volume of professional journals. our mission is straightforward.we strive to be both conduit and standards setter. there are many superb scholars who conduct groundbreaking and vital theoretical and empirical studies. we hope to be an inviting way to get their work showcased to the world.we work hard to get manuscripts reviewed as quickly as possible and get them into print. our review process is rigorous, with some of the finest scholars serving as our reviewers. we invite you to consider us for that manuscript that deserves to be shared with the world. besides serving as a conduit, the journal seeks to produce issues that coalesce stateof-the-art research and theory in a manner that pushes the field of social work to a more in-depth consideration of important topics. in the future, we will be developing special issues that will explore a topic inmore depth and capability than any one article could provide.we hope to offer a thoughtful, useful issue that will serve as a valuable resource for the social workers and other professionals in urgent need of the latest knowledge. the profession of social work exists in an information overloading and complex environment in which social workers must gather knowledge, analyze the best technologies, and create useful intervention strategies that produce empirically verified outcomes that benefit our clients.we are accountable to everyone and our very survival stems from justifying our actions. other professions are rapidly developing best practice protocols, eroding profession-specific boundaries, and asserting claims that they, rather than social workers, are more capable, evidence-based, and resourceful. fortunately, social work has a proud heritage of capability and has itself launched a myriad of best practice initiatives. our mission, blending client-focused skills and effective societal advocacy, continues to be desperately needed and invaluable as a contribution to improving our world. this journal is an important part of that social work mission. as editor, i accept a leadership role in supporting thatmission.this issue exemplifies that commitment to excellence. the six articles provide you with a rich variety of thoughtful, useful information. the topics range from training social workers to using spirituality in practice, online socialworkpractice, contrasting rural andurbandifferences in clients, issues of professional liability and risk, poetry therapy as a useful technique, and a more indepth examination of substance abuse and suicidal behavior in young adult women. this issue should offer stimulating reading and education. it continues our effort to give the reader a depth and breadth of information that strengthens your skills. i hope you enjoy the issue. i look forward to the vibrant path that this journal is taking. stick around and watch what happens. it will be exciting! editorial i editorial william h. barton the year 2008 is nearing its end. if nothing else, the year has been a wild rollercoaster ride. considering the global economic woes, continuing armed conflicts, energy and climate crises, and the united state’s historic presidential election, the future certainly presents social work with both challenges and opportunities. as i assume the editorship of advances in social work, i invite you to share your innovative efforts towards promoting knowledge that can improve social work practice, education and research by submitting your work to our journal. our new, all-online format encourages timely review of manuscripts and free, open access to all new and archived issues. the current issue continues the journal’s history of presenting articles addressing a wide range of issues and employing diverse methods. it begins with several articles relevant to social work education. in “a multiparadigmatic approach to judeo-christian religion in social work education,” jon e. singletary presents a carefully constructed framework for integrating sociological paradigms of knowledge and practice to incorporate content on religion and spirituality in social work education. in “the generalist model: where do the micro and macro converge,” shari e. miller, carolyn j. tice and diane m. harnek hall present data suggesting that, despite efforts by many schools of social work to incorporate content on macro practice, undergraduate social work students feel less prepared to practice with larger system sizes. they offer recommendations for classroom techniques and greater emphasis on macro learning assignments in field in addition to curricular changes. in the third article, “online practice course development with action research: a case example,” khadija khaja, phillip ouellette, carenlee barkdull and joanne yaffe tackle this sometimes controversial issue through a qualitative analysis of student and instructor responses to a pilot attempt to offer portions of an msw practice course online. student feedback was mixed, and the instructors faced a sizeable learning curve, but the authors conclude that the approach holds promise. scott e. wilks uses quantitative survey methods to explore “resilience amid academic stress: the moderating impact of social support among social work students.” the results demonstrated that social support, particularly from peers, positively influenced resilience in the presence of academic stress. the next three articles present research related to practice with youths with serious emotional disturbances, latinos living with hiv/aids and neighborhood-based community initiatives, respectively. nathaniel j. williams and michael sherr present findings from a “longitudinal evaluation of outcomes for youth with serious emotional disturbance during two years of children’s psychosocial rehabilitation.” they evaluated the children’s psychosocial rehabilitation treatment model using a 24-month retrospective panel design of 49 youths, with outcome data from seven administrations of the child and adolescent functional assessment scale (cafas; hodges, 2000). they ii found a statistically and clinically significant improvement in outcomes between intake and 16 months. although the rate of change decreased during the last eight months of the study, significant improvements were observed during treatment, especially during the first year. in “social work practice with latinos living with hiv/aids,” diana rowan, rich furman, april jones and kevin edwards discuss a qualitative case study of a support group for latinos infected or affected by hiv. they ground their study in values specifically relevant for practice with latinos, and argue that translating such values into skills is essential in providing culturally competent services in this context. next, daniel brisson and susan roll describe “an adult education model of resident participation.” following a review of the literature on comprehensive community initiatives, they present a stage model for developing true participation of residents in community change efforts, and apply that model to reflect upon their experience working with the annie e. casey foundation’s making connections initiative in one city. in this issue’s concluding article, jeong woong cheon makes a case for the “convergence of a strengths perspective and youth development: toward youth promotion practice.” he argues that social work is particularly well-suited to champion youth promotion practice as an antidote to the prevailing problem-focused, deficit-based interventions found in a variety of contexts involving children and youth. those of you who may be familiar with some of my own writings will notice a certain kinship here (see barton & butts, 2008). i will end my inaugural editorial with an hypothesis: no one reads the editorial in an issue of an online journal. when opening a printed copy of a journal, your eyes are confronted with the editorial and you will likely at least skim through it. in the online format, you’d have to take the initiative to click on the link to the editorial. i suspect that you would be much more likely to simply go directly to the links to the articles themselves. so, if you actually are reading this, you can disprove my hypothesis by sending me an email at wbarton@iupui.edu. feel free to provide feedback about the journal’s format or contents. finally, i would like to acknowledge the many years of hard work my colleagues and editorial predecessors, jim daley and barry cournoyer, devoted to building advances in social work into a well-respected journal in our field. i hope the new online format helps to extend its reach. welcome aboard. it will be an interesting journey. references barton, w. h., & butts, j. a. (2008). building on strength: positive youth development in juvenile justice programs. chicago: chapin hall center for children at the university of chicago. available from: http://www.chapinhall.org/article_abstract.aspx?ar=1471. hodges, k. (2000). the child and adolescent functional assessment scale (2nd rev.). ypsilanti: eastern michigan university. mailto:wbarton@iupui.edu http://www.chapinhall.org/article_abstract.aspx?ar=1471 microsoft word editorial vol 11_1 _________________ william h. barton, ph.d., is a professor in the indiana university school of social work on the indiana university-purdue university indianapolis campus. contact information: (317) 274-6711; email: wbarton@iupui.edu copyright © 2010 advances in social work vol. 11 no. 1 (spring 2010), i-ii editorial: william h. barton welcome to the spring 2010 (volume 11, no. 1) issue of advances in social work. the work of another academic year is finding its way into neatly organized file folders (right!). everybody knows that the summer for those of us fortunate enough to work in higher education means a languorous string of balmy evenings on the porch following days of mindless recreation at the beach, lake or wherever. sound familiar? not to me either. summer is more likely to find academics, at least those who don’t teach full loads all year, frantically seeking grant funding, reworking or developing new courses, and/or cranking out manuscripts. speaking of those manuscripts, please consider sending your best ones our way! before previewing the current issue, let me remind you that advances will be publishing a special issue on “social work and service learning in the age of competency-based education,” co-edited by virginia majewski and lisa mcguire. this special issue is linked to the conference “assessing professional competencies through service learning,” to be held in indianapolis from june 16 to 18, 2010. attendees will be invited to submit papers for inclusion in this peer-reviewed issue, although others not attending the conference are also encouraged to submit papers as well. papers may be either theoretical or research-focused. the submission deadline is september 1, 2010, with anticipated publication in the spring of 2011. to view the complete call for papers, see the announcement on the journal’s home page. the current issue opens with an article by david hodge, robin bonifas and rita jing-ann chou entitled “spirituality and older adults: ethical guidelines to enhance service provision.” recognizing that spirituality plays an important role in the ways many older adults address their challenges, hodge and colleagues urge gerontological social workers to equip themselves by attending to three ethical principles: 1) client autonomy, 2) cultural or spiritual competence, and 3) professional competence. regarding clients at the other end of the lifespan, madhavappallil thomas and barbara reifel’s article, “child welfare workers’ knowledge and use of a resilience approach in out-of-home care,” examines the extent to which child welfare workers understand and use a resilience approach in their work. among their key findings: child welfare workers who have social work degrees are more likely to be familiar with and use resilience-based assessment and interventions that are those workers without social work degrees. while there is no lack of literature concerning attitudes towards marriage and divorce in western cultures, the third article, “attitudes of kuwaiti young adults towards marriage and divorce: a comparative study between young adults from intact and divorced families” by humoud alqashan and hayfaa alkandari, provides one of the few descriptions of such attitudes in an arab country in the gulf region. while their findings mirror those in the west in many respects, they do find some differences, especially advances in social work, spring 2010, 11(1) ii among women, and discuss these in terms of both historical and recent cultural, social and political influences in the region. from another part of the world, australia, comes our fourth article, “mental health, access, and equity in higher education.” jennifer martin and fiona oswin present findings from an exploratory study in which they asked students if they experienced mental health difficulties and, if so, whether or not they disclosed such difficulties and if they perceived support or discrimination as a result of such disclosure. the most common types of reported mental health issues included depression and anxiety. many students indicated that they did not disclose their problems to university officials because they feared discrimination in their studies and future employment. on the other hand, those who did disclose generally reported that they received helpful assistance. continuing a “tradition” in advances in social work, the next article, “information and communication technologies in social work” by brian perron, harry taylor, joseph glass and jon margerum-leys, discusses the role of technology in both social work education and practice. in addition to describing an array of current applications of such technologies, the article critically examines their link to specific standards in the nasw code of ethics and makes the argument that such technologies appear necessary for ensuring the delivery of ethical social work practice. this issue concludes with a report of a state-level workforce survey, “employmentrelated salaries and benefits in social work: a workforce survey.” noting that the 2004 national nasw workforce survey included too few cases from arizona to provide state-level information, suk-young kang and judy krysik adapted that survey instrument and applied it to a random sample of arizona’s nasw membership, obtaining a 72% response rate (n=465). among their findings: salary was positively related to level of education and years of experience; salaries were higher for men than women and higher for those in administrative roles; and access to employee-related benefits appeared widespread. they conclude by suggesting that such information should be used to market social work as a career choice in arizona, as the profession can provide good salaries and benefits. in closing, i am pleased to report that advances in social work has been able to provide highly efficient processing of most submitted manuscripts, thanks to the timely response by our reviewers. for example, one of the articles in this issue was initially submitted during the holiday break in late december. both peer reviews were completed within two weeks and the decision made to “provisionally accept – minor revisions needed.” the revised manuscript was submitted within another month, the second round of peer reviews was completed in two days, and the manuscript was accepted – total time from initial submission through revision to acceptance was two months! the timeline for another article in this issue was virtually identical – two months total time from initial submission to acceptance with two rounds of review. while these may be the fastest, the four others were not slow, with total times of three, four, six and eight months, and all required at least two rounds of review. now, to the beach or porch …. spring2005-107_page109 spring2005-108_page110 spring2005-109_page111 spring2005-110_page112 spring2005-111_page113 spring2005-112_page114 spring2005-113_page115 spring2005-114_page116 spring2005-115_page117 spring2005-116_page118 spring2005-117_page119 spring2005-118_page120 spring2005-143_page145 spring2005-144_page146 spring2005-145_page147 spring2005-146_page148 spring2005-147_page149 spring2005-148_page150 spring2005-149_page151 spring2005-150_page152 spring2005-151_page153 spring2005-152_page154 spring2005-153_page155 legally the violence against women act is included in the violent crime control and law enforcement act passed into law on september 1994 ________________ shreya bhandari is a doctoral student at the school of social work, university of missouri-columbia. copyright © 2008 advances in social work vol. 9 no. 1 (spring 2008), 44-50. analysis of violence against women act and the south asian immigrants in the united states shreya bhandari abstract. the issue of domestic violence among south asian immigrant population in the united states is examined in the light of the violence against women act. the paper gives a background to the issue of domestic violence in the south asian community and examines the violence against women acts of 1994, 2000 and 2005 with regard to issues affecting south asian women. it addresses issues around marriage and has emphasized the difficulties of women with dependent immigration status. policy alternatives are examined and discussed with regard to efficacy and efficiency of the policy. keywords: south asian immigrant women, domestic violence, violence against women act. domestic violence cuts across race, religion, countries, class and is a universal phenomenon (orloff & kelly, 1995). a study of 160 south asian women in heterosexual relationships in greater boston revealed that 40.8% of the women were physically abused and/or sexually abused by their current male partner, 36.9% of them were reported to be victimized in the past year and 65% of them reporting physical abuse also reported sexual abuse. the sample was collected through community outreach methods like flyers and snowball sampling (raj & silverman, 2002). about 30 to 50 % of asian and latina immigrant women in the u.s face domestic abuse from their intimate partners (dutton, orloff, & hass, 2000). as per the research by manavi, a south asian women’s group, 2530% of asian indian women in the united states suffer abuse at the hands of their partners at one time or another (warrier, 2000). immigration and vawa background this article looks at the issue of domestic violence among the south asians and the pros and cons of the battered immigrant women protection act under the violence against women act of 2005 in comparison with the earlier violence against women acts. the south asian community consists of people from india, pakistan, bangladesh, sri lanka, bhutan, nepal and the maldives. due to its friendly laws of immigration, the united states is built on a huge and ever growing immigrant population (abraham, 2000b). moreover after the easing of the immigration laws in 1965, a large number of south asian families started coming to the united states. in the 1960s the south asians who immigrated to the united states were professionals. this demographic composition changed in the 1990s. the cycle of “chain immigration” started wherein the south asians who were u.s citizens sponsored their relatives to migrate to the united states. recently the migration consists of professionals working in the information technology industry (abraham, 2000b). there has been a sharp growth in the south asian population from bhandari/ violence against women act and south asian immigrants 45 1990-2000, more than double than before with indians being 88% of the entire south asian population (u.s bureau of the census, 2002). the application process for residency in the united states there were many fraudulent marriages reported among the immigrant population in the 1980s which led to the congress passing the immigration marriage fraud amendment (imfa) in 1986 (rae, 1988). after the passing of this act the u.s citizen or the legal permanent resident would have to file for the “conditional resident status” for the dependent spouse. there would be a waiting period of 2 years after which the couple would jointly petition to the immigration and naturalization service (ins) to adjust the conditional residency to permanent residency. the couple would have to undergo a personal interview with the ins to prove that the marriage was not a fraud. the waiting period began from the day conditional status of residency was obtained (anderson, 1993). it is interesting to note that under the guise of detecting “fraudulent marriages” the ins has made many stringent policies for the application of residency. it did not realize that it is equally important to provide welfare and economic security to legal dependent immigrants as it is to detect the illegal immigrants (narayan,1995). though a lot of south asian women enter the united states on their own, there are a considerable number of them who enter the country on a dependent status through marriage with a legal permanent resident, u.s citizen or a professional on a wok permit. women who are already socially, psychologically and economically dependent on their partners become legally dependent on them too because of the imfa (abraham, 2000b). analysis and comparison of violence against women act of 2005 with the earlier acts on violence against women. until the violence against women act of 1994, the control of the immigration status of the dependent spouse rested on the spouse who was a u.s citizen or a legal permanent resident. thus, if the husband was abusive the battered woman was rendered without any support (orloff & kelly, 1995). however the violence against women act of 1994 offered a big respite. it included the violent crime control and law enforcement act which was passed into law on september 1994. this allowed an alien spouse to do a self petition for unconditional permanent resident status or apply for suspension of deportation (orloff & klein, 1995). with the improvements and changes made in the act from 1994 to 2000 there has been an increase in the access of services by the battered women (orloff & kaguyutan, 2002). however for the self petition or suspension of deportation, the woman should have stayed in the united states for 3 years. even though violence against women act of 1994 made several provisions in favor of abused women of color, it did not take into account women who experienced abuse within the first three years of marriage. further the passing of the welfare reform legislation in 1996 denied legal immigrants access to federal, state and local benefit programs. even if a woman became eligible for welfare benefits, she had to give proofs through police, hospital, social service agencies that she was abused. hence the complex immigration policies which were discriminatory and not in favor of women increased their vulnerability during violence (abraham, 2000a; anderson, 1993). there advances in social work, spring 2008, 9(1) 46 were some groups of battered women like survivors of elder abuse, etc, which were not covered by the act. most of the time women did not have their own resources or structural support to attain legal assistance (orloff & kaguyutan, 2002). there were a few positive introductions made in the violence against women act (vawa) of 2000. two new categories of non immigrant visas were introduced in the vawa 2000“t” and “u”. “t” visas provides legal status for up to 5,000 victims of sex trafficking and forced labor each year. “u” visas are issued to immigrants who are either victims of or who possess information regarding many forms of criminal activity like rape, domestic violence, and sexual assault. both the visas provide nonimmigrant status, including work authorization, to the victims and certain family members (ncadv, 1/16/06). there was requirement of extensive documentation that the immigrant women would suffer extreme hardship if deported back to the country. as a result women did not receive approvals of their self-petition cases. it required the help of attorney. with no requirement of documentation to prove extreme hardship if deported back to the home country in vawa 2000 made it easier for the domestic violence advocates to collect more evidence for other issues in vawa cases.(orloff & kaguyutan, 2002). specific issues related to spouses on dependent visa where the partner is on work permit about 3,00,000 visas have been issued to the dependent spouses of “h-1 b” visa holders, which is the “h-4”. these women are mostly educated, english speaking, and most of the time have had a rewarding career back home. as per the us immigration laws, they are not authorized to work if they are on a dependent “h4 visa”(workpermit.com, 2005). thus the legally dependent women land up in a powerless position financially as well. social isolation adds to the already existing dependency of these women. thus the legally dependent spouses in this category are left with no options. hence what is increasingly needed is a space for such immigrant women where they could seek redress if faced with a violent situation. in spite of being from middle and educated class, they are trapped in a “catch 22” situation. they are not authorized to work or self-petition as their husbands are on temporary visas and hence are dependent on the abuser. so there is no way to escape the abuser. “h-1 b” sponsorship for these women also becomes difficult as it needs an employer and on several occasions degrees from their countries are not recognized unless from a u.s. university. moreover getting a student visa is also not easy as the cost of education is very high and the scholarships and grants are mostly available to u.s. citizens. the victim can file a police complaint and apply for u visa, which is meant for crime victims. however immigrant women don’t want to get into options of deporting their spouses. however what is needed is that these women should have a right to work and self petition (shah, 2004). features of the violence against women act (vawa) 2005 title viii of vawa 2005 deals with the protection of battered and trafficked immigrants. the violence against woman act of 2005 has taken care of a number of the above drawbacks in the 1994 and 2000 act. even though the 1994 and the 2000 act had bhandari/ violence against women act and south asian immigrants 47 worked in the direction to reduce violence against women, there were still several categories of women and children whose lives were at risk. many of them are still being deported and several others are still trapped by the abusers in life threatening situations (lin & orloff, 2005). as per section 813 (a) of the violence against women act and department of justice reauthorization act of 2005, battery and extreme cruelty are added to the list of exceptional circumstances in deportation proceedings of the abusers. at the same time in section 812 of vawa act of 2005 the victims of domestic abuse, sexual assault and trafficking are exempted from sanctions for failing to depart voluntarily. the self petitioning is also extended to the victims of elder abuse where the perpetrators are u.s citizens. it allows child abuse and incest victims to self petition up to age 25. thus section 805 (c) of vawa 2005 protects the abused immigrant children and children of abused immigrants from being cut off from vawa immigration protection when they turn 21. the most important leap made by section 814 (b) of the vawa 2005 is to provide the spouses entering the united states accompanying or joining the partner on a, e, (iii), g, or h non-immigrant visa granted work authorization if the spouse demonstrates that during the marriage he or she has been battered or exposed to extreme cruelty [814 (c)]. employment is authorized for victims with approved vawa petitions and “t” visas. there was an amendment in the 2005 act and section 104 guaranteed access to legal services for immigrant victims by authorizing any legal services corporation (lsc)funded program to use any source of funding, including lsc funding, to represent any victim of domestic violence, sexual assault, trafficking, or other crime, regardless of the victim’s immigration status. as per section 821 (a) and (b) the duration of “t and u” visa has been extended to 4 years (vawa, 2005). recommendations for improving immigration policies as per section 814 (c) of the vawa 2005 work authorization is allowed to a immigrant woman on a dependent visa if she faces violence. her status still depends on that of her spouse as the act does not allow her to self petition and it does not spell out her status if the husband returns to the home country. moreover her visa status still remains the same. the alternative would have been to allow these women to self petition so that they are not dependent on the abusers. the leap made by the violence against women act of 2005 is allowing work authorization if the woman faces violence and not otherwise. this however again puts the onus on the woman as she has to gather proofs to report her abuse to the criminal justice system (raj, silverman, mccleary-sills, & liu, 2005). instead it should allow her to self petition and authorize her to work regardless of whether or not she faces violence. the act requires the k(fiancé visa) visa petitioners to disclose criminal background information to the department of homeland security. it states that this would help the government track down serial k petition filed by the same petitioner (vawa, 2005). however the act does not spell out the status of the woman if she does not marry the person who brought her to this country. the law discriminates against women who refuse to marry an abusive fiancé by failing to provide a status for them. the act should accommodate such women by allowing self-petition and exempting from the penalties for failing to depart if not married within 90 days. advances in social work, spring 2008, 9(1) 48 there should be a new ground for a hardship waiver for conditional residence for abused intended spouses who unknowingly married abusers who were legally married to someone else. another suggestion is that there should not be a waiver of 5 years for the victims of violence against women act to receive public benefits. they should have direct access to food stamps and social security insurance (lin & orloff, 2006). the proof of marriage to a u.s citizen or legal permanent resident and legal entry to the united states should automatically confer the conditional residency to spouses and the couple should not be asked to wait till the application is filed (narayan, 1995). this will be a step at the preventive level and will not rest the immigration status on the partner who is a resident or a citizen. it will be really helpful to women if they land in violent situations. the entire concept of battered women expected to prove violence becomes difficult as most of the times immigrant women are not able to collect such proofs and it becomes all the more complex when mental cruelty needs to be proven. so the testimony should be gathered from relatives, friends, religious leaders and the woman’s testimony should also be sufficient (narayan, 1995). assessing the alternatives and evaluative criteria the policy alternatives are assessed on the basis of equity and effectiveness. equity has been defined as the extent to which “situations in similar circumstances are dealt with similarly”. so a program is considered to be inequitable if two persons are identical in other aspects but receive different treatment from it (jannson, 1984). moreover the united nations declaration on the elimination of violence against women and international human rights laws provide the right to employment and full equality to all under the law (united nations, resolution 48/104, 1993). the immigration laws prohibit women from working or changing their visa statuswhich are the rights guaranteed to their immigrant husbands on work visas. thus denial of this right leads to denial of basic human rights (raj et al., 2005). hence an immigrant woman should also have the right to be in a safe environment and if she is in a violent situation she should have access to resources to redress the violence. similarly if a woman comes here on a working visa, she will have access to more resources than a woman who is on a dependent visa. thus the vawa 2005 does not follow the principle of equity nor does it abide by the united nations declaration on the elimination of violence against women and international human rights laws. work authorization will not make the immigrant women invulnerable to violence but will give them access to resources if they encounter a situation of violence. the alternatives should also enable battered women to access the legal services without the help of experts like the legal attorney. the evaluative criteria for the policy alternatives could be known by conducting research studies with south asian women to measure if the changes brought about in the policy are effective in enabling the women to rebuild their lives. moreover research needs to be done to see if the changes made at the policy level in violence against women act has been utilized by women safely(raj et al., 2005) . it needs to be assessed if the accessibility of the battered women to the requisite relief services has been made easy especially with the cultural and immigrant barriers. the other bhandari/ violence against women act and south asian immigrants 49 important criterion is to determine if the policy level change is appropriate, culturally competent and empowering the woman to resist violence. conclusion united states is a country where one in ten is an immigrant and hence knowledge about the policies affecting the immigrant population is necessary for competent social work. also inclusion of practice with the immigrants within international social work demonstrates the link between domestic and global issues, advocating that there is nothing like local social work in the 21st century (healy, 2004). by being aware of complex topics like policies for abused immigrant women, social workers can equip themselves if they come across any abused immigrant woman. this article specializes in south asian immigrant women, however the above information can be used for any abused immigrant woman. moreover awareness about such issues will also give them greater negotiating power for advocating for progressive policy level changes which will enable the immigrant women to seek relief in the times of violence. all this will help more and more immigrant women and children to live violent free lives. there is a lot of lack of awareness about this issue other than south asian domestic violence organizations, hence such an article will educate social workers who are at times directly involved with the survivors. references abraham, m. (2000a). isolation as a form of marital violence: the south asian immigrant experience. journal of social distress and the homeless, 9(3), 221-236. abraham, m. (2000b). speaking the unspeakable: marital violence among south asian immigrants in the united states: rutgers university press. anderson, m. j. (1993). license to abuse: the impact of conditional status on female immigrants. yale law journal, 102(6), 1401-1430. dutton, m. a., orloff, l. e., & hass, g. a. (2000). characteristics of help-seeking behaviors, resources and service needs of battered immigrant latinas: legal and policy implications. the georgetown journal on poverty law and policy, 7, 245305. healy, l. (2004). strengthening the link: social work with immigrants and refugees and international social work. in d. drachman & a. paulino (eds.), immigrants and social work: thinking beyond the borders of the united states. jannson, b. s. (1984). theory and practice of social welfare policy: analysis, processes, and current issues. belmont: calif: wadsworth. lin, j., & orloff, l. (2005). vawa 2005 immigration provisions. washington, dc: legal momentum advancing women's rights. lin, j., & orloff, l. (2006). aftermath of vawa immigration 2005: what was not included in final vawa (h.r.3402). washington, dc: legal momentum advancing women's rights. narayan, u. (1995). `male-order' brides: immigrant women, domestic violence and immigration law. hypatia, 10(1), 104. advances in social work, spring 2008, 9(1) 50 ncadv. (1/16/06). comparison of vawa 1994, vawa 2000 and vawa 2005 reauthorization bill. retrieved 4/19/2006, 2006, from http://www.ncadv.org/files/vawa_94_00_05.pdf orloff, l., & kaguyutan, j. (2002). offering a helping hand: legal protections for battered immigrant women. american university journal of gender social policy and the law10(1), 95-170. orloff, l., & kelly, n. (1995). a look at the violence against women act and gender related asylum. violence against women, 1, 380-400. orloff, l., & klein, c. f. (1995). with no place to turn: improving advocacy for battered immigrant women. family law quarterly, 29(2), 313-329. rae, k. l. (1988). alienating sham marriages for tougher immigration penalties: congress enacts the marriage fraud act. pepperdine law review, 15(1), 181-205. raj, a., & silverman, j. (2002). intimate partner violence against south-asian women in greater boston. journal of american medical women's association, 57(2), 111116. raj, a., silverman, j., mccleary-sills, j., & liu, r. (2005). immigration policies increase south asian immigrant women's vulnerability to intimate partner violence. journal of american medical women's association, 60(1), 26-32. shah, s. (2004, 11/28/2004). trapped, on a 'h-4'. the hindu. retrieved 4/19/2006, 2006, from http://www.hinduonnet.com/thehindu/mag/2004/11/28/stories/2004112800380300. htm the violence against women act and department of justice reauthorization act of 2005 (vawa) pub. l. no.109-162, title viii, (2005) united nations general assembly (1993) resolution 48/104 declaration on the elimination of violence against women. new york: united nations general assembly. u.s bureau of the census. (2002). the asian population (1990 and 2000u.s. census brief). in u.s bureau of census (ed.): government printing press. warrier, s. (2000). social, legal, and community challenges facing south asian immigrant women. in s. nankani (ed.), breaking the silence domestic violence in the south asian-american community (pp. 89-97): xlibris corporation. workpermit.com. (2005). dependent spouses of us h-1 visa holders often frustrated (pp. 1-3). author’s note: address correspondence to: shreya bhandari, doctoral student, university of missouricolumbia, school of social work, 708 clark hall, columbia, missouri 65211. e-mail: ssb7dd@mizzou.edu. http://www.ncadv.org/files/vawa_94_00_05.pdf mailto:ssb7dd@mizzou.edu aisw vol. 5, no. 1 i special issue editorial robert vernon welcome to our special edition focusing on assessment.we have the pleasure of presenting eight articles that address assessment in social work education from a variety of perspectives. these contributions were chosen in keeping with the philosophy of this journal: the examination of issues and ideas that will influence how our profession will address the countless assessment questions we continually discover. assessment is interwoven throughout the fabric of social work education.we continually take stock of what we are doing and how well we are accomplishing our intended goals. it permeates our academic lives whether we notice it or not. assessment presents itself when we emerge from class. are we smiling or frowning because of what occurred? assessment happens when we select textbooks. are we happy with our choices or do we have the urge to write our own? assessment is salient againwhenwe craft syllabi.we can only cram somuch into 15weeks—something has to go—yet, we know from professional wisdom that we easily could use more time. it comes into play when the faculty meets to take stock of what the curriculum is accomplishing. is graduation joyful because we are confident in what we have created? or do we cross our fingers from reservations and misgivings? and, assessment presents itself when we engage in the self-study process for accreditation. most of us feel torn between pride and anxiety when that site visit team arrives to assess our work. as a personwho has brought two social work programs through the complete precandidacy-initial accreditation process, served on numerous site visits, and is currently serving on the council on social work education (cswe) commission on accreditation, i can attest that the complexities and challenges of assessment are enormous. there is no single path. there is no unique way to create a sound social work curriculum. there is no one way to deliver it. the educational policy and accreditation standards (epas) fromcswe (2003) provide benchmarks. these standards establish content and assessment specifications, but howwe choose to incorporate them is most challenging. epas’s accreditation standard 8.0 is especially salient: we must have an assessment plan and procedures in place for evaluating every program objective within the curriculum, including specific measures, procedures, andmethods. standard 8.1 is just as crucial:wemust implement the plan and continually use the results to affirm and improve the program. perhaps assessment is best understood as an art, the willful choice to pursue evaluative knowledge from countless sources of potential information towards fulfilling this obligation. we select some approaches and sources but neglect others. the eight articles presented in this edition provide ideas about how this process may be undertaken and how these choices may be made. one ofmymore interesting tasks has been choosing the presentation order for this issue. while some readers will only want to read occasional contributions, others maywant to enjoy this issue from cover to cover. this hasmade sense-making out of the diversity in the contributions a challenge. the following underlying order has been crafted: the big picture… the first contribution by dr. charles zastrow and dr. tim reutebuch provides insight into the gestalt of program design. the authorsmap out a fairly comprehensive vision of how to approach assessment within the program design and accreditation process. just as the baer-federico report (1978) guided us in the ’80s, this article illustrates a model approach to developing an accreditable program and specifically delineates where assessment fits in. using their own school as a case, the authors provide detailed information—including instruments—that readers who are in the beginning stages of creating a social work program may find invaluable. for the more established programs, the article provides an excellent perspective on what one program accomplishes through assessment and how colleagues go about this process. gatekeeping… howmany of us have had to “council out” inappropriate students who discover well into their studies that they should have focused their pursuits elsewhere? the second contribution from larry reynolds looks at quality control in the admissions process, hopefully towards preventing this problem. again, presenting instrumentation, professor reynolds examines a much-neglected area: the course work students take prior to acceptance into the program. we have a gap in our literature: how dowe craft amethodology that helps us assess potential students before we let them in? this article provides steps toward using preparatory coursework as a benchmark for potential student success. it illustrates how we may begin to establish benchmarks in this important area. even when we have established criteria and benchmarks for admissions, do these really work? the third article by professors thomas, mcclearey, and henry asks this difficult question.they provide an interesting history and overviewof this area.they then examine the effectiveness of admission criteria on graduate student performance in the classroom and field. just how effectively does the graduate record exam serve as a predictor for classroomperformance?what about the student grade point averages? and those glowing reference letters? quality control over whomwe admit into our programs has an eventual effect on the lives our graduates touch. both articles in this section provide insights into the gatekeeping process. classroomassessment… once admitted, dr. paul adams shows a way to listen to the heartbeat of the classroom. all of us strive for dynamic, learner-friendly classrooms that focus on critical thinking. our day-to-day, class-by-class events shape this. how do we assess these efforts? professor adams describes fine-grained assessment activities: classroom assessment techniques, such as polling students about the “muddiest point” that they did not understand. this approach provides ongoing assessment feedback. combined with other approaches from the literature, this case presentation on micro-assessment promotes the art of discerning just what worked well and what did not. ii just how confident canwe be in our assessmentmeasures? drs. cathy pike, robert bennett, andvalerie chang’s efforts in instrument validation provide amethodological example. they compare two instruments that assess how well students interview—a core skill for social work practice. in their comparative examination of a classical instrument and a new one, the authors demonstrate how construct validity, reliability, and a clear factor structure can help establish confidence in assessment efforts and measures. online course assessment… our profession has only recently come to grips with web-based teaching, where the instructor may never even physically meet the students. how can one assess these online courses? articles six and seven take this up through two evaluative reports. dr. zvi gellis takes data from a clinical research methods course and explores various facets of online instruction from the learner's perspective. this qualitative study illustrates one approach to assessing the dimensions of online learning. a collaborative learning and teaching framework is presented for those social work educators interested in implementing web-based courses and assessing howwell they accomplish their objectives. drs. philip ouellette and valerie chang take web-based learning a step further in their preliminary assessment of how well a traditionally taught classroom-based practice course on interviewing skills compares with a completely web-based course, where the students never meet each other or the instructor face to face. this is a “third rail” issue: can you really teach practice in a total web environment? students’ background characteristics and their perceptions of their learning experience and skill acquisition are compared and reported as preliminary findings. the initial results are provocative and we look forward to learning more from their findings. portfolio as an assessment approach… dr. mona schatz looks at the larger summative perspective: assessment through portfolios. in her study of a graduate-level portfolio approach, she investigates whether this technique promotes critical thinking, class and field learning integration, reflective thinking, professional socialization, and practice competence. she also investigates efficiencies: does an adequate portfolio really necessitate endless hours of work on the part of the student? further investigation finally, as editor, i am most grateful to my colleague mary stanley, associate dean for theuniversity library and liaison to the school of socialwork.together, we have amassed a large bibliography on social work assessment for the reader’s continued research.we cast a fairly wide net and, while we have probablymissed a few favorite articles, we have attempted to provide a sound beginning research bibliography for social work education assessment. as editor for this edition, i have had the task of soliciting contributions, overseeing the jury process, and editing the chosen contributions for publication. i am deeply indebted to those colleagueswho chose to submit their work. i regret that we are not able to share them all. i am also indebted to the colleagues who painstakingly reviewed the submissions. many reviewers clearly spent hours carefully examining iii and assessing the contributors’ thoughts and work. finally, i deeply appreciate the support i have enjoyed frommy associates on the journal’s editorial board. references council on social work education. (2003). handbook of accreditation standards and procedures, 5th edition, alexandria, va: author. baer, b., & federico, r. (1978). educating the baccalaureate social worker. cambridge, ma: ballinger publishing company. iv aisw vol. 5, no. 2 172 advances in socialwork views of reference list accuracy from socialwork journal editors and published authors scott e.wilks christina a. spivey abstract:objective: the study’s purposewas to answer two research questions: (1) in the opinion of social work journal editors, how important is reference list accuracy? and (2)who is primarily responsible for the accuracy of reference lists published in social work journals? method: a sample of 119 authors and 26 journal editors was surveyed to ascertain their views on the above questions and additional items. results: regarding the importance of reference list accuracy, editors’ responses (likert scale) averaged between moderately and extremely important. fifty-three percent of responding editors and 36.5% of authors reported that responsibility is shared between the editor/staff and manuscript authors; the remaining 47% and 63.5%, respectively, responded that responsibility falls upon manuscript authors. responses from authors, mostly educators, revealed a greater-than-moderate importance (likert scale) given to instructing students on the accurate construction of reference lists. implications for social work education and journal publishing are discussed. keywords: apa,publication, reference, reference list, reference list accuracy journal article reference lists serve several significant functions: (1) they provide background information on a particular area of interest; (2) they are used in assessing faculty production during contract negotiations; (3) they are used in constructing citation indexes; (4) they are used to evaluate the rigor of an article; (5) they are used in the development of journal, publisher, and author rankings; (6) they help to establish the credibility of an author as a researcher; and, perhaps most importantly, (7) they are used in the identification and location of an article that the reader wishes to consult (asano, mikawa, nishina, maekawa, & obara, 1995; fenton, brazier, de souza, hughes, & mcshane, 2000; foreman & kirchoff, 1987; peden, 1991; sweetland, 1989; taylor, 1998). as ritchie (1995) stated, “[r]eferences should be cited to support the importance of the topic under investigation, to trace the historical development of the topic, and to summarize the current state of affairs” (p. 2). scott e.wilks is assistant professor, department of sociology & socialwork, appalachian state university, boone, nc 28608. christina a. spivey was a doctoral student at the university of georgia, athens, ga 30602. copyright© 2004 advances in socialworkvol. 5 no. 2 (fall 2004) 172-181. indiana university school of socialwork. 173 in a study conducted by spivey andwilks (2003), results indicated that five leading social work journals suffered reference list error rates ranging from29% to 57%. this study serves as a follow-up; the authors have conducted a survey of social work journal editors and authors in regard to their views on the importance of reference lists in scholarly work. the purpose of this study was to answer two research questions: (1) in the opinion of social work journal editors, how important is reference list accuracy? and (2)who is primarily responsible for the accuracy of reference lists published in social work journals? literature review rates of error spivey and wilks (2003) examined a stratified random sample of 500 references from the year 2000; references were obtained from volumes of the fivemost highly circulated social work journals (naswpress, 1997):clinical socialwork journal (cswj), journal of social work education (jswe), social service review (ssr), socialwork (sw), and socialwork research (swr). each of the references included in the sample was verified for accuracy in six fields: article title, author name(s), journal title, pagination, volume, and year. the breakdown of the rates of error was as follows: (1) cswj, 57%; (2) jswe, 47%; (3) sw, 42%; (4) swr, 31%; and (5) ssr, 29%. the overall rate of error found in the investigation was 42% (i.e., 206 of the 500 references had at least one error; there were 262 errors found in total). a search of social work literature has revealed that this is the only study of reference list accuracy in this field. other fields, however, appear to acknowledge the importance of reference accuracy through a rich knowledge base in their respective bodies of literature, including medicine (de lacey, record & wade, 1985; evans, nadjari & burchell, 1990), nursing (taylor, 1998), and psychology (faunce & job, 2001;white, 1987). causes of error several reference list accuracy researchers have offered explanations as to the causes of the high error rates cited above. sweetland (1989) discussed several comprehensive reasons behind the error rates. they include (1) failure to check material against original sources; (2) failure to recognize or acknowledge the importance of reference lists; and (3) failure to recognize or acknowledge the importance of reference lists. prior to sweetland,white (1987) had cited a lack of clear education as one of the main factors contributing to reference errors and also posited that pressure to publish may lead authors to neglect their reference lists when preparing to submit manuscripts. fenton, et al. (2000) also concluded that the “carelessness and misuse of language” led to inaccuracies in references (p. 42). strategies to minimize error authors have proffered numerous suggestions for addressing the causes of inaccuracies and decreasing error rates. fenton, et al. (2000) proposed: • assessment of a certain percentage of a submitted manuscript’s references as part of the acceptance process; wilks, spivey/views of reference list accuracy from socialwork journal editors and authors 174 advances in socialwork • placing a limit on the number of references allowed for a submitted manuscript; • inclusion of the first page of each referenced article, or a complete copy of each reference article, in the manuscript submission package; • utilization of reference software, such as endnotes; and • shared responsibility between authors, editors, and reviewers. fenton, et al.’s study, particularly the final point above, served as an impetus for the current study. in addition, foreman and kirchoff (1987) and taylor (1998) encouraged authors to check each reference against the original source, and foreman and kirchoff further suggested that authors review each draft of a manuscript for errors to prevent them from becoming embedded in the work. who is responsible? the question of responsibility has been addressed by several researcherswhohave conducted investigations of reference list accuracy. several of those researchers, including de lacey, record and wade (1985); white (1987); evans, nadjari and burchell (1990); goldberg, et al. (1993); and ritchie (1995) agree that the task of ensuring accuracy belongs to the author(s). as foreman and kirchoff (1987) stated, “the author cannot be absolved of primary responsibility for assuring that references are both complete and correct” (p. 182). key and roland (1977) offered a different perspective, assigning responsibility to journal editorial boards. while the majority of researchers in this area have declared authors primarily responsible, several of these scholars recognize that there is a need for some degree of shared responsibility (that does not diminish the primacy of the author’s role). de lacey, et al. (1985) wrote, “[e]ditors should accept some responsibility for accuracy” (p. 885), while fenton, et al. (2000) stated, “[a] certain accountability lies within the editorial panel of the journal” (p. 43). goldberg, et al. (1993) also holds the position that “some degree of editorial oversight appears to be necessary” (p. 1453). in addition, evans, et al. (1990) advocated a stronger role for peer reviewers. the role of education white (1987) and sweetland (1989) both questioned the role of (or lack of) instruction as one of the causes of high error rates in reference lists. furthermore,white stated, “[t]he problem is one that must be recognized and then solved by writers themselves, who also are, for good or ill, the major models for writers-to-be” (p. 291). as a means of redress, sweetland encouraged the improved training of researchers (p. 301). another researcher, peden (1991), described a technique for educating students as both to the preparation of correct apa-style reference lists and to the importance of the accuracy of those lists. peden exposed students to a method for teaching reference list construction that included a handout on apa references, six tests (three focused on identifying the type of material by its reference structure and threewhich required students to actually construct references), and a posttest as to the students’ reaction to the instruction. in the posttest, students agreed that in comparison with learning the “importance of accuracy in research . . . it was equally important for them to learn accuracy in referencing” (p. 104). peden concluded that, “developing and using this technique increased my 175 awareness and understanding of other aspects of writing beyond referencing . . . abilities that serve all of us well in our roles as authors, reviewers, and teachers” (p. 104). method a purposive sample of authors was selected for this study: lead authors on articles published in the year 2000 volumes of the five journals reviewed in the spivey and wilks study (2003):clinical socialwork journal, journal of socialwork education, social service review, socialwork, and socialwork research. the vast majority of these authors were (at the time of the study) faculty members at various social work programs; thus, verification of mailing addresses was conducted through online websites of their respective employing academic institutions. only those authors who were deceased or whose mailing addresses could not be verified via the internet were excluded from the sample. a total of 119 authors were included in the sample. an additional purposive sample was selected for the study: editors of highly circulated, peer reviewed social work journals. contact information for editors was available in their respective journals. the number of journal editors—26 in total—was limited due to various motives. for one, the opinions of reference list accuracy within the social work profession have never been gauged, thus justifying the exploratory nature of this study. as such, a small subset of the larger population (all social work journal editors) was deemed appropriate (see rubin & babbie, 2001, p. 254) in this untapped area of social work research. second, because journal circulation was an element involved in selecting the authors, for the sake of consistency, this component (specifically, wide circulation) was considered in selecting the editors. the cutoff was 1,000, meaning that only editors from journals with a 1,000+ circulation were qualified for selection (nasw press, 1997). third, their journals must be focused on content relating entirely (or almost entirely) to social work, as opposed to journals centered with other human service professions (e.g., american journal of sociology or psychological review). finally, the editors’ journals must subscribe to the apa publication style. to reiterate, after considering all of the aforementioned qualifications, the sample size of journal editors was 26. there were two distinct questionnaire forms: one specifically for journal editors, the other for authors. the editor questionnaire consisted of five questions geared toward measurement of the importance of reference list accuracy and determination of views on responsibility. the author questionnaire was somewhat longer, 12 questions in total. authors were also asked their opinions on responsibility; in addition, questionswere included to discover authors’ reference verification practices, whether or not they were university instructors, and whether, as instructors, they emphasized reference accuracy in their curriculum. results response rates as stated in the previous section, the study surveyed 26 social work journal editors and 119 authors of published social work manuscripts. eighty-nine of the wilks, spivey/views of reference list accuracy from socialwork journal editors and authors 176 advances in socialwork total 145 participants completed and returned the questionnaires, yielding a response rate of 61.4%. isolating the two groups of participants, journal editors produced a higher response rate of 73% compared to the author response rate of around 50%. next, we looked at descriptive statistics within editor and author questionnaires. editorviews when asked about whom is primarily responsible for reference list accuracy, editors had one of three options: editor/staff, manuscript authors, or shared responsibility. approximately 53% of responding editors reported that such responsibility is shared between the editor/staff and themanuscript authors. the remaining 47% responded that responsibility falls upon manuscript authors; as such, no editor reported that the primary responsibility of reference list accuracy rests solely upon her/himself or the editorial staff. two subsequent items on the questionnaire centered on editorial practices. regarding substantiation for reference list accuracy, only 21% of responding editors reported that their journals maintain a formal procedure for verifying such accuracy in submitted manuscripts. not surprisingly (in light of the previous statement), 21% of responding editors replied thatmanuscripts have been rejected for acceptance into their journals based primarily on reference list inaccuracies. the remaining items on the editor questionnaire were based on a 7-point likert response scale, ranging from 1–not important to 7–extremely important. first, editors were asked, “how important is reference list accuracy?” second, editors were surveyed about the influence of reference list accuracy on a manuscript’s probability of publication. for both items, responses averaged between moderately and extremely important. exact numbers (means, standard deviations) are displayed in table 1. authorviews the first item in the author questionnaire was identical to that in the editor questionnaire, inquiring about primary responsibility for reference list accuracy. compared to 53% reported by editors, only 36.5% of responding authors reported that the responsibility is shared between editors and authors. the remaining majority (63.5%) responded that primary responsibility falls squarely on the shoulders of manuscript authors. it is interesting to note that no one, editors or authors, responded that primary responsibility for reference list accuracy lies exclusively with editors. the next two items dealt specifically with reference list construction in manuscripts. authors were asked whether or not they use any type of specialized comitem mean std. deviation importance of reference list accuracy 5.8 1.01 influence of accuracy on publication chances 4.1 1.43 table 1: importance/influence of reference list accuracy 177 puter software in constructing reference lists; and, if usage was reported, authors were invited to document the specific software. approximately 86% of responding authors reported no usage of such software; the remaining 14% credited the use of the following software programs: clarisworks, endnotes, excel, and prolite. the following two items focused on verification of reference list accuracy by checking against the original sources. in constructing their manuscripts, almost 80% of responding authors reported that they verify against the original sources. less than half of the authors who responded, 43%, reported that any pressure to publish resulted in rushed verification of accuracy. in order to confirm that such pressure to publish does exist, instructors were asked to rate their feelings on this issue. based on a likert response method ranging from 1–no pressure to 7–extreme pressure, instructors as a group (n=59) reported a rather elevated amount of pressure to publish: mean=5.2, std. deviation=1.48. the remaining items of the author questionnaire were geared toward their roles (if applicable) as instructors. an overwhelmingmajority of authors who responded, 93.7% to be exact, reported that they were an instructor at a college or university at the time of data collection. those who confirmed their role as instructor were invited to complete the remaining items on the questionnaire; thus, the remaining statistics revealed in this section illustrate opinions only from the aforementioned respondents who disclosed their roles as academic instructors. respondents were asked to indicate the length of time that had acted as an instructor. based on three options, the data revealed the following: approximately 71% reportedmore than 10 years; 27% reported 5-10 years; and 1% reported less than five years.when asked whether or not they correct inaccuracies in reference lists when grading students’ papers, 81% reported that they indeed correct students’ reference list errors. going a step further, instructors were asked to specify what type of inaccuracies they checked for in students’ reference lists: specifically, content and/or format accuracy. (as was clarified in the questionnaires, please note that examples of content accuracy include accurate spelling of authors names, correct journal title, and exact page numbers; examples of format accuracy (apa) include hanging indent, double spacing, and proper italicization.) over half of responding instructors reported checking for both types of accuracy within their students’ reference lists. table 2 illustrates the specific percentages of aggregate responses for each method of correction. additionally, instructors were asked about specific information they provide for their students regarding the apa publication manual. options included one or more of the following: incorporating the manual as a required text, handouts on wilks, spivey/views of reference list accuracy from socialwork journal editors and authors option frequency of response (%) n do not check 11.9 7 check for content only 8.5 5 check for format only 20.3 12 check for both content and format 59.3 35 table 2: reference list accuracy: method of correction in students’ papers 178 advances in socialwork specific elements of themanual, and in-class presentations regarding elements of themanual. the largest portion of respondents, approximately 27%, reported giving no information to students. the next highest percentage of respondents, 18%, reported using the manual as a required text in their classes. table 3 reveals the percentages reported by instructors for each option. lastly, using a 7-point likert response system ranging from 1-not important to 7-extremely important, instructors’ opinions weremeasured regarding the overall importance of instruction to students on reference list accuracy. aggregate data from instructors’ responses (n=59) revealed a greater-than-moderate importance given to instructing students on the accurate construction of reference lists: mean=5.0, std. deviation=1.52. discussion and applicationto socialwork practice the larger population of this study was easily identified: social work journal editors and recently published authors in social work journals. because enumerating them would be nearly impossible (especially the authors), a purpose sampling technique was employed (see rubin & babbie, 2001, p. 254). purposive sampling carries the same limitations as most non-probability sampling techniques. in practice, according to rubin and babbie (p. 259), there is less likelihood that a non-probability sample will be representative of the population from which it is drawn compared to a probability sample. also, the sample size may be considered rather small. justification for the sample size was explained in the method section. a primary limitation of a mail survey is the possibility of low response rate (grinnell, 1997). low rates may threaten measurement validity. this study, which included follow-up mailings, yielded a response rate of about 61%. according to consistent views of social work researchers (babbie, 1995; rubin & babbie, 2001), this constitutes a “good” rate. nevertheless, a higher response rate (preferably over 70%) would have been preferred. there are others disadvantages to the self-administered survey. first, no assistance was available to any respondent if s/he needed clarification on a particular questionnaire item(s) (grinnell, 1997, p. 352). second, the questionnaire is useful option frequency of response (%) n no information given 27.1 16 apa manual as required text 18.6 11 handouts 15.3 9 presentations 11.9 7 required text & handouts 1.7 1 required text & presentations 1.7 1 handouts & presentations 15.3 9 required text, handouts, & presentations 8.5 5 table 3: information provided to students in class only with those respondents who have the physical capacities to complete it. third, as with any survey research, this study provided information with little context of social life (rubin & babbie, 2001, p. 381). information was obtained regarding views of reference list accuracy; however, a deeper, richer understanding of editors’ and authors’ opinions of reference lists (as revealed through qualitative data) remains unknown. to reiterate, the primary purpose of this study was twofold: (1) to learn the degree of importance social work journal editors attributed to reference list accuracy, and (2) to learn who editors and authors believe is primarily responsible for this accuracy. the results of the survey showed that, based on the sample, journal editors consider accuracy of references important. the extent of this importance is mademore evident in the finding that reference list accuracy is at least moderately influential in the chance a manuscript will be accepted for publication. as to the second purpose, editors seemed to favor shared responsibility between authors and themselves, while the majority of authors responded that they and their fellow writers were primarily responsible for reference list accuracy. it is rather telling, however, that although accuracy of references was rated as more than moderately important and editors tended to fall on the side of shared responsibility, only a small minority of editors reported that their journals had a formal procedure for checking reference accuracy. the authors of the current study agree with themajority of editors who believed that responsibility should be shared. ultimately, each actor, the author and the editor, has a role to play in the publication of a manuscript. it is the duty of the author to provide the editor with a sound, accurate manuscript (both in terms of content and references) and it is likewise the duty of the editor to provide consumers with a sound, accurate article. inaccuracies within a publication cast doubt upon both the author and the journal, which is represented by the editor. therefore, both participants in the publication process should have some degree of responsibility for the finished product. we would also encourage editors to consider instituting formal verification procedures, as this strategy has proven effective for journals in other disciplines (case in point: canadian journal of anesthesia, see bevan and purkis, 1995). regarding the survey of authors, secondary issues, such as pressures to publish, checking original sources, computer software, and education were examined. white (1987) questioned the role of pressure to publish by an author’s university of employment in rates of reference list error. on one hand, white’s supposition was supported by the current study’s findings: authors indicated that they felt more than moderate pressure to publish. on the other hand, less than half the authors reported that pressure to publish resulted in a rush to check references. the findings suggest that while there is pressure to publish, it has limited influence on the time devoted to verification of references. several authors (i.e., foreman and kirchoff, 1987; sweetland, 1989; goldberg, 1993; and fenton, et al., 2000) have posited that failure to check references against the original sources has led to inaccuracies in reference lists. the results in this study fail to support this premise. the vast majority of authors stated that they do indeed verify references with the original materials. amore sophisticated 179wilks, spivey/views of reference list accuracy from socialwork journal editors and authors 180 advances in socialwork study than the one done here, however, will be needed to conclusively determine the causal link, if any, between failure to check original sources and inaccurate reference lists. fenton, et al. (2000) suggested the utilization of computer software as a strategy for reducing reference errors. authors participating in this survey, however, indicated onlyminimal use of such software.we speculate that as computer technology becomes further ingrained in our professional work, we will see an increase in the availability and employment of software in the preparation of manuscript reference lists. the utilization, impact, and effectiveness of software in scholarly writing should be an avenue of future investigation. education is, without question, the most significant of the secondary issues addressed in this study. those who have conducted research in the area of reference list accuracy, including white (1987), sweetland (1989), and peden (1991), stressed the importance of proper instruction in reference list construction and the role instructors-as-authors have as models for future scholars. in the current study, authors who are also instructors clearly agree with the above-named scholars. they rated importance of reference accuracy instruction as more than moderately important. the majority provided some form of information to their students, whether it was in the form of presentations, handouts, the apamanual, or some combination of the three. the majority also indicated that they check the accuracy of reference lists in student papers. the findings regarding education suggest at least two possible areas for further research: • what form of information provided or method of instruction is correlated with increase in reference list accuracy in student papers? and, • what impact does the provision of information have on students’ attitudes toward the importance of reference list accuracy? in a human service profession, such as the social work profession, where consumers of literature are faced with clients battling such issues as poverty, abuse, and mental illness, research pertaining to reference list accuracy may seem trivial. when we examine the purposes of reference lists, however, this triviality diminishes and their true importance is acknowledged. reference lists are a testament to the work of scholars, they are evidence of a knowledge base in a given field of interest; moreover, reference lists are a sign of the professionalism, preparedness, and hard work put forth by scholarly writers. inaccuracies cast a shadow upon references and, by extension, their producers. for our students, our consumers, and our own professional credibility, we should make every effort to ensure the accuracy of our published work, including references lists. references asano, m., mikawa, k., nishina, k., maekawa, n., & obara, h. (1995). improvement of the accuracy of references in the canadian journal of anesthesia. canadian journal of anesthesia, 42(5), 370-372. babbie, e.r. (1995). the practice of social research (7th ed.). belmont, ca:wadsworth. bevan,d.r.,&purkis, j.m. (1995).citationerrorscanbereduced.canadianjournalofanesthesia,42(5), 367-369. 181 de lacey, g., record, c., &wade, j. (1985). how accurate are quotations and references in medical journals? british medical journal, 291, 884-886. evans, j.t., nadjari, h.i., & burchell, s.a. (1990). quotational and reference accuracy in surgical journals: a continuing peer review problem. journal of the american medical association, 263(10), 1353-1354. faunce, g.j., & job, r.f.s. (2001). the accuracy of reference lists in five experimental psychology journals. american psychologist, 56, 829-830. fenton, j.e., brazier, h., de souza, a., hughes, j.p., & mcshane, d.p. (2000). the accuracy of citation and quotation in otolaryngology/head and neck surgery journals. clinical otolaryngology, 25, 40-44. foreman, m.d., & kirchhoff, k.t. (1987). accuracy of references in nursing journals. research in nursing and health, 10, 177-183. goldberg, r., newton, e., cameron, j., jacobson, r., chan, l., bukata,w.r., & rakab, a. (1993). reference accuracy in the emergency medicine literature. annals of emergency medicine, 22(9), 1450-1454. grinnell, jr., r.m. (1997). social work research and evaluation:quantitative and qualitative approaches (5th ed.). itasca, il: f.e. peacock publishers, inc. key, j.d., & roland, c.g. (1977). reference accuracy in articles accepted for publication in the archives of physical medicine and rehabilitation. archives of physical medicine and rehabilitation, 58, 136-137. nasw press. (1997). an author’s guide to social work journals (4th ed.).washington, d.c.: author. peden, b.f. (1991). teaching the importance of accuracy in preparing references. teaching of psychology, 18(2), 102-105. ritchie, m.h. (1995). proper use of literature review. counselor education and supervision, 35(1), 2-3. rubin, a., & babbie, e. (2001). research methods for social work (4th ed). belmont, ca:wadsworth. spivey, c.a., &wilks, s.e. (in press). reference list accuracy in social work journals.research on socialwork practice. sweetland, j.h. (1989). errors in bibliographic citations: a continuing problem. the library quarterly, 59(4), 291-304. taylor, m.k. (1998). the practical effects of errors in reference lists in nursing research journals. nursing research, 47(5), 300-303. white, a. (1987). reference inaccuracies in two counseling journals.counselor education and supervision, 26(4), 286-292. author’s note: address correspondence to: scott e. wilks, ph.d., assistant professor, department of sociology & social work, appalachian state university, 209 chapell wilson hall, boone, nc 28608, usa. e-mail: wilksse@appstate.edu wilks, spivey/views of reference list accuracy from socialwork journal editors and authors microsoft word negi et al. _teaching note_self-awareness_final _________________ nalini j. negi, ph.d., is an assistant professor in the school of social work at the university of maryland, baltimore. kimberly a. bender, ph.d., is an assistant professor at the university of denver graduate school of social work. rich furman, ph.d., is director and associate professor in the social work program at the university of washington, tacoma. dawnovise n. fowler, ph.d., is an assistant professor in the school of social work at the university of texas, austin. julia clark prickett, msw, is a student in the school of social work at the university of maryland, baltimore. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 223-234 enhancing self-awareness: a practical strategy to train culturally responsive social work students nalini j. negi kimberly a. bender rich furman dawnovise n. fowler julia clark prickett abstract: a primary goal of social justice educators is to engage students in a process of self-discovery, with the goal of helping them recognize their own biases, develop empathy, and become better prepared for culturally responsive practice. while social work educators are mandated with the important task of training future social workers in culturally responsive practice with diverse populations, practical strategies on how to do so are scant. this article introduces a teaching exercise, the ethnic roots assignment, which has been shown qualitatively to aid students in developing self-awareness, a key component of culturally competent social work practice. practical suggestions for classroom utilization, common challenges, and past student responses to participating in the exercise are provided. the dissemination of such a teaching exercise can increase the field’s resources for addressing the important goal of cultural competence training. keywords: cultural competence, cultural responsiveness, self-awareness, teaching exercise introduction social work’s specialized focus on social justice requires an active engagement in finding the best strategies to address the needs of marginalized and ethnically/racially diverse populations. the importance of effectively reaching marginalized groups is especially compelling in the face of ethnic/racial minority populations’ underutilization of social services (atkinson, morten, & sue, 2004). in an attempt to narrow the health disparities gap, the council on social work education’s (cswe) educational policy and accreditation standards and the social work code of ethics underscore the importance of cultural competence training in social work education. these standards require that all american social work graduates understand forms and mechanisms of oppression and discrimination and demonstrate the ability to practice with respect, knowledge, and skills related to clients’ backgrounds (cswe, 2008; nasw, 2001). schools of social work have undertaken the difficult task of preparing social work students to facilitate and promote culturally responsive services. social work educators and researchers have long identified barriers to this important task, including the lack of specific operational understanding of cswe’s mandates (horner & borrero, 1981; negi, bender, furman, fowler, prickett/enhancing self-awareness 224 roberts & smith, 2002), and students’ lack of readiness for understanding multicultural content (lee & greene, 2003). in response to the complexities of training social workers for culturally competent practice, educational models such as the newcastle model (gibbons & gray, 2002) and sakina-mama’s (2001) educational model have been developed to emphasize the value of experiential learning in social work education. however, the literature remains limited on practical teaching assignments that incorporate experiential methods to enhance students’ preparation and motivation for culturally responsive social work practice. this article outlines one such practical strategy, referred to as the ethnic roots assignment, which has been used over several semesters in a graduate social justice course at a public university in the southwest. initial qualitative results have demonstrated the effectiveness of the assignment in engaging students in a process of self exploration and investment in culturally responsive social work practice (bender, negi, & fowler, 2010). with a focus on offering specific strategies for facilitating student self awareness, this article describes detailed components of the ethnic roots assignment, practical suggestions for implementation (including classroom utilization and navigating potential challenges), and concludes with student responses to the assignment. the importance of self-awareness in building cultural competency social work educators, in developing teaching models for culturally competent social work practice, have emphasized the important role of self-awareness development in preparing culturally responsive social workers (colvin-burque, zugazaga, & davismaye, 2007; messinger, 2004). guided by cswe educational principles to “engage diversity and difference in practice,” social work educators encourage students to “gain sufficient self-awareness to eliminate the influence of personal biases and values in working with diverse groups” (cswe, 2008, p. 5). solely addressing the importance of learning about the other’s culture is not sufficient as it absolves individuals from learning and understanding the impact of their own sociopolitical and ethnocentric biases on their work with clients who are racially/ethnically or culturally different from themselves. cultural competence training must then not only encourage the continued aspiration to learn about other cultures but also aim to foster self-awareness (green et al., 2005; lum, 2007). in order to prepare students for culturally responsive social work practice, social work educators have developed specific educational models to facilitate student selfreflection. for example, sakina-mama’s (2001) educational model emphasizes the need to incorporate an understanding and acceptance of one’s own culture, knowledge of other cultures, and recognition of diversity as normative. this is a paradigm that can be used as a framework for selecting readings, assignments, and facilitating classroom discussions. gibbons and gray’s (2002) newcastle model similarly stresses the importance of experiential learning as instrumental in teaching cultural competence. they emphasize teaching social work students the meaning of their own personal cultural history and how to integrate this knowledge in social work practice. for example, they underscore the importance of using relevant videos, professionals in the field, and client groups to elicit critical analysis, foster student exploration and discovery, and develop intervention skills. advances in social work, fall 2010, 11(2) 225 the self and other awareness project (soap) model of instruction has also been developed as an instrument for training in cultural competence (colvin-burque et al., 2007). recognizing self-awareness as a vital component of cultural competence, the soap model goes into more depth to identify various teaching strategies in fostering self-exploration. through the use of large and small group activities, journal assignments, videos, guest speakers, and self-evaluations, this model has demonstrated potential to enhance student self-awareness (colvin-burque et al., 2007). each of these models contributes greatly towards the development of pedagogical frameworks that allow for the selection of teaching materials that will instigate student self-awareness. however, there is a gap in literature that outlines specific teaching exercises to build self-awareness within these frameworks. the ethnic roots assignment one specific educational exercise that has qualitatively demonstrated promise in increasing student self-awareness regarding cultural responsiveness is the ethnic roots assignment (bender, negi, & fowler, 2010). this paper assignment asks students to explore their families’ ethnic roots and processes of acculturation as well as the implications of their families’ experiences of their own sense of ethnic or racial identity. it also asks students to translate this renewed understanding of self to their ideas regarding cultural competence. to do so, the assignment requires students to interview their family members to gather family histories with a particular emphasis on their ancestors’ processes of immigration. in addition, students are required to apply required readings regarding theories of acculturation and white-conformity to develop a critical understanding of how their family members, and, in turn, the students themselves have integrated into mainstream u.s. society (see mclemore, romo, & baker, 2001). in this assignment, the process of acculturation is understood as being on a continuum influenced by families’ degree of membership in the dominant culture or racial group as well as generations of immigration in the united states. for a more detailed description of the ethnic roots assignment, see appendix a. the ethnic roots assignment is essentially a two-part exercise that requires students to both investigate their family history and then to write about this process in a paper. the pedagogical rationale for each section of the exercise is discussed below. investigating family history furthering one’s self-awareness is a multi-layered and dynamic process (richardson & molinaro, 1996). assigning students to interview their family members is one important way that students can begin to access their own personal history. family interviews may give students a venue to ask their family members potentially difficult questions regarding race, ethnicity, immigration, and acculturation. the goal of this investigative exercise is to unravel patterns of privilege and discrimination that have affected their families’ trajectories in the u.s. the interview process requires students to assign meaning to facts given to them by their family members by incorporating theory about acculturation processes. this experience of eliciting information from family members will vary by student and negi, bender, furman, fowler, prickett/enhancing self-awareness 226 provide important learning opportunities (bender et al., 2010). students should be able to critically examine the meaning behind what information is shared and not shared by family members. for example, for some students, family history may have been purposefully forgotten, untold, or kept a secret. this can often be an important component of the assignment and students need to be cognizant of these nuances. writing the ethnic roots paper the second part of the ethnic roots assignment requires students to organize their experiences and thoughts, regarding the exercise of investigating their backgrounds, into a structured paper (see appendix a). the process of investigating their own ethnic roots may be the first time many students have attempted to personalize the experience of immigration, marginalization, and acculturation. although this process of self-discovery and self-awareness is a highly complex and mostly internal process, the paper assignment allows students to develop their thoughts more cohesively as well as provides the instructor a glimpse of this internal process. the paper is inherently descriptive but it also requires students to critically analyze these historical facts about their family through a theoretical understanding of acculturation. implementing the ethnic roots assignment classroom utilization authentic use of self. educators using the ethnic roots assignment are placed in the challenging position of creating an authentic and open atmosphere in the classroom. an introduction by the instructor at the beginning of the semester that acknowledges her/his own identity in regards to ethnic/racial background, age, gender, and experience may set the stage for students to feel comfortable exploring their own backgrounds within the classroom. instructors must also be explicitly cognizant of the various power and racial dynamics that may exist within the classroom. by demonstrating an awareness of the role of racial dynamics, the instructor further personalizes the meaning of these dynamics as opposed to simply understanding it as a theoretical construct. for example, one co-author utilized her experience as an african american professor in a predominately white classroom as an example of how racial dynamics can play a role even within the classroom (patton, 1999). drawing students’ attention to their own reactions to classroom dynamics may initiate students on a path of reflection. the instructor, however, must be cautious, as the use of self requires a delicate balance between overstepping boundaries and authentic self-disclosure. the overarching goal is to create a challenging yet secure environment for discussion regarding power. preparation for the assignment. in addition to the educator introducing her/himself authentically, lectures preceding the ethnic roots assignment should help students understand the meaning of concepts such as authenticity, identity, and genuine sense of self. moving beyond surface-level discussions of ‘treating each other with respect’ and ‘appreciating differences,’ lectures can help students explore the psychological and social advances in social work, fall 2010, 11(2) 227 components of their own identity formation, thus laying a foundation for the exploration of their ethnic roots. through such a discussion students can gain a more profound understanding of themselves as individuals with biases that must be explored in order to competently serve diverse client populations. in preparing for the ethnic roots assignment, instructors should anticipate that the intense exploration of pre-existing beliefs and biases will create anxiety for many students. this is not necessarily problematic, as instructors can help students understand their own performance issues. for the purposes of meeting the learning objectives of this assignment, instructors must present the assignment in such a way that clearly illustrates several key aims for students: 1) take ownership of their education; 2) understand the aims of the assignment; 3) be willing to grapple with an assignment for which there are no clear cut “correct answers;” 4) utilize the material for their own growth. below is one example of how an instructor addresses these potential challenges with her students: i challenge all of you to think about what it means to be in a social justice course about to complete an assignment about your ethnic roots. it is an opportunity for you to grow and gain new perspectives about yourself, your background, and your current viewpoints. this assignment is rumored by past students to be challenging, controversial, powerful, critical, scary, dynamic, evolving, and inspiring. many of these rumors may hold true for you as you complete this ethnic roots assignment. this experience has the potential to be emotionally charged. you will be challenged to think about your family’s history and how that has formed who you are today. you will also have to consider the genuine thoughts, feelings, and perspectives you’ve developed as a result of your background. for some of you, the issues and ideas that are brought up through completing this assignment may be very emotional or feel threatening, for others it may be quite difficult to reach a depth of emotion and you may find yourself discussing ideas at a more intellectual level. it is to be expected that we will each have different reactions to exploring where we come from and how it affects us today. however, i challenge all of you to “go there”—to give yourself permission to begin this journey of thinking about how you think, and feeling what you really feel, authentically thinking about ourselves and each other and our place in society. accepting this challenge opens the door to immense growth and the development of improved skills as future social workers. by making such statements, the instructor can help students anticipate possible reactions to completing the assignment, recognizing that the experience will vary greatly across students. the instructor should also aim to encourage students to explore a deeper level of insight necessary for culturally competent social work practice. after reading the assignment to students aloud, the instructor may encourage students to discuss the assignment in small groups. this allows students to normalize the struggles and challenges that they may experience as a result of the ethnic roots assignment. after the assignment is discussed in small groups, students should be encouraged to ask questions or discuss any concerns. negi, bender, furman, fowler, prickett/enhancing self-awareness 228 debriefing the assignment after completion. several factors should be considered when planning classroom debriefing after the completion of the assignment. instructors should carefully consider the timing of the semester and the level of comfort developed in the classroom when deciding if students are ready to share insights gained from the assignment. a moment should be given before students turn in their assignments to discuss any residual feelings that may have risen due to the assignment’s requirements. the instructor can open up the class for discussion by asking a general question such as, “does anyone want to share before we turn in our assignments?” if debriefing is not given careful consideration by the instructor, several problems may arise. for example, students may have concerns about evaluation and grading, especially early in the semester, which may make sharing about the assignment uncomfortable and superficial. discussing the experience in this superficial manner can be reductionist and may diminish one of the main goals of the assignment, to elicit depth of student participation. alternatively, discussing the assignment with too much depth may risk the potential of crossing professional boundaries as students may over-share private or sensitive information to the class and may come to regret it. understanding and addressing challenges student responses. while the ethnic roots assignment can be helpful for many students, it should be noted that facilitating the process of self-awareness related to cultural responsiveness can be very challenging as it often involves sensitive and controversial topics (chizhik & chizhik, 2005). students may resist the level of selfreflection required to complete the ethnic roots assignment. potential sources of student resistance or apprehension include students’ resistance to accepting the role of privilege in their own lives, downplaying the presence of oppression in society, and the fear of responsibility for change. for example, student resistance to exploring their racial and ethnic identity has manifested in papers that focus on a discussion of regional identity (i.e. being texan) versus an exploration of ethnic roots and its subsequent impact on privilege or marginalization in their lives. furthermore, the challenge of critically analyzing oneself can be an overwhelming and an uncomfortable experience. students have been known to respond to the ethnic roots assignment with confusion, discomfort, anger, or an inability to answer the assigned questions. the assignment may be particularly challenging to those students who have difficult family relationships or may not be in communication with family members. in these cases, instructors should provide the necessary accommodations by allowing students to explore their ethnic roots in alternative ways. while a detailed exploration of an alternative assignment is outside of the scope of this article, instructors are encouraged to think through an alternative assignment for students with such difficult family backgrounds by requiring them to critically think through their ethnicity. to achieve this, students can be asked to reflect on the similarity or dissimilarity of their racial or ethnic backgrounds to their adopted or family of choice and its subsequent impact on their lives (values, ethnic identity, understanding of cultural responsiveness, among others). however, it is important that this alternative is only offered on a case by case basis and after careful examination of the student’s background as instructors walk a advances in social work, fall 2010, 11(2) 229 fine-line between being supportive of students versus being overly caretaking. students should be encouraged to struggle with the material enough to be challenged, but not so much that they are angry, frustrated, or disrupt class room dynamics. maintaining boundaries. since the ethnic roots assignment facilitates the process of self-reflection—which requires students to expose themselves emotionally—it is important that the instructor establish guidelines for appropriate disclosure early in the class. it is vital for the instructor to initiate the class with a discussion underscoring the importance of boundaries and professionalism within the classroom. instructors should work to establish the difference between educational processes and psychotherapy. while the importance of encouraging students to engage in self-reflective processes is evident, there are also risks to which the instructor must attend. some students find that engaging in self-reflection is a stressful and sometimes emotionally taxing process. students with mental health concerns may be particularly vulnerable to feelings of guilt and shame over this type of self-exploration. instructors should inform students of these potential risks by addressing these issues both in the syllabus and verbally in the beginning of the semester as well as making themselves available to discuss concerns about engaging in this type of self-reflection outside of the classroom. it is important to note that students who demonstrate serious problems maintaining boundaries should be referred to discuss their concerns with their own mental health providers. group dynamics. the ethnic roots assignment cannot be implemented without a clear understanding of group dynamics. every classroom of students will have their own dynamics and bring into the classroom their own backgrounds, characteristics, and experiences. the level of guardedness or open-mindedness of a few students can affect group interactions as a whole. as a class, students may work through many of the stages of group formation and these processes can affect individuals’ abilities to gain insight into their own experiences. it should be expected that many students avoid disclosing their individual thoughts and experiences, while other students may more openly share their insights. educators must be aware of the group dynamics at work and frame discussions in the context of these dynamics. student experiences of the ethnic roots assignment in an effort to explore students’ processes and reactions to the assignment, the ethnic roots assignment was collected and analyzed qualitatively over the course of one semester (bender et al., 2010). students were informed about the study and were asked for voluntary participation through submission of their ethnic roots assignment paper electronically or as hard copies. all papers were de-identified before analysis. this study’s protocol was approved by the institutional review board (irb). the sample included the papers of 23 graduate social work students. content analysis revealed eleven main themes emerging from the qualitative data analysis, including students’ enlightenment of their privilege, experiences of cultural loss, and acknowledgement of biases and empathy as integral parts of culturally competent social work practice (detailed results are reported elsewhere in bender et al., 2010). in general, students reported that the process of completing the ethnic roots assignment challenged them to critically think through their familial history and how structural forces worked to negi, bender, furman, fowler, prickett/enhancing self-awareness 230 privilege or marginalize their family’s incorporation into mainstream american society. the findings of this study indicate that graduate social work students felt that the ethnic roots assignment presented them with many eye-opening insights regarding their own history of privilege and/or marginalization in america. student responses revealed an increased empathy for the struggles of marginalized populations and a renewed commitment to the provision of culturally responsive services. specifically, four key themes revealed the utility of the exercise as a culturally responsive teaching exercise. first, students developed an understanding of the role of race in social work clinical practice. particularly, white students gained perspective of their own privilege and how this may potentially translate in building a working alliance with their clients. students expressed developing an understanding of the importance of acknowledging ethnicity and race as important variables within the therapeutic process. for example, one student wrote, “being part of a dominant ethnic group, i have been afforded the luxury of ignorance on many issues regarding ethnicity. through the process of exploring the history of this phenomena and my personal history further, i recognize that what was a non-culture (‘white”) just feels that way to me because it is the dominant culture and i am a part of it.” secondly, students recognized a need for social workers to be empathetic to the many struggles and obstacles people face when they do not belong to the dominant group. students acknowledged that social workers, especially those of the dominant group, must begin to understand their position of privilege to be more culturally competent. one student quote reads: by recognizing the lack of hardships i have experienced as an assimilated citizen of this country, i must consider the undeniable fact that some or many of my clients will not have had a similar experience to my own. they may not feel welcome in this country, due to legislation that tries to deny them services, curriculum that is taught in our schools, or even the way people treat them based on race, ethnicity, language, religion, dress, etc. i need to be sensitive to these differences and aware of barriers and prejudices that people from different backgrounds experience. thirdly, students discussed that, in order to understand clients and their backgrounds, social workers must be open and willing to learn more about their clients’ worldview. finally, students further recognized that self-awareness is an ongoing process, thus underscoring the value for continued reflection and its influence on social work practice. while many students explicitly described the insights they gained through the process of developing self-awareness, educators using this tool should be aware that not all student growth will be so evident. one educator’s perspective on the impact of this assignment follows: the overarching purpose of the ethnic roots assignment is to foster social work graduate students’ understanding of the interplay between their cultural and familial backgrounds, identity constructs, and present beliefs, values, and biases. achieving this level of depth in self-awareness from one assignment is obviously challenging. a major part of the professor’s role is facilitating this process. it is noteworthy, however, that professors often will not be privy to all of the ‘light advances in social work, fall 2010, 11(2) 231 bulb’ moments that students experience during the process nor will all of these epiphanies be unmasked in the final product of the assignment. this is to be expected and is acceptable because the depth and breadth of the process of selfunderstanding is such that significant parts may and should remain confidential to enforce the format of the educational classroom ethic. ultimately, that which is most important, the impact on the student toward self-understanding, and the foundation of what this means for their future social work practice with clients, nonetheless has occurred. the instructor’s role, therefore, should be to guide students through each stage of the assignment, facilitating students’ unique forms of progress toward self-awareness and cultural competence. conclusion social work educators continue to shoulder the challenge of training culturally responsive practitioners despite a dearth of published educational strategies designed to promote cultural responsiveness (boyle & springer, 2001). the ethnic roots assignment, with its focus on self-awareness as a vital component of cultural competence, is one such promising teaching exercise that has been demonstrated qualitatively to facilitate students’ understanding and motivation to engage in culturally responsive practice. it should be noted that while this assignment shows considerable potential to increase students’ self-awareness regarding cultural responsiveness, a limitation, consistent with other qualitative inquiries, is the small sample of participants included in the analysis of this exercise. future work is then needed to quantitatively test the effects of the ethnic roots assignment on student competencies and to revise the assignment to adapt to varying contexts. furthermore, other exercises with similar goals should be shared and empirically investigated in order to broaden the field’s resources for addressing the important goal of cultural competence training. as ideas and teaching techniques, such as the ethnic roots assignment, are more widely disseminated across schools of social work, educators will be better equipped to employ diverse pedagogical methods in training culturally responsive social workers. references atkinson, d. r., morten, g., & sue, d. w. 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(2007). culturally competent practice: a framework for understanding diverse groups and justice issues. belmont, ca: brooks/cole. mclemore, s., romo, h., & baker, s. (2001). racial and ethnic relations in america (6th ed.). boston: allyn & bacon. messinger, l. (2004). the good, the bad, and the ugly: a teaching innovation to help students develop cultural competence. the journal of baccalaureate social work, 10(1), 61-74. national association of social workers (nasw). (2001). nasw standards for cultural competence in social work practice. retrieved from http://www.socialworkers.org/sections/credentials/cultural_comp.asp patton, t. o. (1999). ethnicity and gender: an examination of its impact on instructor credibility in the university classroom. howard journal of communications, 10(2), 123-144. richardson, t. q., & molinaro, k. l. (1996). white counselor self-awareness: a prerequisite for multicultural competence. journal of counseling and development, 74(3), 238–242. roberts, t. l., & smith, l. a. (2002). the illusion of inclusion: an analysis of approaches to diversity within predominantly white schools of social work. journal of teaching in social work, 22(3-4), 189-211. sakina-mama, r. (2001). preparing social work students to work in culturally diverse settings. social work education, 20(3), 373-382. advances in social work, fall 2010, 11(2) 233 author’s note: address correspondence to: nalini j. negi, ph.d., university of maryland school of social work, 525 w. redwood street, baltimore, md 21201. email: nnegi@ssw.umaryland.edu appendix a: outline of ethnic roots assignment ethnic roots paper each student will write a 5-7 page paper that explores his/her “family” ethnic roots and the unique experiences of parents, grandparents, and/or other significant caregivers in the student’s life. in the paper a) describe the “family” system, b) identify the variations that arise from cultural processes, such as race and ethnicity, gender, sexual orientation, disability, socioeconomic status, and/or urban/rural differences, and c) the implications of assimilation on social and economic justice for you and your family. the purpose of this assignment is for students to explore their own ethnic roots and examine the unique experiences of parents/grandparents/great grandparents and beyond/or other significant caregivers that have shaped their path in life. this paper will allow students to look at their roots globally as well as those prevalent in the southwestern region of the united states, if applicable. the paper should be double-spaced, in apa format, and responding to the following set of questions. specific information from the mclemore, romo, and baker (2001) reading should be incorporated and each student should personally address parts a) – d) below: a) background: very briefly describe yourself (age, birthplace, social class and status when you were growing up, current cultural orientation, etc.) b) background of parents/grandparents/great grandparents and so on • description of what you know about your (1) mother, (2) father, (3) maternal grandparents, (3) paternal grandparents, (4) maternal and paternal great grandparents, and so on. • how did ancestors enter into the united states (e.g., were they voluntary immigrants, involuntary through conquest, time of entry, etc.?). c) experiences with anglo conformity and factors affecting inclusion • by the standards of anglo conformity, were individuals related to you included or excluded in american society? • how did they avoid/attempt/achieve assimilation and integration? (e.g., were names changed to fit into mainstream american society? were ethnic roots emphasized or downplayed? were traditions/language/customs suppressed or passed down?). • what role did social class and social power play in their experiences? negi, bender, furman, fowler, prickett/enhancing self-awareness 234 • describe experiences of family members in terms of the presence or absence of (1) cultural assimilation by addition, (2) cultural assimilation by substitution, and (3) marital assimilation. • does the “three-generations process” of assimilation described in the reading apply to your family’s experience in this country? why or why not? d) conclusion: what conclusions do you personally draw about your own current status of assimilation based on your ethnic roots, socialization, and personal experiences and its implications for cultural sensitivity and culturally competent practice? text: mclemore, s., romo, h., & baker, s. (2001). racial and ethnic relations in america (6th ed.). boston: allyn & bacon. advances vol. 1, no. 2 ccuullttuurraall sseennssiittiivviittyy iinn aattoodd aaggeenncciieess:: aaddmmiinniissttrraattoorr aanndd ssttaaffff ppeerrcceeppttiioonnss iinn tthhee hhiissppaanniicc hheeaarrttllaanndd david r. hodge paul cardenas harry montoya abstract: administrator and staff perceptions (n = 72) of alcohol, tobacco, and other drugs (atod) agency cultural sensitivity were explored in a predominantly hispanic rural area with elevated levels of acculturation and high atod usage. while providers generally agreed that a relatively moderate need existed for training related to cultural issues, a more nuanced picture emerged in the purview of culturally-related barriers. administrators viewed the lack of appropriate interpreters and language as a greater barrier than did the staff. administrators also held higher perceptions of agencies’ cultural competency. the overall high assessment of cultural sensitivity may result from the substantial number of latino providers. keywords: alcohol, drugs, culture sensitivity, hispanic, latino, prevention, administration, atod agencies hispanics are projected to surpass african americans in the next few years as the nation’s largest minority group (castex, 1994; perez & de la rosa, 1993) due to their relative youth, high fertility rates, and high documented and undocumented immigration. although long-range projections are problematic, one census estimate predicts the hispanic/latino population will reach 128.3 million by 2050 (castex, 1994). castex (1994) highlighted four social indexes as particularly salient in illuminating the hispanic context (1992 figures): high poverty levels (26.2% vs. 10.3% for non-hispanic families, a high ratio of single-parent families (30% vs. 20% for non-hispanics), low levels of median income ($22,848 vs. $33,388 for white households), and a low median age (26 vs. 33.5 years). while it is commonly assumed that such social indicators presage high levels of alcohol, tobacco and other drugs (atod) usage (austin & gilbert, 1989), studies exploring atod use and related issues have produced inconsistent results (warheit, vega & khoury, 1996). for example, the us department of health and human services’ (1997) latest national household survey on drug abuse (nhsda) data revealed overall hispanic atod use and abuse as significantly below that of whites and frequently less than african americans. it is noteworthy 137 david r. hodge, m.c.s., m.s.w. is a rene sand doctoral fellow at the george warren brown school of social work, washington university, st. louis, missouri, usa. paul cardenas, m.s.w. is president, national multicultral associates, denver, colorado. harry montoya, m.a. is president, hands across cultures, española, new mexico, usa. copyright© 2000 advances in social workvol. 1 no. 2 (fall 2000) 137-147. indiana university school of social work. that the nhsda is the most extensive source of national information on atod usage patterns among members of the civilian, non-institutionalized population age 12 and over in the united states. conversely, other observers (austin & gilbert, 1989; caetano, 1983, 1994; carrasquillo, 1991; casas, et al., 1998; deren et al., 1997; rodriguez & brindis, 1995; warheit, vega & khoury, 1996; weeks et al., 1996) have found a more nuanced picture. these authors cite, in at least some contexts, higher rates of atod usage and related problems as compared to the general population. numerous methodological factors may underlie the difference in the results obtained. possible causes for the lack of consensus have been credited to sample size and location, non-random sampling, differences in operationalizing the constructs measured, underreporting of certain groups due to fear of deportation, undercounting youth due to the high hispanic drop-out rate, and confounding due to the disproportionately higher rates of abstinence among latina females (austin & gilbert, 1989; casas et al., 1998; warheit et al., 1996). as parker, weaver, and calhoun (1995) noted, despite the recent interest in exploring atod issues among minority populations, few studies of latinos have been conducted. another critical element in the disparate findings may be the relative degree of acculturation. in aggregate, atod use tends to increase with acculturation (austin & gilbert, 1989; caetano, 1994; casas et al., 1998; deren et al., 1997; warheit et al., 1996). for example, warheit, vega, and khoury (1996) found in their longitudinal study a generally linear trend between length of time in the united states and increased substance use among all four hispanic subgroups. thus, high rates of recent immigration may have produced a relatively favorable portrayal of current atod usage in the nhsda data set. furthermore, this depiction may be substantially altered in the future, as a relatively young, unacculturated population is exposed to acculturating influences. corporate america’s (roslow & nicholls, 1996) recent discovery of the hispanic market has exacerbated the acculturation effect. alcohol and tobacco companies are leaders in employing psychologically sophisticated advertising to penetrate the latino market (nuiry, 1997). examples of the manifestation of this targeted marketing effort (rodriguez & brindis, 1995) are spanish cigarette brands and the predominance of liquor outlets in hispanic neighborhoods. accordingly, it seems probable that atod use and related issues will increase among the latino population in the immediate future. atod problems are likely to grow significantly due to a high percentage of the hispanic population reaching adolescence, an anticipated increase in the level of acculturation, and the stepped-up use of psychological marketing techniques by alcohol and tobacco advertisers. in fact, studies employing smaller sample sets of highly acculturated hispano subjects may be more representative of the future than the extensive nhsda study. while consensus has not yet been reached concerning the prevalence, extent, or antecedents associated with atod use, a widespread agreement exists regarding the importance of developing culturally sensitive methods for delivering services to hispanos. in addition to the importance of culture sensitivity in agency settings 138 advances in social work (applewhite, wong & daley, 1991; colon, 1996; gant & gutierrez, 1996; santiagorivera, 1995; weeks et al., 1996), it has been cited as a critical component in a number of diverse areas. for example, assessment and prevention of aggressive behavior (delva-tauili’ili, 1995), health care interventions (bird, otero-sabogal, ha & mcphee, 1996), caregiving for elders (delgado & tennstedt, 1997), community organization/practice (kahn, 1997; weil, 1996), as well as atod programs (austin & gilbert, 1989) have all been mentioned as areas where an awareness of latino cultural issues is crucial. yet, as gant and gutierrez (1996) noted, the empirical investigation of agencies’ cultural sensitivity is still in its infancy. while a growing body of literature that delineates the cultural characteristics significant for the delivery of services in latino settings exists, to the best of the authors’ knowledge, the cultural issues in atod agencies have not been empirically explored. this is a significant oversight given the growing prevalence of atod problems in hispano communities. accordingly, this study examines cultural sensitivity issues in atod agencies in a predominantly hispanic area that has experienced a high degree of acculturation. in line with gant and gutierrez’ (1996) observations that provider perceptions of the agency environment are often more significant than the actual characteristics of the agency, administrator and staff perceptions are explored in three areas: culturally-related training needs, culturally-oriented barriers that inhibit access to atod services and programs, and an overall assessment of agency cultural competency. method as suggested above, it may be especially salient to examine perceptions in relatively acculturated environments, as such contexts may presage the future for a substantial segment of the relatively unacculturated hispanic population. accordingly, the geographic area surrounding the town of española in northern new mexico was selected. this catchment area includes the counties of southern rio arriba, northern santa fe, and southern taos. in total, this sparsely populated district comprises an area approximately the size of massachusetts. in this tri-cultural area, 70% are hispanic, with the remaining 30% equally divided between native americans and anglos or non-hispanic whites (1998 u.s. census). hispanics or hispanos have been the dominant population in the area for almost 400 years. in fact, with a history of settlement stretching back to 1598, the region is the center of the nation’s oldest continuous european settlement and proudly selfidentifies as the nation’s hispanic heartland. despite becoming a united states possession in the mid-19th century, until relativey recently, acculturating influences have been minimal. the relative geographic and linguistic isolation, combined with the strong spanish/latin culture (the area was under spanish rule for 213 years and mexican for 25 years) and mainstream oppression (wright, 1994), has limited acculturation. however, wide ranging societal changes dating from the end of wwii, including such factors as mass communication, increased access to transportation, and a growing influx of anglos, have fostered a high level of acculturation in the past few decades. 139hodge et al./cultural sensitivity in atod agencies interestingly, the area’s current poverty rates, incidence of single-parent families, income levels, and median age among hispanics approximate castex’s (1994) national averages for latinos (new mexico department of health, 1996). however, atod use and related problems are generally significantly higher than state or national averages (lewis, 1997; new mexico department of health, 1996). as suggested above, the rates of atod usage may be related to the extended acculturation process the area has experienced during the preceding 50 years. in light of the existing atod problems, a number of agencies have developed programs to address the area’s concerns. as part of a previous project undertaken by hands across cultures—an española-based prevention agency—an exhaustive list of the area’s community agencies had been compiled. from this schedule, 52 agencies were identified as having the potential for providing atod services. phone interviews with the respective organizations yielded 29 agencies involved with atod issues in some form (e.g., education, counseling, prevention). after confirming atod services, permission was sought from each agency’s executive director, ceo, or in their absence, an administrative assistant for authorization to mail surveys to the appropriate personnel. twenty-six agencies agreed to participate. in organizations with fewer than five staff involved with the direct provision of services, every individual was mailed a survey. in agencies with 5 to 10 employees, every second staff member was sent a survey. executive directors and when warranted by agency size, department heads or their equivalents, were sent administrator surveys. in addition to the survey, the mailed package included a personalized cover letter, postage-paid return envelope, and a $2.00 bill as an incentive. one week after the mailing a phone call was placed to ensure the package had arrived and to offer assistance in facilitating the return of the survey. three weeks after the mailing a second follow-up call was placed to those individuals who had not returned completed surveys. thirty-two of the administrator surveys were sent to identified personnel at the 26 agencies. twenty-four were returned, for a response rate of 75% among executive directors and department supervisors. seventy-eight staff surveys were sent and 48 were returned, resulting in a 61% return rate by staff involved in the direct provision of atod services. survey instrument the instrument explored cultural issues from three angles. administrators and staff were asked to assess their agencies in two domains: training needs that would enhance atod services, and barriers that inhibit the utilization of programs and services. the questionnaire utilized a series of likert-type scales (1=not at all, 5=extremely) to operationalize perceptions in the 10-question training domain (see table 2) and the 9-question barriers domain (see table 3). providers were also asked to choose the best statement from a choice of four that most accurately depicted the cultural stance of their agency—the one that most accurately reflected different levels of cultural orientation (see table 4). researchers specializing in minority studies at arizona state university (castro, 1997) pretested and refined the instrument on a prior sample of administrators and staff. 140 advances in social work findings sample characteristics table 1 reveals that provider characteristics are generally reflective of the surrounding community, although native americans are noticeably underrepresented. this finding suggests the need for further empirical exploration. the lack of native american representation is particularly notable in light of the high percentage of latino providers. in fact, among administrators, 71% were hispanic (vs. 55% of staff and 70% of the catchment’s general population). however, chi-square tests revealed no significant differences among provider characteristics, with the exception of professional status (χ2=19, df=3, p<.001). there were, for example, substantially more social workers among staff (34%) than administrators (8%). training needs as table 2 demonstrates, independent two-tailed t-tests revealed no statistically significant differences between administrators and staff in any of the areas surveyed. the resulting scores of the two groups were basically congruent. the general parity is also demonstrated by the fact that administrators recorded marginally higher assessments on seven queries, while staff had slightly higher scores on the other three questions. table 2 is organized in descending order of perceived training need in terms of the provider mean. in other words, when administrator and staff scores are averaged together, the question concerning how to involve community members in the planning of atod programs received the highest score. thus, in aggregate, providers perceived this to be the area reflecting the greatest need for training. accordingly, it is listed first on the table. however, it should be kept in mind that there was minimal variation between the areas requiring the most and the least training. in short, providers gave all areas an essentially moderate score in terms of culturally oriented training needs. barriers to atod services as table 3 reveals, there was more variation between administrators and staff in the purview of barriers. independent two sample t-tests disclosed statistically sig141hodge et al./cultural sensitivity in atod agencies characteristic % gender male 51 female 49 ethnicity hispanic 61 anglo 31 native american 4 other 4 birthplace new mexico 60 southwest 14 other 26 fluency in spanish excellent 31 good 22 fair 39 none 8 social work degree 25 education high school or < 11 associates 7 bachelors 37 masters 35 doctorate 10 table 1: characteristics of atod providers (n = 72) nificant differences in the areas of access to appropriate interpreters and lack of congruence between clients’ language capabilities and those of providers. in both cases administrators perceived the obstacle to be of greater consequence than did the staff. however, in the remaining insignificant areas, administrators and staff were evenly split, with each assessing three areas as marginally more of an impediment. table 3 was also arranged in descending order based upon provider means, with the greatest obstacle listed first. unlike training needs, which demonstrated little variation, there were marked differences in how the various barriers were rated. client transportation was cited as the most prominent obstacle to clients receiving atod services, perhaps an expected finding given the poverty and lack of transportation networks in the region. lack of advertising agency services and restrictive scheduling policies, followed by eligibility criteria, which limit some clients, were also listed as important barriers. at the other end of the continuum was the issue of appropriate interpreters and having a significant number of minority providers with whom minority clients can identify. agencies’ cultural competency respondents were given a choice of four cultural orientations and asked to select the perspective that best embodied their agency’s orientation towards cultural issues. providers were asked to consider both program development and service 142 advances in social work administrators staff m sd m sd t-score how to involve community members 3.42 1.04 3.21 .93 .86 in program planning evaluating programs designed to help 3.50 .72 3.24 1.05 -1.07 clients from diverse backgrounds learning about community resources 3.20 .83 3.38 1.05 .71 (e.g., churches, traditional healers) understanding atod services barriers 3.42 .83 3.23 .96 -.79 various clients face helping clients become more involved 3.25 .85 3.17 1.11 -.31 in meeting their own health needs understanding the health-related beliefs, 3.25 .79 3.17 1.01 -.34 behaviors, and traditions of clients how to provide cultural sensitivity 3.15 1.01 3.12 .61 .12 training to others understanding how to communicate 3.21 1.06 3.17 1.01 -.15 and work more effectively with minorities learning how to make the agency more 3.29 .86 2.98 1.03 -1.28 sensitive and responsive to diverse clients understanding the major health needs 3.12 .85 2.87 1.13 -.96 of minorities table 2: agency training needs (n = 72) delivery. as can be seen by the choices delineated in the agency cultural competency scale presented in table 4, a higher score represents a greater degree of cultural awareness. independent two sample t-tests revealed a significant difference in perceptions. administrators rated their agencies as more culturally competent than did staff (m=3.72, sd .57 vs. m=3.18, sd=.90; t=-2.32, p<.05). although on balance, both groups had very positive assessments of their agencies’ level of cultural competency. discussion as an exploratory study examining providers in one geographic region, the results cannot be generalized to other contexts. further, in light of the diversity intrinsic to the hispanic classification (castex, 1994), the applicability of results obtained from one group to others has been questioned (austin & gilbert, 1989). since a single homogeneous hispano culture does not exist, replication with other latino populations is clearly warranted. despite their diversity, there tends to be a number of shared cultural values among the discrete populations that comprise this group (rodriguez & brindis, 1995). for example, familismo, the understanding that family is central to one’s personal ontology, is a widely held value (munoz, 1997; rodriguez & brindis, 1995). indeed, madison avenue’s success in targeting the latino market testifies to numerous points of congruence among discrete hispanic groups. 143hodge et al./cultural sensitivity in atod agencies administrators staff m sd m sd t-score clients’ limited transportation 3.33 1.00 2.96 1.22 -1.29 lack of advertising of agency services 2.71 .91 2.41 1.21 -1.06 in clients’ communities agency’s scheduling policies that don’t 2.42 1.21 2.56 1.16 .48 offer evening or weekend service eligibility criteria that limit access of 2.36 1.25 2.21 1.12 -.50 atod services for some groups cultural differences between 1.96 .98 2.00 .94 .18 clients and providers clients’ language skills (speaking only 2.29 .80 1.73 .78 -.80** spanish or other language) providers’ negative attitudes towards 1.83 .92 1.91 1.00 .32 clients too few minority staff with whom 1.83 .76 1.78 1.06 -.23 minority clients can identify lack of appropriate interpreters 1.96 .98 1.51 .76 -2.01* (having to use children, cleaning staff, etc.) table 3: barriers to atod services (n = 72) *p<.05. **p<.01. furthermore, there is evidence that similarities may also exist in the purview of atod issues, as well. for instance, atod usage patterns show more symmetry than dissimilarity among diverse hispanic populations (warheit et al., 1996). in fact, warheit, vega, and khoury (1996) have suggested the similarities are of such magnitude in this area that one can generally place latinos in a single category without violating the integrity of their individuality. similarly, as noted in the introduction, widespread agreement exists that cultural sensitivity issues have broad applicability. in addition, acculturation tends to foster increased atod usage among numerous latino subgroups. indeed, in light of the acculturation effects seen in this geographic area, as well as other settings (caetano, 1994; casas et al., 1998; deren et al., 1997; warheit et al., 1996), this study may have particular salience for hispanic-area atod agencies. the high level of hispano presence among providers was an unexpected finding. as mentioned above, the percentage of latinos among administrators slightly exceeded the proportion within the surrounding population. this suggests acculturation may be a double-edged sword for hispanics. while it may foster increased atod use, it may also facilitate higher levels of education and atod agency involvement. interestingly, munoz (1997) has posited that the hispano sense of familismo is not limited to the immediate family but is often generalized to the community. correspondingly, individual identity development is intertwined with community development. in other words, as wholeness in the community is achieved, it is achieved in the individual. this dynamic may foster increased hispanic involvement in atod agencies as a means to achieve community development. while some qualitative evidence supports this theory (lazzari, ford & haughey, 1996), further research with other samples of highly acculturated latinos is required to confirm this hypothesis. in terms of the cultural issues explored, providers perceived their agencies as needing only average amounts of training. there is little doubt that provider characteristics played a substantial role in this assessment. providers were well educated, exhibited high levels of spanish fluency, and perhaps most importantly, incorporated minority representation on a par with the surrounding community. there was a noticeable pattern in both the training and barriers domains, although more pronounced in the latter. in questions that addressed cultural sensitivity issues at the interpersonal level, agencies were rated with more proficiency 144 advances in social work 1. attention to cultural issues is seen as totally unnecessary in atod programs and service delivery. 2. people should be treated equally in all situations; no one should receive special attention. 3. cultural issues should be examined from time to time; although cultural factors are not major issues in the development of atod programs and service delivery. 4. cultural issues should be examined in depth and with respect in order to offer better atod programs and services. table 4: agency cultural competency scale and barriers perceived to be less formidable. conversely, broader, systemic, and macro issues were found at the other end of the continuum. thus, for example, the lack of appropriate interpreters was the lowest obstacle impeding service utilization, while the lack of transportation systems was the highest. colon (1996) has suggested that the most important aspect of cultural sensitivity is the macro dimension (cf. gant & gutierrez, 1996). integrating the agency into the community through outreach, recruitment of community members, and inclusive decision making were understood to be essential to facilitating widespread hispano use of services (colon, 1996). interestingly, even with the substantial numbers of locally “recruited” providers evident in this study, macro issues remained at the forefront of provider concern. it would seem that agency integration with the community is a prominent issue regardless of provider characteristics. in other words, recruiting local community members, even at the provider level, is only part of the solution. macro outreaches, such as strategically located advertising agency services in spanish, are a crucial element to enhancing service provision to latinos (bird et al., 1996). spanish language skills are essential in working with most latino groups (applewhite, wong & daley, 1991; ross, 1995; santiago-rivera, 1995). provocatively, this was the only area where significant differences emerged between administrators and staff in the training and barrier domains. in both cases (lack of appropriate interpreters and clients’ lack of proficiency in english), administrators, rather than staff, perceived a greater barrier existed. although no significant differences emerged between administrators and staff in terms of birthplace, ethnicity, or spanish linguistic ability, staff were somewhat more likely to be born outside of new mexico, to be anglo, and to report less fluency in spanish. these factors may have resulted in administrators’ perceiving linguistic areas as more of an obstacle. the counterpoint to this explanation, however, is that no significant differences arose in other cultural areas. for example, assessments were essentially identical in other barriers, such as too few minority staff with whom minority clients can identify, and cultural differences between clients and providers. while more research is required, perhaps the most salient point is that both sets of providers perceived language to be a relatively minor hindrance to service. both administrators and staff had positive overall assessments of their agency’s cultural competency in program development and service delivery. although administrators held significantly higher perceptions of competency, this may have resulted from an enhanced sense of ownership toward their agencies. in spite of the differences, both sets of providers held very high opinions of their agency’s attention to cultural issues. conclusions this is the first empirical exploration through the eyes of administrators and staff of atod agency cultural sensitivity in an acculturated hispanic area. no outstanding culturally related training needs appeared in administrators and staff perceptions. concurrently, with the exception of clients’ access to transportation, all culturally associated barriers received net negative scores, indicating that on 145hodge et al./cultural sensitivity in atod agencies balance, cultural barriers were not an overriding obstacle. this positive picture was confirmed by providers’ high assessment of their agency’s cultural competency in the purview of overall program development and service delivery. additional corroboration is seen in the high degree of overlap between the results obtained in this study and the principles outlined by gant and gutierrez (1996) in terms of embodying their related concept of culturally sophisticated agencies. the key factor that emerged in the substantial degree of cultural sensitivity can be traced to the high percentage of hispano providers. replication in alternate settings, including a qualitative component, may reveal that acculturation in tandem with a generalized sense of familismo fosters a high level of latino presence among providers. since minority providers play a critical role in facilitating a 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(1994). hispano forestry, land grants and the u.s. forest service in northern new mexico. focus, 44, 10-14. author’s note: address correspondence to: david r. hodge, washington university, 1 brookings drive, campus box 1196, st. louis, missouri 63130-4899 usa. 147hodge et al./cultural sensitivity in atod agencies abstract the generalist model: where do the micro and macro converge? shari e. miller carolyn j. tice diane m. harnek hall abstract. although macro issues are integral to social work, students continue to struggle with the acquisition of knowledge and skills pertaining to larger systems. educators have developed innovative methods to integrate learning across systems of various sizes however it appears an imbalance persists. this challenge is supported by baccalaureate student responses to a social work program evaluation. four years of data from 295 undergraduate students revealed that they felt less prepared to practice with larger, macro systems. changes in curriculum to reflect collaboration and holism, and more research are needed to adequately provide macro learning and macro practice opportunities within the generalist model and in the context of the current socioeconomic-political environment. keywords: generalist model; macro practice; macro learning; social work education research findings indicate that social work students have notably more learning opportunities to work with individuals, families, and groups than they do to work with communities and organizations (butler & coleman, 1997; hymans, 2000; koerin, reeves, & rosenblum, 2000; raber & richter, 1999). of particular concern is the reluctance of many students to consider involvement in social action through activities such as lobbying, legal advocacy, and neighborhood organizing (kasper & wiegand, 1999). as such, social work students may be hampered in their abilities and/or willingness to develop the skill sets necessary to identify and utilize organizational and community strengths to empower clients and effect systems change (koerin et al., 2000). review of the literature the generalist model the socio-political climate of the late 1960’s and 70’s encouraged social work educators to evaluate the content and conceptual frameworks of social work practice (bisno, 1971; iacono-harris & nuccio, 1987; pincus & minahan, 1973; teare & mcpheeters, 1970). the result of this evaluative effort was the emergence of the generalist model, a method of practice that integrates casework, group work, and community organization, and focuses on the interaction between persons and their environments. according to compton, galaway, and cournoyer (2004), the notion of person-in-the-environment allows for change strategies directed toward (a) individuals, (b) the environment, and, (c) the interface between the individual and his/her environment (iacono-harris & nuccio, 1987, p. 80). for johnson (1998), the generalist _________________ shari e. miller, ph.d., is an assistant professor at the school of social work, university of georgia, athens. carolyn j. tice, dsw, is associate dean and program chair of the university of maryland baltimore county department of social work. diane m. harnek hall, ph.d., is an assistant professor in the department of family studies and community development at towson university. copyright © 2008 advances in social work vol. 9 no. 2 (fall 2008), 79-90 miller, tice, hall/the generalist model 80 approach requires that social workers recognize the variety of systems that interact with one another and that interact with people (meenaghan, gibbons, & mcnutt, 2005). the generalist model provides the overarching structure for the undergraduate social work and foundation year graduate curriculum continuum. several generalist perspectives have emerged including those of tolson, reid, and garvin (2002) who present a task-centered approach to generalist practice; miley, o’melia, and dubois (2008) who suggest an empowerment approach; and mcmahon (1990; 1996) who presents a problem-solving approach. these models all include a structure and process that direct the social worker to approach each client and situation with openness to the use of a variety of techniques and levels of intervention (waites, 2000). whatever the perspective, generalist practice is multi-method, multi-theoretical, and transferable across diverse fields of practice, settings, and populations. further generalist practice uses problem-solving to assess and intervene in micro, mezzo, and macro systems. though there are some definitional differences between and across social work programs at the undergraduate and graduate levels, there appear to be universal points of agreement, including that generalist practice: 1. uses the person-in-the-environment perspective as the theoretical foundation for assessments and interventions. 2. involves assessments that support interventions involving micro, mezzo, and macro practice. 3. assumes that social workers will have diverse roles such as educator, advocate, counselor, planner, organizer, and administrator. 4. integrates practice, policy, and research through roles and functions. 5. conceptualizes practice as comprised of engagement, assessment, planning, implementation, and evaluation (gelman & mirabito, 2005; kirst-ashman & hull, 2008; miley, et al., 2008; poulin, 2000). macro practice macro practice is intrinsic to the generalist model, so how is this level of intervention defined? according to long, tice, and morrison (2006), macro practice “involves the ability to see and intervene in the big picture, specifically with larger systems in the socioeconomic environment” (p. 3). macro practice can include collaboration with clients to strengthen and maximize opportunities for people at the organizational, community, societal, and global levels. many social workers would argue that the profession’s particular attention to state, national, and international issues of importance to clients, distinguishes social work from other helping professions (glisson, 1994; long et al., 2006). historically the term indirect practice was used to denote the elements of macro practice. unlike the term direct practice, which characterized specifically face-to-face contact with clients, indirect practice was used to refer to social work’s commitment to change-efforts at the environmental level with a focus on societal issues such as poverty, advances in social work, fall 2008, 9(2) 81 housing, and healthcare (pierce, 1989). thus, macro activities, by definition, extend beyond individual interventions but are often based on needs, problems, issues, and concerns identified in the course of working one-on-one with clients (netting, kettner, & mcmurtry, 1998). larger systems are typically the focus of macro level work. according to rothman, erlich, and tropman (1995), there are three key arenas of macro intervention: communities, organizations, and small groups. kirst-ashman and hull (2008) state that integrating generalist social work practice with macro systems involves interventions that (a) maintain positive community social processes, (b) develop and restore social processes that can contribute to human development and functioning, and (c) empower individuals and small systems to influence the larger systems affecting people’s lives (pp. 116-117). other writers focus on the policy context in which macro intervention occurs as policy change is integral to communities and organizations (fisher, 1995; flynn, 1992; jansson, 1994). as stated by netting, et al. (1998), fundamental to macro practice and subsequent broad based change is “an understanding of overriding ideologies and values that influence local, state, and national politics” (p.7). the strengths and empowerment models have enhanced the macro perspective by focusing on elements such as positive attributes and social power essential to achieving positive change (meenaghan et al., 2005; saleebey, 2005; 2003). the literature related to social work education includes a variety of different strategies to enrich macro content, some of which engage students in the context of the classroom, others through the field experience (koerin et al., 2000). one identified approach requires students to engage in an in-depth community study or needs assessment within the context of a macro practice class (hymans, 2000; sherraden, 1993). bordelon (2003) describes a practice class in which students create a universitycommunity partnership along with their instructor, and huber and orlando (1993) define an innovation that engages students in an in-class, hypothetical project to challenge the bounds of their interventive thinking. other approaches invite students to engage in advocacy (butler & coleman, 1997; raber & richter, 1999), and still further approaches are designed to address the nature of field placements, field assignments and field instruction (allen & shragge, 1995; kasper & wiegand, 1999; koerin et al., 2000; siu, 1991; skolink & papell, 1994; wolk, pray, weismiller, & dempsey, 1996). social work educators conclude that macro practice necessitates that students both produce and consume research (walsh, 1998). examples of assignments that integrate a macro perspective with research are community assessments, organizational analyses, and surveys (dunlap, 1993; grinnell & kyle, 1977; plionis, 1993). thus macro practice much like micro and mezzo intervention uses critical thinking to engage in (a) problem identification and definition, (b) study, exploration, and data collection, (c) differential assessment, planning, and intervention, (d) evaluation, (e) termination, and (f) follow-up (meenaghan et al., 2005, p. 9). miller, tice, hall/the generalist model 82 students’ evaluation of macro learning to better understand the student experience of learning macro practice several years of program evaluation data were analyzed. a program evaluation was developed in accordance with the council on social work education standards by faculty at a large mid-atlantic baccalaureate social work program. questions were designed to help evaluate the quality and effectiveness of (a) the overall baccalaureate social work program, (b) the field education setting and experience including evaluation of the agency, field instructor and specific assignments within the agency, and (c) the field liaison component of the program. face validity was confirmed through faculty development, and internal consistency was analyzed and found to be high (cronbach’s α = .97). however no other tests of validity or reliability were administered. the sample included all graduating baccalaureate social work students for the years 2004 through 2007 (n=312). completed program evaluations were collected from a total of 295 students (95% response rate) at the end of the spring semester during their graduating year. a majority of the respondents were female (91.3%) and white (59.8%). the other racial groups represented were african american (22.0%), hispanic (10.4%), asian american (3.5%), bi/multiracial (1.2%), and other (3.1%). the respondents ranged in age from 20 to 63 years, with a mean age of 28 years. the gender and racial characteristics of the study’s respondents are similar to those of social work students across the nation (lennon, 1999; knight, 2002). a manova analysis was utilized to compare data from year to year (2004 through 2007) – no significant differences on overall program evaluation findings emerged. in the four years of program evaluation the same two areas of inquiry reflected a noticeable pattern of responses related to the level of system. responses to two areas of questioning (feelings of preparedness and extent of experience) illustrate the differences in students’ perspectives regarding varying system levels. macro experience in field assignments the program evaluation asked the respondents to evaluate on a 5-point likert scale (“1” = low; “5” = high) the extent of experience gained in field education assignments that integrated generalist practice across client systems. such assignments pertained to individuals, groups, and community involvement. as described in table 1, respondents reported a high degree of experience with field assignments involving individuals (m = 4.43; sd = .961). assignments with groups (m = 3.35; sd = 1.46) yielded a lower level of experience, yet still more experience noted than that pertaining to community assignments (m = 3.24; sd = 1.29). the findings from the evaluation suggest that, for the evaluation of assignments in this sample, the larger the client system the lower the level of experience among students. advances in social work, fall 2008, 9(2) 83 table 1: what was the extent of your experiences in assignments with: (1 low through 5 high) rating individuals groups communities 1 2.4% 18.2% 12.4% 2 3.4% 10.7% 16.5% 3 9.2% 18.9% 25.1% 4 19.1% 22.7% 26.5% 5 65.9% 29.6% 19.6% preparedness to use knowledge and skills in macro practice respondents were asked to consider their overall preparation in generalist social work including both class and field education, and to rate on a 5-point likert scale (“1” = not at all; “5” = very much) for each item how well the program prepared them to appropriately use the knowledge and skills of generalist social work practice with individuals, groups, and communities. as indicated by table 2 a majority of respondents reported feeling very prepared to work with individuals (m = 4.46; sd = .702), while responses of very prepared were much lower in work with groups (m = 3.80; sd = 1.06) and communities (m = 3.18; sd = 1.05). most graduates from this program seem to feel less prepared to work with larger systems at graduation. table 2: how well has the program prepared you to practice with: (1 not at all through 5 very much) rating individuals groups communities 1 .3% 4.2% 5.9% 2 1.0% 5.9% 18.5% 3 7.0% 24.8% 38.3% 4 35.9% 36.0% 26.1% 5 55.7% 29.0% 11.1% it is important to note that the lack of clarity and consistency in the language used to discuss macro interventions and generalist practice in the literature had bearing upon the miller, tice, hall/the generalist model 84 questions asked in the program evaluation. similar to a limitation noted by koerin, et al., (2000) the program evaluation reflected ambiguity when asking students to describe their macro learning experiences in both the classroom and field placement. also the findings discussed are descriptive of this sample of graduates. though the sample may reflect the demographics of the population of baccalaureate social work graduates it may not be representative of the population, which limits generalizability. discussion of program evaluation findings the four years of evaluation data reported in this article support the challenges of integrating macro learning in the social work curriculum. of particular concern is students’ perceived imbalance between the micro and macro in the curriculum content and field education experiences. though the authors do not believe that a polarization of micro and macro practice is a productive construction for the social work profession, the authors recognize that an imbalance exists in the described baccalaureate program, and from what is gathered from the literature, this imbalance exists pervasively (butler & coleman, 1997; huber & orlando, 1993; hymans, 2000; kasper & wiegand, 1999; koerin et al., 2000; raber & richter, 1999; siu, 1991; wolk et al., 1996). over the past 100 years a debate has persisted within the profession that encourages the idea that micro and macro social work are two mutually exclusive orientations (haynes, 1998). by polarizing practice in this way the fundamental values and ideas at the heart of social work become muted. what identifies social work as a distinct profession is its focus on the possibilities for change in the person and the environment. by polarizing micro and macro practice social work becomes about the person in one vacuum and the environment in another. over the course of the four years of evaluation the social work program discussed in this article introduced pedagogical and experiential methods that attempted to integrate micro practice with macro practice through lectures, inand out-of-class assignments, case studies, and continuing education sessions. however these attempts have not yet resulted in any significant change in students’ evaluations – clearly other barriers to integrating micro with macro practice exist. barriers to integration of micro and macro practice and learning the enormous changes in the fabric of the nation’s social welfare and social service delivery systems are of particular significance to social work education. welfare reform legislation, devolution of policy responsibility and involvement in social service delivery to states and localities, the increasing privatization of social services, agency budget cuts and downsizing, the dominance of managed care in both health and mental health arenas, and economic globalization have influenced the practice of social work and by extension social work education (jarman-rohde, mcfall, kolar, & strom, 1997; reisch & jarmanrohde, 2000). within this socio-political climate there is an enormous impact upon the availability and quality of field placements and subsequently a great deal of shifting and increasing demands placed on field education (jarman-rohde et al., 1997). according to jarmanadvances in social work, fall 2008, 9(2) 85 rohde et al. (1997) for agencies the focus on productivity, accountability, and managed care has created barriers to providing social work students with appropriate placements and/or adequate supervision. field instructors often carry heavy caseloads, are required to do more paper work, and have less time to spend supervising students. at the same time agency expectations regarding the types and breadth of student assignments increase parallel to agency needs. students are assigned increasing numbers of clients with complex and multiple problems, yet agencies are also concerned about the potential liability associated with having students on-site (jarman-rohde et al., 1997). it has been documented that other barriers to making macro learning assignments available to students in field education, though related to the large-scale shifts as discussed above, are also traceable to the orientations of agencies and field instructors. “most agencies fail to validate macro practice tasks as worthy aspects of workers’ defined responsibilities, while the individual workers serving as field instructors possess neither the competence nor the confidence to model and teach macro level practice responses” (butler & coleman, 1997, p. 65). although this position points to current realities, and might even explain the strikingly consistent program evaluation findings, it unfortunately fosters the culture of micro-macro encampment within the profession and social work education. the future of macro learning the complex environment of social work practice requires social work educators to reassess the profession’s fundamental purpose. historically social work has supported the dynamics of individual, community, and societal change. given the centrality of change to social work, reisch and jarman-rohde (2000) suggest that: an expectation of change can provide social work educators with a framework to comprehend and potentially influence that environment, and thereby nourish a sense of hope and possibility in an era shrouded with a growing sense of powerlessness and resignation (p. 212). reflective change is integral to this article’s focus. program revisions are needed to enhance macro learning content and to better integrate micro practice with macro practice at the same time as the profession struggles to redefine its focus in an increasingly complex and contentious social and political climate. a number of social work educators suggest that the need for change in curriculum and field education can be embraced as an opportunity (abramowitz, 1998; bisno & cox, 1997; jarman-rohde et al., 1997; reisch & jarman-rohde, 2000; weil, 1996). such change values a model of social work education and practice that fosters a sense of leadership and empowerment in clients, students, educators, field instructors, and in our collective selves. a model of social work that invites meaningful change across levels of interactions encourages not only students, but also practitioners and educators, to consider their actions in the context of environments. a reflective stance that encourages a view of the environment from within might encourage students, field instructors, and classroom educators to see both what is up close and what might be a bit further away. expanding and enhancing content that connects micro and macro theory with practice miller, tice, hall/the generalist model 86 requires faculty to ask questions as part of a dialogue with students, field instructors, and each other. some of these questions are: 1. in what ways does the “use of self” offer opportunities for re-organizing how the macro can be found in and around the micro? 2. how do the values and principles of social work complement and/or conflict with the national and international socio-political climate? 3. does the generalist social work curriculum include content that supports not only analysis of societal issues like oppression and poverty but also a call for collective action that leads to peace, social justice, and social change? 4. what is the role of the international and/or the nontraditional field placement in generalist social work education? 5. how can social work programs collaborate with agencies and communities to provide students with macro learning opportunities? 6. to what degree do social work educators, field instructors, and professional organizations model macro change efforts? although these emerging questions appear divergent in some ways, and although they each require extensive dialogue to fully address, they share some common ground and interlocking themes. reflectivity, collaboration, and holism undergird the above avenues of inquiry. in keeping with the work of ruffolo and miller (1994) the above questions point to the need for university and agency collaboration and partnerships to reciprocally inform curriculum development. effective learning relies on exchange of ideas, resources, and energy to teach practice skills in an increasingly diverse community of social work agencies. further, another ingredient of collaboration embedded in the questions is that of social work educator as activist. by this we mean that, in order to teach macro skills in an integrative way, the questions imply that the instructor be an active participant in the learning process in and outside of the classroom. the practice experience gained and shared by the instructor encourages students to reflect upon their skill acquisition in a mutual learning environment (ringel, 2003). finally the challenge of teaching macro skills in an integrated fashion underscores the need for a multi-method holistic teaching approach in which students actively engage with readings, research, case studies, multimedia resources, and social action opportunities that capture both domestic and international large scale settings (dewiest & roche, 2001). using an array of teaching approaches encourages students to understand and apply macro practice from different perspectives and by doing so bridges the gap between recognizing problems, needs and strengths, and designing strategies for systematic change. conclusion the program evaluation discussed in this article suggested that over a period of four years undergraduate social work students rated their macro learning experiences as less satisfactory than their micro ones. this consistent imbalance underscores the need to examine the generalist curriculum as well as field experiences that involve the acquisition advances in social work, fall 2008, 9(2) 87 of skills and knowledge related to macro practice. future research is needed to examine approaches to enhance macro learning including agency and community collaborations and in-class teaching innovations. the language of generalist practice might need to be further clarified to best undertake future research. research should also include measurement of students’ macro skill development; evaluation of students’ opportunities to gain practical experience in organizing, community assessment, and advocacy; and assessment of the inclusion of macro content across the generalist curriculum. ideally this article and others like it will generate a dialogue within the profession regarding macro experiences in generalist social work and where the micro and macro converge. given that all clients and agencies are influenced by their communities, as are all social workers, the understanding of and skills to effect broad-based change are critical to practice across all levels of intervention. change as a unifying construct makes social work, be it direct service in a clinical setting or grassroots organizing in a community, the unique profession it is. references abramowitz, m. 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(2000). the future of social work in the united states: implications for field education. journal of social work education, 36, 201-21. ringel, s. (2003). the reflective self: a path to creativity and intuitive knowledge in social work practice and education. journal of teaching in social work, 23(3/4), 1528. rothman, j., erlich, j. l., & tropman, j. e. (1995). tactics and techniques of community intervention (3rd ed.). itasca, il: f. e. peacock. ruffolo, m. c., & miller, p. (1994). an advocacy/empowerment model of organizing: developing university-agency partnerships. journal of social work education, 30(3), 310-316. saleebey, d. (ed.). (2005). the strengths perspective in social work practice (4th ed.). boston: allyn & bacon. miller, tice, hall/the generalist model 90 saleebey, d. (2003). power in the people: strengths and hope. advances in social work, 1, 127-136. sherraden, m. s. 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(1998). a model for integrating research, practice, and field instruction in the undergraduate curriculum. journal of social work education, 17, 49-63. weil, m. o. (1996). community building: building community practice. social work, 41, 481-499. wolk, j. l., pray, j. e., weismiller, t., & dempsey, d. (1996). political practica: educating social work students for policymaking. journal of social work education, 32. retrieved on october 24, 2005, from ebscohost database. author’s note: address correspondence to: shari e. miller, ph.d., school of social work, the university of georgia, 209 tucker hall, athens, ga 30602. e-mail: semiller@uga.edu. mailto:semiller@uga.edu the concept of cultural competence first appeared on the academic scene in the early 1 980s with social work literature providing the first and most prolific discussions on the topic the need for advancement in the conceptualization of cultural competence joseph s. gallegos cherie tindall sheila a. gallegos abstract. the concept of cultural competence has become ubiquitous in human services language and settings. though the literature from various disciplines is replete with discussions on the topic, there still exists much disagreement regarding the definition of cultural competence as well as how to operationalize, test, and apply concepts related to cultural competence in social service settings. a related issue stems from debate regarding whether cultural competence is a theory, model, paradigm, framework, or perspective. though cultural competence has been referred to as a theory by some scholars from different disciplines (e.g., lum, 2005; blue, thiedke, chessman, kern, & keller, 2005; wu & martinez, 2006), there is still disagreement about whether the concepts related to cultural competence actually meet the criteria for a theory and, consequently, whether they can be used to generate hypotheses and allow for independent observations that can be used to continue building theory, conduct empirical research, and provide evidenced-based practice implications. the authors join in this theory debate through an analysis of the elements of theory and conclude that it has better fit with the definition of social perspective than it does social theory. keywords: culture, competence, theory the term “cultural competence” has become ubiquitous in human services language and in human service settings. the concept appeared first in social work literature (gallegos, 1982; green, 1982) as well as in counseling psychology literature (pedersen & marsell, 1982; sue, bernier, durran, feinberg, pedersen, smith, & vasqueznuttall, 1982). a decade later a number of articles calling for cultural competence in nursing and education were published, and, most recently, similar articles appeared in the medical education literature (suh, 2004; bigby, 2003.) as early as the 1980’s, following the social directions initiated by the civil rights movements, federal mandates and, in turn, local governments made the inclusion of cultural competence objectives a funding requirement for service programs. from coast to coast, from portland to philadelphia, laws have been enacted requiring public agencies to comply with cultural competence standards (multnomah county, 2005; and adams, 2005.) today organizations and social work programs commonly espouse cultural competence in their mission statements. the national association of social workers (nasw) provides an operational definition (2001) which is a key element of a theory suggesting measurability and suggesting quantitative accountability is attainable. the authors consider the concept of cultural competence against criteria that establishes a concept as a theory and conclude that it is not a theory and that cultural competence is _________ joseph gallegos ph.d. is the director of the social work program at the university of portland. cherie tindall b.s. is a master’s degree candidate in the cross cultural studies program at the university of houston at clear-lake. sheila gallegos m.a. is a research associate with western research associates. copyright © 2008 advances in social work vol. 9 no. 1 (spring 2008), 51-62. gallegos et al./conceptualization of cultural competence 52 better thought of as a value-based perspective. this conclusion is important with respect to our expectations of social work students and practitioners in setting outcome goals and objectives. this determination is also important because, if we, as a profession, continue to promote a valued-professional goal as if it were a hard scientifically-measurable concept by which we can hold individuals and organizations accountable, and do not acknowledge the malleable nature of the concept, then we continue to allow the profession to be vulnerable to criticism of conservative and libertarian views. cultural competence there are several iterations of cultural competence as described by different authors with each striving to describe the concept, such as: ethnic competence (gallegos, 1982; green,1995), cultural awareness (winkleman, 2005), with the majority of authors eventually converging on the term “cultural competence” (cross, bazron, dennis, & issacs, 1989; lum, 2005; weaver, 2005). additional areas of contribution to the body of knowledge on the subject come from other professional literature in helping fields such as psychology, education, and the medical field (bigby 2003; purnell & paulanka, 2003). most recent contributions call for progressing beyond cultural competence into “transnational competence” (koehn & swick, 2006). the tremendous volume of literature alluded to earlier on the topic of cultural competence illustrates the importance of the concept as a tool for effective communication, intervention, and outcomes in the multicultural environment pervasive in the helping professions. (klienman & benson, 2006; williams, 2006). table 1 contrasts efforts to conceptualize cultural competence in social work and health care. one can see immediately an eclectic array of theories and constructs used to formulate the various conceptualizations of cultural competence. in education literature addressing cultural competence, one would see terms such as multi-culturalism, diversity, poverty, and social justice (inside higher education, 2006). social work accreditation standards supporting the promotion of cultural competence in social work practice, the council on social work education (cswe) requires all accredited programs to incorporate standards regarding diversity, populations at risk, and social justice (cswe, 2006, fifth ed., education policies, standards 4.1 and 4.2) which seem to have encouraged many, if not most, schools of social work to incorporate the term “cultural competence” in their mission statements if not in their learning objectives. the nasw, which sets the standards of practice, incorporates similar practice objectives in its code of ethics and offers an operational definition of cultural competence. advances in social work, spring 2008, 9(1) 53 table 1. matrix of cultural competence theories/models/perspectives theory/model/author major components/ defining terms & process steps fields of focus major distinctions/ based upon sources cultural competence, practice stages, client intersectional systems, & case studies model; doman lum & others cultural competence, cultural awareness, knowledge acquisition, skill development, inductive learning; mastery of particular set(s) of knowledge, skill, policies, & programs used to address cultural needs of individuals, families, groups, & communities; social patterns, social work values, honor & respect the cultural values w/in the larger context, implications of social class, and ethnic & social stratification social work cultural competence model; practice stages; main theory based upon a systems-theory approach; five-stage continuum that constitutes a system (lum 1999, pg. 7) terry l. cross, et.al. (1989); lum, doman culturally-competent practice: a framework for growth and action (1999) purnell model for cultural competence (purnell & paulanka, 2003) cultural competence scale, awareness, 12 domains: overview/heritage, communication, family roles and organization, workforce issues, biocultural ecology, high-risk behaviors, nutrition, pregnancy and childbearing practices, death rituals, spirituality, health-care practice, health-care practitioner concepts health care: practice, administration, education, & research a conceptualization based on multiple theories and a research base gained from organizational, administrative, communication, and family development theories as well as anthropology, sociology, psychology, anatomy and physiology, biology, ecology, nutrition, pharmacology, religion, history, economics, political science, and linguistics. campinha-bacote, j. (1994). the process of cultural competence, in the delivery of health-care services: a culturally-competent model of care (3rd ed.); hage, j . (1972). techniques and problems of theory construction in sociology; purnell l, & paulanka, b. (2003). transcultual health care: a culturally-competent approach. gallegos et al./conceptualization of cultural competence 54 nasw standards for cultural competence in social work practice prepared by the nasw national committee on racial and ethnic diversity approved by the nasw board of directors june 23, 2001 cultural competence cultural competence refers to the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each. cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals and enables the system, agency, or professionals to work effectively in cross-cultural situations. operationally defined, cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services, thereby producing better outcomes (davis & donald, 1997). competence in cross-cultural functioning means learning new patterns of behavior and effectively applying them in appropriate settings. gallegos (1982) provided one of the first conceptualizations of ethnic competence as "a set of procedures and activities to be used in acquiring culturally-relevant insights into the problems of minority clients and the means of applying such insights to the development of intervention strategies that are culturally appropriate for these clients." (p. 4). this kind of sophisticated cultural competence does not come naturally to any social worker and requires a high level of professionalism and knowledge. there are five essential elements that contribute to a system's ability to become more culturally competent. the system should (1) value diversity, (2) have the capacity for cultural self-assessment, (3) be conscious of the dynamics inherent when cultures interact, (4) institutionalize cultural knowledge, and (5) develop programs and services that reflect an understanding of diversity between and within cultures. these five elements must be manifested at every level of the service-delivery system. they should be reflected in attitudes, structures, policies, and services. cultural competence as foundation theory in human behavior and the social environment (hbse) theoretical content most germane to social work is found in hbse courses. the cswe stipulates the following standard of educational policy with regard to hbse: advances in social work, spring 2008, 9(1) 55 4.3 human behavior and the social environment social work education programs provide content on the reciprocal relationships between human behavior and social environments. content includes empirically based theories and knowledge that focus on the interactions between and among individuals, groups, societies, and economic systems. it includes: 1) theories and knowledge of biological, sociological, cultural, psychological, and spiritual development across the life span; 2) the range of social systems in which people live (individual, family, group, organizational, and community; 3) and the ways social systems promote or deter people in maintaining or achieving health and well-being. in a review of five popular hbse text books, the authors found that elizabeth d. hutchinson [dimensions of human behavior: person and environment (1999)] includes a short discussion on theory in general and how it relates to study and research. she also includes a chapter on “theoretical perspectives on human behavior” in which she describes different theoretical approaches used in social work settings, utilizing case studies throughout the book to elucidate how each of the approaches may be used in various hbse situations. d. lum and d.w. sue & d. sue are leading authors in cultural competency literature that are referenced in the works cited section of the hutchinson text and, although the importance of appreciating different cultural needs is stressed, the term “cultural competence” is not used. in the hbse text book by josé b. ashford, craig winston lecroy, and kathy l. lortie, human behavior in the social environment: a multidimensional perspective (2006), in chapter one of the text, “a multidimensional framework,” the authors include a section that discusses “cultural competence, globalization, and our diverse society.” this is a short section that briefly addresses the significance of cultural competence and cultural diversity as related to the globalization of cultures but does not include any references to any particular authors on the topic. the text includes sections titled “multicultural and gender considerations” within each of the chapters concerned with various stages of child development, family considerations, and community systems, but these are more application-oriented rather than theoretical. the text by john f. longres, human behavior in the social environment (2000), introduces and briefly describes the term “cultural competence” in the first chapter of the text during discussion of social theories, and, herein, the author references james w. green’s work titled cultural awareness in the human services: a multiethnic approach (1982). as with the other hbse texts noted above, this text includes multicultural considerations as applicable to each topic of discussion or case study throughout the work but presents little exploration of cultural competence as a theory. another popular hbse is the text by charles h. zastrow and karen k. kirstashman [understanding human behavior in the social environment (2004)] which is the most in depth of the hbse texts reviewed as far as the discussion of cultural competence is concerned, but even this consisted of only two and a half pages of information on gallegos et al./conceptualization of cultural competence 56 culturally-competent practice. cultural competence is defined in the text as the need to follow the “ten standards for cultural competence in social work practice” as defined by nasw (2001). the work then moves on to discuss application of the concept. as with the other texts, this one appears to be intended to be used in a survey course and provides a generalized overview of hbse concepts as a foundation for further study but does not delve into any specific topic in depth. and, finally, the most recent textbook in the field surveyed by the authors is anissa taun rogers’ human behavior in the social environment (2006). although the term “culturally competent” does not appear in either the table of contents or the index, the text uses it in a table (table 4.1) displaying various theories that are useful in social work practice. even though the term is not specifically defined in the table, it indicates that the “theory of culturalism” helps social workers to be more culturally competent in practice. the text includes a section concerning cultural perspectives and social work and begins by defining terms such as multiculturalism and cultural pluralism. theory a central question that these education and practice mandates raise is how to assess the degree to which cultural competence has been met. when considering measurability or the accountability of organizations or individuals, a place to begin is to determine the theoretical nature of cultural competence (kleinman and benson, 2006; william, 2006). is cultural competence theory or not? whether it is or not has significance for measurability and accountability. to qualify as a theory, certain criteria must be met (see table 2). a theory can be tested. one is able to empirically observe the phenomenon in question. the observation is replicable and the outcome reliable. if it does not meet standard criteria for a theory, then it should be considered to be a perspective. meeting the criteria of a perspective allows for measurements of various components or aspects of the perspective. table 2. criteria or components for useful theory (babbie & rubin, 2005) cultural competence observations: what we experience in the real world that helps us build a theory or verify whether it is correct what may be observed as culturally competent is given to value judgments empirical support: when our observations are consistent with what we would expect to experience if a theory is correct cultural competence does not lend itself to prediction or measurement attributes: concepts that make up a variable (characteristics or qualities that describe) cultural competence lacks discernable or agreed upon attributes hypothesis: something that ought to be observed in the real world if a theory is correct cultural competence does not predict behavior variables: the things that hypotheses predict that hold relationships to one another (independent & dependent variables); logical groupings of attributes cultural competence lacks a dynamic relationship among variables advances in social work, spring 2008, 9(1) 57 theories are social constructions of what we think we know of reality. epistemology is the study of knowing, and epistemologies are ways of knowing. research based upon the scientific method is one approach to knowing. in social science, the scientific method remains the dominant approach to knowing or knowledge development. the recent debate between positivist and post-modernists notwithstanding, the building blocks of knowledge within the social sciences utilizing scientific method remain to be theories, constructs, models, paradigms and perspectives. a theory is the primary tool in the knowledge-building process. theories are supposed to be testable, measurable, and constructed of logically-linked concepts and principles. or, in babbie’s own words, “the credibility of a theory will depend on the extent to which: (1) our observations empirically support it, and (2) its components are systematically organized in a logical fashion that helps us better understand the world,” (babbie & rubin, 2005, p. 46.) discussion when considering the concept against the criteria for a theory, cultural competence does not meet the criteria for a stand-alone theory. it seems rather to be a perspective based upon a number of supportive social theories (such as socialization, theories of power, and theories about diversity) and values (such as equity and social justice). that it lacks the rigor of true theory need not diminish the value of the concept as a guide for social work education and practice. as a perspective, cultural competence can be viewed as a social construct that takes into account such factors as culture, politics, and history to help form a professional judgment. the inclusion of the variable of culture into the practice and education process is both a simple matter and a complex undertaking. it is, nonetheless, the basic element of cultural competence. systems theory cultural competence seems to have developed conceptually much like systems theory. systems theory was introduced in 1927 by ludvick von bertalanffy in his search for a unifying theory for the science of biology (vonbertalanffy, 1975.) when gordon hearn applied systems theory to social work, he pointed out that it was less a theory than a perspective and should be appreciated as such (hearn, 1958.) accordingly: life process is neither determined nor random. prior life processes shape the probability of future events . . . . prior life process shapes the probable range of future patterns of interaction. stochastic process refers to the flow of human interactions subject to continual change, within a range of probability of future process (hearn, 1976, p. 15-16.). similarly, the cross-cultural and pluralistic perspective in social work, referred to over 30 years ago, implies a conscious effort to break loose from the tendency to see social work practice exclusively in terms of one culture, class, or nation. it is in part an ongoing process of adding new dimensions and testing of values, gallegos et al./conceptualization of cultural competence 58 assumptions, knowledge and skills. it is a freeing from the limited culture-bound view of man and society (sanders, 1974, p. 47.). the usefulness of systems “theory” in social work cannot be denied. it can be seen as the forerunner of such contemporary social work models as strength-based perspectives or ecological perspectives. similarly, cultural competence may best be thought of as a social construct composed of a number of concepts and principles, some of which might qualify as theories and others not (see table 3). an example of contributing concepts is empowerment which for most authors seems to be a cornerstone of cultural competence. empowerment was initially introduced to the cultural competence discussion by barbara solomon in 1978, and, more recently, it has been refined as a cultural competence concept in the writings of lorraine guttierez (gutierrez, zuniga, & lum, 2005). as a whole then, cultural competence best fits the definition of a perspective, i.e., a way of looking at things. table 3. components of a social perspective for culture/economy/political systems. farley (2005), also see gordon hearn, systems theory (1969) sociological perspective: a way of looking at a question or problem. a perspective has three components: cultural competence as a perspective 1. an approach to a topic that helps to determine the kinds of questions that are asked about the topic. cultural competence as an approach to social work helps the profession to ask critical questions at the individual and environmental levels. 2. a theory or set of theories describing what is/are believed to be the realities of the topic. while not a theory in and of itself, cultural competence contains within its conceptualization a number of theories. 3. stated or unstated values concerning potentially-controversial issues related to the topic values of diversity and social justice are evident in any conceptualization of cultural competence. consequences the lack of intellectual consistency by which the concept of cultural competence has been presented leaves it open to criticism as a political ideology as is occurring with a number of critics [lee & farrell, 2006; mcelroy (nd)]. a spate of articles began to appear in the chronicle of higher education in december of 2005 and continued until as recently as october 2006 (wasley, 2006) describing a movement supported by the national association of scholars and the foundation for individual rights in education (fire) to question the accreditation standards in social work and in education that required curriculum which promoted social justice and diversity (chronicle of higher advances in social work, spring 2008, 9(1) 59 education, 2006; powers, 2006). the concerns were that these terms were being used to press a (liberal) political ideology on students of social work and education. the group of critics went so far as to threaten a law suit based upon the denial of civil rights of a student. an article in the october 2006 the chronicle reported that the national association of teacher education had withdrawn the “offensive language” referring to social justice from its accreditation requirements (chronicle of higher education, 2006). this backlash against cultural competence and the multiculturalism it represents is being seen globally as in anti-immigrant protests throughout europe. a cultural-competence perspective would appreciate in these cases that cultural competence may be different within societies just as the elements of democracy may be different in the mid-east or in the rules of the free market different in china. the failure of cultural competence to meet the standards/criteria of theory, notwithstanding, means students, practitioners, organizations, and institutions still should be held accountable for being culturally sensitive and to promote diversity and social justice. if cultural competence calls for the inclusion of the variable of culture into the social work process, then it is fundamental to effective practice. not to dilute the attention needed to address racism and discrimination but recognizing the universal value of cultural competence for social work would move our practice expectations from a specialized application of social work to a normative one. consider, for example, a study by boyle and springer (2001) in which four measures of cultural competency in the social work profession are analyzed and are found to measure global constructs that may not be applicable to specific cultures. and, as we can assess good social work, so can we assess cultural competence through models of evidencedbased practice and client outcomes. perhaps it is time for a new term that would incorporate the perspectives of cultural competence and good social work (koehn & swick, 2006). civic/civil competence might achieve such a conceptual task. the notion of civic competence infers a move beyond a focus upon the variable of culture only and beyond the implicit emphasis on ethnicity or race (klienman & benson, 2006; williams 2006). moving our attention from cultural competence to civic competence would place cultural competence within the realm of the assessment of concepts and principles of good social work such as are already applied to practice activities like trust building, therapeutic relationships, clinical observations, and assessment skills. on a macro scale, civic competence should represent a standard of assessment and analysis similar to that applied to issues of social justice. it is a value framework that incorporates culture in our critical analyses of power differentials present, for example, in gender and racial disparities as are found in poverty, discrimination, and oppressions. acknowledging cultural competence as a value-based way of looking at things would disarm critics who hold the concept to the light of empirical analysis. viewing cultural competence as a perspective and not a theory would also help practitioners to focus upon the specific variables of culture much as social workers focus upon the variables of psychology within an environmental context. this broader conceptualization recognizes the lack of conceptual specificity in definitions of cultural competence and the resulting difficulty to lend itself gallegos et al./conceptualization of cultural competence 60 to outcome assessments. this vagueness of the concept also exposes the concept of cultural competence to intellectual and 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(2006). understanding human behavior in the social environment (6th ed.). belmont, dc: brooks/cole. author’s note: address correspondence to: joseph s. gallegos, ph.d., director, social work program, university of portland. 5000 n. willamette blvd., portland, or 97203. e-mail: gallegos@up.edu. mailto:gallegos@up.edu microsoft word jones et al haiti disaster copyedit2 _________________ jenny l. jones, msw, acsw, ph.d., is an associate professor; karen smith rotabi, msw, mph, ph.d., is an assistant professor; and lisa a. gray, msw, lcsw, is a 2nd year doctoral student, all at the virginia commonwealth university, school of social work. jason k. levy, ph.d., is an associate professor of homeland security and emergency preparedness at virginia commonwealth university and director of the national homeland security project, the energy security policy research group and the undergraduate research opportunities program. the authors would like to acknowledge jean andre constant, msw and hilda chanchavac for giving voice to those affected by disaster in haiti and guatemala, respectively. their testimonies were critically important to making this learning experience real for students. funding for this flc was made possible form the center for teaching (cte) at virginia commonwealth university. both the financial and creative support was invaluable. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 279-290 an interdisciplinary approach to developing innovative teaching strategies for responding to global disasters jenny l. jones karen smith rotabi jason k. levy lisa a. gray abstract: this paper summarizes the development of an interdisciplinary faculty learning community (flc) bringing together the virginia commonwealth university, school of social work and government and public affairs, department of homeland security to develop an in depth, comprehensive pedagogical approach to the many issues associated with disaster risk reduction. as the title suggests, this is an interdisciplinary team that explores learning and demonstrates learning models. this particular flc focuses on understanding the antecedent conditions and root causes of disaster events. we explore best practices to prevent, mitigate, and prepare for such events in the undergraduate and graduate curriculum with an emphasis on homeland security and social work. the flc is an example of a non-traditional educational model providing content on disaster risk, response, and global impact. this particular flc was committed to bringing together appropriate expertise from the academic setting as well as inviting community members and organizations into the classroom to share the “lived experience” and intuitive knowledge about disaster. keywords: globalization, disaster relief, human rights, faculty learning community, interdisciplinary, natural disaster the impact of the 2010 haiti earthquake, the boxing day 2004 indian ocean tsunami, hurricane katrina, 9-11, and the gulf oil spill provide painful reminders of the vulnerabilities of communities to disaster risk. these events highlight the fact that natural, health-related, technologic and human-induced disasters are on the rise worldwide, including statistically-probable but unanticipated catastrophes as well as moderate-scale repetitive events. the responsibility of educational programs, including social work and other disciplines to provide opportunities for students to connect global content is magnified during a crisis. educational programs are struggling with how to infuse already packed curricula with new knowledge and skills related to combating social injustices while responding to environmental devastation. one potential mechanism for addressing this issue is to provide opportunities for students to engage in learning about global injustices outside the traditional classroom setting. this may advances in social work, summer 2012, 13(2) 280 include bringing those who have experienced disasters into the classroom for testimony in combination with response from experts on disaster and social problems. this paper summarizes the development of an interdisciplinary faculty learning community (flc) bringing together the virginia commonwealth university, school of social work and government and public affairs, department of homeland security to develop an in depth, comprehensive pedagogical approach to the many issues associated with disaster risk reduction. as the title suggests, this is an interdisciplinary approach to exploring learning and demonstrating learning models. this particular flc focuses on understanding the antecedent conditions and root causes of disaster events and explores best practices to prevent, mitigate, and prepare for such events in the undergraduate and graduate curriculum, with an emphasis on homeland security and social work. the flc is an example of a non-traditional educational model providing content on disaster risk, response, and global impact. this particular flc was committed to bringing together appropriate expertise from the academic setting as well as inviting community members and organizations into the classroom to share the “lived experience” and intuitive knowledge about disaster. ultimately, this increased opportunities for students to learn from enhanced and highly interactive curriculum. the flc also served as a vehicle for building collaborative partnerships for faculty at the school of social work with academics from across and outside the university. in order to engage students in this approach to learning in non-traditional classrooms, the partners developed a case study approach to learning. this paper begins with a review of the literature and establishes the case for using new and innovative approaches to learning, including a description of the flc development and process. we focus primarily on the haiti earthquake as a case study given its magnitude and because it was a catalyzing event in terms of the flc development. also, other subsequent case studies will be highlighted, to include british petroleum (bp) oil spill/hurricane katrina aftermath, and guatemalan mudslides. literature review recent trends in globalization are a challenge to the social work profession as a whole (lyons, 2006) and in turn this has created unique pedagogical challenges for disaster preparedness in health and human services curriculum. social workers practice in an environment where they come in contact with global social injustice frequently and they have “an ethical responsibility to the broader society to promote the general welfare of society, from local to global levels, and the development of people, their communities, and their environments”. this expectation is articulated in the national association of social workers [nasw] code of ethics, which emphasizes the need for social workers to advocate for living conditions conducive to the fulfillment of basic human needs, promote social, economic, political, and cultural values and institutions that are compatible with the realization of social justice (nasw code of ethics, 1999, p. 8). as a result, the goal of educating future social work and human services professionals to respond as ethical and competent practitioners, including advocacy and human rights considerations for vulnerable peoples continues to be challenge. jones, rotabi, levy, gray/teaching strategies for responding to global disasters 281 as a global profession, social workers should be aware of both the global and local concerns facing our profession (healy & link, 2011; lyons, 2006). immigrants, refugees, asylum seekers are only a few of the populations which social work has invested heavily and participatory inclusion of marginalized people in self determination (e.g. planning for and responding to disaster) is a core value for social workers (cookcraig et al., 2010; nash, wong, & trlin, 2006). teaching and learning strategies that focus on issues of diversity, globalization and disaster risk reduction in a non-traditional classroom setting provides an opportunity for students to be educated in a “ new field of practice” (cook-craig et al., 2010, p. 345) with specialized skills at the micro, mezzo, and macro levels that addresses the unique challenges faced by these populations. nagy and falk (2000) stress the education implications of addressing social problems that are caused by international crises and the growing tendency to solve problems by using policy approaches that are the result of an international cross-fertilization of ideas. as such, the study of global social work can better prepare students for working with diverse populations with a variety of social problems, many of experience issues related to social justice dimensions and inequality. this not only includes new and innovative solutions, but also multi-disciplinary approaches to the problems. as communities continue to struggle while coping with international and national disasters, social work professionals will need to be prepared to address the myriad of issues related to the trauma associated with disasters. the literature on the relationship between disasters and mental health, find that post traumatic stress disorder (ptsd) was most frequently be observed and ptsd is considered to be “probably the most debilitating psychological disorder that occurs after traumatic events and disasters” (satcher, friel, & bell, 2007). the stressors associated with disasters and traumatic events are numerous—including special considerations for children (gammonley & dziegielewski, 2006) and often the condition goes unaddressed in the immediate disaster response and later undiagnosed in the long term. even simple grief and loss is important for social workers to understand more fully in the case of disasters. grief and loss can be experienced and expressed in a variety of ways that include physical, emotional, cognitive, behavioral, social, and spiritual dimensions (corr, nabe, & corr, 2003); also loss of family, loss of status in community, fear (potocky, 2008); and, violence against women (enarson, 1999). often grief and loss behaviors differ across race, gender, ethnicity, and cultural groups thereby creating even greater challenges for delivering competent health and human services. the frequency and disturbing toll of natural disasters around the world have increased exponentially during the last 30 years (emergency disaster database, 2007). schools of social work are poised to partner with other disciplines to engage students in practice that combats social justices, confronts human rights abuses, and promotes global citizenship. beginning with haiti as a case study the earthquake that struck haiti in january 2010 was one of the most devastating moments in the contemporary history of the americas. globally, millions witnessed the advances in social work, summer 2012, 13(2) 282 event as outsiders looking in through the lens of international media. images of dazed and confused haitians desperately searching for the family and friends among the rubble were profound and deeply troubling. the social justice and human rights dimensions of haiti’s poverty and pre-earthquake infrastructure—including simple and inadequate building codes—became discourse as the news covered the tragedy. for many us citizens, the gross social inequality in this neighboring nation-poorest of nations in the western hemisphere (united states central intelligence agency, 2010) -became real, in their personal understanding for the first time. a collective shock occurred as consciousness was raised about not only the grief, loss, and trauma, but also the global social stratification and economic inequality in which haiti is entangled. for many, haiti became a case study of poverty, globalization, international debt and related social justice dimensions and human rights abuses. as we searched for a way to put the disaster into perspective, students wanted to know more about haiti and how to intervene and offer more assistance. the sheer volume of information about haiti, in the immediate and the aftermath of disaster were difficult for most to digest. and, fundamentally, many were called to action through voluntary donations and other forms of ‘helping’ as a personal coping mechanism. most needed a ‘debriefing’ to process the graphic images seen in the media in order to resolve secondary trauma from bearing witness to the disaster (cunningham, 2004). exploring the causes and consequences of haiti’s poverty became a source of discourse on college campuses across the usa. recognizing this need, several student groups combined resources to develop an event entitled forum on the disaster in haiti: early reflections on humanitarian assistance and beyond held at virginia commonwealth university. the event took place within two weeks of the disaster and a key speaker invited to participate was a trained professional social worker (msw-level) who had recently returned from an emergency trip home to haiti to search for lost family members. as a guest speaker, the personal and lived experience of this trip to haiti offered insight into the depth of the tragedy, and was documented as testimony to which a panel of experts responded. panelists included a social work faculty member, a school of government faculty member, an executive director of a small organization focused on empowerment and development work in guatemala, and a staff member of oxfam who joined the panel via video-telephone communication. the overall program was facilitated by faculty members in the school of social work. the students who participated were those involved in sponsoring the event, including the association of black social workers and an “americas interest group” called “la milpa.” also, several social work classes joined the event. finally and importantly, members of the community participated including the director of the local chapter of the american red cross. this element of local relevance was an added value because it gave practical solutions for local community for haitian living locally, and the red cross is the leader in disaster assistance. review of panel discussion the key speaker for the event, a haitian born msw began with his personal story of losing a brother and sister-in-law in the quake, showing photos of the family home that jones, rotabi, levy, gray/teaching strategies for responding to global disasters 283 was left in ruin. he had the unfortunate task of searching for the remains of his family lost under the rubble. talking about this trauma helped the audience understand the transnational relationship between many haitians living in the usa and the island nation. he reflected on the nation’s history of slavery and debt obligations to france in which is well over 50% of the national budget went to debt repayment (johnson, 2009). this fact was undoubtedly a surprise to many in the audience and it illustrates economic inequality in a way which is undeniable and brings to bear issues of colonialism in real and pragmatic terms. the oxfam america representative talked about her experience on the ground in the nation in the early days and she focused on community capacity and hope. she reflected on the human condition in such extreme circumstances, talking about the public health threats in the make-shift camps for homeless haitians while reflecting on the many issues, as well as opportunities. many students were surprised to learn that oxfam had closed its donation system because they had reached financial saturation in terms of their organizational capacity to respond to the crisis (personal communication, coco mccabe march 24, 2010). a social work faculty member then presented on a policy paper (rotabi & bergquist, 2010) focused on responding to the problems of orphaned and vulnerable children in the nation, emphasizing the importance of preventing human trafficking. included was the highly publicized attempt to abduct children for intercountry adoption into the usa (thompson, 2010). also, restaveks-children who are sold into child labor in haiti— were also discussed with considerations for culture and social class. this particularly complex discussion was framed with the united nations alternative care of children agreement (2009), which provides a framework for understanding international standards of child care and protecting orphaned and vulnerable children. related guidance includes use of institutions for care of children verses family based solutions, all within the value system of the best interests of the child. further, some guidance is found in this international instrument for disaster situations, including evacuations of children for medical reasons. our panelist from the school of government reflected on the bigger picture of disasters, reminding us that responding to disaster is something that all nations must have a plan. the circumstances in haiti, as underscored, can happen anywhere and we must ask ourselves if we are personally ready here in the usa. also noted was the fact that the international relief community is being pushed to the limit by the unparalleled intensity, frequency and scale of natural disasters and catastrophes. he recalled that in 2009, 335 natural disasters occurred worldwide, killing 10,655 persons, disrupting the lives of 119 million others, and causing over us$ 41.3 billion economic damages. asia accounted for nearly nine-tenths of global reported natural disaster victims and more than a third of total worldwide economic damages (vos, rodriguez, below, & guha-sapir, 2010). these events highlight the fact that natural, health-related and technologic disasters are on the rise worldwide, including statistically-probable but unanticipated catastrophes as well as moderate-scale repetitive events. finally, the panelist acknowledged that disaster research has made great strides since the pioneering work of disaster behavior (prince, advances in social work, summer 2012, 13(2) 284 1920) and hazard mitigation (white, 1942); adding, the debate continues over “what is a disaster?” (quarantelli, 1998). our final panelist was a community partner who presented on the colonial history of the island nation, reminding us how us foreign policy has led to significant problems in the neo-colonial era in which global policies continue to enslave the people of haiti. comments specific to hope for the haitian people to be given an opportunity to have a voice in rebuilding their nation with their vision and cultural value system setting the agenda was presented. this particular heart-felt presentation was a good wrap-up to content about global oppression and empowerment. finally, students from the social work program enrolled in a crisis intervention class, provided comments on their assessment of local resources for disaster intervention. the wiki page developed by the class for the assignment was also identified, illustrating the use of technology to communicate about disaster and respond appropriately. these students modeled ‘learning in action’ and their project was open to the audience for further contribution and consideration. haiti disaster a catalyst for flc development it should be clarified that this first event was not officially developed as a flc activity. it was, actually, a catalyst which brought together a group of faculty, students, and community members. this forum was not only a one-time success, but the involved faculty agreed to develop a “haiti six months later” event in the fall of 2010. ultimately, the result was the development of the flc itself which executed this second event as well as several other case studies over 2010-2011 academic year, including consideration for the important question posed earlier, “what is disaster?” the learning content specified in the flc reflected core values of the social work profession: service, social justice, dignity and worth of the person, importance of human relationships, integrity and competence (nasw, 1999). additionally, the flc learning activities were in alignment with core competencies outlined in the educational procedures and assessment standards (epas) from the council on social work education (2008). seven core competencies reflected in the flc are: epas 2.1.2, apply social work ethical principle to guide professional practice; 2.1.3, apply critical thinking to inform and communicate professional judgments; 2.1.4, engage in diversity and difference in practice; epas 2.1.5, importance of advancing human rights and social and economic justice; epas 2.1.8, engagement in policy practice to advance social and economic well-being and to deliver effective social work services; and 2.1.9, respond to context that shape practice. these standards were integrated throughout the flc event described below. see table for summary of core competencies and application of practice behaviors embedded in these disaster education activities. haiti revisited six months later this second event “haiti revisited six months later” summarized that what was known about the earthquake and subsequent humanitarian and development assistance. strengths and weaknesses were explored with reflections from many of the same jones, rotabi, levy, gray/teaching strategies for responding to global disasters 285 panelists and participants from the first event. an enhancement for this particular event was the involvement of undergraduate students in the school of government who were given a class assignment that involved constructing poster presentations, describing the impact and progress of the earthquake on the haitian people six months later. those presentations were juried by university faculty, and were later displayed on campus. the power of this second event was reflective capacity. also, organizing faculty had more time to actually implement the event. as a result, the student poster assignment was integrated into the activity. for many of the undergraduate students participating, this was a first opportunity to present their work in a large forum, using their voice and creativity to illustrate core concepts and knowledge related to the history of haiti, earthquakes as a disaster experience, and post-disaster responses. mudslides in guatemala later in the fall of 2010, mudslides in guatemala became an emergent disaster opportunity for consideration when well over one hundred people perished as a result of heavy rains and resulting mudslides in this central american nation. drawing upon the resources from our haiti flc, we partnered with the local organization the highland support project to bring to campus one of their community health promoters to present on her lived experience of responding to the mudslides. this particular health promoter, an indigenous woman, was invited to campus to present photographs of the devastation. the focus of the presentation was for her to give personal testimony based on what she saw and experienced in the aftermath of the disaster. the event was structured so that she not only had ‘voice’, but the concept of self-determination was clear in her presence—our guest speaker was speaking for herself and the indigenous communities that she serves. this speaker spoke also of the dynamics of help from outsiders, including faith-based approaches which are encroaching upon traditional religious practices and beliefs of mayan indians. this particular aspect of the testimony underscored the power and oppression that obstructs self-determination of indigenous peoples as they struggle with poverty and the devastation of disaster. when faith groups seize upon desperation and offer disaster assistance with expectations that long-term relationships and opportunities related to proselytization will be formed, the power to preserve traditional faith beliefs and rituals is at risk if not under attack (manewal, 2007). additionally complicating to the issue are elements of colonialism and social stratification which were a part of the discourse given the fact that guatemala has some of the greatest structural inequality in the western hemisphere and indigenous people bear the greatest injustices (united states central intelligence agency, 2012). all of these complex elements were brought together in a powerful testimony of not only despair, but also hope as community resilience was ultimately a critical part of the rebuilding discourse. gulf coast oil spill and the aftermath of hurricane katrina given the recent disasters of the gulf coast, the flc held in the spring of 2011 focused on the deleterious impact of the bp oil spill of the gulf coast, while reflecting advances in social work, summer 2012, 13(2) 286 on the devastation caused by hurricane katrina. students and faculty alike participated in a 2.5 hours discussion on the implications of policy and practice on these disasters, with an emphasis on the impact of minority and vulnerable populations. the goal of the event was to elicit discussion on how to improve disaster preparedness in the u.s. and to educate students on existing policies i.e., the robert t. stafford act (2007), and practices that influenced the handling of hurricane katrina and the bp oil spill. an expert panel of clinicians and policy practitioners were convened to highlight areas specific to mental health symptoms and treatment in children and families, social and economic impact these disasters had on the region, and the lack of communication among policy-makers specific to levels of authority. the discussion specific to policy practice focused on the robert t. stafford disaster relief and emergency assistance act (2007), public law 93288, which highlights provisions of the act related to emergency management and case management services. a limitation of this policy as it relates to the case management feature is there are no guidelines specific to training case managers to practice in a culturally responsive manner. this has major implications for minority populations that are impacted by disaster. panelists provided an overview of the two provisions and engaged students in a dialogue about the connection between policy and practice, and how often one shapes the other. student were encouraged to participate in policy practice to include advocacy via letter writing, making phone calls, coalition building, and grassroots organizing. one of the panelists, a policy professor in the school of social work, engaged participants in a discussion specific to the lack of federal policies in place specific to the handling of oil spills (questions were raised around responsibility for clean-up, timeliness of the cleanup, and response to the families affected), all which ultimately impacted the gulf coast communities economically, physically and emotionally. resources specific to federal initiatives to improve conditions for those impacted by these two disasters were also discussed. the guest panelist from florida state university, college of social work (via skype) spoke about changes made to the stafford act regarding case management procedures in a natural disaster. discussed was the provision of case management services after a disaster occurs and the need for culturally competent case management training for social workers that provide such services, particularly in the wake of hurricane katrina and the gulf oil spill. a second guest panelist from the school of social work that specialize in treating trauma in survivors of disaster led the participants in a discussion on best practices for intervention with trauma victims. the discussions referenced the levels of trauma experienced by hurricane katrina victims, and drew parallels of grief, loss, displacement, loss of community, and loss of value for those impacted by the oil spill. participants shared their personal reflections and stories of family and friends impacted by the disasters, reflecting on grief and loss, displacement, health concerns, and lack of communication related to available resources. following the panel discussion, the flc led a segment on a “call for action” which encouraged participants to engage in critical thinking to explore ways in which they could aid their communities in disaster preparedness. this discussion included identifying available resources, locating volunteer opportunities, and engaging in the jones, rotabi, levy, gray/teaching strategies for responding to global disasters 287 development of new policies and research avenues aimed at increasing social workers response to future disasters. table 1: application of education standards to disaster response for haiti earthquake, gulf oil spill and guatemalan mudslides human rights issues gathering knowledge & applying values application of knowledge and values core competencies haiti: alternative care of children and child trafficking knowledge: analysis of orphaned and vulnerable children/institutional care values: importance of kinship care, culturally relevant care, and practice of not removing traumatized children from their communities witnessing testimony of a haitian who searched for his family member’s bodies in the rubble use of assessment and social work values to arrive at a just and ethical intervention for orphaned and vulnerable children. critical thinking and discourse about global social inequality, extreme poverty, humanitarian and development assistance in addition to international debt load 2.1.2; 2.1.3; 2.14; 2.15; 2.1.8; and 2.1.10 gulf oil spill: clean water and work rights related to fishing, etc knowledge: identification of causes and consequences of deep sea drilling and connections to healthy oceans values: dignity and worth of the person and social justice critical thinking about global corporate rights over individual and family rights and social workers role in response to economic justice and trauma, including substance abuse, unemployment, depression, and suicide. 2.1.5 and 2.1.9 guatemalan mudslides: indigenous population rights in context of deforestation & global rainfall changes knowledge: identification of causes and consequences of environmental rainfall changes (global warming). values: dignity and worth of persons— especially vulnerable populations like indigenous people and their self determination. social planning analysis as related to effective responses to environmental derogation in the context of global warming and international humanitarian and development assistance. implications for indigenous populations and the inherent dilemmas. critical thinking about global corporate rights over individual and family rights and social workers role in response to economic justice and trauma including, substance, tribal rights, and depression. 2.14 and 2.19 advances in social work, summer 2012, 13(2) 288 lessons learned disaster resilience has become a topic of intense discussion in the natural resources and policy research communities where resilience is defined as the capacity of a system, community, or society to successfully adapt to extreme events. hence, a disaster resilient community is able to withstand these external shocks, persist, and rebuild itself when necessary, using the hazards associated with sea level rise and climate change as an opportunity to build back stronger (un/isdr, 2002). the resilience concept should be embraced by disaster educators that are working with communities to improve decisionmaking under conditions of uncertainty and rising risk: applications range from "safefail” engineering systems to robust financial instruments (i.e. portfolio hedging) for coping with catastrophe. the most valuable disaster management strategies are robust despite rapid changes in environmental variables and unanticipated outcomes. this emerging and holistic concept of community disaster resilience requires educators to recognize that lives and property can be secured through sustainable local preand postdisaster planning in advance of an extreme sea-level event, just as homes raised above the expected flood elevation (“homes on stilts”) are better designed than many non-elevated structures to absorb the shock of an inundation event. disaster resilience can help communities to overcome pathological behavior (including unsustainable livelihoods, institutional rigidity, social dependencies, political hegemony, and ecological degradation) by viewing human culture as embedded within nature; dependent on it, and capable to harm it. however, despite decades of conceptual debates there remain challenges related to the definition and operationalization of disaster resilience, particularly in the context of mitigating and adapting to the impacts of sea-level rise and disaster losses continue to mount. bringing these concepts to life in the graduate and undergraduate classroom can best be achieved by:  bringing in speakers 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(1942). human adjustment to floods: (research report no. 29). chicago: university of chicago, department of geography. united nations. (2009). guidelines for the alternative care of children, human rights council, eleventh session resolution 11/7. retrieved on february 1, 2010, from http://ap.ohchr.org/documents/e/hrc/resolutions/a_hrc_res_11_7.pdf united states central intelligence agency. (2012). the world factbook: guatemala. retrieved from https://www.cia.gov/library/publications/the-worldfactbook/geos/gt.html united nations inter-agency secretariat of the international strategy for disaster reduction (un/isdr). (2002). living with risk: a global review of disaster reduction initiatives. retrieved from http://helid.digicollection.org/en/d/js2653e/ author note: address correspondence to: jenny l. jones, ph.d., virginia commonwealth university school of social work, 1001 west franklin street, p.o. box 842027, richmond, va 23284-2027. email: jljones2@vcu.edu advances vol. 1, no. 2 ffaaccuullttyy--ssttuuddeenntt ccoollllaabboorraattiioonn:: iissssuueess aanndd rreeccoommmmeennddaattiioonnss angeline barretta-herman kendra j. garrett abstract: this exploratory qualitative study of 11 social work faculty identified the benefits and risks of faculty-student collaboration. benefits articulated include helping students learn to write for publication, learning the publication process, getting innovative student material published, and enriching the project through shared problem-solving. the benefits, however, must be weighed against the risks of exploitation of the student collaborator. successful faculty-student collaboration in this dual relationship demands that faculty take responsibility for safeguarding boundaries, following the nasw code of ethics, and openly negotiating roles, tasks, workload, and order of authorship with the student. keywords: faculty-student, collaboration, mentor, multiple authorship, dual relationship, publication ethics academia encourages faculty-student collaboration in research and publication as a strategy for creating a mentoring relationship and providing students with a valuable opportunity to gain experience in working with a proven researcher (austin & baldwin, 1991). nevertheless, there are risks that must be acknowledged when forming faculty-student collaborations (congress, 1996). the nasw code of ethics (nasw, 1996) prohibits dual relationships in academia when there is a “risk of exploitation or potential harm to the student” (section 3.02 (d), p. 19). students are dependent on faculty for expertise, grades, and references, leaving them in a less powerful position (see leatherman, 1997). the power differential inherent in the faculty-student relationship carries over into the collaborative relationship (kagel & giebelhausen, 1994). bonosky (1995) suggests that educators have a fiduciary accountability to protect students who are dependent on the knowledge and skills of the faculty. thus, it is the faculty’s responsibility to set clear boundaries and protect students from exploitation. this is particularly pertinent when the student works with faculty on a research project that could potentially lead to publication or co-authorship. because of these concerns, the authors conducted exploratory qualitative research to learn the perceptions of social work faculty who had participated in faculty-student collaborations. this was viewed as a critical first step toward developing ethical guidelines. 148 angeline barretta-herman, ph.d. is professor and m.s.w. program director, and kendra j. garrett, d.s.w. is assistant professor, school of social work, college of st. catherine/university of st. thomas, st. paul, minnesota, usa. copyright© 2000 advances in social workvol. 1 no. 2 (fall 2000) 148-159 . indiana university school of social work. review of the literature faculty-student collaboration as the major focus (fine & kurdek, 1993; netting & nichols-casebolt, 1997; over, 1982) or as part of discussions on collaboration (austin & baldwin, 1991; krysik & nichols-casebolt, 1994), mentorship (wright & wright, 1987), and multiple authorship (gelman & gibelman, 1999; zook, 1987) has received limited attention across the disciplines. discussions of collaboration and coauthorship between colleagues of equal or unequal rank has dominated the literature. benefits of collaboration several benefits to collaboration are noted in the literature. aram, morgan, and esbeck (1971) assert that collaboration promotes psychological well-being by penetrating the barrier of academic isolation. collaboration can assist the student or academic neophyte to negotiate the maze toward publication (wright & wright, 1987). for colleagues, collaboration can serve to generate ideas, maintain momentum, emphasize individual expertise, and provide opportunity for faculty to develop new skills (mccullagh, 1988). research by gordon (1980), presser (1980), and endersby (1996) suggests that collaboration is particularly beneficial when conducting interdisciplinary research. zook (1987) notes that the challenge to remain current in this period of exponential knowledge and methodological development demands collaboration among colleagues because “the chances that a given individual can maintain currency with a wide spectrum of fields is increasingly. . . remote” (p. 78). impact on tenure and promotion the literature reports wide variations in academia regarding the relative importance of solo, dual, and multiple authorship. bayer and smart (1991) note that the biomedical fields and “hard sciences” are highly collaborative in stark contrast to the humanities, which have “markedly lower rates of collaboration” (p. 613). they suggest that a biomedical scientist with a solo pattern of publication might be considered suspect when compared to a colleague with a collaborative pattern. the latter colleague is likely to be viewed as a “team player” (p. 614)—able to work with colleagues, learn from them, and expose his or her work to critical commentary. endersby (1996) concluded that “collaboration in the physical sciences is the norm. . . and the number of credited authors is increasing in most disciplines” (p. 376). in the humanities where work in libraries and archives is performed independently, collaboration is less common. here, the primacy of solo scholarship is most apparent in tenure and promotion decisions. collaboration for developing scholars can be particularly detrimental in settings where solo authorship is deemed supreme (austin & baldwin, 1991; fox & favor, 1984). the case is much the same in the social work profession. netting and nichols-casebolt’s (1997) respondents agreed that “sole authorship is important for tenure and promotion decisions in schools of social work. single authorship demonstrates one’s ability to do independent scholarship” (p. 562). author order bayer and smart’s (1991) research on author order in multiple authorship highlights the wide variations in protocol. in some fields, senior faculty traditionally 149barretta-herman, garrett/faculty-student collaboration: issues and recommendations take the first author position. however, martin’s study (cited in bayer & smart, 1991) noted the “reverse snobbery” practiced in selected disciplines that place the senior faculty last. “authorship order is not entirely a function of just individual attitudes. it is also a reflection of differences in disciplinary practices” (p. 616). endersby (1996) highlighted discipline-based protocols. he found that although social sciences most often cite multiple authorship in alphabetical order, there are dramatic differences within the social sciences. “four-fifths of economists list authors alphabetically, only a third of psychologists do” (p. 382). the american psychological association (1992) published ethical standards for reporting and publishing of scientific information. the standards mandated that psychologists should not present the material of others as their own, nor credit others who did not contribute to the work. psychologists were advised that “mere possession of an institutional position. . . does not justify authorship credit” (section 6.23(b), p. 1609). with regard to faculty-student collaboration, the standards state that a student is to be principal author on any article that is “substantially based on the student’s dissertation or thesis” (section 6.23 (c), p. 1609). the social work code of ethics (nasw, 1996) concurs regarding acknowledging the credit of others. “social workers should take responsibility and credit, including authorship credit, only for work they have actually performed and to which they have contributed” (section 4.08 (a), p. 24). the challenges of collaboration the potential conflicts in assigning credit, identifying the origin of the idea, negotiating author order, and determining “substantial credit” can be a “matter of individual perspective” (floyd, schroeder, & finn, 1994, p. 744). the apa publication manual (1994) attempts to distinguish between substantial professional contribution to a work (formulating the problem or hypothesis, structuring the experimental design, organizing and conducting the statistical analysis, interpreting the results, or writing a major portion of the paper) and lesser supporting contributions for which only acknowledgment might be necessary (such as suggesting or advising about the statistical analysis, collecting or entering the data, and recruiting participants). however, the challenge of distinguishing between substantial and supporting contributions is widely acknowledged, and that distinction may become more or less clear over the life of the project. it is important to explore understanding of this complex issue for three reasons. first, discussion of faculty-student collaboration in social work is in its initial stage. the lack of research, literature, and guidelines is acknowledged in the literature (gibelman & gelman, 1999). second, encouraging faculty-student collaboration is one means to prepare “the next generation of social work scholars” (netting & nicholscasebolt, 1997, p. 563). and lastly, the social work profession has been challenged to increase research productivity (task force on social work research, 1991). through mentoring, faculty-student collaborations may provide a way to make student scholarly work available to the professional community and support faculty scholarship. methodology the authors chose a qualitative research design due to the exploratory nature of the research and their desire to gain in-depth understanding of the respondents’ 150 advances in social work experiences. gibelman and gelman (1999) point out the improbability of gathering reliable data on unethical practices through survey research. using a modified snowball sampling technique, the authors sought to draw a regionally representative sample of social work faculty who had experience being in a faculty-student collaborative relationship either as faculty or students. as table 1 indicates, 11 taped interviews were conducted with faculty from all parts of the country. a respondent gender balance of five women and six men was achieved. faculty rank was unevenly balanced among the three ranks of assistant, associate, and full professor, with six of the 11 respondents holding the assistant professor rank. although half the respondents are presently in teaching institutions, eight described collaborative relationships that took place in research institutions. respondents were initially contacted by phone with a description of the research. if they agreed, a consent letter was sent describing the types of questions they would be asked and detailing the arrangements for the interview. respondents were asked to describe their experience in a faculty-student collaboration of their choosing. the researchers did not intervene in that choice but asked only that the respondents choose an experience with collaboration details they could recall and an experience they wanted to discuss. it is important to note that of the six student collaborations that respondents chose to describe, three occurred 10 or more years ago. the respondents were asked questions regarding the process, including workload decision-making, determining authorship order, satisfaction with the process, other collaborative work, and recommendations for successful collaboration. five face-to-face interviews were conducted at a place of the respondents’ 151 respongender rank location position kind years gender of dent as of since collaborator(s) collaboinsticollaborator for tution ration this research 1 f asst. south student research 10 f 2 m asst. midwest student research 3 m 3 m full midwest faculty research 2 m,f 4 f assoc. west faculty teaching 2 m 5 f full southwest faculty research 2 f 6 m asst. east student research 5 m 7 m asst. northwest student research 10 f 8 f full east faculty research 1 f 9 m asst. midwest student teaching 20 m 10 f assoc. midwest faculty teaching 5 f 11 m asst. southeast student research 2 m table 1: demographics barretta-herman, garrett/faculty-student collaboration: issues and recommendations choosing; the rest were conducted using a speakerphone in order to audiotape the interviews. the tapes were transcribed and independently analyzed to identify categories and themes, employing standard manual content analysis techniques. confidentiality was of major concern to several of the respondents who expressed concern that the details of their experience, if reported accurately, would unnecessarily embarrass or anger their collaborators. the researchers carefully selected quotes and described the reported experiences. to protect the confidentiality of the respondents, drafts of the finished manuscript were sent to all respondents for review. respondents were asked to review and comment on the manuscript. no respondent requested that any reference or description be altered or excised. sending the manuscript for review had a second, but equally important function. respondents’ review and comment on the manuscript enhanced its accuracy and validity. results although all of the respondents currently hold a faculty position, six were students at the time of the collaboration. they are described below as “student collaborators.” those who were faculty at the time of the collaboration are labeled “faculty collaborators.” none of the respondents’ schools had policies, formal or informal, about facultystudent collaboration for publication. one faculty collaborator indicated that final projects were viewed as an opportunity for such collaboration, but faculty were left on their own to determine how that collaboration was to occur. three respondents indicated that they had created their own rules to guide the process. one discussed being very clear about the equality of authorship credit and described her experience as an application of a feminist model. another indicated that the student is always the first author in a collaborative effort between herself and a student. decision making and planning faculty members, rather than students, initiated most of the reported collaborative efforts. there was a beginning phase in which faculty chose students with whom they felt comfortable and who were interested in similar topics: as she and i worked on developing [a classroom assignment], i really was impressed with the work on it and we talked about the possibility that maybe we would work together to publish it when she finished the course. after she finished her assignment and graduated, we worked on it over the summer and it became published. faculty viewed the students with whom they collaborated as among their best students: i got involved with [the students] because they had been with my advanced research class. . . the students at [location] were extremely bright, hard-working people. i could have picked any one of 20 students in that research class, but i picked these three women. the faculty initiated discussions about roles, tasks, responsibilities, or order of authorship before the collaboration began. three faculty collaborators indicated that they felt it was important to discuss roles and expectations and the way the collaboration would take place before deciding to work together. when no discus152 advances in social work sion about the collaborative process occurred, student collaborators assumed that the faculty collaborator would assign tasks. they felt humbled by the prospect of writing a professional paper for publication, were pleased to be involved, and rarely thought about authorship issues. some described themselves as naive about how collaboration generally takes place and expressed a wish that there had been a discussion about the collaborative processes, what was expected, and how authorship would be determined. one student collaborator said: there was never any discussion about tasks and who was going to do them other than that the two experienced faculty members were going to do the majority of the work. so, for the most part, i didn’t do any of the writing. i was wondering about that, but i wasn’t assertive about it, and i wasn’t clear about what i should be doing. one faculty collaborator used what she described as a feminist model in writing, in which collaborators shared the work but did not, in her words, “worry about the amount” of each person’s contribution. authorship order in this case was alphabetical. the planning done by this group was an ongoing process. some people felt much more comfortable with the majority of the literature search and literature review. other people had other strengths. it was a process we went through as we worked through and sometimes shifts would be made. . . it was always a process. . . always in motion, which might drive some people nuts. the collaboration process respondents described a broad range of activities under the term “collaboration.” some shared responsibility equally, others had a relationship in which one person (usually the faculty collaborator) took major responsibility for assigning roles and tasks, one did virtually all of the work, and others described shifting responsibilities. one faculty respondent advocated for a partnership involving compromise and shared ownership: when you are collaborating, you spell out and develop and reach consensus on what the project is so that everybody has ownership. so, if i come to you with a project, we have to massage that and incorporate your ideas so that we’re really looking at something that’s the whole. we talk about shared power; we talk about how decisions are going to be made; we talk about how conflict is going to be resolved. i think that it’s really a collaboration when two people come together and give up some pieces. . .when we both come with our distinct roles and they don’t at some point merge, then, that’s not collaboration. . . you’ve got to have something that everybody owns. respondents also described a wide variety of working styles. some would meet regularly to compare notes and combine what they had written separately. one pair sat together in front of a word processor and composed simultaneously. some wrote independently, then blended the parts together. most described meetings in which joint work was discussed either before or after it had been entered into a document. one student collaborator who felt less satisfied by the collaborative effort described reporting to the first author who did not reciprocate by sharing information. 153barretta-herman, garrett/faculty-student collaboration: issues and recommendations power issues four faculty collaborators indicated a desire to work together and encourage students to work with them as equals or partners. they acknowledged that this was difficult at first, as students were accustomed to viewing the faculty person as an evaluator. initially, even when faculty members were working toward a sense of partnership, students were hesitant to challenge them. “i think the issue of power became problematic . . . because i was bending so hard over backwards not to be using power. . . i felt a little bit taken advantage of.” one faculty collaborator indicated a sense of responsibility to set guidelines or boundaries because of the power differential: i am always very clear that i’m the professor with the student, the authority. and with a [msw] graduate, there hasn’t been much of a [power] shift. with a doctoral student, the shift comes fairly quickly that they [move] to a co-equal status before they begin [the collaboration]. student collaborators also commented on the need for equality to feel a true sense of collaboration. one felt mentored by his faculty person who encouraged him to express his ideas and take ownership of the project. others did not feel their faculty collaborator shared power with them. they were continuously aware of their lower status and aware of the extent of their dependency on the faculty person, “i did feel very vulnerable during the whole process. i felt subservient. . . [i] definitely felt a sense of hierarchy and a certain amount of fear that if i didn’t play the game right i wouldn’t get my ph.d.” of the six student collaborators interviewed, five felt that the faculty person with whom they collaborated had exploited them in some way. these former students talked about how they felt betrayed by someone they trusted to look after their interests. four spoke with anger and a sense of pain because of what they perceived as a clear misuse of power. i did all the research on it and wrote up the paper, pretty much the whole thing, and then we got back together and recommendations were made about how it could be changed, and then i would go back and change it because i was the one who had it on the computer. . . but it finally came after multiple revisions. . . to a version that we sent out to a publisher and basically it went out with my name second on it. it is important to note that none of these student collaborators had communicated their anger or concern to their faculty collaborator. two expressed concern that their faculty collaborator not be identified or learn that they had participated in this research. two others indicated that they knew that their faculty collaborators had published their material without giving the student collaborator credit because colleagues had informed them of it. however, neither had personally looked up the published article and both expressed a reluctance to do so. i never tried to find [the article published by my professor]. i think that i was so stunned by it all that i just kind of went on. i think that basically i was in a very vulnerable place personally at that time. i think the reason that i didn’t try to find out more about it is that i didn’t have the psychological strength to deal with it because it felt like it was going to be a conflict. 154 advances in social work costs of collaboration student collaborators talked about the process as an exchange. they gave up some independence and solo authorship in exchange for help from the faculty person and experience in the publication process. “at the time i don’t think i did [feel taken advantage of]. now i do. but, like i said, at the time. . . i was fairly happy to be getting what i wanted.” three former student collaborators still feel confusion about the collaborative process, and especially about feelings towards their former faculty collaborators. they questioned their own feelings and judgment. they wondered how responsible they were for having been taken advantage of by the person in power. one student collaborator spoke about the internal contradiction he felt towards his former mentor, indicating that he felt a fondness for the mentor while at the same time knowing the mentor was using him. he indicated that the confusing boundaries of that relationship still haunt him many years later. another student collaborator doubts his ability to read the situation: part of me says that i don’t have a policy, nothing to go on, so, is it just me? or, is this really unethical? that’s a big part of why i hesitate. there isn’t anything to compare what i see has occurred and what’s appropriate. . . i guess i’m kind of torn and ambivalent about it. on the one hand, i’m irritated by it because of all the work i put in. on the other hand, i don’t know. i don’t have anything to compare it with—whether this was o.k. to do. another cost of a poorly structured collaborative relationship between faculty and student merits mention. two of the student collaborators who felt they had been exploited by a faculty collaborator indicated that they are now reluctant to enter into faculty-student collaborations: “i think that i’ve been pretty hesitant to [collaborate with students]. i haven’t sought it out...and, i hadn’t really thought about why not. . .maybe because of my bad experience, i worry about the boundary issues.” perceptions of other students three respondents mentioned reactions from other students regarding the facultystudent collaboration. one student collaborator indicated that his fellow students were quite accepting of the collaboration and expressed a wish that they could also find such a mentoring relationship. a faculty collaborator indicated that she always waits until after a student has graduated before initiating a collaborative project so that the collaboration does not affect relationships in the classroom. another expressed a desire to keep the collaboration quiet: i’m not sure that other students were aware of [the collaboration] and i think that it was [deliberate], because how could i explain that these nine were part of it and others weren’t? it was a matter of hurt feelings or feeling like maybe they weren’t liked. so, i’m not sure that i made other students that widely aware of it. it was a sticky piece. . . i really didn’t want other students to know about it. faculty as mentor faculty collaborators assume part of their role is to mentor students and help them learn to publish. they spoke of the satisfaction in helping students move 155barretta-herman, garrett/faculty-student collaboration: issues and recommendations beyond the student role and become contributors to the knowledge base of the profession. “i felt like i had a part in getting something important into the literature. i really felt like it was a wonderful, important study. that was fun and i liked the feeling of nurturing somebody.” another said, “my goal is ... to help them really learn how [to publish] ... so i see it as an apprenticeship learning.” others spoke of the responsibility of faculty, once they are established in their own careers, to help others become established as well. that is kind of the role i see myself in as a faculty member. . . to help develop people’s capacities and skill to a point where they demonstrate it ... through some type of publication in a scholarly journal. a student collaborator indicated gratitude for the willingness of a senior faculty person who shared time, effort, and first author status to help him begin his writing career: “i felt very honored just to be working with somebody with that stature. somebody who has all those skills but is very willing to give—it’s a gift.” student collaborators expressed their desire for help in learning how to publish, and some described experiences in which they received it: i did write another paper. . . [and] some professors looked at it. one professor in particular, worked with it, helped me, taught me how you do it, and that paper got published. and, i was sole author on it. he did not put his name on it at all, but that paper was a published paper. i think that i learned a lot from him in terms of how you can help students with that. collaboration in social work respondents expressed the opinion that collaborative work was valuable and a model toward which to strive. they indicated a satisfaction and enjoyment they had with collaboration, which was not there when they worked on their own: i think that one of the major advantages that i see in it is that it makes the project richer because you have two minds or more working. i think it becomes richer and more valuable because it’s not just one person’s thinking going on. i also think that it’s a healthful model for what we should be doing more of, collaborating with each other. not only within the university, but out in the community. despite the idea that social workers can benefit from collaborative work, two respondents indicated that their institutions regarded collaborative work as substandard, particularly for purposes of promotion and tenure. discussion the respondents described a wide variety of experiences that ranged on a continuum from equal contribution and credit for theory development, literature review, data collection, writing, and overall management of the project at one extreme, to student collaborators who performed most or all of the work and received no credit or acknowledgement at the other extreme. all respondents acknowledged their commitment to assume responsibility for setting boundaries and safeguarding student rights when working collaboratively with them. of the six student respondents who were involved in faculty-student collaboration, five felt exploited in 156 advances in social work some way by their faculty collaborators. the pain and anger of their experience remains despite the passage of a considerable amount of time. their negative experience constrains the way these former students, now faculty themselves, work with students. two hesitate to collaborate with students. all of the student collaborators who described negative experiences also discussed a subsequent successful collaboration with colleagues. although this positive collaborative experience gave them a model for appropriate, non-abusive collaboration, the memory of the negative experience remains strong. it is especially important to recognize the mixed and ambivalent feelings that five of the student collaborators reported. they felt both beholden to and taken advantage of by the person they trusted as a mentor. these mixed feelings led to a sense of self-doubt that has been extremely slow to resolve. this parallels the dynamics of other boundary violations in which the victim was unsure whether or not he/she was the responsible party. it underscores faculty responsibility to safeguard boundaries and avoid student exploitation. two respondents expressed a lingering concern that their participation not be identifiable to their former mentors. it is also worth noting that three of the faculty collaborators who were interviewed were aware of these boundary issues and had created their own set of rules for collaborating with students. they viewed collaboration with students as a part of their responsibility to ensure that future social work scholars will continue to contribute to the knowledge base of the profession. there are recognizable limitations to this study. it is not possible to generalize about faculty-student collaborations, as it was an exploratory study with a small sample. it is possible that the subjects chose to elaborate on their negative experiences rather than their positive ones because the negative experiences stand out for them or because they perceived that the researchers were more interested in their negative stories. nevertheless, the concerns and issues raised by these respondents highlight the risks of dual relationships in faculty-student collaboration. if faculty do not take responsibility for safeguarding student rights in collaborative relationships, students are likely to be at risk for exploitation. recommendations one: it is imperative that social work, as a discipline, engage in deliberate, focused, frank, and open discussion regarding the value of collaborative efforts and the regard attributed to them in academia. social work educators must address the extent to which collaboration and the synergy of small group scholarship efforts should be recognized and respected. only then can the issue of the relative value of solo versus coor multiple authorship in tenure and promotion decisions be addressed. two: deans and directors must take responsibility for initiating discussions with faculty to develop protocols that guide faculty-student collaborations. the experiences reported in this study raise several disturbing issues that can best be addressed by thorough discussion and full understanding of the complexity of collaboration, in general, and faculty-student collaboration, in particular. 157barretta-herman, garrett/faculty-student collaboration: issues and recommendations three: the faculty member in faculty-student collaborations carries the primary responsibility for avoiding the risk of exploitation. professional responsibility is clearly delineated in the nasw code of ethics (nasw, 1996). initial discussions about each collaborator’s responsibilities, authorship order, and credit about workload, tasks, and responsibilities must be followed by periodic review of those expectations and contributions with modifications to the original agreement, as required. four: collaboration can be enhanced by written agreements. making those agreements known to others can minimize the risk of exploitation. faculty-student collaboration agreements reviewed in consultation with non-collaborating colleagues, deans, or directors can provide an opportunity to forestall future misunderstandings and enhance the development of non-exploitative guidelines. this study raises several difficult issues that must be researched before firm guidelines can be established. the ethical implications of multiple authorship are coming under scrutiny (see, for example, gelman & gibelman, 1999). not enough is known about the processes and myriad implications that collaborations have for the individuals involved. replication of this study with a random sample of social work educators will confirm or refute the findings of this study. other questions need to be answered: does faculty-student collaboration lead to increased dissemination of student research? how can “substantial contribution” to a project be evaluated? how should changes in responsibility be renegotiated over the course of collaboration? how do the perceptions of collaboration differ in the faculty-student dyad? what is the ideal protocol for authorship order? what approach to multiple authorship best serves the social work profession? is the absence of program and institutional protocol, as evidenced in this study, the result of default or design? are the products of faculty-student collaboration valued in social work programs and the academic institution? we are convinced that discussion must occur regarding the faculty-student collaboration issues raised here. our profession has an opportunity to maximize the benefits that accrue through collaboration, including helping students learn to write for publication, getting innovative student material published, and enriching projects through shared problem solving. while these are advantageous to the students, they also benefit faculty, the profession, and ultimately those we serve. social work is a profession that espouses the virtues of collaborative and cooperative efforts and emphasizes the importance of a systemic view of phenomena. the basic assumption of the superiority of solo authorship in social work needs to be rigorously questioned through strong advocacy of the multiple benefits of fair and ethical collaboration. references american psychological association. (1992). ethical principles of psychologists and code of conduct. american psychologist, 47, 1597-1611. american psychological association. (1994). publication manual (4th ed.). washington, dc: author. aram, j. d., morgan, c. d., & esbeck, e. s. (1971). relation of collaborative interpersonal relationships to individual satisfaction and organizational performance. administrative science quarterly, 16, 289-296. 158 advances in social work austin, a., & baldwin, r. (1991). faculty collaboration: enhancing the quality of scholarship and teaching. (ashe-eric higher education report no. 7). washington, dc: the george washington university, school of education and human development. bayer, a., & smart, j. (1991). career publication patterns and collaborative “styles” in american academic science. journal of higher education, 62(6), 613-636. bonosky, n. (1995). boundary violations in social work supervision: clinical, education, and legal implications. the clinical supervisor, 13(2), 79-95. congress, e. (1996). dual relationships in academia: dilemmas for social work educators. journal of social work education, 32(3), 329-338. endersby, j.w. (1996). collaborative research in the social sciences: multiple authorship and publication credit. social science quarterly, 77(2), 375–392. fine, m., & kurdek, l. (1993). reflections on determining authorship credit and authorship order on facultystudent collaborations. american psychologist, 48(11), 1141-1147. floyd, s., schroeder, d., & finn, d. (1994). only if i’m first author: conflict over credit in management scholarship. academy of management journal, 37, 734-747. fox, m. f., & favor, c. a. (1984). independence and cooperation in research: the motivations and costs of collaboration. journal of higher education, 55(3), 347-359. gelman, s. r., & gibelman, m. (1999). a quest for citations? an analysis of and commentary on the trend toward multiple authorship. journal of social work education, 35(2), 203-213. gibelman, m., & gelman, s. r. (1999). who’s the author: ethical issues in publishing. arete, 23(1), 77-88. gordon, m. d. (1980). a critical assessment of inferred relations between multiple authorship, scientific collaboration, the production of papers, and their acceptance for publication. scientometrics, 2, 193-201. kagel, j., & giebelhausen, p. (1994). dual relationships and professional boundaries. social work, 39(2), 213-220. krysik, j., & nichols-casebolt, a. (1994). women authors in social work journals: a research note. social work research, 18(3), 186-193. leatherman, c. (1997, july 18). should dog walking and house sitting be required for a ph.d.? the chronicle of higher education, a10-a11. mccullagh, j.g. (1988). trends in publication: a study of contributors to the school social work journal. school social work journal, 13(1), 4–12. national association of social workers. (1996). nasw code of ethics. washington dc: author. netting, f., & nichols-casebolt, a. (1997). authorship and collaborations: preparing the next generation of social work scholars. journal of social work education, 33(3), 555-564. over, r. (1982). collaborative research and publication in psychology. american psychologist, 37(9), 9961001. presser, s. (1980). collaboration and the quality of research. social studies of science, 10, 95-101. task force on social work research. (1991). building social work knowledge for effective services and policies: a plan for research development. washington, d.c.: national institute of mental health. wright, c., & wright, s. (1987). the role of mentors in the career development of young professionals. family relations, 36, 204-208. zook, a. (1987). trend toward multiple authorship: update and extension. journal of counseling psychology, 34, 77-79. author’s note: address correspondence to: angeline barretta-herman, ph.d., school of social work, college of st. catherine/university of st. thomas, 2115 summit avenue, st. paul, minnesota 55105 usa. 159barretta-herman, garrett/faculty-student collaboration: issues and recommendations microsoft word williamson et al_i found myself final _________________ sabrina williamson, ph.d., and carol hostetter, ph.d., are associate professors, and katherine byers, ph.d., is associate professor and director of the bsw program, all at the indiana university school of social work, bloomington campus. pamela huggins, msw, acsw, lcsw, is an associate clinical professor at the saint louis university school of social work. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 235-247 i found myself at this practicum: student reflections on field education sabrina williamson carol hostetter katherine byers pamela huggins abstract: the field experience is understood to be pivotal in social work education. in this qualitative study, bsw students reflected on their learning outcomes and processes in their field experiences. they highlighted how their work in agencies helped them to operationalize social work values and ethics, develop an awareness of themselves as social workers, and enhanced their confidence. implications for strengthening the practicum experience though more reflective experiences and enhancing the preparation of field instructors is discussed. keywords: field education, reflective practice introduction for most bsw students, the field practicum is the first setting in which they are able to integrate and apply social work theory, values, skills, and knowledge under the supervision of a professional social worker (barretti, 2004; dalton, stevens, & maasbrady, 2009; vayda & bogo, 1991). the field placement is where students put into practice what they have learned in the classroom with respect to micro, mezzo and macro skills and also with respect to upholding professional values and following ethical codes of conduct. though field coordinators and other faculty serve as liaisons to the student and the field instructor throughout the course of the practicum, there are many experiences that students have with their field instructors apart from those listed in the learning plan and discussed in the field seminar. as students near graduation and prepare for either their first professional positions or further education, a more complete picture of their field experiences can be gained from gathering their reflections on their field experiences in a way that differs from the typical final input they may have in their evaluations with their field instructors or faculty liaisons. one obvious benefit to this data gathering process is that the student reflections can be used to assess strengths and limitations in current field placement settings. more importantly, however, the authors posit that this time for self-reflection on practice (furman, coyne, & negi, 2008) is, of itself, an essential aspect of students’ learning. as students recount meaningful experiences in their field placements, they have the opportunity to explore these experiences in a different way, critically reflect upon them, williamson, hostetter, byers, huggins/i found myself at this practicum 236 and perhaps develop a new perspective on the situation. while this process has the immediate effect of helping a student reflect on his or her current level of professional development, this process may also model for students the importance of continued reflection on their professional practice. obtaining student reflections on their field placements can also be of benefit to social work programs seeking accreditation or reaccreditation. in 2008, the council on social work education (cswe) outlined revised educational policy and accreditation standards (epas). the epas clearly define that field education is the “signature pedagogy” for the social work profession (cswe, 2008, p. 8). in other words, the field education component is the primary venue in which social work students are socialized to be professionals (cswe, 2008). in accordance with the new epas, schools and departments of social work are called upon to demonstrate an “integrated curriculum” for classroom and field (cswe, 2008, p. 9). given the renewed importance of demonstrating student outcomes in the field, and the fact that educators will be dependent on student products to illustrate outcomes, it is critical to understand not only what students learn in the field, but also to understand how they reflect on their learning, and how they make connections between the classroom and the field setting. this paper presents findings from a larger study in which faculty in a baccalaureate social work program in the midwest engaged in a self-study of the field program. the focus of this paper is to share student reflections on their professional development and offer some implications for social work education that will enhance the ways in which social work faculty work with students to build a foundation for their professional development. the following section of the paper includes a brief review of the relevant literature. next is an explanation of the methodology employed in the larger study and a discussion of student reflections. the paper concludes with a discussion of limitations and an offering of the implications for social work education. review of field education literature social work educators expect the transfer of learning from classroom to practice to occur in the field practicum, with field instructors providing the primary, on-site supervision of that transfer (cavazos, 1996; knight, 2001). the practicum serves as the experience in which students are able to integrate and apply social work theory, values, skills, and knowledge (bogo, 2005; vayda & bogo, 1991). in the field, students develop practice skills; apply theory to actual practice situations, and otherwise “test their ability to be professional social workers” (fortune, mccarthy, & abramson, 2001, p. 111). there is a substantial and growing literature on various aspects of field instruction. researchers have studied the motivation to become field instructors (bogo & power, 1992; globerman & bogo, 2003), student satisfaction in the field (fortune et al., 2001), learning opportunities valued by students (fortune & kaye, 2002; fortune et al., 2001), availability of field instructors to students (barretti, 2009), student performance (fortune et al., 2001; zosky, unger, white, & mills, 2003), and student motivation in the field practicum (fortune, lee, & cavazos, 2005). advances in social work, fall 2010, 11(2) 237 a link between reflection and learning has been discussed in the social work literature (mishna & bogo, 2007). mishna and bogo define reflection on practice as “… reflection after the experience to derive learning and new understanding from a situation” (2007, p. 531). a compatible definition, although broader, is that reflection involves “those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations” (boud, keogh, & walker, 1985, p. 19). ellis (2001) emphasizes the confidence that can result from reflective practice, enabling the student to better deal with future practice challenges. d’cruz, gillingham, and melendez (2007) also propose that using reflections to acknowledge uncomfortable emotions such as anxiety can promote a stronger field instructor and student relationship. from this fertile soil, self awareness can occur and subsequently can enhance practice (d’cruz et al., 2007). lam, wong, and leung (2007) found that disturbing events and the self-discovery reflected in student reflection logs during practicum aided the learning process, particularly by focusing on “… individual values, beliefs, strengths and weaknesses” (2007, p. 96). methods research design at the beginning of this study, the authors committed to using a collaborative, strengths-based (saleebey, 2008) approach in their interviews with students. this primarily involved providing a space to hear the voices of students as they shared their experiences and reflections on their own learning. specifically, the interviewers asked questions to draw out students’ capacities and assets as they reflected on their field work in addition to asking about challenges that were faced. description of sample data for this study were collected over the course of three academic years. all graduating seniors in three cohorts (n=74) were invited to participate in the study and 38 chose to participate. all participants were students on the same campus of a large, public, midwestern university. the sample was 95% female, and 92% were of a traditional student age, between 21 and 23 at the time of the interview. all sample members except one were full-time students who completed each of their field placement experiences in either the home county of the university, or in one of the surrounding counties. the remaining member of the sample had been a part-time student for several years. this sample accurately mirrors the student body of the social work program on campus. likewise, the participants’ field placement sites were representative of all available practicum sites. of the field placement experiences, 31% were in a public school system; 31% were in non-profit agencies serving youth or families; 13% were in a non-profit agency providing services to people experiencing homelessness; 7% were in public or private agencies providing services to older adults; 7% were in a non-profit agency providing services to people experiencing domestic violence and the remaining field placements williamson, hostetter, byers, huggins/i found myself at this practicum 238 (11%) were in various settings including those for addictions treatment, community development programs, and political or legal settings. data collection and analysis at the time of data collection, the program under study utilized a model of field placements that had students completing one practicum placement in their second semester of the junior year (15 hours a week on average) and completing a second placement in the first semester of senior year (20 hours a week on average). this arrangement afforded students with learning opportunities in two different agencies which meant that they gained experience working with a broader array of client populations and challenges. the sample was one of convenience, with the use of inclusionary criteria in order to create a purposive sample (patton, 2002). sample members (n=38) all met the following criteria; seniors in an undergraduate social work program who had completed two semesters of field placement (the first in the spring of the junior year and the second in the fall of the senior year) and who were in their final semester of academic course work. a structured interview protocol was developed to ensure the comparability of data obtained across sample members and researchers (maxwell, 1996). the interview protocol is found in table 1. table 1. interview protocol ________________________________________________________________________ 1. tell me about your first field placement. a. probes: where was it? what were some significant learning experiences you had? to what extent was it a fit for you? 2. tell me about your field supervisor at your first field placement. a. probes: did he or she have an msw or bsw? what did he or she do to facilitate your skill development? 3. tell me about some of the ways you saw your skills develop at this practicum. 4. tell me how you saw core values of social work embodied. 5. tell me about your second field placement: a. probes: where was it? what were some significant learning experiences you had? to what extent was it a fit for you? 6. tell me about your senior year field supervisor. a. probes: did he or she have an msw or bsw? what did he or she do to facilitate your skill development? 7. tell me about some of the ways you saw your skills develop at this practicum. 8. tell me how you saw core values of social work embodied. 9. anything else you want to say about your field placement experiences at iub? ________________________________________________________________________ advances in social work, fall 2010, 11(2) 239 interviews were conducted for three cohorts of bsw seniors over the course of three academic years. all interviewers were faculty members in the school of social work at the same university but none had responsibility for field placement or field liaison duties. the use of the structured protocol, by which participants were asked a set of questions about their first field placement and then were immediately asked the same set of questions about their second field placement, addressed the challenge of obtaining comparable information from each student about each of their two placements. data collection and analysis occurred simultaneously. one interviewer/researcher had primary responsibility for analysis. the strategy of open coding (strauss & corbin, 1990) was used to identify themes that emerged from the raw data. as similar themes emerged, the researcher grouped like codes together in order to form conceptual categories. the interview transcripts, codes, and conceptual categories were shared with the co-principal investigator for feedback and continued analysis. as additional interviews were completed, initial codes were referred to in a process of constant comparison (strauss & corbin, 1990). as interviews were conducted just prior to the students’ graduation ceremonies, member checks could not be employed. findings the findings presented here center on the reflections that students provided concerning their professional development. it is important to note that, no matter their overall perceptions about the agency or satisfaction with their field instructors, all participants reflected that learning and development had occurred in the field placement. one student summarized it well when she said, “…this is where the light popped on.” the experience of having the light “pop on” was echoed, to some extent, by every participant. this self-awareness of knowledge and skill emerged because the students got to do “in real life” the things they had practiced in their classes. for example, students discussed recording and documentation responsibilities, assessments they had conducted, referrals they had made, and ways in which they had built rapport with clients. while this discussion of practicum learning is always reassuring for a faculty member/researcher to hear, there was little that was surprising in this recounting of tasks and meaningful experiences because of the general expectation that students will practice these types of skills in their practicum placements. more provocative, however, in terms of thinking about social work pedagogy, were the students’ reflections on what we categorized as becoming a social worker. this category captures the major themes that students discussed when they were reflecting on their field experiences. within this category were three primary themes: values and ethics, awareness of self in practice, and confidence. students reflected on each of these as being a part of their growth from social work student to professional social worker. values and ethics the way in which students articulated their perceptions of values and ethics in the field indicated that this was an area of importance for them. students clearly saw that, the majority of the time, social workers operated with a set of ethical standards and values williamson, hostetter, byers, huggins/i found myself at this practicum 240 different from those held by other staff in the setting. major themes that emerged included the importance of maintaining confidentiality, establishing professional boundaries, and operationalizing the social work value of dignity and worth of the person. some students spoke about confidentiality being broken in ways such as “having staffing in a room next to the lobby, when people can hear through the door” and having an unlocked records room, “where clients actually got in and read other clients’ files.” other students gave examples of non-social work staff talking about clients in break rooms of agencies and of staff in general leaving “confidential paperwork out where the public could see it.” another theme that emerged related to values and ethics was that of boundaries between professionals and clients. one interviewee stated that while confidentiality at her agency was observed in a way that she expected, she was surprised by the lack of boundary setting by the staff (none of whom was a social worker), that they were “really close with the teens, and sharing personal things with them.” another student reflected that in her placement, there was another student intern from a different discipline, and that while the person’s clinical skills were good, “she has no clue about setting boundaries with clients.” though there were instances other than the ones above related to non-social workers and boundary issues, more often our interviewees discussed being relieved that a social worker in their setting had modeled for them the importance of establishing and maintaining boundaries. one student reflected that “boundary building was the biggest skill i accomplished” in the first placement, and another student shared, the other thing i learned a lot about is dual relationships and boundary issues. the men would ask you out, ask for your phone number and stuff like that. [my field instructor] told me, taught me how to handle this. she also helped me to learn to set boundaries with clients who only wanted to talk to me for hours on end. in terms of operationalizing dignity and worth of the person, students were quick to point out ways in which they saw this value enacted and ways in which the agencies and staff members fell short of this goal. one student, a self-identified “investigator,” said that she had grown the most at one of her placements in her ability to demonstrate dignity and worth. “families are definitely treated with a lot of respect and dignity, even when they are extremely challenging. no matter how challenging a family presents, there is always someone who can look for the strengths and propose a way of how to use them.” another student, placed at a shelter for survivors of domestic violence, said, we talk a lot about client self-determination in social work. in that practicum i was challenged by that, to really put that into practice. facilitating a group where women had a desire to return to abusers was challenging. i really wanted to say ‘don’t go back there’ – but i had to learn how to explore this with them. in anything related to values and ethics, it was clear that the soon-to-be-graduates held social workers to a higher standard than they did other professionals because of the advances in social work, fall 2010, 11(2) 241 code of ethics (nasw, 1999). when social workers were observed to be in violation of the letter or spirit of the code, the students were more distressed than when staff members from other disciplines took actions that were in conflict with social work values. one student said that while her supervisor was “compatible with social work values,” another social worker, in charge of recruiting patients, had values that “were off the chart, in the wrong direction, in terms of trying to get people to come to [the agency] for services.” another student talked about some inappropriate signs and bumper stickers on the office wall that belonged to her (social work) supervisor and still another student talked about how one of the social workers had handled confidential information inappropriately. throughout the interviews, it was evident that students had learned a great deal about social work values and ethics in their coursework. as they were interviewed, most related situations that demonstrated that they not only understood the social work value and ethical framework but also embraced it as the desirable framework for effectively serving clients and developing an awareness of appropriate boundaries. awareness of self in practice the majority of study participants shared how one or both of their practicum experiences helped them find their niche in social work. as one student said, “i found myself at this practicum.” many interviewees, however, also realized that working with people who are vulnerable is not about “warm fuzzies” for the social worker. similarly, one student shared, “trying to find local low-income housing for people was a huge challenge. sometimes it seemed hopeless but i still had to be hopeful. it was hard because some times there were not the best options available to a mother with three children and addiction problems.” along these lines, another student stated, my knowledge base grew about what it was really like to deal with clients. we have these theories at school, and a homework assignment, and it seems like there is a right answer. but in real life with real clients, it takes awhile to come up with answers. students also realized that they needed to be aware of their own strengths and weaknesses in terms of coping with stress and interacting with others. talking about her increased confidence, one student said, “i became more comfortable in communication, and was seeing how what i said affected clients. i learned how to not overpower them...” also in this regard, a student shared, “we had to do drug screens and house searches. those are pretty personal. it forced me to be professional and not take things personally. i became more aware of my own limitations…. i learned to be open with my supervisor so she could help me with situations.” another interviewee remembered a time when “there was a client that i had talked to a lot…she blew up at me when she was having conflict with another person. she threatened me, but i knew how to make contact with her because of [my relationship with her]. after it happened i broke down and was shaking.” the impact of challenging practicum experiences clearly prompted awareness of self in a way that classroom discussions and activities may not. as a group, students reporting challenging and uncomfortable experiences in the practicum were also able to follow up williamson, hostetter, byers, huggins/i found myself at this practicum 242 with a self appraisal of how their actions, communications, and/or skill development changed as a result. this self awareness seemed vital as well as they worked on becoming social workers. confidence not surprisingly, almost every study participant reflected on his or her confidence and how it had grown during field placements. most of the respondents talked about feeling an increase in confidence in interacting with clients and colleagues, feeling as though they had a professional voice in addition to feeling more confident about their skill set. one student faced many challenges at one of her placements, including being one of the few social workers in a legal setting. despite her frustrations, she shared, i am still processing that placement. i am angry at school for putting me in a place where i wasn’t supported. that’s been difficult for me, and for the other person who was placed there, but i also have these moments where i think ‘wow i haven’t been so challenged in a long time’. …i ended up figuring out how to have a strong voice. another student articulated, “i think practicum really makes you understand whether you are cut out for social work or not.” clearly, students found the practicum experience to be the primary venue for developing confidence in their abilities to be good social workers. summary of findings in asking students to reflect on their learning in the bsw field placements, three important themes were identified. first, their knowledge and skills went beyond identifying values and ethical issues in practice. the students demonstrated a strong ability to analyze practicum situations and how unethical approaches might adversely affect the client or themselves. this finding was especially supported by their reported discomfort in observing non-social workers’ approaches with clients and by their experiences in setting professional boundaries. second, students recognized that self awareness was a part of becoming a professional social worker. self-awareness was seemingly promoted at times when the students felt uncomfortable or were confronted with the realities of some social problems. finally, as students reflected on their practicum experiences, the increase in their level of confidence from the beginning to the end was an important product of the overall learning in the practicum. the findings underscore the importance of barretti’s statement that “… a socialized identity is not a continuous process of reacting passively to curricular knowledge and professional experiences but may depend more on students’ negotiations of their dilemmas and interactions with significant others” (2004, p. 277). limitations to the study as with any qualitative study, a primary limitation for this research lies in the inability to generalize findings to the larger population. another limitation to the study advances in social work, fall 2010, 11(2) 243 involves the use of interviews as a primary source of data collection and analysis (padgett, 1998). one element of this limitation lies in the chance that the respondent in an interview may give answers that he or she feels are socially desirable. to counteract this possibility, all respondents were reminded prior to the interview that their names would remain confidential, and that the purpose of the study was to learn about the strengths and challenges of their field placements, not to “name names” for purposes of reward or criticism. additionally, the interviews were conducted in the spring semester of the participants’ senior year and interviewers did not have the participants in class at the time. consequently, students did not have to be concerned that their interview responses would affect their grades. another aspect of the limitation to conducting interviews lies in the chance that the researcher/interviewer may be the source of bias or error (patton, 2002). it is possible that the researcher’s verbal and nonverbal cues prompted the respondent’s discussion and reflection in some cases, and inhibited it in others. to minimize the impact of researcher bias, semi-structured protocols were used. the use of the protocols increased the likelihood that questions and probes were used uniformly. implications for social work education the results of this study have implications for teaching, research, and the overall approach to field education. the study validates that the practicum, the signature pedagogy (cswe, 2008; shulman, 2005) of social work, is critical in helping students find themselves and enhance their development as social workers. as a result, social work education should continue to focus on the overall quality of field education through a number of current and specific ways. the current epas for social work education include ten core competencies with articulated practice behaviors for each. the field placement is a logical, even necessary, venue in which to demonstrate student achievement of these competencies and behaviors. as social work educators and administrators begin to prepare for accreditation and reaccreditation processes, it is important to continue obtaining students’ perspective on their practicum work. the process of determining whether or not, and to what extent, a program’s graduates demonstrate mastery of a particular competency cannot be done without student input. while many programs likely have an understanding the nature of experiences that students routinely have in the field, it is also important to understand how the students are processing their own learning. one possibility would be to engage in this type of reflective process with students as we are reviewing “products” from their practicum work (i.e. assessments, genograms, process recordings, etc.). by doing this, we can ascertain not only how students performed that task at a particular point in time, but we will also be able to understand how they took that initial feedback (whether a grade or field instructor evaluation) and used it to further their own knowledge in this area. the findings from this study also provide guidance to social work educators regarding the “implicit curriculum” identified in the new epas (cswe, 2008, p.10). the implicit curriculum is defined as the environment in which the explicit curriculum is williamson, hostetter, byers, huggins/i found myself at this practicum 244 delivered. the training and support of field instructors can certainly be considered an aspect of the implicit curriculum. social work education must move beyond a brief field instructor orientation to an advanced educational or training module which assists field instructors to develop and use strategies that systematically explore values and ethics, develop self awareness, and build confidence. while many field education programs focus on aspects of strong supervision, this study underscores the need to help field instructors develop as teachers and develop daily or weekly strategies to promote student reflection as a key part of their learning. some of the current tools, such as process recording, journaling, values conflict discussions, and case analysis, continue to be useful in the ongoing development of the thinking of a social worker. each of these assignments is included in courses leading up to the field placement, as well as in the field seminar, in the program where the study was conducted. in the interviews, students identified these assignments as being helpful transitions from the classroom to the field. to the extent that field instructors can be more aware of classroom tools and assignments, they will be even better prepared to reinforce learning. the skills needed for ongoing reflection could also aid the field instructors in their own professional practice. then, in turn, they would become stronger role models and mentors for future students. in addition to the focus on the school’s responsibility to train field instructors, schools of social work should also evaluate potential placements for an environment where the student would have the time and interest from a field instructor who would go beyond the minimal teaching tasks. as kanno and koeske assert, the quality of field instruction is highly important for student satisfaction and sense of efficacy (2010, p. 34). the value of integrative seminars is underscored as another important part of the socialization process as a student becomes a professional social worker (barretti, 2009). the seminars provide many assignments requiring students to reflect in a focused way on practicum experiences and their reactions. while seminars are primarily viewed as providing support to students in the field, the opportunities apart from the rest of the curriculum for verbal and written reflection promoting self-awareness tend to be greater in these settings. as students discuss client situations, values and ethical challenges, or broader social issues, they are able to add to their practice skills and knowledge. additionally, they are able to build on their self-awareness and confidence. the key factor for successful integrative seminars would be to ensure that they are studentcentered, with students teaching other students through case presentation and analysis, peer feedback, and consultation models. in addition to integrative seminars, social work programs could design an overall program assessment or plan that engages students in reflection at several points in their journey toward the degree. these assessments could range from a series of questions where students respond in a reflective journal or paper to an added dimension to existing assignments. this engagement would foster development and confidence through on-going self awareness and appraisal. faculty would need to commit to completing the loop through providing feedback and assistance in response to reflections. professional socialization of social work students is complex and challenging, and the literature at this point raises more questions than it answers (barretti, 2004). advances in social work, fall 2010, 11(2) 245 many “introduction to social work” courses have reflection assignments based on volunteer work or reactions to various target populations or social challenges. these opportunities can continue as we engage students to think critically and reflect on new information that is provided in policy or human behavior courses as well. as we teach in relation to social work practice, students also see the holistic attention as they move from student role in class to practicum student, prepared for the field. lastly, the study has implications for social work research. though important, research on field education continues to be lacking. select reflection papers, journals, or assignments could be analyzed using qualitative analysis. preor post-testing could be designed around the themes identified in this study: infusion of values and ethics, the value of self awareness, and the importance of building confidence. further study could focus on a comprehensive exploration of the student’s experience by comparing the field instructor’s and student’s perceptions in these areas. additionally, research on students’ view of the discrepancies between their ideal of social work practice and their lived experience of it would be beneficial (barretti, 2009). conclusion through asking students to reflect on learning experiences in the practicum, social work educators are able to know more about preparing the next generation of social workers. this study has reinforcing implications for many current methods employed in social work education such as integrative seminars, orientation and selection of field instructors, and use of various assignments. assignments such as journals, process recordings, supervision meetings and other activities that promote self-awareness and reflection appear to be especially important in the development of social work practice skills (lam et al., 2007). additionally, the study sheds light on the importance of additional factors not always addressed in a practicum evaluation, such as the growth and development of confidence and awareness of self. it also focuses attention on the need to provide advanced education for field instructors to help them develop as stronger “teachers” in the field. in addition to the many wonderful learning moments that can and do happen in social work classrooms, there is no substitute for guided learning in the field. as one student reflected, watching my supervisor was the most beneficial learning experience that i’ve had in any environment. she’s a very centered, balanced person who knows what she’s doing. she was able to convey that, to teach by example and not by being directive, with staff, parents, kids, me…. when i was dealing with certain circumstances, i would think about her and draw on her. this student echoes the findings about the power of positive modeling by field instructors on professional socialization (barretti, 2009). clearly, the practicum remains integral to social work education and all efforts to further understand how students learn in this pedagogy will serve to continue to enhance the quality and outcomes of the experience. williamson, hostetter, byers, huggins/i found myself at this practicum 246 references barretti, m. 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(2008). commentary on the strengths perspective and potential applications in school counseling. professional school counseling, 12(2), 68-75. shulman, l.s. (2005, summer). signature pedagogies in the professions. dædalus, 134, 52–59. strauss, a., & corbin, j. (1990). basics of qualitative research: grounded theory procedures and techniques. newbury park, ca: sage publications. vayda, e., & bogo, m. (1991) a teaching model to unite classroom and field. journal of social work education, 27(3), 271-278. zosky, d. l., unger, j. m., white, k., & mills, s. j. (2003). non-traditional and traditional social work students: perceptions of field instructors. journal of teaching in social work, 23(3/4), 185-201. author’s note: address correspondence to: sabrina williamson, indiana university bloomington, 1127 e. atwater, bloomington, in 47401. email: sabawill@iupui.edu spring2000-101_page93 spring2000-102_page94 spring2000-103_page95 spring2000-104_page96 spring2000-105_page97 spring2000-106_page98 spring2000-107_page99 spring2000-108_page100 spring2000-109_page101 spring2000-110_page102 spring2000-111_page103 spring2000-112_page104 spring2000-113_page105 spring2000-114_page106 the effect of statutory regulations on social workers’ decisions to report child maltreatment _________________ vicki ashton, d.s.w., is a professor of social work at york college of the city university of new york, department of social sciences. this research was supported by national institutes of health grant #41385. the author wishes to thank beth s. rosenthal and w. cody wilson for reading earlier drafts of this work and for their invaluable insight and suggestions. copyright © 2009 advances in social work vol. 10 no. 2 (fall 2009), 128-143 the effect of statutory regulations on social workers’ decisions to report child maltreatment vicki ashton abstract. this study examined social workers’ perceptions of the new york state law requiring the reporting of child maltreatment and the relationship of those perceptions with the likelihood that workers would report incidents of maltreatment to child protective services. data were collected by a mailed questionnaire from a sample of 710 social workers belonging to the new york city chapter of nasw. findings show that social workers differ in their understanding of the law and that the worker’s understanding is related to reporting behavior. the worker’s understanding of the law had a small but significant effect on the likelihood of reporting, accounting for 6% of the variance. the binomial effect size of the relationship (r = .24) is such that a worker’s understanding of the law is sufficient to increase the likelihood of reporting a case of maltreatment from 38% to 62%. implications for practice are discussed. keywords: law and reporting, mandated reporters and social work, maltreatment and reporting introduction the united states’ child protection system is based on federal and state statutes. federal law requires states to have reporting laws. state laws require designated individuals to identify and report suspected child abuse and neglect to a local office or central registry of child protective services. the mandated reporting system has been in effect for more than thirty years, yet despite its long-term existence there is empirical evidence that many incidents of child maltreatment are not reported to child protective services (delaronde, king, bendel & reece, 2000; hansen et al., 1997; kalichman, 1999; kalichman, craig & follingstad, 1990; sedlak & schultz, 1997; zellman & bell, 1990). previous research has provided many reasons for not reporting including concern that reporting does more harm than good (hansen et al., 1997; melton, 2005; zellman & bell, 1990) and that reporting would damage the worker/client relationship (alvarez, kenny, donohue & carpin, 2004; hansen et al., 1997; kalichman, 1999). however, failure to report a suspicion of maltreatment is also a legal issue and the question arises as to whether mandated reporters know their state’s law. this study examines the understanding that professional social workers have of the new york state reporting law and the relationship of that understanding to differences in reporting child maltreatment. background the federal child abuse prevention and treatment act, enacted in 1974, provided money for child protection, established definitions for child abuse and neglect, and established requirements for the reporting of child abuse and neglect at the state level advances in social work, fall 2009, 10(2) 129 (nelson, 1984). consequently, while each state is responsible for drafting its own reporting laws, the reporting laws of all jurisdictions share several core components, including: 1) identification of those individuals mandated to report suspected child maltreatment (child welfare, 2008, pp. 1-2); 2) a definition of reportable circumstances (kalichman, 1999); 3) provision of penalties for failure to report (child welfare, 2007, para. 3 & 4); and 4) provision of immunity from civil and criminal liability for reporting in “good faith” (child welfare, 2008, para. 3 & 4). reporting laws in all jurisdictions, however, also share a language that is open to the interpretation of the reader (carleton, 2006; davidson, 1995; foreman & bernet, 2000). both opponents and supporters of mandatory reporting laws agree that the language of the state laws is overly vague (davidson, 1995; kalichman, 1999; kalichman, craig & follingstad, 1990). supporters maintain that the broad language of the reporting statutes provides the needed flexibility to include rather than exclude possible cases of abuse (davidson, 1995). critics of the language point out that the vaguely worded reporting procedures fail to provide an enforceable standard (davidson, 1995; foreman & bernet, 2000; kalichman, 1999). ambiguity of the statute’s language leads to confusion regarding what constitutes abuse in a given situation and may result in both reporting circumstances that should not be reported (leon, 2007) and failing to report circumstances that should be reported (kalichman, 1999). whether because of the language of a state’s law or ignorance of the law, mandated reporters frequently disregard the law (melton, 2004; 2005). indeed, many professionals appear to view reporting as an option based on evidence of abuse rather than a mandate based on suspicion of abuse (kalichman & craig, 1991; vanbergeijk, 2007). in the state of new york, those persons designated as mandated reporters include medical professionals, teachers, social workers, and police officers, among others. these professionals are required to immediately report any circumstance in which they have “reasonable cause to suspect” that a child has been abused or maltreated (state statute results, 2008). professionals practicing in the state of new york who willingly fail to report a case of suspected child maltreatment are guilty of a class a misdemeanor and are “…civilly liable for the damages proximately caused by such failure” (state statute results, 2008). professionals who report suspected maltreatment in the execution of their job responsibilities are presumed to be acting in good faith and are immune “from any civil or criminal liability that might otherwise result…” (state statute results, 2008). a number of studies have identified characteristics of the worker that influence reporting behavior such as the age of the reporter (zellman & bell, 1990), gender (almoosa, al-shaiji, al-fadhli, al-bayed & adib, 2003; hansen et al., 1997; kenny, 2001; tilden et al., 1994; webster, o’toole, o’toole & lucal, 2005), ethnicity (ashton, 2004; kenny, 2001; levi, brown & erb, 2006; o’toole, webster, o’toole & lucal, 1999; webster et al., 2005), years of experience (kenny, 2001; lane & dubowitz, 2009; o’toole et al., 1999), training (feng & levine, 2005; hansen et al., 1997; sedlak & schultz, 1997; tilden et al., 1994; webster et al., 2005); reporting history (delaronde et al., 2000; o’toole et al., 1999; webster et al., 2005; zellman & bell, 1990) and agency setting (o’toole et al., 1999; webster et al., 2005; zellman & bell, 1990). moreover, there is some empirical evidence indicating that understanding of the law and attitude ashton/the effect of statutory regulations 130 toward the law is related to the reporting of child maltreatment. several studies have found that workers’ perception about the mandate to report is strongly related to actual reporting; workers who believe that they have a legal obligation to report are more likely to be consistent reporters of maltreatment than workers who do not believe they have an obligation (brosig & kalichman, 1992; zellman & bell, 1990). other studies have found that workers who believe the law is effective are more likely to report maltreatment than workers who do not perceive the law as effective (delaronde et al., 2000; tilden et al., 1994). a limitation of previous research is that these studies did not examine the provisions of the law directly; rather they asked whether the respondent thought that a particular situation fell under the general provision of the law. previous research is limited also in providing information about social workers who are a major group working with families and children. social work is the predominant provider of mental health services (mechanic, 1999) and services to children (kadushin, 1999). the present study this research is a cross-sectional study of professional social workers. its purpose is to investigate the relationship between the failure of social workers to report suspected child maltreatment and their interpretation of three key aspects of the new york state law: 1) situations that must be reported, 2) sanctions for failing to report, and 3) protection from liability. the study tests the hypothesis that workers who misunderstand the law are less likely to report maltreatment than workers who correctly interpret the law. the protocol for this research was examined and approved by the institutional review board for the protection of human subjects at the author’s institution. methods sample the population of interest in this study is professional social workers working with families and children in the new york city metropolitan area. the sample for this study was systematically selected from a general list of members of the local chapter of the national association of social workers (nasw). the membership list included workers who worked with families and children as well as workers who did not. in order to obtain a sufficient sample of workers serving families and children for the required statistical analysis, 4,194 undifferentiated members, approximately half of the total membership, were systematically randomly selected into the study sample (systematic random sampling was conducted by selecting an initial name from the membership list by using a number from a table of random numbers and then by selecting every other name for inclusion in the mailing). each name selected into the sample was mailed a letter explaining the study and requesting the individual’s participation, a self-report questionnaire, and a stamped addressed envelope for returning the questionnaire. the first mailing was followed by three reminders sent at three-week intervals; the third reminder included a “non participant” postcard requesting selected demographic information to determine if non participants differed from participants. a completed questionnaire was accepted as subject consent. advances in social work, fall 2009, 10(2) 131 of the questionnaires that were distributed, responses were received from 2,112 individuals, a response rate of 50%. this number includes 257 “non participants” who differed from respondents in that they were slightly older and less likely to work with families or children. the respondents were sorted into the population of interest, those working with families and children. seven hundred ten (710) individuals who worked with families and children and who completed the questions of interest comprise the sample for this study. sample characteristics the sample of 710 was predominately white (67.6%) and female (78%). three percent (3%) were asian; close to 14% were black (9.7% black american and 4.1% black caribbean); 11% were latin; 4% identified themselves as “other.” ninety-two percent had at least a master’s in social work (msw). the sample had a mean of 13 years experience as a professional social worker (post msw). this sample comprised higher proportions of minorities, a higher percentage with a master’s degree, and had slightly more years of experience than the most recently reported national sample of social workers (gibelman & schervish, 1997). measurement the study focused on the relationship between the likelihood of reporting suspected child maltreatment and social workers’ understanding of three aspects of the reporting law: 1) situations that must be reported; 2) sanctions for failing to report; 3) protection from liability. data on the “likelihood of reporting maltreatment” were collected using eight vignettes of probable maltreatment, two adapted from hong and hong (1991) and six taken from incidents known to local child protective agencies (see figure 1, next page). the vignettes were used in a previous study (ashton, 2004) and rated for seriousness by a sample of social service workers. on a scale of 1, “not serious” to 7, “very serious”, the vignettes in this study ranged in seriousness from 5.3 to 6.8; thus, all of the vignettes represented reportable situations. other studies have indicated that the use of vignettes is a valid measure for the likelihood of reporting child maltreatment (feng & levine, 2005; hansen et al., 1997; zellman & bell, 1990). dependent variable: to measure the “likelihood of reporting” respondents were asked to read each of the eight vignettes and rate the likelihood that they would report the incident depicted in the vignette to child protective services using a scale from 1, “almost certain not to report” to 5, “almost certain to report.” responses for all eight vignettes were added together for an overall score of “likelihood of reporting” (cronbach α = .77). the scale has a theoretical range of 8 to 40; the higher the score, the more likely the individual will report incidents of probable child maltreatment. ashton/the effect of statutory regulations 132 figure 1. case vignettes ________________________________________________________________________ 1. both parents work long hours; they leave very early in the morning and come home late at night. their nine-year-old son is left on his own. the boy gets himself ready for school in the morning and lets himself in after school. the parents tell their son to eat food prepared and left in the refrigerator, warming it up if he wants. he usually eats it cold. he goes to bed by himself because his parents are usually not back by his bedtime. 2. a sixteen-year-old yells and curses at his parents during a recent argument. his parent punches him in the mouth. 3. the classroom teacher notices that a nine-year-old boy has red marks on his palms and legs. when asked about the marks, the boy tells the teacher that yesterday he went to a friend's house to play instead of going home to do his homework. when his father found out, he hit him on the palms and legs repeatedly with a stick. the child says that his father does this whenever he does not do his homework. 4. a six-year-old wets the bed. parents punish the child by immersing his lower body in a tub of very hot water. 5. recently when asked a question, a 10-year old child mumbled a rude answer under his breath. his parent banged the child against the wall, bruising his shoulders. 6. a 12-year-old is caught stealing candy from the corner store. when his parents found out what the child did, they beat him with a stick and burned a mark on his arm to remind him not to steal again. 7. the parents discipline their eight-year-old child by hitting him with a strap whenever he misbehaves. 8. a family recently arrived in the metropolitan area from a rural location. last week after school, their 10-year-old son went off with a group of new friends instead of coming straight home. his parents disciplined him in their usual way, which is to make him kneel in the closet for several hours. ___________________________________________________________________________________________________ independent variables: independent variables included seven personal and professional characteristics of mandated reporters identified in previous research as being related to reporting behavior. they are: 1) age, 2) gender, 3) ethnicity, 4) years of professional experience, 5) hours of training within the last two years, regarding child development, maltreatment, parenting, and reporting procedures, 6) reporting history (i.e. the number of times the respondent made a report to child protective services within the last five years), and 7) agency auspice, i.e. public or private. in addition, there were three independent variables pertaining to the mandated reporting law: “situations that must be reported”; “sanctions for failing to report”; and “protection from liability”. “situations that must be reported” was operationalized by asking respondents: “in your opinion, which of the following statements best reflects new york state’s reporting advances in social work, fall 2009, 10(2) 133 requirements? a) take no chances; report any situation for which you have a reasonable cause to suspect maltreatment; b) use your discretion; report only those situations where you can substantiate abuse or neglect; c) report only situations involving serious harm to a child; d) avoid reporting, if you can do so safely; use agency and community resources to work with victims and perpetrators; e) unable to answer. i am not aware of the state’s reporting requirements.” responses were dichotomized into response , “a” which reflects the language and intent of the statute, versus all other responses. “sanctions for failing to report” was operationalized by asking respondents the following: “what is the likelihood that you would be criminally prosecuted (that is, arrested and/or incarcerated) if you failed to report a case of suspected child abuse or neglect? a) not at all likely; b) hardly likely; c) somewhat likely; d) very likely.” responses were scored 1 to 4, with higher scores reflecting a stronger belief in the likelihood that sanctions would be carried out for not reporting, as stated in the law. “protection from liability” was operationalized by asking respondents, “what is the likelihood that new york state law would protect you from being sued by a parent you report for maltreatment? a) not at all likely; b) hardly likely; c) somewhat likely; d) very likely.” responses were scored 1 to 4, with higher scores reflecting a stronger belief that the worker would be protected, as stated in the law. analysis frequency distributions were obtained for independent and dependent variables. correlation analysis was used to identify relationships between the “law” variables, demographic variables (age, gender, ethnicity), professional variables (years of experience, hours of on-the-job training, reporting history, agency auspice – public or private) and likelihood of reporting. in order to test the study hypothesis, hierarchical multiple regression analysis was used. in model 1, personal variables (age, gender, ethnicity) were entered as a block to determine their effect on the likelihood of reporting. in model 2, professional variables (years of experience, hours of training, reporting history, and agency auspice) were entered in a block to determine what influence they added to the likelihood of reporting, over and above personal characteristics. lastly, in model 3, the law variables, dummy coded into “1” for the “correct” response and “0” for all others, were entered as a block to determine their added effect on likelihood of reporting. the bonferroni t-statistic for multiple computations was used to adjust the probability of falsely rejecting the null hypothesis when multiple statistical tests are made (pedhazur, 1997). the criterion of an alpha of .05 based on the bonferroni correction was used to reject the null hypothesis. the sample of 710 individuals had the power to detect a small effect size of r = .10 within the population 84% of the time using the .05 level of significance (cohen, 1988). results the sample varied on the likelihood that they would report the incidents depicted in the eight vignettes to child protective services. the actual range of scores for “likelihood ashton/the effect of statutory regulations 134 of reporting” was the same as the theoretical range, 8-40; some respondents would not report any of the cases while some respondents would report all eight cases. the median score for “likelihood of reporting” was 35; over half the respondents were “almost certain” to report at least four of the incidents depicted in the vignettes. the distribution was negatively skewed, meaning that as a sample, respondents were more likely to report the incidents depicted in the vignettes than to not report them (table 1, next page). the vast majority of this sample of social workers working with families and children, 82%, knew that the law requires them to report any suspicion of maltreatment to child protective services; however, there was a small percentage of the sample (approximately 15%) that had a different interpretation of the law and another 2.7% of the sample admitted that they did not know the law (table 1). the sample varied considerably in their perception of sanctions being enforced for failing to report maltreatment. only 21.7% believed that they would likely be prosecuted for failing to report, as written in the state law. over 40% believed that being sanctioned was hardly likely or not at all likely (table 1). there was considerable variation, also, in the workers’ perception that the law would protect them from liability. most of the sample indicated, rightly, that the law provides protection from liability; 45% believed it was “very likely” they would be protected; 27.7% believed it was “somewhat likely” they would be protected. close to a third did not believe they would be protected (table 1). correlation analysis found that the law variables were associated with each other and that each was related to the likelihood of reporting. of the personal and professional variables, reporting history was correlated with likelihood of reporting and ethnicity was related to one of the law variables; white respondents were more likely than respondents of other ethnic groups to understand that they could be criminally prosecuted for failing to report maltreatment. none of the other professional or demographic variables were related to either the law variables or likelihood of reporting (table 2). hierarchical multiple regression analysis (table 3) confirmed the hypothesis that workers who misunderstand the law are less likely to report maltreatment than workers who correctly understand it. in model 1, the personal variables combined explained less than 2% of the variance in reporting and most of the effect was contributed by ethnicity; asian respondents were less likely to report maltreatment than were respondents of other ethnic groups (table 3). in model 2, the addition of the professional variables produced an r2 of .032 and added .017 (p <.05) to the variance in the likelihood of reporting, most of it contributed by “reporting history;” respondents with a higher number of previous reports were more likely to report current incidents of maltreatment (see table 3). hierarchical regression model 3 shows the effect of the worker’s perception of the law on the likelihood of reporting. the addition of the law variables produced an r2 of .094 and added .062 to the variance in the likelihood of reporting (p <.0001). most of the variance contributed by the law variables came from “situations to be reported” and “sanctions for failing to report.” advances in social work, fall 2009, 10(2) 135 table 1. frequency distributions for personal, professional, law and likelihood of reporting (n = 710) personal variables age mean 44.3 median 45 sd 12.4 n % male 158 22.3 female 552 77.7 ethnicity asian 21 3.0 blk american 69 9.7 blk caribbean 29 4.1 latin 82 11.5 white 480 67.6 other 29 4.1 professional variables yrs experience mean 13.1 median 10 sd 10.7 hrs of training n % none 164 23.1 1 to 4 hours 255 35.9 5 to 10 hours 126 17.7 over 10 hours 165 23.2 reporting history mean 5.7 median 2.0 sd 15.4 agency auspice n % public 346 48.7 private 364 51.3 law variables situations to report n % *take no chances 586 82.5 use discretion 83 11.7 report serious harm only 15 2.1 avoid reporting 7 1.0 unaware of law 19 2.7 sanctions for failing to report *very likely 154 21.7 somewhat likely 252 35.5 hardly likely 238 33.5 not at all likely 66 9.3 protection from liability *very likely 320 45.1 somewhat likely 197 27.7 hardly likely 113 15.9 not at all likely 80 11.3 likelihood of reporting mean 34.0 median 35.0 sd 4.5 skewness -1.2 *the correct response according to the state statute. ashton/the effect of statutory regulations 136 table 2. correlations between personal, professional, law, and likelihood of reporting variables (n = 710)a situations to report sanctions for failing to report protection from liability likelihood of reporting situations to report .11 .16* .22* sanctions for failing to report .13* .11* protection from liability .10* age .08 -.03 .04 -.01 gender .07 .00 .08 .03 ethnicity: asian .05 .01 .04 .10 blk american .00 .06 .05 .05 blk caribbean .00 .08 .01 .01 latin .04 .04 .02 .01 white .03 .12* .01 .06 other .04 .05 .01 .01 yrs experience .07 -.04 .05 .03 hrs of training .09 .05 .00 .02 reporting history .02 .02 .05 .18*b agency auspice: public/private .08 .03 .00 .02 *p <.05 (bonferroni correction for multiple computations, c = 16). a pearson correlations except where noted. b spearman’s rank-order correlation advances in social work, fall 2009, 10(2) 137 table 3. summary of regression analysis for likelihood of reporting by personal, professional and law variables (n = 710) model #1 model #2 model #3 variable b β b β b β personal age -.007 .020 -.023 -.063 -.028 -.077 gender .367 .034 .429 .040 .605 .056 ethnicity asian 2.839 .107* 2.796 .105* 2.559 .096* blk am. .946 .062 .917 .060 1.014 .067 blk carib. .066 .003 .288 .017 .521 .023 latin .123 .009 .132 .009 .083 .006 other .472 .021 .527 .023 .795 .035 professional yrs experience .026 .061 .022 .051 hrs of training .051 .024 .003 .001 report history .034 .116* .033 .113* agency auspice .231 .026 .396 .044 law situations to report 2.474 .209** sanctions for failing to report .974 .089* protection from liability .514 .057 r2 for the model .015 .032 .094 sig r2 ns .017 .000 r2 change .015 .017 .062 sig r2 change ns .015 .000 *p <.05 **p <.01 the findings reveal that respondents who believed that any suspicion of maltreatment should be reported, that they would be prosecuted for failing to report, and that the law protects them from being sued by a parent or caretaker, were more likely to report child maltreatment than respondents who interpreted the law to permit flexibility in reporting, believed that they would not be prosecuted for failing to report, and believed that they could be sued for reporting. discussion this study examined social workers’ perceptions of the law requiring the reporting of child maltreatment and the relationship of those perceptions with the likelihood that workers would report incidents of maltreatment to child protective services. the study also looked at the effect of several personal and professional characteristics that have been found in previous research to be related to reporting behavior. the findings of this ashton/the effect of statutory regulations 138 study support previous research that shows that ethnicity is related to reporting behavior (ashton, 2004; kenny, 2001; levi, brown & erb, 2006; o’toole et al., 1999; webster et al., 2005). in the present study, asian respondents were less likely to report child maltreatment than were respondents of other ethnic groups. the findings of this study also support previous research which indicates that past reporting behavior influences the likelihood of future reporting (delaronde et al., 2000; o’toole et al., 1999; webster et al., 2005; zellman & bell, 1990). the present study found that respondents who had reported a higher number of incidents of maltreatment in the past were more likely to report a current incident of maltreatment than respondents who had fewer past reports. the primary focus of this study was the relationship between the worker’s understanding of the law and the worker’s reporting behavior. the findings reveal that social workers differ in their understanding of the reporting law and that the likelihood of reporting maltreatment is related to that understanding. in order to protect children from maltreatment it is critical that mandated reporters know what to report. it is reassuring to see that most, 82%, of the social workers in this study understood that they are to report any suspicion of maltreatment. close to three percent (3%) were not knowledgeable about what to report; the other 15% of this sample had an interpretation of the law that permitted professionals working with families and children more flexibility in reporting, namely: reporting only situations that can be substantiated; reporting only situations involving serious harm to a child; or avoiding reporting and using agency and community resources to work with victims and perpetrators. indeed, there may be some workers in this group who essentially oppose the idea of reporting altogether as there is evidence from earlier studies that some professionals see the system of mandated reporting as an ill-conceived policy that fails to prevent the recurrence of maltreatment and which diverts resources from actual service delivery to investigation (melton, 2004; 2005). social workers differed in their interpretation of the other two aspects of the law – whether they would be sanctioned for failing to report and whether they would be protected from liability when reporting. and in fact, these two aspects are ambiguous. the law states that failure to report is a crime, yet enforcement is very unlikely because prosecution becomes complicated when specific cases are under examination. similarly, protection from liability is not absolute (mcleod & polowy, 2000). the differences in worker response to these two aspects of the law reflect the uncertainty of their application in real life. the study has some limitations which must be noted. first, generalizations from this sample are limited to the geographical region (new york city area) from which this sample was drawn; nonetheless, the finding that perception of the law is related to reporting behavior among social workers is consistent with findings from studies concerning other mandated reporters in other geographical locations (brosig & kalichman, 1992; delaronde et al., 2000; zellman & bell, 1990). second, the current study focused on intended behavior using vignettes. although vignettes have been verified as valid measures for likelihood of reporting maltreatment, the vignettes in this study could be strengthened by: having fewer incidents of physical maltreatment and more incidents of neglect; being consistent in the amount of detail; and specifying how the reporter would learn about the incident. ideal vignettes would also match intake advances in social work, fall 2009, 10(2) 139 information of a typical service agency. moreover, in an agency setting, incidents coming to the worker’s attention might be checked for prior reports or other data. it should also be noted that the vignettes omitted other types of maltreatment including sexual, emotional and medical abuse. these types of abuse are quite different from physical abuse in that they are more subtle and more complicated, and may result in reporter responses that are very different from the response to either neglect or physical maltreatment. despite its limitations, this study provides information about an important group of mandated reporters, who previously have not been studied regarding the relationship of their knowledge of the law and their reporting behavior. the addition of the law variables added 6% to the variance in reporting and, although the strength of the relationship between knowledge of the law and the likelihood of reporting child maltreatment represents only a medium effect size (cohen, 1988), it is large enough to have practical implications. the binomial effect size display (besd) illustrates the practical implications. rosenthal (1991) and rosenthal and rosnow (2008) propose using the besd as an appropriate tool in demonstrating that small correlations can reflect an important social effect in a way that is easy to understand, requiring no particular statistical expertise. in the present case, the besd shows that the size of this relationship where r2 = .06, r = .24, is such that a worker’s understanding of the law is sufficient to increase the likelihood of reporting a case of maltreatment from 38% to 62%. it is true that the besd provides an estimated prediction but it is a prediction of improvement and indicates that knowledge of the reporting law affects practice. an increase of 24% in the likelihood of reporting maltreatment is a considerable impact on practice and calls for agencies to periodically review state law requirements. the finding in this study that onthe-job training was not related to knowledge of the law suggests that agency supervisors should review their in-service training to assess what is effective and what is not. using agency listservs and e-communication, as well as face-to-face meetings and workshops, supervisors can incorporate various techniques, including case presentations, clinically based vignettes, surveys, and policy updates, to help workers learn and stay abreast of state reporting requirements. agency supervisors must also help workers recognize and agree on values underlying the mandate to report so that all workers regardless of racial or ethnic background are knowledgeable and effective providers of services to children and families. future research is needed to understand the complex psychosocial processes involved in decisions to not report the combined and interactive effects of worker characteristics, case specifics, the agency environment in which the worker practices, and innovations in practice interventions. in addition, this study raises the question about the steps workers should take to protect children and help families in situations where the worker identifies a reportable incident but decides, for whatever reason, not to report the incident to child protective services. it may be that the dichotomy of report/not report is no longer valid and that research is needed to understand what it is that workers do in addition to (or instead of) reporting suspicions of child maltreatment. ashton/the effect of statutory regulations 140 references al-moosa, a., al-shaiji, j., al-fadhli, a., al-bayed, k., & adib, s. m. 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(1984). making an issue of child abuse. chicago, il: the university of chicago press. o’toole, r., webster, s. w., o’toole, a. w., & lucal, b. (1999). teachers’ recognition and reporting of child abuse: a factorial survey. child abuse & neglect, 23(11), 1083-1101. pedhazur, e. j. (1997). multiple regression in behavioral research: explanation and prediction. new york: harcourt brace college publishers. rosenthal, r. (1991). metal-analytic procedures for social research (rev. ed.). newbury park, ca: sage publications. rosenthal, r., & rosnow, r. l. (2008). essentials of behavioral research: methods and data analysis (3rd ed.). new york, ny: mcgraw-hill. sedlak, a. j., & schultz, d. j. (1997). followup to the nis-2 and ncands studies. sentinel questionnaire followup study. final report (contract no. 105-94-2022/10595-1856 from the national center on child abuse and neglect administration on children, youth, and families. administration for children and families). washington, dc: us department of health and human services. state statute results. (2008). a publication of child welfare information gateway. retrieved june 1, 2009 from: http://www.childwelfare.gov/systemwide/laws_policies/state/index.cfm?event= statestatutes.processsearch. tilden, v. p., schmidt, t. a., limandri, b. j., chiodo, g. t., garland, m. j., & loveless, p. a. (1994). factors that influence clinicians assessment and management of family violence. american journal of public health, 84(4), 628-633. vanbergeijk, e. o. (2007). mandated reporting among school personnel: differences between professionals who reported a suspected case and those who did not. journal of aggression, maltreatment & trauma, 15(2), 21-37. webster, s. w., o’toole, r., o’toole, a. w., & lucal, b. (2005) overreporting and underreporting of child abuse: teachers’ use of professional discretion. child abuse & neglect, 29(11), 1281-1296. zellman, g. l., & bell, r. m. (1990). the role of professional background, case characteristics, and protective agency response in mandated child abuse reporting. santa monica, ca: the rand corporation. http://www.ispcan.org/documents/vid/mandatedreportingmelton.pdf http://www.childwelfare.gov/systemwide/laws_policies/state/index.cfm?event advances in social work, fall 2009, 10(2) 143 author’s note: address correspondence to: vicki ashton, d.s.w., york college of the city university of new york, department of social sciences, rm 3a11, jamaica, ny 11451. email: ashton@york.cuny.edu. mailto:ashton@york.cuny.edu advances vol. 4, no. 1 hearing the silence: children’svoices onviolence kathryn s. collins abstract:each yearmore than fivemillion children in the united states are exposed to traumatizing events in their communities. this paper presents a discussion of multiple areas in violence and victimization research that needs to be continued as well as provides suggestions on how to un-silence child survivors through bridging the gaps between research and practice. it reviews the overarching problem of violence in the u.s. at the domestic and global levels and the effects of victimization. suggestions on how to study possible mediators and moderators of victimization and individual and family adjustment, including: 1) the ecological perspective; 2) court process and verdict; and 3) utilization of victim services, are explored. finally, a rationale and examples of combining qualitative and quantitative methods in future research that uses children’s attributions of violence as a mediator are presented. keywords: children, victimization, community violence, court process, victim services eachyearmore than fivemillion children and adolescents in theunited states are exposed to traumatizing events in their communities and they represent one-quarter of american crime victims. further, the children’s defense fund (2001) indicates that in 1999more children and teens died from gunfire than from cancer, pneumonia, influenza, asthma, and hiv/aids combined. violence endured in children’s homes, neighborhoods, and communities must continue to be considered one of the most alarming public health concerns in our society. this paper presents a discussion of multiple areas in the research that needs to be continued and provides suggestions on how to un-silence child survivors by bridging gaps between research and practice. it reviews the overarching problem of violence in the u.s. at the domestic and global levels and the effects of victimization. suggestions on how to study possible mediators and moderators of victimization and individual and family adjustment including: 1) the ecological perspective; 2) court process and verdict; and 3) utilization of victim services are explored. finally, a rationale and examples of combining qualitative and quantitative methods in future research that uses children’s attributions of violence as a mediator are presented. 20 kathryn s. collins, ph.d. is assistant professor, university of pittsburgh, school of socialwork, pittsburgh, pa 15260. copyright© 2003 advances in socialworkvol. 4 no. 1 (spring 2003) 20-33. indiana university school of socialwork. literature review prevalence ofvictimization the u.s. is a culture with an interwoven thread of violence from its birth in revolution to recent violent episodes at the world trade center, pentagon, and shanksville, pennsylvania. violence is the foundation of many revered ideals and institutions and a common and defining characteristic of american society (cicchetti & lynch, 1993;van soest & bryant, 1995). however, even as the evidence of violent events appears to be decreasing in the u.s., its presence in the lives of children is still a signal for alarm.violence figures significantly into the lives of children and families, and researchers and social scientists often underestimate its effects (bell & jenkins, 1993; gibbs, 1988; osofsky, 1995; richters & martinez, 1993a). an abundance of literature recognizes the impact of violence on children; however, there is little to direct researchers andpractitioners in developing effective victimization services to address the long-lasting effects of such violence. furthermore, research on the mediators and moderators of the effects of violence is still in its infancy (nimh, 2002). children are exposed to violence through direct victimization or by witnessing violent episodes. they also hear about accounts of community and domestic violence from parents, friends, relatives, neighbors, and themedia. children who witness violence experience co-victimization or secondary trauma.the line of demarcation between direct victims and those who witness or hear about violence is obscure because of the similar reactions and effects produced by each (figley & klebeer, 1995; shakoor & chalmers, 1991). jordan (2002) examined he complexities of the impact of domestic violence on the child survivor.primary care physicians and mental health practitioners claim that children are the silent victims in their work with mothers who are survivors of domestic abuse (zuckerman, augustyn, groves & parker, 1995). research indicates that children are present in 80% of the homes where there is violence against a woman (u.s.department of justice, 1999).the relationship between spousal abuse and the physical or sexual abuse of children in the home is now documented to reach 30% to 70% (bowker, arbitell &mcferron, 1988; stark & flitcraft, 1988; suh & abel, 1990). several studies from metropolitan areas have addressed frequency and prevalence and the extent and nature of adolescents’ exposure to violence (bell & jenkins, 1993; fitzpatrick &boldizar, 1993; hill &madhere, 1996; osofsky,wewers, hann & flick, 1993; pynoos & nader, 1990; richters &martinez, 1993b; shakoor & chalmers, 1991). the number of gun-related deaths and injuries to children are on a decline in theu.s.; however, nearly 12 children, approximately one every 100 minutes, die each day from gunfire in their homes, schools, and neighborhoods, which is the equivalent to a classroomof children dying every two days in theu.s. (children’s defense fund, 2001). according to the u.s. department of health and human services, centers for disease control and prevention (1997), the rate of firearms deaths among children under age 15 is almost 12 times higher in theu.s. than in 25 other industrialized countries combined. 21collins/hearing the silence: children’s voices onviolence 22 advances in socialwork trauma symptomatology and exposure a variety of trauma symptoms follow violence exposure. childrenwho are victims andwitnesses to violence experience increased levels of fear, anxiety, and depression as well as psychopathological disorders such as post-traumatic stress disorder, physical injury, and sometimes death (bell & jenkins, 1993; fitzpatrick & boldizar, 1993; garbarino, 1986; pynoos, frederick, nader, arroyo, steinberg, eth, nunez & fairbanks, 1987; richters & martinez, 1993b). symptoms of post-traumatic stress disorder include emotional and physiological hyper-arousal, intrusive and frightening thoughts, feelings, and images of the trauma, and the numbing of emotional responses. some children exposed to violence demonstrate a sense of futurelessness characterized by a belief that they will not reach adulthood, along with a sense of anomie associated with feelings of hopelessness and low self-esteem (freeman,mokros & poznanski, 1993; terr, 1989). these reactions may be accompanied by feelings of vulnerability, self-blame, and retaliation (finkelhor, 1980; saunders, 1996). the clinical effects of children who witness parental violence are characteristic of trauma, with dissociation and defensive projections against recall and resolution, which can be pathological (silvern & kaersvang, 1989). the child who endures family violence, such as parental homicide, has to cope with the trauma of the terrifying event; the grief associated with the loss of both parents (offender and victim) simultaneously; dislocation and insecurity regarding where and with whom they will live; and stigma, secrecy, and conflicts of loyalty (black & kaplan, 1988; burman&allen-meares, 1994). dyson (1990) states that the damage caused to african-american children from exposure to homicide perpetrated by a family member or an acquaintance reflects in post-traumatic stress disorder, behavior problems, and poor school performance. furthermore, children who witness domestic violence are subject to cognitive and social developmental delays, a potential increase in violent and aggressive behavior, and a limited ability to establish trusting and empathic relationships (coffee & coffee, 1996). nationally, children in preschool, elementary school, and high school who experience frequent verbal aggression and severe physical violence from parents exhibit the highest rates of aggression, delinquency, and interpersonal problems within the student population (salzinger, feldman, hammer & rosario, 1993; vissing, strauss, gelles & harrop, 1991;wolfe & jaffe, 1991). some researchers have focused on exposure to violence as a cause of later perpetration of violence (prouts, shopler &henley, 1982;widom, 1989). studies indicate that prolonged exposure to violence may constitute a form of early childhood socialization toward violence. perry, perry and boldizar (1990) suggest in a theoretical framework that environments of community violence: 1) provide aggressivemodels, 2) reinforce aggression, and 3) frustrate and victimize the child who is exposed. all of these factors may contribute to the development of aggressive tendencies in children. some adolescents and children cope with their feelings of helplessness and being out of control by identifying with individuals who frighten them and deny their vulnerability (safyer, 1994). osofsky,wewers, hann and flick (1993) found a direct correlation between exposure to violence and violent behavior. for example, children and adolescents who have been exposed 23 exhibit higher incidences of fighting with peers compared to adolescents who have not been exposed. these individuals put themselves at risk for further harm by associating with gang members or aggressive individuals and by participating in activities such as assaults, robberies, rape, and murder (bell & jenkins, 1993; herman, 1992; shakoor & chalmers, 1991). the degree of children’s victimization and exposure to violence correlates with distress symptoms. however, richters andmartinez (1993a) caution against overinterpreting children’s psychological distress symptoms as indices of maladjustment. just as fear, anxiety, and depression can cause long-term negative consequences, they may also serve as adaptive functions in dangerous environments. the distress may signal increased vigilance and normal, healthy reactions to loss and pain. richters and martinez (1993a) further assert “it remains an important task for researchers to develop strategies and criteria for discriminating between adaptive and maladaptive responses to violence exposure” (p. 6). mediators andmoderators of effects considerable variation exists in the amount, type, and severity of violence children experience. because of distinct worldviews, coping strategies, self-concepts, and constructed ideas of violence, adolescents respond and endure exposure to violence differently. very little is known about themediators between the stressor of victimization and the exposure and effects of symptomatology in children. information developed through qualitative and quantitative research can be used to increase understanding of the mechanism and etiology of trauma symptomatology in child survivors of violent crime. examining individual and aggregate factors of the ecological perspective, attributions, court process and verdict, and service provision and utilization associated with individual and family adjustment will provide data for research and development of interventions to reduce trauma and stress. ecological perspective the ecological perspective enables one to simultaneously focus on person and environment and their reciprocal relationship. according to germain and glitterman (1995), “instead of valuing prediction ofmaladaptive exchanges based on simplistic cause and effect, ecological thinking embraces indeterminacy in complex human phenomena” (p. 817). therefore, it is necessary to examine adjustment of child survivors and their families from an ecological perspective. specifically, researchers and practitionersmust take into consideration the child’s individual and family characteristics, such as race, gender, coping styles, socioeconomic status, health and mental status, social support, history of violence exposure, and neighborhood and school supports, resources, and history of service utilization. research literature recognizes application of the ecological perspective to the impact of violence. one such study by richters andmartinez (1993b) argued that the mere accumulation of environmental adversities such as community violence does not lead to adaptational failure of children living in violent environments. rather, the odds of their adaptational failure increase only when community violence contaminates or erodes stability or safety levels of the children’s collins/hearing the silence: children’s voices onviolence 24 advances in socialwork homes. their study concluded that the erosion of quality of the child’s microsystem and macrosystem is not an inevitable process (richters & martinez, 1993b). elbedour, ten bensel and bastien (1993) and walton, nuttall and nuttall (1997) proposed that the amount of failure and suffering of children exposed to different levels of war violence is ecologically conceptualized with their interaction among five factors: intensity and duration of exposure to violence, the individual, the family (microsystem), the community (exosystem), and the culture (macrosystem). the level of influence of the person-community ecosystem in which the person experiences trauma, copes, and makes meaning out of violent events depends on the child’s individual characteristics and her/his relationshipwith other individuals involved, the child’s perceptions of the events experienced, and her/his description of the larger environment (harvey, 1996). research also suggests that abuse ismore common in families where economic hardship and unemployment are issues (meiselman, 1978; straus, gelles & steinmetz, 1980; jordan, 2002); in familieswhere thedecision-makingprocess is hierarchical, inwhich themale figurehas significant power and control, instead of amore cohesive and collaborative relationship structure (finkelhor, 1980; gelles, 1974); and where there is little to no social support from the community, extended family, friends, and agency and institutional affiliations (finkelhor, 1980; garbino & gillian, 1980; gelles, 1974). garbarino (1995) asserted that children are often capable of coping with one or two major risk factors in their lives, though the risk of developmental damage increases substantially when the experience of violence occurs in combination with other factors. many children in such conditions are poor, live in fatherabsent homes, contend with parents who cope with depression or substance abuse problems, have parents with little education or employment prospects, and are exposed to domestic violence. family adjustment and functioning relates to how familymembers of child survivors perform necessary roles and tasks, adapt to problems, and communicate with one another in such a way that promotes family health and well being (fobair & zabora, 1995). the relationship between family adjustment and functioning and a child’s individual adjustment is a transactional process—the family system both affecting and being affected by the behavior of individual family members (freisen & koroloff, 1990). furthermore, social support is an important factor in the ecological perspective which prevents child symptomatology. individual family members’ social support is the experience of intimacy, acceptance, companionship, and tenderness from peers and other family members. research has shown that social support is a protective factor for children and families enduring stress (wasserstein & la greca, 1996). the school environment is a variable in the ecological perspective. “nowhere has this nation’s educational system failed more dramatically than in inner-city schools serving predominantly poor african-american populations,” stated gerdes and benson in their 1995 needs assessment of inner city school children. (p. 139) in many eastern urban schools, the drop-out rate for african-american youth living in areas of poverty and community violence is almost 40% (u.s. bureau of the census, 1993). schools fail to accommodate the variance of abilities, interests, learning styles, and individual needs such as poverty, parental illit25collins/hearing the silence: children’s voices onviolence eracy, poor health, and community violence of inner-city children and youth (gerdes & benson, 1995). safyer (1994) indicated that many children and adolescents living in areas where violence is prevalent face considerable academic distress. she cited examples of adolescents not sleeping soundly at night as a result of not feeling safe in their home environments. as a result, these students find it difficult to concentrate in the classroom, causing some teachers to erroneously believe that these students are disinterested or lack academicmotivation and the ability to succeed (safyer, 1994). pynoos and colleagues (1987) found significant relationships between proximity to violence and the type and number of post-traumatic stress disorder symptoms in their study of 159 elementary school children sampled after a sniper attack on their school premises. richters andmartinez (1993b) discovered in their study of children in the washington, d.c. area that 22% of the victimization, according to the children’s reports, occurred in school, and another 30% stated victimization took place near their school. court process andverdict althoughnot all accounts of experienceswith violence are reportedor endup in the court process, onemust consider the difficult challenges that court processes pose for children and families who are survivors of violent crime. designed with shortterm, narrow interventions without adequate follow-up, they need to be considered as part of the research, practitioner, and legal system agenda; the judicial system is a harsh environment that is not child-centric. children often feel intimidated by the criminal justice process and “re-live” the abuse and victimization, particularly in the courtroom. this is predominantly true of younger children. this “reliving” of the abuse may intensify the victim’s trauma, thereby, causing the child to be apoorwitness andprovideweak testimony that poses additional barriers to successful investigation and prosecution (u.s. department of justice, office for victims of crime, 1999). children involved in court situations rely on professionals across several disciplines and viewpoints (e.g., law,mental health, policy, advocates, victim services, batterer programs, etc.) to help them through the lengthy process of navigating the justice system that can affect the child’s psychological development in significant and long-termways (rossman, hughs & rosenberg, 2000). the u.s. department of justice, office forvictims of crime (1999) and lipovsky and stern (1997) report a number of court-related factors that have been identified as stressful for child victims and witnesses: (1) multiple interviews and not using developmentally appropriate language; (2) delays and continuances; (3) testifying more than once; (4) lack of communication among professionals; (4) fear of public exposure; (5) lack of understanding of complex legal procedures; (6) face-to-face contact with the defendant; (7) practices that are insensitive to developmental needs; (8) harsh cross-examination; (9) lack of adequate support and victims services; (10) sequestration of witnesses who may be supportive to the child; (11) placement that exposes the child to intimidation, pressure, or continued abuse; (12) inadequate preparation for testifying; and (13) lack of evidence other than the testimony of the child. however, there is paucity in the 26 advances in socialwork research and practice literature regarding the impact of court related factors on long-term individual and family adjustment. the office for victims of crime (1999) reports that some researchers and practitioners have found that testifying is not necessarily harmful to children, as long as they are adequately prepared (goodman,taub, jones & england, 1992; oates, gray, schweitzer, kempe, et al., 1995). having a trusted person, such as a victim-witness advocate, helps to reduce the anxiety and traumatic stress symptomatology of the child (henry, 1997). research further indicates that by reducing the number of interviews from lawyers, court officials, medical examiners, and police officers regarding the victimization can help to minimize psychological harm to child victims (tedesco & schnell, 1987). victimization services child survivors and their families do not choose to be victims. therefore, it is necessary for survivors to choose and utilize a wide range of services that help them maneuver the criminal justice system and promote healing from victimization and trauma. for many children and families, violence is an unavoidable part of their lives (noguera, 1995). children need safe havens and people to help them overcome their experiences of vulnerability and ambivalence. early interventions and services for child survivors and their families are essential for their health and well being (u.s. department of justice, office forvictims of crime, 1999). in the u.s. and other countries, there has been a phenomenal growth in victim service programs. roberts (1990) reports that there were only 23 victim programs in 1975 but more than 600 such programs by 1986. likewise, there were only seven emergency shelters for women survivors of domestic violence and four police-based crisis intervention programs in 1974. by 1987, however, there were more than 1,250 emergency shelters and crisis programs for women survivors of domestic violence and their children. during 1982 the president’s task force on victims of crime identified the american justice system as“appallingly out of balance” and made 68 recommendations for how rights and services for crime victims in this nation could be substantially improved. these accomplishments include thevictims of crime act in 1984, the landmark crime act of 1994, and the countless state statutes that strengthen victims’ rights and provide effective community-based victim services. however, there is still a lack of comprehensive services for victims of crime in every community, resulting in part from inadequate funding (u.s. department of justice, office of crimevictims,1998; lippert, 1999; national victims assistance academy, 1999; jordan, 2002). research indicates that the participation of victim services, such as interventions provided by victim–witness advocates in child cases, appears to increase the percentage of guilty verdicts and promotes coping and adjustment for child survivors (u.s. department of justice, office of victims of crime, 1999). dible and teske (1993) found the conviction rate for child sexual abuse cases almost doubled (38% to 72%) after a district attorney in collin county, texas implemented child victim–witness advocacy programs. the proportion of offenders receiving prison sentences also almost doubled from 25% to 48%. over the same period, prison sentences increased from 9.24 years to 16.48 years. 27 there is a need to create individualized interventions and services for children and families who are survivors of violent crime. child advocates and researchers are becomingmore aware of the unique effects of a myriad of violence and abuse situations. intervention efforts should be tailored to what is needed by families at a particular point in time, with careful analysis focusing on the context of the violence, specific incidents, patterns, and psychological reactions (national victim’s assistance academy, 1999). access to a continuum of ecologically-based services for families and children rather than short-term, narrow interventions without adequate follow-up need to be considered part of the research, practitioner, and legal system agenda (u.s. department of justice, office for victims of crime, 1999; rossman, hughes & rosenburg, 2000; jordan, 2002). bridging future research and practice in our society, children represent a population whose voices are often ignored and silenced. as stated previously, psychology, social work, public health, sociology, andmedicine have begun to study the effects of children’s exposure to chronic community violence. however, little research has been done to both quantitatively and qualitatively examine children’s perceptions of the violence they are experiencing. for example, a study that was initially designed to rely only on quantitative methods to gather frequency and perceived severity data of children’s exposure to violence as part of a larger study on perceptions of safety (collins, 2001) turned into a more valuable and comprehensive study, because the researchers found that the children wanted to tell their stories of violence. children’s perceptions hill and madhere (1996) confirmed in their study that “the saliency of children’s perceptions of violence in their communities, the nature of their exposure to it, and whatmeaning they attach to it all become critical in understanding how they interpret the stressor of violence and how it affects them” (p. 26). considerable variation exists in the amount, type, and severity of violence children experience. because of distinct worldviews, coping strategies, self-concepts, and constructed ideas of violence, children respond and endure exposure to violence differently. garbarino (1995) stated that the most crucial feature of child development is the child’s emerging capacity to form and maintain social maps. he suggested that social maps represent the world, reflect the simple cognitive competence of the child, and indicate the child’s moral and affective inclinations. children’s social maps include experiences in the larger environment in counterpoint with the child’s inner life, both rational cognitive forces and the unconscious impetus (garbarino, 1995). through these social maps, childrenmay develop a framework within which to understand danger and safety. simpson (1996) stated, “perceptions of safety and danger are ‘intersubjective’ products of social construction, collective agreement, and socialization” (p. 549). she insisted that while objective danger and violence exist, perceptions do not derive directly from observation of the empirical world. instead, the objective environment provides only discrepant and ambiguous information about danger and violence, providing room for socially constructed beliefs. collins/hearing the silence: children’s voices onviolence 28 advances in socialwork children’svoices children are placed in a subordinate role and are not relied upon as resources for understanding concepts related to their well-being. as lecompte (1993) described it, those in subordinate roles are those who are oppressed, silenced, and “have been deprived of voice without their consent” (p. 10). it must be the researcher’s goal to make the voices of the children heard. the role of the researcher in this type of comprehensive study is to be the mediator between those who are powerless, the children, and those in power who do not have the ability or do not choose to hear children’s voices. being a mediator between the powerful and the powerless has been described as the traditional perspective of feminist researchers (kerlin, 1997). for example, the u.s. department of education and the u.s. department of justice (2001) suggest that their data indicate that children are safer at school and most harm and violence occurs within the home or en route to and from school. yet, collins (2001) has discovered through using a combined qualitative and quantitative research design that none of the children (high or low exposure) indicated that they felt safe at school. to many children violence is more than the number of incidents reported or the number of weapons children are “caught with” and safety is more than having structured rules, wire fences, or metal detectors. lecompte (1993) described silence as occurring at two levels during the research process. the first level of silence occurs among the overall population of children. the second level of silence is within each individual child. using the research role and providing a safe, warm environment of trust can be created between the children and the researcher so that children feel empowered to tell their stories and break the silence. attributions an example of breaking the silence is qualitatively and quantitatively studying children’s attributions of violence. attributions are the suspected or inferred causes of an event, situation, or behavior. the research on abuse-specific attribution style is important to understanding the sequelae of childhood victimization (brown & kolko, 1999; cohen & mannariono, 1996; spaccarelli, 1994; wolfe, gentile &wolfe, 1989). attributions are possible mediators of the response children undergo who have been sexually abused (celano, 1992; janoff-bulman, 1979; mannarino & cohen, 1996; wolfe, gentile &wolfe, 1989), physically abused (brown & kolko, 1999), or exposed to natural disasters (joseph, williams & yule, 1993). attributions have been demonstrated to be positively correlated with psychological and behavior problems. however, research has not examined the relationships among children’s attributions regarding the causes of violent crime, court process and verdict, and service utilization in children. finkelhor and browne (1985) suggest that specific attributions may be associated with specific trauma symptomatology. children who perceived less blame and felt more empowered also reported a more positive adjustment and less trauma symptomatology. another attribution, personal vulnerability, reflects adolescents’ beliefs that abuse happens often to adolescents, that it could happen again, and that adolescents are not able to prevent bad things from happening. youth also may have a dangerous worldview— 29 children will be victimized in society and adults cannot be trusted for protection. the issues of self-blame/guilt, responsibility, and power/control have been found to mediate symptoms associated with child sexual abuse (gold, 1986; wyatt & newcomb, 1990; cohen &mannarino, 1996). children who are psychologically manipulated tend to blame themselves, take on responsibility for the abuse occurring, feel extreme amounts of guilt and shame, and have a sense of isolation from their peers and other family members. the perpetuation of abuse under these circumstances is common, therefore, increasing the likelihood of child survivors having low self-esteem, depression, suicidal tendencies, an inability to trust, and difficulty developing interpersonal relationships (herman & hirschman, 1977;walker, 1979; jordan, 2002). conclusions a paradigm shift from traditional methods of violence research to more comprehensive and revealing research that includes the voices of children would continue to advance the knowledge and skills of child advocates in the areas of practice, policy, and research. delineating the factors in the individual and her/his social environment, which could be addressed in interventions, may also provide support for more effective victim services and treatment programs. research on the impact the court process and verdict have on child survivors’ adjustment in relation to the victim services provided to children and families is an area of research that has been afforded little attention, yet has promising policy implications. to effectively pursue and prosecute offenders in cases involving child survivors, the investigators, prosecutors, and judges must adjust their practices to meet the needs of these children in an age-appropriate and responsive manner. reducing trauma to the child increases the child’s participation, leading to an increased chance of a successful outcome to the investigation and prosecution. this research also contributes to the children’s mental health and health services research literature. few, if any, studies examine access and barriers to services for child survivors and their families. victimization is an incident in one’s life that demands a response; 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(1995). silent victims revisited: the special case of domestic violence. pediatrics, 96(3), 511-513. author’s note: the author expresses gratitude to the university of pittsburgh’s center for minority health, graduate school of publichealth and thecenter formentalhealth services research, school of socialwork for their support in preparing this manuscript. address correspondence to: kathryn s. collins, ph.d., assistant professor, university of pittsburgh, school of socialwork, 2117 cathedral of learning, pittsburgh, pa 15260, usa. e-mail: kscpitt@pitt.edu. 33collins/hearing the silence: children’s voices onviolence spring2006-071_page67 spring2006-072_page68 spring2006-073_page69 spring2006-074_page70 spring2006-075_page71 spring2006-076_page72 spring2006-077_page73 spring2006-078_page74 spring2006-079_page75 spring2006-080_page76 spring2006-081_page77 spring2006-082_page78 spring2006-083_page79 spring2006-084_page80 spring2006-085_page81 spring2006-086_page82 spring2006-087_page83 spring2006-088_page84 spring2006-089_page85 spring2006-090_page86 spring2006-091_page87 spring2006-092_page88 spring2006-093_page89 advances vol. 3, no. 1 1 keynote speech: 90th anniversary symposium indiana university school of socialwork andrew cuomo abstract: in celebration of 90 years of social work education at indiana university, the school of socialwork sponsored an anniversary symposium on april 12, 2002. andrew cuomo, former u.s. secretary of housing and urban development and current candidate for newyork state governor, delivered the keynote address. in his address,mr. cuomo recognized the history and growth of indiana university school of social work from its origin in 1911 to its current status as a state-wide, multicampus enterprise. he discussed the formation of project help (housing enterprise for the less privileged) and shared some of his experiences as secretary of hud. he also explored several contemporary social, political, and philosophical issues, including the potential long-term effects of the tragic events of september 11, 2001. introduced byms. jane schlegel,m.s.w., chair of the indiana university school of social work campaign committee, mr. cuomo interspersed his prepared remarks with spontaneous reflections.his comments are presented here in unedited fashion. keywords: andrew cuomo, indiana university school of social work, housing, social policy, homelessness jane schlegel: it’s nowmy pleasure to introduce our guest for the day, who didn’teven get lunch.he just got here, and it’s one of those dayswhenprobably everything didn’t go according to the plan, butwe’ve all had those. so, we’re very sympathetic to that. i could immediately sense the energy andrew cuomo brings to his work, to his campaigning, and i’m sure to his family. i just want to touch on a few things. he has awebsite,which is http://andrewcuomo.com. if youwant to readabouthiswork and his campaign for thegovernorofnewyork inmoredetail, youcouldgo to thewebsite. in the meantime, i want to mention something that he did that i think as social workers is significant and reflects his energy and creativity. in 1986, as a young andrew cuomo, j.d. is former u.s. secretary of housing and urban development and current candidate for newyork state governor, newyork city, ny 10017. copyright© 2002 advances in socialworkvol. 3 no. 1 (spring 2002) 1-14. indiana university school of socialwork. 2 advances in socialwork attorney, he started a program called help. help stands for housing enterprise for the less privileged. this is a provider of transitional housing, and many of the wraparound services that go with helping people who have been homeless move to self-sufficiency. after he started that program, in 1991 he became head of the newyork city commission on the homeless while continuing to operate help. in 1993, he came to washington, d.c., first as under secretary of hud, and he was determined fromwhat i could tell from reading, to bring to the federal government the lessons he had learned at the city level. he developed a continuum of care strategy to help the homeless become self-supporting at hud. at hud he created a consolidated planning process that gave communities and their residents a greater role in determining how hud money was used. both his continuum of care project and his consolidated planning process won the harvard universities kennedy school of government innovations in america government award. i think that’s pretty impressive.we’re always looking for innovations in government. i want to quote david osborne, who wrote a book that was actually the bible of our former mayor steve goldsmith, and that book is reinventing government. some of you may have read it or heard of it. he wrote that andrew cuomo’s management reform“represents one of themost ambitious, fundamental, and exciting reinvention plans in the recent history of federal government.” andrew cuomo was born in new york city. he became a lawyer. as you know, we’ve heard of his father who served as governor of new york. andrew cuomo is now running for governor of new york, himself. he is married to kerry kennedy cuomo. they have three daughters, and i would predict as those daughters get a little older, he may wish he were back running hud. it will probably look like a walk in the park. andrew cuomo: thank you very much. i’m going to leave the comment about the three daughters and runninghud alone, because i’m not sure what i could do with that that would work out well. thank you for the kind introduction. it’s a true pleasure to be here today with all of you. i want to first thank chancellor bepko and dean patchner for the invitation. it’s a pleasure to be with them. it’s a pleasure to be back in indianapolis. i did a lot of work here when i was the hud secretary. mayor goldsmith was mentioned, and mayor hudnut, who was a very creative fellow.we did a lot with indianapolis, and it’s a very beautiful city. one of the good things frommy experience inwashington: i was all across the nation in literally every state, and i think indianapolis really brings the best of all the different urban components together. it has a strong economy. it has an urban life, but it’s a very livable city. it’s a pleasant city, and it has a great population. so, it’s a pleasure to be here. i didwork in fortwayne, and i didwork in gary.whenever you thinkwe’re a success, and we’ve mastered the universe, you can always just take a ride to gary and look at some of those neighborhoods. then you know how much more work that we have to do. i’ve heard the slogan that was used in the other room. i heard it a little differently, though. maybe it’s an east coast thing. i heard that great cities have great universities, and great universities have great schools of social work, and great schools of social work have great alumni and faculty. that’s the way i heard that statement. congratulations on 90 years of greatwork! i believe that the school of socialwork truly does do the lord’s work. i believe it’s going to be a growth business, and i’m going to speak to that in a moment. i’m sure we need it more and more than ever before. it is a tough field, but ultimately more rewarding, if not more challenging than dealing with buildings, or dealing with finance, or dealing with marketing. you’re dealing with people. that’s the beginning, and that is the end. you heard about my experience at help from jane. help was a not-for-profit organization that helped homeless families. homeless families was a euphemism. homelessness still is a euphemism.we don’t want to admit exactly what it is, sowe call it homeless. it sort of immunizes us from the pain of what it actually is. when i was working with homeless families in new york in the late ’80s, the number one cause of homelessness was domestic violence. number two was substance abuse. number threewasmental health.we called it all homeless.wemade it a housing problem, which made it almost simpler to deal with, less painful. if you ever had to admit the problemwehavewith domestic violence, and admit that we have a problem where men abuse women in our society physically and with frequency, that this is not an issue that is isolated to any economic group, but is pervasive, that would be difficult for us. so, we call it homeless. i started working with the homeless and formed an organization called help. fifteen years later it’s the largest provider for the homeless in the nation. seventyfive thousand people have gone through it. to this day, i believe it’s the greatest thing that i’ve done with my life thus far. it got difficult, and that’s why i say your work is so challenging. primarily, we were a social service organization that provided housing, but only as a place for the delivery of services. we worked with social workers, who basically ran the operations.we went from two employees to 500 employees over a number of years. i did it for five years, and at the end of five years i couldn’t take it anymore. the day-in, the day-out, the human trauma that you deal with. for every one success, you have two stories where you take a step back. ultimately, i couldn’t take it. it was toomuch of a toll. i fled help for the safety of the bureaucracy. i became a paper pusher in washington, dc. it was nice. there was no human contact. i dealt with the congress, and i didn’t consider that human contact. i was one of the youngest cabinet secretaries in history as you heard from the chancellor. bobby kennedy, who would have been my father-in-law, was younger when he was named attorney general by his brother. that was nepotism, so i don’t count that as competition. i was appointed, and i was 39 years old. i was head of hud. i left four years later, but those were a long four years. those were the clinton administration four years. we experienced all sorts of things in those four years. those were long days, and those were long nights. four years later i left, and i was 67 years old. that’s why i look the way i do. hud was a difficult post. i got hud basically because everyone else was too smart to go there. it was the enemy of the republican congress. they wanted one thing. they wanted to blow uphud. that was their main point. they wanted to eliminate it, and god bless them, they were not shy. they told you exactly how they felt. i remember when i was nominated for hud. the president can nominate you, but only the senate can confirm you. these are very different concepts, and the 3cuomo/90th anniversary symposium: indiana university school of socialwork senate wants to make sure that you understand this, that the president only nominates, but they confirm, so, therefore, youwork for the senate, and therefore you are responsive to them. so, they hold your life in their hands for a period of time. they call it the senateconfirmation process, but really they just take youby a string, and they dangle you over a flame for a period of time until you pay the amount of appropriate respect due to the united states senate and congress, and then they either release you to four years of pain, or just drop you directly into the flame. so, i ran the gauntlet that was the senate confirmation process, and i was going through the hearings, and one of the senators, whowas from down south, andwho was a big enemyofhudand everything thathuddid, becausehudhelped those poor people in those poor places with those funky problems that shouldn’t exist in the first place, and we were going through the process, and the senator looked at me and said, “now, boy, you don’t have to bother unpackingwhen you come down because you’re not going to be here that long,” but i was, and we saved hud. i turned out to be a successful hud secretary, successful hud secretary being defined as a hud secretary who’s not indicted by the end of his tenure, and i did that.we actually made some changes, and we did some good things.we did good things on the areas that youwork in.we did a lot of work on the homeless.we doubled the budget.when i got to hud, the budget for homelessness was about $300 million. it was still seen basically as a housing physical problem, the continuum of care, but as a social service model to helping the homeless, and we brought the budget up to over a billion dollars, and we brought not-for-profits in all across the nation to work on the issue.we bought home ownership to its highest level in history, 67%, and we fought discrimination. we did a lot of good work, and if i took any lesson, it was how much needs to be done, but yet what a great potential we have to do great things. those are the points i want to touch on today. i want to start with one quick story that sums up the point tome. that’s the story of the farmer and the flood, which sort of brings it all home tome. the story of the farmer in the rural part of the county. it had been raining for a number of days.the county officials were concerned about the rain, and they called up the county, and they found out that the river was starting to swell, and that there was going to be a flood. the county officials got in a large truck, and they went out to the rural part of the county and went to the farmhouse. they said to the farmer, “you see all this rain? actually the river’s swelling, and there’s going to be a flood, but we have some time.we have a big truck outside.we’re going to take you and your belongings to safety.” the farmer looked at the county official and said, “no, i’m a god fearing man. i go to church every sunday, and the lord will take care of me.” the county official said, “all right, but we have the truck, so let’s go ahead and get in the truck.” the farmer said, “no,” and they were back and forth a little bit. then the county officials left disgusted. the rain kept coming and kept coming, and a few days later there was six feet of water. the county officials, being industrious as they were— good government employees, they now had a boat. they got in the boat, and they went back to the farmhouse. they said to the farmer, “we told you that it was raining.we told you that they said it was going to flood, and now you have six feet of water, but don’t worry we have a boat outside.we’re going to bring you to safety in the boat.” the farmer looked at them, and said, “no, i’m a god fearingman. i go to 4 advances in socialwork church every sunday, and the lord will take care of me.” they said, “we know.you said that last time, and lookwherewe are now in six feet water. get in the boat now while we still have time!” the farmer said, “no, the lord’s going to be there for me. i’m sure of it! i’m sure of it!” they said, “come on, we’ll get in the boat, and we’ll take care of the lord later.” he still said, “no,” and they went back and forth, and they argued. eventually, the farmer insisted that they get back in the boat, and they leave. the rain keeps coming, and keeps coming, and now the farmer is standing on the roof of the farmhouse, and the water is up to the farmer’s neck. only his head is above the water. he has his head above the water, and he’s looking up. as he’s looking up, he hears a great rumbling sound, and the clouds start to part, and there’s a loud noise as the clouds are parting, and it gets windy. then there’s a helicopter. it’s the county officials that are in the helicopter. they throw down a rope and they say, “grab the rope! it’s us, the county officials.we can still save you. grab the rope, and we’ll pull you up to safety.” the farmer said, “no, i’m a god fearing man. i go to church every sunday, and the lord. . .” they said, “grab the rope before it’s too late!” in the next scene, the farmer’s at the pearly gates. hemeets our maker, and the lord says, “hello, welcome to heaven.” the farmers says, “it’s nice to be here. i guess it’s better than the alternative, but, lord, i’m confused. i went to church every sunday. i thought you were going to be there for me. what happened?” our lord looked back at the farmer and said, “you’re confused? i’m confused. i sent a truck, a boat, and a helicopter.what happened?” the point to me is that in the final analysis, it is up to us. it is our action. it is our initiative that will decide destiny and decide fate. nothing happens.what happens is whatwemake happen, and it starts with us. i think that’s an important lesson for today, becausewe are at a crossroads. i think the chancellor is exactly right. i think this nation is at a point that it can go in different directions, and we’re working through that right now, but we are truly at a crossroads. as they say indiana is at a crossroads, we are at a crossroads today for a number of reasons. number one, the economy is basically good. it’s not great, but it’s basically good, and we don’t have to be preoccupied with the economy. when the economy is bad, it becomes the entire subject of the day.when the economy is good, we’re not worried about our immediate economic wealth. we have a 1996 welfare reform act that has given us a totally different program model of howwe’re going to helpmillions of people across theunited states.we are more diverse as a nation than ever before. by the year 2050, we will be a majority minority. you go all over the united states and you meet new immigrants. immigration and diversity is now not just a function of the coasts. they’re in minneapolis.therearenew immigrationpatternsall across theunitedstates, and that is changing us. we are younger. the baby boomers are moving on. there is a new generation. generation x, generationy, and i’m not part of it, but they see the world totally differently. a different set of values, different stimuli, and they’re now taking their place. most importantly, i think, andwhat’s going to bemost transformative is the 9/11 experience. i think one day they will talk about 9/11 the way they talked about the john f. kennedy assassination, or world war i, or world war ii, or being a depression baby. this is going to be individually formative, and formative of the 5cuomo/90th anniversary symposium: indiana university school of socialwork 6 advances in socialwork nation. i thinkwe’re still working through it, and i don’t thinkwe’ve determined yet what it has meant. i think we’re still processing the feelings, but you can see two very different options, and you can see that we’re at a fork. one option is that we can take the 9/11 incident, and we can take that fear, and we can close down.we can constrict. in someways it’s almost the natural response.when you get startled, (remember) the startled reflex with a child. . .when you’re afraid, you constrict. your body says, “pull within. close down. cover your vulnerable parts. reduce your vulnerability.” you can almost see us doing that as a people. closing down, building walls, getting suspicious, getting afraid. you’re different than i am. you have a different skin color. you have a different tone. maybe you’re a terrorist. let me see your papers. let me pull you off the line. getting afraid and getting tight is an option for us individually, and for us as a nation.you can’t trust anyone. become nationalistic, close out borders, close out boundaries, and get tight. the second option is to go the exact opposite way.yes, we are vulnerable.yes, we can be hurt, but the solution is not to close down, but to open up, and be liberated by the vulnerability. not to be restricted by it. let’s learn why, understand why, and let’s becomemore protective andmore secure certainly, but let’s reach out and form alliances, and form connections, and become safe in the whole, rather than individualized and isolated. that is a less natural response. it is a more intellectual, more intelligent response, and i believe long-term amore productive response, but not a natural one. i believe in government. i’m running for governor. why? because i believe in government. forget all the politics and all the bologna. government is purely the vehicle that says we will operate as a collective. if you choose the fork that says, “we should be community. we should be together,” then the vehicle that does together, that does community, is government! it gets too complicated with all thesetv shows, all these programnumbers, and all this federalmumbo jumbo. all government is is when we decide we’re going to do something together, the committee we form is called government, and it does what we can’t do as individuals. we need the military defense. not everyone can defend the country. okay, we’ll have a committee do it. we need to protect ourselves domestically. we’ll have a police force. we can’t do it individually. okay, we’ll form a committee. that committee becomes government. if you believe in the collective rather than the individual, and you need an implementation vehicle, that then is government. so, yes, i believe in government. yes, i’m running for governor, and yes, i was at hud, but only because i believe in the collective. not because i have any great need to amass pension benefits as a government employee, only because i believe in the collective. i believe that the vehicle has to work. i believe that the vehicle has to be credible, and i believe we have a lot of reform to do in that way, because the government vehicle doesn’t work today. only 18% of the new generation that’s coming on vote. why? because government doesn’t work. government isn’t inspirational. they didn’t have a john f. kennedy, a bobby kennedy, or a martin luther king. they had none of that. their main interactionwith government is thedepartment ofmotorvehicles, when they get a license, and the internal revenue service, when they decide to make some money. these are not inspiring interactions where you say, “i want to be with them. i want to be that clerk in the dmv.” they don’t have that same feeling. you have to make it work. first, the politics, the political paradigmwehave today is outdated.when iwas in washington, one of the marbles i had was whatever the issue was before the unitedstatescongress; the votewasalwaysbyparty line.democrats always voted for democrats, and republicans always voted for republicans on whatever the issue. should we cut down trees under six feet tall in the midwest? democrats all have one opinion, andrepublicans all have one opinion.howcan it be?the loyaltywas to the party label rather than the public interest in public service. it had become more about your party affiliation than your popular sentiment.they didn’t bring the independent judgment that was suppose to be representative of government that jefferson andmadison talked to us aboutwhere you’re going to represent the people and bring your skills and abilities. they said, “what’s the call on this one boss?” “we vote against the trees that are six feet tall.” it constantly was that sort, and that doesn’twork.the traditional definitionsdon’t evenwork.thedemocratswant tohave a simplistic view that says, “the private sector is bad, and we need government to control the private sector.”that doesn’t work.maybe you have that fear coming out of the depression, where you saw the private sector victimizewomen and children, but that was decades ago. the republican view is that government is bad. if you just let the private sector work, life will be all rosy. go look at gary and deanna after eight years of the strongest economy in history, and tell me how well the private sector does lifting all votes. gary was anchored if that was your theory that it lifts all votes. the traditional paradigm doesn’t work. also the operating model of government doesn’t work. it is where the corporate sector was 30-40 years ago. the best analogy i have is the analogy of the bank in the ’60s. remember what a bank was about in the ’60s. the power was in the bank. the power was in the corporate institution, and you were just a consumer. you were just a customer. you had no power. you were just a person. they were the corporate entity. the bank was always on the corner of every city. big granite building with big columns that made the statement, “i am the bank and you are a mere person.” you would go to the bank, but you would go to the bank on the bank’s terms. the bank closed at 3 o’clock in the afternoon.why?who could get there by 3 o’clock in the afternoon? it didn’t matter. if you wanted yourmoney, you figured out how to come. they laid a reform, and then they were actually open on saturday mornings as a convenience. you’d have your little pass book, and you’d go up to the teller and say, “may i please havemymoney back?” “well do you have your pass book? letme see if the paper is in order?” “i forgot my pass book.” “then, no money for you today!” the power was with the bank. the power was with the institution. we’ve gone 180 degrees from there. now i have my atm card. if i have to move more than 10 feet in any direction to find an atm teller, i’m going to get a new bank because that’s just unacceptable. i have the power. i am the customer. i am the consumer. i don’t care. the power is not in the institution. the power is me. government is still in the ’60smodel.they think theyare the institution,andyoumust cometo them. itdoesn’twork thatway.thewhole servicedeliveringmechanismdoesn’t work. the whole organization doesn’t work. the stovepipe approach doesn’t work. 7cuomo/90th anniversary symposium: indiana university school of socialwork i was in the department of housing. then there’s the department of health and human services.what if you had a health problem and a housing problem? then you come tome, and i’ll give you an apartment.then you have to go next door and see donna shalala, and she’ll give you health needs, but the problems aren’t presented that way. homelessness, domestic violence, substance abuse, it doesn’t happen that way. it doesn’t happen in the stovepipes, but that’s the way the government is organized, and if you don’t present the problem the way the government is organized, they don’t recognize the problem. none of these things work top down anymore. all of the solutions are bottom up. all of them are comprehensive solutions on a community basis. government as a service deliverer doesn’t work. the not-for-profits are much better. make the government work. change the political paradigm, get out of the old labels, change the operatingmethodology, make it perform, andmake it work. then you’ll start to have the credibility to actually address the new problems. onceyouhavegovernmentworking, the twopriorities inmyopinion, first of all, the public education system. you can go to any city in this nation, and there are two education systems. you can go to the rich side of town. they will show you the schools on the rich side of town, either public or private, and they will be state-ofthe-art. you go to the first grade, and you see first graders on a pentium processor. you go to school on the poor side of town, and it’s the exact opposite. the most sophisticated piece of electronic equipment they will have is the metal detector that youwalk throughon theway to the classroom.twodifferent education systems. what was supposed to be the great equalizer for american society, the education system, now has become the great discriminator. it was the great equalizer. it said, “i don’t care what color your skin, where you came from, what your accent is, what your country of origin, or how much money your parents have in the bank, you can become the president of the united states based just on the public education system.” that was the american experiment, and that was american democracy. we’ll invest in you.we’ll grow you, and you’ll help all of us.we did that through the public education system.that was it. no handouts. nobody ever asked for a handout, but we’ll give you an education, the public education system. now it does the exact opposite. and now you have a real fear that if your child goes to the wrong school, the child will never catch up. if your child goes there seven, eight, or nine years, he or shemay be left behind for the rest of their lives andnot be able to catch up. that is job one. job two is going to be the issue of race. the outside threats have gone for this nation. the internal threat is more dangerous and more insidious. racism is alive and well. we don’t even want to admit it. we don’t even want to talk about it, let alone solve it. it’s almost like homelessness and domestic violence.we don’t want to say domestic violence. why? because it hurts us. it’s too painful to admit the problem we have. race is the same thing.we don’t even want to talk about it, but it is there across the board. it is just as ugly as it was in the ’60s and the ’50s. that same brutal, physical kind of ugliness and racism. they dragged a black man, mr. bird, to his death in texas only because he was african-american. i did a case in pennsylvaniawhen iwas at hud.we sued the ku klux klan.why? because the kuklux klan targeted awomenwhowas biracial. she 8 advances in socialwork had an african-american father and a white mother. this was a biracial girl. the kkk’s fear was that you may not know that she was biracial, because she was very light skinned. this is a great fear for the kkk that you’re going to mix blood, and you may not know that this woman is african-american. so, what they did as a public service was they put her picture and her identification on their website. they would track her whereabouts, so everybody would know exactly where she was. so, if you went into an establishment, and someone happened to meet her, you would know she’s black. god forbid you would be on notice. the family ultimately moves from pennsylvania. thank god for the internet, because the kkk could track the family. the family moves five times in two years, trying to get away from the kkk. we sued the kkk. that was the first time the kkk had ever been sued, and the grand marshall of the kkk of the state of pennsylvania. that was two and one-half years ago. discrimination has also become a little more subtle, and a little more intellectual and institutionalized. it is inherent in our banking system, our housing system, and our insurance system. we used to do discrimination testing at hud. take the same financial form, every number and every statistic the same. we’d give it to an african-american, and give it to a white person. they would both go into the bank. the same exact life history, everything exactly the same, just the color of the skin different. the white would get the loan, and the african-american wouldn’t. that’s in the year 2000, and we don’t even want to talk about it, but we’re becoming more and more diverse. the problem’s not going to go away on its own. don’t worry, it will go away. no, it’s going to get worse, and it’s not just black/white. it’s black, white, brown, yellow, asian. seventy-five different languages in the newyork city public school system. one-hundred and ten different languages in the l.a. public school system. learn how to deal with this, or it will defeat you, i am convinced, because the whole experiment was, “don’t worry, we can take people from different places and bring them together, and they’ll forge one nation.” the differences will be a source of strength and not weakness. that’s not where it is now. we have to have the courage to speak about this issue and address it. god blessed bill clinton. he talked about a one america race dialogue. he said, “let’s have this discussion in every church, in every temple, in every school, and every kitchen table all across the nation,” and understand why we get afraid when a person is different. what does it say to us? when a person has a different skin color or a different accent, why does it challenge me? why does it threaten me? what does it say to me that makes me angry and makes me fearful? understand the problem.then secondly, say to this nation, “it is not just wrong discrimination, it is illegal.” by the current laws today, it is illegal.we don’t enforce the laws, but it is illegal. enforce those laws with the same vengeance that you enforce the drug laws, that you enforce the tax laws. say to the people in this nation, “no, wewill not tolerate discrimination, and we’re going to enforce it,” and take the enforcement agencies and those laws, and make them work. not that the eeoc is a joke. in my state, the state of new york, division of human rights, you make a complaint, it takes seven years to hear the case. you know what that means? the case is never heard because justus delayed is justus denied. you can’t make a case after seven years.what are we really saying?we know what goes on, and it’s going to be a subtle admission. public education and race relations are going to be the top two 9cuomo/90th anniversary symposium: indiana university school of socialwork priorities, and we have to do it now. i believe in the fork in the road and the crossroads. i believe we’re going to take the right fork. i believe that the 9/11 experience is going to wind up having a silver lining. i don’t think we’re there yet. i think we’re still processing it, but i think that’s where it’s going to come out.maybe i have a different perspective coming from new york, where this is a much more intense response, but i think it is formative, and i think there is a silver lining, and i think this is the silver lining. on 9/11, the first image was the plane hitting the building. that image is etched in our memory, in our heart, and in our soul. that image will never leave us. that is an image of fear, cowardliness, and pain. that is there. the second frame is the ground floor, with policeman and firefighters running into the building and showing a courage that we have never seen before. then, people coming out of the building and being embraced by new yorkers. not a place known for love and charity. new yorkers were there together in a way they had never been before. nothing i had seen inmy 44 years was anything like this. a sense of giving, a sense of charity, a sense of unity, where literally there is nothing that you could have asked that they wouldn’t have done one for the other.where they literally gave the shirt off of their backs, the blood out of their veins, themoney out of their pockets. one for another, and we were one. we were one! we were united! we didn’t look one to the other and say, “oh, you’re a different color skin than i am. i’m nervous of you!”we said the opposite.we didn’t see the differences.we saw the similarities. we saw the commonalities. we saw the humanity. we saw the brotherhood. we held one another.we cried for one another.we looked to one another with hope, with love, and with openness, and not just within newyork, the entire nation saw this. the entire nation responded the same way. from california to all across the country, they said, “we’re there with you!we’re all one!we’re americans!you’re not a different city, a different state, you are one of us! we’re united in this moment. this event has been transcended, andhas brought us together.”this event has created such an energy that it has gotten past all the bramble and all the weeds, and its taken us to a higher place. it said we are connected. the chancellor said we are a fabric. we’ve heard for so many years that we are a fabric. we felt it. we felt that there’s a cord that connects me to you, to you, to you, and to you, and maybe the cord’s been invisible, but we felt the fabric that that cord weaves, and we understood that when one goes up, we all go up. when one comes down, we all come down. we got it that day. we felt it, and that was a beautiful feeling. it’s like love. once you feel it, you want it again and again and again. love is stronger than fear. that togetherness, that joining, that union is such a powerful feeling that we want it again and again and again. if you had it once, you canhave it again. if youweren’t afraid of the other person once, maybe you can be together again. if you could be united as a nation once, maybe you could be united as a nation again. that is a very powerful feeling, and we had it. it’s not an intellectual concept. it’s not a religious concept.we tasted it. it’s not in the history book, community, from the latin communitos of the common. we were the common. it was matthew 25. we were brothers.wewere sisters.we felt it, and it was a great feeling. if you did it once, you can do it again. it comes back to the farmer and the flood. it’s up to you! no one else is going to do it. someone has to start the pattern. someone has to start the cycle. someone has to be the first person to put his or her hand out, and say, “i’m 10 advances in socialwork with you. i’mnot afraid of you. i’mhere for you. i’m vulnerable, yes.maybe you can hurt me, but we’re all vulnerable, and i’m going to take the chance because love is greater than fear. we can do so much more together than we can do alone, and we’re really together in the first place.” thank you and god bless. questions and answers any of the difficult questions i will give to the dean and the chancellor. when are you running for president? at this rate, i’m going to be running for cover soon. what do you think about welfare reform reauthorization, the limited resources for welfare, and the time limits for welfare recipients? i thinkwelfare reformwas a great opportunity, and in someways a good thing, but in most ways a bad thing. i was on the welfare reform task force that president clinton put together. the welfare reform that he put in had nothing to do with the welfare reform that came out. to do real welfare reform, it would have cost more money short-term,not lessmoney.welfare reformwasnot about savingmoney todo it intelligently. i think it came up with a false construct. the construct for welfare reformbecame shouldn’t wemake peoplework.the answer is obviously yes. if you can work, you should work, and welfare reform then said, “well then you must work!”yes, except that was never the issue in the first place. i’ve been in every poor community in this country. i never once had someone say, “mr. cuomo, do me a favor. can you help me get a welfare check?” never once. instead “help me get transportation. help me get education. can you help me get child care?” never once, “can you help me get a welfare check?” the trick was getting the person through the transition to the job. getting from here to there is often a chasm, and resolving those issues, which are expensive and often long-term. we haven’t felt the pain of this because we were in a very strong economy. the economy was going so strong that it just inhaled everyone into the job market, and the government had a lot of money, and the welfare reform plan block granted all of that money down to the cities and states, and the states gave it to the cities. so, whateverwelfare burden therewas could be paid. i’mafraid now the economy slows, the money that was block granted is now gone. if indiana has a welfare problem now, and the feds say, “well use themoney i gave you four years ago,” they’re going to say, “that money’s gone.” they’re giving away tax cuts. there’s going to be no money, andnowwe’re going to have amajor problem. if the economy slows, the first person laid off will be the samepeople.they’ll become the unemployment roles.they’ll be very expensive. there will be no money. that’s the fear. the only good news, because i was inwashington for eight years, so you had to be an optimist otherwise life was very long, the good news was politically it’s not the same issue that it was. the politics of this afforded conservatives an opportunity to beat the progressives over the head with the welfare reform stick. it was quite effective for them. it’s no longerapolitical issue touseagainst theprogressivecommunity.that’s thegoodnews. how can government do a better job anduse technological innovations to improve services? 11cuomo/90th anniversary symposium: indiana university school of socialwork (we’re beginning) to see local governments getting this. i talked about the dmv. the wealthier and more advanced communities will now have web-based dmv systems, which is their way of saying, “we’re starting to get this.” the government needs to perform the way the bank does, and the way any institution in the country that you’re going to contract with does, and they’re not there yet. local governments are starting, states with income, the federal government will come. in some ways, themore removed from the person the government is, themore entrenched it tends to be in its own bureaucracy. when i was at hud, i went to a web-based system. i went to kiosks in shopping malls, so that government goes where you are. you’re not supposed to come to the government. the government should go where you are. government should be convenient. it’s the atm, 10 feet here and 10 feet there. government should speak your language. when i worked at hud, they have a whole language of their own there at hud. it had nothing to do with the english language. i remember the first day i walked in, they would say, “hi, i’m working at cdbg now, and i’m going to put out a nofa, andwe’re going to do a section 8 certificate for the new complan, so we’re excited you’re here.” i’d say, “that’s great. i’m really happy i’m here now, too.” that’s how they talked to people. like you were supposed to know their language, otherwise, you were unintelligent. that is changing slowly. i think you’ll see local governments start to get it first because you will demand it of local government, or they will no longer be in office. then, it will rip them up. what do you think about the eviction from public housing of family members of those persons convicted of drug offenses? this was passed when i was there. this is, if you are convicted of a drug offense in public housing, it’s the family associated or a tenant associatedwith that person that gets evicted. the most common case is when a grandmother has the lease, and the grandson is convicted of drugs, so the grandmother gets evicted. i believe this was an overreaction.we tend to work in pendulum swings.we had a problem in public housing. we had a problem with drugs, and public housing had gotten out of control. it was out of control, the chicago housing authority. the children sleep in bathtubs because the mothers are afraid of stray bullets. the chicago housing authority would drive the children across a courtyard in a vehicle with armor-plated glass because they’re afraid to let the child walk across the courtyard to go to a school. it was out of control. dramatic response, over-response. anyone who was associated with a person who does any drugs is a victim. i think that’s what the first strike was, but its been upheld by the supreme court, and it’s going to be the law. it will have, no doubt, some effect, a chilling effect, on the behavior in public housing. that’s the good news. the bad news is a lot of innocent people are going to be evicted because of it, and we’re going to pay a very high price. my guess is that the pendulumwill swing back, but it’s going to take a couple of years, and sometimes the pendulum comes back very slowly. the analogy that i’mworking on now. . .newyork has something called the rockefeller drug laws. they were passed by governor rockefeller. this was in the ’60s when you had high drug crimes. they passed a law for a very small amount of drugs. you have a minimum sentence,mandatoryminimum, 10 years or 15 years. so, you have kids whowould get busted with a small amount of drugs, and bang, you go away. mandatory min12 advances in socialwork imum. it doesn’t matter what the judge says. it doesn’t matter what the specific facts are. you go away.we had a tremendous increase in the prison population. all young, almost all minorities, males, small-drug related. now, i’m trying to talk about alternatives to incarceration substance abuse for minor offenders. a prison cell costs about $30,000 in change innewyork. residential substance abuse can be $16,000-$17,000. it’s less expensive. it’s about half the cost, plus you also redeem a person rather than paying for them forever, but change comes slowly. what role do you see universities playing in your vision of a united, compassionate, and caring society? i think it’s going to be a key role because it is not the natural response of people. i believe the natural response is to constrict. it’s almost biological. it’s almost chemical. it’s the startled response. you hear the noise and you close down. the alternative is an educated, informed, disciplined, intellectual response. with the universities, it is much more taught than instinctive. your school of social work, definitely what you’re doing, the skills you’ve learned, will inform not just you, but you can bring this message to others. also, universities on a practical level. universities are great assets in a community and for most community development (and) urban development. i started a program at hud, the university partnership program. build off of the university. make the university part of the community. it’s not a fortress isolated onto itself. it is a great asset in the community. breakdown those university walls, and let the university open itself onto the community, and let the community open itself onto the university. i had a lot of success with that program, both in concept and in practice. so, i think it works on both levels. you said after 9/11 that people in new york united. so, what do you think about gays and lesbians getting the equal opportunity to receive the same compensation that heterosexual couples receive? i agree with that. i’m 100% in favor of that. there’s a law in the united states in the state of vermont that’s called civet union, which says essentially that a civet union partnership has all legal rights as if you were husband and spouse.vermont is the only state that has that law. i would propose it in the state of new york. i would like to see the state of newyork be first, but i’ll settle for being second with that law. you spoke about the (9/11 tragedy) in new york of bringing people together, and how this is the way we really should be within the nation.what seems to happen in america’s past is that it seems to be a tragic situation or something very significant where we all see each other as one, but at some time after that it reciprocates.what do you see are the roles that individual non-profit government can play to sustain that and really make it a part of american life as opposed to (a transient phenomenon)? that’s an excellent question. i’m working through that now. i don’t have a really specific answer for you, but i don’t know that it’s going to be that fleeting. you had generations that camehome fromworldwar i andworldwar ii, andboy, theywere americans, and they understood the flag. they were united, and they felt a sense of camaraderie that no one has felt since. certainly in my 44 years, i’ve never had any galvanizing experience inmy lifetime. so, i don’t know that it’s necessarily that 13cuomo/90th anniversary symposium: indiana university school of socialwork fleeting for that reason, and also i don’t know that the threat goes away. i don’t know that 9/11 will have been a one shot, pardon the pun, i think the fear is going to be lingering because the first image of the plane in the building is going to be lingering. you turn on the tv and you hear about the middle east and its suicide bombers and cafes and buses. after 9/11, this means it brings it home here to you, also. if you turned on the tv and you saw what’s happening in the middle east on 9/10, you would have said, “well that’s the middle east. that could never happen here. this is america.” you turn on the tv and you see that on 9/12 and you say, “that could be here.” i was in the middle east the week before last as a sign of solidarity during this period. i went to israel, and they live with it every day. i think thatmay very well be what happens here. i would love to be able to say, “oh, don’t worry, that’s never going to happen again,” but i don’t believe it’s true. i believe in someways that 9/11 was a precedent in that it said to the world, “you can do this.”why didn’t this happen before? well, because you couldn’t do it. why not? because it’s the united states. we have all the security. they’re very powerful. they’re very smart. you could never do this. nobody could ever get away with it. now it’s sort of a given. 9/11 says it’s not a given. you could be a terrorist organization, not the most sophisticated, and you could actually do this. by the way, you can hit the giant in the jaw, and the giant’s knees buckle, and you could take the entire united states of america and bring it down with one terrorist act. we’ve informed the globe of that, and i’m afraid it became self-fulfilling. when i was in the federal government, after the oklahoma city bombing, the fbi said, “be careful, because there’s now going to be a rash of bombings.” i said, “why?”they said, “because these types of fanatics see one incident, and then says to them gives them license.” if you can do it once, i can do it also. i can do it again. after oklahoma city, i don’t know if they were publicized, but we had a rash of bombings. not bombings, literally, but domestic type terrorist activities, and i think that’s very much going to happen here. so, i don’t know that it’s fleeting for those reasons. there are going to be plenty of reminders. i also think some of this is going to be that we will remember it because it was nice. there was an element of nice here. i don’t think we can say that yet. to talk this way in new york, it’s almost incongruous, but therewas a sweetness tonewyork.therewas a sweetness that you’ve never felt in newyork. it is enticing, and it is appealing. once you taste it, you want it again. you want that sweetness back. i think that’s probably the greatest reason that we’ll follow that fork. it felt right, and it felt good. it felt nice, and we were just in a good place on that plane in life, and i want to go back there. author’s note: address correspondence to: andrew cuomo, andrew cuomo for governor, 18 east 41st street, 3rd floor, newyork, ny 10017 usa, http://andrewcuomo.com. 14 advances in socialwork aisw vol. 5, no. 1 gatekeeping prior to point of entry larry r. reynolds abstract: social work educators have an obligation to the profession to admit into its ranks those applicants judged to have the requisite knowledge, skills, and values for effective practice. even though considerable disagreement exists as to what those specifics encompass, there is a general sense that students should be monitored throughout the curriculum and that, by making admission decisions for students, the profession and ultimately the clients are better served. this study presents longitudinal data on an instrument utilized by a small bswprogramacross five pre-professional courses, yielding scores at mid-term and at the end of the semester that address students’ compatibilities with the demands of the profession. data are used in a feedback loop for assessing students compatibility with the profession prior to the initial point of entry into the major. strengths and limitations of the study are addressed. keywords: bsw gatekeeping, student assessment, evaluation, longitudinal data professional academic programs across the nation articulate standards for admission into their courses of study, and these standards are readily found in such programs as nursing, education, and social work. the council on social work education (cswe) requires in accreditation standard 5.0 that “the program has admissions criteria and procedures that reflect the programs’ goals and objectives,” (council on socialwork education, 2002, p. 39). once these criteria and procedures have been established, it is incumbent upon the program to utilize those articulated standards in their decision-making processes for selecting students whom they perceive as meeting the standards and possessing the requisite qualities to successfully complete the course of study and move into the profession. this decision-making process, commonly known as “gatekeeping,” is of concern for social work admissions committees and for students who endeavor to enter the profession. the concerns of admissions committees cover such realities as institutional pressures to maintain student enrollments and, thereby, ensuring a criticalmass that guarantees the survivability of a program to determiningwhich students actually meet the admissions criteria (mcclelland, et al., 1991). students applying for admission into the major are also concerned with whether they can meet the standards and what it may mean to them if they are denied admission into the major. 18 advances in socialwork larry reynolds is director of the socialwork program at marian college of fond du lac,wisconsin, fond du lac,wi 54935. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 18-31. indiana university school of socialwork. social work faculty are frequently confronted with multiple and conflicting goals that create dilemmas and raise questions as to whether the admission decisions they make meet the intentions, goals, and objectives of the program. social work programs also face the potential of creating lawsuits as a function of admission decisions. this is partly due to the difficulty the profession has in arriving at a consensus regarding the operationalization of the criteria for admission into the major (younes, 1998; morrow, 2000). it is difficult to define the qualities and characteristics that are requisite to the profession, and this subject generates much debate and controversy within the social work profession (miller & koerin, 1998; glenmaye &oakes, 2002). nevertheless, it is imperative for programs to avoid utilizing arbitrary and capricious standards for admissions and to develop admission policies capable of differentiating between suitable and unsuitable applicants for the profession (cole, 1991; moore & urwin, 1991; cole & lewis, 1993; gibbs, 1994a; miller & koerin, 1998). the core values of the profession, as identified in the preamble of the nasw code of ethics (1996), include “service, social justice, dignity and worth of the person, importance of human relationships, integrity, [and] competence,” (p. 1). “a review of the code of ethics informs us of the importance of professional judgment as we make admission decisions in social work education” (scott & zeiger, 2000, p. 410). this, in combination with cswe accreditation standards and the program’s admissions policies, sets a backdrop for decision-making related to admitting or denying students access to the professional program. students applying for admission to social work programs also experience considerable consternation. they invest time, energy, financial resources, and become invested in the application process and they are concerned about what it will mean if they are or are not accepted into a professional program. once students are admitted into a social work program, they are likely to continue experiencing concerns as to whether they will be allowed to progress through the curriculum, enter a field internship, graduate, and successfully negotiate social work certification or licensing examinations. as students progress through the curriculum, becoming more involved with student social work organization activities and understanding the values and ethics of the profession, they becomemore cognizant of the demands inherent in the profession. this added knowledge allows students to engage in the process of self-reflection regarding their compatibility with the profession. through this process of self-reflection, it is not out of the ordinary for some students to determine that they are a mismatch for the profession. likewise, as social work faculty learn more about a specific student and become more adroit at perceiving the student’s strengths and liabilities, they may also determine the student possesses a significant level of incompatibility with the demands of the profession. consequently, social work faculty may initiate a student’s termination from the professional program. either action typically creates some concern about litigation potential and social justice and raises value conflicts in faculty and students. thus, social work programs throughout the nation are continually attempting to refine the process of identifying suitable students for the profession (miller & koerin, 1998; pelech, et al., 1999). 19reynolds/gatekeeping prior to the point of entry it is this desire to attempt to refine the process of identifying suitable students for the profession that has led to the focus of this study. specifically, a small bsw program developed an instrument that assesses students enrolled in pre-professional level courses on selected requisite behaviors for studying and practicing social work. faculty observations of these behaviors tap into some of the qualities and characteristics perceived as being critical to successful social work practice. it is suggested that the data from this instrument provides yet another vehicle for social work students and program faculty to better assess a student’s compatibility with the demands of the profession. it is argued that, through the use of this data prior to the actual point of entry into the student’smajor, the programand the profession are better served and informed about gatekeeping and admission decisions. literature review social work educators continue to debate the criteria for admission into the profession that allows for the safeguarding of the profession and ultimately the clientele who are the recipients of social services (dunlap, et at., 1998; magen, et al. (2000); glenmaye & oakes, 2002; kane, et al., 2002). one source that provides some guidance concerning the criteria for admission into the profession is the nasw code of ethics (1996). this document identifies ethical principles and standards to which social workers are held accountable. the code of ethics specifically points out that practitioners are to be competent to deliver services, attend to the well-being of those receiving social work services, and that educators are to evaluate students “in a manner that is fair and respectful,” (nasw code of ethics, 1996). cswe is another source that provides guidance for admission into the profession. the cswe 1994 handbook of accreditation standards, 4th edition, stated in evaluative standard 5 student development, 5.0 that “the program must clearly articulate and implement criteria and processes of student admission” (p. 87). section 5.8 of this handbook requires that programs have “procedures for terminating a student’s enrollment … for reasons of academic and nonacademic performance” (p. 89). in 2002, cswe published the 5th edition of the handbook of accreditation standards, which contains the new educational policy and accreditation standards (epas). it also specifies in accreditation standard 5, student professional development, 5.6, that “the program informs students of its criteria for evaluating their academic and professional performance” (p. 40), and in 5.7, “the program has policies and procedures for terminating a student’s enrollment in the social work program for reasons of academic and professional performance” (p. 40). note the modification of language in the above statements concerning programs having policies for terminating students from the program. the 1994 standards called for students to be terminated for academic and nonacademic performance, while the 2002 standards call for termination for reasons identified as related to academic and professional performance. it will be recalled thatmoore and urwin (1991) advocated that “professional behavior is an academic requirement,” (p. 11), and essentially suggested that in professional programs all behaviors are seen as academic and commingled into the educational process. 20 advances in socialwork the gatekeeping function in baccalaureate social work programs is an issue that has received considerable attention from numerous authors (moore & urwin, 1991; gibbs, 1994; gibbs, 1994a; younes, 1998; moore, et al., 1998; morrow, 2000). recommendations for monitoring student readiness throughout the entire curriculum have been suggested (moore & urwin, 1991), and these same authors have identified five areas of specific interest to the gatekeepers: (1) grades, (2) indications of students taking responsibility, (3) effective communication skills, (4) student’s attention to social work values, and (5) student’s skills in handling feedback. gibbs (1994b) noted in her study that there were not well researched screening criteria for assessing baccalaureate students’ professional qualities. she notes that developing policies and procedures on these professional qualities was a difficult and contentious issue. gibbs (1994a) stated “…educators have yet to devise policies that clearly and unimpeachably outline the qualities and characteristics that are requisite to effective professional practice” (p. 15). hull, et al. (1994) also argues for the development of relevant outcome measures for social work education. younes (1998) suggests social work educators face considerable dilemmas in their role as gatekeepers. programs need to balance student enrollment and survival of a program with questions regarding whether some students should be allowed to enter the profession. this research concurs that there is considerable difficulty in defining the characteristics that a candidate for the profession needs to possess to be qualified for the profession. moore, et al., (1998) uses case studies to describe problematic situations in gatekeeping and calls for innovative ways to identify social work students who may not be qualified to proceed in the profession. this study also articulated how corrective actions were taken with students, thereby supporting the gatekeeping function. morrow (2000) points out that small baccalaureate programs face critical admission decisions, as they have the opportunity to know their students in more depth, but they also face the conflict of limited resources and institutional pressures to retain students. she noted three opportunities for programs to engage in gatekeeping and identified them as: (1) admission to the major, (2) admission to the field, and (3) sanctioning graduation lists. bogo, et al. (2002) notes that even though students have graduated from accredited social work programs, that “educators do not appear confident that graduates are competent to practice” (p. 386). they further note that “if social work educators are unable to differentiate reliably between those students who possess the skills to practice and those who do not, we are failing in our critical role as gatekeepers for the profession” (p. 386). in an effort to clarify the requisite characteristics that are compatible with entrance into the profession, koerin andmiller (1995) conducted a study of msw programs by assessing the reasons for terminating students for what were then classified as “nonacademic” reasons. they determined that violations of ethical standards, mental health or substance abuse problems, inadequate performance in the field, illegal behaviors, and disruptive classroom behaviors were reasons provided by graduate programs for terminating students from social work programs. these authors did not provide any information relative to the initial onset 21reynolds/gatekeeping prior to the point of entry of these problematic behaviors; however, it would be unlikely that these behaviors would only manifested themselves during the graduate school experience. dunlap, et al., (1998) examined the relationship between msw program admission requirements and the subsequent relative academic success of the graduate student. their findings suggested that the undergraduate grade point average (gpa) and graduate record examination scores were positively related to academic performance. miller and koerin (1998) suggested that, at the msw level, determining who is suitable to enter the profession requires continual monitoring throughout the educational process. they accurately recognize the interaction that exists among personal characteristics, life experiences, and “emphasis on the professional use of self” (p. 451). all of these authors note that social work educators, through continual gatekeeping activities, have an obligation to help students identify their compatibility with the demands of the profession. social work educators are cognizant that litigationmay arisewhen decisions are made to deny students’ entrance into the profession. cole, (1991) and cole and lewis (1993) have provided educators with guidelines recommending due process for students and citing case law in which the courts have generally recognized and sustained faculty’s professional judgment when functioning as a gatekeeper. the courts have also agreed that there is not a constitutional right to education, but that education is in fact a privilege. rhodes, et al., (1999) identifies the failure to enforce established gatekeeping standards as one of the elements that threatens social work education and the profession itself. they argue that, even though student enrollment has increased, there is little indication that a comparable number of students have been screened out of programs. karger and stoesz (2003) suggest that the growth in undergraduate, graduate, and doctoral programs has had an adverse effect on the profession, and that this growth has contributed to a reduction in the status of social work, kept salaries low, and has generally flooded the marketplace with an excess of socialworkers.they recommend thatcswecurtail its endorsement of new social work programs in an effort to enhance the quality of education and its graduates. there continues to be much activity within the profession geared toward identifying instruments that can assist in the selection process of those students who seek access to the profession. glenmaye and oakes (2002) investigated the use of an instrument designed to objectively score an applicant’s personal statement and relate this objective score to the student’s effectiveness in the field experience. they found that reliability of the instrument was low, confirming the difficult task of assessing the suitability of applicants to social work programs. mcclelland, et al., (1991) also found that social work faculty were highly idiosyncratic in their evaluations of bsw applicants and tended to streamline the gatekeeping criteria. pelech, et al., (1999) studied several pre-admission variables and their relationship to problems students later had in the field experience. interestingly, their results were contrary to what some social work educators and admission committees might have predicted. their study revealed that students who tended to have more problems in the field were older, male, had more experience in social service delivery, weremale, andwere seen as lessmature than students who did not demonstrate problems in the field experience. 22 advances in socialwork one element that is consistent in the literature is that on-going, continuous feedback to students concerning their performances in a variety of areas supports the idea that better judgments can be arrived at relative to student compatibility with the demands of the profession.the literature review also suggests admission decisions can be very challenging and that social work educators are generally looking for more effective means of gatekeeping and determining the quality of the applicants who request admission into the profession. a gap remains in the gatekeeping literature with respect to establishing a methodology prior to the point of entry into the major for systematically providing undergraduate social work students with feedback on their behaviors that are viewed as critical to the demands of the profession. to address this gap, what follows is a description of a feedback mechanism utilized by a small bsw program with pre-professional level social work students. feedback is provided to students at mid-term and again at the completion of the semester across five pre-professional level social work courses. these data form a benchmark by which students and faculty are better able to gauge the extent to which a student possesses behaviors deemed requisite to the profession. this longitudinal data provides useful feedback to students prior to their point of entry into the major, assisting the student and the decision-makers with an identification of a student’s compatibility with the profession. these data are used initially in an advising role with students providing them formative feedback on some of their behaviors that have been identified as being essential to the practice of social work. these data are reviewed again at the time of the formal application to the major and, become part of the overall data set that is considered in rendering a summative decision relative to admission into the major. method a small bsw program in the midwest examined its gatekeeping procedures and reflected upon the experiences it hadwith studentswho had been admitted to the major and to the field experience. the formal gatekeeping process in this program is typical of bsw programs nationwide and begins during the second semester of the sophomore year when students submit a formal application for admission to the major. the second phase of the gatekeeping process commences during the second semester of the junior year when students submit a formal application for admission to degree candidacy and field internship. students accepted into the field are then formally evaluated on at least two occasions each semester. the final gatekeeping mechanism is approving the students for graduation. the program consulted with its community advisory group as advocated by dalton and wright (1999). this advisory committee is composed of social work practitioners at the bsw and msw levels, social services organization administrators, a county government official who chairs the county social services committee, a county judge who presides over family and juvenile court, a community member who has received social work services, an undergraduate social work student, and social work faculty. this group suggested it would be desirable to develop a method whereby social work faculty gathered more systematic data on 23reynolds/gatekeeping prior to the point of entry self-declared freshman and sophomore social work majors covering specific characteristics deemed requisite to the profession. the advisory committee then reviewed the professional literature and the program’s objectives in relationship to the 12 foundation program objectives as articulated by epas. the advisory committee recommended that an instrument be developed that incorporated the general intent of the program objectives as articulated by epas, as well as including items the committee deemed essential for practitioners. consequently, a 12item instrument was developed (see evaluation of student’s performance in appendix i), which provided systematic data on student behaviors seen as requisite to the profession. the advisory committee, social work faculty, and social work students judged six of the 11 items on this instrument to have face validity with the objectives articulated by epas 3.0 foundation programobjectives (items 1, 2, 3, 4, 8, and 10). the five remaining items were judged to be required by agencies, and were also seen as critical in the academy, since they are typically contained in social work syllabi (items 5, 6, 7, 9, and 11). several of the latter items frequently impose a sanction on students for non-compliance, thus adding weight to their relevance. administration of this instrument yielded data on these essential behaviors which could then be used in a feedback loop with the students and program faculty to facilitate assessment of the students’ compatibility with the requisites of the social work profession. following training for administering the evaluation tool, social work faculty rated students in the classroom on these perceived critical elements of professional social work practice. a maximum score of 77 was possible and feedback was provided to students at two points in time—at midterm and upon completion of the pre-professional course. data represented a longitudinal perspective of each student’s compatibility with social work prior to being formally admitted into the professional foundation curriculum. the five courses where the rating instrument was used were taught at the freshman and sophomore levels and were designated by the program as pre-professional courses and included community service, introductory social work, interpersonal skills, history of social welfare, and elementary statistics. full-time social work educators or adjunct social work faculty who were practitioners in the community taught these courses. students were typically enrolled in at least one of the courses per semester throughout their freshman and sophomore years. it was anticipated at the initiation of this study that not all students who enrolled in the social work programwould have completed all five pre-professional courses contained within the program’s curriculum. in fact, the students were at various stages of completing their pre-professional courses, as some had beenwaived out of a course, while others were transfer students who had completed equivalent coursework at another institution, and yet others had only recently changed their self-declared major to social work. in an effort to obtain an adequate sample for analysis, the program examined all of the data it had obtained on students over the five pre-professional courses. this examination yielded amaximumof 32 students who had completed at least three of the five courses, including introductory social work, history of social welfare, and elementary statistics. this provided six pairs of data points, two per course (a mid-term rating and a rating at the end 24 advances in socialwork of the course), and included ratings from both full-time and adjunct faculty. data analysis was conducted with statistix 8 software (2003) utilizing descriptive statistics, repeated measures anova, simple linear regression, and correlation analysis. results the sample (n=32) consisted of 90.6% females (n=29) and 9.4%males (n=3), with 59.4% (n=19) being characterized as traditional students and 40.6% (n=13) being characterized as non-traditional students. the ethnicity of the sample was 91% caucasian (n=29) and 9% minority (n=3), including african-american, hmong, and latino students. the sample’s age ranged from 20 to 49 years and, as can be gleaned from table 1, below, 56.3% were single, 18.8% were single-parents, and 25% were married with at least one child. table 2 shows themeans and standard deviations of age by gender, parental status, and type of student. in comparing the ages of males and females in this sample, the females were about six years younger than themales; traditional students were around 12 years younger than non-traditional students; the single student was around three years younger than the single parent and about 12 years younger than the married student. the grade point averages by gender as determined at the close of the introductory course (gpa 1), upon completion of the history of social welfare course (gpa 2), and at the end of the elementary statistics course (gpa 3), respectively, are shown intable 3.malegpas for all courseswere higher than thegpas for females, 25reynolds/gatekeeping prior to the point of entry descriptor m sd male 32.0 12.767 female 26.172 7.7509 traditional 21.684 1.5653 non-traditional 34.077 8.5192 single 23.222 5.9956 single parent 26.333 4.2269 married 34.875 9.6130 table 2: age of student type of status frequency percentage single 18 56.3 single parent 6 18.8 married 8 25.0 total 32 100.0* *rounding error table 1: frequency distribution of parental status but due to the small number of males in the sample (n=3), no statistical analysis on the differences between gender and gpa was undertaken. the non-traditional students’ gpas for all courses were higher than the traditional students: gpa1 = 3.5141 vs. 2.7445, gpa2 = 3.4953 vs. 2.7927, and gpa3 = 3.4371 vs. 2.8593 (n=13 for non-traditional and n=19 for traditional students). as might be predicted, the gpas for married students and single parent students were higher than the single students (see table 4). the program was also interested in examining inter-rater reliability among the three faculty members who rated the students’ behaviors. two faculty were fulltime social work instructors and one was an adjunct faculty. spearman correlations were computed using the final ratings from each class. the correlation between the final score from the introductory course and the history course was r=.57; for the introductory course and the statistics course, it was r=.72, and for the history course and statistics course, it was r=.70. these correlations are all statistically significant at p<.01. table 5 reports the means and standard deviations for the mid-term and final scores across the three courses. a repeated-measures anova revealed a significant change in the ratings across the three courses f (5,155) = 2.70, p<.05). there were also statistically significant differences in scores between traditional and non-traditional students f (31, 155) = 4.95, p<.01). to locate where the differences existed between the mid-term and final scores, tukey post-hoc analysis was conducted. two significant differences were found: (1) between the final score in course 1 and the mid-term score in course 2 (the introductory and history course), and (2) between the final score in course 3 and themid-term score in course 2 (statistics and history course). tukey post-hoc was also conducted on differences between scores, and the differences were found in scores below 63. the effect size for differences among the courses was small at only 4%, but much larger, 48%, for differences between scores. 26 advances in socialwork gpa1 gpa2 gpa3 married 3.3134 3.3377 3.2419 single parent 3.3989 3.2608 3.3319 single 2.8293 2.9020 2.9490 table 4: grade point average descriptor course m sd male intro gpa1 3.6136 .5373 history gpa2 3.6322 .5237 statistics gpa3 3.6322 .5237 female intro gpa1 2.9996 .6426 history gpa2 3.0209 .5172 statistics gpa3 3.0383 .5018 table 3: grade point average to locate where the differences existed between the mid-term and final scores, tukey post-hoc analysis was conducted. two significant differences were found: (1) between the final score in course 1 and the mid-term score in course 2 (the introductory and history course), and (2) between the final score in course 3 and themid-term score in course 2 (statistics and history course). tukey post-hoc was also conducted on differences between scores, and the differences were found in scores below 63. the effect size for differences among the courses was small at only 4%, but much larger, 48%, for differences between scores. linear regression was used in an effort to predict a theoretical cutoff point for the final scores and the program’s requisite gpa of 2.5 to be eligible to apply for admission to themajor. the regressionmodel for the introductory course yielded a predicted value of 67.573 on the rating scale, whereas, the history course yielded a predicted value of 64.145 and for the statistics course, the predicted value was 65.332. finally, it is interesting to note that the program’s admission decisions fall into three categories: (1) admitted, (2) provisionally admitted, and (3) denied admission. the program examined the mean scores from the three pre-professional courses for students who had applied for admission to the major in relationship to the actual admission decisions made on these students. findings indicated that students were admitted outright to the major when their ratings were 65 or higher. provisional admission decisions were made on students with scores of 64 or 63 points and, in this limited sample, the means scores of 62 or less resulted in a denial of admission into the social work major. implications gatekeeping in social work programs is a vital function intended to identify those students who possess the requisite knowledge, skills, and values consistent with the demands of the profession, and who are adroit at providing competent services to clients. social work educators must continue to identify methods that can strengthen the gatekeeping function. nasw and cswe both articulate requirements for educators to engage in gatekeeping as part of their professional obligation to protect clients and the profession.the professional literature suggests that there is little agreement among social work educators as to what those specific characteristics are. nevertheless, the literature suggests that, as social work students progress through the curriculum, they can benefit from continuous monitoring and feedback concerning their “fit” within the profession. this is based on 27reynolds/gatekeeping prior to the point of entry course m sd mid-term course 1 68.000 8.4051 final course 1 69.656 7.6690 mid-term course 2 64.781 11.975 final course 2 68.031 5.9972 mid-term course 3 67.969 5.9323 final course 3 69.406 6.4150 table 5: scores for mid-term and final across three courses the idea that feedback strengthens students’ awareness of the requisite professional behaviors and assists them in judging their compatibility with the profession. it is incumbent upon social work educators to assist students as early as possible in their educational experience to identify whether they possess the qualities that are compatible with the delivery of effective social work services, and then to aid students in the strengthening of those behaviors. the earlier this identification can bemade, the better for the student, client, and ultimately, the profession. the longitudinal data from this small, non-representative sample lends support to the idea that pre-professional students used feedback from the instrument to assess their compatibility with the demands of the profession. the expert panel assembled by the program consisted of its advisory committee, social work students, and social work faculty. the achieved consensus gives face validity to the identified behaviors that are consistent with the demands of the profession. the instrument is consistent with the intent of the nasw code of ethics, the 12 foundation program objectives detailed by epas, and the program’s goal of graduating competent entry level practitioners. the reader is cautioned that the instrument described in this paper was designed only to assist the program and the student with identifying pre-professional behaviors viewed as conducive to the practice of entry level social work. it is beyond the scope of this paper to articulate the mechanisms by which the program monitors those students admitted into the major as they progress through the foundation curriculum and the field internship. nevertheless, an instrument such as the one described in this paper becomes amechanism for providing feedback to students prior to their admission into the major and ultimately benefits the student and the program’s admissions decisions. faculty and students utilize the data from this instrument in academic advising conferences regarding course selections and career goals (moore, et al., 2003). in addition, as part of the application process for admission into themajor, the program requires students to document how theymake use of this data in their socialization to the profession and in their professional development plans. even though there is some utility promised by the instrument described here, it is obvious that there are several limitations to this study. the instrument has been utilized with only a small number of students, thus, no generalizations can be claimed. the program is still learning ways to incorporate this feedback into its gatekeeping obligations and, certainly, validation studies need to be conducted on the instrument. as professional educators, wemust continue to strengthen the profession by searching for methods that help identify which students are suitable to enter the social work profession. conclusions the obligation of “guarding the gate” to the profession is a critical one. there continues to be a dearth of agreement among social work educators concerningwhat constitutes the qualities and characteristics that are requisite to the profession. nevertheless, it is incumbent upon social work educators to explore ways to identify and test these requisite behaviors. once the behaviors are identified, educa28 advances in socialwork torsmust then use that information to help strengthen students’ compatibilitities with the demands of the profession and to select individuals for admission into the profession who possess and develop those qualities. social work educators have stressed that the life of the profession is tied to whom we select to enter our profession and provide services to clients. this is an awesome responsibility, and a modest attempt to contribute to the conceptualization and thinking about the gatekeeping process of admission decisions in a small bsw program has been presented here. clearly, there is a need for ongoing research to articulate the requisite professional behaviors needed to be effective in delivering social work services and interventions. it is also critical to conduct studies to validate measurement tools purported to evaluate the preparedness of the students who seek admission into this profession. finally, research should explore the “best practices” of pedagogy that develop and/or strengthen these requisite behaviors in our students. references bogo, m., power, r., regehr, c., globerman, j., & hughes, j. (2002). evaluating a measure of student field performance in direct service: testing reliability and validity of explicit criteria. journal of social work education, 38(3), 385-401. cole, b. (1991). legal issues related to social work program admissions. journal of socialwork education, 27(1), 18-24. cole, b.s., & lewis, r.g. (1993). gatekeeping through termination of unsuitable social work students: legal issues and guidelines. journal of socialwork education, 29(2), 150-159. council on social work education. (2002). handbook of accreditation standards and procedures (5th ed.). washington, d.c.: author. council on social work education. (1994). handbook of accreditation standards and procedures (4th ed.). washington, d.c.: author. dunlap, k.m., henley, c., jr., & fraser, m.w. (1998). the relationship between admission criteria and academic performance in a msw program. journal of socialwork education, 34(3), 455-462. gibbs, p. (1994a). screeningmechanisms in bswprograms. journal of socialwork education, 30(1), 63-74. gibbs, p. (1994b). gatekeeping issues in bsw programs. aretê, 19(2), 15-27. glenmaye, l., & oakes, m. (2002). assessing suitability of msw applicants through objective scoring of personal statements. journal of socialwork education, 38(1), 67-82. hull, g. h., mather, j. h., christopherson, p. m., & young, c. m. (1994). quality assurance in social work education: a comparison of outcome assessments across the continuum. journal of social work education, 30, 388-396. karger, h.j., & stoesz, d. (2003). the growth of social work education programs, 1985-1999: its impact on economic and educational factors related to the profession of social work. journal of social work education, 39(2), 279-295. koerin, b., & miller, j. (1995). gatekeeping policies: terminating students for nonacademic reasons. journal of socialwork education, 31(2), 247-260. magen, r.h., & emerman, j. (2000). should convicted felons be denied admission to a social work education program?yes!*.journal of socialwork education, 36(3), 401-408. mcclelland, r.w., rindfleisch, n., & bean, g.j., jr. (1991). rater adherence to evaluative criteria used in bssw admissions. aretê, 16(2), 10-18. miller, j., & koerin, b. (1998). can we assess suitability at admission? a review of msw application procedures. journal of socialwork education, 34(3), 437-453. 29reynolds/gatekeeping prior to the point of entry moore, l.s., & urwin, c.a. (1991). gatekeeping: a model for screening baccalaureate students for field education. journal of socialwork education, 27(1), 8-17. moore, l.s., dietz, t.j., & jenkins, d.a. (1998). issues in gatekeeping. the journal of baccalaureate social work, 4(1), 37-50. morrow, d.f. (2000). gatekeeping for small baccalaureate social work programs. the journal of baccalaureate socialwork, 5(2), 65-80. national association of socialworkers. (1996).nasw code of ethics.washington, d.c.: author. pelech,w., stalker, c.a., regehr, c., & jacobs, m. (1999). making the grade: the quest for validity in admissions decisions. journal of socialwork education, 35(2), 215-226. rhodes, r.,ward, j., ligon, j., & priddy,w. (1999). fighting for field: seven threats to an important component of social work education. the journal of baccalaureate socialwork, 5(1), 15-25. scott, n., & zeiger, s. (2000). should convicted felons be denied admission to a social work education program? no! journal of socialwork education, 36(3), 409-413. statistix 8 (2003). statistix 8. tallahassee, fl: analytical software. younes, m.n. (1998). the gatekeeping dilemma in undergraduate social work programs: collision of ideal and reality. international socialwork, 41(2), 145-153. author’s note: address correspondence to: larry reynolds, marian college of fond du lac, 45 south national ave., fond du lac,wi 54935, usa. e-mail: lreynolds@mariancollege.edu note: a version of this paper was presented at the association of baccalaureate socialwork program directors 21stannual conference reno, nv, october 29-november 2, 2003. 30 advances in socialwork 31reynolds/gatekeeping prior to the point of entry instructions: write the student’s name in the blank below and check whether your evaluation is for the mid-term or the final evaluation of the student for the course. using the scale from 1 to 7, with 1 as low and 7 as high, write the number in front of the statement that corresponds to your evaluation of the student in each of the areas below. name of student ______________________ mid-term _____ final ________ 1. ____ demonstrates the use of appropriate grammar. 2. ____ discusses relevant issues in a manner consistent with social work values. 3. ____ demonstrates openness to diverse perspectives. 4. ____ demonstrates the ability to work effectively with others. 5. ____ demonstrates the ability to work effectively alone. 6. ____ turns in assignments on time. 7. ____ comes to class prepared. 8. ____ demonstrates critical thinking. 9. ____ demonstrates the ability to accept constructive criticism. 10. ____ demonstrates respect for others. 11. ____ demonstrates enthusiasm for learning. ____ total score 12.your recommendation concerning this student’s choice of social work as a career. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________ name of course instructor ________________________ date ______________ appendix evaluation of student’s performance spring2006-094_page90 spring2006-095_page91 spring2006-096_page92 spring2006-097_page93 spring2006-098_page94 spring2006-099_page95 spring2006-100_page96 spring2006-101_page97 spring2006-102_page98 spring2006-103_page99 spring2006-104_page100 spring2006-105_page101 spring2006-106_page102 spring2006-107_page103 spring2006-108_page104 spring2006-109_page105 spring2006-110_page106 spring2006-111_page107 aisw vol. 8, no. 1:aisw vol. 5, no. 2 113 ecological theory origin from natural to social science or vice versa? a brief conceptual history for social work karen smith rotabi abstract: the origin of holistic social work and ecological theory was investigated. emphasis was placed on howard w. odum, founding dean of the university of north carolina school of public welfare, and subsequent scholarship by his sons, collaborators on the first american ecology text. eugene and howard thomas odum, internationally recognized ecological scholars, identified holism as a universal concept originating in social sciences, crediting their father’s earlier sociological work, which later bridged to ecosystems ecology. a historical review of the influential sociologists, social workers, and ecologists is presented to build the case for ecological theory transfer across the three disciplines, beginning with sociology. critique of the current use of the ecological perspective is discussed, specifically social work’s tendency to target social systems and behavior while largely ignoring the natural environment. keywords: ecology, ecosystem, regionalism, science, history, odum introduction social work theory is integrative by nature, pulling from a variety of disciplines (payne, 1997; robbins, chatterjee, & canda, 1998). we typically think of sociology and psychology as two primary theory sources. however, other disciplines have also had an important influence on social work theory, especially natural science ecology. because natural science ecology theory predates the formal use of the term ecology in social work (germain, 1973; golley, 1993; tansley, 1935; odum, 1953), a one-way transfer of theory from natural science to social work may be assumed. however, a longer-term historical view indicates otherwise—with social sciences directly influencing the development of natural science ecology in north america. the foundation for the assertion that social sciences have informed theory development in natural science ecology is anchored in the work of two generations of theorists from the odum family (craige, 2001; hagen, 1992; kirby, 1991; rotabi, 2004). the story begins with howard w. odum (1884-1954), a sociologist karen smith rotabi, ph.d., lmsw, mph is assistant professor of social work, school of social work, virginia commonwealth university, richmond, va 23284-2027. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 113-129. indiana university school of social work. and founding dean of the university of north carolina (unc) school of public welfare (brazil, 1988). in addition to his innovations in social work education and important and progressive work in social reform in the south (brazil, 1988; odum, 1923a,b,c,d, 1926, 1932, 1934, 1936, 1939, 1945, 1947a, 1947b, 1997), h.w. odum founded the science of regionalism (brazil, 1988; kirby, 1991; odum, 1977; odum, 1936, odum & moore, 1938) which is the forerunner of the current discipline of landscape ecology (odum, 2004). the next generation of scholars in the odum family, his sons eugene p. odum (1913-2002) and howard t. odum (1924-2002), continued their father’s theory building in natural systems ecology (rotabi, 2004). just as their father before them, both e.p. and h.t. odum have written broadly on the subject of ecology, consistently bringing the reader back to questions about human problems and solutions (craige, 2001; odum, 1977, 1983, 1993, 1997, 2004; odum, 1971, 1983, 1994; odum, 2001). between the two generations of scholars, approximately 75 books have been published and countless manuscripts. h.w. odum’s social sciences theory development was then transferred to his sons, who consistently referred to their father’s work, especially regionalism, as an important influence to their own contributions in natural science ecology (craige, 2001; hagen, 1995; kirby, 1991; odum, 1977, 2004; odum, 1971). the family’s contribution to ecological theory development has been extraordinary, and this foundation has had a significant impact on science and a number of disciplines, including social work. with the emergence of ecology as a unique science in north america, social work theorists, including carel germain, alex gitterman, and others, have built a substantial body of theory that is typically called the “ecological perspective” or “person-in-environment” (germain, 1973, 1979a, 1979b; germain & gitterman, 1980, 1995, 1996; grief & lynch, 1983; karls & wandrei, 1994; meyer, 1983; siporin, 1980). today, ecology is a fundamental conceptual framework for human behavior in the social environment curriculum in social work education (anderson & carter, 1974, 1984, 1990; germain, 1991; hutchinson, 1999). however, in social work, the origin of ecology is largely misunderstood, and its application has been limited to social environment rather than more holistically including natural environments. this limitation ultimately ignores the importance of natural science ecology (rotabi, 2004). this paper presents a brief history of ecological theory in sociology, ecology, and social work. it is part of a larger body of work that analyzes the legacy of the odum family in the history of science (rotabi, 2004). focus will be the relevant work of both odum generations and other scholars, which under gird the social work ecological perspective. more recent social work theory development will be presented. finally, the strengths and weakness of the current use of ecology in social work will be discussed. sociology: howard w. odum just like jane addams (deegan, 1988), the elder odum considered himself a sociologist. as such, he took a holistic view of social systems, indicating that “society and nature are inseparable” (odum, 1947b, p. 83). this perspective is found throughout his work, beginning in his earliest documentation of folk music in the 114 advances in social work south (odum, 1909), which is recognized to be the earliest publication of african american blues music (sanders, 2003). documenting blues music and folklore and its emergence from both natural and social environments was the beginning of odum’s research career, and this work remained a passion throughout his life (sanders, 2003). h.w. odum started with folk documentation and expanded into questions about race and race relations. some of this earliest work is considered, by today’s standards, to be racist (sanders, 2003). however, at the time, odum was carrying out far more progressive research than his contemporaries. he actually entered african american communities and carried out ethnographic research in the south (brazil, 1988), setting one of the first studies of its kind into motion. odum described his reasons for selecting this topic of research as follows: the studies themselves grew out of the observation that there had been practically no scientific studies of the negro in the south; that the south itself was amazingly ignorant about the negro; that practically no one was interested in the subject; and that nevertheless this was the distinctive field of inquiry where knowledge must be had before progress in other respects could be made (1951, p. 154). this passage not only indicates odum’s interest in the culture and anthropology of african americans, but it also illustrates his ability to see research as providing guidance for social and policy change. odum made some mistakes, and most glaringly, he initially promoted the idea that african americans were inferior (brazil, 1988; sanders, 2003). however, during this early research, he began to question the implication of social environments on human behavior and educational outcomes. in the course of this research, odum came to some realizations about social environment issues for which he began suggesting change strategies (brazil, 1988). for example, he noted that textbooks for african american children had illustrations of only caucasian children who were spared the hardship of childhood labor and possessed such luxuries as toys and pets (brazil, 1988; odum, 1910; sosna, 1977). odum suggested that african american schoolchildren be given culturally appropriate texts that more adequately represent their reality to encourage learning. while diversity in educational materials is more commonplace today, it was a radical idea at the time. this early prescriptive work marks the beginning of odum’s examination of the impact of social environments on human development and made recommendations for progressive social change. this emphasis on environment—the context for behavior—became an increasingly central characteristic in his subsequent writing (brazil, 1988; sosna, 1977). odum became increasingly tolerant (sanders, 2003) and was considered to be an important and leading liberal scholar in the south (sosna, 1977), often taking great personal risks by attacking the klu klux klan, documenting lynchings, and other social dynamics (odum, 1923, 1931, 1997). one must judge a man by his behavior to fully understand his value system. in the case of h.w. odum, he was deeply committed to social reform. his progressive viewpoints were rooted in his graduate training, which took him to the northeast. odum earned a ph.d. in psychology (1909) at clark university and a ph.d. in soci115smith rotabi/ecological theory origin ology (1910) at columbia university. odum had an opportunity to view the beginning of social work education at columbia (feldman & kamerman, 2001), and he returned to the south intent on developing a social welfare education program. by 1920, odum founded the unc school of public welfare, with a vision for a broad curriculum grounded in multiple sciences, including geography, sanitation, and biology (h.w. odum, 1920). odum headed the school for over a decade, wrote extensively on the subject of social welfare (odum 1923c,d, 1926, odum & willard, 1925), and developed important social work training programs (brazil, 1988). odum’s commitment to the profession was such that, when founding the journal of social forces in 1922, he established a permanent public welfare section reporting the proceedings of charities and corrections conferences, educational opportunities, practice standards, and research (odum, 1922). h.w. odum’s integration of natural and social sciences was most obvious in his later work, beginning with southern regions of the united states (1938). historian morton sosna discusses this text and odum’s founding the discipline of regionalism, noting that the regionalist’s belief that “resource planning could advance the nation’s welfare provided the differences between the six regions were taken into account. in [the regionalists’] view, the whole would, and should, be greater than the sum of its parts” (sosna, 1977, p. 56). h.w. odum laid out a holistic template for national planning and “development through a fine equilibrium of geographic, cultural, and historical factors” (odum & moore, 1938, p. 39). from 1920 until the time of his death in 1954, odum was identified as one of the most progressive southern scholars, and his publications have led to national recognition for his social reform work in the south (brazil, 1988; mcdonough, 1993; milligan, 1994; sosna, 1977). an obituary in the new york times summarized his contributions as follows: “odum had laid the groundwork for understanding the facts, customs and history of southern people. no man in our time then had done more than odum to help the understanding of the south in the south, and of the south in the nation, too” (“howard w. odum, sociologist, dies,” 1954). odum’s approach to social problems was based on a holistic theoretical perspective focusing on and integrating both natural and social environments (odum, 1934, 1936, 1939, 1945, 1947a,b; odum & moore, 1938). his research focused on both of these systems, emphasizing natural and human resource management from a social policy perspective. his work is one of the earliest examples of the explicit application of ecological theory to social problems. like his theoretical perspective, odum’s vision for social work education was also holistic, integrating natural and social sciences (odum, 1920) natural science ecology: e.p. & h.t. odum both of odum’s sons were ecosystem ecologists and carried on their father’s holistic legacy by asking large-scale systems questions. their approach ultimately influenced other academic fields, including social work (craige, 2001; hagen, 1992; kirby, 1991; odum, 1953, 1977; smith, 2001). his elder son, e.p. odum, has been called the father of modern ecology (craige, 2001) largely because of his book fundamentals of ecology (1953), which deals with ecosystem as the central unit of 116 advances in social work study (craige, 2001; golley, 1993). this text was the first in america to summarize ecosystem ecology by focusing on holism, and it was the only such text for 10 years (craige, 2001). today, it is in its fifth edition and has been translated into more than a dozen languages (craige, 2001; hagen, 1992). the younger son, h.t. odum, collaborated with his brother on fundamentals of ecology. he also wrote numerous texts of his own, including environment, power, and society, which he dedicated to his father (odum, 1971). h.t. odum discusses the interrelationship of the three systems found in the book title. the small ecological systems, the large panoramas that include civilized man, and the whole biosphere of the planet earth—all receive only certain amounts of energy. hence, we approach man and nature by studying limited energy of environmental systems (p. 1). h.t. odum goes on to apply the concept of energy flow to society, pointing out man’s dependence on and attempts to control natural systems and resources, such as fossil fuels. these sources of energy are then “put back into [man’s] environmental system so that his yield of food and critical materials is greater” (odum, 1971, p. 6). he explores other systems with which man interacts and controls the flow of energy, including religion, politics, and economics. h.t. odum later published systems ecology: an introduction (1983), in which he makes a clear link between general systems theory (bertalanffy, 1968) and ecology, linking systems theory back to social science. sometimes called the “odum bible” by his students, systems ecology was hailed as “a tour de force of systems thinking focusing on bringing the concepts of systems into general education” (brown, 2003, p. 1). in a revised edition of this text, entitled ecological and general systems (1994), h.t. odum acknowledges both his father and older brother e.p. odum among the scholars who were influential in his development of systems theory. more recently, he co-authored with his wife, elizabeth odum, a prosperous way down (2001), which is a text that focuses on our current state of resource over-consumption, especially of fossil fuels. his overall work focuses more specifically on energy, and he is recognized as a leader in modeling energy flows across systems including human systems (hall, 1995). the scientific achievements of the odum brothers have been recognized internationally. e.p. odum was a member of the national academy of science and received countless accolades from state, national, and international scientific and other organizations (craige, 2001). both brothers were recognized for their contributions to the science of ecology and their collaborative thinking as they shared the swedish crafoord prize, considered ecology’s equivalent of the nobel prize (brown, 2003; craige, 2001; h.t. odum, 1983). today, they are recognized as important scholars who developed holistic concepts central to ecology and related natural sciences. their work typically leads the reader to consider complex issues by relating how larger systems incorporate and interact with the human condition. from a formal education perspective, both e.p. odum and h.t. odum were first influenced by natural science scholars at unc, where they both received their bachelor’s degrees in zoology, then later in their graduate programs, where they received doctoral degrees on this subject—e.p. odum at the university of illinois 117smith rotabi/ecological theory origin and h.t. odum at yale university. while at unc, e.p. and h.t. odum studied with biologist and family friend robert coker. eugene odum recalled his tutelage with coker as being laboratory-based, with his days being spent dissecting frogs and other small animals. this experience impressed upon eugene the joys of outdoor and naturalistic pursuits, where he could explore the landscape and observe natural phenomena, such as observing birds in their habitats (craige, 2001). during his graduate work at the university of illinois, fredric clements and victor shelford introduced eugene to the concept of succession (craige, 2001), a major concept of community ecology. succession is the way in which communities change over time by going through a series of predictable stages (carpenter, 1962). for example, a bare field will go through a series of stages, from one with grass, to one with herbs and bushes, and frequently into a forest, depending upon the local physical environment. e.p. odum was so influenced that he informed his father’s thinking about the systematic changes in human systems presented in american regionalism (odum & moore, 1938). e.p. odum said that shelford: instilled . . . four concepts [in him] that influenced his thinking thereafter: nature tends towards stability, ‘the whole is more than the sum of its individual parts,’ ecology is the study of large-scale systems and the interrelationships therein, and real ecology is not reductionistic (craige, 2001, p. 25). while completing his doctoral work at yale university, h.t. odum studied with g. evelyn hutchinson, one of the preeminent animal ecologists of the last century, who focused on population ecology and energy flow in systems (hutchinson, 1978). the odum brothers frequently exchanged ideas throughout their lifetime, and h.t. odum specifically encouraged his older brother to consider new ideas, such as hutchinson’s holistic approach to the study of systems. hutchinson influenced e.p. and h.t. odum to focus on higher levels of organization, such as ecosystems, as the central unit of study, and e.p. odum used this idea as one of the foundations for his ideas in the fundamentals of ecology (craige, 2001). just as their father before them, the younger odums were known to push their scholarly contemporaries to think in terms of large-scale systems. the following quotation summarizes e.p. odum’s view of holism as it relates to science: it is self-evident that science should not only be reductionist in a sense of seeking to understand phenomena by detailed study of smaller and smaller components, but also synthetic and holistic in the sense of seeking to understand the large components as functional wholes. a human being, for example, is not only a hierarchical system composed of organs, cells, enzyme systems, and genes as subsystems, but it is also a component of supra-individual hierarchical systems such as populations, cultural systems, and ecosystems. science and technology during the past half century have been so preoccupied with reductionism that the supra-individual systems have suffered benign neglect (1977, p. 1291). the odum brothers’ concern for both human and natural systems is remarkable among biologists and naturalists of their generation. scientific training in the 118 advances in social work mid-20th century often focused on natural subsystems; those who received this training historically have been reductionists and neglected the discussion of multiple and nested systems, including human systems (odum, 1977). as a result, much of the recent work in the natural sciences defines problems but fails to bridge to pragmatic recommendations to ensure the future of human civilization. prescriptions for the future were found in the work of both brothers as well as their father’s work before them. both generations made significant contributions to systems theory in their respective fields. european roots of ecology the odums built upon the european tradition of ecology, drawing from the work of early theorists who developed critical concepts and groundbreaking research. darwin’s concepts of evolution and adaptation of an organism within an environmental context are at the root of early theory development. ernst haeckel, who avidly studied darwin, coined the term ecology and was the first to use it in 1866 to “draw attention to the inclusive study of organisms in the environment, in contradistinction to the narrower study of organisms in the laboratory” (keller & golley, 2000, p. 9). haeckel discussed ecological adaptation, using the concepts of reciprocity and mutuality between organism and environment (greif & lynch, 1983). by 1885, the term ecology was used in a book title, and the development of ecological theory rapidly progressed (keller & golley, 2000, p. 9). coursework began to be developed, and the first professional society, the british ecological society, was inaugurated in 1913. by 1935, botanist sir arthur tansley challenged the use of ecological language in his article, “the use and abuse of vegetational concepts and terms” (keller & golley, 2000; tansley, 1935). “tansley challenged the term biotic community, because it aggregated animals and plants as members of a community without specifying their interrelationships and implicitly separated them from their physical environment” (craige, 2001, p. 25). the problem with separating humans from the physical environment, tansley asserted, is that one must then ask, “is man a part of nature or not?” (craige, 2001, p. 6). in his article, tansley describes ecosystems as follows: “they form one whole category of the multitudinous physical systems of the universe, which range from the universe as a whole down to the atom” (craige, 2001; tansley, 1935, p. 290). beginning from the whole-system perspective and the development of the concept of the ecosystem, eugene and h.t. odum built an ecological legacy in american scholarship. social work: carel germain & other theorists ecologically grounded practice dates back more than 100 years, with the practice of jane addams and mary richmond (deegan, 1988; richmond, 1917). however, in 1973, carel germain was the first social worker to formally apply ecological concepts to social casework, emphasizing the concept of ecosystem (germain, 1973; germain & gitterman, 1995; robbins et al., 1998). she wrote about ecology and its conceptual relationship to social work: ecology is the science concerned with the adaptive fit of organisms and their environments and with the means by which they achieve a dynamic equilibrium and mutuality. it seems to furnish an appro119smith rotabi/ecological theory origin priate metaphor for a helping profession concerned with the relationships between human beings and their interpersonal and organizational environments, with helping to modify or to enhance the quality of transactions between people and their environments, and with seeking to promote environments that support human wellbeing (1973, p. 326). although germain discusses ideas central to ecosystem ecology, she fails to cite previous use of the concept ecosystem, which, by that time, was widely recognized in the natural sciences, as introduced into contemporary american ecology by the odum brothers (craige, 2001; hagen, 1992). however, germain cites a range of contributors from the social sciences, including psychologists and social workers, specifically those professionals working in psychiatric settings. germain followed her general work about ecosystems ecology with a discussion of specific ecological concepts, such as time (1976) and space (1978), as they relate to the human condition. from ecological theory, germain began development of the life model of practice (germain & gitterman, 1995), which, she states, “may provide us with the necessary action concepts as guides in engaging the progressive forces and adaptive potentialities of the person, mobilizing the environmental processes as helping media, and altering elements of the environment” (germain, 1973, p. 326). germain points out that the central strength of the ecological perspective is its treatment of the individual and the problem, both in and as part of the environment, instead of focusing solely on the person or the illness as the problem. this point targets the age-old professional struggle between community systems practice and the medical model, which focuses solely on person and illness, removing him or her from the environmental context (weick, 1981). in contrast to massive institutionalization based on assumptions of individual path-ology, ecological theory, by its very nature, requires study of the personenvironment interrelationship as a central theme for practice activities. in this initial discussion of the ecological life model, germain focuses on previous use of ecological ideas by psychological theorists, including the concepts of adaptation and milieu. germain builds upon her early ecological work with a more specific conceptual treatment in time: an ecological variable in social work practice (1976), in which she discusses time as it relates to the rhythms of life from the biological, cultural, and social perspectives. practice implications included casework planning surrounding the sense of time for children and elders as it relates to their respective developmental cycles. she points out that lengthy foster care placement decisions are out of sync with children’s developmentally anchored experiences of time. on the other end of the lifespan, she points out that elders often have a fleeting sense of time, which also requires immediate case management action, according to this internal clock. germain continued to explore ecological concepts in her 1978 article, “space: an ecological variable in social work practice.” she begins her discussion by noting that, “human beings have tended to overlook the physical settings in which they are embedded as sources of influence in behavior” (p. 515). in her discussion of human behavior in the physical environment, she states that there are “recip120 advances in social work rocal relations between the social and physical environments and their interaction with culture, personality, and behavior” (p. 516). the ecological concepts of population density and territoriality emerge in this discussion. she defines the latter term as: an observable social phenomenon among individuals, groups, and families. people have feelings of possessiveness toward space and objects. they mark spatial territories with nameplates, signs, doors, locks, and fences. they use gestures, in-group jargon, and threatening verbal behavior to defend their control of space (p. 522). this idea of territoriality has important implications for social work practice, given the human behavior realities associated with the individual’s need for personal space as he or she interacts with others and the physical environment. for example, historical overcrowding of people in inner-city public housing has set a context for multiple social problems, including youth delinquency and gang violence. germain’s commitment to the emerging social work ecological paradigm in the mid-1970s culminated in the edited collection social work practice: people and environments: an ecological perspective (1979b). chapters include discussion on child welfare, social networks, and hospitalization within the ecological framework. the introductory chapter defines such foundational ecological concepts as adaptation, environment, stress and coping, competence, relatedness, and autonomy (germain, 1979a). this book marks the first comprehensive overview of the ecological model as it relates to practice focusing on specific populations and problems. throughout her career, germain continued to build upon the ecological framework, setting forth the groundwork for its emergence as a dominant social work perspective (payne, 1997). her collaborative work with gitterman resulted in numerous publications, including the 1980 book the life model of social work practice (germain & gitterman, 1980), which was revised and presented in a new edition in 1996 after germain’s death (germain & gitterman, 1996). in this second edition, a long overdue reference to eugene odum’s work was made in the discussion of the concepts habitat and niche, metaphorically described by odum as an organism’s “address” and “profession,” respectively (germain & gitterman, 1996, p. 20). these concepts are defined respectively by gitterman as a “place where the organism is found . . . all the social settings of human individuals or groups” and “the social status occupied in a human community by an individual or a group” (germain & gitterman, 1996, p. 23). germain developed social work ecological theory, while other social work theorists made equally important contributions to our understanding of holism and general systems theory (bertalanffy, 1968) from a social environment perspective. ralph anderson and irl carter (1974) published human behavior in the social environment (hbse), which, for two decades, was one of the most widely adopted texts for social work education on the subject of social systems (robbins et al., 1998). their discussion focuses on the concept of holon, defining the term as “denoting that a system is both a part of a larger suprasystem and it is itself a 121smith rotabi/ecological theory origin suprasystem to other systems” (anderson & carter, 1984, p. 321). their discussion draws on the natural science concepts of energy, synergy, entropy, and organization as they are related to systems at all levels. anderson and carter begin by discussing culture and society and move on to communities, groups, and organizations, and finally summarize the concepts as they relate to families and individuals (anderson & carter, 1984). their discussion, starting at the broadest of scales, is in contrast to other more recent hbse texts, which focus more on the individual’s development within the social environment (hutchinson, 1999). in this text, anderson and carter draw upon the ecological approach, which they state, originated “probably” at the university of chicago; however, references to specific theorists are absent, except for their 1990 reference to kurt lewin’s field theory in which he develops the ecological psychology model (anderson & carter, 1990). anderson and carter state that the ecological approach is “virtually synonymous with a systems approach” (1990, p. 262) but do not directly cite germain or any other ecological systems theorists, including the odum family. they do state that the term ecological systems is “used by some writers in the broad sense of systems that are hierarchically related. in biology and ecology, the term refers to living organisms in the earth’s biosphere that are hierarchically related” (anderson & carter, 1984, p. 230). anderson and carter’s contributions to understanding human behavior in the social environment have endured over time, and their framework is based on nested systems, a hallmark concept of ecology. germain began to theorize about ecological social work practice 19 years after the death of h.w. odum (germain, 1973). in her early work, germain reviews previous approaches that consider the environment from the psychological perspective, but she does not cite the work of the important, ecologically-focused sociologists before her, including scholars at the chicago school of sociology who were historically recognized for social ecology theory (mckenzie, 1925; odum, 1951). even though germain was a scholar of social work history (germain & hartman, 1980), she never recognized the senior odum and only briefly mentions e.p. odum in 1996 (germain, 1973, 1976, 1978, 1979a; germain & gitterman, 1996). several factors may have contributed to less attention to odum’s work in the major schools of social work in the northeast and midwest: 1) odum was recognized nationally primarily as a southern regionalist and as the founding editor of social forces, 2) major scholarly work in social work research and treatment was being carried out in urban environments in the northeast and in chicago, where their major focus was on urban problems and urban approaches to practice and research, 3) because the most prominent schools of social work at the time did not study rural problems and approaches. in contrast to this focus of northern schools, odum’s work focused on description and measurement of social problems with a broad prescription for policies and administrative practice. germain also overlooked american natural systems ecologists and their european predecessors, including haeckel and tansley, who built substantial scientific theory by this time (golley, 1993; greif & lynch, 1983; keller & golley, 2000). theory bridging between sociology, ecology, and social work the fields of sociology, ecology, and social work have benefited from the work of both generations of odums. the odums’ theoretical contributions connect the 122 advances in social work disciplines through ecosystems’ ecology as a unifying and overarching paradigm (odum, 1997). the inter-relationship of these three disciplines and the unifying paradigm in illustrated in figure 1. ecology is a powerful perspective that bridges the gap, which has traditionally existed between natural and social sciences. currently, social work incorporates basic human ecology. the odum contributions offer social work an opportunity to construct interventions more broadly, incorporating a natural resource management strategy. the theoretical cross-fertilization is best illustrated by the parallel concepts developed by both generations. the senior odum began to integrate natural science and ecological concepts into his publications in the late 1930s (odum, 1939; odum & moore, 1938). in american regionalism (1938), he devoted an entire chapter, “exploring the region: the ecologists,” (p. 323) to an exploration of the fundamental concepts of the natural sciences. in his descriptions of the concepts of biome and succession, odum directly quotes his son eugene: the ecologist, according to eugene p. odum, characterizes his major divisions as “biotic formations” or “biomes,” regions in which there is a uniform “climax,” which is the highest type of vegetation possible in the region, and also in which the most important animals are similar. this idea of climaxes is fundamental in modern ecology, and it is believed that they represent climatic influences perhaps more than soil. another fundamental idea is succession, which represents, of course, the environmental and time quality. thus, if one lets a field in the southeastern deciduous forest lie fallow, there are, first of all, grasses of various kinds, then pines, and finally if we wait long enough, the oak-hickory deciduous or hardwood forest, which is the climax for that area. the animals will also change with the plants (p. 326). 123smith rotabi/ecological theory origin figure 1. theory bridging between sociology, ecology, and social work. this passage not only marks a clear intersection of perspective in regionalism and modern ecology, but it also indicates the cross-fertilization of ideas within the odum family, including feedback from the younger generation, specifically eugene, to the senior odum scholar. today, ecologists and regionalists recognize this relationship as indicated by kirby’s observation that “howard w. odum and his regionalist colleagues at the university of north carolina are entangled in the roots of our age of ecology” (1991, p. 23; hagen, 1992). odum’s holistic worldview, which was clearly passed onto his sons, is one of the earliest examples of ecological theory developed by a social work scholar. he was a man ahead of his time, laying out major ecological concepts for his regionalism theory development and research. strengths and weakness of ecological perspective in social work in social work and other social sciences, ecological theory has been applied to nearly every population and significant social problem, from juvenile delinquency (fraser, 2004), to child development (bronfenbrenner, 1979), and child abuse (garbarino, 1977). however, ecological theory has been criticized as being inadequate (finn & jacobson, 2003) and too abstract and impractical for the applied practice nature of social work (wakefield, 1996). as a result, some scholars consider it to be only a perspective that “offers a lens” (grief & lynch, 1983, p. 53) from which to view problems and practice rather than an appropriate theory related to intervention (fraser, 2004). one of the reasons for this diversity of opinion may be because ecology and general systems are typically treated as synonymous; they are not. ecology is an organic theory, whereas general systems theory is mechanistic, making it more difficult to apply to human social problems. ecological theory offers social work a paradigm that recognizes the interconnected nature of our world and the long-term survival of humans and other species and demands that we view ourselves and our environment in a holistic manner. polluted air, which is the result of automobile and industrial emissions, has contributed significantly to the decrease of ozone and ultimately to the destruction of artic environments. as a result of global warming, the ice caps melt and populations living at or below sea level are losing their life-supporting land at alarming rates. the resulting human costs include the destruction of villages, towns, and cities throughout the world, from charleston, south carolina to bangladesh. with growing environmental devastation, social work still needs to become more aggressive about using ecological theory above and beyond social ecology. this adaptation will require modification of theory and concepts to direct greater focus onto human issues in both the natural and social environments, as well as develop an ecological vocabulary and implement interventions grounded in applied ecology. in the face of globalization and rapid social and economic change, social work researchers and practitioners need advanced ecological theory to develop models of practice and research, incorporating sustainable development principles (gamble & hoff, 2005). these interconnected human/environmental phenomena have an impact on social work practice on a daily basis. however, as a profession, social work has failed to partner in the development of policy and practice to prevent environ124 advances in social work mental devastation and inherent human costs. this failure is most likely related to the fact that social work education has not yet embraced biological sciences, such as agriculture, geography, and environmental engineering. however, solving these human problems relies on an integrated natural and social science approach that would further expand our definition of generalist practice. another critique of ecological theory is that some of the major concepts, such as homeostasis and system stability, may be used to promote ideas of social systems remaining the same or constant rather than changing, which is a serious concern when dealing with issues of power and inequality of women, the poor, and people of color. stability may be used as an excuse for oppressive systems and maintaining the dominant paradigm. such concerns are well justified, given the history of social darwinism and the fact that the idea of survival of the fittest has been misused as a justification for social stratification. however, when applied correctly, the ecological perspective provides a powerful framework for understanding systems and social issues, such as inequality and diversity. for example, ecological theory can be applied to the civil rights movement, which began as early as the 1940s (odum, 1997) as a current that reached a critical mass by the 1954 brown v. board of education decision and the massive socio-political changes that took place in subsequent decades. the momentum of the movement demanded that the oppressive and racist social stratification system had to change in the south, as h.w. odum himself argued. change was slow, but change did occur and continues to evolve. among other human phenomena, ecological theory provides social work with a framework by which to study, track, and forecast social movements and social change. conclusion other disciplines have clearly recognized the connection between the two odum generations and ecological theory development. however, the relationship between h.w. odum and his sons has not been recognized in social work. in fact, with the exception of one author’s brief reference (siporin, 1980), the earliest social work discourse failed to even merely cite e.p. odum (germain, 1973, 1979a,b), even though he was an important and seminal ecology author. this oversight is the result of at least three dynamics. first, h.w. odum is overlooked in social work history, as he is traditionally remembered as a sociologist. second, overall, our knowledge of natural science ecology is shallow and, thus, the historical roots of the science are overlooked. a third dynamic is that we have traditionally focused on social systems while failing to fully embrace the reality that natural environments, that is, the healthy forests, rivers, and clean water, air, and pollution, not only impact human behavior and welfare but must be intervention targets. for the long-term welfare of human populations, social workers must more fully embrace ecosystems ecology. this requires enhancing our knowledge and improving our ecological theory. then, the practice will be better informed, including progress in sustainable development. 125smith rotabi/ecological theory origin 1 in order to avoid confusing the reader, howard w. odum from here forth is referred to as h.w. odum, eugene p. odum, is referred to as e.p. odum, and howard t. odum is referred to as h.t. odum. references anderson, r.e., & carter, i.e. (1974). human behavior in the social environment: a social systems approach. new 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(1947b). understanding society: the principles of dynamic sociology. new york: macmillan. odum, h.w. (1951). american sociology: the story of sociology in the united states to 1950. new york: longmans, green. odum, h.w. (1997). race and rumors of race: the american south in the early forties. reprint, with a forward by bryant simon. 1943. baltimore: johns hopkins university press. odum, h.w., & moore, h.e. (1938). american regionalism. new york: holt. odum, h.w., & willard, d.w. (1925). systems of public welfare. chapel hill: university of north carolina press. payne, m. (1997). modern social work theory (2nd ed.). chicago: lyceum. richmond, m.e. (1917). social diagnosis. new york: russell sage. robbins, s.p., chatterjee, p., & canda, e.r. (1998). contemporary human behavior theory: a critical perspective for social work. needham heights, ma: allyn & bacon. rotabi, k.s. (2004). theory bridging between sociology, ecology, and social work: the intellectual legacy of the odum family. unpublished doctoral dissertation, university of north carolina, chapel hill. sanders, l.m. (2003). howard w. odum’s folklore odyssey: transformation to tolerance through african american folk studies. university of georgia press: athens, ga. siporin, m. (1980). ecological systems theory in social work. journal of sociology and social welfare, vii (4), 507-532. smith, k.m. (2001). the legacy of the school’s founder, howard w. odum. contact: a newsletter for the [university of north carolina] school of social work alumni and friends, 18(spring): 4. sosna, m. (1977). southern liberals and the race issue: in search of the silent south. new york: columbia university press. tansley, a.g. (1935). the use and abuse of vegetational terms and concepts. ecology, 16: 284-307. wakefield, j. (1996a). does social work need an ecosystems perspective? part 1. is the perspective clinically useful? social service review, 70(1): 1-32. weick, a. (1981). reframing the person-in-environment perspective. social work, 26: 140-143. 128 advances in social work author’s note: address correspondence to: karen smith rotabi, ph.d., lmsw, mph, assistant professor of social work, virginia commonwealth university, 1001 w. franklin st., p.o. box 842027, richmond, va 23284-2027, usa. e-mail: ksrotabi@vcu.edu. 129smith rotabi/ecological theory origin aisw vol. 5, no. 1 61 evaluation of two interviewing skills measures: an instrumentvalidation study cathy king pike robert bennett valerie chang abstract: this article reports an initial validation of an instrument that measures basic interviewing skills and compares its psychometric results with another instrument that has been used more frequently to measure similar skills. four field supervisors rated 30 students’ videotaped interviews (n=120) using two instruments, the validation, and a comparison instrument. the current validation instrument had high internal consistency reliability, a clear factor structure, and performed well in construct validity evaluations. these preliminary results supported the instrument’s internal consistency reliability, content, factorial, and construct validity. the validation instrument hadhigher internal consistency reliability, lower errormeasurement, and amore interpretable factor structure than the comparison instrument. keywords: assessment; interviewing skills; instrument development; direct measures;measurement before beginning to work with clients, all social work students need to master basic practice skills. these basic skills are generic prerequisites to additional skills required in specialized fields of practice and for particular theoretical approaches. these basic skills are widely recognized as beginning, exploring, and contracting with clients (hepworth, rooney & larsen, 1997). students are expected to learn basic skills in practice courses, later developing more complex competencies during field practice. in a study completed by dore, epstein and herrerias (1992), eight field-training objectives were identified. their first objective was the “development of specific skills for micro practice, including skills in engagement, problem exploration, exploration of feelings, goal setting, contracting, and termination, as well as knowledge of and ability to apply various treatment modalities” (dore, et al., p. 357). also noted by these authors was the paucity of student learning measures. learning basic skills and engaging in self-assessment contribute to becoming self-reflective social workers with the skills to continuously improve praccathy king pike is associate professor, robert bennett is assistant professor, and valerie chang is professor at the indiana university school of socialwork, indianapolis, in 46202. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 61-75. indiana university school of socialwork. tice (bloom, fischer & orme, 1995). although students should be responsible for assessing their progress (shepard & wahle, 1981), they also need ongoing feedback from their classroom and field instructors (stoltenberg & delworth, 1987). beginning students are particularly dependent upon supervisors for direction, feedback, and evaluation (stoltenberg & delworth, 1987). unfortunately, students report that they receive minimal feedback (barth & gambrill, 1984) and that they need critical analyses of their use of social work skills (urbanowski, 1988). relevant, practical, and psychometrically sound evaluation tools that can be used across practice settings to provide feedback to students about their interviewing skills are needed (vourlekis, bembry, hall & rosenblum, 1996). with the increased pressure for accountability in practice and education (bernotavicz, 1994), social work educators need outcome measures that accurately assess competency in the use of basic and more complex practice skills (matarazzo & patterson, 1986; o’hare & collins, 1997; ragg & mertlich, 1999). however, sound, psychometrically tested measurement tools for evaluating basic practice skills are not readily available (o’hare & collins, 1997; vourlekis, bembry, hall & rosenblum, 1992).without solid evaluation tools, it is difficult to effectively and consistently evaluate beginning practice skills. evaluation instruments that have good levels of reliability and validity can enhance the learning experience for students. specifically, evaluation instruments should assess accurately students’ skill development and identify skills that students need to develop further. only three instruments related to basic practice skills were identified in the social work literature: a measurement tool used in evaluating students’ field process recordings (vourlekis, et al., 1996), a social work practice skills instrument (o’hare & collins, 1998), and a somewhat dated interview skills assessment instrument (katz, 1979). vourlekis, et al. (1996) reported research on the usefulness of a checklist in evaluating interviewing skills in field. the instrument contains 26 items and is scored from “1=beginning level” to “5=advanced level.” vourlekis, et al. (1996) found high internal consistency reliability and good validity results for the instrument. however, this instrument was developed for use in evaluating apparent interviewing skills through the use of process recordings and is limited to students’ self-report and the verbal content reported in a process recording. the checklist, although useful, is an indirect measure, rather than a direct measure of interviewing skills. o’hare and collins (1997) reported the most recent instrument development project related to practice skills measurement. their instrument addressed the frequency with which practitioners use 23 skills that are therapeutic, supportive, case management, and evaluation. the items are measured from 1 to 5, and the anchors range from “never/almost never” to “very often.” this is a self-report instrument that better relates to the frequency with which msw students and msw practitioners (o’hare & collins, 1998) use a variety of skills in their practices, rather than measuring competencies in the use of these skills. in psychometric analyses, the instrument yielded 62 advances in socialwork acceptable to strong internal consistency reliability coefficients (.78 to .92), with the four-factor solution remaining stable across two studies (o’hare & collins, 1997; 1998). although this instrument is easy to use and can be completed quickly, the measurement goals, i.e., identifying the frequency of use of skills, differ from the instrument tested in this study. the katz (1979) instrument is more dated than the two instruments described above and has a complicated scoring mechanism. however, this instrument is similar to the current validation instrument and has been used more frequently in research on students’ levels of interviewing skills, as reported in the katz (1979) writing. the katz instrument contains 23 items and was designed to include identifiable skills taught in beginning social work practice methods courses. the first 11 items on this instrument are descriptions of interviewer characteristics. the items are “attentive to clients,” “eye contact,” “relaxed,” “self-conscious,” “fidgety,” “distracted,” “genuine,” “respect for client,” “sensitive to client’s feelings,” “mutuality” and “warmth” (katz, 1979). these items are rated using a four-point likert-type scale ranging from “0=almost never present” to “3=almost always present.” items 12 through 22 are associated with discrete interviewing skills. these skills are “verbal following,” “exploratory responses,” “understanding responses,” “primary-level empathy,” “summarizing responses,” “self-disclosure,” “advice,” “confrontation,” “advanced-level empathy,” “immediacy,” and “concreteness.” for these items, the rater uses a three-point scale for appropriateness of use. the scale ratings are “0=not appropriate and not used,” “1=over-use or under-use,” “2=appropriate use.” that score is then multiplied by a weight from a four-point scale of effectiveness with high effectiveness rated as a “4” and low effectiveness rated as a “1.” the final item, 23, requires an overall judgment about the student’s competence as an interviewer when compared with other students. this item is rated on a seven-point likert-type scale of “1=poor” to “7=excellent.” in preliminary studies conducted across three cohorts, inter-rater reliability ranged from poor to good, .48 to .82 (katz, 1979). katz’ (1979) validation studies exhibited two major flaws in analyses. first was the use of 22 items in three very small samples (n=15 or fewer for the first two samples, and n=26 in the third sample) to predict overall performance, a global item contained in the instrument. these sample sizes were too small to provide stable multiple regression results (pedhazur, 1973). second, the katz (1979) studies used an excessive number of dependent samples t-tests that were computed to examine changes from pretest to posttest. an astounding 23 analyses were conducted for each of the items of the scale (katz, 1979). cohen and cohen (1983), using tables that take sample size into account, reported the estimated type i error rate for 20 separate tests as being about 90%. the objectives of this research were to: (1) psychometrically test an instrument designed by chang and scott (1999) but for which no psychometric testing had been completed, and (2) compare the chang and scott (1999) instrument’s psychometric characteristics to those of the katz (1979) instrument, 63pike et al./measuring basic interviewing skills which has been more frequently used in research on basic interviewing skills. the katz (1979) instrument was designed to offer instructors a tool for evaluating skills taught in the classroom and practiced in a laboratory setting. although the katz (1979) instrument does not contain some currently recognized practice skills, the instrument is a core set of interviewing skills items that are similar to those in the chang and scott (1999) instrument. permission was obtained to include the katz (personal communication) instrument in this research in order to compare the chang and scott (1999) instrument results to the more frequently used katz (1979) instrument. methods description of thevalidation instrument the chang and scott (1999) instrument focuses on social workers’ behaviors related to interviewing and is constructed with the goals of having faculty, field instructors, and students use it to evaluate students’ interviewing skills. the instrument is designed to measure a variety of interviewing skills: communicating involvement, observing, active listening, beginning process, reflective questioning, exploration, seeking clarification, initial contracting, and interpersonal skills. see the appendix for additional details about the skills and behaviors or descriptors that comprise the broader level skills included in this instrument. within the first nine skills are lists of behaviors that are inherent to broaderlevel interviewing skills. for example, communicating involvement includes the following discrete behaviors: attentive body posture, facial expressions, and eye contact. the purpose in listing behaviors was to focus raters on the specific grouping of behaviors that comprise each overall skill. each of these behaviors or descriptors is rated dichotomously (present or not present). the process of reviewing the dichotomously scored skills can assist raters in more accurately appraising the broader category. similarly, students’ can further their understanding of specific behaviors that will improve their interviewing competencies. for purposes of this study, these discrete behaviors, which comprise a broader skill, were not included in psychometric analyses. each broader-level skill is rated on a five-point likert-type scale (1 = ineffective and/or inappropriate to 5 = highly effective and appropriate). an additional four items (10–13) focus on the interpersonal qualities of warmth, respect, empathy, and genuineness. each of these final four qualities is more abstract than many of the practice skills, involves less universally recognized behaviors, and requires raters tomake a somewhat subjective judgment. because of this, no attempt wasmade to include specific lists of behaviors for these four items. the final item (14) is focused on rating the general effectiveness of students’ responses to clients. scoring the instrument is accomplished by summing up the first 13 ratings. this item was included for purposes of using it in evaluating the instrument. sample and informed consent procedures study participants were graduate social work students recruited from two sections of a first-year msw theory and practice methods course. the course 64 advances in socialwork objectives, textbooks, workbook, and required final videotape were the same in each section. an “informed consent” form, provided to students, described the following: the intent of the study, the students’ extent of involvement, any risks and benefits associated with the study, information about the voluntary nature of the study, students’ right to refuse to participate, and their right to withdraw their consent to participate in the study at any time during their involvement in the study. thirty of 44 students (response rate = 68.2%) across the two course sections voluntarily participated in the study. demographic information was gathered at the time the students agreed to be involved in the study. the sample consisted of 26 females and four males. there were 27 caucasian students, two african-american students, and one hispanic student. the students ranged in age from 22 to 53 years old, with a mean age of 28 and a median age of 25 years. design and procedures students in each class were videotaped conducting a 15-minute interview with an individual trained to simulate a single client. the authors hired two senior-level bsw students and two-second year msw students to simulate the client. these students were included in the development of a client profile and practiced the client roles with coaching from the authors. four social workers with at least 10 years of post-msw practice experience were recruited and trained to rate the videotapes. their years of social work experience ranged from 10 to 23 years, with a mean of 14 years. all the raters were female and had from one to six years of field instructor experience. three of the raters were caucasian and one african american. in a four-hour training session, the raters were instructed in the use of the chang and scott (1999) instrument, as well as the katz (1979) comparison instrument. during the training, the raters watched two videotaped interviews not included in the study and evaluated them using both the validation instrument and the katz (1979) instrument. raters’ evaluations were compared and discussed by the trainers and raters. each rater received copies of the 30 student videotapes and evaluation instruments. the raters were instructed to evaluate each tape using both the revised chang and scott (1999) and the katz (1979) instruments (n=120) and complete and return the ratings within two months. psychometric examinations several statistical analyses examined the psychometric properties of this instrument in relation to the katz (1979) instrument. internal consistency reliability evaluations were conducted through computations of cronbach’s coefficient alpha. information about inter-rater reliability was obtained through analyses ofvariance (anova) andtukey’s hsd follow-up tests.when the important assumption of homogeneity of variance was violated by one data set, kruskal-wallis tests (the non-parametric analogue to anova) were used. principal components factor analyses using promax rotations examined the content, construct, and factorial validity of the instrument. these factor 65pike et al./measuring basic interviewing skills analyses were interpreted through the use of the percentage of variance accounted for by factors, eigenvalues, visual inspection of the scree plot, and theoretical considerations. a final analysis to examine evidence of construct validity was conducted by computing a pearson’s correlation for the chang and scott (1999) instrument scores with the katz (1979) instrument scores. the purpose of this examination was to test the hypothesis that the two instruments would have a positive, moderate correlation, suggesting that the two instruments are measuring related, but different, constructs. no attempt was made to use individual items to predict overall ratings (item 14) of the students’ responses to clients, because the sample was too small to permit the large number of predictors (13) that would be needed for computing a multiple regression analysis. however, a pearson’s product-moment correlation was computed for the chang and scott (1999) summed scores (items 1-13) and the global rating item (item 14) to assess their correlation and the amount of variance in the global rating scores that can be accounted for by the 13 items taken together. item 14 asks the rater to provide an overall effectiveness of students’ responses to clients. it is scored 1-5, from “1=ineffective” to “5=highly effective.” results descriptive statistics and initial examinations descriptive statistics were generated for both the katz (1979) and the current version of the chang and scott (1999) scale. the katz (1979) scale scores ranged from 45 to 127 (mean = 78.62, mdn = 80.00, std. dev. = 17.68). the chang and scott (1999) instrument’s scores ranged from 31 to 76 (mean = 58.18, mdn = 58.0, std. dev. = 8.68). a rater scored one videotaped interview on the validation instrument as 31, which was more than two standard deviations below the mean. because outliers like this score can unduly influence small samples, this case was deleted from the database (n=119). the data were examined for additional positive outliers, but none were identified within the analyses as highly atypical. there were some differences between the two instruments on the issue ofmissing data. the katz (1979) scale had no missing data. however, the chang and scott (1999) instrument had enough missing data to bring its sample size to 86 (rather than 119) in reliability analyses where listwise deletion is used. frequencies were generated for individual items to assess systematically the extent to which data were missing. most of the items in the chang and scott (1999) instrument hadminimalmissing data (ranging from 0-6). two items (8 and 9), respectively, had 19 and 14missing data-points. item 8 referred to seeking clarification. the dichotomous statements used to focus raters were as follows: exploring the meaning of clients’ words, conclusions, contradictory statements, and eliciting detail about statements. item 9 involved the contracting process and, likewise, seemed well defined through the use of its dichotomous focusing statements. those items where one might expect missing data because of their level of abstraction (e.g., interpersonal qualities of warmth, respect, empathy, and 66 advances in socialwork genuineness) had nomissing data. no explanationswere apparent in these examinations, which explained the missing data. the sample sizes for internal consistency reliability analyses, by definition, deleted cases where data were missing (listwise deletion). however, factor analyses accommodated the missing data through the use of a pairwise deletion. evaluations of reliability internal consistency cronbach’s coefficient alphas were computed for both the katz (1979) and the current version of the chang and scott (1999) scales. analyses were computed with and without the global rating item of each scale. the katz (1979) scale achieved an acceptable internal consistency reliability score for research purposes, .77 (n=119) for all items and a .74 when the global rating item was removed from analysis. the chang and scott (1999) scale achieved an excellent level of reliability of .91 (n=86) for all items and a closelymatching .90 when the global itemwas removed from analysis. the chang and scott (1999) instrument had substantially lower standard errors of measurement than the katz (1979), indicating that the chang and scott instrument (1999) exhibits more precise measurement of basic interviewing skills than the katz (1979) instrument. table 1 contains further information about the internal consistency reliability examinations. inter-rater reliability inter-rater reliability was assessed for both instruments via analyses ofvariance (anova), where rater was the independent variable and scale score comprised the dependent variable. the levene’s test for the katz (1979) data resulted in a significant f-score (f=11.034, p.<.001), indicating that the homogeneity of variance 67pike et al./measuring basic interviewing skills instrument evaluated std. dev. alpha sem katz (1979)–all items 15.17 .77 7.35 katz (1979)–global item 14.28 .74 7.13 omitted chang & scott (1999)–all items 7.39 .91 2.04 chang & scott (1999) 6.74 .90 2.16 –global item omitted using factor analysis results katz (1979) factor 1 10.82 .81 4.70 factor 2 7.88 .54 5.32 chang & scott (1999) factor 1 6.48 .91 1.91 factor 2 1.35 .61 .84 note: results are rounded to two places. figure 1: internal consistency reliability results assumption of the anova had been violated. consequently, the non-parametric kruskal-wallis was computed for these data. it yielded a non-significant chisquare of 5.67 (p.=.129), indicating no significant differences by rater on mean rank (ranging from a low of 47.48 for rater 3 to 65.85 for rater 1). the data for the revised chang and scott instrument (1999) did not violate the homogeneity of variance assumption by the levene’s f-test (f=.813, p.=.489). the overall anova indicated significant differences inmean ratings among the raters (f=9.137, p.<.001). thetukey’s hsd follow-up test indicated that rater 3 had a significantly lowermean rating (52.37) than the remaining three raters (ranging from 58.40 to 61.57). frequencies were generated for all raters in order to further understand the differences among raters’ distributions. hand computations of t-tests for kurtosis and skewness for all raters were not significant (df=29, tskewness ranged from .115 for rater 4 to -.806 for rater 2, and tkurtosis ranged from -.278 for rater 2 to –1.358 for rater 4). however, an examination of the frequency distributions indicated that fully half of rater 3’s ratings were below a score of 50, compared to the frequencies of 1, 3, and 3 scores that were below 50 for raters 1, 2, and 4, respectively. median ratings were 51 for rater 3 and 61, 62, and 56 for raters 1, 2, and 4, respectively. based upon the above obvious inconsistency of the third rater’s ratings, the kruskal-wallis and anova were recomputed. in this computation, rater 3’s ratings were removed to identify the extent to which this person’s ratings were unduly influencing the overall inter-rater reliability. rater 3’s data were retained for all other analyses, however. the katz (1979) data again violated the homogeneity of variance assumption (levene’s f=16.050, p.<.001), and the subsequently computed kruskal-wallis chi-square was not significant (.148, p.=.929). the chang and scott instrument (1999) data again did not violate the homogeneity of variance assumption (levene’s f=1.206, p.=.304). the anova for these data yielded a non-significant f of 1.058 (p.=.352, eta-square = .02). only about 2% of the variance in ratings can be attributed to rater differences when rater 3’s data was removed from the analyses. themean ranks andmeans across both data sets were similar for raters 1, 2, and 4. the katz instrument (1979) mean ranks ranged from 43.53 to 45.88, and the chang and scott instrument (1999) means ranged from 58.83 to 61.57, indicating good evidence of inter-rater consistency across these three raters in scoring both instruments. rater 3’s inconsistent ratings call somewhat into question the interrater reliability for the chang and scott (1999) instrument. however, the results, after removing rater 3’s data, aremore suggestive of rater, rather than instrument, inconsistency. this finding is based on both the insignificant results and the fact that when rater 3’s data were removed from the sample, only 2% of variance among the remaining raters can be attributed to rater differences. however, rater 3’s data were included for all other analyses, including evaluations of internal consistency reliability, factor analyses, and all other validity examinations. this decision prevents the loss of data but also provides more conservative psychometric estimates. 68 advances in socialwork examinations of factorial, content, and constructvalidity factor analysis principal components factor analyses were computed to examine the factor structure of both the revised chang and scott (1999) and katz (1979) instruments. the kaiser-meyer measure of sampling adequacy for the katz (1979) items yielded a score of .868 and a bartlett’s test of sphericity chi-square of 1,450.92 (p.<.001). these two tests, respectively, examine the extent to which the items in the analysis are sufficiently correlated and differ significantly from an identity matrix. both tests indicated that the items were well suited for examinations using factor analyses. likewise, these two tests of assumptions were met with the chang and scott (1999) items, yielding a kaiser-meyer coefficient of .923 and a bartlett’s chi-square of 710.59 (p.<.001). the initial factor analysis of the katz (1979) instrument yielded a 4-factor solution, with the factors accounting for the following percentage of variance, respectively: 36.84, 11.29, 6.49, and 5.62. an examination of the scree plot indicated that the last two factors were likely comprised of error variance. the first two factors were correlated at .484, and factors 3 and 4 had low to trivial correlations with all factors. the correlations of the last two factors with the other factors ranged from -.000006 for factors 3 and 4 to .377 for factors 3 and 2. factor 4 was negatively correlated with all other factors, with its highest correlation being a -.329 with the first factor. a second factor analysis was conducted with the katz (1979) items, where a 2factor solution was specified. in this analysis, 36.84% of the variance was attributed to factor 1 and 11.29% to factor 2, for a total of 48.13% of variance accounted for by the two factors. all but six items loaded most heavily on the first factor. those items loading most heavily on factor 2 were items 17-22. these items were designed tomeasure self-disclosure, the provision of advice, use of confrontation, “advanced-level” empathy (as opposed to “primary-level” empathy), discussion of current therapeutic relationships, and concreteness. factors 1 and 2 had a very low correlation (r=.225), indicating that these factors measure different latent constructs and should be scored separately. the initial factor analysis of the revisedchang and scott (1999) instrument indicated the presence of two factorswith 50.88%of the variance accounted for by the first factor and 8.71% for the second factor. only three items loaded most highly on factor 2 (items 5-7). these items related to assessing client problems in relation to: (1) the nature of the problem, its history, severity, and precipitating factors; (2) the problem’s effects on the person’s feelings and functioning, and the client’s personal strengths; and, (3) situational stresses, supports, and strengths. these three items are highly correlated and more focused than items stated at a general level, e.g., general interpersonal, process, and exploring skills. however, they are central components of basic interviewing skills in social work. further, the two factors were moderately correlated at .54, a level that nunnally and bernstein (1994) considered sufficiently high to combine factors. a second factor analysis was conducted specifying a one-factor solution. the total percentage of variance explained by this solution was 50.80%. in this analy69pike et al./measuring basic interviewing skills sis, items 5, 6, and 7 loaded positively on the single factor, with a range from .372 (item 6) to .606 (item 5). internal consistency reliability of identified factors based on the findings of the above factor analyses, changes to both the katz (1979) and the chang and scott (1999) instruments’ internal consistency reliability were re-examined. two evaluations of the internal consistency reliability were conducted for each factor of each instrument using cronbach’s coefficient alpha. first, internal consistency reliability analyses were computed on the katz (1979) instrument for the two factors identified through factor analyses. the internal consistency reliability and the standard error of measurement (sem) of factor 1 were improved through deletion of items 17-22 (alpha=.81, sem=4.70), but the internal consistency reliability still remained lower and the sem higher than had been found for the chang and scott instrument (1999) in earlier analyses. in addition, the internal consistency reliability coefficient for factor 2 was unacceptably low (alpha=.54), and the sem unacceptably high (sem=5.32) for a scale having only six items and a narrow possible range of scores. the items identified as comprising factor 2 are not internally consistent and exhibit a high level of measurement error. internal consistency reliability analyses were computed on the revised chang and scott (1999) instrument for the two factors initially identified by the factor analysis. the first factor’s internal consistency and sem remained essentially unchanged (alpha=.91, sem=1.915). the second factor, comprised of only three items, had an unacceptably low level of internal consistency reliability (alpha=.61) for evaluating individual interviewing skills, but its sem (sem=.844) also was very low in relation to the possible range of scores (possible range = 315). scales containing only three items tend to suffer from low levels of internal consistency reliability and poorly represent the breadth of constructs (nunnally & bernstein, 1994). for these reasons, the three itemswere retainedwith the other items to comprise a single scale. further, when these three items were removed from the scale, their omission did not change an already very strong level of internal consistency reliability, and the items’ inclusion with the other items yielded only a very trivial amount of increase in error measurement. from a theoretical framework, the inclusion of the three items is sound, because those skills measured by the three items are central aspects of conducting effective interviews. further evaluation of constructvalidity the final analyses evaluated the construct validity of the chang and scott (1999) instrument (seetable 2). a pearson’s product-moment correlation was computed for the chang and scott (1999) revised instrument scores and the older, more frequently used katz (1979) instrument scores. based on the similarity of some of the items in both scales, a positivemoderate correlation coefficient had been hypothesized. the pearson’s correlation resulted in a positive and moderate correlation between the two instruments (r=.585, p.<.001). this result supported the hypothesis that the two instruments wouldmeasure somewhat different but similar constructs. 70 advances in socialwork the pearson’s product-moment correlation between the summed chang and scott (1999) instrument scores (items 1-13) and the global rating item (item 14) resulted in a positive, moderate, and significant relationship (r=.676, p.<.001, n=119). about 46% of the variance in the global item can be accounted for by scores on the first 13 items. this solid relationship between the global item that measures overall effectiveness of student responses to clients with the individual items taken together provides preliminary evidence of construct validity. discussion and applicationsto socialwork practices like much research that is based in field or natural settings, i.e., classrooms, this research has several limitations. first, the research used a single sample of social work students from one school and across sections of only one course. further research is needed to examine the instrument’s psychometric properties withmore diverse groups of social work students and at varying academic levels and courses. 71pike et al./measuring basic interviewing skills validation instrument katz (1979) instrument items one-factor items factor 1 factor 2 (structure matrix) 13. .87 10. .80 .22 12. .85 23. .80 .54 14. .84 9. .76 .15 10. .81 6. -.76 -.09 11. .80 11. .75 .12 1. .80 5. -.73 -.08 4. .77 2. .72 -.23 8. .75 3. .70 .23 3. .72 13. .70 .46 5. .61 8. .68 -.17 2. .60 7. .67 .06 9. .53 1. .67 -.27 7. .44 12. .68 .39 6. .37 14. .66 .49 15. .6 .43 4. -.59 -.28 16. .54 .48 21. .17 .54 18. .09 .54 17. -.04 .50 20. .03 .50 22. .14 .41 19. .08 .38 note: items are rounded to two places. figure 2: final factor analyses results second, the katz (1979) instrument was not ideal as a comparison instrument, because it is dated and was examined using problematic validation techniques. therefore, any interpretations based solely on this instrument require caution. however, there were strengths which using the katz (1979) instrument provided the research. the katz (1979) measurement purpose matched the purpose of this research, and the katz (1979) instrument shared a common set of core interviewing skills with the chang and scott (1999) instrument. in addition, by examining the internal consistency reliability and factorial validity of the katz (1979) instrument, preliminary information not only was obtained regarding the katz (1979) instrument’s psychometric properties, but it allowed a comparison between the katz (1979) instrument and one (chang & scott, 1999) that had not previously been psychometrically evaluated. these analyses were positive steps toward mediating the limitations of using an instrument with unknown psychometric qualities. a third limitation of the study was substantial missing data for two items of the chang and scott (1999) instrument compared to no missing data in the katz (1979) instrument. these were the two items that measured seeking clarification and contracting process skills. it is unclear whether the missing data are due to some aspect of formatting or a lack of clarity in the items. however, the cronbach’s alpha analysis indicated that both items had moderate to strong corrected item-total correlations (.70 and .46, respectively), indicating that they were internally consistent, i.e., contributed to accurate measurement. a fourth limitation became evident in examinations of inter-rater reliability, specifically those of rater 3, whose scores were substantially different from the other raters.with this research, it was not possible to identify whether the differences in this rater’s scores were due to the rater’s incomplete training, the researchers allowing too much time for raters to complete the rating tasks, the rater’s procrastination in completing the ratings, or unreliability in the instrument. further research should be conducted on inter-rater reliability. however, other findings from this study suggest that instrument unreliability is not likely the cause of rater 3’s inconsistent ratings. specifically, the strong results on virtually every psychometric evaluation argue against instrument unreliability as the explanation for rater 3’s inconsistency in rating. a fifth limitation is that this research used simulated clients and, because of that, it is impossible to know how valid and reliable this instrument would be when applied to interviews with actual clients. further research is needed to examine the usefulness of the instrument with actual clients. despite the preliminary nature of findings from this study, the chang and scott (1999) instrument performed very well in evaluations of its internal consistency reliability, inter-rater reliability (when rater 3’s scores were omitted for this analysis), and content, factorial, and construct validity. both the evaluations of internal consistency reliability, where all 14 items were used, and the evaluation with the global item omitted, yielded high enough alpha coefficients for the instrument to be used in evaluating individual students’ basic interviewing skills. furthermore, the instrument had higher internal consistency reliability coefficients when its items were used as hypothesized, rather than those computed on the basis of the 72 advances in socialwork factor analysis results. the factor analyses provided evidence of good content, factorial, and construct validity. the correlation analysis also provided preliminary evidence of construct validity, resulting in a positive, moderate correlation with another instrument that has been used to measure interviewing skills. in contrast, the katz (1979) instrument fared less well on virtually all analyses than the chang and scott (1999) instrument.the katz (1979) instrument had substantially lower alpha coefficients and higher measurement error on both analyses, where all of its items were analyzed, and then with the global itemmeasuring interviewing skills omitted. an examination of this instrument’s factorial structure found two factors, rather than the implied one-factor, solution. further analyses of internal consistency based on the factor analyses supported a twofactor solution for the instrument, substantially increasing the level of the alpha coefficient for themajority of items when the items comprising the second factor were omitted from the reliability analysis. the katz (1979) instrument and the chang and scott (1999) instruments had a moderate positive correlation, providing very preliminary evidence from the katz (1979) instrument of convergent construct validity for the chang and scott (1999) instrument. a larger validation study that includes a representative sample of students from a diverse sample of schools could provide additional information about the instrument’s usefulness as a tool in evaluating interviewing skills. increased structure and data collection controls may improve the instrument’s inter-rater reliability. in addition, further research is needed to examine the extent to which basic interviewing skills are transferred from class exercises to work with clients in field placements. from a teaching viewpoint, an instrument that exhibits good evidence of reliability and validity and which can be used in both the classroom and the field may be helpful in coordinating learning across the areas. a further advantage would be the ability to promote discussions across the two learning environments regarding learning needs and challenges. perhaps such consistency would promote the better transfer of learning from the classroom to field settings and, ultimately, to effective social work practice. this research sought to achieve a preliminary step toward facilitating coordination in learning across the classroom and the field by psychometrically evaluating two instruments that evaluate students’ basic interviewing skills. references barth, r., & gambrill, e. (1984). learning to interview: the quality of training opportunities. the clinical supervisor, 2, 3-14. bernotavicz, f. (1994). a new paradigm for competency-based training. journal of continuing social work education, 6, 3-9. bloom, m., fischer, j., & orme, j. (1995). evaluating practice: guidelines for the accountable professional. boston: allyn & bacon. chang, v.n., & scott, s.t. (1999). basic interviewing skills: a workbook for practitioners. chicago, il: nelson-hall. 73pike et al./measuring basic interviewing skills cohen, j., & cohen, p. (1983). applied multiple regression/correlation analysis for the behavioral sciences (2nd ed.). hillsdale, nj: lawrence erlbaum associates. dore, m.m., epstein, b.n., & herrerias, c. (1992). evaluating students micro practice field performance: do universal learning objectives exist? journal of socialwork education, 28(3), 353-362. hepworth, d.h., rooney, r.h., & larsen, j.a. (1997).direct social work practice: theory and skills (6th ed.). pacific grove, ca: brooks/cole. katz, d. (1979). laboratory training to enhance interviewing skills. in f.w. clark &m.l. arkava (eds.), the pursuit of competence in social work (pp. 205-226). san francisco: jossey-bass. matarazzo, r.g., & patterson, d.r. (1986). methods of teaching therapeutic skill. in s.l. garfield & a.e. bergin (eds.), handbook of psychotherapy and behavior change (pp. 821-843). newyork: johnwiley & sons. nunnally, j., & bernstein, i.h. (1994). psychometric theory (3rd ed.). newyork: mcgraw-hill. o’hare, t., & collins, p. (1997). development and validation of a scale for measuring social work practice skills. research on socialwork practice, 7(2), 228-238. o’hare, t., & collins, p. (1998). validation of the practice skills inventory with experienced clinical social workers. research on socialwork practice, 8(5), 552564. pedhazur, e.j. (1982).multiple regression in behavioral research (2nd ed.). fortworth: holt, rinehart and winston. ragg, m.d., &mertlich, g. (1999). toward measuring practice skill outcomes: three measures of practice skill. paper presented at the annual planning meeting of the council of social work education, san francisco, ca. shepard, g., &wahle, l.p. (1981). a competency-based approach to social work education: does it work? journal of education for socialwork, 17(3), 75-82. stoltenberg, c.d., & delworth, u. (1987). supervising counselors and therapists: a developmental approach. san francisco: jossey-bass. urbanowski, m.l. (1988). learning through field instruction: a guide for teachers and students. milwaukee,wi: family service of america. vourlekis, b., bembry, j., hall, g., & rosenblum, p. (1992). evaluating the interrater reliability of process recordings. research on socialwork practice, 2(2), 198-206. vourlekis, b., bembry, j., hall, g., & rosenblum, p. (1996). testing the reliability and validity of an interviewing skills evaluation tool for use in practicum. research on socialwork practice, 6(4), 492-503. author’s note: address correspondence to: valerie chang, professor, indiana university school of socialwork, 902west newyork street, es 4153, indianapolis, in 46202, usa. e-mail: vchang@iupui.edu 74 advances in socialwork 75 appendix definitions of skills in the chang and scott (1999) instrument 1. communicating involvement includes attentive body posture, facial expressions, and eye contact. 2. beginning process skills consist of the ability to communicate beginning information such as describing the initial purpose of the meeting, explaining the process, discussing ethical and agency policies and introducing yourself and your role. 3. questioning skills involve balanced use of open-ended and close-ended questions. 4. exploring problem/challenge contains such areas as gaining information about previous attempts to solve the problem, history of the problem, and severity of the problem. 5. exploring person includes seeking information about feelings about having the problem, effects of the problem on functioning, and personal strengths. 6. exploring the situation consists of gaining information about effect of the problem on others, available social support, other demands and stresses in the situation/environment, and strengths in the situation/environment. 7. reflecting skills range from the ability to summarize the client’s feelings and basic content to the ability to encapsulate themes related to behavior, thoughts, feelings, and interactions with others. 8. seeking clarification skills entails using questions to explore areas such as the meaning of words, the basis of conclusions, statements that appear contradictory, and details about sequences of interaction. 9. contracting process skills range from the ability to reach agreement about problems to establishing clearly defined goals and creating a contract. 10. expressing warmth involves verbal and nonverbal expressions of concern and compassion. 11. expressing respect is defined as communicating regard for such things as the client’s feelings, thoughts, potential, strengths, and resources. 12. expressing empathy is defined as communicating understanding and acceptance of the client’s felt experience. 13. expressing genuineness includes being sincere, fully present, and able to able share reactions with the client. 14. effectiveness of responses involves using interventions that invite the client into further exploration. pike et al./measuring basic interviewing skills aisw vol. 5, no. 1 47 assessment as learning: the role of minor assignments in teaching and learning paul adams abstract: this article focuses on assessment at the level of the course and classroom, rather than the program or institution. the assumption that building a culture of assessment in a social work program,or its host university—assessment,understood as a “rich conversation about student learning informed by data” (marchese, 2004)—requires that both faculty and students are engaged by assessment as an activity that directly benefits their own teaching and learning while these are in progress. classroom assessment based on the frequent use of minor assignments— ungraded tasks set by instructors for students to perform in the classroom—offers this direct and immediate linkage of assessment to learning. the uses and advantages of minor assignments are described, and the dynamic interplay between minor assignments and assessment is illustrated with an example from the teaching of social security in a social welfare policy class. keywords: assignments,assessment, instruction technique assignments and assessment assessment has assumed growing importance in higher education, partly because of the pressure to show that increasingly expensive college education produces the results it claims in terms of student learning. the assessmentmovement in higher education has drawn attention to the gap thatmay exist between coverage—the material taught in a course—and what students learn (huba & freed, 2000). at the level of the individual classroom, this emphasis on accountability for outcomes has highlighted the need for summative assessment of student learning in terms of the course’s objectives. this in turn requires welldesigned assignments with clear grading criteria that test student attainment of the intended outcomes (walvoord & anderson, 1998). the assessment movement and the demand for accountability also draw attention to the need for formative assessment to provide both students and instructor with ongoing feedback that enables them to adapt and improve their learning and teaching from week to week. accrediting bodies, such as the council on social work education’s commission onaccreditation, require processes of ongoing program assessment and improvement as a permanent feature of programs, rather paul adams is professor at the university of hawaii at manoa, school of socialwork, honolulu, hi 96822. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 47-60. indiana university school of socialwork. 48 than as a surge of energy in the year before a site visit. similarly, classroom assessment can be designed to provide frequent feedback to inform and improve teaching and learning as students’ progress throughout a term, rather than as a burst of activity at the end. assessment-centered teaching, which is also necessarily learner-centered (bransford, brown, cocking, donovan, & pellegrino, 2000), thus emphasizes formative and summative feedback and focuses on what students learn as distinct from what the instructor “teaches.” this latter distinction, drawing attention to the ways in which prior knowledge and preconceptions constrain as well as enable new learning, has been a central theme in the cognitive science of learning and expertise development in recent years and in the assessment movement in higher education (reference omitted; bransford, et al., 2000; daley, 1999; palomba & banta, 1999; steadman, 1998). whatever their value or potential for program assessment, assignments are, in the first place, part of the process of evaluating student learning in an individual course. assignments are the student tasks that teach and test those things the instructor most wants students to learn. that, at least, is the assumption students make when they direct their energies to learning what they need to know in order to do their assignments well. assignments provide the raw material for assessment. classroom assessment is not only concerned with evaluation of outcomes. it is also part of the process of student learning.this aspect of assessment has been called assessment-as-learning, the involvement of students in the metacognitive processes of assessing their own learning as it progresses (gingerich & kaye, 1997; alverno college faculty, 1994). as social work programs take assessment more seriously, two different but complementary tendencies are evident: the first is toward evaluation of student learning in terms of its ultimate utility for improving client outcomes in the field (gambrill, 2001a, 2001b, 2002); the second is toward incorporating classroom assessment, peerand self-assessment into the normal, everyday instruction of professional social work education that is organized around assuring that students develop and can articulate theirmastery of the abilities they need for professional practice (gingerich & kaye, 1997; adams, 2004; fanney, 2003). these developments point to the key importance of assignments, both major and minor, in course design and teaching strategy. an assignment is defined here as any student task set by the instructor that both teaches students and tests their learning. shifting the emphasis fromwhat the instructor must cover in a course to what a student should be able to do by completion of the course points to the need tomove up the development of assignments in the design of a course (walvoord & anderson, 1998). from this assessment-centered and learner-centered perspective (bransford, et al., 2000), it is preferable to design a course around the major assignments that teach and test the knowledge, values, and skills that the faculty (collectively and individually) most want students to learn. these are properly specified in a course rationale and in the course objectives for student learning that the faculty has approved while building a horizontally and vertically integrated curriculum. after the rationale and course objectives or student learning outcomes are in place, developing themajor assignments becomes the first task of the instructor, rather than the last. these assignments, based on the objectives, link advances in socialwork 49 the desired learning outcomes to the course’s structured opportunities to learn and assess them. walvoord and anderson (1998) provide a step-by-step guide to constructing an assignment-centered course outline that begins with the major assignments and selects them for the likelihood of their eliciting from students the kind of learning the instructor wants to measure. designing a course around the major assignments has at least two results. first, assignments are unlikely to be clustered at the end of the term, a practice that creates an undue burden on teachers and students, alike. if assignments and assessment are understood to be part of student learning rather than serve only as a means to evaluate it after the fact, they are likely to be shorter and less formal. a single policy analysis assignment, for example, that is due at the end of term can be broken up into several steps. indeed, policy analysis frameworks lend themselves to this approach, because they are typically divided into steps or clusters of questions to be addressed sequentially (e.g., bardach, 2000; dunn, 2004; gilbert & terrell, 2002; karger & stoesz, 2002). the instructor and peers can give feedback on each part—without grading the work, while the student is still learning and revising—and the student can rewrite as she improves her skills. such short, wellsequenced assignments build students’ skills as well as assessing them. they also provide opportunities for selfand peer-assessment that can build metacognitive skills—learning how to learn—aswell as helping the instructor providemore helpful feedback while the student develops an improved final product (kusnic & finley, 1993). second,minor or small-scale assignments also assume anew importance. as the course progresses, these assignments teach and assess what students need to learn to do in order to complete the major assignments successfully and, thereby, show students that they have achieved the learning outcomes of the course, which, in a well-designed curriculum, support mastery of the abilities students’ need for professional social work practice. what areminor assignments? major assignments, as we have seen, can be divided into smaller, more frequently assessed parts in order to allow for several iterations on the path to a final product. minor assignments are on a smaller scale still. they are the small classroom tasks—usually ungraded and often anonymous—that provide feedback to both students and instructor on how they can improve their learning and teaching in progress. they support completion of the major, graded assignments by building the knowledge, values, and skills that those major assignments test, but they are not themselves part of or early drafts of those assignments. minor assignments provide the instructor with data for assessing student learning, but they are not necessarily intended for measuring the performance of individual students. the briefest and perhaps most useful minor assignments are classroom assessment techniques (cats). these are “small-scale assessment techniques that provide information to teachers and students about what is going on in the classroom” (palomba & banta, 1999, p. 168). they were collected, developed, refined by angelo and cross (1993) as part of a larger classroom research project involving several thousand college teachers in a wide range of disciplines and adams/assessment as learning: the role ofminor assignments in teaching and learning 50 professional fields. the purpose of cats is “to improve learning in progress by providing teachers with the kind of feedback they need to inform their day-to-day instructional decisions, and by providing students with information that can help them learn more effectively” (angelo, 1994, p. 5). the student tasks required by cats are assignments on the smallest scale, usually taking only a few minutes during or at the end of a class session. brief as they are, cats teach as well as assess. for each of the 50 cats described and illustrated by angelo and cross (1993), the authors list the related teaching goals that the technique supports. for example, the simplest of cats, the muddiest point, asks students in the last few minutes of class to describe on a half-sheet of paper or card the least clear point in the preceding class period or unit—lecture, discussion, video, or assignment. its purpose is to guide teaching decisions about what to emphasize, clarify, or spend additional time on. students learn quickly to identify and articulate what they do not understand (angelo & cross, 1993). like many cats, this technique requires and develops skills in metacognition, enabling students to becomemore conscious of and to take control of their own learning. as angelo andcross (1993) describe, the technique also supports several teaching goals in their teaching goals inventory, an extensively field-tested and refined instrument for self-assessment of instructional goals for college teachers. the goals related to the muddiest point technique are: • improve skill at paying attention. • develop ability to concentrate. • improve listening skills. • develop appropriate study skills, strategies, and habits. • learn concepts and theories in this subject angelo and cross, p. 154 some techniques, such as classroom opinion polls (an informal but anonymous poll of student opinion) and everyday ethical dilemmas (which asks students to respond to a scenario involving a realistic ethical dilemma that they might encounter in practice), both foster and assess students’ awareness of their own attitudes and values. both can be administered as preand post-assessment devices to ascertain what changes occur as a result of classroom activities and assignments. (for a fuller discussion of cats, their theoretical and empirical basis, and their application to social work education, see adams, 2004; for ametaanalysis of the empirical research literature on cats, see becker, in press.) otherminor assignments—such as role plays and simulations, or in-class small group tasks—typically take longer and are more clearly designed to teach than assess. they too, however, provide the instructor with feedback about student learning that can be used to improve both teaching and learning in the course, while it is in progress. all these classroom activities are given the name minor assignments to emphasize that they all: (1) are tasks assigned by the instructor, (2) facilitate learning needed for successful completion of the major assignments, and (3) enable both the instructor and students to assess student learning on a frequent and regular basis, allowing for improvements in teaching and learning advances in socialwork 51 while the course is still in progress. drawing on learning theory and empirical studies on the structure of knowledge, novice and expert learning, problem solving, development of learning in children, self-assessment, and the role of culture in learning, these activities provide for a learning environment that is focused on the course objectives while promoting metacognitive skills for lifelong learning (adams, 2004; boitel, 2002; bransford, et al., 2000). the muddiness of assignments the muddiest point typically focuses on a particular lecture (mosteller, 1989) or specific component of a class (discussion, video, etc.) and is intended to elicit feedback about the content of that component. in an analysis of muddiest points collected weekly from several classes over the course of an academic year, the author found that asking the general question, “what was the muddiest point in this class session?” did, after some coaching to go beyond such unhelpful answers as “everything” or “nothing,” produce responses that illuminated the substantive elements in each class session that remained unclear. for example, the muddiest point for several students in a policy class session was the concept of regressive taxes, or more specifically, what was regressive about a sales tax when everyone paid the same amount of tax on a given purchase and the rate was the same on all taxable goods and services. but students also took the opportunity to ask questions about the major assignments.what was muddy to these students was what they were expected to know or be able to do. this was a variant of the muchdespised question, “will it be on the test?” or “what do i have to remember?” and initially elicited the irritation instructors, who love their subject traditionally feel, when confronted with this question. eventually, however, the attempt to persuade students not to use the muddiest point device to ask such questions was abandoned. this feedback posed a legitimate question—what do you expect us to know? it pointed to the overwhelming volume of unfamiliarmaterial a student is expected tomaster in a foundation policy course that includes the history of social work and social services, current policies, service delivery structures, policy analysis, policy practice and advocacy, and financial, organizational, administrative, and planning processes pertaining to service delivery (council on social work education, 2002). it also indicated the inadequacy of such answers from the instructor as “all of it” or “the main points.” advantages of minor assignments an important advantage ofminor assignments as assessment is the flexibility they allow in adapting teaching and learning strategies in response to the feedback they provide. major assignments are typically written into the syllabus that students receive at the beginning of the term and, thereby, assume a contractual quality that leaves limited room to maneuver. minor assignments, on the other hand, allow instructors to change their teaching strategy and combine assignments and assessment techniques so as to take advantage of opportunities created by feedback from prior assignments or address the problems of teaching and learning that come to light in the course of the term. the adoption or adaptation of new minor assignments and their combination in unanticipated ways makes for lively, responsive teaching. adams/assessment as learning: the role ofminor assignments in teaching and learning 52 the muddiest point, for example, can be the organizing element of an ongoing weekly dialog. the instructor can respond to the class by e-mail or on a class electronic discussion board to clarify points about the content or the assignment that were unclear.the distinction between policy and program in amajor policy analysis assignment, for example, or between obsession and compulsion, or race and ethnicity, may need repeated clarification and exemplification before all students are clear about it. the first part of each class can also be used to clarify muddy points and provide linkage between the previous and current class. other cats or minor assignments can be used to stimulate recall and critical thinking about the content of the previous class. the technique called rsqc2 (recall, summarize, question, connect, and comment) offers a five-step protocol for guiding students through a process of quickly recalling, summarizing, analyzing, evaluating, and synthesizing content from the previous class session (angelo&cross, 1993). studentswrite downquickly what they recall from the previous week, summarize the important points into a single sentence, jot down a question that remains for them about the previous class, connect the main points of that class with the objectives of the course as a whole, and finally make an evaluative comment about the previous class session. this process enables instructors to compare their own sense of what they are teaching with what students are remembering and understanding. it gives students a framework for organizing and integrating their new learning, pushing them to manage their efforts well and develop good study habits and skills. the questions students raise in doing the rsqc2, the muddiest point, or the minute paper—which asks students to jot down on an index card: a) the most important point of a lecture or reading, and b) what important question remains unanswered—donot necessarily need to be answered by the instructor. if the class is divided into small groups to compare their unanswered questions, only those questions the group cannot answer internally need the instructor’s clarification. thus, students have the opportunity to compare among themselves what they thought wasmost important and answer each other’s questions, while the instructor focuses on what he or she alone can teach. tebo-messina and van aller (1998) illustrate in a case study how classroom research can be joined with program assessment and some cats, like the muddiest point, lend themselves to research across sections, courses, and programs that can improve teaching by identifying the most common misconceptions and misunderstandings in a particular curricular area. nevertheless, such minor assignments and assessment tools have the practical advantage of adoptability by one or a few faculty members with or without wider utilization or support at the departmental level or above. instructors have found them intrinsically rewarding in a variety of educational settings (catlin & kalina, 1993; cross, 1998; light, 1990; steadman, 1998). they offer immediate rewards to teachers and their students in terms of feedback that can lead to immediate improvements in teaching and learning, while supporting a culture of assessment as an indispensable aspect of professional faculty responsibility for student learning rather than as a tool ofmanagerial surveillance and control of individual facultymembers (angelo & cross, 1993). advances in socialwork 53 reading and chunking required reading constitutes perhaps themost problematic kind of assignment. it is in itself only a partial assignment—a task the student carries out that teaches what the instructor wants students to learn. but the testing of that learning requires an additional assignment or examination. frustrated instructors sometimes view the purpose of multiple choice or similar tests as “making students do the reading.” that, however, is not typically a student-learning outcome, but a means to achieve other objectives. the direct link betweenmajor assignments and course objectives is thus broken or attenuated. for their part, students may be frustrated with a large textbook replete with thousands of discrete facts that they are expected to recall for a test. they naturally want to know what of this mass of unfamiliar material they are expected to remember. it would be amistake, however, to substitute themastery of analytic skills for the learning of factual content. students need to master a substantial body of factual knowledge in order to develop analytic skills. as the recent national research council’s review of the research on how people learn (bransford, et al., 2000) argues, “the ability to plan a task, to notice patterns, to generate reasonable arguments and explanations, and to draw analogies to other problems are all more intertwined with factual knowledge than was once believed” (p. 16). but students unfamiliarwith a field such as social policy or humanbehavior and the social environment lack the organizing frameworks, concepts, and prior knowledge that would enable them to learn large amounts of material in these areas as an expert would (bransford, et al., 2000). at least two contrasting approaches are available to instructors in face of this challenge. one is to try to enforce prodigious feats of memorization on students through appropriate tests. the other is to help students acquire learning with understanding by focusing on the “big ideas”—key concepts, organizing themes— that will enable them to see patterns and relationships in what at first appears to be a mass of disconnected facts. as research on differences between the learning of novices and that of experts indicates, the ability to “chunk” information in this way, to cluster it into meaningful patterns—and not superior memories—is what distinguishes expert from novice learners (reference omitted; bransford, 1979; bransford, et al., 2000; chi, feltovich & glaser, 1981; miller, 1956). from the second perspective, assignments that support required reading then need to teach and test learning with understanding. assessments that measure propositional knowledge alone and emphasize accurate memorization may inadvertently direct student effort to decontextualized remembering rather than understanding. this, in itself, makes remembering harder, even if the reading explains key concepts and“big ideas” thatwould enable students (if theywere able to apply them) to organize new learning into interrelated conceptual chunks and retrieve it without undue effort. sometimes, students see the solution in terms of more work on the part of the instructor to “predigest” the reading—providing a summary of key points in advance, for instance, summarizing them again at the beginning of class, and organizing the class itself as a lecture that goes over the substance of the reading. adams/assessment as learning: the role ofminor assignments in teaching and learning this approach does little to build student skills in conceptualizing and synthesizing, and it is perhaps reasonable to suspect that thismethod does less to“make the students read” than it does to render reading superfluous! cats are particularly useful in addressing this problem. they can be used to foster—and enable instructors to assess—student progress in integrating and synthesizing new information, articulating key concepts, and using them to organize new knowledge. rsqc2, for example, can be used at the beginning of a class to encourage students to identify the key points of an assigned reading, to pose a question that the reading left unanswered for them, and to connect it to the objectives of the class. the summarizing part of this technique can be used on its own, as a one-sentence summary. students are given the task of answering the questions, “who does what to whom, when, where, how, and why?” and then synthesizing “those answers into a single informative, grammatical, and long summary sentence” (angelo & cross, 1993, p. 183). this minor assignment builds student skill in chunking, as it provides the instructorwith feedback about the range of student understanding of a required reading in a class. using the feedback from minor assignments: an example althoughminor assignments are not normally graded and do not identify individual students for particular instructional intervention, they do provide valuable feedback for instructors regarding student learning. reporting that feedback to the class affords an opportunity both for the class to reflect on student learning, difficulties, assumptions, values, and opinions, and for the instructor to account for his or her own use of the feedback to improve instruction. minor assignments, as argued, allow for a kind of responsiveness and flexibility that preset major assignments may not. the feedback minor assignments provide makes it possible to develop new minor assignments, add or refocus lecture material, or arrange for a guest speaker or video not previously planned. a brief account of the author’s teaching of social security over three class sessions in an undergraduate social policy course offers one example of how this can work. the process described here has been replicated with minor variations and similar results in five sections of an msw policy course over three years. social security exemplifies all the key challenges of relevance, content, and prior knowledge facing teachers of social policy to social work students (adams, 2004). it does not seem relevant or applicable to the direct practice with individuals and families, which is most students’ main focus of interest. as a federal program, social security does not lend itself readily to a policy-practice curriculum focused on legislative lobbying at the state level. the program is complex, with many provisions and technical terms that are unfamiliar to most students. on the other hand, students bring to the topic prior knowledge andpreconceptions thatmay be partial, inaccurate, and serve as a barrier to new learning (adams, 2004; bransford, et al., 2000; behr, harel, post & lesh, 1992; confrey, 1990; mestre, 1994; minstrell, 1989; silver, shapiro & deutsch, 1993;white & frederickson, 1998). the instructor has to address all these challenges in order to be effective. in order to assess students’ response to the assigned reading on social security, a reading rating sheet (angelo & cross, 1993) was used. students were asked to 54 advances in socialwork 55 respond to three multiple-choice questions about how well they had read the assignment, how useful it was in helping them understand the topic, and how clear and understandable the reading was. a fourth question asked whether the student would recommend the reading to a friend (and why or why not), and the final question inquired, “what did you learn from it that you want to make sure to remember?” this assessment technique invited students to reflect metacognitively on what use they had made of the reading, while giving the instructor feedback on student responses to it. one striking response to the anonymous rating sheet was from a student who would not recommend it to a friend, because “all my friends watch videos.” before giving a lecture on social security, the instructor administered amodified form of directed paraphrasing (angelo & cross, 1993). students were asked to define social security in one or two sentences, addressing themselves to clients, their families, or professionals in other fields. as a prompt, the first sentence was started for them: “social security is….” the instructor added to this exercise the instruction to “describe two or three facts about social security or beliefs you have about it that you believe others should know or share.” students compared and discussed their responses in small groups and reported their most frequent responses and recurring themes. by far, the most common response was that the program “would not be around” for them. this was important feedback, though unsurprising in light of reports that young people are more likely to believe in ufos than in the prospect of ever receiving social security benefits (dinitto, 2003). it revealed that, despite reading a text that challenged both these assumptions, most students saw social security as a program solely for elderly people and did not believe it would survive into their own old age. but this view—the prior knowledge and preconceptions students brought to the subject— not only survived contact with the reading, it also reinforced students’ sense that this content was irrelevant to their personal lives and (since few intended to work with aging persons) to their future professional practice as well. the instructor was able to use this feedback to shape the lecture and classroom activities that followed, not in order to disprove students’ assumptions about the future of social security, but to call into question the arguments and evidence on which they were basing them, to make them available to students for their own critical examination. in lecture, the case of germany was discussed, where the country’s social insurance program, unlike other financial institutions, survived depressions, hyperinflation, two world wars, and several regime changes. a brief op-ed piece from the newyork times called “survivor security” (altman, 2001) was distributed and discussed in small groups. the author describes in it how social security helped the families of the victims of september 11, providing benefits to surviving children, which would continue every month until their late teens. the article not only emphasized the non-retirement aspects of social security in this dramatic way, it also argued that with minor adjustments, the retirement of baby boomers was readily affordable and that social security could be put on a sound financial footing for the foreseeable future—again, reinforcing arguments that were supported in detail in the assigned reading. adams/assessment as learning: the role ofminor assignments in teaching and learning 56 students next completed a 10-question quiz, taken from the social security administration’s (1998) set of teaching materials for high school students. the quiz, like the lecture, focused on the basic principles—the“big ideas”—underlying the program. rather than provide the answers, the instructor directed students to the social security administration’s website (www.ssa.gov), where the quiz and answers were available online in the youthlink section. at the next class session, students reported their surprise and humility in finding that they did not do better at a test designed for high school students on material they had just covered. this assignment, though ungraded and anonymous, both created an information gap that students were motivated to fill and reinforced their learning of the basic principles of the social security program. with this information and a new openness to learning about the program, students were asked in small groups to design a video for high school students. they were asked to discuss both the presentation of thematerial—use ofmusic, dramatization, narrators, and so forth—and the key points about the program that they wanted tomake to young people. this minor assignment was suggested and legitimated by the unenthusiastic student’s comment that his or her friends all watched videos (and did not readmore than they had to). each group reported its design for a video and the points were summarized on the board for the class as a whole. finally, the class watched the social security administration’s own video for high school students, reel security (1998b), then compared their own designs and key points with those of the federal government. although some of these students were more familiar with a teaching format emphasizing lectures, readings, and multiple choice tests to enforce and assess memorization of both, they responded well to this more active and adaptive approach. despite their initial lack of enthusiasm for the topic, at the end of term they rated it—equally with their working visit to the state legislature—as the most interesting part of the course and the one from which they learned most. their final essay examination confirmed their impression and showed that the students had learned to reexamine the ideas they had formed from popular sources about the most important program in the american social welfare system and were able to explain and apply their new knowledge. they had actively and self-reflectively engaged in the learning process andhadbecomeboth conscious and critical of the assumptions and beliefs they brought to the subject. limitations and challenges classroom assessment techniques and other classroom activities that we have referred to here as minor assignments are widely used and there is evidence of both student and instructor satisfaction with them and increased class participation (adams, 2004; angelo, 1991; catlin&kalina, 1993; steadman, 1994, 1998). less clear, however, is their relation to improved student learning outcomes. becker (in press) conducted a meta-analysis and critique of quantitative studies employing inferential statistics to assess cats and other active-learning strategies. he found many methodological problems with existing studies and proposed criteria for future research.he concluded for the present that active-learning strategies donot demonstrably improve learning outcomes but that there is evidence to support advances in socialwork 57 the hypothesis that periodic use of cats like the (best researched) 1-minute paper does increase student learning. further and more rigorous research is needed before much can be said with confidence about the relation of cats (or still more, minor assignments in general) to student learning outcomes. the disadvantage of cats most widely cited by faculty is the time required to design, administer, analyze, and report back to students on the findings (e.g., steadman, 1994, 1998). catlin and kalina’s (1993) study, using both questionnaire and interview, found a discrepancy between faculty and student perceptions of improved student metacognition. their finding suggests the importance of taking the time to repeat particular cats and to explain their potential for transfer to other learning contexts in order to improve study and learning habits. in short, we may conclude that although cats, the least time-consuming of minor assignments, take only a fewminutes at the beginning or end of class to administer, they require a substantial investment of instructor time in and out of class to be used well. foundation courses in social work education, however, necessarily cover a great deal of content and time that is at a premium. the regular use of minor assignments in the ways suggested here probably cannot be achieved as an add-on but require changes in teaching strategies and use of classroom time. assumptions about content need to be re-examined. for example, howmuch content has to be covered in class as opposed to in readings and research for major assignments? is superficial coverage of extensive content in class a waste of time if students do not retain or apply it (bransford, et al., 2000)? in addition, cats and other techniques may, themselves, be used to address the challenge of content as adams (2004) illustrates for the case of social welfare policy teaching. conclusions as the social security example described above suggests, frequent and flexible use of minor assignments, whether classroom assessment techniques, such as directed paraphrasing or improvised group tasks like designing a video on social security, provides information about student learning that can be used to improve instruction as the course progresses. it can make for a dynamic, interactive, and learner-friendly classroom environment that encourages active learning, metacognition, and critical thinking. taking major assignments seriously, as walvoord and anderson (1998) argue, involves organizing courses around them, so that the assignments teach and test what the faculty most want students to learn. this, in turn, places a new importance on those minor assignments and formative assessments that enable students and instructors to foster and assess new learning. minor assignments identify the often unrecognized assumptions and preconceptions that hamper learning, enabling the instructor to expose them to evidence and analysis while there is still time. minor directed assignments identify the often unrecognized assumptions and preconceptions that hamper learning, enabling the instructor to expose them to evidence and analysis while there is still time. instructors can use them to check their own idea of what they are teaching against what students are learning. this enables instructors to improve their teaching as it progresses during a course adams/assessment as learning: the role ofminor assignments in teaching and learning 58 and provides students with opportunities to improve their thinking and learning (vye, et al., 1998). minor assignments build and assess the knowledge, values, and skills students need to complete the major assignments successfully, that is, to master the abilities the course sets out to teach. minor assignments, used as assessment and teaching techniques, do not require buy-in bywhole faculties or even administrations. individual facultymembers can adopt them for their own teaching and later, excited by their experience, discuss, collaborate, share, and analyze data across sections, courses, or programs. cats and related approaches to assessing student learning in the classroommay thereby contribute to building a culture of assessment rooted in the professional and personal interest of faculty in effective teaching and student learning rather than in reluctant response to accountability pressures from above or without. they may, in the process, serve higher-level assessment goals designed to respond to those pressures whether or not they are used directly in program or institutional assessment. references adams, p. 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(1993). sensemaking and the solution of division problems involving remainders. an examination of middle school students’ solution processes and their interpretation of solutions. journal for research in mathematics education, 24(2), 117-135. social security administration (1998a). social security and you: a guide for teaching. baltimore,md: social security administration. social security administration (producer). (1998b). reel security. baltimore, md: social security administration. steadman, m.h. (ed.). (1998). using classroom assessment to change both teaching and learning [special issue].new directions for teaching and learning, 75, 25-35. tebo-messina, m., &van aller, c. (1998). classroom research and program accountability: a match made in heaven?new directions for teaching and learning, 75, 87-99. vye, n.j., schwartz, d.l., bransford, j.d., barron, b.j., zech, l., and cognition and technology group at vanderbilt (1998). smart environments that supportmonitoring, reflection, and revision. ind.hacker, j. dunlosky, & a. graessner (eds.), metacognition in educational theory and practice. mahwah, n.j.: erlbaum. walvoord, b.e., & anderson,v.j. (1998). effective grading: a tool for learning and assessment.san francisco, ca: jossey-bass. white, b.y., & fredrickson, j.r. (1998). inquiry, modeling, and metacognition: making science accessible to all students. cognition and science, 16, 90-91. author’s note: address correspondence to: paul adams, professor, university of hawaii at manoa, school of socialwork, 1800 east-west road, honolulu, hi 96822, usa. e-mail: pladams@hawaii.edu 60 advances in socialwork aisw vol. 8, no. 1:aisw vol. 5, no. 2 theory for the public good? social capital theory in social work education maryann overcamp-martini abstract: as a concept, social capital is both relatively recent and highly controversial. this analysis overviews the history of social capital theory and the three main theoretical frameworks related to the concept. the components of social capital are discussed, as well as the controversy over its conceptualization. a review of recent studies is provided, particularly in the relationship between social capital and mental health. the article concludes with a discussion regarding the heuristic usefulness of social capital theory in the human behavior and social environment sequence in social work education, opening discourse in civic engagement and participation, collectivity, and the value of social networking. keywords: social capital theory, social work education, human behavior and the social environment, social capital and mental health, social networks, social work and civic participation it is rare enough that there is enthusiasm around a term or theory used in the macro human behavior and the social environment curriculum, particularly at this time in social work history. does it matter that we join groups or associations? does the number of television sets in the nation actually affect whether i can get help when my car stalls in traffic? is there something called “social capital,” and if so, do i really have to be more of a joiner to make more of it? does it matter, in other words, whether or not we are “bowling alone” as robert putnam (2000) suggests? the concept of social capital is a relatively recent one, with the development of theory in an unsettled and underdeveloped state. while potentially very relevant as theory for students in social work, particularly in the sequence of studies regarding human behavior and the social environment (hbse), its usefulness may remain limited due to its seeming endless elasticity. this analysis will provide an overview of the history of social capital theory, which, in the social sciences, is generally agreed to at least mean “…social networks that can be activated” (wall, ferrazzi, & schryer, 1998, p. 304). implicit in much of the discussion is that social capital at 196 maryann overcamp-martini, ph.d. is assistant professor, school of social work, university of nevada, las vegas, las vegas, nv 89154-5032. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 196-207. indiana university school of social work. some level represents a public good to be encouraged. because of this seeming prejudice toward the public good, scrutiny of the term and its accompanying theoretical base is especially important. history of the term the fact that six authors sporadically used the term “social capital” over a period of approximately 70 years in the 20th century may be a foreshadowing of the widely diverse uses of the term today. putnam (2000) names the six early users of “social capital” as: hanifan (1916), canadian sociologists (1950s), jacobs (1961), loury (1970s) and bourdieu (1980s), and schlicht (1980s). the interests of these authors ranged from education to sociology to economics, but with all focusing use of the term “social capital” on the importance of social relationships, apparently without knowledge of the others’ work. generally, credit is given to jacobs (1961) for first use of the term: if self-government is to work, underlying any float of population must be a continuity of people who have forged neighborhood networks. these networks are a city’s irreplaceable social capital. whenever the capital is lost, from whatever cause, the income from it disappears, never to return until and unless new capital is slowly and chancily accumulated (p. 138). as a 1960s urbanist critiquing the governmental practices of urban renewal, jacobs deplored the imposition of governmental destruction and reconstruction of depressed urban areas, advocating instead the development of dense urban communities similar to greenwich village in new york city. interestingly, governments seem to be coming full circle on that issue. bourdieu (1986), coleman (1988), and putnam (1993, 2000) represent the three main developments of theoretical frameworks for social capital (wall et al., 1998). bourdieu’s (1986) original theoretical work described the term “capital” as having three forms: economic, cultural, and social. he saw social capital as the property of the individual, such that someone with social “connections” could convert his or her connections into economic advantage or capital. he posited that social capital could also be institutionalized into the fabric of society in ways such as the titling of the noble class or, for that matter, acceptance at a better university due to the social capital of a prestigious high school’s name. coleman (1988) is credited with shaping a different theoretical framework for social capital. attempting to forge an alternative to an economic (“undersocialized”) purpose of social action as rational self-interest and a sociological (“oversocialized”) purpose of social action as determined by social norms and obligations, coleman developed a concept of social capital to include components of both. given the economic emphasis on physical capital (tools and equipment) and human capital (skills and capabilities), coleman brought forward the term social capital to discuss the “something more” of social action, a value-added dimension. all capital being productive, social capital made human capital more so, suggesting that a group “within which there is extensive trustworthiness and extensive trust is able to accomplish much more than a comparable group without that 197overcamp-martini/theory for the public good? social capital theory in social work education trustworthiness and trust” (p. s101). coleman’s work developed out of a study of the interlocking expectations of adult networks on children—an intergenerational closure of social networks—where high school graduation rate outcomes were significantly higher for those in the religiously-affiliated private high schools than in public schools or non-religious private schools. whereas bourdieu had focused social capital at the individual level, coleman placed it at the family and community level. putnam (1993) drew more directly from coleman’s work, placing the level of analysis at the community or regional level (wall et al., 1998). putnam (1993) initially introduced his interest in social capital through a study of local governmental effectiveness in italy. he later brought his concept of social capital to the public fore with the publication of bowling alone, supporting a more expansive theory of social capital as based on civic participation, a property of a group. it was the metaphor of “bowling alone” that engaged the public discussion of social capital. is the response to putnam’s book a visceral national reaction to the “malaise” in the nation? according to lehman (1996), this is the case. lehman contends that putnam’s book “struck a nerve,” because it provided a rationale for a growing sense that “the quality of our society at the everyday level has deteriorated severely” (p. 4). the bottom line of putnam’s thesis is that civic engagement has been in rapid decline in the united states since the 1960s, largely as a result of television privatizing our leisure, in essence causing our associations with one other in voluntary groups to suffer. whether this is true or not—and lehmann suggests not—is the subject of some lively academic discussions. lehmann contends that the associational groupings that putnam studied have simply been replaced by newer groupings of people and that our civic engagement remains largely intact. regardless, the discussion itself points to re-visiting the issues of individualism and collectivity. the movement toward individualism has been noted as a major trend in social organization since at least the 18th century and was forged by related movements in political philosophy and economic theory. individual rights have subsequently become embedded in “sociocultural arrangements that encourage and legitimate the autonomy, dignity, and equality of individuals” (horwitz & mullis, 1998, p. 119). in reference to social action, however, coleman (1990) called it a “broadly perpetuated fiction in modern society” (p 300) that social action is independent action by independent individuals working solely from self-interest, rather than actions influenced by relations among people. thus, the corrective construction of the term “social capital.” much passion is fashioned into the current discussion surrounding the term and beginning theory of social capital. as a brief taste of the intensity of the discourse, greeley (1997) suggested the work of others to be “pop social science” (p. 587), while greeley, himself, used coleman’s (1988) definition of social capital to illustrate the importance of certain social structures in creating social capital. putnam’s arguments were supposedly “devastated” by ladd (greeley, 1997, p. 587), while ladd (1996) admitted that, while he would prefer not to argue with putnam, he had little choice, “. . . it’s testimony to the prominence of his work that it’s impossible to avoid such an argument” (p. 1). the data debate has continued 198 advances in social work since. perhaps it will turn out that our civic engagement has remained steady, but that changes in the form of that engagement will still mean at least a temporary decrease in social capital. if people are switching types of engagement, they may actually be as actively involved as ever (greeley, 1997). however, the new activity will slowly construct new ties that begin to interconnect and overlap, while old ties are likely to loosen and unweave. putnam (2000) discussed social capital in this country until recently as cyclical; however, perhaps the loss he described in social capital is more of a cycle caught up in these changes than a permanent issue. that putnam’s work became a part of the popular and political culture of our times is itself no small matter and represents the importance of its recognition in the social work curriculum. although the study of social capital began in the literature on urban and community studies, it has moved into such diverse disciplines as education, health, urban poverty, unemployment, criminology, sociology, social philosophy, public policy, international development, economics, trust in society, experimental psychology, sociology, political science, and economics. on the other hand, it is exactly this popularity and over-generalization of the theory of social capital that has initiated the current onslaught of criticism (wall et al., 1998). the theory and research currently seem boundary-less. the advice of wall et al. (1998) is worth noting: …there is a point where diverse interpretations create more confusion than clarity. social capital is on the threshold of being used so widely and in such divergent ways that its power as a concept is weakened (p. 319). confusion over the boundary-expansiveness of the theory should not be allowed to deflate all the energy this concept is generating. abandoning the concept of social capital before it is fully pursued would be unfortunate, rare as it is to obtain the benefits of the attention of the larger non-academic community, while pursuing a potential lead in the social sciences. political and popular focus on macrolevel theory may provide some impetus for political advocacy of governmental investment in community. coming as it does at a time when traditional public policy agenda-setting techniques are similarly changing in the light of the electronic communications revolution, the need to better understand the building of networks is particularly timely. fortunately, the next steps in further research of social capital theory have begun. perhaps the greatest disagreement lies in the definitions of social capital, beginning with the determination whether social capital is the property of the individual or the property of the group. individual social capital originally, social capital was seen more generally as the property of the individual; in other words, it was a good that the individual could access as a resource (bourdieu, 1986; coleman, 1988, 1990). for example, the individual could derive benefit from contacts with friends of friends who had information about a potential job opportunity (a private good) or the individual could benefit from a support group for cancer survivors at a local hospital (a public good). it was the differential access that represented the extent or amount of social capital that 199overcamp-martini/theory for the public good? social capital theory in social work education belonged to a person. in either case, the individual benefits from phenomena we already term as social supports and social networks (mckenzie & harpham, 2006). ecological social capital in putnam’s study of government in italy (1993), for instance, he concluded that our tendency to contrast the ability of government and business to solve social problems ignored the factor that added something extra to each—that “both states and markets operate more efficiently in civic settings” (p. 181). according to putnam, the horizontal relationships built by groups engaged in society build a thicker web of social trust that everyone benefits from, making the outcome (social capital) a property of the group. the most accepted definition for ecological social capital is currently that of putnam (1993), and it refers to “features of social organization, such as trust, norms, and networks, that can improve the efficiency of society by facilitating coordinated actions” (p. 167). of importance are the number and density of community networks, civic engagement and participation, reciprocity and norms of cooperation, and the building of personal and social trust (putnam, 1993, 1995, 2000). the assumption is that the problems of society could be resolved by increasing social capital. components of social capital putnam (1995) concluded a study on italian governments with the idea that “the performance of government and other social institutions is powerfully influenced by citizen engagement in community affairs,” an engagement he termed “social capital” (p. 664). for this, putnam drew on coleman’s (1990) discussion, developing the idea of social capital as “features of social life—networks, norms, and trust—that enable participants to act together more effectively to pursue shared objectives” (p. 664-665). clearly, it is the building of relationships upon which social capital is dependent, not simply goal-directed actions and their outcomes. according to putnam, relationships and trust build on each other, therefore, associating with others leads to a more trusting society. the main components seem to have achieved some general acceptance as such: trust, networks, and norms of reciprocity between and within groups and institutions. trust in society has come under increasing scientific and popular scrutiny, apparently, in the past few decades, as a result of the perception of a decline in trust in society. again, the impact of individualism on our society seems to be at least on the edge of people’s thinking: what is happening to this town, this country, this world? people will say that they do not feel as safe, as trusting. attempting to address the risk of dealing with untrustworthiness in relationships, institutions, and society has led to a resurgence of trust in this study (cook, 2001). personal trust is reinforced by the actions of someone who is found to be trustworthy, someone who does what is expected of them in response to an action, fulfilling the obligation invested in that interpersonal exchange. at the most basic level, these transactions involve a specific reciprocity, a version of “i’ll do this for you if you do that for me” (putnam, 2000, p. 20). in small communities where people are familiar with each other and know more of what to expect from each other (and are likely to remain in relationships with each other with the concomitant consequences), personal trust becomes social trust. the familiarity breeds what 200 advances in social work putnam (2000) calls “thick” trust, “trust embedded in personal relations that are strong, frequent, and nested in wider networks” (p. 136). where this thick trust continues to be reinforced, wider networks reach farther into society, creating a more trusting society, which, in turn, results in a greater efficiency where each transaction does not have to be negotiated separately. things function more smoothly, with less friction and the weighing of costs. however, this trust is different from that built on a personal relationship and specific reciprocity. as it reaches out further from the trust-based exchange of personal relationships, people may expect reciprocity on a different basis: “i’ll do this for you now, without expecting anything immediately in return and perhaps without even knowing you, confident that down the road you or someone else will return the favor” (p. 134). called “generalized reciprocity,” this trust is called “thin trust” in the further reaches of the network, and it is putnam (2000) who suggests that it is this thin trust that can make a larger society function more efficiently. so, it is social trust, these norms of reciprocity, and the interconnectedness of social networks, that are the building blocks of social capital theory. as scholars have pursued definitions of social capital, they have identified different dimensions: structural/cognitive, bonding/bridging, and horizontal/vertical. in addition to the question of whether social capital is the property of individuals or groups, these dimensions represent some general agreement in this unsettled theoretical discussion (mckenzie & harpham, 2006). structural/cognitive structural social capital involves the “relationships, networks, associations, and institutions that link together people and groups” (mckenzie & harpham, 2006). these are somewhat measurable and analyzable units, such as groups, associations, networks, and linkages; this is the data that comprises much of putnam’s analysis of social capital. reference to “collective moral resources”—the underlying values, the norms of reciprocity, and the civic ideas, such as altruism and civic responsibility—is considered cognitive social capital (mckenzie & harpham, 2006, p. 15). bonding/bridging called “sociological superglue,” (putnam, 2000, p. 23), bonding social capital refers to that which bonds or holds groups together. the thick trust, strong norms of reciprocity, and social networks in bonding social capital are focused on a particular group. the boundaries of the group are clearly defined and the networks closed, so that the social capital is exclusive and inward-focused, with a strong sense of group identity and loyalty. bonding social capital maintains and reproduces itself (lin, 1999). although putnam (2000) uses the idea of social capital as inextricably linked to civic engagement and thus is generally seen as a public good, neither putnam nor other authors assume that only positive results will accrue from bonding social capital. usually, examples of bonding not noted as a public good are groups, such as the ku klux klan. bridging social capital is “sociological wd-40” (putnam, 2000, p. 23). while bonding social capital holds a group together, bridging social capital focuses on linking to other groups and external resources. it is thought of as inclusive, finding 201overcamp-martini/theory for the public good? social capital theory in social work education commonalities with those outside the closer group, and pulling groups together in the social fabric. in contrast to bonding, which brings a group in closer relationship, bridging “greases the wheels” between groups, lowering the perception of difference and separation of interests. according to putnam (2000), bridging social capital may be more important to study than bonding, since it stretches relationships and thus social trust into more layers of society (“thin” trust), interconnecting networks, and producing greater ease in social relationships. bridging social capital may provide for information diffusion, access to resources, and the broadening of our personal identification and trust. it has also been judged as the more fragile of these types, as it stretches outward (mckenzie & harpham, 2006). horizontal/vertical critics of putnam’s (1993, 2000) framework of social capital as a solution to social problems point to the lack of attention to hierarchical class inequalities and the potential of social groups to increase their command over the benefits of inequality, using social capital as a means for social control (wall et al., 1998). earlier formulations of the definition of social capital also seemed to suggest to some scholars that neighborhoods and communities were being told to build their own social capital—that government could not do anything for them, thus, as providing an “excuse” for a de-politization of responses to poverty (foley & edwards, 1997). critiqued as institutionalizing inequity and excusing public neglect brought about a further clarification of its dimensions. the dimension of social capital focusing on the horizontal and vertical nature of relationships responds to these critiques. out of this developed an understanding of horizontal social capital, then defined to consider the social capital between people in similar social strata. earlier formulations fell within horizontal social capital. vertical social capital, on the other hand, delineates linking, or the degree of integration, between people in different social strata of society. those in lower strata can influence policy and access resources through relationships with those above them; whereas, those with more power and status have a way to dispense resources downward out of self-interest, charity, or justice (mckenzie & harpham, 2006). perhaps we could call this sociological “chutes and ladders.” review of empirical studies while social capital is an engaging concept, it would have to be placed among the many hbse theories without either an accepted operationalization or a solid empirical base. there does seem to be general agreement that the term social capital pulls together knowledge and research in three areas: trust, norms of reciprocity, and networks (mckenzie & harpham, 2006). for instance, social capital research builds on a renewed interest in the concept of social trust, a topic that resurfaced in the 1990s. the literature on social trust spans from psychological trust in another person, to social trust among groups, into the role of trust in networks, organizations, and institutions (cook, 2001). yet, most studies measure generalized trust using the same simple question, “do you think people in general can be trusted?” (de silva, 2006, p. 50). building on the concept of generalized trust are norms of reciprocity and networks, again shifting from the micro to the macro, and from cognitive social capital to structural social capital. analyzing the state of cur202 advances in social work rent research in social capital and mental health, for instance, de silva (2006) reviewed 28 studies, finding different aspects of social capital being measured, including cognitive social capital, structural social capital, family social capital, social capital at organizational and community levels, and neighborhood safety and disorder issues. there have been three general perspectives on the definition of social capital in regard to the level of society it is applied to, broadly stretching the spectrum between the individual and the ecological. generally, application in theory is made to levels beyond the individual, defining social capital as occurring in relationships within and between groups, thereby making it the “property of groups” (mckenzie, whitley, & weich, 2002); yet, the feasibility of measurement has frequently led to an aggregation of the individual perspectives on the level of social capital they experience. in de silva’s review (2006), 21 of 28 selected studies measured social capital at the individual level, while only eight measured social capital at the ecological level either solely or in both categories. therefore, while conceptualized in mezzo or macro levels, measurement generally occurred at the individual level. the question that has festered in these discussions has been whether that is a valid approach to measurement, or whether it measures an individual’s ability to access social support and social networks, which is better seen as a property of individuals (mckenzie & harpham, 2006; bourdieu, 1986). recommending the co-existence of these approaches, de silva (2006) suggests that the point of convergence exists in the value of social relationships: indeed, it seems that research into the two streams is so entrenched that it would be naïve to assume that either one can be ignored. however, taking a holistic view of social capital as the “value” of social relationships at any level allows the two streams not only to coexist but also to complement each other. individual social capital considers direct relationships with a network (i.e., the impact of an individual participating in or perceiving a network), while ecological social capital considers the indirect relationships (i.e., the impact of networks irrespective of participation). for example, effective community networks that prevent the closure of a local hospital benefit everyone who depends on that hospital, not only those people involved in campaigning against the closure. as it is not necessary to be part of the campaign group to benefit from its actions, this is an example of an indirect relationship. however, there may also be an additional impact on those involved personally in the group (direct effects), with positive effects such as feelings of self-worth and negative effects such as time and emotional investment (p. 44). thus, this third perspective suggests that social capital, as a resource embedded in the relationship between individuals while being subject to access by the individual, is actually a property of relationship (de silva, 2006). pursuant to the difficulties in defining social capital has been, of course, the difficulties of operationalizing its components. how do we actually measure social capital? the response to this question thus far has been to measure it indirectly. for example, using the dimension of structural social capital is a feasible way to 203overcamp-martini/theory for the public good? social capital theory in social work education study social capital, since it can be undertaken through the quantitative analysis of indicators, such as participation in civic groups and associations. yet, again, problems surface in the mixed use of terms, such as “civic participation,” which is widely used to describe “engagement in public affairs” and “membership in civic groups” (de silva, 2006). due to the diffusion and popularity of putnam’s (2000) work, putnam’s preference for measuring the membership has often been accepted as the preferred definition, with much of the literature focused in the direction of challenging his results. honing in on an area of special interest to social workers will demonstrate challenges to the research. for example, research regarding social capital and mental health may be fruitful to consider. as background, mckenzie (2006a) offers three important questions that social workers would also want answered: • can social capital prevent mental illness? • can the lack of social capital cause mental illness? • does the level and/or type of social capital in an area have an impact on the rate of mental illness? given that mental health/illness studies involve addressing the complexity of the intervening variables of risk and preventive factors, mckenzie notes that, what little longitudinal research has been done has been inconclusive in demonstrating causation. whereas studies have demonstrated correlations between different aspects of social capital and a variety of mental illnesses, the pathways of causation through the intervening variables have not been researched. de silva (2006) also noted that more recent theory conceptualizes social capital as multidimensional, although much of the research focuses on unidimensional measurements, creating additional challenges in research, such as the unequal treatment of dimensions and the question of the validity of combining different measures and aspects of social capital. alternative approaches to studying social capital and mental health support increasing the level of sophistication in this line of research. mckenzie (2006a) suggests the use of speculative models of association for research into social capital and mental health. de silva (2006) recommends a number of refinements in research, including the increased use of longitudinal methods, the psychometric validation of measures, and analysis through statistical modeling using multi-level techniques. qualitative and mixed methodologies are also recommended, especially to develop the conceptualization of social capital. de silva also suggests that our concept of community may need some updating, considering that we most often place community in a geographical context when we have entered a non-spatial relationship with each other through electronic communications. the future of research will involve the study of non-spatial communities to social capital and the connections between all types of communities and the individual. yet, despite all these difficulties, several findings have begun to emerge from studies of social capital and mental health. mckenzie (2006b) describes three: • areas with higher levels of social capital are associated with social environments with fewer risks of mental health. 204 advances in social work • social capital reflects facilitative behavior of residents that produces social supports and safety nets that buffer the effects of life events on mental health. • neighborhoods with high levels of certain types of social capital—for instance, collective efficacy—are better able to acquire and hold on to educational, health and housing resources that are linked to mental health. (p. 156). there are also findings that relate more directly to practice with individuals who have serious mental illness and social capital. for this information to be useful to social work practice in mental illness, we need knowledge of the differential and negative effects of social capital, as well. for instance, longitudinal studies have shown social capital to be a protective factor in mental health, as noted above. however, as de silva (2006) points out, the specific encouragement of group or civic participation, while conceptualized as positive for all groups in a democratic society, can lead to negative outcomes in mental health, where that encouragement actually can be experienced as increased stress by the individual, a known risk factor in mental illness. relatedly, the theory base for social capital generally directs us to think of social capital as a social good, rather than potentially leading to both positive and negative outcomes; however, the de silva (2006) review also showed that many studies have understandably framed social capital as value-neutral in their measures. perhaps related to this, theory would be better moved to match its operationalization. before embracing social capital theory, the social work profession needs a fuller understanding of any differential effects on individuals, groups, organizations, and communities. implications for social work let’s face it. social capital is easier to teach than trying to bring de tocqueville’s enthusiasm for civic participation in democratic society into most classrooms today. the concept of social capital touches a frayed nerve in the classroom, just as it has in the public’s imagination. students begin assessing their own social networks and civic engagement without prodding. for putnam, the bogeyman is the privatizing of leisure through television. for me, it may well be the electronic door device that allows me to slip my car into the garage against the advances of a talkative neighbor. my students agree with both and, at least briefly, they heap other ideas onto the bonfire of individualism; the change of pace from our daily lives can be exhilarating. some of my students tell me that these discussions change them in small or large ways; they re-consider their lack of engagement. as prospective social workers, they appropriate more the need for macro engagement and interventions in their work. social capital theory enjoys other uses in the hbse and social work curriculum. as our society moves increasingly toward an individualistic political culture (see elazar, 1972) linked to a capitalistic economy, the assumption of the need or right for social work intervention at the mezzo and macro level has diminished. stronger emphasis on a development of the religious and philosophical bases for 205overcamp-martini/theory for the public good? social capital theory in social work education social justice stances is helpful. yet, to a great extent for some students and for all students to some extent, the link of macro theories of intervention to economic theory can also assist this process. whereas individual social capital takes students to the literature on social support and social networks, ecological social capital theory suggests that a higher level of social capital makes for a more efficient society where each exchange need not be handled individually but is based on a higher level of social trust and norms of reciprocity (putnam, 2000). coleman (1988) suggested social capital as an “aid toward making micro-tomacro transitions without elaborating the social structural details through which this occurs” (p. s101). it was precisely to offer social capital as a flag, to let the reader know that what was important in a particular situation lay in the social context: trust, norms or reciprocity, networks, and organization. as a heuristic tool alone, social capital theory can act as a doorway to other relevant concepts and theories, such as social trust and network analysis, which also lay just outside the boundaries of mainstream curricula. unpacking the concept was then a secondary step available to the reader and researcher, alike. the availability of social capital in one context also signaled its potential availability for use in another context; for example, a group formed for one purpose could also be used to further a different purpose. the dimensions of social capital theory—bonding, bridging, linking—tie together discussions in many areas. resources for the individual, building strong neighborhoods and communities, and developing policy networks for social and political action, to name a few. for example, when bressers and o’toole (1998) point out dimensions of policy networks, cohesion and interconnectedness come as no surprise to those already studied in similar dimensions. it never hurts to run into old friends in the curriculum. nevertheless, despite a decade of academic flurry surrounding social capital theory and the dynamism that social capital can raise in the classroom, a review of popular hbse texts shows that reference to it has been minimal in hbse curriculum resources. for example, in the popular robbins, chatterjee, & canda (2006) text, one of few to mention the theory at all, social capital theory is given but a scant paragraph in which it is briefly related to exchange and rational choice theory as a social resource obtainable by the individual. its increasing popularity in social work is noted, with students encouraged to visit putnam’s (2000) work. putnam’s work, of course, was primarily developed ecologically as a property of the group, based on “neo-detocquevillean” ideas of participatory democracy and civic ideals (fried, 2002), a far cry from the theory base referenced. thus, it would be fair to say that social capital theory has not yet found a solid niche in social work education. it is hopefully not overreaching to suggest that this review of social capital theory has helped to detect a place in the hbse curriculum for a macro theory with enough energy that it might yet find its legs. references bourdieu, p. (1986). the forms of social capital. in j. richardson (ed.), the handbook of theory and research for the sociology of education. ny: greenwood press. 206 advances in social work bressers, h.t.a., & o’toole, l.j., jr. (1998). the selection of policy instruments: a network-based perspective. journal of public policy, 18(3), 213-239. coleman, j.s. (1988). social capital in the creation of human capital. the american journal of sociology, 94(supplement), s95-s120. retrieved august 22, 2006, from jstor database. coleman, j.s. (1990). foundations of social theory. cambridge, ma: belknap press. cook, k.s. (2001). trust in society. in k.s. cook (ed.), trust in society (pp. xi-xxviii): vol. 2. russell sage foundation series on trust. ny: russell sage foundation. de silva, m. (2006). systematic review of the methods used in studies of social capital and mental health. in k. mckenzie & t. harpham (eds.), social capital and mental health (pp. 39-67). philadelphia, pa: jessica kingsley publishers. elazar, d. (1974). american federalism: a view from the states (2nd ed.). ny: crowell. foley, m.w., & edwards, b. (1997). escape from politics? social theory and the social capital debate. american behavioral scientist, 40(5), 550-561. fried, a. (2002). the strange disappearance of alexis de tocqueville in putnam’s analysis of social capital (pp. 21-49). in s. mclean, d.a. schultz & m.b. steger (eds.), social capital: critical perspectives on community and “bowling alone.” ny: new york university press. greeley, a. (1997). coleman revisited: religious structures as a source of social capital. american behavioral scientist, 40(5), 587-594. horwitz, a.v., & mullis, j.s. (1998). individualism and its discontents: the response to the seriously mentally ill in late twentieth century america: the moral community. sociological focus, 31(2), 119-133. jacobs, j. (1961). the death and life of great american cities. london: penguin. ladd, e.c. (1996). the data just don’t show erosion of america’s social capital. the public perspective, 7(4), 7-16. lemann, n. (1996). kicking in groups. the atlantic monthly, 277(april). retrieved august 8, 2006, from http://xroads.virginia.edu/~hyper/detoc/assoc/kicking.html. lin, n. (1999). building a network theory of social capital. connections, 22(1), 28-51. mckenzie, k. (2006a). social risk, mental health and social capital. in k. mckenzie & t. harpham (eds.), social capital and mental health (pp. 24-38). philadelphia, pa: jessica kingsley publishers. mckenzie, k. (2006b). the state of the art. in k. mckenzie & t. harpham (eds.), social capital and mental health (pp. 151-158). philadelphia, pa: jessica kingsley publishers. mckenzie, k., & harpham, t. (2006). meanings and uses of social capital in the mental health field. in k. mckenzie & t. harpham (eds.), social capital and mental health (pp. 11-23). philadelphia, pa: jessica kingsley publishers. mckenzie, k., whitley, r., & weich, s. (2002). social capital and mental health. british journal of psychiatry, 181, 280-283. putnam, r.d. (1993). making democracy work: civic traditions in italy. princeton, nj: princeton university press. putnam, r.d. (1995). tuning in, tuning out: the strange disappearance of social capital in america. ps: political science and politics 28(4), 664-683. retrieved january 9, 2007, from jstor database. putnam, r.d. (2000). bowling alone: the collapse and revival of american community. new york: simon and schuster. robbins, s.p., chatterjee, p., & canda, e.r. (2006). contemporary human behavior theory: a critical perspective for social work (2nd ed.). boston, ma: pearson. wall, e., ferrazzi, c., & schryer, f. (1998). getting the goods on social capital. rural sociology 63(2), 300-322. author’s note: address correspondence to: maryann overcamp-martini, ph.d., school of social work, university of las vegas, 4505 maryland parkway, box 455032, las vegas, nv 89154-5032, usa. e-mail: mao.martini@univ.edu. 207overcamp-martini/theory for the public good? social capital theory in social work education manuscript 08-0001 online practice course development with action research: a case example khadija khaja phillip ouellette carenlee barkdull joanne yaffe abstract. despite the proliferation of online courses in social work, questions still exist about learning practice skills in an online instructional environment. this paper describes a case example of an action-oriented approach to the development of an online practice course. lessons learned from students’ and instructor’s perspectives are shared as well as recommendations for future research relative to course development and evaluation of online courses. the study examined student feedback with respect to their overall learning experience. findings indicated that involving students in the design and development of an online practice course benefited both students and faculty and can be an effective teaching and learning strategy regardless of the instructional medium used. keywords: instructional design; technology; distance learning; online education; social work practice skills; action research computer technology has affected social work education in many ways. the rapid use and growth of internet technology have provided students and educators with opportunities to retrieve large quantities of information quickly from all over the world, and technological advancements have given rise to a wide array of multimedia teaching tools. these developments have contributed to increased demand for online social work courses in colleges and universities (siebert & spaulding-givens, 2006). social work education in the 21st century is experiencing a paradigm shift in which traditional classroom-based teaching is being supplemented or supplanted by technology-delivered instructional content. while research would seem to indicate that there is no significant difference between the efficacies of learning outcomes with courses taught in an online learning environment versus those in a face-to-face classroom learning setting (macy, rooney, hollister, & freddolino, 2001; ouellette & chang, 2004; ouellette, westhuis, marshall, & chang, 2006), social work educators still appear apprehensive about teaching practice courses in an online setting. in a field where interpersonal communication skills and use of self are emphasized, the development and implementation of online social work practice courses may be resisted by students, faculty and administrators due to the perceived need for face-to-face contact between instructors and students. _________________ khadija khaja, ph.d., is an assistant professor and philip ouellette, ph.d., is an associate professor, both at the indiana university school of social work, indianapolis. carenlee barkdull, ph.d., is the msw coordinator in the department of social work at the university of north dakota. joanne yaffe, ph.d., is an associate professor in the college of social work at the university of utah. copyright © 2008 advances in social work vol. 9 no. 2 (fall 2008), 91-105 khaja, ouellette, barkdull, yaffe/online practice course development 92 a case study conducted within an action research framework was designed and implemented in collaboration with graduate students enrolled in a practice class in an effort to explore this question. challenges and lessons learned through this collaborative process will be shared, as will implications for further research relative to social work practice classes in online learning environments. literature review social work programs generally appear to be behind many other disciplines in using web-based technology for offering their programs (siebert & spaulding-givens, 2006). although many social work programs offer some baccalaureate and graduate level courses in an online setting, few are offering their degree programs entirely online. the resistance or apprehension of many social work faculty to teach curricula entirely online may be that “social work’s focus on human connection and hands-on practice skills can seem antithetical to technology-mediated education” (siebert & spaulding-givens, 2006, p. 2). hence, there has been lively debate and even controversy around teaching social work courses in an online environment. this resistance is beneficial to the field as it places a higher burden on social work educators to design online social work courses that are accountable to a profession that values human connectedness (ouellette, khaja, & westhuis, 2007). increasing use of technology in social work education online course enrollment is clearly on the rise in the united states with enrollment in a number of disciplines increasing by as much as 33% each year (pethokoukis, 2002). in 2002, approximately 2.3 million students took online courses (katz-stone, 2000). in the academic year of 2000-2001, about 90% of two-year public schools and 89% of public four-year academic institutions offered online courses (waits & lewis, 2003). the increased use of technology as an instructional medium has clearly continued to grow rapidly in the field of social work education as well. distance technology can be employed to reach students in rural areas; for example, the use of technology has been successfully used to reach aboriginal social work students in remote areas of canada (hick, 2002). online social work courses are now offered to teach areas such as diversity, gerontology, policy, human rights, introduction to social work, international social work (ouellette et al., 2007), advocacy (mcnutt & menon, 2002), research (westhuis, ouellette, & pfahler, 2006), and clinical practice (coe & elliot, 1999; ouellette et al., 2006; shibusawa, vanesselstyn, & oppenheim, 2006). other examples for integrating technology for teaching and learning practice skills include the use of digital practicum portfolios and online assessment tools (lee, 2007). there is also a growing body of literature relative to social work training that describes the use of various technological tools worldwide, from cd-roms and video disks to interactive web-based modules, both for students and those seeking additional professional development opportunities (ballantyne, 2007; menon & coe, 2000; sandell & hayes, 2002; shibusawa et al., 2006). increasingly, communication technologies are advances in social work, fall 2008, 9(2) 93 also being employed as knowledge storage (holden, 2002) and as possible delivery systems for reaching at-risk population groups (ouellette & wilkerson, 2008). characteristics of the online learner studies have shown that students who tend to do well in independent learning environments generally succeed in their online courses (tallent-runnels et al., 2006); however, online learning environments may not be perceived as user-friendly by all students (schrum, 1995). one survey of 70 academic institutions conducted by schrum and hong (2002) revealed that learner success in an online environment was predicted by eight characteristics, including access to the latest tools, technology experience, learning preferences, study habits, goals, purposes, lifestyles, and personal traits. in another study, nearly 42% of online students were not content with their learning experience if their instructors’ sole teaching strategy was to simply post a great deal of written text online. students preferred that instructors utilize more audio-visual technology in their online classes (faux & black-hughes, 2000). teaching practice courses in online settings: framing questions the debate or controversy around the integration of computer technology for teaching practice courses in social work has prompted several critical and important questions: (1) what constitutes good teaching and learning in an online environment? (2) what can be done to assist faculty in integrating traditional teaching strategies to an online setting? (3) what leadership roles can administrators play to support an online learning culture? for faculty, time for development of online courses is often a major barrier. another issue is the necessity of developing a new set of technical skills to integrate technology into curriculum design. the authors have learned from their own experiences that one cannot simply mimic or transfer a traditional classroom-delivered social work course into an online environment without a major shift in how we think about what constitutes good learning via an electronic medium. in addition to the pedagogical challenges, many social work educators are not as savvy with technology as are their students and require considerable mentoring and support in this area (ouellette et al., 2007). the implications of alterations in student-instructor relationships must also be considered. it has been asserted that online learning environments shift considerable amounts of power, authority, and control from the instructor to the students because they are expected to demonstrate more initiative and must be motivated to learn independently (jaffee, 1998). others argue that online learning environments give a great deal of authority and power to the instructor, especially if students do not have easy access to the technological tools they need to engage in online learning (ouellette et al., 2007). the development of interpersonal skills is emphasized in social work practice courses, yet instructors may underestimate the difficulty in capturing feelings in online instructional settings (tallent-runnels et al., 2006). some instructors have used emoticons such as smiley faces, pictures, and cartoon characters to create more of a relational atmosphere (bielman, putney, & strudler, 2000; tallent-runnels et al., 2006), khaja, ouellette, barkdull, yaffe/online practice course development 94 but it is not known how successful these attempts to create a sense of interaction and community in the classroom really are. practice skills curricula focus intently on the nature of interpersonal interaction, including non-verbal communication, listening skills, empathy, and authenticity. social work students are expected to learn how to simultaneously read and interpret the complex communications of others while monitoring and modeling high-level communication skills themselves. mindful of the challenges mastering these skills presents, siebert and spaulding-givens (2006) offer several recommendations for teaching clinical content in practice social work courses in an online setting. they suggest that instructors need to have taught clinical social work face-to-face for a number of years before even attempting to transfer this knowledge to an online setting; the course design must be able to capture feelings and emotions of students; video technology that illustrates exemplars of clinical skills should be available for students to see and hear in their online courses; publishing companies should make it easier and less complex for educators to use such materials; instructors with technology expertise need to be consultants or coaches to the process so that audio-visual interaction with students is available; and web camera communication technologies should be utilized to enable students to communicate with each other and to engage in practice role plays which can be reviewed by the instructor. while these recommendations are instructive and helpful, research related to how such practice-related skill sets can be developed and assessed in online learning environments is largely absent (siebert & spaulding-givens, 2006). the case for building online learning communities one key question about teaching social work practice courses online is whether or not an online environment can contribute to the development of a community of learners (tallent-runnels et al., 2006). we assume that attention to this aspect of online pedagogy is particularly relevant for online social work practice courses in which students are expected to learn empathic communication skills as well as skills for relating to other professionals. some have reported that students can form a learning community in an online environment where a sense of camaraderie, support, and warmth can be experienced (johansen & ouellette, 2006). others have suggested that online instructors can establish a community of learners early on by modeling and reinforcing effective communication techniques, identifying potential problems early in the course, and designing a plan of action for dealing with a lack of student interaction in an online class (knupfer, gram, & larsen, 1997). knupfer and colleagues (1997) found that collaboration and flexibility were critical to the success of online classes, yet instructors who promote collaborative learning environments in face-to-face classroom settings may find the online environment presents some real challenges to instructors in this regard (ouellette et al., 2007). while social work educators embrace such concepts as the strengths perspective (saleebey, 2006), empowerment, (ellsworth, 1999) collaborative learning (george, 1999), and principles of adult learning (knowles, 1980), the literature provides few illustrations of how students are actively involved with their instructors to contribute to the design, implementation, and evaluation of online courses. advances in social work, fall 2008, 9(2) 95 fetterman (1996) defined empowerment as a process in which client selfdetermination is fostered. one of the prime roles of helpers is to help clients to realize that they can “gain control, obtain needed resources, and critically understand one’s social environment” and “become independent problem solvers or decision makers” (fetterman, 1996, p. 4). in many ways this empowering role is not so different from educators’ roles. empowerment at its best is a “collaborative group activity” that if successful creates a more “open forum” (fetterman, 1996, p. 5). research indicates that empowerment teaching models can help students take more responsibility in the design, implementation, and evaluation of their courses (huff & mcnown-johnson, 1998). increased participation and collaboration by students with instructors to assist in conceptualizing design of a course may help to develop a “dynamic community of learners” (fetterman, 1996, p. 4). in other words, if students feel that their voices count and that they can be trusted, they will develop greater confidence, initiative and leadership skills which will benefit their clients and communities. other literature has indicated that when students are invited to share in the responsibility for actively defining mutually shared learning objectives with their instructor, they will subsequently take more interest in and responsibility for their own learning (saleebey, 2006). inevitably they begin viewing themselves as more responsible, competent, significant, empowered, and trusted (ellsworth, 1999). levin (1996) indicates that if one includes students in the process of a course design that it provides students with “unity of purpose,” “responsibility,” and builds upon student strengths (p. 52). unity of purpose ensures an environment where students and faculty are working together in a collaborative culture that incorporates the setting of goals, standards, and a school community. one major gap in the research is whether active student involvement in the design, development, and implementation of an online practice course could be helpful in making such courses more conducive to the learning needs of students. hence, the central question for further study would be to explore to what extent student collaboration and student participation in course design actually contributes to learning of practice skills in an online environment. students were asked the following research questions: how similar or different were online course modules to materials presented in the classroom? what ideas or concepts presented in online course modules needed more clarification? what online exercises or assignments were useful/not useful and why? what ideas or recommendations did students have to improve the quality of online course modules with special reference to suggestions on audio-visual presentations and practice exercises? although social work educators embrace principles of empowerment, collaborative learning, and adult learning, the literature does not appear to sufficiently address the role of the student or the adult learner in online course development, much less how this could be done in a practice course. hence, studies that would investigate how student involvement impacts the development of effective course designs and how this could realistically be implemented in an actual course would further enhance our understanding of what constitutes good teaching and learning practices in an online setting. what follows is a description of such a study. khaja, ouellette, barkdull, yaffe/online practice course development 96 methods participants the lead author is an experienced social work practice instructor, but a novice to online course delivery. with assistance from a technologically-savvy social work colleague, she embarked on a journey to develop an online practice skills course using an incremental approach that would also harness the expertise and experience of social work practice students. graduate students in a three-credit, classroom-based, social work practice course at a large midwestern university were offered the opportunity to voluntarily remain in the classroom environment for the entire course, or to opt for online instruction for the final one-third of the course (a five-week period). all twenty-nine students opted to enroll in the online segment. twenty-one of the students in the participating class were female; the class was also relatively ethnically diverse. students appeared intrigued both by the opportunity to provide feedback on their experience of the online modules in relation to the classroom segment, and to help evaluate newly-developed online course materials. the course was taught by an experienced practice instructor who is also a relative newcomer to online instruction. procedure action research was deemed most congruent with the purposes of this inquiry as it is concerned with both “practical knowing” and with participatory values (reason & bradbury, 2001). an action research framework, which can incorporate any combination of methods appropriate to a given research question, was viewed as most appropriate to this line of practical pedagogical inquiry as it involves “stakeholders both in the questioning and sense making that informs the research, and the action which is its focus” (reason & bradbury, 2001, p. 2). thus, an action research framework was employed to recruit the active involvement and assistance of key stakeholders, i.e., social work students, in pursuit of a pragmatic objective: the development and evaluation of an online practice course segment that might serve as a “launching pad” for an eventual online offering. it was also hoped that this inquiry would help yield some broader insights into some of the thornier questions surrounding the teaching and learning of social work practice via online technology. in other words, instructors and students embark together on a journey of discovery as both co-teachers and co-learners, and commit together to the enterprise of mutual support and continuous improvement. instruments the web-based instructional materials were developed in collaboration with the second author, a fellow faculty member with many years of technological experience and technical expertise in designing online courses. a graduate research assistant, who had previously taken the practice course in a traditional classroom setting, was hired as a research assistant to help develop the new online class sessions or course modules, and to provide her unique insights as a former course student. advances in social work, fall 2008, 9(2) 97 the level of student participation in this effort was remarkable given that all students voluntarily provided feedback on an ongoing basis via anonymous online questionnaires after reviewing each online practice module. the questionnaires addressed the following questions: how similar or different were online course modules to materials presented in the classroom? what ideas or concepts presented in online course modules needed more clarification? what online exercises or assignments were useful/not useful and why? what ideas or recommendations did students have to improve the quality of online course modules with special reference to suggestions on audio-visual presentations and practice exercises? data analysis the course instructor and technological expert reviewed student feedback, recommendations, and suggestions, noted themes for each course module, and worked collaboratively to incorporate this feedback into the subsequent module. making such responsive and action-oriented course adjustments necessarily entailed additional time and effort for everyone involved. the consistently high level of participation in the questionnaire process, however, reinforced the instructor’s impressions that students were aware that their insights and input were valued and put to use in hopes of better promoting the dynamic process of learning. findings the findings in this study illustrated several themes that may be helpful for instructors who are considering teaching practice courses in an online learning environment. some of the key themes that evolved form this action research initiative illustrated the following: (i) students’ online learning experience of an online practice course varied depending on their technology skill level. (ii) students were generally surprised at the rigor of the online practice modules that were developed because initially they assumed it would not be challenging. (iii) skeptical students found they learned practice skills effectively but still missed live interaction with peers and the instructor in the online setting. student learning experience – similarities and differences not surprisingly, students did not all share the same impressions of the classroom and online instructional environments. for instance, some reported that the materials in the online course modules were rigorous and demanding and provided more detailed practice information than what was presented in the classroom. other students reported that both learning environments provided a great deal of information, and that both were comparable. in addition, some students did not feel that they were receiving the same kind of feedback from their classmates or instructor in the online context, while others indicated that, “it was not very different [online].” khaja, ouellette, barkdull, yaffe/online practice course development 98 presentation of online course materials some of the web-based materials for the online course modules were prepared using a variety of multimedia tools and software such as impatica oncue, breeze presenter, and streaming videos. as a result, the online materials included a significant number of audio-visual presentations, including taped videos of the instructor’s lectures. students were asked to evaluate how these presentations contributed to their overall learning experience in the online environment. the majority of students thought that the online lectures, presented through streaming video and audio-visual powerpoint presentations were clear, well-presented, enjoyable, and user-friendly. one student suggested that it would be more interesting if the powerpoint presentations were taped in front of a live classroom audience so that they could hear other students’ comments and reactions. other students recommended that learning would be enhanced through live interaction with both instructor and peers via the use of desktop videoconferencing technology. a few students reported difficulty with some of the multimedia presentations due to their home computers being “too slow” or too outdated to enable utilization of all of the features of the presentations. students without easy access to dsl or a broadband internet connection found that their ability to access some of the online materials was limited. student reaction to online materials the vast majority of the social work students in this course enjoyed the face-to-face classroom experiences, but also judged the online segment quite positively. they reported being surprised at the amount of information they grasped from the practice online course segments. the following comment from one student was fairly typical: “i can't really think of anything else. i liked the fact that the presentation included the power point, your explanation, and reading notes at the bottom. i also think the exercises you provided helped me retain the information. i think it is about as good as an online course can be. if you can't tell, i'm a little biased to the old fashioned teaching methods? but nonetheless, i thought it [the online segment] was really good.” another student’s overall experiences with the online course modules were summarized in this way: “it took me a couple of hours to complete but i was rewinding a lot and pausing to take notes and that is another thing that i liked about it. it didn't freeze up or anything. i really enjoyed it actually!” generally students found the online modules easy to understand, interesting, and informative, and loved that they could fast forward, and rewind taped sessions of the instructor. advances in social work, fall 2008, 9(2) 99 online exercises and assignments the course modules that were initially developed for this course were designed so that material was as interactive as possible, which required students to view and study materials online. the disadvantage was that it was difficult for students to copy or download content for viewing and/or studying the materials offline. this was a departure for students who have traditionally used the electronic medium mostly as a means to capture materials that can be downloaded and reviewed offline. as one student commented: “i think it would be nice if all the notes for the assessment process were under one tab so i didn't have to click back and forth so many times. then we could print the information as one document as well.” the inability to work offline may explain why some students thought that reducing the information in the online lectures could help. student feedback and comments on course design a few students commented that clicking too many buttons in the online practice modules seemed to be a lot of unnecessary work. this suggests that when too many links on a course web site are provided, students tend to find it difficult to navigate through the materials presented, and may even find it somewhat overwhelming, and frustrating. other students found the online design strategy that was used to be useful and responded very positively to its interactive emphasis. they indicated that the instructional design used helped them remain organized and on task. for example, one student reported, “i felt that i was able to learn a lot from the presentations because i was able to go back and listen again if i missed a concept. i did not feel that i needed more clarification.” another reported, “i felt that all the information in the presentations was clear and concise, and it helped even further when accompanied by the powerpoint, the quiz, and the required readings.” student skeptics overall, the students valued the online course modules. it is important to note that, initially, many students expressed concern that the online practice modules might not be helpful for developing practice skills. in retrospect, however, even more skeptical students stated they were surprised that they learned so much about practice skills in an online setting. in summary, students participating in this project judged the online course modules effective in meeting course objectives as articulated in the course syllabus, and asserted that the online assignments contributed to their learning. one student commented: “as with the other online assignment, i found this surprisingly effective. perhaps i was a skeptic (yes, i was), but i have completely enjoyed this format. i believe not incorporating discussion would be a disservice to the students, however.” khaja, ouellette, barkdull, yaffe/online practice course development 100 limitations there are several caveats to the findings. this non-random single case study was exploratory in nature and findings obviously cannot be generalized. although students in this project completed all the survey questionnaires as requested, they may have felt some pressure to frame their responses positively because they were reviewing and giving feedback on online course modules while simultaneously enrolled in a course graded by the instructor. although student feedback was anonymous, students may still have been reluctant to be perceived as critical of the online practice course modules. the key course assignment, consisting of three video-taped practice sessions with a colleague, was carried out in face-to-face class time. thus, this study was not able to explore whether students could have successfully carried out a comparable skills-related assignment that they would have found as meaningful in an online setting. finally, the extent to which students’ experience of the real classroom environment favorably disposed them toward the online segment of the course must also be taken into account. students’ impressions of a “hybrid” course are likely to be qualitatively different from students’ experiences of a course that is delivered solely online, and such comparisons must be made with great caution. discussion lessons learned – students’ perspectives while students indicated that they felt instructional material presented in the online course module and in the face-to-face classroom were similar in content, most reported missing the live social interaction with their classmates and the instructor. one student said, “it was similar with the same amount of information, but it lacked the interaction of the class.” the use of synchronous (i.e., live or real time) class discussions via electronic chat rooms or group conferencing software (e.g. macromedia breeze meeting or elluminate live) might have helped students feel more connected to their peers and less isolated. the addition of webcams for video desktop conferencing might also have expanded opportunities to communicate and connect with peers, thus creating an environment similar to the more interactive cohesive learning community of a classroom (siebert & spaulding-givens, 2006). our experience with asynchronous discussion groups (i.e., students not present in the “virtual” classroom at the same time) received mixed results from both students and the instructor. some students found that online asynchronous discussion groups were helpful for discussion of certain topics, but many students reported that the quality of the discussion and the interaction largely depended on the extent to which students were truly engaged in the discussion. other students found it difficult to actively participate due to the lack of postings by group members during an assigned discussion period or at times when the group was too large for a meaningful discussion. this suggests that synchronous discussion groups might be used to enhance the quality of social interaction in an online context, and that the size of discussion groups should be limited to small groups to facilitate participation. when asynchronous groups are used, highly-focused advances in social work, fall 2008, 9(2) 101 discussion questions, clear criteria relative to participation and assessment of participation, and a high level of monitoring may be required by the instructor to enhance learning. because of the high level of ongoing engagement necessary to successfully facilitate asynchronous online discussions, the use of teaching assistants should be considered if this technique is employed extensively (e.g., siebert & spaulding-givens, 2006). lessons learned – instructors’ perspective even with the assistance from an excellent technical support staff and consultation from a faculty colleague with considerable online instructional design experience, the instructor found that developing online course modules was a lengthy, exhausting and rather tedious process. having release time from regular teaching responsibilities before starting this process could have reduced these stressors. in addition, it was erroneous to assume that the first step toward online practice course development is simply to upload a number of powerpoint presentations and reading materials onto a course management system such as webct, blackboard, or angel. when we developed the first online course module, which primarily focused on introducing the student-learner to the online instructional environment, we discovered a number of unexpected challenges. first, we had to describe in great detail exactly how students were going to navigate and use the virtual classroom for learning purposes. further, we had to specify what computer equipment would be needed to successfully participate in an online session, as well as provide a detailed description of how assignments were to be submitted and evaluated. this procedure took the most time for students to grasp. as a novice online instructor, the first author was quickly overwhelmed with a barrage of student e-mail messages, requiring the development of new strategies for managing the virtual classroom, such as the use of electronic drop boxes and the creation of troubleshoot discussion forums to reply to student concerns. the first author also had to spend a great deal of time learning how to monitor and retrieve student assignments in an online setting. the immediacy of follow-up and responsiveness to ‘mid-flight adjustments’ created a great deal of work for the instructor, but made the developmental process student-driven, and, judging from student comments made both formally and informally, contributed to student enjoyment of learning in the online setting. the use of diverse and creative multimedia audio-visual teaching strategies also made the course visually appealing, but required a great deal of collaboration with technical support staff and a colleague experienced in instructional design. another valuable lesson learned was that students needed to feel that they could freely express their concerns regarding their online learning experience with the instructor. the instructor also had feel free to be herself in an online instructional environment without fear of repercussions. initially, she was rather nervous and worried that any response made inadvertently would be recorded, and eventually come back to haunt her. as she developed her confidence, this fear subsided, and she began to value the ways the online learning environment made her more accountable as well. in an online environment, one cannot assume that knowledge is always being clearly disseminated. for example, when teaching in a classroom environment, students benefit khaja, ouellette, barkdull, yaffe/online practice course development 102 from immediate and spontaneous instructor and peer feedback to help clarify course presentations and materials. however, in an online environment, students are more reliant on the electronic medium. this requires the instructor to be particularly sensitive to how each student is interpreting and learning from the online content and format. as a result, instructors may be forced to examine course materials and presentation formats more thoroughly for clarity than they would normally do for classroom instructional materials. as such, the online instructional environment encourages “outside-the-box” thinking and testing of creative pedagogical alternatives which, in turn, enhances classroom-based instruction. involving students by encouraging the provision of voluntary feedback to inform the design of online course materials was a wonderful and empowering experience both for the instructor and the students. students took more responsibility for directing their learning in the on-line course environment, and dispelled much of their own skepticism with regard to the potential effectiveness of teaching and learning practice skills online. an equally important outcome of this process was the apparent change in the teacher-student relationship. the somewhat hierarchical relationship between the instructor and her students became more egalitarian and open as a result of this initiative. this, in turn, led to a more collegial atmosphere where both the students and the instructor formed a genuine partnership in their teaching and learning journey. modeling openness and free expression of thought and feelings is possible when an instructor teaching in an online context is open to critical feedback. conclusions the authors believe that involving students in the design and development of a course benefits both students and faculty. the development of this “hybrid” course served several important functions. 1) the experience provided a scaffolded learning experience for a novice online instructor. 2) it enhanced the development of unique online instructional materials. 3) it contributed to the instructional design process. 4) it aided to the development of criteria to better evaluate learner outcomes in an online instructional environment. 5) and finally, it encouraged students to take more responsibility for their own learning. empowering students and faculty to co-create new and innovative learning environments can be an effective teaching and learning strategy regardless of the instructional medium used. when students are given the opportunity to assist in collaborating in the designing of course materials, and to provide continuous evaluation throughout the process of while taking the course, it communicates to students that their feedback is valued, important, and helps to create a more tailored, responsive, and userfriendly learning environment. the authors also maintain their initial assumption that the task of designing a quality online learning environment is greatly facilitated if the instructor has also excelled in teaching in a face-to-face classroom setting. in other words, the same principles of good teaching and learning in the classroom (e.g., chickering & gamson, 1987) apply to the virtual classroom. advances in social work, fall 2008, 9(2) 103 the most critical and unaddressed area of research concerns the task of determining whether or not students in field placements who have taken practice classes online perform as well, better, or worse 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(2006). third space: a web-based learning environment for teaching advanced clinical practice skills. journal of technology in human services, 24(4), 21-33. tallent-runnels, m. k., thomas, j. a., lan, w. y., cooper, s., ahern, t. c., shaw, s. m., et al., (2006). teaching courses online: a review of the research. review of educational research, 26(1), 93-135. waits, t., & lewis, l. (2003). distance education at degree-granting postsecondary institutions, 2001-2001. retrieved october 10, 2007 from http://nces.ed.gov/surveys/pequis/publications/2003017/ westhuis, d., ouellette, p., & pfahler, c. (2006). a comparative analysis of two class formats for teaching and learning social work research. advances in social work, 7(2), 84-100. author’s note: address correspondence to: khadija khaja, ph.d., indiana university school of social work, 902 west new york street, indianapolis, in 46202. email: kkhaja@iupui.edu. http://nces.ed.gov/surveys/pequis/publications/2003017/ mailto:kkhaja@iupui.edu literature review characteristics of the online learner teaching practice courses in online settings: framing questi the case for building online learning communities methods participants procedure instruments data analysis findings student learning experience – similarities and differences presentation of online course materials student reaction to online materials online exercises and assignments student feedback and comments on course design student skeptics limitations discussion lessons learned – students’ perspectives lessons learned – instructors’ perspective conclusions references bielman, v., putney, l., & strudler, n. (2000). constructing faux, t. l., & black-hughes, c. (2000). a comparison of usin katz-stone, a. (2000). online learning. washington based bus knupfer, n. n., gram, t. e., & larsen, e. z. (1997). partici levin, h. m. (1996). empowerment evaluation and accelerated ouellette, p., & chang, v. (2004). the acquisition of social pethokoukis, j. m. (2002). e-learn and earn. u.s. news and w reason, p., & bradbury, h. (2001). introduction: inquiry and saleebey, d. (2006). the strengths perspective in social wor siebert, d. c., & spaulding-givens, j. (2006). teaching clin schrum, l. (1995). online courses: what have we learned? pap schrum, l., & hong, s. (2001, april). the potential for elec shibusawa, t., vanesselstyn, d., & oppenheim, s. (2006). thi tallent-runnels, m. k., thomas, j. a., lan, w. y., cooper, s waits, t., & lewis, l. (2003). distance education at degreemicrosoft word wilkerson_kim_we_have_sleeping_parents_final _________________ david wilkerson, msw, lcsw is a doctoral candidate and hea-won kim, ph.d., is an associate professor, both in the indiana university school of social work at the indianapolis campus. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 144-157 “we have a lot of sleeping parents”: comparing inner-city and suburban high school teachers’ experiences with parent involvement david wilkerson hea-won kim abstract: teachers’ experiences with parent involvement were compared at an inner-city high school and a suburban high school. parent involvement has been described as underutilized by teachers, due to either ideological barriers or cultural biases against parents of lower socio-economic status. a sample of 62 teachers found no significant group differences between teachers at the two schools for either problematic or collaborative parent involvement. there was a significant difference for beliefs about parent competency. results may suggest that the ideological barrier of a “protective model” for home/school relations devalues parent involvement for teachers. parent involvement may be further devalued for inner-city teachers, who hold beliefs that parent competence is reduced by socioeconomic challenges. keywords: parent involvement, high school teachers, home/school relations, school social work introduction low achievement and graduation rates for children from impoverished households have represented ongoing failures in american education. some ethnic groups, including african-american and hispanic/latino-american families, have been disproportionately represented in these low rates. for example, in 2000, 12% of african american fourthgraders were proficient readers compared to 40% of caucasian fourth-graders, according to the national assessment of educational progress (united states department of education, n.d.). in 2001, studies of national graduation rates found only 50.2% of african-american students, and 53.2% of hispanic/latino students graduated from high school within four years, as compared to 74.9% of white students (orfield, losen,wald, & swanson, 2004). overall, these disparities in achievement and graduation rates for students whose families’ socioeconomic status (ses) have included low income, single parent-headed households and various ethnic and minority groups, have resulted in an educational equality ranking for the united states of 21 out of the 24 industrialized nations (mathis, 2003). policy and practice efforts to reduce these achievement and graduation gaps have been primarily school or student-centered (dynarski & gleason, 1998; lehr, hansen, sinclair, & christenson, 2003). school busing was a preeminent example of a large-scale school and student-centered effort. while family-centered efforts appear to receive less interest and action than school, teacher or student-centered interventions, parent involvement has been found to have both direct and indirect effects on student grades and test scores (henderson & mapp, 2002; jeynes, 2005; parcel & dufur, 2001; seyfried & advances in social work, fall 2010, 11(2) 145 chung, 2002) and improved behavioral outcomes for regular attendance and cooperation in the classroom (mcneal, 1999). as children become older and more autonomous, parent involvement is thought to play a lesser role. however, when adolescent students have been studied, although it is mediated by socioeconomic status, supportive parent involvement continues to have direct and indirect effects on academic achievement and adaptive functioning (bean, bush, mckenry, & wilson, 2003; hill et al., 2004; voydanoff, 2004). this influence has been capitalized on by interventions like daily home-school report card systems (chafouleas, riley-tillman, & mcdougal, 2002), as well as other reinforcement systems that derive their effectiveness from parent involvement (embry, 2004). numerous organizations, including the american youth policy forum (2003), center for mental health in schools at ucla (2004), national dropout prevention centers (n.d.) and the southwest educational developmental laboratory (2002), have identified parent involvement as a needed resource for schools. however, parent involvement has been underutilized in united states schools (gonzalez-dehass & willems, 2003). given the research findings on the importance of parent involvement for student success, and the significant achievement and graduation gaps in the united states, it’s important to understand what factors limit its use by schools and teachers. two explanations have been ideological barriers and cultural biases that devalue the importance of parent involvement for teachers (swap, 1993; thompson, warren & carter, 2004). ideological barriers that support negative teacher attitudes about parent involvement have a historical basis. swap (1993) suggested that underutilization of parent involvement has been a byproduct of the earliest and most traditional form of homeschool relations, the “protective model.” in swap’s “protective model,” school autonomy was privileged by its cultural mission to create opportunity through education for children to achieve beyond their family backgrounds. in essence, the schools’ role was to “protect” its students by fostering upward social mobility. the protective school model represented a school organizational culture that operated to minimize home/school communications and to suppress or eliminate conflict with parents by creating strict boundaries between school and home. educators were charged with the sole responsibility for educating children, and parents were not to interfere or attempt to usurp teachers’ authority. examples of swap’s “protective model” continue to be found in studies of elementary, middle school, and high school teachers’ communication with parents. these studies found communication between teachers and parents was minimal. teachers did not receive tangible school support for activities that involved communicating with parents (baker, 1997; decastro-ambrosetti & cho, 2005). they had not received significant pre-service or professional training that focused on methods for involving parents (gonzalez-dehass & willems, 2003; greenwood & hickman, 1991). their preferred method involved limited communication to support educators through home activities like monitoring homework completion (bruneau, ruttan, & dunlap, 1995). teachers rarely saw parents at times other than at biannual parent-teacher conferences (baker, 1997). in a junior high school study, barriers to parent involvement were defined wilkerson, kim/“we have a lot of sleeping parents” 146 as a “communication mismatch” (halsey, 2005). teachers preferred institutional communication like newsletters, open houses, public announcements and invitations to school-wide events, while parents preferred individual communications that were personal and direct. while these studies suggested that teachers’ ideological preferences were for limited communication with parents, some studies suggested that negative attitudes towards parent involvement reflected cultural biases and were primarily directed toward lower ses families. elementary and secondary school teachers were found to be more likely to blame lower ses parents when students performed poorly and to have lowered expectations towards students from lower ses families (lightfoot, 2004; nakagawa, 2000; thompson et al., 2004). studies also found that when lower ses students underperformed, secondary school teachers believed it was because parents did not value education. however, when teachers and parents worked together, studies found their combined influence increased academic achievement for lower ses students (gregory & weinstein, 2004). the compensatory involvement of teachers when parents were uninvolved was not found to predict increased achievement for lower ses students. in summary, parent involvement has been an important, though underutilized resource, which exerts a positive influence on high school students’ academic and adaptive behaviors. however, high school teachers have not been found to support parents’ involvement. one explanation for this has been that the oldest and still prevalent ideological barrier for collaborative home-school relations is a protective model, where communication with parents has been devalued and discouraged. however, some studies have suggested teachers’ limited support of parent involvement results from cultural biases toward lower ses families. the goal of this exploratory study was to further evaluate these explanations for the underutilization of parent influence. to accomplish this goal, high school teachers’ experiences and beliefs about parent involvement at a suburban high school were compared with the experiences and beliefs of teachers at an inner-city high school. methods settings and study participants the participants were high school teachers from an inner-city and a suburban high school in the midwest. the two schools were chosen because they represented maximum variation in the numbers of their students that graduated in four years and that received free and reduced price lunch. small samples that represent extremes in a condition allow the researcher to discover commonalities that can intersect across a condition or situation (hoepfl, 1997). at the time of this study, 59% of the inner-city school student body was caucasian, while 29% was african-american. at the suburban high school 96% of the student body was caucasian and 1% was african-american. graduation rates were reported as 48% for the inner-city high school and 88% for the suburban high school for the 2005/2006 school year (indiana department of education, n.d.). advances in social work, fall 2010, 11(2) 147 free and reduced price lunches were used as a proxy measure of ses because eligibility for this benefit is based on family income (sirin, 2005). children whose families have income of 130% or less of the federal poverty guideline as well as those who receive food stamps or temporary assistance for needy families (tanf) are eligible for free lunch. those whose families have incomes from 131% to 185% of the poverty guideline are eligible for reduced-price lunch. during the study period, 921(67%) of the inner-city school’s students received free lunch and 208 (14%) received reduced price lunch. at the suburban high school, 93 (4%) of the students received free lunch, while 57 (3%) received reduced-price lunch (indiana department of education, n.d.). ninth through twelfth grade teachers at both schools were surveyed during the 20052006 school term, through their school’s email service. all teachers at each school had an assigned email address. an invitational email was first sent to teachers announcing the forthcoming survey and requesting their participation. it briefly presented the purpose and benefits of the survey and assured confidentiality to respondents. a follow-up email was mailed a week later. the data collection period was one month. at the conclusion of the survey period, 70 surveys had been returned out of total of 221 teachers at both high schools. eight surveys were excluded from analysis, as two contained large amounts of missing data, and six were completed by administrators and others. the final samples consisted of 62 teachers, 46 from the suburban high school and 16 teachers from the inner-city high school. the overall the teacher demographics at the suburban high school were reported to be 100% white, while at the inner-city high school, 67.3% were identified as white, 30.77% were identified as black and 1.92 % were identified as hispanic/latino. in addition, the teacher samples’ years of experience teaching were equivalent to the teachers in general at the two schools (indiana department of education, n.d.). measures a self-administered survey was developed for this study from three previously researched surveys. items were selected from meyer’s (2004) organizational conflict survey, schaefer and edgerton’s (1979) teacher report of parent involvement, short form; and ponterotto, baluch, greig, and rivera’s (1998) teacher multicultural attitude survey. of the items selected from each of these three scales, both wording and response choices were modified to suit this study’s survey. the study survey consisted of 26 items describing teacher experiences with parents. these items included experiences with conflict and experiences with collaboration. they also included teacher beliefs about parent competence and non-traditional parent involvement. teachers were asked to rate their experiences and beliefs about parent involvement on a 5point scale from (0) “none of the time” to (4) “all of the time.” a factor analysis was conducted to summarize the survey items for the modified teacher experiences with parents scale using principal components analysis with varimax rotation. a total of three factors were extracted from 19 items explaining 56.9% of the variance (see table 2). seven items were excluded because of low factor loadings (i.e., less than .40). the first factor, experiences parents as problems, consisted of nine items, which accounted for 37.2% of the variance (cronbach’s alpha=.90). this factor included wilkerson, kim/“we have a lot of sleeping parents” 148 items that described abusive, forcing, and avoiding parent behaviors. the second factor, experiences parents as collaborators, included six items and accounted for 12.5 % of the variance (cronbach’s alpha=.83). the items in this factor included collaborative behaviors to help teachers understand their student and solve problems. the final factor, beliefs about parent competency (for supporting educational goals), consisted of four items, which accounted for 7.2 % of the variance (cronbach’s alpha=.72). these items primarily concerned supporting and valuing education at home. the second section included background information such as gender, ethnicity, years of teaching, grades taught and courses taught. face validity was evaluated during questionnaire construction by having two teachers and two administrators at the suburban high school and one teacher and one school social worker at the inner-city high school review the items. in addition to the self-administered survey, qualitative interviews with two teachers at the inner-city high school were conducted: two teachers from the suburban school declined to participate. qualitative interviews were used as a supplemental strategy to aid in the interpretation of quantitative survey data results. teachers who taught special and alternative education students were selected because they have been suggested to have greater involvement with parents (lake & billingsley, 2000). an hour-long, semistructured interview was conducted using an interview guide of open-ended questions to gather information on school policy concerning parent involvement, teacher involvement practices, and teacher recommendations regarding parent involvement. the questions from the interview guide were developed to explore explanations for the underutilization of parent influence from the literature review of parent involvement in secondary schools. data analysis independent samples t-tests were performed to compare the teachers’ experiences and beliefs about parent involvement at the two high schools. the face-to-face interviews were transcribed and coded to derive themes and patterns from the individual teacher’s narratives. coding was done concurrently with the quantitative analysis of survey data using a case study approach (creswell, 1998). this approach was used to compare and contrast the explanations for parent underutilization from the literature review to the teacher practices from the inner-city school and to search for exceptions and disagreements within these explanations. findings school comparisons of the final sample (n=62), the majority of respondents at both schools were female and caucasian, and had been teaching longer than 10 years. teaching 9th grade was the most frequently reported teaching assignment of survey respondents from both schools. the group differences on gender, years of teaching, and grade taught were not statistically significant (see table 1). group differences for ethnicity were statistically significant. although about 75% of both schools’ teachers identified themselves as being “white,” 11 respondents from the suburban high school identified themselves as “other,” which included hispanic-american ethnicity, as compared to one respondent at the inneradvances in social work, fall 2010, 11(2) 149 city high school. additionally, three teachers at the inner-city high school identified african-american ethnicity compared to none of the teachers at the suburban school. table 1 displays demographic information. it is also noted that while 75% of the suburban school teachers identified themselves as “european-american”, state records for the study period showed that 100% of the teachers were “white”. the discrepancy is believed to have resulted from the use of the term “european-american” in the study survey. the 11 teachers who identified themselves as “other” may have elected not to identify themselves as “european-american” as opposed to “white”. table 1. comparison of high school teachers based on background inner-city school (n=16) suburban school (n=46) test statistics gender (female %) 11 (68.8%) 30 (65.2%) x² = 0.07 ethnicity european american african american other 12 (75.0%) 3 (18.8%) 1 (06.3%) 35 (76.1%) a 0 (0.0%) 11 (23.9%) x² = 10.54** years of teaching 1 to 3 years 4 to 6 7 to 9 10 or more 1 (06.3%) 0 (0.0%) 3 (18.8%) 12 (75.0%) 4 (09.3%) 6 (13.1%) 7 (16.3%) 26 (60.5%) x² = 3.97 grade taught 9th grade 10th 11th 12th other 7 (43.8%) 2 (12.5%) 4 (25.0%) 0 (0.0%) 3 (18.8%) 14 (30.4%) 7 (15.2%) 5 (10.9%) 9 (19.6%) 11 (23.9%) x² = 5.59 **p<.01 a state records showed 100% of teachers at this school were “white” during the study period. the discrepancy in this response category where 11 of the teachers picked “other” may have occurred because these teachers did not identify themselves as “european-american” but as “white”. wilkerson, kim/“we have a lot of sleeping parents” 150 table 2. factor item comparisons factor loading inner-city high school (n=16) mean (sd) suburban high school (n=46) mean (sd) t-test (2-tailed) factor 1: experience parents as problems 1. expect to get their way .75 2.63(0.81) 2.54(0.81) .729 2. try to overrule my authority .80 0.88(0.89) 1.07(0.93) .478 3. get angry over misunderstandings and work against me .69 1.06(1.34) 0.86(0.93) .520 4. demand special exceptions .68 1.88(0.86) 2.00(1.10) .682 5. seek revenge when dissatisfied .73 1.69(1.25) 1.30(1.01) .224 6. insult, yell or swear .70 0.69(0.95) 0.42(0.62) .309 7. disrespect my role .73 1.00(1.16) 0.76(0.77) .352 8. avoid problem discussions .60 1.81(0.91) 1.78(0.66) .889 9. hold back useful information .79 1.38(0.96) 1.67(0.82) .249 factor 1 summary score 13.0(7.07) 12.33(5.75) 0.38 factor 2: experience parents as collaborators 1. give positive feedback .59 1.38(1.20) 1.65(0.82) .310 2. help me understand my student .78 1.69(1.14) 1.72(0.83) .911 3. appreciate suggestions about activities .75 1.75(1.13) 2.11(0.82) .179 4. provide information to problem-solve .68 2.00(0.97) 1.98(0.76) .924 5. ready to work together .54 1.69(1.14) 2.09(0.73) .203 6. interested in academic progress .58 1.69(0.95) 2.04(0.76) .188 factor 2 summary score 10.19(5.58) 11.54(2.98) -1.23 factor 3: beliefs about parent competency 1. support education at home*** .68 1.06(0.57) 1.93(0.75) .000*** 2. help their children to learn** .69 1.44(0.81) 2.11(0.71) .007** 3. parent concerned about education* -.54 2.31(1.07) 3.06(0.87) .020* 4. availability to help -.68 1.93(1.03) 2.53(1.01) .062 factor 3 summary score*** 6.63(2.96) 9.50(2.21) -4.09*** note: items were rated on a 5-point scale (0=not at all, 1=just a little, 2=some of the time, 3=much of the time, 4=all of the time). *p<.05; **p<.01; ***p<.001 table 2 presents mean scores of items on each factor, as well as factor loadings and ttests for statistically significant differences. for each factor, a summary score was calculated and compared between the two school locations. no statistically significant advances in social work, fall 2010, 11(2) 151 group differences were found for the summary scores from two of the three factors: experiences parents as problems and experiences parents as collaborators. in addition, no statistically significant differences were found for any of the individual items that made up these two factors. for the summary score for the factor beliefs about parent competency, teachers from the suburban school reported significantly stronger beliefs of parent competency than did teachers at the inner-city high school (t= -4.09, p<.001). there were also statistically significant differences between teachers from the two schools in all of the individual items making up this factor, except for the item “availability to help” (see table 2). the effect sizes for the factor beliefs about parent competency and its three statistically significant individual items were between .81 and 1.23, all large effects according to cohen (1988). bivariate correlations between study variables were also examined. teachers who experience parents as problems were less likely to experience parents as collaborators (r = -.42, p=.001) or to hold the beliefs about parents competency (r = -.56, p=.000). also, teachers who experience parents as collaborators were more likely to hold the beliefs about parent competency (r=.51, p=.000). gender of teachers or years of teaching were not significantly correlated with any of the three summary scores. themes from qualitative interviews themes from the qualitative interviews with two teachers at the inner-city high school are consistent with the findings from the survey. two primary themes were identified: 1) ses limits parent competence; and 2) parent involvement is complementary rather than collaborative to teachers’ efforts. the most frequently reported theme related to teachers’ negative beliefs about parent competency. this aspect of the teachers’ narratives mirrored the research of thompson et al. (2004), as they attributed a lack of competence to parents who deal with various challenges such as poverty, single-parent headed households, and little formalized education. the interviewed teachers described these parents as lacking motivation and energy for supporting basic educational goals like supervising school attendance and homework completion. they also reported these parents as either difficult to contact or unavailable due to lack of interest or resources. verbatim examples included: very few of the teachers will assign homework and without giving time in the class to finish it. most feel if they take their homework home it will not be done. not a lot of parents are encouraging their kids to do their homework. you have to realize the population of our kids, many or our parents are single parents. many are working, one, two jobs, or they have a live-in boyfriend, or girlfriend, that kind of thing. we have a lot of sleeping parents. or they say, “we’re coming,” and then you call, and they are in the shower. or they’ve gone to their granny’s or something that’s so important that they couldn’t come to the conference. wilkerson, kim/“we have a lot of sleeping parents” 152 teachers also stated parents were helpful when they complemented teachers’ efforts through their actions at home to support work completion, regular attendance and adaptive classroom behavior. verbatim examples included: at the high school level, i don’t know that teachers need any more parental involvement other than more parental involvement at home. i guess the high school level teachers would just appreciate the support at home for what they do; making sure the work gets done, making sure they have a phone number that they can reach a parent if there is a problem at school. well, the only involvement i have with parents is getting their support to make sure that their kids’ lessons were done and that they get here…their attendance. a minor theme concerned school competence. teachers stated that parents have greater difficulty contacting them at the inner-city school, as compared to a suburban school. related to school competence, teachers also shared a belief that parents at the inner-city school consider the quality of education their children receive to be inferior to that of a suburban high school. verbatim examples included: in the suburban high school classrooms, i know teachers do have voice mails [unlike the inner-city classroom], so if i wanted to contact a teacher, i could call and leave a message. teachers at suburban high schools are far more accessible, if parents do want to have some type of contact with them. it’s what it is, [an inner-city high school]. they tell their kids that “if we were in the suburbs, you would get a better education. you’d have a better ability to learn. it’s a utopia over there (suburban school system).” discussion this exploratory study compared teachers’ experiences and beliefs about parent involvement at an inner-city high school and at a suburban high school location. high schools were chosen because parent involvement has been thought to be of less importance during this time in a student’s academic career, however, numerous studies have found that it continues to be significantly related to academic achievement and positive adaptive functioning. in the case of lower ses high school students, gregory and weinstein (2004) found that teacher and parent collaboration predicted increased achievement. the two schools chosen for this study represented maximum variation in their percentages of student graduation rates and student eligibility for free and reduced-price lunch. significant differences in teacher experiences and beliefs would have suggested school location affects the use of parent involvement. however, there were no significant differences between the two school locations for either problematic or collaborative teacher experiences with parent involvement. in other words, although some school cultures may operate to “blame” parents rather than to foster collaborative partnerships, as described by thompson et al. (2004), in this study, teachers at a suburban and an inner-city school did not display significant differences in their experiences with parent involvement that were either helpful or obstructive. the lack of significant differences in advances in social work, fall 2010, 11(2) 153 teacher experiences between the two school locations could suggest that overall, the high school teachers in this study may not see parents as having a role to play at this stage of a student’s academic career, regardless of factors like a parent’s socioeconomic status. while we did not directly measure the variable of a “protective model” this finding does suggest that home-school communication is limited and as such, adheres to the structure of “protective model” of home-school relations. however, there were significant differences between the two schools’ teachers in their beliefs about parent competency. qualitative interviews with inner-city teachers offered additional information. teachers believed a lack of parent competency was a consequence of socioeconomic factors including poverty, single-parent headed households, low parent support for education, parents’ lack of education and lack or resources. additionally, teacher interviews suggested some inner-city parents did not experience the inner-city high school to be as competent as are suburban high schools for providing a good education. even so, these concerns about school competency were not described to be a contributing factor to the level of parent involvement. if a protective ideological model is in operation for teachers whose work settings are inner-city schools, negative experiences and beliefs about parent competency, as depicted in a teacher’s observation, “we have a lot of sleeping parents,” can be seen as a further cultural barrier for teacher encouragement of parent involvement. these findings can have implications for modifying levels of parent involvement to address problems of achievement and graduation gaps. interviews with inner-city high school teachers suggested several school-based efforts to encourage greater parent involvement, such as offering child-care to improve parents’ attendance and participation, providing more invitational family programs, offering parent management training programs, and providing teacher voicemail. however, because in the current study parent involvement is not presumed to play an important role for high school teachers regardless of location, it is unclear who would provide leadership for such efforts within the school. in practice, when students are academically underperforming or adapting poorly at school, the support staff (deans, guidance counselors, psychologists and social workers) intervenes and may operate to increase linkages that enable collaborative parent involvement. when considering leadership necessary to increase collaboration between home and school, these staff members have been identified as a resource whose capacity is currently underutilized. one model that increases the capacity of school student support services has been proposed and supported by the center for mental health in schools at ucla (2002). their model highlights the three key components for successful systemic change: (1) teachers, (2) school managers/administrators, and (3) student support services staff. the model advocates for each component to have an equal voice in policy and practicedecision making. without an equal voice, the capacity of student support service staff to provide comprehensive and collaborative home-school linkages is limited by their marginalized budgetary and policy decision-making roles within school systems. this study had several limitations. although maximum variation was used to increase the generalizability of this study’s findings, there were several other limitations for wilkerson, kim/“we have a lot of sleeping parents” 154 generalizability. this study did not randomly select schools or their teachers for inclusion. additionally, survey response rates were low: 40% response rate for suburban high school and 15% response rate for inner-city school. these low response rates may not have captured the total spectrum of teachers. the especially lower response rate from the inner-city school teachers might have been affected by an external factor. during the survey period, teachers at the inner-city school were facing staff cut-backs as a consequence of declining enrollment. this may have reduced teacher interest and motivation for completing surveys. although qualitative interviews provided additional information, the external circumstances in school may be an important factor affecting their response rates or even their attitudes toward this issue. finally, the survey instrument was developed based on previous studies and may not capture other important information to measure teacher experiences and beliefs about parent involvement. we did not ask for other important factors that may influence their attitudes and beliefs such as frequency of parent contact, nature of contact, or method of contact. a further limitation was this study’s use of free and reduced-price lunch as a proxy measure of ses. sirin (2005) notes “ecological fallacy” may result when between-school aggregated measures that proxy ses are used to interpret within-school differences. therefore, follow-up study that also collects individual ses information from parents would be recommended. additionally, a follow-up study could benefit by including parent perceptions about involvement. this survey only represented teachers’ perception. in order to have a more accurate picture of parent-teacher relations, it would be important to examine parents’ perceptions and experience with teachers regarding parent involvement. references american youth policy forum. 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(2004). work, community and parenting resources as predictors of adolescent problems and grades. journal of adolescent relations, 12(2), 155-173. author’s note: address correspondence to: david wilkerson, indiana university school of social work, 902 west new york st., indianapolis, in 46202. email: dawilker@iupui.edu microsoft word chakradhar_teaching circle final _________________ kala chakradhar, ph.d., is an assistant professor and llena chavis, msw, lcsw, is a lecturer, both in the department of social work, criminal justice, and gerontology at murray state university in murray, ky. an earlier version of this paper was presented at the 33rd annual national institute on social work and human services in rural areas, boise, idaho, usa by the above authors and ms. merry miller, acsw, dcsw, lcsw (former lecturer) and mr. jeff wylie, acsw, lcsw, senior lecturer in the same department. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 203-222 developing a pedagogy of itv teaching experience through a teaching circle kala chakradhar llena chavis abstract: objective: distance learning through the use of interactive television (itv) has been a part of social work education for more than two decades. amidst abundant proof of the overall successes of itv programs, there are limited accounts of the pedagogical experiences and challenges encountered by faculty who are called upon to teach distant learning courses. this paper describes a pedagogy of itv teaching experience derived through a teaching circle in a rural undergraduate program. method: a teaching circle comprised of four social work faculty enabled data gathering through focused discussion and critical thinking of the itv teaching experience. results: extended preparation, augmenting instructional design and technology to enhance interactivity and instructor comfort with the technology emerge as key observations. pragmatic barriers like the technology and restricted face-to-face contact are workable challenges. conclusion: social work education would need a sincere examination of the interface of synchronous and asynchronous teaching with sensitivity to context and course curricula. keywords: itv, teaching circle, pedagogy, rural, interaction, technology introduction with a century and a half of history, beginning with mail correspondence courses in europe, ‘distance education’ has been described as the twenty-first century learnercentered model in higher education (miller & king, 2003). distance education has been defined [negatively] as “(f)ormalized instructional learning where the time/geographic situation constrains learning by not affording in-person contact between the student and instructor” (as cited by miller & king, 2003, p.284). raddon (2006) cites perraton’s definition of distance education as “an educational process in which a significant proportion of the teaching is conducted by someone removed in space and/or time from the learner” (p. 157). his analysis of the narratives of distance learners describes the ‘absence’ (space/time) as an opportunity for access amidst demanding work and family roles. advances in technology have revolutionized the medium of teaching for social work educators, proving that the traditional face to face method of teaching is not indispensable. social work programs, particularly those located within larger institutions, have increasingly included distance learning, such as compressed video and interactive video technology (itv/ivt). these distance learning options have become part of both graduate and undergraduate teaching delivery programs. course management programs, chakradhar, chavis/devloping a pedagogy of itv teaching 204 such as webct/blackboard to enhance the delivery of such programs, are widespread (petracchi & patchner, 2000; vernon, vakalahi, pierce, pittman-munke & adkins, 2009). according to wilke and vinton’s (2006, p. 607-608) review, this growth has been a developmental process moving from the phase of ‘off-campus programs’ (faculty traveling to sites), to ‘distributed education’ (itv), to ‘computer-mediated education’ (web-based courses), with at least sixteen percent of degree programs having gone this route. a recent online survey of social work programs (n=137) initiated by the commission on accreditation (vernon et al., 2009) found that 40 percent of the programs at the bsw level and 50 percent at the msw level were engaged in some form of distance education. the outcomes of instruction using the itv (interactive television) format have been evaluated predominantly in graduate programs out of large urban institutions. however, reports of outcome experiences in undergraduate programs have been limited, especially in rural areas (pettracchi & patchner, 2000; vernon et al., 2009). outcome studies show substantial evidence of the success of courses taught by itv or the web in the form of student performance and feedback, particularly when drawing comparisons with traditional face-to-face methods (freddolino & sutherland, 2000; huff, 2000; pettracchi & patchner, 2001; potts, 2005). nonetheless, such outcome studies have been limited in that they have not given adequate attention to the processes involved in the development of effective distance education programs. in particular, the description of processes of course evolution relative to the pedagogical experiences and challenges in streamlining a satisfactory learning environment has been scant. the intent of this paper is to provide a case example of the processes involved, and challenges encountered, in creating and delivering an itv program. this itv based instruction was offered by social work faculty in a rural undergraduate program with limited itv teaching experience. observations of the collective experiences were gathered in a teaching circle formed by the faculty offering various undergraduate social work courses via itv. the broad questions that this research addressed were: what was the sense of preparedness at venturing into teaching via itv? what went into preparing faculty to teach via itv generally and specifically for the course being taught? what were the teaching/course adaptations made to suit the new classroom environment? what were the lessons learned? literature review interactive video technology also referred to as interactive television (ivt/itv), is a synchronous form of distance education, where learners are separated from the instructor by physical space but present at the same ‘time.’ the students and instructor are able to see and hear each other via television screens, though students and instructor are situated in different locations (miller & king, 2003). detailed descriptions of this classroom environment and the technology have been given by other studies (coe regan, 2008b; pettracchi, 2000; pettracchi & patchner, 2000). the credibility of distance education has been established, both by social work programs and the council on social work education (vernon et al., 2009). a fifteen-year review (1984-1998) of evaluations of the distance education mode of instruction by social work faculty reveals that it has equally advances in social work, fall 2010, 11(2) 205 positive outcomes (compared to traditional face-to-face format), with itv being the most widely used technology for course delivery (abels, 2005a; petracchi & patchner, 2000). the twin advantages of itv instruction that clearly stand out are accessibility to nontraditional students in remote locations and proven cost effectiveness (raymond, 2005). the interactive television alternative to course delivery offers rewards to students in rural areas in the form of opportunities for higher education. specific to social work, benefits are seen in rural regions for the public child welfare specialty in the form of expanding the workforce and the right to service by competent practitioners (glezakos, 2005; kleinpeter, 2005). coe regan’s review (2005) argues that the single most important challenge in higher education is assisting faculty to integrate technology into instruction. courses taught and reviewed for their learning outcomes have covered a major part of the curriculum (freddolino & sutherland, 2000; potts & hagan, 2000; vernon et al., 2009; wilke & vinton, 2006), including specific courses on research (pettracchi, 2000; petracchi & patchner, 2000), statistics (harrington, 1999), practice (coe regan & elliott, 1999), policy (huff, 2000), electives like substance abuse and child welfare (hollister & mcgee, 2000; pettracchi, 2000), and field instruction (mcfall & freddolino, 2000; stocks & freddolino, 2000; wilke & vinton, 2006). entire programs that have adopted the itv mode of course delivery have also been evaluated with reports of favorable outcomes (wilke & vinton, 2006). a recent report reveals that a majority of the distance education courses offered in social work are electives followed by practice courses (vernon et al., 2009). however, references to the experiences of instructors in the processes involved in adaptation to this technological change as well as improvisation required in course content and delivery have received limited focus (mottet, 2000; potts & hagan, 2000; smith & wingerson, 2006; stocks & freddolino, 2000; wolfson, marsom, & magnuson, 2005). this often necessary transition from traditional face-to-face (f2f) to technology enhanced instruction has not been devoid of faculty apprehension, with many having already “made peace with the technologies of instruction of face-to-face settings and mastered them to an acceptable degree of competence” (natriello, 2005, p. 1890). new to distance education but otherwise experienced, instructors rely ‘heavily’ on the traditional classroom experience when beginning itv instruction (natriello, 2005; vernon et al., 2009). there is some limited reference to ‘teaching’ social work courses using itv in the literature. pettracchi and patchner (2001) compared live instruction and interactive televised teaching over two years. sharing their teaching experience of a research methods course at the master’s level, they express that the distance instruction left students desiring more interaction with other students and with the instructor. instructor availability was facilitated via telephone contact and e-mail. facilitating interaction between sites was proposed by the authors as a plausible way of enhancing cohesion between the student groups within a course. they further emphasized that ensuring availability of course-related resources outside the classroom adds to effective course delivery. chakradhar, chavis/devloping a pedagogy of itv teaching 206 the need to build a cohesive class and focus on engagement is alluded to by potts and hagan (2000) as well. they taught practice courses via itv originating from the urban campus of california state university to rural campuses elsewhere in the state. some strategies mentioned included traveling at least twice a semester to teach live, holding office hours and social events at off campus sites, adapting teaching techniques in the form of oral reports via technology between sites, and planning assignments requiring e-mail linkages between student pairs. specific to the practice class, on-site remote coordinators facilitated role-play sessions and small group discussions. over time, the course was taught with support from remote site liaisons. at michigan state university, field instruction using distance education was facilitated by accommodating employment-based placements by having field advisory boards at each site (mcfall & freddolino, 2000). additional assistance was also provided by liaisons, a local coordinator, a faculty associate, and adequate technical staff. this infrastructure reflected additional financial investments (freddolino & sutherland, 2000). consequent recommendations called for looking into course-specific issues, and examining the compatibility between the technology and the specific course being taught. their futuristic question, “what is the right mix of human and technological supports required to create comparable quality learning environments for undergraduate and graduate social work education?” (freddolino & sutherland, 2000, p. 127) is the same that was posed by the teaching circle discussed in this paper when it was formed. a systems perspective framework highlights an equilibrium that has to be established through the combination of teaching, learning, interaction, technology, policy, and administration (potts & hagan, 2000). sensing the unpreparedness of many institutions for the cultural changes that this initiative demands, a gap in terms of a clear pedagogical model is observed (natriello, 2005; wilke & vinton, 2006). the pedagogical gap suggests the need for a more complete understanding of limitations and possibilities from the educator’s perspective. the quest for gaining an understanding can serve as a learning opportunity (natriello, 2003) and build knowledge for best practices (forster & washington, 2000; miller & king, 2003). forster and washington (2000) proposed a valuable model for developing and managing distance education programs, underscoring the importance of course adaptation when translating into interactive video format. they also emphasized the relationship between opportunities to develop pedagogical skills and teaching effectiveness of instructors. the need for development of pedagogical skills is reinforced by ouellette, westhuis, marshall, and chang’s (2006) recommendation that future research target pedagogical discussions and online strategies that facilitate creation of a context for good learning and a better understanding of learning processes. vernon and colleagues’ (2009) survey identified a strong felt need for skill building in teaching when it came to distance education. they found that it is not a matter of simply transferring teaching strategies from the traditional setting and is in fact a source of pressure for instructors in efficacy building. the need to examine various pedagogical strategies in itv teaching environments is especially stressed in the context of undergraduate social work programs in rural regions which are required to operate distance education programs to meet the need for bsw graduates (hylton & albers, 2007; vernon et al., 2009). advances in social work, fall 2010, 11(2) 207 against this backdrop, this paper draws upon the initial itv teaching experiences of a group of faculty in a rural undergraduate social work program who also started with uncertain pedagogical agendas. at the time, the instructors had been teaching in the itv format for at least three semesters and a maximum of five semesters. during this developmental phase, the instructors struggled through course adaptations, invented suitable teaching and learning strategies and attempted to discover what strategies worked and what failed. the formation of a teaching circle was envisaged to encourage knowledge building, affirm mutual teaching experience and evolve workable strategies. the following sections will address the outcome of the experiences of this teaching circle which met over two semesters to review the itv format of teaching. it is hoped that this will add valuable knowledge to undergraduate social work teachers in distance education, particularly in rural areas. method the method of study is based on the outcomes of a teaching circle comprised of four social work faculty. the teaching circle focused discussions on eight social work courses taught using the interactive television (itv) medium. teaching circles have been described as a form of “ peer review of teaching practices” driven by the shared purpose of understanding pedagogical goals and critically thinking through the processes involved in student learning (marshall, 2008, p. 418). in one of the only published reports found on teaching circles and social work (strom-gottfried & dunlap, 2004) the authors bring attention to the limited training received by social work educators in equipping themselves for teaching. comparing teaching circles to learning communities, strom-gottfreid and dunlap (2004, p. 67) see teaching circles as “structured to carve out convenient, consistent, common time for faculty to develop instructional skills and knowledge.” in listing the scope of the variety of curriculum issues that can form the content for teaching circles, they briefly describe at least a dozen of them. technology-enhanced teaching is listed as one potential theme for teaching circles, in addition to sub-themes like creating effective assignments, supporting minority students, ethical dilemmas, grading standards and successes, to name a few. their report also addresses some ways to evaluate the effectiveness of these teaching circles. for the purpose of this paper, the authors subscribe to the foregoing description and purpose in the use of the teaching circle to gain knowledge and enhance teaching skills in the itv teaching environment. the teaching circle here has also been used as a data gathering tool through mirroring a focus group experience in a large part, in the validation building exercise. the teaching circle met monthly during the fall semester of 2007 and spring of 2008. to guide and steer the discussion, a set of questions was presented by the first author for the teaching circle members to address in the context of their itv teaching. these questions helped members look at their personal reactions to teaching via itv, the preparations made, and changes adopted in course construction and method of instruction. in addition, through these questions, members were able to look at the teaching process (teacheror learner-centered), specific instructional strategies used to chakradhar, chavis/devloping a pedagogy of itv teaching 208 reduce social/psychological distance, differential student responses/attitudes between sites (if sensed), and individually analyze course-specific experiences. background to the teaching circle the seeds for attempting an extended itv form of distance education spanning various social work courses were sown in the spring of 2005, when a few introductory courses were already being delivered in the format. there were apprehensions in terms of the new format of delivery and embarrassments about how appearances on screen would play out. what seemed to drive decisions to forge ahead with the plan was to be able to be pioneers in the western kentucky region, where the university serves 18 counties including counties in the neighboring states of illinois, indiana, missouri and tennessee. the primary teaching site being this mid-western state university, two of the distance sites were within 60 miles and another two about 100-140 miles away. a potential population was ensured since a good contingent of students was already commuting these distances. all these geographic areas had community colleges whose associate degrees could be linked with the undergraduate social work courses. with substantial leg work accomplished by the program director, negotiating logistics with communities and colleges, social work courses were incrementally added to the long distance itv schedule. the cumulative itv teaching effort culminated in the first cohort of exclusive distance education students graduating in december of 2007. once the entire bsw degree became accessible via itv, the implications were that it was no longer one or two professors, but every professor in the department teaching via itv. the ambivalence about the logistics of implementation essentially included the question of how conventionally taught courses would be adapted to the itv situation. given a brief 10 minute orientation on the use of the technology, the reality was that one just took the plunge. it thus evolved into a ‘learning by doing’ set of strategies, testing the waters in the respective classes that were taught. an ethical commitment to be able to deliver education to those with limited access to the same became another key motivation. the university’s mission of academic outreach coupled with the social work program’s mission of equipping students to serve rural and underserved populations complemented this commitment. serving a predominantly rural area, a considerable number of post-secondary students are not only first-generation college degree seekers, but also potential candidates to add to the rural social work workforce. the distance education option offers many non-traditional students the flexibility to balance multiple roles and pursue a college degree. however, a pervasive sense prevailed about wanting to know what was working and what was not and needing to validate classroom experiences, especially in the light of diverse social work courses that were being taught. thus evolved the idea of a teaching circle to put forth individual pedagogical experiences and look for streams of convergence and unique strategies that were course-specific. an added purpose was to search for available literature to validate and build a knowledge base. paul abels’ (2005a) edited work on ‘distance education in social work’ was read by all members of the teaching circle and served as the starting point in initiating the advances in social work, fall 2010, 11(2) 209 discussion. giving exclusive attention to itv in social work as a form of distance education, abels predicts this form of teaching to be a viable medium for future social workers to attain their professional degrees, especially those from rural locations. based on experience of its use in master’s level programs, abels highlights the positive and comparable outcomes on student performance (vs. f2f classrooms). with due acknowledgement of the limitations of the absence of face-to-face (f2f) opportunities, glitches in technology, and restricted visual cues, social work’s sensitivity and familiarity with group dynamics is seen as an asset that could open possibilities to work through these barriers. abels shows that whole programs have been taught itv at the master’s level, but experiences in bsw programs receive less mention. he in turn expresses that little attention has been devoted to instructor experiences, the teaching process and preparation for a new class environment. with this background, the teaching circle, in monthly sessions during the fall semester of 2007 and spring of 2008, uncovered, through an inductive process, some of the common strategies that developed and evolved. in addition to some unique coursespecific approaches to course delivery, the barriers that were experienced came to light as well. results of the teaching circle experience as a warm-up exercise, the members of the teaching circle shared thoughts on the unique context of the itv teaching experience and individual responses to it. to begin with, what was available in terms of instructor preparation was a ten minute quick orientation to the itv equipment by a technician. primarily this included becoming familiar with alternate use of camera views of the instructor, computer (when being used) and a document camera (a modified chalkboard equivalent called the ‘elmo’ used as a presentation tool) and use of microphones. instructors were then immersed in the classroom situation, and it was noted that they relied on conventional f2f preparation skills to adapt courses to the itv context. initially, because it was new to all in the program, little could be done to share experiences, especially when elements can be course-specific. common to all, though, was the classroom context, in which one was on camera, able to view one’s self onscreen, with one screen displaying the multiple site-based classrooms (a maximum of 4) in rotation. students from the main site were seated in the classroom f2f with the instructor. the instructor must be stationary, on an elevated platform, facing the cameras, but must shift between the computer and the ‘elmo.’ when using these forms of technology assistance, the instructor is blocked from students’ sight at the distant sites, as only one view at a time is possible. teaching circle members noted that not being able to move around the classroom was a barrier; due to the camera not being able to follow the instructor, the instructor must sit behind a desk in a positioned chair. as discussed in the teaching circle, this decreases the instructor’s ability to interact with students—even distance learners—on a physical level. a virtual learning environment in the form of blackboard was a tool that the instructors came to use extensively to make up for the void in direct f2f communication. chakradhar, chavis/devloping a pedagogy of itv teaching 210 blackboard is a virtual course management system which consists of an integrated set of communication, assessment, and content management tools that instructors can use to mimic a regular classroom. the asynchronous communication enables e-mails, discussion boards, posting of course materials, links, announcements, tests, and grades (littlefield, 2002). personal reactions to the prospect of teaching various courses through itv varied among the members. the various courses taught by the members of this teaching circle via itv included introduction to social work, social work practice with individuals, social work practice with families and groups, social welfare policy and services, social work research methods, quantitative analysis (statistics), senior seminar and field seminar. at that point, each of these courses had been taught in the itv class environment for a minimum of two semesters and a maximum of five semesters. the last mentioned (field seminar) had just been started in the itv format. it seemed, for the instructor teaching the practice with families and groups class, that if it were a matter of choice she would have opted out, due to concerns of effectiveness of the itv platform. this instructor described adapting method and materials as the course proceeded, sometimes stumbling on effective techniques. another instructor had some previous exposure, having participated in state-wide class sessions delivered via itv, and therefore had realistic expectations as well as a sense of the limitations. for the other members, there was a prevailing sense of unease and reluctance in venturing into an unfamiliar teaching setting, but the commitment to making education accessible and a desire to succeed became the driving forces. the following sections give an account of individual course teaching experiences as reflected upon and shared by respective instructors. introduction to social work. for the instructor teaching this course, the class size was relatively large (40-60) with the course taught mostly through lectures. students at this beginning level tend to be less familiar with technology. due to the limitations in opportunities for interaction, student engagement was considered important. a way to facilitate a positive situation for this class was establishing ground rules the first day of class. giving an orientation to students on the class environment, student and instructor expectations, technology issues and especially for the distant sites “what happens if” situations (e.g., if communication was lost), was one strategy that worked well. encouraging students, especially remote site students, to ask questions, and acknowledge the challenges of itv (“this was hard” and it was best “to lay it on the table”) helped in the acclimation process for both instructor and students. student reticence to interact via itv was a barrier for interaction during daily class discussions; encouraging students not just on the first day of class but also throughout the semester was deemed very important. due to the inability of the instructor to see if a hand is raised at an offsite, a student must press a button and begin speaking; then the camera will move to their site. only when a student from the distance site talks by pressing on the microphone is the camera activated and the site/student visible to the instructor. if students from an extended campus are not willing to take that initiative, they could feel disconnected from the class process. however, a rotation feature allows the instructor to view the sites automatically in rotation at about 30 second intervals. the advances in social work, fall 2010, 11(2) 211 instructor also stressed the importance of contrasting the itv experience from watching tv for entertainment, where the culture is to multitask or take breaks while only partly engaging with the medium. this multi-tasking is evident in the form of students conversing with each other, briefly leaving the classroom, using their laptops or reading other material. students at off sites who view the instructor on a tv monitor had a tendency to slip into this culture and lose sight of the fact that they were being watched. the alternate distraction can convey lack of attention or indifference, and students in turn can miss important course content. the reminder of the tv culture analogy gradually helped students stay on task in the classroom and restrict break-taking. social work practice i (sw with individuals). teaching the class posed a challenge, considering the interaction required and the need to use role-play as a teaching tool. conducting role-plays becomes even more difficult when there is just one student at a site with no partner in a role-play situation. the first semester that this course was taught via itv, role-play seemed impossible: students were given role-play assignments to try at home and discuss the experiences in class. realizing that this did not accomplish any skill learning, the instructor attempted a “hot seat” exercise. in a “hot seat” exercise, a student is assigned a role by the instructor and students take turns in the “hot seat,” or social worker’s chair, in order to complete a psychosocial evaluation. one student would start out and when that student began to struggle, another student in the class would volunteer or be called upon to jump into the “hot seat” to complete the psychosocial assessment. initially the exercise seemed awkward, since some students could not see each other due to the camera position, and there seemed to be a disconnect between onsite and offsite students’ level of involvement (a higher participation level from the onsite students was noted). over time both onand offsite students began moving into the “hot seat” without prompting. the “hot seat” game is now used weekly in this practice class to help students practice, develop, and critique their own skills. the learning curve was seen to be staggered and slower among distant site students when compared to onsite students. social welfare policy and services. implementation of itv instruction in this class was not particularly difficult. the instructor had already innovated teaching strategies to be learner-centered, given the nature of a policy course. one such strategy was to give students chapter questions to complete before a class session so as to initiate interaction and discussion. however, small groups that were used to enable discussions in a live classroom were not as practical in an itv classroom. consequently at the distant sites, the limited students present became one discussion group. an additional difficulty with the small group technique was the difficulty the instructor had monitoring the participation of offsite participants. panel presentations of policy analysis by student groups were not necessarily smooth due to difficulties in across-site communication. for instance, groups of three to four students that constituted a panel for a policy presentation were not all visible on screen and individual students would have to position themselves for the camera to be seen and heard. it seemed that the students at the main site had a “better” experience than the remote site students. as is evident, in this course traditional teaching methods were transferred to the itv classroom and the nuances of the technology were accommodated. chakradhar, chavis/devloping a pedagogy of itv teaching 212 social work with families and groups (practice ii). teaching this course posed more challenges since the traditional format involved observation of in-class task groups as a learning exercise. with distant sites, mixing groups (between sites) was not practical and groups had to be formed within sites. for a better evaluation experience the instructor chose to travel to sites. students, however, were not able to observe closely when watching a group onscreen. closely observing non-verbal behaviors like facial expressions is very difficult, since zoom features are extremely limited on the itv cameras. trying out specific group exercises in class had to be withheld when there were only two or three students at a particular distance site. one strategy that was somewhat effective was to have students from all sites come to the main campus for a ‘lab day,’ where group demonstrations were presented. though it was time-consuming and required extensive advance planning and coordinating with other faculty and class schedules, it was a worthwhile learning experience that accomplished course goals. therefore, in this instance the instructor had to move away from the itv classroom to the traditional f2f format to facilitate a better learning and skill-building experience. social work research. the already intimidating nature of research and statistics courses is made no better in an itv learning environment. strategies that were used in traditional classrooms to initiate favorable attitudes toward learning research methods were transferred to the itv setting in the form of warm-up exercises, discussions of research as a professional activity, and soliciting student opinions and reactions. one way of enhancing the inclusion experience and replicating the feel of an onsite classroom was inclusion of presentations of research proposals. the primary objective was to have students present ideas to their peers and to interact and gain exposure to different contexts and issues. geographical and other site-specific differences came into play in the kind of ideas presented. wherever possible, in-class exercises were included that would get students involved. sample student papers were also distributed as a way to get students oriented to writing literature reviews and proposals. it also helped to re-organize course content, space out topics and stagger the pace of course delivery in keeping with class readiness. this monitoring of pace was especially a felt need in the itv class setting where students who are otherwise reluctant to ask questions/clarifications feel intimidated by the camera and microphones. the instructor takes on a more active role in posing questions and reviewing to get a sense of where the class is in relation to the topic. quantitative analysis. challenging mathematics content and (at least for the less computer-savvy) difficult software (excel) pose challenges even in a conventional classroom. for itv application, topics had to be simplified and the pace of delivery adapted to be more learner-centered than they are conventionally. as mentioned with the research course, the pace of student learning and understanding directed the pace of the course. in a f2f classroom, nonverbal cues from students give the instructor additional indicators of response to course material which are nonexistent (for distant site students) in the itv classroom environment. student dissatisfaction can also be heightened due to inability to meet the instructor after class. an added advantage was that students were able to use their laptops, when they had one, to simultaneously try out exercises on excel. laptops were made available for the students during class time at a couple of distant advances in social work, fall 2010, 11(2) 213 sites. this was a feature that was accommodated wherein students in a traditional setting would work in a computer lab. in the core assignment for this class, students administered a survey to the class, their sample, using the e-mail feature on blackboard. they then worked through data organization and analysis steps to produce a report. the survey exercise not only got all the sites connected but also sensitized students to the vagaries of data collection and response rates. although this assignment was originally part of a traditional teaching strategy, in the itv classroom it served the much needed purpose of inclusion and connectedness. for this instructor, what was seen as paramount was ensuring a comparable immediacy of connectedness with students at all sites through prompt e-mail communication, clarification, and reaching out when there were concerns. student comfort was enhanced when the instructor was in control and able to stay prepared in advance. this preparedness included faxing/mailing handouts/quizzes to sites, judicious use of blackboard, and making backup plans in anticipation of possible technology failures. the last-minute inclusion of an interesting handout or quick print-out of a quiz or exercise before class is not a possibility in the itv class. visits to the remote sites when class schedules permitted were an essential complement. senior seminar. this is the final course in the curriculum, a pre-field class taken by students in their last academic semester in preparation for their field experience. these seminars were greatly enhanced by the generous utilization of the blackboard tool to post reading material, guidelines and the like, where previously they were printed and handed out in class. a switch to electronic mail to receive student assignments was made. following a semester of planning logistics, students from the ‘social work practice with individuals’ class were enlisted to partner with students in this class for role play sessions to practice interviewing. both classes were scheduled at the same time and therefore made this a mutually beneficial exercise. other technological aids like videos and youtube clips, also used in conventional classroom settings, complemented teaching efforts. guest speakers from various sites also helped to enhance student interest. the instructor ensured availability through e-mail and cell phone access and also visited the sites at least twice in a semester. one of these visits was to plan field placement interviews and thus served a dual purpose. field education. based on student distribution among the sites, faculty liaisons were the best way to plan periodic face-to-face seminars with their respective field groups. at the time of this research there were three instructors who shared the internship supervision. on occasion, use of liaisons to facilitate seminars from other sites has added to the quality of the experience. however, budget constraints have made continued use of liaisons uncertain. the itv classroom setup is only used for two seminars (first and last) when the entire field intern group is on the same chronological level. during the rest of the internship each site (section) meets as an independent group. it has been observed that the instruction and supervision work better when there is an on-site liaison available. the lack of this option requires the respective faculty member to travel to the site. the latter option is the practice even in a non-itv situation. for the itv setup, the creation of virtual discussion groups on blackboard has been so well received and used that it chakradhar, chavis/devloping a pedagogy of itv teaching 214 mirrors the face-to-face experience. in addition, podcasts have been used to disseminate information prior to the discussion board exercise. discussion in reviewing the data gathered through the teaching circle experience, it was found that basic to making this form of synchronous distance learning work is being able to create a new classroom culture and a new learning community. the physical distance between students and between students and instructor created by the geographical distance and the bridging of this distance by the technology requires the instructor to facilitate this connection. this connection has to complement the basic commitment to instruction and engagement. common to all instructors was the need to get prepared for the different teaching environment. assessing one’s own technological and pedagogical skills and preparedness to adapt course content and teaching style is tied to taking those first steps. feeling one’s pulse on what will drive commitment to teaching in this format is also a good reflective exercise, especially for the less technologically savvy or the skeptical. also evident, especially in a discipline like social work, was that planning course delivery and instruction is course-specific, driven by course content and expected outcomes. the limitations posed by restricted f2f contact and minimal sensing of nonverbal cues has to be compensated for by more active instructor presence and interaction. for the practiceoriented classes requiring role plays and group exercises, there is a suggestion about making a minimal class size requirement for off-sites to prevent the possibility of ending up with a site with only one student present. the monitoring of an optimum class size, however, will not compensate for the severe limitation in sensing nonverbal cues on screen (student-student and student-instructor) and the value of live interaction. the absence of nonverbal cues is indeed an imposing gap in the learning experience in practice-oriented classes with no known immediate solutions. thus, preparation and advance planning are essential with respect to tasks like copying and faxing or e-mailing handouts or materials for class exercises, scanning documents where necessary, and posting them on blackboard in advance. although not far removed from preparing for conventional classes, there is the added urgency to get the materials to the distant sites in time for use. in bridging the ‘social distance,’ asking direct questions of various sites by calling on students by names, and using the camera and zoom feature to focus on students when they speak (especially in presentations) helps in facilitating inclusion and group cohesion. the skill involved in engaging students in this environment includes the appropriate and planned interspersing of videos, powerpoint, youtube clips and elmo with the lecture delivery. one instructor used news clips that featured information from the respective counties and cities (relevant to the class) to generate interest and participation. although these strategies are no different from those common to on-campus classes, they could be deliberate choices necessary in the itv class environment. apart from facilitating active interaction through inviting participation and strategic questioning within the classroom, an instructor’s virtual presence through an alternate advances in social work, fall 2010, 11(2) 215 learning environment like blackboard is almost indispensable. use of the virtual discussion board feature on blackboard holds promise especially when the class is asynchronous, as in internship periods or online classes. while itv students do have a synchronous classroom experience, the participation on asynchronous discussion boards fluctuates based on the assigned topics and participation credits. additional supports at remote sites in the form of site coordinators or liaisons are a welcome boon. flexibility to navigate the unexpected, travel to sites, and train oneself makes the itv form of teaching an interesting challenge. at this institution, instructors do receive travel support every semester for the trips they make to the remote sites. at the beginning of every semester administrative coordinators at every distant site give an update of equipment and other infrastructure support available at their sites for the benefit of the instructors. barriers and solutions some barriers identified in this itv teaching experience range from issues with technology to relational struggles, including student-faculty relationships, classroom or peer-student relationships, classroom dynamics, and struggles with time and logistics around classroom planning and implementation. the technological barriers were the most pervasive, followed by relational issues, especially when considering the social work curriculum and courses that are oriented towards interactional skill-building. initial struggles with students being intimidated by the technology (especially on-site students who were used to face-to-face classes) and technology failures impeding class projects were ubiquitous experiences. the more instructors overcame these barriers themselves over repeated semesters, the more they were able to put new students in these classes at ease. instructors also had to learn to anticipate and work with technological glitches at all sites and be prepared to compromise on class time, interruptions, and abrupt endings to a class session. responding to such glitches by instructors requires establishing contact as soon as possible with the affected sites within or outside the classroom (as the situation demands) to keep them tuned in and give them updates of what they missed (if anything). here, the ‘announcement’ feature on blackboard enables connecting with and updating the class as a whole. when visiting and teaching from other sites, one encounters dissimilar equipment that needs attention. with the increased use of cell phones becoming concerns even in non-itv class settings, itv classrooms have had the added challenge of cell phone sounds interfering with the transmission equipment. laptop use by students within the classroom often needs monitoring; at distant sites the laptops could complement instructor use of power points or the web by providing more clarity. however, the absence of the instructor at the distant site perhaps encourages students to use the laptop for non-class purposes as well. with regards to what could be termed relational barriers, the struggles include not being able to better understand student concerns, dealing with students competing with one another for instructor attention, and issues with helping students interact across sites. attempts to form “open relationships” with students and address mutual fears (students’ and professors’) around readiness to try something different were ongoing. the negotiation of ongoing relational barriers calls for a certain cultural sensitivity to the chakradhar, chavis/devloping a pedagogy of itv teaching 216 demographic and geographic differences and the dynamics that emerge, probable ‘site specific tensions,’ alliances, and discords. offsite students do not have the advantage of an informal class discussion before and after class with the instructor. this constraint to meeting the instructor may need consideration when organizing class time. it thus demands more time than ‘traditional classrooms’ without any compensation or accommodations with respect to extended ‘itv air time.’ in discussing instructor investment the teaching circle members were drawn to look at the impact on teaching evaluations as well. discovering that the itv teaching setting did not engender favorable teaching evaluations, particularly in the experimental stages, there were suggestions about considering a different evaluation tool. this tool should take into consideration the instructor’s skill level with itv instruction, and should not include a tool that was used to evaluate teaching in traditional class settings. summary of findings it is evident that there is a need for understanding and accepting itv instruction in rural educational settings. there are, however, manifest issues related to overcoming technical difficulties, integrating off-site with on-site classrooms, and developing relationships between instructors and their students. the primary struggle seems to be developing new pathways for classroom “interaction” removed from more traditional methods of teaching. the experiences of the teaching circle discussed here reveal an increased need for instructors to engage in planning and exploring alternative methods of technology to augment teaching, as well as a willingness to travel to alternative sites. improvement of interaction among students, as well as between students and instructors, requires a high level of creativity geared to the special dynamics of the course and the particular composition of a given group of students. conclusions and implications having unraveled the pedagogical experiences of the teaching circle in a midwestern rural undergraduate setting, a parallel exercise was to search for affirmation of the circle’s conclusions by reviewing the literature. circle members assigned themselves the task of delving into the literature to validate the discoveries made and understand the philosophy that guided the instruction. this concluding section attempts to identify the most relevant findings of the general literature that support the observations of this teaching circle. for example, glezakos (2005) compiled a list of ‘lessons learned’ from distance education that capture much of the experience of the teaching circle. this includes anxiety-provoking limited computer literacy, camera shyness, negative student reactions to an instructor’s dry sense of humor, sharing the classroom with site-coordinators or other assistants, and the effect of student evaluations on faculty. also in keeping with the teaching circle is the conclusion that the two most important challenges are technological barriers (e.g., quality of audio/video, time loss, disruptions) advances in social work, fall 2010, 11(2) 217 and the loss of f2f/personal contact (of instructor) with students and between students (coe regan, 2005; hylton & albers, 2007). the repeated emphasis on ‘interaction’ or ‘interactivity’ is evident as quintessential in the literature on distance education. instructors need to work towards infusing such interaction, especially due to loss of f2f contact (coe regan, 2005; darabi, sikorski, & harvey, 2006; dupin-bryant, 2004; knowles, 2002; roblyer & wiencke, 2003). instructor comfort with the technology has a direct bearing on the teaching quality and management of classroom logistics (coe regan, 2008a; darabi et al., 2006). so, the more instructional design components that instructors can add to augment meaningful interactions, facilitating collaboration between and among students and themselves, the greater the success (roblyer & wiencke, 2003). some of the recommended exercises from the literature that were used by the teaching circle included ice-breakers, small group exercises, team-building activities, debates, and problem-solving sessions. the instructional design also included use of technology such as e-mail, podcasts, blackboard, and blogs to maximize interactivity (beldarrain, 2006; kim, 2008; roblyer & wiencke, 2003). in addition, it is stressed that instructors need to share responsibility with students to promote interactive learning and create an atmosphere supportive of favorable interaction and learner autonomy. evidence of high instructor engagement is seen to be reflected in “timely, consistent and useful feedback” to students (roblyer & wiencke, 2003, p. 89). instructors in the teaching circle were also cognizant that a not so easy but encouraging note for current and future instructors is to have realistic expectations and to be aware that student non-responsiveness may influence teaching and quality of teacherstudent relationships. as reported by mottet (2000), the lack of nonverbal responsiveness may not relate to quality of instruction and need not color effectiveness as distance teachers. in the substantial absence of visual cues, paying attention to voice tones, pitch, and developing a ‘keen sense of listening’ are recommended (mottet, 2000). it became clear to the teaching circle that a competent distance teacher needs to manage the logistical aspects of the course (coordinate with personnel, have back-up plans, plan synchronous and asynchronous activities, ensure access to and functioning of equipment) (darabi et al., 2006) and be more of a facilitator and mentor than lecturer or expert (knowles, 2002). it is better for instructors to be “overprepared” and to make greater use of audio-visual materials, graphics and creative questioning techniques to draw students to engage and form a cohesive learning community. conscious use of humor, monitoring one’s nonverbal behavior, and paying attention to the pace of instruction are also recommended (as cited by coe regan, 2005; hylton & albers, 2007). abels (2005b, p. 18) alludes to mcfall and freddolino’s “action steps” to meet fieldwork requirements for students in social work distance education programs. these action steps include resource building (community and office), enhancing cultural sensitivity to agency uniqueness, and giving due regard to confidentiality issues (individual and organizational). glezakos (2005) suggests that knowledge of site-specific practice issues and diversity characteristics would assist in gauging student expectations and negotiating course requirements. chakradhar, chavis/devloping a pedagogy of itv teaching 218 the teaching circle experience confirmed the finding of kleinpeter (2005) that, in order to counter the challenges of the multi-site classroom environment, it is productive to engage site coordinators who can complement instruction by offering experiential exercises and discussions, proctoring exams, and conducting student advising. technological support, monetary compensation and travel benefits have been emphasized in the literature as well. all of these combined, namely, training and support, have been underscored as most helpful contributors to successful course delivery (coe regan, 2005). ‘technology and teaching’ is not a part of the accredited graduate curriculum in social work. is a possible implication of this study that utilization of technology should be incorporated into the social work curriculum? rural communities have a definite need as indicated by this research. at a minimum, graduate programs in rural communities may want to consider this as a possibility. despite substantial support from social work faculty for distance education, the existing gap in pedagogical experiential reports is obvious and in need of being bridged. while there have been scattered efforts at capacity building through training and even certification to teach in distance education (abels, 2005c), published reports of the instructors’ own pedagogical, course-specific discoveries are still scant. this research effort has made a beginning, and a continuation of this thread is recommended. within this aspect of competence and its dissemination, proposals have also been made to reward itv instructors through special recognition by tenure systems (coe regan, 2005). in recognizing the value and credibility of the itv format of distance education to empower ‘underserved populations,’ there is continued stress on the need to track graduates of this distance education stream. such a follow-up would help recognize the professional performance, market value and competencies gained through a nonconventional medium of instruction (potts, 2005). on a concluding note, distance education is no longer a nonconventional approach given the changing demographics of students and growing demand for online education. for example, 24 percent of today’s students are single parents, of whom 75 percent are nontraditional students (gonick, 2010). the growing demand for online education (ahala, 2009; kim & bonk, 2006; vernon et al., 2009) and the complementary role of technologies such as wikis, blogs, podcasts, e-books and the like have opened avenues to examine the suitable integration of synchronous and asynchronous teaching and learning. asynchronous teaching methods enhance cognitive participation while synchronous methods enable personal participation (hrastinski, 2008). chernish and associates’ (2009) comparative assessment of students in traditional, itv and online classroom environments revealed no difference in learner achievement levels. however, students in the traditional classroom had the highest ‘comfort’ levels and ‘group’ sense, whereas students in the online environment had the lowest. having established a firm foothold in the arena of distance education, social work educators have to undertake the task of understanding and establishing the goodness of fit given the variables of contexts and needs (curricular and learner). ahala’s (2009) examination of advances in social work, fall 2010, 11(2) 219 the interface of online and f2f instruction with specific reference to social work education advocating for a blended learning approach is a case in point. last but not the least, the members of this teaching circle strongly recommend the use of the teaching circle for pedagogical pursuits as well as a knowledge building research tool. in today’s environment of increased accountability, evidence-based practice and cost-efficient, quality-assured delivery of service, the teaching circle provides just the platform to realize some of these objectives. references abels, p. 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(2006). absence as opportunity: learning outside the institutional space and time. journal of further and higher education, 30(2), 157-167. raymond, f. b. (2005). the history of distance education in social work and the evolution of distance education modalities. in p. abels (ed.), distance education in social work: planning, teaching and learning (pp. 23-40). new york: springer publishing. roblyer, m. d., & wiencke, w. r. (2003). design and use of a rubric to assess and encourage interactive qualities in distance courses. the american journal of distance education, 17(2), 77-98. smith, p. r., & wingerson, n. w. (2006). is the centrality of relationship in social work at risk with ivt? journal of technology in human services, 24(3), 23-37. stocks, j. t., & freddolino, p. p. (2000). enhancing computer-mediated teaching through interactivity: the second iteration of a world-wide web-based graduate social work course. research on social work practice, 10(4), 505-518. strom-gottfried, k., & dunlap, k. m. (2004). talking about teaching: curricula for improving instructor’s classroom performance. journal of teaching in social work, 24(3/4), 65-78. vernon, r., vakalahi, h., pierce, d., pittman-munke, p., & adkins, l. f. (2009). distance education programs in social work: current and emerging trends. journal of social work education, 45(2), 263-276. wilke, d., & vinton, l. (2006). evaluation of the first web-based advanced standing msw program. journal of social work education, 42(3), 607-620. wolfson, g. k., marsom, g., & magnuson, c. w. (2005). teaching notes changing the nature of discourse: teaching field seminars online. journal of social work education, 41(2), 355-361. author’s note: address correspondence to: kala chakradhar, ph.d., assistant professor of social work, criminal justice & gerontology, 101s applied science bldg., murray state university, murray, ky 42071. email: kala.chakradhar@murraystate.edu microsoft word 6. shier_graham_4180 identifying muslim social service needs copyedit_final ______________ micheal l. shier is a ph.d. candidate in the school of social policy and practice at the university of pennsylvania in philadelphia. john r. graham, ph.d., is the murray fraser professor of community economic development at the university of calgary. this work was supported by the ford foundation. the authors would like to thank their research participants and greatly appreciate the time they spent answering questions. furthermore, the authors would like to note the valuable feedback provided by the anonymous reviewers, and thank them for their time and commitment to enhancing this article. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 395-415 identifying social service needs of muslims living in a post 9/11 era: the role of community-based organizations micheal l. shier john r. graham abstract: in this qualitative study the investigators sought to better understand the ways in which service provider organizations (n=19) working with muslim service providers have adapted to the changing social and political contexts in a post-9/11 era in new york city, and how this changing environment has affected the types of services that muslims need. service providers described two general ways in which services were adapted: 1) they have sought to address limits in service delivery programs that were a result of emerging sociopolitical dynamics (such as increasing discrimination) through adaptations to existing programs or through the development of new initiatives, programs, and organizations; and 2) they have adapted programs and services to meet the emerging sociocultural demands (such as changing attitudes towards help-seeking, and presenting problems of services users) of the muslim population. the study illustrated the role of service provider organizations in adapting existing services, or creating new services, in response to a changing sociopolitical context. social work education must focus attention on how social workers can adapt and create organizations that are responsive to the changing needs of service users. more curriculum content is necessary on the intraand inter-organizational context of direct social work practice, with particular attention to innovation and adaptation within and between human service organizations. keywords: social work, social environment, service delivery, muslims, organizations social work research supports the notion that socioeconomic and sociopolitical events within a social environment can have a direct impact on social service user groups’ experiences (greene, 2008; zastrow & kirst-ashman, 2010). social scientists have found that complex socioeconomic and sociopolitical factors (such as the events of 9/11) can influence the types of services and programs that populations need to ensure their well-being (hacker, 2002; o’connor, 2001). a major theoretical framework informing this type of understanding is the person-in-environment approach in which social work serves as a bridging agent between the service user and the complex environment in which services are offered (kirst-ashman & hull, 2008; rogge & cox, 2002). in practice, the person-in-environment approach stresses the role of the social work practitioner in helping individual service users navigate their social environment. this can include support to individuals seeking employment, community access, and mental health treatment; among other forms of direct intervention where the social worker shier, graham/social service needs of muslims post 9/11 396 themselves act as a bridging agent for a social service user to meet their individual needs. however, this approach only considers the direct (or micro-level) aspects of how social workers act as a bridging agent between the social environment and service users (ezell, 2001; schneider & lester, 2001; spencer, gunter, & palmisano, 2010). instead, social service organizations (and in particular, non-profit organizations) have also been found to be active agents in addressing emerging issues or challenges within the social environment (boyd & wilmoth, 2006; choca et al., 2004; gulati & guest, 1990; kline, dolgon, & dresser, 2000 spergel & grossman, 1997). what this previous research suggests is that the mezzo (or organizational) level interaction with service user groups is also important and can be instrumental in addressing service user needs. the present qualitative study focused on understanding the mezzo level experiences of service provider organizations working predominantly with muslim service users living in new york city. our main question was: as a result of the changing social and political contexts after the september 11, 2001 (9/11) terrorist attacks, in what ways (if any) did social services providers working with muslims adapt their services? this study illustrates that social service needs of individuals cannot be assessed or determined effectively without examining the broader sociopolitical context in which clients are living in, and that service provider organizations within local communities are instrumental in assessing changing (or emerging) service user needs and responding through adapted or new programs and initiatives. literature review the effect of september 11, 2001 touched all parts of american life. social scientists have studied its impact on american attitudes towards their government (kimberly, brewer, & aday, 2009), legal system (morgan, 2009), and social structures (gross, aday, & brewer, 2004). numerous scholars have examined how americans experienced this collective trauma (updegraff, silver, & holman, 2008), with some research indicating that some residents living around crash sites were at risk of post-traumatic stress (ptsd) (digrande et al., 2008; wilson, lengua, meltzoff, & smith, 2010) and suicide (claassen et al., 2010). research has also shown that the nation’s sense of social trust may also have been impaired (gross et al., 2004). gross and colleagues (2004) found that individuals exposed to television news coverage of the september 11, 2001 terrorist attacks experienced declines in levels of trust towards other individuals. muslims have been specifically impacted. for instance, numerous studies illustrate that muslims have been the subject of increased islamaphobia if living in the united states (jalalzai, 2011), or other countries (mandaville, 2009; sheridan, 2006). islamaphobia has generally been defined as the fear of islam and muslims with increased prejudice and discrimination directed to them due to their religion. public opinion polls conducted in the united states have showed public opinion towards muslims has generally been negative since 9/11. one study illustrated that 50% of americans thought that muslim individuals were being unfairly targeted since 9/11, but by january 2002 the proportion of americans who felt this way decreased to 31 percent, rising to approximately 35 percent by september 2002 (panagopoulos, 2006). a year following the terrorist attacks, the majority of americans (approximately 60 percent) were reported advances in social work, fall 2013, 14(2) 397 to believe that the muslim “world” considered itself at war with the united states. in 2002 there were about 42% of americans (a number only decreasing to 39 percent by 2003) who believed that the american government should have more powers to monitor muslims (panagopoulos, 2006). to add, after the attacks on the world trade center, the muslim community living in the united states, and in other parts of the world, particularly the west, became widely mis-represented in the mainstream media (hodge, 2005; kenan, 2005). the term terrorist has generally become associated with muslim. hence, many muslims appear to experience negative sociocultural, sociopolitical, and socioeconomic consequences, especially those who live in new york city. they experience more stereotypes, more hatred directed to them and appear to be feeling more segregated from the larger mainstream population (bornstein, 2005; peek, 2003). employment discrimination of american muslims after 9/11 has become more common (cavico & mujtaba, 2011) and many acts of vandalism, threats, and attacks on mosques have occurred. one study illustrated that muslims living in new york city experience more fear, than other ethnoreligious minority groups, that a hate crime will be directed at them and they are more anxious about the future (abu-ras & abu-bader, 2008; akram, 2002). employmentbased discrimination towards muslims has increased 150 percent since 9/11 (pelofsky, 2010). likewise, hate crimes directed towards muslims remains high when compared to many other religious groups (federal bureau of investigation, 2011). the numbers of hate crimes towards muslims have decreased considerably when compared to the 1600 percent increase in hate crimes directed towards muslims directly following the 9/11 terrorist attacks (potok, 2011), but recent reports have shown increases beginning again in 2010. for instance, there was a 50 percent increase in hate crimes towards muslims in 2010 when compared to 2009 (federal bureau of investigation, 2010). these trends demonstrate the continued prevalence of hate crimes directed towards muslims post 9/11. recent anecdotal evidence from news reports following the 2013 boston marathon bombings reaffirms the prevalence of this negative sentiment directed towards muslims in the united states (gray, 2013). post 9/11 there were also public policy changes related to national security and immigration which led to a substantial increase in the number of deportations of undocumented immigrants within the united states. the passage of the homeland security act led to an increase in financial resources used to monitor immigrants within the united states and provided greater flexibility for immigration officers to detain illegal immigrants (besthorn, 2008). these policies affected the well-being of muslims, who now had to deal with the possibility of deportation (in the case that they were undocumented migrants) and detainment. furthermore, under the homeland security act, efforts to address the situation of undocumented immigrants within the united states were coordinated among multiple government departments (including the department of health and human services). as a result, individuals who needed health and human services became less likely to seek such support because of fears it would impact their immigration situation. these policies also led to muslims now needing more services related to employment discrimination, legal services as some became the victims of hate acts and detention, and supports promoting community inclusion as the general public shier, graham/social service needs of muslims post 9/11 398 perception towards muslim became negative. many of new york city’s muslim communities then started turning towards their mosques for services (such as for legal, financial and subsistence resources) to deal with the increased discrimination and inequality that they were facing, whether it be at the workplace, when travelling, when accessing government services, within the school systems, and generally when undertaking their day to day activities (abu-ras, gheithb, & cournosc, 2008). the dominant focus within the research literature has been on investigating experiences of individual muslims post 9/11 (abu-ras & abu-bader, 2009; carter, 2010; hall, 2007). other studies have looked into the experiences of social work practitioners working with muslim service users (adams, boscarino, & figley, 2006; matthieu, lewis, ivanoff, & conroy, 2007; mctighe, 2009). both research trajectories focus on identifying gaps in knowledge and training needs of service delivery personnel to assist muslims (colarossi, berlin, harold, & heyman, 2007; miller, 2001). few studies have looked at how service provider organizations that work with muslim service users have responded to the changing sociopolitical context post 9/11. waizer, dorin, stoller, and laird’s (2005) exploratory research described the need for service providers to re-focus service delivery goals and the types of services offered based on the emerging needs of members in the community (both muslim and non-muslim alike). but their research only describes an organization within new york city being responsive to the immediate needs that emerge following a crisis. for instance, they describe the need to be responsive with food and other forms of subsistence aid. they describe organizational processes that are necessary to be effective in their response to the immediate crisis, such as being coordinated or having adequate infrastructure support. based on the description of their case study analysis, this one organization did not change or adapt to meet the emerging needs of a population of service users because of a changing sociopolitical context. instead, they describe an organization that is immediately responsive to help deal with a particular crisis. in this particular case, it is apparent that human service organizations responding to social service users post 9/11 were simply looking to address the needs that individuals had because of the act of terrorism itself. the assumption within much of this research is that the social environment did not permanently change because of the terrorist act and that the role of service provider organizations is only to respond to the immediate crisis. other research on the role of human service workers in responding to the needs of service users following a situation of terrorism has similarly made this assumption. for instance, the focus is primarily on individual service users and the implications of the terrorism experience for individuallevel functioning with a focus on addressing experiences with trauma and grief in certain population groups, such as children (baum, 2005; kaplan, pelcovitz, & fornari, 2005). within these studies, emphasis is placed on the role of practitioners in being responsive to these individual-level psycho-social needs by providing therapeutic interventions or outreach services to affected individuals (miller, 2003). however, what has become apparent following the 9/11 terrorist attacks is that the sociopolitical context has changed permanently and this has resulted in different social welfare needs among muslims. for example, kaplan and colleagues, (2005) described methods of intervention when working with children directly impacted by the 9/11 terrorist attacks. however, their research did advances in social work, fall 2013, 14(2) 399 not comment on the longitudinal impacts of the 9/11 terrorist attacks on muslim children and their experiences. the present study is the first to consider the impact of 9/11 on human services that served a predominantly muslim clientele living in new york city. methods data were collected in 2004 from all five of new york city’s densely populated boroughs. a total of 19 social workers or related human service professionals participated in face-to-face interviews with the researcher and/or a trained research assistant. since changes in public policy would likely impact adaptations to service provision differently in community-based organizations and public sector programs of support, we differentiated between participants working in community-based organizations (whether they received government funding or not) and those that were working directly for government programs. our focus was on the efforts of community-based organizations that were providing services and supports (including counseling services, resources, community access, etc.) to muslims. purposive sampling methods were used to identify participants. initially, a member of the research team conducted a preliminary screening of key informants through interviews with leaders (both professional and religious) in the muslim community in new york city. the inclusion criteria of the study were that all respondents must be working with muslim service users and/or muslim communities providing some form of mandated individual, familial, or community support such as advocacy, referrals, implementation of community development projects, counseling, and so on. many participants were muslim, but not all were. table 1 provides a description of participant gender, educational background, area of practice, and religious community of service users. the study received ethics certification and approval from the university of calgary’s conjoint faculties research ethics board. table 1. characteristics of study participants gender and frequency educational background and frequency categories of area of practice religious community of service users female 9 male 10 uncompleted post-secondary -3 certificate1 bachelor 9 master 4 phd 2 corrections immigration services child welfare youth development hiv/aids support domestic violence mental health housing support income support shi’ia sunni ismaeli data collection qualitative interviewing techniques were utilized to collect data (holstein & gubrium, 1995; patton, 1990; seidman, 1991). initially, participants were contacted by telephone and informed of the study by one of the research team members. after shier, graham/social service needs of muslims post 9/11 400 respondents agreed to participate, the initial interviews were conducted in-person by a trained research assistant, usually in the respondent’s office. most participants were interviewed twice for approximately one and a half hours each time (some participants declined participating in a second interview). two interviews were conducted, several months apart, to allow the researchers to follow up with content reported in the initial interview. in some cases (for participant convenience) the second interview was conducted over the telephone. the interviews were digitally recorded with consent. a semi-structured, open-ended interview guide was utilized. the interviewer asked the respondent a question from the interview guide, allowing sufficient time for an indepth response. depending on the extent of the response or the reaction of the interviewee (i.e. inquiring for more clarification) probing questions were utilized to get at the phenomenon under study. questions included: what are the models of social work intervention used by you and your agency? what has been the agency’s role after the september 11, 2011 terrorist attacks? what aspects of your training work well with muslim people? are there aspects that don't work well? how does your ethno-religious background influence your practice? what are the most important pieces of knowledge a practitioner needs in order to work in a muslim context? other questions related to ways of implementing ethno-religiously sensitive practice techniques, practicing with clients of the opposite gender, and discussing the agency’s role in the context of new york city after the 9/11 terrorist attacks. data analysis qualitative methods of analytic induction and constant comparison strategies were used to analyze the data (goetz & lecompte, 1984; glaser & strauss, 1967). specifically, emergent themes (charmaz, 2000; williams, 2008) and patterns (creswell, 2009; fetterman, 2008) were identified that focused specifically on how participants described their interaction with clients and other factors that could be considered external to their organization. first, the researchers read through all the interviews with the goal of identifying common themes related to the different ways in which service providers responded to the changing social environment factors external to their organization post 9/11. these themes were then coded based on the theme they represented, and the data were searched for instances of the same or similar phenomena. following this, the themes were then translated into more general categories and refined until all instances of contradictions, similarities, and differences were explained, thus increasing the dependability and consistency of the findings. all members of the research team worked collaboratively on this stage of research to maintain the credibility criteria of the study. that is, each of the three members of the research team independently coded the data, keeping notes about their own thoughts and impressions of the themes (i.e. audit trail), and then consulted with each other. two general categories related to the organizational level context of service delivery post 9/11 emerged from the analyses. within each of the two categories, data were analyzed further following the same processes as described above until all findings were coded. the following section provides the findings, supported by representative participant quotes. advances in social work, fall 2013, 14(2) 401 findings the two general themes that emerged were: 1) organizations sought to address limits in service delivery programs that were a result of emerging sociopolitical dynamics (such as increasing discrimination) through adaptations to existing programs or through the development of new initiatives, programs, and organizations; and 2) organizations adapted programs and services to meet the emerging sociocultural demands (such as changing attitudes towards help-seeking, and presenting problems of services users) of the muslim population. addressing limits of service delivery programs when systemic issues in society go unaddressed and traditional methods of service delivery are not challenged, there can be an ongoing repetition of service usage that does not meet changing service user needs. most research has preferred to focus on the role of practitioners working with service users in addressing these systemic issues or service delivery challenges, with less emphasis on how these issues are addressed at an organizational level (ezell, 2001; lundgren, curtis, & oettinger, 2010; schneider & lester, 2001; spencer et al., 2010). this omission is problematic since locally based nonprofit direct social service organizations have taken on increasing responsibility over the last three decades in addressing the direct needs of service users (maloney & van deth, 2008; mayer, 2003; mulvale, 2001; powell, 2007; salamon, 2002). the findings from this study contribute to this literature by pointing out the role undertaken by predominantly muslim service providers in new york city in addressing limitations in existing programs and services as a result of the changing social and political context post 9/11. respondents highlight that their community-based organizations responded to these changing needs by adapting existing programs and by developing new initiatives, programs, and organizations. by adapting existing programs following the 9/11 terrorist attacks, public policy (such as immigration and national security policy, with the advent of the homeland security act) and general public perception towards muslim individuals changed considerably (jalalzai, 2011). as a result, local community-based social service organizations were challenged to address emerging issues of discrimination that muslims who lived in new york were facing, along with their increasing fears of detainment and deportation if they accessed government social support. while previously, individuals might simply have accessed benefits on their own, following 9/11 more outreach was required from social service agencies to reach individuals in need. beyond outreach, other respondents described the need to adapt programs to be more focused on advocacy. one respondent commented on how muslims now experienced more violations of human rights in their local communities, unfair access to resources, poor employment opportunities and unlawful detainment: the needs of [people], basically [we asked] ‘what should be the first thing we should do?’, and we found out that so many people were uneducated especially shier, graham/social service needs of muslims post 9/11 402 just in speaking english or writing english that it was greatly needed. so we started doing esl courses and as we did esl courses we got legal representation, we did legal clinics, we did “know your rights” clinics, we gave help to people who were detained. addressing language barriers is important for all new immigrant groups, but it became particularly important for muslims living in new york city post 9/11 so that they could advocate for their rights when being questioned about their legal status by authorities. respondents also said that, among programs aimed at supporting individuals directly affected by the 9/11 terrorist attacks, they perceived an absence of support to muslims who were now the subject of a growing public resentment. for instance, one respondent said: …[respondent identified initiative] was the initiative we launched immediately after 9/11 because the city and the country seemed to only be focused on psychological healing and america defending itself and attention to the victims. we (muslims) all were suffering along with the rest of the country, but it was clear also that there was something else at play here with the hate crimes, and the scapegoating of south asians. immediately after (the attacks) i got a random call from a funder, a south asian funder at [respondent names foundation] asking about the situation because the word was spreading within the south asian community – south asian and other muslim communities – that we were isolated and there was really no attention or recognition of what was happening with our community. respondents also said that help-seeking by muslims changed because now they required more direct support. muslims felt so vulnerable that agency staff had to be present when muslims were dealing with the legal and immigration system. agency staff reported having to really advocate for muslims who now felt fearful even when they had done nothing wrong, especially if they were interacting with the legal authorities. there was a tremendous sense of fear and isolation by muslims living in a post 9/11 climate in new york city. one respondent said, so we become the third person sitting in the office with the lawyer to provide them with what the client is saying …that again happens in the housing. people are usually afraid when they sit in front of a lawyer so we not only do that but we also provide a kind of a moral support. when they go to the immigration judge, we stand together with them…going with them to the court so that they do not feel alone. this is even in the cases where people with legal backgrounds have received notices to appear. social service agencies also had to provide increased support in other areas of services users’ lives. for instance, some respondents talked about having to provide support to assist children facing discrimination in schools. one respondent shared: for example: say if i was a muslim person and i have to report a crime to the police, i worry are they going to ask me for my social security number or are advances in social work, fall 2013, 14(2) 403 they going to ask me if i am documented or not. if they are doing that then i am better off not asking for help. so not only are people now scared of asking for help to the law enforcing agencies but that fear has been extended to asking for social services. even the concrete type of social services like your benefits, medical care and public assistance. by developing new initiatives, programs, and organizations some organizations also began challenging these emerging sociopolitical dynamics by developing new initiatives, programs, and organizations or by restructuring existing organizations. respondents identified six ways that their organizational focus changed when assisting muslims. first, respondents described changing program mandates and their general goals of service delivery. this program now offers a bit of counseling and it’s a space where youth can share, name their feelings and understand it within a broader context. you know the context of post 9/11, being south asian in america, being an immigrant, being a minority, being a man, etc. then there’s an organizing piece. they wanted to do something. they wanted to exercise their new skills or share what they’ve learned. what they’ve decided to do is to put on a play which highlighted some of the challenges that they face and i thought it was quite powerful. as this respondent describes, a key focus of organizational efforts for some organizations was on creating awareness and validation among muslims about their experiences with discrimination. second, other service providers described how they created organizations to respond to some of the needs of muslims living in new york city. one respondent described: we were able to come together quickly…we all took ownership of the organization and we took the responsibility of responding to the media, responding to children, to interfaith groups. that was our responsibility, and only ours in the sense that even if somebody else was out there to do it we wanted to be the people who were the go ‘teach people about islam. this respondent describes the need to develop a new organization following 9/11 that sought specifically to educate others on who muslims were. there appeared to be a great misunderstanding of what islam was. a third theme was that some service providers felt they had to change their organizational make-up by changing the diversity of human resources and the specific demographic categories (such as gender and age) of service users that qualified for services. for instance, one respondent said: well i would say that we get a lot of phone calls and a lot of inquiries for help and i think the main thing is that we want to expand our services. we also are a multi-ethnic staff of muslims and we want to continue to expand on that because that alone helps us break down stereotypes that people have; ethnic stereotypes shier, graham/social service needs of muslims post 9/11 404 or ethnic preferences. so that’s something that you can just do and it speaks for itself. i think that is very important. a fourth theme was that some service providers felt they had to change the mission of the organization so that they addressed the misperceptions of muslims held by the general public. instead of just offering individual level services some organizations began public education initiatives. now agencies were finding that they had to undertake advocacy-based initiatives to address the discrimination experienced by muslim service users. for instance, one respondent described: there is certainly a lack of understanding or even lapses of understanding of the needs of the muslim community and what goes on in their lives. so i have been focusing a lot on educating people and raising awareness of what the trauma of 9-11 has done to us collectively and how it has changed the lives of the muslim community. especially those that have come directly under attack. a fifth theme described how service providers responded to the sociopolitical context by changing the way that their services were offered. the workshop environment [type of service delivery model this organization was using before september 11, 2001] may not be the best situation, and also parents may not want to talk about their situation, their child, or their family, particularly in the heightened fear of immigration, almost mccarthy like period that new york city at least, if not the country, is living under. also there have been difficulties in terms of people reporting on each other to the fbi, and nobody wants to draw attention to themselves in this really heightened, politicized environment. we had to find different ways of training parents, and this was not the best way. the final theme in this category was the recognition by organizations of their need to interact in collaborative advocacy arrangements with other organizations and community groups: and yes, we do, the advocacy part is in collaboration efforts, like for example, we did participate in the freedom right movement. we did…we put our point of view towards the mayor for the executive order 41 which is the do not tell policy. and [long pause] we focus on every issue which is important to an immigrant and whatever can be done, we try to do. we are young. we are not even two years old, so we take our help of the umbrella organizations and advocacy based organizations and join hands with them. some respondents also described the need to work with other community-based actors and connecting with cultural groups: yes, this is the one that just happened last week, december 2. we wanted to work in a low threshold way into the south asian community. we were talking about drugs and alcohol which are often the negative side effects of stress. especially after 9/11, that’s something that we wanted to address as part of our work. that’s the mandate of our grant—prevention and treatment of drugs and alcohol. advances in social work, fall 2013, 14(2) 405 obviously we connected that to stress management and the factors that cause stress in these communities that can lead to abuse of alcohol and drugs and domestic violence that emerges and sexual health, as well as hate crimes and racial discrimination obviously. in order to address these factors, we planned a community event where we brought together social service providers such as lawyers, doctors, and employment specialists and some of our social workers who acted as consultants and could speak to people one-on-one, give them advice and services on an individual level at this community forum. another respondent described the need to develop relationships with other organizations and work collectively towards some larger systemic goals. because we want experts, so we actually got in touch with them and got them. we got the new york civil liberties union, the new york immigration coalition, aalef (asian/american legal education fund). we are also now working with the city board. we are working with private attorneys also – (respondent gives name) one of the best immigration attorneys. we’re also working to help to help to initiate a coalition bordc – bill of rights defence campaign. refocus programs and services to align with sociocultural and demographic changes community-based human service organizations are challenged to adapt to emerging trends within the social environment (gronbjerg, 2001; spall & zetlin, 2004; strolovitch, 2006). these adaptations (or innovations) have been defined in a typology of three categories: 1) adaptations to programs and initiatives to meet the changing administrative and technological needs of the organizations (including fundraising, resource sharing, and technological improvements) (see for example: mano, 2009; sargaent, 2001); 2) direct practice innovations including implementation of evidence based practices and changing methods of intervention (see for example: cook & sabah, 2009; murray, 2009; simpson, 2009); and 3) program implementation, including new program development to meet changing or emergent client needs and the procedures utilized in the way services are provided (see for example: blue-howells, mcguire, & nakashima, 2008; prince & austin, 2001; wood, 2007). in this order, jaskyte and lee (2006) refer to these three types of innovative or adaptive programs or initiatives as administrative, product, and process innovations. respondents here provide evidence that their organizations undertook product and process innovations by refocusing existing programs to align with changing sociocultural and demographic needs (such as attitudes towards help seeking or increasing the level of services available for a specific gender) of muslims living in new york city. for instance, some respondents described that patterns and attitudes towards help-seeking among muslim people in new york city changed resulting in the need for more informal processes of helping: this is what’s happening. do you think if this individual witnesses a rape, a murder, do you think he’s going to say, “oh that’s the person,” no way. i had another case – i came from work – a 12-hour shift…individuals crying on my shier, graham/social service needs of muslims post 9/11 406 doorstep. i asked them what happened. he said he was unable to urinate for the past 12 and ½ hours. i said, “why don’t you go to the hospital? why don’t you call 911?” and he’s crying and said, “because i’m undocumented. i’m afraid to go there.” i took him immediately to the hospital – the doctors worked on him for two hours – operated on him. and the doctor informed me if he did not come in at that moment he would have been in critical condition. his bladder would have burst. he had some sort of blood clot. besides changing patterns in service utilization and access, other respondents identified that muslim men would require more services and some organizations adapted the focus of their programs that might only provide services for women and children: some people find that women come to us more often after the special registration and 9/11. after special registration you will see men, a lot of men coming here for legal advice and legal services. similarly, another respondent described: we have males coming here to the centre. they were shy about it but some others you know they just feel they have to do it because they were not in a good situation and they needed help. some respondents also described how the presenting issues of service users had changed and this resulted in service delivery adaptations to adequately reach the population in need. for instance, one respondent described: i'll give you examples – pre 9/11 a lot of women who were undocumented and had found themselves in abusive relationships would, if encouraged enough, seek counseling, seek advocacy, seek legal help. we have the violence against women act that allows them to self petition for themselves if they are undocumented and their abusive husband or spouse is a green card holder …now post 9-11 these women are very hesitant to go and ask for help unless there has been a breach of trust. the women who are being abused at home, and i am giving you a scenario where the abuser says “try going out and asking for help, the children will be taken away and you will be put on a plane and be deported”. whether that would actually happen or not that's enough to put fear in the woman's mind to not access help. likewise, another respondent commented on how the issues faced by youth in the community had changed resulting in changes in program focus to deal with the psychosocial implications of experiencing discrimination or the fear of deportation: most of the young people were shocked and they were upset and they were grieving and they were confused, but the one thing that they experienced which was unique is – after the attacks and the rumors about the attack spread very quickly, is they suddenly felt like they were being scapegoats or that they were responsible for it. then there were the special registrations targeting them as a community, and some of these kids, kids who were born here or had been here advances in social work, fall 2013, 14(2) 407 who only know america even if you know they came here when they were small, were like “well ok i thought this was my country…where do i fit in”. respondents also identified that they saw changes in clients’ cultural identity. for one respondent service delivery adaptation was about recognizing the new dynamics between muslim cultural groups: yes, i mean sometimes muslims would be active within their own muslim cultural groups within a certain area and would build a mosque together, would organize together, help each other get jobs and things like that. but now it has become much broader and it is beginning to expand beyond those ethnic boundaries. discussion and conclusion for respondents in this study, social environment factors such as rights violations, changes in public perceptions about a service user group, the emergence of restrictive public policy, the lack of acknowledgement of social injustice by the general population, and the absence of supports and empathy from government institutions, all acted as triggers for organizations to adapt after 9/11. the result were changes to organizational mandates and the general focus of service delivery, the creation of new organizations, changes to the organizational structure and the diversity of personnel within organizations, new missions and goals within organizations, adaptations to service delivery approaches, and increasing collaboration with other organizations and community groups. as a result of the changing social environment for some muslim service users after 9/11, from the perspective of these respondents, these adaptations were important because patterns and attitudes of help seeking, types of services needed, the demographics of the service user population, and the presenting issues within the service user group all changed. the findings demonstrate the need for social workers and other human service practitioners to be adaptive and flexible in the program delivery models offered in their organizations. extending these ideas into other practice settings might be useful for social work practitioners who struggle to become adaptive and flexible as service progresses. this research gives service provider organizations some ideas about where to begin thinking about what factors external to their organization are impacting their services. if service providers can make these connections between social environment change and service user needs they might be able to respond differently (as service providers in this study did) to the changing needs that service users have. there are some limitations of this research. this research is exploratory and, as is the case with all qualitative research, the findings are not generalizable to all organizations providing services to muslim service users. in fact, some human service organizations are more adept at responding to those social environment factors that promote or support marginalization of certain groups within the population (jones, 2006; netting, o’connor, & fauri; 2007; schmid, 2004). our findings identify ways in which some human service organizations providing services to muslim client groups had adapted their services after the events of 9/11. we also identified what factors acted as triggers for these changes. these excerpts help to highlight those sociopolitical and sociocultural factors that they shier, graham/social service needs of muslims post 9/11 408 were responding to, providing useful insight for the transferability of the findings to other contexts where service providers are working with marginalized groups in society made vulnerable by negative social environment factors. the data presented in this study were collected in 2004. this is an important period, following a several-year hiatus since 2001, that provides historical perspective with which the reader may begin to put the data in proper context. but further research based on the present context of services for muslim service users needs to be undertaken to determine the extent that these factors contribute to service delivery adaptation in the present. nonetheless, the 2004 data still provides a context for better understanding the role of community-based or nonprofit service delivery organizations in addressing the needs of service user groups and the aspects of our social environment that contribute to organizational adaptation. for this purpose, the data and findings are particularly useful for social welfare theory development. for instance, large portions of the system of social welfare in north america, and throughout many parts of the developed world, have been changing modestly since the mid-1990s. in many places there has been further government decentralization, heightened individualism, and neo-liberal policies supporting financial retrenchment of welfare state spending (evers, 2009; jordan, 2008; gonzales, 2007; mulvale, 2001). likewise, nonprofit and nongovernmental organizations have become more involved in directly addressing the changing social welfare needs of individuals and communities (anheier, 2004, 2009). this study provides some empirical evidence of the role of organizations in addressing changing needs as a result of sociopolitical changes in our social environment. mulroy (2004) clarifies these emerging dynamics of the role of community-based organizations and service user need through a discussion of an ‘organization-inenvironment’ approach. she highlights how organizations and communities are embedded in a hierarchy of structural conditions, but at the same time they have the capacity to change macro inequities that exist within society. this organization-inenvironment approach is evident in the case of the muslim service providers in this study. these agencies, of which the practitioner participants from this study were a part, played an active role in meeting the social welfare needs of some muslim individuals and groups in new york city after extreme sociopolitical shifts that emerged out of public reaction to the 9/11 terrorist attacks. in many cases these organizations acted as a first wave of response by assessing immediate changing needs of muslim service users. what these participants describe is that in order to be responsive to changing needs—developed from ongoing changes within the social environment—service providers, generally, need to be actively engaged in responding to these negative sociocultural and sociopolitical aspects of the social environment. for instance, practitioners need to look for changes in the demographic aspects of the service population; they need to examine the sociopolitical and sociocultural context impacting client groups; and they need to undertake ongoing assessment of the role of their organization in defining service based on changing service user needs that are in conflict with government policies. advances in social work, fall 2013, 14(2) 409 while these data show that events happen that require service organizations and practitioners to change in many different ways, it is important to ask: how do they respond if these ‘events’ are slow progressions, in situations where clients have simply become passive recipients of a service that is defined by an ineffective government policy or externally mandated initiative? these findings suggest that social work education could train students to better recognize and adapt to the implications of locality – not just cultural factors related to a demographically defined sub-population, but also political factors, public perception, economic conditions, geographic parameters, and social relationships. content within social work education could focus not just on organizational management, but also methods of collaboration, program and service delivery development, and ongoing community or environmental assessment. the research here also demonstrates the complexity of the social environment and the implications for social service user groups that are specifically affected by the sociopolitical and sociocultural context of the present. moreover, the insights that the respondents in this study provide are practical, and many can be carried out without enormous commitments of resources. but also, many of the ways these respondents describe adapting and changing services to meet evolving needs are complex and require a substantial commitment on the part of the service provider and an effort of actively seeking resources to adjust service mandates. this creates significant challenges for social workers and other human service professionals in community-based settings to adequately adapt services to changing service user needs. within our current social environment context there may be potential for scaling up these insights to any agency that works with muslim communities. and further research to consider how to scale up, and evaluations of such activities, would be valuable. this is necessary to adequately investigate the role of social work and its functional purpose with groups or individuals negatively affected by 9/11 in the united states and elsewhere in the world where similar experiences exist (such as in canada and european countries). more fundamental though, there needs to be an adaptation to mainstream social work knowledge and education within traditional welfare state countries which begins to recognize the role and function of direct service providers in nonprofit and nongovernmental organizations in adapting their services to meet changing service needs. as demonstrated by the respondents in this study through this case example of service providers for muslim service user groups in new york city post 9/11, it is evident that practitioners and organizational-level service providers have a key role in assessing need and responding through revised organizational mandates and practices. references abu-ras, w., &. abu-bader, s.h. 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(2010). understanding human behavior and the social environment (8th ed.). belmont, ca: brooks/cole publishing. author note: address correspondence to: micheal l. shier, penn school of social policy and practice, university of pennsylvania, 3701 locust walk, philadelphia, pa 19104-6214. email: mshier@sp2.upenn.edu toward building a culture of strengths in u toward building a culture of strengths in u.s. msw programs linda plitt donaldson barbara p. early min-ling wang abstract: social work has embraced the strengths perspective as a vital part of micro, mezzo, and macro practice. yet the authors’ experience suggests that the medical model of deficits, disease, and disorder remains the dominant paradigm. this exploratory study sought to determine how and to what extent strengths-based practice is integrated into the msw practice curriculum. forty-four (44) of 181 programs responded to a 12-item web-based survey. quantitative and qualitative responses indicate an almost universal awareness of and attention to integrating strengths-based content. however, a smaller number of programs appear to be looking beyond curriculum content towards the creation of a broader culture of strengths. even so, challenges remain toward overcoming a pathological orientation in social work practice curricula. keywords: social work education, strengths, assets, social work practice, culture of strengths introduction since the publication of saleebey’s first edition of the strengths perspective in social work practice (1992), the social work profession has embraced the strengths perspective as a vital part of the foundation of practice at the micro, mezzo, and macro levels. the council on social work education (cswe) defines the purpose of social work practice as the promotion of “. . . human well-being by strengthening opportunities, resources, and capacities of people in their environments and by creating policies and services to correct conditions that limit human rights and the quality of life” (cswe, 2001, p. 2) further, cswe requires curriculum content on practice at both the bsw and msw levels to be focused on “. . . strengths, capacities, and resources of client systems in relation to their broader environments” (p. 10). however, in the practice experience of the authors and in their students’ reports from the field, the medical model of deficit, disease, and disorder remains present if not the dominant model of social work practice in all, not just health-related, settings. in addition, less than half of our field agencies report using a “theory base” that includes a focus on strengths and empowerment. for those that do, they typically identify strengthsbased methods as one in a long list of models they use that could be applied from a strengths-perspective or not. while agency policy and individual social workers use the language of strengths, there is a parallel and competing focus on pathology and problems. true strengths-based practice requires that “. . . everything you do as a social worker will be predicated, in some way, on helping to discover and embellish, explore and exploit clients’ strengths and resources in the service of assisting them to achieve their goals, _________________ linda plitt donaldson, ph.d., is an assistant professor, barbara p. early, ph.d., is an associate professor and min-ling wang is a doctoral candidate, all in the national catholic school of social service at the catholic university of america in washington, dc. copyright © 2009 advances in social work vol. 10 no. 2 (fall 2009), 211-229 plitt donaldson, early, wang/toward building a culture of strengths 212 realize their dreams, and shed the irons of their own inhibitions and misgivings, and society’s domination” (saleebey, 2006, p. 1). educators are challenged to prepare students for strengths-based practice in a society and professional discipline that remain primarily problem-centered and deficit-focused. in such a context, a mere integration of strengths-based content into the curriculum may not be sufficient to educate, socialize, and help students internalize strengths as a paradigm, perspective, or set of practice models. msw programs may need to create a culture of strengths where strengths-based practice is taught in the curriculum, modeled by faculty in faculty-student interactions, and integrated in other aspects of the program. an organizational culture refers to shared values, assumptions, beliefs, norms, and expectations that guide the thoughts, feelings, and actions of organizational participants in all areas of their work (hemelgarn, glisson & james, 2006). in msw programs, organizational participants primarily include faculty, administrators, staff, and students. creating a culture of strengths may represent the stronger commitment required by msw programs to deliver social work education that best prepares students for strengthsoriented practice in a problem-centered world. this paper reports the findings of a preliminary study of master of social work (msw) programs in the united states. the study sought to determine how and to what extent strengths-based practice is integrated into the practice curriculum and educational climate of msw programs as a beginning look for a culture of strengths. this paper first discusses the struggle the profession has endured in its attempt to shift from a disease model to one of strength followed by a discussion of organizational culture and how that may be applied to conceptualize a culture of strengths within an msw program. to present the study, the paper describes the methodology and preliminary findings, and concludes with the implications of those findings for social work education and research. for the purpose of this study and consistent with the literature on strengths-based practice, we define strengths-based social work practice (saleebey, 2006) as micro, mezzo, and macro methods that facilitate change by first placing an emphasis on uncovering the strengths, capacities, resources and assets of individuals, family, and/or community and building upon those strengths, etc., to promote change. examples of strengths-based methods include: solution-focused and narrative therapies (dejong & berg, 2002; freedman & combs, 1996); strengths-based case management (rapp, 1998); asset-based community development (kretzman & mcknight, 1993); and popular education (friere, 1993). we view the teaching of strengths-based practice methods as guided by the following underlying principles: all individuals and families have strengths and all environments have resources; growth and change happen by mobilizing strengths to further develop and capitalize on existing resources rather than placing a primary focus on deficits, disease, dysfunction, or disorder. the role of a practitioner is non-expert. it is collaborative, educative, and facilitative; the individual, family, and/or community are experts on themselves. advances in social work, fall 2009, 10(2) 213 literature review in 1915 abraham flexner argued that social work was not a profession, in part, because it lacked a systematic and transmissible set of practice methods and a grounding in science (2001). the budding profession responded to this critique by developing a culture and set of practice methods where “treatment” for the ills of individuals and society was predicated on presenting problems and deficits, modeled after the medical profession. specht and courtney (1994) chronicle the profession’s “connection with modern psychiatry in the 1920s, psychoanalysis in the 1930s, and humanistic psychology in the 1950s” (p. 97) leading to its emphasis on fixing the problems within the individual. modern day social work visionaries believed that the traditional disease model of explaining social and psychological problems and the medical model of intervention or treatment were not reflective of core social work values. therefore, they began to propose another way to view helping. among those visionaries was ann weick, who in 1983 wrote a seminal article on this emerging perspective entitled “issues in overturning a medical model of social work practice.” in it, she called for a “health-oriented paradigm of human behavior” (p. 467) in which clients no longer “give over” the assigning of meaning of their “illness” to an expert, but rather mobilize their capacity for self-healing. however, even the “health” model, while changing the locus of healing from the expert to the self, continued to imply an “illness” to be healed. as time progressed, the health paradigm transformed into the strengths perspective, again with weick and others (1989) shifting the dynamic from healing to change or growth and eschewing the need for diagnosis as a prerequisite for that change. the emerging strengths perspective is captured in the posing of a question, “the question is not what kind of a life one has had, but what kind of a life one wants, and then bring to bear all the personal and social resources available to accomplish this goal” (p. 353). in both articles, weick and her colleagues gave examples of the conflict between social work’s deeply held values and the intransigent culture of the medical model. they noted that in the medical model a problem must be named and its cause determined by an expert. in this process a client is required to give over control of the understanding of the problem to the meaning system of the healer. this presents a conflict with the espoused social work values of inherent dignity of the person, and self determination and empowerment in change. if social work assessment and intervention were based instead on an inherent belief in human potential, the conflict would be ameliorated. the new paradigm of strength more firmly grounded itself into social work practice in the 1980s. the deinstitutionalization of persons with serious and persistent mental illness via the 1963 mental retardation facilities and community mental health centers construction act led to the need for more effective community-based methods to serve people with the most severe forms of mental illness in their transition from hospital to community (solomon, 1992). in 1982, representatives of the university of kansas school of social welfare developed the first of a series of case management pilot projects that led to the development of strengths-based case management (staudt, howard & drake, 2001). in addition, the great society programs established through the economic plitt donaldson, early, wang/toward building a culture of strengths 214 opportunity act of 1964, particularly the community action agencies, led to a resurgence of community and policy practice models whose principles could be summarized by the phrase “power to the people” (fisher, 2005, p.47), practice principles that align well with strengths-based practice methods. since then, a growing practice literature has developed in micro, mezzo, and macro practice (berg, 1994; butler, 2005; chapin, 1995; dejong & miller, 1995; green, mcallister & tarte, 2004; rapp, 1998; rapp & lane, 2009; waites, 2009). in addition, social work education has embraced the strengths perspective. the council on social work education mandates strengths content in its educational policy and accreditation standards (cswe, 2001). many contemporary texts are oriented towards strength and capacity, in the generalist (dubois & miley, 2005; poulin, 2004; timberlake, farber & sabatino, 2008), clinical (dejong & berg, 2002; helton & smith, 2004; rapp & goscha, 2006), and macro (chapin, 2007; long, tice & morrison, 2005) practice areas. however, it is not clear that the profession is ready to break out of its emphasis on disease and disorder to fully embrace and internalize the mobilization of strengths as the core focal point for interventions. social work education is designed to socialize and educate competent social work professionals, to generate knowledge, and to exercise leadership in the profession. consequently, to prepare students to competently apply knowledge and skills in strengths-based practice, schools of social work must both teach a strengths-based curriculum and model a culture of strength within their organizations or programs. this study is an effort to begin assessing the extent to which msw programs in the united states integrate strengths-based content into their programs. to determine whether an existing study on social work education and strengths-based practice had previously been done, the researchers queried databases in the scholarly literature (social work abstracts, social services abstracts, and sociological abstracts) using key word searches that paired the term “social work education” or “education” with the following terms: strengths, resilience, assets, empowerment, coping, capacity, and resources. researchers also reviewed the table of contents for the previous ten years of the journal of social work education and the journal of teaching in social work. none of these efforts uncovered any study examining the state of strengths-based practice in u.s. msw programs. organizational culture organizational culture refers to the shared norms, beliefs and behavioral expectations that drive behavior and communicate what is valued in an organization (hemelgarn, glisson & james, 2006). schein (2004) describes culture as a gestalt, where the whole is more than the sum of its parts. some of the elements that comprise this culture gestalt include, e.g., shared language, norms, values, roles, formal philosophies, habits of thinking, and formal rituals. however, while these elements are a manifestation of culture, they do not capture the full essence of culture, for they do not address the depth and breadth of those manifestations, nor do they let the observer fully understand how these elements integrate to create the gestalt. schein proposes three levels of culture to define, describe, and understand the various dimensions of culture within an organization. advances in social work, fall 2009, 10(2) 215 schein (2004) refers to level 1, where the surface level of culture exists, as artifacts. these are “the phenomena that one sees, hears, and feels when” they encounter an organization (p. 25). examples of the artifacts include language used, visible products such as mission and value statements, formal descriptions of organization, and so on. schein notes the importance of realizing that these artifacts are easy to observe but very difficult to interpret unless one was part of the culture that created these artifacts or has used these artifacts for some time, i.e., taking an anthropological approach. level 2 refers to espoused values and beliefs. schein differentiates between actual values and beliefs and “espoused” values and beliefs. espoused values and beliefs are those which a group aspires to reflect in their actions and behaviors, but have not yet achieved. schein refers to level 3, as underlying assumptions, which are views about the organization, its structure and processes, ways of being that are a given. they are so ingrained as part of the culture, they are unconscious to the stakeholders and taken-for-granted as “the way it is.” these underlying assumptions often begin as espoused values and beliefs, but overtime become fully internalized and second-nature to organizational or group members. social work researchers have acknowledged the need for change in the organizational culture of social work programs when a curricular change represents a challenge to traditional assumptions, values, and attitudes of program faculty. nichols-casebolt, figueira-mcdonough and netting (2000) argue for social work curricula that integrate the long-neglected experiences of women throughout the curricula, including a critical analysis of how women’s experiences have informed the dominant theories and models that form the basis for social work knowledge construction and intervention. because this curricular shift reflects “a major shift in institutional culture whereby fundamental beliefs [are] challenged” (p. 67), the authors recommend that the change strategy begin by assessing the school’s culture. nichols-casebolt et al. argue that an understanding of culture is important to achieve desired changes in program curricula, but they do not explicitly address the changes, beyond the program curricula, that would represent a cultural shift beyond curricular issues. several authors have talked about the importance of changing the professional culture of social work programs to promote the teaching of evidence-based practice (ebp) (shlonsky & stern, 2007; soydan, 2007; springer, 2007). springer observes that this shift in culture requires more than an integration of ebp throughout the curriculum, but a modeling of critical inquiry in the classroom. this study begins to uncover cultural shifts some programs have embarked upon to both integrate and model strengths-based practice in their programs. methods this research project used a survey design to explore the degree to which u.s. msw programs were integrating strengths-based content into their curricula. to gain a better sense of the strengths-based nature of the program, we solicited information on other indicators which may suggest that a program goes beyond curricular content in an effort to build a culture of strengths in the program. the researchers collected data through a web-based survey consisting of open-ended and closed-response questions sent to 181 chairs of accredited msw programs across the united states. institutions were only plitt donaldson, early, wang/toward building a culture of strengths 216 permitted to submit one survey. the researchers selected a survey design for this initial inquiry into the integration of strengths into msw programs, intending to follow-up with a set of the respondents with more in-depth qualitative interviews as a continuation of this project. instrument the researchers developed a 12-item survey that was divided into two sections: 1) demographic information, and 2) strengths-based culture. a copy of the survey is included in the appendix. the demographic information section solicited data about the respondents (i.e., their position and number of years they had been with the program), and the program itself (i.e., the number of full-time tenure-line faculty members; the number of part-time or non tenure-line faculty members, the number of students in the program, and a list of concentrations). the strengths-based culture section included six questions designed to assess the degree to which programs infused and promoted a culture of strengths. language is the primary symbolic representation through which groups, organizations, and communities convey their culture. therefore, the first survey question related to strengths-based culture asked respondents to list the words used in their msw programs’ written materials that “indicate the presence of strengths-based social work practice content in your curriculum.” in the second survey question, respondents were given a set of 10 characteristics (see table 4), and were asked to select all items that applied to their program during the last academic year. to use schein’s (2004) terminology for culture, these 10 characteristics, along with the language programs use to convey strengths, represent the level 1 dimension of a culture of strengths within an msw program. these characteristics represent the artifacts, the visible manifestations and formal descriptions of the organization and do not necessarily reflect a deep or broad culture of strengths within the program. respondents were also asked to rank their programs on a scale from 1 to 10 according to 1) the extent to which the program infuses strengths-based content in the curriculum, and 2) how well the program promotes the learning of micro-mezzo-macro strengths-based practice methods. for these two scalar questions, respondents were asked to elaborate on why they selected the numerical ranking. the qualitative explanations of these rankings provided some insight into the degree to which a program’s strengthsbased culture extended beyond artifacts to include schein’s level 2, espoused values and beliefs, and level 3, underlying assumptions or degree to which a strengths-based culture is internalized within msw programs. data analysis the data analysis included both quantitative and qualitative methods. the quantitative data were coded and entered into spss. researchers calculated average scores for the scalar question responses and ran correlations among various program characteristics to test for significance. in addition, researchers used spss to analyze descriptive features of the programs. researchers entered the qualitative data into a word advances in social work, fall 2009, 10(2) 217 document and analyzed those responses together as a team to assess convergence between quantitative and qualitative data. researchers also analyzed the qualitative data to identify items beyond the 10 characteristics given in the instrument that demonstrate a strengths-based program, and to uncover challenges toward building a strengths-based culture in msw programs. the results of the data analysis are presented below. results this section presents the findings from this exploratory research project. first, a profile of the respondents is presented. next is a discussion of how programs create a culture of strengths, including the language used to connote strengths and the characteristics that reflected an integration of strengths into their programs, i.e., the artifacts (schein, 2004) of a strengths-based culture. included in this discussion are some of the challenges expressed by respondents in moving their program culture beyond mere artifacts to a level where a strengths-based culture is reflected in the values and beliefs of its members through their actions, behaviors, and ways of being, i.e., levels 2 and 3 of schein’s framework. a discussion with implications of these findings concludes the paper. profile of respondents representatives of forty-four of the 181 programs (24.3%) completed the survey. table 1 includes a breakdown of demographic characteristics of the respondents and their programs. of the 44 respondents, most were on the faculty either in msw department chairs/directors positions (n=18, 40.9%) or in a regular tenure-line faculty position (n=13, 30%). most respondents had been with their program between 8 and 12 years (n=14, 31.8%), although 8 respondents had been with their programs 19 years or more. the 44 programs were sorted into size categories based on the number of students. twenty-six percent were considered small, 30%, medium, and 44% were large. the majority of respondent programs (87%) were located in places from the midwest to the northeast, with very few respondents in western states. the majority of programs (59%) were located on urban campuses. there were no significant relationships found between any of these demographic characteristics and strengths-based rankings. however, all four of the programs located on rural campuses were among the high and highest self-ranked programs regarding how well they infused and promoted strengths-based content. this causes one to ponder possible cultural differences between programs located in urban versus rural locations, a question that was beyond the scope of this study. culture of strengths in msw programs the language of strengths. schein (2004) includes language as an important artifact of culture. saleebey (2006) writes of a “lexicon of strengths” (p. 10), reminding the reader that words and language exert strong influence on practice and on the self assessment of clients. the words chosen by respondents to indicate the presence of strengths-based social work practice in their curricula reflect one type of artifact (schein) showing how their culture of strengths are observable to outsiders. the respondents’ plitt donaldson, early, wang/toward building a culture of strengths 218 words fell into four general types—two describing client characteristics and positive processes and two describing practitioner perspectives and methods. table 1: demographics of msw program respondents and programs (n=44) characteristic n % total programs 44 100 position of respondents faculty 13 30 department chair/director 18 40 other 13 30 years have been with the program 0-3 5 11 4-7 7 16 8-12 14 32 13-18 10 23 19-30 6 14 over 30 2 4 program size (# of students)* small (0-100) 11 26 medium (101-200) 13 30 large (over 200) 19 44 number of ft tenure-line faculty 4-7 12 27 8-12 19 43 13-18 5 11 19-30 8 19 geographic region northeast 9 20 south 15 35 midwest 14 32 west 5 11 pacific 1 2 campus type urban 26 59 suburban 14 32 rural 4 9 *only 43 respondents indicated program size so percentages are calculated based on an n of 43. advances in social work, fall 2009, 10(2) 219 the first and largest category included individual client and external environmental characteristics. within this category, there was considerable consistency of responses. for example, of individual characteristics, there were mentions of “strengths,” or “ego strengths,” “assets,” “capacity” or “capability,” “resilience,” and “resources.” among the external or environmental characteristics, respondents mentioned “opportunity,” “protective factors” and “risk and protective factors.” the second category of responses described normative human growth process or positive goal oriented client behavior such as “coping,” “growth,” “post-traumatic growth,” and “rebound from adversity.” the third and fourth categories focused on the practitioner. the third reflected the practitioner’s strengths-oriented view or perspective on clients. examples were “strengths perspective,” “strengths-based perspective,” “biopsychosocial strengths-based perspective,” and “strengths-based framework.” the fourth and last category included the practice methods or approaches a strengths-oriented social worker might take. words chosen included “assessment of assets and resources,” “collaboration,” “freire model,” “solution-focused,” and “therapy for liberation, power and equality.” one final contribution fit in none of the categories. it was simply, “saleebey.” table 2 includes a full list of words mentioned by respondents placed into one of the four categories. table 2: the language of strengths client/person social work practitioner category 1: client and environment characteristics internal individual: strengths/ ego strengths (n=13); assets (13); capacity (11); resilience (17); resources (10); competency, human capacity for growth, motivation, client resourcefulness, human/social capital (n=1) external environmental: resources (9); opportunity, risk and protective factors, supports, buffers (n=1) category 3: social worker perspective empowerment, empowerment oriented, theories of empowerment (13); strengths, strengths-based perspective, or biopsychosocial strengths perspective (7), holistic (3); strengths-based framework, ecological framework, ecological and strengths perspective, social and economic justice, social work values and ethics, partnership, respect (n=1) category 2: normative human growth processes coping, growth, post traumatic growth, reach potential, rebound from adversity, recovery, skills (n=1) category 4: social worker practice methods strengths-based approach, practice, or models (4); assessment of assets and resources, strengths-based relationships, collaboration, community collaboration, use of natural networks, strengths-empowerment approach, enhance client pride and competence, enhance strengths, mobilizing supportive resources, freire model, advocacy, integrated practice, therapy for liberation and power (n=1) plitt donaldson, early, wang/toward building a culture of strengths 220 self-rankings for infusing and promoting strengths. respondents were asked to rank their programs according to two items: 1) the extent to which the program infuses strengths-based content in the curriculum (infusion), and 2) how well the program promotes the learning of micro-mezzo-macro strengths-based practice methods (promotion of practice). table 3 shows how respondents ranked their programs on each item using a scale of 1 to 10. as expected, since strengths content is required of msw programs, only two respondents ranked their programs as very low (rankings of 1, 2 or 3) for one or both questions. the majority of programs (34 out of 44) fell in the middle (scores of 4 through 9) with roughly 19% giving themselves the highest ranking of 10 on one or both questions, indicating that strengths-based methods were extensively infused throughout their program and/or that their program promoted the learning of micromezzo-macro strengths-based methods extremely well. table 3: self-ranking frequencies for scalar questions, scale from 1 to 10 (n = 44) self-rankings 1 3 4 6 7 9 10 total n % n % n % n % n % to what extent does your msw program infuse strengths-based content throughout the curriculum? 2 4 15 34 19 43 8 19 44 100 overall, how well does your msw program promote the learning of micro-mezzo-macro strengths-based practice methods? 1 2 11 25 23 53 9 20 44 100 for each program, researchers took the average ranking from the two scalar items (infusion and promotion of practice), and categorized msw programs according to the following criteria: medium: programs with average rankings between 2 and 6;1 high: programs with an average ranking of 6.5 to 9; and highest: programs with an average ranking of 10. 1 the researchers placed two programs with average rankings of 6 into the high category because they selected 6 or more characteristics, and the qualitative responses to other survey items clearly demonstrated a culture of strengths consistent with other programs in the high category. advances in social work, fall 2009, 10(2) 221 table 4 lists each strength characteristic and the corresponding number of respondents from the medium, high, and highest groups that indicated that their program reflects that characteristic. again reflecting the cswe mandate, nearly all programs (n=42, 95%) reported that they require texts or articles in foundation year courses that teach social work practice methods that use strengths or assets in the intervention (characteristic #4). furthermore, other characteristics selected by more than half of table 4: comparing selected characteristics of programs with average selfrankings of medium, high, and highest (n=44) medium (1 6) high (6.5 9) highest (10) total n % n % n % n % total programs by ranking 11 25 25 57 8 18 44 100 characteristics 1. explicitly refer to strengths/capacities/ assets in program mission. 2 18 16 64 7 88 25 57 2. explicitly refer to strengths/capacities/ assets in program goals. 1 9 15 60 7 88 23 52 3. explicitly refer to strengths/capacities/ assets in program objectives. 3 27 20 80 8 100 31 70 4. require texts/articles in foundation year courses that teach methods using strengths and assets as part of the intervention. 10 91 24 96 8 100 42 95 5. offer one or more advanced year concentrations with strengths/assets as the organizing principle, e.g., family preservation. 0 0 13 52 6 75 19 43 6. introduce strengths-based concepts as part of program orientation. 3 27 17 68 7 88 27 61 7. link students to field agencies whose primary method of practice is strengthsbased. 3 27 14 56 7 88 24 55 8. offer faculty development workshops to both pt and ft faculty on strengthsbased content. 0 0 3 12 4 50 7 16 9. offer continuing education in strengthsbased methods. 1 9 7 28 1 13 9 21 10. offer 1 or more discrete courses in strengths-based approaches to social work practice. 0 0 4 16 2 25 6 14 plitt donaldson, early, wang/toward building a culture of strengths 222 programs included: explicitly referring to strengths/capacities/assets in program mission, goals, and objectives (#1, #2, and #3 respectively); introducing strengths-based concepts in program orientation (#6); and linking students to field agencies whose primary method of practice is strengths-based (#7). two of the least frequently selected characteristics across programs were #8 and #9; with less than 20% of programs offering faculty development or continuing education in strengths-based methods. this may be more a reflection of capacity or community priorities than a lack of program commitment to strengths. notably, only six programs (14%) indicated that they offer a discrete course in strengths-based methods such as solution focused therapy, asset building, or strengths-based practice with families. this may not reflect an inattention to strengths, as some programs use an integrated strategy to promote strengths rather than offering discrete courses. eight of the 44 respondents gave their programs the highest ranking, i.e., 10, on both infusing strengths-based content and promoting the learning of micro-mezzo-macro strengths-based practice methods. these eight highest ranking programs also tended to reflect an integration of strengths beyond the core curricula to include the program environment or culture. for example, several of them indicated that they introduce strengths concepts at program orientations, through faculty development workshops, and by linking students to field agencies with a primary practice model that emphasizes strengths. these highest ranking respondents deepened the meaning of their numerical self-rankings with qualitative comments that further explained the strengths-based nature of their program. some respondents described strengths as the “core philosophy” or “organizing principle” underlying all aspects of their program. a respondent from a highest ranking program with 9 out of 10 characteristics reported that faculty research activities were “primarily strengths-oriented, with many consumers and family members involved in participatory action research.” another respondent identified the writing and presentations of faculty as further evidence of commitment to strengths. one respondent reported that they not only infuse strengths throughout their curriculum and through characteristics 1 through 9, but also by reflecting a value and philosophy of strengths in their personal interactions with faculty, staff, and students, i.e., living their values and philosophy in each personal encounter. it was difficult to characterize programs as “high” or “not-so-high,” as “strong” or “not-so-strong” by the rankings chosen on infusion and promotion of strengths-based practice or by the number of strengths characteristics the chairs selected to describe their programs. in fact, there was sometimes a discrepancy between the strength of the ranking and the size of the number of characteristics chosen with some respondents ranking their programs as high yet selecting only four or fewer strengths characteristics. instead, it was in the qualitative explanations of their rankings that the nature of a program’s culture emerged. some respondents’ explanations reflected a strong degree of integration of strengths in curricula content but not necessarily in the broader environmental aspects of the culture of the program such as through orientations, continuing education or faculty development workshops, and so on. other respondent comments suggested a mixed level of commitment to integrating strengths in curricula depending on faculty philosophies and interests. still others noted that strengths are present in written materials, but advances in social work, fall 2009, 10(2) 223 expressed some uncertainty as to whether or not what is espoused actually “plays out consistently” in teaching. also in the explanations of rankings, respondents shared the challenges of integrating strengths-based content in their programs. some of the challenges expressed by survey respondents included faculty views that strengths-based methods were not empirically tested and therefore did not meet the criteria for evidence-based practice. one respondent wrote there is “no evidence to support its usage.” others saw strengths as a perspective not a theoretical construct so they “include it as a basic consideration of enhancing client strengths and empowerment” but not a conceptual framework with its own practice models. several respondents discussed the challenge of different faculty views on or ambivalence about integrating strengths content. one respondent wrote that it was “not easy to change orientation of faculty; evidence of [its] effectiveness is not clear to some.” another respondent wrote “not sure how strongly sb content is implemented; most faculty are modest advocates. not necessarily a core feature, wish i knew more.” these challenges suggest that a strengths orientation may be an espoused value of their culture, but that they still lack a fully internalized culture of strength in which underlying assumptions of strengths become an unconscious “given” that is fully accepted by the group. discussion of limitations and implications for social work education and research this study proffers a modest preliminary glimpse into the progress of social work education toward integrating strengths into msw programs across the u.s. it is the first study to explore the state of strengths-based social work education since the publication of the first edition of the strengths perspective in social work practice (saleebey, 1992) over 15 years ago. however, the study was compromised by its most obvious limitation, a response rate of only 25% of u.s. msw programs; only 44 out of 181 programs responded to the survey. another limitation is the self reported nature of the data. consequently, these preliminary findings need to be enhanced through qualitative methods that include content analyzing syllabi, in-depth interviews with multiple levels of stakeholders within select msw programs. incorporating these methods will provide more depth and richness to the narrative of strengths that both defines a developing culture of strengths and obscures the remaining presence of deficit and disease still associated with the culture of msw programs. despite its limitations, the study provides some insights about the current state of affairs of strengths-based practice in msw education. given the cswe epas standards and the growing awareness and attention strengths-based practice is gaining in the profession, it is understandable that few responding representatives ranked themselves as low (1-3) on infusion of strengths-base content throughout their curricula (2/44) and low on promotion of strengths-based practice methods (1/44). in fact, more than half ranked themselves with scores of 8 to 10 on infusion (23/44) and on promoting strengths-based practice (24/44). similarly, it is not surprising that program mission, goals, objectives, and readings were the most common characteristics selected to show how programs plitt donaldson, early, wang/toward building a culture of strengths 224 incorporate strengths-based content, since these are subject to review during the cswe accreditation and reaffirmation processes. however, it is significant that there are some social work programs that appear to be giving considerable attention to the integration of strengths-based methods. these programs appear to be looking beyond these obvious aspects of their curricula towards the creation of a broader culture of strengths. this was seen in their incorporation of strengths into their relationships with various networks of faculty, staff, students, and field agencies. further, for these programs that are highly attentive to strengths, the culture of strengths is extended into written program materials and presented at orientation. it is reinforced through faculty development workshops and reified in participatory research methods that include consumers and families as full partners. it is these programs that should be a focus of further research to determine how and why they have gone beyond what will satisfy the mandates of cswe. the challenges to the development of a culture of strengths that were raised by a number of respondents suggest new areas of social work education and research. for example, some respondents expressed a suspicion of strengths-based practice methods as conceptually weak and empirically invalid methods for engaging with people and communities in need. rapp, saleebey and sullivan (2005) have identified a number of empirical research studies showing the promise of strengths-based approaches in case management, community development, and clinical practice. while applauding these efforts, they also note that much of that research has methodological flaws that limit their conclusiveness. consequently, more empirical research demonstrating the comparative effectiveness of strengths-based methods is needed to help strengths-based approaches to practice gain acceptance as legitimate interventions with individuals, families, and communities. furthermore, educators teaching in the macro areas, e.g., social policy, community practice, and organizational practice are challenged to identify, research, and teach practice models whose underlying assumptions emphasize and build on the strengths of the target system such as asset-based community development (kretzman & mcknight, 1993), participatory methods (castelloe & gamble, 2005), and strengthsbased policy analysis (chapin, 1995). especially because of the richness of the qualitative responses, future research should employ qualitative approaches rather than attempting further surveys with a more representative sample of all msw programs. this form of research would use in-depth interviews with faculty, staff, and students of programs that are moving beyond the surface-level artifacts of a culture of strengths to explore the 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(1989). a strengths perspective for social work practice. social work, 34(4), 350-354. author’s note: address correspondence to: linda plitt donaldson, ph.d., catholic university of america, 620 michigan ave., ne, washington, dc 20064. email: donaldson@cua.edu. mailto:donaldson@cua.edu plitt donaldson, early, wang/toward building a culture of strengths 228 appendix survey exploring strengths-based content in msw programs strengths-based nature of msw program 1. strengths-based social work practice has been part of the social work lexicon since the first publication of saleebey’s important work in 1992. some of the words faculty and departments use to connote strengths include, capacities, assets, resources, resilience, etc. list some of the words that are included in your written materials to indicate the presence of strengths-based social work practice content in your curriculum. 2. the following is a list of characteristics that show how msw programs incorporate strengths-based content into their curricula. please click all items that have applied to your msw program in the last academic year. explicitly refer to strengths/capacities/assets in program mission explicitly refer to strengths/capacities/assets in program goals explicitly refer to strengths/capacities/assets in program objectives require texts/articles in foundation year courses that teach methods using strengths and assets as part of the intervention offer one or more advanced year concentrations with strengths/assets as the organizing principle, e.g., family preservation introduce strengths-based concepts as part of program orientation link students to field agencies whose primary method of practice is strengthsbased offer faculty development workshops to both part-time and full-time faculty on strengths-based practice content offer continuing education in strengths-based methods offer one or more discrete courses in strengths-based approaches to social work practice 3. please list anything else that demonstrates the strengths-based nature of your program. 4a. to what extent does your msw program infuse strengths-based content throughout the curriculum? 1 2 3 4 5 6 7 8 9 10 not infused at all extensively infused throughout 4b. please elaborate on why you selected this numerical score. advances in social work, fall 2009, 10(2) 229 5a. overall, how well does your msw program promote the learning of micro-mezzo-macro strengths-based practice methods? 1 2 3 4 5 6 7 8 9 10 not well at all extremely well 5b. please elaborate on why you selected this numerical score. 6. whom may we contact if we want to learn more about the strengths-based nature of your msw program? msw program demographics 7. what is your position in the department? program chair faculty staff other (please specify) if you selected other, please specify: __________________________________________ 8. how many years have you been with this program? 0-3 4-7 8-12 13-18 19-30 over 30 9. approximately how many full-time tenure-line faculty members teach in the msw program? 0-3 4-7 8-12 13-18 19-30 31-50 51 or more don’t know 10. approximately how many part-time and/or non tenure-line faculty members teach in the msw program? 0-3 4-7 8-12 13-18 19-30 31-50 51 or more don’t know 11. how many msw students are in your program? 0-50 51-100 101-150 151-200 201-250 over 250 don’t know 12. please list the concentrations of your msw program (e.g., advanced generalist, health/mental health, child welfare). introduction literature review organizational culture methods instrument data analysis results profile of respondents culture of strengths in msw programs discussion of limitations and implications for social work e references appendix spring2001-006_page 1 spring2001-007_page 2 spring2001-008_page 3 spring2001-009_page 4 spring2001-010_page 5 spring2001-011_page 6 spring2001-012_page 7 spring2001-013_page 8 spring2001-014_page 9 spring2001-015_page 10 spring2001-016_page 11 microsoft word boys_same_sex_copyedit_final _________________  stephanie k. boys, ph.d., jd, msw, is an assistant professor in the indiana university school of social work on the indianapolis campus. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 117-128 let’s talk about same sex: how social workers can make judges listen stephanie k. boys abstract: researchers have created a diverse toolbox of literature reporting that same sex cohabitating relationships are strikingly similar to heterosexual marriages in amicus curiae briefs submitted to the courts. however, judges are trained to fit information into legal frameworks and to ignore data that does not fit the rhetoric of a case. the following article aims to fit existing data on same sex relationships into the framework judges will use to decide whether same sex marriage can be prohibited. the primary precedent used to support same sex marriage is based on the analogy of a case prohibiting marriage discrimination based on race. the legal framework created by this case requires social work policy practitioners to frame research in terms of the evolution that has occurred in scientific understanding of same sex attraction and public opinion. a simple shift in the discourse used to frame the data can significantly impact whether judges listen. keywords: policy practice, same sex marriage, discrimination, discourse, social policy introduction the purpose of this article is to situate the social science literature on same sex marriage into a legal context useful in a courtroom. the national association of social workers (nasw) has been an active participant in advocating for same sex marriage in the legal arena through amicus curiae briefs and testimony in previous cases. the evidence that homosexual couples form relationships equivalent to married heterosexual couples has been clearly stated; however, judges are trained to ignore evidence that is not relevant to the legal framework from which they must decide a case. the case of loving v. virginia (1967) provides one of the likely legal precedents that will be used to frame and decide whether same sex marriages can be denied for public policy reasons. the case established that states cannot ban interracial marriage, and the similarity to state bans on same sex marriage has created a legal argument advocates call the loving analogy. the analogy is explained in the first section of this article. the next section explores ways to incorporate social science data into the framework of the loving analogy. in explaining these data, advocates should employ a discourse focused on the evolution of both scientific understanding of homosexuality and the evolution of public opinion. the admitted ignorance of the court regarding issues of sex and intimacy underscores the importance of advocacy by policy practitioners. by placing the current social science literature in the context of the legal precedent, advocates can make this literature relevant for judges who have been trained in law rather than social science. the importance of courtrooms to the future of marriage in the united states on june 17, 2008, california courthouses were flooded with same sex couples filing for legal marriage licenses for the first time. it was a day shrouded with controversy. boys/let’s talk about same sex 118 advocates of same sex marriage rights celebrated in the streets, while opponents protested. the celebrations, as well as marriage ceremonies of same sex couples, ceased only a few months later when a public referendum passed and voided legislation that had permitted the marriages. however, turmoil erupted once again on august 4, 2010 when the case of perry v. schwarzenegger was decided in the united states district court for the northern district of california. the decision invalidated public referendum proposition 8, but it is unlikely we have heard the last word on this issue as opponents are at work on arguments to appeal. currently, the issue of whether to solemnize same sex marriages in the united states is addressed on a state by state basis. the legality of same sex marriage is in flux across the united states. as of the writing of this article, six states grant same sex couples marriage licenses; however, unlike most other couples who marry in the united states, these marriages may not be recognized if the couples travel or relocate to another state. in order to adapt to the frequent migration of united states’ citizens from state to state, the states honor most marriages performed in other states and grant those couples the same rights and privileges of couples married within the state. however, the supreme court has validated some exceptions to marriage recognition on public policy grounds, such as if another state were to permit polygamous or incestuous marriages (strasser, 1998). to ensure states could add same sex unions to the small list of public policy exceptions, congress passed the defense of marriage act (doma) in 1996. this federal legislation permitted states to outlaw same sex marriage and treat those marriages as void within the state. however, the confusion and turmoil caused by varying laws will require the supreme court to address the validity of doma and state laws invalidating same sex marriages performed in other states in the near future. although advocacy for same sex union legislation is important, courtrooms are the focal concern because most legislation on same sex marriage is challenged on the state level, and it is likely either a case challenging doma or a state law will be accepted for review by the supreme court. the laws certainly raise a constitutional issue regarding 14th amendment equal rights; the court, however, routinely waits to accept review of controversial issues until public sentiment on the issue is more settled (perry, 1991). due to the inclusive nature of supreme court decisions and the court’s reluctance to overturn decisions once made, it is imperative that social work practitioners be prepared when the case comes before the court. the loving analogy another instance in us history when marriages could be voided for public policy reasons by states objecting to the union was the invalidation of interracial marriages. in 1967, sixteen states voided interracial marriages performed in other states. this practice was determined to be unconstitutional by the united states supreme court under the 14th amendment of the constitution, as a discriminatory practice based on race (loving v. virginia, 1967). advances in social work, fall 2010, 11(2)     119 history of the case the historic lawsuit was brought by richard loving and mildred jeter, who wed in 1958 in washington, dc (pratt, 1998). mildred and richard returned to virginia and moved into her parents’ home. about a month later, the two were awakened when the county sheriff entered the unlocked home and found the couple asleep in their bedroom. the two were charged with unlawful cohabitation after being told their district of columbia marriage license was “no good here” (pratt, 1998, p. 236). the virginia 1924 racial integrity act automatically held void all marriages between a white person and a “colored” person. it also prohibited recognition of legal marriages permitted in other states (loving v. virginia, 1967). when the law was challenged in front of the us supreme court, the lovings’ attorney argued that virginia’s statute invalidating interracial marriages violated the equal protection and due process clauses of the 14th amendment of the us constitution. virginia supported the law by arguing that it was non-discriminatory because it treated white persons and black persons equally since neither was permitted to enter into an interracial union. the supreme court did not accept virginia’s argument and held that the facial, or explicit, classification based on race could not stand under the equal protection clause (loving v. virginia, 1967). the reasoning needed to overturn the virginia law was completed at this point, and the opinion could have been finished and signed by the members of the court. however, the opinion did not stop there. even though the case could have rested completely upon the equal protection clause, the court chose to also address the issue of substantive due process raised by the lovings’ attorney. over time, precedent has established that certain fundamental rights, as defined by the supreme court, cannot be infringed by the states under the 14th amendment by what has become known as substantive due process. in loving, the court recognized marriage as one of those fundamental rights. the opinion stated marriage is a basic right of man, “fundamental to our very existence and survival” (p. 12). how the precedent is used by advocates of same sex marriage the invalidation of anti-interracial marriage laws has been the primary precedent for legal advocates arguing for same sex marriage rights across the united states. the argument follows that, as stated by the majority opinion in the loving case, the “fourteenth amendment requires that the freedom of choice to marry not be restricted” (loving v. virginia, p. 12). this establishment of marriage as a fundamental right set the stage for what has been termed the loving analogy (morrison, 2007). the analogy reasons that loving is precedent for permitting same sex couples to marry. advocates argue that freedom to marry means freedom to marry, and that it applies equally to all subordinated groups in society. although the court specified that choice of marriage partner could not be restricted by race, the language used by the court was gender neutral. additionally, although gender classifications have traditionally received a lower level of scrutiny than racial classifications under equal protection doctrine, the court’s addition of marriage as one of the fundamental rights allows same sex marriage to be supported boys/let’s talk about same sex 120 under the due process clause instead of equal protection, making the difference between classifications based on race and gender moot. how the precedent is used by opponents of same sex marriage although the court has granted freedom of whom to marry, it must be acknowledged that this quote is often used out of context. the full quote reads, the “fourteenth amendment requires that the freedom of choice to marry not be restricted by invidious racial discriminations” (loving v. virginia, p. 12). the choice of whom to marry as a fundamental right has been touted by the legal community supporting same sex marriage with little question to the fit of the precedent. it seems logical that if choice of who to marry is a fundamental right, the gender of that person should be a moot point. however, opponents of same sex marriage have developed several strong arguments to puncture the arguably solid fit of the precedent established in loving for the invalidation of laws prohibiting choice of a same sex marriage partner. the primary retort made by both legal scholars and much of the public in opposition to the legal recognition of same sex marriages is that if the loving precedent is extended beyond race, marriage will be set upon a slippery slope that could end in the recognition of unfathomable unions, such as man and livestock or polygamist unions with one groom and 30 wives (andreasen, 2003). though some public figures have dramatized this argument to a laughable extent, the legal argument does remain sound when considering that marriage has never been an unrestricted freedom. legislatures have been permitted to regulate some elements of who may marry for public policy concerns, such as the age of consent to marry, the prohibition against incest marriages, as well as the elements that permit the dissolution of a marriage (andreasen, 2003). another strong retort to the loving analogy is that the supreme court has already decided that loving does not extend to same sex couples. just five years after loving was decided, two men in minnesota filed suit when their marriage license application was rejected (baker v. nelson, 1971). the case to invalidate minnesota’s ban on same sex marriage relied primarily on the loving analogy. the minnesota supreme court rejected the argument stating that it was not directly supported by us supreme court precedent. it is likely minnesota was not ready to extend the loving decision regarding such a controversial subject without explicit approval by the us supreme court. the us supreme court was not willing to give this approval. the couple appealed the case to the supreme court, who dismissed the claim for lack of a substantial federal question (baker v. nelson, 1972). legal opponents of same sex marriage, wardle and oliphant, use this point to argue that utilizing loving as precedent for invalidating same sex marriage bans is a “first-semester law student kind of error,” and illustrates a lack of thorough research, since they assert that baker v. nelson was the final answer in whether lovings’ precedent extends to same sex couples (2007, p. 137). as taboo as it is to appear to be using “bad law,” the idea that baker v. nelson settled the law is far from a thorough examination of the issue. although at the time baker was dismissed this was interpreted as an indication of a correct interpretation by the lower court, the supreme court was also declining cases they were not yet ready to decide. additionally, although the court attempts to maintain consistent precedents, it has always been permitted to overrule earlier precedent if it can advances in social work, fall 2010, 11(2)     121 be deemed that society has evolved to a point where the earlier precedent is no longer sustainable under public policy considerations. framing advocacy discourse for the courtroom a common way social science research is presented to the courts is through submission of an amicus curiae brief. these briefs are used to provide information to the court regarding the impact of a potential court decision upon society rather than just the individuals involved in the current case. social workers have teamed with psychologists and other social scientists to write amicus curiae briefs submitted in previous court cases in support of same sex marriage (american psychological association et al., 2007). a debate has been waged over whether the discourse of the briefs should be focused on mental health or social justice (kitzinger & wilkinson, 2004). this author proposes that in the courtroom, issues of both social justice and mental health can be relevant so long as they are discussed in a discourse that is used by judges. the purpose of law school is often said to be to teach students to think like lawyers (wetlaufer, 1990). this means learning the rhetoric by which opinions must match a framework based on legal precedent, or decisions that have been written by previous judges. the principles of previous cases must be determined, and then similar cases must be decided based on those principles. material that is not relevant to the principles is not relevant to the case. therefore, in order to garner the attention of judges, discourse regarding social science data must match the rhetoric of the principles. a simple change in the discourse used to discuss the data can greatly impact the weight it is given in a judge’s decision (wetlaufer, 1990). in connection to same sex marriage jurisprudence, one of the leading precedents is loving v. virginia. the question the court will be called upon to answer is whether the precedent that marriage choice cannot be infringed based on race should be interpreted as expanding to include marriage infringement based on gender. utilizing the precedent of baker v. nelson (1972), the opposition will argue the supreme court of 1967 did not intend the loving case to be interpreted so broadly. legal advocates for same sex marriage will counter that knowledge and public opinion about gay marriage has evolved to broadly prohibit any infringement upon the choice of whom to marry. if the court were not permitted to expand previous principles, schools could still be segregated and executions permitted for robbery. the us constitution, and the government it created, has been able to govern effectively because of the supreme court’s ability to interpret using evolving standards. therefore, social work advocates who frame the social science data in discourse focused on evolution of knowledge and public opinion will fit the decision framework of judges and garner more attention to their words. the evolution of social science data and how it can strengthen the loving analogy wardle and oliphant have shown in a recent study of state cases and law journals that loving is often used in law review articles supporting same sex marriage, but the analogy has rarely been successful when actually tested in court (2007). the remainder of this boys/let’s talk about same sex 122 article will explore discourse that can strengthen the precedent of the loving analogy in response to the case the opposition has been building. the better the fit between the discourse in the amicus briefs, testimony and the legal precedent, the more likely the information will sway the justices. the literature must be discussed in a discourse focusing upon the evolution of society. evolution has occurred in stages. first, the scientific community shifted from understanding homosexuality as a disease to a healthy lifestyle. next, studies were conducted that changed understanding of homosexual relationships as “different” from to very similar to heterosexual relationship dynamics. finally, evidence is showing a progressive societal evolution toward acceptance of same sex unions. evolution of the scientific understanding of same sex attraction in us history, it is well known that the scientific community used data to support the racial inferiority of african americans and justify discrimination propagated against the race. however, it is often ignored that scientific evolution of the understanding of a group may be even more profound for homosexual men and lesbian women. although it has been acknowledged that the supreme court dismissed a claimed violation of due process and equal protection for same sex couples wishing to marry, this case was decided in 1972 (baker v. nelson). since that time the scientific community has greatly evolved in its understanding of the nature of sexual orientation. in order to fit courtroom discourse, it is imperative social workers advocating for same sex marriage frame the evidence in terms of a new understanding of homosexuality. the first shift in scientific understanding was made in the diagnostic and statistical manual of mental disorders (dsm) categorization of homosexuality. the first two editions of the dsm, published by the american psychiatric association (apa) and used as the primary diagnostic authority by the medical, psychological and social work communities in the united states, defined homosexuality as a mental disorder until 1973 (goishi, 1997). in 1973, same sex orientation was not removed from the dsm, but rather was downgraded to sexual orientation disturbance. prior to the change in terminology, all persons attracted to the same sex were considered to have a disease which could be treated with psychotherapy. the change in the third edition was made because the board of trustees of the apa voted, “a significant portion of homosexuals are apparently satisfied with their sexual orientation, show no significant signs of manifest psychopathology…and are able to function socially and occupationally with no impairment” (apa, 1980, p. 380). therefore, only those “disturbed by, in conflict with, or wish[ing] to change their sexual orientation” (apa, 1980, p. 380) were subsequently diagnosed with sexual orientation disturbance, which was later changed to ego-dystonic homosexuality and then eliminated in the fourth edition (apa, 1987). today, in the dsm-iv-tr, there is a category of sexual and gender identity disorders, but it has been explained to only pertain to those who experience conflict from their sexual orientation rather than per se to all those experiencing same sex attraction (apa, 2000). some scholars still assert that the dsm should be interpreted as encouraging the treatment of gender identity disorders in childhood, and that successful treatment can prevent homosexuality later in life (rekers, 1995); however, the majority of the mental advances in social work, fall 2010, 11(2)     123 health community diagnoses with the purpose of resolving the emotional conflict without regard to the outcome of the patient’s adulthood sexual orientation (goishi, 1997). this discourse of evolution of the diagnosis of homosexuality must be stressed in amicus curiae briefs and testimony in order to illustrate how vastly the scientific understanding of sexual orientation has changed since the court case decided in 1972. evolution of the understanding of same sex relationships since acknowledgement by mental health professionals that same sex attraction is not a disease, many studies have been conducted to assess the similarities and differences between heterosexual and homosexual relationships. after a thorough review of these studies spanning several decades, an amicus curiae brief submitted by the national association of social workers, the american psychological association, and several other professional organizations reported same sex couples form committed relationships in the same ways as heterosexual couples (american psychological association et al., 2007). findings further indicate persons with same sex attraction desire committed relationships. in a 2000 poll, 74% of a randomly sampled pool of lesbian women, gay men and bisexual persons stated that they would like to be married to a partner of the same sex if it were permitted (henry j. kaiser foundation, 2001). the amicus curiae brief is an excellent, thorough and timely review of what science has learned about the nature of same sex relationships (american psychological association et al., 2007). whether same sex relationships have changed cannot be known since it was not empirically studied at length prior to the 1970s paradigm shift from homosexuality as a dysfunction; however, the understanding of the relationships has greatly changed. it has gone from little knowledge to a host of studies demonstrating that issues from desire for commitment to topics of conflict are similar among heterosexual and homosexual couples (kurdek, 2004). it is this evolution since the baker v. nelson decision in 1972 that must be stressed in order to persuade the court to dismiss arguments that the case is a ruling precedent. discourse must specifically state that what we know about same sex relationships and their similarity to heterosexual married relationships has evolved greatly since 1972. the tactic of persuading judges to understand homosexual relationships as analogous to heterosexual relationships very recently gained empirical support through the success of theodore olson’s arguments in front of judge walker on the issue of overturning proposition 8. olson is a self-pronounced conservative and was appointed solicitor general by former president george w. bush. however, he recently represented several same sex couples in a lawsuit that overturned california’s proposition 8 ban on same sex marriage (perry v. schwarzenegger, 2010). olson’s strategy to change public and judicial opinion regarding same sex marriage is to show that legalization will actually encourage conservative family values as more couples are formally united (olson, 2010). he further argues that encouraging marriage will strengthen communities both socially and economically through the increase in legal unions of two persons for a lifelong commitment toward family stability (olson, 2010). boys/let’s talk about same sex 124 evolution of public opinion although social science knowledge has evolved to understand cohabitating same sex couples to be similar to heterosexual married couples, the obvious counter by opponents is, regardless of knowledge, the general public is still opposed to legalizing same sex marriage. while reviewing the published literature on same sex marriage, many discussions of the previous studies and data are written in a way that stresses how much opinions have changed to favor same sex marriage (andersen & fetner, 2008). although there has been an increased acceptance, the percent of americans who favor legalizing gay marriage is still only about one-third. in a 2004 survey, the number of americans reported to support gay marriage was 33%, while 49% support legalizing civil unions (avery et al., 2007). however, the discourse of evolution is a perfect linguistic fit with evidence on public opinion regarding same sex relationships. public opinion has been evolving in the direction of support. the level of increase has surprised even those who study changes in generational cohort attitudes and other sex-related issues. the youngest generational cohort of adult americans has been termed the “millennials”. this generation has shown almost a reversion to traditional family values of monogamy, however, they do not seem to care if the monogamy is between homosexual or heterosexual couples (howe & strauss, 2000). acceptance of same sex relationships is inversely correlated with age, that is, increasing with younger generations; therefore, if the current trend progresses, americans will become more accepting over the next few decades (howe & nadler, 2009). recent studies indicate the evolution of acceptance of homosexuality may increase even faster than through evolution of younger cohorts coming into power. most research shows that social attitudes of generational cohorts tend to remain static from the time the generation reaches adulthood (howe & nadler, 2009); however, tolerance of homosexuality has been found to be an exception (anderson & fetner, 2008). although the time period when change occurred is debated, by the year 2000, american attitudes had shifted substantially among older cohorts in the direction of support for gay unions (smith, 1992; yang, 1997; loftus, 2001). treas (2002) found that public opinion on same sex relationships has changed far more dramatically than on any other sex-related issue, illustrating the unique increase in public support. anderson and fetner (2008) found the phenomenon of increased social support was even stronger in canada than the united states. the authors theorized the legalization of same sex marriage in canadian public policy could have spiked public acceptance. if same sex marriage was legalized across the united states, would the same spike occur in us public opinion? recommendations & future directions the purpose of this article was to place social science research on same sex relationships into a discourse social work policy practitioners can use in future amicus curiae briefs and testimony before judges. increasing the toolbox of research knowledge advances in social work, fall 2010, 11(2)     125 available for social workers to place in the framework will be important as us public policy on same sex marriage continues to change quickly and is often seen in courtrooms across the country. now that some states have granted marriage certificates to same sex couples, it will be imperative to assess the impact on public opinion. will the state government’s acceptance of same sex marriage increase acceptance similar to that seen in canada after the legalization of same sex marriage? if so, this evolution of public opinion as more states legalize same sex marriage could be set in a discourse of evolving societal standards that would certainly pique the ears of the us supreme court members who have been trained to incorporate evolving societal standards into their decisions. additionally, social work education must be expanded to include discourse on the evolution of the understanding of same sex attraction and public opinion. unless students are educated regarding the historical struggle for equality same sex couples have already endured, future social workers will not be able to provide the type of advocacy suggested by this author. finally, the future discourse on same sex marriage advocacy must be extended to be inclusive of the gay, lesbian, bisexual and transgendered (glbt) population. strategists have thus far kept discussion focused on relationships between gay men and lesbian women in order to garner the widest range of support; however, for true equality to be achieved, the discourse must work toward evolving to include other subsets of the glbt community. conclusion: the duty to advocate social workers advocating for same sex marriage must educate the court regarding the evolution of society in order to strengthen their case that the loving analogy of freedom to marry should extend to same sex couples. judges themselves have illustrated that they are not socially educated regarding sex and intimacy. judge posner has written “judges know next to nothing about the subject [of sex] beyond their own personal experience, which is limited, perhaps more so than average, because people with irregular sex lives are pretty much (not entirely, of course) screened out of the judiciary especially the federal judiciary, with its elaborate preappointment investigations by the fbi and other bodies. this screening, along with the gap, for which the screening is in part responsible, in judges systematic knowledge of sex is a residue of the nation's puritan more broadly of its christian heritage. another residue is the large body of laws regulating sex which judges are called on to interpret and apply, and sometimes asked to invalidate” (posner, 1992, p. 1). justice powell has also stated he has never known a homosexual (hermann, 2005). some judicial decision makers who will ultimately be deciding the rights of same sex couples admittedly have no knowledge regarding the lives of persons with same sex attraction. therefore, advocates for same sex marriage must be prepared with as much ammunition as possible to persuade and educate legal decision makers. research in the area of same sex relationships is plentiful; however, it must be presented to judges in a boys/let’s talk about same sex 126 discourse that will be relevant. scientific knowledge and public opinion have evolved, and it is time to tell the court. references american psychiatric association. 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(2007). in praise of loving: reflections on the “loving analogy” for same-sex marriage. howard law journal, 51, 117-186. boys/let’s talk about same sex 128 wetlaufer, g. b. (1990). rhetoric and its denial in legal discourse. virginia law review, 76(8), 1545-1597. yang, a. s. (1997). the polls—trends: attitudes toward homosexuality. public opinion quarterly, 61, 477-507. author’s note: address correspondence to: stephanie k. boys, indiana university school of social work, 902 west new york street, education/social work building, room 4157, indianapolis, in 46202. email: sboys@indiana.edu spring2005-066_page68 spring2005-067_page69 spring2005-068_page70 spring2005-069_page71 spring2005-070_page72 spring2005-071_page73 spring2005-072_page74 spring2005-073_page75 spring2005-074_page76 spring2005-075_page77 spring2005-076_page78 spring2000-002_i spring2000-003_ii spring2000-004_iii spring2000-005_iv spring2000-006_v spring2000-007_vi advances vol. 3, no. 1 i editorial barry r. cournoyer thespring2002 (volume3,number1) issueofadvances in socialworkmarks the beginning of its third year of existence. the editorial board and i are extremely pleasedwith andproud of the journal’s growth anddevelopment.we feel privileged to be associated with indiana university school of socialwork and the prestigious cadre of consulting editors that provide such sage advice and consultation. i personally wish to thank all members of the aisw teamwho have enabledme to serve as editor during these past two years. i could not possibly have produced these four issues without their hard work and scholarly input. this is my last issue as editor. i have truly enjoyed and valued this experience. i have been energized by my involvement with the many authors who have contributed their written work and have been inspired by the wonderful reviewers who have helped to improve the quality of both accepted manuscripts and those that were returned. i will miss this role but, at this time, i must turn my attention to other projects. however, we have the good fortune to have a new editor who will guide the journal’s development toward an even more prominent future. dr. jamesg.daley is associate professor, indianauniversity school of socialwork. he is a prolific author, exceptional researcher, and a truly great social worker. dr. daley brings a multitude of strengths to the editor position. he has 24 years of clinical experience. he has served as the director of an inpatient alcoholism treatment program, the chief of a mental health clinic, and a policy analyst on mental health and family violence issues. he regularly conducts workshops nationally and internationally. he has published extensively and has served as a reviewer for several prominent journals. his areas of interest include families in crisis, internationalmilitary social work, and family measurement issues. he is extraordinarily well-suited to shepherd aisw for the foreseeable future. i feel special delight in introducing the contents of this issue.during the 2001-2002 year, we have celebrated the 90th anniversary of social work education at indiana university. formed in 1911 as a small department, the school of social work has grown into one of the nation’s largest andmost prestigious institutions. on april 12, 2002, the school sponsored a day-long symposium as part of the anniversary celebration. several hundred participants joined as social work doctoral students presented research posters, experts led workshops and seminars, and all enjoyed various celebratory activities. the symposium’s keynote address was delivered by mr. andrewcuomo, formeru.s. secretary ofhousing andurbandevelopment and current candidate for governor, newyork state.we are especially pleased to introduce this issue with a transcript of his remarks. his speech is funny, poignant, philosophical, spiritual, and, of course, political. he addresses issues dear to the hearts of social workers as he discusses housing and homelessness, social and political philosophy, and the potential impact of the tragic events of september 11, 2001. dr. lisa s. patchner’s article “in the belly of the beast: a case study of socialwork in amanagedcareorganization” addresses the contemporary employment of social workers withinmanaged care organizations. in particular, dr. patchner explores the nature and quality of social workers’ service as case managers within a medicaid ii health maintenance organization (hmo). based upon semi-structured interviews, focus groups, and participant observations, she concludes that case management services were successful in helping hmomedicaid clients address various bio-psychosocial needs. she also outlines the specialized knowledge and expertise required by social workers who practice within managed care organizations. in “evaluating kinship care alternatives: a comparison of a private initiative to traditional state services,”rodneyellis,garyellis, androchellegaley explore the“newold” practice of kinship care as an alternative to traditional foster care programs and approaches. most social workers are painfully aware of the challenging state of the childwelfare systemand the increasing demands for placements for at-risk children. kinship placements offer numerous advantages over non-familial foster care. this paper represents one of the first attempts to evaluate the effectiveness of kinship careby comparing the stability of placement outcomesobtainedby twoprograms: an innovative, multi-service program operated by a private, not-for-profit organization and a more traditional program sponsored by a public state child welfare agency. in their article“africanamericansandclinicaltrialsresearch:recommendations for client engagement,” sharonmoore andwanda lott collins discuss the understandable suspicions that many african-americans hold when invited to contribute as participants in research studies, particularly those involving clinical trials. drs. moore and collins review some of the historical events and associated theories that lead to apprehension, fear, and sometimes rage among african-americans whose brothers and sisters have been violated in various medical experiments. they identify significant healthproblems commonamongafrican-americans, outlinehowand for whom participation in clinical trials might be safe and helpful, and suggest means and processes that researchers might adopt to recruit african-americans as informed consenting participants in research studies. nancy p. kropf and mininder tracey address the subject of service learning, an increasingly popular topic throughout university and professional settings. in “service learning as a transition into foundation field,” they distinguish the functions of service learning activities from those of professional internships and explore their use as a bridge to traditional field practicum experiences. in “student-identified strengths and challenges of using blackboardtm for group projects in a socialwork course,”melissa b. littlefield discusses her study of students’ experience in the use of a popular web-based educational tool that facilitates online communicationand learning.blackboardtm enables studentsand instructors to engage in real-timeor asynchronousonlinediscussion, transmit and receive e-mailmessages, exchange computer files, and link to internet resources. most students reported that blackboardtm was user-friendly and contributed to the success of their group project. the results suggest that online technologymay contribute to group learning activities, increase efficiency, and enhance personal accountability among social work students. the editorial board and i are pleased to present this issue ofadvances in socialwork to the social work community. in this,my last editorial, i wish to expressmy gratitude to all members of the aisw team, the indiana university school of socialwork community, the many authors and reviewers, and especially the social workers who conscientiously continue to readand think and learn fromprofessional journals in order to provide the highest quality of social service to the peoplewe call clients.thank you for your service to the most vulnerable among us. aisw vol. 5, no. 2 139 the struggle to survive: the power of partnerships in the quest for nonprofit sustainability karl besel ngoan hoang richard cloud seana golder linda bledsoe patrick mckiernan abstract: this article provides information about a youth service bureau’s (ysb) experience in collaborating with court officials to expand services and a subsequent funding base.ysbs, like many other nonprofit human service agencies, have found that partnering with local governmental officials, especially judges, can enhance sustainability. implications for strengthening partnerships between local nonprofits and county judges are discussed. keywords: family courts, governmental funds, funding nonprofit organizations obtaining andmaintaining funding over an extended period is a critical issue in the survival of nonprofit agencies. however, systematic research about the survival of nonprofits was almost nonexistent until the 1990s. most studies conducted on organizational behavior have focused on productivity or profitability, rather than survival (peters &waterman, 1982). furthermore, the limited number of studies on organizational survival have typically used for-profit or public organizations for analysis (sheppard, 1995). in light of the substantial role nonprofits such asyouth service bureaus (ysbs) play in addressing human service issues through a variety of court-related services, the ability of communities to provide quality programs is intricately linked to nonprofit sustainability and survival. this article examined theprocessof creatingandmaintainingpartnershipsbetween local nonprofits and court officials to expand services and funding for addressing human service issues. in particular, the authors examined and provided information on how a ysb was able to obtain funding over an extended period of time. karl besel is assistant professor, kent school of socialwork, university of louisville, louisville, ky, 40292. ngoan hoang is assistant professor, school of nursing, indiana university, columbus, in 47203. richard cloud , seana golder, and linda bledsoe are assistant professors at kent school of socialwork, university of louisville, louisville, ky, 40292. patrick mckiernan works for volunteers of america, louisville, ky, 40203. copyright© 2004 advances in socialworkvol. 5 no. 2 (fall 2004) 139-149. indiana university school of socialwork. 140 advances in socialwork literature review throughout the 1990s, nonprofit agencies created or expanded services to implementmany court-directed strategies. possibly themost innovative local court creations were implemented by community-based nonprofit agencies. these innovations included the development and expansion of divorce education classes (blaisure &geasler, 1996), supervised visitation and exchange programs (clement, 1998), and a host of juvenile justice programs (kaye & lippman, 1998). until recently, however, little attention was given to how these typically small and budget strapped nonprofits acquire sustainable resources.while the number of studies on nonprofit survival has generally increased (i.e., galaskiewicz & bielefeld, 1998; gronberg, 1993), relatively little is known about how court officials can work to enhance the survival of their greatest ally—the local nonprofit agencies. the relationship between agency survival and recent policy initiatives organizational survival has become increasingly important for nonprofit agencies over the past decade (bocage, homonoff & riley, 1995: jarman-rohde, mcfall, kolar & strom, 1997). due to federal and state funding cuts that began during the reagan era, nonprofit organizations continue to explore innovative ways to sustain their operations (motenko, et al., 1995). typically, these strategies employ merging, decentralizing, or cost-cuttingmeasures that parallel recent trends in the for-profit sector (ortiz & bassof, 1988; strom-gottfried, 1997). consistent with reductions in fiscal support for human services that took root in the mid-1980s, and political and policy changes that continued into the next decade, the 1990s witnessed a push toward nonprofits providing welfare-to-work programs. federal granting institutions earmarked considerable funding for nonprofits to develop training, mentoring, and cultural sensitivity programs on behalf of welfare recipients (family services report, 1999). in addition, nonprofit organizations were also being encouraged to expand their existing programming to address childcare, counseling, transportation, and housing needs so that welfare recipients would have the necessary resources to continue employment once they were adequately trained. a multitude of federal grant opportunities have been available to nonprofit organizations that provide educational, job training, and other human services to low-income families since welfare-to-work legislation was passed (family services report, 1999). at first glance, governmental strategies that provide significant monetary incentives for nonprofits to pursue welfare-to-work related programs give the appearance of systematic planning to promote sustainability and survival among nonprofit agencies. however, these legislative efforts do not adequately account for or address the previous difficulties in sustaining locally based nonprofits. for example, thecommunitymentalhealthcenters act of 1963 resulted in the creation of community-based mental health organizations that could be accessed by every american citizen regardless of income. similar to welfare-towork strategies, federal funds were granted to community-based mental health organizations, with the eventual goal of sustainability by local and/or state funding. yet, many of these mental health agencies were forced to close operation (greer & greer, 1983). ultimately, many of the surviving organizations had to develop private sector growth strategies that made their services less accessible to low-income clients (greer & greer, 1983). despite increased reliance on private sector practices such as collecting fees for services and third-party reimbursements, nonprofits continue to rely heavily on governmental sources for survival. nonprofits’ increased reliance on public funds over the past 50 years has been termed “voluntary failure” (salamon, 1987). according to salamon (1987), american communities have traditionally relied on nonprofits to provide human services as a result of “market failure,” or the inability of the private sector to deliver human services at a profit, especially within less affluent communities. as populations of american cities skyrocketed in the late 1800s, nonprofits that traditionally relied upon charitable giving for survival became increasingly dependent upon governmental grants and contracts to sustain their operations. thus, voluntary failure was evident by the end of the 20th century as a result of the symbiotic relationship that had developed between governmental funders and these agencies. for example, the three largest religiously affiliated social service agencies in the u.s., catholic charities, lutheran social services, and the salvation army, all receive more than half of their annual program revenues from governmental sources (shafritz & russell, 2003). the bush administration’s faith based and community initiative that was passed this year seems to demonstrate that many federal officials (and their constituents) are in favor of perpetuating this trend of reliance on government funds by religiously affiliated nonprofits. in light of the history of past public policy initiatives such as the community mental health act, this recent initiative may do little to foster the long-term sustainability of these faith-based organizations. role of local governments in nonprofit survival although county governments have historically played a direct role in service delivery to incorporated urban areas, few studies have explored this area. since the 1970s, counties have had amore significant role in funding social services than city governments (peterson & strachota, 1991). most cities invest only small amounts in social welfare functions. in contrast, county governments spend upwards of 17% of their total budgets on current operating expenses for social services (scheider & park, 1989). the expanded role of counties as providers of human services has been coupled with cutbacks in state and federal funds to support local communities. by the 1980s, federal support of local communities consisted primarily of funds for developmental services such as construction of interstate road networks (petersen & stracota, 1991). county governments that were already fiscally strapped became significant funding sources for local nonprofit organizations such as youth service bureaus.the growth and expansion of locally basedunitedway organizations and community foundations coincide with this reliance on county entities to fund human services. court-related nonprofits: a brief history ofyouth service bureaus youth service bureaus are a key example of community-based agencies that have consistently served family courts through a variety of human service programs. in most cases, these organizations have operated as nonprofit agencies at the city or 141besel et al./the struggle to survive: partnerships in the quest for nonprofit sustainability county level. youth service bureaus were initiated throughout the u.s. following a funding recommendation by the president’s commission on law enforcement and administration of justice in the 1960s (iysa red book, 2002). indiana’s experience and the establishment of youth services bureaus provides an illustrative example of the process of creating and maintaining partnerships between local nonprofits and court officials to expand services and funding for addressing human service issues. in indiana,many counties were able to establish youth service bureaus as a result of federal “start-up” grants. federal officials provided funds to county-based youth service bureaus with the understanding that communities would eventually sustain these bureaus through local governmental bodies, unitedways, and other county-based funding institutions. county judges often initiated funding requests to governmental institutions to initiate bureaus and, in cases such as themonroecounty bureau, served as the agency(s) first presidents. subsequently, bureaus such as the ones started in laporte andporter counties had county judges working in tandem with the women league of voters in submitting initial funding requests to the federal government (besel, 2000). at their peak asmany as 45 bureaus operated in indiana.when federal funding dried up in themiddle 1970s,many of the bureauswere unable to generate enough local funds to continue services and were therefore forced to close operation. many of the bureaus that survived the depletion of federal funds were able to exhibit significant growth during the late 1980s and early 1990s. furthermore, the number of bureaus operating statewide expanded significantly throughout the 1990s (besel, 2001). the growth patterns and funding dilemmas of the indiana youth service bureaus have run in tandemwith national growth trends in the nonprofit sector.while the nonprofit sector as a whole experienced significant growth during the 1980s by increasing its share of total earnings from 6.4% ($75.9 billion) to 7.8% ($254.8 billion), as well as experiencing percentage increases in government payments from 1987 to 1992, human service organizations took the bulk of cutbacks in federal funding that occurred during the 1980s. between 1977 and 1989, the social and legal services subsector share of total annual funds as a percentage of total funds for the nonprofit sector declined from 10.2% in 1977 to a low of 8.9% in 1987, then increased its share to 9.5% in 1989. over this period, government support as a proportion of this subsector’s total annual funds steadily declined from 54.3% to 41.4% in 1987, then increased slightly to 42.0% in 1990 (hodgkinson, weitzman, toppe & noga, 1992). in 1992, this subsector witnessed an increase of 50% with regard to governmental payments (hodgkinson, weitzman, abrahams, crutchfield & stevenson, 1996). it is significant to note that this potential reversal in the percentage of funding received by human service nonprofits during the early 1990s still did not bring the social and legal services subsector up to the 1987 government funding level. setting johnson county, indiana, celebrated its 175th anniversary in 1998. johnson county was settled early in the nineteenth century and the area soon grew to become an important agricultural and manufacturing center. as a result of the county’s close 142 advances in socialwork 143besel et al./the struggle to survive: partnerships in the quest for nonprofit sustainability proximity to indianapolis, the growth of the metropolitan area has had a lasting impact on johnson county, especially during the 1960s and 1970s. the rapid growth of indianapolis during this time period induced the construction of suburban tract housing in many areas around greenwood in northern johnson county. within a 10-year time period during the middle 1970s and 1980s, the population of the greenwood almost doubled (division of historic preservation & archaeology, 1985). the significant growth experienced by johnson county during this time was coupled with an increased demand for community-based efforts to prevent juvenile delinquency. the establishment of a county-based youth service bureau was viewed by community leaders and local citizens as an effective means of addressing status offenses and providing temporary shelter for youth who were often victims of abuse and neglect. the funding experience efforts to begin a youth service bureau in johnson county began in the midst of this period of rapid bureau expansion throughout indiana. in june of 1976, a group of concerned citizens discussed the need for a shelter care facility that would serve as an alternative to placing juveniles in the county jail. the enthusiasm of this initial group sparked the mobilization of citizens throughout the county. with the assistance of the indiana juvenile justice task force, the johnson county chapter of the juvenile justice task force was initiated in july of 1976. this communitybased volunteer network began to formulate strategies for the provision of court diversion and shelter care services. by october 1976, the johnson county youth service bureau (jcysb) was incorporated and a nine-member board of directors was elected. initial funding for bureau operations was provided through the federal comprehensive employment andtraining act (ceta) funds, the indiana department of public instruction, and a federal grant from the law enforcement assistance administration. when substantial federal grants available to indiana youth service bureaus dried up during the late 1970s, jcysb became more reliant on state and local sources for program funding.while the bureau experienced significant shifts in service delivery strategies, including the closing of its shelter care facility in 1995, it has continued to rely on county-based funds for program sustainability. the process of acquiring funding from local institutions during the 1980s and 1990s often involved local judges (jcysbhistorical report, 1996). subsequently, these county judges oftenmet with members of the board of commissioners the week prior to their budget hearings at the request of jcysb boardmembers (jcysb boardminutes, 1997, 1998). these “behind the scenes” meetings between county judges and board of commissioners members set the stage for the ysb being able to consistently secure program funding. bureau dependency on county funding table 1 demonstrates howdependent jcysbwas on county governmental funding during the early 1990s. most of the county funding provided to the bureau throughout its history came in the form of per diem payments provided for the agency’s youth home.when the youth home closed in october 1994, the bureau witnessed a tremendous cut in annual revenue.while the small nonprofit agency was forced to implement new programming strategies as a result of its primary service closing, bureau staff and boardmembers exhibited considerable success in acquiring new funding from their county government. this section provides a summary of three incidences in which county funding was secured for agency operations during the 1990s. saving the safe place/host homes program by the start of 1992, the bureau’s safe place/host homes program, a crisis intervention program that served primarily teenage runaways and other youth at risk for reoccurring abuse or neglect, was experiencing substantial funding difficulties. the program needed to generate $18,000 in revenue in order to meet its annual budget. the bureau’s executive director delegated the responsibility of securing revenue to alleviate this deficit to the safe place/hosthomes coordinator.the program coordinator quickly found that officials from local city governments viewed the funding of social services to be the responsibility of county government.when the coordinator began to approach elected county officials on an individual basis to elicit funding support, she found an ally in one of threemembers of the johnson county board of commissioners. this commissioner encouraged the coordinator to submit a written proposal to the board of commissioners for a formal hearing. after the $18,000 funding request was approved by the commissioners in order to alleviate the safe place/host homes’ program deficit, one of the commissioners volunteered to present the proposal to the johnson county council for final approval. this action ultimately resulted in the bureau securing $18,000 from county officials. 144 advances in socialwork fiscal year total revenue county % county 1989-1990 273,420 173,325 63 1990-1991 259,930 180,640 69.5 1991-1992 257,197 159,315 62 1992-1993 330,615 243,013 74 1993-1994 237,137 141,509 60 1994-1995 158,816 399,580 25 1995-1996 150,111 1996-1997 156,686 1997-1998 205,944 *50,000 24 source: independent auditors’ reports for fiscal years 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997, and 1998. *this revenue was actually federal revenue sharing dollars, initially earmarked for an independent living center. however, the bureau had to submit a funding proposal to the commissioners in 1998 in order to secure and utilize these funds. table 1: bureau revenue from county government, 1990-1998 rescuing the bureau—twice aswithmost nonprofit human service agencies, the bureau continued to exhibit a reliance on local governmental funding throughout the 1990s. in 1998, when it became obvious to the bureau’s professional staff and board members that county financial assistance was again needed due to a shortfall in the agency’s operating budget, the bureau’s executive director contacted a county commissioner for advice. this former family physician and ally of the bureau encouraged the director to submit a funding proposal to the commissioners. despite a heated debate between the agency’s representatives and one of the commissioners during the hearing, the $20,000 funding request was approved by a two-to-one vote. since this funding request was acquired from the county commissioner’s discretionary account, approval from the county council was not necessary. some of the bureau’s success in attaining county funding in november 1998 could be attributed to timing. the bureau was fortunate to have the current county treasurer on its board; she encouraged agency staff to pursue funding toward the end of the calendar year since this is a time when discretionary funding from the county commissioners was historically more obtainable. although the agency’s long time ally had retired from the board of commissioners before bureau officials were able to submit an additional funding request, the timing of this proposal may have paid off again, as the $12,000 request received unanimous approval from the commissioners. a key difference between this funding hearing and the argumentative nature of the previous year’s hearing was the absence of a debate on the details of the funding proposal. the commissioner who had voted against the bureau’s request the previous year believed that state government, rather than county government, needed to be funding local nonprofits. this commissioner also voiced concern about new funding requests potentially impeding the county’s ability to cover construction costs related to the local jail. some of the combativeness of 1998’s hearing may have been avoided by steps bureau staff and board members enacted prior to the hearing. these steps included individual meetings held with each of the commissioners prior to the hearing with the agency director and having an experienced and highly respected local judge speak on behalf of the bureau at a monthly board of commissioners budget proposal hearing. discussion of funding success the jcysb’s experience with securing funding is consistent with other studies that demonstrate nonprofit dependence on governmental revenue for survival (i.e., galaskiewicz & bielefeld, 1998; gronberg, 1993; salamon, 1987). in building upon this previous research, this study shows the vital role local governments play in sustaining community-based nonprofits. in order to attain funding from local officials, agency leaders must devise strategies that consist of mobilizing other local organizations in their defense, actively promoting their services, and negotiating satisfactory solutions to their fiscal needs. the dynamic process of negotiating and bargaining with public officials and identifying influential allies who will “make the case” for an agency’s funding requests, requires that nonprofit leaders possess considerable political skills. these generic political skillsmay be more important in acquiring resources and subsequent survival than the technical or managerial skills required for day-to-day operational activities. 145besel et al./the struggle to survive: partnerships in the quest for nonprofit sustainability judges as service consumers as demonstrated by this case study, local public officials, specifically judges, play a key role in acquiring resources for court-related nonprofits. constitutional scholarwilliammorrow (2000) views judges as the only public officials who consistently advocate on behalf of marginalized groups, such as homeless youth and children who are victimized by abuse. the history of judges advocating on behalf of disenfranchised groups can be traced to influential court decisions such as the brown vs. board of education in 1954 (morrow, 2000). since judges often hold lifetime positions and many are appointed rather than elected, they do not have the same need to please constituency groups as state or national representatives and may therefore be more inclined to create laws that promote social justice. in light of relatively long career tenures and considerable control over local resources (everything from courts to jails), judges often possess considerable influenceover county andcitybudgets; thispolitical clout canbeemployed toenhance the likelihood of a nonprofit being funded by local taxpayers. since nonprofits continue to play an integral part in the comprehensive strategies implemented by family courts nationwide, it is definitely in the interest of judges to enhance their survival. in light of the “make or break” role judges often play in resource acquisition, nonprofit administrators need to view these local officials as prime consumers of their services. as program consumers, judges need to be providedwith regular statistics on program participants and be involved in significant programmatic changes. they also need to be considered primary advisors when services are being created and as key sources of praise and criticism when program evaluations are being administered. thus, when agency directors view judges as consumers, it only seems logical to have themperiodically evaluate programs through written reports. ultimately, the more judges are included in the service delivery strategies of nonprofits, themore they will perceive themselves as consumers and, more importantly, be personally invested in the sustainability and survival of the agency(ies). as highly invested and active recipients of court-related services, judges will bemore likely to advocate on behalf of nonprofits when new resources need to be acquired. conclusion this article highlights the symbiotic relationship between human service agencies and local governmental institutions. in light of these findings, local judges who depend upon a wide variety of social services in order to operate family court systems should be viewed as natural allies in combating governmental cuts or, at least, in keeping these cuts to a minimum. furthermore, judges should be viewed as service consumers and need to be kept appraised of program outcomes. ultimately, judges possess the power and influence to potentially make or break an agency and are more likely to invest time in social service agencies than other officials such as state or local representatives. in these times of federal and state budget deficits and subsequent budgetary shortfalls experienced by many social service providers, agency leaders need to align with local judges “now more than ever,” as the john cougar mellencamp lyric goes. 146 advances in socialwork once judges are on board with an agency’s funding strategy, these local officials can be very effective in making the case for perpetuating or increasing agency funding. program data that judges can employ to advocate for continued funding of court-related services include the following: • quantitative data that highlights the costs of providing community-based social services vs. the costs of detention, incarceration, or hospitalization. for example, the johnson county bureau compared the cost of providing a 24/7-crisis intervention programper runawaywith the costs of incarcerating or hospitalizing a young person. • qualitative information in the form of anecdotes or case studies that reveal the “human side” of a child’s experience with a community-based program. these narratives, coupled with statistical data, can convince county commissioners that social services need to be at least partially supported by taxpayer dollars. a primary lesson to be learned from the johnson county example is that qualitative information needs to be presented initially to funders as a vehicle for captivating their attention. once their attention is gained, quantitative data, especially when presented in terms of cost savings to taxpayers, makes for a highly effective funding strategy. these findings also suggest that social work courses need to prepare students for the highly competitive and diverse nature of social service delivery. social work is not just about the provision of services to individuals, families, and small groups. social work incorporates advocacy, community organizing, and organizational and social policy development (brueggemann, 2002). in light of the most severe funding cuts many state and local governments have experienced in the last 50 years, nonprofit agencies must compete with for-profit hospitals and outpatients clinics and with local police departments and other governmentally funded services impacted by revenue cuts. schools of social work need to implement innovative strategies for training emerging social work professionals to work effectively within the nonprofit world in the current political and economic climate. for example, through a series of required research classes, the kent school of social work at the university of louisville teaches master’s level students to work with local nonprofits to evaluate and document programmatic outcomes and effectiveness. each student is required to complete a research project in conjunction with a local agency over the course of two semesters during his or her second program year. these projects, which often take the form of program evaluations, assist cash strapped agencies in preparing outcome data for grants and other funding pursuits. in summary, partnershipsmade between agency leaders and governmental officials, especially local judges, constitute a starting point for an organization’s overall survival and growth strategy. community-based agencies often play the silent partners in the symbiotic relationship between human service agencies and local governmental officials. while the high profile, typically sensationalized murder and other felony cases judges preside over are often featured as front page news, the efforts of agency staff whowork in tandemwith judges to ensure that the needs 147besel et al./the struggle to survive: partnerships in the quest for nonprofit sustainability of vulnerable children and families are cared for often go unnoticed. indeed, the only time human service workers and their clients are typically featured in papers is when the social service delivery system fails to serve the public well, such as in cases of fraudulent or abusive behavior perpetrated by social service workers. local judgeswhooften bask in the rays of themedia can shed somenecessary light on the central role played by agencies in providing a host of court-related services for disenfranchised youth. references besel, k. 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(1996). nonprofit almanac 1996-1997: dimensions of the independent sector. san francisco: jossey-bass. the indiana donor’s alliance, annual report, 1998. 22 eastwashington street, indianapolis, in, 46204. the indiana youth services association red book, 1998. 309 west washington street, suite 245, indianapolis, in, 46204. the indiana youth service association red book, 2002. 309 west washington street, suite 245, indianapolis, in 46204. jarman-rohde, l., mcfall, j., kolar, p., & strom, g. (1997). the changing context of social work practice: implications and recommendations for social work educators. journal of socialwork education, 33, 2946. the johnson countyyouth service bureaumeeting of the board of directorsminutes. 1997-1998. p.o. box 115, franklin, in 46131. the johnson county youth service bureau history. 1996. p.o. box 115, franklin, in 46131. 148 advances in socialwork kaye, j., & lippman, j. (1998). new york state unified court system: family justice program. family and conciliation courts review, 36(2) 144-178. morrow, w.l. (2000). a republic if you can keep it: constitutional politics and public policy. new jersey: prentice hall. ortiz, e.t., & bassof, b.z. (1988). proprietary hospital social work.health and socialwork, 13, 114-121. peters, t.j., & waterman, r.h. (1982). in search of excellence: lessons from america’s best run companies. newyork: harper and row. peterson, j.e., & strachota, d. (1991). local government finance: concepts and practices. chicago: government finance officers association. salamon, l.m. (1987). partners in public service: the scope and theory of government-nonprofit relations in the modern welfare state. journal of voluntary action research, 16(1-2), 29-49. shafritz, j.m., & russell, e.w. (2003). introducing public administration (3rd ed.) newyork: longman. sheppard, j.p. (1995). a resource dependence approach to organizational failure. social science research, 24(1), 28-62. strom-gottfried, k. (1997). the implications of managed care for social work education. journal of social work education, 33, 7-18. author’s note: address correspondence to: karl besel ph.d., kent school of social work, university of louisville, louisville, kentucky 40292, usa. e-mail: kbesel@iuk.edu 149besel et al./the struggle to survive: partnerships in the quest for nonprofit sustainability advances vol. 2, no. 2 113 the 2001 educational policy and accreditation standards: implications for msw programs marionwagner paul newcomb robertweiler abstract: the 2001 educational policy and accreditation standards (epas) establish guidelines for baccalaureate and masters’ level social work education throughout the united states. in this article, the authors discuss implications of the epas for masters’ level social work educational programs. they focus especially upon the opportunities afforded programs to introduce innovative educational experiences. keywords: msw education, social work, epas, educational policies, accreditation standards the council on social work education (cswe) educational policy and accreditation standards (epas) (cswe, 2001) offer challenges, opportunities, and increased flexibility to msw programs. as with all accreditation documents, implementation will bring clarification and a“legislative” history, providing further resources for msw programs working to stay in compliance while adapting curricula and program design to the needs of a new century. to be implemented in july 2002, epas offers social work programs an opportunity to deliver social work education in a more flexible manner than in the recent past. according to the cswe bylaws, the statements on educational policy and the accompanying accreditation standards are subject to review every seven years. in past iterations, the policy statement and standards have been developed sequentially, with the policy statement developed by the commission on educational policy and the standards written by the commission on accreditation. epas was a joint product of the commissions working in tandem with one another. the commissions hoped to reduce the size of the documents, streamline the accreditation process, and encourage educational innovation. epas represents amended views of the purpose of social work education, program structure, and the eight (formerly nine) essential curricula areas: values and ethics, diversity, populations-atrisk and social and economic justice, human behavior and the social environment (hbse), social welfare policy and services, social work practice, research, and field education. although the general content areas remain the same, social work promarionwagner, ph.d. is associate professor and director of m.s.w. education, indiana university school of social work, indianapolis campus; paul newcomb, ph.d. is associate professor and m.s.w. program director, indiana university school of social work, south bend campus; and robert weiler, a.b.d. is lecturer and interim m.s.w. program director, indiana university school of socialwork, northwest campus. copyright© 2001 advances in socialworkvol. 2 no. 2 (fall 2001) 113-118. indiana university school of socialwork. 114 grams may use the new policies and standards to present these curricular areas in innovative and creative combinations. purpose of socialwork education thepurpose statement in the epaspushes students towards leadership in the profession. it reads as follows: “the purposes of social work education are to prepare competent and effective professionals, to develop social work knowledge, and to provide leadership in the development of service delivery systems” (cswe, 2001, p. 5). contrast that with the previous purpose statement, which read: “the purpose of professional social work education is to enable students to integrate the knowledge, values, and skills of the social work profession into competent practice” (cswe, 1992, p. 3). the epas statement may reflect a growing recognition of requirements for social workers to participate in the building of the professional knowledge base and to take leadership roles in policy-making arenas. a message for msw programs includes encouragement to expand beyond interpersonal direct practice foci. programs will need to highlight the integral connection of research, policy, and practice in their curricula. curriculum integration: foundation andconcentration with the new epas, msw programs have an opportunity to develop foundation and concentration curriculum in a more integrated manner than was previously assumed. the eight curricular areas are to be presented in the foundation content and further developed in the concentration content. msw programs are thus encouraged to consider combining curricular areas, providing for potentially seamless transitions through the curricular structure. msw programs have heretofore presented hbse, practice, policy, research, and field curricula in discrete blocks. while practice courses refer to hbse content, policy classes discuss the need for and impact of research, and field content includes reference to the other areas, actual content has continued to be presented separately. in particular, hbse courses are generally presented only as foundation content. although faculty understand the connections and use foundation content as building blocks, students may not always see the connection between theories learned in the foundation content and content addressed in concentrations. the clarity of the new epas in describing foundation and concentration content opens doors for programs to develop new concepts for combining area content in innovative ways. one innovative way is that courses may be developed that combine two or more content areas in the foundation, to better prepare students for the need to combine knowledge and skills in their practice. for example, a course could be developed for foundation students wherein they study basic theories, practice methods, policy development, and research methodologies essential for work with communities. the course could be delivered concurrently with a student’s field placement in a community development agency. integration of such content would reduce redundancy between and among courses and would free-up credit hours for specialized concentration content. introducing creative combinations of course content in the concentration curricula would further enhance students’ appreciation for theneed to consider all content areas in their practice. course content on values and ethics, diversity, populations-at-risk, and social justice is already advances in social work 115115 generally integrated throughout the curriculum and would continue to serve as core subject matter in both foundation and concentration courses. creating a smoother curricular flow from foundation to concentration content and infusing the eight areas throughout the curriculum may also encourage programs to strengthen concentration content. many msw programs spend half the student credit hours presenting the foundation. with the new epas, a majority of credit hours may be spent presenting concentration content, with continuing integration of the eight areas. diversity, populations-at-risk and social justice the new epas further advances the social work professional commitment to celebrate diversity and concern for populations-at-risk and social justice.the newpolicy is more specific about the need for cultural competence, which should encourage programs to focus even more on expanding content. the recently approved national association of socialworkers (nasw) standards for cultural competence will assist programs in improving content on diversity (nasw, 2001). several challenges are included for social work educators who are committed to social justice for all populations-at-risk. for example, epas requires all programs to prepare their graduates to “practice without discrimination and with respect, knowledge and skills related to clients’ age, class, color, culture, disability, ethnicity, family structure, gender, marital status, national origin, race, religion, sex, and sexual orientation” (cswe, 2001, p. 8). however, discussions of the foundation content addressed within the areas of diversity and populations-at-risk and social justice do not specifically list populations or categories of discrimination or oppression. the curriculum policy statement (cps) of 1992, replaced by the current epas, was more specific. for example, under the populations-at-risk category was the statement, “the curriculum must provide content about people of color, women, and gay and lesbian persons. such content must emphasize the impact of discrimination, economic deprivation, and oppression upon these groups” (cswe, 1992, p. 8). by including these groups in only the longer list, the new epas may inadvertently diminish the requirement for schools of social work to particularly support social and economic justice for these three categories and include specific content on each. legal advice led cswe to reduce examination of programs’ commitment to social justice, especially for lesbian, gay, bisexual, or transgendered (lgbt) people, as civil rights protections for lgbt people are not currently federally mandated (parr & jones, 1996). as a result, social work educators in academic environments who do not share social work’s mission and philosophy of human rights have less accreditation policy support for non-discriminatory practices in their programs. unfortunately, this may decrease opportunities for social work educators to model good practice for students in the area of diversity. the combination of this reduction and the deletion of specific population groups from the curricular areas may lead to less focused content on populations-at-risk and diversity. programs may well defend the omission of one group by the inclusion of the others. social work educators committed to thenaswcode of ethicswill need to be vigilant in maintaining quality content on all populations in the curriculum. in preparing graduates to practice “without discrimination and with respect, knowledge, and skills related to clients’ . . . family structure, gender, marital stawagner et al./the 2001 epas: implications for msw programs 116 advances in social work tus. . . sex, and sexual orientation” (cswe, 2001, p. 8) may encourage programs in all university contexts to expand social policy content by focusing on the need to secure federal civil rights for lgbt people. resource needs what resources do msw programs need to take advantage of potential opportunities inherent in the new epas? programs with a core of faculty expertise in curriculum development and design may be better positioned to create innovative programs that improve educational quality. programs need faculty and administrators who are sufficiently creative to think “outside of the box.” faculty, deans, and directors who actively participated in the formulation of the new standards should be important resources as should cswe site visitors trained under the new standards. as this process is laborious, faculty motivation and the availability of time become important additional resources in relation to these tasks. in order for these resources to be appropriately harnessed, however, strong and innovative leadership is required at both the administrative level and the program level. deans and msw program directors need to work together in a cooperative manner, a goal which is easier to accomplish if they share a similar vision of the new curriculum models emerging from faculty discussions and processes. challenges andobstacles what challenges andpotential obstacles facemswprograms in creating innovative curriculum designs? for at least four reasons, some faculty may resist new curriculum models. first, in terms of effort, it is simply easier to continue business as usual than to design and implement new ideas, regardless of how attractive they might seem. second, faculty may be required to retool and develop new areas of expertise corresponding to emerging trends in practice and societal needs. curriculum change provides an opportunity to make our teaching relevant for our students but requires us to stay abreast of such developments. this problem is exacerbated by the fact that many faculty members are quite removed from practice. the rapidly changing context of social work practice underscores this problem.third, it is difficult to reach a consensus on innovative curriculum change, especially among larger msw programs. the degree and extent of support for change is likely to vary greatly among faculty. some faculty may vigorously oppose innovation, making implementation difficult, if not impossible. fourth, some innovative teaching modalities (e.g., distance or on-line learning models) may be opposed by faculty on pedagogical grounds or because they require faculty to develop new skills and familiarity with technological advances in teaching and learning. in the past, the council on socialwork education seemed to make it difficult for msw programs to implement innovative curriculums that deviated from“the letter of the law” (i.e., accreditation policies and standards). many programs were afraid to make significant changes that might place them at risk for losing accreditation. the historic difficulty that several programs had in implementing part-time programs is a case-in-point. as a consequence of the perceived risk, msw programs may be reluctant to take full advantage of the new flexibility afforded by the new epas. thus far, no programs have gone up for accreditation under the new standards. it is likely to take several years of experience with these processes before 117117 social work educators feel confident enough to move forward in curriculum innovation. such curriculum changes also have a significant impact on schools of social work in relation to the practice community. it will be essential to involve practice community leaders and consumers of social services in this process, as their input is needed to develop relevant curriculum models for the 21st century. their participation is vital in both the curriculum development and implementation phases. summary and conclusions msw social work programs are entering an exciting period of growth potential unprecedented in the history of social work education. while continuing to focus on content areas that remain relatively unchanged from the previous accreditation standards, schools of social work are now, under the new epas standards, capable of being more creative and innovative in developing their curricula. programs will be in the best position to take advantage of the new standards if they remain open to new possibilities and if they encourage the imaginative process to unfold. they will be able to recreate and redefine themselves with a greater degree of latitude than perhaps they have enjoyed in the past. the degree of flexibility that the new epas affords to msw programs brings many challenges and opportunities. no substantial change in the life of an educational institution—whether positive or negative—comes without a shift in priorities, focus, and energy. as in many areas of human life, change does not always come easy. however, with the adequate resources outlined in this paper, what might be perceived as obstacles to growth can be reframed as positive challenges. the eight areas of curricular content can now be more fully integrated throughout foundation and concentration coursework. this provides programs with opportunities to provide a more seamless and connected approach to content delivery. content on research, policy, and practice, as well as values and ethics, diversity, populations-at-risk, and social justice, and the notion of cultural competence, is also integrated throughout the curriculum. msw programs will need to ensure that categories of persons affected by discrimination or oppression continue tobe identified and specified; that themswcurriculumsupports social and economic justice for these populations and includes specific, high-quality content regarding all at-risk-persons; and that social policy content expands to address the civil rights of these populations. the2001epaspermitsprogramadministrators, deans, anddirectors toencourage and support faculty in developing and implementing new educational approaches. interestingly, under the new policies and standards, msw programs that maintain the educational status quo may be at greater risk than those that engage in regular program assessment and make innovative changes based upon findings. the epas implicitly encourages programs and faculty to engage in the invigorating process of professional development, explore new arenas of academic interest and expertise while keeping abreast of emerging trends in social work practice. faculty and staff alike can utilize their brainstorming, negotiation, and compromise skills while reaching consensus on comprehensive, innovative program change. msw programs can step forward with new confidence and optimism, taking advantage of the flexibility of the new epas in regenerating their curricula without wagner et al./the 2001 epas: implications for msw programs 118 fear of jeopardizing their accreditation. they can, with a greater degree of freedom, aspire to achieve their mission and reach their goals in ways and means that best match community and societal needs and their own contexts and resources. under the new standards, excellence in social work education becomes a genuine possibility. the good counsel of the social work practice community, consumers, and stakeholders can and should be sought throughout the process of curricula revision and implementation. their participation ensures that curricula models are relevant for clients today and in the future. themodified statement of thepurpose of socialwork education, an integral component of the epas, steers the profession and our msw graduates beyond a narrowly-focused approach to social work practice into the development of relevant and effective service delivery systems, the discovery of knowledge, and the formulation of social policy. we stand at a turning point in graduate social work education.wemust prepare for—andwe can ascend to—the challenge of becomingwhat our students, clients, and stakeholders need us to be.we believe that the 2001 epas provides just such an opportunity. references council on social work education. (1992). curriculum policy statement for master’s degree programs in social work education. alexandria, va: author. council on socialwork education. (2001). educational policy and accreditation standards. alexandria,va: author. national association of social workers. (2001). nasw standards of cultural competence in social work practice [online]. washington, dc: author. retrieved november 15, 2001, from the world wide web: http://www.socialworkers.org/pubs/standards/cultural.htm. parr, r. g., & jones, l. e. (1996). point/counterpoint: should cswe allow social work programs in religious institutions an exemption from the accreditation nondiscrimination standard related to sexual orientation? journal of socialwork education, 32, 297-313. author’s note: address correspondence to: marion wagner, ph.d., indiana university school of social work, 902 west newyork street, indianapolis, in 46202-5156 usa, iboh100@iupui.edu. advances in social work residential mobility from the neighborhood to the school _________________ robin l. ersing, ph.d, is an assistant professor in the school of social work at the university of south florida. richard d. sutphen, ph.d., is an associate professor and diane n. loeffler, ph.d. is a lecturer, both in the college of social work at the university of kentucky. the authors of this article wish to thank dr. martin tracy for his insight and critique of the manuscript. we would also like to acknowledge ms. flo lankster, msw for her assistance and support in conducting this study. copyright © 2009 advances in social work vol. 10 no. 1 (spring 2009), 1-18 exploring the impact and implications of residential mobility: from the neighborhood to the school robin l. ersing richard d. sutphen diane n. loeffler abstract: this cross-sectional study examines residential relocation among a cohort of 495 fifth graders in one urban community in the southeastern u.s. the impact of residential mobility is discussed in relation to student/family outcomes as well as the stressors placed upon schools. results support previous findings which suggest residential relocation is correlated with academic problems. in addition, highly mobile students are twice as likely to be referred by teachers for disciplinary intervention and families are five times more likely than their residentially stable counterparts to be involved with child protective services. implications from this study address the need for school systems, including school social workers, to look beyond the classroom to understand and respond to the needs of highly mobile families. keywords: residential mobility, children and families, education introduction we are a mobile nation. data from the u.s. census bureau shows that 17% of families with children both pre-school and school-aged experience at least one residential move each year (u.s. census bureau, 2007). among these movers, 68% relocate within the same county. this relatively high percentage of families with children that relocate annually raises many concerns for researchers and practitioners alike (dong et al., 2005). previous research has been conducted on both the reasons for and implications of residential mobility, yet recent findings are contradictory (currie & yelowitz, 2000; duncan, clark-kauffman & schnell, 2004; hango, 2003) and research on school-aged children is limited. for school-aged children, a residential move is often coupled with a change in schools—which implies a change in routine, a need to make new friends/assimilate into new social groups, and a disruption in a child’s education. although not all moves result in a need to transfer to a new school, a residential change can still create stress for children who face adjusting to new living space and integrating into a new neighborhood. this is especially relevant for highly mobile families who may have relatively few resources to support the many transitions required by a move. these families may not have an abundance of social capital upon which they can rely for support during such transitions (coleman, 1988; 1990; tucker, marx & long, 1998). ersing, sutphen, loeffler/impact and implications of residential mobility 2 the purpose of this study is to understand the effect that frequent residential moves can have on educational and social outcomes of elementary school age children. are children who experience more frequent residential moves more likely to have lower educational attainment than their less mobile peers? are these same children at risk for behavior problems and/or involved in more disciplinary action within the classroom than their less mobile peers? and, finally, are these children more likely to be involved in the child welfare system than their less mobile peers? if residential mobility is related to these factors, then intervention strategies that extend beyond the school’s walls must be created and implemented, increasing opportunities for vulnerable children to achieve their full potential. literature review schafft (2005) suggests that for economically vulnerable families moving is generally not associated with “moving up;” rather moves are often “unplanned and unpredictable” and can create “broken social ties and interrupted academic experiences” (p. 1). these lateral moves within limited geographical areas are more typical among lower-income families (fitchen, 1994; gramlich, laren & sealand, 1992; long, 1992; kerbow, 1996; tucker, et al., 1998; schafft, 2005; wood, halfon, scarlata, newacheck & nessim, 1993). it is often assumed that a move to a “better” neighborhood or community may benefit school-aged children; however, research findings in this area remain contradictory. regardless of where and why, a move is often viewed as a “stressful life event” (henderschott, 1989) and can be a disruptive process for school-aged children. hango’s (2003) research suggests that the effects of residential mobility can vary depending upon the nature of the move. using the national longitudinal study of youth, she examines the relationship between neighborhood and negative behaviors among children. in this study, negative behaviors were defined using mother’s report of negative behaviors, as scored using the behavior problem index (p. 53). moves from “poor” to “non-poor” neighborhoods were correlated with decreased negative behaviors (though this impact was found to decrease over time) and lateral moves within poor neighborhoods were related to an increase in negative behaviors (though these behaviors also manifested over the course of several years). duncan, clark-kauffman and snell (2004) further highlight the complexity of residential mobility among children. findings from their study of the moving to opportunity (mto) program indicate that for boys, moves may be associated with negative behaviors, even when the moves were to more affluent areas. however, currie and yelowitz (2000) report that residential stability has been linked to positive outcomes for children. thus, these contradictory findings suggest that the impact and implications of residential mobility are complex and in need of further study. there is a substantial body of evidence that links residential mobility to negative outcomes. the adjustment to new schools, peers, and teachers can be stressful for students (tucker et al., 1998). additionally, children who are frequent movers may also have to adjust to family crises and uncertainty that create a cycle of perpetual mobility (wood et al., 1993). advances in social work, spring 2009, 10(1) 3 residential mobility has been shown to have a direct negative effect upon the wellbeing of children including decreases in self-concept and locus of control and increases in the likelihood of depression (hendershott, 1989), emotional-behavioral problems (simpson & fowler, 1994), and engaging in acts of violence (haynie, 2005). many researchers have suggested that residential mobility is a “proxy” for an underlying construct of personal instability that is believed to be at the root of family and residential instability (astone & mclanahan, 1994; long, 1992; speare & goldshneider, 1987). additional research has revealed that residential mobility is associated with an array of negative outcomes in children including increased psychiatric admissions, multiple hospitalizations, impaired impulse control, antisocial behavior, and caregiver abuse and neglect (eckenrode, rowe, laird & brathwaite, 1995; mundy, robertson, greenblatt & robertson, 1989). in their retrospective cohort study of over 8000 adults, dong et al. (2005) examined the relationships between residential mobility and adverse childhood experiences using respondents’ self-report of childhood sexual abuse/neglect. their findings show that the odds of having endured emotional, physical and sexual abuse increased with the number of residential moves experienced during childhood (p. 1107). the relationship between residential mobility and academic performance is also complicated. coleman (1988) uses the construct of social capital to explain how residential mobility negatively affects school performance through the loss of social capital. when families move, they may lose social capital as established supportive relationships in the family, neighborhood and community are severed (coleman, 1988, 1990; hagen, macmillan & wheaton, 1996; tucker, et al., 1998). residential mobility is associated with lower school attainment including an increased probability of dropping out (astone & mclanahan, 1994; coleman, 1988), lower graduation rates (haveman, wolfe & spaulding, 1991), lower school achievement that is often operationalized as a greater likelihood of repeating a grade (eckenrode et al., 1995; wood et al., 1993), lower math and reading test scores (schuler, 1990; warren-sohlberg & jason, 1992), and more academic problems (tucker et al., 1998). additionally, the effects of mobility are not cross sectional; rather students feel those effects over time. dunn, kadane and garrow (2003) found that one move (to a new school) was as detrimental to a student as 32 absences in the year following the move – and as 14 absences in the third year. the effects of mobility are both immediate and long-term. similarly, students who are highly mobile are more likely to experience more behavioral problems in school (tucker et al., 1998; wood et al., 1998). given the association between academic performance and behavior problems, this is not surprising. maladjustments to a new school can result in social isolation, disruptive or antisocial behavior, and detachment from the educational process (astone & mclanahan, 1994; mclanahan & sandefur, 1994). hango’s (2003) work suggests that the extent and duration of different negative behaviors is mediated by the type or types of moves experienced by the child (e.g. poor to non-poor, poor to poor, poor to poorer). taken together, these findings all suggest that further research needs to examine how academic performance and behavior problems can be related to—or perhaps understood by— residential mobility. ersing, sutphen, loeffler/impact and implications of residential mobility 4 residential mobility also has a role in mediating the relationship between child maltreatment and lower academic outcomes. maltreating families are more unstable and isolated with fewer social supports and ties to neighborhoods (social capital). this increases the likelihood of residential mobility as well as subsequent academic failure (eckenrode et al., 1995). a study by ziesemer, marcoux and marwell (1994) demonstrated the extent to which highly mobile children are an at-risk population by comparing their school achievement and behavioral performance with a population of homeless children. they found that there were no differences between the groups; both exhibited low levels of school achievement and higher levels of behavioral problems. highly mobile families may continually uproot themselves from neighborhoods and communities, therefore limiting the development of social capital. several studies have identified social capital as being related to educational attainment (coleman, 1988; israel, beaulieu & hartless, 2001; mcneal, 1999; parcel & dufur, 2001; sandefur, meier & hernandez, 1999) as well as to school behaviors (parcel & dufur 2001). additional research supports the idea that mobility erodes social capital, which helps to explain negative child outcomes (astone & mclanahan, 1994; coleman, 1988; furstenberg & hughes, 1995; hagan et al., 1996; pribesh & downey, 1999). in considering how mobility impacts students in terms of academic behavior, behavioral problems and involvement with child protective services, recognition of social capital—or a lack thereof—is potentially helpful in thinking about how to positively impact the lives of highly mobile children. in spite of this body of research, there is still a need for current research to further explore the relationships between child well-being and residential mobility. thus, this research addresses a gap in the literature and focuses on the effect of residential moves on educational attainment, and social and behavioral outcomes, including family involvement with child protective services due to allegations of abuse and neglect. we hypothesize that elementary school-aged children experiencing higher rates of residential instability are more likely to perform academically below their less mobile peers and that children in highly mobile households face an increased risk for social and behavioral problems both within and outside of the classroom. specifically, we posit a direct relationship between residential mobility and the likelihood of family involvement with the child welfare system. methods sample the sample consisted of 495 fifth grade students attending public elementary schools in one urban school district in a mid-south city with a population of 250,000. since students enrolled in this public school system transfer to middle school beginning in sixth grade, it was necessary to pull our sample from the population of fifth graders to maintain a focus on the residential mobility experiences of elementary school children. stratified random sampling was used to ensure inclusion of schools with concentrations of both poor and more affluent student populations. the purpose was to obtain a representative advances in social work, spring 2009, 10(1) 5 sample of students from varying neighborhoods and school types. thirty-five elementary schools located within the district were divided into three strata using the combined percentage of free and reduced lunch as a proxy for school socioeconomic status (ses). the population of elementary schools fell into three strata that corresponded to low ses (63.6%-94.6% combined free and reduced lunch rate), moderate ses (36.6%-53.2% combined free and reduced lunch rate), and high ses (5.8%-26% combined free and reduced lunch rate). the low ses group contained thirteen schools while the moderate and high ses groups each contained eleven schools. a total of 11 elementary schools were randomly selected from among the three strata of schools to generate an optimal sampling frame of 5th grade students. a random sample of the fifth grade student population was then selected in equal proportions from each of the three school tiers representing 22% of the total fifth grade population in the school district. after accounting for student records that were unavailable, the final sample for the study (n = 495) was reached. data collection data for this secondary analysis were compiled from three sources: cumulative student records, a district-wide data base, and a state-level family and child welfare agency. the irb approved protocol for this study involved the use of school social workers employed by the district to collect data from student records of enrolled fifth graders. all data were extracted from school files and/or a central student database maintained by the district, and stripped of any personally identifying information (e.g. names, identification numbers). in order to standardize the process, an instrument was created to ensure that data were appropriately gathered on each subject. each of the data sources is discussed below: cumulative student records. school social workers were trained to use the data collection instrument, ensuring that there was consistency in the information extracted from the student records. the cumulative student record provided historical and background information on the individual child and his/her and family, including residential moves. academic information included standardized reading and math scores, attendance, grade retention, and teacher referrals for behavioral concerns. the research team collected retrospective data on each child from first through fifth grade. given the nature of the data, some student files were incomplete meaning not all of the requested information was available. district wide data base. data collected from the central office data base included system wide information for each school such as rates of free and reduced lunches, the ethnic and racial composition of the student body, and each school’s standardized achievement test scores. state office on family and child welfare. this agency is responsible for addressing issues that impact the well-being of children and families throughout the state, including the protection of children suspected of having been maltreated. this agency confirmed, while maintaining confidentiality, whether a child in the sample had been referred for suspected abuse or neglect during their fifth-grade year. no information related to past ersing, sutphen, loeffler/impact and implications of residential mobility 6 involvement with the agency was reported, nor did the agency indicate the outcome from any referral. variables residential mobility is used as a predictor variable in the study. residential mobility is operationalized as a change of address recorded in the student’s cumulative file. each change of address denotes a single move. the variable was coded categorically with zero moves representing “stable households,” one or two moves representing “low mobility” households and three or more moves representing “high mobility” households. coding mobility categorically is consistent with other recent research on mobility (for example, in her 2003 work, hango creates a dichotomous mobility variable). several student educational outcomes are used as criterion variables in the study. standardized math and reading scores are taken from results of standardized tests administered to 5th graders throughout the state. school attendance is a count of the number of days each student was marked present during the 5th grade school year. grade retention was operationalized as a categorical variable (1 = retained; 0 = not retained). teacher referrals for behavior or disciplinary concerns during the 5th grade school year were operationalized by the use of the district’s suspension and failure elimination program (safe). safe is an in-school intervention tool that assists students in adjusting to the classroom environment. referrals to safe may include disruptive outbursts by the student, use of inappropriate or profane language, and inability to cooperate with classmates. this variable was also coded categorically (1 = referred to safe; 0 = no referrals to safe). given that not all disciplinary referrals are equal, it was deemed appropriate for the purpose of this study to create a dichotomously coded proxy variable to capture whether or not the student has had a disciplinary referral, not how many referrals have been made. involvement with the child protection system (cps) is also operationalized as a categorical variable wherein 1 indicates an open case during 2001 and 0 represents the absence of an open case in 2001 (the child’s fifth grade year). data analysis three analytic strategies were used in examining the data. first, frequency distributions were computed for each of the sociodemographic variables and a chisquared test was performed to examine relationships across levels of residential mobility. second, linear regression models were used to evaluate the effect of residential mobility on the continuous education variables (e.g. reading and math scores, attendance) controlling for sociodemographic factors. a hierarchical regression was conducted entering covariates initially, controlling for each, and then entering the predictor variable for mobility. finally, residential mobility was used as a predictor in logistic regression models to examine the effect on dichotomously coded criterion variables including disciplinary referrals (i.e. safe), grade retention, and cps involvement. only variables with significant bivariate relationships to the dependent variables were included in the multivariate analyses. advances in social work, spring 2009, 10(1) 7 results descriptive statistics over half the students in the sample were male (52%). more than two-thirds of the sample (69%) were non-hispanic white and a quarter (26%) were african american. children living in two-parent households comprised slightly more than half the sample (51%) compared to 32 percent who resided in households headed by a single parent. in cases where information on housing status was available in student records, slightly more than one-quarter of the sample (27%) were identified as renters compared to 36 percent who owned their homes. thirty-six percent of the sample had no information on file. residential moves ranged from zero to 16 (m = 1.4 moves, sd = 1.8). nearly twothirds of students sampled had experienced at least one episode of residential mobility between first and fifth grade. thirty-seven percent of the students were considered “stable” with no moves; 46 percent were considered “low mobility” with one or two moves; and 17% were found to be “highly mobile” with three or more moves between the first and fifth grade. descriptive data for the dependent variables show a mean standardized reading test score of 832.9 (sd = 240.8, range = 151-1500); and an average standardized math test score of 6.23 (sd = 2.1, range = 2.0-12.9). the mean attendance rate was 95.6 days (sd = 5.6, range = 6.8-100). nearly one-fifth of the sample (19.4%) had received a disciplinary referral (safe), and 18.2% had been referred to child protective services (cps). table 1 displays additional descriptive characteristics for students in the sample according to their level of residential mobility. chi-square tests indicate that students changing residences three or more times between 1st and 5th grades were more likely to be african american, (χ2 = 46.0, df = 4, ρ ≤ .001), and live in single parent families (χ2 = 101.6, df = 6, ρ ≤ .001). ersing, sutphen, loeffler/impact and implications of residential mobility 8 table 1: descriptive statistics for students across residential mobility groups (n = 495) ________________________________________________________________________ variable stable low high (0 moves) (1-2 moves) (3 > moves) n = 181 n = 228 n = 86 gendera, % male 51.4 53.5 52.9 female 48.6 46.5 47.1 race/ethnicity, %*** african american 12.7 28.5 46.5 white (non-hispanic) 85.1 63.6 48.8 otherb 2.2 7.9 4.7 family composition, %*** single parent 16.0 35.1 55.8 two parent 76.2 43.9 17.4 step parent 6.1 14.9 10.5 otherc 1.7 6.1 16.3 note. a n = 490. b other category for race includes asian, hispanic, and other race/ethnicity. c other category for family composition includes foster parent, grandparent, and other family composition. p ≤ .05, ** p ≤ .01, *** p ≤ .001 __________________________________________________________________ multivariate analysis educational outcomes. residential mobility was entered into a linear regression model to predict three educational outcomes: achievement on standardized reading and math test scores, and daily school attendance. with regard to reading scores, after controlling for the sociodemographic factors (i.e. gender, race, and family composition), having a high level of residential mobility was significant in the regression equation (see table 2). thus, students who have moved 3 or more times between 1st and 5th grades scored on average 97 points lower on state-wide reading tests compared to their stable counterparts who had never encountered a residential move (β = -.153, ρ ≤ .01). no statistically significant effect was found for students with low mobility (i.e. 1 or 2 moves). other factors in the regression model that significantly predicted reading scores included race (“being african american”, β = -.266, ρ ≤ .001), and family composition (“residing with a step parent”, β = -.104, ρ ≤ .05). it should be noted that although advances in social work, spring 2009, 10(1) 9 mobility was found to significantly affect reading scores, the added explanatory power of this predictor is small (.011). residential mobility was not found to be significant in predicting achievement on standardized 5th grade math tests. table 3, however, does show the variable school attendance to be statistically significant with highly mobile students (β = -.201, ρ ≤ .001). thus, students who relocate frequently have a greater number of recorded school absences compared to their residentially stable peers. although the overall explained variance on attendance is rather low (r-square = .072), the predictor of residential mobility in this model adds greater explanatory power than found with standardized reading scores (see table 2). table 2: regression of 5th grade reading scoresa (n = 428) ________________________________________________________________________ step 1 step 2 variable β t β t gender male (coded = 1) -.063 -1.384 -.067 -1.486 race african american -.281 -5.774*** -.266 -5.462*** otherb -.034 .738 -.024 .523 family composition single parent -.148 -2.906** -.092 -1.684 step parent -.129 -2.726** -.104 -2.148* otherc -.098 -2.071* -.061 -1.250 residential mobility low (1-2 moves) -.069 -1.311 high (3 > moves) -.153 -2.717** r2 .156 .167 note. a january 2001 standardized 5th grade reading scores. b other category for race includes asian, hispanic, and other race/ethnicity. c other category for family composition includes foster parent, grandparent, and other family composition. * p ≤ .05, ** p ≤ .01, *** p ≤ .001 ________________________________________________________________________ ersing, sutphen, loeffler/impact and implications of residential mobility 10 table 3: regression of 5th grade school attendancea (n = 459) ________________________________________________________________________ step 1 step 2 variable β t β t gender male (coded = 1) .050 1.066 .048 1.058 race african american .059 1.188 .074 -1.496 otherb -.013 .270 -.010 .218 family composition single parent -.168 -3.233** -.110 -1.995* step parent .002 .031 .018 .375 otherc -.018 .373 .031 .630 residential mobility low (1-2 moves) .044 .830 high (3 > moves) -.201 -3.536*** r2 .028 .072 note. a reported for the 2000-2001 school year. b other category for race includes asian, hispanic, and other race/ethnicity. c other category for family composition includes foster parent, grandparent, and other family composition. * p ≤ .05, ** p ≤ .01, *** p ≤ .001 ________________________________________________________________________ social-behavioral outcomes. we used logistic regression analysis to determine whether residential mobility was a statistically significant predictor of three dichotomous dependent variables: student disciplinary referrals (safe), grade retention, and involvement with child protection services (cps). results from this type of analysis are most often reported in terms of the odds ratio for a unit change in a given independent variable. in other words, the odds to which an event will occur. when the variables for gender, race, and family composition were held constant in the model, being highly mobile increased the likelihood of receiving a teacher referral to the safe program for behavioral or disciplinary reasons by 2 times (β = .725, ρ ≤ .05) compared to residentially stable households (see table 4). in other words, children who experienced three or more residential moves through 5th grade increased the odds of receiving a disciplinary referral by a factor of two (or = 2.064) when compared to classmates living in non-mobile households. similarly, when we examined cps involvement (see table 5), highly mobile students were 5.5 times at greater risk for having an open case with child protective advances in social work, spring 2009, 10(1) 11 services (β = 1.709, ρ ≤ .001) compared to students experiencing no residential moves. residential mobility was not found to be a significant predictor of grade retention. table 4: logistic regression of referrals to safe programa (n = 490) ________________________________________________________________________ variable β se odds ratio gender male (coded = 1) .570 .254 1.767* race african american .643 .271 1.903* otherb .726 .540 2.067 family composition single parent 1.127 .315 3.085*** step parent 1.302 .390 3.675*** otherc 2.060 .467 7.844*** residential mobility low (1-2 moves) .299 .304 1.349 high (3 > moves) .725 .368 2.064* constant -3.082 model χ2 65.7*** df 8 note. a suspension and failure eliminated program. b other category for race includes asian, hispanic, and other race/ethnicity. c other category for family composition includes foster parent, grandparent, and other family composition. p ≤ .05, ** p ≤ .01, *** p ≤ .001 ____________________________________________________________________________________________________________________________________ ersing, sutphen, loeffler/impact and implications of residential mobility 12 table 5: logistic regression of involvement with child protective services (cps) (n = 490) __________________________________________________________________ variable β se odds ratio gender male (coded = 1) .340 .258 1.405 race african american .078 .284 1.081 othera -.463 .691 .630 family composition single parent .910 .320 2.483** step parent 1.356 .386 3.881*** otherb 1.685 .481 5.394*** residential mobility low (1-2 moves) .619 .330 1.858 high (3 > moves) 1.709 .381 5.522*** constant -3.052 model χ2 65.4*** df 8 note. a other category for race includes asian, hispanic, and other race/ethnicity. b other category for family composition includes foster parent, grandparent, and other family composition. * p ≤ .05, ** p ≤ .01, *** p ≤ .001 ________________________________________________________________________ discussion the findings from this study suggest those elementary school students living in families that make frequent residential moves are an at-risk population who are likely to have academic and behavioral problems in school. these children are more likely to be african american, living in single parent impoverished families and to have involvement with child protective services. more specifically, the findings indicate that high residential mobility is related to academic and behavioral problems in elementary school children. high mobility students had significantly lower reading scores (97 points) than stable students. they were also more likely to be referred for behavioral problems. the poorer school performance of mobile students may be related to a number of problems that emanate from both the advances in social work, spring 2009, 10(1) 13 immediate adjustments that children have to make when changing residences and schools, and the disruptive impact that mobility has on instruction and learning. these findings are consistent with previous findings on child mobility (hango, 2003; schuler, 1990; tucker et al., 1998; warren-sohlberg & jason, 1992). changing residences can be viewed as a major stressor for children that probably presents more challenges and needed adjustments for them than it does for adults, not only because children may have fewer coping abilities, but also because they must also adapt to a new school and neighborhood environments. most of the time school changes accompany residential moves. when children change schools, it requires an immediate adjustment to a new school setting, new teachers and students, possibly a different academic focus and curriculum, and perhaps a more accelerated pace of curriculum coverage. additionally, student mobility occurring during the school year disrupts the continuity of instruction and can create many challenges for teachers and administrators related to enrollment and attrition (schaff, 2005). as we found in the study, low-income families headed by a single parent are likely to change residences more often than other types of family configurations and income levels. it is common for these residential changes to be short lateral moves from one lowincome neighborhood to another (schaff, 2005). there are many income-related reasons for frequent family moves. the lack of affordable housing is a major problem for most low-income families. the growth of single parent families over the past thirty years, many of whom are poor, have greatly increased the demand for more affordable housing. an increase in demand along with a lack of available affordable housing, especially inexpensive rental units, has disproportionately raised the cost of renting compared to the cost of owning. most of the highly mobile families in this study were renters. they, like other low-income families, have taken the brunt of the “shelter-poverty” crisis in america that has been created by a serious decline in available low-income housing (mulroy, 2002; mulroy & lane, 1992). many of the families in our study lived in several predominately african american neighborhoods where it is difficult to find sufficient affordable housing. perhaps many families are forced to accept housing that they cannot afford. one of the strongest findings of the study indicated that cps involvement was 5.5 times more likely to occur in families with high residential mobility. the referrals involved cps investigations into allegations of abuse and neglect of children and for reported incidents of domestic violence and unfortunately did not reflect rates of substantiation. there is very little in the research literature on the rates of residential mobility for maltreating families. the work of eckenrode and associates (1995) stands out as the first empirical verification of this relationship demonstrating that maltreating families had high rates of residential mobility. the study found that the relationship of child maltreatment to poor school performance was mediated by high rates of residential mobility. maltreating families move for some of the same income-related reasons as other low-income families such as the problems associated with the lack of affordable housing. they also move for reasons connected to the unstable relationships and poor family functioning that characterize these families. families may be constituted and ersing, sutphen, loeffler/impact and implications of residential mobility 14 reconstituted as members come and go and as they move from one residence to another. maltreatment incidents themselves create mobility when child victims are placed with foster care families. maltreating families may move more often because they are more socially isolated with fewer ties to parents, extended family members, neighbors and teachers, greatly diminishing their connections to given residences and neighborhoods. they have few supports and low social capital. the way in which maltreatment incidents are related to residential mobility is not entirely clear. in the study conducted by eckenrode et al. (1995) based on a small sample, they reported that maltreatment incidents preceded mobility events. however, without time-sequenced data to match incidents to moves, they could only speculate that the stress from residential moves would be a likely contributor to the possibility of subsequent maltreatment. astone and mclanahan (1994) suggest that an underlying factor of personal instability in these families contributes to both unstable family relationships and residential mobility. research into the temporal sequencing of residential moves and school transfers with maltreatment incidents would help to clarify the nature of this relationship. among highly mobile children, school records were often incomplete or spotty. thus, this study was limited by the data that was available. we frequently encountered missing or incomplete data and data entered over time by multiple people in multiple locations. though not uncommon within social science research that relies on extant data, this did limit the depth of our analysis and bears mentioning within this discussion. as discussed above, the initial sample included 22% of fifth grade students from the school district. students with very limited records (e.g. missing most data) were excluded from the sample. while we cannot be certain of the reason for their spotty records, we can likely infer that among those excluded may have been highly mobile students or students with very limited attachment to the school. implications for social work children from families with high residential mobility constitute an at-risk population who are likely to suffer from poor school performance. these children are embedded in family and neighborhood environments that present a broad array of risk factors including impoverished single parent families, changing family composition, frequent residential and school moves, and a substantial likelihood of maltreatment or domestic violence. taken together these factors can place children at significant risk for many negative outcomes in addition to school failure. these risks could include delinquency, substance abuse, mental health problems, teen pregnancy and running away. this is an atrisk population with whom social workers have great familiarity, yet rarely is residential mobility alone viewed as a risk factor leading to negative outcomes. although social workers are likely to encounter these children in school settings, workers must possess skills that go beyond school walls to be effective with these children. social workers must engage with students, their families, and their communities to help create opportunities and to decrease negative outcomes. advances in social work, spring 2009, 10(1) 15 interventions targeted to address the problem of residential mobility among families with school-age children require a range of social work skills including those at the mezzo and macro levels of practice. we suggest that an important priority of this work focus on promoting family stability and the building of social capital. at the mezzo-level, school-based interventions such as orientation programs, tutoring, and counseling can be useful tools to help a family forge a stronger connection with the educational system. school social workers can be instrumental in strengthening ties between the home and the classroom through an open line of communication between parents and teachers. direct school services should be augmented with school-based family and community services that provide economic, psychosocial, educational, and social networking assistance. such resources offer support to those families who must cope with the stressors of a new environment. an important priority at the macro level involves the need for social workers to advocate for policy change in an effort to support the provision of special services to mobile children and their families. social workers should be willing to address client housing problems including intervening in disputes with landlords, advocating for rent supports, affecting government policies and practices concerning low income housing and mobilizing community support. furthermore, child welfare advocates should urge child protection systems to consider residential mobility to be a significant risk factor negatively impacting the well-being of children in their care. they should be encouraged to develop policies that support the prevention of residential mobility with the goal of keeping families stable and children healthier and safer. future research on residential mobility and student outcomes should examine evidence-based strategies within school and community settings to promote more stable behavioral and academic outcomes for school-aged youth. an examination of the impact of state and federal legislation on the ability of school systems and community institutions to address student mobility is warranted. references astone, n., & mclanahan, s. 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(1990). effects of family mobility on student achievement. ers spectrum, 8, 17-24. speare, a., & goldshneider, f. (1987). effects of marital status change on residential mobility. journal of marriage and family, 49, 455-464. tucker, c. j., marx, j., & long, l. (1998). “moving on”: residential mobility and children’s school lives. sociology of education, 71, 111-129. u.s. census bureau. (2007). geographic mobility: 2005 to 2006 detailed tables. retrieved january 21, 2008, from http://www.census.gov/population/www/socdemo/migrate/cps2006.html. warren-sohlberg, l., & jason, l. (1992). how the reason for a school move relates to school adjustment. psychology in the schools, 29, 78-84. wood, d., halfon, n., scarlata, d., newacheck, p., & nessim, s. (1993). impact of family relocation on children’s growth, development, school function, and behavior. the journal of the american medical association, 270, 1334-1338. ziesemer, c., marcoux, l., & marwell (1994). homeless children: are they different from other low-income children? social work, 39(6), 658-668. http://www.ed.psu.edu/crec/pdf/psupoverty.pdf http://www.census.gov/population/www/socdemo/migrate/cps2006.html ersing, sutphen, loeffler/impact and implications of residential mobility 18 author’s note: address correspondence to: robin l. ersing, university of south florida school of social work, 4202 e. fowler avenue mgy 132, tampa, florida 33620. email: rersing@cas.usf.edu. mailto:rersing@cas.usf.edu sample data collection results descriptive statistics implications for social work spring2001-044_page 39 spring2001-045_page 40 spring2001-046_page 41 spring2001-047_page 42 spring2001-048_page 43 spring2001-049_page 44 spring2001-050_page 45 spring2001-051_page 46 spring2001-052_page 47 spring2001-053_page 48 spring2001-054_page 49 spring2001-055_page 50 spring2001-056_page 51 spring2006-002_i spring2006-003_ii spring2006-004_iii advances vol. 3, no. 2 online social work practice: issues and guidelines for the profession goutham m. menon julie miller-cribbs abstract: there has been growth in the utilization of information and communication (ict) tools in the field of social work in recent years.while most of the work has revolved around community practice, some social workers have moved into the realm of online, web-based therapeutic practice. this paper discusses important issues emerging from this new form of social work practice and concludes with suggested guidelines for the use of icts in social work practice. keywords: web-based counseling, online therapy, technology-enhanced practice the profession of social work has witnessed a growth in the creative use of technology in various areas of professional work for many decades (finn & lavitt, 1994; finn, 1995; shyne, 1954). ranging from telephone support groups (kennard & shilman, 1979; meier, galinsky & rounds, 1995; roffman, beadnell, ryan & downey, 1995; rounds, galinsky & stevens, 1991; wiener, spencer, davidson& fair, 1993) to themore recent exploration of computer-based applications in human services (finn, 1995; finn & lavitt, 1994; smyth & harris, 1993;weinberg, uken, schmale & adamek, 1995; stofle, 1997), professional practice with individuals, families, and groups has seen the influence of emerging information and communication technologies (ict). icts have also influenced the field of community practice in positive ways (downing, fasano, friedland, mccullough,mizrahi & shapiro, 1991;mcnutt, 2000), especially in the area of electronic advocacy (bennett & fielding, 1999; boland, 1998; buck, 1996; fitzgerald & mcnutt, 1999; mcnutt & boland, 1988; 1999; menon, 2002; 2000c). while most of the utilization of technology falls into the area of helping groups and communities, social work is beginning to see a growing interest in the provision of online counseling and therapeutic services for individuals (cutter, 1996; grohol, 1997; levenson, 1997; sampson, kolodinsky & greeno, 1997). some of these professionals offer such services alone or as part of a group of practitioners1. as students and practitioners becomemore familiar with technology-based appli104 goutham m. menon, ph.d. is assistant professor & director, center for technology in social work education and practice, college of social work, university of south carolina, columbia, sc 29208. julie miller-cribbs, ph.d. is assistant professor, college of socialwork, university of south carolina, columbia, sc 29208. copyright© 2002 advances in socialworkvol. 3 no. 2 (fall 2002) 104-116. indiana university school of socialwork. cations (either on their own or through education), it is probable that the use of ict for counseling will becomemore prevalent. professional organizations in fields similar to social work have begun to address the issue of online counseling. for example, the american psychological association (apa) and the medical field, particularly psychiatry, has begun to address ethical issues associated with the delivery of services online (see apa, 1997; american medical informatics association, 1998). the national board of certified counselors (nbcc) purports to “…create standard definitions of technology-assisted distance counseling that can be easily updated in response to evolutions in technology and practice” (nbcc, 2001) and the american counseling association (aca) approved ethical standards for internet and on-line counseling in 1999 (aca, 1999). internet healthcare coalition (ihc), an organization that attempts to set high standards for the distribution of health information via the internet, has developed a set of ethical guidelines relevant to our profession (ihc, 2000). finally, the international society formentalhealthonline (ismho)has also developed guidelines for the practice of online counseling, though these are not specific to social work (ismho, 2000). despite this continued and expanded use of ict in the field of social work, the profession currently has no established guidelines for the practice of social work online. many individuals and organizations have begun to address issues related to the online practice of social work, citing possible advantages and disadvantages of such practice and occasionally providing some general guidelines for online practice (coleman, 2000; levenson, 1997; stofle, 1997). stofle (2001), a social worker, has written a book about choosing an online therapist; yet, this book is geared towards potential consumers, not practitioners. finally, it was noted by powell (1998) that while the nasw insurance trust mentions that social workers who practice online are covered for malpractice, they express concern about the issue of online practice. some social work organizations, such as the clinical social work federation (cswf), have also argued strongly against the use of online counseling: “so much human suffering has been caused by disconnection—disconnection between individuals, between thought and feeling, between body and mind—and e-therapy offers yet another form. clients seek our services in order to improve the quality of their lives, the quality of their relationships. alienation from others and the self will not be healed through a virtual connection in cyberspace, a ‘connection’ that is fraught with risks and hazards for both clients and clinicians.” (cswf, 2001) despite cswf’s position, social workers currently provide online services and are likely to continue doing so. it is the contention of the authors of this paper that simple warnings about the dangers of online therapy or broad ethical discussions of this new modality of practice are not enough to protect our clients and practitioners, alike.there is clearly a need for the profession to step up and lead a debate culminating in specific guidelines for practice that helps to regulate the profession in virtual therapeutic and supportive environments. 105menon, miller-cribbs/online socialwork practice 106 advances in socialwork the current practice of online counseling has heightened the need for the social work profession to seriously examine this avenue of service delivery. to expand this endeavor, this paper explores and highlights the important issues related to this area of social work practice. it will conclude by providing suggested guidelines for the practice of online social work. defining online therapy computer-mediated communication (cmc) is frequently thought of in terms of technology only, thus, many often assume that cmc is simply about receiving and exchanging information (december, 1997). however, it has been argued that cmc is “a process of human communication via computers, involving people, situated in particular contexts, engaging in processes to shapemedia for a variety of purposes” (december, 1997).2 we know that social work communication in faceto-face settings involves the use of communication to bring about change. online therapy is just one form of cmc, one that obviously involves more than simple information exchange. bloom (1998) defines webcounseling™ as “the practice of professional counseling that occurs when client and counselor are in separate or remote locations and utilize electronic means to communicate with each other” (p. 21). obviously, this definition is fairly basic, including only the “context” of practice in the definition. perhaps a definition adopted by king and moreggi (1998) would be more inclusive and holistic. they define “behavioral tele-health” as “… all forms of synchronous and asynchronous internet mental health efforts, where the stated goal is the establishment of some form of therapeutic contact” (p. 93). cmc can also be referred to as the creation and dissemination of meaning; through various mechanisms (e-mail, chat, web sites), the perception ofmeaning, and the participation in “forums for communication that begin to exhibit characteristics of community—including a shared sense of purpose, norms for behavior, and traditions” (december, 1997). distinguishing between the simple provision of information versus the communication and perception of meaning is particularly salient for social work. there are a wide range of services being provided online, ranging from the provision of information to the actual provision of social work services. often, the terms used to describe these services are used interchangeably and, thus, provoke a misunderstanding as to the nature of services provided. for example, sometimes, online counseling services are simply informational services. at such websites the client has an opportunity to request information or ask a question related to a specific problem area. this is analogous to the many “help” columns seen in popular newspapers and magazines. sometimes, the individual pays for the e-mail response that he or she receives for the question posed. another type of service is what is commonly known as “online therapy.” the goal of online therapy is to provide a long-term therapeutic relationship. such a service involves individual-therapist communication using electronic mail, chat rooms, instant messaging, and other tools over a protracted period of time. such services aim to build rapport and provide for an ongoing therapeutic relationship. this paper largely focuses on the second kind of service, online therapy. for pur107 poses of this paper, we will define on-line therapy as the provision of therapeutic services utilizing internet applications, both text-based and audio/video, which enable clients to receive services without real face-to-face contacts with the provider (menon &miller-cribbs, 2001). there are major issues related to providing online therapy that must be addressed by the field of social work (menon, 1998a/b; 2000a/b; 2001; menon & miller-cribbs, 2001). the following is a discussion of important issues related to providing online therapy by social workers: the issue of face-to-face contacts, anonymity, technical aspects of the provision of the service, legal issues, licensing and cross border practice, and evaluation of online therapy. face-to-face: is it better? is it necessary? the inability of a social worker to assess non-verbal cues online is an area that concerns many in the profession (coleman, 2000). thus, social workers are pressed to think about why face-to-face contact is preferable and highlight ways in which therapy can be conducted without non-verbal cues. can warmth, caring, and compassion be conveyed via text? how should social workers account for the absence of non-verbal communication? therapy essentially involves an ongoing therapeutic relationship between two people who meet face-to-face. the therapist establishes trust and rapport with clients through this relationship. often, non-verbal communication is as important as verbal communication. online, it may be more difficult to establish trust and rapport since face-to-face contact is unavailable and the subsequent utilization of non-verbal cues becomes impossible. however, others have argued that face-to-face communication is not necessarily themost ideal type of therapy for all clients and their problems.walther (1996) argues that when a therapist has freedom from the social responsibilities of “looking interested,” then, he or she is able to take the time to thoughtfully respond in terms of selecting the right words and message. furthermore, the time delay betweenmessages forces individuals to think about what they send prior to communicating their feelings. there are also some possibilities for mimicking non-verbal cues using the keyboard. for example, internet-based communication is filled with the usage of acronyms and emoticons (emotional icons, such as :) happy face ;( crying sadly, etc.).3 one possibility is to develop a set of standardized emoticons and acronyms to capture the feelings of the client at any given point in time. these could be tailored into the software utilized for online practice. alternatively, an online therapist could provide clients with a sheet of “emoticons,” so that the client could incorporate these during sessions with the therapist. some of the issues listed above may be addressed once social workers have faster access to the internet through broadband internet-video technology. broadband, either through dsl connections or by cable tv providers, may allow practitioners to have computer-based video conferencing options. this will enable social work practitioners to have adequate visual access to clients. however, until then, one must expect poor quality video/audio streams when menon, miller-cribbs/online socialwork practice 108 advances in socialwork using telephone lines. currently, the majority of the population who have internet access utilize modems to dial-up in speeds ranging from 28.8k to 56k using regular analog phone lines. in some sectors of the country, we are also seeing an increase in dsl linkups. dsl, which stands for digital subscriber line, provides high-speed internet access using regular telephone lines. it has the ability to move data over the phone lines at speeds up to 6mb/s (six million bits per second) or 140 times quicker than the fastest analog modems available today (56,000 bits per second). in addition to its high speed, dsl hasmany benefits over analog connections. unlike dial-up connections that require analog modems to “dial-in” to the internet service provider every time the user wants to retrieve email or obtain access to the internet, dsl connections are always on. that means no more logging on and off, no more busy signals, and no more waiting for the connection to happen. another benefit is the ability to use the telephone while accessing the internet and not having to choose between the two. the cloak of anonymity—a good or bad thing? there is a growing body of literature that attempts to disentangle the concerns around intimacy and nonverbal communication (burgoon, buller & woodall, 1989; cherny, 1995; guerrero, devito & hecht, 1999; patterson, 1983; 1990). furthermore, there are greater philosophical conversations conducted regarding the meaning of intimacy and self-disclosure (walther, 1996). in fact, lerner’s (1990) definition of intimacy reveals little about the necessity for face-to-face contact in establishing intimacy as she notes: for starters, intimacymeans that we can be whowe are in a relationship, and allow the other person to do the same. “being who we are” requires that we can talk openly about things that are important to us, that we take a clear position on where we stand on important emotional issues, and that we clarify the limits of what is acceptable and tolerable to us in a relationship. “allowing the other person to do the same”means that we can stay emotionally connected to that other party who thinks, feels, and believes differently, without needing to change, convince, or fix the other. an intimate relationship is one in which neither party silences, sacrifices, or betrays the self and each party expresses strength and vulnerability, weakness and competence in a balanced way.” (p. 3) others have argued that the lack of face-to-face contact can be a positive feature when working with certain clients. in some cases, the anonymity that faceless interaction provides could have certain advantages, such as higher levels of self-disclosure, more intimacy, heightened self-expression, and stigma management (cohen & kerr, 1998). people who are reluctant to seek out counseling in a traditional setting may be more willing to seek out an online counselor. thus, online counseling may be a viable method of service delivery for certain client groups and problems. the telephone, for example, has been a long established and accepted mode for delivering crisis intervention services. as cohen & kerr (1998) note, “while clients with strong needs for emotional supportmay find the reduced cues environment a poor substitute for face-to-face interaction, computer-mediated counseling may be a viable option for more independent 109menon, miller-cribbs/online socialwork practice people dealing with specific problems or those interested in personal growth” (p. 24). stofle (2001) addresses the issue of the appropriateness of online counseling in his conceptualization of “levels of care and online therapy” continuum. he refers to varying levels of intensity of treatment that need to match the intensity of the client’s problem. he places online therapy on the lower intensity side of the level of care continuum and, so, it is best used for issues/problems that are low intensity, as well. such a conceptualization is helpful in determining the uses and possibilities of online therapy by social workers. the profession of social work should carefully consider what kinds of problems and issues are best suited for online delivery and establish guidelines for the delivery of such services. the provision of anonymity is both a strength and weakness of online social work practice. often, particularly in small communities, people know where the therapists live or practice, so by simply parking a car in a certain place, an individual risks being “found out.” these risks are not as apparent with online counseling. this could be especially beneficial for those individuals who seek help but are too embarrassed to go to a social worker’s office. online practice also has the potential to limit or eliminate biases that can corrupt treatment and slow the rapport-building process. in this way, the internet can be seen as a social leveler (levenson, 1997). age, gender, ethnicity, race, national origin, and other demographic features that provoke bias are absent.the client is a “faceless” individual and, thus, therapist and client bias are held in check. some authors have stated that the “faceless” nature of counseling might, in fact, improve the chances of certain reluctant individuals seeking treatment (cohen & kerr, 1998). under the cloak of supposed anonymity, certain people might actively take part in therapy sessions. it might allow some to bemore open about the problems they face and not be embarrassed to talk about them. technical aspects: hardware, software, and skills for socialworkers and clients the utilization of technology for counseling has its inherent technological problems. typically, web-based therapies are conducted through the client-side computer, the therapist-side computer, and the servers that connect the two. furthermore, depending on the nature of the counseling session, somewhere between two and six software programs are used (see table 1). adding hardware and software into the practice repertoire creates some noteworthy salient issues. social workers who practice online are ultimately responsible for protecting data (levenson, 1997) as well as ensuring that they have the technical skills that are requisite for practicing online (stofle, 1997). keeping data secure the most important is data security. the “real world” is replete with reports of data and identity theft either through the improper, unauthorized access to a person’s personal computer or through the malicious hacking of server or network traffic. in a review of websites conducted by the authors, it was disheartening to note that many of the mental health professionals who conduct webbased therapy often utilize unsecured servers and almost never use encryption software. 110 advances in socialwork with the growth of software that “snoops,” it is also becoming much easier for anyone withmalicious intent to load certain software into an unsuspecting client or therapist’s computer (see walker, 8/21/2000). the software, thus, is programmed to “capture” activities on a regular basis. such an individual is then able to read confidential material and access client files and records. protecting health information is a critical social work issue, even beyond the online arena. there are numerous cases regarding the violation of health care information security4 that are critical for social workers to be aware of while embarking in virtual practice. for the most part, social workers are unaware of who ultimately has access to their data, particularly electronic data such as e-mail. text residue a gravematter in the area of web-based counseling is the issue of reporting and taking down case-related notes. in an online, text-based environment, entire transcripts are recorded which include files that are seemingly “deleted” by the user. in fact, text residue is left behind even if records are deleted from the therapist or client computer. this residue can be resuscitated through the use of widely available data scavenging software. current convention on recording case notes emphasizes that the social worker record only what is truly important in the case. in a web-based environment, this is not possible. as previously mentioned, protective measures such as encryption can be taken, but it is impossible to remove all the residual effects of communication (unless the hard drive is reformatted). this has legal implications for social workers, as these text-based communications, including electronic mail and other forms of data stored on the computers and servers, could be subpoenaed in court cases. as such, case notes would include the content of entire sessions and the social worker has less control over how the notes are to be interpreted. for example, if a social worker were conducting a group session using an online chat session, each group member would have a transcript of the group session that could be printed, copied, and distributed to other individuals. of course, this risk also exists in “live” group sessions, but individual group members do not have access to a printed record. however, the danger of the “printed” record should not be ignored. clients in violent relationships who receive counseling client/therapist side server side •modem dial-up (aol, msn, etc.) • encryption software • browser (ms internet explorer/ • html server software netscape) • ftp server software • instant messenger clients (msn, yahoo, • java applets icq, etc.) • credit card processing • video link (msn, netmeeting) • firewall • java programs for applets • real media (for videos/audios)l •msword/wordperfect for documents table 1: software that may be utilized during sessions for detailed information on any of the terms used here, search http://www.google.com. 111 online might become more vulnerable if their text residue, e-mail, or chat information is intercepted. of course, there are risks associated with any kind of therapy (on-line or offline) as a result of negligence on the part of the social worker or malicious intent by an individual. however, most can be eliminated by proper use of secured sites and/or encryption software. encryption5 allows the sender and the receiver to scramble and unscramble messages sent through the network. this prevents the data from falling into the wrong hands. currently, no one is required to utilize such software when they practice online, but such a requirement may be a useful guideline. licensing and cross border practice:who is responsible forwhom? the “global” nature of online therapy makes the issue of licensing quite complicated. obviously, ensuring accountability in social work practice is an important aspect of social work. almost all states have some form of exam and/or the mandatory upgrading of skills through the accumulation of continuing education units. in an online environment, verification of such qualifications becomes more difficult. however, requirements for social work licenses vary from state to state. the licensing boards in each state are free to set their own standards and require practitioners to abide by them. furthermore, most licenses have limited portability. state differences in licensing and portability issues make agreement on national standards for online counseling difficult. social workers providing services to individuals in countries other than the u.s. is also an issue that needs to be addressed. stofle (1997) remarks that online therapists should practice only in states where they are licensed and that a “national certification for online therapists” should be instituted. he further argues that only “experienced therapists” should practice online counseling. currently, several online sites provide a service that provides a “credentials check” of therapists. consumers can go to such sites and retrieve information regarding the education, degree(s), and licensees of registered online therapists. it may be feasible to require that social workers register with such services and for the profession to develop some kind of national certification program for those interested in online therapy. to date, no national or state social work organizations have attempted such a service. evaluating online socialwork practice the efficacy of online therapy has not been well studied. most of the evidence, thus far, has been anecdotal with a few exceptions (barak, 1999; barak &wanderschwartz, 2002; king &moreggi, 1998;murphy &mitchell, 1998). there is an obvious need to conduct empirical studies in order for the social work profession to proceed in this area of practice. the same standards utilized to evaluate face-toface therapy should be applied to online therapy. there aremany approaches one could try in order to understand the nature of semantic conversations. apart from using standardized measures that are typically used in real-life settings, transcripts of online sessions could give way to the potential for rich qualitative and content analysis. it would also be interesting to see what types of theoretical frameworks work best in an online setting. menon, miller-cribbs/online socialwork practice 112 advances in socialwork conclusions there is enormous potential for the delivery of online social work practice. ict can provide services to hard-to-reach clients, as it is geographically accessible and can reach clients in remote areas. online counseling can be conducted from home, thus, bringing services to homebound individuals or those with limited mobility. ict can be convenient, perhaps helping busy individuals carve time from their lives to talk to a social worker. from a physical standpoint, online services are a safe way to deliver services. some people may enjoy the anonymity it provides either because of the issue they would like to discuss or because the community in which they live is small, which compromises their privacy. it may be the best, most cost-effective way to deliver services such as follow-up, referrals, support for relapse prevention, group services, informational services, and case management. not much is known regarding the effectiveness of online therapy. in addition, there are a host of possible legal and ethical issues thatmust be considered. social work must begin to seriously consider the impact of online therapy on the profession. as previously noted, many social workers are already using these new forms of electronic service delivery without having a set of specific social work guidelines in place. professional organizations in other fields have begun to take online counseling seriously, to the point of amending the language in their code of ethics to reflect on-line therapies. social workmust also develop guidelines for the online practice of social work. it is suggested that social work consider the following as suggestions for incorporating standards for online therapy into the social work profession: 1. revise the code of ethics to reflect technological innovations, including such issues as: a. confidentiality of clients. b. providing services via secured and non-secured websites. c. transferring information electronically. d. securing client records. e. identifying best use or a mandatory list of software, particularly encryption. f. identifying the scope and boundaries of online practice. g. establishing guidelines regarding the types of clients and issues for which online therapy is appropriate. h. establishing availability of therapists. i. providing limits of confidentiality (as in face-to-face therapy) but also including a discussion of the pros/cons and limits of online counseling. j. addressing issues related to professional identification online, perhaps by mandating participation in “credentials check” services or establishing a “national socialwork credential check.” k. addressing issues related to developing social work websites that advertise therapy services. 113 2. nasw tasks a. reflect issues ofweb-based counseling in thenaswpractice standards. b. create a task force to examine the practice of and effectiveness of online therapies. c. offer specific technology-based ceus to online therapists. d. limit cross-state/national borders counseling until liability guide lines are laid out. 3. other tasks a. mandate an intense empirical evaluation of any type of web-based therapy. b. generate a list of accredited social work programs and licensed social workers available to potential clients on the web, with a link placed at the bottom of online social workers’ web pages. c. establish constant credibility/content checks of websites by nasw, cswe, and other professional bodies. the socialwork profession must keep pace with the new and emergent tools of practice. traditional counseling will not “disappear” as these new approaches are adopted; however, poor practice of social work may occur if clear guidelines are not created for those social workers practicing online. like it or not, social work practice will occur online, and it is up to the profession to ensure that such practice is conducted thoughtfully and ethically. as stofle (1997) notes, “if the ethical therapist is not online, who is?” endnotes 1metanonia.orgprovides a list of individualswhoprovideonline counseling.there are several socialworkers listed on this site. 2 for a discussion of scholarly debate on the definitions of computer-medicated communications, refer to cmc magazine,volume 4, no. 1, 1997 at: http://www.december.com/cmc/mag/1997/jan/december.html. 3 for information regarding emoticons, refer to: http://wombat.doc.ic.ac.uk/foldoc/foldoc.cgi?query=emoticon. 4 for a list of news articles and resources related to healthcare information security, refer to: http://www.unh.edu/social-work/sw810/ethicis.htm. 5 for details about encryption, refer to netaction’s page: http://www.netaction.org/encrypt/. references american counseling association. 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(2001). choosing an online therapist: a step-by-step guide to finding professional help on the web. harrisburg, pa:white hat communications. menon, miller-cribbs/online socialwork practice 116 walker, j. (8/21/200). cyber-spying. retrieved on march 2, 2002 from abc news.com at: http://more.abcnews.go.com/onair/worldnewstonight/wnt000821_cyberspying_feature.html. walther, j. (1996). computer-mediated communication: impersonal, interpersonal and hyperpersonal interaction. communication research, 23, 3-43. weinberg, n., uken, j., schmale, j., & adamek, m. (1995). computer-medicated support groups. social work with groups, 17(4), 43-54. wiener, l.s., spencer, e.d., davidson, r., & fair, c. (1993). national telephone support groups: a new avenue toward psychosocial support for hiv-infected children and their families. social work with groups, 16(3), 55-71. some sites of interest • www.metanoia.org • http://www.ismho.org/ • http://www.rider.edu/users/suler/psycyber/psycyber.html • http://netpsychology.com/ • http://members.aol.com/stofle/onlinepsych.htm author’s note: address correspondence to: gouthamm. menon, ph.d., center for technology in socialwork education and practice, college of social work, university of south carolina, columbia, sc 29208, usa. e-mail: goutham.menon@sc.edu. advances in socialwork advances vol. 2, no. 2 104 advances in socialwork the 2001 educational policy and accreditation standards: issues and opportunities for bsw education irene queiro-tajalli katharine byers edward fitzgerald abstract: the educational policy and accreditation standards (epas) combines social work educational policies and accreditation standards within a single document. the epas establishes guidelines for baccalaureate and masters’ level social work education throughout the united states. in this article, the authors discuss the implications of the epas for bachelor of social work (bsw) programs. they focus especially upon those aspects of the epas that relate to foundation-level program objectives and curriculum content. keywords: bsw education, social work, epas, educational policies, accreditation standards the 2001 educational policy and accreditation standards (epas) integrates in a single document curriculum policies and accreditation standards and combines the mandates for social work education at the bsw and msw levels. it is too early to say how well this document will serve social work educators and students.we can say, however, that the epas document is a reflection of efficiency—one of the elements of a mcdonaldized society (ritzer, 2000). this article discusses the educational opportunities and concerns related to epas. in considering the implications of epas for bsw programs, we focus primarily upon the foundation program objectives and foundation curriculum content sections under the educational policy section.we also discuss selected passages in the accreditation standards section. educational policy the educational policy sets the basis for the accreditation standards by defining the purposes of the social work profession and education, the structure of social work education, program objectives, and the foundation curriculum content. the educational policy mandates baccalaureate social work programs to achieve 12 foundation program objectives. these objectives reflect the common irene queiro-tajalli, ph.d. is professor and director of undergraduate education, indiana university school of social work; katharine byers is associate professor and b.s.w. program director, indiana university school of social work, indiana university bloomington campus; and edward fitzgerald, m.s.w., j.d. is assistant professor and b.s.w. program director, indiana university school of socialwork, indiana university east campus. copyright© 2001 advances in socialworkvol. 2 no. 2 (fall 2001) 104-112. indiana university school of socialwork. 105queiro-tajalli et al./the 2001 epas: issues and opportunities for bsw education body of the profession’s knowledge, values, and skills. a close look at both the 1992 and 2001 program objectives indicates that practically no differences exist between these two sets of objectives. while there are some differences in language, the intent of the objectives appears the same. perhaps, the difference will be in the way programs link these objectives to their assessment plans to demonstrate objective achievement as required under the content area “program assessment and continuous improvement.” the foundation curriculum, reflected in eight curriculum content areas and in conjunction with a liberal arts perspective, mandates coverage of professional knowledge, values, and skills tomeet the foundation objectives. in the following pages we focus on selected aspects of the foundation curriculum. values and ethics social work is a value-based profession (gordon, 1965) that is subject to change (congress, 1999). as a result, the curriculum in this area needs to be sufficiently open to accommodate to societal changes (e.g., advances in medicine and technology). this content area expects social work programs to “integrate content about values and ethical decisionmaking as presented in thenational association of socialworkers code of ethics” (cswe, 2001, p. 9) in their foundation curriculum and prepare students to “understand the value base of the profession and its ethical standards, and practice accordingly” (p. 8). these expectations seem to establish the nasw code of ethics (nasw, 1999) as the primary guide for ethical decision-making. this raises issues and opportunities of various kinds. the nasw code of ethics is, without question, the predominant social work ethical code in the united states. however, there are other codes that have merit (e.g., national association of black social workers, international social workers, canadian association of social workers, federation of clinical social workers, code of radical socialworkers). we believe that these other codes may contribute to students’ education and enable them to recognize the value of different professional perspectives. nonetheless, the implicit endorsement of thenasw code establishes a clear and specific expectation for all social work students educated in accredited programs in the united states. diversity emerging societal changes will impact the way we conceive and shape social work practice in the next decade (2004-2014). we expect that in the years ahead, the process of devolution will continue on a global scale with repercussion at the individual and community levels. there are clear predictors of significant demographic changes in the usa based on the nature of work (gurnstein, 1996), multiculturalism (kivisto & rundblad, 2000), religion/spirituality (porter, 2000), and the aging of the population (greene, 2000). advances in technology will bring greater connectivity among people and social agencies (schoech, cavalier & hoover, 1993; queiro-tajalli & campbell, 1999) as well as widening the gap between the “technology rich” and the “technology poor” (tapscott, 1998). clearly, these changes will expand the nature of diversity in previously unimagined ways. several foundation program objectives refer to the abilities social workers require in serving diverse populations.we believe that the phrase “integrate con106 tent,” as used in the passage “integrate content that promotes understanding, affirmation, and respect for people fromdiverse backgrounds,” (cswe, 2001, p. 9), suggests that bsw programs are expected to thoroughly address diversity content throughout the foundation curriculum. similarly, the term “affirmation” is used in the new policy. we posit that “affirmation extends well beyond tolerance” to suggest an active, engaged search for the value andmeaning of diversity among individuals, groups, and communities. this implies a commitment to practice that truly reflects competence in diversity even if it requires opposingmainstreamprofessional practices. if bsw programs design curriculums and implement learning experiences suggested by the diversity-related foundation objectives and content, we anticipate that graduates will be ethnicallyand culturally-sensitive practitioners capable of enhancing human well-being in partnership with diverse clients. populations-at-risk and social and economic justice whereas diversity content helps students learn to acknowledge, celebrate, promote, and affirm diversity in bswpractice, the populations-at-risk and social and economic justice content encourages students to learn and think critically about deeply ingrained mechanisms of oppression that adversely impact the lives of individuals, groups, and communities. epas does not specifically identify which at-risk-groups should be addressed within the foundation curriculum. however, two foundation program objectives indicate that graduates must demonstrate the abilities to “practice without discrimination and with respect, knowledge, and skills related to clients’ age, class, color, culture, disability, ethnicity, family structure, gender, marital status, national origin, race, religion, sex, and sexual orientation”(cswe, 2001, p. 8), and to “understand the forms and mechanisms of oppression and discrimination and apply strategies of advocacy and social change that advance social and economic justice” (cswe, 2001, p. 8). among the purposes of the profession are to “. . . alleviate poverty, oppression, and other forms of social injustice” (p. 5) and “. . . pursue policies, services, and resources through advocacy and social or political actions that promote social and economic justice” (p. 5). social work education is charged with the responsibility to prepare social workers who are able to engage in activities intended to achieve such professional purposes. in generalist practice, we cannot target our focus of intervention on the individual without addressing those societal constraints that place diverse groups at risk. by the same token, we cannot address societal oppression without intervening to mitigate its impact at the interpersonal level. the epas enables bsw programs to build upon lessons learned from earlier attempts to develop and deliver content in this area. certainly, given the intricate interaction between economic and societal factors, greater emphasis on “economic justice” is needed. indeed, the 2001 epas requires coverage of “distributive justice, human and civil rights, and the global interconnection of oppression” and “…prepare students to advocate for non-discriminatory social and economic systems” (cswe, 2001, p. 10). in addition, the epas suggests that bsw programs include human behavior and the social environment content about “...empiri107107queiro-tajalli et al./the 2001 epas: issues and opportunities for bsw education cally based theories and knowledge that focus on the interactions between and among individuals, groups, societies, and economic systems” (p. 10). we recognize a clear need to educate students about economic systems as entities that can deter or enhance individual and community growth. as educators, we look forward to helping students learn to assess the sources and ramifications of oppression within the interconnection of global systems and demonstrate competency in efforts to achieve distributive justice and human and civil rights, and to develop nondiscriminatory social and economic systems within a global perspective. as we complete thismanuscript, the horrendous attacks of september 11, 2001, and the subsequent retaliation by the united states, combined with fears of biological warfare are extremely painful reminders of the negative side of global interconnections in the 21st century. at the same time, we experience the compassionate face of global interconnections in the form of solidarity, unity, and relief efforts. the unspeakable acts of violence and the expressions of compassion have revealed the worst and best of globalization. as queiro-tajalli and campbell (2002) state, “these horrendous attackswill not abate, butmay intensify given the apparent intolerance toward diversity and a seemingly ever-increasing lack of respect for human rights on a global scale.” perhaps, for the first time in our lives as educators, students, and practitioners, we must grapple with so many unanswered questions related to national and international social and economic justice. we hope to seize the opportunity of a new educational policy statement to transform our curriculums to encourage the preparation of competent practitioners in a world of contradictions, where forces of destruction are so closely interrelated with those of construction, goodwill, and resilience. we support asamoah, healy, and mayadas (1997) in their call to abandon “…the conceptual separation of domestic and international content andmove toward a curriculum with a truly global perspective” (p. 389) in order to prepare students for the realities of this millennium. socialwelfare policy and services epas highlights the integral relationship between policy and practice. the document emphasizes policy analysis from local to international levels as well as the explicit linkage of policy to social work practice. it makes clear that bswprograms must help students develop “policy practice skills” needed to participate actively in the policy development process in both organizational and political contexts. this emphasis on policy practice and advocacy skills places policy squarely in themidst of the practice of social work, not as a separate foundation content in the curriculum. the challenge for bsw educators is how to make this linkage explicit for students. socialwork practice the 2001 epas continues to emphasize generalist practice. each bsw graduate is expected to demonstrate the ability to “apply the knowledge and skills of generalist social work practice with systems of all sizes” (p. 8). furthermore, content about social work practice should focus on “strengths, capacities, and resources of client systems in relation to their broader environments” (p. 10), help students learn to 108 advances in socialwork develop, analyze, advocate, and provide “leadership for policies and services; and promoting social and economic justice” (cswe, 2001, p. 10). the educational policy appears to suggest that policy and practice content be more integrated, and that policy-related work is indeed part of social work practice. “policy practice skills” seem fundamental to generalist social work practice. we anticipate that the integration of policy and practice will serve graduates well. it will equip practitioners with the knowledge and skills to provide leadership in developing policies and programs that are research-based, tailored to the circumstances of state and local contexts, and derived from their experience serving clients affected by social policies. this content area also calls for a curriculum that includes empirically-based interventions to achieve client goals. we believe that this mandate will reinforce the orientation of best practices in social work. there is no doubt that empirically-based practice is of paramount importance in the 21st century, yet, we are cognizant that as a profession we are continually challenged to agree as to what is an effective intervention and for whom it is effective. the inclusion of the application of empirical and technological advances to practice is another important aspect of the foundation practice content. the context of contemporary social work practice is changing dramatically and will continue to do so in light of emerging knowledge and advances in technology. bsw students need to know about the risks and opportunities associated with technological innovations as well as legal and ethical factors associated with its application in practice. access to services through agency-sponsored “chats” or “e-mail support groups” increase accessibility, particularly to clients who have typically been underserved, those in remote or rural areas, and those whosemobility challenges limit their ability to physically access agencies for services. online counseling or teleconferencing expands the possibilities for reaching those who have been isolated. bsw social workers prepared for generalist practice also need to learn about the potential for “electronic community organizing” and the use of technology for advocacy purposes (fitzgerald &mcnutt, 1999; mcnutt & boland, 1999; queiro-tajalli & campbell, 2002). as we promote the promising aspects of technology in social work practice, we need to educate students in the ethical use of technology (cwikel & cnaan, 1991) and in the obligation social workers have to advocate for access to technology for all people. numerous writers (pippa, 2001; slater, 2000; tapscott, 1998; vernon & lynch, 1999) have warned us about the dangers of a “digital divide” in the information society, creating a gap that separates those with access to the internet and those without (slater, 2000). in the industrial economy we talked about an unequal distribution of resources creating a division between the “haves” and “the have-nots.” in the information society we have to be vigilant not to allow society to become fragmented between “the knowers and know-nots” and the “doers and do-nots” based on access to technology and education. accreditation standards educational accreditation standards establish a minimal level of expectation without either establishing or guaranteeing excellence. some authors have point109109queiro-tajalli et al./the 2001 epas: issues and opportunities for bsw education ed out that at times, accreditation standards may impede curricular innovation (markward & drolen, 1999), may not assure program effectiveness (wellman, 2000), andmay contribute to conflict and controversy among the social work professional and academic communities (gibbs, 1995). despite its occasional disadvantages, accreditation is the vehicle social work education and educators have chosen to help define the profession, refine curriculum, and develop generations of practitioners. the question that must be addressed is what impact the epas will have on social work education in teaching, training, and socializing future practitioners. budgetary authority epasmandates the presence of “sufficient” resources in the area of support staff, other personnel, library resources, office and classroom space, and technology necessary to “achieve program goals and objectives” (p. 14). bsw programs will be challenged to document what is “sufficient” in order to achieve their mission. this is also related to the question of who owns the budget? while the 1994 evaluative standard clearly stated that “the programmust have its own budget, as well as responsibility for budget development and administration” (cswe, 1994, p. 82), the 2001 accreditation standard 3 is silent on this issue. the closest statement is accreditation standard 3.1.2, which reads, “the program has sufficient and stable financial supports that permit program planning and achievement of program goals and objectives. these include a budgetary allocation and procedures for budget development and administration” (cswe, 2001, p. 14). it appears that budget planning and implementation need not be the prerogative of the social work faculty and administrators.we wonder about the implications of potentially reduced budgetary authority within bsw programs in an educational context of competing programs and diminishing resources. non-discrimination and human diversity epas requires bsw programs tomake “specific and continuous efforts to provide a learning context in which respect for all persons and understanding of diversity (including age, class, color, disability, ethnicity, family structure, gender, marital status, national origin, race, religion, sex, and sexual orientation) are practiced” (cswe, 2001, p. 16). this standard appears to make clear that programs must adopt policies and practices that respect diversity and prohibit discrimination. although the legal rationale for less affirmative language may be understandable, many social work educators wonder about the nature of professional social work education in college and university contexts that do not support protection for vulnerable groups. the positions of certain religions on topics such as sexual orientation and status of womenmaymake it difficult for some bsw programs to provide learning contexts that meet accreditation standards related to nondiscrimination and human diversity.we wonder how bsw programs of all kinds will respond to this mandate. similarly, we wonder how accreditation site visitors and commissioners will evaluate programs on this standard.we anticipate considerable controversy in the years ahead. 110 advances in socialwork program assessment and continuous improvement program assessment is at the core of the accreditation process. through assessment, programs demonstrate that they are accomplishing their mission and goals. as suggested by palomba and banta (1999a), assessment involves more than the purposeful collection of data. assessment also includes the use of information to improve educational programs. the “ultimate emphasis of assessment is on programs rather than on individual students” (p. 5). program assessment has been difficult formany social work programs to implement. according to baskind, shank, and ferraro (1999), “96% (n=70) of all programs that were reviewed for reaffirmation for the period february 1998 through october 1999 were required to submit an interim report for this standard” (p. 103). clearly, regular assessment is essential for the development and maintenance of quality social work education. epas requires programs to demonstrate that they have a conceptual plan for assessment, that they implement the plan, and that based on the analysis of the assessment data, that they make the necessary adjustments to the educational program. indeed, this standard requires that programs“evaluate the outcome of each programobjective…” (p. 17). such a requirement represents an opportunity for faculty to collaborate on assessment processes that relate specifically to each program’s unique goals and objectives. as suggestedbybanta, lambert, andblack (2001), it is unlikely that a single assessment tool will meet all the needs of all programs. certainly, some instruments (e.g., the beap)will beuseful across-the-boardbutprogramswill undoubtedlyneed todevelop additional processes (e.g., portfolios, capstone products, comprehensive exams). we hope that program assessment will be used to enhance students’ learning and strengthen the quality of social work programs.we recognize that some programs may engage in assessment primarily to “satisfy” accreditation expectations. we also fear that program assessment results may be used for purposes other than quality improvement (e.g., personnel evaluation, funding decisions, or program elimination). if programs anticipate that negative findings constitute major risks to their survival or accreditation status, the processes of assessment may become superficial or irrelevant. program renewal program renewal is closely related to assessment in the inclusion of relevant stakeholders in the process. programs are required to have “ongoing exchanges with external constituencies that may include social work practitioners, social service recipients, advocacy groups, social service agencies, professional association, regulatory agencies, the academic community, and the community at large” (cswe, 2001, p. 16). while each stakeholder may have different roles in assessment and program renewal, each is a precious resource to improve the quality of social work education. integral to the emphasis on program assessment and renewal is the encouragement for programmatic innovation and change. the 2001 epas permits “programs to use time-tested and new models of program design, implementation, and evaluation” and encourages “programs to respond to changing human, professional, and institutional needs” (p. 3). we welcome this opportunity to meet accreditation standards while changing and revising curriculums and learning experiences in our efforts to improve educational quality. conclusions social work is a diverse profession as reflected in itsmany practicemodalities, varied ideologies, and wide range of fields of practice. nonetheless, throughout the history of social work accreditation, educators have captured the essential elements of the profession and have integrated them into curriculum policy statements, including the recently approved epas. based on themany faces of the profession, the demands onbsweducation aremany.however, this has been the case since 1974 when the council on social work education began to accredit undergraduate social work programs. certainly, the newepas calls formore emphasis in certain areas, including technology, affirmation of diversity, empirically-based research and interventions, and attention to global systems. in the final analysis, the epas has retained the intent of the 1992 curriculumpolicy statement program objectives. nonetheless, we should not feel complacent about current curriculum designs and content but take the opportunity afforded by epas to bring changes in the curriculum that truly reflect our commitment to assist vulnerable populations and promote social and economic justice. furthermore, through our assessment processes, we should determine the validity of what we teach and the praxis of how we teach. references asamoah, y., healy, l. m., & mayadas, n. 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(1996). planning for telework and home based employment: reconsidering the home/work separation. journal of planning education and research, 15(3), 212-224. 111111queiro-tajalli et al./the 2001 epas: issues and opportunities for bsw education 112 advances in socialwork kivisto, p., & rundblad, g. (eds.) (2000).multiculturalism in the united states. current issues, contemporary voices. thousand oaks, ca: pine forge press. markward,m., &drolen, c. s. (1999). do accreditation requirements deter curriculum innovation? journal of socialwork education, 35, 183-195. mcnutt, j. g., & boland, k. m. (1999). electronic advocacy by non-profit organizations in social welfare policy.non-profit andvoluntary sector quarterly, 28(4), 432-451. national association of socialworkers. (1999). code of ethics.washington, d.c.: author. palomba, c. a., & banta, t. w. (1999a). assessment essentials: planning, implementing, and improving assessment in higher education. san francisco, ca: jossey-bass publishers. palomba, c. a., & banta, t. w. (eds.) (1999b). assessing student competence in accredited disciplines. pioneering approaches to assessment in higher education. sterling, virginia: stylus. pippa, n. (2001). digital divide: civic engagement, information poverty, and the internet worldwide. cambridge, ny: cambridge university press. porter, r. y. (2000). clinical issues and intervention with ethnic minority women. in j. f. aponte, & j.wohl (eds.), psychological intervention and cultural diversity (2nd ed.) (pp. 183-199). needham heights, ma: allyn, & bacon. queiro-tajalli, i, & campbell, c. (2002). organizing women of color online. in s. hick & j. mcnutt (eds.), social work advocacy and community organizing on the internet, (pp. 113-127). chicago:lyceum. queiro-tajalli, i., & campbell, c. (1999). challenges of program directors and field instructors: use of information technology in field instruction. paper presented at the annual baccalaureate program directors conference, st. louis, missouri, november 3-7, 1999. ritzer, g. (2000). the mcdonaldization of society. thousand oaks, ca: pine forge press. schoech, d., cavalier, a., & hoover, b (1993). amodel for integrating technology into amulti-agency community service delivery system. assistive technology, 5(1), 11-23. slater, d. (2000). low-income grassroots organizations work to close the digital divide. paper presented on comm-org: the on-line conference on community organizing and development. [on-line] http://comm-org.utoledo.edu/papers.htm. tapscott, d. (1999). growing up digital. the rise of the net generation. newyork, ny: mcgraw-hill. vernon, r., & lynch, d. (1999). social work on the web: tools for cyberpractice. the indiana socialworker, 17(6), 1-2. wellman, j. v. (2000, september 22). accreditors have to see past learning outcomes. the chronicle on higher education, p. b20. author’s note: address correspondence to: irene queiro-tajalli, indiana university school of socialwork, 902west new york street, indianapolis, in 46202-5156 usa, itka100@iupui.edu. microsoft word casey_strategies_for_engaging_men_final     _________________  erin casey, ph.d., is an assistant professor of social work at the university of washington, tacoma. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 267-282   strategies for engaging men as anti-violence allies: implications for ally movements erin casey abstract: as ally movements become an increasingly prevalent element of social justice efforts, research is needed that illuminates effective strategies to initially engage members of privileged social groups in anti-oppression work. this study presents descriptive findings regarding ally engagement strategies and barriers from a qualitative study of a particular ally movement – male anti-violence against women activism. twenty-seven men who recently initiated involvement in an organization or event dedicated to ending sexual or domestic violence were interviewed regarding their perceptions of effective approaches to reaching and engaging other men in anti-violence work. participants viewed tailored engagement strategies that tap into existing social networks, that allow men to see themselves reflected in anti-violence movements, and that help men make personal, emotional connections to the issue of violence as most effective. implications for engaging men in the project of ending violence against women, and for ally movements more generally are discussed. keywords: ally development, engaging men, domestic violence, sexual assault, prevention introduction ally movements are predicated on the notion that institutionalized oppression will persist until members of “dominant” social groups become actively involved in ending it. of central relevance to social work’s core values of pursuing social justice and social change, these overlapping anti-racism, anti-heterosexist, and anti-sexism efforts endeavor to engage people who are privileged by oppressive social systems in the project of dismantling those very sources of unearned advantage (bishop, 2002; broido, 2000). while significant work has conceptualized processes through which members of “dominant” groups come to recognize their own sources of unearned social privilege (e.g., helms, 1990), scant research has examined how members of these groups are then best supported in translating this awareness into active engagement in working to disassemble systems of oppression. this study examines ally engagement through the lens of a particular ally movement – men organizing against violence against women. given that sexual and domestic violence persist as significant public health crises, and are largely perpetrated by males (tjaden & thoennes, 1998), a consensus is emerging that reducing and preventing violence against women requires the participation of men who can model non-violent behavior, and hold their male peers accountable for sexist or abusive conduct (e.g., flood, 2005). like ally movements more generally, however, few studies have taken up the question of what approaches best serve to engage “average” men (i.e., men who do not currently see violence against women as an issue relevant to their lives) as potential anticasey/strategies for engaging men as anti-violence allies 268 violence allies. the purpose of this study is therefore to present findings from a study of new male anti-violence allies regarding the strategies they perceive to be relevant to other men. implications of these findings for ally development efforts more broadly will then be discussed. men’s anti-violence organizing groups men’s anti-violence organizations are increasingly prevalent in communities and on college campuses, and typically involve males in violence prevention education, skill building related to responding to disrespectful peer behavior, and mentorship of other boys and men (dekeseredy, schwartz, & alvi, 2000; katz, 1995). inherent in this work is often an effort to build a critical consciousness among men about the prevalence and impact of violence against women, the links between the embodiment of traditional forms of masculinity, male privilege and violence perpetration, and the role of men in addressing other men’s abusive behavior (hong, 2000). examples of existing programs include the mentors in violence prevention program (katz, 1995) and the men can stop rape program in washington, dc, whose “men of strength” (most) clubs provide adolescent and young adult men the opportunity to critically interrogate notions of masculinity and to enhance their capacity to take a more active stance against male violence (men can stop rape, 2010). a non-experimental evaluation of most club participants found that high school aged boys reported a greater willingness to intervene to stop a peer’s inappropriate behavior after 16 weeks of club participation (hawkins, 2005). although some evidence is emerging about the impact of involvement in antiviolence programs, little is known about the nature or effectiveness of the strategies employed to encourage men’s initial participation. a handful of studies have examined factors associated with individual men’s decisions to become involved in anti-violence work. these factors include sensitization to or personal experience with the issue of violence (casey & smith, 2010; coulter, 2003), peer mentorship or support for involvement (coulter, 2003), a pre-existing social justice consciousness regarding other issues of oppression (funk, 2008), and concrete involvement invitations that highlight men’s strengths and potential contributions (casey & smith, 2010). these factors may therefore also be relevant to ally outreach and engagement strategies. indeed, evidence from studies of racial ally development suggest that anti-racism involvement is precipitated by exposure to and reflection about race-based oppression, as well as personal connection with mentors and peers who both model ally behavior and invite active participation (reason, roosa-millar, & scales, 2005). finally, numerous antiviolence scholars and practitioners have also suggested the importance of using positive engagement strategies that approach men as having a critical role to play in solving violence, rather than approaching men as potential perpetrators or “part of the problem,” a method that is likely to foster defensiveness and disengagement (berkowitz, 2002; flood, 2005). findings from efficacy studies regarding sexual and domestic violence prevention education may also provide hints about elements of effective ally engagement. although not directly addressing initial outreach strategies for getting men “in the door,” these advances in social work, fall 2010, 11(2) 269 findings highlight possibly compelling characteristics of engagement programs for men. for example, consensus is emerging within prevention research that single sex (brecklin & forde, 2001), male-facilitated (kilmartin, 2001) prevention programming is more effective in changing men’s attitudes than is co-educational programming. additionally, culturally-tailored efforts that match presentation content to and employ facilitators from within audiences’ cultural communities are associated with greater resulting attitude change (heppner, neville, smith, kivlighan, & gershuny, 1999). thus, initial ally engagement techniques which are facilitated by and for men and are culturally relevant may hold greater appeal for potential allies. still, these components have not been explicitly examined in relation to efforts to reach out to previously uninvolved men. purpose of study in summary, although evidence is emerging about the impact of participation in antiviolence organizations or curricula on men and the factors that predispose men to seek these opportunities, very little research has examined the strategies that may best foster initial interest among and engagement of male allies in particular, or of anti-oppression allies more generally. to this end, this study examines qualitative data from interviews with 27 men who recently initiated membership or involvement in an anti-sexual or domestic violence effort. specifically, this study aims to 1) describe the strategies perceived by these allies as effective in engaging other men, 2) identify the barriers to reaching out to potential allies, and 3) evaluate the implications of anti-violence men’s engagement strategies for ally development efforts more broadly. methods participant recruitment data for these analyses were drawn from a larger study examining factors that precipitate anti-violence involvement for recently recruited male allies. in accordance with procedures approved by the institution’s human subjects committee, respondents were recruited via notices disseminated on several topic-relevant national email listservs, through announcements at relevant community meetings throughout a northwest state, through leaders of men’s anti-violence groups in the pacific northwest, and through referrals from participants themselves. potential respondents contacted the researcher directly, and were screened for eligibility. participation eligibility criteria included initiating on-going involvement in an anti-violence against women organization, event, or group within the past two years at the time of contacting the researcher, and being a man 18 years or older. because the primary aim of the larger study was to understand the most current influences on men’s entrée into anti-violence involvement (these findings are described elsewhere (casey & smith, 2010)), recent initiation into anti-violence work was included as an eligibility criterion. this eligibility decision was made in consultation with current male activists, who felt that although data exist on factors associated with long-time involvement in anti-violence men’s organizations (e.g. funk, 2008), knowledge about how to attract and engage “new,” and more broadly representative casey/strategies for engaging men as anti-violence allies 270 recruits to the movement is needed. findings regarding ally engagement presented here therefore reflect the experiences and perceptions of those newly initiated male allies. sample forty-three men contacted the study and were screened for eligibility. of these, 14 reported long-term anti-violence involvement and an additional two did not return consent forms and were therefore ineligible for participation. the final sample consisted of 27 men, ages 20-72. all but one identified as white; one man identified as latino. of the 16 men ineligible for the study, five identified as african american, one as latino and 10 as white. participants came from all regions of the u.s. length of involvement in anti-violence work at the time of the interview ranged from one to approximately 30 months (only one participant had been doing anti-violence work more than two years at the time of the interview; this discrepancy resulted from a delay in conducting the actual interview). participants’ involvement in anti-violence work generally fell into two categories. first, 11 of the men (41%) were post-college aged respondents who worked (3 participants) or volunteered (8 participants) with a domestic and/or sexual violencerelated program, government agency, or partnering men’s group. these participants’ roles ranged from doing direct advocacy with survivors of violence, to volunteering in a shelter or a prevention education program for youth. the other 16 participants (59%) were involved in college campus-based organizations in which they were engaged in activities such as facilitating educational presentations for other college students, organizing campus-wide anti-violence awareness events, or designing activities or events aimed at garnering additional male participation. data collection and analytic strategy nine participants were interviewed in person and the remaining 18 were interviewed by phone. interviews varied from 45 to approximately 90 minutes in length and were semi-structured, with general questions designed to elicit information about engagement strategies and barriers, followed by tailored follow-up questions to explore relevant issues in greater depth. question topics included the nature of men’s involvement, their use and perceptions of effective and ineffective strategies for engaging other men, and the barriers they encountered in efforts to reach men. all interviews were digitally recorded and transcribed. eight participants chose to review and approve the written transcripts of their interviews. data were analyzed as transcripts were completed using techniques drawn from grounded theory (strauss & corbin, 1998). analysis proceeded in two stages using the qualitative analytic software program atlas-ti. because of the paper’s primary focus on engagement, all transcripts were first coded by two researchers for general domains, with like domains pertaining to discussions of engagement grouped together. next, following techniques described by charmaz (2006), inductive, line-by-line coding on relevant domains was done with the author using extensive simultaneous memoing to uncover concepts within the data. particular analytical attention was paid to the dimensions of concepts (strauss & corbin, 1998), such as temporality, notions of “effectiveness,” affective components, etc., which were enhanced using a constant advances in social work, fall 2010, 11(2) 271 comparative method both within and between cases. from this comparison, layers of concepts related to both engagement and barriers to engagement were uncovered, which resulted in the construction of a two-tiered framework (see table 1). once saturation of concepts was reached, all transcripts were re-read and compared for both confirming and disconfirming cases. resource constraints did not allow for re-interviewing or theoretical sampling at this point. trustworthiness was then enhanced in three ways; through review by the second researcher, through six member checks, and through third party checks by two independent readers who evaluated the face validity of concepts and the data used to support them. results participants described two tiers of strategy for reaching other men. these layers are summarized in table 1 and are described in turn below. counts of the number of participants mentioning each theme are provided to further contextualize the data and to speak to “internal generalizability” (maxwell, 2010, p. 478), or the validity of concepts based on the degree to which they characterize individuals within the sample vs. subgroups within the sample, vs. the sample as a whole. on the surface, men talked about a variety of ways to gain initial access to men, or create venues for engagement. secondly, respondents discussed tactics or particular ways of approaching deeper conversations about violence and being an ally that they believe hold promise for connecting with other men. these strategies cut across approaches to “gaining access” and are summarized under the “delivering the message” section in table 1. at both of these levels of engagement, participants described related barriers or challenges to successfully reaching and connecting with other men. gaining access participants identified a variety of strategies for “getting men in the door,” and a majority of respondents had personally implemented more than one. twenty-one of the men (78%) reported that gaining access through personal networks was the most effective approach. this largely occurred through tailored, individual conversations with men in their existing social, family or professional networks. all of the college-based allies endorsed this strategy, while about half of the community-based men mentioned it. participants identified five additional strategies for gaining access to men (noted below), but many felt that, in isolation, these less personalized approaches are less likely to attract longer term anti-violence involvement among men. fourteen participants (52%), mostly college-based allies, reported active involvement in presenting or facilitating educational presentations or regarding dating or sexual violence. eight allies (30%) had participated in organizing larger anti-violence community events or in arranging speakers. five respondents (19%) took part in staging pledge campaigns (events at which men are encouraged to pledge non-violence or support for ending violence against women), and 5 respondents (19%) were involved in outreach to male youth. seven men (26%) speculated that larger anti-violence media (tv/radio) campaigns are needed to reach men, although only one had experience implementing this kind of effort. a higher percentage of community-based participants endorsed this strategy. as previously noted, casey/strategies for engaging men as anti-violence allies 272 however, a majority of participants felt that broad, generalized approaches such as media campaigns or large public events are likely to be ineffective at engaging men in a meaningful or longer-term way unless coupled with more personalized opportunities for discussion (see below for further discussion). table 1: proportion of participants endorsing engagement strategies and barriers theme college-based allies (n=16) n (%) community-based allies (n=11) n (%) total (n=27) n (%) gaining access strategies using personal networks 16 (100) 5 (45) 21 (78) educational presentations 12 (75) 2 (18) 14 (52) community events or speakers 6 (38) 2 (18) 8 (30) media campaigns 3 (19) 4 (36) 7 (26) pledge campaigns 4 (25) 1 (9) 5 (19) outreach to youth 2 (13) 3 (27) 5 (19) barriers to gaining access non-personal approaches 10 (63) 4 (36) 15 (55) male social privilege 9 (56) 6 (54) 15 (55) not identifying with the messenger 8 (50) 3 (27) 11 (41) structural barriers 5 (31) 2 (18) 7 (26) delivering the message meeting men where they are tailoring conversations 8 (50) 4 (36) 12 (44) relevant role models 5 (31) 4 (36) 9 (33) using masculinity 3 (19) 2 (18) 5 (19) use of self 9 (56) 2 (18) 11 (41) strengths-based approach to men 6 (38) 4 (36) 10 (37) survivor stories 5 (31) 3 (27) 8 (30) broader conversations 6 (38) 2 (18) 8 (30) compelling communities 2 (13) 3 (27) 5 (19) barriers to the message perceived negativism toward men 8 (50) 2 (18) 10 (38) ambivalence about “feminism” 3 (19) 2 (18) 5 (19) barriers to accessing men based on their own experiences of attempting to engage other men’s interest in antiviolence work, as well as their perceptions of their own past barriers to engagement, participants described a number of factors that they believed prevent men from attending educational or involvement opportunities. these fell into four general themes. first, 15 advances in social work, fall 2010, 11(2) 273 respondents (55%) identified non-personalized approaches as ineffective at reaching other men. these respondents, mostly college-based allies, perceived that generalized strategies such as posting flyers, sending out letters or mass emails, using posters, billboards or media campaigns, or holding broader community events were often unsuccessful at attracting men’s attention or attendance. participants speculated that because many men view sexual or domestic violence as “women’s” issues, they are not motivated to engage with materials or messages that raise these issues in a general way. respondents suggested that without more personal or individualized links to the issue of violence, men are unlikely to notice educational opportunities or to see them as relevant. one participant expressed frustration with multiple attempts to garner male interest for a campus-based men’s anti-violence group through advertising campaigns: i guess our big problem is that even though we can do advertising or send out emails, not many people are willing to sign up, or who knows if they’re even reading them because i have no reasons for why they would. we really wanted to get our name out there… but it just didn’t work for us. (mav16) second, 15 respondents (55%) identified male social privilege as a significant engagement barrier. participants alternatively described this barrier as other men’s beliefs that violence against women is not a significant problem or does not apply to men, or as other men’s performance of “stereotypical masculinity” that results in minimizing, making light of, or even tacitly perpetuating the problem of sexual or domestic violence. as one participant noted, “a lot of people, you know, they’ve grown up with this [attitude] their whole lives, and they just don’t see anything wrong with it. they think it’s just fine… either, ‘i just don’t want to get involved, this is not my problem,’ or ‘yeah, that’s just a normal thing to do.’” (mav1) another participant described male privilege as a tendency and ability to avoid the topic: i think that me being an older student, and having lived a little bit of life, i know that just about anything that is very honest about the problem turns men off. it’s not something we want to admit to. it’s not something we want to acknowledge. it’s not something that we willingly want to be confronted with. (mav14) next, 11 respondents (41%) described not identifying with the messenger as a barrier for many men. these participants, a higher percentage of whom were college-based, suggested that the identity, perceived identity, age or “outsider” status of some male antiviolence messengers may have reduced the degree to which they influenced other men or convinced them to attend an event or presentation. one college-based participant shared: we [men against violence group] had an outsider come in… and one time he came in to kind of rouse the masses, and the second time he came in to kind of pull in everybody else… and it didn’t really grab many people. so you know that really didn’t work. it didn’t really work all that well getting someone who was seen as an expert in the field. (mav11) some speculated that the title of anti-violence or men’s organizing groups might not offer a point of connection for many men, or that stereotypes of anti-violence men as casey/strategies for engaging men as anti-violence allies 274 “liberal,” or “soft,” deterred men from joining, as evidenced in the following communitybased respondent’s comments: i think that in terms of getting involved in women’s issues, one of the hesitations is a lot of guys think the guys that are involved are like my friend… meek, ponytailed, soft-spoken, birkenstocks…. and they don’t want to be associated with that kind of like, asexual, sort of meek stereotype. (mav3) finally, seven participants (26%) mentioned structural barriers such as a lack of time, lack of an accessible anti-violence group in some men’s communities, and lack of support from campus administrations or other social structures as factors in impeding men’s antiviolence engagement. delivering the message participants described a variety of specific, intentional approaches to framing messaging about anti-violence work to men. these “delivery” strategies were at the core of what participants identified as strategic and effective approaches to engagement. six “delivering the message” approaches were described, and are summarized in table 1. meeting men where they’re at. the most common set of engagement strategies employed by men in the study was to approach other men in a tailored and individualized way. comprised of three sub-themes, “meeting men where they’re at” is a group of strategies generally intended to allow other men to personally relate to anti-violence efforts or conversations and to build on the knowledge and attitudes they hold at the moment they are engaged. inherent in this set of strategies was an effort to help a potential ally find a personal point of connection to the issue of violence, or to a compelling “harm” done to him or his loved ones because of the existence of violence. many of the “meeting men where they’re at” strategies seemed to parallel, or perhaps be a response to the barriers to engagement described later in this article. tailoring conversations. this first sub-theme in “meeting men where they’re at” was reported by 12 respondents (44%). these participants used an open approach to engaging men individually or in groups that involved asking them questions, assessing their attitudes, learning about them and/or using what they know about the men to frame the way they subsequently engaged in discussion related to the issue of violence. this strategy was reported by half of college-based participants, and about one third of community-based allies. as one participant noted, “i think it’s vitally important to listen to where people are at and truly understand where people are coming from because there’s no way that we can engage people effectively until we know where they are coming from” (mav24). for some participants, meeting men where they’re at meant literally going to the places men are likely to be – fraternities, elks club, workplaces, etc. participants endorsing this strategy did not have a prescriptive approach to how they talked about violence with other men, but tailored their conversation to their audience in the moment, such as the approach described by the following participant: i don’t really go in with a set strategy of how i’m going to work with a person. i kind of go in, i feel out the situation, i see what’s going on, and we might not advances in social work, fall 2010, 11(2) 275 even get into that first day. it might just be me making friends with them that day and then talking about it at a later point. but i always go back to it. (mav15) relevant role models. nine respondents (33%) described the importance of having messengers in their anti-violence group who appeal to, are respected by, or are reflective of the men they are speaking to, so that men could literally “see themselves” in the group. connected to this is the idea that men should get the message that they don’t have to be someone else, or change in order to be involved. not mentioned in this category by participants, however, was diversity among messengers in terms of race/ethnicity. one respondent described his groups’ efforts to appeal broadly to their college peers: i think it’s really important to show that men that are already involved are average, normal people… because i know that when i had heard presentations before i could never really relate to the person giving the presentation about sexual assault, and it’s never someone that i could really see as… similar to me. and so … we’ve shown the men on our campus that the men of [anti-violence group] are average joe type guys. like they’re a lot like you. they like to go out. they’ve been to a college party before. they have friends, possibly have girlfriends. and it’s because of either they know a victim of sexual assault, or they have girlfriends, and they don’t want a sexual assault to happen to them is why they get involved. and i think like if you could show men that it’s all right to speak up about this subject, more men are going to get involved. (mav12) using masculinity. finally, five respondents (19%) described strategies that capitalize on or appeal to “traditional” or stereotypical aspects of masculinity as a way to “meet men where they are.” for example, one respondent described using an approach based on his perception that “challenges” appeal to men and draw them in: … it may even be a cultural stereotype in and of itself, but i think guys tend to… like challenges and respond to them in a positive way for the most part. so if you can sort of frame it in that idea that, ‘we don’t want you to go against the norm simply for the sake of going against the norm; we want you to step up because this is something that we think is an important issue. hopefully we’ve convinced you that it’s an important issue, and you know we want to challenge you to be the one to take a stand. (mav2) use of self. the second “delivery” strategy was described by 41% of participants, a majority of whom were college-based. this approach was generally characterized by participants being open about their own experiences, faults, past “sexist” mistakes, or vulnerabilities in conversations with other men, or by being a visible advocate or role model and demonstrating the kinds of behaviors he is hoping to see in others. one participant described how he allows other men access to his own emotional processing as a way to engage their empathy: i will kind of just allow myself to become emotional and just say, ‘you know today was really rough at the meeting… when we talked about this one woman that was sexually assaulted on our campus.’ or if i get a really intense call on the hotline, you know i’ll come back and say… ‘i got a call and she was saying casey/strategies for engaging men as anti-violence allies 276 how her boyfriend is stalking her and how she’s scared he’s going to become violent towards her.’ you know? i do it because i want people to know that those issues are real, and …they’re in front of our face. (mav28) a strengths-based approach to men. a common “delivery” strategy was to relay to men that they are a critical ingredient in ending violence against women. endorsed by 10 respondents (37%), this strategy is founded on an assumption that men generally want to help, have important strengths to lend, and will be more compelled to become involved if they are approached as “part of the solution” than as the source of the problem. one participant noted: i think we sometimes believe that men… how can i say this? that men aren’t as intelligent about this issue as they really are, and the conversations that i have really show a level of intelligence and a level of integrity that a lot of men have about this issue. and frankly… if you ask a group of men, “what do you guys think about rape and sexual assault,” almost every single one of them… will say, ‘that’s terrible. i would never want that to happen to another person.’ and i think that’s a real key of starting this kind of work, is that men think sexual assault is a bad thing. (mav 12) exposing men to survivor stories. eight participants (30%) felt that hearing stories, either directly or indirectly, from survivors of violence serves as a powerful way for other men to make emotional connections to the issue of violence and its impact. several men specifically mentioned take back the night rallies as a particularly compelling awareness and recruiting tool. other venues mentioned by participants for communicating survivor stories included readings, trainings and videos. broader conversations: an additional eight respondents (30%) described organizing trainings, workshops or conversation groups in which education and engagement related to violence was a piece of a larger discussion. these events tackled topics such as sex, dating, masculinity and communication and contextualized issues of violence within these potentially more broadly appealing topics. creating compelling communities. finally, five participants (19%) talked about being a part of or intentionally fostering groups that others would admire and want to join. for these men, the experience of being in a fun, visible, engaged, mutually supportive community was both a transformative personal experience and a persuasive tool for inviting other men’s participation. one participant mused: well for me personally, the community aspect of it is unlike anything i’ve ever had. and that definitely keeps me coming back. it keeps me coming. and it’s weird because that was what hooked me in the first place, and i’m still like dumbfounded by this, like really? it’s something that just never gets old, that still kind of surprises me that i walk into a room and talk about my feelings with other men. like that still amazes me. (mav30) advances in social work, fall 2010, 11(2) 277 barriers to message delivery participants described two primary barriers to men “hearing” anti-violence messaging, or connecting with the engagement strategies employed by respondents. first, 10 respondents (38%) noted that any strategy with a remotely negative approach to men was ineffective. these mostly college-based participants described negative approaches as dwelling on statistics about the proportion of perpetrators who are male, giving men behavioral “don’ts” to avoid rape, or talking about men’s responsibility for the problem, and suggested that these strategies create an environment in which men feel defensive, “bashed,” or blamed. respondents suggested that because most men are not perpetrators, hearing about men as perpetrators may feel inordinately shaming, or make the content seem irrelevant. one participant noted that extra caution is needed to guard against a blaming message to men: …when people talk about this kind of stuff… to men, [the men] are being made to feel guilty as a man. like, ‘all this sexism exists, and part of it’s your fault.’ i think that’s what a lot of men are hearing. regardless of whether that’s what people say, that’s what a lot of men are hearing. (mav19) secondly, five participants (19%) felt that men’s ambivalence about or resistance to “feminism,” along with their association of violence against women as a “feminist” issue creates a barrier to seeing the contribution they might make in anti-violence work. respondents speculated that some men may feel confusion about how to simultaneously negotiate their own masculinity and oppose violence against women, or about how to be active against violence without endorsing everything that they feel “feminists” are proposing. one participant summed up this dilemma: i think a lot of men are afraid that if they embrace feminism… they’re suddenly going to be hypocrites if they still want their wife to please shave her legs. or if they hold the door for a woman, and that sort of thing. if they look at pornography, you know – ever – they’re going to be a big hypocrite. (mav3) discussion and implications for ally building as a vehicle for examining the process of ally recruitment, this study examined strategies identified by male anti-violence allies as potentially effective for reaching out to other men. across the tactics described by respondents, three themes emerge that hold implications for both the practice of engaging men in anti-violence efforts, and for thinking about ally development projects more generally. many of these implications are congruent with core tenets of social work practice and are described more fully below. use of social networks across the domains of both gaining access and delivering the message to potential allies, respondents highlighted their belief that reaching men through their existing social networks was more effective than generalized approaches to advertising anti-violence messages. all of the college-based participants and nearly half of the community-based men leveraged their own social, professional and familial ties as a means of reaching out. casey/strategies for engaging men as anti-violence allies 278 in addition to the relatively easier access allies have to their own social circles, engaging men within personal social networks enhances the probability that potential anti-violence recruits will see the movement as relevant, and will view the “messenger” as credible. this strategy is supported by social psychological evidence that individuals may be more influenced by the perceived beliefs of their closest referents, such as friends and family members than by general norms emerging from their community (cialdini & trost, 1998), as well as by the evidence cited in the introduction to this paper that culturallyrelevant prevention approaches are more effective (heppner et al., 1999). further, research suggests that men’s own reported willingness to intervene in the disrespectful behavior of other males is related to their perception of their male friends’ willingness to do the same (stein, 2007). ally building efforts more generally may benefit from leveraging allies’ existing social networks as a core strategy for creating personalized and compelling conversations and relationships. indeed, previous research on social justice ally formation has found that allies’ entrée into activism is often predicated on friendships or mentoring relationships with other allies (broido, 2000; reason et al., 2005). however, prioritizing the leveraging of allies’ social networks may limit access to groups of potential allies who are outside of the “choir” familiar with anti-violence or anti-oppression movements. here again, prevention research may be instructive. popular opinion leader approaches (pol) identify and recruit natural, charismatic leaders within specific social networks, who are then trained to initiate conversations and skill building with their friends regarding specific health behaviors. pol approaches have been successfully applied in several fields, including hiv prevention (fernandez et al., 2003), and may be powerful tools within ally-building to harness the influential power of everwidening circles of social networks. starting where potential allies are like the social work mantra of “starting where the client is,” participants in this study highlighted the perceived effectiveness of assessing men’s current beliefs and attitudes, and of tailoring conversations to an ally’s level of violence-related awareness at the time of engagement. this tailored engagement is likely assisted by participants’ focus on and perceived success with leveraging their own social networks, as described above. inherent in this individualized approach was a focus on helping each potential ally to recognize or form a personal connection with the issue of violence against women, in order to foster an emotional commitment to the topic. to do this, study participants used survivor stories, their own experiences, and their knowledge of what is important to the potential ally to personalize their message. interestingly, although college-based and community based participants endorsed these strategies in somewhat different proportions, all engagement approaches were mentioned by at least some members of both groups, highlighting the importance of tailored efforts. participants in this study also echoed the sentiments of anti-violence activists and scholars (e.g.., berkowitz, 2002) in stressing the importance of strengths-based approaches to men that communicate men’s important role in ending violence. indeed, in previous analyses of this data, and in other research related to social justice ally advances in social work, fall 2010, 11(2) 279 development, a specific, tangible, and tailored involvement invitation is often a necessary pre-requisite to initiating formal ally involvement (broido, 2000; casey & smith, 2010). all of this suggests that efforts to encourage potential allies to consider involvement likely need to account for and embark from the current set of beliefs with which they are operating. further, reaching out to potential allies by highlighting their individual strengths and specific potential contributions is likely a compelling element of engagement. negotiating privilege meeting potential allies “where they are” also raises the complication of how and when to assist those allies in confronting their unearned social privilege. participants in this study, and voices within violence prevention movements more generally (i.e., flood, 2005), argue for engagement of expanded numbers of men as a way to viably combat violence. this may include men who may identify with or perpetuate problematic aspects of male privilege. indeed, several of the participants in this study identified male privilege and ambivalence about “feminism” as fundamental barriers to “average” guys becoming involved in anti-violence work. some of the strategies described by respondents were, concordantly, designed to prevent or deflect male defensiveness related to the issue of violence against women. to overcome these barriers, participants endorsed tailored engagement strategies that highlighted potential male allies’ strengths that at times made strategic use of stereotypical masculinity, and that accounted for the current belief system of the men they were approaching. these strategies create a potential tension between the value of “meeting men where they are” and risking reinforcing or reproducing male privilege within anti-violence efforts. indeed, in conceptual work regarding “aspiring” social justice allies, edwards (2006) notes that allies who lack an understanding of the underlying systems of inequity that support violence may unknowingly support those very systems by acting to “protect” women rather than working in partnership with them. navigating this tension likely requires a “both-and” approach that combines tailored outreach with increasingly pointed opportunities to consider issues of oppression. similar to the formation of a social justice consciousness (helms, 1990), ally-formation is apt to be developmental. ally efforts can incorporate progressive discussions and learning opportunities regarding privilege while simultaneously calibrating specific involvement activities to individual allies’ current knowledge and ability, in an effort to avoid possible harm to members of marginalized groups. it may also be important to connect with men both around positive aspects of masculinities as well as around ways that some aspects of stereotypical masculinity constrict their own well-being or relationships. for example, men can stop rape places an emphasis on generating “counterstories” to dominant, narrow conceptualizations of masculinity, which reframe “strength” in terms of men’s contributions towards ending violence and promoting respect. many current activists also note the importance of building in explicit mechanisms for consulting with and accountability to women and women’s organizations (flood, 2005; funk, 2008). as a whole, this suggests that ally engagement efforts should simultaneously demonstrate to individuals the need for their unique contributions within social movements, while casey/strategies for engaging men as anti-violence allies 280 providing progressive opportunities for accountability and for deeper analysis of social inequity. limitations study limitations include the racial homogeneity of the study sample. findings presented here almost exclusively reflect white men’s perceptions of anti-violence ally development and the factors relevant to their own ally experiences, which was in part an unanticipated consequence of limiting the sample to recent initiates into anti-violence work. a glaring gap in both the findings presented here, and research about male antiviolence allies more generally remains the experiences of men of color around antiviolence mobilization. the small, self-selected nature of the sample also represents a limitation as findings may represent a sub-group of male anti-violence allies whose experiences may not be more broadly generalizable. future research with larger, more diverse samples is needed to evaluate the replicability of these findings. research that empirically evaluates the effectiveness and impact of the various engagement strategies surfaced by respondents is also warranted. the limitation of the study sample to men who had joined anti-violence efforts within the past two years likely circumscribed the range of engagement strategies discussed by participants, and potentially narrowed the focus to strategies relevant to men who are relatively early in their ally formation process. long-term activists have very important and perhaps different insight into the outreach strategies they experience as effective, and future research would do well to capture this knowledge. finally, because this study focused only on men who have successfully been engaged in anti-violence work, the voices of non-involved men and what they might find compelling or unappealing are missing. additional scholarship focusing on the discriminating factors separating male anti-violence allies from non-involved men may shed light on how to design engagement strategies to maximize effective male participation. conclusion social justice ally movements are an important component of efforts to dismantle oppressive systems such as pandemic violence against women. fostering these movements requires an understanding of the strategies that best engage and retain potential allies in the project of understanding and challenging social injustice. participants in this study of male anti-violence allies surfaced several engagement strategies that hold promise for recruiting other men into the movement. specifically, respondents perceived that effective strategies are grounded in potential allies’ own social networks, are tailored to and reflective of their diverse identities, and help them make personal connections to the issue of violence. future research will need to more rigorously test the effectiveness of these engagement strategies, both with anti-violence movements and across social justice ally efforts more broadly. advances in social work, fall 2010, 11(2) 281 references berkowitz, a. 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(1998). social influence: social norms, conformity and compliance. in d. t. gilbert, s. t. fiske, & g. lindzey (eds.), the handbook of social psychology (4th ed., pp. 151-192). new york: mcgraw-hill. coulter, r. p. (2003). boys doing good: young men and gender equity. educational review, 55, 135-145. dekeseredy, w. s., schwartz, m. d., & alvi, s. (2000). the role of profeminist men in dealing with woman abuse on the canadian college campus. violence against women, 6, 918-935. edwards, k. e. (2006). aspiring social justice ally identity development: a conceptual model. naspa journal, 43, 39-60. fernandez, m. i., bowen, g. s., gay, c. l., mattson, t. r., bital, e., & kelly, j. a. (2003). hiv, sex and social change: applying esid principles to hiv prevention research. american journal of community psychology, 32, 333-344. flood, m. (2005). changing men: best practice in sexual violence education. women against violence, 18, 26-36. funk, r. (2008). men’s work: men’s voices and actions against sexism and violence. journal of intervention and prevention in the community, 36, 155-171. hawkins, s. r. (2005). evaluations findings: men can stop rape, men of strength clubs 2004-2005. retrieved from www.mencanstoprape.org helms, j. e. (1990). toward a model of white racial identity development. in j. e. helms (ed.), black and white racial identity: theory, research and practice (pp. 49-66). westport, ct: greenwood publishing. casey/strategies for engaging men as anti-violence allies 282 heppner, m. j., neville, h. a., smith, k., kivlighan, d. m., & gershuny, b. s. (1999). examining immediate and long-term efficacy of rape prevention programming with racially diverse college men. journal of counseling psychology, 46(1), 16-26. hong, l. (2000). toward a transformed approach to prevention: breaking the link between masculinity and violence. journal of american college health, 48, 269-279. katz, j. (1995). reconstructing masculinity in the locker room: the mentors in violence prevention project. harvard educational review, 65, 163-174. kilmartin, c. t. (2001). sexual assault in context: teaching college men about gender. holmes beach, fl: learning publications. maxwell, j. a. (2010). using numbers in qualitative research. qualitative inquiry, 16, 475-482. men can stop rape (2010). the men of strength club. retrieved from http://www.mencanstoprape.org/usr_doc/most_club_brochure_&_criteria.pdf reason, r. d., roosa-millar, e. a., & scales, t. c. (2005). toward a model of racial justice ally development. journal of college student development, 46, 530-546. stein, j. l. (2007) peer educators and close friends as predictors of male college students' willingness to prevent rape. journal of college student development, 48, 75-89. strauss, a., & corbin, j. (1998). basics of qualitative research: techniques and procedures for developing grounded theory. thousand oaks, ca: sage publications. tjaden, p., & thoennes, n. (1998). prevalence, incidence and consequences of violence against women: findings from the national violence against women survey. washington, dc: national institute of justice. author’s note: address correspondence to: erin casey, 1900 commerce, box 358425, university of washington, tacoma, wa 98402. email: ercasey@uw.edu spring2000-035_page27 spring2000-036_page28 spring2000-037_page29 spring2000-038_page30 spring2000-039_page31 spring2000-040_page32 spring2000-041_page33 spring2000-042_page34 spring2000-043_page35 spring2000-044_page36 spring2000-045_page37 spring2000-046_page38 spring2000-047_page39 spring2000-048_page40 spring2000-049_page41 spring2000-050_page42 advances vol. 2, no. 2 the 2001 educational policy and accreditation standards: thevalue of research revisited barry r. cournoyer margaret e. adamek abstract: although doctoral programs in social work are not accredited by the council on social work education nor subject to the educational policy and accreditation standards (epas, 2001), dsw and ph.d. programs are affected by the nature and quality of baccalaureate andmasters’ social work education. in this article, the authors discuss the implications of the 2001 epas as they relate to bswandmsw graduates’motivation and preparation for doctoral education. keywords: doctoral education, social work, epas, educational policies, accreditation standards doctoral programs in social work are not accredited by the council on social work education nor subject to the educational policy and accreditation standards (cswe, 2001a). nonetheless, dsw and ph.d. programs are affected by the nature of baccalaureate and masters’ social work education, and thus, by the policies and standards that guide the preparation of students for professional practice. we offer our views about the implications of the 2001 epas as they relate to bsw and msw graduates’ motivation and preparation for doctoral education. doctoral education in social work is of relatively recent origin. for most of the 20th century, the masters’ degree in social work was the terminal degree and, at least implicitly, themost significant graduate level of preparation. the profession’s growth in size and popularity, and the increasing importance of social work educationwithin institutions of higher learning, led to a heightened demand for social workerswith doctoral degrees. indeed, the number of social work educational programs has expanded exponentially over the course of the last several decades. however, social work education still does not produce enough social workers to keep upwith demand (austin, 1992, 1997, 1999). according to the bureau of labor statistics (2001), the number of employed social workers educated at the bsw, msw, or doctoral levels will rise from 604,000 in 1998 to approximately 822,000 by 2008. the number of employed social workers is projected to increase 36.1% during the 10-year period (1998-2008) and the number of social work job openings over that time period is expected to be 296,000 (braddock, 1999, p. 58). 119 barry r. cournoyer, d.s.w., l.c.s.w. is professor and chair of the ph.d. committee. margaret e. adamek, ph.d. is director of the ph.d. program, indiana university school of social work, indianapolis, indiana 46202-5156. copyright© 2001 advances in socialworkvol. 2 no. 2 (fall 2001) 119-126. indiana university school of socialwork. the more than 610 accredited bsw or msw educational programs in the united states produced approximately 28,000 bsw and msw graduates during 1999 (cswe, 2001b; 2001c). despite the large number of graduates, the demand for social workers will continue to exceed supply—especially in rural areas. social workers qualified to fill university faculty positions are among the greatest in demand. doctoral level social workers are also highly sought for their roles in social and behavioral science research centers and institutes. in an effort to meet these needs, the number of programs offering social work doctoral degrees has grown dramatically during the last several decades. there are now approximately 66 colleges or universities in the united states, six in canada, and one in israel offering dsw or ph.d. degrees in social work. at least five more are in the process of developing programs (group for the advancement of doctoral education [gade], 2001). however, the annual number of professionals graduating with a social work doctorate remains in the range of 250 to 300—as it has for the past several years. furthermore, approximately one-third to one-half of those doctoral graduates tend to choose positions outside academia (khinduka, 2001). as a result, the current supply of doctoral graduates in social work remains woefully short of current and projected demands in research and education. why so few? as faculty members in a large school of social work, we recognize the advantages and rewards associated with our social work doctoral degrees. certainly, the life of a professor in contemporary academic settings is challenging and stressful. nonetheless, social work professors with doctorates are highly sought and usually quite well paid—at least when compared to their colleagues in the liberal arts. unlike social work, several disciplines have a surplus of ph.d. graduates, resulting in fierce competition for academic and research positions. we consider ourselves fortunate indeed to be able to serve as professors and researchers in the challenging and evolving world of social work. as a result, we question why relatively few graduates pursue doctoral education and aspire to careers in research or higher education.the demand for social work educators and researchers is so great that something must serve to lessen the attraction of doctoral study for bsw and msw professionals. indeed, we wonder whether social work accreditation standards and policies, and the nature of baccalaureate and masters’ level social work educational programs, may inadvertently discourage graduates from pursuing doctoral studies. as professors of the “baby boom” generation retire in substantial numbers, we anticipate a difficult situation inwhich the need for doctoral-level social work educators and researchers grows extremely quickly, further increasing the gap between supply and demand. we certainly cannot overstate the value of experienced msw-level faculty who are able to contribute their practice wisdom to students. however, in many university settings, programs need doctoral-level faculty to compete successfully with the increasing number of alternate educational programs (e.g., baccalaureate and masters’ programs in human services, mental 120 advances in socialwork health counseling,marriage and family therapy, counseling psychology, substance abuse treatment). social work programs without a substantial number of doctorallevel faculty who have an active research agenda that yields external funding and contributes to a national reputation, are simply less valued on many university campuses. accreditation policies and standards we view several passages in the 2001 epas with favor and hope that their implementation improves the quality of bsw andmsw social work education; increases students’ familiarity with, interest in, and use of service-related research; and enhances the effectiveness of graduates’ service to clients (gambrill, 2001a). in general, however, the document does not seem to acknowledge the need to encourage and adequately prepare bsw andmsw students to pursue social work doctorates for careers in research or higher education. favorable signs the preamble of the epas includes a passage that reads: social work education combines scientific inquiry with the teaching of professional skills to provide effective and ethical social work services. social work educators reflect their identification with the profession through their teaching, scholarship, and service. social work education, from baccalaureate to doctoral levels, employs educational, practice, scholarly, inter-professional, and service delivery models to orient and shape the profession’s future in the context of expanding knowledge, changing technologies, and complex human and social concerns. (cswe, 2001a, p. 3) the clear recognition that social work education includes “scientific inquiry” is encouraging. we interpret this passage to suggest that social work professors are expected to engage in scientific research activities as a natural part of their roles and functions. the preamble also suggests that bswandmswprogramsmay“use time-tested and newmodels of program design, implementation, and evaluation. it does so by balancing requirements that promote comparability across programs with a level of flexibility that encourages programs to respond to changing human, professional, and institutional needs” (cswe, 2001a, p. 3). this passage appears to encourage, at least implicitly, change toward more contemporary and perhaps more effective approaches to teaching and learning. the emphasis upon assessment of the “results of a program’s development and its continuous improvement” (p. 3), and the expectation that programs must revitalize and renew their curriculums and educational processes by “pursuing exchanges with the practice community and program stakeholders and by developing and assessing new knowledge and technology” (p. 7), encourage those who value the conduct, use, and dissemination of research as a fundamental aspect of effective service delivery— including the delivery of professional social work education (cournoyer & powers, 2002). these passages suggest that bsw and msw programs must conduct program evaluation and other forms of outcomes-related research related to student learning as a natural and ongoing dimension of their activities and processes. despite the obstacles inherent in their implementation, we believe that such activities, if undertaken as forms of “scientific inquiry,” contribute to an educational 121121cournoyer, adamek/the 2001 epas: thevalue of research revisited 122 culture in which research and scholarship are normalized and perhaps even valued. we also believe that the overall quality of the educational experience can improve if findings from assessment activities are used to guide changes in curriculum design and in teaching and learning processes. we would be especially pleased if evaluation included assessment of graduates’ effectiveness in service to clients (buchan, 1991: gambrill, 2001a, 2001b). the epas also states that among the purposes of the social work profession is to “develop and use research, knowledge, and skills that advance social work practice” (cswe, 2001a, p. 5) and among the purposes of social work education is “to develop social work knowledge” (p. 5). programs pursue these educational purposes by “developing knowledge” (p. 6) and “preparing social workers to evaluate the processes and effectiveness of practice” (p. 6). in addition, through the foundation curriculum, all bsw and msw graduates are expected to demonstrate the abilities to “apply critical thinking skills within the context of professional social work practice,” to “use theoretical frameworks supported by empirical evidence to understand individual development and behavior across the life span and the interactions among individuals and between individuals and families, groups, organizations, and communities,” and to “evaluate research studies, apply research findings to practice, and evaluate their own practice interventions” (p. 8). these passages and others suggest that social workers should be able to understand, analyze, apply, evaluate, and perhaps synthesize research-based evidence in and for their service to others. if these expectations are implemented and students indeed accomplish the associated learning goals and objectives, we anticipate both improved quality of service to clients and heightened interest in and readiness for doctoral study and perhaps even engagement in service-related research. the suggested flexibility in the 2001 epas may lead some msw programs to develop “research concentrations” to encourage and enable some students to develop advanced proficiency in research methods. others may design and offer doctoral “fast-track” curriculums that enable students to proceed efficiently from the baccalaureate to the doctoral degree. we hope it is indeed possible to implement curriculum innovations and concentrations thatmotivate andprepare social work students for doctoral study. concerns althoughwe recognize the value of several changes suggested by the newepas,we have some concerns.we fail to understandwhy it does not emphasize preparation of students for advanced levels of higher education. althoughwe notice the expectation that programs promote “continual professional development of students, faculty, and practitioners” (cswe, 2001a, p. 6), we would prefer an emphasis upon students’ development of knowledge, attitudes, and skills associated with lifelong learning and continuous professional development while they are enrolled in social work programs. as suggested by numerous surveys over the years, most social work graduates do not regularly read research articles related to practice innovations or effectiveness (gambrill, 1999; holosko & leslie, 1998). we assert that unless students learn to engage actively in self-directed learning during their advances in socialwork 123 formal educational programs, they are not likely to do so as practicing social workers following graduation. we certainly value the breadth of knowledge, values, and skills suggested by the foundation program objectives and the descriptions associated with the eight required content areas. however, we find it difficult to imagine how any bsw or msw program could actually meet all the required expectations. we wonder whether the suggested flexibility and innovation is truly feasible given the nature and extent of the foundation requirements. in order to illustrate the incredible breadth of learning required by the epas, consider the curriculum implications of the foundation program objectives. although 12 objectives are identified, most subsume additional expectations as well. we have selected one of the 12 to illustrate the enormity of the challenges associated with delivery of the foundation curriculum. according to the epas, graduates should be able to: “practice without discrimination and with respect, knowledge, and skills related to clients’ age, class, color, culture, disability, ethnicity, family structure, gender, marital status, national origin, race, religion, sex, and sexual orientation” (cswe, 2001a, p. 8). there appear to be dozens of subordinate expectations within this single objective. fourteen client categories are identified (each of which could be classified by at least two and some by several dimensions) and although “practice” is not specifically described, we presume that the definition is broad and expansive in order to be consistent with a generalist perspective. at least four explicit aspects of practice must be demonstrated in relation to clients within each of the 14 categories: a) practice without discrimination, b) practice with respect, c) practice with knowledge, and d) practice with skills. presumably, bsw andmsw graduates would not only practice without discrimination and with respect but also with knowledge and skills in service to clients of all ages (e.g., infants, toddlers, children, adolescents, young adults, adults of middle-age, old-age, and old-old age), with clients of all cultures (consider the range within this dimension), with clients of all abilities or disabilities, and with the diverse range of clients with each of the remaining categories. given a generalist perspective, we should include the dimensions of system size (e.g., individuals, dyads, families, groups, organizations, communities, societies) which further expands the array of expectations. although the nature of “knowledge” is not defined, we presume there would be many aspects (e.g., biological, psychological, sociological, economic, legal, spiritual, cultural, as well as knowledge of change processes and practice effectiveness). “skills” would similarly be multidimensional (e.g., skills in engagement, assessment, contracting, intervention, prevention, evaluation, ending, and follow-up). imagine the potential number of learning expectations within this single foundation program objective. there are 13 other foundation objectives, eight prescribed content areas, and the expectation that msw programs also offer advanced practice concentrations. we wonder if depth of knowledge, critical thinking abilities, and research knowledge and skills suffer due to the breadth required in the foundation. wewill spare you from further application of this exercise to the remaining foundation program objectives, or within the expectations contained within the eight 123cournoyer, adamek/the 2001 epas: thevalue of research revisited required content areas.we do wonder if, in the absence of clear and precise definitions of terms and a limited, focused array of high priority learning goals, achievement of the foundation program expectations appears impossibly ambitious. a common foundation for all social workers certainlymakes sense.however, when the expectations are as extensive and prescriptive as those contained in the epas, we ask where we would find curriculum room for advanced concentrations or leeway for genuine innovation? conclusions we applaud the efforts of the individuals and groups whoworked long and hard to update and attempt to streamline the policies and standards that guide social work education in the united states. we recognize their attempt to enhance students’ educational experience, advance the profession, and most importantly, improve the quality and effectiveness of services to clients and other persons in need. we believe, however, that four major aspects of the epas need additional work. first, the foundation curriculummust become less prescriptive and expansive in order to enable social work programs generally to becomemore responsive to students’ learning needs in a rapidly and continuously changing world. second, preparation for doctoral level study should be specifically recognized as one of the major purposes of social work education at the bsw andmsw levels. third, learning to learn, engaging in lifelong learning and assessment of one’s own learning are essential abilities in the contemporary information society (cournoyer & powers, 2002; cournoyer & stanley, 2002). might we substitute these for one or perhaps a few of the 14 foundation program objectives? finally, bsw and msw students should undertake some form of service-related research and prepare a scholarly report (e.g., paper, presentation, or thesis) about the nature and outcomes of their studies. in the absence of a genuine research experience, graduates are unlikely to conduct studies of their own, evaluate the impact of their own practice, or use findings from scientific studies that might improve the quality of their service to clients. we posit that these steps would help address a truly dire problem facing the profession of social work; that is, the extraordinarily small number of social workers educated at the doctoral level. the profession desperately needs dsw and ph.d. graduates to teach the expanding number of bsw andmsw students and to conduct practice-related research. we especially need research regarding the effectiveness of services to our most vulnerable population groups and those services that address our most challenging social problems. psychiatry, psychology, and nursing do a much better job of preparing their professional students for the possibility of additional study at the doctoral level, and, not coincidentally, conducting research related to the effectiveness of psychiatric, psychological, and nursing services for medical and psychiatric problems. doctoral level social workers are desperately needed to research the effectiveness of services directed toward the resolution of social problemsunder-addressed or even ignored by our more medically-oriented sister professions. research regarding the effectiveness of programs and service models designed to help people overcome poverty and oppression, alleviate domestic violence, prevent child abuse, promote effective parental involvement, or learn interpersonal and self124 advances in socialwork 125 advocacy skills would be examples of the kinds of studies that social workersmight pursue that psychiatrists, psychologists, and nurses might not. we propose that social work educators must, as a matter of course, prepare and encourage talented bsw and msw students to pursue doctoral study.we suggest that bsw and msw programs incorporate—formally or informally—educational policies, standards, and objectives that reflect the goals of: 1. encouraging substantial numbers of bsw and msw students to pursue additional social work education at the doctoral level; 2. preparing substantial numbers of bsw andmsw students for the rigorous academic requirements of doctoral level education and research, and; 3. promoting increased practice-effectiveness research undertaken by social workers. we suggest that these measures might well yield an increase in the number of social workers prepared at the doctoral level and thereby meet an urgent need within the profession for additional educators and researchers. furthermore, emphasis upon these competencies might well enhance students’ educational experience, advance the profession, and, most importantly, improve the quality and effectiveness of services to clients and other persons in need. references austin, d. m. (1992). findings of the nimh task force on social work research. research on social work practice, 2(3), 311-322. austin, d. m. (1997). the institutional development of social work education: the first 100 years—and beyond. journal of socialwork education, 33(3), 599-613. austin, d. m. (1999). a report on progress in the development of research resources in social work. research on socialwork practice, 9(6), 673-708. braddock, d. (1999, november). occupation employment projections to 2008. monthly labor review online, 122(11). [on-line.] available: http://stats.bls.gov/opub/mlr/1999/11/art5full.pdf. buchan, v. v. (1991). to assess or not to assess is no longer the question: potential of programmonitoring. journal of socialwork education, 27(1), 25-34. bureau of labor statistics (bls). (2001). social workers. in the u.s. department of labor bureau of labor statistics occupational handbook. washington, dc: u.s. printing office. [on-line]. available: http://stats.bls.gov/oco/ocos060.htm. council on socialwork education. (2001a). educational policies and accreditation standards.washington, dc: author. [on-line]. available http://www.cswe.org/. council on social work education. (2001b). member program directory. washington, dc: author. [online]. available http://www.cswe.org/. council on socialwork education. (2001c). annual report: 1999-2000.washington, dc: author. [on-line]. available http://www.cswe.org/. cournoyer, b. r., & powers, g. t. (2002). evidence-based social work: the quiet revolution continues. in a. r. roberts, &g. j. greene, socialworkers’ desk reference (pp. 798-807). newyork: oxforduniversity press. cournoyer, b. r., & stanley, m. j. (2002). the social work portfolio: planning, assessing and documenting lifelong learning in a dynamic profession. pacific grove, ca: brooks/cole. gambrill, e. (1999). evidence-based practice: an alternative to authority-based practice. families in society, 80(4), 341-350. 125cournoyer, adamek/the 2001 epas: thevalue of research revisited gambrill, e. d. (2001a). educational policy and accreditation standards: do they work for clients? journal of socialwork education, 37(2), 226-240. gambrill, e. d. (2001b). from the editor: evaluating the quality of social work education [electronic version]. journal of socialwork education, 37(3). group for the advancement of doctoral education (gade). (2001). membership directory. [on-line]. available http://cosw.sc.edu/gade/member.html. holosko, m. j., & leslie, d. (1998). obstacles to conducting empirically based practice. in j. s.wodarski & b. a. thyer (eds.), handbook of empirical social work practice: social problems and practice issues (vol. 2, pp. 433-451). newyork: johnwiley & sons. khinduka, s. (2001, november).musings on doctoral education in social work. keynote address presented at the annualmeeting of thegroup for advancement ofdoctoral education,minneapolis,mn. [on-line]. available: http://www.cosw.sc.edu/gade/documents/keynote2001.pdf. author’s note: address correspondence to: margaret e. adamek, indiana university school of socialwork, indianapolis, indiana 46202-5156 usa, madamek@iupui.edu. 126 advances in socialwork aisw vol. 8, no. 1:aisw vol. 5, no. 2 1 using a semiotic metatheory for theory understanding, appraisal, and use: an illustrative social work translation of the affect control theory of emotion james a. forte abstract: charles sanders peirce’s creed, “do not block inquiry,” and his triadic model of the signs serve as the base for a semiotic metatheory of science and scientific theory. semioticians characterize science as a universe of diverse sign systems, and scientists as members of different language communities. this paper introduces this approach. affect control theorists ponder and investigate how actors, identities, actions, objects, emotions, and social settings are interrelated during interaction. semiotic tools and principles guide the translation of the affect control theory (act) of emotion. act is summarized and appraised for its value in increasing our understanding of human behavior in the social environment, its suitability to social work, and its applicability. act technical words are translated into simpler language, act displays into words, and act’s interactionist language is translated into the language of ecosystems theory. suggestions for strengthening act and for promoting semiotic translation are included. keywords: semiotics, human behavior and the social environment, translation, theory what language should north american social workers speak? english, only. no, bloom and others (1991) argued, convincingly, that competent social workers must achieve fluency in many additional languages. besides our native language, professional practitioners must learn to converse in the language of clients, research, information management, social work practice (the profession’s distinctive jargon), values, and theory. often, these languages seem foreign and assistance is required. social workers have developed strategies for translating the language of research into practice (allen-meares, hudgins, engberg, & lessnau, 2005). translation research refers to “the practice of translating basic science data or discoveries from the laboratory bench into clinical applications aimed at treating various diseases” (hudgins & allen-meares, 2000, p. 2). translation research bridges diverse professional arenas and specialized languages. the translator works james a. forte, msw, ph.d. is associate professor of social work at the department of social work, salisbury university, salisbury, md, 21801. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 1-18. indiana university school of social work. 2 advances in social work to make empirical studies accessible and applicable by creating simple, short summaries, for instance. translation research lacks a metatheory of science and a methodology. moreover, translation work has not been extended to the other languages identified by bloom, wood, and chambon (1991). in this paper, i will concentrate on theory literacy and fluency and introduce a semiotic metatheory for theory translation and its distinctive vocabulary (forte, 2001, 2002, 2006). i will illustrate the semiotic translation methodology by rendering the affect control theory (act) of emotions into a language clear and useful for social work, appraising act’s suitability for diverse practice challenges, and decoding the theory’s implicit directives for application. in this first section, i present the essentials of a semiotic approach to theory translation. metatheorizing is an activity that involves theorizing about theorizing (ritzer, 1991). this activity mandates “reflexivity,” the self-examination of the profession’s theoretical development by the profession’s members (zhao, 2001). social work is a pragmatic profession that applies tested theories to ameliorate personal and public problems. here, i develop a new type of metatheorizing for social work use: metatheorizing for application. the prefix “meta” means “above” or “beyond” (zhao, 2001). metatheorizing can result in the creation of a metatheory, a theory about theories. a metatheory’s subject matter is the process of theorizing and the structure of the theory. the semiotic metatheory presented in this paper originates in the work of charles sanders peirce. peirce was the founder of semiotics, “the systematic investigation of the nature, properties, and kinds of signs, especially when undertaken in a self-conscious way” (colapietro, 1993, p. 179). peirce asserted, “everything may be comprehended or more strictly translated by something” (cited in osimo, p. 606). meaning, for peirce is “the translation of a sign into another system of signs” (osimo, 2002, p. 620). peirce’s semiotics was part of his philosophy of science commitment to the credo, “do not block inquiry.” a sign is “anything that stands for something” (colapietro, 1993, p. 180). there are three major types of signs. an icon “designates a type of sign in which the sign vehicle represents its object by virtue of a resemblance or similarity” (colapietro, 1993, p. 114). examples include a text, chart, diagram, and a map (danesi, 1998). an index is a type of sign that represents the object by virtual or real connection; for instance, a weathervane indicates wind direction by connection to the wind (colapietro, 1993). a symbol is “a sign based on convention or established usage or habit” (colapietro, 1993, p. 190). a symbol stands for its referent in an arbitrary, conventional way (danesi, 1998), as the word “tune-in” refers to an important helping action. semioticians conceive science to be a multimodal sign system. metatheory or “metascience” is “the science of sciences,” because of its attention to “the methods, history, sociology, and language of sciences” (morris, 1946, p. 510). morris, a systematizer of peirce’s intellectual system, added that social-humanistic sciences (referred to by social workers today as hbse theories) “are semiotical sciences, in that the subject matter studied always involves sign processes and, correspondingly, the terms of the sciences always require for their definition reference to terms in the theory of signs” (p. 511). scientists communicate by using linguistic sign systems and sign systems using diagrams, graphs, figures, gestures, statistics, and mathematical formulas (sarukkai, 2002). science is a sign system, but it is a sign system that is different in important ways from every day english. scientific communication requires a precision, a degree of technical knowledge, a mastery of logical argument, a vocabulary, and a familiarity with notations that is not expected in everyday discourse (halliday, 1978; hodge & kress, 1988). each theoretical tradition is a distinctive sign system with its own central metaphors, core concepts, categories, typical sentences, implicit grammatical rules, pronunciations, dialects, preferred displays, and particular network of native-speakers (watson, 1985). because of the multimodality of science and the complexity of its signs, social workers and their clients need assistance in decoding theories. translation is the act of translating from one sign system into another, rendering meanings intelligible across sign systems (forte, 2002). although bloom (1975) did not recommend a semiotic metatheory for language mastery, he viewed translation as central to social work problem solving, “the major task of using theories from the literature is to find them . . . to know how to understand them, and, finally, to translate them into direct strategy statements” (p. 162). in the remainder of this paper, i will translate the affect control theory of emotion. my efforts will interweave three strategies (jacobsen, 1965). intralingual translation involves the interpretation of act as a sign system in its own theoretical language, symbolic interactionism. interlingual translation is the interpretation of the act sign system in the native language of north american social workers, plain english. intersemiotic translation involves the interpretation of act’s nonverbal signs (displays, models, and formulas) into words, and the interpretation of act words as an eco-map, social work’s preeminent visual sign system. translation for understanding: historical roots language translation requires first the placement in space and time of the sounds of the foreign speaker. theory translation requires similar placement (forte, 2002). act is located in the discipline of sociology, so that social structure and social situations are considered the sources of emotional experience, labeling, and expression. in the early 1980s, sociologists developed an informal network or subdiscipline called the “sociology of emotions,” with its own association, newsletter, and conference workshops (smith-lovin, 1989, 1995). act affirms the sociology of emotions premises that emotions are linked to “aspects of social action including identity, role, identity, and culture” and “emotional responses are an integral part of social interaction” (smith-lovin, 1990, p. 238). act and arlie hochschild’s emotion management theory have become the “cornerstones of this subdiscipline” (lively & heise, 2004, p. 1110). affect control theory is located in the symbolic interactionist theoretical school. affect control theorists share with all interactionists the conviction that the human experience is based in language. heise (2007) claims, “your ability to interpret actions is built into the languages you speak. languages everywhere provide nouns and verbs that describe actions in noun-verb sentences” (p. 35). he adds that people use language to describe events, actors, behaviors, emotions, objects, settings, and social actions in culturally standard ways. affect control theorists share the interactionist aversion to dualistic thinking. the environment influences 3forte/using a semiotic metatheory for theory understanding, appraisal, and use how a person experiences and manages emotions, but the person is active in creating definitions of the emotions and actions responsive to emotions (smithlovin, 1995, p. 128). identities are a function of both situational pressures and personal inclinations. affect control theorists have an affinity for the structural symbolic interactionism. members of this sub-school give attention to how society, through stable and reoccurring experiences in institutions and roles, structures the self, and the self then shapes behavior. affect control theorists share the structuralist appreciation for quantitative research and experiments (smith-lovin, 2003). affect control theorists consider role theory another kindred school of thought. both assume that actors learn “a set of behavioral expectations associated with a social position” (robinson & smith-lovin, 2006, p. 137). both agree that, when self and others conform to expectations, positive emotions result. when self and others deviate, negative emotions result. other sociological theoretical languages have influenced affect control theorists (francis, 2003). these include stryker’s identity theory, goffman’s impression management theory, and labeling theory. affect control theorists have borrowed ideas and words from psychology’s attribution, balance, and consistency theories and from powers’ control model of perception (mackinnon, 1994). heise and o’brien (1993) note a commonality with social constructionists who also conceive of “emotions as intelligent conduct, contrived according to cultural rules, so as to effect desired interpersonal outcomes” (p. 490). while affect control theorists speak the language of interactionism, they reject the theoretical assumptions and language of other schools. skinnerian behaviorists argue that there is no interpretation between stimuli and response; emotions are triggered automatically and the actor is not an active constructor of situations (smith & miowlin, 2006). parsonian functionalists argue that the person is completely socialized into playing scripted roles within stable institutions. the creative interpretation and use of emotions is minimal (smith-lovin & robinson, 2006). psychodynamic theorists emphasize the unconscious, instinctual aspects of emotions and how shame and guilt are controlled through mechanisms of repression (heise & o’brien, 1993). organismic, bioevolutionary theorists view emotion as a byproduct, not an integral element, of interaction and focus on the equivalence between animals and humans even in emotional display (smith-lovin, 1995). act developers consider the sign systems of these theorists bizarre. affect control theorists have organized a global network organized around a distinctive and shared “theoretical research program” (heise, 2007). numerous theorists collaborate in or at least communicate about theory expansion, research projects, and software development. the affect control theory internet site (http://www.indiana.edu/ ~socpsy/act/), developed in 1997, posts 175 readings, software, conferences, and exhibits. what are the historical origins of the theory as they have shaped theoretical language? here, i will translate by use of exemplary role models (forte, 2006). george herbert mead was the founder of symbolic interactionism. mead theorized about language as the basis for a social psychology of mind, self, and society (mackinnon, 1994.) people use culturally provided symbols to assign meaning to social situations and their elements (robinson & smith-lovin, 2006), and people 4 advances in social work 5forte/using a semiotic metatheory for theory understanding, appraisal, and use escape the boundaries of individual consciousness to coordinate action via the use of shared symbols provided by the speech community. the person develops a self and adjusts behavior in membership groups by the feedback provided through taking others perspectives. act shares mead’s emphasis on language as a theoretical starting point and mead’s pioneering use of the root metaphor: the self as a cybernetic system. act has also incorporated into its vocabulary many meadian key words, including meaning, situation, definition of the situation, role, role taking, identity, self, and coordinated action. mead’s theorizing, however, was thoroughly cognitive, and he gave minimal attention to emotions. act advances symbolic interactionism by operationalizing its major concepts, including meaning, identity, behavior, and setting and by focusing on the affective meaning of objects. unlike mead, act assumes and documents with research evidence that affective meanings are more or less shared as cultural sentiments. unlike mead, act believes that actors communicate private emotional experience through emotional displays and narratives, and such communication evokes symmetry of responses similar to that in cognitive communication. david r. heise is the second major act exemplar (smith-lovin, 1999). a professor of sociology at indiana university, he was the first to develop the control system perspective on identity. his statement in 1971 at the southern sociological society meetings, explicated the major act tenets about identity, action, and meaning. he has also developed software to facilitate the analysis of social life, conceived of a methodology called event structure analysis, and nurtured many students. most act “texts” considered in this paper were written or co-written by heise, written by his students, or inspired by his example. david heise was also the recipient of the cooley-mead award for distinguished lasting career contribution to sociology. how do the members of the contemporary theory community make use of their historical texts? translation by intertextuality starts from the semiotic conviction that translation should trace “the allusion of a text to some other text” (danesi, 1998, p. 286). affect control theorists seem to agree on the tradition’s classics (francis, 2006; heise, 2007; smith-lovin & robinson, 2006). in 1979, heise published “understanding events.” this first major book-length statement included the essential theoretical principles, mathematical formulas, measurement tools, and dictionaries. in 1987, smith lovin’s article extended the actor-behavior-object predictive model to include settings. the abos model can thereby investigate settings, sentiments associated with a particular setting, such as a church, and how setting sentiments relate to other sentiments. smith-lovin and heise (1988) next published analyzing social interaction. this book includes empirical studies, theoretical elaborations, refinements of mathematical formulas, and reports on theory tests. the collection includes an article showing how the meaning of actors can be modified by social identities (membership characteristics, such as class, race, gender), dispositional traits (extroverted agency director), and mood and emotion descriptors (depressed client or angry father), and how such modifiers enrich the model (averett & heise, 1987). in the late 1980s, there were a series of studies exploring emotions and their expression (mackinnon, 1994), followed by a formal call for more emotion theorizing and research (smith-lovin, 1995). in 1994, mackinnon published symbolic interactionism as affect control, a sophisticated theoretical systematization that organized the theory as seven sets of propositions. this represented a large-scale intersemiotic effort to translate act’s mathematical models into verbal statements (smith-lovin & robinson, 2006). in 2002, rashotte added nonverbal behavior into the event grammar (abos becomes anbos) and demonstrated how nonverbal behavior modifies the meaning of the behavior. contemporary act researchers and theorists frequently cite these classics. recently, heise (2007) released expressive order, an intersemiotic and interlingual translation of act from mathematical and interactionist language into plain english. this may become the next classic. translation for understanding: current developments in this section, i offer a translation of the contemporary set of act texts, with a focus on emotions and reference to significant work, conceptual developments, and empirical studies. act is a multimodal sign system. its conception of the interrelation of the actor, identity, behavior, emotion, and setting is represented in visual form (displays and diagrams), lexical form (words, sentences, and paragraphs), and mathematical form (equations and formulas) (scher & heise, 1993). i will prioritize the translation of words. david heise (2007) has worked to make his theory comprehensible. he provides intralingual translations (symbolic interactionism to plain english) and intrasemiotic translation (equations and formulas represented by mathematical symbols into plain english words). his summary of the 30-year body of work provides “an accessible introduction to affect control theory for advanced undergraduates and graduates” and “communicates affect control theory conversationally, in words enriched with some figures and tables” (preface, 2007, p. i). for example, heise (2007) clearly identifies focal questions asked by affect control theorists. what are expected behaviors for persons enacting various role identities? how do these behaviors change because of unusual events? what are the typical emotional reactions to victimization or oppression? how do emotions vary by identity, setting, and events? in a particular situation, what must one do to feel positive emotions, such as joy, and what negative emotions might be anticipated? how do identity, social interaction, and emotional response vary across cultures? translation by key words and dictionaries theory understanding requires mastery of a theory’s vocabulary. translation by key words and dictionaries serve as important theory translation tools (forte, 2001, 2006). heise (2007) provides nominal definitions of 45 concepts central to act, a simple dictionary. here are a few illustrations. affect refers to “emotions, sentiments, impressions, and motives” (p. 145). affective meaning is “the connotation of a word or symbol, measured as an evaluation-potency-activity (epa) profile” (p. 145). affect control theory focuses on “resisting changes in affective meanings and actualizing sentiments” (p. 145). affect control theorists include much definitional discussion in their publications. several nominal definitions are focused on emotions. affect control theory 6 advances in social work proposes, “humans try to manage experiences so that immediate feelings about people, actions, and settings affirm long term sentiments” (heise, in mackinnon, 1994, p. xi). affect is “a general mode of consciousness pervading all our cognitions” (mackinnon, 1994, p. 123). affect includes “any evaluative (positive or negative) orientation toward an object, such as emotions like contentment and anger, attitudes like liking and disliking, and connotative meanings” (smith-lovin, 1995, p. 118). emotions are “ephemeral affective experiences signaling the extent to which situational identities are being confirmed or disconfirmed in social interaction” (mackinnon & goulborne, 2006, p. 245). a mood is an “emotional state of longer duration than emotion” (mackinnon, 1994, p. 139). emotion norms are “cultural norms that specify the type of emotion, the extent of emotion, and the duration of feeling that are appropriate in a situation” (smith-lovin, 1995, p. 124). fundamental sentiments are “subconscious references that people have learned from their cultural heritage about the affective meanings about such everyday concepts as individual traits and states, the settings in which interactions take place, the identities of people involved in interactions, and behaviors of people in these interactions” (francis, 2006. p. 139). transitory impressions are the “moment-tomoment feelings about the identities and behaviors involved in the interactions, especially about the self” (francis, p. 143). a deflection is “the discrepancy between a fundamental sentiment and a transient impression “(turner & stets, 2006, p. 136). translation by architectonic maps theory understanding requires grasp of the language’s grammar and how theoretical elements are organized into hierarchical order. architectonic is a term adapted by peirce to describe the systematic form a body of knowledge takes (colapietro, 1993). affect control theorists have diligently made explicit their assumptions. i will report those related to emotion. first, people react affectively to every event (mackinnon, 1994). second, the appraisal of an event, its categorization, or label, influences the affective impact of the event (smith-lovin, 1990), and appraisal considers three dimensions: evaluation, power, and activity. third, people seek to create events that maintain consistency between fundamental sentiments and their moment-to-moment feelings (francis, 2006). fourth, people manage their emotions and conform to emotion norms by effecting culturally acceptable emotion displays (heise & o’brien, 1993) and, fifth, emotions signal spontaneously the actor’s success or failure in confirming fundamental sentiments and complying with norms (francis, 2006). finally, membership processes are critical to emotions. act “conceives of person in a context, examines how a society’s culture and social structures influence the arousal, flow, and display of emotions and how people use emotions to constitute culture and maintain structures” (turner & stets, 2006, pp. 1-2). act’s assumptive foundation differs from theoretical languages that assume emotions are primitive biological reflexes, indicative primarily of individual processes, independent of context, automatic, rather than constructed, and private (francis, 2003; heise & weir, 1999). pepper (1942), a philosopher, brought direction to the decoding of complicated theoretical architectonics. he argued that each framework of thought is built on a root metaphor. affect control theorists rely on several root metaphors. borrowing from mead, the person is compared to a control system (francis, 2006; heise, 1979; 7forte/using a semiotic metatheory for theory understanding, appraisal, and use mackinnon, 1994). the person uses cybernetic processes, such as those in a house’s cooling system. the person seeks to maintain an ideal state defined in terms of standards or reference settings stored in memory; fundamental sentiments are our thermostat settings. like a cybernetic system, the person obtains input (perceptions and information) by monitoring the environment (situations). fluctuations in perceptual signals (transitory impressions) are compared to reference settings (fundamental epas for the situational elements) to determine whether conditions are at variance with the system’s standards. there is continuous comparison. if errors occur, the person takes restorative actions, similar to the thermostat activating the air conditioning to cool the house after a blast of hot air. the desired equilibrium is again realized; transient impressions are realigned with fundamental sentiments. in the human system, emotionality is the critical signaling process. emotions signal the degree to which events confirm or disconfirm the actor’s identity meanings as a good teacher, a trustworthy friend, or a competent social worker. turner and stets (2006) remark, “emotions are thus the gyroscopes of human behavior, keeping it on track in diverse situations, so that individuals can experience positive and avoid negative emotions” (p. 22). affect control theorists borrow interactionist imagery for their environment metaphor. a social environment is like a warehouse of symbols. it provides members with the names to designate all forms of social stimuli: identities, identity modifiers, and emotions. the warehouse contains dictionaries for cultural and subcultural groups. each dictionary records the group’s essential concepts and their meanings. these dictionaries accumulate across generations through members’ experiences with others, public interactions, and the mass media. different institutions, such as religion and academia, use different subsets of the society’s dictionary: the nouns, adjectives, and verbs necessary for institutional action (heise, 2007). from these dictionaries, individuals select relevant symbols to quickly orient themselves to a variety of situations. affect control theorists inspired by this root metaphor have studied the united states and compiled its dictionary with epa ratings for 500 social identities, 500 social behaviors, 300 emotion and trait terms, and 300 social settings (francis, 2006). affect control theorists also compare the theoretical notion, “assignment of meaning,” to a three-dimensional space. meaning occurs, in this comparison, in a room containing all possible sentiments. any particular epa rating, a foster parent, for instance, is at a point in this room. very good identities are near the ceiling, and very bad identities are near the floor. very powerful identities are near the front wall. very powerless identities are near the back wall. very active identities are near the right wall, while very quiet or inactive identities are near the left. the foster parent identity is located in this room, similar to the way a star is located in the cosmos, by its rating on all three dimensions. the meaning of any emotion (love directed to a foster parent) is also found in this three-dimensional epa space (mackinnon & keating, 1989). as a person moves through this space, the comparison continues; her emotional experience is determined by the absolute position in the room and by the direction of movement (smith-lovin & douglas, 1992). theoretical explanations are like paragraphs. translation by explanations interprets deductive, propositional paragraphs, and inductive paragraphs. affect con8 advances in social work trol theorists have deduced propositions about the basic characteristic of the relation between identity and emotions. regarding intensity, act contends emotional intensity signals the degree to which an identity has been disconfirmed by an event (francis, 2006). specifically, the greater the degree of discordance between fundamental sentiments and impressions, the more intense is the arousal of emotion (turner & stets, 2006). regarding identity modifiers, smith lovin (1990) contends that the more stigma associated with an identity, the more negative the emotions. additionally, the more power associated with the identity, the more likely the person experiences deep high-potency emotions, such as pride and fury, while the less powerful the positional identity, the more likely the person will experience emotions of impotency, such as fear, anxiety, and depression. regarding situation variables, act theorists propose predictable relationships between situation type and the type of emotional arousal (smith-lovin, 1990). first, the greater the disagreement about the definition of a situation (i see myself as therapist, a client sees me as boyfriend), the more likely there will be a disconfirmation of identities and the arousal of emotions. second, the greater the difference between cultural backgrounds, the greater the likelihood of emotional arousal due to disconfirmation of event elements. finally, the more identities that a person enacts in a situation, the more likely that identity conflict will occur, some identities in the identity set will not be confirmed, and, consequently, the greater certainty of emotional arousal. act theorists have theorized about and studied emotional displays (heise, 1989, 2007). people judge each other on the basis of observable conduct, including the expressive signaling of subjective emotional states. the more that the actor displays culturally appropriate affect, the greater the likelihood that the actor’s status will be enhanced. conversely, the more often the actor displays inappropriate affect, the more likely the actor will be stigmatized. the proposal has been extended to courtroom judgments of culpability and punishment. a malicious action accompanied by emotions indicating remorse and guilt helps an actor more than malicious action accompanied by displays of satisfaction or glee (smith-lovin & robinson 2006). in an example of intertextuality, act theorists have referred to hochschild’s (1983) work on emotion norms and work (heise & calhan, 1995). emotion norms prescribe a range of permitted feelings, given particular circumstances. persons engage in emotion work in an effort to bring automatic emotional reactions in line with cultural expectations. based on a study of college students, several propositions emerged. influential people can more successfully shape emotional norms to reflect their ideological preferences and create resources for personal gain than minimally influential people. moreover, there is a relationship between gender and emotions. gender has minimal effect on the emotion norms that actors associate with particular events. however, women are more likely to report negative emotions, embarrassment, and vulnerability to events than men. finally, the greater the discrepancy between emotion norms and emotion reactions (and the researchers found discrepancies in almost 50% of the 128 events), the greater the demands for emotion work, such as masking or overriding reactions. 9forte/using a semiotic metatheory for theory understanding, appraisal, and use thanks to the act theoretical research program, there are testable propositions about specific emotions. for ambivalence, smith-lovin (2003) proposes that, if an actor occupies more that one identity simultaneously and experiences events from these multiple perspectives, it is likely that events will evoke a mixture of emotions and the feeling of ambivalence. for example, an action supporting the identity of “judge” might produce negative deflection on the evaluation (likeability) and positive deflection on the potency dimensions of “women,” resulting in a troubling mixture of feelings. in the case of anger as related to justice considerations, scher and heise (1993) propose that the more often a person who is involved in a transaction feels anger and the emotion is not ameliorated, the more likely that he will decide that the transaction is unjust. this relationship is conditioned by justice importance. so that the more one cares about justice, the greater the emotional impact of an incongruence. regarding depression, mckinnon and goulborne (2006) propose a relationship between the emotion and perceptions of one’s situational identity. those events that create transient identity impressions with a negative valence on evaluation, potency, and activity produce bad, powerless, and unlively emotions; that is, depression. furthermore, people who often enact social disvalued identities more typically experience depressed emotions compared to those who enact non-stigmatized identities. finally, the more that positively evaluated identities are disconfirmed in interaction or stigmatized identities are continuously confirmed, the more likely depression will become an enduring mood. for surprise, smith-lovin (2003) suggests that the greater the disconfirmation’s unexpectedness, the more the emotional experience of surprise, unreality, and confusion. regarding stress, to the extent that a deflection is experienced psychologically as a sense that the world is unpredictable, not right, or disturbing, the greater the likelihood of stress. smith-lovin adds that the more frequent the experience of stress, the greater the probability that the disconfirmed actor will attempt to leave the interaction. affect control theorists build on each other’s work. empirical studies translating these propositions into testable format and seeking verification are likely to follow. theoretical translation must also consider inductive work identifying processes, typologies, or themes. affect control theorists explain the typical social process, an encounter, inductively (francis, 2006; scher & heise, 1993). first, the actors comprehend and define the social situation (a work meeting in an agency’s office). second, the actors anticipate, perceive, and interpret the elements of the event: identities, objects of actors’ behavior, behaviors, and setting features. third, the actors behave to confirm their pre-existing sentiments about these elements. fourth, the actors appraise behavioral and emotional displays to determine how each participant is faring in the social interaction (good, potent, lively, or otherwise). fifth, when unanticipated events occur (a senior social worker harshly criticizes a novice worker), the actors attempt to create subsequent events that fit within their frame of expected behaviors and confirm fundamental sentiments (other workers help the manager show consideration or workers redefine the manager’s identity to be inept or cruel). the balancing or restorative actions for failed event confirmations can be one of three types. an actor can reconceptualize the role behavior of self or other, leaving identities intact: the supervisor is teaching a lesson not criticizing. an actor can reconceptualize the setting: the supervisor is 10 advances in social work critical, because it is a personnel evaluative session. an actor can reconceptualize the other’s identity by adding a modifier: a mood, trait, or moral condition (senior social worker is grumpy, arrogant, unprofessional), or by assigning a new identity (the supervisor is a corporate hatchet man initiating a dismissal process). translation for theory appraisal semiotics can assist us in appraising the act and identifying its strengths and limitations. three types of standards must be used: universal standards (parsimony, testability, explanatory power, scope, predictive power, and so on), social work standards (strengths orientation, appreciation of social justice, sensitivity to diversity, biopsychosocial explanations, ethical and values integrity, attention to varied size-systems and life stages, and empirical support), and semiotic standards (degree of articulation of theory elements and their relationships, communicability) (forte, 2006). i will illustrate each. first, act is a parsimonious theory. “act = predictions for anbos based on epa profiles” is my summary of the theory’s ingredients. act theorizes that “humans try to manage experiences so that immediate feelings about people, actions, and settings affirm long-term sentiments” (heise, in mackinnon, 1994, p. xi). each event is composed of predictable elements: an actor (a) performing an act, including nonverbal (n) and verbal behavior (b) on an object (o) in a setting (s). the epa profile summarizes the fundamental sentiment on three dimensions (francis, 2006). if we know the epa for four of the five elements of an event, the affect control theorists can predict the sentiments for the fifth element. all act’s theoretical models, middle-range theories, theoretical elaborations, and applications build on this foundation. this single integrated theory explains much about social life, the normal social actor, and what motivates and shapes behavior (robinson & smith-lovin, 2006). second, from the perspective of social work’s preference for biopsychosocial theories, act is lacking. the theory gives minimal attention to the biological processes central to emotion and overemphasizes situational cues, cultural norms, and social structures (turner & stets, 2006). affect control theorists have responded to social work’s appreciation for diversity. meaning universally involves three dimensions. this has been confirmed in studies of more than 20 cultures (robinson & smith-lovin, 2006), and the affect control process applies cross-culturally. all people use the same psychological processes, but cultural dictionaries (the specific meanings for identities, emotions, behaviors, and settings) vary. within a culture, there is consensus among persons integrated into the culture about the meanings of event elements. cultures tend to be fairly stable in sentiments, too (heise, 2007). but, there are identifiable variations across cultures and subcultures in the particular epas for event elements. by comparing the fundamental sentiments of more than six countries, affect control theorists have documented how members of different cultures perceive elements of events differently (robinson & smith-lovin, 2006). robinson and smith-lovin also review how act documents the specific dictionaries endorsed by males, females, and by subcultural groups, including internet networks, gay members of a religious community, people aligned with different political ideologies, psychiatric patients, and alcoholics anonymous 11forte/using a semiotic metatheory for theory understanding, appraisal, and use members. extending the act knowledge base to increase understanding of diverse groups is a priority of the theoretical research program. act meets that standard of scientific rigor. fararo (1997), one of sociology’s theory experts, regards act as one of the “best developed empirically applicable models” (fararo, in heise, 2007, p. 4). its measurement tools and mathematical model of meaning prediction have been carefully developed, tested, and improved continuously (francis, 2006). many of the theory’s basic assertions and predictions have been validated. heise and weir (1999), for example, compared act predictions about emotions with what people reported they will experience in imagined situations. their findings generally confirmed the theory. the emotions experienced were close to those predicted by act. emotions predicted to be unlikely by act were rarely experienced. lively and heise’s two studies (2004) of 2,904 english speakers supported the act assertion of the three-dimensional structure of emotions and act propositions about the intentional transformation of emotions and the specific pathways for change. third, theories are semiotic resources for communicating and meeting challenges encountered by theory users. act successfully carries out theory’s communicative functions (heise, 2007; scher & heise, 1993). it describes well. epa profiles have been collected as large data sets for numerous countries and subcultures. it predicts behavior. interact, act computer software, can be used to predict the unknown element of an event, based on known elements. it has explanatory power. act provides theoretical models to explain health outcomes, social movement transformations, support group dynamics, courtroom processes, and many other social experiences. it has reference use and serves as a highly developed and specialized language for collaborative inquiry by large a group of scientists. affect control theorists have done an excellent job of transforming the theory into communicable form. translation has been relatively easy. root metaphors and propositions are explicitly identified. concepts are defined conceptually and operationally. historical exemplars and classical texts have been identified. the theory has even been presented in a comprehensive, plain english format (heise, 2007). translation for application scientists and social workers often use visual aids and words to depict highlighted aspects of a theory as a theoretical or practice model (forte, 2006). francis (1997) carried out a participant observational study of two different support groups: one for divorcees (spiritually-oriented) and one for bereaved persons. based on her research and grounded theory method, francis developed a useful act conceptual model of mutual aid processes. support groups are focused on emotions and emotional behavior and are directed towards helping members with “interpersonal emotion management” (p. 153). group leaders and members work to “shape, work, or manage emotions” (p. 153). her model includes the following components. each support group identified three actors with identities of consequence: self-ex-god for the divorce group. the group leader facilitated a process of redefining the meanings for each of these identities and for the traumatic event during three phases. first, the worker helped members examine their initial self-definitions, generally an epa characterizing self as bad, weak, and inactive. the coun12 advances in social work selor challenged the negative self-label, argued that the sufferer is a good person with a “bad experience,” and promised that the negative identities (failure, victim) and emotions (powerlessness, stunned, futility) resulting from the deep deflection could be resolved. in the second phase, the leader and members embrace new self-definitions. in the divorce group, the sufferer is redefined as good, strong, and active. the ex-spouse is defined as bad, weak, and active, and god is introduced as a resource. in the third phase, there is further definitional and emotion work. the sufferer’s identity as good, strong, and active is reaffirmed, and god is identified as a very good, very strong, and very active ally in the healing process. with changes of identity meanings, new emotions are experienced, labeled, and discussed. these include determination, rejoicing, and trust. during the process of affective resocialization, members learned to redefine elements of the difficult event, reduce the event-caused deflection between fundamental sentiments and transient impressions, and replace negative identities with positive ones. members confirmed each other’s new identities, and these positive identities generated behaviors and emotions considered healthy by the leaders and members. act also provides theoretical models relating identity, emotion, and interaction to health outcomes (francis, 2003), showing how gay rights social movement leaders use emotion management techniques to transform members’ emotions from fear, to anger, to pride (britt & heise, 2000); diagramming the relationship between situational factors, emotional arousal, and cognitive deliberations about justice (scher & heise, 1993); profiling a gay-friendly church and how it uses rituals to change the religious and gay identities of its members from stigmatized to positive meanings (smith-lovin & douglas, 1992); and identifying the conditions necessary to build “empathic solidarity” (heise, 1998). these should be adapted for social work use. a theoretical language must be translated from abstractions into strategies for practical use during the helping process (forte, 2006). specifically, a theory translator must interpret theoretical knowledge to direct every phase of the planned change process, including engagement, assessment, intervention, and evaluative activities. for the engagement phase, francis (2006) hints at a root metaphor for “social worker,” when she characterizes the support group leader as a facilitator of “assisted deflection resolution.” expanding on this kernel, we can imagine the ideal engagement of the client from the act perspective. the client has been deflected or set off course by a disconfirmation. the worker reaches out to identify the original course settings (epa profiles on situational elements), communicate respect for and validation of these sentiments, and most importantly, convey the conviction that the client, with assistance, can again take control of affect and return to course settings (francis, 2006). imagery and concepts associated with guide and guidance, sailing and navigating following a disorienting storm, revalidation, and reconfirmation might embellish the root metaphor. for the data gathering and assessment phases, act can be translated into the verbal and visual language of the eco-map. the focal system would be the actor enacting an identity in a social situation (mackinnon, 1994). the identity can be described concisely with modifiers, including mood, trait, and moral characteristics, and the actor’s behavior can be described with quantitative modifiers, includ13forte/using a semiotic metatheory for theory understanding, appraisal, and use ing always, sometimes, or rarely. heise (2007) has researched the range of possible focal identities. in the united states, actors can enact between 500 and 1000 identities. these are related to socioeconomic and work systems; kinship, political systems, and religious organizations; categorical memberships, such as age, sex, and race; ethnic and ancestral heritage other than race; global identities associated with personality traits; leisure time and hobbies, sexual orientation, and sexual style. the systems surrounding the focal system are social institutions. institutions are “constellations of roles, identities, settings, and actions related to some elementary concern” (heise, 2007, p. 28). surrounding circles would then include the family (marriage, child care, and caregiving); the realm of sexual encounters; business (working at a job and buying and selling in markets); religion (organizations and divine beings); education at all levels; medical; legal (judicial and law enforcement); political (executive and electoral government at all levels); leisure, including travel and entertainment; military; and science. the total environment on the eco-map would be a society’s entire social structure of institutions and identities. connections between the focal actor and actors in various institutions involve identity-relevant actions. positive connections are those that confirm the person’s identity. stressful or negative connections are those that disconfirm the identity (smith-lovin, 2003). theory-based assessment tool can also be built from the operational definitions of theory variables. the procedure for assessing evaluation-potency-activity profiles is based on osgood’s semantic differential research (smith-lovin & robinson, 2006). the procedures are clear and specific. the measurement approach can be used to assess identities, behaviors, objects, emotions, and settings, and the measurement procedure allows for adjustment for institutional domains and cultures. each of the three dimensions is placed on a nine-point scale from the extremes. evaluation, for example, uses a good/bad and positive/negative valence for its continuum (scher & heise, 1993). the measurement procedure can be used in either paper-and-pencil format or as a computerized software program. a social worker might collect information on the meanings assigned by a client to all elements of an event, then compare this to the shared cultural meanings documented by affect control theorists. epa profiles can also be used to assess current meanings and predict likely emotions or behaviors based on those meanings. act researchers have used the measurement procedures in dozens of studies. unfortunately, there is no example of its use for helping purposes. during the intervention phase, social workers might use act by applying its ifthen statements (forte, 2006). the “if” part of the clause refers to personal and membership processes and structures where intervention is possible, and the “then” part refers to the probable outcomes of intervention for the quality of biopsychosocial functioning. several translations follow. regarding consistent disconfirmation, to the degree that a person is in a relationship characterized by the repeated disconfirmation of a positive identity (wife abused by a spouse), then depression will result. if the worker can help the person avoid or exit the situation, or if the worker can help the person participate in support groups where others validate positively evaluated, powerful, and lively identities, then there will be a reduction of deflection and emotions maximally distant from depression will be 14 advances in social work generated (mackinnon & goulbourne, 2006). regarding event characteristics, if the client is in a situation where expectations are violated and identities are disconfirmed, then socially undesirable emotions will be evoked (heise, 2007). if the worker can implement a new event that replaces the unwanted emotion with a different emotion, or if the worker can help the client reinterpret the past event so that the emotion produced by the original interpretation is replaced by another emotion, then equilibrium will be achieved again (heise & o’brien, 1993). translation by exemplar is another strategy for translating a theory for intervention purposes. this sense-making task requires the practitioner to imagine that he or she could ask a theory’s exemplars for intervention advice and then use this advice to increase professional effectiveness. “what would david heise and other affect control theorists do in this situation?” unfortunately, the act literature provides few clues about how david heise or any affect control theorist or researcher would engage in service or answer specific social work practice questions. one piece of advice comes from lively and heise (2004). social workers should use act-based emotional shortcuts to help people move between positive and negative emotions. conclusion: future work on act and semiotic translation social workers need theory translation for many reasons. theories are often stated in obscure, unclear ways. theorists use abstract, general terms that are hard to apply to the particulars of social work situations. some theorists use ill-defined terms. some use well-defined terms in unusual ways. some use specialized terms that are very unlike words from natural languages. theory translation is necessary, because there are so many theoretical languages and because the major theoretical languages are alive and changing continually. theory translation can make communication possible between theory specialists (theorists), theory users (practitioners), theory testers (researchers), and the beneficiaries of theories (clients). theory translation is necessary, because theoretical explanations must be adjusted for different contexts, including team meetings, sessions with clients, and discussions with family members. translators who specialize in particular languages can help (forte, 2006). this article has been an exercise in theory translation. a semiotic metatheory was offered as a framework for understanding science and scientific theories. affect control theorists ponder and investigate how actors, identities, actions, objects, emotions, and social settings are interrelated during social interaction. act has been interpreted in terms of its value in increasing our understanding of human behavior in the social environment, for its suitability to social work, and for its applicability. a variety of theory translation tools were used to translate act technical words into simpler language, act displays into words and act’s interactionist language into the language and imagery of ecosystems theory. semiotic metatheorizing about act can be taken further. act uses the language of mathematics in its formal theory statements and prediction equations. i am not fluent in mathematics and am unable to translate these statements. additionally, semioticians are concerned about “polysemy,” the notion that any sign has multiple meanings and translators focus selectively and differently on the sign’s mean15forte/using a semiotic metatheory for theory understanding, appraisal, and use ing (colapietro, 1993). my translation needs to be compared to that of theory experts. finally, this paper has addressed the linguistic aspects of text analysis. future communication-oriented theory appraisal should consider the ideological positions embedded in act texts and act’s use of rhetoric to persuade readers. this article represents an exploratory effort in the use of semiotics as a metatheory for translating theories. at this point, social work lacks a semiotic pedagogy for theory learning. pedagogical principles, lessons, drills, and vocabulary tests based on this foundation have not been developed. additionally, the semiotic translation skills for the mastery of act and other theories have not yet been codified. further work might specify the principles and procedures associated with profiling exemplars, creating and reading theoretical models, comparing target and source domains to generate root metaphors, deconstructing a theory’s architectonic, and identifying plain english equivalents for theoretical keywords. while act provides useful root metaphors for the person and the environment, its theory-based root metaphor for the social work helper is too sketchy. social work has not yet established evidence-based links between particular theoretical languages, such as act, and the fields and practice settings in which the languages are most useful. affect control theorists make some claims about applicable situations. social workers need to validate these claims. conceptual models developed by act to guide emotion work are based on studies of the planned change activities conducted by non-act practitioners. these conceptual models have not been based on the direct application of act to practice situations. social workers must develop act models related to our practice efforts and begin to incorporate act concepts, propositions, models, and findings into our own personal practice models. a translator specializes in providing equivalent terms in a target language for terms in a source language (sarukkai, 2002). the translator serves practitioners who are eager to learn new theoretical languages by making sense out of some text, discourse, or other semiotic system (colapietro, 1993). science is a sign system. scientists use symbols, icons, and indexes that seem like an unbreakable code and a 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(2003). self, identity, and interaction in an ecology of identities. in p.j. burke, j. owens, r.t. serpe, & p.a. thoits (eds.), advances in identity theory and research (pp. 167-178). new york: kluwer academic/plenum. smith-lovin, l., & douglas, w. (1992). an affect control analysis of two religious groups. in d.d. franks (ed.), social perspectives on emotion. volume 1 (pp. 217-247). greenwich, ct: jai press. smith-lovin, l., & heise, d.r. (1988). analyzing social interaction: advances in affect control theory. new york: gordon and breach. smith-lovin, l. & robinson, d.t. (2006). control theories of identity, action, and emotion: in search of testable differences between affect control theory and identity control theory. in k.a. mcclelland & t.j fararo (eds.), purpose, meaning, and action: control systems theories in sociology (pp. 163-188). new york: palgrave macmillan. turner, j.h., & stets, j.e. (2005). the sociology of emotions. new york: cambridge university press. watson, w. 1985. the architectonics of meaning: foundations of the new pluralism. albany, ny: state university of new york press. zhao, s. (2001). metatheorizing in sociology. in g. ritzer & b. smart (eds.), in handbook of social theory (pp. 386-394). london: sage. author’s note: address correspondence to: professor james forte, department of social work, 1101 camden avenue, salisbury, maryland, 21801, usa. e-mail: jaforte@salisbury.edu or jamesforte@mac.com http://web.mac.com/jamesforte/iweb/ 18 advances in social work aisw vol. 5, no. 2 considering family and significant others in the faculty recruitment process: a study of socialwork recruiting practices michael e. sherr johnny m. jones abstract: one of the most important facets of quality social work education is the recruitment and retention of faculty. this mixed methods study uses findings from an on-line survey of 106 recent (within three years) faculty hires and their (n=24) spouse/partner/significant others (s/p/so) to determine the degree to which familyintegrative recruitment strategies were being used in recruiting social work faculty and the impact with which the presence or absence of these strategies have on retention. amajority of respondents reported that s/p/sowere excluded from the recruitment process. though the few respondents who felt includedwere pleasedwith their current position and planned to pursue tenure to stay with the school, a significant number of facultywhose s/p/sowere not involvedwere already contemplating their next position.the authors suggest family integrative strategies that help s/p/so connect with the community may give social work programs the competitive edge they need to attract and retain the best and brightest social work faculty. keywords: family, recruitment, education, social work, spouse, partner introduction the quality of any social work program is dependent on the quality of its faculty. through research, teaching, and service, faculties are responsible for producing and disseminating social work’s knowledge base (frazer, 1993; green & bentley, 1994; netting & nichols-casebolt, 1997). faculties determine how students are socialized into a program, how curricula is structured, how social problems are understood, and how practice interventions are designed and implemented. faculties, along with their administration, are also responsible for recruiting and retaining new faculty to maintain and enhance their program (frazer, 1994; lindsey & kirk, 1992; simon &thyer, 1994). in an era of tremendous demand and limited supply of qualified social work faculty (thyer & wilson, 2001), this study explores how recruitment efforts, which include faculty spouses, partners, and significant others (s/p/so), may help promichael e. sherr, ph.d., lcsw is an assistant professor at the school of social work, baylor university, waco, tx 76798-7320. johnny m. jones, ph.d. is an assistant professor at the college of social work, university of south carolina, columbia, sc 29208. copyright© 2007 advances in socialworkvol. 8 no. 2 (fall 2007) 275-287. indiana university school of socialwork. 275 grams gain a competitive advantage in recruiting faculty best suited for their program. literature review socialwork job landscape/literature with more than 450 bsw programs, almost 160 msw programs, and 72 social work doctoral programs, there is great competition for qualified social work faculty (council on socialwork education, 2003; thyer & arnold, 2003). yet, despite the demand for qualified people, the number of degrees awarded at social work doctoral programs has remained relatively stable over the last decade. in fact, it is estimated that there are three to four faculty vacancies annually in social work education for every doctoral graduate (thyer &wilson, 2001). however, while an abundance of recent literature addresses issues, including increasing ph.d. enrollment, training social work teachers and researchers, promoting diversity, and financing doctoral education in social work (e.g., ross-sheriff & huber, 2001; tirrito & ginsberg, 2001; see also schiele &wilson, 2001), there is a void in the literature regarding how social work programs are to manage, while waiting for increasing numbers of qualified graduates. social work programs have vacancies to fill immediately. they simply cannot wait for the future. the immediate need will escalate further, asmore andmore senior facultymembers continue to retire. historically, the emphasis in the social work literature has been to focus on the tasks and qualifications of potential faculty. for instance, harrison, sowers-hoag, and postley (1989) conducted a national study examining the hiring decisions in graduate and undergraduate schools of social work. the article captures themost frequently cited factors search committees look for in new faculty. as one would expect, the respondents indicated that, having a doctoral degree in hand at the time of the on-campus interview, wasmost important. other things, such as prior teaching experience, an identified research area, and publication in refereed journals, are all important factors in the hiring decision as well. other articles focus on the tenure and promotion of social work educators. articles by gibbs and locke (1989) and euster and weinbach (1983) review the important factors influencing successful tenure and promotion for junior faculty. as one would expect, research in refereed journals, solid teaching evaluations, and service to the university weremost important, with variations in degree being determined by the type of institution. in addition, dedmon (1989) explored the effects of junior faculty attempting to engage in practice during their time before tenure and promotion. despite possible costs in terms of tenure and promotion, dedmon concluded that being an effective researcher and teacher in social work may include some commitment to continue to engage in some type of professional practice. more recently,wilson,valentine, and pereira (2002) conducted a telephone survey assessing the effectiveness of the mentoring relationship between newly hired faculty and senior faculty. their findings suggest that mentoring was quite helpful in increasing publications, helping new faculty get acclimated to the culture of the department, and transition from student to educator. likewise, 276 advances in socialwork sherr, jones/family and faculty recruitment beckerman (2002) described a faculty orientation group at yeshiva university with incoming faculty. the article details how helpful the group was in developing a clear sense of expectations, providing consultation in regard to difficult situations encountered in the classroom, and increasing the potential for collaboration on projects. although each of these studies (andmany others) represents laudable efforts in helping schools of social work recruit and retain quality faculty, a common consideration missing from this literature is any mention of the faculty’s family. for example, in a specific article on finding and retaining new social work employees, there was no mention of family, spouse, or partner (gummer, 2002). moreover, pamelawilson (lead author of the article written bywilson et al., 2002) states that she and the other authors did not even think to consider the family (personal communication, june 14, 2002). when families with higher levels of education consider changes related to work, however, they are likely to engage in direct dialogue and negotiations before making decisions (zvonkovic, schmiege, & hall, 1994). moreover, faculty from cultures that tend to value collective social relationships (asian-americans, hispanic/latino, american indian) are likely to emphasize family inclusion when it comes tomaking career decisions (lee, 1991; leong, 1991; sue & sue, 1990; yagi & oh, 1995). for that reason, family considerations become a cultural competence issue that could impact the efforts of social work programs to recruit a diverse faculty. lessons from business literature “let’s face it, today’s workplace is busier than ever” (rogers, 2002, p. 2). great numbers of layoffs have left those who remain in their jobs working more hours. a situation similar to that of social work faculty, with demanding workloads and increasing budgeting restraints, the consequences are increasing amounts of stress, burnout, and higher turnover. in business, the bottom line is presumed to be the production of a quality product that will win favor in the marketplace and ultimately create a profit. to keep production costs low, employers need productive employees to survive. to support the productivity of employees, many employers are attempting to create a working environment that recognizes and supports a balance between work and family. rogers adds, “a workplace that fosters balance results in less turnover, absenteeism, and burnout” (p. 2). utilizing a family-integrated retention and recruitment strategy is one way of encouraging a balanced and productive work environment. a family-integrated strategy consists of policies and practices that provide different services, financial supports, and time for employees to fulfill their family responsibilities (championhughes, 2001). specific family-friendly practices include flexible work schedules, on-site/near-site child care, dependent-care reimbursement accounts, homework assistance programs, extended leave care, elderly care, telecommuting, time-off benefits for children’s school activities, employee assistance programs, family considerations for travel and relocation, and resource and referral services. this array of benefits is more than an expression of altruism on the part of employers. instead, family-integrative strategies are calculated investments with an expectation of great returns for the company. the return is having a business 277 with employees who are loyal to the company. champion-hughes (2001) describes this sense of loyalty as organizational citizenship. she explains: organizational citizenship refers to the willingness of employees to engage in behaviors that help the organization achieve its goals. such behaviors include helping co-workers with job-related activities, accepting orders willingly, tolerating impositions without fussing, and making sacrifices for the good of the company. generally, when employers are loyal to their employees, that loyalty is reciprocated (p. 301). one noteworthy area in business that is similar to social work education is the amount of potential travel. whether a faculty member moves across country to assume a new position or travels to present at a national conference, the business literature suggests that it is vitally important to think of the employee’s spouse or partner during times of transition and travel. one of the main reasons employees leave a new job area is the stress from familymemberswho feel isolated and unadjusted. likewise, faculty will be less willing to travel to conferences when they perceive that their family is not fully connected in their new community (grensingpophal, 2001). this is a serious issue for human resources personnel, because it is costly to recruit employees only to have them leave due to factors not related to their job. in fact, family resistance ranks as the top reason for leaving a new position after relocating and being reluctant to travel at all. grensing-pophal adds: any policy that does not address issues related to the spouse and family misses the mark. if the family is not settled, then nine times out of ten the employee is not going to be settled. for human resource professionals, taking the stress out of relocations means a transferee can quickly be settled into the new position and the new home and bemore productive on the job (p. 118). when beginning a newposition in a foreign country, the relocation issues for the family are even more complex. shaffer and harrison (2001) developed a family integrative model for conceptualizing how employers can assist families to successfully adjust to living in a foreign environment. themodel consists of three key dimensions that are important to consider for spouse or partner readjustment. the three dimensions are: 1) how well the spouse or partner builds relationships with host-country nationals; 2) how well the spouse or partner adjusts to local customs and the culture in general; and 3) the extent to which the spouse or partner has a sense of becoming part of or feeling at home in the foreign country. a key factor in achieving successful adjustment in all three dimensions depends on whether the spouse can reestablish his or her identity in the new culture. another key factor depends on whether the spouse has realistic expectations of what to expect in terms of workload and work hours of the employee. “companies should give realistic job previews to spouses both prior to and during relocation. this will help spouses accurately identify the challenges they will face as well as the personal assets they can bring to bear” (shaffer & harrison, 2001, p. 251). research questions several key research questions emerge for this initial study that explore recruitment efforts to include faculty s/p/so in gaining a competitive advantage in advances in socialwork278 279 recruiting social work faculty. first, do s/p/so play a pivotal role in the recruitment process? second, do s/p/so perceive that they play a role in the recruitment process?third, do facultymembers perceive that their s/p/sohas some control in the recruitment process? method respondents and data collection procedures respondents for this study consisted of a purposive sample of social work faculty working less than three years in their current position. an e-mail was posted on the list-serve for the national association of deans and directors of schools of social work (nadd) and the association of baccalaureate social work program directors (bpd) asking deans and directors to forward the e-mail to facultymembers working less than three years. the e-mail included an informed consent form as an attached document as well as the website address for either the faculty or the partner survey. faculty receiving the e-mail were asked to do the following: 1) read the informed consent form and anonymously complete the online faculty survey and 2) have s/p/so read the informed consent form and anonymously complete the online partner survey. survey instrument the online faculty survey and partner survey, whichwere designed specifically for this study, consisted of three parts. part one asked respondents if they were with their s/p/so at the time of hire and, if so, which, if any techniques, were used by their current university employer to include their s/p/so in the recruitment process. respondents were asked to choose from the following recruitment techniques used by their current university employer: 1) providing connection to a realtor; 2) inviting s/p/so to the campus interview; 3) paying for s/p/so to come to the interview; 3) providing job search assistance for s/p/so; 4) inviting s/p/so to social functions during the interview (e.g., dinner, lunch); and 5) providing opportunities for interaction with other faculty s/p/so. part one also consisted of three semantic differential questions that asked respondents to assess on a scale between 0-5 the influence the s/p/so had on the hiring process, how supportive the s/p/so was in the decision to accept the current position, and their overall satisfaction with their current position. part two of the survey consisted of demographic items, such as gender, ethnicity, the number of years working in higher education, highest degree, and the type of university. s/p/so were also asked if they, too, worked for the same university and, if so, in what role—faculty, staff, administration, or other. the last part of the survey consisted of one open-ended question that asked respondents to tell us the story of their recruitment experience with regards to their s/p/so. the online faculty survey and partner survey were field tested with social work faculty from the authors’ institutions (names of the authors’ institutions) to assess face validity. in response to the initial field test, the phrase “spouse, partner, or significant other” was added to each item to enhance the face validity of the survey. further efforts to establish more dependable measures of reliability and validity were beyond the scope of this initial study. sherr, jones/family and faculty recruitment advances in socialwork280 results faculty respondent’s characteristics dichotomization of sample characteristics will better facilitate the description of the sample. the two sub-samples include respondents who identified themselves as faculty and those that identified themselves as s/p/so.onehundred six (n=106) respondents identified themselves as faculty by completing the faculty questionnaire online. although an exact response rate could not be determined, todd lennon, coordinator of member services for the council on social work education, estimated these respondents represented one third of faculty accepting positions within the last three years (personal communication, february 28, 2005). these respondents tended to be females (66%, n=70). they also claimed relationships with s/p/so (79.2%, n=84) and that they were with their other s/p/so at the time they were hired into their current position (72.6%, n=77). the majority of respondents identified themselves as white/caucasian (69.8%, n=74). other ethnic and racial identifications included african american (9.6%, n=11), american indian (5.7%, n=6), hispanic/latina/o (2.8%, n=3), asian american (2.8%, n=3), pacific islander (1.9%, n=2), african (1.9%, n=2), british of africa (n=1), jewish (n=1) and three subjects provided no data with regards to this question. while recruitment of the sample focused on those faculty persons in their current position for the past three years, there was considerable range in the number of years in higher education. the range was between 0 and 39 years with a mean of 6.25 years and a standard deviation of 6.53 years. the majority of respondents indicated that they worked in public universities and/or colleges (68.9%, n=73) over private ones (28.3%, n=30). these programswere approximately 48.1% (n=51) doctoral/research universities, 34% (n=36) bachelor’s programs, and 16% (n=17) master’s programs. a total of 46.2% (n=49) of the faculty respondents indicated that they hold a ph.d. in social work or social welfare, 1.9% (n=2) indicated that they held d.s.w. degrees, 21.7% (n=23) indicated that they held ph.d.s in other fields and 1.9% (n=2) indicated that they hold other doctorates (e.g., ed.d.). a relatively large proportion of the sample (24.5%, n=26) indicated that the latest degree was anm.s.w. or m.s.s.w. spouse/partner/significant other characteristics there were a total of 25 submissions of the s/p/so online survey. however, one of the submissions contained no data and was omitted for a sub-sample size of 24. the submission may have been an accidental early submission before the survey had been completed. eighty-three and one third percent (n=20) identified themselves as white/caucasian. one person identified her/himself as african american, one person as asian american, and two identified themselves as pacific islander. the majority of the respondents (70.8%, n=17) reported that they were with their faculty partner at the time of the most recent hire. nine (37.5%) of the respondents indicated that they were employed in higher education and five of those nine reported that they worked at the same institution as their faculty partner. five of the respondents in higher education reported also being faculty, one reported being staff, one reported being an administrator, and two reported their positions in higher education as “other.” 281sherr, jones/family and faculty recruitment descriptive statistics on the faculty recruitment process when asked about techniques that involved s/p/so in the recruitment process, the majority of both faculty and s/p/so respondents indicated exclusion rather than inclusion in the process. only 17 (16%) of the faculty respondents and 4 (16.7%) of the s/p/so respondents indicated that they were connected to a realtor by their prospective employer. only nine (8.5%) faculty indicated that their s/p/so were invited to the on-campus interview and only one (4.2%) s/p/so indicated he or she was invited. the same number of faculty and s/p/so respondents indicated that their s/p/so expenses were paid to attend the interview. twelve (11.3%) faculty respondents indicated that their s/p/so was offered job search assistance by the prospective employer. only one s/p/so indicated that they had received this same assistance. twenty-two (20.8%) faculty and 6 (25%) s/p/so indicated that they (i.e., s/p/so) were invited to attend social functions. thirteen (12.3%) faculty noted that their s/p/so were offered opportunities to interact with other spouses, partners, and significant others of the hiring faculty. only four (16%) s/p/so indicated that they were afforded the same opportunity. both faculty and s/p/so were asked to rate the influence of the s/p/so on the faculty member during the recruitment process using a 6-point likert-type scale from 0 (least influence) to 5 (most influence). seventy-five faculty responded to this question. a total of 21 of the 75 respondents (28%) scored the influence of their s/p/so as 2 or below, indicating that they felt that the s/p/so had little influence on their decisions. in contrast, only two (8%) s/p/sos scored their influence over their faculty partner as 2 or below. an overwhelming majority of s/p/sos (87.5%, n=21) indicated that they supported their faculty partner in accepting their current position.where it is assumed that production is equated with job satisfaction, 28 of 78 (35.9%) faculty reported lower levels of job satisfaction on a likert-type scale. similarly, 8 of 21 (38.1%) s/p/so reported lower levels of satisfaction with their faculty partner’s current position. an exploratory regression analysis on the independent variables (i.e., whether or not the faculty person was connected to a realtor; whether the s/p/so’s expenses were paid to attend the interview; whether job search assistance was provided for the s/p/so; whether opportunities were provided for social interaction between the s/p/so and the faculty/staff of the interviewing program; the faculty person’s perception of the influence of their s/p/so on the decision of whether or not to take their current position; whether or not the s/p/sowas supportive of the faculty person’s acceptance of the current position; the number of years the faculty person has been employed in higher education; the education level of the faculty person; and, whether or not the employing program is a public or private program) of the faculty survey on the dependent variable (satisfaction with current faculty position) yields some interesting results. the authors chose to report regression analyses despite the small sample size for several reasons. first, the small sample size yielded significant results, suggesting that there is indeed a true effect size within the population. in this model, approximately 32% of the variance (r2adj = 31.5, p=.006) in job satisfaction was attributable to the independent variables listed above. only three of the predictor variable’s individual model coefficients were statistically significant however, indicating possiadvances in socialwork282 ble strong predictors of job satisfaction. these statistically significant predictors included whether or not the s/p/so’s expenses were paid to attend the interview process (t=-2.852, p=.006); whether or not the s/p/so was provided opportunity for social interaction with recruiting faculty, spouse, partners, etc. (t=2.891, p=.005); and the number of years in higher education (t=-2.574, p=.012). second, the results of the regression analyses provide support for the qualitative results obtained. although the use of inferential statistics is suspect at best given the limitations of this study, these results are consistent with qualitative results of the open-ended questions of both faculty and s/p/so surveys discussed in the following section. open-ended responses extent of s/p/so involvement. respondents shared a range of experiences regarding recruitment to their current institution. the majority of respondents (70%) reported that their s/p/so was not included or considered in the recruitment process. one faculty member stated, “neither my spouse nor my children were involved in the recruitment process in any way.” another faculty member indicated, “no assistance or attention was given to my spouse or his needs in moving here.” a supportive s/p/so lamented about being left out of the process: not once in any of the recruitment process has anyone asked her about her family, the richness of the experiences she brings outside of the dollar signs she can bring to the university from her grants, or cared how her job might impact her family life. some respondents discussed their s/p/so having a “behind the scenes” role in the recruitment process. in some instances, the s/p/so worked with faculty to establish parameters for accepting a position. a male faculty member stated: my wife was a major factor in my job decision—while i was the one considering school fit with my interests, school reputation, and potential for professional and scholarly growth, she was the one helping to determine geographic limits, family expectations, and social climate of the setting. at the same time, other respondents described s/p/so communicating full support for the facultymember to have the autonomy to choose the best position possible. one faculty member commented, “my partner was very interested in my professional success and she encouraged me to take the best or highest ranked offer i received.” a smaller number of respondents described s/p/so as being fully included and considered in the recruitment process. several characteristics emerged as common experiences of s/p/sowho felt included during the recruitment process. for example, for s/p/so with their own careers, all of them mentioned formal and informal support with job relocation. as one faculty member stated, “my colleagues in the social work department genuinely understood how important my husband’s professional and social considerations were to my decision, and did everything they could to accommodate his needs.” another common experience was being invited to participate in the interview and learn more about the area surrounding the school. one faculty member reported, “my wife was fully sup283sherr, jones/family and faculty recruitment portive of our move, because our dean was very inclusive of her, paid for her to visit the town, andmade her feel part of the process.” an additional faculty member shared how his wife’s inclusion influenced his choice between two different offers. my wife was invited to come to the town, but not to the interview. she was shown around town by an administrative assistant and joined the faculty for lunch. she feltmuchmore a part of this process than another onewhere she was not invited to attend anything. i was offered that position, but did not accept it. specific same-sex findings. faculty in same-sex relationships expressed three additional areas of importance to them and their s/p/so. first, respondents expected the university to provide partner benefits. “i will not consider any institution that does not offer domestic partner benefits for healthcare and life insurance,” was a typical response. second, respondents indicated that it was crucial for them to feel that faculty search committees considered their relationship legitimate and important. finally, just as with all s/p/so, members of faculty search committees should portray genuine warmth and acceptance. one respondent described experiencing complete acceptance and inclusion: the invitation and general welcome extended to my partner was especially significant to me, given that our relationship is a same-sex partnership. i came out during the interview, and no one blinked an eye. it wasn’t that they were of the naïve mindset that sexual orientation doesn’t matter. rather, they were genuinely inclusive and valued the diversity i could bring to campus. my relationship was immediately treated as legitimate and important. faculty, administration, staff were immediately warm and comfortable toward my partner and embraced us into the campus community at the welcoming dinner at the start of the academic year. afterwards, i was struck by the fact that so many folks on campus remembered my partner’s name and asked about her often. consequences and benefits. consequences and benefits of s/p/so involvement emerged as another finding. faculty whose s/p/so were not included in the recruitment process, having only been in their current position for less than three years, were already contemplating their next position. as they plan for their next position, these same faculty members are making s/p/so involvement and consideration an important part of choosing where they will teach next. as one respondent indicated: i do not feel valued as a faculty member at this institution, nor do i feel as though the university was invested in helpingmy spouse find employment. i plan to leave this university in the near future and will not accept another faculty appointment until i know that my spouse has also procured employment in his field. another respondent shared: in my recruitment experience, my partner was excluded and i was the one offered any information about the university, program, area, etc. because i am the sole provider for my family, my partner fully accepted my decision to choose this present school. however, because i am extremely dissatisfied with this faculty, i will be seeking a different teaching position andmy partner will/must be more involved in the decision-making process. i believe that recruitment needs to include family members. when s/p/so felt involved and considered, respondents weremore supportive, happy, and hoping to remain in their current positions for a long time. a s/p/so shared why it was important for him to be part of the recruitment process. i was glad to be along for the recruitment process. i could tell that the area would be good for the family and that the position would be great for my wife. knowing this allowed me to be fully supportive of my wife working there. a faculty member simply stated, “i am happy here and likely to stay (assuming i can get tenure) because i am happy and my family is happy. discussion in the midst of the current labor market, this exploratory research has sought to understand how expanding recruitment efforts to include faculty s/p/so could help social work programs recruit and retain faculty best suited for their programs. several limitations are important to consider in interpreting the findings of this study. although several steps were taken to recruit a purposive sample of social work faculty working less than three years in their current position, the lack of randomization prevents generalization of findings. further, the low response rate of partner surveys prevents comparing the responses and experiences of faculty with s/p/so.the online surveys, though field-tested, were not standardized. it is possible that responses were more indicative of instrument error than respondents’ actual recruitment experiences. in the same way, the survey items were limited to respondents’ general perceptions of satisfaction and influence with other factors not considered (i.e., teaching load, research support, salary, geographic location). finally, findings primarily describe the responses from faculty and s/p/so; it may be equally or more important to understand the impact of entire family systems, including the presence, number, and age of children, as well as the influence of other extended family members. despite these limitations, several important findings emerged from this study. perhapsmost notable was that amajority of both faculty and s/p/so respondents indicated that s/p/so were not included in the recruitment process. a majority of s/p/sowere offered no support in finding a place to live, no job search assistance, no invitation to come to the interview, and no opportunity to interact with other faculty s/p/so at social functions. just as important, however, was the expressed commitment of respondents when s/p/so felt included. for the small number of respondents whose s/p/so felt included in the recruitment process, each mentioned how pleased they were with the current position and how they were intent on pursuing tenure and staying with the school. in contrast, a significant number of respondents whose s/p/sowere not involved were already contemplating their next position. considered together, these findings suggest that, while including advances in socialwork284 sherr, jones/family and faculty recruitment 285 s/p/so in the recruiting process does not guarantee faculty “goodness-of-fit” in terms of scholarship productivity, teaching proficiency and service with a social work program, it may improve the likelihood of faculty wanting to remain with their current school. furthermore, if faculty, whose s/p/so were excluded from the recruitment process are spending time and energy contemplating their next position, it is reasonable to believe that they are spending less time and energy fulfilling their responsibilities in their current faculty position. when faculty members in this study do look for another position, they anticipate looking for schools that include their s/p/so in the recruitment process, giving schools that consider the s/p/so a competitive advantage. implications for socialwork education the findings that emerged from this study provide initial support for including s/p/so in the recruitment process of social work faculty. consistent with the literature (champion-hughes, 2001; grensing-pophal, 2001; rogers, 2002; shaffer & harrison, 2001), the current findings suggest that it is good business to include s/p/so in recruiting and retaining social work faculty. after investing time and financial resources for advertising, faculty search meetings, expenses for interviewing candidates, moving expenses, new equipment and office space, readjustment of teaching schedules, and orientation, social work programs need faculty who can contribute to their programs as soon as possible. stated differently, social work programs cannot afford to have faculty contemplate leaving in less than three years of being hired. in the same way, the quality, morale, and stability of social work programs depends on hiring faculty who, on one hand, add diversity of experiences and dynamic thought (holley & young, 2005) and, on the other hand, are invested in becoming productive scholars willing to make a long-term commitment to the program and the community. academia does not operate with the exact same parameters as the business world. although including s/p/so seems to be a pragmatic idea, social work educators will have to tailor their strategies to fit into the culture of their program. the authors, however, recommend beginning with two simple strategies that build upon the assets of the social work profession. first, faculty search committees can at least begin to make contact with the s/p/so of the newly hired faculty person. utilizing reflective listening skills, clarification skills, and empathetic responses, members of the faculty search committee can establish rapport and trust early in the hiring process. furthermore, grensing-pophal (2001) suggests determining one or two critical elements for the s/p/so that would make the transition easier. perhaps the faculty on the search committee could help family members meet new friends, help with housing, and locate adequate childcare. through establishing rapport and trust, s/p/so will be more likely to share the issues that are most important for the transition to go smoothly. another strategy, which builds upon social work literature, is to consider implementing a mentorship program for the s/p/so of new faculty. mentoring is already effective in acclimating new faculty into social work programs (wilson et al., 2002). deans and other administrators within the programs can identify s/p/so of senior faculty who would be willing to provide some mentoring to the advances in socialwork286 family members of new faculty. once a new faculty member accepts an offer to begin working at a university, the faculty search committee can partner the new faculty’s s/p/so with one of the volunteer mentors. the mentor can provide support during the transition of moving into a new area. thementor can also discuss, fromhis or her perspective, realistic expectations of the new faculty’s work responsibilities, including what to expect in terms of travel, work hours, and time for leisure. such a program may also be beneficial to the s/p/so of senior faculty, as they are included in a very important aspect of the universities’ operations—the recruitment and retention of quality faculty. finally, several areas of research are needed to address the limitations of this study and build on its findings. first, replicating this study with a larger, random sample would allow for greater comparisons between the experiences of faculty whose s/p/so were included in the recruitment process and faculty whose s/p/so were not included. furthermore, the importance of including s/p/so in the recruitment process should be examined in conjunction with other significant factors. although exploratory regression analysis revealed initial support for the significance of including s/p/so in the recruitment process, additional analysis with other variables (e.g., research support, workload expectations, salary, family responsibilities, number of children, and geographic location) would offer more conclusive evidence (euster & weinbach, 1983; gibbs & locke, 1989; harrison, sowers-hoag, & postley, 1989; holley & young, 2005). second, much could be learned by a follow-up study using in-depth interviews with faculty and s/p/so. how would faculty and s/p/so characterize a successful recruitment experience? after accepting a position, how would s/p/so describe their transition experiences and how do their experiences affect faculty productivity? for those who left a previous faculty position, what influence did s/p/so have on their decision to leave?third, a survey of deans on their rationale for inclusion/exclusion of s/p/so would yield useful findings. the survey could assess the rationale of deans at the beginning of recruitment and after selecting a faculty person. finally, additional discussion and study is needed to further understand the impact of recruiting entire family systems in academia. in business, the impact appears to be less turnover and greater morale and productivity of employees (rogers, 2002; champion-hughes, 2001), which is consistent with operating a successful social work program. in the midst of the current labor market, expanding recruitment efforts to include faculty s/p/somay help programs recruit faculty best suited for their program.helping s/p/so to feel included in the hiring processmay send themessage to faculty that the school wants the whole family system to feel a part of the university. such efforts, as supported in the business literature, could reduce turnover, increase recruitment and retention, and encourage faculty to be more loyal and productive for the university. finally, one respondent offers another important reason to include s/p/so in the recruitment process, “it would seem that, sincewe often teach of systems and their impact on client functioning, social work search committees would include systems thinking in their search processes.” sherr, jones/family and faculty recruitment 287 references beckerman, n.l. 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(1995). counseling asian american students. in c.c. lee (ed.), counseling for diversity (pp. 61-84). needhamheights, ma: longwood. zvonkovic, a.m., schmiege, c.j., & hall, l.d. (1994). influence strategies used when couples make workfamily decisions and their importance to marital satisfaction. family relations, 43(2), 182-188. author’s note: address correspondence to: michael e. sherr, ph.d., lcsw, assistant professor, school of social work, baylor university, one bear place #97320,waco, tx 76798-7320, usa. e-mail: michael_sherr@baylor.edu. running head: mental health problems of chinese students addressing the mental health problems of chinese international college students in the united states meirong liu abstract: this article identifies unique mental health problems experienced by chinese international students in the united states. the uniqueness of these problems suggests the need to address them independently from other chinese and international student communities. first, an overview of the common sources of mental health problems and specific stressors these students face is provided. this article then develops culturally sensitive programming recommendations to improve collaborative efforts between health providers, mental health social workers, faculty, and academic staff within universities to serve these students more effectively. keywords: chinese international student; mental health introduction the increase in cultural diversity in the united states is reflected in its educational systems (bradley, parr, lan, bingi, & gould, 1995). being an important center of information and advanced technology, along with its generous scholarship policy, the u.s. attracts more international students than any other country (sandhu, 1995). during the 2004-2005 academic year, a total of 565,039 international students were studying at the academic institutions in the u.s. (institute of international education [iie], 2006). students from asian countries represent more than half (55%) of these students (iie, 2006). transition to university can be a dramatic life change for all young people. first year university students can experience elevated psychological distress (fisher & hood, 1987), and features of the new environment can interact with personality factors to precipitate psychological problems (fisher, murray, & frazer, 1985). therefore, not surprisingly, international students who enter american universities and also must cope with cultural relocation tend to experience more psychological problems than do american students (leong & chou, 1996; mori, 2000; pedersen, 1991; sandhu & asrabadi, 1994). in addition, yeh and inose (2003) found that international students from asian countries, including china, experience more acculturative stress than their counterparts from europe. since the open-door policy in the 1980s, the number of mainland chinese students attending western universities has increased dramatically. in the 2004-2005 academic year, china became the second largest sending country, with 62,523 students enrolled in u.s. educational institutions (iie, 2006). because of the large cultural differences between long-isolated china and the western world, chinese students can face severe _________________ meirong liu, m.a., is a ph.d. candidate in the school of social work at the university of illinois at urbana-champaign. the author would like to thank dr. mary k. eamon, associate professor in the school of social work, university of illinois at urbana-champaign, for her advice and encouragement regarding the development of this article. this article would not have been possible without her kind help. copyright © 2009 advances in social work vol. 10 no. 1 (spring 2009), 69-86 liu/mental health problems of chinese students 70 cultural shocks upon landing in the u.s. for example, embracing confucian philosophy of harmony, which is passive and yielding (e.g., oldstone-moore, 2002), chinese international students, in order to fulfill the expectations of american society and develop a non-confrontational relationship with members of the host society, may experience more difficulty than international students from other regions (hsieh, 2006). research suggests that chinese students’ psychological problems should not be simply considered the same as those of chinese immigrants. berry, kim, minde, and mok (1987) identified five distinct different acculturation groups on the basis of the nature of their contact with the host culture: immigrants, refugees, native people, ethnic groups, and sojourners. international students are most accurately described as sojourners according to this classification scheme (wang & mallinckrodt, 2006). their status as sojourners is more likely to contribute to difficulties such as lack of experience, social connectedness, and language ability. they are also less likely to have time to develop coping mechanisms to cope with discrimination and isolation and to establish a social support system, and may be more likely to be subject to many legal restrictions with regard to their academic eligibility and employment opportunities in the united states than immigrants (bikos & furry, 1999). however, despite the unique issues faced by chinese international students, little research has been done on this population. this article addresses the mental health problems of chinese international students who come from mainland china and attend american universities. the article first explores the students’ views of mental health, followed by an examination of common sources of mental health problems experienced by them. the main intent of the article is to develop a nuanced understanding that is needed to develop culturally sensitive programs and services. the article concludes with programming suggestions to guide collaborative efforts between health providers, mental health social workers, faculty, and academic staff within universities for serving these international students more effectively. the ultimate goal is to help chinese international students to enhance their functioning on university campuses. concepts of mental health in chinese culture introverted concepts of mental health chinese and american cultures are fundamentally different from each other. first, there are cultural variations in the concept of mental health. it has been suggested that chinese culture has introverted inclinations, while modern western culture has extroverted inclinations (yip, 2005). western concepts of mental health include role performance, adaptation, social functioning, and well-being in various aspects of social life (laffrey, 1986). individuals should function well in their families and employment settings. they also should improve or change oppressive social systems so as to assert their own rights and functions (read & wallcraft, 1995). in contrast, the introverted inclinations of chinese culture imply self-absorption or self-demand, but not being demanding of others or trying to change the external environment (yip, 2005). the traditional confucian concepts of mental health, which still advances in social work, spring 2009, 10(1) 71 have a strong influence on chinese people, suggest both internal and external requirements for individuals to maintain good mental health (yip, 2005). the internal requirements encourage people to restrain emotions, including the expression of intense emotions and desires (sue & sue, 1990). it suggests a step-by-step process to cultivate one’s mind, restrain one’s emotion, and discipline one’s behavior so as to achieve peace of mind (yip, 2005). the external requirements of confucian concepts of mental health are moral standards in interpersonal and societal interactions. this suggests that one has to be kind, humane, and considerate in interactions with others; to be faithful to one’s friends, family, and country; and to be forgiving of others’ faults and shortcomings (oldstone-moore, 2002). in short, in confucianism, internally, a mentally healthy individual is self-cultivated with a purified mind, a well-disciplined manner and mild expressions of emotion; externally, an individual is humane, righteous, faithful, and forgiving in interactions with others. besides confucianism, traditional chinese medicine also describes that in order to maintain a good mental balance, one should reduce his or her inner desires, emotions, and stress to an extent that he or she is psychologically released from external and internal burdens. finally, taoism, another influential ideological concept in china, also points out that the best way to achieve a high level of mental health is to maintain a state of nothingness and let everything, including life and death and calamity and blessing, happen naturally (yip, 1999). these introverted traditional chinese concepts of mental health, therefore, facilitate a form of passive egocentric preservation (sue & sue, 1997). chinese people are encouraged to restrain emotion and suppress individual rights to maintain harmony with other people and the law of nature. under this influence, chinese people typically choose self-control, self-discipline, and self-transcendence, rather than attempting to change the social environment. these tendencies may heavily influence the likelihood that individuals with problems will seek mental health services, as well as their responsiveness to services. for example, their introverted nature may help explain why chinese international students tend to underuse mental health services, despite the fact that they experience more problems than students in general and have an urgent need for psychological assistance (bradley et al., 1995; pedersen, 1991). in addition, in the helping process, they are more likely than american students to terminate therapeutic relationships prematurely (pedersen, 1991). somatic tendency: integration of body and mind in chinese culture and medicine, the body and mind are integrated (kaptchuk, 2000); no distinction is made between physical and mental illness. psychological, physical, and social factors are viewed as collectively contributing to the development of specific symptoms and illness (lin & yi, 1997). yet, people tend to manifest stress through physical symptoms. for example, “neurological weakness” is the preferred diagnosis over the psychological diagnosis of major depression, because it recognizes the presence of a physical process (kleinman, 1986). chinese international students, therefore, often seek medical help for their physical complaints, such as sleep disturbances, eating problems, fatigue, stomachache, or headache, even when those problems may stem from psychological stressors (lin & yi, 1997). if such physical causes are not found, they liu/mental health problems of chinese students 72 probably will not continue to seek alternative causes or services that are mental health in nature. the stigma of mental health illness, that is, losing face and embarrassment, may also prevent chinese international students from seeking mental health services. these students may choose to keep their difficulties or emotional problems to themselves because they may imply personal failures, which actually only increases their vulnerability to depression (heppner, et al., 2006). empirical studies have found that although prevalent in all cultures, stigma of mental health illness is much more severe among asians than among white europeans and americans (fogel & ford, 2005; furnham & chan, 2004). unique sources of mental health problems understanding the sources of mental health problems among chinese international students might facilitate counselors and educators in preventing or addressing these students’ mental health problems. chinese international students report a variety of mental health and personal concerns related to social interaction and communication problems, social connectedness, social support, filial piety, language barriers, homesickness, and academic, financial, and other difficulties (leong & chou, 1996; mallinckrodt & leong, 1992; mori, 2000; pedersen, 1991; yeh & inose, 2002). social interaction and communication problems asian students encounter values and customs in the u.s. that contradict those of their country of origin, such as cooperation versus competition (lynch, 1992), collectivism versus individualism, and hierarchical relationships versus equality of relationships (sue & sue, 1990). the accepted norms and behaviors in their country of origin may be ridiculed or misunderstood in the new environment, which can create confusion and discomfort (lynch, 1992). researchers suggest that asian international students may have more difficulty than students from other regions in fitting the norms and expectations of the dominant culture (hsieh, 2006). the students are aware of the need to learn western values and cultural norms; however, despite the widespread belief that adolescents can adjust easily to a new culture (huang, 1997; hernandez & mcgoldrick, 1999), this learning process is not easy (james, 1997) and requires considerable time for many. this may explain why chinese students who have been in the u.s. for a shorter time (one year or less) reported more stress than those who have been in the u.s. for a longer period of time (four years or more) (wei et al., 2007). overall, differences in cultural values and customs, especially when coupled with other factors such as language, often create social interaction, social connectedness, and social communication problems. cross-cultural differences in social interaction may prevent international students from forming close relationships with american students and may contribute to acculturative stress (mallinckrodt & leong, 1992). for example, yeh and inose (2002) found that asian immigrant students reported having social interaction problems. lack of advances in social work, spring 2009, 10(1) 73 skill in english and strong cultural differences in interactional styles are among the factors argued to contribute to such problems. the chinese self is fundamentally a social one. hsu (1953) has argued that people in the west are defined by their uniqueness and separateness from others. in contrast, people in the east are defined by their similarity and connection with others. the permeable boundary between the self and other is exemplified by the use of body parts to describe intimate relationships in the chinese language. for example, siblings are referred to as “hand and foot” (tung, 1994). as such, chinese society has been characterized as interpersonally oriented and collectivistic (markus & kitayama, 1991; triandis, mccusker, & hui, 1990). in contrast, there is a clear demarcation between the self and other in american mainstream culture, which highly values independence (markus & kitayama, 1991). americans are strong proponents of individual freedom and the right to exercise control over their lives without outside interference (bellah, madsen, sullivan, swidler, & tiption, 1985). indeed, hofstede (1980) found americans scored significantly higher on individualism compared with chinese people. for americans, the wish for interpersonal connectedness is counterbalanced by a wish for autonomy and privacy (lutz, 1985). as such, american society has been characterized as individualistic (markus & kitayama, 1991; triandis, mccusker & hui, 1990). hence, students from collectivistic cultural backgrounds may prioritize close relationships, and they may feel confused when interacting with western students who tend to emphasize aspects of individualism, such as independence, assertiveness, and self-reliance (cross, 1995). consequently, many international students perceive friendships in western culture to be less permanent and lasting than in their home countries (cross, 1995; mori, 2000). findings of a related study conducted in the united kingdom suggest that chinese international students often perceive the nature of relationships with host country students as problematic. many felt “very alone” and “marginalized and isolated” from “home” students. they perceived that while “home” students are outwardly friendly, relationships usually remain superficial, and it is difficult to determine who is a friend (bradley, 2000). in addition, chinese international students can feel disappointed and discouraged with their interpersonal connections (mori, 2000). these issues partially explain why international students tend to remain exclusively in limited groups of their fellow nationals (yeh & inose, 2003). this is unfortunate, because close relationships with american students may predict better adjustment (furnham & alibhai, 1985). such isolation from american peers likewise forces international students into a highly artificial social environment dominated by “forced” interactions with a small number of their fellow nationals (wright, 1987). one study also indicates that chinese international students are significantly more likely to have communication difficulties than japanese and korean international students (yeh & inose, 2002). these greater difficulties are likely to result from the previously discussed unfamiliar values, behaviors, and norms. furthermore, these difficulties can result in chinese students becoming frustrated, irritated, depressed, and withdrawn. to complicate matters, it is difficult for these students to express their feelings due to liu/mental health problems of chinese students 74 linguistic barriers and the fact chinese confucian culture emphasizes self-control and deemphasizes emotional expression (lee & zhan, 1998). social connectedness social connectedness is defined as the self-in-relation-to-others, particularly the subjective recognition of being in a close relationship with the social world (lee & robbins, 1995; 1998). this sense of connectedness guides individuals’ feelings, thoughts, and behaviors in social situations (lee & robbins, 1998). thus, people with high levels of connectedness are better able to manage their own needs and emotions through cognitive processes (tesser, 1991). on the other hand, people with low levels of connectedness are unable to effectively manage their needs and feelings and are more prone to low self-esteem, anxiety, and depression (lee & robbins, 1998). international students with high social connectedness are, therefore, likely to adjust to the new social environment more easily and to experience less psychological stress than students with low social connectedness. unfortunately, most chinese international students stay in the circle of their national fellows, thus lack broader social connectedness (yeh & inose, 2003). this formulation of cultural subgroups, in turn, tends to isolate international students even further (hayes & lin, 1994). social support research indicates that a loss of social support has a significant influence on the psychological well-being of international students (hayes & lin, 1994; mallinckrodt & leong, 1992; pedersen, 1991). in moving to another country, international students tend to feel a deep sense of loss after leaving their families and friends (hayes & lin, 1994). establishing a comparable social support system in the u.s. also is extremely challenging for them (mallinckrodt & leong, 1992). therefore, international students may be suddenly deprived of social supports that validate their sense of self-esteem and provide emotional and social support (mallinckrodt & leong, 1992; pedersen, 1991; sandhu, 1995). there is an old saying in china that captures this hardship: “everything is easy when you stay home, but everything becomes difficult when you are away from home.” normal responses to the withdrawal of social support include anxiety, ranging from irritation and mild annoyance to the panic of extreme pain and the feelings of disorientation which accompany being lost (pedersen, 1991). mallinckrodt and leong (1992) investigated the significance of social support among international students and found that the quality of the social support system can have both a direct and a buffering effect when international students undergo psychological stress. these authors concluded that social support, especially from one’s academic program, is essential to the welfare of international students. differing cultural values with respect to how international students perceive social support systems and how satisfied they are with their social support networks also may influence their levels of acculturative stress (yeh & inose, 2003). together, loss of social support and lack of social connectedness contribute to international students' acculturative stress. this acculturative stress often accompanies advances in social work, spring 2009, 10(1) 75 emotional pain, such as feelings of powerlessness, marginality, inferiority, loneliness, and perceived alienation and discrimination (sandhu & asrabadi, 1998). in addition, particularly difficult acculturative stress experiences tend to remain within the individuals over a long period of time (sanhu & asrabadi, 1998). filial piety in western culture, although parents are honored, there also is an emphasis on the nuclear family and independence, which reduces the importance of the family of origin. in fact, obligation to children is often stressed. however, as hsu (1953) observed, what parents should do for their children is a priority for americans; but for chinese, what children should do for their parents is emphasized. in chinese culture, persons are taught to obligate, respect, and have duty to their parents. the principles, which collectively are referred to as “filial piety,” are highly valued among chinese people. allegiance to parents is expected from offspring even after they have married and begun a family of their own and the pressure to meet parental obligations and expectations often clashes with individual goals and desires (sue & sue, 1997). this latter observation is supported by research, which found nearly all of a sample of chinese students seeking counseling (both foreign and america-born) experienced stress associated with filial piety (bourne, 1975). language barriers language barriers appear to be one of the most challenging issues for international students (mori, 2000). in addition, asian international students appear to have the greatest difficulty in the use of the english language among international students (abuein, 1993; stafford, marion, & salter, 1980). in yeh and inose’s study (2003), higher frequency of use, fluency level, and the degree to which participants felt comfortable speaking english, predicted lower levels of acculturative distress among international students. this finding is associated with the fact that higher english fluency indicates smoother interactions with majority group members (hayes & lin, 1994; pedersen, 1991). students with higher english fluency are able to more easily interact with people in new cultural settings, and this leads to greater feelings of adjustment. international students also may be less embarrassed and less self-conscious about their accent or ethnic background (barratt & huba, 1994). higher levels of english language fluency also help international students perform at a higher level in some academic classes, because they may feel more comfortable in articulating their knowledge in classrooms and on essay exams or research papers (kao & gansneder, 1995; lin & yi, 1997). in contrast, low english language fluency is likely to affect international students’ academic performance, which in turn negatively affects their psychological well-being (lin & yi, 1997; mori, 2000). finally, international students with few english language skills might not be eligible for receiving teaching assistantships in universities because students complain about their foreign accents. in response, several state legislatures have passed laws mandating higher educational institutions to test foreign teaching assistants for english competency (lin & yi, 1997) liu/mental health problems of chinese students 76 homesickness another important stressor that international students face is homesickness. previous research (fisher & hood, 1987) demonstrates that homesickness often accompanies students’ transition to university life. the previously mentioned strong links with family members in chinese culture is likely to exacerbate this problem among chinese international students. in lu’s study (1990), every subject in the entire overseas chinese student sample in great britain reported homesickness. because there were no differences between the more homesick and less homesick groups in personality traits, or in perceived demands or symptoms, the study concluded that among chinese international students, homesickness is a general widespread phenomenon resulting from being away from family. academic difficulties chinese students also are likely to experience academic and career problems (yeh & inose, 2003). there are several explanations for these negative outcomes. first, language difficulties and the difference in teaching styles between the u. s. and china can negatively influence chinese students’ academic performance, as they must learn entirely new classroom norms and skills (yeh & inose, 2003). for example, the format and emphasis on classroom participation varies greatly between china and the u.s. in addition, since many asian families strongly emphasize academic achievement (homma-true, 1997; kim, 1997; sue & sue, 1997), chinese international students likely feel pressured to succeed academically, even in the new environment. moreover, those who are accepted by american universities, and particularly those who are provided scholarships, have always been excellent students (pedersen, 1991). they would, of course, like to continue to be successful academically in the new environment. unfortunately, a strong emphasis on academic achievement can result in international students feeling too pressured to succeed. sue and sue (1990) noted that asian students experience greater fear of academic failure than their non-asian counterparts. in addition, academic achievement comes at a price. sue and zane (1985) found that foreign-born chinese american university students achieve higher grade point averages by studying more hours per week. partly because of this, the students experience greater anxiety, loneliness, and feelings of isolation and have difficulties in social interaction compared to other college students (sue & morishima, 1982). additional factors contributing to mental health problems there are other factors which contribute to the psychological problems of chinese international students. one study found that european international students are significantly less likely to experience acculturative distress than are students from the geographic regions of asia, africa, and latin/central america (yeh & inose, 2003). the researchers believe that this is because european students experience less acculturative distress associated with racism and discrimination than students from these other regions (yeh & inose, 2003). advances in social work, spring 2009, 10(1) 77 maintaining non-immigrant status also creates barriers for chinese international students. that is, they are legally prevented from assuming part-time student status or from temporarily dropping out, both of which often serve useful functions for domestic students. otherwise, they would have to forfeit their student visas (lin & yi, 1997). in addition, due to the strict immigrant visa policies, chinese international students may experience difficulties in re-entering the u. s. if they need to leave for any reason. in particular, students who are majoring in certain “sensitive” technological subjects (e.g., chemical, biotechnology and biomedical engineering) are required to go through an often long “visas condor program,” in which the consulate and the department of state check the students’ security background for counter-terrorism purposes (jacobs, 2003). this, along with academic and financial issues, creates a major barrier for family reunions, which exacerbates the previously mentioned homesickness and loss of social support. finally, financial problems could be severe for chinese international students. the reasons include the considerable expense of u.s. study for foreign students and immigration regulations that strictly limit opportunities for employment outside the university and for welfare benefits, loans, and federal financial aid (lin & yi, 1997; pedersen, 1991). implications the preceding discussion suggests several possibilities for addressing the mental health problems of chinese international students. implications are presented for health providers, mental health social workers, faculty, and academic staff within universities. health providers and mental health social workers it is important to educate health providers and mental health social workers on the importance of multicultural training to increase their awareness of the help seeking behaviors of chinese international students. because of cultural stigma or their lack of awareness of the availability of psychological services, chinese international students may not seek formal assistance and may be reluctant to discuss personal problems (pedersen, 1991). thus, student service professionals can conduct culturally sensitive outreach programs to increase these students’ awareness of the available resources to normalize their experiences (wei et al., 2007). counseling centers could also be located close to or in the same building as the health center or student affairs office to reduce the potential stigma that students may have when seeking help. the somatization pattern among chinese international students is important to monitor. college health and mental health care providers need to be aware that the tendency to manifest stress through physical symptoms may lead to an underutilization of potentially beneficial counseling and mental health services. health providers should determine whether students are experiencing mental health problems while they are reporting physical problems, and refer such students to university or community mental health services (mallinckrodt & leong, 1992). due to the unfamiliarity of chinese students with mental health problems and services, preparing them for counseling by engaging in role preparation may be effective. liu/mental health problems of chinese students 78 lambert and lambert (1984) found that asian clients who were told about what happens in therapy, the need for verbal disclosure, problems typically encountered by clients in therapy, the role of the therapist and client, misconceptions of therapy, and the need for attendance adjusted better to counseling than did a control group who did not receive role preparation. the clients who were prepared developed more accurate perceptions of the therapy and were more satisfied with their adjustment (lambert & lambert, 1984). practitioners also might assist chinese international students by teaching them effective coping skills. in a study on chinese international students in australia, two coping strategies were identified: problem-solving and seeking social support (le & liu, 2007). in another study on chinese immigrants’ resettlement in hong kong, problemsolving and seeking social support were reported to be the most widely used coping strategies (wong, 2002). to assist chinese international students to use these strategies effectively, practitioners first must be aware of the common sources of the problems that the students may have (as was previously discussed in this article). practitioners should focus on the specific problems identified by the students, and assess whether the identified problems have arisen from specific constraints such as language barriers. second, assisting students in effectively solving problems and in enhancing social support requires practitioners to be aware of and provide information about the resources that may help solve problems and provide social support, for example, practitioners should be aware of available language training resources and make appropriate referrals when necessary (wang & mallinckrodt, 2006). they must also be aware of the resources that may increase international students’ contacts with local people or cultural events to establish social networks and to interact more with the host culture (pan, wong, joubert, & chan, 2007). third, it is equally important to help students recognize what they can and cannot resolve in a given time period, lest they become more emotionally upset or unhappy when nothing positive is forthcoming. while using these strategies, practitioners should also take the length of the time in the u.s. into consideration, as was discussed earlier. they may need to develop and implement different strategies for those who have studied and lived in the united states for a longer period of time as compared with those who recently arrived. berry et al. (1987) identified that integrated individuals, defined as those with a high degree of identification with both home and the host culture, tend to report lower levels of distress and better adjustment. integration is achieved when one tries to maintain his or her own culture and also participates in the host culture. thus, it appears that valuing both acculturation to the host culture and continuing strong identification with the home culture may be necessary for optimal socio-cultural adjustment. with this in mind, practitioners should not automatically set assimilation as the counseling goal when helping chinese international students or other groups of international students with issues such as cultural adjustment. a more appropriate counseling goal might be to assist international students in developing cultural competence to function in the host culture while embracing their home culture. such an approach might help them bridge and integrate the two cultures. during the counseling process, practitioners should listen and talk to the students patiently. this allows the concerns of the students to be presented, and reduces the advances in social work, spring 2009, 10(1) 79 chance that the western world view of the therapist will be imposed on students (ishisaka, nguyen & okimoto, 1985; lorenzo & adler, 1984; tung, 1985). while engagement of clients in this respect is important in all counseling arrangements, the significant cultural differences and language problems discussed in this paper elevate the importance when working with chinese international students. practitioners, however, should take an active and directive role in counseling sessions. because of introverted chinese cultural expectations and a lack of experience with mental health therapy, the clients will rely heavily on the counselor to furnish direction (ishisaka et al., 1985; lorenzo & adler, 1984;). sue and sue (1997) also found that in the process of psychotherapy, clients influenced by chinese culture are more prone to external locus of control, that is, to being controlled by others. universities hsieh (2006) found that chinese international students reported not receiving sufficient and immediate help from their institutions. hsieh suggested that the large population of international students is usually disproportionate to the small number of staff in the international student office, and the office has difficulty offering quality services to meet the students’ needs. because most international students have problems with the english language and are unfamiliar with culture and the structure of higher education in the united states, they need much more help from their institutions than do american students. therefore, to meet international students’ needs, colleges and universities may need to recruit additional staff for their international student offices. social support, especially from one’s academic program, is essential, and schools can play useful roles along these lines (malinckrodt & leong, 1992). interventions to assist chinese international students in developing a strong social support system may be effective. for example, writing support letters for students or their family members in the visa application process can facilitate family reunions and reduce homesickness. program advisors can play an active and important role in this process. professors also should be informed of the potential psychological and culture issues of their students and should be aware of class diversity. providing students with mentors may be another useful approach. for example, mallinckrodt and leong (1992) found that quality relationships with faculty, as well as the quality of instruction perceived by students, can provide a strong protective function against the development of depression in international students undergoing stress. these findings are congruent with a number of other studies that underscore the importance of mentoring for u.s. graduate students (cronan-hillix, gensheimer, cronan-hillix & davidson, 1986). the quality of student-faculty relationships may be especially important for international students, because of their preference for formal sources of help and their difficulty in building social relationships with american students (furnham & bochner, 1982; leong, 1984). pairing or mentoring international students with host national students could be a promising intervention (bradley, 2000). this suggestion is based on previous research indicating that international students prefer host nationals to other nationals (alexander, liu/mental health problems of chinese students 80 klein, workneh & miller, 1981). host students can help international students by providing information and guidance on academics, social life, and western culture. recruit more staff for the international student offices. some of the participants reported that they could not receive sufficient and immediate help from their institutions. host family programs also have been successful (pedersen, 1991). such programs pair international students with local american families for monthly get-togethers to share activities, interests, and ideas. in these programs, international students can share time with a family, resulting in their feeling less lonesome for their own family. together with peer help, these two programs can provide international students with social support and social connections. they also can help to improve language and provide more knowledge on western culture. international programs of educational institutions can develop online communities for students and offer them ongoing support. online ethnic groups appear to be an effective resource for providing social support and reducing acculturative stress for chinese international students (ye, 2006). the unique features of online groups, such as anonymity and easy accessibility, can encourage these students to express their feelings and exchange opinions and ideas and at the same time reduce stigma. parr, bradley, and bingi (1992) have made a number of other suggestions that can assist international students to successfully adjust to the u.s. for example, special efforts can be focused on helping students prepare for a letdown that often occurs in the second year of residence. preparation might be enhanced by having their more senior international counterparts discuss successful methods for acquiring realistic expectations, coping with cultural differences, and being “school wise.” in addition, given the great concern students have about their extended family, offices of student affairs could increase their efforts to promote family contact. videos, letters informing parents of college activities, programs, departmental accomplishments or plans, special events, and services available to students could be sent more often to reassure parents that the college welcomes and values international students. offices of student affairs might periodically feature articles in the school newspaper about international students, and these issues also could be mailed to parents. dormitories and student service offices also could be encouraged to display pictures and celebrate some important chinese festivals. the suggestions discussed in this section, as well as a number of other creative efforts, can help prevent or reduce mental health problems of international chinese students and assist them in making a successful social and academic adjustment. acting on these suggestions also can convey the message that these students are cherished guests who enrich our university campuses. references abu-ein, m. m. 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(2005). chinese concepts of mental health: cultural implications for social work practice. international social work, 48, 391–407. author’s note: address correspondence to: meirong liu, m.a., doctoral candidate, school of social work, university of illinois at urbana-champaign, 1010 w. nevada, urbana, il 61801. email: mliu22@uiuc.edu. mailto:mliu22@uiuc.edu abstract: this article identifies unique mental health probl unique sources of mental health problems advances vol. 4, no. 2 i editorial is it possible to be a “radical clinician”? james g. daley socialwork is a profession that dreams of radical change. a noble, targeted effort that creates housing, expands medical coverage, changes public opinion on an issue, reaches the forgotten, embraces the unacceptable, and perhaps even recognizes our profession as the stealth catalystwith aheart.the radical dreams call to us like sirens sitting on the rocks of reality.we are drawn by our need, hungering for the grand event. therehavebeenconcerted efforts tomake thedreamcome true. someauthorshave advocated for a specialty called radical social work, most schools of socialwork have concentrations that offer a “macro practice” choice. authors have reminded us that all of social work is “political.” students face a fork in their educational path where they oftendecidebetween“clinical” and“macro.” some students assert from thebeginning the path they will choose. courses often have content that remind students of their need to advocate for change, not to“settle” for clinical adaptation for issues that reflect social injustice. the radical or macro camp share stories of program development, political change, and wrongs exposed that excite students. these endless efforts reinforce the importance of radical change as amandate of socialwork. socialwork is also aprofessionheavily invested in the effective clinical interventions that directly help our clients with psychosocial problems. legends of socialwork students and graduates strive to learn the trade and take great pride in offering ethical, evidence-based practice with clients who are in great pain and confusion. i was a clinician for 21 years and savor thememories of families who presented initially in pain, anger, and confusion but were transformed into a nurturing, empowering support system. i recall the entrenched client who finally committed to recovery. as a teacher, i share my experiences in class. each case, successful or heart wrenching, is part of socialwork in action. each story shared in class further ignites the passion in students to help. the clinical camp continually strives to build better, clearer, more precise methods for helping. i feel very comfortable as brethren of the camp. of course, there is nopure campof either view.wemust be both advocate and intervener. i have experienced this tug of war (clinical change and societal change) both as student and faculty member and heard endless faculty meetings strive to balance the two issues. i have seen some very creative faculty efforts to blend the issues. i believe that we recognize this dual role. i suspect that we discretely (or boisterously) slip into the camp that best feeds our passion. students assert, “i justwant to be a clinician,” or, “i could never work with clients.” they sift through the course offerings seeking the content that fuels that passion. macro change overwhelms some, clinical encounters scare others. and, i think this self-selection is healthy. neither choice is the exclusive path to a productive career. neither choice is “better” or “worse.” each choice is a best fit for the person. so,whatdoes this discussionhave todowith the conceptof a“radical clinician?”the two terms “radical” and “clinician,” when combined, seemweird.when you are a clinician, youwork in an agencydefinedby rules, reimbursement policies, and the social constructionof aperson inpaincalleda“client.”payne (1997) eloquentlydescribes the social construction of the client-social worker encounter.you are part of the “system,” whether acknowledged or not. making a diagnosis (either dsm or alternative framework) commits the person/client to be part of a client-focused system. supervision, agency mission, and funding options are all mechanisms that reinforce clienthood anda client-focused agenda. social issues are distilled into interventionplans. change efforts are focused on resolving those plans. in other words, the clinician has a subtle context to navigate in an effort to effectively help the client. can a clinician really be radical? macro advocates firmly assert that the clinician is tainted, even invested in the structure within which client issues are presented. radical change is best donebyoutsiderswhocan see the“real picture,” thewhole context, and are not seduced by being part of the agency. clinicians argue that they have power within the agency, can develop programs, or change policies. clinicians can translate client need into agency-ese, so that new programs are more likely to occur. outside agitators have less credibility than an established clinician. macro advocates shout that agitation is needed and the agency should listen rather than wait for translation. and the argument goes on and on. what would a radical clinician look like? i assert that the radical clinician would be highly versed in effective intervention choices and able to provide appropriate care that empowers and builds on the strengths of the client systems. the radical clinician must first be credible as a clinician to have power and influence within the agency. clinical competence is a major currency in agency politics, though obviously not the only skill valued. the radical clinician must be an effective program developer. you have to have the ability to transform an idea or need into a viable program to know what to do with a radical need. finally, a radical clinician is sensitized to social justice and connected to themacro advocates who can voice the unmet needs. frankly, all of these skills are a basic component of anmswprogram. in summary, an ongoing debate rages about radical change agents versus clinically skilled interveners, whichmisses an important point. each camp is a valuable place to learn the arena forwhich students have a passion to learn and implement.there is no “right” way to do socialwork and each camp can be a partner in a jointly productive endeavor. radical clinicians are possible and can effectively challenge social injustice and produce new programs tomeet client and societal need.we can all dream of that magnificent social change but radical cliniciansmayhelp navigate us past the rocks of reality into the safe bay of social justice. references payne, m. (1997). modern social work theory. (2nd ed.). chicago, iii: lyceum books. ii social work practice with latinos with hiv/aids social work practice with latinos living with hiv/aids diana rowan rich furman april jones kevin edwards abstract. this article explores social work practice with persons living with hiv/aids within the latino community. it presents a general discussion of social work practice hiv/aids, followed by an exploration of culturally sensitive social work practice with latinos. the authors then synthesize these bodies of knowledge into a discussion of hiv/aids in the latino community, and social work practices that can be useful when working with this population. a case example of group work practice with latinos living with hiv illuminates many of the themes explored throughout the paper. finally, implications for social work practice are examined. keywords: hiv/aids; latinos; social work practice introduction social work as a profession is concerned with helping and empowering vulnerable populations. the two vulnerable populations that have garnered national attention in the last three decades now come together to create a new population that presents both challenges and opportunities for the social work profession, are people living with hiv/aids (plwha) and latinos. social work practice with latinos living with hiv/aids encompasses several areas of knowledge that include practice interventions for people living with hiv/aids, knowledge of cultural values of latinos that affect treatment, and effective strategies for dealing with hiv/aids based on those cultural values. the authors seek to explore the aforementioned issues in this article and will provide a case study to illustrate certain principles related to working with this vulnerable population. social work with hiv/aids hiv/aids hiv or human immunodeficiency virus is a virus that destroys the immune system. hiv is transmitted through sexual contact (via such fluids as semen, vaginal, cervical, and anal secretions), blood, and breast milk. the hiv virus progressively develops into aids (acquired immune deficiency syndrome) while the person living with the disease eventually succumbs by way of opportunistic infections associated with the later stages of the disease. hiv/aids is considered a pandemic with sixty million people infected _________________ diana rowan, ph.d., is the msw coordinator in the department of social work at the university of north carolina at charlotte. rich furman, ph.d., is an associate professor and director of the social work program at the university of washington, tacoma. april jones and kevin edwards are msw students in the department of social work at the university of north carolina at charlotte. copyright © 2008 advances in social work vol. 9 no. 2 (fall 2008), 142-156 advances in social work, fall 2008, 9(2) 143 worldwide. the united states prevalence for the disease is 1.2 million cases with 16% affecting latino americans (centers for disease control and prevention, 2005). social work case management case management, formerly called social casework, is a staple characteristic of the social work profession. chernesky and grube (2000) describe case management’s core functions or activities as consisting of: intake, assessment, care or services planning, linkage with formal and informal resources, advocacy, and follow up and monitoring. the case management standards work group acknowledges that social work case management distinguishes itself from other forms of case management because it “addresses both the individual client’s biopsychosocial status as well as the state of the social system in which case management operates” (2002, p. 248). therefore the social worker plays a vital role in helping the client manage all of their needs and accomplish this task by moving fluidly through distinct helping processes. social worker roles and hiv/aids providing services to clients with hiv/aids can be daunting to even a seasoned social worker simply because of the sheer magnitude and scope of services these clients need. chernesky and grube (2000) noted several themes in the hiv case management process that highlight both the characteristics of the clients and the roles of the social workers in servicing those clients. the first theme noted was that hiv/aids clients are an extremely vulnerable population and thus are often in need of advocacy services from social workers. the functions of an advocate include interventions on both a micro and macro level. social workers providing case management services can help clients by assisting them with the disability determination process. macro level social workers can affect change by lobbying for increased funding from varied sources to assist in the treatment of clients with hiv/aids and prevention efforts (krisberg, 2006; linsk & keigher, 1997). the second component of hiv case management involves linkage with other services and systems and requires that social workers take on the role of a services broker. the most common overlapping systems that clients and workers interface with are the governmental, medical, and legal systems. linkage with the governmental system includes receiving subsidized housing for people living with aids (hopwa funding, 1999) and assistance in procuring haarts (highly active anti-retroviral therapies) and medications from federally funded aids drug assistance programs (adaps) (subways, 2005). the medical system provides plwha referrals to physicians specializing in infectious diseases and experimental clinical trials that may offer free medications in exchange for participation. the legal system also provides relevant services to hiv/aids clients by assisting them in the preparation of living wills, estate planning (shernoff, 1998), power of attorney orders, and documentation of domestic partnerships. also, the stigma surrounding hiv/aids can make clients a target for discrimination and harassment and they may require help with legal proceedings. rowan, furman, jones, edwards/social work practice with latinos 144 the third theme is that the case manager is often the central support system. serving as a vital part of a client’s support system requires that workers often simultaneously work as counselors and educators. plwha experience many losses and grief work is an essential component of counseling (guilino, 1998). clients often express a variety of fears, including fear of isolation, rejection, and abandonment. they may express fear over developing painful symptoms associated with diagnosis with one of the 23 aidsdefining illnesses and opportunistic infections (ois). social workers also work on educating the client and their support network of family and friends about the disease. social work practice with latinos in culturally competent practice with other groups, social workers must develop the skills, values and knowledge for working with a diverse population (leigh, 1985). in this section, we will briefly address the areas of relevant values and knowledge. important skills for working with latinos with hiv/aids will be addressed more fully in a subsequent section. knowledge social work practice with latinos is as diverse and complex as the group itself (furman & negi, 2007). the term latinos, usually used interchangeably with the term hispanics, refers to people whose ancestry can be traced to the countries of latin american and the caribbean. however, many latinos did not "arrive" in the united states, but were actually mexican nationals whose ancestral territories were annexed by the united states as part of the treaty of guadalupe hidalgo at the end of the mexican american war. the same can be said for puerto ricans living on mainland puerto rico, who have been citizens of the united states for nearly a century. the united states population consists of nearly 14% latinos, according to the latest census statistics (marotta & garcia, 2003). it is thought that by the year 2025, 25% of the population of the united states will latinos (u.s. bureau of census, 1998). for many latinos, the term itself is a social construction which is perhaps less important to their identity than other factors (furman & negi, 2007). most latinos, for instance, identify primarily by their nation of origin. some, for instance guatemalan decedents of the maya, identify primarily by their ethnic group (little, 2004). however, in spite of the diversity within the latino population, thinking of latinos in terms of group identity is useful for several reasons. first, with the exception of brazilians who speak portuguese and those who primarily speak indigenous languages, latinos are bound by the historical use of spanish. second, many latinos have come to view themselves as being an increasingly powerful political entity whose unity is a considerable source of power (gregory, steinberg, & sousa, 2003). national and local elections are increasingly influenced by latino votes. recent legislative actions concerning immigration have, in part, been slowed by politicians’ concern about the impact of legislation on latinos as a voting block. third, latinos share many similar values which are rooted within the lives of post-colonial latin america. the centrality and importance of these values contrast to those of the dominant u.s. society and set latinos apart as a distinct and evolving group. advances in social work, fall 2008, 9(2) 145 values and their translation into skills several key values are extremely important to all social work practice with latinos. while the several presented are only a partial list, they form a core that binds latinos and will help social workers who are new to providing services to the population. each of these values has important practice implications for working with latinos with hiv/aids. in general, the values expressed below are extensions of the overall collectivist values that many latinos hold, which compares to the more individualistic values of the dominant american culture. these collectivist values have been shown to be adaptive in that they have lead to historical group cohesion during times of social disruption and distress (cabrera & padilla, 2004) and have been shown to be a protective factor inculcating against some types of psychosocial problems, such as substance abuse (sale, et al., 2005). familismo social workers and other professionals new to working with latinos often misinterpret the importance of family and its centrality in how latinos view identity and existence (lugo steidel & contreras, 2003; valenzuela & dornbusch, 1994). for white americans, the individual is viewed as the most essential unit of analysis. we tend to think of people as individuals who live in the context of environments and groups (williams, 2003). social work in the united states is largely a reflection of this individualistic focus. for instance, one of the most central organizing principles of social work practice is "person in the environment" (ashford, lecroy, & lortie, 2001). in this perspective, the individual is located within various levels of systems that form its social context and create its reality. however, implicit within this perspective is the centrality of the individual to the practice model. this perspective breaks down for work with latinos who view themselves as inextricably connected to family life in ways that white americans cannot understand (garcia & zuniga, 2007). social workers often express confusion at latinas’ willingness to sacrifice their well-being for their families and may "diagnose" them as having poor boundaries or insufficient individuation. the worker may seek to help women develop individual goals and more "ego" strength. these concepts are largely inconsistent with latinos’ culture in which such concepts will sound selfish (cauce & domenech rodríguez, 2002). when working with latinos, workers need to suspend or “bracket” their negative assumptions about how their clients relate to their family members and adopt a strengths-based orientation. personalismo personalism, or personalismo, refers to latinos preference for warm, personal and engaged relationships (gonzález-ramos, zayas, & cohen, 1998). this applies to both the helping relationship and the nature of agency life itself. for instance, cold, impersonal, highly structured and bureaucratic services often make latinos feel unwelcome. while respecting professional roles and expertise is extremely important, this respect is not of a detached and distant manner. professionals are expected to be engaging, warm, kind, and empathic. it is also valuable for social workers to share some personal information about themselves and especially their own families. self-disclosure of this nature is an rowan, furman, jones, edwards/social work practice with latinos 146 important practice skill. it helps latinos feel a sense of trust and view their social workers as authentic, real and caring people. this is especially important when providing services to latinos, such as newly immigrated or undocumented residents, who have good cause to mistrust mainstream institutions. orgullo and respecto orgullo, or pride, is an extremely important value within latino communities. orgullo manifests as pride for one’s cultural identity, pride about one’s skills and capacities, and pride for the ability to maintain one’s family. orgullo at times may make it difficult to seek and receive help, as latinos often perceive the need for help as harming their sense of self (delgado & humm-delgado, 1982). respecto, or respect, is a key value within latino communities. as treating individuals with dignity and respect is a core social work value, social workers should find adhering to this value congruent with their practice. however, what constitutes respect can differ greatly between latinos from different countries of origin and between individuals within groups. it is therefore important for social workers to ask their clients about their own understanding of respect and what the worker can do to make them feel respected. as a general guideline, social workers can demonstrate respect by attempting to value the cultural and personal worth of all of their clients. it is also important that social workers spend a great deal of time establishing a quality helping relationship before they “intervene” in a manner that would make a latino feel judged or criticized. analysis and clinical interpretations, while an important part of some clinical systems, should be used judiciously with latinos by those from other cultural contexts, especially early in treatment. critical analysis can often be viewed as being disrespectful, as tact and delicacy are important cultural means of expressing respect. machismo within latino society, machismo is considered the constellation of ideal male characteristics which include physical power, social domination, and a discounting of feminine characteristics. the roots of machismo have been traced to the influence of catholicism on indigenous peoples and the reaction of indigenous men to their own subjugation at the hands of spanish conquistadors (hardin, 2002). too often, the “negative” aspects of machismo have been highlighted. taylor and behnke (2005) contend that a central component of machismo is centered on the role of the latino father and their capacity to provide for the family and the lengths they will go to do so. latino men who for socioeconomic reasons are unable to engage in this pro-social aspect of machismo may engage in other, less positive ways of proving their worth and masculinity. when working with latinos, it is important to recognize that machismo can often be a double edged sword. on one hand, many latino men believe they can handle problems on their own and will therefore neglect to seek services. on the other hand, latino men can be helped to tap into the more positive aspects of machismo, their responsibility to family and community, as a motivation for seeking help and resources. the other side of machismo is marianismo. in marianismo, women are expected to be advances in social work, fall 2008, 9(2) 147 subservient and obedient to their men (sherraden & barrera, 1997). as we shall see, this has important implications in terms of safe sex and sexual choice. service delivery considerations for latinos with hiv/aids as noted, culturally sensitive practice with latinos with hiv/aids is influenced by a large degree of within-group variation. therefore, the information presented must be carefully applied after assessing the specific needs of each client and their system. the following are specific suggestions for delivery of effective, culturally relevant social work interventions to latinos with hiv/aids. they draw upon important ideas from the previous discussion on values and extend to other important clinical and macro level issues. spanish speaking service providers for less acculturated clients there exist various degrees of acculturation within the latino culture. for those clients that are less acculturated and speak mostly spanish, services should be provided in spanish to reduce misinformation and miscommunication (aronstein, 1998; deren, shedlin, & beardsley, 1996; giulino, 1998). for example, specific details about antiretroviral medication regimens may be complex and difficult to understand even without a language barrier, so the potential for miscommunication should be removed whenever possible. furthermore, medical terminology regarding aids symptomology and pharmacology should be phrased to clients in easy to understand, jargon-free language. culture-bound illnesses and folk healing in medical care when working with hiv, the client’s sicknesses and ailments are often a subject of discussion with the social worker. culturally sensitive practice entails awareness of culture-bound illnesses such as empacho, which is a stomach ailment, embrujado, which is erratic behavior possibly due to bewitchment (koss-chioini & canive, 1993), and ataque de nervios, a panic reaction following a time of grief (guarnaccia, delacanceela, & carillo, 1989). being acquainted with these conditions within the latin culture can help the practitioner determine what is a culture-bound syndrome and what may indicate the need for medical or psychiatric intervention. in evaluating culture-bound syndromes in latin american culture, the social work practitioner must also maintain an awareness of the role of folk healers, priests, etc., who treat such illnesses. in immigrant populations coming from mexico and central america, the curandero, or folk healer, would treat such illnesses. a potential problem is that curanderos sometimes claim that they can “cure” hiv (bowden, rhodes, wilkin, & jolly, 2006) and also numerous culture-bound illnesses through less traditional interventions such as the use of herbs (land, 2000), teas purchased at a botanica (botanical shop) (delgado & santiago, 1998), and intercession and healing services, which could lessen the clients’ efforts to avoid infection or participate in traditional medical treatments. social workers should be sure to advise clients to use the alternative herbal therapies only with physician approval. rowan, furman, jones, edwards/social work practice with latinos 148 sometimes the culture-bound traditions impede care or place an individual at risk. consider a case where uninfected latino immigrants were known to wear amulets (available at local latino grocery stores called tiendas) around their wrists to protect them from sexually transmitted diseases (bowden, rhodes, wilkin, & jolly, 2006). myths such as this should be addressed with facts in order to save lives. recognition of importance of traditional religion recitation of prayers, praying to the saints, blessing oneself with holy water, wearing holy artifacts (land, 2000) and lighting religious candles are important elements of latino practice of catholicism. prayers to the our lady of guadalupe or other representations of mary are common especially during times of crises. acknowledgement that these are important practices to latino clients may be helpful to their establishing a bond with the social worker. sexuality and latino culture one latina service provider interviewed in the bowden, rhodes, wilkin, and jolly (2006) study reported, “the catholic influence that sex is for procreation and not for pure enjoyment, combined with the idea that talking about sex encourages more sexual activity, poses barriers to educating the hispanic population about hiv/aids (p. 553).” this silence surrounding sexuality in latino culture affects different latino sub groups in varying ways and poses different challenges to social workers. hiv positive gay, lesbian, & msm latinos diaz (1998) reports that open discussion of sexuality is often seen as taboo in latino culture. when this sexuality taboo and the concept of machismo collide, many gay latinos often feel alienated from their own culture. hunter and hickerson (2003) note that “the primary allegiance for latino lesbian and gay persons usually remains with their ethnic identity, their community, and most prominently, their family” (p. 24). by disclosing both their hiv status and homosexuality, it can cost these individuals their family support (hunter & hickerson, 2003). also, to complicate matters, there are men who identify as heterosexual yet engage in risky (unprotected) sexual behavior with other men without informing their female partners (wolitski, jones, wasserman, & smith, 2006). this is a significant problem in the latino community as fernandez et al. (2005) found that 43% of latino msm (men who have sex with men) are having unprotected sex, with 22.5% of those men being hiv-positive. to address the needs of latino msm, the sex check was developed (katz et al., 2005). katz et al. (2005) describe the sex check as a brief, one-on-one, telephone-delivered hiv prevention intervention used to target individuals who were at risk for hiv infection or transmission but were not seeking support or engaging in harm-reduction strategies. social workers can use interventions such as the sex check to aid them in discussing issues around sexuality with their clients. also, social workers working with hiv-positive gay, lesbian, bisexual, transgender, and msm latinos must maintain a constant awareness of the role that their culture plays on expressing their sexuality. advances in social work, fall 2008, 9(2) 149 latina women’s sexuality women of color have a history of disenfranchisement, oppression, and marginalization in both the u.s. and global community. this oppression expresses itself in a myriad of ways. one method of controlling women’s sexuality is to control their access to reproductive health services and information. latina women have suffered such oppression and as a result are reluctant to encourage condom use “because women fear verbal and physical abuse and because condoms are associated with prostitution, poor hygiene, and contraception” (land, 2000, p. 90). social workers can help confront the oppression present in latinas’ primary relationships by making referrals to culturally sensitive physicians and other medical professionals who can educate them about issues surrounding their reproductive health. social workers can also provide assertiveness training techniques to latina clients to help facilitate more equality in their relationships. the family as a supportive and preventative mechanism the value that latinos place on the family has been well-documented. however, a scarcity exists in the availability of hiv prevention literature about the role of the latino family in helping to mitigate risk factors associated with the hiv virus. despite this scarcity, social workers can examine and draw from research focused on other minority populations to gain knowledge and find some relevant practice guidelines. icard, schilling, and el-bassel (1995) found that when comparing two groups of african american parents who had received standard hiv prevention training, the experimental parental group that received communication and problem solving skills training were found to feel more comfortable talking with their children about sex and safer sex practices. social workers can adapt certain techniques and strategies for use with this population to reflect a cultural practice that is sensitive to their client’s needs. latino families also, as noted before, provide much tangible as well as intangible support to their families. however, special attention must be paid to latina women. latina women are often the main caregivers in the home, and when they are hiv-positive they must carry the burden of caring for themselves and the other people in the household. often their own needs for rest and reduced stress are ignored (remor, penedo, shen, & schneiderman, 2007). in addition to the numerous responsibilities taken on by hiv-positive latina women in the household, the pervasive cultural attitude mandates that the caretaking activities of household members be placed solely on the immediate family, making the hiring of a personal assistant prohibited. social workers should provide education to caregivers about issues regarding burnout and provide linkages to organizations offering respite care in an effort to help clients deal with the stress of caretaking. latino support group case study a common method of service delivery in asos (aids service organizations) targeted at sub-groups of the hiv/aids population is the use of culture-specific or agespecific support groups. at a local aso in the community of charlotte, north carolina, targeted support groups are offered for adolescents and latinos with hiv. based on rowan, furman, jones, edwards/social work practice with latinos 150 actual group dynamics seen at the aso, the following is a composite case example of a latino social worker facilitating a support group for latinos infected or affected by hiv. notice the following latino-related themes: the worker establishing personal contacts with the clients, viewing the group as an extended family, the need for spanish-speaking practitioners and culturally sensitive agency procedures, the machismo tendency to see females as caregivers, and the importance of spiritual beliefs and practices. the following aids-related themes are illustrated: the need for support at times of crisis such as hospitalizations, plwha’s lack of support due to isolation or death of partner, judgments made about the mode of one’s transmission, the presence of debilitating symptoms such as forgetfulness due to aids-related dementia, and struggles around if, when, and/or how to disclose one’s seropositive status to family members. the group is led in spanish, but for purposes of usage, dialogue will be presented in english. isabel heads down the hall of her workplace, an urban aids service organization (aso) located on the outskirts of a latino community. she is on her way to lead a support group offered once a month for latino clients of the agency. she mentally thinks through who will be in attendance. she knows who will be at the group meeting because she is conscientious to call each of her members the day before to remind them of the meeting time and find out if they will attend. she knows this practice is much more effective than the use of mailings or flyers. her group population responds well to her personal contacts. (isabel has effectively utilized the value of personalismo to reach her clients and encourage attendance for the support group). as she enters the group room, an older lady named rosa is talking with other members about their visit to see maria in the hospital earlier in the week. maria, a group member, has had back to back hospitalizations for kidney failure, as a consequence of her aids. “who will visit maria tomorrow?” rosa asks. “i will. do you want me to pick you up, also?” responds jose, a young man who contracted hiv through an iv drug habit. (jose is offering tangible support to maria and providing others the opportunity to participate by offering transportation to the hospital; he views the group as an extended family). “yes, i would. she needs visitors. we’re all she has …i don’t have anyone to visit me since my dear husband died of respiratory failure from his aids so i’ll be there for maria,” says rosa. (rosa shows compassion for maria and provides support as she is aware of the hardships associated with dealing with the illness without a partner). after a few minutes of group discussion about maria and the importance of feeling connected to a group of supportive people at times of crisis, the door to the group room opens. “sorry we’re late,” says a young couple, in unison. “we had trouble finding the place.” advances in social work, fall 2008, 9(2) 151 “did the receptionist lady give you directions? because i got lost my first time, too. i couldn’t follow all those crazy street names. look, just remember to turn left at the fire station, then another left at the funky pink daycare center and you’re here,” explains chico. (chico fills in a gap regarding culturally sensitive agency procedures by providing directions with landmarks so that the couple may better find the meeting location). isabel smiles because she has noticed that her clients respond well to following directions using landmarks. she’s learned to use that method to help get them to their numerous medical and resource appointments around the city. she knows it is the young couple’s first meeting, but she doesn’t want to lose an opportunity to point out the importance of promptness. “try to be on time, because it’s important to get in that habit. what happens if you’re late with a dosage of medications or you’re late for your new doctor or late for your appointment for emergency rent help?” isabel asks. “they skip over you. yep, they do,” confirms rosa. “remember, if anyone needs a calendar i have some free ones from drug companies to share with you. it’s very important to keep your appointments written down so you won’t miss them if you have memory difficulties,” explains isabel. “i’ve been having a hard time with forgetting things the last couple of months,” confides jose. “i found something that helps. i have chico call me the morning of my appointments to make sure i remember and i do the same thing for him.” (notice how the group members find supportive solutions to dealing with such symptoms like aids related dementia by calling each other on the day of their appointments). “yea, when he remembers…which is rarely!” chides chico, with a laugh. “i don’t need anyone to call me. lupe tells me what i need to do. she keeps it all straight,” says julio. julio and his wife, lupe, are regular attendees, but rarely participate in the group discussions. “does she make your appointments, too?” asks isabel, the group facilitator. “of course! what’s a wife for?” laughs julio. the group collectively looks puzzled and concerned. jose asks lupe, “why are you taking all the responsibility for your husband’s care?” lupe shrugs her shoulders and looks to julio in a subordinate manner. chico, a gay man who contracted the virus from a partner who did not disclose his own positive status, says, “honey, your man needs to take care of his own stuff…and mister, you need to take responsibility for your own treatment.” (the group notices the cultural values of machismo and confronts both lupe and jose rowan, furman, jones, edwards/social work practice with latinos 152 to take responsibility for themselves and how the disease is affecting each of them). julio seems threatened and volleys back, “what do you know about marriage anyway, you (spanish gay slur)!” (julio demonstrates prejudice and bias regarding chico’s sexuality by insulting him with a derogatory slur). jose chimes in with “hey, we’re all family in here. we don’t put each other down. it doesn’t matter how you got it, now you have to deal with it.” isabel intervenes, interjecting the importance of personal responsibility and of someone taking ownership for care. “mr. sullivan may extend you more grace in your case management meetings,” says isabel, making reference to the fact that mr. sullivan, a non-latino practitioner may be overcompensating in an effort to be culturally sensitive. “i will not allow group family members to be disrespectful in this place,” adds isabel. “that is the truth,” adds rosa. “julio, you may not understand this now, but from now on if you need something from me, i’d like you to make the call, not lupe,” explains isabel. she feels that his disengagement from the coordination of his care is part of julio’s denial at being hiv positive and shows he doesn’t want to deal with it. the group discussion continues, with various members drawing out the new couple and finding out their story. they have both recently been diagnosed as positive, and are struggling with the decision of whether or not to tell their families back in guadalajara. (lupe and julio struggle with whether or not to reveal their hiv status to their families, which is a major decision that could result in reduced support from their families). “i’d like to close the meeting with a prayer to our mother mary, for help for maria in the hospital,” says rosa, gathering up the hands of those on each side of her. (by closing the meeting with a prayer to a catholic saint, group members feel validated and that their religious beliefs are valued and respected). the group closes in prayer for one of their “family” members. conclusion the preceding case study demonstrates examples of how values and skills are implicated in providing services to latinos with hiv/aids. the case example also points out the complexities of providing culturally competent services. it is important to note that developing cultural competence is a lengthy process; and while we have explored many key issues in working with hiv-positive latinos, social workers are encouraged to view the development of cultural competence as a life-long journey. this is especially true when working with a population as diverse as the latino community. working with latinos suffering from hiv/aids challenges social workers to understand the confluence of complex and varied psychosocial factors; social workers providing services to this population are also working with two groups who have been the recipients advances in social work, fall 2008, 9(2) 153 of tremendous discrimination. in addition to direct practice interventions, social workers are encouraged to engage in advocacy on the organizational and community levels to insure that increased and competent services are developed for latinos. future research is needed on effective means of providing services to this population. references ashford, j. b., lecroy, c. w., & lortie, k. l. 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(2006). self-indentification as “down low” among men who have sex with men (msm) from 12 us cities. aids and behavior, 10, 519-529. author’s note: address correspondence to: rich furman, ph.d., social work, university of washington, tacoma, 1900 commerce st, tacoma wa 98402-3100. email: rcfurman@u.washington.edu mailto:rcfurman@u.washington.edu introduction social work with hiv/aids hiv/aids social work case management social worker roles and hiv/aids social work practice with latinos knowledge values and their translation into skills familismo personalismo orgullo and respecto machismo service delivery considerations for latinos with hiv/aids spanish speaking service providers for less acculturated cli culture-bound illnesses and folk healing in medical care recognition of importance of traditional religion sexuality and latino culture hiv positive gay, lesbian, & msm latinos latina women’s sexuality the family as a supportive and preventative mechanism latino support group case study conclusion references aisw vol. 8, no. 1:aisw vol. 5, no. 2 19 motivational interviewing: a theoretical framework for the study of human behavior and the social environment katherine van wormer abstract: this article provides a critical analysis of motivational interviewingstages of change model. although rarely included in textbooks on human behavior and the social environment, this model has much to teach us about that aspect of human behavior most germane to social work practice—personal motivation for change of behaviors that are dysfunctional. the basic concepts that underlie motivational interviewing are derived from empirically-based principles from the science of social psychology. this article provides a historical and comparative approach to theory development, argues for the utility of this perspective as a guide to practice, and provides suggestions for further theory development. keywords: motivation, motivational interviewing, stages of change, human behavior and the social environment, cognitive approach, harm reduction motivational interviewing (mi) is a brief treatment model designed to help clients who are low on motivation change—to help them wakeup to the need to change certain problematic behaviors—those that are healththreatening. mi may seem simple on the surface, but it is a very sophisticated modality based on advanced research knowledge from social psychology. mi is based on knowledge about how an individual’s motivation to change can be enhanced by a practitioner, even when the client is reluctant to make any changes in his or her behavior (gance-cleveland, 2005). mi offers specific reinforcing maneuvers for every step of the way as the client advances, often in a spiraling fashion, toward change. closely paralleling the strengths perspective in its underlying premises, motivational interviewing can be viewed as a developmental model in the spirit of the work of erik erikson (1950) and carol gilligan (1982). like theirs, this model is stage-based or sequential. unlike their formulations, however, mi is geared to direct practice; it is at once a theory and a therapy. the concern of this paper is with the theory dimension. motivational interviewing is defined by william miller (2006) as “a person-centered, goal-oriented approach for facilitating change through exploring and resolving ambivalence” (p. 138). this term is most commonly used to represent a katherine van wormer is professor at the school of social work at the university of northern iowa, cedar falls, ia 50614. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 19-29. indiana university school of social work. 20 advances in social work series of pragmatic strategies tailored to the client’s level of willingness to adjust his or her behavior (for example, to comply with a medical regimen, reduce criminality, or for smoking cessation (miller & rollnick, 2002). these strategies have also been applied with favorable results in batterer intervention programming (bennett, stoops et al., 2007). this paper provides a critical analysis of motivational theory and discusses the theoretical assumptions that underlie this approach. where do these assumptions come from, and what are the research findings regarding its treatment effectiveness? beginning with a historical analysis of the development of motivational theory, this paper demonstrates that the roots of this approach are found in the teachings of social psychology. that mi should be taught along with other developmental theories in hbse courses is a further and related argument. uniquely, this paper analyzes motivational concepts and insights that parallel empirically-based truths from the science of social psychology. comparisons between this approach and its direct opposite—samenow’s confrontational cognitive approach—are drawn. this discussion leads into an overview of evidence-based research pertaining to this theoretical model. finally, we explore some ideas for theory progression and implications for social work education. historical analysis the concept of mi was first described by william r. miller (1983) in the literature and elaborated by miller and rollnick (1991). miller (1996) credited the formulation of mi to the relentless, spirited questioning by his student interns in norway as he demonstrated how he would work with clients in various settings. the kind of questioning that ensued, (“why have you taken this approach rather than another?”), according to miller, required him to “make explicit the approach i had learned from my clients” (p. 835). the result was a beginning conceptual model (miller, 1983) that was followed by years of testing and refinements, which culminated in the groundbreaking text motivational interviewing: preparing people to change addictive behavior (miller, 1991). with characteristic modesty, miller and rollnick later stated, “there is little that is highly original in motivation interviewing” (2002, p. xvi). for their inspiration, miller and rollnick credit the theoretical contributions of carl rogers and his students who developed the principles on which client-centered psychotherapy was based. the development of motivational theory took a major leap forward when it absorbed the notion that behavior change occurs in increments or stages and that it involves specific tasks related to the degree of an individual’s willingness to change (diclemente & velasquez, 2002). the impetus for theoretical advance came with the publication of the research on smoking cessation conducted by prochaska and diclemente (1982). called the transtheoretical model, because it was interdisciplinary, the stages-of-change approach revealed the thinking patterns of smokers who eventually were able to quit. their thinking was found to progress from precontemplation, before they were ready to change, to contemplation to quit, to preparation for action, to action, to maintenance, to possible relapse, and so on. specific interventions have now been spelled out to match the client’s stage of readiness to move from a refusal to cooperate to a decision to work on his or her problems. the trail for the wide acceptance of these conjoined models leads from the united states to europe and back to this side of the atlantic. motivational concepts about instituting change were seen as compatible with the western european goals of harm reduction or public health. preventing drug users from contracting hiv-aids through the use of contaminated needles was the impetus here. the netherlands, the united kingdom, and switzerland were among the nations that, in the 1980s, were at the forefront of this paradigm shift. the shift was away from a focus on punishment for drug use towards an emphasis on safety and persuasion. two developments in the united states promoted the advocacy of motivational therapy. the first was cross-fertilization of knowledge through international conferences on substance misuse. through such exchanges, american social scientists began to grow familiar with principles of motivation and teach these concepts to their students. a second major development came with one of the most massive and best-publicized research experiments in substance abuse treatment history—project match. this research project is discussed in a later section of this paper. motivational theory motivational strategies, to reiterate, are built on sophisticated understandings of human behavior in the social environment (hbse), most of which have been confirmed through real-life experimentation. the theoretical foundation of mi is first and foremost the knowledge that people often modify their behavior as a result of their interaction with others. a related assumption is that therapists who possess critical counseling skills can help facilitate personal change in their clients. research indicates, for example, that one such skill, counselor empathy, can be a significant determinant of clients’ response to treatment (miller & rollnick, 2002). the four basic principles of enhancing motivation, as singled out by miller and rollnick, are: 1) expressing empathy; 2) developing discrepancy between one’s long-term goals and one’s behavior; 3) rolling with resistance (avoid arguing for change, which increases resistance); and 4) supporting self-efficacy—this refers to a person’s belief in his or her ability to change. note that the first of these four principles is derived from rogers’ (1951) work in the area of empathic understanding of a client’s previous behavior. as defined by rogers, accurate empathy involves skillful reflective listening that clarifies and amplifies a person’s presentation of reality. unlike rogers’ extensive use of reflective listening, however, miller and rollnick’s practice is to offer advice in terms of providing “a menu” of options. also, in contrast to rogers, motivational therapists use a cognitive approach to help clients see the discrepancy between their goals and present behavior (developing discrepancy is the second principle above). miller and rollnick’s reinforcement of their clients sense of confidence in their ability to overcome difficulty (fourth principle above) is a combination of the use of positive listening skills and reframing thoughts in a healthier direction, a cognitive-based strategy (van wormer & davis, 2003). through establishing a close therapeutic relationship, the counselor can help a person develop a commitment to change. 21van wormer/motivational interviewing 21 the way motivational theory works, simply put: if the therapist can get the client to do something, anything, to get better, this client will have a chance at success. this is a basic principle of social psychology. such tasks that william miller (1998) pinpoints as predictors of recovery include: going to aa meetings, coming to sessions, completing homework assignments, and taking medication (even if a placebo pill). the question, according to miller, then becomes, “how can i help my clients do something to take action on their own behalf?” a related principle of social psychology is that, in defending a position aloud, as in a debate, we become committed to it. one would predict, according to motivational enhancement theory, that, if the therapist elicits defensive statements from the client, the client would become more committed to the status quo and less willing to change. for this reason, explains miller, confrontational approaches have a poor track record. research has shown that people are more likely to grow and change in a positive direction on their own than if they get caught up in a battle of wills. the effectiveness of motivational strategies in eliciting change in even the most recalcitrant of people is worthy of closer analysis. actually, the effectiveness of this model of person-centered counseling should come as no surprise, as each of the basic principles is derived from strategies that have been shown to be effective in social psychology laboratory situations. the overall technique of eliciting in the client self-motivating statement is perhaps the most basic of these scientific insights. i have filtered from one of the most popular books on social psychology, the social animal, by elliot aronson (2003), the basic principles of persuasion. the ones that most closely parallel the principles of motivational enhancement are: • if we’re encouraged to state a position, we become motivated to defend that position (p. 85). • when individuals commit themselves in a small way, the likelihood that they will commit themselves further is increased. the behavior needs to be justified, so attitudes are changed (p. 158). • people with high self-esteem are more likely to resist the temptation to commit immoral acts (p. 186). • a person can become committed to a situation by making a decision, working hard to attain a goal (p. 186). • dissonance theory predicts that people will change their attitudes to bring them in line with the evidence (p. 189). • changing one’s attitudes in order to justify one’s behavior can initiate the processes that are persistent over time (p. 193). • people desire dissonance-reducing behavior (p. 198). note that dissonance theory is comparable to this developing-discrepancy idea as enunciated by aronson. in fact, as stated by miller and rollnick (2002), this idea was derived from classic sociological research on people’s discontent with a discrepancy between their personal belief and the facts. a state of tension is thereby 22 advances in social work built-up and, out of this tension, comes the desire to end the dissonance. the therapist can take advantage of this state of ambivalence to lead the client in the direction of desirable change. also note that, when using motivational interviewing, practitioners are attempting to assist clients in talking themselves into changing, rather than using direct persuasion (corcoran & springer, 2005). resistance is sidestepped, so that it is not reinforced through “a battle of wills.” to gain an appreciation of how these theoretical premises are played out in practice and to learn how the development sequence works, let us consider the situation of an adolescent mandated to treatment for substance use problems. following the formulation set forth by miller and rollnick (2002) and wallen (1993), major tasks for the adolescent’s counselor at each stage of decision making directly parallel the client’s state of mind. at the precontemplation stage, the goals are to establish rapport, ask rather than tell, and build trust. eliciting the young person’s definition of the situation, the counselor reinforces discrepancies between the client’s and others’ perceptions of the problem. during the contemplation stage, while helping to tip the decision towards reduced drug/alcohol use, the counselor emphasizes the client’s freedom of choice. “no one can make this decision for you” is a typical way to phrase this sentiment. information is presented in a neutral, “take-it-or-leave-it” manner. typical questions are: “what do you get out of drinking?” “what is the down side?” and (to elicit strengths) “what makes your sister believe in your ability to do this?” at the preparation for change and action stages, questions such as “what do you think will work for you?” will help to guide the youth forward without pushing him or her too far too fast. when there is resistance, as there inevitably will be with young substance misusers, miller and rollnick advise rolling with the resistance instead of fighting it. the use of reflective summarizing statements is helpful; for example, “let’s see if i’ve got this right. you have a concern that i’m trying to get you to give up smoking and drinking all at once. we do seem to be moving along too fast. why don’t we look at some things people have done in this situation, some of the options you might want to consider?” central to this whole treatment strategy is the belief that clients are amenable to change and that timing is crucial in persuading clients to take the steps that will free them from harm. on the college campus, the most promising type of intervention to address high-risk alcohol use (and ultimately reduce harm) appears to be a brief intervention with motivational interviewing. in britain, new zealand, and canada, such brief sessions that promoted reflection on substance use and the personal consequences, have been shown in randomized controlled trials of high-risk students to reduce drinking and drug use significantly (poulin, 2006). link to human behavior and the social environment motivation is a key element in human (and much of non-human) behavior. motivation drives us to get up in the morning, go to work, be productive, and control our impulses to do otherwise. of course, there is motivation to engage in harmful, even criminal, practices as well. motivation has to do with the human will to overcome daily obstacles and it is basic to our very survival. accordingly, 23van wormer/motivational interviewing much of the psychology of human behavior is concerned with the motivation of individuals, while other social and behavioral sciences are concerned with the motivation of aggregates of people (to organize a mass movement, for example, or to conform to group norms). social work textbooks on human behavior typically include theories of development, theories that are often associated with crucial life stages. motivation, however, (especially motivation to change) is not usually a part of the presentation. motivational interviewing is discussed as a cognitive approach and also as a developmental life model of human behavior in van wormer’s (2007) human behavior and the social environment, but this is an exception to the rule. since a major purpose of social work education is to provide background knowledge about human behavior to prepare students for practice, attention to factors related to the change effort are vital. what are turning points in a person’s life? when does crisis produce worthwhile change? which empirical findings from social psychology can serve to inform social workers how to help people who are in trouble turn their lives around? these are all research questions pertinent to those aspects of human behavior most relevant to social work practice. (they bear on policy issues as well, for example, in making a case for policy change, but that is a topic for another day.) in any case, for hbse textbooks to fail to cover such content, which directly links knowledge about modifying problematic behavior and how people get motivated to change, is a serious omission. in summary, motivational interviewing theory is highly relevant to the study of human behavior and should be covered as a developmental, stage-based model as a grounding for effective social work practice. empirical research hester and miller’s (2003) handbook of alcohol treatment approaches is a research book that has been widely cited in the research field of alcoholism treatment in terms of the large scale comparisons of treatment outcomes. the first edition of this book was published in the 1980s. what these researchers learned was that the treatment methods with the strongest support of efficacy were virtually unknown and unused in u.s. standard practice. after their most recent review of hundreds of empirically-based clinical trials, the authors reached two major conclusions—there is no single superior approach to treatment for all individuals and treatment programs and systems should be constructed to include a variety of approaches, inasmuch as different individuals respond best to different approaches. of the 47 different treatment modalities that were tested in the literature, the top scores for measurable effectiveness were received for: • brief intervention • motivational enhancement • the medications acamprosate and naltrexone • self-control and social skills training 24 advances in social work • aversion therapy • cognitive therapy • acupuncture the lowest rankings were received from worst to least bad by: • education tapes, lectures, and films • confrontational counseling • relaxation training • 12-step facilitation the central message of this comparative study is that the widely used confrontational modalities are among those of little proven effectiveness. we should take into account, however, as hester and miller caution, the fact that some modalities, such as brief intervention and motivational enhancement, generally have been conducted with less seriously addicted populations than some of the others. directed by the national institute on alcohol abuse and alcoholism, the $28 million multi-site, eight-year comparison study of 1997, known as project match, involved nearly 2,000 patients in the largest trial of psychotherapies ever undertaken. the three treatment designs chosen for this extensive study were based on the principles of the three most popular treatment designs—conventional twelve-step-based treatment, cognitive strategies, and motivational enhancement therapy (met). although project match was designed to test the general assumption that matching could improve treatment outcomes, individuals were randomly assigned to three varieties of treatment, so that researchers could determine which modality worked best for whom. the results showed that one year and three years after treatment, former clients demonstrated substantial improvement, regardless of the modality used. to the surprise of the research team, outcome evaluations showed that patienttreatment matching is not necessary for satisfactory results and that participants in the intensive twelve-step format did as well on follow-up as those in the cognitive-behavioral therapy and motivational enhancement designs. treatments were provided over eightand nine-week periods, with motivational therapy being offered only four times and the other two designs offering 12 sessions. all of the participants showed significant and sustained improvements in the increased percentage of days they remained abstinent and the decreased number of drinks per drinking day, the researchers said. however, the researchers noted that outpatients who received the twelve-step facilitation program were more likely to remain completely abstinent in the year following treatment compared to outpatients who received the other treatments. individuals high on religiosity and those who indicated that they were seeking meaning in life generally did better with the twelve-step, disease-model focus, while clients with high levels of psychopathology did not do better with this approach. clients low in motivation did best ultimately with the design geared for their level of motivation. 25van wormer/motivational interviewing in aftercare, in the subjects who were studied, less successful outcomes were associated with male gender, psychiatric problems, and peer group support for drinking. because there was no control group who was deprived of treatment, generalizations concerning the efficacy of treatment cannot be made, a fact that has brought this massive project in for considerable criticism (wallace, 2005). another major criticism is that of selection bias in study recruitment. clients who were dependent on heroin, cocaine, used iv drugs, and were suicidal or had acute psychoses were barred from the experimental treatment. since the clients that counselors typically see are not as homogeneous and carefully screened, such restrictions affect generalization of the findings (wallace, 2005). what this extensive, long-term study does show, however, is that all three individually delivered treatment approaches are relatively comparable in their results—that treatment that is not abstinence-based (motivational enhancement) is as helpful in getting clients to reduce their alcohol consumption as the more intensive treatment designs. these findings provide support for the guiding principle of this paper, which is to find what works in seemingly diverse treatment designs. project match results showed that, for clients who scored high on measurements of anger, the motivational approach worked best, while for persons of a strong religious bent, the twelve-step approach was most effective. the met sessions were fewer in number than were the cognitive or aa facilitation sessions; therefore, met emerged as the most cost-effective, a fact that has not been lost by treatment centers or their sources for reimbursement, such as insurance companies (van wormer & davis, 2008). burke, arkowitz, and menchola’s (2003) meta-analysis of the efficacy of motivational interviewing clinical trials is also relevant for our purposes. data were gathered from the literature of 30 controlled clinical trials that compared an adaptation of motivational techniques to another treatment format. the overall finding was that motivational adaptations showed equivalent benefits to other strategies but that they achieved the same results in far less time. the results were positive for problems involving alcohol, drugs, and diet, but less so for smoking and hivrisk behaviors. samenow’s confrontational approach even as insurance companies favor brief motivational-based interventions for persons with substance abuse problems, correctional counselors and substance abuse treatment providers are often trained in techniques derived from yochelson and samenow (1977) and further elaborated by samenow (2004). in common with motivational philosophy, samenow and yochelson’s goal is the promotion of new ways of thinking in clients with behavioral problems. both approaches draw on a cognitive approach to elicit behavioral change. whereas miller and rollnick work in collaboration with clients to help them tap into latent strengths, samenow’s approach is decidedly negative, as the title of his most recent book, inside the criminal mind, would indicate. based on his extensive work with psychopathic males who were institutionalized in a prison for the criminally insane, inside the criminal mind tears down the theories of psychologists and sociologists and draws on multiple anecdotes in 26 advances in social work support of his position that the criminal uses addiction or a rotten childhood as an excuse to manipulate people, that he (there is no mention of females except as victims) is a victimizer who constantly seeks out people to exploit and cheat. counseling is useless, because “any knowledge the criminal gleans from depth psychology he converts into excuses” (2004, p. 102). the recommended method is to show the client basically what a rotten person he is, then to force him to list his thinking errors and to correct them. the criminal is to identify himself as a criminal and use such self-talk as, “i am a criminal by nature and must control these natural tendencies.” unfortunately, workbooks based on this harsh confrontation approach are widely used in the substance abuse treatment field and by correctional counselors who work with both men and women, people who variously have been victims of others and/or themselves, and/or of cruel circumstances. yet, research has consistently shown that harsh confrontational techniques are of limited effectiveness. as miller and rollnick (2002) indicate, “counsel in a directive, confrontational manner, and client resistance goes up. counsel in a reflective, supportive manner, and resistance goes down while change talk increases” (p. 9). contrast samenow’s accusatory style with the much more positive approach of motivational interviewing: in their seven-part professional training videotape series, w.r. miller and rollnick (1998) provide guidance in the art and science of motivational enhancement. in this series, the don’ts are as revealing as the do’s. according to this therapy team, the don’ts, or traps for therapists to avoid, are: • a premature focus, such as on one’s addictive behavior • the confrontational/denial round between therapist and client • the labeling trap—forcing the individual to accept a label, such as alcoholic or addict • the blaming trap, a fallacy that is especially pronounced in couples counseling • the question/answer habit, characterized by asking several questions in a row and reliance on closed, yes-or-no responses; this exchange paves the way for the expert trap • the expert trap, whereby the client is put down (the opposite of a collaborative exchange of information) implications for social work for favorable results in the change effort that is the essence of social work, knowledge of the fundamentals of motivation enhancement is crucial. the hbse curriculum can promote such understanding through an inclusion of the principles of motivational interviewing theory—a developmental, stages-of-change model that could be studied alongside the stage models of erikson and gilligan. the motivational stages-of-change model is rich with possibility of theoretical development. barbara wallace (2005), for example, has integrated this developmental model into a proposed training anti-racist scheme. when used with historically oppressed populations, (racial or sexual minorities), the focus is on pro27van wormer/motivational interviewing moting healthy identity development, and ethnic pride. for members of dominant groups, the focus at the pre-contemplation level is on motivating people who have a sense of racial superiority to work toward more mature feelings of self-pride and respect for diversity. work to develop ethnic pride among minorities is probably less problematic (more likely to be well received by the client) than helping clients reduce their feelings of grandeur, homophobia, or racism. in either case, the focus is on maladaptive affective, behavioral, and cognitive responses and their replacement by less offensive and adaptive responses. the flexible, client-centered, brief counseling approach of mi is consistent with social work’s strengths perspective and the theme of harm reduction, ”first do no harm.” “meet the client where the client is” is another commonly heard social work theme, one that can serve to summarize mi philosophy, as well. motivational theory, finally, is consistent with nasw’s policy statement that “adopting a comprehensive public health approach will enable social workers to focus on prevention and treatment of alcohol, tobacco, and other drug problems. this focus will prevent unnecessary stigma and will combat substance-related illnesses, disabilities, and premature death” (nasw, 2000, p. 23) references aronson, e. (2003). the social animal. new york: worth publishers. bennett, l.w., stoops, call, c., & flett, h. (2007). program completion and re-arrest in a batterer intervention system. research on social work practice, 17(1), 42-54. burke, b.l., arkowitz, h., & menchola, m. (2003). the efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. journal of consulting and clinical psychology, 71(5), 843-861. corcoran, j., & springer, d.w. (2005), in j. corcoran (ed.), building strengths and skills: a collaborative approach to working with clients (pp. 131-162. new york: oxford university press. diclemente, c.c., & velasquez, m. (2002) motivational interviewing and the stages of change. in w.r. miller & s. rollnick (eds.) motivational interviewing: preparing people for change (2nd ed.) (pp. 201-216). new york: guilford publications. erikson, e. (1963). children and society. new york: norton. gance-cleveland, b. (2005). motivational interviewing as a strategy to increase families’ adherence to treatment regimens. journal for specialists in pediatric nursing, 10(3), 151-155. gilligan, c. (1982). in a different voice: psychological theory and women’s development. cambridge, ma: harvard university press. hester, r.k., & miller, w.r. (2003). handbook of alcoholism treatment approaches: effective alternatives (3rd ed.). boston: allyn & bacon. miller, w.r. (1983). motivational interviewing with problem drinkers. behavioral psychotherapy, 11, 147172. miller, w.r. (1998). enhancing motivation for change. in w.r. miller & n. hester (eds.), treating addictive behaviors (2nd ed., pp. 121–132). new york: plenum press. miller, w.r. (2006). motivational factors in addictive behavior. in w.r. miller & k.m. carroll (eds.), rethinking substance abuse: what the science shows (pp. 134-150). new york: guilford press. miller, w.r., & rollnick, s. (1991). motivational interviewing: preparing people to change addictive behavior. new york: guilford press. 28 advances in social work miller, w.r., & rollnick, s. (2002). motivational interviewing: preparing people to change addictive behavior (2nd ed.). new york: guilford press. miller, w.r., & rollnick, s. (1998). motivational interviewing: professional training videotape series. directed by theresa moyers. university of new mexico: albuquerque. national association of social workers (nasw) (2000). social work speaks: nasw policy statements 20002003 (5th ed.) (pp. 32-40). washington, d.c.: nasw. poulin, c. (2006, august) harm reduction policies and programs for youth. canadian centre on substance abuse. retrieved august 2006 from www.ccsa.ca. prochaska, j., & diclemente, c. (1992). in search of how people change: applications to addictive behaviors. america psychologist, 47, 1102–1114. project match research group (1997, january). matching alcoholism treatment to client heterogeneity: project match post-treatment outcomes. journal of studies on alcohol, 58, 7–28. rogers, c.r. (1931). client-centered therapy. boston: houghton-mifflin. samenow, s. (2004). inside the criminal mind (revised). bethel, ct: crown. van wormer, k., & davis, d.r. (2008). addiction treatment: a strengths perspective. (2nd ed.) belmont, ca: brooks/cole. van wormer, k. (2007). human behavior and the social environment, micro level: individuals and families. new york: oxford university press. wallace, b.c. (2005). making mandated treatment work. lantham, md: jason aronson. wallen, j. (1993). addiction in human development: developmental perspective on addiction and recovery. new york: haworth. yochelson, s., & samenow, s. (1977). the criminal personality, vol. 1. lanham, md: jason aronson. author’s note: address correspondence to: katherine van wormer, professor of social work, university of northern iowa, sabin 36, cedar falls, ia 50614, usa. e-mail: vanworme@uni.edu. 29van wormer/motivational interviewing spring2005-219_page221 spring2005-220_page222 spring2005-221_page223 spring2005-222_page224 spring2005-223_page225 spring2005-224_page226 spring2005-225_page227 spring2005-226_page228 spring2005-227_page229 spring2005-228_page230 spring2005-031_page33 spring2005-032_page34 spring2005-033_page35 spring2005-034_page36 spring2005-035_page37 spring2005-036_page38 spring2005-037_page39 spring2005-038_page40 spring2005-039_page41 spring2005-040_page42 microsoft word 10. haffejee et al_2125_changes in illegal behavior copyedit_final ______________ badiah haffejee, msw, and jamie rae yoder, msw, are doctoral students, and kimberly bender, ph.d., is an assistant professor, all at the university of denver graduate school of social work. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 458-476   changes in illegal behavior during emerging adulthood badiah haffejee jamie rae yoder kimberly bender abstract: emerging adulthood marks a critical developmental juncture during which some individuals disengage from the illegal behavior of their adolescence while others continue to use substances and commit crimes. while risk factors for delinquency during adolescence are well studied, factors that influence persisting or desisting from illegal activities during emerging adulthood have not been fully explored. this mixed methods study utilizes a sample of college students aged 18-25 (n=74) and examines factors differentiating those who abstained from illegal behaviors, desisted from illegal behaviors, and persisted in illegal behaviors. multinomial logistic regression models indicated peers offending and hours spent studying predicted desisting and peers offending predicted persisting (compared to the abstaining group). three qualitative themes: family and peer bonds, morals and values, and fear of consequences further explained factors influencing emerging adults’ persisting and desisting choices. implications for social work practice are explored. keywords: desistance, emerging adults, illegal behavior, college students, substance use many adolescents across cultures report committing some form of criminal or delinquent behavior (uggen & massoglia, 2002). as adolescents age into emerging adulthood, however, they face a critical developmental period in which some will experience maturity and positive behavioral changes (arnett, 2000) often desisting from illegal behaviors (griffin, 2006; mulvey et al., 2004) while others will continue to use substances and commit crimes (arnett, 2000, 2005; tucker, ellickson, orlando, martino, & klein, 2005). although substantial research has identified risk and protective factors for adolescent delinquency, relatively little is understood about the factors influencing emerging adults’ choices to desist (stop) or persist (continue) illegal activities (laub & sampson, 2001; maruna, 1999). furthermore existing work on desistance typically includes samples of offenders who have, at some point, been involved with the criminal justice system (maruna, 1999; uggen & kruttschnitt, 1998). the current study aims to add to the current literature by examining the factors associated with continued engagement in or desistance from illegal behaviors (i.e., crime and substance use) among emerging adults enrolled in a higher education institution. emerging adulthood emerging adulthood is described as the developmental stage between the ages of 1825 characterized by “finding one’s self”, instability, and “feeling in-between” (arnett, 2004, 2005). this period is not classified as adolescence nor young adulthood (arnett, 2000). transitioning to adulthood looks drastically different than it did fifty years ago. it advances in social work, fall 2013, 14(2) 459 has been extended to last longer, with milestones (such as marriage and parenting) delayed until individuals are much older (arnett, 2000, 2005). societal evolution, pressure to complete educational endeavors, and identity exploration are all reasons for the evolving definition of emerging adulthood (arnett, 2000, 2005). emerging adults can be separated into subgroups; one important distinction is involvement in higher education during emerging adulthood (arnett, 2007). many young adults entering emerging adulthood strive to obtain skills to compete in the global economy by obtaining postsecondary education, with 60% of emerging adults who graduate high school seeking higher education (hamilton & hamilton, 2006). while young adults who do not go to college are struggling to find employment and survive financially, youth entering college are also inundated with a host of life changes and attempt to adapt their behaviors to fit their new life and freedom style (arnett, 2007). some of these transitions include an increased work and study load, decreased sleep, new stress and pressures to perform to a higher standard, and an unfamiliar sense of autonomy (lev ari & shulman, 2012). as the notion of emerging adulthood has changed, behaviors of youth as they enter this stage also continue to change (arnett, 2000, 2005). so, while previously emerging adulthood referred to a tapering off of illegal behavior, more recently, emerging adulthood has been recognized as a vulnerable period during which youth often extend their criminal or delinquent activity (arnett, 2004, 2005; tucker et al., 2005) and continue to engage in substance use behaviors such as marijuana use, smoking, and binge drinking (tucker et al., 2005). research has demonstrated how alcohol use, in particular, progressively increases during emerging adulthood (xue, zimmerman, & cunningham, 2009), with high rates of alcohol abuse and dependence during this time (arnett, 2005). also notable during this developmental period is the high prevalence of non-violent and violent arrest rates (piquero, brame, mazerolle, & haapanen, 2002). although collegeinvolved and uninvolved emerging adults may both be at risk for criminal behaviors and substance use, the reasons for these behaviors may differ. long-term unemployment and basic educational achievement are predictors of offending behavior more generally (aaltonen, kivivuori, & martikainen, 2011), while college students may be acclimating to a new lifestyle characterized by new demands and increased stress and pressure (goldman et al., 2002; lev ari & shulman, 2012; white, labouvie, & papadaratsakis, 2005). several researchers attribute these changes and increases in high-risk behavior to the “college experience” (bachman, wadsworth, o’malley, johnston, & schulenberg, 1997; chassin, pitts, & prost, 2002; goldman, boyd, & faden, 2002; white et al., 2005). the insecurities of adapting to college life, including the susceptibility to new peer influences, place youth at risk for engaging in substance use (schulenberg & maggs, 2001). arnett (2005) further suggests that this developmental stage provides more freedom and less social control than high school years. through this transitional period, more youth are without parental supervision; this newfound autonomy is associated with peaks in substance abuse and alcohol consumption (bachman et al., 1997; chassin et al., 2002; white et al., 2006). haffejee, yoder, bender/changes in illegal behavior 460 factors associated with illegal behavior life course criminologists theorize that age and maturation are not one and the same (laub & sampson, 2003). while not all adolescents desist from illegal behavior as they become young adults, those who mature (i.e., experience the commitment and stability associated with developmental turning points such as marriage and employment) leave adolescence behind and reduce their criminal behavior (laub & sampson, 2003). thus, as individuals mature, social consequences of criminal engagement are deterrents and desistance from illegal behavior becomes normative. persistent criminals, on the other hand, often follow more antisocial trajectories due to heightened environmental and biological risk factors (laub & sampson, 2003). in predicting youth engagement in illegal behavior, school success plays a critical role. researchers have highlighted certain risk factors that can emerge in grade school or high school but have impacts on delinquency as youth reach emerging adulthood (falls et al., 2011). factors such as poor academic achievement (katsiyannis, ryan, dalun, & spann, 2008; maguin & loeber, 1996), lack of social bonds to school staff, and low attachment to school while youth are in high school have been associated with delinquency (felson & staff, 2006). longitudinal research also finds low academic aspirations and poor motivation for schoolwork predict youths’ substance use (bachman, staff, o’malley, schulenberg, & freedman-doan, 2011). youth who cause classroom disruptions are also more likely to engage in substance use (wong, 2008). in addition to academic factors, much of the research on illegal behavior has identified association with delinquent peers as a significant correlate of problem behavior (haynie, 2001; rebellon, 2006; warr, 2002). these studies suggest that youth continuously attempt to maintain a “delinquency balance” with their closest friends by changing their behaviors to match to their friends’ behaviors rather than altering their friendships to fit their own behavior (mcgloin, 2009). negative peer relationships and associations may also increase youths’ willingness to engage in substances (ferguson, swain-campbell, & horwood, 2002), and peer influences continue to predict substance use into emerging adulthood (monahan, steinberg, & cauffman, 2009). individuals who desist from illegal behavior in early adulthood, on the other hand, are more likely than those who persist to report pro-social bonding with peers (clingempeel & henggeler, 2003). research questions the current study aims to build on the current literature by examining the critical transition to emerging adulthood among a sample of college students. the study seeks a better understanding of why some emerging adults desist while others persist in regards to illegal behavior (crime and substance use). this study uses quantitative and qualitative methods to identify factors differentiating emerging adults who never engaged in illegal behavior (abstainers), who committed illegal behaviors but have stopped (desisters), and who continue to commit illegal behaviors (persisters). specifically, this study asks two research questions: 1) how do college students qualitatively describe their reasons for and against engaging in illegal behavior during emerging adulthood? 2) what advances in social work, fall 2013, 14(2) 461 quantitative risk and protective factors are associated with illegal behavior among college students? methods procedures data were collected, with institutional review board approval, through confidential questionnaires completed by a sample of college students (n=74) at one university on the west coast of the united states. students were invited to participate in a study asking them about their involvement in illegal behaviors such as minor thefts, vandalism, and substance use. they were informed the study would take approximately 20 minutes and they could complete the questionnaire in class. following informed consent, students were given the opportunity to voluntarily participate in the survey or leave the classroom. the survey was administered using pencil and paper, took approximately 20 minutes to complete and did not involve student compensation. one hundred percent of the students sampled agreed to participate. sample participants consisted of emerging adults, between the ages 18-25 years of age, attending a public university located in an urban area in the western united states. the researchers sought a purposive sample of full-time undergraduate students attending courses in the college of letters and sciences (sociology, statistics, & english) with the goal of accessing the largest college with racially/ethnically and academically (i.e., freshman through senior) diverse student groups. measures the researcher-developed concurrent qualitative and quantitative measure was piloted with 40 students in two full-time undergraduate classes prior to the current study. the measure was given to students to determine the usefulness of the questions and to see if we would achieve the desired response rate of at least 70 percent. a response rate of 100% was achieved and the measure took approximately 20 minutes to complete. after completing the questionnaire, the participants were invited to provide feedback. the participants made the determination that the open-ended question that allowed participants to “tell their story” was too complex; the question included several subquestions for which the respondents failed to provide detailed answers. to address this feedback, prior to administering the measure with the study sample, the instrument was revised for clarity. the data collection instrument used in this study contained demographic questions as well as qualitative and quantitative questions regarding participants’ experiences with illegal behavior. demographics included age, gender (0=female, 1=male), ethnicity (1=african american, 2=asian, 3=caucasian/white, 4=latino/a, chicano/a, hispanic, 5=other), parent’s education (1=did not complete high school, 2=graduated high school, 3=some college, 4=completed college), household income (1=less than 12,000, haffejee, yoder, bender/changes in illegal behavior 462 2=12,000-24,999, 3=5,000-50,999, 4=51,000-100,999, 5=101,000-250,000), and selfidentified social class (1=working class, 2=lower middle-class, 3=upper middle-class, 4=upper-class). qualitative measures to capture qualitative information from emerging adults regarding their level of engagement in illegal behaviors, qualitative questions were designed with sensitivity in an attempt to give participants an opportunity to share their unique perspectives and give voice to their stories and experiences (padgett, 2008). participants were asked a series of three qualitative questions to better understand their involvement in illegal behaviors. a short statement introduced the topic of illegal behavior during emerging adulthood: “research from the last fifty years data indicates that many, if not the majority of people from a variety of cultures commit some form of illegal behavior in their adolescence. for many people these illegal behaviors involve minor thefts, vandalism, or banned drugs. yet, many youth also abandon these activities at some point.” the participants were then asked, “thinking about your own involvement in illegal behavior, please describe the factors, events or circumstances that encouraged you to stop offending.” the second question focused on persistence and asked students, “if you have not stopped, please explain the reasons why you think you continue.” the third part of the question focused on abstaining and asked, “if you have never engaged in illegal behavior (traffic offenses such as speeding are not crimes) please outline the factors that you think contributed to your decision.” these qualitative answers were later quantified to create a dependent variable labeled illegal behavior described in greater detail below. qualitative data analysis analysis began by reading the students’ answers to the three open-ended questions about involvement in illegal behavior. raw data was then “pre-coded” (layder, 1998) by highlighting rich words, short phrases, and significant quotes directly from the respondents’ answers to begin to organize and categorize the data (saldana, 2009). this method of in-vivo coding was used to keep the data rooted in the participants’ own language and to honor their “stories” (saldana, 2009). the second type of coding, structural coding, was used to identify patterns/themes in the way abstainers, persisters, and desisters defined and interpreted their experiences (saldana, 2009). two authors completed this analysis and emerging themes were coded paying special attention to the social meaning of student responses (saldana, 2009). this form of analysis facilitated an understanding of the students’ identities and the social meaning of the language they used to describe their offending and abstaining behavior. it is through the respondents’ language about themselves and their social norms that it became clear how abstaining, desistance, and persistence behaviors occur.   advances in social work, fall 2013, 14(2) 463 quantitative measures dependent variable: illegal behavior for the purposes of this study, desistance is defined as a termination from illegal behavior among individuals who had once engaged in illegal behavior (crime or substance use). persistent offending is defined as continued participation in illegal activities. abstaining refers to the absolute abstinence from illegal behavior. it was imperative that there be a conceptual link between the quantitative and qualitative measures. the students’ written responses to three predesigned qualitative questions were collapsed to create one quantitative categorical variable labeled illegal behavior. participants who discussed reasons they had never committed illegal behaviors were labeled “abstainers”, respondents who described why they had stopped their illegal behaviors were labeled “desisters”, and respondents who explained why they continue to engage in illegal behaviors were labeled “persisters”. this dependent variable illegal behavior was coded with three categories (0= abstaining, 1= desisters, and 2= persisters). independent variables independent variables were selected for inclusion in this study based on previous research on risk and protective factors for delinquency more broadly, and, although more limited, on existing research on illegal behaviors during emerging adulthood. school engagement. four questions measured the broad area of school engagement. these questions included: “how important is getting good grades?” (1= not important at all, 2= not very important, 3= somewhat important, 4= very important); “how likely are you to achieve your educational goals?” (1= not likely at all, 2= not very likely, 3= somewhat likely, 4= very likely); “how many hours do you spend studying per week?” (1= 0-6, 2= 7-13, 3= 14-20, 4= more than 20); and “how many hours per week do you work at a paid job?” (1= 0-10, 2= 11-20, 3= 21-30, 4= 31-40, 5= more than 40). delinquent peers. to assess peer influence on illegal behavior, participants were asked: “what proportion of your close friends regularly breaks the law (not including traffic offenses)?” delinquent peers were measured (1= none, 2= few, 3=some, 4= most, 5= all). social bonds. two indicators of adolescent social bonds were included. the first question asked respondents how often they spent time with parents or siblings (1= never, 2= holidays, 3= weekends, 4= everyday). the second question inquired about spending time with a romantic partner and was measured (1= not important at all, 2= not very important, 3= somewhat important, 4= very important). quantitative data analysis raw data from the interviews were entered into spss (version 18.0). tests for normality were conducted, and assumptions were met. descriptive analyses were conducted to illustrate sample characteristics using mean and standard deviation, frequency, and percentages. prior to running bivariate analyses, the variable parent’s haffejee, yoder, bender/changes in illegal behavior 464 education was dummy coded to account for insufficient number of cases per category and measured (0= did not complete college, 1= completed college). class was similarly dummy coded to indicate (0= other, 1=upper/middle class). bivariate analyses (chisquare tests and one-way anovas) were conducted to determine whether independent variables and demographic variables differed across the three categories of the dependent variable (abstaining, desisting, and persisting groups). variables with significant bivariate relationships to the dependent variable were entered in multivariate analyses. to do so, categorical demographic variables were dummy coded. due to the low power afforded in this relatively small sample, ethnicity was dummy coded to indicate (0= other, 1= white or caucasian). while controlling for demographic characteristics (age, gender, ethnicity (white), parent’s education, household income, and social class) a multinomial logistic regression model was analyzed, regressing illegal behavior on independent variables that were statistically significant at the bivariate level (hours spent studying per week and the proportion of friends committing crimes). the multinomial logistic regression model examined the likelihood of the emerging adults being in the desisting and persisting group compared to the abstaining (reference) group. results sample characteristics as shown in table 1, participants (n = 74) were primarily females (73%). the mean age of the sample was 21 years of age (sd= 2.3), with the majority of the sample (95.9%) between 18 and 25 years of age. this sample was ethnically diverse, with 8.1% selfidentified as african american, 35.1% identified as asian, 32.4% identified as caucasian, 12.2% identified as hispanic, and 12.2% identified as other. the sample demonstrated varying levels of illegal behavior; approximately 38% of the sample indicated they had always been abstaining, 38% of the sample indicated they were desisters (had once participated in illegal behaviors but had stopped) and 24% of the sample indicated they were persisters (continued to participate in illegal behaviors). qualitative results several themes emerged across persisting, desisting, and abstaining emerging adults. in discussing their rationales for whether or not they engaged in illegal behavior, all three groups discussed: social bonds with family and peers, internalized morals and values, and a fear of consequences for their behavior. social bonds and behavioral norms within family and peer groups persisters frequently mentioned that their connections to peers and family members heavily influence their decision to persist in illegal behaviors. these participants shared that, not only is engaging in illegal behavior (particularly substance use) common, it is an important part of the college experience. moreover, it provides emerging adults a “sense advances in social work, fall 2013, 14(2) 465 of belonging” and “connectedness to a larger group.” one respondent’s statement exemplified the importance of her bond to her social environment as she described: table 1. sample characteristics and differences between abstaining, desisting, and persisting groups total sample abstaining desisting persisting f or χ2 freq % freq % freq % freq % gender χ2 = 2.5 male 20 27 5 25 8 40 7 35 female 54 73 23 42.6 20 37 11 20.4 ethnicity χ2 = 14.6 african american 6 8.1 1 16.7 5 83.3 0 0 asian 26 35.1 13 50 9 34.6 4 15.4 caucasian 24 32.4 9 37.5 5 20.8 10 41.7 hispanic 9 12.2 3 33.3 5 55.6 1 11.1 other 9 12.2 2 22.2 4 44.4 3 33.3 parent’s education χ2 = 1.0 did not graduate college 36 48.6 14 38.9 15 41.7 7 19.4 graduated college 38 51.4 14 36.8 13 34.2 11 28.9 class χ2 = 4.4 upper-middle 26 35.1 8 30.8 8 30.8 10 38.5 other 48 64.9 20 41.7 20 41.7 8 16.7 mean sd mean sd mean sd mean sd importance of grades 2.7 .5 2.6 .7 2.8 .4 2.7 .5 f = .9 likely to achieve educational goals 2.6 .5 2.6 .5 2.6 .6 2.6 .5 f = .1 proportion of friends regularly break the law 1.5 1.0 .9 .7 1.6 .9 .2 1.0 f = 14.9*** time spent with parents 2.5 .6 2.6 .6 2.5 .6 2.4 .6 f = .5 time spent with partner 5.1 2.7 5.2 2.7 5.0 2.7 5.1 2.7 f = .1 age 20.9 2.3 20.9 1.4 20.7 2.0 21.3 3.6 f = 1.4 hours spent studying per week 1.1 .8 1.5 .7 .8 .8 1.0 .6 f = 6.6** hours per week worked at a paid job .7 .8 .8 1.0 .6 .7 .6 .7 f = .6 *p <.05 **p <.01 ***p <.001; note: χ2 analyses for ethnicity failed to meet minimum cell count assumptions, with a few cells including 0 participants; these frequencies are included in the table to provide the reader with a general sense of proportions and trends across ethnic groups. haffejee, yoder, bender/changes in illegal behavior 466 it is part of the college culture. as a sorority, drinking is encouraged, if not mandatory. at times i feel it is necessary to drink to function socially…drinking is a big part of my social scene and it’s not bad…smoking marijuana…it’s a part of the social scene. i am in college, what else is there to do? desisters, on the other hand, reflected upon family norms against illegal behavior more so than did persisters. desisters cited shaming, hurting, and disappointing their parents as motivators to desist from their illegal behavior. one participant simply said, “my parents, as poor as they were…strongly believed in honesty. i highly respect them and did not want to make them ashamed of me. i was going to lose them if i continued [to commit illegal behavior].” a second participant echoed these sentiments and described coming to the realization that her behavior was no longer “cool,” instead she “was actually losing the respect” of her parents. social bonds with prosocial family members therefore encouraged participants to desist. abstainers, described social ties with their family (i.e., parents/caregivers) members in much more detail compared to either persisters or desisters. they emphasized positive parenting, being raised the “right way”, including “strict parents setting rules,” consequences, and stability in the home to reinforce prosocial behavior. abstainers discussed not only being loved, but also being monitored and guided by parents. they also described social bonds to peer groups that reject illegal behavior. one participant noted: i have a stable home life with two loving parents that have always spoken to me about the pitfalls of committing crimes. for this reason i have never wanted to commit a crime. i have also never felt pressured by my friends. i always knew that i wanted to be successful so i chose friends that also wanted to be successful. another participant aptly said, “when i saw some of my friends engage in stuff that would get them into trouble, i stopped hanging out with them.” their decision to refrain from illegal behavior appeared to be due to their strong familial ties and a lack of association with deviant peer groups. a vital feature that emerged across three categories is parents. for abstainers, strong bonds and ties to parents including parental involvement influenced their decision not to engage in illegal behavior. for persisters, the lack of parental involvement and supervision (weaker bonds to parents) aligned with greater influence of negative peer groups and contributed to their involvement in illegal behavior. because the emerging adults in this study were no longer under continual parental surveillance, the influence of prosocial bonds with parents must have been internalized for abstainers. for persisters, they may have estimated that they could conceal their involvement from disapproving others or lacked bonds with individuals who disapprove. desisters who made the decision to desist from illegal behavior spoke about the shame, guilt, or embarrassment that antisocial behavior caused, particularly in their relationships with their parents.   advances in social work, fall 2013, 14(2) 467 morals and values participants in all three groups described their perspectives of right and wrong or moral behavior in answering questions about their illegal behaviors. persisters described illegal behavior by discussing a sense of right and wrong, but they held the perspective that their behavior was socially acceptable. they recognized that society may label their behaviors as deviant, but they argued their behavior is benign because they were not causing harm to others. one respondent said, “for the most part i have stopped small crimes, however, i do continue to violate laws or rules [about drinking and drug use] that i feel cause no danger to me and others. i am not hurting anyone.” actually, persisters articulated an independent even defiant attitude toward authority, valuing their own autonomy and rebellion against mainstream rules. a second respondent explicitly remarked: i still smoke marijuana. i don’t consider marijuana an illegal drug. i don’t believe marijuana use (which is probably the most illegal thing i have done) is actually a crime...making it a crime and enforcing certain laws only encourages and perpetuates under-age substance use. desisters appeared focused on shame and guilt for their behavior. often this shame and guilt grew out of pain they may have caused others rather than a sense that they were doing “the wrong thing.” according to one participant, “the last time i did it, i felt horribly guilty even though it was a small item…[i] felt guilty and [i] was afraid to return to the store.” desisters seemed to be concerned with disappointing others who would view their behavior as wrong while abstainers seemed to have internalized these values— which kept them from engaging in illegal behavior. abstainers explained that “high morals and values instilled” by their parents and “strong moral religious beliefs positively affected” their choices not to become involved in illegal behavior. internalization of that sense of right and wrong (morals) seemed weaker among desisters who were accepting of illegal behavior but worried about parents or other people disapproving. fear of consequences a fear of consequences (or lack thereof) for committing crimes or using substances played an important role in influencing emerging adults’ choices to engage in illegal behavior. persisters typically did not fear consequences for their behavior. past consequences, namely a citation for “minor in possession (mip)” and “always getting into trouble with campus police,” were viewed as insignificant. often, participants discussed committing behaviors that went unnoticed and thus had little consequence for them or others. in fact, several persisters discussed the rewards of illegal behavior, feeling “high” and thrilled at the adrenaline “rush” of committing illegal acts. one participant described this overwhelming excitement saying, “i stole a huge cardboard sign from behind the movie theater…i did it, 50% for the acquisition of the sign and 50% for the thrill of it. it was a huge sign.” defying authority was a risk, but it was viewed as an exciting risk well worth any minor consequence or punishment. desisters, on the other hand, frequently discussed a fear of consequences for their behaviors. several discussed their own or their friends’ arrests. these consequences were haffejee, yoder, bender/changes in illegal behavior 468 viewed as serious and detrimental. a clear line was drawn for desisters as they approached age 18. one respondent wrote, “once i turned 18, i realized that my behavior had more serious consequences, particularly in a legal sense. before i was 18, committing minor crimes did not seem like a big deal, especially since others around me engaged in the same behaviors.” another participant wrote, “i stopped when i was 18 for fear of going to jail.” they realized the legal consequences of their behavior were amplified as adults, and thus chose to make changes to avoid these more serious sanctions. abstainers discussed weighing the costs (i.e., being caught, having a criminal record, social stigma) and benefits (limited excitement and temporary fun) and recognized early on that deviant behavior was not worth the costs. this finding fits well within the context of social exchange theory which suggests that individuals choose behaviors based on a comparison of alternatives and a weighing of the relative costs and benefits of each option (homans, 1958). importantly, the determination of costs and benefits is subjective and individualized (mcdonell, strom-gottfried, burton, & yaffe, 2006). costs, for abstainers, were broad and far-reaching compared to the more immediate costs described by desisters. while desisters were concerned about arrest and prosecution, abstainers considered their future goals and career aspirations. they appeared to consider themselves as taking a different path through life that did not leave room for illegal behaviors. abstainers, unlike the other two groups, also discussed concern for greater society, suggesting they refrained from illegal behavior to protect society as a whole. quantitative results group differences across desisting, persisting, and abstaining emerging adults the results of the one-way anova demonstrated that abstainers, desisters, and persisters differed significantly in their number of hours spent studying per week (f (2, 73) = 6.6, p = .002, eta-squared = .2), with abstaining students reporting the most studying (m = 1.5, sd = .7), followed by persisters (m = 1.0, sd = .60), and desisters reporting the least studying (m = .8, sd = .8). post-hoc analyses using games-howell indicated a significant difference in hours studying only between abstaining and desisting students (p <.01). furthermore, the results indicated that abstaining, desisting, and persisting students differed significantly in their proportion of friends that regularly broke the law (f (2, 73) = 14.9, p < .001, eta-squared= .3). persisters had the greatest number of law-breaking friends (m = 2.3, sd = 1.0), followed by desisters (m = 1.6, sd = .9), and then abstaining participants (m = .9, sd = .7). scheffe post-hoc tests indicated statistically significant means across all three groups. correlates of illegal behavior in a multivariate model the multinomial logistic regression model controlling for age, gender, race and class found that participants’ illegal behavior was significantly predicted by the independent variables of interest (χ2 (12) = 45.5, p < .001). as noted in table 2, two factors of interest (peers’ offending and hours spent studying per week) significantly predicted being in the advances in social work, fall 2013, 14(2) 469 desisting group compared to the abstaining group. students with greater proportions of peers who offended were nearly three times more likely to be in the desisting group compared to the abstaining group (or = 2.7, p < .05). students who studied less often were more likely to be in the desisting group compared to the abstaining group (or = .2, p < .01). one factor significantly predicted being in the persisting group compared to the abstaining group. students who reported a greater proportion of peers who offended were significantly more likely to be in the persisting group than the abstaining group (or=5.6, p < .001). table 2. multinomial logistic regression to predict desisting and persisting compared to abstaining desisting persisting factors or 95% ci or 95% ci hours spent studying per week .2** .1-.6 .3 .1-1.2 proportion of peers offended 2.7* 1.1-6.2 5.6*** 2.1-16.6 class (upper/middle) 1.5 .3-6.3 2.4 .4-13.1 ethnicity (white) .3 .1-1.4 1.5 .3-7.9 gender 1.3 .3-6.6 1.3 .2-8.0 age 1.0 .7-1.3 1.1 .8-1.6 note. reference category= abstaining group; or= odds ratio; 95% ci= 95% confidence interval *p<.05 **p<.01 ***p<.001 discussion this study sought a better understanding of the factors that influence desistance and persistence of illegal behaviors during emerging adulthood. a key finding was the significant influence of peers on emerging adults’ participation in crime and substance use. emerging adults who described their peer networks as consisting largely of friends who participate in illegal behaviors were much more likely to have committed illegal acts than those who were bonded more closely with their families and prosocial peer groups. while previous research has documented the strong influence of peers on adolescent delinquency (havighurst, 1987; kandel, 1985; steinberg, 2008), this study extends this work by acknowledging peers’ continued importance into individuals’ early twenties. in fact, emerging adults looked similar to youth in their descriptions of peers’ influencing behavior, particularly when it related to substance use. the evolving notion of what it means to be an emerging adult may influence behaviors during this stage (arnett, 2005). in college, emerging adults are confronted with peer influences (quinn & fromme, 2011; white, fleming, min, catalano, & mcmorris, 2008), and social pressures to participate in substances were described as substantial and influential. the college environment may partially explain why peer relationships continue to be a strong indicator of continued engagement in high-risk behaviors (quinn & fromme, 2011; white et al., 2008). whereas substance use during haffejee, yoder, bender/changes in illegal behavior 470 high school may have been viewed as deviant, substance use during college may be more typical or even normative. furthermore, emerging adults who, in previous generations, may have moved on to employment or marriage during their late teens and early twenties are now more likely to live independently on a college campus surrounded by other emerging adults. many students described following parental rules when they lived at home, but abandoned these when they attended college where their peers had a notable negative effect on their decisions. for example, a female student reported that her parents kept her sheltered from mainstream “ideas” and “thinking,” and it was easy for her to follow the rules of her home. however, once she entered college, she was negatively influenced and she tried “new” things because her parents were not around. in other words, college culture and the desire to fit in and be a part of the social scene that values independence and substance use may foster illegal behavior. the influence of peers is more complex than the immediate peer group surrounding emerging adults. participants described a much longer process, starting when they were children, in which parents provided consistent supervision, monitoring, and implicit lessons of right and wrong which fostered a value for prosocial behavior and friendships. emerging adults who were raised with loving parents including “strict” rules, structure, and consequences for their behavior were more likely to desist and abstain from illegal behaviors and negative peer groups. prior studies have documented the instrumental role that positive parenting has on moderating the effects of substance use including several other problem behaviors among high school students (chassin et al., 2002; white et al., 2006). this study indicates that strong parental bonds and monitoring continue to play a significant role in the lives of emerging adults and their decisions to refrain and abstain from high-risk behaviors. given that emerging adulthood invites less social control, parental monitoring and involvement, and more freedom than adolescent years (arnett, 2005; white et al., 2006), this study suggests that parental bonds can strengthen prosocial behaviors in emerging adults and may reduce risk-seeking opportunities for illegal behaviors. thus, increasing parents’ awareness about the importance of parental engagement and monitoring during the emerging adulthood period may be an essential preventative target. the results also suggest that academic achievement plays a fundamental role in determining illegal behavior of emerging adults. previous literature suggests that academics may serve as a protective factor against ever initiating criminal behaviors (jenson & fraser, 2006). academic motivation and dedication appears to continue to play an important role in emerging adults’ behavior. emerging adults entering college are motivated to obtain academic success (lounsbury, fisher, levy, & welsh, 2009); this motivation can be attributed to fear of consequences and risks associated with failure (loughran, paternoster, piquero, & pogarsky, 2011). that time spent on school work predicted abstaining from illegal behavior compared to desisting, suggests youth who are dedicated students are more likely to come from backgrounds free of crime and substance use. advances in social work, fall 2013, 14(2) 471 the current study also demonstrates that another common element in persistence and desistence is perceived certainty and severity of punishment. overwhelmingly, persisters mentioned that the punishment imposed for minor offenses is not severe enough; hence they continue to engage in high-risk behaviors. persisters noted that marijuana and underage drinking should not be illegal. this finding is consistent with previous studies of adolescent samples that find little deterrent effect for perceptions of the costs of punishment (paternoster, 1989). conversely, desisters reported a heightened sensitivity to the legal consequences of illegal behavior and the severity of punishment, an awareness that may have resulted from their transition to early adulthood in the eyes of the courts. these results are consistent with the rational choice (becker & murphy, 1988) approach that states that a rational offender calculates the costs and benefits of offending, even though s/he may not have the most complete information. an increase in the expected costs of the illegal behavior or in the rewards for conformity should make illegal behavior less attractive. for those who participated in illegal behavior during adolescence but recently desisted, fear of both legal and relational consequences appeared to influence decisions to stop. notable in the desistance process described by this sample are the feelings of fear, guilt, and shame. many emerging adults reported that they felt guilty or ashamed after their illegal behavior and were sorry that they may have hurt someone, including their parents. this finding is consistent with sampson and laub’s (1993) age-graded theory of informal social control and their argument that desistance is more likely when offenders change the way they feel about illegal behavior, themselves, and the relationships they have with others. limitations this study has some evident limitations that need to be addressed. first, the study has a small quantitative sample size, which resulted in reduced power and required several variables to be dichotomized, losing specificity. ethnicity categories were transformed into a dichotomous form of the variable (white/non-white) for the multivariate analyses. this dilutes the variance found in this variable and future research with larger samples should better investigate the role of ethnic diversity in the relationships found in this study. secondly, the quantitative outcome of illegal behaviors (abstainers, desisters, persisters) was derived from participants’ answers to qualitative questions; although this allowed the participants to describe their illegal behavior in their own words, this may have resulted in less accurate categorization. independent variables were developed by the researcher, and thus do not have established psychometrics. to the extent that the host university looks similar to other public institutions, our findings may be transferable; however, findings cannot generalize to the broader, non-student population of emerging adults. third, the reliance on self-reported data of participants poses a drawback to the study design. however in this study, emerging adults self-report was necessary for examining the multiple pathways from illegal activities that involve both social and psychological processes (laub & sampson, 2003). the unique interpretations of the experiences of abstainers, desisters, and persisters were therefore best captured by the mixed-method design and reliance on self-report. fourth, the cross-sectional design haffejee, yoder, bender/changes in illegal behavior 472 leaves the direction of causality ambiguous. that is, it cannot rule out the possibility that participation in illegal behaviors causes one to hang out with antisocial peers and results in less academic motivation. implications for practice this mixed methods study has several implications for practice and research. first, the quantitative portion of the study examines the crucial influences of peers and academic motivation in criminal behavioral outcomes. the strong relationship between negative peer associations and illegal behavior suggests that intervening to encourage prosocial and sober opportunities for socializing and relationship building is imperative. encouraging healthy and adaptive peer relationships through extracurricular clubs and social events, particularly during unstructured evening hours, could be influential in changing college students’ behaviors. clearly, peers play a vital role in shaping attitudes and beliefs among emerging adults. students who spend more time working on schoolwork during down time are consequently more motivated to do well in school and less inclined to engage in illegal behaviors. furthermore, from a prevention standpoint, programs to enhance parenting skills, promoting parental limit setting, supervision, monitoring and relationship building with children and adolescents are likely to protect youth from later illegal behavior as adolescents and emerging adults. parenting skills can also serve to help parents relay the importance of academic motivation and subsequently aid in deterring youth and emerging adults away from illegal behaviors. implications for research although there is a developing body of research on desistance, there is still much to learn. our understanding of desistance is hampered by a focus on individuals involved with the criminal justice system and other systems of formal social control. additional research needs to examine desistance among adolescents and emerging adults who have not been institutionalized or sanctioned in some way. furthermore, the role of parent involvement in influencing emerging adults’ illegal behavior should be further investigated as both a potential risk and protective factor, as this role may be changing and may vary greatly across individuals. the important relationships discovered here should also be investigated internationally, as cultural differences may impact emerging adults’ behaviors and associated risk factors. from a methodological point, much of what we know about the desistance process is obtained retrospectively, and longitudinal designs are necessary to study the natural evolution of illegal behavior and provide a better description of the processes of offending over time. greater investigation is also required to understand ecological or neighborhood-level factors influencing desistance. furthermore, researchers and funding mechanisms need to support further investigation of emerging adulthood as a distinct developmental period, clarifying unique, relevant, and modifiable risk and protective factors for this important group. emerging adulthood is a time of great opportunity mixed with heightened vulnerability. as students make decisions regarding their academics and peer groups, it appears they are implicitly placing themselves at varying risk for dangerous behaviors. prevention and intervention efforts aimed at connecting emerging adults to prosocial advances in social work, fall 2013, 14(2) 473 parents and friends and encouraging their dedication to academics may offer protection for those who aim to abstain or desist from criminal behavior and substance use. references aaltonen, m., kivivuori, j., & martikainen, p. 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(2009). relationship between alcohol use and violent behavior among urban african american youths from adolescence into emerging adulthood: a longitudinal study. american journal of public health, 99(11), 2041-2048. author note: address correspondence to: badiah haffejee, msw, university of denver graduate school of social work, 2148 s. high street, denver, co 80208. email: badiah.haffejee@gmail.com fall2005-004_page231 fall2005-005_page232 fall2005-006_page233 fall2005-007_page234 fall2005-008_page235 fall2005-009_page236 fall2005-010_page237 fall2005-011_page238 fall2005-012_page239 fall2005-036_page263 fall2005-037_page264 fall2005-038_page265 fall2005-039_page266 fall2005-040_page267 fall2005-041_page268 fall2005-042_page269 fall2005-043_page270 fall2005-044_page271 fall2005-045_page272 fall2005-046_page273 fall2005-047_page274 fall2005-048_page275 clinical social workers and social justice: advocacy clinical social workers: advocates for social justice anne marie mclaughlin abstract: advocacy activities provide an avenue for all social workers to connect their practice with the profession’s aim of social justice. in fact, it is this social justice connection to the advocacy role that may distinguish social work from other professions. yet advocacy remains a controversial practice for many clinical social workers. this study reports on one aspect of a larger study (mclaughlin, 2006), which examined how clinical social workers in mental health conceptualized social justice as part of their work. the data revealed a strong relationship exists between clinical social work practice, social justice and advocacy. the concept of advocacy that emerged from the data was multi-dimensional and included strategies that were instrumental, educational, and practical. keywords: advocacy, social justice, mental health introduction although in the past clinical social workers have been maligned by their own profession in terms of their commitment to social justice (andrews & reisch, 2002; hawkins, fook & ryan, 2001; specht & courtney, 1994), current practice models tackle social justice issues head on. such frameworks as anti-oppressive practice, feminist practice, and narrative and constructionist models consider contextual issues such as culture and gender, as well as social, economic and political imbalances (morley, 2003; parker, 2003; swenson, 1998; vodde & gallant, 2002). yet suspicions regarding clinical workers’ commitment to social justice persist. for many, practice models and frameworks are insufficient and students and practitioners alike wonder exactly what the link between their practice and social justice might be. results of a recent qualitative inquiry into clinical work and social justice (mclaughlin, 2006) revealed that participating mental health social workers overwhelmingly identified advocacy efforts—with and on behalf of clients—as strategies for social justice. that inquiry posed three questions: 1) how do mental health social workers conceive of social justice; 2) how do they incorporate social justice in their work, and; 3) what barriers do they encounter. this paper reports on one aspect of the larger study, specifically, the predominant way in which participants incorporate social justice into their work. the data revealed a strong relationship exists between clinical social work practice, social justice and advocacy. the concept of advocacy, as described by practitioners, was multi-dimensional and included strategies that were instrumental, educational, and practical. _________________ anne marie mclaughlin, ph.d., is an assistant professor of social work at the university of calgary. copyright © 2009 advances in social work vol. 10 no. 1 (spring 2009), 51-68 mclaughlin/clinical social workers: advocates 52 social justice and advocacy advocacy is a well-established strategy for achieving social justice (gehart & lucas, 2007; hoefer, 2006; kiselica & robinson, 2001; miley, o’melia & dubois, 2007). moreover, advocacy is considered a professional obligation (hepworth, rooney & larson, 2002). national and international professional social work bodies entrench professional social work practice, advocacy and social justice through their codes of ethics (british association of social workers, 2002; international federation of social workers, 2004; national association of social workers, 2008). the canadian association of social workers (2005) explicates the link between advocacy and social justice: social workers advocate for fair and equitable access to public services and benefits. social workers advocate for equal treatment and protection under the law and challenge injustices, especially injustices that affect the vulnerable and disadvantaged. (casw, 2005) many studies have explored the connection between social justice and advocacy (bowes & sim, 2006; kiselica & robinson, 2001; miley et al., 2007; mitchell & lynch, 2003; van voorhis & hostetter, 2006), and agree that advocacy strategies provide powerful “tool[s] for challenging social injustice” (dalrymple, 2004, p. 188; kiselica & robinson, 2001). while the connection between advocacy and social justice is sometimes indirect (johnson, 1999), advocacy activities provide an avenue for all social workers to connect their practice with the profession’s aim of social justice (wakefield, 1988a, 1988b). in fact, it is this social justice connection to the advocacy role that may distinguish social work from other professions (butler & webster, 2003; ezell, 1994; hoefer, 2006, reamer, 1998). advocacy is often represented in the literature as a strategy more closely aligned with macro or policy practice (wolfer & gray, 2007). however, social workers in direct practice are intimately involved in many aspects of individual client lives, including financial, cultural, medical, legal and spiritual issues, and are therefore able to assess and intervene in many areas in which injustice may occur. the advocacy role appears to be a hand-in-glove fit with generalist practice (hoefer, 2006; kirst-ashman & hull, 2006; walker, 2004). yet, most current generalist practice text books make scant reference to the role of advocacy in social work practice (compton, galaway & cournoyer, 2005; heinonen & spearman, 2006; miley et al., 2007; poulin, 2005; segal, gerdes & steiner, 2007; sheafor & horejsi, 2008). further, little attention to advocacy or social action can be found in undergraduate curricula. when evidence of advocacy instruction emerges it falls primarily in community development courses, which frequently are optional for students (radian, 2000). this has led some to wonder if social work’s “tradition of advocacy for social and economic justice has fallen prey to benign neglect” (mitchell & lynch, 2003, p. 14). advances in social work, spring 2009, 10(1) 53 advocacy: form and function the concept of advocacy varies both in form and function. in form, advocates can be paid professionals, as in the case of patient advocates in mental health or child welfare systems (herbert & mould, 1992). the citizen advocate is another form of advocacy where non-professionals volunteer time to help another (hunter & tyne, 2001; rapaport, manthorpe, hussein, moriarty & collins, 2006). self-advocacy is an important contribution to the advocacy movement with deep roots in the disability field. empowerment forms the cornerstone of self-advocacy where individuals build skills and gain strength to advocate for themselves (buchanan & walmsley, 2006; walker, 2004). within generalist practice advocacy is considered a technique or skill, typically a subset of case management (compton, galaway & cournoyer, 2005; hepworth, rooney & larson, 2002; hoefer, 2006; miley et al., 2007). historically, advocacy has been divided into case and cause (carlisle, 2000; compton, galaway & cournoyer, 2005; miley et al., 2007; sheafor & horejsi, 2008). cause advocacy addresses systemic issues and involves lobbying efforts aimed at policy or institutional restructuring. cause (sometimes referred to as class) advocacy has as its goal “to advance the cause of a group in order to establish a right or entitlement to a resource or opportunity” (sheafor & horejsi, 2008, p. 425). this form of advocacy has been closely allied with policy practice and other forms of macro social work. in case advocacy, the aim is to redress power imbalances and promote the rights of individuals who are marginalized or vulnerable (carlisle, 2000). narrowly defined case advocacy “assure[s] that the services or resources to which an individual client is entitled are, in fact, received” (sheafor & horejsi, 2008, p. 55). this definition appears weak and does not distinguish itself from case management or other types of service delivery (herbert & levin, 1996). social workers advocating for resources may find clients require more than they are entitled to, depending on who has established the entitlement. a more robust definition rejects entitlement and emphasizes need. for instance case advocacy implies intervention when available services are not relevant to needs or when an organization is not responsive to those needs (herbert & levin, 1996). advocacy can be directly related to clinical work through a common goal, that is, “helping clients become independent and exercise influence and control over their own lives” (lens & gibelman, 2002, p. 614). contemporary social work practice models have moved beyond individualistic problem-focused perspectives and attend to issues of power, culture, social and economic injustices (finn & jacobson, 2003). in the current global climate of job and financial insecurity where individuals and groups have shrinking access to resources and opportunities, advocacy takes on greater urgency not only within macro approaches to social work but also within direct practice (walker, 2004) although advocacy appears to be a central role for social workers, many authors are extremely cautious and somewhat ambivalent in supporting its implementation. for instance, forbat and atkinson (2005) doubt social workers’ ability to separate client needs from organizational demands and to speak against colleagues. shearfor and horejsi mclaughlin/clinical social workers: advocates 54 (2008) caution that class advocacy is not for everyone, especially those who feel uncomfortable with confrontation. compton, galaway and cournoyer (2005) are even more cautious and raise flags for those contemplating class advocacy saying that practitioners “risk infringing upon the self-determination of those for whom [they] claim to speak. who is the client? who decides the purpose and objectives of your actions?” (p. 128). they also ask social workers to reflect on who suffers if they are successful in achieving their ends. the warning to social workers is to think through ethical obligations to individual clients before pursuing structural and systemic change (compton, galaway & cournoyer, 2005). controversy continues around the relationship between clinical work and advocacy for social justice (egan, 2007). this controversy impacts practice. despite the relevance of advocacy in theory, in practice advocacy is not as common as it would seem (davis, baldry, milosevic & walsh, 2004; ezell, 1994; herbert & levin, 1996; lens & gibelman, 2000; nelson, 1999). for instance nelson (1999) found that frontline workers in her study ranked advocacy last out of five commonly performed functions. in a similar study, social workers in an australian hospital ranked advocacy ninth out of eleven identified functions (davis et al., 2004; davis, milosevic, baldry & walsh 2005). similarly ezell (1994) evaluated time spent in advocacy activities and discovered that 90% of responding social workers (n=353) indicated some advocacy activities within their regular employment. however, the actual number of hours involved in advocacy was low (less than five hours per week for the majority). social justice as well as advocacy are both considered professional and ethical obligations, yet few studies have explored with practitioners how these may be linked in practice. clinical social workers and those in direct practice carry the same professional and ethical obligations to work for social justice but may feel limited in their opportunities. this study explores how participants expressed social justice in their work. method in this qualitative research study 18 social workers from a western province in canada were sampled. purposeful sampling was used for the first five participants. these participants were considered to be information-rich sources (patton, 2002). they were selected for their practice experience in mental health and their interest in social justice, as demonstrated through their participation in their professional association. snowball sampling, with participants providing the names of potential additional participants, provided the remainder of the sample. participants identified themselves as clinical social workers (considered the standard for practioners working in mental health in this province), had earned an msw degree and were employed in various aspects of a provincially funded mental health system. nine participants worked on in-patient wards or programs including geriatric psychiatry, forensic psychiatry, mental health administration, and a brain injury unit. two participants worked as outreach psychiatric emergency/crisis workers, six participants worked in community clinics, and one worked in a day program. advances in social work, spring 2009, 10(1) 55 participant interviews lasted between 1 and 1.5 hours and were conducted at the convenience and discretion of each interviewee either at their place of work (n=13) or at an agreed upon location. interviews were transcribed and coded using familiar qualitative processes (strauss & corbin, 1998). computer assisted qualitative data management software (qsr international, nvivo 7) was utilized for data management and retrieval. the results reported in this paper comprise one element of a larger research project which explored the meaning participants brought to the term social justice and how that meaning was translated into practice (mclaughlin, 2006). grounded theory methodology was utilized and the concept of advocacy emerged early as an in vivo category representing participants expression of social justice in their work. the author initially resisted this concept in part, because of received ideas, preconceived notions, assumptions and conceptualizations already surrounding advocacy. eventually, the author began to think of advocacy as a sensitizing concept (bowen, 2006; charmaz, 2006; glaser, 1978). rather than resist the term, advocacy was used to explore participants’ meaning in depth. data analysis proceeded according to the constant comparison method in which each slice of data is compared to each other slice (glaser & strauss, 1967). analysis and data collection proceed together and the researcher is guided by what emerges. as mentioned, the theme of advocacy emerged early in the data analysis and each incident and each sentence were compared against each other. throughout the interview process, as well as the analysis, the researcher stayed open to variations, interpretations and applications. in later interviews the author became sensitized to discussion concerning advocacy and used more probes when this discussion arose. the author also returned to earlier interviews, once advocacy was identified as a sensitizing concept, to reexamine the texts with fresh awareness. to ensure the trustworthiness of the findings the author employed several techniques (cohan & crabtree, 2008; creswell, 1998). the author attempted to maintain a reflexive stance toward the data by way of memo writing and peer debriefing. memos were written following individual interviews as well as throughout the data analysis process. the author met with a peer team throughout the research and writing process to share themes as they emerged and to discuss possible research bias and assumptions as well as to review possible connections between concepts and categories. the analyst also sought negative cases as a way of exploring and accounting for all the data. eventually, a conceptual framework for advocacy emerged representative of the participants’ experience. while generalization to the larger population is not a goal of qualitative research, identifying and describing patterns of behavior in a specific context is. this tentative conceptualization expands and enlarges on previous iterations of the concept of advocacy and relates particularly to clinical social workers in mental health. mclaughlin/clinical social workers: advocates 56 findings advocacy the concept of advocacy captures significant variation in the ways in which participating social workers worked for social justice. at times advocacy appeared to be a proxy for social justice, as one worker expressed, “i think [advocacy] would be the closest thing to embodying social justice at a practice level in clinical social work”. advocacy also served as a direct example of social justice: “when i am advocating, i am aiming for a target that i think everybody deserves… in a sense i am seeking justice for this person.” the goal of advocacy, as the next participant explains, is the realization of social justice, “anytime i go to an appeal [with my client], the person that is appealing feels (and i would not appeal it if i did not believe) that they were achieving some sort of social justice.” regardless of the meaning of social justice for participants, the most frequent manifestation of social justice appeared through advocacy activities. advocacy goals and strategies, according to participants, are both broad and varied, encompassing micro (aimed at a particular individual), mezzo (aimed at a particular group of people, such as the mentally ill, or those living in poverty), and macro levels (activities aimed at betterment of all society such as a fair minimum wage, clean water, or access to health care). a number of strategies were identified at each level. these strategies and dimensions are listed in part in table 1. three types of advocacy are embedded in the data: instrumental advocacy, educational advocacy, and practical advocacy. instrumental advocacy concerns particular actions taken by the study participants on behalf of clients. educational advocacy involves heightening awareness of social justice issues, rights, needs, and opportunities, not just for clients but also for colleagues or the public at large. practical advocacy involves working with clients directly to access resources, such as in accompanying them to appeals or even filling out documentation that is posing a barrier to the access of resources. these three types of advocacy are listed below. instrumental advocacy. in some situations requiring advocacy activities, clients may be unable to take direct action themselves, either as a result of their marginalized status, or because of particular challenges they face. for instance, in the following scenario, the social worker working on a geriatric psychiatric ward describes her advocacy work for seniors who resist institutionalization: when anyone at that age isn’t functioning the way they should, everyone wants them placed somewhere that is secure so that nobody has to worry about them. that’s the big thing. i have been a very strong advocate of risk, and allowing people to live in risk if they are competent to understand the risk. advances in social work, spring 2009, 10(1) 57 table 1: advocacy strategies and dimensions individual marginalized groups just society instrumental holding systems accountable  lobby on behalf of  ensuring accountability  liaison between services  letter writing  demonstrations  marches  program development  campaign for social issues e.g. living wage  professional association work educational educating individuals, families, colleagues, society  educating individuals about rights, options or choices, the system  educating others about needs/rights, stigma  committee work  anti-poverty groups  school systems  multidisciplinary teams  public education initiatives  public health awareness strategies, aids, mental health practical engaged in action  assist by filling out forms  accompany to appeals or interviews  locating housing  volunteer work for food bank, hiv network  volunteer on crisis line  run for political office in the next example, a community mental health social worker advocates for children he is counseling who are drifting in the foster care system. instrumental advocacy on the part of this social worker involves contacting a client’s child welfare worker in an effort to see service improve and hold systems accountable: [it was a] child welfare case and children who were taken from the home and placed with another family member, hadn’t had contact with their parents, i think it was for four weeks. i know that … the child welfare worker had every intention to have the children return to live with their family, but for whatever reason the children hadn’t met with their parents in perhaps four weeks. to me that was just ludicrous from the point of view of the child’s perspective, strictly. …i get upset about it, i can’t believe that. …the children have rights, the children weren’t informed of anything, they had no idea what was going on. and so i [got] in touch with [the worker]. mclaughlin/clinical social workers: advocates 58 working on behalf of others occurs frequently, in particular with vulnerable populations. instrumental advocacy involves engaging with other systems to secure rights and resources. in the next example a mental health social worker describes institutional constraints that adversely affect her client: often the challenge in these facilities is lack of staff, and there was a client who was in the later stages of multiple sclerosis, and she had depression which is why we were involved. through doing the assessment i had a chance to speak with her husband, and he had informed me that his wife wasn’t getting fed enough and he had some concern around that. when i approached the care manager of the facility, she expressed that there are a certain amount of hours per resident per a 24 hour time period that residents were entitled to. when someone is in the later stage of ms, everything is time consuming because they are extremely heavy care. and so the reality was, from the perspective of this care manager, that there simply wasn’t enough time for her to be fed completely, and so the staff would do what they could and then they had to move on. the worker, on behalf of the client and her family, advocated for a humane response from an unyielding bureaucracy. respondents frequently indicated that they are firsthand witnesses to bureaucratic injustice that place unnecessary constraints on individuals. respondents know these systems and often challenge the injustices they meet. the next participant, a mental health worker for inner city residents, explains: i have to fight with social services financial benefits workers for little things. for example, a fellow who has a decent work history, but has a horrific past that has kind of caught up with him, so he has gotten depressed and suicidal…. he needs life skills and how to deal with stress and anger and conflict and managers and so on. he had good potential for that, and so the occupational therapist set him up in a sheltered workplace out of [a local] hospital, a very good wood working shop. he has not enough money to get there by bus, and so we have had to fight for the last three months for them to fulfill their own regulations about giving him enough money for bus fare to get to this. this participant recognizes the injustice facing the client and advocates vigorously on his behalf. educational advocacy. educational advocacy concerns efforts social workers engage in on behalf of a particular client or client group, with the goal of influencing others in the direction of social justice. as one respondent noted, “you keep trying to educate the system about the population.” in institutional settings clinical social workers use sensitivity and skill to influence other members of the multi-disciplinary team around issues of social justice, without alienating others, as this respondent illustrates: our team [has] a good reputation and i think a lot of that is because we really try to work collaboratively with staff. we don’t come in there and try to tell them what to do, because they have enough of that. we are there to listen to their concerns and try and do a little bit of negotiation between the needs of the advances in social work, spring 2009, 10(1) 59 residents and resources of staff, and trying to get them to look at things at a different slant. this worker emphasizes that the goal of her advocacy is to influence. she is attempting to shift institutional attitudes. respondents recognize that environmental conditions and a problem focus within institutions negatively impact staff’s ability to view each client as unique and valued. advocacy, in this instance, means directing the attention of others away from the problem focus of classification and toward a more human understanding of the individual and their particular needs. other strategies employed by respondents include: attempting to encourage more client input in decisions affecting them, or finding a more equitable allocation of resources based on needs rather than protocol. education advocacy attempts to influence those within the system, as one respondent pointed out: “it’s some of the people working in the system that need to be educated and taught an attitude change.” education advocacy includes educating others about issues that oppress or stigmatize: when i am spending extra hours every year doing [awareness] activities—going on tv, radio, newspaper articles—why i am doing that is because my clients say that they feel stigmatized in the community and they want people to understand more about brain injuries so they can feel more a part of society. i am being motivated by social justice values in doing that, not because i like to be on tv. bringing issues of social justice to the awareness of colleagues is part of advocacy work. social workers in this study are familiar with how attitudes and judgments can negatively impact access to resources: we need to bring it to people’s awareness, that this is a social justice issue— awareness among other health care providers. now a days, we deal a lot with judgment—we can’t get away from the fact that a lot of health care providers come from a privileged position, so they get attitudes and judgments around what is the right way to do something and whether or not somebody should be allowed to do thus or so. [for example] ‘you can’t let them go back home to live such and such a life’. educational advocacy also includes educating clients about their own rights within the system so they “can access systems and situations in better ways that they might not have come up with by themselves,” as one participant explains. this advocacy strategy views knowledge as power and empowerment as informed decision-making. educating clients to the system is part of empowerment: clinically, if you are not writing policy and you are not doing any of that stuff, so you’re not doing social justice, i think that’s false. i think on an individual level, knowledge is power, by providing somebody with all the information of the mental health act, all the help available to them, the good and bad parts of medication, the good and bad parts of accepting this diagnosis…. the fact that you do not have to accept this label, and i will say that to people that they don’t. mclaughlin/clinical social workers: advocates 60 practical advocacy. practical advocacy is typified by clinical social workers assisting individual clients in various ways: assisting with an application for funding, accompanying clients to appeals or interviews and, on some occasions, much more. for some individuals with chronic mental illness it may mean that the worker must take an active role in assisting as the following worker describes: … accompanying … patients to interviews to ensure that they are properly heard and understood when they are in an interview. it’s a vulnerable population, and they often get overwhelmed by so many questions or questions they can’t answer, and we’re able to be there to rephrase questions for them, to ensure that they are heard. a lot of them don’t have the confidence and skill to present themselves well during an interview. the next participant describes his practical efforts with a client who was turned down for financial benefits: i helped him when the time was right to apply for [assistance]. he was turned down partly, or mostly, based on his history being a drug user and all that. it was not based on the fact that he had become quite disabled, physically and cognitively, and needed the support that he was supposed to have a right to. i did the appeal for him, went to the appeal with him, and made the case that he have equal access to [assistance] as anybody else. i brought his mother in to help make the case, we won the appeal, and he got his [money] and was able to live a reasonable quality of life. by giving practical and often hands-on assistance the workers in conjunction with clients achieve justice for their clients. barriers advocacy as a strategy for social justice is not without challenges. advocacy for social justice may be blocked within organizations and not viewed as “part of the job” that social workers were hired for: “i don’t think i have ever been at a table where social justice or social action has been the primary objective.” social workers who embrace the advocacy role may find themselves marginalized or discounted as others tire of the message: you’re sort of going against the stream when all around you people seem to say, “we’re not listening”. …so what happens is, after a while, you have to sort of back off, because it becomes, “well, that’s [the social worker] and that’s the way that she sees things.” social workers fear being stereotyped. one respondent, adept at accessing scarce resources for clients, expresses resentment at being seen only as “the resource girl.” she also expresses concern for social workers who advocate for resources: “we’re the resource people… i have had to spend the last two years proving that i have some value, that i have some knowledge base, first of all. i am very conscious of the fact that i am not just the resource girl.” in this instance participants also find themselves advocating for their professional identity. advances in social work, spring 2009, 10(1) 61 advocacy efforts may also be seen as misguided due to a lack of appreciation of the larger issues. not all participants valued individual advocacy efforts: “the advocacy that i’ve seen done… consisted of lower level case by case stuff when the problems were up here.” beyond this, social workers are also faced with philosophical questions regarding whether or not to engage those they work for in a political battle for social justice. the mental health population is vulnerable and frequently is already shouldering additional burdens such as poverty and stigma. some participants question the ethics of politicizing clients in their own quest for social justice, and are concerned about the implications of advocacy when and if workers start to drive the agenda. a related dilemma is the concern that by making social justice the priority, the real mental health treatment issues may be eclipsed. focusing on societal change could compromise issues for the individual. advocating for wholesale change may seem misguided: to me that advocacy role would be more about changing society, and that’s what i think the danger is, that idealistically and philosophically buying into an idea about how things should be, and then going out and trying to do it. i think it’s really dangerous because you are not looking at the individual situations, and it could overstep what really needs to take place. for this participant, the focus in clinical work has to be on the individual. advocating for group issues may jeopardize the needs of the individual, “i think that everybody has to be treated individually around these issues, not as a group, ‘cause that sort of supersedes everything. when you group people together, you don’t see the diversity.” discussion this study extends the discussion of advocacy to better reflect and capture advocacy strategies employed by participating mental health social workers pursuing social justice. the case/cause dichotomy does not adequately do justice to the breadth of activities employed by participants in this study. the proposed typology sees advocacy as having three functions: instrumental, education and practical. each of these functions can be practiced at the level of the individual, group, community or societal level. advocacy strategies described here comprise an integral component of direct social work practice and need not be seen as a separate skill set (hoefer, 2006). hoefer (2006) defines social work advocacy as, “that part of social work practice where the social worker takes action in a systematic and purposeful way to defend, represent, or otherwise advance the cause of one or more clients at the individual, group, organizational or community level, in order to promote social justice” (p. 8). this definition fits well with what participants in this study have described. yet, many research studies report that advocacy in practice is lagging behind other social work functions such as assessment, counseling, resourcing, and consulting (ezell, 1994; nelson, 1999). considering the close association between advocacy and pursuit of social mclaughlin/clinical social workers: advocates 62 justice, and, considering the desire on the part of the profession to strengthen efforts to affect social justice, greater emphasis on advocacy seems timely. based on the findings from this study it is possible to propose a framework for advocacy by clinical social workers and to more clearly delineate the connection these practices have with the pursuit of social justice. making the connection between advocacy and social justice explicit could increase commitment and provide impetus for practitioners to enhance and hone their advocacy skills. van voorhis and hostetter (2006) argue that increased self-confidence and competence with advocacy increases an individual’s commitment to the process. social workers who feel empowered are better equipped to advocate with and on behalf of clients. like participants in this study it is possible that not all social workers are clear about the connection between social justice and advocacy. advocacy’s connection to social justice in order to connect advocacy as described here with the social justice mission of the social work profession, we must first consider the meaning of social justice. this is no easy task as the meaning of social justice not only changes with the times but may change depending on the context (reisch, 1998; 2002). two prominent interpretations of social justice familiar to social workers are distributive justice as articulated by rawls (1971) and the politics of identity as expressed by young (1990). from the distributive paradigm, issues of access to resources and the fair and equitable distribution of scarce resources are central. in addition, social justice is concerned with fair and just procedures and treating individuals with dignity and respect. social workers pursue fair and just procedures for distribution of social goods and hold governments and agencies accountable for this. distributive social justice stipulates that each individual is entitled to a minimum of basic social goods: liberty, wealth, opportunity, and also, self-respect (rawls, 1971). we can see that participants in this study are, in fact, conscious of and concerned with distributive issues of social justice. participants pursed fair and equitable access to resources with and on behalf of their clients. they worked hard to hold systems accountable and ensure needs were met. they encountered unjust procedures and advocated with and on behalf of those they worked with. they pursued care for individuals that respected the dignity and worth of those they served. within the mental health system as with many bureaucracies dehumanizing and unjust practices persist. a social worker’s ability to advocate with and on behalf of clients, individually or collectively, is important work that confronts injustice and seeks change. the politics of identity conceives of social justice differently. here social justice is not limited to the distribution of social goods. rather the central concern is with how individuals and groups are valued or devalued in society and how existing social structures: values, attitudes, behaviors and beliefs, support and perpetuate these positions (young, 1990). the result of these valued and devalued positions is domination and oppression; one group is privileged while another is suppressed-male over female, able bodied over disabled, rich over poor. marginalization, exploitation, and powerlessness advances in social work, spring 2009, 10(1) 63 occur as individuals are shut out from decision-making (young, 1990). tackling injustice from this perspective requires challenging the domination of ideas, values, beliefs and behaviors of one group over another. those accessing services within the mental health system may find themselves marginalized and powerless, cut out of decision-making, unable to advocate on their own because of stigma, a debilitating illness or temporary incapacitation, overwhelmed by the many social and institutional injustices they face. clinical social workers can use advocacy strategies to change attitudes, secure resources, reduce stigma, defend cultural identities, remove barriers, and ensure discounted voices are heard. healing and health require more than counseling and support, they require attention to attitudes, values, and practices that oppress and constrain individuals from fully participating in society (gomez & yassen, 2007; pearlmutter, 2002). advocacy strategies with the aim of social justice include educating individuals about their rights: rights to service, rights to resources, rights to respect, rights to appeal, and rights to refuse treatment. instrumental, educational and practical components of advocacy may challenge the way some social workers have viewed direct practice. the obligation to be an advocate pushes workers to get involved. advocacy requires the acknowledgment that many constraints and limitations that individuals experience are not the result of personal or mental deficits but are real limits imposed by unjust environments. social workers are adept at understanding the interplay between the person and their environment and it is this perspective that motivates workers and facilitates a social justice perspective. concerns some participants expressed reservations about the social justice agenda and its impact on clients. others noted that a focus on social justice may overshadow the real concerns of mental health clients. still others maintain that while they value the role of advocate and feel obligated to speak out with and on behalf of clients, they sense that this role may not be valued by others such as colleagues and employers. this can lead to the marginalization of some workers as well as resistance and push-back from organizations (greene & latting, 2004). these are real ethical and practical issues that cannot be ignored. however, workers in this study have found ways and means to be both an advocate and maintain employment. in part, as one participant noted, workers must make judgments about what strategies to pursue, and when. more discussion among practitioners and students, regarding the challenges and opportunities for incorporating advocacy for social justice into direct practice is required. practitioners and students alike report an interest in bettering their skills (gomez & yassen, 2007). conclusion participants in this study clearly identified advocacy strategies as their best efforts to link clinical practice with social justice; advocacy with and on behalf of clients to access resources, increase opportunities and reduce barriers and stigma. on one hand, advocacy in clinical practice is obviously part of how social workers, those in direct practice and mclaughlin/clinical social workers: advocates 64 others, view good social work practice (herbert & levin, 1996). on the other hand, reports from the practice literature indicate that as a component of practice it is underutilized. the challenge for clinical social workers and those in direct practice is to find ways to work for social justice and to respect the individual needs of clients. integrating advocacy into practice poses specific challenges. these challenges are practical as well as ethical and deserve further exploration. within the social work curriculum advocacy has not received the attention it requires in order to become a more effective and relevant component of practice. advocacy needs to come out of the macro and policy classes and be fully integrated into clinical and direct practice course work. social justice and the code of ethics require that all social workers develop the skills and knowledge to recognize and overcome injustice. yet, social workers appear to face resistance to advocacy activities. on a practical level we need to know more about how to support advocacy practice in the field. do employers view advocacy activities by clinical social workers in a positive light? is advocacy even valued as a practice strategy in any mental health job description? practice research indicates that although not a top priority for social workers in terms of job functions, advocacy is a relevant and legitimate component of most mental health practice. the need for highly developed advocacy skills and knowledge is well recognized as vulnerable individuals increasingly find themselves overwhelmed and underserved by complex social systems (bronstein, kovacs & vega, 2007; levy & payne, 2006). finally, this paper has delineated three crucial components of advocacy activities: educational, practical, and instrumental. by identifying these specific components of advocacy, educators and practitioners may be able to increase awareness and skills related to advocacy in social work and thereby better meet their social justice aims. references andrews, j., & reisch, m. 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(1990). justice and the politics of difference. princeton, nj: princeton university press. author’s note: address correspondence to: anne marie mclaughlin, ph.d., assistant professor, central and northern region, university of calgary, faculty of social work. #444, 11044-82 avenue, edmonton, alberta, t6g 0t2. email: am7@ualberta.ca. mailto:am7@ualberta.ca advocacy advances vol. 4, no. 1 48 advances in social work exploring redundancy in socialwork education bruce dalton loiswright abstract: : the issue of redundancy has not beenwell explored in the social work curriculum. the educational policy and accreditation standards (epas) (cswe, 2001) requires redundancy in the form of integration of material across content areas and addresses redundancy vertically between levels of education and year of program. furthermore, research and theory support the notion that various types of redundancy produce educational benefits. this paper uniquely usesmsw students to track instances of redundancy over their first year of study and distinguishes between helpful and unhelpful redundancy. it presents both the study results and a description of the study process so that other schools may use or adapt it. keywords: curriculum review, curriculum building, redundancy redundancy is a persistent concern in social work education. faculty guard against it by trying to ensure that teaching materials (e.g., readings, films, case examples) are not used in more than one class and that course content is discrete. though social work educators generally aim to purge redundancy from curricula, the concept of redundancy in social work education has not been fully explored, its positive functions have not been articulated, differentiation between useful and useless redundancy not defined, and differing perceptions of educators and students regarding redundancy not considered. this paper addresses these concerns. it first explores the concept of redundancy as variously defined and studied, with particular attention given to social work education. it then describes a study in which the authors asked students to record and describe instances of redundancy that they experienced during their foundation year of the msw program at a large state university. the authors hope the findings will increase faculty sensitivity to the issue of redundancy and help to support integrated, vital curriculum building. this paper also describes a process that other schools may use to identify redundancy in their own curriculum. this process will be a valuable tool for informing the periodic self-study required by the council on social work education (cswe) of all accredited schools. bruce dalton, ph.d. is assistant professor and lois wright, ed.d. is assistant dean at the university of south carolina, columbia, sc 29208. copyright© 2003 advances in socialworkvol. 4 no. 1 (spring 2003) 48-63. indiana university school of socialwork. 49 literature review redundancy in curriculum building often has negative connotations and has been viewed as something to be eliminated. in social work education, this is most clearly seen in relation to the bsw/msw continuum. anderson (1976) looked specifically at bsw/msw education and identified advanced placement as a strategy for eliminating redundancy. seipel (1986) surveyed policy sequence coordinators of 100 bsw and 91 msw programs to analyze policy course content areas, focusing especially on knowledge and skills taught at different educational levels, including articulation between bsw and msw content. examining course outlines and questionnaire results, he concluded that students could experience extreme gaps or redundancy between bsw and msw levels and recommended that educators generate models and principles that could be used to distinguish appropriate content on different levels to avoid these. there is also reference to student perceptions of redundancy within one educational level. tungate, lazzari and buchan (2001), reporting student responses to exit interviews from a bsw program, concluded that students wanted content that was integrated and could be applied but not redundant. this begins to get at the heart of the redundancy issue: though students do not like what they view as repetition, they value other curriculum features, such as integration. in short, redundancy is not always a negative. in fact, in contrast to these criticisms of redundancy, various fields offer examples of redundancy that enhance learning. for instance, an article from the field of mass communications that focused on television messages defined redundancy as “simultaneous presentation of the same or similar information through two or more channels” (hanson, 1992, p. 7), that is, both auditory and visual. the assumption was that repetition in more than one channel reinforces messages already present in each so that the sum is greater than its parts. useful redundancy is also addressed in relation to reading comprehension (bensoussan, 1990). prior knowledge of a topic is one form of redundancy, and smith (1978) argues that one only comprehends text which has been previously encountered in the real world, and that written text, in order to be understood, must reflect information that is already present in the reader’s mind. a strong case for redundancy in curriculum design comes from the field of legal education. in an article describing a seminar that revisits the entire first year of law school education through a feminist lens, providing a “unifying and altering perspective” (p. 218), bernstein (1996) states: law school curricula in the united states are full of revisits…the educational benefits of such revisits…are indisputable…common ground emerges when students hear the same concepts in different classrooms…. redundancy is integral to legal education, not least because it distinguishes what is central from what is marginal. (pp. 217-218) from the field of psychology,winstanley and bjork (2002) discuss the effectiveness of repetition in terms of both spacing information and repeating key ideas dalton, wright/exploring redundancy in social work education 50 advances in social work from various standpoints. each of these strategies provides multiple opportunities to revisit the same content, thereby, encouraging various ways of encoding information and aiding retention. from the field of social work education, the concept of useful redundancy has been long present. towle (1954), drawing upon the work of ralph tyler, while warning against repetition that “deadens interest and engenders resistance” (p. 168), speaks eloquently about the value of repetition that progresses, or repetition with a difference. towle’s examples of useful repetition include (a) repetition of major ideas, principles, and methods in new situations; (b) repetition which provides the learner an “expectancy of success (p. 168)” or reassurance based upon past successes and upon finding old elements in the new; (c) repetition that involves different learning experiences focusing on the same outcome, thus giving the learner confidence in the methods being taught; and (d) repetition in which students are encouraged to find common and distinctive elements, thus assisting with transfer of learning and supporting the students’ integration of learning. a major difficulty in exploring the literature on redundancy, however, is that the concept is seldom addressed explicitly as “redundancy” or as “repetition.” rather, it is implied within discussions of various learning and teaching theories and strategies. subsumption theory (ausubel, novak & hanesian, 1978) addresses the need to integrate new material with previously presented material using comparisons and the cross-referencing of new and old material to enable differentiation and specificity. elaboration theory (english & reigeluth, 1996; reigeluth & stein, 1983) addresses the need for ongoing summary and synthesis to form a context for assimilation of new ideas, thus aiding retention and transfer. closely related is the work of bruner (1966) on spiral curriculum that describes various ways of connecting new material to old. winstanley and bjork (2002), discussing learning as an interpretive process, state that new information is stored by linking it to existing knowledge through associations and that recall is heavily cue dependent. in addition, they discuss the elaborative process which requires that information be thought of in different ways and practice in retrieval of previously presented information as aids to memory encoding and retention. implicit references to redundancy are also found in the social work literature. aviles (2002) explored mastery learning, which involves multiple testings and feedback (repetition) to move students toward achievement. both sokolec (2001) and walsh (1998) discuss the use of integrative assignments, designed to draw upon material from several courses, as a strategy for deepening learning. haynes (1999), in an article on teaching professional social work values, suggests a framework that uses an “interconnected continuum of values dimensions that fosters the ongoing processes of reexamining and reanchoring student values within a professional social work context.” (p. 44) cswe has addressed redundancy both explicitly and implicitly and its negative and positive uses. at the time of this writing, cswe is in the process of implementing new educational policy (ep) and accreditation standards (as) (collectively known as epas) (cswe, 2001), with full implementation required by february 2004. both epas and the outgoing curriculum policy statement (cps) 51 and evaluation standards for msw programs (evs) address redundancy (cswe, 1994). the outgoing standards address redundancy in evs m5.8, stating “duplication and redundancy of content mastered at the baccalaureate level must be avoided in master’s programs.” epas similarly permits course waivers, exemptions, advanced placement, and other allowances by stating “in those foundation curriculum areas where students demonstrate required knowledge and skills, the program describes how it ensures that students do no repeat that content.” (as 5.3) this avoids students retaking courses similar to those they have already taken.while this is important, the crux of the issue of redundancy as discussed in this paper is the avoidance of useless redundancy in the courses that students are required to take and the seeking of planful repetition. epas (cswe, 2001) addresses issues of redundancy in several ways, though the word redundancy is not used. epas addresses vertical integration in terms of (a) “curricula that build on a liberal arts perspective” (ep 1.2), (b) “baccalaureate and master’s levels of educational preparation are differentiated according to …depth” (ep 2.0), and (c) “build an advanced curriculum from the foundation content” (ep 5, as m2.0.1). these requirements ask for repetition in the form of vertical redundancy involving sequencing of material in which subsequent mentions of a concept or theory are dealt with at a deeper, more abstract, or more conceptual level. this allows for cumulative and continuous learning over time (ornstein & hunkins, 1993). epas addresses horizontal integration in terms of “baccalaureate and master’s levels of educational preparation are differentiated according to…breadth, and specificity of knowledge and skills.” (ep 2.0), and “integration” into the curriculum of content on values and ethics, diversity, populations-at-risk, and social and economic justice (ep 4.0, 4.1, 4.2). designing curricula for horizontal integration means linking different topics and elements that students may experience simultaneously (ornstein & hunkins, 1993). both vertical and horizontal integration require overlap of content that allows repetition with progression or repetition in different contexts. epas requires consideration of different practice contexts (ep 2.0), thus it is appropriate to consider a theory or concept’s application in different curricular areas, such as policy, micro practice, or macro practice. in summary, though the literature offers only limited explicit references to redundancy, tending rather to include it as a concept within the discussion of some more general theory or approach, we believe that it is important enough a concept for social work education to merit special consideration. it is a concept that is recognizable to both faculty and students, regardless of their familiarity with teaching or learning theory. in addition, the structure of social work education, with its emphasis on connections between bsw and msw curricula, between foundationand advanced-year curricula, and among concurrently taught courses, brightlines the issue of redundancy. thus, well-designed curricula require some repetition, while avoiding useless and “deadening” redundancy.we believe that it is important for faculty who are involved in curriculum design as well as faculty who want a better understanding of teaching integration and connectedness to closely examine the concept of redundancy. faculty need to examine the usefulness of redundancy in the dalton, wright/exploring redundancy in social work education 52 advances in social work curriculum and to differentiate between useful and useless, “deadening” redundancy. we assume that faculty have some sense of techniques to help ensure that using repetition has the desired effect on students—promoting and facilitating lateral connectedness, application across contexts, and vertical knowledge building.yet, we know little about how students experience our efforts. both hanson (1992) and bensoussan (1990) address the subjectivity of interpretation and individual differences in perceptions that people bring to the learning situation. certainly, we may expect differences between student and faculty perceptions of redundancy as well as differences among students. the methodology used in this study makes a unique contribution as it accesses student perceptions of redundancy in the social work curriculum. methods this is an exploratory, two-year longitudinal study of redundancy among courses in the msw program at a large state university. students were recruited to provide their perceptions regarding redundancy during their two years in the program. this report is for the first year of the study. sample during orientation for the 1999/2000 school year in august 1999 the authors made a presentation to the incoming class of full-time msw students. the authors explained that the purpose of the study was to improve the curriculum and that participation would require keeping a log, turning it in periodically, and attending three meetings to discuss material from the logs. initially, 27 students agreed to participate, though only 17 turned in logs for the fall semester. of these, five were african-american, 12 were european-american, and four were male and 13 female. further attrition resulted in only 12 students’ completing logs in the spring semester. of these, two were african-american and 10 were european-american, and three were male and nine were female. these students resemble the student body at large, which is mostly european-american and female. as this was a convenience sample, it was not expected that it would be truly representative due to both the sample size and self-selection effect. though fewer students participated than we had hoped, those who did were dedicated to the project and provided much useful data. procedures the participants attended a one-hour orientation meeting soon after recruitment. at this time (a) the study was further described, (b) educational concepts that related to redundancy were explained, (c) consent forms signed, and (d) the journal forms and data collection process reviewed. three additional meetings were held. to encourage attendance we scheduled all meetings for the lunch hour on class days, with lunch being provided. the meetings’ discussions were recorded and transcribed. the first meeting was held at the end of september to discuss how the data collection process was proceeding up to that point. twenty students attended this meeting. 53 two further meetings were conducted, one near the end of the fall semester and another near the end of the spring semester. participants were asked to turn in their logs early so that the authors could present material from the logs (e.g., redundancies that were identified) at the meetings for general discussion. this allowed students to elaborate upon the material, especially the helpfulness or lack of helpfulness of the redundancies. students were paid $40 for each semester of participation. analysis a content analysis of the students’ journal entries was performed to categorize identified redundancies according to course, content, and perception of usefulness. a considerable qualitative focus was also maintained, as the students went beyond merely identifying instances of redundancy and commented on many aspects of the curriculum, both in their logs and in the group meetings. results collecting data at two time periods allowed students to report redundancy both within and between semesters. results from fall 1999 seventeen students attended the end-of-semester meeting and turned in completed logs. as part of their first semester, the students take four classroom courses and field placement. the courses are human behavior in the social environment i (hbse i), which covers culture, community, and organizational theories; introductory courses in micro practice and macro practice; and policy. fall 1999 content the first stage of data analysis consisted of reading the journals and counting the number of times materials (e.g., readings, videos, and class activities) and content (e.g., ideas, information) were noted as having been covered in more than one course. there were 28 separate types of content redundancy noted in the journals and a total of 161 entries.while some content topics took considerable class time and were cited by more than half of the participants, others were minor topics in the class and were cited by only one person. for the sake of brevity, only the most commonly cited topics will be discussed. table 1 lists the more common content topics cited, the classes the content was identified in, the number of students placing the content in a particular class, and the number of students who stated whether the redundancy was helpful. according to participant logs, social work history was the most commonly identified content redundancy, appearing in all four classes (table 1). it was gratifying to see that so many participants believed the redundancy was helpful.when horizontal redundancy works, it works as shown in this comment made by a student who identified social work history in both the policy and micro practice class: “both classes showed historical significance for different areas, e.g., how settlement houses affected policies.” this student had an experience in which similar content was made relevant to different curricular areas. other students made comments indicating that this topic was important to stress in the different curriculum areas for the purpose of socializing into the profession, such as “helps to dalton, wright/exploring redundancy in social work education 54 advances in social work reinforce what social work is all about” and “this was very helpful to me coming from a psychology background.” it also seems that students have different reactions to hearing content for the second time, with some appreciating it and others not. one student who thought the redundancy useful commented that it “helped reinforce the material,” while another who thought it was not useful commented, “i have had social work history in every class.” social work history was further discussed at the fall end-of-semester meeting. the oral comments made at the meeting were more negative than the written comments from the logs, with no one speaking positively about redundancy in this area. the first three comments in the meeting about history were as follows: “it was overdone,” “it was dealt with the same way,” and “it was just thrown out and then left.” the moderator of the meeting asked specifically whether the topic of social work history was dealt with differently in the different classes and gave the example of how the policy course might focus on how social workers have had an impact on public policies. one participant said, “i think they tried to bring it out later, but it didn’t work very well.” another participant said that two classes had very similar articles on social work history and that all classes had some type of reading on the subject. the reason for the difference in tone between the written comments in the logs and the comments made at the meeting is unclear, but the consensus at the meeting was that redundancy in this area was not helpful. eight participants cited the topic of feminist theory as being present in both the micro practice class and the hbse i class (table 1). five students believed that this repetition was helpful and wrote comments such as: “wasn’t clear the first content classes number was the redundancy helpful? cited in of citings yes no unsure social work history micro 6 6 3 macro 7 policy 8 hbse i 3 feminist theory micro 8 5 1 2 policy 1 hbse i 8 ecosystems theory micro 7 5 1 2 macro 3 policy 1 hbse i 8 values and ethics micro 5 3 2 2 macro 6 policy 4 hbse i 1 the various u.s. micro 3 5 1 cultures, cultural policy 2 differences, and race hbse i 5 community structures macro 4 1 1 2 and dynamics hbse i 4 table 1: content redundancies identified in the fall 1999 semester 55 time,” “difficult to understand, but repetition helped to clarify it,” and “refresher.” it seems that the difficulty of the topic and the ability of the instructor may have influenced whether the students appreciated the repetition. in the end-of-semester meeting, several students spoke to this while discussing feminist theory, saying, “well, some of the instructors are better at teaching, too, so you may have heard it in one class and not fully grasped it, and then the same information is presented similarly but maybe in a little more in detail or something, and… its plainer.” another added that students like to hear and recognize information for the second time as “…it is a reaffirmation for myself that i did understand it…” the college’s curriculum committee had been intentional when placing content on feminist theory in both courses. the curriculum was constructed so that feminist theory would be explained in the hbse i course, and the micro practice course would focus on implications of feminist theory for the practice relationship and treatment. participants in the end-of-semester meeting disagreed as to whether this separation worked as planned. one participant said, “in my hbse course, it was just one of the theories. it was kind of a quick overview, and then in micro, it was more practice, how to put it into practice. i didn’t see it as a redundancy.” however, another participant said, “it was never reviewed that way in micro.” a further issue is temporal coordination between courses. it would be best if the components of the theory were discussed in hbse i before the implications and applications of the theory were discussed in micro practice. as individual instructors are in charge of their own course calendars, the sequencing of material may not occur this way. one participant said that feminist theory was covered in the micro practice class before it was covered in the hbse i class. ecosystem is the organizing theory that undergirds the curriculum at the college. it would be disappointing if it did not appear in each class, though it would be expected that different use of the theory would be made, depending on the system level or curriculum area. indeed, the logs showed a high level of redundancy of ecosystems content (table 1). at the end-of-semester meeting the participants were able to understand why this repetition was important, and one participant recognized that different applications were made in the different courses, saying, “one applies it to… behavior in humans, one applies is to institutions and organizations and how they operate, and then one, i think, in practice…” others were not as sure whether such good use was made of the theory in their various courses, but this seemed to be a matter of their having unclear memories of how it was dealt with in each course rather than having any clear impression that the repetition was not handled well. thus, the discussion around ecosystems indicated that students could identify and understand the importance of repeating material in different ways across courses. the topic of values and ethics is also one that should appear across the curriculum and, in fact, the participants did identify it in every course (table 1). the only written comment on this topic noted from the logs was that the micro and macro practice courses discussed different ethical responsibilities. in the end-ofthe semester meeting, it was stated that the topic was dealt with in policy and dalton, wright/exploring redundancy in social work education 56 advances in social work macro practice and it was also covered in field placement and orientation. the students felt that this was an important topic and valued the times it was applied to particular material in the micro practice and policy courses. the students did not value it when the facts of social work values and ethics were all that was presented, as in hbse and orientation. redundancies of information on u.s. cultures, cultural differences, and race were largely seen as helpful (table 1). one person made the log entry “micro focused more on counseling, hbse focused on behaviors and values in general.” another noted that “hbse focused on differences, and micro practice on the ‘inclusive cultural model of practice.’” it thus seems that the topic was covered appropriately, yet differently, in each class. the one student who believed that redundancy was not helpful commented, “should be in hbse only,” offering no explanation. at the end-of-semester meeting several students commented that they believed this redundancy was often not helpful and cited cultural preferences for the degree of eye contact and physical proximity as examples that were presented identically in both hbse i and micro practice. another student thought that the level of discussion was too shallow and that the information was often presented as a generalization about a culture. the background of the students was a factor for how this topic was viewed, as shown by the following excerpt from the transcript. student one: i don’t think it’s that difficult a concept to grasp. student two: it’s not if you’ve already done a lot of stuff…i mean, you’re talking to someone who was a music major. student three: i was in hotel administration. redundancies regarding information on community structures and dynamics were identified by four participants in the macro practice and hbse i classes (table 1). only one participant judged the redundancy as helpful, and this was not because a different use or application was made for the material but rather because it was “more detailed second time, reinforced.” this sentence fragment seems to indicate that if the material had been presented in a more complete fashion the first time, it may not have been seen as helpful the second time. fall 1999 materials it is frustrating and embarrassing to a teacher when introducing a video to have one or more students brightly say, “oh, we saw that last semester in smith’s class.” these participants identified many such instances of identical materials, usually videos, being used in different courses. the college maintains a list of videos that are reserved for particular courses. in no case have videos been reserved for two courses with the intent of making different use of them. six participants identified five videos as being used in two different courses. in three instances, this was cited as being helpful, in one instance it was not, and in one instance the participant was unsure. there was one case of missing data. in addition to the videos, there were two in-class exercises and two similar articles identified in two different courses. the five students who identified these judged them as being helpful on two occasions and not helpful on three. 57 overall, though findings were mixed, there was limited support for redundancy of materials and students perceived that when materials were repeated, there was little attempt to highlight different uses or learning anticipated from the repetition. results from spring 2000 during the second semester of the foundation year students again take field and four classroom courses—practice with groups, research i (research methods), research ii (single subject design [ssd] and descriptive statistics), and human behavior in the social environment (hbse ii), which covers theories of family and individual development. the types of redundancy that may emerge during this semester include redundancies between semesters and those among current courses. spring 2000 content there were 33 separate content areas of redundancy noted in participant logs and a total of 129 entries. there were slightly more types of redundancy noted than in the fall semester (5) but fewer actual entries (32). since the course work is different and there were fewer respondents (reduced from 17 to 12), any direct comparison of fall-semester and spring-semester findings is not possible. table 2 shows the content areas that were most often noted in the spring semester. the degree of overlap between the two research courses was not surprising. level of measurement is a basic research concept relevant to both research methods and statistics. whether the students believed the redundancy was helpful depended in part on how it was presented each time (as was seen in the fall semester). for example, a student who said that the redundancy was not helpful commented in the log, “in both classes it was explained and defined in the same way.” a student who said that the redundancy was helpful commented that the second time, “there was more information and there were relevant examples that helped me understand the terms.” the same was true for the threats to internal validity item. a student who thought the topic was helpful when repeated in research i commented, “we went over it so quickly in research ii.” a student who did not think the redundancy was helpful commented, “it just repeated the same dalton, wright/exploring redundancy in social work education content classes number was the redundancy helpful? cited in of citings yes no unsure level of measurement research i 6 4 2 research ii 6 reliability, validity research i 5 3 1 1 research ii 5 threats to internal research i 5 2 3 validity research ii 5 ecosystems theory hbse i 6 5 3 hbse ii 6 groups 3 “fall” 2 table 2: content redundancies identified in the spring 2000 semester 58 threats to research studies like history, maturation, etc.” for the reliability/validity item the only comments were from students who thought the redundancy was helpful. ecosystems was a topic taught in both the fall and spring semesters.whether or not students perceived redundancy around this topic as helpful related to how the material was presented. a student who believed the redundancy was helpful commented that the repetition demonstrated a “new way of using theory in group setting” in the group class. another stated that the repetition “expanded upon previous base.” ideally, vertical redundancy would demonstrate increased depth of analysis and application of ecosystems theory. students recognized and appreciated when this occurred. this was not always the case, however, and two students who thought this redundancy was not helpful commented, “recap, but was too long” and “re-presented in a confusing way.” it seems the ability of the instructor plays a crucial role in whether redundancy is helpful, regardless of whether it is planned redundancy or not. at the spring end-of-semester group meeting a student noted that in two of the spring classes the professor asked whether everyone was clear on ecosystems theory from the fall semester before applying the theory in class. time was thus saved by the professor allowing the students to ask clarifying questions they might have had rather than re-presenting the entire theory. spring 2000 materials four videos were identified as having been shown in the spring semester of hbse ii and in the previous semester of hbse i. the six students who reported this were unanimous in believing that this redundancy was not helpful. a group activity that had been done in micro practice during the fall semester was repeated in the groups course in the spring semester. the student who identified this commented, “enjoyed activity, but 1st time was enough.” an article that was used in both hbse i and hbse ii was also identified. this student did not think the repetition was helpful. process evaluation a surprising aspect of this study was the high attrition rate. the researchers believed that the food and monetary compensation would be adequate to keep the students involved considering the minimal amount of time and effort requested from them.while we may have correctly estimated the relative value of the compensation to the time and effort requested, we may have underestimated the competing demands for time and effort made upon the students by school, family, and employment. one student who did not participate in the spring semester said he was overwhelmed by planning his wedding, to which 600 guests were invited. the quality and quantity of comments made by the students varied considerably. some students were very thorough in their recording and highly verbal during discussions, while others made minimal written and oral contributions. some were highly organized and analytical in their comments, while others made more concrete comments. one had difficulty grasping the full definition of redundancy, persisting in thinking that if he benefited from or enjoyed the repetition, it was advances in social work not redundancy. other students provided very insightful comments aimed at the overall organization of the curriculum. just as faculty may advocate for the inclusion of particular content of interest to them, students also bring their personal agendas to the educational process. at the spring end-of-semester meeting, while discussing the balance of content among gays, lesbians, and minorities compared to some other groups, such as the disabled and the elderly, some students reacted on a personal and very emotional level. as several students persisted in their contention that there was too much content on gays and lesbians, the conversation grew more animated with a louder tone and fewer pauses, indicating a higher emotional content. a student who several times stated that there was too little content on the elderly mentioned that after graduation she planned to work with the elderly. discussion usefulness of the methods this methodology adds a valuable new source of information to the curriculumbuilding process. students have not been used previously to inform the curriculum about redundancy. they identified teaching methods and areas in the curriculum that needed more attention, planning, and conceptualization. these methods ranged from being more careful not to repeat videos to the planned application of similar theories to different content areas. what participants told us as noted by hanson (1992) and bensoussan (1990), participants vary in their perceptions of redundancy. discussions during group meetings showed that students brought to the educational experience different attitudes toward content (e.g., views on feminism), different educational backgrounds and preparedness (e.g., bsw, other social sciences, non-related), and different levels of attention and analytical abilities. these differences contributed to variation in awareness of redundancies as well as to lack of unanimity regarding its helpfulness or unhelpfulness. in addition, student perceptions of redundancy were influenced by what instructors brought to the classes, regardless of the formal requirements of the curriculum. in accordance with the findings of shavelson (1986), students noted that in different sections with different professors they can get very different content, depending upon the professor’s interests and personal life experiences. they described some professors as having “soap boxes” and talking about their interests regardless of the course. thus, students generally thought that choosing different professors would reduce redundancy. an exception was noted in relation to the two concurrently taught research courses in which having one instructor contributed to greater discretion of content. students related the usefulness of redundancy to the skill of the instructors. for instance, if an instructor presented a concept ineffectively, a repetition of that content in another course was seen as helpful redundancy. likewise, students noted that some instructors were better than others at deepening and expanding material. 59dalton, wright/exploring redundancy in social work education students not only were aware of redundancies but also for the most part could differentiate between helpful and unhelpful redundancy. though individual students had different perceptions based on their own characteristics and experiences or on sections/professors, they generally agreed on certain factors that contributed to helpfulness or unhelpfulness. generally, students found redundancy not useful when it was merely repetition, dealing with the same material in the same way, and they were able to recognize “repetition with a difference” (towle, 1954). they did, however, note that sometimes simple repetition can be reinforcing and thus feel good, as also noted by towle (1954). students could discern different levels of coverage of material—e.g., readings without discussion, description of theory, depth of discussion, or application. students were generous in allowing that faculty might have attempted to handle repeated concepts differently, though they might have missed the mark. other comments and observations from students included that: � sequencing of some material was off, resulting in a lack of the intended progression (e.g., theory to application); � there was more redundancy at the beginning of courses than later, when each course took a more distinct form; and � the shorter the time between the initial presentation of content and the repetition, the less helpful, with greater time lapses adding to the perception of helpfulness. students perceived some differences between first and second semesters. they reported that teaching styles changed, as the first semester focused on giving information through lectures, while the second semester used more application and discussion, thus enhancing the usefulness of redundancies. in addition, some students reported that their attitudes had changed by second semester, when they were more able to accept the positive uses of redundancy. in terms of redundancy in materials, overall, students reported less redundancy than we had anticipated and generally saw it as not helpful. students reported that when materials were repeated, instructors made little attempt to highlight different uses or different learning anticipated from the repetition. findings as related to the college’s curriculum the college’s 1999 self-study for reaffirmation of accreditation identified several major themes that were infused throughout the curriculum. these included (a) social work values and ethics as the base for practice; (b) an ecosystems perspective to provide conceptual and theoretical integration; (c) a commitment to social and economic justice, with a focus on the needs of the poor, oppressed, and populations at risk; and (d) awareness of and appreciation for diversity. one of the benefits of redundancy is reinforcing themes, helping students “distinguish what is central from what is marginal.” (bernstein, 1996, p. 218) the curriculum aims to support horizontal and vertical integration. student comments provided some support for horizontal integration (e.g., repeating material during the first semester in different contexts) and some for vertical integration 60 advances in social work (e.g., focusing on depth of understanding or application during the second semester). further examination of vertical integration particularly will occur during the second year of this study. findings as related to cswe requirements findings suggest that students experience the college’s curriculum in a manner consistent with cswe requirements. whether or not they experience horizontal and vertical coherence, students at least recognized and valued that repetition of content and themes both horizontally and vertically was reinforcing and knowledge-building. the epas (cswe, 2001) requires that “frameworks and perspectives for concentration include…practice contexts” and students recognized redundancy of theories applied to different settings, groups, and problem areas and saw it as helpful. they commented particularly on the importance of infusion of values and ethics throughout the curriculum. conclusions and implications what has been described is a new process of gathering student feedback on the curriculum. this first year of the study has suggested that students are aware of redundancies in the curriculum and, though their perceptions vary, can differentiate between helpful and unhelpful redundancies and can state reasons for each. it is likely that any educator reading these results will be spurred to think about redundancy in his or her own program in new and different ways. we offer as an aid table 3, which summarizes the types of redundancy discussed explicitly or implicitly in the literature or by students and the benefits suggested. faculty may want to consciously emphasize these positive uses of redundancy in curriculum design and implementation. they may want to check to ensure that their uses of redundancy clearly are those which can produce a range of learning benefits for students and ensure that teaching does not lapse into “boring repetition.” the authors present this study as a process other schools may choose to replicate or adapt in their own ongoing curriculum planning, as it would constitute a new feedback loop, systematically entering student perceptions into the curriculum revision process. though the ultimate responsibility for the curriculum design rests with faculty, understanding how students experience the curriculum is vital information. we have only begun the empirical study of redundancy in the social work curriculum. how, where, and when to place purposeful redundancies into the curriculum remains based largely upon opinion and theory, and research into the effect of redundancy upon educational outcomes is lacking. future challenges involve becoming better informed and more intentional in our use of redundancy and to empirically assess the relationship between educational outcomes and redundancy. to make the process of including purposeful redundancy overt and empirically guided will both streamline the curriculum and make it more effective. 61dalton, wright/exploring redundancy in social work education references anderson, w.a. (1978). avoiding redundancy: advanced placement in social work education. journal of sociology and socialwelfare, 5(2), 250-262. 62 types benefits present material through several channels synergistic reinforcement connect old material to new can comprehend only in relation to what already know repetition with progression reinforce and build vertical integration, building over time deepening, cumulative, progressive on previous material understanding present same concept in different distinguish what is central from what is classes and from different perspectives marginal presenting material from different opportunity for various ways of standpoints encoding information horizontal integration, linking concepts aids transfer of learning, applying that are experienced at the same time in material across contexts and in new different courses situations spacing presentation of material, return to opportunity for various ways of same material later encoding information, aids retention presenting old material in new situation aids with transfer finding new elements in old material build confidence, feelings of success using different methods to arrive at same build confidence outcomes exploring common and distinct elements aids transfer of learning, integration, and discrimination interpreting new material in relation to old, aids with differentiation, specificity, with comparisons and cross-references while reinforcing using periodic summaries and syntheses aids with transfer and retention as context for new ideas elaborating, interpreting in different ways builds multiple cues which aid with recall practicing retrieval of information supports memory encoding and transfer offering multiple opportunities for testing supports mastery and feedback in relation to same material making integrative assignments that use deepens learning material from several courses or content areas conducting ongoing reexamination of fuller understanding and integration concepts repeating material previously inadequately opportunity to learn what was missed presented on the initial presentation table 3: types of and benefits from redundancy advances in social work ausubel, d., novak, j., & hanesian, h. 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(2002). successful lecturing: presenting information in ways that engage effective processing. in d. halpern & m. hakel (eds.), applying the science of learning to university teaching and beyond (pp. 19-31). san francisco, ca: jossey-bass. author’s note: address correspondence to: bruce dalton, ph.d., assistant professor, the university of south carolina, columbia, sc 29208, usa. e-mail: bruce.dalton@sc.edu. 63dalton, wright/exploring redundancy in social work education aisw vol. 5, no. 2 328 social work practice with arab families: the implications of spirituality vis-à-vis islam ronald e. hall abstract: in the aftermath of september 11, 2001, spiritualism has become apparent as critical to social work practice with arab families. regrettably, research on arab families today is all but non-existent.their belief in islam is the fastest growing form of spirituality in central asia. social workers who do not acknowledge this fact will be at a severe disadvantage in their attempts to treat arab clientele. it is not compulsory that practitioners endorse client belief systems or other aspects of their spirituality, but practitioners should acknowledge said systems as a critical point in the client’s frame of reference. in the interest of social justice, social workers are thus challenged to develop creative treatment strategies less confined towestern bias. keywords: spirituality, islam, social work, families, arab introduction post september 11, 2001, spiritualism has become apparent as critical to social work practice with arab families (kilpatrick & holland, 1990). professional and anecdotal accounts of spiritualism offer considerable evidence to substantiate that claim. dominating the aftermath of horrendous destruction, political pundits of every tenor find little basis for disagreement in the wake of renewed patriotism, stern warnings, and calls to military action. within the midst of such fervor, social work will require a more informed response if it is to remain viable and loyal to its code of ethics (gambrill, 2001). furthermore, despite the events in new york and washington, d.c., which ended in commercial aircraft being used as missiles to assault non-military targets, america will prevail. no doubt, these most recent and past instances of arab terrorism suggest concern for america’s ability to prevail, but any call to action must be tempered with patience. patience will accommodate informed practice methods with arab families, despite episodes of terrorism perpetrated by a few among their population. failure on the part of family social workers to comprehend the circumstanceswill facilitate ignorance exacerbated by political repercussions. repercussions have the potential to dampen enthusiasm for the incorporation of spirituality into social work practice. such a dampening effect extends to practice ronald e. hall is an associate professor of social work at the research institute, school of social work, michigan state university, east lansing, mi 48823. copyright© 2007 advances in socialworkvol. 8 no. 2 (fall 2007) 328-337. indiana university school of socialwork. with arab families who may find themselves subjected to the auspices of western service providers. without exception, spiritualism is a necessity of practice with arab families that could impede the ability ofwell-meaning socialworkerswho lack either the knowledge or motivation to apply it (hodge, 2000). furthermore, in an effort to divert attention from the issue of spirituality, activists have expanded the rhetoric of social justice to include age, sexual orientation, gender, and disability (sam, 2000). yet, within society—and in spite of rhetoric to the contrary—spiritualism for many remains pertinent. although the literature acknowledges spiritualism among the list of treatment resources, amidst the augmentation of social issues, it has been all but trivialized (solomon, 1992). greater focus on ethnic and cultural diversity will enable social workers to assist arab clientele without incident. instead, discussions pertaining to arab families rely too heavily upon circumventing controversy and/or discussion of terrorist acts. in the outcome, rather than asking how they might incorporate spiritualism, social workers pose nebulous questions, such as: “what are the deficits of arab families?” “in what ways can arab families adjust to the american cultural ideal?” regrettably, most social work research on arab families today continues to be all but non-existent (schiele, 1997). in the aftermath of september 11, 2001, such oversight has loomed conspicuous in social work practice.while american diversity has experienced a significant increase in recent years, mainstream studies invariably focus on western/eurocentric resource models, which do not account for nonwestern criteria or cultural variations in family clientele. any attempt on the part of practitioners to stray from standard models encourages invitation to ostracism in journal publication and ridicule by mainstream professionals (schiele, 1996). fortunately, in recent decades, increasing numbers of family studies have begun to focus on spirituality not addressed by the mainstream (phan, 2000). these studies seek the incorporation of religion and other manifestations of spirituality that have been heretofore dismissed as inappropriate for practice settings. in fact, spirituality has been proven invaluable to arab families and the social workers who incorporate it into their practice. furthermore, spirituality utilized by social workers and other helping professionals assists community-based groups and policymakers. spirituality allows for the development of comprehensive program interventions that fortify and give voice to non-western families or families otherwise not identified with thewestern mainstream of society. conscientious social workers would be remiss to exclude a critical aspect of life from practice with families. spirituality may facilitate access to family values, family belief systems, and family practices otherwise inaccessible by traditional methods. furthermore, spirituality for arab families may contain coping mechanisms that enable them to confront and overcome the many challenges of daily life. in an effort to educate and contribute to the effectiveness of social work practice, this paper will have four objectives: 1) provide a beginning introduction to the history of the arab population, including spirituality as per the religion of islam; 2) illustrate the importance of spiritualism vis-à-vis arab families; 3) provide implications for social work practice; and 4) make available a resource to assist social workers and policymakers in the design and development of treatments that incorporate spirituality. 329hall/social work practice with arab families arab/islamic history despite their growth among america’s population, arab families who follow islam represent an unfamiliar component of society (al-krenawi & graham, 2000). their numbers have caused concern among judeo-christian scholars for the mounting tension that has accompanied their growth. as islam continues to become a more significant aspect of western society, it will necessitate portrayal of its followers fairly, objectively, and accurately. suffice it to say that, in western countries, american families who follow islam may eventually outnumber the followers of judaism. given the continued middle-east unrest, recognition of this fact will be critical to maintaining civil order and governmental stability. the potential for tension brought about by arab families who follow islam is a consequence of their relocation towestern societies. in the united states, there are now more than 1,000 mosques and islamic centers, where followers may worship their faith (shuja, 2001). these arab families are respected and productive members of society who are engineers, attorneys, social workers, etc.their numbers are calculated to be in the millions and still growing. in fact, dearborn, michigan, ranks as home to one of the largest arab and/or islamic populations outside the middle-east (goodstein, 2001). no doubt, such a large population has given america cause to anticipate cultural tensions between islamic factions and its citizens, which extends throughout thewestern world. what is more, america is not alone in receiving those who follow islam. among european nations in toto, there are currently 20,000,000 followers of the islamic faith. nearly half–8,000,000–reside inwestern europe.when the republic of turkey is calculated among this number, it increases dramatically to at least 50,000,000 (shuja, 2001). while most americans and otherwesterners known very little about the religion of islam, it is the fastest growing form of spirituality in central asia. following the collapse of communism in the u.s.s.r., kazakhastan, kyrghystan, uzbekistan, turkemenistan, and tajikistan, by official decree, became islamic nations. among the french, islam rivals catholicism in the number of individuals who follow the traditions of an established faith. among the british, followers of islam exist in numbers large enough to advocate for state subsidies in the funding of islamic schools (shuja, 2001). among germans, similar efforts were introduced byturkish immigrants in the 1970s. even in australia, islam has become a mainstay of the population, given its being situated adjacent to the largest islamic country in the world, i.e., indonesia. families who follow islam are a diverse population, but repercussions from september 11, 2001 have been directed primarily at arab members of the faith and arab christians (kennedy, 2001). the origin of the arab population is associated with semitic peoples on what is referred to as the arabian peninsula. the term “arab” in america more often includes those who regard their mother language as arabic. arab countries consist of algeria, bahrain, egypt, iraq, jordan, kuwait, lebanon, libya, morocco, oman, qatar, saudi arabia, sudan, syria, tunisia, the united arab emirates, thewest bank, andyemen. there is disagreement as to how the term “arab” came to be. scholars on more than one occasion have redefined its meaning. some, in particular, have associat330 advances in social work ed the origin of the termwith an ancient patriarch,qahtan,whose tribal groupwas thought to have originated in saudi arabia (glubb, 1969). others equate the origin of arabs with nomadic peoples who resided in parts of the arabian peninsula (glubb, 1969). subsequently, the local population in the same area was not considered arab. still, others applied the term to residents of the entire arabian peninsula and the desert areas of the middle-east. arab people may form significant communities elsewhere in the world, including u.s. non-arab immigrants who are often assumed to be arab, but, in fact, are separate and apart from the true arab population. they include jews in north africa who speak arabic, kurds, berbers, copts, and druze. christians who speak arabic and reside in countries, such as syria, lebanon, israel, and jordan, are counted among the number of those regarded as arab (glubb, 1969). there has been an ongoing effort on the part of arab leaders in the 20th century to form an arab nation. it would consist of morocco on the west and across the middle-east to the borders of iran andturkey. that not being possible, the various arab nations have joined to form the arab league.the purpose of the arab league is to garner unity around issues of arab interest, such as oil prices, colonialism, and the arab-israeli conflict. today, the arab league is composed of 22 memberstates. their ownership of two-thirds of the world’s oil reserves has made them a formidable social, economic, and political force. in the aftermath ofww ii, much of their energy and resources have been devoted to their relations with israel.their belief that the state of israel was brought about by confiscation of arab land resulted in four arab-israeli wars.violence associatedwith that issue has remained aprimary factor in the perpetration of terrorism not irrelevant to social work practice (kulwicki & miller, 1999). arab spirituality islam is by far the prevailing manifestation of spirituality among families of arab descent. in middle-eastern villages, individuals are born into the islam faith and are expected to remain committed to it for life. their commitment to islam is so old and deep-rooted that it has permeated all aspects of family life (al-krenawi & graham, 2000). it is most evident in the belief system held by persons dedicated to the faith. these beliefs are considered canons and are not subject to debate. perhaps foremost in importance among such canons is a belief in the oneness of allah (god). that belief is associated with the prophet mohammed. according to arab tradition, mohammed is the messenger of allah. while the koran regards allah as an ordinary human being, in the arab belief system, mohammed has been accorded the status of a divine entity (wasfi, 1964). akin to mohammed in status is the canon that takes the koran to be the literal word of allah. the koran is the holy literature that exemplifies the final revelations of mankind. it holds the directives for life to which all arabs must submit. not to be minimized in context is its recognition of gabriel. gabriel is the most prominent among angels and is considered to be the bearer of the revelation and spirit of holiness. belief in angels is essential, because it enables the last arab canon, which is life after death. dependent upon how one lives, reward or punishment will await him or her in the hereafter (siegel, 1980). 331hall/social work practice with arab families despite fundamental differences between various arab factions, arab families place a high value on spirituality in the form of islam.the patriarchal arrangement is its traditional family structure. both recent and not-so-recent arab immigrants who follow islam conform to a hierarchical organization of authority that extends to roles, obligations, and status. the welfare of the family supersedes the welfare of the individual, making it the basis of identity (wasfi, 1964). family is furthermore a reference point for behavior and spiritual directives. its union all but completely negates individuality and/or independence—a concept that is foreign to western mores. especially among arab families where islam is the spiritual tradition, reverence for the patriarch, as well as concern for the family’s status, provides a strong sense of solidarity and loyalty (p. 44). hence, the individual family member is not free to live independently but must consider family in each of his or her life decisions as prescribed by the koran.the koran, being the direct instruction from allah, means that family members are expected to fulfill rules of behavior, family roles, such as husband, wife, child, etc., without the opportunity for personal input or preference. an individual’s ability to adhere to spiritual directives reflects not so much upon him or her personally, but upon the family and its kinship network. in the islamic tradition, males are then more valued than females, which may cause conflict in western practice settings. however, unless influenced by western norms, anxiety levels from this secondary status may not increase for women of traditional arab families. the importance of religious spiritualism among arab families is evident in the extreme reluctance of individuals to yield to conversion (p. 49). christian missionaries of the last century are well aware of this reluctance. the number of arab believers who have converted from islam to christianity is very small. for the individual arab, family is not irrelevant to that small number, as the family role in the existence of the community is crucial. thus, those families who migrate to the u.s. more often send for their relatives who are in the “old country.” once abroad, there are few who do not have blood ties with the“old country.”those who do stand out, due to their difficulty in finding jobs or otherwise sustaining themselves. frustrated, such arabs without family frequently return to the“old country,” where normal family ties are a way of life. this significance to family is evident by the fact that whole arab communities may contain a small number of patrilineages (p. 22). consequently, there is considerable overlap between family and spirituality within the arab community. however, while family is an important social structure, spirituality, vis-à-vis islam, guides life and the family belief system. social workers who do not acknowledge this fact will be at a severe disadvantage in their attempts to treat arab clientele. those who do will consider the values extended from spirituality when working with such families. values recognized by the koran include the following: respect for elders and parents, wealth and male children, subordination of women to men, modesty, 332 advances in social work intensive religiosity, equality of all human beings, and health and strength (p. 61-62). implications for socialwork practice the implications of spirituality for social work practice in the u.s. extend from the colonial era (farber, 1977-78). during this time, various christian sects took part in an effort to ensure the new nation would not validate, by official decree, any one religion, philosophy, or other manifestation of spirituality. that notion was put forth by roger williams and others who felt imposed upon by any religious doctrine to which they did not aspire. the preferred separation of church and state also accommodated the emerging diversity that characterized the flow of immigrant and native people who occupied american shores. consequently, religious movements in both the new england north and the protestant south failed in their attempts to institutionalize religion (levine, 1994). that concept enabled complete separation of church and state contained in the u.s. constitution. in comparison with other nations today, there is relatively less confrontation between church and state in america. however, existing lines of demarcation have not eliminated problems completely. school systems on occasion have sought to solicit federal tax dollars to fund religious curriculums (midgley, 1990). at the turn of the century, federal courts still continue to grapple with various religious factions that construct creative mechanisms to obtain federal funds. social workers have not been isolated from the efforts of such activists, who many see as violating the constitution in their attempts to federally-fund religious education. in the aftermath, family practitioners have been less inclined to utilize spiritual resources for fear that spirituality is not only biased but unconstitutional, as well. the implications of spirituality for practice with arab families include the need for practitioners to acknowledge, and when appropriate, apply values, belief systems, and other culture-specific criteria. this will provide the practitioner with alternatives to bringing about the desired change or coping-mechanism. it is not compulsory that practitioners endorse client belief systems or other aspects of spirituality, but they should acknowledge said systems as a critical point in the client’s frame of reference. social workers who serve arab communities would be advised to cultivate working relationships with islamic clergy. these relationships might prove useful in the clarification of arab norms, the facilitation of referrals, and the effective application of treatment strategies. such relationships are mutually beneficial to the extent that both community and service provider is enabled by the information that is exchanged. while some arab families may prefer assistance from islamic personnel, others may be uncomfortable or self-conscious about expressing family concerns to islamic members of a tight-knit community. under such circumstances, the availability of professional social work practitioners might prove invaluable. what is more, the availability of social workers will be particularly helpful if, in fact, the spiritual system, i.e., islam, is the focus of the client’s 333hall/social work practice with arab families dysfunction. the professional social worker will allow the client to explore spiritual alternatives within the context of a spiritually-neutral environment. from the perspective of the social worker, there are several reasons why practitioners might consider the incorporation of spirituality into their practice. first, the effects of spiritualism are well known and are likely to enable practice with arab families (de la rosa, 1988). second, the term “spiritualism,” for most social work practitioners, conjures images of legal conflicts, with the potential to charge emotions; when it is associated with stereotypes, it encourages knee-jerk condemnation of an entire race of people, their social structure, lifestyle, and other aspects of their being (bar-tal & labin, 2001). the outcome will impair the ability of such groups to sustain themselves in the human social environment unless more rational social work factions prevail. third, spiritualism must be viewed as being separate and apart from the legal process. to do otherwise will bias practice with arab families, rendering social work as being less potent in its ability to accommodate them. beyond legal conflicts, the most efficient means of enabling practice with arab families is for social workers to become more educated about arab spirituality. education pertaining to spirituality and arab populations, together, will enable practice (al-krenawi & graham, 2000). social workers who are so enabled will be in a better position to learn and assist arab families in sustaining themselves. furthermore, social workers who help to reinforce respect for arab populations build the self-esteem of their younger family members, which will assist the group’s ability to survive in toto. equally important is the impact of education upon the society at-large. one approach to this method is for social workers to create tolerant environments by building bridges to arab communities beyond what is professionally necessary. the focus on such communities should be their language, history, cultures, etc., rather than the terrorist acts associated with any one member(s). community action groups and youth projects, which familiarize the otherwise unfamiliar, have the potential to validate social work as a helpful profession among arab families who might not otherwise seek social work services (edmond, 1990). conclusion due to the potential for harm and legal repercussions brought about by spirituality, it is critical that practitioners exercise caution when incorporating spirituality into their practice. some aspects of islamic and other manifestations of spirituality might appear abnormal and indeed dysfunctional from awestern perspective. for example, among certain christian sects is the phenomenon of “speaking in tongues,” where church-goers slip into a trance-like state and begin to verbalize in an unfamiliar language (gilbert, 2000, p. 79). in the not too distant past, such persons may have been diagnosed as psychotic and prescribed psychotropic medication. in fact, among said christian sects, “speaking in tongues” is not regarded as psychotic or abnormal. indeed, it is perceived by these sects as a gift from god.thus, for legal as well as practice reasons, social workers must resist the inclination to label spiritual phenomena simply because it is unfamiliar and/or notwestern. this necessitates worth in the much-heralded emphasis upon diversity. social workers who fail to value diversity not only impair client progress, but 334 advances in social work they may also alienate spiritual resources in the community, which could prove invaluable to client treatment. thewestern assessment of spiritual phenomena should not suggest that pathology is non-existent. some aspects of spirituality may, in fact, represent psychotic or other mental impairments. the diagnostic statistical manual lists symptoms that include “bizarre” religious behaviors, delusions, obsessions, and rituals (p. 79). subsequently, spiritual phenomena may indeed extend from psychosis and other mental disorders, which would otherwise require professional attention. when legitimate psychotic symptoms are evident, social workers must exercise the wherewithal to differentiate between what is normal spiritual phenomena and what is not in an effort to accurately assess and diagnose arab clientele. professional social workers engaged in family practice with arabs must also be cognizant of their own spiritual belief systems and what these spiritual belief systems convey to the client (p. 80). the practitioners’ position on spirituality is relevant to setting the tone of the practice environment (p. 80). from those who endorse spirituality, to those who reject it, the practitioners’ position on spirituality will have an impact on the practice setting in a myriad of ways but they will impact it, nonetheless. hence, the practitioner who endorses spiritually may be inclined to overlook dysfunction in certain beliefs and practices, particularly if there is spiritual commonality between practitioner and client. conversely, the practitioner who rejects spirituality will view the same beliefs and practices as dysfunctional when they are not. social workers who reject spirituality may further unintentionally minimize its role in practice with arab families for whom it is essential. subconsciously, by their behavior, such social workers suggest that spirituality is irrelevant or otherwise not appropriate as a treatment resource. therefore, those who both endorse or reject spirituality must be vigilant that their personal belief systems do not cause injury or harm to family practice clientele. finally, the ability to accurately perceive, conceptualize, and interact with arab families is a necessity in a rapidly changing and complex world. in order to enhance harmony and reduce the threats of terrorism by any aspect of the world’s complex population, social workers and other concerned citizens must acknowledge that all groups have assets, capacities, and strengths that should be reinforced despite the heinous acts committed by a relative few (sontag, 2001). since many of these assets, such as cultural technologies, are derived from cultural legacies, social workers must increase their knowledge base considerably. otherwise, their lack of education could contribute to the extinction of an irreplaceable component of mankind that might prove antidotal to violence and terrorism. furthermore, at a time of increased contact among the world’s various populations, social workers are confronted by issues and perspectives that did not require intellectual consideration in the past (shatz, 2001). they are thus challenged to develop creative treatment strategies that are less confined to western bias. additionally, journal editors, book publishers, and other affiliates of the “fact” manufacturing industry must be actively receptive to the consideration of alternative views. that consideration must remain consistent and viable without interruption from unpredictable events to sustain the integrity and prestige of the social work profession. 335hall/social work practice with arab families references al-krenawi, a., & graham, j. 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[on-line], 17 available: http://www.findarticles.com/cf_0/m2242/1624_278/75533389. siegel, r. (1980). the psychology of life after death. american psychologist, 35(10), 911-931. solomon, a. (1992). clinical diagnosis among diverse populations: a multicultural perspective. families in society: the journal of contemporary human services, 73(6), 371-377. sontag, d. (2001, may 20). as emotions boil over, arab-israeli violence rages on. the newyork times, p.4. wasfi, a. (1964).dearborn arab-moslem community: a study of acculturation. east lansing, mi.: michigan state university. 336 advances in social work author’s note: address correspondence to: ronald e. hall, ph.d., school of social work, college of human medicine, michigan state university, room 224, baker hall, east lansing, mi, 48823, usa. e-mail: hallr@msu.edu. 337hall/social work practice with arab families spring2005-180_page182 spring2005-181_page183 spring2005-182_page184 spring2005-183_page185 spring2005-184_page186 spring2005-185_page187 spring2005-186_page188 spring2005-187_page189 spring2005-188_page190 spring2005-189_page191 spring2005-190_page192 microsoft word martin_mental health access formatted 3 _________________ jennifer martin, ph.d., is an associate professor of social work at rmit university in melbourne, australia specializing in mental health. fiona oswin is a social worker in the disability field in malaysia. she conducted the research presented in this paper as an undergraduate mobility exchange student at rmit university on the endeavour australia cheung kong scholarship programme with the university of malaysia-sarawak. the authors wish to express their utmost gratitude to the students who gave generously of their time to participate in this study. they also extend their appreciation to rmit university student union and school of global studies, social science and planning; endeavour australia cheung kong scholarship programme and the university of malaysia-sarawak for supporting this research. copyright © 2010 advances in social work vol. 11 no. 1 (spring 2010), 48-66 mental health, access, and equity in higher education jennifer martin fiona oswin abstract: this paper tackles the difficult and often not openly discussed topic of access and equity in higher education for people with mental health difficulties. recent legislative and policy developments in mental health, disability, anti-discrimination and education mean that all students who disclose a mental health condition can expect fair and equitable treatment. however the findings of an exploratory study at an australian university reveal that just under two thirds of the 54 students who reported mental health difficulties did not disclose this to staff due to fears of discrimination at university and in future employment. students who did disclose felt supported when staff displayed a respectful attitude and provided appropriate advice and useful strategies for them to remain engaged in university studies when experiencing mental health difficulties. key words: access and equity, stigma, mental health and wellbeing, education introduction access and equity are at the forefront of legislation, policy and practice in mental health, disability and education in australia and new zealand, the united kingdom, the united states and canada (knapp, mcdaid, mossialos, & thornicroft, 2007). in accordance with these legislative and policy frameworks, government funded universities have clearly articulated access and equity policies and programs. however a dilemma presents itself when students with mental health problems do not disclose the difficulties they are experiencing, or seek assistance, due to fear of possible discrimination (mclean & andrews, 1999). this paper considers policies and practices in teaching and learning in higher education focusing on issues of access and equity for students experiencing mental health problems within the dominant paradigm of population health wellbeing programs. this is followed by a case study and discussion of the experiences of students with mental health problems enrolled at an australian university. the main mental health conditions experienced by students are identified and ways in which these have impacted upon their studies. issues concerning disclosure are considered followed by the identification of the types and sources of assistance that students found most helpful. the paper concludes with a discussion of the key findings of the case study and a conclusion and recommendations for practice and further research. policy context worldwide increased efforts are targeted at programs for the prevention of mental illness by government, the world health organization and the world bank. this is in advances in social work, spring 2010, 11(1) 49 response to predictions that within the next two decades mental health problems will be the largest single burden of illness globally (mathers & loncar, 2006). a main focus is on centralization of governance and stronger accountability measures, with population health and wellbeing programs considered to be the most economically viable and equitable solution (world health organization [who], 2009). equity of access to mental health care is a central objective of mental health systems in canada, australia and new zealand and has underpinned the national health service of the united kingdom since its inception in 1948. contrary to popular belief, high levels of government funding and the privatization of healthcare systems does not ensure equity as witnessed in india, the united states, australia and new zealand (leeder, 2003). equity is an ethical issue with mental health care primarily concerned with access to hope by ‘eliminating disparities that are associated with underlying disadvantage or marginalization’ (braverman & gruskin, 2003, p. 539). mental health services today are provided within the dominant paradigm of wellbeing that has seen a shift from a disease to a wellness model. the who (2009, p.1) defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” the focus of wellness models is on general population health promotion and prevention activities such as nutrition, exercise, stress reduction and developing strategies to deal with barriers to wellbeing. the integration of student wellbeing programs in high stress academic vocational programs has resulted in reports of marked improvements in overall student mental health (hassed, sierpina, & kreitzer, 2008). wellbeing programs are increasingly preferred by policy makers due to current health care costs under existing primary care models and projected increases considered unsustainable in the long term (who, 2009). however such reforms will only succeed if the needs of those with chronic conditions are also met. this shift in funding and emphasis, from primary care to general population wellness models, has been criticized as a further means of stigmatization of those diagnosed with severe mental illnesses with them deemed ‘unworthy of social investment’ (reidpath, chan, gifford, & allotey, 2005, p.1). richardson (2005) argues that the current focus on population health and wellbeing programs fails to address major inequities and system deficiencies in australia’s healthcare system. these policy changes have been influenced by dominant paradigms in community mental health such as deinstitutionalization, normalization and, in more recent years, recovery. the recovery movement, led by consumers of mental health services, originated in the united states in the 1980s. central to recovery is hope and the active role taken by the individual to live well in the presence or absence of mental health problems. all of the rhetoric associated with the dominant paradigms in community mental health supports access and equity in higher education. higher education the world bank’s world development report 2000/2001, attacking poverty, highlights the importance of access to education in dealing with poverty. the organization for economic co-operation and development (oecd) (2009) highlights martin, oswin/mental health access and equity 50 both the individual and national benefits that result from educational equity including social inclusion, improved quality of life and satisfying employment. first onset of mental illness can occur at any age, although it is most prevalent amongst young people with three quarters of first diagnoses occurring between the ages of 16 and 25 (megivern, pellerito, & mowbray, 2003). this is the time when young people are likely to be considering, or embarking upon, post secondary education programs. they may have a pre-existing mental health condition or experience stress that can trigger a first episode of mental illness. the nature of the studies may generate stress that can lead to mental health difficulties. the incidence of mental health problems amongst university students is steadily increasing with estimates of between 10 to 20 per cent (collins & mowbray, 2005). of particular concern are reports that these students have lower completion rates than all other disability groups (cavallaro, foley, saunders, & bowman, 2005; moisey, 2004). it is likely that students with mental health problems experience other forms of disadvantage. students can experience a cumulative impact due to membership in more than one equity group such as: low socio-economic status, indigenous or non-english speaking background, rural and remote or other disability. they may also have more than one mental health difficulty. membership in more than one equity group has been found to reduce the likelihood of success in post secondary education and increase the possibility of withdrawal from studies (john, 2004). however the main disadvantage is the stigma arising from discriminatory attitudes and behaviors that deny students opportunities and the support they require to successfully complete their studies. stigma insinuates itself into policy decisions resulting in institutional discrimination with the stigma associated with mental illness, and the hidden nature of the disability, constituting powerful barriers to students seeking and receiving assistance (martin, 2006). for some people the stigma of mental illness can cause even more negative impacts than the mental illness itself (link & phelan, 2006). nonetheless there is increased evidence that students with mental health problems who receive appropriate support to remain engaged with their studies are successful in postsecondary education (megivern et al., 2003), experience decreased hospitalization rates (isenwater, lanham, & thornhill, 2002), and increased levels of self confidence, self efficiency and empowerment (collins & mowbray, 2005). those who are able to successfully develop strategies to resist and challenge discrimination experience improved mental health and educational outcomes. they are able to do so by externalizing the stigma and viewing it as a means of oppression. in doing so they are able to study in their chosen area and access opportunities for professional identity and social mobility afforded by educational qualifications (elstad, 2004). a barrier to university education is the view that people with mental illness are not suitable candidates for vocational courses such as social work and welfare education (martin, 2006). however, this view is generally not openly expressed particularly because it contravenes disability discrimination conventions, legislation and university policy and procedures. according to this view it is perfectly acceptable to work with people with mental health problems as clients, but not as colleagues. this creates a dilemma for students as they are informed of university policies and procedures for advances in social work, spring 2010, 11(1) 51 access and equity yet are not confident that they will receive the assistance required and may experience discrimination (mclean & andrews, 1999). this leads some students to hide their mental illness in the fear that it may jeopardize their position at university and future career opportunities. a further problem arises when assistance is sought, and the staff response is that if a student is mentally unwell they should not be attending classes (martin, 2006). this reflects the dominant view that people must be symptom-free before they can participate or be let in (davidson et al., 2004). students receive a double message as they are advised to take time off to recover, yet if they do so they can be penalized for not attending or participating in class activities, and be put at risk of failure or exclusion. the result is active social exclusion particularly for those students with persistent and ongoing symptoms of mental illness (reidpath et al., 2005). those who do not support students with mental illness entering the human service professions may use this as an opportunity to exclude a student under the guise of care and concern or the upholding of educational standards. teaching and learning approaches to teaching and learning have changed considerably in recent years providing increased flexibility and opportunities for students experiencing mental health difficulties to remain engaged in their university studies during periods of mental illness. flexible delivery and different approaches to teaching and learning provide scope for increased responsiveness to individual student needs. the three main approaches used in higher education over the past century are absorption, behavioral, and cognitive, with different instructional architectures used to support each approach (clark, 2003). increasingly there has been an emphasis on the more active approaches to teaching and learning both in the classroom and online. the suitability of each approach will vary according to a student’s mental health status (martin & mckay, 2009). absorption views of education focus on the transmission of information to students, with learning occurring through the assimilation of this content. receptive architecture is used with an emphasis on the provision of information (mayer, 2001). in some forms of receptive instruction students have minimal control over the pacing or sequencing of the information provided. examples of this architecture include didactic methods such as (non-interactive) lectures and instructional videos. flexibility is provided to students through the use of information communication technology, such as lectopia, that provide an audio recording of the lecture and visual slides for students to access and download online. this is particularly useful for students who want to keep up with course materials and information but are experiencing mental health difficulties that prevent them from attending university and participating in class discussions. the behavioral approach was promoted in the first part of the 20th century by behavioral psychologists, with learning based on mental associations. educators use directive architecture by providing small amounts of information, followed by questions and frequent reinforcement through immediate corrective feedback to ensure that accurate associations are made. programmed instruction in short lessons, popular in the martin, oswin/mental health access and equity 52 1950s and 1960s, is a prime example of directive architecture. this approach is particularly useful for students with mental health problems that affect concentration. the cognitive approach to education was developed in the latter half of the 20th century with an emphasis on the active processes learners use to construct new knowledge. the two main architectures used with the cognitive approach are guided discovery and exploratory (mckay, 2008). guided discovery architecture uses real world problems or scenarios to drive the learning process. students typically access various sources of data to resolve problems with instructional support available to help them. guided discovery provides students with opportunities to try alternatives, make mistakes, experience the consequences of those mistakes, reflect on their results, and revise their approach. exploratory architecture offers high levels of learner control. instruction is designed to provide a rich set of learning resources that include: learning content, examples, demonstrations, and knowledge/skills building exercises, complete with the means to navigate these materials. architectures of this type are frequently used for online courseware. high levels of learner control can be useful for students experiencing mental health difficulties that affect class attendance. however clarity is required on the learning tasks required with regular opportunities for communication and feedback from staff to ensure the required learning outcomes are being met. open-ended tasks and activities can generate considerable stress and anxiety that can exacerbate a pre-existing mental health condition, due to a lack of structure and clarity and even more so if this is reliant upon group work assessment. equitable assessment requires consideration of varied approaches to assess the same learning outcomes. it is the responsibility of the educator to assess a student’s performance in a manner that allows them to best demonstrate the learning they have achieved according to the required course outcomes. students experiencing mental health difficulties during their studies are discriminated against if they are not treated as favorably as other students. discrimination can also occur if students are required to comply with conditions that are unreasonable and that they do not, or are not able to comply with (martin & mckay, 2009). the following discussion of the findings of an exploratory study highlight how the approach to teaching and learning, institutional policies and practices, staff and student attitudes, and support services available, influence access and equity in higher education for student’s experiencing mental health difficulties. case study: mental health expereinces in higher education an exploratory research project was conducted in an australian university in an endeavor to gain an understanding of the experiences of students with mental health difficulties during their studies. a main aim was to identify factors that students identified as affecting their performance and ways that staff might respond to support them to achieve their educational goals. advances in social work, spring 2010, 11(1) 53 methods an anonymous online survey was sent to all students enrolled in a school, within an australian university, identified by the university’s disability liaison unit as having the highest number of students with mental health difficulties using their services. this included students enrolled primarily in human services courses in social work, social science, psychology, youth work, planning, environment, international and legal dispute studies. students were asked to disclose whether or not they had experienced any mental health difficulties during their studies. those who had experienced mental health difficulties, that had affected their studies, were then invited to complete the online survey. open and closed questions were asked focusing on three areas: disclosure, impact on studies, and support. the self-selection process was a significant aspect of the research as it allowed for participation of students who may not have a formal psychiatric diagnosis. it meant that students defined their mental health condition rather than selecting from pre-determined categories of “mental illness.” the categories identified by the students were then compared with those used by mental health services during the data analysis. previous studies of this nature have surveyed students who have declared a mental illness, and registered for disability liaison unit services. the survey was posted online for a six-week period with a request to participate sent to 1,517 students in the school. this method proved effective as students were able to anonymously share their experiences in their own time. a total of 54 students responded – 3.6 percent of the student body. it is not possible to accurately gauge the proportion of students with mental health difficulties given it is likely that not all students experiencing mental health difficulties would have elected to participate in the research. the survey included ten open questions to be answered only by those students who self-identified as having experienced mental health difficulties during their studies. students were asked what their mental health condition was, whether or not it had affected their studies, and if they had disclosed this to university staff. students who had not disclosed were asked for reasons why they had not done so. those who had disclosed were asked to provide details of how staff had responded and what they found most helpful, and most problematic. students were asked to provide details of services used when they experienced mental health difficulties and, finally, general comments and/or advice to staff and/or students. frequencies were recorded for the responses to each question with thematic analysis also used to collate and present the study findings. students were not limited in their responses to each question. this meant that if a student recorded more than one category in response to a particular question, each response would be reflected in the data. for instance, figure 1 presents each diagnosis mentioned with some students having more than one diagnosis, with figure 2 on area of study affected, showing 85 responses from the 54 students surveyed. other questions recorded the actual number of students who gave a particular response, as in the reported number of students who had disclosed their mental health difficulties to staff. martin, oswin/mental health access and equity 54 limitations as a small exploratory study of students in one university the study findings are not generalizable. given the anonymous survey and the self reporting of students of their mental health status, it was not possible to verify that students really had the mental health conditions they reported. the sample size is small and self selecting and as such it is potentially biased as the larger population of all students experiencing mental health difficulties is not included in the study. the length of the survey was limited to 10 questions that did not include demographic data on age, gender or cultural background. a longer survey that collects detailed demographic information would be useful for further research. the collection of detailed demographic data would enable analysis according to gender, age, cultural background and socio-economic status. in addition, further broad scale research that provides a brief mental health screening tool to select survey participants would be useful to identify the impacts of different types of mental illness, particularly schizophrenia and personality disorder, on students’ education experience and performance. a comparative case study approach comparing metropolitan, regional, rural, remote and international experiences would provide further insights. findings the mental health conditions identified by students are presented, followed by consideration of those who had, or had not, disclosed and reasons for this. the impact of disclosure on study performance is presented, alongside strategies students found most helpful during periods of mental illness. mental health condition the main mental health conditions identified by students were depression (n= 35) and anxiety (n=23), with anxiety including students with eating disorders (see figure 1). two students were recorded for both schizophrenia and bi-polar affective disorder. individual students reported post traumatic stress disorder, obsessive compulsive disorder, dissociative identity disorder, asperger’s syndrome, head injury, autism and epilepsy. these latter responses would not normally be classified as mental health conditions by today’s standards; however, this was not the case in the not too distant past. just over half of the students (n=28) reported multiple conditions with just under half recording a dual diagnosis of depression and anxiety (n=25). three students reported dual, triple and quad diagnoses. the dual diagnosis was dissociative identity disorder and anxiety. the triple diagnosis was post-traumatic stress disorder, anxiety and depression. the quad diagnosis was asperger’s syndrome, autism, anxiety and obsessive compulsive disorder. advances in social work, spring 2010, 11(1) 55 figure 1: mental health condition 0 5 10 15 20 25 30 35 40 number of responses response categories depression anxiety other schizophrenia bi-polar disorder post-traumatic stress disorder head injury eating disorder a couple of students reported physical problems triggered by their mental health condition. one experienced anxiety that resulted in physical problems that caused further, and more serious mental health problems with depression. the other student’s physical condition led to mental health difficulties with anxiety. the complex interplay of mental and physical health conditions is illustrated in the following student comment: my mental health condition under extreme forms of stress can activate an underlying physical condition. high stress and ongoing fatigue directly impact on this physical condition which ultimately is life-threatening if not managed. disclosure of mental health condition the majority of students, slightly under two thirds (n=34) had not disclosed to university staff about their mental health condition or the problems they were experiencing with their studies, even though many were experiencing considerable difficulties. reasons for not disclosing varied. some students did not disclose because there was no need to, even though for all but one student, their mental health condition had impacted negatively on their studies. some students did not disclose for reasons of privacy and confidentiality. others were embarrassed or had past bad experiences disclosing to staff. one student was concerned that staff might not understand and ask difficult and personal questions, with another student noting that communicating with anyone was difficult when unwell. a further student had only recently been diagnosed. concerns were expressed that students would be seen by staff as telling lies and/or wanting privileges (n=12). a further concern was a fear of being found out, judged, stigmatized and discriminated against by being treated differently from other students; martin, oswin/mental health access and equity 56 possibly losing their place at university and being discriminated against in the workplace (n=9). of those who did disclose their mental health condition to staff (n=20), the responses were mostly positive (n=18), with only two students reporting a negative experience. the main assistance provided was for gaining extensions and special consideration. in some instances where extensions were granted, additional support was needed. students wanted staff to understand the reasons why they were not finishing their work on time. while support was provided, students found it difficult to ask for help. some staff members tried to be helpful but their efforts were misguided, resulting in embarrassment for the student, particularly when they were singled out for special treatment in front of the student group: i’m worried i'll be treated differently or given unwanted attention. however, in the past i have used the disability liaison service to make contact for me. one staff member contacted by the dls on my behalf then addressed me about my “special needs” in front of the whole class, with everyone's attention, when we had a test saying ‘if you don't feel well at any time, you can just leave if you need to.’ i never attended that class again, failing it, and have never disclosed to any staff since. impact of mental health condition on studies all but one student reported that their mental health condition had impacted negatively on their studies as illustrated in figure 2. figure 2: areas of study affected by mental health condition 0 2 4 6 8 10 12 14 16 18 20 number of responses response categories concentration completing assessment tasks motivation attending class stress failing subjects/extend study period physically fear mixing with other students other physical, psychological and social difficulties were experienced in the areas of; concentration (n=20), completing work on time (n=16), motivation (n=12) and attending advances in social work, spring 2010, 11(1) 57 classes (n=12). other areas affected included increased levels of stress (n=8), failing courses (n=6), poor physical health (n=4), fearfulness (n=2) and problems mixing with other students (n=2). physical problems included tiredness and exhaustion from not sleeping well, extra time required to complete study requirements as well as overall poor physical health. inadequate sleep affected mood and coping skills as well as energy levels and academic performance. students who had a first episode of mental illness, or who went undiagnosed, experienced considerable difficulties with their studies, often over extended periods. main psychological difficulties were in relation to concentration and maintaining motivation and focus, as well as managing the disturbing signs and symptoms of the particular mental health condition. for many students this was lowered mood and feelings of overwhelming sadness. poor concentration impacted negatively on most areas of study including attendance, participation, and assessment, with students losing confidence in themselves and their abilities. it was particularly difficult for students to maintain the focus required if they could not see the relevance of their studies for the future. feelings of guilt and failure were experienced in relation to studies, for not submitting work on time and having to apply for special consideration, and life in general. socially students experienced main difficulties in coping with everyday life as well as their studies. attending and participating in class was problematic for many students who feared an exacerbation of their condition and that others might find out and not understand: the main difficulty for me is the fear being found out and considered somehow less than acceptable. this means i don't and won't ask for an extension on the grounds of what is going on in my life at the time, and avoid at just about all cost ever asking for an extension or some kind of support, in case it makes me more open to being found out. i don't want people starting to interact with me on the basis of their interpretation of what such a diagnosis means, rather than taking me for who i am in the present moment. i’m fearful that i won't have the resilience to pull through an episode and get stuff in on time, that i will burn myself out keeping up a façade. the university where this study took place did not have an attendance policy. however it was apparent that it was generally difficult to meet the course requirements for those who did not attend classes. motivation, attendance, and the submission of assignments were affected during periods of mental illness and hospitalization. often there were major difficulties in managing to complete assessment activities in the set timeframe, with the work submitted not of a standard that students believed reflected their true abilities. the failure to attend class was connected with low levels of motivation, difficulties with concentration, and high stress levels. students feared that they might not have the resilience required to pull through and worried about lost time when unwell. the martin, oswin/mental health access and equity 58 following comment highlights the added problem of first onset of mental illness and not being diagnosed: the hardest thing was trying to keep up with the work and not fall too far behind. i was lucky it happened towards the end of semester so although i had a lot of essays to do i had a six week break to recover. once medicated it only took me a month or so to get back on my feet, however there were three months when i went undiagnosed where my studies really suffered. raising the issue and asking staff for help was a main difficulty for students. they were particularly concerned that a lack of understanding from staff and students would result in stigma and negative discrimination leading to restricted opportunities at university and in future employment. negative experiences with faculty, administrators and staff from counseling and disability services left students feeling disempowered, particularly when deemed ineligible for services, with one student describing feelings related to being ‘shut out’: my main problem was being shut out. like when i became so depressed and anxious and withdrawn, absolutely no-one made an effort to contact me, to give me the opportunity to explain my circumstances. i know they expect us to be responsible adults but adults are not immune from illness. you do need to look after your students. staff need training in mental health and how it can affect your studies. i nearly cried when a staff member demanded to know how depression could impact on my studies, the experience was really undermining. additional time was needed during the recovery period to attend regular treatment. a cumulative impact was experienced by students who were members of more than one equity group. further difficulties were experienced when english was a second language and when alcohol and other drugs were used in excess. the cost of treatment caused financial hardship for some students with this particularly an issue for students with a longstanding mental health condition. most helpful assistance half of the students surveyed sought assistance from services within the university (n=27) and just under half from outside services (n=26), with some of these students using a combination of services within and outside of the university. a smaller number of students (n=8) did not use any services. as illustrated in figure 3, of those who sought assistance just under two thirds of students (n=30) found the university to be most helpful even though many of these students had not disclosed their mental health condition. the next main source of support was family and friends (n=15) followed by professionals outside of the university (n=10). a small number of students who were using services felt that the best support came from themselves and not service providers (n=5) with one student gaining most support from a pet. all, with the exception of one student, who found that ‘nothing was helpful’, were able to access some kind of positive assistance. advances in social work, spring 2010, 11(1) 59 figure 3: source of most helpful assistance 0 5 10 15 20 25 30 number of responses response categories the university family and friends (including partner) outside professional self help nothing sources of assistance within the university were of both a practical and supportive nature and were provided by academic, administrative, counseling, disability, student union and housing services staff. students valued online access to staff, course information, support services, and information about their rights and responsibilities, so that they could continue with their studies when it was difficult to attend the university. special consideration with extensions of time for assignments, altered assessments, and changed exam venues was helpful. the attitude and approach by staff was critical as this impacted on a student’s ability to disclose about a mental health condition and seek the support required as reflected in the following student comment: tutors need to not just see their role as ‘teaching and marking assignments.’ they should take a personal interest in the students as they are after all our role models whilst at university. it sometimes feels like lecturers and tutors are ‘untouchable’ thereby being difficult to approach. teachers who understand and are open for discussion are more approachable. students appreciated staff who treated them with respect and dignity; were understanding, supportive, and trustworthy; and provided reassurance, information and advice without being too intrusive. some students wanted time off to recover while others did not want to do so. these students appreciated staff who reassured them and supported them while they continued with their studies when unwell. remaining connected to the university was important with one main point of contact preferred. given the effort required at times to attend class, when unwell it was appreciated when this time was well spent. structured lectures were preferred by those who found it difficult to interact with others. family and friends were main sources of support and encouragement as they listened and provided emotional and practical assistance with organization and time management. students appreciated a non-judgmental attitude, understanding, kindness, and loyalty – in martin, oswin/mental health access and equity 60 spite of the mental health condition. however, students were mindful of not being a burden and straining these relationships. services from outside the university were provided by general medical practitioners, specialist mental health youth services, mental health crisis services, psychiatrists, psychologists, social workers, nurses, counselors and therapists. some students required regular medication with this increasing when the symptoms of their condition were exacerbated. other interventions included counseling and assistance with coping skills and problem solving. counseling approaches that addressed issues of stigma and mental illness and used an empowerment approach, combined with practical assistance, were particularly helpful. wellbeing approaches for stress management and relaxation were also used, including massage. students found access to a regular worker important for accessing reports for applications for special consideration. having to explain the situation to a stranger was difficult, even more challenging when unwell, and in some cases not possible due to the mental health condition at the time. the financial costs incurred for some of these services was also an issue. a range of self help strategies were used by students. maintaining a positive outlook and remaining connected with university, family, and friends were generally considered important. approaching staff required considerable motivation and communication skills, particularly at times when these were impaired. early intervention from academic staff and counseling services was preferred, with concerns that services could only be accessed if problems were acute. students found it important to acknowledge their reduced level of capacity at different times and to make allowances for this. a holistic approach to general health and wellbeing was noted with students finding physical exercise, eating well, and regular sleep vital. relaxing in a quiet area and meditation assisted with stress reduction and remaining calm and positive. one student found playing computer games relaxing. however not all of the ‘most helpful’ coping strategies reported by students were positive including illicit drug use, social isolation, and self harm. students made a number of recommendations for improvements, including respectful relationship building with staff, generic distribution of information on access and equity services through varied face to face and online media that are easily accessed by all students. students wanted understanding from staff and flexible and responsive arrangements to suit their particular and changing needs. what they did not want was pity or special favors. nor did they want a lowering of academic standards. if students did attend classes when unwell, they wanted the time to be well spent – given the effort involved in getting there. the following student quote directed at both staff and students highlights the individual response needed: if you want to help us then ask us what we think would help every student with a mental illness will have special/different needs. your school is like your family for as long as you're there. treat it as such and expect to be treated as though you belong and have a place, even if you make a few mistakes. advances in social work, spring 2010, 11(1) 61 this sense of belonging extended beyond respectful and responsive relationships with staff to developing friendships with other students, with staff expected to take an active role in facilitating this: encourage friendships during first year. i don't know how you'd do that, but during my first year course they heavily encouraged friendships and having somebody in class, and who you can talk to about class, has helped me cope with the stress immensely. students commented on the university procedures for academic progress – similar to most universities – that involve sending an “at risk” letter to students whose results are in the bottom quartile, and inviting them to attend a student progress interview: you cannot possibly extract this information from them when they feel they are under attack from their school. call each student before sending out the letter, arrange to meet them informally, discuss the letter with them, come up with a way to address the problem then mail them a letter explaining the outcomes of that meeting. it might also be nice to inform students on their rights etc. special consideration, equitable assessment, remission of fees etc. it's all too easy to feel like you're stuck when you have a problem at university. students noted the importance of addressing possible mental health difficulties early in the semester in a general manner with all students and making information accessible through multiple face-to-face and online sources: i think it would be extremely helpful if tutors were to speak broadly to their tutorial groups about this very issue at the start of semester and the possible need for non-disclosure, directing any student to the disability liaison unit-without any assumptions of mental health status of the persons in the tutorial group. obviously this would be a general directive, as it cannot be guaranteed that a student will speak up in class, nor approach the tutors afterwards. discussion the study findings illustrate the important and central role the university plays in the development of policy and provision of both academic and support services, to increase the likelihood of successful educational outcomes for students experiencing mental health difficulties during their studies. however as mentioned earlier, it is important to note that these study findings are limited, due to the small sample size and number of survey questions, and are therefore not generalizable to other settings. key study findings include the importance of respectful communication and relationship building; between staff and students, and students with each other. individual responses that allow for flexible and active learning approaches, with appropriate levels of structure, facilitate a learning environment that allows students to remain engaged with the university. the early provision of information on student rights and equitable assessment to all students, with multiple access points, reduces the likelihood of discrimination arising from the stigma of mental illness. martin, oswin/mental health access and equity 62 the majority of students in the study experienced multiple levels of disadvantage, due to the presence of more than one mental health condition, thereby increasing vulnerability. the complex interplay between physical and mental health was also evident amongst the study participants. while the study design allowed students to identify their own mental health conditions, these were consistent with the diagnostic categories in the diagnostic and statistical manual (dsm) of the american psychiatric association. thus students defined their mental health conditions according to the dominant medical paradigm used for eligibility for mental health services in australia today. as in previous studies of student mental health, the main disadvantage was stigma arising from fear of discriminatory attitudes and behaviors. stigma prevented the majority of students from disclosing their mental health condition. students were fearful of discrimination in their studies and in future employment, worried that they may be considered undesirable or unsuited to their chosen profession. interestingly however, almost half of the students were able to gain assistance without disclosing their mental health condition. however, this type of assistance is potentially limited as disclosure is needed for eligibility for disability support services and special consideration. it raises the issue of limits to disclosure applied by the students themselves as well as confidentiality of service providers within and outside the university. a key consideration is whether or not staff actually need to know details of a student’s mental health condition to best assist them. further research on disclosure would be useful focusing on issues concerning process, content, response and outcome. a comparison of students who disclosed and those who did not reveals that those who did not disclose experienced a range of mental health conditions and difficulties that were no less significant than those experienced by students who did disclose. the majority of those who did disclose received helpful assistance. this suggests staff are able to provide appropriate support, and implement more appropriate teaching and learning strategies, when they are aware of the particular difficulties a student faces. this is another area for further substantive research. staff development and training in mental health, access and equity in education can provide staff with the knowledge, attitudes, and skills required to intervene effectively in accordance with university policy and legislative requirements. the study findings are consistent with those of pilgrim (2005, p. 99), with helpful conversations by supportive and empathic staff, without specialized knowledge in mental health, appreciated by students and leading to positive outcomes. useful conversations with academic and administrative staff facilitate an understanding of how a student’s mental health impacts upon their studies, what their rights are, available assistance and how to best access this. counseling, disability support and student right’s services are particularly important in instances where academic and administrative staff responses are either not forthcoming or inappropriate. the study findings highlight the dilemma that arises when students are not diagnosed, or are unable to communicate effectively due to their mental health condition at the time, advances in social work, spring 2010, 11(1) 63 thereby preventing them from being able to seek assistance in an appropriate and timely manner. the students in the study experienced a range of psychological, social and physical difficulties that impacted negatively upon their studies. the tendency to not disclose mental health difficulties created further problems, with students not attending class in fear of being found out and discriminated against. consideration is required of the most appropriate teaching style that best suits the changing and often complex needs of students experiencing mental health difficulties, with suitable architecture to support this. increasingly students are able to access course materials and other relevant information for their studies online. the cognitive approach to teaching and learning using guided discovery and exploratory architecture, for online course materials means students can continue their studies during periods of mental illness. however the open-ended nature of much of this learning can be problematic with appropriate teacher guided structure and guidance required, particularly if a student is experiencing cognitive difficulties. the availability of lectures online also provides students with greater flexibility. given the availability of quality online course materials, particularly in more recent years, a main challenge is how much classroom activity is required to meet both university and professional standards and requirements to prepare students for the human services workforce. early intervention is crucial for preventing mental health problems by averting fears and anxieties and assisting with the necessary adjustments and changes required to engage in university studies. many newly enrolled students do not know where and how to get assistance when they experience mental health difficulties. commencement of studies at university generates considerable stress, and it is therefore important that academic and counseling support and services are offered to prevent first onset or relapse of mental illness. clear explanations of student rights, staff responsibilities, course expectations, study workload, and assessment requirements provide students with the necessary information required to adequately plan for their studies. the ongoing provision of information on support services available throughout their studies is beneficial, particularly prior to and during peak assessment periods. this includes information on university policies and procedures for extensions, special consideration, equitable assessment, remission of fees, and university academic progress procedures. a wellbeing preventative approach, targeted at all new students can alleviate stress thereby reducing vulnerability to mental illness. for students who have disclosed a mental illness, particularly those who have applied though university access and equity programs, targeted support can be provided at the outset if required. this study has shown that disclosure is more likely to lead to positive outcomes when university staff have a respectful attitude and provide appropriate assistance and advice, supported by university policies and services. martin, oswin/mental health access and equity 64 conclusion legislation and policy in mental health, disability, anti-discrimination and education espouses principles of fair and equitable treatment for students experiencing mental health difficulties. in practice however, a major barrier to the enactment of these principles is non-disclosure of mental health difficulties by students due to fears of discrimination. the exploratory study findings presented in this paper support the findings of previous studies that consider stigma to be a major obstacle preventing students from disclosing mental health difficulties and receiving appropriate assistance. student mental health and educational outcomes can be improved by universal wellbeing programs and targeted interventions for those students experiencing mental health difficulties. targeted interventions are required that address the stigma of mental health so that students can confide their difficulties to staff in the confidence that they will be treated fairly and with dignity and respect. at the same time students require assurance that measures will be put in place to assist them to do their best work and remain engaged with their studies during periods of mental ill health. the dominant paradigm of recovery in mental health and access and equity in higher education, alongside increased flexibility in the design and delivery of higher education programs, means that the future for students, experiencing mental health difficulties in social work and welfare studies is more hopeful than ever before. further research, in particular, substantial comparative case studies, that include a brief mental health screening tool and demographic data, will result in transferable knowledge generation. references braverman, p., & gruskin, s. 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(2005). key concepts in mental health. london: sage publications. martin, oswin/mental health access and equity 66 reidpath, d., chan, k., gifford, s., & allotey, p. (2005). he hath the french pox: stigma, social value and social exclusion. sociology of health and illness, 27(4), 468-469. richardson, j. (2005). priorities of health policy: cost shifting or population health. australia and new zealand health policy, 2, 1-19. world bank. (2001), world bank development report 2000/2001. attacking poverty: opportunity, empowerment and security. washington dc: world bank group. world health organization. (2009). what is mental health? retrieved november 15, 2009, from http://www.who.int author’s note: address correspondence to: jennifer martin, rmit university, school of global studies, social science & planning, gpo box 2476, melbourne, victoria 3001, australia. email: jenny.martin@rmit.edu.au running head: child welfare workers’ connectivity child welfare workers’ connectivity to resources and youth’s receipt of services alicia c. bunger arlene r. stiffman kirk a. foster peichang shi abstract: youth involved in the child welfare system are at high risk for mental illness, substance abuse, and other behavioral health issues, which child welfare workers are expected to address through referrals. child welfare workers (n=27) who participated in project improve (intervention for multisector provider enhancement) reported on services they provided to youth (n=307) in their caseloads. using survey and administrative data, this paper examines workers’ service actions on behalf of youth. results were consistent with the gateway provider model and showed that youth received help from a greater variety of service sectors when their workers were able to identify behavioral health problems, and were familiar with and connected to other providers in the community. improving service delivery to youth in child welfare may be accomplished by training workers in the signs and symptoms of behavioral health problems and familiarizing them with providers in the community. keywords: child welfare workers; behavioral health; connectivity introduction child welfare workers are responsible for advancing the safety, permanency, and well-being of youth involved in the child welfare system. consistent with federal child welfare goals, workers must also help youth obtain treatment and support services (u.s. department of health and human services, 2003) requiring them to reach across the traditional boundaries of the child welfare system to other human service systems. because the estimated prevalence of behavioral health conditions is greater for youth in the child welfare system than in the general public assistance sector, workers’ connections with behavioral health services are particularly important (burns, et al., 2004; harman, childs, & kelleher, 2000; leslie, hurlburt, landsverk, barth & slymen, 2004). workers in public child welfare agencies are well-positioned to identify behavioral health service needs among youth and connect them to appropriate care in the community, thus serving as gateway providers to mental health, substance abuse, and other service sectors (stiffman, pescosolido & cabassa, 2004). this paper examines the predictors of child welfare workers’ service actions for youth with behavioral health _________________ alicia c. bunger is a doctoral student at the brown school of social work in st. louis, mo. arlene r. stiffman, ph.d., is the barbara a. bailey professor of social work, emeritus and director of the nida comorbidity and addictions center; kirk a. foster is a doctoral student and nida comorbidity and addictions center administrator; and peichang shi is a statistical data specialist, all at the brown school of social work. this research was supported by nimh grants r34 mh072871, p30 mh068759, t32 mh19960 and k02 mh001797, and nida grant r24 da013572. special thanks to jennifer bellamy for comments on earlier drafts of this paper. copyright © 2009 advances in social work vol. 10 no. 1 (spring 2009), 19-38 bunger, stiffman, foster, shi/child welfare workers’ connectivity 20 problems from the context of the gateway provider model (stiffman, pescosolido et al., 2004). behavioral health problems and services use youth who experience traumatic and adverse experiences like child abuse and neglect are at high risk for psychiatric disorders, social problems, and general functional impairment (cerezo & frias, 1994; famularo, kinscherff, & fenton, 1992; kaufman, 1991; kazdin, moser, colbus, & bell, 1985). youth involved in the child welfare system have high rates of behavioral health problems with estimated prevalences ranging from 50-70% (burns, et al. 2004; garland,et al., 2001; trupin, tarico, low, jemelka, & mcclellan, 1993) compared to 20% in the general youth population (costello et al., 1996; shaffer, et al., 1996). behavior problems and conduct disorders are particularly prevalent but depression, anxiety, post-traumatic stress, and substance use disorders are also common (garland et al., 2001; halfon, berkowitz & klee, 1992; stiffman, chen, elze, doré & cheng, 1997). youth in the child welfare system use behavioral health services at high rates. state medicaid programs and child welfare agencies finance a range of behavioral health services that include inpatient, outpatient, and residential care. studies of mental health service users show that youth in child welfare, particularly those in out-of-home placements, use these behavioral health services at a much higher rate than youth in the community (farmer et al., 2001; halfon et al., 1992; harman et al., 2000). youth’s need is a strong predictor of their use of behavioral health services. although research supports the relationship between need and receipt of behavioral health services, evidence suggests that other factors such as abuse type, placement type, age, and race/ethnicity also influence youth’s receipt of services (garland, landsverk, hough & ellis-macleod, 1996; hurlburt et al., 2004; leslie et al., 2000; walrath, ybarra, sheehan, holden & burns, 2006). in addition, child welfare workers’ daily decisions and actions on behalf of the youth they serve also have the potential to impact the services youth receive. role of child welfare workers in youth access to care child welfare workers impact the services, resources, and placements youth receive when involved with the system (ryan, garnier, zyphur, & zhai, 2005). specifically, youth’s entry into the behavioral health service sector has been linked to their contact with child welfare services (leslie, hurlburt et al., 2005; stiffman, chen, elze, doré & cheng, 1997). however, poor assessment of treatment needs and limited access to behavioral health services are barriers in youth’s pathways between the child welfare and behavioral health systems, leaving many with unmet service needs (leslie, gordon, et al., 2005; stiffman, pescosolido et al., 2004). research on systems of care suggests that provider-level actions are important determinants of care regardless of administrative reforms designed to bridge systems (bickman, 1996; bickman, lambert, andrade & penaloza, 2000; bickman, noser & summerfelt, 1999). the gateway provider model posits that non-mental health providers play a key role in connecting youth to services (stiffman, pescosolido et al., 2004). to advances in social work, spring 2009, 10(1) 21 ensure that youth receive treatment, gateway providers must be able to recognize behavioral health service needs and be familiar with and connected to the larger service network. therefore, connectivity, or the degree to which a provider interacts with youthserving agencies can influence services youth receive (stiffman, hadley-ives et al., 2000; stiffman et al., 2001). this paper examines the relationship between worker knowledge and skills and behavioral health service provision to youth. we believe it is the first to explore the applicability of this framework for child welfare workers, while verifying it with state billing data. based on evidence with providers from multiple disciplines (stiffman, hadley-ives et al., 2000; stiffman, pescosolido et al., 2004), we posited that child welfare workers’ connectivity and recognition of behavioral health service needs would be positively associated with service provision (figure 1). figure 1. selected elements of the gateway provider model of service provision gateway provider skills and knowledge •assessment of youth mental health and environment • resource knowledge (connectivity) • familiarity • referrals provider type and training • experience • education • training service provision decision to provide services • service actions method design project improve (intervention for multisector provider enhancement) was an intervention study funded through the national institute of mental health (nimh). through the intervention, the study examined child welfare worker knowledge of their clients’ needs, their referral and treatment actions on behalf of those clients, and also obtained billing records concerning diagnoses and services provided to these youth (stiffman, foster, hamburg, & doré, 2003). the analyses for this paper utilized state billing records and baseline quantitative survey data from the larger improve intervention study. bunger, stiffman, foster, shi/child welfare workers’ connectivity 22 sample child welfare workers (n=27) in the st. louis city and county children’s division, missouri department of social services self-selected into the study, providing they had an active case load of at least 15 youth between five and 17 years of age and a job description that included mental health and substance abuse assessment and referral as regular job duties. as part of the intervention, workers were invited to the university for training and data collection. while onsite, workers completed self-administered surveys where they provided data on 307 youth whom they identified only though their public record locator code (the departmental client number or dcn). both the university’s institutional review board and the missouri department of social services privacy review board approved the protocol and each worker provided written consent. the review boards waived third party consent for workers’ reports on the youth because youth names were never available to the study, and all other youth data were de-identified prior to the study’s access. workers in the sample were predominantly female (85%) and white (66%). all workers possessed a bachelors-level degree with 15% having a masters-level degree. the average worker was employed by the children’s division for three years (sd=2.14), with a range from less than one year to seven years. measures measures consisted of worker reports and state administrative data. worker reports workers reported on (1) their background and knowledge of community referral resources (connectivity); (2) youth’s mental health and environmental problems; and (3) services obtained for youth, via self-administered surveys comprised of measures used successfully in several prior studies (horwitz et al., 2001; stiffman et al., 2006; stiffman, hadley-ives et al., 2000; stiffman, horwitz et al., 2000; stiffman et al., 2001), worker background education and training. workers reported the highest level of education they obtained, the total hours of in-service training or continuing education in the past year, and the types of topics covered in the training (e.g. illicit drug use, assessment, neglect). connectivity. provider connectivity is the degree to which an individual worker is connected to other youth-serving agencies (stiffman et al., 2006; stiffman, hadley-ives et al., 2000; stiffman et al., 2001). workers reported their relationships with twenty-eight service categories grouped into four major service domains (appendix a): six for the health and education domain (e.g., job training, tutoring, public health centers); seven for the inpatient behavioral health care domain (e.g., psychiatric or substance abuse treatment facilities); eight for the outpatient treatment domain (e.g., community-based mental health or substance abuse services); and seven for the ‘other’ service domain (e.g., religious providers, basic needs). advances in social work, spring 2009, 10(1) 23 workers reported on two types of relationships: familiarity and referrals (for any youth in their caseload, not just those reported on in this study) in the past six months. the data provided three measures: 1) the number of service categories with which workers were familiar (familiarity); 2) the sum of referrals made to service categories (referrals); and 3) an aggregate score of the sum total of both familiarity and referrals (total connectivity). worker reports on youth workers reported on their perceptions of youth’s behavioral health and environmental problems. behavioral health problems. we measured workers’ perceptions of behavioral health problems using eight questions concerning depression, post traumatic stress, anxiety, alcohol misuse, illicit drug use, behavior problems/conduct disorder, and other (stiffman et al., 2006; stiffman, hadley-ives et al., 2000; stiffman et al., 2001). youth could have between zero and eight behavioral health problems. behavioral health problems were assigned if the worker perceived the problem to be moderate, serious, or critical. environmental problems. workers reported on the presence or absence of 14 types of environmental or social problems including school and learning problems, physical health problems, basic need issues, problem peers, violence in the family, family problems, living in a violent neighborhood, exposure to violence in school, gangs, family instability, not living at home, lack of family support, legal problems, and family financial problems (stiffman et al., 2006; stiffman, hadley-ives et al., 2000; stiffman et al., 2001). service provision we collected information about workers’ service actions on behalf of youth, and the services youth obtained. service actions. the number of services that workers provided directly to youth, and the number of services referred were measured (stiffman, hadley-ives et al., 2000, stiffman et al., 2001). workers reported whether they acted in any of four ways (took no action; recommended or referred youth to service; personally provided but did not refer; or personally provided and referred) for 11 types of services: parenting/caregiving, counseling/therapy, teaching/alternative/education-related services, substance abuse treatment, self-help group or peer counseling, crisis intervention, inpatient/residential mental health care, medication to control symptoms, psychiatric evaluation, family counseling, and service coordination and referral. services obtained. workers completed the brief module of the services assessment for children and adolescents (saca) which collects information about inpatient, outpatient, school and other services used in the last six months, whether or not they were provided by the child welfare workers (horwitz et al., 2001; stiffman, horwitz et al., 2000). bunger, stiffman, foster, shi/child welfare workers’ connectivity 24 administrative data billing records from the missouri division of mental health and medicaid were extracted for each youth reported on by the workers. these records were included because they reflect outcomes of child welfare service actions child welfare workers refer youth to outside service providers who, in turn, bill the division of mental health or medicaid for services rendered. we used dcn numbers to merge the records from both sources. the data included information about services billed for the youth between july 1, 2005 and march 8, 2008. each billing record contained a diagnostic code indicating the type of problem the youth was treated for, and a procedure code indicating the type of service provided. diagnostic codes the data contained icd-9 behavioral health diagnostic codes and their descriptions. we grouped the diagnostic codes into the same eight types of problems that workers reported in the survey (depression, post traumatic stress, anxiety, alcohol misuse, illicit drug use, behavior problems/conduct disorder, and other). procedure codes procedure codes followed the common procedural terminology (cpt) and healthcare common procedure coding system (hcpcs) conventions. we obtained descriptions of the cpt and hcpcs codes and grouped them into four main types of services: overnight, outpatient, school-based, and other. procedure categories (like the diagnostic categories) were grouped to parallel the types of services reported through the saca. analyses two forms of analysis were performed: 1) accuracy calculations (the percentage of all cases in which both data sources agreed that the youth had a problem or service or did not have a problem or service) to examine the relationship between provider reports on youth and the billing data; and 2) generalized estimating equations (gee) with a negative binomial distribution to examine multivariate predictors of service provision. our data did not satisfy the independence and normality assumptions of general linear regression. first, our data was nested (307 youth clustered by 27 workers) and the reports about youth with the same worker were related observations, and not independent. second, the dependent variable (services obtained as reported on the saca) was not normally distributed. as is common when studying services or other counts of rare events, the data took the shape of a negative binomial distribution (gardner, mulvey, & shaw, 1995), where the majority of observations were concentrated at the low end (none or only a few types of services), and only a few observations fell along the upper range (six or more types of services). therefore, gee is an appropriate method to analyze the non-normal (negative binomial) distribution of the dependent variable and to account for correlations within worker subgroups (ballinger, 2004). the model fit was determined by a pearson chi square test where a lack of significant difference between the observed and expected values indicated a good fit. analyses were run using sas 9.1 and stata se 9. advances in social work, spring 2009, 10(1) 25 results we examined information about youth’s demographic characteristics, the relationships between worker reports and administrative data on youth’s behavioral health problems, environmental problems, and services received, and workers’ connectivity to community resources. then we explored the gateway provider model’s assumptions about predictors of service provision. youth demographic characteristics (based on worker reports) the youth were nearly evenly split between males (49%) and females (51%). the age of the youth ranged from five to 20 (median of 13 years). over two-thirds of youth in the sample were african-american (70.9%), about one-quarter were caucasian (28.8%), 1.5% hispanic, and 1.2% were “other.” relationship between worker reports and administrative data youth’s behavioral health and environmental problems, and service provision reported by workers and documented in the administrative data were examined separately. then the two data sources were compared to determine the correspondence between both types of reports. behavioral health problems we examined youth’s behavioral health problems by analyzing worker reports and the diagnostic codes that accompanied the billing records in the administrative data. findings from each data source were then compared (table 1). worker reports of behavioral health problems. workers reported that nearly twothirds (64%) of youth in each of their caseloads had a moderate to severe behavioral health problem. the two most commonly reported were depression (44%) and behavior problems/conduct disorder (43%), followed by anxiety (33%), post traumatic stress (29%), illicit drug use (5%), suicidality (4%), and alcohol misuse (2%). about 10% of youth had “other” types of behavioral health problems such as developmental delays and personality disorders. billing records on behavioral health problems. like the worker reports, billing records showed that nearly three quarters (73%) of youth were diagnosed with some type of behavioral health problem. similarly, the most common diagnoses were behavior problems/conduct disorder (57%) and depression (41%), followed by anxiety (18%), post-traumatic stress (11%), illicit drug use (10%), suicidality (1%), and alcohol misuse (1%). unlike the worker reports, a much higher percentage of youth had “other” types of behavioral health problems. approximately 50% of youth were diagnosed with psychotic and personality disorders, developmental delays, or other disorders not otherwise specified. relationship between worker reports and billing records for behavioral health problems. behavioral health diagnoses in the billing records and worker reports on whether or not youth had a behavioral health problem matched 69% of the time. the highest concordance between worker reports and billing records were for alcohol misuse bunger, stiffman, foster, shi/child welfare workers’ connectivity 26 (97%), suicidality (96%), and illicit drug use (89%), followed by post traumatic stress (72%), behavior problems/conduct disorder (65%), anxiety (63%), depression (62%) and other (52%). table 1. youth behavioral health problems reported by workers and billing data (n=307) behavioral health problem worker report % billing data % concordance % depression 44 41 62 behavior problems/conduct disorder 43 57 65 anxiety 33 18 63 post-traumatic stress 29 11 72 illicit drug use 5 10 89 suicidality 4 1 96 alcohol misuse 2 1 97 other 10 50 52 total 64 73 69 it is unlikely that two data sources will ever be in total concordance, therefore some discordance between worker reports and billing data is to be expected. these data may not agree because of differences in perception of the problem between workers and providers, as well as differing reporting, and billing policies. environmental problems first we explored worker reports of environmental problems and second we examined the diagnostic codes that accompanied the billing records in the administrative data. findings from each data source were then compared (table 2). worker reports of environmental problems. almost all (98%) of the youth had environmental problems, which is not surprising for public child welfare clients (for example, see berger, 2004 or hardin & koblinski, 1999). workers most frequently noted the following environmental problems among youth in their caseload: family instability (78%), family problems (78%), not living at home (67%), and school and learning (66%). these were followed by lack of family support (53%), basic need issues (52%), family financial problems (41%), problem peers (38%), violence in the family (30%), physical health problems (14%), violent neighborhoods (13%), violent schools (12%), legal problems (9%), and gangs (7%). billing records for environmental problems. billing records showed much lower rates of environmental problems than worker reports. these results are to be expected since billing records reflect service needs reimbursed by the state which are typically psychiatric or health-related rather than environmental. almost 21% of youth were diagnosed with some type of environmental problem. about 10% received a diagnostic advances in social work, spring 2009, 10(1) 27 code for violence in the family, 7% with family problems, 4% with basic needs, 2% with school and learning problems and 1% with exposure to violence in school. relationship between worker reports and billing records on environmental problems. the diagnostic codes in the billing records matched worker reports of environmental problems (those that are billable) 65% of the time. exposure to violence in schools had the highest match rate (83%) followed by violence in the family (65%), basic needs (49%), school and learning problems (35%), and family problems (27%). table 2. youth environmental problems reported by workers and billing data (n=307) environmental problems with billing codes worker report % billing data % concordance % family problems 78 7 27 school and learning 66 2 35 basic needs 52 4 49 violence in the family 30 10 65 violent schools 12 1 83 total (for problems with billing codes) 94 21 65 environmental problems without billing codes family instability 78 -- not living at home 67 -- lack of family support 53 -- family financial problems 41 -- problem peers 38 -- physical health problems 14 -- violent neighborhoods 13 -- legal problems 9 -- gangs 7 -- total 98 -- service provision we explored three types of service reports: (1) worker reports of personal service actions on behalf of youth, (2) worker reports of any youth services according to the saca, and (3) procedure codes for services in the billing records. the agreement between the saca service data and billing records was also calculated (table 3). worker reports – service actions. workers reported their personal service actions on behalf of the youth. workers provided and/or referred 84% of youth to services. for the most part, when workers identified youth’s need for service, they responded by either bunger, stiffman, foster, shi/child welfare workers’ connectivity 28 providing the service or through referral. on average, workers did not take action for 12% of youth’s identified service needs. most commonly, workers provided or referred youth for counseling/therapy services (67%) followed by service coordination and referral (57%), and education-related services (50%). other services included family counseling (33%), medications for symptom management (26%), psychiatric evaluation (25%), crisis intervention (21%), self help or peer groups (20%), parenting/care-giving (17%), inpatient mental health care (14%), and substance abuse treatment (7%) (figure 2). figure 2. service actions on behalf of youth 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% pare nti ng /care giv ing cou nse lin g o r t her apy edu cat ion sub sta nc e a bu se tx self -h elp cris is i nte rve nti on inp ati ent m h care med ica tio n psyc h e val fam ily cou nse lin g svc coo rdi na tio n services pe rc en t o f y ou th needed, action taken needed, no action not needed worker reports – saca. workers reported that youth and their families received services from an average of four different service sectors within the previous six months. the most commonly received services by youth include incidentals/clothing/transportation (68%), school-based help for problems with behavioral health issues (47%) and recreational/community activities (46%). according to workers, about 38% of youth received help from outpatient facilities such as a mental health clinic, and 23% received overnight help from a facility such as a hospital, group home, or foster home for problems with drugs, alcohol, or emotional problems. billing records of services. similar to worker reports, administrative data showed that 88% of youth had a procedure code in the billing records for services. unlike the saca data, only 12% had records for incidentals/clothing/transportation. but once again, as with environmental issues, these types of services are seldom billed to medicaid or the division of mental health. most youth (88%) had records for outpatient services, 15% had charges for overnight services. advances in social work, spring 2009, 10(1) 29 relationship between worker reports and billing records of services. the presence of worker reports and procedure codes in the billing records matched 80% overall. the highest match rate was for overnight care (76%), followed by outpatient services (45%), and incidentals/clothing/transportation (38%). table 3. services provided reported by workers and billing data service sector worker report % billing data % concordance % incidentals/clothing transportation 68 12 38 school-based help 47 -- recreational/community activities 46 -- outpatient 38 88 45 inpatient/overnight 23 15 76 overall match (services v. no services) 86 88 80 connectivity scores workers’ connectivity to referral resources in the community is a key construct examined in this study. total connectivity scores (familiarity and number of referrals) ranged from 37 to 272. the average was 83 with a median of 64, indicating that the distribution was positively skewed by several extreme outliers. there was no statistically significant relationship between worker education, number of training hours, or type of training and connectivity. each component of the score is described below and summarized in table 4. familiarity workers are familiar with at least some organizations in most service domains. all of the workers were familiar with at least one resource in each of the four domains and almost half (47%) were familiar with all 28 service categories. on average, workers were familiar with 26 of the 28, or about 93% of the service categories. referrals workers made referrals across all four major domains of services in the six months prior to the intervention. the number of total referrals ranged from 15 to 245. the average number of referrals was 57 and the median was 37, indicating large variations in referral patterns. twenty six percent of referrals were made to outpatient services, 25% to inpatient services, and 19% to health and education services, with the greatest (29%) to “other” service domains. bunger, stiffman, foster, shi/child welfare workers’ connectivity 30 table 4. familiarity, referrals and connectivity by domain baseline domain familiar % referrals x̄/(median) connectivity x̄/(median) health & education 92 10.7/(8.0) - inpatient 93 14.4/(8.0) - outpatient 93 14.9/(11.0) - other 94 16.6/(14.0) - total 93.2 56.7/(37.0) 82.7/(64.0) model exploration above, we examined the separate constructs of the gateway provider model which posits that providers’ connectivity to the larger service network and ability to identify behavioral health service needs influences youth’s receipt of behavioral health services. here we examine the multivariate relationships between those variables and service provision. multivariate predictors of service provision. the gateway provider model predicts that provider assessment of behavioral health problems and connectivity determines provision of care. the multivariate model is based only on worker reports of behavioral health problems, connectivity and services; billing records are not included in this analysis because they reflect the billable actions of multiple service providers, not the individual child welfare actions that are the focus of this study. as hypothesized, when all key variables were entered into the equation, workers’ assessment of mental health and workers’ connectivity together contributed to the prediction of saca reports of the number of sectors of care that served youth. however, assessment of environmental problems was not significantly related to service receipt. in our final model, where we retained only the significant predictors, workers’ assessment of mental health problems (b=.2923, se=.0664, p<.0001) and workers’ connectivity (b=.0026, se=.0009, p=.0048) predicted 37% of the variance (marginal r2) in service receipt. a goodness of fit test demonstrated an adequate model fit, χ2(253)=260.12, p=.37. we ran a similar analysis to examine whether workers’ assessment of behavioral problems and connectivity predict the number of sectors of care that served youth in the billing records. none of the independent variables significantly predicted the number of sectors of care reported in the billing records. advances in social work, spring 2009, 10(1) 31 discussion this paper addressed the influence of child welfare workers’ ability to recognize mental health problems and the effect their knowledge of community referral resources had on behavioral health service provision to youth. youth involved in the missouri children’s division received services from multiple sectors of care, reinforcing the importance of child welfare workers’ role as gateways to care for youth. as expected, child welfare workers’ connectivity and their identification of mental health problems were associated with youth’s receipt of services and explained 37% of the variance in youth’s service receipt. these two worker-level characteristics had more explanatory power than andersen’s model which is usually found to explain about 20% of the variance in service use (mechanic, 1979; phillips, morrison, andersen & aday, 1998). youth receive help from a greater variety of service sectors when their gateway providers are able to identify mental health problems and are familiar with and connected to community resources. for example, one way of thinking about these relationships is that if a youth with two types of mental health problems is working with a child welfare worker with a connectivity score of 131, she or he will likely receive care from an average of six different service sectors. however, if the same youth is working with a child welfare worker with a connectivity score of 74, she or he will likely receive care from about five different service sectors (assuming that both child welfare workers similarly identify youth’s mental health problems). these are important findings because youth in the child welfare system have multiple behavioral health and environmental problems requiring services from multiple service sectors. while more service referrals may not benefit an individual client, the more service sectors involved in their care increases the likelihood that a greater number of service needs are addressed, which is the ultimate goal of the call for inter-agency coordination and reduced fragmentation (stroul & friedman, 1986). identification of youth’s problems our data show that workers’ ability to identify mental health problems among youth in their caseload is critical for service delivery. workers reported that most of the youth had moderate to severe mental health problems. behavior problems and mood disorders were most common among youth while substance misuse and suicidality were less frequent. workers identified environmental problems for nearly all of the youth. the majority of these problems were related to families and school. although workers’ identification of environmental problems was not significantly related to service provision in multivariate analyses, the descriptive information about the types of mental health and environmental problems illustrates the multitude of complex problems that child welfare workers address on behalf of youth. worker response to youth’s problems workers responded to mental health problems with a variety of services. the service action data suggests that workers address youth’s mental health problems by recommending counseling and therapy, service coordination, and education-related bunger, stiffman, foster, shi/child welfare workers’ connectivity 32 services. their connections with community agencies that provide these services reveal additional insight about referral practices that guide youth in the child welfare system to the behavioral health service system. connectivity data show that workers are familiar with nearly all of the service domains and make frequent linkages with other organizations. workers often connected with general social service agencies in the community to meet youth’s basic needs. however, workers also refer frequently to outpatient and inpatient services specifically designed to address behavioral health needs. the wide range of reported referrals to and familiarity with youth-serving agencies suggest that workers vary in the way they are connected with the full inter-organizational network of agencies in the region. neither education, experience, nor training accounted for the variations in connectivity, suggesting that other factors determine workers’ knowledge and connections to referral resources. understanding these variations in connectivity is important because workers’ connections to resources facilitated youth’s receipt of services. our results provide an opportunity to advance a practice-oriented research agenda focusing on individual worker characteristics, practices, and skills that help bridge multiple service delivery systems. limitations the primary findings of this study were based on workers’ reports on youth so we were concerned that recall biases may influence the data. to evaluate the potential impact of such a bias, we compared worker reports with state billing records. if there was little concordance between billing records and worker reports, our findings in support of the model might have been spurious. however, the billing records support the general reliability of worker assessments and reports of service provision. both worker reports and billing data were consistent in reports of mental health problems, particularly conduct disorder/behavior problems and depression. the high correspondence between worker reports of service receipt and billing records bolstered our confidence in the reliability of the saca data. the discrepancy between worker reports and the billing records on youth’s environmental problems may be attributed to an underestimation of environmental problems in the billing records in our study because cpt or hcpcs codes do not exist for all of the types of environmental problems measured in the workers’ survey instrument, and the state may not reimburse providers for services related to all of types of environmental problems. the discrepancy does raise questions regarding youth’s access to social services, and how organizations finance the provision of services that address environmental problems among youth in the child welfare system. our worker reported data indicate that youth obtained services (e.g. transportation and incidentals) that could address some environmental problems (e.g. basic needs and family financial problems). however, we cannot draw any conclusions about whether and how youthserving agencies in the community address other environmental problems like family violence or instability. this gap suggests that child welfare workers need to be familiar advances in social work, spring 2009, 10(1) 33 with youth-serving agencies that are able to provide non-billable services in addition to those with formal contracts or the ability to bill public systems for services. neither worker self-reports nor billing records are gold standard measures for behavioral health or environmental problem diagnoses and there is no perfect measure for capturing service receipt. however, we can present our data and results here with greater confidence because the billing data and worker reports of youth’s problems and services are fairly consistent. the study focused on practices within public child welfare offices in st louis, mo and findings may not be generalizable across other locales. other factors not included in this study may influence assessment, referral practices and service provision for youth. studies conducted with the st. louis children’s division (fedoravicius, mcmillen, rowe, kagotho & ware, 2008; foster & stiffman, 2009; mcmillen, fedoravicius, rowe, zima & ware, 2007) show that mental health services for youth in the child welfare system are frequently court ordered. the pressure to comply with court demands for documentation and time constraints influence workers’ assessment and referral practices (fedoravicius et al., 2008; foster & stiffman, 2009; smith & donovan, 2003). the small sample size did not allow us to run a structural equation model to test the gateway provider model, the preferred method to examine such relationships. social desirability and recall biases may have influenced the accuracy of the connectivity data reported. workers may have felt pressure to appear well-connected or may have had difficulty remembering the number of referrals they made. finally, the continuity of services was not addressed in the data. we cannot determine whether youth received continuous services from a single provider, or sporadically by many providers. despite these limitations, the study findings provide support and direction for the growing body of literature on the role of child welfare workers’ knowledge and practices on youth entry into the behavioral health service system. future studies given the variation in workers’ connectivity, the next step in this line of research is to examine how workers develop their knowledge of referral resources. if training, experience and education were not associated with connectivity, other factors that were not included in these analyses must be important. focus groups revealed that interactions at the office shaped workers’ familiarity with other providers and their referral patterns (foster & stiffman, 2009). constructive organizational culture and positive perceptions of organizational climate influence work-place interactions and may have a role in the transfer of practice knowledge (glisson & green, 2006; uzzi & lancaster, 2003). the gateway provider model also posits that organizational culture and climate are related to connectivity. exploring and testing these relationships could inform training in child welfare agencies and have implications for cross-sector service delivery to youth served by the system. bunger, stiffman, foster, shi/child welfare workers’ connectivity 34 conclusion this study highlights how child welfare workers act as gateway providers and influence youth’s receipt of behavioral health services. the identification of behavioral health problems and connections to service providers who can meet youth’s needs are critical skills and knowledge for child welfare workers. these skills might also be important for social workers and other human service professionals who are responsible for working across system boundaries. child welfare workers’ ability to identify behavioral health problems and their knowledge of service providers in the community make a difference. given the high prevalence of behavioral health problems among youth involved in the child welfare system, it is important to identify and provide clear pathways to needed treatment for youth. by improving providers’ connections with agencies in their community and their 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(2003). relational embeddedness and learning: the case of bank loan managers and their clients. management science, 49(4), 383-400. walrath, c. m., ybarra, m. l., sheehan, a. k., holden, e. w., & burns, b. j. (2006). impact of maltreatment on children served in community mental health programs. journal of emotional and behavioral disorders, 14(3), 143-156. author’s note: address correspondence to: alicia c. bunger, the brown school of social work, 1 brookings drive, campus box 1196, st. louis, mo, 63130. email: abunger@gwbmail.wustl.edu. http://www.acf.hhs.gov/programs/cb/pubs/cwo03/cwo03.pdf mailto:abunger@gwbmail.wustl.edu bunger, stiffman, foster, shi/child welfare workers’ connectivity 38 appendix a: service domains and categories domain service category health and education any public health clinic with mental health services pregnancy related services or similar resources a school social worker, guidance counselor or school psychologist special schools job training resource educational resources (e.g., tutoring) inpatient resources psychiatric hospital or psychiatric or medical units in a general hospital for emotional or behavioral problems drug or alcohol treatment units residential treatment centers group or foster homes detention center/prison or jails emergency shelters for emotional or behavioral problems other places like summer treatment programs or boarding schools outpatient resources community mental health center or outpatient mental health clinics professionals (e.g., psychologist, psychiatrist, social worker or marriage or family counselor) not mentioned day treatment programs intensive in-home services emergency room that treats emotional/behavioral problems pediatrician/family doctors for emotional or behavioral problems probation or juvenile corrections services self-help groups (e.g., aa, 12-step programs, or peer youth counseling program) other crisis intervention services (e.g., suicide hotlines) social services (basic needs) religious providers of services (e.g., churches, ministers) life skills programs for children/youth family or parenting programs victim’s programs (domestic violence programs; crime victims’ assistance) any other resources which service the drug/alcohol/mental health needs of children/youth introduction microsoft word editorial vol 10_2.doc _________________ william h. barton, ph.d., is a professor in the indiana university school of social work on the indiana university-purdue university indianapolis campus. copyright © 2009 advances in social work vol. 10 no. 2 (fall 2009), i-iii editorial: journal news, issue preview, and acknowledgments william h. barton welcome to the fall 2009 (volume 10, no. 2) issue of advances in social work. if you are reading this during the holiday season, i hope this finds you well and enjoying a brief respite from your busy professional lives. before previewing the contents of this issue, i’d like to bring a few things to your attention. first, advances will be publishing a special issue on “social work and service learning in the age of competency-based education.” the issue will be co-edited by virginia majewski and lisa mcguire. participants at the conference “assessing professional competencies through service learning,” to be held in indianapolis from june 16 to 18, 2010, are invited to submit papers for inclusion in this peer-reviewed issue, although others not attending the conference are also encouraged to submit papers as well. papers may be either theoretical or research-focused. the submission deadline is september 1, 2010, with anticipated publication as the spring 2011 issue. to view the complete call for papers, see the announcement on the journal’s home page. second, advances is getting increased exposure, both nationally and globally. we have had requests for permission to publish the special issue on “the futures of social work” (vol. 6, no. 1) as a book in poland. we are now indexed in china via socolar. we are also seeing an increase in submissions from authors and registrations as reviewers from scholars outside of the united states. we welcome this development, and encourage more attention to international issues relevant for social work around the globe. we may well develop a special issue with an international focus at some point in the near future. feel free to let us know of your interest in this arena. third, the editorial board has approved the adoption of a more formal review format, adapted with permission from one developed by another online journal, the journal of the scholarship of teaching and learning (http://www.iupui.edu/%7ejosotl/). reviewers will now be directed to download a rubric and an evaluation form to be completed and uploaded. we hope this will enhance the review process further. now, on to the contents of this issue. we begin with “a social work model of empathy,” in which karen e. gerdes and elizabeth a. segal drawing from both social science and neuroscience sources, arrive at a model of empathy that seems particularly suited for social work. it is a model that invites further development and testing. next comes “the effect of statutory regulations on social workers’ decisions to report child maltreatment,” a report of a study by vicki ashton on social workers’ perceptions of state law regarding the reporting of child maltreatment and the relationship of those perceptions with the likelihood that workers would report such incidents. the results indicate that workers do not share a common understanding of the law, and that their perceptions of the law are related to their likelihood of reporting maltreatment. the third article represents an international perspective, as christopher chitereka discusses “social advances in social work, fall 2009, 10(2) ii work practice in a developing continent: the case of africa.” chitereka traces the colonial origins of social work in africa, and highlights the tension between the remedial and social development approaches of the profession. the remaining four articles focus on educational settings. first, in “modern social support structures: online social networks and their implications for social workers,” kala chakradhar, victor raj and arabella raj present the results of a study on college students’ use of online social networks (osn), such as facebook. their study examined the profiles of osn users, the reasons for their use, and their experiences with osns. continuing the discussion of technology and education is the next article, “virtual worlds and social work education: potentials for ‘second life’.” here robert vernon, lisa lewis and darlene lynch report upon their use of “second life,” a virtual world, in classroom and online education. they present the ways in which second life can be used to address selected competencies specified by the council on social work education’s educational policy and accreditation standards, and conclude with a discussion of the potential and challenges posed by excursions into virtual worlds. mark thomas lynch, lening zhang and wynne s. corr examine the relationship between social work research education and subsequent research activity in their article, “research training, institutional support, and self-efficacy: their impact on research activity of social workers.” reporting on data collected from a random sample of social workers, they test a model in which research training and institutional support for research within agencies each affect the research activity of practitioners directly and indirectly through their effects on the practitioners’ research self-efficacy. their results provide partial support for their model. in the concluding article, “toward building a culture of strengths in u.s. msw programs,” linda plitt donaldson, barbara p. early and minling wang present the results of an exploratory study in which they surveyed msw programs regarding how and to what extent the strengths-based paradigm is integrated into their practice curricula. their findings suggest that most programs are aware of and include strengths-based content, but that few seem to be moving beyond curriculum content to a more comprehensive culture of strengths. i would like to take this opportunity to acknowledge the valuable contributions made by the many scholars who have completed one or more peer reviews of manuscripts since i began my term as editor with the fall 2008 issue. the following have provided detailed, constructive reviews in a timely manner, and authors have frequently expressed their appreciation for the reviewers’ guidance (apologies if our system has omitted anyone who has reviewed for us lately): margaret adamek scott anstadt carolyn black javier boyas daniel brisson kala chakradhar valerie chang hyunkag cho patricia coccoma barry cournoyer james daley rafael engel robin ersing gail folaron rose handon karen harper-dorton david hodge carol hostetter grafton hull jayshree jani michael kane barton/editorial iii hea-won kim athena kolbe kathy lay dianne loeffler virginia majewski eldon marshall stephen marson jennifer martin lisa mcguire shari miller paul newcomb philip ouellette brian perron phu tai phan cathy pike gerald powers marilynne ramsey larry reynolds diana rowan michael sherr patrick sullivan robert vernon david westhuis scott wilks sabrina williamson joanne yaffe if you happen to be reading this and have not yet registered with the journal, it’s free and easy to do. benefits include email notification whenever a new issue is published, the opportunity to serve as a peer reviewer for manuscripts received by the journal, and easy access to manuscript submission. if you do register, please consider also enrolling as a reviewer. to do so, when you are filling out the requested profile information, just check the box next to “reviewer” near the bottom of the page and then indicate the topics you are interested in reviewing in the textbox provided. it is my intent not to overburden individual reviewers, and the more reviewers we have, the easier that is to do. finally, please consider submitting your work to advances in social work. we do offer an exceptionally quick turnaround – authors can usually expect to receive the peer reviews and initial editorial decision within two to three months of submission. the online format means that we are not constrained by an issue’s page length, and so backlogs of accepted manuscripts rarely occur. to submit a manuscript, you must first register with the journal and select “author” as one of your roles in your profile. then, when you wish to submit a manuscript, log in, select “author” and follow the detailed instructions. thanks are due to the editorial board for their conscientious oversight of the journal, to the indiana university school of social work and its dean, michael patchner, for supporting the work of the editor, to the university library at iupui for providing the open access online platform, to kristi palmer for invaluable technical assistance with the journal’s website, and to julia carter for administrative support. may the year 2010 bestow opportunities and support upon our profession, the world, and each of its inhabitants. william h. barton, ph. d., professor editor, advances in social work indiana university school of social work 902 west new york street indianapolis, in 46201 (317) 274-6711 wbarton@iupui.edu spring2005-077_page79 spring2005-078_page80 spring2005-079_page81 spring2005-080_page82 spring2005-081_page83 spring2005-082_page84 spring2005-083_page85 spring2005-084_page86 spring2005-085_page87 spring2005-086_page88 spring2005-087_page89 spring2005-088_page90 aisw vol. 5, no. 2 288 journalwriting for life development dorothy m. epple abstract: : journal writing can be a creative adjunct to psychotherapy. this article will describe a qualitative study of the experiences of journal writers. each participant’s narrative illustrates the integration of winnicott’s transitional phenomena, freeman’s four stages of epiphanies, and kegan’s adult developmental stages through journal writing. the central findings of this research are that the experience of the participants can be identified in the following three categories: therapeutic experience, meditative experience, and a transformative experience. journal writing can be adapted by psychotherapists, as an adjunct to therapy, to aid clients in elaborating their stories, listening within, identifying epiphanies, and moving forward in the change process. this article will present a case study of one of the narratives from this research. keywords: journal writing, narrative, interpretive interactionism, ethnography, transitional phenomena, transitional space, epiphany introduction psychotherapy is regarded as a talking cure that relies on a clinical relationship between a client and a therapist based on conceptual understandings from ego psychology, object relations, self-psychology, systems theory, and narrative theory. through the use of language and storytelling, the client develops a narrative that is representative of his/her world. a relationship develops in which the therapist honors the client’s self-determination, the client’s inner knowledge of self, and the client’s interpretation of meaning of the events of his or her life. the therapist relays to the client a belief in the client’s strengths and value and helps to empower the client to tap his/her potential. the process begins by accepting the client’s current experience of his or her own life and providing a structure within sessions to enable the client to begin a self-discovery process. this study on journal writing indicates that journal writing may be an adjunctive method that complements the therapy process. journal writing is mediated through language, writing, and storytelling. it enriches and aids the client in the self-discovery process by drawing out of the client knowledge he or she already possesses but does not know he or she has. journal writing has the potential to dorothea marie epple, ph.d., lcsw, bcd, is assistant professor in the social work program at the university of st. francis, joliet, il 60435. copyright© 2007 advances in socialworkvol. 8 no. 2 (fall 2007) 288-304. indiana university school of socialwork. 289 become a dynamic self-realization. the journal starts where the client chooses to begin. at the heart of journal writing is a narrative that is consistent with that of the therapeutic encounter. journal writing is a non-analytical, non-judgmental method that helps clients crystallize issues in their lives, identify changes needed, and move forward to enact the change. the purpose of this paper is to present the process of the progoff (1992) journal writing, its relationship to personal growth, and its parallels to psychotherapy. both therapy and journal writing focus on a process of quieting one’s self, reflecting within, identifying ideas, epiphanies, strengths, potentials, and living these potentials in the world. this paper will: 1) review the literature on journal writing and psychotherapy; 2) report the process and findings conducted on a study of progoff journal writing; 3) present one of the research participant’s experiences of journal writing that illustrates the process and findings in the research; and 4) examine journal writing as an adjunct to psychotherapy. reviewofthe literature this review of the literature will document: 1) journal writing as a means to personal growth, creativity, and use in treatment, 2) studies that document the therapeutic effects of journal writing, and 3) the progoff journal method and theory. journalwriting as a means to personal growth journal writing has been a springboard for personal growth and the creative process. psychoanalysts and psychotherapists, including freud (1935, 1965), jung (1965), milner (1936/1981), and progoff (1992) have utilized journal writing, autobiography, and diaries or letter writing for personal insights, creativity, and the development of their own theories. freud (1935, p. 36) referred to his own autobiographical study as follows: “two themes run through these pages: the story of my life and the history of psychoanalysis. they are intimately interwoven.” marion milner (1981, p. 219), an english psychoanalyst, wrote “i was so astonished at what my diary keeping had shown about the power of the unconscious aspects of one’s mind, both for good and for ill, that i eventually became a psychoanalyst.” jung recorded in his journal dreams, images, fantasies, imaginary conversations with his anima, and drew mandalas. jung used his diary as a springboard for his theory of the collective unconscious. jung (1965) states, “all my works, all my creative activity, have come from those initial fantasies and dreams.” germain (1991) has utilized and researched journal writing in social work hbse courses to develop students’ writing, analytic, and integrative skills. psychotherapists have noted the professional use of journals for treatment (freud, 1919; blos, 1962; horney, 1980; dalsimer, 1982; and hymer, 1991). freud (1919, p. 341) discussed the importance of hermine von hug-hellmuth’s diary stating, “the diary is a little gem. i believe it has never before been possible to obtain such a clear and truthful view of themental processes that characterize the development of a girl in our social and cultural stratum during the years before puberty.” blos (1962, p. 94) states, “the diary stands between daydream and object world, between make believe and reality, and its content and form change with the times.” dalsimer (1982) critiqued thediary of anne frank and viewed the epple/journalwriting for life development diary as analogous to the clinical situation in content and in associative sequence. dalsimer (1982) and blos (1962) view the diary as being endowed with attributes of an object with which the writer develops an intimate relationship. hymer (1991) states, for some, the diary becomes a “constant object” helping to ground the writer. laird (1989), utilizing women’s personal stories, writes of the importance of narrative, story telling, and myth. “stories and myths help us to order the world, to sort out, explain, and integrate events in a striving for continuity and coherence” (laird, 1989, p. 435). psychotherapists who have utilized journal writing as an adjunct to therapy have found it to be a form of self-expression, self-reflection, a mirror, an object, a confident, and a bridge from past to present and future. studies that document the therapeutic effects of journalwriting studies document the therapeutic effects of journal writing (nichols, 1973; pennebaker, 1990; wiener & rosenwald, 1993). nichols (1973) exploratory study of journal keeping revealed the most frequently reported benefits of the journal included an increase in self-awareness and acceptance, the ability to express feelings, and help in centering the individual, as well as fostering a relationship of friendship to oneself. wiener and rosenwald (1993) found developmental and integrative benefits associated with keeping a diary. pennebaker (1990) conducted controlled clinical research on the mind-body connection and demonstrated that individuals who wrote about their traumas experienced greater well-being, both psychologically and physically, and significantly bolstered their immune functions, compared with those who did not keep a journal. multiple methods of journal writing have emerged in the 20th century (rainer, 1978; cameron, 1992; capacchione, 1979, 1989; phillips, 1997; neubauer, 1995; keen & valley-fox, 1989; nelson, 1991; kelsey, 1980; dorff, 1998). ira progoff’s (1992) journal techniques are reflected in many of the current journal methods (bender, 1997; dorff, 1998; kelsey, 1980; nelson, 1991; rainer, 1978). progoff (1992, p.12) states: “once you have learned how to use it, the intensive journal method becomes like amusical instrument you can play; and itsmelodies are the themes and the intimations of meaning in your life.” progoff refers to his journal as an intensive, structuredmethod of writing for personal and spiritual growth. it is a dynamic way to record one’s life rather than the traditional diary, which tends to be a chronological ordering of experience. the journal becomes a continual confrontation of oneself in the midst of one’s own life. ira progoff journal method—development and research progoff (1956, 1959, 1963) published a trilogy of books that reflect the development of his theoretical view that underpins the methodology of the journal process. progoff’s (1956) first book is written from a historical perspective, crystallizing the evolving insights of freud, adler, jung, and rank, which represent a transformation from the repressed to an awareness of the inner self and a creative wholeness. each theory brought new insights, and a unity of development unfolded, which transcended any one individual school of thought and reached beyond to a science to which they all contributed. but, progoff saw these theories “build a psychological hedge around the realities of man’s creative and spiritual advances in socialwork290 291 experiences” (p. 81). the theories stifled creativity in their analytical, intellectual, and rationalizations of the self. progoff’s (1959, 1963) second and third books in his trilogy present his new view of the magnitude of human personality. progoff saw the primary task of depth psychology as developing a capacity of perceiving the inward process of one’s growth. as one becomes sensitive and attuned to one’s growth inwardly, one is able to draw one’s potentialities forward. symbols appear as spontaneous images from the depth of the person and are a vehicle that the potentiality latent within can be brought forth. symbols should not be approached in an analytical way, because, if they are reduced to experiences of the past, they are deprived of their potentiality. to break a symbol apart and analyze it deprives it of its power of life. instead, one works affirmatively, encouraging, nurturing, and drawing forward a symbol (progoff, 1963). progoff (1959) used the term “organic psyche” to emphasize the close relationship between the psyche and natural evolution. he sees the psyche as the directive principle in the human that guides its growth from the moment of conception forward. the psyche is a unitary principle. it is not conscious, as opposed to unconscious, nor is it unconscious, as opposed to conscious. it is both. the inherent process of growth takes place with awareness and direction, as though it were consciously guided toward a certain purpose. it begins on a level of intuition as a non-conscious intimation of things to come. neither the goal nor the manner of its fulfillment is thought out in advance. the pattern discloses itself as it acts itself out. in the course of the enactment, the person discovers the nature of the goal the person is truly seeking. progoff created the journalmethod in 1966 to help individuals become in touch with the dynamic aspect or potential that their life is trying to become. he uses the image of the acorn having the potential to become an oak tree. the journal helps individuals become in tune with this potential within. progoff (1992) believes there is a specific process working at the depth of a person. this process can be evoked with the use of a journal. this process is the movement of the psyche in the life of an individual. it is purposeful, elusive, and reflected in dreams or images, which are often transient. recordings in a journal of one’s dreams or images can preserve the process and become an image or mirror of the psyche. progoff’s journal method was an attempt at a tool to help individuals open to the core of self and lead beyond the self. in the journal experience, one is ask to suspend any critical judgments and allow whatever emerges to emerge. progoff’s journal workbook is a loose-leaf binder with dividers. the four main sections of the workbook are the lifetime dimension (historical data), the dialogue dimension (relational aspects of life), the depth dimension (symbolic dreams and images), and themeaning dimension (inner experiences and spiritual aspects of life). each of these dimensions is divided into several subsections. there is a section for a traditional daily log and for a period log. the process begins with recording factual data in the journal log sections. these data are then expanded and worked with in other dimensions or sections of the journal. working withmaterial in one section of the journal has the tendency to stimulate material to work with in another section of the journal. as one follows the leads from one section of the journal to another section, new awareness, connections, epple/journalwriting for life development and integration of one’s life can take place. the process of working with one’s own experience by writing in the journal activates a creative energy. through dialogue in the journal, one speaks of conscious plans and experiences, but hears the symbolic messages, the wisdom, the intuitions, and the inherent possibilities that life reflects from the written page. the journal method utilizes meditation, images, and dreams to explore the symbolic messages beneath the everyday experiences. the process of personal growth often begins with an image that previsions the achievement. it is on the level of intuition and it is a non-conscious intimation of things to come. images do not state meaning in specific logical terms but portray meaning. when an emotion is felt, imagery conveys that emotion. the journal helps one link the conscious and unconscious in an integral unity, bringing a new awareness that restructures the prior conscious view and moves one forward in life. janet loyd (1991) completed her thesis at seattle university on “journal keeper’s experiences.” this clinical, qualitative approach of the progoff journal method involved identifying subjective attitudes through three cumulative stages, namely, the pre-pilot, the pilot, and the survey. in the survey stage, a formal questionnaire of agree/disagree statements was sent to 50 different people nationally, all of whom were obtained from the mailing list of advanced studies students at dialogue house in new york city. seventy-six percent of the questionnaires were completed and returned. some of the results from this survey included reports that: 1) journal writers maintained the journaling process on their own, apart from the workshop—86%. 2) they conferred that they had developed from their journal work a sense of their life as an ongoing process, which needs to be respected and allowed to unfold—97%. 3) they reported becoming more conscious of their own worth as an individual—95%. 4) of those 58% who reported working with a therapist, they felt the journal was helpful in the course of receiving psychotherapy—91%. 5) they have found meaning in images and symbols—94%. 6) they reported a sense of connection with god or the divine when working with the exercises in the process meditation sections of the journal— 92%. this survey indicates that specific exercises in the journal were helpful for particular needs. this study indicates that, for those who utilize the progoff journal method, they get significant benefits. in february 1971, an 18-month on-the-job training program was sponsored by thenewyork state department of labor, applying the progoff journal, in addition to 20 weeks of on-the-job training and remedial education. the trainees had earned less than $3,000 a year in their former employment and 50% had formerly received state welfare. one year after initiation of the program, 249 of the 286 trainees had completed the program and were employed. transcribed taped advances in socialwork292 interviews with the trainees indicated that the journal aspect of the training empowered the participants to make changes from within. “the ultimate poverty is a person’s lack of feeling for the reality of his own inner being. people in poverty situations tend to feel they are powerless to change their circumstances because their individuality is submerged by the group situation. thus, they do not feel they are persons and, therefore, that they have no power to redirect their lives. the answer to poverty lies in making it tangibly possible for a person to experience the fact that he is a person.we do that in our program by using the journal in such a way that it becomes the outer embodiment of the inner life of the individual.” (sealy & duffy, 1977, p. 5) a pilot target prison program was conducted at the bedford hills correctional facility in bedford hills, new york, utilizing the progoff journal. this is a maximum-security facility for women. twenty-eight inmates, who later narrowed to a core nucleus of 15, attended three core workshops, totaling 50 hours of instruction, followed by ongoing sessions and consultations. the women had been incarcerated primarily due to substance abuse violations, theft, or murder. racial and ethnic backgrounds varied. the age of the group ranged from 25 to 45, with one inmate being over 60 years of age. the inmates were literate and interested in writing about their life experiences. the study included evaluations with the inmates, who provided feedback on how they were using themethod and its benefits related to their self-development. the prison officials were consulted regarding the progress of the inmates. the inmates commented that the journal helped their ongoing growth and rehabilitation process by self-empowerment, release of feelings of anger and frustration, increased self-understanding, heightened sense of inner peace, more self-control, and greater awareness of creative abilities. visible results of changed behavior were documented by feedback from the prison officials (mcnair, 1999). other studies of the progoff journal include the dissertation work of gerard werckle (1990); a phenomenological study of the experiences of persons who consider the progoff journal important in their lives; andwalter hopkins (1997), a non-analytic qualitative study of dreams and symbolic material. theresa craig (1991) utilized the progoff journal to keep a personal record of responses to her field log notes of her dissertation. methodology purpose the purpose of this qualitative narrative study is twofold: 1) to provide a window into the personal experience of how people use the progoff journal method to tell their stories, make sense of their experience, and identify whether the writing has provided a change process; 2) to examine the utility of journal writing as an adjunct to psychotherapy. the ira progoff journal method was selected for study based on the understanding that many of the journal techniques in other current methods of writing are encompassed in the progoff method. also, the progoff method makes claim to a dynamic form of writing that moves one forward in epple/journalwriting for life development 293 their life, rather than making a chronological ordering of experience that is often reflected in other methods. this continual confrontation of oneself in the midst of one’s own life has the potential to tap creative energy that will continue with a life of its own. paradigm for inquiry qualitative methods were used to explore the process, meaning, and subjective understanding of participants’ experiences with the progoff journal. qualitative methods provide depth and detail by preserving the individual’s story through direct quotation. “knowledge of the realm of meaning is gained through interpretive or hermeneutic procedures” (polkinghorne, 1988, p.159). the qualitative design in this study includes an integration of narrative methodology (bruner, 1986; polkinghorn, 1988; riessman, 1988, 1993; schwandt, 1997), ethnographic methods (van maanen, 1988; denzin, 1997), and interpretive interactionism (denzin, 1989). denzin’s (1989) interpretive interactionism was utilized as an overarching method of inquiry. embedded in the bracketing process was an examination of each participant’s writing related to freeman’s (1993) four stages of an epiphany. deconstruction capture bracketing freeman’s (1993) four states of an epiphany recognition distanciation articulation appropriation construction contextualization the interpretive interactionism process included a five-step process as indicated above. deconstruction was an analysis of prior studies and a review of the literature of the phenomenon of journal writing. capture included semi-structured recorded interviews of the experiences of 14 participants who had used the progoff journal method for eight years or longer. bracketing isolated the key features of the journal process. embedded in the bracketing process, freeman’s (1993) four phases of an epiphany were examined for each participant’s story. this four-phase process includes: recognition of a disjunction between one’s life and one’s potential, distanciation or separation of oneself from the disjunction, articulation of the old self and the new self being projected in the future, and appropriation or transforming the new knowledge into action. the last two steps of the interpretive interactionism allowed for a construction of each participant’s process of journal writing over time and a contextualization or locating of the phenomenon in the worlds of lived experience. this narrative approach allowed for a rich, thick description of the experiences of each participant and allowed advances in socialwork294 295 various levels of themes and categories to emerge from the data. an expanded analysis of the narrative then developed the context of stories within stories. validity is measured in verisimilitude, related to how this project captures the experiences of the participants so that others can share, vicariously, in their experience and resonate with it. participants participants were recruited from a mailing list provided by journal leaders in the midwest. the 14 participants included nine women and five men. ranging in age from 44 to 68. the participants included threemarriedmen, twomen never married and committed to the clergy, five married women, one divorced woman, two lesbian women, and one nun. five participants had children. employment for five of the participants was in the social service field (msw, psychotherapist, hospital chaplain, director of volunteers, rn), three were employed in a writing profession (teacher of creative writing, editor, freelance writer), three were in religious life (parish priest, monk, nun/retreat director), one was a political science professor, one was an executive owning his own company, and one was a systems programmer. four participants had earned a bachelor’s degree, seven earned a master’s degree, and three had a ph.d. faith backgrounds identified by the participants included catholic, buddhist, taoist, wicca, tibetan buddhist, jewish/buddhist, and united church of christ. participants had utilized the progoff journal method for eight to 30 years. ten participants had practiced diary writing before theywere introduced to the progoffmethod. four of these had kept a diary since their teen years. the participants were asked to describe their experience of the progoff journal writing over time and how the writing had affected their life. the participants were allowed to let their stories unfold in a semi-structured interview. those participants who were willing also shared quotes from their journal that exemplified their experience of journal writing. the interviews were recorded and transcribed. the participants read the transcribed interviews and the analyzed interviews for the purpose of member checking. data analysis the data were analyzed using denzin’s (1989) interpretive interactionism and freeman’s (1993) four phases of epiphanies. each epiphany is illustrated in the participant’s narrative by exploring the “recognition” of a disjunction between one’s life and one’s potential; “distanciation,” or separation of oneself from the disjunction; “articulation” of the old self and the new self being projected in the future; and “appropriation” or transforming the new knowledge into action. winnicott’s (1951) concepts of potential space in the intermediate area of experience were also examined.winnicott describes transitional phenomena as a third part of life: “an intermediate area of experience, to which inner reality and external life both contribute . . . it shall exist as a resting place for the individual keeping inner and outer reality separate yet inter-related . . . the substance of illusion” (1951, p. 30). this potential space lies between the inner world and the external reality, while both are joining and separating the two.winnicott widens his concept of transitional phenomena to play, art, religion, and dreaming. the journal process of quieting one’s self, meditating, and writing allows one’s experience in epple/journalwriting for life development this intermediate area to be written in the journal. the containing of one’s story in the potential space of the journal is attuned to the illusive process of imagery and its symbolism that is below the surface of conscious awareness. limitations this qualitative study was exploratory in nature and specific to the experience of the 14 participants who used the progoff method for eight years or longer. other journal methods were not examined. as a qualitative research project, there are limitations inherent in this design. all narratives of an experience are representations of an experience but are not the complete true experience itself. the teller of a narrative selects aspects of his or her experience to tell and interprets aspects of the experience in the telling. telling is limited by language and by the awareness of the teller. narratives about the subject’s narratives are a creation of the researcher, as a result of the interaction with the subjects of research. there is a co-construction process between the researcher and the participant. meaning is fluid and contextual. meaning is not fixed and universal. objective science discovers facts. the notion of an objective reality will not be applicable in this project. findings the experiences of the journal writers were identified in the following three categories: therapeutic experience, meditative experience, and the integration of the journal methodology into other disciplines. the vignettes reveal a journey to the creative inner voice that leads to self-discovery and wisdom (therapeutic), transcendence (meditation and creativity), and transformation (the methodology of the journal is owned, integrated with another theory, and transformed). selected participant comments related to each theme are listed below: therapeutic experience “the journal was saying to me, ‘you are not here to do bookkeeping. you are here to be a midwife of souls. you are here to evoke from within other people what is there.’ today i get great joy out of seeing other people blossom and grow and find their path in life.” “i had this absolutely mind-breaking, totally un-grounding experience that just opened up all kinds of new things.” “progoff has helped me to realize my value system and i want to live my value system.” “the journal gave me a voice.” “the journal has been a factor in my having the courage to believe in myself.” meditative/transcendent experience “the journal has taken me beyond one religion in the sense that i have become very active in inter-religious dialogues and in learning about the spiritual and mystical sides of other religions . . . it opened me beyond the rigid structures of any system. it opened me to seeing the truth wherever it is, without totally leaving my roots.” advances in socialwork296 297 “the journal has given me a place in which to experience myself and to discover my existence.” “it is a way of making contact with strengths or powers within myself which i may tend to habitually over look or minimize.” “i accessed my inner wisdom and, after that, i knew that everyone has inner wisdom.” application and transformation of the methodology four participants in the study learned the journal method, made the method their own, then transformed the method by integrating it with their own discipline or career and, in turn, creatively came up with something new. these new inspirations included writing books; giving retreats, one-act plays, and journal methods for businessmen and companies; and counseling techniques. “all i did is take the language that ira progoff is using and translate it into business. . . . i’ve used it in corporations to answer strategic questions or vision questions.” “i’m an intuitive thinker with rational training, so what happens is i get an image of either a change inmy life or a change in society and then rationally construct the means to have that happen. getting the original vision of where i’m headed is important and the journal certainly helps in that.” the author’s analysis of the vignettes demonstrates that epiphanies that emerge in journal writing have the potential to bring a new view of life and a new action in the world. rather than just an intellectual understanding, this epiphany often appears for the participants as a result of an image or a series of images that convey meaning at a symbolic level. the imagery process entails leaving behind the logical mind and creating a space where an image can emerge. the image carries the seed for future action and taps a developmental unfolding. the process of journal writing produces images, symbolic meanings of the images, and the initiation of a developmental process or spiritual deepening. each participant’s narrative illustrates the integration of winnicott’s transitional phenomena, freeman’s four stages of epiphanies, and kegan’s adult developmental stages through journal writing. significanceto socialwork the narrative in the journal is parallel to the narrative the client brings to case management or therapy. the journal as a potential adjunct to therapy could facilitate the narrative process and the construction of a coherent story. this could increase the progress made in each therapy session and continue the therapeutic process between sessions by harnessing and organizing the person’s thoughts. the potential of the journal to initiate the developmental process, tap intuitive abilities, broaden the perspective of the client, approach life situations from new perspectives, create a bridge between past memory and future intimations or hopes, would all move the process of the therapy forward. narrative theory and journal writing could be integrated with any other therapeutic theory to form a foundation, to assist in the process of narrative construction toward therapeutic epple/journalwriting for life development advances in socialwork means related to the client’s presenting problem. in psychotherapy, the journal has the potential to facilitate the process of bringing to the surface the not yet conscious aspects of life. as an aspect in short-term therapy, the journal canmake the course of therapy briefer and give the client a method to continue the therapeutic process and enhance self-development following treatment. the therapeutic atmosphere of the journal is a means to a continued therapeutic process within the self after therapy has ended. a goal, in therapy, is to help the client develop ameans with which to be present to themselves and to findwithin themselves their own answers and their own authority. the journal experience of one participant was chosen to present, because her experience was illustrative of the three findings of the study, and it also demonstrated the integration of the transitional phenomena, epiphanies, and the tapping of the developmental process through the journal writing. this methodology was a narrative study (as opposed to a grounded theory study), which kept the integrity of each participant’s story intact. it allows for the rich breadth and depth of the experience to be realized. liliana—journalwriting: beyondthetwelve steps liliana was a 64 year-old caucasian of german/irish/american background. she was a published poet and fiction writer. her full-time employment was at a university as an instructor in creative writing. liliana has earned amaster’s degree in literature and the teaching of writing. she was raised a roman catholic, but, at the time of the study, was a taoist and a practitioner of religious science. i met with liliana at her home. liliana’s energy and exuberance overshadowed her facial lines of aging, bringing her a natural glow. i immediately felt at home with her warm welcome. the desire to write began as early as five years of age, when liliana dictated a “novel” to her mother, while waiting for doctors’ appointments to address a serious early-childhood illness. liliana had been a lifelong journal writer, beginning at age eight. liliana described hermother as an alcoholic. she remembered being lonely and feeling her parents did not know her or see her unique qualities. liliana became her mother’s confidant, creating a cycle of intimacy, dependency, confusion, rejection, and loneliness. liliana appeared to have been born with creative capacities, but her early life experience discouraged a belief in her own talent: “i used to play in my bedroom closet when i was quite young . . . i would stage plays . . . i have this image inwhich i say to little liliana ‘i have to leave for aminute. i’ll be right back.’ then, i didn’t come back. that is when i lost touch with my authentic self. . . .when i graduated from college, i remember, putting things back in that same closet, thinking, i have to stop writing because i am not good enough and i don’t have the right to put my life into something that i am not going to be successful with.” liliana abandoned herself and her talent to marry and support the talent of her husband, who was a performing musician. many years later, she embarked on a midlife change that included recovery from addictions, divorce, relocating to 298 another part of the country, and obtaining a master’s degree in creativewriting. liliana also began progoff journal writing. “takingme back to that first workshop, i remember checking in and getting this huge book and thinking, ‘oh my god!what is it that they are going to expect of me here?’ at that time i had been in a twelve step program for eight years. thetwelve steps demand that you look at yourself and the way you are functioning and be open to change. those of us who are in that process are a fruitful field for plowing. i don’t think that there was any specific thing that i was working on but i was anxiously trying to get deeper into myself. progoff refers to the journal, especially the life history log, as “loosening the soil of our life,” which is similar to the twelve step self-examination process that liliana calls a “fruitful field for plowing.” both allow for an opening of the channels in the inner space of one’s life. with eight years of twelve step reflection in the aa program, liliana came to the journal workshop ready to freely explore her inner life. liliana described the first weekend: “i mostly remember the psychological movement that happened that i just thought was fabulous! it told me that i had more rooms inside myself than i had been in consciously. they were accessible. they were willing to open the doors, if i was willing to keep writing. that was very exciting to me . . . i remember that experience the way you remember psychological milestones . . . i learned to trust myself in a way that i hadn’t been known to do before . . .what that moment told me was that my insides were a trustworthy geography . . . wow! i’m getting emotional now! the thing that i got when i came into aa was that i realized that i was getting a second chance in life. it was a new arena in which to discover who i was and become who i wanted to be. this is a very similar thing. this process told me that there were a lot of riches within me waiting for discovery and that they were mine. it was reclaiming myself . . . but it’s more than that because it moves you forward in life. you’re not just reclaiming the past . . . it has messages to . . . reveal your past to you.” ira progoff (1992) describes his journal method as having a feedback process in which the feedback generates an energy that thrusts forward, in the form of new experiences, new recognitions or new ideas, connecting one to an inner-self or inner-movement in life. liliana describes the energy in her journal as helping her to become aware of “more rooms inside” herself that she had not “been in consciously” and that were “accessible” if she was “willing to keep writing.” she described this movement as being a “psychological milestone” in which she learned that her insides were a “trustworthy geography.” she came to realize that she had many “riches within” that were “waiting for discovery” and that she was being given another chance to “reclaim” herself by allowing the journal to reveal her past to her. this process, as described, is similar towinnicott’s (1971) transitional phenomena, or intermediate area of experience, in which a person searching for self requires a new experience in a specialized setting. the journal provided a space for liliana to do a ticking-over of the un-integrated aspects of her personality and realize sensations that had been beyond detection and defied epple/journalwriting for life development 299 description. lillian’s first epiphany in this transitional space was a recognition (freeman’s term) that she could trust her insides. she describes this process: “images are not always visual but they are in the body and so sometimes they are felt, and they are very specific. they have all the characteristics of a visual image in that they have parameters, scope and roundness or flatness. they have texture . . . a sense of color, a sense of flavor . . . the recognition of trust within came . . . it was like an explosion of opening. sometimes, when you see a film and it fast forwards, like the opening of a flower—it just opens just like that . . . the space opened. it was an opening of a space within me . . . i was holding myself. i was bigger then i usually thought of myself. wiser, all of that was present . . . i felt this underlying structure that had been present . . . it was buried down there, it was active and it was alive. that toldme a great deal aboutmyself . . .what i foundwas that these were things that were alive, that were actively functioning in me, even though i wasn’t conscious of them and that they were accessible and that i could make decisions about them. that is a lot of power.” liliana described the sensation of trust within as “an explosion of opening,” like the “opening of a flower,” and a “space within me” that allowed for a “holding myself.” this instant explosion had parameters, scope, roundness, flatness, texture, color, flavor, and layers, without being visual. this moment in time, an epiphany of inner knowing and trust, gradually changed the future internal and external life for liliana. the holding of the infant by the mother, termed as the environment, is seen bywinnicott (1965) as providing a transition from an “unintegrated state to a structured integration.” liliana’s movement from awareness of a “trustworthy geography within,” to the felt “underlying structure that had been present and was active and alive,” resembles winnicott’s early motherinfant holding environment. the journal provided a space for transitional phenomenon to occur that reconnected liliana to that early mother-infant relationship that was “present” and “buried” within her. this made available the “power” to enact the epiphany of inner trust. liliana reports the early journal writing exercises that brought about this epiphany experience were a sequence of childhood writings that included steppingstones, life history log and enlargement, dream enlargement, twilight imagery, and dialogue with individual family members. liliana states, “what the journal did formewas reconfirm the path i had chosen.” liliana’s new path had included divorce, relocation, and a career change. she knew she could trust these changes, because they emanated from a sense of knowing herself. rather than leaving home, liliana was finding a home within herself, a home that had been there but had been unknown. this recognition of inner trust was the beginning of the four steps of her epiphany. the disjunction and the distanciation phase of liliana’s epiphany of gaining inner trust was not one of separating herself, but rather, one of embracing herself. liliana describes how the journal epiphany led to the articulation and appropriation of inner trust through fiction writing: “the journaling process gave me a vocabulary for talking about my innerlife, which i had never had . . . for instance, the entrance meditations have a vocabulary thatmatchesmy insides right away . . . i could then talk about advances in socialwork300 301 it to myself and to other people . . . i think something i didn’t have before was a sense of respecting my own sacred language. there are images that are specific to me that are sacred and are just as loaded as any image in the bible . . . another thing progoff gave me was language for a sense of connectedness with something larger thanmyself . . . progoff does assume that every human being has a spiritual dimension . . . i think that what the progoff journaling has done for my writing process is to deepen me into that spiritual connection and give me more language so that i could write from that place. most of what i write about in my fiction is about how people come to a moment of change. i think those turning points in our lives are the story of our life. they’re themost interesting things that happen and how you get there and how you negotiate it.” liliana described the journal as giving her a “vocabulary” for her inner life, an experience that resembled “turning a light on over a terrain that had been in semi-darkness.” this experience is parallel to helen keller’s acquisition of language, as told by freeman (1993). helen keller’s loss of sight and hearing had resulted in an experience in which she “forgot that it had ever been different” until the teacher came, “who was to set my spirit free” with the acquisition of language. as humans, we are immersed in language. it is only through language that we can describe our memories and our inner experience, allowing for meaning. the journal provides a space, a playground, where one can listen to and feel the movement of the words as they tell and retell the experiences of life, while rewriting the self. a respect for her own sacred images brought a connectedness to the larger than personal. this connection to the larger than personal gave liliana a language to write about the spiritual dimension of life, of “how people come to a moment of change” in her fiction. liliana’s writing was a concrete expression of the articulation and appropriation of her epiphany of inner trust. the development of a small performing arts group that integrates poetry reading andmusic was another concrete example of appropriation of this inner trust. liliana’s epiphany in the journal writing took her beyond the aa program and beyondwhat therapy provided to a spiritual substratum. from this she developed an inner trust to act out of her knowledge of herself. the language of progoff was evocative in allowing liliana to find metaphors, rich descriptions, and words to describe her internal space. the journal exercise of steppingstones, life history log, dream enlargement, twilight imagery, and dialogue were used to examine childhood experiences with a therapeutic result. the journal process provided a space for transitional phenomenon that reconnected liliana to an inner trust and an active, underlying structure that she had been disconnected from since childhood. the connection to a “trustworthy inner geography” was mediated by language. multiple layers of meaning flowed from her experience of inner trust and resulted in reclaiming her artistic and spiritual inclinations. outward activity of fiction writing, poetry writing, and performing arts was propelled from within, the now trusted interior terrain of her life. the central findings of the research are evident in her narrative. the journal writing provided a therapeutic experience, a spiritual or meditative experience, and a transformative experience in which her epple/journalwriting for life development advances in socialwork302 personal journal writing became integrated with her professional work as an author, teacher of creative writing, and a co-founder of a performing arts group. discussion this experience of journal writing, as exhibited by liliana, illustrates a process of change that includeswinnicott’s transitional phenomena, freeman’s four stages of epiphanies, and kegan’s adult developmental stages through journal writing. vignettes, in liliana’s own voice, demonstrate the epiphanies, metaphors, and themes as they emerge in the journal writing. these vignettes illustrate a developmental process through the journal writing. the author’s analysis of the vignettes demonstrates that epiphanies that emerge in journal writing have the potential to bring participants a new view of life and new possibilities for action in theworld.the imagery process entails leaving behind the logicalmind and creating a space where an image can emerge. the image carries the seed for future action and taps a developmental unfolding. the process of journal writing produces images, symbolic meanings of the images, and the initiation of a developmental process or spiritual deepening. all of these themes in journal writing are the clinical process. parallels exist betweenwinnicott’s transitional phenomena, transitional space, illusion, play, and creativity, and the process of journal writing. the meditative state, when using the journal, is a transitional space that creates the illusion of transitional phenomena, while the journal itself is an objective object that is highly personal and used in play, providing a form of transitional experience. one knows the journal is a notebook filled with paper andwriting but is deeplymoved by it, as though it were muchmore than a notebook. through illusion, the participant plays with words, symbols in dreams, or twilight imagery. the participant is able to distinguish between fantasy and fact, inner, and outer, but through illusion, allows the outer and inner reality to speak to each other, finding a journey through remembering and reliving fantasy and dreams and integrating past and present and future. winnicott states, the person searching for self requires “a new experience in a specialized setting. the experience is one of a non-purposive state, as one might say a sort of ticking over of the unintegrated personality” (1971, p. 55).winnicott also states the therapeutic proceduremust “afford opportunity for formless experience, and for creative impulses, motor and sensory which are the stuff of playing” (1971, p. 64). he refers to this state as one of “formlessness.” he goes on to state the person must be allowed to “communicate a succession of ideas, thoughts, impulses, sensations that are not linked” (p. 55). the journal parallels this source of playing and manifests itself in its choice of words, humor, analogy, metaphor, and symbols. it relies on both the conscious and unconscious cooperation utilizing dreams, twilight images, and the connections of dream state images with factual events. this dynamic use of journal writing can be adopted by psychotherapists as an adjunct to therapy to aid clients in elaborating on their stories, listening within, identifying epiphanies, and moving forward in the change process. epple/journalwriting for life development 303 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(1996). the maturational processes and the facilitating environment. collected papers. madison: international universities press. author’s note: address correspondence to: dorothea epple, ph.d., assistant professor, social work program, university of st. francis, 500wilcox street, joliet, il 60435, usa. e-mail: depple@stfrancis.edu. microsoft word cuevas manuscript_copyedit2 _________________ michael nino, m.a., is a former graduate student in the department of psychology, sociology, and social work at west texas a&m university. mo cuevas, lcsw, ph.d., is an associate professor of social work and mssw program director, and melody loya, ph.d., is an assistant professor of social work, both in the department of psychology, sociology, and social work at west texas a&m university in canyon, texas. copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), 33-48 transformational effects of service-learning in a university developed community-based agency michael nino mo cuevas melody loya abstract: the purpose of this article is first, to provide a model for the development and implementation of a university developed, community-based agency that incorporates service-learning projects infused throughout the social work curriculum. the inspiration for the community-based agency was grounded in mezirow’s (1978) theory of transformational learning and designed to provide social services to underserved populations and a training ground for future social workers. second, we examine the transformational effects on students engaged in a competency-based, service-learning course at the agency, methods of social work practice. using clark’s (1991) adaptation of mezirow’s theory of transformation, results indicate students experienced three dimensions (psychological, convictional, and behavioral) of transformational learning while engaged in the course and provide evidence that service-learning is directly related to the developmental process of social work students. keywords: service-learning, transformational learning, social work education, competency-based course curriculum introduction the education and professionalization of future social workers has long had roots firmly established in experiential learning. experiential learning places students in a social learning context, with a range of learning environments, providing experiences on ways to help people deal with their challenges (bialeschki, 2007). in social work education, experiential learning has been the keystone to cultivating needed skills for future social workers. the inclusion of a field practicum at the end of both the bachelor and master’s degree program has served to ground social work as an applied profession. field instruction may be identified as the “signature pedagogy” for the profession of social work (cswe, 2008); however, this hands-on pedagogy should not be confined only to the experiential learning inherent in field practicum courses. as social work education moves toward a competency-based practice model, which includes the ability to fulfill obligations to the client, the community, society and the profession, it becomes apparent that experiential learning should be introduced early in a student’s academic career in the form of service-learning projects. service learning is an approach to pedagogy that requires social work students to engage in direct contact with individuals considered to be part of a vulnerable population early in their educational careers, allowing students to apply classroom knowledge with real-life situations. in doing so, students become more aware of their own beliefs and nino, cuevas, loya/transformational effects of service-learning 34 practices and how they can contribute to a socially just society (carrington & selva, 2010. the positive effects of service-learning have been documented in numerous studies (dauenhauer, steitz, aponte, & faria, 2010; sanders, mcfarland, & bartolli, 2003; williams, king, & koob, 2002; williams & reeves, 2004); however, little research has examined if there is evidence of transformational learning in competency-based social work education curriculum that incorporates service-learning. furthermore, arranging a service-learning project for an entire cohort of students at community-based agencies can be extremely challenging and time consuming, forcing many faculty within social work education to continue using traditional models for educating future social workers. to our knowledge, there has been no attempt to establish a community-based agency solely developed and supervised by social work faculty that not only provides meaningful services to the community but also a training ground for future social workers through service-learning projects. therefore, the purpose of this article is twofold. the first is to provide a model for the development and implementation of a university developed and supervised community-based agency that incorporates service-learning projects, which can be infused throughout the social work curriculum. the second is to examine the transformational effects on students engaged in a competency-based course that incorporates service-learning into the curriculum at the university developed communitybased agency. service-learning in higher education over the last two decades service-learning has become a prominent form of educating students in higher education. this trend to utilize service-learning models within the halls of academia is aimed at solving society’s most challenging social problems (lemieux & allen, 2007). there are varying definitions of service-learning within academic scholarship. for the purposes of this article the authors have chosen to use the most cited definition of service-learning developed by bringle and hathcher (1996): we view service-learning as a credit bearing educational experience in which students participate in an organized service activity that meets identified community needs and reflect on the service activity in such a way as to gain further understanding of course content, a broader appreciation of the discipline, and an enhanced sense of service responsibility (p. 222). service-learning places emphasis on three overarching outcomes: (1) service to the community, (2) enhanced critical thinking and problem solving skills, and (3) the cultivation of lifelong, morally just, democratic citizens (harkavy, 2004). servicelearning models have one primary goal, to connect classroom theory with real-world experience (dauenhauer et al., 2010). considering social work’s deep-rooted history as an applied profession, it is obvious service-learning occupies a compatible niche within social work education. service-learning activities can have a tremendous positive impact on students and the faculty that initiate their experiences. students engaged in service-learning activities have advances in social work, spring 2011, 12(1) 35 had changes in attitudes towards lower-socioeconomic groups (sanders et al., 2003), significantly increased levels of perceived self-efficacy (williams et al., 2002), growth in personal and professional learning (williams & reeves, 2004), and retain course content in a meaningful way (dauenhauer et al., 2010). service-learning programs established at institutions of higher learning typically develop collaborative partnerships with community-based agencies, which provide students with direct contact with client groups considered to be vulnerable populations (rothman, 1994). however, creating and sustaining partnerships with a community-based agency requires the goals of both the agency and the university to intersect, ultimately providing a mutually beneficial collaborative project (rubin, 2001). this can be challenging, considering universities and community-based agencies have different cultures and agendas. in order to bring service-learning more closely into the curriculum construct of social work education, new and innovative models must be developed. these new models must be grounded in both theory and research, ensuring experiences that will allow students to gain a deeper understanding of themselves and human needs (dauenhauer et al., 2010). theory of transformational learning the concept of the university developed, community-based agency’s foundation lies in mezirow’s (1978) theory of transformational learning, which posits that learning is an understood process that utilizes prior interpretations to construct new and revised interpretations to guide future behavior. these new and revised interpretations are promoted through two major domains of learning, with different purposes. the first domain (instrumental learning) involves learning through task-oriented problem solving with the objective of improving a person’s performance. the second domain (communicative learning) involves understanding the meaning of what others communicate concerning concepts such as social justice, freedom, love, commitment and democracy. when these two domains of learning are coupled with critical reflection, a transformational process occurs. mezirow defines this process as perspective transformation, which “refers to the transforming of a problematic frame of reference to make it more dependable in our adult life by generating opinions and interpretations that are more justified” (mezirow, 2000, p. 20). since the inception of transformational learning theory, most researchers have concurred with mezirow’s original definition of perspective transformation. however, there is an increasing body of evidence that suggests mezirow’s theory is too narrow and places too much emphasis on individuals becoming more aware of their rational perspective, thus discounting other ways of learning (clark, 1991; courtenay, merrriam, & reeves, 1998; hunter, 1980; lucas, 1994; neuman, 1996; pierce, 1986; pope, 1996; scott, 1991; van nostrand, 1992). characteristics of transformation that have emerged from other studies include three dimensions of transformational learning: psychological, convictional, and behavioral (clark, 1991); new revelations of knowledge, mystical experience, and redefined perspective (van nostrand, 1992); an increase in personal power (hunter, 1980; pierce, 1986; pope, 1996); compassion for others (courtenay et al., 1998); creativity (scott, 1991); and courage (lucas, 1994; neuman, 1996). nino, cuevas, loya/transformational effects of service-learning 36 over the last decade a number of researchers have suggested transformational learning can be fostered in a variety of settings. based on a review of thirteen studies (bailey, 1996; carrington & selva, 2010; cusak, 1990; dewane, 1993; gallagher, 1997, herber, 1998; kaminsky, 1997; ludwig, 1994; matusicky, 1982; neuman, 1996; pierce, 1986; saavedra, 1995; vogelsang, 1978), transformational learning has occurred in settings such as respite groups for terminally-ill children, meal support for adult and child literacy programs, tutoring programs for fourth and fifth grade children, teaching for racial understanding, and self-help groups. with the advent of new projects designed to promote transformational learning, much more research is needed to understand how educators in higher education establish the conditions necessary to produce positive outcomes. this includes the completion of course objectives, and the promotion of social work competencies, while still allowing for in-depth personal exploration (taylor, 2000). the following section provides a brief historical outline of the university developed community-based agency, the competencybased service-learning projects integrated into the agency, followed by an overview of the competency-based course, methods of social work practice. community-based agency designed to promote transformational learning the community-based agency was created by the department of social work at a mid-sized public university located in texas, for a dual purpose: (1) to provide social services to underserved populations and (2) to provide a training ground for future social workers through field practica and service-learning projects. the first phase in the development of the community-based agency stemmed from a community needs assessment conducted as part of a class project for a macro-level practice course. the results of the needs assessment revealed a lack of comprehensive case management and free counseling for those who were homeless or at-risk of being homeless. from this groundwork, social work faculty submitted a proposal to a local charitable foundation to develop the agency. faculty located space in a local outreach center, which houses a consortium of agencies providing services to the homeless and other vulnerable populations. senior field practicum students were the first to initiate services while more stable funding was secured. initially, social work faculty supervised the students by holding office hours on-site. funding was awarded through a local foundation, one year after the initial needs assessment. during the subsequent fall semester, two full-time and three part-time senior social work interns were placed in the agency and several graduate students offered counseling. while unstable staffing and funding was challenging initially, faculty and senior interns provided a measure of continuity and stability. two years after the agency was first awarded funding, the university was able to hire a full-time director with over twenty years of experience practicing social work in the field. with a committed director now in place and outside funding currently secured, the center continues to grow, change, and expand services. bachelor’s students provide case management to the homeless and other at-risk clients with administrative oversight. additionally, students provide psychoeducational groups, such as anger management for advances in social work, spring 2011, 12(1) 37 teens and adults, financial literacy, nutrition, and parenting instruction, as well as women’s self-esteem groups, and grandparents parenting grandchildren support groups. the agency has also secured funding to provide services to military personnel and their families previously or currently deployed to iraq or afghanistan. various other projects have provided outreach and services to the elderly and persons with disabilities through a supplemental food program, micro-lending to a group of refugees through a local resettlement agency, and parenting classes to mothers in a shelter for homeless women. most recently, the agency was awarded a sub-contract with local government in a city adjacent to the university. clients are assessed and certified for rental assistance offered through federal stimulus monies and receive more comprehensive case management services in the process. since opening its doors, the agency has served over 3,500 clients, with faculty providing over 1,500 hours of supervision, and service hours provided by interns have totaled more than 9,500. additional volunteer activities provided by social work students included child care, answering phones, researching resources, and assessments -these hours have numbered over 4,500. the agency continues to operate year to year on grants, so agency continuity is always challenging; however, the university has recently begun to provide some monetary support and administrative officials often promote the agency. integrating service-learning into university developed community-based agency with the need for more competency-based service-learning in social work education, coupled with the overall positive community oriented outcomes resulting from these activities, three service-learning courses were developed and integrated into course curricula at the agency. all three courses were designed to promote transformational learning through social work competencies. these courses, which included group processes, the community, and methods of social work practice, allowed for the cultivation of relationships between students and underserved populations like the homeless and other at-risk groups in multiple settings. the following section provides an overview of course objectives, class activities, assignments, and core competencies addressed in the most comprehensive service-learning course offered, methods of social work practice. methods of social work practice the methods of social work practice course was designed to introduce students to a broad base of knowledge, skills, values, and ethics, which underlie all forms of social work practice: micro, mezzo, and macro. the generalist practice framework included exploration, assessment, planning, implementation, evaluation, and termination as applied to multi-sized client systems. the course framework also included the processes of establishing professional relationships, communication, role taking, the principle of empowerment, and decision making around ethical dilemmas in practice. course objectives for methods of social work practice were developed in conjunction with the ten core competencies for social work practice identified in the council of social work education (cswe) education policy standards (cswe, 2008). nino, cuevas, loya/transformational effects of service-learning 38 of the ten core competencies, eight were addressed (see table 1) in the course and their outcomes were measured using a variety of course assignments. table 1: core competencies addressed in methods of social work practice ________________________________________________________________________ 1. identify as a professional social worker and conduct oneself accordingly. 2. apply social work ethical principles to guide professional practice. 3. apply critical thinking to inform and communicate professional judgments. 4. engage diversity and difference in practice. 5. engage in research-informed practice and practice-informed research. 6. engage in policy practice to advance social & economic well-being & to deliver effective social work services. 7. respond to contexts that shape practice. 8. engage, assess, intervene, and evaluate with individuals, families, groups, organizations, and communities. ________________________________________________________________________ utilizing the eight core competencies addressed in the course, seven course objectives were developed. table 2 identifies the course objectives. table 2: course objectives __________________________________________________________________ upon completion of this course, students will be able to: 1. define the components of a problem solving method for social work practice: exploration, assessment, planning, implementation, evaluation and termination by in class analysis activities, interview assignment and class project. 2. demonstrate the application of the problem solving method at the various levels of social work practice by assessment with assigned clients and class project at community-based agency. 3. recognize levels of theory and apply them for appropriate use of social work practice by client assessment, interventions and class project. 4. define a professional relationship in social work practice, differentiate it from other relationships, and identify its benefits to clients by self-assessment in journals, exploring personal values in papers and developing a client relationship through community-based agency. 5. relate social work professional values to a system of ethical reasoning for decision making in social work practice situations and explain how this reasoning aids the resolution of ethical dilemmas. 6. demonstrate the understanding of the effects of culture, gender, age, ethnicity, physical ability, sexual orientation, spirituality, national origin, and other personal characteristics advances in social work, spring 2011, 12(1) 39 on work with various client systems of social work concern through the communitybased agency, and the development of interventions for clients. 7. demonstrate good verbal and written communication skills that emphasize an understanding of the cultural, social, and economic factors that affect social work systems and their functioning through the final essay, individual handout exercise, in class exercises and class project. ________________________________________________________________________ the methods of social work practice course was held in the training room at the community-based agency. each week the class met with the instructor, where lectures were conducted on a multitude of topics, including case management process, contracting, interview skills, and methods of helping. periodically, the instructor had local social work professionals with various areas of expertise provide presentations on community resources and information on working with different at-risk populations in the community. student assignments included reflective journaling; papers on individual topics of interest with at least six readings, articles and other resources related to the topic; classroom presentations on individual topic papers; a write-up and processes for handling an ethical dilemma; response papers on mandatory course readings; and a summative reaction paper as to what each student learned from the course and how their new-found knowledge will be used in future social work practice. the service-learning component of the course, offered exclusively to junior-andsenior bachelor’s level social work students, required students to work approximately three hours per week, or a total of fifty hours over the semester at the university developed community-based agency. tasks were assigned to each student based on community needs at that given time. this is a critical distinction to make. in order for the task to truly be considered service-learning, student roles must be “determined by the needs of the community they are serving, not the learning goals of the student or institution” (lemieux & allen, 2007, p. 311). through the course of the semester, students spent time talking to clients who came into agency, visited clients at their homes, conducted psychoeducational groups, or provided case management to clients served at the agency. students were required to keep a log of their hours at the agency and their activities. this log was turned in at the end of the semester and verified by the director of the agency by comparison with the log kept on-site. there were three primary assignments integrated into the methods of social work practice course structure. the first assignment, designed to provide opportunities for service-learning engagement, required students to conduct a recorded interview, utilizing clients engaged in services. before conducting interviews, students developed realistic goals to meet during the interview process. once the interview was completed, each student exchanged recordings with a peer to evaluate. peers were required to address strengths and weaknesses in the interview, goals for the interview, and if those goals were met. the evaluation of the interview was provided in a one page summary and given back to the student with the recording. using peer feedback, students conducted a second interview in order to address peer identified weaknesses from the first interview. each student was to then listen to the second interview and required to self-determine the nino, cuevas, loya/transformational effects of service-learning 40 quality of their interviewing skills and if their original goals had been met. finally, students submitted a two-to-three page paper answering the following questions: 1. how you think you did in this interview as compared to your first one? 2. have you met your working goals, or where are you on the goals you initially set for yourself? 3. what were your strengths during the interviewing process? 4. what are ways you could improve the interview process? 5. identify what you learned from the clients you interviewed in this process. summative papers, along with the two recordings, were then turned at the end of the semester and counted as a substantial portion of the final grade. the second assignment focused on the policy side of the community-based agency. at the beginning of the semester each student was given a copy of the policy and procedures manual and given a brief introduction to all of the policies and procedures that play an integral part in the agency’s social service structure and success. after spending at least thirty-five of the mandated fifty hours at the agency and familiarizing themselves with agency processes, students were required to develop a policy that could potentially be added to the policy and procedure manual. the third and final assignment required students to write a two-page reaction paper in reflection of their experiences at the community-based agency, what they learned from these experiences, and how they would use this new found knowledge in future social work practice. students were also encouraged to describe any personal changes made, as a result of their experiences, along with any concerns or challenges they may have encountered. since the inception of the community-based agency, seventy-five junior-and-senior bachelor’s level social work students have completed the methods of social work practice course and submitted reaction papers regarding learned experiences. as stated earlier, much of the research regarding service-learning in social work education has suggested that service-learning provides an opportunity for positive outcomes; however, there is a lack of empirical research that has examined the transformational effects of service-learning in a competency-based course in social work education. thus, the purpose of the following research was to examine the transformational effects of students engaged in a competency-based, service-learning course, methods of social work practice. advances in social work, spring 2011, 12(1) 41 method selection of participants all seventy-five students that completed methods of social work practice were invited to participate in the study; however, the majority of students selected had since graduated from the university and dispersed throughout the united states. in order to obtain proper consent, emails and phone calls were made to all students and all were given the option of a verbal or electronic consent. additionally, all students were given the option of receiving a hard copy of the consent for their records. students were assured of the confidential nature of their responses and were reminded that they could withdraw from the study at anytime without question or prejudice. ultimately all seventy-five students agreed to participate in the study and consisted of one male (1.3%) and seventyfour (98.7%) females. prior to obtaining consent the research design and all corresponding forms were reviewed and approved by the institutional review board (irb). analysis of data in order to examine the transformational effects of competency-based, servicelearning, student reaction papers were analyzed. initial coding of data began by reviewing all seventy-five reaction papers. in the coding process each line was reviewed and scrutinized. in order to identify dimensions of transformational learning, themes were coded using qualitative techniques developed by strauss and corbin (1998). to uncover and develop concepts, open coding was first used to expose broad recurring ideas and the meanings contained within them. data were then dissected into parts, examined for similarities and differences, and then grouped into broad categories. broad categories were then further scrutinized, regrouped, and developed into core concepts or subcategories. data were initially analyzed using mezirow’s (1978) original theory of transformational learning. however, once patterns emerged, it became evident mezirow’s original theory of transformational learning was too narrow. thus, an adaptation to the original theory developed by clark (1991) was utilized. clark argues that transformational learning does not occur in two domains (instrumental and communicative); rather, transformational learning occurs in three dimensions: psychological, convictional, and behavioral. this adaptation of transformational learning will be expounded upon in the next section. results building on the work of clark (1991), the results of this study identified three dimensions of transformational learning: psychological-structure or understanding of one’s self was altered; convictional-belief systems were revised; and behavioral-lifestyle was changed. these dimensions were identified in a variety of the service-learning experiences at the agency but in different proportions. the following will illustrate how transformations were triggered and the dimensions of transformational learning students experienced. nino, cuevas, loya/transformational effects of service-learning 42 behavioral dimension the service-learning model established in the methods of social work practice course created an environment that allowed students to combine classroom theory with real-life situations by being placed into direct contact with clients considered to be vulnerable populations. this type of interaction creates what clark (1991) refers to as an “integrating circumstance.” integrating circumstances are considered “indefinite periods in which a person consciously or unconsciously searches for something they are missing in their life; when they find this missing piece, the transformation is catalyzed” (p. 117118). by placing students into direct contact with clients, students are introduced to the missing piece of the puzzle, creating an environment for a transformational experience. in this case, students enrolled in methods of social practice experienced a behavioral transformation, meaning students’ lifestyles were transformed. one student explained her experience by saying: i feel like i have grown tremendously during this semester and feel more dedicated than ever to the social work profession… in the beginning i was really worried about how little i knew from our community. now i find myself helping friends and even family find resources…this class gave me the real life perspective that social workers can really impact lives. overall, students enrolled in the methods of social work practice course expressed that this unique interaction acted as a catalyst for students to experience a dramatic behavioral dimension of transformational learning. more specifically, students were empowered to work with other vulnerable populations, were motivated to find new avenues for resources and donations, became more assertive in their personal and professional lives, and were enabled to build friendships beyond the classroom. convictional dimension before engaging in the service-learning component of the course, students were provided with demographics, social characteristics and risk factor associated with the homeless. students were also encouraged to participate in classroom dialogue regarding their current attitudes and expectations when interacting with the homeless. additionally, throughout the entire methods of social work practice course students were required to submit a weekly journal to be posted anonymously to an online discussion forum, creating a reflective community that is essential in triggering a transformational experience (mezirow, 2000). when examining students’ reaction papers, most expressed that the open classroom dialogue and journaling process allowed for the discovery of hidden prejudices that existed. students were uncomfortable with the notion of working with the homeless population. some even expressed that they had “no desire to work with the homeless” prior to beginning the service-learning portion of the course. for most students, the root of these prejudices resulted from prior experiences with the homeless or was shared by members of their primary group. “i was raised by someone with the stereotype that all homeless individuals are bad people who will take anything from you and was told to just stand clear of them if at all possible.” students did not realize the extent of their prejudice advances in social work, spring 2011, 12(1) 43 until they were faced with the challenge of working with the population, producing a disorienting dilemma or acute internal or personal crisis (mezirow, 2000). once students realized the extent of their prejudice a remarkable convictional dimension of transformation occurred; according to clark (1991) this can be described as an actual revision of one’s belief system. one student exclaimed: i had really bad misconceptions and assumptions about the homeless population…those feelings went away the further i got into my hours…i will never think of people that are homeless the way i used to. i have more compassion and am more aware of the facts that surround the issue of homelessness…i learned that the homeless population is not scary, their[sic] people just like you and me, who just need a little boost, and a lot of them are eager to share information about their life experiences. the skills that i’ve learned will never be forgotten, they will be so valuable to me in the future. clark (1991) argues that when a convictional dimension of transformation is primary, a secondary behavioral dimension of transformation can occur. in the current study, the majority of students experienced this secondary dimension of behavior change. one student exclaimed: i did not want anything to do with the homeless…after my first interaction with a client, it all changed…it completely changed who i am on the inside, and it also began to be reflected in the way my family perceives the homeless. psychological dimension during the course of the service-learning project students were required to interview at least two clients engaged in services at the agency. students expressed an overwhelming fear of interviewing clients on their own, “the first interview i was so scared and shaking that i could barely talk.” many believed that they would “mess up” a client psychologically or would be unable to provide the client with solutions needed to overcome their current problems. this event triggered a disorienting dilemma. once students initiated conversations with clients, their fears (acute internal or personal crises) began to lessen. as their experiences progressed throughout the semester this selfexpressed fear of interviewing seemed to vanish, prompting a primarily psychological change, what clark (1991) describes as transformational understanding of oneself. “i have overcome my interviewing fear and believe that i could do this more out in my field work because i have had this experience.” student also realized that “it is ok not to know everything.” it is important to note that most students credited the recorded interviews as the key for identifying critical points in the interview process. patterns within reaction papers revealed that students not only had an initial fear of interviewing but also possessed a deeper overall fear of working with clients faced with real problems, needing real solutions. “it may have been more intimidation than fear but either way i did not feel comfortable at all.” the idea of confronting these fears produced varying levels of anxiety among the majority of students; however, once these fear were confronted, students experienced increased levels of confidence that did not exist prior to client interaction, again prompting a significant psychological change. nino, cuevas, loya/transformational effects of service-learning 44 i get nervous doing anything that is out of my comfort level…i have never had a high level of confidence…working at the agency has taught me that i am educated enough to handle most situations. if i didn’t know the answer i was able to find the answer out. i look back at certain situations and how i handled them, and i am proud to say that i handled them professionally. i was surprised at how easy it was to interact and help those that i came in contact with… gaining confidence is the biggest tool that i will take with me from my time at the agency. clark (1991) also argues that when a psychological dimension is primary, convictional and behavioral dimensions of transformation can exist, however, only secondarily. the changes students experienced by overcoming their initial interviewing fear and larger overall fear of interacting with clients also had a secondary impact on their behavior (behavioral dimension). initial interactions inspired students to work with more clients from vulnerable populations, educate themselves and persons in their primary groups concerning community resources, and motivated some to solicit community businesses for monetary support or hygiene products distributed at the agency to the homeless. although these experiences produced both psychological and behavioral dimensions of perspective transformation, there was no evidence suggesting a secondary convictional dimension. discussion the aim of the research was to first provide a model for a university developed, community-based agency that incorporates service-learning projects into competencybased social work courses. second, the research demonstrates the transformational effects on students engaged in a competency-based course that incorporates service-learning into the curriculum. the results of this study revealed that a university developed, community basedagency model provides a rich environment for both service-learning and transformational learning. the introduction of client interaction through service-learning allowed students to utilize concepts learned in the classroom and connect them to real-life situations, while also providing a service to the community. the primary difference between this model and traditional models of service-learning is this type of model alleviates the challenges of collaborating with local community-based agencies. the university developed, community-based agency model also allows faculty to integrate appropriate measures for examining course effectiveness, without the constraints of agency policy. finally the model encourages students to examine agency policy and to find areas that need improvement. this type of openness allows students to experience necessary policy practice with the potential for real-world application. shifting to the transformational impact service-learning had on social work students, results indicated that this service-learning course promoted three dimensions of transformation and provided evidence that service-learning is directly related to the developmental process of social work students. this first dimension of transformation, behavioral, instilled a new found confidence to work with vulnerable populations, advances in social work, spring 2011, 12(1) 45 motivated students to identify new avenues for community resources, and produced more personal and professional assertiveness in students. this type of transformational experience also gave students the confidence needed to establish new social networks amongst their peers. the second dimension, convictional, allowed students to uncover hidden prejudices towards vulnerable groups and forced students to confront those prejudices. for the majority of students this resulted in an overall positive behavior change towards the group. finally, the psychological dimension of transformation prompted students to overcome fears of interacting with vulnerable groups. the psychological dimension of transformation also invoked a secondary behavioral change, leading students to seek further education about groups such as the homeless. the implications of these findings are wide-ranging. for students enrolled in methods of social work practice, dimensions of transformation produced varying levels of personal and professional growth, interpersonal and moral development, and commitment to serving the community. for social work education, incorporating the three dimensions of transformational learning used in this study can provide a format for exploring the impact of other service-learning, volunteer, and field experiences students experience during their education. it also provides a framework for discussing these experiences with students and helping them to see the ways they are impacted by their learning, increasing their self-awareness and appreciation for the processes involved in their education. although students experienced revisions to both their behavior and belief systems, a critical question remains unanswered. once these transformations occur, do they have a lasting positive effect when students enter the field? it is unknown whether or not the transformations experienced in their service-learning project produce a permanent behavior and belief change and this is an avenue that needs to be explored in the future. additionally, the findings described in the study also come with some limitations. first, the overall sample was relatively small and confined to students from one university, making the results of the study difficult to generalize. second, the study utilized student reaction papers, which can only capture organized thoughts retrospectively. this made it impossible to access actual changes in meaning structures during the process of transformational learning. therefore, longitudinal studies examining transformational learning are needed, studies that incorporate social work students from a variety of universities, in a number of settings, creating a framework to examine the immediate impact service-learning has on the restructuring of meaning systems in social work education. references bailey, l. d. (1996). meaningful learning and perspective transformation in adult theological students (unpublished doctoral dissertation). deerfield, il: trinity evangelical divinity school. bialeschki, m. (2007). the three rs for experiential education researchers. journal of experiential education, 29(3), 366-368. nino, cuevas, loya/transformational effects of service-learning 46 bringle, r. g., & hatcher, j. a. (1996). implementing service-learning in higher education. journal of higher education, 67(2), 221-239. carrington, s., & selva, g. (2010). critical social theory and transformative learning: evidence in pre-service teachers’ service-reflection logs. higher education research & development, 29(1), 45-57. clark, c. m. (1991). the restructuring of meaning: an analysis of the impact of context on transformational learning (unpublished doctoral dissertation). athens: university of georgia. council on social work education (cswe). 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(2000). analyzing research on transformative learning theory. in j. r. mezirow and assoc. (eds.), learning as transformation: critical perspectives on a theory of progress (pp. 285-328). san francisco: jossey-bass. nino, cuevas, loya/transformational effects of service-learning 48 van nostrand, j. a. (1992). the process of perspective transformation: instrument developmental and testing in smokers and ex-smokers (unpublished doctoral dissertation). denton: texas women’s university. vogelsang, m. r. (1978). transformative experiences of female adult students (unpublished doctoral dissertation). ames: iowa state university. williams, n. r., king, m., & koob, j. j. (2002). social work students go to camp: the effects of service-learning on perceived self-efficacy. journal of teaching in work, 22(3/4), 55-70. williams, n., & reeves, p. (2004). msw students go to burn camp: exploring social work values through service-learning. social work education, 23(4) 383-398. author’s note: address correspondence to: mo cuevas, lcsw, ph. d., mssw program director & associate professor, west texas a&m university, wtamu box 60876, canyon, tx 79016-0001. email: mcuevas@mail.wtamu.edu aisw vol. 8, no. 1:aisw vol. 5, no. 2 reassembling the social environment: a network approach to human behavior dhrubodhi mukherjee abstract: this paper critically examines the influence of the structural elements of human behavior that are often neglected in social work literature (robbins et al., 1998). it incorporates a new multi-theoretical framework that critically examines the significance of a network approach in analyzing social, ideological, and economic structures and their influence on individual actors. this paper discusses two interrelated theories: social network theory and social capital theory, and critiques their relevance in explaining human behavior for social work educators and professionals in an increasingly information-driven and electronically-interconnected global society. the author hopes that an expanded theory base will provide a holistic view of individual problems stemming out of inequitable social structure. keywords: social capital, social network, structural analysis, network perspective, macro-theory introduction theoretical reflections are imperative to maintaining the integrity of the concepts involved when applied to empirical research. in this paper, two interrelated theories, namely, social network theory and social capital theory, will be critiqued to evaluate their relevance in understanding the influence of social structures on human behavior. the idea of conceptualizing social structure as networks of interconnected actors is comparatively new to social work. this approach, known as the network perspective, has been imported from electrical engineering to sociology in an attempt to understand the influence of social relations and interconnected ties on individual actors (wasserman & faust, 1994). this paper argues that the network perspective is descriptively superior to the “person in environment” centric perspective simply because “it explicitly takes into account the social context within which actors make evaluations” (burt, 1992, p. 8). this paper outlines the importance of incorporating the network approach into the matrix of human behavior theories. dhrubodhi mukherjee, msw, ph.d. is assistant professor of social work, school of social work, southern illinois university carbondale, carbondale, il 62901. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 208-218. indiana university school of social work. 208 in the 1970s, adoption of the “ecological perspective” experienced a shift from the classical social work definition of human behavior, which primarily focused on the behavior of the individual, to a broader, interdisciplinary approach that included the behavior of groups, families, communities, organizations, cultures, and societies. this broadening in the scope of the definition has resulted in a better understanding of the contextual nature of human behavior. the contextual nature refers to both personal and social contexts or structures in which individual behavior is enacted (robbins et al., 2005). these contextual variables constantly change to incorporate the new social, technological, economic, and cultural processes that occur in our society. as the contextual variables absorb these ever-changing processes, they inform and influence the content of human behavior theories. accordingly, the old theoretical perspectives are re-examined, while new perspectives are proposed. this paper discusses two interrelated theories: social network theory and social capital theory and critiques their relevance in explaining human behavior for social work educators and professionals in an increasingly information-driven and electronically-interconnected global society. this paper critically examines the influence of the structural elements of human behavior that are often neglected in social work literature (robbins et al., 1998). it incorporates a new multi-theoretical framework that critically examines the significance of a network approach in analyzing social, ideological, and economic structures and their influence on individual actors. the author hopes that an expanded theory base will provide a holistic view of individual problems “caused by inequitable social structure” (findley, 1978, p. 55). accordingly, the social network and social capital theories have been applied as analytical devices, as well as descriptive tools. network perspectives: the missing dimension historically, social work has “borrowed human behavior theories, primarily from the disciplines of psychology and medicine” (robbins et al., 1998, p. 14). since well-known champion of reform in the medical profession, abraham flexner (1915), had questioned the lack of theoretical basis for social work to qualify as a profession, social work drew closer to clinical and psychological orientations. as a result, human behavior theories turned toward a more individualistic focus to guide social work practice (robbins et al., 1998). this pervasive psychological orientation during the early stages of social work led to the exclusion of macro-level theories from the theoretical framework of human behavior. macro-level theories use a broader definition of human behavior, which includes a structural analysis of large entities, such as societies, cultures, organizations, and communities. the theoretical knowledge from sociology, anthropology, economics, political science, and social psychology has been parsimoniously used and rarely included in the core of human behavior curriculum (coyle, 1948). even the ecological perspective framework, which is widely used to understand human behavior, focuses primarily on the interface between people and their environment, instead of “analyzing macro-level social problems and their impact on people’s lives” (robbins et al., 1998, p. 15). however, the legacy of jane addams and the hull house movement suggests that social work had had a macro-practice tradition right from its 209mukherjee/reassembling the social environment: a network approach to human behavior inception, but the profession did not follow through on a later date. this drift from its rich, macro-practice background has prompted scholars to suggest that social work had abandoned an important mission that its founder had envisaged for it (specht & courntney, 1994). though, over the last decade, some progress has been made to retrieve macro-practice from this enforced obfuscation, however, much remains to be done. moreover, social work scholarship, in particular, has rarely explored the possibility of social network and social capital perspectives in defining social problems. interestingly, approaches akin to social network and social capital theory have periodically surfaced in social work literature. in the 1960s, leichter and mitchell (1967) studied the kinship networks of urban jewish families and described their influence on individual decision-making processes. they called for caseworkers to take into consideration clients’ social and kinship networks in their diagnosis. however, such instances of incorporating structural variables were not common in social work practice. when a literature search was conducted for this paper, only a handful of published works could be found in social work literature that dealt with any form of social structure analysis; whereas, in other social science disciplines, empirical and conceptual works using a network perspective were found in abundance. as discussed above, some of the reasons for this slow pace in experimentation with new theoretical frameworks lie in the propensity of the social work profession to focus towards traditional clinical practice models (kramer & specht, 1983). furthermore, the methodologies to measure the benefits of social networks have developed only in the last 10 years, making it difficult for an applied profession like social work to use them. investment in the potential of social network and social capital theory can prove vital for social workers to understand human behavior from a network perspective. a recent study by loeffler et al. (2004) suggested that social work needs to take into account the dynamics of clients’ social networks, while designing micro, mezzo, and macro interventions. these authors further suggest that nurturing the social network and social capital of clients in their respective communities could save social policy dollars (loeffller et al., 2004). the next section will trace the historical background of the emergence of social network and social capital theories and underline the factors that contributed to the development of their key concepts. the evolution of concepts social network and social capital theories fall into the long and distinguished historical tradition of structural analysis. structural analysis originated and grew across diverse interdisciplinary fields. spencer (1982) and durkheim (1964), in sociology, radcliff-brown (1959), in anthropology, de saussure (1916), in linguistics, and, at some level, germain and gidderman’s (1978) ecological perspective in social work have underlined the significance of understanding the structural variables in explaining the inadequacies of person-centered perspectives on human behavior. there are two distinct traditions that historically locate development of the core ideas of social networks and social capital; they are: 1) networks as structure; and 2) the inherent values and norms in network ties. 210 advances in social work the network as structure perspective can be traced in the work of moreno (1934). moreno started asking people who their friends were and what were the organizations for which they worked, he then developed a diagram of points and lines to represent relations among different social entities. moreno termed such a diagram a sociogram and developed a distinct method to analyze the sociogram, called sociometry. barnes (1954), however, was the first scholar to coin the term social network. according to wasserman and faust (1994, p. 10), the “notion of a network of relations linking social entities, or of webs or ties” evolving into a social structure “had found wide expression throughout social sciences.” recognition that social networks can be used to understand social structure came from the works of mark granovetter (1972) and most recently from ronald burt (1982). the network-based perspective of social structure compliments the positional notions of explaining human behavior by early system theorists, including max weber (1947), talcott parsons (1951), and george homans (1958). moreover, the development of social network analysis as a distinct methodology has “brought the power of mathematics to the study of social systems” (wasseman & faust, 1994, p. 12). a detailed outline of this historical development can be found in the work of harary, norman, and cartwright (1965). the notion of network as structure, described above, is a part of social network theory; however, many scholars, including putnam (2001) and coleman (1998), believe that it does not take into account the active part individuals play in creating and shaping such network structure. thus, the social capital theory intervenes to characterize certain values and norms inherent in network ties, which further explain the role of individual actors in creating advantages and disadvantages within social network structures. the fundamental idea of social capital can be traced as far back as alexis de tocqueville (1966), a french diplomat who argued for the virtue of associations in american civil society in 1830. hanifan (1920) coined the term social capital, equating it with concepts, such as family relationships, goodwill, and fellowship. in the 1960s, schultz (1961), becker (1964), and other economists articulated the theories of human capital. this paved the way for a broader understanding of social norms and values as capital within the social context. it was only 19 years ago when coleman (1988) carried out the first systemic conceptualization of social capital. he viewed social capital as a public resource that is inadvertently created by unconscious human interaction. moreover, the value of this resource is embedded within the quality of social ties, which are determined by the existence of the degrees of trust and reciprocity within those social ties. other theorists, such as burt (1998), lin (2001), field (2003), dasgupta (2000), wellman and hasse (2001), fukuyama (1995), and woolcock (1998) further extended the concept into different structural, social, and theoretical dimensions and thus, contributed to an interesting evolution of a complex concept. thus, social capital began as a comparatively simple concept and evolved into “a complex account of people’s relationships and their values” (field, 2003, p. 45). unlike other forms of capital (physical and human), social capital is defined in multifaceted ways, broadening its dimensions and making its measurement a challenging and contentious task (field, 2003; wellman, 2001). bourdieu’s (1986) understanding of social capital stems from structural hierarchies of society that allow 211mukherjee/reassembling the social environment: a network approach to human behavior individuals who are better positioned in social, economic, and cultural hierarchies to use their homogenous (similar) and heterogeneous (diverse) social networks to sustain the existing power distribution that benefits them. finally, it was robert putnam, a political scientist at harvard, who popularized the concept of social capital and articulated it as “features of social organization, such as trust, norms, and networks that can improve the efficiency of society by facilitating coordinated actions” (putnam, 1995a, p. 169). he was the first theorist to draw a correlation between social capital and civic participation. putnam’s theory of social capital emulates the durkheimian concept of solidarity, which is primarily based on trust and norms across social networks (baron et al., 2000; field, 2003; fukuyama, 1995). social capital and social network social network and social capital theory in their present form were identified by grannovatter (1973) and bourdieu (1990) but have since been developed most extensively by burt (1995), portes (1998), coleman (1988), and putnam (1993, 1995, 2000). social network and social capital theories are interconnected and provide a multi-theoretical framework for understanding the structural components of human behavior. social capital theory proposes that there are some qualities and values embedded in social networks and relationships that render certain types of benefits, both instrumental and emotional, which people can use. these potential benefits depend on whom one knows and how well one knows his or her social connections. this social connectedness creates a relationship that generates a potential flow of benefits for the individuals who are connected. these benefits could appear in forms of valuable information, job creation, education dissemination, monetary or other instrumental support, and emotional support. as these qualities are embedded in our social networks or connections, they are capable of generating future benefits for some individuals. thus, they are called social capital. social capital refers to network ties of goodwill, mutual support, shared language, shared norms, social trust, and a sense of mutual obligation (huysman & wulf, 2004). thus, the core idea of social capital theory develops around this value embedded in social networks (putnam, 1993a). moreover, the value acquired through investment in social relationships is translated into social and economic gain for individuals, but it is unlike other forms of capital—no single individual can claim ownership of this value, as it only generates through useful interactions across social networks (coleman, 1988). this particular network characteristic of social capital generates collective behavior among social units. coleman (1988) equated this characteristic of social capital with “public good,” which forms itself inadvertently through human exchanges within their respective social networks. networks are constituted by a set of relational ties across a set of actors that form social structure (scott, 2001). network theorists argue that an understanding of social capital requires a finer-grained analysis of the specific quality and configuration of network ties (wasserman & faust, 1998). putnam (2001) distinguishes two types of networks that characteristically determine different social capital through bridging and bonding (exclusive and inclusive). bridging refers to diverse 212 advances in social work networks that encompass more distant ties outside of close networks, such as acquaintances and workmates, whereas bonding refers to homogenous (similar) networks that denote ties between like-people in similar situations, such as immediate family, close friends, and neighbors (putnam, 2000). coleman (1988) named these bonding ties as dense and closed networks. before going further in this analysis, we should note that structure and networks are not to be identified as the same. structure is a much broader concept, with many interconnected networks existing as structural components at different levels of hierarchy (burt, 1992); whereas, “a network is a set of interconnected nodes” of single individual units (castells, 1996, p. 470). the architecture of modern day social structures is complex and hierarchical. according to lin (2001), it still represents the shape of a maslow’s pyramid. if the matrix of social structure is hierarchical, then the location of the positions of individual units in that matrix attain significance in accessing the embedded resources of the network structure. this positional advantage can render characteristics, such as status, prestige, class, and authority to individual position holders who could further translate these characteristics into reputation, wealth, and power, which would increase their access to embedded resources by improving the quality of their network ties (lin, 2001). the quality of network ties depends on the degree of social capital that they could generate (fukuyama, 1995; scott, 2001). thus, the location of individual units in a structure is an important determinant of the influence that a particular unit can exercise through actions. thus, social capital is embedded in social structure (ostrom, 1994). the bonding ties are stronger than bridging ties, and they tend to produce more emotional, but less instrumental, support (burt, 1992; coleman, 1988; lin, 2001). strong relationships and mutual acquaintances tend to develop between people with similar social attributes, such as education, income, occupation, and age (burt, 1998; field, 2003). vertical bridging ties provide opportunities for individual units to move up to networks located higher in social structure and thus improve their structural positions and gain social capital. burt (1992, 1998) further argues that social capital is equivalent to social resources that people accumulate through their positions and ties in social networks or structure. eventually, people invest their earned social capital in various social opportunities. if people or units remain unconnected in a network, it is called network holes, which provide further investment opportunities by reaching out to unconnected entities within or across networks. according to monge and contractor (2003), these investments are largely motivated by self-interest. thus, contrastingly, the benefits accumulated through participation in social networks, which are more collective in nature, could generate capital benefits that are private in nature. coleman (1988, p. 598) defines social capital as “a variety of different entities, with two elements in common: they all consist of some aspect of social structure, and they facilitate certain actions of actors—whether personal or corporate actors—within the structure.” this definition highlights the existence of two functional concepts: 1) the presence of a social network structure and 2) an element of action/interaction. lin (2001, p. 29) further refined this definition by calling social 213mukherjee/reassembling the social environment: a network approach to human behavior capital the “resources embedded in a social structure that are accessed and/or mobilized in purposive actions,” therefore referring to the existence of resources embedded within the structure. hence, theoretically, the network perspective should be able to explain the following three factors: the quality and distribution of resources ingrained in a structure, how individual actors access these resources, and what kind of outcome the aforementioned resources bring about in their lives, as well as to the structure as a whole (bourdieu, 1990; burt, 1992; coleman, 1988; lin, 2001). the value of these resources can be either instrumental or relational, depending on the context of the action. as bourdieu (1990, p. 119) rightly explained, “social capital is the sum of the resources, actual or virtual, that accrue to an individual or group by virtue of possessing a durable network of more or less institutionalized relationships of mutual acquaintance and recognition.” empirical support and methodological concerns social network and social capital theories, though they conceptually compliment each other, grew out of distinct traditions and thus follow two separate empirical lineages that often cross paths. these theories reflect both positivistic and phenomenological orientations. social network theory uses social network analysis (sna), a distinct methodology, for empirical research. though sna has existed as a mathematical concept since 1930, it was only during the 1990s that interest in sna peaked (carrington et al., 2005). sna has been used mostly in sociology, economics, political, and health sciences to analyze and measure community support networks, social capital (wellman, 2001), kinship networks, information dissemination, organizational partnerships, international trade, terrorist networks, and the spread of epidemics. according to carrington et al. (2005), the behavioral sciences have been showing greater interest in sna as they explore the social context of human behavior. baerveldt et al. (2004) applied sna to examine whether peer relations play a role in the precipitation of delinquent behavior. sna has been widely used in psychology to study the influence of a patient’s network on schizophrenia (baars et al., 1990). with the media attention given to terrorist activities in recent times, social scientists have used sna to predict the logistics of terrorist operations by investigating the workings of terrorist networks (carrington et al., 2005). within economic sociology, social networks have been utilized widely by studies “in eliciting the role of social capital and trust for economic purposes” (koniordos, 2005, p. 5). the measurement of social capital has been a debatable issue in empirical research, with various researchers contributing in their own ad-hoc ways. social capital is a multidimensional concept and thus is difficult to measure. a theoretically informed measurement approach suggests that measures of social capital vary in different network types. as a result, it would require a wide range of measures to locate the concept. neuman (1991, p. 575) suggests that our inability to recognize social capital as a multi-dimensional concept might “muddle our empirical question;” still, many studies follow a one-dimensional approach by identifying one item that is a deductive measure of social capital. 214 advances in social work both social network and social capital theories have been widely criticized for relying heavily on the quantification of empirical data and overlooking subjective phenomenon (bollig, 2000). social ethnographers believe that the network perspective follows a typical reasoning, such as “i know that bob hates mary, so, if i want to know about mary’s new boyfriend without mary finding out, i can safely ask bob, but i can’t take what bob says as gospel;” however, it is difficult to elicit a subjective network qualitatively (bollig, 2000). some scholars further believe that, by emphasizing the structural variables, social network and social capital theories have replaced qualitative approaches, like the “network therapy” that extended the boundaries of family therapy to work with personal networks (wolfe, 1982a). within the methodological concerns described above, there is no denying that the social network and social capital theories posit an exciting opportunity to explain human behavior at a global level. with the growth of information communication technologies, communities across continents are quickly becoming interconnected and are contributing to the rise of a network society (castrells, 1996). nothing can be more appropriate for human behavior perspectives than to reposition the existing theoretical frameworks towards this emerging macro-level phenomenon. new challenges: the rise of network society during the last 15 years, we have witnessed an unprecedented spurt in technological development associated with growth of the internet and electronic infrastructure, which have literally wired the whole world. monge and contractor (2003, p. 4) describe this phenomenon as “spectacular advances and convergences in computer and communication technology,” which is changing the social and organizational landscapes and is resulting in the “emergence of network forms of organization as an integral part of the co-evolution of the new ‘network society’” (castells, 1996, p. 10). a network is defined as a “personalized exchange among many agents” that elicits a social structure that has properties that influence human behavior and actions (rauch & hamilton, 2001). the key concept of a network society is not new; however, the unprecedented rise in electronic communication due to proliferation of the internet and the gradual trickle-down effect that it has had across different social segments, have qualified it as an emerging social context in understanding human behavior. according to castells (1996, p. 394), the development of electronic communication and information systems allows for an “increasing disassociation between spatial proximity and the performance of everyday life’s functions: work, shopping, entertainment, healthcare, education, public services, governance, and the like.” as the structural barriers become fluid and multiple bridging ties, facilitated by technological means, individuals transcend their immediate community and function virtually anywhere in the world. thus, the architecture of social structure opens up its barriers and undergoes a “spatial transformation” (castells, 1996, p. 10). as a result, communities become disembodied from their geographic meaning and get integrated into functional networks (castells, 1996; coleman, 1988). according to castells (1996, p. 375), “today the space we live in has elements of reality and virtuality and is no longer transfixed into territories.” this “space of 215mukherjee/reassembling the social environment: a network approach to human behavior flow” is characterized by the material foundation of a new culture, the “culture of real virtuality.” social science theorists have long been interested in how changes in communication technology impact human behavior. the new millennium was characterized by the rapidly expanding internet communication technologies, with 75% of americans having access to the internet by the end of 2006 (pew internet report, 2006). this astronomical growth in computer-mediated communication throws new challenges to the existing theoretical frameworks for analyzing human behavior and raises pertinent macro-level questions that postulate theoretical restructuring. do networks formed through the internet influence human behavior? does it accentuate structural disadvantages? does it call for a redefinition of “social environment” as we know it? wellman (2001, p. 2031) claims that, “when computer systems connect people and organizations, they are inherently social, because computer networks principally support social networks.” this infusion of a technology-driven lifestyle, notably in the last two decades, has necessitated fundamental changes in the way individuals, communities, and societies interact and behave across their social and political networks. however, these changes have not been accounted for within the human behavior theoretical matrix that informs social work practice. according to vugt and snyder (2002), rapid globalization of the local economy and the escalating spread of information networks lead to the transformation of traditional states and communities. for social workers, these trends would inspire exciting, new areas of intervention and research in which every discipline would have the opportunity to understand different perspectives on human behavior in emerging social environments. the social network and social capital theories herald such a possibility for the future of the social work profession. references baars, h., uffing, j., & dekkers, g. 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(2001). computer networks as social networks. science, 293, 2031-2034. wolfe, a.w. (1982a). improving communication between network theorists and practitioners. paper presented at the 2nd annual sun belt conference. tampa, february 1982. woolcock, m. (1998). social capital and economic development: toward a theoretical synthesis and polity framework. theory and society, 27(2), 151-208. author’s note: address correspondence to: dhrubodhi mukherjee, school of social work, quigley hall 6—mail code 4329, southern illinois university carbondale, 875 s. normal avenue, carbondale, il 62901, usa. e-mail: dhrubodh@siu.edu. 218 advances in social work spring2005-119_page121 spring2005-120_page122 spring2005-121_page123 spring2005-122_page124 spring2005-123_page125 spring2005-124_page126 spring2005-125_page127 spring2005-126_page128 spring2005-127_page129 spring2005-128_page130 spring2005-129_page131 microsoft word 6. linton et al_16429 safe_copyedit final ______________ kristen f. linton, msw, ph.d., is an assistant professor, and andrea birmingham, loren case, laura ezzy, jandee ferguson, courtney harrison, and leina’ala launiu are msw candidates, all in the myron b. thompson school of social work at the university of hawai’i at manoa. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 334-351 special needs adoption and foster exigencies (safe): a model for case managers kristen f. linton andrea birmingham loren case laura ezzy jandee ferguson courtney harrison leina’ala launiu abstract: children with special needs disproportionately receive child welfare services in out-of-home placements, such as foster and adoptive homes. this theoretical model has been developed to describe or explain exigencies of adoptive and foster families of children with special needs (n = 82). a web content analysis, including theme, feature, link, exchange, and language analyses, of online discussion forums of adoptive and foster parents of children with special needs using a phenomenological framework was conducted. inductive and quantitative web content analyses were conducted on themes. parenting concerns were clustered into two main themes, disability and placement issues, and focused on children’s pre and post placement needs. a phenomenological analysis resulted in the development of the special needs adoption and foster exigencies (safe), which outlines exigencies of adoptive and foster parents of children with special needs during engagement, assessment, and intervention phases of case management. keywords: special needs, adoption, foster, case work children with special needs (e.g., disabilities) disproportionately receive child welfare services (hill, 2012). they are also more likely to receive services longer and in out–ofhome placements (lightfoot, hill, & laliberte, 2011). minimal research on adoptive and foster families that care for children with disabilities has found that they have special needs related to case work, interventions, and school (geenen & powers, 2004; manders & stoneman, 2009; raghavan, inoue, ettner, hamilton, & landsverk, 2010). child welfare case workers may need additional training in order to meet the needs of adoptive and foster families of children with special needs. however, no previous theoretical model has been developed to describe or explain exigencies of adoptive and foster families of children with special needs. prevalence of children with special needs in child welfare children with disabilities are more likely to be involved in the child welfare system than other children (lightfoot et al., 2011; sullivan & knutson, 2000). an elaborate study that merged state, school, child welfare, and police records found that there was a nine linton et al./special needs adoption and foster exigencies 335 percent prevalence rate among nondisabled children and 31% prevalence rate among disabled children for substantiated child maltreatment (sullivan & knutson, 2000). another study using child welfare administrative data found that 22% of children with substantiated maltreatment were labelled as having a disability in their case files suggesting that one out of every fifth child with substantiated abuse on a child welfare case load may experience disabilities. most commonly, children were diagnosed with emotional disturbance. other diagnoses included intellectual, developmental, and learning disabilities (lightfoot et al., 2011). children with special needs are more likely to receive out-of-home services longer and experience instability. hill (2012) found that youth with disabilities were in out-of-home placements longer (m = 24.7 months compared to m = 21.4 months for no disability) than other children. youth with disabilities also had a higher average number of out-of-home placements in two studies ranging from four to five and a half placements for children with disabilities compared to three to four and a half placements for children without disabilities on average (hill, 2012; slayter & springer, 2011). out-of-home placement and instability may be associated with the decreased likelihood that children with disabilities have a permanency plan with a goal of reunification for various reasons. children with disabilities were more likely to have different types of placements than their peers in two studies (slayter & springer, 2011; hill, 2012). slayter and springer (2011) found that children with disabilities were 49% less likely to be placed with families in a trial home, 61% less likely than peers to be placed in kinship care, and two-times more likely to be living in non-kinship care or a pre-adoptive foster home. needs of adoptive and foster parents of children with special needs adoptive and foster families caring for children with disabilities have special needs associated with case work, interventions, and school. scant research exists about case workers’ support of children with special needs. a recent study shed light on case workers’ perceptions of cases with children with disabilities using vignettes (manders & stoneman, 2009). manders and stoneman (2009) found that 75 child welfare case workers were more likely to attribute abuse to child characteristics rather than parent characteristics, have empathy for parents, and suggest child-focused rather than parent-focused services when responding to vignette cases of maltreatment among children with disabilities. this powerful study demonstrated that case workers perceive cases with children with disabilities differently (e.g., child characteristics contributed to abuse and more empathy for parents) and plan to respond to cases differently (e.g., child-focused services) than they would for children without disabilities. children receiving child welfare services are more likely to need mental health interventions. the child welfare league of america, the american academy of pediatrics, and american academy of child and adolescent psychiatry recommend that children should receive a mental health screening when they are placed in foster care, a subsequent comprehensive mental health assessment, and a coordinated approach to delivery of mental health services. only half of the children in a sample of 3,802 children receiving child welfare services were receiving any one of the recommendations (raghavan et al., 2010). however, research has also demonstrated that children receiving advances in social work, fall 2014, 15(2) 336 child welfare services are more likely to use antipsychotic medications. youn, rubin, riddle, noll, and rothbard (2011) found that children in foster care were more likely to be taking more than one antipsychotic medication for more than 180 days (19-24%) than children who were not in foster care (less than 15%) in a sample of 16,969 youth aged 20 or younger. children with disabilities are more likely to struggle in school and receive special education services. a study of 327 children found that children in foster care had significantly lower gpas, changed schools more frequently, earned fewer credits toward graduation, had significantly lower state test scores, and had greater difficulty in reading and math (geenen & powers, 2004). a strong correlation has been found between children’s receipt of child welfare and special education services (algood, hong, gourdine, & williams, 2011; jonson-reid, drake, kim, porterfield, & han, 2004). interestingly, one study found that child welfare involvement predated children’s receipt of special education services (jonson-reid et al., 2004). this study only reports that children began receiving special education services after child welfare services. children could have had a disability prior to receiving special education. increased special education may be a result of education and advocacy among case workers and/or parents. children with special needs are more likely to receive child welfare services longer than other children and be placed with non-kinship foster families (lightfoot et al., 2011; slayter & springer, 2011). children with special needs have additional needs associated with case work, interventions, and school than other children (bean & sidora-arcoleo, 2012; geenen & powers, 2004; manders & stoneman, 2009; raghavan et al., 2010). therefore, adoptive and foster parents of children with special needs may have unique exigencies. this study aimed to develop a theoretical model, special needs adoption and foster exigencies (safe), to better describe the needs of adoptive and foster parents of children with special needs. a web content analysis was used to understand themes in parenting concerns and advice given among adoptive and foster parents of children with special needs’ online discussions. these themes were used to begin to develop safe. child welfare case workers can use safe as a guide to learn about the exigencies of adoptive and foster parents of children with special needs and prioritize services and resources for those families. methods data collection parenting concerns among adoptive and foster parents of children with special needs were collected from posts on forums.adoption.com, a popular online discussion forum used by adoptive and foster parents. the university of hawaii at manoa institutional review board determined that this study was exempt. online data, such as those in discussion boards, are considered public data if no password is needed to access the data. no passwords were required to access the data used for this analysis. the discussion forum was chosen based on google search terms: adoption, foster, special needs, discussion, and forum. this site was chosen because its members were primarily from the u.s. and it had a large membership. a total of 223,200 members had participated in 396,527 threads and linton et al./special needs adoption and foster exigencies 337 2,881,276 posts on forums.adoption.com at the time of data collection suggesting a large, active membership. a sub-forum on forums.adoption.com was selected titled, “special needs and attachment.” under the “special needs and attachment” sub-forum, the most common forum was titled, “special needs adoption.” for clarification, data for this analysis was found by going to the forums page, then selecting the category, “special needs and attachment,” and then selecting the sub-category “special needs adoption.” this forum was chosen to gather data on parenting concerns among adoptive and foster parents of children with special needs only. other forums under “special needs and attachment” were specific towards certain diagnoses, such as autism. in addition, the “special needs adoption” forum chosen for analysis included 11,310 threads and 110,310 posts at the time of data collection. other forums under “special needs and attachment” had significantly lower thread and post counts with a maximum of 670 threads and 5,264 posts suggesting that the forum chosen for analysis was the most popular discussion forum on special needs on the forums.adoption.com site. the first author read through the “special needs adoption” forum from the most recent threads. the first author consulted the data for themes and determined that saturation, or redundancy of information, was met in the threads that were most recently posted between july 1, 2013 and august 31, 2013 (padgett, 2008). twenty-six threads and 163 posts were analyzed. sample a total of 82 adoptive or foster parents of children with special needs participated in the analyzed discussion threads. participants self-identified their gender as female (n = 80; 93%) and male (n = 4; 4.8%); two participants did not specify their gender (2.3%). participants reported that they were from 31 u.s. states, while one woman reported that she was from europe and another reported she was from canada. the most common states that participants were from were california (n = 6), texas (n = 6), ohio (n = 4), alabama (n = 3), connecticut (n = 3), illinois (n = 3), maine (n = 3), maryland (n = 3), new jersey (n = 3), and washington (n = 3). one to two participants were from: arizona, colorado, florida, hawaii, idaho, indiana, kansas, kentucky, massachusetts, michigan, minnesota, missouri, new hampshire, new york, oklahoma, oregon, pennsylvania, tennessee, utah, virginia, and wisconsin. participants self-reported their roles as adoptive parents (n = 63; 73.3%), foster parents (n = 13; 15.1%), and people who were adopted (n = 4; 4.7%). the total, mean, standard deviation, minimum and maximum number of posts, child placements, boy placements, and girl placements for the sample participants are displayed in table 1. analysis web content analysis (wca) of a leading online discussion community of adoptive and foster parents was performed. as described by herring (2010), wca includes many similar aspects to content analysis including image and theme analysis (krippendorff, 2008). it also includes feature, link, exchange, and language analysis to demonstrate the multimodal capabilities, or characterization of many different modes of activity or occurrence, available to users during online discussions (herring, 2010). this study advances in social work, fall 2014, 15(2) 338 included all aspects of wca with the exception of image analysis, because no images were posted on the discussion forum used for analysis. table 1. descriptive statistics of posts and themes n m sd min max total posts 296 3.44 3.92 1 19 total placements 195 3.98 6.10 0 27 total girls 53 1.66 2.51 0 13 total boys 57 1.58 2.61 0 15 disability 117 1.36 1.42 0 7 intervention 75 0.87 1.41 0 9 empathy 61 0.71 1.32 0 7 placement 39 0.45 1.04 0 6 resources 39 0.45 1.18 0 7 school 33 0.38 0.77 0 3 case worker 20 0.23 1.04 0 9 physiological 14 0.16 0.63 0 4 historical information 9 0.10 0.34 0 2 parental social support 7 0.08 0.56 0 5 theme analysis was conducted with inductive content analysis and quantitative content analysis (ryan & bernard, 2003; nimrod, 2009). the first author created a set of codes after reading through all text. the codes were revised after reading through the text a second time. one or more codes could be assigned to every segment of text. multiple codes were subsumed by larger categories or themes. a codebook describing the themes was created. six graduate student researchers coded the text. three researchers were assigned to the first half of the text and three researchers were assigned to the second half of the text. they coded their assigned text using the codebook to assess inter-rater reliability. a kappa of .72 for the first half of the data and .82 for the second half of the data was reached suggesting good agreement among the coders (orwin, 1994). k is a measure widely used for agreement (orme & gillespie, 1986; viera & garrett, 2005). the k values in this study refer to agreement between the six raters on a total of 193 statements. this use of the k is similar to that in other previous phenomenological research (linton, krcek, sensui, & spillers, 2013). quantitative content analysis was conducted following inductive content analysis. sample demographic information and theme information were entered into spss v.19. demographic information available included gender, state, and total number of child linton et al./special needs adoption and foster exigencies 339 placements, boy placements, and girl placements. theme information included the number of times that each participant posted on a certain theme. the frequency of posts regarding each theme was analyzed first. dichotomous variables were created to demonstrate whether or not participants discussed each theme. feature, link, and exchange analysis were used to provide context to the additional information available to the participants as they engaged in discussion. feature analysis was conducted by viewing the “special needs adoption” forum page. the author counted and described the advertisements and sidebars. link analysis included reading through all data and copying hyperlinks to a separate document. the author counted the hyperlinks and described the main theme(s) of the links. exchange analysis included counting the times that participants mentioned continuing discussion elsewhere, e.g., using private messages. language analysis was used to assess emotion words associated with the themes. balog, mishe, and de rijke (2006) conducted correlational analysis between the uses of emotion words, such as “excited,” “worried,” or “sad,” with discussion of world events among blog users. similarly, the methodology utilized in this study searched for emotion words described throughout all discussion text. the theme discussed while using the emotion word(s) was described. the emotion words and their corresponding themes were described to demonstrate emotions associated with each theme. results theme analysis the final codebook resulted in ten themes related to parenting concerns: disability, placement, school, physiological versus psychological symptoms, lack of historical information, parental social support, case workers, interventions, and empathy (table 1). cross tabulations and chi-square statistics indicated that the discussion of the following themes were correlated with each other: 1) placement, case worker, empathy, lack of historical information, and social support and 2) disability, interventions, school, resources, and physiological versus psychological (figure 1 and 2). the focal areas of discussion fit into the initial steps of the social work practice framework: engagement, assessment, and intervention. placement concerns and topics associated with placement were primarily related to engagement and assessment. disability concerns and topics associated with disability were primarily related to assessment and intervention. parents focused their engagement discussion on their relationships with child welfare case workers. participants made recommendations about assessing appropriate placements and receipt of disability diagnosis assessments, which included differentiating between psychological or physiological diagnoses. they also reported that they often lacked historical information on adoptive and foster children that could help them to understand and receive appropriate assessments of their child. parents recommended interventions for specific disabilities as well as provided advice on adaptations to the educational experience of children with special needs. pseudonyms are used to refer to participants to ensure confidentiality. advances in social work, fall 2014, 15(2) 340 figure 1. statistically significant correlations between disability, interventions, school, and resources themes (p < .05) figure 2. statistically significant correlations between placement, case worker, history, empathy, and social themes (p < .05) engagement the only aspect of engagement discussed by parents was their relationship with child welfare case workers. four adoptive and foster parents reported that case workers are “notorious for taking time to respond” to emails and phone calls of inquiries. kandy, an adoptive mother of four from oregon explained, “i remember giving up hope on certain linton et al./special needs adoption and foster exigencies 341 inquiries and hearing weeks later from the child's case worker.” the only advice given by parents was to be patient and “hang in there” while waiting for responses. in addition, other participants expressed concerns that case workers were not supportive of them. for example, one parent expressed, “i guess our worker is pissed at us because she went to town on the stand.” assessment placement assessment. potential adoptive and foster parents sometimes questioned whether they were appropriate placements for children with special needs. placement assessments were discussed in the context of the potential adoptive or foster child’s disability and severity of the child’s disability. the following disabilities were discussed concerning placement decisions: hydrocephalus, west syndrome, fetal alcohol syndrome (fas), reactive attachment disorder (rad), mental retardation (mr), and co-occurring disorders. hydrocephalus and west syndrome were only discussed by one parent with advice given by two others. jenny, a foster mother of seven children from texas, reported: “we're considering submitting our home study for a girl we found through the state photo listing. she is 4 and has the following diagnosis: west syndrome, static encephalopathy, cortical blindness, and hydrocephalus.” regarding the child’s hydrocephalus diagnosis, taylor, an adoptive mom of five children, urged jenny to be: “most concerned on what damage was caused to the brain before the shunt was placed or during placement. it could range from no damage to severe.” providing advice to another parent regarding a placement of a child with west syndrome, leilani, a foster parent of two children from maryland expressed that: “west syndrome is a severe epilepsy syndrome, with a poor prognosis. the majority of children with it will have severe mental retardation, often with psychiatric or behavioral problems as well. the seizures tend to be very difficult to control with medications.” helga, an adoptive mother of three from california, asked other parents about their knowledge of adopting a 10-year old girl with fas and adhd (attention-deficit hyperactivity disorder). she reported that she and her husband are “pros” at adhd, but had no experience with fas. five other parents reported that there were two main aspects to the diagnosis to consider: learning difficulties and impulse control. amy, a foster mother of two, demonstrated the learning difficulties: my first son has been diagnosed with fas... he is a joy. yes, it does take longer for a fas child to learn things, but once they get it, they have it. my son…will attend 1/2 day kindergarten and 1/2 day 1st grade. this will allow him to get 11/2 yrs each of kinder and 1st grade. that will give him the best chance for success in school because by then he will have had the chance to get his abc's and 123's down pat. he also has a great deal of trouble with his fine motor skills so it will also let him have that extra year of learning/practicing to write and start to read. an adoptive mother, jacqueline, illustrated potential issues with impulse control experienced by children with fas: “at 16, he would still walk out into the street without a thought of looking for cars.” advances in social work, fall 2014, 15(2) 342 an adoptive and foster mother of 27 children over time, nancy, expressed concern about possible foster placement with an 11-year old girl with rad whom she previously fostered but ultimately disrupted due to nancy’s belief that the child contributed to breaking up nancy’s relationship. nancy also had two other teenage children with autism in her home. rose, an adoptive mother of one child concurred with nancy’s assumption that the child contributed to her relationship breakup and warned against it happening again: “she'll likely divide and attempt to conquer. i wouldn't take any kids older than mine-especially if they're small and she's volatile.” another mother suggested that the 11-year old with rad should be the only child in a home. another foster and adoptive mother of 27 children from connecticut had very strong, negative feelings about children with rad: “i've been dealing with a kid with rad for 14 yrs and the things she has put us through i wouldn't wish on my worst enemy…run!” a potential adoptive mother from pennsylvania, lilly, was concerned about adopting a child with ptsd (post-traumatic stress disorder), bi-polar disorder, adhd, and an iq score of 72. lilly was mostly concerned about the child’s iq score in consideration of adopting the child. two other parents suggested to lilly that iq is a subjective measurement of intelligence. monica, an adoptive mother of a child with borderline mr recommended: 72 is borderline…iq tests are not always reliable with kids like ours [with cooccurring disorders]. my son tests very low, but in reality, there's no way a child with an iq score as low as his would be able to learn as quickly as he does. he has ptsd and anxiety, so any sort of testing is pretty unreliable for him. he also has poor visual and auditory processing skills due to early neglect/possible substance abuse. but, his skills have increased so significantly with less than 2 years of interventions, i think that eventually he will function much more independently. honestly, his remaining behavioral/mental health issues impact him way more than any cognitive deficits. social support. adoptive and foster parents often discussed their need for social support throughout the placement assessment process. typically, the discussions of social support were regarding spousal emotional support. an example of this is susan, an adoptive mother from hawaii, whose parenting challenges with an adoptive child with rad were causing marital conflict. susan expressed, “…my husband doesn't come to therapy, it is just her and i cause him and her are just fine. i am the evil one…we had a knock down drag out tonight so i don’t know about the marriage.” another mother, natia, empathized with susan and encouraged her to address her marital concerns: this kind of stuff isn't uncommon when it comes to rad and marriage. the mother figure is always the one to receive the worst of everything, period. the bigger issue would seem to be your marriage.... i think someone awhile back suggested marriage counseling for just the two of you...is that totally out of the question? lack of historical information. while the parents above had information about children, other parents reported that they lacked information about children’s medical, disability, and sexual abuse history prior to or after placement. yasura, an adoptive mom of three from new jersey, expressed: “ugh. i wish i knew what went on while he [my son] linton et al./special needs adoption and foster exigencies 343 was in foster care. the family seemed nice enough when we picked him up. or maybe his mom abused drugs. or it could just be genetic. we'll never know.” discussed in context with specific disabilities, three parents felt that child welfare case workers intentionally did not give out information about disabilities, behaviors, and experiences of children. an adoptive mother of one from washington, mia said, “rad [reactive attachment disorder] is hard…i hate hate hate it that caseworkers do not give this information to foster parents. i hate hate hate that they sugarcoat it and end up doing so much damage to the foster parents and to the children they are supposed to be helping.” lacey, an adoptive mom from pennsylvania, expressed: to be honest i think some agencies downright lie and omit things that foster parents should be made aware of --sexual abuse is one of them. some kids can talk about sexual abuse they experienced and get through it and others internalize it and end up becoming sex offenders themselves. --i think this is one reason agencies are less than upfront about sexual abusethey know it is going to make it much more difficult to find placement for a child who is acting out sexuallyespecially if it's a boy. disability assessment. after families began to foster or had adopted children, they wanted to learn more about their children’s disabilities. general disability diagnosis discussions focused on obtaining educational and neuropsychological assessments. advice included obtaining the right assessments and finding the right person to conduct the assessment. participants reported that educational and neuropsychological assessments are different based on the process of requesting assessments, what information is provided for the assessments, and cost. monica, an adoptive mother of one child from ohio, explained: educational testing can be requested in writing…. this testing needs to be educationally-relevant--for example, cognitive testing, functional performance testing (how she actually uses her cognitive skills), speech and language testing, etc…. most districts will not complete assessments for mental illness, etc., as they aren't really qualified. you may be able to request help from your county board of developmental disabilities or from a local mental health recovery board for a neuropsych assessment. neuropsych testing is expensive. another adoptive mom of one from massachusetts informed other parents that it is important to find the right neuropsychologist to perform the assessment. cynthia advised parents to ask the neuropsychologist initial questions: the questions you should ask should relate to what you suspect are your kiddo's issues -and making sure the neuropsych has knowledge/expertise in that area. and that the np [neuropsychologist] can write a report that will get you what you need for kiddo (referral to therapy, iep with the school, etc.) physiological versus psychological symptoms. physical and psychological comorbidity or the possibility of co-morbidity assessment was a difficult challenge discussed by parents of children with special needs. sometimes parents could not differentiate between the symptoms of psychological and physical health conditions. for example, an experienced adoptive mother of five children, taylor, reported the following story about advances in social work, fall 2014, 15(2) 344 her son with autism, “i got a call friday from [my son’s] school. he was sitting in circle time, his nurse was watching and all of the sudden his body went ridged and his eyes rolled back into his head… eeg (electroencephalogram) came back normal.” other parents shared similar experiences of children who exhibit seizure-like behaviors that could be associated with a psychological diagnosis, such as “stimming” in autism. they reported that some seizures do not show up on eegs. other typical assessments could include ct (computed tomography) scans and taping seizures and showing the tape to a neurologist. taylor shared an unorthodox assessment given to her by her neurologist: …real test is that if you can “snap him out of it,” it isn't a seizure. so here we go with the oddest script i have ever seen…. if he does either of the behaviors, (hands by face or eyes rolling back) we are to tickle him. yep, that's right. i have a script ordering us to tickle [my son]. intervention advice on interventions was given for specific diagnoses including apraxia, adhd, cerebral palsy (cp), dyslexia, fas, ptsd, and reactive attachment disorder (rad). it should be noted that 52% of the intervention-themed posts discussed medication use to address children’s disabilities. only one person recommended an intervention for apraxia. victoria, an adoptive mother from oklahoma, reported that her daughter “works with a speech pathologist who is helping her find ways to access the missing words, and to communicate while multi tasking. for example, she can't talk and complete a project with her hands at the same time.” adhd interventions were discussed frequently among adoptive and foster parents. recommendations for interventions were divided into medication and alternative interventions. eight parents reported medications that worked as metadate and tenex as a combination, adderall, concerta, daytrana, and intuniv. they also reported those that did not work as vyvanse, strattera, and intuniv. parents reported that vyvanse caused a child to have a negative mood, strattera caused a child to be like a “zombie,” and intuniv did not do anything. andy, an adoptive mother of two children, who reported that intuniv worked for her child, clarified that it took a while to show an effect. monica, an adoptive mother with a son with adhd from ohio expressed her success with alternatives to medication, “several doctors that we have seen immediately wanted to throw medication at [my son]…if we had agreed, i really don't think we would have seen the huge changes in him that we've seen so far.” monica and 11 other parents suggested the following alternative treatments for adhd: 1) consuming caffeine and/or a diet of whole foods and no high fructose corn syrup, supplements including fish oil, b vitamins, and melatonin at night, 2) cultivating good habits or routines throughout the day that are accomplishment driven not time driven (i.e. “when you finish your breakfast, brush your teeth”) and at night that are calming, 3) concentrating on what “to do” rather than what not to do, 4) therapies including occupational therapy and eye movement desensitization and reprocessing (emdr) therapy, and 5) using “fidget toys” or sensory chair cushions. intervention ideas for children with cp were prompted by an adoptive mom from maine’s request for fun ideas to do with her two adopted children in the summer. the ideas linton et al./special needs adoption and foster exigencies 345 provided by four other mothers were fun and entertaining activities to do with children with or without cp: swimming, legos, making home videos, playing dress up, writing silly stories, board games, baking cookies, and arts and crafts (i.e., paper mache, coloring books, modeling clay, shaping and decorating playdoh, making things out of duct tape, sculpting ornaments, and jewelry). two parents provided advice on intervening with children with dyslexia. an adoptive mother of one from texas advocated for the strengths perspective: the biggest thing is to focus on his [my son’s] strengths and let reading be not as important…it [focusing on strengths] has helped him maintain his passion for learning to read despite the fact that it is hard for him. he still loves to read, and that is all that matters, the ability will catch up. another parent suggested that others read: unlocking the power of print: a tutor practicum manual for teaching the dyslexic reader. advice on intervening with children with fas was provided by two adoptive mothers. kandy, a mother of four, and yasura, a mother of three, reported that strict adherence to rules and routines, balancing glucose, and peace were essential for their children. kandy shared how her son exhibits the need for routine and glucose balance: my tantrummer doesn't transition well, has difficulty with self-regulation, impulse control is an issue, and he can't go too long between meals. tantrums are sometimes exacerbated by the need to eat. "irritability" is a sign of low blood sugar…. often before dinner he's particularly easily annoyed, so we try to make sure that we eat on time then. yasura demonstrated that children with fas need peace and quiet: “he [my son] said if my daughter is watching tv in the front room, and my husband is mowing the lawn, and my other son is in the garage lifting weights, and i am cooking or cleaning, it makes him crazy and he acts up to stop it.” therapeutic approaches for ptsd were recommended by three parents. recommendations included medications (i.e. intunive and clonodine) and therapies (i.e. neuropsychological therapy, art therapy, and emdr). however, two mothers advocated that the therapeutic approach must address the underlying issues of ptsd rather than the symptoms. nina explained, “i can't say that the therapy has helped much, no. the goals of therapy were to deal with things like her flashbacks, memory processing, hypervigilance etc. though. the symptoms you see in ptsd basically.” another mother, tracy responded, “until the root of the problem is identified and addressed, the individual can't change their behavior.” parents of children with rad discussed the struggles of parenting children who could often be manipulative, make bad choices, and whose anxiety could be easily triggered. francine, an adoptive mother of one from maine illustrated her daughter’s manipulation: “i can see the ‘wheels turning’ all the time. i have to be one step ahead of her [my daughter] at all times.” cristina, another adoptive mother of one from utah made a suggestion to deal with “bad choices” made by children with rad, “the only real way to help them make advances in social work, fall 2014, 15(2) 346 better choices is by helping them meet their needs in the least destructive way possible.” mandy, an adoptive mother of three from california, demonstrated how much children with rad need stability: redid [my son’s] room. painted it the colors he chose…. for five minutes he loved it. and then he hated it, and proceeded to meltdown for a few hours…. after which, we debriefed for a bit, and realized that having a whole new room reminded him of all the moves and families he's had to move to. and freaked him out. … only in our world does fresh paint result in a revisiting trauma! education four main themes of advice were given to parents pertaining to children having no interest in school, stigma and confidentiality, and the idea of “unschooling.” four parents reported that their children were not interested and sometimes refused to go to school. two parents reported that it is normal for children to have a difficult time adjusting to 1st grade and middle school. river, an adoptive mother of one and former teacher from minnesota, suggested that parents ask teachers to give children who are uninterested in school a special task to help them to “gain a feeling of importance.” a few parents were afraid to inform schools of their children’s diagnoses, especially rad, because their children would be treated differently and stigmatized. one parent noted that, because of hippa, parents only have to share what they want to share. hannah suggested, “i would only share with the school what you are comfortable sharing. i have been told by a few counselors to ‘watch the labels’ when it comes to school because it can come back to bite the child.” “unschooling” is a method of homeschooling that does not use a predetermined curricula, but meets the students where they are and progresses in challenging the student to learn new material when they are ready. four parents discussed using this method for children with various special needs. kandy, a mother of four from oregon who “unschools” her children explained her method: we limit “class time” the actual, sit down, write, read, pay focused attention time during homeschool. we do a lot of reading out loud (them to me, me to them) and lots of hands on kinds of things. games. math games that the kids have made up, board games, actual “educational” games, online games like how to type (keyboarding skills). we love documentaries and netflix has bunches of them. feature, link, and exchange analysis the forums.adoption.com “special needs adoption” sub-forum included 138 advertisements posted by the website administrators, 23 hyperlinks posted by members in discussion, and three members mentioned continuing their discussion in “personal messages” (pm). the advertisements were relevant to users, because all of them advertised adoption resources or organizations, such as “adoption community information.” the hyperlinks were posts as a part of member’s signatures (n = 8) or as resources (n = 15) that they were providing to other members. five of the hyperlinks used as signatures were links to the participants’ blog while the others included links to websites on post-adoptive depression and the church of the latter day saints beliefs. links posted as resources linton et al./special needs adoption and foster exigencies 347 included school (n = 8), dyslexia (n = 2), dyspraxia (n = 1), adhd (n = 1), medical (n = 2), and child cell phone (n = 1) resources. participants who mentioned using pm to continue discussions were referring to an instant messaging capability available on forums.adoption.com. language analysis the most common emotion word used in all themes was “hard” reflecting that parenting children with special needs was difficult. it was often used as an emotion, such as “it is hard.” the language analysis resulted in 63 emotion words associated with disability issues. the majority of emotions were negative, such as “hard,” while some suggested positivity, such as “joy.” the disability-related emotion words are displayed in a wordle (feinberg, 2013), which shows more common words in larger, bolder text and less common words in smaller text (figure 3). seventeen emotion words were associated with intervention discussion. all words except three were negative (e.g., out of control). the positive words reflected outcomes that participants desired based on interventions, such as “control” and “better.” twenty-three emotion words were associated with empathy. the most common word was “hard.” the only positive emotion word associated with empathy discussion was “awesome,” which reflected a member’s excitement for another member. twenty emotion words were associated with placement issues. emotion words reflected mixed emotions associated with placements. discussion of school is associated with eleven emotion words; four were positive, such as “proud,” while the rest were negative, such as “panic.” discussions of case worker issues were associated with 11 emotion words. all but one word were negative. discussions of social support were associated with seven negative words, such as “hurt.” discussion of resources and lack of historical information were both only associated with four emotion words. discussions of resources were associated with three positive words, such as “powerful” and one negative word, “anxiety.” discussions of lack of historical information were associated with all negative words, such as “helpless.” discussion of physiological versus psychological was only associated with one emotion word, “scary.” figure 3. disability theme wordle advances in social work, fall 2014, 15(2) 348 safe theoretical framework the needs expressed by adoptive and foster parents of children with special needs are reflective of pre-placement and post-placement needs. the findings of this study are displayed in the safe model (figure 4), which shows that prior to a placement adoptive and foster parents need engagement and assessment including child welfare services, knowledge about the symptoms associated with the potential foster or adoptive child’s diagnoses, and historical information about the child. after a child with special needs is placed with an adoptive or foster family, the family needs assessments and interventions including educational and neuropsychological testing and potential behavioral and educational interventions associated with the child’s diagnoses. figure 4. safe model pre-placement placement post-placement discussion the wca of an online discussion forum of adoptive and foster parents of children with special needs identified that the topics of discussion on parenting concerns were clustered into two main themes, disability and placement issues, and focused on children’s pre and post placement needs. discussions of disability issues were statistically significantly correlated with discussions of intervention, school, and resources. thus, adoptive and foster parents of children with special needs were concerned about and needed resources regarding interventions and school for their children. discussions of resources were also associated with discussions of differentiating physiological versus psychological symptoms in children with special needs. negative emotion words were primarily used during discussions in the disability cluster with the exception of mixed emotions associated with school and positive emotions associated with resources. hyperlinks posted by participants provided resources for school and other disability-related or interventionrelated information. discussions of placement issues were correlated with discussions of case workers, empathy, social support, and lack of historical information. placement issues among adoptive and foster parents of children with special needs were statistically significantly correlated with case worker issues and not having information about children’s history. in addition, parents’ reports that they were experiencing social support issues, such as marital conflicts, were often reported in conjunction with discussions of placement issues. thus, making placement decisions may have caused marital or social engagement case worker availability and support placement assessment knowledge of symptoms and severity of children’s diagnosis and children’s history; parental social support diagnosis assessment educational and/or neuro psychological testing for children intervention behavioral and educational interventions activities based on specific diagnoses of children linton et al./special needs adoption and foster exigencies 349 tension. the data also showed that participants primarily provided empathy for one another regarding placement issues. mixed emotion words were used during discussions of placements, while negative words were primarily used in discussions of case workers, empathy, social support, and lack of historical information. adoptive and foster parents of children with disabilities need support in finding appropriate interventions and making choices regarding school for their children. this study shows that parents went to each other for advice regarding interventions and school issues. these are resources that child welfare case workers may be able to provide parents. as indicated by manders and stoneman (2009) child welfare case workers tend to refer families with children with disabilities to receive child-focused services. child welfare case workers should receive training on disability diagnoses and possible interventions associated with disability diagnoses to increase the provision of mental health services to children with special needs. however, this study showed that parents not only needed interventions for their children, but also needed social support. case workers should be aware that adoptive and foster parents may also need support. participants in the study were quite critical of case workers. this may reflect the challenges experienced by case workers with large sample sizes and minimal resources due to budget cuts. this study may demonstrate the potential impact of budget cuts and increased caseloads among case workers. a recent study found that an additional 50% of case workers were needed to provide adequate in-home services to clients suggesting the minimal resources available in current child welfare agencies (kaye, shaw, depanfilis, & rice, 2012). this study showed that placement decisions among adoptive and foster parents relied on case workers, knowledge of children’s history, and social support. child welfare case workers can support adoptive and foster parents by being supportive of and available to them, providing as much history as possible about children, and counseling parents about any social support issues that they may be experiencing. in trainings, child welfare case workers should be informed of parent-focused interventions for parents of children with special needs. this information may need to be emphasized since case workers may tend to provide these families with information only about child-focused interventions (manders & stoneman, 2009). conclusion the safe theoretical model can inform child welfare workers of basic pre and post placement needs of adoptive and foster parents of children with special needs. 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(2008). testing the reliability of content analysis data: what is involved and why. in k. krippendorff & m. a. bock (eds.), the content analysis reader (pp. 350-357). thousand oaks, ca: sage publications. lightfoot, e., hill, k., & laliberte, t. (2011). prevalence of children with disabilities in the child welfare system and out of home placement: an examination of administrative records. children and youth services review, 33(11), 2069-2075. linton, k. f., krcek, t. e., sensui, l. m., & spillers, j. l. h. (2013). opinions of people who self-identify with autism and asperger’s on dsm-5 criteria. research on social work practice. doi:10.1177/1049731513495457 manders, j. e., & stoneman, z. (2009). children with disabilities in the child protective services system: an analog study of investigation and case management. child abuse & neglect, 33(4), 229-237. linton et al./special needs adoption and foster exigencies 351 nimrod, g. (2009). seniors’ online communities: a quantitative content analysis. the gerontologist, 50(3), 382-392. orme, j. g., & gillespie, d. f. (1986). reliability and bias in categorizing individual client problems. the social service review, 60(1), 161-174. orwin, r. g. (1994). evaluating coding decisions. in h. cooper & l. v. hedges (eds.), the handbook of research synthesis (pp. 139-162). new york, ny: russell sage foundation. padgett, d. k. (2008). qualitative methods in social work research. thousand oaks, ca: sage publications. raghavan, r., inoue, m., ettner, s. l., hamilton, b. h., & landsverk, j. (2010). a preliminary analysis of the receipt of mental health services consistent with national standards among children in the child welfare system. american journal of public health, 100(4), 742-749. ryan, g. w., & bernard, h. r. (2003). techniques to identify themes. field methods, 15, 85-109. slayter, e., & springer, c. (2011). child welfare-involved youth with intellectual disabilities: pathways into and placements in foster care. intellectual and developmental disabilities, 49(1), 1-13. sullivan, p. m., & knutson, j. f. (2000). maltreatment and disabilities: a populationbased epidemiological study. child abuse & neglect, 24(10), 1257-1273. viera, a. j., & garrett, j. m. (2005). understanding interobserver agreement: the kappa statistic. family medicine, 37(5), 360-363. yoon, y., rubin, d. m., riddle, m. a., noll, e., & rothbard, a. (2011). antipsychotic treatment among youth in foster care. pediatrics, 128(6), e1459-e1466. author note address correspondence to: kristen f. linton, msw, ph.d., myron b. thompson school of social work, university of hawai’i, 1800 east west road, honolulu, hi 96822, kfbean@asu.edu spring2000-087_page79 spring2000-088_page80 spring2000-089_page81 spring2000-090_page82 spring2000-091_page83 spring2000-092_page84 spring2000-093_page85 spring2000-094_page86 spring2000-095_page87 spring2000-096_page88 spring2000-097_page89 spring2000-098_page90 spring2000-099_page91 spring2000-100_page92 editorial editorial this very special issue has powerful meaning as two important events converge. first, this is my last issue as editor. i took over the reins with the fall 2002 from the very capable hands of professor barry cournoyer and i pass on the leadership to the highly talented professor bill barton. the journal is in good hands. it feels simultaneously as forever and just a moment since i took over as editor. a lot of work and creativity has resulted in top notch scholarship and conceptualization being disseminated to the profession and beyond. i am particularly proud of the special issues that have produced in-depth coverage of student assessment, the future of social work, and a critique of hbse theories. i say goodbye with a tired smile on my face. the second, more important event is that our journal begins its digital life with this issue. advances in social work is a freeaccess electronic journal as of this issue. there are no more paper copies being produced as of this issue. we have pushed hard to get as many past issues uploaded to the advances website so visitors to our website can look at not just the spring 2008 issue but at the dozens of past articles. the indiana university school of social work views this journal as one of our contributions to the profession. hopefully we have made the journal more accessible and visible. this issue continued the high standards and diversity of content that our previous paper copy issues have had. khaja and frederick describe a very timely issue, how to best work with muslim communities and what they have learned about teaching about muslim issues. washington offers a nice discussion of attachment theory. besthorn raises several important issues about how we live after 9-11 and offers a somber warning about legislative directions such as the patriot act. miller and colleagues report on the findings from their study looking at dual degree social work i ii programs. bhandari offers some important insights on how the violence against women act has helped immigrant women from south asia get better protection and rights. gallegos, a pioneer on cultural competence theory, and his colleagues offer a very provocative discussion on the status of cultural competence theory. the reader will receive, as always with our journal, a range of thought-stimulating and informative articles. i encourage you to get a cup of coffee and curl up with your laptop on a comfortable chair. let the paradigm shifting begin! advances vol. 4, no. 1 i editorial what is the “cutting edge” of social work? james g. daley social work is a proud, complex profession with a broad, sweeping mandate. every time some theorist or academic scholar or street-wise advocate asserts the “mission” of socialwork, a flood of alternative interpretations pour in. as scholars are busy building “evidence-based practice models,” post-modern cynics naysay the premise of science. advocates of best-practice protocols butt headswith zealots of the “social work is an art” camp. this conflict was raging in 1986 when i earned my doctorate.today’s swirl of arguments has a lot in commonwith the fiery debates ofmy doctoral class. capturing the essence of socialwork seems clearly confirmed by each person’s passion for a cause but seems rarely affirmed by amajority. there have been clear advances since 1986.there are a growing number of research centers at schools of social work. hopefully, there will soon be an nimh socialwork research center. there have been myriad studies on the effectiveness of socialwork practice. there have been dozens of textbooks on practice, policy, and advocacy. various authors have even asserted their own models of social work. but have we made progress? the same arguments are being made that were made in 1986 (and probably in 1916). we are science; we are art. we are a professional service; we are “save-the-disenfranchised” missionaries.work within the system; fight the system as outsiders. as teachers, we face a fascinating challenge.we teach the professional skills, while flaming the inner fires of advocacy.we teach strategies for clinical intervention, while cautioning against blind acceptance of the diagnosis.we teach how to use the dsm, while discussing the stigma of labeling and the importance of context.we prepare the next generation of social workers to be professionally prepared for both clinical and advocacy roles. the above beef stew of issues sets the stage for my question: what is the “cutting edge” of socialwork? as editor, i strive for articles that stimulate the reader and push the edge of our knowledge. but what cutting edge should i look for? one argument would be that the best article is the one that systematically builds on existing research literature and adds a small piece to the slowly emerging theory or model. empirical articles with large sample sizes, multi-site locations, and precise measures that are directly linked to the statistically confirmedmodelwould step to the front of the line. a series of articles that repeatedly confirm themodel would add credence that themodel is the cutting edge. another argumentwould be that the best article is the bold, newdirection previously untapped or perhaps even conceived. such an article puts old ideas or strategies together in a unique way. the article would shake our paradigms to the core. no data would be necessary, just clear, thoughtful, provocative ideas. as you look at this issue, have the authors pushed to the cutting edge? besthorn and saleeby’s fascinating review of and advocacy for biophilia is certainly thought provoking. collins’ in-depth discussion of the issues that child victims of violence face is invaluable in bringing the reader up-to-speed on the topic. both early, vonk, and kondrat’smulti-cultural practice article anddalton andwright’s empirical exploration of redundancy in a school of social work give the reader some data-based ideas that can improve howwe teach students. but are they cutting edge articles? i would advocate that the articles are cutting edge. my reasoning is simple. do they provokenew ideas?do their findings encourageus to re-evaluatehowwedobusiness? do they add to our understanding of an issue, perhaps even prompt us to read more on that issue? are they eloquent arguments from authors who are passionate about their topic? i submit that all of the articles in this issue (and previous issues) meet the criteria in these questions. theymake us think. they give us a chance to advance our skills or viewpoints. so what is the “cutting edge” of socialwork?we bump up against it every day. the cutting edge is the new and stimulating. it might be an evidence-based skill. it might be a bold new idea. it might be new data that suggests we should change how we do business. it could be marching together to a state capitol to advocate for change. the cutting edge is not defined by camp leaders or by excluding people who do not think the “right” way. for a complex profession, the cutting edge is multi-faceted and embracing. for socialwork, the profession that prides itself with being inclusive, the cutting edge is aplace thatwelcomes science andart, advocate andclinician, thedataobsessed, and the dreamer. as editor, i hope the cutting edge is advances in social work. so, to the reader i give this simple invitation. sit back in a comfortable chair and begin to read this issue. i promise you will be tasting the cutting edge. i4 advances vol. 3, no. 2 85 equipping socialworkers to address spirituality in practice settings: a model curriculum david r. hodge abstract: while there is growing interest in incorporating clients’ spiritual beliefs and values into social work practice, several studies have shown that social workers lack the necessary training to address spiritual issues in a culturally competent manner. this paper addresses this need by providing an annotated spirituality training course for use in various settings. topics or domains covered in the curriculum include ethics and values, research and theory on spirituality, the nation’s spiritual demographics, the cultures of major spiritual traditions, value conflicts, spiritual interventions, assessment approaches, and the rights of spiritual believers. a number of potential assignments are offered,which are designed to promote practitioner self-awareness, respect for spiritual diversity, and an enhanced ability to assess and operationalize spiritual strengths to ameliorate problems in practice settings. keywords: spirituality, course curriculum, training, education, religion there is growing realization that formany clients spirituality is fundamental to their existence. spiritual belief systems often function as an interpretive framework for understanding reality, informing individuals of who they are and how they should live (maslow, 1968). as rey (1997) has observed, these spiritually informed worldviews can affect numerous attitudes and practices of significance to social workers. for instance, bereavement, childcare, diet, intergenerational relationships, marriage relations, medical care, military participation, recreation practices, and schooling are all areas in which clients’ spirituality can affect beliefs and actions. evidence is also building that spirituality is a significant personal strength for many clients. several hundred studies on spirituality and religion have been conducted during the past few decades (koenig, mccullough & larson, 2001). reviews have consistently found a generally positive association between spirituality and a wide number of salutary characteristics (ellison & levin, 1998; gartner, 1996; koenig et al., 2001; pargament, 1997). for example, various dimensions of spirituality david r. hodge, m.c.s., m.s.w. is a rene sand doctoral fellow, george warren brown school of social work,washington university, st. louis, mo 63130-4899. copyright© 2002 advances in socialworkvol. 3 no. 2 (fall 2002) 85-103. indiana university school of socialwork. 86 advances in socialwork have been associated with empowerment (calhoun-brown, 1998; maton & salem, 1995), female leadership (robinson, 1996), healing (maton &wells, 1995; mcrae, thompson & cooper, 1999) and recovery from addiction (turner, o’dell &weaver, 1999), depression (propst, 1996), divorce (nathanson, 1995), homelessness (lindsey, kurtz, jarvis, williams & nackerud, 2000; montgomery, 1994), serious mental illness (sullivan, 1997), and sexual assault (kennedy, davis & talyor, 1998). research also indicates that many clients wish to incorporate their spiritual strengths into practice settings (privette, quackenbos &bundrick, 1994). according to gallup data reported by bart (1998), 66% of the public would prefer to see a professional counselor with spiritual values and beliefs and 81% wanted to have their own values and beliefs integrated into the counseling process. approximately 60% of the public believe that their faith can bemarshaled to address most of the problems they encounter (gallup & castelli, 1989). furthermore, the salience of spirituality frequently becomes more prominent during times of personal hardship (ferraro & kelley-moore, 2000; pargament, 1997), times when social workers may bemore likely to encounter clients. as the nasw code of ethics (national association of socialworkers, 1999) standard 1.05 stipulates, it is important for social workers to increase their understanding regarding the unique characteristics of spiritually-based cultures to be able to provide culturally competent services to clients. several surveys have shown, however, that most social workers have received no training in spirituality during their graduate education (bullis, 1996; canda & furman, 1999; derezotes, 1995; furman & chandy, 1994; furman, benson, grimwood & franz, unpublished manuscript; sheridan & amato-von hemert, 1999). for instance, canda and furman’s (1999) stratified random sample of the national association of socialwork (nasw)members (n=2,069) found that 73% received no content on spirituality during their social work education and only 17% agreed that social workers possessed the knowledge to address spiritual issues. while most social workers recognize the importance of spirituality, the data suggest that many social workers are not adequately equipped to address spirituality in practice settings (canda&furman, 1999). the lack of education implies that widespread training is required in this area. accordingly, this paper addresses the need by presenting a spirituality-training curriculum. the aim of the curriculum is to develop an understanding of spiritual diversity and lay a foundation for acquiring the necessary skills and knowledge to utilize spirituality in various practice settings in the areas of assessment, planning, and intervention. toward this end, the three-fold objective is to develop a deeper understanding of the empirical and theoretical knowledge base, acquire a greater understanding of the various spiritual traditions practitioners are likely to encounter in practice settings, and develop the skills necessary to utilize spirituality in practice settings to ameliorate problems in amanner consistent with the profession’s ethical mandates. the curriculumcanbeadapted to anumber of different settings, including agencybasedworkshops, short-term seminars, graduate level courses, small groups, or even self-study. this is accomplished by adjusting the amount of material addressed in various contexts, such as classroom settings, small groups outside of class, and homework assignments. since curriculummaterial consists of a number of articles/ book chapters designed to address specific topics, contextual alterations can be made to tailor the material by incorporating additional pertinent readings. while compiling the material is more work than merely assigning textbooks, the reading packet serves as a type of textbook itself and can be continually updated by adding new articles as the knowledge base grows over time (patterson, hayworth, turner christie & raskin, 2000). as implied above, this paper provides an annotated overview of the curriculum material.there are 10major domains or topics thatmight be considered indesigning a spirituality curriculum: 1) ethics and values, 2) a review of the empirical research on spirituality, 3) theoretical explanations for spiritual strengths, 4) spiritual demographics of the nation, 5) an overview of the nation’s major spiritual traditions, 6) value conflicts, 7) spiritually-based interventions, 8) assessment and operationalization of spiritual strengths, 9) rights of spiritual believers, and 10) assignment suggestions. the material below is presented in a manner that highlights connections between readings and emphasizes pertinent themes that can be amplified upon in discussion or through personal reflection. the major topics are reviewed in the sequence in which they would be presented in a seminar, workshop, or course. small-scale mini-assignments to enhance learning, which might take the form of class discussion topics or reflective take-home papers, are suggested for most domains. in a section at the end of the paper, suggestions for major assignments that help to integrate the material are provided. the material presented below is also designed to be consistent with the foundation curriculum content requirements specified in the educational policy and accreditation standards (epas) issued by the council on social work education (cswe) (2001: iv). more specifically, the suggested domains and assignments have been created to foster learning in the content areas listed in the epas as they intersect spirituality; namely, values and ethics, research, humanbehavior and the social environment, diversity, populations-at-risk and social and economic justice, social work practice, and to a lesser extent, social welfare policy and services. ethics and values an appropriate place to begin a presentation on spirituality is with the profession’s code of ethics (national association of social workers, 1999). as the epas standards iv and a (council on social work education, 2001) state, education should provide students with the opportunity to integrate the nasw code of ethics into their practicewith, and service to, clients. three areas of particular significance are the standards related to client self-determination, religion, and professional competence. it is important to note that social workers are to respect the spiritual autonomy of clients (1.02). practitioners must be careful not to impose or otherwise coerce clients into accepting their values. richards, rector, and tjeltveit (1999) provide a concise overview of the intersect between values and spirituality in the clinical setting, along with helpful suggestions for safeguarding clients’ rights in the area of autonomy. as supplemental reading to raise awareness concerning value differences, jafari (1993) offers an islamic view that helps to illustrate how the values associated with the enlightenment-based western counseling project may differ from the values associated with some faith-based perspectives. 87hodge/spirituality training the nasw code of ethics (national association of social workers, 1999) lists four standards that explicitly address religion (1.05c, 2.01b, 4.02, and 6.04d), the vehicle through which most, although not all, clients express their spirituality (gallup & lindsay, 1999; pargament, 1999). furthermore, since religious believers comprise distinct cultural groups based on the norms of their faith traditions (fellin, 2000; talbot, 2000), there are at least two standards that implicitly address religion (1.05a, 1.05b). these standards can be reviewed and their implications regarding how social workers should interact with religious peoples examined. social workers are also mandated to offer services only within their area of professional competency (1.04). practitioners do not function in the role of a pastor or spiritual director/mentor (o’rourke, 1997). while it is generally appropriate for social workers to attempt to tap into clients’ spiritual strengths to assist them in solving their problems, it is essentially outside practitioners’ area of competence to address issues related to clients’ spiritual well-being. put simply, social workers should focus on helping clients overcome the obstacles they face rather than offering advice on clients’ spiritual state, beliefs, practices, or behaviors. social workers who envision themselves as working with spiritual issues on a regular basis should consider forming collaborations with local clergy drawn from themost prominent local faith traditions (weaver, koenig & larson, 1997). to help assimilate thismaterial, course participantsmight consider what type of practitioner responses would engender a practice atmosphere that promotes creating a safe place in which spirituality can be explored in a non-judgmental manner. at some point in the curriculum, ethical dilemmas could be analyzed in light of the ethical standards discussed above (council on socialwork education, 2001: iv, a). for instance, given that islam affirms sexuality within the context of heterosexual marriage (halstead & lewicka, 1998; islamic society of north america, 1999), the challenges that a gay therapistmight face with amuslim client wrestling with her sexual orientation might be explored. review of the empirical research as implied above, research on spirituality is increasing at a dramatic rate, with hundreds of studies on the topic now in existence (koenig et al., 2001). the results of these studies have been remarkably consistent across populations regardless of age, ethnicity, gender, national origin, race, religious affiliation, and study design (ellison & levin, 1998; mcfadden & levin, 1996). reviews consistently report a generally positive association between devout faith and awide number of salutary characteristics (ellison & levin, 1998; gartner, 1996; koenig et al., 2001; pargament, 1997). the following articles provide a window on this growing body of empirical knowledge. after reading these five articles, students may be surprised at the breadth of available research. interested individuals should be informed that research exists on most populations and issues of interest to social workers. green, fullilove, and fullilove (1998) offer a good entry point into the research with their qualitative study that describes stories of spiritual awakenings among participants of 12-step programs.the narrative format affords students the oppor88 advances in socialwork tunity to encounter an experiential, phenomenological element that often gets lost in research.worthington, kurusu, mccullough, and sandage (1996) present a thorough 10-year reviewof research that relates to practice concerns, such as studies on the relationship between spirituality andmental health, the role of values in therapy, and effective interventions. in maton andwells’ (1995) review, the potential of religion to foster well-being through the pathways of prevention, healing, and empowerment is examined. this content area also includes two studies that highlight the salience of spirituality with specific populations of interest to social workers. donahue and benson’s (1995) study illustrates the significance of religion as a protective factor with adolescents, with religion often exhibiting a stronger influence than gender, single parent status, and other variables widely thought to be significant predictors of attitudes and behaviors. kennedy, davis, and talyor’s (1998) study documents the role of spirituality in facilitating recovery from sexual assault among a sample comprised largely of inner city minority women. since this section is oriented towards empiricism, it may be difficult to provide an assignment to help foster learning in this topic area. accordingly, this may be an appropriate time to integrate into the course one of themajor assignments discussed later in this paper. alternatively, when the course is being taught in a cswe-accredited educational institution and/or students have an understanding of research methodology, students might critique some of the existing research, explore, and summarize the existing research in a given area (e.g., the relationship between spirituality and depression), relying on good reviews such as koenig, mccullough, and larson’s (koenig et al., 2001), or conduct a literature search to explore the intersection between spirituality and a given population, such as african-americans or the elderly. theoretical explanations as the cswe’s educational standards (council on socialwork education, 2001: iv, d) imply, it is important for students to be exposed to empirically-based theories that explain the relationships between humans and their environments with an emphasis on the relationships that maintain and promote health and well-being. as interest in researching the effects of spirituality has grown, a number of theories have been proposed to explain the underlying mechanisms. while the preceding domain helps students understand the nature of spiritual assets, theory can assist course participants in their comprehension of the pathways involved. in other words, theory provides an explanation for how spirituality fosters positive outcomes. ellison and levin (1998) provide a smooth transition from overviewing the research to discussing theoretical explanations for the association between religion and health. seven possible explanatory mechanisms are reviewed, which may account for salutary outcomes, including the provision of social resources, promotion of positive self-perceptions, and provision of specific coping resources. jacobs (1992) explores the underlyingmechanisms betweenmental health and ritual, a key spiritual practice inherent in essentially all faith traditions. finally, borrowing from attachment theory, kirkpatrick (1995) suggests that god functions as 89hodge/spirituality training 90 advances in socialwork an attachment figure. since attachment is theorized to be a malleable construct that can change over time, the negative effects of insecure childhood attachment can be compensated for by developing a secure attachment with a divine other. for enhanced learning, students can reflect upon the various theoretical mechanisms as they intersect their own lives, or the lives of other significant individuals they know.which theoretical explanations best explain the spiritual strengths they observe in their own lives? the lives of others? do other theoretical pathways exist that provide a better theoretical explanation for the operation of spiritual strengths? if students had to construct their own theoretical model to describe the relationship between spirituality and well-being, what might it look like? demographics and overview of major spiritual traditions in the nation while diversity is a fundamental tenet of social work education (council on social work education, 2001: iv, b), in practice, individuals tend to form social networks based upon shared norms and values (scheepers & van der slik, 1998). because people tend to enter into relationships, watch media, and read news reports that validate their own understanding of reality, individuals may not have an accurate understanding of the nation’s spiritual demographics. alternatively, individuals may only be dimly aware of other faith traditions and their own unique worldviews. to countermisperceptions, it is important to provide studentswith a description of the most numerically prominent faith traditions in the united states. since clients are most likely to come from these traditions, it is critical that social workers have some comprehension of the nation’s largest faith groups and their animating value systems. since, to some extent, most of the research and theory is based upon these populations, it helps to have some level of understanding of the nation’s spiritual demographics in order to integrate the former content areas. gallup and castelli’s (1989) text, especially chapter 4, provides a comprehensive overview of the major denominations and faith-based groups in the country, including evangelicals, catholics,mormons, jews, and“nones.” also examined are the distinctive profiles of african americans, hispanics, teenagers, and baby boomers. while the material is somewhat dated, religious demographics remain relatively stable over time (gallup & castelli, 1989) as more recent data confirm (hutchison, 1999). for further reflection, individuals may wish to delineate the major faith groups in the nation, then map out the number of close friends in each group, paying attention to their level of orthodoxy or commitment to the historic mainstream tenets of their faith tradition. of particular note is the degree of homogeneity vs. the degree of diversity. if one’s social network is largely comprised of, for example, members of liberal denominations, nominal adherents, and “nones,” it is important to reflect upon how this may affect interaction with groups, such as evangelicals, who tend to have a different value system. similarly, if one’s social network primarily consists of devout mormons, reflection upon the possible difficulties involved with working with more liberal groups is called for. overview of major spiritual traditions as an extension of the above material, this content area provides more specific information about major spiritual traditions that social workers are likely to encounter. articles in this domain can introduce readers to the unique beliefs, practices, values, and assets associated with the specific spiritual tradition under discussion. by providing students with a basic understanding of the value system that guides adherents, social workers are better equipped to provide services that are culturally competent as stipulated by the code of ethics (1.05). the following is a core list of common spiritual traditions that cover the majority of clients with whom social workers are likely to encounter in practice settings (gallup & castelli, 1989; hutchison, 1999). depending on such factors as time restraints and, perhaps, more importantly, the spiritual demographics of the area in which the course is taught, it may be appropriate to add material that addresses such traditions as mormonism (ulrich, richards & bergin, 2000), islam (daneshpour, 1998), judaism (zedek, 1998), pentecostalism (dobbins, 2000), hinduism (juthani, 1998), buddhism (scotton, 1998), native american spirituality (trujillo, 2000), and/or other traditions. in short, the content in this domain should be tailored to equip course participants with understanding the faithbased cultures they are most likely to encounter in practice settings. evangelical christians are the nation’s largest spiritual minority (hutchison, 1999). diblasio (1988) provides an introduction to this population and discusses some of the implications of an evangelical worldview for therapy. catholics comprise the second largest spiritual tradition and the nation’s largest denomination. shafranske (2000) provides an overview of this tradition, highlighting issues of importance to practitioners. mccullough,weaver, larson, and aay (2000) provide a review of mainline protestants, which includes an overview of their history, fundamental beliefs and practices, views on social and moral issues, and suggestions for practice. a brief introduction to eastern faiths is offered by ryan (1993), who reviews hinduism, buddhism, confucianism, and taoism in the context of death and dying work. as mentioned above, this list should be adapted to reflect the client populations which course participants are likely to encounter in practice settings. it is critical, however, that thewritings in this domain reflect anunbiased, empathetic tone that communicates respect for the culture in question. authors whose value systems are derived from the dominant secular culture, or whose value systems are otherwise incongruent with the group being discussed, can misrepresent faith-based cultures when value conflicts occur between the writer’s value system and the population the author is addressing (ginsberg, 1999;wambach&van soest, 1997). when writers encounter values that differ from their own, they may attempt to counter the group’s beliefs or depict them as deficits, problems, or concerns instead of conveying a strengths-based depiction that genders an empathetic understanding. for instance, one article on the pentecostal experience seems to suggest that beliefs central to this faith group, such as believing that jesus performed miracles or believing in the necessity of a spiritual re-birth, are either incorrect or problems (belcher & cascio, 2001).while enlightenment-based secular discourse commonly 91hodge/spirituality training discounts the reality of the supernatural realm, applying this framework as an interpretive lens tominority faith groups facilitatesmisunderstanding in the same manner that applying a white lens facilitates misunderstanding of, for example, african-americans. in short, the articles selected for this content area should reflect the same sensitivity to faith-based groups that is extended to other groups commonly discussed in social work forums. to enhance learning, course participants might select one of the commonly encountered faith groups whose value system differs substantially from their own and attempt to envision life through that particular worldview. as part of this process, individuals might visit a house of worship and/or obtain and read a variety of literature from a spiritual tradition that differs from their own, noting their personal reactions to these experiences. the aim is to move toward spiritual competency by 1) developing an empathic understanding of a spiritually different worldview and 2) developing an awareness of one’s personal spiritual worldview and associated biases (sue, arredondo & mcdavis, 1992). more specifically, using evangelical christians as a possible client population whose worldview differs from the students’ own, one might reflect upon the lens orworldview throughwhich evangelicals are viewed, attempt to discern how the biases associated with their worldview affects their understanding of evangelicals, consider how to set aside their worldview and associated biases and see reality through the worldview used by evangelicals, and finally, come to the point of appreciating reality as seen through an evangelical worldview (wambach &van soest, 1997). value conflicts content on spiritual diversity flows naturally into a discussion on value conflicts that arise between subordinate and dominant spiritual worldviews. as implied above, conflict often occurs between the value system advocated by the dominant secular culture and the value systems of spiritual believers. as the cswe educational standards (cswe, 2001: iv, c) suggests, it is important for curriculum content to address issues of social justice and oppression. in order to work effectively with people of faith, it necessary to understand the bias they encounter in the dominant secular culture. one of the more influential models for understanding value conflicts is hunter’s (1991) epistemological theory. this model posits that contemporary society is characterized by impulses towards twoworldviews referred to by hunter as orthodox and progressive. orthodox believers derive their value system from transcendent authority, such as the bible, the koran, or the dharma, while progressives individually construct their own value systems within the parameters proscribed by the current enlightenment derived, secular ethos. two sections from hunter’s 1991 text provide a succinct introduction to this framework, the prologue “stories from the front” (pp. 3-29) and “new lines of conflict: the argument in brief” (pp. 42-51). as implied above, the secular enlightenment-based worldview referred to by hunter as progressive dominates the centers of social power, particularly the reality defining the knowledge sector (e.g., media, academia, government bureaucracy, helping professions, etc.). 92 advances in socialwork asmentioned above, it is important to develop an empathetic understanding of the bias that the difference inworldviews between people of faith and progressives often engenders toward orthodox believers (roberts, 1999). it may be helpful to recognize that the dominant progressive worldview often marginalizes or otherwise de-legitimizes devout faith in such influential knowledge sector forms as television (skill & robinson, 1994; skill, robinson, lyons & larson, 1994), popular periodicals (perkins, 1984), high school (sewall, 1995; vitz, 1986; 1998) and college level textbooks (glenn, 1997; lehr & spilka, 1989), including social work texts (cnaan, 1999; hodge, baughman & cummings, 2002). stockton (1994) illustrates how the clash in value systems can lead to muslims being depicted in an unfavorable light in media, a forum that shapes general perceptions about populations (hunter & schaecher, 1995; tower, 2000). as one of the professions that comprise the knowledge sector, hunter (1991) observes that a progressive worldview also pervades social work. one illustration of the salience of the progressive worldview in the profession is provided by the fact that some 60% to 70% of social workers reject the notion of a personal god in favor of non-theistic understandings of transcendent reality (sheridan, bullis, adcock, berlin & miller, 1992; sheridan,wilmer & atcheson, 1994). in contrast, at least 66% of the general population believe in a personal god (canda & furman, 1999; gallup & castelli, 1989). furman, perry, and goldale’s (1996) study demonstrates the effects that the difference in value systems can have on the willingness of some theistic clients to receive services from social workers who hold substantially different worldviews in tandemwith little knowledge of spiritual diversity. to enhance understanding in this area, course participants might consider which worldview they orient towards (i.e., orthodox or progressive) and how that particular orientation might affect their ability to work with clients from the alternativeworldview in a culturally competentmanner. a feminist, for example,might consider how her affirmation of the egalitarian gender roles might effect her ability to provider services to a hindu couple that affirms complementary gender roles. or to cite another example, an evangelical christianmight reflect upon how her worldview might effect her ability to provide services to a sexually active gay man wrestling with the intersection between his spirituality and sexual behavior. material from the nasw code of ethics (nasw, 1999) might also be incorporated into assignments. given that the code of ethics indicates that social workers should actively work to prevent and eliminate religious discrimination (standard 6.04d), individuals might deliberate upon the experiences of spiritual believers who encounter life in a culture that often ignores, devalues, and even ridicules their most cherished beliefs and values. individuals might consider what actions they might take, both personally and systemically, on behalf of evangelical christians, traditional catholics, muslims, and people of faith from other traditions who often encounter bias in the dominant secular culture. spiritually-based interventions spiritually competent practice is predicated upon acquiring the ability to develop intervention strategies that are appropriate, relevant, and sensitive to the client’s spiritual worldview (sue et al., 1992). as the cswe educational standards (council 93hodge/spirituality training on socialwork education, 2001: iv, f) imply, practice should focus on the clients’ spiritual strengths, capabilities, and resources. although it is important to consider interventions within the context of the specific spiritual tradition of the client, there are some interventions that have been empirically validated with a number of traditions. perhaps the most widely used spiritual intervention is prayer. mccullough and larson (1999) provide a helpful overview of prayer, including information about its frequency, various manifestations, associations with well-being, and its function as a resource for practitioners. incorporating spiritual beliefs into traditional cognitive/behavioral modalities is also a widely used intervention. studies suggest that a spiritually modified form of cognitive/behavioral therapy is at least as effective as traditional forms of therapy in a number of areas, including depression among christians (hawkins, tan & turk, 1999; johnson, devries, ridley, pettorini & peterson, 1994; johnson & ridley, 1992; propst, 1996), perfectionism among mormons (richards, owen & stein, 1993), and anxiety disorders (azhar, varma & dharap, 1994), bereavement (azhar &varma, 1995a), and depression (azhar &varma, 1995b) among muslims. propst (1996) provides a good introduction to this approach. a significant body of research also testifies to the importance of spirituality as a mechanism for coping (pargament, 1997). pargament, individually (pargament, 1996) and in association with brant (pargament & brant, 1998), overviews some of the more salient features of spiritual coping. options for reframing difficulties as opportunities for spiritual growth are presented along with spiritual beliefs that may facilitate healthy spiritual coping. spiritual resources can also be tapped into to facilitate forgiveness, which is a major component of most major faith traditions (mccullough, paragament & thoresen, 2000). diblasio (1998) gives a helpful account of the use of decisionbased forgiveness in therapeutic contexts. to promote further assimilation of the above material, individuals might consider selecting one or more interventions and one or more of the spiritual traditions listed above. course participants could reflect upon how the intervention(s) could be tailored to assist a client from a particular tradition. in other words, how might the intervention be customized to achieve therapeutic goals by tapping into a client’s spiritual value system? to use muslims as an example, students might consider the tenets that might be drawn from the koran and those integrated into traditional cognitive interventions to assist a client who is wrestling with depression. assessing and operationalizing spiritual strengths a number of frameworks have been developed to assess and operationalize clients’ spiritual strengths. one of the more common approaches is taking a spiritual history (boyd, 1998; bullis, 1996; canda & furman, 1999; dombeck & karl, 1987; o’rourke, 1997; peck, 1993; rizzuto, 1996; tan, 1996). this process is analogous to taking a family history except the format is tailored to elicit the significant spiritual events that have occurred over the course of a client’s life. for further specificity, boyd’s (1998) model might be presented. 94 advances in socialwork while spiritual histories offer a verbal format for spiritual assessment, hodge’s (2002) spiritual life map provides a pictorial delineation of a client’s spiritual journey. in their most basic form, clients use drawing pencils to map out their spiritual life history on a large piece of paper. significant events, in the form of pictures, words, symbols, or other entities that resonate with the client’s experiences are depicted on a path, a roadway, or a single line that represents the client’s spiritual sojourn, typically from birth to the afterlife. spiritual genograms offer another method for accessing the spiritual dimension of existence (bullis, 1990; dunn & dawes, 1999; frame, 2000; hodge, 2001; rey, 1997; roberts, 1999). as is the case with traditional genograms, spiritual genograms focus on the intergenerational aspects of spirituality. hodge (2001) provides a good example of this assessment method while highlighting interventions that may be particularly suited to this approach. while spiritual genograms highlight spiritual strengths over time, spiritual ecomaps emphasize spiritual strengths in space (hodge, 2000). put differently, while spiritual genograms focus on intergenerational strengths, spiritual ecomaps accent strengths that exist in the current environment. hodge (2000) provides an introduction to this diagrammatic instrument. these assessment approaches provide social workers with a set of tools that emphasize different aspects of clients’ spirituality and, correspondingly, lend themselves to the operationalization of different spiritual strengths. assessments conducted with spiritual genograms, for instance, may reveal spiritual assets in a client’s family system that other methods might fail to uncover. to promote a better understanding of these assessment approaches, course participants might list the strengths and limitations of eachmethod. areas to consider include ease of client involvement, client preference, ability to tap particular strengths, and smoothness of transition to particular interventions. for example, spiritual genograms may be particularly appropriate with clients where the extended family plays a significant role in clients’ lives, while spiritual eco-maps may be better suited to clients who wish to focus on their immediate presenting problem. similarly, spiritual histories may be ideal for verbally oriented clients, while more artistic or less verbal clients may find lifemaps a better choice. rights of spiritual believers when addressing spirituality, issues related to the free expression of religion arise with some degree of frequency. to use hunter’s (1991) terminology, orthodox believers may encounter discrimination in forums in which progressives dominate. for instance, school social workers may have to address situations in which students are sanctioned for wearing spiritually-based attire or sharing their spiritual beliefs in class settings. consequently, it is important for social workers to have some knowledge of the rights that spiritual believers possess in public forums. the updated version of former president clinton’s (1995) memorandum on religious expression in the public schools provides a helpful summary of the free expression rights of believers (riley, 1998). also helpful is esbeck’s (1998) review of supreme court decisions bearing on first amendment freedoms. in addition to 95hodge/spirituality training the first amendment of the united states constitution, the united nations (1948/1998) universal declaration of human rights is also an original source that contains material that directly relates to individuals’ religious rights. to promote further understanding of this material, students might summarize the rights that spiritual believers have. alternatively, course participants could take a scenario of relevance to social work, such as a student in school or an employee at work, and list the rights that people of faith enjoy in these settings. students might explore how a social worker might advocate for a client who has been denied religious rights or is facing some type of religious discrimination. for example, individuals might examine the steps that a school social worker might take on behalf of a devout muslim student whose paper on islam is rejected out-of-hand solely due to its spiritual content. in addition, in keepingwith thecsweeducational standards (cswe, 2001: iv, e), students might analyze social welfare policy and services in light of the religious rights believers possess. for instance, individuals might explore ways in which public policy conflicts with the rights of spiritual believers. the unlevel playing field (white house, 2001), an examination of faith-based barriers that exist in federal social service programs, might be used as a starting point. assignment suggestions in addition to the domain-relatedmini-assignments discussed above, a number of major assignments can also be incorporated into the curriculum. these projects provide opportunities for course participants to develop a deeper, more personal understanding of many of the themes presented above in a manner that is congruent with cswe educational standards (council on social work education, 2001: iv). although any number of assignments could be proposed, the three discussed belowmay be particularly helpful. spiritual autobiography spiritual autobiographies can be helpful tools for fostering student awareness of their own unique spiritual history. writing a spiritual autobiography can assist individuals to understand their spiritual values and how these values have informed their lives. individuals can chronicle their own relationship with the transcendent, including parental influences, spiritual awakenings, key turning points, specific spiritual strengths, how their spirituality has helped them to cope with trials, and how their spirituality has functioned as a protective factor in their lives. since this exercise is designed to foster increased self-awareness regarding one’s personal spiritual journey, it may be particularly advisable to undertake this project early in the course. spirituality can be defined in a broad manner so that all individuals can discuss how their views regarding transcendent reality have informed their lives (canda & furman, 1999). for individuals interested in a model, the confessions by african spirituality writer augustine (354-430/1991), widely considered to be the first autobiographical work in recorded human history (clark, 1993), can be used. 96 advances in socialwork religious countertransference as course participants develop awareness of their own spiritual values, it is important to consider how those values may interact with the spiritual values of clients. in some situations, value systems may interact in a manner that inhibits the provision of client-centered services. the effectiveness of service provision may be particularly imperiled when individuals hold negative sentiment toward other spiritual traditions (genia, 2000; larson, sherrill & lyons, 1994). approximately one-third of social workers report ambivalent-to-negative feelings towards their religious background, which is primarily christianity (canda & furman, 1999; furman, canda&benson, 2001; sheridan et al., 1992). for instance, 44% of virginia-based clinical practitioners (n=108) no longer participate in their childhood religious tradition, with the shift occurring primarily away from christianity to none or “other” (sheridan et al., 1992). asgenia (2000) observes, individualswhohave failed towork through these negative feelings may encounter religious countertransference biases when working with individuals from their former spiritual traditions. internal pressures from unresolved personal needs can drive interactions with devout clients from the christian faith tradition and perhaps other traditions that affirm similar values (black, jeffreys&hartley, 1993). interactionswith committedchristiansmay result in social workers acting out their unresolved negative feelings toward their past traditions with their present clients (gartner, harmatz, hohmann, larson & gartner, 1990). accordingly, course participants might write a paper exploring their ability to work with clients from other spiritual traditions. particular attention should focus on examining negative sentiments towards one’s former childhood spiritual tradition and how unresolved issues might affect service provision. thought could also go into deciding what emotional signals might indicate the necessity of a referral to another practitioner. this papermight be written later in the course, perhaps as a useful complement to the “values conflicts” content area. since this domain directly addresses the issue of conflicting worldviews, course participants are already thinking about macro level, epistemologically-based conflicts. as a supplemental assignment, this paper can assist individuals explore micro-level conflicts that may affect their ability to work with clients from differing spiritual traditions. spiritual assessment reflection papers course participants might also benefit fromwriting a number of reflection papers on the spiritual assessment process. in conjunction with the “assessing and operationalizing spiritual strengths” topic area, course participants might form dyads and take turns conducting spiritual assessments. one individual could present with a particular problem, while the other conducts an assessment with the aimof eliciting spiritual strengths thatmight be operationalized to help ameliorate the presenting problem. after completion, the roles could be reversed. depending on time constraints, this process could be undertaken for each of the four assessment approaches profiled above. in other words, each course partici97hodge/spirituality training pant would play the part of a practitioner conducting four assessments, using a spiritual history, a spiritual lifemap, a spiritual genogram, and a spiritual ecomap. concurrently, each individual would also serve as a client, experiencing each assessment approach from the vantage point of a social service consumer. after completing an assessment, each person in the dyad might write a paper reflecting on his or her experiences. attention should be directed towards regarding the extent to which spiritual strengths were identified and harnessed to address the presenting problem and how both members of the dyad experienced the process. particular attention should focus on practices that promote or hinder a spirit of openness and acceptance in the clinical dialogue and alternative practices that might better achieve these goals. after completing the reflection papers, the dyad members might exchange papers and discuss ways in which the individual who role-played the clinician might improve his or her ability to conduct a spiritual assessment. points of congruence, in which both participants shared similar perceptions, should be noted as well as areas in which perceptions differed. the individual who functioned as the client should note the strengths of the person conducting the assessment and offer suggestions for building upon those strengths to improve his or her ability as a clinician. finally, as is the case with all group exercises, issues of student privacy, comfort level, and group dynamics should be considered before engaging in the above exercise. conclusions most social workers seem interested in learning more about spirituality (derezotes, 1995). given that themajority of social workers appear to address spirituality in practice settings without proper training (canda & furman, 1999; furman et al., unpublished manuscript), it is critical that resources be developed that can be used to equip practitioners toworkwith spirituality in an ethically consistent manner.while individuals interested in engaging spiritual issues on a regular basis should be encouraged to develop an extensive knowledge base concerning the major spiritual traditions they are likely to encounter in practice settings, the curriculum content presented in this paper provides a basic foundation on which to build. in short, the material presented in this paper lays the groundwork for spiritually competent practice. references augustine. 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(1997). marriage and family therapists and the clergy: a need for clinical collaboration, training, and research. journal of marital and family therapy, 23(1), 13-25. thewhite house. (2001, august). unlevel playing field: barriers to participation by faith-based and community organizations in federal social service programs. retrieved january 21, 2003 from: http://www.whitehouse.gov/news/releases/2001/08/unlevelfield.html. worthington, e.j., kurusu, t., mccullough, m., & sandage, s. (1996). empirical research on religion and psychotherapeutic processes and outcomes: a 10-year review and research prospectus. psychological bulletin, 119(3), 448-487. zedek, m.r. (1998). religion and mental health from the jewish perspective. in h.g. koenig (ed.), handbook of religion and mental health (pp. 255-261). newyork: academic press. author’s note: address correspondence to: david r. hodge, m.c.s., m.s.w., georgewarren brown school of socialwork, washington university, 1 brookings drive, campus box 1196, st. louis, mo 63130-4899, usa. e-mail: drh1@gwbmail.wustl.edu. 103hodge/spirituality training aisw vol. 5, no. 2 factors that influence domesticviolence practice self-efficacy: implications for socialwork fran danis abstract: this article discusses the results of an exploratory study to identify facilitating factors and barriers for practice self-efficacy with battered women. based on self-efficacy theory, personal factors such as professional experience, academic preparation, personal experience, and continuing education training were explored with a random sample of licensed and degreed professional social workers. professional experience (ß=.61; t=9.54, p=.000) and academic preparation (ß=.26; t=4.29, p=.000) were the strongest predictors of self-efficacy. these findings suggest that to advance the capacity of social workers to respond to domestic violence, social work education, practitioners, and researchers have a number of important steps available to take. keywords: domestic violence, self-efficacy, social work practice, domestic abuse surviving an abusive relationship can be a complicated process that has an impact on all facets of a person’s life, including relationships with children, family, friends, neighbors, and employers. it may mean getting help from unfamiliar and complicated systems such as criminal and civil courts, law enforcement, legal services, social services, hospitals, employment, and housing services. the most difficult part of surviving may be finding someone with the knowledge and skills to effectively help negotiate the myriad of decisions needed to bemade, emotions to sort through, and options to consider. although we know that thousands of women are faced with this potentially lethal, complicated, and emotionally overwhelming problem every day, what we do not know is the capacity of professional social workers to assist battered women when they reach out for assistance. this article presents the results of an exploratory study to identify facilitating factors and barriers for competent service provision to battered women. based on self-efficacy theory (bandura, 1986; 1997), personal factors such as professional experience, academic preparation, continuing education, and personal experience were explored. the implications for social work education, practice, and research are addressed. 150 advances in socialwork fran danis is assistant professor at the school of social work, university of missouri, columbia, mo 65211. copyright© 2004 advances in socialworkvol. 5 no. 1 (fall 2004) 150-161. indiana university school of socialwork. 151danis/factors that influence domestic violence practice self-efficacy socialwork responsetodomesticviolence domestic violence is a multifaceted problem that is defined as a pattern of coercive behaviors that involve physical abuse or the threat of physical abuse andmay include repeated psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, or economic coercion. domestic violence refers to violence perpetrated by adults or adolescents against their intimate partners in current or former dating,married, or cohabitating relationships of heterosexuals, gay men, lesbians, bisexuals, or transgendered people. domestic violence is one type of “family violence,” a term that refers to all types of violence that occurs within a family, including violence towards adult partners, children, siblings, parents, and elders (salber & taliaferro, 1995). domestic violence is also one type of “violence against women,” a broad term that includes sexual assault, stalking, female genital mutilation, sexual harassment, and violence within intimate relationships. the terms domestic violence, domestic abuse, spouse abuse, woman abuse, and wife battering are often used interchangeably. since the late 1970s, women who have been victims of abuse by their male intimate partners have been referred to as “battered women” (walker, 1979). in the vast majority of cases, domestic violence is committed by a man against his female partner. the national violence against women survey (tjaden & thoennes, 1998) estimates 5.9 million incidents of physical assaults against women annually, with approximately 76% of those incidents perpetrated by current or former husbands, cohabiting partners, or dates. fourteen to 50% of all women will experience domestic violence by a male partner at least once in their lifetime (straus, gelles & steinmetz, 1980). nearly one in three of all female homicide victims were killed by their husbands, former husbands, or boyfriends. in contrast, just over 3% of male homicide victims are killed by their wives, former wives, or girlfriends (bachman & saltzman, 1995). two studies conducted by the centers for disease control (cdc) found that more than one-third of american adults have witnessed a man beating a female spouse or partner and 50% of all emergency room visits by injured women were the result of a partner’s abuse (rand, 1997). the links between domestic violence and the use of public assistance (raphael & tolman, 1997), co-occurrence with child abuse (edleson, 1999), substance abuse (bennett, 1995), and prevalence among populations of homeless women (browne & bassuk, 1997) have been established. these prevalence studies establish domestic violence as a crosscutting issue with a high probability that professional social workers will encounter persons experiencing domestic violence in their caseloads.what is unknown is how social workers respond to survivors and victims of abuse. previous research looking at the beliefs and practices of service providers confirmed that many held stereotypical views about domestic abuse and battered women viewed abuse within the context of the interaction between family members, thereby, blaming the victim and placed primary importance on keeping the family together for the sake of the children. through interviews, surveys, and reviews of case records, researchers found that social workers viewed violence as 151 their client’s masochistic tendencies (ball, 1977), blamed the victim (dobash & dobash, 1979; davis & carlson, 1981), failed to recognize abuse as a problem (bowker, 1983; hansen, harway & cervantes, 1991; pagelow, 1981; eisikovits & buchbinder, 1996), and failed to make appropriate interventions and referrals (bass & rice, 1979; davis, 1984; ross & glisson, 1991). what could account for this history of bias and blame?what factors determine social work response to domestic violence? davis and carlson (1981) surveyed frontline workers in organizations likely to provide services to battered women in a three county moderate-sized metropolitan area. as compared to other service providers, family service workers tended to adopt victim-blaming attitudes. in a follow-up analysis, davis (1984) looked at the factors that different groups of service providers believe impede an abused wife and her abusing husband from preventing subsequent acts of violence as well as service providers’ recommendations for actions each party should take. among davis’ findings were that professional experience, personal experience, and training were all positively correlated with each other, leading davis to conclude that knowledge increases exposure and vice versa. those with high levels of training were far more likely to have had high levels of professional experience. training also led respondents to identify lack of services as a barrier to the wife’s seeking change. davis and carlson (1986) next looked at public school personnel, including school social workers. findings from this study confirmed that the more professional and personal experience with domestic violence, the more knowledge of the subject. tilden, schmidt, limandri, chiodo, garland and loveless (1994) also found that the level of professional experience with domestic violence makes a difference in how social workers respond to battered women. although these findings date back to the 1970s, there are few published studies that address social work response to domestic violence in recent years. these dated studies also had a number of other limitations. they all used convenience samples of persons employed in social service agencies andmade an assumption that persons employed by those agencies were professionals with an educational degree in social work. earlier studies also failed to identify a theoretical framework that connects the various independent factors with the desired outcomes or dependent variables. for example: what is themechanism that links the factors of education or past personal experience with domestic violence and translates them into the ability to respond to cases of domestic violence? domesticviolence practice self-efficacy this study used self-efficacy theory to develop the linkage between personal factors influencing the capacity and response of social workers to domestic violence. self-efficacy “is the extent to which people believe they are capable of exercising influence and control over the events that effect their lives” (bandura, 1994, p. 421). it is not just the skills that people have, but their judgment of what they can do with whatever skills they possess (bandura, 1986). self-efficacy theory has been applied extensively to the training and development of helping professionals including social workers, psychologists, nurses, 152 advances in socialwork and physicians.within social work, the theory has been applied and tested within the context of hospital social work practice (holden, cuzzi, spitzer, rutter, rosenburg & chernack, 1996), teaching research skills to social work students (holden, barker, meenaghan & rosenberg, 1999), and teaching generalist social work skills (holden, meenaghan & metrey, 2002). self-efficacy has been found to predict subsequent behavioral outcomes (holden, 1991; abusabha & achterberg, 1997), thus creating the link between perceived self-efficacy and the behavioral response. self-efficacy is context specific. for example, someone who works in child welfaremay have high self-efficacy for working with children but low self-efficacy for assisting in end of life decisionmaking for an elderly individual. therefore, a global measure of self-efficacy cannot be applied to specific contexts. as this study is the first to apply self-efficacy theory in this specific domain, it was necessary to create the concept of domestic violence practice self-efficacy. domestic violence practice self-efficacy was defined as the extent to which social workers believe they are capable of assisting battered women. the research question guiding this study was what are the personal factors that facilitate or act as barriers to domestic violence practice self-efficacy? based on prior literature, it was hypothesized that each of these factors: social work education, continuing education, professional experience, and personal experience would be positively associated with self-efficacy in this domain. higher levels of each variable would result in higher levels of self-efficacy. methodology a written survey was developed and pilot tested for content validity on 10 social work practitioners employed by a community-based domestic violence agency and work directly with battered women. staff at a national organization that provides training and consultation on domestic violence also reviewed the survey. it was mailed to a random sample of 1,000 licensed social workers licensed by a large southwestern state’s board of social work examiners. the spss random sampling function was used to draw a pure random sample. resources limited follow-up to the survey to one reminder postcard and no financial or material incentives were available to help boost return rates. the instrument used the definition of domestic violence outlined previously. the instrument contained a five point likert–like scale (1 = not at all to 5 = a great deal) with questions relating to personal factors such as to what extent respondents had professional experience working with battered women and to what extent have you or members of your family been personally affected by domestic violence. in addition to asking for the highest social work degree completed, respondents were asked three questions that focused on social work education. these questions served as a substitute measure for knowledge of domestic violence and addressed the extent of specific coursework on domestic violence identification, assessment, and intervention; whether field placement experiences prepared them for working with batteredwomen; and the overall extent that their formal social work education (both classroom and field) prepared them for workingwith batteredwomen.tomeasure the impact of continuing education on self153danis/factors that influence domestic violence practice self-efficacy efficacy, respondents were asked, “how many hours of continuing education or in-service training on domestic violence have you received in the past two years?” forced choice response categories include: 1) none, 2) 3 hours or less, 3) 4 to 8 hours, 4) 9 to 16 hours, and 5) 17 or more hours. these response groupings were chosen as they represent the length of standard conference sessions or continuing education workshops. the survey measured domestic violence practice self-efficacy through an 11item scale that has a reliability coefficient of .95.the scale contained questions on comfort and perceived capability level in identifying and discussing domestic violence with clients, assessing the level of danger the client is facing, and helping clients with safety planning and other interventions. the mean of the self-efficacy scale was used to create a “self-efficacy mean” for each respondent. missing values for individual self-efficacy items were replaced with the aggregate mean for that item. as only eight values out of a possible total 1,606 were missing, the method was considered appropriate (mertler &vannatta, 2002). the overall self-efficacy score was used for multiple regression analysis. for multiple regression analysis, the three education items regarding coursework, fieldwork, and overall social work education preparation (field and course work combined) were blended to form a new variable, “academic preparation.” each of the three items comprising this new variable was highly correlated with one another. together they created a multi-item scale with a chronbach’s alpha of .78. the creation of this new variable reduced the overall number of personal factors from six to four items, thus creating a more parsimonious model. all variables were entered at the same time to allow the investigator to assess the relative contribution of each item to the total model. findings the surveys were returned from all areas of the state. the proportion of returns from each region of the state was approximately the same proportion as the total sample. out of 987 deliverable surveys, 172 were returned. however, 26 returns were excluded from analysis due to lack of a social work degree and/or incomplete answers, leaving 146 usable surveys. despite a 15% return rate, the sample size of 146, setting alpha at .05 and using the r-squared effect size of .60, set statistical power for this analysis at more than .95. all respondents (n=146) had at least one degree in social work and were licensed as social workers in their state. the majority of respondents were european american (69%, n=101), women (84.6%, n=121) holding msw degrees (79.5%, n=116). respondents had a range of less than one year of experience to 52 years of experience since graduation with their highest social work degree. nearly three-quarters of respondents (73.3%, n=107) indicated that they worked in a direct practice role, with a majority of respondents (60.3%, n=88) providing services to adults. respondents worked in diverse fields of practice including agency-based adult mental health (17.2%, n=25), private clinical practice (10.3% n=15), child and adolescent services (17.1%, n=25), child welfare (11.6%, n=17), medical social 154 advances in socialwork work and services to persons with disabilities (19.1%, n=28), general adult services (9.7%, n=14), family services (8.9%, n=13), and domestic and sexual violence programs (3.4%, n=5). self-efficacy: respondents had an aggregate self-efficacy mean of 3.59 (sd=.87) for all items combined. table 1 (self-efficacy means & standard deviations in descending order) displays each of the 11 items. professional experience: respondents’ professional experience varied, with 92% having contact with battered women in their professional role and only 12 respondents reporting no experience working with battered women. social workers in all practice settings had professional experience with battered women. personal experience:themajority of respondents 56.5% (n=82) reported having personal experience with domestic violence, ranging from a little to a great deal. less than half of the respondents 42.5% (n=62) were not personally affected by domestic violence. academic preparation:more than half of all respondents (56%, n=81) recounted little to no social work coursework specifically addressing domestic violence identification, assessment, and intervention. only 25% of all respondents felt that their field placement experiences moderately prepared them to deal with workingwith batteredwomen.with regard to their overall social work education,more than half (56%) reported little to no preparation in working with battered women. 155danis/factors that influence domestic violence practice self-efficacy item mean sd comfort in discussing domestic violence 4.21 .86 capability for identifying domestic violence victims 3.85 .84 ability to identify domestic violence as an 3.82 .93 underlying cause of client problems have necessary skills to discuss domestic violence 3.82 .99 with clients ability to work with clients who are survivors of 3.79 1.04 past domestic violence capable of helping battered women develop 3.61 1.17 safety plans ability to work with clients who are currently 3.60 1.09 being abused capable of assessing the level of danger that a 3.34 1.13 a battered woman is currently facing capable of assisting clients in same sex relationships 3.19 1.19 capable of conducting culturally sensitive 3.17 1.08 assessments of battered women capable of discussing legal options available to 3.03 1.19 battered women table 1: self-efficacy means & standard deviations in descending order continuing education: more than half of all respondents (56%) had none to three hours or less of training on this topic, with 30% (n=44) receiving no training and 26% (n=37) receiving three hours or less. table 2 presents the means, standard deviations, and correlations among all of the variables. table 3 (multiple regression analysis of personal factors on domestic violence practice self-efficacy) shows the contributions of each individual personal factor. together, personal factors accounted for nearly 59% of the variance (r squared =.59). of the four personal factors, only professional experience and academic preparation significantly contributed to the model, with professional experience accounting for nearly 61% of the total variance explained. academic preparation accounted for nearly 26% of the total variance explained. neither domestic violence training nor personal experiences are significant contributors, with personal experience showing a slightly negative but non-significant relationship. 156 advances in socialwork variable 1 2 3 4 5 1.dv practice self-efficacy 2.professional .73** experience 3.academic .52** .41** preparation 4.personal .19* .25** .15 experience 5.continuing .36** .41** .28** .23** education mean 3.59 3.12 2.39 2.22 2.43 standard .87 3.12 .91 1.38 1.30 deviation note: n=146, *p<.05, **p<.01, f1(16.10,4) = 50.27, p<.000 table 2: means, standard deviations, and correlations among measured variables independent variable b se b beta professional experience .44 .041 .61* personal experience -8.23 .036 -.01 academic preparation .24 .057 .26* continuing education 3.13 .046 .05 r sq. = .59, adjusted rsq. = .58, *p<.05 table 3: multiple regression analysis of personal factors on domestic violence practice self-efficacy discussion this study identified the personal factors that act as facilitators or barriers experienced by social work practitioners to domestic violence practice self-efficacy. findings confirm that professional experience is a facilitating factor, and a lack of professional experience is a significant barrier to self-efficacy in this domain. as the strongest determinant of self-efficacy is performance ormastery experiences, the mean of this sample (m=3.59) reflects the findings that nearly 92% of respondents had professional contact with battered women. high contact with battered women is consistent with previous studies that found that social workers were the most likely professional group to be contacted (hamilton & coates, 1993) and that battered women have multiple service needs, requiring interaction with as many as 10 different societal institutions (peled & edleson, 1994). these findings are also consistent with other self-efficacy studies that show positive relationships between self-efficacy and professional experience (holden, et al., 1999; holden, et al., 1996). these findings are also consistent with previous studies linking professional experience with social work response (davis & carlson, 1986; tilden, et al., 1994). since the personal experience of being battered or watching a member of your family battered is not the same type of performance, mastery, or vicarious learning experiences that serve as strong determinants of self-efficacy, this study fails to determine whether personal experience is a facilitating factor or a barrier to domestic violence practice self-efficacy. academic preparation is also a facilitating factor to self-efficacy, and a lack of social work education is a barrier to self-efficacy. despite the relative importance of academic preparation to self-efficacy, 55% of all respondents identified little or no coursework specifically addressing domestic violence, 66% had little or no field experience, and 56% had little or no overall social work education preparation. as a substitute measure for knowledge, these findings are also consistent with davis and carlson (1996). specific continuing education training in domestic violence can also be considered a facilitating factor, but the lack of training may not necessarily be a barrier to self-efficacy. although higher levels of continuing education were associated with higher levels of domestic violence social work self-efficacy, when controlling for all other factors, training was not significantly associated and only accounted for 5% of the variance explained. a contributing factor to this findingmay be that most respondents (56%) had none or three hours or less of specific domestic violence training in the past two years. it may be possible that respondents had training previous to this time frame. additionally, nothing is known about the extent of the training, its content, or how the training was delivered. this study was exploratory in nature and used a non-experimental survey design based on self-reports from licensed social workers. as such, it holds all of the limitations of non-experimental research (kerlinger, 1986). mailed surveys, in particular, are hampered by the inability to check responses given, lack of depth of information generated, and inability to generalize from response rates commonly as low as less than 40% of the total sample (fowler, 1993). certainly that 157danis/factors that influence domestic violence practice self-efficacy was true of this survey; although responses were geographically representative of the state surveyed, a 15% return rate limits generalizability only to survey respondents. it may also be argued that the survey appealed to social workers with experience with domestic violence. implications for socialwork education, practice, and research there are a number of implications for social work education, practice, and research that result from these findings. academic preparation does make a difference and hasmore impact on self-efficacy than continuing education and, yet, there is a disconnect between what is taught or not taught in schools of social work and social workers’ ubiquitous professional contact with battered women. a recent editorial in the journal of socialwork education challenges social work education to develop a comprehensive agenda to “ensure that we prepare competent and effective professionals with beginning knowledge, skills, and attitudes to address domestic abuse in a safe, culturally competent manner” (danis & lockhart, 2003, p. 220). the infusion of domestic violence content into foundation courses should be a primary goal of this agenda. to maximize self-efficacy, the content should be accompanied by opportunities for experiential exercises, particularly in universal screening, risk assessment, and intervention, including safety planning. domestic violence self-efficacy can be tested before and after specific courses to test the effectiveness of course content and assignments in raising self-efficacy of social work students. schools of social work can also increase opportunities for students to practice domestic violence related skills in child welfare, hospital emergency rooms, child and family counseling services, school, and substance abuse field settings. the findings related to personal experience call for a number of considerations. many social workers may have been exposed to parental violence as a child, involved in past or current abusive relationships themselves, or have been affected by domestic violence vicariously through friends, neighbors, and familymembers. supervisors need to offer opportunities for staff to discuss their own personal exposure. this discussion may lead to consciousness-raising among staff about the nature of domestic violence and help to reduce the self-blame that many battered women feel (levy, 1995). employee assistance programs also have a responsibility to develop their capacity to respond to employees. social work educators must also pay attention to the personal experiences of social work students. research into social workers’ personal experience of domestic violence is fundamentally important. studies can be undertaken to learn more about the nature, intensity, severity, and duration (length of time, when it occurred) of social workers’ personal exposure to domestic violence. an important issue to undercover is resolution of the violence (if any) and the role the social worker assigned to herself in escaping the violence.will social workers who felt they were empowered to escape violence have higher levels of domestic violence practice self-efficacy compared to social workers who felt they did not have an active, effective role in escaping the violence? the impact of secondary victimization or compassion fatigue (figley, 1995) on social workers who have been battered by intimate partners is an additional research area. are social workers who have 158 advances in socialwork already been personally affected by domestic violencemore or less susceptible to secondary victimization in their practice with battered women? despite the relatively weak contribution of training to overall self-efficacy, training is the modality or intervention most often used to enhance the capacity of providers to respond to specific problems, new situations, and new technologies. training is considered so important that many licensed social workers must demonstrate that they have received a minimal level of additional training in order to renew their professional licenses each year. in the state of florida, social workers must receive one hour of domestic violence training to renew their licenses. are there differences between domestic violence practice self-efficacy between social workers who are required to receive additional training in domestic violence and social workers in states that do not have such a requirement? and what difference does this training make to their clients? finally, given the study’s limitations with regards to generalizability, this research should be replicated with an emphasis on increasing response rates and expanding the sample to include amore nationally representative sample of professional social workers. conclusion over the past 20 years, social workers have begun to improve their knowledge of domestic violence and their ability to respond appropriately to survivors of domestic abuse. social workers have overall positive perceptions of the extent to which they are capable of addressing domestic violence. personal factors such as professional experience, academic preparation, and continuing education training can facilitate domestic violence practice self-efficacy. barriers to self-efficacy include a lack of professional experience and inadequate academic preparation. the findings from this study do not confirm whether personal experience is a facilitating factor or a barrier. implications for social work education, practice, and research recommended by this study’s findings include more emphasis on preparing future social workers for the realities of their practice experiences by increasing specific course content and field experiences for students. the high percentage of social workers who have been personally affected by domestic violence suggests that social work educators and supervisors need to be sensitive to the needs of these workers and students. it is hoped that this study provides a baseline for future research regarding social work response to domestic violence and domestic violence practice self-efficacy. references abusabha, r., & achterberg, c. (1997). review of self-efficacy and locus of control for nutrition and health related behavior. journal of the american dietetic association, 97(10), 1122-1132. ball, m. (1977). issues of violence in family casework. social casework, 58(1), 3-12. bandura, a. (1986). the explanatory and predictive scope of self-efficacy theory. journal of social and clinical psychology, 4(3), 359-373. 159danis/factors that influence domestic violence practice self-efficacy bandura, a. (1994). self-efficacy. in h.s. friedman (ed.), encyclopedia of mental health (vol. 3, pp. 421432). san diego: academy press. bandura, a. (1997). self-efficacy: the exercise of control. usa:w.h. freeman and company. bass, d., & rice, j. (1979). agency responses to the abused wife. social casework, 60, 338-342. bennett, l.w. (1995). substance abuse and the domestic assault of women. socialwork 40(6), 760-772. bowker, l.h. (1983). beating wife beating. lexington: lexington books. browne, a., & bassuk, s. (1997). intimate violence in the lives of homeless and poor housed women: prevalence and patterns in an ethnically diverse sample. american journal of orthopsychiatry, 67, 261277. danis, f.s., & lockhart, l. (2003). domestic violence and social work education: what do we know, what do we need to know? journal of socialwork education, 39(2), 215-224. davis, l.v. (1984). beliefs of service providers about abused women and abusing men. socialwork, 29(3), 243-250. davis, l.v., & carlson, b.e. (1981). attitudes of service providers toward domestic violence. social work research and abstracts, 26(4), 34-39. davis, l.v., & carlson, b.e. (1986). school personnel’s awareness of spouse abuse among parents. social work in education, 8(3), 175-186. dobash, r.e., &dobash, r. (1979).violence against wives: a case against the patriarchy. newyork:the free press. edleson, j.l. (1999). the overlap between child maltreatment and woman battering. violence against women, 5(2), 134-154. eisikovits, z., &buchbinder, e. (1996). pathways to disenchantment: batteredwomen’s views of their social workers. journal of interpersonalviolence, 11(3), 425-440. figley, c.r. (1995).compassion fatigue: secondary traumatic stress disorders from treating the traumatized. newyork: brunner/mazel. fowler, f.j. (1993). survey research methods (2nd edition ed.). newbury park: sage publications, inc. hamilton, b., &coates, j. (1993). perceived helpfulness and use of professional services by abusedwomen. journal of familyviolence, 8(4), 313-324. hansen, m., harway, m., & cervantes, n. (1991). therapists’ perception of severity in cases of family violence. violence andvictims, 6(3), 225-235. holden, g. (1991). the relationship of self-efficacy appraisals to subsequent health related outcomes: a meta analysis. socialwork in health care, 16(1), 53-93. holden, g., barker, k., meenaghan, t., & rosenberg, g. (1999). research self-efficacy: a new possibility for educational outcomes assessment. journal of socialwork education, 35(3), 463-476. holden, g., cuzzi, l., spitzer,w., rutter, d., rosenburg, g., & chernack, p. (1996). the hospital social work self-efficacy scale: initial development. research on socialwork practice, 6(3), 353-365. holden, g., meenaghan, t.j.a., &metrey, g. (2002). outcomes of social work education: the case for social work self-efficacy. journal of socialwork education, 38(1), 115-133. kerlinger, f.n. (1986). foundations of behavioral research. (3rd ed.). orlando: holt, rinehart andwinston, inc. levy, b. (1995). violence against women. in n.v.d. bergh (ed.), feminist practice in the 21st century. washington, d.c.: nasw press. maddux, j.e. (1995). self-efficacy, adaptation,and adjustment: theory, research, and application. newyork: plenum press. mertler, c., & vannatta, r.a. (2002). advanced and multivariate statistical methods, 2nd edition. los angeles: pyrczak publishing. pagelow, m.d. (1981). woman-battering: victims and their experiences. beverly hills: sage publications, inc. 160 advances in socialwork 161 peled, e., & edleson, j.l. (1994). advocacy for battered women: a national survey. journal of family violence, 9(3), 285-296. rand, m.r. (1997). violence-related injuries treated in hospital emergency departments.washington, d.c.: u.s. department of justice. raphael, j., & tolman, r.m. (1997). trapped by poverty, trapped by abuse: new evidence documenting the relationship between domestic violence andwelfare. chicago: project for research onwelfare,work, and domestic violence, taylor institute and university of michigan research development center on poverty, risk, and mental health. ross, m., & glisson, c. (1991). bias in social work intervention with battered women. journal of social service research, 14(3-4), 79-105. tilden, v.p., schmidt, t.a., limandri, b.j., chiodo, g.t., garland, m.j., & loveless, p.a. (1994). factors that influence clinicians’ assessment and management of family violence. american journal of public health, 84(4), 628-634. tjaden, p., & thoennes, n. (1998). prevalence, incidence, and consequences of violence against women: findings from the national violence against women survey. washington, d.c.: national institute for justice and centers for disease control and prevention. author’s note: address correspondence to: fran danis, ph.d., school of social work, 720 clark hall, university of missouri, columbia, missouri 65211, usa. . e-mail: danisf@missouri.edu danis/factors that influence domestic violence practice self-efficacy advances vol. 3, no. 1 60 service learning as a transition into foundation field nancy p. kropf mininder tracey abstract: service learning is a pedagogicalmethod to bridge classroomand community experiences for students. although social work education has historically emphasized this connection through internship experiences, service learning can fill a different function within the curriculum. this article proposes a service learning experience to assist graduate students with the transition into their foundation field placement. beneficial outcomes of using service learning as an educational bridge are discussed for students, faculty, and the social work program. keywords: service learning, social work education, curriculum, field practicum, community service during the last 10 years, colleges and universities have become more involved in providing students with opportunities for community service. service learning is a type of community service that is designed to promote student education and development, along with promoting community goals (gray, ondaatje & zakaras, 1999). in the 15 years since its initiation into educational institutions, faculty across disciplines (e.g., humanities, business, social and natural sciences) have started to include service learning projects in their courses as a way to bridge academic and experiential learning. this article proposes service learning as a way to assist graduate students with the transition into foundation internships. the use of community experience is certainly not a new phenomenon in social work education, as the curriculum at both the baccalaureate and graduate levels involves extensive practicum experience. in fact, jane addams is credited with being one of the early proponents of “promoting learning by community service” which is the underlying premise of service learning (morton & troppe, 1996). yet, service learning is largely absent in social work, as faculty seem to mistakenly perceive that internships and service learning serve the same purpose in the curriculum. service learning can fill a different function and can be structured to complement a field program by preparing students for their initial social work practicum. service learning serves to bridge practice and academic experiences by having students “learn while doing” in real community settings and functions as a transition into the foundation internship. nancy p. kropf, ph.d. is professor anddoctoral programdirector, andmininder k.tracey,m.s.w., l.c.s.w. is director of concentration field, school of socialwork, university of georgia, athens, ga 30602. copyright© 2002 advances in socialworkvol. 3 no. 1 (spring 2002) 60-71. indiana university school of socialwork. 61 overviewof service learning history and development in the mid-1980s, faculty and administrators were increasingly concerned about the lack of civic mindedness within higher education. in 1985, presidents from brown, georgetown, stanford universities, and the educational commission of the united states signed the college compact to promote community service for students and provide national leadership in bringing together universities with their communities. the college compact was based on the principle that students would willingly become involved and support their communities if they were given the opportunity (kraft, 1996). by the mid-1990s, almost 1000 colleges and universities participated in some form of campus—community service partnerships (cohen & kinsey, 1994). statistics suggest that service learning has become an integral part of many schooland campus-based curricula. current estimates indicate that about two million students participate in service-learning projects at four-year public and private institutions (shumer & cook, 1999). in addition, many students enter college having experienced service learning in their secondary education. currently, the number of high school students involved in service learning is almost three million, with an additional 2.5 million middle school students involved in community projects. a boost for service learning was achieved in 1993 with the establishment of the national and community trust act of 1993, which established 20,000 positions through the americorps national service and the national learn and serve america programs (brandell & hinck, 1997). since the time that the college compact was signed, the number of students involved in service learning has grown 3663% (shumer & cook, 1999)! definitions although service learning was started to promote civic responsibility, it moves beyond the concept of volunteerism. as mccarthy and tucker (1999) state, “service learning is not volunteerism; it delivers on the learning objectives of the course (for which the student has contracted) via community service activity just as an exam or paper does” (p. 555). likewise, service learning is not identical to an internship experience. furco (1996) offers a useful typology of different kinds of experiential education based upon two dimensions: intended beneficiary of the service activity, and degree of emphasis on service or learning. • volunteerism engages students in activities where the primary emphasis is on service provided, and the intended beneficiary is clearly the service recipient. examples are a friendly visiting program to a nursing home or being an activity leader in a recreational center for teenagers. • community service involves students in activities that primarily focus on service provided, with some defined benefit for the student. an example is having students provide ameal to the homeless population during the holidays. as a result of this activity, students receive some benefit by learning more about how this project makes a difference in the lives of homeless individuals. kropf, tracey/service learning 62 advances in socialwork • internships require that students become engaged in activities primarily to obtain hands-on experiences to enhance learning or skill development. in social work, the internship typically involves a close relationship with an agency supervisor, structured objectives, and assignments. • service learning equally focuses on benefits for the service provider (the student) and the service recipient. process and outcome are equally important in service learning projects. while this typology is useful in discriminating among different instructional experiences, it does not yield a clear and precise definition of service learning. multiple definitions exist. they stress various components of the service and learning dimensions. some authors describe service learning in educational terms such as “structured learning” (burns, 1998) or as involving reflection to further the understanding of course content and the discipline (bringle & hatcher, 1996; mccarthy & tucker, 1999). other definitions stress the connection to the community such as being a method to “participate in organized service activities to meet community needs” (brandell &hinck, 1997) or the opportunity to“engage students in real life experiences” (morton & troppe, 1996). the most widely accepted definition, however, appears to be based upon thenational andcommunity service act of 1990. this conception includes these four dimensions of service learning: • students learn and develop through participation in organized experiences that meet actual community needs and are coordinated in collaboration with school and community; • the program is integrated into the academic curriculum and provides structured time to think, discuss, or write about their experiences; • students are provided with opportunities to use their newly acquired skills and knowledge in real-life situations in their own communities; and • experiences enhance what is taught by extending learning beyond the classroom into the community, which fosters development of a sense of caring. service learningoutcomes impacts of service learning have been identified for students, faculty, and communities. students appear to develop both personally and professionally from involvement in service learning experiences. service learning is also beneficial to faculty, who tend to become more involved in relevant community issues and learn along with their students. in addition, communities are enhanced by increased numbers of individuals involved in programs, and also benefit from resources associated with college and university settings. several studies on student outcomes in higher education have identified positive psychological, cognitive, and social results from service learning. students in service learning courses have an increased sense of self-esteem (conrad & hedin, 1982; hedin, 1989), and a sense of empowerment in promoting social change (boss, 1994; giles & eyler, 1994; miller, 1994). in addition, cognitive gains such as enhanced creative problem solving have also been reported (batchelder & root, 63 1994;markus, howard&king, 1993), enhanced ability to apply concepts to real life issues (mcclusky-fawcett & green, 1992), and increased motivation to learn (berson & younkin, 1997). gains were also reported in students’ ability to empathize with individuals who are experiencing social problems (forte, 1997; nnakwe, 1999). these outcomes are beneficial for students in any discipline, but are specifically related to program outcomes in social work education. although faculty often benefit from service learning experiences, they may initially be reluctant to engage in service learningdue to their perception that students will not be committed to projects or will fail to carry out assigned tasks (mccarthy & tucker, 1999). however, the opposite appears to be the norm. in a study carried out by the rand corporation, students in higher education were surveyed about their experiences with service learning. those enrolled in service learning courses reportedmore satisfaction by rating their classes as above averagemore frequently (72%compared to 47%) than their cohortswhowere in courses that did not include service learning assignments (gray, et al., 1999). faculty report that their service learning students are eager to learn and demonstratemore defined skills in analysis and application of content (hesser, 1995). communities also benefit from partnerships with academic programs. since service learning is equally focused on education and the provision of community service (furco, 1996), programs receiveadditionalpersonnel andsupport. in1997, for example, approximately 1,650 hours of servicewere, on average, generated for each service learning project (gray, et al., 1999). in another evaluation of impact, 300 service learningprojectswere initiated from17 sites that providedmore than 150,000 hours of service (center for human resources, 1999). the added resources allow communities to pilot innovative or novel approaches without over extending or sacrificing resources. in addition, service learning ventures provide an impetus for expanding collaborations between the academic and service communities. possible outcomes of service learning partnerships include generation of grant proposals, stimulationofadditional internshipsites for students,and jointlyauthoredpublications. service learning as atransition into foundation internships in spite of the positive outcomes associated with service learning, there has been little attempt to integrate this instructional method into the social work curriculum. a notable exception is a service learning project for social work students with the homeless population (forte, 1997). as a result of their experience on this project, students gained valuable insight into the lives of homeless persons and developed skills in civic responsibility and empathy building. based upon similar outcomes reported from other disciplines, service learning can serve an important function in social work education. service learning as an educational bridge although social work education already includes community service activities through internships and volunteer requirements, service learning can serve as a transition into foundation field placements. because of the focus and structure of service learning, this experience can help graduate students prepare for their first social work internship experience. used in this way as an “educational bridge,” service learning can be beneficial to faculty, students, and the program. kropf, tracey/service learning in certain respects, graduate students are much less prepared to enter their initial social work practicum than baccalaureate students. bsws have frequently taken a variety of social work courses prior to an internship and have worked with a social work advisor to construct a program of study.when undergraduates enter their field placement, they have some initiation into the professional social work role. conversely, graduate students often come to the social work program with a variety of backgrounds and baccalaureate degrees. their understanding of the professional issues, roles, and dilemmasmay be at an elementary level. part of the focus in the initial semester is to helpmodify the identity that wasmolded in their undergraduate major (e.g., psychology, sociology, humanities) into that of a professional social worker. service learning provides such students an opportunity to view some of the issues that face practitioners and communities, and to become involved in promoting positive changes. the initial experience as a “change agent” is a positive entry into the beginning identity as a social worker. after completing the service learning experience, graduate students may enter their foundation internships with a more realistic and holistic sense of social work practice. since students do not always have a comprehensive understanding of professional practice, service learning can acquaint them with different client populations and service contexts. for example, gerontology is an under-represented field of practice in social work. while about 60% of all nasw members recognize the need for gerontological knowledge (damron-rodriguez & lubben, 1997; peterson & wendt, 1990), most practicing social workers have not received education or training in this field of practice (klein, 1996). in fact, only about 10% of all social work students take a gerontology course (damron-rodriguez & lubben, 1997). students’ reluctance to take content on aging in coursework and internships may be related to a lack of exposure to older adults, ageism, and feelings about the undesirability of working with this client population. service learning experiences provide students an opportunity to become more familiar with older adults and break through the associated myths. in an analysis of service learning in a longterm care facility, for example, 90% of the students reported that the experience was useful in their education. in addition, significant positive changes were found in their attitudes toward older adults from preto post-experience (hegeman, 1999). this is just a one example of how service learning can expose students to new situations to generate excitement and enthusiasm. as a result of positive experiences in service learning projects, students may be motivated to select internships in areas they had not previously considered. service learning also can be enriching for social work faculty and the entire curriculum. since faculty collaborate with agency personnel to construct learningpractice experiences for students, they become cognizant of priority issues in their communities.theseopportunities allow faculty to engage in real practice challenges that add depth to the entire curriculum. as the result of their involvement in service learning projects, faculty can bring knowledge and experience to the other courses that they teach. some of these partnerships can translate into expanded collaborations with community partners on grants, publications, and other research. while a service learning experience may be pivotal for some students, others may struggle with their beginning practice experiences. an additional benefit of 64 advances in socialwork using service learning as a bridging experience in the curriculum is the opportunity to evaluate student readiness for fieldwork prior to placement. social work education has been admonished for failing to assess whether students are prepared for internships (deweaver&kropf, 1995;gibbs, 1994; isaac, johnson, lockhart&white, 1993; koerin&miller, 1995). service learning provides a gatekeeping juncture early in theprogramandallows faculty to evaluatewhether students possess thenecessary skills and knowledge to move into the foundation practicum. more importantly, this experience allows students the opportunity to evaluate their own goodnessof-fit with the profession early in the curriculum. students who have difficulty at this point are identified early enough to make a decision regarding their academic careerprior tospendingconsiderable time,effort, andresources inagraduateprogram. integrating service learning into foundation courses during the first semester of graduate study, many programs delay entrance into the foundation practicum. some programs have students begin field placement midway through the first semester, and others have students start in the second semester. in either of these situations, a service learning experience can be incorporated into courses prior to the practicum. in this way, service learning functions as a transition into themore structured and individualized experience of the foundation internship. service learning activities vary greatly and can be incorporated into any foundation course. with the passage of the educational policy and accreditation standards (epas) in july 2001, foundation content covers eight major areas within the curriculum: values and ethics, diversity, populations-at-risk and social and economic justice, human behavior in the social environment, social welfare policy and services, social work practice, research, and field education (council on social work education, 2001). the following section provides examples of how service learning can be incorporated into various core courses, and demonstrates ways that projects can augment content. in addition, methods that instructors can use to help students learn from and with each other will be highlighted. practice content. in practice courses, students begin to master fundamental social work skills. they learn about ways to build relationships with clients, construct service plans, interview, and evaluate their practice. in some programs, students are also initially exposed to practice with various client systems, including individuals, families, groups, organizations, and communities. in addition, content on ethical issues, professional use of self, and working with diverse clients is typically included in this course. service learning activities can help students begin to employ their skill repertoire within various community contexts. as students begin to put these skills into action, the complexity of practice becomes more real, which provides opportunities to discuss how “reading about” practice differs from implementation. in addition, students have the opportunity to strugglewith situationswhere the ideal outcome is not always achieved. in these instances, instructors can help the students identify alternate ways of progressing to accomplish their tasks. one way of integrating service learning into a practice course is to have groups of students work in different agencies with various client populations. in non65kropf, tracey/service learning profit agencies, student support is welcomed as a way tomaximize personnel and provide programs that go beyond what the agency could offer with its own resources. the course instructor could construct an assignment to run a program for participants in two different community settings. one group of students could be assigned to a homeless shelter, for example, leading a job readiness program. this assignment would involve serving as an educator to teach residents various employment skills, such as filling out applications and interviewing. other skills include linkage to community resources including potential employers and ged courses. a second group of students would be placed at a different site in the community, such anhiv/aids service agency. at this site, a programmay involve providing community education about hiv/aids. this type of activity allows students to serve as educators on a macro practice level and focuses on prevention activities. assignments that focus on service learning experiences such as these can highlight several aspects of social work practice. students can compare and contrast practice with client populations and different service contexts. in addition, students can begin to experience the complexity of social work practice as they become aware that some people are both homeless and hiv-positive. using two different levels of practice (working directly with individuals and community education) provides examples of the ecological perspective. as they discuss and reflect on these issues, students become aware of the need to be flexible and innovative in their work with clients. in addition, they develop an appreciation for how the agency context impacts the various roles that social workers hold in different settings. students also begin to struggle with personal values and biases such as racism, classism, ageism, or homophobia in themselves, classmates, or service providers. these personal values and biases can then be processed in classroom discussions. as students enter their initial practicum, they have an awareness of the dynamic and challenging context of social work practice. humanbehavior in the social environment. in thehbse content, students learn theoretical perspectives that provide a comprehension for understanding and assessing human functioning. similar to the practice sequence, the course provides a theory base from individual to community levels. in addition, this content has a dynamic perspective that looks at the phases of development for the various levels of client systems (e.g., lifespan, group dynamics, family development, organizational change). service learning canprovide studentswith an opportunity to understandhuman functioning at different points in the life course. students also can work with similar services in different types of communities to gain insight into the macro-level variables that impact human behavior, for example, working with geographic communities (e.g., urban, suburban, rural) or non-place communities (e.g., ethnic or racial communities, gay and lesbian communities). these experiences allow students to evaluate micro-level factors, such as developmental issues and life stages, as well asmacro issues of discrimination and oppression on human behavior and functioning. one example of a service learning activity for thehbse sequence is for groups of students to work in settings that contrast issues across the lifespan. some students 66 advances in socialwork maybe involvedwith children at a day care center, while another groupworkswith older adults at an adult day care center. in both of these settings, students have the opportunity to assess individual functioning, group dynamics, and family issues. through their interactions at either day care setting, students can evaluate various developmental tasks at different points in the life course. as the children are becomingmore individuated, for example, the older adults are adapting to a period of decreasing independence. family dynamics also serve as a rich source of comparison as both sets may struggle with juggling multiple demands of caregiving, such as being in the labor force and filling other roles (e.g., marriage, other family relationships, leisure pursuits). service learning assignments provide a way to have students apply human behavior theory to actual situations. assignments can stress the relationship between social work assessment and intervention, as human behavior content provides the foundation for client assessment. in addition, students also can reflect on particular biases in different theories. if, for example, an eriksonian perspective is used to conceptualize human developmental processes, the experience with different types of individuals can highlight groups that are marginalized or omitted in this perspective (kropf & greene, 1994). in day care settings, a contrast between the issues facing children and older adults can highlight how late life is undifferentiated in erikson’s psychosocial theory, which leads to a conclusion that all older people face similar issues. this critique can be extended to analyze issues of race, ethnicity, gender, sexual orientation, and disability status in humanbehavior theory. as students move into their internships, they have a more complete understanding of the relationship between assessment and practice. in addition, theywill have also started the process of critical thinking about theories and application to various client populations. social welfare policy. in the policy sequence, students gain an historical perspective of social policy. policy is examined at local, state, and federal levels, aswell as learning more about policymaking in each of these arenas. students learn dimensions of social welfare policy and analyze implications for various individuals, such as women, racial and ethnic groups, older adults, gay men, and lesbian women. in addition, policies related to different service contexts, such as health care, aging, mental health, and incomemaintenance, are also considered. through the use of service learning activities, students can become aware of the link between policy and functioning of individuals, families, and communities. students may also become aware of how various groups are marginalized or unrepresented in policy decisions and resource allocation. as a result, students learn ways to mobilize and empower these groups as a step to creating more just and equitable programs and legislation. during an election period, a service learning assignment can involve students in voter participation campaigns. through the project, students can become involved in community efforts to register new voters, provide education and information about relevant issues to community constituencies, and assistwithmethods to increase voter turn-out (e.g., requests for absentee ballots, transportation to polls). as a result of their experiences, students become involved in the various aspects that are part of the democratic process. 67kropf, tracey/service learning 68 advances in socialwork in the policy sequence, service learning projects can help students recognize how legislative processes and actions impact individuals, families, and communities. assignments that relate to the service learning project can help students to focus on weaknesses in the current political structure as a way to stimulate thinking about necessary reforms. in addition, comparisons between different legislative models used in local, state, and national levels involve students in critical thinking about the strengths and limitations in the different political processes. such assignments can help students become more aware of the political context involved in service provision (e.g., funding sources, accountability, constituencies). research. the foundation research course overviews the process of scientific inquiry. students learn how to identify a problem for investigation, use existing research in problem definition, and understand various research methodologies. students may also learn data analysis skills, and how to use various statistical procedures. in addition, they may be required to put all of these dimensions together in a research project. in research, service learning provides an opportunity for students to collect, analyze, and interpret data. this type of experience allows them tomaster skills in the research process, as well as struggle with real challenges and ethics, such as informed consent, non-response, and missing data. in addition, many agencies lack the resources to collect and analyze data regarding their programs and services. this type of assignment can provide a valuable, needed service to many social welfare agencies. one type of service learning project could involve working with an agency to evaluate a service that is currently provided. for example, foster care programs frequently run courses for families that are interested in providing care for children. a service learning activity could be constructed to help the agency evaluate the course and identify outcomes on foster family recruitment. groups of students would assume different responsibilities in the research project, such as performing a literature review on foster family recruitment, constructing an evaluation instrument, completing human subject reviews, collecting data, and performing the analysis. as a class, the students could make decisions regarding how to organize and construct a final report on their findings that would be sharedwith the agency. the use of service learning provides a real experience for students with the research project. students begin with a problem area, and are expected to use previous research as a beginning step in framing their study. this type of assignment links the practice community with research content and reinforces evaluation as a necessary component of practice. in addition, students face the challenges of reporting and disseminating data as they report findings from the project back to the agency. as students enter their first internship, they have a deeper understanding of the fit between practice and research content. programmatic issues the previous section provides a model for integrating a service learning project into foundation courses. particular examples are included to demonstrate actual projects that can build upon content that is included in each of the courses. assignments that relate to the service learning projects provide students with an 69 opportunity to process their successes and struggles, integrate course content with their experiential learning, and prepare them for their first social work internship. while these experiences are beneficial, they are also intensive in both preparation and implementation. for faculty, this process is time consuming, as close collaboration between the academic program and community agency is necessary. the faculty role is to work with the community site to structure service learning experiences for students. ideally, faculty should spend time in the community alongwith the students to provide support, structure, and integrate academic content at opportune moments. service learning projects are not haphazard experiences for students, and faculty need to provide the connection between the different learning settings. faculty need to think carefully and critically about ways to structure academic components with the experience that students are having in the community. in addition, faculty must be flexible and innovative as service learning projects do not always develop in the actual ways that they are conceived. programs must also consider the issue of possible competing demands on agency resources between service learning and field education experiences. as such, a service learning experience can help students master the knowledge and skills that will allow them to have a richer experience within their field setting. however, uncoordinated efforts between field and service learning components may tax agency resources and compromise the integrity of the program.therefore, field faculty should be involved in identifying those agencies that are potential sites for service learning in order to avoid negative outcomes on field education. service learning can be intensive for students.with competing demands on their time, students may believe that a service learning project is difficult to schedule along with other course assignments and responsibilities. it would not be feasible, for example, to have students involved in different service projects in each of their foundation courses. curriculum committees can take responsibility for examining which courses offer the best fit to include a service learning project in their particular program. in this way, learning is not diluted by having students spread across several projects within the same semester. while themodel that is presented examines service learning in discrete courses, an integratedmodel could also be developed. a service learning experience would be required for students in the first semester, and each foundation course would integrate the project into the course assignments. the students’ experience in the service learning project would be reflected in assignments within their practice method, hbse, social policy, and research courses. this model has exciting possibilities, but also requires a well-integrated foundation curriculum and faculty who work closely together around assignments. for these reasons, smaller programs might be better suited to implementing an integrated service learning project. in conclusion, service learning is an educational strategy that helps students “learn while doing.” unlike volunteer experiences or internships, the goals of providing a community service and integrating academic content are equally important. through service learning, social work programs can form partnership with their communities to help students learn more about relevant issues, promote civic responsibility, and leave a legacy by providing a real service to the community. kropf, tracey/service learning service learning has the potential to serve an important function in the social work curriculum. as graduate students prepare to enter their first social work internship, service learning experiences can be incorporated into foundation courses to serve as an educational bridge between academics and practice spheres. through initial “real life” involvement in service learning experiences, students learn more about the challenges of the profession, have exposure to a variety of contexts and client populations, and begin to employ their social work knowledge and skills. references batchelder, t. h., & root, s. (1994). effects of an undergraduate program to integrate academic learning and service: cognitive, prosocial cognitive, and identity outcomes. journal of adolescence, 17, 341-355. berson, j. s., & younkin,w. f. (1997). doing well by doing good: a study of the effects of a service-learning experience on student success. [on line], 1-7. available: http://fs.broward.cc.us/dtc/sa/servlearn/doingwell.html. boss, j. a. (1994). the effect of community service work on the moral development of college ethics students. journal of moral education, 23, 183-198. brandell, m., & hinck, s. (1997). service learning: connecting citizenship with the classroom. nassp bulletin, 81(591), 49-56. bringle, r. g., &hatcher, j. a. (1996). implementing service learning in higher education. journal of higher education, 67, 221-223. burns, l.t. (1998).make sure it’s service learning, not just community service.educationdigest, 64(2), 38-41. center for human resources. (1999). summary report: national evaluation of learn and serve america. waltham, ma: brandeis university. cohen, j., & kinsey, d. (1994). “doing good” and scholarship: a service-learning study. journalism educator, 48(4), 4-14. conrad, d., & hedin, d. (1982). the impact of experiential education on adolescent development. child andyouth service, 4, 57-76. council on social work education. (2001). educational policy and accreditation standards. [online]. alexandria, va: author. available: http: www.cswe.org. damron-rodriguez, j., & lubben, j. (1997). the 1995 whcoa: an agenda for social work education and training. in c. saltz (ed.), social work response to the 1995white house conference on aging: from issues to actions (pp. 65-77), newyork: haworth press. deweaver, k. l., & kropf, n.p. (1995) gatekeeping in baccalaureate social work education. council on socialwork education, san diego, ca. forte, j. a. (1997). calling students to serve the homeless: a project to promote altruism and community service. journal of socialwork education, 33, 151-166. furco, a. (1996). service learning: a balanced approach to experimental education. in b. taylor (ed.), expanding boundaries: service and learning (pp. 2-6). washington, dc: corporation for national service. gibbs, p. (1994). gatekeeping in bsw programs. arete, 19(2), 15-27. giles, d. e., & eyler, j. (1994). the impact of a college community service laboratory on students’ personal, social, and cognitive outcomes. journal of adolescence, 17, 327-339. gray,m.j., ondaatje, e. h., & zakaras, l. (1999).combining service and learning in higher education. santa monica, ca: rand corporation. hedin,d. (1989).thepowerof community service.proceedingsof theacademyofpolitical science,37, 201-213. hegeman, c. r. (1999, november). service learning in elder care. paper presented at the gerontological association of america, san francisco, ca. 70 advances in socialwork hesser, g. (1995). faculty assessment of student learning: outcomes attributed to service-learning and evidence of changes in faculty attitudes about experiential education.michigan journal of community service learning, 2, 33-42. isaac, a. r., johnson, r. n., lockhart, l. l., &white, b. (1993). gatekeeping: how effective are social work educators performing this function? council on socialwork education, nyc, ny. klein, s. (ed.) (1996). a national agenda for geriatric education: white papers. rockville, md: health resources and services administration. koerin, b., & miller, j. (1995). gatekeeping policies: terminating students for nonacademic reasons. journal of socialwork education, 31(2), 247-260. kraft, r. j. (1996). service learning: an introduction to its theory, practice, and effects. education & urban society, 28, 131-159. kropf, n.p., & greene, r.r. (1994). erikson’s eight stages of development: different lenses. in r.r. greene (ed.).human behavior theory: a diversity framework (pp. 75-91). newyork: aldine de gruyter. markus, g. b., howard, p.f.j., & king, d. c. (1993). integrating community service and classroom instruction enhances learning; results from an experiment. educational evaluation and policy analysis, 15, 410-419. mccarthy, a. m., & tucker, m l. (1999). student attitudes toward service-learning: implications for implementation. journal of management education, 23, 554-573. mccluskey-fawcett, k., & green, p. (1992). using community service to teach developmental psychology. teaching of psychology, 19, 150-152. miller, j. (1994). linking traditional and service-learning courses: outcome evaluations utilizing two pedagogically distinct models.michigan journal of community service learning, 1(1), 29-36. morton, k., & troppe, m. (1996). from the margin to the mainstream: campus compact’s project on integrating service with academic. journal of business ethics, 15, 121-132. nnakwe, j. e. (1999). implementation and impact of college community service and its effect on the social responsibility of undergraduate students. journal of family & consumer sciences, 91(2), 57-61. peterson, d. a., & wendt, p.f. (1990). employment in the field of aging: a survey of professionals in four fields. the gerontologist, 30(5), 679-685. shumer, r., & cook, c. c. (1999) status of service-learning in the united states. [on-line]. available: http://www.servicelearning.org/library/online documents/status.html. author’s note: address correspondence to: nancy p. kropf, ph.d., school of social work, tucker hall, university of georgia, athens, ga 30602 usa. e-mail: nkropf@arches.uga.edu. 71kropf, tracey/service learning advances vol. 2, no. 2 assessment of student learning in socialwork education: the indiana model barry r. cournoyer abstract: in this paper, the author discusses assessment of student learning in light of evolving accreditation standards. the author describes the indiana model—a comprehensive approach that includes: (a) a course-learning objectives (clo) classification system to organize and analyze the total array of course learning objectives addressed in a curriculum, (b) a direct assessment of student learning system to demonstrate student learning outcomes, and (c) an indirect assessment of student learning system to provide for the perspectives of consumers and other stakeholders. when integrated, the three systems may be used for curriculum analysis and development, assessment of student learning, and program evaluation—particularly in terms of student learning outcomes. the proposed integrated approach to student learning assessment addresses both university and professional accreditation standards. keywords: assessment, student learning, curriculum analysis, social work education, accreditation many schools and departments of social work struggle with issues related to curriculum analysis, program evaluation, and assessment of student learning. accreditation standards of the council on social work education (cswe) require programs to “specify the outcomemeasures andmeasurement procedures that are to be used systematically in evaluating the program, and that will enable it to determine its success in achieving the desired objectives” (commission on accreditation [coa], 1994). the recently adopted educational policy and accreditation standards (epas) suggest that academic programs become even more active in assessment and evaluation. consider accreditation standard 8: program assessment and continuous improvement : • the program has an assessment plan and procedures for evaluating the outcome of each program objective. the plan specifies the measurement procedures and methods used to evaluate the outcome of each program objective. • the program implements its plan to evaluate the outcome of each program objective and shows evidence that the analysis is used continuously to affirm and improve the educational program (cswe, 2001). 128 barry r. cournoyer, d.s.w., l.c.s.w. is professor, indiana university school of social work, indianapolis, indiana 46202-5156. copyright© 2001 advances in socialworkvol. 2 no. 2 (fall 2001) 128-151. indiana university school of socialwork. 129 national and regional university accreditation associations have also become more rigorous in their requirements for the assessment of student learning outcomes. all university regional accreditation bodies emphasize the assessment of student learning and the incorporation of quality improvement principles in educational and program evaluation. many social work programs throughout the country have begun to consider the means to assess student learning. indeed, most programs are sincerely motivated to develop and implement processes bywhich to evaluate progress toward accomplishment of their mission and goals, including those that refer to student learning, and then to use the results to improve outcomes. the issues may be captured in the question: “how do we assess students’ learning in an efficient manner that coincides with accreditation standards, helps us improve the quality of our curriculum and instruction, and enables us to document optimal student learning outcomes?” in this paper, the author addresses this question by describing: • the elements of acourse-learningobjectives (clo) classification system that facilitates organization and analysis of the total array of course learning objectives addressed throughout a social work curriculum. • a direct assessment of student learning system to document studentlearning outcomes. • an indirect assessment of student learning system to gather consumer and stakeholder generated information. • themeans bywhich thecourse-learningobjectives (clo) classification, and the direct and indirect assessment of student learning systems may be integrated to contribute to the evaluation of academic programs, assessment of outcomes, and as part of the means by which to address cswe and university accreditation standards. • the implications of the comprehensive and integrated approach for social work programs. cournoyer/assessment of student learning figure 1. illustrates the main components of the indiana model—an integrated approach to the assessment of student learning outcomes1. 130 advances in socialwork course-learningobjectives (clo) classification system: conceptualoverview all social work schools and departments have goals and objectives. whether explicit or implicit, their missions, visions, values, and goals become manifest by the words and the actions of the faculty and staff. some goals are highly abstract (e.g., statements of mission and vision) and others are quite descriptive and operational (e.g., course learning objectives). the goals of bsw, msw, or doctoral programs (i.e., program objectives) tend to fall approximately in the middle—not as abstract as a school or university mission but not as descriptive or operational as individual course learning objectives. ideally, all goals and objectives should reflect conceptual congruence and logical interrelationships. a review of a curriculum, for example, should readily reveal connections from the most abstract to the most descriptive goals and objectives, and vice-versa—from the most concrete to the most general. optimally, a reviewer should be able to link all individual course-learning objectives to at least one program objective, at least one school or departmental goal, and at least one dimension of the organizational mission. conversely, several lower level goals and objectives (sub-goals) for each highly abstract goal should be apparent. this is, of course, a daunting challenge. however, it is worth undertaking because the major indication of an organization’s success or failure centers upon the degree to which it achieves its goals and objectives. optimally, when students achieve a courselearning objective, their learning should simultaneously contribute to the achievement of one ormore program objectives and some aspect of the school or departmental mission. to support this claim, however, each course-learning objective must clearly link to and support higher-level goals and objectives. a course-learning objectives (clo) classification system represents a means by which social work programs may analyze their curriculum in light of higher-level goals. for example, suppose a school of social work offered educational programs leading to the bsw, msw, and ph.d. degrees. each program offers several classroom or practicum courses, or other educational experiences that address several learning objectives. a school that offers a full continuummight offer 50 or 60 distinct courses or seminars, each of which might have seven to 12 learning objectives. collectively, the school might have as many as 500 or 600 discrete courselearning objectives. ideally, all professors, students, and relevant stakeholders should carefully read and reflect upon themeaning and implication of each learning objective offered in all courses and seminars. a simple “eyeballing” process can be extraordinarily revealing! however, a formal classification system facilitates organization and systematic analysis. a small group of faculty and stakeholders could classify each discrete learning objective according to higher-level program objectives, school goals, and other relevant factors. computer software programs (e.g., database, spreadsheet, or some statistical packages) may facilitate the classification process and, of course, contribute to subsequent data analysis. in light of emerging accreditation standards and growing expectations for greater accountability, a programmight classify each course-learning objective in terms of the following dimensions: 131 • school or department mission-related goals • programobjectives (bsw,msw [foundation & concentration], ph.d.) • cswe content areas (epas) • cswe foundation objectives (epas) • aswb examination content domains • principles of cultural competence • levels of bloom’s taxonomy mission related goals schools and departments of social work typically create and publish formal statements of mission. a mission statement is a declaration of an organization’s raison d’être. a good mission statement answers key questions such as “what is our primary purpose?” “what is our reason for being?”what are our primary activities?” written in the present tense, themission statement describeswhat is and serves as a general guide for action and decision-making. the primary reason that most schools and departments of social work exist is to promote learning, especially by students, but also by faculty, that enables graduates to provide high quality social services. the vision statement addresses the same questions albeit in the future tense. the vision describes what the organization wants to become in the future—typically five or so years hence. some organizations also establish a set of values or principles that serve as moral and ethical guideposts for operational activities. together, the mission and vision statements lead to school or departmental goals. derived from the mission and vision statements, organizational goals are anticipated outcomes or accomplishments rather than activities or processes. although described in outcome fashion, organizational goals remain fairly general. these abstract statements and goals help clarify the major purposes and functions of the organization aswell as its direction for the future. typically, statements of mission, vision, values, and goals relate to aspects of the well-known trinity of academic life: teaching, service, and research or scholarship. in schools and departments of social work, student learning usually receives a great deal of prominence within the teaching dimension. a mission statement might include reference to an aspect of student learning such as, “we educate students for competent, ethical, and effective social work service in the 21st century.” a vision statement might refer to student learning in this manner: “we aspire to offer educational experiences that prepare students to adapt to emerging knowledge and changing circumstances through continuous processes of learning, unlearning, and learning anew.” an organizational goal might include reference to both mission and vision statements by indicating that graduating students demonstrate the abilities to: • think critically and analyze contemporary research studies for application in practice. • engage in self-assessment of their learningneeds, developpersonal learning plans, and implement those plans in an active, self-directedmanner. cournoyer/assessment of student learning 132 advances in socialwork the school or departmental goals link directly to and support the mission and vision. in social work education, university, and campus expectations, the policies and standards of cswe, professional principles and values, student and faculty aspirations, and the nature of community needs also inform the identification of organizational goals—which become a fundamental component of the course learning objectives classification system. program objectives each academic program (e.g., bsw,msw, ph.d.) develops program objectives that guide curriculum planning, development, and implementation. they link directly to one or more mission-related organizational goals. the specific standards and policies of cswe (coa, 1994; cswe, 1992, 2001) serve to guide, but not necessarily constrain, the development of bswandmswprogramobjectives. althoughnot required, some social work doctoral programs refer to cswe policies as part of the process of identifying higher-level program objectives. academic program objectives tend to be less abstract andmore descriptive than organizational goals, but not nearly as specific as course learning objectives. they, too, appear as outcomes or accomplishments rather than as activities or processes. faculty in a baccalaureate program might, for example, identify the following as a program objective: “graduates of the program are able to provide competent, ethical, effective, and ethnically-sensitive generalist social work services to a diverse range of individuals, families, groups, organizations, and communities.” cswe content areas the cswe curriculum policy statement (1992) and the standards for accreditation (1994) require social work programs to address certain content areas. the newly adopted epas2 include the following: 1. socialworkvalues and ethics 2. diversity 3. populations-at-risk and social and economic justice 4. human behavior and the social environment 5. socialwelfare policy and services 6. socialwork practice 7. research 8. field education. (cswe, 2001) although many social work educational programs organize their curriculums into sequences that address required content areas (e.g., the policy sequence, the practice sequence, the research sequence),many donot. someprograms integrate knowledge, values, and skills from several content areas within each course, seminar, practicum, or other learning experience. indeed, even within highly structured, formally sequenced curriculums, many course-learning objectives contribute to students’ learning in several cswe-required content areas. virtually all social work practice courses include information about human behavior and the social environment, and many incorporate research content and skills as well. most courses consider at-risk populations, social and economic justice, and some aspects of diversity. furthermore, knowledge about values, ethics, laws, and the skills of critical thinking and ethical decision-making are integral to courses throughout the social work curriculum. classifying course-learning objectives by cswe content area may be particularly useful as programs experimentwith innovative teaching and learning approaches. integrative orientation, field practicum, and capstone experiences frequently enable students to learn throughout many and sometimes all of the eight content areas. programs that clearly and precisely identify the curriculum location of expected learning within these domains may easily demonstrate coverage of cswe-required foundation content. cswe foundation objectives the epas (cswe, 2001) require bsw and msw social work programs to address certain foundation program objectives: the professional foundation, which is essential to the practice of any social worker, includes, but is not limited to, the following program objectives. graduates demonstrate the ability to: 1.apply critical thinking skills within the context of professional social work practice. 2.understand the value base of the profession and its ethical standards and principles, and practice accordingly. 3.practicewithout discrimination andwith respect, knowledge, and skills related to clients’ age, class, color, culture, disability, ethnicity, family structure, gender,marital status, national origin, race, religion, sex, and sexual orientation. 4.understand the forms andmechanisms of oppression and discrimination and apply strategies of advocacy and social change that advance social and economic justice. 5.understand and interpret the history of the social work profession and its contemporary structures and issues. 6.apply the knowledge and skills of generalist social work practice (or, for msw graduates, “a generalist social work perspective”) with systems of all sizes. 7.use theoretical frameworks supported by empirical evidence to understand individual development and behavior across the life span and the interactions among individuals and between individuals and families, groups, organizations, and communities. 8.analyze, formulate, and influence social policies. 9.evaluate research studies, apply research findings to practice, and evaluate their own practice interventions. 10.use communication skills differentially across client populations, colleagues, and communities. 133cournoyer/assessment of student learning 134 advances in socialwork 11.use supervision and consultation appropriate to social work practice. 12.functionwithin the structure of organizations and service delivery systems and seek necessary organizational change. (cswe, 2001) these programobjectives constitute the required foundation learning objectives for both bsw andmsw academic programs. although accredited msw programs educate students for advanced practice within an area of concentration, they also must help all studentsmaster the foundation curriculum. therefore, classification of course-learning objectives by foundation objectives is useful for both bsw and msw programs. social work doctoral programs may find them useful as a stimulus for the development ofmore advanced program and learning objectives. as do a large number of bsw and msw programs, many d.s.w. or ph.d. programs in social work develop sets of objectives, competencies, or abilities that graduating students are expected to demonstrate. these program-specific objectives complement those required by cswe and contribute to the unique identity and mission of the school or department. for purposes of clo classification, they may be added to the array of foundation (and msw concentration) objectives or considered within a separate dimension. aswb examination content domains almost all states, one territory, and one canadian province have adopted the association of socialwork boards (aswb) sponsored social work examinations for the purposes of licensing or certification. although there are many areas of common interest, the goals of academic programs vary somewhat from those of professional associations and licensing boards. these divergent functions provide healthy tension and often lead to useful conversations among the organizations. of course, schools and departments of social work should never “teach to the test.” nevertheless, some programs may decide to classify course-learning objectives according to the content domains addressed within the aswb basic or intermediate examinations in order to provide additional perspective. the publicly disseminated domains reflect the findings from large studies of current practices of professional social workers from throughout the united states (and soon fromat least oneprovince of canada aswell).the resulting content outlines, based as they are upon studies of practicing social workers, may complement the policies of cswe. the aswb basic examination is typically required of bsw graduates; the intermediate examination of msw graduates. advanced or clinical examinations are required of msw graduates with supervised post-graduate practice experience. the current aswb basic examination addresses the content domains (aswb, 2001)3 listed in table 1. principles of cultural competence in socialwork the changing demographics, composition, and globalization of society require that all social workers understand, value, and demonstrate cultural competence in their service to others. because of the extraordinary significance of multi-cultural abilities, many social work programs may decide to emphasize their importance 135 through the classification of course learning objectives according to certain dimensions of cultural competence. anderson, richardson, and leigh (leigh, 1998) identified seven principles of the culturally competent social worker. they posit that the culturally competent social worker would agree with the following statements: 1. i accept the fact that i have much to learn about others. 2. i have an appreciation of the regional and geographical factors related to people of color and contrasting cultures, how the individual may vary from the generalizations about their regional and geographical group, and how regional groups vary from the total cultural group. 135cournoyer/assessment of student learning 010 human development and behavior 011 theoretical approaches to understanding individuals, families, groups, communities, and organizations 012 human growth and development 013 human behavior in the social environment 014 impact of crises and changes 015 abnormal and addictive behaviors 016 dynamics of abuse and neglect 020 diversity 021 effects of diversity 030 assessment in social work practice 031 social history and collateral data 032 use of assessment instruments 033 problem identification 034 effects of the environment on client behavior 035 assessment of client strengths and weaknesses 036 assessment of mental and behavioral disorders 037 indicators of abuse and neglect 038 indicators of danger to self and others 040 social work practice with individuals, couples, families, groups, and communities 041 theoretical approaches and models of practice 042 the intervention process 043 components of the intervention process 044 matching intervention with client needs 045 intervention techniques 046 intervention with couples, families, and groups 047 intervention with communities 048 professional use of self 049 use of collaborative relationships in social work practice 050 interpersonal communication 051 theories and principles of communication 052 techniques of communicating 060 professional social worker/client relationship 061 relationship concepts 062 relationship practice 070 professional values and ethics 071 responsibility to the client 072 responsibility to the profession 073 confidentiality 074 self-determination 080 supervision in social work 081 educational functions of supervision 082 administrative functions of supervision 090 practice evaluation and the utilization of research 091 methods of data collection 092 research design and data analysis 100 service delivery 101 client rights and entitlements 102 implementation of organizational policies and procedures 110 social work administration 111 staffing and human resource management 112 social work program management table 1: association of social work boards (aswb) basic examination content domains 136 advances in socialwork 3. i follow the standard that knowledge is obtained from the person in the situation and add tomy learning about the situation from that person before generalizing about the group-specific person. 4. i have the capacity to form relationships with people from contrasting cultures in social, work, and professional relationships. 5. i can engage in a process characterized by mutual respect and conscious effort to reduce power disparities between myself and persons of minority status. 6. i have the ability to obtain culturally relevant information in the professional encounter. 7. i have the ability to enter into a process of mutual exploration, assessment, and treatment with people of contrasting culture and minority status in society. (leigh, 1998, pp. 173-174) these seven principles could be converted into characteristics, attitudes, or abilities and incorporated within the course learning objective classification scheme. as a supplement or substitution for anderson, richardson, and leigh’s principles, programsmay prefer to adopt the recently publishednaswstandards of cultural competence in socialwork (2001) as part of their classification system. nasw organizes their conception of cultural competence into 10 standards that could represent categories for classification: 1.ethics andvalues 2.self-awareness 3.cross-cultural knowledge 4.cross-cultural skills 5.service delivery 6.empowerment and advocacy 7.diverseworkforce 8.professional education 9.language diversity 10.cross-cultural leadership bloom’s taxonomy of cognitive educational objectives in addition to organizational,mission-related goals, academic programobjectives, cswe content areas, foundation (and concentration) objectives, alongwith program specific competencies or abilities, aswb examination content domains, and principles of cultural competence, each course-learning objectivemaybe classified according tobloom’staxonomyofcognitive educationalobjectives. several decades ago, benjamin bloom and a group of educational psychologists (bloom & krathwohl,1956)developedataxonomyofcognitive learningobjectives.thetaxonomy remains pertinent today, andmay be used formultiple purposes4. the six hierarchical levels represent a useful scheme for classification of course learning objectives within a socialwork curriculum. in ascendingorder of cognitive complexity, the six levels are: 137 level one: recollection. the ability to recall is the basic level of learning and refers simply to the ability to remember material such as facts and basic theoretical terms and concepts. level two:comprehension. the ability to comprehend refers to an understanding of the material. this is often demonstrated by providing an explanation, summary, or interpretation of the material. level three: application. the ability to apply knowledge refers to use of the material in a particular situation. in social work, for example, this ability might be demonstrated through the application of a practice skill in service to a client. or, a social worker might use a theoretical concept to better understand a particular person-and-situation dynamic. application refers to the use of rules, methods, and principles outlined in the material. level four: analysis. the ability to analyze involves the careful examination of the various elements of the material. relationships among and between components are critically considered in terms of organizational structure and internal coherence. level five: synthesis. the ability to synthesize includes pulling together elements in a new way to form an innovative structure. the creation of a new conceptual model could be a form of synthesis. level six: evaluation. the ability to evaluate involves the determination of the relative value of knowledge for a defined purpose. typically, this would include the creation, adoption or adaptation, and application of evaluative criteria. course-learningobjectives classification (clo) system: application tables 2 through 4 reveal how an individual course objective may be identified, coded, and categorized within a clo classification system as described above. table 5 reflects how the classified course objective appears as a row within a spreadsheet or database. of course, all course objectives throughout the entire curriculum require classification and entry into the system. furthermore, programs may add additional categories to meet organizational needs. table 6 illustrates a hypothetical distribution of an academic program’s course learningobjectives as classified in accordancewith bloom’s taxonomic levels.the table reveals the potential value of the clo classification for curriculum analysis and development. the example (see table 6) suggests that 82.5% of the classified course objectives address the first (recall), second (comprehension), and third (application) levels of bloom’s taxonomy. according to table 6, the curriculum reflects only modest attention to higher level cognitive abilities (analysis, synthesis, and evaluation) that aremost associated with critical thinking. if the classification system is reasonably valid and reliable, faculty may decide to add or revise selected course-learning objectives in order to strengthen students’ learning at higher levels of cognitive learning. assessment of student learning emerging professional (e.g., cswe) and regional university accreditation standards (e.g., new england association of schools and colleges, middle states cournoyer/assessment of student learning 138 advances in socialwork association of colleges and schools, north central association of colleges and schools, western association of schools and colleges, northwest association of schools and colleges, southern association of colleges and schools) require academic programs to evaluate student-learning outcomes. clearly, student-learning assessment is a major component of accreditation expectations. however, our conceptions of learning and student-learning assessment require elaboration. consider the following as working definitions: student learning is growth in knowledge, values, and skills that occurs as the result of learning activities and experiences. student-learning assessment includes the tools and processes used, and the findings obtained from intentional efforts to appraise students’ growth in course course course sect. year term status program learning title no. no. level objective fall=1 bsw=1 statement spring=2 req’d.=1 msw found=2 summer 1=3 elect.=2 msw conc=3 summer2=4 msw conc=4 msw conc=5 msw conc=6 msw conc=7 ph.d.=8 01. social 501 342 01 1 1 2 understand work the practice i fundamental values, ethics, and legal obligations of the profession table 2: course learning objectives (clo) classification system framework—part one course learning syllabus unique clo school goal program objective objective learning number statement objective 1xx=bsw number 2xx=msw 3xx=ph.d. 01. understand the 01 5013420111201 4. prepare ethical, 205. demonstrate fundamental values, effective social commitment to ethics, and legal workers that the values and obligations of the reflect personal ethics of social work. profession. and professional integrity in all aspects of their service to others. table 3: course learning objectives (clo) classification system framework—part two 139 knowledge, values, and skills that occurs as the result of learning activities and experiences. students reflect evidence of learning when, for example, they becomemore proficient in interviewing, assessment, intervention, and evaluation skills as a result of social work educational experiences. professors engage in a student-learning assessment when they examine students’ videotaped interviews and apply a welldesigned scoring rubric to evaluate students’ performance of clearly identified interviewing skills. student-learning assessment occurs at the conclusion of their classroom or practicum courses when students complete questionnaires about the extent to which they have gained the knowledge and skill necessary for competent professional service. feedback from focus groups of graduates’ employers represents a form of student-learning assessment. programs engage in studentlearning assessment when, for instance, they analyze the individual and aggregated results of a qualifying examination that all students complete at the conclusion cournoyer/assessment of student learning course cswe cswe aswb principle level of learning content foundation content of cultural bloom’s objective area objective domain competence taxonomy statement (01. 1. social 2. understand 070. 3. i follow 2. understand understand work values the value base professional the standard the the and ethics. of the values and that meaning fundamental profession and ethics. knowledge and values, ethics, its ethical is obtained relevance and legal standards and from the of obligations of principles, and person in knowledge the profession. practice the situation and accordingly. and add to information my learning (e.g., about the comprehend, situation interpret, from that explain, and person summarize). before generalizing about the groupspecific person. table 4: course learning objectives (clo) classification system framework—part three unique school program cswe cswe aswb principle level of clo goal objective content foundation content of bloom’s number area objective domain cultural taxonomy competence 5013420111201 4 205 1 2 070 3 2 table 5: course learning objectives (clo) data analysis system—spreadsheet, statistical package, or database 140 advances in socialwork of their foundation studies. student-learning assessmentmay occur during a capstone seminar, when students and faculty systematically evaluate the quality of social work portfolios submitted as a requirement for graduation. schools and departments may view assessment of student learning as a form of program evaluation, educational assessment, quantitative or qualitative research, or an aspect of continuous quality improvement or total quality management. the nature and forms of assessment are wide and surprisingly flexible. programs may focus on inputs, outputs, or outcomes andmay do so through direct and indirect forms of assessment (see table 7). input assessment tends to focus on the resources or “raw materials” of the school or program (e.g., quality of faculty, incoming students, curriculum design, or programmatic resources). output assessment usually addresses the productivity of the organization (e.g., numbers of graduating students and graduates, graduation and retention rates, number of teaching awards, amount of research). outcome assessment involves consideration of the effects of organizational activities upon those intended to benefit from them. in the context of social work education, we hope that successful students who complete the coursework and earn degrees benefit in some tangible way from those experiences (e.g., increase their knowledge and skill, secure employment, feel competent in their professional lives, and effectively serve clients). most schools and programs are familiar with the collection and analysis of inputs and outputs. programs regularly report on the average sat or gre scores of admitted students, acceptance and retention rates, the numbers of graduates, gpa averages, the amount of external funding, the faculty-to-student ratios, the number and kind of faculty publications, the amount of physical space, the number of library volumes, the amount of secretarial support, and other aspects of inputs and outputs. assessment of student learning outcomes is less common. however, it is precisely the area that accrediting bodies and other stakeholders increasingly emphasize. indeed, assessment of student learning outcomes appeals to many social work faculty who regularly teach students to evaluate clients’ progress toward goal achievement. such perspectives are highly compatible with quality improvement initiatives. direct assessment of student-learning outcomes involves examining students’ or graduates’ knowledge, attitudes, and skills (e.g., depth or breadth and expertise) through observation and evaluation, or through valid and reliable measures. indirect assessment also seeks to determine students’ or graduates’ knowledge total level 1: level 2: level 3: level 4: level 5: level 6: total number recall compreapply analyze synthesize evaluate classihend fied objective 200 80 150 100 60 5 5 400* number (20%) (37.5%) (25%) (15%) (1.2%) (1.2%) (100%) and percent table 6: hypothetical example of number and percent of a program’s course learning objectives (clo) classified by bloom’s taxonomy of cognitive learning 141 and expertise but does so through the collection of data presumed to be associated with actual understanding and performance (e.g., self-reports, faculty and field instructor evaluations of students, letter grades, focus groups or surveys of employers’ views of graduates’ performance, evidence of graduates’ practice effectiveness in service to clients). direct assessment of student learning direct assessment of learning usually involves the systematic evaluation of the performance or products of students or graduates. there are many kinds and forms of available evidence. doctoral, masters’, or senior theses; qualifying examinations; standardized tests; scores on licensing examinations; videotapes of actual or simulated interviews; results of single-subject research; and social work portfolios represent forms of evidence that may be used to assess student learning outcomes. ideally, the products and performances relate to learning goals at one or more organizational levels (e.g., school or departmental goals, program objectives, or course learning objectives). three forms of direct assessment that may be especially useful for social work programs are: 1) entry and exit essays, 2) preand post-exams, and 3) social work learning portfolios. entry and exit essays many programs require applicants to prepare an essay, perhaps in the formof an autobiographical statement, as part of the admissions process. such essaysmaybe used by screening committees to consider the readiness of the candidate for the nature and rigor of the academic program. they may also become useful for assessment purposes in that applicants complete them before beginning the program. a similar kind of essay could be expected just before graduation. comparisons between the two essays might well reveal areas of growth, knowledge, and expertise. the nature of the essay assignment and the assessment criteria used to assess them should be well constructed to match school goals and program objectives to best serve the function of student-learning assessment. for instance, rather than an autobiographical statement, applicants might be provided a case scenario to analyze. towards the end of the program, graduating students could be asked to repeat the process with an analogous case situation. preand post-instruments in addition to or insteadof entry and exit essays, preandpost-instrumentsmight also be adopted (e.g., the baccalaureate educational assessment package [beap]) or developed for use as evidence of growth and learning. the instruments would require careful analysis in order to determine validity, reliability, and relevance to cournoyer/assessment of student learning assessment direct indirect inputs outputs outcomes table 7: student learning assessment matrix the program objectives. and, assessment guidelines should match the program’s purposes, goals, and focus. socialwork portfolios portfolios are becoming increasingly popular both within social work and other disciplines as well. portfolios may be course specific or may apply to an entire program of study (e.g., bsw, msw, ph.d.). program-oriented portfolios reflect tremendous potential for assessment of student learning because they incorporate samples of students’ work throughout various stages of the educational process. as a central part of the development of program-oriented portfolios, some schools and departments encourage students to prepare learning contracts, learning goals, and learning plans at the beginning of their studies. the contracts then help students and faculty to guide the selection of courses, and the emphasis that is placed within the classroom and practicum experiences. they also serve as contexts for the assessment of the final portfolios submitted as a requirement for graduation. the portfolios include carefully selected learning products that serve as tangible evidence for the direct assessment of learning. in the aggregate, evaluation of graduating students’ portfolios would ideally reveal that most, if not all, demonstrate mastery of program objectives as well as reflect progress toward achievement of their individual learning goals (cournoyer, 2001; cournoyer & stanley, 2002). indirect assessment of student learning indirect forms of student-learning assessment also have considerable value, especially when used in conjunction with direct evidence. indirect assessment tends to yield opinions about, rather than demonstration of, knowledge, values, and skills. nonetheless, the views and experiences of consumers and stakeholders are at least as important and sometimes more important than scores on exams or grades on papers. most schools and departments of social work have faculty that are well trained to develop surveys, conduct focus groups, and collect and analyze data. these are well-established forms of indirect assessment. the famous, or infamous, end-of-semester “course evaluation” is one that might be adapted for the indirect assessment of student learning. professors’ and instructors’ performance tend to be the focus of the items presented in traditional course evaluations. however, they can be easily adapted to assess student learning. assessing student learning through course evaluations traditionally, students enrolled in schools and departments of social work have completed end-of-semester questionnaires to evaluate the general quality of courses and their instruction. although the format varies somewhat from university to university, course evaluations are widely used—both for personnel evaluation purposes (i.e., promotion, tenure, salary increments) and as a measure of student satisfaction. course evaluations may take many forms. in some programs, professors design their own instruments. in others, professors may select items from a “cafeteria” system provided by the university. some programs require that professors use a standard or “common” course evaluation, which enables the social work school or department to analyze students’ opinions of courses and professors through comparison to average scores. 142 advances in socialwork common items. programs derive many benefits from the use of standard or common items in end-of-semester evaluation instruments. students in all social work courses respond to these standard items, potentially yielding a rich data set for statistical analysis. traditionally, most common items within course evaluation questionnaires tend to elicit students’ opinions about the characteristics and behaviors of the professor and the nature of the course. items that refer to the professor’s accessibility, preparedness, fairness in grading, and ability to communicate are typical, as are items related to the utility of textbooks, examinations, and assignments. most course evaluation instruments include few, if any, items about students’ learning. table 8 contains items that are representative of those commonly used in universities throughout north america. all items in this instrument (table 8) refer to the course or the instructor. indeed, they are quite useful if faculty or administration want data for personnel or performance evaluation. the items are consistent with traditional pedagogical approaches to education where the focus is more upon the quality of teaching performance than on the nature or quality of student learning. [see barr & tagg (1995) for a comparison of the “teaching” and “learning” paradigms in higher education]. however, programs may easily convert end-of-semester course evaluation forms into an assessment of student learning instruments. instead of or in addition to asking students what they think about the professor and the course, we could inquire about their learning. items could reflect a greater emphasis upon student learning. consistent with research findings about effective teaching and learning (chickering & gamson, 1987) and trends toward active, adult learning, programs might develop end-of-semester student-learning assessment instruments that contain items such as those presented in table 9. programs could also add to these general items those that correspond to the course learning objectives for each social work classroom or practicum course or seminar offered throughout the school or department. in effect, this requires the development of individualized assessment of student learning instruments for each course or seminar. however, it provides students an opportunity to indicate the degree to which they believe they learned what they might reasonably expect to learn—based upon the learning objectives outlined in the course or seminar syllabus. table 10 illustrates how learning objectives from a social work course might appear as items within an end-of-semester course evaluation instrument. students, of course, respond to these items based on their perceptions of learning. undoubtedly, various factors (e.g., nature of the course, rigor, grading policies, and the characteristics of the instructor) affect their responses. this approach clearly represents an indirect rather than a direct measure of learning. nonetheless, when combined with direct evidence of student learning (e.g., standardized testing, student portfolios, qualifying examinations, theses, or scores on licensing exams), they represent a powerful source of assessment information from the consumers’ perspective. in a manner consistent with the principles of continuous quality improvement (cqi), students assess the degree of their own learning. 143cournoyer/assessment of student learning 144 advances in socialwork statistical analysis of aggregated responses to both common items (ci) and course-learning objective (clo) items may yield pertinent information about students’ perceptions of learning by course, sequence, academic status (i.e., junior, senior, msw-foundation, msw-concentration), and other pertinent factors. for example, table 11 reflects the common item scale (cis) scores (i.e., aggregated averages) of a hypothetical set of common items (such as those presented in tables 8 or 9) by course and year. scores may range from 1 (reflecting strong disagreement) to 5 (reflecting strong agreement). in this example, all items appear in an affirmative fashion so that higher scores consistently reflect stronger agreement. the table illustrates the kind of assessment information that various constituencies may receive. the data indicate that some courses reflect similar ratings over a four-year period, while others vary considerably. of course, the analysis of findings and the way they are, or are perceived to be, used are central to the success or failure of any assessment process. in general, readers should view “average” ratings with caution. despite the limitations, descriptive statistics serve a function as “indicators” of courses or curriculum areas that deserve closer attention. for example, in table 11, the cis scores associated with social work course #1 reveal a substantial drop in students’ evaluation of the course during the 1996 and 1997 years and a fair recovery during 1998. the cis scores associated with social work course #2 reveal a continuously declining trend from 1995 through 1998, while those connected with socialwork courses #3 and #5 reflect a more favorable, upward trend during the same period. cis scores for socialwork course #4 are consistently positive throughout the entire period. 1 sa a u d sd this course is well-described. 2 sa a u d sd this course has clearly stated goals. 3 sa a u d sd the course assignments contribute to the quality of the course. 4 sa a u d sd the course text(s) are well-chosen. 5 sa a u d sd the course contributes to my professional development. 6 sa a u d sd the instructor is knowledgeable about course content. 7 sa a u d sd the instructor is well-prepared for class. 8 sa a u d sd the instructor is organized. 9 sa a u d sd the instructor clearly explains the grading system. 10 sa a u d sd the instructor assigns grades fairly. 11 sa a u d sd the instructor is excited about the subject. 12 sa a u d sd the instructor is a good teacher. 13 sa a u d sd the instructor communicates well. 14 sa a u d sd the instructor treats students with respect. 15 sa a u d sd the instructor is accessible for consultation. 16 sa a u d sd i would recommend this course to others. 17 sa a u d sd i would recommend this instructor to others. table 8: typical items in traditional “instructor” oriented course evaluation instruments 145 course learning objective (clo) related items. because they involve the students’ (i.e., consumers’) view of their attainment of specific course objectives, ratings of clo items are especially useful for the assessment of student learning within the context of accreditation standards—if all course objectives clearly link to program objectives, organizational goals, and ultimately, the mission of the school or department. students’ aggregated clo ratings represent indirect evidence of learning for discrete items, courses, sequences, or programs. students’ responses to all clo items associated with a particular course may be averaged in the form of a course learning objectives scale (clos) score to provide general indications of the degree of overall learning in a particular course. in many social work programs, professors agree to use identical learning objectives in all sections of the same course.when this occurs, programsmay aggregate students’ responses from multiple course sections and analyze them by semester or year. the clos score reflects an average of students’ ratings of the learning objectiverelated items for each course. since each itemmay be rated on a one-to-five basis, the lowest possible clos score would be one and the highest five. table 12 reflects the clos scores (i.e., aggregated averages) of students’ responses to a hypothetical set of course-learning objective-related items (such as those presented in table 7) by course and year. scores may range from one cournoyer/assessment of student learning 1 sa a u d sd learners held high expectations for one another. 2 sa a u d sd learners spent a lot of time and energy undertaking learning experiences and assignments. 3 sa a u d sd learners interacted frequently with other learners including the professor. 4 sa a u d sd learners engaged in active learning experiences. 5 sa a u d sd learners participated in one or more cooperative learning teams. 6 sa a u d sd learners gave prompt and constructive feedback to other learners. 7 sa a u d sd learners respected diverse talents and ways of learning. 8 sa a u d sd learners assumed individual and collective responsibility for learning. 9 sa a u d sd learners cooperated and collaborated with one another. 10 sa a u d sd learners actively sought out, discovered, and constructed relevant information. 11 sa a u d sd learners applied information to understand, assess, analyze, and address real issues. 12 sa a u d sd i learned a great deal in this course. 13 sa a u d sd i became more proficient in the social work knowledge base. 14 sa a u d sd i developed critical thinking abilities. 15 sa a u d sd i learned much that will help me as a practicing professional social worker. 16 sa a u d sd i became a more competent social worker. table 9: typical items in a “student learning” oriented evaluation instrument 146 advances in socialwork (reflecting strong disagreement) to five (reflecting strong agreement). in this example, all items appear in an affirmative fashion so that higher scores consistently reflect stronger agreement. information such as that presented in table 12 provides useful insight into students’ perceptions of learning. scores in the four-to-five range (“agree” to “strongly agree”) suggest that students believe that they learned what their social work instructors hoped they would learn—based upon the course learning objectives. such a table also reflects changes across semesters as well as students’ ambivalence about the extent of their learning in certain courses. as such, program administrators and faculty may attend to certain courses or sequences within the curriculum. for example, in reviewing table 12, faculty members might well decide to investigate the factors associated with the drop in clos scores and the increase in variability as indicated by the standard deviations for the sw9 courses from the 1995 and 1996 levels to the 1997 and 1998 levels. integrating the cloclassification andassessment of student learning systems theuseof end-of-semester evaluation instruments that emphasize student learning in both general common items (ci) and course learning objective (clo) related items represent a substantial contribution to the demonstration of progress toward achievement of program goals and the epas standard that requires pro1 sa a u d sd understand the fundamental values, ethics, and legal obligations of the social work profession. 2 sa a u d sd apply social work values, ethics, and legal obligations in processes of ethical decision-making. 3 sa a u d sd understand the skills associated with each of phase of social work practice (i.e., preparing, beginning, exploring, assessing, contracting, working and evaluating, and ending). 4 sa a u d sd apply social work skills in interviews with real or simulated clients. 5 sa a u d sd apply knowledge and understanding of self in interactions with and service to others. 6 sa a u d sd apply social work knowledge and skills differentially to avoid discrimination and demonstrate respect for persons of diverse backgrounds and characteristics, and populations-at-risk. 7 sa a u d sd prepare clear and well organized professional social work case records (e.g., intake and social histories; social work assessments of person-issue-situation, including strengths as well as problems; contracts and plans, including clear specification of intervention goals; progress and evaluation notes; and closing summaries). 8 sa a u d sd assess one’s strengths, limitations, and learning needs, including evaluation of the quality and appropriateness of social work skill selection and application. table 10: clo-related items in an assessment of student learning instrument please use the enclosed five-point (strongly agree to strongly disagree) scale to rate the degree to which, as a result of the learning experiences you completed in this course, you learned to: gram assessment. they are consistent with the principles of continuous quality improvement. when direct assessment indicators are added (e.g., entry and exit essays, preand post-instruments, or program oriented student portfolios), an array of data about student learning outcomes become available. however, maximum benefit occurs when assessment processes are integrated with the course learningobjectives classification system. if each course-learning objective offered throughout a curriculum is classified according to pertinent dimensions—including school or department goals and program objectives, and if direct and indirect forms of assessment are geared toward evaluation of progress toward achievement of those goals and objectives, then programs have the capacity to analyze data according to any or all of the classified categories. for example, suppose a program classifies its course objectives according to cswe foundation program objectives. the program may then, with the aid of computer software, separate and statistically analyze students’ responses to clo items that pertain to each objective. the programmay also develop evaluation rubrics to directly assess learning products (e.g., essays, papers, examinations, portfolios) in relation to those objectives as well. for purposes of both continuous improvement and to address requirements for accreditation, the program could then describe the nature and extent of student learning for each competency, ideally over a period of several years to reveal patterns or trends. table 13 presents data from students’ ratings of course learning objective related items by competency and year. if they were actual, rather than hypothetical data, the programmight be concernedwith students’ (especially those completing end-of-semester instruments during 1998) perception of learning in regard to their ability to “apply critical thinking skills within the context of professional social work practice” (foundation programobjective #1). theymight be especially 147cournoyer/assessment of student learning 1995 1996 1997 1998 course mean sd n mean sd n mean sd n mean sd n sw6 4.68 .42 24 4.50 .86 85 4.50 .50 109 4.42 .57 111 sw7 4.46 .72 42 4.35 .78 32 4.60 .49 45 4.52 .66 49 sw8 4.67 .38 36 4.65 .44 42 4.73 .42 36 4.53 .53 43 sw9 4.41 .54 124 4.34 .70 119 3.84 1.09 107 3.78 1.12 92 table 12: course learning objective scale (clos) scores by social work course and year 1995 1996 1997 1998 course mean sd n mean sd n mean sd n mean sd n sw1 4.68 .42 24 3.88 1.15 99 3.86 .99 149 4.13 .85 125 sw2 4.56 .61 70 4.08 .80 62 3.98 .96 61 3.60 .97 55 sw3 3.65 .91 48 3.94 1.01 72 4.37 .67 67 4.68 .55 76 sw4 4.24 .88 94 4.37 .67 88 4.31 .73 96 4.45 .75 110 sw5 3.67 .99 60 3.83 1.12 100 4.50 .50 109 4.49 .66 11 table 11: common item scale (cis) scores by social work course and year concerned if direct assessment of performances or products also revealed weaknesses in critical thinking abilities among a substantial number of graduating students. similarly, there might be concern about students’ learning during 1997 in relation to the ability to “apply the knowledge and skills of generalist social work practice (or, for msw graduates, ‘a generalist social work perspective’) with systems of all sizes” (foundation program objective #6). professors might be particularly curious about what may have happened during 1995 in relation to students’ perceptions of their ability to “evaluate research studies, apply research findings to practice, and evaluate their own practice interventions” (foundation program objective #9) and their ability to “use communication skills differentially across client populations, colleagues, and communities” (foundation programobjective #10) during 1998. although far from definitive, these data help programs identify how well their students think they learn within certain areas of a curriculum. direct assessment of students’ performance and learning products may serve to substantiate or refute findings from indirect forms of assessment. similarly, information gained through indirect means may be supported, or challenged, by evidence generated by direct forms of assessment. although table 13 illustrates data that relates to one classification dimension (i.e., cswe foundation program objectives), programs may conduct similar analyses based upon other factors. analyses based upon organizational goals help support a school or department’s claim that they accomplish their mission. analyses based upon bloom’s taxonomy may indicate that students are learning how to analyze, evaluate, and synthesize professional knowledge, values, and skills. these higher order cognitive skills constitute essential aspects of critical thinking—one of the hallmarks of professionalism. implications for socialwork education social work deans, program directors, and faculty members are likely to confront numerous challenges as they implement processes for assessing student learning and educational effectiveness. faculty may anticipate dilemmas such as the following: • at a time when programs are asked to do “more with less,” programs may lack sufficient resources to support extensive assessment processes. personnel are needed to develop and administer instruments, and to collect and analyze data. higher costs may be expected during developmental phases when the program determines an assessment philosophy and decides what, how, and how much to assess. administrators may anticipate the need for release time for personnel undertaking these activities. some programs might benefit from faculty and staff development programs that address the topic andmethods of assessment and evaluation. finally, programs may need to invest in some equipment (e.g., scanners, computers) and computer software programs through which to organize and analyze data. • within some university contexts, social work educators may be successful in implementing a sound assessment process but lack authority or resources to use findings for decision-making. for example, a program director may obtain assessment data suggesting that students in professor “x’s” social policy class148 advances in socialwork es appear to learn a great deal from the course. both direct and indirect sources of evidence indicate that students achieve most of the course objectives. in professor “x’s” human behavior and the social environment (hbse) courses, however, the assessment data suggest that students tend to achieve few of the course objectives. although it might seem reasonable to assign professor “x” to teachmore social policy courses and fewer, if any, hbse courses, a directormay not possess the authority or have sufficient faculty resources to reassign professors based upon evidence of student learning. • individuals or committees that implement assessment programs face questions related to the validity, reliability, and relevance of assessment processes and outcomes. assessment approaches that rely primarily or exclusively upon student (i.e., consumer) feedbackmay be strongly challenged—especially if the results are usedmore to evaluate personnel performance than to assess student learning and program quality. at a time when social work students are being confronted with multiple roles (e.g., parent, full-time worker, caregiver of older parents), demanding learning environments may influence the way courses, instructors, and the overall quality of the program are perceived. nonetheless, when both direct and indirect assessment processes are used and the findings converge, serious challenges to the accuracy and utility of the information are less likely. • social work educators should anticipate how various stakeholders might interpret and use assessment findings—especially during the early phases. for instance, some university administrators may be quite uncomfortable with assessment results because they sometimes highlight significant issues and lead to difficult decisions. some officials may find it easier, safer, or more comfortable to deny, minimize, or ignore findings that call for decisive, unpopular, or costly action. 149cournoyer/assessment of student learning 1995 1996 1997 1998 objecmean sd n mean sd n mean sd n mean sd n tive 1 4.04 .55 83 4.01 .68 96 3.99 .57 109 3.73 .86 65 2 4.41 .65 122 4.29 .75 145 4.36 .56 140 4.34 .53 108 3 4.22 .67 115 3.96 .84 126 4.29 .59 160 4.16 .71 112 4 4.20 .60 108 4.27 .56 132 4.28 .57 179 4.29 .65 177 5 4.39 .64 139 4.37 .70 176 4.09 .74 102 4.07 .62 68 6 4.28 .62 94 3.96 1.03 169 3.71 1.00 199 4.36 .79 80 7 4.34 .57 104 4.33 .63 134 4.44 .57 131 4.15 .91 131 8 4.23 .63 97 4.36 .69 97 4.01 .98 131 4.65 .46 104 9 3.07 1.01 105 4.27 .76 113 4.18 .76 119 4.21 .77 103 10 4.19 .68 75 4.56 .45 120 4.27 .47 105 3.63 1.65 90 11 4.75 .32 34 4.67 .47 52 4.61 .48 44 4.51 .94 38 12 4.18 .71 112 4.26 .79 120 4.42 .69 106 4.29 .66 98 table 13: aggregated average clo ratings by cswe foundation program objective • within many academic contexts, programs “compete” with one another for resources (e.g., funding from the university, “faculty lines,” or even students). at times, negative assessment findings place a programat a disadvantage vis-à-vis other programs that engage in little, if any, assessment or evaluation activities. directors and faculty members should consider how, for example, higher administration might respond to a program that implements a strong assessment system that yields negative findings about student learning. in some contexts, programs may be recognized and credited for conducting assessment, and providing encouragement and resources to make improvements based upon the findings. in other circumstances, unfavorable results may be used to punish the program that conducted the assessment activities. during the early phases of implementation, such punitive responses send a clear message that genuine assessment is unsafe and probably unwanted. during the next decade or two, social work programs will face many challenges. certainly, demands for greater accountability will continue to increase. various stakeholders will expect answers to questions such as the following: do your students learn what you say you teach? does your faculty genuinely help students learn? does your curriculum truly meet cswe and university accreditation standards? are your learning expectations and experiences progressively more intellectually, academically, and professionally challenging? in other words, do you expect more of seniors than you do of juniors, and more of juniors than you do of sophomores? do you require more of msw students than you do of undergraduates, and more of msw concentration students than msw foundation students? social work educators will also be asked to produce evidence of their program’s effectiveness in pursuing its mission and accomplishing its goals. in attempting to provide such evidence, they may be challenged from various sources. higher administration, students, parents, and some organizations (e.g., legislatures and social service agencies) may demand more and better indications of program quality and effectiveness. some faculty colleagues may also question the purposes, validity, reliability, and relevance of the assessment processes—particularly if the results are used primarily for personnel evaluation decisions (e.g., for promotion and tenure decisions) rather than for enhancing faculty development or improving program quality and educational effectiveness. we suggest that the indianamodel—which incorporates both direct and indirect processes, and integrates course learning objectives classification and assessment of student learning systems—represents a strategy by which to address some of these questions.we fully recognize that data obtained exclusively from direct or from indirect forms of assessment have finite value. as important as the consumer voicemight be, and as appealing as a valid and reliable standardized examinationmight be, feedback from one source alone is simply insufficient. indeed, we strongly recommend the use of multiple indicators of both an indirect and direct nature in order that findings may be subject to multidimensional consideration. 150 advances in socialwork endnotes 1 this approach to student learning assessment originated at indiana university school of social work. other schools and programs of social work have begun to refer to “the indiana model” to capture the general thrust of this form of assessment. 2 the educational policy and accreditation standards (epas) (2001) of the council on social work education reorganized the content areas by combining (a) populations-at-risk and (b) social and economic justice. these domains were separate in the 1992 cps and 1994 standards. 3 note: the items have been renumbered to facilitate classification. 4 bloom’staxonomy is used by the association of socialwork boards (aswb) to organize test items on the standardized social work licensing examinations. references association of socialwork boards. (2001).basic examination:content domains. association of socialwork boards. [on-line]. retrieved august 21, 2001, from theworldwideweb: www.aswb.org. barr, r. b., & tagg, j. (1995). from teaching to learning: a new paradigm for undergraduate education. change, 27(6), 13-25. bloom, b. s., & krathwohl, d. r. (1956). taxonomy of educational objectives: the classification of educational goals, by a committee of college and university examiners. handbook i: cognitive domain. new york: longmans, green. chickering, a.w., & gamson, z. f. (1987). seven principles for good practice in undergraduate education. aahe bulletin, 39(7), 3-7. commission on accreditation. (1994). handbook of accreditation standards and procedures. alexandria, va: commission on accreditation of the council on socialwork education. council on socialwork education (1992). curriculum policy statement. alexandria, va. author. council on socialwork education. (2001). educational policy and accreditation standards (epas). council on social work education. [on-line]. retrieved august 21, 2001, from the world wide web: http://www.cswe.org. cournoyer, b. r. (2001, november 2). the social work portfolio. paper presented at the annual meeting of baccalaureate program directors, denver, colorado. cournoyer, b. r., & stanley, m. j. (2002). the social work portfolio: planning, assessing, and documenting lifelong learning in a dynamic profession. pacific grove, ca: brooks/cole. leigh, j.w. (1998). communicating for cultural competence.needhamheights, ma: allyn and bacon. national association of social workers. (2001). nasw standards of cultural competence in social work. washington, d.c.: author. author’s note: address correspondence to: barry r. cournoyer,d.s.w., indianauniversity school of socialwork, 902west newyork street, indianapolis, in 46202-5156 usa, bcourno@iupui.edu. 151cournoyer/assessment of student learning running head: lgbtq issues & social work education addressing sexual minority issues in social work education: a curriculum framework lindsay gezinski abstract: this paper will explore a curriculum framework that explicitly addresses the reduction of heterosexism as a means to produce students that are culturally competent to practice with the lesbian, gay, bisexual, transgender, and queer (lgbtq) community. van den bergh and crisp (2004) place great importance on addressing beliefs/attitudes, knowledge, and skills when broaching culturally competent practice with the lgbtq population. beliefs/attitudes, knowledge, and skills in an educational approach will be advocated in this paper. specifically, the creation of a constructivist environment will be endorsed as a means for students to critically assess their own beliefs/attitudes, knowledge, and skills. a curriculum framework that utilizes classroom activities related to heterosexual privilege, policy, and practice role plays will be discussed. this curriculum framework is intended to prepare social work students to work with lgbtq clients. keywords: lgbtq, social work, curriculum, constructivism, heterosexism introduction the sexual identities of lesbian, gay, bisexual, transgender, and queer (lgbtq) represent a risk factor within the context of social work practice (van den bergh & crisp, 2004). however, lgbtq issues are not sufficiently included in social work education (mackelprang, ray & hernandez-peck, 1996). therefore, this paper will develop a culturally competent curriculum framework to prepare social work students to work with lgbtq clients. emphasis will be placed on the acquisition of critical thinking skills in a constructivist learning environment. literature review cultural competence is the end result of a process requiring one’s attempt to recognize and understand another’s culture (van den bergh & crisp, 2004). the council on social work education (cswe)’s accreditation guidelines for schools of social work address diversity in the learning environment, as well as diversity in practice. accreditation standard 3.1.1 states that the social work program “describes the specific and continuous efforts it makes to provide a learning environment in which respect for all persons and understanding of diversity and difference are practiced” (council on social work education [cswe], 2008, p. 11). further, the program and curriculum are expected to understand and respect diversity. the national association of social workers (nasw) (2001) standards for cultural competence in social work practice emphasize the importance of self-awareness of _____________ lindsay gezinski is a ph.d. student at the ohio state university, college of social work. copyright © 2009 advances in social work vol. 10 no. 1 (spring 2009), 103-113 gezinski/lgbtq issues & social work education 104 one’s values and beliefs, as well as knowledge and skills of cultures that are different from one’s own. the aforementioned guidelines and standards serve as a framework for the evaluation of social work programs to determine if curriculum is inclusive of lgbtq issues. the likelihood is high that social work students will interact with lgbtq clients at some point during the course of their careers (mackelprang et al., 1996); however, colleges of social work often fail to incorporate lgbtq material in programs of study (hylton, 2005). this lack of inclusion may be a result of the fact that sexual orientation is consistently ranked as being less important than race, ethnicity, and gender (mackelprang et al., 1996). the inclusion of lgbtq issues in curriculum is necessary due to rates of homophobia among social work practitioners and students. while berkman and zinberg (1997) found that 10.7 percent of social workers holding a msw are low-grade homophobic, wisniewski and toomey (1987) found that one-third of social workers are homophobic. msw students were found to be more tolerant than existing social work practitioners (newman, dannenfelser & benishek, 2002), which may indicate that the field is becoming increasingly tolerant and accepting of sexual minorities. while several of the previously mentioned studies indicate relatively low homophobia in the field of social work, one must also consider the construct of heterosexism. morrow (1996) defines heterosexism “as the promotion and valuing of heterosexuality over nonheterosexuality. heterosexism systematically privileges those who have a heterosexual identity while simultaneously oppressing those who have a gay, lesbian, or bisexual identity” (p. 2). raiz and saltburg (2007) found that 21.3 percent of bssw students were non-accepting of lesbians and gay men, while 40.0 percent of bssw students were found to be tolerant with conditions. the ‘tolerant with conditions’ subgroup was found to conceive this population in a heterosexist manner. thus, many participants held heterosexuality as the norm. this paper will explore a curriculum framework that explicitly addresses the reduction of heterosexism as a means to produce students that are culturally competent of the lgbtq community. van den bergh and crisp (2004) place great importance on addressing beliefs/attitudes, knowledge, and skills when broaching culturally competent practice with the lgbtq population. beliefs/attitudes, knowledge, and skills in an educational approach will be advocated in this paper. specifically, the creation of a constructivist environment will be endorsed as a means for students to critically assess their own beliefs/attitudes, knowledge, and skills. curriculum framework a holistic approach that examines the macro/micro, theoretical/practical is necessary in the inclusion of lgbtq material in social work curriculum. although schools of social work may offer courses with a focus on lgbtq issues, the infusion of lgbtq material into all social work coursework is necessary. this relies on the belief that lgbtq oppression cannot be viewed separate from other oppressions (e.g., race/ethnicity, sex, physical ability, class, etc.) due to the intersectionality of individuals. intersectionality realizes the social stratification of people, meaning that the combination advances in social work, spring 2009, 10(1) 105 of one’s race/ethnicity, sex, physical ability, class, sexual orientation, and gender identity intersect resulting in unique experiences (collins, 2000). for example, in contrast to white gay men, black lesbians are forced to contend with heterosexism and racism and sexism. the endorsement of within group differences is extremely important when discussing lgbtq material with students. however, the creation of binaries is potentially dangerous resulting in an object/subject dichotomy (mcphail, 2004). the creation of a constructivist environment that fosters and nurtures students’ critical thinking skills may contribute to the rejection of such binaries that create sexual minorities as “other”. setting the stage—creating a constructivist space for critical thinking the effectiveness of engaging with students in a dialogue about sexuality and gender identity will rest on the environment of the larger community, college, and classroom. prior to the first day of class, the instructor may choose to assess the context of the larger community and the college. questions may include the following:  is the college or school located in a rural or urban area? rural areas have been found to contribute to higher sexual prejudice towards homosexuals (herek, 2002; wills & crawford, 2000).  does religion figure prominently in the community and in the college? identification as protestant or catholic is associated with negative anticipated professional behavior with lesbian clients (cramer, 1997).  what is the racial breakdown of the community and school? some studies have shown that blacks hold more negative attitudes towards homosexuality than whites (lewis, 2003), while others indicate that whites hold more negative attitudes (levitt & klassen, 1974).  do the community and college favor conservative or liberal ideology? conservatism has been found to be associated with greater homophobia when compared to liberalism (snively, krueger, stretch, watt & chadha, 2004). answers to these questions may offer important information related to teaching approaches. for example, students attending schools of social work in rural areas that are highly conservative and religious may be resistant to lgbtq material. thus, a great amount of attention may be placed on attitudes/beliefs prior to addressing knowledge and skills. in contrast, social work students in urban areas that are highly liberal may be more receptive to such material. therefore, emphasis may be placed on knowledge acquisition and skills rather than attitudes/beliefs. it is important to consider whether or not students are bred inside or outside of the community surrounding the college. the aforementioned assessment may be more pertinent for students bred in the surrounding community. however, some students may originate from communities quite different than the one surrounding the college. gezinski/lgbtq issues & social work education 106 the creation of a constructivist classroom that acts as a safe space is of utmost importance to student learning. brooks and brooks (1993) describe a constructivist classroom in contrast to a traditional classroom (p. 17) as follows: traditional classroom curriculum is presented part to whole, with emphasis on basic skills. strict adherence to fixed curriculum is highly valued. students are viewed as ‘‘blank slates’’ onto which information is ‘‘etched’’ by the teacher. teachers generally behave in a didactic manner, disseminating information to students. teachers seek the correct answer to validate student learning. assessment of student learning is viewed as separate from teaching and occurs almost entirely through testing. constructivist classroom curriculum is presented whole to part with emphasis on big concepts. pursuit of student questions is highly valued. students are viewed as thinkers with emerging theories about the world. teachers generally behave in an interactive manner, mediating the environment for students. teachers seek the students’ point of view in order to understand students’ present conceptions for use in subsequent lessons. assessment of student learning is interwoven with teaching and occurs through teacher observations of students at work and through personalized assignments. piaget is often considered to be the founder of constructivism. he held that reality is not concrete. instead, individual realities are constantly changing as a result of time and new experiences (piaget, 1970). a constructivist environment is the result of teamwork and support on the part of the instructor and students in an effort to analyze one’s own beliefs and the beliefs of others (nichols-casebolt, figueira-mcdonough & netting, 2000). discourse is constructive when students are active participants in their own learning and the learning of others. the instructor may facilitate this type of environment through denying ideas as factual and concrete and rather as fluid and open to interpretation. additionally, it is the instructor’s responsibility to act as a model for challenging her/his own beliefs and those of the students. through modeling the instructor, students may feel greater comfort in challenging beliefs and attitudes. this type of environment is conducive to the endorsement of critical thinking. critical thinking relies on the notion that knowledge is socially constructed and requires students to be reflexive considering strengths, weaknesses, and underlying notions of arguments (gibbons & gray, 2004). a guiding question for conversation may be “how do we know what we know?” this simple question relates to the social-historical construction of knowing and may act as a catalyst for deep analysis of the origins of beliefs/attitudes regarding power dynamics on multiple levels. advances in social work, spring 2009, 10(1) 107 this constructivist environment of critical thinking is likely to be most effective in a classroom that acts as a safe space. a safe space is defined as “a classroom climate that allows students to feel secure enough to take risks, honestly express their views, and share and explore their knowledge, attitudes, and behaviors” (holley & steiner, 2005, p. 50). the space is safe when students know that they will not face criticisms as a result of sharing their ideas (boostrom, 1998). rather than prohibit conflict amongst students, it should be the responsibility of the instructor to manage conflict (osborne, 1997). holley and steiner (2005) found that the creation of a safe space results in students’ increased learning and self-examination of beliefs. this safe space results in free expression, which may result in the discomfort of some students. the instructor may choose to devise a policy that balances this freedom of expression with a stance of non-discrimination. while the aforementioned strategies for inclusion of material are relatively abstract, tangible strategies are also available. for instance, the random assignment of students to small groups for the length of the course may allow students to become acquainted with others that are unlike themselves resulting in relationship-building and a sense of community offering opportunities for empowerment (dore, 1997). students that openly identify as lgbtq may positively impact group members. research indicates that homophobic attitudes are reduced when an individual has contact with a gay man or lesbian (berkman & zinberg, 1997). this process of creating a constructive atmosphere conducive to free thought sets the stage for challenging beliefs/attitudes. challenging beliefs/attitudes—the power dynamics of institutionalized heterosexism the discussion of power differentials and the “mythical norm” (lorde, 1984) may serve as a backdrop for continued conversations of oppression, such as institutionalized heterosexism. lorde (1984) describes the “mythical norm” and states, “in america, this norm is usually defined as white, thin, male, young, heterosexual, christian, and financially secure. it is with this mythical norm that the trappings of power reside within society” (p. 116). thus, this “mythical norm” serves to define those that do not fall into these categories as the “other.” students could be asked to reflect on this notion of the “mythical norm” and discuss its implications. for instance, students could describe their own “otherness” and how this “otherness” fosters various forms of oppression, including institutionalized heterosexism. students could be requested to describe the ways in which social welfare policy perpetuates institutionalized heterosexism. for example, the underlying notion of heteronormativity found in temporary assistance for needy families (tanf) could be analyzed (fineman, mink & smith, 2003). students could be requested to describe the ways in which this promotion of marriage and two-parent families relies on the presumption of heterosexuality. further, discussion could reflect on the ways this presumed heterosexuality results in the invisibility of the lgbtq population. a discussion of heterosexual privilege would nicely complement this discussion of institutionalized oppression. mcintosh (1990) describes the privileges associated with being white, which include the following: gezinski/lgbtq issues & social work education 108 “if i should need to move, i can be pretty sure of renting or purchasing housing in an area that i can afford and in which i would want to live.” “i can go shopping alone most of the time, pretty well assured that i will not be followed or harassed.” students could be assigned mcintosh’s (1990) article and requested to identify heterosexual privileges. the lgbt resource center at university of missouri-columbia (2008) exemplifies heterosexual privileges with the following statements: “if you are heterosexual (or, in some cases, simply perceived as heterosexual), you can go wherever you want and know that you will not be harassed, beaten, or killed because of your sexuality (16 people were known to be murdered in 2000 because of being perceived as gay, 29 were killed in 1999, and 26 in 1998).” “if you are heterosexual (or, in some cases, simply perceived as heterosexual), you can raise, adopt, and teach children without people believing that you will molest them or force them in to your sexuality. moreover, people generally will not try to take away your children because of your sexuality.” a discussion of institutionalized heterosexism could be followed by a self-assessment of students’ own homophobia and heterosexism. the use of a preand post-test may represent a useful tool for students to gauge their own levels of homophobia and heterosexism. the following represent reliable instruments for this task: attitudes toward lesbians and gay men scale (herek, 1988) and index of attitudes towards homophobia (wisniewski & toomey, 1987). following the students’ initial self-assessment, the instructor could facilitate a discussion requesting students to reflect on their understanding and perceptions of homophobia and heterosexism. students could again complete the self-assessment at the conclusion of the course. resultant discussion could revolve around changes in attitudes or lack thereof over the course of the class. building knowledge—theory and practice the acquisition of knowledge regarding lgbtq issues can be framed in theoretical and practical terms. in human behavior and the social environment (hbse) courses, theories of development can be viewed as they apply to sexual minorities (van den bergh & crisp, 2004). for instance cass’ (1984) model of gay and lesbian identity formation could be examined in combination with erikson’s (1950; 1959) stages of psychosocial development. identity confusion, identity comparison, identity tolerance, identity acceptance, identity pride, and identity synthesis are associated with gay and lesbian identity formation (cass, 1984). additionally, theories may be examined as to how they affect sexual minority populations in contrast to other populations. regarding practice, knowledge is needed around appropriate terminology, coming out, familial relationships, and so on (morrow, 1996). further, students should become acquainted with community resources and social service networks that specifically address the lgbtq population, as well as effective methods for advocacy work (mackelprang et al., 1996; van den bergh & crisp, 2004). videos, guest speakers, and advances in social work, spring 2009, 10(1) 109 journal articles represent various methods for knowledge acquisition regarding minority populations (colvin-burque, zugazaga & davis-maye, 2007). various journal articles may be helpful in incorporating lgbtq issues in mental health, health, aging, youth, families, and so on. (see berger, 1984; gomez & smith, 1990; laird, 1994; levy, 1995; marsiglia, 1998; parks, 2001). teaching skills for practice vignettes and role-plays represent mediums in which to practice clinical skills (cramer, 1997; van den bergh & crisp, 2004). the following represent potential roleplays for classroom activity. role play 1. you are a school social worker in a rural area. charlotte, once a straight ‘a’ student, has experienced a sharp decline in grades and class participation. charlotte tells you that she has been thrown out of her household following “coming out” to her parents. she currently has no communication with her parents and is residing on friends’ couches. for role play 1, students could be encouraged to examine the ways in which charlotte’s sexual orientation interacts with her school and home life. issues for special consideration include: school, family, homelessness, child welfare, and so on. cass’ (1984) model of gay and lesbian identity formation could be discussed in relation to adolescent development. further, exploration of housing issues, social support networks for lgbtq youth, and community resources provide a starting point for discussing the impact of lesbian-identification on youth. role play 2. you are a hospital social worker. darrell has been hospitalized following a stroke and remains in a coma. his partner of forty years, michael, is being refused access to darrell by hospital staff because they state that he is not a relative. for role play 2, students could be asked to reflect on the implications of policy and the ways in which marriage affects gay and lesbian rights. further, students may be requested to explore effective ways for navigating the bureaucracy of the hospital system. special issues for consideration include grief and bereavement, as well as family systems. it may be important for the student to consider the quality of the relationship that exists between michael and the rest of darrell’s family. are they accepting and supportive of darrell and michael’s relationship? further, access to resources may be addressed. for instance, michael may not have access to darrell’s assets despite their lengthy cohabitation. role play 3. leslie, born joel, presents at your office due to depression and cocaine abuse. leslie states that she hopes soon to transition fully from male to female. she claims that her mental health and substance abuse issues will diminish following transition. for role play 3, students may be asked to consider leslie’s mental health and substance abuse issues. further, special consideration should be placed on leslie’s gezinski/lgbtq issues & social work education 110 transition process, including key terminology and stages of transition. the student may choose to assess leslie’s claim that her depression and cocaine abuse will cease to exist following transition. further, a discussion could ensue around community resources and social support networks for transgendered individuals. finally, a discussion could commence regarding the ways in which the diagnostic and statistical manual of mental disorders (dsm) pathologizes transgendered individuals with the classification of gender identity disorder. future research although a curricular framework has been presented here, its level of effectiveness is unknown. research is needed that examines the reliability and validity of this approach through the utilization of a quasi-experimental design. research questions may include the following:  do social work students experience a change in their attitudes/beliefs, because of increased coverage of lgbtq issues in social work curriculum? specifically, do homophobia and heterosexism decrease as a result of lgbtq-inclusive curriculum?  do social work students gain knowledge regarding the lgbtq community, because of exposure to lgbtq issues in social work curriculum? specifically, do students gain knowledge of theories of development, terminology, community resources, etc.?  do social work students gain effective skills for practice with lgbtq clients as a result of lgbtq-inclusive curriculum? specifically, are social work practitioners able to effectively interact with lgbtq clients as a result of lgbtq-inclusive curriculum? concluding remarks a culturally competent curriculum framework is necessary to prepare social work students to work with lgbtq clients. a constructive, “safe space” is essential for the development of students’ critical thinking skills. these critical thinking skills will allow students to analyze their own attitudes/beliefs regarding oppressions, including institutionalized heterosexism. through the dispersal of diverse knowledge and skills, schools of social work will likely produce culturally competent social work practitioners. references berger, r. m. (1984). realities of gay and lesbian aging. social work, 29, 57-62. berkman, c. s., & zinberg, g. (1997). homophobia and heterosexism in social workers. social work, 42(4), 319-332. boostrom, r. (1998). ‘safe spaces’: reflections on an educational metaphor. journal of curriculum studies, 30(4), 397-408. advances in social work, spring 2009, 10(1) 111 brooks, j. g., & brooks, m. g. (1993). in search of understanding: the case for constructivist classrooms. alexandria, va: association for supervision and curriculum development. cass, v. c. (1984). homosexual identity formation: testing a theoretical model. the journal of sex research, 20(2), 143-167. collins, p. h. (2000). black feminist thought (2nd ed.). new york: routledge. colvin-burque, a., zugazaga, c. b, & davis-maye, d. (2007). can cultural competence be taught? evaluating the impact of the soap model. journal of social work education, 43(2), 223-241. council on social work education. 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(1990). taking the home out of homophobia: black lesbian health. in. e. c. white (ed.), the black women's health book: speaking for ourselves (pp. 198-213). seattle, wa: the soul press. herek, g. (1988). heterosexuals’ attitudes toward lesbians and gay men: correlates and gender differences. journal of sex research, 25, 451-477. herek, g. m. (2002). heterosexuals' attitudes toward bisexual men and women in the united states. journal of sex research, 39 (4), 264-274. holley, l. c., & steiner, s. (2005). safe space: student perspectives on classroom environment. journal of social work education, 41(1), 49-64. hylton, m. e. (2005). heteronormativity and the experiences of lesbian and bisexual women as social work students. journal of social work education, 41(1), 67-82. http://www.cswe.org/nr/rdonlyres/2a81732e-1776-4175-ac42%2065974e96be66/0/2008educationalpolicyandaccreditationstandards.pdf http://www.cswe.org/nr/rdonlyres/2a81732e-1776-4175-ac42%2065974e96be66/0/2008educationalpolicyandaccreditationstandards.pdf gezinski/lgbtq issues & social work education 112 laird, j. (1994). lesbian families: a cultural perspective. smith college studies in social work, 64 (3), 263-296. levy, e. (1995). feminist social work practice with lesbian and gay clients. in n. van den bergh (ed.), feminist practice in the 21st century (chapter 15, pp. 278-294). washington, dc: nasw press. levitt, e. e., & klassen, a. d. (1974). public attitudes toward homosexuality: part of the 1970 national survey by the institute for sex research. journal of homosexuality 1(1), 29–43. lewis, g. b. (2003). black-white differences in attitudes toward homosexuality and gay rights. public opinion quarterly, 67, 59-78. lorde, a. (1984). sister outsider: essays and speeches. berkeley, ca: the crossing press. mackelprang, r. w., ray, j., & hernandez-peck, m. (1996). social work education and sexual orientation: faculty, student, and curriculum issues. journal of gay & lesbian social services, 5(4), 17-31. marsiglia, f. f. (1998). homosexuality and latinos/as: towards an integration of identities. journal of gay and lesbian social services, 8(3), 113-125. mcintosh, p. (1990). white privilege: unpacking the invisible knapsack. independent school, 49(2), 31-35. mcphail, b. a. (2004). questioning gender and sexuality binaries: what queer theorists, transgendered individuals, and sex researchers can teach social work. journal of gay & lesbian social services, 17(1), 3-21. morrow, d. f. (1996). heterosexism: hidden discrimination in social work education. journal of gay & lesbian social services, 5(4), 1-16. national association of social workers national committee on racial and ethnic diversity. (2001). nasw standards for cultural competence in the practice of social work. washington, dc: author. newman, b. s., dannenfelser, p. l., & benishek, l. (2002). assessing beginning social work and counseling students’ acceptance of lesbians and gay men. journal of social work education, 38(2), 273-288. nichols-casebolt, a., figueira-mcdonough, j., & netting, f. e. (2000). change strategies for integrating women’s knowledge into social work curricula. journal of social work education, 36(1), 65-78 osborne, m. d. (1997). balancing individual and the group: a dilemma for the constructivist teacher. journal of curriculum studies, 29(2), 183-196. parks, c. w. (2001). african-american same-gender-loving youths and families in urban schools. journal of gay & lesbian social services, 13(3), 41-56. piaget, j. (1970). logic and psychology (w. mays, trans.). new york: basic books. advances in social work, spring 2009, 10(1) 113 raiz, l., & saltzburg, s. (2007). developing awareness of the subtleties of heterosexism and homophobia among undergraduate, heterosexual social work majors. the journal of baccalaureate social work, 12(2), 53-69. snively, c. a., kreuger, l., stretch, j. j., watt, j. w., & chadha, j. (2004). understanding homophobia: preparing for practice realities in urban and rural settings. journal of gay & lesbian social services, 17(1), 59-81. university of missouri-columbia lgbt resource center. (2008). what is heterosexual privilege? retrieved on march 8, 2008 from http://web.missouri.edu/~umcstudentlifelgbt/resources/heterosexualprivilegeintro.pdf van den bergh, n., & crisp, c. (2004). defining culturally competent practice with sexual minorities: implications for social work education and practice. journal of social work education, 40(2), 221-238. wills, g., & crawford, c. (2000). attitudes toward homosexuality in shreveport-bossier city louisiana. journal of homosexuality, 38, 97-115. wisniewski, j. j., & toomey, b. g. (1987). are social workers homophobic? social work, 32(5), 454-455. author’s note: address correspondence to: lindsay gezinski, msw, m.a., college of social work, the ohio state university, 1947 college road, columbus, ohio 43210. email: lgezinski@yahoo.com http://web.missouri.edu/%7eumcstudentlifelgbt/resources/heterosexualprivilegeintro.pdf mailto:lgezinski@yahoo.com traditional classroom constructivist classroom fineman, m., mink, g., & smith, a. m. (2003). no promotion of marriage in tanf! social justice, 30(4), 126-134. lewis, g. b. (2003). black-white differences in attitudes toward homosexuality and gay rights. public opinion quarterly, 67, 59-78. raiz, l., & saltzburg, s. (2007). developing awareness of the subtleties of heterosexism and homophobia among undergraduate, heterosexual social work majors. the journal of baccalaureate social work, 12(2), 53-69. snively, c. a., kreuger, l., stretch, j. j., watt, j. w., & chadha, j. (2004). understanding homophobia: preparing for practice realities in urban and rural settings. journal of gay & lesbian social services, 17(1), 59-81. microsoft word yun_weaver attitudes to poverty scale manuscript_final _________________ sung hyun yun, ph.d., msw, and robert d. weaver, ph.d., are both assistant professors in the school of social work at the university of windsor in windsor, ontario, canada. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 174-187 development and validation of a short form of the attitude toward poverty scale sung hyun yun robert d. weaver abstract: this study outlines the development and validation of a short form of the 37item attitude toward poverty (atp) scale. employing a cross-sectional survey design, the authors sampled 319 undergraduate students at a mid-sized university located in central canada. the short form evinced high levels of internal consistency ranging from .87 to .89. evidence for the validity was established through correlational analyses and independent samples t-tests. the findings suggest the short form is a feasible alternative to the original atp scale for researchers and academics seeking to assess the povertyrelated attitudes of university students. keywords: measurement, short form development, validation, factor analysis introduction a large number of studies have been conducted to investigate attitudes toward poverty and/or impoverished persons. generally, these studies indicate the multidimensional nature of poverty-related attitudes (e.g., cozzarelli, wilkinson, & tagler, 2001; feagin, 1972; 1975; gil, 1981; handler & hasenfeld, 1991; karger & stoesz, 1990; price, desmond, snyder, & kimmel, 1988; rosenthal, 1993; ryan, 1976; shek, 2002; smith & stone, 1989). two constructs frequently identified are the individualistic and structural explanations of poverty. the individualistic explanation emphasizes individual/personal deficits as the primary cause of poverty, while the structural explanation highlights deficiencies within a market economy (dinitto, 2000; mullaly, 2007). researchers have also identified the fatalistic explanation of poverty, which generally attributes poverty to uncontrollable factors such as personal misfortune and disability (e.g., cryns, 1977; feagin, 1972; 1975; golding & middleton, 1982). macdonald (1971; 1972) and feagin (1972; 1975) empirically investigated multidimensional attitudes toward poverty. the macdonald’s poverty scale (macdonald, 1972, p. 118), a 12-item likert-type scale (including five filler items), contained seven items that measure a broad combination of perceptions/stereotypes about poor people, causes of their poverty, and public policies targeting the low-income population (e.g., “although we don’t like to face it, most people on welfare are lazy”; “i can’t understand why some people make such a fuss over the disadvantaged state of the poor. most of them could improve their condition if they only tried”; “by pouring money into poverty programs we are destroying the very thing that made this a great and prosperous country: competition”). feagin (1972; 1975) developed an 11-item likert-type scale that includes three dimensions: individualistic explanations, structural explanations, and fatalistic advances in social work, fall 2010, 11(2) 175 explanations of poverty. these three constructs identified by feagin (1972; 1975) have been widely used and modified in several studies which measure people’s attitudes toward poverty and/or poor persons (e.g., cozzarelli et al., 2001; cryns, 1977; kluegel & smith, 1982; smith & stone, 1989). for example, cryns (1977) modified the feagin poverty scale and developed the 9-item economic success scale to evaluate beliefs about reasons for economic success. the economic success scale (cryns, 1977) consists of three subscales: individualistic interpretation, structural interpretation, and fatalistic interpretation, all of which correspond to the three dimensions or constructs of the feagin poverty scale outlined above. moreover, cozzarelli et al. (2001) tested the three constructs (internal, external/societal, and fatalistic) originally proposed by feagin (1972; 1975). the principal component analysis with oblique rotation confirmed the two constructs (internal and external), although the fatalistic construct was replaced by the cultural attribution or the belief about the subculture of poverty construct. golding and middleton (1982) developed a 12-item scale that measures attitudes toward the causes of poverty and identified four dimensions: prodigality, injustice, ascribed deprivation, and fatalism. prodigality represents a negative perspective toward impoverished persons, such as a belief in “the wasteful spending patterns, financial ineptitude, imprudent breeding habits and sheer fecklessness or lack of motivation of the poor” (p. 197). injustice indicates “a positive explanation of poverty as the converse of wealth and a direct consequence of the exploitative or unfair distribution of financial reward” (p. 197). the ascribed deprivation and fatalism dimensions are alternatives to the single dimension that feagin (1972; 1975) identified as fatalistic. while scale items of the ascribed deprivation dimension are based on the cycle of deprivation, such as impoverished persons “never stood a chance because their parents were poor” and “come from places where there’s little opportunity for most people” (golding & middleton, 1982, p. 197), the fatalism items measure a belief that people are poor because of random misfortune. the fatalism construct includes such items as poor people “are just unlucky individuals” (p. 197) and “have had a bad break at some point in their lives” (p. 197). golding and middleton’s (1982) multidimensional causes of poverty align with the three dimensions by feagin (1972, 1975) outlined above, that is, the individualistic, structural, and fatalistic explanations. rosenthal (1993) gathered more evidence for individualistic explanations of poverty by examining graduate social work students’ beliefs about poverty and attitudes toward the poor. through the development of two scales (the belief in the individual cause of poverty scale and the antipathy to the poor scale), rosenthal measured the attitudes of graduate social work students toward impoverished people. the belief in the individual cause of poverty scale is a likert-type measure that consists of four items which reflect a belief that poverty is the result of a person’s flawed characteristics rather than society’s restricted opportunities. on the other hand, the antipathy to the poor scale, a 10-item likert-type scale, measures an individual’s propensity for disliking poor persons or avoiding situations which involve contact with them. overall, the existing measures outlined above suggest that attitude toward poverty and poor people is multidimensional. yun, weaver/short form of the attitude toward poverty scale 176 unidimensionality of the attitude toward poverty (atp) scale in contrast to the trend of the multidimensionality of the attitude toward poverty and poor people, a unidimensional measure also exists. atherton et al. (1993) published a brief research report on a scale for measuring university students’ attitudes toward poverty. the attitude toward poverty (atp) scale is a 37-item likert-type scale that assesses attitude toward poverty and impoverished persons, with high scores indicating a belief that structural determinants are the primary causes of poverty while low scores indicate an individualistic explanation of poverty (atherton et al., 1993). the internal consistency (cronbach’s alpha) of the original scale was .93 and the split-half (odd versus even) reliability was .87 (atherton et al., 1993). the authors noted the atp scale also demonstrated construct validity when they compared the response scores of social work and sociology students with business students. atherton et al. (1993) concluded this instrument was a single-factor scale even though they found ten factors when using the eigenvalue-greater-than-one criterion. considering that all of the 37 items loaded high (.33 or more) on factor 1 and the eigenvalues of the ten factors were higher than one, it seems likely that a complicated factor structure (cross factor loadings) was apparent. nonetheless, the authors did not elaborate sufficiently to justify this conclusion. similarly, whalen (2005) identified 13 factors using the same principal components analysis employed by atherton et al. (1993), yet concluded, without an in-depth discussion regarding the possibility of a multidimensional factor model of the atp, that the atp is unidimensional. in particular, whalen (2005) specified that in both the original and current study at least two factor eigenvalues larger than 1.0 were identified; 11.40 for factor 1 and 2.80 for factor 2 (atherton et al., 1993) and 8.66 for factor 1 and 2.71 for factor 2. in contrast to the results of whalen’s study, the potential multidimensionality of the atp was verified by rehner, ishee, salloum, and velasques (1997). in their study, rehner and colleagues determined that the atp scale contained the following ten factors: irresponsibility; determinism; nofault circumstances; deficiency; complacency; unworthiness; identification; paternalism; denigration; and lost rights. purpose of the study the contradictory findings regarding the dimensionality of the atp scale prompted the authors’ interest in clarifying how many dimensions this measure actually contains. the authors supposed that the atp would contain more than one factor. this hypothesis was made after reviewing the literature and the number of items and factors found in comparable measures, such as feagin’s scale (1972, 11 items, three factors), cryns’ scale (1977, nine items, three factors), and golding and middleton’s scale (1982, 12 items, four factors). considering 37 items too numerous to be exclusively loaded on only one factor without cross-loadings (e.g., rehner et al., 1997; whalen, 2005), the authors aimed to retain only necessary items without cross-loading by using a series of factor retention procedures. these procedures included the eigenvalue-greater-than-one rule (kaiser, 1960), cattell’s scree test (cattell, 1966), and velicer’s minimum average partial method (map; velicer, 1976). these procedures were selected in order to answer the authors’ questions regarding factor dimensionality and to produce a short form that could be advances in social work, fall 2010, 11(2) 177 administered more quickly than the original 37-item scale. therefore, the objectives of this study were to: (1) identify the multidimensionality of the original 37-item atp scale; (2) generate an alternative short form that has compatible levels of reliability with the original 37-item atp scale; and (3) establish evidence for the validity of this short form to determine its suitability for measuring the poverty-related attitudes of university students. methods design and participants a cross-sectional survey research design was used in this study. the survey was administered at the beginning of a fall semester at a mid-sized university located in central canada. prior to the inception of the data collection phase, the authors received approval from the host university’s research ethics board (reb). the participants were informed that the study was voluntary and that they could withdraw at anytime without consequence. three hundred and nineteen students participated in the study. the participants were selected from a total of 389 undergraduate students enrolled in one of three selected social work courses (two introductory and one third-year). of this group of students, 329 met the authors’ inclusion criterion that required students to major in a social science or human service profession, such as social work, psychology, sociology, political science, criminology, or nursing. the authors excluded sixty students because they either did not specify a major (n = 49) or they reported a major that differed from those outlined above (n = 11). furthermore, ten students were removed from the data since their response scores were determined to be outliers through normtest (decarlo, 1997). in cases where respondents did not respond to some of the scale items, the authors replaced the missing values with the mean of the response values for that specific scale item. the authors did not exclude any cases due to an inordinate number of missing items, since none of the cases exceeded their pre-determined threshold of expulsion, that is, 15% or more items missing on the original 37-item scale (johnson, 2003). the mean age of the sample was 21.5 years (sd = 5.3). two hundred and seventyone (85.0%) of the participants were female while 48 (15.0%) were male. as for ethnicity, the participants were primarily caucasian (n = 221; 69.3%), followed by africancanadian/black (n = 31; 9.7%) and then asian (n = 14; 4.4%). the median income for an individual student and her/his family was $9,000 and $80,000, respectively. the majority of the participants (n = 253; 79.4%) reported they were financially secure when the survey was administered. refer to table 1 for a complete demographic profile of the participants. yun, weaver/short form of the attitude toward poverty scale 178 table 1. socio-demographic characteristics (n = 319) demographic variable characteristic age m 21.5 sd 5.3 income individual gross income (median) $9,000 family gross income (median) $80,000 gender female 271 (85.0%) male 48 (15.0%) ethnicity caucasian 221 (69.3%) african-canadian/black 31 (9.7%) asian 14 (4.4%) multiethnic 13 (4.1%) middle eastern 6 (1.9%) indo-canadian 6 (1.9%) aboriginal 6 (1.8%) other 22 (6.7%) religion catholicism 139 (43.6%) protestantism 74 (23.2%) islam 12 (3.8%) orthodox 10 (3.1%) buddhism 3 (.9%) hinduism 3 (.9%) none 46 (14.4%) other 31 (9.7%) missing 1 (.3%) political affiliation conservative 49 (15.4%) liberal 133 (41.7%) social democrat 26 (8.2%) socialist 8 (2.5%) none 91 (28.5%) other 8 (2.5%) missing 4 (1.3%) financial security very secure 42 (13.2%) secure 116 (36.4%) somewhat secure 95 (29.8%) somewhat insecure 42 (13.2%) insecure 13 (4.1%) very insecure 8 (2.5%) missing 3 (.9%) advances in social work, fall 2010, 11(2) 179 measurement modification the atp scale, developed by atherton et al. (1993), was used in this study. in the authors’ judgment, there were two items on the original scale developed by atherton et al. (1993) that required modification in order to better reflect the canadian context. these items were “an able-bodied person using food stamps is ripping off the system” (p. 29) and “poor people use food stamps wisely” (p. 29). given that the food stamp program is an american scheme not delivered by the canadian welfare state (lightman, 2003), the authors, after consulting with four canadian social work academics (three at the full professor rank and all of whom had earned a graduate level social work degree in the united states), replaced the term ‘food stamps’ with ‘welfare benefits’ in the items outlined above. construction and validation of the alternative short form in order to retain/discard items and identify the number of factors, the authors used the eigenvalue-greater-than-one criterion (kaiser, 1960), the conventional factor-loadinggreater-than .40 criterion, the keil-wrigley criterion (keil & wrigley, 1960), reliability analysis, and the scree test (catell, 1966). specifically, principal axis factoring was conducted in order to maximize the covariance extracted by each successive factor. the authors chose the promax (kappa = 6) solution because the scale items were expected to moderately correlate with each other. items with factor loading less than .40 were discarded, while retained items were further tested for exclusion in order to reach the highest level of reliability (the corrected item-total correlation). the authors proposed the three-factor solution because the fourth factor (and above) did not have at least three salient loadings, as determined by the keil-wrigley criterion (keil & wrigley, 1960). the number of factors was evaluated by the scree plot and the interpretability of factors. the authors established evidence for internal consistency for the short form and convergent validity between the original 37-item atp scale and the short form. in addition, evidence for the known-groups validity was established through investigating the response differences between students who identified themselves as politically leftwing (i.e., liberals/social democrats/socialists) from those who identified themselves as politically right-wing (i.e., conservatives). results preliminary analysis the authors tested the data for univariate and multivariate normality. a common guide for normal distribution is if univariate skewness and kurtosis are less than |2.0| and |7.0|, respectively. according to these conventional cut-offs, all of the items were within the accepted normal distribution parameters. in order to test for multivariate normality, the authors conducted normtest (decarlo, 1997) and examined the suitability of the data for factor analysis by using the kaisermeyer-olkin (kmo) measure of sampling adequacy (kaiser, 1970), as well as bartlett’s test of sphericity (bartlett, 1950). the results showed that the kmo value for the data yun, weaver/short form of the attitude toward poverty scale 180 was .92, which is greater than kaiser’s (1970) recommended value of .6, suggesting the variability in the data was sufficient for conducting factor analysis. bartlett’s test of sphericity (1950) was statistically significant, which indicated that the variables were not independent. hence, the data were deemed appropriate for conducting factor analysis. atp short form development the eigenvalue-greater-than-one criterion initially extracted five factors for the atp short form (eigenvalues: 5.88, 1.78, 1.39, 1.07, and 1.04); however, the last two factors were dropped because they lacked at least three salient loadings, as determined by the keil-wrigly criterion (keil & wrigley, 1960). the three factor solution was also confirmed after discarding 12 items that were less than the factor loading cut-off criteria (.40). initially, there were 11 items for factor 1, eight items for factor 2, and six items for factor 3. from factor 1, three more items were eliminated to increase the alpha coefficient from .76 to .82, while one item was removed from factor 2, which resulted in an increase in the alpha coefficient from .62 to .75. all items were retained for factor 3 because item expulsion did not improve the alpha coefficient (.67). the factor structure of the 21-item short form of the original atp scale is demonstrated in table 2. all of the factor loadings of the three factors were equal or higher than .40: factor 1 (.44 – .76), factor 2 (.40 – .81), and factor 3 (.50 – .60). the authors also administered the scree test (catell, 1966) and found a linear decline commencing with the fourth factor, which supports the three factor solutions: factor 1 (personal deficiency), factor 2 (stigma), and factor 3 (structural perspective). the alpha coefficient for the total 21 items, which included factors 1, 2, and 3, was .87 (see table 3). to compute the alpha coefficient for the total 21 items, the authors reversed the item scores for factor 3 because the items in factor 3 reflected structural explanations for poverty while factors 1 and 2 were individualistic and discriminatory explanations of poverty, respectively. validity convergent validity. evidence for convergent validity was established by examining the correlation coefficients between the original 37-item scale and the atp short form. table 4 shows that the original 37-item atp scale had statistically significant correlations across the atp short form and its three subscales. all the subscales of the atp short form had high positive correlations with the original 37-item atp scale, ranging from .76 to .85, except for factor 3 that was negatively correlated (-.30). advances in social work, fall 2010, 11(2) 181 table 2: atp short form (21 items) factor structure and loadings scale item factor factor 1a factor 2b factor 3c poor people are different from the rest of society. .76 -.26 -.01 poor people are dishonest. .65 -.20 -.19 most poor people are dirty. .64 .04 .01 poor people act differently. .60 .13 .28 children raised on welfare will never amount to anything. .54 .01 .00 i believe poor people have a different set of values than do other people. .48 .14 .08 poor people generally have lower intelligence than nonpoor people. .44 -.06 -.05 there is a lot of fraud among welfare recipients. -.15 .81 .13 some "poor" people live better than i do, considering all their benefits. -.12 .77 .19 poor people think they deserve to be supported. .13 .63 .27 welfare mothers have babies to get more money. .17 .53 .01 an able-bodied person collecting welfare is ripping off the system. -.15 .51 -.26 unemployed poor people could find jobs if they tried harder. -.01 .46 -.22 welfare makes people lazy. .17 .45 -.18 benefits for poor people consume a major part of the federal budget. .07 .40 -.23 people are poor due to circumstances beyond their control. .08 .09 .60 i would support a program that resulted in higher taxes to support social programs for poor people. -.02 -.04 .60 if i were poor, i would accept welfare benefits. .07 .18 .58 people who are poor should not be blamed for their misfortune. .00 .02 .51 society has the responsibility to help poor people. -.07 .00 .51 poor people are discriminated against. -.02 .20 .50 note. factor loadings ≥ .40 are in boldface. principal axis factoring and promax (kappa = 6). afactor 1 = personal deficiency bfactor 2 = stigma cfactor 3 = structural perspective yun, weaver/short form of the attitude toward poverty scale 182 table 3: internal consistency reliability (alpha coefficient) of the atp short form scale alpha coefficients atp short form (21 items – total) .87a factor 1: personal deficiency (7 items) .82 factor 2: stigma (8 items) .75 factor 3: structural perspective (6 items) .67 note. n = 319. athe alpha coefficient of the atp short form (total) was computed after reversing the response scores of the factor 3 items because they reflect attitudes that are opposite to the items of both factors 1 and 2. table 4: correlations between the original 37-item atp scale and the atp short form scale correlations atp short form (21 items total)b .826* factor 1: personal deficiency (7 items) .846* factor 2: stigma (8 items) .762* factor 3: structural perspective (6 items) -.302* note. the correlation between the atp short form (total) and the original atp scale was computed after reversing the response scores of the factor 3 items because they reflect attitudes that are opposite to the items of both factors 1 and 2. n = 319. *correlation is significant at the 0.05 level (2-tailed). known groups validity. the literature indicates that measures of attitudes toward poverty and impoverished persons usually include conceptually distinct explanations such as individualism and structuralism (cozzarelli et al., 2001; gil, 1981; handler & hasenfeld, 1991; price et al., 1988; ryan, 1976; shek, 2002). furthermore, there is empirical evidence which supports the relationship between political affiliation and attitudes toward poverty and impoverished persons (e.g., auclaire, 1984; davis, 1988; handler & hasenfeld, 1991; ryan, 1976). advances in social work, fall 2010, 11(2) 183 in our study, evidence for known-groups validity was established by investigating the attitudinal differences between students who identified themselves as politically left-wing (liberals/socialists), and those who identified themselves as politically right-wing (conservatives). an independent-samples t-test (one-tailed) was conducted to evaluate whether students who identified themselves as politically left-wing reported more structural attitudes toward poverty and impoverished persons than students who identified themselves as politically right-wing. table 5 shows that the atp short form could successfully differentiate between political orientation and attitude toward poverty and poor persons. table 5: summary of study outcome measures and critical comparison m sd t df sig. (one-tailed) atp short form (total) politically right wing (n = 49) (conservatives) 70.0 9.7 -3.5 214 .000 politically left wing (n = 167) (liberals/social democrats/socialists) 75.6 10.2 discussion in this study, the authors described the development of the short form of the original 37-item atp scale (atherton et al., 1993) that measures people’s attitudes toward poverty and poor people. the authors identified the presented atp short form as a robust alternative to the original atp scale. the factor structure shows that all the items within the atp short form had salient factor loadings on their respective factors equal to or greater than a cut-off of .40. in addition to establishing its reliability, the validity of the atp short form was established through correlational analyses and independent samples t-tests. the multidimensionality of the atp short form was theoretically examined and empirically tested. the atp short form includes three factors (personal deficiency – 7 items, stigma – 8 items, and structural perspective – 6 items), which measure a range of diverse attitudes toward poverty and poor people. in contrast to the unidimensionality reported by atherton et al. (1993), the present study developed a theoretically and statistically sound alternative, the multidimensional atp short form. the authors’ preliminary psychometric analyses indicated a high level of internal consistency (cronbach’s alpha) for the alternative atp short form (α = .87). all of the subscales of the atp short form exceeded the minimum acceptable level for internal consistency between 0.50 and 0.70 (bowling, 2002). evidence for convergent validity was established by investigating the correlational relationships between the original 37-item scale with the atp short form (r = .83). yun, weaver/short form of the attitude toward poverty scale 184 factor 3 (structural perspective) of the atp short form had a significant negative correlation (r = -.30) with the original 37-item scale, while the other subscales were positively correlated with the original scale (between .76 and .85). this is most likely due to the fact that factor 3 of the atp short form includes a unique dimension that measures a structural explanation of poverty, which is conceptually distinct from the personal deficiency and stigma perceptions of poverty. evidence for known-groups validity was also supported because the independent samples t-test (one-tailed) suggested that students with a left-leaning political orientation demonstrated a more structural attitude toward poverty and poor people than did right-leaning students. despite the promising and clear findings regarding psychometric properties, there were limitations to this study. for instance, a convenience sample of university students who were primarily female, white, and middle class was used. hence, replication studies with various populations who differ in terms of age, gender, ethnicity, socio-economic status and political affiliation are necessary to boost the generalizability of this study’s results. in addition, confirmatory factor analysis should be conducted within these replication studies in order to further establish evidence for the three constructs detected within the atp short form. the atp short form, due to its reduced number of items, is potentially easier to administer and thus more efficient in collecting data than the original 37-item atp scale. furthermore, the multidimensionality of the atp short form allows researchers to measure students’ attitude toward poverty and impoverished persons in a much more comprehensive and accurate manner than the original atp scale. it is vital that university students aiming to work in the human service professions are sensitized to issues surrounding social justice, and the liberation and empowerment of under-served and under-represented population groups within society, including people experiencing poverty. this is because their attitudes will dictate the policy, programmatic, and practice decisions they make as human service professionals which, in turn, can either empower or harm low-income persons (krumer-nevo, weiss-gal, & monnickendam, 2009; mullaly, 2007). the accreditation standards of social work programs within north america emphasize the importance of promoting social and economic justice and nondiscrimination. for example, the council on social work education’s (cswe) educational policy and accreditation standards (epas) maintain that social work programs should provide curricula that foster the implementation of strategies that combat discrimination, oppression, economic deprivation and that promote social and economic justice (2001). specifically, the epas states that social work education should help “prepare social workers to alleviate poverty, oppression, and other forms of social injustice” (p. 10). furthermore, the canadian association of social work education (caswe) standards for accreditation (2008) emphasize that “the curricula should reflect social work values that promote a professional commitment to analyze and eradicate oppressive social conditions” (p. 8). in light of these guidelines, the authors propose that the atp short form developed in this study can assist university educators in detecting if their pedagogical efforts are sensitizing students to the structural advances in social work, fall 2010, 11(2) 185 determinants of poverty, and thus boosting the likelihood of their becoming professionals that are committed to poverty reduction efforts. references atherton, c. r., gemmel, r. j., haagenstad, s., holt, d. j., jensen, l. a., o’hara, d. f., et al. (1993). measuring attitudes toward poverty: a new scale. social work research and abstracts, 29(4), 28-30. retrieved from http://search.ebscohost.com.ezproxyuwindsor.ca/login.aspx?direct=true&db=a9h&a n=9609194559&site=ehost-live auclaire, p. a. (1984). public attitudes toward social welfare expenditures. social work, 29(2), 139-144. retrieved from http://search.ebscohost.com.ezproxy.uwindsor.ca/login.aspx?direct=true&db=a9h&a n=5273831&site=ehost-live bartlett, m. s. (1950). tests of significance in factor analysis. british journal of psychology, statistical section, 3, 77-85. bowling, a. (2002). research methods in health: investigating health and health services (2nd ed.). buckingham: open university press. canadian association for social work education. (2008, may). caswe standards for accreditation. ottawa, on: caswe-acfts. retrieved from www.caswe-acfts.ca cattell, r. b. (1966). the scree test for number of factors. multivariate behavioral research, 1(2), 245-276. council on social work education. (2001). education policy and accreditation standards of the council on social work education. retrieved from http://www.wheelock.edu/socialwork.sw_policy.pdf cozzarelli, c., wilkinson, a. v., & tagler, m. j. (2001). attitudes toward the poor and attributions for poverty. journal of social issues, 57, 207-227. cryns, a. g. (1977). social work education and student ideology: a multivariate study of professional socialization. journal of education for social work, 13, 44-51. davis, l. f. (1988). rural attitudes toward public welfare allocation. human services in the rural environment, 12(2), 11-19. decarlo, l. t. (1997). on the meaning and use of kurtosis. psychological methods, 2, 292-307. dinitto, d. m. (2000). social welfare: politics and public policy (5th ed.). boston, ma: allyn & bacon. feagin, j. r. (1972, november). poverty: we still believe that god helps those who help themselves. psychology today, 101-129. feagin, j. r. (1975). subordinating the poor: welfare and american beliefs. englewood cliffs, nj: prentice hall. yun, weaver/short form of the attitude toward poverty scale 186 gil, d. g. (1981). unraveling social policy: theory, analysis, and political action toward social equality. rochester, vt: schenkman. golding, p., & middleton, s. (1982). images of welfare: press and public attitudes to poverty. oxford: martin robertson. handler, j. f., & hasenfeld, y. (1991). the moral construction of poverty: welfare reform in america. newbury park, ca: sage. johnson, m. l. (2003). lose something? ways to find your missing data. retrieved from www.hsrd.houston.med.va.gov/documents/mj%20missing%20data%20pds%2009 1703.ppt kaiser, h. (1960). the application of electronic computers to factor analysis. educational and psychological measurement, 20, 141-151. karger, h. j., & stoesz, d. (1990). american social welfare policy: a structural approach. new york: longman. keil, d., & wrigley, c. (1960). effects upon the factorial solution of rotating varying number of factors. american psychologist, 15, 383-394. kluegel, j. r., & smith, e. r. (1982). whites’ beliefs about blacks’opportunity. american sociological review, 47, 518-532. krumer-nevo, m., weiss-gal, i., & monnickendam, m. (2009). poverty-aware social practice: a conceptual framework for social work education. journal of social work education, 46(2), 225-243. lightman, e. (2003). social policy in canada. don mills, ontario: oxford university press. macdonald, a. p. jr. (1971). relation of birth order to morality types and attitudes toward the poor. psychological reports, 29, 732. macdonald, a. p. jr. (1972). more on the protestant ethic. journal of consulting and clinical psychology, 39(1), 116 – 122. mullaly, b. (2007). the new structural social work (3rd ed.). don mills, ontario: oxford university press. price, j. h., desmond, s. m., snyder, f. f., & kimmel, s. r. (1988). perceptions of family practice residents regarding health and poor patients. journal of family practice, 27(6), 615-21. rehner, t., ishee, j., salloum, m., & velasques, d. (1997). mississippi social workers’ attitudes toward poverty and the poor. journal of social work education, 33(1), 131142. rosenthal, b. s. (1993). graduate social work students’ beliefs about poverty and attitudes toward the poor. journal of teaching in social work, 7(1), 107-121. ryan, w. (1976). blaming the victim. new york: vintage. advances in social work, fall 2010, 11(2) 187 shek, d. t. (2002). chinese adolescents’ explanations of poverty: the perceived causes of poverty scale. adolescence, 37(148), 789-803. smith, k. b., & stone, l. h. (1989). rags, riches, and bootstraps: beliefs about the causes of wealth and poverty. the sociological quarterly, 30(1), 93-107. velicer, w. f. (1976). determining the number of components from the matrix of partial correlations. psychometrika, 41, 321-327. whalen, m. h. (2005). measuring msw student attitudes toward poverty and the poor: a tool for evaluating social work education outcomes. unpublished doctoral dissertation, michigan state university, east lansing, mi. author’s note: address correspondence to: sung hyun yun, assistant professor, school of social work, university of windsor, 401 sunset avenue, windsor, on n9b 3p4, canada. email: yshhsy@uwindsor.ca. the authors would appreciate being contacted by anyone planning on using the atp short form. advances vol. 2, no. 2 i editorial barry r. cournoyer the editorial board began to plan this issue about one year ago. we hoped to use it as a context to celebrate the 90thanniversary of social work education at indiana university. as one of the oldest schools in the country and the only one to have a full continuum of education from the associate to doctoral degrees, we have a long and distinguished history. we thought it would be helpful to social work educators, researchers, and practitioners to consider the nature and implications of the new educational policies and accreditation standards (epas) that the council on social work education (cswe) was developing. we anticipated that they would be considered, reviewed, revised, and probably approved sometime during the summer of 2001. indeed, they were approved in june 2001 and will be effective as of july 1, 2002. (the text of the new epas may be found at www.cswe.org). however, we had not expected the events of september 11, 2001. familiar as we social workers are with the beaten faces and bodies of abused women and children, we were nonetheless unprepared for the full impact of the suicide attacks upon buildings in newyork city andwashington, d.c. and the subsequent bacterial exposures. the events remain profoundly disturbing. in preparing this editorial, i am challenged by context and perspective. certainly, the 90th anniversary of indiana university school of social work deserves recognition. i would dearly love to shout happy 90th on behalf of our thousands of alumni and others who have contributed so much to our school. context and perspective, however, tempers my enthusiasm. i mourn the thousands who were killed on september 11th. i grieve their families’ losses as well as those who lost love ones through exposure to bacterial agents. i wonder about the impact upon our children, our relations with others, and indeed our future. i also recognize more clearly than before what it may be like to be an israeli who is constantly alert to the possibility and reality of a car bomb, or a palestinian uncertain about almost everything. i wonder about the murdered, mutilated, and missing in so many parts of our world—usually so far away from our everyday experiences with mcdonald’s and starbuck’s—but suddenly so profoundly near. in such a context, how significant is the 90th anniversary of a school of social work? given the perspective generated by september 11th and its aftermath, how much does it matter that social workers have new educational policies and accreditation standards for their educational programs? as i ponder these questions, my initial reaction is, not much. on reflection, however, i think that could be might be amore accurate response. might the 90th anniversary of a school of social and a new set of educational standards for social work be significant? yes, i think could be is about right. here in the united states, the indiana university school of social work is almost as old as the profession itself. socialwork has entered its second century and nearly has our school. in celebration of this milestone, we invited monique busch, gerald t. powers, david metzger, cyrus s. behroozi, sheldon siegel, and barry r. cournoyer to prepare a brief historical review of social work education at indiana university. a daunting task, the authors crafted an article that will interest social workers everywhere. in light of the recently approved educational policy and accreditation standards (epas), we invited leaders in the school’s bsw, msw, and ph.d. programs to prepare brief reaction papers. irene queiro-tajalli, katharine byers, and edward fitzgerald prepared a bsw response; marion wagner, paul newcomb, and robert weiler wrote an msw reaction paper; and barry r. cournoyer andmargaret adamek prepared a ph.d. response. these papers serve to help us reflect upon the implications of educational standards in general and the new epas in particular. policies and standards may be viewed as a burden or as an opportunity to reconsider and reinvigorate our profession by energizing the nature and perhaps the manner through which we educate our future social workers. perhaps these papers may help us adopt the new epas as an opportunity to improve the overall quality of the profession’s education, research, and practice. as a natural complement to the new epas, which require programs to evaluate the effectiveness of their educational activities, we invited barry r. cournoyer to address the topic of student learning assessment. he describes the indiana model—a system that incorporates both direct and indirect methods for the assessment of learning outcomes—that may be useful to social workers in settings of all kinds. we also accepted a refereed article that complements the themes of innovation and assessment in social work education. terry a. wolfer, miriam l. freeman, and rita rhodes of the university of south carolina discuss the development and implementation of an msw-level capstone course that adopted a case method form of instruction. the editorial board and i are pleased to present this issue of advances in social work to the social work community. we publish it in celebration of the 90th anniversary of social work education at indiana university and dedicate it to the thousands of students, alumni, faculty, field instructors, social workers, community leaders, and university colleagues who have contributed so much during these nine decades. ii advances in socialwork sw 979 method of naturalistic and qualitative research convergence of a strengths perspective and youth development: toward youth promotion practice jeong woong cheon abstract: in recent years, increased attention has been paid to the development and application of the strengths perspective and positive youth development. this paper develops youth promotion practice as a convergence of a strengths perspective and youth development principles. historical and contemporary contexts of a problem-focused perspective in social work with adolescents are reviewed and a critique developed with emphasis on the evolution of strengths-focused practices. the importance and possibility of combining the strengths perspective and youth development toward youth promotion practice are addressed. youth promotion is defined as a process of enhancing youth strengths and resources to promote positive outcomes and help young people be healthy adults. complementary aspects of the two perspectives are expected to support and supplement the strengths and weaknesses of each perspective in synergistic ways. several advantages of youth promotion practice are discussed as well as its implications for improved social work practices with adolescents. keywords: strengths perspective; youth development; youth promotion; problemfocused; strengths-based practice. introduction there has been increasing attention given to the positive aspects and strengths of adolescents over the past two decades in the human development, social work, and related fields (amodeo & collins, 2007; saleebey, 2005). more interest in the strengths perspective, positive psychology, quality of life, psychological wellness, and health promotion has been emphasized in social work and allied fields (crowe, 2007; maton, schellenbach, leadbeater, & solarz, 2004). in particular, resilience and youth development have gained prominence as ways to help adolescents become competent and responsible adults (benard, 2004; clary & rhodes, 2006). however, the image of “youth as problems” is still dominant in public discourse, professional work, and social science (males, 1996; scales, 2001). social work has essentially tied its tradition to problems, deficits, and diagnoses rather than strengths and resources. social work theory and practice have been more interested in troubled youth and the services they require, and youth development is less emphasized than treatments and therapeutic interventions compared to other disciplines (melpignano & collins, 2003; morrison, alcorn, & nelums, 1997). although many agencies state that they practice using the strengths perspective and youth development principles, the field needs more efforts to incorporate these strengths-based practices for improved social work practices with young people. _________________ jeong woong cheon, ph.d., is a research manager in the school of social welfare at the university of kansas. copyright © 2008 advances in social work vol. 9 no. 2 (fall 2008), 176-190 advances in social work, fall 2008, 9(2) 177 this paper proposes youth promotion practice as a convergence of a strengths perspective and youth development principles. it reviews the historical and contemporary contexts of the problem-focused perspectives on adolescents, and then develops a critique with emphasis on a strengths perspective and youth development principles. the importance and possibility of the youth promotion practice are addressed. it concludes with discussion of the advantages of youth promotion practice and its implications for improved social work practice with adolescents. historical contexts of practice with youth according to popular and professional thinking, young people are understood as either problems or victims rather than strengths or resources. mass media often portray young people as violent, drug addicted, pregnant, dropouts, or homeless (nichols & good, 2004). youth of color and those youth from low-income backgrounds or residing in urban areas usually have been viewed more negatively than other youth from a deficit perspective (delgado, 2002). in order to understand the negative perspective toward young people, it is necessary to examine the historical evolution of youth issues, the conceptualization of the dominant discourse on adolescence and their relation to intervention by the social work professionals as responding to the problems of young people. although youth issues can be found throughout history, the first time that youth became objects of heightened public concern can be traced as far back as the 1830s with the development of america’s first urban slums (trattner, 1999). social welfare agencies participated in the child-saving movement, “orphan trains” and the junior republic movement of the 19th century urban youth crisis (trattner, 1999). several youth-serving organizations were created in the 1850s, along with religious and charitable groups, to meet the needs of young working people including the young men’s christian association (ymca) and the young women’s christian association (ywca). in 1889, jane addams established hull house, the best known settlement house, with the intention of protecting and promoting the development of young people and well-being of their families (addams, 1910). youth services agencies and settlement houses utilized group work and emphasized character building. settlement houses and youth service agencies were once extensively staffed with professionally trained social workers. however, today they staff relatively few of the neighborhood-based youth services (morrison et al., 1997). in the beginning of 20th century, the concept of adolescence as a special time between childhood and adulthood had been developed. in 1904, hall (1904) introduced the concept of adolescence as a time of “storm and stress” to explain the behaviors of youth. he wrote that “development is less gradual and more salutatory, suggestive of some ancient period of storm and stress” (p. xiii). hall’s “storm and stress” description of adolescence influenced adults’ perception of adolescence as a stormy period of life and it was internalized by society as a way to describe the typical teenagers (nichols & good, 2004). cheon/youth promotion 178 with the dominant view of adolescence as a stage of turmoil, youth have been viewed by social workers as problems to be solved or victims to be saved (finn & checkoway, 1998). social workers began to call for a more professional approach, and more attention was paid to the problems in people’s lives; thus interest in community work was decreased (day, 2000). studies of pathology and individual differences were incorporated into the casework approach to social work practice. by the late 1930s, the social work profession was shifting toward a psychoanalytic approach as the dominant theoretical structure for defining individuals’ problems (weick, rapp, sullivan, & kisthardt, 1989). for example, freud (1946) argued that youth were inevitably fraught with parent-child conflict. according to de anda (1995), psychoanalytic theorists see “the developmental processes of adolescence as a recapitulation of earlier infantile stages of development through the re-experiencing of either oedipal or pre-oedipal conflicts” (p.18). the psychoanalytic theory and its derivatives further facilitated pathology theories in their practice with youth (day, 2000). by the 1950s, the psychiatric approach and psychosocial approach seemed to exist together. although psychosocial theories of adolescents emphasized the impact of the sociocultural context on individual development, the two approaches still focused on problems (mcmillen, morris, & sherraden, 2004). a problem-solving framework for social casework was also introduced and prevailed as one of social work’s durable practice models. moreover, the negative conceptualization of adolescence was further introduced during this period. for example, erikson (1963) also viewed adolescence as a time of turmoil and stress characterized by the result of an “identity crisis.” for erikson, adolescence came to signify both key physiological changes and the development of a separate independent adult identity. as the mental health field began to emerge in the profession, problem-focused and deficit-based perspectives and practices became more dominant among social workers (finn, 2001). in the early 1980s, troubled youth were increasingly pushed into residential hospitals for treatment. males (1996) asserts that the commitment of adolescents to psychiatric treatment was not increased by a rise in mental health problems of young people, but promoted more by hospital profiteering. finn (2001) discusses the ways in which particular images of pathology are appropriated and deployed in the constructions of troubled youth. she contends that “young people are assessed and diagnosed in an ever-expanding taxonomy of risk, danger, and pathology” (p. 184). evolution of a strengths perspective and youth development although social work played an important role in dealing with the problems of young people, the problem-focused understanding of adolescence has been too dominant. the neglect of youth’s “social agency” has been one of the consequences, and society may miss important opportunities to keep young people on a positive trajectory. problemfocused perspectives are criticized as promoting a construction of adolescence itself as pathology (delgado, 2000). advances in social work, fall 2008, 9(2) 179 a challenge to biological determinism has been posed along with the conceptualization of adolescence. many studies have contradicted the understanding of adolescence as a universal life stage of “storm and stress.” for instance, mead (1928) argues through her study of adolescent girls in samoa that youth do not experience a turbulent time. rather, given the appropriate cultural context, teenage years could be ages of gradual, peaceful transition to adulthood. in the 1960s, bandura (1964) reported that published research data showed that the view of “storm and stress” was unwarranted and rather argued that the mass media sensationalizes adolescent behavior. arnett (1999) found that when asked about teens as a group, adults were more likely to characterize them in negative terms. problem-focused views and practices also have been criticized in social work literature. goldstein (1990) points out that a pathology approach tends to reduce the complexities of the human state to narrow compartments of diagnostic schemes. weick et al. (1989) summarized the problem with problem-focused practice into three points: “(1) the problem invariably is seen as a lack or inability in the person affected; (2) the nature of the problem is defined by the professional; and (3) treatment is directed toward overcoming the deficiency at the heart of the problem” (p. 352). in fact, the prevailing negative perspective was continuously challenged with the new perspectives or models of practice. attention to capacity-building has been found in the writings of the settlement house workers (addams, 1910; mcmillen et al., 2004), and motivation and opportunities have been mentioned in social casework. in particular, the ecological models and empowerment models have been presented as a challenge to a deficit orientation. although social work has taken pride in being a problem-solving profession, problem-focused treatment practice was further criticized and prevention approaches began to be emphasized. according to goleman (1995), crisis interventions “come too late, after the targeted problem has reached epidemic proportions and taken firm root in the lives of the young” (p. 256). the prevention approach grew out of the realization that it can be more cost-effective and efficient to prevent problems from occurring initially than to treat them after they are established. along with criticisms of the problem-focused perspective, positive views on adolescents have increased over last 20 years. some people who work with young people recognize the power of an alternative approach, one which focuses on the strengths and positive aspects of the youth. this approach views young people as having strengths, assets, potential, or resources, in contrast to the views of youth as problems and victims. proponents of this approach have recognized that the solutions to many problems that adolescents face can be found in the strengths of young individuals themselves, their families, and their communities (edwards, mumford, & serra-roldan, 2007; maton et al., 2004). it was in these conditions that the strengths perspective and youth development principles began to attain greater attention among practitioners, researchers, and policy makers working with youth. the strengths perspective has emerged based on the recognition that focusing on the problem does not solve the problem. the strengths perspective is defined as an approach to social work practice that places its emphasis on cheon/youth promotion 180 the individual’s inner and environmental strengths and resources instead of deficiencies and problems. it was based on the assumption that, despite their adversities, such as mental illness, individuals could build a life beyond the problems. it is rooted in the belief that “people can continue to grow and change and should have equal access to resources” (chapin, 1995, p. 507). although the concept of strengths is represented in a variety of forms, saleebey (2005) suggests a simple device for framing and remembering the essence of the strengths perspective as 3p (promise, possibility, positive expectations), 3c (competence, capacities, courage), and 3r (resilience, reserve, resources). although a single definition does not exist, youth development can be defined as “the process in which all youths engage over time in order to meet their needs and their competence” (nixon, 1997, p. 571). youth development is explained in three ways: a natural developmental process; a set of principles, a philosophy or approach; and a range of practices in programs, organizations, and initiatives (hamilton & hamilton, 2004). the youth development perspective sees “youth as resources to be developed rather than as problems to be managed” (roth & brooks-gunn, 2000, p. 3). this perspective assumes that all youth possess individual and ecological assets that have the potential to be marshaled in the service of enhancing their healthy life chances. in contrast to prevention approaches, it moves beyond the eradication of risk and deliberately argues for the positive development and the conditions that contribute to youth health and wellbeing. youth development advocates assert that simply preventing problems is not enough to prepare youth for adulthood (borden & perkins, 2006). convergence of a strengths perspective and youth development: youth promotion development and application of the strengths perspective and youth development there is a need for a more strengths-focused practice of social work with adolescents. seita (2000) called for a shift in child welfare practice toward more positive approaches, including incorporating elements of connectedness, continuity, dignity, and opportunity in working with youth. benard (2004) acknowledges that “the most effective, efficient, and even rewarding and joyful approach to problem prevention is through supporting healthy youth development” (p. 2). saleebey (2005) also mentioned developmental resilience, health and wellness, and solution-focused approaches as areas of the important “converging lines of research and practice” that support the strengths perspective. this understanding is supported with the recent growing interest in the development and application of the strengths perspective and youth development to social work practice with adolescents (barton, 2006; bender, thompson, mcmanus, lantry, & flynn, 2007; yip, 2006). needless to say, the strengths perspective is implemented throughout social work practice with youth. this includes adolescents’ mental health (harniss & epstein, 2005), substance abuse prevention (delgado, 1997), child welfare (collins, 2001), group work (malekoff, 2004), and juvenile justice (bazemore & terry, 1997), to name but a few. in particular, rapp (1998) has developed a strengths-based case management model. poertner and ronnau (1992) have used a strengths perspective with advances in social work, fall 2008, 9(2) 181 children with emotional disabilities. laursen (2000) outlines the strengths-based practices that have been found to be effective with challenging children. a strengths perspective is not limited to social work. it is widely applied in the youth development field. for example, resiliency research offers strong support for the possibility of successful application of strengths perspective to youth development practice. in the words of benard (2004), “the prevention research community is heartened by the accumulating research evidence that resilience and youth development approaches work” (p. 2). it challenges the youth development field to move beyond a fixation with content to a focus on context. resilient youth have a set of strengths and competencies that they draw upon. recently, youth development practice has been applied to the field of social work with adolescents. according to melpignano and collins (2003), “a development relevant to addressing adolescent youth in the child welfare system has been increased attention to principles of positive youth development to help all youth to achieve successful life outcomes” (p. 160). kim, crutchfield, williams, and helper (1998) describe ways that a youth development approach can be integrated in the prevention of substance abuse and other youth problems. youth involvement in systems-of-care communities is everevolving (matarese, mcginnis, & mora, 2005). the converging characteristics of the strengths perspective and youth development in addition to these developments of a strengths perspective and youth development practice, some similarities and complementary aspects between these two perspectives emphasize the necessity and importance of a convergence of the two approaches. the first common element of the strengths perspective and youth development is that they both grew from discontent with the problem-focused perspectives, and both transform deficit-based approaches into strengths-based approaches (rapp, saleebey, & sullivan, 2005). as already discussed, the strengths perspective builds interventions on strengths and de-emphasizes pathology. positive youth development stresses the values, strengths and potential of children and youth regardless of their situations rather than focusing solely on responses to particular risks. second, the strengths perspective and youth development begin with a focus on the positive potential of individuals, families and communities. for the strengths perspective, “almost anything, given circumstances and context can be a strength or asset” (saleebey, 2005, p. 301). strengths-based practice facilitates client links to community contexts where client strengths can flourish. youth development also values internal and external assets, supports and opportunities which denote an ecological perspective. for youth development, one of the goals is that society comes to view youth as community resources rather than community problems (amodeo & collins, 2007). third, both perspectives lay stress on the role of helping people and using environmental resources. the strengths practice often involves helping people put together their personal assets and their environmental resources toward the building of a better life. when using the strengths perspective, the relationship is accepting, purposeful, cheon/youth promotion 182 and empathetic (rapp et al., 2005). in addition to the importance of a caring adult, relationships in which youth and adults are partners are considered as the core of youth development (youngblade & theokas, 2006). youth promotion as a converging practice of the strengths perspective and youth development when taken together, all the development and application of the strengths perspective and youth development principles serve as a guiding practice toward “youth promotion” as a convergence of the two perspectives. complementary aspects of the two perspectives are expected to support the strengths of each perspective in synergistic ways. the importance of a convergence of the strengths-based practices. convergence is important to supplement the weaknesses of the strengths perspective and positive youth development in the establishment of “youth promotion” practice. there is criticism of the strengths perspective for underplaying the constraints and the often-overwhelming struggles that poor and oppressed people face in their every day lives (finn & jacobson, 2003). also, youth development is criticized for overlooking the fact that youth face risks that can jeopardize their health and development if not addressed. according to small and memmo (2004), “although the likelihood of a problem behavior steadily decreases as the number of assets an individual possesses increases, the presence of even one risk factor can double or triple the occurrence of a problem behavior, even among youth who report many assets” (p. 6). efforts of convergence are also significant to embrace youth development principles in the social work field more than ever. although strong needs and interests in positive youth development programs exist, these have not generally been easily applied in the public child welfare system (collins, 2001). however, a youth development approach is critical, given that an examination of social work practice literature has suggested that social worker’s methodology still predominantly maintains a clinical treatment focus (morrison et al., 1997). convergence contributes to the expansion of the scope and realm of social work with adolescents. the strengths perspective has been applied in case management and thus evolved around the relationship between clients and professional helpers (arnold, walsh, oldham, & rapp, 2007). however, youth development is especially popular with group activity situations, such as after-school programs or in the activities of youth-serving organizations (youngblade & theokas, 2006). therefore, by converging the two perspectives into youth promotion practice, social work within the field of youth expands its practice beyond case management to youth group work as well as beyond welfare agencies to youth-serving organizations. definition of youth promotion. as a converging practice, youth promotion can be defined as a process of enhancing youth strengths and resources to promote positive outcomes and help young people be healthy and productive adults. as a synergistic way of convergence, youth promotion can be defined as having complementary goals of the two perspectives. for example, the strengths perspective on youth emphasizes relationship building and youth development focuses on developing the assets of youth advances in social work, fall 2008, 9(2) 183 based on youth-adult relationships (benson, 2003; 2007; scales & leffert, 1999). thus, youth promotion practice enhances strengths, relationships, and developmental assets of youth. the promotion of strengths and resources can increase psychosocial and competency-based outcomes and hence reduce risk for problem outcomes. youth promotion assumes positive acceptance of youth and values their role as active participants in their own positive development. resources and environments, including adults and professional support, also need to be emphasized in the youth promotion practices. in particular, the mechanisms for identifying and mobilizing youths’ strengths need to be developed in the process of implementing services (morrison et al., 1997). the term, “promotion” is utilized in the literature of youth development to mean that “efforts [are] specifically designed to bring about clearly defined positive outcomes, or designed to foster the development of skills and competencies in young people” (halpern, cusack, raley, o’brien, & wills, 1995, p. 1). promotion by this definition accepts the premise that youth have innate strengths and resources that need to be enhanced rather than developed. promotion also acknowledges use of strengths and promotes young people’s strengths (delgado, 2002). the term “promotion” is also utilized throughout the social welfare field and other helping professions. as a multidisciplinary concept that is on a continuum ranging from disease prevention to optimal health, the health promotion perspective also stresses capacities rather than deficits. according to durak (2000), health promotion believes that “individuals have high capacities for growth and development if their physical and social environments provide them sufficient opportunities, guidance, and support” (p. 225). family promotion is also applied in the family support field with stress on family strengths, informal support and resources, and helping as the mobilization of social and community resources (dunst, trivette, & deal, 1988). practice principles of youth promotion. practice principles play an influential role in carrying forth the perspectives into the field. the principles of youth promotion, as a social work practice which combines the strengths perspective and youth development, can be inferred from the existing principles of the strengths perspective and other efforts of infusing youth development principles into the social work field. for example, saleebey (1997) identifies five principles of the strengths perspectives: “(1) every individual, family and community has strengths; (2) trauma, abuse, and struggle may be sources of challenge and opportunity; (3) take individual, group, and community aspirations seriously; (4) collaborating with clients; and (5) every environment is full of resources” (pp. 12-15). each of these principles serves to guide and direct each element of the strengths approach. eccles and gootman (2002) summarize a list of features of settings that promote youth development based on the best available research: (1) physical and psychological safety; (2) clear and consistent structure and appropriate adult supervision; (3) supportive relationships; (4) opportunities to belong; (5) positive social norms; (6) support for efficacy and mattering; (7) opportunities for skill building; and (8) integration of family, school, and community efforts. cheon/youth promotion 184 delgado’s (2000) fourteen strengths principles for effective youth programming in youth development can be applicable to the youth promotion principles. as one of the principles, he recognizes activities for youth to participate in and opportunities for youth to increase their self-esteem. he also suggests a principle of effective youth programs to be built upon what youths value and their assets. according to his principles, programs must (1) emphasize innovative, dynamic, and comprehensive approaches to serving youth, (2) provide youths with opportunities to succeed and contribute to their community, (3) have multiple clear, high, and realistic expectations for participants, (4) be voluntary and provide youth with decision-making powers in shaping programming, (5) be built on quality staff and programming and a willingness to invest resources in support of staff, and (6) emphasize positive intergenerational mentoring relationships. all of these examples of principles are hypothetical qualities of the strengths-based practices that both meet the needs of developing adolescents and attempt to promote strengths rather than correct deficiencies. these sets of principles can apply to youth promotion practice with minor modifications. in addition, since the strengths perspective builds on the values of the social work profession (gleason, 2007; weick et al., 1989), youth promotion practice is also consistent with the code of ethics of the national association of social workers, as it acknowledges young people’s capacities and strengths, preservation of their dignity, the potential of their circumstances, and promotion of positive aspects of the young person from a value stance of self-worth and respect. key principles or themes of youth promotion practice. this promotion-based practice emphasizes two key principles or themes: strengths promotion and relationship promotion. first, strengths promotion is the most critical principle and theme of youth promotion practice. the basis for improving quality of life rests on developing youth strengths, but in order to build strength, one must start with existing strengths. all people can be viewed as having strengths. existing strengths can be valued, tapped, and enhanced and also new strengths can be acquired and developed. the strengths promotion principle is well inferred from the strengths perspective and youth development principles. for instance, the strengths perspective argues that, to be true to the values of the profession, we need to begin our work by recognizing people's capacities and the potential of their circumstances (weick, kreider, & chamberlain, 2005). youth development principles also offer a shift in perspective “away from a focus on correcting ‘deficits’ in individual youth toward enhancing the potential for healthy youth development in all youth in the community” (barton, watkins, & jarjoura, 1997, p. 484). second, relationships are at the heart of youth promotion practice. throughout the development of both the strengths perspective and youth development work, the importance of interpersonal relationships in the helping effort has been a constant theme. in the field of youth development, the relationships between young participants and adult youth workers have been shown to be an important protective factor for positive youth development. for the strengths perspective, “clients are engaged as partners; clients least able to function as partners will need an active helper who can structure growth experiences, ensure reasonable goals, and minimize barriers” (amodeo & collins, 2007, advances in social work, fall 2008, 9(2) 185 p. 77). thus, belief in youth strengths and facilitation of trustful relationship need to be emphasized as basic principles or key themes of the youth promotion practice. implications of youth promotion for social work with adolescents several advantages emerge as implications of youth promotion for improved social work practice. first, the long-standing dominance of discourse on youth as problems and pathologies can be further challenged and changed. youth promotion practices are expected to bring into the vision and the vocabulary of social work a compendium of human qualities that are the building blocks of human change. the strengths perspective and youth development approaches clearly focus on human capacity, assets, and aspirations, rather than on deficits and failure (arnold et al., 2007: rapp et al., 2005; saleebey, 2005) second, service to targeted youth can be strengthened from the strengths perspective and expanded to the provision of support and opportunities which is advocated by the youth development practice. the strengths perspective offers a way for social workers to move beyond the role of therapy to connect more deeply with the broad roles and goals of the social work profession. as a productive developmental process of growth, youth development can contribute to healthy, satisfying, and productive lives for adolescents by promoting their well-being. third, the social work profession can extend its service to the youth development field. one of the challenges that the youth development field faces is the question of who will step forth to claim this practice as their own. youth development practice needs professionals who can integrate values, skills, knowledge, and leadership into programs (borden & perkins, 2006). however, social work education does not really focus on youth development. youth promotion practice can supplement the lack of a “home” discipline for youth development, thus allowing social work to expand opportunities for the employment of its graduates. despite these advantages, since youth development principles have been incorporated into youth promotion practice, social workers who work with troubled youth tend to experience more challenges than other social workers. for example, social workers in specific agencies have to learn to walk in two worlds. as chalmers (2000) notes, staff need to learn “how to see youth as competent and as having potential, while also emphasizing problems enough to address important issues and to keep referral sources assured that they are attending to fixing problems and issues” (p. 27). agencies providing foster care need to become more deliberate in utilizing the strengths perspective and youth development principles to work with youth in care if youth are to reap the benefits of youth development efforts. therefore, by converging the two perspectives into youth promotion practice, better professional service, support, and opportunities can be provided to adolescents in need and all young people in the end. if promoted with acceptance and belief in the strengths perspective and positive development, adolescents will produce better outcomes and cheon/youth promotion 186 create more confident relationships in the community. their energy and strengths will contribute to the societal development in a more productive way. if the social work profession is to be relevant to youth promotion practice, social workers’ professed interest in a strengths perspective and youth development is necessary. if social work wants to infuse youth development principles into existing practices, it needs to emphasize “non-traditional” settings, such as youth-serving organizations and community development centers rather than traditional settings of child welfare agencies and schools. social work education must put more stress on the strengths perspective and positive normal development of youth. as the quest for new conceptual frameworks for practice is essential for continuing innovation and advances in social work, more studies to conceptualize youth promotion are needed for improved social work practice with young people. references addams, j. 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(1989). a strengths perspective for social work practice. social work, 34, 350-354. yip, k. (2006). a strengths perspective in working with an adolescent with self-cutting behaviors. child and adolescent social work journal, 23(2), 134-146. youngblade, l. m., theokas, c. (2006). the multiple contexts of youth development: implications for theory, research, and practice. applied developmental science, 10(2), 58-60. author’s note: address correspondence to: jeong woong cheon, ph.d., school of social welfare, university of kansas, 1545 lilac lane, lawrence, ks 66044-3184. email: jwcheon@ku.edu. mailto:jwcheon@ku.edu introduction historical contexts of practice with youth evolution of a strengths perspective and youth development convergence of a strengths perspective and youth development development and application of the strengths perspective and the converging characteristics of the strengths perspective youth promotion as a converging practice of the strengths pe implications of youth promotion for social work with adolesc references spring2005-049_page51 spring2005-050_page52 spring2005-051_page53 spring2005-052_page54 spring2005-053_page55 spring2005-054_page56 spring2005-055_page57 spring2005-056_page58 spring2005-057_page59 microsoft word thomas_sw knowledge and use of strengths_final _________________ madhavappallil thomas, ph.d., is associate professor and barbara reifel, msw, lcsw, is a lecturer, both in the department of social work, california state university, bakersfield. copyright © 2010 advances in social work vol. 11 no. 1 (spring 2010), 17-32 child welfare workers’ knowledge and use of a resilience approach in out-of-home care madhavappallil thomas barbara reifel abstract: this paper examines child welfare workers’ use of resilience-based knowledge and intervention in a public child welfare system in a county in california. the data for the study were collected from child welfare workers who worked with out-of-home care children (n= 102). descriptive analysis including chi-square tests was carried out. findings show that a significant majority of child welfare workers are able to correctly identify risk and protective factors that are central to the concept of resilience. although a significant majority recognizes the importance of using a resilience-based approach, most workers without a degree in social work are not familiar with it and are not currently using it in their practice. in terms of familiarity with and in the use of resilience-based assessment and interventions, significant differences were found to exist between workers with degrees in social work and workers without degrees in social work. implications for social work education, agency training, and practice in child welfare are discussed. key words: child welfare, resilience-informed intervention, risk factors, protective factors, out-of-home care services. introduction out-of-home care services have become the most widely used intervention with abused, neglected and abandoned children. it is, therefore, extremely important that the benefits of out-of-home care be optimized. knowledge of resilience-based assessment and intervention can aid child welfare workers in effectively working with the families of children who enter and reenter foster care. an in-depth understanding of a resiliencebased approach will help reduce the risk factors and enhance the protective factors in the life of the child in out-of-home care. such an approach has the potential to enhance prevention and provide growth-promoting opportunities, lead to the development of resilience-based assessment, intervention, and case management, and promote more positive outcomes. researchers have identified several factors, such as having multiple placements, being an older child, having an insecure attachment to parents, living in poverty, having behavior problems or special needs, and having a brief stay in an out-of-home placement, as “hazards” or risks, which make children more likely to re-enter out-of-home care after they have been reunified with their families (courtney, 1995; davis, sandsverk, newton, & ganger, 1996; festinger, 1996; fraser, walton, lewis, pecora, & walton, 1996; george & wulczyn, 1990; jones, 1998; palmer, 1996; wells & guo, 1999). likewise, a number of resilience or protective factors, such as having a sense of being loved, a positive ethnic identity, family flexibility, and attendance at good schools, are known to thomas, reifel/child welfare workers’ knowledge of resilience 18 help shield vulnerable children from high-risk situations (conger & conger, 2002; douglass, 1996; fergusson & lynskey, 1996; henry, 1999; miller & macintosh, 1999; laframbose, coleman, & gerton, 1993; palmer, 1996; patterson, 2002; smokowski, 1998; werner & smith, 1982). child welfare workers who are aware of these risk and protective factors should be better able to develop interventions to enhance resilience and minimize risk than child welfare workers who have limited knowledge and skills in using this perspective. it is therefore important to examine child welfare workers’ level of such skills and knowledge in order to address any deficiencies. against this backdrop, the study examines the extent to which child welfare workers understand and use resilience-based knowledge and skills in working with children in foster care and whether child welfare workers with a degree in social work differ significantly from workers without social work training in their understanding and use of resilience based assessment and intervention. resilience as a construct resilience as a concept emerged in the 1970s and represented a paradigm shift from psychopathology to the identification of protective and risk factors, which differentiate resilient individuals from non-resilient individuals (anthony, 1987). recent literature indicates that researchers have operationalized the construct of resilience as both a process and an attribute or trait. generally defined, resilience refers to “manifested competence in the context of significant challenges to adaptation” (masten & coatsworth, 1998, p. 206). it has been viewed as interactional in nature and defined as a “dynamic process encompassing positive adaptation within the context of significant adversity” (luthar, cicchetti, & becker, 2000, p. 543). in contrast, others consider resilience to be an attribute or trait of the individual. viewed from this perspective, it is the ability to maintain adaptive functioning in the presence of risk factors without experiencing serious long-term harmful effects largely due to characteristics of the resilient individual (nash & bowen, 1999). luthar et al. (2000) argue that the terms resilience, resiliency, and the concepts they represent must be differentiated. they describe resilience as most closely related to a “dynamic process” through interaction between the person and their environment at various levels. resiliency, on the other hand, represents the construct as a trait or characteristic, which is not as amenable to intervention or change. in making the choice to use only the term resilience and the meaning ascribed to this term by luthar et al. (2000), the authors believe the appropriate emphasis is given to the aspects of this construct which are most amenable to change and avoid any sense of “blaming the victim” for having what might be considered by some as “low resiliency.” for the authors, the study of “resilience” as opposed to “resiliency” leads to prioritization of the search for effective ways to decrease risk factors and increase protective factors in order to enhance the resilience. gilligan (2004) has also affirmed this distinction by indicating acceptance of the definition of resilience as a dynamic process and promoting this definition as the most useful for related conceptualizations and studies on the topic. advances in social work, spring 2010, 11(1) 19 although strengths and resilience have often been used interchangeably in the literature, goldstein (1997) sees resilience as the attribute that epitomizes and operationalizes the conceptual framework of the strengths perspective. the strengths perspective emphasizes the resources, assets, potentials, and capabilities of individuals, groups, families, and communities (saleebey, 1997). this approach also marks a paradigmatic shift from the typical human service perspective from a focus on pathology and deficits to a strengths perspective which asks what is right. the strengths perspective emphasizes such concepts as empowerment, dialogue, and collaboration. based on a review of the literature, it is logical to surmise that the two concepts— resilience and the strengths-based perspective—are closely linked and quite complementary. however, there is an important distinction between the two concepts. resilience is a dynamic process which exists in the interaction between clients and their environments, whereas the strengths perspective describes the helping professional’s positive framework which enhances the ability to identify and apply resilience-informed assessments and interventions in practice. unless the client is viewed from a strengthsbased perspective, the worker is likely to miss the resilience factors associated with a particular client and his or her environment and thus be less able to build on them. literature review no research appears to have been published on the subject of child welfare workers’ attitudes toward resilience or knowledge concerning resilience. this is also true regarding child welfare workers’ application of resilience-informed assessment, interventions, and/or case management in practice settings. several major databases were queried for this review (i.e., academic search elite, eric, psycharticles, psychinfo, sociological abstracts, social sciences citation index, social service abstracts, and social work abstracts). results indicate that there have been many studies involving resilience in the social work literature but none of the authors could locate any investigations of child welfare workers’ attitudes toward resilience, knowledge of resilience, or actual use of resilience in social work practice contexts. social work researchers have made a convincing case for the utility and effectiveness of resilience as an organizing framework for research in social work (fraser & richman, 1999; gilgun, 1996). as a result, an increasing number of social work researchers have used resilience as the overarching construct that guides studies in a wide variety of practice arenas (coombes & anderson, 2000; dillon, liem, & gore, 2003; early & vonk, 2001; flynn, ghazal, legault, vandermeulen, & petrick, 2004; fraser & richman, 1999; gilgun, keskinen, marti, & rice, 1999; greene, 2002; johnson et al., 1998; kaplan, turner, norman, & stillson, 1996; little, axford, & morpeth, 2004; nash & bowen, 1999; freedman, 2004; van breda, 1999). for instance, early and vonk (2001) use resilience and related concepts (protective and risk factors) to frame a review of several effectiveness studies concerning the practice of school social workers. in addition, compilations of research on resilience applied to many topics of great interest to social workers are available (fraser & richman, 1999), most notably, two recent books which include the works of several authors (fraser, 2004; greene, 2002). thomas, reifel/child welfare workers’ knowledge of resilience 20 many articles reflect the state of the research as skewed more toward the identification of risk factors than protective factors (little, et. al., 2004). fraser and richman (1999) supply a reason for this imbalance, when they point out that research on resilience seems to indicate risk may be “more potent than protection” when high levels of risk are encountered. though this may be the case, notable recent efforts are being made to present a more balanced approach with empirical findings concerning applicable protective factors listed simultaneously with risk factors (corcoran & nichols-casebolt, 2004; fraser & galinsky, 2004; thomas, chenot, & reifel, 2005: thomlinson, 2004). corcoran and nichols-casebolt (2004) have outlined the utility of resilience for assessment, goal formulation, and intervention planning based on empirical evidence. their work is very important in light of the present study. finally, there have also been studies concerning the resilience of social workers in various practice arenas (egan, 1993; horwitz, 1998). however, many child welfare workers do not appear to have much familiarity with the concept of resilience or how it might be applicable in various practice situations. one of the social work specializations which appears most interested in resilience is school social work (bein, 1999; early & vonk, 2001; reimer, 2002). this may be due to the long-standing interest in resilience in the field of education and the fact that much of the resilience literature has focused on childhood. however, even in the literature devoted to school social work, there do not seem to be any studies on social workers’ familiarity with resilience, knowledge of resilience or applications of resilience-based treatment. in spite of child welfare workers’ lack of familiarity with resilience and its implications for practice, there is an increasing body of knowledge addressing the effectiveness of many resilience-informed interventions (fraser & galinsky, 2004). thomlinson (2004) describes a number of interventions that have been empirically researched and found to be effective in addressing issues leading to or resulting from child maltreatment on an individual, family, and environmental level. for example, there are programs that have been found to be effective for increasing parenting skills or for enhancing family social support, both of which are related to resilience. as pointed out by fraser and galinsky (2004), effective social work practice utilizes strategies that enhance protective factors and minimize risk factors in a child’s individual life, family life, and community. child welfare workers who are operating from a resilience-informed perspective must be aware not only of the risk and protective factors that make up resilience, but also of interventions that have been found to be effective in increasing resilience. corcoran and nichols-casebolt (2004) have developed a framework for assessing risk and protective factors and developing related goals for intervention on three levels: the micro (individual and family), mezzo (neighborhood, school, church), and macro (broader society). for example, intervention goals for a child who is born with low intelligence might be to increase parenting skills (micro), to develop school programs for special needs children (mezzo), or to advocate for educational funding for special needs children (macro). advances in social work, spring 2010, 11(1) 21 as brought out by the literature review, researchers have made a convincing argument for the usefulness and effectiveness of the resilience perspective and its relevance to practice. however, there is hardly any research about child welfare workers’ attitudes toward or knowledge about the use of resilience in practice. distinguishing it from other studies, this study examines child welfare workers’ application of resilienceinformed assessment and intervention. it further answers the question whether child welfare workers with a degree in social work are more likely to use resilience based approach in their practice than those with non-social work training. methodology the purpose of the study was to examine child welfare workers’ self-reported knowledge and skills in using resilience-based assessment, intervention, and case management in working with children in the public child welfare system in a central california county. accordingly, the data for the current study were collected from a public child welfare services (cws) agency in a central california county. all of the child welfare workers contacted had worked or were currently working with children in out-of-home care. a self-administered questionnaire consisting of closed and open-ended questions was used to collect information from the respondents. in order to examine respondents’ knowledge of resilience approach, a selected number of variables from the literature review were identified and listed as risk and protective factors associated with the concept of resilience. respondents were then asked to put a check in one of the appropriate boxes marked as “protective factors” and ‘risk factors.” questionnaires were then distributed to 240 child welfare workers, and 102 completed questionnaires were returned which resulted in a response rate of 42.5%. the data collected from the 102 completed questionnaires were analyzed using spss. descriptive analysis including chi-square was performed in order to achieve the study objectives and answer the research questions. qualitative data were also analyzed by identifying the major themes. the following section summarizes the main findings of the study. findings demographic profile respondents’ ages ranged from 24 to 65 years with the mean age of 39.37 years (sd = 10.21). with respect to gender, 69% of the respondents were females and 31% were males. in terms of educational qualification, 24% had msw degrees while nearly twothirds (65%) had undergraduate degrees. the majority (53%) had social and behavioral science as the major. while 24% reported social work as their major, the rest had counseling, psychology and business administration as their major. the respondents worked in a variety of programs such as adoptions (8.8%), family services such as family reunification, family maintenance, court review (25.5%), independent living and family decision making, etc. (11.8%), emergency response (9.8%), court intake (15.7%), long term foster care/permanent placement (27.5%), thomas, reifel/child welfare workers’ knowledge of resilience 22 and licensing (1%). their length of experience in these programs ranged from three months to 30 years with a mean of 6.09 years (sd = 5.57). most of the respondents were child welfare workers along with a few supervisors, one program specialist, and one program director. child welfare workers’ knowledge of the concept of resilience review of literature indicates that resilience includes concepts such as: risk factors, protective factors, vulnerability, adversity/trauma, adaptation and buffer. to examine the extent of child welfare workers’ understanding of resilience, respondents were asked to identify whether or not the above listed concepts are associated with resilience. as shown in table 1, a significant majority of child welfare workers correctly identified all the listed concepts as associated with resilience. clearly, from a conceptual standpoint, most of the workers were able to identify some of the resilience constructs. table 1. understanding of constructs associated with resilience yes no total risk factors 72.5% (66) 27.5% (25) 100% (91) protective factors 79.1% (72) 20.9% (19) 100% (91) vulnerability 82.0% (73) 18.0% (16) 100% (89) adversity/trauma 83.7% (77) 16.3% (15) 100% (92) adaptation 91.4% (85) 08.6% (8) 100% (93) buffer 73.0% (65) 27.0% (24) 100% (89) similarly, from the literature review, a selected number of variables identified by the researchers as risk and protective factors were listed. as child welfare workers, respondents were asked to mark whether a given variable is a risk or protective factor associated with resilience in the provision of child welfare services. it was thought that the correct identification of these factors by the majority of the respondents would be further evidence of their understanding of resilience and its application to various situations related to clients. table 2 presents data on the child welfare workers’ views on risk and protective factors. advances in social work, spring 2010, 11(1) 23 based on the literature review, protective factors used in the questionnaire and presented in table 2 include sense of being loved, positive ethnic identity, family flexibility, and attendance at good schools. risk factors include multiple placements, being an older child, having a brief stay in out of home placements, having an insecure parent-child attachment, coming from a single parent family, living in poverty, and being a child with special needs. as shown in table 2, an overwhelming majority of the respondents correctly marked sense of being loved (98%), positive ethnic identity (91.8%), attendance in good schools (88.8%) and family flexibility (85.7%) as protective factors. similarly, most of them correctly identified multiple placements (91.8%), single parent family (91.5%), living in poverty (93.8%), and child behavioral problems (98%) as risk factors. interestingly enough, “being an older child” stands out as a variable which 59.2% identified as a protective factor while the existing literature identifies it as a risk factor. table 2. views of risk and protective factors related to resilience factors protective factors risk factors total sense of being loved 98.0% (96) 2.0% (2) 100% (98) positive ethnic identity 91.8% (90) 8.2% (8) 100% (98) multiple placements 8.2% (8) 91.8% (90) 100% (98) family flexibility 85.7% (84) 14.3% (14) 100% (98) being an older child 59.2% (58) 40.8% (40) 100% (98) attendance at good schools 88.8% (87) 11.2% (11) 100% (98) brief stay in out of home placement 37.8% (37) 62.2% (61) 100% (98) insecure parent/child attachment 4.0% (4) 96.0% (95) 100% (99) single parent family 8.5% (8) 91.5% (86) 100% (94) living in poverty 6.3% (6) 93.8% (90) 100% (96) child behavior problems 2.0% (2) 98.0% (97) 100% (99) child with special needs 4.1% ( 4) 95.9% (94) 100% (98) the study participants were asked to write about their knowledge and understanding of a resilience-based approach in the context of child welfare practice. the majority of respondents had limited knowledge about the approach or were unfamiliar with the thomas, reifel/child welfare workers’ knowledge of resilience 24 approach. it is important to exercise caution since the majority of the respondents in this sample had social and behavioral sciences as their major and did not have a degree in social work. however, some participants felt child welfare staff used this approach. the themes derived from the qualitative data included: 1) resilience may be genetic; 2) resilience approach identifies strengths of the child and identifies the risk factors as a way to foster resilience in a child; 3) resilience approach is the ability of a child to recover from a traumatic situation and 4) resilience approach encourages intervention that strengthens families through developing supports in the family’s environment. these themes show that participants’ understanding of the resilience-based approach primarily includes identifying strengths within the individual’s and/or family’s environment in an effort to foster support systems that will assist individuals and families in becoming autonomous or in recovering from traumatic experiences. some comments about a resilience-based approach that highlight these themes include: this focuses on a child’s strengths and how to foster those strengths by reinforcing the child’s sense of self worth, and strengthen family ties … use strengths of the child in order to increase the child’s self image and therefore impact the child’s life familiarity with and use of resilience table 3 presents data on the familiarity with and use of resilience-based interventions by child welfare workers sorted by those with a degree in social work and by those without a degree in social work. findings show that 96% of workers with a degree in social work are familiar with the concept of resilience compared to 45% of workers without a degree in social work. these differences are found to be statistically significant (df = 1, p< .0001). similarly, 54% of respondents with a degree in social work reported familiarity with the use of resilience-based interventions in child welfare services (cws) practice. in sharp contrast, only 12% of workers without a degree in social work are reported to be familiar with the use of resilience-based interventions. these differences are found to be statistically significant (df = 1, p< .0001). similar differences are found to exist between workers with a degree in social work and workers without a degree in social work in terms of their current and past use of resilience-based interventions and or case management in working with out of home care children (df = 1, p< .04). advances in social work, spring 2010, 11(1) 25 table 3. child welfare workers’ degree and familiarity with and use of a resilience-based approach question social work degree no social work degree are you familiar with the concept of resilience? yes 23 (95.8%) 32 (45.1%) no 1 (04.2%) 39 (54.9%) df = 1, p < .0001 are you familiar with the use of resiliencebased interventions in child welfare services? yes 13 (54/2%) 9 (12.3%) no 11 (45.8%) 64 (87.7%) df = 1, p < .0001 do you currently use any resilience-based assessment or case management in working with foster care/child welfare? yes 10 (43.5%) 14 (21.5%) no 13 (56.5%) 51 (78.5%) df = 1, p < .04 have you used any resilience-based assessment or intervention in working with foster care/child welfare in the past? yes 11 (45.8%) 15 (23.4%) no 13 (54.2%) 49 (76.6%) df = 1, p < .04 study participants were asked to describe their understanding of the concept of resilience. qualitative analysis of the data shows that the majority of the respondents had some familiarity with the concept. some of the ideas related to the resilience concept include: 1) ability of the children to “bounce back” from adverse situations; 2) ability to adapt to various situations; 3) elements of the social environment that contribute to healthy adoption of children and families; 4) child’s strength in family and foster family areas; and 5) use of coping mechanisms under stress. these themes show that the respondents viewed resilience as including both the ability to bounce back from adverse situations or traumas and the existence of certain elements in the family or environment that contribute to the healthy development of individuals despite the adversities of their life. the following quotes on resilience concepts support the above discussion: being able to bounce back to normalcy from a traumatic experience, illness or misfortune thomas, reifel/child welfare workers’ knowledge of resilience 26 ability to overcome odds that others seem to succumb to those elements of the social environment that contributes to healthy adoption of children and families to the environment this study also examined whether or not child welfare workers used any resiliencebased interventions in their work with the children. respondents were asked to describe their understanding of resilience-based interventions. qualitative analysis of the data shows that some of them consider the use of the strengths perspective as synonymous with resilience-based interventions. the major themes derived from this question are: 1) using services that minimize trauma and builds on strength; 2) using a strengths-based approach; 3) cultivating strength in children and families to increase functioning; and 4)fostering protective factors. these themes are generally related to strengths perspective, and child welfare workers in this study seem to relate resilience mostly with strength. the following are some of their responses on resilience-based interventions: any meetings or assessment to assist the family with getting back to normalcy providing preventive services to clients to strengthen their support structure utilizing/cultivating strengths in families/children to increase functioning the participants were asked to describe whether or not they used any resilience-based assessments, interventions, or case management techniques in working with foster care/child welfare in the past. the majority of the respondents were able to identify some techniques used in their current practice that they believed were related to resilience. the themes derived from the qualitative data analysis included: 1) using a strengths-based approach with families as a technique; 2) using resilience-based assessments including a “multi-integrated service” approach (active collaboration with various community agencies); 3) using the community resources to support a child’s current living environment; 4) maintaining a child’s connection to a significant adult, to the child’s family, and to other support systems; and 5) feeling that the child welfare worker’s practice itself is based on a resilience-based approach and assessment. excerpts about child welfare workers’ use of resilience-based assessments, interventions, and case management that highlight these themes include: build on child’s strengths—provide child with positive experiences and positive understanding of self … ssw’s can intuitively identify those strengths on which to build … use of community resources, concurrent planning, permanency planning, least restrictive placements … use strengths of the child in order to increase the child’s self image and therefore impact the child’s life the respondents’ perceived importance of resilience-based assessment, intervention, and case management has been analyzed. on a scale of 1 to 5, with 1 being “not important” and 5 being “important,” child welfare workers were asked to rate “how important do you think it is to use resilience-based assessment, interventions and case advances in social work, spring 2010, 11(1) 27 management in out of home care services?” their responses show that a majority think it is important or very important to use resilience-based assessment (65%), resilience-based intervention (68%), and resilience-based case management (66%). clearly, child welfare workers do recognize the importance of using a resilience-based approach to working with children in out-of-home care. the study further explored whether or not respondents’ education and training contained any course work on resilience in general or resilience-based assessment, intervention and case management. for this, the education variable was recoded into child welfare workers with a degree in social work and child welfare workers without a degree in social work. this variable has been further analyzed using whether respondents’ education included content on resilience. the findings reveal that while 79% of workers with a degree in social work reported that resilience was discussed in their course work, only 17% of workers without a degree in social work stated that resilience was discussed in their course work. furthermore, 36% of workers with a degree in social work also reported that their course work included specific resiliencebased assessment, interventions and case management. in contrast, 88% of workers without a degree in social work stated that their course work did not include specific resilience-based assessment, interventions and case management. clearly, this has implications for practice and for the hiring decisions made by public child welfare programs. discussion a significant majority of child welfare workers correctly identified all the listed constructs associated with the concept of resilience. similarly, most of them correctly identified risk and protective factors which are central to the understanding of resilience concepts. they were able to group most of the constructs that were listed in the questionnaire into risk and protective factors. however, findings from qualitative analysis show that majority of the respondents were not very aware of the difference between resilience and the strengths perspective. for example, major themes which emerged from qualitative analysis concerning child welfare workers’ knowledge about resilience seem to center on identifying strengths within the individual, family, and the environment. many respondents described resilience as use of services that minimize trauma and build on strength or use of interventions related to strengths-based approaches to enhance functioning. a similar interchange of concepts is evident in the literature: some writers describe strengths and resilience as synonymous. in terms of familiarity with and use of resilience concept in their practice, findings reveal a significant difference between workers with a degree in social work and workers without a degree in social work. clearly workers with a degree in social work are more familiar with the concept of resilience and in the use of resilience based approaches in their practice. similar differences are also observed between workers with and without a social work degree in their current use of resilience based assessments and interventions. clearly, resilience based assessment and interventions are currently used more by workers with a social work degree. this has implications in the public child welfare thomas, reifel/child welfare workers’ knowledge of resilience 28 system for hiring social workers who are trained to use a resilience-based approach in working with children. the majority of workers without a degree in social work reported that a resilience framework was not discussed in their course work nor did the course work include specific resilience based assessments, interventions, and case management. these findings have implications for hiring social workers over non-social workers and for providing additional training for non-social workers in the use of resilience-based approach. if public child welfare system hires workers with a degree in social work, they are more likely to incorporate resilience informed practice in working with at-risk children. such resilience-based assessment and intervention strategies focusing on identifying and building protective factors for at-risk children can enhance quality of service. it is equally important to provide extra training for non-social workers in the use of resilience-based approach in working with out of home care children. such education and training is likely to improve the success rate of out-of-home care services. despite the differences between child welfare workers with social work degree and without social work degree, a significant majority of child welfare workers think that it is important or very important to use resilience-based assessment, intervention, and case management in their work. clearly, child welfare workers in general do recognize the importance of using a resilience-based approach to working with children in out-of-home care. given the nature of risk and vulnerability found in these children, child welfare workers possibly realize the importance of building on the protective factors which in turn can buffer the risk factors. in terms of practice, child welfare workers’ knowledge of resilience-informed interventions not only helps them to refocus on the assets and resources of the child, but also stimulates children and families to build on resources. knowledge of a resilience informed framework helps the workers to focus on protective factors and sow the seeds of prevention at an early stage in the intervention process (thomas, chenot & reifel, 2005). this is possible only if all child welfare workers, including those without a degree in social work, possess the knowledge and skills to use resilience-based interventions. although the findings of this study add to the existing literature, there are several limitations that need to be considered. the study employed a convenience sample of child welfare workers currently working in the public child welfare system of a central california county. such a sampling method does not assure adequate representativeness of the population. thus, the results cannot be generalizable beyond the study population. it should be noted that this is primarily a baseline study, and, by intent, exploratory. hence, it only provides an empirical base for future theoretical formulations, by identifying a matrix of important variables associated with knowledge and skill levels of some child welfare workers. these factors serve as external threats to the generalizability of the study’s findings to child welfare workers in other settings. the weak response rate is yet another threat to the external validity of this study. advances in social work, spring 2010, 11(1) 29 conclusion the majority of child welfare workers in this study are familiar with the concept of resilience, recognize its importance, and believe that a resilience-informed practice is important. however, the majority also state that they do not use resilience-based assessments, interventions, or case management. furthermore, the majority of child welfare workers without a degree in social work state that the concept of resilience and its implications for practice were not discussed during their education and training. child welfare workers with a social work degree are more likely 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(1982). vulnerable but invincible: a study of resilient children. new york: mcgraw-hill. author’s note: address correspondence to: madhavappallil thomas, ph.d., department of social work, california state university, bakersfield, 9001 stockdale highway, bakersfield, ca 93311-1099. email: mthomas5@csub.edu spring2000-069_page61 spring2000-070_page62 spring2000-071_page63 spring2000-072_page64 spring2000-073_page65 spring2000-074_page66 spring2000-075_page67 spring2000-076_page68 spring2000-077_page69 spring2000-078_page70 spring2000-079_page71 spring2000-080_page72 spring2000-081_page73 spring2000-082_page74 spring2000-083_page75 spring2000-084_page76 spring2000-085_page77 spring2000-086_page78 fall2005-049_page276 fall2005-050_page277 fall2005-051_page278 fall2005-052_page279 fall2005-053_page280 fall2005-054_page281 fall2005-055_page282 fall2005-056_page283 fall2005-057_page284 fall2005-058_page285 fall2005-059_page286 fall2005-060_page287 fall2005-061_page288 fall2005-062_page289 fall2005-013_page240 fall2005-014_page241 fall2005-015_page242 fall2005-016_page243 fall2005-017_page244 fall2005-018_page245 fall2005-019_page246 fall2005-020_page247 fall2005-021_page248 fall2005-022_page249 fall2005-023_page250 advances vol. 3, no. 1 in the belly of the beast: a case study of socialwork in a managed care organization lisa s. patchner abstract: the employment of social workers within managed care organizations is a new phenomenon. as such, this case study utilized an exploratory-descriptive design that assessed social workers as case managers within a medicaid hmo. the semi-structured interviews, focus groups, and participant observation suggested that the use of casemanagement services, delivered primarily by social workers,was effective in addressing the bio-psychosocial needs of medicaid consumers within a provider-drivenhmo.study findings recommend specific knowledge and skills that social workers need in order to prepare for practice within managed care environments. keywords: managed care; medicaid; case management; hmo, health care policy as managed care more completely penetrates the health care and public service delivery markets, the industry can expect to enroll increased numbers of high-risk populations.with advances in medicine, coupled with the aging of the population, there are increased numbers of individuals with chronic illnesses and complex psychosocial concerns that require long-term health and community-basedservices (u.s.generalaccountingoffice, 1996).themanagedcare industry, familiar with the provision of a lower-cost alternative to traditional indemnity insurance forhealthypopulations, has limited experience servinghigh-risk populations (kaiser commission, 1995). as kelly (1997) reported, most managed care companies are inexperienced in the supply of community support services (i.e., psychosocial services, outreach, casemanagement, and transportation) needed to manage health care and promote wellness among high-risk populations.with the increased privatization of medicaid, leading to managed care arrangements, the industry has had to hasten delivery systems to meet the health and social service needs of a growing, heterogeneous population. even thoughmanaged care continues to grow at a rapid pace, there have been no empirical studies of social workers’ involvement in private managed care organizations. this study represents a beginning attempt at understanding professional social work involvement in the evolving managed health care delivery system by examining social workers employed in a medicaid managed care organization. specifically, this case study investigated the role and functions of social workers in a 16 lisa s. patchner, drph., lsw., acsw is associate professor, socialwork department, ball state university, muncie, indiana 47306-0525. copyright© 2002 advances in socialworkvol. 3 no. 1 (spring 2002) 16-32. indiana university school of socialwork. medicaidmanaged care organization, and determined the structure and function of casemanagement servicesofferedby these socialworkers. implicationsaredrawn for social work’s involvement inmanaged care organizations and for the education of future professional social workers for casemanagement positionswithinmanaged health care organizations. background managed care will increase its penetration into the continuum of care in order to demonstrate efficient and cost-effective health improvement for large, chronically ill populations (goldsmith, goran&nackel, 1995). expansion into the provision of community services alters the treatment focus from acute care to chronic care, and highlights the need for cost-effective, long-term care management of the chronically ill and other high-risk consumers (moore-greene, 2000). social work case management models have traditionally been applied in the coordination and linkage of service components within the service delivery continuum. in providing case management services, social workers transition highrisk clients with chronic illnesses to appropriate levels of care in order to increase desired health outcomes and decrease inappropriate utilization of services. traditionally found within community service settings, case management services have begun to emerge as an important component of insurance utilization management. managed care systems have begun to integrate case management strategies into their organizational processes in order to coordinate acute and chronic care services for increased medicaid enrollments (kaiser commission, 1995). as medicaid managed care systems provide the consumer with a primary care provider and facilitate the coordination of integrated services through case management services, better population health outcomes should emerge. according to a recent health care financing administration (hcfa) press office fact sheet onmanaged care in medicare andmedicaid (u.s. dept. of health and humanservices, 1997), enrollment inmanaged care plans has experiencedunprecedented growth. in 1999, more than half (55.59%) of the national medicaid populationwas enrolled in amanaged health care plan (u.s. dept. of health andhuman services, 2000). the accelerated growth ofmedicaidmanaged care systems, which serves the most vulnerable populations, is the result of a failure to agree upon a national healthpolicy, increased fiscal deficits, and inequalities of access toprimary medical care. most states have focused theirmanaged care enrollments on low-income families, which constituted approximately 73% of the medicaid population in 1994 (u.s. general accountingoffice, 1996). as states initiatemandatedmanaged care for their entire medicaid populations, individuals with disabilities, who represented approximately 15% of the 1994 medicaid population and account for more than one-third of medicaid expenditures, will also challenge states to provide quality health care to a diverse population. additionally, the prevalence of chronic illnesses and disabilities among children enrolled in the former afdc and current tanf programs isapproximately twice thatof children fromthegeneralpopulation (meyers, lukemeyer&smeeding,1998).accordingtoarecentstudy(shatin,levin, ireys&haller, 1998), children with selected chronic health conditions are enrolled at a higher 17patchner/in the belly of the beast: a case study of socialwork in amanaged care organization 18 advances in socialwork rate inmedicaidmanaged care plans than inprivatemanaged care plans, and those enrolled inmedicaidmanaged care plans requiremore services than childrenwith similar conditions who are enrolled in private managed care plans. due to the heterogeneity of chronic disabling conditions and demographic trends, individuals with chronic illnesses and disabilities will need awell-designed service delivery continuum (the institute for the future, 2000). somers and martin (1997) state: health plans entering the medicaid marketplace must adapt their health care delivery systems to serve the disabled and aged populations. purely medical-model health care delivery systems must become social-model organizations able to coordinate bothmedical care and social services. (p. 2) a series of recommendations is beginning to emerge from advocacy, research, government, and industry experts indicating that a refined and informed approach to meeting the unique health care needs of high-risk populations, including those with chronic health care needs, is urgently needed. the kaiser commission (1995) asserts that the special needs, ethnic characteristics, and other unique features of the medicaid population must be addressed when designing effective managed care systems for low-income consumers. their report further indicates that such services as case management and care coordination have the potential to improve health delivery by modifying managed care services to address unique health concerns. the pewcommission (1995) predicts that the future americanhealth care system will bemore concernedwith disease prevention, health promotion, and caremanagement, and less focused on specific medical treatments. the commission recommends that health professionals broaden their understanding of the psychosocial-behavioral sciences, population health promotion strategies, and health management sciences in order to better meet national health needs. the pew commission also asserts that thenewly emergingdemand-drivenhealth care system warrants consumer-focused and culturally-sensitive health care delivery. preister (1996) recommends a new model of consumer-focused delivery that incorporates four characteristics: community-based human services; flexible and holistic services; family-centered services; and professional services that reflect accountability. additionally, preister (1996) stresses that families need to partner with case managers to design consumer-focused interventions. mcmanus, fox, and newacheck (1996) acknowledge the important contributions of case management services to families of children with special health needs. according to nicolaysen (1996), the need for case management within managed care will continue to grow as wellness among high-risk populations is promoted, thus indirectly reducing costs and contributing to cost containment. harris (1992) anticipates that in addition to educating consumers about health prevention, there will be more emphasis on improved health outcomes by better management of clinical interventions. others predict thatmanaged carewill focus more uponmanaging health outcomes of high-risk populations (goldsmith, et al., 1995; u.s. gao, 1996). as managed care better adapts its service delivery systems to address the needs of high-risk populations, increased opportunities for professional case managers 19 will emerge. although various professions have provided case management services, social workers continue to bemost commonly associated with case management, especially at the community level. the national association of social workers (1992) defines social work case management as: amethod of providing services whereby a professional social worker assesses the needs of the client and the client’s family, when appropriate, and arranges, coordinates, monitors, evaluates, and advocates for a package of multiple services to meet the specific client’s complex needs. (p.5) long familiar to social workers, case management has grown in importance in health care due to the changing health needs of the population and the resulting changes in health delivery systems. landgarten (1988) argues that the growth of case management services reveals the fragmentation and inefficiencies throughout the health care delivery system. he asserts that case management attempts to reintegrate the fragmented health delivery system tomeet the convergent needs of the consumer, payers, and providers. as the u.s. population is increasingly covered under managed health and welfare services, the expertise of social work case managers in serving high-risk populations will be sought out by the private managed care sector. social workers are specifically trained to utilize tested interventions from community-based programming and adapt these to managed care settings in order to deal with problems of access to services, continuity of care, and chronic care management (hughes, 1999). despite these opportunities, social workers have generally avoided working for managed care organizations even though their knowledge, skills, and values could greatly benefit persons served by these plans. reluctance on the part of professional social workers to seek employment in managed care systems is due, in part, to an historical aversion to participate in the for-profit sector of the economy. in addition, the ethical issues surrounding cost-containment measures implemented by these systems have made them suspect to the profession. however, due to their specific skills and training, social workers can make significant contributions to the availability, accessibility, and quality of services provided through managed care arrangements. methodology this case study examined social workers in a medicaid managed care system and described the unique applications of social work casemanagement services in this environment. specifically, the study had two major foci. the first was to analyze the role and functions of social workers in a medicaid managed care organization serving thewestern region of amiddle atlantic state.the secondwas to describe the structure and functionof casemanagementwithinamedicaidmanagedcare system. setting a for-profit, managed care organization that delivers an hmo product specifically designed for the medicaid population served as the setting for the study. the health plan began in november 1992, when an agreement and plan of limited partnership was signed by three major health care organizations. two of the three partners are not-for-profit organizations and the third is for-profit. the health plan patchner/in the belly of the beast: a case study of socialwork in amanaged care organization 20 advances in socialwork began enrollingmedicaid recipients in july 1993 with a start-up population of 111, and at the time of this study, covered more than 102,000 beneficiaries. the health plan began serving one county and expanded to a 16-county area. as a network model hmo, the health plan concentrated on developing a quality provider network with a strong internal utilization management structure during its early development. as membership increased, attention to both the external and internal delivery process led to further refinement of health services, specialized case management, quality improvement techniques, and utilization management. incrementally, health improvement strategies utilizing disease prevention programs (i.e., asthma program, maternal health program), member education, and targeted casemanagement were implemented. this particularmedicaidmanaged care organization was selected for study because they had a unique case management unit where social workers played an integral part in the delivery of case management services to a high-risk medicaid population. design given the complexity of case management, several data collection methods were employed. these included interviews with case managers and the mswmanager of the unit, focus groups with consumers, and participant observation. face-to-face interviews were held with eight case managers. five were mswlevel social workers, two were bsn-level nurses, and one was a ms-level rehabilitation counselor. the interviews focused on assessing their specific roles and functions and ascertaining the model of intervention that they employed. semi-structured interviews allowed for in-depth questioning about the casemanagers’ specific roles and functions, and their use of case management interventions. each interview occurred at the casemanager’s workstation and took approximately 45 minutes to complete. in addition, this investigator engaged in participant observations of the operations of the case management unit. these day-long observations occurred oneto-two days a week for a 15-month period. the purpose of these observations was to gain a comprehensive understanding of the structure, function, and practices of the casemanagementunit at the health plan. this researchwas authorized by the managed care organization for the purpose of sharing information regarding their social casemanagementmodel with other stakeholders. the researcher was not monetarily subsidized by the managed care organization for this research. during the 15-month period, the investigator interacted with a variety of staff within the medicaid health plan and attended departmental staff and other corporate meetings that addressed case-management related activities. the researcherwas given a cubicle, limited access to themanagement information system, and a telephone within the casemanagement unit to better assess the operations andprocesses of the department and to participatemore fullywith the staff. the researcher signed a confidentiality statement pledging not to disclose identifying information about any of the cases. staff routinely shared case situations with the researcher. observations were noted either in writing through daily field notes or mentally. daily field notes included the activities of the investigator and impressions of the observations being made, such as how case management was conceptualized and carried out. 21patchner/in the belly of the beast: a case study of socialwork in amanaged care organization two focus groups were held with consumers who had recently received case management services to evaluate their satisfaction with those services and their perceptions of their health status. the focus groups were designed in such amanner that those individuals who directly interfaced with a case manager (i.e., they had telephone or face-to-face contact with a case manager) were invited to one group (focus group a) and those who did not interface with a case manager (i.e., casemanagement serviceswere provided, but the individual had no direct contact with the case manager) were invited to the other (focus group b). all focus group members were chosen from a systematic random sample of recently closed case management cases. two other selection criteria for participation in the focus groupswere residency in the primary county served by the health plan and current membership in the health plan. application of these criteria resulted in a pool of 36 potential participants for focus group a and a pool of 26 for focus group b. attempts weremade to phone all of the eligible members to invite them to participate in the focus groups. those contacted were assured that their participation was voluntary and that their anonymity was guaranteed. those who were unable to participate indicated a variety of reasons including: work schedules, child care issues and not wanting to participate. approximately one-third of the eligible focus group members were unable to be reached by phone. letters inviting participation in the focus groupswere sent to all eligible focus groupmembers, except those who declined to participate. seventeen people accepted the written invitations and participated in the process: 12 participated in focus group a and five in focus group b. free transportation to and from the focus group meetings was provided to any participant who needed it, and each participant was given $20.00 for participating in the focus group. focus groups were held at the corporate office of the health plan and lasted for two hours each. the following areas of inquiry were addressed: the consumers’ views of the health plan, case management services, case managers, medical services provided, and past and present health status. findings casemanagement process by its very function of providing and coordinating services to consumers, social work case management within health care delivery uses a client-driven approach to meet consumer health needs. case management services at this health plan accomplished this by focusing their interventions on client-centered needs by coordinating services, communicating health concerns, educating consumers about health promotion, advocating for necessary services, assessing health needs, and informing consumers about care options. the traditional casemanagementmodel that uses a client-driven approach is in sharp contrast to the provider-driven approach which has increased in recent decades due to accountability and profitability factors. at this health plan, a very structured, client-driven approach was in operation within the casemanagement unit, where individual consumer health care needs were the primary focus of the case manager’s intervention. 22 advances in socialwork to bridge the client-driven and provider-driven approaches to case management services, the casemanagement unit adapted a practicemodel developed by the case management society of america (cmsa) (smith, 1995). this model places the case manager as the central figure who addresses the various concerns and desires of client, provider, and payer in order to develop effective services. the cmsa model directed case management practice, interventions, and services to meet consumer needs within the managed care health delivery environment, wheremediation between the payer, provider, and client occurs. advocacy, assessment, collaboration, communication, coordination, empowerment, evaluation, facilitation, planning, andproblem solving are utilized by the casemanager to broker resources for the member of the health plan. case management services focused on intervening with complex, catastrophic cases that benefited from increased coordination of medical and communitybased services. using a bio-psychosocial assessment to determine medically necessary care, case managers assisted the members in accessing health and social services through advocacy, coordination, monitoring, counseling, and education functions. the case management process consisted of referrals, screening, assessment, intervention, and quality monitoring (see figure 1: case management decision-making process). high-risk cases were routed by utilization nurses, customer services, marketing, providers, members directly, and community-based services to the case management unit. the referral process was accomplished through the management information system, which allowed internal routing of cases on-line rather than on paper. cases with specific psychosocial andmedical indicators were automatically referred to the case management unit for assessment and, if necessary, intervention. when personnel within the health plan, community providers, or the health planmembers themselves identified a psychosocial need, caseswere routed to the case management unit for intervention. certain illnesses or conditions, such as mental illness or substance abuse, automatically triggered a referral.when a referral was made to the case management unit, the member was assigned to a specific case manager who provided the necessary intervention. the case managers were assigned to specific cases where their expertise in behavioral health, highrisk pregnancy, geriatrics, rehabilitation, developmental disabilities, cancer, or hiv/aids was needed. once a referral was received, a screeningwas performed to assess health plan eligibility, case management criteria eligibility, and member’s willingness to participate with case management. an assignment of the member, based on diagnosis and caseload, was made to a specific case manager. the bsw intake coordinator, in consultation with the manager of the case management unit, made these assignments. next, the case manager completed a bio-psychosocial assessment. the assessment was done in narrative format on-line. the case manager then assigned a level of case intensity—general, moderate, or complex. these case intensity levels depended upon the amount of time and effort that the case manager would be involved with the case. a plan of care was then developed in conjunction with the health plan member, the family, and/or the provider. 23patchner/in the belly of the beast: a case study of socialwork in amanaged care organization figure 1: case management decision-making process internalreferrals • members services •marketing • utilization management externalreferrals • health planmembers • health plan providers • social service agencies eligibilityverified • cordination of benefits meet cm criteria? • utilizing route to reason criteria yes assignment of case-to-casemanager based on specialty, case load, & primary diagnosis bio-psychosocial assessment assign level of case intensity • general, moderate, or complex development of a service plan with member and/or family and/or provider implementation of service plan • coordinate medical services • coordinate community referrals • provide counseling • provide education monitoring case status • telephone vs. face-to-face casemanagement goalsmet? refer toappropriate department •otherdept. •outsideprovider continuous documentation no yes caseclosure yes no no or 24 advances in socialwork the case manager coordinated the implementation of the interventions specified in the plan of care. this required a variety of contacts with medical and community services and themember and the family. throughout this process, the case manager strived for the self-determination of themember through education and counseling of the member regarding service alternatives. on-going monitoring of cases to determine whether treatment goals had been met was an integral component when implementing interventions. regardless of the professional orientation of the casemanager, services were initiated when there was an onset of chronic or catastrophic illness or injury that required coordination of multiple medical and psychosocial needs. it was essential that the case manager focus on an individual treatment plan that was costeffective, satisfying to the consumer, and guided by professional standards. complex medical referrals of consumers were routed into the case management unit for individualized attention and action by a casemanager who addressed the multiple psychosocial needs that impeded medical treatment. due to the complexity of health care delivery, casemanagement services had grown into a powerful tool formanaging the health needs of high-risk populations that exhibitedmultiple bio-psychosocial needs. quality monitoring was a continuous process where case reviews on intensive cases were presented within the department or discussed with themanager of the case management unit. case management activity was monitored weekly through the management information system documentation to determine the case manager’s workload and efficiency in processing the cases. monitoring of phone calls for quality assurance purposes and adherence to corporate standards were available tomanagerial staff. an audit, conducted quarterly, was designed by case management staff to assess the quality of the case manager’s interventions and documentation through peer and supervisory review. consumers served by casemanagement at the time of this study, the health plan served more than 102,000 individuals within a 16-county network. since the inception of case management mis data collection capability, the case management unit received 16,713 referrals, which included 3,502 separate individuals. these individuals accounted for 3.5% of the membership in the health plan. of those served by the case management unit, 70.2%were female and29.8%weremale.their ages ranged fromnewborn through 95 years of age, with amedian age of 25.6 years and amean age of 28.9 years. for their primary care physicians, 42.6% of the members who utilized case management services chose family practice physicians, 40.4% chose internal medicine physicians, and 17.0% chose pediatricians. these health plan members, all of whom weremedicaid recipients, fell into 45medical assistance categories. these include 33.2% afdc—cash medicaid, 20.1% ssi—disabled, 8.1% disabled elderly, 7.0% general assistance or chronically needy, 6.9% afdc—medicaid no grant, 1.4% ssi—aged, 16.3%not classified, and 7.0% that were dispersed among the remaining categories. of the 16,713 referrals, 69.9% came from the health plan utilization management unit, 11.4% from the behavioral health unit, 4.0% from community agencies, 3.7% from the health plan maternity program, and 2.5% from a selfreferral or a referral of a family member. the remaining 8.5% came from social workers in hospitals, rehabilitation units, nursing homes, and home health agencies, obclinics, primary care physicians,member services within the health plan, and several other sources. each time a member was routed for services, the member’s diagnosis was recorded for each specific episode of care. a member’s diagnosis could vary each time the case management unit was involved. for example, a member could receive casemanagement services because of a behavioral health problem on one referral into case management, and, on the next referral, the samemember could receive casemanagement services due to a bone fracture. thus, each time an individual received case management services, the primary diagnosis might be retained, as might typically be the case for a chronic illness, or could change due to a change in condition for each episode of care. theprimarydiagnosesof the16,713 referrals that receivedcasemanagement services fell into 921 unique classifications utilizing the international classification of diseases (icd-9) (practice management information corporation, 1996), thus demonstrating that the case management unit handled consumers with a wide variety of presenting diagnoses and resulting psychosocial problems. the icd-9 classification system is elaborate and specific. for example, among the 921 diagnoses of consumers who used services of the casemanagement unit, therewere nine different codes for bipolar disorders, 22 for substance abuse, 10 for high-risk pregnancies, and 14 for diabetes. for analyses purposes, these 921 unique diagnoses were reclassified into 11 general categories and an “other” category for those diagnoses that did not fit into one of the 11 categories. the 12 reclassified categories included: 1) aids/hiv, 2) bipolar disorders, 3) depression, 4) alcohol/drug abuse, 5) asthma, 6) diabetes, injury/trauma/fractures, 8) highrisk pregnancy, 9) normal pregnancy, 10) congenital anomalies, 11) neurological diagnosis/cerebrovascular disease, and 12) other. when reclassified, the distribution of diagnoses addressed through case management services revealed that high-risk pregnancy accounted for 10.7% of the diagnoses, injury/trauma/ fractures accounted for 6.8 %, normal pregnancy accounted for 6.7%, depression accounted for 5.4 %, neurological diagnoses/cerebrovascular disease accounted for5.1%,asthmaaccounted for5.0%,alcohol/drugabuseaccounted for2.7%,diabetes accounted for 2.6%, congenital anomalies accounted for 1.8%, aids/hiv accounted for 1.6%, bipolar disorders accounted for 1.1%, and other accounted for the remaining 50.6% of the diagnoses. the “other” category is quite high because it includedseveral hundreddiagnoses.however, eachoneaccounted for less than one percent of the total diagnoses. socialwork casemanagement roles and functions the working environment at the managed care organization reflected an integration of aspects of both social welfare and business paradigms.the publicmandate to serve themedicaid consumer was a priority within the casemanagement unit. on the other hand, the corporate mandate to be efficient and cost-effective was also routinely evident. usually, the two mandates could be accomplished by staff within theunitwithout anyprofessional conflict of interest.when the publicman25patchner/in the belly of the beast: a case study of socialwork in amanaged care organization date and the corporate mandate conflicted, however, the case management staff conferred with other co-workers in this interdisciplinary unit and with supervisors, including the unit manager and the health plan medical director. they weighed the benefits and costs to the individual consumers before making any decisions. this allowed for a more informed decision-making process and facilitated a collaborative approach to conflict resolution. an example of such a conflict would be in a case where a prescribed medication that the primary physician had ordered was not included in the organization’s drug formulary. for a special needs consumer, the task of case managers would be to advocate for a waiver to permit the consumer to receive the prescribed medication. case managers reported that their advocacy efforts were usually successful. when asked to describe their duties, roles, and responsibilities as casemanagers, all eight individuals identified coordination of services and service as a resource specialist formembers. four of the casemanagers considered themselvesmember advocates, with one case manager describing empowerment of members as a key job function. other job functions described by case managers included: consultation with providers, crisis management, development and monitoring of treatment plans, education of the member, promotion of good health practices, and service as a liaison between themember and community services. one casemanager described her function as “assisting members in getting appropriate, costeffective care in a timely fashion.” irrespective of their professional identification as a social worker, nurse, or rehabilitation counselor, all eight case managers responded by identifying job functions performed by professional case managers and not necessarily those of their individual professions. the case management unit used a social case management model staffed primarily with social workers. however, as the department expanded, it developed an interdisciplinary approach to case management by adding the other professional disciplines of nursing and rehabilitation counseling. all but one of the case managers interviewed felt that this interdisciplinary approach influenced what they did as case managers. the case managers generally felt that the collaboration and consultation among staff from different disciplines allowed them to become better informed andmore efficient in decision-making. therewas a high level of comfort among the social workers that functionedwithin an interdisciplinary approach while utilizing their specialized discipline specific skills to address individual consumer needs. there were few value conflicts or professional conflicts observed or reported among unit staff. social work case managers reported performing similar functions to those used by social workers in the community setting (i.e., advocacy, counseling, coordination, brokering, program development). generally, they did not view their telephone interventions with consumers and providers as problematic. according to all case management staff, providing services through community providers also appeared to work well when the consumer and provider had developed a good working relationship. there were instances where casemanagers had to advocate for members’ needs that were not covered by the health plan. some of these advocacy efforts (such as a member needing supplies or medications) may have cost the health plan more in the short-run, but in the long-run was considered preventative and cost-effec26 advances in socialwork tive in nature. staff indicated that they were comfortable working within this corporate setting, and it appeared that they were well respected by other units throughout the managed care company. as a profession, social work has been lukewarm regarding its role in providing services within corporate managed care settings primarily because of our unfamiliarity withmanaged care, lack of direct access to themanaged care policymaking process, and the desire to adhere to the profession’s ethics and values (epstein & aldredge, 2000). in contrast, case management staff within this managed care organization possessed a clear understanding of the organization’s role in providing health care delivery, their role as advocates and facilitators in securing necessary and appropriate services, and their potential to impact organizational policies and procedures that affected the overall health of consumers. benefits of interdisciplinary casemanagement included the convergence of perspectives, more in-depth assessment, and a more holistic approach to service. none of the workers could identify any specific weaknesses with the interdisciplinary approach. one suggested that “the informal nature of their professional collaboration might need to be formalized in the future should the department grow significantly.” when asked what other disciplines should be added to the case management unit, all but one of the casemanagers suggested that additional staff should have a background in the area of developmental disabilities. other suggested areas of expertise for new staff were in benefits and funding, early intervention and education, behavioral health, community outreach, homehealth, and rehabilitation and orthotics. one worker felt that until the needs of the growing membership could be determined, it was premature to anticipate what additional areas of expertise would be needed within the case management unit. staff indicated their concern that communication among unit case managers might be challenged as additional professionals are added to the unit and new procedures for addressing larger numbers of high-risk populations emerge. staff indicated that the interdisciplinary approach was well-integrated into daily operations of the casemanagement unit. utilizing a quality improvementmechanism to address staffing loads, communication patterns, casemanagement policies and procedures, documentation of case findings, and consumer outcome measures could enhance successful future growth of the case management unit. consumer satisfaction in general, members who participated in the focus groups were very positive about the health plan and the case management services they received. members who interfacedwith casemanagement weremuchmore favorable than thosewho had not. indicative of the enthusiasm demonstrated by members who had interfaced with case management staff, some described the health plan as “miracle insurance” and a “thank you health plan.” members who interfaced with case managers reported that the case manager listened and responded to their needs, remembered who they were, indicated genuine concern for their unique health concerns, had good communication skills, and were knowledgeable about resources. members generally noted prompt follow-up by casemanagers following hospitalizations andmember-initiated calls to theunit. of significant helpwas the 27patchner/in the belly of the beast: a case study of socialwork in amanaged care organization 28 advances in socialwork brokering role of case management, where case managers linked members to other health plan services, such as a high-risk maternity program, or to community agencies providing services for alcohol or drug problems, mental health issues, special needs children, and the like. members noted the tangible services they received, such as assistance with alcohol rehabilitation assistance, transportation, rehabilitation therapies,maternity outreach assistance,medical equipment, information on available services, and coordination of services prior to and after hospitalization. they were particularly pleased that case managers understood their needs, were kind and respectful, and were resourceful. they acknowledged the efficient manner in which the case management unit appeared to operate. somemembers who did not have direct contact with the health plan case managers did receive case management services from providers and vendors who served them following an illness or injury. members of this group generally felt pleasedwith the services they received from the providers and vendorswho assisted them in the home. these services, many of which were arranged by the case managers, included home health assistance with insulin training, high-risk pregnancy bed rest with home health and homemaker assistance, and orthotics with follow-up physical therapy. generally, these members were pleased with the prompt arrangements for services, the effectiveness of the service, and the quality of the personnel providing the services. one member indicated that “i wouldn’t change if i had the choice.” although members were quite satisfied with case management services, both groups of members—those who had interfaced with case management and those who had not—provided suggestions for the improvement of services. some suggestions that related to case management interventions included: assistance with prescriptions not covered under the health plan, education of procedures for emergency room visits and ambulance transport, assistance in obtaining respite help and parenting skills in dealing with challenged children, and assistance in locating providers within the health plan network for their unique family needs. suggestions related to overall services provided both in the home and for followup of chronic conditions included: the need for information on continuity of care decisions, future involvement of the member in the decision-making process on services, education of procedures for emergency room visits, a desire to have one primary provider and not multiple providers at a pcp site, and referrals to specialists for chronic care problems. conclusions and implications the utilization of social workers within managed care organizations is a recent development. this case study represents an effort to describe this phenomenon. an exploratory-descriptive design permitted a broad assessment of social workers utilizing casemanagement services at a specific health plan and demonstrated the perceived effectiveness of casemanagement in deliveringmedicaid hmo services to vulnerable high-risk populations. the findings of the semi-structured interviews, the focus groups, and the participant observation indicated that the use of casemanagement services, delivered primarily by social workers, were effective in addressing bio-psychosocial needs ofmedicaid consumerswithin a provider-driven managed care system. this case study demonstrated that social workers utilizing case management skills are highly effective in a managed care organization, suggesting that other managed care organizations can employ social workers to improve the quality of services. however, individualized attention to client needs is essential to effective case management. in this case study, the interdisciplinary approach to the delivery of casemanagement servicesmaximized the capabilities and unique talents of personnel in thecasemanagementunit. othermanaged care organizations interested in emulating thismodel should consider having social workers at the core of such aunit. successful delivery of casemanagement services included formal linkages with community-based organizations that weremaintained through ongoing quality assessment and improvement activities. consequently, other managed care organizations employing this case management model would be wise to develop strong linkages and relationships with community-based organizations. social workers interested in seeking careers inmanaged care organizations need to garner specific skills for such practice. in studying the growth of managed care and its effect on the training of professional social workers, strom-gottfried (1997); strom-gottfried, et al. (1998); and jarman-rohde, mcfall, kolar, and strom (1997) recommended additional training of social workers and social work students inmanaged care. black (1997) identified several competencies for emerging professionals in managed care that will be needed within the near future. these include familiarity with the systems’ perspective, familiarity with multidisciplinary teams both within and across organizations, computer literacy, data analysis skills, familiarity with management techniques, knowledge of case management, familiarity with epidemiological research techniques, and interpersonal skills that assist the consumer and the community (black, 1997). professional skills for practice need to be focused in three areas: basic professional skills, population-specific skills, and autonomy-building skills (new york academy of medicine, 2000). there may be a growing gap between the training given social work students and the real-life needs of health care consumers (cswe, 1998; the newyork academy ofmedicine, 2000). if so, emerging professionals will benefit from specific training on the actual mechanics of managed care systems and how they operate. such specialized trainingmight include coverage of health care delivery systems, health care policy issues and analysis, medical terminology, outcomes measurement research and program evaluation techniques, accountability techniques, development of individual treatment plans, and health promotion and disease prevention strategies. as social workers serve as both primary care providers and function in a variety of case management roles within managed care settings, a thorough understanding of the managed care environment is essential (national association of socialworkers, 2000). in the future, case management will increasingly be applied to chronic disease caremanagement (the institute for the future, 2000). educators need to examine their curricula and field placement options to ascertain how they relate to the competencies and skills demanded frommanaged care organizations. social work educators will need to enlighten policymakers on the state and local level of the value and need for professional social workers within managed care systems. future health care delivery systems will provide new employment opportunities for social workers and other allied health professionals. as managed care systems employ a wide variety of disciplines and profession29patchner/in the belly of the beast: a case study of socialwork in amanaged care organization als to staff this growing field, research conducted with managed care systems will strengthen pre-employment training. on-site participant observation can be highly valuable in developing foundation knowledge about emerging service delivery environments such as managed care. while much has been learned about the utilization of case management at a medicaid managed care organization, a major limitation is that only one case management unit at one medicaid managed care organization was examined. therefore, the findings of this case study are limited in their generalizability. nonetheless, the implementation of a social case management model with highrisk populationsmay prove to be as effective in other locations where similar populations are served bymanaged care organizations committed to providing quality services. a possible confounding factor in this study is that of social desirability. even though the interviewswith the casemanagers appeared to be balanced and objective, there may have been a bias with presenting information in a manner that would positively reflect upon the case management unit and the health plan. similarly, and perhaps even more of a factor could be the responses by the consumers in the focus groups. historical recall of the services received was difficult for a few consumers, and somemay have been reluctant tomention service delivery problems even though confidentiality was assured. some consumers might have felt intimidatedwhen participating in the study or even fearful of sharing any negative experiences. these factors could have contributed to the high regard that the consumers held for the case management unit and the health plan. nonetheless, the perceptions of the consumers allowed for an understanding of their basic health care needs.these perceptions provided a basis for understanding the primary impact of social work case management services upon high-risk consumers. subsequent replication of this study should be conducted in othermedicaid settings and in the private, commercial, managed care arena with larger populations. such replication would be prudent in light of continued scrutiny of managed care arrangements by policymakers and consumer groups. additionally, continued research and examination of best practices will assist stakeholders to modify and improve medicaid managed care in order to safeguard particular populations. in particular, the delivery of social work case management to vulnerable high-risk populations should receive increased attention due to the aging of the population and the subsequent increase in related bio-psychosocial needs. this case study indicated high consumer satisfaction by high-risk populations with case management services. further research is needed to ascertain future consumer satisfaction as more heterogeneous high-risk populations enroll in managed care arrangements. research comparing customer satisfaction and health perceptions for those high-risk populations under traditional fee-for-service and medicaid hmo arrangements would enlighten policymakers in addressing the challenging and unique needs of this population. replication of this case study within other medicaid hmos serving similar high-risk populations in other states would be beneficial to policymakers as they implement mandatory managed care for medicaid recipients as part of welfare reform initiatives. 30 advances in socialwork references black, j. t. (1997,may 5). the revolution in health care: trends and implications. public health socialwork institute presentation. pittsburgh, pa. council on social work education. (1998). report identifies health care issues affecting social work education. socialwork education reporter, 46(3), 8. epstein, m., & aldredge, p. (2000). good but not perfect: a case study of managed care. needham heights, ma: allyn and bacon. goldsmith, j. c., goran, m. j., & nackel, j. g. (1995). managed care comes of age. healthcare forum journal, 38(5), 14-24. harris, n. (1992).what’s ahead in health care for 1993? business and health, 12, 32-38. hughes,w. c. (1999).managed care,meet community support:ten reasons to include direct support services in every behavioral health plan.health and socialwork, 24(2), 103-111. the institute for the future. (2000).health and health care 2010: the forecast, the challenge. san francisco, ca: jossey-bass. jarman-rohde, l., mcfall, j., kolar, p., & strom, g. (1997). the changing context of social work practice: implications and recommendations for social work educators. journal of socialwork education, 33(1), 29-45. kaiser commission on the future ofmedicaid. (1995).medicaid andmanaged care: lessons from the literature. menlo park, ca: the henry j. kaiser family foundation. kelly, j. (1997). medicaid reform.university of pittsburgh institute of politics report, 15, 1-2. landgarten, s. (1988). introduction. in k. fisher & e.weisman (eds.) case management: guiding patients through the health care maze. chicago, il: the joint commission on accreditation of healthcare organizations. mcmanus,m., fox, h., &newacheck, p. (1996). strengthening partnerships between state programs for children with special health needs and managed care organizations. rockville, md.: maternal and child health bureau. meyers, m., lukemeyer, a., & smeeding, t. 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(1997). key issue to address inmedicaidmanaged care’s future: populations with special needs.managed medicare and medicaid perspectives, january, 27, 1997, 1-4. 31patchner/in the belly of the beast: a case study of socialwork in amanaged care organization strom-gottfried, k. (1997). the implications of managed care for social work education. journal of social work education, 33(10), 7-18. strom-gottfried, k., & corcoran, k. (1998). confronting ethical dilemmas inmanaged care: guidelines for students and faculty. journal of socialwork education, 34(1), 109-119. u.s. department ofhealth andhuman serviceshealth care financing administration pressoffice. (1997, january 28,).managed care in medicare and medicaid.washington, dc: author. u.s. department of health and human services—hcfa. (2000, july 13). national summary of medicaid managed care programs and enrollment.washington, dc: author. u.s. general accounting office. (1996).medicaid managed care: serving the disabled challenges state programs. (gao/hehs-96-136).washington, dc: u. s. government printing office. author’s note: address correspondence to: dr. lisa s. patchner, ball state university, social work department, ar 227, muncie, in 47306-0525 usa. e-mail: lpatchner@bsu.edu. 32 advances in socialwork examining predictors of social work students’ critical thinking skills examining predictors of social work students’ critical thinking skills kathleen holtz deal joan pittman abstract: this study examined bsw, msw and phd social work students’ (n=72) critical thinking skills using the california critical thinking skills test (cctst). social work students who tested as more open to experience on a personality inventory, took chemistry in college, and reported having both parents with a college degree had higher critical thinking skills. there was a trend toward higher levels of critical thinking as academic levels increased. implications and recommendations are discussed for social work classrooms, field practica, and admissions. keywords: critical thinking, personality factors, social work education introduction national education reports since the 1980’s have emphasized the role of higher education in developing students’ critical thinking skills (tsui, 1999). however, research shows mixed results on whether a college education improves these skills (see, for example, mcmillan, 1987; williams & worth, 2001). the educational policy and accreditation standards (epas) of the council of social work education (cswe) (2008) reflect this national interest in the importance of critical thinking by identifying critical thinking as one of the 10 core competencies social work students must master during their professional education. educational policy 2.1.3 identifies how critical thinking should be applied to “inform and communicate professional judgments” based on social workers’ knowledge of “logic, scientific inquiry, and reasoned discernment . . . augmented by creativity and curiosity” (cswe, p. 4). this policy statement identifies critical thinking as crucial to social workers’ ability to:  distinguish, appraise, and integrate multiple sources of knowledge, including research-based knowledge, and practice wisdom;  analyze models of assessment, prevention, intervention, and evaluation; and  demonstrate effective oral and written communication in working with individuals, families, groups, organizations, communities, and colleagues. (cswe, 2008, p. 4). _____________ kathleen holtz deal, ph.d., is an associate professor and joan pittman is a doctoral candidate, both in the school of social the ability to think critically has direct relevance for competent social work practice. social work students need to learn how to assess client problems using a complex biopsychosocial model and how to implement interventions at multiple levels. they are being trained to collaborate within interdisciplinary settings with professionals whose work at the university of maryland, baltimore. earlier versions of this paper were presented at the fourth international interdisciplinary conference on clinical supervision, buffalo, ny on june 13, 2008 and the council of social work education apm, philadelphia, pa on october 31, 2008. copyright © 2009 advances in social work vol. 10 no. 1 (spring 2009), 87-102 deal, pittman/critical thinking skills 88 perspective on client problems and preferred interventions may differ from theirs. social work students must develop skills to make nuanced judgments about complicated ethical dilemmas that have no clear or obvious solutions. the importance of helping students develop critical thinking skills assumes particular importance as the social work profession moves toward an emphasis on evidence-based practice (ebp) defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of clients” (gibbs & gambrill, 2002, p. 452). as shlonsky and stern (2007) explain, “ebp is a way of putting critical thinking into systematic action” (p. 604). thinking critically, therefore, is a core competency in the development of professional judgment, a hallmark of our profession. the epas also specify that social work programs identify how they assess each of the core competencies in order to “evaluate the extent to which the competencies have been met” (cswe, 2008, p. 16). whether or not students are learning critical thinking skills needed for competent professional practice, therefore, is an important focus for social work educators. despite recognition of its importance to the development of professional competence, research on social work students’ critical thinking skills has been sparse. little is known about students’ skill levels, including whether these skills improve over the course of social work education or whether courses designed to increase students’ critical thinking skills are successful. even less is known about whether student characteristics are associated with critical thinking ability. the purpose of this study is to add to the knowledge about whether demographic and/or personality variables are related to critical thinking skills and to determine the levels of critical thinking skills attained by social work students at the baccalaureate, masters, and doctoral levels. various definitions of critical thinking stress different aspects of this concept. halpern (1997) identifies “thinking that is purposeful, reasoned, and goal-directed” and consists of “strategies that increase the probability of a desirable outcome” (p. 4). dobrzkowski (1994) concludes that critical thinking “requires one to be able to discriminate relevant from irrelevant, to consider multiple facts and data from a variety of sources, to analyze these facts and data into working hypotheses, and to derive plausible consequences from these hypotheses” (p. 273). gambrill (1990) stresses the ability to identify and refute fallacies in logic, consider contrary evidence, understand statistical principles, and apply research findings to understanding client problems. under the leadership of the american philosophical association, a group of 46 experts engaged in a systematic study of the elements of critical thinking resulting in the delphi report (facione, 1990) which defines critical thinking as “purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, inference, as well as the explanation of evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based” (p. 3). this definition was used as the basis for developing a discipline-neutral test of critical thinking skills called the california critical thinking skills test (cctst) (facione, facione, blohm & giancarlo, 2002). a controversy within the critical thinking literature exists over the extent to which the generic critical thinking skills described above are sufficient for, or good predictors of, making well-reasoned judgments in a particular domain (smith, 2002; williams, oliver & stockdale, 2004). gibbs et al. (1995) developed a domain-specific measure of critical advances in social work, spring 2009, 10(1) 89 thinking for social work students called pride 1 (principles of reasoning, inference, decision-making and evaluation). this instrument attempts to measure whether students transfer knowledge about research principles to practice decisions by analyzing the extent to which student responses to a video employ logical reasoning and identify common fallacies in arriving at a sound clinical decision. however, the pride 1 has not been widely used and has failed to find a relationship between critical thinking about practice and research knowledge (gibbs et al.) or detect a change in bsw students’ critical thinking following a course designed to teach critical thinking skills (kersting & mumm, 2001). this study uses the cctst (facione et al., 2002) to measure students’ levels of critical thinking. one advantage of using the cctst over other generic scales is that it is based on the american philosophical association’s definition of critical thinking (facione, 1990) which was developed by a multidisciplinary group of experts through a process of consensus (facione et al.). this same definition of critical thinking was used as the framework for the us department of education in setting its educational goals in 2000 (facione et al.). therefore, the definition of critical thinking underlying the cctst has wide acceptance as conceptually valid. a second reason for choosing the cctst for this study is its history in measuring the critical thinking skills of nursing students who, like social workers, are being educated to develop sound clinical judgment. aggregate data analysis of 145 samples from 50 nursing programs that used the cctst to test their students’ critical thinking skills showed modest gains in critical thinking (facione & facione, 1997). more recent studies of nursing students using the cctst found significant increases in students’ scores over time (mccarthy, schuster, zehr & mcdougal, 1999; spelic, et al., 2001; thompson & rebeschi, 1999) and across educational levels (shin, jung, shin & kim, 2006), while others had mixed results (beckie, lowry, & barnett, 2001) or found no change (choi, 2004; saucier, stevens & williams, 2000). nursing research on critical thinking has been driven by the national league for nursing requirement that nursing schools provide quantifiable evidence of their students’ critical thinking skills (rapps, riegel & glaser, 2001). this requirement has resulted in a substantial body of literature that focuses on ways to measure nursing students’ critical thinking and to test the effectiveness of educational strategies in improving these skills (for overviews, see staib, 2003 and tanner, 2005). the controversy mentioned above concerning the use of generic measures (such as the cctst) versus developing discipline-specific measures of critical thinking is evident in the nursing literature. although a delphi study of expert nurses agreed on a discipline-specific definition of critical thinking for nursing (scheffer & rubenfeld, 2000), this definition has not been used to guide further research (tanner). the experience of nurses, who have conducted research on critical thinking for over a decade, highlights for the social work profession the complexity involved in describing critical thinking, choosing and/or developing appropriate measures, and testing which educational methods are effective in enhancing students’ skills. deal, pittman/critical thinking skills 90 literature review six studies have tested the critical thinking skills of bsw and/or msw students, while there have been no studies involving social work phd students. using the cctst, clark (2002) found no statistical differences between the scores of bsw and msw students; however, scores of both groups were comparable to norms established for college students by the developers of the measure. klau (1996), using the watson-glaser critical thinking appraisal, found that bsw students scored lower than upper division students in four-year colleges, but that bsw students who took chemistry and geometry scored significantly higher than students who did not. while harrison and atherton (1990) did not measure critical thinking per se, their study of the related concepts of reflective judgment and cognitive maturity is informative. they used the scale of intellectual development (sid-iv) to measure reflective judgment and the attitudes about reality (aar) scale to distinguish between a positivist or social constructivist view of reality. the sid-iv consists of four subscales (dualism, relativism, commitment, and empathy) and is derived from perry’s (1970/1999) scheme of how individuals’ problem-solving processes become more complex and ethical over time. using these instruments, the authors found that msw students were significantly more likely than bsw students to view reality in complex, rather than dualistic ways, indicating the greater cognitive maturity of msw students. three studies examined whether specific training in critical thinking improved social work students’ skills. huff (2000) found that msw students’ scores on the cctst significantly increased after a policy course, whether their educational experience was in the classroom or by interactive television. statistically significant increases were found for overall scores and for the subscales of evaluation and inference. plath, english, connors, and beveridge (1999) found that bsw students’ scores on the ennis-weir essay test showed statistically significant improvement following an instructional unit on critical thinking, while their scores on the cornell critical thinking test (cctt) did not. kersting and mumm (2001) taught a one-semester bsw course that emphasized identifying and evaluating evidence and recognizing faulty reasoning. the authors found no statistical difference in students’ preand posttest scores using a social work-specific instrument (pride 1) that measured how students made decisions about interventions. a related study tested the critical thinking skills of social work field instructors. rogers and mcdonald (1992) found that supervisors who were taught critical thinking skills in a 10session seminar had higher posttest scores on the watson-glaser critical thinking appraisal than a control group. there is some preliminary evidence that students with low critical thinking skills encounter particular difficulty in improving these skills. kowalski and taylor’s (2004) finding that psychology students with higher critical thinking scores were more willing than those with lower scores to change their misconceptions about psychological information suggests that students with lower levels of critical thinking may require additional assistance in overcoming a natural bias toward belief preservation. williams et al. (2004) concluded that students with low critical thinking skills “appear to find critical thinking activities somewhat disconcerting, often characterizing critical thinking demands as tricky and even unfair” (p. 50). williams, oliver, allin, winn, and booher advances in social work, spring 2009, 10(1) 91 (2003) observe that students with lower critical thinking skills are more focused on identifying correct answers than understanding the reasoning involved in arriving at those answers. certain personality characteristics have been found in previous studies to be related to critical thinking skills and have been included in this study. studies of undergraduates (clifford, boufal & kurtz, 2004) and nursing students (profetto-mcgrath, 2003) have found a relationship between the personality characteristic of open mindedness and higher critical thinking scores. ennis (as cited in clifford et al., 2004) was one of the first to advocate that cognitive ability and personality dimensions contribute jointly to critical thinking skills. as facione et al. (2002) conceptualize this relationship, simply possessing good critical thinking skills does not guarantee that individuals will choose to routinely use these skills. certain mental disciplines or habits, such as open mindedness, cognitive maturity, truth-seeking, and being systematic, are elements of our personality or character that “impel us toward using ct [critical thinking], rather than something less rational, as our problem-solving strategy” (facione et al., p. 4). previous research has also shown that certain demographic variables such as race/ethnicity (flowers & pascarella, 2003), socioeconomic status (cheung, rudowicz, lang, yui & kwan, 2001; klau, 1996), and undergraduate courses in science and/or math (klau, 1996; tsui, 1999) are associated with critical thinking. building on prior research, this study examines whether certain personality characteristics or demographic variables are associated with higher levels of critical thinking. the study also explores critical thinking skills across academic level by including social work students at the baccalaureate, masters, and doctoral levels. such information can begin to inform social work educators about students’ critical thinking skills and guide them in developing curricula and teaching strategies that further the ongoing development of these skills across the educational continuum. methods participants participants for this study included 73 social work students from three social work programs located in mid-atlantic region of the united states. sixty of the participants (82.2%) were enrolled in a large publicly funded social work program as masters (n = 49) and doctoral students (n = 11). the remaining 13 participants were enrolled as bachelors of social work students at a small private college (n = 12) and a large public university (n = 1). one participant was excluded from the study due to incomplete data on the critical thinking test, resulting in a final sample size of 72. most respondents were female (93.1%) and caucasian (80.6%), ranging in age from 21 to 60 (m = 32.39, sd = 10.51). a majority of masters and doctoral students (69.5%) had an undergraduate degree in psychology (n = 24), sociology (n = 4) or social work (n = 14). when compared to national data on social work students (lennon, 2000), this sample had a higher percentage of caucasian and female students. deal, pittman/critical thinking skills 92 table 1. sample demographics bsw (n=13) msw (n=48) phd (n= 11) total (n=72) race/ethnicity caucasian non-hispanic 11 40 7 58 minority 2 7 3 12 missing 1 1 2 gender female 13 44 10 67 male 0 4 0 4 missing 1 1 age 21-29 10 29 2 41 30-49 3 13 8 24 50+ 0 6 1 7 parents’ college degree both parents 8 33 9 50 one or no parents 5 14 2 21 missing 1 1 procedures a cross sectional design which examines a single group at one point of time was used for this survey research project. study participants were recruited in april and may of 2007 by receiving a flyer in their student mailboxes and classrooms explaining the purpose of the study and inviting all students to participate. to facilitate greater student participation, surveys were administered several times at each participating university. at each survey administration session, students received a letter of invitation which explained the purpose of the study and the anonymous and voluntary nature of the study. the authors provided directions for completing the survey instruments and monitored the sessions. consistent with the time periods suggested by the authors of the personality inventory and the critical thinking test, students were given 75 minutes to complete the full survey which also included demographic information. no incentives were offered to the students who volunteered. study procedures were reviewed by the institutional review boards of all three universities, which granted exemptions due to the anonymity of the survey. measures california critical thinking skills test 2000 (cctst). the cctst is a 34-item multiple choice test based on the american philosophical association’s definition of critical thinking as “the process of purposeful, self-regulatory judgment” (facione et al., 2002, p. 2). the test provides a total critical thinking score and five subscales. the subscales of analysis, evaluation, and inference represent the core critical thinking skills and when combined provide a total critical thinking score. “the two other sub-tests on advances in social work, spring 2009, 10(1) 93 the cctst follow a more traditional conceptualization of reasoning which divides the realm into inductive and deductive reasoning” (facione et al., 2002, p. 6). the analysis subscale includes the skills of categorization, clarifying meaning, examining ideas, and assessing arguments (facione et al., 2002). evaluation refers to the ability to assess the credibility and logical strength of relationships as well as the ability to justify reasoning (facione et al.). the inference subscale includes the skills of “querying evidence, conjecturing alternatives, and drawing conclusions” (facione et al., 2002, p. 7). the cctst has demonstrated good reliability and validity (alphas ranging from .70 to .84) (facione et al.). for this study, the most recent version of the test was used (cctst 2000) which is considered to be a richer and more robust instrument for evaluating critical thinking (facione et al.). neo-five factor inventory (neo-ffi). the neo-ffi is a 60-item test with good reliability (alphas ranging from .74 to .89) that measures five personality domains: neuroticism, extroversion, openness, agreeableness, and conscientiousness (costa & mccrae, 1992). each domain represents a continuum of the personality dimension and although the scales are described as a comparison of the extremes, most individuals will score in the middle of the scale (costa & mccrae). the neuroticism scale contrasts emotional stability at the lower end of the scale with emotional distress at the high end of the scale (costa & mccrae). extraversion is defined as a preference for being around people as well as being more energetic; while introversion is defined as being independent, reserved, and even tempered (costa & mccrae). the openness domain, short for openness to experience, measures a person’s preference for variety and curiosity (open) versus a preference for conventional behavior and a narrow scope of interests (closed) (costa & mccrae). agreeableness contrasts the tendency to help and cooperate with others with the opposing tendency toward competitiveness and skepticism of others’ intentions. lastly, the conscientious individual is determined, focused, and strong-willed (costa & mccrae). the neo-ffi uses a five-point likert scale ranging from strongly disagree (0) to strongly agree (4). in this sample of social work students, all personality domains had good reliability scores with alphas ranging from .72 to .89. demographics. students were asked their race, age, gender, and academic degree. because the sample size was smaller than expected, and had limited diversity, race was recoded into two categories: caucasian and minority. based on prior research exploring ses status (cheung et al., 2001) and the influence of undergraduate science courses (klau, 1996), students were asked if their mother and father had a college degree and if they had completed undergraduate courses in geometry and chemistry. completion of a course was coded as 1 and non-completion was coded as 2. data on parent’s degree was recoded into one dichotomized variable representing students with two college degree parents (coded as 1) compared to students with one or no college degree parents (coded as 0). data analysis using spss 13, predictors of critical thinking were analyzed by running a regression analysis. research and theory did not provide a clear rationale for the order of entry into deal, pittman/critical thinking skills 94 the regression model; therefore all variables were entered simultaneously. nine predictor variables were entered into the regression model: race, parents’ degree, the five personality domains from the neo-ffi, geometry, and chemistry. assumptions for regression analysis (cohen, cohen, west & aiken, 2003) were tested and adequately met. results predictors of critical thinking the overall regression model was significant (f = 3.423, p = .002), accounting for 35.5% of the total variance in critical thinking (adjusted r2 = 25.1). the lower adjusted r2 is due to the limited sample size in relation to the number of predictors in the model. students who reported that both of their parents had a college degree had significantly higher critical thinking scores (t = 3.238, b = 3.460, p = .002). students with higher scores on the openness scale of the neo-ffi had higher critical thinking scores (t = 2.594, b = .243, p = .012) and those who reported taking an undergraduate chemistry course also had higher scores (t = -2.182, b = -3.740, p = .033). race was also significant (t = -2.014, b = -2.834, p = .049) with caucasians having higher critical thinking scores than minorities. however, this finding should be interpreted with caution due to the p value being close to .05. geometry was not significant and openness was the only personality domain significantly related to critical thinking (see table 2 for regression statistics). thus, social work students who took chemistry in college, reported having both parents with a college education, and are more open to experiences had higher critical thinking skills. table 2. summary of regression analysis for variables predicting critical thinking (n = 66) variable b se b  t p race (caucasian = 1, minority = 2) -2.834 1.407 -.233 -2.014 .049 parents college degree (both yes = 1, no = 0) 3.460 1.069 .381 3.238 .002 neuroticism .021 .068 .040 .313 .756 extraversion -.019 .095 -.025 -.201 .841 openness to experience .243 .094 .305 2.594 .012 agreeableness .138 .105 .158 1.311 .195 conscientiousness .059 .088 .083 .676 .502 geometry (yes = 1; no = 2) 1.180 1.993 .069 .592 .556 chemistry (yes = 1; no = 2) -3.740 1.714 -.255 -2.182 .033 (f = 3.423, p = .002) advances in social work, spring 2009, 10(1) 95 critical thinking skills by social work degree due to a limited number of respondents in the bsw and phd categories, the study had insufficient power for a statistical comparison by social work degree. however, it is interesting to note that critical thinking scores were in the expected direction (higher scores for higher degrees) and the mean scores for each degree category were higher than the averages given by the test developers (facione et al., 2002; insight assessment, 2006). table 3. critical thinking scores by social work degree (n = 72) compared to norm samples (facione et al., 2002; insight assessment, 2006) n mean sd social work students: bsw 13 17.92 4.33 msw 48 19.83 4.64 phd 11 22.00 4.69 total 72 19.82 4.679 norm samples: 4-year college 2677 16.80 5.062 masters nursing 153 19.01 5.087 discussion the purpose of this study was to explore social workers’ critical thinking skills across academic levels and examine the predictors of these skills. the regression model found several significant relationships between demographic and personality variables and critical thinking skills. the correlation between critical thinking and socioeconomic status in this study is consistent with previous research. higher socioeconomic status has been found in previous studies to be correlated with higher levels of students’ critical thinking (cheung et al., 2001; klau, 1996). previous studies, however, measured ses by parents’ occupation (cheung et al.) or used hollingshead’s criteria (klau). this study’s finding that students who had two parents with college degrees had higher levels of critical thinking than students with only one or neither parent with a college degree adds information on the significance of a different indicator of ses (i.e., level of parental education), to students’ critical thinking skills. due to an inadequate number of bsw and phd respondents, it was not possible to conduct a statistical analysis of critical thinking scores by social work degree. however, critical thinking scores did show a clear trend toward greater ability to think critically as social work students’ academic levels increase. this trend is of particular interest as the study is the first to include doctoral social work students. future longitudinal studies that include social work students at all academic levels could help to assess changes in students’ critical thinking skills over time. deal, pittman/critical thinking skills 96 limitations and strengths the generalizability of this study’s findings is limited by its use of a small, mostly female, volunteer sample, predominantly from one school of social work. the predictor to respondent ratio (9 to 66 in this study) for the regression analysis exceeds the 1 to 15 recommendation by stevens (2002) which may decrease the generalizability of the regression results. in addition, the small sample size compromised the power to detect statistically significant relationships where they may have existed. using a crosssectional rather than a longitudinal design, limits the ability to examine the effects of social work education on students’ critical thinking skills. finally, students self selected to participate in this voluntary study, therefore results may be influenced by selection bias. this study has several strengths. it is unique in that it represents the first effort to include students across the entire continuum of social work education and to examine the connections between personality factors and critical thinking for social work students. another asset was the use of reliable and valid instruments to measure critical thinking skills and personality factors. implications for social work education one of the study’s most important findings, a correlation between critical thinking skill and openness to new experience, has several implications for social work educators. suggestions are offered on ways to foster the development of students’ critical thinking skills in the classroom and field by focusing on increasing their open-mindedness and ability to imagine alternative ways to assess and solve problems. implications for admissions and field instructor training are also offered. while previous studies of nursing students (profetto-mcgrath, 2003) and undergraduates (clifford et al., 2004) found a correlation between critical thinking and the personality characteristic of open-mindedness, this was the first study of social work students to find this connection, lending additional support to a correlation between these two variables. this finding suggests that helping social work students develop the habit or discipline of open-mindedness may have a positive effect on their critical thinking skills. some of the attitudes and behaviors associated with the openness domain in the neo-ppi include “active imagination, aesthetic sensitivity, attentiveness to inner feelings, preference for variety, intellectual curiosity, and independence of judgment” (costa & mccrae, 1992, p. 15). individuals who score high on this scale tend to have an interest in both their inner lives and the outer world, are open to new ideas, and experience emotions intensely (costa & mccrae). by designing assignments to target the enhancement of these qualities, establishing a safe atmosphere where discovery is valued, and modeling an attitude of open inquiry, classroom teachers can help to increase students’ openness to new ideas and experiences with the ultimate goal of improving their ability to think critically. by providing an environment that encourages discovery, including being open to new learning that emerges through student inquiry and discussion (pithers & soden, 2002), social work educators can model an attitude of openness to new experiences. gray (1993) advances in social work, spring 2009, 10(1) 97 suggests that after teachers present their ideas as clearly as possible, they honestly invite students to collaborate in examining these ideas and to generate alternative views by asking such questions as, “i can’t think of any other explanation, can you?” (p. 70). such questions are most effective when posed in the spirit of genuine inquiry, not as a way to “test” students or as a device to help them arrive at a pre-determined “correct” answer. irving and williams (1995) caution that instructors may feel anxious when “dealing openly with challenging and conflicting views” as this process entails “being prepared to expose our own (and others’) vulnerabilities” (p. 112). however, when the classroom instructor is willing to take such risks, the classroom environment can feel like a place for students to acknowledge their own limitations, increase their willingness to examine their own views and consider alternatives. van gelder (2005) identifies cognitive bias, a natural tendency of individuals to selectively use evidence to support and preserve their own beliefs, as a hurdle to developing openness to new information. by explicitly raising students’ awareness of this tendency, along with providing opportunities to actively practice looking for contradictory evidence, students can be helped to be open to changing their minds when evidence contradicts their original belief (van gelder). gibbs and gambrill (1999) offer games and exercises that highlight cognitive bias which can be effective tools in helping students recognize how such biases affect perception and decision-making. social work educators can design assignments to highlight cognitive bias while encouraging students’ intellectual curiosity, imagination, and openness to new ideas and information. for example, prior to studying adolescence as a life stage in an hbse class, instructors could ask questions about this developmental stage such as: “is it generally a time of turmoil? what happens to teenagers’ relationships with their parents and siblings during this time? what marks the “end” of adolescence?” students could then be assigned to find evidence that supports and evidence that contradicts their opinion and bring this information to a subsequent class discussion. as part of this discussion, the instructor could invite students to consider how much their own experience of adolescence affected their initial opinions and to what extent research evidence supports and/or challenges their beliefs. specific strategies for helping students become more openminded are often based on using group discussion and analysis, for example, listening to, considering, and evaluating alternative views and experiences in arriving at a solution. material in films (shdaimah, 2009; weerts, 2005) and case vignettes can be used to identify problems and generate alternative solutions. for example, mottola and murphy (as cited in staib, 2003) trained nursing students to be open to alternative views through having them engage in group discussion and analysis of solutions to a practice dilemma. students were directed to identify all the factors they included in formulating their solution and then “think about factors they had not previously considered before the group discussion” (staib, p. 502). the final step, which explicitly required students to identify and be open to previously unconsidered solutions, was seen as crucial by the researchers. as mentioned earlier, there is preliminary evidence that students with low critical thinking skills present particular problems due to their unwillingness to change their misconceptions (kowalski & taylor, 2004), their experience of critical thinking as “tricky” (williams et al., 2004), and their preference for concrete answers (williams et deal, pittman/critical thinking skills 98 al., 2003). such research seems consistent with the connection found in this study between open-mindedness and critical thinking. for these students, instructors can help by focusing on the decision-making process, rather than the correct answer, when reviewing exam material or in-class exercises. williams et al. (2004) suggest a peer coaching program in which students with high levels of critical thinking review exams with students with lower critical thinking levels and explain how they arrived at their answers, a process that could benefit both groups of students. instructors can also address students’ lack of critical thinking skills by providing written feedback on assignments, e.g., thoughtful questions which are intended to provoke students’ curiosity about their work. the student could be given a period of time to consider the questions posed by the instructor and then meet to discuss their thoughts. this process allows the instructor to identify strengths and weaknesses in the student’s critical thinking skills and to use the specifics of the student’s written work to engage and challenge the student. devising strategies to assist students who are less interested, motivated, or able to engage in a critical thinking process is a fruitful area for additional research. helping these students first develop open-mindedness as a “habit of mind” could lay the groundwork for developing critical thinking skills such as seeking and evaluating evidence to support their beliefs or decisions. field instructors have many opportunities to provide new experiences for their students through selecting case assignments in the agency and community. in order for these experiences to provide fertile ground for development of critical thinking skills however, field instructors need to purposefully engage students in reflecting upon and evaluating their experiences. by modeling openness to students’ ideas, sharing with students how they make decisions and evaluate their own work, and asking questions that require reflection and analysis, field instructors can help students use their new experiences to sharpen their critical thinking (deal, 2003). schools of social work might consider offering training in critical thinking to field instructors. by improving their own critical thinking skills, field instructors could be better prepared to assist their students develop these skills (rogers & mcdonald, 1992). the correlation between critical thinking and openness to new experiences also provides implications for admission of students into social work programs. as part of admissions scoring, schools of social work could design an essay question to evaluate students’ openness and curiosity or consider looking for signs of these attributes in student essays or interviews. one school found that applicants who succeeded in gaining admission to a social work postgraduate program following an interview scored higher on the openness scale of the neo-pi-r, suggesting that students perceived by interviewers as “more open, less judgmental and more accepting” were seen as a good fit with the profession (manktelow & lewis, 2005, p. 305). conclusion given the mixed results found in this and previous studies (clark, 2002; harrison & atherton, 1990; huff, 2000; kersting & mumm, 2001; klau, 1996; plath et al., 1999), future research is needed to assess the impact of social work education on social work advances in social work, spring 2009, 10(1) 99 students’ critical thinking skills, particularly whether social work education in general, and/or courses specifically designed to teach such skills, are successful in increasing students’ critical thinking abilities. the correlation found between students’ ability to think critically and the personality trait of open-mindedness, however, suggests one promising area of future knowledge development. by developing and testing strategies to increase students’ openness and curiosity in both classroom and field, social work educators may discover ways to prepare students to engage in the rigorous process of critical thinking. references beckie, t. m., lowry, l. w., & barnett, s. 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(2006). critical thinking dispositions and skills of senior nursing students in associate, baccalaureate, and rn-to-bsn programs. journal of nursing education, 45(6), 233-237. deal, pittman/critical thinking skills 102 shlonsky, a., & stern, s. b. (2007). reflections on the teaching of evidence-based practice. research on social work practice, 17(5), 603-611. smith, g. (2002). are there domain-specific thinking skills? journal of the philosophy of education society of great britain, 36(2), 207-228. spelic, s. s., parsons, m., hercinger, m., andrews, a., parks, j., & norris, j. (2001). evaluation of critical thinking outcomes of a bsn program. holistic nursing practice, 15(3), 27-34. stevens, j. (2002). applied multivariate statistics for the social sciences (4th ed.). mahwah, nj: lawrence erlbaum associates. staib, s. (2003). teaching and measuring critical thinking. journal of nursing education, 42(11), 498-508. tanner, c. a. (2005). what have we learned about critical thinking in nursing? journal of nursing education, 44(2), 47-48. thompson, c., & rebeschi, l. m. (1999). critical thinking skills of baccalaureate nursing students at program entry and exit. nursing & health care perspectives, 20(5), 248-252. tsui, l. (1999). courses and instruction affecting critical thinking. research in higher education, 40(2), 185-193. van gelder, t. (2005). teaching critical thinking: some lessons from cognitive science. college teaching, 53(1), 41-46. weerts, s. (2005). use of films to teach critical thinking. journal of nutrition education behavior, 37, 100-101. williams, r. l., oliver, r., allin, j. l., winn, b., & booher, c. s. (2003). psychological critical thinking as a course predictor and outcome variable. teaching of psychology, 30(3), 220-223. williams, r. l., oliver, r, & stockdale, s. (2004). psychological versus generic critical thinking as predictors and outcome measures in a large undergraduate human development course. the journal of general education, 53(1), 37-58. williams, r. l., & worth, s. l. (2001). the relationship of critical thinking to success in college. inquiry: critical thinking across the disciplines, 21(1), 5-16. author’s note: address correspondence to: kathleen holtz deal, ph.d., associate professor, university of maryland school of social work, 525 west redwood street baltimore, md 212011777. email: kdeal@ssw.umaryland.edu. mailto:kdeal@ssw.umaryland.edu introduction literature review methods procedures measures data analysis results predictors of critical thinking critical thinking skills by social work degree discussion limitations and strengths implications for social work education conclusion references spring2001-002_i spring2001-003_ii spring2006-005_page1 spring2006-006_page2 spring2006-007_page3 spring2006-008_page4 spring2006-009_page5 spring2006-010_page6 spring2006-011_page7 spring2006-012_page8 spring2006-013_page9 spring2006-014_page10 spring2006-015_page11 spring2006-016_page12 spring2006-017_page13 spring2006-018_page14 spring2006-019_page15 spring2006-020_page16 spring2006-021_page17 spring2006-022_page18 spring2006-023_page19 aisw vol. 8, no. 1:aisw vol. 5, no. 2 attachment theory and the social work curriculum timothy page rhonda norwood abstract: attachment theory, as developed by bowlby and ainsworth, represented a major departure from the current theories of human development of the time, particularly in its rejection of the major tenets of psychoanalytic theory and its integration of core ideas from evolution theory and cybernetics (ainsworth & bowlby, 1991). attachment theory posits that a foundational human instinct, the desire to achieve safety and protection through proximity to a protective figure, is responsible for the formation of a special class of life-long affectional bonds, referred to as “attachments.” emotional security is derived to a great extent, according to the theory, from experience with caregivers who are consistently responsive to the developing infant’s expression of attachment behavior toward them. forty years of empirical research has shown that attachment is a universal characteristic that predicts children’s development of cognitive and social competence, emotional regulation, and positive self-image (weinfield, sroufe, egeland, & carlson, 1999). social work educators are currently challenged to better integrate the findings of attachment research into their curricula to reflect more the current state of developmental science. keywords: attachment theory, social work theory historical context of the development of attachment theory the creation of attachment theory, beginning with the work of john bowlby (19071990) and, later, mary ainsworth (1913-1999), was, like all great ideas, as much a product of new intellectual currents as it was an explicit rejection of the old ideas it was intended to replace. bowlby, a british practicing psychiatrist at the tavistock clinic in london, was the originator and major theorist, while his colleague, ainsworth, an american developmental psychologist, extended and provided the first empirical support for the theory with her observational studies in uganda and later in the u.s. bowlby developed his ideas about infant development within the intellectual context of mid-20th century london, where current ideas about child development were dominated by freudian thought. he diverged from freudian theory in many important ways, none more so than in his emphasis on the importance of actual experience to human development (bowlby, 1982). the classical psychoanalytic model was based on a concept of a unique form of internal psychic timothy page, ph.d. is an associate professor and rhonda norwood, msw is a doctoral candidate at louisiana state university school of social work, baton rouge, la 70803. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 30-48. indiana university school of social work. 30 energy, distinguished from physical energy, as the motivating force for human development, conceived of primarily as psycho-sexual drive energy (greenberg & mitchell, 1983). this conceptualization of internal psychic development, the socalled “hydraulic model,” was derived from ideas current in 19th century physics concerning the process of accumulation and discharge of energy within closed systems, the goal of which is a state of relative quiescence. in freud’s view, through the process of build-up and discharge of psychic energy, and especially the pleasures and frustrations associated with it, internal fantasy is created, characterized by the sexual nature of drive energy. these fantasies were presumed to be (especially as expressed in freud’s earlier works) even more important to the course of human development than the infant’s actual experience. the classical freudian view, then, is one that stresses the importance of internally derived developmental processes (bowlby, 1982). bowlby replaced the freudian notion of instinct as psycho-sexual drive with a model of instinct that depended on the interaction of organism and environment, among the earliest and most fundamental of which is the instinct to achieve and maintain physical proximity to a known individual perceived to be protective in times of distress, the foundation for attachment. the motivations associated with attachment, therefore, were seen as fundamentally social in nature, oriented toward building and maintaining close relationships from the time of birth. in this respect, bowlby’s ideas reflected the revisionist school of psychoanalytic theory, object relations theory. he differed from these theorists, however, in several important ways, beginning with his assertion that the instincts and motivations most important for human development are those having to do with the need for safety and protection. bowlby also took exception to the theories postulated by some of the most prominent object relations theorists, in particular, those of melanie klein and margaret mahler, who represented very diverse views within the larger object relations school. he rejected kleinian theory primarily because of her emphasis on the importance of aggressive and destructive impulses, and the primary significance for the course of development of the child’s internal mental representations produced by these impulses. he also rejected mahler’s theory of separation-individuation, starting with her postulation of a phase of “symbiosis,” where the infant has no sense of differentiation from the caregiver, as well as the notion that object permanence is acquired only in the third or fourth year. these ideas were not then and, especially as seen in the light of contemporary research, are not now reflective of what is known about the developing infant’s perceptions and capabilities (see national research council, 2000). also, unlike freudian theory, bowlby created attachment theory on a foundation of systematic observations of children in their interactions with caregivers. one of the strongest influences on the thinking of bowlby and ainsworth was their colleague at the tavistock clinic, social worker james robertson. in several influential films, robertson observed children in hospitals and orphanages, recording their protest and grief reactions in conditions of confinement, separated from their parents (robertson & robertson, 1959). this early work helped to establish some of the central tenets of attachment theory, that children’s intense reactions to pro31page, norwood/attachment theory and the social work curriculum longed separation from or loss of their primary caregivers indicate that a strong emotional bond exists between them, which begins in infancy, and that even young children experience mourning when they suffer prolonged separation from or loss of their primary caregivers (bowlby, 1960). as common as these ideas seem today, they were not widely accepted in his time. in attachment theory, the growing child’s actual life experience, therefore, in particular, the child’s early experiences with adequate care and, in unfortunate circumstances, the loss of a caregiver, are regarded as the most important determinants of development (bowlby, 1982). bowlby also founded his theory on the evidence provided by comprehensive analyses and syntheses of scores of diverse ethological studies, with a particular concentration on primate studies, which he used to establish attachment theory within the larger theory of evolution. attachment theory has been called a “major middle level” evolutionary theory (simpson, 1999), because of its foundation in and refinement of darwinian theory. evolution theory became increasingly established as the dominant paradigm of the natural sciences in the 20th century, though it had not, until bowlby, had a significant place in our understanding of human psychosocial development. one of the great achievements, therefore, of bowlby’s attachment theory is that it represents the first time that a major theory of human psychosocial development became integrated into the dominant paradigm of modern biological sciences. linkages of attachment theory to hbse curricula in social work education attachment theory is a theory of human behavior within the social environment that incorporates the basic ideas of goal direction, exchange, and systemic integration characteristic of social systems theories. (see the summer 2004 issue of development and psychopathology for discussions of interfaces between attachment and social systems theories.) as bowlby’s basic notion of behavioral systems indicates (see discussion below), human behavior can only be understood as it becomes expressed in social relationship transactions. this view is thus representative of the contemporary view in developmental science that the old naturenurture dichotomy is a false one (national research council, 2000). what was formerly thought of as “nature” and “nurture” is now understood as component parts of one process; the one has no meaning without the other. attachment theory should be a cornerstone of theories presented in social work hbse courses, because of its roots in human biology, its theoretical grounding in evolution theory, its explanatory power in addressing fundamental aspects of human experience, its reflection of social system dynamics, its widespread current acceptance among developmental scientists, and the vast empirical literature that supports it. while attachment theory has received notice in some hbse texts, its presentation in them, with the notable exception of haight and taylor’s recent text (2007), is often superficial. there are several current hbse texts, however, that make no mention of attachment theory or of bowlby. surprisingly, many of the current hbse texts still prominently feature detailed presentations of freudian theory and its derivatives, despite the absence of empirical support for 32 advances in social work these and the view shared among the great majority of developmental scientists that, while of historical importance, as contemporary developmental theories they are obsolete. that the profession of social work, as judged by our hbse texts, has taken so long to join the majority view of developmental scientists in this regard is puzzling. there is a particular imperative for social workers and social work educators to be thoroughly grounded in attachment theory and research. as a profession, we have a unique responsibility to provide services to the most vulnerable of our society’s children in our child welfare systems. making the best-informed decisions about the well-being of these children requires thorough knowledge of the processes through which children form attachments to their caregivers. unless we address these issues in depth in our curricula, reflecting the current state of knowledge in the field, we are neither honoring our professional responsibilities nor practicing ethically. component parts of attachment theory theory of instinctive behavior: the goal-corrected behavioral system paradigm attachment theory was first and foremost a new theory of human instinct and, thus, basic motivation. according to bowlby, instinctive behavior necessarily involves the following four components: it is shared by a species; it contributes to individual or species survival; it is not dependent on learning; and it is characterized by a behavioral sequence, “not a simple response to a single stimulus” (1982, pg. 38). despite the fact that his work to a great degree was concerned with the essential human instincts, he was wary toward the use of this term, concerned that it might communicate a view of inherited behavior operating in isolation from environmental conditions. instead, borrowing a concept from cybernetics and control systems, bowlby created the construct of the “goal-corrected behavioral system” to reflect the essential components of instinctive behavior as inherited capacities that are always dependent on the nature of the social context for their expression. thus, the activation of behavioral systems in developing children always involves instinctive expression and the social learning associated with this in a feedback loop. the child influences this process through a capacity for “goal correction”, that is, modification of behavior directed toward the social goal vis-àvis the caregiver, based on feedback received regarding the effectiveness of pursuit of the goal. attachment behavior bowlby’s main interest was the formation, beginning in infancy, of the behaviors that collectively compose the attachment behavioral system. similar to the way in which the neonate responds to tactile stimulation of the lips and hard palate with reflexive grasping and sucking (elements of the feeding behavioral system), bowlby proposed that the infant responds to conditions of vulnerability, such as fear, pain, cold, hunger, fatigue, and illness with reflexive behaviors, including crying, clinging, smiling, visually following the caregiver, signaling, and later, movement toward the caregiver. he proposed that the explanation for the genetpage, norwood/attachment theory and the social work curriculum 33 ic inheritance of these capacities lies specifically in their function in maintaining physical proximity to a caregiver. beginning around the age of six months, these early behaviors become increasingly organized and incorporated into the attachment behavioral system (bowlby, 1982). proximity-seeking directed to a specific caregiver in distressing circumstances, the fundamental component of attachment behavior, serves the proximate purpose of calming feelings of insecurity and the evolutionary function to heighten the infant’s odds of survival and, thus, the ultimate reproductive success of the species (bowlby, 1982). the caregiver’s sensitive response to the infant’s activated attachment behavior produces, under favorable conditions, calming and a growing sense of emotional security. attachment behavior and attachment although bowlby adapted terminology from cybernetics and control systems for his theory of instinct, the functioning of the attachment system is conceptualized primarily as an affective process, the chief consequence of which is the formation of a special class of affective bonds (what we think of as the attachment proper), which is a particular expression of love for a specific attachment figure and which tends to be relatively enduring across the lifespan. because the formation of attachments is a life-long developmental theme (ainsworth [1989] pointed out, for example, that successful marriages are those where the partners are able to alternate their reliance on each other as attachment figures), attachment theory recast what it means to need another person in times of distress. anxiety and longing, as responses to separation from loved ones, could now be seen as normal indicators of strong bonds, not immaturity or insufficient autonomy. attachment, fear, and exploration the attachment behavioral system functions directly in relation to two other major behavioral systems within the child (bowlby, 1982), the fear/wariness and exploratory behavioral systems, representing, respectively, the instinct to withdraw from frightening circumstances and the instinct to explore novel situations. bowlby proposed that the attachment and fear/wariness behavioral systems operate in close, but not absolute, synchrony. very frequently, but not always, bowlby argued, attachment behavior is activated by fear-inducing conditions that simultaneously activate withdrawal from the feared object. attachment behavior may also be activated, however, according to bowlby, in conditions not directly associated with an instinct to withdraw, such as fatigue and illness. the exploratory behavioral system, in contrast to the fear/wariness system, plays a role fully equal in importance to the attachment system in determining how attachment behavior ultimately becomes expressed and, thus, how the attachment bond is formed. a natural, instinctive desire to explore the social and physical environment is normally activated in conditions where the child is relatively stress-free. through this process, the child learns about the world, taking in new information and developing perceptual, analytical, and motor skills that provide opportunities for the child’s development of mastery and autonomy. inevitably, however, the child experiences depletion in energy or becomes distressed by encounters with unfamiliar objects or events, or from the separation from an attachment figure which produce felt vulnerability, activating the attach34 advances in social work ment behavioral system. in this way, exploratory and attachment systems are regarded as polar dimensions of a larger process, whereby the activation of one normally involves the relative deactivation of the other. in order for the child to be able to explore the world with confidence, s/he must be able to trust in the availability of the “secure base” of the attachment relationship, as described by ainsworth (ainsworth & bowlby, 1991), where the child can return for care and protection when needed. the way in which the attachment figure accurately perceives and responds to the child’s alternating needs for exploration and attachment will determine the nature of the attachment bond that the child will form with the attachment figure. as ainsworth (1989) later demonstrated, the transactions associated with exploration and proximity-seeking provide the infant with opportunities to learn an array of communication and social skills that become a foundation for social relatedness in ever widening social spheres as the infant matures into childhood. essential relational styles of communication of need, and the expectations of others’ responses to expressions of need, are therefore first learned in infancy in the first attachment relationships. cognition and development through repeated experiences with the attachment figure in times of distress, the child learns about the responsiveness and reliability of the caregiving environment. these early experiences become increasingly organized in memory in structures bowlby (1973, 1982) referred to as “internal working models”, a term first used by the philosopher and cognitive psychologist kenneth craik. bowlby preferred this term over more static representations of cognitive structures, because it communicates a sense of patterned responses to the social environment and, at the same time, the capacity for ongoing revision, based on learning from new social experiences. internal working models, thus, can account for continuity of individual development as well as individual change. internal working models become increasingly established and resistant to major revisions as the child grows, however. (the conceptualization of stability and change in cognition is one of several areas where bowlby [1973] acknowledged the influence of piaget on his thinking.) early and consistent inadequate caregiving is especially associated with rigidly defensive representational models that are relatively impervious to change (bowlby, 1980). positive caregiving experiences tend to promote relatively flexible internal working models that serve a protective function for children: according to bowlby, the primary adaptive function of internal working models is to provide the developing child with the capacity to predict the likely responses of potentially protective figures in situations where the child experiences vulnerability. expectations of responsive care from others become associated with emotional security, which can provide a buffer against future negative interpersonal experiences (weinfield, sroufe, egeland, & carlson, 1999). from the initial period at age six months until approximately 18 months, bowlby viewed the child’s development of internal working models as embryonic. at this latter age, the child, under favorable conditions, is able to apply the representation of attachment figure(s) in a new capacity. the child now has the more complex mental organization of the internal working model of attachment figure increasingly available for the purpose of executing increasingly complex behavpage, norwood/attachment theory and the social work curriculum 35 ioral plans, especially those that involve venturing farther away from the proximity of the caregiver, using the internal representation of the caregiver to make predictions about his/her availability (bowlby, 1980). as most children approach the end of the third year, the internal representation of the caregiver begins to carry with it the security-providing functions which, for the infant, were previously associated only with the actual presence of the attachment figure. at this point, the child can increasingly “turn to” the internal working model of the attachment figure when experiencing vulnerability when s/he is away from the attachment figure. bowlby thought that this period is one in which the child is highly susceptible to external influences upon the formation of internal working models (bowlby, 1980), reflecting their, as yet, formative nature. while approximate developmental age-markers are useful for tracking these changes, it is important to note that bowlby disliked the use of “watershed”-type age markers. he saw the development of internal working models as a gradual life process that changes qualitatively over time and is susceptible to revision. at the same time, however, according to his theory, it is the formation of internal working models in infancy that account for the enduring quality of early attachment relationships throughout life (bowlby, 1982). the formation of internal working models in unfortunate conditions and defensive processes in optimal conditions, attachment figures respond adequately and consistently to children’s experiences of vulnerability, and corresponding internal working models of attachment figures as reliable and trustworthy are formed. when a child consistently encounters behavior on the part of an attachment figure that does not adequately address conditions of vulnerability, however, the child is likely to form conflicting internal working models of the same attachment figure, a conscious internal working model that preserves a sense of the caregiver as good and one that is defensively excluded from consciousness containing the information regarding inadequate responses (bowlby, 1973). bowlby asserted that this sort of defensive exclusion is necessary for the child to preserve mental stability. attempts to consciously integrate the experience of threat and persistent insecurity associated with an attachment figure would be likely to overwhelm the child. in order to preserve some sense of safety and security, the child maintains an illusory mental model of an adequate caregiver. effects of prolonged separations from caregivers unlike nearly all other psychoanalysts of his time, bowlby was especially interested in loss and the reactions of grief and mourning that young children between the ages of six months and three years experience when separated from their caregivers, the time of life when, as noted previously, attachment is especially sensitive to environmental changes. relying to a great extent on robertson’s observational studies, bowlby and robertson (bowlby, 1980; robertson & bowlby, 1952) proposed that young children normally react to prolonged separation from their attachment figures in phases characterized by protest, despair, and (if the separation is not addressed) detachment. his theory of grief and mourning, influenced by the work of colin murray parkes (bowlby, 1980), involves a normative 36 advances in social work progression through four major phases of adjustment: a) numbing and shock; b) yearning and searching, accompanied by anger and disbelief; c) disorganization and despair, including the dismantling of internal working models of the relationships; and d) reorganization and redefinition. this theory proved to be very influential on the work of others in the field, including that of kubler-ross. in his theories of separation and loss, the phases of adjustment are characterized by initial activation and subsequent deactivation of attachment behavior for the missing or lost figure, thus the meaning and function of these events were recast as expressions of attachment behavior. he also emphasized that the course taken in childhood in reaction to separation or loss may well affect a person throughout the entire lifespan, depending to a great extent on the way in which attachment behavior was expressed in the relationship and the nature of response received from the caregiving environment. the contribution to attachment theory of mary ainsworth and colleagues in contrast to the comprehensive analytical syntheses and elegance of his theory, bowlby directly participated to a lesser degree in empirical research. the application of his ideas about human development to empirical research was left by and large to his followers, the first and most notable of whom was mary ainsworth. first in uganda, and later in her landmark baltimore study (ainsworth, blehar, waters, & wall, l978), home observations of mother and child interactions were coded for various aspects of the mother’s sensitivity to the child and the child’s autonomous and responsive behavior in relation to the mother. patterns of secure and insecure attachment (described below) emerged from these observations, providing an empirical basis for bowlby’s theoretical construction of attachment in humans and expanding the theory of how individual differences occur with respect to the organization of attachment. a major methodological innovation created by ainsworth and colleagues in the baltimore study was the so-called strange situation procedure, a laboratory protocol containing several progressive steps designed to directly observe how infants react to separation from their attachment figures in an unfamiliar setting (see solomon & george, 1999, for more detail). significant relationships were found between the home observations of the quality of mother-child interactions and the laboratory attachment patterns observed in the strange situation, suggesting that the laboratory observations were valid indicators of interactive behavioral patterns between mother and child. the observations of mothers and children led to the construction of three main categories (composed of eight subgroups) reflecting what ainsworth referred to as patterns of attachment. these categories are: insecure-avoidant (a); secure (b); and insecure-ambivalent (resistant) (c). in the strange situation, avoidant babies tended to avoid their mothers upon her return following separation by turning their backs or snubbing maternal overtures, and their communication styles were marked by affective restriction. secure babies generally approached their mothers following separation and returned to exploration after having brief contact with her. their communication styles were characterized by affective openness and mutuality, with clear modulation and regulation of extremes. page, norwood/attachment theory and the social work curriculum 37 ambivalent babies tended to approach their mothers upon the mother’s return following separations but remained dissatisfied and angry, not soothed by her presence. their affective communication was typically disregulated and hostile. ainsworth’s findings supported and elucidated several important aspects of bowlby’s theory of attachment, especially the notion that attachment behavior will look different for children depending on their life experiences. she made it clear, however, that these variations in attachment styles were not equivalent to variations in the strength of attachments (ainsworth, 1972). avoidant children, for example, are just as strongly attached to their caregivers as secure children; they differ in the strategies they have learned to express their attachment needs in relation to their specific caregivers. the strange situation was important, first, because it provided a standard behavioral measure of attachment for infants up to approximately two years of age (it is typically used for infants between the ages of 12 and 18 months). it also came to be viewed as essentially a “shortcut” in the assessment of parent and child interaction that normally would be done in the naturalistic setting of the home (ainsworth & marvin, 1995). assessment in the strange situation, then, has become a standard against which other measures of attachment, especially those taking place later in childhood, are compared. the work of mary main (main & solomon, 1990), one of ainsworth’s many distinguished students, has contributed an additional fourth category of attachment behavior to ainsworth’s original formulation, the disorganized/disoriented category. characteristics observed in the strange situation reunion behavior of children assigned to this group are immobilization and disorientation upon the mother’s return, contradiction in physical movement, and, inferred from the contradictory physical movements, contradictions in intended or planned behavior. the disorganized/disoriented attachment pattern is considered a more severe adaptation to inadequate caregiving circumstances, distinguished by the absence of any coherent strategy for engagement and interaction, and has been shown to be prevalent among maltreated children (as high as 82% reported in carlson, cicchetti, barnett, & braunwald, 1989). the goals and boundaries of attachment theory bowlby clearly intended the attachment behavioral system to be understood as instinct-based behavior of at least equal importance to feeding and reproduction for lifespan development. this is not to say, however, that he viewed attachment in the same deterministic sense that freudian theory reduced development to internal psychosexual drives. instead, bowlby conceptualized the formation of attachment in terms of dynamic systems that provide a foundation for the trajectory of lifespan development, which is modified through maturation and many other developmental influences, including subsequent relational interactions in the social ecology. 38 advances in social work page, norwood/attachment theory and the social work curriculum other important influences on the child-parent relationship and the child’s personality attachment and temperament in the early years of attachment research, there was some speculation that the individual differences that ainsworth reported in attachment styles were actually temperamental differences (e.g., kagan, 1982) and that, therefore, the theoretical edifice created by bowlby was unnecessary to explain child development. since then, however, several studies of attachment and temperament have concluded that these are independent processes (belsky, 2005; vaughn & bost, 1999) and that, while the child’s temperament appears to exert some influence on the nature of the interaction that evolves between the child and his/her caregiver, the relational basis of the organization of individual differences in attachment has been shown to be robust over time and across cultures (van ijzendoorn & sagi, 1999). attachment and social learning another area of early criticism of bowlby’s ideas came from adherents of social learning theories. from this viewpoint, of course, personality is regarded as the sum total of learning experiences, with essentially no allowance for any innate predispositions in the developing child beyond the seeking of pleasure and the avoidance of pain. attachments form to caregivers, according to this viewpoint, as a secondary result of the gratification associated with meeting physiological needs. attachment theory does not contradict the learning mechanisms associated with social learning theories, but it goes beyond them in its core emphasis on instinctive inheritance. bowlby pointed out, for example, that children (as well as adults) form attachments to people who have nothing to do with providing sustenance or meeting other physiological needs, and he cited harlow’s primate studies, among many others, in support of his view (bowlby, 1982). likewise, as ainsworth and bowlby wrote, in circumstances where an infant is distressed, “timely and appropriate close bodily contact does not ‘spoil’ babies, making them fussy and clingy” (1991, pg. 7), a cautionary concern often voiced by traditional behaviorists. attachment and culture like much of developmental research, many of the early studies of attachment, including ainsworth’s early baltimore study, were done on white, middle-class samples in the u.s., with intact marriages. (the notable exception to this, as indicated above, was ainsworth’s very first fieldwork and the first empirical examination of attachment, which was done in ugandan villages.) since these early days, however, attachment has been studied in numerous cultures on every continent and across a wide diversity of environmental risk conditions. in general, the basic three attachment categories have proven to be robust indicators of children’s development (van ijzendoorn & sagi, 1999). culture, however, does appear to exert an influence on the ways in which children come to express attachment and exploration in relation to their caregivers and, therefore, may influence the assessment of attachment in the strange situation. for example, in north american normative samples, approximately two-thirds of children are classified as secure and approximately one-fourth are classified as avoidant (the remainder 39 are either insecure-ambivalent or disorganized). in contrast, research in israel has found similar or higher percentages of secure children, more insecure-ambivalent children, and extremely few insecure-avoidant children. despite variations such as these, the accumulated research has shown that attachment is a universal, normative phenomenon and that the major distinguishing factors among children’s attachment classifications, as obtained in the ssp and other attachment assessments, relate to the quality of care and responsiveness provided by the caregiver and the social context within which this is provided (van ijzendoorn & sagi, 1999). an attachment framework for intervention bowlby’s original intention in constructing attachment theory was primarily to elucidate a practice theory that “fit the facts” better than freudian theory. his ideas, however, were soon adopted by developmental research psychologists, who found in them powerful explanations for early childhood development. in recent years, there has been a renewed interest among many to return to bowlby’s original intention to apply the theory to problems associated with clinical intervention. in his later work, bowlby (1988) described a set of guidelines for therapeutic intervention informed by attachment theory. among these, he included the therapist’s sensitivity to the primacy of safety and protection in the developmental experience of the client. interpretations and analysis of the client’s relational experience, including within the therapeutic relationship, should be based on an understanding of the centrality of the expression of attachment behavior to social experience and the creation of personal identity. several evidenced-based interventions founded on attachment theory that incorporate these guidelines have recently been developed. these approaches focus first and foremost on systematic observations of parent-child interactions, many of which use videotape to document relationship qualities as well as teach parents how to strengthen their observational skills toward their children (cohen et al., 2002; lieberman, silverman, & pawl, 2000; marvin, cooper, hoffman, & powell, 2002; mcdonough, 2004). it is also important to note, however, that the construct of attachment and related concepts, unfortunately, have been distorted and misapplied to illegitimate interventions, often referred to as “attachment therapies.” part of this confusion of terms involves the notorious “holding therapy”, variations of which have been responsible for serious injury and death (boris, 2003; mercer, 2001). illegitimate uses of the concepts of attachment theory, which are perhaps inevitable, can only be avoided through true understanding of its tenets and related research findings. emerging ideas: attachment and developmental psychopathology recent advances in the field of developmental psychopathology have contributed to a new understanding of psychopathology more as adaptation than illness, and attachment theory has made a substantial contribution to this new direction of inquiry (sroufe, 2005). highlights of these new applications include recent work on reactive attachment disorder (lieberman & zeanah, 1995), new insights into the processes associated with traumatization and post-traumatic stress (lyonsruth & jacobvitz, 1999; main & hesse, 1990), and early attempts to discover developmental foundations for axis ii disorders based on attachment theory (crittenden, 1997; page, 2001a; sroufe, 2005). 40 advances in social work selected major empirical studies attachment theory created a virtual explosion of empirical research in developmental science over the past 40 years that continues to bring new discoveries in ever-increasing areas of inquiry. due to space limitations, only a selection of this literature is reviewed here. for more detailed analyses, the reader is referred to cassidy and shaver’s (1999) compendium. the first and most important methodological contribution to the study of attachment remains the ainsworth and wittig strange situation procedure (ssp) (see above), which is considered the “gold standard” of attachment research. two of ainsworth’s students, jude cassidy and robert marvin, adapted the original ssp for use with preschool children up to age 5 (cassidy & marvin, 1992). since ainsworth’s landmark work, researchers following her trail have studied attachment in varied conditions with the ssp and newer methodologies, including various high-risk samples (cicchetti & barnett, 1991; crittenden, 1988; maslin-cole & spieker, 1990); culturally diverse samples (noted above); and in increasingly older samples, beyond infancy, the preschool and school years, and into adulthood (bretherton, prentiss, & ridgeway, 1990; cassidy, 1988; elicker, englund, & sroufe, 1992; feeney, 1999; main, kaplan, & cassidy, 1985; sroufe, 1983; sroufe, 2005). children’s attachment organization has been found to predict individual characteristics, such as self-esteem, emotional regulation, and cognitive and social competence (weinfield, sroufe, egeland, & carlson, 1999; van ijzendoorn & sagi, 1999), and it has been found to be predicted by qualities of the wider social ecology and history of the family, including mothers’ sensitive responsiveness (ainsworth, blehar, waters, & wall, 1978); mothers’ social support (crockenberg, 1981); parent-child communication qualities (stewart & marvin, 1984; sroufe, 1983; main, kaplan, & cassidy, 1985); and violence, maltreatment, and trauma (lyons-ruth & jacobvitz, 1999). representational research most of the early studies of attachment relied on observed behavioral interactions of the child-caregiver dyads to determine how differences in security of attachment at one point in time relate to past dyadic interactions, concurrent social characteristics, or to future development or behavior. an important shift in the study of attachment occurred, however, when main, kaplan, and cassidy (1985) suggested that the study of attachment should also be conducted at the representational level, directly assessing qualities of internal working models, especially as these are revealed in discourse qualities. in a pivotal longitudinal study, main et al. (1985) examined the discourse qualities between 6 year-old children and their parents following a separation, as well as the parents’ state of mind with respect to attachment as assessed with the adult attachment interview (aai; george, kaplan, & main, 1984). the aai is a semi-structured interview that probes for adults’ memories, thoughts, and perceptions regarding their relationships with their own parents or attachment figures and how those relationships have affected their adult personalities and relationships with their own children. the interviews are scored on the basis of coherency of the discourse, involving qualities such as consistency, flow, truthfulness, and richness of supporting memories offered in responses, as well as the succinctness, completion, relevancy, and clar41page, norwood/attachment theory and the social work curriculum ity of responses (hesse, 1999). of particular importance, these qualities of discourse, in contrast to the interview content, are the dimensions of most importance to the assessment of attachment organization with the aai, because they reveal the ways in which significant memories of early experience are organized and stored (for more detail of the theory and method of the aai, see hesse, 1999). the interviews are classified into four categories, reflecting attachment styles, corresponding to the same attachment styles identified in children: autonomous/secure, dismissing/avoidant, preoccupied/ambivalent, and unresolved/disorganized. in the main et al. study, secure parents were more likely to value attachment relationships, believe that attachment related experiences were influential on their own personality, and tell coherent, objective narratives, whereas dismissing parents minimized the value and importance of attachment relationships, preoccupied parents seemed confused or preoccupied with particular relationships, and unresolved/disorganized parents demonstrated lapses in discourse when discussing traumatic events or losses, indicating that they had not yet successfully resolved their mourning. analyses indicated that these classifications of the parents’ states of mind with respect to attachment were associated with their children’s corresponding attachment classifications obtained in infancy (main et al., 1985). most impressively, adult attachment styles obtained with the aai with expectant mothers in the third trimester of pregnancy have been found in subsequent studies to predict their children’s attachment styles longitudinally when the children are 12 months old (fonagy, steele, & steele, 1991). the aai has led to a new understanding of the significance of discourse qualities in speech and has spawned a new generation of interview protocols that reflect these insights (oppenheim & koren-karie, 2002; zeanah & benoit, 1995). recent studies of attachment with foster parents and children using the aai are of particular importance to social work. among the salient findings of these studies, adoptive or foster parents’ states of mind with respect to attachment are associated with the degree to which their foster homes provide developmentally corrective environments for maltreated children (dozier, higley, albus, & nutter, 2002; dozier, stoval, albus & bates, 2001). children’s representations several representational measures of young children’s attachment organization have also been developed in recent years using semi-projective techniques. for example, george, kaplan, & main (1985) used the separation anxiety test (sat) to elicit children’s narratives about drawings illustrating child-parent separations and derived coded attachment categories that were found to be associated with their infant attachment classifications obtained from strange situations. narrative story stem techniques (nsst; bretherton, ridgeway, & cassidy, 1990; emde, wolf, & oppenheim, 2003) are similar to the sat in their projective natures but use play props to facilitate the child’s narrations and increase the interpretability of the child’s representations. in 20 years of research, the nsst has been found to relate to several dimensions of children’s and parents’ psychological and social functioning, including infant attachment, child social competence, child maltreatment, and parent psychological distress (see page, 2001b for a review). recently (toth, maughan, todd-manly, spagnola, & cicchetti, 2002), the 42 advances in social work nsst has also been used as an outcome variable for a parenting intervention, showing that clinical improvement on the part of parents is associated with children’s attachment representations of children in relation to parents in predicted ways. attachment and development over the lifespan attachment research has also been conducted in the lives of participants in several longitudinal studies over the course of several years (see grossmann, grossmann, & waters, 2005). the first of these, the minnesota longitudinal study of parents and children, merits special consideration, however brief, because of its unique contribution to our understanding of the linkages between infantcaregiver relationships and child development. this study began in 1975 with the recruitment of 267 low-income, first-time mothers in their third trimester of pregnancy and continues today with the children now in their 30s. numerous assessments have been made, including representational and observational, across home, laboratory, and school settings, to examine the predictive power of attachment across the lifespan. in brief, the quality of attachment relationships established in infancy, especially when combined with other conditions in the family social ecology, have been shown to be predictive of children’s developmental outcomes, particularly in the areas of self-reliance, emotional self-regulation, cognitive and social competence, and in particular for disorganized attachments, psychopathology (sroufe, 2005). this and other longitudinal studies provide support for bowlby’s notion that the “trajectories” of development, once established, are relatively difficult to alter (vaughn, 2005, p. 378). next steps for theory progression and implications for social work in 1999, mary main contributed an essay for the handbook of attachment entitled, attachment theory: eighteen points with suggestions for future studies, in which she provided a comprehensive discussion of current issues in theory and research development. using this as a foundation, we identify here a selection of four issues that we consider important for future exploration and application of theory. integration of multiple attachments/attachment hierarchies bretherton (1985), in expanding on bowlby’s original ideas, proposed that internal working models eventually become organized in hierarchical structures, where, in some instances, the model derived from one attachment relationship supersedes others in providing guidance and direction and, in other instances, syntheses of internal working model qualities are formed. bowlby used the term “monotropy” to describe the tendency for a developing child to regard one attachment figure above all others as primary. there has been little direct empirical investigation of these ideas, and much more needs to be learned, especially in circumstances where children live with multiple attachment figures. the critical period for attachment formation bowlby’s original theory posited that the first three years mark the critical period for the initial formation of attachment in normal circumstances and subsequent research has supported this (main, 1999). despite some recent groundbreaking studies of previously institutionalized children (see zeanah, smyke, koga, & 43page, norwood/attachment theory and the social work curriculum carlson, 2005), little is yet known about how children cope with the most extreme adversity in caregiving environments and their capacity for the formation of attachments relatively later in childhood. consequently, more needs to be known about how children form so-called “second” attachments, as in the case of placement in foster homes. a child’s capacity to form an attachment after suffering severe deprivation is likely to be the single most important developmental event in the child’s life, setting the stage for future social relatedness. brain chemistry main pointed out that a more precise understanding of the function of fear in relation to attachment must include a better understanding of the neurochemical processes and brain functions, in particular the role of the amygdala involved in the activation of the attachment behavioral system. bowlby posited that attachment behavior is founded in a genetically inherited capacity controlled by the central nervous system. an as yet unknown portion of variation in the way in which attachment becomes expressed may be associated with differences in brain chemistry and functions. assessment and intervention perhaps most important to social work, far more work must be done to integrate attachment theory and research methods into social work practice. we believe that there are, in particular, four important areas where this can be accomplished: assessments with children, especially adapting representational measures such as the nsst to clinical settings; adult interviewing, using the insights of research with the aai on the significance of discourse qualities to attachment organization; the use of videotape, using the technical achievements from the history of observational attachment research; and education for parents and foster parents, applying our developmental knowledge about the significance of attachment to development to problems in parenting. in particular, many commonly observed problems encountered in clinical interventions concerning family violence and child maltreatment, such as the strong, instinctive desire to seek and maintain proximity to an abuser, are illuminated with an understanding of attachment behavioral dynamics and the imperative for survival associated with violent circumstances (bowlby, 1982; page, 1999). in general, much more needs to be learned, and what is currently known disseminated more broadly, about the centrality of the human need for safety and security as central organizing concepts in clinical assessment, diagnosis, treatment planning, and intervention. the understanding of basic needs as embodied in attachment theory, in our view, should be core to the conceptualization of treatment approaches. the past 40 years have brought us considerable new knowledge about the importance for lifespan development of the processes associated with attachment organization. we in the profession of social work are now challenged to take this knowledge and effectively incorporate it into our educational and practice methods to better respond to the needs of vulnerable children and families. 44 advances in social work references ainsworth, m.d.s. 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(2005). discovering pattern in developing lives: reflections on the minnesota study of risk and adaptation from birth to adulthood. attachment and human development, 7(4), 369-380. vaughn, b.e., & bost, k.k. (1999). attachment and temperament. in j. cassidy & p. shaver (eds.), handbook of attachment: theory, research, and clinical applications (pp. 198-225). new york: guilford press. weinfield, n.s., sroufe, l.a., egeland, b., & carlson, e. (1999). the nature of individual differences in infant-caregiver attachment. in j. cassidy & p. shaver (eds.), handbook of attachment: theory, research, and clinical applications (pp. 68-88). new york: guilford press. zeanah, c.h., & benoit, d. (1995). clinical applications of a parent perception interview. child and adolescent psychiatric clinics of north america, 4(3), 539-553. zeanah, c.h., smyke, a.t., koga, s.f., & carlson, e. (2005). attachment in institutionalized and community children in romania. child development, 76(5), 1015-1028. author’s note: address correspondence to: timothy page, m.s.w., ph.d., louisiana state university school of social work, 216 h.p. long fieldhouse, baton rouge, la 70803, usa. e-mail: tpage2@lsu.edu. 48 advances in social work aisw vol. 5, no. 2 the internationalization of doctoral socialwork education: learning from a partnership in ethiopia alice k. johnson butterfield abstract: what does it mean to internationalize doctoral education by working abroad? what does it mean to internationalize doctoral education in one’s home country? this article offers a perspective based on the social work education in ethiopia partnership, which established ethiopia’s first-ever master’s degree in social work in 2004. to ensure sustainability of the msw program, a doctoral program in social work and social development was launched in 2006. this article describes the development and research base of the doctoral program. beginning in the first semester, teams of doctoral students join with poor communities in action research. overall, these efforts lead to an emerging model of university-based development. through engaged action research, faculty and students use human capital resources and the educational process to function as “development actors.” some ideas for internationalizing doctoral education are offered. deans and directors in the united states and canada are challenged to expand doctoral education within a developing country and to prepare doctoral students to include international perspectives in their teaching and research. keywords: doctoral education, international, community development, higher education partnerships, action research introduction international social work is a two-way street. this phrase illustrates that there is much that social workers in the developed world can learn from social work in developing countries (midgley, 1990).this idea guidesmywork internationally and represents what i believe should be the ultimate goal of international social work. but, howdowe andothers cross the intersections of theworld andbring each other to our side of theworld inways that promotemutual learning and development? in translating thesewords to the themeof internationalizing doctoral socialwork education, two questions emerge.what does it mean to internationalize doctoral education by working abroad?what does it mean to internationalize doctoral education at our home universities? alice k. johnson butterfield is professor, jane addams college of social work, university of illinois at chicago, chicago, il 60411. copyright© 2007 advances in socialworkvol. 8 no. 2 (fall 2007) 237-251. indiana university school of socialwork. 237 in the history of international social work, there are critiques ofwestern models that have been imposed on curriculum in developing nations, such as africa, and earlier in india and elsewhere (healy, asamoah, &hokenstad, 2003). i would like to posit, however, that we are in a new global environment defined by the information age—a concept articulated by thomas friedman (2006) as “the world is flat.” in a world with fewer trade and political barriers, billions of people are instantly “connected” to one another through the internet and advances in digital communication. in this environment of horizontal relationships, global collaboration takes on new meaning: international social work education partnerships can be ways of sharing methods, skills, models, and innovative practices without imposing them on developing countries in a fashion reminiscent of colonialism. to provide an example of what itmeans to internationalize doctoral education by working abroad, i will share experiences and involvement at both the master’s and doctoral levels in ethiopia. what i have learned about the internationalization of doctoral education has been learned through this practice. my thoughts are based particularly on my work and that of my colleagues at the jane addams college of socialwork at theuniversity of illinois atchicagoand thegraduate school of social work at addis ababa university in ethiopia through our university-to-university partnership. based on a formal agreement committing our two universities to joint efforts in teaching, service, and research, we envisioned that our partnership could become a “development actor.” holding fast to the idea that international social work is a two-way street, we imagined that the major efforts of our development, which occurred through our partnership, would occur in ethiopia. over time, its deliverable products—new degree granting programs, a professional workforce, and applied research—together would build the overall capacity of the host country to deal more adequately with its social and health problems. socialwork education in ethiopia partnership (project sweep) the story starts with an e-mail message inviting me to travel to ethiopia with a group of medical faculty. inmay 2001, i went to ethiopia as amember of a delegation led by former ambassador to ethiopia david h. shinn. the purpose of our visit was to identify specific needs and opportunities for collaboration with university and government officials and leaders of local non-governmental organizations (ngos) working in community health and social service delivery (shinn, 2001). i was particularly interested in the role of social work in ethiopia.what was the need for social work? did the profession exist? i found that the previous military regime had ended social work education. prior to 1976, there was a vibrant school of social work offering a bachelor’s degree. some 30 years later, only a remnant of social work education remained. two former deans, dr. seyoum gebre selassie and dr. andargatchew tesfaye, both whom received their ph.d. in social work and sociology from the university of michigan in the early 1970s, had “hidden” six courses in macro social work within the undergraduate curriculum at addis ababauniversity (aau). in the practice field, less than 50 social workerswith bachelor’s degrees remained where they had practiced social work in ethiopia for approximately the last 30. althoughmost were ending their careers through retireadvances in socialwork238 ment and several were recently deceased, these social workers were leaders in ngos and had mentored many graduates of sociology in the ways of social work. also, drs. seyoum and andargatchew, and a few younger colleagues in the department of sociology and social anthropology, had successfully placed the development of amaster’s degree in social work in theuniversity’s five-year strategic plan.while a goal, therewas little or no capacity to actually develop such a program. together, we wrote a proposal for seed funds to higher education for development (hed), the intermediary organization established in 1992 as the association liaisonoffice foruniversity cooperation indevelopment (alo). hed assists the nation’s six major higher education associations in partnering with the u.s. agency for international development (usaid). hed has funded more than 250 university-to-university partnerships over the past five years, from education, law, agriculture, and other disciplines, but wewere the first social work program to receive funding. the jane addams college received $99,000 to partner with addis ababa university to establish ethiopia’s first-ever master’s degree in social work. through the social work education in ethiopia partnership (project sweep), we completed an assessment of needs and planning, curriculum development and faculty exchange, andprogramdevelopment, including syllabi and teachingmaterials [http://www.aboutsweep.org]. a five-year memorandum of agreement was signed by the two universities to collaborate in teaching, research, and service. in developing the newmaster’s degree curriculum, we aligned it with the “global standards for socialwork education and training” (iassw, 2004). the curriculum addresses ethiopia’s current and emerging health and social needs by emphasizing engaged research and community-based services that focus on poverty reduction. the new graduate degree prepares professional social workers to manage community-based services and develop newprograms in the areas of health, child welfare, and community development. specific courses focus on community practice, socialmobilization, food security, andmigration; poverty and gender discrimination; counselling for people infected with hiv/aids; and extended family support for orphaned and abandoned children. project sweep lays the groundwork for developing ethiopia’s educational capacity for preparing a professional social work workforce. we also imagined that the establishment of the very first mswprogram in ethiopia would be a significant step toward the accomplishment of the ethiopian government’s long-range goal for reducing poverty. the faculty senate at aau approved the curriculum and the new degree in 2004. the uic-aau partnership has been extraordinarily successful (c.f., johnson butterfield & linsk, 2005). an indicator of this success is that aau decided midproject to begin the graduate program as a new graduate school of social work, rather than as a master’s degree in the department of sociology and social anthropology. in july 2006, the “first batch” (as they call themselves) of 39 students defended their thesis research projects and graduated with an msw degree. the “second batch” of 39 students graduated in september 2007, and a new class of 32 students, one-third of whom are women, were enrolled. applications have nearly doubled each year, from 60 applications to 109 applications to 210 applications in 2006 (third class of students). at the graduation celebration,which students organ239johnson butterfield/the internationalization of doctoral education advances in socialwork240 ized at the hilton hotel in addis ababa, remarks by the minister of capacity building and andreas eshete’, aau’s president and unesco chair for human rights and democracy heralded the new program as a major educational development and the most successful international partnership on the campus. our experience of success is also due to another phenomenon at work in some countries in africa, such as tanzania, ethiopia, and southern sudan. in ethiopia, for example, the government is expanding technical institutes to academic degree granting institutions and building 13 new public universities from the ground up. this includes expanding capacity at eight institutions, each projected to grow by 8,000-10,000 students, plus the development of new universities, for a total of 21 institutions of higher education. this expansion also includes administrative improvements and quality education. to update pedagogical techniques, the university encourages faculty to move away from a strict lecture format to applied research, class exercises, group projects, internships, and other interactive methods. project sweep is valued for fostering several innovations, including a skillsbased curriculum, block teaching for course scheduling, a transparent admissions process, intensive student orientation, an adult-learning approach, and new pedagogical methods, such as group projects and field placements. our block-teaching method was born out of necessity and from our understanding of adult learning models. since there were only two ethiopian faculty (the dean and associate deanwith other administrative responsibilities), faculty and colleagues fromother universities throughout the world went to ethiopia to teach for one-month periods, including classes scheduled during their summer vacations or mid-semester breaks. in the first year, for example, four one-month courses were taught each semester. another reason for the success of our partnership was the infusion of leadership from the aau side of the partnership, with the appointment of abyetasse as dean and dr. melese getu as associate dean. their leadership was essential in obtaining university approval, securing computers, classroom space, and administrative staff. until the appointment ofdeanabye, our project functionedmore as a“grassroots” initiative within the larger university. with leadership from president andreas, and with dean abye also holding a key administrative position as associate vice president for international affairs, project sweep quickly turned into a recognized innovation and center of excellence within addis ababa university. this is a good example of how partnerships working at the “grassroots level” can become solidly a part of larger systems when leadership at the top joins grassroots initiatives. building capacity and sustainability the success of our partnership must also be assessed by its ability to accomplish two goals: 1) build capacity for dealingwith social problems in ethiopia and 2) sustain social work education at the university level over the long-term. to provide some context to these issues, this section provides a brief overview of the social, health, and economic context of ethiopia. restarting social work education was seen as part of the answer to social problems in the country. it was in the following context that we planned the msw curriculum to build the capacity of social work 241johnson butterfield/the internationalization of doctoral education in ethiopia and work to develop the doctoral program to sustain social work education at the university. the social, health, and economic context of ethiopia ethiopia facesmany problems. the situation in ethiopia is not unlike that inmany african countries. ethiopia is an extremely poor country of 71 million people. eighty-one percent of its population lives on less than $2 usd per day. as first exposed in 1984 by cameraman mohamed amin, recurrent drought and famine continue to plague the country (smith, 1998). since the appearance of hiv/aids, life expectancy has fallen from 45 years in 1990 to 42 years in 2001. approximately three million people have hiv/aids, the third largest number of any country in the world. an estimated 1.2 million ethiopian children have been orphaned. “orphans in africa suffer recurrent psychological trauma, starting with the illness and death of their parents, followed by cycles of poverty, malnutrition, stigma, exploitation, and often, sexual abuse. experiencing this, orphans are at risk of developing antisocial behavior patterns that can endanger community and national development” (matshalaga & powell, 2002, p. 185-186). impoverished grandparents care for many of these orphans, but as their numbers of grandparents decline, child-headed households are becomingmore common. child-headed households are a great risk, because of their limited economic capacity, gender inequality, prostitution, and drug and alcohol abuse. in part, these problems result frommore than 30 years of war with eritrea, which consumed the country’s resources. similar to countries in eastern and central europe ruled by communist or totalitarian regimes, ethiopia was ruled by a military regime prior to the 1990s. about the same time that the berlin wall fell and revolutions occurred in former communist-bloc countries, ethiopia changed to a democratic government in 1991. the country ismaking progress towards amarket economy through its sustainable development and poverty reduction program (sdprp), which gives regional states the responsibility to plan and implement the delivery of health and other human services. in terms of human development, ethiopia’s reform and decentralization program has made progress: • gross school enrollment increased from 33% in 1990 to 64% in 2000 to 93% in 2005. • gdp per capita grew from an average 5.4% in 2000 to 8.7% in 2005. • infant mortality decreased from 128 per 1,000 live births in 1990 to 92 per 1,000 live births in 2000 to 80 per 1,000 live births in 2005 (world bank, 2007). these improvements indicate a good context for development, even though improvement has not been uniform and disparities have widened in different regions of ethiopia betweenurban and rural areas and among various groups of the population. the high-risk groups who are less able to take advantage of democratization and economic growth are the large numbers of people living in poverty, including women and children, the elderly, the disabled, and the handicapped. from the perspective of higher education, ethiopia has lacked the professional infrastructure to address the problems discussed above. thus, for many years, attempts to build a professional workforce meant sending people overseas for advanced degrees and training. sending students to graduate programs in other countries does not build the capacity of local universities. this approach has proved at times to be disastrous, because of the high cost of education at overseas sites and the “brain drain” or “brain bleed,” as some have called it. doctoral students who study abroad too often remain there, and the resultant expatriate loss further reduces the opportunity for the country to build its own cadre of doctoraltrained faculty. the statistics are staggering. a survey at addis ababa university shows that 400 of 600 graduates who went for further study in the united states and europe did not return to ethiopia. two out of 10 doctors from addis ababa university’s medical faculty returned. only 20% of the graduates of sociology and social administration whowent for further study returned, andmost were anthropologists who have a rich context for their work in ethiopia. although the department sent several graduates abroad to obtain advanced degrees in social work in the late 1990s, none returned to provide leadership for developing the master’s degree, as outlined in the university’s strategic plan (getu, 2005). the ph.d. program from the beginning of project sweep, sustainability was an underlying concern of our planning team. “sustainability is built on the capacity of the faculty.” those words by professor seyoumare etched inmymind and, from that point, our team’s unspoken and ultimate goal was the development of a doctoral program in ethiopia. this became our vision. therefore, once themaster’s programwas operational, attention returned to developing a doctoral program to prepare ethiopian faculty for positions at addis ababa university and other universities in ethiopia that may develop social work programs. with david moxley, formerly of wayne state university and now on the faculty of the university of oklahoma, abye tasse and i collaborated on a grant proposal that was to be presented to the ministry of education for funds to start the ph.d. program. eight students from the msw class of 2006 were admitted to the doctoral program and hired as staff. their roles included partial responsibilities for field education, scheduling and logistics for international visitors, student advising, assisting in strategic planning, administration of the graduate school of social work, and so on.thus, in the short-term, the doctoral program increased the capacity for ethiopians in residence by about 200%. addis ababa university has also provided transportation funds and a small per diem for visiting international faculty, as well as funding for action research. a challenge faced by the international team who developed the doctoral curriculumwas combining their various views about what doctoral education should entail. the two ethiopian members of our team had received doctorates from france and england; another professor obtained her doctorate in india; i had obtainedmine in the united states. the british experience leaned toward individual work with a faculty chairperson and extensive individualized readings; the french experience included lively “discussion and debate” seminars with the great minds of the university; the program in india focused on applied research. my experience atwashington university in st. louis involved interdisciplinary courses and research practicum. as we sought to create a plan for doctoral education in 242 advances in socialwork ethiopia, each of us brought our biases to the table.we each hoped to incorporate some of what we felt were the strengths of our doctoral programs; each of us wanted to address some ofwhatwe felt were our program’s shortcomings.we also knew that the new doctoral program had to address the difficult problems of ethiopia and the urgent need for faculty. moreover, from our various perspectives, we sought a way to streamline the doctoral educational process without compromising quality. our work together became synergistic. we created a curriculum plan for the ph.d. program in social work and social development at addis ababa university, which includes innovative elements borrowed from our international experiences but which is also shaped by the particular context and educational realities in ethiopia. table 1 shows the year-round curriculum,which includes amenu of eight courses, nine seminars, and eight planning/research units. courses (for credit) are completed in the first four semesters of study. seminars (pass/fail), held by the resident or visiting faculty, include four doctoral pro-seminars that critically examine substantive topics, such as poverty, gender, community heath, homelessness, migration, urban and rural development, child welfare, criminal justice, and so on, through multi-disciplinary and interdisciplinary frameworks. seminars engage faculty and students in dialogue and debate to critically analyze the topic of discussion, examine the theory and research base, and identify best practice models and policies for addressing it. a comprehensive portfolio is the anchor uponwhich the qualifying assessment is completed at the end of the fourth semester. students who pass can move forward in doctoral study. since coursework will be completed by the end of the first calendar year, students will be able to teach during the second calendar year of their studies. the dissertation consists of three original empirical papers of publishable quality for submission to relevant journals. these articles are based on team-led action researchprojects but reflect a carve-out areaof independent research carriedout by each student. the three papers comprise an integrated series of scholarly publications that focus on a social issue of local, regional, or national importance.the final product, which documents the student’s scholarly expertise, includes three additional sections: an introduction to the substantive area of the research, implications for socialwork and social development, and a summary and conclusions.theph.d. program is a year-round course of study; thus, students will complete their dissertation projects and graduate in three years (c.f., tasse & getu, 2006). the planning/researchmodules became the solution to another problem thatwe faced in developing the doctoral curriculum. how could we reduce delays in completing doctoral degrees and associated research projects? without question, we wanted to avoid “credentializing” doctoral students, but at the same time, neither the urgent needs of the country nor the scarce resources of the university could afford extended financial and human resource investment in a few select students. we also wanted to do something different than the traditional process of doctoral education in the united states, where the typical trajectory towards a doctoral degree requires students to: 1) complete coursework; 2) pass a qualifying exam; 3) write anddefend aproposal; 4) carry out research and analyze data; 5)write the dissertation; and 6) successfully defend it. i do not know the average length of time it 243johnson butterfield/the internationalization of doctoral education advances in socialwork244 takes for the complete process to occur, but my experience is that four years is a “quick study,” and the average time may be more like five or six years. thus, to reduce delays in completing research, we decided to start team-based action research projects through the planning/research components of the curriculum. these team-based action research mini-projects begin immediately in the first semester, alongside the doctoral coursework and seminars. year 1: year 1: fall year 1: spring year 2: summer summer semester semester models and doctoral prodoctoral proevaluation for theories of seminar i (s) seminar ii (s) field research social change (s) (c) 2 credits action research quantitative ethics in field teaching & & philosophy of data analysis research (s) pedagogy in science (c) (c) 4 credits socialwork (c) 2 credits 4 credits action action research advanced meta-evaluation research mini-project ii assessment and mini-project i (p/r) for action dissemination (p/r) research (c) (c) 4 credits 4 credits advanced data portfolio collection & development analysis (c) i (p/r) 4 credits planning major action research project (p/r) 4 credits 8 credits 8 credits 8 credits year 2: fall year 2: spring year 3: summer year 3: fall semester semester semester dissertation doctoral proaction research dissemination (8 credits) seminar iv (s) supervision ii workshop & (p/r) portfolio preparation (s) doctoral proaction research action research seminar iii (s) supervision i supervision iii (p/r) (p/r) academic portfolio writing and development dissemination ii (p/r) (s) design and proposal writing (s) 8 credits table 1: ph.d. sequence of courses—school of socialwork, addis ababa university johnson butterfield/the internationalization of doctoral education 245 action research and community engagement action learning is a form of engagement that focuses on the utilization of existing knowledge and best practices to design and implement research projects that achieve important development outcomes and, at the same time, contribute to scholarly knowledge. action learning is a central idea of the doctoral program: 1) ethiopia is addressing serious social issues that require effective and high impact action to ameliorate these issues; 2) the university is amajor resource to the country and, through its civic engagement, can create long-term action projects sustainable across generations of doctoral students to achieve beneficial community outcomes, while contributing to a global knowledge base; and 3) action projects will generate dissertation research that can potentially have an impact on the country’s national poverty reduction, healthcare, and development agendas. as a core aspect of the doctoral program, action research imbues it with relevance, practicality, innovation, and a linkage between social theory and social work practice. we believe that this action research focus also makes this doctoral program distinctive within the range of programs existing internationally. an aau doctoral degree in social work and social development is perhaps one of a kind, given this action research frame of reference and ethos of community/civic engagement. the planning/research requirement of the doctoral program contributes to an emerging model of a university-community partnership for development (c.f., soska & johnson butterfield, 2005). table 2 shows the process of our engagement with the gedam sefer community, an urban slum area in addis ababa. our engagement startedwith a community assessment as part of a course assignment in the msw program, followed by a small research study that assessed the skills and capacities of 100 poor women living in the community. for their field practicum, three students were placed in local government offices. later, two msw students carried out thesis research in the same community.when the doctoral program began, four students selected the gedam sefer community for ongoing engagement based on the asset based community development strategy (kretzmann & mcknight, 1993). the involvement of the doctoral students through action research in gedam sefer has led to increased formalization of the emerging university-community partnership through action research miniprojects i and ii and other planning/research segments of the curriculum. currently, doctoral students are playing a leadership role in developing a largescale proposal and action plan for asset-based development with residents of the gedam sefer community. the gedam sefer example illustrates how engaged research on the part of students and faculty in institutions of higher education, in partnership with local communities and organizations, can work collaboratively toward community change and build social interventions. we expect that the model of community engagement we are developing will lead to sustainable outcomes for improving the standard of living and quality of life of poor households in ethiopia. ourmodel is also onemeans of responding to poverty by extending the teaching, service, and research capacity of a university in the united states and a university in ethiopia to international development. as such, our partnership envelops the idea that partnerships aremore than an exchange; they should exhibit a two-way transfer of advances in socialwork246 knowledge, methods, and practice skills. there is the opportunity to teach and learn frommultiple partners. there is the opportunity to incorporate service into practice. and, there is the opportunity to engage in community development processes through action research. internationalizingdoctoral education athome i have some thoughts to share about what it might mean to internationalize doctoral education at one’s home university. my comments relate to teaching in the doctoral program at the jane addamscollege of socialwork. as a doctoral program,we have not made a decision to internationalize our curriculum. yet, my experience with the doctoral program in ethiopia is influencing my teaching at uic. global issues, large policy frameworks, and innovative practices fromdeveloping countries can be used to expose students to different ways of thinking about recalcitrant social problems in the united states. here are some ideas: • the un convention on the rights of the child (and others). child welfare systems in the united states are built on the premise of “the best interests of the child.” in developing countries (as well as other industrialized ones), timeline assignment projects in gedam sefer fall 2004 community community assessment on slum upgrading msw student assessment program: the case of gedam sefer community team (hagos, gessese, kebede, abebe, goshu, barry, & yared, 2004). summer 2005 slum housing and income generation:women’s research role in obtaining public housing in ethiopia (johnson butterfield, kebede, & gessese, 2005). fall 2005 community assessment of beggars community in arada msw student assessment sub-city addis ababa (mekonnen, hailu, team bezabih, nega, jonfa, & b/mesquel, 2005). spring 2006 field three students placed in local government placement office. spring 2006 thesis project– social networks and communication among msw student msw program female householders (kebede, 2006). spring 2006 thesis project– human strengths approach for sustainable msw student msw program livelihood (gessese, 2006). fall 2006 action research take research back to the community. form a ph.d. team mini-project i core group to work with aau and uic in university-community partnership. 2007 ph.d. action workshop with core group on family based team research minicommunity development (kordesh, 2006). project ii discuss university-community partnership. form a technical committee. 2007 ph.d. planning a develop a major action research proposal in team major action collaboration with core group and technical research committee. project table 2: action projects in the gedam sefer community johnson butterfield/the internationalization of doctoral education 247 the guiding principle for child welfare is the “rights of the child.” juxtaposing these two policy agendas will place child welfare policy in the united states in a global perspective.what would a child welfare system in the united states or canada look like if our policies incorporated some or more of the idea of children’s rights? why hasn’t the united states signed this declaration? some discussion of this topic is included in the american psychologist (c.f., levesque, 1996; melton, 2005; murphy-berman, levesque, & berman, 1996). • comparative analysis.much social work research on poverty seems to lack comparative or international perspectives. recently, i was privy to hear dr. jeffrey sachs from columbia university speak. his book, the end of poverty: economicpossibilities ofourtimebrings a global perspective topoverty policy (sachs, 2005). can one imagine such a title to a book?who can imagine ending poverty? this book shows methods of comparative social policy by looking at the nations and gis mapping of such things as the re-location of the textile industry, availability of internet access, the malaria belts of the world, and so on. he also features what some countries, india and korea for example, have done to make progress toward ending poverty. as a macroeconomist, sachs quips about his expertise in “long and short division,” while calling for “clinical economics”—a perspective that takes researchers out to the field to examine poverty first-hand, then works directly with the poor to solvepoverty from their perspectives, basedon their strengths.there is some recent comparativework onwelfare and theworkingpoor population in the united states (e.g., hoefer &midgley, 2006). the challenge for doctoral education in a global world is to advance policy research in social work to include comparative analysis. a good resource is rihoux and grimm (2006). • millennium development goals. faculty, practitioners, and students of community practice in the developed world have paid little attention to the millennium development goals (mdgs) set by the united nations for decreasing global poverty by one-half by the target year of 2015. the eight goals of this relatively unnoticed framework range from halting the spread of hiv/aids, to ensuring environmental sustainability, from promoting gender equality and the empowerment of women to providing universal primary education. themdgs form a blueprint agreed to by all the world’s countries and all the world’s leading development institutions. sachs and un secretary kofi annan are working with some villages in africa to see what it takes to meet the mdgs.what does it take for a village community to get out of extreme poverty, to position itself on the lowest rung of the economic ladder? early findings indicate the following: medicine, a truck, one internet hook-up, fertilizer, and bed nets. bed nets treated with insecticide last for five years and cost fifty cents per person. they will prevent half of the malaria cases each year. one dollar will provide three days of malaria treatment for each infected person. just one day of the u.s. military budget ($150 billion) will buy bed nets for all of africa for five years.we could extrapolate this kind of thinking to community development efforts in communities with extreme poverty in the developed world. advances in socialwork248 • community development. as a planned approach to improving the living conditions of poor and vulnerable populations around the world, community development responds to diverse global contexts. in the developing world, conditions of abject poverty noticeably require comprehensive and interdisciplinary approaches that include economic development, community participation, self-help, community organizing, capacity building, and so on from many disciplines and modes of intervention (johnson butterfield & chisanga, in press; johnson butterfield & korazim-korosy, 2007). creative efforts also seem to emerge in the developing world in an environment where less is sometimes more: there are less supports, but there may also be fewer barriers to getting things done by mobilizing human resources. evidence from promising models and methods of community development include, among others, the effects of participatory asset-based approaches to alleviating poverty (o’leary, 2006), the evidenced-basedrapid-results approach [http://www.rapidresults.org/], and community conversations (gebre & admassie, 2005). • action research, measurement, and evaluation. action research designs combine quantitative and qualitative methods (reason & bradbury, 2006). action research is also applicable to larger scale efforts at the community level, which are designed to foster participation, empower individuals, and so on. providing doctoral students with methods applicable to larger systems should be a part of doctoral research training, so that within these larger systems, smaller studies can assess individual and group outcomes with particular measures at the psychosocial level. there is much work to be done by the world bank in measuring empowerment (narayan, 2005; alsop, bertelsen, & holland, 2006) and one can suppose that the international community is far ahead of our ability in social work to define and measure empowerment. action research methods also teach teamwork and collaboration in research. by exposing our doctoral students to solid methods in action research, we can prepare them for team collaboration in research as junior faculty of the future. my last comment presents challenges to deans and directors of doctoral education in social work.what would doctoral education look like if these two things happened? • expand doctoral education within a developing country. the first challenge is for each doctoral program in the united states and canada to become involved in expanding doctoral educationwithin a developing country. this does not mean educating international students in doctoral programs at our home universities with the assumption that they plan to return to their homelands after completing their doctoral degrees. the partnership idea described in this article is just one of many potential and possible ways that doctoral programs contribute to building faculty capacity abroad. higher education for development (hed) continues to provide usaid funding for such partnerships [http://www.hedprogram.org]. online courses or other distance learning methods could be used to share doctoral courses johnson butterfield/the internationalization of doctoral education 249 and faculty from one country to another. these models represent a movewithin universities as awhole to“globalize” their systems inwhat is becoming a nationalmovement towards globalizing the campus. for example, since the mid-1990s, a number of large universities have opened new campuses in other countries, particularly india, the middle east, and southeast asia, with new growth occurring in china, india, and central asia. these branch campuses move beyond a place to send students for study abroad but are designed to educate the population from the host country (macburnie & ziguras, 2005). social work doctoral education should be at the forefront and lead the way toward internationalizing the profession. • preparing doctoral students for international work. internationalizing doctoral social work education in the united states and canada would mean that each new recipient of the degree is well prepared to include international perspectives in his or her teaching and research. by internationalizing doctoral education, can we break out of the old paradigm that cautions our junior faculty not to pursue internationalwork until they get tenure? can the newparadigmbe that those junior faculty who are involved internationally in their research and service aremore competitive in the job market and tenure review processes? can we imagine a world of social work faculty and researchers with doctorate degrees who are involved in the reality of the global world in some way? this does not mean that everyone has to travel abroad.we know, for example, that the internet can put us in direct contact with the world. the world is flat. comparative policies can be taught in the classroom. learning from innovative practices in other countries has the potential to inform the profession, its current methods, and standards. scholarship can build on and help build the best practices—not only in our home countries—but in those countries throughout the world that share our professional work. references alsop, r., bertelsen, m., & holland, j. (2006). empowerment in practice: from analysis to implementation. washington, d.c.: theworld bank. friedman,t.l. (2006).theworld is flat:abrief history of the twenty-first century.ny: farrar, straus andgiroux. gebre, a., & admassie, y. (2005, december). community conversations on hiv/aids pilot projects in alaba and yabello: assessment of the methodology. addis ababa, ethiopia: united nations development programme. gessese, a. (2006). human strengths approach for sustainable livelihood. msw thesis. school of social work, addis ababa university. getu, m. (2005). report of the associate dean of the college of social sciences. addis ababa university, addis ababa, ethiopia. hagos, a., gessese, a., kebede,w., abebe, s., goshu,m., barry, a., &yared, b. (2004, october). community assessment on slum upgrading program: the case of gedam sefer community. unpublished report. school of socialwork: addis ababa university. healy, l.m., asamoah, y., & hokenstad, m.c. (eds). (2003).models of international collaboration in social work education.washington, d.c.: cswe. hoefer, r., &midgley, j. (eds.). (2006). international perspectives on welfare to work policy. bimington, ny: the haworth press. international association of schools of social work (iassw). (2004). global standards for social work education and training. retrieved 9/9/06 from http://www.iassw-aiets.org/. johnson butterfield, a.k., & chisanga, b. (in press). community development. int.mizrahi and l.e. davis (eds.) encyclopedia of socialwork, 20th edition. ny: oxford university press. johnson butterfield, a.k., & korazim-korosy, y. (eds.). (2007). interdisciplinary community development: international perspectives. bimington, ny: the haworth press, inc. johnson butterfield, a.k., & linsk, n. (2005). the social work education in ethiopia partnership (project sweep). final report to the association liaison office for university cooperation in development (alo/usaid). chicago, il: jane addams college of social work, university of illinois at chicago. http://www.aboutsweep.org. kebede,w. (2006). social networks and communication among female householders.mswthesis. school of socialwork, addis ababa university. kordesh, r.s. (2006). restoring power to parents and places: the case for family-based community development. ny: iuniverse, inc. kretzmann, j.p., & mcknight, j.j. (1993). building communities from the inside out: a path toward finding and mobilizing a community’s assets. chicago: acta publications. levesque, r.j.r. (1996). international children’s rights can they make a difference in american family policy? american psychologist, 51(12), 1251-1256. macburnie, g., & ziguras, c. (2005). the international branch campus. institute of international education, newyork. accessed 9/26/06 at http://www.iienetwork.org/page/84656/. matshalaga, n.r., & powell, g. (2002). mass orphanhood in the era of hiv/aids. british medical journal, 324 (january), 185-186. mekonnen, a., hailu, d., bezabih, e., nega, m., jonfa, m., & b/mesquel,w/s. (2005, october). assessment of beggar’s community in arada sub-city addis ababa.unpublished report. school of socialwork: addis ababa university. melton, g.b. (2005). building humane communities respectful of children: the significance of the convention on the rights of the child. american psychologist, 60(8), 918-926. midgley, j. (1990). international social work: learning from the third world. socialwork, 35(4), 295-301. murphy-berman, v., levesque, h.l., & berman, j.j. (1996). u.n. convention on the rights of the child a cross-cultural view. american psychologist, 51(12), 1257-1261. narayan, d. (ed.). (2005).measuring empowerment: cross-disciplinary approaches.washington, d.c.: the world bank. o’leary, t. (2006). asset based approaches to rural community development: literature review and resources. international association for community development for carnegie trust uk. http://rural.carnegieuktrust.org.uk/files/rural/asset-based%20approaches%20-iacd.pdf. reason, p., & bradbury, h. (2006).handbook of action research. thousand oaks, ca: sage. rihoux, b., & grimm, h. (eds.). (2006). innovative comparative methods for policy analysis: beyond the quantitative-qualitative divide. ny: springer publishing co. sachs, j.d. (2005). the end of poverty: economic possibilities for our time. ny: the penguin press. shinn, david h. (2001, july). hiv/aids in ethiopia: the silence is broken; the stigma is not. center for strategic and international studies, africa program. retrieved february 9, 2008 from http://www.csis.org/media/csis/pubs/anotes_0107.pdf. smith, b., with amin, s. (1998). the man who moved the world: the life and work of mohamed amin. nairobi: camerapix publishers international. soska, t.m., & johnson butterfield, a.k. (eds.). (2005). university-community partnerships: colleges and universities in civic engagement. bimington, ny: the haworth press, inc. 250 advances in socialwork tasse, a., & getu, m. (2006, july). rationale and course descriptions for a doctor of philosophy (ph.d.) in social work and social development at the graduate school of social work, addis ababa university. available at: http://www.aboutsweep.edu. world bank. (2007). ethiopia country brief. http://www.worldbank.org/afr/et/ctry_brief.htm. author’s note: address correspondence to: professor alice k. johnson butterfield, jane addams college of social work, university of illinois at chicago, 1040 west harrison street (m/c 309), chicago, il 60411, usa. e-mail: akj@uic.edu. this article is based on keynote speeches given at the group for the advancement of doctoral education (gade), calgary, canada, on october 13, 2006; and the 11th annual ph.d. spring symposium at the school of socialwork, indiana university, indianapolis, indiana, on april 20, 2007. this article is dedicated to the memory of dr. seyoum gebre selassie, former dean and professor emeritus at addis ababa university. his vision for the rebirth of social work education in ethiopia continues to guide our work. it is one of the great privileges of my professional life to have worked with him and to have learned so much from him. 251johnson butterfield/the internationalization of doctoral education microsoft word van breda article final bb _________ prof. adrian d. van breda is an associate professor at the department of social work at the university of johannesburg, south africa. prof. van breda was an active duty military social worker, in uniform, from 1991 to 2007, leaving the sandf with the rank of lieutenant colonel. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 17-33 military social work thinking in south africa adrian d. van breda abstract: military social workers in south africa have developed distinctive ways of thinking about military social work. these developments have been influenced by various contextual factors, such as the transition of south africa to a non-racial democracy in 1994 and the establishment of a military social work research capacity. these factors contributed to new ways of thinking, such as the recognition that military social work has a mandate to facilitate organizational change and the adoption of a resilience perspective. a central development in military social work thinking in south africa was the formulation of a military social work practice model, which is described and illustrated in some detail. this model emphasizes binocular vision (focusing on the interface between soldiers and the military organization) and four practice positions, derived from occupational social work theory. the author notes the importance of creating appropriate contexts that facilitate further developments in military social work theory. keywords: military social work, ecosystems, person-in-environment, occupational social work, south africa. introduction the ten to fifteen years since 1994 have evidenced substantial growth in thinking about military social work (milsw) in south africa. south africa’s relative isolation from the rest of the world, due partly to our location on the southern tip of africa and as a result of the sanctions during the dying years of apartheid, resulted in the development of a rather distinctive approach to milsw. this paper will show this distinctive approach and the kinds of factors that have influenced it. this paper is focused primarily on how military social workers in south africa think about milsw practice, rather than in describing the history, structures and staffing of milsw. it is the practice theories and approaches that are central to this paper. the paper will contend that milsw thinking emerged in a particular context and evolved in ways that are distinct (though not entirely different) from militaries elsewhere in the world. the paper opens with four contextual factors that i believe facilitated the evolvement of milsw in south africa. particular attention is then given to a practice model of milsw, which has been the guiding framework for all milsw thinking and practice over the past 15 years, and brief practice examples illustrate how this thinking about milsw guides the activities of social workers in south africa. the paper concludes with some reflections on furthering the growth of milsw thinking. advances in social work, spring 2012, 13(1) 18 the south african military social work context military social work has formally existed in south africa since 1968 (de klerk, 1991). in the years leading up to 1994, seven separate military organizations were established in south africa, including the south african defence force (sadf), the militaries of the four homeland states (the transkei, bophutatswana, venda and ciskei defence forces) and the armed wings of two liberation movements (umkhonto we sizwe (mk) and the azanian people’s liberation army (apla)). few social workers were employed by the homeland state militaries; most social workers were employed by the sadf, mk and apla. it is of course true that during these years there was no partnering between social workers in the sadf and social workers in mk and apla. in 1994, with the collapse of apartheid, these seven military organizations began a process of integration into the south african national defence force (sandf). currently, the sandf employs approximately 130 social workers, most of whom are uniformed members and a handful are civilian employees. ranks range from lieutenant (the most junior rank for an entry-level military social worker) to brigadier general (the director social work). the 10 or so years, starting from 1994, evidenced a rapid growth of thinking among military social workers. this is not to say there was no development before 1994 or in the past several years; rather, i have observed an intensification and flowering of new ideas during this ten-year period. one may go so far as to term this a ‘golden era’ in milsw in south africa. in this section i point to four major contextual factors that facilitated the growth and development of milsw (table 1). table 1. developments in south african military social work (milsw) contextual factors development of milsw macro changes in south africa in 1994 expanded insights into the role of milsw engagement with military families new insights into deployment resilience establishment of a milsw research department new milsw social technologies social work supervision course a new model of milsw practice macro changes in south africa in 1994, the first democratic elections took place in south africa, resulting in a handover of power from the national party to the african national congress. at the same time, and over the following years, the sadf was transformed into the sandf, a composite of the seven former forces, welded into one new military force (uys, 1997). two key macro changes occurred that influenced milsw thinking, through a change in the composition of milsw personnel and shifts in the national welfare approach. the integration of various forces and of various departments of social work introduced new thinking and insights about the nature and purpose of milsw. sadf social workers had perhaps been conservative in the extent of change they felt free to van breda/military social work thinking in south africa 19 facilitate, giving primary emphasis to micro-level change without challenging the status quo. by contrast, mk and apla social workers had a much greater investment in social change, social justice and social action. these social workers grew up in the liberation movement and had embraced the liberation themes of transformation and revolution. consequently, the understanding of the social work target system expanded from primarily individuals and families, to include the whole military system and even surrounding communities and society itself. a much more expansive sense developed of who social work served. military social workers also appropriated a mandate for organizational change, ensuring that the social environment of soldiers (which is used as a collective noun in this paper, including all military employees and their families) was conducive to well-being. a somewhat more radical approach to social work thus evolved after 1994. post-1994 social workers got involved in the anc government’s reconstruction and development programme (rdp), which called for a much more holistic engagement with the needs of all peoples and for work at a structural and institutional level, not just at the level of individuals and communities (anc, 1994). the rdp led, a few years later, to the white paper for social welfare (rsa, 1997), in which south africa adopted a developmental approach to social welfare (midgley, 2001). much effort was invested in coming to terms with what this approach meant for milsw. developmental welfare calls for a bridging of the micro-macro divide (patel, 2005), which had been characteristic of pre-1994 milsw in the sadf. furthermore, it advances a rights-based approach and an increase in democracy and people’s participation in their own welfare (patel, 2005), supported by the bill of rights and the south african constitution (rsa, 1996). this further facilitated a shift from paternalistic social work towards a more radical approach to social work. as a result of these macro changes, milsw thinking became more radical, more willing to challenge the status quo, more willing to engage in macro change processes and more committed to listening to and being guided by the needs and rights of the military workforce. engagement with military families a second paradigm shift emerged in response to the engagement of military social workers at the institute for maritime medicine with military families in the mid-1990s. naval wives had established a support network to help them deal with the absence of their husbands (at that time only men could serve on naval vessels). navy social workers were invited to partner with this network and together evolved a comprehensive system of support to naval families. this engagement with a group of women who had taken the initiative and in which social workers were ‘tagging along’ facilitated a new recognition of the coping resources of military families. an article by logan (1987) was particularly influential in prompting the study of resilience literature (mccubbin's work was particularly influential, e.g. mccubbin & lavee, 1986). milsw’s engagement with resilient families and encounter with literature on family resilience led to the coining of the term ‘deployment resilience’. previously, social workers were interested primarily in the ways in which deployments stress families and contribute to their breakdown (van breda, 1997b) – what antonovsky (1988) calls a pathogenic perspective. however, from the mid-1990s emphasis shifted advances in social work, spring 2012, 13(1) 20 to uncovering and then developing mechanisms that families had evolved to cope with deployments (van breda, 1998; 1999). resilience theory (van breda, 2001) sparked a new way of thinking about military families. they were not passive victims of the military system. nor were they inevitably dysfunctional and damaged. rather, families were recognized as having inherent skills, abilities and talents, which helped them thrive in the face of the challenges of living in a military environment. this new way of thinking about military families, and about the military itself, emerged at around the same time as saleebey’s book on the ‘strengths perspective’ in social work (saleebey, 2008). the practice implications of a resilience approach to social work practice became rapidly evident and have continued to impact on milsw in the sandf. the first was the design of a deployment resilience seminar (van breda, 1999), a one-day program aimed at teaching all military families the coping skills and patterns that resilient families had discovered for themselves. several other resilience programs were developed thereafter, for example, focusing on single soldiers or soldiers whose families lived far away from the military base, often in rural areas. some years later, military social workers developed an assessment model and scale for screening soldiers prior to deployments, as part of the military’s concurrent health assessments (van breda, 2002b). this process, which included a conceptual model for assessment, a standardized rating scale and a standardized clinical interview schedule, was similarly grounded in resilience theory (van breda, 2008; 2011). through their close engagement with military families, milsw began to incorporate an appreciation for the strengths and coping resources of military families. this was enriched through intensive reading on resilience, and particularly international literature on the resilience of military families. milsw thinking became more strengths-oriented and this has influenced virtually all subsequent developments in milsw in south africa. social work research department a third key factor that facilitated the development of milsw thinking was the establishment of the first social work research department in the sandf in 1997 (van breda, 2002a). initially staffed with just one social worker, and located in the military psychological institute, the department grew over the subsequent four years to five posts. this initiative was vital to the growth of milsw, in setting aside a team of social workers, each with several years of milsw practice experience, to give dedicated attention to thinking about milsw and to develop new knowledge and interventions for the organization. social work practitioners are preoccupied with practice in their own sphere of responsibility; social work managers are preoccupied with performance management and the budget; social work researchers have the space to think and innovate. this department, during its first several years of existence, developed the concurrent health assessment model and tools mentioned previously, a new management information system based on a model of milsw practice, a range of new courses and interventions (such as a program for soldiers with financial challenges), research on family violence, hiv kap studies, and a massive hiv peer-training van breda/military social work thinking in south africa 21 program. in recent years, much effort has been invested in monitoring and evaluating pepfar-funded hiv programs in the sandf. the provision of a dedicated research capacity within social work opened up space for intensified thinking about milsw and the translation of these ideas into models and tools for social work practice and management. social work supervision course the fourth contextual factor that facilitated growth was the implementation of a series of social work supervision courses, headed by arista bouwer, a military social worker with a wide vision for social work. the courses were run to develop a cadre of senior social workers who could supervise younger social workers and contribute to the development of the quality of social work services in the sandf. in the 1990s, this course incorporated the requirement to develop new social technologies for the social work department, thus serving to stimulate new thinking about and the evolvement of milsw. in 1997, alida kruger and i (who were students on this course) were tasked to develop a model of milsw practice. this model was widely reviewed by social workers throughout the sandf and underwent a number of revisions. it has become the foundation of milsw thinking and practice in the sandf, guiding practice and shaping reporting requirements (kruger & van breda, 2001). for example, the model is a key element of the induction training provided to all new social workers. in addition, a management information system was developed that required practitioners to report on their professional activities according to the four practice positions of the model. part of what was distinctive about this model was that it was grounded in occupational social work theory. occupational social work was burgeoning in south africa at the time, particularly in the mining industry, thanks in particular to angela du plessis, who ran a masters program in industrial social work at the university of the witwatersrand (du plessis, 2001). several sandf social workers did this course and brought this theory into milsw thinking. this marrying of military and occupational social work lent a distinctive flavor to how social workers in the south african military think about their practice. some military social workers in the usa, for example, have shaped their understanding of milsw on clinical social work (e.g. applewhite, hamlin, brintzenhofeszoc, & timberlake, 1995) or employee assistance programs (e.g. ortiz & bassoff, 1987). both of these forms of social work tend towards a micro and therapeutic approach to social work practice. by contrast, occupational social work endeavors to work not only with employees, but also with the organization as client, promoting a more integrated and holistic approach to social work practice. the provision of intensive training opportunities that incorporated an expectation of innovation in milsw facilitated the development of new technologies for milsw practice. the incorporation of occupational social work theory lent milsw thinking a distinctive flavor, through its interest in facilitating organizational change. advances in social work, spring 2012, 13(1) 22 the military social work practice model in the preceding section i proposed four key contextual factors that occurred in south africa in the years following 1994 and the ways in which these factors contributed to the evolvement of milsw thinking in the sandf. in this section i aim to give particular emphasis to one of those developments, namely the military social work practice model (milswpm). occupational social work as previously mentioned, milsw in the sandf has been influenced by occupational social work literature, though not uncritically. milsw’s initial thoughts about occupational social work were influenced primarily by the theoretical models developed by googins and godfrey (1987) and ozawa (1980). both models describe the development or “evolvement” of occupational social work practice “along the continuum from micro to macro” (du plessis, 1994, p. 91). these models were valuable in shaping the evolvement of milsw in south africa, and especially in challenging social workers towards more organizationally-based, macro activities. nevertheless, they were found to be insufficient to guide military social work practice. the key concern was with the notions of ‘phases’ or ‘stages’ (googins & godfrey, 1987; ozawa, 1980). military social workers in the sandf tended to understand these terms to mean that in order to progress towards the higher and more sophisticated levels of practice they must abandon the individual as client in favor of the organization as client. these terms suggest that when one moves on to a next phase, the previous phase becomes of lesser importance or even irrelevant. stage models of occupational social work are flawed because they are progressive, not additive – that is, they involve leaving one stage to progress to the next, rather than adding the stages together. this tendency is mirrored in the use of the expression ‘micro-macro continuum’ (du plessis, 1994; googins, 1987; googins & davidson, 1993). du plessis (1994, p. 169) locates occupational social workers along this continuum based on their emphasis on micro versus macro practice. a continuum, however, is a linear, twodimensional construct that does not correlate with our organic and multifaceted reality. postmodernist and systems theories reject linear models for this reason. when one places micro interventions at one end of a line and macro interventions at the other, micro and macro become polarized and thus mutually exclusive. writers who use the micro-macro metaphor are forced, by the essential limitation of the metaphor, to repeatedly stress that macro interventions should be added to, rather than replace, micro interventions (e.g. du plessis, 1994, p. 169; googins, 1987, p. 49). these metaphors of ‘stage’ and ‘micro-macro continuum’ inadequately reflect the reality of social work practice, consequently confusing the developmental aspirations of social workers. in essence, they do not allow for the integration of different forms of intervention. this is reflected in the on-going debate in the literature regarding “who is my client?” the answer has centered on the micro-macro distinction between the ‘employee-as-person’ and the ‘person-as-employee’ (spiegel, in du plessis, 1994). this has been augmented by the notion of the ‘organization as client’ (googins & davidson, 1993). while these three conceptions of the occupational van breda/military social work thinking in south africa 23 social worker’s clients are helpful, they are not integrated, and thus inadequately guide milsw practice. in response to these limitations, the sandf developed a new milswpm in 1997. the milswpm aimed to integrate the various ‘stages’ of occupational social work, in line with developmental social welfare’s call to bridge the micro-macro divide, to transform the micro-macro continuum from a line to a circle, and to address all potential client systems. it was hoped that the model would shape an understanding that milsw development is not through a series of stages along a continuum, but rather, that development involves an expanding role, in which one gradually grows into a more comprehensive practitioner. binocular vision social work is guided by various theories, most central of which is, arguably, ecosystems theory (gitterman & germain, 2008). central to ecosystems is the notion of what gordon hamilton termed ‘the-person-in-situation’ which highlights the “threefold configuration consisting of the person, the situation, and the interaction between them” (hollis & woods, 1981, p. 27, emphasis added). however, social workers frequently struggle to think ecosystemically, and have a tendency to focus on either the person or the environment (i.e. the soldier or the military system), rather than on the integrated person-in-environment. consequently, the milswpm proposes a new metaphor to facilitate the grasp of the notion of person-in-environment, viz. ‘binocular vision’. wilfred bion, the british psychoanalyst, proposed the term ‘binocular vision’ to describe a way of simultaneously seeing one thing with one eye and another thing with the other eye (in casement, 1985, p. 4). this metaphor is adapted to suggest that the one lens is microscopic (looking at the individual and family), while the other is telescopic or ‘macroscopic’ (looking at the military organization). binocular vision occurs when we simultaneously look through the microscopic and telescopic lenses. to close one or other eye is to lose one’s depth perception, to lose half one’s vision, which is to become handicapped in one’s work. bateson used the metaphor of binocular vision in a similar way. he says (in keeney, 1983, p. 37), “it is correct (and a great improvement) to begin to think of the two parties in an interaction [e.g. the soldier and the military] as two eyes, each giving a monocular view of what goes on and, together, giving a binocular view in depth. the double view is the relationship.” binocular vision thus enables one to see a whole situation in greater depth, enhancing the quality and scope of assessment and intervention. it also shifts the focus off the two separate client systems and onto the relationship or interface between them. this relationship then becomes the client, much as in marital counseling the relationship is often defined as the client. inherent in binocularity is social work’s commitment to promoting the fit between people and their situations or environments. the utility of binocularity for the military social worker is to provide a metaphor that will assist in making sense of the tension between commitment to the soldiers’ interests and commitment to the military’s interests. the milswpm contends that there ought to be tension in this area of milsw, since it is only in the presence of advances in social work, spring 2012, 13(1) 24 tension that true binocularity is achieved (googins, 1987). at the fulcrum of soldierand-military lies the immense creative potential of milsw. the metaphor of binocular vision assists military social workers in south africa to remain at this fulcrum. binocular vision’s creative potential can be realized by seeking out the most problematic point of interface between soldiers and the military. the cutting edge of milsw can be located at this point. the following four questions can assist in identifying this point:  what are the unique demands the military places on its members?  what are the unique demands soldiers place on the military?  what human skills are required by members to be effective in their work?  what organizational systems/structures are essential to ensure military readiness? by addressing themselves to the point at which the military and soldier fit least well, military social workers are able to ensure that they play a pivotal role in the achievement of the military’s mission and in the well-being of soldiers and their families. in business terminology, the social worker’s ability to facilitate these problematic points of interface is one of the organization’s critical success factors. the military social work practice model the milswpm endeavors to move away from the language of ‘stages’ that was found to be a limitation of much occupational social work literature. instead, the model uses the term ‘position’, which was coined by melanie klein (the postfreudian child analyst). klein (in hinshelwood, 1991, p. 393) used the term to avoid the sense of prescriptive progression through freud’s psychosexual stages of development, as well as to describe the positions from which a human child or adult may view the external world and experience the internal world. the milswpm’s preference for the concept ‘position’ is not mere semantics. it allows for a greater fluidity of movement between positions. positions are less value laden, so that one position is not necessarily better or more important than another position, merely more appropriate. a practice model comprising positions is more organic and holistic than one comprising stages/phases. it avoids the pitfalls of linear thinking by ensuring circularity. the milswpm, therefore, comprises four practice positions from which a military social worker may intervene (figure 1). each position describes a different way of perceiving a problem, a client, an intervention or one’s own role. the four positions, which will be described below in some detail, are: position one: restorative interventions position two: promotive interventions position three: work-person interventions position four: workplace interventions van breda/military social work thinking in south africa 25 figure 1. military social work practice model position one: restorative interventions in this position the military social worker renders a problem solving service to people who have an identified biopsychosocial problem. the intervention is aimed at restoring the client’s problem solving and coping capacities. the soldier is viewed first as a person, and only secondly as a soldier. any intervention that addresses people’s problems at a personal level falls into this position. the presence of a problem may suggest that all position one interventions are therapeutic. therapy, however, is only one form of problem resolution and is typically individually focused. not only individuals, but also couples, families, groups and even whole communities can have problems. the size of the client system is irrelevant in the milswpm. when people request assistance in resolving their personal problems, a position one intervention is typically appropriate. it should be clear, then, that i avoid micro-macro distinctions in the milswpm. case, group and community work all have a place in position one. in order for a problem solving intervention to be located in position one, it should not directly address the work-person interface. position one interventions thus address problems that are primarily of a personal nature, e.g. substance abuse, marital distress, adjustment difficulties, child abuse, family problems, financial difficulties, poor sanitation, and high crime rates. work-related problems may be addressed, but the intervention in this position does not directly aim to facilitate the work-person interface. if, for example, a client presents with alcohol dependency that is influencing his/her work, a position one intervention could be to enable sobriety. as soon as the social worker focuses directly on the fit between the soldier and his/her work (e.g. should the worker be dismissed or not?), s/he has moved to position three. because binocular vision is relevant at all four positions, it is important to note that although position one interventions address the employee-as-person, the person is also an employee. it is thus likely that her/his functioning in the workplace will also be impacted by the intervention, albeit indirectly. advances in social work, spring 2012, 13(1) 26 in brief, then, position one interventions are directed at helping people resolve their problems at a personal, non-work-related level so as to restore healthy psychosocial functioning. position two: promotive interventions in this position the military social worker renders a preventive, educational and developmental social work service. these interventions are aimed at promoting or enhancing the social functioning of people. these people have psychosocial needs that the social worker assists in fulfilling. as in the previous position, soldiers are viewed first as people and only secondly as soldiers. any intervention that addresses the needs of people (rather than their problems) at a personal level falls into this position. positions one and two are similar in most respects, except one: rather than problem resolution, position two focuses on promotion of need fulfillment, thus an emphasis on building resilience and adopting a strengths perspective. promotive interventions may aim to prevent the escalation of a social problem that would require restorative interventions, thereby promoting the human need for well-being. the social worker may also assist clients who have an unalterable problem, but who desire to live more fully despite the problem. a psychoeducational intervention for the families of schizophrenic patients is an example of this. a broad range of interventions is possible in position two. the military social worker may make use of case work, group work, community work, psychoeducational workshops, lectures, seminars, pamphlet and poster campaigns, and exhibitions. as in position one, the client system covers the full micro-macro range and interventions are addressed at a personal level; interventions that directly address the worker-work interface fall into position three (although binocularity simultaneously argues that a position two intervention will, indirectly, impact on the clients’ job performance). in summary, position two interventions aim at promoting healthy psychosocial functioning and resilience by facilitating people’s needs at a personal, non-workrelated level. position three: work-person interventions in this position the military social worker addresses the systems of interpersonal relationships within the workplace in order to produce a productive work community. interfaces between the workplace and other systems (e.g. the family or community) are also important in this position. any intervention that addresses people in relation to the work setting falls into position three. the fundamental distinction between the first two and last two positions is that the military social worker’s attention now shifts to the interface between the soldier (worker) and the military (workplace). as soon as an intervention seeks to facilitate the ability of people to fit with the workplace (including colleagues, managers and the organization itself), the social worker has moved to position three. conceptually, the military social worker endeavors to facilitate the interfaces between the workplace and people (hence work-person interventions). the interface will often be between workers themselves, or between a worker and the workplace. van breda/military social work thinking in south africa 27 position three interventions may also focus on the interface between the workplace and the soldier’s family, particularly when families are helped to tolerate or transcend military demands (e.g. the deployment resilience seminar). in this position the military social worker may utilize group work techniques, problem solving processes, experiential exercises, community development, team building, community building, negotiation, mediation, and participation in committees and workgroups. in brief, then, position three interventions strive to promote a healthy workperson interface by addressing soldiers in relation to the military setting. position four: workplace interventions in the fourth position the military social worker focuses on the military as an organization so as to create a conducive work milieu. here the worker is interested in establishing standard practices, structures, processes and policies that will benefit the functioning of the organization and thereby also the employee. this entails a more radical approach to social work practice, focused on structural or systemic changes at macro level. any intervention that addresses the workplace itself falls into position four. positions three and four are similar inasmuch as both address the work-person interface. while position three focuses on people, however, position four focuses on the workplace itself. where position three endeavored to enable soldiers to adjust to the needs of the military, position four endeavors to enable the military to adjust to the needs of soldiers. the military social worker works with the organizational dimensions within which soldiers function. while there may be a complete turnover of soldiers in a particular unit, the unit itself remains the same; individual soldiers are simply present in the unit at this point in time. these organizational dimensions can include the structure or hierarchy, culture, processes and procedures, policies, politics, setting, and physical layout. the role of the military social worker is that of change-management consultant, social activist, social engineer, policy maker, systems analyst, researcher, and organizational development consultant. the social worker assists the workplace in developing a structure or way of working that promotes optimal productivity, effectiveness, morale and social well-being among employees. the worker plays an integral part in the management of the workplace, being a specialist on the interface between an impersonal organization and a personal workforce. in focusing on this interface, the social worker humanizes and may serve as the social conscience of the organization. in conclusion, position four interventions target the workplace itself for the reciprocal benefit of both the military and the soldiers (and their families). practice examples the sandf is one of the largest employers of military social workers in south africa. a complete range of social work services is provided to military employees, their families and the sandf itself. only statutory cases are referred to outside advances in social work, spring 2012, 13(1) 28 welfare agencies. this section provides brief practice examples for binocular vision and the four positions. binocular vision previously i suggested that the creative potential of binocular vision could be realized by seeking out the most problematic point of interface between soldiers and the military. in most military contexts this point is located at the military’s requirement of operational readiness. operational readiness is the military’s demand that all employees are able to perform operational duties (e.g. peace keeping missions and combat operations) at any time (segal & harris, 1993). the sandf has addressed itself largely to ensuring that soldiers are capable of performing their tasks and functions during military operations. limited attention has been given to the emotional dimensions of operational readiness, let alone to the effects on and role of families. as a result, in the mid-1990s sandf social workers conducted several research projects to evaluate the impact of operational readiness on employees and their families, to evaluate the effect of families on the operational readiness of the organization and on the characteristics of a good fit between families/soldiers and the organization in terms of operational readiness (herbst, 1995; kruger, 1997; mathee, 1997; van breda, 1997a). in this research we can clearly see binocular vision at work. the studies were able to assess both the military’s and the family’s contribution to operational readiness and the factors which social workers needed to promote to ensure (a) well functioning families and soldiers, (b) an operationally ready organization, and (c) a good fit between soldiers and the military. position one: restorative interventions vignette 1. one social worker worked with a young man whose chaotic childhood had left him with a disordered personality, which impacted on all areas of his life. the social worker focused on the client’s personal relationships and selfesteem. the client’s sense of adequacy improved which reflected positively in his private and work lives. the intervention aimed at restoring the client’s ability to relate to others in a positive and productive way. vignette 2. another social worker was struck by the number of battered wives seen in her unit. she therefore began a weekly treatment group for these women that replaced their individual therapy. the social worker taught the women about the cycle of battering, their legal rights and the community resources available to them and facilitated on-going problem solving. this group work intervention entailed the restoration of personal power. position two: promotive interventions vignette 1. one social worker ran a stress management course for the management team of his unit at the request of the commanding officer, who wished to enhance the well-being of his team members. the course ran for three days and addressed a broad range of principles and techniques of stress management. in the process, a more personal level of interaction developed in the management team that van breda/military social work thinking in south africa 29 had not been evident before. this course was intended to enhance and promote the clients’ personal functioning. vignette 2. a clinical social worker was approached by a soldier who was interested in her dreams. the social worker assessed the client’s functioning and found no significant psychosocial problems. they worked for several months, making sense of the client’s dream life. the social worker sought to promote the client’s individuation or self-actualization. position three: work-person interventions vignette 1. i developed a psychoeducational program that contributes to the operational readiness of military employees and their families (van breda, 1997a, 1999). the program develops seven factors that are present in families who are resilient to the repeated separation of a soldier from the family unit. in so doing, this program promotes the family’s ability to fit with a stressful organizational demand. vignette 2. another social worker was consulted by a soldier who had significant frustrations with his supervisor at work. after assessing the problem, it appeared that there was a conflict of interest between the client and his supervisor. the social worker suggested that she mediate between them. both the soldier and his supervisor agreed that the mediation was valuable in ameliorating a long-standing work conflict between them. position four: workplace interventions vignette 1. one social worker heard repeated complaints from black african members of her unit that only western food was being served in their living quarters. the social worker formed a joint employee-management committee and facilitated discussions, which led to a change in the unit’s provision of food – traditional african food was also served. this worker used community work processes to address a problem of organizational culture. vignette 2. a social worker was concerned that naval management should address its own role in the operational readiness of naval families. he therefore wrote several reports to his unit and to naval headquarters, making recommendations on how to reduce the deployment stress of sailors and their families. in meetings he emphasized how executing these recommendations would enhance the operational readiness of the unit (thereby emphasizing the problematic point of interface). this led to the formation of a work team at naval headquarters to address the matter. conclusions milsw in south africa has evolved over the years with its own distinctive flavor. this evolvement has been shaped by a variety of contextual factors, particularly the transition from apartheid to a non-racial democracy in 1994. three other relevant contextual factors include engagement with military families, the establishment of a dedicated milsw research capacity and the implementation of a series of social work supervision courses. in raising these four contextual factors, i hope to have shown how milsw thinking takes place within particular local contexts and does not exist in the abstract. advances in social work, spring 2012, 13(1) 30 the implication is that if we hope to see further evolvement in milsw thinking (including theory development) militaries need to create or capitalize on existing contextual factors. it is noteworthy that two of four factors identified involved creating spaces for social workers to step away from action and into reflection. a third factor involved social workers taking a ‘one-down’ position and learning from their clients. a fourth factor involved locating milsw more squarely in the mainstream of developments within social work and social welfare at national and international levels. all four of these factors disturbed the milsw status quo and demanded new ways of thinking about practice. the milswpm has been advanced as a central exemplar of this kind of new thinking in south africa. it illustrates milsw’s engagement with a body of theory (primarily occupational social work, but also elements of developmental social welfare, ecosystems, cybernetics and psychoanalytic theories) and the critical integration of selected aspects of this theory into our own understanding of milsw. the new thinking is also spurred on and informed by real-world practice concerns, such as the tendency of military social workers to ally with either soldiers or military management or the perception that good milsw practice involves abandoning micro practice in favor of macro practice. in addition, most of the developments noted in the preceding section have influenced the conceptualization of the milswpm. for example, the notions of working to change the military system itself, rather than aiming to change only the individuals within the system, were informed by the transition to democracy, the emergence of developmental social welfare, and a greater commitment to social action and structural change. the notions of resilience shaped the understanding of promotive interventions and work-person interventions, both of which emphasize a striving for balance, rather than the elimination of pathology. the milswpm, in itself, serves to advance our thinking about milsw. it is the only substantive model of milsw available in the 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(2008). the military social health index: a partial multicultural validation. military medicine, 173(5), 480-487. van breda, a. d. (2009). the scope of occupational social work in south africa. social work practitioner-researcher, 21(3), 281-297. van breda, a. d. (2011). resilience assessments in social work: the case of the sa department of defence. social work / maatskaplike werk, 47(1), 1-14. van breda, a. d., & du plessis, a. w. (2009). a model of occupational social work practice: a developmental social welfare critique. social work practitionerresearcher, 21(3), 316-333. van breda/military social work thinking in south africa 33 author’s note: address correspondence to: professor adrian d. van breda, department of social work, university of johannesburg, po box 2354, rooihuiskraal, 0154, south africa. e-mail: adrian@vanbreda.org microsoft word ashton_does ethnicity matter final _________________ vicki ashton, d.s.w., is a professor of social work at york college of the city university of new york, department of social sciences. this research was supported by national institutes of health grant #41385. the author is grateful to w. cody wilson and beth s. rosenthal for reading earlier drafts of this work and for their invaluable insight and suggestions. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 129-143 does ethnicity matter? social workers’ personal attitudes and professional behaviors in responding to child maltreatment vicki ashton abstract: this study examined differences in the attitudes of professional social workers regarding corporal punishment and the perception and reporting of child maltreatment, according to the worker’s ethnic group membership (asian, black american, black caribbean, hispanic, and non-hispanic white). data were obtained by mailed questionnaires from 808 members of the new york city chapter of nasw. data were analyzed by analysis of variance. results indicate that approval of corporal punishment and perception of maltreatment differed according to ethnic group membership. however, ethnicity had no effect on the likelihood of reporting maltreatment. findings suggest that social work values override personal-culture values in the execution of jobrelated responsibilities. implications for education and practice are discussed. keywords: professional socialization and ethnicity; culture, attitudes and social work practice; personal values and professional practice; corporal punishment and maltreatment introduction child maltreatment remains a serious social problem affecting more than one million children and families each year (sedlak et al., 2010). health and social service professionals are required by law to report suspected abuse and neglect, yet many incidents of suspected abuse are not reported; moreover, there is often disagreement as to what constitutes maltreatment (sedlak et al., 2010). research on mandated reporters suggests that the process of identifying and responding to child maltreatment is a complex phenomenon that involves at least three phases: observing a given situation; assessing and labeling parental behavior; and responding to that behavior. each phase of the process is filtered through the personal characteristics of the observer. these personal characteristics include attitudes and opinions which direct behavior. for example, a worker’s opinion of the severity of parental behavior in an incident of probable maltreatment is related directly to the likelihood that an incident is reported (ashton, 1999; ashton, 2001; morris, johnson, & clasen, 1985; zellman, 1992). it has also been documented that opinions of mandated reporters differ in what they consider to be maltreatment and that these differences in perception can be attributed to worker attitudes about parenting and discipline (ashton, 2001; morris et al., 1985). an individual’s attitudes about parenting and discipline are shaped by experiences that are to a considerable extent marked by socio demographic traits, of which ethnicity is salient (green, 1978; korbin, 1994; webb, 2001). ethnicity remains an “enduring dimension” of american life (devore & schlesinger, 1999, p.4) and an important social construct (dolliver, 2008; miehls, 2001). ethnicity represents a “peoplehood” based on common physical appearance, language, and homeland, and on norms, traditions, values, ashton/does ethnicity matter? 130 and history that make up the content of culture (devore & schlesinger, 1999; korbin, 1994). ethnic group membership includes a common approach for solving problems of daily living which is based on a historical development for coping that has worked for a given group (devore & schlesinger, 1999). these problem solving approaches and the rationale surrounding them become subtle influences that shape attitudes, opinions, and behavior such as parenting (devore & schlesinger, 1999; webb, 2001). a number of studies have found differences in the use and endorsement of corporal punishment according to ethnic group membership, with black americans being the most frequent users of corporal discipline, whites the least and hispanics in between (deaterdeckard, lansford, dodge, pettit, & bates, 2003; mosby, rawls, meehan, mays, & pettinari, 1999). asian (lau, takeuchi, alegri'a, 2006) and caribbean (smith & mosby, 2003) parents have also been found to be more authoritarian and more favorable toward corporal punishment than white non-hispanic parents. in addition to ethnicity being related to the endorsement of corporal punishment as an effective means of discipline, ethnicity also appears to influence the perception of child maltreatment (ashton, 2004; hong & hong, 1991; korbin, 1994). among social workers, personal attitudes and opinions that influence professional behavior are tempered and shaped by the norms, values, and ethics acquired through the process of professional socialization (hantman et al., 2006). professional socialization can be defined as the acquisition of specific knowledge, skills, and values through the process of social work education (barretti, 2003). the purpose of social work education is to prepare competent and effective professionals who apply critical thinking skills within the context of professional social work practice and who understand the value base of the profession and practice accordingly (council on social work education [cswe], 2008). throughout the educational process, students acquire knowledge of social work principles and ideals at the same time they are called on to evaluate their own personal values (abrams & mojo, 2009; cswe, 2008; devore & schlesinger, 1999). throughout social work education and into professional practice, social workers are required to scrutinize their intervention decisions and to be aware of the ways in which their value preferences influence and shape their practice (mattison, 2000). the educational process of self-assessment recognizes that much of social work practice involves discretionary judgments which require social workers to effectively resolve conflicts between their personal and professional values. a desired outcome of social work education is the internalization of social work norms and values that allows workers to effectively regulate their practice and appropriately use their autonomy (costello, 2004). professional socialization involves the integration of professional and personal identities (hantman et al., 2006) so that “one’s identity as social worker is inseparable from the practice of social work” (jeffery, 2005, p. 419). the process of achieving integration requires some struggle with personal and professional value conflicts, an ability to set personal preferences aside, and the willingness to adopt professional values in accomplishing work with clients (johnson & yanca, 2007; tam & coleman, 2009). it is generally presumed that there is an eventual fit between personal and professional values and that practitioners reach a similar level of assimilating social work ideals, attitudes, knowledge and skills (spano & koenig, 2007). yet research on social advances in social work, fall 2010, 11(2) 131 work education finds that the process of professional socialization is not uniform; it does not produce a homogenous group of practitioners with the same attitudes and values (barretti, 2003; costello, 2004). in fact, there are some studies that suggest that persons of color have a different socialization experience into social work than whites (barretti, 2003, daniel, 2007; jeffery, 2005). the literature on professionalization raises many questions including the question, what happens when there are conflicts between personal and professional values? do social workers disregard one system over the other or is a compromise made? several studies have found that personal attitudes toward corporal punishment impact directly on a worker’s judgment of the severity of an incident of probable child maltreatment and relate both directly and indirectly to the likelihood of reporting an incident to child protective services (ashton, 2001; morris et al., 1985). previous studies have examined the relationship between attitudes toward corporal punishment and the reporting of child maltreatment among non professionals (ashton, 2001; bluestone, 2005; ibanez, borrego, pemberton, & terao, 2006) and physicians (morris, johnson, & clasen, 1985); however, no study has examined one of the largest groups of mandated reporters—social workers. nor has any study examined the effect of ethnicity on professional decision making among mandated reporters. ethnicity is an important personal characteristic affecting perception and response to child maltreatment. professional socialization provides a lens that presumably supersedes the personal perspective. race and ethnicity are often used interchangeably; however, in this study, the term “ethnicity” is used to reflect the interest on culture rather than biology (webb, 2001). this study examines differences in the personal values and attitudes of professional social workers regarding corporal punishment according to ethnic group membership. the study also examines how ethnicity is related to the workers’ professional behavior in the identification and reporting of probable child maltreatment. based on the literature, three hypotheses guided the study: 1. there is a difference in approval of corporal punishment according to ethnic group membership. it is expected that white social workers will be less approving of corporal punishment than other ethnic groups. 2. there is a difference in the perception of the seriousness of an incident of probable maltreatment according to ethnic group membership. it is expected that white social workers will perceive incidents of probable maltreatment as more serious than other ethnic groups. 3. there is a difference in the reporting of child maltreatment according to ethnic group membership. it is expected that white social workers will be more likely to report incidents of probable child maltreatment than other ethnic groups. method this was a cross sectional, correlational study. data were collected using a mailed printed questionnaire. the population of interest in this study was professional social ashton/does ethnicity matter? 132 workers working with families and children in an agency setting in the new york city metropolitan area. the study sample comprised 808 social workers who were systematically randomly selected from a list of the members of the new york city chapter of the national association of social workers (nasw). four thousand one hundred ninety four members (4,194) were randomly selected from the full membership and were mailed the study questionnaire. three follow-up communications were sent at three-week intervals, encouraging the recipients to participate in the study by completing the questionnaire. the third reminder included a short postcard questionnaire requesting selected demographic information if the person was unwilling or unable to fill out the longer questionnaire. one thousand eight hundred fifty five (1,855) individuals returned the questionnaire and 257 individuals returned the postcard questionnaire for a total response rate of 50%. those who returned the postcard were similar to those who completed the full questionnaire except that they were slightly older and were less likely to work with families or children and therefore were not members of the population of interest in this study. of those who returned the questionnaire, 808 indicated that they were employed in agencies serving families and/or children and completed the questions pertinent to this study. those 808 respondents comprise the sample of professional social workers for this study. sample characteristics the sample of 808 participants was predominately caucasian (67%) and female (78%). approximately 10% were black american; 4% were black caribbean; 3% were asian; 12% were hispanic; and 3.7% “other”. this last category consisted of persons who identified themselves as “american indian/alaskan native” (n = 3) or “other” and described themselves as multi ethnic, multi racial (n = 27). the mean age for the sample was 45. most (90%) had a master’s degree as the highest level of their education. the sample had a mean of 13 years of professional experience; whites had the most years, hispanics the least (table 1). most of the sample had received some training in the area of child abuse; proportionately, persons categorized “other” and black caribbeans received the most training, whites the least (table 1). measurement the independent variable “ethnicity” was measured by asking respondents to select the one ethnic group they identified with most from seven categories: american indian/alaskan native, asian/asian american/pacific islander, black/african american, black/african caribbean, latin/hispanic, white (non-hispanic) and other. respondents who identified themselves as american indian/native alaskan or “other” were combined into one category, “other.” responses “were dichotomized into “1” for the selected ethnic group and “0” for all others. advances in social work, fall 2010, 11(2) 133 table 1. sample characteristics: frequencies and percentages (n = 808 unless specified) age: mean 45 years sd 12.3 gender: (n=806) n percent male 179 22.2 female 627 77.8 educational level: ba/bs 28 3.5 masters 734 90.7 ph.d/dsw 46 5.7 race/ethnicity: asian 26 3.2 black american 82 10.1 black caribbean 33 4.1 hispanic 94 11.6 white 543 67.2 other 30 3.7 years of experience by ethnic group (n=799) mean sd asian 10.5 9.9 black american 12.9 10.6 black caribbean 11.5 8.9 hispanic 8.9 7.2 white 14.6 11.3 other 10.2 9.1 total sample 13.5 10.8 10 hours or more training by ethnic group percent asian 27 black american 29 black caribbean 42 hispanic 31 white 19 other 43 there were three dependent variables: approval of corporal punishment, perception of maltreatment, and likelihood of reporting maltreatment. each dependent variable was measured using multi-item additive scales. ashton/does ethnicity matter? 134 “approval of corporal punishment” was measured by a five-item scale adapted from danso, hunsberger, & pratt (1997). each item has 8 response alternatives ranging from 1 “very strongly disagree” to 8, “very strongly agree.” an example item asks the respondent to rate her or his level of agreement with the statement, “a good firm spanking can be one of the best ways to teach children right from wrong.” the scores for all five items were added together. the scale has face content validity and good internal consistency with a reliability coefficient of .88 with the danso, hunsberger, pratt sample (1997) and of .79 with this study sample. “perception of maltreatment” was measured by a multi-item additive scale using eight vignettes adapted from hong and hong (1991) and from cases known to the local child protective agency. each vignette describes parental behavior that ranged from what could be considered moderate maltreatment to behavior considered severe maltreatment (figure 1). respondents were asked to rate the behavior of the parent on a likert scale of “seriousness” from 1 to 7, with “1” being “not serious” and “7” being “very serious”. responses to the eight items were added together for a single score for “perception” (alpha .76). “likelihood of reporting” was measured by using the same eight vignettes of probable maltreatment. (these vignettes had been pre tested and rated for seriousness in a previous study by a sample of entry-level social service workers [ashton, 2004]. on a scale of 1, “not serious” to 7, “very serious”, the vignettes in this study ranged in seriousness from 5.3 to 6.8; thus, all of the vignettes represented reportable situations). in the current study, respondents were asked to read each vignette and indicate the likelihood that they would report the incident to child protective services. ratings ranged from 1 (almost certain not to report) to 5 (almost certain to report). the responses for all eight vignettes were summed to give an overall score for the respondent’s “likelihood of reporting" (alpha .77). figure 1. case vignettes 1. both parents work long hours; they leave very early in the morning and come home late at night. their nine-year-old son is left on his own. the boy gets himself ready for school in the morning and lets himself in after school. the parents tell their son to eat food prepared and left in the refrigerator, warming it up if he wants. he usually eats it cold. he goes to bed by himself because his parents are usually not back by his bedtime. 2. a sixteen-year-old yells and curses at his parents during a recent argument. his parent punches him in the mouth. 3. the classroom teacher notices that a nine-year-old boy has red marks on his palms and legs. when asked about the marks, the boy tells the teacher that yesterday he went to a friend's house to play instead of going home to do his homework. when his father found out, he hit him on the palms and legs repeatedly with a stick. the child says that his father does this whenever he does not do his homework. advances in social work, fall 2010, 11(2) 135 4. a six-year-old wets the bed. parents punish the child by immersing his lower body in a tub of very hot water. 5. recently when asked a question, a 10-year old child mumbled a rude answer under his breath. his parent banged the child against the wall, bruising his shoulders. 6. a 12-year-old is caught stealing candy from the corner store. when his parents found out what the child did, they beat him with a stick and burned a mark on his arm to remind him not to steal again. 7. the parents discipline their eight-year-old child by hitting him with a strap whenever he misbehaves. 8. a family recently arrived in the metropolitan area from a rural location. last week after school, their 10-year-old son went off with a group of new friends instead of coming straight home. his parents disciplined him in their usual way, which is to make him kneel in the closet for several hours. analysis the frequency distributions of demographic variables, “approval of corporal punishment”, “perception of maltreatment” and “likelihood of reporting” were described. zero order correlations were obtained for key demographic variables, independent, and dependent variables. the hypotheses were tested using analysis of variance (anova). the large sample size of 808 with six groups used in the anova has the statistical power to detect even a small relationship (η = .10) at the .01 level of significance 99% of the time (cohen, 1988). results the sample as a whole varied considerably in their level of approval of corporal punishment, perception of maltreatment, and likelihood of reporting. the theoretical range of scores for approval of corporal punishment was 5 to 40; the actual range of scores was 5 to 38. the mean score was 14.3 with a standard deviation of 7.8. most of the respondents did not endorse corporal punishment highly but a minority did. as a whole, the sample tended to perceive the situations of probable maltreatment as relatively serious; however, some respondents did not see the situations as serious. the theoretical range of scores was 8 to 56; the actual scores ranged from 25 to 56. the mean score for the sample was 49 with a standard deviation of 4.8. the distribution was negatively skewed; more than half the sample had scores of 50 or above. the actual range for likelihood of reporting was the same as the theoretical range, 8 to 40. some of the respondents would not have reported any of the cases of possible child maltreatment to child protective services, while others would have reported every case including those with moderate levels of seriousness. nonetheless, the mean score for reporting was 34.1 (standard deviation 4.4) indicating that most of this sample would report most of the cases (table 2). ashton/does ethnicity matter? 136 table 2. descriptive statistics for approval of corporal punishment, perception of maltreatment and likelihood of reporting (n = 808) total sample approval of corporal punishment perception of maltreatment likelihood of reporting mean 14.27 49.51 34.12 median 13.00 50.00 35.00 mode 5.00 50.00 34.00 std. deviation 7.84 4.84 4.42 skewness .642 -1.012 -1.069 correlation analysis shows several demographic variables—age, education, experience and training – related to the independent variable, ethnicity. age, education and training are also related to one of the dependent variables, approval of corporal punishment (table 3). there were no correlations between demographic variables and any other dependent variable. the first hypothesis is confirmed by the statistical analysis. anova showed significant difference between means for approval of corporal punishment according to ethnicity (f = 24.9; p. <.0001). the sample mean for approval of corporal punishment was 14.3. black americans had the highest approval rate with a mean of 20.4, followed by black caribbeans (mean, 18.1), hispanics, asians, and “other”, each with a mean of approximately 17. whites had the lowest approval score with a group mean of 12.4. ethnic group membership had a medium effect on approval of corporal punishment (η = .36) (rosenthal, 2001). the second hypothesis is also confirmed. anova showed a difference in perception of maltreatment (f = 2.4; p < .05) according to ethnicity. an anova post hoc tukey test for multiple comparisons identified a difference between black americans and whites and black americans and hispanics. there were no other between-group differences. ethnic group membership had a small effect on perception of maltreatment (η = .12), (table 4). the third hypothesis was not supported by the data. anova showed no difference between ethnic groups in their likelihood of reporting maltreatment. there was virtually no association between ethnicity and reporting (η= .08). 137 advances in social work, fall 2010, 11(2) table 3. zero order correlations between demographic, independent and dependent variables (n = 808) gender education experience training asian blkam blkcar latin white other approval perception report age -.12* .30* .72* -.22* -.05 -.03 -.12* -.14* .21* -.05 -.14* .03 -.00 gender -.09 -.08 .02 -.00 .07 .00 -.01 -.02 -.04 -.06 .05 .03 education .33* -.18* .03 -.11* -.07 -.09 .18 -.06 -.11* -.01 -.04 experience -.23* -.05 -.01 -.03 -.15* .16* -.06 -.09 -.01 .02 training .00 .09 .11* .08 -.20* .10 .13* -.08 .02 ethnicity asian .05 -.02 -.06 blk american .26* -.11* -.04 blk caribbean .10 .02 .04 latin .13* .04 .02 white -.35* .04 .02 other .07 -.01 -.01 *p <.05 (bonferroni correction for multiple computations, c = 14). ashton/does ethnicity matter? 138 table 4. analysis of variance for approval of corporal punishment, perception of maltreatment and likelihood of reporting maltreatment by ethnic group (n=808; df=5, 807) discussion the reader should exercise some caution in interpreting the results of this study. first, the percentage of minority respondents is rather low. however, this sample comprised higher proportions of non whites than the most recently reported national sample of social workers (gibelman & schervish, 1997). second, the data were obtained from a sample of new york city social workers who were members of their local chapter of nasw; therefore, application of the findings to social workers outside of the sample population should be tentative. finally, the vignettes used in this study are predominately approval of corporal punishment mean sd asian 16.6 7.5 black american 20.4 8.2 black caribbean 18.1 8.1 hispanic 17.1 8.1 white 12.4 6.8 other 17.0 9.2 f=24.9 p<.0001 perception of maltreatment mean sd asian 49.1 4.5 black american 47.9 5.4 black caribbean 50.0 5.2 hispanic 50.1 4.5 white 49.6 4.7 other 49.4 4.9 f=2.4 p<.05 likelihood of reporting mean sd asian 32.6 4.8 black american 33.6 4.2 black caribbean 35.1 3.5 hispanic 34.4 4.4 white 34.2 4.4 other 33.9 6.2 f=1.2 ns advances in social work, fall 2010, 11(2) 139 incidents of physical abuse; there is only one incident of neglect and none of emotional or sexual abuse. the study has strength in that it employed a representative sample large enough to detect fairly small relationships among the variables (cohen, 1988) and the reliabilities of the three multi-item measures (.76, .77 and .79), though not excellent, are reasonably good and well within the range of reliabilities found in social science research. in addition, while vignettes in general have limitations in that they cannot portray all the information necessary to make an actual assessment and while the vignettes in this study are imperfect, vignettes have been used successfully in research to indicate probable decision-making (ashton, 2004; zellman, 1992). the findings of this study suggest that professional socialization has an impact at the most critical point—professional practice. this sample of social workers varied significantly in their personal approval of corporal punishment according to ethnic group membership. asian, black american, black caribbean, hispanic, and other non-white social workers, all endorsed corporal punishment as an appropriate form of discipline more so than did whites. the attitudes of these social workers of color mirrored the attitudes of their related ethnic groups within the general population (deater-deckard et al., 2003). ethnocentric attitudes appeared to be most prevalent among black american social workers, who differed also in their perception of maltreatment, i.e. black american social workers had the lowest mean score (47.9) for the perception of the seriousness of the eight incidents of maltreatment (table 4). nonetheless, ethnic group differences in perception of maltreatment were considerably smaller than ethnic group differences in approval of corporal punishment, suggesting the effectiveness of professional socialization and training. professional socialization appears to have occurred among all ethnic groups in the area where it is arguably most important, in practice. the desired outcome of child safety took precedence; these workers seemed to be able to put aside their personal opinions and protect children in need. when it came to responding to maltreatment, ethnic group membership did not matter and most of the sample regardless of ethnicity indicated that they were likely to report most of the cases of probable maltreatment. professional socialization overrode personal opinions when it came to required action. the findings from this study have implications for social work education. social work education is committed to exploring diversity (cswe, 2008) and has done so for at least two decades by including cultural competency and ethnic sensitivity in the curriculum (abrams & gibson, 2007). the latest issue of cswe accreditation standards calls for school social work programs to “engage diversity and difference in practice” (cswe, 2008). however, a frequent criticism of the diversity/cultural competence curricula is that there are few tangible learning or practice outcomes (abrams & mojo, 2009). the results of this study indicate that social work education should continue to call for students to explore diversity including their own diversity and the effect that their cultural background has on their personal and professional lives. a concrete objective should be for social work students to be knowledgeable about different perspectives of parenting and discipline and to be familiar with the historical context of those ashton/does ethnicity matter? 140 perceptions. for example, students should know that what is often seen as harsh physical discipline in the black american family was used historically as a protective mechanism against the harsher reality of white dominated society and against the dangers of street culture (boyd-franklin, 1989). it is important for students to recognize that tolerance of physical punishment by persons of color is a reflection that the world is often different for families of color than it is for white families. in addition to being familiar with different cultural perspectives of parenting, students should be required to examine the effectiveness or lack thereof of various types of parenting by reviewing the research outcomes of discipline and child rearing practices based on culturally held norms. clearly, professional socialization does not stop with an advanced degree; rather it is ongoing and the findings of this research have implications for the continued professionalization of the child welfare system and for continuing professional education. a number of states, including new york, have made efforts to professionalize the public child welfare workforce (barbee et al., 2009; sar et al., 2008). this study suggests that those efforts should be maintained and that social workers are well suited to child welfare work, in that they can make informed decisions based on their professional training rather than personal opinion. the findings of this research also have implications for in-service training. in this study, in-service training was related to a higher approval of corporal punishment. this correlation does not indicate a cause/effect but rather the fact that “hours of training” is related to ethnicity, with minority workers receiving more training than whites, perhaps in recognition of the discordance between their personal beliefs and practice expectations or in recognition that social workers of color had fewer years of experience than whites. training showed no correlation with either perceptions of maltreatment, or likelihood of reporting. these findings suggest that social welfare agencies are challenged to provide the kind of training that is tailored to improve the fit between attitudes and professional behavior. moreover, social welfare agencies should include training that helps workers identify their personal opinions and attitudes, explore the bases of those attitudes, and explore the possible effects those attitudes have on practice. the study does raise questions. for example, are the differences among ethnic groups in terms of their personal attitudes toward discipline and perception of maltreatment a result of differential socialization? further research is needed to explore this issue and to find ways for social work education to enhance professionalization for all groups. in addition, one wonders if the disharmony between thought and action among non-white social workers results in a tension that social workers of color experience in daily practice. if such a tension exists, is there a psychic toll required of the worker to resolve that disharmony? on the other hand, the difference between the private self, i.e. attitudes and beliefs, and the public professional self, may be an indication of two social work skills—self-awareness expressed in the ability to objectively assess oneself, and selfcontainment expressed in the ability to set aside personal attitudes and beliefs and put into practice the norms and values of the profession. it is left to future research to identify those factors that lead workers to put aside their private opinions and to do what is right in terms of professional conduct. advances in social work, fall 2010, 11(2) 141 references abrams, l. s., & gibson, p. 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(2010). fourth national incidence study of child abuse and neglect (nis–4): report to congress. washington, dc: u.s. department of health and human services, administration for children and families. smith, d. e., & mosby, g. (2003). jamaican child-rearing practices: the role of corporal punishment. adolescence, 38(158), 369-381. spano, r., & koenig, t. (2007). what is sacred when personal and professional values collide? [electronic version]. journal of social work values and ethics, 4(3). retrieved from: http://www.socialworker.com/jswve/index2.php?option=com_content&do_pdf=1&id =69 tam, d. m. y., & coleman, h. (2009). construction and validation of a professional suitability scale for social work practice. journal of social work education, 45(1), 47-63. webb, n. b. (2001). culturally diverse parent-child and family relationships: a guide for social workers and other practitioners. new york: columbia university press. zellman, g. l. (1992). the impact of case characteristics on child abuse reporting decisions. child abuse & neglect, 16(1), 57-74. author note: address correspondence to: vicki ashton, d.s.w., york college/cuny, department of social sciences, jamaica, ny 11451. email: ashton@york.cuny.edu spring2005-191_page193 spring2005-192_page194 spring2005-193_page195 spring2005-194_page196 spring2005-195_page197 spring2005-196_page198 spring2005-197_page199 spring2005-198_page200 spring2005-199_page201 aisw vol. 5, no. 1 the acquisition of socialwork interviewing skills in aweb-based and classroom instructional environment: preliminary findings philip m. ouellette valerie chang abstract: little is known regarding the learning of social work practice skills in a web-based online environment,most especially, social work interviewing skills. this article presents a review of the research methodology used to initiate a study to explore the similarities and differences of two groups of students who were taught interviewing skills in a classroom-based teaching environment with those taught in aweb-based instructional environment during the same 15-week period. students’ background characteristics and their perceptions of their learning experience and skill acquisition are reported as preliminary findings. keywords: telelearning,web-based instruction, social work interviewing, social work practice the infusion of technology into social work courses has progressed exponentially in the past few years. some have indicated “no significant difference” between the efficacies of learning outcomes with courses taught in an online learning environment versus those taught in a face-toface classroom-based learning setting (macy, rooney, hollister & freddolino, 2001). little is known, however, regarding the learning of social work practice and interviewing skills in a web-based online instructional environment. to date, most of what has been done to teach social work practice skills with the use of technology has been conducted through the use of web-enhanced instructional format, which combines the classroom with some web-based instruction (ouellette, 1999). doubt as to whether interviewing skills can realistically be learned in an online environment still prevails in the field of social work education (burton & seabury, 1999). research specifically addressing the extent to which social work students learn actual interviewing and practice skills from an online course is needed. this paper presents the preliminary findings of a recent study initiated to explore the similarities and differences in the acquisition of basic interviewing skills between two groups of students enrolled in an undergraduate meth91 philip ouellette, ph.d. is associate professor and valerie chang is professor at the indiana university school of socialwork, indianapolis, in 46202. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 91-104. indiana university school of socialwork. ods course in social work. one group was taught interviewing skills in a traditional three hours per week classroom-based teaching environment. the other group was taught interviewing skills strictly in aweb-based instructional environment with no face-to-face contact with the instructor. instruction for both groups took place during the same 15-week period. a description of the research project and preliminary findings regarding student perceptions of their learning experience follows. in addition, examples of pedagogical strategies used in each of the instructional settings to teach basic interviewing skills will be outlined. background literature learning social work practice skills in an online instructional environment has already been suggested as a possibility if one adheres to adult learning principles (friedman, 2002) and effective active learning paradigms which are conducive to a technology-supported instructional environment (environment (brooks, 1997; ewell & jones, 1996; ouellette & sells, 2003). attempts have been made to teach an advanced practice course by combining the use of several technological mediums, such as teleconferencing andweb-instruction (ouellette & sells, 2001), the results of which have shown much promise. in addition, some have suggested that the task of teaching and learning social work practice in an online environment can greatly be facilitated if careful attention is paid to proper preparation and by following a step-by-step approach to course design of a technology-supported learning environment (ouellette & sells, 2003; brooks, 1997). one criticism often heard from social work educators with respect to the use of technology as an instructional medium is that this environment is not particularly conducive to the training of social work practitioners (kreuger, 1997). as a result, many have been reluctant to offer their programs in a distance education format and have been suspicious of the use of technology in education and practice (burton & seabury, 1999; butterfield, 1998; marson, 1997). this argument is largely articulated based on the unsubstantiated notion that only a face-to-face, classroom-based social environment provides meaningful interaction between students and instructor. from this perspective, the teacher becomes the major communicator of new information and influence for the students. on the other hand, a technology-based learning environment shifts a considerable amount of power, authority, and control from the instructor to the students (jaffee, 1998). it ismore compatible with progressive educational approaches that are characterized by a climate of mutual collaboration between student and teacher in developing learning activities and goals (trigg & cordova, 1987). the birth of telelearning since the early 1990s educational experts coming from disciplines other than social work have been examining the impact of teaching and learning in webbased instructional environments (harasim, 1999). as a result of the pioneering work of many technology-sensitive educators, a new concept has emerged, that of telelearning. telelearning is understood to mean the use, at school or at home, of multimedia computers networked to other computers for learning purposes (tl*nce, 1995). this means that learners, using computers networked together, 92 advances in socialwork communicate from one site to the other using a variety of information sources. networked computers permit students to expand their acquisition of new information beyond a single instructor. another term that describes the use of computer networks for teaching and learning is “network learning” (kearsley, 1993). it has been suggested that learning networks, based on asynchronous communication using computer technology, offer additional opportunities for active participation between learners (harasim, hiltz, teles &turoff, 1995). the difference between traditional forms of asynchronous communication used in the conventional classroom, such as an integrative paper, a quiz, or exam, and asynchronous communication in an electronic medium, such as the use of e-mail and a discussion board, lies mainly in the following. the speed with which feedback can be provided is accelerated, the nature of the setting used to communicate ideas can be in one’s home or work setting, and the ability to easily and quickly disseminate ideas to peers or a large number of people is greatly enhanced by the electronic medium. it is for this reason that asynchronicity in an electronic medium has been suggested as having the potential to elevate the quality of student interaction and participation (doherty, 1998). researchdescription irrespective of the training context or instructional medium being used, the transfer of learned skills from the training setting to actual practice continues to be a challenge for social work educators. with respect to learning interviewing skills, there are many factors that contribute to a student’s skill acquisition. for example, these may include the quality of the instruction, teaching methods that are utilized, opportunities for skills practice, opportunities to practice observation skills, and opportunities to self-evaluate performance and provide constructive feedback to others. to further enhance our understanding of how interviewing skills are acquired, irrespective of the teaching medium, a study was initiated with two groups of undergraduate students enrolled in two different sections of a social work practice course in generalist social work. both instructors adhered to similar teaching and learning principles. one section of the course was taught in a classroombased instructional environment, while the other was taught in a web-based instructional environment. this study explored the similarities and differences between two groups of students who were taught interviewing skills in different instructional contexts. design: the study employed a quasi-experimental design (cook & campbell, 1979). students registered in the bsw program were provided with the opportunity to enroll for a required core practice course in one of two sections having the same number of students. the primary instructional method for one section was the use of a classroom-based instructional format. the group met once each week for a three-hour class session during the 15-week semester. the other section followed a web-based instructional format with no face-to-face meetings between the instructor and the students. the online students received a different unit of study each week, with learning objectives and learning activities to be 93ouelle, chang/assessing and comparing a class-based andweb-based course completed on a weekly basis. both courses followed the same semester and were implemented during the same timeframe. once the semester was completed, all students who participated in the study were asked to attend a face-to-face session at the university to conduct a 10minute interview segment with a simulated client who was coached and trained by the two investigators. the interview was videotaped for further analysis by independent evaluators. selection process: once the course was initiated, students from each class were invited to voluntarily participate in a study to examine the acquisition of practice skills. a total of 60 students were invited to participate in the study. a consent form outlining the purpose of the study, what was to be expected, and what steps were taken to ensure confidentiality, was provided. a demographic survey questionnaire was provided, which was completed by those students who chose to participate. in response to our invitation, a total of 30 students agreed to voluntarily participate in the study. table 1 outlines the number of students from each class section who participated in the study. demographic characteristics: table 2 presents the gender, age, and ethnic characteristics of the 30 student beneficiaries. as can be seen, themajority of students (93.3%) were female. more than half (53.3%) were between the ages of 20 and 29, with 30%being between the ages of 30 and 39. only 16.6%were older than 40, with 60% being caucasian and 33.3% african american. in addition, 3.3% were hispanic and 3.3% were from other cultural backgrounds. it is interesting to note that both groups had similar characteristics. table 3 presents the number of students with no online course experience and those with prior experience in taking online courses. of the students in the study, 66.6% had never taken an online course, 10% indicated they had one previous online training experience, and only 24% reported having had two ormore online course experiences, all of which were part of the online group. table 4 presents the number of students who indicated they had previous experiencewith using interviewing skills either through their existing employment situation or volunteer work. of the students involved in the study, 83.3% reported having had no prior experience with the use of interviewing skills. using a t-test and chi-square measure, table 5 compares the statistical differences between the background characteristics of students in both groups. it is interesting to note that except for the online group’s age and their prior experience with online courses, both groups are very similar. 94 advances in socialwork section total number percentage classroom setting 14 46.6% online setting 16 53.3% totals 30 table 1: study participants by section 95ouelle, chang/assessing and comparing a class-based andweb-based course gender total percentage online classroom number male 2 6.67% 2 (12.5%) none female 28 93.3% 14(87.5%) 14 (100%) totals 30 16 14 age range number percentage online classroom 20-29 16 53.3% 7 (43.75%) 9 (64.29%) 30-39 9 30% 5 (31.25%) 4 (28.57%) 40+ 5 16.67% 4 (25%) 1 (7.14%) totals 30 16 14 ethnicity number percentage online classroom african 10 33.33% 6 (37.5%) 4 (28.5%) american hispanic 1 3.33% 1 (6.25%) 0 caucasian 18 60% 9 (56.25%) 9(64.2%) other 1 3.33% 0 1 (7.1%) totals 30 16 14 table 2: study participants by gender, age, and ethnicity # total percentage online classroom number none 20 66.67% 9 (56.25%) 11 (78.5%) 1 3 10% 0 3 (21.4%) 2 4 13.3% 4 (25%) 0 3 1 3.33% 1 (6.25%) 0 4 2 6.67% 2 (12.5%) 0 totals 30 16 14 table 3: number of online courses taken instructional methods classroom setting: for the classroom-based instructional setting, the following methods were used to learn and practice basic interviewing skills. the classroom course used a competency-based model, with skills defined and operationalized using clear, behavioral, observable, specific terms and an evaluation system for assessing levels of competency (clark & horejsi, 1979). the students learned basic interviewing skills by focusing on one skill group at a time, adding new skills in each class (chang & scott, 1999). in this class, students learned basic interpersonal skills; communicating involvement; observing, active listening, and exploring skills; reflecting, questioning; and seeking clarification. the learning sequence involved reading, writing, discussing, practicing, and evaluating. after reading about the appropriate use of a group of skills, the students had opportunities to use the skills by writing responses to client statements. discussion of skill usage was promoted by showing videotaped examples of student interviews. using transcripts of the interview, students discussed individual transactions, use of specific skills, 96 advances in socialwork prior total percentage online classroom experience number yes 5 16.67% 2 (12.5%) 3 (21.4%) no 25 83.3% 14 (87.5%) 11 (78.5%) 30 16 14 table 4: prior experience with interviewing skills background characteristics online classroom group group (n=16) (n=13) t p age 32.69 25.46 2.037 .052 credit hours 12.69 13.85 -1.3382 .192 paid work hours per week 21.81 21.85 -.005 .996 s231 importance 8.38 8.85 -1.416 .168 grade expected 7.25 7.38 -.227 .822 overall gpa 3.15 3.11 .303 .764 last semester gpa 3.37 3.41 -.276 .785 chi p square percent of ethnicity 43.8% 38.5% .083 .774 percent of prior experience 43.8% 0% 7.49 .006 with online courses table 5: comparison of background characteristics and the overall process of the interview. students then practiced simulated interviews with other students in the role of client. receiving immediate evaluation was an important part of the learning process. each interview was followed by an evaluation. the person in the role of client gave feedback to the person in the role of social worker. the person in the role of social worker identified his/her strengths and weaknesses. a third person in the role of peer supervisor completed a detailed evaluation form. likert-type scales measure overall skill categories and dichotomous categories assess specific behaviors. as each group of new skills was learned, the students also learned how to evaluate the appropriate use of these skills. this immediate feedback provided students a chance to identify strengths and begin working to correct problem areas. safety was created, because all students were facing similar learning challenges, feedback was constructive, and encouragement was freely given. at the end of the semester, each student completed a final 10-minute videotaped interview with another student from the class as the client. the student wrote a transcript of the interview and evaluated it. the instructor met with each student to review both his/her videotape and evaluation of the videotape. web-based setting: in the web-based instructional environment, several pedagogical strategies were used to learn and practice interviewing skills. these were: (i) interactive notes, (ii) self-test, (iii) collaborative-learning activities, (iv) video demonstrations, (v) skills practice exercises, (vi) selfassessment reports, (vii) peer reviews, and (viii) instructor feedback. the first was the use of a series of “interactive notes,” where students were to develop conceptual skills about the interviewing process. these notes complimented traditional reading materials. interviewing skills were divided into five different stages of the interview process. for the purpose of this study, examination of skill development focused primarily on specific interviewing skills associated with the beginning stages of the interview, that is, the social or engagement and the problem identification stage. embedded learning activities made the notes interactive. as a student explored the interactive notes on different micro-skills of a particular stage of the interview, learning assignments were integrated to permit the student to reflect on the content. these assignments required the student to stop his/her exploration of the notes, complete a brief learning task that required some critical thought, and upload the assignment to a specific electronic drop box. a series of learning tasks of this kind were embedded throughout the interactive notes. this strategy provided the instructor with some initial feedback regarding how the student was progressing in the development of basic conceptual skills about a particular interviewing strategy. the second pedagogical strategy was the extensive use of “self-tests.” a selftest is a short multiple choice or short answer online quiz that reviews the content of the required readings and interactive notes. self-tests provide opportunities for immediate feedback regarding the student’s level of understanding or the meaning of specific interviewing strategies. to enhance the development of conceptual skills, students were then required to engage in a 97ouelle, chang/assessing and comparing a class-based andweb-based course collaborative learning exercise. this was facilitated by the use of an electronic bulletin board of a small group discussion forum using asynchronous communication. this provided an opportunity for the students to articulate the meaning of certain interviewing strategies to one another and acquire additional input from peers and the instructor on how certain strategies can be implemented in an interview. the next step in the learning process involved the development of actual executive skills through practice. to set the stage for practice, a series of small streaming video interview segments were provided online that were easily downloadable through regular connection lines. a discovery learning strategy was used to guide students towards implementing a particular interviewing skill. the initial video segment illustrated the beginning moments of the interview between a social worker and a fictitious client. only the sound track of the fictitious client was heard, but the social worker in the interview could be seen. after a particular segment was completed, the students were to provide examples of the kinds of questions and/or statements that could be used to solicit the client responses they were hearing. these suggestions were provided in an observation form and forwarded to the instructor. this technique provided students with an opportunity to examine the multiple ways a message can be articulated while acquiring similar responses from clients. in the second part of the exercise, the student reviewed the same interview segment, but this time with what was actually said by the interviewer. questions and answers were compared, with the surprising results that student questions and guesses were at times far superior to what was actually said in the training video. after reviewing several segments of the video using this process, the students were then asked to practice the skills associated with a particular stage of the interview. to do this, each student selected a friend, classmate, or relative at home to role-play and practice a particular skill during the initial stages of the interview. these practice sessions were videotaped either at home or by accessing videotaping facilities at the university. the students were to practice and videotape each interview segment several times before advancing to the next step. the final step involved using a self-assessment strategy and peer reviews. by using an observation tool provided online, each student selected his/her last practice segment and self-evaluated the performance. a peer was asked to assist by reviewing the same segment and providing his/her own comments and reflections. these practice tapes, along with self-evaluation reports and peer reviews, were submitted to the instructor for additional feedback. this process was repeated for each stage of the interview process. once the video-tape practice sessions were completed, each student was then required to conduct an entire 30-to-45 minute interview which demonstrated their skill acquisition at each stage of the interview process. this tape was submitted to a peer for a peer review, which was completed using a behavioral checklist and observation sheet designed for this purpose. the results of the peer review were submitted to the instructor. 98 advances in socialwork data collection procedures three sets of data were collected for this study. the first set of data was based on information regarding the demographic nature of the study participants. a second set was collected to gather information on student perspectives of their learning experience and determine the degree to which they perceived their level of skill acquisition. a third set of datawere collected to acquire information on the acquisition of actual interviewing skills. instruments: two instructors, respectively, administered all evaluative instruments used for this study. specifically, three instruments were used to collect information from student beneficiaries. (1) demographic survey: at the time of student recruitment, a pre-interview demographic survey questionnaire was used to gather the demographic characteristics of students who chose to voluntarily participate in the study. this questionnaire provided information on age, ethnicity, gender, prior experience using interviewing skills, and prior experience with taking online courses. (2) end-of-semester survey questionnaire: once the course was completed, students in the study were requested to complete an end-of-semester questionnaire to gather subjective information on the students’ perception of the clarity and effectiveness of the learning exercises used to teach interviewing skills, irrespective of the instructional medium used. likert-type scales measures were used to acquire data on the following characteristics: (i) organization of learning exercises, (ii) the extent to which interest levels were sparked by the learning exercises, (iii) clarity of instructions, (iv) student perception regarding implementing interviewing skills, (v) student perception of their learning experience, and (vi) student’s level of confidence with the use of interviewing skills. in addition, the students were provided an opportunity to add subjective data for each of the characteristics. (3) videotaped interviews: after the course was completed and grades were turned in, the students were invited to conduct a 10-minute interview with a simulated client. this interview was conducted and videotaped at the university. the simulated client was trained and role-played by graduate-level students and one undergraduate senior-level social work student. all three students used for the client simulation were coached and trained to role-play the same simulated client role-play scenario. the students used for the simulated client were neither part of either the classroom or online group being studied, nor were they known to the study participants. analysis for the purpose of the article, qualitative and quantitative data analysis was conducted on information collected from the demographic survey and the end-ofsemester survey questionnaire. a t-test and chi-square was used to determine the extent that the two groups were similar or different with respect their background characteristics. a t-test was used to determine if there was a significant difference between student responses regarding their perceptions of the clarity and effectiveness of the learning exercises used and their perception of their level of skill acquisition. qualitative data collected from the two survey questionnaires 99ouelle, chang/assessing and comparing a class-based andweb-based course were coded and examined using nivo software to assess student attributes and emerging themes from their comments. the qualitative data were reviewed independently by the two co-investigators. data from the videotaped interviews are currently being evaluated by independent evaluators, the results of which will be reported at a later date. preliminary findings the following tables summarize findings from data collected from the two survey questionnaires. tables 6 and 7 present information on how students in 100 advances in socialwork online respondents strongly disagree undecided agree strongly reporting n=16 disagree agree (1) (2) (3) (4) (5) exercises well-organized 0 0 2 (12.5%) 5 (31.25%) (56.25%) exercises sparked my 0 3(18.75%) 0 5 (31.25%) 8 (50%) interest enjoyed participating 0 1 (6.25%) 1 (6.25%) 7 (43.75%) 7(43.75%) instructions were clear 0 0 1(6.25%) 7(43.75%) 8 (50%) can implement 1(6.25%) 1(6.25%) 2 (12.5%) 7(43.75%) 5(31.25%) interviewing skills learned a lot from 0 2(12.5%) 0 10(62.5%) 4(25%) activities achieved a high level 2(12.5%) 1(6.25%) 2(12.5%) 8(50%) 3(18.75%) of confidence with interviewing skills table 6: clarity and effectiveness of learning exercises online respondents strongly disagree undecided agree strongly reporting n=13 disagree agree (1) (2) (3) (4) (5) exercises well-organized 1 (7.69%) 3 (23.08%) 9(69.23%) exercises sparked my 1(7.69%) 4(30.77%) 8(61.54%) interest enjoyed participating 8(61.54%) 5(38.46%) instructions were clear 1(7.69%) 1(7.69%) 7(53.85%) 4(30.77%) can implement 1(7.69%) 8(61.54%) 4(30.77%) interviewing skills learned a lot from 6(46.15%) 7(53.85%) activities achieved a high level 1(7.69%) 11(84.62%) 1(7.69%) of confidence with interviewing skills table 7: clarity and effectiveness of learning exercises the online and classroom group assessed the clarity and effectiveness of the learning exercises that were used. from the data we can conclude that a majority of the students in both groups agreed or strongly agreed with all the characteristics used to assess clarity and effectiveness of the learning exercises. table 8 compares the group means and statistical significance of the student responses regarding the clarity and effectiveness of the learning exercises used in each course. on all variables regarding clarity and effectiveness of learning exercises, both groups showed no significant differences in their responses. students’ qualitative responses what follows is a description of the typical responses students provided when asked to add additional comments for each characteristic used to define the clarity and effectiveness of learning exercises. with respect to organization of the learning exercises, the following is an example of student responses: “the order of the interview skills was good—beginning with small skills and building upon them.” the following exemplifies how the students felt the learning exercises sparked their interests: 101ouelle, chang/assessing and comparing a class-based andweb-based course variables online classroom group group (n=16) (n=13) t p learning exercised 4.44 4.6216 -.686 .498 well organized learning exercised 4.13 4.54 -1.151 .260 sparked my interest i enjoyed 4.25 4.38 -.499 .622 participating in learning exercises instructions were 4.44 4.08 1.302 .204 clear i can implement 3.88 4.23 -1.009 .322 beginning skills my interviewing 3.56 4.00 -1.195 .242 confidence is high interviewing skills 3.56 3.85 -1.069 .294 confidence is high table 8: mean differences of clarity and effectiveness of learning exercises “i feel that the learning exercises were interesting, because they contained so much information such as: empowering the client to allow him/her to use resources that he/she already possess, asking open questions, and not focusing on what’s wrong—putting emphasis on what’s already working and helping the client to develop skills to strength the resources that already exist.” many students expressed feeling uncomfortable when initially experimenting with practicing interviewing skills. the following is a typical response from students in both groups. “doing the taped interviews without previous personal experience was really uncomfortable, i was very unsure of myself.” students in both groups indicated that the learning exercises used were useful in preparing students for conducting interviews. “these learning exercises were very helpful in lettingme knowwhich questions to ask and how to ask them.” table 9 presents combined data from both groups with respect to student perception of the clarity and effectiveness of the learning exercises used for learning interviewing skills. once again, the majority of all students agreed or strongly agreed with the quality of the learning exercises used. concluding remarks integrating technology into higher education has turned universities’ attention to distance education. although distance education has come a long way in providing quality educational programs to populations that would not otherwise attend universities, some have cautioned years ago that it should not be the driving force behind the development of computer-facilitated instruction (boot & hodgson, 102 advances in socialwork online respondents strongly disagree undecided agree strongly reporting n=13 disagree agree (1) (2) (3) (4) (5) exercises well-organized 0 0 3 (10.34%) 8 (27.59%) 18 (62.07%) exercises sparked my 0 3(10.34%) 1 (3.45%) 9 (31.03%) 16 (55.17%) interest enjoyed participating 0 1 (3.45%) 1 (3.45%) 15 (51.72%) 12(41.38%) instructions were clear 0 1(3.45%) 2(6.9%) 14(48.28%) 12 (41.38%) can implement 1(3.45%) 1(3.45%) 3 (10.34%) 15(51.72%) 9(31.03%) interviewing skills learned a lot from 0 2(6.9%) 0 16(55.17%) 11(37.93%) activities achieved a high level 2(6.9%) 1(3.45%) 3(10.34%) 19(65.52%) 4(13.79%) of confidence with interviewing skills table 9: clarity and effectiveness of learning exercises 1987). the main goal for developing technology-supported instructional mediums should not be limited to reaching out to students in isolated areas. rather, the primary goal for developing technology-supported instructional environments should, first and foremost, be to provide students with a rich, stimulating learning experience. it builds upon the diverse expertise and resources that the medium makes possible and provides students with the opportunity to develop their own individual interests as they discover newmeanings and understandings made possible by this unique learning context. this study addresses the issue of learning efficacy in an online environment, most especially with respect to learning basic interviewing skills considered so essential to the development of effective social work practitioners. preliminary findings do not indicatemajor differences between student perceptions of the quality of their learning experience and/or their level of confidence, as beginning social work practitioners, irrespective of the learning medium used to learn interview skills. with further analysis of the data collected for this study, wewill be able to determine to what extent learning interviewing skills in the classroom or in a technology-supported learning environment actually transfers to actual practice. as ehrmann (1995) has suggested, future research and discussion must focus on learning methods specific to the instructional environment and not on the technology itself. the goal of this study is tomove our pedagogical discussion towards a greater understanding and appreciation of the conditions that appear to facilitate the creation of a context for good learning, regardless of where or when an educational experience is delivered. by ensuring that we focus on sound principles of good teaching and learning when developing medium-specific learning tasks, our journey in developing quality technology-supported learning systems will greatly be facilitated. irrespective of the teaching medium we choose, above all else, what remains important is that we continue to strive towards a better understanding of the learning processes that guarantee social work students receive a quality educational experience. references. boot, r.l., & hodgson, v.e. 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(1997). a selective history of internet technology and social work. computers in human services, 14(2), 35-49. ouellette, p, & sells, s. (2003). learning therapy in a technology-supported instructional environment. journal of systemic therapies, 22(3), 15-27. ouellette, p. (1999). moving toward technology-supported instruction in human service practice: the “virtual classroom.” journal of technology and human services, 16(2/3), 97-111. ouellette, p., & sells, s. p. (2001). creating a telelearning community for training social work practitioners working with troubled youth and their families. journal of technology and human services, 18(1/2),101-116. telelearning network of centres of excellence (tl*nce) (1995). research proposal submitted to the nce program. ottawa, canada: sshrc. trigg, a.m., & cordova, f.d. (1987). an integrated model of learning. radiologic technology, 58, 431-436 author’s note: address correspondence to: philip ouellette, ph.d., school of social work, indiana university, 902 west newyork street, es 4153, indianapolis, in 46202, usa. e-mail: pouellet@iupui.edu 104 advances in socialwork spring2005-200_page202 spring2005-201_page203 spring2005-202_page204 spring2005-203_page205 spring2005-204_page206 spring2005-205_page207 spring2005-206_page208 spring2005-207_page209 microsoft word hodge_spirituality and older adults final _________________ david r. hodge, ph.d., is assistant professor, school of social work, arizona state university, and senior nonresident fellow, program for research on religion and urban civil society, university of pennsylvania. robin p. bonifas, ph.d. is assistant professor, school of social work, arizona state university. rita jing-ann chou, ph.d., is assistant professor, college of social work, university of south carolina. preparation of this paper was supported by a grant from the john a. hartford foundation. copyright © 2010 advances in social work vol. 11 no. 1 (spring 2010), 1-16 spirituality and older adults: ethical guidelines to enhance service provision david r. hodge robin p. bonifas rita jing-ann chou abstract: spirituality plays an important role in the lives of many older adults. consequently, it is not surprising that gerontological social workers frequently engage spirituality in practice settings. the paucity of training gerontological workers have received on this topic, however, is a cause for concern. to help equip workers, three ethical principles are proposed to guide interactions in the area of spirituality. these principles can be summarized as: 1) client autonomy, 2) spiritual competence, and 3) professional competence. the application of these principles in practice settings will enhance the ability of gerontological social workers to interact with older adults’ spirituality in a professional and ethical manner. key words: spirituality, religion, strengths, ethical practice, older adults introduction spirituality and religion are important constructs in the lives of many older adults (taylor, chatters, & jackson, 2007). for instance, among those 65 and older, 72 percent report that religion is very important in their lives (newport, 2006). this represents the highest percentage reported by any of the age groups surveyed by the gallup organization (newport, 2006). spiritual beliefs and practices often play a central role in helping older adults navigate life-challenges (barusch, 1999; cabassa, 2007; lawrence et al., 2006). research has associated spirituality with: health and wellness (koenig, mccullough & larson, 2001; vink, aartsen, & schoevers, 2008), life satisfaction (yoon & lee, 2007), and selfesteem (keyes & reitzes, 2007). similarly, spirituality has been linked to the ability to cope with a variety of issues, including adversity (barusch, 1999), anxiety (rajagopal, mackenzie, bailey, & lavizzo-mourey, 2002), depression (koenig, 2007a), fear of falling (zhang, ishikawa-takata, yamazaki, morita, & ohta, 2006), hiv (vance, 2006), vision loss (brennan, 2002), and lifetime trauma (krause, 2009). in short, the extant empirical research suggests that spirituality is typically a strength in the lives of older adults. in light of this research, some observers have suggested that older adults’ spiritual beliefs can be harnessed to enhance outcomes (koenig, larson, & matthews, 1996; lewis, 2001; moberg, 2005; nelson-becker, nakashima, & canda, 2007). since hodge, bonifas, chou/spirituality and older adults 2 spirituality is often related to outcomes of interest to gerontological social workers, it is argued that practitioners should tap all relevant client strengths to address problems. consequently, it is perhaps not surprising that the existing research suggests that most gerontological workers are, at least in some form, addressing the spiritual dimension in their practices with older adults (murdock, 2005). incorporating spirituality into practice in an ethical manner may, however, pose somewhat of a challenge to gerontological social workers. despite widespread interest in tapping clients’ spiritual strengths to address problems, most gerontological practitioners appear to have received little or no training on the topic during their graduate educations (murdock, 2005; sheridan, 2009). these self-reports have been corroborated by a content analysis of widely used social work foundation practice textbooks, which found minimal content on older adults and spirituality and religion across approximately 10,000 pages of surveyed text (tompkins, larkin, & rosen, 2006). the lack of training is particularly concerning in light of the vulnerabilities commonly associated with aging. although many individuals in later life continue to lead productive lives, aging is often associated with increasing cognitive, emotional, and physical challenges (aldwin, park, & spiro, 2007). further, it is often at points of heightened vulnerability that gerontological social workers encounter older adults. without proper training workers may engage in unethical practice, perhaps even unknowingly, that engenders harm. the available research on this topic, although limited, corroborates this concern. a national survey of direct practitioners affiliated with nasw (n = 2,069) found that only 17% agreed that their social work colleagues possess the knowledge to appropriately address spirituality in practice settings (canda & furman, 1999). this assessment was supported by an analysis of the qualitative data (canda, nakashima, & furman, 2004). another study that examined practitioners’ reliance upon formal ethical frameworks reportedly found that many practitioners were not basing practice decisions on ethical principles (sheridan, 2009). in light of these findings, calls have appeared in the literature highlighting the need for more training on ethical principles (canda et al., 2004; murdock, 2005; sheridan, 2009). murdock (2005), for instance, has specifically mentioned this need regarding gerontological social workers. in other words, gerontological workers’ practice with older adults may be enhanced by the delineation of ethical principles related to spirituality (murdock, 2005). accordingly, the purpose of this paper is to provide gerontological workers with some ethical principles to guide interactions regarding client spirituality. applying these principles will enable workers to approach older adults’ spirituality in a professional and ethical manner that helps safeguard older adults’ well-being. before discussing these principles, however, conceptualizations of spirituality and religion are overviewed. advances in social work, spring 2010, 11(1) 3 spirituality and religion: distinctions and connections in academic circles it has become increasingly common to conceptualize spirituality and religion as distinct but overlapping constructs (canda & furman, 2010; derezotes, 2006). spirituality is commonly defined as a person’s existential relationship with god or the transcendent (hodge, 2005a; wuthnow, 2007). religion can be understood as a shared set of beliefs and practices—developed in community with people who have similar understandings of the transcendent—which is designed to mediate an individual’s relationship with the transcendent (geppert, bogenschutz, & miller, 2007; koenig et al., 2001). at the risk of oversimplification, spirituality emphasizes the personal and religion the communal. while these types of distinctions are widespread in academic circles, it is important to note that such demarcations are less frequent among members of the general population, and perhaps older adults in particular (moberg, 2005). the vast majority of older adults self-describe as both spiritual and religious (musick, traphagan, koenig & larson, 2000). in short, many older adults appear to use both terms to connote similar ideas (musick et al., 2000). it can also be useful to envision spirituality as a continuous construct (gallup & jones, 2000; miller, 1998). this continuum ranges, on one end, from those who are uninterested in spirituality, to those for whom spirituality is just one of many lifedimensions, through to those on the other end of the continuum for whom spirituality plays the primary role in shaping beliefs and actions (gallup & lindsay, 1999; van hook, hugen, & aguilar, 2001). while ethical practice is imperative across the continuum, older adults on the latter end of the continuum may be particularly at-risk for unethical treatment. ethical principles to guide interactions with older adult spirituality as texts on ethical practice indicate, many ethical principles should guide practice decisions (reamer, 2006). this paper focuses on three interrelated principles that may be particularly pertinent in guiding gerontological workers’ interactions with older adult spirituality. these principles are among the most commonly cited in the literature calling for additional training on ethics in practice settings (canda et al., 2004; murdock, 2005; sheridan, 2009). in brief, these principles can be summarized as follows: 1) respect for client autonomy, 2) sufficient competency in the client’s spiritual tradition, and 3) practicing within the boundaries of professional competency. it may be helpful to note that these principles are interrelated. thus, although discussed separately, they inform one another when working with older adults in practice settings. client autonomy as indicated in the nasw code of ethics (1999), respect for client autonomy is a fundamental social work value. the importance of this value is accentuated when dealing hodge, bonifas, chou/spirituality and older adults 4 with spirituality, which is often a highly personal and sensitive subject among clients (hodge, 2006a). older adults may be particularly sensitive to breaches of client selfdetermination due to the importance they often ascribe to spirituality (lewis, 2001). autonomy can be violated in many ways. for example, imposing spiritual beliefs that are inconsistent with clients’ spiritual narrative contravenes self-determination (canda & furman, 2010). this might take the form of using terminology that is foreign to older adults’ spiritual narrative. similarly, assuming that spiritually committed older adults want to incorporate spirituality into treatment can also represent a more subtle violation of self-determination. some spiritually committed clients may desire to keep private the spiritual dimension of their lives. alternatively, ignoring spirituality when older adults desire to integrate their spiritual assets into the helping process also represents a breach of autonomy (nelson-becker, 2005). clients often believe that spirituality plays an essential role in ameliorating, or coping with, problems (cabassa, 2007; lawrence et al., 2006). disregarding clients’ expressed desires also demonstrates a lack of respect for their autonomy. likewise, waiting for clients to raise the topic can also be problematic. for instance, elderly clients who want to have their spirituality taken into account during service provision may not initiate a discussion of spirituality. because of its highly personal nature, older adults may not broach the subject of spirituality unless directly asked (nelson-becker et al., 2007). to fully respect clients’ wishes, interactions should typically be preceded by a brief spiritual assessment to determine interest in spirituality, religious tradition, and other basic, preliminary information (nelson-becker et al., 2007). indeed, the joint commission—the largest and most influential health care accrediting body in the united states—now requires such assessments in hospitals, nursing homes, home care organizations, and many other health care settings providing services to older adults (hodge, 2006a; koenig, 2007b). such an assessment can be used to create a supportive space in which client self-determination is honored (hodge, 2004). both hodge (2006a) and koenig (2007b) have developed brief spiritual assessment tools that are congruent with the joint commissions’ accrediting requirements. the use of informed consent is an important mechanism for safeguarding autonomy (miller, 2003). if a brief assessment reveals that spirituality is potentially relevant to professional practice, informed consent should be obtained before proceeding with a more extensive examination of how spirituality might be incorporated into practice. initially, consent may be obtained on an informal, verbal basis. if the ensuing conversation confirms the relevance of spirituality, then a more formal, written consent might be considered to clarify the nature, scope, and role of spirituality in the helping process. ideally, however, informed consent should be viewed as ongoing process rather than an event-specific procedure (hodge, 2006a). practitioners should continuously monitor clients’ responses to ensure that they remain fully supportive of the continuing dialogue. older adults’ wishes can easily change over time. advances in social work, spring 2010, 11(1) 5 in some cases, for example, clients may communicate a desire to integrate spirituality into practice, but later change their minds, perhaps due to perceived lack of sensitivity to their spiritual values. the initial brief assessment may go well, for example, indicating the use of a comprehensive assessment to explore possible ways in which older adults’ spiritual strengths might be operationalized (hodge, 2006a). however, during the comprehensive assessment gerontological workers may, perhaps inadvertently, make comments about the clients’ spiritual tradition that are perceived to be offensive. alternatively, clients may initially indicate that they are uninterested in discussing spirituality. in some such cases, clients may be hesitant to trust workers with a sacred life-dimension (lewis, 2001). the potential for such a response is heightened given the lack of training in spirituality most gerontological workers report and the often volatile nature of the subject matter (murdock, 2005). trust may be developed over time, however, resulting in a change in disposition. the following principle is intrinsically linked to the process of developing and maintaining trust. spiritual competence the second principle that should guide interactions with client spirituality is spiritual competence. due in large part to changing immigration patterns, the population of older adults in the united states is characterized by increasing spiritual diversity (berkman, maramaldi, breon, & howe, 2002; melton, 2003). the numbers of buddhists, hindus, and muslims—to list just some traditions—have increased substantially during the past few decades (smith, 2002; smith & seokho, 2005). they join a spiritual landscape populated by various protestant, catholic, and jewish faiths, each with their own distinct value system (koenig, 1998; richards & bergin, 2000; van hook et al., 2001). as a result, the united states is now perhaps the most spiritually diverse nation on the planet (eck, 2001). spiritual competence can be understood as a distinct expression of cultural competence that deals with spiritually-informed cultures (sue & sue, 2008). the construct can be conceptualized as a continuous, life-long process whereby workers develop: 1) a growing awareness of their own value-informed spiritual worldview and its assumptions, limitations, and biases, 2) an empathic understanding of the client’s spiritual worldview, and 3) the ability to design and implement interventions that resonate with their client’s spiritual worldview (hodge & bushfield, 2006). thus, spiritual competence is a dynamic set of attitudes, knowledge, and skills regarding various spiritual traditions, which can be developed over time with different populations (sue & sue, 2008). awareness of one’s worldview plays an important role in managing spiritual countertransference (frame, 2003; genia, 2000; hodge, 2003; miller, 2003). when encountering spiritually different worldviews, unresolved personal issues may unconsciously affect interactions. for instance, gerontological workers who have rejected their family of origin’s religion may consciously or unconsciously react when encountering older adults who affirm that particular value system. subtle expressions of disapproval can damage the worker’s relationship with clients. to manage these types of hodge, bonifas, chou/spirituality and older adults 6 reactions, self-exploration can be a particularly useful tool, especially when conducted in a supervisory context with spiritually competent practitioners. toward this end, gerontological social workers might consider administering spiritual self-assessments (hodge & derezotes, 2008). a number of comprehensive spiritual assessment tools have been developed which highlight different aspects of spirituality using diagrammatic approaches that lend themselves to self-assessments (hodge, 2005b). included among these pictorial approaches are spiritual lifemaps (hodge, 2005a), spiritual genograms (hodge, 2001), spiritual eco-maps (hodge & williams, 2002), and spiritual ecograms (hodge, 2005c). practitioners might conduct a spiritual selfassessment with each of these tools, and then reflect upon the implications of their spirituality as it intersects practice with various client populations. this exercise helps acquaint practitioners with the strengths and limitations of various approaches to spiritual assessment (hodge, 2005d), while facilitating self-understanding of one’s personal worldview. cultivating awareness of the strengths and limitations of one’s worldview helps develop a positive understanding of culturally different spiritual worldviews. demonstrating empathetic awareness of widespread beliefs and practices within older adults’ various traditions can meta-communicate respect for, and acceptance of, clients’ spiritual choices. in turn, this can help alleviate the concerns among some older adults that practitioners will not respect their spiritual values (lewis, 2001). it is at this point of empathic understanding that spiritual interventions can be coconstructed with older adults. while developing fluency in all spiritual traditions may be unrealistic, it is usually possible to developing a working knowledge of traditions that are commonly encountered in practice. for instance, practitioners living in utah might familiarize themselves with beliefs and practices that are widely affirmed within the latter day saints tradition. while working to cultivate an understanding of various traditions, it is important to remember the diversity that exists with each individual tradition (hodge, 2002; hodge, 2005e). individuals who self-identify as members of a given spiritual tradition can affirm a wide variety of beliefs, including beliefs that are at odds with the norms of the tradition. as a result, it is helpful to view traditions as flexible templates that suggest, rather than require, the presence of particular beliefs and practices. while each client’s spiritual narrative is individualized by the client’s unique experience of the transcendent, it is also typically expressed within the parameters of a spiritual tradition (musick et al., 2000). developing familiarity with common norms can help practitioners use more culturally relevant language, avoid offensive comments, and suggest possible intervention strategies. while older adults must always be encouraged to affirm, reject, or modify the options provided by practitioners, the ability to tentatively offer working models can facilitate engagement and salutary outcomes. a number of options exist for developing understanding of various traditions. for instance, reading content on frequently encountered spiritual traditions—preferably written by cultural insiders, or sympathizers—can aid understanding of common norms advances in social work, spring 2010, 11(1) 7 (ginsberg, 1999). toward this end, a number of resources have appeared in the academic literature (koenig, 1998; richards & bergin, 2000; van hook et al., 2001). visits to local houses of worship can also help in enhancing knowledge. congregants are often willing to answer questions about their spiritual tradition. clergy are also frequently open to sharing information about common norms within their tradition (harr, openshaw, & moore, 2006). as will be discussed in more depth below, it is typically productive to form collaborative relationships with clergy whenever possible (benes, walsh, mcminn, dominquez, & aikins, 2000; edwards, brian, mcminn, & dominguez, 1999). many older adults exhibit a high degree of trust in their clergy (oppenheimer, flannelly, & weaver, 2004). in addition to helping gerontological practitioners understand the norms within spiritual traditions, clergy are also front-line mental health workers (oppenheimer et al., 2004). in other words, older adults often present to clergy first with mental health problems. forming collaborative relationships with clergy can enhance overall service provision to clients (harr et al., 2006). another option for developing understanding of various spiritual traditions is to cultivate relationships with practitioners who are more conversant in the norms of a particular tradition. some practitioners have developed specialized knowledge of spiritual beliefs and practices within given traditions (nielsen, 2004). consulting with such individuals can be particularly helpful as they are often well-versed in how the norms within a tradition intersect health and mental health issues. if older adults are at-risk of experiencing culturally insensitive practice, referral to a more spiritually competent practitioner should be considered (reamer, 2006). some gerontological workers may not have the necessary skills and knowledge to work with older adults from some traditions. others may feel that worker/client value differences preclude an effective working relationship. still others may feel the value differences are surmountable, but they have not fully worked through the countertransference issues. referral may also be relevant in the context of the next ethical principle, although for somewhat different reasons. professional competence the third ethical principle is to practice within the boundaries of professional competence. as is the case with the above principles, it is drawn from the nasw code of ethics (1999, p. 1.04a) and has particular relevance to the area of spirituality. although closely related to the above content, it can be distinguished from the concept of spiritual competency in some important aspects. namely, spiritual competency emphasizes training related to workers’ interpersonal capabilities while professional competence emphasizes training regarding interventions designed to ameliorate problems (resnicow, soler, braithwaite, ahluwalia, & butler, 2000). for instance, when exploring spirituality with older adults, it is important to ensure the dialogue is focused on addressing clients’ problems (hodge, 2005a). considerable overlap exists between counseling, a practice designed to minimize clients’ difficulties, and spiritual direction, a practice designed to increase a person’s intimacy with god or the transcendent (tan, 2003). gerontological workers and spiritual directors can, in the hodge, bonifas, chou/spirituality and older adults 8 context of working with older adults, address both content areas: spirituality and problems. although the content discussed within each area may be similar, the aims tend to differ (ganje-fling & mccarthy, 1991). a gerontological worker discusses spirituality with the goal of increasing the client’s ability to ameliorate the problem. alternatively, a spiritual director discusses problems with the goal of increasing the client’s intimacy with god. table 1 summarizes some common differences between therapy and spiritual direction. neither enterprise sanctions authoritarian relationships, preaching, or advice giving (tan, 2003). both therapy and spiritual direction are conversationally based enterprises that are essentially egalitarian and growth-oriented in nature. within this context, however, they do tend to stress different points. understanding these different areas of emphasis can assist practitioners to remain within the parameters of their area of professional competence. table 1: distinctions between therapy and spiritual direction emphasis in therapy emphasis in spiritual direction • clients typically in crisis/emotional distress • clients often exhibiting wellness • focuses upon problems • focuses upon spiritual growth • emphasizes symptom amelioration • emphasizes the link between life experience and clients’ relationship with god • empathic to clients emotional experiences • empathic to the spirit of god • concentrates on emotional and cognitive dimensions • concentrates on the spiritual dimension (e.g., spiritual experiences) • typically employs therapies developed and validated within positivistic scientific tradition (e.g., cognitive behavioral therapy) • typically uses strategies developed and validated over centuries of experience in a given spiritual tradition (e.g., spiritual exercises, such as meditation) • aims to enhance client autonomy • aims to enhance surrender to god’s will • may help clients adjust to societal norms • helps clients adjust to spiritual norms • characteristically fee-based • characteristically offered without cost based upon ganje-fling and mccarthy (1991) and tan (2003) gerontological workers—perhaps especially those interested in spirituality—can inadvertently fall into the role of a spiritual director when exploring the issue of spirituality. for most workers, however, this role falls outside the parameters of their professional competence (richards & bergin, 2005). it is important to be aware of such dynamics and ensure that the conversation typically remains focused upon the present therapeutic challenges faced by older adults. in instances where spiritual growth is the primary focus, clients should typically be referred to clergy (richards & bergin, 2005). it is important to note that clergy are experts in spirituality, and often have training in mental health issues. for instance, the american association of pastoral counselors requires members to have a bachelor’s advances in social work, spring 2010, 11(1) 9 degree, a three year professional degree from a seminary, and a specialized master’s or doctorate in a mental health discipline. in the same way that social workers should avoid dispensing medical or legal advice, dispensing spiritual advice should also be avoided. clients’ interests are typically served more appropriately by providing services within the boundaries of one’s area of professional competence. by way of qualification, it should be noted that the clear demarcation of professional responsibilities between social workers and clergy is often relatively complex in actual practice (miller, 2003). for instance, an older adult may be wrestling with spiritual issues related to their clergy member and desire a safe neutral environment in which to process the issues. in other cases, spiritual growth may be intertwined with symptom amelioration (sullivan, 2009). in yet other situations, gerontological workers may be the only helping professionals whom older clients trust to address spiritual issues (anderson, anderson, & felsenthal, 1993). while it is important to acknowledge this complexity, the limits of one’s professional expertise should always be borne in mind and steps should typically be taken to avoid assuming dual relationships (richards & bergin, 2005). this same basic principle also applies to interventions. when constructing spiritual interventions—or therapeutically oriented strategies that incorporate spirituality or religion as a central component of the intervention—it is important to remain within the parameters of one’s clinical expertise (drake, jonson-reid, hovmand & zayas, 2007; hodge, 2006b). the degree of training and experience with a given intervention should be considered in the selection process (canda & furman, 2010). spiritual interventions should only be used when workers are reasonably confident that the intervention can be implemented in a professional manner (richards & bergin, 2005). for example, in the same way that gerontological workers trained in cognitive behavioral therapy (cbt) might avoid using psychodynamic interventions, workers should refrain from using spiritual interventions that fall outside the boundaries of their professional training. this is a particularly significant issue in light of the limited training on spirituality most workers may have received during their graduate education (murdock, 2005; sheridan, 2009). clients have a right to expect that workers have some degree of expertise in the interventions used. thus, if gerontological workers lack sufficient training in an intervention, referral to a practitioner with the necessary proficiency should be considered (reamer, 2006). similarly, if the exploration of spirituality cannot be linked to some therapeutic goal that falls within the preview of a social worker’s responsibilities, then referral to clergy is typically appropriate (gilbert, 2000; –tan, 2003). when exploring the issue of referral it is important to ensure that clergy share older adults’ value system. as implied above, beliefs and practices can differ substantially within a given tradition. it should not be assumed, for instance, that a methodist pastor would be a good referral with a methodist client, just because the client self-identifies as methodist (hunter, 1991). to help ensure client autonomy is respected, steps should be taken to help ensure some degree of value congruence exists between older adults and potential referrals. as is the case with many issues, older adults themselves are often hodge, bonifas, chou/spirituality and older adults 10 excellent resources and can point gerontological workers in the right direction regarding possible referrals. indeed, clients’ spiritual expertise can often supplement workers’ professional competence. as is the case with spiritual competence, professional competence is best understood as a continuous, rather than a dichotomous, construct. by virtue of their professional training and experience, gerontological workers typically have some degree of competence with an array of different practice strategies. moderate levels of competence can often be supplemented with the knowledge of clients, who can typically be considered experts on their own spirituality. through such a collaborative process, spirituality can often be integrated into treatment (nielsen, 2004). consider, for example, a worker trained in cbt who is professionally proficient in constructing health-promoting self-statements to alleviate problems. such a practitioner may be able to co-construct spiritually modified selfstatements in a professional manner when working with a spiritually motivated older adult, particularly if the practitioner is conversant with the norms of the client’s spiritual tradition (ellis, 2000; hodge, 2006b; nielsen, 2004). similarly, collaborating with clergy can be helpful in developing spiritual interventions (miller, 2003). as specialists in spirituality, clergy can often provide helpful insights into spiritual beliefs and practices that may be relevant to the challenges encountered by clients. engaging spiritual specialists from older adults’ religious communities can aid in the process of constructing professionally designed, culturally relevant interventions. it may be helpful to note that some research suggests that many clergy are open to working with social workers (galek, flannelly, koenig, & fogg, 2007; harr et al., 2006; oppenheimer et al., 2004). gerontological workers can facilitate collaborative relationships by pro-actively implementing a number of strategies (harr et al., 2006). included among these strategies are communicating: respect for clergy’s status as professionals, deference to clergy’s specialized knowledge in spirituality, recognition regarding the importance of spirituality as a distinct dimension of human existence on a par with emotional/cognitive dimensions, and interacting with clergy as co-equals. when considering potential collaborations or referrals, it is important that clients fully consent to such associations. although clients generally view their religious communities positively, in some cases conflicts can exist. such conflicts may be due to value incongruence, interpersonal problems, or other issues. as implied above, it may be appropriate to discuss clients’ spiritual concerns in such situations. it may be helpful, however, to obtain supervision in such cases from someone with some degree of expertise in spirituality. conclusion many older adults believe that spirituality plays an important role in helping them address the challenges they face in later life (cabassa, 2007; lawrence et al., 2006). research suggests that most gerontological social workers are sensitive to these beliefs, advances in social work, spring 2010, 11(1) 11 cognizant of their lack of training, and desirous of becoming more proficient in this area (murdock, 2005). according to one study (n = 299), approximately 75% of gerontological social workers wanted to become more sophisticated about the use of spirituality in practice (murdock, 2005). toward this goal, three principles that may be particularly salient in work with older adults were discussed: client autonomy, spiritual competence, and professional competence (canda et al., 2004; murdock, 2005; sheridan, 2009). it is important to emphasize the inter-connected nature of these three guidelines. it is much easier to respect older adults’ autonomy if one develops spiritual competence in the client’s tradition. similarly, professional competence can often be supplemented if one has sufficient fluency in the norms of an older adult’s tradition and the client desires to work with the practitioner to co-construct spiritual interventions. engaging clients in the therapeutic process respects their autonomy and can enhance outcomes. indeed, this is the bottom line—client welfare. in other words, the point of ethical principles is to ensure clients’ best interests are prioritized. the application of these and other relevant ethical guidelines in practice settings will assist workers to interact with older adults in a professional and ethical manner that helps safeguard and enhance their well-being. references aldwin, c., park, c. l., & spiro, a. 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(2003). integrating spiritual direction into psychotherapy: ethical issues and guidelines. journal of psychology and theology, 31(1), 14-23. taylor, r. j., chatters, l. m., & jackson, j. s. (2007). religious and spiritual involvement among older african americans, caribbean blacks, and non-hispanic whites: findings from the national survey of american life. journal of gerontology, 62b(4), s238-s250. tompkins, c. j., larkin, h., & rosen, a. l. (2006). an analysis of social work textbooks for aging content: how well do social work foundation texts prepare students for our aging society? journal of social work education, 42(1), 3-23. van hook, m., hugen, b., & aguilar, m. a. (eds.). (2001). spirituality within religious traditions in social work practice. pacific grove, ca: brooks/cole. vance, d. e. (2006). spirituality and living and aging with hiv: a pilot study. journal of religion, spirituality and aging, 19(1), 57-74. vink, d., aartsen, m. j., & schoevers, r. a. (2008). risk factors for anxiety and depression in the elderly: a review. journal of affective disorders, 106, 29-44. wuthnow, r. (2007). after the baby boomers: how twentyand thirty-somethings are shaping the future of american religion. princeton, nj: princeton university press. yoon, d. p., & lee, e.-k. o. (2007). the impact of religiousness, spirituality, and social support on psychological well-being among older adults in rural areas. journal of gerontological social work, 48(3/4), 281-298. zhang, j.-g., ishikawa-takata, k., yamazaki, h., morita, t., & ohta, t. (2006). the effects of tai chi chuan on physiological function and fear of falling in the less robust elderly: an intervention study for preventing falls. archives of gerontology and geriatrics, 42(2), 107-116. author’s note: address correspondence to: david r. hodge, ph.d., school of social work, copp, arizona state university, mail code 3920, 411 n. central avenue, suite 800, phoenix, az 85004-0689. aisw vol. 8, no. 1:aisw vol. 5, no. 2 49 a critique of feminist theory kathy lay james g. daley abstract: objective: feminism has grown rapidly in the last 40 years as both a multidisciplinary voice advocating for change and an area of scholarship and theorybuilding. a review of empirical articles describes 17 studies that indicate a wide range of applications of feminist theory, but theory is applied primarily as a lens for other issues, rather than to expand theory development. advocacy and philosophical views seem to overshadow theory development. suggestions for improving feminist theory are offered. keywords: feminism, theory, social work introduction feminist theory has developed as a small part of a very large feminist movement striving to challenge traditions, methodologies, and priorities in all aspects of life. the movement “began a widespread call for a major reassessment of concepts, theories, and methods employed within and across the academic disciplines (hesse-biber, 2002, p. 57). the feminist lens was applied to many areas of research. hesse-biber and colleagues assert that, “research conducted within a feminist framework is attentive to issues of difference, the questioning of social power, resistance to scientific oppression, and a commitment to political activism and social justice” (hesse-biber, leavy, & yaiser, 2004, p. 3). many authors have focused on feminist theory and how the conceptualization of the feminist perspective evolved (e.g., duran, 1998; donovan, 2000; evans, 1995) and some authors have emphasized the methodology of feminist theory (e.g., fonow & cook, 1991; hesse-biber, gilmartin, & lydenberg, 1999; hesse-biber & yaiser, 2004). an explosion of articles, books, and conferences has produced a very credible area of scholarship. the next section describes the historical development of feminist theory and how complex the perspective is. historical analysis of theory development feminist theory: an overview feminist theory offers a perspective for understanding human behavior in the social environment by centering women and issues that women face in contemkathy lay, ph.d. is assistant professor and james g. daley, ph.d. is associate professor at indiana university school of social work, indianapolis, in 46202-5156. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 49-61. indiana university school of social work. 50 advances in social work porary society. feminism reflects “a world view that values women and that confronts systematic injustices based on gender” (chinn & wheeler, 1985, p. 74). a feminist lens asks us to see individuals, groups, family, and organizations in their social, political, economic, ethnic, and cultural contexts. the intersection of these contexts produces the potential for oppression that is rooted in gendered relationships. feminist theory is most often associated with the rights of women. this is both simplistic and reductionistic. many of the human behavior texts offer a precursory review of feminist theory; however, for a comprehensive understanding and application, a broader study is required. there are encompassing concerns inclusive of the discipline’s particular epistemological, ontological, and methodological assumptions; however, there is no one monolithic feminist perspective; instead, there are many perspectives, with various theoretical groundings (andermahr, lovell, & wolkowitz, 1997). theory is about understanding our world and everyday experiences. flax (1999) stated that we all engage in a “systematic analytic approach to everyday experience” (p. 9) and it is done unconsciously. “to theorize, then, is to bring this unconscious process to a conscious level so it can be developed and refined” (p. 9). it is paramount to make theorizing explicit and inclusive of feminist concerns. there are several assumptions associated with feminist theory. flax (1999) delineated three, with the first being that “men and women have different experiences” (p. 10) in that their worlds are not the same. some see the goal of feminism as equality, which would include having the same choices and opportunities as men. feminist theories attempt to explain differences between men and women, call for centering gender and consideration for how gender differences effect human behavior in the context of historical, political, social, and cultural concerns, as well as oppressions that are gender based. the oppression of women is not simply related to some other social relationship such as a class system. flax (1999) explained that instead, feminist theory views women’s oppression as “a unique constellation of social problems and has to be understood in itself . . . ” (p. 10). oppression is seen as a part of the way the world is structured and is not due to pockets of “bad attitudes” (p. 10) or backward traditions, but oppression is embedded in the very socio-economic and political organization of our society. the structure is the patriarchy, which has deep roots in the culture at large (flax, 1999). flax also associated specific goals with feminist theory. these goals include understanding “power differentials between men and women” (p. 10) and power in relationship to the evolution of oppression as well as to bring about social change to end oppression. a central purpose of feminist theory is a “commitment to change oppressive structures and to connect abstract ideas with concrete problems for political action” (p. 11). oppression has been defined as the “absence of choices” (hooks, 1984, p. 5). women in western society have choices with regard to everyday human experiences, which include production of resources, reproduction, and the merger of the biological and psychological (flax, 1999). it is for this reason that some women do not name oppression as a concern or identify as feminists. “the lay, daley/a critique of feminist theory absence of extreme restrictions leads many women to ignore the areas in which they are exploited or discriminated against; it may even lead them to imagine that no women are oppressed” (hooks, 1984, p. 5). types of feminism the understanding and analysis of oppression are central to feminist theories. much of the work in the second wave of feminism focused on attempts to identify the nature of women’s oppression. theories may identify the lack of education, economic dependence, unequal political rights, or the need for control over sexuality as related to the nature of oppression. theories address the causes of oppression as the cultural order, labor and economic relations, biological differences, political institutions, and women’s own self-understanding. feminist theory requires us to critically analyze what is happening in our social world from multiple contexts and provide strategies for the amelioration of adverse conditions that effect the lives of women (kolmar & bartkowski, 2000). though one central feminist theory has not evolved, basic principles are commonly given when describing feminism, including such concepts as valuing women and their experiences, identifying conditions that oppress women, changing society through advocacy, and recognizing that many factors, not just gender, impact a woman’s actions and views (mccormick & bunting, 2002). the progress in feminism has been more focused on different types of feminism. feminism has evolved in different arenas rather than as one unified concept. the labels that define those arenas have varied. the most commonly used are eight separate feminist theories: black feminism, radical feminism, cultural feminism, lesbian feminism, liberal feminism, marxist feminism, materialist feminism, and socialist feminism (andermahr, lovell, & wolkowitz, 1997; evans, 1995). some theories can be grouped due to similarities, but distinctions offer a broader critical lens of a myriad of political, social, economic, ethnic, and cultural contexts. black feminism focuses not only on women, but specifically on the struggles of black women (kanneh, 1998). collins (2000) saw the concern of black feminism as resisting oppression through empowerment, which entails understanding the intersection of racism and sexism. black feminist thought insists “that both the changed consciousness of individuals and the social transformation of political and economic institutions constitute essential ingredients for social change” (collins, 1991, p. 221). black women face social practices within a historical context that represent a “unique matrix of domination characterized by intersecting oppressions” (collins, 2000, p. 23). individual transformation involves acknowledging the historical structure of institutions of domination. the result of this understanding is a changed consciousness, which collins (1991) believed necessary for social change. black feminist analysis insists on understanding what it means to be a black woman in a racist patriarchy (johnson, 1983). differences due to race, class, gender, sexuality, and religion are of distinct importance in many cultures and are “visible and palpable” (collins, 1991, p. 23) for black women. knowledge and consciousness as to how race, class, and gender 51 represent interlocking systems and a sociohistorical context for that analysis is seen as absent in other feminisms (collins, 1991). radical feminism attributes the oppression of women to men. male power must be analyzed and understood and not reduced to other explanations, such as labor relations. cultural feminism has been critiqued, because it provides moral grounding for men to make claims that they cannot help being oppressive. this logic takes a further turn, in that it is then likewise natural for women to be submissive (ferguson, 1996). lesbian feminism focuses on establishing lesbians as a distinct group. much like radical feminism, lesbian feminism sees the male agenda as dominant in the culture at-large (andermahr, lovell, & wolkowitz, 1997). compulsory heterosexuality is challenged by lesbian feminism (rich, 1986). it must be challenged, because compulsory heterosexuality is linked to the oppression of all women. heterosexuality benefits men, in that it reflects male needs and fantasies, it controls women, and is linked to capitalism. liberal feminism focuses on rights for women, as in access to education, the right to vote, and economic independence, citizenship, and other issues of equality (saulnier, 1996). prescribed roles are challenged in that prescriptions lead to inequality. many women benefit from the strategies of liberal feminism and its focus on the public lives of women; however, it has been critiqued for this very reason, in that it does not adequately address private issues, such as child care and poverty, to name a few (saulnier). marxist feminism is focused on the emancipation of women via a concern for the production of labor in family life, as it is concerned with capitalism (andermahr, lovell, & wolkowitz, 1997). mackinnon (1997) stated that, “sexuality is to feminism what work is to marxism: that which is most one’s own, yet most take away” (p. 65). marxist theory sees work as creating our social lives and creating what is of value: work creates who we are. material feminism relies on marxist theory. the focus is on the material conditions of women’s lives and their transformation. a central concern is for women to maintain a socialized and professional household. this could include adequate pay for professional labor related to childcare, cooking, cleaning, and other domestic labors that are often relegated to women (donovan, 1993). socialist feminism is closely related to marxist feminism, radical feminism, and materialist feminism (andermahr, lovell, & wolkowitz, 1997). perhaps a distinguishing point is that socialism distinguishes between groups with regard to oppression and acknowledges that it takes different forms, depending on the context and particulars. socialist feminism in the extreme demands the end of capitalism, property ownership, the emancipation of workers, and the ending of all forms of oppression (evans, 1995). feminists seem to have a love/hate relationship with postmodernism. postmodern feminism is perhaps the most difficult to characterize or define, because it is a story that is incomplete. because postmodernism claims the end of grand narratives and totalizing truths, it is seen as problematic in that it appears blind to the affects of gender in relationship to oppression and the total52 advances in social work 53 izing of women (evans, 1995). at the same time, the rejection of grand narratives opens space for women to redefine “woman.” this discussion of feminist theories is not meant to be complete or serve as a conclusive explanation for any of the theories represented. instead, it is meant to acknowledge the diversity and similarities among feminist theories. the authors also sought to understand feminist theory as explored within the research literature. besides the wide range of authors describing and conceptualizing feminist theory, some authors have strived to apply feminist theory to research agendas or even explore the basic components of feminist theory. we wanted to capture the research activity within our discussion. the next section of the article provides a review of the empirical studies conducted that involve feminist theory empirical studies on feminist theory development a systematic search of the literature was conducted using social science databases of abstracts (psycinfo, social service abstracts, sociological abstracts, social work abstracts). the search used the words “feminist theory” and “research” as keywords or as words found in the abstract of an article. there were 1,174 citations listed using psycinfo, social service abstracts, and sociological abstracts and 12 citations found in social work abstracts. a search was also done using the words: radical feminism, cultural feminism, lesbian feminism, liberal feminism, and marxist feminism. only empirical or theory-focused articles were included; articles that were on the general topic or did not strive to examine feminist theory were not included in this analysis. book chapters and dissertations were not included, as they were not juried materials. of the 1,186 citations, there were only 17 articles that focused on empirical research that applied feminist theory to various settings and three articles that strived to summarize research on feminist theory and an area of practice. table 1 summarizes the 17 articles. the three summary articles were on a feminist perspective on cardiovascular research (mccormick & bunting, 2002), feminist engagement with restorative justice (daly & stubbs, 2006), and the application of feminist principles to therapy (israeli & santor, 2000). the authors found numerous articles that speculated on applications and integration of feminist concepts, but these three articles strived to link empirical work with the feminist principles. we wanted to develop a table that divided the articles according to the eight feminisms described earlier in this article, but the database searches found few or no studies identifying themselves by one of these types of feminism. therefore, table 1 is an alphabetical listing of studies, and any identification by type of feminism is included. the 17 articles show a diversity of applications of feminism. there were no articles found that described a feminist meta-theory. snelling (1999) did strive, using q-sort, to develop different perspectives on feminism but did not discuss the central components of a feminist theory. most articles focused on applying a feminist lens to the various research agendas. for example, chemical dependence recovery (pursley-crotteau, 2001), heterosexist harassment (szymanski, 2006), relationships facing dementia (ward-griffin et al., 2007), the relationship between sisters (mize & pinjala, 2002), or inter-sibling violence lay, daley/a critique of feminist theory 54 advances in social work author sample method findings barns, 2003 six 14 to 15-yearfeminist interpretive women described how old young women research to capture femininity occurs within how women negotiate, the family, within them construct, and resist selves, through mass “the feminine.” media, and through what they wear. ciclitira, 34 women age a semi-structured, a range of diverging 2004 23 to 52 years taped interview with views was given, with discourse analysis of advocacy, sexual free transcripts; the focus dom, and politics as the of study was on pornkey issues discussed. ography and feminist politics. cook, 2006 observed 12 observational field four themes emerged: diversionary notes during or after offenders’ claims about conferences and each conference. self and motive, mothers interviewed 16 as responsible and vulconference nerable, fathers as silent coordinators partners, and community representatives and facilitators challenging or reinforcing hierarchies. denny, ten women a semi-focused women had diverse 1994 (seven women interview of seven views of pro-natalism, alone and three women alone and their experience, power, couples) three women with and control while going partners; the focus through ivf, and how was on understanding these views conform or and interpreting their diverge from radical experiences with infeminism. vitro fertilization (ivf). gentry et 45 african ethnographic four groups were idential., 2005 american women interviews aimed at fied (street women [subat risk for hiv understanding the groups of absolute infection context of women homeless, hustling applying hiv riskhomeless, and rooming reduction strategies. housed] and house participant observation women) as the women and geographical felt their living arrangemapping were also ments were key to hiv done. coding was risk. done using black feminist themes. harnois, 1,619 women focused on multifactor analysis showed 2005 from a 1996 racial feminist theory more educated white womgeneral social using key survey en embraced feminism survey questions answered and gay/lesbian issues; by white and black weaker predictors for black women in structural women embracing feminequation modeling. ism or gay/lesbian issues. table 1: research studies on feminist theory 55lay, daley/a critique of feminist theory author sample method findings hoffman 651 college survey assessing sibling 70% had at least one et al., 2005 students residing violence, parent-child episode of sibling viowith a sibling in interaction, gender, lence, males were more his or her senior and gender inequalities. violent, males favored a year of high school gendered division of and both parents chores more than females. mize & 36 sister teams with a combined the results showed that pinjala, ranging in age feminist/narrative interviewing sisters 2002 from 24 to 85 years theoretical approach in together provides a powof age a qualitative format, erful, creative process the researchers asked a that allows for an imporseries of conversational tant understanding of the questions to biological/ potent mix of anger, love, adoptive adult sisters, competitiveness, and together, regarding their protectiveness that sisvarious perspectives on ters reflect in their historinteractions in their ical views as well as in the original families. the current research interview interaction. pearson, 24 women of color ethnographic interviews women of color did not 2007 in new york city focused on support or see that multicultural or los angeles denial of multicultural feminism was helpful as feminism as dialogue a dialogue; a specific reaand communication son to talk is more among women of color. important, especially when focus is on power and dominance issues. prindville, 30 women holding qualitative data from 33% identified self as 2000 public office in field interviews focused feminist, 40% rejected new mexico on whether they outright the label “femiidentify themselves or nist,” but most favor politheir policy goals as cies and programs profeminist. moting equality. pursley19 women using the feminist staying clean was the crotteau, perspective and social-psychological 2001 grounded theory problem generated from method, women who the data. becoming temwere participating or perant was identified as interfacing with a the process by which the psychiatric-obstetrical women managed to stay clinic within a maternal clean. and infant project in a large southeastern city were interviewed. table 1: research studies on feminist theory (cont.) 56 advances in social work author sample method findings skelton, 22 academic semi-structured oneboth generations of aca2005 women (10 ages hour interviews later demics experienced mas40-50; 12 ages 29recorded with data culinized, organizational 34) in english and reviewed for patterns structures that marginalwelsh universities and themes; themes ized or subordinated were linked to materialthem whether the superist feminism. particivisor was male or female. pants sent ahead a list of proposed areas of discussion that focused on what factors shaped and developed their careers. snelling, 59 women ages 17q-methodological six factors were derived 1999 73 (85% white, 85% study with 50 q-sort from the factor analysis: heterosexual) items reflecting perradical/lesbian/liberal spectives on feminism; antiracist perspective, women sorted four feminist perspective, cards into extreme poshumanist perspective, itions, five cards into conservative position middle positions, and with some anti-feminist six cards in neutral poselements, post-feminist itions. nine women had viewpoint, and nonfollow-up telephone labeled position. many interviews. factor women had q-sorts analysis was done on loaded on more than one data from q-sort. factor. thus, the taxonomic system of feminnism was not yet ready, but the q-sort research was promising. szymanski, 143 lesbian women this survey included harassment and rejec2006 several scales on tion connected to disheterosexist harassment tress in lesbians. and rejection. wang et al., 62 chinese women these women taught women used photo1996 age 18-56 years photo novella (using graphs to show condicameras to show conditions and advocate for tions and issues in their health improvements. villages; this program the main points were to was part of larger comempower women, munity empowerment increase knowledge on program. no research health status in rural methodology was used communities and influin this article, just ence policymakers on the anecdotes. greatest needs. these authors advocated that the program reflects a feminist approach to change. table 1: research studies on feminist theory (cont.) (hoffman et al., 2005) were foci of articles cited in this review. the articles seemed to acknowledge feminist theory as important, but mainly as a lens to explore their topic of interest. thirteen studies used qualitative methodology, while four studies used quantitative methodology. the most intriguing part of our review was the findings of the studies. oppression, power and control, harassment, and masculinized environments still occur (denny, 1994; gentry et al., 2005; hoffman et al., 2005; pearson, 2007; skelton, 2005; szymanski, 2006; wang et al., 1996). sometimes oppression is not gender-specific but occurs regardless of gender in supervisory positions (skelton, 2005). many women do not identify themselves as feminist but still advocate feminist principles (prindville, 2000). some women of color do not embrace feminism to be as important as focusing on power and dominance issues (harnois, 2005; pearson, 2007). using feminism as a lens to conduct research allows researchers to explore a better understanding of women’s views and experiences when they face a wide range of issues (pornography, incarceration, in-vitro fertilization, homelessness, family violence, child rearing, academia, rural communities, dementia). in other words, the use of feminism as a guide in research is a tool that has wide-ranging utility. the greatest disappointment was the dearth of research actually focusing on refining feminist theory. where were the studies that asserted the crucial components of feminist theory or sought to empirically test those components? where were the studies that sought to add the additional confirmation of existing feminist theory? we recognize that there are strong voices of post-modernist view that would say that empirical research is not required to value a theoretical discussion. we readily acknowledge that there is utility to the numerous articles that discuss feminism. however, we recognize that post-positivist advocates are also valuable and that empirical research is a part of a collective discussion of feminist theory. we were surprised by the absence of critical scholarship on feminist theory development. 57lay, daley/a critique of feminist theory author sample method findings ward-griffin 15 mothertwo individual four types of relationet al., 2007 daughter dyads interviews “guided ships (custodial, combatfacing dementia by socialist-feminist ive, cooperative, cohetheory.” sive) connected with emotion focus and resource provision. wilson, 2004 4 social workers single, indepth interthree dominant themes views with each worker, emerged from the interand feminist discourse views. they were “control analysis was chosen as and perfection,” “femithe method of text interninity,” and “self-destrucpretation. tion/self-preservation.” table 1: research studies on feminist theory (cont.) implications for social work feminist theory and social work practice bergh, 1995). feminist principles are presented as a challenge to privilege. who benefits from privileges that serve as barriers to quality of life for certain groups who bear social cost is a question that feminist social workers raise as an affront to dominance. feminist theories are presented as a threat to the dominant social order (saulnier, 1996). feminist social work practitioners rely on theory to challenge the pathologizing discourses about women, inequalities, and oppression. practitioners are asked to critically examine feminist theory in order to provide a suitable fit for a broad range of problems experienced by women (saulnier, 1996). van den bergh (1995) identified principles or ideas for feminist social work practices that are specifically related to postmodernism. she views postmodernism as an epistemological framework. first is “partnerships rather than domination” (p. xv). this calls for relationships that build community. practices that support hierarchy give rise to false dichotomies—a practice “inherent in sex role stereotyping” (p. xvi). second, “local rather than universal truths” (p. xvii) foster partnerships in knowledge construction. knowledge production is the result of reflection and collaboration. third, the local construction of knowledge has specific implications for social work interventions. cultural meanings provide the context for social work practice. fourth, feminist social work calls for a “critical mass” (p. xvii) around situations requiring social change. “establishing community meanings” (p. xviii) or a group of people who share similar realities constitutes a critical mass in order to address social concerns within a network of support. and, fifth, van den bergh (1995) identified the deconstruction and reconstruction of knowledge. deconstruction is utilized to uncover knowledge “phallacies” (p. xix) by recovering knowledge that has been decentered by grand theories. reconstruction refers to a restorying of knowledge that allows for the inclusion of marginalized voices, resulting in a more inclusive story. next, van den bergh (1995) asserted the importance of socially constructed knowledge. she pointed to feminists’ concern with consciousness-raising as a form of knowledge production, which includes the life experiences of women. voice—naming reality is empowering, which brings forward the importance of her last identified idea for social work practitioners—the “link between knowledge and power” (p. xxiii). she linked those who control society with those who are privileged to establish what is known. it is crucial for social workers to make space for voices that have been marginalized by hierarchies of expertness in order to have a voice. the challenge of third-wave feminism claims is to go beyond rights and equity, although these are notable challenges in a global world. the post-structuralist agenda, articulated 10 years ago, is to “remain aware of the complex ways that power, oppression, and resistance work in a media-saturated global economy so that what at first glance looks like progress might not be the change we most need, and what looks like regression might be progressive” (heywood & drake, 1997, p. 23). 58 advances in social work pollio (2000) advocates for three principles of practice: understand the social context of the individual as including personal, political, and historical factors; include the strengths and experiences that women in oppressed populations have, and recognize that political correctness can be a form of oppression. pollio cautions against focusing on labels rather than respecting each person’s individual uniqueness. israeli and santor (2000) review the basic components of feminist therapy, including empirical evidence of the effectiveness of each component. they see the basic components as consciousness raising, social and gender role analysis, resocialization, and social activism. promoting feminist principles for social work practice is a critical priority for the future. women face issues of equity related to economics, poverty, healthcare, childcare, and so forth. the analysis of these issues must also include race, ethnicity, socio-economic status, and how these play out on a global landscape. strategies to create a practice framework that empowers and honors women are the challenge for the future. the research reviewed in the article indicates that oppression and masculinized environments still occur. social work must take the lead in the advocacy and service needed for these issues. feminist theory and research initiatives social work scholarship often feeds advances in social work practice technology. currently, there are many scholars discussing and conceptualizing feminist theory as it applies to practice principles, policy initiatives, and as a lens when conducting research. virtually no scholars are testing feminist theory to move the theory from discussed theory to confirmed theory. no scholars are refining feminist theory, describing the components of the theory, and showing empirical evidence that demonstrates that the components fit together as hypothesized. no scholars are either advocating for one meta-theory of feminism or showing why multi-cultural feminist theory is different from radical feminist theory. in summary, the absence of theory development work is stunning. what should happen? journals that specialize in feminist issues should begin a series of special issues on feminist theory development. perhaps a special issue for each type of feminism would be helpful. scholars with expertise in theory development should prioritize feminist theory. methodology critics should apply the same scientific rigor to feminist theory as they would any other theory. scholars should collaborate, by developing multi-site projects with diverse populations and central research agendas. debates should rage about how to honor the feminist view while still demanding scientific rigor. the attention, energy, and findings of these multiple efforts would prompt significant advances and clarity to feminist theory. advocacy work and practice guidelines would continue and be informed by the scholarship. conclusion this article has explored the diversity of views on feminism and how researchers have applied feminist theory as a lens to conduct their research. our review of the feminist literature uncovered more than a dozen textbooks and more than a thou59lay, daley/a critique of feminist theory sand literature citations. much discussion and conceptualization about feminist issues appears in the literature, especially on the importance of advocacy and empowerment. however, there is scant empirical research on feminist theory and only one article focusing on feminist theory itself. no articles were found that sought to define feminist theory, then tested the components of the theory. feminism as a movement and advocacy issue is vibrant, diverse, and wide-ranging. feminism as a focus within social work practice is often discussed and a complex issue to incorporate into practice principles. with the conditions of oppression, lack of power, or lack of control, a male-dominated culture still exists. projects that identify, expose, and remove those conditions are still being developed (see for example, the creative use of photographs in the hands of poor rural chinese women as collating evidence of conditions and advocating for change as described in wang et al. [1996]). research informed by feminist views continues to enlighten us on a very diverse set of conditions from pornography, to dementia, to diversionary conferences. the challenge for the reader is to be a discontent consumer. there are many avenues for learning about feminism, and the importance of advocating for feminist principles is more important today than 10 years ago. the mission for social workers is increasingly vital to the welfare of women and society in general. however, the reader should also be discontent, as scholars need to prioritize basic theory development research on feminist theory and ensure that our research leads to evidence-based practice guidelines. the lack of scholarship hampers getting the best answers to the reader regarding applying feminist theory to practice. we only hope that the next 10 years show a renaissance of academic rigor with scholarly articles as outcomes. time will tell. references andermahr, s., lovell, t., & wolkowitz, c. (1997). a concise glossary of feminist theory. london: arnold. barns, a. (2003). social work, young women, and femininity. affilia, 18(2), 148-164. chinn, p.l., & wheeler, c.e. (1985). feminism and nursing: can nursing afford to remain aloof from the women’s movement? nursing outlook, 33(2), 74-77. ciclitira, k. (2004). pornography, women and feminism: between pleasure and politics. sexualities, 7(3), 281-301. collins, p. (2000). black feminist thought: knowledge, consciousness, and the politics of empowerment (2nd ed.). new york: routledge. cook, k.j. (2006). doing difference and accountability in restorative justice conferences. theoretical criminology, 10(1), 107-124. denny, e. (1994). liberation or oppression? radical feminization and in vitro fertilization. sociology of health and illness, 16(1), 62-80. donovan, j. (1993). feminist theory: the intellectual traditions of american feminism. new york: continuum. duran, j. 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(2004). beyond psychiatry: how social workers conceptualise women and self-starvation. australian social work, 57(2), 150-160. author’s note: address correspondence to: kathy lay, ph.d., school of social work, 902 west new york street, indianapolis, in 46202-5156, usa. e-mail: klay@iupui.edu. 61lay, daley/a critique of feminist theory aisw vol. 5, no. 1 33 effectiveness of admission criteria on student performance in classroom and field instruction m. thomas roseanna mccleary patricia henry abstract: this study examines the effectiveness of admission criteria on graduate student performance in classroom and field instruction in a new msw program. graduate applicants’ undergraduate gpa, gre, and total weighted admission score consisting of four items were gathered. these were correlated with their classroom and field instruction performance. findings reveal that gre, undergraduate gpa, and total weighted admission scores are significantly correlated with their classroom performance. end of first year cumulative gpa and human service experience were identified as significant predictors of field performance. implications of these findings for social work educators and graduate school programs are discussed. keywords: admission criteria, classroom performance, field instruction performance social work educators and administrators shoulder the paramount responsibility of selecting the most suitable candidates for graduate social work programs and providing students with the best education and training. in this process, they play a vital role as gatekeepers of the profession, thereby, assuring the public and the professional community of the highest standard in professional practice. admittedly, recruiting appropriate graduate applicants who demonstrate an aptitude and commitment to professional values is élan vital for social work programs. however, this remains an area that has not been adequately researched (glenmaye & oakes, 2002; miller & koerin, 1998). social work educators struggle to design effective admission criteria. although there is no consensus regarding admission criteria in graduate schools across the nation, a combination of factors are utilized by most schools in the admissions decision-making process. undergraduate grade point average (gpa), scores from the graduate record examination (gre), work experience, personal statements, reference letters, and academic potential are some of the factors considered by social work schools when admitting students into programs. some scholars have m. thomas, ph.d. is assistant professor, roseanna mccleary, ph.d. is assistant professor, and patricia henry, msw, lmsw is the field education coordinator at the department of social work at california state university bakersfield, bakersfield, california, 93311-1099. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 33-46. indiana university school of socialwork. 34 advances in socialwork argued that the selection criteria used to recruit social work students is often invalid given the kind of tasks they are called upon to perform later in their practice.these critics point out that the admission procedures in early social work programs are modeled after the selection process of math, psychology, sociology, medicine, law, and nursing (wodarski, 1979). furthermore, the use of the gpa and gre as predictors of academic success has also been questioned by some researchers (donahue & thyer, 1992; duehn & mayadas, 1977; sampson & boyer, 2001) on the grounds that their relationship to professional performance has not been empirically established. critics also argue that personal statements, interviews, and reference letters that lack standardization and predictive powers often reflect what students think social work schools are looking for. these criteria seldom predict the skill level and competency required for professional social work practice. against this backdrop, duehn andmayadas (1977) have proposed a competency-based program with specific entrance and exit requirements for social work programs. social work literature on the effectiveness of admission criteria on student performance in classroom and field instruction or the predictive power of these criteria on the graduate students’ success in later practice has not historically attracted adequate research interest. however, there has been some effort in the 1970s and 1990s as evidenced by the review of literature. some of these studies have focused their attention on the suitability and reliability of using certain admission criteria and its impact on student performance (constable, 1977; donahue &thyer, 1992; glenmaye & oakes, 2002; miller & koerin, 1998). the link between pre-admission data, classroom, and field instruction (pelech, stalker, regehr & jacobs, 1999), problems with using undergraduate performance alone as admission criteria (moxley, moxely & najor-durack, & dumbrigue, 2000), and the need for establishing suitability criteria (cole, 1991) have also been examined. a review of literature revealed that there have been some efforts particularly in the 1970s and 1990s in understanding the influence of the admissions process on graduate students’ success later in their practice.while some studies have focused on predictive factors that lead to success in the classroom, others have focused on the relationship between those factors and field performance. very few studies exist that examined the relationship between the admissions process and classroom and field performance particularly of foundation year graduate students. this study highlights the significance of this area and contributes to the existing knowledge in the area of admission criteria and foundation year graduate student performance.the purpose of this studywas to examine the effectiveness of admissions criteria on student performance in classroom instruction and field practicum in a relatively new graduate program in a public university in california. this research focused on the following three research questions: 1. do students who are rated high in admission criteria items such as undergraduate gpa and gre and overall weighted average, also score high in their first year msw courses and field practicum? 2. do students who perform better in classroom instruction also perform better in field instruction? 35thomas et al./effectiveness of admission critria on student performance 3. are these outcomes the same for different cohorts such as full-time, parttime, first year and second year msw students? review of literature glenmaye and oakes (2002) describe the program admissions process in departments and schools of social work as “... one of the least studied components of social work education” (p. 67). yet, dunlap, henley, and fraser (1998) state, “admissions decisions are among the most important decisions made in schools of social work” (p. 455). a review of existing literature reveals an inconsistent and fragmented relationship between admissions criteria and student performance in social work programs. findings among studies done over the past 30 years are mixed, even when the same or similar variables and methods are used (pelech, stalker, regehr, & jacobs, 1999). the following are examples that illustrate the current state of the admissions process in social work education. pfouts and henley (1977) describe a multivariate predictive index of student field performance that can be used as an admission tool in graduate social work programs. these researchers attempted to construct an index that would enhance the ability of the admissions process to select candidates who would perform well as practitioners. the results of a factor analysis identified four factors, which were then used as independent variables in a stepwise regression analysis. these factors were: the student’s potential for graduate school, experience in post-college paid employment, the student’s gender, and the quality of undergraduate school. these background variables used as predictors together explained 38.6% of the variation in the field performance. of these, student potential for graduate school contributed the most to the prediction of student field performance followed by paid work experience. in a similar study, dunlap (1979) reviewed predictors of student performance using the following criteria: undergraduate grade point average (gpa), graduate record examination (gre) score, length of prior social work or related experiences, andwhether or not the student had an undergraduate degree in social welfare. a student interview and letters of reference were also quantified and used as predictor variables. the student’s graduate school gpa and a quantitative faculty rating on his/her “professional potential” were used as the dependent variables. usingmultiple discriminant analysis, dunlap found that the best predictor of student performance was the faculty interview, with undergraduate gpa being a moderate predictor, and gre score and letters of reference serving as weak predictors. thedunlap’s study had been called into question byglisson andhudson (1981) primarily on statistical and methodological grounds. these critics have argued that there is a serious statistical flaw in trying to predict academic performance and professional potential of social work students with faculty interviews and undergraduate grade point averages. despite these limitations, this study has been applauded by these critics as a groundbreaking endeavor in understanding the effectiveness of admissions criteria in predicting the potential of student applicants. 36 advances in socialwork using yet another dependent variable to define student performance, dunlap, henley and fraser (1998) looked at the relationship between admissions criteria (previous social work experience, undergraduate gpa, and gre score) and msw students’ scores on a pre-graduation comprehensive examination. the authors ran a blockwise multiple regression of exam scores using the background variables of age, gender, and race as covariates. total gre score and undergraduate gpa emerged as useful predictors of good performance on the comprehensive examination. this conflicts with dunlap’s (1979) finding of gre score being a weak predictor, yet supports the finding of undergraduategpa as amoderate predictor. donahue and thyer (1992) focused on the gre as part of the admissions process for msw students. predictive validity of the gre has been studied in a variety of graduate programs (e.g., house & johnson, 2002) with positive results. however, studies that focus on this topic using minority graduate students’ academic performance report negative results (milner, mcneil & king, 1984; sampson & boyer, 2001). donahue and thyer (1992) challenged the validity of a portion of the gre—the reading comprehension sections. narratives for a set of multiple-choice questions were blanked out and students were asked to guess an answer from the five choices. it was expected that students would be correct 20% of the time due to chance. results showed an average correct response rate of 36%, significantly higher than what was expected. the authors then calculated a correlation between these scores and the verbal component of the students’ actual gre score and found a statistically significant correlation. this poses questions regarding the strength of the gre’s content validity and supports dunlap’s (1979) and milner, mcneil and king’s (1984) findings. pelech, stalker, regehr and jacobs (1999) took a different approach to identifying predictors in the admissions process. faculty members teaching in an msw programwere asked to identify a group of students who experienced problems in four areas (placement breakdown, extended practicum, poor academic performance, and problems with interpersonal relationships) and admissions data for these students were examined. multiple regression analysis was done using this group of students and a group of randomly chosen students from those whowere not identified. this study supported the finding that undergraduate gpa predicts subsequent academic achievement in an msw program. an additional finding revealed a negative relationship between age and prior social service experience and academic performance. the authors noted that students who had extensive social work experience might return to school with a false sense of competence. the facultymembers involved in the admission decision-making process are as important as the applicants’ background information. dailey (1979) examined the validity of admission predictions, including the role of faculty members as admission decisionmakers. the study compared the faculty’s admission decision to student outcome measures of classroom performance and field performance separately. interestingly enough, classroom faculties were able to predict both classroom performance and field performance at statistically significant levels. on the other hand, field instructors were only able to predict classroom performance and not field performance. 37thomas et al./effectiveness of admission critria on student performance miller and koerin (1998) and moxley, najor-durack and dumbrigue (2000) emphasized the importance of using nonacademic criteria in the admissions process. in an exploratory study that looked at the use of nonacademic admissions criteria, miller and koerin (1998) mailed surveys to accredited msw programs. qualitative questions were included in the survey to explore respondents’ views on what constituted appropriate indicators of applicant suitability for a social work program. they concluded that while the majority of study respondents did use nonacademic admissions criteria in their programs, they reported similar problems in screening that had already been identified in previous articles that focused on admissions criteria and gate-keeping. improvement in assessment of student suitability and a model for this process was suggested. moxley, najor-durack and dumbrigue (2000) focused on nontraditional students and the need to develop alternative strategies to account for differences among this group. using adult learning theory, the authors support the need to devise strategies for nontraditional students who may not have the level of academic credentials to meet admissions criteria to an msw program. these strategies involved institutional commitment and planning, support for applicants during the admissions process, and helping them with the transition from applicant to student. methods data for this study were collected from several sources. these sources included a survey questionnaire for graduate students admitted to the program in 2000 and 2001, pre-admission student information from admission files, quarterly field instruction evaluation files maintained by the field education coordinator, end of first year gpas of full-time and part-time students, and the current cumulative graduate gpa of all students, including advanced standing students from the admissions and records office of the university. the study was conducted among graduate msw students in a california public university. the program began admitting students in 2000 and was recently accredited by the cswe. currently, there are 87 full time and part time students in the program. graduate students (n=68) admitted to the program in fall 2000 and 2001 were asked to voluntarily complete a survey questionnaire that consisted of demographic information.the pre-admission information gathered included such admission criteria as the undergraduate gpa (ugpa), gre score, and total weighted admission score of four items as rated by two faculty members. these items included: intellectual and academic potential (ugpa, gre, and conceptual ability, problem-solving ability, writing skills, creativity, and academic skills as demonstrated through personal statement), relevant human service experience (length, demonstrated success and quality of the work experience), leadership potential (social work values, communication skills, initiative, and interpersonal skills), and quality of reference letters (the appropriateness and nature of endorsement). two faculty members rated each application on the above four items. these items were rated on a scale of 1 to 10, with 1 being “unacceptable applicant” and 10 being “outstanding applicant.” thus, each applicant can get a maximum of 40 points from each rater, totaling 80 maximum points. 38 advances in socialwork although the points for all items were the same, the relative weight for these items in the overall score were different. based on experience, knowledge, and information from the social work literature, faculty raters assigned weights for each of the four criteria. intellectual and academic potential were rated 50%, human service experience and leadership 20% each, and quality of reference letters was rated 10%. the item-scores on each student by two faculty raters were then transferred to a percentage scale based on the above relative weight. thus, the score obtained is the “total weighted admission score.” the scoring instrument has neither been pre-tested nor has it been tested for reliability and validity. the cumulative gpa of full time students admitted in 2000 and 2001, the current cumulative gpa of third year part time students, and second year part time students were also collected. to assure the accuracy of comparisons between cohorts andwithin each cohort, the end of first year gpawas also calculated. this does not include five advanced standing students and, hence, the sample size for this variable was reduced to 63. the research team decided to use both the end of first year cumulative gpa and current cumulative gpa, as it represents a student grade reflecting their performance in the classroom. the evaluation of field instruction was carried out every quarter, and the content of the evaluation forms were different for foundation field practicum and concentration practicum. the field instructor and the faculty field liaison conduct the evaluation jointly. because of this collaborative evaluation process, the possibility of increasing subjectivity in the evaluation needs to be recognized and, therefore, findings should be interpreted with caution. for the foundation field practicum, the evaluation contains the following major areas: (a) illustration of development of professional self, (b) social work values and ethics, (c) microlevel assessment skills, (d) micro-level intervention skills, (e) communication skills, (f) macro-level assessment and intervention skills. each of these areas has several items as subcategories. the illustration of the development of professional self was one of the categories that was defined as: (a) demonstration of professional self demeanor, (b) demonstration of independence and initiative, (c) selfevaluation of performance, (d) effective use of supervision, and (e) commitment to life-long learning. each of these subcategory items is structured on a progressive skill assessment grading rubric ranging from 1 to 5, much like a likert scale where one indicates the lowest performance in that area and five the highest performance in the area. table 1 illustrates an example of the grading rubric. students need to earn a minimum of 75 points out of a possible 90 points to pass the foundation field practicum. in the second year, students chose an area of concentration that included children and family services and health and mental health. for concentration field practicum, the students are evaluated quarterly in the following areas: relationship skills, communication skills, assessment skills, collaboration skills, intervention skills, social work values and ethics, and development of professional self. each of these areas has several items as subcategories or indicators that define the area of skill and competence. for example, intervention skill has been operationalized as: (a) effectively contracts with client regarding their stated goals; (b) assists reluctant client in the change process; (c) demonstrates flexibility andwill39thomas et al./effectiveness of admission critria on student performance ingness to utilize different roles, methods, and techniques; (d) demonstrates ability to proceed from engagement, assessment, problem identification, goal setting, and intervention to termination and evaluation; (e) demonstrates ability to monitor ongoing intervention process, accepting feedback from clients, significant others, and other professionals; (f) demonstrates case management skills, accepting realities of agency constraints, and serving as client advocate; and (g) intervenes in crisis and professionally helps client to stabilize and links themwith resources. each of these subcategories is structured on a scale ranging from na (not applicable) and a likert scale ranging from 1-5. table 2 provides an example of this. students can earn a maximum of 190 points, and they need 152 points (80%) to pass the field practicum. the actual points they earned were converted into percentages to facilitate comparisons. a sample rating scale in shown intable 2. the percentage points students gained during foundation and concentration practicum years are considered representative of their performance in field instruction. since there were items in the likert-type scale not rated by field evaluators due to the not-applicable nature of those areas in their learning opportunity, the entire field practicum performance points were recalculated based on items actually rated jointly by the evaluators. accordingly, percentages were calculated based on items actually rated. this procedure was adopted in order to assure the accuracy of the field instruction outcome. furthermore, there were three academic quarters of field practicum in the foundation year and similarly three academic quarters in the concentration year. since some data weremissing in the fall quarter, which happens to be the beginning field practicum quarter for full time students, the winter and spring quarterly evaluation were selected for analysis. additionally, mean field instruction scores for winter and spring quarters were calculated for foundation-year students and concentration-year students. thus, both foundation and concentration year percentage point scores were gathered. study participants a description of the demographic profile of the students is important to better understand their commitment and performance in the social work program. professional selfprogressive rating scale rubrics development 1 2 3 4 5 1.demonstraappears occasionally appears usually consistion of probored, appears interested completes tently fessional passive, interested, and the respondemeanor fails to assertive motivated. assignsible, and maintain and calm calm and ments poised poise, only under poised with with poise even under unable to routine exceptions and control. extreme plan work. conditions. to high very conditions. easily overstress motivated. highly whelmed. situations. motivated. table 1: sample rating scale from quarterly foundation field instruction evaluation 40 advances in socialwork insights into their demographic profiles may help us understand who they are and how they perform in the classroom and field instruction. the study participants’ age ranged from 23 to 64 years and themean age was 39.5 years. more than four-fifths (84%) of the students were females and the rest were males (16%). regarding their ethnicity, the data further indicated that 57% of the students were white, 18% african americans, 22% hispanic/latinos and the remaining were pacific islanders and others. furthermore, the study participants came from various types of family backgrounds: 41% were married, 38% were single, 16% were divorced and the remaining 5%were separated or had other types of family structure. more than half (52%) were working in full time jobs, 19% in part time jobs, and 31%did notwork and had full time commitments to the program.themajority (54%) worked in public/governmental agencies. data analysis the data were analyzed using spss® version 10. descriptive data analysis and inferential data analysis were performed in order to answer the research questions under study. the study examined the demographic characteristics of the students in order to gain insight into students’ broader social context. for this, descriptive analyses of selected variables such as age, gender, ethnicity, employment and family background, were performed. the study also tested for possible correlations between admission criteria (gre, ugpa, total weighted admission score), student performance in the classroom (using current cumulative gpa and end of first year gpa) and field instruction performance (using two-quarter field instruction mean percentage scores). it was assumed that the graduate cumulative gpa and the field instruction score would be good indicators of student perintervention skills rating scale 1. effectively contracts with clients na no opportunity to judge regarding their stated goals 1 fails to meet expectations 2 meets expectations some of the time 3 consistently meets expectations 4 exceeds expectations some of the time 5 consistently exceeds expectations 2. demonstrates ability to monitor na no opportunity to judge ongoing intervention process, accepting feedback from clients and other professionals. 1 fails to meet expectations 2 meets expectations some of the time 3 consistently meets expectations 4 exceeds expectations some of the time 5 consistently exceeds expectations table 2: sample rating scale from quarterly concentration field instruction evaluation 41thomas et al./effectiveness of admission critria on student performance formance in the program. in order to ascertain the relationship between admission criteria and students’ performance in the classroom and the field, pearson’s correlation test was used. further analysis was performed to examine the difference in outcome for part time students and full time students as well as for students admitted in 2000 and 2001. in order to compare group differences, t-tests were used. a step-wise linear regression analysis was used to identify the predictors of student performance in field instruction. findings admission criteria and classroom performance the total weighted admission score was an important criterion taken into consideration in admitting students to the program.two facultymembers rated each applicant on four items. the total admission score, which was representative of admission criteria, consisted of intellectual and academic potential, relevant human service experience, and leadership potential and quality of reference letters. the mean score of these items were calculated based on both the raters' evaluation and a two-tailed pearson’s correlation test was run. among these four items, only intellectual and academic potential significantly correlated with end of first year cumulative gpa (see table 3). the study further found that the gre score correlated with total weighted admission score and the relationship was statistically significant (r=.353; p<.003). similarly, higher undergraduate gpa was significantly associated with the total weighted admission score (r=.404; p<.001). it is important to note here that gre and undergraduate gpa were factors considered under “academic potential” whichwas one of the four items in calculating the total weighted admission score. the correlation between gre and undergraduate gpawas statistically significant but relatively weak (r=.293). the current cumulative graduate gpa includes gpa of students graduated in 2002, current full time and part time second year, current part time third year and advanced standing students who were at various stages of study in their msw program. due to this variation, correlation of this variable with other variables needs to be considered with caution when making comparisons within and between groups. hence, the end of first year cumulative gpa for full time and equivalent cumulative gpa for part time students was calculated. this was based on one-year full time equivalent of courses taken by part time students. the data showed that end of first year cumulative gpa significantly correlated with gre (r=.266; p<.03) and ugpa (r=.411; p<.001). admission criteria and field instruction performance themean field instruction performance score for all graduate students was 88.44 with a standard deviation of 9.50. the admission criteria and field instruction performance were also tested for possible correlation using pearson's two-tailed test. the admission criteria items (academic potential, work experience, leadership and references) and the field instruction performance were tested for possible relationships using a pearson's correlation. as can be seen from table 3, both 42 advances in socialwork human service experience (p<.002) and quality of references (p<.002) were significantly correlated with field instruction performance. the data show that the total admission score significantly correlated with student performance in field instruction (r=.333; p<.008). similarly, we found a relatively strong and significant correlation between the current cumulative graduate gpa and student performance in field instruction (r=.542; p<.0001). similarly, the end of first year gpa had a significant correlation with first year field instruction performance (r=.573; p<.0001). however, undergraduate gpawas not significantly related with field performance. the gre yielded a weak correlation with field performance (r=.224) that was not significant at .05 level. it should be noted here that the gre and undergraduate gpa were factors in calculating the total weighted admission score. although individually these were not correlated with field instruction performance, the total weighted admission score was associated with student performance in the field. several factors considered in the admission process and the end of first year cumulative gpa were positively correlated with the field instruction performance. linear regression analysis using a stepwise method was used to identify the predictors of field instruction performance. undergraduate gpa, gre, academic potential, leadership potential, human service experience, quality of reference letters, and end of first year cumulative gpa were used as independent variables. the first year field instruction performance score was treated as the dependent variable. only the end of first year cumulative gpa (β=.502***) and human service experience (β=.329**) emerged as significant predictors. these variables combined accounted for 47% of the variance in field instruction performance (adjusted r2=.407). group comparisons the differences in admission criteria mean scores (such as gre, ugpa, and total weighted admission score) of full time and part time students admitted in 2000 and 2001 were compared as shown in table 4. it is important to note that mean gre score dropped for full time students in 2000 from 1433.85 to 1226.19 for full time students in 2001. similar drops in mean scores for full time students admitted in 2001 were observed in total admission scores, field instruction scores, and current cumulative graduate gpa. variables end of first year field instruction cumulative gpa performance intellectual/academic potential .573*** .209 human service experience .122 .377*** leadership potential .005 .189 quality of reference letters .222 .376*** ***p<.001 table 3: bivariate correlation of admission criteria items with end of first year cumulative gpa and field instruction performance (n=68) 43thomas et al./effectiveness of admission critria on student performance in order to test whether full time students differ significantly frompart time students on any of the above items, a comparative analysis of group mean differences of gre scores, ugpa scores, total weighted admission score, and current cumulative gpa was performed. the results did not yield any significant group differences. similarly, t-tests were run on these items for students admitted in 2000 and 2001. table 5 summarizes the results. the data show that these two cohorts differ significantly on current cumulative graduate gpa (t=2.59; p=<.01). findings do students who were rated high in admissions criteria items also score high in their first year msw courses?with regard to this first research question the study found that out of the four items that constituted the total weighted admission score, only academic potential significantly correlated with the end of first year gpa. the other three items did not translate into classroom performance of graduate students. although these results cannot be generalized due to the small sample size, these findings suggest that social work programs and admission procedures may want to pay more attention to intellectual and academic potential. admission year 2000 admission year 2001 areas full time part time full time part time gre mean score 1433.85 1233.24 1226.19 1246.50 ugpa mean score 3.24 3.19 3.24 2.95 total weighted 87.30 86.58 84.78 89.33 admission score field instruction 91.15 89.94 85.05 89.33 score current cumulative 3.71 3.69 3.58 3.40 graduate gpa table 4: mean comparison of gre, ugpa, total admission score and field instruction score (n=68) items 2000 2001 mean t-test t-test admission admission difference significance values mean mean gre 1316.71 1222.65 94.06 .171 1.38 total weighted 86.87 86.27 .60 .76 .29 admission score undergraduate 3.22 3.1 .10 .33 .96 gpa current cumulative 3.7 3.4 .23 .01** 2.59 graduate gpa field instruction 90.47 86.61 3.86 .10 1.65 performance score **p<.01; ***p<.001 table 5: admission criteria and performance differences between students admitted in 2000 and 2001 (n=68) 44 advances in socialwork the study further found a significant relationship between gre, ugpa, total weighted admission score, and end of first year gpa. clearly, students’ performance in the gre and their undergraduate success translates into academic performance in the first year graduate program. as evidenced by the correlation statistics, the undergraduate gpa showed the strongest relationship with graduate students’ performance in the classroom. this is also consistent with the findings of dunlap, henley and fraser (1998), where gre and ugpa were predictors of graduate performance. with regard to the correlation between undergraduate gpa and end of first year graduate gpa, our study also confirms similar findings by pelech, stalker, regehr and jacobs (1999). admittedly, these findings may offer some support for including gre scores and undergraduate grades as part of admission criteria. in spite of the scholarly criticisms leveled against using gre and ugpa as predictors of academic success, evidently, there is merit in using themas part of an effective admissions process.while the support for gre is clear based on this study, the applicants’ success in undergraduate programsmay have accounted for their success in the gre. the second question asked: do students who perform better in classroom instruction also perform better in field instruction? of the four admission criteria, only relevant human service experience and quality of reference letters had a significant, positive relationship with the field performance of graduate students. academic potential did not translate into their field performance. however, the total weighted admission score (combination of four admission items scores) significantly correlated with field instruction performance. this is indicative of the need to give more weight to applicants’ relevant work experience and the testimony of referees in the admission criteria. this raises an important issue concerning the integration of classroom performance with field performance as the profession not only requires social workers to demonstrate skills in empathy, warmth, and establishing relationship with clients, but also necessitates social workers as having an adequate knowledge base as a springboard from which these skills can develop. it is important to exercise caution, once again, regarding the small sample size of the study in generalizing these findings. these findings show that both the end of first year cumulative gpa and current cumulative gpas had a significant and positive relationship with the field instruction performance of students. this suggests that students are able to apply the knowledge and skills acquired in the classroom to their field situations. along similar lines, dailey (1979) found a significant correlation between classroom performance and field performance, indicating some commonalities that are essential for success in both these areas. it is these common factors that should form the basis of any sound admission process in social work. another noteworthy point that does not correspond to common expectations is the absence of a significant relationship between undergraduate gpa and field instruction performance. are classroom and field instruction outcomes the same for different cohorts, such as full-time, part-time, first year, and second year msw students? with respect to this third research question, a significant difference was observed only between cohorts admitted in 2000 and 2001 in terms of current cumulative gpa. it is important to exercise caution in interpreting the results, as there was a larger pool of students in 2001 compared to 2000. moreover, some students who could not cope with the increasing demands of the program dropped out in the first year. this may have left behind a more resilient group of students during 2000, as compared to 2001. interestingly, there was no significant difference between full time and part time students in terms of their gre scores, ugpa scores, total weighted admission score, and current cumulative gpa. results from the regression analysis identified two significant predictors of field instruction performance of graduate students, namely, end of first year cumulative gpa and relevant human service experience. this underscores the significance of considering work experience as an important component in the criteria for admitting students into graduate programs. this finding is consistent with pfouts and hanley’s study (1977) that identified paid work experience as a significant predictor of field performance. demographic data revealed that the mean age of the population studied was 39.5 years. this is reflective of the growing number of non-traditional students seeking msw degrees and suggests that social work programs need to modify their admission criteria and/or provide additional help for the non-traditional applicants. this was also consistent with the findings of moxley, najor-durack, and dumbrigue (2000). with respect to ethnicity, the majority of students were caucasian, although close to a fifth were african-american, and a littlemore than a fifth were hispanic. consistent with the current distributive pattern in other programs, most of the students in this program were women. although the findings of this study add to the existing literature, there are several limitations in this study that need to be considered. it should be noted that it is primarily a baseline study using a small sample size in a relatively new graduate program in social work. hence, it only provides an empirical base for future theoretical formulations by identifying amatrix of important pre-admission variables associated with graduate student performance in classroom performance and field performance. the relationship between demographic variables and student performance was not explored, as it was not within the scope of this paper. however, it is important to note that demographicsmay also influence successful student learning outcomes. furthermore, in rating student applications, faculty raters have relied on their experience, knowledge, and information from the social work literature in weighting the problem solving ability, leadership potential, and quality of the references. these factors serve as external threats to the generalizability of the study’s findings to other sub-populations. in conclusion, the study reiterates the significance of adopting appropriate admission criteria in selecting suitable students for graduate social work programs. although these findings cannot be generalized for all programs mainly due to the small sample size, these results identify indicators and predictors that are related to the success of graduate student performance in classroom and field instruction. similar studies using large sample size need to be replicated in other settings in order to validate and support these findings. this is an important area of research that would contribute to the establishment of effective admission criteria for graduate social work education. the findings in this short study prompted the admission committee to revise its methodology by adapting the old crite45thomas et al./effectiveness of admission critria on student performance rion and reassigning the numerical weight within each of the variable categories, e.g., gpa, gre, and work experience. undoubtedly, the gate-keeping function of the profession begins with a reliable and valid admissions process, which, in turn, will contribute to the highest standards for the graduates later in their professional practice. references cole, b.s. (1991). legal issues related to social work programadmissions. journal of socialwork education, 27, 18-24. constable, r.t. (1977). a study of admissions policies in undergraduate education. journal of education for socialwork, 13(3), 19-246. dailey, d.m. (1979). the validity of admissions predictions: a replication study and implications for the future. journal of education for socialwork, 15(2). donahue, b., & thyer, b.a. (1992). should the gre be used as an admissions requirement by schools of social work? journal of teaching in socialwork, 6(2), 33-40. duehn,w.d., & mayadas, s.n. (1977). entrance and edit requirements of professional social work education. journal of socialwork education, 13(2), 22-29. dunlap, w.r. (1979). how effective are graduate social work admission criteria? journal of education for socialwork, 15, 96-102. dunlap, k.m., henley, h.c., & fraser, m.w. (1998). the relationship between admissions criteria and academic performance in anmsw program. journal of socialwork education, 34, 455-462. glenmaye, l., & oakes, m. (2002). assessing suitability of msw applicants through objective scoring of personal statements. journal of socialwork education, 38, 67-82. glisson, c.a. &hudson,w.w. (1981). applied statisticalmisuse in educational research: an admissions criteria example. journal of education for socialwork, 18(2), 35-44. house, j.d., & johnson, j.j. (2002). predictive validity of the graduate record examination advanced psychology test for grade performance in graduate psychology courses. college student journal, 36, 32-37. miller, j., & koerin, b. (1998). can we assess suitability at admission? a review of msw application procedures. journal of socialwork education, 34, 437-453. milner, m., mcneil, j.s., & king, s.w. (1984). the gre: a question of validity in predicting performance in professional schools of social work. educational and psychological measurement, 44, 945-950. moxley, d.p., najor-durack, a., & dumbrigue, c.y. (2000). seven strategies for facilitating access of nontraditional students to graduate education in social work. socialwork education, 19, 335-348. pelech,w., stalker, c.a., regehr, c., & jacobs, m. (1999). making the grade: the quest for validity in admissions decisions. journal of socialwork education, 35,c215-226. pfouts, j.h., & henley, h.c. (1977). admissions roulette: predictive factors for success in practice. journal of education for socialwork, 13, 56-63. sampson, c., & boyer, p.g. (2001). gre scores as predictors of minority students’ success in graduate study: an argument for change. college student journal, 35, 271-280. wodarski, j.s. (1979). critical issues in social work education. journal of education for socialwork, 15(2) 5-13. author’s note: address correspondence to: m. thomas, ph.d., department of social work at california state university bakersfield, bakersfield, california, 93311-1099, usa. e-mail: mthomas5@csub.edu note: an early version of this paper was presented at the 49th annual programmeeting of the council on social work education, february 27–march 2, 2003, atlanta, georgia. 46 advances in socialwork aisw vol. 8, no. 1:aisw vol. 5, no. 2 i editorial james g. daley with great pride, we offer this special issue on a critical review of theories of human behavior in the social environment (hbse). the original idea for this special issue stemmed from several simultaneous issues. first, i taught a doctoral class on theory development twice, with three resulting articles (daley et al., 2005; gentle-gennitty et al.; and decker et al. featured in this issue), which indicated that theory critique and advancement was rarely in the social work journal literature. second, the council on social work education (1994) has required that master in social work students should be able to “use theoretical frameworks to understand the interactions among individuals and between individuals and social systems” (p. 137) and that “the professional foundation must provide content about theories and knowledge of the human bio-psych-social development, including theories and knowledge about the range of social systems in which people live” (p. 140). third, there are various textbooks that focus on hbse and discuss different theories (i.e., shriver, 2004; zastrow & kirst-ashman, 2007). fourth, we could not find such a critique in any recent journal. in summary, our profession seemed to require hbse theories for our education; the theories are frequently discussed but not critically evaluated in popular hbse textbooks and such a review is long overdue. we sent a call for papers with five parameters for each manuscript. first, we asked for each author to describe a historical analysis of theory development, including how theory links to hbse. second, we asked that the author clearly describe the components of theory and operationalize the relationship between the variables within the theory. third, we asked that the author provide a discussion of the goals or outcomes intended with theory and the boundaries of the theory. fourth, we required that the author provide a description of empirical studies that have supported and/or progressed the theory. fifth, we requested that each author describe any specific next steps for theory progression and implications for social work. we received a wide range of manuscripts that were diverse in perspective. some articles focused on well-known theories, such as ecological theory or psychodynamic theory. some articles introduced innovative theories that are new to our profession, such as semiotic metatheory or complexity theory. the result is a special issue that is likely to expand any reader’s horizons! there are some cautions to consider. different scholars have developed frameworks for evaluating theories (e.g., fischer, 1973; payne, 2005; turner, 1996; witkin & gottschalk, 1988) and some of those authors would challenge our emphasis on “operationalize” or “empirical studies” as being positivist biased. other authors would probably acknowledge the importance of empirical testing but say that we should have demanded proof that the theory advanced social justice or was ethical or that everything is unique in its own way and cannot be compared to another setting. the arena of theory development is rampant with diverse perspectives of what constitutes a theory, what value any evaluation has, and whether theory progression is a useful term to use. i have had lively discussion in my course on these very topics. each reader must decide for him or herself how much weight to put on empirical validation of the theory. i encourage the reader to see each article as an intellectually stimulating journey into a theory’s framework and credibility. consider how that theory could be incorporated into your professional toolbox of skills. how might this article help you to better understand your client and the context of their actions? then compare and contrast different articles and theories. how could affect control theory (forte) be compared to attachment theory (page & norwood) or kinship ties (hall)? finally, consider, after you have read all the articles, what expansion of knowledge has occurred in you. social work is a broad profession demanding a diverse set of skills. these articles can help you continue to heighten your awareness of the many ways to impact our clients, whether person, family, or community. references council on social work education (1994). handbook of accreditation standards and procedures. alexandria, va: author. daley, j.g., peters, j., taylor, r., hanson, v., & hill, d. (2005). theory discussion in social work journals: a preliminary study. advances in social work, 7(1), 1-19. decker, v.d., suman, p.d., burge, b.j., deka, a., harris, m., hymans, d.j., marcussen, m., pittman, d., wilkerson, d., & daley, j.g. (2007). analysis of social work theory progression published in 2004. advances in social work, 8(1), 81-112. fischer, j. (1973). a framework for the analysis and comparison of clinical theories of induced change. in j. fischer (ed). interpersonal helping (pp. 110-130). springfield, il: charles c. thomas. gentle-gennity, c.s., gregory, v., pfahler, c., thomas, m., lewis, l., campbell, k., ballard, k., compton, k., & daley, j.g. (2007). a critical review of theory in social work journals: a replication study. advances in social work, 8(1), 62-80. payne, m. (2005). modern social work theory, 3rd edition. chicago, il: lyceum books inc. shriver, j.m. (2004). human behavior and the social environment: shifting paradigms in essential knowledge for social work practice, 4th edition. new york: allyn & bacon. turner, f. (ed) (1996). social work treatment: interlocking theoretical approaches, 4th edition. new york: the free press. witkin, s., & gottschalk, s. (1988). alternative criteria for theory evaluation. social service review, 62, 211224. zastrow, c., & kirst-ashman, k.k. (2007). understanding human behavior and the social environment, 7th edition. belmont, ca: thomson higher education. ii advances in social work aisw vol. 8, no. 1:aisw vol. 5, no. 2 104 a lesson on social role theory: an example of human behavior in the social environment theory agnes m. dulin abstract: this paper discusses the social role theory, a theory of human behavior in the social environment (hbse). relevance of this topic is briefly discussed, as well as a definition of the theory and its historical background. empirical research that employs this theory will be discussed. recommendations will be made for future theory development and implications for social work education will conclude the discussion. keywords: social role theory, gender roles, gender stereotypes human behavior in the social environment (hsbe) is part of the foundation curriculum for social work education, according to the council on social work education (cswe) (2004). according to the accreditation and policy standards, “content includes empirically based theories and knowledge that focuses on the interactions between and among individuals, groups, societies, and economic systems. it includes theories and knowledge of biological, sociological, cultural, psychological, and spiritual development across the life span: the range of social systems in which people live, and the ways social systems promote or deter people in maintaining or achieving health and well-being” (p. 9). social role theory appears to fit nicely with the description of hbse, in that it is a theory that focuses on interactions between and among individuals, groups, societies, and economic systems as developed by social systems in which people live. at times, these social systems sometimes promote or deter certain people in maintaining or achieving health and well-being. this paper will attempt to demonstrate how social role theory is appropriate to study in hbse courses. historically, social role theory developed during the 1980s as a genderrelated theory. earlier studies in the 1970s that covered differences between the sexes had been strongly criticized and progress on the topic was slow. since the 1980s, eagly has devoted considerable time to this topic and has published a book in 1987 on the theory: sex differences in social behavior: a social role interpretation. although earlier research had been conducted on agnes m. dulin, lmsw, is a doctoral student, university of houston, houston, tx 77204-4013. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 104-112. indiana university school of social work. 105 sex differences, most had focused on areas, including biological differences and early childhood socialization. eagly thought that “explanations based on the social roles that regulate behavior in adult life” (p. 4) had not been explored and proceeded to show how a theory of sex-typed behavior could explain differences in men and women. at this point, some definitions, as defined by eagly, are needed in order to better understand her theory and reasoning. the term sex is defined, based on biology, as grouping of humans into two categories: male and female. gender is described as meanings that people and society in general assign to female and male categories. eagly used gender roles as a term for the social roles that a society designates to men and women. gender stereotypes are stereotypes that people believe about men and women. sex differences, as defined by some psychologists, make up biological differences, and gender differences embody environmental differences. however, eagly used the term sex differences to denote the differences between males and females on several measures, not just biology. her intent was mostly social psychological, but, at the same time, did not want to exclude biology entirely, since there is no clear consensus on the causes of differences between the sexes. eagly set out to determine whether biology or society determined our behaviors; the same old question: nature or nurture. her thesis was that, “the contemporaneous influences arising from adult social roles are more directly relevant to sex differences in adult social behavior than is prior socialization or biology” (1987, p. 9). what she found was that there was not necessarily an either/or answer but determined that sex roles or social roles are indeed influenced by the society in which we live. social role theory uses a structural approach to sex differences, rather than a cultural approach, in that structural pressures (family, organizations, and communities) have caused men and women to behave in different ways. the perception is that people have a social role based solely on their gender. these stereotypic gender roles are formed by social norms that apply to people of a certain category or social position. social norms, according to social psychologists, are shared expectations about appropriate qualities or behaviors (eagly, 1987, p. 13). according to eagly, “social role theory of sex differences promotes a view of social life as fundamentally gendered, given current social arrangements” (p. 31). in other words, society has shared expectations about women, and these expectations form female gender roles, and shared expectations about men form male gender roles. surprisingly, people tend to do what is expected of them or act the way that these roles imply and, as a result, men and women learn different skills, thus perpetuating sex differences. gender roles are more general and encompass a greater scope of definition of male and female roles. in contrast, social roles are more specific to roles in family and work life. eagly believed that social roles guide our behaviors more than the gender we inhabit. earlier research has shown that most beliefs about the differences between men and women can be divided into two dimensions: communal and agendulin/a lesson on social role theory 106 advances in social work tic. the definitions of these dimensions, preferred by eagly, were actually originated by bakan (1966). agentic qualities are manifested by self-assertion, self-expansion, and the urge to master. agentic qualities are attributed to males more than females. communal qualities are manifested by selflessness, concern for others, and a desire to be at one with others. in contrast, these qualities are attributed to females more than males. eagly used these dimensions to differentiate between males and females in work and family life. eagly proposed that division of labor was the culprit that designated the differences between males and females. division of labor induces gender role expectations and sex-typed skills and beliefs, therefore, producing sex differences in social behavior. for example, young people learn and emulate the roles they see played out by the adults in their lives. they deduce that males are more agentic and females are more communal and, in order to be successful, each conforms to the appropriate roles. social roles are dictated by division of labor, and gender roles tend to reinforce the status quo. eagly and steffen (1984) tested the correlation between gender stereotype and division of labor and found that occupational role was a strong determinant of judgments of communal and agentic qualities. results indicated that, when people did not know the job status (employee or homemaker), women were perceived as more communal and men as more agentic. however, when job status was known, employed men and women were perceived as more agentic and homemakers, both male and female, were perceived as communal. so, those who are in domestic roles were rated as more communal and less agentic than those in the employee role. with more and more women in the labor market since the 1970s and the feminist movement, it is surprising that studies continue to show that there is a tendency to view women with communal qualities and males with agentic qualities (eagly & steffen, 1984). conway, pizzamiglio, and mount (1996) conducted research to test eagly and steffen’s study, comparing job status with agency and communality. they found that low status individuals were rated as more communal than agentic and high status individuals were rated as more agentic than communal, regardless of sex or occupation. these findings imply that communal, which is normally associated with females, is associated with low status positions, so that females are associated with low status jobs. the same implication represents males having agentic qualities, therefore, having high status positions. to test her theory further, eagly and her colleagues conducted research on aggression and helping behavior using social role theory. eagly and steffen (1986) conducted extensive research on aggression by using meta-analysis and found that men are more aggressive than women and that the difference is greater for physical than psychological aggression. results also indicated that men and women think differently about aggression, and this difference could be an important mediator in studying aggression. eagly and crowley (1986) conducted a meta analysis to determine whether there were sex differences in helping behavior. ways of defining “helping behavior” for women, according to social role theory, was, for example, caring for the personal and emotional needs of others and helping others to attain their goals. ways of defining this behavior for men, according to social role theory, might be heroic behavior, altruistic acts that may save others but put their own safety at risk. however, most research conducted on helping has been geared toward the male definition of helping and, as a result, the analysis did determine that men are more helpful than women. eagly suggested more research using other definitions of helping to produce more valid outcomes. more currently, eagly and johannesen-schimidt (2001) presented new data concerning transformational, transactional, and laissez-faire leadership styles using meta-analysis and the framework of social role theory. transformational style includes motivating workers to feel respect and pride, because of their association with the leader. transactional style includes strategies of rewards and self-interests, while laissez-faire style uses a passive form of management until there is a problem. results indicated that leadership style findings from experimental settings tend to be gender-stereotypic. female leaders exceeded male leaders on the female-stereotypic transformational dimensions of motivating their workers to feel respect and pride because of their association with them, showing optimism and excitement about future goals, and tending to mentor and attend to individual needs. females also exceeded males in the transactional dimension of contingent rewards. however, male leaders exceeded females on active and passive management-by-exception and laissez-faire styles, which means that males tend to pay attention to workers’ problems and mistakes, wait until problems become severe before attempting to solve them, and become absent and uninvolved at critical times. the authors indicated that the greater effectiveness of females reflected the negative relationships of the passive management-by-exception and laissez-faire styles to the positive relationships of transformational and contingent reward styles. eagly, karua, and makhijani (1995) conducted an extensive meta-analysis on gender and the effectiveness of leaders. they found that, generally, male and female leaders were equally effective, which can be interpreted as a good thing. however, there was evidence that showed that male leaders were rated as more effective than females when the leadership role was defined in masculine terms, such as ability to direct and control people, and women were more effective when the roles were defined in less masculine roles, such as ability to get along with other people. eagly’s research on social role theory implies that conformity to genderrole expectations is a major source of the sexes’ differing behavior (1987, p. 126). eagly’s intent was to introduce another facet to the mystery surrounding sex differences, to narrow the idea to a simple idea so that it would be possible to produce a “coherent conceptual representation” (p. 4) of a theory about sex differences. eagly intended, not so much to solve the mystery, but to open up another avenue for study on this topic. she hoped that the theory would induce others to test the theory; upholding her beliefs or dispelling them, she did not care. her goal was to increase the knowledge of sex-typed behavior, using this theory and other interrelated theories. 107dulin/a lesson on social role theory 108 advances in social work an outcome of the social role theory is that social roles appear to be dynamic, which is encouraging for men and women alike. diekman, goodfriend, and goodwin (2004), using social role theory, tested whether gender stereotypes are dynamic in that, as women progress in the work world, certain stereotypes disappear or change. this study examined whether this dynamic aspect of gender stereotypes extends to beliefs about power, or whether the gender power hierarchy is perceived as being relatively immutable. the first study examined participants’ beliefs about the power of men and women in the future. the majority of participants (98%) predicted that women would gain power by the year 2050. about half predicted that men’s power would stabilize, and 45% predicted a decrease in power for men. the second study examined the relative gains or losses in power and explored the relationships among perceived power, perceived social roles of men and women, and gender stereotypes. the second study found that male power would decrease only relationally and would maintain power in other areas, such as economic, political, and occupational. the authors also perceived that women would gain in individual and relational power more than economic, political, and occupational power. it appears that stereotypes can be dynamic. others have conducted considerable research using social role theory as a theoretical framework. for instance, forsyth, heiney, and wright (1997) predicted that conservative subordinates would be less satisfied with a woman leader, regardless of her leadership style, compared to liberal subordinates. results support eagly’s analysis that, those who possessed more traditional stereotypes about women, judged women more harshly than individuals whose attitudes about women were less stereotypical. social role theory proposes that women in leadership roles face a dilemma in that, when they are effective leaders, they are judged more harshly and are usually evaluated more negatively than men in the same roles. another work-related study by fuegen, biernat, haines, and deaux (2004) used social role theory to predict that the parenting role, rather than gender, would determine how parents are judged. they set out to determine the influence of gender and parental status on employment decisions. participants evaluated applicants for a job, some being female, male, married, or single. they found that parents were judged less agentic and less committed to employment than non-parents, and those who were male parents were given more slack than female parents and childless males. franke, crown, and spake (1997) used meta-analysis to investigate the role gender plays in the perceptions of ethical decision-making and used social role theory to rationalize gender differences. the authors predicted significant gender differences in the perceptions of what constituted ethical business practices, but these differences would decline with work experience. they found that differences were smaller in samples of individuals with more work experience. however, on average, women show higher ethical standards than men. harrison and lynch (2005) used the theory to test several hypotheses concerning gender role and athletics. the first hypothesis predicted that an athlete’s gender would not singularly influence perceptions of agency and communality. the findings indicated that there were no significant differences in perceived agency and communality of both females and males. the second hypothesis predicted that the type of sport would singularly influence the perceptions of agency and communality because of the influence of athletic roles. findings indicated that, for the communality index, there was a significant effect on the type of sport. an example being that cheerleaders were higher in communality than football players. the third hypothesis predicted that perceptions of agency and communality would be mutually influenced by an athlete’s gender and the type of sport. findings indicated that males and cheerleaders were high in communality, but the type of sport of females did not influence perceived communality. the fourth hypothesis predicted that there would be higher rates of approval for those who played gendered traditional sports. findings indicated higher rates of approval for females who played in male-dominated sports. however, approval rates for males were the same for masculine and feminine type sports. the research consistently supported social role theory, that an athlete’s gender did not significantly affect global perceptions of gender role orientation. in their study, vogel, wester, heesacke, and madon (2003) proposed that emotional vulnerability causes people who are involved in close relationships to adhere to gender roles. previous research had been conducted using participants who were not acquainted. the initial results of this study were consistent with the hypothesis. women’s behaviors stayed consistent, whereas, men exhibited fewer emotionally restrictive behaviors and more withdrawal behaviors when they talked about emotionally difficult topics, which would be consistent with social role theory. as demonstrated above, social role theory has been used in theoretical frameworks for studies about sex differences addressing various issues, such as aggression, helping behaviors, the dynamics of stereotypes, leadership styles, attitudes and effectiveness, parenting, ethical decision-making, athletics, and emotional vulnerability. most of the research upholds the theory’s premise that, in certain social situations, males and females act according to the social norms that originate from a division of labor at work and in the home. however, with any theory, there is always criticism. archer (1996) examined social role theory and evolutionary theory as explanations for sex differences. evolutionary theory attributes most sex differences to the consequences of sexual selection and the conflict that arises with the different reproductive strategies of the sexes. remember that social role theory attributes the division of labor to sex differences. archer concluded that, since evolutionary theory could explain other mammals’ sex differences, that it was a better explanation. eagly (1997) gave a rebuttal to archer’s criticism of social role theory, stating that she never intended for the theory to be an ultimate answer to the puzzle of sex differences. instead, she defended her theory as one of many interrelated theories that, “social scientists have provided [as] an array of interrelated theories, each of which illuminates certain aspects of the 109dulin/a lesson on social role theory complex of psychological and social processes by which gendered behavior is produced” (p. 1382). eagly intended for her theory to be used in conjunction with other theories to better understand the intricacies of males and females. several limitations exist concerning social role theory. one limitation suggested by eagly was that none of the research that she analyzed about sex differences was done in natural settings, and outcomes might have been different. eagly suggested that further research be conducted in more natural settings so that males and females have the advantage of being in their natural roles. how people react to real life situations can be very different from controlled situations or when they are completing surveys. another limitation to eagly’s early research was the way in which she conducted the research, which was by using meta-analysis. there is always the effect-size dilemma of what size is considered to be effective. although eagly was able to review numerous studies on the various topics, there was usually considerable disparity between the outcomes, causing effect size to be less significant. however, more recent research has entailed other forms of statistical analysis. a third limitation with the theory itself may be that it may not be as relevant to today’s culture. monk-turner et al. (2002) conducted a study on altruistic behavior and found no differences between men and women. they suggested that, possibly social role theory is not as relevant as it was in the 1980s, when eagly formulated the theory in that gender roles are not as pronounced or defined as 20 years ago. this suggestion is strengthened by the study conducted by diekman, goodfriend, and goodwin (2004) on the dynamics of gender stereotypes, which was discussed earlier. the next steps for theory progression involve continuing to use it as a theory of sex differences, along with other interrelated theories, to help explain why and what the differences are. as we better learn the differences, then it is possible that conditions and expectations of certain roles will be defined in agentic and communal ways, not exclusively, but inclusively. this knowledge can add to equalizing opportunities for men and women, alike. an important tactic to strengthen social role theory would be to find better measurements of constructs, such as aggression, helping behavior, and others that are difficult to measure accurately for both males and females. the research would be more salient if instruments measured what they were intended to measure. implications for social work education are positive, in that as we learn more about the differences between men and women, we will inadvertently discover more similarities than differences. in working with our clients, just being aware of expected social roles within their environment may help us to work more effectively with them. being cognizant that stereotypes and social roles are powerful tools that most people tend to conform to, whether they realize it or not, is pertinent to all aspects of our lives—our families, our work, and our community. the most powerful tool of this theory is to help us know there should be a continuum of role styles. until we get away from agentic equaling masculine 110 advances in social work and communal equaling female and lean more towards a continuum of agency to communality, stereotypes will not lessen or diminish. as seen in the research by conway, pizzamiglio, and mount (1996), communal qualities are perceived to be characteristic of low status jobs. in other words, there cannot be a continuum if one dimension is perceived as better than another. it is important for social work educators to continue to stress the importance of using communal and agentic qualities in social work. educators should help students find their own style so they can use it as a strength to better serve clients and manage agencies. references. archer, j. (1996). sex differences in social behavior: are the social role and evolutionary explanations compatible? american psychologist, 51(9), 909-917. archer, j. (1997). on the origins of sex differences in social behaviors: darwinian and non-darwinian accounts. american psychologist, december, 1383-1385. bakan, d. (1966). the duality of human existence: an essay on psychology and religion. chicago: rand mcnally. conway, m., pizzamiglio, m.t., & mount, l. (1996). status, communality and agency: implications for stereotypes of gender and other groups. journal of personality and social psychology, 71(1), 25-38. council on social work education (cswe) (2004). educational policy and accreditation standards. http://www.cswe.org. diekman, a.b., goodfriend, w., & goodwin, s. (2004). dynamic stereotypes of power: perceived change and stability in gender hierarchies. sex roles, 50(3/4), 201-215. eagly, a.h. (1987). sex differences in social behavior: a social-role interpretation. lawrence erlbaum associates: hillsdale. eagly, a.h. (1997). sex differences in social behavior: comparing social role theory and evolutionary psychology. american psychologist, december, 1380-1383. eagly, a.h., & crowley, m. (1986). gender and helping behavior: a meta-analytic review of the social psychological literature. psychological bulletin, 100, 283-308. eagly, a.h., & johannesen-schimidt, m.c. (2001). the leadership styles of women and men. journal of social issues, 57(4), 781-797. eagly, a.h., karau, s.j., & makhijani, m.g. (1995). gender and the effectiveness of leaders: a meta-analysis. psychological bulletin, 117(1), 125-145. eagly, a.h., & steffen, v.j. (1986). gender and aggressive behavior: a meta-analytic review of the social psychological literature. in a.h. eagly, sex differences in social behavior: a social role interpretation (128-135). lawrence erlbaum associates: hillsdale. eagly, a.h., & steffen, v.j. (1984). gender stereotypes stem from the distribution of women and men into social roles. in a.h. eagly, sex differences in social behavior: a social role interpretation (pp. 70-95) lawrence erlbaum associates: hillsdale. forsyth, d.r., heiney, m.m., & wright s.s. (1997). biases in appraisals of women leaders. group dynamics: theory, research, and practice, 1(1), 98-103. franke, g.r., crown, d.f., & spake, d.f. (1997). gender differences in ethical perceptions of business practices: a social role theory perspective. journal of applied psychology, 82(6), 920-934. fuegen, k., biernat, m., haines, e., & deaux, k. (2004). mothers and fathers in the workplace: how gender and parental status influence judgments of job-related competence. journal of social issues, 60(4), 737-754. 111dulin/a lesson on social role theory 112 advances in social work harrison, l.a, & lynch, a.b. (2005). social role theory and the perceived gender role orientation of athletes. sex roles, 52(3/4), 227-236. monk-turner, e., blake, v., chniel, f., forbes, s., lensey, l., & madzuma, j. (2002). helping hands: a study of altruistic behavior. gender issues, fall, 65-70. vogel, d.l., wester, s.r., heesacke, m., & madon, s. (2003). confirming gender stereotypes: a social role perspective. sex roles, 48(11/12), 519-528. author’s note: address correspondence to: agnes m. dulin, lmsw, doctoral student, university of houston, 237 social work building, houston, tx 77204-4013, usa. e-mail: agnes.dulin@mail.uh.edu. spring2006-048_page44 spring2006-049_page45 spring2006-050_page46 spring2006-051_page47 spring2006-052_page48 spring2006-053_page49 spring2006-054_page50 spring2006-055_page51 spring2006-056_page52 spring2006-057_page53 spring2006-058_page54 spring2006-059_page55 spring2006-060_page56 microsoft word daley_hassan editorial copyedit bb _______  james g. daley, ph.d., is an associate professor at the indiana university school of social work, indianapolis. anthony m. hassan, ed.d., lcsw, is a clinical associate professor and director at the center for innovation and research on veterans & military families (cir), school of social work, university of southern california. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), i-iv editorial: embracing the diversity of military social work james g. daley anthony m. hassan special issue co-editors this special issue illustrates the wide diversity of the field of military social work. military social work has spanned more than 60 years (daley, 1999; maas, 1951; rubin, weiss, & coll, in press) and social workers were working initially in world war i as red cross staff (harris, 1999). uniformed social work officers serve in the army, navy, air force, coast guard, guard/reserve, and public health service in a wide range of jobs. civilian military social workers work within many social service programs serving the military, veterans, and their families. many countries have uniformed and civilian social workers and programs to aid and care for the military and their families (daley, 2003). despite a diverse range of programs provided by and often developed by military social workers, very little is shared in the professional literature or identified as “military social work.” in recent years, there has been a rapidly growing emphasis on the challenges of military personnel, veterans, and their families. textbooks have begun to multiply, particularly focused on military families (e.g., blaisure et al., 2012; everson & figley, 2011; hall, 2008; martin, rosen, & sparacino, 2000) and on the impact of war (kelly, howe-barksdale, & gitelson, 2011; pryce, pryce, & shackelford, 2012; slone & friedman, 2008). intervention protocols are being suggested (e.g., decarvalho & whealin, 2012; whealin, decarvalho, & vega, 2008). special issues of journals have highlighted military concerns and coping (e.g., smith college studies in social work, 2009) and a chapter on military social work in each edition of the encyclopedia of social work is noteworthy. there have been some significant efforts to sharpen the vision of what military social work is. the council on social work education (cswe) formed a series of committees and developed a guideline called advanced social work practice in military social work that identified competencies in military social work (link to cswe document is http://www.cswe.org/file.aspx?id=42466). the document includes a broad definition of “military social work:” military social work involves direct practice; policy and administrative activities; and advocacy including providing prevention, treatment, and rehabilitative services to service members, veterans, their families, and their communities. in addition, military social workers develop and advance programs, policies, and procedures to improve the quality of life for clients and their families in diverse communities. military social workers provide assistance and treatment in the daley, hassan/editorial ii  transition from military to veteran status, including a continuum of care and services for military personnel and their families (cswe, 2010, p. 2). this special issue strives to further strengthen the public awareness of the complex issues and program initiatives facing our servicemembers, veterans, and their families. nedegaard and colleagues report on the key issues navigated in a multi-national mental health program for troops in afghanistan. van breda outlines the military social work approaches and thinking in south africa. issues of military families are well represented including child-parent relationship training for military families (jensen-hart et al.), single parent issues (blanchard), spousal communication (ponder & aguirre), and building marital resilience (ponder & aguirre). the effects of trauma on military women are explored (osborne et al.). community resources are explored such as a home-based reintegration program for military families (devoe et al.) and building better informed civilian providers of care for military or veterans (luby). veterans issues are well represented with articles on rural veterans (stotzer et al.), developing a student veterans study and helping veterans in academic settings (smith-osborne), assessing ptsd in older veterans (yarvis et al.), and strategies for helping veterans (hazle et al.). beder’s article discusses hospital-based social workers working in military hospitals and the issues of compassion fatigue. whitworth and colleagues outline a framework for teaching military social work in a school of social work. in sum, this special issue provides for the reader a rich sampler of military social work. each area is a portal to understanding a portion of the vast terrain that is military social work. there are other initiatives evolving. the council on social work education (cswe) is seeking to develop a list of schools of social work that have educational content on military social work (ranging from a course to a full concentration in military social work). there have been special panels focused on military social work at cswe’s annual conferences, the society for social work and research annual conferences, and various regional workshops on helping military, veterans, and/or their families. there is a multidisciplinary military and family collaborative called the alliance of military and veteran family behavioral health providers (http://www.ecu.edu/che/alliance/) that is developing suggested resources for clinicians that work with military personnel, veterans, and their families. first lady michelle obama has made military families a priority and developed joining forces (http://www.whitehouse.gov/joiningforces) to support and recognize the issues of military families. in short, the topic has transformed from a benignly neglected field of practice to a hot topic in the country. there are good reasons for the heightened attention. this country has been in a prolonged series of “operations” (e.g., operation iraqi freedom (oif), operation enduring freedom (oef)) that have produced more than ten years of combat with an allvolunteer force. the military demands are delivered by a small proportion of our population (commonly called “the 1%” indicating that only one percent of the population is serving in the military). the november 21, 2011 edition of time magazine called the servicemembers “the other 1%” and defined them as “an army apart.” the basic message is that combat veterans are transformed by the experience and return to face an isolated adaptation in hometowns that are not certain how to relate. further, the national guard and reserve troops have an unprecedented volume and frequency of deployments. unlike advances in social work, spring 2012, 13(1) iii   active duty troops who return to a military base, the guard/reserve often return to small communities naïve to what the military person has been through and insensitive to the struggles the military families have endured throughout the deployment. troops are facing repeated deployments, extension of time on deployments, and loss of civilian jobs when they return home. post traumatic stress disorders, traumatic brain injuries, and suicides have risen in military personnel. the organizations to support and care for veterans are seen at times as a poor fit for veterans with oef/oif issues and identity. some young oef/oif veterans see the veterans administration (va) programs as not geared for their needs. the american legion and veterans of foreign wars organizations are finding many of the young veterans as hesitant to join. young oef/oif veterans have created their own support system in the iraq and afghanistan veterans of america (http://iava.org/). the va has developed special oef/oif programs and separate check in procedures. the va is preparing for the inevitable onslaught as the 2.4 million veterans will possibly seek benefits and care. according to iava, each year 300,000 individuals complete their military service and there is a growing backlog on claims for benefits (http://iava.org/). families of servicemembers and veterans are often stressed and can feel isolated during the deployment cycle (matsakis, 2007; pavlicin, 2003; pryce, pryce, & shackelford, 2012). they are the primary support system and are caught between the servicemember’s struggles and the naïve view of the community. financial strains, the accordion experience of deployments, and monitoring the wellbeing of the children often fall on their shoulders. support systems targeted to military families can range from family support centers to only phone advice depending on their location. when servicemembers transition to veterans, the family struggles with benefits and the servicemember’s new identity as a veteran. often there are few resources targeted for the family within the va system. military social work deals with all the issues described above from individual, to family, to community. servicemembers and veterans rely on our commitment and expertise in creating safety nets for them as they navigate the care systems that are available to ease their challenges. the articles in this special issue are exemplars of efforts to understand and assist servicemembers, veterans, and their families. this generation of veterans needs the help of every social worker and each of us needs to be better trained and savvy to the needs of these veterans. our work has truly just begun. references blaisure, k. r., saathoff-wells, t., pereira, a., macdermid-wadsworth, s., & dombro, a. l. (2012). serving military families in the 21st century. new york: routledge. council on social work education. (2010). advanced social work practice in military social work. alexandria, va: author. daley, j. g. (1999). social work practice in the military. new york: haworth press. daley, j. g. (2003). military social work: a multi-national comparison. international social work, 46(4), 437-448. daley, hassan/editorial iv  decarvalho, l. t., & whealin, j. m. (2012). healing stress in military families: eight steps to wellness. hoboken, nj: john wiley & sons. everson, r. b., & figley, c. r. (eds.). (2011). families under fire: systemic therapy with military families. new york: routledge. hall, l. k. (2008). counseling military families: what mental health professionals need to know. new york: routledge. harris, j. (1999). history of army social work. in j. g. daley (ed.), social work practice in the military (p. 3-22). new york: haworth press. kelly, d. c., howe-barksdale, s., & gitelson, d. (eds). (2011). treating young veterans: promoting resilience through practice and advocacy. new york: springer publishing company. maas, h. s. (ed.). (1951). adventure in mental health: psychiatric social work with the armed forces in world war ii. new york: columbia university press. martin, j. a., rosen, l. n., & sparacino, l. r. (eds.). (2000). the military family: a practice guide for human service providers. westport, ct: praeger. matsakis, a. (2007). back from the front: combat trauma, love, and the family. baltimore, md: sidran institute press. pavlicin, k. m. (2003). surviving deployment: a guide for military families. st. paul, mn: elva resa publishing. pryce, j. g., pryce, d. h., & shackelford, k. k. (2012). the costs of courage: combat stress, warriors, and family survival. chicago, il: lyceum books. rubin, a., weiss, e. l., & coll, j. e. (in press). handbook of military social work. hoboken, nj: john wiley & sons. slone, l., & friedman, m. j. (2008). after the war zone: a practical guide for returning troops and their families. philadelphia, pa: perseus books. whealin, j. m., decarvalho, l. t., & vega, e. m. (2008). clinician’s guide to treating stress after war: education and coping interventions for veterans. hoboken, nj: john wiley & sons. author’s note: address correspondence to james g. daley, ph.d. indiana university school of social work, 902 w. new york st., indianapolis, in 46202. e-mail: jgdaley@iupui.edu spring2005-154_page156 spring2005-155_page157 spring2005-156_page158 spring2005-157_page159 spring2005-158_page160 spring2005-159_page161 spring2005-160_page162 spring2005-161_page163 spring2005-162_page164 spring2005-163_page165 spring2005-164_page166 aisw vol. 5, no. 1 using portfolios: integrating learning and promoting for socialwork students mona c.s. schatz abstract: portfolios are a valuable educational tool to aid in the integrative experience for graduate social work students. forty-one graduate students were asked to evaluate their portfolio experience. a pearson correlation shows that graduate students find the experience of developing a portfolio to be reflective of their second year msw program (r=.511; p<.01), reflective of their competence as a social worker (r=.587; p<.01), and reflective of their personal uniqueness (r=.526; p<.01). all students demonstrated generalist social work practice through the inclusion of materials reflecting practice with individuals, families, groups, organizations, agencies, and communities.students also report that the portfoliowas a valuable tool to foster integration of class and field learning (n=24 or 58.5%).findings reveal that two-thirds of the students, 68.3%, applied a “medium level of effort” in the development of their portfolios, yet were able to create a final product that adequately reflected their uniqueness, their integration of learning, and their competence as a second year student. keywords: portfolio, reflection, integration, social work education integration of learning implies that there is a process wherein students takediscreet ideas, thoughts, and knowledge and move to a level of synthesis, incorporating different types of information and thought processes to create their own personal perspective. lowy, bloksberg and walberg (1971) describe the need to integrate learning as more than a process of aggregating components. they posit that this process of integration is meant to suggest “organic unity, creative synthesis, psychological gestalt” [author’s italics] (p. 13). achieving integration for social work students is vital (lowy, bloksberg & walberg, 1971) and must merge the basic foundation concepts and skills in the educational curricula, and later integrate specialized and advanced knowledge and practice. problems in reaching adequate integration exist. for example, the prevailing theoretical and practice base of generalist social work is so broad that some students are unable to grasp its extensiveness without student-centered educational approaches that aid in the integrative process. 105 mona c. s. schatz, dsw is professor, school of socialwork; director, education and research institute for fostering families, colorado state university; and coordinator and faculty for the great plains-idea youth development graduate online program, colorado state university, ft. collins, co 80523. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 105-123. indiana university school of socialwork. furthermore, the experiential learning component in social work, the field placement, varies widely for students. thus, in some cases, social work programs do not succeed in providing adequate exposure and practice competence related to central curricular areas. a portfolio is a collection of materials assembled in a manner that demonstrates either a prescribed outcome, such as a financial portfolio, or a self-initiated professional outcome, such as an artist uses to bring his or her “best” work to a potential employer. portfolios have been used in some schools of social work at graduate and undergraduate levels. the value of the portfolio among undergraduate social work students was examined several years ago by simon and schatz (1999). in this study, field supervisors identified six benefits for students, highlighting its value for self-directed learning. benefits included: (1) its practicality as a self-directed learning approach; (2) a more focused approach for student learning; (3) greater ability for students to gain an understanding of social work in the social agency; (4) a way of getting students more organized “in what is often a somewhat chaotic experience;” (5) being able to combine school and field learning through a collection of materials; and, (6) encouragement of student’s own creativity, thus promoting the uniqueness of each learner. (p. 104) no published articles were found that addressed the use of portfolios at the graduate level. in addition, no articles appear in publications that examine either the reflective processes inherent in portfolio develop or the integrative process that is achieved from the use of a portfolio approach. the key question that motivated this study was whether portfolio projects can serve as a valid assessment tool for the graduate learning experience. does this tool foster a strong process for student integration of the field and classroom educational experiences? a second question sought more understanding about the role of self-reflection in this learning approach. it asked what role self-reflection plays as students formulate their portfolios. before moving into the study design, a brief overview about portfolios is provided. background on portfolios the use of portfolios is extensive. discussions span fields as diverse as occupational therapy (kramer & stern, 1994), health information management (barron & sartori, 1994), higher education—graduate level (condon, 1994; palmer, holahan & johnstone, 1996), field-based experiential higher education (lewis &williams, 1994), social work (risler, 1999; simon & schatz, 1998), and doctoral candidacy (heiges, 1994). portfolios also are used to prepare new teachers (weiser, 1994), foster literacy (irwin-devitis, 1996; standerford, 1996), teach pre-service english teachers (yagelski, 1994), english methods (yancey, 1994; condon, 1994), creative writing (fischer, 1994), and developmental writing (rich, 1994). generally, what students are asked to include in portfolio projects is unique. the portfolio development related to this specific study asked second year graduate social work students to examine their experiences in the field experience and select examples of practice that illustrated their generalist and 106 advances in socialwork advanced generalist practice competencies. these competencies were broadly presented at the beginning of the academic year, thus allowing students wide latitude in organizing their notebooks. portfolios that ask students to collect their class papers and class projects serve more as a “mini-filing” experience and may actually limit some of the real educational benefits that portfolios can offer related to self-discovery, creativity, and self-expression. strengths frequently associated with portfolio use include the self-directed nature of the assignment, the shared responsibility for assessing the learning experience, and the ongoing developmental nature of the product (eric trends and issues alerts, 1993). portfolios allow students to better portray their learning experience within its unique context (e.g., yancey, 1994). they help students’ capture personal meaning (barnett & lee, 1994) from the learning process. white (1994) states that the portfolio brings teaching, learning, and assessment together as mutually supportive activities in the educational milieu (p. 27). toward confirming that premise, proponents also suggest that portfolios offer the world of [educational] assessment a view of student learning that is active, engaged, and dynamic, as opposed to the overwhelmingly passive concept that still dominates the educational assessment movement (white, 1994, p. 27). yet, many of these proponents (e.g., paulson & paulson, 1990; white, 1999; elbow, 1994) are clear that educators must produce evidence beyond personal testimony that this educational assessment tool is effective, credible, beneficial, and capable of achieving its intended purpose(s) as an assessment tool for the learner(s). portfolios in the university milieu during the last two decades, universities have been scrutinizing the quality of education, seeking to better define and articulate learning outcomes. schon (1987) states that educators worry about the gap between a school’s perception of professional knowledge and the actual competencies required of practitioners in the field (p. 10). ashelman and lenhoff (1994) suggest that maintaining portfolios for graduate and undergraduate students serve three primary departmental goals. first, they allow departments an assessment strategy congruent with the department’s need; second, instruction and assessment are based on a constructivist approach; and third, the assessment, when using the portfolio, involves the faculty in a similar process of self-reflection and individual change—a collegial process (p. 66) use of portfolios in social work portfolios have been used in social work education programs for several decades at least. at national conferences and workshops over the last 10 or 20 years, social work educators have presented their perspectives and experiences using portfolios. risler (1999) suggested that the portfolio invites divergent thinking. this provides valuable illustrations of collaboration in the learning process which occurs between students and instructors during field experiences. for social work education, chambers and spano (1982; also see knox, 1986) believe that integration implies a synthesis, but that synthesis only occurs if the student is made aware of how the elements of the learning are interrelated. they further inform us that the learning process must be 107schatz/integrating learning and promoting reflection through portfolios “reflective, rather than a reflex” (p. 229). they do not mention educational tools which would advance this reflection, however. a portfolio can accomplish this integration while also allowing students the opportunity for selfdirection and self-reflection. evaluation, assessment, and grading of portfolios in the educational field, student portfolios have been assessed by knight and gallaro (1994) to benefit: (1) curriculum, (2) student learning in the classroom, and (3) improving student satisfaction in the learning experience. standerford (1996) suggests that this is the ultimate goal of educational assessment. others (e.g., ashelman & lenhoff, 1994) suggest that the process of engaging students in self-assessment and reflection for the purpose of making judgments about their own work is highly individual and personal, requiring high order thinking of critical awareness and non-defensiveness of one's evaluative strategies (p. 75). the 1990s provided valuable discussions among among educational specialists, particularly related to the evaluation, assessment, and grading of portfolios (see paulson & paulson, 1990; yancey, 1994; weiser, 1994). other issues that have been discussed when assessing portfolios include the wide variability of material included in portfolios (ashelman & lenhoff, 1994) and the validity of the portfolio to measure what it is intended to measure (yancey, 1994). an evaluation study of portfolios by undergraduate social work students found positive support among students and field instructors. simon and schatz (1998) used an evaluative survey instrument to assess how well students perceived their portfolio process as an integrative of the field and classroom learning. in a second study using a survey instrument, schatz and simon (1999) found that both field instructors (n=14) and students (n=39) believed that the portfolio supported the integrative aspects of learning needed for students in an undergraduate generalist program. students and field instructors saw the portfolio project as extremely valuable, indicating that the portfolio brought more depth to learning in the field placement experience. this study did not examine how students made decisions related to their final portfolio presentation. purpose andmethodology this study explored graduate social work students’ decisions regarding how they organized their portfolios and the role self-reflection played in this learning strategy. questions developed to guide this study included the following: 1. does the portfolio process used for second year graduate social work students promote reflective thinking? 2. do students achieve an integration of class learning and field experience through the use of a portfolio process? 3. do students see this tool as helpful for both academic and professional endeavors? 108 advances in socialwork 4. do students view their portfolio process as promoting their competence? 5. doportfolios adequately illustrate generalist and advancedpractice? researchdesign a research approach that was both qualitative and quantitative was constructed to respond to the research questions. a student survey instrument gathered qualitative and quantitative responses about the portfolio development experience (see appendix a). the questionnaire instrument served as a tool for the evaluation of the student’s actual portfolio notebook, which was handed in at the end of a year-long seminar and field placement experience. the instructor made the decision to use the portfolio with second year concentration students, in part, because she was the instructor of the seminar class, and in part, because this instructor views the portfolio as an effective self-assessment instrument that can be used throughout one’s social work career. a second research tool (appendix b) was used by a team of three researchers: two were graduate research assistants and the third was the author. the team providedmore objectivity and consistency when examining the quality of portfolios, because the author also served as the instructor for the student participants. the evaluation of portfolios done by the team was conducted after the grading period so that there would be no inherent conflict or bias in the team’s evaluation of portfolios. design of two instruments: the survey and portfolio review instrument students were asked to complete a written survey instrument that inquired into the creation of their portfolio. this survey was completed at the end of the concentration year graduate experience. to answer the research questions, the survey looked as several focuses. first, some questions explored what types of items students included in their portfolio (questions 1, 5, 6, and 7) and informed research questions 3, 4, and 5. these items, in aggregate, represented a generalist social work orientation (schatz, jenkins & sheafor, 1990). second, some questions asked about attitudes related to the portfolio process and the student’s reflection about that process (questions 2, 3, 4, 5, 11, and 12) and informed research questions 1, 2, and 4. for example, some questions sought to capture student decisions about what they chose to include in their portfolio and what they excluded, if any (questions 6b, 7b). third, some questions examined areas such as the student’s level of effort (questions 10), their view of the strengths of this assignment (question 9), if they had shared their portfolio with others (question 8), and if they would continue to use this tool in the future (question 13). question 12 asked students about grading and evaluating portfolios. these questions informed research questions 1, 2, and 3. the survey also asked students their age, gender, and social work field setting. the second tool (see appendix b) was designed in order to use a team score that judged the quality of the portfolio and whether it demonstrated aspects such as: a) the portfolio’s ability to be seen as a highly professional tool, b) the quality of the organization, c) the level of effort, d) the demonstration of social work com109schatz/integrating learning and promoting reflection through portfolios petency, e) the demonstration of integration of class and field experience, f) demonstration of advanced generalist practice orientation, and g) reflective quality used by the student in organizing their portfolio. the three research team members did a“trial run”with a portfolio fromanundergraduate student in order to discuss the rating process towards providing consistency on what each item in the review instrument sought to evaluate. student sample student participation was voluntary. forty-one of the 42 students in the sample completed the written survey (97.6% of the population). sixteen of the 42 students, (38.1% of the population) agreed to allow the research team to review their portfolio. this lower participation rate was due to timing: this portfolio assignment was due at the end of the graduate coursework and students just wanted to leave and take their work with them. reviewing these portfolios by the team required an extra week for review purposes. respondent demographic information shows that the mean age of graduate social work student respondents was 32.69 (standard deviation=7.85); 75.6% (n=31) were women and 24.4% were men (n=10). the field placement setting of students varied. thirteen students worked in family and children's programs, 11 students were in mental health programs, 7 were in community and education programs, 6 were in medical settings, and 4 were in corrections. results the portfolios were unique. illustrative of the reflection process in portfolio development, the students were able to indicate which items in their portfolio illustrated their “best practice,” which item(s) were excluded from their portfolio, whether they were ambivalent about having included certain items in their portfolio, and what decisions influenced them in these decisions. the first research question asked: “does the portfolio process used for concentration graduate social work students promote reflective thinking?” the process of reflecting on one’s competence and uniqueness: when asked if the portfolio served as a reflective tool, students indicated their level of agreement using a four-point likert scale. a pearson correlation coefficient was calculated to explore the relationship of these variables. a strong positive relationship was found among these three (r=.526; r=.511, and r=.587; 39 df; p<.001). table 1 shows these correlations, indicating a reliable relationship between the variables. demonstrating their competence: demonstrating their competence: each student was able to provide specific examples of his or her: a) emerging practice competence and b) “best” practice(s). thus, students presented their portfolio in an integrated way and expressed their own sense of competence. a wide range of examples of practice was evident due to the many types of field placement agencies that students were involved in. from a pre-constructed list of nine (9) items, respondents were asked to indicate whether any of these nine items were included in their portfolio. students were also asked if they included items such as class activities and assignments. 110 advances in socialwork table 2 shows the types of items included by students. demonstrating their competence: demonstrating their competence: each student was able to provide specific examples of his or her: a) emerging practice competence and b) “best” practice(s). thus, students presented their portfolio in an integrated way and expressed their own sense of competence. a wide range of examples of practice was evident due to the many types of field placement agencies that students were involved in. from a pre-constructed list of nine (9) items, respondents were asked to indicate whether any of these nine items were included in their portfolio1. students were also asked if they included items such as class activities and assignments. table 2 shows the types of items included by students. respondents listed items in their portfolio that represented experiences beyond the field and classroom if they believed these items represented their social work competence. twenty-four respondents (58.5%) included non-academic/field items. the lower section of table 3 lists the most frequent items included which were of this nature, such as copies of grant submissions, certificates, certification awards, licenses, and personnel evaluations. to explore the constructivist process of the portfolio notebook, students were asked to identify two examples from their portfolio that demonstrated their social work competence. a second question asked them to indicate one item in their portfolio that represented their “best” practice. table 2 illustrates that “practice materials” were listed as most representative of their competence (38.73%) and best work (38.89%), credentials (21.92%) and field materials (15.07%) gained second in position, professional materials (10.96%) created by the student, and class work materials (8.22%) followed. furthermore, it appears that students value their work with clients and their recognition for this work. 111schatz/integrating learning and promoting reflection through portfolios reflects reflects reflects 2nd personal socialwork year field survey statements uniqueness competence experience reflects personal uniqueness pearson correlation 1.000 .587** .526** significance** . .000 .000 reflects social work competence pearson correlation .587** 1.000 .511** significance** .000 . .001 reflects 2nd year field experience pearson correlation .526** .511** 1.000 significance** .000 .001 . *degrees of freedom=39; **correlation is significant at the 0.01 level (2-tailed). table 1: pearson correlation demonstrating reliability of student responses on perception of competence and uniqueness (n=41)* respondents identified certain materials which they had ambivalence about including in their portfolios. for example, some respondents were unsure or uncomfortable including “class work” (25.93%), certain “field materials,” particularly if the materials might divulge someone’s identity (18.52%), and “credentials” (14.81%). “non-client specific practice materials” and “materials developed by the students” were items students’ were less ambivalent about (7.41%). respondentswere asked if they excluded items from their completed portfolios. twenty-five respondents (61.0%) indicated that they excluded items when finalizing their portfolio. most frequently, students excluded items that were “not reflective of me or my best practice” (29.63%) or were “left out because of confidentiality.” for a small number of students, “space constraints” (14.81%) and items from their “distant work experiences” (14.81%) were reasons for exclusion. the process of reflecting on one’s competence and uniqueness when asked if the portfolio reflected the respondent's sense of competence as a second yearmsw student and as a social worker, as well as their personal uniqueness, students indicated their level of agreement using a four-point likert scale. a pearson correlation coefficient was calculated to explore the relationship of these variables. a strong positive relationship was found among these three correlations (r=.526; r=.511, and r=.587; 39 df; p<.001). table 3 shows these correlations, indicating a reliable relationship between the variables. 112 advances in socialwork items that reflected theirwork number percentage in field placement work with individuals 33 80.5% work with clients in groups 24 58.5% work with families 18 43.9% community work 35 85.4% training and seminars 39 95.1% funding activities 11 26.8% administrative activities 30 73.2 public relations/media activities 12 29.3% class assignments and activities 35 85.4% items from other professional experiences other training 3 * certifications and licenses 3 * college transcripts 1 * grants 2 * public relations/media materials 3 * personnel evaluations 2 * *individual items not tabulated, however, 24 respondents (58.5%) did include some type of non-field items. table 2: portfolio items that reflect educational experience and items that reflect practice competence from other professional experiences respondents identified certain materials with which they had ambivalence including in their portfolios. for example, some respondents were unsure or uncomfortable including “classwork” (25.93%), certain “field materials,” particularly if the materials might divulge someone’s identify (18.52%), and “credentials” (14.81%). “non-client specific practice materials” and "materials developed by the students" were items students were less ambivalent about (7.41%). respondentswere asked if they excluded items from their completed portfolios. twenty-five respondents, or 61.0%, indicated that they excluded items when finalizing their portfolios.most frequently, students excluded items that were “not reflective of me or my best practice” (29.63%) or were “left out because of confidentiality.” for a small number of students, “space constraints” (14.81%) and items from their “distant work experiences” (14.81%) were reasons for exclusion. the second research question asked: “do students achieve an integration of class learning and field experience through the use of a portfolio process?” respondents were asked to evaluate whether “the portfolio had been a valuable 113schatz/integrating learning and promoting reflection through portfolios portfolio items that portfolio items that represent represent socialwork “best” socialwork practice portfolio item competence n* % of total n** % of total responses responses practice materials: assessments/ 29 39.73% 14 38.89% interventions credentials, e.g., resume, certifications, 16 21.92% 2 5.56% license field materials, e.g., learning plans, 11 15.07% 5 13.89% evaluations professional materials 8 10.96% 6 16.67% developed by student class work materials, 6 8.22% 4 11.11% e.g., organizational scans, research projects other 6 8.22% 6 16.67% e.g., thank you’s, letter of recommendation, syllabi total 73 100.00% 36 100.00% *respondents were asked to provide two examples of portfolio items that represented their social work competence. some respondents provided more than two responses while others did not respond at all. **respondents were asked to provide one “best” item that represented their social work competency. some respondents provided more than one response while some did not provide any response. table 3: portfolio items respondents identified as demonstrating social work competence (n=41) way to integrate class and field learning.” twenty-four students, or 58.5%, indicated their “agreement” or “strong agreement” with this statement; only 9.8% of students “strongly disagree” (mean=2.44; sd=.78). reviewers determined whether, in their assessment, the portfolios demonstrated the integration of class and field experience. using an 8-point likert scale, the mean score from this review was 4.56 (standard deviation=2.42) slightly higher thanmid-point. this is similar to the mean of respondents (mean=2.44, standard deviation=.78). “do students see this tool as helpful for both academic and professional endeavors?” to assess this third question, whether the portfolio served as an educational or professional tool during the past year, students were asked whether they shared their portfolios with others, such as faculty, supervisors, co-workers, family, and fellow students. thirty-eight (38) students responded (92.7%) affirmatively to this question.thirty-five respondents, or 85.4%, sharedportfolioswithother students. faculty were shown portfolios by 18 students or 43.9% of the respondents. thirteen or 31.7% of the students shared their portfolios with their families. question four asked: “do students view their process of portfolio development as promoting competence?” the students were asked about the best way to evaluate their portfolio. results show that only one student believed that the instructor should solely assess the portfolio. most frequently, respondents thought that the assessment process should be mutual, the student meeting with the instructor to discuss the development process and the final submission (14 or 41.18%). twelve (12) students, or 35.29%, suggested that self-grading the portfolio was the best way to accomplish the evaluative process. finally, “do portfolios adequately illustrate generalist and advanced practice?” because the graduate educational experience rests in a specialized area of study, the research sought to examine whether students’ portfolios illustrated the generalist and advanced generalist social work specialization. table 4 shows a strong validation for the generalist social work approach. as shown, students have included materials that illustrate the multiple level practice experience (micropractice,mezzo practice, andmacro practice) in field and themulti-method practice process. the advanced level assessment was only possible to ascertain when reviewers looked at the nature and extent of the practicematerials included. as an example, reviewers were looking for the complexity of practice presented by students. the reviewers used an 8-point likert scale, “1” representing “very high” and “8” indicating “very low.” reviewers might judge, for example, an advanced generalist representation in the portfolio, whether examples of treatment plans were included, or grant projects or other activities requiring application of competencies generally viewed as “graduate level.” the mean score of reviewers for this demonstration of advanced generalist social work practice was 3.5 (standard deviation=2.68), representing a “high” score in this area. examination of students’ level of effort in portfolio development though no one research question specifically asked about the level of effort, the idea that different student levels of effort might influence the quality of the work 114 advances in socialwork was surmised.when the concentration year began, students were given the portfolio assignment that this research examined. it was suggested at that time that students use their portfolios as an on-going tool where they could collect items that would be indicative of their field and class learning experiences. since the survey was given at year’s end, the students were asked to select from a threepoint scale of “high,” “medium,” and“low” to indicate their level of effort in developing the portfolio. to better guide the response process, these three response choices had a short descriptive narrative as follows: “high–worked on [the portfolio] regularly during the year;” “medium–worked on intermittently throughout the year;” and “low–worked on just the last few weeks of each semester.” table 5 shows that two-thirds of the respondent students (68.3% or 24) put a medium level of effort into development of the portfolio. nine students or 22% put in a low level of effort; less than 10% (8 students or 9.8%) of the sample population placed high effort into this project. significancewas foundwith the level of effort and correlationswith (1) the portfolio’s value as a tool for class and field integration (r=.394; p<.005 (one-tailed)), (2) the ability of the portfolio to reflection the second year msw experience (r=.302; p<.028), and (3) the use of the portfolio as a tool that reflects the student's uniqueness as a social worker (r=.383; p<.007(one-tailed)). no significance was found when correlated with the variable that assessed whether the portfolio reflected the student's competence as a social worker (r=.228; p<.076). the review team that examined each portfolio also assessed the level of effort. this review of portfolios revealed that the level of effort for the sample as compared with the population as a whole is significant (mean=3.5; sig. .000, p<.001). having used an 8-point likert scale, the mean of 3.5, between “high” and “medium” on the rating descriptors is quite similar to the respondents themselves, whose mean is 2.12, a middle-rating on a 4-point likert scale. 115schatz/integrating learning and promoting reflection through portfolios yes, included not included not sure portfolio items n % n % n % micro practice: work with individuals 33 80.5% 7 17.0% 1 2.4% mezzo practice: work with groups 24 58.5% 14 34.1% 3 7.3% work families 18 43.9% 21 51.2% 2 4.9% macro practice: community work 35 85.4% 4 9.8% 2 4.9% training and seminars 39 95.1% 1 2.4% 1 2.4% administrative activities 30 73.2% 6 14.6% 5 12.2% funding development 11 26.8% 26 63.4% 4 9.8% class activities/ 12 29.3% 28 68.3% 1 2.4% assignments table 4: items included in portfolio that represent multiple systems level practice and multi-method practice (n=41) discussion the study found significant support for the idea that development of a portfolio can serve as a tool that reflects social work competence for graduate students who are nearing the end of their academic experience. their ability to identify items that represent their competency is evident. the respondents could also identify what items in their portfolio reflected their best work. the items that students included in their portfolios illustrate their multi-level practice with individuals, agencies, and communities, and their class assignments and related school activities. training and seminar information accumulated during the advanced concentration year were included in student portfolios and were viewed as important. this may be the case, because these external learning opportunities actually enhanced the person's learning, e.g., field experiences, and probably provided more advanced knowledge and skill development. students’ work with clients was included in all portfolios. for some, issues of confidentiality brought ambivalence for them regarding whether to include this kind of information in the portfolio. these results indicate that students were ambivalent about how or whether they should put client work into their portfolio, demonstrating their ability to reflect on value and ethical issues related to practice and professionalization. it is interesting to learn that a medium amount of effort was adequate to build quality individual portfolios. among some opponents of portfolios there has been expressed concern that they are too time consuming (simon & schatz, 1998) and, therefore, not a valuable learning tool. from this respondent group, it may be more realistic to suggest that a medium level of effort is sufficient for students to create a professional/educational tool that demonstrates social work competence. it is worthy of mention that the assessments made by students regarding their level of effort was based on a set of definitions presented in the survey tool. it is possible that the descriptors served to create amid-range response, since students were comfortable stating that their work was actually intermittent throughout the year, versus, regularly worked on, which qualified for the “high” descriptor. this honesty gave the researcher the ability to conclude that the construction of the portfolio, as intended, does not have to be overwhelmingly time-consuming. the time needed by the instructor to examine the portfolios is often a concern. for this author and for those who have joined in adopting portfolios as assessment tools, the time and effort is worth the outcome. students are so pleased to 116 responses choices n* 1% high 8 9.8% medium 24 68.3% low 9 22.0% total 41 100.0% *mean=2.12; sd=.56 table 5: level of effort in portfolio development (n=41) advances in socialwork have a tangible product that illustrates the many tasks and responsibilities they undertake in their education and field experience. faculty should not shy away from this teaching tool because of time requirements. the respondents demonstrated their generalist orientation and advanced generalist practice. the team assessed that more than 80% of the students included materials that reflected advanced practice throughout the continuum of intervention levels—individuals, groups, families, organizations, and communities. this demonstration also reflects the specialized, advanced social work curriculum at this university program. a number of factors have become apparent through the analysis of data that suggest that there are considerations made about the construction of the portfolio and, in turn, influence what is included and not included in the portfolio. when students were asked what two items in the portfolio represent their social work competence, all students had a response. yet, no two responses were alike. second, when asked if they had included items in their portfolio that they were ambivalent about, 27 responded in the affirmative. third, the students were then asked if there were items they had excluded when submitting their portfolio at year's end. twenty-seven individuals had excluded items. while the items that respondents were ambivalent about or what they excluded is important, what may be more valuable is the awareness that these three questions, considered altogether, capture a process of personal decision-making and reflection that responds to one of the research questions initially posed. a series of five statements were used to uncover whether the portfolio served reflective purposes that included educational integration, social work competence, and personal uniqueness. it was found that the perception of the portfolio’s value as an integrative tool was highly associated with its perceived value in determining social work competence. these correlations show the magnitude and direction of the linear correlations between each set of variables (craft, 1990). the r scores show positive correlation with strong significance. this is not surprising since portfolio work reflects many things for students. because the students were able to articulate what they did and did not include in their portfolio, the research uncovers a process of decision-making used by students and a process of reflection about their construction of their portfolio. it might be possible to imply from portions of this analysis that students amass a large quantity of materials that may be worthy of inclusion in their portfolio. then, closer to the time when the portfolio is to be submitted for review, the student makes a series of determinations about the final set of materials that will actually be used as representations of practice and educational performance. the reflective process promotes aspects of the person's professional endeavors and their educational experience. materials that are either too old or questionable on ethic grounds may be excluded, as well as other considerations such as the sheer size and magnitude of the volume. implications with stronger demands to evaluate educational outcomes in academic programs throughout the nation, this study offers an educational strategy that could serve 117schatz/integrating learning and promoting reflection through portfolios as an outcome assessment tool. schools of social work or individual social work faculty who consider using a portfolio project may aptly demonstrate what students are learning and how they take their learning and create integration for themselves. to achieve a process of integration, the educator could consider how class work and fieldwork combine to support that process for students.with further exploration, we could learn how a portfolio could become more useful for students. another implication of this study found that students were able to achieve the portfolio experience by merely using a medium amount of work level. this finding may be helpful to students who are given the portfolio assignment in the future, because it allows them to realize that they can accomplish it without the assignment being overly time-consuming. limitations of study the survey population comes from the same graduate program as the research team. there are biases when subjects know the researcher. measures were taken to redirect some potential bias, however, the bias could not be eliminated entirely. the respondents represent 97.6% of the population under study. therefore, the results confidently reflect the population under study. it is, however, not plausible to generalize these findings to other schools of social work that use portfolios. for example, the school of social work used in the study has one specialization in a generalist perspective, where other schools of social workmay have several specializations and, therefore, the survey may not be as useful. consequently, the results may not meet the needs of other schools of social work that have multiple specializations. future considerations limited research has been able to capture student learning and reflective aspects related to integration in social work educational curricula. this study only initiates a possiblemethod, e.g., portfolios, to consider in this area. though this study found some insights into a process of reflection related to building a portfolio, examining more closely how reflection services the educational experience should build from this initial effort. this study was intended to explore how students reflect and cognitively process construction of the portfolio. five research questions were posed at the start of this study and have since been successfully answered. this study found the portfolio to be reflective of the students thinking around their competence in the second year of graduate school. it found that students are able, through the use of portfolios, to express their integration of class, professional uniqueness, and field learning. respondents confirmed the generalist perspective and students working in multisystem areas of practice. students also believe that assessment of the portfolio is best done in a collaborative process with the instructor. most important, the findings promote the idea that schools of social work can benefit from adopting a portfolio approach. 118 advances in socialwork endnote 1 these items represented major areas of social work practice in the field placement experience such as work with individuals, groups, families, and communities, as well as items that represented work with or involvement in training, seminars, administrative activities, and public relations/media activities. references. ashelman, p., & lenhoff, r. (1994). early childhood education. inm. knight (ed.), portfolio assessment: an application of portfolio analysis (pp. 65-76). lanham, md: university press of america. barnett, b.g., & lee, p. (1994). assessment processes and outcomes: building a folio. in l. jackson & r.s. cafffarella, (ed.), experiential learning: a new approach 62(summer) (pp. 55-62). ca: jossey bass. barron, m., & sartori, n. (1994). planning a portfolio: medical record administration/health information management. in m. knight (ed.), portfolio assessment: an application of portfolio analysis (pp. 9-19). lanham, md: university press of america. chambers, d.e., & spano, r. (1982). integration of learning in field instruction. in sheafor, b.w. & jenkins, l.e.,quality field instruction in social work: program development and maintenance (pp. 226-234). ny: longman. condon,w. (1994). building bridges, closing gaps: using portfolios to reconstruct the academic community. in l. jackson & r.s. cafffarella, (eds.), experiential learning: a new approach 62(summer) (pp. 197-213). ca: jossey bass. craft, j.l. (1990). statistics and data analysis for social worker. itasca, il: f.e. peacock publishers. elbow, p. (1994).will the virtues of portfolios blind us to their potential dangers? in black, l., daiker, d.a., sommers, j. & stygall, g. (1994). new directions in portfolio assessment: reflective practice, critical theory, and large-scale scoring (pp. 40-55). portsmouth, nh: boynton/cook publishers. eric trends and issues alerts (1993). portfolio assessment in adult, career, and vocational education. columbus, ohio: eric clearinghouse on adult, career, andvocational education. fischer, k.m. (1994). down the yellow chip road: hypertext portfolios in oz. in l. jackson & r.s. cafffarella, (eds.), experiential learning: a new approach 62(summer) (pp. 338-356). ca: jossey bass. heiges, j.m. (1994). portfolio for doctoral candidacy. in l. jackson & r.s. cafffarella, (eds.), experiential learning: a new approach 62(summer) (pp. 125-137). ca: jossey bass. irwin-devitis, l. (1996). literacy portfolios: the myth and the reality. in m.d. collins and b.g. moss (eds.), literacy assessment for today’s schools (pp. 135-144). va: college reading association. knight, m., & gallaro, d. (1994). summary. in m. knight (ed.), portfolio assessment: an application of portfolio analysis (pp. 135-139). lanham, md: university press of america. knox, a.b. (1986). helping adults learn. san francisco: jossey bass. kramer, p., & stern, k. (1994). portfolio assessment in occupational therapy. in m. knight (ed.), portfolio assessment:an application of portfolio analysis (pp. 121-134). lanham,md:university press of america. lewis l.h., &williams c.j. (1994). experiential learning: past and present. in l. jackson & r.s. cafffarella, (eds.), experiential learning: a new approach 62(summer) (pp. 5-16). ca: jossey bass. lowy, l., bloksberg, l.m., & walberg, h.j. (1971). integrative learning and teaching in schools of social work. ny: association press. palmer, b.m., holahan, m.e., & johnstone, j.r. (1996). the challenge of change: the m.ed. portfolio. in m.d. collins, and b.g. moss (eds.), literacy assessment for today’s schools (pp. 123-133). va: college reading association. paulson, p.r., & paulson, f.l. (1994). a different understanding. in l. jackson & r.s. cafffarella, (eds.), experiential learning: a new approach 62(summer) (pp. 278-292). ca: jossey bass. paulson, l., & paulson, p. (1990, august). how do portfolios measure up? paper presented at the annual meeting of the northwest evaluation association, union,wa. (eric document reproduction service no. ed 324 329). 119schatz/integrating learning and promoting reflection through portfolios rich, s. (1994). test me, test me knot: the portfolio alternative for developmental writers. in m. knight (ed.), portfolio assessment: an application of portfolio analysis (pp. 47-63). lanham, md: university press of america. risler, e. (1999). student practice portfolios: integrating diversity and learning in the field experience. aretê 23(1), 89-96. schatz, m., & simon, s. (1999). the portfolio approach for generalist social work practice: a successful tool for students in field education. journal of baccalaureate socialwork 5(1) pp. 99-107. schatz, m.s., jenkins, l., & sheafor, b. (1990). milford redefined: a model of initial and advanced generalist social work, journal of social work education, 26(3). schon, d. (1987). educating the reflective practitioner. san francisco: jossey-bass. schon, d. (1987). educating the reflective practitioner. san francisco: jossey-bass.schon, d.a. (1983). the reflective practitioner: how professionals think in action. ny: basic books. simon, s., & schatz, m. (1998). the portfolio approach for bsw generalist social work students. the new socialworker 5(1), 12-15. standerford, n.s. (1996). rethinking the role and practice in assessment in teacher education: learning to assess authentically on multiple levels. in m.d. collins & b.g. moss (eds.), literacy assessment for today’s schools (pp. 161-183. va: college reading association. weiser, i. (1994). revising our practices: how portfolios help teachers learn. in l. jackson & r.s. cafffarella, (eds.), experiential learning: a new approach 62(summer) (pp. 293-301). ca: jossey bass. white, e.m (1994). issues and problems in writing assessment. assessingwriting i(1): 11-28. yagelski, r.p. (1994). portfolios as away to encourage reflective practice among pre-service english teachers. in l. jackson & r.s. cafffarella, (eds.), experiential learning: a new approach 62(summer) (pp. 225243). ca: jossey bass. yancey, k.b., &weiser, i. (1997). situating portfolios: four perspectives. logan, utah: utah state university press. yancey, k.b. (1994). teacher portfolios: lessons in resistance, readiness, and reflection. in l. jackson & r.s. cafffarella, (eds.), experiential learning: a new approach 62(summer) (pp. 244-262). ca: jossey bass. author’s note: address correspondence to: mona c.s. schatz, dsw, school of socialwork, colorado state university, ft. collins, co 80523, usa. e-mail: schatz@cahs.colostate.edu 120 advances in socialwork 121schatz/integrating learning and promoting reflection through portfolios appendix a survey instrument instructions: please take a few minutes and complete this questionnaire. the more specific your responses the more helpful you will be in aiding this study. your are welcome to use the back of the survey to continue your written comments. return to: socialwork dept./schatz’ mailbox/csu. 1. please check below if you have items in your portfolio that represent your work with or involvement in: yes no not sure individual clients worked with ____ ____ ____ clients in groups worked with ____ ____ ____ family clients worked with ____ ____ ____ communities’ members/organizations ____ ____ ____ training and seminars ____ ____ ____ administrative activities ____ ____ ____ funding development activities ____ ____ ____ public relations/media activities ____ ____ ____ class activities/assignments ____ ____ ____ 2. having completed your portfolio please respond to the following statements: sa a d sd a) the portfolio has been a valuable way to 1 2 3 4 class learning and the field agency placement. b) the portfolio reflects my competence as a social 1 2 3 4 worker. c) the portfolio reflects my second year field 1 2 3 4 experience. d) the portfolio helped me identify areas for field. 1 2 3 4 e) the portfolio reflects my uniqueness as a social 1 2 3 4 worker. 3. describe two items in your portfolio that reflect your practice competence? a) ______________________________________________________________________ b) ______________________________________________________________________ 4. describe one item you included in your portfolio that reflects your best social work practice. 5. describe any item(s) that you were ambivalent about including in your portfolio? 6. did you include items beyond field placement that were related to past or present work situations? a) yes ___ no ___ b) why did you include these items? appendix a survey instrument (cont.) 7. were there items you excluded from this portfolio submission? a) yes ___ no ___ b)what thoughts or considerations led you to exclude these items from your portfolio? 8. please check below if you shared your portfolio (at whatever stage of completion) at any time during the year with: yes no a. your supervisor ____ ____ b. co-workers ____ ____ c. other students ____ ____ d. family members ____ ____ e. friends ____ ____ f. university faculty ____ ____ 9. what are the strengths of using a portfolio assignment for the second year field experience, if any? 10.what level of effort did you put into the development of this portfolio? high medium low (worked on regularly (worked on (worked on just the last throughout the year) throughout the year) few weeks of each semester) 11.what two conclusions would you make about yourself as a social worker by reflecting on what you included in your portfolio? 12.what do you believe is the best way to evaluate the portfolio? for example, should the instructor meet individually with each student? have students selfgrade their notebook? other approaches? 13.will you continue to use and update your portfolio? yes __ no __ not sure __ comments? _________________________ age:___ gender: female __ male __ social work setting: mental health ___ medical ___ family/children ___ community/education ___ hospice ___ corrections/probation ___ have you ever done a portfolio before? yes ___ no ___ not sure ___ 122 advances in socialwork appendix b instrument: review of the portfolio reviewer: __________________________ date of the review: __________________ student code ____ 1. items in the portfolio reflect work in any of the following situations. yes no not sure individual clients you have worked with ____ ____ ____ clients in groups you have worked with ____ ____ ____ family clients you have worked with ____ ____ ____ communities members/organizations ____ ____ ____ training and seminars ____ ____ ____ administrative activities ____ ____ ____ funding development activities ____ ____ ____ public relations/media activities ____ ____ ____ class activities/assignments ____ ____ ____ 2. are there items in the portfolio that represent efforts outside of the field experience? yes __ no __ list items: _____________________________________________ 3. portfolio presentation is professional. 1 2 3 4 5 6 7 8 can’t judge very high high medium low very low 4. there is a quality of organization to the portfolio. 1 2 3 4 5 6 7 8 can’t judge very high high medium low very low 5. there is an apparent level of effort by the student. 1 2 3 4 5 6 7 8 can’t judge very high high medium low very low 6. portfolio demonstrates social work competency. 1 2 3 4 5 6 7 8 can’t judge very high high medium low very low 7. portfolio demonstrates integration of class and field experience. 1 2 3 4 5 6 7 8 can’t judge very high high medium low very low 8. portfolio demonstrates advanced generalist practice orientation. 1 2 3 4 5 6 7 8 can’t judge very high high medium low very low 9. portfolio resonates a reflective quality by student. 1 2 3 4 5 6 7 8 can’t judge very high high medium low very low 10. general comments 123schatz/integrating learning and promoting reflection through portfolios running head: theory in child welfare research attachment and alternatives: theory in child welfare research karla t. washington abstract. in an effort to improve the effectiveness of their services with children and adolescents, many social workers consult research guided by attachment theory. this article provides a brief overview of attachment theory with specific attention given to its application to contemporary child welfare research. criticisms of attachment theory are discussed in detail, along with possibilities for alternative research frameworks including crisis intervention, anti-discrimination, social construction, and critical social work theories. key words: child welfare, research, attachment theory, theoretical alternatives a substantial body of research now supports what child welfare workers have known for decades: the detrimental effects of child abuse and neglect are significant, long-lasting, and can impact every aspect of a child’s life (augoustinos, 1987; cahill, kaminer, & johnson, 1999; fagan, 2001; glaser, 2000; pollak, cicchetti, hornung, & reed, 2000; smetana & kelly, 1989; starr & wolfe, 1991). furthermore, many children experience additional trauma and problematic outcomes after they enter protective services (dumaret, coppel-batsch, & couraud, 1997; fish & chapman, 2004). faced with the task of protecting some of the country’s most vulnerable clients, those in the field of child welfare must continually seek out ways to improve the effectiveness of their services. for many, social work research guided by attachment theory has provided some answers. attachment theory the basic premise of attachment theory is that a child’s relationship with a primary caregiver during infancy is critically important to later development and serves as a prototype for the child’s relationships throughout the lifespan (howe, 1995). the theory originated in the work of john bowlby and mary ainsworth who sought to explain and measure infants’ responses to separation from their mothers. bowlby (1969, 1973, 1980) viewed the infant as an active participant in shaping the relationship between mother and child, responding to innate drives to increase the proximity of the mother for reasons of safety and security. ainsworth’s most significant contribution to attachment theory was the now-famous “strange situation” test, which has become the standard method of assessing attachment (ainsworth, blehar, waters, & wall, 1978). during the strange situation test, an infant (12 to 18 months old) is observed experiencing the separation and return of a primary caregiver. based on the observed responses, the infant is classified in one of four attachment categories: insecureavoidant, secure, insecure-ambivalent, or insecure-disorganized. these attachment classifications have been used extensively in child welfare practice and research (mennen & o'keefe, 2005). applications to child welfare proponents of attachment theory stress its usefulness in understanding the psychological ramifications of child abuse and neglect. they argue that the challenges that karla washington msw. is a doctoral student at the school of social work, university of missouri-columbia. copyright © 2008 advances in social work vol. 9 no. 1 (spring 2008), 8-16. advances in social work, spring 2008, 9(1) 9 children who have been mistreated introduce into the foster care system are more clearly understood and addressed by workers who are familiar with basic attachment concepts (golding, 2003; mennen & o'keefe, 2005). attachment theory attributes the problems that children continue to experience even after being removed from an abusive situation to the trauma that they endure when experiencing repeated separations from caregivers. importantly, research has shown that difficulties are not restricted to interpersonal relationships. the quality of a child’s attachments has been shown to predict performance socially, cognitively, behaviorally, and academically (golding, 2003). researchers interested in the long-term consequences for children in out-of-home care have given considerable attention to attachment patterns due to evidence that children’s attachment classifications are associated with the quality of their relationships and development over the entire lifespan (howe, brandon, hinings, & schofield, 1999). children who are securely attached are typically able to balance autonomy with participation in satisfying, emotionally reciprocal relationships later in life. a child classified as insecureavoidant may minimize the importance of connections to others as an adult and will likely find it difficult to empathize with emotional individuals. an insecure-ambivalent classification may predict impulsivity and a limited ability to regulate one’s emotions in adulthood. the insecure-disorganized classification category was not originally included in the work of ainsworth and her colleagues. this pattern of attachment was recognized by main and solomon (1986) who noticed unusual responses in infants who had experienced significant trauma and/or behavior on the part of the primary caregiver that was frightening or unpredictable. adult relationships for individuals who are classified as insecuredisorganized are typically volatile and may include emotional or physical abuse (howe et al., 1999). studies have shown that children displaying disorganized attachment patterns are significantly overrepresented in the child welfare system (golding, 2003; howe et al., 1999). criticisms of attachment theory although attachment theory is widely used in child welfare, it is not without criticism. some writers suggest that it is culturally-biased and may lead to decision making that ignores the importance of raising children in an environment consistent with their cultural heritage (neckoway, brownlee, jourdain, & miller, 2003). others propose that attachment theory is particularly vulnerable to sociopolitical influence (bolen, 2002; olafson, 2002). arguably the most vocal opposition to attachment theory in recent years has come from the field of genetics. in the most recent formulation of the nature versus nature debate, some researchers are exploring the idea of inborn temperament. their findings suggest that many traits currently thought of as “personality” may be influenced by a person’s biological make-up (kagan, 1998, 2004; kagan & snidman, 2004). further study in this area may challenge attachment theory’s assertion that environmental factors, specifically parental behavior, are most significant in shaping the character of children. additional criticism of attachment theory originates in feminist thought. although attachment theorists do not claim that mothers are exclusively able to be primary caregivers, much of the research in this area focuses on females as the critical attachment figures in washington/theory in child welfare research 10 children’s lives. therefore, feminist theorists have contributed significantly to the discussion regarding political issues inherent in the attachment theory movement (contratto, 2002). since attachment theory posits that a child’s relationship to a primary caregiver (again, often female) serves a critical role in the child’s psychological development, the theory logically implies that complications in development (i.e. psychopathology) can be attributed to problems within the child-caregiver relationship. this professionally sanctioned “motherblaming” has been identified by feminist writers as problematic, sexist, and designed to support the status quo (birns, 1999; contratto, 2002). attachment’s response with a few key exceptions, attachment theorists do not seem defensive regarding criticisms. the inclusive nature of attachment theory and its ability to adapt in light of new science has contributed to its staying power. for example, attachment theorists have not totally rejected the idea of temperament. in fact, contemporary attachment work has absorbed some of the ideas that guide temperament research and is currently exploring the interaction among biological factors, parenting styles, and attachment (steele, 2002; zeanah & fox, 2004). additionally, some professionals who use attachment perspectives in their work consider themselves to be feminists and disagree with criticisms of the theory. they explain that attachment theory actually honors women and the significant contributions that female caregivers make to society (harvey, 2003). alternative theoretical frameworks in his discussion of theory, howe (1987) explains that social workers always employ some frame of reference when making practice decisions, even if they are not consciously aware that they are doing so. if theory serves as an anchor for decision making in child welfare, it is important that the theories be appropriate to and useful in child welfare practice, as well as in accordance with professional ethics. with regard to the utility of attachment theory, the jury is still out. however, even if attachment theory is accepted as a sound framework for research, use of a more diverse range of perspectives will almost certainly enhance studies in the field. crisis intervention theories, anti-discrimination perspectives, social construction theories, and critical social work all contribute unique viewpoints and can be useful in forming research questions in child welfare. table 1 summarizes the basic premises of these theories and research questions that emerge from each perspective. crisis intervention theories according to crisis intervention theories, individuals are typically able to cope with change (roberts, 2000). when an event occurs that overwhelms a person’s existing coping strategies, he or she may learn new and more effective coping skills and emerge from the situation better able to handle taxing situations. conversely, if one is unable to acquire adequate coping abilities, he or she will fail to handle the stressor, resulting in a compromised level of functioning and an increased susceptibility to behavioral and mental health problems. advances in social work, spring 2008, 9(1) 11 children who enter protective services may experience events that challenge their ability to cope, including abuse and/or neglect and removal from their family of origin. crisis intervention theories provide a useful framework for research into how, if at all, children are able to cope with maltreatment. furthermore, studies may explore how children regain a sense of normalcy following removal from their home of origin, entry into the foster care system, and introduction of new caregivers. table 1: social work theories and potential applications to research in child welfare theoretical framework(s) basic premise child welfare research questions crisis intervention theories individuals are typically able to cope with change. crises challenge existing coping strategies and either result in improved skills or failure to cope, resulting in a decreased ability to manage life events (roberts, 2000). • how, if at all, are children able to cope with removal from home of origin? • how, if at all, are children able to cope with experiences of abuse or neglect? • what is the relationship, if any, between family crises and child abuse/neglect? anti-discrimination theories oppressive conditions exist to advance the power of privileged groups. institutionalized discrimination is harmful to society and individuals and should be challenged (thompson, 2003). • how can minority overrepresentation in child welfare system be explained? • are culturally acceptable practices misunderstood or viewed as inferior (e.g. fictive kinships)? • how are homosexuals impacted by child welfare policies? social construction theories human understanding of reality is the product of participation in social processes. social “problems” are not inherently problematic. they become so only when a social group labels them as such and suggests that political or social action is required (berger & luckmann, 1971; kituse & spector, 1973). • how effective is the use of strengths perspectives in changing behaviors/attitudes of child welfare workers? • do sociopolitical forces dictate which conditions are considered problematic or deviant? critical theories society as it is presently constructed is corrupted by political and economic inequalities that should be rectified. rather than focus on the well being of individuals, people should strive to change exploitative societal practices (pozzuto, angell, & dezendorf, 2005). • are child welfare decisions based on best interests or financial considerations? • how will privatization impact child welfare? • are child welfare courts accessible and understandable to the people they serve? research findings may also inform child welfare workers, law enforcement officers, and mental health professionals of which interventions improve the experiences of children in the child welfare system. in her qualitative study of children on the day they were taken washington/theory in child welfare research 12 into custody, folman (1998) found that virtually every child in her study who was removed from their home by a law enforcement officer was subsequently taken to a mcdonalds® restaurant. clearly, professionals are looking for answers on how to best support children when they are at risk of entering a crisis state. it is also clear that more answers are needed. anti-discrimination theories anti-discrimination theories focus on the oppressive forces that are present in our society’s institutions and policies. according to anti-discrimination theories, these conditions exist to advance the power of privileged groups and are harmful to both individuals and society (thompson, 2003). some theorists do not consider antidiscrimination perspectives to be a separate set of ideas, but argue that issues pertaining to equality and social justice should permeate all social work practice, policies, and research (payne, 2005). it is common knowledge that individuals experience discrimination of the basis of race, class, gender, sexual orientation, ethnicity, and religion, despite countless laws and policies designed to protect marginalized groups. child welfare is not immune to these discriminatory practices. anti-oppressive research may seek to explain minority overrepresentation in the child welfare system. are culturally sanctioned practices (e.g. fictive kinship, group care) misinterpreted by child welfare workers or viewed as somehow inferior? research may also attempt to answer the question asked by many social work practitioners: if social work is dominated by women, why are so many supervisors men? perhaps the most discussed discrimination in child welfare over the past decade is that pertaining to members of the lesbian, gay, bisexual, and transgendered community. politics and religion aside, objective research can provide answers to whether or not homosexual couples or individuals are as capable as their heterosexual counterparts of providing stable, nurturing environments for children awaiting foster homes or adoption. further study may also determine whether or not homosexual adolescents are adequately supported in foster homes or alternative care settings. not only do anti-discrimination theories provide a background for innovative research, they also allow social workers to fulfill obligations dictated by the profession. ethically, social workers must work toward increasing equality and social justice for all people (nasw, 1999). this is an honorable goal; however, it is impossible to achieve without a clear understanding of oppressive practices as they presently exist. continued research will grant the profession insights into the current status of discrimination in society. social construction theories social construction theories take objection with the notion that there is a singular, fixed reality upon which everyone naturally agrees. according to berger and luckmann (1971), human understanding of reality is the product of participation in social processes. kituse and spector (1973) expanded on the work of earlier social constructionists, explaining that there is nothing inherently problematic about the social phenomena that are labeled “social problems.” social problems only become defined as such when a group with considerable power or influence suggests that political or social action is required to change a given condition. research informed by social construction theories may seek to determine if advances in social work, spring 2008, 9(1) 13 there is something inherently dysfunctional about single parent families, all other things being equal. furthermore, would studies investigating the “problem” of children being raised by grandparents obtain different results if society viewed this family arrangement as legitimate, or at least adaptive? in recent years, the strengths perspective has gained popularity in child welfare settings, challenging workers to reconstruct the ways they think, write, and talk about clients and their families, viewing what would previously have been labeled as “problems” as opportunities or needs (saleebey, 2001). as professionals work to integrate strengths into practice models, it seems fair to ask how effective the use of the strengths perspective is in changing attitudes of child welfare workers and clients. furthermore, if thoughts and attitudes are changing, are these changes resulting in better outcomes for clients? research can contribute findings to answer these questions. critical theories critical theorists believe that society as it is presently constructed is corrupted by political and economic inequalities that should be rectified. rather than focus on the well being of individuals, critical theories suggest that members of society should strive to create macro-levels changes that minimize exploitation and distribute power more equitably (pozzuto et al., 2005). research in this area may seek to illustrate ways that social work supports and participates in an unjust society. studies may focus on the “hidden agendas” of social work decision makers by asking whether child welfare decisions are actually based on what is believed to be in the child’s best interest or if they are based on economic or public relations considerations. this will be a decidedly important focus as increasing numbers of private agencies provide child welfare services. with regard to individual rights of children and families, critical theorists may study the legal processes involved in the child welfare system, asking whether children (or their families, for that matter) adequately understand and are able to successfully navigate the complex world of guardians, child welfare workers, juvenile officers, therapists, and judges. research can then be used as a catalyst for systems-level change. conclusion albert einstein once said that it is the theory that decides what can be observed. if this is true, then research guided by a diverse range of theories can only expand social work’s knowledge base and improve the profession’s ability to thoroughly explore important social conditions. with nearly 300,000 children entering foster care each year (u.s. department of health and human services, 2003), the child welfare system undoubtedly deserves the highest quality of research and attention available. through continued diligence, study, and effort, social workers can create changes that improve the lives and futures of children. references ainsworth, m. d. s., blehar, m. c., waters, e., & wall, s. (1978). patterns of attachment: a psychological study of the strange situation. hillsdale, nj: erlbaum. washington/theory in child welfare research 14 augoustinos, m. (1987). developmental effects of child abuse: recent findings. child abuse & neglect, 11(1), 15-27. berger, p. l., & luckmann, t. (1971). the social construction of reality. harmondsworth: penguin. birns, b. (1999). attachment theory revisited: challenging conceptual and methodological sacred cows. feminism & psychology 9(1), 10-21. bolen, r. (2002). child sexual abuse and attachment theory: are we rushing headlong into another controversy? journal of child sexual abuse, 11(1), 95-124. bowlby, j. (1969). attachment and loss, vol. 1: attachment. new york: basic books. bowlby, j. (1973). attachment and loss, vol. 2: separation, anxiety and anger. new york: basic books. bowlby, j. (1980). attachment and loss, vol. 3: loss, sadness, and expression. new york: basic books. cahill, l. t., kaminer, r. k., & johnson, p. g. (1999). developmental, cognitive, and behavioral sequelae of child abuse. child and adolescent psychiatric clinics of north america, 8(4), 827-843. contratto, s. (2002). a feminist critique of attachment theory and evolutionary psychology. in m. ballou & l. s. brown (eds.), rethinking mental health and disorder: feminist perspectives (vol. xxii, pp. 29-47). new york, ny: guilford press. dumaret, a., coppel-batsch, m., & couraud, s. (1997). adult outcomes of children reared for long periods in foster families. child abuse & neglect, 21(10), 911-927. fagan, a. a. (2001). the gender cycle of violence: comparing the effects of child abuse and neglect on criminal offending for males and females. violence and victims, 16(4), 457-474. fish, b., & chapman, b. (2004). mental health risks to infants and toddlers in foster care. clinical social work journal, 32(2), 121-140. folman, r. d. (1998). "i was tooken": how children experience removal from their parents preliminary to placement into foster care. adoption quarterly, 2(2), 7-35. glaser, d. (2000). child abuse and neglect and the brain--a review. journal of child psychology and psychiatry, 41(1), 97-116. golding, k. (2003). helping foster carers, helping children: using attachment theory to guide practice. adoption & fostering, 27(2), 64-73. harvey, a. m. (2003). interview with dr. margaret keiley: a feminist journey to attachment theory. journal of feminist family therapy, 15(1), 65-71. howe, d. (1987). an introduction to social work theory. aldershot: gower. howe, d. (1995). attachment theory for social work practice. basingstoke: macmillan. howe, d., brandon, m., hinings, d., & schofield, g. (1999). attachment theory, child maltreatment and family support: a practice and assessment model. basingstoke: macmillan press. kagan, j. (1998). is there a self in infancy? in m. ferrari & r. sternberg (eds.), selfawareness: its nature and development (pp. 137-147). new york, ny: guilford press. kagan, j. (2004). the limitations of concepts in developmental psychology. merrill-palmer quarterly, 50(3), 291-298. advances in social work, spring 2008, 9(1) 15 kagan, j., & snidman, n. (2004). the long shadow of temperament. cambridge, ma: belknap press/harvard university press. kituse, j. i., & spector, m. (1973). the definition of social problems. social problems, 20(4), 407-419. main, m., & solomon, j. (1986). procedures for identifying infants as disorganized/disorientated during the ainsworth strange situation. in m. greenberg, d. cicchetti & m. cummings (eds.), attachment in the preschool years (pp. 273310). chicago: university of chicago press. mennen, f. e., & o'keefe, m. (2005). informed decisions in child welfare: the use of attachment theory. children and youth services review, 27(6), 577-593. nasw. (1999). code of ethics of the national association of social workers. retrieved september 23, 2005, from http://www.socialworkers.org neckoway, r., brownlee, k., jourdain, l. w., & miller, l. (2003). rethinking the role of attachment theory in child welfare practice with aboriginal people. canadian social work review, 20(1), 105-119. olafson, e. (2002). attachment theory and child sexual abuse: some cautions. journal of child sexual abuse, 11(1), 125-129. payne, m. (2005). modern social work theory (3rd ed.). chicago, il: lyceum books. pollak, s. d., cicchetti, d., hornung, k., & reed, a. (2000). recognizing emotion in faces: developmental effects of child abuse and neglect. developmental psychology, 36(5), 679-688. pozzuto, r., angell, g. b., & dezendorf, p. k. (2005). therapeutic critique: traditional versus critical perspectives. in s. hick, j. fook & r. pozzuto (eds.), social work: a critical turn. toronto: thompson educational publishing. roberts, a. r. (2000). an overview of crisis theory and crisis intervention. in a. r. roberts (ed.), crisis intervention handbook (2nd ed., pp. 3-30). new york, ny: oxford university press. saleebey, d. (ed.). (2001). the strengths perspective in social work practice (3rd ed.). boston, ma: allyn & bacon. smetana, j. g., & kelly, m. (1989). social cognition in maltreated children. in d. cicchetti & v. carlson (eds.), child maltreatment: theory and research on the causes and consequences of child abuse and neglect (vol. xx, pp. 620-646). new york, ny: cambridge university press. starr, r. h., jr., & wolfe, d. a. (eds.). (1991). the effects of child abuse and neglect: issues and research (vol. xiv). new york, ny: guilford press. steele, h. (2002). state of the art: attachment theory. the psychologist, 15(10), 518-522. thompson, n. (2003). anti-discriminatory practice (3rd ed.). basingstoke: palgrave macmillan. u.s. department of health and human services, children's bureau. (2003). 12 years of reporting maltreatment 2001. washington, dc: government printing office. zeanah, c. h., & fox, n. a. (2004). temperament and attachment disorders. journal of clinical child and adolescent psychology, 33(1), 32-41. http://www.socialworkers.org/ washington/theory in child welfare research 16 author’s note: address correspondence to: karla t. washington, msw, lcsw, university of missouricolumbia, school of social work, 7th floor clark hall, columbia, mo 65211. e-mail: washingtonkt@missouri.edu. mailto:washingtonkt@missouri.edu aisw vol. 5, no. 1 1 sequencing tasks in developing an accredited socialwork program and assessing program outcomes charles zastrow tim reutebuch abstract:two of themajor challenges for developing an accredited social work program are to sequence the tasks in developing an educational program and to develop accurate and useful assessment instruments. a model for sequencing the tasks is presented, and a field placement evaluation instrument is highlighted in assessing the extent to which students are attaining the program objectives. programs need to utilize multiple measures of program outcomes. keywords: accreditation, assessment, program development the accreditation standards of epas (educational policy and accreditation standards) (council on social work education, 2003) outline what baccalaureate andmaster’s programs in socialworkmust address inorder for aprogram to develop or reaffirm an accredited social work program. however, epas does not present a model for successfully accomplishing the tasks necessary to design an accredited program. administrative officials and faculty at colleges and universities in the united states who are seeking to develop an accredited social work educational program are often uncertain as to the specific steps that need to be taken. this article has two focuses. first, it summarizes an approach, ormodel, of the sequencingof tasks for developing an educational program. in the summary, it is advantageous to sequence the tasks in the following order: statement of programmission; statement of program goals; statement of program objectives; integrating program objectives with course objectives and into course syllabi; designing an assessment plan and developing assessment instruments; implementing the assessment plan; and using the results of assessment to improve the educational program. the second focus of the article is to illustrate how a carefully constructed field placement instrument, completed by the agency supervisors in field placement, has immenseusefulness in assessing the extent towhich students are attaining theprogram objectives. charles zastrow is professor and tim reutebuch is assistant professor, university of wisconsinwhitewater,whitewater,wi 53190. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 1-17. indiana university school of socialwork. 2 advances in socialwork sequencingoftasks indeveloping an accredited program for accomplishing complex projects, hepworth and larson (1993, p. 398-401) have noted it is essential to first partialize the tasks into “sub-tasks” in order to reduce them tomanageable parts.these parts consist of discrete actions that need to be undertaken. after partializing tasks into sub-tasks, the next step is to order the sub-tasks so that they flow from one to another in a natural sequence. the senior author of this article has visited/consulted with over 50 programs who were in the process of developing a social work program, or were in the process of seeking reaffirmation of accreditation. the senior author has also served two terms on the commission on accreditation. with this background experience, a model (or approach) has been formulated as to the sequencing of tasks in developing an accredited social work program. the faculty at a college or university who are seeking to develop an accredited social work program (in this model) should first state its program mission. the mission should be consistent with the campus’ mission and should reflect the intent for such mission statements as specified in educational policy and accreditation standards (epas) (council on socialwork education, 2003). to illustrate a program mission, our program has adopted the following mission statement: “the baccalaureate social work program (bsw) at the university of wisconsin-whitewater seeks to prepare social work students so as to ensue that they obtain the knowledge and skills necessary for beginning generalist social work practice as competent, effective professionals in urban and rural areas. the program has an emphasis on the strengths of client systems. recognizing that people are an integral part of their environment, the program utilizes an ecological model of human behavior. another emphasis of the program is on preparing social work professionals who are committed to services to the poor and oppressed, and who are oppressed, andwho are committed to promoting social and economic justice for populations-at-risk. the social work program also has a commitment to developing social work knowledge and providing leadership in the development of social work systems.” in our self-study documents, we further elaborate on how this programmission statement is consistent with the campus’ mission. next, program goals need to be stated, which should be derived from the program mission, and also reflect the intent of epas. to illustrate, our program has stated its goals as follows: 1. to prepare students for beginning generalist practice who facilitate the functioning of individuals, families, groups, organizations, and communities by helping them to accomplish tasks, and obtain and use resources. 2. to prepare students for beginning generalist practice who engage in prevention activities that promote well-being. 3. to prepare students for beginning generalist practice who participate in the planning, formulation, and implementation of social policies, services, resources and programs needed to meet basic human needs and support the development of human capacities. 4. to prepare students for beginning generalist practice who participate in the pursuit of policies, services, resources, and programs through organizational or administrative advocacy and social or political action; to empower groups at risk; and to promote social and economic justice. 5. to prepare students for beginning generalist practice without discrimination, with respect, and with knowledge and skills related to clients’ age, class, color, culture, disability, ethnicity, family structure, gender, marital status, national origin, race, religion, sex, and sexual orientation. 6. to prepare students for beginning generalist practice who participate in the development and testing of professional social work knowledge and skills. 7. to prepare students to recognize the global context of social work practice. 8. to emphasize preparation for providing direct services to diverse populations (with particular attention to populations-at-risk in southeastern wisconsin), to alleviate poverty and oppression, and to promote social and economic justice for all its citizens. 9. toprovide studentswith content about social contexts of socialworkpractice, the changing nature of those contexts, the behavior found in organizations, and the dynamics of change. 10. to provide curricula and teaching practices at the forefront of the new and changing knowledge base of social work and related disciplines. 11. to provide curricula that build on a liberal arts perspective to promote breadth of knowledge, critical thinking, and communication skills. uw-whitewater socialwork self-study documents, 2001 in our self-study documents, we also elaborate on how these goal statements are consistent with the programmission. then, the faculty should state the program objectives, which should relate to the program goals, and also reflect the intent for program objectives as specified in epas. the statement of program objectives is very important, as the development of the social work curriculum and assessment plan are largely determined by the statement of these program objectives. an example of the statement of program objectives follows. 1. apply critical thinking skills within the context of professional social work practice. 2. practicewithin the values andethics of the socialworkprofessionandwith an understanding of and respect for the positive value of diversity. 3. demonstrate the professional use of self. 4. understand the forms andmechanisms of oppression and discrimination and the strategies of change that advance social and economic justice. 3zastrow, reutebuch/sequencing tasks in developing an accredited socialwork program 5. understand the history of the social work profession and its current structures and issues. 6. apply the knowledge and skills of generalist social work to practice with systems of all sizes. 7. apply knowledge of bio-psycho-social variables that affect individual development andbehavior, anduse theoretical frameworks to understand the interactions among individuals and between individuals and social systems (i.e., families, groups, organizations, and communities). 8. analyze the impact of social policies on client systems, workers, and agencies. 9. evaluate research studies andapply findings topractice, and, under supervision, to evaluate their own practice interventions and those of other relevant systems. 10. use communication skills differentially with a variety of client populations, colleagues, andmembers of the community. 11. use supervision appropriate to generalist practice. 12. function within the structure of organizations and service delivery systems, and under supervision, seek necessary organizational change. (uwwhitewater social work self-study documents submitted to the council on socialwork education) such a statement of program objectives appears to be consistent with the guidelines for such objectives in the curriculum policy statement for baccalaureate degree programs in social work education (council on social work education, 1994). such a statement of program objectives also appears to be consistent with the guidelines for such objectives in epas (council on social work education, 2003). the next step is for faculty to specify the required courses in social work in which material related to these objectives will be taught and assessed. a time-consuming part of this process is to write the syllabi for the required courses. in writing the syllabi, it is important to incorporate (in appropriate courses) the program objectives. specified content in the syllabi needs to be “relevant to the mission, goals, and objectives of the program and to the purposes, values, and ethics of the social work profession” (council on social work education (2003, p. 34). the syllabi for the required courses alsoneed to address the following foundation curriculumcontent, which is described in epas: values and ethics; diversity; populations-at-risk and social and economic justice; human behavior and the social environment; social welfare policy and services; social work practice; research; and field education (council on socialwork education, 2003, p. 34-36). it is desirable for each required social work course syllabus to specify: lecture content, classroom activities, reading material, and assessment measures (such as tests, role-plays, classroom exercises, and student presentations) to assess the extent to which students are attaining the course objectives (which incorporate the program objectives). 4 advances in socialwork 5zastrow, reutebuch/sequencing tasks in developing an accredited socialwork program the next step is for the faculty to develop its assessment plan, which utilizes a variety of measurement instruments and procedures. examples ofmultiple assessmentmeasures include: periodic alumni surveys, student course evaluations, focus groupmeetings with selective students (such as minority, nontraditional students) to identify shortcomings in the educational program, passage rates on the certification exam for graduates of the program, and evaluation by agency supervisors on the extent to which interns are attaining program objectives. (a later section in this article will highlight a field placement instrument for assessing the extent to which students in a social work program are attaining the program objectives.) the next two steps in developing the social work educational program are: (a) implementing the assessment plan, and (b) using the results of the assessment to improve the educational program.these componentswill also be discussed later in this article. the importanceof assessing programoutcomes the educational policy and accreditation standards (epas) require that accredited baccalaureate and master’s programs in social work education in the united states have “an assessment plan and procedures for evaluating the outcome of each programobjective” (council on socialwork education, 2003, p. 41). epas further states, “the plan specifies themeasurement procedures andmethods used to evaluate the outcome of each program objective (council on social work education, 2003, p. 41). the organization that oversees accreditation entities in the united states is the council for higher education and accreditation (chea).when accreditation entities apply for accreditation recognition by chea, these entities must show their accreditation standards and procedures are consistent with chea’s principles. principle 1 of chea’s statement on good practices and shared responsibility in the creation and application of specialized accreditation standards states: (educational outcomes) standards should be designed to produce desired or needed educational outcomes for a profession and should refer to resources only to the extent required for graduates to emerge from programs intellectually prepared for their professional lives. (council for higher education accreditation, 2001, p. 1) this principle emphasizes the importance for all accredited higher education programs to assess the extent towhich graduates are attaining programobjectives. there are a variety of ways (previously mentioned) in which programs can assess the extent to which students are attaining the program objectives. one of these approaches is developing a field placement instrument in which field instructors assess the extent to which students are attaining program objectives. this approach has a number of strengths. an evaluation instrument can be constructed (relatively easily) that focuses on identifying the extent to which students are attaining program objectives. since evaluation of intern performance has to be conducted for grading purposes, using the same evaluations to assess program outcomes does not require much additional work. finally, this approach has the additional advantage of having external observers (field supervisors) evaluate the interns. (external observers are apt to bemore objective than evaluation plans that utilize students or faculty to assess the extent to which students are attaining the program objectives.) using a field placement instrument to assess programoutcomes the field placement instrument used by our program to assess program objectives is presented in the appendix at the end of this article. the agency supervisors fill out this evaluation at midterm and at the end of placement. in this social work baccalaureate program, practically all of the students enroll in block field placements—they are at an agency for one term (either fall, spring, or summer) for 480 hours—either four or five days a week. the faculty designed this instrument with the goal of using the results to provide information on the extent towhich students are attaining the 12 program objectives that were previously identified in this article. in developing this instrument, it should benoted that the program faculty concluded that since the 12 programobjectives are so broadly stated, the faculty needed to identify a number of more specific items for each program objective, which interns are evaluated upon by agency supervisors. the program has an annual departmental meeting to review the results of the various outcomemeasures that are used. at this meeting the identified shortcomings of the program are discussed by the faculty, and curriculum changes are then usually made to address these shortcomings. this process (including the assessment results and the resulting changes in curriculum) are then communicated to the campus administrative officials in an annual report. the faculty also communicate this information to the members of the program’s advisory board. the results from the field placement instrument in the past two years, 167 students have had field placement and graduated from the program. the results of the field placement evaluations were tabulated for all the interns who graduated in 2001 and 2002. a variety of mean scores were tabulated. through deliberation, the faculty decided that mean scores of higher than 2.00 were a matter of concern. mean scores of 2.00 or lower were considered acceptable by the faculty as they included the two following ratings: “(1)the intern has excelled in this area” and “(2) the intern is functioning above expectations for interns in this area.” the following are the results. the mean scores were tabulated on the midterm evaluations and separately on the final evaluations to get an averagemean score of all the items under each program objective. for example, under objective #1 (applies critical thinking skills within the context of professional social work practice) the average mean score received on the following items (grouped together) was tabulated: 1.1 has good assessment skills 1.2 has good problem-solving skills 1.3 has good data gathering skills 1.4 analyzes complex material well 1.5 has good critical thinking capacities 6 advances in socialwork the average mean scores for each program objective for both the midterm evaluations, and the final evaluations, were less than 2. this result indicated, overall, that agency supervisors believe that the interns in the programare doing quitewell in attaining the program objectives. furthermore, it was found the average mean scores for each program objective for the final evaluations were more highly rated (that is closer to 1.0) than for the midterm evaluations. this rating suggests the agency supervisors perceive interns, on the average, are attaining the program objectives to a higher extent at the end of field placement than at the middle of field placement. the mean scores for each item on the final evaluations were then tabulated. all of the mean scores for each item were found to be less than 2.0. this suggests the agency supervisors believe that, on the average, the graduating students in the program have sufficiently attained the knowledge, values, and skills expected of beginning level, generalist social workers. as far as program development is concerned, probably the most useful results were obtained when the mean scores for each item on the midterm evaluations were tabulated. the following items received mean scores higher than 2.0—indicating they were a matter of concern to agency supervisors. item number: (readers will note the wording of these items has been slightly changed for clarity purposes) 1.1 assessment skills 1.2 problem solving skills 5.3 knowledge of community resources 5.4 resourcefulness in identifying and using resources not commonly known 5.5 understanding of existing social welfare programs 6.4 effectiveness in macro change efforts in the community 7.1 knowledge of biological variables in assessing clients 7.2 knowledge of psychological variables in assessing clients 7.3 knowledge of sociological variables in assessing clients 7.6 integrating information from appropriate assessment tools 7.7 knowledge of intervention theories and techniques 9.3 capacity to evaluate his or her own practice interventions 9.4 capacity to evaluate the services provided by the field placement agency 10.1 being assertive 10.7 written work 10.9 contributing his or her thoughts in groupmeetings 7zastrow, reutebuch/sequencing tasks in developing an accredited socialwork program using the assessment results to improve the educational program it appeared to the faculty that agency supervisors were indicating by these midterm evaluation results that these are the areas that interns (on average) have some deficiencies in the first few weeks of placement. the facultymet at its annual assessmentmeeting and reviewed the results. for a few of the items, such as “knowledge of community resources” and “resourcefulness in identifying and using resources not commonly known,” it was thought that a contributing factor to such items being identified was that a number of interns selected a field placement in a geographic area in which they were not familiar. nevertheless, it was thought that faculty supervisors should give guidance to interns in these areas in field seminar meetings and in the faculty supervisor’s weekly review of intern logs. after considerable discussion, it was agreed that faculty who teach social work majors in any course should (in the future) refer those students having difficulties in the following areas: writing skills, being assertive, speaking in classes, assessment skills, problem solving skills, knowledge of intervention theories and techniques, and evaluation skills, to the department’s standards and support committee. the standards and support committee was formed several years ago to work with students identified as having issues involving academic or professional performance. the main thrust is to develop an individualized plan to assist each referred student in improving the identified academic or professional performance areas. for example, a student who is nonassertive and says little in class is apt to be urged to enroll in the department’s one-credit assertiveness course. a student who has deficiencies in writing skills is apt to be urged to take an additional writing course and go to the university’s writing laboratory for assistance in writing all of his/her papers. as a last resort, if a student does not show improvement in an essential social work competence area, the standards and support committee has the authority (with appropriate due process and grievance procedures) to terminate a student’s future enrollment in the social work program. the program will continue to use the field placement evaluation instrument, along with other assessment instruments and procedures, to assess the extent to which students are attaining the identified program objectives. summary this article has two main focuses, which are interrelated. first, it presents an approach (ormodel) of the sequencing of tasks for developing an accredited social work educational program.the suggested sequencing of tasks includes: specifying a mission statement; specifying program goals; specifying program objectives; integrating program objectives with course objectives and into course syllabi; designing an assessment plan and developing assessment instruments, implementing the assessment plan; and using the assessment results to improve the educational program. it is anticipated that this model, or approach, will be particularly useful to those programs that are in candidacy and those programs that are in the process of preparing their self-study documents for reaffirmation of accreditation. 8 advances in socialwork the second focus of this article demonstrates that a carefully constructed field placement instrument, completed by agency supervisors in field placement, has considerable usefulness in assessing the extent to which students (right before graduation) are attaining the program objectives. (it should be noted that social work programs need to use multiple measures of the extent to which students are attaining program objectives.) finally, social work programs need to use multiple measures of the extent to which students are attaining program objectives. references council for higher education accreditation. (2001, september). “statement ongood practices and shared responsibility in the creation and application of specialized accreditation standards,” washington, d.c.: author. council on social work education. (1994). handbook of accreditation standards and procedures, 4th edition, alexandria, va: author. council on social work education. (2003). handbook of accreditation standards and procedures, 5th edition, alexandria, va: author. hepworth, d.a., & j. larsen. (1993). direct social work practice, 4th ed. pacific grove, ca: brooks/cole publishing. uw-whitewater socialwork self-study documents, submitted to the council on socialwork education. (2001). additional resource references baskind, f.r., shank, b.w., & ferraro, e.k. (2001). accountability for professional practice: assessment in social work education. in c.a. palomba & t.w. banta (eds.), assessing student competence in accredited disciplines:pioneering approaches to assessment in higher education (pp. 95-119). sterling,va: stylus. cuzzi, l.c., holden, g., chernack, p., rutter, s., & rosenberg, g. (1997). evaluating social work field instruction: rotations versus year-long placements. research on socialwork practice, 7, 402-414. cuzzi, l.c., holden, g., rutter, s., rosenberg, g., & chernack, p. (1996). a pilot study of fieldwork rotations vs. year long placements for social work students in a public hospital. socialwork inhealth care, 24, 7391. gambrill, e.d. (2000). honest brokering of knowledge and ignorance. journal of socialwork education, 36, 387-397. gambrill, e.d. (2002). evaluating the outcomes of social work practice: a pilot program. journal of social work education, 38, 355-362. garcia, j.a., & floyd, c.e. (2002). addressing evaluative standards related to program assessment: how do we respond? journal of socialwork education, 38, 369-382. holden, g., barker, k., meenaghan, t., & rosenberg, g. (1999). research self-efficacy: a new possibility for educational outcomes assessment. journal of socialwork education, 35, 463-476. holden, g., meenaghan, t., anastas, j., & metrey, g. (2002). outcomes of social work education: the case for social work self-efficacy. journal of socialwork education, 38, 115-133. hull, g.h., mather, j.h., christopherson, p.m., &young, c.m. (1994). quality assurance in social work education: a comparison of outcome assessments across the continuum. journal of socialwork education, 30, 388-396. lubinescu, e.s., ratcliff, j.l., & gaffney, m.a. (2001). two continuums collide: accreditation and assessment.new directions for higher education, 113, 5-21. sheridan, m. (1998). assessment of the 1992 curriculum policy statement. council on social work education: alexandria, va. 9zastrow, reutebuch/sequencing tasks in developing an accredited socialwork program sheridan, m. (1999, winter). coep assessment of 1992 curriculum policy statement complete. social work education reporter, 47, pp. 7, 28. author’s note: address correspondence to: charles zastrow, social work department, university of wisconsinwhitewater,whitewater,wi 53190, usa. e-mail: chzastrow@charter.net 10 advances in socialwork 11zastrow, reutebuch/sequencing tasks in developing an accredited socialwork program midterm ❏ final ❏ name of intern date instructions for rating interns on the 12 objectives in the first part of the evaluation: the standard by which an intern is to be compared is that of a new beginning-level social worker. the 12 objectives specified in this evaluation form are those established by our national accrediting organization (the council on socialwork education). under each objective statement are several items that we ask that you rate according to the following criteria. comments may be made under any objective, if desired. please be sure to indicate those areas in which you think the intern is particularly strong and those areas that need improvement. this evaluation is intended to give the intern feedback about her or his performance. the agency supervisor’s rating of these items will not directly be used to calculate the grade that is given to the intern. the faculty supervisor has the responsibility of assigning the grade for the course. the grade that is assigned will be based on: the faculty supervisor’s overall evaluation of the student’s performance in placement in conjunction with the agency supervisor’s evaluation (65%); intern logs (10%); seminar participation (5%); two papers (10% each—20% total). if you prefer to use another evaluation system in addition to this form to evaluate a student’s performance, please discuss this with the faculty supervisor. 1.1 has good assessment skills 1 2 3 4 5 na 1.2 has good problem-solving skills 1 2 3 4 5 na 1.3 has good data gathering skills 1 2 3 4 5 na 1.4 analyzes complex material well 1 2 3 4 5 na 1.5 has good critical thinking capacities 1 2 3 4 5 na comments: appendix rating scale for evaluation of field placement performance (1) the intern has excelled in this area. (2) the intern is functioning above expectations for interns in this area. (3) the intern has met the expectations for interns in this area. (4) the intern has not as yet met the expectations in this area, but there is hope that the intern will meet the expectations in the near future. (5) the intern has not met the expectations in this area, and there is not much hope that the intern will meet the expectations in this area in the near future. (na) not applicable, as the intern has not had the opportunity to demonstrate competence in this area. objective #1: applies critical thinking skills within the context of professional social work practice. 12 advances in socialwork 2.1 has a commitment to promoting the well-being of clients 1 2 3 4 5 na 2.2 respects the right of clients to self-determination 1 2 3 4 5 na 2.3 is perceptive and attentive to cultural diversity 1 2 3 4 5 na 2.4 follows agency’s guidelines on confidentiality 1 2 3 4 5 na 2.5 has the capacity to communicate well with a variety of diverse groups 1 2 3 4 5 na 2.6 treats all clients with dignity, courtesy, and fairness 1 2 3 4 5 na comments: 3.1 presents self as a professional social worker 1 2 3 4 5 na 3.2 has a high level of self awareness 1 2 3 4 5 na 3.3 dress and appearance are consistent with agency standards 1 2 3 4 5 na 3.4 is self-confident 1 2 3 4 5 na 3.5 maintains poise and control in stressful situations 1 2 3 4 5 na 3.6 conveys an interest in helping others 1 2 3 4 5 na 3.7 has good interviewing skills 1 2 3 4 5 na 3.8 formulates realistic contracts with clients (including goals and planned intervention) and follows through, as appropriate to the agency setting 1 2 3 4 5 na 3.9 has ability to utilize group dynamics therapeutically 1 2 3 4 5 na 3.10 has ability to observe a group and make accurate assessments 1 2 3 4 5 na 3.11 has ability to co-facilitate or facilitate a group effectively 1 2 3 4 5 na comments: rating scale for evaluation of field placement performance (cont.) objective #2: practices within the values and ethics of the social work profession and with an understanding of and respect for the positive value of diversity. objective #3: demonstrates the professional use of self. 13zastrow, reutebuch/sequencing tasks in developing an accredited socialwork program 4.1 treats diverse clients with dignity and respect 1 2 3 4 5 na 4.2 has considerable awareness of the forms and mechanisms of oppression and discrimination 1 2 3 4 5 na 4.3 is committed to advancing social and economic justice for individuals and groups who are subjected to discrimination 1 2 3 4 5 na 4.4 uses pertinent information to assess clients, including attending to cultural/ethnic influences, gender roles, diversity of lifestyle, and access to resources 1 2 3 4 5 na 4.5 has an understanding of the impacts of various environmental conditions on individuals, groups, families, and communities (such as poverty and discrimination) 1 2 3 4 5 na comments: 5.1 is knowledgeable about the agency’s mission—its history, goals, and functions in the community 1 2 3 4 5 na 5.2 is knowledgeable about current social problems 1 2 3 4 5 na 5.3 is knowledgeable about community resources 1 2 3 4 5 na 5.4 demonstrates resourcefulness in identifying and using resources not commonly known 1 2 3 4 5 na 5.5 has a good understanding of existing social welfare programs 1 2 3 4 5 na comments: 6.1 is effective in providing services to individuals 1 2 3 4 5 na 6.2 is effective in providing services to groups 1 2 3 4 5 na 6.3 is effective in providing services to families 1 2 3 4 5 na 6.4 is effective in macro change efforts in the community (macro change efforts include efforts to develop new services and to improve existing services) 1 2 3 4 5 na 6.5 has the skills and tact to effectively work toward organizational changes in agencies 1 2 3 4 5 na comments: rating scale for evaluation of field placement performance (cont.) objective #4: understands the forms and mechanisms of oppression and discrimination and the strategies of change that advance social and economic justice. objective #5: understands the history of the social work profession and its current structures and issues. objective #6: applies the knowledge and skills of generalist social work to practice with systems of all sizes. 14 advances in socialwork 7.1 effectively uses knowledge of biological variables in assessing 1 2 3 4 5 na clients 7.2 effectively uses knowledge of psychological variables in 1 2 3 4 5 na assessing clients 7.3 effectively uses knowledge of sociological variables in 1 2 3 4 5 na assessing clients 7.4 is knowledgeable about social system theory 1 2 3 4 5 na 7.5 is effective in using the agency’s assessment system 1 2 3 4 5 na 7.6 uses and integrates information from appropriate 1 2 3 4 5 na assessment tools 7.7 has a good knowledge of intervention theories and 1 2 3 4 5 na techniques 7.8 demonstrates ability to establish intervention plans, and 1 2 3 4 5 na through in implementing the plans comments: 8.1 is knowledgeable of the field placement agency and its 1 2 3 4 5 na organizational structure 8.2 is knowledgeable of the relationship between the field 1 2 3 4 5 na placement agency and the larger human service delivery system in the community 8.3 has the ability to see gaps in the service delivery system 1 2 3 4 5 na and has the ability to suggest appropriate plans for change 8.4 understands the community and makes use of that 1 2 3 4 5 na understanding in working with clients 8.5 has an understanding of how social policy issues impact 1 2 3 4 5 na clients and the field placement agency 8.6 understands the limitations of the field placement agency 1 2 3 4 5 na in regard to financial and material resources and in regard to agency policy, and is able to work effectively within these constraints comments: rating scale for evaluation of field placement performance (cont.) objective #7: applies knowledge of bio-psycho-social variables that affect individual development and behavior, and uses theoretical frameworks to understand the interactions among individuals and social systems (i.e., families, groups, organizations, and communities). objective #8: analyzes the impact of social policies on client systems, workers, and agencies. 15zastrow, reutebuch/sequencing tasks in developing an accredited socialwork program 9.1 has demonstrated an appreciation of the importance of 1 2 3 4 5 na research 9.2 is interested in reading the results of research studies that 1 2 3 4 5 na are relevant to improving services at this field placement agency 9.3 has the capacity to evaluate his or her own practice 1 2 3 4 5 na interventions 9.4 has the capacity to evaluate the services provided by this 1 2 3 4 5 na field placement agency 9.5 has demonstrated competence in research at this field 1 2 3 4 5 na placement 9.6 has demonstrated competence in adhering to the 1 2 3 4 5 na documentation and records requirements of the agency comments: 10.1 is assertive 1 2 3 4 5 na 10.2 written work communicates ideas clearly 1 2 3 4 5 na 10.3 has written work completed on time 1 2 3 4 5 na 10.4 has written work completed in an efficient and accurate 1 2 3 4 5 na manner 10.5 is able to pull out the most important material/information 1 2 3 4 5 na to incorporate in his/her written work 10.6 is familiar with and clearly understands the style of writing 1 2 3 4 5 na utilized within the agency (i.e., knows the language, anachronisms, abbreviations, etc.) and makes appropriate use of these in assessments and other written work 10.7 written work reflects a clear understanding of the social 1 2 3 4 5 na worker’s role within the agency and service delivery system 10.8 has good public speaking skills 1 2 3 4 5 na 10.9 willingly contributes his or her thoughts and opinions 1 2 3 4 5 na in group meetings 10.10 appropriately adjusts his or her choice of work in 1 2 3 4 5 na communicating with different populations (e.g., communicates well with such diverse populations as children, adolescents, and other professionals) comments: rating scale for evaluation of field placement performance (cont.) objective #9: evaluates research studies and applies findings to practice, and, under supervision, evaluates his or her own practice interventions and those of other relevant systems. objective #10: uses communication skills differentially with a variety of client populations, colleagues, and members of the community. 16 advances in socialwork 11.1 is prepared for supervisory conferences 1 2 3 4 5 na 11.2 has a positive attitude toward supervision 1 2 3 4 5 na 11.3 is receptive to suggestions 1 2 3 4 5 na 11.4 is open to new ideas and differing points of view 1 2 3 4 5 na 11.5 seeks supervision when needed, and asks appropriate 1 2 3 4 5 na questions 11.6 appropriately informs supervisor of problematic situations 1 2 3 4 5 na 11.7 follows through effectively on work responsibilities 1 2 3 4 5 na assigned by supervisor(s) 11.8 handles differences of opinion with supervisor(s) with 1 2 3 4 5 na tact and diplomacy comments: 12.1 good attendance and punctuality 1 2 3 4 5 na 12.2 promptness in completing work assignments 1 2 3 4 5 na 12.3 good at prioritizing the work that needs to be done 1 2 3 4 5 na 12.4 dependable 1 2 3 4 5 na 12.5 is a team player 1 2 3 4 5 na 12.6 is a self-starter 1 2 3 4 5 na 12.7 has good professional relationships with clients 1 2 3 4 5 na 12.8 has a commitment to continue to seek out opportunities 1 2 3 4 5 na for professional growth 12.9 is aware of personal limitations 1 2 3 4 5 na 12.10 has good time management skills 1 2 3 4 5 na 12.11 abides by agency’s policies and standards 1 2 3 4 5 na 12.12 is professional in making suggestions for changes 1 2 3 4 5 na comments: rating scale for evaluation of field placement performance (cont.) objective #11: uses supervision appropriate to generalist practice. objective #12: functions well within the structure of organizations and service delivery systems, and under supervision, seeks necessary organizational change. 17zastrow, reutebuch/sequencing tasks in developing an accredited socialwork program please check one of the following at the midterm evaluation. at the final evaluation do not complete this section. � this intern is excelling in field placement by performing above expectations for interns. � this intern is meeting the expectations of a field placement intern. � this intern is functioning somewhat below the expectations of a field placement intern. there is a question whether this intern will be ready for beginning level social work practice by the end of placement. � this intern is functioning below the expectations of a field placement intern. there is considerable concern that this intern will not be ready for beginning level social work practice by the end of placement. this intern should perhaps be encouraged to pursue another major. comments/elaboration: please check one of the following at the final evaluation. at the midterm evaluation do not complete this section. � this intern has excelled in field placement by performing above expectations for interns. if an appropriate position were open at this agency for a beginning level social worker, this intern would be considered among the top candidates for this position. � this intern has met the expectations of the field placement. this intern is ready for beginning level social work practice. � this intern is not yet ready for beginning level social work practice. � this intern is not yet ready for beginning level social work practice and has demonstrated serious problems in performance, and perhaps should be encouraged to pursue another major. comments/elaboration: signature of agency field instructor _____________________________________________ agency __________________________________________________ date _______________ the following section should be completed by the intern: my agency supervisor and faculty supervisor have discussed this evaluation with me, and i have received a copy. my agreement or disagreement follows: intern’s signature ____________________________________date ____________________ � if the intern disagrees with the evaluation she/he should state that disagreement in writing and submit a copy to both the agency supervisor and the faculty supervisor. the dis agreement should be specific and should also relate to the items in the evaluation. rating scale for evaluation of field placement performance (cont.) overall evaluation at midterm: final overall evaluation: i agree with the evaluation � i do not agree with evaluation � microsoft word beder article copyedit bb __________ joan beder, dsw, is professor at the wurzweiler school of social work at yeshiva university in new york city. the author would like to acknowledge the support of the u.s. army medical department and the u.s. army medical command in this research project and particularly the gracious support of the medical command’s health policy and services directorate, behavioral health division. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 132-148 social work in the department of defense hospital: impact of the work joan c. beder abstract: social workers in the department of defense hospital system are faced with numerous challenges to best address the needs of the war wounded. social workers serve diverse roles on the multidisciplinary team and are integral to the hospital and hospital out-patient work environment. sometimes, however, the work extracts a toll on the social worker that may be expressed in terms of burnout and compassion fatigue. the converse is also true, that social workers may have a strong sense of compassion satisfaction about what they do. this article details the experience of social workers in department of defense hospitals. it describes the impact of the work on the social workers noting levels of compassion satisfaction, compassion fatigue, and burnout. keywords: military social workers, compassion satisfaction, compassion fatigue, burnout introduction quantitative research is the systematic investigation of phenomena that can be analyzed numerically. quantitative research is often done using surveys, structured questionnaires and/or multiple-choice questions. results are often presented as ‘hard numbers’ using varied statistical techniques for analysis (patten, 2004). the quantitative research reported in this article sought to inform the social service/military community about the experience of social workers working in the department of defense health care system, specifically evaluating levels of compassion satisfaction, compassion fatigue and burnout. the care of our wounded service members is divided into two systems – the department of defense and the veterans administration. while there is some overlap in terms of care, the usual trajectory for service members who have been wounded is that they will return to the united states and begin their treatment in a department of defense hospital. some of the less seriously injured – physically and/or emotionally are treated and will return to active duty overseas; for the more seriously wounded, those who will not be able to return to active duty, their medical situation is stabilized and ultimately their care is transitioned to a veterans administration (va) facility, ideally near their home and family. the department of defense employs approximately 500 social workers placed in 26 treatment facilities (hospitals offering both inand out-patient care), within 6 regions across the united states. the dod social workers may be military or civilian. within each dod facility social workers, as part of the multidisciplinary medical team, are managing caseloads of patients with complex psychosocial, mental and physical health needs. according to robichaux and keesee (2008) the responsibility of the multidisciplinary team within the dod is to ensure delivery of optimal health care while eliminating barriers, restrictions, and the stigma associated with injury, illness and beder/social work in the department of defense hospital 133 disability. this allows the service member to focus on both physical and psychological healing and to enable a return to good health. despite the integral role for social workers, limited research exists detailing the impact of their work experience – specifically, levels of compassion satisfaction, compassion fatigue and burnout for the social workers. within the dod system, many social workers are working with oif/oef service members with severe injuries, ptsd and traumatic brain injury. caseloads have increased as so many soldiers are surviving their injuries. chivers (2011) reported “…that fewer than 7.9 percent of the americans wounded in 2010 died, down from more than 11 percent the previous year and 14.3 percent in 2008. the reasons for the decline in death rates are mainly due to enhanced levels of care for the wounded, body armor and heavier armored vehicles. what this ‘improvement’ implies for the dod and va systems of care is a large and continuing influx of seriously wounded service members with intense and substantial physical and psychosocial needs” (p. 1). the study described in this article sought to examine whether a caseload, dominated by oif/oef service members cared for in a dod facility, had an impact on the social worker in terms of compassion fatigue, burnout and compassion satisfaction. were there particular units within the hospital that were more stressful (measured by burnout and compassion fatigue) for the social worker, regardless of their immersion in oif/oef? what was the impact on cf, bo and cf of a number of variables? it was anticipated that findings on this study would be helpful for social work administrators within the dod and by extension, the va system. purpose the war in afghanistan is nearing the tenth year and the iraq war has entered its eighth year. yet, there remains a paucity of research on clinicians who deliver health and mental health care to the returning troops. these clinicians physicians, social workers, nurses are faced with the daunting challenge of providing clinical treatment to a complex cohort amidst the collective shared trauma of ongoing war (tyson, 2007). while there has been a great deal of research on post traumatic stress disorder among trauma survivors, few researchers have examined the effects that traumatic events (such as war injury) have on people who are indirectly exposed to traumatic content, specifically, the helpers (palm, polusny, & follette, 2004). more recently, as noted by ballengerbrowning, schmitz, rothacker, hammer, webb-murphy, and johnson (2010), “…little is known about the burden of treating mental health disorders in the military” (p. 253). social workers play a vital role in the multidisciplinary team within the dod health care system and may be involved with mental health treatment, staff consultation, offering support for caregivers and family members, and participation in utilization review (rahia, 1999) as well as primary responsibility for direct patient interaction, support and care. in these diverse roles, the social worker is in daily contact with those severely injured and/or those who may have experienced traumatic injury to their body or mind. family members are also part of the caseload and often require as much if not more care and attention that the injured service member. in almost all cases, the patient, advances in social work, spring 2012, 13(1) 134 family and the social worker can anticipate difficulties with readjustment to the service member’s injury, potential for redeployment and/or adjustment to civilian life. the social worker is expected to be responsive to and involved in helping make that transition while involving caretakers and family members in the care of the patient. while engaged in their work, the social worker faces many challenges: helping the patient, engaging the family, managing increasing workloads and bureaucratic expectations. all of this is done in the context of being as supportive as possible to the needs of the service members and his/her family and within the context of a social work relationship based on empathy and caring. in the course of doing their work, social workers are exposed to the experiences of the returning service member as they recount what happened to them during the war. figley (1995) comments that “there is a cost to caring. professionals (social workers) who listen to clients’ stories of fear, pain, and suffering may feel similar fear, pain, and suffering because they care…the professional’s work, centered on the relief of the emotional suffering of clients, automatically includes absorbing information that is about suffering. often it includes absorbing that suffering as well” (p. 17). this absorption can lead the helper to a variety of responses. compassion satisfaction, compassion fatigue and burnout three major constructs help describe the potential for impact on social workers that work mainly with service members: compassion satisfaction (cs), compassion fatigue (cf) and burnout (bo). each construct addresses an aspect of the possible response of a social worker to their work. while cf, cs and bo are not limited to social workers in the military, this study details only the military cohort. compassion satisfaction compassion satisfaction relates to the pleasure derived from being able to do your work well. it includes feelings regarding satisfaction with one’s ability to be a caregiver, one’s feelings toward their colleagues, and their ability to make a contribution in the lives of another (stamm, 2005). “ to flourish, social workers experience the joy of helping others and find satisfaction in their work. this joy and satisfaction can lead to compassion satisfaction, including a sense of fulfillment derived from seeing clients suffer less and watching them transform from the role of victim to survivor (radey & figley, 2007, p. 208). many in the helping professions experience compassion satisfaction and have a positive feeling while doing work that is sustaining and nourishing (bride, radey, & figley, 2007). often, however, compassion satisfaction can be compromised by feelings of compassion fatigue. compassion fatigue compassion fatigue aka secondary traumatic stress and vicarious traumatization refers to the negative effects on the clinician due to work with the traumatized client, effects that leave the clinician depleted to some degree and unable to adequately or more fully engage empathically with the client (bride, 2007; adams, boscarino, & figley, 2006). at some point in the life of most professionals, there will be a period of time when beder/social work in the department of defense hospital 135 compassion fatigue occurs. this is not unique to social workers. however, the likelihood of experiencing compassion fatigue is higher for those who work with the traumatized (gentry, baranowsky, & dunning, 2002). research has documented that the following groups have reported compassion fatigue: first responders (salston, 2002), child protection workers (bride, radey, & figley, 2007; myers & cornille, 2002; nelsongardell & harris, 2003); mental health counselors (brady, guy, poelstra, & fletcherbrokaw, 1999; pearlman & mac ian, 1995); domestic violence counselors (bell, 2003); sexual assault counselors (ghahramanlou & brodbeck, 2000; schauben & frazier, 1995); ny city social workers who worked with clients after the 9/11 attack on the world trade center (boscarino, figley, & adams, 2004); substance abuse counselors (bride, 2007) and, various other healthcare services (cunningham, 2003; dane & chachkes, 2001). this expanse of research supports the assertion that caregivers of the traumatized are at risk for experiencing symptoms of compassion fatigue/traumatic stress, disrupted cognitive schema, and general psychological distress as a result of their work (bride, robinson, yegisdis, & figley, 2004). by extension, those who work with those traumatized by war are also at high risk for development of compassion fatigue. for those who experience compassion fatigue, there is greater potential for disruption in the helper’s experience of safety, trust, power, esteem, intimacy, independence, and control (mccann & pearlman, 1990; pearlman & saakvitne, 1995). additional symptoms of anxiety, disconnection, avoidance of social contact, difficulty in maintaining the therapeutic alliance, depression, somatization and disrupted beliefs about the self and others are also identified as possible outcomes of compassion fatigue (cunningham, 2003; pearlman & saakvitne, 1995). burnout burnout “…is associated with feeling of hopelessness and difficulties in dealing with work or in doing your job effectively. these negative feelings usually have a gradual onset. they can reflect the feeling that your efforts make no difference, or they can be associated with a very high workload or a non-supportive work environment” (stamm, 2005, p. 8). symptoms of burnout include feeling strained by having to work with people, issues with concentration and attention level and decreasing memory of work related details (national center for ptsd, 2004). burnout is often associated with bureaucratic demands that the worker feels are difficult to address or amend. empirical studies of burnout reveal it as an especially prevalent condition among helping professionals with mental health professionals demonstrating higher levels of burnout than primary healthcare workers (sprang, clark, & whitt-woosley, 2007). burnout differs from compassion fatigue in that compassion fatigue is the direct result of hearing emotionally shocking material from clients; burnout is a problem of the social environment in which people work. issues such as workload, lack of control and input into the system, insufficient rewards, unfairness, etc. are all potential causes of burnout (canfield, 2005). burnout is conceptualized as a defensive response to prolonged occupational exposure to demanding interpersonal situations that produce psychological strain and provide inadequate support (jenkins & baird, 2002, p. 424.) the process of ‘burning out’ is described as a “…progressive state occurring cumulatively over time with contributing advances in social work, spring 2012, 13(1) 136 factors related to both the individual, the populations served, and the organization.…” (newell & macneil, 2010, p. 59). maslach, jackson, and leiter’s (1996) view of burnout a widely acknowledged perspective is that it can be conceptualized as a multidimensional construct with three distinct domains: emotional exhaustion, depersonalization, and reduced sense of accomplishment. other attributes of burnout include physical exhaustion, dissatisfaction about oneself, cynicism towards clients (ballenger-browning, et al., 2011). in a recent study (ballenger-browning, et al., 2011) comparing levels of burnout among mental health providers serving the military and a normative sample of mental health providers serving a civilian population, it was noted that burnout in military mental health providers was similar to that reported in similar studies of mental health workers. of particular value in the study were the findings that patient caseload (both size and type), long working hours, amount of clinical experience, gender, occupation, and social support at work were predictors of burnout in the mental health providers working with the military. methods instrumentation the professional quality of life scale is a 30-item self-report measure that assesses the potential for compassion satisfaction (cs), the risk of compassion fatigue (cf) and risk of burnout (bo). according to the creators of the scale, it is “…the most commonly used measure of the positive and negative effects of working with people who have experienced extremely stressful events” (stamm, 2010, p. 12). the scale has been translated into numerous languages. the scale is available on the proqol website and “may be freely copied as long as (a) the author is credited, (b )no changes are made and (c) it is not sold except for in agreement specifically with the author” (stamm, 2010, p. 5). the scale is easily administered and takes about 7-10 minutes to complete. respondents are instructed to indicate how frequently each item was experienced in the last 30 days. each item is anchored in a 6-item likert scale (o=never, 1=rarely…5-very often). scoring requires summing the item responses for each 10-item subscale. five scores are reversed, (1, 4, 15, 17 and 29) before computing total subscale scores (stamm, 2010). the alpha reliabilities of the scale are: compassion satisfaction =.87, compassion fatigue =.80 and burnout =.72. the scale has good construct validity and is well validated with over 200 articles noted in the peer review literature (stamm, 2005). higher scores on the compassion satisfaction (cs) subscale indicate the subject is experiencing better satisfaction with his/her ability to provide care (e.g., care giving is an energy enhancing experience, increased self-efficacy). higher scores on the compassion fatigue (cf) subscale indicate the subject is at higher risk for compassion fatigue. higher scores on the burnout (bo) subscale indicate the subject is at risk of experiencing symptoms of burnout (e.g., hopelessness, helplessness, and depression). beder/social work in the department of defense hospital 137 the average score on the compassion subscale is 37 (sd 7; alpha scale reliability .87). about 25% of people score higher than 42 and about 25% score lower than 33. if you are in the higher range, you probably derive a good deal of professional satisfaction from your position. if you score lower than 33, you may be having proems with your job. the average score on the compassion fatigue scale is 13 (sd 6, alpha scale reliability .80). about 25% of people score higher than 17 and about 25% score lower than 8. if one score is above 17, you may want to take some time to understand and address your fears and work at what is frightening to you. on the burnout subscale, the average score is 22 (sd 6.0, alpha scale reliability.72) about 25% of people score higher than 27 and about 25% score lower than 18. if your score is below 18, this reflects positive feelings about your ability to be effective in your work. if your score is above 22, you may wish to think about what it is at work that makes you feel like you are not effective in your work (stamm, 2005). caution in interpreting the scores is suggested in that the scale is not designed as a diagnostic tool but is more designed to ‘raise flags’ and be a guide to both subjects and administrators as areas of concern and attention (stamm, 2010, p. 18). recruitment procedure this study was initiated at a large dod hospital in the northeast united states. institutional review board permission was granted to do both face-to-face and survey monkey interviews and an email soliciting participation in the study was sent to several dod hospitals through the initial irb granting institution. survey monkey is an internet computer program that allows a researcher to place their survey on a site that the subject can access through a dedicated link. responses were blinded so the researcher did not know where the responses were coming from and as no identifying information was noted on the survey, full anonymity was guaranteed. in both cases survey monkey or face-to-face interviewing the social worker guaranteed confidentiality and anonymity for both person and venue. several face-to-face interviews were conducted to help refine the survey before sending it out system wide. the sample was considered a convenience sample comprised of those who agreed to participate; it was clearly stated that participation by the social worker was voluntary. the survey consisted of essential demographic information (see figure 1) and the proqol instrument which measures compassion satisfaction, compassion fatigue and burnout. it was anticipated that the responder would spend about fifteen minutes completing the survey. all data from the surveys was aggregated. advances in social work, spring 2012, 13(1) 138 figure 1. dod interview questions ________________________________________________________________________________________ basic demographics age: 25-35______ 35-45_______ 45-55___ 55-65_______ 65+_______ gender: m_______ f________ how long have you been working as a msw? ____0-5 years ____6-10 ____11-15 ____15+ how long have you worked in the dod system? ___0-5 years ____6-10 ____11-15 ____15+ how long have you worked with oif/oef veterans? _____0-5 years 6-10_____ what service do you work on? _____surgical _______ptsd _______tbi _____behavioral health _______other ________case mgmt. ________administration do you work in-pt ________or out-pt _______ ________________________________________________________________________________________ sample one hundred forty-one social workers from 26 treatment facility venues completed surveys. table 1 shows the demographics of the study sample. as can be seen, the subjects were mostly female (75%), mainly working in out-patient services, with over 50% with less than 5 years within the dod hospital system. in addition, 80% had been working with the oef/oif population for 5 years or less, with a majority of social workers (37%) working in behavioral health. results in general, the sample (n=141) was above the reported national norms on the proqol sub-scales (stamm, 2005). while the compassion satisfaction mean score was 39.22 with a range from 23 to 50; 59%of the sample was higher than the nationally normed score of 37. the mean score for compassion fatigue was 21.5 with a range from 12 to 33; 45% of the sample was higher than the nationally normed score of 17. the burnout mean score was 28.22 with a range from 10-38 with 66.2% above the national norm of 22. to simplify this finding, this sample of social workers registered positive feelings (compassion satisfaction) about their work with over 59% feeling strongly positive. the scores on the compassion fatigue scale were high indicating the presence of compassion fatigue with 45% of the sample registering levels of compassion fatigue. in the area of burnout, the social workers were strongly above the norm with 66.2% registering high levels of burnout. beder/social work in the department of defense hospital 139 table 1. demographic characteristics of study participants (n=141) characteristic n % age: 25-35 10 07.1 36-45 32 22,7 46-55 50 35.5 56-65 42 29.8 > 65 7 05.0 gender: male 37 25.5 female 104 74.5 years as an msw: 0-5 10 07.1 6-10 27 19.1 11-15 34 24.1 16-20 19 13.5 21-25 16 11.3 > 25 35 24.8 years in the dod: 0-5 82 58.2 6-10 25 17.7 11-15 17 12.1 16-20 9 06.4 > 20 8 05.6 years working with oef/oif: 0-5 112 79.4 6-10 29 20.6 inpatient/ outpatient: inpatient 17 12.1 outpatient 124 27.9 service: surgical 10 07.1 ptsd 39 27.7 tbi 9 06.4 behavioral health 52 36.9 case mgmt. 6 04.3 administration 15 10.6 other (fap etc.) 10 07.1 an independent samples t-test was conducted to compare the levels of cs, cf and bo for those who work 50% and those who work 75% of their time with oef/oif service members. for those workers who spent 50% of their time with oef/oif service members, the scores on the subscales were minimally different, registering statistical significance (p>.05) only on cs, i.e., those social workers who worked 50% of their time with oef/oif service members experienced higher levels of cs. for those social workers who spent 75% of their time with oef/oif, the difference in the scores on the subscales was not statistically significant. advances in social work, spring 2012, 13(1) 140 table 2. demographic findings on proqol (n=141) compassion satisfaction (cs) – national norm = 37 compassion fatigue (cf) national norm = 17 burnout (bo) – national norm = 22 characteristic n cs cf bo age: 25-35 10 36.90 21.40 26.00 36-45 32 38.94 22.15 28.38 46-55 50 39.12 22.17 28.25 56-65 42 39.88 20.86 28.62 > 65 7 40.57 18.00 28.00 gender: male 37 38.81 21.68 28.30 female 104 39.37 21.45 28.19 years as an msw: 0-5 10 39.00 19.20 28.70 6-10 27 37.96 23.43 27.89 11-15 34 40.18 21.03 27.56 16-20 19 40.21 32.21 28.89 21-25 16 38.50 19.94 27.81 > 25 35 39.15 20.88 28.82 years in the dod: 0-5 82 38.66 22.21 28.70 6-10 25 40.16 21.44 26.12 11-15 17 39.88 20.17 29.06 16-20 9 39.56 19.33 28.33 21-25 4 43.00 18.00 29.25 > 25 4 37.50 19.50 26.75 years working with oef/oif: 0-5 112 39.18 21.68 28.04 6-10 29 39.39 20.82 28.96 inpatient/ outpatient: inpatient 17 40.94 18.88 27.24 outpatient 124 38.98 21.87 28.30 service: surgical 10 42.40 20.80 27.40 ptsd 39 39.85 22.59 28.69 tbi 9 36.00 20.33 30.44 behavioral health 52 38.33 21.96 28.71 case mgmt. 6 40.50 16.83 24.00 administration 15 38.80 20.40 26.33 other (fap etc.) 10 40.94 21.20 28.00 beder/social work in the department of defense hospital 141 proqol differences by demographics multiple regression is a statistical technique used to examine the effect of multiple variables on a dependent variable. this technique allows the researcher to identify which factors, from a group of factors, predict an outcome; in this case, which factors create the findings on the proqol subscales. multiple regression was conducted to determine which variables (age, gender, years in the dod, years as a social worker, and years working with oef/oif) were predictors of cs, cf and bo. regression results for cs indicated that no variable was reliable in predicting cs. for cf, the only variable that was a reliable predictor was years working in the dod health care system with higher cf scores for those working in the system from 0-5 years with cf decreasing over time. for bo, no variables were predictive. proqol by service social workers were asked to identify which service they worked on (surgical, ptsd, tbi, behavioral health, case management, administration). scores on the cs, cf and bo subscales were studied to assess scores by service worked. for cs, the three highest scores for the social workers were on the surgical service, followed by case management and administration – i.e., these three services registered the highest levels of compassion satisfaction, in that order. those social workers working with ptsd, followed by behavioral health and surgical recorded the highest scores on cf. the social workers working with tbi followed by behavioral health and ptsd recorded the highest scores on bo. it is important to note that the differences in these scores was not dramatic, perhaps a few points, but noteworthy nonetheless. the proqol subscales also evaluated the social workers to determine the impact of in-patient versus out-patient work. survey responders were asked to indicate whether the majority of their work was with in-patients or out-patients. scores on the subscales for cs and bo were not statistically significant based on inor out-patient service however the score on the cf scale registered statistical significance (p=>.05), i, e., those social workers who had a caseload that was predominately out-patient had higher levels of compassion fatigue. multiple regression was conducted to determine which variables – service, years in the dod health care system and whether the social worker worked inor out-patient – predicted subscale scores (see table 3). none of the three variables was a predictor for cs; for cf, each variable was predictive in the following order – whether the social worker was inor out-patient, years in the dod system and service worked; for bo, the only predictor was service worked with those working with traumatic brain injuries scoring the highest levels. advances in social work, spring 2012, 13(1) 142 table 3. results of multiple regression analysis – predictors of compassion satisfaction factor b std. error beta t sig. age 2.055 .655 .169 1.611 .109 msw (yrs) -.485 .559 -.126 -.868 .387 dod (yrs) .482 .533 .098 .903 .368 oef/oif (yrs) -.496 1.581 -.031 -.314 .754 gender .328 1.291 .023 .254 .800 service -.022 .281 -.007 -.080 .937 in-pt/out-pt -2.302 1.738 -.119 -1.325 .187 *p<0.05 **p<0.01 table 4. results of multiple regression analysis – predictors of compassion fatigue factor b std. error beta t sig. age -.874 .475 -.183 -1.842 .068 msw (yrs) .699 .405 .237 1.727 .087 dod (yrs) -.895 .387 -.237 -2.313 .022* oef/oif (yrs) .594 1.146 .049 .518 .605 gender -.235 .936 -.021 -.252 .802 service -.427 .204 -.175 -2.091 .038* in-pt/out-pt 3.738 1.260 .252 2.967 .004** *p<0.05 **p<0.01 table 5. results of multiple regression analysis – predictors of burnout factor b std. error beta t sig. age .194 .470 .043 .412 .681 msw (yrs) .373 .401 .133 .929 .354 dod (yrs) -.468 .383 -.130 -1.221 .224 oef/oif (yrs) 1.433 1.135 .124 1.263 .209 gender -.033 .927 -.003 -.035 .972 service -.474 .202 -.204 -2.345 .021* in-pt/out-pt 1.552 1.248 .110 1.244 .216 *p<0.05 **p<0.01 findings – recap for this sample of social workers: cs, cf and bo all registered above the subscale normed means; for those social workers who worked 50% of their time with oef/oif, cs was high; for those who work 75% of their time no subscale scores were elevated; beder/social work in the department of defense hospital 143 in evaluating demographic factors, bo and cs subscales were not related to demographic factors; cf was noted in those who were with the dod system 0-5 years; for those who worked on the surgical, case mgmt. and administration, higher levels of cs were noted, for those who work with ptsd, behavioral health and surgical, higher levels of cf were noted; for those who work with tbi, behavioral health and ptsd, higher levels of bo were noted; for those who work with out-patients, higher levels of cf were noted, not so with cs and bo; in evaluating the impact of service, years with the dod and in-patient factors, none were related to cs, out-patient, years with the dod (0-5 years in the system) and service were related to cf and only service was related to bo. discussion this sample of social workers represents approximately 35% of the total social work staff in the dod (141 sample of 500 social workers in the system). as such, the findings assume a fairly strong level of credibility as reflective of the feelings of the social workers system-wide. generally the social workers expressed compassion satisfaction derived from their work with 59% above national norms for the subscale. of some concern were the findings on the compassion fatigue and burnout subscales. while almost every social worker at some point will feel fatigued and burned out, over half of the responders (59%) noted levels of fatigue and two-thirds (66.2%) noted levels of burnout. this finding is not necessarily reflective of the oef/oif influx as scores on the subscales were not higher when social workers worked either 50% or 75% of their time with this specific cohort of returning service members. in fact, just the opposite; a surprising finding was that for those social workers who worked 50% of their time, their levels for compassion satisfaction were significantly (statistically) higher than those whose caseload was under 50%. the elevated cf and bo subscale scores suggests that attention to the burnout and compassion fatigue symptoms of the social workers might be initiated. these scores can be seen as reflecting the need for investigation of setting characteristics that might influence the development of these conditions. to further refine the cf and bo findings, the analysis indicated that the service areas where the high cf and bo scores occurred were those working with ptsd, behavioral health, surgery and tbi. these might be areas where administration could focus intervention designed to ease some of the pressure on these units. another area of concern, which was indicated in the analysis of the subscales, was the cf and bo scores for those social workers new to the system. both subscale scores were statistically significant above normed levels for those in the system 0-5 years. as the years went on, in five-year increments, the subscale scores went down to below cf and bo normed levels. this suggests that there is a ‘settling in’ process, an acculturation into the system and to the work that leads to diminished levels of cf and bo. to smooth advances in social work, spring 2012, 13(1) 144 the transition into the system, administration might consider particular attention to the new worker who may be assailed with challenges not anticipated when joining the system. the in-patient/out-patient finding – that those working in an out-patient setting had higher scores on the cf subscale – might be reflective of the location and size of the facilities in which the social workers are placed. on in-patient services, the interdisciplinary atmosphere and larger pool of workers might buffer some of the feelings of compassion fatigue. this finding might well be further researched to determine what specific action could address these responses. perhaps diversifying case assignments might be helpful with time spent working both inand out-patients. limitations interpretation of the findings of this study is limited by several factors. first, the design of the study utilized and relied on one instrument for its research. as noted earlier, the instrument is not to be considered diagnostic but more trend based; as such it is possible that the participant taking the survey might be having a ‘bad day’ or a few bad days which would be reflected in the responses on the proqol. in addition, as a selfreport device, many may have chosen not to respond to the call for participation, noting time constraints and other work obligations. conclusion “in many ways, the health of an organization depends on the health of its staff. this is especially important for industries like health care…..these facilities are often challenged when providers are worn down by either their work environment (burnout) or the content of their work (compassion fatigue)” (rudolph, stamm, & stamm, 1997, p. 88). since social workers are an integral component of the multidisciplinary team in the dod systems such, their care and well-being is important to the overall quality of care offered to our service members. the research reported in this article can be seen as a snapshot, a picture in time, which reflects a certain reality. as with any snapshot, the picture can change. as the war efforts in iraq and afghanistan continue and our wounded service members continue to return home, the work in the department of defense health care system will not ease, if anything, it will become more intense. work demands will increase. the social workers in the system are dedicated professionals working on behalf of our wounded. for the most part, as reflected in this study, they derive a large degree of satisfaction from their work. due to the nature of the work and the degree of caring, there is the potential for experiencing compassion fatigue and burnout. for optimal care to be given to our wounded, attention to staff needs is warranted. the findings in this article – not to be seen as a critique point to certain areas in the social work experience that merit attention. on-going research on the experience of social workers is needed to help social work administrators to be sensitive to the needs of their staffs, especially as caseloads expand and the war effort continues. beder/social work in the department of defense hospital 145 references adams, r., boscarino, j., & figley, c. 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(2010). the concise manual for the professional quality of life scale (2nd ed.). pocatello, id: proqol.org. tyson, j. (2007). compassion fatigue in the treatment of combat related trauma during wartime. journal of clinical social work, 35, 183-92. author’s note: address correspondence to: professor joan beder, wurzweiler school of social work at yeshiva university, 500 w. 185th st, new york, ny 10033. e-mail: beder@yu.edu advances in social work, spring 2012, 13(1) 148 appendix 1 professional quality of life scale helping others puts you in direct contact with other people’s lives. as you probably have experienced, your compassion for those you help has both positive and negative aspects. consider each of the following questions about you and your current situation. write in the number that honestly reflects how frequently you experienced these characteristics in the last 30 days. 0=never 1=rarely 2=a few times 3=somewhat often 4=often 5=very often _______1. i am happy. _______2. i am preoccupied with more than one person i help. _______3. i get satisfaction from being able to help people. _______4. i feel supported by the staff i work with. _______5. i jump or am startled by unexpected sounds. _______6. i feel invigorated after working with those i help. _______7. i find it difficult to separate my personal life from my life as a helper. _______8. i am losing sleep over a person i helped traumatic experiences. _______9. i think that i might have been infected by the traumatic stress of those i help. _______10. i feel trapped by my work as a helper. _______11. because of my helping, i feel "on edge" about various things. _______12. i like my work as a helper. _______13. i feel depressed as a result of my work as a helper. _______14. i feel as though i am experiencing the trauma of someone i have helped. _______15. i have beliefs that sustain me. _______16. i am pleased with how i am able to keep up with helping techniques and protocols. _______17. i am the person i always wanted to be. _______18. my work makes me feel satisfied. _______19. because of my work as a helper, i feel exhausted. _______20. i have happy thoughts and feelings about those i help and how i could help them. _______21. i feel overwhelmed by the amount of work or the size of the caseload i have to deal with. _______22. i believe i can make a difference through my work. _______23. i avoid certain activities or situations because they remind me of frightening experiences of the people i help. _______24. i plan to be a helper for a long time. _______25. as a result of my helping, i have intrusive, frightening thoughts. _______26. i feel "bogged down" by the system. _______27. i believe that i am a "success" as a helper. _______28. i can’t recall important parts of my work with trauma victims. _______29. i am an unduly sensitive person. _______30. i am happy that i chose to do this work. © b. hudnall stamm, 2003. professional quality of life: compassion fatigue and satisfaction subscales, riii. the authors of the scale have given permission for free copying of the scale as long as the items are not changed, the authors are credited, and the scale is not sold. advances vol. 3, no. 1 student-identified strengths and challenges of using blackboardtm for group projects in a socialwork course melissa b. littlefield abstract: blackboardtm provides social work educators integrated online communication tools that they can employ to facilitate student learning through features such as e-mail, discussion forums, file exchange, virtual classroom, and links to online resources. this study describes students’ experiences using blackboardtm to support a group project assignment. the majority of students found it easy to use and useful for the project, and indicated that they would like to use it in other courses. in addition, students gained technical skills as a result of the group project. students’ group project grades and final course grades were comparable to those in other sections of the same course taught by this investigator. the findings of this study suggest that online technology can be used to facilitate group assignments for msw students. the benefits include increased efficiency of group functioning and increased accountability of group members. the challenges include technical problems and student resistance to using the technology. keywords: social work education, technology, computers, internet, diversity, racism the proliferation of online educational software packages such as blackboardtm provides socialwork educators integrated communication tools to facilitate student learning through features such as e-mail, discussion forums, file exchange, virtual classroom, and links to online resources. blackboardtm may be employed in social work courses to support group project assignments that require frequent communication and interaction among students. scheduling difficulties and insufficient time pose a serious challenge to collaborative work on group projects outside of class. many msw students juggle courseworkand field instructionwithpaidemployment and family responsibilities. at regional schools, greater driving distances and long distance phone charges create additional challenges. blackboardtm can help students overcome these obstacles by facilitating ongoing interaction outside of class and between group meetings. this study described students’ experiences using blackboardtm for group projects in a social work course about racism and diversity. a qualitative study was undertaken to elicit student-identified strengths and challenges associated with using online technology for this purpose. 72 melissa b. littlefield, ph.d. is assistant professor, school of socialwork, university ofmaryland baltimore, baltimore, maryland 21201. copyright© 2002 advances in socialworkvol. 3 no. 1 (spring 2002) 72-83. indiana university school of socialwork. 73 literature review the promise of online technology for social work education lies in its capability to support adult learning processes. andragogy is the art and science of helping adults to learn. according to crook and brady (1998), strategies that promote collaborative learning, self-directed learning, and the immediate application of newly acquired knowledge and skills are key to andragogical approaches. online technology offers new formats for delivering course materials and facilitating ongoing interaction among students and between students and instructors that are congruent with andragogical approaches. social work educators have begun to employ online technology in courses about those addressing human diversity (miller-cribbs & chadiha, 1998); research (stocks & freddolino, 1998; 2000); introduction to social work (gasker & cascio, 2000); psychopathology (crook & brady, 1998); and social work with task groups, organizations, and communities (crook & brady, 1998). online technology has been employed to provide course materials, including lectures (stocks & freddolino, 1998; 2000;wernet, olliges, & delicath, 2000), lecture outlines (crook & brady, 1998; schoech, 2000), web pages with links to other web sites and documents that illustrate course concepts (miller-cribbs & chadiha, 1998; schoech, 2000), and for posting student work to share (schoech, 2000). online technology including listservs, e-mail, discussion forums, and online assignments have been used to enable students to collaboratively process course content and to extend class discussions (crook & brady, 1998; faux & black-hughes, 2000; gingerich, abel, d’aprix, nordquist & riebschleger, 1999; miller-cribbs & chadiha, 1998; stocks & freddolino, 1998; 2000;wernet et al., 2000). evidence suggests that online interaction increases class participation and enthusiasm for course content and enhances educational relationships (gasker & cascio, 2000; gingerich, et al., 1999; stocks & freddolino, 1998; 2000; vansoest, cannon, & grant, 2000). it is particularly beneficial for shy students (vansoest, et al., 2000) and female students (gasker & cascio, 2000). the flexibility in terms of time and space for discussion allows for thoughtful participation, as students have more time to process interactions and prepare their responses (schoech, 2000). schoech (2000) found comparable learning outcomes for students in sections taught entirely online compared to those in sections that did not employ online learning strategies. several authors have reported enhanced student learning as a result of implementing online technology into their courses (crook&brady, 1998; johnson & huff, 2000; miller-cribbs & chadiha, 1998). improvements in student technical proficiency have also been reported (miller-cribbs & chadiha, 1998; stocks & freddolino, 1998). despite the numerous benefits, the integration of online technology into social work courses presents significant challenges and raises certain instructional questions. for example, which students benefit from the use of such technology? wernet, et al. (2000) found that graduate students benefited more from using online technology in a research class than did undergraduates . they also determined that non-traditional students weremore likely than traditional ones to utilize online technology when it was available and to perceive it as beneficial. littlefield/using blackboardtm for group projects 74 advances in socialwork the need for face-to-face interaction appears to be important for some students, but not for others.while stocks and freddolino (1998) found that students inmsw research courses taught entirely online experienced the lack of face-to-face interaction with their classmates as a loss of an important classroom element, schoech (2000), who taught an online doctoral level course on technology-supported practice, did not. student-student interaction in online technology-enhanced courses has been relatively unstructured and voluntary. this may contribute to the somewhat less than optimal participation rates reported for students in online interaction and a high volume of exchanges that are not specifically related to course content. for example, some authors report a large proportion of online interactions related to questions about grades, assignments, acknowledgements of receiving messages, and other administrative concerns (johnson & huff, 2000; stocks & freddolino, 1998). stocks and freddolino (1998; 2000) found that providing more prompts for student interaction and self-directed learning increased the number of interactions that were relevant to course content and improved overall student perceptions of the class. a related issue is the need for guidelines regarding the appropriate uses of different types of online technology and the combinations of features necessary to support specific learning tasks. for example, faux and black-hughes (2000) found that providing course materials online without opportunities for student-student interaction resulted in negative student perceptions of the online instructional strategy they employed. technical problems are a consistent theme in the literature. students who lack computer skills or who are unable to consistently access the internet are often blocked from fully participating and generally report negative perceptions of the course, overall. students tend to experience frustration and anxiety as they develop new technical competencies. other technical problems that interfere with the learning experience include limited understanding of the capabilities of the online features by instructors, which may result in flawed assignment designs and systemic problems with the software that prohibit executing even the best conceived assignments (e.g., slow connections, system overloads, and crashes). the tiny body of literature on the use of online technology in social work education provides merely a glimpse of its possibilities and the concomitant pitfalls. to date, it has beenused in very limitedways todeliver course content, to increase student interaction in processing course materials, and to enhance educational relationships. only one study has reported using online technology for group projects. schoech (2000) attempted to use a chat feature for a group debate in a class taught entirely online, but found it unwieldy. this study involves the application of online technology for a group project in a class primarily taught face-to-face in a classroom setting. a qualitative research approachwas adopted to allowadeeper examination of students’ perceptions than is afforded by quantitative analysis, which characterize most previous studies on this topic. 75 methods group project design students in an msw-level racism and diversity course worked in groups to critically analyze a current issue related to the course. content included a brief historical summary that addressed how oppression and discrimination or sociallyconstructed difference shaped the issue; an incidence report; theories of causation; identification of current controversies; policy and practice intervention options; and implications for practice development. students self-selected into groups of three-to-five based on topics they generated in a class brainstorming session. the groups’ research findings were displayed in the form of “digital posters,” in the form of microsoft powerpointtm slideshows posted on blackboardtm and presented at an in-class digital poster forum. each student was required to complete a weekly journal that documented her or his experience completing the group project. the digital poster accounted for 75% of the group project grade. all students in a given group received the same grade for the digital poster portion of the group project. grading criteria included thoroughness in addressing the topic, appropriate utilization of concepts from class to analyze and discuss the issue, and organization and clarity. the journals accounted for the remaining 25% of the group project grade. the group project comprised 30% of the overall course grade. at the inception of the assignment, the instructor created a “group page” in blackboardtm for each group that contained a set of communication features that only group members could access. these included a discussion forum that enabled any group member to create a virtual space where all group members could post and respond to a particular issue; a “file exchange,” where any group member could upload a computer file in any format for other group members to access (provided that they had the software to open it); and an e-mail feature that allowed for messages to be exchanged within the group. the groups were instructed to utilize their group pages to support their group project work. no specific directions about how they should employ the features were given. brief instruction on how to use blackboardtm was provided by the professor in the early class sessions. an online manual was available to students, as well. students had some prior experience with using blackboardtm for a previous assignment. no inclass instruction on the use of powerpointtm was given. however, links from blackboardtm to online powerpointtm tutorials were provided. participants participants were social work students in one section of a racism and diversity course on a large urban campus that enrolls students from a multi-state area on the eastern seaboard. students ranged in age from 25 to 53, with a mean age of 31 years. the majority were female (84%), and predominantly white (58.3%), although 33.3% were african-american. the remaining 8.4% were asian and hispanic. full-time students represented 64%, while 36% were part-time students. the overwhelming majority of respondents (88%) had internet access at home, while 12% accessed the internet at work or from some other location. littlefield/using blackboardtm for group projects 76 advances in socialwork measures and data collection procedures two mechanisms were used to collect relevant data: (1) a self-report questionnaire consisting of 13 closedand open-ended items filled out by students at the end of the project; and (2) a 1,600 to 2,000 word journal where 400 to 500 words were written each week for the four week duration of the project. the questionnaire contained demographic items, items about the student’s computing capabilities before and after the group project, items about access to computers, three likert-scale items, and two open-ended questions about the disadvantages of using blackboardtm for completing group projects and how the professor could havemade the technologymore useful for the group project. journal content was required to focus on how the student used blackboardtm to work with his or her group, including information about the strengths and challenges of using the software. limitations a limitation of this study was a potential social desirability bias in student journals. students were strongly encouraged to be honest in sharing their feelings about their experiences with blackboardtm, and most reported both pros and cons of using the technology. however, some students may have been uncomfortable because their journals were not anonymous and counted toward their final grade. also, some students may have been very negative because they were resentful about being required to use blackboardtm. the questionnaires were anonymous and posed less of a threat to validity; however, a few students could be identified based on demographic information (e.g. the only black male in the class). again, the range of responses from positive to negative, suggested that social desirability did not pose a significant threat. results quantitative analysis students completed surveys in class at the conclusion of the group project assignment. a total of 25 surveys were returned (response rate of 96%). table 1 shows the distribution of students’ computing capabilities before and after the group project. practically all of the students were able to send e-mail and use word processing software prior to the group project, and the majority could send an attached document via e-mail. however, fewer than one-third could use powerpointtm prior to the group project. following the group project, there was a 32% increase in students who could send an attachment via e-mail and a 60% increase in those able to use powerpointtm. table 2 presents the distribution of students’ evaluation responses. themajority of students agreed that blackboardtm was useful in completing their group project, easy to use, and they would like to use it for group projects in other classes. qualitative analysis a qualitative analysis of the journals was conducted to identify the major themes and elements concerning how students utilized blackboardtm to support their group project work, identify the benefits of using the program for this purpose, and uncover problems and pitfalls they encountered. the results of the openended survey questions overlapped with the themes identified in the qualitative analysis of the student journals and are therefore not reported separately here. each student submitted four journal entries for a total of 104 documents that were analyzed. journals were electronically submitted to the professor in a popular word processed format (e.g., ms word, wordperfect) via the “digital drop box” feature of blackboardtm. analysis of the journals was facilitated by using atlastm, a software program designed for qualitative analysis. first, an open coding process was used to examine, compare, and categorize the data based on their latent content. in the subsequent phase of the analysis, axial coding was used to make connections between categories and pull out themes that naturally emerged. data were systematically reduced to three main themes: (1) how blackboardtm was employed to support group projects; (2) the strengths of using blackboardtm; and (3) the challenges of using blackboardtm. subthemes were identified within each of these main themes. using blackboardtm to support group projects balancing online and face-to-face interaction. all of the groups met face-toface outside of class over the duration of the project; they used blackboardtm for communicating with each other between meetings. earlier meetings focused on formulating the topic and work plan. towards the end of the project, groups met face-to-face to finalize their presentations. they also uniformly met in person to learn powerpointtm. the following comment illustrates this process. 77 computing capabilities before after frequency % frequency % send e-mail 25 100 25 100 attach document to e-mail 16 64 24 96 word processing 24 96 24 96 powerpointtm 7 28 22 88 table 1: percentage distribution of students’ computing capabilities before and after group project n=25 survey item strongly agree neutral disagree strongly agree disagree blackboardtm was 16% 52% 12% 8% 12% useful in completing my group project blackboardtm was 48% 28% 12% 12% 0% easy to use i would like to use 32% 32% 12% 4% 20% blackboardtm for group projects in other classes table 2: percentage distribution of students’ evaluation responses n=25 littlefield/using blackboardtm for group projects 78 advances in socialwork achieving the appropriate balance between using the blackboardtm technology and meeting in person, our group worked extremely well together. at first, we were apprehensive about relying solely on blackboardtm to complete the presentation; however, as time progressed,we discovered that blackboardtm was helpful in facilitating meetings, posting any completed work, and, of course, communicating in the absence of any member. our group found it necessary tomeet in the final stages of completing our project so we could compile and edit our information and create appealing slides. the few groups that did not establish a work plan, deadlines, and procedures for posting and updating documents experienced problems communicating, regardless of the extent to which they employed blackboardtm. as with any form of communication, blackboardtm was only useful if everyone in a group used it as prescribed by the group, including checking the group page frequently. many students found it difficult to have complex discussions or brainstorm online. one student who actively and effectively used blackboardtm throughout the project felt that the creative process was somewhat stifled due to a lack of regular face-to-face contact with group members. a few expressed a feeling of isolation from their groupmembers because the efficiency of blackboardtm decreased the need to meet frequently. there seemed to be a general consensus that faceto-face contact is a valued aspect of group project work. meeting in person was viewed as a way to get to know one’s classmates and feel connected to the group. the following comments capture these sentiments: the blackboardtm system,while good in theory, has mademe feel very disconnected frommy group. i think this is one of the negative aspects of the system. it doesn’t mandate meeting in person and tends to discourage forming friendships that come out of working together with classmates. but it has allowed me to better manage my time, as it negates having to drive to (campus) or stay very late after class. use of specific blackboardtm features. e-mail was the feature most often used in the earlier stages of the project, probably due to the fact that most students were familiar with it. students used e-mail to update each other on the status of their work, schedule meetings, send internet resources to each other, send drafts of their work, and provide feedback to each other about those drafts. the file exchange was most often used by groupmembers to share their ideas, resources, and drafts of their work. many students used e-mail in conjunction with the file exchange to inform other group members when they had posted a document. eventually, some groups moved away from using e-mail in favor of using the discussion forum because it provided a central place for group members to view all messages on a given topic and it automatically organized messages posted there by topic. students used the discussion forum feature to update their groups on the progress on their tasks and for group problem-solving. it was also used widely to provide feedback to each other on documents that were posted on the file exchange. 79 strengths of blackboardtm for group projects improved group efficiency. effective use of blackboardtm increased the efficiency of the group process for most groups. many students reported being able to accomplish more between meetings as a result of continuous communication. students were able to share resources and preview groupmembers’ work prior to meeting, thereby eliminating the need to spend valuable in-person group time engaged in these tasks, reducing the number of group meetings, and shortening face-to-face meetings, as illustrated by the following remarks. the blackboardtm system has been helpful in time management issues that all graduate students face but especially helpful in addressing concerns of a full-time working student. it has allowed me to work on the project anytime i have a free moment at the office or after i have finished my paid employment for the day. i have found this extremely helpful and wish my other courses were subscribed to this service. it would help me greatly with the term paper i am working on with two other students for human behavior 2. …because of blackboardtm we were able to stay focused during the meetings and they remained short and precise. in other group meetings i have had, we have always met for at least two hours and it would take the first half of the session to get all the information compiled and figure out who would dowhat. i definitely feel that by having blackboardtm available and being able to communicate before the meetings through e-mail and file exchange, we saved a lot of time in face-to-face meetings. many students found using blackboardtm to be easier for contacting their group members than attempting to reach them by phone. …inever had to deal with telephone answeringmachines (a definite plus) and the complications of reaching a convenient time for all of us to converse. …we do not have to make any long distance phone calls…we can respond even faster to each other’s questions and comments over the internet compared to a phone call” finally, students found that the links to databases and other internet resources provided on blackboardtm by the professor and the university’s library saved them time by helping them locate resources specific to their topic. increased accountability. an unanticipated benefit of blackboardtm was that it seemed to increase the level of accountability of students to their groups. members who were unable to attend meetings could still participate if they were near a computer. because there were ways to get information to the group even if they were not present, they were not “off-the-hook” in the eyes of their group members. even students who did notmissmeetingsmentioned that they felt that blackboardtm provided them with ways to demonstrate that they were making a contribution to the group. i have found that using blackboardtm is … particularly helpful when other group members simply can’t meet due to various reasons. blackboardtm littlefield/using blackboardtm for group projects 80 advances in socialwork enables allmembers of the group the ability to stay updated and current on the project at hand. blackboardtm holds all members responsible for completing their part of the project, because all members can communicate and access each other’s information from home, work or school. i have sent back a message to everyone in the group so that they will know that i haven’t abandoned the project and that i am still looking for information. challenges of using blackboardtm technical issues. some students experienced technical problems that were most likely due to their limited computer skills. they often reported their inability to log on or that the system was down when it was not. others experienced problems establishing network accounts at the university level, which delayed their online involvement and frustrated them and their group members. these students often needed hands-on technical assistance from the professor and the university technical support staff to resolve their issues. also, several students exchanged files that were infected with computer viruses. in addition to possibly infecting other group members who received and opened the files on their computers, the corrupted files often were illegible when opened. a major barrier for some students was limited access to a computer with an internet connection at homeorwork. using blackboardtm increased the amount of time students needed to spend online.thosewho could not frequently check their e-mail or their group’s pages in blackboardtm were at a disadvantage. in addition, students who relied on a dial-up connection to the university server experienced delays orwere unable to log onto the systemduring peak traffic hours.these problems were extremely frustrating for students and sometimes led them to view blackboardtm negatively and use it infrequently. resistance to computer usage for interpersonal communication. some students were very resistant to using computers in a social work course for which they believe that face-to-face interaction is paramount, in this case, racism and diversity. for these students, even the improved efficiency they found in using the program was not persuasive. i am fine with the idea of group projects, i even like and look forward to them, but the idea that i have to communicate with this stupid monitor more than my fellow humans, bothers me. i am dependent on my modem and the internet more than my brain, this doesn’t seem right or fair. my grade should not be so dependent on my computer literacy. it seems that the whole idea is antithetical to the theories behind group discourse. the idea of a group is to work together and bounce ideas off of one another. if i can’t see the faces of my group members, how will i know how they really feel about my ideas? to be perfectly honest, i feel like the entire conception and organization, as well as the digital nature of this project were highly unorganized. lack of comfort or skill with using the computer in this capacity led some students to resist, causing them to delay using the programuntil very late in the project. however, once they began to use it more frequently, they becamemore com81 fortable with it and appreciated the increased efficiency. ultimately, many of these students conceded that they never would have used the program if it had not been required, but they were glad they did because it helped them to overcome their technophobia and learn valuable new skills, as noted in the following comment: i am grateful for the exposure to blackboardtm and powerpointtm that this assignment has givenme. i see this opportunity as an important element of my graduate education. it is something i will take with me and be able to use in my professional career. as a matter of fact, i will be presenting this project to the adoption agencywhere i haveworked… for the past 10 years. discussion this study described students’ experiences using blackboardtm to support a group project assignment in a course about racism and diversity. the majority of students felt that the software was useful in completing the project and easy to use. they indicated that they would like to use it for group projects in other courses. in addition, students improved their technological proficiency as a result of the group project. students’ group project grades and final course grades were comparable to other sections of the same course taught by this investigator. this study suggests that online technology can be used to support group assignments. the benefits include increased efficiency of group functioning and increased accountability of group members. the challenges include technical problems and resistance to using the technology. the one previous study that addressed employing online technology for group projects found it to be cumbersome for this purpose (schoech, 2000). thismay have been due to the fact that the course in that study was taught entirely online, suggesting that using online technology for group projects may be more appropriate as an adjunct to face-toface courses. alternatively, it may be that the some features or combinations of features of online technology aremore appropriate for facilitating group projects. for example, asynchronous communication features, such as discussion forums and e-mail, may be more effective than real-time features, such as chat. consistent with other studies, this study found that online technology could support self-directed and collaborative learning for social work students. students used the technology to work in groups to investigate a current issue related to racism and diversity, and to share their findings with their classmates. given a structured task that required computer-mediated interaction, students employed technology primarily to facilitate their work, rather than for administrative purposes, as was the case in other studies in which the learning task involving online technology was less structured. it is also noteworthy that the vast majority of the students used online tutorials and worked collaboratively outside of class to learn at least some of the technological skills necessary to complete the project (e.g., powerpointtm, e-mailing attachments). this suggests that despite initial resistance, social work students can learn to use and appreciate technology. basic training and direction on how theymight employ particular features is beneficial in acclimating students. itmay also be useful to help students anticipate how computer-mediated interaction littlefield/using blackboardtm for group projects 82 advances in socialwork may differ from face-to-face interaction, and to offer guidelines for effective online communication. in addition, discomfort and limited proficiencymay prevent students from voluntarily using available technology, thus, educators may need to make it a requirement in order to ensure participation. finally, instructors need to anticipate technical problems and ensure that students have adequate computer and internet access, as well as technical support. consistent with the findings of other studies, blackboardtm did not eliminate the need for face-to-face contact, but supplemented it. until more effective strategies for sustaining educational relationships online and conventions for conveying nonverbal communication are developed, it seems unlikely that computer-mediated communication can replace face-to-face interaction in social work education. however, “cyberculture” is rapidly expanding and such conventions are beginning to emerge in limited forms. for example, schoech (2000) reported varied success in promoting online relationships in a course taught entirely online; studentdesigned personal web pages were useful, though online “class parties” were not. also, america online instant messengertm allows users to accent their chats with “emoticons,” that is,modified smiley face iconswith facial expressions that convey various emotions. in conclusion, online technology is redefining the educational arena—offering new formats for course delivery and expanded opportunities for students to engage in interactive, self-directed, and experiential learning that is relevant and related to real-world problems. although research in this area is limited, social work educators can begin to take advantage of the increasingly available online resources on campuses to help students meet their specific course objectives and to introduce them to technology that they are likely to encounter in their professional careers. references crook, w. p., & brady, m. j. (1998). computer-assisted instruction in the classroom: using a web shell. computers in human services, 15(2/3), 193-208. faux, t. l., & black-hughes, c. (2000). a comparison of using the internet versus lectures to teach social work history. research on socialwork practice, 10(4), 454-466. gasker, j., & cascio, t. (2000). computer-mediated interaction: a tool for facilitating the educational helping relationship. the journal of baccalaureate socialwork, 5(2), 145-159. gingerich,w. j., abel, e. m., d’aprix, a., nordquist, g., & riebschleger, j. (1999). using a listserv to extend classroom learning: a content analysis. journal of technology in human services, 16(4), 1-16. johnson, m. m., & huff, m. t. (2000). students’ use of computer mediated communication in a distance education course. research on socialwork practice, 10(4), 519-532. miller-cribbs, j. e., & chadiha, l. a. (1998). integrating the internet in a human diversity course. computers in human services, 15(2/3), 97-108. schoech, d. (2000). teaching over the internet: results of one doctoral course. research on social work practice, 10(4), 467-486. stocks, j. t., & freddolino, p. p. (1998). evaluation of a world wide web-based graduate research methods course. computers in human services, 15(2/3), 51-69. stocks, j. t., & freddolino, p. p. (2000). enhancing computer mediated teaching through interactivity: the second iteration of a world wide web based graduate social work course. research on social work practice, 10(4), 505-518. 83 vansoest, d., cannon, r., &grant, d. (2000). using and interactivewebsite to educate about cultural diversity and societal oppression. journal of socialwork education, 36(3), 463-480. wernet, s. p., olliges, r. h., & delicath, t. a. (2000). postcourse evaluations ofwebct (web course tools) classes by social work students. research on socialwork practice, 10(4), 487-504. author’s note: address correspondence to: melissa b. littlefield, ph.d, university of maryland school of socialwork, 525 w. redwood street, baltimore, maryland 21201 usa. e-mail: mlittlef@ssw.umaryland.edu. littlefield/using blackboardtm for group projects spring2001-057_page 52 spring2001-058_page 53 spring2001-059_page 54 spring2001-060_page 55 spring2001-061_page 56 spring2001-062_page 57 spring2001-063_page 58 spring2001-064_page 59 spring2001-065_page 60 spring2001-066_page 61 spring2001-067_page 62 spring2001-068_page 63 spring2001-069_page 64 social work practice in a developing continent: the case of africa social work practice in a developing continent: the case of africa christopher chitereka abstract: social work is a professional approach to ameliorating social problems. it is generally understood as a helping profession that utilizes professionally qualified personnel who use its knowledge base to help people tackle their social problems (mupedziswa, 2005). nevertheless, in developing countries, social work is a relatively young profession which was influenced by colonialism in its formation. the type of social work practiced in these countries largely mirrors the one that is being practiced in britain, france and portugal among others. utilizing the continent of africa as a case study, this article argues that social work practice in africa tends to be curative or remedial in nature and is not adequately addressing people’s problems. it therefore proposes a paradigm shift from remedial to a social development paradigm if it is to make an impact in the 21st century. keywords: social work; social development; africa introduction social work is a profession which seeks to help and empower vulnerable groups in society such as women, persons with disabilities, children and the elderly as well as people living with hiv/aids. in 2000, the two professional representative bodies, the international federation of social workers and the international association of schools of social work adopted the following definition of social work: the social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance wellbeing. utilizing theories of human behavior and social systems, social work intervenes at the points where people interact with their environments. principles of human rights and social justice are fundamental to social work (international federation of social workers, 2000, para. 1). that definition of social work will also be adopted for purposes of this article. the article seeks to discuss social work practice in africa. the basic argument advanced by the article is that the curative or remedial approach which is currently used in many african countries is not adequately addressing the needs of the majority of the population which resides largely in rural areas of the continent. it therefore advocates for the adoption of the social development paradigm. it first highlights the genesis of the profession of social work in africa. it then goes on to mention some of the problems faced by the african continent. the article then discusses social work in africa and the social development paradigm. it finally provides the conclusion and way forward. _________________ christopher chitereka, msw, is a senior lecturer in social work in the department of social anthropology/sociology and social work at the national university of lesotho. copyright © 2009 advances in social work vol. 10 no. 2 (fall 2009), 144-156 advances in social work, fall 2009, 10(2) 145 genesis of the social work profession in africa over the past few years, social work has expanded to virtually every corner of the world (darkwa, 2007). factors such as the fall of communism in the soviet union (hokenstad & kendall, 1995), the emergence of democratic institutions in africa, and the impact of the technological revolution have all contributed to the globalization of social work. in africa, a number of factors played an influential role in facilitating the emergence of social work. the activities of missionaries from europe and other parts of the world, african mutual aid societies, and the colonization of the continent by external powers all contributed to social work development on the continent. the missionaries preceded the colonizers. even though their primary role focused on addressing the religious and spiritual needs of africans, by establishing schools, vocational training, and engaging in almsgiving and community work, the missionaries functioned as informal social workers (darkwa, 2007). tribal and mutual aid societies have always existed in africa. prior to the development of statutory welfare systems, different types of mutual aid societies across the continent provided assistance to family members. some were family or kin-based (the largest category); others were culturaland/or religious-based (such as rotating credit societies, and informal service societies) (midgley, 1997). the african extended family, for example, has always operated as a social welfare system (apte & grieco, 1994), and they continue to address the social welfare needs of a sizeable number of africans who lack any form of social protection. however, on a more professional note, social work in africa is a relatively young profession introduced in the 1960s. although the first school of social work—the cairo school of social work in egypt—was established way back in 1937 (yiman, 1990), the profession did not take root until the 1960s. most african countries were once colonized and they attained independence in rapid succession in the 1960s. asamoah (1995) notes that although there are many regional differences with regards to social problems, economic growth, social development and political arrangements, newly independent countries south of the sahara had inadequate political and social infrastructures to support rapid social change and industrial development. social work in africa was generally influenced by and molded after activities in the colonizing powers, including britain, france and portugal, among others (mupedziswa, 2005). today, one can safely conclude that social work now exists as a profession in most african countries with some countries like zimbabwe, south africa, zambia, ethiopia, swaziland, nigeria, uganda, ghana, kenya, tanzania, rwanda and egypt training their own social workers. the training normally takes place in universities. basically, however, the approach of social work practice which was introduced and which remains in force in many african countries is the curative or remedial approach. this approach is really reactive and dealing with the symptoms and not the real causes of problems. a section below will highlight this issue in greater detail. problems faced by the african continent the continent of africa, home to more than 50 nations, is often dismissed as a continent of vast natural resources and primitive societies, governed by military dictators chitereka/social work in a developing continent 146 who change regularly. in fact, getting past the sensationalist headlines, one finds democratic governments struggling to get a foothold on this continent as well. many nations in africa have severe social problems which are threatening the moral fiber of societies. research has shown that one of the main triggers of social problems in africa is the scourge of poverty (muzaale, 1987). despite the fact that africa is potentially the richest continent on the planet, it is actually the poorest. for instance, studying poverty figures in africa produces a daunting picture. 315 million people: one in two people in sub saharan africa survive on less than one dollar per day. 184 million people: 33% of the african population suffers from malnutrition (united nations development programme, 2007). with regard to poverty of income, it is estimated that “just under three million households in south africa live on less than r1000 a month, approximately 105 euro” (monama, 2006, p. 3). poverty, manifesting itself in the form of the majority spending less than a dollar a day on their livelihood, degraded environment, and homelessness, is increasing at an alarming rate in africa and is mainly caused by corrupt regimes which do not care for the welfare of their citizens. it has been reported that the late presidents sani abacha of nigeria and mobutu sese seko of the former zaire looted their countries’ resources and had off-shore accounts. some current african leaders are still plundering their countries’ resources leading to the majority of their citizens wallowing in poverty. food insecurity is also a critical underlying factor that interfaces directly with extreme poverty particularly among the vulnerable groups. many african countries experience continued starvation year in and year out despite the rich and unexploited potential for increased food production. unreliable weather conditions, poor food security policies, high costs of fertilizers and other farm inputs, prohibitive transportation costs, lack of credit facilities for farmers and competition for markets created by global forces are contributory factors to food insecurity in africa. another serious problem facing most african countries is that of rampant unemployment. in south africa for instance, current unemployment rates range around 40% of the economically active population. the correlation between unemployment and poverty is significant in that 55% of people from poor households are unemployed, compared with 14% of those from non-poor households (may, 1998). many people are out of employment including university graduates. the rate of unemployment is likely to increase in the next few years considering the current global economic crisis. it can be argued that the problem of unemployment has led to other social ills such as prostitution, human trafficking, teenage pregnancies and high crime rates in africa. african countries also face unending civil wars and conflict among and within countries. conflicts in darfur-sudan, uganda and chad are some of the long-running ones on the continent and they have caused untold suffering among the ordinary people. this has led to a high number of people becoming refugees. refugees greatly strain the host countries’ resources and violent confrontations often occur between the refugees and the local population, like what happened in may, 2008 in south africa when south african citizens attacked people from other african countries. these conflicts and civil wars also lead to the abuse of women and children. child soldiers are now a rampant phenomenon in most conflict zones in africa. for instance, ariyo (2005) notes that out of advances in social work, fall 2009, 10(2) 147 300,000 child soldiers around the world, it is estimated that 120,000 of these are african children who have been forced and recruited to take part in wars and fighting in some african countries. the lord’s resistance army, a rebel group in uganda, is known to have a lot of child soldiers among its ranks. girl children are also being used as sex slaves by the rebels. so, in a nutshell, wars and conflicts in africa violate basic human rights, destabilize families and communities, and impact negatively on food production. africa has been affected most severely by the hiv/aids pandemic on the planet. the sub-saharan africa region has the highest infection rates in the world. the pandemic escalated in the region mainly due to the denial of the existence of the disease by most african leaders. by the time they acknowledged its existence, many people had been infected. an estimated 22 million adults and children were living with hiv in subsaharan africa at the end of 2007. during that year, an estimated 1.5 million africans died from aids. the epidemic has left behind some 11.6 million orphaned african children (avert, 2009). the estimated number of adults and children living with hiv/aids, the number of deaths from aids, and the number of living orphans in individual countries in sub-saharan africa at the end of 2007 are shown below. country people living with hiv/aids adult (15-49) rate % women with hiv/aids children with hiv/ aids aids deaths orphans due to aids angola 190,000 2.1 110,000 17,000 11,000 50,000 benin 64,000 1.2 37,000 5,400 3,300 29,000 botswana 300,000 23.9 170,000 15,000 11,000 95,000 burkina faso 130,000 1.6 61,000 10,000 9,200 100,000 burundi 110,000 2.0 53,000 15,000 11,000 120,000 cameroon 540,000 5.1 300,000 45,000 39,000 300,000 central african republic 160,000 6.3 91,000 14,000 11,000 72,000 chad 200,000 3.5 110,000 19,000 14,000 85,000 comoros <200 <0.1 <100 <100 <100 <100 congo 120,000 3.5 43,000 6,600 6,400 69,000 côte d'ivoire 480,000 3.9 250,000 52,000 38,000 420,000 dem. republic of congo 400,000500,000 1.21.5 210,000270,000 37,00052,000 24,000 34,000 270,000380,000 djibouti 16,000 3.1 8,700 1,100 1,100 5,200 equatorial guinea 11,000 3.4 5,900 <1,000 <1,000 4,800 eritrea 38,000 1.3 21,000 3,100 2,600 18,000 ethiopia 980,000 2.1 530,000 92,000 67,000 650,000 gabon 49,000 5.9 27,000 2,300 2,300 18,000 gambia 8,200 0.9 4,500 <1,000 <1,000 2,700 ghana 260,000 1.9 150,000 17,000 21,000 160,000 table continued on next page chitereka/social work in a developing continent 148 country people living with hiv/aids adult (15-49) rate % women with hiv/aids children with hiv/ aids aids deaths orphans due to aids guinea 87,000 1.6 48,000 6,300 4,500 25,000 guinea-bissau 16,000 1.8 8,700 1,500 1,100 6,200 kenya 1,500,0002,000,000 7.18.5 800,0001,100,000 130,000180,000 85,000 130,000 990,0001,400,000 lesotho 270,000 23.2 150,000 12,000 18,000 110,000 liberia 35,000 1.7 19,000 3,100 2,300 15,000 madagascar 14,000 0.1 3,400 <500 <1,000 3,400 malawi 930,000 11.9 490,000 91,000 68,000 560,000 mali 100,000 1.5 56,000 9,400 5,800 44,000 mauritania 14,000 0.8 3,900 <500 <1,000 3,000 mauritius 13,000 1.7 3,800 <100 <1,000 <500 mozambique 1,500,000 12.5 810,000 100,000 81,000 400,000 namibia 200,000 15.3 110,000 14,000 5,100 66,000 niger 60,000 0.8 17,000 3,200 4,000 25,000 nigeria 2,600,000 3.1 1,400,000 220,000 170,000 1,200,000 rwanda 150,000 2.8 78,000 19,000 7,800 220,000 senegal 67,000 1.0 38,000 3,100 1,800 8,400 sierra leone 55,000 1.7 30,000 4,000 3,300 16,000 somalia 24,000 0.5 6,700 <1,000 1,600 8,800 south africa 5,700,000 18.1 3,200,000 280,000 350,000 1,400,000 swaziland 190,000 26.1 100,000 15,000 10,000 56,000 togo 130,000 3.3 69,000 10,000 9,100 68,000 uganda 1,000,000 6.7 520,000 110,000 91,000 1,000,000 united rep. of tanzania 940,000 5.4 480,000 130,000 77,000 1,200,000 zambia 1,100,000 15.2 560,000 95,000 56,000 600,000 zimbabwe 1,300,000 15.3 680,000 120,000 140,000 1,000,000 total sub-saharan africa 22,000,000 5.0 12,000,000 1,800,000 1,500,000 11,600,000 source: unaids/who (2008.). the above statistics paint a grim picture for africa’s long-term development. hiv and aids have had a great impact in all spheres of life. avert (2009) observes that taking care of a person sick with aids is not only an emotional strain for household members, but also a strain on household resources. loss of income, additional care-related expenses, the reduced ability of care-givers to work, and mounting medical fees push affected households deeper into poverty. the financial burden of death can also be considerable, with some families in south africa easily spending seven times their total advances in social work, fall 2009, 10(2) 149 household monthly income on a funeral. the aids epidemic adds to food insecurity in many areas, as agricultural work is neglected or abandoned due to household illness. in malawi, where food shortages have had a devastating effect, it has been recognized that by 2020, malawi’s agricultural workforce will be 14% smaller than it would have been without hiv and aids. in other countries, such as mozambique, botswana, namibia and zimbabwe, the reduction is likely to be over 20% (avert, 2009). children have also been greatly affected by the pandemic. the epidemic not only causes children to lose their parents or guardians, but sometimes their childhood as well. as parents and family members become ill, children take on more responsibility to earn income, produce food and care for family members. it is harder for these children to access adequate nutrition, basic health care, housing and clothing. many children are now raised by their grandparents or left on their own in child-headed households (avert, 2009). finally, most african countries face the problem of homelessness especially in urban areas. the majority of the people lack shelter and they stay in squatter camps and slums. for instance, kenya is home to one of the world’s largest squatter settlement known as kibera which is located in the capital city of nairobi. other countries like south africa also have large informal settlements where poor people stay in shacks without access to basic social welfare services. according to chitereka (2005) the “abc” (abstinence, be faithful and condomise) model for managing hiv/aids is hampered in the slums and other informal settlements by overcrowding, a lack of essential facilities and poor communication among other factors. slums have serious implications for the prevention, treatment and care strategies for hiv/aids. improper housing to a greater extent contributes to the spread of hiv/aids among the vulnerable women and categories such as widows and women with disabilities, domestic workers, girls and elderly women. young girls are often exposed to early sexual intercourse, higher frequencies of unwanted pregnancies and exposure to rape (chitereka, 2005). the world cannot afford to overlook the problems faced by africa. it is a continent in great need and social workers, being helping professionals who seek to liberate and empower people, should be in the forefront of finding solutions to these problems. the nest section highlights the need for the adoption of the social development paradigm by social workers in africa to tackle the above-named problems. social work in africa and the social development paradigm social work in most african countries embraced the curative or remedial approach to solving social problems during its inception. for instance, kaseke (1991) notes that the development of social work in zimbabwe is closely tied to the country’s colonial history, its orientation reflecting a wholesale transfer from the british experience. he goes on to say that social work in zimbabwe also developed as a response to urban social ills such as crime, prostitution and destitution. the philosophy of the colonial policy makers was that such ills, if unattended, would undermine order and stability. social work was, therefore, seen primarily as an instrument of social control, and never seriously addressed itself to the root of social problems. even after independence, the department of social chitereka/social work in a developing continent 150 welfare, the largest employer of social workers, continues to be basically curative in orientation. nyanguru (2003) also notes that that in lesotho, social work practice was introduced during the colonial era by the british. it was mainly introduced to deal with social problems in the country. social welfare services were offered in such specialized areas as psychiatry and health sectors. they were basically remedial in nature and did not really address the causes of the problems. darkwa (2007) gives the example of ghana which was strongly influenced by the british welfare system during the 108 years of british colonization. he observes that the evolution of social work education and practice in ghana was based on british principles and values. the british were mainly interested in supporting the welfare of those who were of crucial importance to the goals of furthering the colonization of the country, i.e. the civil service. as a result, social work education and practice was oriented towards addressing the needs of those working in the formal sector and it was curative in orientation. to date, the colonial influence still shapes social work training and practice in ghana. however, of late, the country is experiencing a trend toward the localization of social work education and more specifically, the programs are evolving to become more relevant to the needs of the ghanaian people (darkwa, 2007). francophone african countries such as senegal and ivory coast also inherited the french social welfare system which was largely remedial in nature and did not serve the needs of the vast majority of the people in these countries. services were mostly concentrated in urban areas where a few people stayed at the expense of rural areas where the majority of the people stayed. this situation continues to this day. the development of social welfare systems, social work practice and social work education must be understood within the historical context of each country’s pre-colonial and post-colonial experience. the basic institutions (political, legal, social, economic and educational) of all african countries both influenced and were influenced by the formal response to the meeting of human need (asamoah, 1995). britain exported a remedial model which was based on the principles underlying remedial services in the united kingdom. therefore, services in former british colonies focused on rehabilitation and, not surprisingly, selected as the unit of attention vulnerable individuals including women, migrants, homeless children, the disabled, juvenile delinquents, the unemployed, and the physically and mentally ill (asamoah, 1995) social policies and systems in former french colonies and territories reflected the more comprehensive approach embodied in the french overseas labor code. neither the british nor the french approach placed much emphasis on prevention. prevailing social problems were targeted for cure, and a developmental focus was virtually non-existent. asamoah (1995) also argues that, perhaps even more important, many of the approaches and practices labeled social work were not compatible with the cultural traditions of the countries in which they were carried out but they continued for many years. it is clear that even after attaining their independence most african countries are still using the remedial or curative approach in dealing with social problems in their countries. the majority of social workers are employed in departments of social welfare whilst advances in social work, fall 2009, 10(2) 151 others are employed in correctional services and hospitals, police and defense forces and industries where the remedial approach is usually used. a few are employed by nongovernmental organizations (ngos).the social workers employed by ngos normally use the community work method and they are contributing a lot to most african countries’ development. for instance fikre mariam worku the founder of the ngo misericordia ethiopia in an interview by alain leterrier (2000) says that if there is no development, social work is not important. if you have to solve the problems of people, you have to work for development as well as for social work. she goes on to say, “what i mean is that social work to be effective has to be sustainable. people have to be self autonomous, they have to help themselves, and that is development. so for me, social work is another side of development” (worku quoted in an interview by leterrier 2000, p. 1). midgley (1981) coined the term “professional imperialism” to highlight the continued use by developing countries of western oriented social work practice. he also laments the use of remedial social work especially in african countries where problems are vast. the casework method which is normally utilized by social workers in the departments of social welfare in most african countries is clearly inadequate to meet the challenges and immense problems faced by the continent. mupedziswa (2005) also argues that this strategy takes insufficient cognizance of the social and economic reality of the situation in africa, for instance, the culture, poverty levels and squalid conditions. the remedial approach has been accused of lacking in terms of sensitivity to the demands of african culture. it tends to ignore traditional, informal forms of welfare and the role of the extended family network in particular, in social welfare provision. public assistance, which thrived on the granting of means-tested handouts, for instance, has routinely not taken cognizance of the reciprocity that is synonymous with traditional african communities, rendering its interventions and programs virtually ineffective. mupedziswa (2005) further notes that a major concern has also been that the remedial approach in social work in africa has tended to ignore concerns of a more developmental nature, such as unemployment, inadequate shelter, homelessness, illiteracy, disease and ignorance, while concentrating on individual pathologies. as a result of this, many critics (gray, coates & bird 2008; ose-hwedie & rankhopo, 2008) argue that social work practice in its present form is virtually ineffective. worku in the interview by leterrier (2000) says that she perceives that social work in africa is different from social work in europe. in europe she argues, you might have to work with people with psychological problems but in africa social work has to focus on the poverty, the problem of people. if you work on poverty, you work for development so there is a strong link. there is, therefore, need for a paradigm shift if social work in africa is to make a difference in the lives of the majority of the population in the 21st century. for social work to be effective in the african context, the author proposes the adoption of the social development paradigm by social workers. it is widely accepted that a social development paradigm is both appropriate and necessary for the african context, and social development has significantly influenced social work theory, policy and practice on the continent (cox & pawal, 2005; gray & fook, 2004, patel, 2005). indeed, this approach seeks to liberate and empower people instead of having them rely on the state for assistance. there are so many problems in chitereka/social work in a developing continent 152 africa which can be ameliorated by the social development approach. healy (2008) notes that among the many development concepts, social development is particularly important to social work. social development acknowledges the importance of social factors in ensuring that development improves human well-being, arguing that development should be a holistic process. it aims to integrate social with economic factors. as midgley (1995) explains: social development “is a process of planned social change designed to promote the well-being of the population as a whole in conjunction with a dynamic process of economic development” (p.25). social development also gives emphasis to outcomes of improving well-being of the poor and processes that emphasize participation. paiva’s (1977) early definition of social development is a very vital one: “the goal and substance of social development is the welfare of the people, as determined by the people themselves, and the consequent creation or alteration of institutions so as to create a capacity for meeting human needs at all levels (especially those at the lower levels) and for improving the quality of human relationships and relationships between people and social institutions” (p. 329). it includes the ideas of participation, institution building, and distributive justice, key concepts in social development. omer (1979) defined social development as “a goal and a process that aims to achieve an integrated, balanced and unified (social and economic) development of society” (p. 15). healy (2008) observes that these elements of early social work definitions of social development are repeated in more current united nations definitions. the international forum for social development, an initiative of the un secretariat, characterizes social development as a set of objectives, a process, and a perspective. advances in social development mean advances in the well-being of the person and the harmonious functioning of society. it includes improvements in individual and family well-being through the enjoyment of human rights, the provision of economic opportunities, the reduction of poverty, and access to social security, social protection and social services. it includes also the building or maintenance of social relations, structures and institutions through which individuals and groups constitute a viable society (united nations, 2002). healy (2008) notes that in some parts of the world, social work redefined itself as social development to align the profession more closely with national objectives. this was particularly true in parts of asia. midgley (1999) also recommends human capital development, social capital development, and productive employment projects as social development intervention strategies relevant for social work. indeed, african countries should embrace the social development paradigm because, unlike curative or remedial social work, it makes people self-reliant. many people in these countries usually depend on their governments especially during times of crises. if a social development paradigm is adopted by social workers in african countries, more people will be more self-conscious and aware of their rights. issues of corruption and poor governance will be minimized as the majority of the people will participate in issues affecting their welfare. a strong correlation exists between good governance and positive social development outcomes. although good governance on its own does not necessarily lead to improved quality of life, it is perhaps the single most important determinant factor advances in social work, fall 2009, 10(2) 153 in eradicating poverty, reducing development disparities, and minimizing the occurrence of several other human-generated tensions, conflicts and social problems in africa, and often calls for social workers’ interventions. corruption, unethical practices and all other associated vices are principal manifestations of poor governance. conclusion and the way forward although social work is a relatively young profession in africa, it has over the years developed into a viable profession. it is now integrated in most government departments of social welfare, hospitals, correctional services, police and defense forces where the casework method is mainly dominant. social workers employed in ngos can be commended because by and large they utilize the community work method of social work in the course of their work, which is consistent with the social development paradigm. the profession of social work in africa nevertheless faces a number of problems which need to be addressed urgently if it is to effectively deliver social services to the majority of people who are mainly poverty stricken. some of the problems include lack of resourcesboth material and financial, low wages and salaries for social work professionals coupled with poor conditions of service as well as lack of proper professional recognition of social workers in africa. these will be briefly explained below. firstly, most social workers in africa lack both material and financial resources to carry out their duties. this a result of insufficient allocations of budget funds for the social services. there has been a general decline in social welfare budgets throughout africa in the last few years, yet there are more social problems which need to be tackled. social workers often lack basic items like offices, telephones and computers as well as transport to carry out home visits. this completely compromises their effectiveness to deliver services. secondly, there remains a considerable lag in wages and salaries between social workers and those employed in other sectors in africa. furthermore, their working conditions are not very attractive. they work long hours and carry heavy caseloads. because of these reasons, highly qualified social workers in africa have left the profession altogether whilst some have left the continent to work in countries like britain, usa, new zealand, canada and australia where salaries and conditions are comparatively better. finally, there is a general lack of professional recognition of social workers in africa. this is due to the fact that most people do not understand what social work is, even among some government officials. that is the reason why in countries like lesotho and zimbabwe people with no training sociologists and political scientists are employed as “social workers”. social workers in africa have to raise awareness on the hiv/aids pandemic which is threatening to decimate the people on the african continent. they must lobby governments to provide anti-retroviral drugs to hiv positive people. social workers should also help in the destigmatization of the disease so that more people get tested and get treatment early. chitereka/social work in a developing continent 154 if social workers are to be taken seriously as a profession in africa, they should form strong professional associations in their respective countries which in turn lobby for their rights with governments. these professional associations will also highlight the need for increased budget allocations for the social welfare sectors by governments as well as improve wages, salaries and conditions of service for social workers. in conclusion, africa is a continent with great developmental potential but it is still mired by a myriad of social problems which require social work intervention. social workers in africa need to be proactive rather than reactive when dealing with these problems. although the curative or remedial approach which hitherto has been the major form of intervention is still needed, social workers need to adopt the social development paradigm if they are to effectively confront the various problems currently facing the continent. social development leads to an improvement to people’s quality of life. once people see real changes in their lives because of social work intervention, they will ultimately respect the profession and value social work services. references apte, n. & grieco, m. 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(2003). the strengths and weaknesses of the department of social welfare in lesotho. maseru: lesotho law reform commission. omer, s. (1979). social development. international social work, 22(3), 11-26. osei-hwedie, k., & rankopo, m. (2008). developing culturally relevant social work education in africa: the case of botswana. in m. gray, j. coates & m.y. bird (eds.), indigenous social work around the world (pp. 203-219). cornwall: ashgate. http://www.ifsw.org/p38000279.html http://www.lesnouvelles.org/p10_magazine/15_grandentretien/15015_fikremariam2eng.html http://www.lesnouvelles.org/p10_magazine/15_grandentretien/15015_fikremariam2eng.html chitereka/social work in a developing continent 156 paiva, j. f. x. (1977). a conception of social development. social service review, 51, 327-336. patel, l. (2005). social welfare and social development in south africa. cape town: oxford university southern africa. unaids/who. (2008). report on the global aids epidemic. geneva: united nations. united nations. (2002, february 7-8). financing global social development: report. paper presented at international forum for social development, new york. united nations development program. (2007). facts on poverty in africa. retrieved april 27, 2009 from: www.africa2015.org/factspoverty. yiman, a. (1990). social development in africa 1950-1985. avebury: aldershot. author’s note: address correspondence to: christopher chitereka, the national university of lesotho, department of social anthropology/sociology and social work, p.o. roma 180, roma, lesotho. email: chitereka@yahoo.co.uk. http://www.africa2015.org/factspoverty mailto:chitereka@yahoo.co.uk introduction genesis of the social work profession in africa problems faced by the african continent social work in africa and the social development paradigm conclusion and the way forward aisw vol. 5, no. 2 197 teaching content on socialwork practice with religious congregations: a curriculummodule michael sherr terrywolfer abstract:this pilot study represents an effort to implement and evaluate use of a curriculum module on charitable choice and social work practice in a faith-based organization. using a nonequivalent control group design, repeated measures manova showed significant differences between the treatment (n=54) and comparison groups (n=53) on knowledge and degree of comfort at posttest.despite the use of a small sample (n=107) of msw students at a public university in the southeast, the findings provide initial support for further use and future evaluations of curriculum modules covering specific content on practice in faith-based settings. keywords: religion, congregations, case,macro, practice, education until the end of the 19th century, religious congregations and the organizations they spawned were virtually the sole providers of social services in the united states (cnaan, 1999; garland, hugen, myers, sheridan, sherwood & wolfer, 2002; salamon & teitelbaum, 1984; wineburg, 2001). the social work profession itself emerged out of the efforts of “friendly visitors” and founders of settlement houses, both of which worked under the auspices of congregational outreach. congregations and their volunteers founded relief agencies, children’s homes, recreation services, family and children associations, and mental health associations. in other words, religiously motivated volunteers preceded social work in almost every field of practice (anderson & ambrosino, 1992; forte, 1997; sherr, 2003). despite social work’s origins, the nascent profession quickly embraced the scientific method in the early 1900s, spawning eight decades of social services largely disconnected from religious traditions. as the delivery of services became more systematic and social work became increasingly secular, religious congregations and other faith-based organizations (fbos) silently continued providing a hidden safety net of services (cnaan, 1999). nevertheless, the role of congregations and their volunteers became increasingly marginalized and virtually ignored by the social work profession (garland, et al., 2002). michael sherr is assistant professor at the school of socialwork, northwest nazarine university, nampa, idaho 83686 and terry wolfer is associate professor at the college of social work, university of south carolina, columbia, sc 29208. copyright© 2004 advances in socialworkvol. 5 no. 2 (fall 2004) 197-210. indiana university school of socialwork. since 1980, several converging factors have created a contemporary urgency for social work educators to prepare students for practice with faith-based organizations (fbos). over his two terms in office, president reagan set forth a devolutionary era in social welfare policy that continues to this day. then in 1996, democrat and republican leaders officially welcomed fbos into the circle of service providers by including charitable choice in section § 104 of the personal responsibility and work opportunity reconciliation act of 1996 (castelli & mccarthy, 1998; devita, printz & towombly, 1999; sherman, 2000; wineburg, 2001). more recently, in the 2000 presidential election, both al gore and george w. bush endorsed expanding the role of fbos as major components of their social welfare strategy. shortly after his inauguration, president bush announced the formation of the white house office of faith-based and community initiatives. today, charitable choice and fbos continue garnering bipartisan support as some on the right see an opportunity “to cut public spending while maintaining a spirit of care,” while some on the left see a way “to circumvent bureaucratic administration of publicly funded services” (cnaan & boddie, 2002, p. 229). background literature social work practice in fbos may involve working with social systems ranging from large religiously affiliated international organizations to local religious congregations (cnaan, wineburg & boddie, 1999). of these, local congregations are by far the most numerous and widely dispersed in american society (wolfer & sherr, 2003). for this study, congregations can be defined simply as “local gatherings [of people] for religious purposes” (harris, 1998, p. 602). while no one knows exactly, there are more than 150 million people in american congregations (linder, 2001). roughly one third of people attend services weekly, another third occasionally, and one third attend rarely or not at all (hodgkinson,weitzman & kirsh, 1990; see also holifield, 1994). the total number of congregations in the united states range from a low of 200,000 to a high of 450,000 (ammerman, 2001; boddie, et al., 2001; dudley & roozen, 2001). by various counts, american congregations also represent more than 200 denominations (cnaan, et al., 1999, p. 28) or nearly 1600 denominations (warner, 1994, p. 58). although the size of congregations vary considerably, more than half of the congregations in the united states have 100 to 400 members (linder, 2001). typically, congregations have linkages to larger fbos. in fact, they usually provide the base of support for larger fbos in terms of both finances and personnel. congregations also provide a variety of social services on their own. in the two most thorough assessments to date, chavez, konieczny, beyerlein and barman (1999) estimate that 57% of congregations offer at least one social service program, and boddie, et al., (2001) estimate that 87% of congregations offer at least one social service program. from a systems perspective, congregations are likely the first level of fbos students will interact with in their professional practice. on one hand, students may work with individuals, groups, and families who are members of congregations. on the other hand, they may work with congregations themselves as community 198 advances in socialwork organizations. regardless of the level of practice, students must be prepared for competent practice with these macro level systems. socialwork’s responseto religious congregations andtheir social programs until recently, social work scholars have tended to overlook the role of religious congregations in people’s lives (wolfer & sherr, 2003). this is ironic given the social work profession’s ecological and social systems perspectives. commenting on the absence of interest,wineburg (2001) laments: the academic community skipped by the most dramatic shift in public policy in more than half a century…[and if the academic community is going to become effectively involved] it will be difficult without an overarching analysis of the impact of the service contributions the people in these 300,000 congregations make, with their organizational arms reaching both inward to help their ownmembers and outward to support sectarian and secular agencies in the nonprofit sector (p. 40). in the last several years, however, social work literature has given limited but increasing attention to religion and religious congregations. research on religion has focused primarily on the notion of religious beliefs as a tool for practitioners to use in building rapport with clients for whom religion is an important issue (cnaan, wineburg & boddie, 1999). furthermore, only a handful of studies exist on religious congregations as organizations providing social programs. while such studies are laudable efforts, they are primarily descriptive, with findings that are difficult to interpret. after a review of the literature, wolfer and sherr (2003) conclude, “the american religious world is decentralized in the extreme…. [because of the difficulty in locating good sampling frames], it is difficult if not impossible to measure the various aspects of congregational life” (p. 44). despite the methodological difficulties, there is growing consensus among social work scholars that: 1) the efforts of religious congregations are greater than previously imagined; 2) there is a lot more to learn; and 3) social workers, if informed about charitable choice initiatives and the willingness of many religious congregations to provide social services, can participate and provide leadership in coordinating partnerships with congregations to deliver effective service programs (e.g., garland, 1992, 1998; garland, et al., 2002; cnaan, et al., 1999; sherman, 2000). effortsto prepare students and practitioners in light of the current context, efforts to incorporate content about religion, congregations, and charitable choice into the social work curriculum have been distressingly slow. in fact, recent research on social work education and religion reveals that the profession is still primarily assessing the place of religion in the curriculum (casio, 1999; kaplan & dziegielewski, 1999; sheridan &hemert, 1999; staral, 1999). the authors posit that the time for assessing the place of such content has passed and a new era of social welfare requires attention. a few scholars offer different approaches for preparing students to practicewith fbos. most notably, loewenberg (1988) provides an overview of the history of religion within society, netting, et al. (1990) describe integrating religious content 199scherr,wolfer/teaching content on socialwork practicewith religious congregations into the macro practice curricula, and canda (1989) presents a comparative approach for integrating religious content into the hbse curricula. more recently, furman (2002) makes recommendations for schools of social work that want to infuse religious and spiritual diversity throughout the entire curriculum, and ai (2002) endorses a multidisciplinary approach that covers an array of different theoretical and conceptual perspectives. finally, sherwood, wolfer and scales (2002) suggest using decision cases for infusing spirituality and religion content into the classroom. although each of the approaches represent innovative and laudable efforts to provide resources for social work educators, further research is needed to examine how to implement and evaluate teaching methods for integrating religious content in the curriculum. this study outlines an initial effort to implement and evaluate use of a curriculummodule on charitable choice and social work practice in a faith-based organization. specifically, it addresses the question: howwill a module on social work practice in faith-based organizations affect students’ knowledge about and comfort with such practice? methods and procedure given the above information, the authors developed, administered, and evaluated a curriculum module on charitable choice and religious congregations in six sections of a foundation level mswmacro practice course. the decision to introduce the module to students in a foundationmacro practice course was prompted by the author’s agreeing with netting, et al. (1990) that: “understanding local congregations and their enmeshment within the social service delivery system is important to any social work practitioner who hopes to effect community change” (p. 22). the curriculummodule the module consisted of four components: a journal article reading, didactic instruction, small group work, and decision case discussion. the first component covered the basic provisions of charitable choice law. charitable choice has far reaching implications for social work practice as it opens the door for collaboration between religious organizations and public services. in a recent article, cnaan and boddie (2002) explain that having a basic understanding of the law will lay “a foundation for considering the implications for social work practice, education, and research” (p. 225). in advance of the class session, the authors provided students with copies of a journal article and a decision case to read in preparation for the class session. the article assessed the potential benefits and challenges of charitable choice. more specifically, it discussed charitable choice in the current political context, the contradictory and limited research on implementation of the law, and encouraged social workers to attend to these developments (cnaan & bodie, 2002). the decision case highlighted the experiences of a licensed clinical social worker who was solicited by a church leader to meet with a family that had come to their church for help. what began as a one-time occurrence, eventually led to a decision about whether and how to advocate for systematic changes in the congregation’s community outreach (author citation for published case). 200 advances in socialwork decision cases differ from the types of casesmost often used in social work education. merseth (1996) refers to the traditional type of cases as examples or exemplars. these cases depict practice situations with (usually) appropriate responses and serve to illustrate the application of theory or professional skill in concrete situations. in contrast, decision cases present students with dilemmas encountered by social workers in their professional practice. these cases provide explicit opportunities for students to practice making decisions and contemplate possible interventions.more than exemplars, decision cases present the complexities and ambiguities of actual social work practice (sherwood,wolfer & scales 2002). sherwood, et al. (2002) explain: rather than simply critique a professional’s behavior, [decision] cases require that students use their analytic and critical thinking skills, their knowledge of social work theory and research, and their common sense and collective wisdom to identify and analyze problems, to evaluate possible solutions, and to formulate a preferred intervention (p. 5). borrowing from carlson-thies (2001), the authors’ also created a one-page handout that covers the purpose of charitable choice (available from the first author). the handout specified how charitable choice attempts to: 1) encourage more states to contract with fbos; 2) protect the unique character of religious organizations; 3) protect the religious freedom of potential beneficiaries; and 4) maintain separation of church and state. for instance, states that contract with any nonprofit organization must give fbos an equal opportunity to compete for funding. charitable choice also affirms that fbos can display religious symbols, use faith-based approaches in providing services, and can use religious criteria in staffing the programs. the religious freedom of recipients are protected by ensuring that alternative services are available for recipients who object to religious providers and affirms that recipients are not required to participate in religious activity as a precondition for receiving services. finally, separation of church and state is maintained by requiring that government funds only be used for providing public service and not for inherently religious practices such as worship, sunday school, or proselytization. after a brief lecture on the basic purposes of charitable choice, students were divided into small groups of six to eight. each group reviewed a specific section of the cnaan and boddie (2002) article. one group reported on the political evolution of charitable choice. they discussed how the law, although initially supported by conservatives, now claims bipartisan support. they also discussed how the law remains controversial and is currently being challenged in state and federal court. the next group discussed the findings of several studies mentioned in the article. for instance, the group shared how few clergy were even aware that charitable choice existed. they also conveyed how slowly charitable choice was being implemented among most states. the last group summarized cnaan and boddie’s call for social workers to carefully follow the implementation process of charitable choice to assess the potential benefits and consequences of the law. the final component of the module was a class discussion of the grace house ministry (author citation)—the decision case specifically written for the module. 201scherr,wolfer/teaching content on socialwork practicewith religious congregations the case had several twists and turns that worked as step off points for examining social work practice with religious congregations. during the course of the class discussion, students were given opportunities to reflect upon practice issues such as: confidentiality, self-determination, dual relationships with clients (as both a member of a congregation and a social worker), and balancing a congregation’s desire to provide needed services while respecting the specific characteristics of the congregation that may or may not conflict with social work values. towards the end of the case discussion, students were prompted to consider two interrelated questions: 1) how close was the congregation to securing charitable choice funding? and 2) what concrete steps should the congregation take in order to receive funding? the entire curriculummodule required approximately 90minutes of class time. the approximate timetable for each component was as follows: • 10 minutes for reviewing the basic purposes of charitable choice; • 20 minutes for meeting in small groups to discuss and summarize three sections of the journal article (cnaan & boddie, 2002); and • 60 minutes for the decision case discussion. research design using a quasi-experimental design, a convenience sample of msw students was selected for the study. students registered for one of six sections of a foundation level mswmacro practice course. a total of 116 msw students enrolled in the six sections; however, nine students were not present at the posttest and were excluded from the study. after all students registered, three of the sections were randomly assigned as treatment groups (n=54, 50.5%) and three sections were randomly assigned as comparison groups (n=53, 49.5%). the six sections met once a week from 9 a.m. to 12 noon. three sections met on tuesday, the other three onwednesday. to minimize contamination from selection bias and to account for the hawthorne effect, the first author handled all phases of implementing the curriculummodule and administering the survey instruments to each of the sections at pretest and posttest. during the first three weeks of the fall 2002 semester, the survey instrument was administered for pretest. the survey was re-administered for posttest at least six weeks after each pretest. this allowed enough time inbetween measurements to reduce the possibility of any testing effects that might occur from filling out the same survey. students in both the comparison and treatment groups covered the standard material on fbos within the context of ontological communities (brueggemann, 2002) with their assigned instructors. students in the comparison group were administered posttests after covering the normal coursematerial. students in the treatment group were administered posttests after covering the standard course material and the curriculummodule. at the request of instructors, the first author presented the curriculummodule to students in the comparison group after data was collected. 202 advances in socialwork survey instrument the survey, whichwas designed specifically for this study (see appendix), asked students to indicate their level of agreement on a scale of 1 (strongly disagree) to 4 (strongly agree) for a list of 10different statements.the10 statements comprised two subscales intended to measure students’ knowledge of charitable choice and their degree of comfort workingwith religious congregations. a total scorewas calculated for each scale at pretest and posttest. higher scores on the knowledge scale indicated better comprehension of the governing rules of charitable choice. higher scores on the second scale indicated a greater degree of comfort working with religious congregations. four additional questions asked for demographics—sex, age, ethnicity, and how often students attended worship services during the past year. the survey was found to have an internal consistency of .81 (n=116). according to nunnally (1978), this level of reliability is adequate for basic research. although the survey appears to have face validity, efforts to establish more dependable measures of validity were beyond the scope of this study. it was hypothesized that students enrolled in the sections comprising the treatment group would differ significantly from those in the comparison group in: 1) their increased knowledge of the governing rules of charitable choice; and 2) their increased comfort working with religious congregations. data analysis data analysis consisted of three stages. in stage one, the data were entered and checked for entry errors, missing data, and outliers. all entry errors were corrected; the missing data consisted of only the nine excluded cases, and there were no extreme values on any single variable. in stage two, frequency distributions and chi-square analyses were used to examine the distribution of demographic categories between treatment and comparison groups. finally, repeated-measures manova was performed to assess the overall affects of the curriculum module over time, the overall difference between treatment and comparison groups over time, and the individual differences in knowledge and degree of comfort scores between the two groups over time. findings demographic characteristics table 1 presents the distribution of selected demographic characteristics of the 107 respondents by treatment and comparison groups. as the table reveals, there are no significant differences between the treatment and comparison groups in terms of ethnicity and frequency of attending worship services during the last year. there was, however, a significant difference between the two groups in terms of age. although a majority of the respondents in both groups are age 20 to 29, more than 80% (81.1%, n=44) of the respondents in the treatment group are age 20 to 29, while only two-thirds (66%, n=35) of the respondents in the comparison group are age 20 to 29. moreover, less than 6% (5.6%, n=3) of the respondents in the treatment group are age 30 to 39, whilemore than 20% (22.6%, n=12) of the respondents in the comparison group are age 30 to 39. respondents age 40 and older appear evenly distributed between the two groups. 203scherr,wolfer/teaching content on socialwork practicewith religious congregations table 1 also reveals that female students represent a large majority of the respondents in both groups.male students, however, represent 13.2% (n=7) of the comparison group and 1.9% (n=1) of the treatment group. chi-square analysis could not be completed since the treatment group had less than five males. the differences in age and gender reflect enrollment trends in this social work education program. however, the small sample and the preliminary nature of the study preclude further inferences. outcomemeasures as noted previously, repeated measures manova was performed to assess whether the overall effects of the curriculum module resulted in significant changes over time. wilks’ lambda (f (2,104) = 13.35, p<.05) allows the null hypothesis to be rejected. thus, overall significant changes were discovered from pretest to posttest. likewise,wilks’ lambda (f (2,104)=7.30, p<.05) indicates overall significant differences between the treatment and comparison groups. table 2 depicts measures of the treatment and comparison groups at pretest and posttest. the means of the two groups at pretest were similar for both dependent measures. at posttest, the findings reveal a significant difference in knowledge measures between the two groups. although knowledge scores were higher for both groups at posttest, students exposed to the curriculum module 204 advances in socialwork treatment group comparison group (n=54) (n=53) variable n (%) n (%) significance gender no analysis male 1 (1.9) 7 (13.2) female 53 (98.1) 46 (86.8) ethnicity nonsignificant anglo american 34 (63.0) 36 (67.9) african american 17 (31.5) 11 (20.8) other 3 (5.5) 6 (11.3) age χ2=6.49, df=2 20 to 29 44 (81.5) 35 (66.0) p=.039 30 to 39 3 (5.6) 12 (22.6) 40 and older 7 (6.6) 6 (11.3) frequency of attending worship services during the last year nonsignificant twice a year and 14 (25.9) 10 (18.9) less once a month to 17 (31.5) 16 (30.2) twice a year two or three times 6 (11.1) 9 (17.0) a month every week 17 (31.5) 18 (34.0) table 1: distribution on select demographic characteristics scored significantly higher than students in the comparison group. in the same way, the findings reveal a significant difference in the degree of comfort measures between the two groups. here again, students exposed to the curriculummodule report a greater degree of comfort working with religious congregations compared to students in the comparison group. interestingly, the posttest scores for the degree of comfort for students in the comparison group were marginally lower than at pretest. discussion the findings from this study must be interpreted with caution. the use of a small convenience sample of students as well as a nonstandardized instrument limits their generalizability. furthermore, although data analysis reveals statistically significant differences in the hypothesized direction, the amount of improvement remains unclear. conclusions regarding the practical development in knowledge about charitable choice or the degree of comfort working with religious congregations is not warranted. as an initial effort to implement and evaluate a curriculum module, however, this study begins to fill the need for empirical studies on teaching social work practice with fbos. knowledge and degree of comfort the curriculum module received preliminary support from this study. although knowledge subscale scores increased for both groups, only the scores in the treatment group were significantly higher at posttest. similarly, students in the treatment group reported a higher degree of comfort in working with religious congregations. similar to knowledge scores, however, only students in the treatment group reported higher degrees of comfort working with religious congregations at posttest. the degree of comfort scores was actually lower for students in the comparison group at posttest. the lower scores related to the degree of comfort subscale for students in the comparison groupwas an anomalous finding. at first glance, the authors’ expected that after completing a foundation level macro practice course, students would feel more comfortable working with all types of communities and organizations, including religious service providers. in hindsight, however, the authors suggest that it may be necessary to present specific material on religious providers as legitimate places for social work practice. otherwise, students may never recognize their newly acquired knowledge and skills as relevant for working with fbos. 205scherr,wolfer/teaching content on socialwork practicewith religious congregations pretest posttest f test of x (sd) range x (sd) range posttest measure treatment comparison treatment comparison score knowledge 14.3 (1.5) 10 –19 14.1(1.7) 11-19 15.7 (2.0) 12 -20 14.6 (1.8) 11-19 6.0 comfort 15.3 (2.5) 10 – 20 15.5 (3.1) 11-20 17.0 (2.3) 13 -20 15.3 (3.5) 10 -20 .9   p<.05.  p<.01. table 2: measures of knowledge and degree of comfort with manova of posttest scores 206 conclusion the current module, with its emphasis on religious congregations as potential partners in delivering effective service programs, is ideally suited for courses focusing on organization and community development. additional innovative modules on religion and spirituality need to be developed and implemented in other courses, including hbse, social policy, and practice with individuals, groups, and families. more importantly, however, the efficacy of this and other approaches needs to be empirically evaluated. that being said, this study provides preliminary support for using the current module for teaching social work practice with religious congregations in a foundation macro practice course. references. ammerman, n.t. 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(1999). seeking religion and spiritual competence: the perceptions of bsw students at a private, catholic university. socialwork and christianity, 26, 101-111. warner, r.s. (1994).the place of the congregation in the contemporary american religious configuration. in j.p.wind & j.w. lewis (eds.), american congregations (vol. 2, pp. 54-99). chicago: the university of chicago press. wineburg, r.s. (2001). a limited partnership: the politics of religion,welfare, and social service. newyork: columbia university press. 207scherr,wolfer/teaching content on socialwork practicewith religious congregations 208 wolfer, t.a., & sherr, m.e. (2003). american congregations and their social programs. in t. tirrito & t. casio (eds.), religious organizations in community services (pp. 23-50). newyork: springer. author’s note: address correspondence to:michael sherr, assistant professor, school of socialwork, northwest nazarine university, 623 holly street, nampa, idaho 83686, usa. e-mail: mesherr@nnu.edu advances in socialwork appendix student questionnaire on social service programs and policies please take a few minutes to respond to each item by indicating whether or not you agree with the following statements. your participation is completely voluntary. however, if you decide to participate, be assured that your responses are strictly confidential. please do not write your name anywhere on the questionnaire as we wish to keep your responses anonymous. please mark an x or a ✓ in the box indicating the extent to which you agree with the following statements. please mark only one box per question. knowledge strongly agree disagree strongly agree disagree 1. “charitable choice” is a provision [ ] [ ] [ ] [ ] designed by the federal government to encourage more religious congregations to offer social service programs. 2. “charitable choice” permits a [ ] [ ] [ ] [ ] religious congregation to require clients to participate in worship ceremonies in order to receive social services. 3. social service programs offered by [ ] [ ] [ ] [ ] religious congregations primarily serve members of the same congregation. 4. “charitable choice” permits a religious [ ] [ ] [ ] [ ] congregation to receive government funds to help the poor. 5 “charitable choice” allows a religious [ ] [ ] [ ] [ ] congregation to display religious art, scripture, religious apparel, and other symbols while delivering social service programs. degree of comfort 6. i would be willing to refer clients to [ ] [ ] [ ] [ ] a social program provided by a religious congregation. 7. i would be willing to collaborate with [ ] [ ] [ ] [ ] a religious congregation to develop a social program for my clients. 8. i would be willing to receive services [ ] [ ] [ ] [ ] from a social program provided by a religious congregation. 209scherr,wolfer/teaching content on socialwork practicewith religious congregations 210 appendix (cont.) student questionnaire on social service programs and policies degree of comfort (cont.) strongly agree disagree strongly agree disagree 9. social workers should be willing to [ ] [ ] [ ] [ ] work for a social service program run by a religious congregation. 10. i would be willing to work for a social [ ] [ ] [ ] [ ] service program run by a religious congregation. advances in socialwork research training, institutional support, and self-efficacy: their impact on research activity of social workers* research training, institutional support, and self-efficacy: their impact on research activity of social workers mark thomas lynch lening zhang wynne s. korr abstract: while the expectations for social work practitioners to do research have increased, their involvement is still limited. we know little about what factors influence involvement in research. the present study proposes a theoretical model that hypothesizes research training and institutional support for research as the exogenous variables, research self-efficacy as an intervening variable, and research activity as the endogenous variable. the study tests the model using data collected from a random sample of social workers. to a large degree the data support the model. research selfefficacy has a significant effect on research activity. it is also an important mediating variable for the effect of institutional support on research activity. although institutional support for research has no direct effect, it has an indirect effect via self-efficacy on research activity. however, research training has no effect on research activity and selfefficacy in research. the implications of these findings are discussed. keywords: research self efficacy, research training, research activity introduction for some time, authors have expressed concern about the level of research activity among social workers (cheetham, 1997; rosen, 2003; rosen, proctor & staudt, 1999; shaw and lishman, 1999; thyer, 1991). for too long social workers have relied on treatment that is not research based (rosen, 2003). we need to accumulate evidence about the effectiveness of social work interventions (evidence-based interventions) and to be able to demonstrate the profession’s contributions to solving the problems of individuals as well as larger social systems. with this increased emphasis on accountability and on measuring if treatment is effective, social work research is considered more important than ever (cheetham, 1997). accountability in the consumer-social worker relationship also necessitates involvement in research. there is a fiduciary relationship between the consumer and the social worker which is based on the trust that the consumer places in the social worker to act in the consumer’s best interest. it is difficult to show that the social worker is acting in the best interest of the consumer unless the social worker has evidence of the effectiveness of treatment, based on the social worker’s own research or the research of others (kutchins, 1998). it is a fundamental responsibility of human and health service professionals to participate in advancing the knowledge base of their professions (austin, 1999). the knowledge base of social work must continuously expand due to the nature of our role as _________________ mark thomas lynch, ph.d., is an associate professor and program director in the department of social work and lening zhang, ph.d., is a professor of sociology, both at st. francis university in loretto, pa. wynne s. korr, ph.d., is a professor and dean of the school of social work at the university of illinois at urbana-champaign. copyright © 2009 advances in social work vol. 10 no. 2 (fall 2009), 193-210 lynch, zhang, korr/ research training, institutional support, and self-efficacy 194 change agents in a changing society. old methods of intervening may not be adequate in our new culture, and new methods of intervening should be constantly developed through research activity. the profession has acknowledged a need to produce research on interventions to continue the development of a knowledge base for making clinical decisions with clients which in turn will produce more effective interventions leading to improved social work outcomes (gellis & reid, 2004). there is a need to increase research by social workers and educators. the task force on social work research (1991) indicated that only 900 individuals of 400,000 practitioners and 4,200 educators had published research results between 1985 and 1991. gerdes, edmonds, haslam and mccartney (1996) found that only a small minority of msw practitioners used empirical measures of treatment effectiveness. there are compelling reasons for social workers to research their interventions. it appears that social work organizations have been supportive of this research; however, the amount being performed by individual practitioners is quite limited. the national institutes of health (nih) (2005) have identified a need for social work intervention research and have provided funding for the research through a number of grants. this program announcement indicated nih’s belief concerning the importance of social work research: as one of the largest allied health professions in the u.s., social work is a primary provider of psychosocial interventions and services intended to facilitate treatment of medical conditions, improve disease management and prevention, and address related social, psychological or emotional problems in order to improve health and functioning…. an empirical approach to understanding the mechanisms of action in social work practice, to improving the efficacy and effectiveness of social work interventions, and to disseminating and implementing exemplary practice approaches and methods can add a significant but understudied component to the portfolios of various nih institutes and make a unique and important contribution to improving public health (national institutes of health, 2005). the current study explores factors that influence research involvement in the social work profession. the major factors studied are research training, institutional support, and self-efficacy. building upon previous studies regarding research training, institutional support and self efficacy, the purpose of this study is to assess how these factors influence social workers in their involvement in research activity by developing and testing a theoretical model influential factors in research activity several studies have addressed factors that may influence research activity (gerdes et al., 1996; fraser &jensen, 1993; holden, barker, meenaghan & rosenberg, 1999; kirk, 1999; lindsey, 1999; monette, sullivan & dejong, 1998; proctor, 1990; rubin & babbie, 2001). some concentrated on research training (fraser & jensen, 1993; kirk, 1999; lindsey, 1999; proctor, 1990), and others examined the role of institutional support and self-efficacy (gerdes et al., 1996; fraser & jensen, 1993; holden et al., 1999). all http://grants.nih.gov/grants/guide/pa-files/pa-06-081.html advances in social work, fall 2009, 10(2) 195 the studies have documented the factors individually. no study has made a systematic assessment of how these factors interrelate in their effects on research activity. the present study utilizes the findings from these studies and develops a model that addresses how the factors affect research activity. research training some educators suggest that the best way to increase knowledge about evaluating practice is to teach students to integrate rigorous research in their social work practice (fraser & jensen, 1993; kirk, 1999; lindsey, 1999; lyons, 2000; proctor, 1990). others found that social workers do not believe that they have sufficient training to effectively use research methods (dunlap, 1993; epstein, 1987; wodarski, 1986). training appears to be an important factor according to many researchers. reid (1993) reported that cswe has been successful in the past in promoting research education in the social work curricula. in 1982 the council on social work education mandated that msw and bsw programs include education to show students how to do systematic evaluation of their practice. students must learn to answer the question “what is the point to what i’m doing?” (cheetham, 1992, p. 268). the council on social work education’s handbook on accreditation standards and procedures (2003) specifically indicated three areas of research training for msw students: “1.) content on qualitative and quantitative methodologies to build practice knowledge; 2.) preparation to develop, use and communicate empirically based knowledge including evidence-based interventions and; 3.) research knowledge to provide high-quality services; to initiate change; improve practice policy and service delivery; and to evaluate one’s own practice” (p. 104). however, problems in research training of msw students have been observed. rosen (1996) noted that one of the obstacles to performing practice research is found in msw training. he identified three concerns: 1) selective use of examples and applications, 2) unclear criteria for use of different designs, and 3) failure to encompass practice complexity (p. 106). lyons (2000) argued for the development of research material in social work education. she suggested the need to “promote methods and approaches compatible with the overall goals of social work” and use of interactive forms of research where people are participants in the research process (lyons, 2000, p. 441). she indicated a number of factors that influence an institution’s level and quality of the research enterprise related to social work, including the value placed on research, incentives and resources available to undertake research, credibility accorded certain types of research and the different career patterns of social work educators. she stated that “research must be an essential component of social work education and professional activity” (lyons, 2000, p. 446). proctor and rosen (2008) discussed the need for social workers to do more research, its applicability to the profession, and how research can help guide social worker’s practice. they also identified challenges that social workers face such as the inability to use research due to the lack of preparation, their attitudes about research, and lack of lynch, zhang, korr/ research training, institutional support, and self-efficacy 196 awareness of relevant literature. they also indicated that some social workers have difficulty using research effectively due to training issues. unrau and grinnell (2005) examined research self-efficacy of undergraduate and graduate social work students. their finding indicated that students have a wide range of confidence in doing research both at the beginning and after completing a research course. they discussed a positive research training experience by social work instructors as being essential in the training of social workers. institutional support for research activity support in the work environment is also related to research activity by social workers. rubin and babbie (2001) indicated that getting approval to conduct a research project from a number of different sources, such as agency administrators, human subject review committees, and other practitioners, may take time and be frustrating. since some studies may take much time, it may be difficult to justify them to agency superiors. it may also be difficult to persuade peers to assume the workload for the practitioner who is doing research. these problems would affect the support that the practitioner feels for doing research. monette et al. (1998) described some additional costs of research that may be incurred, including salaries of staff conducting research, transportation and living expenses, computer expenses, office supplies and equipment, dissemination of research findings, and incentives paid to ensure cooperation. many agencies simply cannot afford to support research. gerdes et al. (1996) reviewed several aspects of the work environment in determining their effects on research activity in a survey of social workers in utah. they found that work environment factors such as support by peers and administrators, time allotted, and cost impacted research activity. research self-efficacy self-efficacy, a construct from social cognitive theory, involves “people’s judgment of their capabilities to organize and execute courses of action required to attain designated types of performances” (bandura, 1986, p. 391). competent functioning is based on both having skills and believing that one can use the skills correctly, or possessing self-efficacy regarding the skill set. according to bandura, “self-efficacy not only reduces anticipatory fears and inhibitions but, through expectations of eventual success, it affects coping efforts once initiated.... the stronger the efficacy or mastery expectations, the more active the efforts” (1977, p. 80). holden et al. (1999) conceptualized “social work self-efficacy” as an individual’s confidence in her/his ability to carry out a wide variety of professional tasks. research self-efficacy was considered a subcomponent of social work self-efficacy. they attempted to determine if msw training led to research self-efficacy which, in turn, would lead to social work empowerment, (i.e., feelings of confidence in performing treatment tasks, confidence in measuring treatment results, and enhanced use of research in practice). the traditional assumption is that education or training leads to activity, that is, having coursework in research methods should lead to doing research. self-efficacy advances in social work, fall 2009, 10(2) 197 theory suggests that there is an intermediate step, the experience of mastery which leads to perceived self-efficacy. self-efficacy has been applied to expectations and skills regarding research. a variety of authors have found significant relationships between research self-efficacy and the training that individuals receive in graduate school in social work and related fields (brown & lent, 1996; gelso, mallinckrodt & brent-judge, 1996; holden et al., 1999; love, bahner, jones & nillson, 2007). agency support for research may also be related to self-efficacy in research. in their study of 96 licensed social workers, gerdes et al. (1996) found that social workers would evaluate their practice if required to do so. many respondents in the study also listed a lack of time as a problem in doing research. therefore, for those social workers who do wish to do research, the reality of their practice situation may preclude them from doing so. sadique (1999) discussed some questions that researchers ask themselves while preparing to do research in their practice setting. these questions include: “how the researcher/social worker will be viewed in the organization?” “is the research related to the current position of the social worker?” “how will the research be viewed by the workers, peers, and managers?” “does the research support the purpose of the organization?” all these questions may affect the researcher’s confidence and efforts to engage in research activity, and in turn affect his or her research activity. in summary, the assumptions are that research training and institutional support for research activity, and research self-efficacy may have direct impact on research activity as the previous studies have documented. further, the present study argues that both research training and institutional support may affect research efficacy and, in turn, affect research activity indirectly as well. these assumptions and arguments lead the study to propose an intervening model in which both research training and institutional support are the exogenous variables, research self-efficacy is the intervening variable, and research activity is the endogenous variable (see figure 1). the model involves several hypotheses: (1) both research training and institutional support for research activity have direct effects on research activity; (2) research self-efficacy has a direct effect on research activity; (3) both research training and institutional support for research activity have indirect effects on research activity via research self-efficacy. lynch, zhang, korr/ research training, institutional support, and self-efficacy 198 figure 1: intervening model of research training, institutional support, research self-efficacy, and research activity research training research self efficacy research activity institutional support methods study sample the data for the study come from a random sample of the clinical register of the national association of social workers (nasw). nasw is the largest professional organization of social workers in the world, with over 155,000 members. the register provides a list of social work practitioners that have met the national education and professional standards to be a qualified clinical social worker (qcsw) and/or a diplomate of clinical social work (dcsw) (national association of social workers, 2009). the qcsw can be obtained by a social worker that received a masters or doctorate from a council on social work education (cswe) accredited program. they must also have 3000 hours of supervised clinical practice and hold a license or certificate in the state in which they practice. the dcsw must have the same qualifications as a qcsw with the addition of three years of advanced clinical practice beyond the qcsw requirements and successfully completion of the nasw diplomate clinical assessment examination. the sample was 300 individuals randomly chosen from the list. a mail survey was conducted using available names and addresses in the list. each survey was coded to a recipient and as surveys were returned, the number from the return envelope was checked. two months following the initial mailing, a second mailing was sent to those social workers whose surveys were not returned from the initial mailing. all survey responses were confidential. as a reward for participating in the survey, respondents were able to receive information regarding the results of the survey and were eligible for a cash drawing valued at $100. ninety-six questionnaires were returned, and 87 were usable. before the survey was conducted, a pretest of the survey instrument was performed using a convenience sample of 20 msw level professionals attending a workshop. some modifications were made in terms of the pretest results. advances in social work, fall 2009, 10(2) 199 there is a concern with the representativeness of the study sample because of a low response rate (29%). to address the concern the study compared the demographic characteristics of the sample with those of the study population using age, gender, race, educational degree, and fields of practice. the study sample does not differ from the population significantly in the major demographic characteristics (see table 1 for the comparison). table 1: sample characteristics compared to those of the nasw population sample nasw populatione variables frequency % % gendera female 66 76.7 79 male 20 23.3 21 degreeb msw 81 94.2 91 ph.d. 1 1.2 6 other 4 4.7 3 agec under 30 0 0.0 5 30-39 9 12.8 16 40-49 29 37.2 33 50-59 28 35.9 37 60+ 11 14.1 9 raced blacks 1 1.2 5 hispanic 3 3.5 3 asian 2 2.4 2 native american 0 0.0 whites 67 78.8 89 other 11 12.9 0 practice field private practice 23 27.1 28 mental health 24 28.2 21 social service 5 5.8 9 medical 13 15.3 12 school 9 10.5 8 other 11 12.9 22 note: n is different due to missing cases. asource: (national association of social workers, 2000) bsource: (o’neill, 2001) csource: (national association of social workers, 2000) d source: (national association of social workers, 2000) esource: (national association of social work, 2001) http://www.socialworkers.org/pubs/news/2001/01/data.htm http://www.naswdc.org/naswprn/demogr.pdf http://www.naswdc.org/naswprn/demogr.pdf lynch, zhang, korr/ research training, institutional support, and self-efficacy 200 variables and measures the endogenous variable for this study is research activity. the variable is measured using the empirical practice and evaluation index (epe) by gerdes et al. (1996). originally, epe consisted of 29 items that measure the extent to which lcsws used an empirical approach to evaluate their practice activities. the present study used 13 items relevant to this study. each item asked respondents to indicate how frequently they used a particular empirical evaluation procedure, for example, "how often do you use a singlesubject research design to evaluate practice?" response categories range from 1 = never to 3 = routinely (a list of the items may be found in the appendix). a sum of the response scores was made to create an index to represent research activity. the standardized cronbach’s alpha is .88 for the index. the exogenous variables are research training and institutional support for research. research training was measured using 10 items developed by identifying aspects of research training discussed by montcalm (1999) and schunk (1999). respondents were asked to respond to the items regarding their research training in their msw programs. for example, an item asks “did you complete a research project in your msw program?” there are two response categories, “yes” and “no” for all items (see appendix 1 for a list of the items). the “yes” responses were counted to create an index of research training. the standardized cronbach’s alpha is .90 for the index. five items were used to measure institutional support for research. the items were developed based on a review of the gerdes et al. survey (1996) and related literature (babbie, 2000; briar, 1990; dunlap, 1993; epstein, 1995; fuller, 1999; monette et al., 1998; rubin & babbie, 2001; sadique, 1999; wodarski, 1986). each of the items is a statement regarding the current setting where a respondent practiced. for example, one item states “i am encouraged to perform empirical research on my practice.” a likerttype scale was used for these items, ranging from 1 = strongly disagree to 5 = strongly agree (see appendix 1 for a list of the items). items were recoded so that the score of 5 was always for an item that indicated high research support in the work environment. by taking the sum of response scores of the items an index was created for institutional support. the index has a standardized cronbach’s alpha of .65. self-efficacy is the intervening variable. it is measured using a scale adopted from holden et al. (1999). the scale has 10 items that tap different aspects of engaging in research activities. the present study added an item regarding confidence in the use of single-subject research design. the items ask respondents how confident they are when they engage in research-related activities. a likert-style scale was used for the items, ranging from 1 = not at all confident, to 5 = highly confident. for instance, one item states, “i am confident that i can formulate a clear research question or testable hypothesis” (see appendix 1 for a list of the items). the standardized cronbach’s alpha for the index is .94. in addition, gender, age, race, educational degree, and employment types were also included as control variables in the analysis. they may have some confounding effects on research activity. gender is a dummy variable coded in the direction of male, and age is measured in years. race is coded as 1 = white; 0 = other because only a few respondents advances in social work, fall 2009, 10(2) 201 are minority group members. educational degree was also coded as a dummy variable (1 = msw; 0 = other) because a majority of respondents had the msw degree (94.2%). finally, the variable of employment types is also dichotomized with 1 = private and 0 = public (see table 2 for the descriptive statistics of the variables). table 2: descriptive statistics of variables variable mean std. dev. minimum maximum n gender 0.23 0.43 0.00 1.00 86 race 0.80 0.40 0.00 1.00 84 age 49.33 8.67 34.00 72.00 78 educational degree 0.94 0.24 0.00 1.00 86 employment type 0.27 0.45 0.00 1.00 85 research activity 28.13 8.04 15.00 51.00 86 research training 3.60 3.29 0.00 10.00 88 institutional support 10.67 3.67 5.00 19.00 87 self-efficacy 27.85 10.48 11.00 53.00 87 analytical strategy path analysis was conducted to assess the intervening model using ordinary least squares (ols) regression.1 the analysis first assessed the effects of research training and institutional support on research self-efficacy followed by an assessment of the effects of research training and institutional support on research activity without research selfefficacy as an independent variable. finally, the analysis assessed a full equation that includes research training, institutional support, and research self-efficacy as the independent variables and research activity as the dependent variable. results table 3 presents the results of the path analysis of the proposed intervening model. the table has three regression models. the first model regresses self-efficacy on research 1 our sample size of 87 respondents is sufficient to detect the expected differences. there are a total of 8 independent variables in our regression analyses. if we take a fairly conservative approach to allow the r2 to increase from 0 to 0.20 for the full model, the projected sample size is about 69 subjects. lynch, zhang, korr/ research training, institutional support, and self-efficacy 202 training and research support along with the control variables. the results show that institutional support has a significant effect on research self-efficacy (beta = .27 for institutional support). it implies institutional support is an important source of research self-efficacy. however, research training has no such effect. the second model assesses the effects of research training and institutional support on research activity along with the control variables except the intervening variable of self-efficacy. institutional support shows a significant effect on research activity (beta = .23) while research training does not. as institutional support for research increases, the amount of research activity increases. in addition, gender, race, and educational degree are also significantly associated with research activity. males and whites were more likely to engage in research activity. respondents who had a msw degree were less likely to do research-related activities than those who had other degrees. table 3. regression models of path analysis for the effects on research activity model 1 model 2 model 3 research selfefficacydv research activitydv research activitydv variable beta t-ratio beta t-ratio beta t-ratio gender .16 1.48 .26** 2.51 .20* 2.08 race .01 .09 .27** 2.69 .27** 2.85 age .18 -1.53 -.09 -.80 -.01 -.14 educational degree 1.53 -1.67 -.26* -2.50 -.20* -2.07 employment type .06 -.53 -.19 -1.79 -.16 -1.70 research training .04 -.37 -.12 -1.13 -.10 -.99 institutional support .27* 2.28 .23* 2.17 .14 1.40 self-efficacy -------- .38** 3.63 r2 .20 .34 .45 n 76 75 75 notes: dvdependent variable for the model. *p<.05 **p<.01 advances in social work, fall 2009, 10(2) 203 the last model examines whether research training and research support have significant effects on research activity when self-efficacy is included as an independent variable and assesses the direct effect of self-efficacy on research activity when the effects of research training and research support, as well as the control variables, are held constant. the results indicate that institutional support is no longer a significant predictor of research activity when the self-efficacy is controlled. self-efficacy shows a significant effect on research activity (beta = .38). social workers who had stronger research selfefficacy were more likely to engage in research activity than those who had weaker selfefficacy. these findings imply that institutional support has no direct effect on research activity. its effect is mediated by research self-efficacy, meaning that it has an indirect effect on research activity via self-efficacy. research training still does not have an effect on research activity. additionally, gender, race, and educational degree are still significant factors when self-efficacy is controlled. figure 2: intervening model of research training, institutional support, research self-efficacy and research activity with the beta coefficients research training research selfefficacy institutional support research activity residual residual .74 -.10 .89 .04 .27* .14 .38** discussion and conclusion previous studies have identified research training, institutional support for research, and self-efficacy as important factors influencing the research activity necessary to establish researched interventions for social workers. building upon these studies, the present study developed an intervening model using these factors. the model hypothesized that both research training and institutional support are exogenous variables, self-efficacy is the intervening variable, and research activity is the endogenous variable. using data collected from a sample of registered social workers the study assesses the model. the findings provide support for the hypothesized model. lynch, zhang, korr/ research training, institutional support, and self-efficacy 204 research self-efficacy appears to be most important for those social workers to engage in research activity. it has a direct effect on research activity when research training and institutional support as well as several other important variables are controlled. social workers who had strong self-efficacy in research were likely to do research-related activities. self-efficacy is also an important mediating factor for the effect of institutional support. these findings support the hypotheses in the model. research training does not show a significant effect on research activity when institutional support and other important demographic variables were controlled. it may imply that social work practitioners’ self-confidence in research and the working environment are more critical for doing research activities when they get into the actual field. research training may have already been transformed in the form of research selfefficacy. another possible explanation of the non-effect of research training is the time since receiving msw research training. there may be problems with the results due to relatively long time since graduation from the msw training program. individuals involved in earlier studies were current graduate students and were familiar with the research training they were receiving, permitting them to better judge the impact of research training on their research activity. on the other hand, since these social work practitioners had a mean graduation year of 1982, many of them had difficulty remembering their research education. they commented that they had difficulty remembering how many research classes they had while in graduate school or what research skills they were taught to use while in graduate school. perhaps a study of what recent graduates of msw programs think of their training in research would provide better results that support others who have seen the importance of training on research activity (lyons, 2000; reid, 1993). finally, the causal order between self-efficacy and research activity may be problematic given that this was a cross-sectional study. if social workers are successful using their research skills and/ or being rewarded for research activity, they may develop more research efficacy. the cross-sectional data do not allow us to have a definitive determination of whether self-efficacy leads to research activity or it is subsequent to research activity. by doing research, the participants may have improved their research self-efficacy. this issue needs to be addressed in future longitudinal studies. it is a concern that research training in msw education does not have an effect on research activity in social work practice, no matter what the reason. the council on social work education had identified research as one of the nine foundation areas necessary in all bsw and msw curriculums. more recently, the 2008 education policy and accreditation standards, under education policy 2.1.6, indicate that competent social workers must be involved in research: social workers use practice experience to inform research, employ evidencebased interventions, evaluate their own practice, and use research findings to improve practice, policy, and social service delivery. social workers comprehend quantitative and qualitative research and understand scientific and ethical approaches to building knowledge. social workers advances in social work, fall 2009, 10(2) 205 • use practice experience to inform scientific inquiry and • use research evidence to inform practice. (cswe, 2008) although a supportive research environment is not likely to affect social workers’ engagement in research activity directly, it is likely to affect their research self-efficacy and, in turn, affect their research activities through self-efficacy. it also supports our hypothesis and is consistent with the previous studies (e.g., montcalm, 1999). social workers often find themselves working in agencies whose administrations are wary of doing research that is not required by funding organizations. the social worker in such agencies meets with resistance by those that must approve research (yegidis & weinbach, 2006). some agencies are concerned that an evaluation of the work done may reflect poor performance. due to this, some agencies are not only nonsupportive, they are even hostile to research. this makes for a difficult work environment for the social worker who believes it is important to perform evaluations of interventions (yegidis & weinbach, 2006). one implication is that agencies need to look at policies that may affect the level of support they are willing to give social work practitioners who would like to do research in order to increase involvement in research activity. such support enhances social workers’ research self-efficacy. in our study, a high percentage of the social workers felt that institutional support was not evident. agencies must realize the importance of research on interventions and social workers must inform the agency of the importance of research in the identification of effective strategies that will improve outcomes. further study is necessary to identify how agencies can be persuaded to support research. since the work environment is linked to research self-efficacy, it is important to find ways to improve the support level at agencies. agency administrators must learn to value research for its ability to show the effectiveness of interventions, and realize that if an intervention is ineffective, it will not help clients, and will also impact the communities’ negative or positive perception of the agency. social workers are expected to be involved more and more in researched interventions (evidence-based research) due to the need for effective and accountable practice. as interventions are researched more, there will be increased availability of known, effective interventions from which social workers can choose. additionally, it is important to the profession that we develop practice guidelines that will help us decide on proper interventions. to establish these guidelines, we also need to research the interventions’ implementations (rosen, 2003). too many times social workers depend on lay judgments instead of a systematic decision making process guided by evidentiary criteria (rosen, 2003). this practice puts both the client and social worker at risk. social work as a profession and the agencies that employ social workers are demanding more evidence of the quality of the interventions. as has been discussed, social workers do not always choose interventions that have been researched as to their effectiveness. but the social worker’s commitment to the client’s best welfare is a basic value of social work. this means providing the client with the most effective, cost efficient treatment available. without research on practice, we will be unable to respond to this basic value. social workers must develop an organized knowledge base of lynch, zhang, korr/ research training, institutional support, and self-efficacy 206 evidence-based practice. by doing so, social workers will not be wasting as much of their resources on interventions that are not effective and more cost effective practices will be supported (gellis & reid, 2004). references austin, d. 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(2006). research methods for social workers. boston: pearson education, inc. http://www.socialworkers.org/pubs/news/2001/01/data.htm advances in social work, fall 2009, 10(2) 209 author’s note: address correspondence to: mark thomas lynch, ph.d., 220 scotus, saint francis university, loretto, pa 15940. email: mlynch@francis.edu. appendix: measurement items research activity: how often do you….. • search electronic data bases scholarly literature • use technological advances in carrying out research • measure goals and objectives to evaluate your own or an agency’s practice • design and implement a measurement approach to study some aspect of social work practice • present your studies and their implication orally (e.g., in conference presentation, in workshops, for agency demonstrations) • review research to improve the quality of your social work practice • participate with others who are .developing a research design • collaborate with others to present studies and their implications in written form • write items for a questionnaire • work with others to develop survey questions • read social work journal relevant to practice • read journals from related fields (e.g., sociology, psychology etc.) relevant to practice • use a single-subject research design to evaluate practice research training: please respond to the following regarding your research training in your msw program: • did anyone try to persuade you to be involved in research activities? • did you have hands on experience in evaluating clinical/direct practice? • did you complete a research project in your msw program? • did you have faculty mentoring to help formulate a clear research question? • did you have faculty mentoring to help conceptualize a hypothesis? • did you have faculty mentoring to help construct a research instrument? • did you have faculty mentoring to help collect data? • did you have faculty mentoring to help do a statistical analysis? • did you have faculty mentoring to help write up your research? • did you have faculty mentoring to help prepare presentations of research results? mailto:mlynch@francis.edu lynch, zhang, korr/ research training, institutional support, and self-efficacy 210 institutional support: please circle the appropriate number regarding these statements involving your current working setting: • i am encouraged to perform empirical research on my practice. • i am given enough time at my job to perform research tasks. • no payers (insurance, county, managed care organizations) support empirical research at my job. • i am given financial incentives to perform empirical research at my job. • i have access to continuing education for development of my empirical research skills. self-efficacy: i am confident that i can . . . • do effective electronic database searching of scholarly literature • use various technological advances effectively in carrying out research (e.g., statistics packages, internet resources) • review a particular area of social science research, and write a balanced and comprehensive literature review • formulate a clear research question or testable hypothesis • choose a reliable and valid outcome measure • choose a research design that will answer a set of questions and/or set a hypothesis about some aspect of social work • design and implement the best measurement approach for studying some aspect of social work • design and implement the best sampling strategy possible for studying some aspect of social work • design and implement the best data analysis strategy possible for studying some aspect of social work • effectively present my study and its implications to other practitioners • effectively perform a single-subject research study introduction influential factors in research activity research training institutional support for research activity research self-efficacy methods study sample variables and measures analytical strategy results references appendix: measurement items advances vol. 1, no. 2 message from the dean weat the indianauniversity school of socialwork are very pleased to present this second issue of advances in social work. in publishing advances in socialwork, we envision a journal that provides an opportunity for faculty, practitioners, students, and other professionals to have a forum whereby scholarly work related to social work research, education, and practice can be published. advances in social work, as the title connotes, serves to contribute to the knowledge base of the social work profession by providing a publication that advances knowledge anddemonstrates effectiveness andquality improvements for social work through research, education, and practice. the indiana university school of social work has a very distinguished history. founded in 1911, it is the oldest social work program in the nation continuously affiliated with a university. next year we will be celebrating our 90th anniversary, commemorating many milestones in teaching, research, and service. this year we celebrated the 25th anniversary of the bsw program. the publication of advances in social work marks another milestone in the history of the school of socialwork. it advances our mission by disseminating new knowledge for the advancement of the profession. i amgrateful to anumber of individualswhohave contributed extensively tomake advances in socialworkpossible.my gratitude is extended todeanroberta greene and interim dean sheldon siegel for supporting the development and publication of the journal, and to dr. paul sachdev, the first editor, whose vision gave birth to the journal. a special thank you goes to dr. barry r. cournoyer, who now serves as editor. his leadership, attention to detail, and quest for quality are clearly evident. the editorial board, whose names appear inside the front cover, deserve special credit for their direction, support, and hard work. finally, the consulting editors, whose names also can be found inside of the front cover, have served as reviewers for the manuscripts submitted. their able assistance is greatly appreciated. in closing i feel compelled, as the new dean, to make a few personal comments about the indiana university school of socialwork. the school has approximately 900 students and offers the bsw, msw, and ph.d. degrees. the school offers educational programs on five indiana university campuses, located in bloomington, gary, indianapolis, south bend, and richmond. the school of social work has a rich history of providing quality social work education, producing excellent research and scholarship, and having a strong commitment to serving the profession and thepeople of indiana.headquartered in the state capital, indianapolis, the school has strong ties to state agencies and engages in a variety of projects in collaboration with these agencies. the university and the school of socialwork serve as models for utilizing advanced technology in the management of its programs. advances in socialwork represents another significant contribution that the school ismaking.with such a strong history, quality faculty, and strong support, it is a privilege to be at such a high quality school of social work. michael a. patchner, ph.d. dean fall 2000 iv advances in socialwork advances vol. 3, no. 1 33 evaluating kinship care alternatives: a comparison of a private initiative to traditional state services rodney a. ellis gary d. ellis rochelle galey abstract:multiple stressors on the child welfare system have forced innovative solutions to the overburdened foster care program. a promising alternative is kinship care, in which children are placed with biological relatives. proponents cite the opportunity to place the child in familiar surroundings, the natural access to additional family resources, and the degree to which it is sensitive to the norms and values of non-dominant cultural groups. various models of kinship care have been implemented in several jurisdictions, yet little or no research has been done to determine which alternatives are the most effective. this paper addresses that deficit. it reports the results of a study that compares stability of placement outcomes between a program operated by a private, not-for-profit organization (n=60) and amore traditional program (n=79) operated by a state child welfare agency. results support the use of the private alternative over the more traditional state-operated program. keywords: kinship care, child welfare, foster care, at-risk children, children’s services, placement thechild welfare system in the united states has recently experienced amyriad of stressors. the number of children in care has skyrocketed, as has the number of children with special needs (courtney, 1996; united states department of health and human services, 1996). experts cite large numbers of children with special education or mental health issues (chernoff, combs-orme, risley-curtiss &heisler, 1994), an influx of substance-exposed infants (ross, 1995), and children with serious health problems (bilaver, jaudes, koepke & goerge, 1999). increasing numbers of minorities have entered the system (scannapieco & jackson, 1996), raising questions about the appropriateness of traditional programs. the system, never rich in resources, has been hard-pressed to respond. kinship care, the placement of at-risk childrenwith biological relatives, has been lauded as a partial, yet effective response (national adoption information clearinghouse [naic], 1997). relatives provide a familiar, comfortable environrodney a. ellis, ph.d. is assistant professor, the university of tennessee college of social work. gary d. ellis, ph.d. is professor and chair, university of utah department of parks, recreation, and tourism. rochelle galey, m.s.s.w., is an alcohol and substance abuse counselor in colorado springs, colorado. copyright© 2002 advances in socialworkvol. 3 no. 1 (spring 2002) 33-45. indiana university school of socialwork. 34 ment, lessening the trauma children experience from forced relocation (ingram, 1996). family members may know of others who can help with transportation, supervision, or financial needs. placement with relatives may help to address cultural issues, allowing the child to remain in a culturally similar environment (child welfare league of america, 1994). perhaps most important to the overburdened system, a diligent search for relatives can help to generate placement alternatives, directing children away from the traditional system. kinship care is not a new concept. children in need of protection have been removed from their homes and placed with relatives throughout the history of child welfare. what is new, however, are the kinds of resources directed to caregivers (gleeson, 1999; ingram, 1996). some programs are exploring alternative management processes, such as familymediation (scannapieco, 1999;wilhelmus, 1998). others use family meetings for decision-making and support long-term care as an alternative to adoption. many offer a variety of new resources, such as financial assistance, caregiver support groups, and parenting courses (scannapieco, 1999). despite the enthusiasm with which new approaches to kinship care have been greeted, few researchers have compared the effectiveness of various program alternatives. this paper reports the results of different outcomes of two kinship programs. both operated in davidson county, tennessee (nashville). one program, herein identified as “public,” served children placed in the temporary custody of the tennessee department of children’s services, which then encouraged relatives to provide care and seek permanent custody of the children. this program offered a more traditional style of supervision, including case management, emergency financial support, clothing, and transportation. the second program (“private”) was operated by a partnership among three private agencies, the court appointed special advocate program (casa), the vanderbilt legal clinic, and family and children’s services. the privately sponsored relative caregiver program offered the same basic services as did the public program, but also included a broader range of services, including linkage to casa volunteers (provided by casa), weekly support groupmeetings, therapeutic activity groups, family and individual counseling, educational training (provided by family and children’s services), and legal representation (provided by the vanderbilt legal clinic). literature review the kinship literature features a variety of publication types, including: 1) studies of children, caregivers, andbiological parents, 2) programdescriptions, and 3) outcome evaluations. because of their value in conceptualizing this study, the literature in each of these categories is reviewed here. in addition, potential outcome variables are identified. descriptive studies several studies have examined the characteristics of children in relative care, their caregivers, and the parents whose children are placed with kin. children’s studies have focused on demographics, medical conditions, and behavioral or psychosoadvances in socialwork 35 cial problems (berrick, barth, & needell, 1994; dubowitz, tepper, feigelman, sawyer & davidson, 1990; gabel, 1992; iglehart, 1994; task force on permanency planning for foster children [tfppfc], 1990). caregiver studies have reviewed demographics, commitment to caregiving, and willingness to comply with traditional permanency alternatives (berrick, et al., 1994; dubowitz, et al., 1990; gabel, 1992; iglehart, 1994;tfppfc, 1990). research regarding biological parents has been primarily limited todemographics (berrick, et al., 1994;dubowitz, et al., 1990;gabel, 1992; iglehart, 1994; tfppfc, 1990; thornton, 1991;wulczyn & goerge, 1990). the mean age of children in kinship care is seven to eight years (berrick, et al., 1994; dubowitz, et al., 1990; iglehart, 1994; tfppfc, 1990). they are predominantly african-american (berrick, et al., 1994; iglehart, 1994). distribution by gender appears to be equal (berrick, et al., 1994; dubowitz, et al., 1990). most of the children are in custody due to neglect or parental substance abuse (berrick, et al., 1994; gabel, 1992; tfppfc, 1990). often, the substance abuse has resulted in prenatal exposure for the child (berrick, et al., 1994; gabel, 1992; tfppfc, 1990; thornton, 1991). regarding psychosocial issues, conclusions have been inconsistent. in the area of physical health, berrick, et al. (1994) found that most children were free from significant physical problems. dubowitz, et al. (1992), however, found that only 10% of the children they studied were free from medical problems. scannapieco, hegar and mcalpine (1997) suggest that results may vary because of different sources of assessment data. several researchers have identified behavioral problems. dubowitz, et al. (1990) found that 35 percent of the children in kinship care scored in the clinical range on the child behavior checklist. berrick, et al. (1994) concluded that children in relative care scored more than one standard deviation above the norm on the behavior problem index. however, both berrick, et al. (1994) and iglehart (1994) found fewer problems among children in kinship care than among those in foster care. in school, 60 percent of the children in kinship care behaved satisfactorily (berrick, et al., 1994; dubowitz, et al., 1990; iglehart, 1994), but between 36 and 50 percent performed below grade level in academic performance (dubowitz, et al., 1990; iglehart, 1994). caregivers have been primarily african-american, about 50 years old, and female (berrick, et al., 1994; dubowitz, et al., 1990; gabel, 1992; tfppfc, 1990). most have been maternal grandmothers (over 50%) and aunts (up to 33%) (dubowitz, et al., 1990; gabel, 1992; tfppfc, 1990; thornton, 1991). most have been single, and high school graduates (berrick, et al., 1994; dubowitz, et al., 1990; gabel, 1992). many were employed, yet lived at or below the poverty line (berrick, et al., 1994; dubowitz, et al., 1990). regardingwillingness to complywith childwelfare goals, many caregivers were willing to provide long-term care (berrick, et al., 1994; dubowitz, et al., 1990; thornton, 1991) but were reluctant to adopt or assume legal guardianship (berrick, et al., 1994; iglehart, 1994; thornton, 1991). biological parents were predominantly african-american, with amean age of 27 years. their primary income was from income maintenance programs. many could not be located when their children were taken into custody (gabel, 1992; ellis et al./evaluating kinship care model 36 advances in socialwork tfppfc, 1990). although different reasons were cited for removal of children, the primary reason was neglect, often compounded by parental substance abuse (berrick, et al., 1994; gabel, 1992; iglehart, 1994; thornton, 1991; wulczyn & goerge, 1990). programdescriptions the literature regarding kinship program descriptions has been summarized by scannapieco (1999). she identifies two categories of programs, one distinguished by funding source and a second defined by continuum of service. similar typologies will be needed to facilitate outcome comparisons of models. review of the current literature suggests at least four programmatic dimensions.they include: 1) formal vs. informal programs, 2) types and ranges of services, 3) identity of service providers, and 4) program goals and philosophies. formalversus informal programs placement with relatives has long been an alternative. in some cases, placements have been arranged without court involvement or state supervision. these placements have been termed informal (naic, 1997). in other cases, children have been placed by court order, and ongoing state supervision has been mandated (naic, 1977). these arrangements are considered formal. generally, when professionals refer to kinship care programs, they mean formal programs where judicial order and state responsibility are present. types and range of services programs offer a range of services.theymay include amonthly stipend, casemanagement, emergency financial relief, support groups, counseling services, parenting classes, educational services, and others (wilson, 1999). for example, scannapieco, et al. (1997) identified the services offered to baltimore kinship homes as medical and mental health, education, transportation, in-home aid, housing, crisis intervention, and parent education. service deliverymodels ranged from directive case management to mediation (wilhelmus, 1998). the variability of service availability among programs raises the question of the contribution of each to outcome. in multi-faceted interventions, it is critical to know which components are effective and which are ineffective. for example, stipends may enable families with limited resources to accept a child when it might not otherwise be possible. similarly, programs that include support groups may help caregivers deal with stressors that might otherwise disrupt the placement. identity of service providers another important dimension is the identity of the service provider. in some programs, the primary service-delivery organization is a government agency. in others, it is private (wilson, 1999). the primary agency may directly offer a broad range of services or may broker most services among a network of agencies. similarly, some may provide the majority of services through a case manager, while others may serve primarily as a source of referrals. 37 program philosophies and goals program philosophies and goals differ among programs. philosophical bases include family preservation, diversion from out-of-home care, or out-of-home care (scannapieco, 1999; scannapieco & hegar, 1996). goals may include reunification with parents, long-term placement with relatives, overall placement stability, preservation of family ties, adoption, independent living, reduction of the trauma generated by removal, and ongoing contact with the child’s natural culture (gleeson & craig, 1994; hegar, 1999; ingram, 1996; scannapieco, 1999). outcome evaluations few kinship outcome evaluations have been published. most have defined success in terms of duration and stability of placement (scannapieco, et al., 1997). these measures are closely related to program goals such as placement stability, preservation of family relationships, adoption, trauma reduction, and cultural sensitivity. previous research has compared placement stability in kinship homes to that in traditional foster homes. kinship placements have been more stable than traditional placements (berrick, et al., 1994; dubowitz, et al., 1990; gabel, 1992; tfppfc, 1990; wulczyn & goerge, 1990). the current researchers were unable to locate any studies reporting the results of outcomes between kinship care models. kinship care is likely to be a permanent child welfare strategy (scannapieco, 1999). this makes comparisons between kinship and traditional programs far less relevant. in fact, dubowitz (1994) observed that, “rather than asking whether kinship care is good or bad, the important policy-relevant question is what factors influence the success or failure of kinship placements” (p. 562). this suggests that future research should examine effectiveness among program alternatives as well as the elements of successful programs. a single outcome study focused on quality of care. berrick (1997) found that children in kinship settings were less safe than children in traditional settings (based on such factors as the presence of a first-aid kit, caretaker knowledge of cpr, and the physical environment of the home and community). however, kinship homes ranked higher in terms of both presence of and quality of a relationship with the mother. identification of outcomevariables the literature suggests that a broad selection of outcome variables is relevant. dimensions from which variables might be selected include: 1) characteristics of children (such as psychosocial functioning, quality of care [berrick, 1997], medical and behavioral conditions [bilaver, et al., 1999]); 2) conditions of the family (relationships [berrick, 1997; ingram, 1996] , contact with biological parent [berrick, 1997]); and 3) conditions of the placement (safety [berrick, 1997], stability of placement [berrick, 1997; henry, 1999; gleeson & craig, 1994]). ideally, evaluations should include a combination of these variables, but the nature of the data and sample size often inhibit choice. stability of placement is itself a valuablemeasure, and may serve as a proxy for others, such as psychosocial functioning, quality of care, and family relationships. evidence of its suitability as a proxy can be found in ellis et al./evaluating kinship care model 38 studies that have shown placement disruption can have a negative effect on the psychological, emotional, and intellectual development of children (ainsworth, blehar, waters & wall, 1978; fahlberg, 1979; goldstein, freud & solnit, 1973; verschueren, marcoen & schoefs, 1996). methodology sample the data were abstracted from the private program files and davidson county juvenile court records. data collectors were trained in abstraction techniques and closely supervised to minimize the probability of problems with inter-rater reliability. training techniques included: 1) a thorough review of the document containing the original data, 2) trial efforts in data collection using fabricated data, and 3) a discussion of how discrepancies in the original data should be handled. supervisory techniques involved the presence of the same supervisor during each data collection period. the supervisor answered questions and reviewed random data collection forms for clarity and accuracy. some inconsistencies may have existed in the way in which data were originally collected by workers from the private program or the juvenile court. the sample consisted of 148 children between infancy and age 18. nine children who had received services from both the private and the public programs were excluded from the analysis. each of the participants represented a distinct kinship placement, that is, neither group’s total included settings in which siblings were placed together in the home of a relative. table 1 reports distribution by age for the 139 participants. seventy-five (54%) were female and 64 (46%) were male (see table 2). theywere predominantly african-american (n=113, 81.3%), and included 23 caucasians (16.5%), one native american/alaska native (.7%), one who selfidentified as multi-racial (.7%), and one who self-identified as other (.7%). distribution by race is reported in table 3. all were residents of the metropolitan davidson county (nashville) area. the private group (n=79) included all children who participated in the program between august, 1997 and february, 1999. the public group (n=60) consisted of a randomly selected sample of children who received services from that program during the same period. outcome data were collected throughmay 2000. variable selection, research design, andhypothesis since randomization was not possible, the researchers selected three variables to determine group equivalency. age, sex, and race were used for comparison. age was continuous, including children from infancy to 18 years. sex was, of course, dichotomous. race was categorical, the categories having been determined by program documents. categories included asian, native american or alaska native, black, hispanic, hawaiian or pacific islander, multiracial, caucasian, and other. positive outcome was defined as stability of placement. stability of placement was defined as remaining consistently within the same home without permanent removal to an alternative setting. disruption for any reason other than return to a biological parent was regarded as unsuccessful. the dependent variable was, advances in socialwork therefore, dichotomous, representing either continuous residence with the kinship caregiver or removal to a setting other than the biological parent. the independent variable was treatment, consisting of the categories private and public. a retrospective cohort design was used to test the hypothesis that children from the private group would experience greater stability of placement than those from the public. statistical method the groups were compared on three variables: age, sex, and race. ages were compared using a t-test. chi-square analysis was used for both sex and race. to compare outcomes between groups, placement stability was cross-tabulated with treatment and the hypothesis was tested using the chi-square distribution. 39 age private public total % n % n % n 1 3.8 3 1.7 1 2.9 4 2 6.3 5 6.7 4 6.5 9 3 6.3 5 3.3 2 5.0 7 4 5.1 4 1.7 1 3.6 5 5 1.3 1 11.7 7 5.8 8 6 5.1 4 5.0 3 5.0 7 7 8.9 7 5.0 3 7.2 10 8 6.3 5 6.7 4 6.5 9 9 11.4 9 11.7 7 11.5 16 10 10.1 8 11.7 7 10.8 15 11 11.4 9 10.0 6 10.8 15 12 1.3 1 6.7 4 3.6 5 13 10.1 8 0 0 5.8 8 14 7.6 6 10.0 6 8.6 12 15 5.1 4 1.7 1 3.6 5 16 0 0 5.0 3 2.2 3 17 0 0 0 0 0 0 18 0 0 1.7 1 .7 1 total 100.0 79 100.0 60 100.0 139 table 1: distribution of the sample by age private public total % n % n % n female 28.1 39 26.6 36 54 75 male 28.1 40 17.3 24 46 64 total 56.9 79 43.1 60 100.0 139 table 2: distribution of the sample by gender ellis et al./evaluating kinship care model results analysis of the demographic variables showed little indication of difference between the groups.themeanageof participants in theprivate (8.63 years) and the public groups (8.95 years) did not differ significantly and, perhapsmore importantly, the squared point bi-serial correlation revealed that only .2% of the variance in age could be explained by groupmembership (t=-.456, p=.649, rpbi=.039). no significant relationship between group membership and gender was observed and the relationship between these two variables was also quite weak (χ2=1.367, p=.242, φ=.100). the groups also did not differ significantly by racial composition (χ2= 1.889, p=.169, cramer’s v=.118). the sample was thus similar to those from other studies where children were seven to eight years old, evenly distributed between the genders, and predominantly african-american. on the outcome placement stability variable, 69 of the 78 private participants (88.5%) remained in kinship care at the end of the study period. in comparison, 42 of the 54 public participants remained with relatives, a total of 77.8% (table 4). seven participants were excluded because of missing data. the results were significant at the .10 level (χ2=2.723, p=.10,φ=.144). the p=.10 alpha level was selected over the traditional p<.05 criterion to offset the probability of a type ii error. stevens (1999, p. 135) suggests that alpha levels of .10 or even .15may be appropriate in certain contexts. as stevens points out, small and medium effect sizes are very common in social science research. failure to reject null hypotheses based on stringent alpha levels may thus dissuade researchers from engaging in inquiry in new areas of research that may ultimately prove fertile (stevens, 1999, p. 126). as such, relatively liberal alpha levels are often appropriate for studies that represent initial inquiries into new research problems. 40 race private public total black 77.2 61 86.7 52 81.3 113 white 20.0 16 11.7 7 16.5 23 native american 1.3 1 0 0 .7 1 multiracial 1.3 1 0 0 .7 1 other 0 0 1.3 1 .7 1 total 100.0 79 100.0 60 100.0 139 table 3: distribution of the sample by race private public n % n % no disruption 69 88.5 42 77.8 disruption 9 11.5 12 22.2 _________________ χ2 = 2.723, p = .10, φ = .144 table 4: stability of placement by program advances in socialwork it is also instructive to consider the practical significance of this finding in the context of power versus risk reduction (stevens, 1999, p. 135).given that costs of the two programs under consideration in this study are similar, power should take precedence over the risk of falsely rejecting a null hypothesis. rejecting a true null hypothesis would only lend support to a program of similar cost, which also produced a somewhat more positive outcome in the sample data. if, indeed, themore than 10% improvement is supported in future studies with larger samples, this could make an important difference for many children in state custody. in a group of 50,000 (not unrealistic to imagine in the future given today’s escalating childwelfare population), conditions for 5,000 would be improved. this suggests that proper program selection could have a substantial positive effect for thousands of children. discussion this study supports the efficacy of the private over the public program. this suggests that childwelfare practitioners should be actively involved in developing and evaluating kinship programs. research should focus on outcomes betweenmodels and the elements of thosemodels. for example, it may be that the weekly support groups offered to caregivers in the private program were critical to their ability to copewith stress andmake effective familymanagement decisions. alternatively, it is likely that the legal consultation and representation offered by the program helped participants make sound decisions while navigating the court system, enhancing the probability of placement stability. the success of kinship programs does notmean that practitioners should expect placement with a relative to ensure success. the programs in this study provide intensive, specialized support. these supportive conditions often do not exist where specialized programs are not in place. although practitioners should always consider kinship placements, they should not assume results such as those in this study. practitioners should develop initiatives using models and concepts that have been effective elsewhere. outcomes should be evaluated and results disseminated. advocacy efforts will need to include special funding allocations, policy accommodations, and some restructuring of service delivery systems. researchers should conduct evaluations using larger samples,more sophisticated designs, more informative statistical methods, andmore comprehensive variables that use higher levels of measurement. additional questions need to be answered regarding family assessment techniques, referral patterns, service utilization patterns, and service delivery systems. protocols for programcomparison should be developed andused across studies. an example would be a table of program characteristics that includes a typology such as the one suggested by scannapieco (1999) anddeveloped in this article.the table could serve as a basis for program comparison. an example, protocol for model comparison (pmc), is included in table 5. thepmcillustratesprogramdifferences in thecurrent study. in the first dimension, formality/informality, both programs are formal. the programs offer different services (dimension 2). one consists of stateworkers (public) and the other of private 41ellis et al./evaluating kinship care model employees (private) (dimension 3). comparisons could not be made in the fourth dimension because one program lacked a clear statement of philosophy. future studies could help to determine characteristics that are most crucial to outcome. 42 dimension iformality/informality ___ formal ___ informal dimension iisource of funding ___ federal and state foster care funds ___ state funds only ___ tanf funds ___ other dimension iiitypes and range of services ___ monthly stipend ___ case management ___ emergency financial relief ___ support groups ___ counseling services ___ parenting classes ___ educational services ___ medical services ___ mental health services ___ education ___ transportation ___ in-home aid, housing ___ crisis intervention ___ parent education ___ clothing ___ linkage to casa volunteers ___ therapeutic activity groups for children ___ family and individual counseling ___ educational training dimension ividentities of service providers ___ government agencies ___ private, not-for-profit ___ private, for profit dimension vprogram philosophies and goals philosophies ___ family preservation ___ diversion from out-ofhome care ___ out-of-home care goals ___ reunification with parents ___ long-term placement with relatives ___ overall placement stability ___ preservation of family ties ___ adoption ___ reduction of the trauma generated by removal ___ ongoing contact with the child’s natural culture table 5: protocol for model comparison advances in socialwork limitations the study was limited in a number of ways. it would have been desirable, for example, to include data from a traditional foster care group. unfortunately, the structure of the record-keeping system between the juvenile court and the state child welfare department prevented the researchers from accessing foster care data. next, archival data limited the selection of variables and predetermined the level of measurement. this precluded the use of more complex statistical methods and restricted access to information that might have been available with higher levels of measurement. another limitation was the manner in which original data were collected. study staff received extensive training to assure consistency in data collection. various workers from different sources collected the original data, introducing the possibility of inter-rater reliability problems. the outcome variablewas also limited.the assumption that relocation of a child into a setting other than the care of a biological parent is detrimental may not be accurate. for example, a move to a more restrictive placement may be desirable when the services available are necessary to improve the child’s condition. furthermore, it cannot be assumed that return to the biological parents is always desirable. a final limitation involved the referral process into the programs. some children (n=3) in the public program had originally been referred to the private, but either their families had elected not to participate, or the children were screened out because they failed to meet selection criteria. criteria included a continuum of conditions, ranging from families showing no need for specialized intervention, to being in an extreme state of crisis. depending on the number of children who did not participate in the private program for any of these reasons, outcomes might have been affected. despite the limitations of this study, it provides valuable information in an area characterized by its paucity, constituting a valuable foundation for future research. different designs, such as experimental or single-subject, may provide additional insight into effectiveness. future studies should use live data sources with levels of measurement chosen to provide optimal conditions. researchers should usemultiple outcome measures, including placement stability, psychosocial functioning, and family adjustment.within themodels of care, treatment integrity andpatterns of service utilization should be examined. differential effects should be considered among ethnic groups, genders, age groups, and groups of children with special needs. summary kinship care is a promising, although partial, response to the growing pressure on the child welfare system. placing children with relatives can help to minimize the trauma of removal,maintain supportive family relationships, and preserve consistency of cultural experience. it is a desirable alternative for children, families, and child welfare providers. 43ellis et al./evaluating kinship care model there are various kinship care models, ranging from informal, unfunded arrangements to highly structured, well-funded interventions. additional research is needed to identify effective models and their critical components. the current study supports the effectiveness of the private over the public program. these findings argue for continued research into program alternatives. references ainsworth, m.s., blehar, m.c.,waters, e., &wall, s. (1978). patterns of attachment: a psychological study of the strange situation. potomac, md: lawrence earlbaum. berrick, j.d. (1997). assessing quality of care in kinship and foster family care. family relations: interdisciplinary journal of applied family studies, 46(3), 273-280. berrick, j.d., barth, r.p., & needell, b. (1994). a comparison of kinship foster homes and family foster homes: implications for kinship foster care as family preservation. children andyouth services review, 16(2), 33-64. bilaver, l.a., jaudes, p. k., koepke, d., & goerge, r.m. (1999). the health of children in foster care. social service review, 73(3), 401-416. chernoff, r., combs-orme, t., risley-curtiss, c., & heisler, a. (1994). assessing the health status of children entering foster care. pediatrics, 93(4), 594. childwelfare league of america. (1994). kinship care: a natural bridge.washington, d.c.: author. courtney,m.e. (1996). kinship foster care and children’swelfare:thecalifornia experience.focus,17(3), 4248. dubowitz, h. (1994). kinship care: suggestions for future research. childwelfare, 73, 553-562. dubowitz, h., feigelman, s., zuravin, s., tepper, v. davidaon, n., & lichenstein, r. (1992). the physical health of children in kinship care. american journal of diseases of children, 146, 603-610. dubowitz, h., tepper, v., feigelman, s., sawyer, r., & davidson, n. (1990). the physical andmental health and educational status of children placed with relatives: final report. report prepared for the maryland department of human services and the baltimore city department of social services, baltimore, maryland. fahlberg, v. (1979). attachment and separation. lansing, mi: department of social services. gabel, g. (1992). preliminary report on kinship foster family profile. new york: human resources administration, childwelfare administration. gleeson, j.p. (1999). kinship care as a child welfare service: emerging policy issues and trends. in r.l. hegar & m. scannapieco (eds). kinship foster care: policy, practice, and research (pp. 28-53). new york: oxford university press. gleeson, j.p., & craig, l.c. (1994). kinship care in child welfare: an analysis of states’ policies.children and youth services review, 16, 7-31. goldstein, j., freud, a., & solnit, a.j. (1973). beyond the best interests of the child. newyork: free press. hegar, r. l. (1999). the cultural roots of kinship care. in r.l. hegar &m. scannapieco (eds). kinship foster care: policy, practice, and research (pp. 17-27). newyork: oxford university press. henry, j. (1999). permanency outcomes in legal guardianships of abused/neglected children. families in society: the journal of contemporary human services, 80(6), 561-568. iglehart, a.p. (1994). kinship foster care: placement, service, and outcome issues. children and youth services review, 16(2), 107-122. ingram, c. (1996). kinship care: from last resort to first choice. childwelfare, 75(5), 550-556. national adoption information clearinghouse. (1997). keeping the family tree intact through kinship care. [online]. available: http://www.calib.com/naic/pubs/f_kinshi.htm. ross, j.l. (1995, may 25). services for young foster children.washington, d.c.: u.s. general accounting office (gao/hehs-95-114). 44 advances in socialwork scannapieco, m. (1999). formal kinship care practice models. in r.l. hegar & m. scannapieco (eds). kinship foster care: policy, practice, and research (pp. 71-83). newyork: oxford university press. scannapieco,m., &hegar, r.l. (1996). a non-traditional assessment framework for formal kinship homes. childwelfare, 75(5), 567-579. scannapieco, m., hegar, r.l., & mcalpine, c. (1997). kinship care and foster care: a comparison of characteristics and outcomes. families in society: the journal of contemporary human services, 78(5), 480488. scannapieco, m., & jackson, s. (1996). kinship care: the african-american response to family preservation. socialwork, 41(2), 190-196. stevens, j. (1999). intermediate statistics (2nd ed.). mahwah, nj: lawrence erlbaum associates. task force on permanency planning for foster children, inc. (1990). kinship foster care: the double-edged dilemma. rochester, ny: author. thornton, j.l. (1991). permanency planning for children in kinship foster homes.childwelfare 70(5), 593601. united states department of health and human services, national center on child abuse and neglect. (1996). no place to call home: discarded children in america. washington, d.c.: u.s. government printing office. verschueren, k., marcoen, f., & schoefs, a. (1996). the internal working model of self, attachment, and competence in five-year-olds. child development, 67(5), 2493-2511. wilhelmus, m. (1998). mediation in kinship care: another step in the provision of culturally relevant child welfare services. socialwork, 43(2), 117-125. wilson, d.b. (1999). kinship care in family-serving agencies. in r.l. hegar &m. scannapieco (eds). kinship foster care: policy, practice, and research (pp. 84-92). newyork: oxford university press. wulczyn, f., & goerge, r.m. (1990). public policy and the and the dynamics of foster care: amulti-site study of placement histories. washington, dc: u.s. department of health and human services, office of assistant secretary for planning and evaluation. author’s note: address correspondence to: rodney a. ellis, ph.d., the university of tennessee, college of social work, 193e polk street, nashville, tn 37210. e-mail: rellis5@utk.edu. 45 2002 national association of socialworkers (nasw) indiana chapter annual state conference october 9-11, 2002 marriott hotel — indianapolis, indiana ellis et al./evaluating kinship care model aisw vol. 5, no. 2 319 social justice and lesbian feminism: two theories applied to homophobia denise l. levy abstract: trends in contemporary social work include the use of an eclectic theory base. in an effort to incorporate multiple theories, this article will examine the social problemof homophobia using two different theoretical perspectives: johnrawls’ theory of social justice and lesbian feminist theory. homophobia, a current social problem, can be defined as “dislike or hatred toward homosexuals, including both cultural and personal biases against homosexuals” (sullivan, 2003, p. 2). rawls’ theory of justice and lesbian feminist theory are especially relevant to the issue of homophobia and provide a useful lens to understanding this social problem. in this article, these two theories will be summarized, applied to the issue of homophobia, and compared and contrasted based on their utility. keywords: homophobia, theory, lesbian feminism, social justice practicing social workers encounter a wide variety of client situations that often require the use of multiple theories and interventions. it is important for social workers to be able to use a range of theories to inform their practice with unique clients (lehmann & coady, 2001). the more tools that social workers have at their disposal, the better equipped they will be to help clients. in fact, “the valuing of multiple perspectives for understanding and intervening . . . are consistent with and can inform social work practice” (lehmann & coady, 2001, p. 13). in this spirit, this article will examine the social problem of homophobia using two different theoretical perspectives: john rawls’ theory of social justice and lesbian feminist theory. homophobia is an important concern for social workers today. according to the national association of socialworkers (nasw, 1999) code of ethics, social workers should understand oppression based on sexual orientation, advocate for equal access and equal rights for all individuals, promote respect for diversity, and work to end social injustice and discrimination against individuals based on their sexual orientation. first and foremost among these directives is the call for social workers to understand oppression, which includes homophobia. denise l. levy is an assistant professor at the department of socialwork, appalachian state university, boone, nc 28608. copyright© 2007 advances in socialworkvol. 8 no. 2 (fall 2007) 319-327. indiana university school of socialwork. 320 advances in social work in defining homophobia, it should be distinguished from heterosexism. lorde (2001) defined homophobia as “a terror surrounding feelings of love for members of the same sex and thereby a hatred of those feelings in others” (p. 234). on the other hand, heterosexism is the societal superiority of heterosexuality (krieglstein, 2003; lorde, 2001). in other words, homophobia signifies an individual’s beliefs or feelings about homosexuals; the broader term, heterosexism, deals with the denial of privilege to non-heterosexuals at the societal level (simoni & walters, 2001). these concepts are certainly intertwined, and both will be addressed in this article. furthermore, although the focus is on homophobia against gay and lesbian individuals, this discussion is certainly relevant to discrimination against other queer populations. in an effort to better understand homophobia, this article will examine this social problem through the lens of two theories: john rawls’ theory of justice and lesbian feminist theory. specifically, there will be a focus on the contribution of each perspective to understanding homophobia. the two theories will be compared based on their utility and their implications for social work practice. rawls’theory of justice basics of the theory john rawls, born in 1921, was a major american political theorist (martin, 2002). rawls’ book, a theory of justice, published in 1971, “stimulated a revival of attention to moral philosophy . . . [and] made a sophisticated argument for a new concept of justice, based on simple fairness” (martin, 2002, p. 19). this theory is certainly relevant to social work, especially considering the profession’s value of social justice (nasw, 1999). furthermore, this theory, as outlined below, can provide a unique framework in which to view and examine homophobia. john rawls’ theory of justice includes three main concepts: reflective deliberation, the original position, and a well-ordered society. reflective deliberation. in reflective deliberation, rational people generate ideas regarding what is just or right, as well as what is unjust or wrong. in other words, individuals deliberate and reflect on what is just in order to come up with considered judgments (kaufman, 2006). these considered judgments are simply a list of what individuals find to be right through the reflective deliberation process. once considered judgments are identified, they can be tested using the original position (rawls, 2001). the original position. in the original position, individuals are blinded to their position, status, and wealth in society as they debate considered judgments (rawls, 2001). for example, if a rational individual does not know whether he or she will be rich or poor, that individual will most likely advocate for programs to assist underprivileged groups. because individuals do, in fact, know their positions in society, the original position is more of a thought experiment than a reality. however, utilizing this “veil of ignorance,” in which individuals test principles of justice while being ignorant of their positions in society, is certainly useful (rawls, 2001). the idea is that individuals will act in 321 their best interest but, without knowing their eventual societal status, they will choose principles of justice that are beneficial to everyone. essentially, individuals will approve principles that forbid anyone from being oppressed so that they can keep from being exploited themselves (nathanson, 1998). if the considered judgments do not stand up to the hypothetical test of the original position, further reflection and deliberation is needed. rawls (2001) explained that: by going back and forth [between reflective deliberation and the original position] . . . i assume that eventually we shall find a description of the initial situation that both expresses reasonable conditions and yields principles which match our considered judgments duly pruned and adjusted. this state of affairs i refer to as reflective equilibrium (p. 58). rawls asserted that reflective equilibrium will lead to the formation of two central principles of justice: the liberty and difference principles (rawls, 2001; nathanson, 1998). awell-ordered society. rawls (2001) explained that the process of reflective equilibrium will always lead to the liberty and difference principles. the liberty principle outlines basic human rights and states that all people will have equal rights in a just society (nathanson, 1998). the difference principle, though it does allow for some economic inequalities, focuses on providing the greatest benefit to those who are least advantaged (nathanson, 1998). this entire process of reflective discourse and the original position leads to and is based on a well-ordered society, or a society in which every member follows and adheres to the principles of justice. assumptions rawls’ theory of justice includes several assumptions and may not be considered a very practical theory. for example, critics might question the utility and value of a hypothetical thought experiment. in fact, as everyone knows their place in society, the “veil of ignorance” is impossible. however, the theoretical situation is useful in contemplating social justice and principles of justice in a new way. this theory also posits that we live in a well-ordered society, and rawls (2001) acknowledged this as a limitation. finally, rawls (2001) assumed that individuals in the original position will always come up with his two principles of justice: the liberty and differences principles. it is, in fact, the difference principle that highlights one of the main assumptions of this theory— the assumption of deep inequalities in society (rawls, 2001). definition of homophobia rawls’ theory of justice does not specifically speak to the social problem of homophobia. this issue may not be addressed simply because the theory is designed as a thought experiment and is not applied, by rawls anyway, to everyday issues and problems. however, based on an understanding of the theory itself, inferences can be made regarding how it can be used to understand homophobia. in the theory of justice, the first principle is concerned levy/justice and lesbian feminism 322 advances in social work with basic human rights and liberties. the second deals with greater assistance to the least advantaged in a society. rawls’ theory, therefore, would characterize homophobia and heterosexism as removing these liberties and continuing the cycle of oppressing the least advantaged. rawls (2001) explained that basic liberties include “freedom of the person, which includes freedom from psychological oppression and physical assault and dismemberment (integrity of the person)” (p. 60). consequently, homophobia would be defined as the psychological oppression of gay and lesbian individuals. this oppression would go against respect and self-respect, which rawls “regards as a primary social good—a value more important than money and power” (jones, 1980, p. 286). causes of homophobia although the theory of justice does not specifically describe the causes of social injustices and social problems, these can be inferred. using the definition of homophobia as the psychological oppression of homosexuals, the theory could identify a variety of causes of this social problem. for example, nathanson (1998) discussed the importance of self-interest in rawls’ theory: to take account of these facts about human motivation, rawls assumes that people in the original position are concerned with advancing their own interests. they want to make sure that their own lives will go well, and they want principles of justice that will protect them from various kinds of bad conditions (p. 83). in society, some individuals are totally motivated by self-interest and, knowing their position in society, they want what is best for them and for those like them. if these individuals are part of the heterosexual majority, then the result could be heterosexism and limited opportunities for gay and lesbian individuals. homophobia might also be caused by individuals who have not tested their considered judgments in the original position. these individuals, for example, might be surrounded with others who are homophobic and never question this belief. if examined using the rawls’ “veil of ignorance,” though, homophobia would be discarded as unjust. another cause of homophobia could be discriminatory religious views. rawls explained that principles of justice must be just in and of themselves, and he discouraged any appeal to a religious or moral authority when deciding these principles (rawls, 1999). however, people do defer to their religion for what is right, moral, and just. because many forms of christianity, for example, consider homosexuality to be a sin (buchanan, dzelme, harris, & hecker, 2001), the result could be fear of and prejudice against homosexuals. rawls’ theory of justice assumes that social problems and inequalities exist in society, but it does not explicitly discuss causes of these issues. therefore, in inferring causes based on the tenets of the theory, the result might be less than satisfying. for example, the social justice perspective does not account for homophobia being caused by lack of contact with homosexuals. 323 solutions and implications rawls’ theory provides a thought experiment in which to test our considered judgments about what is right and wrong. this, in and of itself, can be a solution to homophobia. the original position provides a way for individuals to suppose that they do not know whether they will be gay, lesbian, bisexual, transgendered, queer, or straight. because of self-interest and other principles at work in the original position, individuals will not likely stand for homophobia to be considered just in a society if they do not know what their sexual orientation would be. any rational individual who goes through this hypothetical situation will acknowledge that homophobia is unjust. because the “veil of ignorance” is not truly possible, we are left with the question—what practical solutions, then, does this theory provide to this social problem? rawls explains that the original position will lead to the formation of two principles of justice (rawls, 2001). if applied across a society, these two principles can encourage social justice and discourage social injustice. furthermore, in employing the liberty principle, all prejudice against gay and lesbian individuals would be considered unjust. in addition to equal liberties, gays and lesbians would be given greater assistance under the difference principle. though it does allow for economic inequalities, the difference principle states that the greatest benefits must be provided to those who are least advantaged (nathanson, 1998). because social workers have historically been concerned with social justice and empowering the least advantaged in society, this theory provides an appropriate framework for interventions. it supports social workers in their efforts to raise awareness about homophobia and heterosexism, lobbying politicians regarding related issues, petitioning teachers and educators concerning school curriculum changes, and increasing community outreach programs to gay and lesbian individuals. lesbian feminist theory basics and assumptions lesbian feminist theory had its beginnings in the 1970s with lesbians who felt like they did not have a place in the radical feminist women’s movement (saulnier, 1996; stein, 1997). the early lesbian feminist movement joined together: 1) lesbians who felt denied, silenced, or even expelled from the women’s movement by heterosexual feminists; 2) lesbians who were dismayed by the inability of the gay movement to incorporate lesbian perspectives; and 3) radical feminists whose analysis of sexism extended to an analysis of heterosexism (pp. 76-77). these individuals, despite their differences, held a couple of the same central beliefs: lesbians should not be devalued based on their sexual orientation; and heterosexism, rather than patriarchy, should be the primary focus of the feminist movement (garber, 2001). these women believed that heterosexuality eliminated the solidarity between women, lesbianism was a political choice, and that women often experienced compulsory heterosexuality (enns, 1997; hawkesworth, 2006). levy/justice and lesbian feminism 324 advances in social work although saulnier (1996) referred to lesbian feminist theory, the term “lesbian feminism” often signifies the movement itself. this article will utilize the central ideas from the lesbian feminist movement as a unique theory or standpoint by which to analyze homophobia. in fact, jackson and jones (1998) explained that lesbian feminist theory, rather than emerging from academia, is one of the few theories based on experience. further, contemporary scholars tend to refer to lesbian feminism as a theory (enns, 1997; enns & sinacore, 2005; jackson & jones, 1998; lehmann & coady, 2001). lesbian feminist theory is a causal theory. it outlines very clearly the causes of social problems, such as homophobia, and it proposes suggestions for how to rectify these issues. in fact, a core ambition of the lesbian feminist movement was to create a sort of lesbian nation, which might end homophobia (garber, 2001). to be a lesbian feminist in the 1970s was to be political, and the politics of the woman-identified-woman focused on patriarchy and male privilege (bunch, 2001; stein, 1997). lesbian feminist theory is based on multiple assumptions, including one that makes this theory distinct from other feminist perspectives: eliminating patriarchy in our society will not necessarily produce an end to heterosexism (saulnier, 1996). in addition, lesbian feminists assumed that sexuality would be the most important part of a lesbian’s identity (stein, 1997). they believed that a separate movement was needed in order for lesbians to find their rightful place in feminism. furthermore, they concluded that the best way to accomplish feminist goals was for women to join together independently from men (saulnier, 1996). definition of homophobia some lesbian feminists use the term “homophobia” as synonymous with heterosexism (saulnier, 1996). they do not differentiate between an individual’s homophobia, the assumption of heterosexuality, and beliefs in the superiority of heterosexuality (saulnier, 1996). therefore, this theory includes the following individuals as homophobic: those who are prejudiced against homosexuals, those who fear homosexuals, and those who believe that heterosexuality is superior. causes of homophobia the cause of homophobia, when viewed from a lesbian feminist perspective, is the power and value that society gives to heterosexuals. in this theory, homophobia results from the notion that lesbianism is a threat to heterosexuality and male superiority (bunch, 2001). some causes of homophobia, however, are not considered in this theory. for example, lesbian feminists did not consider that lack of contact with homosexuals might fuel homophobia. this is evident in that they advocated increased separation and isolation from men and non-lesbians (stein, 1997). in addition to lack of contact, religious beliefs are not considered to be a cause of homophobia in this theory. solutions and implications lesbian feminist theory offers a clear solution to homophobia: creating a group of like-minded women to influence society (garber, 2001). the solution begins with creating such groups to form the lesbian feminist movement and eventually the lesbian nation. this nation would be one in which heterosexism was not superior and in which lesbians had equal opportunities and political power. in addition, lesbian feminism insists on political action and ending male supremacy; being a lesbian without action is not enough (bunch, 2001). these individuals can challenge heterosexism by “denying women’s ‘innate’ need for men” (bunch, 2001, p. 129). finally, this theory can serve as a basis for increasing social and community interventions for lesbians. in particular, lesbian feminists encourage programs where women are empowering and assisting other women. comparing the two theories rawls’ theory of social justice is a broad theory that can be easily applied to almost any social problem. the liberty and difference principles provide a way to tackle social injustices. furthermore, by using the thought experiment of the original position, one can test considered judgments about society in order to see if these judgments are truly just. however, rawls’ theory is almost too broad in its nature. it does not adequately explain causes of social problems, such as homophobia. furthermore, this theory is designed for a wellordered society in which all members will follow the principles of justice. in reality, there are people in society who break laws and commit unjust actions. this theory does not address how to handle these situations; thus, other theories are needed in order to fully understand homophobia. lesbian feminist theory, on the other hand, is very narrow in its scope. it is focused on the specific experience of lesbians in a heterosexist society. this theory does address the causes and solutions of a specific social problem, homophobia. though lesbian feminism provides a unique and important perspective on homophobia, it does not encompass a wide variety of social problems. therefore, this theory is a good counterpart to social justice theory in understanding homophobia. implications for socialwork practice the nasw (1999) code of ethics states that “social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to . . . sexual orientation” (p. 9). this mandate is especially important in today’s society; social workers often encounter homophobia and heterosexism in practice. gays and lesbians may experience homophobia and heterosexism in the form of jokes, ridicule, and violent physical attacks (garnets, herek, & levy, 2003). in addition, these individuals are not afforded the rights given to heterosexuals, including the ability to adopt children, marry partners, or visit partners in the hospital. using the theoretical perspectives presented in this article, social work practitioners can assist their clients in a variety of ways. rawls’ theory of justice is helpful when organizing or planning educational seminars around homophobia and heterosexism. social workers can present rawls’ concept of the original position in order to have attendees analyze these social issues. in addition to educational 325levy/justice and lesbian feminism programs, rawls’ theory of justice provides a framework by which to advocate for equal rights for gay, lesbian, bisexual, transgendered, and queer clients. social workers can also use the tenets of lesbian feminist theory to create support groups and networks of underrepresented individuals. according to this theory, it is important for women to empower each other and experience solidarity. by starting these support groups, social workers can ensure that women and other non-heterosexual community members encourage and empower each other. in conclusion, no one theory is all-inclusive when practicing social work and doing research. both lesbian feminism and rawls’ theory of justice provide distinctive and significant elements to the understanding of homophobia. as this article has demonstrated, it is only through using multiple perspectives and theories that inclusive comprehension can be achieved. in using a broad theory, such as social justice and a specific one like lesbian feminism, the framework for understanding homophobia highlights both macro and micro aspects of this issue. references. buchanan, m., dzelme, k., harris, d., & hecker, l. 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(2003). homophobia, history, and homosexuality: trends for sexual minorities. in m. sullivan (ed.), sexual minorities: discrimination, challenges, and development in america (pp. 1-13). binghamton, ny: the haworth social work practice press. author’s note: address correspondence to: denise l. levy, assistant professor, department of social work, chapell wilson hall, appalachian state university, boone, nc 28608, usa. e-mail: dllevy@gmail.com. levy/justice and lesbian feminism spring2000-051_page43 spring2000-052_page44 spring2000-053_page45 spring2000-054_page46 spring2000-055_page47 spring2000-056_page48 spring2000-057_page49 spring2000-058_page50 spring2000-059_page51 spring2000-060_page52 spring2000-061_page53 spring2000-062_page54 spring2000-063_page55 spring2000-064_page56 spring2000-065_page57 spring2000-066_page58 spring2000-067_page59 spring2000-068_page60 spring2000-009_page1 spring2000-010_page2 spring2000-011_page3 spring2000-012_page4 spring2000-013_page5 spring2000-014_page6 spring2000-015_page7 spring2000-016_page8 spring2000-017_page9 spring2000-018_page10 spring2000-019_page11 spring2000-020_page12 spring2000-021_page13 spring2000-022_page14 spring2000-023_page15 spring2000-024_page16 spring2000-025_page17 spring2000-026_page18 spring2000-027_page19 spring2000-028_page20 spring2000-029_page21 spring2000-030_page22 spring2000-031_page23 spring2000-032_page24 spring2000-033_page25 spring2000-034_page26 advances vol. 3, no. 2 134 correlates of msw students’ perceptions of preparedness to manage risk and personal liability michael n. kane abstract:few studies in the discipline of social work have identified correlates of preparedness to manage risk and personal liability among practitioners or students. this study investigated predictors of msw students’ perceptions of managing personal risk and liability (n=116). four correlates were identified from the standard regression model that accounts for 43% of the adjusted variance. these predictor variables included: (a) concern and worry about lawsuits (beta=-.458, p=.00), (b) understanding the fit between client advocacy and managed care (beta=.328,p=.00), (c) understanding agency documentation requirements (beta=-.164, p=.05), and (d) perceptions of field preparation for documentation (beta=.162, p=.05). implications are discussed. keywords: risk management, documentation, career preparedness throughout the united states and the world, managed care and other types of service delivery continue to change (frazee, 1997). much of this change is a result of evolving models of managed care and privatization (berkman, 1996; corcoran & vandiver, 1996; davis & meier, 2000; fletcher, 1999; kane, hamlin & hawkins, 2000; motenko et al., 1995; oss, 1996; perloff, 1998; rose, 1996; rosenberg, 1998; vernon, 1998). these models were conceived to provide effective intervention while controlling costs (corcoran & vandiver, 1996; davis & meier, 2000). while these restrictive models of service delivery have infiltrated most health, mental health, and social service venues and have been a source of financial success, they have also been perceived as a political and cultural failure (robinson, 2001). attitudes toward managed care among consumers as well as practitioners of many disciplines are generally negative (berger & ai, 2000; robinson, 2001; yedidia, gillespie & moore, 2000). it appears that these models of service delivery have focused primarily on the cost of services. no doubt the cost of services is an important consideration for practitioners, payers, clients, and organizations (davis & meier, 2000), especially in an age of scarce resources.while practitioners may hold negative attitudes toward these models, many practitioners work in managed care and michael n. kane, ph.d., m.s.w., m. div. is assistant professor, school of social work, florida atlantic university, boca raton, fl. copyright© 2002 advances in socialworkvol. 3 no. 2 (fall 2002) 134-145. indiana university school of socialwork. privatized venues. consumers may also hold negative attitudes toward managed care and privatization. however, consumers have more options. when consumers perceive that they have received service that does not meet the standard of care, they may increasingly opt for litigation. practitioners are acutely aware that they face the brunt of exposure to litigation and are increasingly urged to seek legal counsel to ensure that they meet professional standards of care (bernstein & hartsell, 2000; houston-vega, nuehring, with daguio, 1997; madden, 1998; reamer, 1998; 2001). also, professional schools are adding content to address the management of personal risk and liability. this exploratory study sought to investigate msw students’ perceptions of managing personal risk and liability. it also attempted to identify those variables that may be predictive for managing personal risk and liability among msw students. health care curricula, socialwork curricula, privatization, andmanaged care as a result of the pervasiveness of managed care and privatization, professional education for most health and allied health disciplines has been altered (berger & ali, 2000; coggan, 1997; fletcher, 1999). medical schools have developed specific curricula that will responsibly prepare practitioners for current and future service demands in managed care and privatized environments (coggan, 1997; fletcher, 1999; nordgren, 1996; yedidia et al., 2000) as have schools of nursing (jacobson, 1998; sherer, 1993). while perspectives may be discipline specific, content includes clinical and ethical issues associated with managed care and privatized environments, best-practices and clinical pathways, practice evaluation methods, and risk management strategies (coggan, 1997; jacobson, 1998; sherer, 1993). social workers function in these same managed care and privatized environments. many social workers have contributed to a growing body of literature dealing specifically with these areas of concern. some of this literature has investigated managed care operations and preferred practice models (corcoran & vandiver, 1996; kadushin, 1996; mitchell, 1998; poole, 1996) as well as reconciling the profession’s code of ethics and managed care’s preferred methods of service delivery (madden, 1998; reamer, 1998; 2001). practitioners have contributed to the profession’s knowledge base in the areas of client advocacy (houston-vega et al., 1997; sessions, 1998), appealing decisions of utilization reviewers (callahan, 1998; corcoran & vandiver, 1996; frager, 2000), confidentiality in current service delivery environments (bernstein & hartsell, 2000; reamer, 1998; 2001; rock & congress, 1999), the fiduciary relationship (bernstein & hartsell, 2000; houstonvega et al., 1997; madden, 1998; reamer, 1998), methods of client referrals (frager, 2000; houston-vega et al., 1997; munson, 1998; rock & congress, 1999), documentation requirements in current environments (bernstein & hartsell, 2000; davidson & davidson, 1998; kane, houston-vega & nuehring, 2002), and evaluating relationships with reimbursement sources (corcoran & vandiver, 1996; frager, 2000; madden, 1998; reamer, 1998;watt & kallmann, 1998). 135kane/managing risk and liability 136 there is also a growing body of social work education literature that focuses on the skills and knowledge necessary in current service environments (berger & ali, 2000; kadushin, 1997; kane, in press; kane, hamlin & green, 2001; kane, hamlin & hawkins, 2000; kane, houston-vega & nuehring, 2002; rosenberg, 1998; shera, 1996; strom-gottfried, 1997; volland, berkman, stein & vaghy, 1999). these authors generally suggest that practitioners must possess the knowledge and skills specific to managed care and privatized environments to competently provide service. riskmanagement and personal liability a common theme throughout most of this literature is the need for practitioners to provide appropriate service that meets the standard of care. this literature seeks to inform practitioners not only about the standard of care, but also about substandard service delivery that may result in charges of malpractice or negligence. there are several specific areas in the literature in which risk management and personal liability are referenced, including practitioner education, over-diagnosis, agency protocols, documentation, reimbursement, and client advocacy (bernstein&hartsell, 2000;houston-vega et al., 1997;madden, 1998; reamer, 1998). it appears that organizations and reimbursement sources continue to shift the bulk of responsibility for service decisions onto practitioners as they seek to reduce organizational and payer risk and liability. practitioners are required to have a keen understanding of their fiduciary responsibilities in order to provide appropriate service and manage risk and reduce personal liability (callahan, 1998; davidson & davidson, 1998; davis & meier, 2000; frager, 2000; houstonvega et al., 1997; kane et al., 2002; kapp, 1999; madden, 1998; moline,williams & austin, 1998; reamer, 1998; 2001). awareness of professional responsibility and competent practice strategies may be important for reducing concern and worry over potential liability and law suits (houston-vega et al., 1997; kapp, 1999; madden, 1998; moline et al., 1998; reamer, 1998). professional social workers are formed through a specific educational program that includes both classroom and field components. both components provide the essential knowledge and skill development necessary to prepare future practitioners for competent and independent functioning. of critical importance in both classroom and field portions is the knowledge and skills associated with documentation in practice (kane, 2002). as a method of risk management, documentation provides a record of the encounter between client and provider. it serves as a protection to both clients and providers (houston-vega et al., 1997; kane et al., 2002; madden, 1998; moline et al., 1998; reamer, 1998; 2001). professional organizations and state licensing bodies require practitioners to document. kapp (1999) suggests that documentation should be (1) accurate and truthful, (2) thorough and complete, (3) legible, (4) timely, and (5) without editorializing comments. documentationmay support practitioners in allegations of substandard service delivery and provide detailed information regarding how clients were best served. agencies and providers may depend on documentation for reimbursement from third-party payers and other funding sources. these agencies and providers advances in socialwork may have their own agendas regarding documentation and require specific information to ensure organizational reimbursement.these agendas, whichmay center on reimbursement, have the potential to become ethical and/or value conflicts for professional social workers. in these cases, some practitioners may feel pressured to “chart-to-the-negative,” over-diagnose, or mis-diagnose to ensure that clients receive necessary services and/or the agency gets reimbursed (houstonvega et al., 1997; kane et al., 2002; madden, 1998; moline et al., 1998; reamer, 1998; 2001). these pressures may be particularly powerful as practitioners interact with utilization reviewers and other funding sources. social work practitioners are aware that they have a primary responsibility to their clients’ welfare as informed by the profession’s code of ethics (houstonvega et al., 1997; nasw, 1996; reamer, 1998). this requires that they clearly understand their responsibility to clients and develop ethical skills to advocate for clients in current service delivery environments. without this awareness, practitioners are rendered vulnerable from a risk management perspective and clients may receive inadequate service. as noted previously, future practitioners may hold various attitudes toward managed care and other restrictive models of service delivery. these attitudes may influence their ability and willingness to navigate in these environments. future social workers will face clinical and ethical conundrums as they try to obtain appropriate services for clients while managing risk and personal liability (berger & ai, 2000; kane, 2002; reamer, 2001; strom-gottfried, 1997). the social work literature reveals that educators and practitioners have investigated how best to prepare practitioners for the demands of current and future social work practice along with the necessary skills and knowledge critical to these environments. yet, there is little empirical information that directly focuses on the predictors of managing risk and personal liability among future practitioners, especially in managed care and privatized environments. this study investigated predictors of msw students’ perceived ability to manage personal risk and liability. through a literature review, several variables appeared as potential factors that may predict an individual’s ability to manage risk and personal liability. these variables include: professional experience in managed care and privatized environments, occupational responsibilities, type of agency at which the professional is employed, understanding agencies’ financial agendas, understanding agency documentation guidelines, awareness of ethical and value conflicts such as over-diagnosis/mis-diagnosis, educational preparation for documentation, the skills of advocacy in current environments, preoccupation with lawsuits, understanding gatekeeping and utilization review processes, and field preparation for employment. these exploratory findingsmay offer educators and curriculum planners information about students’ perceived preparedness for future employment opportunities and practice competency. this important information may assist students, employers, and educators in providing services to clients that meet the standard of care and allow organizations and practitioners to effectively manage risk and personal liability. finally, this information may provide valuable content for curriculum development. 137kane/managing risk and liability methodology participants.a sample of students (n=116) was obtained from two florida msw programs. students currently enrolled in or who had completed at least one field practicum andwere enrolled in clinical practice, advanced research, or field seminar classes were asked to anonymously volunteer to complete an instrument. access to these students was based on instructor willingness to dedicate class time to completing this instrument. the typical respondent in this survey was female (84%), anglo (49%), and had some social work experience. because of the diverse population of florida, respondents self-identified as hispanic/latino (19%), african-american (10%), andwest indian/caribbean (15%). themean age of respondents was 31.86 years, with ages ranging from 22 to 51. field sites were identified as public (41%), private for-profit (17%), or private not-for-profit agencies (40%). approximately 53% of the sample indicated that they had two to five years of social work experience, while 28%of the sample indicated that they had less than two years of experience. instrument. kane, houston-vega, tan and hawkins (in press) developed an instrument that contained nine variables that measured student preparedness for managed care environments. the “understanding agency financial agendas” variable used six items to measure respondents’ understanding of how organizations use clients’ benefit packages for reimbursement. specific items in this scale investigated agencies’ concern for service reimbursement, service termination if benefits are exhausted, and their preferences for serving clients who can pay for services. the variable of “managing personal risk and liability” used six items to determine whether respondents perceived that they had adequate knowledge and skill to prevent a lawsuit. specifically, items investigated respondents’ beliefs about having the necessary skills to protect themselves from being sued and avoid potential liability. “understanding agency documentation requirements” is a variable that uses four items to evaluate whether respondents are aware of specific documentation guidelines that are in place at agencies to shape professional behavior. “awareness of ethical conflicts surrounding over-diagnosis or misdiagnosis” measured the tension that may exist in practice that would encourage a practitioner to “stretch the truth” to ensure agency reimbursement or service authorization for clients. the variable “classroom preparation for documentation” used several items to measure perceptions about the level of preparedness that respondents may feel as a result of their classroom education. “understanding the fit between client advocacy and managed care” was a variable that evaluated respondents’ perceptions about their ability to navigate and advocate for their clients in complicated and restrictive service environments. an item in this variable is, “i believe i am capable of advocating for my clients in managed care environments” (kane, houston-vega, tan & hawkins, in press). the variables of “worry and concern over lawsuits,” and "knowledge of utilization review and gatekeeping" assess a respondent’s perceptions in these specific areas. the variable of “field preparation for documentation” assesses respondents’ perceptions of how well the field site prepares them tomanage risk and personal liability through documentation strategies. one item used in this variable is “documentation of my clinical work is a skill i learned mostly in my field place138 advances in socialwork ment” (kane, houston-vega, tan & hawkins, in press). respondents receive a score for each variable scale. values assigned by respondents for each variable item are added together to obtain a variable score. there is no overall instrument score. the variable of managing risk and personal liability was designated as the study’s dependent variable for the purposes of multivariate analysis. reliability alpha coefficients were computed for each variable, including agency financial agendas (α=.88), personal risk and liability (α=.84), agency documentation requirements (α=.79), ethical conflicts (α=.81), classroom preparation for documentation (α=.80), advocacy skills (α=.80), concern over lawsuits (α=.76), knowledge of utilization review and gatekeeping (α=.58), and field preparation for documentation (α=.49). normally, alpha scores above 0.7 are preferred. because of the exploratory nature of this research, two variables with lower alpha scores were retained. finally, kane, houston-vega, tan & hawkins (in press) reported face validity for this instrument. to this instrument, demographic variables were added such as gender, age, ethnicity, social work experience, field experience, agency type, and future employment plans. the instrument was administered to all participants and took less than 20minutes to complete. prior to participant completion, the instrumentwas piloted using practitioners and field supervisors. analysis: univariate analysis included mean, standard deviation, minimum, and maximum scores for each variable scale. to determine the strength of the relationship between each independent variable and the dependent variable, correlation coefficients were computed. finally, standardmultiple regressionwas used for model building to identify those variables that were most predictive in understanding the dependent variable. findings descriptive analysis of thevariables overall, respondents indicated that they perceived themselves to be moderately well prepared to manage risk and personal liability (table 1). most respondents reported feeling moderately well equipped to understand agency financial agendas, understandingmanaged care gatekeeping and service authorization requirements, and advocating for clients in managed care environments. most respondents also believed that they had beenmoderately well prepared in the classroom for documentation, moderately aware of ethical conflicts regarding over-diagnosis, and had a moderate concern and worry about lawsuits. most msw student respondents strongly indicated that the field had prepared them to document and that they understood agency documentation requirements. table 1 provides specific information regarding these variables. bivariate analysis correlation coefficients (table 2) were computed for the dependent variable (managing risk and personal liability) and gender, age, msw status (concentration or foundation year), ethnicity, field placement site, and career goal. none of these coefficients were significant. correlation coefficients were also computed for the dependent variable and (a) understanding agency financial agendas, (b) 139kane/managing risk and liability understanding agency documentation requirements, (c) awareness of ethical conflicts/over-diagnosis, (d) classroom preparation for documentation, (e) understanding advocacy for clients in managed care environments, (f) concern and worry over law suits, (g) understanding managed care gatekeeping and service authorization, and (h) field preparation for documentation. three of these variables were significantly correlated with the dependent variable: classroom preparation for documentation, understanding advocacy for clients in managed care environments, and concern and worry about lawsuits. two other variables approached significance (awareness of ethical conflicts/over-diagnosis and field preparation for documentation). finally, several variables, including concern and worry about lawsuits, were negatively correlated with the dependent variable. this finding suggests that the concern and worry about lawsuits variable is reduced through managing risk and liability. multiple regression analysis standard regression analysis was initially performed using (a) understanding agency financial agendas, (b) understanding agency documentation requirements, (c) awareness of ethical conflict/over-diagnosis, (d) classroom preparation for documentation, (e) understanding advocacy for clients in managed care environments, (f) concern and worry over law suits, (g) understanding managed care gatekeepingand service authorization, (h) fieldpreparation fordocumentation, (i) age, and (j) field placement site. the initial solution yielded a model (r=.688, adjusted r2=.419, f=8.718, p=.000) with few significant predictive variables. in further exploratory analysis, all items that were not significant in the initial regression analysis were excluded from further model development. a final model was selectedwhich accounted for 43.1%of the adjusted variance (f=21.994,p=.000) using four independent variables. these variables included (a) concern and worry about lawsuits (beta=-.458, p=.00), (b) understanding the fit between client advocacy andmanaged care (beta=.328, p=.00), (c ) understanding agency documentation requirements (beta=-.164, p=.05), and (d) perceptions of field preparation for documentation (beta=.162, p=.05). table 3 contains further information. 140 advances in socialwork variable mean sd min. max. managing personal risk and liability 16.04 3.93 8 25 understanding agency financial agendas 17.57 6.07 6 30 understanding agency documentation requirements 15.52 3.63 4 20 awareness of ethical conflicts/over-diagnosis 9.40 3.89 4 18 classroom preparation for documentation 7.44 3.07 3 15 understanding advocacy for clients in managed 12.85 3.39 6 20 care environments concern and worry about lawsuits 8.82 2.74 3 15 understanding managed care gatekeeping and 9.58 2.41 5 15 service authorization field preparation for documentation 7.33 2.00 2 10 table 1: variable descriptives discussion and implications four variablesmade significant contributions to a regressionmodel and attempted to explain social work students’ perceptions ofmanaging risk and personal liability. these variables included (a) concern and worry about lawsuits, (b) understanding the fit between client advocacy and managed care, (c) understanding agency documentation requirements, and (d) perceptions of field preparation for documentation. it appears that respondents’ perceived that concern or worry about potential lawsuits would be reduced by managing risk and personal liability. in some sense, this worry or concern over the potential for litigation may foster an increased sensitivity among practitioners to provide services that meet or exceed the recommended standard of care.while not the primary motivation for the provision of appropriate service, awareness of personal liability may still be a powerful incentive. 141kane/managing risk and liability variable correlation significance gender .033 .735 age .070 .482 msw status .108 .262 ethnicity .006 .952 field placement site -.030 .753 career goal -.094 .330 understanding agency financial agendas -.084 .378 understanding agency documentation requirements -.061 .525 awareness of ethical conflicts/over-diagnosis -.166 .080 classroom preparation for documentation .357 .000 understanding advocacy for clients in managed care .454 .000 environments concern and worry about lawsuits -.577 .000 understanding managed care gatekeeping and -.050 .598 service authorization field preparation for documentation .172 .070 table 2: bivariate analysis: correlations to perceptions of managing personal risk and liability b beta t sig. understanding agency documentation -.176 -.164 -1.926 .05 requirements understanding the fit between client advocacy .381 .328 4.166 .00 and managed care concern and worry about lawsuits -.658 -.458 -5.983 .00 field preparation for documentation .317 .162 1.995 .05 table 3: final regression summary 142 the traditional social work role of client advocate was viewed by respondents as being an important method of managing risk and personal liability. in managed care and privatized environments, clients are frequently in need of scarce services. social workers have been trained to navigate these complicated systems for their clients and to advocate for scarce resources. this suggests that by ensuring the primacy of clients’ needs, practitioners are aware that they are most appropriately upholding the standard of care. a practitioner’s best strategy from a risk management perspective is to meet or exceed the standard of care (houstonvega et al., 1997; kapp, 1999; madden, 1998; moline et al., 1998; reamer, 2001). in addition, it seems reasonable to assume that clients who are cognizant that their practitioner is also their advocate realize that their best interests are being upheld by practitioners. clients who feel that they have someone working on their behalf are generally those who are less likely to choose litigation. respondents indicated that understanding agency documentation requirements was critical tomanaging risk and personal liability. this information is typically provided in both the classroom and field components of social work education. as noted previously, documentation critical to protecting both client and practitioner has repeatedly been cited in the literature, as it provides an accounting of client-practitioner interaction and evidences whether the standard of care was met (corcoran & vandiver, 1996; houston-vega et al., 1997; kane, in press; kane et al., 2002; madden, 1998; moline et al., 1998; reamer, 1998; 2001). finally, respondents perceived that the field component is critically important for career preparation. this critical area in social work education assists students to develop expertise and competence in many areas, especially in developing an awareness of risk management strategies. these strategies may be learned from the field supervisor who informs students about personal liability or through the risk management strategies of the organization. of critical importance in these settings is the use of documentation. it appears that the experiential learning that occurs in field education prepares students for documentation in compliance with agency agendas. while these contributing variables are important to understanding students’ perceived preparedness to manage risk and personal liability, the variables that did not significantly contribute to the model are of equal interest. the following variables were not significant predictors for the final model: gender, age, msw status, ethnicity, field placement site (private-for-profit, private-not-for-profit, public), career goal (private practice, agency work, combination), or experience in managed care and privatized environments. of particular interest is the fact that field placement site and experience (private for-profit, private not-for-profit, public) were not contributors. it seemed logical to assume that experience and field site might affect perceptions and suggests that future investigation is necessary to verify these findings. consistent with other literature, particularly among medical educators and students, perceptions of knowledge and skill development were not significantly influenced by either managed care or non-managed care settings (yedidia et al., 2000). while negative attitudes toward service delivery models accomplish little, so does excessive worry regarding potential litigation. while practitioners must advances in socialwork ensure that they provide the best service possible, they must also develop an awareness of potential risks and seek to avoid them. it is important for students to develop not only the necessary knowledge and skills to protect themselves and their clients in these environments, but also to develop attitudes that will ensure that they capably advocate for vulnerable populations and options that will enhance service delivery. developing curriculum to adequately prepare students for current service environments continues to be a great challenge for professional educators (berger & ai, 2000). client advocacy, liability concerns, documentation requirements, and field experience may be pivotal in preparing students to manage risk and personal liability. limitations and suggestions for future research this study used a purposive sample of 116 msw respondents from two educational programs. while small samples from one educational program have been used to investigate levels of student preparedness and satisfaction, in order to assert generalizability and statistical power, larger and more representative samples of students from geographically diverse locations are necessary. while this study relied on social work student respondents, further investigation is necessary. curriculum development and knowledge generation will require other information sources such as managed care organizations, service environments, supervisors, educators, administrators, risk managers, and practitioners. references berger, c.s., & ai, a. 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(1999). socialwork education for practice in health care: final report—a project.newyork: newyork academy of medicine. watt, j.w., & kallmann, g.l. (1998). managing professional obligation undermanaged care: a social work perspective. family and community health, 21(2), 40-49. yedidia, m.j., gillespie, c.c., & moore, g.t. (2000). specific clinical competencies for managing care: views of residency directors and managed care medical directors. journal of the american medical association, 284(9), 1093-1098. author’s note: address correspondence to: michael kane, ph.d., florida atlantic university school of social work, 777 glades road, boca raton, fl 33431, usa. e-mail: mnkane@aol.com. 145kane/managing risk and liability aisw vol. 8, no. 1:aisw vol. 5, no. 2 kinship ties: attachment relationships that promote resilience in african american adult children of alcoholics j. camille hall abstract: for many african americans, the extended family has been the source of strength, resilience, and survival. although changes in african american families, like changes in all families in the united states that have diluted the importance of kinship ties, many african americans continue to place a high value on extended family members. children of africans and communities of african descent traditionally interact with multiple caregivers, consisting of kin, and fictive kin. utilizing both attachment theory and risk and resilience literature, this paper discusses ways to better understand the resilient nature of african american families and how multiple attachment relationships assist at-risk african american children, specifically adult children of alcoholics (acoas). keywords: african-american, acoas, kinship ties introduction alcoholism is a complex phenomenon, with many factors affecting its onset, progress, and remission. the effects on individuals in the alcoholic’s life are equally as complex, as is the fact of resiliency in many of those people (hall, 2007; hawley, 2000). it is estimated that one out of every eight americans is the child of an alcoholic (niaaa, 2002a, 2002b). a rather large body of current empirical research clearly indicates that there is great variability in adult children of alcoholics’ adjustment and that, not all children of alcoholics develop drinking problems or psychopathology as a result of their alcoholic parentage (black, 2001). many studies (hall, 2007; niaaa, 2002a; velleman, 1999) have pointed to a common core of individual dispositions and support systems in the extended family and community, which appear to foster resilience. this paper explores the effects of secure attachment relationships through a known support system within african american families, kinship ties, in promoting resilience among african american adult children of alcoholics (acoas). in this paper, factors related to acoas’ risk and resilience, and the protective functions of the kinship network within african americans, which are significant in the development of kinship ties, are presented. i will conclude this paper by proposing an agenda for future research and implications for social work practice. 130 j. camille hall, ph.d. is assistant professor, bssw program, college of social work, the university of tennessee, knoxville, tn 37996. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 130-140. indiana university school of social work. alcoholism and african american alcoholics alcohol is the world’s most commonly used drug. unlike most addictive substances, alcohol is legally available with minimal governmental regulation, does not require a prescription, is openly and frequently advertised, and is relatively inexpensive. alcohol-related problems include economic losses resulting from time off of work, owing to alcohol-related illness and injury; disruption of family and social relationships; emotional problems; impact on health; violence and aggression; and legal problems. there is now a burgeoning interest in alcoholism among african americans (niaaa, 2002a). the national institute on alcohol abuse and alcoholism (niaaa) contends that alcoholism ranks almost certainly as the number one mental health problem, if not the most significant of all health problems in black urban communities (2002b). determining the incidence of alcoholism in any community is difficult and largely depends on the definition one uses. the niaaa (2002a) found that african americans report significantly higher numbers of drinking consequences and alcohol-dependence symptoms than do whites. according to a report by the niaaa (2002a), african americans and whites report similar rates of frequent heavy drinking, but, african americans are more likely to die of alcohol-related illnesses and injuries, such as cirrhosis of the liver and alcohol-related car crashes. results from research studies on alcohol consumption among racial/ethnic groups found that african american men with relatively low incomes were significantly more likely than their white counterparts to report high rates of alcohol dependence symptoms; the reverse was true for african american and white men with relatively high incomes (niaaa, 2002a). alcohol studies on african americans make up a small but growing body of research. a report by the niaaa summarized research regarding drinking patterns in african americans as follows: 1) african americans report higher abstention rates than do whites; 2) african americans and whites report similar levels of frequent heavy drinking; 3) rates of heavy drinking have not declined at the same rate among african american men and women as among white men; and 4) variables, such as age, social class, church attendance, drinking norms, and coping behaviors may be important in understanding differences in drinking and drinking problem rates among african americans and whites (2002b). adult children of alcoholics data suggest that families with alcoholic members are often confused about the specific ways alcoholism has compromised their lives (black, 2001; niaaa, 2002a). the niaaa (2002b) contend that the clinical literature focusing on the more dramatic events associated with alcoholism gives a misleading picture of its impact on the family. adult children of dysfunctional families, where alcoholism is present, are typically referred to as adult children of alcoholics (acoas). numerous self-help books and other publications describe acoas as maladapted. more than 20 years ago, researchers first noted that children of alcoholics (coas) appeared to be affected by a variety of problems over the course of their lifespans. such problems include fetal alcohol syndrome, which is first manifested in infancy; emotional problems and hyperactivity in childhood; emotional problems and conduct 131hall/acoas attachment relationships problems in adolescence; and the development of alcoholism in adulthood (black, 2001; niaaa, 2002a, 2002b). currently, there is a move to classify acoas’ identifiable and diagnosable characteristics as a separate clinical syndrome in the diagnostic and statistical manual of mental disorders (dsm-iv-tr) (american psychiatric association, 2000). coas tend to encounter many serious problems as they attempt to fulfill the demands of adult life. the clinical literature has suggested that acoas may also be at risk for emotional and interpersonal problems (black, 2001). acoas have reported more alcohol-related deaths, more frequent divorces, significantly less communication with their parents, and greater frequency of parental arguments and violence in their families of origin (black, 2001; niaaa, 2002a, 2002b). limited data is available that examines the development of resilience among this population; very few studies have targeted the african american population. although it is clear that many acoas experience difficulties within their families, it is also clear that many factors can contribute to positive adjustment outcomes. extended family and/or social support networks found in african american family systems are known protective mechanisms for at-risk children. research regarding the impact of kinship ties on fostering resilience among african american acoas is scarce. researchers (black, 2001; hall, 2007; niaaa, 2002a, 2002b) suggest that children of alcoholic parents may be at risk for developing a variety of self-esteem, depressive symptoms, coping problems, family dysfunction, and perceived lack of control over events in their environment. family circumstances define the nature and extent of the trauma, making a detailed examination of family environment important. in addition, coas’ adjustment to the alcoholic member and their attempts to cope with and survive the realities of alcoholism may mediate the effects on coas. because it is clear that not all coas are maladjusted, examination of the variables, such as secure attachment relationships with other family members, may have a role in buffering the stress of parental alcoholism and may provide important insights. alcoholic family environments have been demonstrated to exhibit a higher level of family conflict and a lower level of cohesion than nonalcoholic families. it is unclear whether those characteristics of the alcoholic family that lead to poor offspring outcome are specific to alcoholic families or are merely characteristic of dysfunctional families in general and may lead to similar negative outcomes in families where alcoholism does not play a role. consequently, coas’ status has been linked to various negative outcomes, while certain aspects of family environment (i.e., high conflict and low cohesion) have also been linked to negative offspring outcome. alcoholic homes are not all alike, but there are threads of commonality. conflict, inconsistency, and role confusion are daily occurrences. an air of tension is nearly always present. reality testing is difficult when the child is confronted by an alcoholic parent’s cycle between drinking and sobriety and also starts reactive cycles of turmoil (demanding heightened problem-solving and emotional states) and calmness for family members (black, 2001; hall, 2007). the ever-presence of alcoholism is such that families’ inclination to preserve homeostasis leads them to confront, yet accommodate to the alcoholic (niaaa, 2002a). 132 advances in social work which parent and how sick s/he is seems to be an important consideration. if the mother is an alcoholic, the household is usually more chaotic and the children suffer more, especially if the father escapes the drinking problem by overworking (black, 2001). when the mother is an alcoholic, the oldest child may be turned into a surrogate housekeeper and companion, giving rise to the problems that accompany pseudo adulthood (black, 2001). this is especially true for african american children living in an alcoholic home. in many cases, younger siblings in the home form a secure attachment to the eldest female (hall, 2007; werner & smith, 1992). this child is respected and held in high regard, because of his or her ability to take care of everything and perform well. african american acoas in this role earn respect in the community (hill, 1999). werner (1999) asserted that the feeling of being responsible is a source of satisfaction for those providing assistance or support to the family. mccubbin and thompson (1998) pointed out that the african american female, because of culture, will also assume the role of hero in healthy family functioning and is unlikely to seek help for her problems because of the rewards of praise from the family for being responsible. children in alcoholic homes live with chronic embarrassment. a lack of trust develops in children who grow up in alcoholic homes (black, 2001; niaaa, 2002a). one or both parents seemingly fail to nurture the child; hence the child discovers his or her parents cannot be depended on (black, 2001; hall, 2007). the availability of caring and emotionally supportive family, friends, siblings, teachers, and neighbors (multiple attachment relationships) help to mediate stressors for african american acoas. bernard (1999), hall (2007), hawley (2000), and werner (1999) found that, in the presence of stressful life events, the odds of child maltreatment decreased as social support increased. werner and smith’s 1989 longitudinal study, covering more than 40 years, found that the presence of at least one caring person provides support for healthy development and learning (werner & smith, 1992). participants in hall’s study of african american acoas reported their problems decreased when kin and fictive kin provided support. risk and resilience factors the literature is replete with references to the strengths and resiliency in african american families (logan, 2000). african american families have received an abundance of negative press in regard to crime, violence, female-headed households, joblessness, and alcohol and other drug use, while the positive aspects have not received comparable attention. at a time of widespread concern about the demise of the family, the african american family has much to teach us, because social workers need useful conceptual tools as much as techniques to support and strengthen families. mccubbin and thompson (1998) found that knowledge of successful adaptation under stressful life conditions also strengthens the conceptual base needed to frame both treatment and preventive intervention for highrisk youth, families, and especially ethnic minority families. rutter (1994) noted that there are difficulties in presenting a format for research in an area in which there exists neither a substantial body of empirical data nor a formal conceptualization. resilience implies the presence of two components in the lives and makeup of “at-risk” children: 1) the presence of sustained and intense life stresses, and 2) the maintenance of mastery and competence despite such 133hall/acoas attachment relationships stress exposure. garmezy (1993) posits that three types of protective factors emerge as recurrent themes from several diverse studies: 1) dispositional attributes of the individual that elicit predominantly positive responses from the environment, such as physical, robustness, and vigor; an engaging, “easy” temperament; good problem-solving and communication skills; and an area of competence valued by the person or society; 2) socialization practices within the family that encourage trust, autonomy, initiative, and affectional ties to a stable, caring, competent adult, whether a parent, grandparent, older sibling, or other kin; and 3) external support systems in the neighborhood, school, church, or the community that reinforce self-esteem and self-efficacy and provide the individual with a positive set of values. these “buffers” appear to make a more profound impact on the life course of children and youth who grow up under adverse conditions than do specific risk factors or stressful life events. hence, these buffers appear to transcend geographical, historical, and social class boundaries and have been replicated in samples of asian, black, caucasian, and hispanic youth (niaaa, 2002a). hawley (2000) contends that specific family circumstances define the nature and extent of trauma; however, others (bernard, 1999; black, 2001; niaaa, 2002a; werner, 1999) have suggested that parental alcoholism can be conceptualized as a form of chronic stress and trauma. risk factors are factors that have a statistically significant association with the occurrence of one or more harmful outcomes (e.g., physical and/or mental illness, substance abuse, poverty, racism). resilience appears to be governed by interactions among protective factors within the individual, the family environment, and the larger social context. werner (1999) documents how a chain of protective factors is forged over time, making it possible for high-risk children to become competent, confident, and caring individuals. for example, when werner and smith examined the links among protective factors within the individual and outside sources of support, they noted a certain continuity that appeared in the life courses of the men and women who successfully overcame a variety of childhood adversities (including parental alcoholism) (werner & smith, 1992). their individual dispositions led them to select or construct environments that, in turn, reinforced and sustained their active, outgoing dispositions, and rewarded their competencies. there was, for example, a significant positive link between an “easy” infant temperament and the sources of support available to the individual in early and middle childhood. werner (1999) posits that individual disposition is critical to being resilient. an understanding of the correlation between the infant and mother attachment behavioral systems is important for the development of resilience. attachment theory also has relevance to our understanding of the role of the family in african american acoas’ lives. a broader discussion of kinship ties and social support, in the context of multiple attachment relationships, follows. kinship ties: a culturally unique protective mechanism hollingsworth (1999) proposed that the african american community is central in the socialization of african american children. the childrearing strategies of african american families are protective of the child against the antagonistic environment located beyond the community and, in some cases, within the family. mccubbin and thompson (1998) noted that, without the agency of caregivers 134 advances in social work from outside nuclear families, many black children would live significantly brief and less comfortable lives. this interaction gives meaning to the definition of family and the ways in which extended family members assist in socialization of the young. multiple attachment relationships formed by kin and fictive kin caring for children began during slavery. according to bowlby, a warm and continuous relationship with a caregiver promotes psychological health and well-being throughout life in a manner that accords with the adaptive requirements of the human species (thompson, 1999, p. 265). the afrocentric paradigm proposes that, in african culture, humanity is viewed as a collective, rather than as individuals, and that this collective view is expressed as shared concern and responsibility for the well being of others (mbiti, 1969). “my family, “my folks,” “my kin,” “my people” are terms used by african americans to identify blood relatives and to denote relationships with special friends or “cared for” individuals who are not related. thus, family is a group of people who feel they belong to each other, although they may or may not live in the same house, and those relationships are governed by complex rules that guide interactions and ensure that physical necessities and support are available to all. common cultural patterns that have contributed to the resiliency of african american families include supportive social networks, flexible relationships within the family unit, a strong sense of religiosity, the extensive use of extended family, and a strong identification with their racial group (billingsley, 1992). it bears repeating that a discussion of african american family characteristics is exemplified in the extensive use of the entire family in childrearing, including siblings, and the extensive use of intergenerational support-giving (usually a grandmother or aunt to a younger mother). various scholars have found that many grandmothers, sisters, aunts, or cousins act as “other mothers” by taking on childcare responsibilities for one another’s children (guy-sheftall, 1995; hill-collins, 2000). in 1995, guy-sheftall added that the presence of other mothers in black extended families and community role modeling offers powerful support for the task of strengthening black selfhood. hill-collins (2000) adds that boundaries between biological mothers and other women who care for their children are fluid. hence, a child living with an alcoholic parent can receive the nurturance and support needed to become resilient. juxtaposed with the role of motherhood, the parameters of fatherhood are broad in the african american community. uncles, ministers, deacons, elders of the church, and male teachers can all be viewed as father figures. in his discussion of father-child interaction in the african american family, denby (1996) noted that, given economic and social supports, african american fathers welcome the responsibilities of childrearing; black fathers, like fathers of all ethnic groups, take an equal part in childrearing decisions in the family. in the case of the dubious father who may require an extra incentive to fulfill his rightful responsibilities, elders or male fictive kin fill in the gaps by encouraging and redirecting him towards familial matters of importance. these elders or male fictive kin also serve as role models, caretakers, tutors, and informal counselors for the youth of the community. african american acoas form attachment relationships with many family members. 135hall/acoas attachment relationships attachment theory the importance children having close ties may be understood in the context of attachment theory. the origin of attachment theory lies in the early work of john bowlby, who posited that individuals are motivated to maintain a dynamic balance between attachment to familiar situations and protective figures who provide security and “antithetical exploratory and information-seeking behaviors” (bretherton, 1992, p. 28). bowlby (1988) introduced the idea that individuals may have multiple models of attachment figures. the first and most important test for bowlby’s theory of attachment was conducted by mary ainsworth in a series of naturalistic and laboratory studies in which she coined the term “secure base relationship” (ainsworth, 1967). bowlby’s evolutionary rationale is that infants in all cultures should demonstrate secure base behavior. data provided by researchers support the idea that the secure base phenomenon is observable in different social and cultural contexts (see ainsworth, 1985; bretherton, 1992; howes, 1999). in his early writings, bowlby (1951) proposed that a child develops a hierarchy of attachment relationships: first, to the mother as the primary relationship, and then to others, specifically the father. later, ainsworth (1967) wrote that “nearly” all the babies in a ganda sample, who became attached to their mothers during the period spanned by observations, also became attached to some other familiar figure— father, grandmother, or other adult in the household, or to an older sibling (p. 67). hence, ainsworth acknowledged the possibility of other attachment figures. although these findings show that the recognition of alternative attachment figures has been a part of attachment theory since its development, attachment research has largely been conducted on the child-mother attachment relationship; considerably less is known about attachment to other familiar figures (ainsworth, 1985). the significance of this theory for african american acoas is that it stresses the nature of alternative and multiple attachments found in the african american family system. these attachment relationships have been proven to be significant in the development of resilience (see hall, 2007; rice, cunningham, & young, 1997). multiple and cross-cultural patterns of attachment various studies have generally shown that emotional availability and other aspects of emotional communication are predictive of security of attachment (see ainsworth & eichberg, 1991). for example, infants whose mothers are depressed are often insecurely attached, though not all infants of depressed parents will develop insecure attachments. it is the quality of caregiving, not the depression per se, that is predictive of attachment. other factors, such as infant temperament, may be indirectly related to attachment, though causal relationships are difficult to demonstrate. hence, it is reasonable to conclude that infant temperamental characteristics interact with caregiving to increase or decrease the probability of developing an insecure attachment. unfortunately, a/coas’ parents are not always available to nurture or provide them with a secure base for exploration, which is important for future development (main, 1990). fortunately, african american acoas have the benefit of multiple caregivers, who facilitate the development of secure attachment relationships. the african american family emits an opportunity for support and attachment relationships that serve as protective bar136 advances in social work riers against the negative dynamics of alcoholism. attachment in a network of multiple caregivers is of crucial importance, because cross-cultural evidence shows that, in most societies, non-parental caretaking is either the norm or is frequently formed (marvin et al., 1977). rothbaum et al. (2000) argue that the focus on individuation and related qualities, such as self-reliance and efficacy, seems to lead many researchers to devalue reliance on others as a way of meeting one’s needs. perhaps further exploration of multiple attachment relationships provided through kinship ties is a beginning step towards acknowledging the value and worth of interdependence found in the african american culture. discussion after years of focusing on pathology, social scientists have begun the task of identifying strengths, resources, and talents of individuals and families. werner and smith’s 1989 longitudinal study of 49 at-risk children, which covers more than 40 years, found that the presence of at least one caring person provides support for healthy development and learning (see werner and smith, 1992). this availability of caring and emotionally supportive family, friends, siblings, teachers, and neighbors may mediate stressors. bowlby clearly recognized that an infant can, and usually does, become attached to more than one figure. in fact, bowlby maintains that, at 9 or 10 months of age, most children have multiple attachment figures. the small but growing literature on attachment to an alternative caregiver suggests that this process is similar to that of the infant-mother attachment. many, if not most of the infants in the united states today, will have multiple caregivers. some longitudinal studies, several of which follow individuals over their entire lifespan, have consistently documented that, between half and twothirds of children growing up in families with mentally ill, alcoholic, abusive, or criminally-involved parents or those in poverty-stricken or war-torn communities, do overcome the odds and turn a life trajectory of risk into one that manifests “resilience” (bernard, 1999; rutter, 1994; weinfield, sroufe, & egeland, 2000; werner & smith, 1992). in sum, a key characteristic of resilient children was their history of having received whatever emotional nurturance is available in the family. rice, cunningham, and young (1997) posit that an attachment bond can be considered a resource factor in the initiation of other relational support systems as well as serve as a factor in the evolution of coping skills necessary for managing developmental challenges. rice and others (1997) further argue that, having an attachment to the mother, was not a significant predictor of social competency or emotional well-being among black and white adolescent students. research has demonstrated that infant attachment security might provide a buffer, which allows for continued competence in the face of adversity (weinfield, sroufe, & egeland, 2000). difficult life experiences take their toll on children, despite possible avenues of resilience. research has indicated that individuals with secure early histories may show a rebound to better functioning after setbacks. furthermore, rice and others (1997) found that, early on, children develop internal working models with multiple attachment figures, which enable them to bounce back and serve as protective 137hall/acoas attachment relationships mechanisms when exposed to risky situations. by acknowledging the significance of kinship ties/bonds that serve as alternate attachment figures for at-risk populations, we have identified a resource that enables african american acoas and/or groups to prevail against adversity. implications for social work practice the literature on acoas tends to focus mostly on males, alcoholics, and non-people of color. studies tend to contain too few people of color to infer useful conceptual tools for understanding african american acoas. african american acoas, like all other children, are apprentices of their parents and family. they learn to function based on the models they observe. a variety of adults, older children, and friends also influence the self-concept and personality development of any one black child. the development of a positive self-concept for african american acoas is predicated based on their ability to overcome economic, environmental, and psychological stressors (parental alcoholism). in spite of these obstacles, african american families have been able to instill positive selfconcept into their children. to uncover the role of kinship ties in fostering resilience, emphasis should be placed on the connection between african american functioning and the acoas’ attachment experiences within the context of the family and community. the prognosis for children growing up in alcoholic families is bleak. these children are twice as likely to develop an alcohol problem compared to children of abstainers and moderate drinkers. it is therefore important to help them modify their coping techniques to withstand their adverse conditions. attachment to a caretaker in the first few years of life is apparently crucial to the child’s later ability to cope with a chaotic household. thus, when there is an infant in an alcoholic home, and the primary caretaker is unable to provide consistent care, extended family members who act as surrogates become important resources. armed with this insight, attachment and risk and resilience theories provide a starting point for understanding some of the types of experiences that may help to inoculate atrisk children against the deleterious effects of stress. we infer from such research that adaptive, stressed children seemed to have enjoyed compensatory positive experiences outside the family and a bond with some supportive surrogate figure/s. we infer too that these children appear to possess cognitive skills that are critical for adaptation under stress—social problem-solving skills marked by greater variability, flexibility, and resiliency. the ability of african american family members to exercise extendedness and role reversibility when faced with a crisis increases strong kinship ties and provides a balance for the family in the event of prolonged illness of dysfunction among key family members. we may conclude, therefore, that modes of intervention are available for effecting change in less favored children. surrogate figures are to be sought, models are to be observed, and a more formal explanation invoked to teach those problem-solving skills so as to facilitate in a crisis. 138 advances in social work references ainsworth, m.d.s. 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(1992). overcoming the odds: high-risk children from birth to adulthood. new york: cornell university press. author’s note: address correspondence to: j. camille hall, ph.d, assistant professor, bssw program, 323 henson hall, college of social work, the university of tennessee, 1618 cumberland avenue, knoxville, tn 37996, usa. e-mail: jhall39@utk.edu. 140 advances in social work a social work model for empathy a social work model of empathy karen e. gerdes elizabeth a. segal abstract: this article presents a social work model of empathy that reflects the latest interdisciplinary research findings on empathy. the model reflects the social work commitment to social justice. the three model components are: 1) the affective response to another’s emotions and actions; 2) the cognitive processing of one’s affective response and the other person’s perspective; and 3) the conscious decision-making to take empathic action. mirrored affective responses are involuntary, while cognitive processing and conscious decision-making are voluntary. the affective component requires healthy, neural pathways to function appropriately and accurately. the cognitive aspects of perspective-taking, self-awareness, and emotion regulation can be practiced and cultivated, particularly through the use of mindfulness techniques. empathic action requires that we move beyond affective responses and cognitive processing toward utilizing social work values and knowledge to inform our actions. by introducing the proposed model of empathy, we hope it will serve as a catalyst for discussion and future research and development of the model. key words: empathy, social empathy, social cognitive neuroscience introduction ask a social worker if empathy is important to practice, and the response is likely to be “yes.” ask for a social work definition or social work conceptual model of empathy, and the response is likely to be “is there one?” other disciplines have attempted to define empathy and construct models to explain what it is. today, even politicians are weighing in on the importance of empathy. president obama used “empathy” as one of his criteria for selecting a nominee to the supreme court (hook & parsons, 2009). an examination of the emerging interdisciplinary research and literature on empathy, together with the strength of empathy as a tool for our professional work, make it imperative that social work embrace a model of empathy that not only fits but enhances our discipline. while other disciplines have their unique perspectives, their conceptualizations of empathy are not always a perfect fit for social work. in this article, we propose a social work model of empathy that reflects the latest interdisciplinary findings, particularly those of social cognitive neuroscience, and places them within the context of social work values and perspectives. empathy is critical to social work practice – however it is defined the list of studies in social work mentioning the importance of empathy is significant. recent studies on the importance of practitioner-to-client empathy would fill several volumes. [examples include berg, raminani, greer, harwood & safren (2008); _________________ karen e. gerdes, ph.d., is an associate professor and elizabeth a. segal, ph.d., is a professor, both in the school of social work at arizona state university. copyright © 2009 advances in social work vol. 10 no. 2 (fall 2009), 114-127 advances in social work, fall 2009, 10(2) 115 forrester, kershaw, moss & hughes (2007); green & christensen (2006); mishara et al. (2007); and sale, bellamy, springer & wang (2008)]. while empathy is essential to an effective client-worker relationship, it is also crucial that we help populations such as atrisk parents, partners, and sex offenders to develop and cultivate empathy (curtner-smith et al., 2006, busby & gardner, 2008; hunter, figueredo, becker & malamuth, 2007; waldinger, schultz, hauser, allen & crowell 2004). parental empathy has been cited as crucial for raising healthy children (curtner-smith et al., 2006). partner empathy is a key element in satisfying relationships (busby & gardner, 2008; waldinger et al., 2004). empathy is one of the core elements of healthy relationships at every level, and is therefore a pivotal theme in social work theory and practice. interestingly though, empathy is never mentioned in the nasw code of ethics nor does it have an entry in the encyclopedia of social work. empathy is listed once in the cswe educational policy and accreditation standards [section 2.1.10(a)] (council on social work education, 2008) as one of several general components of practice. the social work dictionary (barker, 2003) does provide an entry and defines empathy broadly as “the act of perceiving, understanding, experiencing, and responding to the emotional state and ideas of another person” (p. 141). the ubiquitous nature of empathy in social work practice and the lack of a concrete conceptualization of empathy, rather than a lack of regard for the importance of empathy may explain its limited presence in important social work documents. the very familiarity of the word “empathy” renders it somewhat vague. common usage often creates false assumptions and misunderstandings, and this process is definitely at work in current social work literature on empathy. morgan and morgan (2005) noted that most social work researchers and educators seem to assume simply telling practitioners “empathy is very important” is enough to convey a precise message and make the listeners proficient in practice an assumption which, however wellintentioned, is incorrect. pithers (1999) noted that “operational definitions [of empathy] are not consistent across studies” (p. 258) and there has been considerable confusion over whether empathy is a multidimensional or unidimensional construct. as a result of this semantic fuzziness, conceptualizations and measurement techniques for empathy vary so much that it has been difficult to engage in meaningful comparisons or make significant conclusions about how we define empathy, measure it, and effectively cultivate it in social workers and clients (cliffordson, 2001). lest we are overly critical of social work, these problems of definition, measurement and conceptualizations are shared across disciplines, and likely have contributed to social work’s lack of depth in both how we define and how we teach empathy. there is a general agreement across disciplines that empathy is the ability to imagine what another person is feeling and thinking. in this context, empathy has been presented as a dispositional trait, a cognitive skill, a physiological reaction or some combination of these components. is it an innate trait? a cognitive skill? is it a feeling, a thought, or an action? can it be taught? can it be learned? if we have it, can we develop more? to develop, cultivate, and use empathy effectively in practice, it would be beneficial to have a model that answers these questions, and we propose such a model. gerdes, segal/a social work model of empathy 116 what do we know (almost) for sure about empathy? empathy and developmental psychology german and american psychologists, theodor lipps (1903) and edward tichener (1909) first used the word “einfühlung” or “empathy” to describe a psychological phenomenon or the inner imitation an observer experiences when observing another person or object (davis, 1996; iacoboni, 2008). empathy was conceived as both a passive reflection of another, and as an active effort to get inside another. the dual nature of empathy, while not initially embraced by every researcher across disciplines, is now widely acknowledged. hoffman (1984) and other developmental psychologists placed empathy and its dual nature in the context of the continuum of human development. developmental psychologists recognized that as infants we rely on mimicry to develop our ability to automatically recognize what our parents and others are feeling. as we age, we develop the ability to take on other roles and imagine the feelings of others (i.e., the cognitive processing part of empathy). more recently, hoffman (2000) put forth five modes of empathic arousal. the first three are automatic, involuntary and hence primitive: mimicry, conditioning, and direct association. the other two, which are culturally influenced and involve cognition, are mediated association and role-taking. hoffman’s focus was on “empathic distress” because he regarded the discomfort of seeing someone in distress as what motivates people to prosocial moral action. alleviation of distress was part of the motivation behind psychological research on empathy during the early 1990s. batson (1991) viewed empathy as a means to altruistic behavior. he and his co-researchers argued that empathy is related to other personal motives, such as reducing the pain of watching and feeling others suffer or for the sense of rewards in helping others (batson et al., 1991). his link to altruism is persuasive, but not conclusive. the research used stories of personal distress, and asked participants whether they would help. such experiments were all hypothetical and did not measure mirroring or physiological affective responses. thus, “empathy” may lead to altruistic outcomes, but it also may not. people may “do good deeds” for all sorts of reasons, including personal reward or satisfaction, sympathy, guilt, or due to other egoistic motivations. the contributions of batson’s research to analyzing the link between empathy and positive social outcomes is an important part of our understanding of empathy. but the confirmation of the physiological imperative of empathy had yet to be discovered. davis (1996) developed a model that includes most of the empathy constructs that have been developed prior to the recent neurobiological discoveries related to empathy. his model starts with what he calls antecedents, goes through multiple processes, and results in outcomes. the antecedents include biological capacities as well as learned socializations. the processes include the action of motor mimicry as well as active cognitive processing. the outcomes are divided into two categories, intrapersonal and interpersonal, including affective response (physiologically feeling something), and cognitive processing of attribution (figuring out how the other person feels and why based on the observed behaviors). his model, while comprehensive and inclusive of all advances in social work, fall 2009, 10(2) 117 major concepts, is very complicated and mixes the physiological and cognitive aspects of empathy throughout the model. he does include the outcomes of empathic feelings, but limited to the individual level. empathy and mirror neurons in recent years, a great deal of research in the field of social cognitive neuroscience has emerged identifying the biophysical components that mediate empathy in the brain (decety & jackson, 2004; decety & lamm, 2006; decety & moriguchi, 2007). this new neuroscience uses sophisticated brain imaging equipment to confirm what many have suspected for years: that when we see another person’s actions (for example pain, laughing or crying), our bodies respond as if we feel a degree of that action too. this phenomenon is called mirroring, and the circuitry of the brain responsible for this are called mirror neurons (iacoboni, 2008). these cells that transmit nerve impulses are defined as “neurons that fire when an action is performed or when the same action is observed” (kaplan & iacoboni, 2006, p. 175). this may seem simple, but the confirmation is significant. we now know through the work of neuroscientists that the human brain is wired to mimic other people, and this mimicry involves actual involuntary, physiological experience in the observer. human beings tend to imitate actions that they see. physiologically, our brains include mirror neurons, which react to actions that are seen as if we are doing the action ourselves. it is largely an unconscious and automatic experience. when we hear people speak, observe their vocal nuances, watch their posture, gestures, and facial expressions, etc., neural networks in our brains are stimulated by the “shared representations,” generating feelings within us that reflect the experience of those we are observing. “our drive to imitate seems to be powerfully present at birth and never declines” (iacoboni, 2008, p. 47). imitation helps us to learn to interact with our surroundings and socialize. it may be a key component for learning to speak. research suggests that the more imitation a toddler engages in, the better the child’s later facility at speaking and language acquisition (nadel, 2002; eckerman & didow, 1996). the lack of physiological mirroring seems to relate to a lack of empathy. neurologists have discovered some evidence that affective sharing is physically diminished in people with autism (dapretto et al., 2006; decety & moriguchi, 2007). earlier research found that brain injury diminished empathy (eslinger, 1998). these findings suggest that genetics or biological composition may play a role in human capacity to experience affective sharing. iacoboni (2008) explains the entire neurological process as follows: mirror neuron areas help us understand the emotions of other people by some form of inner imitation. according to this mirror neuron hypothesis of empathy, our mirror neurons fire when we see others expressing their emotions, as if we were making those facial expressions ourselves. by means of this firing, the neurons also send signals to emotional brain centers in the limbic system to make us feel what other people feel (p. 119). gerdes, segal/a social work model of empathy 118 while the response is automatic and hence involuntary, there is a conditioning element as well. from a young age children are often reinforced for their imitative behavior, particularly if those behaviors are socially desirable. for example, adults often smile at babies and try to get them to smile back. as the infant is hard-wired to imitate, it does smile back, delighting the adult, which gives the infant positive reinforcement for the mirroring. a social cognitive neuroscience conceptualization of empathy decety and colleagues (decety & jackson, 2004; decety & lamm, 2006; decety & moriguchi, 2007) combined cumulative, qualitative descriptions of empathy from the social sciences with the new findings in social cognitive neuroscience, which led to a conceptualization of empathy as the dynamic interaction of four “neural networks.” all four networks are empirically observable brain phenomena, and all four components must come into play for a human to experience the full extent of empathy. if any of the components is missing or inhibited, the subjective experience of empathy fails to emerge. the components identified by decety and colleagues are listed below (decety & moriguchi, 2007, p. 4). 1. affective sharing. the experience of similar emotions between the self and an other, “based on automatic perception-action coupling and shared representations.” (see the previous discussion on mirror neurons). 2. self awareness. “even when there is some temporary identification between the observer and its target, there is no confusion between self and other.” 3. mental flexibility. the cognitive capacity to imagine another’s situation “from the inside,” “to adopt the subjective perspective of the other.” 4. emotion regulation. “the regulatory processes that modulate the subjective feelings associated with emotion.” self-awareness self-awareness refers to recognizing and understanding one’s own emotions, strengths, limitations, and motives (goleman, boyatzis & mckee, 2002). london (2002) describes it as “self-insight” or the ability to be self-understanding, self-monitoring, and self-evaluating. both these authors agree that healthy, high-functioning individuals are consistently aware of their own emotional condition, but are also conscious of how they impact others. in other words, high-functioning social beings are aware of both their private and public selves: what they perceive, and how they are perceived by others. mental flexibility/perspective-taking mental flexibility, also called perspective-taking, is mediated in a part of the brain that deals with executive function—a task-based way of getting things done. it is the ability to toggle between what you are feeling and what the other person is feeling, while maintaining the self-awareness to know there is a boundary between the two. simply put, advances in social work, fall 2009, 10(2) 119 the brain treats mental flexibility as a job, not a feeling. it requires a logistical, rational understanding of other people’s experience. for example, a parent may have to logically take the perspective of an infant to imagine what it would be like to be weak, small, helpless, preverbal, and so on. at the same time, the parent must be aware of his or her own perspective as the strong adult who can care for this weak, helpless infant. mental flexibility is the understanding that the other person is like me, but is not me. role taking is another component often considered part of empathy. while others have described it in terms of child development, davis (1996) includes it in his discussion of empathy, citing it as a “cognitive process in which the individual suppresses his or her usual egocentric outlook and imagines how the world appears to others” (p. 6). emotion regulation emotion regulation refers to an internal ability to change or control one’s own emotional experience. sometimes, feeling what others are feeling can be overwhelming, and one can lose sight of whose feelings are whose. we might see this as overidentification with another person, or from a clinical perspective see it as lack of boundaries. most people use a variety of cognitive and affective strategies to achieve emotion regulation; soothing self-talk, motivational visualizations, seeking affirmation from others, listening to music, and so on. psychotherapists and, of course, social workers are often responsible for teaching clients emotion regulation techniques (linehan, 1993). one way that we may regulate our emotions is through judgment. to what extent we believe people “deserve” to feel the way they do can impact our empathy towards them (davis, 1996). in fact, we may have a bias towards those we deem worthy of our concern. there is a tremendous amount of literature on group or kin selection, which is far beyond the scope of this article (see hamilton, 1964; hoffman, 1981). however, the tendency to favor survival and reproduction of those who share our genetic make-up in order to ensure the continuation of our species can affect our processing of empathic feelings. if we are taught that we are different from another tribe, or race, for example, then we can pass judgment that cognitively overrides empathic affective responses we may have. such cognitive processing may be the reason people have been able to witness atrocities against other human beings and stifle, ignore or process away sharing of feelings. if the slave being whipped before your eyes is regarded as different from you or inhuman, then feelings of empathy can be cognitively dismissed. we conclude that the voluntary aspects of cognitive processing are part of our socialization and therefore can be taught. while part of this interdisciplinary model is known territory for social work researchers, the neurological evidence supporting the model has powerful new implications. in recent years, neuroimaging studies have allowed scientists to locate the neural networks in specific parts of the brain that mediate each of the four components of empathy. detailing all of the brain studies is beyond the scope of this article, but the work of decety and colleagues (decety & jackson, 2004; decety & lamm, 2006; decety and moriguchi, 2007) provides evidence of this link. these four components go far in linking earlier psychological research with recent neuroscience findings to conceptualize empathy. however, what is missing is a broader environmental component and the place of social justice. we propose building on this gerdes, segal/a social work model of empathy 120 model and adding aspects that take into consideration environmental contexts and social justice. a social work model of empathy based on the aforementioned theorists and numerous studies on empathy as an intellectual foundation, coupled with years of social work experience, we have developed a model that incorporates the findings of other disciplines, particularly social cognitive neuroscience, but is uniquely placed within social work. this model reflects the personin-environment approach of social work and the commitment to social justice, which is a core value of the profession (nasw, 2008). the model we propose consists of three components, all of which build upon the prior part: 1) the affective response to another’s emotions and actions; 2) the cognitive processing of one’s affective response as well as the other person’s perspective; and 3) the conscious decision-making to take empathic action. table 1 outlines the model. table 1: social work model of empathy component definition key aspects ways to develop affective response involuntary, physiological reaction to another’s emotions and actions. mirroring1,2,3,4 mimicry5 conditioning6 promote healthy neurological pathways cognitive processing voluntary mental thought processes used to interpret one’s affective response; enables one to take the other person’s perspective. selfawareness6 mental flexibility7 role taking6 emotion regulation7,8 labelling6 judgment6 perspective taking7,8 self-agency8 set boundaries practice mindfulness use role plays conscious decision-making voluntary choices for action made in response to cognitive processing. empathic action9 social empathy10,11,12,13 morality5 altruism14,15,16 helping advocacy organizing social action 1 iacoboni (2008) 2 kaplan & iacoboni (2006) 3 gallese & goldman (1998) 4 rizzolatti & craighero (2004) 5 hoffman (2000) 6 davis (1996) 7 decety & moriguchi (2007) 8 decety & jackson (2006) 9 gerdes & segal (in press) 10 segal (2008) 11 segal (2007a) 12 segal (2007b) 13 segal (2006) 14 batson (1991) 15 batson et al. (1991) 16 batson et al. (2003) the first component, affective response, encompasses the involuntary physical reactions we have that are triggered by our exposure to external events. the second component of empathy is the cognitive processing of mirrored emotions and actions. this advances in social work, fall 2009, 10(2) 121 process is voluntary mental thought that strives to interpret the physiological sensations as well as the thoughts that mirroring triggers. it includes the components of selfawareness, mental flexibility and emotion regulation. this process results in an understanding of the lived experiences of others. the third component, conscious decision-making is the piece that draws from social work, the need to take action. the imperative of social justice, which is clearly outlined as a value of social work (see the nasw code of ethics and the cswe educational policy and accreditation standards, 2008) (council on social work education, 2008; national association of social workers, 1999), requires that social workers engage in practices that advance social justice. to empathically understand people means to enter into their situations in ways that reveal inequalities and disparities. such awareness must be followed by action to promote fairness, which is the advancement of social justice. our proposed model requires that all three components of empathy be present in order to experience empathy that is rooted in social justice as well as social cognitive neuroscience. it is currently not possible to weigh each component. however, the extent of mirroring, processing, and action-taking may vary in different circumstances. what neuroscience has proven through the use of brain imaging (fmri) is that affective response must be followed by cognitive processing to experience empathy (decety & moriguchi, 2007). is empathic action a necessary component of empathy? the first two components, affective response and cognitive processing, are widely accepted as the necessary components of empathy and typically discussions of empathy end after describing these components. as decety & moriguchi (2007) identify in their list of components, empathy exists when there is affective sharing, self-awareness, mental flexibility and emotion regulation. in their model, taking action based on the affective response and cognitive processing is not required for one to experience the full extent of empathy. davis’ (1996) model is multi-dimensional and includes outcomes, but is limited to the individual. the author himself notes this as a limitation (p. 220). for hoffman (2000) empathy “might transform the task of choosing among abstract principles into an empathy-relevant task that leads one to imagine the consequences of different systems for society’s least advantaged people or for people who work hard (p. 230).” he hopes that empathy can be linked to caring and justice principles (p. 298). iacoboni (2008) accepts that although we have neuroscientific evidence of empathy, it does not guarantee action. he hopes that “a more explicit level of understanding of our empathetic nature will at some point be a factor in the deliberate, reflective discourse that shapes society” (p. 271). we argue that empathy is not simply a condition, a nature, or a domain, rather it is an induction process that culminates in empathic action. empathic action is the result of the third component of the model, conscious decision-making. in our view, and more specifically from a social work perspective, having empathic feelings and participating in perspective-taking is not the full extent of empathy. having empathy includes voluntarily taking action in response to the cognitive processing that is in response to the initial affective response. this is where social work’s value of social justice and full integration of person-in-the-environment comes into play. as social workers, to be empathic is to gerdes, segal/a social work model of empathy 122 experience the affect, process it, and then take appropriate, effective, empathy-driven action. the empathic actions we take can impact individuals, groups, communities and even society. segal (2007a; 2007b; 2008) describes social empathy, which is the action of using our empathic experiences and understanding to shape public policy. this is a form of empathic action. without action in response to the empathic induction process, we believe a person is not truly empathic. a social work model of empathy includes action. being empathic means understanding the situation of others and taking action in response to the interpretation of the situation. two examples illustrate the point. the empathy model in action new social workers often find themselves overwhelmed the first time they visit a family in a socially and economically isolated neighborhood. the deprivation and desperation is often visible everywhere. for example: a family preservation worker visits a single mother living in a poor, rural area. the mother has been referred by her children’s teacher who is afraid the children are being neglected. the mother appears depressed; she has no food to put on the table for dinner. if the worker does not have an advanced degree of self-awareness, and has not been trained to cognitively process his or her affective responses in this situation, it is easy to be overcome with feelings of pity and sympathy. there is an overwhelming urge to jump in and try to solve an immediate problem – for instance, to give the mother money to buy food for dinner or to go to the store and buy food for the family. an empathic action or response is to help the mother assess her situation, identify resources she can rely on in an emergency (e.g., family, neighbors, local food bank) and then help her to plan ways to avoid being in this situation again. consideration of the larger environment as part of the worker’s cognitive processing may also require action on a macro level, such as helping to create employment opportunities. pity and sympathy often inspire actions that are enabling or disempowering, whereas empathic action is driven by knowledge of the person-inenvironment framework and the strengths perspective and result in empowerment. there are several examples of social policies that have been, at least in part, the result of empathic action. for example, when robert kennedy visited jackson, mississippi in 1967, he introduced the country to a level of hunger and malnutrition that few were even aware existed in the united states. kennedy’s description of his visits with families were not only inspiring, they were filled with empathy. as a result, he was able to push congress to open the food stamps program and provide stamps for the needy (mills, 2006). when decision-makers like kennedy are able to toggle back and forth between what it would be like to live in a poor mississippi community, and their own life experience, they are more readily able to identify social and economic inequities. on the other hand, staying away from personal visits and labeling people living in poverty as “undeserving” or “lazy” allows decision-makers to separate themselves from the people in need and thereby avoid issues of social justice. empathy requires moving beyond feeling sympathy or pity and being overwhelmed by the seeming hopelessness of the situation. it is imperative that social workers be taught and trained to practice selfawareness, mental flexibility, emotion regulation, and perspective taking. mental flexibility encourages us to ask what is fair and right; self-other awareness and emotion advances in social work, fall 2009, 10(2) 123 regulation can help prevent compassion fatigue and burnout. an empathic perspective is more likely to result in actions that utilize strengths, empower clients, and promote social and economic justice. is empathy all or nothing? our model includes both unconscious or automatic affective responses and cognitive processing as well as consciously choosing to take empathy-driven action. however, the extent to which we can experience all three components, or the full extent of empathy, when confronted by any given situation varies greatly. this suggests that there is a dynamic nature to empathy. some aspects are experienced more than others, and in varying degrees by different people. this is due in part to varying skill levels required for effective cognitive processing as well as variation in the strength of healthy neural pathways. the experience of empathy is not perfectly linear, although the model is described in a progressive, linear fashion. however, if we try to define empathy without including all three components, then we dilute the meaning and power of the concept. empathy from a holistic social work perspective needs to include all three components. empathy is not only a condition, it is an action motivated by affect and cognition. one important caveat is in order. the involuntary act of mirroring is not discerning. human beings are hard-wired to mimic, thus they can be as likely to mirror positive actions as well as negative actions. iacoboni (2008) warns us that empathy in action is not always positive. he hypothesizes that we have atrocities because we have imitative violence, we can dissociate our mental processes from our reflexive behavior, and that cross-cultural opportunities for mirroring can be countered by the influence of massive religious and political belief systems that keep us apart and deny the neurobiology that links us together. so part of the social work challenge of our model is to not only link action to affect and cognition, but to nurture action that is positive, that promotes wellbeing, that is socially just. by building a framework of empathy on the principles of social justice, we can promote imitation of socially constructive behaviors and cognitive processing that stress our similarities rather than beliefs that are created to divide us. conclusion our mirrored affective responses are involuntary; cognitive processing and conscious decision-making are voluntary. the affective component requires healthy, lesion-free neural pathways to function appropriately and accurately. empathy deficits have been linked to damaged and/or underdeveloped neural circuitry (dapretto et al., 2005; decety & moriguchi, 2007). however, we can help people create new neural pathways to improve their ability to effectively mirror another person’s actions and emotions. the cognitive aspects of perspective-taking, self-awareness, and emotion regulation can be practiced and cultivated, particularly through the use of mindfulness techniques. empathic action requires that we move beyond affective responses and cognitive processing toward utilizing social work values and knowledge to inform our action choices. all three components of the model can be taught, practiced, and cultivated. by gerdes, segal/a social work model of empathy 124 introducing the proposed model of empathy, we hope social work researchers will engage in a critical discussion of the model and begin research that can help validate the model. for example, what are the benchmarks for social workers in terms of empathy levels required to be an effective practitioner? we are currently field testing a scale that incorporates the three components of empathy. it is our hope that in the near future, by utilizing this model social work practitioners can better cultivate client-worker empathy, and teach clients how to develop greater empathy. finally, we believe that the importance the social work profession has placed on empathy must be be matched with a conceptualization of empathy that is sophisticated and rich with implications for becoming more effective practitioners. references barker, r. l. 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(2006). welfare as we should know it: social empathy and welfare reform. in k. m. kilty & e. a. segal (eds.), the promise of welfare reform: political rhetoric and the reality of poverty in the twenty-first century (pp. 265-274). binghamton, ny: haworth press segal, e. a. (2007a). social empathy: a new paradigm to address poverty. journal of poverty: innovations on social, political & economic inequalities, 11(3), 65-81. segal, e. a. (2007b). social empathy: a tool to address the contradiction of working but still poor. families in society: the journal of contemporary social sciences, 88(3), 333-337. segal, e. a. (2008). welfare reform: the need for social empathy. in i. colby (ed.), comprehensive handbook of social work and social welfare, volume 4: social policy and social practice (pp. 371-384). hoboken, nj: john wiley & sons. tichener, e. (1909). elementary psychology of the thought processes. new york: macmillan. waldinger, r. j., schultz, m. s., hauser, s. t., allen, j. p., & crowell, j. a. (2004). reading others’ emotions: the role of intuitive judges in predicting marital satisfaction, quality, and stability. journal of family psychology, 18, 58-71. author’s note: address correspondence to: karen e. gerdes, ph.d., school of social work, arizona state university, 411 north central ave, suite 800, phoenix, az 85004-0689. email: kegerdes@asu.edu. mailto:kegerdes@asu.edu a social work model of empathy introduction empathy is critical to social work practice – however it is what do we know (almost) for sure about empathy? empathy and developmental psychology empathy and mirror neurons a social cognitive neuroscience conceptualization of empathy self-awareness mental flexibility/perspective-taking emotion regulation a social work model of empathy table 1: social work model of empathy is empathic action a necessary component of empathy? the empathy model in action is empathy all or nothing? conclusion references aisw vol. 5, no. 2 late onset of prescription drug abuse or dependence among older adults: implications for treatment kathy lay lucy j. king abstract:prescription drug abuse and dependence is an increasing concern for older adults. this article describes issues specific to older adults with late onset abuse or dependence on prescription sedatives and/or opiates. the older adult with late onset should not be viewed as having the same issues as individuals who have a life pattern of drug and alcohol abuse/dependence. a chart review of older adults in a treatment program contrasts late onset prescription dependence clients (n=12) and early onset addiction clients (n=104) and outlines differences and similarities between the two samples. social workers need to understand the specific and changing needs of older adults as they relate to assessment and treatment of drug abuse and dependence. keywords: addiction and the aged, sedative/opiate abuse and/or dependence elderly as a growing population at risk of drug abuse the older adult population, those 65 and older, will grow exponentially at a rate greater than in previous years. at the turn of the century, older adults were a small portion of the total population; however, projections indicate that, by the year 2030, older adults will make up 21% of the total population (berkman, 2006). the growing aging population represents the success of industrialized countries and, at the same time, presents challenges to health care providers (kinsella & velkoff, 2001). like no previous generation, aging adults have experienced increased opportunity for illicit drug abuse and increased availability of prescription drugs developed by new technologies to address a spectrum of emotional and physical illnesses. the advent of both brings challenges for care providers of pain management, addictions treatment, and case management of the older adult. older adults, like younger individuals, abuse the same types of substances: alcohol, prescription drugs, and illicit drugs (shibusawa, 2006; simoni-wastila &yang, 2006). for many years, alcohol continues to be the leading drug abused by older adults (samhsa, 2003). however, the last decade brought projections regarding 264 kathy lay, ph.d. is an assistant professor, indiana university school of social work, indiana university school of socialwork, indianapolis, in 46202-5156. lucy j. king,m.d. is clinical professor emeritus in psychiatry at the indiana university school of medicine, indianapolis, in 46202. copyright© 2007 advances in socialworkvol. 8 no. 2 (fall 2007) 264-274. indiana university school of socialwork. an increasing concern for prescription drug abuse and dependence in older adults (anderson & kerluke, 1996). misuse and abuse of prescription medications has long been widespread among older adults (barnea & teichman, 1994). older adults take medications more frequently; they are three times more likely than younger adults to use prescription drugs, and use of over-the-countermedications is also a concern (patterson & jeste, 1999). “thirty percent of all prescription drugs are prescribed for elderly persons and many of these medications are psychotropics” (bogunovic & greenfield, 2004, p. 233). it is estimated that the aged spend “between $2,000 and $3,000 per person per year on prescription drugs” (moxey, o’connor, novielli, teutsch, & nash, 2003, p. 140). older adults are more likely to use prescription drugs due to a variety of chronic illnesses, thus their annual costs of drugs are much higher than that of others. it is estimated that those 60 and older are taking, on average, five differentmedications (oslin, 2000). they are also a group that is least likely to have supplemental insurance to cover the cost of drugs, although the still controversial medicare prescription benefit may alter the situation. the annual out-of-pocket cost of medications can be as high as $9,000 (angell, 2004). the high cost of medications is another aspect in the non-compliance of prescribed medications, which can also be a factor in abuse/dependence. facing financial constraints can bring about drug swapping, reliance on over-the-counter drugs that are ineffective, or the use of stored medications that are either out-of-date or inappropriate for the illness. individuals abusing alcohol or taking multiple drugs are at risk for poor compliance (braithwaite et al., 2005; anderson & kerluke, 1996). patterns of misuse and abuse associated with medications among the aging population include misunderstanding how amedication is to be dosed or used, use of multiple medications with potential for harmful interaction, and use when it is contraindicated (barnea & teichman, 1994). all of these patterns can contribute to abuse or dependence. the prescription drugs that aremost commonly prescribed and have the potential for abuse are sedatives and opiates (meadows, 2001), two classes of prescription medications that can lead to addiction (substance dependence). sedatives include barbiturates and benzodiazepines. the prevalence of benzodiazepine use among older adults is widespread, despite its well-known adverse effects (cook, marshall, masci, & coyne, 2007). opiates aremorphine-like painkillers. the risk of dependence on these drugs increases with age and with chronic medical conditions requiring multiple medications (bogunovic & greenfield, 2004). as the population of older adults increases over the next decade, so will the demands formental health and addictions treatment specific to the aging population (satre, knight, dickson-fuhrmann, & jarvik, 2004). likewise, the increase of prescription medications for illnesses associated with aging processes will bring potential abuses. the past two decades have seen research differentiating individuals who begin addicting substance abuse when young or middle-aged from those who begin abuse of addicting substances at age 50 or older. these studies have dealt primarily with alcohol abuse (atkinson, turner, kofoed, & tolson, 1985; liberto, oslin, & ruskin, 1992; sattar, petty, & burke, 2003). the focus of this article will be those lay, king/late onset of prescription drug abuse or dependence among older adults 265 advances in socialwork266 older adults whose addiction began at age 50 or older and were diagnosed as having abuse or dependence on prescription sedatives, opiates, or both. special issues for elder substance abusers addiction treatment: identification and diagnosis identification with an addiction culture may be a daunting task for older adults. the culture of addictions treatment asks individuals to “negotiate both a new social as well as personal identity…[helping] move clients from addiction into recovery” (matto, 2004). some may choose self-identification as an “addict” and may experience it as empowering. this is a common practice in addiction treatment. historically, older adults have viewed addiction as a moral failure, a source of shame, and stigma (satre, knight, dickson-fuhrmann, & javrik, 2004). therefore, the initial task is to provide a complete biopsychosocial assessment that establishes a need for treatment that both the client and family can collaboratively understand. the older adult with late onset should not be viewed as having the same issues as individuals who have a life pattern of drug and alcohol abuse/dependence. there is a great deal of misunderstanding among the public and health care professionals alike about what constitutes addiction. accurate understanding involves consideration of both diagnostic criteria and pharmacology (erickson, 2007). substance dependence, alcoholism, or drug addiction is officially diagnosed using thedsm-iv-tr (american psychiatric association, 2000) as having a pattern of three ormore of seven specific symptomswithin a 12-month period: 1) tolerance, needingmore andmore to achieve the same effect of the drug; 2) withdrawal, a characteristic set of symptoms for each class of addicting drugs on stopping heavy use; 3) taking more of the substance for a longer time than intended; 4) “persistent desire or unsuccessful efforts to cut down” (p. 197); 5) spending a great deal of time obtaining, using, and recovering from effects of use; 6) giving up important “social, occupational, or recreational activities” (p. 197) because of use; 7) continuing use despite having frequent physical or psychological problems related to use (american psychiatric association, 2000). loss of control of use (symptoms 3 and 4) and psychosocial factors (symptoms 5, 6, and 7) indicate that the use of the substance is taking over the individual’s life. it would be theoretically possible for an individual to meet criteria for three symptoms with any three of these five symptoms (i.e., without tolerance and withdrawal symptoms). conversely, tolerance and withdrawal, alone, do not meet criteria for three symptoms. older adults having abuse or dependence on sedatives or opiates may fall into this grouping. withdrawal symptoms from sedatives are medically dangerous as well as distressing. opiate withdrawal is extremely unpleasant, including having generalized pain. tolerance and withdrawal, alone, are simply pharmacologic properties of long-term use of moderate doses of sedatives and opiates.what appears to be “drug-seeking behavior” might simply be the result of an individual’s attempts to stop medication and finding it produces painful and distressing symptoms. this, in turn, can result from long-term prescription use without careful follow-up and lay, king/late onset of prescription drug abuse or dependence among older adults 267 failure to explain the nature of themedication to the individual. pohl (2004) noted that, what is frequently viewed as “drug-seeking” behavior, is often a reflection of poor pain management, and typical addiction is characterized by deviant behaviors. these behaviors may not be typical of this late onset population. chronic pain andmanagement chronic pain is another concern for the older adult and, particularly, propermanagement of chronic pain. benzodiazepines are inadequate in treating pain despite the evidence that between 40% and 60% of those struggling with chronic pain are prescribed these medications (kranzler & ciranulo, 2005). analgesics, opiates, and non-opiates are the most commonly prescribed pain medications, and older adults are most likely to have prolonged use. studies suggest that even low-dosage, long-term use of opiates can produce tolerance or dependence (edwards & salib, 2001). individuals with chronic pain, regardless of addictive disorders, experience pain in the same way as others and must be treated aggressively with appropriate pain management (pohl, 2004). a tension exists between addiction treatment and pain management. addiction treatment providers tend to focus on abstinence from all addicting substances, including opiates, while pain treatment professionals focus on relief of pain using aggressive medication prescription with less concern about addiction. both want to alleviate problems for the client and are challenged by the issues of pain and addiction. assessment of pain, especially in individuals with a history of or current diagnosis of substance dependence, is complex. “pain is experienced and perceived by an individual with an addictive disorder in just the same way it is experienced and perceived by healthy non-addicted patients” (pohl, 2004, p. 121). in any individual with chronic pain, it is important that careful medical, psychiatric, and substance dependence evaluation be administered and all illnesses be treated.multiplemodalities for the relief of pain, including non-pharmacologic means, should be employed in collaborating with an individual in order to find out what works or does not work. non-pharmacologic therapies include: psychotherapy, physical therapy, occupational therapy, hypnosis, acupuncture, non-addicting medications, meditation, and others (gunderson & stimmel, 2004). ongoing assessment, frequent contact with the client, and modification of treatment plans as indicated, prevents the kinds of problems faced by this special population of aging adult. chronic illnesses many older adults struggle with chronic illnesses and pain associated with aging. chronic illness and pain may be exacerbated by abuse and dependence (finlayson & hofmann, 2002). addiction treatment providers must engage these clients on behalf of their health benefits and costs. the treatment process must work to build an understanding that recoverymanagement can provide the client with valuable tools that can assist in their autonomy and quality of life without their having to identify as an “addict.” many see older adults as a population with sleep problems, chronic pain, and therefore in need of sedatives and analgesics; however, use and certainly abuse of advances in socialwork268 these drugs adds to morbidity and dysfunction of older adults (finlayson & hofmann, 2002). misuse, abuse, and dependence on sedatives and opiates used in combinations with alcohol create the “potential for serious consequences, such as falls, automobile accidents, or even death” (pringle, ahern, heller, gold, & brown, 2005, p. 1930). alcohol use, even in small amounts, further compromises the individual’s health, that is, usingmultiplemedications (pringle et al., 2005). older adults are likely to be under medical care for chronic illnesses, such as heart disease, diabetes mellitus, and arthritis (finlayson, 1997). adults in addiction treatment often have co-morbidity with diseases associated with addictions, such as copd, liver disease, and peptic ulcers. in that this group of older adults with late onset does not have a long history of substance dependence, it is quite possible that they may not be likely to struggle with chronic illnesses associated with addiction as do populations that have a long history of abuse or dependence on alcohol and illicit drugs. due to the late onset, there is no prolonged use that is associated with liver disease, peptic ulcers, and chronic obstructive pulmonary disease. co-occurring disorders in older adults studies have established that mood and anxiety disorders develop independent of addiction and they are the most common psychiatric disorders (grant et al., 2004). stromwall and larson (2004) found that women with co-occurring substance abuse are seven times more likely than men to be diagnosed with posttraumatic stress disorder and are significantly more likely to have anxiety and mood disorders. this points to a strong need for a thorough psychosocial assessment of older women, as well as integrated treatment, addiction, and mental illness treatment, simultaneously. women, and in particular, older women, are less likely to be screened and diagnosed for alcohol and drug abuse/dependence, and they are more likely to have a psychiatric diagnosis and also increased use of prescription drugs (satre, mertens, &weisner, 2004). the use of sedatives is more prevalent among women (bogunovic & greenfield, 2004). women may be prescribed sedatives appropriately for anxiety disorders, but inappropriately for other issues, such as griefmanagement or the catch-all phase, “nerve problems.”the latter are indicative of gender-biased misdiagnosis at best, and practices that do not meet the standard of care, at worst. older women are candidates for addiction treatment, but their needsmay differ significantly from clients with a history of addiction, inclusive of alcohol and illicit drug dependence. these individuals must be assessed carefully for co-occurring psychiatric disorders and evaluated properly for the continuation of psychotropic medication and psycho-social interventions, such as cognitive-behavioral treatment. family assessment and treatment it has long been established that substance dependence affects the family, that these disorders run in families, and that families are distressed by the consequences of drug abuse and dependence (steinglass & kutch, 2004). family history is often seen as a predictor for abuse or dependence on drugs and alcohol. this special population with late onset may not present with this history, and this lay, king/late onset of prescription drug abuse or dependence among older adults 269 should not be a variable utilized to formulate a diagnosis or prognosis. however, steinglass and kutch point out that “inclusion of the family as a central partner in the therapy process significantly improves treatment outcomes” (p. 405). the family and client working together will serve to enhance recovery. complex clinical issues, such as substance abuse and dependence, combined with chronic illness, chronic pain, and psychiatric disorders, require collaboration in decisions related to their health care. “patients and their families are increasingly seeking more active participation in health care decision making as they are faced with more complex clinical choices” (berkman, gardner, zodikoff, & harootyan, 2005, p. 333). ageism kelchner (1999) points out how costly ageism is to individuals and society. ageism and sexism are of particular concern for this group of older adults who abuse or are dependent on drugs. both sexism and ageism prevent the older clients with prescription addiction from being seen in the context of their particular struggles with addiction and co-occurring psychiatric or physical disorders. belonging to two groups (elderly and female), which are sometimes stereotyped and patronized, can be costly in that they go for a prolonged period of time without proper treatment. older adults are often stereotypically viewed as a declining group that no longer contribute economically (kane, 2004), and a younger population may be more likely to get the attention of addiction treatment providers in that resources are limited. older adults in treatment may only represent 3% (samhsa, 2004) of the total population in treatment for substance dependence, and this may further serve as misguided statistical evidence to support less attention to the older adult in need of treatment for substance abuse and dependence. little attention has been paid to this specific population, and this compromises an individual’s understanding of the necessity for treatment. these key issues (assessment, chronic pain management, chronic illnesses, co-occurring disorders, family issues, and ageism) are particularly important in assessing older adults who have potential prescription abuse concerns. the initial identification of prescription dependence in older adults can be masked by the context of illness, pain, changes in the family, and stereotypic views of aging clients. social workers must fully comprehend the effects of these drugs, educate clients and their families, and advocate for medical detoxification and evaluation. methodology this studywas obtained from themedical records of patients age 55 andolderwho were admitted as inpatients for the first time to amidwestern non-profit addiction treatment facility in either 1992 or 2002. a larger study focusing on changing drug use patterns is published elsewhere (lay, king, & rangel, in press). this study analyzed individualswhowere diagnosed as either abusing orwere dependent onprescription sedatives and/or opiates. the aims of the current study were to (a) provide a descriptive summary of the prescription abuse subpopulation, (b) contrast older prescription abusers (n=12) and older abusers of alcohol and/or illicit drugs (n=104) on key factors, and (c) advances in socialwork270 determine if there were differences in the characteristics of older prescription abusers. the internal review board of a university approved the study. charts from a private non-profit addiction treatment facility in a midsized city were reviewed retrospectively from the year 1992 and 2002 for a total of 2,313 individuals admitted to all levels of treatment. individuals age 55 and older having a single admission to inpatient treatment were identified (n=116), representing 5% of the total admission from the two cohorts. data were recorded on standardized forms and entered into a database for analyses (lay, king, & rangel, in press). this article focuses of those older adults who began using addicting substances at age 50 or older (n=12) and,more specifically, thosewhose drug abuse and dependence was restricted to sedatives and opiates. results of the 2,313 individuals admitted to treatment from the two cohorts, 1992 and 2002, 116 met the study criteria, having a single admission to inpatient treatment at age 55 or older upon admission. this represents 5% of the single admissions to all treatment programs at the facility. the mean age of first use for all subjects (n=116) was 23 years of age. illicit drug users (specifically, marijuana, cocaine, and heroin) were found only in the 2002 cohort, with amean age of first use of 15 years of age. including both cohorts, 27% reported previous psychiatric treatment. at the time of admission 34% of the 2002 cohort were diagnosed with a co-occurring psychiatric disorder as compared to only 10% of the 1992 cohort. the 1992 cohort had more diagnoses of illnesses associated with addictions (copd, liver disease, and peptic ulcer) than the 2002 group. for all individuals in both groups, alcohol was the first and primary drug of abuse or dependence, with the exception of 12 individuals who began using at age 50 or older (lay, king, & rangel, in press). twelve (12) individuals began use of addictive substances at age 50 or older. this represents 10% of the total sample (n=116). eight (8) of the 12 individuals were from the 2002 cohort and four were from the 1992 cohort. the mean age of onset for this group was age 61, and the mean age at the time of admission was 69. this sets them apart from the larger group, primarily diagnosed with abuse or dependence on alcohol, which had a mean age of onset of 23. four of the 12 individuals, twomales and two females, abused or were dependent on alcohol. the remaining eight people abused or were dependent on prescription sedatives and/or opiates. of the eight individuals, seven were women. this represents 20% of the females from the total sample. only one individual had a positive family history for addiction. only women reported chronic pain. four women had a diagnosis of anxiety ormood disorders. this group had a variety of medical illnesses typically associated with the aged: hypertension, diabetes, and cardiac disease. almost half of the older adults with late onset in this study were diagnosed with a mood or anxiety disorder at admission or during treatment for addiction. they are all female. treatment implications this special population of older adults diagnosed with abuse of or dependence on prescription sedatives and/or opiates represents a small group of individuals who enter treatment for addiction and are in need of specialized treatment. these were lay, king/late onset of prescription drug abuse or dependence among older adults 271 individuals who either self-referred or were identified by health care providers as being in need of detoxification and treatment; however, theremay be others treated in other inpatient settings or with poor attention to the inappropriate use of medication. late onset, age 50 or older, sets themapart from those individuals typically entering addictions treatment who have a history of chronic abuse or dependence of multiple drugs inclusive of alcohol and who often identify themselves as “addicts.” this group of older adults entering treatment for addiction, averaging 69 years of age, has no documented history of abuse/dependence in their younger years. conclusions the older adults with late onset of abuse or dependence on prescription sedatives and or opiates are predominately women, who use alcohol occasionally or not at all. they tended to have chronic pain and did not report positive family histories of substance abuse or dependence. it can be conjectured that these individuals are not only atypical substance dependent individuals, but they are also individuals with inappropriate pain management. generalizability cannot be reached from this small sample; however, we are provided with valuable information about treatment implications and further research for this group of older adults. systematic, prospective follow-up of larger numbers of individuals will be necessary to determine treatment outcomes of this group and to design specific treatment strategies. specific knowledge related to abuse of or dependence on opiates and benzodiazepines is paramount. these drugs can cause confusion and unsteadiness in this population, predisposing them to falls (kurzthaler et al., 2005), another matter of concern, which is directly related to quality of life. although widely used with the elderly, these drugs account for impairment in functionality, escalation of abuse, and often result in morbidity and, in some instances, mortality (lantz, 2005). in addition, benzodiazepine withdrawal is the most dangerous of all withdrawals medically. predictions for the future are that there will be increasing numbers of women among the substance-dependent population (grant, dawson, stinson, chou, dufour, & pickering, 2004) and that they will present specific needs in addiction treatment (blow, 2000). most likely, abuse or dependence of opiates and sedatives will be a primary treatment concern for this population.these are not the“typical” individuals admitted to addiction treatment. this group requires a different approach to treatment than the traditional addiction treatment that tends to be group oriented and, at times, confrontational regarding denial. the use of nonaddicting pain treatment modalities, such as physical therapy, occupational therapy, acupuncture, non-addicting medication, and support groups focusing on management of pain and disability are indicated in the context of cognitive behavioral therapy. older adults entering treatment for substance abuse and dependence are not a homogeneous group (lay, king, & rangel, in press). social workers and health care providers of the older adult must understand assessment of substance abuse and advances in socialwork272 dependence, management of chronic pain, chronic illness, co-occurring psychiatric disorders, family assessment, and ageism—all important concerns related to the older adult entering addiction treatment. substance abuse among the aged is “overlooked and underreported…presentation may be atypical and hence easily missed by the medical practitioner” (mcgrath, crome, & crome, 2005, p. 228). social work practitioners working in settings with older adults must complete a biopsychosocial evaluation that includes a listing of all medications, historical, and current use, with the understanding that the prescribed dosage may be problematic or used incorrectly. pain management is critical to understanding treatment of the older adult. social workers must be prepared to provide clients with psycho-education and appropriate referral to pain management as well as addiction treatment when indicated. social workers are trained to view people from an ecological lens, and this lens, including amultidisciplinary approach, is a necessity in order to address the complexity of issues the older adult brings to treatment settings (berkman, gardner, zodikoff, & harootyan, 2005). social work curricula and continuing education must include content specific to gerontology and produce research that will inform practice specific to the complex addiction treatment needs of the older adult. references american psychiatric association. 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(pp. 405-415).washington, d.c.: american psychiatric publishing. stromwall, l., & larson, n. (2004). women’s experience of co-occurring substance abuse and mental health conditions. journal of socialwork practice in addictions, 4(1), 81-96. author’s note: address correspondence to: kathy lay, ph.d., indianauniversity school of socialwork, 902west newyork street, indianapolis, in 46202. e-mail: kalay@iupui.edu. this research was supported in part by a grant from the central indiana coalition on aging (cicoa). 274 advances in socialwork aisw vol. 5, no. 1 student assessment of an online clinical socialwork research course: using a collaborative learning model zvi d. gellis abstract: this article reports on a clinical research methods course taught online to a total of 90 off-campusmsw students in the fall of 1999, 2000, and 2001. the course was taught in a mid-size public university in a cswe-accredited school of social work. the purpose of the course was to teach single subject design research skills for the evaluation of clinical social work practice. the student experience of the online course was assessed using qualitative interviews that add a deeper, textured understanding of the various facets of online instruction from the learner's perspective. important dimensions for social work instruction in online courseware were delineated. a collaborative learning and teaching framework is presented for those social work educators interested in implementing web-based courses. keywords: single subject design, clinical, online, collaborative learning the world of web-based instruction enables universities to implement distance education to reach a diverse population and to provide an open learning environment 24 hours a day, seven days a week. currently, there are approximately 17,000 web-based courses and 5% of all post-secondary students are presently online in the united states (u.s. department of education, 2000). in 2000, estimates were that 2.2 million individuals would be enrolled in online courses by 2002 (international data corporation, 2000). the internet (it) has also permeated the educational and organizational environments of social work faculty, students, and professionals (gifford, 1998). computers and other information technologies have become standard fixtures within the profession. one reason for this proliferation is that social work is a knowledge-intensive profession where information is essential in decision-making and clinical practice. information must be relevant, appropriate, and pertinent for practitioners. social work graduate students require knowledge about the effects of it on their clients (i.e., confidentiality and privacy), the profession, and society. moreover, understanding the range of current uses, identifying emerging trends, and developing competency to optimize the use of it for professional purposes is essential. 77 zvi gellis, ph.d. is a hartford social work faculty scholar at the state university of new york at albany, albany, ny 12222. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 77-90. indiana university school of socialwork. this article reports on a clinical research methods course taught online to off-campus msw students in the fall of 1999, 2000, and 2001. the course was taught in a mid-sized public university in a cswe-accredited school of social work. the purpose of the course was to teach single subject design research skills for the evaluation of clinical social work practice. the online course is evaluated using qualitative methods. an online collaborative learning and teaching framework is described for those social work educators interested in implementing web-based courseware. this exploratory research contributes to the field of social work education in several ways. first, knowledge gained from the study of student perceptions of self-mastery and technology may be particularly valuable to social work educators. second, an understanding of individual online learning experiences can provide social work educational programs with insight into preparing future social workers to use technology in evaluating practice. finally, recognition of the utility of a collaborative learning framework within online education is significant for course development and sustainability (riel, 1998). collaborative learner-centered framework a primary goal of our online academic program is to ensure that it is reflective of collaborative learning. our conceptual framework for effective pedagogy is based on the national research council’s commission on behavioral and social sciences and education (nrc) publication on how individuals learn (bransford, et al., 2000). thenrc report provides amodel for effective learning environments in which a system of four interconnected elements exists and mutually supports each other. these components are focuses that identify environments as learner centered, knowledge centered, assessment centered, and community centered. this paper focuses on the collaborative learner-centered component as an effective learning environment that accounts for learner strengths, interests, and preconceptions and assists students to gain insight into themselves as learners. the nrc guidelines provide an excellent framework fromwhich to consider the design of online learning environments. there are three reasons why this framework presupposes that teaching social work practice and research skills online encompasses a method of instruction towards a collaborative learner-centered model and away from a traditional didacticmodel (duffy, dueber &hawley, 1998; bonk & cunningham, 1998). first, this model views students as engaged in critical inquiry and problem solving within the context of a collaborative environment (duffy et al., 1998; garrison, anderson & archer, 2000). second, the ability of students to project themselves socially into a community of discussion and inquiry is deemed critical in the absence of the physical presence of the course instructor. finally, the model asserts that the design, facilitation, and direction of cognitive and social processes online may influence meaningful and educationally worthwhile learning outcomes for students. the benefits of online education for teaching and learning have included increased equity and collaboration among students (johnson & johnson, 1996), promotion of critical thinking (gokhale, 1995), high satisfaction with student-faculty interaction (shea, swan, frederickson & pickett, 2002), and high class participation rates (frederickson, pickett, shea & pelz, 2000). given that one of our objectives in social work educa78 advances in socialwork tion is to help students explore their potential as thinkers and conveyors of ideas, online instruction offers considerable possibilities. proponents of collaborative learning claim that the active exchange of ideas within small work groups promotes critical inquiry, with shared goals and values that inform decisions and actions (gokhale, 1995; walther, 1996). this approach is viewed as consistent with information processing theories that place more emphasis on the student’s role for constructing and reconstructing his or her own knowledge by trying to make sense of new information (brufee, 1999; chong, 1998). gellis (2000) has noted that knowledge is not something that is presented to students in this process, but something that emerges from active dialogue and interaction among those who seek to understand, apply, and integrate concepts and techniques. developing internet courses entails using a different lens since collaborative online activities require social work instructors tomake changes in their role from content provider to flexible facilitator with the purpose of teaching in a learnercentered style. in order to facilitate student learning, cahoon (1998) and bereiter and scardamalia (1992) recommend using six methods of instruction for the online environment: 1. coaching—focuses on issues and problems arising while students are in the process of attempting online tasks. 2. modeling—focuses on cognitive modeling, which demonstrates to students the online thought process involved. 3. reflection—particularly reflection that compares the student’s processes with each other’s and with those of the teachers. 4. exploration—focuses on students, not only in solving online problems independently, but seeks them out independently. 5. articulation—prompting students to demonstrate or verbalize their own knowledge and cognitive process in a specific online topic. 6. scaffolding—this is external online support from the teacher that helps students achieve early success but can be withdrawn as students are able to function independently. the author has found that developing and implementing collaborative online activities takes substantial preparation and planning at various levels including: choosing content-based activities, weekly tasks and assignments, decisions on how student groups will be organized, and decisions about rules and expectations for online participation. the clinical research course discussed in this paper was developed in approximately fourmonths for an online environment. student work group and discussion group size appears to be an important factor for effective collaborative learning. online work group size ranged from four to six participants for the entire semester. empirical studies note that the optimum size for decision-making groups is five in order not to dilute the experience nor change the group dynamics (brna, 1998; bruffee, 1999; felder, 1996). creating the appropriate conditions for an online student learning environment presents many other challenges for the social work instructor during the 79gellis/student assessment using collaborative learning planning stages of online curriculum development. experience suggests that pedagogical decisions need to be considered in the following areas: • orientation of students in the use of internet technology. • management of the interaction of the student community. • preparing students to participate in quality online discussions. • assessment of the online group interaction and individuals within the group. • sustaining student commitment to continuing in the discussion forum. • management of any online problems. • how the online group will be monitored by the instructor. • how toconvey to students a senseofmastery in anonlinediscussion. an example of integrating a learning-centered model in an online social work course is delineated in the next section. teaching socialwork researchonline initiative supported by the alfred p. sloan foundation, the state university of new york’s suny learning network (sln) is an online distance learning delivery system using an asynchronous learning network (aln) approach to teaching and learning that is studentcentered and eliminates the constraints of time and location that higher education normally places on students. key characteristics of the sln asynchronous software system includes the capability for secure student login via a standard java-enabled browser, centralized database-centered syllabus with links to internal or external web pages, on-line, time-monitored quizzes with randomized dynamically-generated testing, discussion groups, and integrated email. the sln software system also provides instructor development tools to ease transitions from other media. typically, an sln online course is delivered weekly over a semester and the instructor directs the course for about three hours during the week. using lotus notes as the software platform, an online clinical research course was taught as part of the required msw direct practice sequence. identical syllabi and assignments were also utilized in other course sections where students are taught in a traditional classroom setting. no comparable data were collected for this investigation. this msw-level course is fundamental for social work practitioners in empirically evaluating their clinical practice. clinical social workers must be able to understand and use various researchmethods in order to conduct ethical, efficacious, and accountable practice interventions. therefore, it is important that professional social workers have the advanced knowledge and skills needed to retrieve and critically analyze existing intervention research and the ingredients to carry out such clinical practice evaluations. sample and procedures ninety msw students were enrolled in three sections of a required social work graduate course titled “evaluation of clinical socialwork practice,” at a mid-size 80 advances in socialwork research university in the northeast. to obtain the data for this study, a qualitative instrument was administered on the internet as part of the culminating activities during the 14th week of the course. students were asked to write their answers to open-ended questions online in a short interview format, then assign a rating on a scale from 1 (much less than expected) to 5 (much greater than expected) on seven questions about the online course activities. this combined method of assessment resulted in a numerical indicator of learning with a richer understanding provided by the qualitative data. a total sample of 81 (90%) social work students (31 males, 50 females) volunteered with informed consent to participate in the study. to reduce possible response bias, instructions to participants stated that the students’ qualitative responses would only be viewed by the course instructor after the submission of grades. participants were informed that the survey was anonymous and confidential and that the instructor would not be able to identify any particular student. to increase response rates in the project, no personal or student identifiers were requested. participants were asked to send their answers to an administrative assistant at a secure website, at which point all identifiers were deleted. instructions to respondents stated that the qualitative information would be used by the course instructor to evaluate and improve the online course experience for future students; the students did not have to answer any questions they did not wish to, they could withdraw from completing the qualitative instrument at anytime without penalty, and participating or not in the project would have no effect on their course grade. online course each of the three online course sections had identical formats and materials including syllabi, online lectures, shared references and websites, quizzes, lecture notes, discussion questions, discussion groups, a class bulletin board, and virtual office hours. all of these course features were integrated online to provide students with the opportunity to relate lecture material with hands-on computer experience. the specific objective of the online lecture section was to develop student comprehension of topics, such as single system designs, target problem assessment, measurement packages, behavioral observation, logs and journals, data analysis and interpretation, and computer software applications for clinical social work practice. in addition, other portions of the course involved working with microcomputer applications including word processing, database, graphics, and electronic mail. qualitative results the online short interview method was used to explore the perceptions of students on technology-related activities, online learning, knowledge, and overall course experience. the short interviews were conducted primarily to lend rich, qualitative texture to this exploratory study. these interviews were designed to invite the student participants to give voice to their cognitive experiences and their plans with respect to technology in social work practice. it was hoped that the short interviewmethod would capture student experiences as they occurred in a variety of online activities. in the section that follows, participant comments 81gellis/student assessment using collaborative learning 82 were selected from these short interviews, representing the range of responses and experiences that generally reflect variation along the two dimensions of affect and cognition. the interview questions are delineated in the order they were asked online. table 1 presents the characteristics and prior experience of the sample with previous computer courses. all students were registered as full-time in their second year of an msw program. the mean age for the sample was 29.4 years (sd = 6.29), with an age range of 22-51 years. about half of the respondents indicated that they had a computer course in their undergraduate program. the most common course reported is word processing, followed by internet navigation and searching. the most common type of computer used in undergraduate courses was an ibm compatible computer (92.5%). macintosh computers accounted for approximately (7.5%). more than two-thirds of the students (69.2%) reported having a cable modem connection, with a 56k modem being the next most common connection (28.4%). the students had access to computers in three different ways: (1) they had their own computer at home (97.5%), by far the most common situation; (2) they had access to computers provided by the university in public user rooms (1.2%); and (3) they had access to a computer in their remote area at a small community college or local library (1.2%). learningtousetechnology in socialwork practice table 2 presents the results of the student participants on the rating scale. overall, none of the participants rated any of the items as either “worse” (2) or “much worse” (1) than expected, suggesting that they were satisfied with various facets of the online course. the first question asked of students was to rate how much the online course prompted them to become more aware of learning to use technology in their social work practice. they reported learning much about applications and issues surrounding technology in social work practice, with a mean score of 4.62 out of a maximum of 5.00 on the self-rating scale. more than three-quarters of the students reported the online course to bemuch better than expected, and it expanded their thinking about integrating information technology into their work with clients. less than 5% perceived it to be about what they expected. the general theme of technology integration by the students in this course can be summed up in this student’s comments: “the use of technology in socialwork practice includesmany things: assessment tools, clinical data collection, evaluation tools, and other software programs. i hadn't thought about all the potential uses.” (student #79) experience and attitudes of learning to use technology in socialwork the second question asked students about their level of awareness of their own experiences and attitudes as they relate to learning to use technology in social work. the mean score was 4.66 out of a maximum of 5.00 on the rating scale. more than 90% of the students perceived their awareness level to be better or much better than expected at the end of the course. in the short interviews, students reported contrasting opinions about their level of awareness. students generally reported increased awareness and improved attitudes towards techadvances in socialwork 83 nology in social work. however, there was a minority of students who felt anxious during the course due to a lack of confidence in using technology. “as a socialwork student,…i learned that i amnot the only onewho is anxious about workingwith computers. i have a computer at home and i need more practice to increase my comfort zone.” (student #62) “completing this online course has taughtme a lot aboutmyself. i realized that i have mastered many new information technology skills and that excited me.” (student #2) the majority of students indicated positive attitudes towards technology at course completion. “i learned that i am on the high end of attitudes and aptitudes [regarding technology],which surprisedme somewhat. i likeworkingwith computers, but sometimes i feel overwhelmed.” (student #51) gellis/student assessment using collaborative learning n percent gender male 23 28.4 female 58 71.6 total 81 100.0 taken computer class as undergraduate yes 41 50.6 no 40 49.4 total 81 100.0 type of computerworked on ibm or compatible 75 92.5 macintosh 26 7.5 other 0 0.0 total 81 100.0 type of internet service connection 56k modem 23 28.4 cable 56 69.2 dsl 2 2.4 total 81 100.0 student access to computers have own computer 79 97.5 university public user rooms 1 1.2 local library or college 1 1.2 total 81 100.0 table 1: sample characteristics (n=81) 84 online collaborative discussions the third question asked students if they perceived the online course to promote greater collaborative discussions amongmembers of their online course group as compared to their traditional classroom experiences on a scale ranging from “much better” (5) to “much worse” (1) than expected. the mean score on this questionwas 4.90 out of amaximum score of 5.00. themajority of students (more than 90%) reported positive experiences on promoting collaborative group discussions. advances in socialwork rating scale items much better better about worse much mean than than what i than worse score expected expected expected expected than expected 5 4 3 2 1 1. rate whether 64 13 4 0 0 4.62 the online course (79.01%) (16.04%) (4.93%) (0%) (0%) prompted you to become more aware of learning to use technology in social work practice 2. rate the level of 59 17 5 0 0 4.66 awareness of your (72.83%) 20.98%) (6.17%) (0%) (0%) ownexperiences and attitudes toward technology 3. rate whether the 74 5 2 0 0 4.90 online course (91.35%) (6.17%) (2.46%) (0%) (0%) promoted collaborative discussions 4. rate how the 67 7 7 0 0 4.74 online course (82.71%) (8.64%) (8.64%) (0%) (0%) compared with your expectations at the beginning of the semester 5. rate the features 27 33 21 0 0 4.07 of the online course (33.33%) (40.74%) (25.92%) (0%) (0%) template 6. rate the technical 43 30 8 0 0 4.43 support/assistance (53.08%) (37.03%) (9.87%) (0%) (0%) you received for the course 7. rate your ability 77 3 1 0 0 4.93 to access the online (95.06%) (3.70%) (1.23%) (0%) (0%) instructor as compared to a traditional course table 2: student ratings of the online socialwork course by frequency and percent (n=81) 85 “i loved the intensive interactions among [online] group members, stimulated by the weekly discussion questions. i don't remember ever having such intensity in a regular classroom. these [clinical evaluation] questions and online discussions really helped me to understand the topics of the course.” (student #44) “i have only positive things to say about our group. i personally found the interactions almost “addictive,” in that i was anxious to get on and find out whatmy groupmembers had said… [about the discussion question or field internship question]... i was also fortunate to be in such a stimulating, thoughtful, and thought-provoking group. these were not the experiences i have had in a traditional classroom.” (student #70) only four participants in the sample expressed their preference for live communication in a traditional classroom, instead of the asynchronous online group discussion format. upon examination of this subgroup’s qualitative comments, the online course experience was perceived to be more time-consuming than other traditional courses they had completed. perhaps, this perception was due to a course requirement of logging onto the sln website for a minimum of three times during the week for the purpose of collaboration and communication on weekly discussion assignments, in contrast to a traditional three-hour weekly course session. online socialwork course expectations the fourth question asked was, “how did this online course compare with your expectations at the beginning of the semester?” students had amean score of 4.74 out of a maximum of 5.00. more than three-quarters of the students rated this item as “much better than expected.” course participants were prompted to describe times during the online course when they were interacting online with regards to their expectations of the course. a majority of students stated that the online course was flexible, and enjoyed working at one's own pace at home. the course also provided access to clinicalmeasures in social work practice, useful for clinical evaluation. “the course offered somuch flexibility…i was able to use the cd that came with our text to choose several reliable and validated screening instruments to use with clients in my field placement…our [online] discussion group decided what was the most convenient time to meet online. also, it offered direct online participation regularly, which i did not have in other courses.” (student #31) “it forced me to become familiar with the technological aspects within the [social work] field, something that i may have avoided had i not taken this course…in addition, i learned so much about how to use computer-guided assessment and clinical information systems for my field internship…” (student #29) some students described how completing the short interview seemed to trigger an awareness of their feelings of anxiety, which otherwise remained in the background of their online experiences. gellis/student assessment using collaborative learning 86 “i always feel like i am going to break the computer if i type in the wrong command, though i feel less and less like that now. i've learned to be more patient and to discuss these issues with other online groupmembers. i realize that other people are struggling with the same things through this course. that is comforting. i don’t panic as much, because i realize that happens to even the experts.” (student #78) online course template the fifth question asked to students was to rate the features of the online course template (for example, chat, discussion group, course documents, announcements, course evaluation, virtual lectures, shared references, private course folders) on a scale from “much worse to much better than expected.” students rated the features of the online coursewith amean score of 4.07 out of amaximumscore of 5.00 on this question, somewhat lower than the other rating scale items. onethird of the participants rated the course template as “much better than expected.” forty percent of responses were in the “better than expected” category, while a quarter were in the “about what i expected” category. this question was significant, since it focuses on sustaining the student's interest and developing a webpage environment for continued curiosity and interest in the course material. the examination of qualitative responses found that students were generally pleased with the discussion groups and, in particular, the amount of sustained interaction. other course template features frequently mentioned as helpful included the shared class references section and the private course folders for student-instructor interaction. “the discussion [bulletin] board was helpful with information, but i really enjoyed chatting with members in my group and sharing ideas on various topics that we were learning for clinical practice.” (student #48) “the chat room, announcements, course documents, and the discussion groups were all helpful. the shared resources were very helpful external links. i was finding myself checking these resources more than i realized.” (student #12) technical support/assistance the sixth question asked students to rate the technical support/assistance they received during the course. technical support was provided by university personnel who were available five days per week, 12 hours each day, to assist with computer or internet problems experienced by registered sln students. the mean score on this item was 4.43, with the majority of responses in the “better” and “much better than expected” range. interview responses were positive for perceived technical support and assistance during the online course. “i had problems logging on and the tech support came through for me.my anxiety level decreased immediately.” (student #48) “the course docs, announcements, and online helpdesk were very useful, especially when i ran into a problem.” (student #16) advances in socialwork 87 online access to the course instructor the seventh and final question asked students to rate their ability in accessing the online instructor as compared to a traditional course from much better than expected to much worse than expected. the majority of students rated this item very high, with a mean score of 4.93 out of a maximum 5.00. “i have never had so much interaction with a course instructor as i have had in this online course. it is much appreciated. all courses should be this way.” (student #22) “the instructor responded very quickly to questions and concerns. papers and assignments were graded on the same or next day andwere on theweb for viewing. i couldn’t believe howquick the turnaround timewas.this has never happened in any other courses i have taken.” (student #73) student responses to the short interview questions provide some evidence of a diversity of positive cognitive experiences triggered by technology-related experiences.the richness of these responseswas heightened by the articulatemanner in which studentswere able to describe their thoughts and affect. the timing of these interviews at the end of the course was successful in eliciting an inclusive set of cognitive experiences as well as triggering student experiences in other traditional courses. taken at face value, the diverse range of student experiences reported here may have been influenced by levels of technological competency, attitudes toward technology, and the amount of time spent with computers during the semester. discussion the purpose of this study was to explore student perceptions of their experiences in an online required graduate-level social work course. the findings will be used to identify key dimensions for designing and improving collaborative learning activities in online social work courseware. based on the qualitative interview findings, several components of teaching online should be emphasized. students can interact with each other, with the instructor, and access online resources at any time without the constraint of a classroom or office hours. the instructor acts as facilitator rather than a lecturer. in addition, the instructor can provide immediate support, guidance, and feedback on assignments and discussion questions. the online course can facilitate a democratic and collaborative learning environment and may place students in control of their learning, offering them a choice of content, online time, feedback, and a wide range of media for expressing ideas. instructors can also update course materials, review assignments rapidly, interact with individual students and through group discussions with ease at anytime. in the course presented, students were able to log on anytime, access all resources, review virtual lectures, complete assignments, take quizzes, and receive results instantly. online courses permit students to meet their own needs in a self-paced, self-monitoring environment. within this online experience, video and audio media and text interactions are used frequently; this is provided through asynchronous communication, thus gellis/student assessment using collaborative learning maintaining visual anonymity. students are reliant on each other for completion of tasks, therefore, increasing group influence. online interaction is required of all groupmembers for a sustained period (14weeks), and task activities are balanced with online non-course related social interaction in a bulletin board lounge. one of the main course objectives is to develop an online collaborative learning community with increased student participation. collaborative learning among students and instructor emphasizes active participation and sustained interaction. it creates a medium for conversation, discussions, and an exchange of ideas. the processes of this online course group experience is concisely described by felder (1996), who suggests that students in online groups can be organized to collaborate on projects and discussion forums under circumstances that include the following elements: • online group processing.online groupmembers set group goals, periodically assess what they are doing well as a group, and identify changes they will make to function more effectively online over the semester. • individual accountability. all members of the group are held accountable for doing their share of the work and form amastery of all of the material to be learned. • positive interdependence. online group members are obliged to rely on one another to achieve the goal. if any groupmembers fail to do his or her part, everyone suffers the consequences. • appropriate use of collaborative skills. students are encouraged and helped to develop and practice trust building, leadership, decision-making, communication, and conflict management skills. • communication and interaction. although some of the group work may be parceled out and done individually, some must be done interactively in person and online, with group members providing one another with feedback, challenging one another’s conclusions and reasoning, and perhaps most importantly, informing and encouraging one another online. favorable online collaboration and communication combines elements of the learner’s and instructor’s capabilities, needs, and goals with academic content, pedagogy, and the application of technology. online communication offers the potential for collaboration, increased participation in the learning process, reflection, peer tutoring, and monitoring of student learning as it takes place in real time. however, for the collaborative approach to succeed, online instructors need to be concerned about developing teamwork skills and structured exercises that promote critical thinking. these online experiences have one factor in common. they are based on the premise that comprehension and problem solving require activities that engage students in constructing knowledge (norman, 1999). student engagement in the online process is likely to includemore time spent on task, more self-directed learning, increased participation in group discussions 88 advances in socialwork and special projects, and less absenteeism (shea, frederickson, pickett & pelz, 2001). teaching an online course can be a rewarding experience for instructors, because it is designed to provide the student with an authentic learning environment by addressing real world problems and issues relevant to social work practice. the suny structured learning network (sln) online experience described here features a virtual community, virtual classroom, virtual office hours, and a virtual real world studio for life-long learning. it is imperative that social work educational programs begin to develop a collaborative learner-centered online environment that will help students feel a sense ofmastery while learning to integrate technology into social work practice. references bereiter, c., & scardamalia, m. (1992). cognition and curriculum. in p.w. jackson (ed.), handbook of research on curriculum. newyork: macmillan publishing. bonk, c., & cunningham, d. (1998). collaborative learning tools. in c. bonk, & k.s. king (eds.), electronic collaborators: learning centered technologies for literacy, apprenticeship, and discourse. mahwah, nj: lawrence erlbaum associates publishers. bransford, j., brown, a., cocking, r., donovan, m., & pellegrino, j. (2000).how people learn.washington, d.c.: national academy press. brna, p. (1998). models of collaboration. [online] available: http://www.cbl.leeds.ac.uk/ ~paul/papers/bcs98paper/ brufee, k. (1999). collaborative learning. baltimore: johns hopkins university press. burton, d., & seabury, b. (1999). the virtual social work course: promises and pitfalls. newtechnology in the human services, 12(3/4), 55-64. cahoon, b. (1998). new directions for adult and continuing education. san francisco: jossey-bass. chong, s.m. 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(2001). information industry and technology update. framingham, ma. johnson, d., & johnson, r. (1996). cooperation and the use of technology. in d.h. jonassen (ed.), handbook of research for educational communications and technology (pp. 1017-1044). new york: simon and schuster macmillan. norman, e. (1999). action research concerning technology for design and associated pedagogy. education action research journal, 7(2), 297-308. riel, m. (1998). foreword: conceptual order and collaborative tools—creating intellectual identity. in c.j. bonk, & k.s. king (eds.), electronic collaborators: learning centered technologies for literacy, apprenticeship, and discourse. mahwah, nj: lawrence erlbaum associates publishers. shea, p., frederickson, e., pickett, a., & pelz, w. (2001). measures of learning effectiveness the suny learning network. online education: learning effectiveness, faculty satisfaction, cost effectiveness. needham, ma: sloan-c. shea, p., swan, k., frederickson, e., & pickett, a. (2002). student satisfaction and reported learning in the suny learning network. elements of quality online education. needham, ma: sloan-c. u.s. department of education. (2000). distance education at postsecondary education institutions. office of educational research and improvement. jessup, md. walther, j.b. (1996). computer-mediated communication: impersonal, interpersonal, and hyperpersonal interaction. communication research, 23(1), 3-43. author’s note: address correspondence to: zvi gellis, ph.d., school of social welfare, state university of new york at albany, 1400washington avenue, albany, ny 12222, usa. e-mail: gellis@albany.edu 90 advances in socialwork a community participation model to enhance the effectiveness of a cci an adult education model of resident participation: building community capacity and strengthening neighborhood-based activities in a comprehensive community initiative (cci) daniel brisson susan roll abstract. comprehensive community initiatives (ccis) are of growing interest to social work and the social services field as they are an effort to move away from remediation of individual problems within neighborhoods to a comprehensive change effort that builds resident and institutional capacity for long term sustainability of healthy communities. built on ongoing lessons learned from the community development field, ccis are largely foundation supported projects that engage low-income neighborhood residents in a holistic change effort. however, based on what is known about community organizing, ccis will likely face challenges as long as they involve a top-down approach with an outside funder entering a community to make change. this manuscript frames an adult education model of resident participation that can be used in ccis and provides a case example illustrating the model in action. a discussion of how the model can be an effective means for communities to take advantage of outside resources while maintaining their power and voice for change is offered in conclusion. keywords: adult education; community development; community capacity; comprehensive community initiative; resident participation the war on poverty was first declared by president johnson in his state of the union address in january of 1964. yet today, 37 million people in the us remain in poverty (us census bureau, 2007). poverty is associated with, and confounded by, a number of social issues including high crime, unemployment, poor health and educational outcomes, homelessness, substance abuse, and juvenile delinquency (booth & crouter, 2001; brooks-gunn, duncan, & aber, 1997). the disproportionality of families living in poverty by race, ethnicity and legal status further complicate this complex dynamic (massey, 1990; quillian & redd, 2006; wilson, 1987). in addition to the vast social impacts, poverty has far reaching policy implications including financial responsibilities from local, state and federal sources, housing, welfare and publicly funded health insurance programs (jencks & mayer, 1990; joassartmarcelli, musso, & wolch, 2005; o’conner, 1999; wilson, 1987). the illumination of the depth of the problem that was brought forth in the 1960s has been tempered by political and social battles over welfare expenditures, undocumented immigrants and “family values.” with such far reaching implications, notwithstanding the moral and ethical obligations of the wealthiest nation in the world to care for its citizenry, it is of critical import that social scientists work cooperatively with policy makers, private funders, communities, and social work practitioners to address issues related to poverty. _________________ daniel brisson, ph.d., is an assistant professor and susan roll, msw, is a doctoral candidate in the graduate school of social work at the university of denver. copyright © 2008 advances in social work vol. 9 no. 2 (fall 2008), 157-175 brisson, roll/resident participation model 158 in response to the multiple issues facing families in impoverished neighborhoods, practitioners have attempted varied community development initiatives aimed at improving outcomes for low-income community members (annie e. casey foundation, 2007; desouza briggs & muller, 1996; rohe, bratt, & biswas, 2003). the most recent approach is the comprehensive community initiative (cci). ccis are an effort at addressing, in a comprehensive way, the myriad issues facing families in low-income neighborhoods, typically by bringing together community leaders, and the varied organizational and governmental stakeholders to work for common community solutions. on the surface, and based on what is known about community organizing, the success of ccis will be partly based on an initiative’s ability to navigate the tension between resident participation and a top-down approach of an outside funder entering a community to make change. there are examples from across the country of well-meaning philanthropies and foundations investing money in a community only to see that the power differential, the lack of community buy-in, and the differences in culture and values present obstacles that the project cannot overcome (brown & fiester, 2007). we suggest, however, that through the careful development of resident participation, ccis can be an effective way for communities to take advantage of outside resources while still maintaining their power and voice for change. resident participation, a cornerstone of ccis, is critical for building community capacity and neighborhood-based initiatives (annie e. casey foundation, 2007). resident participation allows community change efforts to sustain healthy communities over time. one of the most clearly articulated and applicable theories for resident participation can be found in the field of adult education. although multiple definitions of adult education can be found in the literature, it generally refers to the development and acquisition of knowledge by adults through both formal and informal methods that bring about changes in attitudes and behaviors that in turn affect both the individual and society (selman, selman, cooke, & dampier, 1998). because adult education is voluntary, those who participate are generally highly motivated. in addition, particularly when it involves learning skills through community engagement, adult education has a benefit for both individuals and the community as a whole. what is unique about this presentation is two-fold. one, although adult education has made significant contributions to the field of social work and community development, the linkages have not been made explicit. ccis are a growing resource for communities; however, if resident participation through adult education is not carefully developed, neighborhoods will not be successful in capturing this valuable resource. as was seen in the model cities project of the 1960s, money alone is not the answer for community change. meaningful resident participation cannot be assumed. a thoughtful and often time consuming process of resident engagement is critical. second, this manuscript offers a prescription, using a specific case example, for engaging residents in change. while activists and academics alike hail resident participation as tantamount to creating meaningful change, often this charge is not articulated in a practical model that can be applied by practitioners. advances in social work, fall 2008, 9(2) 159 the contribution of this manuscript is to provide a concise and practical model of resident participation that can be used in ccis as well as other community change efforts in marginalized communities. the model is informed from the well developed literature on adult education, with a focus on critical learning, citizenship, and civil society (johnston, 1999; mezirow, 1996; welton, 1997). the manuscript begins with a discussion of adult education in the context of critical learning theory as a rationale for a resident participation model. then, a detailed description of ccis as a holistic community change strategy to address the multitude of urban poverty issues is offered. an adult education model of resident participation is then presented with case examples at every stage illustrating the practical application of the conceptual model. a critique and implications are considered in conclusion. rationale for resident participation resident participation, at its best, is the voluntary gathering of individuals and groups with the intention of making positive change on specific issues for improved quality of life for the entire community (gamble & weil, 1995). although resident participation is an essential component of a cci, the cci literature does not address the development of resident participation as does the adult education literature using language such as critical learning theory (brookfield, 2005; mezirow, 1996), citizenship (johnston, 1999; welton, 1997), and civil society (gramsci, 1986). also known as “lifelong learning” (johnston, 2000), adult education forms the conceptual underpinning of resident participation. johnston (2000) articulates it well when he says, “one of the most important agendas for lifelong learning is education for active citizenship” (p.22). in the development of critical learning theory, adult educators have long recognized issues of power and control in civic engagement as well as the promise of positive outcomes when community members are actively involved in decision-making through a process of critical reflection. brookfield (2005) suggests that fully integrating several different types of learning such as reflexive learning, evolutionary learning, and communicative action into community change efforts is the necessary component to overcome innate issues of power, particularly in disadvantaged communities. critical learning theory’s focus on free and open communication allows adult learners to confront issues of power and also allows for the exploration of multiple types of learning. a leading scholar on critical learning, mezirow (1996) addresses the issue of the critical self-reflection of assumptions. this is particularly important in diverse communities and where an outside agency is coming in to make change. presuppositions and prejudices commonly get in the way of progress. here, each individual involved in the process, from the facilitators to the resident participants, must be meaningfully engaged in the change effort. drawing on the writings of habermas, mezirow (1996) outlines the specific conditions under which members are free to participate in change efforts, including an open and inclusive environment in which each individual is free to discuss and question without judgment, the encouragement and space to critically reflect and share differing views and opinions, and the ability to come to a consensus that is informed and objective. brisson, roll/resident participation model 160 citizenship is another prominent theme in the adult education literature which underscores the importance of resident participation. johnston (1999), in his discussion of citizenship and social purpose adult education, suggests a framework for adult learning through citizenship that includes both reflective citizenship, e.g. critical learning and active citizenship where individuals are involved in community change efforts. welton (1997) and others (hill, 1994; mayo 1997; newman, 1995) also illustrate citizenship as a crucial component of social change as individual learners become invested in the betterment of their community. finally civil society, made up of social, voluntary and non-government organizations provides a context for adult learning through social change efforts. it is precisely this absence of government in the context of civil society that allows adult learners to have power to make change (gramsci, 1986). many examples of change efforts by traditionally disempowered groups are seen in the context of civil society (johnston, 1999). particularly in the realm of civil society, issues of race, class, gender and ethnicity play key roles in defining power structures that either create or inhibit change. for example, nesbit (2006) suggests that while it has been missing from conversations of adult learning, social class clearly plays a central role in power dynamics and social strata. he shows that this context influences education and education, in turn, affects the broader social arena. civil society is the arena in which social change through adult learning can flourish. different from government, this realm of society is ideally free from structured power and thus can create power based on equality and inclusivity. although no community is totally free from the many pitfalls of power differences, successful and sustainable change in low-income neighborhoods will only come from within this context. resident participation in a cci resident participation in ccis presents a unique situation that calls for critical thinking about participation strategies and stages. residents are likely to participate in an externally funded project only if they are included in goal development, planning and implementation of activities. typically, resident participation is mobilized through a grassroots effort around a common issue or concern. for ccis however, there is a basic difference from classic grassroots community change efforts. namely, initiators of ccis are likely to be philanthropic foundations often in partnership with local governments or with some set of local organizations as partners for change. therefore, rather than the gradual process of building resident participation, or the militant mobilization against a clear neighborhood foe, residents of communities which may be “targeted” for ccis face a complex set of potential benefits as well as likely risks. what is a cci? ccis are largely foundation supported projects that engage low-income neighborhood residents in a holistic change effort. ccis have extended from the advances in social work, fall 2008, 9(2) 161 community development corporation (cdc) movement in the 80s and 90s (glickman & servon, 1998; rohe, 1999; rohe et al., 2003). the cdc movement attempted to address issues faced by families in low-income neighborhoods by focusing on housing needs. as numerous additional needs became apparent, cdcs took on the tasks of community organizing and business development in neighborhoods, broadening and addressing multiple issues in low-income neighborhoods (glickman & servon, 1998; rohe, 1999). the broadening of the cdc mission spurred the development of ccis as the next wave of interventions in low-income communities. according to the aspen institute’s roundtable on community change, there are at least 16 ccis with participation from over 50 communities around the country (roundtable on community change, 2008). most often funded through philanthropic organizations, but occasionally by government bodies, ccis promote change at the individual, neighborhood and systems level (aspen round table, 1995). this change is realized through the development of both community capacity and a set of comprehensive, neighborhood-based activities that permeate through physical, social, and economic sectors (aspen round table, 1995; kubisch, 1996). key to capacity building in the neighborhood is genuine participation by residents in the community change effort and thus resident participation becomes a fundamental building block of social change in low-income communities (aspen round table, 1995; kubisch, 1996). resident participation applied to a cci framework figure 1 illustrates how resident participation is applied to the cci framework. according to the model, resident participation is the essential element for the development of both community capacity and neighborhood-based activities – which together result in the success of ccis. as articulated in the cci literature, the development of both community capacity and neighborhood-based activities then produces improved outcomes at the individual, neighborhood, and system levels (kubisch, auspos, brown, chaskin, fulbright-anderson, & hamilton, 2002). brisson, roll/resident participation model 162 figure 1. resident participation applied to a cci framework develop comprehensive neighborhood-based activities build community capacity improved outcomes at the individual, neighborhood, and system levels resident participation the development of community capacity is the first essential element for improved outcomes for families. like similar concepts of social capital (coleman, 1988; putnam, 2000) and collective efficacy (sampson, raudenbush, & earls, 1997), community capacity is realized through the actions and interactions of individuals, organizations, and networks of a community (bowen, martin, mancini, & nelson, 2000). chaskin (2001) defines community capacity as “the interaction of human capital, organizational resources, and social capital existing within a given community that can be leveraged to solve collective problems and improve or maintain the well-being of a given community. it may operate through informal social processes and/or organized effort” (p. 295). chaskin goes on to note that differences in community capacity can affect safety, economic opportunities, health and educational outcomes and the general quality of life for individuals and families. in his framework, chaskin (2001) defines the fundamental characteristics of community capacity. first is a sense of community where members share values, norms and vision that allow them to work together for a collective purpose. second is a level of commitment where people see themselves as part of a community and are willing to participate in activities for the betterment of the community. third is the ability to solve problems, which chaskin emphasizes as a key to community capacity. it is through the ability to solve problems that ideas and concepts are turned into action. fourth and finally, chaskin identifies access to resources which include human, physical, political, and economic, from both community resources as well as outside resources, as a fundamental aspect of community capacity. these four building blocks of community capacity are reflected in adult education discussions of critical learning, citizenship, and civil society. the second critical component for supporting improved outcomes for families is the development of comprehensive neighborhood-based activities. this happens in two ways. first is an attempt to build on the strengths that already exist in the community. second is advances in social work, fall 2008, 9(2) 163 the identification and implementation of services where the neighborhood has needs (kubisch, et al., 2002). while community work, until recently, focused on remediation of specific problems, for example housing, health or education, the cci movement is an attempt at a more comprehensive approach to neighborhood improvement. this comprehensive approach frees an initiative from the constraints of categorical aid to communities and allows for pursuit of opportunities as they present themselves (aspen round table, 1995), building on community strengths, and filling in service gaps. problematic in the cci model is an inattention to the developmental process of resident participation. despite the best intentions, establishing trust and building participation that is broadly based among residents and institutions in neighborhoods cannot be assumed (brown & fiester, 2007). adults in many low-income neighborhoods have justifiably become very skeptical of “outsiders” who seek community change (kretzmann & mcknight, 1993; medoff & sklar, 1994). there are noticeable failures among community change efforts to “maintain” participation when adults feel they are used only to “sign off” but not to influence directions of plans and change (twelvetrees, 1996). residents of low-income communities have all too often engaged in work for neighborhood improvement or development, only to find that there were strict limits on opportunities for participation, or that their engagement was seen only as an entry into the community rather than an authentic step towards partnership. to address this oversight, an adult education model of resident participation is now offered. a case example for each of the stages is offered to illustrate the practical application of the model. an adult education model of resident participation figure 2 is an adult education model of resident participation built on theory and past practice successes, designed specifically for implementation in a cci. table 1 details in tabular format the specific contributions of each stage. as seen in figure 2 and informed by critical learning theory, action and learning pervade every developmental stage of resident participation. it is through action and learning that residents build skills and confidence that can lead to sustainable community change (mezirow, 1996). action is necessary for change to take place, while learning is necessary to move the developmental process from one stage to the next. although figure 2 can be viewed as a linear process, it is important to keep in mind the constant activities of action and learning taking place concurrently, empowering both individuals and the community. thus, resident participation develops both by moving down the developmental model in stages, and through feedback loops, created through the process of action and learning, that can move residents back up to a previous stage of the model. brisson, roll/resident participation model 164 figure 2: an adult education model of resident participation consciousness raising to understand problems and solutions ownership of an intervention through democratic decision-making neighborhood strengths used to implement the initiative l e a r n i n g a c t i o n mobilization to gain power successfully navigating the potentially problematic power differential is critical to the success of a cci. in a cci, a necessary precursor to mobilization is a funding source for community development, but often a crisis that demands community action stimulates the change process. in either scenario, the process for engagement in participation needs an early focus on mobilization of the members within the community in response to the unequal power between an external funder and the community residents. here adult education plays a key role in managing the unequal distribution of power (cervero & wilson, 1994). advances in social work, fall 2008, 9(2) 165 table 1: an outline of the model and contributions at each stage characteristics of the participation model contribution to the development of community capacity and neighborhood-based activities action and learning • refines action and interaction skills of community members • builds problem solving skills mobilization to gain power • builds a sense of community • develops networks of relationships • provides access to resources • builds a representative forum for decision-making consciousness raising to understand problems and solutions • reveals hidden resources • builds a sense of community • develops networks of relationships • builds problem solving skills • develops trust • facilitates commitment of community members ownership of an intervention through democratic decisionmaking • builds a sense of community • develops trust • facilitates commitment of community members • builds problem-solving skills neighborhood strengths used to implement the initiative • facilitates commitment of community members • builds problem-solving skills • provides access to resources stages of the participation model illustrated with a case example the specific stages of the participation model are described in detail and illustrated using a case example from the authors’ work as consultants with a cci. the case example comes from work done, primarily in one city, as part of the annie e. casey foundation’s making connections initiative. making connections is a ten year comprehensive community initiative in ten cities around the country.1 an explicit goal of making connections is to fully engage residents in the initiative. from the authors’ experiences, making connections achieved many successes in garnering resident participation. however, there were also instances were obstacles to resident participation were not overcome. we will illustrate the stages of the participation model through case 1 for more information see http://www.aecf.org/majorinitiatives/makingconnections.aspx. http://www.aecf.org/majorinitiatives/makingconnections.aspx brisson, roll/resident participation model 166 examples of both successes and obstacles experienced during our work with making connections. stage 1: mobilization to gain power the first developmental stage of the resident participation model is mobilization to gain power. mobilization is a process that was popularized by community organizers during the protest movements of the 1960s, and is used to build community capacity (alinsky 1971; kahn, 1995; weil & gamble, 1995). mobilization occurs when residents of a community are acting as one unit and often results in a group working for a common cause. mobilization may start simply as a group of residents meeting about an issue, but could culminate in a mass of people using their collective numbers to right unequal power structures and influence decision-making. this process is particularly salient in low-income communities where collective action is used in lieu of other resources to acquire power. collective action then becomes the power source for the previously powerless community (cervero & wilson, 1999). for multiple reasons, mobilization is the building block of the resident participation model. mobilization will develop community capacity by generating a sense of community, and begin to develop a community’s network of relationships. also, mobilization allows for a representative forum in community problem solving and decision-making. mobilization may also maximize the resources available to the community. mobilization, at its most powerful, involves the full participation of the community. to truly develop a comprehensive initiative the input of the full range of stakeholders is vital. therefore, the entire community must be mobilized. if certain residents of the community are not participating, then there is danger that needs are not being met in the comprehensive set of activities. mezirow (1996) argues that meaningful discourse can only come as result of full participation through solidarity of the community. this does not mean that every individual must agree, but they must be committed to making change together. this has been well demonstrated in the literature (castelloe, watson, & white, 2001; freire, 1994; rubin, 2000; schleifer, 1991; wilkinson & quarter, 1995). in one making connections site, community organizations were successfully brought together as partners to mobilize residents. one of the organizations, metro organizations for people (mop), specialized in mobilizing community residents. mop’s ability to mobilize is partially based on the trusting network of residents they have successfully organized in the past. thus, when mobilization becomes necessary there is already a network on which to build. the main element of mop’s mobilization strategy is twofold. the first is to spread the word. this is done not simply through hanging flyers and posting public notices in newspapers to bring together a neighborhood force, but involves one-to-one, in person contact with community members. mop participants and volunteers, as neighbors and members of the community, are asked to make one-to-one contact within the neighborhood with the goal of sharing information and eliciting support. each mop members is given a minimum number of residents to contact in these one-to-one opportunities in an effort to reach the greatest number of people. for example, advances in social work, fall 2008, 9(2) 167 recently, following a promise by denver’s mayor to provide scholarships to all high school graduates from one of the poorest performing middle schools in the city, mop organizers conducted over 250 face-to-face visits with middle school families to educate and secure pledges of students’ commitment to graduate from high school. although the making connections site was successful in bringing together organizational partners, making connections never fully utilized mop’s mobilizing skills to bring together a resident group to support the cci. instead, mop was simply brought to the table as a partner organization with other partner organizations. using the case example, one can conclude that making connections was successful in mobilizing organizations, but unsuccessful in organizing residents. by not utilizing mop’s skills and experience in organizing residents, making connections did not fully mobilize the community—a mistake that is exacerbated when examining future stages of the model. stage 2: consciousness raising to understand problems and solutions the second developmental stage of the residential participation model is consciousness raising to understand problems and solutions. consciousness raising is a process in which members of a community come together to share their individual concerns, and through sharing and active listening, come to understand the root causes of individual issues. these root causes often are embedded in community issues that the mobilized community can address. consciousness raising is a powerful emancipation exercise from the adult learning tradition (freire, 1994). consciousness raising begins with an understanding of the social, political, and economic inequities in a system that contribute to individual and collective poverty, and disempowerment. once this awareness has been achieved, an action step to right the unequal system can take place. according to freire, liberation from poverty can only occur through consciousness raising followed by action by the poor themselves. it would be a basic contradiction for liberation from poverty to occur through policies generated through an oppressive system. in the participation model presented here, consciousness raising occurs seamlessly through the introductions, encounters, meetings, and relationships that develop through the mobilization process. the empowerment of both individuals and the community continues at this consciousness raising stage as ideas are shared, information is revealed, and insights are developed through the learning process (mezirow, 1996; wilkinson & quarter, 1995). while one making connections site was successful in mobilizing partner organizations, the site did not mobilize residents and therefore had no opportunity to successfully engage in consciousness raising of the full community. further, other than bringing partner organizations together for meetings, there was no explicit effort made to have partner organizations share stories and ideas to reach a collective understanding for the community. the result was the familiar organizational strategy of crossorganizational meetings dictated by self-interest, and struggles over limited power within the new cci. brisson, roll/resident participation model 168 interestingly, partner organizations from the making connections site have tools available to engage in community consciousness raising. in fact a story circle toolkit was developed by making connections partner organizations for precisely this reason.2 unfortunately, the toolkit was only used in small constituent groups to address isolated issues, and never to develop full participation for the cci. using the participation model as a guide, it would first be important to fully mobilize residents so that outcomes from the story circles would be representative of the full community. stage 3: ownership of an intervention through democratic decision-making the third developmental stage of the resident participation model is ownership of the initiative through democratic decision-making. the first part of this stage, ownership, refers to the meaningful participation in the development of the initiative. one way that this has been framed in the field of adult education is through participatory action research (par) (fals-borda & rahman, 1991; freire, 1994; leach, 1994; mctaggart, 1997; sarri & sarri, 1992). par is a research and evaluation methodology where subjects are considered experts on the topic and inform programmatic and research decisionmaking. through par community dialogue and critical consciousness serve to empower individuals and communities, develop individual change, and drive collective action (leach, 1994; mctaggart, 1997; sarri & sarri, 1992). research shows that community development initiatives experience resistance when community members do not feel included, do not have power, are not given access to information, and are not active participants in the change process (lewin, 1946; sarri & sarri, 1992). in addition to ownership, the third stage of the resident participation model involves democratic decision-making. as defined by jefferson and tocqueville, participatory democracy invites participation in decision-making by all members of the community (schleifer, 1991). although democracy is practiced in many forms (thompson, 1976), the use of participatory democracy is emphasized in this model because of its strengths that include: the opportunity for equal participation by all, the opportunity for true consensus on decisions, and the inclusion of dissenting and minority opinions. as quoted by brookfield (2005), to habermas, democracy is “the adult leaning project of the contemporary era” (p.1130). an inherent issue in ownership of the intervention and democratic decision-making is the notion of power. one site from the making connections initiative valiantly struggled with the issue of power in trying to take ownership of the intervention and trying to consistently enact a democratic decision-making structure. the site’s struggles are illustrated at two different points in the initiative. the first point was at the introduction of the initiative. implied in a foundation initiated program is ownership by the foundation. to transfer ownership of the initiative, the funder talked openly about their desire for true resident participation. the funder used jargon such as ‘authentic demand’ to describe how the goals of the initiative were to come from the community and not the 2 the toolkit is available publicly at http://www.makingconnectionsdenver.org/publications/uploads/66/storycircletoolkit.pdf http://www.makingconnectionsdenver.org/publications/uploads/66/storycircletoolkit.pdf advances in social work, fall 2008, 9(2) 169 foundation. however, the foundation had a model for success that was informed by high profile experts in the field and this model was a major driver in programmatic decisionmaking. further, the foundation board had an outcome agenda for the initiative, which often competed with the authentic demand from the community. resident participants from this making connections site were successful in ‘pushing back’ and scoring some ‘wins’ from the foundation, but it was always clear to participants at the site that the agenda of the foundation needed to be a high priority. one of the ‘wins’ for this making connections site was establishing a communitydriven learning group, as opposed to a community-based learning group. however, even in establishing the community-driven group, issues of power interfered with ownership and the democratic-decision-making of the group. our role in the group was as outside consultant and expert. as an ‘expert’ we often struggled to know when it was appropriate to use expertise to inform the decision-making of the community-driven group. ultimately, it was the trusting relationship with community members that allowed us to successfully navigate the often confusing role that the group wished us to fill. in our experience the issue of power places serious obstacles in front of successfully establishing ownership of an intervention through democratic decision-making in the participation model. these obstacles are not easily overcome, and may need to be resolved through an upward movement in the participation model, specifically by repeating the consciousness raising stage. from our experience, ownership does not happen quickly but is built over time through incremental wins, the building of trust, and gradual transformation. stage 4: neighborhood strengths used to implement the initiative the final developmental stage of the resident participation model is using neighborhood strengths to implement the initiative. from this perspective the individuals and the community are not viewed in terms of deficit areas but instead in terms of their strengths (kretzmann & mcknight, 1993; saleebey, 1997; weick, rapp, sullivan, & kisthardt, 1989). for example, low-income communities are often measured in terms of their earnings, or educational level, which may be deficit areas. from a strengths perspective, low-income communities are measured according to their assets or abilities, which might consist of solid family bonds, a strong work ethic, and informal networking skills (friedmann, 1992). one site from making connections was bold, and subsequently very successful, in using community strengths to implement the initiative. each making connections site is responsible for a local evaluation of their initiative. one site developed a resident research group (to which we served as advisors) to evaluate local performance. the resident research group is composed of neighborhood residents and carries out the site’s research and evaluation activities, a role typically reserved for experts from outside of the community. members of the resident research group work on tasks that build on their strengths and interests. for example, one resident utilized her math and computer skills in data brisson, roll/resident participation model 170 analysis. this resident researcher works on cleaning and analyzing quantitative data for the initiative. another resident prefers the one-to-one contact in the community. this resident has been assigned a number of qualitative field interviews. the concept of utilizing neighborhood strengths has multiple benefits. for one, residents develop an increased investment in the community. those who work on the resident research group, and those who come in contact with the group, either through participating in interviews, newsletter updates, or in the receipt of additional funding based on positive evaluation outcomes, build an increased sense of pride in the community and are motivated to continue to invest in change efforts. clearly, for individuals whose strengths can be utilized and fostered, there is a potential for job and career advancement. for example, several resident researchers have been promoted internally to management and program planning positions. as internal promotions occur, new community members are hired on to the resident research group. finally, the research itself has an authentic perspective from within the community that research performed by outsider researchers can not claim. action and learning at its core, it is important to reemphasize that concurrent with the developmental stages of resident participation is an ongoing dynamic process of action and learning that promote adult education. through action and learning, residents move fluidly between the stages of resident participation toward the dual goals of building community capacity and strengthening neighborhood-based activities. as described in critical learning theory (mezirow, 1996), this combination of both instrumental and communicative learning through critical reflection creates change and growth both within the individual and the community. therefore, as a community progresses through the stages of participation, the use and interaction of action and learning are refined. critique and implications considering the great potential resident participation has for the success of ccis and other social work community development efforts, one criticism of the model is that the power differential between funding experts and community residents undermines the substantive contributions and participation of residents. as one resident participating in a cci put it, “when you get to the table with these outside folks, you are nobody” (kubisch et al., 2002, p. 37). our resident participation model seeks to address these power differentials that are omnipresent in change efforts by using the empowering principles of adult learning theory and putting power, skills and learning in the hands of community members. garnering resident participation for community initiatives is not a new idea. many skilled organizers have struggled with the implementation of the participation stages put forth in this model only to see their work undermined by the protocols and regulations of experts and funders. some organizations have stood their ground and insisted that community change be done their way. most others have had to find middle ground, advances in social work, fall 2008, 9(2) 171 choosing their battles in order to maintain funding for critical neighborhood programs. this manuscript puts forth a model, or a map, for practitioners who believe that sustainable community change will only be accomplished if led by community residents. the model is not a panacea. each stage of the model requires substantial effort and resources and progress will likely not occur in an efficient linear pattern. instead, real life will get in the way. there will undoubtedly be challenges like when community leaders move, funding gets cut, or the burden of fighting the system leads to burn-out. at the same time there will be successes in the form of a vote won at a town council, rival gang members working along side one another in a co-operative business, or a longtime resident becoming a home owner. all are a part of the process. in their book, adult learning, citizenship and community voices: exploring community-based practice, coare and johnston (2003) discuss the changing role of adult education within a new global economy. in this environment, the authors charge that adult education must respond by teaching diversity, social action and citizenship. heeding this advice, the participation model in this manuscript presents a framework that can be used as practice guidelines to achieve an inclusive and productive plan for resident participation that can be the foundation for success in a cci. at the same time, such a model will benefit social work by creating ways in which the field can adjust to new, progressive social movements and engage more non-traditional learners. references alinsky, s. d. 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(1987). the truly disadvantaged. chicago: university of chicago press. author’s note: address correspondence to: daniel brisson, ph.d., graduate school of social work, university of denver, 2148 high street, denver, co 80208. email: daniel.brisson@du.edu. mailto:daniel.brisson@du.edu rationale for resident participation resident participation in a cci what is a cci? resident participation applied to a cci framework an adult education model of resident participation stages of the participation model illustrated with a case ex stage 1: mobilization to gain power stage 2: consciousness raising to understand problems and so stage 3: ownership of an intervention through democratic dec stage 4: neighborhood strengths used to implement the initia action and learning critique and implications references aisw vol. 8, no. 1:aisw vol. 5, no. 2 analysis of social work theory progression published in 2004 valerie d. decker philip d. suman barb j. burge ankita deka melanie harris dwight j. hymans michael marcussen donna pittman david wilkerson james g. daley abstract: the authors reviewed 67 articles that discussed and/or tested human behavior theories from social work journals published in 2004 in order to assess the level and quality of theory progression. the articles were further sorted into council on social work education (cswe) educational policy and accreditation standards (epas) foundation curriculum content areas of hbse, practice, policy, field education, values & ethics, diversity, populations-at-risk/social and economic justice, and research for purposes of categorization. results indicated that hbse and practice were by far the largest group of articles reviewed. also found was that social work has a limited amount of theory discussion in the content areas of field, values and ethics, diversity, and populations-at-risk/social and economic justice. thirty-three articles were found to demonstrate theory progression, eight articles presented new/emerging theories, and 26 articles discussed or critiqued theories without presenting evidence of theory progression. keywords: human behavior in social environment (hbse) evaluation, social work theory, theory progression, social work education, social work practice, social work policy introduction for centuries, scholars have attempted to articulate the implication of theory, to establish a meaningful framework for evaluation of a theory’s merit, and to document progression of a theory through the evolutionary stages of concep81 valerie d. decker, philip d. suman, barb j. burge, ankita deka, melanie harris, dwight j. hymans, michael marcussen, donna pittman, and david wilkerson are doctoral students, and james g. daley, ph.d. is associate professor at the indiana university school of social work, indianapolis, in, 46202-5156. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 81-103. indiana university school of social work. tualization, development, and empirical testing. recently, some social work scholars have taken the stance of rejecting the need to teach theory, instead, advocating a focus on teaching practice skills without communicating the significance of the profession’s theoretical foundation (simon & thyer, 1994). and, yet, researchers must have a starting point from which to begin their inquiries and a roadmap to enable them to recognize where each theory has been. this is essential to direct our scientific progress as a profession. sherraden (2000) states, “theory has a great deal to do with asking questions well,” (p. 1) and from that stance concludes that “certain structures of inquiry may lead to theories that are more productive than others” (p. 2). it is from this perspective that we have attempted to develop a framework to evaluate the discussion and progression of theories of human behavior in the social environment (hbse) in primary social work journals published in the calendar year 2004. in order to begin our discussion of theory quality, an operational definition of theory is necessary. payne (2005) defines theory succinctly as “an organized statement of ideas about the world” (p. 5). turner (1996) offers a similar definition: “a model of reality appropriate to a particular discipline” (p. 2), and sherraden (2000) conceptualizes it as “theory is what explains why an intervention causes an outcome” (p. 3). since we have limited our discussion to hbse theory in social work, all of these theories seem valid and complementary. previous authors have attempted to establish criteria in order to evaluate the merits of human behavior theories (e.g., fischer, 1973; payne, 2005; robbins, chatterjee, & canda, 1999; turner, 1996; witkin & gottschalk, 1988), yet these did not seem to adequately encapsulate the full dimensions of theory discussion in the literature. the concept of theory progression was absent in all of these frameworks. by theory progression, we mean whether the practical application of the theory was solidified, more thoroughly understood, or extended into a broader explanation of behavior. in this article, we have attempted to develop a system of assessment for theory progression. methods the nine members of our research team sorted 67 articles (the pool of articles were drawn from a larger pool sorted by doctoral students and a faculty member (gentle-genitty et.al., 2007) based on theory review procedures cited in daley et.al., 2005) with the sorting emerging from a discussion of theory from primary social work journals published in 2004. the articles were classified into the council on social work education’s (cswe) foundation curriculum content areas as defined in the educational policy and accreditation standards (epas) (council on social work education, 2001). the articles were initially sorted by individual members of the research team, then reviewed collectively by the entire team, who consensually determined the final categorization of each article. the abstracts, authors’ statements regarding the primary focus of the article, and general content guided the classification process. the articles reviewed included research-based studies, policy analysis, and editorials. 82 advances in social work after sorting, the articles were distributed to seven individual team members (readers) to assess the quality of the theory discussion in each article. each reader received approximately 10 articles. to the extent possible, each reader was assigned an entire curriculum content area. areas with more than 10 articles were divided between two readers. the following instructions for summarizing the content of the articles were agreed upon by the team: describe each article briefly in terms of the author’s discussion of theory including: • is it an established theory or emerging? • in terms of the author’s discussion, has the theory been empirically specified and has the historical context been addressed? • can a reader easily use the article to improve practice, teaching, or policy development? if a reader discovered that an article had been incorrectly classified, he/she alerted the team via a listserv and justified the article’s reclassification. this occurred in two cases. the readers returned their article summaries to be synthesized by two team members. the articles, theories, and status of theory progression are individually listed in the tables following each section of this paper dedicated to individual curriculum content areas. also, a brief summary and specific information related to the featured articles will be found under the headings of each content area below. the following categories were established based on summaries of the articles provided by individual team members: progressed, discussed without progression, and new/emerging. an article was classified as “progressed” if it provided the historical context of an existing theory as well as tested the theory empirically or applied the theory in a new context. those articles that were “empirically tested” included both quantitative and qualitative studies. articles that discussed or critiqued an existing theory without attempting to test it empirically were classified at “discussed without progression.” finally, articles that discussed new or emerging theories comprised the final category. results table 1 shows the articles by epas area. subsequent tables give more detail by the epas categories. human behavior in the social environment (hbse) within the scope of social work research and practice, a plethora of theories explore the nature of human behavior and the social environment. these theories originate from a multitude of disciplines, including social work, sociology, psychology, and economics. thirty-one theories of hbse were published in 24 different articles in social work journals in the calendar year 2004 (table 2). twentyone theories from 16 articles in this content area were judged as progressing, which is by far the largest group in this study. four theories were presented as new/emerging and three existing theories were discussed or critiqued with little or no theory progression. 83decker et al./analysis of social work theory progression published in 2004 the theories progressed dealt with four categories: 1) family units, 2) couples, 3) adolescent academic performance, and 4) other. seven articles progressed theories that dealt with the family unit. a theory of adult development and personal authority in the family system was used to explore intergenerational family relationships (lawson & brossart). family development theory was used to explore the life cycle of a family (richman & cook). family systems theory was used to demonstrate a link between divorce and adolescent emotional adjustment (vandervalk spruijt, degoede, meeus, & maas). feminist theory (mack-canty & wright) and role theory (landry-meyer & newman) were used to discuss parenting. lifecycle theory was used to explore the effect of consumer debt on the family (baek & hong). finally, social construction theory was used to examine meaning making, empowerment, and narrative for families who have experienced torture (montgomery). four articles progressed theories for working with couples at various life stages. attachment theory was used to explore infidelity (allen & baucom). a theory of the division of household labor examined power relationships between husbands and wives (zipp, prohaska, & bemiller). gender construction was used to explore traditional gender roles and couples relationships (zuo). finally, life course theory was used to explore satisfaction of retired couples (smith & moen). three articles dealt with adolescents and their academic performance. life course (crosnoe & elder), psychoanalytic (jones), and role theories (baum) were used to explore adolescent academic performance. the remaining two articles discussed trauma theory with respect to child welfare workers (regehr, hemsworth, leslie, howe, & chau) and social capital theory to discuss children’s street work in mexico (ferguson). 84 advances in social work epas area progressed (%) discussed new/ without emerging progression hbse 16 (66.7%) 4 (16.7%) 4 (16.7%) practice 7 (43.8%) 7 (43.8%) 2 (12.5%) policy 3 (42.9%) 4 (57.2%) populations at risk 3 (42.9%) 4 (57.1%) diversity 2 (33.3%) 3 (50%) 1 (16.7%) research 2 (50%) 2 (50%) values & ethics 2 (100%) field 1 (100%) grand total 33 (49.3%) 26 (38.8%) 8 (11.9%) table 1: theory progression by content area 85decker et al./analysis of social work theory progression published in 2004 author progression titles of key points tested theories empirically allen & progressed attachment article demonstrates the yes baucom progression of attachment theory into the area of adult infidelity. citing previous research briefly, they establish an empirical base and proceed to show how attachment style can be used to predict infidelity. implications for practice are explored, including using an understanding of attachment style to create empowering narratives for couples dealing with infidelity. applegate discussed psychoreviews the application of no without analytic psychoanalytic theory to progression social work's theory base, education and practice. discusses theory’s decline over the past several decades. findings from neuroscience on infant attachment have led to a paradigm shift within the theory. incorporations of new understanding of gender and sexuality, and concern for the “person in situation” have reinvigorated the theory base, making it increasingly viable to social work practitioners, working with oppressed populations. baek & progressed lifecycle utilizes life cycle theory to yes hong examine the effects of life stages on consumer debt. does an effective job at establishing a link between consumer debt and the family’s life-cycle stage with families in the empty nest, solitary household, and single parent stages showing a lesser likelihood of having installment debt. table 2: articles summaries for hbse content 86 advances in social work author progression titles of key points tested theories empirically baum progressed role/role applied role theory to look yes model at the effect of maternal employment on a child’s academic achievement. found that maternal employment could have a negative impact on a child’s academic performance that is in contrast to what the theory would predict. castro, new/ parentificathe study reflects that yes jones & emerging tion & childhood parentification mirsalimi imposter over an extended period of phenomenon time in part can be explained by the imposter phenomenon. there is a moderate correlation between the two constructs. no significant differences for ethnicity and race and the parentification scores were found. caucasians however scored higher on the imposter phenomenon score than african-americans. cordon & critique transexamined the application no somerton with no theoretical of the transtheoretical progression model of change to work with parents finding its assessment of parenting is viable when used critically and in particular situations. crosnoe progressed life course advance life course theory no & elder by exploring the many factors that contribute to adolescent educational resilience during this one particular life stage. ferguson progressed social capitol progressed social capital no theory by applying it to a different culture and demonstrating its relevance to children’s street work in mexico. table 2: articles summaries for hbse content (cont.) 87decker et al./analysis of social work theory progression published in 2004 author progression titles of key points tested theories empirically houston critique with heuristic examined gidden’s no no progression heuristic theory and sought to expand on the theory and establish a position on the constructs of structure and agency. jones progressed psychoexamined the effect of yes analytic having a non-resident father on psychological separation and academic performance utilizing psychoanalytic theory as an explanatory model. the findings are consistent with numerous previous studies showing a tie between father involvement and academic performance, but failed to establish a clear link between the results and psychoanalytic theory. kroska critique with division of describes four theories and no no progression household applies them to explaining the labor division of household chores in families. specifically, the author uses gender ideology, relative resources, time availability, and doing gender. the author found these theories to be helpful in explaining the division of tasks but found that gender remains an important determining factor. landryprogressed role/role applied role theory to explore yes meyer & model the grandparent as a caregiver newman role respectively. performed a qualitative study interviewing grandparents who were raising grandchildren. concerns reported were consistent with those that would be predicted by role theory. table 2: articles summaries for hbse content (cont.) 88 advances in social work author progression titles of key points tested theories empirically lawson progressed adult this study explores yes & brossart developdifferences among ment perparticipants intersonal generational family authority relationships. results in family indicate that younger system groups expressed more intimacy and intimidation with each parent and more triangulation with fathers than the older groups. gender differences revealed that females have slightly stronger and healthier intergenerational relationships with parents. mackprogressed feminist use a qualitative research yes canty & design to demonstrate how wright a feminist parenting style can assist children to challenge hierarchy and oppression, thereby, assist in advancing feminist theory. mcphail new/ queer article questions ideas of no emerging feminist gender binaries of (male/ female or homosexuality/ heterosexuality). discusses post-modernist and queer theorists who have offered new insights on sexuality and social justice. develops a queer theory critique on compulsory heterosexuality and calls for deinstitutionalization of the gender binaries, which create problems of oppression and social exclusion. montgomery progressed social author applies the emerging yes construction theories to work with families who have experienced torture. coordinated management of meaning model is supported by the findings of this qualitative study. the model suggests how to help families construct empowering and truthful narratives about torture histories. table 2: articles summaries for hbse content (cont.) 89decker et al./analysis of social work theory progression published in 2004 author progression titles of key points tested theories empirically regehr, progressed trauma authors explore individual, yes hemsworth, incident and organizational leslie, factors that create posthowe, & traumatic stress distress chau among child welfare workers. reports that individuals who develop healthy relationships with others and who exercise greater control on their lives report low levels of stress. individuals who had fewer contacts with the issue also reported less stress. the organizational environment was the most effective predictor of stress. richman progressed family authors describe the no & cook development stairstep framework–an alternative model of family development that encompasses different types of families. it has five life processes: 1) establishing a family, 2) addition of family members, 3) family members pursue inter/independence, 4) separation of family members, 5) adults develop dependence. smith & progressed life course analyzes retirement yes moen satisfaction among retirees and their spousesindividually and jointly. results find differences among retirees and spouses in satisfaction level with retirement. joint satisfaction among couples is lower than the individual levels. the most satisfied couples were retired wives and their husbands who reported that husbands did not exercise any influence in wives decisions. table 2: articles summaries for hbse content (cont.) 90 advances in social work author progression titles of key points tested theories empirically sullivan, new/ health article enhances the yes pasch, emerging belief legitimacy of the hbm cornelius & model to predict couple’s cirigliano counseling decisions. results indicate that the most effective predictors were couple’s perceptive barriers and whether or not counseling was recommended to them through some source utz, reidy, new/ widowhood authors examine how yes carr, nesse, emerging widowhood affects daily & wortman household activities. results indicate that children mediate the affect by helping with errands and housework and that the individual characteristics and intergenerational attributes have impact on the daily household activities in late-life widowhood. vandervalk progressed family advance family systems yes spruijt, systems theory by demonstrating degoede, a link between divorce meeus, & and adolescent emotional maas adjustment. zipp, progressed division asymmetric power yes prohaska, of household relationships between & bemiller labor husbands and wives are explored by examining decision-making, division of household labor, and childcare. results find gender asymmetries in the household are reinforced through routine interactions. study also reveals marital power, which is difficult to locate and is usually exercised covertly. table 2: articles summaries for hbse content (cont.) practice twenty theories of practice were published in 16 different articles published in social work journals in the 2004 calendar year (table 3). seven theories from the articles in this content area were judged as progressing, which is the second largest group in this study. two theories were presented as new/emerging, and seven existing theories were discussed or critiqued with little or no theory progression. the theories progressed dealt with four categories: 1) the therapeutic relationship, 2) families, and 3) other. three articles discussed the therapeutic relationship. attachment theory was used by two authors to discuss working with clients individually (bennett; ringle). control-mastery theory was used to discuss therapists who work with clients in a psychotherapy setting (nol). two articles progressed theories dealing with the family unit. the family resilience model was used to explain how families adjust to economic pressures (vandsburger & biggerstaff). a theory of procedural justice was used to explore family group conferencing in child welfare work (neff). finally, a theory of social justice was discussed for working on a macro level with activism and policy (mulroy), and trauma theory was used to discuss social work education (mckenzie-mohr). policy five theories dealing with policy were published in seven different articles in social work journals in the 2004 calendar year (table 4). three theories from the articles in this content area were judged as progressing. no theories were presented as new/emerging, and three existing theories were discussed or critiqued, with little or no theory progression. responsive regulation appeared in three articles and was judged to be progressed by one (burford & adams) and discussed in two articles (kelly; pennell). the three articles that progressed theories dealt with divergent topics. ecosystem theory was used to study the impact of systems of care model on families and their therapeutic outcomes (coffey). responsive regulation was used to understand the dual roles (social control and empowerment) of most practitioners (burford & adams). finally, transtheoretical theory is used to examine welfareto-work (mcguire). 91decker et al./analysis of social work theory progression published in 2004 author progression titles of key points tested theories empirically zuo progressed gender seeks to advance gender no construction construction theory by examining the link between men’s breadwinner status and the presence or absence of an egalitarian ideology. table 2: articles summaries for hbse content (cont.) 92 advances in social work author progression titles of key points tested theories empirically alperin discussed dream identifies and compares no without analysis four theories of dream progression (classical analysis. concludes that objectoverall purpose of dreams relations, is to develop, maintain, modern and restore self-object psychorelationships analytic, selfpsychology) bennett progressed attachment discusses attachment no theory and infant research to understand the therapeutic relationship. examines how clients who represent the four styles of attachment (secure, insecure ambivalent, insecure avoidant, and disorganized) respond to therapeutic telephone contact, or “disembodied communication.” patients with insecure avoidant or disorganized attachment did not respond to changes in treatment mode. brandell discussed psychotraces the importance no & ringel without dynamic of the therapeutic progression attachment relationship in clinical social work and casework management. identifies psychoanalytic concepts relevant to social work, including therapeutic alliance, the “holding environment,” transitional objects, and phenomena. argues that psychodynamic perspective on relationship should be taught in social work curricula. table 3: articles summaries for practice content 93decker et al./analysis of social work theory progression published in 2004 author progression titles of key points tested theories empirically brownlee discussed bereavement explores perinatal loss no & oikonen without cycle and related issues of progression mourning/grief. provides concise clinical and historical background of theory and family/parental stress during the loss of an unborn. detailed discussion of empirical research studies with parents, extended family members, and primary care providers to support (attachment/loss/ grief). also reports limitations for women in followup clinical services. burlae new/ mindful uses theory to understand no emerging space and suggest tools to prevent violence against women. two forms of violence— invasion and captivity are experienced in subtle ways. ones emotional energy alerts the receiver on a visceral level when a violation occurs. these cues can prevent destructive violence if the receiver acknowledges them and sets limits. if not, the repeated subtle acts of violence fragment the sense of self. corcoran discussed resiliency presents a “risk and resilience no & nicholswithout ecological framework” for casebolt progression client assessment and goal formulation on micro, mezzo, and macro levels. this framework, though comprehensive, is massive and may be overwhelming for some. gubman discussed attachment discusses practical link no without between the theory and progression social work clinical settings using empirical and evidencebased studies about working with “difficult patients.” table 3: articles summaries for practice content (cont.) 94 author progression titles of key points tested theories empirically kahng & discussed modified applies mlt to discuss yes mowbray without labeling the process of mental progression illness (mi) stigmatization. identifies factors contributing to mi stigma(s): selfworth, rejection, and selfesteem. empirical studies related to chronic/severe mi, social work settings, and family support systems are used in this paper to provide a better understanding and framework for mlt. manning, discussed afrocentric identifies three primary no cornelius & without egopsychology theories recommended okundaye progression spirituality for practice with african american clients that incorporate accounts of racism, oppression, stress, mental, and general health issues. mckenzieprogressed trauma discusses theory as an no mohr underutilized tool of knowledge in undergraduate and graduate schools of social work (sw). provides in-depth discussion about integrating it into college level curriculum. offers specific empirical studies that support the need to incorporate skills in sw practice and teaching settings. also, discusses the possibility of traumatizing sw students who are not emotionally capable of processing first-hand trauma. mulroy progressed systems provides in-depth look at no social justice macro social work practice by discussing several prominent theories (systems, social justice, social environment, and community). examines three levels of social justice and applies them to social work community activism and administrative policy. table 3: articles summaries for practice content (cont.) advances in social work 95 author progression titles of key points tested theories empirically neff progressed procedural integrates social no justice exchange theory with equity theory to explain family group conferencing (fgc). the primary concepts discussed regarding child protection are: restorative, retributive, and group value. nol progressed controldiscusses theory as tool used no mastery primarily in psychotherapy settings. author identifies two basic concepts essential in linking theory with practice, 1) clients are motivated to reveal unresolved emotional issues, and 2) therapists provide and develop a trusting relationship in order to allow clients to reveal unconscious materials. ringel progressed attachment author details a change in no attachment style using a clinical case study with an adult. asserts that the treatment relationship and process facilitate the change. use of at shifts focus of treatment away from medical model of diagnosis. rojano new/ community community family therapy no emerging family (cft) in this conceptual article is a progressive theory of the ecosystemic model of therapy for economically oppressed populations. a primary goal is moving clients out of poverty and is achieved through three levels of intervention facilitated by a “citizen therapist.” the “citizen therapist” is a new role for the therapist and includes coaching, advocacy, networking ability, community activism, and civic leadership. table 3: articles summaries for practice content (cont.) decker et al./analysis of social work theory progression published in 2004 populations at risk eleven theories dealing with at-risk populations were published in seven different articles in social work journals in the 2004 calendar year (table 5). theories from articles in this content area were judged as progressing. no theories were presented as new/emerging and four existing theories were discussed or critiqued, with little or no theory progression. as with policy, the three articles that progressed theories dealt with divergent topics. critical constructionist and ecological theories were used to study parents who have been physically abused by their adolescent child (cottrell & monk). marxist theory is used to discuss how alienation of labor, human nature, and humanity has an impact on clients and social workers (ferguson & lavalette). finally, queer theory is used to discuss body image disturbances and psychosocial difficulties experienced by some gay men (wood). summary of findings several interesting trends related to theory discussion and progression in social work appeared as we reviewed these articles. our primary purpose was to evaluate theory progression within the social work literature. overwhelmingly, this occurred within the 24 articles in the hbse category. of the 24 articles reviewed, 16 demonstrated some level of theory progression. in the practice content area, seven articles demonstrated progression, while seven others showed minimal evolution. the populations-at-risk/social and economic justice and policy content areas both had three articles that suggested theory progression, while the research content area had two articles that showed progression, as did the diversity content area. there were no theories discussed that demonstrated progression in the content areas of field or values and ethics. it is reasonable to conclude that social workers are continuing to focus their work on the advancement of theories of human behavior and social work practice, while spending less time on the content areas of policy, populations-at-risk/social and economic justice, diversity, and research methods. across the curriculum content areas, eight new and emerging theories were presented in the literature. among these, four were sorted into the hbse content 96 author progression titles of key points tested theories empirically vandsburger progressed family evaluates family resiliency yes & resilience model/theory to explain biggerstaff model how families adjust when challenged with economic pressures. authors provide discussion of poverty, family functioning, and resiliency. uses the stress adjustment adaptation model (abcx). table 3: articles summaries for practice content (cont.) advances in social work 97decker et al./analysis of social work theory progression published in 2004 author progression titles of key points tested theories empirically baylis discussed lacanian attempts to analyze no without analytic the development, or lack progression there of, of social work’s identity as a profession. provides reader with extensive description of complex theory from a historical context. without showing any evolution of the theory, the author makes an argument for applying it to current debates regarding the nature of the social work profession. no empirical evidence is provided either in support of the theory or its application to social work’s identity crisis. burford progressed responsive in-depth description no & adams regulation of theory that gives both historical context and development of the theory. provides a way to understand the dual roles (social control and empowerment) of most practitioners. suggests a framework to negotiate these roles in practice. coffey progressed ecosystem studies the impact of no systems of care model on families and their therapeutic outcomes. has comprehensive historical discussion of ecosystemic theory. links resiliency theory to the model. provides evidence that the belief that systems of care may have a negative impact on therapy outcomes. table 4: articles summaries for policy content area, two were in the practice content area, and one each was classified in the policy and diversity content areas. this could suggest that social work scholars continue to develop new ways to understand human behavior but are not developing new theoretical frameworks to address issues of social justice, research methods, values and ethics, or field education. of the theories discussed in these articles, psychoanalytic theory and feminist theory appeared across the widest spectrum. psychoanalytic theory was found in articles sorted into the curriculum content areas of diversity, practice, hbse and values, and ethics, while articles related to feminist theory were found in the categories of populations-at-risk/social and economic justice, research, values and ethics, and hbse. other theories that were examined multiple times include attachment theory in practice (three separate articles), and hbse and research; 98 advances in social work author progression titles of key points tested theories empirically mcguire progressed transprovides a thorough yes theoretical and clear historical description of the development, empirical study and evolution of the transtheoretical model and welfare to work. examines the change process that was initiated when welfare to work became the major method of moving people off of welfare toward self-sufficiency. mulroy & discussed political looks at the changing no tamburo without economy climate of nonprofit progression organizations and welfare-to-work. provides little discussion on historical evolution of political economy theory. cites several studies that examine welfare reform programs and policies the political economy framework is used to analyze the impact of welfare-to-work on nonprofit organizations and their delivery of services. pennell discussed responsive provides detailed description yes without regulation of the components and progression processes of family group conferencing (fgc). table 4: articles summaries for policy content (cont.) ecosystems or ecosystemic family theory in policy, and populations-atrisk/social and economic justice; and transtheoretical change theory in hbse and policy. implications for the profession as noted earlier in this paper, we categorized social work articles that discussed theory as either progressing the theory, proposing a new or emerging theory, or simply discussing or critiquing a theory without progression. for the purposes of this article, theory progression was defined as an empirical test (quantitative or qualitative) of the tenets of a theory or as a discussion of a theory that proposes innovative applications or examples. most of this work continues to occur in studies focused on the cswe foundation curricular content areas of hbse and practice. given the current political climate and pending federal and state budget cuts for programming, social work would be well served to focus immediate 99decker et al./analysis of social work theory progression published in 2004 author progression titles of key points tested theories empirically abbott, discussed family authors use family stress yes sharma, without stress theory to interpret the & verma progression emotional climate within indian families living in poverty. the authors operationalize the main constructs of family stress theory for the purposes of this study, but results fail to offer firm support of the theory. one possibly beneficial conclusion is the suggestion that poverty alone does not predict satisfaction with family or life in general. anguiano discussed social studies minority students yes without capitol at-risk of dropping out of progression ecological school using theories. offer no explanations of previous studies that may have verified either theory. primary components of each theory is explained. little attention given to the historical context. they suggest that the types of parental involvement important for students’ high school completion may vary by ethnicity. table 5: articles summaries for populations-at-risk/social and economic justice content and future research efforts on issues of diversity or populations-at-risk/social, and economic justice. it will be necessary to develop new and empowering approaches to working with individuals and families who have been marginalized by restrictive social policies. furthermore, social workers must continue to research the effects of social problems and to evolve theoretical explanations for human behavior in order to develop positive interventions and to assist people of all ethnic backgrounds and people representing diverse sexual orientations and evolving concepts of gender. social work researchers must also do a better job of reviewing pertinent theories of research and developing theories of research methodology than they did in 2004. also sorely lacking is theory discussion or progression in the epas content areas of field education or policy. field clearly is a bedrock content area in social work education, and yet, there is minimal evidence to suggest that any scholars researched its theoretical components in 2004. similarly, policy remains an important content area, yet only seven articles were written in 2004 that included a significant volume of theory discussion and only three of those articles demonstrated theory progression. social workers must do better at researching, refining, and developing a unique theoretical foundation for practice with diverse populations or we will face significant challenges in justifying our existence to political and scientific communities. references. abbott, d., sharma, s., & verma, 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(2004). shifting the breadwinning boundary: the role of men’s breadwinner status and their gender ideologies. journal of family issues, 25(6), 811-832. author’s note: address correspondence to: valerie decker, msw, doctoral student, school of social work, indiana university, 902 west new york street, indianapolis, in 46202-5156, usa. e-mail: cgentleg@iupui.edu. 103decker et al./analysis of social work theory progression published in 2004 resilience amid academic stress: resilience amid academic stress: the moderating impact of social support among social work students scott e. wilks abstract. purpose: the purpose of this study was to examine the relationship between academic stress and perceived resilience among social work students, and to identify social support as a protective factor of resilience on this relationship. a conceptual model of moderation was used to test the role of social support as protective. methods: the sample consisted of 314 social work students (bsw=144; msw=170) from three accredited schools/programs in the southern united states. voluntary survey data were collected on demographics and constructs of academic stress, family support, friend support, and resilience. hierarchical regression analysis was conducted to show the composite impact of demographic and model factors on the resilience outcome. moderation was tested using a traditional regression series as guidelines of moderation with continuous variables. path analyses illustrated main effects and moderation in the study’s conceptual model. results: the sample reported moderate levels of academic stress and social support, and a fairly high level of resilience. academic stress negatively related to social support and resilience. social support positively influenced resilience. academic stress accounted for the most variation in resilience scores. friend support significantly moderated the negative relationship between academic stress and resilience. conclusion: the current study demonstrated the likelihood that friend support plays a protective role with resilience amid an environment of academic stress. implications for social work faculty and internship agency practitioners are discussed. keywords: academic stress; resilience; social support; social work students a number of demands reportedly comprise academic stress: course requirements; time management issues; financial burdens; interactions with faculty; personal goals; social activities; adjustment to the campus environment; and lack of support networks (kariv & heiman, 2005; misra, 2000; von ah, ebert, ngamvitroj, park, & hang, 2004). specific to this latter demand is an implicit assumption that existence or upsurge of social support may moderate, to some degree, academic stress. social support is often deemed a buffer against the negative effects of stress, including stress in an academic context (steinhardt & dolbier, 2008). several studies have revealed the impactful relationship between social support and academic stress among a variety of academic disciplines and college student populations. heiman (2006) noted that academic perceptions are significantly attributable to external factors, including social networks, among university students with learning disabilities. negga, applewhite, and livingston (2007) showed that greater levels of social support were significantly related to lower levels of stress among african american students at historically black colleges and universities. macgeorge, samter, and gillihan (2005) observed a moderating effect of informational, supportive communicative behaviors from _________________ scott e. wilks, ph.d., is an assistant professor at the school of social work, louisiana state university, as well as a john a. hartford foundation faculty scholar in geriatric social work. copyright © 2008 advances in social work vol. 9 no. 2 (fall 2008), 106-125 advances in social work, fall 2008, 9(2) 107 family and friends on the relationship between academic stress and psychological health students in communication classes. macgeorge et al. explained that “the association between academic stress and depression decreased as informational support increased” (p. 369). cahir and morris (1991) stated that a principal component of stress among graduate psychology students is limited by emotional support from friends. a recent study by steinhardt and dolbier (2008) emphasized the interactional relationship between academic stress and social support among students with various majors at undergraduate, graduate, and doctoral levels. they noted that the stressful academic environment of the college student warrants research with outcomes that reflect the student’s ability to adapt to and/or overcome adversity. such is the case with the current study of social work students. the purpose of this study is to examine the potential, moderating role of social support in the relationship between academic stress and successful adaptation to stress, i.e., resilience. conceptually specific to this study, a moderator is a phenomenon that interacts with academic stress and ameliorates the relationship between stress and resilience (see baron & kenny, 1986). the literature review explicates the three primary constructs for this study, beginning with academic stress. literature review academic stress for many students, the pursuit of higher education is a time of transition marked by a set of demands germane to the setting. academic stress is the product of a combination of academic related demands that exceed the adaptive resources available to an individual. if a student is unable to cope effectively with academic stress, then serious psycho-socialemotional health consequences may result (arthur, 1998; macgeorge, samter, & gillikan, 2005; tennant, 2002). zaleski and colleagues (1998) found that as the number of stressful life events increased for college students, physical symptoms also increased. students who experience mental and physical health problems are then at greater risk for poor academic performance, thus increasing academic stress and perpetuating a cycle of stress, maladaptive coping, and compromised health (haines, norris, & kashy, 1996; ward struthers, perry, & menec, 2000). interrelational factors often coincide with academic stress. many of these are related to juggling multiple roles, including interpersonal relationships in the home and at work. these factors may dictate time management skills (misra, mckean, west, & russo, 2000) and consequently the decision of traditional, full time enrollment versus part time enrollment, also suggested as a source of stress among the general college student population (ting, morris, mcfeaters, & eustice, 2006). as ting et al. (2006) asserted, the strain of multiple roles is evident among social work students. like other care or helping professions, they must adapt not only to their role as students, but also to the obligations inherent to their chosen profession (dziegielewski, roest-martl, & turnage, 2004; kamya, 2000). social work students are vulnerable to high levels of psychological distress, and the education period may be more stressful than the actual social work career (pottage & huxley, 1996; tobin & carson, wilks/resilience amid academic stress 108 1994). in addition to the more common stressors faced by college students, social work students have the added burden of coping with the role expectations of professional placement experiences. sun (1999) found that students entering their first practicum placement had an array of concerns: role(s) in the placement agency; skill level in working with clients; personal responses to clients (e.g., stereotyping); and quality of supervision they receive. contextually related to resilience research, academic stress can be viewed as risk. risk implies an individual or environmental hazard that increases susceptibility of a negative outcome (masten, 2001). academic stress is a risk factor that may lead social work students to negative health outcomes, particularly psychological distress (steinhardt & dolbier, 2008). yet, few studies have examined the resources available to social work students as they attempt to temper this risk (rompf, royse, & dhooper, 1993; gelman, 2004). consequential to a recent review of scholarly literature, there appears a deficit of social work research that examines aforementioned resources with an explicit, resultant outcome of adaptational success. thus, a brief review of a construct of adaptational success, along with the functions of resources that temper risk and consequentially enhance such success, ensues. resilience, risk and protective factors resilience is a successful outcome of healthy adaptations during stressful life events (rutter, 1990). resilience is often viewed in the psychological context insomuch as it refers to cognitive capacity to avoid psychopathology despite difficulties (tugade, fredrickson, & barrett, 2004). it is a psychological phenomenon as it is a perception of inner strength that allows for the physical manifestation of that strength, i.e., the quick recovery from disruptions in functioning and return to previous level of functioning (carver, 1998; steinhardt & dolbier, 2008). individuals who are highly resilient exhibit adaptive coping skills and often convert stressors into opportunities for learning and development. in a sample of college students, campbell-sills and colleagues (2006) found that resilience was positively related to task-oriented coping, or employing active, problem-focused to address stressors (kariv & heiman, 2005). similarly, clifton and colleagues (2004) found that, of several demographic and environmental variables, problem-focused coping strategies as well as perceived control had the largest effects on academic achievement. ward struthers and colleagues (2000) also found that students who used problem-focused coping strategies performed better academically compared to students who used emotion-focused coping strategies. therefore, a student’s level of resilience and the manifestations of that resilience are related to effective adaptive resources to academic stress. these adaptive resources can be viewed as protective in the resilience research context. the protective factor is often viewed as the opposite pole of the risk factor (ortega, beauchemin, & kaniskan, 2008). rutter (1990) defined a resource, internal and external, as protective if it moderates risk, tempering the negative impact of risk on resilience. internal resources related to stress and coping include hardiness, self-esteem, and self-efficacy (kamya, 2000; kobasa, 1979; zaleski, levey-thors, & schiaffino, 1998). these concepts do not exist in a vacuum, and associations between protective advances in social work, fall 2008, 9(2) 109 factors are common. for example, kamya’s study found that greater levels of hardiness were associated with greater self-esteem among social work students. in turn, individuals with greater self-esteem are better able to cope with stress and achieve higher gpas (clifton, perry, stubbs, & roberts, 2004). the interrelatedness of these concepts further suggests the existence of an overarching internal strength such as resilience. in addition to internal protective resources, external or environmental factors may interact with academic stress as protective resources. research (e.g., werner & smith, 1992) has shown that social support can be a robust protective factor when individuals experience various forms of stress. the question relevant to the current study is whether social support functions as a protective factor within the process of the social work student’s academic stress–resilience relationship. discussed next are examples of the utilization of this external protective factor in the educational context relevant to the current study. social support the beneficial impact of social support has been associated with both physical and mental health outcomes. greater levels of social support are associated with lower levels of depression, fewer episodes of negative life events, more positive mood, and greater life satisfaction (aldwin, 1994; balk, 1995; demakis & mcadams, 1994; ford & procidano, 1990; losel & bliesener, 1990; sarason, shearin, pierce, & sarason, 1987). within higher education settings, a palpable social support for students is faculty. support from professors and student friends have been positively associated with self-esteem (clifton, et al., 2004). also, the lack of social support from professors had a negative effect on the academic performance of students (clifton, 1997). student perceptions of social support have also been positively associated with health-promoting behaviors such as exercise, good nutrition, and avoidance of substance abuse (hubbard, muhlenkamp, & brown, 1984; martinelli, 1999). conversely, research among college students suggests that withdrawing from social support relates to negative life satisfaction (mori, 2000). social support examined in this research is the perceived availability of resources provided by family and friends that assist the person in everyday activities (rayle, 2006). analogous to previous research with measures of social support (e.g., dolbier & steinhardt, 2000; procidano & heller, 1983), the current study does not limit the defined parameters of family member and friend; rather, it defers the concepts of a family member and friend to those strictly defined by the research participant. most, but not all, studies propose that social support is inevitably perceived as supportive. macgeorge et al. (2005) highlighted the beneficial impact of supportive behaviors from family and friends on the student’s psychological health. similarly, zaleski et al. (1998) noted that social support provided by friends was positively associated with adjustment to college life. yet, zaleski et al. noted that support from family appeared to worsen problems experienced by students. research in this area among social work students, albeit sparse, suggests the beneficial nature of social support in stress-related contexts. forte (1995) emphasized support of social work student classmates as positive on course anxiety. rosenblatt and wilks/resilience amid academic stress 110 mayer (1975) underscored the guidance of fellow students as important to the success of coping with field supervisory conflicts. the purpose of the present study was to obtain a better understanding of the protective role of social support amid the relationship of academic stress and resilience among social work students. to serve this purpose, a moderation model was adapted for the current study using the three integral elements of resilience research (masten, 2001; rutter, 1990): risk, resilience, and the protective factor. conceptual model the model for the present study (figure 1) fused glass and singer’s (1972) traditional understanding of moderation with wang, badley, and gignac’s (2006) illustrative models. glass and singer (1972) noted that the effect of a particular factor on an outcome can be based on the presence or level of a third variable, i.e., a moderator. wang et al.’s (2006) illustrated three similar moderator models using the primary factor, outcome, and potential moderator. these models are distinguished by whether significant relationships exist between the moderator and the other model variables. the model in the current study (figure 1) theorizes that the effect of risk on the resilience outcome depends on the presence or level of the moderator. the risk in the current study is academic stress (as). the moderators tested separately are two forms of social support: family support (fas) and friend support (frs). the outcome in the model is resilience. figure 1: input model: moderating function of social support on the relationship of academic stress and resilience of social work students a moderator (fas, frs) risk (as) abbreviation the dashed co observing modera descriptive purpos (path b), and aca interrelationa factors c s: as – academic stress; fas – family s nnectors represent three direct paths th tion (wang et al., 2006); nonetheless, es: academic stress→social support (pa demic stress→resilience (path c). the b l e resilience d upport; frs – friend support at are not statistically critical to these paths are worth noting for th a), social support→resilience solid connector represents the advances in social work, fall 2008, 9(2) 111 critical path in moderation analysis; the circled x represents the interaction of as and the moderator on the resilience outcome (path d). previously mentioned, interrelational factors have been exposed as potentially influential with as. accordingly, the inclusion of demographic factors relating to home, occupational, and educational interpersonal relationships – marital status, number of children, employment status, and academic status – was deemed relevant as controls in the interaction path (path e). two separate models were used to distinguish social support by its two factions, familial and friend support. moderation exhibited by family or friend support would offer preliminary evidence of social support as a protective factor of resilience among this student population. method research questions and design the following research questions guided this inquiry: • to what extent do social work students perceive academic stress? • what is their level of overall social support? • what is their level of support among family members? • what is their level of support among friends? • what is their perceived level of resilience? • do family support and friend support moderate the relationship between academic stress and perceived resilience? the study used a correlational analysis via self-report questionnaires distributed to bsw and msw students. operationally, within a correlational analysis framework, a moderator is a third variable that affects the zero-order (bivariate) correlation between two other variables. such moderation is observed via a significant interaction effect between a primary independent variable and the proposed moderating variable on a particular outcome (baron & kenny, 1986; wang et al., 2006). sampling the sampling frame consisted of social work students from three schools/programs of social work: one with an accredited bsw program, one with an accredited msw program, and one with both accredited programs (council on social work education, 2006). all are academic units within public universities located in the southern united states. surveys were distributed by participating instructors to students in bsw and msw classes at all levels within the programs. cover letters attached to each survey provided information necessary for informed consent, including the voluntary nature participation and no influence of grade based on participation. surveys completed by students with non-social work majors were collected but not analyzed, as they were few wilks/resilience amid academic stress 112 and represented data outside the study’s purview. three hundred fourteen students (bsw, n=144; msw, n=170) participated in the study. measures the survey instrument solicited demographic data on gender, ethnicity, age, and interrelational demographics – marital status, number of children, employment status (full time, part time, unemployed), enrollment status (full time, part time), and academic level (bsw, msw). the remaining empirical measures on the survey are discussed below. academic stress. the risk in the current study, academic stress, was measured aptly using kohn and frazer’s (1986) academic stress scale (ass). the 35-item ass measures the extent of academic worry across three subscales: physical, psychological, and psychosocial (ginsberg & gapen, 2008). examples of physical stressors include temperature, lighting, and noise in the classroom. psychological stressors are emotional consequence that results from events such as excessive homework, forgotten assignments, and studying for exams. psychosocial stressors are similar to psychological stressors with the inclusion of interpersonal interactions; psychosocial events include evaluating classmates’ work and preparedness to respond in class. item responses range on a 10-point likert format from 0-not stressful to 9-extremely stressful. item responses are summed then averaged. a higher mean indicates greater academic stress. prior research (burnett & fanshawe, 1996; kohn & frazer, 1986) found good-to-excellent internal reliability for the entire measure (α = 0.92) and on each subscale and factor (α = 0.73 – 0.84), suggested predictive validity. social support. two forms of social support serve as protective, moderating factors tested in the current study. family support and friend support were measured via maton et al.’s (1996) shortened, 20-item version of the perceived social support scale (psss20; procidano & heller, 1983). the psss20 measures perceived quantity and quality of social support with two, 10-item subscales for familial and friend support. responses range on a 5-point likert format from strongly agree to strongly disagree. total scores range 0 to 40 on each subscale; a higher score indicates greater perceived family or friend support. shute and spitzberg (2003) cited previously tested properties of the psss20, including a solid range of internal consistency coefficients (α = 0.79 – 0.94). wording on each subscale is similar except for the family and friends distinction. item examples include the following: “my family/friends give me the moral support i need”; “i rely on my family/friends for emotional support”; and “my family/friends are good at helping me solve problems.” resilience. the outcome of resilience in the current study requires an explicit measure of such. neill and dias (2001) revealed a 15-item resilience scale (rs15) that solicits data on positively stated self-descriptions relating to the psychological characteristic of resilience, i.e., the capacity for successful adaptation following exposure to stressful life events (werner, 1989, as cited in neill & dias, 2001). responses range on a 7-point likert format from strongly disagree to strongly agree. summed item responses are averaged. mean scores range from 1 to 7; a higher mean indicates greater overall perceived resilience. past research (neill & dias, 2001; skehill, 2001) reported a advances in social work, fall 2008, 9(2) 113 good-to-excellent range of internal reliability coefficients on the s-rs (α = 0.85 – 0.91). examples of item content relate to self-discipline, determination, and finding meaning in life. data analyses descriptive statistics and correlations were calculated for demographics and conceptual model variables: academic stress, family support, friend support, and resilience. hierarchical regression analysis was conducted to show the composite impact of the combined demographic factors, academic stress, and both forms of social support on the resilience outcome. using baron and kenny’s (1986) guidelines of moderation with continuous variables, resilience was regressed on academic stress, on social support, and on the interaction of academic stress and social support. after calculating an aforementioned interaction term, moderation was tested by observing any significant interaction effect on resilience while controlling for theoretically confounding, demographic factors relating to interrelational issues. path analyses illustrated main effects and moderation in the study’s conceptual model. results sample characteristics three hundred fourteen students constituted the sample size. females comprised the vast majority of the sample (89%, n=278). the average age was approximately 26 years, ranging from ages 19 to 53. the highest reported ethnicity was white (79%, n=239) followed by african american (16%, n=48). in terms of number of children, almost eight out of ten (n=242) reported having none. the plurality of the student sample reported an employment status of part time (44%, n=133), while only 19% (n=155) work full time. a great majority in the sample reported full time enrollment in their social work program (91%, n=280). the distribution between undergraduate and graduate students was fairly balanced, as msw students represented a slight majority (54%, n=169). table 1 reveals complete demographic statistics from the social work student sample. descriptives, correlations looking at the primary variables, the sample of social work students reported moderate levels of academic stress (as), family support (fas), and friend support (frs); and a moderately high degree of resilience (rs). correlational analysis confirmed significant bivariate relationships among all of the primary variables except between as and frs. table 2 presents correlations and descriptives among the primary variables. hierarchical regression analysis explained variation in resilience scores based on the composite impact of all factors, including demographics. upon initial inclusion of demographics, the ordering of primary factors was based on magnitude of main effect on the outcome. to avoid redundancy, overall social support was examined by its subcategories. table 3 presents results from the hierarchical regression analysis. wilks/resilience amid academic stress 114 table 1: sample demographic characteristics (n = 314) characteristics n (valid %) m (sd) median gender female male 278 (89%) 36 (11%) ethnicity african american asian caucasian other 48 (16%) 9 (3%) 239 (79%) 7 (2%) marital status single married divorced cohabitating 208 (67.8%) 66 (21.6%) 21 (6.7%) 12 (3.8%) number of children 0 1 2 3+ 242 (79%) 34 (11%) 20 (6.5%) 11 (3.5%) employment status full time part time unemployed 55 (19%) 133 (44%) 111 (37%) enrollment status full time student part time student 280 (91%) 28 (9%) academic level bsw msw 143 (46%) 169 (54%) age 25.2 (6.43) 23.0 advances in social work, fall 2008, 9(2) 115 table 2. correlations and descriptive statistics among the primary conceptual variables (n=314) variable 1 2 3 4 m sd 1. as -- 4.7 1.38 2. fas -0.21+ -- 30.8 8.07 3. frs -0.12 0.34+ -- 31.4 5.63 4. rs -0.38+ 0.30+ 0.29+ --5.8 1.01 +p < .01; abbreviations: as – academic stress; fas – family support; frs – friend support; rs – resilience table 3. results from hierarchical regression analysis predicting resilience scores ∆ r² f β step 1 demographics (non-interrelational) gender .076 ethnicity .023 age .168 r² .013 .101 step 2 demographics (interrelational) marital status .129 no. of children -.096 employment status .040 enrollment status .101 academic level .018 r² .040 .99 step 3 as .142 4.62+ step 4 fas .052 5.68+ step 5 frs .032 6.10+ r² total .266 +p < .01; abbreviations: as – academic stress; fas – family support; frs – friend support wilks/resilience amid academic stress 116 following baron and kenny’s (1986) moderation suggestions, a three-equation series regressed rs on: (a) the iv of interest, as; (b) the tested moderator; and (c) their interaction. table 4 shows results of this series, conducted twice to test separate moderators: family support (series 1) and friend support (series 2). table 4. results from baron & kenny’s regression series for moderation regression equation series 1: fas as moderator series 2: frs as moderator a) rs regressed on as r² = 0.15, f = 35.30+, β= -0.382 r² = 0.15, f = 35.30+, β= -0.382 b) rs regressed on moderator r² = 0.09, f = 19.89+, β= 0.296 r² = 0.09, f = 19.15+, β= 0.291 c) rs regressed on interaction (moderation path) r² = 0.01, f = 1.23, β= -0.077 r² = 0.03, f = 4.71*, β= -0.149 *p < .05, +p < .01 abbreviations: as – academic stress; fas – family support; frs – friend support; rs – resilience figures 2 and 3 show similar path models of moderation with distinct moderators: family support (fig. 2), and friend support (fig. 3). the direct path of as on the resilience outcome in both models was negative and moderately strong (-.382, p < .01, r2=.15). figure 2. output: family support moderation model (as) -.208+ (r2=.04) fas -.077 (r2=.01) interrelational factors -.089 (r2=.01) .296+ (r2=.09) resilience -.382+ (r2=.15) +p < .01 abbreviations: as – academic stress; fas – family support; frs – friend support figure 2 illustrates the path coefficients in the family support moderation model. the moderation effect (interaction) of as x fas on the outcome was non-significant initially advances in social work, fall 2008, 9(2) 117 (-.077, p=.268, r2=.01). upon controlling for interrelational factors, the moderation effect remained non-significant and its inverse effect to resilience slightly increased (-.089, p=.214, r2=.01). figure 3. output: friend support moderation model (as) frs interrelational factors -.149* (r2=.02) -.382+ (r2=.15) -.121 (r2=.02) .291+ (r2=.08) -.136 (r2=.02) resilience *p < .05, +p < .01 abbreviations: as – academic stress; fas – family support; frs – friend support figure 3 shows the path coefficients in the friend support moderation model. the moderation effect of as x frs on the outcome was significant initially (-.149, p < .05, r2=.02). upon controlling for interrelational factors, the moderation effect loses significance though its negative effect to resilience reduces slightly (-.136, p = .06, r2=.02). discussion consistent with recent research (ting et al., 2006), the current sample of social work students reported a moderate level of academic stress. given this extent of stress, students reported a fairly high degree of resilience. this phenomenon of adaptational success amid substantial risk (stress) has been elucidated in past research (e.g., werner & smith, 1992), at least in part, on the basis of protective resources that bolster adaptive functioning. the current study examined the protective nature of two resources: the magnitude of available family and friend support and their potential, moderating functions bounded concurrently by academic stress and resilience. students reported a fair amount of social support for both support systems – familial and friend. the primary variables significantly related to each other in expected directions. as highlighted in previous resilience research (ortega et al., 2008; rutter, 1990; werner & smith, 1992), risk should exhibit a negative effect with resilience, while the protective factor often exhibits enhancing effect with resilience. such was the case with the current results. the risk in the study, academic stress, inversely related with resilience, and both forms of social support positively related with resilience. all of these associations were moderately strong and empirically significant. wilks/resilience amid academic stress 118 two, distinct moderation models were examined with family support and friend support as potential moderators. moderation would indicate preliminary evidence of these support systems as protective factors of resilience. results indicated that family support did not significantly moderate the negative relationship between academic stress and resilience. this lack of significance is noteworthy. the amounts of family and friend support reported among the sample were reportedly comparable; yet the utility of these support systems were divergent (see later discussion on friend support). hence, quantity of social support does not equal similar functioning. previous research (zaleski et al., 1998) found a similar result with family support. they speculated that the youthful age (18.3 years) of their student sample and lack of emotional independence during the early transition to college contributed to family support’s lack of moderating efficacy. the current study’s sample revealed a larger mean age (26 years) and college longevity (54% graduate students), calling to question the aforementioned justifications posited by zaleski and her colleagues. psychological developmental theories may offer reasoning for lack of moderating, protective functioning of family support. traditional college-age students want to leave the family home, physically and psychologically. developmental stage theories like erikson’s (1968) and loevinger’s (1994) assert that during the typical college years, the individual enters a life phase of finding oneself, detaching from family identity and forming friendships independent of family conformity. further speculation on the statistical shortcoming of family support can be expansive and deficit-focused. instead, the discussion shifts to the factor that exhibited moderation. friend support significantly moderated the relationship between academic stress and resilience. the negative effect of academic stress with resilience was tempered upon the interaction of friend support with stress. this result corresponds to previous theoretical and empirical research that remark on the positive value of friend support as a coping resource (forte, 1995; zaleski et al., 1998) and resource that is deemed protective of resilience (tusaie, puskar, & sereika, 2007). the result of friend support moderation is notable, but it should be noted vigilantly. the student’s relationships at home (marital status, children), at work (employment status), and at school (enrollment status, academic level) exerted extraneous influence on the moderation effect; when the influence was controlled, the significance of that effect waned. this is an interesting finding. friend support is evidently more apt to moderate the stress of academia on the student’s perceived ability to overcome stress during real life settings, i.e., when relational factor(s) are present, rather than controlled, statistical settings. it is logical to speculate that the student may not recognize academic stress as an independent stressor, or even a stressor at all, when other relational stressors are perceived at the forefront. milner and criss (2006) noted that many social work students bear an overarching sense of stress simply by being a social work major. it may be difficult for social work students (or any population, for that matter) to categorize stress into autonomous segments, and for the social work student, the stress of academia may be one segment in a larger, more ambiguous fusion of overall life stress. these findings bear implications on social work faculty and field agency practitioners. it should be no surprise to faculty that the current study revealed a substantial amount of students’ academic stress. ting et al. (2006) noted that students in advances in social work, fall 2008, 9(2) 119 helping professions such as social work may experience higher stress than their cohorts in other disciplines because of the “additional responsibility of helping others” (p. 40). social work students regularly discuss their academic stress, e.g., workload, upcoming deadlines and overall stress levels, among their classmates and faculty in the classroom setting (milner & criss, 2006). yet, social work faculty, though sympathetic and interested in enhancing student coping, are reluctant to modify the academic environment (reeser, macdonald, & wertkin, 1992). given the tight windows of time that faculty face in disseminating course content and the student-teacher boundaries that must remain intact, there are still ways that social work faculty may dissipate this stress. milner and criss (2006) offered faculty a number of simple yet effective stress-relieving suggestions for their students in class, including the following: • allow students an occasional venting process, i.e., brief, general discussions about stress associated with the academic lifestyle; • encourage students to identify and empathize with each others’ feelings; and • create a regular ritual to begin classes, e.g., moment of silence to allow for the student’s personal prayer or reflection. all of the aforementioned suggestions point to the faculty member’s commitment to appropriate student expression in the classroom, whereby the student may “find validation for the stress and difficulties they share” (milner & criss, 2006, p. 18). this commitment to encourage student expression is supported by the council on social work education’s (2008) educational policy on the student’s active participation toward professional development. despite the stress, social work students characterized themselves with a strong level of resilience. it is unlikely that their perceived abilities to overcome stress exist by chance. the current study demonstrates the likelihood that social support, namely that from friends, plays a role in this resilience perception. social work faculty can enhance friendship support by fostering connectedness in the classroom (milner & criss, 2006). this can be accomplished by a number of methods, including class seating arrangement; group project assignments; and encouraging study groups as a pre-assignment, social learning tool and as a post-assignment, stress debriefing tool. these findings also emphasize the need for field agency practitioners to inform practicum students on protective resources, including social support systems, which may create awareness to the rigors of practice stress beyond the logistics of particular agency duties. as maidment (2003) poignantly stated, students need “access to preparation and placement integration material that (is) less about what they might do on placement and more about the processes of learning and managing stress while working in a contemporary agency environment” (p. 57). limitations and future research common to survey research with students, data was collected in class by the instructor. this setting enhances sample size, but also runs the usual risks of (a) wilks/resilience amid academic stress 120 inadvertently creating a sense of academic bias toward some students for participation, and (b) receiving skewed data based on survey completion in a group setting. the survey cover letter assured the contrary to the aforementioned bias, yet the efficacy of this safeguard remains indefinite. future studies with social work students with data collection sites outside of the classroom setting may minimize a hawthorne effect (merrett, 2006) and yield possibly truer results. results on the rs15 displayed limited distribution of resilience responses. while the reported high level of rs15 scores is informative in terms of a descriptive appreciation of the sample’s elevated self-perception of successful adjustment, it may be difficult to generalize results from the moderation model given this limited variation in outcome scores. perhaps a larger sample of social work students would lend disparity in resilience scores and increase generalizability. the effect sizes (r2) in the moderation models were low in this study. though moderation was deemed statistically significant in the friend support model, the nominal effect size suggests extraneous influence of moderation by other factors uncontrolled in the current study. the present study’s sample revealed limited diversity in terms of gender, ethnicity, and enrollment status. as such, observing no significant demographic differences in outcome scores is a restricted observation. future studies with increased heterogeneity in sample characteristics would allow for increased understanding of social work student resilience with demographic breadth. conclusion the author of this study has attempted to provide insight into the resilience of social work students amid a common source of stress and potentially protective, social resources. results demonstrated that the support of friends moderates the negative relationship between academic stress and resilience. the author hopes that recognition of moderating resources such as friend support may help social work educators and professionals design and target more effective interventions to improve academic and health outcomes for their students. references aldwin, c. m. 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(1992). overcoming the odds: high risk children from birth to adulthood. ithaca, ny: cornell university press. http://wilderdom.com/pdf/skehill2001resiliencecopingoutdooreducation.pdf advances in social work, fall 2008, 9(2) 125 zaleski, e. h., levey-thors, c., & schiaffino, k. m. (1998). coping mechanisms, stress, social support, and health problems in college students. applied developmental science, 2(3), 127-137. author’s note: address correspondence to: scott e. wilks, ph.d., school of social work, louisiana state university, 203 h.p. long fieldhouse, baton rouge, la 70803. e-mail: swilks@lsu.edu mailto:swilks@lsu.edu advances vol. 4, no. 1 34 advances in socialwork translating concept into act for multi-cultural practice: comparison of students’ and field instructors’ perceptions of diversity training effectiveness theresa j. early m. elizabeth vonk mary ellen kondrat abstract: education for culturally competent practice increasingly is a responsibility for social work educators. using data collected for an evaluation of the field education component of a large, midwestern social work program, the purpose of this study is to shed light on students’ application in the field practicum setting of classroom training in culturally competent practice. responses were obtained from field instructors (n=76) and students (n=70). students reported learning in areas dealing with diversity at statistically significant levels; however, instructor ratings of student competence were significantly lower than student ratings. results are discussed in light of necessary attitudes, knowledge, and skills. implications for program monitoring and improvement, education, and further research are discussed. keywords: cultural competence,practicum,education the ability to practice social work effectively with diverse populations, commonly referred to as cultural competence (lum, 1999), has become increasingly important as demographic trends have resulted inmore heterogeneity among social work clientele. in response, social work educators have sought effective ways to develop or enhance students’ awareness, knowledge, and skills in preparation for practice with diverse populations. this response to the mandate to educate for cultural competence is well documented in social work literature. several authors have described conceptual models designed to guide learning. for example,mcphatter (1997) describes a conceptual model for cultural competence in the field of child welfare. she emphasizes that cultural competence grows through a developmental process that involves cognitive, affective, and behavioral change. thus, the model includes knowledge, awareness, and skill development. sowers-hoag and sandau-beckler’s (1996) comprehensive model for cultural competence education in the generalist curriculum also includes knowledge, awareness, and skill components. the latter theresa j. early is associate professor at thecollege of socialwork attheohio stateuniversity, columbus, oh 43210.m. elizabethvonk ph.d. is associate professor at university of georgia, athens, ga 30602.mary ellen kondrat ph.d. is professor and dean at louisiana state university, baton rouge, la 70803. copyright© 2003 advances in socialworkvol. 4 no. 1 (spring 2003) 34-45. indiana university school of socialwork. 35 authors suggest objectives related to cultural competence and several learning activities related to each curriculum area, including field. other more specific, classroom-based educational strategies abound, many of which are experiential in nature, in order to foster both cognitive and affective learning. although strategies vary,many are designed to increase students’ awareness and knowledge of self and others in terms of racial, ethnic, or cultural identity. for instance, aponte (1995) requires students to write about their experiences with an unfamiliar cultural group. chau (1990) details a technique termed“ethnic self-profiling,” which involves a process of identifying feelings associated with various words that refer to racial or other forms of human diversity. following a semester of activities, torres and jones (1997) ask students to write an “integrative cultural paper” in which theymust address their own and others’ cultural identity, dynamics of aversive incidents, and thoughts about their potential for culturally competent practice.the discussion of vignettes containing examples of bias provides students with the opportunity to increase their ability to think critically about the function of bias (latting, 1990). the utilization of “cultural guides” (ronnau, 1994), “intergroup dialogues” (nagda et al., 1999), web-based discussion groups (van soest, canon & grant, 2000), and “critical incident interviews” (montalvo, 1999) allow students of diverse group memberships the opportunity to interact in order to gain awareness and knowledge of one another. finally, boyle, nackerud and kilpatrick (2000) describe a non-classroom-based international immersion experience. articles that describe educational strategies, such as those mentioned above, have made several important contributions to diversity education, including providing social work educatorswith a source of teaching strategies that can be adapted for use in numerous diversity related courses. furthermore, this body of literature illustrates approaches for combining didactic and experiential teaching methodologies, strategies considered important in reaching the range of adult learners enrolled in social work programs (knowles, 1990). in addition, the strategies described target change among various combinations of the dimensions of awareness, knowledge, and skills. several strategies (latting, 1990;montalvo, 1999; nagda et al., 1999;van soest et al., 2000) also include a focus on social justice issues and diversity practice. although many authors have strongly supported the need to evaluate the effectiveness of educational strategies for cultural competence, relatively few have reported outcomes. of these, most examine specific educational interventions. table 1 briefly describes interventions, objectives, measurement, and results for eight studies that report outcomes of educational interventions designed to increase competence for practice with diverse populations. although the interventions vary somewhat by conceptual foundation and strategy,most of the objectives are similar in their aim to increase students’ levels of awareness, knowledge, or skills. a few of the authors, however, were also interested in objectives related to the methodology, for example, the creation of a safe, facilitative environment (ronnau, 1994;van soest et al., 2000) or students’ reaction to the intervention itself (montalvo, 1999). early et al./translating concept into act formulti-cultural practice 36 advances in socialwork author, intervention objectives measurement results year chau, 1990 classroom 1. awareness re: students’ perceptions positive model and ethnocentric views of learning based on change strategies and importance of written comments noted for based on pluralistic attitude; post intervention. obj. 1,2,3 concepts of 2. knowledge re: a cultural minority group as ethnocentrism related to practice and pluralism. concerns. 3. skills: modifications of basic interviewing skills for diversity. latting, classroom 1. awareness: re students’ positive 1990 strategy based personal biases; perceptions of change development 2. critical thinking learning based on noted for of critical re: personal and qualitative analysis obj. 1,2 thinking. others’ biases. of written and verbal comments gathered during and post intervention. ronnau, practical 1. awareness of students’ perceptions positive 1994 classroom importance of cc; of learning based on change strategies 2. creation of safe/ written comments observed adaptable for facilitative classroom and likert-style for obj. students’ environment. survey questions 1,2,3 needs. 3. knowledge re: (n=42) post personal and intervention. others’ cultures. torres & classroom 1. self-awareness students’ perceptions positive jones, model and re: identity and of learning based on change 1997 strategies views of others; written comments, noted for based on 2. knowledge re: departmental obj. 1,2,3 cognitive and 3. ethnic groups; evaluations, and affective 4. awareness re: informal feedback integrative consequences of post intervention. framework. stereotypes; 5. skills re: assessment w/people of diverse groups. montalvo, classroom 1. empathy students’ perceptions positive 1999 strategy based development; of learning and of change on racial 2. decreased teaching methodology noted identity engagement in based on open-ended for obj. development stereotyping; survey (n=68) post 1,2,3,4,5 theory. 3. application of intervention. classroom knowledge to “real-life”; table 1: evaluations of socialwork education for practice with diverse populations 37early et al./translating concept into act formulti-cultural practice author, intervention objectives measurement results year 4. increased comfort interviewing; 5. increased confidence in assessment of client’s racial identity. nagda classroom 1. awareness re: students’ perceptions positive et al. strategy self and others in of learning and of change 1999 designed for terms of group teaching methodology noted for learning memberships and based on survey obj. 1,2,3, related to status; (n=50), qualitative 4. positive diversity 2. awareness re: analysis of focus response oppression, dynamics of groups and in-depth to and social difference and interviews (n=10) by most. justice. dominance; post intervention. 3. skills re: analysis from multiple perspectives; 4. skills re: working w/cultural differences. van soest classroom 1. create safe students’ perceptions positive et al., 2000 model and environment in of teaching methodresponse to strategies which to express ology based on method designed to feelings and thoughts, analysis of web-usage related to combine and to engage in and survey (n=65) obj. 1,2,3 diversity and productive conflict post intervention. social justice; re: issues related to utilizes diversity and social computer justice; technology. 2. provide forum for continued discussion following classroom interaction. 3. provide instructors with access to students’ awareness and questions. boyle immersion 1. cultural students’ perceptions positive et al. experience competence of cc and overall change for 2001 in mexico, (knowledge/skills, experience based on obj. 1,2,3 and awareness); standardized measure 2. language skills; of cc (n=6) pre-post; 3. collaborative and qualitative project analysis of journals. development. 38 the eight studies share other characteristics as well. all of the studies measured outcomes by obtaining students’ perceptions of learning immediately after the interventions were completed. a few authors measured outcomes solely by students’ verbal or written comments (chau, 1990; torres & jones, 1997). others increased the methodological rigor somewhat by including likert-scale or openended survey questions (ronnau, 1994;montalvo, 1999; andvan soest et al., 2000) or formal qualitative analysis (latting, 1990; nagda et al., 1999; boyle et al., 2001). pre-post testing with a standardized measure of cultural competence was utilized in only one study (boyle et al., 2001). finally, all eight studies reported positive outcomes for every objective with the exception of one, which was related to skill building (torres & jones, 1997). in summary, existing evaluations of the effectiveness of educating social work students for cultural competence have focused on immediate outcomes of specific classroom interventions and relied on students’ perceptions of learning for outcome measurement. without exception, the various educational strategies have produced positive outcomes.we know very little, however, about how students are applying what they know about cultural competence to their practice. we have located only one study that reported on the application of cultural competence education to practice. rittner, nakanishi, nackerud & hammons (1999) surveyed agency-based social workers with at least two years post-msw experience in order to examine the effect of cultural competence content in msw curricula on social work practicewith small groups. a largemajority of those surveyed indicated that diversity content was part of their msw education, most frequently recalling attention given to areas of age, culture, gender, national origin, and race. despite the reported breadth of exposure, however, respondents indicated difficulties with applying diversity content to their small group practice. many respondents acknowledged that they frequently failed to address group member differences through their interventions. in addition, the repertoire of interventions was extremely limited among those who reported addressing diversity. the authors concluded that their results suggest msw diversity content is applied in very limited ways among social workers practicing with small groups. if cultural competence involves a developmental process, the knowledge and awareness developed in classroom learning should result in a display of skills in the field practicumand in later practice.the literature has documented classroom strategies to develop knowledge and awareness and continued recall of cognitive content several years into practice; however, the literature also reports limited application of this content in post-msw practice. notably missing from the literature is information about one of the steps in the developmental process: application, integration, and amplification of cultural competence learning in the field practicum. a national survey of social work faculty documented this gap (le-doux &montalvo, 1999). respondents indicated that they observed minimal to no linkage of classroom instruction for cultural competencewith students’ fieldwork.the authors point out that this is particularly troublesome since the field practicum represents the primary opportunity for students to integrate theory and practice. it is in the field that students are expected to apply the awareness, knowledge, and skills learned in the classroom to actual practice with diverse populations. advances in socialwork 39 the other major omission in the literature is an evaluation of cultural competence learning from perspectives beyond the student per se. field instructors, in particular, are in a unique position to observe the application of classroom learning and, through supervision, to promote further growth. their perspectives could be expected to provide an invaluable addition to faculty members’ observations and students’ self-reporting. using data collected for an evaluation of the field education component of a large (approximately 600 students) midwestern social work program, the purpose of this study is to shed light on students’ application in the field practicum setting of classroom training in culturally competent practice. responses were obtained from students and field instructors. thus, this study adds to the literature in three ways: (a) by looking at cultural competence in the field practicum, (b) by eliciting field instructors’ perspectives on student cultural competence, and (c) by allowing for a comparison of students’ and field instructors’ perspectives. the data were collected during the 1999-2000 academic year. although each level of field practicum (baccalaureate, foundation, concentration) includes objectives related to diversity, this study focuses specifically on the msw foundation practicum. context themsw programwhich serves as a base for this study uses a model for diversity education in which this content is offered in specific courses. students choose between focusing on race/ethnicity or women’s issues, although both courses include content related to within-group diversity and a range of other diversity issues. both courses use a variety of didactic and experiential techniques. in addition, as appropriate to the course, diversity content appears in most of the courses in the curriculum. faculty are required to document inmaterials for their annual performance evaluations that content on women, ethnic minorities, and gays/lesbians is appropriately included in their courses. such content is included widely across the curriculum, as documented in a recent review of course syllabi conducted as a part of the self-study for reaffirmation of the council on social work education (cswe) accreditation (kondrat et al., 2002). students begin themsw foundation practicumduring the second quarter of the first year after completing one course in each of the foundation areas: human behavior, generalist practice, policy, and research. at the time the program evaluation was conducted, students are typically enrolled in the diversity course during the third quarter, when theywould have been completing the final quarter of foundation field. the study was conducted at a time when the respondent cohort of students had completed the first year of the program and were beginning the second concentration year classes and practicum. in contrast to previous studies, then, this study attempts to evaluate the effectiveness of diversity training which occurs in a number of different ways throughout a major portion of the curriculum rather than the effects of specific activities confined to a single course. methods for the field program evaluation, mail surveys were designed to collect data from students and field instructors. for this study, respondents were students in the early et al./translating concept into act formulti-cultural practice concentration year, along with concentration field instructors. the student survey asked students to rate their achievement of foundation learning objectives, stated as foundation level competencies, using a retrospective pre-test post-test design. the field instructor survey asked instructors to rate the level of competency of their incoming concentration students on the same foundation level competencies in a post-test only design. ratings were obtained late in the first quarter of concentration field instruction. figure 1 details the data collection timeline. the format of the student survey included pairs of “when i began my msw ii field placement” (post-test) and “beforemymsw i placement” (retrospective pretest) items on which students rated their skills on a five-point likert scale from 1 = totally disagree to 5 = fully agree. the retrospective pre-test is a way to obtain preand post-intervention ratings in a single data collection, which was necessary for the evaluation timeline. furthermore, retrospective pre-tests represent a way to enhance validity by guarding against response-shift bias that may occur in a pretest, post-test design where the perception of the dependent variable is initially abstract. for instance, in a traditional pre-test, the student might be asked to rate her or himself on“being aware of and able to observe appropriate boundarieswith clients in regard to self-disclosure and dual relationships.” having never experienced boundary dilemmas, the students’ rating of such behaviormay be based on the abstract perception of the expected or desired behavior. over the course of the field practicum, if the student actually encountered boundary issues or struggles with self-disclosure or dual relationships, he or she then hadmore concrete experience on which to rate actual awareness/behavior. the change in consciousness may result in a lower rating at post-test, not because the student got “worse” in this skill, but because the student did not have an adequate basis onwhich tomake the pre-test rating. conversely, a student rating of improvement also could have been unrelated to actual improvement in the skill but, instead, it may have related to having more information about the issues. 40 advances in socialwork fall 1998 winter 1999 spring 1999 (students begin program) msw foundation practicum msw foundation begins practicum continues; diversity courses taken fall 1999 msw ii concentration practicum begins; data collection frommsw ii students and msw ii field instructors re: foundation practicum experience/incoming student preparation figure 1: explanation of data collection timeline the format of the field instructor questionnaire asked the respondent to evaluate her/his student’s professional preparedness and skill level as the student began the concentration placement. the itemsmirrored the content of the student questionnaire. respondents were directed to answer the questions in relation to their current student or, if providing concentration field instruction to more than one student, to responding in regard to the student whose name occurs first alphabetically. because instructors were asked to rate incoming students who had just completed their foundation practicum, instructor-respondents were not placed in the (potentially biasing) position of having to rate the effectiveness of their ownwork with the student. there was no effort made to match student and instructor responses. the surveys were mailed to students’ home addresses and field instructors’ agency addresses. completed responses were returned bymail or hand-carried to a collection location in the msw program office. identification numbers on the surveys allowed an administrative staff member to follow-up with reminders and additional mailings to non-respondents. data were entered into spss by a doctoral student and analyzed by one of the authors who served on the field practicum evaluation committee. responses were obtained from 76 field instructors (68% response rate) and 70 students (40% response rate; an additional 16 student responses were unusable because a secondmailing contained thewrong instrument). reflective of themsw student population, the majority of students were enrolled in the clinical concentration (81%) and as full-time students (76%).the average number of years of prior work experience in the human services field for respondents was four, although 35% reported no prior human services work experience. experience ranged from none to 29 years. field instructors reported having provided concentration field instruction for six years on average, although 33% reported two years or less. overall, experience ranged frombeing a first time concentration field instructor to providing this level of field instruction for 27 years. field instructors rated the degree to which their agency was able to provide students with experience dealing with clients or systems that represent a range of diversity with special reference to ethnicity, gender, culture, and sexual orientation. on average, the rating of this itemwas 4.6 on a scale from 1 = totally disagree to 5 = fully agree. some 70% of respondents fully agreed that the agency was able to provide these experiences and 26% agreed to some extent, indicating that there would have been opportunities to observe the students’ skills in culturally competent practice. the analysis reported here focuses on two items directly related to diversity and preparation for culturally competent practice. figure 2 details the items. results to determine whether students’ skills increased during the foundation practicum, we compared the retrospective pre-test and post-test ratings using paired sample t-tests. t-tests for both items were significant (both items p<.0001) (see table 2). to determine whether students and instructors perceived similar levels of competence, we compared student post-test and instructor average ratings, using 41early et al./translating concept into act formulti-cultural practice independent samples t-tests. using the bonferoni procedure to take into account multiple comparisons, the p-value for significance is .05 divided by 2, the number of comparisons, or .025. the t-tests for both items indicate that instructors rate student abilities significantly lower than students (p=.021 and p=.005, respectively) (see table 3). 42 advances in socialwork field instructor survey at the time the student began his or her current placement at my agency... the student demonstrated awareness of and sensitivity to ethnic, minority status, and cultural issues in assessment and goal-setting for clients and client systems. the student demonstrated awareness of the impact of gender, ethnic, minority, and cultural issues on her/his own interactions with clients and others. msw concentration student survey when i began my msw ii field placement... i was aware of and sensitive to ethnic, minority, and cultural issues in assessment and goal-setting for clients and client systems. i was aware of the impact of gender, ethnic, minority, and cultural issues on my own interactions with clients and others with whom i interact. figure 2: survey items item pre-test post-test t-value df sig. mean mean aware of cultural issues 3.99 4.43 5.386 66 .000 in assessment and goalsetting aware of impact of 3.99 4.45 4.750 66 .000 cultural issues on own interactions table 2: comparison of retrospective pre-test and post-test means item student instructor t-value df sig. mean mean aware of cultural issues 4.43 4.12 -2.333 142 .021 in assessment and goalsetting aware of impact of 4.45 4.09 -2.833 141 .005 cultural issues on own interactions table 3: comparison of student and instructor means 43 discussion and implications for socialwork education this study is a first attempt at determining msw student cultural competence in the field practicum. the study also goes beyond earlier evaluations in obtaining data frommultiple respondents, although it should be noted that responses from students and field instructors may not match (i.e., concern the same student). consistent with previous studies of classroom education for cultural competence, students in this study report acquiring a significant level of knowledge and skills during the time of the first msw field practicum. in this sense, the foundation field practicum objectives are being met. however, concentration field instructors, on average, reported their incoming students as having less developed cultural competence than the students reported. this apparent difference warrants further investigation. possible explanations for the difference noted here include instructors and students using different criteria for judging cultural competence, based on individual differences, experience, and/or point of reference. although demographic data on race/ethnicity of students and instructors were not collected in the study from which the present data were drawn, the proportion of minority groupmembers is higher among field instructors than among students. furthermore, field instructors who have greater experience may have a different understanding of cultural competence. ideally, this would be a better understanding, although the possibility exists that instructors with many years of practice might actually have a less sophisticated understanding, depending on how thoroughly they have accessed and utilized emerging new perspectives on cultural competence. finally, students may actually have skills that instructors were not able to observe. field agencies are under increasing pressure to maintain productivity, which may translate into less contact between instructors and students (reisch & jarman-rohde, in press). another possible explanation for the difference may lie in the way the questions were asked. students were asked about their awareness and in knowing how to take into account cultural issues, while instructors were asked about students’ ability to demonstrate their awareness and knowledge of how to take into account cultural issues. perhaps we have failed tomeasure skills from the student perspective. if that is the case, then the appropriate interpretation of this differencemight be that although students are aware of the issues, they are less able to act on that awareness than they think they are. the students’ perspectives, compared to that of the field instructors’, may not represent disagreement about skill level, but rather, itmay reflect the cultural competence developmental process. students must have a great deal of awareness of cultural issues in assessment, intervention, and overall interactions with clients and others before they can put this knowledge into practice. as mcphatter (1997) put it, “enlightened consciousness and a grounded knowledge base are the bricks and cement that build cumulative skill proficiency.” (p. 271, emphasis in original) students reported that they have the necessary level of awareness. instructors, on the other hand, reported a lower level of demonstrating use of this awareness and knowledge. early et al./translating concept into act formulti-cultural practice 44 this study used data collected for another purpose, which presents both positive and negative issues. on the negative side are problems common to secondary analysis of other types of data, including the lack of control over what is asked and howquestions are phrased. the existence of these data, however, is a positive step, as they evidence attempts being made to evaluate the effectiveness of social work education in producing cultural competence outcomes in graduates. one implication for social work education is that data such as these should be collected and evaluated on a regular basis and gathered frommultiple perspectives. although it was not practical in the program evaluationwhich provided the data for this study, attempts should also be made to obtain matching responses from students and field instructors. finally, for programmonitoring, data collection on the effectiveness of education for cultural competence should be an integral part of social work education and practice. for example, as a result of the program evaluation reported here, routine data collection instruments (in the form of student exit surveys, alumni surveys, and telephone surveys of employers of our graduates) were expanded to include items rating cultural and diversity competence. in addition, although items related to accomplishing culture and diversity learning objectives have been a regular part of the instrument used by practicum instructors to report evaluation of student learning in field instruction, items were revised to replace the original yes/no format with a likert scale on each item so that changes over time may be tracked for quality improvement. some important issues still need to be addressed in the ongoing research and evaluation of cultural competence outcomes. beyond the issue of whose perspective is more accurate or what the various perspectives actually represent are the issues of how tomeasure skills andwhich skills are important tomeasure. if a practitioner were culturally competent, what would we see them do? the literature here is a bit vague and abstract. is cultural competence amatter of attitude, awareness, understanding, experience, skill, or knowledge? probably all of the above.yet, the literature is not entirely consistent in the way that it deals with the cognitive/affective status of cultural competence. this study suggests the importance of distinguishing more clearly between attitudinal, conceptual, and skill components of practice for cultural competence and when measuring the effectiveness of our educational efforts. it also suggests the importance of focusing more attention on the practicum experience, where affect, attitude, experience, concept, and skill become integrated. does education for cultural competence occur at the interpersonal level, the level of the agency, the community, social policy? most authors define culturally competent practice largely in terms of interpersonal or direct practice with individuals, families, and groups. some, however, like mcphatter (1997) and sowers-hoag and sandau-beckler (1996), suggest that culturally competent practice includes skills to intervene at every level necessary, identifying and removing barriers at the organizational, community, social, economic, and political levels and “correctly identifying and confronting issues of racism and discrimination.” (mcphatter, 1997, p. 273). as helpful as the literature has been to enhancing our understanding of what it takes to educate culturally astute and diversity competent practitioners, clearly,muchmore needs to be done empirically, conceptually, and educationally to define (and develop professional consensus around) the concrete educational objectives and tasks that together advances in socialwork 45 operationalize the overarching goal of cultural competence. the ultimate aim, of course, is to provide students of the profession with the most effective learning experiences possible to meet this important educational/practice goal. references aponte, c.i. (1995). cultural diversity course model: cultural competence for content and process. arete, 20, 46-55. boyle, d.p., nackerud, l., & kilpatrick, a. (2001). the road less traveled: cross-cultural, international experiential learning. international socialwork, 42(2), 201-214. chau, k.l. (1990). a model for teaching cross-cultural practice in social work. journal of social work education, 26, 124-133. knowles, m.s. (1990). the adult learner: a neglected species. houston: gulf publishing co. kondrat,m.e., early, t., greene. g.j., bronson, d., alexander, r., & stevens, n.m. (2002, unpublished), selfstudy document, (the ohio state university college of socialwork). latting, j.k. (1990). identifying the “isms:” enabling social work students to confront their biases. journal of socialwork education, 26, 36-44. le-doux, c., & montalvo, f.f. (1999). multicultural content in social work graduate programs: a national survey. journal of multicultural socialwork, 7(1/2), 37-55. lum, d. (1999). culturally competent practice: a framework for growth and action. pacific grove, ca: brooks/cole. mcphatter, a. (1997). cultural competence in child welfare: what is it? how do we achieve it? what happens without it? childwelfare, 76, 255-278. montalvo, f.f. (1999). the critical incident interview and ethnoracial identity. journal of multicultural socialwork, 7(3/4), 19-43. nagda, b.a., spearmon,m.l., holley, l.c., harding, s., balassone,m.l., moise-swanson, d., & demello, s. (1999). intergroup dialogues: an innovative approach to teaching about diversity and justice in social work programs. journal of socialwork education, 35, 433-449. reisch, m., & jarman-rohde, l. (in press). the future of social work in the united states: implications for field education. journal of socialwork education. rittner, b., nakanishi, m., nackerud, l., & hammons, k. (1999). how msw graduates apply what they learned about diversity to their work with small groups. journal of socialwork education, 35, 421-431. ronnau, j.p. (1994). teaching cultural competence: practical ideas for social work educators. journal of multicultural socialwork, 3(1), 29-42. sowers-hoag, k.m., & sandau-beckler, p. (1996). educating for cultural competence in the generalist curriculum. journal of multicultural socialwork, 4(3), 37-56. torres, j.b., & jones, j.m. (1997).you’ve got to be taught:multicultural education for social workers. journal of teaching in socialwork, 15(1/2), 161-179. van soest, d., canon, r., & grant, d. (2000). using an interactive website to educate about cultural diversity and societal oppression. journal of socialwork education, 36, 463-479. note: a previous version of the paper was presented at the 48th annual program meeting of the council on socialwork education, feb. 26, 2002, nashville, tn. author’s note: address correspondence to: theresa j. early, ph.d., associate professor, college of socialwork, the ohio state university, 1947 college rd., columbus, oh 43210, usa. e-mail: early.22@osu.edu. early et al./translating concept into act formulti-cultural practice microsoft word alqashan_attitudes of kuwaiti young adults final _________________  humoud alqashan, ph.d., is an assistant dean for academic & graduate studies and hafyaa alkandari, ph.d., is an  assistant professor, both in the college of social sciences, department of sociology and social work at kuwait university,  alkhaledya, kuwait.    copyright © 2010 advances in social work vol. 11 no. 1 (spring 2010), 33‐47    attitudes of kuwaiti young adults toward marriage and divorce: a comparative study between young adults from intact and divorced families humoud alqashan hayfaa alkandari abstract: this study investigates whether parental marital status affects young adults’ attitudes toward marriage and divorce. there exists a vast amount of literature on the impact of divorce on young adults in western cultures; however, no previous empirical studies have been conducted on the attitudes of young adults from intact and divorced families in the gulf region or in arab countries in the middle east. the sample of the study consisted of 661 young adults from kuwait university (from divorced and intact families). the findings reveal that adults whose parents divorced show fewer positive attitudes toward marriage than do those individuals from intact marriages. the study also suggests that adults whose parents were divorced carry more positive attitudes toward divorce compared with individuals from intact marriages. furthermore, gender was found to be an important factor in shaping attitudes toward marriage and divorce. a longitudinal study is recommended to look at the changes in young adults’ attitudes toward marriage and divorce over time, which will help to identify the influence of other factors of attitudes toward marriage and divorce. key words: adults, marriage, divorce, attitudes, kuwait, arabs, muslims. introduction the impact of parental divorce on children was reported to be associated with a stressful experience for children at any age (cooney, hutchinson, & leather, 1995; mahl, 2001). parental divorce was reported to be the most stressful event that children experience in their lives (wolchik et al., 1993). likewise, children of divorced families are at an increased risk of social and psychological problems which may continue into their adult life (amato & sobolewski, 2001; wallerstein, lewis, & blakeslee, 2000). moreover, amato (2006) in a review of a 20-year longitudinal study found that younger adults of divorce have weaker ties with their parents, experience more conflict in their future marriage, and are more likely to experience divorce in their own marriage. in kuwait alone, according to the ministry of planning of kuwait (2005), 30% of all first marriages end in divorce. alqashan (2009) reported that because of the increased rate of divorce, almost 45% of all kuwaiti children under the age of eighteen live in a single-parent divorced home, compared with tanner’s (2002) report that 40% of children in the united states will experience parental divorce by the age of sixteen. meanwhile, almost 40% (38.9%) of adolescents from divorced families in kuwait indicated not being in touch with their fathers since their parents got divorced (alqashan, 1999). as a result, alqashan, alkandari/attitudes of kuwaiti young adults    34    divorced fathers were evaluated negatively by their children due mostly to their lack of interaction with their children. indeed, parental divorce has major effects on young adults. a study by kapinus (2004) found that the relationship between parents’ divorce and children’s divorce attitudes is stronger when children are under the age of 25 at the time of the divorce than when they are over 25. attitudes toward marriage and divorce of kuwaiti young adults could be influenced by the teaching of their religion. since islam is the official religion in kuwait, it encourages its adherents to carry positive attitudes toward marriage. islam also warns muslims regarding irresponsible reasons for getting a divorce. although divorce is permitted in islam (alqaradawi, 1997), islamic law does not encourage muslims to seek divorce for minor reasons. it is reported that the prophet mohammad said “among lawful things, divorce is most hated by allah” (abu dawood, 2/254/2177). at the same time, although marriage is regarded highly in islam, it is not considered a religious sacrament (ibsen al faruqi, 1985). muslim men are encouraged to marry when they can offer emotional and financial support for potential wives. islam views marriage as sharing between the two halves of society. the main purpose of marriage in islam, aside from human reproduction, is love, mercy, mutual respect, justice, emotional well being, and spiritual harmony (khan, 2006). marriage is viewed as bringing two families together, rather than bringing two individuals together (ibsen al faruqi, 1985). yunus and ahmad (1985) in their book, islamic sociology: introduction, defined marriage as “essentially a social contract, solemnized between the bride and the groom with their full exercise of free choice” (p. 69). parental divorce and young adults although the literature is inconsistent regarding the impact of parental divorce on young adults, some studies report that some negative attitudes may influence the children's attitudes toward marriage and divorce when they grow up. for example, researchers (amato & booth, 1991; booth & edwards, 1990) found that those adults who came from divorced families exhibited lower levels of psychological well-being and marital quality. other researchers found that young adults whose parents divorced hold more condoning attitudes toward divorce and hesitate more on marital commitment due to fear of repeating their parents’ mistakes and getting divorced themselves (jacquet & surra, 2001; segrin, taylor, & altman, 2005). the impact of divorce on children and young adults receives a lot of attention from researchers. some researchers have focused on the well-being of adults before and after divorce, while others have studied the short-term impact of divorce on children of divorce (amato & cheadle, 2005; amato & keith, 1991). several studies found children from divorced families to have higher levels of depression (amato, 1991; turner & kopiec, 2006). others report higher anxiety (riggio, 2004) and substandard psychological and social adjustment, when compared to children from intact families (furstenberg & teitler, 1994). other researchers found no or less impact of parental divorce on young adults’ marital life or their well-being. consistent with this result, after the initial adjustment period, the majority of children were reported to have done quite well (ahrons, 2004; advances in social work, spring 2010, 11(1)      35     hetherington & kelly, 2002). furthermore, gohm, oishi, darlington, and diener (1998) found that parental divorce was not always problematic on young adults. another study (kurtz & derevensky, 1993) found children of divorced parents showed many healthy coping strategies for stages of post-parental divorce. parental divorce and young adult attitudes toward marriage and divorce studies investigating whether parental marital status affects young adults’ attitudes toward marriage and divorce have yielded conflicting findings. kinnaird and garrard (1986), for instance, found that children from intact families have significantly more positive attitudes toward marriage than do individuals from divorced and remarried families. they also found that although almost all of their participants indicated a desire to marry, children from divorced and remarried families were more skeptical about marriage and more accepting in their attitudes toward divorce than were those from intact families. in a 25-year longitudinal study, wallerstein and lewis (2004) found that young adults from divorced families were more likely to marry at a younger age and to divorce more often. researchers therefore concluded that individuals whose parents divorce are more likely to divorce themselves than individuals whose parents did not divorce (amato, 1996; hetherington, 2003; tallman, gray, kullberg, & henderson, 1999, wallerstein & lewis, 2004). moreover, kinnarid and garrard (1986) studied the relationship between mothers’ marital status and their daughters’ attitudes toward marriage, divorce, and premarital sexual activity. the findings revealed that females from intact families had more positive attitudes toward marriage than did those from divorced and step-families. however, no significant differences were reported between groups in term of attitudes toward divorce. other studies suggested that women are more likely than men to initiate divorce (hetherington & kelly, 2002), and divorce attitudes of women are more likely than those of men to predict eventual divorce (matthews, wickrama, & conger, 1996). in fact, larson, benson, wilson and medora (1998) found no significant differences between males and females with regard to attitudes toward marriage. jennings, salts, and smith (1991) investigated the effects of gender and family structure on adults’ attitudes toward marriage. they found that females had higher positive attitudes toward marriage than did males. trent and south (1992), who studied gender differences on attitudes toward divorce, found that females showed more positive attitudes toward divorce than did males. researchers found that male children, especially those children whose mothers do not remarry, are more likely to be affected more negatively after their parents’ divorce than daughters and those whose mothers do remarry (goodman & pickens, 2001). furthermore, nicholson (2006) concluded that it is important for male children to maintain a close parent-child bond with their father, which can help them overcome the negative effects of divorce rather than develop social, emotional, and psychological disorders. when a mother does not remarry after a divorce, children of both genders are more likely to experience a higher risk of social, emotional, psychological, and academic problems post divorce, as well as low self-esteem and low self-confidence, poor grades, alqashan, alkandari/attitudes of kuwaiti young adults    36    and internalizing behaviors, such as anger, depression, and developing anxiety disorders (nicholson, 2006). theoretical framework the effects of parental divorce on children’s attitudes toward marriage and divorce can be evaluated from several theoretical perspectives. at the broadest level, it can be elucidated using social learning theory (bandura, 1986). according to this theoretical perspective, individuals are thought to learn attitudes and behaviors through imitation, modeling, observation, and experience (segrin et al., 2005). social learning theory can also be used to predict and explain relationship characteristics for individuals whose parents have divorced. parental divorce can cause children to be more likely to observe interpersonal behaviors that weaken attitudes and increase the risk of their own marital instability in adulthood (amato & deboer, 2001). because divorced parents are more likely to carry positive views of divorce (thornton, 1985), children from divorced households may express positive attitudes toward divorce to conform to the views of their parents. consequently, this study suggests that a potential reason for such attitudes is that children learn skills and behaviors from their parental models. significance of the study the present study is unique for several reasons. first, although there is a vast amount of literature on the impact of divorce in western cultures and there are several arab studies done in several regions in the middle east about reasons for divorce (albakaar 2004; aljalabnah, 2006; alqashan, 2009), to the best of our knowledge, only a single study was conducted on the well-being of adolescents from divorced families in an arab country (alali, 2004). there exist no previous empirical studies comparing young adults from intact and divorced families in the gulf region, in arab countries in the middle east, nor in kuwait. therefore, the data from the current study serve a very important descriptive function that will be beneficial to social workers and marriage counselors in kuwait and surrounding countries, so that they can better prepare young adults to become successful partners in marriage. secondly, the researchers tried to avoid a weakness of other studies by including the self-report assessments of both male and female young adults in the data collection measuring children’s attitudes toward marriage and divorce. in addition, most of the previous studies have been restricted to only investigating the effect of parental divorce on the children’s psychological well-being; no study has examined how parents’ marital status may influence the children’s attitudes toward marriage and divorce. third and most importantly, it is essential to understand attitudes toward marriage and divorce because they serve as key mechanisms for predicting actual marital behavior (glenn & kramer, 1987). as previous research reports, parental marital conflict and divorce may have adverse effects on children, which may persist into adulthood (amato, 2001). advances in social work, spring 2010, 11(1)      37     purpose of the study and research questions the literature suggests that divorce is more acceptable in western cultures (amato & booth, 1991). however, it is difficult to discern the data because similar studies have not been conducted on middle eastern adults from either intact or divorced family samples. bean and crane (1996) reviewed all studies on this subject and found that fewer than 5% of the 2,162 articles published in journals focused on the case of racial minorities. therefore, the goal of the present study is to assess the impact of parental divorce on the attitudes of college students toward marriage and divorce in kuwaiti society. it is assumed that young adults from different cultures may have different attitudes toward marriage and divorce compared with findings done on samples from western culture. research questions 1. are there differences in the attitudes toward marriage among young adults of divorced and intact families? 2. are there differences in the attitudes toward divorce among young adults of divorced and intact families? 3. are there gender differences in the attitudes toward marriage among male and female young adults of divorced and intact families? 4. are there gender differences in the attitudes toward divorce among young male and female adults of divorced and intact families? methods the current study is descriptive, and also comparative. it uses a self-report survey methodology to examine the impact of parental marital status and the participant’s gender on the attitudes of college students from intact and divorced families toward marriage and divorce. the study also investigates the likelihood that one would view divorce as an option under certain marital circumstances. definition of terms and instruments marital attitudes: “marital attitudes” refer to the views of young adults in kuwait toward the institution of marriage. the marital attitude scale (mas; braaten & rosen, 1998) measures the marital attitudes of unmarried sons and daughters of divorce. marital attitudes can be positive or negative, and can be held by an individual of any marital status. a positive attitude toward marriage usually includes an idealistic notion of a model marriage (blagojevic, 1989). attitudes toward divorce: attitudes toward divorce refer to the following opinions toward the future of the relationship when a conflict occurs between the partners: 1. ask for divorce because he or she thinks that if it does not work out, one can get always a divorce. alqashan, alkandari/attitudes of kuwaiti young adults    38    2. the personal happiness of an individual is more important than putting up with a bad marriage. the attitudes toward marriage scale this scale is a paper-and-pencil self-report measure in which the participants endorse one of five choices for each of the 23 items (braaten & rosen, 1998). the participants were asked to rate each item on how strongly they agreed or disagreed with statements regarding their future marriage. the answers were given on a 5-point scale ranging from (1) strongly disagree to (5) strongly agree. the total score could range from 23 to 115, with higher scores indicating more positive attitudes toward marriage. the scale presents subjects with statements about marriage such as “people should marry;” “i have little confidence that my marriage will be a success;” and “i am fearful of marriage.” for the purposes of this study, we translated the scale into arabic using the method of back-translation. to ensure the validity of the translated form, and to ensure the maintenance of the themes in the original form, the arabic version was reviewed by several experts. a panel of professors from the departments of social work and psychology reviewed the instruments and agreed that the items have good content validity. they suggested minor changes to some items in the arabic questionnaire, and approved it after amendment. the cronbach alpha coefficient was calculated to test the internal consistency or reliability of the scale. the scale showed excellent reliability with a correlation of 0.86. (see table 1). attitudes toward divorce scale this scale was developed by kinnaird and garrard (1986) to measure beliefs regarding divorce. the scale consisted of 12 questions answered on a 5-point likert scale, anchored by (1) strongly disagree and (5) strongly agree. the scale presented subjects with statements about divorce such as “people should feel no obligation to remain married if they are not satisfied.” the total score ranged from 12 to 60, with low scores indicating more positive and more liberal attitudes toward divorce. our findings suggest that the attitude toward divorce scale is a reliable instrument using kuwaiti young adults. a coefficient alpha was calculated to test the internal consistency or reliability of the scale. the scale showed a very good reliability with a correlation of 0.92. (see table 1). table 1: descriptive statistics and reliability coefficients of attitudes toward marriage & attitudes toward divorce scales (n=661). scale mean sd alpha attitudes toward marriage 74.87 11.09 .86 attitudes toward divorce 42.07 10.28 .92 advances in social work, spring 2010, 11(1)      39     sample criteria for subject inclusion were: (1) subject should be enrolled at kuwait university; (2) parental marital status should be defined as legally divorced or intact; (3) subject should be offspring of kuwaiti parents. the sample was chosen from 12 introductory courses from the department of sociology and social work, as well as the department of psychology. the total number of students in each class ranged from 60 to 70. advance arrangements were made with the instructors of each course. the researchers and their assistants were given approximately 15 minutes at the beginning of each chosen lecture to implement the study questionnaires. the researchers or their assistants thanked the participants and then explained to them the purpose of the study. the participants were asked not to put their names or any personal information such as phone number or addresses to guarantee and maintain confidentiality. the research questionnaires were administered by trained social workers. the instruments were written in english; however, they were translated into arabic since that was the subjects’ native language. the valid respondents consisted of 661 undergraduate students enrolled at kuwait university. the sample consisted of two groups: students from divorced and from intact families. the first group consisted of 480 (72.6%) participants who reported that their parents were not divorced. the males constituted 39.6% of the respondents, the females, 60.4%. the second group totaled 181 (27.4%) respondents, who reported that their parents were divorced. in this group, the males constituted 33.7% of the respondents, the females, 66.3%. the students provided demographic information, including gender, academic year, parental marital status, and age at the time of parental divorce (if divorced). within the divorced sample, 87% of the students lived with their mothers (apparently the mother having custody of the child). only 6.1% indicated living with their custodial fathers and stepmothers. the remainder of the sample lived with relatives or remained within a two-parent household. results the data for this study were analyzed using spss. descriptive statistics were computed to provide information on all variables and on the background of the sample in this study (see tables 2 & 3). the research questions of this study were answered using t-tests to determine whether gender and parental marital status influence the attitudes of young adults toward marriage and divorce by comparing group means. the findings showed significant differences between the young adults from intact and divorced families. the answer to the first question revealed that young adults whose parents divorced have less positive attitudes toward marriage (m = 60.86) than those individuals from intact marriages (m = 80.16) (see table 2). alqashan, alkandari/attitudes of kuwaiti young adults    40    answering the second question suggests that young adults whose parents were divorced carry more positive attitudes toward divorce (m = 29.63) compared with individuals from intact marriages (see table 2). recall that low scores indicate more positive and more liberal attitudes toward divorce. this finding means that young adults whose parents were divorced had more liberal attitudes toward the tendency of divorcing when they themselves get married in the future. table 2: attitudes toward marriage and divorce: comparison of young adults from divorced and intact families young adults with divorced parents (n=181) young adults with intact parents (n=480) scale mean sd mean sd t attitudes toward marriage 60.86 9.41 80.16 5.84 -25.77* attitudes toward divorcea 29.63 8.01 46.76 6.42 -25.79* a lower mean scores indicate more positive attitudes toward divorce. *p<.000. gender differences regarding the third question, the findings indicate that males and females differ significantly in their attitudes toward marriage. specifically, the results shown in table 3 reveal that, among those with divorced parents, males (m = 68.80) had significantly more positive attitudes toward marriage compared with female young adults (m = 56.82). on the other hand, among those whose parents were still married, the attitudes toward marriage of females (m = 81.0) were slightly but significantly more positive than those of males (m = 79.32). meanwhile, for the fourth question, the results shown in table 3 reveal that female young adults whose parents divorced had significantly more positive attitudes toward divorce (m = 28.13) than did those male individuals who came from divorced parents (m = 32.61). on the other hand, males from intact parents showed more liberal attitudes toward divorce (m = 44.78) than female young adults from intact parents (m = 48.74). advances in social work, spring 2010, 11(1)      41     table 3. attitudes toward marriage and divorce: gender by family type young adults with divorced parents young adults with intact parents males (n= 61) females (n= 120) males (n=240) females (n= 240) scale mean (sd) mean (sd) t mean (sd) mean (sd) t attitudes toward marriage 68.80 (7.99) 56.82 (7.28) 9.82** 79.32 (6.67) 81.00 (4.73) -3.19* attitudes toward divorcea 32.61 (8.83) 28.13 (7.15) 3.43* 44.78 (6.54) 48.74 (5.65) -7.10** a lower mean scores indicate more positive attitudes toward divorce. *p<.01; **p<.001 discussion the results from this study show that young adults from divorced families, and females in particular, have less positive attitudes toward marriage when compared with males from divorced but not from intact family backgrounds. in addition, females, from divorced families but not from intact families showed more positive attitudes toward divorce than did males. indeed, kuwaiti young adults whose parents divorced appeared to be more polarized in their attitudes, demonstrating more negative perceptions of marriage and greater openness to divorce. such attitudes could be acquired through exposure to conflict, and contentious interactions could teach offspring that marriage is challenging. the findings of this current study are consistent with other studies (gabardi & rosen, 1993; nicholson, 2006; thornton, 1985) which found that males and females from divorced families possess more negative attitudes toward marriage than do young adults from married families. this finding is also supported by amato and deboer's (2001) longitudinal study of 2,033 individuals from divorced and non-divorced homes, which found that adult children of divorce scored significantly higher on measures of rates of divorce and thoughts of divorce compared with adults from non-divorced homes. gender differences were reported based on social learning theory, in which females typically have closer, more intimate relationships with others than men (shek, 1995), while men generally are more independent and less knowledgeable and/or influenced by outside sources (cross & madson, 1997). moreover, women were more likely than men to initiate divorce (hetherington & kelly, 2002). however, our findings contradict in some ways those of ganong, coleman, and brown (1981), who found that females had more positive attitudes toward marriage than did males, regardless of their family type. however, our findings did not support that for young adults from divorced families. several explanations can be drawn from these findings for such gender differences in the attitudes of kuwaitis toward marriage and divorce. first of all, since kuwaiti women alqashan, alkandari/attitudes of kuwaiti young adults    42    played a significant role during and after the iraqi occupation of kuwait, claims of male superiority have eroded (alqashan, 1995). kuwaiti women have claimed their right to choose their roles, independent of males. in contemporary kuwaiti society, women have successfully challenged men in most fields; and this success should be considered when looking at the current findings. second, the rapid process of modernization in kuwaiti society reflects major economic, political, social, and value changes, which have affected the roles of both males and females as individuals and as a group. therefore, gender differences in this study can be attributed to the sociocultural and economic changes for kuwaiti women. recently, kuwaiti women have participated more in the work force; they are no longer so dependent on their husbands’ income. furthermore, divorced women in kuwait get financial support from the government when they divorce. therefore, divorce is increasingly a viable option for young kuwaitis due to the govermental involvement. the negative stigma associated with divorce in the past is no longer an issue for young adults who are considering marriage and divorce, especially for those from divorced parental backgrounds. such changes may have had an effect on young kuwaitis’ attitudes toward marriage and divorce, as well as raising the rate of divorce. third, kuwaiti drama on television and the movies may contribute to either unrealistic, idealized marital beliefs, or may inhibit the development of realistic relationship attitudes for females. as it was reported, television may play a significant role in such attitudes. segrin and nabi (2002) conducted a study examining college students’ beliefs about marriage in association with the amount and genre of television viewed. they found that the genre of television viewed (romantic comedies, soap operas) was positively associated with unrealistic beliefs about marriage. fourth, although emotional and financial support from the extended family in kuwait may lessen the impact of a conflicted divorce and increase resiliency in the child, some researchers have demonstrated that post-divorce conflict between the parents can last for years after the initial divorce process is complete (forehand, neighbors, devine, & armstead, 1994). in addition, parental divorce and parental custody struggles in kuwaiti courts can have significant psychological and developmental adverse effects on kuwaiti children. fifth, although most of our sample experienced their parents’ divorce when they were very young, they may have still witnessed conflict between their parents, which may have an impact on their social and psychological development and their adjustment in college. it was suggested by trent and south (1992) that marital and familial attitudes seemed to be shaped early in life and remained somewhat constant throughout life, but that the influence of the childhood environment may have a stronger impact on children’s and adolescents’ attitudes than on the attitudes of adults, who are no longer in that environment. sixth, divorced parent-child interactions may play a role in these findings. indeed, children of divorce in kuwait tend to spend less time with their fathers after divorce (alqashan, 1999); this finding is also the case in western societies (amato, 2006; shulman, scharf, lumer, & maurer, 2001). taking this point into consideration may also advances in social work, spring 2010, 11(1)      43     suggest that the child could be old enough to recognize and possibly understand the conflict between his/her parents and may also be old enough to become involved in the conflict, thereby creating confusion and stress during and after the divorce actually occurs. the researchers recommend taking two types of action. first, a serious effort needs to be made to raise awareness of the impact of parental divorce on the family as a whole and children in particular. second, a national campaign needs to be launched to raise public awareness. such awareness can be done through the local media, religious leaders, community conferences, and the local schools, as well as other venues. further studies should include other variables not included in this study, such as inter-parental post-divorce conflict, the quality of the parent-child relationship, and remarriage of one or both parents (amato, 2001; 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(2004). the unexpected legacy of divorce: report of a 25-year study. psychoanalytic psychology, 21, 353-370. wallerstein, j. s., lewis, j. m., & blakeslee, s. (2000). the unexpected legacy of divorce: a 25 year landmark study. new york: hyperion. wolchik, s. a., west, s. g., westover, s., sandler, i. n., martin, a., lustig, j., tein, j., & fisher, j. (1993). the children of divorce parenting intervention: outcome evaluation of an empirically based program. american journal of community psychology, 21, 293-331. yunus, i., & ahmad, f. (1985). islamic sociology: introduction. london: hodder and stoughton: cambridgeshire: islamic academy. author’s note: address correspondence to: humoud alqashan, ph.d., college of social sciences, department of sociology and social work, kuwait university, p. o. box 17872, kuwait. email: hq1965@yahoo.com     spring2005-089_page91 spring2005-090_page92 spring2005-091_page93 spring2005-092_page94 spring2005-093_page95 spring2005-094_page96 advances vol. 1, no. 2 ppeerrcceeppttiioonnss ooff ffiieelldd iinnssttrruuccttoorrss:: wwhhaatt sskkiillllss aarree ccrriittiiccaallllyy iimmppoorrttaanntt iinn mmaannaaggeedd ccaarree aanndd pprriivvaattiizzeedd eennvviirroonnmmeennttss?? michael n. kane elwood r. hamlin ii wesley hawkins abstract: there is an increasing demand for social work practitioners to work in managed care and privatized environments. in an attempt to build social work curriculum and identify important competencies needed in contemporary service environments, researchers investigated south florida field instructors’ (n=79) perceptions of necessary knowledge and skill to work in environments affected by privatization and managed care. this study’s findings indicate that field instructors (98%) identified documentation as the most critically important skill for any social work position. additionally, respondents identified intervention evaluation (95%), timefocused and needs-based assessments strategies (94%), and evaluation of progress through outcome measures (94%) as other critically important skills for current and future practitioners. keywords: managed care, practicum, social work education, field instructors whether functioning independently or as part of a multi-disciplinary team, social workers have provided innovative helping services in various settings over the decades. many of these sites and services are undergoing change, development, and restructuring as a result of government and corporate “obsession with cost” (davis & meier, 2000, p.10). once primarily employed in the public and private not-for-profit sector, social workers have become increasingly more present in private for-profit settings (ginsberg, 2000). over the decades the profession has successfully adapted to various new service environments. currently, the challenge to the profession may extend beyond environmental adaptation to include its knowledge and skills base. the delivery of services within both the public and private sectors of health, mental health, and social services has changed dramatically in the past decade and will likely continue to undergo further change (berkman, 1996; edinburg & cottler, 1995; motenko et al., 1995; oss, 1996; perloff, 1998; rosenberg, 1998; scuka, 1994; vernon, 1998; volland, berkman, stein & vaghy, 1999; white, simmon & bixby, 1993). private health, mental health, and social agencies have adopted service delivery models which incorporate cost-controlling measures while 187 michael n. kane, ph.d., msw, m. div. is assistant professor; elwood r. hamlin ii, d.s.w. and wesley hawkins, ph.d. are associate professors, florida atlantic university, boca raton, florida, usa . copyright© 2000 advances in social workvol. 1 no. 2 (fall 2000) 187-202. indiana university school of social work. 188 advances in social work attempting to provide quality intervention (borenstein, 1990; corcoran & vandiver, 1996). public health, mental health, and social service agencies have also been increasingly privatized with the goal of controlling escalating costs and providing effective intervention (elias & navon, 1998; beinecke, goodman & lockhart, 1998). most americans desire the highest quality, cutting-edge services. however, 21st century fiscal realities inhibit their widespread implementation. federal, state, and local governments representing the sentiments of taxpayers, employers, and insurance companies are sending messages to service providers and service recipients that unrestricted access to service is a luxury that is not economically supportable (fletcher, 1999; mcentee, 1993). therefore, managed care models have emerged as prominent methods for allocating and rationing resources. rationing procedures such as utilization review have become the principal methods of dispensing expensive and scarce resources. underlying these models of service delivery are two assumptions: (a) unnecessary services are being provided to people who do not need services, and (b) inappropriately intensive and expensive services are provided when less intensive services would be sufficient (kapp, 1999; rose, 1996). while the nation has opted for marketplace health, mental health, and social service delivery, current service providers have struggled to remain responsive and competitive by acquiring new knowledge and skills. future health and mental health practitioners are facing new demands as a result of delivery system changes (coggan, 1997; fletcher, 1999; hagland, 1996). social workers have traditionally been present in health care venues. given the profession’s dominant position in the provision of mental health and social services and the prevalence of these managed care models, it is critically important that educators and curriculum stakeholders evaluate curricula that will prepare future practitioners for these new and emerging models of service delivery. there are many sources that may support curriculum development and evaluation of necessary skills and knowledge in the current service environment. field instructors are one critical source to offer important information for social work curriculum evaluation (alperin, gray & wik, 1991). social work and current models of service delivery the profession has begun to focus attention on managed care and privatized models of service delivery. the council on social work education has established a program research commission that questions whether curricula address today’s practice world. furthermore, project “beyond year 2010: public health social work practice” intends to examine practice within the context of managed care (o’neill, 2000). the literature has tended to focus heavily on the ethical conundrums and legal issues associated with current service delivery methods (callahan, 1998; davidson & davidson, 1998; houston-vega, nuehring, with daguio, 1997; madden, 1998; munson, 1998; reamer, 1998; rock & congress, 1999), preferred models of clinical practice in the current service delivery environment (corcoran & vandiver, 1996; kadushin, 1996; mitchell, 1998; poole, 1996), the restrictive aspects of service rationing (callahan, 1998; mcquaide, 1999; sessions, 1998), and enduring practitioner obligations to clients (davidson, davidson & keigher, 1999; houston-vega et al., 1997; madden, 1998; reamer, 1998; watt & kallmann, 1998). 189 this important body of literature appears to focus on the underlying philosophical and value conflicts that exist between professional social work and current service delivery trends. practitioners, educators, and clients’ negative attitudes toward current models of managed care fill scholarly and popular literature (berger & ai, in press-a). yet, in spite of these negative perceptions and attitudes, rationing and limited service delivery are increasing and will continue to be an integral part of health, mental health, and social service delivery (berger & ai, in press-b). at the heart of the matter may be the tension that exists between social work’s preferred models of practice and managed care’s approach to service delivery. many current social work writers and educators favor postmodernist models of practice (parkeck, murphy & choi, 1994), such as empowerment (lee, 1994) or strength-based perspectives (cowger, 1994; rapp, 1998; saleebey, 1996). managed care is a deficit-focused service delivery system that operates on the medical model (kane, houston-vega & nuehring, in press). reconciling postmodernist models to a medical model service delivery system is a challenge that current and future practitioners cannot avoid if they expect to remain consistent with social work ethical obligations and remain competitive in the marketplace. kelly (1998) suggests that the postmodernist key to this practitioner dilemma lies in the ability to understand the reality of clients as well as the reality of managed care and utilization review. based on these realities, practitioners communicate by “talking in two voices” (kelly, 1998, p. 437). essentially, practitioners communicate client needs to managed care companies in the language of utilization reviewers. aside from some potential ethical concerns with this strategy, the more distressing reality for practitioners and clients is managed care’s predictable focus on profit and cost, and the limited attention given to the best interests of clients or the expertise of practitioners. davis and meier (2000) suggest that managed care does not operate from a clinical perspective of service delivery but rather from a business model. these business models inform business activities and support strategies to maximize profits, yet may have limited effectiveness in providing real services to real people in need. educators and curriculum stakeholders find themselves in a difficult position as they observe rapidly changing service environments and multiple new demands that are placed on practitioners. the employment market requires specialized skills for social workers. educators struggle to find the best methods for infusing necessary knowledge and skills that address current needs, while remaining faithful to the profession’s values, knowledge, and skill base. over the past few years, social work educators have been encouraged to include specific knowledge and skills in educational curricula to ensure competency in this new service delivery environment (kadushin, 1997; raskin & blome, 1998; rosenberg, 1998; shera, 1996; stromgottfried, 1997; volland et al., 1999). although there is an abundance of theoretical or position literature, few empirical studies exist that identify the specific knowledge and skills necessary for current service delivery environments. vandivort-warren (1996) developed a list of knowledge and skills as a result of work with several social work focus groups throughout the united states. group participants identified critically important items which include treatment skills based on diagnostic protocols, research skills kane et al./perceptions of field instructors 190 advances in social work using client outcome measures, conceptualizing treatment as best outcomes in a cost-conscious environment, business/financial knowledge and skills, and understanding market forces. other literature has suggested that social work education might include knowledge of managed care models and privatization (brooks & riley, 1996; kadushin, 1997; raskin & blome, 1998; strom-gottfried, 1997; volland et al., 1999), outcomes research (corcoran & gingerich, 1994; strom-gottfried, 1997; volland et al., 1999), documentation (brooks & riley, 1996; raskin & blome, 1998; volland et al., 1999), needs-based assessments (brooks & riley, 1996; kadushin, 1997; raskin & blome, 1998; strom-gottfried, 1997; volland et al., 1999), and case management strategies (volland et al., 1999). volland et al. (1999) propose this can be accomplished if field instruction and classroom education become better integrated. the field practicum has been a critically important and traditional context for social work training. however, field sites currently face several dilemmas. because student services are not reimbursable through medicaid and other forms of insurance (donner, 1998; kane et al., in press), some agencies have opted to eliminate students in field practicum as they are no longer beneficial to the agency (raskin & blome, 1996). field instructors have little time for intensive supervision (berkman, 1996). non-billable time spent in student-supervision by a field instructor reduces the time spent in providing reimbursable services for agencies. and from a bold educational perspective, berger and ai (in press-a) reason that only field settings that incorporate managed care models should be used as practicum sites, as only they will adequately prepare future practitioners. clearly, field instructors are the bridges between educators, students, agencies, and payers. they provide important information regarding critical knowledge and skill for current and future service delivery based on their clinical and agency knowledge and experience. this study sought to identify field instructors’ perceptions of critically important knowledge and skills for preparedness to work in these changing environments. methodology respondents: south florida has several universities with social work programs. because of the geographic proximity of these institutions, field instructors may supervise bsw and msw students from more than one university. a listing of field instructors was obtained from one south florida university. this university has an accredited bsw program and is working to establish candidacy status with cswe for its new msw program. this study used exploratory, self-administered survey methodology. dillman (1978) suggests that researchers should monitor response rates following the first distribution of self-administered instruments, complete with cover letters. additionally, follow-up mailings should be sent to ensure an acceptable response rate. all 109 field instructors identified on this university list were contacted by mail and requested to complete an anonymous questionnaire. no identifying information was elicited to better ensure the confidentiality of responses. a form letter accompanied the questionnaire and explained that this survey’s findings would assist in developing a msw curriculum responsive to current service delivery 191 needs. the letter explained that the investigators were interested in respondents’ attitudes and perceptions regarding the knowledge and skills necessary for practice in current service delivery environments. two of the 109 cover letters and instruments were returned as undeliverable. within two weeks, 54 instruments were returned. since there were no identifying marks or codes on these returned instruments and to solicit a larger response, a second mailing was completed within the month. respondents were told not to resubmit the instrument if they had already returned one. an additional 19 completed instruments were returned within one month. six additional completed instruments were returned within 10 weeks, which resulted in a response rate of 74% (n= 79). rubin and babbie (2000) indicate that a response rate of 50% is acceptable, 60% is good, and 70% is very good. instrument: the instrument consisted of two parts. the first part contained demographic information pertaining to the field instructors and their agencies. the second part consisted of likert format items that were developed based on content from the literature, particularly from the findings of volland et al. (1999), who (1999) identified several key areas for social work curricula. the identified skills included familiarity with biopsychosocial treatment modalities, policies/regulations, population-specific terminology, networking, financial management skills, assessment and interviewing skills, documentation, outcome evaluation, and data management. researchers developed items from this list of skills. instrument items sought to identify the field instructors’ perceptions regarding the importance of these skills and the necessary knowledge for the current service delivery climate. the instrument was piloted using practitioners and field supervisors and on average took approximately 10 minutes to complete. an expert panel of social work educators, practitioners, and organization utilization reviewers established face validity for all items. reliance on field instructor respondents limited this study. other sources for future curriculum development must be investigated to ensure a complete representation of what is necessary in contemporary service delivery climates. these sources may include employers, organizations, educators, students, and managed care organizations. as with all anonymous self-reporting studies, investigators could not determine whether non-responders were significantly different from responders. findings the majority of survey respondents were white (85%), female (72%), with msw degrees (84%). about half worked in private, not-for-profit social service agencies (54%) and had the shared responsibilities of direct client contact and some supervisory function. the sample and nasw demographics appear similar for these variables. the typical nasw member was white (87.9%), female (79.4%), and holds an msw (85.5%) (gibelman & schervish, 1997). unlike this sample, only 29.9% of nasw members work in the private not-for-profit sector and 48.7% of nasw members work in the private for-profit sector (gibelman & schervish, 1997). other demographic information is contained in table 1. kane et al./perceptions of field instructors 192 advances in social work n % gender female 57 72 male 22 28 race/ethnicity african american 4 5 carribean black american 0 0 asian/pacific islander 0 0 hispanic/latino 4 5 native american/american indian 1 1 caucasian/white 67 85 other 3 4 highest degree earned msw 66 84 social work doctorate 1 1 other 12 15 years in social work under 2 2 3 2-5 15 19 6-10 26 33 11-15 11 14 16 or more 24 30 employment private-for-profit 15 19 private-not-for-profit 43 54 public-federal 2 3 public-state 6 8 public-county 11 14 in private practice yes 14 18 no 63 82 primary employment setting health 12 16 mental health/substance abuse 15 19 courts/justice system 10 13 school 5 6 residential facility 2 3 social service agency 24 30 other 9 11 primary clients served children/adolescents 12 15 families 6 8 adults 25 32 older persons 7 9 mix of above 29 37 years of supervising bsw interns < 2 29 37 2-5 28 35 6-10 9 11 >10 13 16 table 1: characteristics of sampled field instructors (n=79) 193 table 2 provides a rank ordering of field instructors’ perceptions of the importance of knowledge and skill in the current service delivery environment. respondents provided information on knowledge and skills they believed to be critically important in current service delivery environments. documentation (98%) was perceived as the most critically important skill, followed by intervention evaluation (95%), time-focused and needs-based assessments (94%), evaluation of progress by outcome measures (94%), solution-focused methods (86%), interdisciplinary collaboration (86%), case management skills (86%), knowledge of insurance (84%), knowledge of managed care (84%), and knowledge of health care coverage and financing (84%). sixty-six percent of respondents identified macro-change skills or knowledgeof medicare/medicaid as important. kane et al./perceptions of field instructors n % years of supervising msw interns <2 42 53 2-5 16 20 6-10 5 6 >10 15 19 primary employment function administrative 17 22 middle management/supervisor 9 11 supervisor with significant client contact 30 38 front line social worker 18 23 other 5 6 table 1: characteristics of sampled field instructors (n=79) (cont.) agree disagree*** n % n % 1. documentation 77 98 1 1 2. intervention evaluation 75 95 2 3 3. evaluation of progress by outcome measures 74 94 3 4 4. time-focused and needs-based assessment 74 94 4 5 5. solution-focused methods 68 86 7 9 6. interdisciplinary collaboration 68 86 9 11 7. case management 67 85 9 11 8. agency-specific terminology 66 84 11 14 9. knowledge of insurance 66 84 11 14 10. knowledge of managed care 66 84 11 14 11. healthcare coverage & financing 66 84 10 13 12. knowledge of entitlement programs 65 82 10 13 13. brief intervention 62 79 14 18 14. knowledge of the business side of agency services 60 76 16 20 15. demonstrating cost-effectiveness of performance 57 72 18 23 16. knowledge of medicare & medicaid 52 66 23 29 17. macro-change skills 52 66 23 29 *** totals may not equal 100% due to missing data table 2: rank order of field instructors’ perceptions of the importance of knowledge and skills in the current service delivery environment 194 advances in social work skill years of agree disagree experience n % n % x2 p documentation <5 17 100 0 0 6-10 25 96 1 4 11 + 34 100 0 0 1.98 .37 intervention <5 17 100 0 0 evaluation 6-10 25 96 1 4 11+ 33 100 0 0 1.94 .37 evaluation of <5 17 100 0 0 progress by out6-10 25 96 1 4 come measures 11+ 32 97 1 3 0.62 .72 time-focused & <5 16 94 1 6 needs-based 6-10 26 100 0 0 assessments 11+ 31 91 3 9 2.35 .31 solution-focused <5 15 88 2 12 methods 6-10 23 92 2 8 11+ 29 91 3 9 0.16 .91 interdisciplinary <5 15 88 2 12 collaboration 6-10 22 85 4 15 11+ 30 91 3 9 0.55 .76 case <5 14 88 2 12 management 6-10 22 85 4 15 11+ 30 91 3 9 0.55 .76 agency<5 16 94 1 6 specific 6-10 20 77 6 23 terminology 11+ 29 88 4 12 2.71 .26 knowledge of <5 17 100 0 0 insurance 6-10 20 77 6 23 11+ 28 85 5 15 4.44 .11 knowledge of <5 16 100 0 0 managed care 6-10 22 88 3 12 11+ 24 75 8 25 5.49 .06 healthcare <5 17 100 0 0 coverage & 6-10 20 80 5 20 financing 11+ 28 85 5 15 3.67 .16 knowledge of <5 15 94 1 6 entitlement 6-10 22 85 4 15 programs 11+ 27 85 5 15 0.92 .63 brief <5 13 77 4 23 intervention 6-10 22 88 3 12 11+ 26 79 7 21 1.14 .57 knowledge of the <5 13 81 3 19 business side of 6-10 19 73 7 27 agency services 11+ 27 82 6 18 0.74 .69 table 3: years of social work experience and perceptions of knowledge and skill importance years of professional experience were collapsed into three options: less than five years of experience, six to 10 years of experience, and 11 or more years of experience. since social work experience might be expected to be a critical component in determining perceptions of skill and knowledge importance, χ2 statistics were computed for all 17 items. because there were 17 individual statistical tests, the possibility of family-wide error rate existed. to control for a family-wide error rate, the significance level was adjusted using the bonferroni technique. the starting statistical significance of 0.05 was divided by 17, which resulted in a new significance level of 0.00294. table 3 contains cross-tabulations and χ2 statistics for all items. interestingly, none of the χ2 statistics were significant, indicating that there was no significant disagreement among field instructors with various levels of social work experience. the only item approaching significance was “knowledge of managed care” (p=0.06). of the total respondents, 84% agreed that knowledge of managed care was a critically important area of knowledge. however, while all of the respondents with less than five years of professional experience and 88% of respondents with six to 10 years of experience indicated that it was a critically important skill, only 75% of the respondents with 11 or more years agreed. when the level of professional experience was statistically controlled, there were no significant differences among the groups. nonetheless, trends were visible in some variables, particularly variables centering on business issues. most noteworthy was the perception difference in the importance of knowledge of managed care and knowledge of insurance. all field instructors with less than five years of experience perceived these items as critically important, while field instructors with more experience did not unanimously concur. additionally, other business-related variables, such as knowledge of healthcare financing and demonstrating cost effectiveness in performance, were more likely to be perceived as critically important by field instructors with less than five years of experience. even though there were no statistical differences among the levels of experience, it appears that these variables were particularly important to field instructors with less professional experience. 195kane et al./perceptions of field instructors skill years of agree disagree experience n % n % x2 p demonstrating <5 15 88 2 12 cost-effectiveness 6-10 17 68 8 32 performance 11+ 25 78 7 22 2.38 .31 knowledge of <5 12 71 5 29 medicare & 6-10 15 63 9 37 medicaid 11+ 24 73 9 27 0.71 .70 macro-change <5 10 67 5 33 skills 6-10 21 81 5 19 11+ 20 61 13 39 2.80 .25 table 3: years of social work experience and perceptions of knowledge and skill importance (cont.) 196 advances in social work implications and conclusions field instructors are one of several critically important sources of information for social work educators and curriculum stakeholders. little empirical data exists confirming the importance of specific skills for managed care and privatized environments. from a literature search, various skills associated with managed care environments were identified. respondent field instructors were asked to identify those skills and knowledge they thought to be the most important for current service delivery climates. critically important skills identified by field instructors included documentation, intervention evaluation, time-focused and needs-based assessment, and outcome measures. other important skills included solution-focused methods, interdisciplinary collaboration, and case management. knowledge of insurance, managed care, health care coverage, and financing were also identified as important. while the literature identified knowledge of medicare and medicaid and macro-change skills as critically important, study respondents did not overwhelmingly agree. finally, there were no significant differences in critically important skill perceptions based on years of experience. these findings offer important insights into current service delivery environments and have potential implications for social work education. because social work is a value-based profession, social work educators filter knowledge and skill through the profession’s code of ethics. the profession’s mission, as identified in the code of ethics, is to “enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (national association of social workers, 1996, p. 1). with such intention, educators and practitioners interact with multiple systems, including clients, managed care organizations, privatized environments, insurance companies, and utilization reviewers. while social work education favors postmodernist models of empowerment and strength-based perspectives, managed care seeks to find the deficit in covered lives that can be quickly, cheaply, and efficiently remedied. but perhaps most importantly, managed care and privatized environments function on a business model. their focus is primarily the cost of services. clients’ needs and practitioners’ expertise appear to be secondary considerations (davis & meier, 2000). despite identified shortcomings, managed care and privatized environments appear to be here to stay. there appear to be no other viable options on the horizon to control escalating costs. this, coupled with society’s general unwillingness to provide limitless and expensive services to all people—especially those who are vulnerable, oppressed, and living in poverty. the model that currently informs service delivery is unmistakably a business model. respondents in this study appeared to have understood the importance of being knowledgeable about the business side of service delivery. as a bridge between students, educators, agencies, and payers, field instructors offer valuable insight into the current service delivery climate. they are also firsthand witnesses to the challenges awaiting new and future social work practitioners. their experience offers educators valuable information about the skills and knowledge which will allow social work practitioners to successfully function in these ever-changing environments and continue to serve vulnerable or oppressed clients. 197 respondents reached the greatest consensus regarding the need for and the importance of documentation as an essential basic skill in the current service delivery environment. this finding supports other research in suggesting that documentation ultimately protects clients, practitioners, and agencies (houston-vega et al., 1997; kane et al., in press; madden, 1998). documentation provides an account of the provision of services, answers charges of malpractice, and evidences adherence to the standard of care (houston-vega et al., 1997; kane et al., in press; madden, 1998). practitioners need specialized knowledge and skills to professionally interact in a society that has become increasingly litigious. by incorporating documentation requirements into the curriculum, social work educators are in a favorable position to ensure that students, clients, and agencies are protected. although variation exists in documentation requirements for managed care and privatized environments, broad principles of responsible record keeping can be incorporated into coursework. practitioners who function in managed care and privatized environments need basic familiarity with consents and releases, assessment tools, problem-oriented service plans, progress notes, treatment outcome documentation, termination summaries, and documenting critical incidents (houston-vega et al., 1997; kane et al., in press; madden, 1998). traditional documentation methods, such as the s-o-a-p method (subjective, objective, assessment & plan) or the problem-oriented medical record model, provide essential skills for current service delivery environments and agency reimbursement: that of charting-to-the-negative (kane et al., in press). educators may hesitate as they consider such strategies. however, the major challenge is to provide students with the skills to document in a problem-oriented fashion while remaining focused on client strengths and empowerment strategies. perhaps the solution lies in honestly informing students of these existing tensions and noting that the language of service delivery environments and reimbursement is not necessarily the language of the profession (kane et al., in press). if for no other reason, educators may wish to include content on documentation and liability to ensure that vicarious liability suits do not include their names for not having adequately prepared competent and responsible practitioners (houston-vega, nuehring & kane, 1999). the findings suggest that field instructors understand the important connection between practice and evaluation. within social work education, research classes have been viewed as very distinct from and not practically connected to the remainder of the curricula. respondent field instructors indicate that in current service environments practice and evaluation are inseparable. the study’s findings support those of volland et al. (1999) and suggest that content in the research sequence include strategies for intervention evaluation and outcome measures. there is nothing new in the concept that students need to understand: only practice that has been evaluated and examined is responsible practice (berger & ai, in press-b; myers & thyer, 1997). for years these themes have been dominant in the educational literature. perhaps actual evaluation and measurement of practice can be incorporated into the practice class, while the skills to perform the evaluative functions may be taught in the research sequence. these notions highlight the importance of empirically-based evaluation and its connection to practice— perhaps over other evaluative methods. one potential recommendation for ensuring kane et al./perceptions of field instructors 198 advances in social work that students understand the connection of practice to empirical evaluation is to ensure that they are concurrently enrolled in practice and evaluation courses. respondents identified time-focused and needs-based assessment as important. social workers have a long history of assessing individuals, families, groups, organizations, and communities. most practice texts identify assessment as an important function of social work, which remains ongoing in the helpingrelationship (cf: hepworth, rooney & larsen, 1997; shulman, 1992; woods & hollis, 1990). in managed care environments, the period in which the social worker has the opportunity to engage in a helping relationship is predicated on the client’s acute need and is generally expected to be brief and time-limited. identifying acute need is referred to as determining medical necessity and includes identifying health, mental health, and social service needs. practitioners need the skills to quickly and accurately assess acute need, implement-attain-evaluate goals, and terminate the time-limited helping relationship. managed care organizations view the assessment process as the shortest possible encounter in an acute situation in which the professional is able to accurately identify the problem and resolve it through an approved intervention. having noted the time constraints of the helping relationship from a managed care perspective, it is not surprising that respondents identified solution-focused methods and brief treatment as important practice models. a body of empirical literature supports the effectiveness of these practice models. furthermore, managed care organizations may not allow providers to choose interventions which are not a part of the organization’s approved list of treatment protocols (davis & meiers, 2000). these protocols frequently include brief and solution-focused methodologies to the exclusion of others (davis & meiers, 2000). field instructors identified knowledge of financing, insurance, managed care, entitlement programs, and the business-side of agency services as important. this appears consistent with their understanding that service environments operate from practice models as well as business models. these findings are consistent with those of volland et al. (1999). respondents, because of their connection to service delivery sites, provide valuable insight which suggests that practitioners in managed care and privatized environments need to be attentive to agency financial health and survival. a surprising element is that despite respondents’ heightened awareness of the financial side of service delivery, only 66% of them identified knowledge of medicare and medicaid as important. this is particularly confusing as most respondents were employed in the private sector. additionally, only 66% of respondents identified the skills to initiate macro changes as important in the current service environment. social work educators have understood that social work education is professional education, rather than purely academic education. because social work curriculum prepares social work professionals, curriculum cannot remain isolated from the pressures of current service delivery needs and demands. educators, as they view the realities of managed care and privatization, will understand the challenges of incorporating material in order that future practitioners remain in competitive positions for existing and future employment opportunities. managed care organizations frequently allow the boundaries of various professions to blur in order to reduce cost and maximize profit. while field instructors and service delivery environments offer important information for educators, educators must still contend with the issue of “how” to incorporate this material into curriculums in a meaningful manner. undoubtedly, incorporating this material will require that educators choose managed care information over other material. knowledge and skills, which were previously expected to be learned in the field site, may need to be formally incorporated into the classroom. this is particularly true of documentation skills, knowledge of business models, and general reimbursement information. not unlike classroom educators, field instructors face similar time constraints as a result of the multiple demands placed on them. previous research indicates that field instructors find it increasingly more difficult to provide intensive supervision and training to students (berkman, 1996; raskin & blome, 1996). with few other choices available, classroom educators may need to incorporate what has previously been covered in field supervision. cooperative work in this fashion will alleviate notions of the disconnection between the field and the classroom and ensure that students receive the preparation they need to negotiate current service demands. references alperin, d., gray, s., & wik, r. 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(1990). casework: a psychosocial therapy (4th ed.). new york: mcgraw-hill, inc. author’s note: address correspondence to: michael n. kane, ph.d., 7311 lyons road, coconut creek, florida 33073-4331 usa. 202 advances in social work spring2005-015_page17 spring2005-016_page18 spring2005-017_page19 spring2005-018_page20 spring2005-019_page21 spring2005-020_page22 spring2005-021_page23 spring2006-061_page57 spring2006-062_page58 spring2006-063_page59 spring2006-064_page60 spring2006-065_page61 spring2006-066_page62 spring2006-067_page63 spring2006-068_page64 spring2006-069_page65 spring2006-070_page66 advances vol. 1, no. 2 aisw editorial barry r. cournoyer iamdelighted to assume the role of editor of advances in socialwork: linking research, education & practice–journal of the indiana university school of social work. i am also grateful to the editorial board and to dean michael patchner for their invitation and support. although this issue is only the second of many, we are proud to contribute to the emerging knowledge base of the profession. the mission of advances in social work (aisw) is to provide a forum for the presentation of scholarly work related to innovations within social work research, education, and practice. the impetus for the development and publication of aisw is, of course, multifaceted. a driving force, however, is the recognition that social work educators and practitioners must become familiar with advances in knowledge that may contribute to improvements in the quality and effectiveness of our professional service–whether that involves the education of students, the advancement of social justice, the prevention of social problems, or the treatment of clients. early in the 21st century, we are well into the “third-wave” information age (toffler, 1983). as such, knowledge and learning are becoming increasingly valuable–in some circumstances more valuable than material goods.we already recognize the signs of a new form of class system where “haves” may be distinguished from“have-nots” by the facility with which they obtain and apply up-todate, valid, reliable, and relevant knowledge. according to some estimates, the total amount of knowledge on earth doubles approximately every seven years (davis & botkin, 1994). this knowledge-doubling process undoubtedly occurs more rapidly within certain areas than others. disciplines and professions that actively participate in the discovery and dissemination of relevant new knowledge are likely to become increasingly recognized and valued in the everexpanding “big bang” of the knowledge explosion. we hope that social work researchers, educators, and practitioners will become major actors in an information age where teaching, learning, and service become increasingly based upon and guided by the most current, valid, and relevant knowledge. “in a time of drastic change, it is the learners who inherit the future. the learned usually find themselves equipped to live in a world that no longer exists” (hoffer, 1973, p. 22). in effect, contemporary social workers must be extraordinarily competent learners both during their professional studies and as practicing researchers, educators, and service providers. during the 21st century lifelong learning is not optional. it is required. alvin toffler suggests that the “illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.” unfortunately, many social workers have been more “learned” than “learning” in their approach to service. relatively few seem to draw upon the wealth of emerging knowledge that could dramatically improve the quality and effectivei ness of their professional activities. as indicated by studies undertaken during the course of the past 40 years, few social workers regularly read scholarly publications or review the results of practice-related research (holosko & leslie, 1998). we presume that fewer still actually apply up-to-date knowledge in the conduct of their service to others. this does not apply to practitioners alone. indeed, we suppose that many social work educators continue to “preach” essentially the same theories and doctrines year after year–as if new knowledge were somehow irrelevant to the contemporary learning needs of their students. eileen gambrill (1999) eloquently refers to this process as “indoctrination” rather than “education” and practice informed by it as “authority-based” rather than “evidence-based.” through aisw, we at the indiana university school of socialwork seek to contribute to a revolutionary change within the profession. we envision a social work profession that genuinely embraces learning and scholarship; that actively searches for valid, relevant service-related knowledge; that disseminates applicable knowledge in a form that is readily accessible and usable by consumers of all kinds; and that continuously applies emerging knowledge in service to others. this issue of aisw offers much of value to learning social workers across the full range of research, education, and practice. in an article based upon his keynote address to the april 2000 annual doctoral symposium at indiana university school of social work and written especially for aisw, dennis saleebey of the university of kansas discusses the fundamental elements of strengths-based social work practice. as affirmative and enthusiastic as ever, dr. saleebey calls upon us to seek out assets and resources within and around each and every person. provocatively, he envisions a new kind of dsm–a diagnostic strengths manual–to provide needed counterbalance to the ever-present diagnostic statistical manual of the american psychiatric association. david hodge, paul cardenas, and harry montoya discuss their study of cultural sensitivity among administrators and staff in agencies that provide services for clients who have problems with alcohol, tobacco, and other drugs (atod) in a predominantly hispanic area within the united states. this is a fascinating investigation and one of the first to assess cultural sensitivity in agencies that address atodmisuse within an acculturated hispanic community. angeline barretta-herman and kendra garrett of the college of st. catherine/university of st. thomas school of social work identify pertinent issues and provide recommendations concerning the timely topic of facultystudent collaboration. in an interesting qualitative study, the authors conducted in-depth interviews with faculty members throughout the united states. several respondents had, as students, participated in collaborative efforts with faculty members during their formal studies. their findings alert today’s faculty members to recognize the potential for real or perceived exploitation by students with whom we collaborate. barry cournoyer, jerry powers, james johnson, and bob bennett of indiana university discuss the application of economic modeling to social work education. they demonstrate howmodern computer software may be used to analyze ii advances in socialwork costs associated with various educational processes. economic modeling may also enable deans and program directors to consider the economic impact of alternate “what if” scenarios. their innovative application may be useful not only for administrators within social work education but for those in human service agencies as well. doris mcgartland rubio, julie birkenmaier, and marla berg-weger of st. louis university discuss the relationship of social welfare policy changes and social work practice. their survey of nearly 300 community service agencies from a large metropolitan area reflects respondents’ views of the effects of welfare reform on their organizations as well as the responsibilities and activities of agency-based social workers.we anticipate the publication of additional studies that describe the results of investigations of the impact of welfare reform upon individuals, families, organizations, and communities. michael kane, elwood hamlin ii, and wesley hawkins of florida atlantic university enhance our understanding of necessary skills for service within managed care and privatized environments through their study of the perceptions of social work field instructors. their findings may encourage educators, supervisors, and agency administrators to consider carefully the contemporary learning needs of their social work students and practitioners. the editorial board and i are pleased to present this second issue of aisw to the social work community. in 2001, the indianauniversity school of socialwork will celebrate its 90th birthday. we dedicate this issue and the next two to the thousands of students, faculty, field instructors, agency administrators, and university colleagues who have contributed to the growth and development of the school over these nine decades. we hope that aisw readers and all members of the social work community will join us in a hearty happy birthday celebration during 2001. references davis, s., & botkin, j. (1994). the coming of knowledge-based businesses. harvard business review, 82 (september/october), 165-170. gambrill, e. (1999). evidence-based practice: an alternative to authority-based practice. families in society, 80(4), 341-350. hoffer, e. (1973). reflections on the human condition. new york: harper & row. holosko, m. j., & leslie, d. (1998). obstacles to conducting empirically based practice. in j. s.wodarski, & b. a. thyer (eds.), handbook of empirical social work practice: social problems and practice issues (vol. 2, pp. 433-451). new york: johnwiley & sons. toffler, a. (1983). the third wave. new york: bantam. iiicournoyer/aisw editorial advances vol. 4, no. 2 82 an outcome evaluation of competency based training for child welfare m. elizabeth vonk w. sean newsome denise e. bronson abstract: in response to the continuing need for competent child welfare professionals, a largemid-western university’s college of socialwork collaborated with a public childwelfare agency to design and implement a one year,title iv-e-funded training opportunity for second-yearmswstudents. student outcomes, including knowledge acquisition, attitudes about child welfare, and field of post-graduation employment, were evaluated using a quasi-experimental pre-post comparison group design (n=28). results indicated that there were statistically significant differences between the two groups concerning attitudes about child welfare practice. however, although trainees’ level of child welfare knowledge increased more than that of the comparison group, the difference did not reach statistical significance. implications for practice and social work education are discussed. keywords: child welfare, knowledge acquisition, evaluation, outcomes recruiting and retaining social workers for child welfare careers has been a topic of significant concern both for schools of social work and child welfare institutions (gleeson, smith & dubois, 1993; hopkins, mudrick & rudolph, 1999; jones, 2002; larner, stevenson & behrman, 1998; lieberman, hornby & russell, 1988). social work students are often reluctant to enter public child welfare due to concerns about job stress, negative public perceptions, and working conditions. retaining those who do enter the field has also been an issue. retention rates in many child welfare agencies have been abysmal, resulting in a workforce comprisedmostly of young, inexperienced caseworkers handling some of themost challenging and difficult cases. in addition, the cost of replacing workers is enormous, especially in terms of orientation and training (daly, dudley, finnegan & christiansen, 2000). nonetheless, extensive training is crucial given the increasing complexity of child welfare work (gleeson, et al., 1993). attracting and retaining a cadre of professionally trained child welfare workers is complicated by a number of factors both within schools of social work and the m. elizabeth vonk, msw, ph.d. is associate professor at the school of socialwork, university of georgia, athens, ga 30602; w. sean newsome, ph.d. is assistant professor, jane addams college of social work, chicago, il 60607; and denise e. bronson, ph.d. is associate professor, college of socialwork, columbus, oh 43210. copyright© 2003 advances in socialworkvol. 4 no. 2 (fall 2003) 82-93. indiana university school of socialwork. child welfare work environment. many social work students are reluctant to enter public child welfare, even if they have a strong interest in serving children and families. public child welfare is often viewed as stressful, low status, and low paying (jones, 2002; pecora, briar & zlotnik, 1989). according to numerous sources, these perceptions are not necessarily false (curtis &boyd, 1996; larner, et al., 1998; lieberman, et al., 1988. public scrutiny of the child welfare system by the media and the recent death of a childwelfareworker during a home visit inohio have further contributed to social work students avoiding public child welfare service. criticisms of social work education as it relates to the field of child welfare have also been voiced (gleeson, et al., 1993; lieberman, et al., 1988; hopkins, et al., 1999). social work education has been criticized for its lack of relevance to the actual skills and knowledge required for work within an agency. another criticism is that social work schools have shown a lack of commitment to recruiting and educating social workers interested in working within the public sector. suggestions for competency-based education and greater collaboration between educators and public agencies have been made in response to these criticisms (rycus & hughes, 1998). problems within child welfare agencies also contribute to difficulties in recruiting and retaining workers. caseloads are typically high, supervision is often weak, opportunities for promotion are limited, and policies are often changing and unclear (guterman & jayaratne, 1994; harrison, 1995; pecora, et al., 1989; rycraft, 1994;vinokur-kaplan&hartman, 1986). as a result, worker burnout is not uncommon and supervisors often recognize the problem too late to intervene (anderson, 1994; cicero-reese & black, 1998; glisson & hemmelgarn, 1998; guterman & jayaratne, 1994). the result is that most child welfare workers do not have social work degrees and, in some states, no pre-service training is provided (larner, et al., 1998). despite the obvious difficulties in attracting social workers to child welfare, the evidence is clear that those with social work degrees are better prepared to serve families and children in the child welfare system. several benefits of social work education for child welfare workers have been reported in the literature (lieberman, et al., 1988; hopkins, et al., 1999; olsen & holmes, 1982). those child welfareworkerswith formal social work training report feeling better prepared and more competent in the performance of their jobs than do non-professionally educated workers. social work educated workers also have been reported to provide higher quality services in child welfare. in addition, the social workers report greater job satisfaction. finally, social work education seems to increase retention of child welfare workers. many schools of social work, in response to the issues described above, have utilized title iv-e money to support the training of social workers for work in child welfare (rose, 1999). in fact, at least 24% of respondents from a recent survey of cswe-approved (or in candidacy) social work programs indicated the use of title iv-e money for degree-related education (zlotnik & cornelius, 2000). title iv-e training money, made available through the child welfare and adoption assistance act of 1980 (p.l. 96-272) is intended to provide education at the undergraduate and/or graduate levels for students who plan to work in public child wel83vonk et al./an outcome evaluation of competency based training for childwelfare 8484 advances in socialwork fare agencies. universities that utilize this money are expected to collaborate closely with public child welfare agencies; and students who receive funded education are expected to work in child welfare for one year upon graduation. at least four reports have recently addressed the use of title-iv-e monies by schools of social work. jones (2002) presented the results of a title iv-e program developed by the california social work education committee. she found that thosewith social work training had longer periods of employment in child welfare. zlotnik and cornelius (2000) have described the use of iv-e funding by schools of social work utilizing survey methodology. rose (1999) described the title iv-e childwelfare training program at the university ofwisconsin-milwaukee in relationship to adult-learning issues. in addition, they included qualitative data related to the students’ evaluation of the program. finally, robin and hollister (2001) examined and reported on the career development in, and contributions to, child welfare practice among 73 graduates of theuniversity ofminnesota’s childwelfare scholars program. they concluded that title iv-e monies were well spent, resulting in committed, social work trained child welfare professionals who were making many positive contributions to the field. this paper briefly describes a title-iv-e funded, msw-level child welfare training program and reports on student outcomes related to knowledge acquisition, attitudes toward child welfare clients and practice, and satisfaction with the training program. after a description of the program, the outcome evaluation method and results are presented. finally, implications for practice and social work education are discussed. program description the goal of the child welfare training program was to prepare a group of 14 masters-level social work students for postgraduate careers in child welfare through a collaborative effort between the ohio state university college of social work (csw) and a large, public county children’s services agency (ccs). students entering the second year of the msw program at the ohio state university were eligible to apply for the program. acceptance into the traineeship required that students express a desire to work in child welfare after graduation, have an acceptable grade point average, and possess a willingness to accept a field practicum at ccs. the organizing framework and foundation knowledge for this project came from the field guide to child welfare (1998) developed by judy rycus and ron hughes from the institute for human services (ihs) in columbus, ohio. this is a four volume set ofmaterials that identifies and teaches the core competencies for child welfare workers. these materials are distributed by the cwla and are currently used as part of the comprehensive competency-based in-service training (ccbit) system that has been adopted to train all child welfare employees in 24 states and six canadian provinces. typically, new workers are required to complete courses on the core competencies during their first year of employment. the ccbit system focuses on 52 competencies in four areas that are deemed crucial to current child welfare practice. for example, the core curriculum covers competencies on (1) the legal aspects of child protection, (2) family-centered 85 child protective services, (3) case planning/casework, and (4) the effects of abuse and neglect on child development. specialized competencies have also been developed on several topics such as adoption/foster care, working with adolescents, sexual abuse, intake/assessment, interventions, substance abuse, and others. despite the comprehensiveness of this system, however, it is still somewhat limited in addressing transfer of learning issues and does not include the most recent research in child welfare. although the ccbit system is widely used by states to prepare child welfare workers, social work programs that train msw students who plan to enter the child welfare field have not previously adopted these materials. the use of these materials by the ohio state university’s college of social work may serve as a model for other social work programs interested in using the institute for human services/cwla materials. in addition to standard msw requirements, a four-course series covering the core competencies (child and family policy, advanced child welfare practice (i and ii), and an integrative seminar on child welfare) was required of trainees. while the field guide to child welfare (rycus & hughes, 1998) provided a competency-based foundation, course content was supplementedwith recent empirical work in child welfare and a critical analysis of current trends in child welfare services. in addition, the curriculum was integrated with the field practicum component of themswprogram to ensure that students acquired the knowledge and skills needed to move quickly into child welfare positions upon graduation. the field practicum experience was supplemented with quarterly meetings including students, faculty members, and field instructors to discuss issues related to the integration of classroom and field learning. through these efforts, trainees in the programwere expected to increase their knowledge and skill competencies for provision of child welfare services, begin to think critically about current practices in child welfare, transfer their learning from the classroom to applied settings, and obtain employment in child welfare after completing the msw program at osu. to ensure continued collaboration throughout the traineeship, an advisory board was convened on a quarterly basis. the advisory board consisted of the authors of the field guide to childwelfare (rycus & hughes, 1998), county child welfare administrators, staff members from private child welfare advocacy groups, and university faculty members. the board met quarterly to review the program’s activities and discuss possible modifications to the curriculum or field experience. other components of the program included devising and implementing an evaluation of the training and disseminating information about the program to interested parties. the trainees were evaluated in terms of knowledge acquisition, skill development, attitudes about the child welfare profession, critical thinking skills, sensitivity to cultural diversity, and post-graduation child welfare employment. skill development was evaluated primarily through the field evaluation process and is not reported here. likewise, critical thinking skills were evaluated primarily through graded classroom assignments. evaluation of the trainees’ sensitivity to cultural diversity is reported elsewhere (vonk & curtis, under review). vonk et al./an outcome evaluation of competency based training for childwelfare 86 advances in socialwork the remainder of this report focuses on the evaluation of knowledge acquisition, child welfare attitudes, and child welfare employment one year after graduation. methods design and selection of students this study utilized a quasi-experimental pre-test-post-test comparison group design with a one-year follow-up. an additional follow-up interview with the trainees was conducted in 2002 (three years after the program for the 1999 cohort and two-years after the program for the 2000 cohort). the two groups used for initial pre-test-post-test comparison were second year msw students selected for the training program (n=14) and a group of second year msw students not involved in the training programwho volunteered to complete the outcome evaluation instruments (n=14). all eligible msw students received solicitation letters describing the child welfare-training program. the solicitation included information about the components of the training program and the expectation that trainees wouldwork in the field of child welfare for one year upon completing the msw degree. interested students were instructed to indicate ways in which the training programwould fit with their future study and career plans. students were then selected for the training group based on application letters reviewed by three faculty members involved with implementing the training grant. as a result, in each of the two years, seven second year msw students were selected to receive competency based child welfare training. comparison group participants also were recruited through letters circulated to all eligible msw participants. the recruitment letters contained information about the time commitment necessary for the study and a monetary incentive upon completing the questionnaires. in each of the two years, seven second-year msw students volunteered for the comparison group that received only the traditional second-yearmswcurriculum.thus, the 14 trainees were compared to 14 non-trainees. measures measurement of the students’ child welfare knowledge was based on the training materials developed by the institute for human services (ihs) and the child welfare league of america (cwla). knowledge acquisition was measured using the 81-item questionnaire that was developed for training purposes by the authors of the field guide to child welfare (rycus & hughes, 1998). specifically, the comprehensive 81-item child welfare knowledge questionnaire is divided into four sections that correspond to the organization of materials in the field guide: (1) “family-centered child protective services”; (2)“case planning and familycentered casework in child protective services”; (3) “the effects of abuse and neglect on child development”; and (4) “separation, placement, and reunification.” a variety of questions were used to gauge student knowledge in each of the aforementioned areas. participant attitudes and beliefs about child welfare practice were assessed using a 20-item questionnaire developed by the first author. the attitude and 87vonk et al./an outcome evaluation of competency based training for childwelfare belief scale was designed to assess student attitudes and beliefs, both about child welfare as a career choice and about working with child welfare clients. a fivepoint likert scale was used to assess student attitudes and beliefs (1=strongly disagree and 5=strongly agree). sample items related to working with child welfare clients include, “sometimes the general interests of the family should supersede the interests of the child” and “child abuse is basically caused by lack of parenting skills or flawed thinking in the abuser.” sample items about child welfare as a field of practice included “it is highly unlikely that i will be working in the field of child welfare 10 years from now.” and “sooner or later most child welfare workers become disillusioned with their jobs.” information about the post-graduate field of employment was obtained with a surveymailed exclusively to trainees one year following graduation from the program. graduates of the training programwere also contacted during the spring of 2002. in addition to questions about current employment, graduates reported their perceptions of the relevance and satisfaction with the child welfare-training program using the same likert scale described previously. procedure all training activities were offered during the second year of the msw program. the tests were administered to the trainees and students in the comparison group at the beginning of training in the fall of 1998 and 1999 and at the end of training in the spring of 1999 and 2000. follow-up surveys were mailed to graduates of the child welfare training one-year following graduation in the spring of 2000 and 2001. also, post-graduates of the training program were contacted via the telephone in the spring of 2002. data were coded and entered into a database, and analyzed using spss 10.0.5. in order to describe the data obtained from the group of trainees and contrast it to the comparison group, univariate, bivariate, and multivariate statistics were calculated. the rationale for using descriptive and inferential statistics was based on uncovering statistically significant differences between the group of trainees and the comparison group. in particular, it was hoped that those who participated in the child welfare-training programwould display greater gains in knowledge of and attitudes toward child welfare practice. results there were no significant demographic differences between the groups for age (x2 (2)=9.44, p=.66), gender (x2 (1)=.297, p=.58), race (x2 (2)=2.62, p=.26), or years of experience in child welfare (x2 (3)=3.39, p=.33). a substantial majority of students involved in the study were caucasian women. the majority of the students were in their twenties, with an age distribution that ranged from 22 to 58 years. with respect to years of experience in the childwelfare profession, 23 participants reported no experience, while five reported having one to three years of experience. overall, descriptive data showed an increase in child welfare knowledge from pre-test to post-test scores for the trainees and the comparison group using the child welfare knowledge questionnaire. specifically, the mean for the child wel88 advances in socialwork88 fare training group increased from 53.42 correct answers at pre-test to 60.46 at post-test. this is an overall increase from 66% to 75% on the 81-item welfare knowledge acquisition questionnaire. an increase in the number of correct answers also occurred in the comparison group from pre-test to post-test. the comparison group mean increased from 49.87 at pre-test to 55.08 at post-test, resulting in an overall increase from 62% to 68% on the 81-item questionnaire. despite the greater increase in knowledge scores among the trainees, independent t-tests uncovered no statistical significance from pre-test to post-test for trainee or comparison groups on the 81-item questionnaire, t (26)=1.08, p=.28; and t (26)=1.06, p=.29; respectively. in addition, when controlling for the pre-test, the one-way anova procedure uncovered no statistically significant difference between the two groups on child welfare knowledge at post-test, f (1, 26)=1.12; p=.30. the differences among mean scores did not produce a large enough effect to be detected within the limits of the statistical power. although there was no statistically significant difference for either group from pre-test to post-test on the knowledge component of the study, independent ttests did uncover a statistically significant difference between the trainees and the comparison group concerning their attitudes towards the field of child welfare practice. students in the training group had more positive attitudes about the profession of child welfare when compared to those students in the comparison group at post-test. on the other hand, there was no statistically significant differcharacteristics n % gender female 24 85.7 male 4 14.3 age (years) 22-30 22 78.6 31-39 4 14.3 40-58 2 7.1 race white 21 75.0 african-american 5 17.9 other 2 7.1 years experience none 23 82.2 one year 2 7.1 two years 2 7.1 three years 1 3.6 table 1: demographic characteristics of participants pre-test post-test knowledge acquisition scale n mean sd mean sd training group 14 53.42 8.53 60.46 6.63 comparison group 14 49.87 8.82 55.08 17.74 table 2: knowledge acquisition scale scores for second-year msw students before and after training 89 ence between the two groups on their attitudes towards child welfare clients at post-test. as expected, it was found that students in the training group were more likely than their counterparts to actively seek positions in the field of child welfare at graduation. in fact, all but one of the students in the training group, as compared to only two of the students in the comparison group, reported the intention to seek employment in child welfare. at the one-year post-graduation follow-up, we were able to contact 11 of the 14 trainees, all of whom completed follow-up questionnaires. all but two were employed in child welfare. at the twoor three-year follow-up, 12 of the 14 trainees were contacted by telephone. all but two of the 12 contacted reported currently being employed in child welfare. specifically, all those in the two-year follow-up cohort were employed in child welfare; whereas, all but two in the three-year follow-up cohort were employed in child welfare. for analysis purposes, missing data were replaced by themean of the distribution; an acceptable procedure when the replaced data do not exceed 15% for a particular case and/or variable (george &mallery, 2001). one-year follow-up also revealed favorable outcomes regarding the training participants’ attitudes about the field of child welfare practice and child welfare clients. in fact, comparisons from post-test to one-year follow-up uncovered that training participants had sustained a positive attitude in each area over the 12month time period. to the point, training group participants reported a minimal decrease of only 0.74 regarding their attitudes toward child welfare practice and a minimal decrease of only 0.70 regarding their attitudes toward child welfare clients. thus, the trainees maintained moderate to strong agreement with positive attitudes toward the child welfare profession and clients. post-test to one-year follow-up comparisons also revealed favorable outcomes concerning trainee satisfaction and trainee perception of relevance of the training they received. specifically, trainee satisfaction remained very high, with only a minimal decrease of 0.35. more importantly, the relevance of programmatic training to child welfare practice also remained very high, with a decrease of only 0.44. favorable outcomes were also uncovered at the twoor three-year followup. in fact, t-test for paired samples uncovered a statistically significant improvement on mean scores from the one-year follow-up to the twoor three-year follow-up concerning the overall relevance of programmatic training t (13)=2.37; p<.05, and overall satisfaction of programmatic training t (13)=2.34; p<.05. vonk et al./an outcome evaluation of competency based training for childwelfare measure cw profession cw clients training group 3.08* 3.14 comparison group 1.72 3.07 results of t-tests: *p<.01. table 3: post-test means for the scales measuring attitudes about the childwelfare profession and attitudes about childwelfare clients by training group and comparison group (n=28) 90 advances in socialwork at the post-test and follow-up interviews participants were also asked their opinions about the field guide to child welfare. the respondents consistently reported that the books were clearly written, easy to read, relevant, and useful. the limitations mentioned by the participants focused on the cost of the fourvolume set (about $120) and the difficulties they experienced transferring the information from the books to “real-life” situations. discussion the results of this study suggest that although child welfare trainees gained knowledge about child welfare practice, they did not do so at a rate statistically significantly greater than a group of students in the standard msw program. the trainees did, however, show amore positive attitude toward the field of child welfare as a career than did the comparison group. also, at one year and then again at either two or three years post-graduation, a high percentage of the former trainees were employed in child welfare with the intention of staying in the field for at least five more years. in addition, they reported the perception that most aspects of the training experience were satisfying and,more importantly, relevant to their current work. before interpreting the results further, important limitations of this study should be mentioned. first, the small sample size seriously limits the ability to generalize the results. in addition, bias in the non-random sample selection limits the ability to draw firm conclusions about the effects of the training intervention. obviously, students in the training group indicated high interest in the field of child welfare prior to training. just as importantly, students in the comparison group were exposed to information about child welfare through other classes in themsw program, or in a few cases, by electing to participate in one of the classes required of the trainees. finally, the instruments lack standardization. as such, the nominal increase in knowledge and the lack of statistical differences between the groups may be the result of learning stimulated by the administration of the pre-test, the overlap of knowledge acquired fromothermsw courses taken by the comparison group, or insufficient statistical power to detect differences. in spite of these limitations, the results suggest additional support for training social workers to work in the field of child welfare. post-test one-year two-year score follow-up follow-up measure m sd m sd m sd satisfaction with 2.92 2.01 2.57 1.73 3.50* .65 training relevance of 2.85 1.95 2.41 1.58 3.71* .82 training note: comparisons between one-year follow-up and two-year follow-up results of t-tests: *p<.05 table 4: satisfaction and relevance of programmatic training (n=12) 91 related to concerns about the professional and educational preparation of social workers for child welfare careers (gleeson, et al., 1993; lieberman, et al., 1988; hopkins, et al., 1999), these results appear to have provided both a reason for hope and continued concern. first, related to the perceived need for more professionally trained social workers in child welfare, these results suggest that thetitle iv-e funding did support the professional education of 14 social workers, the majority of whom were employed in the field of child welfare two to three years after graduation. similar to the findings of robin and hollister (2001), these results were promising also in terms of the retention of child welfare workers whose education was funded by title iv-e money. all of those employed in child welfare one year post-graduation reported the intention of staying there. the interpretation of the results in light of the criticism that social work education has not been relevant to the work of child welfare may also be seen in a positive light. most of those trained perceived the “training overall” to bemoderately to very relevant to their work even after two or three years had elapsed. in spite of these positive findings, the students’ modest gain in knowledge about child welfare remains a concern, both in terms of curriculum planning and researchmethodology. although this study did not address curriculum, per se, we have given thought to this concern and speculate that curriculum might be strengthened in several ways. first, trainees might benefit from a curriculum that could be tailored to the individual’s needs based on pre-training testing of knowledge and skills. many of the trainees began the program with work experience in child welfare. as such, they entered the programwith varying levels of knowledge about child welfare. learning might be maximized by tailoring learning objectives and related activities for each of the overall program goals according to the needs of each student. for example, a student with a high baseline of knowledge and skills in the area of adoptive placement may benefit from a greater focus on other areas of child welfare such as child protective investigation. other curriculum changes might include those that focus on transfer of learning. for example, use of classroom time could place a greater emphasis on experiential learning activities that require analysis and synthesis of information. in addition, classroom instructors and field supervisors might collaborate to create direct ties between field and classroom learning through the use of case-studies and assignments that require integration of classroom knowledge and field experience. regarding future research on child welfare training effectiveness, while there is accumulating evidence to support the effectiveness of training social workers for the demands of child welfare work (hopkins, et al., 1999; robin & hollister, 2001; rose, 1999), the studies, including this one, have all been exploratory in nature. furthermore, methodologically rigorous research is important in order to help guide title-iv-e appropriations and determine whether participants are adequately trained to meet the needs of clients. samples should be sufficiently large that small effect sizes might be detected. multi-site training projects such as one currently in planning stages in the state of ohio potentially would provide a large group of trainees. amulti-site programwould also provide the possibility of interesting comparisons of the effects of various learning activities related to consisvonk et al./an outcome evaluation of competency based training for childwelfare 92 advances in socialwork tent goals among the sites. this would, of course, require careful operationalization of the training interventions. finally, future research must also include the use of meaningful comparison groups. at the very least, the students in the comparison groups should not be exposed to coursework designed specifically for trainees. while this study found that a small cohort of title-iv-e funded child welfare trainees made modest gains in knowledge, maintained favorable attitudes about the child welfare profession, and for the most part, remained employed in child welfare for up to three years following training, it is clear that further evaluation is needed. as others have observed (gleeson, et al., 1993), the complexity of problems encountered by child welfare workers requires increasing levels of knowledge and skills. future child welfare professionalsmust be armedwith the knowledge and skills needed to meet the demands of their jobs. competency-based child welfare training curriculums and educational collaborations must be strengthened and rigorously tested to determine whether those who participate in training are better able to deliver child welfare services. references anderson d. (1994). coping strategies and burnout among veteran child protection workers. doctoral dissertation, university of south carolina. cicero-reese, b., & black, p. (1998). research suggests why child welfare workers stay on the job. partnerships for childwelfare, 5(5), 8-9. curtis, p., & boyd, j. (1996). 1995 salary study.washington, d.c.: childwelfare league of america. daly, d., dudley, d., finnegan, d., & christiansen, j. (2000). staffing child welfare services in the new millennium. san diego, ca: network for excellence. george, d., & mallery, p. (2001). spss forwindows: a simple guide and reference. boston: allyn and bacon. gleeson, j.p., smith, j.h., & dubois, a.c. (1993). developing child welfare practitioners: avoiding the single-solution seduction. administration in socialwork, 17(3), 21-37. glisson, c., & hemmelgarn, a. (1998). the effects of organizational climate and interorganizational coordination on the quality and outcomes of children’s service systems. child abuse and neglect, 22(5), 401421. guterman, n., & jayaratne, s. (1994). “responsibility at-risk:” perceptions of stress, control and professional effectiveness in childwelfare direct practitioners. journal of social service research, 20(1/2), 99-120. harrison, s. (1995). exploration of factors related to intent to leave among child welfare caseworkers. doctoral dissertation, the ohio state university. hopkins, k.m., mudrick, n.r., & rudolph, c.s. (1999). impact of university/agency partnerships in child welfare on organizations, workers, and work activities. childwelfare, 78, 749-773. jones, l. (2002, february). retaining title iv-e graduates in child welfare: a follow-up study. paper presented at the annual programmeeting of the council on socialwork education, nashville, tn. larner, m., stevenson, c., & behrman, r. (1998). protecting children from abuse and neglect: analysis and recommendations. the future of children, 8(1), 4-22. lieberman, a.a., hornby, h., & russell, m. (1988). analyzing the educational backgrounds andwork experiences of child welfare personnel: a national study. socialwork, 33, 485-489. olsen, l., & holmes, w. (1982). educating child welfare workers: the effects of professional training on service delivery. journal of education for socialwork, 18, 94-102. pecora, p., briar, k., & zlotnik, j. (1989). addressing the program and personnel crisis in child welfare. silver springs, md: nasw. 93 robin, s.c., & hollister, c.d. (2001). career paths and contributions of four cohorts of iv-e funded msw child welfare graduates. journal of health and social policy. rose, s.j. (1999). educating adult learners for child welfare practice: thewisconsin experience with title iv-e. journal of teaching in socialwork, 18(1/2), 169-183. rycraft, b. (1994). the party isn’t over: the agency role in the retention of pubic child welfare workers. socialwork, 39, 75-80. rycus, j.s., & hughes, r.c. (1998). field guide to child welfare.washington, d.c.: cwla press. vinokur-kaplan, d., & hartman, a. (1986). a national profile of child welfare workers and supervisors. childwelfare, 65, 323-335. vonk,m.e., &curtis, c.c. (under review). pilot test of a learning experience designed to engage social work students in the development of racial awareness. zlotnik, j.l., & cornelius, l.j., (2000). preparing social work students for child welfare careers: the use of title iv-e training funds in social work education. the journal of baccalaureate socialwork, 5(2), 1-13. author’s note: address correspondence to: m. elizabeth vonk, msw, ph.d., associate professor, school of social work, university of georgia, tucker hall, athens, ga 30602, usa. e-mail: bvonk@uga.edu vonk et al./an outcome evaluation of competency based training for childwelfare aisw vol. 5, no. 2 i editorial seeing the panorama of social work james g. daley aseditor of advances, i am offered a rare gift. i see a wide range of manuscripts that seek to expound on some aspect of social work. some make the cut and become articles in advances, while others are rejected because they needmore work. all of the submissions are socialwork at its finest. all themanuscripts stimulate my thinking about howsocialwork as aprofession advances and towardswhat future. this issue is an excellent illustration of that stimulation. this edition is a potpourri of interesting issues that affect social workers. besel and colleagues insightful article describes how agencies and courts can effectively partner to foster program sustainability. danis’ article emphasizes the key factors that influence a social worker’s effectiveness with battered women. collins and moore’s article highlights an often forgotten but vital issue: the preference of african americans to be addressed by their last name.wilks and spivey discuss how journal editors value reference list accuracy. hodge illustrates theoretical ideas that underlie the spiritual assessment conducted by social workers. sherr and wolfer suggest ways that faithbased organizations can be incorporated into social work curriculum.miller analyzes whether prisonerswithmental retardationwere able to adequately participate in their legal process. half of the articles are empirical studies, while the other half are practice-focused. all of the articles address topics important to consider. as i was piecing together this issue, i pondered past issues of advances and the topics covered. of course, the spring 2004 issue focused on detailed descriptions of student assessment and various ways we strive to educate future social workers. the spring 2003 issue included topics such as biophilia (person and environment link), hearing children of violence, and multi-cultural practice. fall 2003 highlighted such issues as on-line practice guidelines, issues of rural and urban practices, risk and liability, and poetry therapy techniques. spring 2002 issue covered managed care, kinship care, and research with african americans.within two short years, advances has covered quite a range of topics. the spring 2005 issue is being formed now, with leaders in the field contributingadiverse collectionof viewsabout the futureof socialwork as a profession. so what is my point? the high quality of scholarship captures the panorama that is socialwork. the profession is not just clinical precision or academic rigor. thoughwe have depth of expertise in our chosen practice setting, wemust be constantly open to widening our lens of knowledge beyond our parochial setting. a social worker who works with cancer patients is pushed to consider issues such as using a person’s first namewhenworking with african americans, or how to effectively conduct a spiritual assessment, or strategies to foster program sustainability, or how to use bibliotherapy with patients, or consider biophilic principles to enhance well being. regardless of the setting, a social worker reading advances should feel challenged to think differently, to consider an issue not on our radar screen, to gain additional tips for practice.that ismygoal. i strive tohelp expand the reader’s perspective. in the special issues, the reader gets depth of a topic. in the regular issues, the reader gets a diverse collection. we have been fortunate to have a wide range of manuscripts submitted for consideration. each manuscript is critiqued by reviewers. as editor, i take those accepted manuscripts and strive to build a diverse, stimulating issue. whether administrator, clinician, or researcher, advances offers useful articles. so, to the reader, i offer this suggestion. read each article and consider how it can make you a better social worker. this issue has lots to offer. enjoy! ii advances vol. 4, no. 1 1 nature, genetics, and the biophilia connection: exploring linkages with social work values and practice fred h. besthorn dennis saleebey abstract: social work’s notion of environment and its environmental responsibilities has always been narrowly defined. the profession has tended to either neglect natural environmental issues or accept shallow, ecological conceptualizations of nature as something other, quite separate from the human enterprise and/or outside the reach of social work activity. the biophilia hypothesis, first articulated by harvard biologist e.o.wilson in 1984, offers social work as a fundamentally different view of the person/environment construct and argues for a primary shift in the way the profession views its relationship with the natural world. this article traces the conceptual development of the biophilic theory and reviews pivotal empirical evidence explicitly arguing for the essential biophilic premise that humans have acquired, through their long evolutionary history, a strong genetic predisposition for nature and natural settings. it offers key insights and examples for incorporating biophilia into social work’s values and knowledge base and how it may impact the profession’s practice strategies and techniques. keywords: values, genetics, practice, biophilia hypothesis, environment, ecological/systems, nature nearly every culture, from the early aboriginal tribes of australia to the most devoted urbanites of post-industrial europe or america, have recognized that nature is good for the soul and absolutely critical to physical survival. daily, untold numbers of people gaze out a window at an uncomplicated scene of trees and diminutive wildlife or tend a flower garden and feel a deep sense of satisfaction and connection to an unseen natural beneficence. at any given moment a child or older person caresses a cherished pet and feels less alone andmore loved. these phenomena and countless others like them furnish compelling evidence of what pulitzer prize-winning author, harvard biologist, anddistinguished professor edward o. wilson calls the the biophilia hypothesis. wilson (1984) concluded in his groundbreaking work biophilia: the human bond with other species, after a generation of research and observation, that human beings not only derive specific fred h. besthorn, ph.d. is associate professor, department of social work, university of northern iowa, cedar falls, ia, 50614. dennis saleebey, ph.d. is professor, school of socialwelfare, university of kansas, lawrence, ks 66045. copyright© 2003 advances in socialworkvol. 4 no. 1 (spring 2003) 1-18 indiana university school of socialwork. 2 advances in socialwork aesthetic benefits from interacting with nature, but they also have an instinctive, genetically-determined need to deeply affiliatewith natural settings and life-forms. wilson (1993, 2002) and other biophilic theorists contend that the need to affiliate with non-human organisms and eco-systems is innately biological and intensely emotional. human responses to these deep affiliations have complex benefits that not only enhance psychic and physical well being but they are critical to our adaptive skill for survival as a species. evidence of this biologically determined need to affiliate with and experience nature has persisted throughout pre-modern and modern cultures. for example, more than one-half of all u.s. households own pets (beck & myers, 1996) and animal depictions comprise over 90% of the imagery used in language and counting acquisition exercises in children’s preschool books (kellert, 1993). recent research also shows that an estimated 70%of all adolescents speak to or confide in their pets (frumkin, 2001). more americans visit zoos during an average year than attend all professional football, basketball, and baseball games combined (kellert, 1997). people crowd into national parks to experience natural landscapes or travel thousands ofmiles to stroll on a beach.visits to national parks and protected areas have risen so dramatically in the past few years that many are now beset with an excess of interest (kellert, 1997) that threaten to harm or even destroy the fragile ecosystems of these cherished locations. this inclination to affiliate with nature is more than an aesthetic sensibility or emotional support mechanism. it is, according to biophilial theory, integral to healthy human development (kellert, 1997; orr, 1993). the essence of biophilia is that human beings have a need—a biological imperative—to connect with nature in order tomaximize their potential and lead productive, fulfilling lives. biophilia theory is still in its early developmental phase.nevertheless, researchers from diverse disciplines such as architecture, landscape design, psychology, biology, genetics, child development, geography, and evolutionary science are beginning to critically examine and detail both the limits and possibilities of this emerging inter-disciplinary impulse (frumkin, 2001). wilson, considered the progenitor of the nascent fields of evolutionary psychology and sociobiology, has led the way in these efforts by asserting that humans developed in a co-evolutionary manner. in other words, genetic pre-dispositions arose within natural settings and local contexts, and as a species, we have been intimately tied to a variety of natural environments. cultures, too, have developed over time, partially in response to local, natural conditions. these pre-dispositions play a pivotal role in human evolution because theyhave led to the adaptationof the species.other eminent scientists and scholars, including stephen kellert, professor of forestry and environmental studies at yale university and robert ulrich, professor of architecture at texas a&m, also continue to verify from extensive cross-cultural research that our eon’s old affiliation with nature has conferred advantages in our species’ survival throughout history (kahn, 1997). from this evidence it seems clear that people continue to need and value nature precisely because of the genetically encoded adaptive benefits it has conferred upon us physically, emotionally, and intellectually (kahn&kellert, 2002; kellert, 1997).this article focuses on aportionof this expanding data, suggesting a biophilia connection and what this has to recommend to social work theory and practice. evolutionary foundations of biophilia for nearly all of human history people have lived in situations that are deeply embedded into the natural environment (eisler, 1990). survival depended on familiarity with all aspects of physical, natural surroundings. over millions of years, a kind of bio-cultural evolution progressed, wherein genetics and culture evolved simultaneously (verbeek & dewaal, 2002). propensities for certain behaviors (culture)were spread by natural selection if they bestowed adaptive advantage and, thus, the ability to reproduce successfully (natural selection).wilson (1993, p. 33) explains: “a certain genotype makes a certain behavioral response more likely and the response enhances survival and reproductive fitness...the genotype consequently spreads through the population and the behavioral response grows more frequent.” it would be highly unlikely that these adaptive advantages, developing over the course of literallymillions of years from early homo habilus tomore recent homo sapiens, would somehow be diminished simply because humans began cultivating crops, domesticating animals, creating technologies, and forming collective settlements. thus today, an intriguing body of research suggests that people still routinely choose natural landscapes such as water views or eminences nearwater fromwhich park-like land can be viewed.this is probably an important remnant of the fact that all natural selection is “about adaptation to changing local environments” (gould, 1996, p. 139). safety and the savanna it is now generally accepted in the scientific community that humans lived and evolved for most of their two million years on the savanna of east africa (eisler, 1990; haila & levins, 1992; kahn & kellert, 2002; ulrich, 1993;wilson, 2002). this setting was ideal, because certain features of the landscape offered enhanced chances for survival. a basic tenet of biophilia is that “humans function optimally in environments that possess attributes of the natural settings in which they evolved” (knopf, 1983, p. 213). the savannas provided numerous major advantages for early humans. they offered visual openness and thus few hidden predators. they had abundant plant and animal food sources and reliably available water. the trees were spaced distances apart or in small clusters and were shaped to provide either vantage points for surveillance or escape opportunities (ulrich, 1993; wilson, 2002). because humans evolved over millions of years in this environment, biophilic theory asserts that we have become physiologically and psychologically adapted to these particular types of natural settings (kahn, 1997; kahn & kellert, 2002). indeed, ulrich (1993) found that certain cross-culturally consistent preferences provide empirical support for the hypothesis that biophilia is grounded in genetics. groups as diverse as north americans, east asians, australians, europeans, and central africans show a pervasive bias toward savanna-like natural environments. these preferences have also been found to exist across all age groups and even among children as young as seven years old (ball & falk, 1982; newell, 1997). the research demonstrates, for instance, that the species of trees rated most attractive by virtually all cultural groups match the prototypic savanna tree (ulrich, 1993, p. 5) where “canopies were moderately dense and trunks bifurcate 3besthorn, saleebey/nature, genetics, and the biophilia connection: exploring linkages near the ground.” findings of cross-cultural preferences for globular or small groupings of tress and away from conical or columnar tree forms and other savanna-like conditions of spatial openness support the genetically-based condition of biophilia (sommer & summit, 1996; wilson, 1993). other features of the savanna biome that continue to be cross-culturally valued are uniform grassy ground surfaces or open landscapes with smooth ground texture and low-actionwaterscapes (kahn, 1997). a preference for green, verdant vegetation, flowers, and especially water, exists today probably because throughout evolution they could be associated with the necessities of food and water (ulrich, 1993). biophilia asserts that these seminal preferences and many others like them are closely tied to the genetic model of environmental response. thus, “people may have an evolutionary predisposition to view vegetated places as safe and resource rich” (sheets & manzer, 1991, p. 301). kaplan (1983), for example, studied views from homes and found a positive correlation between the presence of trees and neighborhood satisfaction. proximity to natural areas and/or the increased presence of trees also increased the perception of support fromneighbors and feelings of friendliness toward neighbors. neighborhoods are perceived to be better, safer, cleaner places inwhich to live and easier places inwhich tomake a living. not only do people prefer to see the natural world from their homes, but having such views alter people’s experiences of places and effects their satisfaction with physical and social environments. people think more creatively, feel friendlier, and become more cooperative and less sadwhen surrounded by vegetation.there are also economic advantages to having nature close to home. features such as trees and water increase property values (kellert, 1997). gold (1997) found homes and business property located next to well-landscaped parks hold higher value, rental rates the highest for propertieswith a viewofwater, and a lower rate of turnover in property ownership in well-landscaped neighborhoods versus those lacking in vegetation. naturalversus built environments one of the most revealing empirical findings of the existence of biophilia is the consistent tendency of people to prefer natural scenes over built views. numerous studies (heerwagen & orians, 1986; kaplan, 1983; newell, 1997; shafer & tooby, 1973; sheets &manzer, 1991; ulrich, 1981, 1983) have been unanimous in showing that even unspectacular or sub-par natural views elicit higher rates of aesthetic preference and pleasantness compared to very few well-known urban views. earlier research has assumed that preferencewas amatter of learned response and therefore predicted differences would be found among urban and rural dwellers, as well as among cultures. shafer and tooby (1973), among others, found this not to be the case. there is great similarity in response to natural scenes among individuals and across groups. lacking natural views, people prefer environments built with water, trees, and other vegetation to those without these features (kahn, 1997). ulrich (1983) and smardon (1988) found that urban parkswith savanna-like features add greatly to the aesthetics of a cityscape. kellert (1997) notes that when asked to depict an ideal landscape, people consistently describe scenes containing waterfalls or nearby water, flowers, vegetation with fruits, park-like settings, and branching-canopy trees. kellert (1997, p. 41) is convinced that this “…instinctive 4 advances in socialwork aesthetic appears to be tied to the increased likelihood of encountering sustenance and security.” when given the option, people will choose landscapes that “…fit with patterns from deep in human history on the savannas of east africa” (kahn, 1997, p. 1). benefits of nature and animals if certain natural settings have promoted and currently reflect evolutionary survival, and if the biophilia connection to these natural places exist as hypothesized, then, these same constituent places should still show evidence of continuing to nurture human well-being. ulrich (1993) and kellert (1997) analyzed more than 100 studies that had shown exposure to natural areas, especially those with savanna-like properties which have powerful impacts on human physiology, psychology, and metaphysical awareness. they concluded that this postulated biophilia relationship does, in fact, exist even if not yet fully understood. indeed, minimal contact with nature and other-than-human beings, such as looking out a window or having a pet, has a profoundly positive impact on human functioning, which is often disproportional to the amount or degree of exposure to these natural domains (herzog & bosley, 1992; kahn, 1997). nature: physiology and stress reduction the belief that exposure to trees, water, and other natural scenes tends to promote well-being and provides restorative benefits from the burden of everyday living is documented fromroman times (perlman, 1994;ulrich et al., 1991). inmore recent history, frederick law olmstead, the architect of central park in new york city, wrote of his belief that the pressures associated with cities could be mitigated by viewing nature (ulrich et al., 1991). olmstead believed that nature exercised the mind without fatigue and that it acts as a tranquilizer for the mind while simultaneously enlivening it. even today,more than 130 years later, there ismounting evidence from a variety of disciples that he was correct; natural settings have restorative capacities (hartig, mang & evans, 1991; ulrich, 1984). affiliating with nature, either directly or through a surrogate, frequently provides away to escape from the pressures and strains of daily life. even short exposures to nature have an important function for many city-dwellers in facilitating recovery from noise, crowding, and the annoyances of urban life (herzog&bosley, 1992;ulrich et al., 1991). kellert (1993) states: “the solitude of nature can be an antidote to the excessive stimulation of modern life” p. 94). similar kinds of benefits have been documented for persons suffering from severe stress. one study (ulrich, 1993) asked people to describe the settings they sought when they were stressed or depressed. more than 75% of respondents described outdoor places that were either natural environments or urban settings dominated by natural elements such aswooded parks, placeswith scenic views, or the beaches of lakes and oceans. once individuals are stressed, encounters with natural environments have a restorative influence, whereas, many urban environments will hamper recuperation (ulrich et al., 1991). decreases in heart rate and blood pressure, relaxation of muscle tension, and increases in brain alpha waves indicative of relaxation are all typical responses when exposed to natural scenes. these measures are stronger still when people are exposed to scenes containing 5besthorn, saleebey/nature, genetics, and the biophilia connection: exploring linkages 6 advances in socialwork water (ulrich et al., 1991). parsons (1991) points out that another potential influence of natural environmental perception on human health includes an increase in immune system functioning that occurs when stress levels remain low. nature: emotional, cognitive, and spiritual responses while suggesting clear associations between experiences with natural settings, physiology, and stress reduction, the nature connection appears also to go beyond these to include shifts in a broad range of emotional and cognitive states (herzog & bosley, 1992; tennessen & cimprich, 1995; ulrich, 1993). nature seems to have a positive effect on a cluster of emotions, including friendliness, playfulness, elation, and affection (ulrich, 1979; coley, solomon & shafto, 2002). for example, sheets and manzer (1991) report positive emotional attachments rising in direct correlation to the amount of vegetation present in a view. hull and harvey (1989) found that when fatigued and pressured, feelings of pleasure, comfort, and satisfaction rise in proportion to the number of trees within view. ulrich (1979) and hartig, mang and evans (1991) report reductions in anxiety, fear, anger, and aggression when viewing nature scenes, and feelings of tranquility and serenity as common reactions to open spaces, lush vegetation, and large trees. research has also explicitly demonstrated that nature can evoke important cognitive responses. kaplan and talbot (1983) found that when people have difficulty concentrating or find mental work unusually effortful, an experience with nature can provide a feeling of escape. the experience provides opportunities to be interested in something else and removes the demands on one’s behavior that are imposed by humans. this lessens irritability, increases awareness of one’s own thoughts and feelings, and enhances self-confidence. ulrich (1993) cites research which indicates that nature experiences stimulate intellectual activity by increasing curiosity and enhancing creativity. in addition, increased abilities to problem solve can result from contact with nature. the “relaxed attentional state produced by nature may facilitate a more creative, less stereotyped pattern of thought...and could offer advantages...through better problem solving” (katcher &wilkins, 1993, p. ). it seems clear that certain aspects of nature can elicit powerful emotional and cognitive responses. only recently, however, have scholars and researchers begun to systematically look at those feelings of awe, mystery, excitement, and spiritual transcendence that are typical reactions to experiences with natural places. kellert (1993) and many others, such as besthorn (2000; 2001) and besthorn and canda (2002) go beyond conventional emotional responses and emphasize deep metaphysical and spiritual attachments that human beings often formwith the natural world. a certain plant, a nearby forest, or any favorite location can evoke feelings of familiarity, intimacy, and transcendence. even ordinary and unspectacular nature can assume a deep meaning if encountered as a daily part of life. human kind often comes to deeply, passionately, and spiritually “depend on trusted and familiar places” (kellert, 1997, p. 185). destruction of thesewell-known landscapes can produce feelings of profound loss, despair, and even grief (kellert, 1997). the intimacy people feel with nature fulfills social and transcendent needs for relationship and can provide “the emotional strength to confront life’s vicissitudes” (kellert, 1997, p. 110). animals: physiological and emotionalwell-being while direct experiences with natural landscapes contribute to stress reduction and a wide range of physiological, emotional, cognitive, and spiritual benefits, it is humankind’s deep-seated affinity with animals that offers the most convincing expression of biophilia. for millennia, animals have shared our land, air, and water. they have been essential to our physical survival and the source of intense personal friendships and affection. they suffered with us, died for us, inspirited our daily tedium, animated our stories of creation, and have been singly most important, well ahead of our connection to the natural world around us (hogan, metzger & peterson, 1998). kellert (1997) asserts that animals “represent the most common focus of bonding to the non-humanworld” (p. 94). so long standing and resonant are our bonds to animals that we have a tendency to consider animals as kin (katcher &wilkins, 1993). contact with animals promotes physiological health and emotional well being (kahn, 1997). adults aremore likely to be approachedwhen they are accompanied by an animal, thereby, increasing the likelihood of social interaction among people (katcher & wilkins, 1993). numerous studies show a strong correlation between the tactile comfort and companionship provided by pets and better health and life expectancy. people have a need to feel accepted, respected, and cherished. animals fill that requirement by providing us with uncritical attention, devotion, and a sense of being valued and wanted (kellert, 1997). they can evoke a sense of belonging that has an impact on our ability to cope and can provide “an antidote to isolationandaloneness” (kellert, 1997,p. 107). friedmann,katcher, lynch & thomas, (1980) and friedmann and thomas (1995) have found that patients with heart disease have better survival rates if they are pet owners. affiliation with pets has lessened feelings of isolation, uncertainty, and loneliness and has thus reduced physiological arousal and the likelihood of ongoing cardiac distress. pet ownership among elderly people has been shown to decrease visits to doctor’s offices (siegel, 1990) and increase positivemeasures ofmental health. katcher andwilkins (1993) cite dozens of studies showing the beneficial effects of resident animals on institutionalized elderly suffering with chronic brain syndrome. patients who were previously unresponsive focus their attention on animals and interact with them. residents begin smiling, laughing, and talking to the animals and the volunteers who accompany them. over the long-term, these patients are less hostile to their caregivers and generally more socially communicable (kahn, 1997). kahn observed, that people: “...are happier and live longer in the regular presence of animals...there is calming among the bereaved, quicker rehabilitation by alcoholics, improved self-esteem among the elderly, increased longevity by cardiac and cancer patients, improved emotional states among disturbed children... more cheer among the mental and physically handicapped...and general facilitation of social relationships. (p. 9) socialworkvalues and practice in a biophilic context social work has always had an ambivalent understanding of its relationship to the natural world. the profession has consistently claimed for itself an ecological 7besthorn, saleebey/nature, genetics, and the biophilia connection: exploring linkages awareness. our person/environment, ecological, systems, and eco-systems models of practice have centered the profession’s collective attention on the link between the individual and his or her unique surroundings (besthorn, 2002; besthorn & canda, 2002; besthorn &mcmillen, 2002). they have served as helpful guides to our intervention strategies and our understanding of the human condition (germain & gitterman, 1996). indeed, few social workers would allege that their professional orientation is not guided, if only peripherally, by some form of environmental or ecological consciousness. yet, with few exceptions, for all their descriptive and explanatory power, social work’s conventional environmental models have shownan almost complete disregard for integrating a comprehensive understanding of the connection between person and the natural environment and the way we derive individual and collective meaning from this association (bartlett, 2000; besthorn, 2000, 2002; coates, 2000; hoff & mcnutt, 1994; hoff, 1998; kahn & scher, 2002; rogge, 1994).with few exceptions, social work does not generally recognize the connection between person and nature or inquire into it, develop theory around it, or place it in its computations of what is important to those the profession serves (nasw, 2000; besthorn, 2001; 2002). nature has tended to become the benign backdrop formore fundamentally important personal or social interactions.when it comes to nature, social work’s diffidence alsomay be a part of a general reluctance to venture too deeply into the biological sphere, believing it to be the domain of other disciplines and professions (saleebey, 1992; 2001; 2002). yet, scant justification remains for a continuation of this epistemological myopia. indeed, as has been suggested, experiencing nature and finding intense connectionswith animals enriches people’s lives inways never before understood. nature in all its forms is a critical ingredient for healthy development and realization of full human potential. it is certainly essential to survival.while many scholars believe that expressions of biophilia represent, as with most complex phenomena, weak biological tendencies clearly “shaped by themediating influence of learning, culture and experience” (kellert, 1997, p. 4), it is, nonetheless, clear that natural affiliations, operating through as well as expressing our biophilic propensity, represent a vast accumulation of resources critical to the way social work understands and responds to the physical, psychological, social, and spiritual development and well-being of the clients we serve. corevalues: dignity and justice the biophilia hypothesis and the multiple manifestations we see of it in contemporary life are compatible with the core values and concerns of social work. like social work, biophilia theory recognizes the intrinsic worth and dignity of all human beings inasmuch as biophilia respects the significance and integrity of all beings in the biospheric community. biophilia acknowledges the complex interrelationship of life. this means that all living organisms, not just a select few, have inherent value and this value is created and sustained in the context of deep relationship. each of us is dependent on all others in this immense planetary ecosystem we call earth. we are interrelated to such an extent that the lessening of one member of this system is ultimately the diminishment of all. the dignity of individuals and thewell being of society are tied fundamentally to the dignity that eco8 advances in socialwork logical and social justices are intimately intertwined. severed, fractured, and unjust human relationships threaten and diminish the existence of nature. one need only look as far as the incalculable damage done to the natural world as a result of civil strife and international conflict. biophilia is very much about dignified, just, supportive interrelationships built upon integrity and mutual respect and, in this sense, it fits impeccably with the core values of social work. following the principles of biophilia, humans have developed biological preferences for nature beyond the basics of physical survival because nature has enhanced their ability to survive emotionally and spiritually as well as physically. humans need nature not just to sustain life, but to enrich and enhance it (besthorn, 2001; hoff & mcnutt, 1994). having little or no access to vital, healthy, natural areas and animal encounters decreases the value of the human experience. thus, people who are denied the availability of rich, healthy environments and intimate nature experiences are denied the dignity of having full access to resources critical to their healthy development.this is likely to be the case formost if destruction of the environment and loss of bio-diversity continues at its present rate. currently, the impact of environmental degradation falls most heavily on people of color, those living in poverty, or those otherwise socially or politically disenfranchized. not only are the poor andmarginalizedmore likely to reside in settings devoid of healthy nature, they are also more likely to be victims of environmental destruction due to industrial exploitation of land and resources. large industries that cause pollution and community disruption are not likely to be placed in affluent neighborhoods populated mostly by people who are white and prosperous (bullard, 1993). corporate interests have shown little hesitancy to locating these enterprises in poor neighborhoods where a few, often individuals of color, are forced to bear the burdens of industrial processes and residual waste from which the majority benefits. industrialization, pollution, poverty, oppression, and environmentalism are all inexorably linked (besthorn & mcmillen, 2002). in recent reviews, boerner and lambert (1995), stephens (1996), and others have found clear patterns showing that communities with greater minority populations aremore likely to be the sites of heavy industry and commercial hazardous waste facilities. these investigations have also discovered that significant disparities exist in the fines levied against polluters in white communities and those inminority areas. it was also found that the environmental protection agency took longer to clean up waste sites in poor and minority communities than in affluent areas. not only are the hazardous waste sites noxious and potentially very dangerous, but social ills in the form of increased vandalism, crime, and drug use tend to follow placement of these sites in or near communities. at best, this is social and environmental injustice, and at worst, it is the embodiment of environmental racism. it is the denial of equal access to resources in the form of a healthy environment in which to live, and it results in the further marginalization of already disenfranchised people. as such, it is counter to the core values of social work. social workers should find it unacceptable and consistent with our ethical commitments to political and social action (nasw, 1999) to do everything in our professional ability to bring it to an 9besthorn, saleebey/nature, genetics, and the biophilia connection: exploring linkages end. in a sense, thinking of social justice as the provision and, if necessary, the redistribution of those social resources required to undergird and support adequate human development, those resources should be expanded to include those natural ones that have the same purpose and effect. corevalues: community,diversity, and inclusion whether or not social workers choose to be active in environmental causes, they certainly can no longer choose to be uninformed regarding the impact that degraded environments have on their clients (rogge & combs-orme, in press). when we poison an environment, we jeopardize much more than pretty neighborhoods.we also limit the possibilities for vital, secure, sustainable communities and healthy personal and social development. when communities are burdened with pollution and decay, there is often an erosion of community stability. people feel less pride. they become less secure, more alienated, more uncertain of their futures, and less able to realize their dreams.when we do not respect the worth of the natural environment, we do not respect the worth and dignity of the people who reside in and depend on it. if social work is to continue its focus on poverty, discrimination, oppression, and other forms of social injustice, as well as its emphasis on respect for diversity, it must begin to take a farmore active role in the eco-justice/social-justice dialogue. small changes can have big results, as an old expression foretells. this is certainly the case when it comes to our place in the natural world. the presence of even minimal experiences with natural settings and/or non-human beings genuinely matters to people.we are more whole when we can draw sustaining energy from our surroundings and our relationships. as kaplan (1983) observed, “big trees, and small trees, glistening water, chirping birds, budding bushes, colorful flowers— these are important ingredients in a good life. to have these available only rarely...deprives people of tranquility and of spiritual sustenance.” (p. 155) effective social work practice must recognize the impact that nature, or the lack thereof, has on the life of community. as gladwell (2000) says, “…an epidemic of [disorder or disorganization] can be reversed, can be tipped, by tinkering with the smallest detail of the environment” (p. 146). community workers have long recognized thatmodest changes in the physical appearance of a neighborhood can reap big dividends in terms of increasing the sense of security and involvement of residents. however, the natural environment has never been given much attention in these efforts. recently, however, a number of community programs have begun to attend to elements of the natural environment. one of the most common developments is the planting and maintaining of a vegetable and flower garden; an oasis, often, in a built environment that has been the victim of official inattention (delgado, 2000). hynes (1995), commenting on the salubrious effects of community gardens, says: at its core, the community gardenmovement in the late twentieth century is about rebuilding neighborhood community and restoring ecology to the inner city...for the give-and-take of working in gardens attaches gardeners to a particular place through physical and social engagement. community gardens create relationships between city dwellers and the soil, and instill an ethic of urban environmentalism that neither parks nor 10 advances in socialwork wilderness–which release and free us from the industrial city–can do. gardens offer a more intimate and local space than the large landscape parks can offer. (p. x, xv-xvi) access by all people to the opportunities and resources which can result in a better life is one of the dominant historic themes of effective social work practice. social workers recognize that these resources and opportunities are not as readily available to or are frequently denied to some members of society. social workers also understand that for all of its rhetoric to the contrary, modernwestern culture tends to value conformity at the expense of diversity and difference. it typically rewards people who have the same tastes, buy the same consumer products, and share the same collective attitudes. indeed, the economic system could not function without this homogenization of attitudes, ideas, and being. individuals and groups who appear to be different, have alternative beliefs, or represent diverse cultures and backgrounds often find themselves having to make do with scant resources and far fewer opportunities.while social workers recognize that respect for humandiversity is vital to good social work practice, itmust also begin to affirm that diversity is also an imperative for nature. just as loss of human diversity diminishes the richness and potential of our lives, loss of bio-diversity is equally, if not more, destructive. the dominant social paradigm in the west regards humanity and nature as separate entities. humans are viewed as not only separate from nature, but above and superior to nature. biophilia theory, on the other hand, recognizes the inherent inter-relatedness and bio-centric equality of all life forms. bio-diversity is essential for the survival of the human species and its loss is a threat to the entire eco-system (suzuki, 1997). extinctions, species endangerments, and callous acts of resource exploitation are often seen as inconsequential to the global, human community because they do not seem to impact individuals directly. this sense of human identity as separate and independent of others, both human and non-human, is illusionary and selfdestructive. it is a fallacy that humans live apart from and are superior to nature. not all cultures have this view. in fact, “many afrocentric, native american, and asianworldviews share this sense of inter-relatedness of humanswith all elements of the environment…such a holistic perspective is useful and appropriate for social work with its concern for human behavior in the context of the larger environment.” (shriver, 1998, p. 92) socialwork education and practice: biophilic connections principles of biophilia canbe comfortably incorporated into social work education and practice. they can provide the basis for the development of effectively fashioned means to help people maximize their potential and empower them to achieve control of their lives and the communities in which they live. focusing on nature in its many forms and expressions has great potential for social work education for practice and for specific practice settings. let us examine some possibilities. first, since many elements of the natural environment are implicated in reducing levels of stress, promoting healing, and aiding in problem solving, social work educators should begin to instruct their students regarding the importance of 11besthorn, saleebey/nature, genetics, and the biophilia connection: exploring linkages employing natural elements in interventive settings. the design and sighting of buildings and practice spaces is a logical place to begin. observations from office windows can include natural views, gardens, or nicely landscaped areas. flowers and plants can be placed in offices and reception areas. how people respond in a given situation is highly contingent on the immediate ambient environment in which they find themselves (gallagher, 1993).what the decor reflects or says to the observer, what symbolism and messages are embedded in its structure, and the intimate details of the surroundings can be critical to the character of the work that goes on.organizational environments denudedof plants, flowers, water—any hint of the natural—may not be the best place to for productive, interpersonal work (saleebey, 2002). use of water fountains, small ponds, and aquariums should be increased. even things as simple as walking outside or sitting in a picturesque or tranquil natural setting while working with clients can have a profound impact on their progress.mihaly csikszentmihalyi (1990) talks of the importance of “flow,” a kind of optimal experience in which people feel involved, exhilarated, and unself-conscious doing something that feels important or stimulating.what kinds of experiences do the physical environments of social service agencies, social work schools, residential centers, and hospitals encourage?what do they say about the kinds of experiences clients are going to have? what kinds of expectations for involvement do these environments create? second, educating students to discuss with their clients the possibilities of: a) combating depression, b) relieving stress, c) creating more tranquility, and d) renewing energy by attending to and altering the immediate natural environment is no different in some ways than encouraging them to attend to and alter their interpersonal environment in particular ways. a study by marc fried (cited in gallagher, 1993) demonstrated that the quality of life (measured by feelings of satisfaction) for married people was most strongly influenced by a “good” marriage. but the second most important factor was the immediate surroundings, especially the natural environment. research and teaching in environmental health increasingly attests to the benefits associated with attending to and altering ones physical surroundings.while spotlighting the hazardous effects of toxic chemicals, radiation, and biological agents is an important agenda for social work education, especially in light of the new security realities stemming from 9-11, it must not overshadow attending to environmental experiences that have a positive impact on health and well-being. third, this knowledge provides social work students and practitioners with a set of possible scenarios for work with specific populations. in working with the elderly in long-term care facilities, introducing plants and animals (pets brought on visits from the local humane society, birds in cages, and fish in aquaria, for example), may bring some residents a noticeable increase in interest, awareness, energy, and positive feeling (j. nolley, presbyterian manor, lawrence, ks, personal communication, 2001). there has also been much work with adults and youth, some who have serious mental and behavioral problems, involving experience and involvement with nature. the results, at least for a period of time, generally tend to support the idea that these experiences can provide some opportunities for self-discovery and a desire to maintain contact with natural environments in the future (kaplan & kaplan, 1989). 12 advances in socialwork community work in specific geographic locales or among specific sub-populations is a reemerging practice domain that can benefit from a biophilic emphasis. community building that involves restoration and rehabilitation of the proximal natural environment through community gardens, planting of lawns and greenswards, and flower gardens for apartments is a clear case in point. an elderly resident of a public housing community (a development undergoing significant change, much of it stressful and frightening) kept a small flower garden in front of the porch of her apartment. it afforded her and her children respite and renewal. in another example, a program in an urban community in themidwest put adults and children together to develop projects that can improve the natural settings of the neighborhoods whichmake up the community. in an urban high school in the same city, youth were given small grants to work on programs that would benefit the school or the surrounding community. the two largest projects involved rehabilitation of a ramshackle neighborhood block and building a garden with a pond in a school courtyard—a place, as one student said, that would be“peaceful, beautiful, and make us proud” (university of kansas, 2001). finally, a professional alliancewith biophilic principles and ideas provides social workers with a chance to engage with other professionals and grassroots organizations in meaningful advocacy. perhaps it is time for the profession to consider assuming a more active role in educating our society about the consequences of our present lifestyle choices. currently, the rate of habitat destruction outpaces environmental education. ecological activism is usually seen in terms of saving the whales or hugging trees, because it is often framed in terms of wildlife and wilderness and thus appears to be only about saving the earth and it natural systems. most people do not make the connection from this framework to saving humanity.why not also save the people of the earth by saving the earth? initially, it may seem out of place for social workers to be advocates for the environment. citizens are comfortablewith the traditional role of social workers as advocates for foster children, hospital patients, or the poor, for this is the work of helping people. however, if we accept the notion of the deep biophilic connection between nature and humanity, it also becomes our work to improve the quality of life by improving the environment in which people live. nothing is more basic to the quality of life than the water we drink or the air we breathe or our ability to enjoy a natural vista on a beautiful day. social workers need to make a more overt connection between the environment, human survival, and human happiness. it is also true that the most serious depredations of environments occur in poor and inner city places and spaces. if we believe that ourmission as a profession includes addressing conditions that oppress and marginalize people, focusing on the diminishment of resources of the natural environment is one of the most important of these conditions. conclusions long and vigorously promoted by the profession of social work, an ecosystemic view, oddly enough, often overlooks its very own origins. that is, the idea of ecosystems arose, in part, from the articulation of ways of thinking about animal and plant life and how they interact. yet, in the social work version of this complex 13besthorn, saleebey/nature, genetics, and the biophilia connection: exploring linkages perspective, it is the natural world and non-sentient being that is overlooked. while we might examine individuals, families, communities, social institutions and organizations, support and interpersonal networks, cultural and ethnic factors under the ecosystemic aegis, we do little to assess and understand the important role of nature in the daily lives of human beings. the social work profession also has as one of its primary missions the enhancement of humanwell being.nature andnatural connections,mediated through our biophilic attachments, offer an essential vehicle for human identity formation and a tool for healing, both individually and collectively. however, increasing urbanization and sprawl have diminished vast areas of natural habitat and caused immense declines in biological diversity. over-development and sprawl has resulted in habitats suffering unsustainable levels of exploitation, thus, accelerating the scale of species endangerment and extinction. at this point we have precious little understanding of how such factors affect the well being and identity of populations of people that the profession typically serve. the questions now facing us as social workers include: do the prospects of these ecological threats pose a serious threat to the survival of humanity?more immediately, can people experience full lives with material, emotional, and spiritual significance if the natural environment is substantially diminished and degraded? while the answer to the first question is not yet clear, it seems that the unequivocal answer to the second of these questions must be no in light of what we now know about our biophilic connections to the natural world. no, the extinction of our species does not appear to be imminent, but our quality of life being eroded will only continue to deteriorate without attention and action. advocating for a rich and rewarding relationship with nature does not imply a desire to return to the pre-industrial past or a pastoral way of life. this is not possible and probably not ultimately desirable.what is desirable, however, is a respect for nature that helps us to live within it, not in spite of it. as social workers, we need to act in our client’s best interests by helping to arrest loss of bio-diversity and habitat destruction.we need to support creating protected areas where development should not be permitted to occur. we must develop educational strategies that support efforts to fight species extinction. we must educate our students and the public regarding the importance of nature to human well being.we will need to find ways to integrate nature into our values, theories, and practices and into our daily lives.wemust also develop strategies to assist our communities and neighborhoods incorporate biophilia into our homes, our places of work, and our social interactions and recognize the extent to which our physical health, mental health, and happiness depend on a vital, diverse, bio-rich planet. this means we must alter our attitudes about what constitutes the good life. when we impoverish the world, we inevitably reduce our potential for individual physical, material, emotional, intellectual, and spiritual growth andwell being. in addition, “we diminish the possibilities for…collective development. we achieve our fullest humanity by celebrating our widest and deepest dependence on nature” (kellert, 1997, p. 205). understanding the importance of our biophilic 14 advances in socialwork connections to the earth and the role that nature plays in our survival and in assisting a healthy lifestyle empowers social workers and their clients and helps both to achieve their highest potential. references ball, j.d., & falk, j. h. 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(2002). the future of life. newyork: alfred a. knoff. 17besthorn, saleebey/nature, genetics, and the biophilia connection: exploring linkages author’s note: address correspondence to: fred h. besthorn, ph.d., associate professor, department of social work, college of social and behavioral sciences, university of northern iowa, sabin 33, cedar falls, iowa 50614, usa. e-mail: fhbest@earthlink.net; the website for the global alliance for a deep ecological social work (gadesw) is: www.ecosocialwork.org. 18 advances in socialwork spring2001-004_iii spring2001-005_iv fall2005-024_page251 fall2005-025_page252 fall2005-026_page253 fall2005-027_page254 fall2005-028_page255 fall2005-029_page256 fall2005-030_page257 fall2005-031_page258 fall2005-032_page259 fall2005-033_page260 fall2005-034_page261 fall2005-035_page262 aisw vol. 5, no. 1 assessment in socialwork education: a bibliography robert vernon mary stanley wehave attempted to provide the reader with a basic bibliography that examines multiple dimensions of assessment.while no bibliography is ever comprehensive, these 270+ references may prove useful to the reader who wishes to further explore this literature. airasian, peter w. (2000). the theory and practice of portfolio and performance assessment. journal of teacher education, v.51(5):398. akister, a., bannon, h., & mullender-lock, h. (2000). poster presentations in social work education assessment: a case study. innovations in education & teaching international 37(3) 229-233. (ej613454) akister, j., & kim, c. (1998). poster presentations: finding alternatives to written assignments for assessing students. journal on excellence in college teaching, 9(3) 19-31. (ej603583) alter, c. & adkins, c. (2001). improving the writing skills of social work students. journal of socialwork education, 37(3): 493-505. alverno college faculty (1994). student assessment-as-learning at alverno college. milwaukee, wi: alverno college institute. angelo, t.a. (1994). classroom assessment: involving faculty and students where it matters most. assessment update, 6(4), 1-2, 5,10. angelo, t.a., & cross, k.p. (1993). classroom assessment techniques: a handbook for college teachers (2nd ed.). san francisco: jossey-bass, 1993. association of baccalaureate socialwork programdirectors, inc. (1999). baccalaureate education assessment package. available from john p. rogers, department of social work, mount mercy college, 133 elmhurst drive ne, cedar rapids, ia 52402. also see: http://www.rit.edu/~beap/ aviles, christopher b. (2001). implementingmastery learning in the social work classroom, pg. 27. (eric) (ed448401) aviles, christopher b. (2001). curriculum alignment: matching what we teach and test versus teaching to the test, pg. 17. (eric) (ed448402) aviles, christopher b. (2001). grading with norm-referenced or criterion-referenced measurement: to curve or not to curve, that is the question, pg. 15. (eric) (ed446023) aviles, christopher b. (2000). teaching and testing for critical thinking with bloom’s taxonomy of educational objectives, pg. 27. (eric) (ed446025) aviles, christopher b. (1999). understanding and testing for “critical thinking” with bloom’s taxonomy of educational objectives, pg. 20. (eric) 126 robert vernon is associate professor and mary stanley is socialwork librarian at the indiana university school of socialwork, indianapolis, in 46202. copyright© 2004 advances in socialworkvol. 5 no. 1 (spring 2004) 126-137. indiana university school of socialwork. bailey, s. & richards l. (2001). challenges in evaluation: assessing processes and outcomes in human service programs. journal of teaching in marriage and family, 1(4): 53-67. badger, l. &macneil, g. (2002) standardized clients in the classroom: a novel instructional technique for social work educators. research on socialwork practice, 12(3) 364-374. bakx, a., sijtsma, k.,van der sanden, j., & taconis, r. (2002). development and evaluation of a studentcentered multimedia self-assessment instrument for social-communicative competence. instructional science, 30(5), 335-359. bandura, a. (1977). self-efficacy: toward a unifying theory of behavior change. psychological review, 84(2), 191-215. bandura, a. (1995). exercise of personal and collective efficacy in changing societies. in bandura, a. (ed.), self-efficacy in changing societies, newyork: cambridge university press. bandura, a. (1997). self-efficacy: the exercise of control. newyork:w.h. freeman. bandura, a. barbaranelli, c., caprara, g.v., & pastorelli, c. (1996). multifaceted impact of self-efficacy beliefs on academic functioning. child development, 67(3), 1206-1222. (ej528236) bandura, a., (1982). self-efficacy mechanism in human agency. american psychologist, 37(2), 122-147. banta, t.w. (2003,march). student outcomes assessment and social work education. presented at the 49th annual programmeeting of the council on socialwork education, atlanta, ga. barab, s.a., & duffy, t.m. (2000). frompractice fields to communities of practice. in d.h. jonassen & s.m. lands (eds.),theoretical foundations of learning environments.mahwah,nj: lawrence erlbaumassociates. barise, a. (2000). the effectiveness of case-based instruction vs. the lecture-discussion method in multicultural social work.dissertation abstracts international section a: humanities & social sciences, 61(6a), 2181. barnett, b.g., & lee, p. (1994). assessment processes and outcomes: building a folio. in l. jackson & r. caffarella, (ed.), experiential learning: a new approach, 62 (summer). ca: jossey bass. 55-62. barr, r., & tagg, j. (1995) from teaching to learning: a new paradigm for undergraduate education. change, 27(6):12-26. barron, m. & sartori, n. (1994). planning a portfolio: medical record administration/health information management. in m. knight (ed.), portfolio assessment: an application of portfolio analysis. lanham, md: university press of america. 9-19. barth, r., & gambrill, e. (1984). learning to interview: the quality of training opportunities. the clinical supervisor, 2, 3-14. bartlett, t. (2003).what makes a teacher great? chronicle of higher education, v.50(16):a8. becker, w. (in press). a critique of the quantitative research on teaching methods in tertiary education: what really works? in w.e. becker & m. andrews (eds.), the scholarship of teaching and learning in higher education: the contribution of research universities. bloomington, in: indiana university press. bereiter, c., & scardamalia, m. (1992). cognition and curriculum. in p.w. jackson (ed.). handbook of research on curriculum. newyork: macmillan publishing. bernotavicz, f. (1994). a new paradigm for competency-based training. journal of continuing social work education, 6, 3-9. biggerstaff, m. (2000). development and validation of the social work career influence questionnaire. research on socialwork practice, 10(1) 34-54. biley, f., & smith, k. (1999). making sense of problem-based learning: the perceptions and experiences of undergraduate nursing students. journal of advanced nursing, 30(5), 1205-1212. black p., & whelley j. (1999). the social work licensure exam: examining the exam through the lens of cswe curriculum policy. aretê, 23(1): 66-76. bloom, m., fischer, j., & orme, j. (1995). evaluating practice: guidelines for the accountable professional. boston: allyn & bacon. bogo, m., regehr, c., hughes, j., power, r., & globerman, j. (2002). evaluating a measure of student field performance in direct service: testing reliability and validity of explicit criteria. journal of socialwork education, 38(3): 385-401. 127vernon, stanley/bibliography: assessment and socialwork brandon, j., & basanti, m. (1997). an introduction and evaluation of problem-based learning in health professions education. family community health, 20(1), 1-15. bransford, j.d., brown, a.l., cocking, r.r., donovan, m.s., & pellegrino, j.w. (eds.). 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(1998). the gatekeeping dilemma in undergraduate social work programs: collision of ideal and reality. international socialwork, 41(2), 145-153. author’s note: address correspondence to: robert vernon, indiana university school of socialwork, 902west newyork street, indianapolis, in 46202-5156, usa. e-mail: vernon@iupui.edu 137vernon, stanley/bibliography: assessment and socialwork advances vol. 4, no. 2 116 advances in social work socialwork practice innovations: helping clients understand, explore, and develop their friendships rich furman kathryn collins janet swanson abstract: this article demonstrates the importance of helping clients understand, explore, and develop friendships in social work practice. the nature of friendships is explored. a cross-disciplinary analysis of the literature concerning friendships and their relationship to human health and functioning is discussed. case examples illustrating the importance of friendships and examples of the conscious use of friendships as a target of intervention are provided. keywords: friendship, social support, social work practice the importance of relationships as a crucial factor to human well being, growth, and change has been a central theme of social work practice and research (krill, 1969; saleebey, 2001; shulman, 1984). families are recognized as central to emotional health (carter & mcgoldrick, 1999; janzen & harris, 1997; werner, 1987), while supportive communities have been shown to be of nearly equal importance (homan, 1999; netting, kettner & mcmurtry, 1998; weil & gamble, 1995). while social work has done an admirable job of highlighting the necessity of family, community, and other social support relationships, the importance of friendships has been largely ignored in social work practice literature. this is lamentable since supportive friendships have been shown to be essential for psychosocial development (clark & ayers, 1991; hartup, 1979, 1983 & 1989; hutter, 2001; linden, 2003; roff, 1963), school and social functioning (flannagan & bradley, 1999), emotional health (asher & paquette, 2003), and lead to resiliency in many client populations (berndt, 1989; fraser, 1997; miller & fritz, 1998). as managed care and privatization have led to sharp decreases in the number and scope of services for many clients (dorwart & epstein, 1993; dumont, 1996), social workers must rely on different types of natural social supports in helping restore clients to equilibrium and optimal functioning. rich furman, msw, ph.d. is assistant professor, school of social work, university of nebraska-omaha. omaha, ne 68182. kathryn collins ph.d. is assistant professor, school of social work, university of pittsburgh, pittsburgh, pa 15260. janet swanson, bs ismsw intern, colorado stateuniversity, fort collins, co 80523. copyright© 2003 advances in socialworkvol. 4 no. 2 (fall 2003) 116-129. indiana university school of socialwork. 117 this paper demonstrates the importance of helping clients understand, explore, and develop friendships as social work practice intervention. this will be accomplished in three ways. first, the nature of the client’s friendships will be explored. second, a cross-disciplinary analysis of the literature concerning friendship and its relationship to human health and functioning will be discussed. third, case examples illustrating the importance of friendships and examples of the conscious use of friendships as a target of intervention will be provided. why is friendship important in socialwork practice? in keeping with the profession of social work’s unique and historic dual focus on person-in-environment, this paper advocates practices congruent with the ecological perspective. this perspective enables one to simultaneously focus on person and environment and their reciprocal relationship. according to germain and gitterman (1996), social work interventions that adhere to the ecological perspective recognize that causality in social work practice is reciprocal rather than linear in nature. beginning with the initial contact with a client, social work practitioners have the distinctive ability to help clients understand, explore, and develop friendships with individuals within their social environment in order to promote health and well being and to prevent and/or resolve psychosocial problems. for example, throughout the engagement and assessment process of working with individuals, families, groups, and communities, the concepts of friendships, interpersonal relationships, informal/formal networks, and social support should be explored with the client. this process helps the client begin to understand that facilitating friendships draws upon the strengths that exist within themselves and in their homes, schools, neighborhoods, work environments, and larger communities. social workers already trained in tapping into the resources of family and community would be well served to increase their ability to help clients’ understand and utilize friendships as a means of helping people meet their needs. friendships help people learn about and validate themselves and provide the courage to face life’s challenges. the nature of friendships in the united states today, nuclear family relationships are prized above all other social connections. the expression “blood is thicker than water” demonstrates the place of importance that such relationships hold. in spite of the centrality of the family, close friendships may often be as or more important to people’s emotional well being than are families. merely defining the concept of friendship is a difficult task. white and white (1982) surveyed 300 adults age 18 to 82 years regarding friendships. they concluded that there is little clear agreement about the definition of friendship; so much depended on the experiences of participants regarding friendship itself. based on their interviews, white and white developed a model of the attributes that form the building blocks of friendship. these include love, deep sharing, selfsacrifice, encouragement, stimulation, loyalty, and fun. fox, gibbs and furman et al./social work practice innovations 118 advances in social work auerbach’s (1985) conceptualization of friendship was comprised of slightly different variables, including altruism (mutually helping each other), companionship (enjoying shared activity), and empathy (emotional closeness and sharing of feelings). in spite of the difficulties, definitions have been developed. burk (1996) defines friendship as “a dynamic reciprocal relationships between two individuals” (p. 283). wiseman (1996) defines friendships as voluntary relationships that exist primarily for personal satisfaction and enjoyment rather than the fulfillment of a particular task or goal. in spite of the importance of friendships, they are very often undervalued in modern american society. the idiom, “we are just friends,” aptly expresses a prevailing social sentiment regarding the importance of friendships (rubin, 1985). friendship is seen not only as qualitatively different from other types of relationships, but of less value. research often disproves these social stereotypes. blyth and foster-clark (1987) found that adolescent girls reported a same-sex friend as the most intimate relationship in their lives. boys ranked friends third for intimacy after their parents. relationships with siblings and other family members were consistently rated as less intimate than relationships with friends. the nature of friendships change throughout the lifespan (hymel, wagner & butler, 1990). for example, furman and buhrmester (1992) observed fourth graders reported that their parents were the most frequent providers of support, but seventh graders listed parents and friends as being equally supportive. by the tenth grade, friends were listed above parents for providing support. college students still listed friends as important providers of support, but they trailed just behind mothers and romantic partners. in an earlier study, furman and buhrmester (1985) found that fifth and sixth graders identified friends as the greatest source of companionship and ranked them equally with parents for intimacy. friendships are significant to many people, though they are viewed differently from familial relationships. davidson and duberman (1982) provide an explanation for the difference in perception between family and friends. they found that both men and women said they did not feel dependent on their friends, yet were often conflicted over dependency issues with families. many participants recognized the impermanence of friendship relationships compared to family ties. they reported that as long as friends could be replaced, they would be satisfied. berndt, hawkins and hoyle (1986) found that intimacy—defined as a sharing of personal information—was identified by eighth grade girls as being important in their friendships. for both boys and girls, friendships characterized by high intimacy were the most stable. for adults, intimacy was found to predict the success of newly formed friendships. those with intimate interactions after six weeks of meeting were more likely to develop close friendships. as the relationship continued, the closeness of the friendships depended on how intimate the interactions were and not on how much time the friends spent together (hays, 1985). similarity and proximity also seem to be important aspects of forming and maintaining friendships. hays (1985) discovered that the distance between where people resided was negatively correlated to the successful development of new 119 friendships. that is, the farther apart people lived, the less likely they were to effectively form a friendship. nahemow and lawton (1975) conducted a study in new york city public housing with a diverse mix of residents of various ages and races. the closer people lived to each other, the more likely they were to be friends. in fact, when asked to identify who their friends were, more than 80% of the respondents first named someone who lived in their building—often on the very same floor. also, similar age and race were strongly associated with friendship development. although some friends were of different ages and races, they always lived in the same building, so their proximity to each other seemed to mitigate those differences. some did become friends with residents of other buildings, but only if they were the same race and were close in age. the authors subsequently theorized that people are likely to make friends with those who live close to them and reach out of their immediate space to make friends with others who are similar. verbrugge (1977) also discovered a relationship between similarities and the likelihood of developing friendships. he found that friends tended to be similar on such factors as age, occupation, education, and political and religious preferences. indeed, both women and men reported sharing similar values with their friends and felt that having congruent values was important to their friendship relationships (davidson & duberman, 1982). even children tend to be friends with those who are similar to them in terms of sex, race, and academic achievement (tuma & hallinan, 1979). researchers have sought to understand relationship dynamics that have an impact on children’s friendships. it is important to note that these factors change depending upon children’s age, pointing to the necessity of understanding friendship from a developmental perspective. for example, berndt, hawkins and hoyle (1986) saw that competitive fourth grade friends were more stable and maintained their friendships longer than non-competitive friends, but the opposite was true for eighth graders. seventh graders placed more importance on empathic understanding and less on mutual activities than third graders and felt that they received more empathy from their friends. as children mature, they move from competitive and activity-driven friendships to ones characterized by more emotional connectedness and intimacy. differences were also apparent between the friendships of boys and girls. boys were found to have larger social networks, whereas, girls were more likely to limit the size of their friendship group (benenson, 1990; berndt & hoyle, 1985; eder & hallinan, 1978). boys were more concerned with status among friends and described their peers in relation to their authority and achievements, while girls were concerned with affiliation and described their peers in terms of how nice and reciprocal they were (benenson, 1990). girls also expected more conventional morality (not lying or cheating), loyalty, and empathic understanding and perceived that they received more of those things in their friendships than boys. despite those differences, both boys and girls had the same expectations and perceptions of mutual activities (clark & bittle, 1992). the nature and structure of friendship relationships also differ by gender. the commonplace view of male friendships paints a picture of relationships that furman et al./social work practice innovations 120 advances in social work often do not meet men’s psychosocial needs. buckner (2001) maintains that friendships between men are less intimate than are men’s friendships with women or friendships between women. elkins and peterson (1993) discovered that men reported more satisfaction with their friendships with women than with men and had lower ideal standards for male-male friendships. it is argued that patriarchy contributes to male competitiveness, whereby, men become less likely to risk “the loss of power that closeness with another might create” (rosen, 1999, p. 129). mcadams, healy and krause (1984) support this claim with their finding that men who were “power-motivated”—that is, seeking friendships in order to have influence over others—were much less likely to have dyadic (oneon-one) friendships. they tended to have more group interactions where the potential for power was greater. men see each other more as playmates than sources of emotional support (fox, et al., 1985). when asked to describe what is important in their friendships, men frequently emphasize shared activities (caldwell & peplau, 1982; parker & de vries, 1993; sapadin, 1988). male friendships tend to show less reciprocity (giving and receiving) than do women’s (parker & devries, 1993). davidson and duberman (1982) found that men related to each other primarily on a topical level, meaning that they discussed impersonal issues rather than talking about their relationship or other personal subjects. women’s friendships, in contrast, are frequently characterized as expressive and intimate (caldwell & peplau, 1982; fox, et al., 1985). women place great significance on self-disclosure, empathic understanding, and connectedness in their friendships (parker & devries, 1993). davidson and packard (1981) asked women to discuss what aspects of their friendships were therapeutic for them by contributing to personal growth, support, or change. factors such as reciprocal expression of feelings, altruism, and communion were rated as highly therapeutic. sapadin (1988) found that women rated their same-sex friendships higher for overall quality, intimacy, enjoyment, and nurturance than did men and emphasized the interactions between friends rather than the activities. although this may seem to imply that women’s friendships are superior to men’s, davidson and duberman (1982) discovered that men actually reported more trust in their friendships than women, possibly because conversations between male friends tended to be less personal and therefore less “risky.” in a more recent study of adolescents with a relatively small sample, benenson and christakos (2003) found that female friendships may be of shorter duration. clearly, more research is needed to clarify these discrepancies. despite these differences, both men and women identify some of the same factors as being important in their friendships. parker and de vries (1993) explored people’s perceptions of friendships and what they valued most in those relationships. both men and women rated trust and authenticity as the most important features in friendships. sapadin (1988) also found similarities between men’s and women’s beliefs regarding friendship. both sexes reported that sharing and enjoying each other’s company are basic to friendships. when studying friendship development, hays (1985) found that men and women were equally as likely to develop close friends after starting college. although women may experience more intimacy with their friends, men are just as capable of forming new friendships. men and women also report similar numbers of friends, similar amounts 121 of time spent with them, and place similar value on intimate friendships (caldwell & peplau, 1982). the impact of friendships research on resiliency has sought to identify factors that help an individual withstand stressful events. resiliency factors prevent the psychosocial problems that social workers normally contend with in a remedial fashion. in her review of resiliency literature, norman (2000) noted that having a positive relationship with at least one other person is the most important factor promoting resiliency throughout the life-span. indeed, various studies have demonstrated the positive impact of social relationships on preventing psychosocial problems (higgins, 1994; rutter, 1979, 1987;werner, 1987;werner & smith, 1992;wolin &wolin, 1993). while often conceptualized as internal attributes, resilience may actually stem from children’s environments (fraser, 1997). specifically, research has demonstrated the importance of the ability to establish and maintain friendships in the lives of children (higgins, 1994). children who master the ability to make and maintain friendships have enormous advantages over peers without this ability. these environmental resources serve as a protective factor against various psychosocial risks. being part of a social network was strongly related to overall peer acceptance, especially for boys (benenson, 1990). according to clark and ayers (1988), middle school students with reciprocated friendships (meaning peers they identified as friends also identified them) were viewed as more successful and attractive by their peers. cauce (1986) looked at african-american seventh graders who came from families of low socioeconomic status. those students who had an extensive social network displayed more social competence. furthermore, in a study based on who children rely on when building a safety plan to avoid violence in their schools and neighborhoods, collins (2001) found that children ages nine to 12 years stated that their friends often “stand up for them” or “protect them” from bullies. research has shown that supportive friendships serve as a protective factor during times of stress (berndt, 1989). in fact, friendships might be more important to decreasing one’s stress than familial relationships. some people are more likely to discuss stressful events with friends than families, as family members often have more expectations and judgments than friends. for example, a person who is experiencing stress over no longer being happy with his or her current work situation is more likely to receive uncritical support from a friend who has less personally at stake than from a family member who is dependent upon that person for fiscal support. in addition, families are often the very issue about which one is experiencing stress, thus, necessitating alternative social supports. dunn, davies, o’connor and sturgess (2001) found that children who had experienced a parental separation reported more positive feelings about moving between two households if they had close friendships. those who lived with a stepmother or who were involved in conflicts between their biological parents confided in friends more often than other children. friendships are valuable in meeting needs that have traditionally been met within the family. as family structures have changed in american society over furman et al./social work practice innovations 122 advances in social work time, people often rely upon friendships to meet various psychosocial needs (bell, 1981). wright (1978) identified various social rewards that friendships can offer. first, a friend can be willing to help one meet needs and goals. friends can affirm positive ideas about oneself while providing ego support—helping a friend see him or herself as a competent, worthwhile person. friends can also introduce new ideas and experiences while expanding knowledge and perspectives. researchers have explored how friendships affect students’ adjustment at school. studies have shown that children and adolescents often exhibit behaviors that are similar to their friends—both positive and negative. berndt and keefe (1995) observed that as the school year progressed, students became more like their friends regarding disruption in class and grades. if a student had friends who were not disruptive and received good grades (or vice versa), he or she would tend to behave in a similar manner. students themselves perceived that their level of disruption in school was similar to that of their friends. friends who exhibit antisocial or deviant behavior are risk factors, while friends who are well socialized and “normatively conventional” are positive factors in development (hartup & stevens, 1997). the quality of friendships may also affect students’ adjustment. seventh and eighth graders with “positive” friendships, characterized by self-disclosure, mutual helping, and faithfulness, tended to not only have more stable, long lasting friendships, but also showed desirable social behavior and good adjustment to school. they reported more acceptance by peers and higher self-esteem (berndt & keefe, 1995). in this study, students who viewed their friendships positively were rated by teachers and themselves as more involved in school. even kindergartners tended to like school more when they perceived higher levels of aid from their friends. when boys perceived conflicts in their friendships, they showed more loneliness and avoidance and liked school less (ladd, kochenderfer & coleman, 1996). seventh and eighth grade students who had conflict and rivalry in their friendships showed poorer adjustment to school and rated themselves as more disruptive and less involved (berndt & keefe, 1995). high school students with friendships high in hostility and low in reciprocity showed more delinquent behavior, alcohol use, and depression (windle, 1994). even for adults, thosewithout close friendships may be vulnerable to feelings of dysphoria and loneliness (elkins & peterson, 1993; williams & solano, 1983). the practice ofhelping clients understand, explore, anddevelop friendships norman (2000) asserts that helping clients develop resiliency factors allows social workers to implement the strengths perspective.the strengths based approach to social work practice has been growing in influence over the last several decades. based upon the literature of resiliency, the strengths perspective challenges social workers to help people utilize their skills and competencies in overcoming life’s problems.the strengths perspective does not deny the existence of problems, but asserts that maximizing the strengths and resources of individuals and groups is the best means of helping them overcome life’s challenges. saleebey (2001) describes the strengths perspective in the following way: 123 practicing from a strengths orientation means that everything you do as a social worker (or therapist) will be predicated, in some way, on helping to discover and embellish, explore, and exploit clients’ strengths and resources in the service of assisting them to achieve their goals, realize their dreams, and shed the irons of their own inhibitions and misgivings (p. 3). proponents of the strengths perspective recognize the importance of social supports found in communities. cowger (1997) recognizes the importance of friendships in his strengths based assessment of clients.workers are encouraged to explore the nature of clients’ friendships, their ability to be understanding of and make sacrifices for friends, and their ability to make friends. by exploring clients’ skills and resources pertaining to friendships, workers are able to help clients maximize their support and their ability to withstand life’s pressures and problems. in this section, case examples are presented in which friendships and friendship systems were a primary target of change. this does not imply that friendships were necessarily the problem but were utilized as solutions to various psychosocial stressors. social workers can help clients meet various needs by helping them strengthen their friendship relationships. dan: case example one dan is a 37-year-old single male. he has worked as a computer repairperson for the last several years. dan sought treatment for feeling isolated and depressed. he has been lonely much of the time and does not feel a sense of connectedness to others. during a previous course of treatment, dan was placed on medication that decreased, but did not eliminate, his depression. he also was able to improve his relationships with his family of origin and joined a book club that increased his sense of connectedness to people. he also started to date a woman whom he saw about once a week. in spite of these changes, dan still felt somewhat depressed. while his new social contacts were important, dan longed for more meaningful and intimate friendships. as a child, dan was often lonely and sad. he had few friendships and was the youngest child in a distant, detached family. the friendships that he developed as a young man in college and in the navy provided his first reprieve from the loneliness that he felt in his life until that time. during therapy he began to realize that the close friendship bonds that he experienced during these earlier years were the missing piece that he needed in order to feel a sense of wholeness. in spite of this realization, dan was not certain how to go about making friends at this stage in his life or whether he wanted to do the work necessary to start a relationship. dan was also deeply afraid of being hurt and rejected by others. several years earlier, dan attempted to start a friendship with a coworker at a previous place of employment. he and this other man began watching football together on sundays and started to talk about their lives, pains, and dreams. just as he and his new found friend were beginning to become close, his friend informed dan that he was “strange” and did not want to be his friend anymore. developing meaningful and supportive friendships became a primary goal in therapy. one of the first early steps to help dan work towards this goal was to furman et al./social work practice innovations 124 advances in social work point out his strengths regarding forming relationships. collaboratively, we developed an inventory of his strengths that included being able to talk to people easily, having interesting things to say, being able to talk about his feelings, having a history of making friends, being a loyal and kind person, and having a good sense of humor. helping dan recognize his strengths was instrumental in helping him become more invested in the process. by focusing on his strengths and not only his deficits, dan began to perceive himself as more socially competent and less fearful of increasing his social contacts. soon, dan was able to ask a fellow member of his book club out for coffee. after meeting several times for coffee, dan stated that he believed this man would become a friend. he reported feeling less isolated and more hopeful. during his final three months of therapy, dan was able to explore difficulties he experienced with reconnecting to friends. for example, dan and the above mentioned new friend had an argument over which restaurant they would have dinner at. dan gave in to his new friend’s demands but felt mistreated and resentful. he believed that the friendship would soon be over and that he would go back to being alone. collaboratively, we explored alternative meanings for the conflict. dan decided that the struggle with his friend really was more about the both of them being afraid of intimacy even though it manifested as being about control. addressing the issue with his new friend allowed both of them to develop a greater sense of trust in their relationships. dan and his new friend learned that their friendship could survive conflict and that they could be closer for it. juanita: case example two juanita, diagnosed with an explosive disorder and mild mental retardation, presented changes requiring a more direct, behaviorally oriented intervention. juanita, a 17 year-old young woman, lived in a residential treatment center for troubled teens. she had been in placements of one kind or another for nearly six years. diagnosed with intermittent explosive disorder and mild mental retardation, she became aggressive in school and ultimately at home. her mother, who was addicted to cocaine, was not able to handle her. juanita never knew her father. by the time she began treatment, her social network consisted solely of the staff in her group home. she was not able to make friends at her school and was thought to have very poor social skills. juanita possessed very negative views of friendships. she recalled a long history of experiences in group homes where other children would take advantage of her. she reported the story of a girl she knew in a prior group home who befriended her as a means of taking advantage of her. this girl “borrowed” money that she never repaid, took her belongings, and manipulated her into doing things that got her into trouble. in her mind, peers and friends led to trouble. in spite of juanita’s negative feelings about friendship, she also desperately craved companionship from her peers. in therapy, we explored what healthy friendships were like. i utilized self-disclosure to help her believe in the possibility of healthy, supportive friendships. i also asked the counselors in the group home to talk about their friendship. over the next two or three weeks, juanita developed a sense of openness to the possibility of a friendship. 125 asked if there were any people currently in her life that she would like to befriend, juanita mentioned one girl in her class at school. she reported that while she enjoyed this girl’s company at times, they would often quarrel and could not figure out how to get along. juanita also mentioned that it was hard to really get to know the other girl in the confines of a highly structured school setting. with encouragement, juanita decided that she would invite this girl (amy) over for dinner during the weekend, when many of the other teens who lived at the group home were visiting with family. i contacted the school social worker and found out that amy lived in another group home a few miles away. juanita called amy and asked her if she would like to have dinner the following weekend. amy said she would love to and that she and juanita would discuss plans the following day. juanita put me on the telephone, and i asked amy if i could discuss arrangements and details with the social worker in the group home. i informed amy that i wanted to learn enough about her and what she liked to help her and juanita have a good experience. she agreed. the following day i spoke with amy’s social worker, whom she saw for individual and group therapy. we discussed both girls’ likes and dislikes, their strengths, and issues that might lead to conflict. we subsequently made specific travel arrangements. later that night, juanita informed me that she and amy decided that they would like to have spaghetti and watch a movie about animals. juanita and i also processed the conflicts that she and amy had in advance and worked out ways of resolving potential disagreements. before their evening together, i met with juanita to discuss potential problems that could occur. she was most worried about not being able to share and compromise with amy. we subsequently role played several scenarios, allowing juanita to practice sharing and compromise. she was able to do this easily. i validated her good communication skills and helped her see that she indeed was able to do things she worried about not being able to do. on the evening that amy was to come over, i made plans to be in the group home but agreed to stay in the therapy room unless i was needed. the evening that amy spent with juanita went smoothly. they had one disagreement during which juanita suggested they both come and speak to me. i was able to help them compromise in regard to what games they would play and when and helped them work on their negotiating skills. amy and juanita started to spend more time together at school, and subsequently spent one or two days a week together. over time, juanita began to learn that while friendships were often difficult and demanded hard work, they did not have to end in her being manipulated. over time, her relationships with other children in the group home improved and she felt less isolated and depressed. implications for socialwork practice we have highlighted some of the unique aspects of the importance of helping clients understand and develop friendships in their social network. increasing research evidence suggests that individuals who have a sense of belonging within their social environment through the use of friendships have greater selffurman et al./social work practice innovations 126 esteem, stability, and well being. consequently, social work practitioners should routinely inquire about a client’s history of interpersonal relationships, their motivation to continue or develop ties with others as friends and supporters, and gain an understanding of how these relationships can benefit the client within current and future life situations. often times, the intervention of helping clients understand, explore, and develop friendships begins at the first meeting with the social worker. it is interesting that in just about every “pop culture” magazine the topic of “how to be or make a friend” is covered, yet social workers often forget the importance of exploring skills within the interventions we provide in our service to clients. social workers teach clients how to network within their community to obtain appropriate services and resources, but often do not help clients find and develop intimate and supportive friendships outside of the social service or health systems. social workers can provide role modeling through using the unique skills of engagement strategies such as empathic listening, attending, and being genuine with clients. the “therapy office” is the microcosm of the broader society. however, one must not confuse professional boundaries of the social support of the helping professional as friendship. social workers realize that, as a helping professional, it is of no use to our client to also be their friend if we are to maintain a supportive, therapeutic alliance. instead, we help to instill the skills of friendship through problem solving on how/where to find friendships, role play on how clients may engage potential friends or develop more meaningful relationships with friends, and develop skills on improving communication patterns. social workers can teach families how they can help children and young adults develop friendships. for example, parents/guardians may want to create a home environment that is attractive to their family member’s social network by inviting classmates, church group members, or club members to the home for an informal or formal function. families can identify local community places where children and young adults typically “hang out” and/or encourage youth to become involved in community groups and activities with their peers. this will provide repeated opportunities for children and young adults to become active and meet new peers. just as social workers can review the process of developing friendships with adult clients, they can also use role-playing and problem solving for younger clients. social service agencies may consider creating connections among clients and between clients and community by implementing “club forums.” club forums are a way for community members to unite around particular issues or situations within the community. this helps to de-stigmatize and de-mystify the mission of social service agencies within the community while providing an opportunity for interpersonal relationships and friendships to develop through a process of mutual interest. it is the hope of these authors that social 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(1978). toward a theory of friendship based on a conception of self.human communication research, 4(3), 196-207. author’s note: address correspondence to: rich furman, msw, ph.d., assistant professor, school of social work, university of nebraska-omaha, 60th and dodge streets, omaha, ne 68182, usa. e-mail: rfurman@mail.unomha.edu 129furman et al./social work practice innovations advances vol. 2, no. 2 developing and teaching anmsw capstone course using case methods of instruction terry a.wolfer miriam l. freeman rita rhodes abstract:using an innovative process, the authors and their colleagues developed a case-oriented msw capstone course. this article outlines the process of developing the course, choosing instructionalmethods andmaterials, and preparing instructors to teach the course. it reviews the process of teaching the course, including preparing to teach individual class sessions, identifying and dealing with several instructional challenges that emerged, and designing means to evaluate the course. the authors provide specific recommendations to faculty whowish to provide a similar course. in particular, they show how course development involves substantial, ongoing collaboration by faculty that yield exceptional benefits. keywords: social work education, case method teaching, course development, capstone course recently, several broad trends have profoundly changed the context for social service provision. these include: growing social and economic inequalities, diminished employment security, rollback of affirmative action programs, reduced funding for public education, increasing distrust for government as problem-solver, reduced funding for public education, shift of political power to the suburbs, spread of information technologies, increasing demographic diversity, and population aging (e.g., reisch & jarman-rohde, 2000; scharlach, damronrodgriguez, robinson & feldman, 2000). these trends have engendered remarkable changes in social service provision such as: devolution of federal responsibility, privatization of the nonprofit sector, agency reorganization (e.g., mergers, downsizing, decentralization), time-limited treatment modalities, cost-containment programs, fee-for-service reimbursement, and other funding innovations (jarman-rohde, mcfall, kolar & strom, 1997; reisch & jarman-rohde, 2000; strom-gottfried, 1997; strom & gingerich, 1993). these changes may necessitate revision of social work education in terms of both the content provided and the processes employed. at minimum, these changes require social work educators to continually reconsider what students need to know and do upon graduation and 156 terry a. wolfer, ph.d. is assistant professor; miriam l. freeman, ph.d. is associate professor; and rita rhodes, ph.d. is associate professor, college of social work, university of south carolina, columbia, sc 29208. copyright© 2001 advances in socialworkvol. 2 no. 2 (fall 2001) 156-171. indiana university school of socialwork. 157wolfer et al./developing and teaching an msw capstone course to assess whether they actually know and can do these things. indeed, as these changes accelerate, there is a growing need for educating social workers who can respond effectively to unanticipated problems and seize unforeseen opportunities (reisch & jarman-rohde, 2000). impetus forthe course in preparation for re-accreditation, faculty at the university of south carolina college of socialwork sought curriculum-relevant information from several constituency groups (e.g., alumni, field instructors). one such group included prospective employers of our msw graduates. two faculty members conducted interviews with executives of 17 state and private agencies. they found that when hiring beginning practitioners, social service agency executives especially prized research and evaluation skills, critical thinking skills, writing and communication skills, and an attitude of openness and flexibility (dalton & wright, 1999). this and other feedback provided the impetus for several curricular revisions. for example, faculty agreed to increase demands upon students for critical thinking and communication skills. faculty decided to develop new, required courses in the advanced year to reunite micro and macro students and integrate these two broad content areas. in designing one of these required courses, the curriculum committee came up with the idea for an integrative capstone course. furthermore, the committee recommended case-oriented teaching methods for this new course, and the dean assigned course development responsibility to a small faculty group. this paper describes and explains our experience developing and teaching the new case-oriented capstone course. however, it is not simply a question of case method teaching, capstone courses, or new course development. rather, it is about our highly collaborative problem-solving process for developing and teaching a case-based course as a capstone of our msw program. we argue that this extensive and unconventional process reflected essential features of the case method itself, promoting both student and faculty development and contributing substantially to our success. we also suggest that case method instruction fits social work education and is particularly well suited for a capstone course. in this paper, we first outline the process of developing this new course, including choosing instructional methods, developing course materials, and preparing ourselves to teach the course. second, we review the process of teaching the course, including preparing to teach individual class sessions, identifying and dealing with instructional challenges, and evaluating the course. based on our experience, we provide recommendations for faculty wishing to provide a similar course. in particular, we show how course development involved substantial, ongoing collaboration by faculty that ultimately yielded exceptional benefits. developingthe course faculty envisioned the capstone course as a unique learning opportunity in the final semester of themswprogram. itwas intended to provide a context for applying knowledge gained throughout the curriculum and for collaborative work by micro and macro students. 158 advances in social work choosing instructional methods beginning with information about desired educational outcomes, faculty sought teaching methods most likely to promote these outcomes (albanese & mitchell, 1993; lundeberg, levin & harrington, 1999; pratt & associates, 1998). we eventually agreed to combine decision case discussion and problem-based learning (pbl) components within the course. very briefly, decision case discussions emphasize analysis, problem formulation, and decision-making processes, while pbl projects emphasize assessment, information search, and treatment planning processes. in addition to their differing emphases, the two methods structure the learning process differently. decision case discussions provided a diverse series of shared weekly learning experiences for all students. problem-based learning projects provided unique, more specialized, semester-long learning experiences for small groups of students. because both methods were case-based, they potentially reinforced key learning objectives. nevertheless, they represented differing strengths and weaknesses. decision cases provided more experience with problem solving across a variety of situations, while pbl cases allowed for more in-depth learning about a particular practice situation. this article focuses on the use of decision cases because that became the primary teaching method, in terms of class time, student effort, and benefits reported by students and faculty. since the profession’s inception, social work educators have used cases for teaching students about practice realities (reynolds, 1942; towle, 1954). traditionally, however, “cases” have most often been used to illustrate theoretical concepts or to depict practice situations and the appropriate professional responses (welsh & wolfer, 2000; also, see, for example, lecroy, 1992, 1999; mcclelland, austin & este, 1998; rivas & hull, 1996, 2000). in contrast, the case methods selected for the capstone course represent specific innovations that have recently emerged in other professions (barnes, christensen & hansen, 1994; lundeberg, levin & harrington, 1999; lynn, 1999), and that have sparked renewed interest among social work educators (cossom, 1991;welsh &wolfer, 2000). most significantly, they rely on openended cases that compel decision-making on the part of students, to both define problems and choose courses of action. case method teaching is frequently touted as a means for promoting critical thinking skills and better preparing students for professional practice by providing them with opportunities to exercise judgment and engage in decision-making (barnes, christensen & hansen, 1994; boehrer & linsky, 1990; christensen, garvin & sweet, 1991; fisher, 1978; meyers & jones, 1993). rather than provide information, case method teachers rely heavily upon a variation of socratic questioning to facilitate in-depth discussion of cases (lynn, 1999;welty, 1989). casemethod teaching employs open-ended“decision” cases, a particular type of case specifically developed for this teaching approach. such cases present students with the ambiguities and dilemmas of social work practice and require active decision-making (e.g., cossom, 1991; golembiewski & stevenson, 1998; lynn, 1999; rothman, 1998). sometimes referred to as “teaching” cases, they describe actual situations practitioners have encountered in great detail. although clearly written and tightly edited, the cases depict situations that are often messy and ambiguous. typically written from one practitioner’s perspective, they some159wolfer et al./developing and teaching an msw capstone course times include conflicting statements (by the various participants involved), time constraints, competing ethical values, extraneous details, and incomplete information. because the cases are open-ended, however, they do not tell what the practitioner ultimately did or how the case turned out. as a result, the cases require that students use their analytic and critical thinking skills, their knowledge of social work theory and research, and their common sense and collective wisdom to identify and analyze problems, to evaluate possible solutions, and to formulate a preferred intervention (welsh &wolfer, 2000). writing from a business perspective, barnes, christensen, and hansen (1994) argue that case method instruction helps students develop an applied “administrative point of view” (p. 50). they suggest that an administrative or practitioner point of view includes: 1) a focus on understanding the specific context; 2) a sense for appropriate boundaries; 3) sensitivity to interrelationships; 4) examining and understanding any situation from a multidimensional viewpoint; 5) accepting personal responsibility for the solution of an organizational problem; and 6) an action orientation (p. 50-51). furthermore, an action orientation includes: a) a sense for the possible; b) willingness to make decisions on the basis of imperfect and limited data; c) a sense for the critical; d) the ability to combine discipline and creativity; e) skill in converting targets into accomplishments; and f) an appreciation of the major limits of professional action (p. 51). in short, the concept redirects our attention fromwhat students know to their ability to use their knowledge. we came to refer to this as “thinking like a practitioner.” developing coursematerials as suggested above, case method teaching requires a particular type of case, a “decision” or teaching case. decision cases that focus primarily on the macro level of social work practice are available in the published literature (e.g., fauri,wernet & netting, 2000; golembiewski & stevenson, 1998; golembiewski, stevenson & white, 1997; wood, 1996) and on the internet (e.g., electronic hallway; john f. kennedy school of government caseweb; program on non-profit organizations), though some must be drawn from public and non-profit management. however, there are few decision cases that focus primarily on micro practice (see rothman, 1998, for cases on ethical dilemmas in micro practice). for that reason, the college dean provided support for the first author to write or edit appropriate micro practice cases for use in the new capstone course. although some cases were designated micro and others macro, there were interwoven micro and macro issues in each one (e.g., legal and policy context for clinical decision-making, interpersonal dynamics in state-level policy development). the decision cases were researched and written using a process developed by welsh (1999). a small group of experienced social workers, several of whom were also enrolled in a doctoral program, were assembled as a case writing team led by the first author. the work sessions were intense, concentrated efforts that lasted four to five hours over two days for each case. in these work sessions, a case situation was reported and discussed in depth among a small group of participants. the case writing process consisted of five steps. first, before the work session, each case reporter prepared a brief written account of a problem or decision he or she actually faced in social work practice and, using a round robin format, each 160 advances in social work participant was assigned responsibility for writing another’s case. second, during the work session, a case reporter told the case writing team the story behind his or her account. these discussions were tape recorded to collect quotes and detailed descriptions. third, immediately after the work session, the assigned case writer prepared a longer working draft of the case that included a title, introductory “hook,” and story line with details, quotes, and descriptions. fourth, the working draft was distributed to the case writing team to be read and discussed again at a follow-up work session. fifth, the case writer used clarifications and further details that emerged from this discussion to prepare the final draft of the case. in addition, analytic information from the last discussion was used to prepare instructor notes for the completed case. this case writing process ensured that a case accurately reflected the practitioner’s own experience and understanding of a challenging situation. preparing toteach the course the college dean also sent the first author to a week-long conference on case method teaching. based on this experience and with an education professor, he designed and implemented a workshop for faculty and doctoral students that included a demonstration case discussion. subsequently, faculty and doctoral students participated in weekly discussions of the nine cases selected for the capstone course. instructors assigned to teach the capstone course took turns leading these case discussions. following each case discussion, the group discussed what participants had learned, the discussion leader’s teaching objectives and how well the actual discussion fit these objectives, and what questions and techniques had been most/least helpful. these faculty case discussions did two important things. first, they provided an in-depth understanding of each case that was not available by simply reading the case, even repeatedly. second, and perhaps more importantly, they provided experience with case method teaching in both student and instructor roles. on alternate weeks, instructors assigned to the capstone course continued meeting for another hour to discuss teaching plans and develop course assignments1. teachingthe course beginning in spring 2000, seven instructors taught nine sections of the inaugural capstone course with about 170 students total. classes met weekly for two and-ahalf hours (excluding break times) during the 15-week semester. the first two weeks were spent orienting students to the course objectives and expectations, and to the purposes and processes of case method and problem-based learning instruction. in the third week of the semester we began the weekly decision case discussions, dealing with a new case each week for nine weeks. the last three weeks of the semester included presentations by the students of their problembased learning cases on which they had collaborated throughout the semester, and a focus on issues involved in making the transition from student to practitioner. various formative and summative evaluations were conducted during and at the completion of the course, and class time was allocated for these purposes. during the nine weeks in which we used decision cases, the class period consisted of an instructor-facilitated case discussion lasting approximately an hour 161wolfer et al./developing and teaching an msw capstone course and forty-five minutes. instructor-led case discussions progressed through three general stages: identifying facts, analyzing the problem, and deciding how to respond. more specifically, these discussions identified facts and assumptions of the case, explored interlocking issues and dilemmas in depth, formulated problem statements, identified possible alternative strategies for resolving the identified problem, identified decision criteria, and finally compared alternatives to recommend the best intervention or course of action (welsh &wolfer, 2000;welty, 1989). most instructors concluded this case discussion with students briefly reflecting in writing on what they learned from the case and a verbal debriefing of the case discussion process. the remaining 35-45 minutes were devoted to students’ work in small groups on their problem-based learning cases. the instructor was available during this time to consult with the groups. preparing toteach individual class sessions instructors agreed to meet before the first decision case discussion to create plans for facilitating the discussion and subsequently met each week before decision case discussions. in these weekly sessions, capstone instructors briefly reviewed the previous case discussion, including what had worked and what had not worked. but most importantly, they discussed possible teaching objectives for the upcoming decision case, formulated opening questions to start the class discussion, anticipated the possible course for the class discussion and planned relevant questions, discussed techniques for facilitating discussions and adding variety (e.g., role plays, small group work), and devised strategies for remediating common deficiencies in student problem-solving (e.g., problem definition, identifying alternative solutions). in general, these weekly faculty discussions provided mutual problem solving and support, both of which proved essential for successfully implementing this instructional innovation. because it was voluntary, the consistent participation of all capstone faculty served as evidence of the perceived value of these weekly meetings. several instructional challenges became apparent as we taught this course. two major themes characterized these challenges including (1) fostering students’ application and critical thinking skills so that they are prepared to the greatest extent possible to “think like practitioners” and (2) managing the uncertainty and anxiety resulting from the challenges students and faculty were experiencing in this new course. thinking like a practitioner theoretically, our entire msw program is designed from beginning to end to prepare students to “think like practitioners” or develop a practitioner’s “point of view” (barnes, christensen & hansen, 1994). however, as those of us teaching this course engaged with students in in-depth case discussions, we were surprised and somewhat alarmed that so many students experienced difficulties in translating practice concepts into action.we were particularly surprised about this because in teaching other courses, we had not been as aware of the gap between knowledge and application. as a matter of fact, those of us who had been teaching for a number of years had been fairly well satisfied with the level of knowledge and skills demonstrated by the majority of students in the program to this point. we were 162 advances in social work also surprised by the extent to which students found it difficult to think like practitioners because this course came in their last semester before graduation. we were assuming a certain level of ability in applying knowledge that, when using this method of instruction, was not initially apparent to us to the extent we had expected or would like to have seen. we were rather quickly able to assess “where students were” when we began the process of teaching and learning through decision cases. through our weekly instructor debriefing and planning sessions, we discovered common concerns about student capabilities.we concluded that the following four areas neededparticular emphasis throughout the semester: (1) encouraging systemic thinking; (2) moving from analysis to decision making; (3) defining problems clearly and concisely; and (4) directly linking interventions to problem definitions. encouraging systemic thinking. students struggled with thinking systemically. although our program uses ecosystems as its unifying theoretical perspective, we had to work very hard to help students think about cases in terms of the various systems involved, the relationships between and among systems, and the results of the interactions on varying system levels. evenwhen theywere able to recognize some of the interrelationships among systems, they frequently were locked into dichotomous thinking of micro or macro, depending upon their chosen concentration. while instructors were initially surprised and concerned about students’ lack of proficiency in thinking systemically, we were also very excited to see the progress that the students made in this area over the course of the semester. by repeatedly emphasizing the systemic nature of practice situations, the case discussions helped the students to finally understand and internalize the ecosystems perspective they had been encountering in all of their coursework to date. moving from analysis to decision making. instructors also were challenged to nudge students beyond the process of case analysis to actually identifying the problem(s) and deciding on an intervention. as students began to think more systemically, they became quite skilled at identifying all of the pieces of the given puzzle andhow they fit together. it appeared that thiswaswheremany of themwere comfortable staying.we also were aware that this was a comfort zone for most instructors, so in order to challenge students to move beyond analysis to making decisions (i.e., to defining the problem and selecting an intervention), we instructors needed to prod ourselves as well. this meant careful attention to pacing and timing to make sure that we did not attempt to move students prematurely but at the same time did not get mired in endless analysis. some decision cases were particularly challenging in this regard because, like practice situations, the information they supplied was at points incomplete or uncertain.we were conscious of needing to move them, and us, on to the decision making step of problem solving which then presented yet another challenge. defining problems clearly and concisely. another practice skill that required particular attention was defining the problem. again, we thought students would bemuchbetter able to clearly and concisely develop a problem statement emerging from problem analysis than they were because the teaching of this skill comes early in our program and is woven throughout the curriculum. we spent more time in class focusing on this aspect of practice than we had anticipated. students 163wolfer et al./developing and teaching an msw capstone course wrote problem statements in the weekly analyses of their cases and received feedback from instructors; we worked on formulating problem statements in class, and as a class, we developed criteria for critiquing problem statements and identifying “good” ones and students critiqued each other’s statements in class. again, it was exciting to see the learning that took place over the course of the semester as students developed their skills in clearly and concisely defining problems within a systems framework of analysis. directly linking interventions to problem statements. instructors also noticed early in the course that students had the tendency to select favorite or familiar interventions. as a result, their interventions often demonstrated little or no connection with their problem statements. we worked on helping them more fully understand the concept of problem-intervention linkage, emphasizing that an intervention must be directly linked to the problem and should emerge from the problem as it is defined. we had the opportunity to work with them both in our case analyses in class and in giving feedback on their written case analyses. we challenged them to develop a rationale or justification for choosing the particular intervention that they did and to make that rationale explicit. we expected that they would be able to defend their choice of intervention by articulating the ways in which a specific intervention would solve a specific problem and how it was better than other alternatives. through these various ways, students came to see more clearly the importance of explicitly and accurately linking the problem and the intervention. managing uncertainty and anxiety this course represented an innovation within our curriculum in terms of both instructional content and process. change naturally tends to be stressful in systems and this certainly proved to be true for both students and faculty as we implemented this innovation. as detailed below, in various ways we tried to recognize, acknowledge, and help students cope with stressors associated with this new course. based on course feedback, these stressors primarily related to: (1) students’ perceptions of an inordinate work load for the course and the explicit ways in which they were held accountable for producing the work expected of them; (2) the grading system used in relation to the work they produced; (3) and the challenges associated with learning and practicing new ways of thinking and acting. work load and accountability. many students complained throughout the semester of what they considered to be an inordinate workload for this course compared to other courses in our program. in reality, the workload in relation to the nine weeks of decision cases consisted of reading a 4-10 page case each week and writing a 2-3 page case analysis. during the nine weeks spent on decision cases, there were no additional readings since the intent was to introduce no new content in this course but to allow students the opportunity to integrate and apply the content they had learned previously. many students complained that writing weekly papers was excessive. instructors believed that the weekly expectations in terms of work were equivalent to the reading expectations for other courses. for this reason we were initially surprised by the students’ very evident distress related to work load. as instructors discussed this distress with students and among ourselves, some of us began to wonder whether students had been able to succeed 164 advances in social work in their other courses without producing on a weekly basis (i.e., without doing the assigned readings each week) but by only producing for a periodic paper or exam requirement. in this course, students were held accountable by demonstrating weekly that they had done the work for that week through delivering a product in the form of a paper and their informed class participation. some of the instructors raised this possible interpretation in class and received mixed responses. some students acknowledged this to be true, while others did not think this to be an accurate interpretation of their experiences. instructors gathered data from students regarding the amount of time they spent on the course in order to better gauge students’ reactions to work load. early in the semester, many students reported spending much more time than usual writing case analyses and preparing for case discussions but with experience they became more efficient. overall, the time required seemed to faculty well within the amount of preparation time expected for a graduate level course. as a result, this experience raised questions about the adequacy of accountability in other courses that rely on a minimal number of exams and major written assignments. grading. many students expressed much distress, and for some, anger related to grading in this course. grading of the weekly case analyses presented a particular challenge for faculty as well. during our planning for the course we struggled with the issue of grading and ultimately decided that each of us would use our own method and criteria for grading. some instructors used a case analysis matrix that provided descriptors for evaluating five dimensions of written case analyses: problem identification, analysis of issues, recommended plan, creative insight, and writing style (morris, 1996). other instructors used a satisfactory/unsatisfactory grading system for each weekly analysis, with specific criteria regarding what constituted each category. for example, one instructor defined “satisfactory” as “a thoughtful, informed, comprehensive, concise, and well-written analysis (limited to two pages) which clearly indicates that the student has read the case and is very familiar with its details and which addresses all six of the required components of the analysis.” across all sections of this course, many students did not receive the kinds of grades on their case summaries they initially thought their work merited. each week they were given specific feedback to help them improve for the following week. for many students, it was several weeks before they began to show improvement in their written work, but over the course of nine weeks, instructors noticed significant improvement in most students’ work. some students remained angry and anxious about the grades they received throughout the semester. instructors anticipated that students might be upset about the differing approaches to grading across sections of the course, i.e., some instructors grading systems being seen asunfair compared to others, but this didnot seem tobe the source of the concern. rather, when students did not do as well on their work as they expected, they thought instructors were grading too strictly and had unrealistic and unreasonably high expectations, regardless of the grading system and criteria being used. this dynamic, of course, tends to be present in academia (and elsewhere) but instructors were surprised and puzzled about the intensity of reaction in this course. as a bonus assignment, one instructor offered students the opportunity to rewrite their initial case analysis at semester end, along with a comparison of the two analyses (lundeberg & fawver, 1994). several of the students who did so expressed embarrassment upon reviewing their initial case analyses, and most were surprised and pleased by the substantial improvement in their ability to analyze cases. learning and practicing new ways of thinking. in this course, students were clearly asked to learn and practice new ways of thinking as we attempted to help them move from the role of student to practitioner. we were also asking them to integrate and apply all of what they had learned in their msw program. certainly in other courses there had been attention to applying knowledge specific to each discrete course or content area, apparently to varying degrees, but integration and application were the central themes and purposes of this course. in this sense, we seemed to be asking students to “go where they had not gone before.” as we engaged them in this process and as they got feedback on their work, students reported that they were beginning to question their readiness, confidence, and competence for practice. in fact, case discussions deliberately undermine certainty by promoting more flexible and complex thinking, “including changing from dichotomous ways of thinking to the appreciation of more conditional ways of thinking” (lundeberg & fawver, 1994). research on conceptual change may help explain learning from case discussions: unless individuals become dissatisfied with existing beliefs and consider the utility of alternative or new beliefs, there may be no change in thinking. however, case discussions may provide the opportunity for participants to confront previously held beliefs and come to understand plausible alternative ideas, which might in turn be the catalyst for a shift in beliefs andunderstandingaboutparticular issues incases. (levin, 1999,p. 146) we think it possible that this dynamic, coupled with the timing of this course in the last semester of the program and coinciding with the job search process, resulted in a high level of anxiety among students. we attempted to help students keep this in perspective by drawing on knowledge of the change process and of the dynamics involved in innovation. for example, virginia satir’s model of change (satir, banmen, gerber & gomori, 1991) helped us to understand and manage this process. change involves the interruption of the status quo by a foreign element (this course and the instructor) resulting in chaos. as the system attempts to cope with the chaos, new learnings result, which allows for movement to the practice and integration phase. in this phase of change, the system’s chaos lessens as it practices and integrates these learnings. moving through this phase of practice and integration leads the system to a new status quo, in this instance, emerging practitioners better equipped to beginmswlevel practice.this model proved very helpful in understanding and managing this innovation as we definitely saw all phases of the process in teaching this course. we used the students’ responses to this innovation to teach about change in systems. it was particularly interesting that one of the decision cases dealt with an innovation in an agency system, resulting in very similar dynamics to the ones we were experiencing in the course. this allowed for a rich discussion of the parallels 165wolfer et al./developing and teaching an msw capstone course 166 advances in social work between the case and our experiences and for the opportunity to normalize feelings of anxiety associated with change. teaching this course was an innovation for instructors as well, so we experienced our own forms of anxiety, which resulted in new learnings for all of us to practice and integrate into our teaching. particularly helpful in dealing with our own anxiety and stress relating to this innovation were our weekly instructors’ meetings. we met each week to debrief the previous class with a particular focus on what worked and did not work in that week’s case analysis. we developed teaching objectives for the upcoming decision case, wrote opening questions to start the case discussion, anticipated the possible course of the discussion, planned teaching techniques for adding variety (e.g., role plays, small group work), and designed strategies to address students’ limitations and enhance their strengths. these weekly meetings served as a much-needed source of support for those of us teaching the course. in addition to being a valuable stress management tool, these meetings allowed us the opportunity to experience firsthand many benefits of case method learning. because cases cut across content areas, we relied on each other for content knowledge. because we all had limited experience in case method teaching (and most of us had none), our weekly debriefing and planning meetings contributed to our learning about teaching, facilitated mutual problemsolving, supported experimentation, and increased collaboration and camaraderie. evaluating the course and student learning at risk of over-evaluating this new course, instructors sought both formative and summative evaluation data at multiple points during the semester. given the orientation to active learning, several of these methods challenged students to reflect on their own and others’ learning. in fact, as explained below, several instruments were selected or designed to promote changes in student thinking and understanding. as a result, these instruments served both as teaching aids and outcome measures. perhaps most significantly, students’ written analyses and class discussion of decision cases provided surprising, even distressing feedback about their lack of readiness for professional practice. for example, early in the semester, capstone faculty realized that, at best, students had great difficulty formulating workable problems for the decision cases. most students tended to formulate problems in superficial ways despite repeated exposure to problem-solving models throughout the curriculum. few exhibited a systemic understanding of problems despite the fact that the master’s curriculum is organized by an ecological systems perspective. in response to these apparent deficits, capstone faculty provided information about formulating problems and incorporating multiple system levels in these formulations.this information included reminders about previous readings, handouts on defining problems, written and oral feedback regarding written case analyses, and in-class problem-setting exercises. in addition to evaluating individual student performance on each weekly case analysis, instructors used several additional methods for gauging student learn167 ing and soliciting feedback concerning the course. because the data are reported in detail elsewhere (wolfer & miller-cribbs, in preparation), the methods will only be summarized here. at the end of most case discussions, instructors asked students to write down what they had learned from the case discussion, an adaptation of the minute paper (angelo & cross, 1993). several instructors collected these student “learnings,” compiled an anonymous aggregate set of learnings, and e-mailed complete copies to members of the class section from which they came. structuring this brief period for personal reflection encouraged students to actively identify and consolidate their own learning. having students write down what they had learned also reinforced what might otherwise be ambiguous and potentially frustrating for some students. sharing student learnings via e-mail further reinforced learning and broadened students’ understanding of how differently people responded to a shared discussion. students were often fascinated and sometimes surprised by what their peers reported learning. at mid-semester and again at semester end, instructors administered a newly constructed learning outcomes instrument. based on the case method and pbl literature, the instrument was designed to solicit student perceptions of correspondence between expected learning benefits of case method and pbl instruction and what they were learning. except for a section on applying content knowledge from others courses, this instrument focused on developing “procedural” knowledge (e.g., “think across system levels,” “explain and support my decisions”). in addition to gauging their own learning, the instrument was intended to remind students of what the course was meant to promote. in this way, it provided a subtle reframe for students, some of whom initially felt unclear about and frustrated with the rather process-oriented benefits of case method instruction. also at mid-semester, instructors administered a teaching improvement evaluation. adapted fromweimer, parrett, and kerns (1988), this instrument asked students to rate their instructor’s classroom methods and performance on a sevenpoint scale, ranging from one for “instructor does very well” to seven for “instructor needs to improve.” the particular items were selected or created for relevance to case method teaching skills and attitudes (e.g., “maintains a high level of safety and respect within the classroom, even when people disagree with each other,” “challenges vagueness in discussions”). each item also provided space for students to suggest ways the instructor could improve his or her performance. the combined quantitative/qualitative items allowed instructors to obtain both summary judgements and detailed feedback about ways to improve. for instructors new to case method teaching, this instrument provided invaluable feedback. on some items, conflicting student responses gave instructors the opportunity to talk about what they were trying to accomplish and how these efforts elicited divergent reactions from students. often, these discussions also helped students to gain a better understanding of the case method of instruction, to appreciate the complexity of the learning process, and to reconsider their own strong reactions to certain aspects of the process. taken together, the learning outcomes measure and teaching improvement evaluation encouraged students to distinguish between what they were learning and how their instructor sought to promote learning, and to think about how these might be related. wolfer et al./developing and teaching an msw capstone course 168 advances in social work finally, capstone instructors administered a course-objectives measure and a newcourse-specific evaluation form.the latter askedwhat contributed or detracted most from students’ learning and solicited their suggestions for improving the course, with special emphasis upon course assignments. because these two instruments were administered at semester end, they could only provide summative data for fine-tuning future courses. overall, strong and fairly widespread negative sentiments at mid-semester were clearly reversedby semester end.the overwhelmingmajority of students expressed satisfaction with the capstone learning experience, with some citing it as the most significant and growth-inducing course in the msw curriculum (wolfer & millercribbs, in preparation). recommendations based on our positive experience with the case method of instruction, we encourage its use in other schools of social work. we offer the following recommendations for social work faculty interested in adopting the case method of instruction in the way in which we are using it in our university. tangible supports numerous tangible supports are needed to develop and implement this innovation. faculty who are developing the course need support in the form of release time or overload pay for this purpose.we found that developing a course of this nature was far more labor-intensive than other course development in which we have been involved. for this reason, the administration should not assume that an already overworked and overloaded faculty will be able to add the responsibility for developing this course without adjustments in their existing work load. faculty development funds for casemethodworkshops, institutes, and/or consultation are useful in preparing them for the development and teaching of a course using this method of instruction. because we recommend a maximum class size of 20 for a course of this nature, a commitment from the administration is needed to keep section sizes small. administrative support is alsoneeded to configure course scheduling in away that allows for diverse representation of students in each class section from across the curriculum.this means that students representing all of the program’s concentrations or specializations or fields of practice (however the curriculumisorganized) should be included in each class section because this diversity substantially enriches case discussions. classrooms that flexibly allow for face-to-face discussion in both small and large groups are needed (erskine, leenders & mauffette-leenders, 1998). committed faculty cohort a committed cohort of faculty interested in developing and teaching a case-oriented course is critical. as mentioned above, faculty involved in our course met weekly during the semester in which the course was being developed and continued to meet weekly while it was taught. we believe this level of involvement was essential to the success of the course. the intermingled learning and support that flowed from these meetings helped us as faculty to deal constructively with our own uncertainty and anxiety resulting from substantial change, and thereby helped to prepare us to better lead students. when we reminded each other that “teachers also must learn” (gragg, 1994), we meant not only content but process. multiple feedback loops a commitment to evaluation using multiple feedback loops throughout a course using case-oriented instruction is important. evaluation was an ongoing theme in our course experience. we incorporated a variety of feedback loops that included instructor discussions, student self-reflection, and classroom interaction in order to promote students’ awareness about their own learning and assessment of their use of self in social work practice.we employed formative and summative evaluative tools, both oral and written, regarding students’ experiences with the course process, our particular strengths and limitations in teaching the course, and learning outcomes. these feedback loops helped us to make mid-course corrections that enhanced the course (e.g., providing handouts and extra discussion on particular learning issues). in the process, we modeled for our students the routine inclusion of evaluation procedures in professional practice and promoted self-reflection among both faculty and students. managing innovation explicit attention to managing the innovation is an important component of developing and implementing a case-oriented approach to teaching and learning. in addition to the needed tangible administrative supports and the intangible collaborative support of those teaching the course identified above, we found other aspects of managing the innovation to be important in the success of this course. students need to be introduced and oriented to the method of case-oriented instruction as part of the course. they need to know the rationale for using this method of instruction and the ways in which it differs from more traditional learning, as well as its challenges and benefits. faculty who teach an innovative course need to be reminded of the normal resistances and anxieties associated with significant change and encouraged to provide support to students and to each other when people experience discomfort as a result of the change process. there is the potential here for a good lesson for both students and faculty in learning to trust the process. support from faculty (or at least the absence of resistance) who are not teaching the course is also important to managing this innovation. therefore, the entire faculty needs to be oriented to case method instruction and its purposes. we experienced the ripple effect in our program during the implementation of this innovation. faculty in other courses were dealing with “fall-out” in their classes in terms of students being distracted by their experiences in the new course. some faculty responded in ways that supported the innovation, while others who were perhaps not as well briefed on this curriculum change, responded in ways that seemed to undermine the innovation. a “united front” is useful in managing the innovation and the chances for this occurring are increased when all faculty have sufficient information about the rationale andprocess for case-oriented instruction. conclusions based on our own informal observations, we believe the case method of instructionmaybe an effective vehicle for promoting and reinforcing critical thinking and problem-solving skills and for helping students to integrate and apply the knowledge, skills, and values to which they have been exposed over the course of their msw education. and given its place in our curriculum, the case method appears 169wolfer et al./developing and teaching an msw capstone course to facilitate students’ role transition from that of student to practitioner. as a further benefit, we find our collaborative efforts in developing the capstone course and using the case method of instruction have energized and improved our teaching, both in this course and beyond. endnote 1a course syllabus, including course assignments, is available from the first author. references albanese, m., & mitchell, s. 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(1999). a technique for cross cultural case research and writing. in h. e. klein (ed.), interactive teaching and the multimedia revolution: case method & other techniques. madison,wi: omni press. welsh, m. f., & wolfer, t. a. (2000). making a case for case method teaching in social work education. faculty development institute presented at the annual program meeting of the council on socialwork education, newyork, ny. welty, w. m. (1989). discussion method teaching. change, july/august, 41-49 [for more detail, see: discussion method teaching: a practical guide. to improve the academy, 8, 197-216]. wolfer, t. a., & miller-cribbs, j. (in preparation). evaluating outcomes of case method learning in an m.s.w. capstone course. wood, m. m. (ed.). (1996). nonprofit boards and leadership: cases on governance, change, and board-staff dynamics. san francisco: jossey-bass. author’s note: address correspondence to: terry a. wolfer, college of social work, university of south carolina, columbia, sc usa, terry.wolfer@sc.edu. 171wolfer et al./developing and teaching an msw capstone course advances vol. 4, no. 2 65 a portal for a school of socialwork: going for the edge robert vernon cynthia schultz abstract: this case study documents how one school of social work addressed the growing complexity of distributing information by developing a state of the art portal andwebsite system to serve itsmany audiences and campuses. preliminary findings are discussed. keywords: website, design, portal, social work social work educationwebsites often reveal design and functionality problems. many are nothing more than electronic brochures with little information on programs, faculty lists, and perhaps a smattering of select details (carlson, 2003). these websites are typically static with very few interactive elements, if any. some are more dynamic and offer prospective students the ability to apply online or download program information. many are “placeholders” crafted by non-social work staff who know very little about the profession or the curriculum.very few are designed tomeet the needs of themany different audiences whowant information about the profession, the school, or its features (curl, bowers & bowers, 2003; vernon & lynch, 2003). this case study is for colleagues who want to expand their school’s website toward reaching wider audiences, supporting administrative routines, and enhancing the quality of teaching through building amore sophisticated web presence. problems and needs our school hosted a first generation website since 1995 and experienced the typical problems and limitations that developed as information needs and consumer expectations grew: • lack of consistency. visitors were more satisfied when a website had consistent navigation and an attractive overall appearance, yet, navigation and design inconsistencies had cropped up after several updates and revisions.what resulted was amain website that actually looked like several separate websites cobbled together. a visitor could easily think that they were at a different website altogether rather than being in another part of the same one. robert vernon, ph.d. is associate professor, indiana university school of social work, indianapolis, in 46202. cynthia schultz,ms is seniordirector of communications, indianauniversity alumni association, bloomington, in 47401. copyright© 2003 advances in socialworkvol. 4 no. 2 (fall 2003) 65-79. indiana university school of socialwork. 66 advances in socialwork • outdated content. it had been easy to amass considerable information on the website. once posted, though, a conference announcement or other time-sensitive item tended to become immortal, available long after the event had taken place or the deadline had passed. • poor quality content. no one regularly reviewed the website for currency and accuracy. content sometimes had grammatical and spelling errors that conveyed a lack of scholarship and professionalism. • linkrot.hypertext links that lead nowhere are a commonproblemwithwebsites. we certainly had our share. • overburdened resources. responsibility for development and maintenance fell on administrative support personnel. our one in-house technician was already working at capacity. in addition, most administrative support personnel lacked the advanced skills needed to develop andmaintain online content.1the process of transferring informationwas laborious. text content had to be changed tohtml, introducing errors, and frustrating staff. long delays became commonplace. •no uniformity between websites.the indianauniversity school of socialwork is completely centralized:we offer four different degrees on five different campuses throughout the state. the indianapolis campus is the flagship and all policies and programs are centrallymanaged from this campus.yet, we had five different websites in place and none of themwere similar in any respect. all had independently evolved and there had been no attempt to develop any content or design uniformity. more subtle problems were emerging, too. as the web was maturing, the user’s expectations were maturing as well (powell & gill, 2003). users expected to find information on the school’s website, and they assumed they would get an immediate response—24 hours a day, seven days per week (spool, 2001). our static website with its “one style fits all” design was failing to meet visitors’ needs as reflected in numerous informal comments and e-mails.therewas a general consensus that the school was rapidly outgrowing its static website and that we also needed to have a system that knit all five campuses together. this problem was taken up by the school’s technology committee, a faculty, student, and administrative group charged with overseeing technology needs. the technology committee conducted several hearings and interviews with key constituencies and determined the following: all of our university’s doctoral applicants had recently been required to submit their applications online, yet, our website could not support this. prospective bsw and msw students wanted detailed information and the ability to apply online, as well. alumni wanted to keep track of each other and know about upcoming events. faculty wanted enrollment lists and access to student information. researchers wanted to work collaboratively and share information. staff wanted access to official calendars and detailed program information. enrolled students wanted class schedules, syllabi, and graduation requirements. administrators needed secure access to the financial management systems and budget information. everyone wanted a new, more interactive, and robust web environment that would support these needs. disability access was paramount. thetechnology committee worried that a cutting-edge solutionwould limit access touserswith special needs.weneededa solution that would seamlessly deliver content to all users nomatter what type of computing device they used to access the website. different connection speeds, browsers, and other universal design requirements would have to be taken into consideration as well. finally, we were aware that the university’s many different computing networks were changing, too, and that any solutionwe createdwould have to adjust to them. the student informationtransaction environment or “site”—already quite sophisticated—was being replaced by a new system that promised to integrate everything fromenrollments and course scheduling to tuition andparking tickets. “oncourse,” indiana university’s course management program that is similar to web ct and blackboard, was becoming universally available and students were starting to demand it. any solution we selected would need to be compatible with these other initiatives. gearing up the chair of the technology committee convened a project task force to inventory needs and recommend a solution. the task force consisted of representatives from major constituencies: faculty, students, staff, alumni, and community leaders. this group began to investigate how to transform our static website into a far more adaptable one that would meet current needs and likely adjust to new demands from the university.we decided we needed a central repository for all of the common documents shared by all of the programs on the five campuses within our system. for example, we needed a way to have the identical msw student manual universally accessible. we wanted a way to distribute centrally managed syllabi. we envisioned a portal—a large, integrated system with a main website for the school and satellitewebsites for each of the five campuses2. each satellitewould be stylistically similar yet recognizably distinct so that visitors would visually know that they were still within the same school but on a different campus. an underlying portal structure would provide this visual continuity, assure uniformity when needed, and support the individual needs and characteristics of the different campuses and their programswhilemakingmanagement of the entire school’s system far easier. we also envisioned a “distributed system” where authorized staff could immediately post or update information without the bottleneck of converting documents to html and waiting for technical support to get them on the server3. one of the first jobs the task force accomplished was to identify and specifically describe the audiences we needed to include. unlike the current “one size fits all” version, we wanted the new portal to accommodate as many different audiences as possible (nielsen, 1999;vernon & lynch, 2000). the task force identified six distinct audiences: potential students, current students, alumni, faculty and researchers, administrative and support staff, and external constituencies such as practitioners, agencies, and social service organizations. each audience had different information needs. 67vernon, schultz/a portal for a school of socialwork: going for the edge we then isolated 45 discrete sub-categories within the original six target audiences. the faculty audience, for example, was divided into junior/non-tenured faculty, senior/tenured faculty, visiting faculty, adjunct faculty, teaching practitioners, associate faculty, field instructors, and potential faculty.we used this finegrained listing based on the assumption that different groups within each target audience would have different information needs. seasoned and tenured faculty, for example, need access to advanced course resources, while associate or adjunct faculty require farmore basic help. a potential student looking for a ph.d. program would not be interested in bsw offerings. the task force then crafted a mission statement along with specific goals and objectives to guide us, based on this initial audience and needs inventory. “the mission of the indiana university school of socialworkweb task force is to create an electronic, web based support system that promotes the school in the preparation of knowledgeable professional social workers, through teaching, scholarship, and service, and to support the pursuit of social, political, and economic justice by iussw web community members. through the development of a user friendly, dynamic, and ever-changing school web site, the task force seeks to streamline internal day-to-day school operations, and to build bridges among faculty, staff, students, and the broader practice community in indiana. such connections are also intended to support the involvement of iussw alumni in continuing social work education and the development of best practices. the iusswweb site design creates a portal for continued engagement with the broader community, and a gateway into the iussw community. in building a web community, the task force seeks to generate electronic resources for users that support the integration of technology into teaching, scholarship, and service. to these ends, the iussw web task force seeks to create a web based system that is responsive to the needs of the iusswweb community.” iusswwebsite mission statement available at: http://socialwork.iu.edu/site/indexer/121/content.htm next, the task force chairmade a prototypehtmlwebpage and shared it and the mission statement with people from the six different audiences. revisions were made from the resulting feedback, and the task force introduced the refined mission statement andprototype at a full facultymeeting in the spring of 2001.the faculty were thoroughly dissatisfied with the current website and clearly understood the benefits of this new approach. the faculty unanimously endorsed the portal project and this proved invaluable. it validated the recommendations of the task force and garneredbroad-based support. everyonewas coming“onboard.”we also began to realize that a static website, perhaps a little more complex than our current one, would never support our evolving needs. it was becoming clear that we might be overwhelmedby the scope and complexity of this project.we realized that we lacked the professional expertise and resources to advance the project successfully. fortunately, our dean had a progressive vision for the school that embraced technology. hewas very aware of what a goodweb presence could accomplish and how 68 advances in socialwork it could advance our many activities. this, combined with complete support from the faculty and staff, set the stage for seeking out the resources we needed. we needed to expand internal capabilities. we sought out professionals experienced in large-scale web projects. the university had a web services unit in the office of communication and marketing.we scheduled a meeting with theirweb development services (wds) consultants and took hard copies of the prototype, our mission statement, and our list of target audiences with us. the meeting withwds was both productive and frustrating. their primary work was with high-level strategic initiatives for the entire university system. they could provide basic consultative services to schools, but this was not their principle function. it became apparent that engaging them to help develop our portal would result in significant delays. we mulled over the idea of cobbling together various parts of the portal from several other university sources. this, too, seemed equally fraught with problems and potential delays. that left us with the all too common dilemma—build or buy?we needed to decide whether we would design and build the portal ourselves or seek an external partner to complete the project.we asked thewds staff to help craft a concise memorandum of understanding (mou) that would focus our choices4. this became the key working document. the mou included a vision statement, ranked target audiences, recommended solutions, identified quantitative and qualitative metrics, and provided an estimated timetable and costs. the mou outlined four possible solutions in increasing order of complexity and cost.we could: 1. redesign the current static html site with similar functional limitations to the ones we had. 2. build a website with some dynamic sections (news, calendar, etc.) and include databases and several administrative tool features. 3. undertake a completely dynamic website using templates and a database repository. robust administrative tools for content management of documents, images, audio, and video files with distributed publishing and workflow management capabilities could also be included. this would make it possible to havemany different people working on the website continuously without bottlenecks and yet have the ability to oversee and control what was being posted. 4. choose a robust solutionwith additional e-commerce, e-learning, and“push and pull” features. in this context, push and pull referred to complete integration with the oncourse course management system and other information systems planned by the university. given the available resources and personnel capabilities, the first two solutions could have been built in-house. the third and fourth would require external help. the fourth solution was the most complex and would involve coordination with major university-wide initiatives.we elected to pursue the third option and retain a consultant. 69vernon, schultz/a portal for a school of socialwork: going for the edge 70 advances in socialwork wpd recommended three firms that they had worked with in the past.we started by reviewing the firms’ websites and tested them for disability access with the “bobby” program (watchfire, no date). “bobby” allows you to analyze how well a website conforms to the world wide web consortium (w3c, 2002) standards for disability access and the federal section 508 requirements.these are industry standards for website disability access (wright, 2002). only one of the three firms, excel communications, inc., passed these crucial tests. next, we asked for references fromexcel’s customers and followed up on them.the recommendations were positive: excel communications had successful experience working with higher education institutions andwas quickly responsive to their customers.they understood some of our more byzantine organizational characteristics. in addition, they had experience with portals and content management systems (cms). their past projects involved design, development, and implementation of “off the shelf” cms products. most importantly, they had developed their own cms solution in response to client needs. the product was called plexcor and was built using open source microsoft protocols—a common industry standard—that we felt would have staying power.we began a relationshipwith excel communications.this produced a contractual agreement including planning and consulting services, creative services (design, development, and implementation), and the plexcor application. this was themost critical juncture—we hadmade a formal commitment to the portal project and found the help we needed to pursue it. planning phase we began the session by brainstorming with the excel team to develop a common vision of what success would look like if we looked back five years from now. we used our mission statement as the basis for this discussion. next, we went back over the list of target audiences and reviewed the groupings. the excel team encouraged us to rank the audiences in order of importance. we then listed strengths, weaknesses, opportunities, and possible threats that could result from the newwebpresence. once everyonewas on the samepage, we developed strategies that would support our vision. we remained mindful that a portal was a means to communicate and not a strategy in and of itself. during the discussion we considered a broad range of topics. not surprisingly, one of ourmain strategies involved developing our portal as our primary communications, marketing, and development tool. at the same time, we compiled a list of possible sub-strategies and activities that we could initiate:wewanted to showcase research activities, develop collaborative teaching resources, convey what you can do with a social work degree, promote prospective students, cultivate alumni, nurture current students, and develop new relationships with organizations through hosting services. we discussed the features and functions we wanted included in the portal from the outset. it was time to take this knowledge andmake it explicit. in collaboration with the excel consultants, we came up with the following features and functions: • the people who would maintain the portal and websites would not need technical skills such as writing, converting files to html, or placing them on the server. • distributed publication would happen by as many people as needed rather than merely relying on one person or office. • a workflow management process would be in place to control content by having a review—approval feature—so that problematic files could be re-edited before being made publicly available. • security, including the ability to control different degrees of access to editing and the uploading of documents and the ability to archive files and web pages taken out of circulation. • disability access at minimum compliance withw3c and section 508 standards. • the hosting of collateral organizations such as social work practice associations that need a web presence. • the ability to add e-learning, especially for continuing and distance education, and e-commerce features if the school decided to pursue these in the future. the final task of the planning phase involved the consultants developing a project review website. this website became our central hub as the project evolved. it was a convenientmechanism for storing documents, reviewing proposed designs, and archiving project information. design phase once this job was done, we disbanded the task force and moved oversight of the project to the school’s standing technology committee. the committee’s first order of business was to agree on themethodology formoving the project forward with the excel consultants. the user centered design approach (norman & drapers, 1986), a dialog process for developing successful interaction between people and computers, was in widespread use at our university. excel was experienced with this methodology, and the consultants had developed a project management matrix that could easily manage the project as it progressed from design to construction. our consultants recommended an “integrated marketing communication” (imc) approach (schultz, stanley, tannenbaum & lauterborn, 1993) noting that the university’s marketing group had been employing it with success for several years. imc results in a seamless uniformity betweenmedia: websites echo printed materials, televised messages, and all other media used for public communication. taking this approach required us to consider development of the overall creative concept for the portal—the “look and feel” and primary messages—as a cohesivewhole (percy, 1997).thiswould result in consistent designs andmessages in all of the school’s media including website, brochures and other promotional and scholarly materials. the concept would begin with our portal. to develop our keymessage, we listed the school’s attributes, whichwere unique and of value. in marketing terms, this is referred to as the “unique value proposition.”we had strong brand recognition and an excellent reputation. as a result, we developed this key message: indiana university school of socialwork…shaping leaders since 1911 71vernon, schultz/a portal for a school of socialwork: going for the edge visual design we initially began working with the consultants to develop the visual look for the website. this caused a fundamental change in our public relations documents. many of the school’s brochures for various programs, reports, and other public documents had evolved at different times over the years. this resulted in a confusing patchwork of many styles, colors, and layouts. the need for a uniform coherence was obvious. we needed to embrace the integrated marketing approach. as a result, apart from website development, excel and the school developed creative concepts that included a common color palette that would be used both on thewebsite and in paper publications. this crystallized the“look” for the portal and satellites. the portal now had a uniformdesign that would bemimicked by all five campus programs.the colorswould be unique for each campus butwould still be from the same palette.visitors would know that they were still within the school but on different campuses.with a little practice, a regular visitor such as a student would be able to immediately recognize where he or she was in the portal. in the samemanner, close attention was given to having some consistency with our host university’s website through the use of visual cues.we portrayed the relationship subtly by re-using the same message, font, stylistic treatments, and logo as our university does in its key marketing strategy. excel then provided us with three different creative treatments. we tested how well the concepts resonated with users in all six target audiences during the prototype testing that took place when the information design was complete. information design with the initial planning and most of the design phase now complete, we were ready to begin designing the information architecture and navigational structure details for the portal and one of the campus websites. we elected to tackle the design and implementation of the portal, now called indiana university school of socialwork and would develop the main campus website first. subsequent development would follow for the other four campus sites.we deliberately decided on this approach because we felt that changing the entire five-campus system all at once would overwhelm us. the first task was to design how the specified contents for the various audiences, programs, and campuses could fit together into a reasonably navigable whole. this proved to be daunting given the number of audiences and varied content specifications. the process evolved into a dialog: our consultants would give us a version of a sitemap.wewould review it, give them feedback, and ask for an updated version that reflected our changes. when we got to the fifth version, we were ready for user testing. we needed feedback from users in all six target audiences before proceeding further. prototype usability testing usability is defined by the international standards organization (iso) as the extent towhich a product can be used by specified users to effectively achieve specific goals efficiently in a specified context of use (iso, 1998).we started to gener72 advances in socialwork ate authentic tasks using the frequently asked questions collected during the planning phase. for example, the directors from the ph.d., msw, and bsw programs reviewed the questions and proposed tasks for their program area. a paper mock-up was developed from text documents that represented potential web pages (snyder, 2001). the pages were assembled into a loose-leaf binder. each page had a numbered tab and the numbers represented links to other pages. this made it possible to simulate movement from one page to the next without actually developing the website. we selected 10 representative users from the six target audiences. we wanted typical users, not people whowere extremely enthusiastic, knowledgeable, or hostile to using technology, and so they were screened for a moderate level of computer experience and familiarity with the school of social work. the test sample was weighted toward females, which represents the school’s population. testing was conducted at the school, one test subject at a time. one of us would read an introductory script, then the test subject would try to accomplish 22 tasks andwas asked questions pertaining to the design. the tasks simulated actual activities such as finding specific information about fieldwork in the bsw program. in accordance with ucdmethods, iterative changes in the pages were made as testing progressed. findings observations and data from the paper tests were consolidated into a report. the findings and recommendationswere grouped according to template styles (portal, campuses, and programs). the report listed 21 “findings” and suggested 13 “recommendations” for consideration. this produced a final sitemap when the recommendations from the usability testing were resolved and adopted. taken together, the sitemap planning process and usability testing produced a workable plan. the excel technical staff developed an electronic prototype within three weeks. the technology committee reviewed it and additional modifications weremade based onminor stylistic and content changes.we now had a clear plan for constructing the portal and its satellites. development and implementation phases hosting and security we had to decide whether to host the portal on our own server or enter into a feefor-service agreement with an internal university service. the school had its own server at that time, but we had encountered security problems with it and maintaining a vigilant presence was getting to be a drain on our school’s one technical support person.while no system is completely immune from attacks such as people attempting to store movie files, alter files as pranks, or worse, our university could provide a far more robust environment. as a result, we decided to go with the university’s hosting services. this decision gave us the advantage of not having to worry about security and also provided the opportunity to host a test-bed website for the prototype. we could populate the new portal and its associated websites while keeping the oldwebsite in service. this would allow us to fine tune navigation and content before rolling out the new portal and help with training. 73vernon, schultz/a portal for a school of socialwork: going for the edge role assignments our consultants installed the prototype and we created a preliminary list of content managers, the people who would have responsibility for specific content areas within the portal. for example, someone from the msw field office would need to develop and maintain content regarding practicum activities. “user groups” could be createdwith different levels of access to the portal and the iupui campus website. we initially created four groups, which included “owners,” the people with complete access and decision control over all aspects of the website. a “security” group consisting of the owners and our technical support person was added to regulate access. a “managers” group was created for people with administrative responsibilities. finally, an “editors” group was created. these would be the peoplewhowould actually enter web content and themanagers would be able to approve that content. assignments to specific groupsweremade by the school’s “administrative team,” the group charged with oversight of all of the school’s production routines. group assignment was based on the staff person’s role and responsibilities. pass-worded access was given to each individual depending on their assigned group. training our consultants then held two field-training sessions. the preliminary documentation formanaging thewebsite was not adequate from a“read it-do it” viewpoint. thiswas largely due to the fact that the plexcor program ismenubased, not graphics based, making it sometimes difficult to understand where you are in the program. this made it important to have hands-on training and experience in addition to the documentation. these sessions focused on the direct skills needed to gain access to the system, how to upload different types of files, set navigation, and edit web page content. in addition, excel provided a lengthy technical instruction session with one of us, who, as a site owner, would also have occasional instructional responsibilities. workflow the initial workflow procedures, such as assigning who was responsible for providing and editing content, began to evolve asmore people contributed to the portal’s database. we discovered that overall management and navigation decisions needed to be made by the site owners because of features in the plexcor system. the navigation features were too challenging for some staff. this resulted in a prototype website that was both centrally managed and yet access-distributed on a controlled basis: exactly what we wanted! launch at this point we had to decide when to take the portal out of the test-bed and present the websites to the public. we still had incomplete data files and occasional gaps where content should have been available but was not. yet, to delay longer would simply continue dependence on our older, inadequate website. expectations had been raised and we needed to deliver on them, even if the product was incomplete.we decided to roll out the portal and the iupui website at the beginning of october, 2002, with the expectation that enough of the database 74 advances in socialwork would be complete by the end of the semester that people would start becoming dependent on it for routine information. evaluation and assessment whatworked andwhat did not?while a summative evaluation of the portal’s effectiveness is premature, several issues concerning how well it has worked and nuances around the development process merit discussion. these are based on observation, experience, and discussion. one key issue is monitoring organizational change and management issues. change management innovation often takes place outside of the organization’s official hierarchy. this project was no exception. many people with varying statuses had participated throughout the formative stages of the project. this resulted in a wide degree of buy-in and certainly fostered designs that addressedmany needs.yet, once up and running, some administrative control over content became necessary. as a result, oversight and policy finality was transferred from the school’s technology committee to the school’s administrative team. this group consists of our dean, the three directors for the different degree programs, the director of research, and the director of development.with this policy established, the evolution of routines and who would be responsible for them began to evolve. since “no single quality of management practice is more highly correlated with success than [participation]” (deetz, tracy & simpson, 2000), it was fortunate that these individuals had been keenly involved in the portal development and were very supportive of it from the start. marketing and promotion little energy was devoted to advertising and promotional planning for the portal at rollout because the databases were incomplete. what would be accomplished by attracting visitors to an incomplete website?we began to turn our attention to promoting the portal and its content once people started to add content.while the portal project began independently, the collateral efforts to create a uniform or “branded” look and feel for all external communications collateral for the school were in development as well. as a result, wemissed an initial opportunity to crosspromote between the various marketing and communication channels. assessment metrics assessment metrics are included in the plexcor module to help determine frequencies and patterns of use. unlike the rather useless logfiles from the older website, this feature provides quantitative measures such as the number of hits per web page per unit of time, page hit frequencies, and hierarchic relationships between web pages. the measures show more visitors are regularly hitting the iupui website than the portal page. this suggests that visitors look for campusspecific information more than general information about the school. the visitation patterns suggest targeted search. for example, information-laden web pages about the msw program have a high visit frequency followed by web pages with more specific information, then by web pages on application information. this suggests a pattern of inquiry, exploration, and commitment on the part of poten75vernon, schultz/a portal for a school of socialwork: going for the edge tial students. the research section of the website enjoys high use as well. these aggregatemeasures have been gratifying because they indicate that, at least for the prospective student and research audiences, the portal is beginning to support them. lessons learned the process we followed—initially envisioning what we needed, then consolidating it into amission statement that was endorsed by the faculty—was probably the most critical part of the planning process. the vision whetted appetites for what could be. the mission was the foundation for our goals. the initial efforts at defining the portal’s audiences, then conducting usability testing, were most worthwhile. these efforts helped transition the mission statement fromgeneral intentions to specific and concrete operational objectives.they also clearly informed everyone about just how complex and how long the endeavorwould take.this led to reasonable expectations.the fact that we put a great deal of energy and effort into this—prior to writing a single line of code—clearly paid off as very few user complaints were voiced after rollout. earlier attention to administrative structures and policies for the website would have been helpful. we had occasional conflicts over just what content needed to be placed within the portal and where it should be located. these conflicts tended to bemechanical rather than philosophical, though, and did not impede progress. additional issues such as who would be responsible for them while initially mapped out evolved into different personnel needs and patterns. in a sense, the loose coupling of various constituencies during the design and implementation process may have been helpful, but rationalizing the results earlier in the process might have resulted in a more complete product at rollout. our decision to use professional designers and developers was invaluable. the efficiencies gainedwere worth the investment. had the school tried to develop the portal with internal and intramural resources, the results would certainly have been an inadequate portal way past deadline. the visual consistency among campusesmight not have emerged. the system formanaging information on thewebsite would have been far more arcane. adequate financing was also very pivotal in our success. our dean was extremely supportive. having a competitively bid price for the entire system rather than contracting with technical personnel on an hourly basis was efficient and resulted in more collaborative involvement with the consulting firm. contracting with numerous independent consultants instead for bits and pieces of the system would have courted disaster. coordination and compatibility would probably have been amajor problem had we chosen this alternative, plus the time drain on staff would have been prohibitive. the planning of revenue streams to eventually amortize investment costs and sustain the system in the future, discussed from the outset but still on our horizon, was very helpful in generating support from key administrative personnel. our security and currency concerns have beenmarginal.whilewe initially set up a hierarchywhere editors’ workwould be reviewed and approved by themanager’s 76 advances in socialwork group, this was not necessary. the portal system fosters mutual oversight among contributors. this has resulted in quick error correction and the elimination of obsolete information. finally, the relationship between our vendor, excel, and the school was instrumental in the portal’s current and growing success. selecting a firm that could guide development and extend support beyond rollout through maintenance agreements was crucial. the spin-offs, such as gaining a uniformmarketing strategy and “look” where previously there had been far too much variation, were invaluable. planning for the future why go to the trouble of developing a complete portal system when individual static websites have worked in the past? why create an initiative when university personnel are often willing to build “brochure” websites for programs? the portal approach holds several distinct advantages. first, people are gravitating toward the web as their first source for information. this means that a recruitment-directed website will not serve other audiences such as research colleagues, alumni, or current students verywell. amore complex environment, built from the ground up to meet the needs of multiple audiences, is far more engaging. this advances the school’s mission. in addition, a dynamic portal system can be adapted to computer applications that evolve within the university. new campus-wide innovations such as additional online services and information resources can be easily incorporated into the portal. this allows the school to seamlessly integrate itself into the university’s computing environment rather than just being an isolated source for information. the school, in return, is perceived as a player instead of just an observer. next, a distributed system encourages “buy in” becausemany people are participating in its ongoing maintenance and growth. a sense of collective ownership generates enthusiasm. new ideas can be quickly implemented. a static website maintained by one or two individuals cannot do this. this encourages growth and innovation for the entire school. for example, rural social workers often have problems finding supervision for licensure.we are considering a web-based service that can mediate supervision online. a static website cannot do this. online training for licensure continuance or other continuing education activities can also be supported by a dynamic system. a static website cannot do this. our portal’s ability to develop online surveys for research or marketing opens new horizons for interacting with many audiences as well. data solicitation and collection is easy in a dynamic system. a static website cannot do this. schools also have the obligation to help support the practice community. specialized groups of practitioners often want websites. some organizations have volunteer-maintained websites but many of these are not well designed or maintained. other organizations simply do not have the means to sustain a website on their own. the portal approach offers the ability to create a sophisticated web presence for these organizations. for example, we now host the association of baccalaureate social work directors (bpd) web site: http://bpdonline.org. select 77vernon, schultz/a portal for a school of socialwork: going for the edge members from bpd have password access to this website and the only skill needed is to be able to upload text files. behind the scenes, the template and management shell for the bpd website is simply another extension of our school’s portal. support initiatives for affiliated organizations thus become possible, furthering the mission of the profession. this type of hosting service works well without draining the school’s resources. finally, the portal system fosters quality teaching. the classic problem of quickly orienting new faculty or supporting adjunct colleagues can be eased throughmaking teaching resources readily available in secure parts of the portal. we are currently developing password accessible resources for faculty through our “indiana university resource online collection” (iurocs) initiative. the website will contain syllabi, lists of media used in each class, testbanks, and voluntarily provided teachingmaterials such as powerpoint files and lecture outlines.thiswill help new instructors, plus it has the added benefit of showing faculty what teachingmaterials other colleagues are using. this should eliminate the problem of students rolling their eyes in class because they have “seen this movie before.” in terms of the council on social work education’s educational policies and accreditation standards (epas), the initiative will directly support non-repetitive learning plus horizontal and vertical integration (council on social work education, 2003). classroommanagement programs cannot do this well. all of these benefits provide the flexibility to adapt to an ever-changing and growing electronic world. through creating portals, we can define and expand our roles ourselves rather than being guided by others who understand little of the social work education mission. endnotes 1while generating a basic html page is relatively easy—most word processing programs can save a text document forweb display—generating one that can be accurately rendered by many different browsers that are running on many different platforms is considered more difficult. a good metaphor is photography: anyone can take a snapshot, but crafting a professional photograph takes farmore considerable skill. 2the term“portal” is not well defined. a “shoppingmall” metaphor is often invoked. common definitions include one-point entry via a main homepage and easy use through extensive navigation aids including sophisticated search engines, “breadcrumbs” that tell the user where they are in the website and how they got there, and other features that facilitate easy access to vast amounts of information. additional features may include chat abilities, newsletters, online shopping, and many other services. a good overview is available at about.com: http://compnetworking.about.com/library/weekly/aa011900a.htm. 3at present, the main portal: http://socialwork.iu.edu has been developed along with one campus, http://socialwork.iupui.edu. two other campuses are under construction and the remaining two are scheduled for development in 2004-2005. 4the complete memorandum of understanding is available at: http://socialwork.iu.edu/site/indexer/ 121/content.htm references carlson, l. (2003).web site evolution; retrieved online july 23, 2003 from: http://www.d.umn.edu/~lcarlson/cms/evolution.html council on social work education. (2003). handbook of accreditation standards and procedures, (5th ed.). alexandria, va: author. 78 advances in socialwork curl, a., bowers, r., & bowers, d. (2003). future of website design: accessibility as an issue of social justice. paper presented at the annual meeting of the council on socialwork education, atlanta, ga. deetz, s., tracy, s., & simpson, j. (2000). leading organizations through transition. thousand oaks, ca.: sage publications, inc. international standards organization, iso 9241-11: ergonomic requirements for office work with visual display terminals (vdts); part 11-guidance on usability (international standards organization, 1998). nielsen, j. (1999). designing web usability: the practice of simplicity, indianapolis, in: new riders publishing. norman, d., & drapers, s. (eds.). (1986). user centered system design. hillsdale, nj: lawrence erlbaum associates. percy, l. (1997). strategies for implementing integrated marketing communication. lincolnwood, il: ntc publishing group. powell,w., &gill, c. (2003).web contentmanagement systems in higher education,educausequarterly, 26(2), 43-50. schultz, d., stanley, i., tannenbaum, r., & lauterborn, r.f. (1993). integrated marketing communication. lincolnwood, il: ntc publishing group. snyder, c. (2001). paper prototyping. retrieved online on june 12, 2001 from: http://www106.ibm.com/developerworks/library/us-paper/?dwzone=usability spool, j. (2001).user engineering institute. retrieved online on june 12, 2001 from: http://www.uie.com vernon, r., & lynch, d. (2000). social work and the web. pacific grove, ca: brooks-cole. vernon, r., & lynch, d. (2003). consumer access to agency websites: our best foot forward? journal of technology in human services, 21(14), 37-51. watchfire. (no date). bobby online free porta.retrieved online october 3, 2003 from: http://watchfire.com world wide web consortium (w3c): web accessibility initiative. retrieved online december 27, 2002 from: http://www.w3.org/wai/ wright, j. (2002)website development does not have tomean denying accessibility. journal of technology in human services, 19(4), 111-114. author’s note: address correspondence to: robertvernon, ph.d., indianauniversity school of socialwork, 902west new york street, indianapolis, in 46202, usa. e-mail: rvernon@iupui.edu 79vernon, schultz/a portal for a school of socialwork: going for the edge advances vol. 3, no. 2 substance abuse and suicidal behavior inwomen ages 30 to 39years nancy j. osgood ameda a.manetta abstract:a growing number of young women abuse substances and engage in suicidal behavior. combinations of these problems are under-researched. research that exists includes women of all ages in the samples. this study adds information to the current state of knowledge on these problem behaviors by limiting the sample to women ages 30 to 39 years. a group of 113 women, part of a larger study of 364 womenwhohad received inpatient psychiatric treatment,was included in this study. findings revealed thatmost of thewomenhadmade at least one suicide attempt and nearly one-quarter were in the hospital for a current attempt. almost 60% had engaged in substance abuse at some point in their lives. the combination of continued substance abuse and suicidal behavior could result in an early death for some women. implications for treatment and future research are discussed. keywords: women, substance abuse, suicidal behavior this study examined the prevalence of substance abuse and suicidal behavior among women in late young adulthood. to date, this population of women has received limited attention (vanwormer, 1999). according to the 1994 report on the treatment of women who abuse alcohol and other drugs, little is known about women who abuse substances because resources for substance abuse research and treatment focus more on men (center for substance abuse treatment, 1994; uziel-miller, lyons, kissiel & love, 1998). there is a need to expand the focus of substance abuse to include women due to the increased acceptance of alcohol and other drug use and/or abuse in young women, plus a lack of accurate diagnosis and reporting of substance abuse in this group (uzielmiller et al., 1998). substance abuse has been linked to suicidal behavior in young women. the actual incidence is hard to identify because many attempts go unreported and many women do not seek treatment for an attempt (crosby, cheltenham & sacks, 1999). compared to males, females attempt suicide and report suicide ideation more often (canetto & sakinofsky, 1998) and, according to the 1990 national institute on alcoholism, female alcoholics complete suicide more frequently than male alcoholics (vanwormer, 1999). nancy j. osgood, ph.d. is professor of gerontology and sociology, virginia commonwealth university/medical college of virginia, richmond, virginia. ameda a. manetta, ph.d., m.s.w., l.c.s.w. is assistant professor,winthrop university, department of socialwork, rock hill, sc, 29733. copyright© 2002 advances in socialworkvol. 3 no. 2 (fall 2002) 158-167. indiana university school of socialwork. 158 159 previous studies on substance abuse and suicidal behaviors have included women of all ages (12 years to 80+ years) in the samples (osgood &manetta, 1998; substance abuse and mental health services administration, 1999). some researchers believe that women undergo changes as they age, and there is a difference in life experiences in the 20s, 30s, 40s, and beyond (bee, 2000). the current study adds to this knowledge base by providing information on women in a distinct age group—30 to 39 years. alcohol,drug abuse, psychiatric illness, and suicide substance abuse encompasses both alcohol and other drug abuse. an estimated 12 million women consume alcohol (center for substance abuse treatment, 1994). reporting on the 1992 national household survey on drug abuse and the 1992 national household survey, the center for substance abuse treatment (1994) stated that 14.5% of women under age 35 consumed alcohol once a week compared with 10.9% of women over age 35. alcohol abuse occurs more frequently than other drug abuse (rogers, 1997). the 1992 national household survey on drug abuse found that 4.4 million women had used illegal drugs and 1.3millionwomen had used psychotherapeutic drugs for non-medical reasons in the one-month period prior to the study (substance abuse and mental health services administration, 1993). an astounding estimated 80% of young adults have tried at least one illegal drug (rogers, 1997). illicit drug use is highest in the late teens, peaks in the mid-20s, and declines thereafter (kandel & raveis, 1997). alcohol and drug abuse are factors in psychiatric illness. some women who seek substance abuse and mental health services often receive dual diagnosis. approximately three out of 10, or 30% of women with a psychiatric illness, have been treated at some point in their lives for a substance abuse problem (center for substance abuse treatment, 1994). depression is often masked by substance abuse (jarvis & copeland, 1997). an estimated seven million women in the united states suffer from clinical depression (norman & lowery, 1995). studies have shown that the frequencies of women with dual diagnoses of substance abuse and psychiatric problems range between 56% and 92% (haver, 1997). a link between substance abuse and suicidal behavior has been identified by other researchers (brabant, forsyth & leblanc, 1997; haver, 1997; jarvis & copeland, 1997). in their study of 298 alcoholic patients, roy, lamparski, dejong, moore & linnoila (1990) reported that 30% of the 85 alcoholic women studied had attempted suicide. there was no difference in the ages (young vs. old) of the women who attempted suicide. in addition, women who attempted suicide reported a greater daily average intake of alcohol than did non-attempters. well over half (62%) of these women also met the criteria for a diagnosis of major depression. abusing substances is a way of numbing psychic pain; suicide is a way to relieve the pain forever. many young women engage in both practices. using alcohol before suicide or a suicide attempt is a common practice. according to the harvard mental health newsletter (1996), alcohol is involved in almost half of completed suicides. nielsen, stenager and brake (1993) reported 44% of the women in their study had consumed alcohol either before or during a suicide osgood, manetta/substance abuse and suicidal behavior inwomen ages 30 to 39 years 160 advances in socialwork attempt. women who attempt suicide are likely to make subsequent attempts and are at high risk for eventually killing themselves (suokas & lonnqvist, 1991). following the premise that substance abuse declines as women enter the latter part of young adulthood (kandel & raveis, 1997; substance abuse and mental health services administration, 1999) and suicide gradually increases across the lifespan (canetto & sakinofsky, 1998), we focused on women between the ages of 30 and 39 years. in this study, we report on chart review of 113 women discharged after inpatient psychiatric treatment. we followed a descriptive cross-sectional survey design by providing demographic information and information on the prevalence of alcohol and other drug abuse and suicidal behavior. the research questions addressed were: (1) is there a positive association between alcohol abuse and suicidal attempts in women 30 to 39 years of age who were treated on an inpatient basis for psychiatric problems? (2) is there a positive association between other drug abuse and suicidal attempts in women aged 30 to 39 years of age treated on an inpatient basis for psychiatric problems? studymethodology data for this study were gathered at one medical hospital and two state psychiatric facilities in central virginia. criteria for inclusion in the study were (l) discharged patient, (2) female, (3) 30 years of age or older, and (4) admitting diagnosis of one of the depressive disorders, substance use disorder, or substance abuse disorder. hospital staff used a computer to randomly generate 364 charts from their enumerated charts that met the above criteria during the period october 1994 to october 1996. the total sample includedwomen 30 to 85 years of age (see manetta, 1997 for a complete description of the sample). the findings reported here are based on a sub-sample of the 113 women who were aged 30 to 39 years. the methodology consisted of a chart review by a trained research team. the team recorded information from patient charts on a standardized coding instrument. the team was instructed to record information only when it was specifically listed in the patient chart. inter-rater reliability was 100%. this high rate of inter-rater reliability was attributed to the amount of training the team received (six hours to review 10 charts) and the specificity of the information to be recorded. demographic information, information on past and current alcohol or other drug abuse, age at first use, and information on past and current suicidal behaviors was generated for each subject. current alcohol abuse was defined as being present when the attending physician recorded a primary or secondary dsm-iv diagnosis of alcohol abuse in the chart. past alcohol abuse was determined by specific notes on the chart referring to a past diagnosis of alcohol abuse, alcohol abuse disorder, or specific notations in the chart of past “alcohol problems.” the variable, alcohol abuse, included any past or current alcohol abuse recorded in the chart. other drug abuse refers to any psychoactive drug (e.g., over the counter drugs, street drugs, and prescribed drugs). current other drug abuse was determined to 161 be present when the attending physician recorded a primary or secondary dsmiv diagnosis of substance use disorder or substance abuse disorder in the chart. other past drug abuse was also determined by recording specific chart notations that listed other drug abuse. other drug abuse was defined as any current or past dsm-iv diagnosis of substance disorder/abuse. current suicide and past suicide attempts were defined as any act or repetitive acts deliberately directed toward the self that resulted in physical harm or tissue damage and/or which were attempts to bring about a premature end of life. suicide attempt(s) were recorded when the behavior was specifically identified in the patient’s charts. the only missing data was for marital status. the available marital status data, however, was used to provide demographic information only and not for any of the other analysis. the demographic data for the 113 women who had alcohol and/or other drug abuse and/or suicide attempt(s) showed the mean age of the sample was 34.6 years, with a range from 30 to 39 years. the women had an average of 12 years of education. the majority of women were separated or divorced (table 1). a little more than half of the sample was caucasian-american and slightly less than half were african-american. the majority of respondents (79.6%) did not list their religious preference. the preferences that respondents noted were baptist (9.7%), catholic (3.5%), and other (7.1%). due to the sizable degree of missing information, religious preference was not analyzed as a variable. findings to describe the prevalence of substance abuse and suicidal behavior we conducted frequency tests using the statistical program for the social sciences (spss). of the 113women, 30.1% (n=34) currently abused alcohol and 44.2%(n=50) currently abused other drugs (table 2). more than half (59.3%, n=67) abused alcohol and/or other drugs at some point in their lives. the average age that women reported first consuming alcohol was 18 years. other drug abuse began slightly later, and the average age for first using other drugs was 20 years. the type of drug abused was listed for 31 women and the drug of choice these women identified osgood, manetta/substance abuse and suicidal behavior inwomen ages 30 to 39 years characteristic n % marital statusa married 24 22.0 separated/divorced 49 45.0 widowed 2 1.8 single 34 31.2 ethnicity caucasian-american 61 54.0 african-american 52 46.0 table 1: demographic information onwomen aged 30 to 39 years (n=113) note: acontained four cases with missing data. 162 advances in socialwork was cocaine (68%, n=21). thirteen percent (n=4) identified abusing prescription drugs. suicide ideation was present in 56.6% (n=64) of the women at the time of their hospitalization.the ideation informationwas collapsed into one variable to show those who had never had any suicide ideation, those who experienced ideation at one point in time (either in the past or currently), and those who experienced ideation at two points in time (past and currently). almost half of the women had experienced suicidal ideation at two points in time (44.2%, n=50). less than half of the women had attempted suicide at some point in their lives (46.9%, n=53) and 23.0% (n=26) were in the hospital for a current suicide attempt. to answer our first question, “is there a positive association between alcohol abuse and suicidal attempts inwomen 30 to 39 years of agewhowere treated on an inpatient basis for psychiatric problems?” we used a chi-square test of independence. the alpha level for the chi-square was set at .10. table 3 shows a statistically significant associationbetween current alcohol abuse andwhether therewas a current suicide attempt (x2(1)=3.5, p ≤.05). however, contrary to our research question, the statistically significant association was in the opposite direction. more women whodid not attempt suicide abused alcohol (34.5%) than thosewho attempted suicide (15.4%). to answer our second question, “is there a positive association between other drug abuse and suicidal attempts in women aged 30 to 39 years of age who were treated on an inpatient basis for psychiatric problems?” we used a chi-square test of independence. the alpha level for the chi-square was set at .10. we found that there was a statistically significant association for current other drug abuse and whether there was a current suicide attempt (x2(1)=2.5, p ≤.08). the statistically significant association was in the opposite direction than we had suggested in our research question. the association showed there was not a positive association between current other drug abuse and current suicidal attempts. abuse of other drugs wasmore frequent amongwomenwho did not attempt suicide (48.3%) than it was among women who did attempt suicide (30.8%) (table 4). yes no n % n % suicide issues in hospital for current attempt 26 23.0 87 77.0 past attempts 53 46.9 60 53.1 current ideation 64 56.6 49 43.4 past ideation 65 57.5 48 42.5 combined attempts and ideation 79 69.9 34 30.1 substance abuse current alcohol abuse 34 30.1 79 69.9 past alcohol abuse 45 39.8 68 60.2 current drug abuse 50 44.2 63 55.8 past other drugs 50 44.2 63 55.8 combined alcohol and drug abuse 67 59.3 46 40.7 table 2: suicidal behavior and substance abuse ofwomen aged 30 to 39 years 163 discussion many factors contribute to suicidal behavior in youngwomen.we have examined the frequency of substance abuse and suicidal behavior only. while the majority of the womenwho engaged in alcohol and other drug abuse were not currently in the hospital for a suicide attempt, many of them had attempted suicide in the past. though the current risk of substance abuse and suicidal behavior may be small, the lifetime risk is much larger, and some of these women are a vulnerable population based on their continued abuse of substances and their combined past and current suicidal behaviors. unfortunately, it is not abnormal to find higher rates of substance abuse among women in this age group. their exposure to risk could be explained by the cohort era. the women were born at a time of changing social values that contributed to the increase in substance abuse (harrison, 1989). at the time when the average subject in the current study began using illegal drugs (roughly 1985), almost 40% of young americans had used some type of illicit drug (mathias, 1996). although the frequency of illicit drug use was high in the 1980s, reports also indicate that most illicit drug abuse was declining at that time (rogers, 1997). it appears that some of the women studied were part of that decline. nearly 50% of the women in our sample began using illicit drugs before age 23, and the rate declined to 39% of those who continued to abuse drugs at the time of this study. these women had engaged in illicit drug use for 12 to 21 years. we were not able to determine why substance use continued because our sample was selected by a chart review of discharged psychiatric patients and lacked information that may have been available had it been selected from a substance abuse population. substances are often used to mask depression. fortunately, patients with cooccurring psychiatric and substance abuse problems are likely to have their subosgood, manetta/substance abuse and suicidal behavior inwomen ages 30 to 39 years current suicide attempt no yes current alcohol abuse (87) (26) x2 no (n=79) 57 (65.5%) 22 (84.6%) yes (n=34) 30 (34.5%) 4 (15.4%) 3.5* table 3: current alcohol abuse and current suicide attempt forwomen ages 30 to 39 years *p<.05 current suicide attempt no yes current alcohol abuse (87) (26) x2 no (n=63) 45 (51.7%) 18 (69.2%) yes (n=50) 42 (48.3%) 8 (30.8%) 2.5* table 4: current other drug abuse and current suicide attempt forwomen ages 30 to 39 years *p<.08 164 advances in socialwork stance abuse problems treated (depression guideline panel, 1993) in order to make an accurate psychiatric diagnosis (weiss, griffin & mirin, 1992). the psychiatric diagnosis most often associated with suicidal behavior is depression (cohen, lavell, rich & bromet, 1994). treating substance abuse, then making a psychiatric diagnosis would be helpful to the women in our study. once their alcohol abuse is under control, their psychiatric problems can be addressed. however, as pointed out previously, women often abuse prescription medications and the alcohol abuse could be replaced by abuse of psychotropic medications. we can speculate that this may have occurred because, in our study, we found that over time, alcohol abuse had declined but other drug abuse had remained the same. thus, we did not support the findings that alcohol abuse is more prevalent than other drug abuse that other researchers have reported (rogers, 1997). the length of time substances were abused, however, was consistent with other studies that report current substance abuse in dually diagnosed patients of long duration (dixon, mcnary & lehman, 1998). others have reported that alcohol abuse/use is present in some women who engage in suicidal behaviors. our findings were congruent with theirs (haver, 1997; jarvis & copeland, 1997; osgood & manetta, 1998). in this study, we found that young women who abused alcohol and/or other drugs were less likely to attempt suicide compared to young women who did not abuse alcohol and/or other drugs. based on the limited research available on this population, we were surprised at these findings. it is possible for young women to use alcohol and/or other drugs to self-medicate for depression and, therefore, they are less likely to engage in suicidal behaviors. this was not a longitudinal study. it is possible that self-medicating with alcohol and/or other drugs is one way to combat depression in the younger years; however, as these women grown older, the alcohol and other drugs could actually become a contributing factor in later suicidal behavior.when we looked at older women from this sample, we found a positive relationship between abusing alcohol and suicidal behavior and abusing other drugs and suicidal behavior (osgood & manetta, 1998). another possible explanation for the current findings is that some young women, in spite of their alcohol and drug abuse, do not turn to suicide because they have other internal or external factors that allow them to be resilient. treatment implications treatment modalities for combined substance abuse problems and psychiatric problems, including suicidal behaviors, are scarce (cornelius, salloum, lynch, clark & mann, 2001). therefore, treatment should be based on the combined known indicators of each diagnosis. it is known that the intent to kill oneself rises with each suicide attempt and depression is often present before and after the attempt (hamdi, amin & mattar, 1991). in addition, many women claim depression is a trigger for their drug abuse (griffin, weiss & mirin, 1989). if a woman seeks treatment for depression and suicidal behavior and her substance abuse is not revealed, she may be given psychotherapeutic medications to treat the depression.when combinedwith alcohol or other illicit drugs, thesemedications can create a lethal cocktail. also, many psychotherapeutic drugs are addictive 165 and, if the underlying causes are not treated, a cycle of drug abuse and suicidal behavior often occurs. it is essential that clinicians working with young women provide concurrent treatment for both substance abuse problems and psychiatric problems. furthermore, a longer length of time is needed to treat dually diagnosed women than the short time used to treat women diagnosed with substance abuse only (center for substance abuse treatment, 1994). thus, the current cost saving measures of brief therapy will not work as well with this population. conclusion in this study, we have provided additional information to bolster the scant knowledge that exists on dually diagnosed women. substance abuse is present inmany suicidal attempts and completed suicides. people who eventually complete suicide have oftenmade a previous suicide attempt. for women, the chance of completing suicide increases with age. in this research, we have identified the prevalence of substance abuse in women in the late part of young adulthood; and we have identified the fact that more than half of these women have engaged in suicidal behavior at some time in their lives. we have suggested treatment implications for professionals who provide services to the women. this study has some limitations. first, data were gathered by chart review. chart review is an acceptable data source and is often usedwhen availability to subjects is limited (carmen, rieker & mills, 1984). second, information may have been missing from the charts. nevertheless, the information in the charts was originally compiled for treatment purposes, thus, the researchers relied on the professionals at the psychiatric facilities to obtain a comprehensive history of the problems being treated. third, most of the information was self-reported by patients and selective information may have been given. providing selective information that portrays people as having desirable social qualities is a limitation in many survey research studies. the women in this study had been in a psychiatric facility; consequently, they were already outside of the norms of social behavior. therefore, we believed the threat to internal validity of obtaining selective information was low. finally, cross-sectional research focuses on what exists at one point in time and, thereby, limits the generalizability of the results. the reader needs to be aware that this research is only generalizable to the population studied. nonetheless, only limited information on substance abuse and suicidal behavior in young women is currently available; and the available information tends to include both genders in the results. thus, the exclusive focus on young women in this study adds valuable information to the knowledge base of professional helpers. there is a need for future studies. a longitudinal study on women with suicidal behavior and substance abuse could describe the behaviors that occur as these women reach different ages. other studies are needed to identify factors that underlie substance abuse and suicidal behaviors among women of various ages. women undergo diverse life events, have dissimilar perspectives toward life, and have different coping skills at different ages. it is only by teasing out the differences in the factors that contribute to suicidal behavior and/or substance abuse that we can begin to understand and build the knowledge base necessary to osgood, manetta/substance abuse and suicidal behavior inwomen ages 30 to 39 years 166 advances in socialwork describe incremental age differences between substance abuse and suicidal behaviors of women. therefore, future examinations of this age group could focus on particular resiliency factors that protect this vulnerable population of women from suicidal behavior. references bee, h.l. 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(1992). drug abuse as self-medication for depression: an empirical study. journal of drug and alcohol abuse, 18(2), 121-129. author’s note: address correspondence to: ameda a. manetta, ph.d., m.s.w., l.c.s.w., assistant professor, 128 bancroft building, dept. of social work, winthrop university, rock hill, sc 29733, usa. e-mail: manettaa@winthrop.edu. osgood, manetta/substance abuse and suicidal behavior inwomen ages 30 to 39 years microsoft word dybicz_role of science final _________________ phillip dybicz, ph.d., is an assistant professor of social work in the school of social sciences at keimyung university in daegu, south korea. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 95-116 the role of science in postmodern practice phillip dybicz abstract: postmodern thought offers a critique to the heavily science-based approaches of the modernist discourse. such critiques however tend to obscure the role that science has to play in postmodern practices. the current scientific-based modernist approaches faced this similar challenge when they arose in the early 1900s. in the 1800s, social agents did not base their interventions upon scientific authority, but rather, moral authority. while scientific knowledge displaced moral knowledge as the main guide for developing treatment plans, the field of social work did not abandon moral knowledge as useless. instead, moral knowledge was transformed into a robust code of ethics—and serves the new role of circumscribing the boundaries within which one employs scientific knowledge. the postmodern discourse calls for this same displacement to occur—it seeks to have scientific knowledge circumscribe the boundaries within which an hermeneutic inquiry driven by a critical consciousness guides social work interventions. keywords: postmodern, science, hermeneutics, narrative, positivism introduction in the past twenty or so years in the field of social work, postmodern thought has established a presence in academic debate and more notably, informed a number of innovative approaches to practice such as narrative therapy, the strengths perspective, and solution-focused therapy. by offering an attack upon the dominance of positivism and a scathing critique of the medical model approach to practice, some confusion has arisen over the role science has to play in the application of these innovative approaches. some opponents (amundson, 2001; pilgrim, 2000; thyer & myers, 1999; thyer 2008) criticize these postmodern approaches as either being weak on employing scientific evidence or willing to ignore it completely.1 supporters (de shazer 1994, weick & saleebey, 1998; white 2004) reply that while they do not ignore scientific evidence, they do not privilege it as the main knowledge that informs treatment goals—recognizing it as a truth, but with a small ‘t’. to the other side, this appears to confirm their claim that postmodern approaches are weak on science. the scientific method’s process of hypothesis testing has been translated into social work practice via the medical model (leighninger 1987; trattner, 1999), now commonly referred to as the problem solving approach (mcmahon, 1990; perlman, 1963; simons & aigner, 1985). the phases of this approach are succinctly encapsulated by the words, “study, diagnose, treatment.” hence, with the above postmodern approaches also attacking the medical model (de shazer et al., 2007; saleebey, 2006b; white & epston, 1990), their allegiance to the scientific method appears quite weak. on the surface, it seems that there can be no clear or prominent role for science or the scientific method within postmodern practice. this poses a definite problem for the practitioner who wishes to employ one of the above postmodern practice approaches. these approaches do not call upon the practitioner to use scientific knowledge to formulate diagnoses as a road dybicz/the role of science in postmodern practice 96 map for the treatment plan. instead, they seek to tap into the dreams and goals of the client (an approach that to the hard-nosed empiricist scientist appears to be overly naïve, starry-eyed, and quite simply odd). so if scientific knowledge is not used to direct the treatment plan, what role does it play in postmodern practice? the purpose of this paper to is to outline this role. understanding of this new role for science can be greatly facilitated by an examination of social work history. the movement from modern to postmodern practice requires a fundamental, paradigmatic shift in how we understand social work practice. yet this is not the first time within the intellectual history of social welfare that a paradigmatic shift in understanding has occurred. social welfare agents practicing within the 1800s operated within a much different paradigm than the one that guides modern practices today. rather than relying upon scientific authority, these agents relied upon their moral authority to generate knowledge in which to address the ills of society (lubove, 1965; trattner, 1999). the scientific method requires the investigator to seek a value-free stance (as its ideal). in fact, it is seen as a way to liberate oneself from falling prey to religious dogma. on the surface, it would have seemed to some of these social agents that this new paradigm—the modern paradigm, or discourse, emphasizing the scientific method—would have no room for a role for moral knowledge to play (leiby, 1978). and on one level this is true; within the modern discourse, applying one’s moral conscience does not generate knowledge in the determination of the problem, identifying causes, and developing a plan for treatment. yet in its transition to the modernist practice and the scientific method, social work did not abandon moral knowledge completely. in fact, moral knowledge plays a very prominent role in guiding treatment—through a very robust code of ethics. in essence, moral knowledge maps the boundaries within which we as social workers may practice the scientific method. benefitting from a historical record, we now know that social work’s embrace of the scientific method did not result in the abandonment, or even sidelining, of moral knowledge. the paradigmatic shift that took place resulted in the transformation of the role played by moral knowledge. this same transformation, but this time in the role played by scientific knowledge, is what is called for by postmodern practice. hence, this paper offers a comparative historical analysis between the clash in paradigms that took place at the end of the 19th century and early 20th century with the clash between modern and postmodern paradigms that is taking place today. understanding how the role played by moral knowledge was transformed from directing treatment to circumscribing the boundaries of treatment via a code of ethics will shed light on how this same transformation is called upon for scientific knowledge within postmodern practice: from directing treatment to circumscribing the boundaries of treatment. thus the first section will outline some basic elements that comprise a discourse (foucault 1991), or paradigm as it is being used above. next, follows a description of the discourse operating during the 1800s which emphasized moral knowledge. this description will lead to greater understanding of the clash between this and the modern discourse and how the role for moral knowledge (as well as scientific knowledge) was transformed. common dynamics are then outlined between this advances in social work, fall 2010, 11(2) 97 clash/transition and the present clash between the modern and postmodern discourses: both discourses are described, as well as their resulting clash around the concept of culture. finally, this positions the analysis to clearly elaborate the role of science within postmodern practice. elements of a discourse many social work histories trace the beginning of our profession to the settlement house movement and the charity organization societies of the late 1800s (bruno, 1957; leighninger, 1987; lubove, 1965). and it is true that the term ‘social work’ arose during this time period (trattner, 1999). yet, the charity organization societies and the settlement house movement also mark the end of an era—an era that stretches all the way back to the early 1800s, within which, the broad conception of social welfare and overarching approaches to social welfare practice remain markedly consistent. it is easy to look back with our present eyes and view the early charity organization society’s (cos) slogan, “not alms but a friend,” as a naïve engagement with the social problems of the time. as the social work profession itself was young, this naïveté is then just simply dismissed as the mark of a young profession (thyer, 2008). yet if one takes a careful look around at the social welfare practices of this era, one notices that a number of oddities arise when looked upon from our present standpoint. for example, why was residency (trattner, 1999) one of the three “r”s (along with research and reform) forming the major pillars of the settlement house movement? how is it that many of the same individuals who advocated for issues such as tenement house reform and suffrage for the landless white, african-americans, and then women, were also the ones advocating for prohibition and making prostitution illegal (boyer, 1978; burnett, 1968)? odder still, how is it that the social agents involved in creating the first penitentiaries looked upon these prisons to serve as models of inspiration for the surrounding community on how to organize itself (rothman, 2002)? or why were social agents erecting statues in town squares or putting on city pageants—not that this is odd in itself, but odd in that they considered these practices social work (mackaye, 1912; patten, 1907; robinson, 1901)? to dismiss such practices as simply resulting from scientific naïveté is reflective more of a scientist’s attempt to understand history (thyer, 2008). a historian seeks to offer a more penetrating analysis. one historian who has offered a unique and penetrating approach in which to analyze historical events from a postmodern perspective is michael foucault. within his historical studies, foucault (1991, 1994a, 1994b) proposed the concept of a discourse: an interlacing web of linguistic structures that serves to order and legitimate knowledge. one particular discourse will gain dominance within an era, and this discourse will serve as the main paradigm for guiding one’s understanding of experiences. foucault identified a number of core elements to a discourse, and some of these will be used within the analyses that follow. the first is that a discourse always arises in response to an urgent need in society (foucault, 1981, 1994b). another is how human beings conceive of themselves as existing within the world (foucault, 1981, 1994b). in addition, examining the intellectual history leading up to the era in question will further help to elucidate the workings of the discourse. dybicz/the role of science in postmodern practice 98 the pre-modern discourse of the 1800s urgent need borrowing a metaphor put forth by the noted historian wiebe (1967), one can describe the various villages and towns during colonial times as ‘island communities’. due to limits in transportation and communication, the various communities throughout colonial america were not very integrated politically, economically, or socially. from roughly 1820 onward this would dramatically change. the advent of industrialization, urbanization, the increased mobility of labor, and technological advancements such as the railroad and telegraph all contributed toward american communities becoming integrated first at the county, then state, then national level by the end of the century (wiebe, 1967). this integration occurred simultaneously at the political, economic, and social levels. what alarmed social agents at the time was that the moral integration of society did not appear to accompany the rapid integration taking place on these other levels. the moral bonds of sympathy that existed within the colonial towns were not replicated within 19th century cities, where social agents saw a rise in crime, vice, and violence. social agents throughout this era bent their efforts at achieving this moral integration on par with the political, economic, and social integration already occurring (addams, 1907; chapin, 1843; richmond, 1899). the rapid integration of society during the 1800s was an experiment in progress to these social agents—one whose outcome was unknown. in their eyes, achieving moral integration would lead to the great community, a lack of moral integration could easily lead to anarchy (boyer, 1978; quandt, 1970; wiebe, 1967). consequently, they bent their efforts toward achieving moral integration. existence in the world during the 19th century, people viewed themselves as existing simultaneously within two ‘worlds’: a transcendental world, and the natural world. existence within a transcendental world was based in the belief that all individuals possessed a soul; this served as a major organizing influence within the human sciences (unlike today, where many people may still hold this belief but it does not organize knowledge-gathering for the human sciences). influenced by revivalist movement in protestant thought—the great awakening of the early 1700s, the second and third great awakening of the 1800s (miller, 1965)—the soul was no longer seen as part of an hierarchical system, but rather, capable of direct communion with god. this ability of the soul to commune led to the belief that the one’s soul was able to commune with other human souls. the sympathy that would necessarily arise via this communion was the model for the moral integration that the social agents sought; its existence would be evidenced by the individual’s moral conduct. at the same time, philosophical materialism had taken root starting with hobbes and descartes, extending through locke, the idéologues, hume, and adam smith, and culminating in the recent developments of jeremy bentham and john stuart mill,. society viewed human beings as existing in the natural world via the notion that there existed such a thing as human nature. yet influenced by enlightenment thought (and advances in social work, fall 2010, 11(2) 99 contrary to our present notions of human nature being biologically based), human nature was anchored within a human being’s ability to use reason. human actions were seen as deriving from a moral calculus of pleasure and pain; the proper use of reason is what allowed an individual to recognize that moral pleasures (derived from one’s communion with other souls) were far superior to base pleasures. giving in to base pleasures was indicative of ignorance, or improper use on reasoning. such actions would need to be corrected for both the benefit of the individual and society. intellectual thought in addition to the broad outlines discussed above, the impact of jeremy bentham and john stuart mill deserves further elaboration. within social welfare, they were the dominant voice in elaborating philosophical materialism—and hence human nature—for their time period. building upon the previous ideas of others concerning a pleasure/pain calculus to human behavior, bentham gave this idea its fullest scope through his development of utilitarian thought. key aspects of his thought as they would relate to social welfare were the following: reason allows one to enjoy moral acts as the highest form of pleasure (i.e. engendering a sense of spiritual communion with others); deviant behavior is conceived as succumbing to sensual pleasures and seeking them at the expense of pursuing moral pleasures; and, most importantly, deviant behavior could be disciplined (i.e. corrected), through the imposition of an orderly routine and the separation from corrupting influences, toward a condition in which reason would once again prevail in guiding one’s actions (mack, 1969; smith, 1997). bentham was hailed by many as the “newton of the moral world” for his law-like depiction of human nature (mack, 1969). with concerns for the moral integration of society being paramount within the minds of social agents, bentham’s ideas found fertile ground and took deep root. mill further fleshed out bentham’s ideas through his concept of ‘sanctions’ (denise, peterfreund, & white, 1999). sanctions, which could be external or internal, reinforced moral behavior through a pleasure/pain calculus. external sanctions, including customs and laws of social approval/disapproval, rewarded moral behavior (e.g. acceptance, respectability) and punished immoral behavior (e.g. scorn, imprisonment). this idea of external sanctions guided practical application to bentham’s ideas on discipline. internal sanctions, representative of proper reasoning and a communion with others, represented the pain (e.g. shame, guilt) in breaking a moral code, and conversely, the pleasure (e.g. love, benevolence) arising from following a moral code. social agents believed that those lacking inner sanctions, evidenced by their giving into base pleasures over moral pleasures, could be disciplined into developing inner sanctions. to do so involved a program of imposing strict external sanctions as a way to facilitate the proper use of reasoning. the belief was that once the individual got enough practice using proper reasoning the artificial structure of the external sanctions could be removed; the individual would now be guided by internal sanctions after experiencing the benefits of properly using reason. dybicz/the role of science in postmodern practice 100 social work practices in the 1800s three broad movements arose in social welfare to address societal ills and the concern for moral integration: moral education, institutionalization, and environmentalism (dybicz, 2006). the scope of this paper prevents a detailed listing of all the various social work practices of the era and how they reflected these movements and thus the pre-modern discourse; however, an enumeration of the practices listed earlier may suffice for our purposes here. moral uplift it was a common viewpoint among the middle class that poverty resulted from a defect of character (mohl, 1970; trattner, 1999). for example, in 1821 the new york society for the prevention of pauperism listed six such defects as leading to poverty (intemperance, extravagance, consorting with prostitutes, idleness, gambling, and early and imprudent marriage), and even the two of three environmental factors (pawnshops, and lack of education,) reflected the notions of reason falling prey to base instincts. the final factor (indiscriminant almsgiving) was seen as merely reinforcing the six character defects. relief agencies would seek to morally educate the poor to help them develop internal sanctions, and hence, eliminate the moral defects causing their poverty. robert hartley, first head of the new york association for improving the condition of the poor (aicp) (formed in the early 1840s), saw as its mission “not merely to alleviate wretchedness, but to reform character” by enlightening the poor to “the true origins of their suffering” via “encouragement and counsel along the path to rehabilitation” (brandt, 1942, as cited in boyer, 1978, p. 318). and as the baltimore aicp framed it, the visitor’s goal was to help the poor reform “from sources within themselves” (becker, 1961, p. 385). home visitations became a central element to this approach (boyer, 1978). the cos societies’ of the 1880s “not alms but a friend” motto was a later incarnation of this approach of attempting to stimulate internal sanctions through moral uplift. they believed that solely providing material aid, while alleviating suffering, would simply feed into the underlying problem (i.e. lack of internal sanctions)—similar to how today we would hesitate to give a drug addict solely material aid without seeking to treat the underlying problem. moral counseling was aimed at attacking the problem directly. moral reform was also directed at the societal level. this led to the various suffrage movements, the abolition movement, and tenement house reform. yet with their desire to create a more moral society, it is not hard to understand that individuals involved in the above also were involved in the prohibition movement and criminalizing prostitution. through their eyes, all of the above contributed toward improving the moral character of society. institutionalization while private charities engaged in moral education efforts, the public response to societal ills was institutionalization. institutions mushroomed up around the country during the jacksonian era (mckelvey, 1936; rothman, 2002), and a particular institution advances in social work, fall 2010, 11(2) 101 arose to address each form of deviance: the penitentiary for criminal behavior, the asylum for insanity, the almshouse for pauperism, the house of refuge for the juvenile delinquent, and the orphanage for the child pauper. institutionalization both served to remove deviants from the corrupting influence of the environment from which they came, and placed them within a disciplined and orderly environment in which strong external sanctions existed so that they could be disciplined into learning the proper use of reasoning (i.e. internal sanctions). their ability to re-create external sanctions reminiscent of the level that existed in the colonial village led to the first penitentiaries being hailed as models for the community (rothman, 2002). the enthusiasm for institutionalization would be short lived (gillin, 1922; rothman, 2002). yet despite being ineffectual, no alternatives to treatment were adopted to any significant degree. as was the case with the moral education movement, failures were ascribed to poor administration, lack of trained workers, and poor funding rather than the model itself (rothman, 2002). it was not until the early 20th century—when the modern discourse began to rise in prominence—that alternatives were both conceived and adopted on large scale. environmentalism a common thread among all three approaches was that an environment lacking in external sanctions exerted a corrupting influence (via numerous temptations), thus inhibiting one’s development of inner sanctions. the moral education movement sought to strengthen the family environment, indoctrinating the individual to resist this influence. institutionalization simply removed the individual from the environment and placed them back when they were sufficiently trained in the use of reason. environmentalism represented a movement directed at changing the environment itself. beginning in the mid 1850s, a broad effort at city beautification emerged that entailed the building of parks, playgrounds, and included such things as erecting statues and hosting city pageants dramatizing the glory of the city. the idea was to create wholesome spaces within the city where the differing classes could intermingle; the beauty of nature or art would then serve to elevate a person’s spirit and thus facilitate the communion of souls so desperately sought (glaab, 1963; peterson, 1976). the settlement house movement represented environmentalism at its most sophisticated. the settlement house served as an extension to one’s cramped tenement, which often consisted of a single room. the living room, drawing room, kitchen, etc., served as a wholesome space in which community members could congregate and intermingle. as the broad goal of this intermingling was to promote communion among all members of society, it was deemed vital that social workers (who came from the middle and upper class) live within the house and thus represent a microcosm of society within this wholesome space (addams, 1893; trattner, 1999). as a result of this intermingling, many practical programs for the poor were set up at the settlement house (ranging from daycare to a penny-savings bank to a meeting hall for union organizing). settlement house workers efforts were also directed outward, taking up such causes as tenement house reform and child labor laws (addams, 1895; trattner, 1999). finally, through their social survey ‘research’ and prolific writing, settlement house workers dybicz/the role of science in postmodern practice 102 sought to communicate the plight of the poor to the middle and upper classes (woods, 1899; zimbalist, 1977). believing that these members of society already possessed the social sympathy reflective of proper moral reasoning, settlement writers worked on the assumption that they simply needed to communicate the poor’s plight and their audience would be motivated to act on the poor’s behalf (as had been the case for themselves in their decision to join the settlement house movement). the clash between pre-modern and modern discourses the analysis of the pre-modern discourse, while highly truncated, is sufficient to move on to one of the main concerns of this paper: the clash between pre-modern and modern discourse. within the pre-modern discourse, the social agent’s base of authority rested upon moral expertise. it was because of the fact that they exhibited a high level of moral reasoning and social sympathy (evidenced by their own moral behavior) that they were well positioned to either model, educate, or discipline the development of internal sanctions in others, or direct changes in the environment which would facilitate this change. however, during mid-century a new, competing discourse based upon science began to take root. an early indication of this is reflected in the re-organization of universities in america that took place around the 1860s and onward from being organized around concerns of philosophy (e.g. natural, moral, etc.) to being organized around specific scientific disciplines (smith, 1997). in addition, darwin’s theory of evolution created a major stir not only in intellectual circles but within the public consciousness as well (smith, 1997). by the late 1800s, the role of science as a means of investigation began guiding social work practices. the cos engaged in ‘scientific charity’. within science they found the missing element for success for their moral education efforts and ascribed the failures of the previous efforts at moral education to their lack of science (leighninger, 2000; watson, 1922). settlement house workers engaged in scientific research, conducting social surveys on the neighborhoods in which they lived. however as zimbalist (1977) aptly notes, neither the cos’s scientific charity nor the settlement houses’ social surveys were scientific by today’s standards (i.e. employing the scientific method to test hypotheses). there is good reason why this is so. the pre-modern discourse still dominated at this time. while the importance of science began to be recognized, ‘science’ was interpreted within the pre-modern discourse by social agents. this necessarily led to a highly constricted view on what science entailed. as social agents rested their authority upon the proper use of moral reasoning, science naturally became an extension of that—a form of reason used to guide one’s behavior: in this instance, their behavior of morally directing aid to recipients. hence, the fundamental element of scientific investigation, hypothesis testing, was lost to these social agents (zimabalist, 1977). in their hands, science was simply an organized form of data collection: a method to organize individual behavior on a collective level. so the cos used science to methodically collect data on all its clients; the organization of that data helped them to better direct their efforts at moral education and to wisely disperse advances in social work, fall 2010, 11(2) 103 material aid (trattner, 1999; zimbalist, 1977). settlement house workers used science, via the social survey, to methodically collect data on the living conditions within poor environments; the organization of that data helped them to more effectively communicate the harshness of these conditions to the middle and upper classes (young, 1949; zimbalist, 1977). as noted earlier, the goal of this communication was to touch upon the bonds of sympathy assumed present in these individuals, and hence, get them to support changes to the environment (young, 1949; zimbalist, 1977). the focus of the above scientific investigations was not one of seeking natural causal linkages—that which defines current investigations and treatment plans. yet even within this constricted framework, science did generate knowledge—knowledge that was used to guide treatment interventions. as history has borne out, science did not simply become the latest fad in the pre-modern discourse on social welfare. its ability to generate knowledge eventually opened up a space to do so on a much broader level via employment of the scientific method and created a growing recognition that science could provide answers to questions left unasked and unexplained in the pre-modern discourse. eventually, this led to the modern discourse supplanting the pre-modern discourse. the transition from pre-modern to modern was not one without contention. science’s emphasis upon natural causes over moral/rational causes led many social agents at first to view science as being anti-religion and hence undermining moral knowledge (lubove, 1965). benefitting from the historical record, we now know that the rise of the modern discourse in social welfare did not lead to the voiding of the importance of moral knowledge; however it did result in its displacement. moral knowledge and expertise was translated into a very robust code of ethics. moral expertise no longer leads to the generation of knowledge in developing a diagnosis and treatment plan; yet, its application in forms such as honoring self-determination, respecting the dignity and worth of the individual, and honoring the importance of human relationships serves to map the territorial boundaries within which scientific investigation and knowledge are applied. in this manner, moral knowledge guides social work practice. few would argue against the notion that this is a vital role: a person who is able to expertly apply scientific knowledge but poorly applies social work values does not a good social worker make—and vice versa. the modern discourse urgent need by the early 20th century, the integration of american society on a national level was an accepted fact. at all levels a critical mass had been achieved—political (prominence of federal reach), economic (national distribution network), and social (national, book/magazine distribution, movies, radio then tv, etc.) (wiebe, 1967). while a great community may not have arisen, neither did anarchy prevail; society remained a stable force. yet numerous social ills remained. attention was now turned toward maintaining the proper functioning of society; at the individual level, this translated into a concern over the proper functioning of the individual. dybicz/the role of science in postmodern practice 104 existence in the world philosophical materialism dominates the view of human beings within the human sciences. with the emergence of the discipline of psychology, the study of mind as well as body is approached materialistically. humans are seen as solely existing within the natural world as (bio-psycho) organisms in an (social) environment. hence questions of human nature are framed within a debate of nature vs. nurture (smith, 1997). intellectual thought positivism, along with the correspondence theory of truth, serve to form the bedrock for the scientific method. empiricism serves to further define it within this materialist framework. while the scientific method can trace its lineage all the way back to galileo, its dominance as an organizing force within the fields of the human sciences did not arise until the late 1800s. it would not be until the early 20th century that it would extend its grasp to fully encompass social work practices. the impact of darwin’s theory of evolution cannot be underestimated in its contribution towards a materialist outlook on human existence. most human behavior theories in the 20th century revolve around concerns of adaptation and adjustment.2 social work practices 1900s to present at the dawn of the 20th century, social work practices underwent a dramatic transformation. by 1920, the scientific method was the dominant organizing influence for the profession (leighninger, 1987). training to acquire scientific expertise took the form of a rigorous academic program emphasizing scientific knowledge, theory, and modes of inquiry; later, this evolved into core elements of a curriculum resulting in degrees in social work (leighninger, 1987). the scientific method, with its emphasis on hypothesis testing, serves as the new organizing influence for social work practices and inquiry, broadly defining the phases of intervention as follows: “study, diagnose, treatment”. the adoption of such a broadly defined approach is what served to unify the social work knowledge base in the 1950s (kadushin, 1959; maas, 1958). whether through the employment of psychodynamic theory in years past (hamilton, 1941) or ecological systems theory in the present (germain & gitterman, 1980), intervention approaches follow these three phases. the scientific approach is also reflected in past calls for the development of the scientistpractitioner, the current employment of the diagnostic and statistical manual, and recent calls for evidence-based practice. the clash between modern and postmodern discourses the historical record for the postmodern discourse is relatively brief, so describing the elements of this discourse poses some difficulty. however, what has been clearly established is the new front upon which this discourse has begun to challenge the dominance of the modern discourse. this new front is the concept of culture.3 through its goal of seeking to generalize results, the scientific method inherently seeks to deemphasize the particularities of culture as they are expressed within the individual (single advances in social work, fall 2010, 11(2) 105 system design may be an exception to this, but it is a minor player in the social work knowledge base and does not direct movements such as evidence-based practice or person-in-environment). it is well established in philosophical circles that positivism seeks to sideline culture and history (shimony, 1987). for most of the 20th century, concerns of culture were indeed sidelined, aided by the embrace of the melting pot theory (green, 1999). scientific theories and evidence were most important in guiding social work practices. whether psychodynamic (e.g. freud), humanist (e.g. erikson), behaviorist (e.g. bandura), or transcendental (e.g. maslow), theory was seen as applicable to all human beings. sociological theory was no different. tools such as the diagnostic and statistical manual and calls for evidence-based practice still emphasize generalizability over particularity when viewing human beings. yet from the 1970s onward, concerns of culture in guiding social work interventions have gained in prominence. various human behavior theory textbooks now include a caveat when discussing most modernist theories, stating that they contain a western, male, and heterosexual bias (greene, 2008; healy, 2005; robbins, chaterjee, & canda, 2006). others (green, 1999; livingston et al., 2008; wong et al. 2003) have noted the role of the scientific method and the generalizing of results as contributing factors to this bias. the importance of this movement in respecting culture is reflected by the wide acceptance and recognition of the need to foster cultural competency, to the point that it has become an ethical mandate (nasw, 1999) for directing social work practice. the modern discourse and culture culture—and hence cultural competency—seeks expression within both the modern and postmodern discourse. yet as was the case with science in the late 1800s, the reigning discourse is only able to provide a highly constricted expression to the concept. the move to express culture and cultural competency within the modern discourse is one of incorporating it within the scientific method (just as ‘science’ was incorporated into the proper use of reason within the pre-modern discourse) via the focus on correcting deviance from a norm. culture is typically conceptualized as “norms of conduct, beliefs, values, and skills” (lum, 2007, p. 4). as such, culture becomes a form of technical knowledge: either an additional variable to consider when determining causal mechanisms or the recognition that an alternative norm may exist. consequently, most models on cultural competency have a strong focus upon knowledge acquisition and skill development particular to various cultural subgroups (lum, 2007; pedersen, 1994; rothman, 2008). yet significant shortfalls have surfaced with this scientific approach and these same authors have felt a need to shore up their models by adding additional, nonscientific elements. one dynamic illustrative of the this dilemma is that there is now a social work value—respecting diversity—that is doing more than just simply mapping the boundaries within which to apply the scientific method. it is generating knowledge used to develop diagnoses and treatment plans, the role heretofore assigned to science and the scientific method. hence, as these models begin to drift from their scientific base, elements that require a critical consciousness are embraced such as, self awareness of one’s own biases, reflective learning, and dybicz/the role of science in postmodern practice 106 recognizing the construction of ‘multiple’ identities of the client (lum, 2007; pedersen, 1994; rothman, 2008). the postmodern discourse and culture another model for cultural competency (ramsey & latting, 2005) has been proposed that avoids the above-mentioned issue. rather than viewing cultural competency as stemming from the acquisition of cultural technical knowledge, it is viewed as stemming from the employment of a critical consciousness. abilities such as reflecting upon self, relationships, and context comprise the model.4 within such a linguistic paradigm, culture is much more than simply technical knowledge—a description of norms for a population. culture is a world-making process that serves to delimit one’s unique being-in-the-world. this view of culture is more reflective of the german notion of kulture, dating back in intellectual thought to herder (2002/1765-1797) and goethe (1987/1811-1822). culture in this manner is something that contributes towards defining one’s spirit, as in one’s essence of being. culture’s expression is highly contextual and particularistic. to properly understand the influence of culture upon one’s essence of being, one must engage in a hermeneutic-driven inquiry. this approach of a hermeneutic-driven inquiry is exactly what drives knowledge generation within postmodern practice. with its emphasis on values and meaning, a hermeneutic inquiry fits hand in glove with a process yielding knowledge generation via employing social work values—such as respect for diversity.5 yet the idea of kulture takes on a much more expansive aspect in terms of encompassing social work values. postmodern practice is highly value-driven; by engaging in hermeneutic inquiry these values generate knowledge. so for example, honoring self-determination is now a knowledge generating process. asking clients to define their dreams and goals generates knowledge regarding the direction of their treatment plans. respecting the dignity and worth of the clients is translated into efforts into understanding and respecting their being-in-the world, or identity (brubaker & wright, 2006; white 2007). a client’s identity is seen as anchored in narrative; one’s dreams and goals serve to generate knowledge regarding this identity (de jong & berg, 2008; mcintosh, & mckeganey, 2000; saleebey, 2006a). honoring the importance of human relationships also generates knowledge. via engaging in the process of mimesis (dybicz, in press), the client is able to build a counterstory which serves to redefine his/her identity. within the client-social worker relationship, the social worker is able to reflect back to the client “i see you this way too,” hence, generating knowledge within the social construction process that serves to reinforce this counterstory and new identity (de jong & berg, 2008; saleebey, 2006a, white & epston, 1990). the hermeneutic inquiry that is able to grasp this expansive notion of kulture does not rest upon expertise in the scientific method. rather, it depends upon expertise in employing a critical consciousness, an understanding of how power filtrates and circulates within linguistic structures, supporting some narratives over others in such a way that in some instances they serve to diminish the client’s essence, or being-in-theworld. the collaborative relationship that the social worker engages in with the client is advances in social work, fall 2010, 11(2) 107 an endeavor aimed at consciousness-raising. this starts with recognizing one’s own learned biases and how they may interfere with one’s ability to understand the client’s being-in-the-world, or essence. this is then followed by the social worker adopting the role of editor via asking the client questions that serve to stimulate reflection upon oppressive narratives at work in the client’s life. thus the watchwords for such a process might be described as “question (the oppressive narrative), generate (a counterstory), and solidify (the counterstory or life-enhancing narrative).” this is a marked departure from the “study, diagnose, treatment” approach of the modern discourse. yet, this does not mean that there is no role at all for the scientific method in the helping situation. postmodern practice and the role of science when the pre-modern and modern discourses clashed upon the battlefront of science, eventually the modern approach based upon the scientific method won out. yet moral knowledge was not trivialized or sidelined; it was translated into a robust code of ethics. this moral knowledge circumscribed the boundaries within which the scientific method could be legitimately employed. within the clash between modern and postmodern discourses upon the battlefront of culture, postmodern practice calls for this dynamic to repeat itself. within postmodern practices, a hermeneutic-driven inquiry displaces a scientific method based inquiry as the dominant form of knowledge generation. this does not call for scientific knowledge to be trivialized or sidelined; rather, its place is to circumscribe the boundaries within which an hermeneutic inquiry can be legitimately employed. michael white (white & epston, 1990) provides an excellent example of this dynamic in his work in family therapy. when discussing his technique of ‘externalizing the problem’, he breaks it down into two steps. the first step is described as ‘mapping the influence of the problem’. in this step, he employs what basically amounts to ecological systems theory to describe the impact that the presenting problem has had among the various family members. yet this knowledge is not used to form a diagnosis and develop a treatment plan; rather, it circumscribes the boundaries for step two, which involves a hermeneutic inquiry. he describes step two as ‘mapping the influence of persons’. this step involves focusing upon the clients’ personal agency in mapping “their influence and the influence of their relationships in the ‘life’ of the problem” (p. 45). from this process, knowledge is created contributing toward a new narrative or counterstory which attacks the narrative diminishing their identity—their essence—by reinforcing their personal agency and empowering their efforts in forming a more positive identity formation. empirical observation (and theory that is used to guide it, such as ecological systems theory) is the means by which a scientific approach seeks to accurately capture the properties of an object or organism and how it reacts to other objects or organisms in the environment. within the modernist discourse, the description of such properties and causal linkages represent reality—a description of the existence of the object. postmodern approaches are based upon a phenomenological view of the world. as such, reality is made up not simply of objects and organisms but rather phenomena. a phenomenon is considered to comprise not only an existence, but also an essence. within a phenomenon, the essence serves to organize the existing properties, emphasizing some over others. dybicz/the role of science in postmodern practice 108 when speaking of humans, this essence may be thought of as one’s individual identity. thus, as briefly described earlier, postmodern approaches seek to affect change by targeting the essence of the phenomenon rather than its existence. yet an accurate description of the existence of the phenomenon still plays a vital role. science provides this description in a very robust way. the better the description, the better one’s ‘territory’ is mapped out. this paves the way for a successful hermeneutic inquiry that seeks to understand the essence of the phenomenon in relation to this existence. for example, as noted above, white (white & epston, 1990) applies systems theory. in the case study of nick, white uses ecological systems theory to map the influence that nick’s encopresis has had on his life at home and at school (i.e. to accurately capture the existence of the encopresis in nick’s life). but rather than using this information diagnostically (i.e. attacking the problem directly), white uses it as a map in which to search for nick’s strengths and successes as they relate to the problem, hence step two: “mapping the influence of persons.” the more detailed the map of the problem, the greater direction and specificity arises for questions geared towards uncovering these strengths and successes (i.e., the many possibilities in which nick has already triumphed over the problem). the gained awareness of these strengths and successes represents the conscious-raising that is sought. of important note is the following: these strengths and successes are always in relation to the presenting problem. the context of the helping relationship will always speak to a presenting problem, challenge, or concern of the client. when the sole focus is upon the existence of this challenge in the client’s life and the essence is ignored, the individuality of the client is lost and he/she becomes viewed categorically by the challenge itself (e.g., pregnant teenager). not only does such an approach carry the danger of social control occurring, but it also undercuts the worth of the individual by painting him/her as “abnormal”, “broken”, or “dysfunctional:” they are someone that needs to be fixed (otherwise one would not need to visit a social worker). yet, one cannot focus solely on the client’s identity (i.e. essence) and ignore the existence of the challenge. if nicole is a pregnant teen who has decided to keep her baby, the existence of her pregnancy is not something that can be conveniently ignored. scientific knowledge tells us that she will need prenatal care, economic support, and perhaps some parenting classes. do we attack the challenge directly and provide all of the above because she is an “at risk” mother? or, do we plug into her dream of wanting to be a good mother, recognize the capacities she has already displayed in this endeavor, and then provide the above as the means to help her further realize her dream of being a good mom? if nicole is supported in developing the image of herself as a good mom, her present and future actions will be tied to this image as she attempts to maintain her dream of being a good mom. scientific knowledge of her situation not only provides a map within which to explore for her strengths and successes related to various parental challenges, but it also provides information and advice to help her fulfill her dream of being a good mom. conclusion the paradigmatic shift required to successfully employ postmodern practices has profound implications for the practitioner. fundamentally, it requires the practitioner to advances in social work, fall 2010, 11(2) 109 move from viewing interventions as an endeavor at problem-solving to viewing them as endeavors at consciousness-raising. within a problem-solving approach to practice, scientific knowledge takes center stage as the means to arrive at solutions to the life problems faced by clients. within postmodern practices, a critical consciousness is the main expertise brought by the social worker as the means to assist the client in generating solutions to his/her life problems. this necessarily creates a new role for scientific knowledge—that of circumscribing the boundaries within which the consciousnessraising will take place. respect for the insights of science regarding the well-being of the client remains, but this knowledge is simply used in a new role, one that is still vital to successful social work practice (just as our present code of ethics is essential to modernist practice). scientific knowledge performs the vital role of mapping out the influence the problem has had or will likely have on the life of the client. this is a necessary first step in the creation of the map that is the goal of the intervention: mapping the influence of the client on the life of the problem. these two steps can be seen as representative of a postmodern dialectical process. science provides the thesis in step one. this allows for an antithesis to emerge in step two. but rather than seeking a simple synthesis, as gadamer (1999) notes, these two steps open up a dialogical process within which many possibilities can be explored. the properties of existence are never denied, but many possibilities of essence are explored, with the best possibility being the one that best captures the uniqueness of the client’s lived experiences by promoting a positive identity of the client. this dialectical inquiry is what comprises the consciousness-raising effort. hence, a new role and conception of culture also takes place, one which places culture center stage during the helping process. within postmodern practice, culture represents much more than simply the norms of a population group. culture is the bedrock of a world-making process (the social construction of reality), a process that emphasizes the uniqueness of the individual within particular contexts. understanding 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(1977). historic themes and landmarks in social welfare research. new york: harper & row. endnotes 1 there is good reason why this appears so. the above postmodern practices embrace the philosophical position of social constructionism (de shazer & berg, 1992; saleebey, 2006a; white, 2007). being a theory of epistemology, social constructionism attacks the epistemological position of positivism and seeks to replace it. regarding concerns of ontology, social constructionism’s inherent embrace of phenomenology also attacks the correspondence theory of truth that is innately tied to positivism. positivism, the correspondence theory of truth, and empiricism are the core elements that make up the scientific method. 2 darwin’s theory met the kantian criteria of an organizing principle that up until then was lacking in the study of biology—consequently, it served to anchor concepts of human nature within biology and reinforced materialist notions of the person and the environment. 3 the broad intellectual front where this clash occurs happens over theories of ontology and epistemology. modernists believe in the correspondence theory of truth—which asserts that the universe is made up of an objective reality. the epistemological theory of positivism offers a method to capture/describe this reality as best as possible through a systematic means of observation (empiricism). postmodernism embraces the ontological theory of phenomenology in which the universe is made up of phenomena—and phenomena are made up of an existence and an essence. heidegger (1962/1927) elaborated the postmodern version of phenomenology by asserting the essence of a phenomenon is granted to it by humans’ attempt to understand it. this creates the stance that a phenomenon can have multiple realities, depending upon the culture of the individuals observing it. the epistemological theory of social constructionsim offers a method to capture/describe these multiple realities via an examination of how the various essences are socially constructed. within the more parochial concerns of social welfare, the ramifications of the above debate have found expression over the concept of culture and concerns for respecting diversity. these ramifications are more fully articulated in the body of this paper. briefly, if one takes the modernist stance of the universe being comprised of an objective reality, culture is merely a perception of that reality. if one takes the postmodern stance that phenomena are comprised of an existence and essence, culture creates reality. 4 further supporting this alternate view of cultural competency is the epistemological theory of social constructionism, and a phenomenological view of ontology: reality as phenomena in which things reveal themselves—that in addition to an existence, phenomena have an essence, which is granted to them by culture. 5 hermeneutics—being the study of meaning—is based in axiology (the philosophical branch of values and meaning); thus a hermeneutic inquiry is an axiological endeavor. values are also based in axiology; this is why the application of social work values generates knowledge. in addition, this is why such an inquiry into human behavior relies upon mimesis—as mimesis is a theory of causality based in axiology. briefly, mimesis refers to the notion that one has an image of “who i am” and “who i want to be.” the image of “who i want to be” guides present actions and informs the “who i am.” for more elaboration on mimesis see dybicz (2010) and ricoeur (1984-88). dybicz/the role of science in postmodern practice 116 this is in contrast to modernist inquiry, which is based in ontology. newton’s causality seeks to explain the movement of objects. the scientific method is an ontological endeavor aimed at uncovering facts that accurately represent reality. ________________________________________________________________________ author’s note: address correspondence to: phillip dybicz, keimyung university, department of social welfare, college of social science building, 2800 dalgubeoldaero, dalseo-gu, daegu 704-701, south korea. email: pdybicz@gmail.com virtual worlds and social work education: virtual worlds and social work education: potentials for “second life” robert vernon lisa lewis darlene lynch abstract: virtual worlds such as “second life” hold promise for social work education. they may be especially useful for distance/distributed education. social relationships, groups, organizations and entire communities can be modeled and explored for role playing and laboratory instruction. this article provides an overview of “second life,” an example of a well developed virtual world. the cswe educational policies and accreditation standards are used to examine possible applications. benefits such as experiential learning opportunities and problems such as technical mastery are discussed. virtual worlds can support and may even supplant current approaches for distance education. key words: second life, distance education, distributed education, virtual world introduction roughly twenty percent of masters and fifteen percent of bachelors social work programs are currently delivering or planning to develop online degree programs (vernon, vakalahi, pierce, pittman-munke & adkins, 2009). given this trend, social work educators need to explore options for delivering online courses. the compelling graphic nature of virtual worlds may well support online social work instruction. from our experience, virtual worlds offer promise for holding classes, conducting exercises and role plays, exploring client systems and examining practice competency issues. virtual worlds are three-dimensional computer simulations that have been steadily evolving over the last decade (bartle, 2003; castronova, 2005). usually accessed through the web, virtual worlds have become commonplace for recreation and entertainment. some, especially those that are created by the participants themselves, have potential for social work education. as reported by the new media consortium “the social aspects of virtual worlds are…useful for educational purposes. these worlds lend themselves to role playing and scenario building, allowing learners to temporarily assume…responsibilities without incurring real-world consequences” (new media consortium, 2007, p. 18). ancillary professions such as human services counseling programs are incorporating second life into their curricula (rockinson-szapkiw & walker, 2009). our work and ideas are based on the virtual world called “second life.” created by linden lab research, inc., second life (sl) holds significant promise for higher education (conklin, 2005; hayes, 2006; linden lab, n.d.). the authors have been using second life for instruction, both in brief classroom demonstrations and for complete _________________ robert vernon, ph.d., is professor and lisa lewis, msw, is a doctoral student, both in the indiana university school of social work, iupui campus, and darlene lynch, ph.d., is director of the division of social work at the indiana university northwest campus. copyright © 2009 advances in social work vol. 10 no. 2 (fall 2009), 176-192 advances in social work, fall 2009, 10(2) 177 courses. second life is regularly demonstrated in a foundation msw macro practice course in a session on working with virtual communities. students are issued preprogrammed “avatars” and explore social service agencies and cause-related simulations that have been developed “inworld” by non-profit organizations.1 in a second application, students in the last semester of their msw leadership concentration may choose an online section of a required class that meets and works in second life. this hybrid class meets face-to-face at the beginning of the semester and inworld throughout the remainder. lectures, agency tours, presentations, and class discussions all take place in second life. students work directly with inworld agencies to help them develop strategic plans and social marketing tactics to advance their causes. students facilitate consultation and focus group sessions in second life with community stakeholders. in addition, one of us spent a semester-long sabbatical exploring second life towards possible social work education and practice applications. second life offers the same features as text-based course management platforms such as webct/blackboard, angel, and sakai. audio and video streaming, powerpoint displays, white boards, two-way audio and other common tools can be included inworld just as easily as in text-driven platforms. links to other media such as websites and video clips can be added. opportunities for group discussion and collaboration are easy to arrange (hobbs, gordon & brown, 2006). the possibility that virtual worlds may supplement and possibly supplant contemporary text-driven platforms has not been lost on higher education administrators and software developers (carnevale, 2007; collins & jennings, 2007; herz, 2001). text-base online learning is less engaging than 3d immersion (brown & cairns 2004). as a result, colleges and universities with online agendas are pushing virtual world technology. instead of just presenting text to students virtual worlds can provide well developed three dimensional visual settings that can be extremely engaging. for example, imagine taking a class on a tour of “cf university” where they can better understand cystic fibrosis policy issues [boomer island 94, 141, 27].2 or consider having students explore what the world may look like to a person with schizophrenia. “virtual hallucinations,” created by the university of california at davis medical center reproduces visual and auditory hallucinations in a way that sensitizes students to this condition [sedig 26, 45, 22] (yellowlees & cook, 2006). or have an administrative practice class sit in on staff meetings every friday in the “non-profit commons” where seventy agencies discuss strategies and resources [plush nonprofit commons 152, 131, 25]. all of these experiences are available in second life. virtual worlds vary considerably and range from those for children such as disney’s “club penguin” to the extremely violent “world of warcraft.” neither of these, of course, is particularly suited for social work education and many virtual worlds are solely intended for amusement and commerce. it is important to understand a fundamental difference between sl and many other virtual worlds. most virtual worlds are “games” with specific participatory agendas and payoffs. gaming worlds have highly organized rules and relationships. sl does not. it is instead a platform where participants may develop simulated environments for any desired purpose. this lack of a specific agenda makes using second life a most flexible tool for distributed education programs. vernon, lewis, lynch/virtual worlds and social work education 178 while second life is currently very popular—1,400,000 people generally visit within a sixty day period—other virtual worlds are available. virtual world projects such as “active worlds” and “there” have educational possibilities as well (thomas & balsalmo, n.d.). the croquet consortium “is dedicated to developing and distributing asynchronous and synchronous croquet-based collaborative simulations, experiential environments and virtual laboratories for industry, research and education. the consortium is committed to a community-source vision of open software development and distribution.” (croquet consortium, n.d.). rather than relying on a single host server controlled by the provider—a possible liability with second life—croquet-based virtual worlds conceivably could be built by individual universities, making for better control and clear ownership. while these other virtual worlds may eventually emerge as platforms for instruction, second life remains the current “killer app” that is readily available and supportive for higher education. at present there are over two hundred colleges and universities with a presence in sl (linden lab, n.d.). some entire systems such as the university of texas are developing extended learning environments in second life (linden, 2009). second life “second life is a 3d online digital world imagined and created by its residents.” (linden lab, n.d.) participants voluntarily create artificial environments on “islands” called “sims.” rich three-dimensional renderings range from literal reproductions of actual places—the complete sistine chapel for example—to imaginative fantasies that can only exist online [vassar 169, 86, 24]. within the sim, the participants create all features including landscapes, architecture, roads, buildings and infrastructure. the scale of the sim can range from a building on a small plot of land to an entire island that is roughly equivalent to sixteen acres in size. costs and ongoing maintenance fees apply and discounts are available to educational institutions and nonprofit organizations. while island and sim development is not within the scope of this paper, social work programs conceivably could build complete islands for student recruitment, instruction, and competency evaluation activities. early adopters are beginning to pioneer sim development. for example, dr. cindy tandy at valdosta state university has created a complete interviewing laboratory in second life. students can conduct and record mock interviews in home, prison, hospital and office settings. practice interviews are a common instructional strategy in many social work curricula (personal communication, 6 september 2009). most relevant for social work education, social service organizations and agencies are present and growing in second life. for example, the “plush nonprofit commons” and “aloft nonprofit commons” host over seventy non-profit organizations [plush nonprofit commons 128, 179, 26]. teaching hospitals for physicians and nurses are reproduced in second life such as the ann myers medical center [hospital 142, 193, 21]. diversity and populations at risk are well represented in second life. one example is the transgender resource center [milo 239, 36, 21]. independent counseling services and support groups are also available. some are staffed by volunteers. others are serviced advances in social work, fall 2009, 10(2) 179 by credentialed professionals such as the center for positive mental health [kkotsam 168, 180, 68]. actual support groups regularly convene in second life such as alcoholics anonymous chapters [idunn 110, 53, 107]. direct services such as information and referral and online counseling by some inworld agencies are provided. information about services and resources both in the real world and in second life is commonly available. in summary, there are abundant locations in second life that have potential for social work practice education. getting into second life learning to participate in second life is an acquired skill. new participants visit the second life website (http://secondlife.com) or alternatives such “virtual ability” (http://virtualability.org). one goes through a registration process. an “avatar” must be selected from generic choices. a name is selected for the avatar from a list of available surnames, and one is free to use any first name one chooses. registration is complete and an account is created when verified through email. the participant then downloads and installs the software, called a “viewer,” and can begin to participate (linden lab, n.d.). the second life economy second life has a virtual economy in which “linden dollars” (l$) are earned or purchased with real currency. several levels of membership ranging from free to fee-paid are available. the paid levels allow participants to own land and create sims, but the free level permits a wide range of activities. as of this writing, 1000 linden dollars costs about $4.00 american dollars (linden lab, n.d.). in the writers’ experience students do not need to spend any money in sl although some occasionally will buy peripherals such as additional costumes for their avatars. there are no associated costs for students or faculty for simply exploring islands and interacting with other avatars or groups. a small fee, generally (l$10) is charged for establishing a group in second life. the “avatar” participants have complete control over the avatar that represents them. with practice, one can literally change the avatar’s gender, age, race, ethnicity, ability, and even species. as a result the participant can create a literal interpretation of herself or himself or instead assume a wholly different visual identity and persona. thus the abilities to experimentally explore diversity and the presentation of self are well developed (meadows, 2007). for example, as an initial test of student competencies at mastering second life we have used a “been there-done that” assignment that requires students to create two different avatars. they craft one avatar that looks as close to their real world selves as possible and an antithetical one that differs in gender, race, age, body morphology, and dress. students then explore sims with each avatar to see how they are treated inworld because of their appearance and report results. this sharpens their awareness of how appearance influences acceptance, a dimension of the professional self. http://secondlife.com/ http://virtualability.org/ vernon, lewis, lynch/virtual worlds and social work education 180 communications in second life avatars can interact with each other on a one to one basis and in groups of up to about fifty avatars within the same island. the most common form of communication is through typing out messages and clicking on a chat button to post the message to the screen. all participants nearby can then read what is being said. a second means for communicating is through instant messaging, or “im.” this channels communications directly to an individual within a group without others seeing the contents. in a sense, this is like being able to privately whisper to a friend nearby. thus, several ways to coach students in role play activities are available. for example, in a role play assignment the instructor can watch two students engaged in a mock intervention, one impersonating the client and the other the social worker. both students can directly see each other’s dialog as can the instructor. should the instructor wish, she or he may send an instant message to only one of the students, perhaps to redirect questioning. this message will only be seen by the student to whom it is directed and not by both. as a result, the ability to use instant messaging so that only one of the role players sees the communication offers opportunities for coaching (bender, 2005.) instant messages can be sent to participants who are not inworld and will be delivered when that person signs in, making delayed and asynchronous communication possible regarding meeting announcements, lectures, or special events. voice is also available if the user has a working headset with a microphone. the avatar can also move its body, head, arms, and face to make non-verbal gestures such as pointing, laughing, and shrugging. a wide range of additional gestures are available. thus, non-verbal communications are possible and these too can be incorporated into role plays and exercises. one is often struck by the truly global nature of second life: it is not unusual to see avatars talking in other languages. several online translators facilitate communication. these can be brought up on the screen as “huds” or “heads up displays.” with the exception of voice, all communications in sl can be recorded and copied as text. this allows participants to create a permanent written record of the inworld session. cutting and pasting transcripts into word processing documents can be easily done through simple keystrokes. for example, in the macro course described at the beginning of this article students regularly interview stakeholders who are developing non-profit sims. the students help them generate “swot” plans (strengths, weaknesses, opportunities and threats) to advance their causes. students probe these factors with organizational leaders inworld and completely record transcripts from focus groups for subsequent analysis and incorporation into recommendations. this results in a written record of how the students’ competencies in mastering the swot process have developed. movement within second life the avatar is capable of movement throughout most of second life, and can “teleport” between the different islands through simple keystrokes and “landmarks” that denote specific sims inworld. once teleported, the most common method of getting around on an island is getting the avatar to walk by using the direction arrows on the advances in social work, fall 2009, 10(2) 181 keyboard. flying is also possible. within our experience students can reasonably learn these skills within a short time. this is convenient when demonstrating second life in single class sessions such as the previously mentioned unit on virtual communities. we keep an inventory of demonstration avatars with preset landmarks for specific non-profit sims that the students can easily use for short visits inworld. “teleporting” to islands is easy in second life, and students guide their demonstration avatar to the assigned sims. once there, they walk about and explore what the sim’s creators have provided and their findings are then discussed. relationships in second life given that tens of thousands of people participate in sl at any given time, many social interactions and relationships become possible. the two common strategies are forming friendships and joining or creating interest groups. typically, one interacts with peoples’ avatars through typing or voice. should one want to form a more permanent relationship, a right click on the other person’s avatar brings up the “add friend” choice. if accepted, the person is automatically added to the “friends” inventory that is readily accessible. one can add private notes about the “friend,” making it possible to keep track of whom one has added to the list. it is easy to instant message friends, offer a teleport, enact payment if a financial transaction is being negotiated, and allow them to see your location and online status if desired. as a result, social contacts are easy to form and maintain. thousands of specialized groups are available in second life. these range from interest and amusement groups to cause-related professional organizations. for example, the “path of support” on healthinfo island lists over seventy different support groups that regularly meet in second life. the path is categorically organized and includes disability, mental health, addiction, abuse, family, bereavement, and health groups. [healthinfo island 93, 73, 21]. the “social workers of second life” has over one hundred and twenty members from many different countries. most groups are free, and generally open to the public. others are more restrictive and can only be joined by contacting the owner. announcements may also be posted for group events, and members who are not inworld will see them when they come inworld. the groups feature is very helpful when teaching in second life. we create an exclusive group for only our class members and require the students to join as proof of beginning competence, part of the “been there, done that.” assignment. once the group is established it becomes easy to send announcements to the class and also provide teleport locations for class meetings and assignments. when we are holding a regular class session avatar-to-avatar we simply put the location into an announcement that all students will see when they come inworld. many possible meeting places for holding classes are located throughout second life. distributing, accessing, and recording information in second life in addition to providing opportunities for social contacts, developers often provide information for visitors. many information kiosks invite the user to “touch” and receive vernon, lewis, lynch/virtual worlds and social work education 182 information, usually through “note cards” about features within the sim or events. in addition, one can easily add ancillary websites through urls. it is also possible to record visual information in second life by taking single snapshots and recording movies via supplemental screen capture software such as “camtasia.” called “machinima,” motion pictures of events in second life can be recovered and edited for both education and evaluation. supports for distance education distance based class discussions are actually easier to follow inworld than through text-based chat rooms. this is because one can see when a student is going to type something in advance plus there are visual cues from the avatar. this makes conversation more natural and less disjoined than in text-only distance sessions. additional resources are also available. several complete islands are devoted to education in second life such as the eduislands [eduisland 148, 69, 23] and the new media consortium [nmc campus 139, 224, 42] and sloan-c [teaching 95, 126, 22]. these organizations offer regular meetings and seminars inworld to support distance education. listservs such as second life educators at educators@lists.secondlife.com offer online discussions and an ongoing digest of readers’ contributions. blogs are available too such as the second lifeeducation blog at http://www.second life-educationblog.org. finally, regional and national education conferences are available. some meet inworld, others meet face to face, and some are jointly convened in both. possible applications for social work education the competencies specified by the educational policy and accreditation standards (epas) for the council on social work education (2008) offer a framework for describing second life applications to social work education. the following examples are presented using selected competencies. we have chosen epas educational policies that correspond to our experience with second life, so not all of them are included here. competencies are practice behaviors that are visible and measurable (commission on accreditation, 2009). second life lends opportunities to directly observe and record practice behaviors that can provide data for outcome measures on competencies. professional identity: educational policy 2.1.1—identify as a professional social worker and conduct oneself accordingly. one key dimension of social work identity is knowledge and presentation of the self. awareness of how one presents the self as a social worker—and how one is perceived by others—is critical to successful practice. second life offers a unique opportunity to explore the presentation of self towards competently mastering how this concept may lead to successful practice. as previously discussed in the “been there, done that” assignment, individual avatars can be radically changed in terms of how they appear. when students explore islands they interact with other second life visitors (not necessarily other students) and visit agencies and organizations. they use each avatar separately and record how they are treated in encounters. the results are reported back in the inworld class meetings. this sharpens their awareness of how physical presentation mailto:educators@lists.secondlife.com advances in social work, fall 2009, 10(2) 183 affects identity and practice, and offers a source for data on how competent the students have become in understanding presentation of self as a professional social worker. this is determined by assessing the depth and sophistication of their comments. diversity: educational policy 2.1.4—engage diversity and difference in practice. the opportunities for exploring difference and diversity and practice are abundant. countless groups from different cultures are available, creating many opportunities for students to interact with people with different and diverse identities from across the globe. for example, isolated people with disabilities such as survivors with neuromuscular disorders often use second life as their principle means for establishing social contact (a. krueger, personal communication, april 11 2008).3 the accident victim on a respirator and confined to a back bedroom may use second life as their major source for making friends and enjoying a social life. one complete island, virtual ability, has been developed as a dedicated place for people with disabilities where they can learn how to use second life for social contact. the orientation pathway can even be negotiated by people who are blind, and assists such as a virtual guide dog or cane are available. as a result, students exploring second life have opportunities to interact with people with disabilities and discuss practice issues with them. in our experience, students encountering people with disabilities in second life become aware of how differently abled people adapt and form strong social bonds. this is evidenced in comments the students make in our inworld class discussions. we have discovered that it is very helpful to provide students with landmarks to islands that have been specifically developed by people with ability challenges. the autistic liberation front, for example, is a sim created by people within the autism spectrum and includes memorials and a museum [porcupine 49, 200, 108]. deaf communities have established a complete island [cape able 132, 177, 21]. “wheelies” is a virtual discothèque for people with mobility challenges. it offers dancing and social contact. virtual wheelchairs are optional [taupo 168, 83, 23]. interactions inworld assist students in separating the individual from the disability and to experience a social environment where it is acceptable to be disabled. student competencies can be measured through either direct observation, text-based captures of student interactions, photographs or machinima movies, or through student narratives that analyze diversity and difference experiences. students’ interactive experiences in second life interactions can help them examine their assumptions about differences in values and abilities. populations at risk, social and economic justice: educational policy 2.1.5— advance human rights and social and economic justice. second life has many cause-related sims, groups, and complete islands that have missions related to human rights and social and economic justice issues. learning activities related to increasing student familiarity with current social justice issues and community organizing activities are available. one of us, for example, has had teams of students help cause-related groups develop social marketing campaigns. in this assignment the students are divided into teams of two or three. they must contact the leaders of a group focused on a population at risk and conduct at least two stakeholders’ vernon, lewis, lynch/virtual worlds and social work education 184 focus groups among members that specifically address the social marketing concepts of product, pricing, placement and promotion. once the data from these meetings have been compiled the students then draft social marketing plans for advancing the group’s cause and present these to the group’s leaders. evaluating how competently the students have mastered the collaborative role as consultants and also the specific concepts of social marketing is easy because complete transcripts of the meetings and also the recommendations that the students have electronically shared are readily available. we have found that this assignment works well provided the instructor spends a bit of time inworld with the group’s leader to explain the nature of the assignment in advance and how the students’ product will help them promote their cause in second life. this holds particular advantage for the distance-based classroom. when students are geographically isolated from each other, in some cases across state lines or international boundaries, this type of learning experience would be difficult or impossible. research: educational policy 2.1.6—engage in research-informed practice and practice-informed research. interview-based and survey research projects lend them themselves to second life particularly well. the student teams in the msw leadership course conduct inworld neighborhood surveys with few difficulties, a classic macro research intervention. the instructor creates a specific research group and requires that students join and wear the group label that appears above their name when conducting neighborhood surveys. this clearly identifies them as researchers. students then participate in all facets of the research process. learning activities include questionnaire development, data collection, and analysis. using the neighborhood survey assignment in a distance education class would be impossible or extremely difficult in the real world because the students are separated and cannot meet together. second life eliminates this barrier because students can easily meet in second life regardless of where they and the informants actually reside in the real world. additional supports for conducting research inworld are also available such as the social simulation research lab that offers over one hundred and fifty full text references on cyber-research, lectures, seminars and discussions [hyperborea 220, 87, 23]. assigned readings and critically evaluating research competencies through graded assignments are thus possible. second life also offers numerous opportunities to engage students in naturalistic research experiences where they become the primary data gathering instrument, use qualitative research methods, or engage in inductive data analysis to identify multiple realities. human behavior in the social environment: educational policy 2.1.7—apply knowledge of human behavior and the social environment. the following example of a learning activity provides students with the opportunity to apply their understanding of a variety of hbse theories to avatar behaviors: have students choose a specific theory, complete associated readings and other research about the theory, and then ask students to join and observe a group of interest in second life. the group need not be directly related to social work practice and may exist for social advances in social work, fall 2009, 10(2) 185 contact or recreation, although many practice-relevant groups are available such as the grief and loss support group that meets in “rachelville.” [imagination island 42, 143, 151] or the regular friday staff meetings in the nonprofit commons mentioned above. students join the group, observe meetings, and assess human and group behavior in terms of the theory. students can be paired and asked to observe the same human or group behavior that they assess using different lenses or paradigms such as a strengths-based perspective and one that is pathology-based. presentations to class members facilitate instructor assessment of competency. educational policy 2.1.9—respond to contexts that shape practice. in some respects, virtual worlds are new contexts that shape practice. just as the ascension of the world wide web dramatically opened up countless opportunities for discovering and exchanging information and social networking, virtual worlds are often populated with people seeking services and opportunities for practice. speculatively, problems with addiction to second life may be present as well, just as with other psychiatric disorders that involve electronic media (block, 2008). for students, experiences in second life can powerfully highlight the importance of context. by interacting with other avatars, students can become acutely aware of how they cannot assume anything about the context of another person, and how context-based their own questions and comments may be. competencies for evaluating contexts include assigning logs and analytical papers that describe encounters with various avatars and sims and how these may be understood. for example, students can analyze their inworld experiences from feminist perspectives identifying second life supports and barriers to women realizing their full and unique potential. discussion based on the examples above, second life clearly holds potential for many teaching agendas in social work that are compatible with and support the new competency-based epas. clinical and micro-focused events and role-plays are readily possible. group opportunities are abundant. macro practices such as community and organizational leveraging assignments are plentiful. second life offers numerous opportunities to observe student competencies in a way that may not be possible in the traditional or textanchored online classroom. yet several limitations that the authors have encountered need to be addressed if one wishes to use second life for teaching. possible problems with student access, the learning curve, finding resources, occasional harassment, and resource stability need to be planned for in advance of instruction. access issues students must have high-speed internet connections and adequate graphics cards in their computers to successfully participate in second life. yet this is not always the case (hawkins & oblinge, 2006). some students may not have adequate connections or computers, so alternatives such as having dedicated machines on campus, perhaps in a lab, may be needed. moreover, university rules regarding software placement and the vernon, lewis, lynch/virtual worlds and social work education 186 nature of the equipment in computing labs can present policy and investment barriers that may need to be addressed. for example, if the university recycles older computers into laboratories, the obsolescent machines may not be able to support second life. from our experience, having second life available in the campus computer labs has been very advantageous because it makes participation possible even when the student has marginal connectivity elsewhere. this strategy may not work for completely distributed classes, but hybrid courses that include accessible face to face meetings may find this advantageous. access, however, has more than technical dimensions. the 3d world of second life is extraordinarily visual, so students with sight disabilities will need accommodations. just as sign language interpreters are often used in the classroom with deaf and hard of hearing students, similar assists may be necessary for students with visual challenges. students from deaf and hard of hearing communities should have few problems provided that communications are kept to typing and the voice feature in second life is not used. students with motor impairments may also encounter difficulties because second life is very dependent on keyboard and mouse controls. development efforts are underway to help resolve this, although the current state of the art is not complete (foster, 2007). as discussed above, virtual ability island is available to help people resolve disability access issues. it is voluntarily staffed and the volunteers are trained in providing all comers with adaptive accommodations for second life participation. a final access issue is the age of the student. second life is limited to participants aged eighteen and over, and actual birthdates are required in the registration process. as a result, under-age students, especially first year undergraduates, may not be able to participate. mastery issues an additional problem must also be taken into consideration: second life has a significant learning curve. students are not able to simply get into second life and immediately participate as is the case when visiting a website. several hours of practice are necessary for acquiring basic social, navigation and communication skills needed to fully participate. moreover, documentation that explains different procedures and features in second life is often spotty and uneven because the islands and sims are developed by many people without an overarching managerial structure. if the reader wishes to conduct a prolonged class in sl we strongly suggest that students enter sl through the virtual ability website and follow the orientation that is provided. in addition, allow students adequate time for skill development. our approach has been to devote a three-hour hands-on orientation in a computer lab at the beginning of the semester and then provide incremental skill-mastery assignments. one work-around to avoid the long learning curve is using “demonstration avatars” discussed above that are pre-programmed with landmarks for specific places for the students to visit. students can learn basic movement skills within a few minutes and, while they cannot extensively participate, they can explore specific islands and sims that advances in social work, fall 2009, 10(2) 187 are relevant to the class when landmarks have been pre-programmed into the demonstration avatars. locating resources in second life while second life has a built-in search feature, it is not as well developed or sophisticated as web-based search engines. as a result, searching for resources such as people, places, or groups can be time consuming and may not always be successful. while this may improve with future iterations in the second life platform, students and instructors may be frustrated when trying to locate specific resources. one strategy we use is to simply set specific landmarks while exploring inworld to build up an inventory and electronically distribute this to students (vernon & lynch, 2009). within the second life world, one can also use the “map” feature and record sim locations. nevertheless, finding and keeping track of teaching-relevant resources in second life remains challenging because of search limitations and the fact that sims occasionally change, expand, or disappear. griefing and harassment as in the real world, deviant behaviors are present in second life. it is important to remember that there are sexually explicit and violence-prone sims in second life such as simulated crack houses and other locations that students may find offensive. some avatars are sexually explicit and engage in exposure and confronting behaviors. warning students about these possibilities must take place. this has a possibly positive dimension as this correlates with harassment and safety issues in actual field placement training. real life brings difficult clients with inappropriate behaviors, and second life could potentially be helpful as a laboratory experience where competencies in dealing with difficult or aggressive people can be developed either through chance encounters and subsequent discussion or intentional role-playing. there are two dimensions to “griefer” behaviors. some “griefers” intentionally attempt to wreck or severely disable sims, just as some hackers attempt to destroy websites. if this happens and if students have been directed to a “griefed” sim, then learning opportunities may be lost or delayed because the sim doesn’t work well. while rare, this remains a possibility. a more sinister dimension is personal assault from malicious avatars. linden lab provides community standards for behavior as policy assistance but these are no deterrents. malicious avatars may push, accost, or physically assault innocent avatars. more commonly, verbally abusive behavior can be presented. the authors have occasionally encountered griefers who spew extremely offensive racist, sexist, homophobic, anti-semitic, and anti-muslem speech. problematic behaviors can be reported to linden lab, but there are no assurances that students will always have safe encounters. liability and risk issues concerning student exposure to abuse remain unresolved at this time (bugeja, 2007). while we have found that greifing is rare, especially in social service related sims and islands, it remains a possibility. at minimum, students must be warned about this possibility, just as they hopefully are forewarned in real-life field settings. an alternative vernon, lewis, lynch/virtual worlds and social work education 188 is to build and use “private” islands and sims that are solely dedicated to education. private islands and sims can be completely restricted only to allow authorized visitors. this may become a common practice within higher education. stability and attendance a final concern is how stable some sims may remain and how long they will be available. for example, the plush nonprofit commons and healthinfo island sims—very promising for social work education—are supported by grants and fund-raising. thus there are no assurances that these will continue to be available. in our experience this is similar to using websites in class or as assigned readings: they sometimes disappear! while second life is less volatile than the web, the best strategy to overcome this is to preview sims prior to using them in class and make alternatives available as needed. who comes inworld to visit sims and when they do so is an issue as well. we term this the “nobody is home” issue. some sims enjoy constant visitors and high use while others, even when well constructed and interesting, seldom attract many people at the same time. for example, the cause-related sim “camp darfur” provides information on genocide [better world 179, 243, 21] but it is usually empty of other avatars. an instructor who wishes to have the students interact with other participants will need to carefully plan for this limitation. one contributing factor is time; people from asia or europe tend to be more active during hours when people in the western hemisphere are generally unavailable.4 conclusions while there are distinct drawbacks to using second life, chiefly the time it takes for students to develop skills, technical and ability challenges, difficulties finding specific locations, and occasional griefers, the authors believe that virtual worlds such as second life are well worth exploration and incorporation into social work education. to summarize some of the lessons we have learned: allow time for mastery if one plans to extensively use second life. using the virtual ability entry into second life and their “orientation island” greatly eases this transition. demonstration avatars for shorter forays inworld are very helpful. we acquired these by asking students in the inworld class to “donate their avatars to science” after the class ended and this has worked well. making certain that students are fully advised about what is required for participation—and having alternative learning opportunities not linked to second life—is extremely important. our inworld macro practice class, for example, has an identical section that meets face to face. other opportunities for using second life in different ways are possible and, while we have only provided sample experiences, other epas competency areas merit exploration. using structured role-play assignments to assess, intervene, and evaluate practice in different settings is certainly a possibility. direct policy leveraging can also take place in sl. for example, an extensive simulation of a hospital complex was designed in the united kingdom for the united health service by the national physical advances in social work, fall 2009, 10(2) 189 laboratory to demonstrate how wraparound care could be deployed. the simulation was specifically designed to leverage parliament [national health service 174, 14, 26]. while speculative at this point, it seems plausible that standardized clients could be developed in second life through artificial intelligence (ai) programs. a reliable ai standardized client could provide consistent experiences and measurable outcomes for evaluating student practice competencies. for example, “bots”—automatons that look like avatars and are crafted to respond to students through ai—could be programmed to interact with students in predictable ways. this would allow evaluation of student competencies in a way that holds client variation constant against a known standard. this paper has mainly focused on using second life as a platform for distance education programming. using second life in the traditional face-to-face and hybrid distance education classroom invites exploration as well. while we currently are limited to contemporary course management platforms, these will evolve. additional “web 2.0” applications such as blogging, wikis, rss feeds, social networking, collaboration, mashup database sharing, geographic information systems, podcasting, social bookmarking, and other emerging technologies will transform course management platforms. virtual worlds may play a key role in how these innovations are incorporated into teaching. if we as a profession wish to develop successful distributed programs, then virtual worlds such as second life are well worth exploration and evaluation. as with any new technology, second life and other online “virtual worlds” will continue to develop over time and many of the current limitations should be overcome. just as social work education and practice today is no longer what it was preinternet, the existence of virtual worlds may shape the future of social service delivery and social work education. endnotes 1 “avatars” are graphic representations of the end user or participant in a virtual reality simulation. this 3d pictorial representation symbolizes the user. avatars may be depicted as humans, cartoons, animals, or other characters. the user participates in the virtual reality simulation through manipulating the avatar. “inworld” is the term for being connected to and actively participating in second life. it is a common term in second life, similar to “login” or “logon” in email. 2 there are no citation protocols for orienting readers to specific locations in virtual worlds. locations in second life are provided by giving the name of the island where the sim is located plus latitude, longitude, and altitude coordinates. this is the convention used by linden lab. we have provided this information for specific sims inworld should the reader wish to view them. 3 alice krueger is “gentle heron” in second life, and has been instrumental in establishing “virtual ability, inc.” a 501(c)3 organization that offers resources for different communities of disabled people. she and other colleagues recently receive a $300,000 linden grant from the annenberg foundation to help develop support groups for people with disabilities. virtual ability recently was awarded the first linden prize as “an innovative inworld project that improves the way people work, learn and communicate in their daily lives outside of the virtual world.” (http://virtualabiity.org). vernon, lewis, lynch/virtual worlds and social work education 190 4 the convention “slt” is the term for “second life time,” necessary because of the need to coordinate times for meetings inworld on a global scale. it corresponds to pacific standard time. references bartle, r. 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(2009). interesting places to visit in sl for social work. retrieved november 20, 2009 from http://home.comcast.net/%7edbsocialwork/secondlife/slswplaces.doc. yellowlees, p., & cook, j. (2006). education about hallucinations using an internet virtual reality system: a qualitative study. academic psychiatry, 30, 534-539. retrieved january 26, 2008, from http://www.ap.psychiatryonline.org/cgi/content/abstract/30/6/534. author’s note: address correspondence to: robert vernon, ph.d., indiana university school of social work, 902 west new york street, indianapolis, in 46202. email: rvernon@iupui.edu. http://home.comcast.net/~dbsocialwork/secondlife/slswplaces.doc http://www.ap.psychiatryonline.org/cgi/content/abstract/30/6/534 mailto:rvernon@iupui.edu introduction second life getting into second life the second life economy the “avatar” communications in second life movement within second life relationships in second life distributing, accessing, and recording information in second supports for distance education possible applications for social work education professional identity: educational policy 2.1.1—identify as one key dimension of social work identity is knowledge and p diversity: educational policy 2.1.4—engage diversity and dif populations at risk, social and economic justice: educationa research: educational policy 2.1.6—engage in research-inform human behavior in the social environment: educational policy educational policy 2.1.9—respond to contexts that shape prac discussion access issues mastery issues locating resources in second life griefing and harassment stability and attendance conclusions endnotes references aisw vol. 5, no. 2 the transformative power of a learning community carol hostetter sabrinawilliamson katharinev. byers pamela j. huggins abstract: recently, higher education has focused on “learning communities.” this study examines a process in which students create expectations for their community of learners. the expectations provide the basis for assessment of students and the program. across three cohorts, common themes arise. the major themes from students’ expectations of faculty are that faculty should be organized, use a variety of teaching methods, and provide mentoring. students primarily want their peers to participate actively and constructively in class, have academic honesty, and contribute to class in a civil, respectfulmanner. study findings indicate that students are empowered in finding their collective voice and holding each other accountable for classroom community. using the transformative power of a learning community to improve both student classroom behaviors and faculty teaching appears to be a promising practice. keywords: learning communities, assessment, program improvement excellence in education is a goal of social work educators (bpd, 2005; cswe, 2005) and understanding ways in which social work programs can provide students with the strongest learning experience is an ongoing challenge. evidence indicates that student engagement affects learning outcomes (chickering & gamson, 1987; handelsman, briggs, sullivan, & towler, 2005). in determining how to engage students, teachers must consider the culture within a classroom and how to promote learning within it. concurrent with the focus on student engagement, social work faculty are called upon to utilize more assessment in their work, in part due to accreditation standards (cswe, 2001). the current study presents a process that addresses the issues of engagement and assessment. in this process, students brainstormed expectations for faculty, their peers, and themselves for the academic year. the group process engendered consensus among faculty and students about mutual expectations for participation in a community of learners. these expectationswerewritcarol hostetter, ph.d. is assistant professor, sabrina williamson, ph.d. is assistant professor, and katharinev. byers, ph.d. is associate professor at indiana university school of socialwork, bloomington, in 47401; pamela j. huggins, msw is associate clinical professor at saint louis university school of social work, st. louis, mo 63103. copyright© 2007 advances in socialworkvol. 8 no. 2 (fall 2007) 252-263. indiana university school of socialwork. 252 ten in the form of an agreement between faculty and students. at the end of the academic year, an assessment tool was used to understand students’ perceptions of how well the expectations in the community of learners’ agreement were met. findings indicate there are core elements that are important aspects of a learning community and that students are able to discern whether or not these objectives are being met. one focus of this paper is to describe the process of creating a community of learners. another focus is to identify core elements that students value in their learning communities, and, finally, to posit how faculty can use students’ selfand program assessments in a way that will transform a classroom into a true learning community. it may be that the learning community develop an assessment process that is described here, which can be useful to other faculty who are hoping to collaborate with students, and build community in the classroom. literature review the concept of the learning community has been promoted in recent years. in a national survey on college student engagement, kuh (2002) found that educational effectiveness was enhanced when students were part of a learning community. college classrooms are a social environment, and students’ cognitive understanding and personal construction of knowledge depend on relations with others (fung, 2004; richardson & swan, 2003;vygotsky, 1978). faculty who create a safe environment for a learning community in the classroomhelp students take risks and collaborate authentically (bonk & cunningham, 1998). research illustrates the importance of students’ perception that they are members of a community in order to collaborate and learn (chickering & gamson, 1987; kuh, 2002; wegerif, 1998). barab and duffy (2000) describe community as providingmembers with shared goals and culture, a shared feeling of being part of a greater whole, the ability to negotiate meaning, and the ability to reproduce the community through new members (p. 37). mutual support among students or “communities of learners,” (pringle, 2002) has long been considered beneficial in social work education (randolph & krause, 2002;wulff, nyquist, & abbott, 1987). in a qualitative study, wegerif (1998) found that students’ sense of community affected their success in the course. understanding what is meant by community can be challenging, as researchers do not always provide a definition of community in their work (jones, 1995; gunawardena, 1995; reid, 1995; rourke, anderson, garrison, & archer, 1999; swan, 2002; tu &mcisaac, 2002). community has been described as shared experiences in which both individual and group needs are met, either linked to a place and time but also transcending place and time (brueggemann, 2002). rovai (2002) describes community as a group of individuals interacting and connecting with each other either through formal or informal organizations. the presence of experienced community members provides the learning context for new members as they enter. teachers can engage students in a process of mutually negotiating the norms and values of the learning community (pringle, 2002). empowering students to establish the criteria for designing and assessing their learning community has its theoretical foundation in constructivism. the perhostetter et al./the transformative power of a learning community 253 advances in socialwork254 spective supported by constructivism states that the instructor is a facilitator and the learner is an active constructor in knowledge creation (bruner, 1996; dewey, 1916; ornstein & hunkins, 1998; piaget, 1973; vygotsky, 1978). similarly, the recently popular concept of the “guide on the side” encourages increased interaction among students, with the teacher providing consultation as needed (huang, 2002; king, 1993). students are almost always given the opportunity to assess their faculty on formative and summative evaluations, based on pre-determined criteria. selfassessment by students, while used in social work education, appears to be based on standard measurement tools, such as might be used for students to assess their skills in the field (university of st. francis, 2005).while both forms of assessment produce valuable information, they do not contribute to empowering the student to become the “maker of history” (freire, 1998, p. 55). if one agrees with freire that teaching does not consist simply of the teacher’s planting knowledge in the student’s garden, onemay be interested in learning from students what are their criteria for assessing their learning community. yet, there is less written in the social work education literature about the method of students’ establishing their own criteria and evaluating both faculty and themselves on the basis of these criteria. further, having students self-assess is a skill they may have to do professionally, since giving and receiving feedback is a vital part of social work practice (meldrum, 2002). the study presents the results of a community-building exercise in which three cohorts of students create the assessment standards and later use the standards to assess faculty and their peers. at issue is finding the answers to two research questions: 1)what do students value from faculty and peers in their learning community? 2)how can faculty use students’ selfand program assessments to increase student learning? methodof constructingthe learning community in three consecutive years, faculty from a small midwestern bsw program invited students to participate in setting their expectations for faculty, their peers, and themselves, during the august incoming student orientation. faculty explained that the students would create expectations for a community of learners and that these expectations would become the basis for evaluating both the faculty and students during the junior and senior academic years. the process involved dividing the students into small groups, each with a faculty member participating. the faculty invited the students to think about what types of learning experiences and environment would make for a successful semester. the small groupswere asked to brainstorm and record the expectations they hold for themselves, their peers, and their faculty. additionally, the students were asked to think about how both the faculty and students could assist in creating a strong learning environment. issues, such as civility, being prepared for class, academic honesty, group work issues, attendance, and participation were also discussed in the process. the following are some examples of prompts used by faculty in the discussion: hostetter et al./the transformative power of a learning community 255 • describe what makes an ideal learning experience for you. • what is a pet peeve that you have in the classroom? • what is something you really find helpful for your learning? • what is it like for you when ____ (people come late to class, most of the students have not done the reading for the day, etc.)? • how do you want conflict or disagreements handled? • what boundaries do you want? after about 20 minutes of discussion, the small groups returned to the wholegroup format. each student group shared what they had written and all the ideas were compiled on newsprint. then, the faculty led a process to combine similar ideas and group differing concepts, ending with a group consensus. the final agreed upon list of expectations for faculty, students, and group work was re-distributed and re-visited during the academic year. at the end of each semester, the faculty provided the students with a survey tool based on the community of learners’ stated expectations, using a likert scale for responses. examples of survey items are: • faculty will: use life experience, real-life examples. use a variety of teaching styles—with activities, lectures, and discussions. be flexible with due dates if students, in general, are having problems. • students will: participate/interact in class. be supportive, rather than competitive. respect others’ diverse opinions. methodof evaluating the learning community participants the students were invited to evaluate their learning community in their junior year. overall, 62 of 68 students in three cohorts completed the survey, for a response rate of 91%. demographic information is provided on the 68 majors overall, since collecting demographic data on the surveys in such a small program could have led to the identification of individual students. asmay be expected for social work majors, very few in the potential response pool were men, 6% (5 of 68). sixteen percent of the total pool were students of color (african american, hispanic american, and arab american). procedure at the end of the spring semester, students from the graduating classes of 2005, 2006, and 2007 filled out the survey in one of their social work classes. the survey was developed by putting the expectations the students had developed in orientation into a series of likert scale items. on the survey, the students were asked to evaluate how well full-time faculty met their expectations, and how well their advances in socialwork256 peers’ and their ownbehaviors’met their own expectations.the response options ranged from 1 to 5, with the following instructions: 1 = nearly none of the time 2 = some of the time 3 = not sure or doesn’t apply 4 = much of the time 5 = nearly all of the time among the three cohorts, there was variation in the number of expectations for students and faculty. the first cohort had 19 items for faculty and 16 for students, the second had 15 items for faculty and 20 for students, and the third had 11 expectations for faculty and 22 for students. the survey was administered by a staff member, rather than the professor of the class, in accordance with the university’s institutional review board requirements. participation was voluntary. the survey response rate for the first year cohort was 82% (n=18), for the second year was 95% (n=20), and for the third year was 96% (n=24). results this study compares the results from the survey administered at the end of the junior year for all three cohorts. in order to compare the results, commonalities were found among the three surveys. from the three cohorts, five similar items were selected for faculty (see table 1) and eight similar items were selected for students (see table 2). the 13-item scale was examined for reliability with a cronbach’s alpha obtained of .83, indicating that the scale has a good degree of internal consistency. table 1 presents themeans for students’ expectations of faculty, andtable 2 presents themeans for students’ expectations of themselves and their peers. further analysis of the differences among cohorts on the common items was done through ordinary least squares (ols) regression testing (not shown here). items that were found to be statistically significantly different, by cohort, are starred. table 1 provides the expectations for faculty listed from lowest to highest in terms of the grand mean of the students’ scoring in all three cohorts. being prepared and being on time ranked highest, and using a variety of teaching styles and providing clear directions ranked lowest. however, all but one rating was at 4.0 (much of the time) or above. interestingly, students’ ratings of faculty improved overall by the time of the third cohort. the third cohort rated faculty statistically significantly higher in three of the five items (although note that, for the “be prepared for class” item, the second cohort’s ratings were tied with the third cohort’s). the students’ expectations of themselves in table 2 are listed from lowest to highest, from the grandmean for each item. participating in class discussion and academic honesty ranked highest, and being on time and using time wisely during group meetings ranked lowest. interestingly, students’ ratings of themselves were lower, overall, than their ratings of faculty.whereas .07% of students’ ratings of faculty were below 4.0, 29% of students’ ratings of themselves were below 4.0. hostetter et al./the transformative power of a learning community 257 however, most of the low ratings were in the first cohort. students’ ratings of themselves improved overall by the time of the third cohort. with the exception of “be on time,” all the statistically significant improvements were found in the third cohort’s ratings. discussion the findings in this study show that students had fairly consistent expectations for their learning community, from one cohort to the next. it is noteworthy that students in three cohorts reproduced 13 nearly identical expectations for their community of learners. perhaps the teachers present in the group exercise acted as experienced community members, providing a bridge from one year to another (pringle, 2002). it could also be that by their junior year in college, students are socialized to expect similar behaviors from both their faculty and peers in the classroom. such similar socialization could account for the considerable overlap in expectations. perhaps other unknown factors are operating. however, the consistency in three cohorts of bsw students does lend value to the community of learners process as a way to discover what students hope to find in the classstudents’ means means means highest expectations cohort 1 cohort 2 cohort 3 rating (n=18, 82% (n=20, 95% (n=24, 96% response response response rate) rate) rate) use a variety 3.8 4.6 4.7 cohort 3* of teaching styles, diverse media and approaches provide clear 4.2 4.2 4.8 cohort 3* direction on assignments provide 4.6 4.8 4.5 cohort 2 professional, positive guidance when asked be prepared for 4.6 4.9 4.9 cohorts class 2 and 3* be on time 4.8 4.9 5.0 cohort 3 note: n for all three cohorts is 62, with an overall response rate of 91% *the differences among cohorts are statistically significant, at a level of p<.05, two-tailed test table 1: means for common items for the assessment of faculty advances in socialwork258 room. the common items listed in tables 1 and 2 help to provide information to answer the research question, “what do students value from faculty and peers in their learning community?” the answer to what students value can also be found by examining the meta themes. regarding what students value in faculty, several clear themes are present. the theme that had themost expectationswas faculty organization (referring to providing clear direction on assignments, being prepared for class, and being students’ means means means highest expectations cohort 1 cohort 2 cohort 3 rating (n=18, 82% (n=20, 95% (n=24, 96% response response response rate) rate) rate) be on time 3.1 4.0 3.8 cohort 2* use time 3.6 3.6 4.4 cohort 3* wisely during group meetings engage in 3.8 3.4 4.8 cohort 3* constructive discussion come to class 3.1 4.3 4.5 cohort 3* prepared, with readings done, so you can contribute in class listen to all 4.1 4.5 4.4 cohort 2 ideas respect others’ 4.0 4.5 4.8 cohort 3* diverse opinions participate in 4.1 4.2 4.8 cohort 3* class discussion have academic 4.3 4.7 5.0 cohort 3* honesty (avoid plagiarism) note: n for all three cohorts is 62, with an overall response rate of 91% *the differences among cohorts are statistically significant, at a level of p<.05, two-tailed test table 2: means for common items for the assessment of students hostetter et al./the transformative power of a learning community 259 on time). the other two themes were good teaching (using a variety of teaching styles and media) and mentoring (providing professional guidance when asked). examining the meta themes of what students value in their peers, one sees that student responsibilities and community civility emerge. the meta theme of student responsibilities has the most expectations, which are to participate in class discussion, engage in constructive discussion, come to class prepared, be on time, use time wisely during group meetings, and have academic honesty. the meta theme of community civility entails respecting others’ diverse opinions and listening to all ideas. it may be of interest to note a meta theme was found in two, but not all three cohorts—that of establishing a respectful classroom environment. it is difficult to speculate why the third cohort did not include this theme, with possible explanations ranging from an oversight to the feeling that the process they were engaged in already demonstrated an atmosphere of respect. another issue to consider in examining student expectations is that faculty might not wish to embrace all expectations held by students. another meta theme seen in two of the three cohorts was that of faculty providing a high amount of student support. for example, students expected faculty to be flexible on due dates if the class was having trouble, to keep in mind that students have other classes, to not overwork students “intentionally,” and to provide review sheets for the examinations. it is improbable that very many faculty aspire to overwork students “intentionally,” instead, perceiving that the amount of work assigned is necessary tomeet the learning objectives. however, the expectation of providing review sheets for examinations may be one that some faculty resist. in short, not all expectations that students have for faculty, or for each other, should be assumed to be adopted by every member of the community. the second research question, “how can faculty use students’ selfand program assessments to increase student learning?” is perhaps more difficult to answer. in the program studied, improvement was found inmany of the expectations at a statistically significant level. over the three years of the study, faculty had been aware of student expectations and had worked on improving aspects of teaching and socialization of social workmajors. faculty discussed issues, such as student tardiness and academic honesty, and worked to educate students for improvement. discussions with individual professors revealed that they had worked on the following items in response to the students’ expectations: • using e-mail to communicate with all students between classes to let them know the professor is prepared and to help students prepare. • creating review sheets for examinations. • discussing the student-generated community of learners expectations during midcourse and final course reviews, to remind students of what they set as expectations and to provide feedback. • creating powerpoint outlines for class, to aid in organization. • using diverse learning experiences, adding more group discussion, exercises, and videos to the class period. advances in socialwork260 in addition, when students clearly violate expectations of faculty and peers, the program director conducts a student review. the purpose of the review is to provide feedback, develop an action plan that supports student success, and closely monitor the student’s efforts. it is possible that use of the learning community helped to transform both faculty and student behavior. such amacro-level intervention would be appropriate in social work education. through this process, faculty can continually work to examine students’ assessments of their expectations, for example, their low ranking overall of their peers’ using time wisely during group meetings. faculty can discuss strategies to address identified issues in student-faculty meetings and implement changes as part of a formative evaluation process. thus, having student-generated criteria for assessing faculty and students provides programswith information that is both germane to the program and authentic in its relevance (freire, 1998). limitations a limitation of this process is that the survey asked students to rate themselves and their classmates, making it unclear in the analysis whether a student is rating him/herself or peers. another complex issue has to do with students’ ratings of faculty. faculty are rated as a group, which raises questions as to whether some students have one professor in mind or are thinking of the program as a whole. a third issue is that of the possible meaning of changes from year to year. for example, the second and third cohorts rated faculty as using variety in teaching muchmore than the first cohort. only those faculty can knowwhether the change could be due to their working to improve their teaching styles or if it is simply due to a less critical group of students. if it is due to faculty improvement, that information is worth knowing for future semesters. finally, the fact that this is a case study of a single bsw program limits its transferability to other settings, but further use of the model in social work education would provide an example of enacting and modeling core social work principles, such as empowerment, client-centered focus, and community development. implications and conclusion future research could shed more light on this topic. for example, having student groups work independently of faculty involvement for several years, then examining overlap among group expectations, might yield interesting results. the use of this method by other social work programs would also expand the knowledge base concerning the efficacy of student-led expectations. it would also be useful to link students’ evaluations of themselves and faculty to a student learning measure to see if there is a correlation. the baccalaureate education assessment project (beap) or a field evaluation might be a good student learning measure. using the transformative power of a learning community to create excellent classroom learning appears to be a promising practice to improve both student classroom behaviors and faculty teaching. faculty can learn what students’ value in their learning communities from examining students’ expectations. students’ assessments of their community of learners agreement can help faculty deterhostetter et al./the transformative power of a learning community 261 mine what expectations were met in a way that is not always reflected in course evaluations. this has good potential for enhancing the teaching and learning process. documentation of such program evaluation would be useful for accreditation. engagement and support in a community of learners contributes to positive teaching and learning. studies have shown that engagement and support in a community of learners is beneficial, providing a safe environment for learning and collaboration (bonk & cunningham, 1998; chickering & gamson, 1987; kuh, 2002; randolph & krause, 2002; wegerif, 1998; wulff, nyquist, & abbott, 1987). it is a potentially useful method to learn the best ways to assess and transform the learning community. assessment is not just a method of evaluating; it also helps us learn and improve (battersby, 1999). in addition, collaborating with students through a process of setting and evaluating their educational expectations may model the type of social work practice we would like them to engage in with clients. social work educators often assert the importance of teaching social work majors to collaborate with consumers in goal development and the change process (miley, o’melia, & dubois, 2001; sheyett & diehl, 2004). practicing what we teach may prove to provide better outcomes for students and consumers, alike. collaborating with students for self-assessment may help them learn skills they will need as professionals, as giving and receiving feedback is an important professional skill (meldrum, 2002). references baccalaureate program directors. 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(1987). students’ perceptions of large classes. in m. gleason weimer (ed.), teaching large classes well (pp. 17-30). san francisco: jossey-bass. author’s note: address correspondence to: carol hostetter, ph.d., assistant professor, indianauniversity school of social work, 1127 e. atwater ave., bloomington, in 47401, usa. e-mail: chostett@indiana.edu. 263hostetter et al./the transformative power of a learning community microsoft word stotzer_article final bb _____________ rebecca l. stotzer, ph.d., is an associate professor at the myron b. thompson school of social work, university of hawai`i, mānoa. julia m. whealin, ph.d., is a clinical psychologist at the national center for posttraumatic stress disorder, pacific islands division, va pacific island health care system, honolulu and an adjunct associate professor at the department of psychiatry, john a. burns school of medicine, university of hawaii, honolulu. dawna darden, msw, is a doctoral student at the myron b. thompson school of social work, university of hawaii, honolulu and has an appointment at the national center for posttraumatic stress disorder, pacific islands division, va pacific island health care system, honolulu. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 1-16 social work with veterans in rural communities: perceptions of stigma as a barrier to accessing mental health care rebecca l. stotzer julia m. whealin dawna darden abstract: the nearly decade long efforts in the global war on terror have led to increasing numbers of veterans of the armed services returning to rural locations, but little is known about their needs. however, recent research suggests that rural veterans face a host of issues, but perhaps more importantly, are facing heightened levels of stigma in rural areas related to their health and mental health. this paper examines how mental health stigma in the military may feed into stigma in rural communities and serve as an additional barrier for veterans in rural areas who are struggling with mental health concerns. recommendations for the unique role of social workers in serving these veterans, as well as addressing community issues around stigma, are addressed. keywords: mental health stigma; veterans; oif/oef; rural social work; barriers to care introduction the global war on terror’s nearly decade of conflict in the middle east has resulted in an increased number of veterans returning from deployments with a variety of mental health issues. however, help for those issues is not evenly distributed across veterans. over 40% of the veterans of the wars in iraq and afghanistan are from rural areas, and existing research shows that rural veterans health administration (va) patients report poorer mental health status and reduced access to care compared to va patients in urban or suburban areas (e.g., weeks, kazis, shen, cong, ren, miller, et al., 2004; west & weeks, 2006). obviously, logistical factors, including longer waiting periods, limited choice of health professionals, and poorer public transportation, limit access to and use of services in rural settings (aisbett, boyd, francis, newnham, & newnham, 2007). however, efforts by the va to overcome logistical barriers by expanding services to rural areas have not led to the expected increase in service utilization (fisher, 2003). identifying logistical barriers answers questions about whether or not a veteran can access care, but offers little insight into whether or not a veteran will access care. this information is particularly troubling given the research that demonstrates the high level of need among rural veterans. research has suggested that veterans located in rural settings generally have worse health-related quality of life than veterans living in urban locations (weeks, et al., 2004). although in greater need of mental health care services, rural veterans face many challenges to receiving care that are different from advances in social work, spring 2012, 13(1) 2 urban veterans. few studies have looked beyond the logistics of care delivery in rural settings to understand the reasons why rural veterans may or may not choose to utilize existing services. in non-veteran populations, rural people have been identified to have three main factors that can act to prevent them from accessing care: sociodemographic factors (e.g. gender, age, and marital status), illness-related factors (e.g. comorbidity, psychological distress), and attitudinal factors (e.g. stigma, stoicism, self-efficacy; jackson, judd, komiti, fraser, murray, robins, pattison, & wearing, 2007). of these three factors, attitudinal factors are the least understood, but research suggests that the more stigma a rural-dwelling person perceives, the more their reported negative attitudes toward help-seeking (wrigley, jackson, judd, & komiti, 2005). research focusing on rural communities and their attitudes toward mental health and mental health services, as well as existing research on military culture and attitudes toward mental health and mental health services, suggests that rural veterans may face significant social challenges in attaining services in their communities. both sets of cultural values, rural and military, emphasize stoicism, self-reliance, and negative attitudes toward help seeking, as well as issues related to privacy concerns, confidentiality, and heightened perceptions of community-based stigma. given social work’s unique place and expanded role in rural environments, particularly in community mental health (e.g., jerrell & knight, 1985; landsman, 2002; riebschleger, 2007), rural social workers can serve as a key point of outreach, advocacy, and treatment for rural veterans. however, there is little social-worker specific information currently available to help guide providers in their attempts to serve active military, national guard, reserve, and veteran populations (savitsky, illingworth, & dulaney, 2009). the purpose of this paper is 1) to review existing research on mental health stigma, 2) to outline the significant challenges that rural veterans face compared to urban counterparts, and 3) to offer suggestions for social workers working in rural areas to facilitate rural veterans finding and receiving the benefits and treatments they earned following their service to their country. stigma and mental health stigma concerns negative stereotypes, social status loss, and discrimination related to a particular perception of difference (link & phelan, 2001). it is a multidimensional concept that brands certain classes of people as inherently “different.” goffman (1963) argued that stigma “spoils” a person’s identify, and asserted that “we believe the person with a stigma is not quite human. on this assumption we exercise varieties of discrimination through which we effectively, if often unthinkingly, reduce life chances” (p. 5). jones, farina, hastorf, markus, miller, and scott (1984) explained that we all are “marked” in some way, whether it is simply having blue eyes, being tall, etc., but stigma is the application of a negative valuation on that mark. thus, stigma is based on assumptions, stereotypes, and value judgments about this marked identity that are shared among a wide population as well as understood by the person bearing the marked identity. stigma toward those with mental health issues has been found to be pervasive and often severe (wahl, 1999). a variety of negative stereotypes have been applied to people stotzer, whealin, darden/veterans in rural communities 3 struggling with mental illness, such as the perception that mental illness leads to violence, even though research suggests that people with mental illness are not more violent than the general population (levin, 2001). mental illness has been called a “concealable” stigma, because in most cases it is not obvious to a stranger (hinshaw, 2007). a person who is dealing with mental health concerns often spends a large portion of mental and emotional energy attempting to conceal their mental health concern, and attempting to judge others’ opinions and perceptions of their behaviors (smart & wegner, 1999). a large motivator for keeping their mental health concern concealed is to avoid a label being applied to them. the desire to maintain concealment can result in refusal to acknowledge an issue or pursue mental health treatment to avoid being affiliated with the stigmatized group (corrigan, watson, byrne, & davis, 2005). this desire to conceal an identity that is stigmatized is pervasive, even when disclosure can result in many mental health benefits and well-being (chaudoir & quinn, 2010). in a general population, greater perceived and self-stigma is related to reduced help-seeking from professional sources (barney, griffiths, jorm, & christensen, 2006). although most populations are aware of, and suffer the consequences of mental health stigma, military-related populations are at particular risk for experiencing the negative effects of stigma, and as a result, avoid seeking care to prevent real or imagined discrimination and/or loss in social status. veteran and military-related mental health stigma traditionally, the military services have embraced normative beliefs consistent with the masculine gender role identity. traditional attitudes common in military groups include valuing independence, self-reliance, competition, power, strength, and emotional control. although recent outreach and education efforts by the military and va have begun to change this culture (e.g., adler, bliese, mcgurk, hoge, & castro, 2009; reivich, seligman, & mcbride, 2011), traditionally military groups tend to eschew mental health services. instead, coping tactics viewed as suitable means for dealing with stress include behaviors such as emotion suppression and substance abuse (lorber, & garcia, 2010). not surprisingly, conformity with masculinity norms is associated with less use of health care services (boman & walker, 2010). the belief that one ought to be able to handle mental health problems on their own continues to be a commonly reported barrier to care (e.g., sayer, friedemann-sanchez, spoont, et al., 2009; stecker, fortney, hamilton, et al., 2007). beliefs held by veteran and military groups suggest that this belief may most strongly reflect concerns about the mental health attitudes of, and potential discrimination by, others, as opposed to internalized beliefs. in one of the most comprehensive studies about veterans and mental health stigma to date, hoge, castro, messer, mcgurk, cotting, and koffman (2004) evaluated active duty soldiers and marine units returning from iraq or afghanistan (n= 6,153) to identify specific barriers to mental health care. the most commonly endorsed items indicating stigma included “my unit leadership might treat me differently” (36.5%), “i would be seen as weak” (35.4%), “members of my unit might have less confidence in me” (34.2%), “it would harm my career” (27.0%), followed by “there would be difficulty getting time off from work for treatment” (26.3%). their findings advances in social work, spring 2012, 13(1) 4 indicated that the majority of the returnees acknowledged a need for help with mental health issues (78-86%). however, less than one third of returnees (13-27%) who acknowledged a need for help accessed available mental health services. when asked about the barriers to obtaining treatment, the service members classified as in need of mental health care endorsed negative stigma about treatment as the greatest barriers to service utilization (hoge, et al., 2004). warner, appenzeller, mullen, warner, and grieger (2008) had similar findings in a study of 2,678 soldiers deploying with a brigade combat team, soldiers (n=2,678) reported their concerns were that “members of my unit might have less confidence in me” (20.8%), “my unit leadership might treat me differently” (22.4%), “it would harm my career” (18.5%), and “i would be seen as weak” (17.8%). these perceptions of stigma from unit members and superiors have direct behavioral effects. among previously deployed national guard soldiers who screened positive for ptsd, depression, or alcohol dependence, many reported significant discomfort reporting mental health symptoms and a belief that their superiors would not encourage mental health treatment (kline, falca-dodson, sussner, ciccone, chandler, callahan, & losonczy, 2010). additionally, 59% of this group indicated that they did not report symptoms during military post-deployment health reassessments in order to avoid “medical hold.” nearly half of those screening positive for ptsd and almost 90% of those screening positive for alcohol dependence reported no treatment in the past 12 months (kline, et al., 2010). recent research with oef/oif military populations (e.g., wright, cabrera, bliese, adler, hoge, & castro, 2009) suggests that military community attitudes and internalized-stigma are two interacting factors that influence service members’ willingness to get help. thus, there is a tremendous need to better understand factors known to impact veterans’ decisions to access mental health care. notably, active duty service members and veterans with mental health problems, arguably those most in need of care, are up to twice as likely as those without mental health problems to report stigma as a barrier to health-care use (e.g., hoge, et al. 2004). pietrzak, johnson, goldstein, malley and southwick (2009) examined beliefs about the effectiveness of mental health care in a sample of 272 predominantly reservist and national guard oef/oif veterans in connecticut. the participants who screened positive for a psychiatric disorder scored higher on scales measuring perceptions of stigma and logistical barriers to care. additionally, negative beliefs about the effectiveness of psychotherapy and psychotropic medications predicted increased stigma and barriers to care. negative beliefs about mental health care were also associated with decreased likelihood of psychotherapy and medication visits. in a sample of vietnam and oef/oif veterans, stecker, fortney, hamilton, and ajzen (2007) found that the belief that one “ought to be able to handle mental health problems on their own” was the most commonly reported barrier to care. in a qualitative study examining the determinants of ptsd treatment initiation in veterans (sayer, et al., 2009), pride in self-reliance was a strong deterrent to treatment seeking. these studies highlight the concerns of service members, and the degree to which they are attuned to perceptions of mental health stigma in their environments. in addition, the elevated levels of psychological problems reported by new oef/oif veterans stotzer, whealin, darden/veterans in rural communities 5 emphasize the need to reduce the stigma as members of this population separate from the military and return to civilian communities. to date, however, relatively little research has been conducted to assess the link between civilian community factors and perceptions of stigma and barriers to care. however, an emerging body of research suggests that rural communities may have a heightened level, or produce the perception of a heightened level, of mental health stigma. rural culture and perceptions of community stigma most studies evaluating rural populations do not attend to the contextual community characteristics of rural settings that likely play a role in impacting individual attitudes about and willingness to use mental health services (boyd, hayes, sewell, caldwell, kemp, harvie, et al. 2008; jackson, et al., 2007). the source of stigma does not appear to be the mental health system itself, but rather the communities’ beliefs and attitudes about mental health (crawford & brown, 2002). evidence suggests that rural residents incorrectly underestimate the prevalence of mental health problems in their communities (bartlett, travers, cartwright, & smith, 2006), perhaps implicitly contributing to the stigma by demonstrating a “that doesn’t happen here” attitude. regardless of severity of mental illness symptoms, and despite similar rates of mental illness, rural residents are also less likely to access mental health services than urban residents (dahlberg, fosell, damstrom-thakker, & runeson, 2007). this may be due in part to the high levels of perceived stigma in rural communities, where rural residents with mental health problems still strongly identify with their rural communities and want to belong (ekeland & bergem, 2006). although the perception of stigma has been found in the general population as a barrier to seeking services (e.g., barney, et al., 2006), in rural settings, recent research has identified fundamental, contextual factors that result from characteristics of social networks that impact help-seeking and service use (boyd, et al., 2008). for example, in rural settings, community members, despite being separated by many miles due to geographical constraints, can have intimate knowledge of each other’s lives due to local gossiping networks (e.g., aisbett et al., 2007; parr & philo, 2003; parr, philo, & burns, 2004). this is the opposite social geographical characteristics experienced in urban settings, where community members may be physically proximate but are often socially distant from each other. as a result, contextual factors of rural settings – including a combination of being socially visible and having strong social networks – have the potential to heighten both community social stigma and internalized stigma related to use of mental health services. research on non-veteran populations supports the role of contextual factors in impacting attitudes about and use of mental health services (e.g., boyd, et al., 2006; boyd, et al., 2008). wrigley et al. (2005) found that the two main reasons not to seek help from a general practitioner for mental health problems were 1) embarrassment (see also hoyt, conger, valde, & weihs, 1997) and 2) not knowing who to seek help from. at the same time, they found a relationship between perceived stigma such that those who reported higher rates of perceived stigma also demonstrated more negative attitudes toward help seeking, drawing a link between stigma and its impact on help-seeking. to advances in social work, spring 2012, 13(1) 6 give additional evidence for these qualitative results, another study asked rural residents to evaluate a vignette of a man exhibiting symptoms of mental illness, and 67% of rural residents said he would be discriminated against in their community (bartlett, et al., 2006). in hoyt et al. (1997), when “place” and both measures of stigma and loss of privacy were entered into the same regression model, the effects of place disappear, suggesting that issues of embarrassment related to confidentiality and anonymity moderate the relationship between place and help-seeking. qualitative studies consistently reveal that recognition as a person with a mental health issue via a community’s informal social networks has a stigmatizing effect. one qualitative study of rural and urban adolescents indicated that those in rural settings identified rural gossip networks as limiting anonymity. in addition, among rural adolescents, fear of social stigma and exclusion after revealing a mental health problem was seen as a barrier to obtaining services (quine, bernard, booth, kant, usherwood, alperstein, et al., 2003). in another study of rural college students, participants noted that gossip networks and social visibility within rural settings play an extremely influential role in stigmatizing those who had received mental health services (aisbett, et al., 2007). furthermore, qualitative studies that have been done with non-veteran populations suggest that those in rural settings are more likely to see those who use mental health services as weak and that their use of services suggests a lack of self-reliance (boyd, aisbett, francis, kelly, newnham, & newnham, 2007). for example, wrigley, jackson, judd, and komiti (2005) found that more negative attitudes toward help-seeking for schizophrenia and depression were related to higher endorsements that these problems were caused by a weakness in character. fuller, edwards, proctor, and moss (2000) found that a rural culture of self-reliance was composed of two features, first, not being allowed to be weak, and second, being suspicious of outsiders (including mental health providers from outside the community). this attitude leads to stigma and decreased probability that rural people will label their mental distress as a mental health problem. fuller et al. (2000) suggested that even in the cases where rural residents recognize their mental distress despite the stigma, they may still not see the “system” as a source of help because of their resistance to be seen as the community “nutcase.” when broken apart, attitudes about the importance of stoicism and general self-efficacy were found to be important predictors of help seeking (judd, jackson, komiti, murray, fraser, grieve, & gomez, 2006). however, the values of selfreliance are not insurmountable. for example, having sought help in the past for mental health concerns was related to more positive attitudes toward help-seeking (jagdeo, cox, stein, & sareen, 2009), though this may not be a consistent relationship for men, who may be more prone to believe in agrarian values (hoyt, et al., 1997). these studies highlight how rural community values and attitudes that prevent help-seeking can be assuaged by positive interactions with mental health systems. there was evidence that in rural settings many people felt that the resources available to them were inadequate or of poor quality, hence keeping them from seeking help. human and wasem (1991) in an overview of rural health concerns in the united states wrote that there is often a difference between accessibility, which is whether or not a client is able to access services, vs. acceptability, which is whether or not a service is stotzer, whealin, darden/veterans in rural communities 7 being offered in a manner consistent with local values and for a rural setting. bartlett et al. (2006) in a survey in rural queensland found that 58% of respondents felt that available services were of poor quality. wrigley et al. (2005) found that when inquiring about why people did not go to a general practitioner (gp) for help with mental health issues, those who felt that their gp would not be helpful with mental health related inquiries were 91% less likely to discuss mental health concerns with their gps. the size of the community may also play a role in the perception of service availability as well as confidentiality and privacy – the smallest communities and the largest rural locations have been shown to have the lowest rates of access compared to moderately sized locations (hoyt, et al., 1997; judd, jackson, komiti, murray & fraser, 2007). in regard to rural social work in particular, the role of rural social workers is varied. fiske (2003) identified many of the strengths (such as the strong connections made with other professionals, strengthened professional teamwork, etc.) and challenges of being a social worker in a rural area (such as being the only social worker, confidentiality concerns, etc.). authors have argued that “as specialist services are few, rural social workers work across a range of methodologies and interventive strategies” (green, 2003, p. 10) and that this focus on generalist models of interdependence, cooperation, and teams are in fact most consistent with rural values. in contrast with the stigma, attitudes, and beliefs held by rural persons, a study of rural social workers (riebschleger, 2007) found that rural social workers also had concerns about stigma against themselves as mental health professionals. the author indicates rural dwellers’ barriers to care can stem from the perception that mental health and social service providers (including social workers) would see them as simpletons, critique their dialects, or assume they are like the stereotypes of rural people in the media (such as hillbillies). green (2003) argues that social workers who are clearly integrated into the community, and are seen as citizens (as opposed to “visitors” or “organizers”) can effectively counteract some of these common concerns with “outsiders” looking down on rural residents who are in need of services. rural veterans and stigma although there is burgeoning research on rural environments and a long history of research on veterans, few studies have focused specifically on rurally located veterans. however, similar to findings about non-veteran rural population, patterns of care utilization have shown that rural veterans access care less often than urban veterans, and that older veterans were more reliant on va care while younger veterans used the private sector (weeks, mahar, & wright, 2005). given that military culture and rural culture share many features that promote perceptions of mental health stigma and discourage mental health treatment-seeking, it seems likely that veterans residing in rural locations may experience stigma as a barrier to care at a heightened level than the general population. among the few studies that addressed rural veterans specifically, there is some indirect evidence that rural community characteristics impact veterans as well. for example, weeks et al. (2004) found that rural veterans had lower overall health (looking at both physical and mental health) related quality of life compared to urban or suburban veterans. wallace, weeks, wang, lee, and kazis (2006) found that although veterans in advances in social work, spring 2012, 13(1) 8 rural settings had less frequency of psychiatric disorder, for those who did, they bore a much higher disease burden as measured by poorer quality of life. one qualitative study which examined implementing integrated health care services in rural communities (kirchner, cody, thrush, sullivan, & rapp, 2004) noted that contextual factors related to the culture of the community were important in the success of clinical interventions. this highlights how not all rural communities may be contributing to heightened levels of stigma. it also suggests the need for community interventions targeting rural communities in regard to mental health education. studies have also found some differences in rural veteran’s experiences that highlight additional areas for intervention. for example, research (e.g., costello, pugh, steadman, & kane, 1997; molinari, boeve, kunik, & snow-turek, 1999) suggest that veteran’s social networks are stronger in rural vs. urban settings. comparisons between chronically ill, older male veteran patients (43 from rural settings and 48 from urban areas) found that rural veterans reported more social contact in their home communities than urban veterans, despite the fact that the veterans in the rural sample were more likely to be older, widowed, and living alone (costello, et al., 1977). these results suggest that in addition to strengthening communities, social workers can help rural veterans by creating interventions that promote strong social networks and social supports. va attempts at reaching rural veterans and providing high quality care have met with significant challenges. in an examination of the community-based outpatient clinics (cboc)s, chapko, borowsky, fortney, hedeen, hoegle, maciejewski, and lukas (2002) found that cbocs rated similarly to their parent vamcs on many factors, (e.g., perceptions of access, emotional support, care coordination, etc.), but were still rated as having lower average quality of care scores. mohamed, neale, and rosenheck (2009) conducted research on the mental health intensive case management (mhicm) program, which is national in scope, in order to identify variance in rural veterans receiving services and service delivery. veterans residing in rural areas had less contact with mhicm staff and they were less likely to receive recovery-oriented services such as rehabilitation services, psychotherapy, crisis intervention, screening for medical problems, housing, or vocational support. mohamed et al. (2009) argued that although these national programs have been established by the va, that rural veterans face specific challenges in accessing these services, and that there is an ongoing need for intensive case management services. discussion many veterans lived in rural communities when they chose to enter the military, and many return to rural communities after they have completed their service. with the high level of stigma against seeking mental health services in rural communities and within the military, rural veterans who are suffering from mental health disorders are at risk for discounting their problems, regardless of their severity. social workers are in a unique position, due to their training at all levels of practice, to educate rural veterans, families, and communities in order to help overcome stigmatizing attitudes and fears. stotzer, whealin, darden/veterans in rural communities 9 most social workers are not trained specifically to deal with rural issues, and social workers in the community are in need of resources to better understand and meet the needs of active military, national guard, reserve, and veteran populations (savitsky, illingworth, & dulaney, 2009). in recognition of the unique needs of rural veterans, the office of rural health within the va was created in 2006 to improve access and the overall quality of care for veterans in rural and remote areas. orh develops evidencebased policies and innovative practices that support the unique needs of those residing in rural areas. in the past two years, $500 million was appropriated for new health initiatives for rural veterans ranging from expansion of specialty services provided via telehealth to community and rural provider outreach and education. additionally, other centers of excellence within the va provide educational materials to providers who work with military populations. for example, the national center for ptsd provides clinicians’ manuals, as well as a variety of on-line courses on topics such as treatment for ptsd and understanding military culture online at http://www.ptsd.va.gov/professional/index.asp. because up to 50% of rural locations in the united states are still without internet access, many of these materials are available on cd upon request. finally, this literature review suggests that there are many strategies that both civilian and non-civilian social workers can employ to best serve the veterans in their rural communities, and to combat both the military and rural stigmas against mental illness and mental health treatment-seeking. prevention there is emerging evidence that addresses the need to prevent veterans from suffering negative mental health as a consequence of their military service (warner, appenzeller, mullen, warner, & grieger, 2008). of the soldiers who had previously deployed, 20.7% had sought mhc upon their return and 84.8% reported that they had received army psychoeducational “battlemind” training, now called “resiliency training” (adler, bliese, mcgurk, hoge, & castro, 2009). soldiers in this brigade who received this training were 1.56 times more likely to report that they would seek treatment if screening results were positive or if they perceived a problem. warner and colleagues (2008) conclude that efforts to reduce stigma via education prior to a problem emerging may be helping to decrease stigma and then increase treatment seeking. culturally-appropriate therapeutic intervention culturally-appropriate care for rural military populations involves understanding the veteran’s values and belief system. for some veterans, this may mean respecting the role that independence, self-reliance, strength and emotional control has in a veteran’s life. at the same time, social workers should understand that once trust is established, a veteran may be more open to broach subjects related to mental health symptoms when asked. it is helpful to openly discuss concerns a veteran may have about stigma and confidentiality, especially in rural areas where “everyone knows everyone.” when a veteran who endorses mental health stigma is suffering from mental health problems, it is helpful to normalize both the commonality of the symptoms and the discomfort with talking about them. finally, in therapy it may be helpful to openly discuss that, while independence, self-reliance, and emotional control can be strengths, rural and military values applied too advances in social work, spring 2012, 13(1) 10 rigidly to everyday civilian situations are maladaptive. for instance, research shows that willful suppression of emotions tends to lead to higher levels of disturbing thoughts and emotions, and is implicated in ptsd (shipard & beck, 2005). once veterans feels that they have 'permission' to confidentially discuss symptoms, they will be better able to identify and address their problems (lorber, & garcia, 2010). strengthening social relationships and networks the existing literature highlights the need for both honoring and utilizing existing social networks and supports for veterans in rural locations. those relationships, although at time can lead to a perception of increased “gaze” from other community members that raise concerns about treatment seeking, can also serve as significant strengths in finding mechanisms to provide care to rural veterans. in regard to stigma specifically, veterans repeatedly cited their concerns that admitting mental health concerns would result in lost face to peers, superiors and families, decreased sense of masculinity, and concerns about their job. interestingly, a study examining active duty soldiers three months after deployment showed that soldiers who rated their leaders more favorably and who reported higher unit cohesion were more likely to report lower stigma scores (wright, et al., 2009). these results highlight how critical relationships are, before separating from the military, as well as post-separation. social workers are in a key position of being able to work with service members and their families to provide services that use strong existing relationships among veterans that can help counteract the negative stereotypes about treatment-seeking. community leaders (such as clergy), cultural brokers, and strong veteran role models all serve as excellent collaborators in such endeavors. given that social workers, particularly civilian social workers, often serve multiple roles within a health care system in rural areas, they have a significant opportunity to intervene with veterans and families in ways that directly target family functioning, and in the long run may decrease perceptions of stigma, and overcome a barrier to care for some veterans. coordinating military and civilian services as the va recognized the difficulty in providing adequate and high quality services to rural areas, it has begun exploring the variety of mechanisms to provide services outside of simply starting entirely new facilities. the possibility of coordinating with existing community mental health services and systems has been strongly encouraged by policy groups such as the national rural health association (2004). this policy organization has been advocating for policy changes that would allow the va and other services (such as local community health centers, vet centers, and other rural providers) to cooperate in a more meaningful and coordinated fashion. savistky et al. (2009) stated that “civilian social workers must acknowledge their responsibility to reach out to their military counterparts in an effort to achieve the most streamlined system of care possible. when military and civilian systems operate in isolation, an opportunity to coordinate well-informed and effective intervention is lost” (p. 337). in their generalist roles, rural social workers often interact with many systems and professions. in this space, rural social workers are poised to help build those connections between systems. however, this stotzer, whealin, darden/veterans in rural communities 11 requires civilian social workers to become at least marginally versed in the language and systems of the military and the va. in order to best serve veterans, particularly those who have seen combat over the last decade, all social workers need a basic understanding of the military and va. however, where urban social workers may more easily be able to refer urban veterans to va services, rural social workers need to 1) look harder for veterans who may not be accessing because of stigma concerns, and 2) may need to have an increased level of knowledge about military and va systems since community access to those resources and information may be limited. this may mean becoming knowledgeable about the va’s current proliferation of online services (such as my healthevet), the possibilities for telehealth (such as completely online individual and group therapy available via teleconferencing), and emedicine as means to overcome logistical barriers to care. the more clearly rural providers know about options for veterans, even in their rural communities, the less stigmatizing treatment-seeking will become as it is normed in the community. community advocacy and education mental health care providers need to consider community interventions, not just individual interventions, to decrease the overall community-based stigma as well as the perception of stigma. as some articles have suggested, providers need training to work against the effects of stigma as a part of their job (crawford & brown, 2002). although mental health stigma is pervasive in the united states, this research highlights how that stigma may be magnified in rural communities where confidentially concerns are high. it is not enough for social workers to simply address the concerns of any veterans that come in their door – there are many more who are suffering and not seeking care. working to reduce stigma throughout the community in ways that honor veterans for their service and does not cast all veterans as “in need” of mental health services can serve to address community-based stigma (or perhaps the perception of that stigma) for veterans who may be have been deterred from treatment-seeking because of reputational concerns. unlike doctors and other health and mental health providers, social workers have a strong history and training in community organization, group work, and advocacy. given that many veterans in rural areas make contact with their gps as a point of entry into mental health services, it is particularly important for social workers to advocate and educate people within the health/mental health care system first, but to also address issues of stigma in the general community as well through culturally appropriate advocacy and education efforts. research about stigma last, there needs to be more research about mental health stigma that impacts veterans, and how the perception of others’ beliefs is impacting the medical choices made by veterans. in particular, there remains a need to better understand the specific reasons for the disparity between the need for treatment and the lack of mental healthcare service utilization among global war on terrorism veterans. for example, suicide rates among this population continue to rise despite increased access to healthcare, and coordination of care seems more critical than access alone (mills, huber, vince watts, & advances in social work, spring 2012, 13(1) 12 bagian, 2011). research has historically focused on the perceptions and beliefs of individual veterans, but they are deeply embedded in communities that may or may not share their beliefs about seeking or receiving mental health care. more research needs to address how community stigma is impacting the rural veteran treatment-seeking in ways that are similar to, or different, from urban veterans. conclusion based on the evidence presented that stigma is a major influence in deterring treatment seeking, rural veterans potentially face compounded challenges of experiencing both community stigma and military-related stigma. community health care providers must understand the societal and systemic processes that influence veterans’ decision to seek mental health care and how community factors may be influencing these decisions. rural veterans already face many logistical barriers to care, but military and rural cultures promote values that can serve as significant psychological and social barriers to accessing treatment. social workers have many key roles to be played in rural environments to help prevent stigmatizing attitudes and fears, to promote better organizational coordination of rural systems and social networks for veterans, to strengthen veterans and family members via culturally-sensitive case management and treatment services, and to conduct advocacy and education at the community level to decrease stigma at all levels in the community. references adler, a. b., bliese, p. d., mcgurk, d., hoge, c. w., & castro, c. a. 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(2009). stigma and barriers to care in soldiers postcombat. psychological services, 6, 108-116. wrigley, s., jackson, h., judd, f., & komiti, a. (2005). role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. australian and new zealand journal of psychiatry, 39, 514-521. author’s note: address correspondence to: professor rebecca l. stotzer, university of hawai`i, mānoa 1800 east west rd., henke hall, honolulu, hi 96822. email: rstotzer@hawaii.edu microsoft word dalton et al copyedit final _________________ bruce dalton, ph.d., is an associate professor in the department of social work at east tennessee state university in johnson city, tn. laura stevens, ph.d., has no current academic affiliation. jane maas-brady, msw, is director of field in the department of social work at east tennessee state university. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 276-288 “how do you do it?”: msw field director survey bruce dalton laura stevens jane maas-brady abstract: this paper reports on a survey of msw field directors in the united states. results indicate that in some areas there is similarity between field programs, such as field training and orientation, and the student placement process. there was great variety between field programs in the areas of student field requirements, student field credits, and field liaison faculty status. most field programs report adequate resources but a significant minority report a lack of resources. the benefits of increasing specificity of mandated standards at the cost of lessened program flexibility is discussed. keywords: field seminar, field placement, msw field program introduction social work field instruction has evolved from an apprenticeship model early in its history to an educationally-focused model in which experienced professionals are selected as field instructors to help students achieve the educational objectives of the field program (bogo, 2005; frumkin & lloyd, 1995). the field experience is where and when students connect the theoretical concepts learned in the classroom with the practical aspects of service provision while also gaining an appreciation for the breadth and depth of the many roles that a social worker performs. this approach is compatible with john dewey’s philosophy of progressive education in which students learn by doing (scannell & simpson, 1996). dewey believed having relevant experience in the wider world brought value and purpose to what goes on in the classroom. according to the educational policy and accreditation standards (epas) of the council on social work education (cswe) field instruction is now seen as the signature pedagogy of social work (epas, cswe, 2008). cswe is the accrediting body for social work programs in the united states. signature pedagogy is defined as “the central form of instruction and learning in which a profession socializes its students to perform the role of practitioner” and its purpose is to “connect the theoretical and conceptual contribution of the classroom with the practical world of the practice setting” (epas, 2.3, cswe, 2008). though the field practicum is considered the signature pedagogy, it is the experience and observation of the authors that many field practicum personnel enter the area of social work field education with no specific training on how to be a field instructor, liaison, coordinator, or director. there is also little information available about how the field component is implemented which may serve as a guide to those directing or forming a field program. it is the purpose of this study to provide a nation-wide overview of how msw field programs are structured, the process by which students are placed in practicum settings, how field instructor orientation and training are provided, and the advances in social work, fall 2011, 12(2) 277 sufficiency of the resources that are allotted to field education. this will help fill the current gap in knowledge regarding the current state of field education in the u.s. literature review this literature review covers field program implementation, orientation and training, field standards, resources, and standardization. program implementation refers to the structure that allows the program to exist in an educational bureaucracy. in some social work programs, field work offices maintain a high degree of autonomy, while in other schools field staff are closely integrated into the general program. orientation and training encompasses the efforts of an institution’s field staff to orient field instructors to the program requirements and to train field instructors to become social work educators and supervisors. as with program implementation, orientation and training efforts have the potential to vary widely from one school to the next. field standards include the type, amount, and quality of activity required of students in their field placements. although cswe sets general requirements for the number of field hours and the types of activities appropriate for students, ultimately it is the responsibility of the individual field program to interpret those standards. resources are the financial and structural support given to the field component in a social work department. standardization is the degree of similarity between programs both in practice and in writing. there have been few previous surveys of social work field directors in the u.s. that address program implementation. kilpatrick and holland (1993) surveyed 64 cswe accredited schools that offered both msw and bsw degrees. after investigating the management structure of field programs, they found that all but one reported having a position titled director of field instruction even though the programs varied considerably in other aspects, such as other field staff available and faculty involvement as liaisons. burke, condon, and wickell (1999) found in their sample of 66 social work programs that 38% reported faculty members were field liaisons, and that all field liaisons (both faculty and other) made a mean average of 2.9 field visits per year. ligon and ward (2005) surveyed msw field liaisons who reported a mean average of 2.2 field visits per semester. the most common recommendation for improvement of the liaison position noted by ligon and ward’s respondents was to “initiate more structure and create standards for field education” (p. 240). there were no national studies found that looked at how students proceed through the field placement process, though recommendations are made for the use of student and agency questionnaires to streamline and systematize the process (brownstein,1989) and student interviews are also suggested when practicable (zanville & markwood, 1982). it appears that in regard to program implementation and staffing, the only common denominator between the programs studied is the position of field director. the number of field hours required within a practicum placement has not been explored on a national level, perhaps in part because cswe sets a minimum standard of 900 hours. raskin, wayne, and bogo (2008) found in the minutes of a may 1982 cswe board meeting a verbal reference to a study of msw programs that found a range of 682 to 2,142 hours spent in field with a mean average of 1,082 hours. this was prior to the dalton, stevens, maas-brady/how do you do it 278 standard set by cswe of a minimum of 900 hours for msw placement. raskin et al. make the case that the current requirement of 900 hours was set arbitrarily and that there continues to be no empirical support for this or any other number being optimal. they advocate that the number of hours be adjusted to the individual student taking into consideration prior work experience. although there is a minimum number of field hours now required in accredited programs, is there still such variability as found by raskin et al.? if so, how does this variability impact the quality of a student’s education and training? skolnik (1989) surveyed field directors at accredited bsw and msw programs and found that 99% provided training for new field instructors and 71% did so for advanced field instructors. of those who provided training, 31% reported it was required for new field instructors and 20% reported it was required for advanced instructors. mcchesney (1999) received surveys from 92 msw field directors and found 93.5% offered field instructor orientation and 70.7% offered ongoing field training. field orientation was offered but not mandated by 47 of the field directors, though many added that it was expected or strongly encouraged for new field instructors. many of the field directors used incentives to encourage attendance, especially meals (41%) and official ceu’s (continuing education units) (38%). mcchesney recommends that cswe provide guidance to programs on field instructor orientation, such as an orientation handbook or national standards. in britain field instructors are required to be trained and certified by the national social work governing body (rogers, 1996). no such requirement exists in the united states and there is not much guidance available for field directors to use when designing programs. in the u.s. neither field instructors nor placement agencies receive direct financial support from the government in support of the field placement, as is the case in britain where agencies are compensated through the general social care council when they accept field students. dettlaff and dietz (2004) conducted focus groups with field instructors to identify their perceived training needs and identified particular areas of knowledge and skills that would be helpful for field instructor training, as well as a preference for a small group format for the training that would allow for the exchange of ideas. berg-weger, rochman, rosenthal, sporleder, and birkenmaier (2007) describe the process of how a group of three social work field programs collaborated to develop and oversee a joint field instructor training program. although berg-weger et al. describe a replicable process for developing a field orientation and training program and curriculum, they do not provide that curriculum; other programs following this process would still be required to develop their own curriculum. there are but two training guides available that give concrete curriculum suggestions for field directors to use when providing field instructor education (bogo & vayda, 1998; detlaff, 2003). a national survey of 218 field directors at accredited bsw and msw programs was conducted by bedard (1998) and found 87% agreed to strongly agreed that “the council on social work education should take some responsibility for field instructor training workshops that set some national standards for field instruction.” the issue of resources both within and without the educational institution was found to impact the field component. the changing practice environment was found by raskin advances in social work, fall 2011, 12(2) 279 and blome (1998) to have impacted the availability of field placements. responding field directors reported agencies were withdrawing as field placement sites due to reduced resources, increased caseloads, and staff who had to document their time as billable units. ligon and ward (2005) also found in their qualitative data a stated concern about the increasing impact of managed care shifting the emphasis onto billable units as an increasing pressure on field placement agencies. bedard’s (1998) survey included the item “there is a lack of institutional support for field instruction in the university” and found that 43% agreed or strongly agreed. in mcchesney’s (1999) survey it was found that the problem most often cited by respondents was the lack of resources of time, budget, and staff. skolnik (1989) found the third most common area cited by her respondents was “the lack of university support and appropriate administration for field education.” respondents in kilpatrick and holland’s (1993) field director survey cited a lack of resources as the most common problem in administering the field program. specific requirements for msw field instruction are described in the educational policy and accreditation standards (epas, cswe, 2008). these include specific “policies, criteria, and procedures for selecting field settings; placing and monitoring students; maintaining field liaison contacts with field education settings; and evaluating student learning and field setting effectiveness congruent with the program’s competencies” (epas, m2.1.5, cswe, 2008), and providing “orientation, field instruction training, continuing dialog with field education settings and field instructors” (epas, m2.1.7, cswe, 2008). the specifics of how to fulfill these policy mandates are not specified; rather it is up to the individual program to determine how to implement them in a way that is most appropriate for their situation. this latitude is beneficial in that it allows each program to use discretion in planning an individual program that appropriately meets needs, but it leaves field programs with the challenge of designing and justifying their choices. whenever such latitude is allowed in implementing policy, it opens a range of possibilities, including some that may be less than ideal (lipsky, 1980). raskin, wayne, and bogo (2008) recommend that field mandates be limited to those which can be empirically shown to be beneficial to students meeting their educational goals. for programs that seek guidance from other institutions there is not much information available on how other programs have implemented their field component. the literature on social work field instruction indicates there is considerable variation in both how the field component is implemented and the standards that are applied to it. further, there are gaps in knowledge of how the field component is implemented. this article will investigate and report how cswe accredited msw programs implement the above aspects of their field program. this study explores the following research questions: what are the common student field placement practices? how do field offices meet the cswe requirement to provide field instructor orientation and training? how is the field component implemented (e.g. seminar characteristics, liaison visits)? this study also collects basic program data on aspects of the field component (e.g. size) that have not been previously examined. dalton, stevens, maas-brady/how do you do it 280 methodology a 29-item questionnaire using both closed and open-ended questions was developed to examine field instructor orientation and training, the student placement process, field seminars, and resources available to field programs. the questionnaire was reviewed by three current or former field directors for content and clarity. the questionnaire was mailed in september 2007 to field directors at all 204 msw programs with either accredited or candidacy status with cswe as of august 2007. follow-up mailings were sent to non-respondents in october 2007. completed surveys were received from 135 field directors for a 66% response rate which is considered good for a mailed survey (rubin & babbie, 2001). though the questions focused primarily on specifics about program structure and administration, the respondents were the field directors, thus the unit of analysis is considered to be the field director. for grammatical simplicity the results are often presented from the perspective of programs. results placement process asking students to fill out a questionnaire before placement is a common practice with 91% of field directors reporting doing so. personal interviews with students require a greater time commitment for the field office field staff: 79% of the respondents reported that their offices conduct these interviews. the most common activity in the placement process is an interview with the field instructor, reported by 95% of the field directors. four programs reported using neither a questionnaire nor an interview but three of these reported the field instructor held an interview with the student, leaving only one program reporting none of the three activities in their placement process (see table 1). table 1. student placement process “before student placement do you require…” yes (%) no (%) n student questionnaire? 91 9 128 interview with placement office? 79 21 127 interview with field instructor? 95 5 124 orientation and training almost all field programs stressed field orientation and training. ninety-eight percent offered field instructor orientation and 96% offered field instructor training. all programs reported offering one or the other. although 60% responded that they require field instructors to attend orientation, only 26% responded that there are consequences for not attending. thirteen went on to report that those field instructors who do not attend orientation would not receive students. field directors in five programs reported that field office personnel would visit the field instructors who do not attend orientation to provide advances in social work, fall 2011, 12(2) 281 the orientation, which places a greater burden on field office personnel. similarly 60% responded that they require field instructors to attend training, but only 34% responded that there are consequences for not attending. because of the high number of missing values for consequences of not attending orientation and/or training it is likely the percentages of programs having consequences is inflated (see table 2). table 2: field instructor orientation and training “does your field office…” yes (%) no (%) n offer field orientation? 98 2 130 require attendance at orientation? 61 39 128 have consequences for not attending orientation? 26 74 96 offer field training? 96 4 125 require attendance at training? 60 40 126 have consequences for not attending training? 34 66 77 field seminars field seminars are reported as a component of 81% of field programs. these seminars are given academic credit separate from field hours at 38% of the field programs with seminars. in cases where academic credit is given separate from field hours the mean number of credits given is 1.8 with a range of 0.5 (n = 2) to 4 (n = 1). field seminars meet between 1 and 16 times per semester with a mean of 9.5. the length of each seminar had a mean of two hours. one program reported conducting four seminar sessions during a semester, each session eight hours in length. the mean total number of seminar hours in a semester was 17.5 with a range of 1.5 to 45. the number of liaison field visits required per semester ranged from zero to three with a mean of 1.5 (see table 3). table 3: seminar and placement characteristics mean range s.d. n times seminar meets each semester. 9.5 1-16 4.74 106 hours each seminar meeting lasts. 2 0.5-8 0.96 104 total hours of seminar per semester. 17.4 1.5-45 9.63 104 credit hours for seminar if separate from field credits. 1.8 0.5-4 .94 39 credit hours for total field placement. 13.4 0-28 4.79 123 clock hours for total field placement. 1010 720-1380 103.50 131 liaison field visits per semester. 1.5 0-3 0.67 131 ratio of students to field office fte’s 84:1 7:1-625:1 72.90 129 dalton, stevens, maas-brady/how do you do it 282 liaisons a slight majority of programs reported liaison work done primarily by full-time faculty, though many relied heavily on adjuncts (see table 4). of the 107 programs that had field seminars 72% reported that field liaisons were also seminar leaders, thus integrating the liaison work and the group processing function of the seminar. in cases where the liaisons were also seminar leaders the number of teaching credits awarded for the combined task varied from .5 to 6 credits (m = 2.7). in 17 cases liaisons were not also seminar leaders, and for being only a liaison they received one to three teaching credits per semester. in 16 cases seminar leaders were not also liaisons, and for being only a seminar leader they likewise received one to three teaching credits per semester. table 4: field liaison status “are your field liaisons…” % n all full time faculty 22.7 29 mostly full time faculty 32.8 42 evenly split 16.4 21 mostly adjuncts 17.2 22 all adjuncts 10.9 14 total 100 128 field requirements and credits the mean number of clock hours required for the total field experience for traditional students (not advanced standing) was 1,010 with a range of 720 to 1,380. two respondents clearly entered fewer than the 900 hours required by cswe. when asked their opinion about the cswe hour requirement 20% responded it was too few, 78% that it was appropriate, and 2% that it was too many. those who responded that the hour requirement was too few tended to require more clock hours (m = 1081) than those who responded that it was appropriate (m = 994) or too many (m = 978). the field directors reported that students receive a mean of 13.4 credits for their total field experience with a range of 0 to 28. although the one program reporting zero credits was an unusual response, low numbers of credit hours were not, as one reported three credits and two reported four. twenty eight programs reported giving students ten or fewer credit hours for the total field experience. there was a weak and marginally significant correlation between number of credits given for the total field experience and the number of clock hours required (r = .173, p = .056.) a case could be made for this being a one-tailed test, in which case the p-value would be .023. despite the correlation there was a wide range of credit given for similar effort. for example the nine programs that required 1,200 or more clock hours of field and did not separate field and seminar credit hours had a range of credits from 14 to 28. the modal number of clock hours advances in social work, fall 2011, 12(2) 283 required for field was 900 (n = 26), and those 26 programs awarded from eight to 24 credit hours for the total field experience (m = 13.1, sd = 3.9). the ratio of academic credit hours to field clock hours was computed by dividing academic credit hours by field clock hours. the range of this ratio went from one academic credit hour per 37.5 field clock hours to one academic credit hour per 306.7 field clock hours. the mean of this ratio was one academic credit hour per 86.3 field clock hours. field office resources the number of students reported in placement during the past year ranged from 10 to 800 (m = 169.6, sd = 164.5). the number of full time equivalent employees (ftes) dedicated to field coordination ranged from .25 to eight and an outlier of 20 (m = 2.6, sd = 2.6). the program with 20 ftes reported 168 students in placement (it is possible they mistakenly included liaisons when replying to this item). the program with 800 students in placement reported five ftes dedicated to field coordination. although the relative resources of these two particular programs may not seem equitable, the overall relationship between the number of students and ftes had a medium strength correlation (r = .332, p < .001). when asked about institutional support for the field component, 58% agreed it was adequate, 17% were neutral, and 24% disagreed it was adequate. when asked about institutional financial support for the field component, 49% agreed it was adequate, 17% were neutral, and 34% disagreed it was adequate. the ratio of students to field coordination ftes was computed. this new variable had a mean of 84:1 (i.e. 84 field students to one field coordination fte), a range of 7:1 to 240:1, and an outlier of 640:1. (see table 3) it was suspected that field directors of programs with a higher ratio of students per employee would perceive their institution was more supportive. this ratio was tested for correlation with the field director’s perception of institutional support to explore if better staffed field offices had directors who perceived greater institutional support. it did not reach statistical significance. this ratio was then correlated with the field director’s perception of institutional financial support and found to have a weak though statistically significant relationship (r = .186, p = .035). qualitative data were solicited by asking respondents if there was anything else they could tell us about their program or field education in general. the most common theme was a lack of resources, which was cited by nine respondents, with one saying the lack of resources was so dire that it caused some students not to be visited at their placements each semester. two respondents said that field is undervalued while one said that their field program is highly valued. two field directors said it was difficult finding field instructors in rural areas. one said “cswe must mandate/specify an appropriate level of support for field if it is to be the signature pedagogy.” other comments were idiosyncratic and covered a wide range of issues. dalton, stevens, maas-brady/how do you do it 284 discussion most programs were diligent in matching students with an appropriate placement. only one program had neither a pre-placement questionnaire, pre-placement field office interview, nor field instructor interview. the activity that is the most time consuming for the field office is the pre-placement interview, and while it is the least utilized of the three pre-placement activities, it is still conducted by 79% of responding programs. this willingness by field directors to invest time in the interview process reflects the importance placed on an appropriate field placement match. the least time-consuming activity for the field office is to have the student interview with the field instructor, reported by 95% of programs. although this may be time consuming for the field instructor, the benefits of this interview far outweigh the effort involved. the consequences for the field instructor and agency of having a poorly performing student or a student who is a poor match for the field agency are high as it is the field instructor and agency that bear the day to day responsibility of providing an educational environment for the student while at the same time protecting their clients. it is also in the student’s interest to participate in a screening interview to ensure that the placement offers a potential good fit because “…the selection, once made, must be lived with unless the circumstances are exceptional” (collins, thomlison, & grinnell, 1992, p. 37). almost all programs offer both field orientation and training, and all offer at least one or the other. cswe (2008) requires that both services be offered, but does not say that programs must require field instructors to attend. over half of respondents reported going beyond offering orientation and training by making attendance required. enforcement of this requirement is problematic. of those who require orientation or training, only a third report there are consequences for field instructors who do not attend, including not placing students with those field instructors. many programs may have trouble recruiting and retaining field instructors and are thus reluctant to enforce consequences for not attending. a field instructor may attend orientation or training because it was presented as required, but later meet other field instructors who forwent the training and suffered no consequences. if a program presents orientation or training to field instructors as required but does not enforce it, then the reputation of the program is reduced. whether or not a program can enforce consequences may be a factor of how many placements are available in the area and how well staffed the field office is. a lack of qualified field instructors has been identified as a concern by raskin, skolnik, and wayne (1991). a dearth of available instructors limits the ability to impose sanctions when program requirements are not met. the field seminar provides an opportunity for students to discuss their practicum experiences and to integrate the learning with classroom courses (collins et al., 1992; mary & herse, 1992). in the current study, most programs (81%) reported providing field seminars for students. if a program does not have a seminar, it is unclear where such integration would take place. at one of the author’s former institutions there was no seminar, but practice classes were asked to devote time to discussing relevant field issues. this was not ideal because not all instructors did so equally, and some included little or no such discussion. when such discussions were held, it was not done with knowledge by the instructor of the student’s placement as it would be in the case of a seminar leader advances in social work, fall 2011, 12(2) 285 who was also the liaison. a field seminar setting also allows for the development of greater trust if there are sensitive issues that need to be processed, and this function of professional support is the most common objective of seminars as previously reported by both students and faculty (mary & herse). of the programs in the current study that offer a seminar, 72% reported that field liaisons were also seminar leaders, a model that seems best at providing the integration purpose of the seminar. the role of a field liaison is to provide a crucial “bridge” between the school and the field site, and is enhanced when liaisons act as seminar leaders. not only do the liaisons then have a more intimate sense of the placement, they are able to identify concerns and address them with more immediacy when they have regular contact with the students in the seminar setting. the large number of programs that rely on adjuncts for liaisons and seminar leaders is not surprising given the trend in much of academia to reduce costs by relying on contingent faculty (thornton, 2008). however, adjunct faculty by its very nature have a temporal and less visible presence within schools of social work. ensuring the quality and consistency of their work with students poses a greater challenge than working with regular faculty members. more research is indicated as how to best integrate the field and classroom experience, whether through the use of an integrative seminar or other means, and how to best provide this instruction. of programs that had field seminars, academic credit was given for field seminar separate from field placement hours 38% of the time. this arrangement allows for a clearer delineation of responsibility between the seminar and field, especially when academic assignments are part of the seminar. in those cases where the seminar is seen as a process group with no readings or assignments outside the seminar, then having it credited as part of the field seems appropriate. this latter pattern more closely matches the purpose of seminar as described by collins et al. (1992). if there are readings and written assignments, the field seminar takes on the air of a classroom and runs the risk of those activities becoming more valued than the processing of field issues, which may then be neglected. the nature of field seminars could be the focus of future research. there were a variety of ways in which liaison and seminar leaders were credited for their work, with considerable variation in whether they were given teaching credits for seminar and liaison work together or separately, how many teaching credits were granted, and how many field visits were required, all of which bring up issues of equity and fairness. as they did for the faculty, the programs also show much variation in how students are credited for the field experience. there was considerable variation in the number of placement hours required and great variation in the number of credits given to students for similar effort. some students received many times more academic credit hours for the same number of field clock hours. these differences in programs for both students and faculty may mean richness in the variety of programs with unique emphases and approaches. it also raises issues of quality standards as some programs are more or less demanding than others yet all result in a msw degree from a cswe accredited institution. for faculty it means that some will have more tasks and less time to complete them. both qualitative and quantitative data indicate that many programs are struggling financially and in terms of perceived institutional support. in some cases the respondents dalton, stevens, maas-brady/how do you do it 286 may have been answering from a sense of felt deprivation when in fact the program has the resources to operate adequately. in other instances these results may indicate true cases of underfunding to the extent that basic operations are not possible, as in the case of the field director who said that some field visits are not made because of a lack of resources. in survey research it will always be impossible to definitively determine the level of subjectivity in responses to items like this. however the number of respondents claiming insufficient institutional support indicates a pattern of underfunding that is too widespread to be easily dismissed. recommendations/conclusions this paper presents general data on how field programs implement the field component. field program directors can now use these data to inform their own implementation choices. there was a wide variation in program characteristics, reflecting a wide range of requirements, programs, and credits. the extent of the variation is large enough to raise questions regarding the provision of an equitable standard for msw candidates enrolled in cswe accredited programs. do the current cswe guidelines ensure that field experiences are of comparable quality across institutions and that they provide the type of baseline competencies as are required in core curriculum courses in the classroom? cswe must strike a balance between mandating uniformity and allowing programs to develop in ways that seem best suited for their institution and community. if the balance goes too far toward program self-determination, then inequity between programs becomes an issue. there is currently such variety between programs in the most basic structures and requirements that field placements may vary widely by quality and degree of supervision. this can mean that students in different schools might all fulfill the requirements of the field practicum yet come out unequally prepared, not just differently prepared. the current research indicates that when programs are left to themselves to implement policy they may do so with varying degrees of proficiency. it may be time for cswe to mandate some basic level of performance for field programs. reasonable first steps could include: to require at least one field visit per semester, to require an expressed plan for the integration of practice and theory for those programs that do not have a field seminar, and to set a minimum target of attendance by field instructors in orientation and training. there should also be consideration of mandating some level of basic equity of student experience between programs. for this a reasonable first step could include requiring at least one academic credit hour for every 80 hours of field. conversely, too stringent a set of requirements leaves little leeway in designing field programs that fit the individual needs of schools and the communities in which they are located. as field placement options decrease as a result of constricted budgets and staffing, and the resources within field programs is limited, there will always be the need to work creatively within the boundaries faced by field personnel. for this reason, although more specific guidelines are needed, such guidelines should be limited in number. the provision of best practice recommendations could offer guidance to programs while allowing them the discretion that they need to function effectively. advances in social work, fall 2011, 12(2) 287 during the process of conducting this research the authors became aware of potential directions for future research in this area. further research is needed to explore if and how differences in the structure of the field practicum impacts learning outcomes. do programs with field seminars better prepare students than those that do not? is it an advantage when field liaisons also lead field seminars? do hour requirements impact the development of basic competencies? additional areas of exploration include the extent of use and the benefit or detriment of employment-based field placements, and the content that field program directors include in field instructor orientation and training. this paper’s description of current practices is only a first step. empirically comparing common field practices on valid, reliable, and commonly agreed upon outcome measures will provide us with the next level of understanding. references bedard, l. e., (1998). a national survey of social work field placement directors. dissertation abstracts international, 59, 955-a. (issn 0419-4209). berg-weger, m., rochman, e., rosenthal, r., sporleder, b., & birkenmaier, j. (2007). a multi-program collaboration in field education. social work education, 26, 20-34. doi:10.1080/02615470601036492 bogo, m. (2005). field instruction in social work: a review of the research literature. the clinical supervisor, 24, 163-193. doi:10.1300/j001v24n01_09 bogo, m., & vayda, e. (1998). the practice of field instruction in social work: theory and practice. ny: columbia university press. brownstein, c. (1989). practicum issues: a placement planning model. in m. s. raskin (ed.), empirical studies in field instruction (pp. 93-104). ny: the haworth press. burke, s. g., condon, s., & wickell, b. (1999). the field liaison role in schools of social work: a break with the past. the clinical supervisor, 18, 203-210. doi:10.1300/j001v18n01_13 collins, d., thomlison, b., & grinnell jr., r. m. (1992). the social work practicum: a student guide. itasca, il: peacock publishers. council on social work education (2008). educational policy and accreditation standards. alexandria, va: author. available online at http://www.cswe.org/cswe/ dettlaff, a. j. (2003). from mission to evaluation: a field instructor training program. alexandria, va: council on social work education. dettlaff, a. j., & dietz, t. j. (2004). making training relevant: identifying field instructors’ perceived training needs. the clinical supervisor, 23, 15-31. doi:10.1300/j001v23n01_02 frumkin, m., & lloyd, g. a. (1995). social work education. in r. l. edwards, (ed.), encyclopedia of social work (19th ed., vol. 3, pp. 2238-2247). washington, dc: nasw press. dalton, stevens, maas-brady/how do you do it 288 kilpatrick, a. c., & holland, t. p. (1993). management of the field instruction program in social work education. journal of social work education, 7, 123-136. doi:10.1300/j067v07n01_10 ligon, j., & ward, j. (2005). a national study of the field liaison role in social work education programs in the united states and puerto rico. social work education, 24, 235-243. doi:10.1080/0261547052000333153 lipsky, m. (1980). street-level bureaucracy: dilemma of the individual in public services. ny: russell sage foundation. mary, n. l., & herse, m. h. (1992). what do field seminars accomplish? student and instructor perspectives. journal of teaching in social work, 6, 59-73. doi:10.1300/j067v06n02_06 mcchesney, m. (1999). agency-based social work field instructor orientation and training. dissertation abstracts international, 60, 551-a. (issn 0419-4209). raskin, m., & blome, w. w. (1998). the impact of managed care on field instruction. journal of social work education, 34, 365-374. raskin, m., skolnik, l., & wayne, j. (1991). an international perspective of field instruction. journal of social work education, 27, 258-270. raskin, m., wayne, j., & bogo, m. (2008). revisiting field education standards. journal of social work education, 44, 173-188. doi:10.5175/jswe.2008.200600142 rogers, g. (1996). training field instructors british style. journal of social work education, 32, 265-276. rubin, a., & babbie, e. (2001). research methods for social work. belmont, ca: wadsworth. scannell, j. j., & simpson, k. (1996). shaping the college experience outside the classroom. rochester, ny: university of rochester. skolnik, l. (1989). field instruction in the 1980’s – realities, issues, and problemsolving strategies. in m. s. raskin (ed.), empirical studies in field instruction (pp. 47-75). ny: the haworth press. thornton, s. (2008). “where are the priorities?: the annual report on the economic status of the profession, 2007-2008. academe, 94(2), 8-34. zanville, h., & markwood, r. (1982). a casebook on practice in internship education. boulder, co: western interstate commission for higher education. author note: address correspondence to: bruce dalton, department of social work, box 70645, johnson city, tn 37614-1702. email: dalton@mail.etsu.edu aisw vol. 8, no. 1:aisw vol. 5, no. 2 institutionalization: a theory of human behavior and the social environment miriam mcnown johnson rita rhodes abstract: institutionalism is the syndrome first recognized and described in inpatient psychiatric facilities, which is now used to describe a set of maladaptive behaviors that are evoked by the pressures of living in any institutional setting. this article traces the development of the theory of institutionalization, which predicts and explains an individual’s response to that particular type of environment. the article makes note of key contributors and contributions, and of empirical studies that have advanced the theory. underlying perspectives and assumptions are identified and earlier theoretical models are reviewed and critiqued. an updated model of the theory, which includes individual vulnerabilities, objective conditions of the institutional placement, and the resident’s perceptions of the environment, is presented. new directions in the field of institutional care and implications for social workers, particularly for those working in nursing home and prison settings, are discussed, along with recommendations for next steps for theory progression. keywords: institutions, institutionalization, institutionalism, normalization, deinstitutionalization, nursing homes, prisons introduction conventional wisdom suggests that institutions are no longer an important feature of american life. two vulnerable populations, however, are likely to experience the effects of institutionalization. america leads the world in the proportion of its citizens who are confined in correctional settings, and improvements in health care suggest that, while americans are living longer, they are also at increased risk for spending some time in a long-term care facility. in this paper, we present a very brief review of the early history of institutions in america, describe the key contributions to theory development, summarize important empirical studies that have supported and/or progressed the theory, discuss theory components, and end with new directions in institutional care, along with implications for social work. 219 miriam mcnown johnson, ph.d., m.s.w. is associate dean for academic affairs and associate professor, college of social work; rita rhodes, ph.d. is professor, college of social work, university of south carolina, columbia, sc, 29208. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 219-236. indiana university school of social work. history for the most part, americans in the colonial period relied on the services of relatives and neighbors to meet the needs of the poor, the insane, and the orphaned (rothman, 1971). criminals were fined, whipped, or hanged—not imprisoned. this pattern was reversed in the mid-19th century, when there appeared to be a well-intentioned effort to provide a new kind of help for several at-risk populations. originally conceived as sanctuaries, asylums were established in the countryside with the intention of resocializing and rehabilitating their inmates (including not only prisoners, but also people with mental illness, mental retardation, and dependent children) in a wholesome environment far from the chaos, temptations, and exploitations of the city (rothman, 1971). physical separation of the asylum away from the community was consistently practiced. eventually, the dreams of institutional effectiveness faded, but the facilities themselves remained, suffering a gradual decline from reform to barely custodial, if not punitive, operation (rothman, 1971; white & wolfensberger, 1969). despite the efforts of early reformers, including dorothea dix (day, 2003), in the last half of the 19th century, there was a growing perception that it was society, not the institutional residents, that required protection (rhodes, 1993). theory development: key contributors and contributions in one of the first professional papers presented or published on the topic in the united states, myerson (1939) used the term “prison stupor” or “prison psychosis” to describe the “psychologic retreat” that was “enhanced in all directions” by the very care that the mental patients received in the hospitals he visited (p. 1198). myerson described a “motivation vacuum” and a “physiologic vacuum,” both of which existed in the mental hospital setting, and he conducted a two-year experiment at boston state hospital that linked a reduction in the number of deaths and an increase in the number of discharges to a “widespread approximation to more normal living,” which included more time outdoors, exercise, hydrotherapy, entertainment, and better food. bettelheim and sylvester (1948) studied the impact of institutional placement on children and described a syndrome that they called psychological institutionalism. they considered this to be a “deficiency disease in the emotional sense,” stemming from the “absence of meaningful, continuous interpersonal relationships” (p. 191). in the case of children, they were particularly concerned with the impact of “depersonalized rules and regulations,” which seemed to lead to emotional impoverishment (p. 191). martin (1955) had seen the term institutionalization used in the clinical notes of mental hospitals, where nurses would write “well institutionalized” as an assessment of a patient’s adjustment to the hospital setting, implying that the patient “has ceased to rebel against, or to question the fitness of, his position in a mental hospital; he has made a more or less total surrender to the institution life” (p. 1188). in fact, this was considered a positive step for the many mental patients whose condition (e.g., schizophrenia) could not be cured or ameliorated with the remedies available at that time. however, martin contrasted this phe220 advances in social work nomenon to the “true cooperation essential to the success of any treatment” (p. 1188). martin (1955) enumerated several potential contributing factors to institutionalism. he suggested that, because the hospital takes care of basic needs, the patient loses the incentive to take responsibility for them; this is the “first step” towards institutionalization. second, “once in hospital, the patient quickly becomes absorbed into its highly organized life. the fact that any large institution needs an efficient and complex organization carries with it the danger that the life of the individual within it will also become highly organized, and this will tend to relieve him of the need to think or plan for himself in any but the most unimportant trifles” (p. 1189). third, patients are hesitant “to criticize staff or the organization or from using initiative” out of fear of being sent to an isolation unit. fourth, rather than inquiring into possible faults of the organization or a personal relationship, which may, in fact, have been the cause of the patient’s agitation, staff take the easy way out and send patients to the isolation unit. fifth, the doctors also foster the institutionalization process, largely unconsciously, due to the pressures of large caseloads and the failure to share their power with lower level staff, who have more direct contact with patients. in addition, although he does not call it staff empowerment, martin suggested that lack of training in relationship building led the psychiatric nurses to focus on maintaining order in the unit, relying on the authority of the institution for enforcement. he ended his essay on a pessimistic note, suggesting that the authoritarian system that he believed caused the problem was likely to remain unchanged, and his only hope was that psychiatrists would become more aware of it. referring to martin’s description of institutionalization, barton (1959) noted that he preferred the term institutional neurosis, because “it promotes a syndrome to the category of a disease rather than a process” (p. 11). he enumerated seven factors associated with it, including: “loss of contact with the outside world; enforced idleness; bossiness of medical and nursing staff; loss of personal friends, possessions, and personal events; drugs; ward atmosphere; [and] loss of prospects outside the institution” (p. 15). in describing the “ward atmosphere,” martin was clearly referring to the physical environment; he discussed the effects of smell and noise and recommended adding “gay colours, carpets, cushions, and curtains” to “create an air of optimism” (p. 44). ellenberger (1960) described the phenomenon using the french term alienization. he compared the process of institutionalization and the results to what happens to wild animals that are captured and put in zoos. (today, a similar comparison might be made by evolutionary psychologists.) ellenberger highlighted the “trauma of captivity” and the frustration of the natural territorial and hierarchical instincts of both zoo animals and humans. sommer and witney (1961) focused on one step in the process of institutionalization, the transfer from the “newly admitted ward” to the “continued treatment ward,” where there was a less favorable staff-patient ratio and poorer physical surroundings. however, sommer and witney saw the transfer as “much more than an administrative act;” the patient was rejected by staff and came to view himself as a “failure,” losing hope, and accepting a “passive institutional role” (p. 113). 221johnson, rhodes/institutionalization: a theory of human behavior and the social environment wing (wing & brown, 1961; wing, 1962) studied institutionalism among chronic mental patients in several hospitals that provided a contrast in social and medical care, concentrating on patients who had been in the hospital for at least two years. he clearly identified three variables related to institutionalism: the social pressures that stem from the institution, the length of time that the resident was exposed to these pressures, and the level of susceptibility that the resident brought. using the term social breakdown syndrome to describe types of behaviors in mental patients who appear “more or less independently of the underlying disorder,” (p. 1481) gruenberg (1967) listed seven steps in the process of deterioration. step four comes with hospital admission and, in step five, the patient learns to comply with the rules to stay out of trouble. in step six, the patient becomes isolated from family and friends. in step seven, the patient identifies with his fellow patients, anticipates staff demands, and strives to “fit in,” to “settle down,” and to become a “good patient” (p. 1485). also, in the mid-20th century, while psychiatrists were describing the experiences of their patients, a number of sociologists were conducting qualitative studies of institutional life (belknap, 1956; caudill, 1958; dunham & weinberg, 1960; goffman, 1958, 1961; scheff, 1966; stanton & schwartz, 1954; strauss et al., 1964). the most well known, goffman, published his findings in a book titled asylums: essays on the social situation of mental patients and other inmates (1961). significantly, he identified the features of total institutions (goffman, 1958). the four “totalistic features” he listed were: first, all aspects of life are conducted in the same place and under the same single authority. second, each phase of the members’ daily activity will be carried out in the immediate company of a large batch of others, all of whom are treated alike and are required to do the same thing together. third, all phases of the day’s activities are tightly scheduled, with one activity leading at a prearranged time into the next, the whole circle of activities being imposed from above through a system of explicit formal rulings and a body of officials. finally, the contents of the various enforced activities are brought together as parts of a single overall rational plan purportedly designed to fill the official aims of the institution (p. 43). among the examples of total institutions goffman cited, in addition to mental hospitals, were tb sanitariums, jails, pow camps, boarding schools, army barracks, monasteries and convents, and ships. goffman summarized that the central feature of total institutions is that work, recreation, and sleep are experienced in the same place (goffman, 1959, 1961). goffman (1958, 1961) also colorfully described admission to the institution as a process of “mortification,” where residents are stripped of their social roles and normal identities. the residents then adopt the official or staff view of themselves and try to act out the role of the perfect inmate (1961, p. 63). wolfensberger (1972) believed that it was deindividuation that made institutions different from other organizations and residences. the features that charac222 advances in social work terize deindividuation include numbers of residents distinctly larger than might be found in a large family, a high level of regimentation, a physical or social environment that aims at a low common denominator, and a place in which all or most of the transactions of daily life are carried out under one roof or on one “campus” (pp. 28-29). wolfensberger was primarily interested in services for persons with mental retardation, but deindividuation can be found in facilities for other populations as well. in 1999, wirt identified four distinctly different explanations, or causal models, for institutionalism. the first, which he called the predisposition model, suggests that institutionalism results from predisposing personal traits when exposed to institutional life. the second, the total institution model, focuses exclusively on the destructive characteristics of institutional life. the asylum model posits that the desire to remain in the hospital is a rational choice from the perspective of the patient. the last model, the symptoms model, identifies institutionalism as either the symptoms of the illness or as the result of years of treatment, regardless of setting. while psychiatrists and sociologists were exploring the effects of institutional placement on mental patients and people with retardation, others were examining the influence of perceptions of control in the lives of older adults and other nursing home residents. epidemiological studies conducted in the late 1970s and early 1980s demonstrated that a sense of control was among the most important psychosocial predictors of morbidity, mortality, and psychological well being in older adults (rodin, 1986; rowe & kahn, 1987.) baron and rodin (1978) distinguished between actual control and perceived control; they defined actual control as the ability to influence intended outcomes and perceived control as the expectation of having the power to obtain desired consequences. also, rodin (1983) speculated that perceptions of loss of control might be more harmful than perceptions of lack of control. as people age, acquired deficits in physical and cognitive abilities may induce perceptions of loss of control, as well as actual, objective experiences of loss (schulz, 1980). an older person’s observation of other, less competent older adults through personal contact may lead to modeling of helpless behaviors. it is particularly likely that nursing home residents will be exposed to models of dependency and passivity, in part, because staff members rarely encourage independent activities (baltes & reisenzein, 1986). inside (and outside) of institutions, people in contact with older individuals tend to offer to assist with tasks they formerly implemented independently. such assistance, although well-intended, may undermine the individual’s sense of control as well as his or her task performance (avorn & langer, 1982; langer & imber, 1979). although these theorists were primarily interested in loss of control in old age, the basic concepts could easily be applied to other vulnerable populations (see, for example, johnson, 1999). in fact, the studies cited in the previous paragraph seem to echo earlier observations of enforced idleness in institutions documented by barton (1959), martin (1955), and wing and brown (1961). 223johnson, rhodes/institutionalization: a theory of human behavior and the social environment empirical studies that have supported and/or progressed the theory given the multitude of factors/features that purportedly contribute to the syndrome of institutionalism and the many symptoms that comprise it, it is not surprising that few studies have examined this topic in its entirety. it may be that there are few recent studies of institutionalism, because several populations that have manifested this syndrome in the past (e.g., orphans, people with developmental disabilities, and chronic mental illnesses) are now, for the most part, either living with families or in small, community-based group homes, or are hospitalized for only brief periods of time. institutional care of very young children is no longer practiced in this country; empirical studies of the effects of institutional care have focused on more recent practices in romania. although research on the effectiveness of various facility characteristics continues in this country, it is not always applicable to institutionalism, as in, for example, landesman-dwyer, sackett, and kleinman’s 1980 study on the effects of size differences among group homes serving the mentally retarded, when the sizes ranged from only 6 to 20 residents. the two populations that continue to experience care and confinement in relatively large institutional settings are older adults and prisoners. with the latter group, the symptoms of institutionalism (e.g., passivity, compliance) are not perceived as problematic. for older adults, alternative models of care are being developed and evaluated (see below). in addition, researchers conducting sophisticated empirical studies face the practical challenges of finding institutions that are willing and able to cooperate with the implementation of experimental conditions, randomly assigning subjects to various treatment conditions, identifying control groups, and controlling other threats to internal validity, including diffusion/contagion of interventions across groups and reactivity (the hawthorne effect). key empirical studies found in the literature the four models that wirt (1999) identified, which are discussed above, are strongly linked to research findings. the predisposition model was supported by several early studies, including wing and brown (1970) and liberkakis (1981). wing and brown, who examined 273 hospital patients with mild-to-moderate mental illness, found that patients with schizophrenia were particularly susceptible to institutionalism, “because of their vulnerability to understimulation” (p. 184). liberkakis studied 324 mental patients; he found that low intelligence, poor education, and disabilities were significantly associated with institutionalism. in two longitudinal studies of patients in mental hospitals, wing and his colleague (wing & brown, 1961; wing, 1962) found data to support the total institution model, with length of stay being one major predictor variable, and the length of time during the day that a patient spent doing absolutely nothing a second variable. in his often-cited ethnographic study of conditions and staff behaviors inside a mental hospital, rosenhan (1973) concluded that “neither anecdotal nor ‘hard’ data can convey the overwhelming sense of powerless which invades the individual as he is continually exposed to the depersonalization of the psychiatric hospital” (p. 198). 224 advances in social work concerned about the effects of living in a “virtually decision-free environment,” langer and rodin (langer & rodin, 1976; rodin & langer, 1977) conducted an experimental study and follow-up on the effects of an intervention to increase feelings of choice and personal responsibility in 91 elderly nursing home residents. nurses’ rating and health-and-mortality indicators documented significant improvement in the experimental group on measures of alertness, active participation, and sense of well-being that persisted beyond 18 months. subsequent studies (e.g., skea & lindesay, 1996; stirling & reid, 1992) documented similar results. studies examining the effects of a more “normalized” environment within an institutional setting include myerson’s (1939) classic experiment in a public mental hospital, (described above), eyman, demaine, and lei’s (1979) work with facilities for people with mental retardation (1979), and preliminary findings on the eden alternative model reported in a study by coleman et al. (2002). eyman, demaine, and lei found positive changes in adaptive behavior in 245 developmentally-disabled individuals living in family-care homes and board-and-care homes, using the wolfensberger and glenn’s program analysis of service systems (pass) instrument (1975) to measure the conformity of service systems to normalization principles. coleman et al. found “no beneficial effects” of the eden alternative in terms of cognition, functional status, or survival, although qualitative observations indicated that “the change was positive for many staff as well as residents” and implied that longer term follow-up might provide additional positive results (p. m422). dependent variables in empirical studies of the asylum model include patients’ attitudes, “attraction to the hospital,” and desires related to discharge or readmission. in his study of 358 institutionalized male veterans, goldman (1965) found that “a sizeable segment of the population was found to have no substantial interest in ever returning to the community” (p. 322). weinstein (1979) reviewed 38 quantitative studies of patients’ attitudes toward mental hospitals and found that favorable attitudes predominated in 79% of them. using a sample of 187 aftercare patients, drake and wallach (1992) found a preference for living in the hospital was associated with past hospital stays, symptoms of psychosis, and severe drug abuse. in a study of patients readmitted to the bronx state hospital, rosenblatt and mayer (1974) found that patients with a greater number of previous admissions were more likely to return to the hospital, independent of the severity of their illness. after concluding their study, rosenblatt and mayer reviewed two dozen other studies on recidivism and found “strikingly consistent patterns” in patient movement with 36 different populations: the more often they had been admitted, the more likely they were to return. in a recent study, rosenheck and neale (1998) linked reduction in hospital utilization with intensive community treatment, using data from nine va hospitals over a five-year period, suggesting that the desire to stay in or return to the hospital is based on community deficits as much as institutional ones. the symptoms model appears to dismiss institutionalism out of hand. mathai and goppinath (1985) found that hospital care does not have a significant influence on the deficits associated with chronic schizophrenia, based on their study 225johnson, rhodes/institutionalization: a theory of human behavior and the social environment of 80 chronic schizophrenic and 16 manic-depressive psychotic patients; they concluded that, symptoms sometimes attributed to institutionalism are an integral feature of the disease process, rather than a result of institutionalization. making the same point, davidson et al., (1995) concluded that diagnosis, rather than residential situation, was most likely to account for negative symptoms. the theory of institutionalization: concepts, assumptions, and model definitions of concepts institutions are facilities where residents exercise little or no choice about their participation in activities, have little input into how they are treated, and cannot leave without being officially released or discharged. lack of control over one’s life is a major feature of institutions; the residents’ needs are usurped by the needs of the institution. goffman (1961) defined a total institution as “a place of residence and work where a large number of like-situation individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered round of life” (p. xiii). usually, total institutions attempt to resocialize the residents to become more compliant and accepting of institutional and societal norms. we define institutionalism as the syndrome (group of symptoms) that results from the process of institutionalization. it is characterized by apathy, lethargy, passivity, and the muting of self-initiative, compliance and submissiveness, dependence on institutional structure and contingencies, social withdrawal and isolation, an internalization of the norms of institutional culture, and a diminished sense of self-worth and personal value (belcher & rife, 1989; bettelheim & silvester, 1948; haney, 2001; wirt, 1999). underlying perspectives and assumptions as a theory, institutionalization fits clearly with the assumptions of the ecosystems perspective. a focus on the importance of the perceptions of those living in controlled environments, in addition to the objective conditions themselves, suggests the relevance of a social constructionist perspective as well. ecosystems introduces the construct of goodness-of-fit, the extent to which there is a match between an individual’s needs, rights, goals, and capacities and the qualities of his or her physical and social environment (germain & gitterman, 1995, p. 817; greene, 1999, p. 299). lawton and nahemow (1973) postulated a two-dimensional model of “competence and environmental press” to illustrate the negative affect and maladaptive behavior that results when personal characteristics and environmental demands are mismatched. institutionalization theory suggests that it is this mismatch, or lack of goodness-of-fit between residents and their institutional environment, that is the primary cause of the syndrome of institutionalism. in addition to the objective reality of the setting, the residents’ perception of the environment and their experiences, contribute to the development of the syndrome. in addition, according to labeling theory, labels such as patient or criminal may result in institutional residents accepting and internalizing the attributes 226 advances in social work of those roles. the impact of labeling is not limited to the label recipient, but it extends to those with whom she or he interacts. for example, once a person is labeled a psychiatric patient, staff may interpret even normal behaviors as symptoms of mental illness (rosenhan, 1973). a theoretical model wirt (1999, p. 264) believed that the four models he described (predisposition, total institution, asylum, and symptoms) were “competing and sometimes antithetical explanations for institutionalism.” we partially concur, noting that the symptom model dismisses institutionalism out of hand. the asylum model, which focuses on the desire to return to or remain in the institution, appears to be related to institutionalism, often occurring simultaneously, but may, in fact, be a separate phenomenon, particularly as it is postulated to be based on rational choice. we are thus left with the predisposition model and the total institution model, which could easily be construed as complementary. these two models, however, do not clearly or fully incorporate the effects of residents’ perception. a synthesis of hypotheses and empirical findings presented here suggests support for a theoretical model of institutionalization as illustrated in figure 1. it is comprised of five constructs: four contributing factors, including individual vulnerability, the conditions of institutional settings, resident perceptions of the institutional environment, and time in care, and the outcome, the syndrome of institutionalism. the individual brings to the institution certain vulnerabilities, such as poor health, limited coping skills, lack of a social support network, or mental illness. the institutional setting then imposes certain demands upon the individual. these include the surrender of personal identify at admission. with longer-term care, this is followed by isolation, regimentation, and deindividuation. the effects of the objective or actual situation are magnified by the resident’s perception of events, including loss of control and fear of punishment or retribution. this is then exacerbated by the actual length of time spent in the institution, as well as the resident’s perception that there is little or no hope of discharge. 227johnson, rhodes/institutionalization: a theory of human behavior and the social environment figure 1. a graphic illustration of how individual vulnerability, multiplied by conditions in the institutions and the resident’s subjective perceptions of it, over time, results in institutionalism. the fact that institutionalism is not manifested by all vulnerable persons in different situations or by all individuals in controlled environments supports the thesis that it is the combination of extremes in some or all of these factors that produces the syndrome. so, for example, it is not surprising that the syndrome was observed commonly, if not invariably, in persons with schizophrenia who were locked for years in the back wards of state mental hospitals. on the other hand, young, mentally and physically healthy, well-trained military personnel who are captured and detained in deplorable conditions in pow camps usually do not manifest the symptoms of institutionalism, although they may suffer from other syndromes, such as ptsd. variables a review of empirical studies on institutionalization and related topics reveals a number of independent and dependent variables that have been used to study this topic. we would suggest that the following variables, listed under the five constructs of the theory, are positively correlated with the probability of the development of institutionalism. individual vulnerability: very young or very old age, poor physical health, compromised cognitive functioning, psychiatric illness, lack of a strong social network, poor coping skills, lack of mobility, and low self-efficacy. we should note, however, that even without identified deficits, all people have basic human needs that leave them vulnerable to extreme environments. wirt suggests, “the restrictive environment of institutional settings coupled with oppressive staff [are] capable of producing institutionalism in almost any person regardless of diagnosis, predispositions, or personality” (1999, p. 260). characteristics of the institution: confiscation of personal belongings, large size (resident capacity), isolated location, authoritarian staff, low staff to resident ratio, lack of staff training, disempowerment of staff, rigidity of routine, drab or standardized physical environment, lack of stimulation, enforced idleness, lack of choice and control, lack of privacy, program or unit designated for long-term residents, and absence of meaningful relationships. resident perceptions: lack of input into the placement decision, mortification, loss of identity, acceptance of patient or inmate label, isolation, loss of control, loss of sense of purpose, expectation of lengthy or permanent stay. institutionalism can be measured by the manifestation of its symptoms, which were also listed above: apathy, lethargy, passivity, and the muting of self-initiative; compliance and submissiveness; dependence on institutional structure and contingencies; social withdrawal and isolation; an internalization of the norms of institutional culture; and a diminished sense of self-worth and personal value. based on our understanding of the literature, we suggest that the features and characteristics within each construct are additive or cumulative. for example, a person might have multiple vulnerabilities, or an institution might have some but not all of the characteristics listed. we further hypothesize that the contributing constructs have a multiplicative effect on each other. in other words, each has a magnifying effect, rather than simply adding to the others. we also hypothesize 228 advances in social work that there is a threshold or critical mass of effects that, once achieved, results in manifestation of the syndrome. new directions in institutional care in response to criticisms of institutions, different theoretical models, and research findings, several alternative models of care and treatment have been proposed and implemented. most of these directly address the limitations of institutions that were summarized above. normalization the normalization model was proposed in the late 1960s (nirje, 1994; wolfensberger, 1972). in simple terms, normalization means making available to institutionalized people living arrangements that closely resemble those enjoyed by other citizens. this approach suggests that facilities should be small (i.e., designed for no more than six to eight residents). they should resemble valued homes in the community—there should be no signs in front that identify the residents inside as different from other citizens. facilities should be integrated into the community so that residents can walk to or have available public transportation to the library, shopping centers, movie theaters, and parks. residents should work and/or receive services away from the facility. there should be a continuum of options available, but residents should not have to move simply because their needs change; instead, services should be adapted so that residents can experience a sense of permanence and security in their living arrangement. the 1980 americans with disabilities act provided unequivocal federal support for the integration of persons with disabilities into the mainstream of american life. for several decades now, most people with disabilities have lived with their families or resided in community-based facilities, including intermediate-care facilities, foster homes, group homes, boarding homes, and supervised apartments (segal, 1995). in 1997, 194,968 people with mental retardation were living in homes with one to six people; the average proportion of developmentally-disabled individuals living in settings of only one to six persons nationwide is 56.9%, with vermont having the highest level at 100%, and arkansas at the lowest, with only 10% according to data from the arc (the national advocacy organization for retarded citizens) (davis, 1998). medicaid pays for a wide range of services and living arrangements for persons with iqs below 60 or those with an iq between 60 and 69 who have an additional handicapping condition of cerebral palsy, spina bifida, prader-willi syndrome, epilepsy, or autism. studies of small, community-based group homes for people with mental retardation show that the community care movement has been largely successful (landesman-dwyer, 1982; community living, 1997). this has provided an impetus for human service providers to develop small, community-based group homes for other populations with special needs (e.g., people with chronic mental illnesses, newly released prisoners, and acting-out adolescents). residential facilities for children at the same time that persons with developmental disabilities were being moved into community-based care, there was also strong federal support for efforts to 229johnson, rhodes/institutionalization: a theory of human behavior and the social environment return children in out-of-home care to their families or to find permanent adoptive homes for them, as codified in the adoption assistance and child welfare act of 1980 (pl 96-272) (see johnson & harrison, 1994). nevertheless, the rate of institutionalization of children has remained relatively stable. schwartz (in gambrill & stein, 1994) reports that “the boundaries between child welfare, juvenile justice, and mental health systems are porous” (p. 276) and that, as reforms and changing policies lead to the closing of institutions under one auspice, corresponding increases appear in the others. during the mid-1990s, there was a renewed interest in congregate group care for sociallyand economically-disadvantaged children and those who suffered instability due to multiple disrupted placements with relatives and foster families (mckenzie, 1996; van biema, 1994; schuh & caneda, 1997; weisman, 1994). this may have been sparked, in part, by a speech by newt gingrich, who suggested that the babies of unwed teen mothers be put in orphanages (van biema, 1994). at the same time, child advocates and professionals were debating the question (gambrill & stein, 1994), with those opposed noting that child-caring institutions were ineffective and costly “while there is a need for a small number of facilities for violent and chronic delinquents and for children and youth who [have other serious problems] . . . the number needing such care is very small in comparison to the hundreds of thousands placed into institutions each year” (schwartz, in gambrill & stein, 1994, p. 276). although family foster homes and small group homes provide a majority of outof-home care for children and youth, placement in more restrictive settings remains a common occurrence. using a national probability sampling design, james et al. (2006) have documented that 25% of youth experience an “intensive or restrictive setting during their first out-of-home care episode” (p. 96). mcmillen et al. (2004) found that three-quarters of youth still in out-of-home care at age 17 had been in residential care facilities and nearly half of them had experienced episodes in inpatient psychiatric care. there are few, if any, orphanages left in america, but they remain a significant part of the child welfare systems in other countries. extensive studies of the effects of institutional rearing in romanian orphanages (see kadlec, 2002; ellis, 2004; parker & nelson, 2005; tarullo, 2005) document stunted physical growth, persistent socio-emotional deficits, and even disruptions in the development of neural circuitry in the brains of young children. deinstitutionalization the deinstitutionalization movement arose in the 1960s and early 1970s in response to a series of trends, including increasing public awareness of the negative effects of institutionalization, growing costs of institutional care, scientific advances that made confinement in institutions obsolete, political, and legal pressures to treat residents in the least restrictive manner, and the development of ssi payments directly to clients (segal, 1995). what was originally conceptualized as a solution to institutionalization eventually became a problem in and of itself, as individuals were moved from one dominant institutional form to another as many community-based nursing homes and groups homes, bowing to the pressures of economy of scale, have come to resemble the institutions they were intended to 230 advances in social work replace (segal, p. 710). a lack of funding has left many communities short of resources. an example of a failure of deinstitutionalization for mentally ill people is the large numbers who are incarcerated in jails and prisons with no provision for mental health services. this problem has been recognized for more than 25 years (see briar, 1983). with 3000 inmates receiving psychiatric services, the los angeles county jail system is said to be the largest mental institution in the united states (izumi, schiller, & hayward, 1996). it is estimated that, as many as 20% of prisoners have a mental or psychological disorder or a developmental disability (haney, 2001). of the 10 million adults booked into local jails each year, approximately 700,000 have active symptoms of mental illness (the sentencing project, 2002). most mentally ill offenders are arrested for minor offenses, such as trespassing, vagrancy, urinating in public, or shoplifting at the corner convenience store. many of them also have substance abuse problems but cannot get into drugand alcohol-treatment programs because of their mental illnesses. it has been documented that, due to budget cuts and lack of space in state mental health hospitals, some mentally ill individuals may remain in jail for up to two years—even with court intervention—before being admitted to a more appropriate facility (bell, 2002). the eden alternative with a growing population of older adults, and particularly those older than 85, many more people are living in institutions designed to care for those experiencing the debilitating effects of very old age. a new model of care for older adults is called the eden alternative (thomas, 1994; weinstein, 1998). this approach was developed in response to the common, sterile, treatment-orientation of nursing homes that often results in loneliness, helplessness, and boredom according to eden alternative founder william thomas. he enumerates three fundamental principles of this new kind of care: acknowledging each resident’s capacity for growth, focusing on the needs of the residents rather the needs of the institution, and emphasizing quality long-term nurturing care, while providing short-term treatment as needed (thomas, 1994). this new philosophy of care involves normalizing the physical environment of facilities with the addition of pets, plants, and children; placing the maximum possible decision-making authority in the hands of residents and those who care for them; de-emphasizing program activities by encouraging resident involvement in the daily routine of the facility; and de-emphasizing the use of prescription drugs. in the eden alternative, thomas specifically addresses staff empowerment. several early theorists (barton, 1959; goffman, 1961; martin, 1955; myerson, 1939) noted that institutionalization affects staff (e.g., ward attendants, nurses, doctors) as well as residents. martin said, “the staff become victims of the system” and he believed that finding staff who were “sufficiently independent and integrated” to resist the process of institutionalization was “pure fantasy” (p. 1190). thomas believes he has found the answer to martin’s dilemma. the green house project furthering development of his vision, thomas has now launched the national green house project, a radical shift away from large institutions for older adults to 231johnson, rhodes/institutionalization: a theory of human behavior and the social environment homes with no more than 10 residents each (hamilton, 2005; kalb & juarez, 2005; mosheim, 2006, rabig et al., 2006; thomas, 2004). this model responds positively to the research on perceptions of control (avorn & langer, 1982; langer & rodin, 1976). green house facilities continue the eden alternative principles of emphasizing residents’ competence through encouraging participation in daily household activities, such as cooking and gardening. a redesigned staff pattern allows the specially-trained certified nursing aides (now called shahbazim) to provide more holistic care and to take a larger role in decision-making. a two-year evaluative study of green house outcomes is underway (rabig et al., 2006). prisons according to a bureau of justice bulletin (harrison & beck, 2007), the total number of prisoners in the united states at the end of 2005 was 2,320,359; one in every 136 american residents was in prison or jail. this reflected an average rate of growth of 3.1% per year since 1995. it was in that year that the united states became the world’s leader in incarceration rates, a position it retains to this day. while new models are being tried in the care of older adults, the american correctional system is moving in the opposite direction (frost, 2006). there continues to exist widespread support for large, monolithic prisons and “the idea that control of prisoners means providing as miserable an existence as possible” (cook, 2001, p. 30). rehabilitation is largely absent in correctional institutions in the united states; instead, the prison, as an institution, is used solely to punish. the worst excesses of total institutions are found in today’s “supermax” (super-maximum-security) prisons, where inmates are typically in solitary confinement for 23 hours a day in small, windowless cells, with no privacy (they are constantly monitored by video cameras), no work, no educational opportunities, and very limited access to recreation or visitors. conclusion next steps for theory progression we have several recommendations for next steps. first, the eden alternative, the green house model, and other residential alternatives to nursing home care can be studied holistically, in addition to investigating smaller scale interventions, such as those studied by rodin and langer, cited above. as the population ages, it is important that this type of research be supported and carried out. second, institutionalism in prisons is not well understood and is long overdue for intensive study. although prisonization, which implies a more oppositional stance towards the institution (haney, 2001), has received some attention, institutionalism and its relation to recidivism, has not. third, the theoretical model proposed in this article should be tested in a variety of institutional settings. implications for social work the profession of social work has a long history of being involved with institutional care and confinement of vulnerable populations. many social workers are, or will be, employed in large, group-care settings (ginsberg, 2001). as part of their job responsibilities, they may be called upon to advocate for the rights and needs of their clients, as well as for vulnerable populations in other institutional settings. 232 advances in social work because many clients in institutional setting are involuntary, social workers have a special ethical responsibility to them. often, “it is social workers who must inform those who have been institutionalized or who face institutionalization of their rights or interpret their rights for them. many times only social workers are available to act as advocates for those who are institutionalized, insuring that their rights are recognized and respected” (saltzman & proch, 1990, p. 360). in a corrections context in particular, but also in other institutional settings, social workers must be prepared to advocate “for safe, humane, and equitable treatment of all individuals” (nasw, 2000, p. 57). understanding the process and effects of institutionalization will help social workers perform these functions. references avorn, j., & langer, e.j. 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(1972). the principle of normalization in human services. toronto, canada: national institute on mental retardation. wolfensberger, w., & glenn, l. (1975). pass 3: a method for the quantitative evaluation of human services. toronto: national institute on mental retardation. author’s note: address correspondence to: miriam mcnown johnson, ph.d., m.s.w., associate dean for academic affairs and associate professor, college of social work, university of south carolina, columbia, sc 29209, usa. e-mail: miriam.johnson@sc.edu. 236 advances in social work modern social support structures: online social networks and their implications for social workers modern social support structures: online social networks and their implications for social workers kala chakradhar victor raj arabella raj abstract: mapping and assessing social networks and the quality of their social support is a valuable intervention strategy for social workers. these networks have now spread onto the digital realm in the form of online social networks (osns). this study investigated the nature of social support provided by such networks to their users in a rural mid-south university (usa) and explored parallels with the current understanding of social support in conventional social networks. a web-based survey administered to college students revealed that users of these online networks were predominantly undergraduate first year students, female, single, unemployed and from a variety of academic disciplines. the examination of the components of osns appears to mirror those of offline networks. they also seem to complement the effects of each other while contributing to an individual's support system. the paper concludes with critical implications of such online social networking for university students and social workers in practice and education. keywords: online social networks; facebook; social support dimensions; social work practice; pie perspective introduction social support has been described as “information leading the subject to believe that he is cared for and loved, esteemed and valued, and a member of a network of communication and mutual obligations” including elements like esteem support, emotional support and network support (cobb, 1976, p. 300). social support includes the kind of support provided by ties or links—“social networks”—that individuals have to friends/family and such other contacts. today these forms of support have been consolidated into functional social support and structural support (hittner & swickert, 2001). _________________ kala chakradhar, ph.d., is an assistant professor in the department of social work, criminal justice and gerontology; victor raj, ph.d., is a professor and department chair of computer science and information systems; and arabella raj, the positive role of social support as a moderator of stress and a predictor of good health (physical/mental) has been investigated with diverse populations and repeatedly affirmed in the literature (brown & riley, 2006; clara, cox, enns, murray & torgrudc, 2003; davidson & demaray, 2007). students transitioning to college life are influenced by the nature and quality of their social support. the entry into, and adjustment to, the university context is a stressful transition, requiring encounters with multiple challenges (clara et al., 2003; phinney & haas, 2003). students adapt using various coping m.s., is a research associate; all at murray state university, murray, ky. an earlier version of this paper was presented at the 32nd annual national institute on social work and human services in rural areas, july 25-28, 2007, montgomery, al. copyright © 2009 advances in social work vol. 10 no. 2 (fall 2009), 157-175 chakradhar, raj, raj/online social networks 158 mechanisms that could involve social support—both positive and negative. technology in the form of telecommunications and the internet has brought in several new factors that impact their support networks. a whole generation of people, especially adolescents and young adults, is now comfortable socializing, learning, and staying current in this virtual world (subrahmanyam & lin, 2007). this technology has taken people’s need to connect with others and propelled them into a world where, with just a few clicks of the computer mouse, they can invite someone to be a “friend” in an online social network (osn). friendships are initiated easily without the benefit/drawback of a face-to-face introduction. the purpose of this exploratory research initiative was three-fold: (1) to investigate the online social networking phenomenon in a rural mid-south university and explore the characteristics of osn users in order to arrive at a profile specific to such populations; (2) to explore the nature of the social support provided by these networks in terms of its functional, structural and perceptual dimensions; and (3) to examine the expanded scope for social work practitioners with osns, given the key role that social workers play in understanding and working with offline social networks. literature review studying and understanding social networks of individuals and families by social workers has set the stage for assessing available social supports and planning appropriate intervention for enhancing individual and family functioning (macneil, stewart & kaufman, 2000). chronister, johnson and berven (2006) conceptualize social support through five theoretical models: stress-buffering, main-effect, support mobilization, perceived support, and support deterioration. they further characterize ‘social support’ as a multidimensional concept consisting of structural, functional, and perceptual dimensions. structural support represents the quantitative aspects of social support like network size, frequency of contacts, density and composition, while functional support characterizes the degree to which an individual believes that help is available and therefore is seen as a qualitative measure. while structural support also includes social network resources and affiliations, functional support includes emotional, instrumental and informational forms of support. the perceptual dimension includes a more subjective measure relating to the satisfaction experienced by individuals in and through their support networks. they also note that not all social support can be assumed to be positive and beneficial. social support is an important predictor of health (mental and physical well-being) with low social support being associated with higher rates of loneliness among college students. perceived social support serves as a protective factor against mental health problems (clara et al., 2003). larose and boivin’s (1998) review infers that first-year students experienced increased stress during their adjustment into college. this is evidenced by low social and emotional adjustment measures compared to junior or senior students, increased feelings of loneliness, report of negative life events and poor academic adjustment. borsari and carey (2006) consider formation of friendships to be advances in social work, fall 2009, 10(2) 159 crucial for college students in acquiring and establishing a psychological identity in this period of ‘major developmental transition.’ these friendships with contemporaries facilitate social interactions and opportunities to emulate through role models (p. 361). these connections are sought through associations that support their social identity like ethnicity, social roles (athletes), membership in organizations (sorority) (weisz & wood, 2000), ‘social smoking’ (waters, harris, hall, nazir & waigandt, 2006), or alcohol use (borsari & carey, 2006). according to liu (2007) in today’s text-heavy online world, identity expression and establishing social links is through creating a social network profile of oneself on online networks. favorable social networks contribute to successful completion of academic careers (borsari & carey, 2006; weckwerth & flynn, 2006; wilcox, winn & fyvie-gauld, 2005). highlighting how computer technology and internet use are impacting social relationships in different age groups, gonchar and adams (2000) demonstrate a need to explore this aspect of an individual’s social system. they recommend inclusion of the online environment in the assessment of client support systems when using the person-inenvironment (pie) approach. of particular concern for this study are network services like myspace and facebook which have been reported to be catering to the academic community, primarily undergraduate populations (golder, wilkinson & huberman, 2006). according to golder et al. (2006, para 8) a “social network website describes a class of web services that invites users to create an online profile of themselves, most commonly...a photograph, a listing of vital statistics (name, location … occupation) and interests. most crucially, these services are focused on allowing users to list other users as ‘friends,’ thereby linking their pages to one another and publicly demonstrating their connection….” a substantial number of these “friendship” sites are structured to “delineate and build on relationships that members have with each other by virtue of their being part of that (geographic) community” (barsky & purdon, 2006, p. 65). in just two to three years of operation (at the time of this survey), these osns had amassed between 10 million (facebook) and 80 million (myspace) users in the united states. these networks provide opportunities for individuals to create online content, post photographs and video clips, share music, and create and maintain friendships (barsky & purdon, 2006; lorenzo & dziuben, 2006; oblinger & hawkins, 2006). these osns have opened outlets for "adolescent expression," information sharing, and skill building, both social and technical (bradley, 2005). campbell, cumming and hughes' (2006) combined online/offline survey of undergraduate students who were regular internet users, showed that for the “socially fearful” the internet offers a low risk approach to socializing and a preliminary form of rehearsing for future face-to-face encounters. however, the risk of social isolation and loneliness is also present (campbell et al., 2006). a nationwide telephone survey in the u.s. in oct/nov. 2006 of 935, 12-17 year olds (lenhart & madden, 2007) yielded data revealing a predominance of girls among members of social networking sites. fifty percent of the sample reported using these sites with membership in myspace, exceeding that of facebook significantly (12:1). the motivating factors included making new friends and dating opportunities (lenhart & madden, 2007). in addition de gagne and wolk (2006) found in their survey of a liberal arts college in massachusetts (n=565) that facebook/myspace helps students retain chakradhar, raj, raj/online social networks 160 friends (alumni) and seek academic help. these “virtual communities” hold potential for boosting psychological health through substituting for face-to-face communities and even relief giving outlets like “e-mourning” (andreatos, 2006). strong connections have also been drawn to the social capital gains that facebook users stand to acquire, apart from a boost to individual self-esteem (ellison, steinfield & lampe, 2006; 2007). the flip side of osns has been privacy concerns, risks of defamation, intellectual property ownership (with indiscriminate downloading and information transfer) and deceptive identities. faculty, administrators, and university presidents sharing facebook membership has led to some online behavior monitoring (mitrano, 2006). prospective employers have been known to use this online medium as a resource for background checks (oblinger & hawkins, 2006). the realization of this dubious outcome of empowerment and vulnerability has led to educational institutions creating and implementing policies to help in monitoring such online activity on campuses nationwide. as cited by de gagne and wolk (2006), the effects of this technology may not be uniform across university campuses and may depend on "institutional affluence, student ability, socioeconomic status, and accessibility” (p. 2), to name a few. an investigation of the effects of this form of osn in a diverse university campus (rural, non-traditional, and international students) (factbook, 2005-2006) hopes to lead to knowledge of this phenomenon and its possible social support dimensions. though there have been reports on use of online therapy in cyberspace as a form of social work intervention (menon & miller-cribbs, 2003) there are no known studies from the social work profession on such online networks and their role. the available literature includes a large number of in-house reports, student papers and limited scholarly work from university populations in the eastern united states, primarily urban campuses (de gagne & wolk, 2006; govani & pashley, 2005; ellison et al., 2006; liu, 2007)— populations that differ from this rural campus. the reported research is from disciplines like telecommunications (ellison et al., 2007), media studies (liu, 2007), communication studies and sociology (hargittai, 2007). from the social work perspective, can this form of networking be a potential adjunct or even a substitute for conventional offline social supports? does this form of networking have the potential to create a favorable and socially positive experience and does it carry the risk of ill effects? for professions like social work, osns raise questions about the quality of support they provide. although strong connections have been drawn to the social capital gains that facebook users stand to acquire at the macro level (ellison et al., 2006; 2007), this research focuses on the social support gains at the micro level. the answers that surface from this research could point to the inclusion of osns in pie (person-in-environment) assessments using the ecological perspective for social workers and use in campus wellness programs (myers & mobley, 2004; wells, mitchell, finkelhor & blease, 2006). furman, collins and swanson (2003), through the use of illustrative case examples, have demonstrated the importance of helping clients develop friendships as a form of intervention in social work practice. advances in social work, fall 2009, 10(2) 161 towards this end, an exploratory study was designed to identify characteristics of the typical online network user in a rural university and the nature of the social support provided by these networks. the results were used to derive implications for the social work practitioner in rural settings. methods after approval from the institutional review board (irb), a list of all the students enrolled in a rural university of about 10,000 students for spring 2007 was obtained from the registrar’s office. an e-mail (with a link to the web survey) was sent to a proportionate stratified random sample (based on academic classification—first year, sophomore, junior, senior, graduate and irregular that matched their distribution in the university population: n=9044. spring 2007 semester) of 400 students inviting them to participate in the web-based survey. the survey ensured voluntary participation and anonymity. responses from 82 (a 20.5% response rate) were returned. earlier web-based surveys at this university had a response rate of 18-20% in spite of incentives and larger sample size (personal communication, judy lyle, march 21, 2008). this experience was consistent with online response rate limitations reported in the literature, ranging from 20% to 70% with an average response rate of 36% (kaplowitz, hadlock & levine, 2004). the distribution of participants closely reflected the population of interest with respect to academic classification (χ2 = 8.25, p = 0.15) and gender (χ2 = 0.02, p = 0.89) thereby reinforcing the representative nature of the sample. though a sampling frame was available and sample representativeness ensured and established, issues of “churn,” namely holding multiple email addresses, changing providers, or equipment malfunction (sheehan, 2001), could have contributed to this response rate. survey measures the survey gathered data on functional and structural support as captured in usage habits, preferred features/services, benefits experienced, and technical competence, as well as awareness of issues relating to privacy and security. though standardized social support measures are available for offline social support assessment, they have been found to have limitations in addressing all support dimensions in one tool (chronister et al., 2006). given the unique nature of the osn and insufficient knowledge of its characteristics, it was necessary to develop a set of questions specific to the nature of this phenomenon using the available literature (campbell et al., 2006; de gagne & wolk, 2006; ellison et al., 2006; golder et al., 2006; govani & pashley, 2005). demographics: this included independent variables like gender, marital status, age, employment status, class load, academic classification, distance from campus, dependents at home, and academic major. functional: functional dimension of social support measures included questions on personal data (profile) posted (birthday, contact information, pictures, etc.), reasons for membership and non-membership, and preferred features of the osn. likert-type scales were also used to elicit responses on use and benefits of osns (instrumental, informational and emotional support). chakradhar, raj, raj/online social networks 162 structural: to address this dimension, the survey gathered data on the preferred osns, duration of membership, frequency of signing in, length of time spent at each login, day of week logged in, and number of friends in their network perceptual: likert scales were used to elicit responses as evidence of their perception of positive and negative effects of osns: hurt grades, prevented normal social interaction, raised objections from friends or family, unpleasant experience, wasting time, felt less anxious, gave comfort with transitions, helped cope with stress, etc. the online survey tool allowed the researchers to automatically direct respondents according to their membership in osns. non-users were taken directly to questions about their perception of osns and demographics. users were probed further about their participation and experience in osns. the data were analyzed using descriptive statistical measures and contingency tables. sample profile: the sample included 59% females and 38% males with 3% not indicating gender (n=82). the respondents identified themselves as first year (15), second year (14), third year (12), fourth year (23) and others (6). the average age of the respondents was 26 (sd = 8.84). unlike other reported studies with university populations (govani & pashley, 2005; ellison et al., 2006), this sample exhibited higher dispersion with respect to age due to the presence of non-traditional and graduate students. of the 82 respondents, about 60% were single, 25% were married and 20% had children less than 18 years of age living with them. about 63% were employed, with about 30% working 10-20 hours a week. these variables (marital status, employment status, dependents) have not been included in earlier research nor has their relationship to the use of osns been examined. with about 70% residing within 3 hours’ driving time from campus, a sizable number of students were not too far from their existing offline networks. to investigate whether the availability of free time encouraged the use of online social networks, data were collected on group affiliation, academic load and choice of academic major. of the 82 respondents, about 37% reported being affiliated with religious groups, 22% with athletics, 13% with fraternities or sororities, and another 11% with art societies or other groups. about 26% had no such affiliations. the number of credit hours taken ranged from 1-19 with an average of 13 (sd=4). the students represented diverse areas of study with no clear dominance of any single academic major. findings and discussion the survey pointed to several distinct characteristics of participants of online social networks. the following discussion addresses demographic characteristics and social support dimensions (functional, structural and perceptual) of osns. differences between the genders and academic classification were also observed and are discussed. user characteristics in keeping with the study’s core objective, a substantial section of the survey focused on the students’ use of osns (such as myspace and facebook), reasons for use, and advances in social work, fall 2009, 10(2) 163 experiences as a result of this use. ninety-nine percent of the respondents were aware of such networks while seventy percent (58 of 82) were using such networks. about 47% of the users were using more than one osn including facebook, myspace, xanga, hi5, wayn, bebo, live journal, orkut and inner circle. facebook and myspace appeared to be the most popular (47% and 43% respectively) with 35% using facebook most of the time. for this survey, the participants were asked to respond using a preferred osn as their frame of reference. female users constituted a higher proportion (55%) than males (41%), with the average age of users being 23. all first-year students in the sample and a majority of second year (86%) and third year (67%) students were users. a sizable number were single (71%), worked less than 20 hours a week (51%) and were affiliated with various non-academic groups (79%). structural support: the typical user had to “login” to access such networks. once logged in, the user can interact with other “friends,” invite others to become friends, and join or start groups with the click of a button. these may be construed as quantitative social support elements for the online community. almost 60% logged on to these sites several times a day. fifty-five percent spent less than 10 minutes during each login. most (65.5%) accessed these sites throughout the week while about 30% did so only on weekdays, possibly indicating that their usual weekend activities were not affected. almost 75% of the participants had their accounts for more than a year and reported having links to more than a hundred friends. about 90% sought and added close friends from college and high school to the osn while 45% accepted friendship from those not known through such contexts. sixty-five percent of the respondents accepted people as friends only after meeting them face-to-face while 71% seemed comfortable accepting acquaintances as friends. it therefore appears that through frequent visits, spending time at each logged-in session and the building of networks of friends, users of osns do seem to experience a form of structural support similar to offline networks. functional support: functional support elements address the purpose served by the networks for the individual. in osns, most used them for posting of pictures (95%), birthdays (91%), and interests (88%). about 55% posted information about their religion. a large portion of the users did not post their contact information and cell phone numbers (74%). it could be inferred that students in this rural population are cautious about seeking support in an osn. the most compelling reasons for creating an osn account were friends’ recommendations, a need to be connected, sharing information and making new friends. a very small number (5%) also saw this osn as providing opportunities to find dates. none of the users in this sample used this medium for job searches. like offline networks, functional support in osns is derived from sharing information about themselves and learning about others who also post such information. the osns also serve the important function of relieving boredom (84%), fighting loneliness (21%) or seeking help for a problem or a crisis (5-12%). they also used these as a tool to “spread the word” and draw people to events or other group activities. chakradhar, raj, raj/online social networks 164 perceptual: the perceptual support dimension looks at the individual’s perception of the positive and negative effects of social networks and the kind of support experienced by that individual. about 70% had rejected or ignored requests for friendship primarily because of not wanting to associate with the individual seeking friendship. other specific reasons given by the respondents were that they did not know them or did not like what they saw posted. one respondent noted that a contact’s face-to-face indifferent behavior had helped in the decision to remove the facebook contact as a “friend.” some highlights from the data suggest that about 40% of the users felt less anxious communicating with people online than they did face-to-face. about 62% felt that the use of these osns did not affect their grades while 22% felt that their grades were hurt. eighty-eight percent of the respondents noted that their participation in osns did not result in objections from faculty or family. this statistic may not remain the same as this activity becomes widespread and is perceived as disruptive. respondents were also asked about the negative effects experienced due to their sharing of personal information. members do not have control over pictures of themselves posted by others in their own albums and linked (“tagged”). twenty-six percent reported that they had some form of unpleasant experience including loss of a potential job and conflicts in intimate relationships. at best this online interaction could be opening doors for new friendships, at worst it could be embarrassing and terminate friendships. given the openness of osns, the potential to cause harm for other users by manipulating such information may be viewed as a form of bullying or hazing, behaviors that exist in offline networks as well. it is natural to assess potential relationships by observing the individual’s behavior prior to developing or nurturing them. in osns, this is accomplished by using the built-in safety and privacy features of the osns judiciously. about 70% of the users had reviewed the osn's privacy policy and 78% had tried to change the setting to ensure a secure and safe operation. however there were 20% who had not. having examined the nature of social support in osns, the following section explores the effects on sub-groups within the sample, especially academic status and gender. sub-group characteristics academic standing effects: reviewing the premise that college-going years are a developmental challenge to many, especially first and second-year students, an analysis of the differences between first year/sophomore (underclass) and junior/senior (upperclass) was made with respect to these social support characteristics. as shown in figure 1, distinct trends and differences were observed between these groups on some of the support-reflecting characteristics. it appears that more underclass students perceive benefits from osns than do juniors & seniors. this measure of the perceptual support dimension included likert-type responses to multiple items where “strongly agree” and “agree” were combined for the values shown in table 1. the measures showed a statistically significant association between academic standing and advances in social work, fall 2009, 10(2) 165 some elements of the perceptual dimension. the underclass students perceived greater benefits in larger numbers from osns than upperclass students. figure 1. perceived benefits of osns on the other hand, the not-so-beneficial outcomes were also experienced by the younger group, though the association was not statistically significant (figure 2). it is imperative that social workers be aware of the benefits and dangers of osns as experienced by underclass students who are adapting to the transition from the school environment to the college environment. table 1. subgroup differences along perceptual dimension measure female % male % fr/so % jr/sr % cope with everyday stresses 58 42 75 25* cope with personal problems 62 38 72 18* feel better since i am not from here 73 27 79 21* feel less anxious asking /telling/ sharing things with people than f2f 57 43* 76 24* forget problems 36 64 90 10* χ2, p < 0.05 chakradhar, raj, raj/online social networks 166 figure 2: perceived negative effects of osns by academic standing. table 2. subgroup differences on the functional dimension measure female % male % fr/so % jr/sr % friend recommended 63 37 61 39 everyone i know is on this 59 41 53 47 ability to make new friends 57 43 69 31 used when needing to share a problem 75 25 33 67 used when needing help in a crisis 67 33 50 50 learn more about others in your class 64 36 56 44 learn more about other people living close by 59 41 63 36 see if you wanted to associate with someone or not 42 58 59 41 χ2, p > 0.05 advances in social work, fall 2009, 10(2) 167 with regard to the functional dimension both groups’ membership in osns served the function of being able to discreetly assess people they met in their classes or those who lived close to them in order to make decisions about continued networking. though the data points to some differences in the subgroups, they are not statistically significant (see table 2). the differences changed direction for only one item, viz., “used when needing to share a problem.” some possible explanations for this reversal: (1) the younger students are reluctant to share their problems because they are still testing their social network and/or (2) the older group has an established osn that facilitates problem sharing. figure 3: differences in time spent per login by academic standing gender effects: as in offline networks, each gender approached these osns differently. though proportionately more females perceived greater benefits, more males seemed to use osns to “forget problems” (see table 1). on the perceptual dimension items, females were more likely than males to report feeling “less anxious asking /telling/ sharing things with people than face-to-face” (χ2, p < 0.05). a similar pattern is observed with respect to the functional dimension with no observed statistical significance (χ2, p > 0.05). however more males seem to use osns “to see if they wanted to associate with someone” (see table 2). they also used them to chakradhar, raj, raj/online social networks 168 affiliate with like-minded individuals in larger numbers than females. the genders also differed on use of osn features related to posting birthdays, pictures and interests, possibly a form of seeking emotional support through self-disclosure (table 3). however, only a small number of males were using these networks to search for dates (n=3). table 3. gender preference for osn features measure female % male % birthday included 60 40 interests 53 47 political views 67 33 posting pictures 67 33 χ2, p > 0.05 as shown in table 4, significantly more women than men were open to accepting acquaintances as friends for their osns (χ2, p < 0.05). although further probing questions could have added clarity, this behavior may have been motivated or encouraged by friends, both offline and online. though statistically insignificant, female users (56%; n=45) changed their privacy settings and appeared to be more cautious than males. table 4. differences in subgroups along structural dimension. measure female % male % fr/so % jr/sr % logged in several times a day 61 39 60 40 invite close friends not known through high school and college 58 42 71 29* invite acquaintances 63 33 62 38 accept acquaintances as friends 69 31** 61 39 accept people you didn’t meet f2f as friends 63 37 56 44 * χ2 , p < 0.05; ** χ2 , p < 0.01 as noted by researchers, gender (in conventional networks) ''moderates the relationship between stress, social support and health" with favorable effects only for females (hale, hannum & espelage, 2005, p. 277). in peer relationships, men are less likely to confide, express vulnerability, demonstrate affection or discuss personal issues. intimacy through social support is activity-based in men while it is accomplished through self-disclosure in women. women are also seen to receive and give more emotional support through their peer relationships than men (borsari & carey, 2006). advances in social work, fall 2009, 10(2) 169 distinction between users and non-users defining “non-users” as those who are aware of osns but did not create an account on any of these networks, this study explored their reasons for eschewing this activity. a little less than half of the non-users (n=23) were not interested in osns. a fifth of them saw this as restricting their other activities and about a tenth saw this as inappropriate for their age (older, non-traditional). another one-tenth preferred other means of communication like phone, e-mail, and face-to-face conversation. one respondent’s quip was that “they [osns] were [a] breeding ground for gossip and smut…. i am a private person who does not like to broadcast [my]…business.” finally, some comparisons were drawn between users and non-users with regard to socio-demographic characteristics (table 5). there was a higher representation of females in both groups (users: 55% to 41%, n=58; and non-users: 65% to 30%; n=23). the average age of the non-users was 38 years while it was 23 years for the users. of the non-users, 61% were married compared to users (76%) who were mostly single or divorced/separated (χ2 = 23.44, df=2, p<0.05). taking academic classification into consideration, all first-year students in this sample were users; sophomores and juniors also had a higher representation of users. the distribution among seniors was spread evenly. however, the pattern reversed among graduate and post baccalaureate students with a higher number being non-users. there was no statistically significant association between number of credit hours a student was taking (less than 12 credits vs. more than 12) and use of this osn (χ2 =3.57, df=1, p > 0.05). no significant association was observed between employment status and use of osns, although osn users were more likely to report working less than 20 hours a week (χ2 =11.20, df=1, p < 0.05). a larger number of the users had affiliations to various groups (athletics, sorority, fraternity, etc); that is, their usual social support structures were not abandoned/ ignored. a larger percentage of non-users reported no affiliations (39.13%) compared to users (20.69%). this difference could be due to a combination of age and family conditions as well as personal preference. table 5. characteristics of osn users/ nonusers characteristic users non-users average age 23 38 marital status* mostly single more married than single academic classification all first years were users mostly post-baccalaureate; no freshmen hours at work* less than 20 a week more than 20 a week affiliation various traditional groups no affiliation *χ2, p < 0.05 chakradhar, raj, raj/online social networks 170 these observations on non-users are unique to this study. other studies that investigated users (members) versus non-users (non-members) had very few non-users for comparison and were only able to report that non-users were older (ellison et al., 2006; 2007; hargittai, 2007). the analyses of the social support dimensions—structural, functional and perceptual—in osns reveal a striking parallel to dimensions used in offline social support assessments. that is, we can use the same framework of understanding used in offline networks to understand osns and their impact on users. the overall purposes served by these osns indicate their use as a medium to socialize and connect. the frequency with which people log on to osns and the time spent reflects the time and effort invested in strengthening and maintaining these digital relationships (golder et al., 2006). consistent with other studies (ellison et al., 2006) another purpose served by these osns was giving the users something to do when idle, a relatively harmless activity. consequently, this activity was also perceived as a waste of time. however, these networks facilitate a form of socializing for some, which is less anxiety-provoking than face-to-face interaction. the distinct patterns observed in the underclass and upperclass student experiences lend considerable support to a possible stress-buffering role of these networks in their beginning years of college (figure 1). the data also reflect a need for caution in time spent in these interactions that might hinder the academic and/or social experience. some distinctions observed between the genders validate observations made by other researchers with respect to dynamics of peer associations in offline situations. respondents’ use of discretion in screening people in their network based on their own individual appraisals and ongoing experience is a reflection of the dynamic that is true of face-to-face interactions as well. although such networks create virtual communities, the tough lessons learned through some negative experiences do re-create the real world of stresses experienced in face-to-face social situations. conclusions and implications the three-fold purpose of this exploratory study was to (1) arrive at a profile of the typical osn user in a rural university, (2) identify the online parallels of offline social support dimensions and (3) to examine the expanded scope for social work practitioners with osns, given social workers’ key role in understanding and working with offline social networks. this exploratory effort revealed a definitive profile of users of online social networks at this rural university: an undergraduate first year (fr), female, younger in age, single, unemployed, and from diverse academic disciplines. though the data reveal no clear repercussions on academic performance yet, use of these sites for social networking is seen by users as making considerable demands on time. those who chose not to participate in such networks did so because of a lack of time. finally the feedback on its impact does not reveal overwhelming support for using osns. in fact, at least half the users saw this type of social networking as fading over time. advances in social work, fall 2009, 10(2) 171 in examining the parallels with social support dimensions in the offline environment, it was possible to conceptualize and operationalize similar dimensions in the online environment. this preliminary investigation enabled delineation of the structural, functional, and perceptual elements of online social networking with some overlap. further research should help validate these observations and add more clarity to these dimensions. the examination of the components within these dimensions appears to mirror those in offline networks. however, what is unusual is that these online networks of individual students exist in addition to their offline networks. they appear to complement each other while contributing to an individual's support system. thus, osns appear to serve an adjunctive function in helping (especially) underclass students acclimatize to the college environment. by extension, colleges may want to consider osns as retention mechanisms. with these explanations in place this research has some direct implications for social workers as practitioners. apart from being aware of this social trend and its effects, it asks for an inclusion of the online environment as an assessment component, especially with school and college populations. planning for assessment should include asking questions about membership in these networks and the nature of support experiences, both favorable and unfavorable. undergraduate populations, particularly females and single individuals in the first two years of college, appear to be a group that may need attention. anecdotal evidence from the sample university reveals that during new student orientations recommendations for facebook memberships are made to incoming students as a way of encouraging networking. the online environment is thus another system to review and evaluate when practitioners use the pie (personinenvironment) approach for social system support assessment. training for social work practitioners must include assessment and intervention techniques for dealing with internet-related issues and conflicts (gonchar & adams, 2000; wells, 2006; wells et al., 2006). for others, practitioners may want to recommend that their clients explore such online associations to supplement their possibly weak offline networks. from a broader perspective, universities should consider encouraging faculty and administrators to become members of osns. this has the dual benefit of opening avenues of socialization outside the classroom with current students and facilitating the maintenance of ties with alumni in a safe and cost-efficient manner. it may also be necessary and prudent for administrators to scan osn activity of potential employees and students, for example, to limit liability and promote safe practices. as an exploratory effort, the study has its share of limitations. apart from the weak response rate some of the questions framed seemed to be ambiguous and may have affected the nature of responses. though the university’s international population and out-of-state students were potential targets, they could not be singled out due to irb constraints. these groups may be targeted for a 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(2006). mental health professional’s exposure to clients with problematic internet experiences. journal of technology in human services, 24(4), 35-52. wilcox, p., winn, s., & fyvie-gauld, m. (2005). ‘it was nothing to do with the university, it was just the people’: the role of social support in the first-year experience of higher education. studies in higher education, 30(6), 707-722. http://jcmc.indiana.edu/vol6/issue2/sheehan.html advances in social work, fall 2009, 10(2) 175 author’s note: address correspondence to: kala chakradhar, ph.d., 101s applied science bldg., murray state university, murray, ky 42071. email: kala.chakradhar@murraystate.edu. mailto:kala.chakradhar@murraystate.edu modern social support structures: online social networks and abstract: mapping and assessing social networks and the qual introduction methods advances vol. 2, no. 2 indiana university school of social work: 90 years of professional education monique busch gerald t. powers david metzger cyrus s. behroozi sheldon siegel barry r. cournoyer abstract: in this invited article, the authors review the history and development of the indiana university school of social work from its origin in 1911 as a small department to its current status as a large organization offering educational programs to nearly 900 students on five campuses. one of the nation’s oldest, it is the only school to offer the full continuum of social work education from the associate through the doctoral levels. inmany respects, the evolution of the schoolmirrors the experiences of other schools and departments of social work.as such, the articlemay be enlightening to those interested in the history of social work education in this country. keywords: history, indiana university, social work, education schools of social work mirror the social, political, economic, and academic contexts within which they evolve. as levy (1968) suggests, “what is true of the history of man in general is true of the history of social work education, the past and present are manifest in each other” (p. 5). the indiana university school of socialwork is no exception. founded in 1911 as the social service department, the school has operated continuously for 90 years (rogers, 1983). on the occasion of this 90th anniversary (1911-2001) celebration, it seems fitting that we reflect upon the school’s history and the events that shaped, and at times, been shaped by its existence. social workers well know that attempts to capture history require difficult choices. we have to decide what and how much detail to include, what perspectives to adopt, and which themes to recognize or emphasize. writing history invariably involves construction as well as recollection of knowledge. this brief review of the 90-year history of the school reflects both choices and constructions.we could not 83 monique busch, m.s.w. is a doctoral student; gerald t. powers, ph.d. is professor; david metzger, m.a. is associate professor emeritus; cyrus s. behroozi, ph.d. is profesor emeritus and former associate dean; sheldon siegel, ph.d. is professor emeritus and former dean; and barry r. cournoyer, d.s.w., l.c.s.w. is professor, indiana university of socialwork, indianapolis. copyright© 2001 advances in socialworkvol. 2 no. 2 (fall 2001) 83-100. indiana university school of socialwork. 84 advances in social work possibly discuss the accomplishments of each one of the hundreds of faculty members and staff, the thousands of students, or the seemingly infinite number of academic and practice leaders and constituents who have contributed to the school and community for nearly a century. nor could we catalog each of the significant events in its distinguished history. rather, we attempt to capture a general sense of the origin and development of the school from three major perspectives. first, we present an historical overview of the development of the school from a small department to a large, multi-campus organization offering a full continuum of social work education, including programs leading to the associate of science in human services (ashs), the bachelor of socialwork (bsw), the master of social work (msw), and the doctor of philosophy (ph.d.) degrees. second, we consider the external forces and contextual factors that have influenced and shaped the school’s educational and service missions in recent years. finally, we provide a brief overview of the school today and present a vision for its future.we hope this history serves as a kind of “case study” that readers may find reflective of the evolution of social work education within the united states. historical review in establishing the social service department in 1911, indiana university declared, “there are new obligations upon the universities. they justly are called upon to help the people in all of the problems of their daily life. . . .whatever knowledge is needed, whatever can aid . . . must be provided to those who can use it on their problems—and problems are many” (indiana university, 1915). perhaps reflecting its origins as a seminary and then a small liberal arts college, indiana university has reflected a strong service commitment throughout its history. indeed, the university began to offer courses in social services at the turn of the 20th century, well before the formation of the department (indiana university, 1920). during the first decade of the 1900s, the chairman of the economics and social sciences department, located in bloomington, sought to create a laboratory context for its students—especially those who were interested in the emerging field of social work. simultaneously, a recently appointed, highly progressive dean of the school of medicine believed that social services could help patients recover more quickly and completely, and could aid families with psychosocial issues associated with patients’ illnesses or injuries. the dean also thought that medical students could benefit from training in social services by learning how to treat each patient in a holistic manner—as a unique person, and as a valuable member of a family and community. the mutual interests of these two academic leaders led to the formation of the indiana university social service department. for administrative purposes, the department was part of the department of economics and social sciences on thebloomington campus. functionally andphysically, however, it was housed within the school of medicine in indianapolis (indiana university, 1915; rogers, 1983). in establishing the department, indiana university became the first public institution of higher learning to form an academic unit for social work education and the first in the united states to offer an advanced degree in the field (indiana university, 1919). 85busch et al./indiana university school of social work: 90 years of professional education the founding director of the indiana university social service department was dr. edna g. henry. the program’s primary functional association was with the medical school, which referred patients and families in need of social service todr. henry, her colleagues, and students of the department. during these early years, much of the learning was experiential in nature. students were assigned cases and learned by providing actual social services to people in need. the faculty of the new social service department developed a coherent curriculum and taught courses such as medical social work and social medicine. they also managed a laboratory for sociology students interested in social work. in addition, they administered hospital social services and supervised community volunteers who provided aid to patients and their families. by 1915, the department offered a series of classroom-based courses for five general types of students. these included sociology students, medical social work students, nursing students, students interested in learning about “social conditions or social work activities; and graduate students seeking advanced work in sociological research or practical social work” (rogers, 1983, pp. 16-17). although students with other interests were included, medical social work constituted the primary educational focus. students learned about the personal and social needs and problems of patients and their families, and provided services while learning through an apprenticeship model. students addressed the common problems of the day including “alcoholism, drug addiction, epilepsy, foreigness (sic), illegitimacy, broken homes, and sex problems” (rogers, 1983, p. 20). those early years engendered a sense of intellectual excitement and social meaning. although the supply was low, the need for “trained” social workers was extremely high. the demand for educated social workers was heightened by a commonly held faith in the capacity of the academy to discover and coordinate facts that could help to ameliorate human misery and suffering. although social work of all kinds grew rapidly throughout many sectors of society, medical social work expanded the fastest. the social service department also reflected this trend through its focus on medical social work. following the end of world war i, tensions between the medical school and the department of economics and sociology (the name had changed in 1915), which shared overall organizational responsibility for the social service department, surfaced. this was certainly understandable. they had different goals and needs. the tensions were apparently resolved in 1921 when the department of economics and sociology of the college of arts and sciences assumed exclusive administrative responsibility for the social service program. now known as the “indiana university combined course for thetraining of socialworkers,” the program augmented students’ liberal arts studies with professional social work training and service experience. under this arrangement, students could complete the social work training program and earn a baccalaureate degree. students in the program undertook the first three years of coursework on the main indiana university campus in bloomington, and the final (professional) year in indianapolis, where they could undertake their field practicum courses (indiana university, 1920). one year of graduate education in social work could also be completed in indianapolis. in addition, social service faculty continued to teach medical and nursing students, 86 advances in social work administered volunteer social service activities, and guided sociology students in research and service activities. despite the shift in administrative authority to the department of economics and sociology, the primary focus of the social service program remained medical social work, although several other courses were offered in social problems (e.g., juvenile delinquency) and social welfare policy and services (e.g., child welfare). in 1923, the program became a member of the american association of training schools of socialwork. since then, the program has continued its membership in the professional organizations that succeeded the association, including the council on socialwork education (cswe), which ultimately assumed responsibility for accreditation of programs in social work education. by 1924, several courses were routinely offered in the social work training program at indianapolis. these included:theory of socialwork,theory of social case work, field work, field of social work, clinical psychology, social psychiatry, industrial welfare problems, techniques of social case work, the family and the community, and research. these and related medical social work courses were offered at the school of medicine. over time, however, most social work courses were relocated to the indianapolis teaching center in downtown indianapolis. by 1927, the organizational title “social service department” became identified with the social services unit of university hospitals, while the academic rubric, “the combined training course in social work,” referred to the academic program. confusion about which department was responsible for which activities continued for decades. although ties to the medical school were clearly loosening, many nursing students continued to enroll in social casework courses and most social work students completed their field placements through the social service department of university hospitals. however, social work faculty sought to expand the number of field placements outside the hospital setting and arranged for placements in numerous community organizations, including the indianapolis orphans asylum, the indianapolis family welfare society, and christamore house–a community service center. in compliance with the educational standards of the american association of training schools of social work, by 1929, the indiana university combined training course required undergraduate coursework in “sociology, economics, and psychology” (rogers, 1983, p. 37) for admission to the program.when admitted, students were expected to complete foundation studies followed by one of five specializations: “medical social work, family social work, child welfare, visiting teaching, and public social work” (rogers, 1983, p. 37). students also completed field practicum experiences in agencies that supported one or more of these specializations. in addition, each student undertook a research study related to the populations served in the agency in which they were placed. by 1930, the university had established a bureau of social research at indianapolis in association with the social work program. the bureau conducted several research studies related to topics such as unemployment, distribution of felonies, mortality rates, and juvenile court statistics. these studies complemented students’ educational and professional experiences. 87busch et al./indiana university school of social work: 90 years of professional education in 1931-32, the combined training course for social work was reorganized as a two-year graduate program in indianapolis. interested in promoting social work as a profession, faculty promoted graduate social work education. leading to the master’s degree, the program provided coursework for three specializations, including social casework, public welfare administration, and social statistics (indiana university, 1936-37). students completed a research thesis and oral examination in addition to classroom and field practicum experiences. in 1935, during the great depression, the combined training course for social work became a division within the department of sociology. the new division shifted its curriculum focus to the preparation of social workers for service to the vast number of unemployed persons who had found their way into the rapidly growing public welfare programs. world war ii introduced a whole new set of challenges for the division as the need for professionally trained social workers increased dramatically. the division introduced a three-semester year in order to train graduate-level social workers more quickly. perhaps related to wartime needs and activities, interest in baccalaureate social work education grew nationally and locally. in 1942, a baccalaureate program with a major in social service was inaugurated on the bloomington campus. in 1944, the indiana university board oftrustees established the division of social services as a unit within the college of arts and sciences, separate from the department of sociology. physically, the division remained in indianapolis and provided professional education leading to the degree of master of arts in social service and continued to collaborate with the college in offering an undergraduate major in social service on the bloomington campus (indiana university, 1945-46). requiring 45 credit hours, the new master’s curriculum offered four distinct concentrations: casework, community organization, administration, and group work (indiana university, 1944-45). in 1945, dr. grace browning, a nationally regarded social work educator from the university of chicago school of social service and author of several books on public and family welfare, joined indiana university to head up the division. she directed both the graduate program in indianapolis and the undergraduate courses in bloomington. by this time, accredited social work programs were required to address eight basic curriculum areas and, in addition, provide more advanced classes and field work in an area of specialization. the eight basic areas included “social work administration, social casework, social group work, community organization, social research, medical information, public welfare information, and psychiatric information” (rogers, 1983, p. 57). by 1946, five faculty members were located on the indianapolis campus and two at bloomington. there were 20 full-time and 30 part-time students in the graduate program. field placements expanded considerably to include “the family welfare association, the indianapolis children’s bureau, the catholic charities bureau, the social service department of the indianapolis public schools, the indianapolis public health center, the jewish family service association, flanner house, and the morgan department of public welfare” (rogers, 1983, p. 62). by 1948, 79 fulltime students were enrolled in the indianapolis graduate program. 88 advances in social work during the late 1940s, the division’s graduate curriculum expanded to a minimum of 60 credit hours in professional coursework. these included courses in human behavior in the social environment, social welfare policy and organizations, research, social work practice, and field practicum.that curriculum emphasized social casework. however, in 1950-51, the division added social group work as a second concentration. in addition, a course in community organization was required. upon dr. browning’s death in 1951, professor mary houk was appointed director of the division. during the 15 years that she served in that position, she transformed the small division into a nationally and internationally renowned professional school. she was remarkably successful in securing educational grants from local, state, and federal sources and in attracting highly qualified faculty and students. primarily because of her success in enhancing the program’s reputation, in 1966, the board of trustees upgraded the status of the division by creating the graduate school of social service. director houk was appointed dean of the school and students earned the master of socialwork degree. following dean houk’s retirement in 1966, professor walter johnson became acting dean of the school, while a national search for a new dean took place. during his short tenure, acting dean johnson was able to obtain a commitment from university officials to move the school from its long time location to a building planned for construction on the new campus of indiana university— indianapolis. in 1967, dr. richard lawrence became the second dean of the school. approximately 115 full-time and 18 part-time students were enrolled in the graduate program at that time. dr. lawrence served as dean for nine-years—overseeing the school during the turbulent years of the 1960s and early ’70s. during this period, the msw curriculum was reorganized. as a participant in a national curriculum project, the school attempted to cross-integrate its coursework content by organizing plenary sessions and discussion groups instead of traditional classes. by 1969-70, block field practicum placements were introduced for the first time and a community organization concentration complemented those in social casework and social group work. in 1969, the school reorganized its undergraduate social work curriculum. building upon the programs that had been offered on the bloomington campus for many decades, undergraduate social work education returned to indianapolis as well. during the early 1970s, the professionalization of baccalaureate social work was a major topic within social work academic and professional circles. faculty of the school embarked on a significant process of curriculum review that led to the conceptualization of a continuum for social work education (indiana university school of social service, 1974a). the envisioned continuum included four levels of education for social work, including programs leading to the associate, baccalaureate, masters, and doctoral degrees. each level would reflect its own educational cohesion and integrity, would be more complex than the previous level, and would be progressively linked to the next level in an ascending order of complexity. 89busch et al./indiana university school of social work: 90 years of professional education in 1971-72, the school moved from its long-time home in the indianapolis teaching center to the fifth floor of cavanaugh hall on the growing indianapolis campus of indiana university. subsequently, this modern, urban campus emerged as indiana university-purdue university indianapolis (iupui), as programs from the two universities were physically merged. two years later, the school of social service was renamed the indiana university school of socialwork to emphasize its full identification with the social work profession. during the 1970s, indiana university expanded its campuses throughout the state. the school, with programs on both the indianapolis and bloomington campuses, was encouraged to promote social work education—especially at the graduate level—on the emerging “regional” campuses. faculty members committed to extending access to social work education engaged in numerous efforts to offer courses and develop programs. one faculty member was assigned to develop graduate courses on the indiana university northwest (gary) campus. courses were also developed for television delivery to the ft.wayne and south bend campuses. in addition, block field placements were developed in communities outside of the indianapolis area so that students could complete their internships in closer proximity to their homes. class schedules were redesigned to accommodate students who resided outside the indianapolis area (rogers, 1983, p. 103). in 1972, the school proposed new curricular designs for the school’s new bachelor of social work (bsw) and the associate of science in human services (ashs) programs. in 1973, the proposal was approved by indiana university and the indiana commission for higher education (iche). in order to accommodate the two new undergraduate programs, “graduate” was dropped from the school’s name to encompass the expanding continuum of social work education at indiana university. the school’s two-year ashs program enabled students, especially nontraditional students, to develop basic competencies for the provision of human services either as part of a service team or as an independent practitioner when intervention at a more complex level was not required (indiana university school of social service, 1974c). in 1975, the ashs program was inaugurated on the indiana university east (richmond) campus. subsequently, a full bsw program was implemented, enabling undergraduate students from the central-eastern portion of the state to enroll in associate or baccalaureate programs. the school’s new bsw curriculum was designed to prepare students for beginning professional social work practice with a focus on the problem-solving process. over several years, this curriculum was also fully implemented on the indianapolis, richmond, and bloomington campuses, replacing the undergraduate social service program that had been offered for so many decades in cooperation with the college of arts and sciences in bloomington. the bsw curriculum required students to complete general education and supportive courses from the arts, physical sciences, and the social and behavioral sciences in addition to social work courses. the social work course areas included: human behavior in the social environment, social welfare policy and services, research, social work practice, and field practicum. the bsw program was initially accredited by cswe in 1976 and has been continuously accredited ever since. 90 advances in social work the professionalization of baccalaureate education significantly affected the master’s program.during 1973-1976, the school substantially revised itsmswcurriculum. two central concepts, generalist practice and social systems, significantly influenced the first (foundation) year of the curriculum.within the advanced year, the long-valued casework and group-work tracks were integrated into an “interpersonal practice” concentration intended to prepare students for “direct clinical practice with the individual, the family, and the small group” (rogers, 1983, p. 100). the planning and management (p&m) concentration curriculum evolved during the late 1970s. both concentrations allowed for secondary emphases in selected fields of service—family and child welfare, corrections, mental and physical health, and school social work—fields that reflected the prevailing interests of faculty and students. furthermore, the concentrations incorporated new and invigorating courses on topics such as race, poverty, probation, and corrections (rogers, 1983). an affirmative action policy was written and adopted by the faculty in the spring of 1973. special efforts were made to recruit african-american faculty and students, leading to greater diversity within the school. widespread interest in social work education continued to heighten during the 1970s. responding to requests from agencies, legislators, prospective students, and other constituents, the indiana university president appointed a committee to examine the statewide needs for graduate social work education. the university’s administrative committee and board of trustees endorsed the committee’s recommendation that the school of social service extend graduate social work education throughout the state. graduate courses continued on the indiana university northwest (gary) and indiana university south bend campuses. new courses were offered at indiana university east (richmond) as well as on the columbus, ft.wayne, and new albany campuses. in the mid-1970s, the school in cooperation with the university of evansville, designed and offered a program of part-time graduate coursework. over a period of four semesters, students could earn as many as 45 semester credit hours in evansville. students were then expected to complete 12 months of full-time study in indianapolis to qualify for the msw degree (rogers, 1983, pp. 106-107). interest in developing a doctoral program at indiana university school of social work originated during dean lawrence’s administration. even as preparations were being completed for the initial accreditation of the bsw program in 1974, the faculty were discussing a larger vision for the school that would eventually encompass the full range of educational programs, including degrees at the associate, baccalaureate, masters, and eventually doctoral levels. by 1970, indiana was the only state in federal region v (including illinois, indiana, minnesota, michigan, ohio, and wisconsin) that did not have at least one doctoral program. consequently, hoosiers who wished to pursue a doctoral degree had to leave the state to do so. as the only school of social work in the state of indiana approved by the commission on higher education to provide graduate education, it was apparent to faculty that if doctoral education was ever to flourish within the state, indiana university was the obvious venue for it to take root. 91busch et al./indiana university school of social work: 90 years of professional education in 1977, dr. lawrence stepped down as dean to return to teaching and research. dr. leonard schneiderman was named dean and dr. cyrus behroozi was appointed first associate dean of the school. during the five years dr. schneiderman served as dean, the academic credentials of the faculty began to shift from one predominantly comprised of highly experienced masters’ level practitioners to one that required doctoral-level education as a condition of tenure track appointment. dean schneiderman employed several additional faculty—most of whom had earned or were about to complete their doctoral degrees. he also dramatically increased the amount of external funding. dean schneiderman identified the creation of a doctoral program as one of the school’s highest priorities. schneiderman was convinced that the realization of the school’s aspirations for national prominence would inevitably require the development of a research infrastructure that could lead to the creation of new knowledge. it was apparent that the schools of social work that had attained this rarified status were schools that had gained reputations for being on the cutting edge of knowledge development. while they varied with respect to their affiliation with public or private universities, all of them had well-established doctoral programs with many having also developed related research centers. if the school was to join this elite group, schneiderman believed it would have to expand its mission to include not only the dissemination of existing knowledge, but also the creation of new knowledge. during 1978-82, the school refined the practice focus of its bsw curriculum as generalist social work. furthermore, the school revised its msw curriculum to emphasize generalist content within the first semester and began the msw concentration coursework in the second semester of the first year curriculum. the school’s statewide mission was reinforced in 1979 and 1980 with the submission of a program improvement proposal to the indiana commission on higher education to extend graduate social work education to campuses in gary, south bend, ft.wayne, and evansville. the commission authorized the school to award the msw degree at these campuses. however, funding did not accompany the approval and efforts to develop “off-campus” programs were impeded due to the enormous resource requirements (rogers, 1983, pp. 122-123). in 1979, a faculty-planning group was formed at the school to consider feasibility issues and prepare a formal proposal for a doctoral program that it hoped eventually would be approved by the indiana commission for higher education. it also struggled with the question of whether the program should be developed primarily with a practice focus and a dsw degree awarded through the school of social work, or whether it should emphasize research and be offered as a ph.d. awarded through the graduate school. this issue was ultimately resolved at the university level when it was determined that the school did not yet possess the requisite research infrastructure necessary to support the kinds of research required of a ph.d. program. despite unanimous approval and enthusiastic support at all levels of the university, including the board of trustees, the iche tabled the proposal in 1980 pending “a report on the progress of the expansion of the msw program” to three 92 advances in social work additional indiana university campuses and the university of southern indiana (iche, 1990). one year later, the commission voted by the narrowest of margins (seven to six) against approval. in 1981, the school relocated from cavanaugh hall to the fourth floor of the brand new education-social work building. a year later, dr. schneiderman resigned his position as dean. dr. beulah compton, a graduate of indiana university school of social service and co-author of a leading social work textbook, served as acting dean for a year followed by dr. gerald powers, who served as acting dean until 1984, when dr. sheldon siegel was appointed dean of the school. initiated by dr. schneiderman and sustained by dr. siegel, the school made a concerted effort to increase the diversity of both its faculty and student body. dr. schneiderman was responsible for developing the school’s affiliation with the council on international programs (cip), an international initiative that has, during the intervening years, been instrumental in bringing literally hundreds of human service professionals from more than 80 countries around the world to the iupui campus.this international and interdisciplinary initiative was sustained by dr. siegel under the direct leadership of professor david metzger. in a further effort to enhance statewide access to graduate social work education, the school initiated a part-time weekend work-study program on the indianapolis campus. initially, the program was limited to applicants currently employed in social service positions living outside the indianapolis area. students completed the master’s foundation curriculum in 15 months by taking classroom courses on saturdays and completing the first field practicum in their place of employment. work-study placements could be arranged in the student’s workplace provided the practicum experience was distinctly different from their regular work responsibilities and a different supervisor could be provided. this program proved to be extremely popular and precipitated large numbers of admission applications. despite the absence of additional funding, through the work-study program, the school found a means to enhance access to graduate social work education to students throughout the state. the program was a resounding success and led to the establishment of part-time evening, part-time day, and part-time saturday programs. the long-established advanced-standing program also enabled qualified bsw graduates to complete the msw program at an accelerated pace. in the late 1980s, dean siegel reconvened a group of faculty to consider the feasibility of submitting a new proposal for a doctoral degree program. in the years that intervened since submission of the original proposal, the makeup of the faculty had changed significantly, both in terms of its academic credentials and its racial diversity. all new faculty appointments were required to have attained a doctoral degree with an identified research agenda. it was evident by this point that the scholarly productivity and research potential of the faculty had increased dramatically. attributable in part to these changes, in 1991 the faculty reaffirmed its commitment to the development of a doctoral program and decided that this time the school should submit a proposal for a ph.d. program with a strong research 93busch et al./indiana university school of social work: 90 years of professional education emphasis. again, the proposal enjoyed unanimous support at all levels of the university review process. it was submitted to the iche for review in the fall of 1992 and was finally approved by the commission in june, 1993. the school was approved to accept its first class of doctoral students following formal accreditation by the north central association of colleges and schools in 1994. the first cohort of six students entered the program the following fall and four years later the school graduated its first doctoral candidate. the format for the doctoral program was built around a flexible interdisciplinary model that included an intentionally integrated series of didactic and experiential learning opportunities. while grounded in the historical and ideological commitments of the social work profession, the program was designed to take full advantage of the relevant human service professions and related academic disciplines available throughout the university. as such, it was designed to enable students to tie their research interests to related areas, such as education, public and environmental affairs, sociology, psychology, women’s studies, philanthropy, or law. given its strong multi-disciplinary thrust, the program was built around a “committee approach” to advising that would intentionally draw upon the professional expertise of scholars throughout the university whose intellectual and research interests paralleled those of the students who were to be enrolled in the program. during the early 1990s, despite the success of the part-time msw programs on the indianapolis campus, interest in graduate social work education once again arose on several other indiana university campuses. given the historical context, the school could not expect to receive funding to establish msw programs on the regional campuses. however, the school emphasized to university and campus leaders its desire to help those campuses mount msw programs provided they generated the funding to house the program, employ necessary faculty and staff, and deliver the educational services. since there was only one school of socialwork at indiana university (headquartered in indianapolis), programs on other campuses would (according to cswe policies) be considered branches. the school, based on its accredited status, provided the curriculum, faculty development, and academic supervision while the campuses provided the funding and earned the income associated with student enrollment. under these arrangements and based on fairly complicated memoranda of understanding, full msw programs were initiated on the indiana university south bend and the indiana university northwest (gary) campuses during 1992-1995. these programs were modeled after the part-time programs that had become such a success in indianapolis. as these programs became increasingly recognized and an msw program received cswe accreditation at the university of southern indiana, the demand for theweekendwork-study program became more manageable. prospective students could now enroll in msw programs closer to their homes and workplaces. in light of these developments and the existence of more than a dozen accredited bsw programs throughout the state, the school was in a position to conclude that it finally realized its long-held goal of providing professional social work education throughout the state of indiana. 94 advances in social work in 1994, dr. roberta greene became the school’s fifth dean. one of her first actions was to create two new positions at the school. dr. barry r. cournoyer was appointed associate dean for quality improvement and dr. irene queiro-tajalli became the school’s associate dean for systems. during her five-year tenure, dr. greene built upon her predecessors’ efforts to develop a variety of community-based field units headed by teacher/practitioners (i.e., non-tenure-track faculty members physically located in agency-based field settings).tied to a range of critical service delivery areas (e.g., mental health, housing, child welfare, youth development, school social work, and neighborhood centers), these field units not only provided dynamic in vivo settings for collaborative student learning, but also viable laboratories for a wide range of practice-sensitive research. dean greene also secured major funding that dramatically enhanced the computer and technological resources of the school, and contributed to a growing interest in and capacity for research among social work faculty and students. external forces shaping the school’s mission: 1960-2000 the election of john f. kennedy as president of the united states generated great optimism that the 1960s might be a decade when major social problems from child welfare to crime and poverty would be addressed and ultimately resolved. indeed, the civil rights, students’, women’s, and, of course, the anti-war movements challenged the status quo. interestingly, much of the social work community—from students and faculty to the professional associations—were noticeably passive during this major social revolution. it would be some time before substantial numbers of social workers would become socially active—often in the form of advocacy for the rights of women and people of color. during the 1970s, federal legislation, including shifts in public assistance to dependent children of unmarried, abandoned, or divorced women, offered new opportunities as well as challenges for social policy and social work practice. title xx of the social security act provided funds directly to the states for social welfare service. in 1979, the indiana general assembly adopted a new juvenile code that provided training for child welfare workers. these initiatives in federal and state policy, while applauded, would later be seen as reflecting the initial indications of a more conservative political approach. the reliance on local and state authority, and the private market for implementation, plus the notion of cost and service accountability, were clarion calls for what was to come in the 1980s. the optimism driving change during the ’70s would not be sustained for long. throughout its history, the school had provided substantial amounts of service to the larger civic and professional communities of the state. during the 1970s, faculty and students became even more active and provided consultation, direct and indirect services, research, and leadership support to numerous constituencies and agencies. in several instances, these efforts contributed to the development of organizations and programs that later became core agencies providing services to children, families, and communities statewide (seechildren’s bureau, 2000). as the decade of the ’80s began, the renewed conservatism and the politics of the new federalism led to further retrenchment in the role of government and shifts in the auspice of social services. during the presidency of ronald reagan, many 95busch et al./indiana university school of social work: 90 years of professional education social workers struggled to challenge or adjust to changes in the nature, organization, and funding of social services. the reagan domestic policy focused on three basic objectives: transfer responsibility and authority from the federal government to state and local communities; rely upon the private sector to provide for social services; and reduce federal programs and spending for social welfare initiatives (segal & brzuzy, 1998). each of these initiatives provided fodder for debate and retrenchment in indiana’s already conservative and residual approach to social welfare. early in 1980, dean schneiderman encouraged faculty and students to further increase the school’s involvement with the professional and general communities of the state. the creation of the indiana coalition for human services (ichs) became one of those initiatives (ichs, 1981). members of the indiana university school of social work community and other professionals convened to consider the implications of legislative policies emanating from the new reagan administration in terms of their impact on the delivery of social services in indiana. the state had little recent history in the design and implementation of social services at the local level. in indiana, public welfare was administered by 92 different county departments and some 1,000 township trustees. social service managers were accustomed to reacting and appealing directly for programs and funding from a cafeteria of categorical federal programs administered by various agencies inwashington, d.c. state government was not organized in a way that fostered or maintained communication or leadership among public social services providers. the indiana coalition for human services was formed during the summer of 1982. there were 24 founding member organizations from throughout the state, and the dean of the school of social work was elected its first president (ichs, 1982). the purpose of the ichs was twofold: (1) educate and prepare state and local leadership for the transformation from federal categorical allocations for social services to block-grant provisions and authority at the state and local level, and (2) coordinate statewide advocacy efforts for social welfare policy at the legislative level. a graduate of the school, employed by this new coalition as a professional lobbyist, gradually gained the respect and trust of legislators and state officials as an authority on social policy and social services. during the 1980s the proportion of initiatives introduced into the indiana general assembly focusing on social services and social work increased from fewer than 20% to more than one-half. faculty served on the ichs board and its committees, while students pursued related field placements and learned to practice in the legislative and policy analysis arena. opportunities for collaboration with professional colleagues and service providers throughout the state became commonplace, and professors and students’ efforts yielded noticeable results. for example, as a direct result of the scholarly and advocacy work of two of the school’s professors, a state commission on abused and neglected children and their families was established. chaired and staffed by the school of socialwork, the commission’s work resulted in legislation that greatly improved the child welfare system in indiana. another of the school’s professors’ scholarly and service work led directly to the establishment of an office 96 advances in social work of community services in the indianapolis department of public housing. second-year students in the planning and management concentration of the graduate program found creative field placements in areas of social policy analysis, information systems analysis, funding and resource development, and social service program design. the visibility and respect for the profession of social work and social work education in indiana made significant strides during this period. socialwork licensing for many years the national association of socialworkers (nasw) and its indiana chapter fought valiantly to secure legal regulation for the social work profession. two of the school’s professors chaired the indiana nasw committee on legal regulation and were tireless in their pursuit of social work certification. during the 1987, 1988, and 1989 legislative sessions of the indiana general assembly, bills providing for social work certification were introduced and passed in one house; only to be denied passage in the other. the ichs and many of its member agencies provided funds to employ a full-time lobbyist during the 1989, 1990, and 1991 legislative sessions. passage finally came late during the 1991 legislative session, but not without substantial compromise. social workers across the state were overjoyed to learn of the passage of this hard fought legislative victory. for several years indiana had remained the only state in the nation without some form of social work regulation. however, the celebration was short-lived. two days following adjournment of the general assembly, the director of the indiana chapter of the national association of social workers and a professor from the school of social work were summoned by the governor’s administrative assistant and advised that governor evan bayh had vetoed the legislation. rushed to meet the constitutional deadline for submitting signed legislation to the secretary of state’s office, the governor had vetoed the bill believing it provided only for the certification of marriage and family counselors and excluded social workers. unaware of last-minute negotiations that led to the inclusion of social workers in the bill, the governor acted on earlier advice not to support the legal certification of this group. following a morning of meetings with the governor and his staff, an unusual agreement was forged whereby the governor would support a legislative resolution to override his own veto at the annual one-day legislative session in the autumn. although formal celebration of the legislative victory was delayed another six months, the decade-long aspiration to secure social work certification had finally been realized. an international perspective in an effort to increase awareness and respect for racial, ethnic, and cultural diversity and global understanding, indiana university school of social work began to develop field practicum outside the united states during the mid-1970s. in 1976, the dean negotiated placements for students in london. over the next 10 years, similar practicums were developed in puerto rico, montreal, the bahamas, germany, and brazil. by 1982, communications with the fachhochschule (faculties of social work) in hamburg, germany resulted in an agreement to offer graduate-level courses and a field practicum to german students (indiana university 97busch et al./indiana university school of social work: 90 years of professional education school of socialwork andfachhochschule esslingen-hochschule fur sozialwesen, 1996). support for this international study program came from the german education and cultural foundation. each year, some six-to-nine german social work students completed msw courses on the indianapolis campus and undertook community-based field practicums alongside their indiana university colleagues. efforts to broaden the range of opportunities for cross-cultural and international experiences for faculty and students led to the school’s admission to the council of international programs (cip). the cip was one of the cultural and educational programs of the united states department of state created in 1955 as part of the fulbright educational exchange programs.the indiana university school of social work became a cip university affiliate in the summer of 1978. for 19 years the school participated in this cultural exchange program referred to locally as the iucip (metzger, 1997). three core objectives shaped the program: (1) host family living, (2) an internship in practice settings that paralleled participants’ prior education and experience, and (3) cross-cultural seminars and workshops covering social work education and practice, and family life traditions and institutions. professor david metzger was appointed to direct the program. a 15-member advisory council comprised of social work faculty, social service agency representatives, and public officials was appointed to assist in gaining financial resources, recruiting host families, and supporting the program. eleven participants from 10 nations came to the school in april of 1979 to begin the first program. nineteen years later, 284 individuals representing 79 nations had participated in this educational and cultural exchange program, and are now identified as iu-cip alumni. the program enhanced the school’s global perspective and enriched the personal and professional lives of everyone involved. during these 19 years, social workers, health specialists, physicians, lawyers, teachers, and elected officials from every part of the globe joined with the school’s students and faculty in classes, workshops, field trips, and social gatherings. many collaborated with faculty from the school of socialwork and other university departments, and with community professionals on research projects and overseas study opportunities. the participants reflected an incredible range of cultural diversity and their professional credentials were exceptional. for example, among the iu-cip participants were a psychiatrist who happened to be the daughter of the president of hungary; an elected member of the parliament of rumania; a principal of the school of socialwork in lahore, pakistan; a sister of theorder of providence teaching in a rural area in the southern philippines; and a non-conventional probation officer from austria. more than 200 families shared their lives with these professional colleagues in ways only possible through host living. hundreds of social workers, lawyers, teachers, and health care professionals examined practice, policy, ethical, social, political, economic, and philosophical issues with these international colleagues through unique learning experiences. needless to say, the nature and depth of these learning experiences were extraordinary, intellectually exhilarating, and often transcendent. these 19 years provided opportunities for learning and experience never expected or even imagined. profoundly touched by the experience, faculty, students, hosts, and colleagues throughout the state were forever changed, yet hard-put to tell others how or why. the impact of the iu-cip program on indiana university school of social work, its faculty and students, and the university’s global educational mission is difficult to overstate. although the school hosted its last cohort of cip participants in 1997, the program’s legacy continues to resonate in many activities. for example, in 1996, 21 students and three faculty members of the school were invited to a twoweek long series of workshops and seminars in german-american social policy and social work practice at the fachhochschule at esslingen university in southern germany (indiana university school of socialwork and fachhochschule esslingen-hochschule fur sozialwesen, 1996). this was the school’s first experience in facilitating a large cohort of students and faculty on such a mission. this event opened doors of opportunity for education, practice, and research still to be developed. similarly, anmswgraduate of indianauniversity school of socialwork currently serves as the director of the international center of indianapolis and continues to coordinate special projects that bring professionals from throughout the world to the city and the university for cultural and educational enrichment experiences. such international activities maintain the rich and enriching legacy of the iu-cip program. the school of socialwork: a contemporary overview andvision for the future currently, indiana university school of social work offers a full continuum of social work education from the associate to doctoral levels. nearly 900 students study social work on several indiana university campuses. the two-year, associate of science in human services program is offered on the richmond campus. the bachelor of social work (bsw) program is a 51-credit hour program of study designed to prepare students for beginning generalist social work practice. full bsw programs are offered on the indianapolis, bloomington, and richmond campuses. the master of social work (msw) program is a 60-credit hour program designed to prepare students for advancedprofessional practice in one of two concentrations: interpersonal social work practice or macro social work practice. interpersonal practice refers to direct work with individuals, families, and small groups in need of social services. macro practice refers to macro system service through policy analysis, advocacy, community organization, planning, or administration. complete msw programs are offered on the indianapolis, gary, and south bend campuses. the social work doctoral program (ph.d.) is a 90-credit hour research-oriented program designed to prepare graduates for leadership positions within the profession. the kinds of intellectual and methodological skills developed as part of a research-focused doctoral program are critical to the profession’s continuing efforts to extend and improve the overall quality of its knowledge base, including its ability to effectively address individual and societal problems, to serve as active participants in shaping public policy, and to meaningfully engage in the process of preventing and ameliorating social and economic injustice. in order to complement and extend this vision, two additional knowledge-building initiatives were introduced. in 1999, the school sponsored the creation of its own scholarly journal advances in social work: linking research, education, and practice. in 2001, the 98 advances in social work office of research services was established. both of these initiatives were designed to strengthen the research infrastructure of the school, the former by providing a vehicle for the dissemination of new knowledge, and the latter by serving as a catalyst in developing a research culture that is supportive, encouraging, and collaborative in nature. it is believed that the synergistic effect generated by a viable doctoral program, a professional journal, and an office for the coordination of research services will contribute substantially to the overall intellectual climate of the school. by increasing opportunities for faculty and students to engage in collaborative practice-sensitive and applied research, the school has positioned itself to foster interdisciplinary knowledge-building projects with colleagues of like mind both within and outside the university. in 2000, dr. michael patchner became the 6th dean of indiana university school of social work. he aspires to build upon the foundations laid by his predecessors to improve the quality of the school’s educational, service, and research activities. dean patchner hopes to continue efforts to provide high quality educational programs with curricula that are current and relevant, recruit students who seek to serve and yearn for challenging educational experiences, and to provide an educational environment that is diverse and representative of its state, national, and international constituencies. dr. patchner anticipates the development of jointacademic programs, especially at the masters’ level (patchner, 2000). research and scholarship will have a higher priority to better complement the school’s historical emphasis upon teaching and service. the school aims to become a national leader in the assessment of educational processes and outcomes. drawing upon the most recent educational policy and accreditation standards (council on social work education, 2001) as a catalyst for change, the school has committed to curricular innovation that will identify it nationally as a leader in learner-focused, outcome-based education (patchner, 2000). in conclusion, the history of social work education is much more than the history of an academic discipline. as such, “it is a significant part of the historical developmentofamerican society . . . markedbyeconomic and societal changes—leading to resolution of some social problems and creation of new problems” (austin, 1986, p. 46). we believe that this brief depiction of the evolution of the indiana university school of socialwork mirrors in many respects the experiences of other schools and departments of social work, and as such may be enlightening to those interested in the history of social work education. references austin, d.m. (1986). a history of social work education. austin, tx: the university of texas school of social work. council on social work education. (2001). educational policy and accreditation standards. washington, dc: author. children’s bureau. (2000). for the children’s sake: a history of the children's bureau of indianapolis: 1851 to 2001. indianapolis: author. indiana coalition for human services [ichs]. (1981, october).minutes of the board of directors meeting. indianapolis: author. 99busch et al./indiana university school of social work: 90 years of professional education indiana coalition for human services [ichs]. (1982, summer).minutes of the board of directors meeting. indianapolis: author. indiana commission on higher education (september, 1990).minutes of the iche. indianapolis, in: author. indiana university (1915). indiana university newsletter, 3(8). bloomington, in: author. indiana university (1919). indiana university newsletter, 7(10). bloomington, in: author. indiana university (1920). indiana university newsletter, 8(7). bloomington, in: author. indiana university (1936-37). the training course for socialwork. bloomington, in: author. indiana university (1944-45). the training course for socialwork. bloomington: the university. indiana university (1945-46).division of social service bulletin 1. bloomington, in: author. indiana university school of social service (1974c). report to the cswe commission on accreditation. vol. ii. indianapolis: author. indiana university school of social service. (1974a). a continuum for social work education. indianapolis: author. indiana university school of social work and fachhochschule esslingen-hochschule fur sozialwesen. (1996). an exchange visit. indianapolis: author. levy, c.s. (1968). social work education and practice: 1898-1955. new york: wurzweiler school of social work, yeshiva university. metzger, d. (1997, january 12). iu-cip: its past and future.memorandum to the indiana university school of social work committee on international affairs. indianapolis: indiana university school of social work. patchner, m. (2000, september). presentation to the faculty senate of indiana university school of social work. indianapolis: indiana university school of socialwork. rogers, h.c. (1983). seventy years of social work education at indianauniversity. indianapolis, in: indiana university. segal, e.a., & brzuzy, s. (1998). social welfare policy, programs, and practice. itasca, il: f. e. peacock. task force on social work research (1991) building social work knowledge for effective services and policies…a plan for research development. austin, tx: the university of texas school of socialwork. author’s note: address correspondence to: barry r. cournoyer,d.s.w., indianauniversity school of socialwork, 902west newyork street, indianapolis, in 46202-5156 usa, bcourno@iupui.edu. 100 advances in social work microsoft word 1. chaumba_1858_mixed methods copyedit_final ______________ josphine chaumba, ph.d., is an assistant professor in the department of social work at the university of north carolina at pembroke in pembroke, nc. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 307-333 the use and value of mixed methods research in social work josphine chaumba abstract: the complexity of social problems addressed by the social work profession makes mixed methods research an essential tool. this literature review examined common quantitative and qualitative techniques used by social work researchers and what mixed methods research may add to social work research. surveys and in-depth interviews were the most common quantitative and qualitative data collection methods, respectively. the t-test was the most frequently used quantitative data analysis method. although thematic analysis was the most common qualitative data analysis method, 12% of the qualitative data analysis techniques were not specified. mixed methods research adds three important elements to social work research: voices of participants, comprehensive analyses of phenomena, and enhanced validity of findings. for these reasons, the teaching and use of mixed methods research remain integral to social work. keywords: mixed methods research, social work there is increasing recognition of the importance of combining quantitative and qualitative research methods (hereafter mixed methods research) when conducting social work research and evaluation (cowger & menon, 2001; grinnell & unrau, 2008; padgett, 1998, 2008; yegidis & weinbach, 2009). at its most basic, mixed methods research refers to research in which investigators use “both qualitative and quantitative approaches or methods in a single study or program of inquiry” (tashakkori & creswell, 2007, p. 4). nevertheless, potential obstacles to the use of mixed methods research in social work have been reported and these include misunderstanding over components that could be integrated in a single study, and training in either qualitative or quantitative methods but not both (padgett, 1998). this article explores the use of mixed methods research in social work through a systematic review of studies that combined quantitative and qualitative methods in published social work journals. the main aims of this literature review were two-fold. first, to understand the common quantitative and qualitative techniques used by social work researchers and second, to explore what mixed methods research may add to social work research. this information may be useful to social workers who are planning to use mixed methods research. most important, knowledge on how to mix quantitative and qualitative methods is needed so that social workers are equipped to conduct and consume mixed methods research. after this introductory section, an overview of mixed methods research is presented highlighting connections between qualitative, quantitative, and mixed methods research, including when and how mixing occurs. this is followed by the method used to select articles for this review, after which the findings, discussion, and implications of the research effort are articulated. advances in social work, fall 2013, 14(2) 308 review of the literature this literature review provides an overview of key characteristics of qualitative and quantitative methods and their connection to mixed methods in relation to goals, sampling, data collection, and data analysis. whereas the main goal of quantitative research is to test existing theories and understand connections among particular variables through a deductive research process, primary goals of qualitative research include comprehending multifaceted worlds of study participants and associated subjective meanings and processes using an inductive research process (padgett, 2008; rubin & babbie, 2008). clearly there are unique advantages and disadvantages associated with qualitative and quantitative forms of inquiry, which may render each method suited to particular research questions. hence, “the goal of mixed methods research is to draw on the strengths and minimize the weaknesses of both types of research” (connelly, 2009, p. 31). as the social work profession advances its understanding of complex social problems such as child abuse, poverty, and substance abuse, mixed methods research will allow exploration of generalizable findings on specific measurable outcomes while capturing the influence of external contexts and subjective processes in a single study (hopson & steiker, 2008). in view of the above-mentioned goals of quantitative, qualitative, and mixed methods research, sampling, data collection, and analysis methods characteristic of each form of inquiry are reviewed. for instance, the logic underlying quantitative and qualitative sampling varies (klenke, 2008). the principal reason for sampling in quantitative research is to select individuals that are representative of the population, and this is best achieved through the use of larger sample sizes and random sampling procedures so that the researcher can estimate the representativeness of the sample to facilitate generalizability (creswell, 2008; patton, 2002; rubin & babbie, 2008). in contrast, the primary rationale for sampling in qualitative research is to select “information-rich cases for study in-depth” so that the researcher can learn about the issues of central importance to the purpose of the research (patton, 2002, p. 230). this is best achieved through purposive or theoretical sampling, and the sample size is determined when the point of saturation is reached as marked by redundancy in participants’ responses (klenke, 2008). consistent with the varying logic between qualitative and quantitative sampling, mixed methods sampling honors the two parallels of representativeness and information-rich cases, and the sample size varies depending on the research strand and questions (teddlie & yu, 2007). even though distinctions between quantitative and qualitative data collection strategies may be blurred because of similar terminology, the form of data that are gathered differs. whereas qualitative research seeks textual data that capture the context such as words and images, quantitative research collects numbers with less emphasis on context (creswell & plano clark, 2007; padgett, 1998). qualitative and quantitative researchers may use similar terminology when referring to methods of data collection such as surveys, interviews, or observations (axinn & pearce, 2006; johnson & turner, 2003), but differ on issues that are emphasized during the data collection process. for instance, when using observations quantitative researchers may use rating scales or count frequencies whereas qualitative researchers may emphasize processes or interactions in advances in social work, fall 2013, 14(2) 309 the setting. similarly, quantitative surveys typically consist of structured questionnaires with embedded standardized scales, whereas qualitative surveys use open-ended questions (weathington, cunningham, & pittenger, 2010). given the differences in the type of data collected for quantitative versus qualitative research, mixed methods research emphasizes the collection of multiple forms of data, such as both numbers and words or images (johnson & christensen, 2007). in addition, there are specific decisions to be made at this stage, especially for concurrent studies, regarding whether the same types of questions or concepts will be used to collect data for both strands (creswell & plano clark, 2011). there are marked differences in the data analysis procedures for quantitative research and qualitative research. quantitative data analysis seeks to quantify phenomena including identifying statistical relationships among variables, differences between groups, or change over time, whereas qualitative data analysis aims at making sense of the text by searching for themes and patterns in the data (creswell, 2008; johnson & christensen, 2007). methods of qualitative data analysis include thematic coding, grounded theory coding, and narrative analysis (flick, 2009). on the other hand, quantitative data analysis methods can be categorized as descriptive and inferential statistics. whereas descriptive statistics summarize how variables of interest are distributed in the sample by describing what the data show, inferential statistics are used to make conclusions about the data. examples of descriptive statistics include frequencies, mean, median, and standard deviation, while statistical tests such as analysis of variance (anova), chi-square, t-tests, pearson’s product moment correlation (r), and regression are examples of inferential statistics (rubin & babbie, 2008). although mixed methods researchers continue to rely on the unique methods of quantitative or qualitative data analysis, they tend to use a variety of data analysis techniques from both forms of inquiry in a single study (creswell & plano clark, 2011). having compared key characteristics of qualitative, quantitative, and mixed methods research, this section delves deeper into the process of doing mixed methods research. prominent scholars in this form of inquiry have provided guidance on how to combine qualitative and quantitative methods (cowger & menon, 2001; creswell & plano clark, 2007, 2011; greene, 2007; padgett, 1998, 2008). foremost are the key decisions that researchers need to resolve prior to conducting a mixed methods study, and these are: (1) whether the quantitative and qualitative methods will be implemented at the same time (concurrent), in two distinct phases (sequential), or in three or more phases that combine concurrent and sequential elements (multiphase), (2) the relative weight of the two approaches, that is, whether there will be more emphasis on one method over the other or both methods will have equal weighting, and (3) when and how the quantitative and qualitative methods will be mixed (creswell & plano clark, 2007, 2011). determination of how and when mixing occurs is discussed in the remainder of this section. lodico, spaulding, and voegtle (2006) caution that “just adding a couple of openended questions to a quantitative measure does not constitute a true mixed-methods study” (p. 282). in order to clarify how and when mixing occurs, creswell and plano clark (2011) envisage four possible points. it is worth noting that a study may have advances in social work, fall 2013, 14(2) 310 primary and secondary points of mixing, and examples of primary points of mixing from the reviewed studies are included. the first possible point of integration is at the design level, where the overall plan of the research involves embedding one approach within a design based on the other type. for instance, a qualitative technique can be embedded within an experimental design, as illustrated by sanders and roach (2007). in their evaluation of a family support services intervention, sanders and roach used a quantitative pre-test post-test non-equivalent groups design with embedded qualitative methods. the second point of integration is during data collection, where results from one strand are used to shape the research questions, sampling, or data collection instruments for the other strand. for example, a researcher may start off with in-depth interviews and use the findings from this qualitative study to construct a survey instrument for use in the quantitative part, or conduct a survey and use the results to identify cases for follow-up, in-depth interviews. varas-díaz and marzán-rodríguez (2007) developed an instrument, emotions associated with aids inventory, for use in the quantitative part of the study, drawing from the findings from in-depth interviews that had explored practitioner emotions associated with interacting with people living with hiv/aids. the third point of integration is during data analysis. at this stage results from a qualitative study can be transformed to numerical data and analyzed using quantitative methods, as demonstrated by redman (2008) who used categories from qualitative findings as the dependent variables for quantitative data analysis. the fourth point of integration is during interpretation, where the researcher merges the qualitative and quantitative strands by comparing or contrasting findings from the two data sets. while this is the only point of integration for researchers who use procedures with separate qualitative and quantitative strands, synthesizing what was learned from mixing the two methods in the discussion section is anticipated in mixed methods studies (creswell & plano clark, 2011). for instance, mcauley, mccurry, knapp, beecham and sleed (2006) discuss how the data from the two methods converged. on the other end, nicotera (2008) discusses how mixed methods research aided in understanding differences between neighborhoods. it is important to note that merging findings at the interpretation stage can be challenging, as padgett (2009) stated, “perhaps the most daunting challenge is integrating findings from the two ‘sides’, especially, when the findings conflict” (p. 104). given the potential challenges associated with mixed methods research, what does mixed methods research add to social inquiry that qualitative or quantitative methods alone may not achieve? to answer this question, the value of mixed methods research is considered drawing from literature on the purposes or rationales that drive the use of mixed methods inquiry and mixed methods research designs. a useful framework for classifying the purposes of mixed methods research was devised by greene, caracelli, and graham (1989) and also reported by greene (2007). table 1 summarizes the five main purposes of mixed methods research, highlighting their descriptions, goals, and benefits in a table format for comparison and clarification. advances in social work, fall 2013, 14(2) 311 table 1. purposes of mixed methods research adapted from greene (2007) and desimone (2009) purpose description goal benefit complementarity different methods are used for different facets of the same phenomena enrichment, elaboration, or clarification of results increases the depth and confidence in interpretation as results from one method clarify or illustrate results from the other method development involves the sequential use of different methods in the development of the study for sampling or instrumentation purposes use the results of one method to inform the other method takes advantage of inherent method strengths for better understanding; e.g., results from a questionnaire can be used to identify issues for indepth study expansion different methods are used for different phenomena or questions expand the scope or breadth of a study enables study to answer more questions of interest initiation different methods are used for different facets of the same phenomena with the goal of identifying contradiction non-convergence of results may lead to new questions or rephrasing of the problem or phenomena under study triangulation use of mixed methods to answer the same question correspondence of results across different methods enhanced validity of results as the combined methods offset biases of either a quantitative or qualitative only study researchers may have multiple purposes for using mixed methods in a single study, such that there can be primary and secondary reasons for the choice of mixed methods (bryman, 2006; greene, 2007). a review of 232 mixed methods studies by bryman (2006) using greene and colleagues’ framework established that complementarity and expansion and were the most frequently cited reasons accounting for 29% and 25% of the studies, respectively. it is important to note that following this review of 232 articles, bryman developed an expanded classification of possible purposes of mixed methods research that can be a useful resource when planning a mixed methods study. stating at least one reason for adopting mixed methods research is critical when planning and reporting a mixed methods research study (creswell & plano clark, 2011), because, when the rationale is explicated, readers are presented with an opportunity to assess the value of combining quantitative and qualitative methods. advances in social work, fall 2013, 14(2) 312 apart from relying on the frameworks of greene and colleagues (1989) or bryman (2006) to identify the rationale for a mixed methods study, articulating the adopted mixed methods research design may point to the underlying primary purpose of a mixed methods study (creswell & plano clark, 2011). for instance, creswell and plano clark (2007) distinguished four main types of mixed methods research designs with associated rationales, and these are: 1. triangulation, concurrent, or parallel design which entails separate quantitative and qualitative data collection and analysis within the same timeframe, and merging of data during interpretation for various reasons that may include validating findings from one method, gaining a complete understanding of phenomenon under study, or confirming findings. 2. embedded design, a concurrent design where a qualitative part is embedded in a quantitative study, or vice versa, so that the findings of one part (e.g. qualitative) are used to support or explain findings from the other method. this can take the form of an experiment with embedded interviews or observations to understand the process or participant experiences. this design can be useful in research that seeks to develop or gain a complete understanding of interventions. 3. exploratory sequential design, a sequential design in which a qualitative study conducted in the first phase informs a quantitative study conducted in the second phase. when using this design, qualitative findings can be used to guide the development of a quantitative instrument or theory development when hypotheses from qualitative findings are validated or tested using quantitative methods. 4. explanatory sequential design, a sequential design in which a quantitative study conducted in the first phase informs a qualitative study conducted in the second phase. with this design, the results of the qualitative design can be used to explain quantitative findings, or quantitative findings can be used to guide sample selection for the qualitative part (creswell & plano clark, 2007, 2011) in sum, if researchers clearly define their mixed methods design and its associated primary purpose, the potential value of combining qualitative and quantitative methods is expressed in addition to enhancing the study’s rigor and quality (creswell & plano clark, 2011). having highlighted the key characteristics of qualitative and quantitative research, the question of when and how mixing occurs, and the purposes of mixed methods research, the method and findings of the systematic review are presented next. method a systematic literature search in social work abstracts, psycinfo, academic search complete, medline, family & society studies worldwide, sociological collection, cinahl, family studies abstracts, and psycarticles was conducted to identify research articles that had used mixed methods research. the literature search was conducted in august 2010 using the ebscohost’s advanced search option with “mixed methods” and “social work” as the search terms. the search yielded 585 articles published between 1995 and 2010. after the removal of duplicates and limiting the advances in social work, fall 2013, 14(2) 313 search to peer reviewed and full text articles, the sample was reduced to 119. abstracts were then reviewed to identify research studies that had combined qualitative and quantitative methods. conceptual articles and literature reviews were excluded during this stage of the review leaving 68 full text articles that were further assessed for eligibility. during this stage, 21 articles were excluded. figure 1 shows a prisma statement flow diagram of the article selection process according to the guidelines by moher, liberati, tetzlaff, altman, and the prisma group (2009). figure 1: the prisma statement illustrating the flow of information through the different phases of the systematic review. articles were included in the synthesis if the study procedures involved the use of both quantitative and qualitative techniques and demonstrated at least one point of integration either at the design level, during data collection or analysis, or interpretation in accordance with the classification by creswell and plano clark (2011). in addition, the articles were reviewed for two other key mixed methods research features. first, the purpose of mixed methods research was evaluated using the framework by greene and colleagues (1989) that identifies complementarity, triangulation, expansion, initiation, and development as the main purposes of mixed methods research. second, the type of id en ti fi ca ti on s cr ee n in g e li gi b il it y in cl u d ed number of records identified through database searching (585) number of additional records identified through other sources (0) number of records after duplicates removed  plus peer-reviewed and full text limiters (119) number of records screened (119) number of records excluded (51) number of full-text articles assessed for eligibility (68) number of studies included in qualitative synthesis (47) number of full-text articles excluded, with reasons (21) advances in social work, fall 2013, 14(2) 314 mixed methods research was determined using the classification by creswell and plano clark (2007) emphasizing four research designs, namely, triangulation/concurrent/ parallel design, embedded design, exploratory sequential design, and explanatory sequential design. data were extracted using an adapted coding scheme informed by o’cathain, murphy, and nicholl (2007). the coding form included the following categories, focus of study, purpose or rationale for mixing methods, type of mixed methods design, focus of the quantitative and qualitative parts, point where mixing occurred, qualitative methods of data collection and analysis, and quantitative methods of data collection. table 2 summarizes the 47 articles that were synthesized in this literature review in line with the categories in the coding form. after completing the literature review table, frequency counts were performed to establish the types and number of times specific qualitative and quantitative methods were used in the reviewed articles. in addition, drawing from the stated foci of the qualitative and quantitative parts, the researcher inferred elements that mixed methods research may add to social work. the study’s main findings are presented next. results to understand where mixing occurred in the reviewed studies, analyses of the extracted data showed that the most frequently used point of integration was the interpretation stage, accounting for 62% (n = 33) of all the 53 points of integration represented in the articles. integration at the design level accounted for 24% (n = 13) and data collection and data analysis stages accounted for 13% (n = 7) each. the other main findings of this review are organized according to: 1) common methods of qualitative and quantitative data collection, 2) common methods of qualitative and quantitative data analysis, and 3) key areas addressed by the qualitative and quantitative strands. advances in social work, fall 2013, 14(2) 315 table 2. published social work journal articles used in the literature review author focus of study primary purpose of mixed methods research mixed methods research design focus of qualitative part focus of quantitative part where mixing occurred qualitative data collection & analysis methods quantitative data collection & analysis methods abel & campbell (2009) assessment of teaching approaches triangulation triangulation students’ perceptions • students perceptions •differences in outcomes interpretation focus groups open & axial coding survey descriptive and inferential statistics ▪chi square test antle & collins (2009) evaluation of a breast cancer support group complementarity embedded respondents’ perspectives and experiences •measure key variables •examine variable relationships design level survey questionnaire with qualitative questions thematic analysis descriptive and inferential statistics anova and pearson’s r ayón & lee (2009) evaluation of a neighborhood leadership program expansion explanatory participants’ experiences on use of skills measure leadership skills and knowledge design level in-depth interviews open-coding survey descriptive and inferential statistics • t-test beecher (2009a) influence of the medical model on treatment of individuals with schizophrenia complementarity triangulation practitioner views measure key variables interpretation web-based survey thematic analysis secondary data descriptive and inferential statistics • anova • kruskal wallis beecher (2009b) practitioner views toward families and barriers to collaboration complementarity triangulation practitioner experiences & views examine variable relationships interpretation webbased survey thematic analysis survey descriptive and inferential statistics • anova • ttest advances in social work, fall 2013, 14(2) 316 bellamy et al. (2006) effects of group leadership on group functioning triangulation triangulation group activities and interactions exploration of differences data analysis observations coding transformed qualitative codes descriptive and inferential statistics • ttest • pearson’s r • chi-square berger, ottosalaj, stoffel, hernandezmeier, & gromoske (2009) barriers and facilitators of transferring motivational interviewing into practice expansion embedded •perceived barriers & facilitators • needs and expectations measure key variables design level focus groups grounded theory survey descriptive and inferential statistics • pearson’s r boateng (2009) social capital & liberian refugee women’s wellbeing triangulation triangulation participants’ experiences & shared issues measure dimensions of social capital interpretation ▪in-depth interviews ▪focus groups ▪photographs constant comparative analysis survey descriptive statistics bryan, flaherty, & saunders (2010) evaluation of adoption support for kentucky program development exploratory gather information to guide the development of a quantitative survey • examine survey instrument’s measurement structure • describe program participants data collection focus groups open coding survey descriptive and inferential statistics • cronbach’s alpha • anova butler (2006) evaluation of the senior companion program triangulation triangulation participants’ experiences measure key constructs interpretation open-ended questions on questionnaire open coding descriptive and inferential statistics •pearson’s r •t-tests •chi-square advances in social work, fall 2013, 14(2) 317 campbell (2008) stakeholder experiences with compulsory admission to psychiatric hospitals, and the use of the mental health review tribunal (mhrt) in northern ireland triangulation triangulation views of a range of stakeholders e.g. clients and key informants describe experiences, knowledge and views on the adequacy of mental health law and policy, and the tribunal system interpretation •focus groups •key informant interviews •document analysis thematic analysis survey descriptive statistics carpenter, barnes, dickinson, & wooff (2006) evaluation of a postgraduate program expansion embedded students’ experiences and process of implementation •measure key outcomes •assess changes in students’ perceptions of their knowledge and skills design level participant observation focus groups individual interviews thematic analysis survey descriptive and inferential statistics •anova/ancov a •t-tests •cronbach’s alpha chan, chi, ching, & lam (2010) student perceptions of learning complementarity embedded students’ transactions student’s ratings of the approach used to facilitate learning design level interpretation ▪videotape recordings ▪telephone interviews thematic analysis surveys descriptive statistics chan, mok, po-ying, & man-chun (2009) evaluation of a teaching method complementarity embedded students’ transactions measure effectiveness of approach design level ▪videotape recordings telephone interviews content analysis surveys descriptive statistics cheung (2008) resilience among older immigrant couples triangulation triangulation respondents’ lived experiences measure key variables interpretation in-depth interviews narrative analysis survey descriptive statistics advances in social work, fall 2013, 14(2) 318 daftary (2009) factors that shape elected leaders’ decision making complementarity triangulation explore process examine variable relationships interpretation ethnography no specified method of data analysis survey descriptive and inferential statistics •structural equation modeling fernandez (2008) outcomes of children in foster care complementarity embedded process of interactions evaluate outcomes design level in-depth interviews no specified method of data analysis survey descriptive and inferential statistics • chi-square • t-test freedman (2009) examination of local food environments triangulation triangulation participants’ perceptions identify the types of food stores and food items interpretation in-depth interviews thematic analysis food audit – survey descriptive statistics gallagher, malone, & ladner (2009) teamwork among school psychologists, counselors, and social workers triangulation triangulation perceptions of the team process measure attitudes and perceptions about teamwork interpretation open-ended questions on survey content analysis survey descriptive and inferential statistics • pearson’s r gioia (2006) work delay in young adults with schizophrenia triangulation triangulation participants’ experiences and meanings of work pre and post illness history interpretation semi-structured face to face interview descriptive statistics (in-depth interview) thematic analysis gioia & brekke (2003) knowledge and use of ada provisions among people with schizophrenia triangulation triangulation participants’ experiences and meanings of work pre and post illness history interpretation semi-structured face to face interview descriptive statistics thematic analysis hernandez et al. (2009) provision of workplace accommodations complementarity triangulation employer perceptions on providing workplace accommodations data on accommodations interpretation focus group content analysis survey descriptive statistics advances in social work, fall 2013, 14(2) 319 hodge & boddie (2007) personal spiritual characteristics and understanding of religion complementarity triangulation participants’ definitions of key variables measure key variables interpretation survey instrument with structured & open ended questions thematic analysis descriptive statistics inferential – chi square, ttest, anova hodge & limb (2009a) validation of an ecomap assessment tool for use with american indians triangulation triangulation strengths and limitations of the concept and suggestions for improvement assess consistency of assessment tool interpretation questionnaire with structured & open ended questions constant comparative method descriptive and inferential statistics – pearson’s r, t-test, anova hodge & limb (2009b) validation of a spiritual assessment tool for use with american indians triangulation triangulation strengths and limitations of the concept and suggestions for improvement assess consistency of assessment tool interpretation questionnaire with structured & open ended questions constant comparative method descriptive statistics and inferential pearson’s r hodge & roby (2010) coping among women living with hiv/aids triangulation triangulation participants’ coping strategies ▪measure perceptions on the usefulness of coping strategies ▪examine variable relationships data analysis interpretation questionnaire with structured & open ended questions constant comparative method descriptive statistics inferential – chi-square, pearson’s r, t test, anova huyck, ayalon, & yoda (2007) validation of assessment tool triangulation triangulation participants’ experiences assess changes in outcome over time design level interpretation in-depth interviews observations grounded theory survey descriptive and inferential statistics ▪cronbach’s alpha advances in social work, fall 2013, 14(2) 320 lee, h. & eaton (2009) older adult korean immigrants’ perceptions & response to financial abuse triangulation triangulation perceptions and responses to a financial abuse case vignette measure key variables interpretation in-depth interviews grounded theory survey descriptive and inferential statistics ▪logistic regression lee, s. et al. (2008) hiv vaccine acceptability among ethnically diverse persons complementarity triangulation social issues, concerns, barriers and motivators of hiv vaccine acceptability measure consumer preferences interpretation focus group thematic analysis conjoint analysis descriptive and inferential statistics ▪ t-test ▪anova leslie, weckerly, plemmons, landsverk, & eastman (2004) evaluation of a project protocol triangulation triangulation experiences of stakeholders measure key variables interpretation interviews thematic analyses survey descriptive and inferential statistics ▪t-test ▪chi-square maiter (2004) cultural sensitivity and cultural competence in child protection triangulation triangulation perceptions of parents and child welfare workers examine differences in responses between parents and child welfare professionals interpretation surveyinstrument with structured & open ended questions content analysis descriptive statistics inferential – mann-whitney u mcauley, mccurry, knapp, beecham, & sleed (2006) evaluation of a family support program triangulation triangulation ▪participants’ experiences with parenting stress ▪perceptions of services assess maternal and child wellbeing design level interpretation in-depth interviews no specified method of data analysis survey descriptive and inferential statistics ▪ anova mccarter (2009) minority overrepresentation in the juvenile justice system triangulation triangulation participants’ perceptions examine variable relationships interpretation in-depth interviews coding secondary data analysis descriptive and inferential statistics ▪ logistic regression advances in social work, fall 2013, 14(2) 321 nicotera (2008) measurement of the concept of neighborhood triangulation triangulation children’s descriptions of their neighborhood s and neighboring experiences measure neighborhood characteristics data analysis interpretation document analysis content analysis constant comparative secondary data transformed qualitative data descriptive statistics inferential statistics chisquare park, knapp, shin, & kinslow (2009) social engagement experiences of older men in assisted living facilities purpose not stated explanatory participants’ social engagement experiences measure wellbeing & social engagement variables data collection in-depth interviews coding survey descriptive statistics inferential statistics chisquare t-tests rakfeldt (2005) evaluation of dialectical behavior therapy purpose not stated embedded participants’ experiences and interactions measure outcomes design level in-depth interviews focus groups survey descriptive statistics inferential statistics chisquare t-tests redman (2008) coping-related motives for substance use triangulation triangulation respondents’ meanings & motives examine variable relationships data analysis survey with open-ended and closed questions ▪ grounded theory for qualitative data ▪ descriptive and inferential statistics ▪ discriminant analysis redmond, guerin, & devitt (2008) attitudes of social work students expansion triangulation participants’ future plans measure variables interpretation survey with open-ended and closed questions focus group for qualitative data collection ▪ content analysis for qualitative data ▪ descriptive and inferential statistics ▪ friedman’s analysis of variance advances in social work, fall 2013, 14(2) 322 sanders, r., & roach (2007) evaluation of family support services triangulation embedded family views and service expectations measure outcomes and change after intervention ▪ design level ▪ interpretation in-depth interviews ▪ no specified method of qualitative data analysis survey descriptive and inferential statistics ▪ t-test sanders, s., ott, kelber, & noonan (2008) grief reactions triangulation triangulation lived experiences measure grief levels interpretation in-depth interviews coding survey descriptive and inferential statistics ▪ t-tests chi-square smith & roberts (2009) young parents’ antenatal & postnatal needs triangulation triangulation add detail and context to survey findings measure variables interpretation focus group thematic analysis survey descriptive and inferential statistics ▪ chi-square (fishers’ exact test) tolmie et al. (2009) needs of older people in cardiac rehabilitation triangulation triangulation participants’ experiences measure key study variables interpretation in-depth interviews framework analysis surveys descriptive and inferential statistics ▪ kruskal-wallis ▪ one way anova ▪ mann-whitney u varas-díaz & marzánrodríguez (2007) role of emotions in hiv/aids stigmatization development exploratory perceptions of people living with hiv/aids and associated emotions ▪measure the different emotions ▪examine differences data collection in-depth interviews thematic analysis survey descriptive and inferential statistics ▪ t-tests waldrop (2007) caregiver grief triangulation embedded participants’ experiences measure dimensions of distress design level survey with open-ended and closed questions ▪ open and axial coding of qualitative data ▪ descriptive and inferential statistics ▪ t-tests advances in social work, fall 2013, 14(2) 323 yamatani, engel, & spjeldnes (2009) caseload standards for child welfare workers triangulation triangulation examine caseload service tasks in their context classify & record case management tasks interpretation focus group no specified method of data analysis) direct observation document review descriptive statistics yoo (2003) organizational characteristics and client outcomes expansion triangulation perceptions of the organization measure key outcomes e.g. job satisfaction interpretation in-depth interviews grounded theory document review survey descriptive statistics and inferential ▪ t-test yoon (2009) role of leadership, community cohesion and mental health in community rebuilding after a flood complementarity embedded ▪ views on elected leadership ▪ identify community assets ▪check convergent validity of data from surveys measure outcomes and examine variable relationships design level ▪in-depth interviews ▪document review no specified method of qualitative data analysis survey descriptive and inferential statistics ▪ spearman’s correlation advances in social work, fall 2013, 14(2) 324 common methods of qualitative and quantitative data collection table 3 presents all the methods of qualitative and quantitative data collection used in the reviewed articles. in-depth interviews were the most common qualitative data collection method, accounting for 41% of all the qualitative techniques reported in the articles, whereas surveys represented 55% of all the quantitative data collection techniques. table 3. methods of qualitative and quantitative data collection qualitative quantitative type count (%) type count (%) in-depth interviews 21 (41) surveys 30 (55) focus groups 13 (25) close-ended questions in questionnaire 12 (22) open-ended questions in questionnaire 12 (24) observations with rating scale 4 (7) secondary data 3 (5) document review 3 (6) document review 2 (4) web-based survey 2 (4) transformed data 2(4) conjoint analysis 1(2) total 51 54 common methods of quantitative and qualitative data analysis table 4 shows all the qualitative and quantitative data analysis methods employed in the reviewed articles. thematic analysis accounted for 29% of all the qualitative data analysis techniques and t-test represented 30% of all the quantitative data analysis methods. whereas all the quantitative data analysis techniques were elaborated, 12% of the qualitative data analysis techniques were not specified. key areas addressed by the qualitative and quantitative strands the key areas addressed by the qualitative and quantitative strands in the reviewed articles are summarized in table 5. drawing from table 5 three elements that mixed methods research adds to social work were categorized. first, mixed methods research adds voices of study participants to social work research. understanding participants’ experiences and views constituted 68% of the stated foci of the qualitative strand in the mixed method studies. the need to understand and incorporate client views and perspectives is central to social work practice and research because it is the means through which social workers are equipped to become the voice for their respective clientele (fernandez, 2008). advances in social work, fall 2013, 14(2) 325 table 4. methods of qualitative and quantitative data analysis qualitative quantitative type count (%) type count (%) thematic analysis 14 (29) t-test 18 (30) open coding 10 (21) chi-square 12 (19) content analysis 6 (12) anova 11 (20) constant comparative method 6 (12) pearson’s r 7 (12) not specified 6 (12) cronbach’s alpha 3(5) grounded theory 5 (10) logistic regression 2 (3) framework analysis 1(2) mann-whitney u 2 (3) discriminant analysis 1(2) friedman’s analysis of variance 1(2) spearman’s correlation 1(2) structural equation modeling 1(2) total 48 59 table 5. focus of qualitative and quantitative parts focus of qualitative part number (%) focus of quantitative part number (%) participants’ experiences 20 (39) measure/describe key constructs 38 (69) participants’ views/perspectives e.g. with program or intervention 15 (29) examine variable relationships 7 (13) examine process e.g. caseload service tasks in their naturalistic setting, interactions between case workers and clients 7 (16) examine differences 7 (13) validity issues e.g. check convergent validity 7 (14) validate instrument structure 3 (5) instrument development 1 (2) total 50 55 advances in social work, fall 2013, 14(2) 326 second, mixed methods research allows for comprehensive analyses of phenomena. central to this category is the realization that a single phenomenon can be best understood from different angles, such as perceptions held by the participants, underlying factors or process as well as the measurable or quantifiable trends and outcomes. to this end the foci of the reviewed studies illustrated these aspects with 29% of the focus areas related to capturing participants’ views/perspectives, 16% examining processes, 69% measuring or describing key constructs, and 13% examining variable relationships. for instance, in his study of the factors associated with community rebuilding after a flood, yoon (2009) used quantitative methods to examine relationships between various outcomes, whereas qualitative methods were used to gather views about elected leadership from diverse informants and to understand other important community assets. after data analyses, yoon found that while elected leaders’ ability to mobilize resources was significantly related to financial recovery, this specific community’s symbolic meaning as the first town chartered by african americans in the united states was also an important asset in the rebuilding process. thus, the ability to simultaneously measure outcomes and capture the context, processes, and participants’ views enable mixed methods research to achieve a more holistic analysis of phenomena. third, mixed methods research enhances the validity of findings. a basic foundation of mixed methods research is the notion of triangulation whereby “two or more methods that have offsetting biases are… intentionally used to assess the same conceptual phenomenon” (greene et al., 1989, p. 256). in addition, “triangulation of methods can provide opportunities for testing alternative interpretations,” such as the influence of context on the observed results (polit & beck, 2007, p. 310). validation of instrument structure accounted for 5% of all the quantitative strand foci whereas efforts to enhance validity, such as by checking for convergent validity, represented 14% of the qualitative strand foci. for example, in their study of well-being of mothers with families under stress, mcauley and colleagues (2006) used quantitative methods to assess the levels of parenting stress and depression among the mothers and qualitative methods to gather their experiences with parenting stress. after analyzing the quantitative data, these authors found that the mothers had high levels of parenting stress and depression, results which were supported by the symptoms reported by the mothers in the qualitative interviews. validity is enhanced when comparisons of results obtained across the quantitative and qualitative methods and data support each other (greene et al., 1989). discussion and social work implications to build our knowledge on the current state of mixed methods research in social work, this literature review examined the common quantitative and qualitative methods used by social work researchers and inferred the value of mixed methods research for social work based on the foci of the qualitative and quantitative strands. similar to reviews in other disciplines, surveys and interviews were the most common methods of quantitative and qualitative data collection, respectively (bryman, 2006; o’cathain et al., 2007). the dominance of in-depth interviews is acceptable because in-depth interviews facilitate access into participants’ cultures and perspectives, and shift authority away from the researcher to the participants (goodman, 2001). the recognition of document advances in social work, fall 2013, 14(2) 327 review as a method of gathering both qualitative and quantitative data is a positive development that may allow increased use of existing agency data by social work researchers, and thereby promote collaboration with social work practitioners. thematic analysis and t-tests were the most common methods of qualitative and quantitative data analysis, respectively. of particular concern 6 out of the 52 (12%) qualitative data analysis techniques used in the reviewed articles were not specified. this finding raises questions regarding the incorporation of qualitative research procedures. failure to elaborate on the qualitative data analysis methods may indicate possible difficulties in ensuring an acceptable balance to the integration of the quantitative and qualitative techniques. cognizant of the challenges associated with achieving competency in both qualitative and quantitative research, the promotion of team work when conducting mixed methods studies is encouraged (padgett, 2009; plano clark, huddleston-casas, churchill, o’neil green, & garrett, 2008). in addition, explicit teaching of mixed methods research in social work is warranted to familiarize social workers with mixed methods research terminology and procedures. the studies reviewed demonstrate that there are added advantages in using mixed methods research in social work. by allowing comprehensive analyses of phenomena mixed methods research echoes principles of social work practice that require social workers to “study things holistically, in context, and from more than one frame of reference” (cowger & menon, 2001, p. 477). given that social workers represent vulnerable populations, capturing the voices of our client groups may be integral to their emancipation and empowerment (fernandez, 2008; o’cathain et al., 2007). for these reasons, the teaching and use of mixed methods research remain integral to social work. this article would not be complete without an acknowledgment of the limitations of this study. first, the reviewed articles do not represent a comprehensive list of all possible mixed methods articles in social work. second, the researcher’s subjective judgment influenced the review process and understanding of the reviewed articles. despite these limitations, this study represents a preliminary attempt to systematically review the use and value of mixed methods research in published social work articles. most important, it provides social work researchers with examples of published mixed methods studies and advances our understanding of the value of mixed methods research in social work. conclusion this literature review examined the common quantitative and qualitative methods in published social work articles and what mixed methods research may add to social work. mixed methods research’s ability to simultaneously capture measurable outcomes, context, participants’ voices, and process underscores its value to social work research. giving voice to study participants and allowing for a holistic analysis of complex social problems may advance the development of useful knowledge and provide a richer understanding of the populations that we serve. even though the idea of mixing qualitative and quantitative methods is not new to social work practice, there is need for more research to understand how mixed methods research is taught and embraced in advances in social work, fall 2013, 14(2) 328 social work. social work educators and researchers may play a pivotal role in ensuring adequate training to conduct, consume, and assess mixed methods research. references abel, e., & campbell, m. 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(2002). the relationship between organizational variables and client outcomes: a case study in child welfare. administration in social work, 26(2), 39-61. yoon, i. (2009). a mixed-method study of princeville’s rebuilding from the flood of 1999: lessons on the importance of invisible community assets. social work, 54(1), 19-28. author note: address correspondence to: josphine chaumba, ph.d., department of social work, the university of north carolina at pembroke, one university drive, p. o. box 1510, pembroke, nc 28372. email: josphine.chaumba@uncp.edu aisw vol. 8, no. 1:aisw vol. 5, no. 2 a critical review of theory in social work journals: a replication study carolyn s. gentle-genitty virgil gregory corey pfahler misty thomas lisa lewis kim campbell kathy ballard kathy compton james g. daley abstract: the purpose of this paper is multifold. key aspects discussed include exploring the extent of theory discussion and progression in social work journals for the year 2004; discussing the necessity of theory in social work research and practice; reviewing previous research literature regarding evaluation of theory discussion and progression; proposing criteria for defining theory in social work journals; and presenting findings from the current study concerning theory discussion and progression in social work journals. results: of the 1,168 articles reviewed from 37 journals, 71 (approximately 6%) met the criteria for theory development with empirical base. thus, a minimal number of articles (3 out of 71 or 4.2%) evaluated, based on the criteria in the theory quality scale (table 1), received high quality ratings. conclusion: based on the results yielded by the analysis, we assert that social workers need to make a conscious effort to include theory in practice decisions. keywords: theory, social work theory, empirical assessment of theory, social work practice, theory progression, human behavior, and the social environment (hbse) theories provide a lens to help us frame the complex interplay between humans and their environment. a large part of this understanding occurs within the context of practice, specifically social work practice. bartlett (2003) and pinderhughes (1996) define this practice as one that endeavors to define a roadmap of a myriad of methods, knowledge, sanctions, values, and purposes for social workers. this practice, the habitual actions of 62 carolyn s. gentle-genitty, virgil gregory, corey pfahler, misty thomas, lisa lewis, kim campbell, kathy ballard, and kathy compton are doctoral students, and james g. daley, ph.d. is associate professor at the indiana university school of social work, indianapolis, in, 46202-5156. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 62-80. indiana university school of social work. 63 actors, and the rules that govern their field (andermahr, lovell, & wolkowitz, 1997), enables social workers, retrospectively and prospectively, to explain and forecast relationships and actions of human behavior (thyer, 2001). nestled neatly within the purposes of social work, social work practice provide skills “to identify, analyze, implement empirically based interventions to achieve client goals; apply empirical knowledge; evaluate program outcomes and provide leadership in the promotion of social and economic justice” (schriver, 2004, p. 5). there are still questions about social work practice and what it is expected to do. for instance, what actually helps to frame social work practice? how do social workers justify practice approaches utilized to attain their goals? answers to these questions help to shape the current discussion. the authors purport that theory and theory progression is what ties these questions together. the question concerning how theory is disseminated among social work professionals is raised. journals serve as a major source for theory dissemination (lindsey & kirk, 1992). for this reason, theory development and discussion is an important component for researchers to address, as well as for journals to publish. the purpose of this paper is multifold: 1.to explore the extent of theory discussion and progression in social work journals for the year 2004; 2.to discuss the necessity of theory in social work research and practice; 3. to review pertinent literature concerning previous research conducted regarding evaluation of theory discussion and progression in social work journals; 4. to propose criteria for defining theory in social work journals; 5. to present findings from the current study concerning theory discussion and progression in social work journals. defining theory social work practice is framed by theory and its modus operandi. theory, turner (1996) outlines, “emerges from the process of ordering facts in a meaningful way” (p. 3). he highlights that theory spotlights notable patterns and relationships that bring homeostasis and stability to the intricacies of practice. failure to do this leaves practice to “guesswork” and “impressionistic responses” to client situations (turner, 1996). a key limitation of theory for practice, turner (1996) warns, is when it becomes “overly cerebral and mechanistic, stressing labeling and classifying, rather than on the individuality of each client and situation it can become an end in itself” (p. 13). a great limitation of bridging theory to practice is that it has become too cerebral. on a whole, the result is that direct and indirect practitioners do not see its relevance to their daily work (rosen, proctor, & staudt, 2003; thyer, 2001). theory may also be defined as “a reasoned set of propositions, derived from and supported by established evidence, which serves to explain a group of phenomena” (schriver, 2001, p. 119). on the other hand, robbins and colleagues suggest gentle-genitty et al./a critical review of theory in social work journals: a replication study 64 that theories “consist of a series of relatively abstract and general statements that collectively purport to explain (answer the question “why?”) some aspect of the empirical world (the “reality” known to us directly or indirectly through our senses)” (p. 5). theory provides practitioners with a systematic method to conceptualize information about individuals, their behavior, and the contexts in which they interact and live. the importance of theory is often emphasized (payne, 2005; robbins et al., 1999; schriver, 2001; turner, 1996) and, realizing that social work is at a critical juncture (finn & jacobson, 2003), there is a current call for theory to play a more integral part in practice—a part that takes the “guesswork” from practice, allowing relationships to be defined via patterns and a specific theoretical lens (turner, 1996), while also empowering social workers to validate their chosen methods of intervention. importance of theory in social work practice rightly so, there has been much debate about the importance of theory in social work practice (gomory, 2001; thyer, 1994). the preceding paragraphs give a brief overview of such a debate. for instance, thyer adopts the stance that teaching and the utilization of theory among undergraduate and master’s level social work students is “largely a waste of time” (p. 148). thyer provides the following three explanations for this stance. first, social work educators lack skills to adequately teach social work theory. second, the majority of theories taught in the social work profession are incorrect. teaching incorrect theories may lead to ineffective methods used in social work. third, while theory attempts to explain outcomes for treatment effectiveness, many outcomes may be explained by other theories or factors. thyer asserts that, recognizing that outcomes may be explained by various theoretical explanations, is unnecessarily complicated. conversely, gomory (2001) refutes thyer’s (1994) stance regarding the importance of teaching theory in social work, as he feels that the use of theory to guide social work research and practice is of major importance. gomory emphasizes the use of “trial and error” among social work professionals (p. 47) to develop educated and autonomous opinions of how theory should guide research and be applied to practice interventions. specifically, the use of theory in social work practice is essential; it provides many more reasons, irrespective of the debate. these reasons may include but are not be limited to the provision of guidelines for practice and policy, treatment and intervention development, and direct social work research. general guidelines provided by social work theory may be useful in providing information about what policies are necessary to change conditions for target groups and vulnerable populations (robbins et al., 1999). the framework provided by theory may be useful by social workers to develop treatment and intervention plans to enhance the functioning of individuals and society (robbins et al., 1999; schriver, 2001). lastly, theory may be used to direct social work research (robbins et al., 1999). research provides a foundation to explain how and why certain conditions and behaviors occur and provides an approach to effectively guide interventions. advances in social work 65 evaluation of theory quality and progression while there is debate as to whether the use of theory is essential in the profession of social work (gomory, 2001; robbins et al., 1999; thyer, 1994), it may be asserted that theory is important to knowledge development. the use of theory to guide research and inform practice is not infallible. however, when examined under a critical lens, theory provides social workers with guidelines to explain and predict outcomes (schriver, 2001). journals are one of the primary means of knowledge development and dissemination among social work professionals. because journals are the primary means through which knowledge of theory is disseminated, these questions are posed: how do social work professionals define the value and credibility of a particular theory? how does one evaluate the quality of a particular journal in which a theory is published? when evaluating the value and credibility of a theory, it is necessary to discuss two topics: theory discussion and theory progression. theory discussion may be simply stated as that discussion of theory within the context of a journal article. discussion of theory may range from merely mentioning a particular theory to discussing the basic premises of that theoretical construct. including discussion of theory in a journal article does not indicate an in-depth examination of the theory. rather, theory discussion may be defined as a superficial description of the theory that does not include exploration of the components or empirical base of the theory. theory progression takes theory discussion further—to explore the components of the theory, examine the empirical basis and supporting arguments, and provide knowledge concerning future development of the theory. a number of authors have developed criteria for evaluating theory quality and development (fischer, 1973; payne, 2005; robbins et al., 1999; witkin & gottschalk, 1988). these authors propose a set of criteria that they believe is adequate for evaluating theory quality and development. payne (2005) provides a critique of five authors’ framework for evaluating theory quality and development. however, he does not propose a synthesizing rating system to evaluate theory, but merely a critique (payne, 2005). fischer (1973) proposed a framework for analysis of theories of therapy. fischer’s main goals for the development of this framework were twofold. one goal of the framework was to serve as a guide for addressing questions raised by clinical therapies. a second goal was to provide guidance in evaluating these theories based upon the questions raised. fischer provided five basic areas in which clinical theories may be analyzed: 1) structural characteristics, 2) characteristics as a theory of therapy, 3) empirical status, 4) assumptions about the nature of man and moral implications, and 5) applicability to social work. fischer also provided a four-point criterion scale for theory rating. robbins and others (1999) proposed criteria for evaluating theory in social work practice. these authors offer three criteria for theory evaluation: 1) theories for social work practice should be consistent with social work values and ethics; 2) theories for social work practice should be subjected to scientific scrutiny, methodologically sound research, and be verifiable, and 3) theories for social gentle-genitty et al./a critical review of theory in social work journals: a replication study 66 work practice should do no harm. each criterion and the application of the criterion to social work practice are discussed in detail. witkin and gottschalk (1988) state that the traditional criteria often utilized to evaluate social work theory are inadequate. the authors propose the utilization of four additional criteria for theory evaluation. criterion one states that theory should be explicitly critical. criterion two states that the theory should recognize humans as active agents. criterion three states that the theory should account for the life experiences of the client. criterion four states that the theory should promote social justice. the authors provide an explanation for each criterion and its application. using this framework, the authors assert that theories that correspond to these criteria are preferable to theories that do not meet them. while several authors (fischer, 1973; payne, 2005; robbins et al., 1999; witkin & gottschalk, 1988) have proposed criteria for theory evaluation, the researchers have found these criteria to be inadequate. the researchers developed criteria to ensure that the journals selected for review would reflect social work content. after selecting journals for review, the researchers reviewed articles in the selected journals based on criteria to determine if the article contained theory discussion. if theory discussion was present to a certain extent, the researchers further evaluated the theory discussion in that article against a second set of criteria. the following methods section provides an explication of the procedures that guided our inquiry. admittedly, this statement could also use some work. method two-hundred and sixty-eight social work journals from 2004 were selected for review. these journals were selected based on social work journals available at the indiana university purdue university (iupui) university library and from the website http://cosw.sc,edu/swan/media.html. these journals were considered “social work” journals by the iupui library. seventeen theory progression team members reviewed the two lists for repetition and condensed the list to 220 journals. these 220 journals were cross-referenced with the authors guide to social work journals (nasw, 1997) for congruence with the social work profession. this process further narrowed the list to 54 social work journals. theory progression team members developed a list of criteria to ensure that the journals would reflect social work content. the criteria were as follows: the journal must be peerreviewed and meet at least one of the following criteria: 1. published by a school of social work or a professional social work organization. 2. the mission statement places primary emphasis on social work or social workers. 3. “social work” appears in title of the journal. to ensure inter-rater reliability, team members independently reviewed three articles for theory quality. an inter-rater reliability (kappa) of .85 was obtained from all raters prior to starting the review process. the theory quality scale included nine criteria. each criterion was a statement regarding the article’s fulfillment of a specific characteristic and received a rating from 1 to 5 (table 1). if the article fully satisfied the purpose of the specific criterion in question, that artiadvances in social work 67 cle received a score of 5, which indicates full credit for that criterion. if an article completely failed to satisfy the criterion in question, that article was given a score of 1. subsequent to determining inter-rater reliability, team members reviewed the 54 journals against criteria put forth by the theory progression team. this narrowed the list to 41 journals. these 41 journals were divided among seven team members. the team members reviewed each journal and its respective articles for the year 2004. due to pragmatic reasons such as inability to access journals electronically or manually, and due to some journals no longer being in publication, four journals could not be accessed. one-thousand one-hundred and sixty-eight articles were reviewed for inclusion of theory. all of the articles in each of the journals were rated according to the journal inclusion of theories scale. the articles were searched via online databases, including ebso host, expanded academic, asap, and via the library of iupui catalog of electronic journals. when journals were not available for review electronically but were accessible manually, hard copies of the journals were obtained and their subsequent articles reviewed. articles were evaluated according to the overall role that theory played in the article, the extent to which the theory was included in the article, and the presence or absence of empirical evidence in the article. this rating scale ranged from 0 to 6 to indicate articles that had no empirical or theoretical links all the way to articles whose purpose was theory development and analyzed empirical data to support its development (table 2). articles that received a rating of 5 or 6 on the journal inclusion of theories scale were further reviewed utilizing the theory quality scale. subsequent to reviewing each article, a sum score for the number of articles that received a particular score on the inclusion of theories scale was calculated. all of the journals with articles that were included in the final analysis were classified according to the educational policy and accreditation standards (epas) gentle-genitty et al./a critical review of theory in social work journals: a replication study criteria score components of theory are described in a tight, internally consistent framework clearly describes each variable within the theory clearly operationalizes the relationship between the variables within the theory clearly describes goals or outcomes intended with theory clearly describes the boundaries or limitations of the theory clearly describes the empirical data that support the premises of theory clearly builds upon previous studies that demonstrate the efficacy of the theory clearly concludes with specific next steps for theory progression clearly expresses the framework for exploring and/or responding to issues of social justice scoring: 5 = strongly agree 4 = moderately agree 3 = slightly agree 2 = moderately disagree 1 = strongly disagree table 1: criteria for theory quality 68 content areas. these content areas include values and ethics, diversity, populations-at-risk and social and economic justice, human behavior and social environment, social welfare policy and services, social work practice, research, and field education. the publishers’ descriptions of their respective journals were used to classify the journals according to the epas content areas. the descriptions of each of the respective journals were found online, most via publisher websites. the journal classification process involved treating the content areas as if they were mutually exclusive and exhaustive; therefore, all of the journals were classified according to only one of the eight content areas. all journal descriptions referenced more than one epas content area; therefore, the content area classification was based on the journal’s primary purpose and title. admittedly, due to each journal referencing several of the epas content areas, the process of classification was somewhat subjective. this subjectivity was decreased by using the journals’ mission and other key descriptive traits as the primary determinants that guided the classification process. the results suggest, however, that practice journals are much more theory-driven than any other journal, despite the fact that the number one rated article was a research journal. results of the 1,168 articles that were reviewed, 71 (approximately 6%) met the criteria for theory development with empirical base (tde) or theory development/explanation as the focus of the article (tdf). table 3 includes a breakdown of journal ratings by degree of discussion of theory (based on journal and theory evaluation criteria, table 2) for each of the 1,168 articles reviewed. given that the purpose of this study was to explore the extent of overall theory discussion and progression in social work journals for the year 2004, the names of the journals that were reviewed are not disclosed, rather, the journals are represented by numerical codes, as it was not our intent to identify which journals support the importance of theory discussion as indicated by articles chosen for publication. overall, the results illustrate minimal focus on theory within the 37 journals selected for advances in social work score rating # of sum % of articles score total 6 theory development with empirical base as the focus of the article (tde) 5 theory development/explanation as the focus of the article (tdf) 4 empirical study that has theory links (et) 3 non-empirical article with theory links (netl) 2 empirical study with brief theory links (ebt) 1 empirical study with no theory links (ent) 0 studies with no empirical or theory links (net) total 100% scoring: sum score divided by the number of articles table 2: theory evaluation criteria 69gentle-genitty et al./a critical review of theory in social work journals: a replication study journal journal tde tdf et netl ebt ent net total % tde type articles or tdf 22 research 1 3 0 0 2 3 0 9 44.44 7 practice 10 7 5 1 9 14 1 46 36.96 36 social 0 2 0 1 2 0 1 6 33.33 service & social welfare policy 6 practice 0 6 1 11 1 2 3 24 25.00 12 population 0 3 0 0 5 2 5 15 20.00 at-risk 15 hbse 2 4 8 3 8 7 3 35 20.00 30 hbse 5 2 0 4 1 11 15 38 18.42 26 practice 0 2 0 2 1 9 7 21 9.52 20 practice 0 2 1 0 3 16 1 23 8.70 33 field 0 2 1 3 2 5 11 24 8.33 education 3 practice 0 4 3 14 16 18 7 62 6.45 14 practice 1 0 1 2 0 8 4 16 6.25 13 practice 1 1 1 3 4 17 6 33 6.06 2 hbse 0 1 0 6 3 5 3 18 5.55 10 practice 0 2 0 0 1 14 21 38 5.26 24 practice 0 3 4 8 11 22 10 58 5.17 5 research 0 1 1 14 0 0 4 20 5.0 4 research 1 0 3 2 7 8 2 23 4.35 11 practice 1 0 3 0 2 18 0 24 4.17 29 practice 1 0 4 7 2 10 5 29 3.45 25 social 0 1 1 0 4 17 7 30 3.33 services & social welfare policy 23 practice 0 1 2 1 7 30 2 43 2.33 32 social 1 0 3 3 2 37 23 69 1.45 services & social welfare policy 1 hbse 0 0 4 9 0 2 63 78 0.0 19 practice 0 0 0 1 4 10 0 15 0.0 21 diversity 0 0 0 0 3 9 0 12 0.0 27 practice 0 0 0 10 2 2 20 34 0.0 table 3: journal ratings by degree of discussion of theory 70 review. twelve of the 37 journals, or 32%, contained no articles with tde or tdf, while three of the 37 journals, or 8%, contained 30% or more articles with tde or tdf. articles containing tde or tdf were further evaluated for theory quality using the criteria in the theory quality scale (table 1). the purpose of this two-step evaluation process was to identify articles that focused on theory development with empirical base or theory development/explanation (tde or tdf) as a first step followed by a second assessment of the quality of theory discussion. factors considered in assessing the quality of theory discussion, included a tight internally consistent framework, operationalization of variables, limitations of theory, identification of steps for theory progression, or consideration of theory with regard to social justice. the theory quality scale (table 1) was developed based on the work of daley and others (2005) and factors blended from the models described advances in social work journal journal tde tdf et netl ebt ent net total % tde type articles or tdf 28 social 0 0 1 4 1 13 14 33 0.0 services & social welfare policy 17 field 0 0 0 1 1 3 9 14 0.0 education 8 hbse 0 0 0 11 0 0 13 24 0.0 31 field 0 0 0 5 1 11 26 43 0.0 education 9 social 0 0 0 6 9 9 13 37 0.0 services & welfare social policy 16 social 0 0 0 5 0 4 10 19 0.0 services & welfare social policy 34 practice 0 0 0 1 1 0 13 15 0.0 35 field 0 0 2 1 2 4 15 24 0.0 education 18 practice 0 0 1 1 0 21 10 33 0.0 37 practice 0 0 3 5 27 22 26 83 0.0 total: 24 47 1,168 tde=theory discussion with empirical base as the focus of the article; tdf=theory discussion as the focus of the article; et=empirical study that has theory links; netl=non-empirical article with theory links; ebt=empirical study with brief theory links; ent=empirical study with no theory links; net=studies with no empirical or theory links. table 3: journal ratings by degree of discussion of theory (cont.) 71 in the “evaluation of theory quality and progression” section. table 2 presents the discussion of theory quality scores for those articles containing tde or tdf. each theory progression team member reviewed articles containing tde or tdf using the nine criteria are listed in table 4. each of the 71 articles containing tde or tdf were evaluated by one team member and was assigned a rating ranging from 5 to 1 (strongly agree to strongly disagree, respectively) for each of the nine criteria in table 1. the rater then computed the mean score for the article (total divided by nine). the mean score for the 71 articles was 3.7, with three articles scoring 5, 21 articles scoring 4 or higher, and nine articles scoring 3 or less. thus, a minimal number of articles (3 out of 71 or 4.2%), which were evaluated based on the criteria in table 1, received high quality ratings. gentle-genitty et al./a critical review of theory in social work journals: a replication study theory rating author & year of publication queer theory 45 mcphail, 2004 housework theory 45 kroska, 2004 feminist theory 45 chafetz, 2004a abcx model and resiliency 44 vandsburger & biggerstaff, 2004 role theory 44 landry-meyer & newman, 2004 feminist theory 43 mack-canty & wright, 2004 feminist theory 43 walker, 2004 feminist theory 43 baber, 2004 gender construction theory 43 zuo, 2004 feminist theory 43 chafetz, 2004b social capital theory 42 anguiano, 2004 feminist theory 42 allen, 2004 nested ecological theory 41 cottrell & monk, 2004 transtheoretical model 40 corden & somerton, 2004 the theory of mindful space 40 burlae, 2004 family systems theory 40 vandervalk et al., 2004 risk and resilience 39 corcoran & nichols-casebolt, 2004 feminist theory queer theory, 39 wood, 2004 gender theory social theory, queer body theory disability theory responsive regulation 39 pennell, 2004 teaching family life cycle 38 richman & cook, 2004 social-psychological attitude theory 37 kahng & mowbray, 2004 table 4: theory listing of 2004 journal review 72 advances in social work theory rating author & year of publication attachment theory 37 applegate, 2004 object relations theory psychoanalytic theory cognitive theory generalized event theory systems theory non-linear dynamic systems theory (also known as complexity or chaos theory) restorative justice 36 crampton, 2004 decision-making theory 36 smith & moen, 2004 life course theory 36 crosnoe & elder, 2004 marx alienation theory 35 ferguson & lavalette, 2004 procedural justice 35 neff, 2004 field instruction 35 fox, 2004 trauma theory 35 mohr, 2004 psychoanalytic 34 jones, 2004 transtheoretical model of change 34 mcguire, 2004 capitol theory 34 ferguson, 2004 psychoanalytic theory 33 bright, 2004 family stress theory 33 abbott et al., 2004 responsive regulation 33 burford & adams, 2004 social constructionism 33 montgomery, 2004 health belief model 33 sullivan et al., 2004 trauma 33 regehr, hemsworth, leslie, howe & chau, 2004 attachment theory 32 bennett, 2004 personal authority in family system 32 lawson & brossart, 2004 relational theory 32 dietz & thompson, 2004 self-in-relation theory 31 lesser, o’neil, burke, scanlon, hollis, & miller, 2004 stigma theory, feminist theory 31 lipton, 2004 lacanian analytic theory 31 baylis, 2004 theory of control mastery 31 nol, 2004 social learning theory self-psychological theory 31 dick, 2004 psychodynamic theory 31 brandell & ringol, 2004 triangle of political space 31 kelly, 2004 restorative justice table 4: theory listing of 2004 journal review (cont.) 73 limitations there are several limitations inherent to this type of study. it is necessary to consider differences in editorial policy and practice regarding the level of importance placed on theory discussion, which undoubtedly varies from journal to journal. these differences in editorial policy and practice represent numerous potential biases that would directly affect our results. one possibility to consider is that authors may limit their discussion of theory due to the restrictions placed on manuscript length, often 20 pages or less, by peer-reviewed journals. an alternative explanation is that authors are submitting articles that incorporate theory gentle-genitty et al./a critical review of theory in social work journals: a replication study theory rating author & year of publication community family therapy 31 rojano, 2004 meta-theory 30 houston, 2004 grief theory 30 brownlee & oikonen, 2004 psychoanalytic theory 30 alperin, 2004 gender entrapment theory 30 bent-goodley, 2004 ethnic identity theory 30 margaret o’donoghue racial identity theory black racial identity development (brid) *white racial identity development (wrid) gender-role androgyny theory 30 utz et al., 2004 imposter phenomenon 29 castro et al., 2004 empowerment theory) 28 manning, cornelius, & okundaye, (afrocentric perspective 2004 political economy theory 28 mulroy & tamburo, 2004 emancipatory disability theory 27 o’connor et al., 2004 attachment theory 27 wampler, riggs & kimball, 2004 critical theory 26 keenan, 2004 organization in environment 26 mulroy, 2004 attachment theory 26 allen & baucom, 2004 attachment theory 25 gubman, 2004 attachment theory 25 ringel, 2004 object relations theory intersubjective theory psychoanalytic theory 24 steger, 2004 role model theory 24 baum, 2004 theory of change 23 little & girvin, 2004 ecosystemic 23 coffey, 2004 psychoanalytic theory 22 sanville, 2004 feminist theory 20 blume, 2004 table 4: theory listing of 2004 journal review (cont.) 74 discussion, and these articles are being rejected for publication. consideration of articles that are rejected for publication would be an interesting addition to future studies of this nature. some additional limitations of this study that necessitate consideration prior to any conclusions drawn about theory progression based on our data are numerous. first, while the authors obtained inter-rater reliability scores at two points in this study, the ratings were subjective in nature. thus, there is most likely some variability in scores assigned during tde and tdf classification (table 2), as well as during evaluation of theory quality (table 1). second, the criteria included in tables 1 and 2 were developed by daley and others (2005). although these scales were developed based on the previous work of daley et al., 2005 and factors blended from the models described in the “evaluation of theory quality and progression” section, it is necessary to recognize biases inherent to this type of process. third, our data reports on only 37 journals reviewed for this study. there are numerous social work journals, as evidenced by the reduction process in this study, which decreased the original 268 journals selected for review to the 37 journals ultimately reviewed. related to this limitation is the fact that we limited our review to peer-reviewed journal articles and did not consider other types of publications. fourth, it is highly likely, given the interdisciplinary nature of the profession, that many social work theorists publish articles containing more extensive theoretical discussion in non-social work journals. considerations for future studies studies of this nature are limited. while reviews of the literature resulted in the identification of articles relating studies of a similar nature (cnaan, caputo, & shmuely, 1994; furr, 1995; gomory, 2001; lindsey & kirk, 1992; sellers, mathiesen, perry, & smith, 2004), these authors did not evaluate the quality of theory discussion or progression within social work journals. rather, the focus of these authors was more relevant to the role of theory in social work research and practice (gomory, 2001), prestige of journals (cnaan et al., 1994), the role of social work journals in the development of the profession (lindsey & kirk, 1992) and assessing journal quality based on citation counts (furr, 1995; lindsey & kirk, 1992). to the best of our knowledge, daley and others’ pilot study (2005) was the first of its kind; the current study is a follow-up to that work. considering this was a pilot study, there were many lessons learned, and the authors offer several suggestions for future studies of this nature. first, while table 3 represents the immense diversity of theories identified within the articles reviewed and evaluated for this study, it is difficult to discern from our results the contribution that these articles make to the progression of a particular theory. a review of the theories listed in table 3 indicate a discussion of micro, mezzo, and macro level theories, incorporating the inclusion of well-known theories (attachment theory, systems theory, feminist theory, psychoanalytic theory) as well as highly focused theories (gender-role androgyny theory, grief theory, queer theory, theory of mindful space). thus, the development of methodology to ascertain the progression of a particular theory would be a beneficial addition to future studies of this nature. advances in social work 75 second, as noted in the “limitations” section, interpretations based on our results are limited to articles published in 2004 that appeared in the 37 journals reviewed for this study. therefore, the consideration of alternative methods of journal/article selection represents the potential for increasing the knowledge base with regard to theory discussion and progression in social work journals. as mentioned previously, it would be interesting to obtain articles submitted and subsequently rejected for publication by various social work journals. evaluating articles rejected for publication based on the criteria utilized in the current study would provide additional information pertaining to the level of importance placed on theory discussion and progression by social work journal editorial boards. an additional alternative method of selection would be to review journals classified by baker (1992) as the “core of the social work journal network” (p. 160). baker (1992) identified five journals considered the “core of the social work journal network,” including social work, social service review, families in society, the journal of social work education, and social work research and abstracts (now two separate journals, social work research and social work abstracts) (p. 160). future studies could compare theory discussion and progression as found in articles published in these journals and classified by baker (1992) as central to the social work profession to other “non-core” social work journals. lastly, the authors recommend that follow-up to this study be conducted in a quasi longitudinal manner to assess the consistency or lack thereof of the degree of theory discussion and progression in social work journals from one year to the next. an alternative to considering undertaking concurrent with future studies that attempt to ascertain the degree of consistency of theoretical discussion in social work journals would be to add the component of comparing social work journals with other professions’ journals. the purpose of this additional component would be to determine whether social work journals contain more or less theory discussion than the profession chosen for the comparison. discussion according to sellers and colleagues (2004), for numerous reasons, evaluating the quality of social work journals is an important aspect of professional social work. explanations offered by the authors (sellers et al., 2004) in support of this contention include: 1. the tremendous increase in the number of social work journals makes it nearly impossible for professionals to read or evaluate all available publications. 2. as a multidisciplinary profession, social work professionals face the additional challenge of reading, evaluating, and writing for journals across diverse fields. 3. the assessment of journals that are considered to be of high quality offers guidance and direction to researchers, writers, and readers, because these publications would presumably model strong research methods, conceptual rigor, and valuable techniques of presentation. 4. for many faculty, being published in prestigious journals may increase the likelihood of pay raises, promotions, and recognition from colleagues (p. 143). gentle-genitty et al./a critical review of theory in social work journals: a replication study while sellers and colleagues are referring to the quality of social work journals in general, rather that specifically addressing the quality of theory discussion within social work journals, we contend that evaluation of the quality of theory discussion is imperative for the same reason as well as additional reasons. marsh (2002) suggests that the role and function of social work journals is a long-standing disparity among social work professionals, especially in consideration of those academic publications whose focus is limited with regard to practice application. given that theory provides 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(2004). the gay male gaze: body image disturbance and gender oppression among gay men. journal of gay and lesbian social services, 17(2), 43-62. zuo, j. (2004). shifting the breadwinning boundary: the role of men’s breadwinner status and their gender ideologies. journal of family issues, 25(6), 811-832. author’s note: address correspondence to: carolyn s. gentle-genitty, msw, doctoral student, school of social work, indiana university, 902 west new york street, indianapolis, in 46202-5156, usa. e-mail: cgentleg@iupui.edu. 80 advances in social work aisw vol. 5, no. 2 305 social work in natural disasters: the case of spirituality and post-traumatic growth li-ju jang walter f. lamendola abstract: this study explored the role of social work in natural disasters by examining the relationship between spirituality and the posttraumatic growth of people in a collectivist culture. in this case, a retrospective study was conducted among people in taiwan who had survived a major earthquake five years earlier. the hypothesis tested was that those who reported higher levels of spirituality would also report higher levels of posttraumatic growth. a concurrent triangulation mixed-methods designwas employed for this study.six hundred and forty participants completed the posttraumatic growth inventory (ptgi). twenty-eight others participated in semistructured in-depth interviews. results indicate that, in taiwan—described here as a collectivist culture—traditional cultural narratives around suffering and adversity, many of which are voiced as spiritual beliefs, have a significant effect on posttraumatic growth. in this situation, social workers need to work with or support spiritual leaders, folk healers, and indigenous religious organizations, as they provide helping services. respect for cultural differences may require that social workers primarily act as community organizers or developers,not clinicians focusing on coordination and development of material resources. keywords: spirituality, posttraumatic growth, natural disaster, hakka spirit, symbolic interactionism introduction on september 21, 1999, a devastating earthquake with a magnitude of 7.6 on the richter scale, which taiwanese people refer to as the 921 earthquake, struck central taiwan. the earthquake was responsible for approximately 2,423 deaths and 11,305 injuries. more than 100,000 people were left homeless. of all the affected townships, tung shih suffered the highest death toll, with 358 (“social aid,” n.d.; liao, 1999). this article reports on a study of tung shih earthquake survivors and service providers, with a focus on social workers and the extent to which spirituality contributed to the posttraumatic growth of survivors. li-ju jang, ph.d. is an assistant professor in the school of medical sociology and socialwork, chung shan medical university, taiwan, republic of china. walter f. lamendola, ph.d. is professor, graduate school of socialwork, university of denver, denver, co 80208. copyright© 2007 advances in socialworkvol. 8 no. 2 (fall 2007) 305-316. indiana university school of socialwork. advances in socialwork spirituality and natural disasters tedeschi and calhoun (1995) have argued that spirituality—in the form of religious beliefs—can offer a direct means for survivors to perceive benefit evolving from disasters. later work has continued to make the case, though in more general terms. for example, saleebey (2002) claimed that spirituality influences survivor coping styles both in the face of disaster and in their ensuing daily life. cadell, regehr, and hemsworth (2003) agreed, arguing further that making sense of an event—attaching meaning to it—is an essential component of successful coping that survivors often attempt to resolve through spirituality (p. 280). nathanson (2003) contributed an important and perhaps distinguishing qualifier by, not only claiming that “spirituality is an important force in recovery” (p. 63), but also by pointing out that spirituality has historically been associated, across different cultures and religions, with the human search to find meaning in suffering. this was also noted by tedeschi and calhoun (1995, 1996), who incorporated spirituality as a subscale in their posttraumatic growth inventory (ptgi). in taiwan, a collectivist culture with strong clan ties, spirituality is seen as both a philosophy and a way of life—primarily expressed through a variety of religious traditions. notions of living harmoniously with nature are a predominant feature of spirituality. nature is an active force in everyday life, particularly in the region included in this study, where natural disasters, though varying in intensity and severity, are frequent. generally speaking, people in taiwan consider natural disasters the will of the gods (davison & reed, 1998; jordan, 1999). spirituality in taiwan is based on a set of beliefs in the fundamental interconnectedness of all natural things and all forms of life, that “all things of heaven and earth are connected by the life force” (davison & reed, 1998, p. 32). these cultural beliefs conform to a pattern strongly noted by social work writers in western cultures and subcultures, where investigations also indicate that a conflation of spirituality and religion occur in social performance (amato-von hemert, 1994; canda, 1998; coholic, 2003; lowenberg, 1988; sheridan, bullis, adcock, berlin, & miller, 1992). for example, in coholic’s study of spirituality and religion among feminists, coholic noted that, while spirituality and religion are conceptualized in different ways, they “overlap and influence each other...” (p. 49). further, the reports of her study participants emphasized: the development of spirituality is, above all, a complex and lifelong process that sometimes encompasses struggle. the process of spiritual development can be influenced by family, friends, culture, religious/spiritual traditions, and transformative life events, which can act as catalysts for spiritual discovery and exploration (p. 62). every one of the influences on the process of spiritual development described by coholic (2003) are important to social workers and are applicable to the situation described in this study. however, the study situation is also notable as an example of the difficulties of conductingwesternworld social work successfully 306 in a collectivist culture like taiwan. the cultural narrative of the hakka spirit in taiwan, described briefly in the next section and elsewhere (jang & lamendola, 2006), is an example. in the spirit of thehakka pioneers, the narrative of their past becomes what mink (1987) would call a “...primary cognitive instrument … rivaled only by theory and metaphor as irreducible ways of making the flux of experience comprehensible” (p. 3). survivors of the earthquake especially note the palpable influence of hakka aphorisms on their behavior. this type of narrative contributes aswell to the development of whathieb (2002), in his study of the hopi, has called a “moral community.” such beliefs are considered a key facet to consider in contemporary risk management (paton, 2006) and social work interventions; for example, it is thought that beliefs that a spiritual life force is “watching over” daily needs may bring great comfort to survivors and actually promote resilience and growth in the aftermath of trauma. growth from trauma is a notion that can escape notice in much of the social work disaster literature. while definitions of resilience, common in social work (e.g., barker, 1999, p. 411), infer that there are intrinsic resources that can be called upon to maintain or regain pre-disaster levels of functioning, recent research has gone further, identifying transformations that go beyond a return to pre-disaster functioning levels in a manner characterized by growth (paton, violanti & smith, 2003; violanti, paton, & dunning, 2000). violanti et al. (2000) have acknowledged that the paradigm in disaster studies is progressively shifting from a pathologic one with a focus on loss or negative psychological outcomes to a salutogenic one.violanti et al. claimed that a salutogenic paradigm directs researchers to look at natural coping resources and encourages them to consider how individuals, families, and communities can draw upon family and social support, as well as other resources to facilitate resilience. salutogenesis refers to people’s ability to thrive in disasters, to achieve greater personal strength, and to have a better understanding of the disaster. in line with violanti et al., norwood, ursano, and fullerton (2000) have suggested that a paradigm shift from a focus on disease to health is necessary in the field of disaster psychiatry. they have encouraged psychiatrists to facilitate the natural recovery process and prevent psychiatric concerns, instead of treating pathology. in addition, ursano, fullerton, and norwood (1995) found that, for some survivors, trauma and loss facilitate a move toward health. they argued that a traumatic experience can help survivors recognize a previously disorganized life and re-evaluate their values and goals—citing other disaster studies to support their claims: many survivors of the 1974 tornado in xenia, ohio . . . learned that they could handle crises effectively (84%) and believed that they were better off for having met this type of challenge (69%) (taylor, 1997; quarentelli, 1985) . . . sledge and colleagues (1980) found that approximately one-third of u.s. air force vietnam-era prisoners of war reported having benefited from their prisoner of war experience; they believed that they had developed an important reprioritization of their life goals, placing new emphasis on the importance of family and country (p. 197). jang, lamendola/spirituality and posttraumatic growth 307 advances in socialwork symbolic interactionists might argue that spirituality would be, to some extent, shaped by the traumatic experience and constructed continuously through interactions between people, creating bonds of shared meanings in the process. in such a view, the social work frame of reference for spirituality would include: a) social processes, b) social norms, c) shared meanings, and d) context (blumer, 1969; mead, 1934). this is the frame of reference for spirituality in this study—as a dynamic but also a historically-based narrative that “everybody knows” in mink’s (1987, 2001) terms—one that re-minds people as they act and react to their situation. an example of this is a hakka folk song (table 1) known bymost people in the region. for the authors, this song represents the hakka view of the world, a world occupied by a people who are guided by the practices of those before them, but who ultimately use the memories of the past to create new forms in the present. it allowed us, as social work researchers, to hear the human promise of disaster. in that promise, survivors act in purposeful ways, reminded by their ancestors and their historical understanding to use social practices of great power, such as those embedded in their song, as a spiritual narrative to transform their lives. methodology a mixed-methods design that creswell (2003) terms a concurrent triangulation approachwas employed. for the quantitative portion of the study, it was assumed that a person who reports posttraumatic growth (ptg) must have a level of resilience sufficient enough to support growth. the focus was onmeasuring posttraumatic growth. the chinese version of posttraumatic growth inventory (ptgi) was used to test a general hypothesis that those “participants who report contin308 migrated from china to taiwan without a penny worked hard tilling the fields and mountains lived frugally for decades without complaint the tradition of frugality and diligence passed on from generation to generation without change in three hundred years never, never, never abandon the hakka spirit living standards are improving, society is change traditional morals and values are facing challenges advice to all the hakka is to seek perfection in conscience be a righteous and kindhearted person just like our ancestors never, never, never forget the teaching of our ancestors translated by li-ju jang table 1: hakka spirit uous religious affiliation will have a significantly higher score on the ptgi than those who report no religious affiliation.” spirituality was measured by participant reports of continuous religious affiliation—an indicator based onwhether or not participants reported religious affiliation before and after the 921 earthquake. while such an indicator would be understandably suspect inwestern studies, the public admission of continuous religious affiliation in taiwan is a serious matter and represents a deep spiritual commitment. in the qualitative portion of the study, study participants, including survivors, service providers, and volunteers, were given opportunities to speak in their own language to share their stories related to changes experienced as a result of the 921 earthquake and the contribution of spirituality. the stories were taken as narratives about posttraumatic growth. instrumentation the posttraumatic growth inventory developed by tedeschi and calhoun (1995, 1996) was employed to assess posttraumatic growth of the 921 earthquake survivors intung shih. they first reviewed studies of perceived benefits and generated 34 items, then performed a principal component analysis (pca) on those 34 items using varimax rotation, which assumed zero correlation between factors. they reported that five factors were extracted, which accounted for 55% of the common variance. a total of 21 items, with loading greater than .5 and cross-loading on any other factor no greater than .4, were included in the final version of the posttraumatic growth inventory. then, tedeschi and calhoun performed a pearson product-moment correlation between the total scores based on the 34item and 21-item versions of the ptgi. the results indicated that there was an almost perfect correlation (r=.98) between these two versions of ptgi. further, tedeschi and calhoun (1995, 1996) reported that the internal consistency of the 21-item version of ptgi was α=90, and for the five factors, α ranged from .67 to .85. they claimed that all items were measuring a similar underlying construct, but nonewas overly redundantwith the others, based on the findings of corrected item-scale correlations (r=.35 to r=.63). its test-retest reliability over a twomonth period was r=.71. because the written language used by the target population was chinese, a chinese version of the ptgi was required. hence, the 21-item version of the ptgi was translated into chinese. the first chinese version of the ptgi was presented to a professional interpreter and four service providers whoworkedwith survivors of the 921 earthquake to ensure accuracy and appropriateness of the language use and word choice. required revisions were made based on those experts’ comments. the final chinese version of the ptgi was a 21-item self-rating scale with a 6-point response format (0 = i did not experience this change as a result of the 921 earthquake, 5 = i experienced this change to a very great degree as a result of the 921 earthquake). higher scores indicated higher levels of posttraumatic growth. a total ptgi score of zero might suggest no posttraumatic growth occurred. any score greater than zero indicated some levels of posttraumatic growth. cronbach’s alpha estimate for the chinese version of ptgi in the present study was α=.96. internal consistency reliabilities for five subscales were presented in table 2. jang, lamendola/spirituality and posttraumatic growth 309 advances in socialwork sampling a single-stage cluster sampling strategy was used in the recruitment of survey participants. the population of tung shih was broken down into clusters (singleton & straits, 1999) consisting of four natural groupings: a) schools, b) religious groups, c) governmental agencies, and d) community members. a total of 17 key informants from schools, religious groups, governmental agencies, and community assisted with questionnaire distribution and collection. recruits for interviews were identified using a snowball sampling strategy. the criteria were that prospective participantsmust be: a) 18 years or older and survivors of the 921 earthquake or b) service providers to survivors in tung shih, or c) volunteers who were involved in relief efforts and/or reconstruction projects in tung shih. data collection and analysis to ensure a reasonable survey response rate, the ptgi was delivered in person by key informants or researchers. “face” is very important to the people of taiwan. it was thought that people were more likely to respond to this study if they were concerned about saving the “face” of themselves and the person who delivered the surveys. a total of 1,250 surveys were distributed to potential participants, resulting in a total of 640 completed surveys. twenty-eight in-depth interviews were conducted. a parallel mixed analysis approachwas employed,meaning that the results from the quantitative and qualitative analysis were not compared or consolidated until both sets of data analyses were completed (onwuegbuzie & teddlie, 2003). participants a slight majority of survey participants were female (65%) and hakka (57%). many were high school graduates (33%). both before and after the disaster, about three quarters of the survey participants reported affiliating with buddhism, taoism, or folk religion. the 28 individuals who were interviewed included 16 survivors, six service providers, and six volunteers. fourteen interviewees were in their 40s at the time of interview. twenty-five reported experiencing loss of loved ones or were suffering from property damage. fifteen participants reported affiliations with folk religion. 310 ptgi subscales cronbach’s alpha relating to others .89 new possibilities .84 personal strength .86 spiritual change .85 appreciation of life .77 table 2: cronbach’s alpha estimates for the chinese version of posttraumatic growth inventory five subscales jang, lamendola/spirituality and posttraumatic growth 311 results quantitative findings of the participants age 46 years or older, 88% reported “continuous religious affiliation,” whereas 68% of the participants ranging in age between 26 and 35 years reported “continuous religious affiliation.” ninety-seven percent of the participants in the “less than junior high” education group reported “continuous religious affiliation,’’ while 65% of the participants in the “college or higher” education group reported“continuous religious affiliation.” in general then, continuous religious affiliation was highest among study participants who were middle-aged or older and had not completed junior high. about 45%of the participants in the“continuous religious affiliation” group, but only 23% of the participants in the “no religious affiliation” group, scored within the fourth or fifth quintile on the ptgi. to assess correlations among sample characteristics and the ptgi, the pearson product-moment correlation was calculated (see table 3). here, age and educationwere treated as scale variables, because they had five or more ordered levels (leech, barrett, &morgan, 2005). the results showed that the ptgi was positively associated with age (r=.20, p<.01) and religious affiliation (r=.19, p<.01), which suggested that participants in the older age groups or those who reported continuous religious affiliation were more likely to score higher on the ptgi than others. the result of an independent-sample t-test indicated that participants who reported continuous religious affiliation scored significantly higher on the ptgi than those who reported no religious affiliation, t(496) = 4.63, p<.01. the hypothesis that, those participants who report continuous religious affiliation will have a significantly higher score on the ptgi than those who report no religious affiliation, was supported by this finding. further, a hierarchical regressionmodel suggested that spirituality (ß=.19, p<.01) was a significant predictor of survivors’ ptg. 1 2 3 4 1. age -.29** .23** .20** 2. education -.27** .01 3. religious affiliation .19** 4. posttraumatic growth inventory mean 3.02 3.52 0.79 57.66 sd 1.10 1.21 0.41 22. note. **p<.01. table 3: intercorrelations between post-traumatic growth and sample characteristics advances in socialwork qualitative findings themes among the major themes important to social work that emerged from the interviews with survivors and service providers were three, which were based in traditional taiwanese culture; namely, the role of fate and destiny, ancestor worship, and lessons from gods. the examples of each theme that follow are primarily extracts from interviews. in each case, social work notice is taken that survivors felt supported in their recovery and posttraumatic growth, regardless of the dominant theme that they expressed. traditional theme: fate and destiny. mr. lu (participant names have been replaced with common chinese family names) was a popular architectural designer who incorporated the concepts of feng shui and date-picking art into his designs. he commented that, “. . . with the knowledge of feng shui and datepicking art, i am able to provide extra services for my customers. my customers can expect 3-in-1 services from me!” lu was an optimistic person, despite the calamities he experienced. he not only lost his wife and daughter to the disaster, but he was also paralyzed from the waist down due to severe spine injury. lu stated that he knew that the feng shui of his family housewas not good for his immediate family. he said that he had tried to change it, but he failed, because it involved all his extended family. regarding his injury, lu felt that people had done their best to help him. he stated that, if he could not be healed, it was because it was his destiny. “i believe in fate and i accept fate,” lu affirmed. generally, service providers reported that people in tung shih accepted natural disasters as the will of the gods. ms. jan, mr. hou, andmr. su reported that, when people in other areas experienced natural disasters, people in tung shih often said, “it’s their turn now.” to the people of tung shih, it was fair, because people took turns experiencing natural disasters. traditional theme: ancestor worship.ancestors—the experiences they survived, the resilience under great duress, and the values that they held—guide everyday behavior. ms. yu said: ancestor worship is a way to show our gratitude for the foundation they laid for us . . . we are connected with our ancestors through daily ancestor worship and the annual tomb-sweeping festival. those rituals constantly remind us not to bring shame to the family name and not to forget our family duties. ms. yu stressed that daily ancestor worship provided the necessary strength to move forward with her life, while reminding her about who she was and her duties to her people. she said that she felt assurance that her ancestors and gods were with her. other survivors asked taoist priests to check on the feng shui of their ancestral tombs, because they were afraid that their sufferings resulted from damaged ancestral tombs. traditional theme: lessons from gods. some survivors believed that people would continue experiencing natural disasters until they learned the lessons that the gods wanted them to learn. ms. liu cited a buddhist master saying, “people 312 experienced natural disaster because they did not live harmoniously with nature. people were not honest with their fellowmen. political turmoil and contentions among people resulted in natural disasters. natural disaster was gods’ way of cleansing evil doers.” ms. jan stressed that, growing up in taiwan, people were constantly being reminded about the folk saying, “lift up your head and then you will know there are gods.” people were told that gods watched people’s deeds and thoughts. gods rewarded people’s good deeds and punished their evil doings. helping services mr. shu and ms. fu reported that several major hospitals set up medical booths, offering counseling services to survivors in tung shih, but that few survivors visited those“mental health professional” booths.mr. shu andms. fu stated that the reason for the lack of use of the mental health professionals was that healing and recovery was associated with spirituality, not mental health. they reported that there were always long lines in front of booths offering religious remedies or folk healing arts. mr. shu and ms. fu commented that religious rituals were more powerful than professional counseling. they went on to emphasize that it was natural that survivors would prefer visiting amedium believed to be able to communicate with spiritual beings than a mental health professional. mr. shu also indicated that he participated in the seeding support group that was facilitated by a group of clinical psychologists fromnational taiwan university. he said that he thought that the facilitators were good people, but somehow he felt that they could not bring inner peace to his life. mr. shu went on to explain that his spiritual beliefs provided explanations for many things that the psychologists could not explain. for example, there were proper spiritual rituals for the deceased to ensure that they were at peace that brought great comfort to survivors. mr. shu stressed that such beliefs were not superstitions but a matter of fact. he also pointed out thatmany survivors hired feng shuimasters to rearrange their house settings, hoping the new arrangements could bring fortune to their families. discussion study results indicate that, intaiwan, a collectivist culture withwidely shared cultural narratives spirituality has a significant effect on posttraumatic growth (ptg). this finding builds on western studies that find that spirituality contributes to people’s resilience and ptg (cadell et al., 2003; tedeschi & calhoun, 1995, 1996). in addition, a hierarchical regressionmodel used in the analysis suggests that spirituality is a significant predictor of posttraumatic growth. as may be commonly experienced in this type of study, there are unexplored levels of analyses and uneven use of data collection techniques. due to the nature of taiwan’s conservative collectivist culture, a non-probability sampling strategy was utilized for the quantitative research and snowball sampling for the qualitative research. taiwanese people are relational, and connections are very important to them, so that research techniques were employed that could ensure adequate response rates. it is also important to note that, because tung shih is located in a water source reserve area and no manufacturing plants are allowed to be built there, younger generations were more likely to study or work in other areas and were therefore not represented well in this study. in addition, the older genjang, lamendola/spirituality and posttraumatic growth 313 advances in socialwork eration was more likely to be illiterate or elementary school dropouts and probably chose not to participate for those reasons. as a result, the majority of participants, in both the quantitative and qualitative studies, were more likely to be in their 30s to 50s at the time of the study. finally, the ptgi used for the quantitative research was developed in an individualist culture in which the development of relationships following adverse experience may represent a unique change to social dynamics. in contrast, in collectivist societies, the importance and quality of social relationships is far higher under normal circumstances. hence, our assumption, that the nature and implications of spiritual beliefs are sufficiently similar across cultures to allow the original ptgi scale to be used, may be questioned. the difficulty of cross-cultural comparisons is not ignored by symbolic interactionists who would point out that meanings also vary between local cultures and contexts, and that they change over time. despite these limits, it is arguable that the theory can provide social workers a rationale that supports understanding the manner in which the 921 disaster survivors in this study define the reality and meaning of the disaster. further, symbolic interactionists view the self as dynamic, creative, and adaptive, a view that is congruentwith the definition of resilience. this study contributes interesting possibilities to be further explored between such theoretical perspectives and their possible utility in the investigation of disasters in varying cultures (e.g., individualist vs. collectivist cultures). the social work implications are much more involved than one might imagine from first glance.while it would seem to be relatively straightforward to support the emphasis on cultural appropriateness current in the field of social work today, in fact, the meaning of that in this context would be to advise social workers to work with and support spiritual leaders or folk healers who appear to be more acceptable and helpful to the survivors. social workers would also need primarily to be community organizers, not clinicians focusing on coordination and development of material resources. in fact, possibly the most serious problem noted by participants was the lack of “government response” and the delay of providers in deliveringmaterial resources and aid—a situation echoed in the 2004 tsunami and, more recently, hurricane katrina in the united states. those delays, in themselves, cause traumatic effects. in other words, social workers need to consider the dominant cultural narratives as an asset and shape their roles accordingly—in terms of their contribution to recovery and growth. in this case, it seems likely that preventative work in the form of material preparation and response scenarios, the coordination and provision of immediate material aid, meeting health needs, and dealing with resource issues are of paramount importance. references. amato-von hemert, k. 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(1996). the post-traumatic growth inventory: measuring the positive legacy of trauma. journal of traumatic stress, 9(3), 455-471. jang, lamendola/spirituality and posttraumatic growth 315 the social aid to and placement of refugees in 921 big quake analysis. (n.d.). taipei, taiwan: [department of statistics, ministry of interior, taiwan]. ursano, r.j., fullerton, c.s., & norwood, a.e. (1995, november/december). psychiatric dimensions of disaster: patient care, community consultation, and preventive medicine. harvard review of psychiatry, 3(4), 196-209. violanti, j.m., paton, d., & dunning, c. (2000). posttraumatic stress intervention: challenges, issues, and perspectives. springfield, il: charles c thomas. author’s note: address correspondence to: li-ju jang, ph.d., assistant professor, school of medical sociology and social work, chung shan medical university, no.100, sec. 2, dah-ching street, taichung, 402, taiwan , r.o.c. e-mail: ljang@csmu.edu.tw. 316 advances in socialwork microsoft word kang_krysik_final _________________ suk-young kang, ph.d., is an assistant professor in the school of social work at the university of texas at arlington and judy krysik, ph.d., is an associate professor in the school of social work at arizona state university. the authors express their appreciation to ms. carol stambaugh, executive director, nasw arizona; dr. mary rogers gillmore, director, asu school of social work; ms. jennifer soltis, bsw research intern; and the 24 asu msw student volunteers who assisted with the survey. copyright © 2010 advances in social work vol. 11 no. 1 (spring 2010), 82-94 employment-related salaries and benefits in social work: a workforce survey suk-young kang judy krysik abstract: the purpose of this study was to develop a descriptive benchmark of social work employment in arizona and to provide useful information to administrators, job seekers, and prospective social work students. the results, based on telephone and internet surveys to a random sample of 463 nasw arizona members, indicate that salary was positively related to level of education and years of social work employment experience. salary was also higher for men than for women and higher for social workers with administrative roles compared to other roles. access to employee-related benefits appeared widespread. implications are provided for administration and future research. key words: nasw, social work, salary, work related benefits, workforce survey introduction recently, the nasw warned the public of an impending shortage of professional social workers that could threaten the future of social work services for all americans (nadelhaft & rene, 2006). this warning came as no surprise. the national institute on aging (1987) had predicted a shortage of professionally educated social workers over three decades ago. in part, the shortage of professional social workers is due to a greater demand for social work services prompted by demographic changes in the united states. the nasw estimated a 35% increase in employment opportunities for social workers due to the growing elderly population (fritschi, 2001). the bureau of labor statistics (2008) recently projected higher than average job growth for social workers to the year 2016, particularly in the fields of aging and health, and in rural areas. child welfare agencies across the nation are also struggling to attract and retain professional social workers (mor barak, levin, nissly, & lane, 2006). the center for workforce studies, established by the nasw in 2004, was created to respond to the problem of limited knowledge on the social work workforce and thus inform related policy and advocacy efforts. the nasw workforce initiative was spearheaded by a national survey of licensed social workers in 2004. the 2004 nasw workforce survey indicated that shortages of professional social workers were burdening the existing workforce as well as disadvantaging the recipients of social work services. the survey documented “increases in paperwork, severity of client problems, caseload size, waiting lists for services, assignment of non-social work tasks, and level of oversight” (whitaker, weismiller, & clark, 2006, p. 5). the survey found commensurate advances in social work, spring 2010, 11(1) 83 decreases in “job security, staffing levels (for both social worker and other staff), availability of supervision, and level of reimbursement for services” (whitaker et al., p. 5). about one in five of the licensed social workers surveyed indicated, “vacancies in social work positions are common” and “difficult to fill” (whitaker et al., p. 18). salary is one factor influencing recruitment and retention of professional social workers. the 2004 nasw workforce survey found the perceived importance of salary to be consistent across race, ethnicity, and gender (nasw the center for workforce studies, 2006a; b; c; d; e). approximately three-quarters of female and male licensed social workers indicated salary as the most important factor that would influence a job change (nasw the center for workforce studies, 2006d; e). the 2004 nasw survey found considerable variability in the salaries and wages of licensed social workers. the median salary for social work employees in 2004 was $55,129 (whitaker et al., 2006). salaries varied significantly by gender, with males earning more than females; and by region, with metropolitan and pacific regions experiencing higher salaries than south central and rural regions (whitaker et al.). sector of employment was also related to salary, with social workers in private practice reporting the highest salaries and those in private, nonprofit organizations reporting the lowest salaries (whitaker et al.). education and employment experience was positively correlated with salary (whitaker et al.). the purpose of this paper is to report the findings of a 2007 nasw arizona chapter workforce survey. the nasw arizona survey was modeled after the 2004 nasw national survey. the 2004 national survey recruited very few subjects from arizona (n = 24), and therefore did not provide state-level information (nasw the center for workforce studies, 2006f). the findings of this study, however, generally mirror those of the larger survey with 24 participants. for example, 72% of the social work respondents in arizona were 45 years or older which is similar to the larger survey. however, without the current study’s corroboration, the findings of the national study with only 24 social work respondents from arizona cannot make a valuable contribution. this paper describes social work salaries and benefits in arizona as they relate to workforce demographics. this information can be used to compare across states and to examine within state trends. the study details a successful methodological approach that could be adopted by other nasw state chapters interested in carrying out similar studies without funding. this study addresses the need to replicate the national study in states that had low representation in the national study of licensed social workers. for 20 states, the sample size was less than 50 respondents. among these 20 states, the sample size in three states was in the single digits (i.e., n=5 in montana, n=7 in rhode island, n=6 in wyoming) (nasw the center for workforce studies, 2006g). the methods used in this study can be used to replicate the study in these 20 states. methods the present study was made possible by collaboration among the executive director of the nasw arizona chapter, the authors, 24 arizona state university msw student volunteers from two sections of a graduate research methods course, and one bsw kang, krysik/employment-related salaries and benefits 84 research intern. together the collaborators designed an 18-item workforce survey. the survey’s design and research protocol relied heavily on the 2004 nasw workforce survey, and the evidence-based survey research practices outlined by dillman (2000). the institutional review board at arizona state university approved the research procedures for this study. an initial random sample of 683 nasw members was drawn for the survey from the january 2007 nasw arizona chapter membership roster. the sample size was based on a population of 1,892 members, a desired confidence level of 95%, and a confidence interval of ±3 percentage points. of the 683 members originally sampled, 43 were unable to be contacted because they had moved out of state or did not have working telephone numbers or e-mail addresses. of the 640 potential respondents, 465 completed the survey yielding a 72.6% response rate. based on the randomly selected sample of 465 members, the results have a maximum margin of sampling error of ± 3.95 percentage points. the response rate in this study is high compared to other workforce surveys reported in the literature (see for example dixon, 2002/2003; whitaker et al., 2006). in order to maximize response rate and minimize cost and time, internet and telephone survey methods were chosen. both telephone and internet administration cost less and consume less time than mailed or in-person surveys. it was assumed that most professional social workers had access to the internet and e-mail, and would be reasonably motivated to respond to a request from the executive director of their local nasw arizona chapter. surveys that could be completed via the internet would reduce the resources needed for telephone interviewing. telephone administration was made feasible by the volunteer labor of 24 msw students who were granted access to private offices with telephones in the asu school of social work. the survey was conducted as a service/learning project in two sections of a graduate research course instructed by the authors. individuals in the sample who had e-mail addresses recorded in the membership database received pre-survey notice e-mails. pre-survey notice postcards were mailed to those without available e-mail addresses. the pre-notice emails and postcards, sent from the executive director of nasw arizona, described the survey’s importance and requested the member’s participation. the survey was programmed for the internet using the upgraded version of survey monkey, and then piloted with nasw arizona board members and msw student volunteers. access to the internet survey was made available through a link sent in a second email. the internet survey was open for one month. an interview schedule was developed for the telephone interviews and was piloted with the msw student volunteers. the authors trained msw students in telephone interviewing skills. the 24 students’ first telephone interviews were supervised by one of the authors or an experienced peer. telephone calls were made to potential respondents from monday through friday in both day and evening hours, and were conducted over a period of one month. three follow-up e-mails, also from the executive director of nasw arizona, were sent to non-respondents at one-week intervals. the upgraded version of survey monkey advances in social work, spring 2010, 11(1) 85 facilitated the tracking of non-response and permitted the automated generation of follow-up e-mails to non-respondents. any individual not responding after three e-mail reminders was then transferred to the telephone list. to encourage participation, three gift cards valued from $50 to $100 each were offered as raffle prizes for respondents. sample of the 465 nasw arizona members who responded to the survey, 258 (55.5%) responded by internet and 207 (44.5%) were interviewed via telephone. of the 175 nonrespondents, 32 refused participation and 143 non-respondents did not respond to numerous telephone calls or e-mails. the sample demographics shown in table 1 closely reflect the population of nasw arizona members. for instance, 78.9% of the sample was female and 21.1% was male compared to the overall population of nasw arizona members who were 81% female and 19% male. the racial and ethnic distribution of the sample also reflected the population, 85% and 86% white respectively. finally, the majority of survey respondents were from maricopa county, the largest urban county in arizona (57.4%), followed in frequency by pima county, the second largest urban county (23.0%) and 19.5% came from other areas of the state. the information in table 1 indicates the sample’s geographic distribution was highly representative of the overall population of nasw arizona chapter members. population data on age were not available, however, in the sample, 40% of the respondents were at least 55 years of age, and 9% were age 65 or older. not only did the demographic characteristics of the sample mirror the population, but they also reflected licensed social workers responding to the national nasw workforce survey described earlier in this paper (nasw the center for workforce studies, 2006f). that is, the sample could be described as predominantly white, female, nearing the standard age of retirement, and urban. kang, krysik/employment-related salaries and benefits 86 table 1. comparison of selected demographic characteristics demographic characteristics sample (n = 347) population (n = 1,892) gender female 78.9% 81.0% male 21.1% 19.0% ethnicity white 85.1% 86.4% hispanic 5.3% 5.5% black/african american 2.9% 2.7% asian/pacific islander 2.9% 1.0% native american 2.0% 2.0% other 1.8% 2.3% region maricopa county 57.4% 59.4% pima county 23.0% 22.7% all other areas 19.5% 17.9% age 25 years or younger 1.2% not available 26 to 34 years 12.0% 35 to 44 years 14.9% 45 to 54 years 32.4% 55 to 64 years 31.0% 65 years or older 8.5% note. demographic data were only collected for the 347 nasw arizona members who were employed in social work at the time of the survey. population data on ethnicity were missing for 572 of the 1,892 nasw arizona chapter members. data on age were missing for five respondents results of the 465 nasw arizona members responding to the survey, 118 or approximately 25% were not employed in social work. of those not employed in social work, 41 were employed in non-social work occupations (see table 2). the remaining individuals, 77 of the 118, were not gainfully employed. although the survey did not ask respondents about their reasons for non-employment, several offered explanations related to retirement, job seeking, and time out for personal health, further education, and caregiving. those employed in non-social work positions often commented that they could not support themselves on the amount of money that they could earn in social work jobs. advances in social work, spring 2010, 11(1) 87 table 2. employment status of nasw survey respondents employment status frequency (n = 465) percent employed in social work 347 74.6% employed, other than social work 41 8.8% not currently employed 77 16.6% status of only those employed in social work (n = 347) year-round, full-time 237 68.9% year-round, part-time 88 25.6% less than 12 months, full-time 13 3.8% less than 12 months, part-time 6 1.7% note. data on status of only those employed in social work were missing for three respondents. the next section of this paper focuses on the 347 respondents who were employed in social work. as shown in table 2, of the 347 respondents, only 68.9% were employed year-round, full-time. a sizable proportion, 25.6%, was employed year-round, part-time; 3.8% were employed full-time although less than 12 months per year, such as a ninemonth academic position; and 1.7% were employed both part-time and fewer than 12 months per year. the majority of the 347 respondents who were employed in social work, 81%, reported employment with a single employer; and 19% reported employment with two or more employers. social worker employment experience the majority of the 347 respondents, 54%, had been employed as social workers for more than 16 years. relatively few respondents were newcomers to social work. for instance, only 2.0% of the social work employed subgroup had been social workers for less than one year, and 13.3% had between one and five years of experience in the profession (see table 3). almost 38% of employed social workers had between one and five years tenure with their current employers, and about 16% had less than one year. kang, krysik/employment-related salaries and benefits 88 table 3. percent distribution of social work experience and current tenure duration of employment as a social worker (n = 345) with current employer (n = 344) less than 1 year 2.0% 16.3% 1 to 5 years 13.3% 37.8% 6 to 10 years 16.2% 18.0% 11 to 15 years 14.2% 9.9% 16 or more years 54.2% 17.7% characteristics of social work employment the majority of the 347 respondents, 79%, were employed by the private sector, split almost equally between for-profit (39%), and non-profit (40%) entities. in the public sector, social workers were employed in order of decreasing frequency by, local government (6.5%), federal and state government (5% each), postsecondary institutions (3%), and the military (1%). the majority of respondents described mental health as the main focus of their primary employment (36.8%), followed in frequency by medical health (13.9%), family services (8.9%), child welfare (6.5%), and hospice (5.6%). addictions, aging, and school social work were each represented as a primary focus of employment by 4.5% of respondents. of those employed in social work, 69% were in positions that required certification or licensure. about one-fourth, 23%, reported experiencing employment-related safety issues, and 33.8% were reportedly required to work weekends or shift work. ability to speak spanish, or a language other than english was required in 16% of the social work positions, and 25% of the respondents working in social work were in positions that required work in rural locations. social work salaries and wages table 4 presents the percentage distribution of annual gross wages or salary for the 235 year-round, full-time social workers and the 105 part-time and part-year employed social workers. less than 10% of full-time, full-year employed social workers had salaries lower than $35,000. about 53% of full-time employed social workers earned between $35,000 and $59,999, and almost 38% reported earnings of $60,000 or more. advances in social work, spring 2010, 11(1) 89 table 4. percentage distribution of annual gross wages or salary from social work annual gross wages or salary full-time (n = 235) part-time (n = 105) less than $15,000 0.4% 19.0% $15,000 $19,999 0.4% 11.4% $20,000 $24,999 6.7% $25,000 $29,999 2.6% 10.5% $30,000 $34,999 6.0% 5.7% $35,000 $39,999 10.6% 12.4% $40,000 $49,999 20.0% 11.4% $50,000 $59,999 22.6% 13.3% $60,000 $69,999 12.8% 3.8% $70,000 $79,999 7.7% 1.9% $80,000 $99,999 10.6% 2.9% $100,000 + 6.4% 1.0% note. part-time includes those working less than 12-months per year, full-time. income from all social work employment was examined by sector of primary employment for the 235 social workers with year-round, full-time employment. the sectors of employment, considered by highest to lowest salaries or wages, are ranked thus: (1) university/college/military; (2) local government; (3) private, for-profit, including private practice; (4) federal government; (5) private, non-profit; and (6) state government. social workers employed full-time and year-round with administrative roles earned significantly more than social workers employed solely in direct service roles, including case management, t(216) = 3.75, p = .0002 (two-tailed), and counseling or psychotherapy roles t(299) = 4.30, p < .0001 (two-tailed). licensure and area of residence, i.e., rural compared to urban, did not have a statistically significant impact on earnings from full-time, year-round social work employment. education was significantly related to salary as expected, however, the correlation was weak (r(342) = .15, p = .004). this weak correlation is likely due to the over representation of masters educated social workers among the nasw membership. most of the respondents, 90% held a masters degree as their highest level of education, about 5% had achieved a bachelors degree and 5% a doctorate, thus there was little variation in education. years of social work employment experience and salary were also significantly related. the relationship between experience and income could be characterized as moderately positive (r(235) = .46, p. < .0001). kang, krysik/employment-related salaries and benefits 90 access to employment-related benefits table 5 displays comparative information on access to 12 employment-related benefits for full-time, full-year employed social workers and part-time or part-year employed social workers. as expected, access to employment-related benefits was greater for full-time, full-year employed social workers than for part-time or part-year employees. the exception was flexible work hours, available to about two-thirds of all employed social workers in the sample. although the availability of employment-related benefits appears widespread, the survey did not take into account whether or not the employees took advantage of workplace benefits, or the associated costs of such benefits. the majority of social workers in this study had relatively long durations of employment. emphasizing the duration of employment and access to employer-sponsored health insurance and other benefits may be a good way to recruit individuals into the social work profession. table 5. percent of social workers reporting access to employment-related benefits type of benefit full-time (n = 235) part-time (n = 105) health insurance 85.8% 57.8% dental insurance 80.2% 44.7% life insurance 77.1% 42.6% pension 75.1% 49.5% tuition reimbursement 58.7% 30.5% travel reimbursement 69.2% 47.4% dependent child or medical savings account 53.1% 30.9% cell phone/cell phone reimbursement 51.2% 25.0% continuing education reimbursement 67.6% 39.6% paid association membership 27.5% 11.0% flexible work hours 66.7% 63.7% paid family leave 52.7% 28.3% note. part-time includes those working full-time and less than 12-months per year. the percentages represent lower-bound estimates, as some respondents did not know if their employers offered access to specified benefits. advances in social work, spring 2010, 11(1) 91 discussion the 2007 nasw arizona workforce survey is the product of a successful collaboration between the leadership of the chapter, and faculty and students from the arizona state university school of social work. the high response rate to the survey, 72.6%, and the comparability of the sample to the population serve to illustrate the power of random sampling combined with evidence-based survey research practices. concentrated in metropolitan areas, the sample was consistent with the nasw arizona membership, and mirrored the population in terms of race, ethnicity, and gender. thus, the findings are generalizable and accurate within plus or minus 3.95 percentage points. the findings of this study suggest possible strategies for recruitment, and point to the benefits of the profession for those who may be considering social work. these include long duration of employment and access to employment related benefits. our findings suggest the need to plan for the retirement of social workers from the baby boom generation. the findings also point out the need to address the retention of social workers prior to retirement. the survey found that one-quarter of those sampled were not employed in social work at the time of the survey, and about 35% of those were employed, but outside of social work. future research should examine the loss of this sizable subgroup from the social work profession to determine reasons for leaving social work and whether those leaving are different demographically from those remaining in the profession. the data collected from the current survey cannot answer whether or not those who leave social work are rewarded through higher salaries and greater benefits, and how much income factored into their decision to leave. this is an important area of inquiry for future workforce research. if we are concerned about the shortage of professional social workers, this study would suggest that we begin with a focus on ensuring those that we are producing are being retained in social work. this gap in knowledge might be filled by alumni studies that survey recent cohorts of graduates. another sizable subgroup of nasw arizona members, 23% of the total sample, was employed less than full-time, year-round. the current survey found that regardless of whether respondents were employed full-time or part-time in social work, about twothirds had flexible work schedules. the issue of keeping the balance between work and life is a critical issue in many workplaces including social work (shoenfeld, 2005). previous studies have found that flexibility in the workplace, such as flextime and a compressed workweek, had a positive effect on productivity/performance, job satisfaction, absenteeism, and satisfaction with work schedule (baltes, briggs, huff, wright, & neuman, 1999) and was associated with self-rated physical health (swanberg & simmons, 2008). the flexibility associated with many social work positions, including the availability of part-time employment, make social work a particularly attractive career choice, especially for those who desire or require a greater balance in employment and personal life. this may also help explain why nasw members tend to be predominantly female and older. this finding has important implications for the interpretation of workforce data on salaries. promoting the profession of social work to potential students should highlight salary and benefits, and the opportunity for flexible work schedules. kang, krysik/employment-related salaries and benefits 92 this survey’s findings leave questions as to whether or not social workers are losing ground in regard to earnings. income from full-time, year-round social work employment in 2007 appeared consistent with that reported in the 2004 nasw workforce survey. in 2004, 45% of licensed full-time social workers in arizona (n = 24) reportedly earned between $40,000 and $59,000 annually, and 23% earned between $20,000 and $39,000 annually (nasw the center for workforce studies, 2006f). the current 2007 nasw arizona survey found 19% of social workers with annual gross earnings from full-time social work in the range of $20,000 to $39,000, and 42.6% with full-time earnings between $40,000 and $59,000 annually, ± 3.95 percentage points. comparing the results of these two surveys seem to indicate that professional social workers have not made salary or wage gains over the past three years. in order to better describe trends in social work salary and wages in arizona, replicating the current workforce survey in coming years is critical. future research in this area should test the assumptions that salaries and benefits are the main inducements in the social work hiring process. many social work students are drawn to the profession by their commitments to society. further study may need to focus on employee morale and working conditions. the access to employer-provided benefits documented in this survey makes social work appear attractive, with over 85% of full-time social workers reporting access to employer-sponsored health insurance. combined with information on projected workforce shortages within the profession, this information can be used to market social work as a career choice in arizona. future social work workforce surveys, however, should collect data on employee-perceived adequacy of workplace benefits, as well as the take-up rates and employee cost of specified benefits. not only will this allow the assessment of trends over time, but will add a further dimension to our current understanding of workplace benefits for social workers. unknown is how many professional social workers in arizona are members of the state nasw chapter. as this study was restricted to nasw arizona members, it has limited ability to describe the entire professional social work workforce. available information indicates that the nasw arizona membership is heavily biased in terms of graduate degree holders and licensed social workers making the current survey limited in its ability to assess the benefits of additional education beyond the bachelor’s-level and the potential benefits of licensure. further study should be conducted to explore the effects of the recent economic crisis. retention of social workers from burn-out is also a critical issue. based on this study, 31% of the sample was between 55 to 64 years, younger than the retirement age for social security benefits. it would be useful to know if their plans for retirement have changed since the data were collected given the economic downturn. advances in social work, spring 2010, 11(1) 93 references baltes, b. b., brigges, t. e., huff, j. w., wright, j. a., & neuman, g. a. (1999). flexible and compressed workweek schedules: a meta-analysis of their effects on work-related criteria. journal of applied psychology, 84(4), 496-513. bureau of labor statistics, u.s. department of labor. (2008). occupational outlook handbook, 2006-07 edition, social workers, retrieved february 29, 2008, from http://www.bls.gov/oco/ocos060.htm dillman, d. a. (2000). mail and internet surveys: the tailored design method (2nd ed.). new york: wiley. dixon, r. (dec 2002/jan 2003). spring 2002 salary survey results. social work networker (nasw il chapter magazine), xli, 1-5. fritschi, l. p. (2001, september). gerontological social workers needed. aging (the newsletter of the nasw section on aging), 3(3), 1-14. washington, dc: nasw. mor barak, m. e., levin, a., nissly, j. a., & lane, c. j. (2006). why do they leave? modeling child welfare workers’ turnover intentions. children and youth services review, 2(5), 548-577. nadelhaft, a., & rene, d. (2006, march). landmark study warns of impending labor force shortages for social work profession. washington, dc: national association of social workers. retrieved march 18, 2008 from http://www.socialworkers.org/pressroom/2006/030806.asp nasw the center for workforce studies. (2006a). 2004 national study of licensed social workers demographic fact sheet – hispanic/latino social workers. washington, dc: author. retrieved july 18, 2007, from http://workforce.socialworkers.org/studies/demo_fact_hispanic.asp nasw the center for workforce studies. (2006b). 2004 national study of licensed social workers demographic fact sheet – non-hispanic, white social workers. washington, dc: author. retrieved july 18, 2007, from http://workforce.socialworkers.org/studies/demo_fact_caucasian.asp nasw the center for workforce studies. (2006c). 2004 national study of licensed social workers demographic fact sheet — black/african american social workers. washington, dc: author. retrieved july 18, 2007, from http://workforce.socialworkers.org/studies/demo_fact_africanamerican.asp nasw the center for workforce studies. (2006d). 2004 national study of licensed social workers demographic fact sheet – female social workers. washington, dc: author. retrieved july 18, 2007, from http://workforce.socialworkers.org/studies/demo_fact_female.asp nasw the center for workforce studies. (2006e). 2004 national study of licensed social workers demographic fact sheet – male social workers. washington, dc: kang, krysik/employment-related salaries and benefits 94 author. retrieved july 18, 2007, from http://workforce.socialworkers.org/studies/demo_fact_male.asp nasw the center for workforce studies. (2006f). 2004 national study of licensed social workers – quick facts – arizona. washington, dc: author. retrieved july 18, 2007, from http://workforce.socialworkers.org/states/arizona.pdf nasw the center for workforce studies. (2006g). 2004 national study of licensed social workers – quick facts – by state. washington, dc: author. retrieved april 6, 2010, from http://workforce.socialworkers.org/studies/demo_area.asp national institute on aging. (1987). personnel for health needs of the elderly through the year 2020. bethesda, md: department of health and human services, public health service. schoenfeld, g. (2005). work-life balance: an mba alumni report. the graduate management admission council (gmac) research report. 1-12. retrieved august 25, 2009, from www.gmac.com/nr/rdonlyres/.../rr0509_worklifebalance.pdf swanberg, j. e., & simmons, l. a. (2008). quality jobs in the new millennium: incorporating flexible work options as a strategy to assist working families. social service review, 82(1), 119-147. whitaker, t., weismiller, t., & clark, e. (2006). assuring the sufficiency of a frontline workforce: a national study of licensed social workers. executive summary. washington, dc: national association of social workers. author’s note: address correspondence to: suk-young kang, ph.d., assistant professor, university of texas at arlington school of social work, 211 s. cooper street, arlington, tx 76019. email: suk-young.kang@uta.edu microsoft word lietz et al_breakthrough series collaborative final _________________ cynthia a. lietz, ph.d., is an assistant professor in the school of social work, kathleen l. andereck, ph.d., is professor and director, school of community resources and development, and richard c. knopf, ph.d., is professor and director, partnership for community development, school of community resources and development, all in the college of public programs at arizona state university in phoenix. this research was funded by the arizona department of economic security. the authors are grateful for the support and guidance of the office of community partnerships and innovative practices (cpip). copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 248-266 the breakthrough series collaborative on service integration: a mixed methods study of a strengths-based initiative cynthia a. lietz kathleen l. andereck richard c. knopf abstract: arizona’s department of economic security (des) engaged in a strengthsbased initiative to increase quality and integration of human services. twenty teams including employees from state agencies, community leaders, and families were brought together to discuss and implement improvements to a variety of social services. a mixed methods study was conducted to explore the complex process of forming diverse teams to strengthen social services. specifically, the research team conducted focus groups to collect qualitative data from a purposive sample of the teams to explore their experiences in greater depth. analysis of the data led to the development of an online survey instrument that allowed all collaborative members an opportunity to participate in the study. findings suggest that while the teams faced many challenges, a commitment to the process brought perseverance, communication, and creativity allowing this collaborative to initiate 105 activities to bring about positive changes in social services within their communities. keywords: strengths perspective, service integration, mixed methods, family voice introduction the issues facing families are complex. problems such as poverty, child maltreatment, delinquency and crime affect the safety of our communities, the stability of our families, and can have negative effects on the growth and development of children. as states seek to respond to these challenges, many recognize the need to increase communication and collaboration between service providers while also seeking involvement of families in the planning and decision making process. arizona’s department of economic security (des) engaged in a year-long initiative known as the breakthrough series collaborative on service integration (bscsi). this effort brought together agency staff from multiple des programs and community leaders from social service agencies with service recipients to form 20 teams across arizona for the purpose of better addressing the complex needs of families. the purpose of this article is to present the findings from a mixed methods study that explored this collaborative process to identify both the challenges and advantages of this approach to social work practice. social work practice with families some claim that social work practice with children and families developed from a deficits-based model seeking to diagnose problems and provide treatment to ameliorate advances in social work, fall 2010, 11(2) 249 symptoms (early & glenmaye, 2000; itzhaky & bustin, 2002; leon, 1999; saleebey, 2001). chapin (1995) asserts public policies stemmed from a similar perspective with an emphasis on the identification of societal problems focused on minimizing factors found to increase risk for dysfunction. practitioners within social service programs responded by adopting diagnostic terminology that would aid those engaged in the helping professions to identify pathology by attaching a label to particular behaviors or experiences ultimately leading to a prescribed treatment (leon, 1999). over time, many have critiqued social work’s adoption of the medical model due to the overemphasis on diagnosis and treatment of problems (blundo; 2001; goldstein, 1997; leon, 1999; lietz, 2006; saleebey, 2001). saleebey (2006) asserts that overattention to deficits hinders a social worker from seeing the strengths and capabilities of an individual, family, or community. others suggest the medical model does not fit social work’s value of collaboration as this perspective creates a hierarchy reinforcing the idea that professional social workers hold the expertise to assess and treat pathology, potentially hindering the voice of families (itzhaky & bustin, 2002; weick, rapp, sullivan, & kisthardt, 1989). still others cite concerns regarding the language of pathology that fails to empower clients to see their abilities, to reflect on past successes, and to foster resilience (goldstein, 1997; greene, lee, & hoffpauir, 2005). proponents of the strengths perspective seek to shift focus away from problems to instead emphasize the inherent strengths that are present in all people, families, and communities (blundo, 2001; brun & rapp, 2001; cohen, 1999; kisthardt, 2006; saleebey, 2006). the language of the strengths perspective includes concepts such as membership, wellness, resilience, and hope, seeking to replace words that draw attention to pathology with ones that empower people to see their capabilities (greene et al., 2005; rapp, saleebey & sullivan, 2005). social workers engaging in strengths-based practice develop collaborative relationships that acknowledge the expertise of families and communities in knowing what works best when addressing the problems families face (boyes-watson, 2005; colby, 1997). the dialogue and collaboration between family and worker seek to highlight abilities, resources, and past successes to accomplish current goals identified by the family (sousa, ribeiro, & rodrigues, 2006). in addition to collaboration between families and workers, we argue that the strengths perspective also highlights a need for communication between service providers and an enhanced integration of services. critical to this perspective is the idea of partnering with families and communities in a way that raises their voice in the discourse about intervention and integration of social services (boyes-watson, 2005; brun & rapp, 2001; colby, 1997; leon, 1999). critics of the strengths perspective claim this practice philosophy simply attempts to reframe problems and fails to acknowledge the real problems that families face (saleebey, 2006). according to recent data from the national child abuse and neglect data system (u.s. department of health and human services, 2007), almost 900,000 children were found to be victims of abuse or neglect in 2005. this suggests that 12 of every 1,000 children in the u.s. face maltreatment. findings reported by the annie e. casey foundation (aecf) (2007) suggest that 1.1 million teens were not in school and did not have high school diplomas in 2003. that same year, the drop-out rate for minority lietz, andereck, knopf/the breakthrough series collaborative 250 groups ranged from 8 to 15% (aecf, 2007). other data suggest that one in five american children live in poverty while many live just above the poverty line (aecf, 2007). american families face many challenges of concern to the field of social work and to public policy makers. those who advocate for taking a strengths perspective do not claim the real challenges families face are ignored. nor do they suggest that children are not heard as they speak of maltreatment or that parents struggling to care for their family are not provided with support needed to meet basic needs. on the contrary, proponents of the strengths perspective care deeply about these concerns. what makes the strengths perspective different is not the concern for the well-being of children and families, but instead, the approach taken as social workers address these issues. service integration as local governments seek to provide for the needs of their communities, one effort that has gained attention is the strategy of service integration. hassett and austin (1997) define service integration (si) as “efforts to reduce or eliminate divisions or boundaries between categorically defined and provided services” (p. 10). similarly, o’looney (1994) describes si as “specific changes believed to make the system more efficient, effective and comprehensive” (p. 32). the strategy of service integration seeks to make improvements to social services that have been found to be fragmented, uncoordinated, inflexible, and confusing (o’looney, 1994; reitan, 1998; waldfogel, 1997). some believe these problems stem from specialization within social services requiring one family to be referred to multiple agencies to meet a variety of needs (leon, 1999; o’looney, 1997). in a system divided through specialized expertise, there may be little communication between service providers, causing families to feel like they are starting over with each new referral. although the si movement can be traced back to the mid 1900s, there was a renewed interest in this practice in the late eighties and early nineties (hassett & austin, 1997; o’looney, 1997). currently, there are examples of si initiatives in several states including georgia, california, kentucky (o’looney, 1997), maryland, colorado (waldfogel, 1997), and arizona. hassett and austin (1997) describe mixed motivations for si efforts. client advocates see integration as an opportunity to provide more comprehensive and effective services to families. agency administrators and governmental leaders may look to si as a more efficient and cost-effective way to provide services. in addition to mixed motivations for employing si practices, there are other factors complicating implementation. for example, halley (1997) states “si has been characterized as lacking crisp language, being, at once, a philosophy, an objective and a set of strategies and structural arrangements” (p. 146). lack of clarity and direction may affect the effectiveness of such initiatives. in addition, o’looney (1997) suggests implementing si is limited by a lack of current research informing this practice. it appears that further development of the idea of si along with research findings may be needed to better inform future efforts. advances in social work, fall 2010, 11(2) 251 arizona’s breakthrough series collaborative on service integration (bscsi) in 2003, social service leaders in arizona were concerned regarding the number of families who were living in poverty, involved with the child welfare system, and at-risk for inadequate housing, nutrition, and healthcare. des leaders desired to increase access and coordination of social services in an effort to better address these issues. des approached the annie e. casey foundation regarding implementing the breakthrough series collaborative (bsc) model as a way of implementing responsive, creative solutions to these complex social problems. through financial and technical support provided by the casey foundation, a planning team was put in place to: (a) form a collaborative of 20 teams for the purpose of increasing service coordination and efficiency, (b) plan the learning summits needed to train and support teams in the bsc process of change adopted for this project, and (c) offer general oversight to the project. the planning team asked each division within des to nominate members who were ultimately assigned to one of the 20 teams located in their geographical area. the collaborative brought together groups of people representing three interests. under the umbrella of arizona’s des, there are many social services including the administration of programs to address child maltreatment, financial need, and child support. each bscsi team was formed through nominations of representatives assigned from each division of des. in addition to des professionals, each division nominated community leaders who were involved in each local area who were also invited to serve on a bscsi team. these bscsi participants could be administrators or practitioners from non-profit agencies, pastors or elders from faith institutions, or other community members concerned with social services. finally, each team also recruited family members to bring the important perspective of service recipients. brun and rapp (2001) conclude “proponents of the strengths perspective risk being one of the oppressors themselves if they do not systematically and consistently seek the opinions of individuals receiving strengths-based services” (p. 279). understanding the collaborative could not adequately address social service issues without hearing directly from recipients; a key priority was the recruitment of family partners. ultimately, throughout this year-long effort, the collaborative included the participation of 93 family partners, 107 community partners, and 118 des partners who were assigned to one of 20 local teams. the entire collaborative came together at the first learning summit in january of 2006. at this meeting, teams were formed and oriented to their purpose. the purpose of each team was to identify barriers to services and to explore creative actions that could lead to increased integration of services in each community. specifically, each bscsi team was trained in the plan, do, study, act (pdsa) process (deming, 1986) for initiating small tests of change that can be spread across to other communities and, ultimately, across the state. teams met locally each month to identify creative ways to strengthen social services for a period of one year. two additional learning summits were held with the entire collaborative in may and october of 2006 to provide further support to the teams. the goal of service integration through collaborative processes fits si practices. one unique aspect of this si initiative was the deliberate attention paid to engaging families lietz, andereck, knopf/the breakthrough series collaborative 252 on each bscsi team. although there are several principles underlying the strengths perspective, “the first is a belief that people have the capacity to determine what is best for them” (weick et al., 1989, p. 353). colby (1997) suggests “a community must have ownership of the project” (p. 9), while chapin (1995) similarly concludes “social policy that reflects the reality of its intended recipients is more likely if the policymakers are also the people directly affected by the policy” (p. 509). we contend that bringing the strengths of professionals, community leaders, and families together through collaboration for the purpose of seeking creative solutions provides an illustration of a strengths-based, community initiative on service integration. methods arizona state university’s partnership for community development (pcd) was approached to conduct a study to examine the process of the bscsi. the research team utilized a combination of quantitative and qualitative methods through a sequential exploratory design (creswell, 2003) to understand the functioning of these teams. specifically, the research team initially collected qualitative data through focus groups conducted with 13 of the 20 bscsi teams. an analysis of this data suggested the qualitative sample cited strengths and barriers related to the functioning of their teams. this qualitative analysis was used to develop a survey instrument with closed-ended items to further test the variables identified in the focus groups. this survey was sent to the entire collaborative, allowing all members the opportunity to participate in at least one component of this study. the study was approved and monitored by asu’s institutional review board. qualitative methods the qualitative component of the research was used to examine the experiences of the teams in greater depth. the researchers used purposive sampling to identify 13 of the 20 teams to participate in the qualitative component of the study. specifically, the researchers desired to seek a sample of teams that represented diversity across the collaborative. therefore, rather than choosing a random sample of teams, teams were chosen from all geographic locations across the state leading to an oversampling of rural areas. specifically, six teams representing metropolitan areas in phoenix and tucson were included whereas the other seven teams came from locations across arizona. a semi-structured interview guide provided in table 1 was used to conduct focus groups with each team to explore their perceptions regarding the purpose of the collaborative, the functioning of the teams, and the effectiveness of their efforts to initiate change. the focus groups were co-facilitated by two members of a team of five researchers. the team included the principal investigator (pi) of the qualitative component of the project and four masters level social work research assistants (ra) who were trained and supervised by the primary researcher. consistency in facilitation was established through: (1) an initial training provided by the pi for all of the ras, (2) weekly ra supervision meetings led by the pi, (3) attendance of ras at two focus groups facilitated by the pi for the purpose of modeling facilitation, and (4) the use of an interview guide. advances in social work, fall 2010, 11(2) 253 table 1: interview guide 1. what led you to become involved in this team? 2. what about being on this team have you enjoyed? 3. were there any barriers that made it difficult for you or someone else to participate fully on this team? 4. what do you see as the purpose of this team? 5. in what ways has your work as a team led to improved services for families in az? 6. can you share a few examples of how your work in this team has led to improved outcomes for a family? 7. if the breakthrough series is to continue successfully, what do you think needs to happen to move forward? the focus groups ranged in length from 50 to 120 minutes and were audio-taped and transcribed to prepare for analysis. ultimately, of the 318 registered collaborative members, 97 participated in one of the 13 focus groups. important to note is that not all 318 people who were registered as collaborative members were actively participating at the point of the study. this sampling frame includes any person who attended a meeting at any time, even if that person only attended one meeting or event. although exact numbers are not available, leaders of the collaborative estimate that the number of active participants ranged from approximately 150 to 200 at the point of the study. therefore, this suggests the 97 qualitative participants represent about half of the active collaborative members. to analyze the qualitative data, the research analysts used both open and theoretical coding as described by coleman and unrau (2008). open coding involved a team of five analysts reading the transcripts for common words or ideas that were expressed. based on this initial reading, master codes were identified leading to the development of a protocol used for secondary coding. the analysts used the protocol to go back into the data and code each meaning unit according to the codes established through the initial analysis. all quotes assigned to each code were integrated allowing for an in depth vertical analysis of all meaning units contained within each theme. additionally, horizontal analysis was conducted that involved looking at relationships across themes. the findings were ultimately reconstructed and presented to the collaborative at the final bscsi summit. the qualitative research team used various strategies to increase the trustworthiness of the findings. first, triangulation by observer (padgett, 2008) was used such that five researchers were involved in data analysis to increase the likelihood that important perspectives on the data were not missed. additionally, reflexivity, a thoughtful consideration of one’s effect on the research process (horsburgh, 2003), was used. lietz, andereck, knopf/the breakthrough series collaborative 254 specifically, the team met before analysis to identify preconceived notions regarding service integration and the bscsi project. the team also met twice during data analysis to reflect on how social location could affect the data analysis process. finally, although member checking was not conducted, the pi presented the findings to the entire collaborative at their final learning summit. anecdotally, several professional, community, and family partners approached this researcher at the end of this presentation and reported the findings captured their experiences. as of result of these efforts and this informal feedback, we believe we increased the confidence that these findings represent a trustworthy portrayal of the data. quantitative methods once the qualitative researchers completed their analysis, the prevailing themes were identified and used to develop a quantitative instrument to test these findings with a larger sample of the collaborative. specifically, the quantitative component of the bscsi evaluation consisted of an instrument developed by the survey team and administered online or by mail. the evaluation consisted of several sections measuring a series of variables. the survey measured (a) the perceived level of functioning of the community teams, (b) the extent to which participants felt the work of their team was effective, and (c) the perceived barriers to effectiveness. all of the following groups of items were derived from the focus groups’ results. nine items asked the extent to which team members felt characteristics related to successful team outcomes were descriptive of their teams. these were measured on a five-point scale ranging from “strongly disagree” to “strongly agree.” five items were asked regarding the extent to which team members felt various actions related to successful team outcomes were descriptive of their teams. these were measured on a five-point scale ranging from “not helpful” to “extremely helpful.” twelve items were asked regarding the extent to which team members felt various problems created barriers to achieving successful team outcomes. these were measured on a five-point scale ranging from “strongly disagree” to “strongly agree.” the next variables incorporated into the survey related to the experiences respondents had with their teams. they were asked questions regarding the formats for their meetings and the level of participation of different types of team members. they were then asked to respond to several questions related to their experiences with the team measured on a five point scale ranging from “strongly disagree” to “strongly agree.” these questions were drawn from krile (2006). finally, they were asked to provide an overall satisfaction assessment of their team’s progress (five-point scale where 1 = not satisfied and 5 = extremely satisfied). the instrument was sent or made available to all team members generally following dillman’s (2007) approach. team members were first sent an email message from bscsi staff letting them know the study would be conducted and encouraging their participation. they were then sent an email message with a link to the web-based survey by the researchers. this was followed by two email message reminders several days after the original message. for team members with no email address, essentially the same advances in social work, fall 2010, 11(2) 255 procedure was followed by mail, with a cover letter, paper evaluation, and postage paid reply envelope sent initially and postcard reminders sent later. a total of 315 team members (contact information for three participants was not available) were contacted by email or mail to complete the questionnaire with 145 responses for a response rate of 46%. the demographic profile of survey respondents is included in table 2. table 2: demographic characteristics of survey respondents (n=145) characteristics frequency percentage gender female 92 78.6 male 25 21.4 age (mean = 48.6) 24-39 19 17.6 40-49 39 36.1 50-59 38 35.2 60+ 12 11.1 education less than high school 1 0.9 high school diploma 7 6.1 some college 37 32.2 two year college degree 21 18.3 four year college degree 34 29.6 advanced degree 15 13.0 annual income $20,000 or less 6 5.4 $20,001-40,000 38 34.2 $40,001-60,000 33 29.7 $60,001-80,000 14 12.6 $80,001+ 20 18.0 race/ethnicity caucasian 66 57.9 latino 34 29.8 american indian 9 7.9 african american 4 3.5 other 4 2.7 type of participant family partner 13 11.0 des partner 72 61.0 community partner 33 28.0 lietz, andereck, knopf/the breakthrough series collaborative 256 findings the qualitative data analysis led to the identification of three themes each explained by a set of sub-codes. specifically, when describing their experiences with the bscsi, findings suggest participants in this research: (1) experienced a series of barriers to their efforts, (2) demonstrated a sincere commitment to the principles of service integration, and (3) relied on strengths to overcome challenges to achieve positive outcomes. these findings were supported by the responses on the quantitative instrument as well. barriers and challenges as team members discussed their experiences, three barriers were consistently identified: (a) confusion regarding roles and purpose, (b) lack of support from the larger social service system, and (c) difficulty maintaining and recruiting family partners. table 3: barriers experienced by team members barriers percents mean strongly disagree disagree neither agree strongly agree confusion about who was in charge of the team 10.9 34.0 20.4 20.4 12.9 2.9 confusion about the purpose of the project 4.8 21.8 20.4 34.7 17.0 3.4 lack of knowledge about the project by the larger des community 1.4 13.6 14.3 32.7 36.1 3.9 not feeling that the team was valued 8.8 27.2 29.3 20.4 12.9 3.0 lack of resources needed to implement actions 2.7 15.0 20.4 32.7 27.2 3.7 lack of authority to implement actions 5.4 13.6 21.8 25.9 32.0 3.7 difficulty engaging family partners 0.7 10.2 12.9 25.2 49.7 4.1 people moving in and out of the team 1.4 8.2 12.9 42.2 32.0 4.0 took a while to get started 1.4 19.7 15.6 36.1 25.9 3.7 establishing team cohesiveness took some time 1.4 21.1 14.3 42.9 19.0 3.6 extranet/computer problems 3.4 16.3 27.9 22.4 27.2 3.6 overly complex process 2.7 21.8 25.9 28.6 19.7 3.4 advances in social work, fall 2010, 11(2) 257 confusion regarding roles and purpose. several participants discussed facing confusion early on in the project regarding their purpose. one community partner stated, “i think in the beginning people didn’t know which way they were going and what was their role” while a des partner stated, “i think a lot of it early on was confusion. we were spinning our wheels a lot at the beginning.” some des partners thought they were required to participate in the collaborative despite contrary communication suggesting involvement was to be voluntary. family and community partners also expressed a lack of clarity regarding their purpose and role. this issue was also noted by respondents to the survey (table 3). a number of participants agreed that there was a lack of clarity regarding the purpose, and some noted confusion about who was in charge of the team. when asked about actions that could have helped, nearly all indicated that increased clarity of the project and process would have been at least moderately helpful (table 4). table 4: support for teams team suggestions percents mean not helpful slightly helpful moderately helpful very helpful increase clarity of the project and process 2.0 9.5 35.4 51.7 3.4 increase knowledge about this project relative to the larger des system 1.4 7.5 33.3 56.5 3.5 increase acknowledgment and encouragement for the teams 2.7 19.0 32.0 43.5 3.2 provide incentives for family partner participation 1.4 14.3 24.5 57.8 3.4 support from des for engaging more family partners 4.8 10.9 27.2 55.1 3.4 lack of support from the social service system. des partners and some of the community and family partners discussed experiencing a lack of support from the larger social service system as one significant barrier to the work of their bscsi team. lack of support was perceived by these participants in different ways. some team members who were social service professionals felt their supervisors did not support their participation in the collaborative, they received criticism for time spent away from their jobs, and they did not receive workload reduction for the time spent on bscsi activities. one team member stated, “there’s no buy in from supervisors.” in addition, many felt administration did not support the work of the bscsi teams. one community partner stated, “we could not get our ideas approved” while another partner stated, “the larger system has not bought into the service integration philosophy creating resistance to the ideas generated through pdsas.” survey participants reported these types of barriers as lietz, andereck, knopf/the breakthrough series collaborative 258 well. most felt that the larger des community was not knowledgeable about the project (table 3) and that increased knowledge about the project would have been at least moderately helpful (table 4). they also felt the teams did not have the resources or the authority to implement actions (table 3). the respondents tended to be split between agreeing and disagreeing that their team was valued, and a large percentage (76%) felt that more acknowledgement and encouragement for the teams would have been helpful (tables 3 and 4). difficulty maintaining and recruiting family partners. all the teams we spoke to expressed a clear commitment to incorporate family and community voice on these teams. when family and community voice was included, the teams clearly saw the benefit. they reported increased insight and understanding regarding how to improve services for families. at the same time, all but two teams discussed significant difficulty maintaining family voice on their teams. the teams reported that some families would verbally commit to attendance but then not show up for meetings. when they did come, attendance was inconsistent making it difficult to fully engage family partners in the process. one des partner explained, “our biggest challenge was keeping the family partners. although initially we had three family partners that were involved and interested and excited, one by one other things in their lives took priority, and they became less interested in us.” teams discussed conflicts in scheduling meetings and events as families needed evening or weekend meetings while des partners and many community partners preferred day events. many teams were quite creative and diligent in their attempts to accommodate and engage family partners. however, when changes were made to accommodate families, sometimes families would not attend and the teams would also lose des and community participation as a result of changing the meeting time. all teams reported a desire for further education and support regarding this barrier. the concern regarding including family members was clearly reiterated in the quantitative results. over 75% of respondents agreed that difficulty engaging family partners was a barrier (table 3) and nearly all felt that incentives and additional support from des would have helped in engaging family partners (table 4). commitment to the service integration philosophy findings suggest the bscsi teams experienced many barriers to their efforts ranging from confusion regarding their roles or purpose, difficulty retaining family partners along with a perceived lack of support and time constraints. considering these struggles, one might expect that some of the teams would not have made it through the full year of this project. yet, as the research team examined the experiences of the collaborative, we discovered that all teams were still meeting, pursuing small tests of change through the pdsa process and making improvements in services in their communities. as we pondered this finding, we identified many statements in our interviews that were coded as “commitment” that explained why the teams kept going despite the struggles they faced. this finding was also apparent in the survey results with 75% reporting agreement to a commitment to the philosophy of the program (table 5). advances in social work, fall 2010, 11(2) 259 table 5: characteristics of successful teams team characteristics percents meansstrongly disagree disagree neither agree strongly agree commitment to the philosophy of the program 2.0 4.1 17.0 49.0 26.5 4.0 strong participation by family partners 17.7 22.4 16.3 27.2 15.6 3.0 strong participation by community partners 4.1 16.3 11.6 40.8 26.5 3.7 diverse knowledge and experience represented on the team 0.7 1.4 4.8 52.4 40.1 4.3 strong leadership for the team 0.7 11.6 22.4 38.1 25.9 3.8 good relationships among team members 2.0 2.0 8.8 51.7 34.7 4.2 having fun during meetings 2.0 4.8 15.0 46.3 31.3 4.0 maintaining flexibility during the process 3.4 4.8 13.6 50.3 27.2 3.9 demonstrating innovation 2.7 6.8 16.3 45.6 26.5 3.9 many reported that as the year progressed, some of the original participants left and the remaining partners were the ones most committed to the philosophy. the teams may be smaller, but in some ways, became stronger through their shared commitment. demonstrating this commitment, one des partner reported: in the past, it’s always been des making decisions and never hearing the voice of des customers. finally, that’s changed and through the breakthrough series this is happening. so that’s a good thing! it’s been a really good experience. similarly, a family partner stated, “i saw all these people in one room saying we can make difference, we want to understand what it’s like. i want to be a part of that so bad! i want to be a part of change!” our research team observed members committed to the project, who desired for this philosophy to continue such that services would be improved through service integration. in addition to demonstrating a commitment toward service integration, participants consistently spoke of their desire to incorporate family voice in social service delivery. one des partner illustrated this commitment stating, “this is the first time we have listened to families. des has always made the decisions, it didn’t matter what anybody else thought. now, the roles are kind of reversed, and it’s really having a good impact for lietz, andereck, knopf/the breakthrough series collaborative 260 the customers.” similarly, one community partner concluded, “we wouldn’t even know some things are problems without hearing it from our families.” des and community partners consistently discussed the insight gained from the involvement of families. along with increased insight, many partners also discussed how their motivation elevated when they saw the impact of their work first hand. for example, one des partner talked about a renewed passion for her job. she stated: i stick with this because my families are benefiting from it. so, it makes me more professional as a social worker, and it makes me fall in love with my job more and with other people with the same passion and purpose. des and community partners reported many intrinsic benefits of collaborating with families on their bscsi teams. one striking finding related to family voice was the benefits identified by the family partners themselves. while family voice brought insight to social service workers, families also came to understand more about the perspective of the worker through their involvement in the bscsi. for example, one family partner shared: being part of the breakthrough series, i get to see them actually doing their job and i see the passion. i have something to offer, because i have been through it. but, they are not just learning what it’s like to be on my side. i am also learning what it is like for them. everyone has been learning. in addition to increased insight, family members also developed self-esteem as they were involved in the bscsi. one family partner stated: when she asked me to participate, i just burst into tears, i was just so excited. just the fact that she would ask me to participate in something to help other people showed that she did have faith in me. it gave me what i needed to continue in my sobriety. if i didn’t have the breakthrough series to be involved in, i don’t know where i would be. another family partner stated, “being a part of the breakthrough series changed my life. before i was nobody, now i am somebody.” overcoming barriers and challenges as the teams discussed overcoming the challenges, it was clear that their commitment to the service integration philosophy and their desire “to make a difference” allowed them to move forward. in addition to this commitment, the teams described several strengths that helped support them as they sought to overcome these barriers. a spirit of perseverance fueled by a sense of hope, collaboration and communication, effective leadership, and relationship building helped these teams to persevere despite these struggles. a spirit of perseverance driven by a sense of hope. as participants discussed barriers they faced during their involvement in this collaborative, our research team observed a spirit of perseverance that defined the character of these teams. as these bscsi teams identified obstacles, they also discussed many strategies used to overcome advances in social work, fall 2010, 11(2) 261 these struggles. collaborative members used phrases like “we just wouldn’t give up” and we “stuck with it” illustrating this spirit. one des partner illustrated this point stating, “we’ve had a lot of barriers, but, i am really proud of the team members because they’ve stuck through it all. we kept trying and trying and trying.” these teams simply would not give up. along with a spirit of perseverance, the research team also identified a sense of hope woven throughout much of our conversation. one family partner stated, “being involved in the bsc gives me more hope for the future” while a des partner shared, “what we did for families gave me a ray of sunshine, of hope, that we’re moving in the right direction.” when asked about his involvement in the collaborative, one community member responded, “what keeps me coming back? hope. hope that whatever services we’re providing can help and we’re united by that one goal.” as these teams talked about their work with the collaborative, they asserted their belief that they could make a difference. it appeared as if they looked past obstacles in order to see the possibilities. the findings suggest perseverance was realized for teams through a pervasive sense of hope. collaboration and communication. in addition to their spirit of perseverance and a sense of hope, these teams consistently talked about the importance of collaboration and communication in their process. how did they overcome the barriers they faced? put simply, they worked together. the ability to bring partners together coming from diverse experiences and backgrounds allowed these teams to understand the problems in a new way. having multiple perspectives allowed the teams to identify more creative solutions. working together and talking things out appeared to help these teams overcome obstacles leading to improved outcomes. one des partner asserted this idea stating, “we worked together, discussing issues and how can we resolve it, and how we can help one another. i felt that a collaborative spirit was there.” another des partner summed up this point stating, “des can’t do it alone. community partners can’t do it alone. family partners can’t do it alone. but, when we come together and work toward a common goal, that’s the key!” involvement by community members was an important aspect of successful teams according to survey respondents, however the challenges of participation by family members was once again evident (table 5). having multiple perspectives also allowed the teams to identify more creative solutions. this was strongly reiterated by survey respondents with 92% agreeing that diverse knowledge and experience was a characteristic of a successful team (table 5). effective leadership. one idea discussed by several participants of the bscsi was coded as “leadership.” many teams who were pleased with the accomplishments of their team gave credit to team leaders for their ability to keep the team organized, on track and informed. one family partner discussed this concept stating, “i think leadership helps. he’s got great leadership. our team leader keeps us well informed. he keeps us involved.” similarly, a des partner stated, “our leader has all the qualities to lead a team like this. i just wanted to recognize her as somebody who i have a lot of respect for, for not giving up and continuing to lead us,” while another des partner concluded, “i think our team leader is a wonderful example of someone who has the right attitude and personality to work with a diverse group of people like we have.” this qualitative finding lietz, andereck, knopf/the breakthrough series collaborative 262 was reemphasized in the survey in which 64% of respondents felt this was a characteristic of a successful team (table 5). relationship building. finally, one of the most consistent comments we heard during our time with bscsi participants highlighted the importance of relationship building during this project. words such as “bonds,” “connections,” and “friendships” were used when participants spoke about what helped their team succeed. relationships were also identified as what many participants enjoyed most about being involved in the collaborative. survey respondents echoed this sentiment noting that both good relationships among team members and having fun during meetings were hallmarks of successful teams (table 5). one community member concluded, “it’s the people that keep me coming back to this team. it’s the heart they have for what they are doing.” similarly, one family partner explained, “there are lots of different personalities, different ways of doing things, but, still, the bond, the bond that we continue to create is there.” the relationships that were formed on these teams allowed diverse groups of people to come together, identify commonalities and move forward in the work of their team. discussion there are limitations to this study. these findings are not generalizable, and data gained through focus groups may be hindered by social desirability. the additional quantitative data that was collected allowed all members of the collaborative to participate. however, there is no way to ascertain whether the 46% response rate may have represented many of the same people who participated in the focus groups. in addition, there was significant missing data in the quantitative survey, particularly for the demographic questions, another limitation of the study. finally, this project focused on the process of the teams, not outcomes. we are unable to draw conclusions about the success of the efforts, but instead focused on the perceptions of the people most intimately involved in the work of this collaborative for the purpose of understanding more about the experiences of those involved in this initiative. despite these limitations, the data provide some important insights into the experiences of participants of this strengths-based initiative. specifically, findings highlighted the challenges faced when collaborative teams are brought together for the purpose of improving services through integration. confusion, lack of support, and practical issues such as scheduling conflicts made this task difficult. however, a striking finding was the commitment the remaining members of this collaborative maintained to the service integration philosophy and to their team approach. this commitment led to perseverance, increased communication, and relationship building to accomplish their goals. at the end of the project, teams were pleased with their progress and were able to cite specific examples regarding how their efforts translated into positive outcomes for families. specifically, the collaborative implemented 105 innovative strategies to improve social services, including procedures to increase community education and awareness of services, efforts to enhance efficiency of service delivery, and activities to improve advances in social work, fall 2010, 11(2) 263 customer service. for example, 19 efforts involved increasing access to services by developing service directories, improving telephone systems, and providing more accurate information in the lobbies of social service areas. another 19 activities sought to increase efficiency by streamlining application procedures, creating new forms and case tracking processes, and implementing new ways of sharing information across the divisions within des. twenty-three of the strategies sought to increase communication between service providers and recipients by holding community forums and further exploring client satisfaction with services. seven of the innovations related to education and training such as offering ged classes during both day and night hours, conducting prevention workshops for teens about dating violence, and providing job training for youth. finally, 37 of the activities related to improving customer service and enhancing the physical environment of places at which services are delivered. for example, one team was able to solicit volunteer artists to paint a mural in a lobby, one team created a waiting area for children inclusive of toys and furniture appropriate for young children, and one team partnered with seniors to provide artwork in the waiting areas. as the collaborative brought social service professionals, community leaders, and families together for the purpose of improving services in arizona, it is important to note a few of the unexpected positive impacts that were also discussed by partners in this project. first, social workers identified a renewed passion for their jobs as they had the opportunity to sit at the table with families to improve services. as social workers came to see families not as clients, but as people seeking positive change for their communities, this commonality encouraged many of the professionals involved in the collaborative. considering challenges facing the social work workforce such as burnout and turnover, striking comments made by professionals involved in this collaborative suggested this type of work may have an impact on one’s renewed commitment to the mission of the field. second, families acknowledged an increased respect for the professionals as they talked about seeing the struggles and barriers social workers face in a new way. increased insight and understanding between families and professionals may help to bridge the gap of misunderstanding common in these relationships. in addition to increased respect for workers, family partners also discussed being empowered by their work on the collaborative. several family partners suggested that being asked to serve in this capacity raised their self esteem, brought purpose to their lives and brought relationships they found meaningful. although this study did not deliberately explore the impact of the bscsi on participants, many of the comments from the qualitative data suggested this was an unexpected but positive finding. implications as agencies consider collaborative efforts such as these, it may be helpful to review implications from this study. first, it is important that early communication seeks clarity for team members regarding their purpose and roles in the process. a decrease in ambiguity may have helped maintain some of the partners who left the collaborative. particularly when people are engaged in volunteer efforts, it seems critical that they be able to see the purpose and potential benefit realized through their efforts to encourage ongoing involvement. second, team members need to be supported by agency lietz, andereck, knopf/the breakthrough series collaborative 264 administration such that their efforts have the ability to affect change within the organization. volunteers and professionals alike experience frustration when they face ongoing barriers to implementation of new ideas. this discouragement can undermine community efforts such as these. therefore, increased communication and collaboration is needed between these teams and the larger social service delivery system in similar efforts that seek to improve and integrate services. even with improved coordination, barriers can be expected. practical support and acknowledgement are needed to encourage teams to move forward despite the obstacles they face. similarly, flexible yet consistent leadership is critical as the teams must negotiate diverse schedules, opinions, and needs while maintaining their commitment a common vision. team leaders play an essential role in facilitating productive dialogue and organizing efforts so that action is taken. finally, as collaborative efforts seek to include family members, clearly one of the hallmarks of this initiative, teams need more support in making this happen. future research is needed to help community-based initiatives understand how to better recruit and engage family partners in such efforts. conclusion the bscsi provides an example of a strengths-based initiative seeking to improve social services through increased integration by creating a collaborative of 20 diverse teams coming together to dialogue about problems and solutions across these local communities. the findings from the mixed methods examination of this effort allowed the researchers to observe a complex process seeing both the challenges faced along with the ability to persevere and ultimately observe the impact for families living in these communities. lessons learned from this initiative can be helpful to other organizations who similarly value community-based efforts to address complex problems. references annie e. casey foundation (aecf). 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(1989). a strengths perspective for social work practice. social work, 34(4), 350-354. author’s note: address correspondence to: cynthia a. lietz, school of social work, arizona state university, 411 n. central ave, suite 800, phoenix, az, 85004-0689. email: clietz@asu.edu ______________ dr. thomas p. felke is the bsw program coordinator and an assistant professor in the department of social work at florida gulf coast university. he focuses his research efforts on conducting community needs and assets assessments using community-based participatory research. he routinely teaches an elective course focused on the use of geographic information systems as a planning, research, and evaluation tool in the social services. (email: tfelke@fgcu.edu) copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 140-153 the use of geographic information systems (gis) in conducting a needs assessment of seniors in collier county thomas patrick felke abstract: despite boasting a population where approximately 50% of individuals are aged 65 or older, naples, florida, has few services specifically targeting this population. this article reports on a project that utilized geographic information systems (gis) to examine the current needs of the senior population in a defined section of collier county, florida. various data points regarding the population age 65 and over were obtained using the u.s. census bureau’s american factfinder tool. these data were incorporated into digital maps that included the census tracts of the selected geographic area, locations of existing programs/services, and the existing transportation network. the results of the spatial analysis were corroborated by data collected via key informant interviews and focus groups. the result of the project was the establishment of the first senior access center in collier county, fl. the project reinforces the use of gis technologies for the purposes of needs assessment and siting program locations in the human services. keywords: geographic information systems (gis), seniors, needs assessment social work practitioners can employ geographic information systems (gis) technologies for a variety of purposes, such as planning, monitoring, and evaluating of programs and services. this article describes a project in which gis technologies were utilized as part of a community needs assessment focused on seniors in collier county, florida. the technologies merged existing descriptive data about the target population to a discrete geographic section of the county. digital representations of the locations for existing services for seniors as well as a digital representation of the public transportation network assisted in identifying possible locations for the establishment of a senior access center within the county. whereas most projects employing gis technologies have focused on ex post facto evaluation, this project utilized gis technologies as a planning tool. the project centered on examining gaps in services to seniors and the identification of a site in naples, fl with the best potential for establishing a senior access center. the project also included focus groups and key informant interviews in concert with gis technologies in order to strengthen the analysis. this methodological approach is not one seen previously in the literature. the leadership coalition on aging for collier county (lca-cc), a partnership of community agencies working with the senior population, sought to commission a needs assessment to examine the specific needs of seniors in collier county. collier county is located in southwest florida, consists of approximately 2,300 square miles, and has an estimated population of over 330,000 residents (u.s. census bureau, 2013). the county includes three cities and nineteen unincorporated areas though the latter have local recognition as communities. one of these cities, naples, has consistently ranked among the top three cities nationally having the most millionaires per capita (kiplinger, 2014). mailto:tfelke@fgcu.edu felke/the use of geographic information systems 141 despite this fact, local human service professionals and members of the lca-cc knew that the events of the 2008 financial crisis had a significant impact on many individuals in naples, particularly seniors. based on their work with seniors in the local communities, members of the lca-cc were interested in exploring the feasibility of establishing one or more access centers for seniors in collier county. at the time, no single point of service access for seniors existed in collier county. lca-cc members felt this resulted in a lack of service coordination as well as sparse information regarding what services are available and to whom. members identified four pre-existing locations in collier county as having potential for being able to accommodate a senior access center but were uncertain which site was the best location or what specific services seniors most desired. this led to the development of the community needs assessment project described here. due to his background with gis technologies as a research instrument, the author was asked to participate in the project. gis applications gis technologies are mapping tools used to create digital representations of key demographic variables according to desired geographic areas. a gis is an organized collection of computer hardware, software, geographic data, and personnel designed to efficiently capture, store, update, manipulate, analyze, and display all forms of geographically referenced information (esri, 1992). these technologies allow the user to join quantitative data that includes a geographic reference with digital maps in order to display the data in a defined geographic space. the majority of descriptive data collected, maintained, and utilized in social work practice is geographically referenced information. this information provides details as to what may exist near, or even at, a specific location depending upon the level of spatial data. spatial data, or digital representations of physical geography, are produced in several levels. these include but are not limited to state boundaries, city or town boundaries, zip code areas, census tracts, block groups, and streets. the following example illustrates the connection between descriptive and spatial data: when a social service agency collects a client’s mailing address during an intake meeting, this data potentially contains several geographic references: the state, town, zip code, and street address where the client resides. using a gis, one can use descriptive data in combination with spatial data to create digital maps that symbolize what lies where. further, the technologies provide tools for analyzing the geographically referenced data to identify patterns, understand spatial relationships, and detect trends (esri, 1992). gis technologies were first introduced in the 1960s for land use management. today, they are used by practitioners from various backgrounds across an array of agencies for a variety of purposes. these technologies are employed at local, national, and international levels for purposes including disaster management (amamoo-otchere & akuetteh, 2005; wood, 2000; zakour & harrell, 2004), monitoring disease outbreaks (ailes et al., 2014; hershey et al., 2011; idowu, 2011), and monitoring of refugee situations (bjorgo, 2000; kemper, jenerowicz, gueguen, poli, & soille, 2011). the application of gis technologies first appeared in the social work literature in the late 1990s when hoefer, hoefer, and tobias (1994) proposed gis technologies as a potential tool for social workers to consider. queralt and witte (1998, 1999) undertook the advances in social work, spring 2015, 16(1) 142 earliest applications of utilizing gis technologies to examine gaps in childcare service in areas of massachusetts and florida. the relevance of geography and, by extension, the application of gis technologies for research and evaluation purposes has been explicated in the social work literature (coulton, 2005; felke, 2007; hillier, 2007). as a result, the social work profession has seen an increase in the use of gis technologies for a variety of planning and evaluation efforts (friesthler, lery, gruenewald, & chow, 2006; guerrero & kao, 2014; leung & hanna, 2001; wong & hillier, 2001). gis technologies have also been utilized to examine issues related to seniors. hirshorn and stewart (2003) believed that these technologies had largely been underutilized for gerontological research efforts between 1983 and 2000. however, a review of the recent literature suggests that efforts in this area have increased. for example, gis technologies have been used to examine barriers in accessing services related to health and food insecurity (lin, 2004; ohta et al., 2007; yamashita & kunkel, 2012). though research on the topic is seemingly limited, gis technologies have been used to ascertain ideal locations for the establishment of services to seniors. carlson, york, and primomo (2011) employed gis technologies in this manner when identifying possible sites to deliver communitybased fall prevention program for older adults; the authors found gis technologies were valuable in facilitating the selection of sites to maximize accessibility and utilization by targeted populations. project overview faculty from the department of social work at florida gulf coast university (fgcu) was engaged to undertake the first ever needs assessment of seniors residing in collier county. an initial meeting was held with lca-cc members to outline the scope of the project and to define certain parameters. the spatial target area was one of the primary aspects of the study needing to be defined. while the lca-cc was concerned with issues related to seniors throughout collier county, it became apparent that the actual study area was smaller than the entire county itself. as a result, an area including the city of naples and its immediate unincorporated border areas became the target geography for the needs assessment as shown in figure 1. this decision was made after a discussion of the feasibility in attempting to focus on an area as large and disparate as collier county. another important decision was the definition of a senior for the purposes of this project. discussion among lca-cc members centered on whether 60 or 65 years old should be established as the minimum age. in the end, the lca-cc resolved to define a senior as an individual aged 65 years or older. this decision had only a minor impact on the data collected as the u.s. census bureau collects data for this population at both ages depending on variable. for example, data related to households receiving snap benefits is available for households including an individual aged 60 and older while data on individuals living alone is available for individuals aged 65 and over. with insight from fgcu faculty, the lca-cc sought to develop a comprehensive demographic profile of the senior population in the target geographic area to better understand the population as a whole. this was important as it was clear that a perception existed among some members of the lca-cc that poverty was not an issue among the http://www.sciencedirect.com/science/article/pii/s0362331910000959 http://www.sciencedirect.com/science/article/pii/s0362331910000959 http://www.sciencedirect.com/science/article/pii/s0362331910000959 felke/the use of geographic information systems 143 senior population. that was clearly reflected when, during an initial planning meeting to discuss possible variables, a lca-cc member stated, “this is naples. there are no poor people in naples.” the lca-cc also sought to create a visual illustration of the senior population in relation to the existing public transportation network and human service providers. the primary purpose of this initiative was to develop an advocacy platform from which lca-cc members could promote the expansion of the public transportation network to areas thought to be underserved. the final objective was to solicit feedback from human service professionals working with seniors and from members of the senior population regarding perceptions of senior needs in the target area. this was deemed important in order to ascertain whether the perceptions of the providers were in line with those of the seniors in the area. figure 1. spatial target area based on this and additional feedback gathered at the initial meeting, fgcu faculty began to formulate an assessment plan. they decided on a mixed methods approach because a quantitative component, including a spatial analysis using gis technologies, would allow for the illustration of the target population in the selected geographic area while a qualitative component would allow for human service professionals, members of advances in social work, spring 2015, 16(1) 144 the target population, and other community stakeholders to lend voice to the quantitative data. the quantitative portion consisted of the analysis of existing data collected using the american factfinder tool of the u.s. census bureau. the qualitative portion included key informant interviews with human service professionals working with the senior population in collier county as well as focus groups with seniors residing in the county. upon acceptance of the assessment plan by the lca-cc, the project began in the summer of 2013. gis methodology while a mixed methods approach was developed, the primary focus of this article is the application of gis technologies in this project. the primary purpose of this particular methodology was to illustrate the senior population in the geographic target area. as mentioned previously, the first step in this process was the development of an orientation basemap which was used to provide viewers with a geographic context of the spatial target area. a decision was made to collect data at the census tract level in order to provide an accurate illustration of the target population in the target geographic area. according to the u.s. census bureau (2012), census tracts “are small, relatively permanent statistical subdivisions of a county…generally have a population size between 1,200 and 8,000 people…to provide a stable set of geographic units for the presentation of statistical data” (para. 1). the general intention of census tracts is to represent neighborhoods, as they are designed to be relatively homogeneous with respect to population characteristics, economic status, and living conditions (iceland & steinmetz, 2003). as the target geographic area in this project consists of both incorporated and unincorporated areas, census tracts were deemed as the best spatial representation of the area. to create a digital representation of the target geography, the author first obtained a digital map, or shapefile, of all census tracts in collier county from the u.s. census bureau website. the author modified the census tract shapefile using arcgis (esri, 2011, version 10.1), a commercial gis software program, to include only those tracts found in the target geography. the resultant shapefile included 53 census tracts from the initial set of 74 as shown previously in figure 1. a shapefile of the major road network of collier county as well as a major highway, interstate 75, were obtained from the collier county gis services division. these shapefiles were added to the arcgis project as overlays to the modified census tracts shapefile. the street network shapefile was modified through a process known as clipping so that it matched the borders of the census tract shapefile. the same modification process was undertaken on the shapefile of interstate 75. to complete the digital representation of the area transportation network, two shapefiles of the public transportation system – one for the transit routes and one for the route stops – were obtained from the collier county metropolitan planning organization (mpo). the route shapefile was not included in the project file as it closely approximated the major road network. these shapefiles were also modified using the clip process outlined previously and then added to the arcgis project as overlays to the census tracts layer. felke/the use of geographic information systems 145 a final layer of the identified site locations were also added to the project file. these locations were added through geocoding, a process of address interpolation whereby street address data is digitally represented as a point along a digital street network (esri, 2010). these layers were combined in the project file to create a basemap of the spatial target area as shown in figure 2. figure 2. spatial target area basemap advances in social work, spring 2015, 16(1) 146 once the spatial data set was modified and assembled, work began on building the descriptive dataset for the spatial target area. all descriptive data were obtained from the u.s. census bureau website using the american factfinder tool. the author collected data from the 2012 american community survey (acs) 5-year estimate dataset. the five-year estimates are a strong choice for use when analyzing very small populations such as at the census tract level (u.s. census bureau, 2013). a further rationale for the selection of this dataset was the availability of a broad range of age-specific variables. using microsoft excel, the author compiled a comprehensive dataset along with a codebook containing descriptions of the variables and the tables from which they were drawn. the use of a microsoft excel workbook also allowed for the calculation of descriptive statistics and the creation of pivot tables used to view and present data in later presentations. the author ensured a unique identifier was included for each row of data, with each row representing a specific census tract found in the target area. this was done in order to create a join between the descriptive data for each census tract with its digital representation in the shapefile. this join between the table associated with the spatial data and the table holding the descriptive data is what allows for the visualization of the descriptive data on the digital map. data analysis the spatial data was first analyzed to locate key features and orient stakeholders to the reduced target area. a geoprocessing tool found in arcmap was employed to locate the central feature, in this case the central census tract, of the target geographic area. this feature was located slightly east of center in the target area. this feature was both centrally located in the existing public transit system and home to one of the potential site locations for the senior center as shown in figure 3. the next step in the analysis was the visualization of the descriptive data that had been joined to the digital map. the author visualized each variable in the digital map using a basic count per census tract in order to identify the census tracts with the highest number of seniors according to each variable displayed. in the target geographic area, the senior population totaled approximately 58,000 individuals (48% male; 52% female). the population was shown to be distributed with the largest concentrations in the northwest corner and central southern sections of the target area. a smaller but concentrated band of seniors was located in the target area near the centrally located site. while this map did not seem to have a major impact factor, the power of utilizing gis technologies was apparent as, upon seeing the maps, several lca-cc members remarked they were not aware the senior populations were located in certain areas. one member, upon seeing the close proximity between a large pocket of the senior population and their agency location, stated, “i had no idea that so many of them were right in my backyard.” several demographic and socioeconomic variables were illustrated via gis using basic counts in each census tract of the spatial target area. within the target area, there were an estimated 2,470 households with a householder aged 65 years or older with income in the past 12 months below the federal poverty level. spatially, the highest concentration of this population was located in the northeast corner of the target area with pockets also identified in the center and southeast corner. additionally, there were approximately 1,200 felke/the use of geographic information systems 147 households with at least one resident aged 60 or older having received snap (food stamps) benefits in the past twelve months. two pockets were identified with one being located in the northeast corner of the target area while the other was found near the central site location. figure 3. central features one of the most important findings was the data regarding the number of households consisting of seniors living alone in the target area. the data showed that approximately advances in social work, spring 2015, 16(1) 148 16,600 individuals, roughly 29% of the total senior population, were living alone. there was almost double the number of senior women (66%) than men (34%) living alone. these populations were found to be distributed evenly throughout the target area with a few exceptions based on gender. the highest pocket of male seniors in this category was located in the southern area whereas three pockets of female seniors in this category were located in the central and northern areas. taken as a whole, the highest densities were found near the central site location as well as on the northwest border. this variable took on the utmost importance as “lack of companionship” was the primary theme of the focus groups conducted with seniors in the target spatial area. using the total senior population by census tract as a base layer, a second geoprocessing tool was used to buffer the stops along the public transportation system. a buffer is an area of a pre-defined distance created around a map feature in order to conduct proximity analysis (esri, 2012). in this project, buffers of a quarter mile and a half-mile were created around the public transportation stops. these distances were selected based on walkability research among the elderly that identified these distances as the outer limits to which seniors will utilize public transportation (hess, 2012; kim & ulfarsson, 2004). an additional one mile buffer was added for comparative purposes. the proximity analysis found that none of the four site locations were particularly accessible for individuals utilizing the existing public transportation system as shown in figure 4. in most cases, minimum walking distances between transit stops and site locations were in excess of one mile. two locations were found to have at least one transit stop situated within a quartermile though only in one direction of the transit loop. in summary, none of the four selected locations were located directly within a census tract with the highest population of individuals over 65, with the largest number of individuals below the federal poverty level, with the lowest median income, or with the largest number of household receiving snap benefits. census tracts located in the northeast and northwest corners of the target area were found to contain high concentrations of seniors who might benefit from a senior access center. however, the lack of an available site location as well as limited public transportation were cited as major barriers for seniors residing in these areas. the centrally located site was in the closest proximity when evaluating the population according to each of these variables. this site was also the only location having a transit stop within a quarter-mile distance. based on the findings of the spatial and proximity analyses, triangulated through data collected via the key informant interviews and focus groups, the author made a series of recommendations. primary among the findings was the confirmation, despite public perception, that the target area was home to seniors with incomes below the poverty level and who lack access to needed services because of either transportation barriers or a lack of basic services for low-income individuals. the findings also showed a need, and want, for social activities and companionship among seniors. given its proximity to high senior populations based on the variables examined, the central site location was recommended for the establishment of a senior center with a second site located in the southeast corner, if feasible. a final recommendation was also made for the development and provision of alternate transportation options for seniors in felke/the use of geographic information systems 149 the northeast and northwest corners of the target area so they might benefit from participation in a senior center. figure 4. site/transportation buffers recommendations gis technologies provide a tool that can be used for planning or evaluation purposes. the project described in this article focused on its use as a planning tool. the resultant advances in social work, spring 2015, 16(1) 150 maps provided a tangible product that allowed stakeholders to visualize the target population, according to various attributes, within the spatial target area. the maps also provided evidence that was difficult to refute and that ran contrary to prevailing opinions regarding the number of seniors in need in the spatial target area. by using gis technologies, an optimal location for a senior access center was established, and some gaps for the senior population in the existing public transportation network were highlighted. the incorporation of qualitative methodologies was a major benefit to this study. while the gis technologies were able to provide a demographic illustration of seniors, it was the qualitative data that both supported and helped reframe the study along the way. companionship was stated in the focus groups as the primary desire of seniors in establishing a senior access center. this was supported by the collected quantitative data showing a high number of seniors living alone in the spatial target area. this fact was corroborated in the key informant interviews with human service professionals who also noted a lack of access to transportation as a major barrier for seniors. however, the majority of seniors noted in the focus groups that this was not a primary issue for them as they did not rely on public transportation opting instead to either drive themselves or carpool with neighbors. means of transportation was not included as a quantitative variable as the lcacc members felt it was too obvious of a barrier to consider evaluating. in hindsight, given the feedback from the focus groups, it might have been a very useful variable to examine. it is important to take into consideration the understanding of the stakeholder group of both available data and gis technologies. lca-cc members often questioned the use of the dataset being utilized, not in terms of its accuracy, but availability. members felt that data such as that used in this project should have been available more frequently and been collected locally. educating members on the complexities of data collection and management, even for the comparatively small spatial target area in this project, became an important task in order to develop confidence in the process. it was also important to educate members on the capabilities of gis technologies. while many members felt they understood what the technologies could be used for, it became clear in preliminary discussions that this knowledge was actually limited. some members felt the technology was, and would be, used to track the target population while others would routinely confuse gis and gps (global positioning systems) technologies both in name and function. conclusion based on the project findings outlined in this article, funding was obtained to establish the first senior access center in collier county. the 4,000-square-foot center opened in january 2014 with a plan to operate a weekly congregate luncheon and occasional social activities for seniors. due to a tremendous response from seniors in the naples community and adjoining areas, the center now operates on a daily basis, serving approximately 450 local seniors. initial analysis of the participant demographics, as well as direct feedback from seniors, has found that the center is meeting the needs identified in the study. gis technologies are now being used as an evaluative tool for this purpose with a spatial analysis showing that participants are from the areas identified as having high concentrations of seniors living alone as well as areas with high numbers of seniors living below the poverty line. the county transit department noted the recommendations felke/the use of geographic information systems 151 concerning transportation preferences as reported in the focus groups. public transportation was expanded to areas with high concentrations of seniors through deviations in the fixed route transit system and expansion of ride share services, which allow seniors to attend activities without the need to walk extended distances or ride traditional public transit routes that include multiple stops and/or circuitous routes. the opening of second center is planned in the southeast corner of the target area by the end of 2014 using the results of this project as a basis for its establishment. the second location is being sited based on recommendations produced through the spatial analysis. moreover, neighboring communities have recognized the value in utilizing gis technologies as a tool in conducting community needs assessments. the author has been contacted by organizations in two neighboring counties who are seeking to utilize gis technologies as part of their needs assessment and planning efforts. one effort will focus on future parks and recreation planning while the second will be aimed at identifying and prioritizing community needs in a currently unincorporated area seeking to become incorporated. the practical application of gis technologies is evident and will hopefully continue to gain visibility as a tool for the social work practitioner. references ailes, e., newsome, k., williams, j., mcintyre, a., jamieson, d., finelli, l., & honein, m. 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(2013). american community survey 3-year estimates – collier county, florida census tracts. retrieved from http://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t wong, y. i., & hillier, a. (2001). evaluating a community-based homelessness prevention program: a geographic information system approach. administration in social work, 25(4), 21-45. wood, w. (2000). complex emergency response planning and coordination: potential gis applications. geopolitics, 5(1), 19-36. yamashita, t., & kunkel, s. (2012). geographic access to healthy and unhealthy foods for the older population in a u.s. metropolitan area. journal of applied gerontology, 31(3), 287-313. zakour, m., & harrell, e. (2004). access to disaster services: social work interventions for vulnerable populations. journal of social service research, 30(2), 27-54. http://gis.esri.com/library/userconf/proc00/professional/papers/pap168/p168.htm http://www.tandfonline.com/doi/abs/10.1080/13658810601135692 http://www.tandfonline.com/doi/abs/10.1080/13658810601135692 advances vol. 3, no. 2 117 social work practice behaviors and beliefs: rural-urban differences? tom a. croxton srinika jayaratne debra mattison abstract: there is continuing debate within the social work profession on whether there are significant differences in the practice behaviors and beliefs between rural and urban clinical social workers and whether different standards should be applied in defining ethical practices. this study measures those differences with regard to five practice behaviors: bartering,maintaining confidentiality, competent practice, dual relationships, and social relationships. differences were found in beliefs regarding the appropriateness of professional behavior though such differences did not translate into practice behaviors. more significantly, the research suggests considerable confusion about the meanings of ethical standards and the utilization of intervention techniques without formal training across both urban and rural social workers. keywords: socialworkers, ethics,urban-rural, standards of practice,practice behaviorsbeliefs sociologists continue to debate whether urban/rural dichotomies are any longer of great significance (castle, 1995; johnson & wang, 1997; nelson & smith, 1999). a similar debate goes on innearly all professions (erickson, 2001; lyckholm,hackney& smith, 2001; roberts, battaglia, smithpeter & epstein, 1999), including social work (carlton-laney, edwards & reid, 1999; davenport & davenport, 1995; ginsberg, 1998a; martinez-brawley, 1999). what is clearly evident in these debates is the dearth of empirical evidence on the differences, if any, in the practice behaviors and professional beliefs of rural and urban social workers in the context of ethics. questions such aswhether community dynamics influence the ethical standards by which social workers practice, or whether there are differences between rural and urban social workers with regard to their ethical beliefs are largely answered with anecdotes or personal opinions (jerrell & knight, 1985; mazer, 1976; miller, 1994). this study is a beginning effort toward answering these questions with empirical data in the context of clinical practice. tom a. croxton, j.d., m.s.w. is professor, school of social work, the university of michigan. srinika jayaratne, ph.d. is professor, school of socialwork, the university of michigan. debra mattison, m.s.w., a.c.s.w., b.c.d. is a clinical social worker, st. joseph mercy hospital, and adjunct lecturer, school of socialwork, the university of michigan. copyright© 2002 advances in socialworkvol. 3 no. 2 (fall 2002) 117-132. indiana university school of socialwork. 118 urban/ruraldifferences in socialwork practice mermelstein and sundet (1995) ask, “are things so basically different about urban and rural contexts that we can justify a specialty, a title, a journal, a special alcove in the halls of social work? increasingly the answer is ‘no’” (p. 5). in a study related specifically to professional practice roles and perceptions of client problems, york, denton and moran (1989) found no differences between rural and urban social workers. this research corroborates the study by whitaker (1986), which found few differences between rural and urban social workers with regard to practice roles. there may also be few differences in the service needs and desires of urban and rural clients and the ways in which social services are delivered (austin, mahoney & seidl, 1978; young & martin, 1989). whether there are differences between rural and urban social workers within the realm of ethics is unknown. despite the lack of supporting empirical evidence, many who practice or identify with the helping professionals in rural communities continue to assert the doctrine of difference. doelker and bedics (1983), ginsberg (1998a), green and webster (1976), andmartinez-brawley (1993; 1999), for example,maintain that the unique features of rural social work practice require a special curricular focus in social work education, if not a specialty in rural practice. in addition, there is growing textbook literature on the special aspects of rural practice, all pointing to differences between rural and urban social work practice (farley, griffiths, skidmore & thackeray, 1982; ginsberg, 1998a; gumpert & saltman, 1998; johnson, 1980; jones, 1993; jones & zlotnick, 1998;weitz, 1992). waltman (1986) maintains that the differences between urban and rural social work practice are so significant as towarrant special attention from the profession. sobel (1992) argues that in rural communities, “psychotherapists, to be successful, must create systems within their own community and they must be willing to make compromises in professional standards and ethical guidelines to effectively establish themselves as members of the health professionals within the community where their practices are located” (p. 62). sobel concludes that, “it is important to rememberwhenpracticing in small towns, strict adherence to ethical codes cannot always be made” (p. 69). sterling (1992) states that, “therapists in small communities have to create their own rules and guidelines and develop their own means of managing (boundary and confidentiality) issues” (p. 113). within the context of bartering for professional services, reamer (2001) notes that, “many believe that barter is appropriate in limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community (p. 24). ginsberg (1998a) also asserts that social workers in rural areas find theymust adapt andmodify traditional approaches to social work practice as taught in social work education. throughout this literature, academics and practitioners argue that practice and ethical standards adopted by professions are derived from an urban perspective and experience and do not take account of the rural environment. in essence, the call is for a “locality rule” as defined by local custom, which would hold rural practitioners to the professional standards of care, including ethical standards practiced in their community. in recognition of the difference between rural and urban professional norms, such a doctrine would, among other behaviors, allow greater advances in socialwork 119 flexibility for rural practitioners when interpreting the meaning of various provisions of the social work code of ethics. while such assertions may make intuitive sense, there is little empirical evidence that can be cited to support it. in recognition of the continuing debate on rural/urban differences within the context of professional ethics, the research reported here identifies five professional behaviors where differences between rural and urban social workers in direct practice have been asserted: 1) bartering; 2) maintaining confidentiality; 3) competency; 4) entering into dual or multiple relationships with clients; and 5) forming social relationships with clients. these behaviors and professional beliefs about their appropriateness are the primary foci of this study. bartering:the exchangeof goods and services as payment fortreatment gutheil and gabbard (1993), kagle and giebelhausen (1994), pope (1991), and simon andwilliams (1999) argue that bartering is so fraught with potential conflicts in the professional relationship that it should always be avoided. yet, bartering is viewed by some as part of the traditional cultural landscape in rural communities (miller, 1994). jennings (1992)maintains “that there are some special circumstances which emerge in rural settings in which bartering is justified and even desirable” (p. 101). the clinical social work federation code of ethics (1997) permits bartering arrangements, but “only in rare occasions” and “only (when the arrangements) involve the provisions of goods, as opposed to services, in exchange for treatment” (cswf, principle v.d). despite recognizing the dangers inherent in bartering, the national association of socialworkers (nasw) code of ethics revision committee did not recommend a categorical prohibition of bartering and opted for a “last resort” rule, but only in the context of community custom; that is, bartering is accepted among professionals in the local community (reamer, 1998). the current nasw code of ethics (1996) warns of the dangers of accepting goods and services as payment for professional services, but permits bartering “if it can be demonstrated that such arrangements are accepted practice among professionals in the local community, considered to be essential to the provision of services, negotiatedwithout coercion and entered into on the client’s initiative and with the client’s informed consent” (nasw, 1996, sec. 1.13). this would appear to be an adoption of a “locality rule” within the context of ethics. however, in allowing bartering under limited circumstances, the code also attaches a caveat warning to the social worker that he or she has the “full burden of demonstrating that this (bartering) arrangement will not be detrimental to the client or the professional relationship” (nasw, 1996, sec. 1.13). miller (1994) laments that this caveat may be seen by social workers as placing them in a too precarious or ethically risky position; hence, arrangements otherwise beneficial to the rural client and community will be lost. despite the debate on bartering and the current stance of various codes of ethics (american psychological association, 1992; cswf, 1997; nasw, 1996), very little is known about the extent of bartering as a common professional practice in rural croxton et al./socialwork practice behaviors and beliefs: rural-urban differences? 120 communities.while borys and pope (1989) found a significant difference of opinion in the ethics of bartering among both social workers and psychologists, they also found its use as a method of payment for professional services to be relatively rare in practice. however, the extent to which rural social work practitioners actually enter into bartering arrangements andwhat they believe about the appropriateness of such behavior is otherwise largely unknown. confidentiality nearly all commentators on professional practice in rural communities write about the lack of professional and individual privacy and the strains on principles of confidentiality (cook, hoas & joyner, 2001; ginsberg, 1998b; schank, 1998; schank & skovholt, 1997). for example, simon and williams (1999) observe that family and community members may mount considerable pressure on the therapist for information about the client. spiegel (1990) notes that, “the maintenance of confidentiality in psychotherapy in a small-town rural setting is constantly threatened because social, hospital, industrial, and educational counseling services overlap, and people know each other well” (p. 637).waltman (1986) states that preserving confidentiality is of utmost importance in the therapeutic relationship with a rural client. however, confidentiality is a sacred professional principle whatever the context of practice (jaffee v. redmond, 1996; nasw, 1996). except in limited contexts such as “duty to warn,” child and elder abuse, or responding to the suicidal patient, there is little debate on the sanctity of confidentiality in all social work-client communications (nasw, 1996; reamer, 1999). there also seems to be little doubt that the knowledge of a therapist/client relationship is more widespread in a small or rural community and that there is easier access to the therapist by interested others in a rural environment. in most cases, entry into professional offices by known townspeople is clearly observable. however, does thismean that theprincipleof confidentiality takesonnewmeanings or presents different dilemmas in a rural environment? again, most of the conclusions in answer to this question are based on anecdotal evidence and generalizations, perhaps even myths, about the current realities of the rural community. competency much of the social work literature on rural practice defines the role of the social worker within the context of a “generalist practice” (davenport &davenport, 1995; ginsberg, 1998b; martinez-brawley, 1999). under the generalist model of practice, the social worker must be competent to work with different systems such as families, groups, organizations, and communities (tolson, reid & garvin, 1994). hargrove (1986) states, “in rural practice, the generalist model of practice prevails because of the lack of available resources and professionals. as a consequence, the rural psychologist is likely to be called upon to respond to a broad range of problems and people” (p. 374). hence, without referral resources, the therapist finds herself in situations where the choice is either to provide treatment despite her limitations, or to provide no treatment at all (welfel, 1998). in addressing this dilemma, hargrove notes, “themost appropriate response to this ethicallymurky situation is not at all clear” (p. 374).within the context of clinical practice, advances in socialwork 121 sobel (1992) asserts, “small town practitioners may be called upon to treat situations with which they may not feel totally competent, but realizing alternative services are a great distance away,may choose to do so in order to keep the patient functioning in the community with support and other health and mental health professionals” (p. 62). roberts, battaglia, & epstein (1999) also note that rural practitioners commonly perform professional work with broadened responsibilities, more independence, and a heightened need for specialist support, but with less training and supervision and fewer resources than their urban counterparts. despite these assertions, the authors lack empirical data that indicates the extent towhich practitioners employ intervention techniques forwhich they have hadno training or whether there are, in fact, differences between rural and urban practitioners regarding levels of success with clients. multiple anddual relationships according to rinella and gerstein (1994), allegations of ethical misconduct based in dual relationships are becoming increasingly common. younggren and skorka (1992) define dual relationships as “any relationship that runs concurrently with the therapeutic relationship” (p. 32), giving examples as friends, lovers, and business associates. other examples would include therapeutic relationships with relatives, neighbors, political, or committee associates (pope, 1991; reamer, 1994). the naswcode of ethics (1996) responds to concerns over themeaning of dual relationships in the professional context by stating, “the social worker should not condone or engage in any dual relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client” (nasw code, sec. 1.06(c)). since former clients often return for help when new problems arise (hartlaub, martin & rhine 1986; mattison, jayaratne & croxton, 2002; robison & reeser, 2000; silbertrust, 1993), one might argue that the potential harm of intervening relationships is always present. the code does not provide a definition of risk in this instance, thereby, placing the burden on the practitioner. despite the provision in the nasw code of ethics with regard to dual relationships, there is very little in the professional literature to guide social work practitioners in more specific terms (ramsdell & ramsdell, 1993; rinella & gerstein, 1994). thompson (1990), for example, asserts that dual relationships introduce competing interests and pose a “major threat” to the therapeutic process, that “friendships, for example, are reciprocal and, thus, would require the focus of therapy to shift from one party to the other, from one set of interests to the other, and back again” (p. 56). kagle and giebelhausen (1994) insist that any “dual relationships are potentially exploitive, crossing boundaries of ethical practice, satisfying practitioner needs and impairing his or her judgment” (p. 213). in his seminal treatise on boundaries, epstein (1994) asserts that “monitoring boundaries is as essential to psychotherapy as maintaining aseptic technique in surgery” (p. 33). other writers suggest the dual relationships are inevitable especially in rural communities (bader, 1994; jennings, 1992; stockman, 1990) and that absolutist positions are unrealistic and unnecessarily restrictive. such authors state that the emphasis should be not on avoidance but on risk management (gottlieb, 1993). ginsberg (1998), for example, states that, “for rural workers, many relationships croxton et al./socialwork practice behaviors and beliefs: rural-urban differences? 122 are multiple. one’s friends, fellow church members, grocers, auto dealers and organizational colleagues may also be clients or may be related to clients” (p. 13). simon andwilliams (1999) write of the necessity to treat friends or relatives in certain situations and conclude, “the treatment of acquaintances that would be a boundary violation in larger citiesmay only require boundary adjustment in small or rural communities” (p. 1443). however, as jerrell and knight (1985) note: many commonly held beliefs about rural practice have been derived from the anecdotal reports of practitioners, but little systematic information exists by which to compare these findings on a larger scale. nor is it possible to make generalizations about rural mental health practitioners from the literature available. (p. 331) social relationswith clients intuitively, there would seem to be little doubt that professional boundary issues arise more frequently in the rural context. as sterling (1992) notes, “small community therapists sometimes accept referrals to treat people withwhom they have had a social relationship and treat people who have close relations with each other” (p.116). fenby (1978) writes of catching a ride to work with a neighbor who happens to be a client. brownlee (1996) relates the experience of treating a client who happens to be the teacher of the therapist’s daughter. backlar (1996) writes of befriending a client and suggests that the therapistmust sometimes exercise judgment and not always follow rules. gates and speare (1990) assert andmazer (1976) agrees that overlapping relationships are built into the fabric of rural communities and see the positive aspects of observing clients in other contexts. as catalano (1997) states, “in small communities, the therapist may have common social and professional contacts with and may know significant people in the other’s life” (p. 25). despite such conclusions, we know little of the extent to which rural social workers maintain such relationships nor what they believe about the ethics of these behaviors. methodology the study population consists of members of the national association of social workers (nasw) who possess an m.s.w. and have identified themselves as being in “direct practice.” this resulted in a sampling frame of 58,056 naswmembers. a simple random sample of 1,200 was drawn from this population. after various exclusions (e.g., retirees, undeliverable addresses, etc.), the sample size was reduced to 1,143. excluding those drawn in this random sample, additional random samples of 478 each were drawn from the following groups: africanamerican, asian-american, and hispanic/latina. in addition, a discrete random sample of 485 social workers in private practice was also drawn. this resulted in a total sample of 3,062 social workers in direct practice. based on cases presented before the michigan committee on inquiry, a pre-test with professional practitioners in the state of michigan and an extensive review of the literature, a 10-page questionnairewas developed to study the previouslymentioned practice domains. the questionnaire was sent to each respondent along advances in socialwork with a cover letter, a commitment postcard, and return envelope. if we did not receive the commitment postcard within three weeks, a second questionnaire, cover letter, and return envelope were mailed to the non-respondent. this procedure resulted in a return of 1,684 useable questionnaires for an overall response rate of 55%. for the purpose of this exploratory paper, we identified practitioners in rural and urban settings by their responses to the following question: “are the clients seen in your agency mostly (70% or more) from….” those respondents who indicated “rural or farm communities (25,000 or less)” were identified as rural practitioners, and those respondents who indicated “a large city (500,000 or more)” were identified as urban practitioners. this procedure resulted in 126 respondents in the rural category and 441 respondents in the urban category. results and discussion tables 1 and 2 present specific items used tomeasure the dimensions of bartering, competency, confidentiality, multiple and dual relationships, and social relationships. the data in table 1 present the respondents’ beliefs about the appropriateness of the given behaviors in the larger professional context. in contrast, table 2 presents information on the reported behaviors in question by the respondents. bartering despite the debate over the use of bartering or the exchange of goods and services as payment for professional services, our data indicate that bartering in practice is a rare event with no significant differences between rural and urban practitioners. in fact, the responses are surprisingly similar given assertions that bartering for professional services is commonplace in the rural community. with regard to professional beliefs about the appropriateness of bartering, rural social workers are significantly different from urban practitioners in that they are more likely to approve of such behavior. these findings are similar to those reported by horst (1989), percival and striefel (1994), and pope, tabachnick and keith-spiegel (1987). however, the data clearly indicate that beliefs about the appropriateness of bartering do not result in actual practice behaviors (see table 2). as sonne (1994) notes, an exchange of services for treatment puts the client in the role of employee, a relationship placing the social worker in a potentially conflictual situation that may have implications for both ethics and social work licensing grievances. a compromise solution, one adopted by the clinical social work federation (1997), permits the exchange of goods but not services as payment. such a compromise is at least partially responsive to those who have raised questions regardingwhether the ethics of bartering arrangementsmay beworth further discussion.however, given the rarity of bartering inpractice, one canonly conclude that “necessity is not the mother of invention,” and the advice of gutheil and gabbard (1993) is well taken: “the clinician should take a case at a reasonable fee ormake a decision to see a patient for a low fee (e.g., one dollar) or none. bartering is confusing and probably ill advised today” (p. 193). 123croxton et al./socialwork practice behaviors and beliefs: rural-urban differences? 124 advances in socialwork tsig appropriate uncertain inappropriate value bartering accept goods or services from client instead of money -2.745 .01 urban 45(10.3%) 84(19.2%) 309(70.5%) rural 22(17.1%) 31(24.0%) 76(58.9%) competency -1.044 ns use treatment techniques for which you received no formal training urban 26(5.9%) 59(13.4%) 356(80.7%) rural 12(9.3%) 17(13.2%) 100(77.5%) maintain confidentiality and privacy (α=.60) -1.065 ns share confidential information about client with relatives without client’s consent when you thought it was in the client’s best interest? urban 47(10.6%) 44( 9.9%) 353(79.5%) rural 17(13.7%) 15(12.1%) 92(74.2%) share confidential information about client with others (not family relatives) without client’s consent when you thought it was in the client’s best interest? urban 54(12.2%) 52(11.7%) 338(76.1%) rural 24(18.9%) 10(7.9%) 93(73.2%) engage in multiple or dual relationships (α=.75) -4.593 .0001 accept business associates or co-workers as clients urban 32( 7.0%) 52(11.4%) 371(81.6%) rural 16(12.4%) 27(20.9%) 86(66.7%) have clients with whom you have another relationship urban 30( 6.7%) 81(18.1%) 337(75.2%) rural 22(17.1%) 38(29.5%) 69(53.4%) accept relatives or friends as clients urban 21(4.7%) 26( 5.8%) 400(89.5%) rural 11(8.7%) 14(11.0%) 102(80.3%) table 1: distribution and t-tests on scales and scale items regarding the appropriateness of practice behaviors—urban vs. rural competency with regard to competency, we asked two simple questions. the first question inquired:howoften have you used treatment techniques for which you have had no formal training? there was no statistical difference in the responses of urban and rural social workers to this question; in fact, the responses from both sets of social workers were remarkably similar. this does notmean, however, that the data does not have significance in the larger context of social work practice. across both groups, more than 20% of our respondents acknowledged that they had used treatment techniques without formal training at least once, with 8% acknowledging that they had done so three or more times. such behavior is surprising on several levels and certainly has insurance and malpractice implications. within the realm of ethics, these behaviors could put those social workers in apparent violation of the nasw code of ethics (1996), which states that: social workers should provide services in substantive areas or use intervention techniques or approaches that are new to them only after engaging in appropriate study training, consultation, and supervision from people who are competent in those interventions and techniques.(sec. 1.04) 125croxton et al./socialwork practice behaviors and beliefs: rural-urban differences? tsig appropriate uncertain inappropriate value engage in social relationships (α=.70) -2.324 .05 accept a client’s invitation to a party or special event (e.g., wedding?) urban 80(17.7%) 149(32.9%) 305(49.4%) rural 28(21.9%) 47(36.7%) 53(42.3%) participate in recreational or social activities with your clients? urban 68(15.5%) 60(13.7%) 305(70.8%) rural 29(22.8%) 19(15.0%) 79(62.2%) ask favors from a client (e.g., a ride home)? urban 10(2.2%) 17(3.8%) 422(94.0% rural 6(4.6%) 9(6.9%) 115(89.5%) invite a client to your home for a social event? urban 13(2.9%) 16(3.5%) 422(93.6%) rural 5(3.9%) 10(7.8%) 114(88.3%) look after a client’s belongings (house, pets, etc.) for a while? urban 9(2.0%) 8(4.0%) 423(96.0%) rural 6(4.7%) 8(6.2%) 115(89.1%) 126 never 1-2 times 3> times x2 sig bartering accept goods or services from client instead of money urban 401(90.7%) 34( 7.7%) 7(1.6%) 2.390 ns rural 111(86.7%) 15(11.8%) 2(1.5%) competency use treatment techniques for which you received no formal training urban 353(78.8%) 59(13.2%) 36(8.0%) 0.077 ns rural 101(78.9%) 16(12.5%) 11(8.6%) maintain confidentiality and privacy share confidential information about client with relatives without client’s consent when you thought it was in the client’s best interest? urban 324(72.0%) 96(21.3%) 30(6.7%) 5.777 ns rural 81(65.9%) 16(25.2%) 11(8.9%) share confidential information about client with others (not family relatives) without client’s consent when you thought it was in the client’s best interest? urban 336(75.2%) 61(13.6%) 50(11.2%) 1.569 ns rural 89(70.6%) 20(15.9%) 17(13.5%) engage in multiple or dual relationships accept business associates or co-workers as clients urban 393(86.6%) 41( 9.0%) 20( 4.4%) 9.692 .01 rural 99(76.2%) 16(12.3%) 15(11.5%) have clients with whom you have another relationship urban 392(87.1%) 41( 9.1%) 17( 3.8%) 25.265 .0001 rural 89(69.0%) 19(14.8%) 21(16.2%) accept relatives or friends as clients urban 408(90.9%) 21(4.7%) 20(4.4%) 2.278 ns rural 111(86.7%) 10(7.8%) 7(5.5%) table 2: distribution and chi-square analyses on conduct of practice behaviors— urban vs. rural advances in socialwork the second question inquired:how successful would you say you were with your most recently terminated client? interestingly, 14.1% of the rural social workers compared to 5.0% of the urban social workers reported they were unsuccessful (x2=7.451, p<.01). we can only speculate why nearly three times as many rural practitioners report lack of success compared to their urban counterparts. it is possible, for example, that the rural social workers have less collegial or supervisory support, fewer options available for clients, or are simply facedwithmore difficult problems. confidentiality to measure the importance of confidentiality, we asked two questions (see tables 1 and 2). as these data indicate, there are no significant differences between the rural and urban social workers with respect to behaviors and beliefs surrounding confidentiality. most respondents attended to the importance of confidentiality in the professional relationship with equal concern and rigor. this does not discount nor minimize the difficulty in preserving confidentiality in the rural community, where pressure to reveal or maintain confidences may, indeed, be greater. nor do the responses attend to assertions regarding common community knowledge of professional relationships. our data only indicate that professional beliefs about confidentiality andmaintaining confidentiality are not dependent on community 127 never 1-2 times 3> times x2 sig engage in social relationships accept a client’s invitation to a party or special event (e.g., wedding?) urban 261(57.6%) 146(32.3%) 46(10.1%) 1.676 ns rural 81(62.3%) 40(30.7%) 9(10.0%) participate in recreational or social activities with your clients? urban 310(69.8%) 86(19.4%) 48(10.8%) 3.193 3.193 rural 82(64.1%) 23(18.0%) 23(17.9%) ask for favors from a client (e.g., a ride home)? urban 417(92.5%) 31(6.9%) 3(0.6%) 1.479 ns rural 119(90.8%) 11(8.4%) 1(0.8%) invite a client to your home for a social event? urban 431(94.9%) 18(4.0%) 3(1.1%) 0.595 ns rural 122(93.8%) 7(5.4%) 1(0.8%) look after a client’s belongings (house, pets, etc.) for a while? urban 445(98.0%) 8(1.7%) 1(0.3%) 3.418 ns rural 126(96.2%) 5(0.8%) 0(0.0%) croxton et al./socialwork practice behaviors and beliefs: rural-urban differences? size. that is, regardless of practice location, social workers place high value on the principle of confidentiality. multiple ordual relationships our data indicate that there are significant differences between urban and rural social workers in both practice behaviors and beliefs with regard to multiple or dual relationships. however, it should be noted that these differences may be partially explained by the responses to an ambiguous question, that is, do you have clients with whom you have another relationship?what is clear, however, is that almost 70%of rural social workers, compared to 85%of rural social workers, report not having another relationship with clients, thus, contradicting those whomaintain such contacts are inevitable. yet, three times as many (17.1%) rural social workers compared to urban social workers (6.7%) consider such relationships appropriate. in addition, nearly a third (29.5%) of rural social workers compared to urban practitioners (18.1%) report uncertainty about the appropriateness of this behavior. it is also noteworthy that accepting business associates and co-workers as clients is more common among rural practitioners, with 23.8% having done this at least once compared to 13.4% of urban practitioners. in addition, rural workers are also far more likely (33.3%) compared to urban workers (18.4%) to consider such behavior appropriate. in contrast, accepting relatives and friends as clients is a relatively rare occurrence, with little difference between rural and urban practitioners. taken as a whole, these data indicate a substantial difference between rural and urban practitioners in both practice behaviors and beliefs.without additional interpretation and guidance, code provisions related to dual and multiple relationships may pose significant dangers for rural practitioners. social relationships despite what the literature suggests as the inevitability of engaging in social relations with clients in rural environments, we found no statistical difference between urban and rural social workers in the behaviors considered in this study. in fact, the responses are again remarkably similar. with regard to accepting a client’s invitation to a special occasion or participating in recreational or social events with clients, nearly one-third of both urban and rural practitioners had done so once or twice.with regard to invitations for social contact initiated by the social worker, 90% of our respondents had never extended such invitations irrespective of community size. it is noteworthy, however, that with regard to clientinitiated requests, our respondents indicated a good deal of uncertainty about the appropriateness of the behaviors mentioned, especially what to do when a client invites the worker to a party or special event, for example, a wedding. implications and limitations on one hand, the research presented here within the context of ethics suggests that the teaching of social work values and ethics at the graduate level is strong enough towithstand environmental pressures, and that despite concerns raised in the literature, there is a broad acceptance of the professional code of ethics across both urban and rural practitioners. on the other hand, the level of uncertainty 128 advances in socialwork about the appropriateness of specific behavioral responses, especially among those who practice in rural settings, suggests that schools of social work and the profession should givemore attention to the ethical dilemmas faced by rural social workers. it should be noted that the data presented here is confined to those in direct practice and excludes social workers who utilize other professional intervention methods such as community practice and administration. in addition, the data do not present a picture of any urban/rural differences as reflected in cases actually brought before the professional committee on inquiry. neither do we know whether the same results would be obtained in a survey of social workers employed at the bachelor of socialwork level. indeed, whether the current nasw code of ethics is efficacious for those practicing other than clinical social work is a matter for continuing debate and research. conclusions based on the behaviors explored in this study, there appears to be a remarkable congruence between the practice behaviors and beliefs of rural and urban social workers. except for differences in beliefs regarding the appropriateness of bartering and entering into multiple or dual relationships with clients, urban and rural social workers appear to have similar practice beliefs and professional behaviors. given the rarity of bartering in practice in both urban and rural communities and in recognition of the potential conflicts of interest involved, perhaps the exchange of goods and services for social work intervention should be categorically prohibited.with regard tomultiple or dual relationshipswith clients, differences between rural and urban practitioners, and the level of uncertainty about appropriateness among all respondents suggest that further clarification and more specific guidelines are needed. in the broadest sense, rural practitioners are more likely to consider all behaviors identified in this study as appropriate (albeit in small percentages). at the same time, rural social workers are also more likely to express greater uncertainty about the appropriateness of the behaviors in question. thus, the rural practitioner appears to be enmeshed in a series of ethical dilemmas that demand additional attention within the curricula of professional education and resolution by social worker ethicists. more disturbing for the profession as a whole is the reported use by both urban and rural social workers of intervention techniques without the benefit of formal training. references american psychological association. 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(1989). social services in rural and urban primary care projects. human services in the rural environment, 13(2), 30-41. younggren, j., & skorka, d. (1992). the non-therapeutic psychotherapy relationship. law and psychology review, 16, 13-28. author’s note: this study was partially funded by the nasw michigan chapter, and the authors are indebted to the chapter’s executive director and the executive board. address correspondence to: srinika jayaratne, ph.d., professor, school of social work, the university of michigan, 1080 south university, ann arbor, mi 48109-1106, usa. e-mail: sirijay@umich.edu. 132 advances in socialwork advances vol. 1, no. 2 eeccoonnoommiicc mmooddeelliinngg iinn ssoocciiaall wwoorrkk eedduuccaattiioonn barry r. cournoyer gerald t. powers james johnson robert bennett abstract: economic modeling provides academic administrators with a logical framework for analyzing costs associated with the processes involved in the delivery of social work education. the specific costs associated with activities such as teaching, research, and service may be determined for a school of social work as a whole or for specific responsibility centers (e.g., programs and services within the school). economic modeling utilizes modern spreadsheet software that can be configured in relation to the idiosyncratic needs and budgeting strategies that exist in virtually all colleges and universities. as a versatile planning tool, it enables managers to identify specific “cost-drivers” that cause the occurrence of real costs in relation to designated programmatic initiatives. in addition, economic modeling provides academic planners and decision-makers a useful vehicle for considering the economic impact of various projected (“what if”) scenarios. keywords: economic, modeling, social work, education, administration, management, accounting in an era of escalating costs, diminishing resources, and increasing demands foraccountability, academic administrators are faced with the apparent paradox of increasing productivity and performance, while reducing or maintaining costs. “doing more with less” has become a virtual mantra for deans and directors. financial resource management must be carried out in the most efficient and effective manner possible. although specific references to the term “economics of education” first appeared in the literature in 1960 (leslie & brinkman, 1988), journal articles that specifically address economic modeling or activity-based costing strategies in higher education have only recently begun to appear (brimson, 1991; brimson & antos, 1994; dehayes & lovrinic, 1994; lewis, 1993; zemsky & massy, 1990). familiar with traditional accounting approaches, social work deans and directors have long understood the income side of the economic equation, including tuition and fees, governmental appropriations, extramural grants, and the like. they are well aware that when the books are closed at the end of the fiscal year, income is 161 barry r. cournoyer, d.s.w. and gerald t. powers, ph.d. are professors, and robert bennett, d.s.w. is assistant professor, indiana university school of social work. james johnson, m.b.a. is management analyst, economic model office, indiana university purdue university indianapolis (iupui). copyright© 2000 advances in social workvol. 1 no. 2 (fall 2000) 161-175. indiana university school of social work. supposed to offset expenditures. however, when it comes to the activities and processes undertaken within school programs, many deans and directors may not be especially well prepared to respond to the expectations for increased fiscal accountability.1 although balanced budgets continue to be necessary, they are, of course, insufficient to meet the accountability and planning demands of modern academia (elliott, 1998). contemporary social work deans and directors are challenged to do much more than merely provide “balanced books.” demands for improved accountability have come from forces both within and outside academia. despite heightened interest regarding the costs of public higher education, governmental appropriations alone remain inadequate. competition for the most highly qualified students has increased even as the sources of external support for the recruitment and retention of such students has decreased. tuition costs and student fees continue to escalate dramatically. parents, governmental officials, and other stakeholders increasingly question whether public higher education warrants these higher costs. the very nature of higher education itself is in transition. as advances in technology occur at what seems to be an exponential rate, administrators are faced with dual problems: (1) paying for each new generation of equipment and related software, and (2) determining how the technological revolution can best serve the purposes of social work education without draining operating costs. while such changes may dramatically affect how faculty and students engage in the educational process, the long-term financial and curricular implications remain unclear. effective leaders provide focus for the future through visions, goals, and strategies. more and more, academic administrators are expected to identify, meet, and even exceed high level goals in a cost-effective manner. they are also expected to not only provide sufficient revenue to meet these goals, but sometimes to surpass revenue expectations. furthermore, they are expected to respond quickly and efficiently when opportunities arise or when diminished resources necessitate programmatic changes. however, deans and directors may lack adequate information regarding the total cost of current or potential activities undertaken in pursuit of organizational goals. in order to meet these increasing demands, schools and departments of social work must be able to examine their costs and activities in ways that will enable them to make informed and timely decisions regarding allocating the most effective and efficient available resources (martin, 1994). economic modeling is an effective framework for addressing these issues. the economic model the economic model presented in this paper is designed to assist social work administrators understand the current internal operations of their academic programs as well as help them focus toward the future through projections and forecasts. this proposed strategy is an extension of a similar model developed and adapted for use in a university setting (johnson, 1999; lovrinic, dehayes & althoff, 1993). economic modeling provides a logical framework for analyzing the costs associated with activities undertaken in pursuit of program goals. application of the economic model allows administrators to examine the full spectrum of organizational efforts typically associated with the delivery of social work education. faculty 162 advances in social work activity costs such as teaching, research, and service may be determined for the school as a whole or in relation to specific cost centers (e.g., academic programs, advising, student services). this model enables administrators to identify the individual and aggregate costs associated with each activity. as a versatile planning tool, economic modeling leads to identifying “cost drivers” (lewis, 1993)—those factors that actually cause real costs to occur in relation to designated programmatic initiatives. essentially then, schools and departments of social work may use economic modeling to determine the costs associated with their processes and activities. as a form of activity-based accounting, the economic model is designed for implementation through modern computer spreadsheet software. social work programs that adopt an economic modeling strategy may find it a valuable planning tool that enables them to: 1. determine the costs associated with delivering academic programs and other cost centers. 2. assess the current and long-term fiscal implications of current and projected (“what if”) personnel distribution and organizational schemes. 3. assess the organizational investment in general processes such as teaching, research, and service as well as more specific activities such as field liaison, advising, and administration. 4. augment overall organizational evaluation efforts by providing a framework within which to determine the relative costs of alternative programming. 5. contribute to the fiscal side of the strategic planning process, including resource allocation decisions and potential revenue sources. in essence, economic modeling results in an accounting system that can determine the costs associated with current and projected educational program delivery and trace those costs to specific personnel activities and cost centers. thus, using economic modeling offers the advantage of addressing current accountability issues as well as forecasting future possibilities of involvement for the school or department. the economic model, as applied in a school of social work, is constructed around a flexible set of user-determined modules (i.e., electronic worksheets). individual social work programs may readily develop, adapt, or revise the parameters of modules in order to address idiosyncratic or changing circumstances, needs, and goals. components of the economic model several essential prerequisites to effective economic modeling exist within the context of social work education. first, each school or department must have access to accurate financial accounting data, especially information about revenues and expenditures. second, the program must identify and classify the range of processes and personnel activities that collectively comprise the program. third, the program must specify “cost centers” that logically encompass the processes and activities. fourth, the program must determine a measurement system from which to assess quality or productivity. fifth, the program requires some methodology for determining the distribution of personnel effort across various cost centers. some sys163163cournoyer et al./economic modeling tems follow “workload policies” that may aid in this process. finally, the program requires access to and the ability to use modern computer spreadsheet software. access to financial accounting data accurate accounting information concerning the sources of revenue and the institutionally defined expense categories associated with the program represent the essential foundation for any economic model. without this information, the process becomes little more than a theoretical exercise. in most publicly supported educational systems, revenues are generated from five major sources: tuition and fees, governmental allocations, voluntary contributions and gifts, private and institutional endowments, and internal and external grants. the type and amount of income generated from any one of these sources will vary widely relative to the nature and mission of the educational institution. on the cost or expenditure side of the ledger, monies are typically allocated to two major categories; each may contain any number of subcategories. the larger of the two categories contains all personnel-related expenses (including faculty, staff, work-study students, etc.). in school and department budgets, personnel costs (including fringe benefits) usually account for most of the expenditures. therefore, the key to understanding business-related costs is learning how the people within the system spend their time and determine the outcomes of their efforts. the second major category encompasses the wide array of direct and indirect costs associated with doing business (including, for example, equipment, supplies, travel, utilities, building maintenance, accreditation fees, and institutional taxes for library/technology services). while the bulk of the budget covers personnel costs, administrators generally have somewhat more freedom when allocating non-personnel discretionary funds. the amount of fiscal information available to educational administrators generally depends on the organization, the culture, and the traditions of the institution in which the program is housed. at one end of a continuum program administrators are accorded full access to all financial information. open systems of this type are usually more conducive to the planning process. they tend to encourage collaboration and reduce suspicion among important stakeholders. at the other end of the continuum are those program administrators who, whether by design or by choice, have limited access to pertinent budgetary information. in systems such as these, program administrators (e.g., deans, directors, coordinators) may need to educate their superiors (e.g., presidents, chancellors, deans) about the potential value and utility of economic modeling and the need for access to financial data. such data is essential for creating a viable economic planning model. program processes and personnel activities revenues make possible the various processes and activities necessary to realize programmatic goals. administrators know this but rarely take the time to identify and classify specific processes and activities for which revenues are allocated. nor do they define the financial and qualitative milestones necessary for programmatic 164 advances in social work success. in order to identify, then classify the essential activities undertaken within the system, administrators must determine how the key actors spend their time. people (i.e., faculty, administrators, and staff) carry out the activities and implement the processes deemed necessary for the realization of organizational goals. the section’s title refers to “processes” and “activities.” these terms are similar but not synonymous. activities refer to fairly specific tasks or circumscribed functions assigned to or expected of a particular person. they tend to be more concrete and time limited. processes imply a sequence of activities that generally involve a number of related steps or operations and often require more than one person for completion. processes tend to be somewhat more abstract. however, both activities and processes should be identified and accounted for in the economic planning process. at the most general level, educators are typically expected to engage in activities involving varying degrees of teaching, research, and service. these general activities may be subdivided, as appropriate. for example, the teaching category might include a range of instructional modalities, such as classroom teaching, field instruction, individual tutoring, or other forms of independent study or mentoring. in more complex systems, these subdivisions might be further categorized in relation to any additional factors that make organizational sense. for example, classroom courses might be specified according to academic program level, curriculum area, or simply by title and number. activities related to research and service may be similarly classified and sub-classified based on the particular interests and needs of the organization. the nature of the organizational unit and the scope of the organizational issues drive the elements of the classification scheme as well as the level of specificity. deans and directors are well aware that in an economic sense some activities are potentially “resource enhancing” (e.g., teaching, funded research, and fundraising), while others tend to be “resource depleting” (e.g., advising, committee work, and community service). while all activities may be considered essential to the ultimate success of the program, in the final analysis, the economic goal is to assure a balanced budget where the deficits generated by the latter are offset by the income produced by the former. a well-designed economic model can greatly enhance an organization’s capacity to discover ways and means to achieve that goal. cost centers a “cost center” may be defined as any cluster of focused activities for which the organization has identified a set of programmatic goals (trussel & bitner, 1996). once the relevant activities and processes have been identified and classified by type, they may be organized in relation to appropriate cost centers. the actual number of cost centers vary widely depending on the size and complexity of the organization. typically, cost centers are associated with programs, projects, or offices with designated leaders and possibly some administrative overhead. each educational program (b.s.w., m.s.w., ph.d., and continuing education) would commonly be identified as a cost center, as might clusters of activities that cut across the major 165cournoyer et al./economic modeling program areas (e.g., enrollment services, general administration, field instruction, student services, and collaborative research initiatives). within a cost center entitled “enrollment services” for example, one might find activities such as admissions, financial aid, registration, and student accounts. the key to forming a cost center is that the activities housed within it have some logical basis for being grouped together. those activities, when viewed in the aggregate, share some common organizational mandate. ideally, there is also a designated person (i.e., a “process owner”) within the system who ensures that the purposes for which the cost center was created are met. measurement system the organization assesses the quality or productivity within a cost center by means of a measurement system. typically, the “unit of measure” varies according to the nature and purpose of the program or activity. for example, an academic program might track the number of graduates, retention rate, proportion of honor students, or the number of credit hours generated. a research center might track the number of grants submitted, the percentage approved, and the amount of external grant money received each year. a field department might track the number and kind of practicum settings arranged and the number of students placed. a school or department might track the number of articles and books published, honors received, and the nature and amount of community or professional service contributed by its faculty. distribution of effort organizations need some means to determine how personnel expend their time and effort across various cost centers. some educational programs have a workload policy or formula that provides a general calculus for the organization of individual effort. formulas of this type are usually determined at the institutional level, and as such, provide only general parameters for how the major components of an individual’s workload are to be distributed—typically in relation to teaching, research, and service. while most general workload formulas are flexible enough to accommodate individual differences in roles and responsibilities, all are based on the assumption that everyone makes a commensurate effort. for example, a particular professor who serves as a field liaison to twice as many practicum students as prescribed by the workload policy might teach one less classroom course than normally expected. despite their shortcomings, even crude workload policies may be useful in applying the economic model. at the very least, they provide general guidelines for distributing valued activities among faculty and serve as a basis for making comparisons between the ideal and the actual labor distribution. even if the program has no workload policy, an economic model can provide information that may assist faculty and administrators frame the dialogue related to those activities that should be recognized and rewarded within the system. modern spreadsheet software the final prerequisite for implementing a reliable cost accounting system based on economic modeling involves a more practical, but no less important consider166 advances in social work ation. organizations interested in creating an economic model must have access to and competency in using modern spreadsheet software (e.g., microsoft excel™, quattro pro™, or lotus 1-2-3™). although it might be theoretically possible to conduct economic modeling by hand, it would be impractical and inefficient to do in this era of diminishing resources. without modern spreadsheet software, sophisticated, economic modeling would be extremely costly, time consuming, and raise serious reliability questions. spreadsheet software provides the means to create, track, and analyze all relevant information. once the data has been entered, administrators may modify any of the allocation algorithm components (such as time, effort, number of personnel, etc.) and assess the fiscal impact. as such, the software provides a useful vehicle for exploring a variety of hypothetical or “what if” scenarios, including for example, the economic impact of adding employees, increasing the number of course sections, or reducing class size. economic modeling in a school of social work indiana university is a publicly supported institution in the united states that has offered social work courses since the early 1900s. over the years the school of social work has grown in size and complexity to where it currently offers a full continuum of education, from the baccalaureate to the master’s, to the ph.d. in social work degrees. several years ago indiana university adopted “responsibility centered management” (rcm) as an overarching approach (west, seidita, dimattia, & whalen, 1997). under rcm, each responsibility center (e.g., campus, school, division, or department) has considerable fiscal autonomy. as a responsibility center, each school is required to contribute to the costs associated with campus and university administration and general services. except for these “taxes,” each responsibility center may allocate its remaining resources as it sees fit, as long as it demonstrates fiscal accountability in the form of a “balanced budget,” shows progress towards achieving of its mission and goals, and operates within the university’s broad guidelines. prior to rcm, deans and directors had relatively limited fiscal autonomy in the area of expenditures. for example, to employ an additional tenure track faculty member, deans were required to seek approval from university administration. when one or more faculty positions remained unfilled, the school could not autonomously reallocate those funds for other purposes (e.g., supplies, equipment, student stipends, or part-time faculty). unless such reallocations were authorized, unexpended monies automatically reverted back to the university’s general fund. with the help of rcm, deans and directors now have authority to design their own staffing patterns—provided they stay within their budgets and university policies. they can now exercise greater budgetary autonomy, flexibility, and control. however, they also carry far greater responsibility. deans and directors are held increasingly accountable for fiscal mistakes within their respective responsibility centers. in order to exercise this greater autonomy, deans, directors, and other school administrators require analytic tools to facilitate planning and decision-making while maintaining the fiscal health of the organization. economic modeling represents one such tool. 167cournoyer et al./economic modeling implementation of economic modeling: an illustrative example to implement economic modeling at the indiana university school of social work, the authors took several steps: step one: formulating economic questions economic models are essentially value free. they do not determine what economic questions or issues should be addressed, nor do they relate what options should be accepted. they provide some of the data needed to make informed decisions, but they cannot and should not be used as the exclusive or primary means for decision-making. some administrative decisions may be necessary or functional but make no sense in strictly “economic” terms. academic administrators also incorporate certain values and principles in their decision-making processes— including identifying those issues and concerns for which economic answers are needed. formulating economic questions represents the first step in the process. the specific issues and concerns that drive efforts at economic modeling vary from program to program, depending upon local conditions and the culture of the institution. for example, some social work programs are freestanding schools or departments, and as such, they exercise considerable autonomy over their own academic and fiscal affairs. others are housed within larger academic units. faculty and resources may be shared, and fiscal decisions may be justified on the basis of factors that transcend any given discipline or profession within the unit. institutions also differ with respect to the relative importance of teaching, research, and service to the overall mission of the institution. non-economic factors such as these are considered in determining what questions to address through economic modeling. step two: defining cost centers once the critical issues have been identified and the economic questions formulated, the most pertinent cost centers are defined. as noted earlier, a “cost center” may be defined as any cluster of focused activities for which the organization has or may have identified a set of programmatic goals. given the nature of social work education, it is not always an easy task to define mutually exclusive or distinct cost centers. social work faculty members engage in many activities that do not neatly fit into a single cost center. for example, functions, such as academic advising and serving as field liaison, may be viewed as properly falling within the teaching domain in one school, while it falls within the service domain at another. for tracking purposes, the responsible administrator ultimately determines where activities and processes should be housed. indeed, sometimes the activities assigned to one cost center overlap with a second cost center. one of the most useful aspects of economic modeling, however, is that activities assigned to one cost center can easily be reassigned to another if or when the rationale for their initial selection changes. step three: obtaining financial information as a critical step in the implementation of the activity-based economic model, administrators must obtain detailed financial information related to sources and types of revenue and expenditures. in the case of the indiana university school of 168 advances in social work social work, the largest single source of revenue is derived from student tuition, with state appropriations the next most significant income source. the largest single expense occurs in the form of faculty salaries and benefits. under rcm, the school receives almost all the tuition income generated from students' enrollment in social work courses. although external grants and contracts comprise significant dollar amounts, their combined proportion of the total income is relatively small. therefore, for illustrative purposes, the authors focused on tuition income and personnel expenses as the primary economic factors within this model. step four: securing additional relevant information next, the authors secured access to the university registrar’s database. this enabled the authors to readily determine the precise number of enrolled students in each section, each term, and each year for all the social work courses offered. the names of the social work instructors were also indicated. the authors then linked and imported the data into a microsoft excel workbook. almost all students pay the same “in-state” tuition; therefore, once sectional enrollments were in spreadsheet format, the authors could easily calculate the amount of “section income” generated by simply multiplying the number of students enrolled (or credit hours taught) in a course section times the tuition paid by each student. they then obtained the computerized records of the university fiscal officer and obtained spreadsheet data regarding the name, rank, and salary of all full and parttime social work faculty and staff members. the authors then imported that information into their own spreadsheet workbook for use as the fundamental data within their economic model. this enabled them to allocate personnel costs to various cost centers. step five: organizing data the authors then edited the spreadsheets they had imported so that they could easily identify pertinent information about all social work classroom and field practicum courses. they summarized the data by course number, course title, academic program, total credit hours instructed, enrollment, and the tuition income generated by each social work course. a spreadsheet containing the salaries of all full-time faculty was prepared and another containing the salaries of part-time faculty. since part-time faculty members are paid on a “per course” basis, the authors could readily assign those costs to specific courses. determining the “cost” of a full-time faculty member to teach a course was more challenging since cost is based on the portion of the faculty member’s full-time effort. step six: determining and allocating costs several approaches were considered in determining the aggregate-per-course costs. the authors could, for example, ask professors to indicate how much time was spent preparing for and teaching their courses. if the authors could specify the amount of faculty effort, the cost per course could readily be calculated. they attempted this approach and encountered several problems. only about 50% of the full-time instructors responded to a faculty effort survey about how they spent their time. and those instructors who responded reported widely differing amounts of faculty effort (in terms of hours or percentage of time) spent in prepar169cournoyer et al./economic modeling ing for and teaching their courses. the authors quickly realized that self-reports of faculty effort raised questions about the validity and reliability of the economic model cost data. therefore, they adopted a more or less standardized “faculty effort” formula based upon a “capacity model” developed by the college of arts and sciences at indiana university (bloomington campus). this capacity model is a fairly simple means of determining the aggregate work capacity of an academic department or school based upon the total number of “course sections” that might be taught if all faculty taught a predetermined maximum number of courses. that number (i.e., total teaching capacity) may be used as a basis for determining the percentage of capacity realized (i.e., the number of course sections actually taught divided by the number of course sections that could ideally be taught if all faculty were to teach a maximum load). suppose, for example, that a department has five full-time faculty members—each with a capacity to teach eight courses per academic year. the total full-time faculty teaching capacity would then be 40 course sections. the department also employs two part-time faculty members—each with a capacity to teach one course per semester (two courses per academic year). their capacity would be four course sections. the department’s total teaching capacity then is 44 course sections. if the department delivers 40 course sections each academic year, it would be operating at nearly 91% of capacity—one indicator of efficiency. the capacity model articulates with the faculty workload policy of the school of social work. under this policy, each full-time instructor at the school is assumed to have the “capacity” to teach eight three-credit classroom courses per academic year. each three-credit course section is then valued at 12.5% of the instructor’s capacity. an instructor who teaches eight courses during an academic year would operate at 100% capacity. however, in addition to teaching courses, social work educators are also expected to conduct research and perform service (e.g., to the university, the school, the community, and the profession). therefore, faculty receive two “course section equivalents” (25%) for those activities. in addition, since full-time instructors also serve as advisors to about 25 students each year, and as field liaisons to another 13-15 students each semester, the school also grants a course section equivalent (12.5%) for those duties. as a result, most fulltime social work instructors on the campus teach five three-credit classroom courses per academic year. they are also expected to fulfill advising and field instruction responsibilities, conduct research, and provide service equivalent to that required in the instruction of three three-credit hour courses. instructors who complete all of these activities during an academic year are viewed as expending 100% effort and functioning at 100% of their individual capacity. of course, this general expectation does not apply to all instructors in exactly the same way. some instructors advise more students but teach fewer classroom courses. others teach more courses while serving as field liaison to fewer students. and, some instructors assume higher levels of school service responsibilities or engage in more research but do less of something else. the school’s capacity formula—eight course sections per year—serves as a basic workload expectation for all full-time social work faculty members. therefore, the authors decided to adopt the same formula for their economic model. they allo170 advances in social work cated 12.5% total annual faculty effort for each three-credit course taught regardless of course level, number of students, or number of preparations; 6.25% for advising and 6.25% for field liaison; 12.5% for research; and 12.5% for service activities. this basic formula could be applied to almost all full-time faculty members. however, some adjustment was required for those with substantial administrative service responsibilities. step seven: activity based economic analysis equipped with some understanding of school finances, information about the total number of credit hours instructed per course, the income generated by those courses, and the estimated percentage of faculty effort expended in their delivery, the authors proceeded to identify and describe key processes and activities reflected throughout the school’s operations. they built upon the allocations of faculty effort related to teaching, field liaison, and advising. they further classified faculty activities within other cost centers, such as student services and administration. although they identified numerous cost centers, they focused on the academic programs, field practicum, and student advising for the remainder of this example. the academic programs served as readily accessible cost centers. spreadsheet pages were created for each program and linked to the pages containing information about tuition income generated by each course section and to those referencing personnel expenses (i.e., instructor salaries, and benefits). because they had classified the percentage of teaching effort (12.5%) by course number (e.g., sw100, sw520, sw720), the authors could easily compare total course costs with the associated income for each program. their courses were numbered so that sw100sw499 referred to baccalaureate social work courses, sw500-sw699 to msw, and sw700-sw899 to ph.d. level courses. indeed, they could determine the net income or loss for each course individually, for each level, program, and for the school as a whole. they had classified the percentage of field liaison effort (6.25%) within the field department cost center by field practicum course number. this enabled the authors to compare tuition income generated by field practicum courses with the costs associated with field liaison activities. because the practicum courses were also numbered, they could readily allocate field department costs to the bsw and msw programs. similarly, the authors classified the percentage of advising effort (6.25%) by student level. most faculty members were assigned groups of students from discrete cohorts (e.g., bsw sophomores, bsw juniors, bsw seniors, msw-i full-time, msw-i part-time, or msw-ii). this enabled them to associate advising costs with academic programs. students do not directly “pay” for advising services. therefore, the authors assigned the costs of advising to the relevant programmatic cost centers (i.e., bsw, msw, and ph.d.) using faculty effort as a cost driver to allocate those costs. although full and part-time instructors teach across all levels and in all academic programs, the modern computerized spreadsheet software enabled the authors to examine the distribution of instructional costs associated with each course, each program, and all other cost centers. they also used the spreadsheet technology to undertake various ad hoc analyses. for example, they wondered about the finan171cournoyer et al./economic modeling cial implications of employing master’s level, non-tenure track instructors exclusively for non-revenue producing advising and other student services activities. this would relieve higher salaried senior ph.d. level faculty from routine academic advising and allow their reassignment to income producing, teaching, and funded research activities. they could then use the economic model to compare the financial implications of a current situation versus a “what if” scenario. for example, suppose a program currently employs six tenured faculty members at an average annual salary and benefit package of $52,500 (see table 1). each instructor teaches five classroom courses per academic year. at 12.5% annual faculty effort per course, each instructor expends 62.5% of her or his annual effort in classroom teaching. each also expends 6.25% conducting faculty field liaison; 6.25% advising students; 12.5% in various forms of school, university, community, and professional service; and 12.5% engaging in minimally funded research and scholarship activities. however, the program offers 36 courses per year. therefore, six part-time instructors are hired to teach one course per year. under the proposed scenario (table 2), a master’s level professional is hired at $35,000 per year to undertake the field liaison and advising functions that the six tenured and tenure-track faculty members had previously completed. under workload policy guidelines, those duties should require 75% of the newly employed faculty member’s effort (six times 12.5%). however, the authors decided to calculate it at 100% effort in order to ensure that sufficient time and energy were available to do the job well. meanwhile, the six tenured and tenure-track faculty members are relieved of their field liaison and advising responsibilities, but each six faculty annual % aggregated direct cost direct income members @ effort per annual % (without govern$52,500 per faculty effort ment appropriaannum member tions) five course 62.50 375.00 $196,875 $283,200 sections faculty field 6.25 37.50 19,688 26,568 liaison scholarship 12.50 75.00 39,375 24,000 service 12.50 75.00 39,375 student advising 6.25 37.50 19,688 subtotals 100.00 600.00 $315,000 $333,728 six part-time 75.00 18,000 24,200 instructors @ $3,000 per course totals 675.00 $333,000 $357,928 net income $24,928 172 advances in social work table 1: current situation where tenured faculty teach five classroom courses, conduct scholarship, provide service, and engage in field liaison and advising 173 teaches one additional classroom course section per year (six instead of five) since the tasks associated with student advising and faculty field liaison have been removed. they continue to provide the same 12.5% effort in service and 12.5% in research and scholarship. since the newly employed master’s level professional performs exclusively in the student advising and field liaison arenas, and the tenured and tenure-track faculty teach additional courses, six fewer part-time instructors are required. this yields an increased net income of $11,000 (from $24,928 to $35,928) to the school. in addition to the considerable cost savings, the authors might also anticipate overall improved quality and consistency of the advising and field liaison activities due to the specialized, focused nature of the non-tenure track professional role. this simple example illustrates the potential utility of economic modeling. it could prove useful in many scenarios. a school or department may decide to add six faculty annual % aggregated direct cost direct income members @ effort per annual % (without state $52,500 per tenured effort appropriations) annum plus faculty one master’s member level professional @ $35,000 six course 75.00 450.00 $236,250 $317,400 sections faculty field 50.00 17,500 26,568 liaison performed by $35,000 salaried nontenure tracked faculty at 50% effort scholarship 12.50 75.00 39,375 24,000 service 12.50 75.00 39,375 student advising 50.00 17,500 performed by $35,000 salaried non-tenure tracked faculty at 50% effort subtotals 100.00 700.00 $350,000 $367,928 less 6 part-time (75.00) (18,000) instructors totals 625.00 $332,000 $367,928 net income $35,928 table 2: proposed scenario where a master’s level professional engages primarily in field liaison and academic advising activities cournoyer et al./economic modeling 174 advances in social work a course to their curriculum but wonder whether it should be offered in a traditional classroom-based format or via the internet in an on-line fashion. this economic model may help assess the financial implications of each course format. continuing education (ce) is also a major area of concern for many schools of social work. administrators often wonder how the school can develop and subsidize their ce initiatives. economic modeling represents a tool for planning and forecasting the financial resources needed for a successful continuing education program. similarly, as schools and departments of social work increasingly seek additional external funding through research grants and service contracts, economic modeling may be used as part of the decision-making process concerning the redistribution of faculty effort or the employment of additional staff. the possible uses of economic modeling in social work education are numerous and varied. summary administrators in social work educational programs may find economic modeling a useful addition to their accounting, decision-making, and planning strategies. even in institutions that have not yet adopted rcm, the expectations for greater programmatic responsibility and accountability suggest, at least implicitly, increased autonomy and much greater need for better data upon which to base programmatic decisions. as suggested by jonas and his colleagues, “…colleges and universities now have much greater freedom—financially and technically—to reinvent their financial practices” (jonas et al., 1996). economic modeling enables administrators to monitor the financial well being of their academic programs and conduct analyses that aid in planning and framing the discussion for decisionmaking. such modeling can contribute greatly to improved organizational effectiveness and efficiency. however, the development and application of economic models do not take place in an ethical and political vacuum. we can be sure that they will not always tell us what we want to hear. however, they can be effectively used to provide data to guide and develop alternative approaches for resource allocation. in summary, economic modeling represents a valuable tool for academic administrators who increasingly must consider finances within the context of planning and decision-making. to be successful, however, attempts to implement economic modeling depend in large part on the degree of support provided by top administration and the level of participation of those most directly affected by its implementation. therefore, if at all possible, developing an economic model should be considered a participatory experience. the architects of any economic model within the academy must realize that they are engaged in an inherently political process that can have profound and lasting consequences on both the program and its participants. every effort should be made to solicit the involvement and input of interested stakeholders at every stage in the development process. endnotes 1the term “program” is used in various ways throughout this article. in some contexts, the term is used to refer to the entire organization (e.g., a school, college, or department of social work). in others, “program” references a particular academic 175cournoyer et al./economic modeling endeavor within the organization (e.g., an undergraduate program, a doctoral program, or a continuing education program). references brimson, j. a. (1991). activity accounting (an activity-based costing approach). new york: john wiley & sons, inc. brimson, j. a., & antos, j. (1994). activity based management.new york: john wiley & sons, inc. dehayes, d. w., & lovrinic, j. g. (1994). activity-based costing model for assessing economic performance. new directions for institutional research, 82, 81-93. elliott, s. (1998). measurement in education isn’t limited to report cards anymore. measurement in practice, 11, 1-8. johnson, j. (1999). economic model office at indiana university-purdue university indianapolis. [online]. retrieved november 8, 1999 from the world wide web: http://www.iupui.edu/~abcmodel/intropage.html. jonas, s., katz, r. n., martinson, l., plymton, m. f., relyea, s. w., rennie, e. d., rudy, j. a., & walsh, j. f. (1996). campus financial systems for the future: an excerpt from the nacubo/cause book. [on-line]. retrieved november 8, 1999 from the world wide web: http://www.nacubo.org/website/members/ bomag/cfs~1196.html. leslie, l. l., & brinkman, p. t. (1988). the economic value of higher education.new york: american council on education and macmillan publishing company. lewis, r. j. (1993). activity-based costing for marketing and management. westport, ct: quorum books. lovrinic, j. g., dehayes, d. w., & althoff, e. j. (1993). developing an economic model: how one midwestern university is approaching cost control. nacubo business officer, 27(1), 34-38. martin, t. (1994). a product based cost evaluation of the school of public and environmental affairs (indianapolis). indianapolis, in: school of public and environmental affairs. trussel, j. m., & bitner, l. n. (1996). re-engineering the cost accounting system. nacubo business officer, june. [on-line]. retrieved november 8, 1999 from the world wide web: http://www.nacubo.org/website/members/bomag/abc696.html. west, j. a., seidita, v., dimattia, j., & whalen, e. l. (1997). rcm as a catalyst: study examines use of responsibility center management on campus. nacubo business officer, august. [on-line]. retrieved november 8, 1999 from the world wide web: http://www.nacubo.org/website/members/ bomag/rcm_0897.html. zemsky, r., & massy, w. f. (1990). cost containment: committing to a new economic reality. change, 22, 16-22. author’s note: address correspondence to: barry r. cournoyer, d.s.w., indiana university school of social work, 902 west new york street, indianapolis, in 46202-5156 usa. teaching effective counseling strategies: healing the muslim heart _________________ khadiji khaja ph.d is an assistant professor and chelsea frederick b.s.w. is a graduate student at indiana university school of social work, indianapolis. copyright © 2008 advances in social work vol. 9 no. 1 (spring 2008), 1-7. reflection on teaching effective social work practice for working with muslim communities khadija khaja chelsea frederick abstract. in many academic departments like social work, psychology, and psychiatry there is a growing consensus that teachers need to instruct students to be culturally competent especially if they are going to be effective helpers with diverse populations. multicultural instructional counseling methods are imperative if we are to ensure that our students of counseling are well prepared to work with diverse families, particularly those from muslim backgrounds. in this narrative the author writes about the challenges of teaching non-muslim students effective counseling techniques with muslim families. culturally innovative teaching methods are illustrated to facilitate students’ learning how to be effective counselors with muslim communities. keywords: muslims, islam, spirituality, religion, clinical skills, counseling introduction it is never easy to teach students how to be effective social workers. those of us that have years of experience teaching social work in the west whether it be in colleges or universities realize that each individual, family, or group is different, and will require different types of interventions. in many academic departments like social work, psychology, and psychiatry there is a growing consensus that teachers need to instruct students to be culturally competent especially if they are going to be effective helpers with diverse populations (brammer, 2004). this is not as easy as it sounds. western helping frameworks generally appear to stress individual self-sufficiency, independence, and autonomy. the majority of students in the united states learn counseling techniques which were primarily designed to serve european american families (brammer, 2004). this could explain why many minority groups end counseling faster than european american clients do (ridley, 1989). the importance of teaching culturally competent social work practice became even more relevant when the horrific attacks took place against the world trade center on september 11, 2001. negative images of muslims were prevalent in the media, which created internalized fear or anger even in the best of social work students (brammer, 2004). thus, teaching non-muslim social work students how to be effective helpers with muslim families can be a rather daunting and challenging task. carter and rashidi (2004) report that most muslim families who have migrated to the west continue to support their traditional beliefs. most western social work students, however, do not even know what this means. this should reinforce that as teachers we should, and can play a leadership role in classrooms by making sure our students understand how best to help muslims. this paper will illustrate lessons learned advances in social work, spring 2008, 9(1) 2 in classrooms when trying to educate mainstream non-muslim students about how to effectively engage in social work practice with muslim communities. educating social work students about muslims one of the first things a teacher can do is illustrate that understanding and helping muslims is relevant simply because of the population’s growing demographics. this sounds like a fairly simple task, but it is powerful because it grabs the attention of the social work classroom. today over one billion, or nearly one in five people around the world are muslim. the islamic faith is the second largest in the world, and there are at least fifty countries around the world in which muslims represent the majority of the population (carter & rashidi, 2004). while the continents of asia and africa have the largest populations of muslims, migration patterns have led to many muslims migrating to north america (khaja, 2004). many have migrated due to civil and political conflicts, to have access to better education and economic opportunities for their families, or to escape religious persecution, and civil wars (carter & rashidi, 2004). seven to eight million muslims live in the united states (rashid, 1999). to prevent stereotyping, it is also important to reinforce to students that 80% of the muslim world is not arab, and that 90% of arab americans are christian (reizian & meleis, 1986). sharing these demographics in social work classrooms is important because it breaks common misconceptions that can be detrimental to both muslims and arabs. also, when students learn how large the muslim community is they become interested, curious, intrigued, and committed to their learning. this is because students realize there is a strong possibility that they will eventually have a helping relationship with a muslim, whether it be in a role as an advocate, case manager, counselor, community development worker, or administrator. stigma of mental health it is critical to teach students that muslim clients have to be the ones that educate a social worker on their lives, supports, and resources (carter & rashidi, 2004). it is, however, equally important to educate students that the term “mental health”, used commonly in western social work classrooms, must be used cautiously. asking anyone to reveal whether they have a mental health concern, or asking them to fill out a form sharing whether they have a mental health diagnosis is never easy, with a muslim it is even more challenging. this can be met with extreme resistance and anger. this is because mental health issues are still viewed in a shameful manner in many muslim communities. often such issues are dealt with privately in the home or with the help of extended family. it is not unusual to hear about cases where muslims have experienced various mental health issues such as depression, anxiety, and psychosis, but suffered silently or were very apprehensive to reach out for help for fear of community gossip (khaja, 2004). for example, in saudi arabia, and pakistan, a stigma still exists that mental illness is caused by the affliction of evil spirits (pridmore & pasha, 2004). muslim mental health patients in such areas are reported to have been chained, burned, beaten, or undergone exorcisms (pridmore & pasha, 2004). hence, it is important to educate students that it is probably better to ask muslim clients if they are experiencing any emotional stresses instead of asking if they have any mental health issues or concerns, khaja & frederick/teaching social work practice with muslim communities 3 especially if a social worker needs the information for an assessment or intake form. clearly stressing confidentiality and what mitigating conditions it can be broken under can alleviate some stress for the muslim client that reaches out to a western mainstream social work agency. speaking about medications that treat mental health issues cannot be taken lightly either. it is not unusual to hear muslim families saying they are against taking medications to cope with mental health issues, as it is considered a sign of spiritual weakness. while there are some muslims that use medications to deal with mental health issues, more studies are needed that explore how common or accepted this practice is. teaching spiritual healing of muslims teaching social work students how to help muslim clients needs to involve education on the role of spirituality (carter & rashidi, 2004). islam often guides how muslim families live (carter & rashidi, 2004). hence, it is important to educate students on the basic tenants of islam. for example, the author will often invite a guest speaker from an islamic center who will educate students on islam. students quickly learn that the average muslim family follows the qur’an which is the holy scripture of muslims, and sunnah which are traditions of prophet muhummed, both of which often play a central role when families face difficulties (carter & rashidi, 2004). the average muslim family will consult with experts of the qur’an, and sunnah when they are dealing with any concerns. students are often surprised to learn that the qur’an provides guidance on family and company, ethics and etiquette, economic well being, order, charity, models of family conduct, social welfare, and oppression (eliyasee & picktall, 1996). experts in the qur’an are often contacted where they will suggest various healing techniques such as reciting paragraphs of the qur’an a certain amount of times, use of herbs, and special diets. thus the role of the qur’an in counseling muslim families is quite central, and cannot be underestimated or ignored. therefore it is important to educate western counseling students that many muslims would probably feel more comfortable consulting a well trained sheik or moalj bel-koran (muslim traditional healer) to help them with emotional struggles instead of relying only on the western trained counselor (al-krenawi & graham, 1999). this can lead to more referrals to muslim traditional healers, and will ensure that western counseling students appreciate the importance of spirituality in the lives of muslim families, and that interventions by god are seen as critical to dealing with emotional crises in many muslim families (al-krenawi & graham, 1999). a central concept of islam is the “belief in fate, that all things that happen to a person, both good and evil, are the will of god” (al-krenawi & graham, p. 55. 1999). teaching muslim psychotherapy i also educate my students on the arabic word islam which literally means peace, and belief in only one god, allah (carter & rashidi, 2004). for muslims, their higher power is allah (carter & rashidi, 2004). the next step is to educate counseling students on the purpose of helping muslim families. for example, in western counseling techniques the focus might be on people realizing strengths, coping mechanisms, dealing with past conflicts, and finding solutions. however, in muslim counseling methods we try to help families in a deeply holistic manner (carter & rashidi, 2004). the focus is on advances in social work, spring 2008, 9(1) 4 balance between mind, and body (carter & rashidi, 2004). counseling techniques need to therefore focus on peace in the “spirit (rouh), mind (aghl), soul (nafs), intellect (aghlaniah, tafakkor), body (badan or jesm) and emotion (atefah)” (carter & rashidi, 2004, p. 153, 2004). the quran sees all these parts as connected, and if one area is not functioning well, the spiritual balance of mind and body are adversely affected. the concepts of “inner tranquility” and “peace” need to be the central point of counseling (carter & rashidi, 2004, p. 154). a person must have virtue inside, and practice it externally (carter & rashidi, 2004). this is done with a strict diet, fasting, prayer, and meditation. this is believed to lead to a person having balance “physically”, “emotionally”, “spiritually”, and “mentally” (carter & rashidi, p. 155). roles of gender in counseling counselors of a different gender than clients can pose a problem. it is not unusual to hear that a muslim woman would have difficulty seeking help from a male counselor because she “cannot occupy private space together without the presence of another person” (carter & rashidi, 2004, p. 153). to complicate matters further, both male and female clients cannot look at counselors of the opposite sex directly, a common practice in many muslim families (carter & rashidi, 2004). because of this counselors may wrongly assume that the client is “lying” or has poor self-esteem (carter & rashidi, 2004, p.153). physical contact as simple as a handshake is not permissible in many islamic cultures. males may often be expected to enter or leave a room first (carter & rashidi, 2004). the counselor may erroneously assume this is a sign of disrespect when actually the client believes they are showing respect. it would also not be unusual to bring other family members to sessions even if the concern pertained to individual matters. a counselor should also realize that statues or pictures of people in a room can be offensive to muslims as this was equated to idol worship in early islamic times. even the smell of pork or ham can be seen as offensive as muslims are forbidden to eat flesh from a pig. in many muslim families, extended family supports are critical, and their expertise or wisdom will be sought even in counseling matters (carter & rashidi, 2004). patience in times of adversity, and helping others are seen as key ways to deal with trouble in one’s inner peace (carter & rashidi, 2004). healing the muslim heart it is important to teach mainstream social work students that many muslim believe that healing of one’s heart is seen as critical to ensuring a peaceful life without any emotional troubles or conflicts. purification and cleansing of the soul (tazkiat) is seen as the ultimate form of healing for the muslim heart (farid, 1991). mental health issues can often be seen as resulting from a sick or dead heart (farid, 1991). many muslims believe that a person with a healthy heart does not give in to temptations, has hope, and dedicates life to god (farid, 1991). it is believed that a person with a sick heart is focused on materialistic things in this world, and will suffer deeply (farid, 1991). the person with a dead heart is viewed as focusing on “lust”, “desire”, and “worships things” other than god (farid, 1991, p.15). this person does not listen to those trying to help, has great impulsivity, can be manipulative, and lives in a world of fantasy (farid, 1991). khaja & frederick/teaching social work practice with muslim communities 5 those with a sick or dead heart are viewed as people who have a soul that lacks remorse, and are preoccupied with this world (farid, 1991). temptations are seen as the main causes of a sick or dead heart. four areas are considered particularly poisonous to the muslim heart. talking a great deal without praise of god is believed to “harden” the heart (farid, p. 20, 1991). what we utter, and how we utter it is believed to affect our peace. farid (1991) states that “those who sow the seeds of good words and deeds harvest honor and blessings; those who sowed the seeds of evil words and deeds reap only regret and remorse” (p. 20). it is also important to educate mainstream social work students that glances of the eye are seen as something that can affect our inner peace in the heart. for example, many muslims believe the eye and the heart are intrinsically connected. if we enjoy viewing things that hurt other humans our heart decays (farid, 1991). the heart becomes more preoccupied with the “beautiful” instead of being preoccupied with “worship” (farid, 1991, p. 23). this is one of the main reasons why muslims are expected to lower their gaze when interacting with others so that the temptations of the devil do not pass through (farid, 1991). if the heart is “dark” problems will overcome the individual. if the heart “lights up” positives things will happen to the individual (farid, 1991). diet is considered intrinsic to a healthy inner peaceful heart. eating tiny portions of food is believed to ensure a tender heart, increases intelligence, encourages humbleness of the soul, reduces temptations, and ensures a gentle temperament (farid, 1991). this is one of the reasons muslims fast so they can cleanse themselves of temptation, purifying their souls, which gives the devil little room to move and tempt a person (farid, 1991). different states of soul for muslims, key methods of dealing with mental health issues are remembering god, seeking forgiveness, patience, gratitude, and praying (farid, 1991). it is also important to teach mainstream social work students that muslim believe souls are accountable. for example, the muslim soul at peace is believed to be one that accepts problems with a sense of surrender, knows it has come from god and accepts it. this type of soul has faith in god’s “predestination” and has deep self awareness, taking responsibility for inner peace that is lacking (farid, p. 54, 1991). the oft-blaming soul is one that moves from positive, and negatives senses of inner peace. one minute the person remembers god and has faith, the next minute the person is forgetful of god (farid, 1991). the soul directing to sin is an individual that blames god for any type of affliction, and does not give to charity (farid, 1991). for example, many muslims will give more to charity if they are experiencing any emotional troubles. teaching strategies one can easily understand why it is so important for mainstream social work students to understand some general beliefs about why muslims believe they may be suffering emotional troubles. god is certainly seen as key to the helping process, and cannot be ignored in any type of counseling intervention with most muslim families. the author has used a number of techniques in the classroom to help social work students advances in social work, spring 2008, 9(1) 6 understand their assumptions about muslims, and what they will need to learn if they want to help muslim clients effectively. one exercise may be to have students analyze how media affects the way they view muslims. this can lead to a powerful discussion on stereotypes that can lead to bias in counseling. students should be taught to be themselves so they appear more personal (brammer, 2004). it is also important to reframe issues that muslim clients face in a positive way so clients don’t feel so different than a counselor from a different culture (brammer, 2004). social work students can also be asked to write personal reflections on what they know about muslims, and where they learned this from. each student could read this to the class and classmates could comment on what they think, even challenging some of these beliefs. this can help students realize the hidden messages they have learned about muslims from families, peers, books etc. students can also be asked to discuss how spirituality fits or does not fit in their own personal life. they should share how this can impede communication with muslims who almost always prefer spirituality to guide the general frame of counseling. students should also be encouraged to do bias checking by having an open dialogue about their concerns about working effectively with muslim populations. most importantly, students should also be encouraged to do visits in the muslim community. they could visit mosques in their community where they can also interview religious heads to ask for advice pertaining to counseling. this allows the mosque to have increased comfort in making referrals to non-muslim counselors, it also allows for mainstream social workers to build collaborative partners in the muslims community who could assist in counseling if necessary, and only if the family is agreeable. conclusion multicultural instructional counseling methods are imperative if we are to ensure that our students of counseling are well prepared to work with diverse families, particularly those from muslim backgrounds. more studies are needed to assess whether in fact non-muslim counselor are going to be effective in helping muslim families. studies are also needed that address whether muslim families are reaching out to nonmuslim counselors, and under what circumstances they drop or continue with counseling. to end, more instructors must take an active role to teach social work students that clients are diverse, with varied belief systems of how they prefer their helping experience. social work students must in turn learn that we live in a multicultural society where people have different beliefs about what can, and will help them. mainstream social work education must commit itself to addressing unique and diverse forms of counseling techniques. references al-krenawi, a. & graham, j.r. (1999). social work and koranic mental health healers. international social work, 42 (1), 53-65. brammer, r. (2004). diversity in counseling. belmont, ca: thompson learning inc. carter, j.d., & rashidi, a. (2004). east meets west: integrating psychotherapy approaches for muslim women. holistic nursing practice, may-june, 152-159. eliyasee, a.h., & pickthall, m.m. (1996). the holy qur’aan. hyderabad, india: eliasii family book service. khaja & frederick/teaching social work practice with muslim communities 7 farid, a. (1991). the purification of the soul: according to the earliest sources. london: al-firdous ltd. khaja, k. (2004). female circumcision: life histories of somali women (doctoral dissertation, university of utah, 2004). dissertation abstracts international, 65(2), 584-794. pridmore, s. & pasha, m.i. (2004). psychiatry and islam. australian psychiatry,12 (4), 380-385. rashid, s. (1999). islamic influence in america: struggle, flight and community. journal of muslim minority affairs, 19 (1), 7-31. reizan a., & meleis, a. arab americans perceptions of and responses to pain. critical care nurse, 1986; 6 (6): 30-37. ridley, c.r. (1989). racism in counseling as an adversive behavior process. in. p.b. pedersen, j.g. draguns, w.j. lonner , & j.e. trimble (eds.), counseling across cultures (2nd ed., pp. 55-78). honolulu: university of hawaii press. author’s note: address correspondence to: khadiji khaja ph.d., assistant professor, indiana university school of social work, 902 west new york street, es 4155, indianapolis, in 46202. email: kkhaja@iupui.edu. mailto:kkhaja@iupui.edu spring2001-070_page 65 spring2001-071_page 66 spring2001-072_page 67 spring2001-073_page 68 spring2001-074_page 69 spring2001-075_page 70 spring2001-076_page 71 spring2001-077_page 72 spring2001-078_page 73 spring2001-079_page 74 aisw vol. 8, no. 1:aisw vol. 5, no. 2 life span and resiliency theory: a critical review alexa smith-osborne abstract: theories of life span development describe human growth and change over the life cycle (robbins, chatterjee, & canda, 2006). major types of developmental theories include biological, psychodynamic, behavioral, and social learning, cognitive, moral, and spiritual, and those influenced by systems, empowerment, and conflict theory. life span development theories commonly focus on ontogenesis and sequential mastery of skills, tasks, and abilities. social work scholars have pointed out that a limitation of life span and other developmental theory is lack of attention to resilience (greene, 2007; robbins et al., 1998). the concept of resilience was developed to “describe relative resistance to psychosocial risk experiences” (rutter, 1999b, p. 119). longitudinal studies focused on typical and atypical child development informed theory formulation in developmental psychopathology (garmezy & rutter, 1983; luthar, cichetti, & becker, 2000) and in an evolving resilience model (richardson, 2002; werner & smith, 1992). research on resilience has found a positive relationship between a number of individual traits and contextual variables and resistance to a variety of risk factors among children and adolescents. more recently, resilience research has examined the operation of these same factors in the young adult, middle-age, and elder life stages. this article examines the historical and conceptual progression of the two developmental theories—life span and resiliency—and discusses their application to social work practice and education in human behavior in the social environment. keywords: life span, resiliency theory, life cycle, critique theories of life span development describe human growth and change over the life cycle (robbins, chatterjee, & canda, 2006). major types of developmental theories include biological, psychodynamic, behavioral and social learning, cognitive, moral and spiritual, and those influenced by systems, empowerment, and conflict theory. life span development theories commonly focus on ontogenesis and the sequential mastery of skills, tasks, and abilities. 152 alexa smith-osborne, ph.d. is assistant professor at the university of texas at arlington school of social work, arlington, tx 76019. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 152-168. indiana university school of social work. the major theories address the entire life cycle, from prenatal or birth to death, but they often focus in-depth on particular age periods, referred to as life stages. some theorists within this field have focused more exclusively on a single life stage (vaillant, 1993) or on a macro-level view of developmental traits that characterize an age cohort with defined ranges of birth dates or historical/cultural periods of primary influence on development (strauss & howe, 1991). for purposes of this paper, only a segment of life span theory can be addressed. therefore, this paper focuses on personality and psychosocial theories, which form the historical foundation for much of the other life span theories. resiliency theory is an emerging theoretical perspective that has been developed within developmental psychopathology and ecosystems perspectives and is influenced by stress and coping theories. although this theory has not been explicitly developed as an outgrowth of life span theory, it is developmental in focus, and theory-driven research typically examines a specific chronological life stage as a starting point. this theoretical framework addresses health development of at-risk populations, and overcoming stress and adversity to achieve functional outcomes either during a life stage, a specific trajectory (e.g., educational or deviancy), or throughout the life span. the initial focus of theory development has been on childhood and adolescence and associations of traits and events at these life stages with outcomes later in life. some recent research in this field has applied resiliency constructs to adults at risk (daining, 2005; smith, 2003; smithosborne, 2006). historical context the notion that life can be understood as a series of significant and sequential stages can be traced to the earliest human civilizations and has appeared consistently in literary, religious, and philosophical writings throughout history (erikson, 1968; robbins et al., 1998). the scientific approach to human development throughout the life cycle was stimulated by the emergence of evolutionary theory at the turn of the century (darwin, 1872), which led to the development of biologically focused maturational and psychosexual perspectives, such as those of g. stanley hall in 1904, sigmund freud in 1905, and arnold gesell in 1925. these seminal theories challenged the victorian (and earlier) conception of children as little adults, and childhood as a time of relative stability, while the children were simply waiting to grow physically (colby, 1970; karl, 1964). these theories also established the conceptualization of human development as occurring in a series of essentially stable stages, with periods of instability during transitions between stages and the mastery of stage-specific skills or conflicts as the foundation for progress to the next stage (hoffman, paris, hall, & schell, 1988). freudian theory came to dominate much of human development theory and clinical practice in the early 20th century, with several of freud’s students, notably jung and erikson, expanding on his concepts on the basis of their own clinical and cross-cultural experiences. these amplifications of freudian theory occurred against the backdrop of the rise of fascism, the holocaust, and world war ii. the originator of what is now called the life span approach to human psychological development, erik erikson, had been a student of freud’s and trained as a psy153smith-osborne/life span and resiliency theory choanalyst in germany. erickson fled nazi germany in 1939 to immigrate to america, where he expanded freud’s stages to apply to the entire life span, emphasizing psychosocial, rather than biological drive theory. resiliency theory, in contrast, originated on the basis of prospective longitudinal research on cohorts of children at risk (garmezy, 1993; rutter, quinton, & hill, 1990; werner & smith, 1982, 1992), rather than on the basis of individual clinicians’ observations and case studies. such studies were informed by prevention science (greene, 2007) and the application of the epidemiological concepts of immunity and resistance to disease to human development and psychopathology (thoits, 1983). in particular, werner and smith’s longitudinal study of 698 infants, many of hawaiian and asian descent, provided a major empirical basis for the inception of resiliency constructs and hypotheses for further testing, as did rutter’s work with early onset mental disorders and with institutionalized romanian children (e.g., rutter, 1983; rutter et al., 1990). resiliency theory’s salutogenic orientation has been heavily influenced by the hawaiian study’s focus on those in childhood adversity who overcome the odds by the time they reach adulthood. the initial formulation of theoretical concepts and constructs based on this research proceeded within the developmental psychopathology framework in psychiatry (e.g., rutter, 1987) and developmental psychology (e.g., garmezy, masten, & tellegen, 1984) and within family stress and adjustment theory (e.g., mccubbin & dahl, 1976; mccubbin & patterson, 1983) in social work. much of the seminal research in this field was begun in the late 1950s (e.g., werner & smith began their study in 1955) and initial findings were reported in the 1980s. thus, this early theoretical development was situated historically in the postvietnam war and the post-colonial era of globalization, and it often focused on identifying factors in overcoming trauma and adverse events, such as warinduced family separations. later, as social work educators and researchers gave more attention to salutogenic, strengths-based (saleebey, 1997) theoretical models for practice, resiliency constructs were further developed within the ecological perspective (e.g., fraser & galinsky, 1997; gilgun, 1996) in social work theory, rather than in life span theory. social workers have continued to draw on resiliency theory constructs and empirical findings in research (e.g., herrenkohl, hill, chung, guo, abbott, & hawkins, 2003) and in human behavior and practice texts (e.g., haight & taylor, 2007; johnson, 2004; thomlison, 2007), either within the ecological perspective (e.g., haight & taylor) or, more commonly, outside a specified theoretical frame of reference. furthermore, some social workers have explicitly identified and used resiliency theory as a theoretical framework, independent of other perspectives, for education (greene, 2007) and research (smithosborne, 2005a, 2006; ungar, 2004). theoretical concepts and critical analysis life span theory life span theory utilizes the central concept of ontogenesis, the chronological unfolding of human development (gunnar & thelen, 1989; thelen & smith, 1994), which includes both change in size and change in the complexity and differentiation of function (e.g., the change in motor reflexes at various stages in 154 advances in social work life). some theorists include deterioration or diminishment in size and function, particularly if the focus is on aging and the adult life cycle, as well as accretion or augmentation (jung, 1965; newman & newman, 1975; santrock, 1989). erikson (1950) proposed the concept of “epigenesis” to convey that human development unfolds from part to whole, with elements of the chronologically appropriate ability or personality feature gradually emerging in a prescribed sequence until the functional whole was achieved. the term has since been used within the developmental psychopathology theoretical perspective to also apply to the chronological unfolding over the life span of the disease process, such as schizophrenia (e.g., cannon, rosso, bearden, sanchez, & hadley, 1999). he saw this emergence as occurring within an interactional and adaptive framework, within which the individual develops through interaction and adaptation to the immediate social environment as well as to the larger society, culture, and historical context. thus, erikson postulated that mutual responsiveness on the part of both the individual and society was necessary for optimal development. another key life span concept associated with the work of freud and erikson is the life stage. the life stage is seen as an age-related period of life characterized by predictable features, tensions, and changes and leads into a subsequent stage. erikson formulated the notion of the psychosocial crisis, a period of tension and disorganization centered on a stage-specific theme, the resolution of which was the goal of the transition phase from one stage to the next. freud and erikson conceptualized stages as prescriptive, in that their sequence was unvarying and defined optimal mature development, was associated with specific tensions/conflicts, and was prerequisite, in that each stage must be worked through and the associated conflicts resolved before successful transition to the next stage could be accomplished. freud’s and erikson’s life stage models are presented in hoffman et al. (1988, pp. 30 and 32). erikson (1950) moved beyond freud’s life stage constructs in proposing that ego development in childhood is a process of identification, which he defined as internalization of another person’s values and standards in an attempt to become like that person or parts of that person. it was in adolescence that erikson observed (1968) the identity was formed through a process of: repudiation and mutual assimilation of childhood identifications and their absorption in a new configuration, which in turn, is dependent on the process by which a society (often through subsocieties) identifies the young individual, recognizing him as somebody who had to become the way he is and who, being the way he is, is taken for granted. (p. 159) in erikson’s theory, then, the concept of the mature ego identity as a complex sense of self, comprising societally-defined life roles as well as aspects of personality, is crucial. the “identity crisis” in adolescence is normative and revolves around issues of personal sameness and historical continuity, which serve as a link between the individual and the larger society. prolonged adolescence, in erikson’s schema, provides a psychosocial moratorium in which the sexually mature individual engages in free role experimentation, sanctioned by society, in 155smith-osborne/life span and resiliency theory order to find a defined niche in society, while postponing adult sexual roles. erickson saw this as a second period of delay in the life cycle, with the first being freud’s psychosexual moratorium of the latency life stage, which permits the young to learn the basics of society’s work situations before embarking on mature sexual roles, such as spouse and parent. erikson used the term identity diffusion, and later the term identity confusion (1968), to describe the state of mild confusion commonly experienced by adolescents in the process of identity formation. james marcia (1980) developed this concept further to apply to adolescents who are not in an identity crisis, because they are not committing themselves to occupational or ideological goals and are not concerned about the situation. based on the mature and socially acceptable ego identity, the young adult, in erikson’s schema, could then take up the mature sexual role in seeking a spouse or intimate partner. in the middle adult stage, the individual was seen as transitioning to the ego strength made up of procreativity, productivity, and creativity, such as in forming a family and mentoring future generations on a personal, societal or even global level. the last stage of life was that of ego integrity, which involves the older adult’s acceptance of his/her own live as meaningful and coherent, and the perspective that one has handled life’s tasks in the best way possible under given circumstances. contemporary theorists have proposed expanded models, particularly in the adolescent and adult stages. two such models, proposed by vaillant (1993, p. 145) and newman and newman (1988, p. 45). erikson (1982, 1986, 1988) built on his earlier work in the last life stage, as he and his wife reflected on their own adult development in later life, conceptualizing aging in terms of revisitation of earlier stages of development within his stage 8 of integrity vs. despair. erikson and other psychodynamic theorists, such as vaillant (1993), acknowledge developmental influences such as culture, race, and gender, but tend to view intrapsychic and biological factors, including iq, as being more important to development. other theorists conceptualize human development as being more fluid throughout the life span, rather than the product of invariant and chronologically sequential stages, and as being more heavily influenced by social roles (goffman, 1959; neugarten, 1985), demographic variables, such as gender, race, or socioeconomic status, culture and historical “moment,” and even the reciprocal, interactive effects of the immediate physical/social environment (gunnar & thelen, 1989). resiliency theory the concept of resilience was developed to “describe relative resistance to psychosocial risk experiences” (rutter, 1999b, p. 119). it has been further defined as “a dynamic process encompassing positive adaptation within the context of significant adversity” (luthar, cicchetti, & becker, 2000) and “the process of coping with adversity, change, or opportunity in a manner that results in the identification, fortification, and enrichment of resilient qualities or protective factors” 156 advances in social work (richardson, 2002, p. 308). research on stress reactions and recovery from stress, with implications for education, has also informed this theory (benotsch et al., 2000; d’imperio, dubow, & ippolito, 2000; dubow, schmidt, mcbride, edwards, & merk, 1993; dubow, tisak, causey, hryshko, & reid, 1991; fontana, schwartz, & rosenheck, 1997; garmezy & rutter, 1983; golding, 1989; keenan & newton, 1984; lazarus, 1993; lazarus & folkman, 1984). thus, resilience is conceptualized as relative resistance to psychosocial stressors or adversity. although varying models of resiliency have been tested, researchers and theorists agree that the construct is salient in the context of stress and adversity and is not operative in the absence of environmental stressors (jew, green, & kroger, 1999; rutter, 1999). the central constructs of the theory include risk factors/mechanisms, vulnerability factors, and protective factors/mechanisms. risk factors and mechanisms have been conceptualized in alternate ways in the literature: either as 1) the events or conditions of adversity (for example, poverty) themselves for which there is empirical evidence of association with psychopathology, illness, or dysfunctional developmental outcomes or as 2) factors that operate to reduce resistance to stressors/adversity. vulnerability factors are traits, genetic predispositions, or environmental and biological deficits (such as cognitive impairments) for which there is empirical evidence of heightened response, sensitivity, or reaction to stressors or risk factors. the constructs of vulnerability factors and risk factors are sometimes used interchangeably in the literature. protective factors and mechanisms are traits, contextual characteristics, and interventions that operate to enhance or promote resistance, or which may moderate the effect of risk factors, and for which there is empirical evidence of association with health and functional developmental outcomes. rutter (1987) suggests that protective mechanisms may operate in one of four ways to allow overcoming odds in the face of adversity: by reducing risk impact, by reducing negative chain reactions to risk factors, by promoting resiliency traits (i.e., the opposite of vulnerability factors, such as self-efficacy and optimism), and by setting up new opportunities for success. reducing risk impact can occur not only by way of buffering events and social networks, but also by inoculation due to successful coping with earlier, milder stressful events. protective and risk mechanisms have been found to vary according to the type of adversity, type of resilient outcome, and life stage under analysis; risk factors in one context may be protective in another (rutter, 1999; smith-osborne, 2006; ungar, 2004). research on resilience among children, adolescents, and young adults has found a positive relationship between spirituality, social support, social capital, income, and personal/family traits (e.g., hardiness, coherence, social competence and self-efficacy, normal attachment, healthy attributions, active stress appraisal, and coping), and resistance to a variety of risk factors, including psychiatric disorders and school failure/drop-out (daining, 2005; garmezy, 1991; luthar et al., 2000; masten & coatsworth, 1998; richardson, 2002; rutter, 1999a; smith & carson, 1997; werner, 1992). research on military families dealing with war-induced separation and trauma has found associations between resilience and similar protective mechanisms (benotsch et al., 2000; lavee et al., 1985; mccubbin & dahl, 1976; mccubbin, dahl, lester, benson, & robertson, 1976; 157smith-osborne/life span and resiliency theory mccubbin, hunter, & dahl, 1975; mccubbin et al., 1980; mccubbin & mccubbin, 1996; patterson, 2002; sutker et al., 1995; thoits, 1983). units of analysis life span theory is most commonly applied to the individual and family as the units of analysis (mccubbin et al., 1980). however, erikson (1962, 1968, 1969) proposed that this theory could apply to humanity as an entity, thus not being limited to one’s interactions with individuals, groups, or specific environments/institutions. subsequent theorists, such as coles (1990, 1991, 1997) and strauss and howe (1991), have focused on the more macro-level implications of erikson’s concepts, for example, in investigating human development within generations and religious reference groups. like life span theory, resiliency theory has been most commonly applied to individuals and family units that are consistent with these theories’ shared developmental focus. more recent investigations of specific risk and protective factors, however, have shown a trend toward the examination of macro-level or contextual variables (herrenkohl et al., 2003; schafft, 2006; smith-osborne, 2005, 2006; ungar, 2004), such as neighborhoods (e.g., disorganized, residentially unstable) and institutional policies. aspects of human development rapid advances in the knowledge base about the biological underpinnings of human development tend to lend support to conceptualizations of the life stages that are more fluid throughout the life span, rather than invariant or even necessarily sequential (robbins et al., 1998; thelen & smith, 1994). incorporation of this new knowledge is seen most clearly in researchers who focus on adult development and aging. george vaillant (1993), for example, pointed out that: if adult development is to be conceived as a psychobiological process then it must conform to biology, and neither to social mores nor to chronological age. this means that, as with shaving and menstruation, not everybody will reach a given stage at the same chronological age (p. 166). similarly, sharon mcquaide, in her research on “women at midlife” (1998), examined biological and cohort variables to add to life span theory. she found that “the generation of women now entering midlife differs from previous generations” (p. 21), and that women who were “’blocked from being in the world’ (through disability, poor health, involuntary unemployment, limited spending power)” (p. 29) were less likely to achieve well-being and other indicators of generativity, erikson’s designation for the midlife stage issue. life span theory, then, has the flexibility to address various aspects of human development throughout its stages. resiliency theory has, from its inception, been remarkable for encompassing the broad biopsychosocial aspects of human development, as well as for crossreferencing empirical findings on normative or healthy human development with findings on pathological development (cichetti & cannon, 1999). early develop158 advances in social work ment of the theory gave more attention to individual characteristics and to factors present in childhood, which were associated with adult outcomes, thus privileging enduring traits from earlier life stages. although recent cross-sectional studies have begun to offer more possibilities for developing an understanding of resiliency in middle and later adulthood, this theory’s current utility is, in its application to the broad aspects of human development, from infancy through early adulthood. philosophical underpinnings the life span theory philosophical underpinnings, most of which have been noted previously in this paper, include: a health and adaptation orientation, rather than a medical illness-oriented orientation; a special interest in the earlier stages of life; an ontogenetic perspective with emphasis on predictable and discontinuous life stages; a transition period between stages, which may be characterized by increased tension and disorganization (erikson’s “psychosocial crises”); an intrapsychic focus and an interactive focus; and lifelong development. as noted previously, the life span theorists who built on erikson’s work have gone far in addressing the limitations of many of these philosophical underpinnings, as well as the biases built into the original theory. resiliency theory is characterized as similarly salutogenic, but with a philosophical orientation toward the linear, cumulative connections between earlier life stages and adulthood for those at risk. resiliency research to date has been largely conducted by western scientists and has had a linear, positivistic paradigm. thus, it has been criticized as hegemonic and, thereby, limited in its scope in accounting for diverse resiliency experiences. philosophically, resiliency theory is more heavily focused than life span theory on interactions between the environment and person in terms of environmental adversity and personal protective traits. as with life span theory, more recent work in resiliency theory has tipped the balance philosophically more in the direction of contextual protective variables, often operationalized as social groups and community and institutional characteristics. strengths and weaknesses the evident strengths of life span theory include its expansion of understanding of personality development through the life span, its utility across a variety of human service settings and functions, and its “generativity,” to borrow erikson’s term and reapply it to theory-building. life span theory gave rise to a rich plethora of human development models, not only to increase understanding of specific life stages or the entire life cycle, but also to address intermediate and macro-level entities, such as families, family-run businesses, social movements led by “great” personalities, faith communities and religious reference groups, and entire generational cohorts. in so doing, this theory has been applied to disciplines beyond the human service domain. for example, the sociological concept of the bourgeois bohemian (brooks, 2001), the theological concept of gen x religiosity (beaudoin, 2000), and the economic concept of style as a form of self-expression (postrel, 2003), all owe their origins ultimately to life span theory. several of the most cogent points of criticism of life span theory weaknesses have been noted above: the euro-american, middle class, male bias; the rigidity 159smith-osborne/life span and resiliency theory of the life stage concept; and the notable lack of empirical support. another, less frequently discussed weakness is the theory’s failure to address or adequately explain the sources of the stage shifts (haroutunian, 1983; oyama, 1985) and the application of those stage shifts across domains (thelen, 1987). concomitantly, the theory has been targeted by critics for failure to account for the emergence of new forms in each stage (e.g., why do immobilized hopi babies start walking at the same age as mobile wasp babies) in the context of the nature versus nurture dichotomy. resiliency theory shows promise as an emerging theory, which extends life span theory in offering predictive and explanatory constructs relevant to healthy development in the face of adversity. its constructs and models have been used flexibly by social workers in concert with other theoretical perspectives, such as the ecosystems perspective (fraser, 1997; gilgun, 1997), systems theory (ungar, 2004), the differential resiliency model (palmer, 1997), and the social development model (herrenkohl et al., 2003). furthermore, this theory has demonstrated that it offers both a viable platform for developmental research and a conceptual framework capable of elegant and parsimonious evolution based on that research. resiliency theory has the advantage of being empirically based from its inception and of thereby incorporating ongoing findings and constructs from biology and neuroscience, such as neuroplasticity (rutter, 1999b). it has begun to demonstrate utility in application across human service settings and practice models and across life stages and trajectories (greene, 2007). one important limitation of resiliency theory is its restriction to application only to populations in adversity or populations experiencing trauma or high stress levels. theoretical constructs may be misapplied in research or practice to normative life cycle issues or moderately stressful events. the constructs themselves have been criticized as tautological and are inconsistently defined across studies, thus limiting validity and reliability of the research. considerable effort has been made by leading resiliency theorists, particularly in the last decade, to clarifying and standardize these definitions. this theory has also been criticized for its positivist research paradigm to date, with consequential bias towards linear explanatory models based on predictable, hierarchical relationships between protective and risk factors (ungar, 2004). this tendency may limit its utility in application to diverse cultures and populations. on the other hand, the original empirical basis for the development of the theory consisted heavily of studies of cross-cultural and ethnic minority populations, which may be evidence to counter this criticism. empirical support life span theory has been criticized as lacking an empirical base of support, much like psychodynamic theory in general has been criticized. it is true that many theorists in this perspective use clinical case and cross-cultural observation (erikson, 1968; coles, 1990; greenspan, 1992) and, in some instances, examination of the lives of great men and women, as their primary methodology for generating the theory. for example, erikson studied the lives of luther and gandhi (1962, 1969), while vaillant looked at florence nightingale’s life in his analysis of women’s adult development (vaillant, 1993). coles is robust in his defense of these clinically ori160 advances in social work ented methodologies in generating rich, contextually-based theoretical constructs, and is critical of the biases and limitations he finds inherent in empirical, quantitative methodologies (1990, pp. 22-39). however, vaillant’s longitudinal study of adult men (1977), his follow-up study of male adults from a different socioeconomic group (1993), and recent quantitative studies of adult development (mcquaide, 1998; norman, mccluskeyfawcett, & ashcraft, 2002) have provided empirical support both for the life span concepts derived from ego defense theory and for life stage concepts. in general, the life span theory has maximal utility when used to describe and explain the human development of individuals and, at a probabilistic rather than prescriptive level (robbins et al., 1998). erikson indicated his general concurrence with this summation in his discussion of the misapplication of his concept of the psychosocial crisis (1968, pp. 15-43). as previously described in this paper, resiliency theory has been conceived on an empirical basis, with two examples being werner and smith’s study of infants in hawaii and the english and romanian adoptees study team’s investigation of institutionalized children who were later adopted (rutter, quinton, & hill, 1990; rutter & era, 1998). resiliency theory-based empirical findings have been useful in refining important practice modalities used in social work. for example, such findings suggested a shift in the focus on family therapy to include assessment of the differential impact of family communication patterns on different family members, depending on individual vulnerability factors and peer group influences (rutter, 1999b; greene, 2007). richardson (2002) has suggested that there have been three waves of resiliency research: the first wave focused on identifying resilient qualities in person and environment, the second wave focused on specifying resilient processes effective in overcoming the odds, and the third and current wave in identifying innate transformational processes. empirical testing of resiliency constructs and models is ongoing in several disciplines, including social work (e.g., finkelstein et al., 2005; hrabowski, freeman, maton, & greif, 1998, 2002; kennedy, 2005; wright, fopma-loy, & fischer, 2005). implications for social work consistency with social work values despite its lack of empirical evidence, life span theory has enjoyed widespread acceptance, not only among social workers, but among the wide range of human service disciplines, particularly those with a psychodynamic theoretical perspective regardless of discipline. thus, part of its appeal has come from its expansion of freudian theory and its correction of some of the limitations and biases of that theory. its optimistic, strengths-oriented perspective, and its applicability to some domains other than the individual (mccubbin et al., 1980) have shown consistency with social work values. the utility of its concepts and theoretical constructs has been amply demonstrated by the variety and magnitude of applications that have been made to practice issues (e.g., streever & wodarski, 1984; snow, 2003; smith-osborne, 2005b), to theory building (e.g., elder, 1998; george, 1993; ingersoll-dayton, krause, & morgan, 2002; vaillant, 1993), and to popular 161smith-osborne/life span and resiliency theory understanding of the nature of human life (e.g., sheehy, 1976). the psychodynamic life span theorists deemphasized the biological determinism of strict freudian theory, and their theoretical concepts focus on successful negotiation of the life stage transitions as a normative, not as pathological process. these factors are seen as consistent with social work values, such as client self-determination and strengths-based practice. contemporary social workers are cautioned to be mindful that the originators of this theory base operated almost exclusively within a euro-american middle class framework, which limits the utility of the theory for application to diverse cultures and classes. the male bias inherent in the original theory base has been partially addressed through research and additional theory formulation on the development of women through the life span (gilligan, 1978, 1982, 1991; friedan, 1963, 1977; and 1993; mcquaide, 1998). the social work emphasis on person-in-environment is a good fit with life span theory’s perspective of human development as proceeding interactively. the limitations of the theory in taking macro-level influences into account, and the expansion work in this area by strauss and howe and others, is noted above. resiliency theory shares with life span theory the excellent fit with social work values detailed above, while avoiding the cultural, class and gender biases that have been noted in life span theory. its focus on vulnerability and populations at risk makes it particularly useful to the social work mission. this theory has been criticized as being less consistent with social work values than it could be, due to the hegemonic tendencies inherent in its positivistic philosophical underpinnings; however, new qualitative and mixed methods research, undertaken within a constructivist paradigm, may develop this theory so as to correct these tendencies. next steps for theory progression the current status of life span theory within social work remains that of widespread, even uncritical acceptance in its application, in a variety of human service settings, from child welfare agencies to parent education classes. social workers who practice or conduct research with specific age groups are informed by this theory in understanding the unique aspects of that age group or birth cohort (e.g., mcquaide, 1998; norman et al., 2002). in social work education, it is taught in theory and human behavior classes at all levels of social work preparation. the concept of developmental stages has been applied to student development through the field instruction process in social work, as well as in counseling and psychology (deal, 2000, 2002). the utility of this theoretical perspective and its value-fit with the social work profession are likely to ensure its continued place within the discipline. in order to enhance its viability as a foundation for best practices, life span theory must take the next steps in theory progression by strengthening empirical support for both its micro and macro levels across life stages, including the incorporation of recent advances in human neuroscience evidence. further development of models for middle and older adult life stages, differentiated by gender and ethnicity, is also needed. continued attention must be paid to the dissemination of updated life span theory development by social work educators, text writers, and researchers. 162 advances in social work the current status of resiliency theory in social work is that of an emerging theory; its main constructs are used more often than the entire, articulated theoretical framework, both in social work research and education, while frequency of practitioners’ use of this theory and its evidence base is unclear. since it represents an extension of more well-established life span theory and shares many of that theory’s strengths and acceptability for the profession, it is likely that resiliency theory will become more widely used in social work education the near future, as indicated by its use in at least two recently published texts in the human behavior in the social environment curriculum (greene, 2007; haight & taylor, 2007). the next steps for progression of this theory should include cross-sectional studies to elucidate applicability of the known protective mechanisms to young adult, middle adult, and older adult life stages, and to generational cohorts. cross-sectional and longitudinal studies are needed to examine the operation of protective and risk mechanisms for particular resilient outcomes, such as educational attainment, health disparities and perceived level of wellness, quality of life, and vocational achievement, to build on results of the most common, previously studied outcome of psychopathology versus mental wellness. qualitative and mixed methods research designs must be applied to extend theory development to diverse cultures and perceived operationalizations of resiliency within the lived experience of persons across the life span and across conditions of adversity. further discussion is needed in the literature to refine the operationalization of this theory’s constructs and models and to promote common usage of the same in research. articulation of practice applications of the theory, followed by empirical testing of related interventions, is necessary to integrate this theory into our understanding of human behavior in the social environment and to add to the evidence base for practice with populations in adversity. resiliency theory offers a rich opportunity for social work to refine evidencebased developmental theory for the vulnerable populations it is our unique privilege to serve. references beaudoin, t. 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(1998). perceived social support, disability status, and affect in college students. journal of college student psychotherapy, 13, 53-70. author’s note: address correspondence to: alexa smith-osborne, ph.d., assistant professor, the university of texas at arlington school of social work, 211 s. cooper, box 19129, arlington, tx 76019, usa. e-mail: alexaso@uta.edu. 168 advances in social work knowledge area module (kam) i intergenerational groups: rediscovering our legacy scott p. anstadt deb byster abstract: intergenerational groups are a community-based group concept designed to engage and mobilize often untapped resources of older adults in effective interaction with younger populations. these groups support an atmosphere of synergistic interaction. members of each generation share reflections on interpersonal strengths and capacities and rediscover emotional and spiritual anchors and bonding. illustrated here is community connections (cc), developed using the phase driven participatory culturespecific intervention model (pcsim; nastasi, moore & varjas, 2004) that included self selected local older adults, caregivers, and multicultural exchange students. the program was structured to offer mutual opportunities for activities built around exchanging cultural and life experiences. the goals were: 1) to reduce social isolation due to age, culture, or disability 2) for international students to practice english and learn about local cultural traditions, and 3) to build intergenerational ‘extended family’ relationships. keywords: intergenerational; community outreach; group; older adult; international students; multicultural introduction intergenerational groups connote the process of bridging beyond and moving across what is often perceived as barriers in relationships between generations. several studies support the benefits of systematically reducing self isolation for both older adults and other vulnerable populations and a strong and consistent social support system which is offered to the consumer (outreach) reduces the risk of inpatient medical and mental health hospital utilizations, chronic physical illnesses such as cardiovascular diseases, and the need for long term out of home placements (caplan, 2004; chan, kasper, black & rabins, 2003; ghose, williams & swindle, 2005; keyes, 2004; 2005; reynolds et al., 1997). the benefits of psychosocial contact in helping to prevent depression (e.g. kasen, cohen, chen & castille, 2003; russell & cutrona, 1991) and anxiety (e.g. fry, 2003) as well as improving overall quality of life (e.g., cohen & wills, 1985; house, landis & umberson, 1988; stanley, beck & zebb, 1998) have been well researched and documented. programs supplying these intergenerational social support services serve as ‘ice breakers’ which encourage the participants to venture out of their home more often to seek additional services such as pharmacological and/or psychosocial interventions, or to enjoy the companionship of others (health resources and services administration, 1993; korte & gupta, 1988; mistry, rosansky, mcguire, mcdermott & jarvik, 2001). common _________________ scott p. anstadt, ph.d, dcsw, lcsw, iabmcp, is an instructor in the division of social work, college of professional studies, florida gulf coast university, fort myers, fl. deb byster is a master’s candidate at walden university. copyright © 2009 advances in social work vol. 10 no. 1 (spring 2009), 39-50 anstadt, byster/intergenerational groups 40 common to all of these studies is that positive informal interactions and trustworthy companionship result in higher self-efficacy, feelings of well being, and self-esteem (bartels et al., 2002; bruce, van citters & bartels, 2005; cole & dendukuri, 2003; cuijpers, 1998). more specifically, this community-based group concept is designed to engage and mobilize the considerable and often untapped resources of the older adult population in effective and sharing interaction with targeted younger populations. the younger populations may consist of cohorts of various age ranges, i.e. toddlers, children, adolescents, or younger adults. the focus of activities and interactions is strength-based, leading to both recognition of what each generation can offer to a group activity and what each may learn in the process (university of pittsburgh, n.d.). transformation away from a negative thought framework is commandeered through the development of mutual appreciation of commonality and generativity at all ages. members become both mentors and learners alike in a holographic context whereby members solidify self concept through reciprocal positive regard. (mistry et al., 2001). the literature shows these groups to be primarily open-ended and based in a community setting such as daycare settings, schools, senior centers, houses of worship, and recreational centers. the structure and theoretical orientation of the group sets the stage for an atmosphere of synergistic interaction (yang & jackson, 1998); thus microcosmic development of a sense of community can be generalized to applications in everyday life. each generation looks at interpersonal strengths and capacities in a contrapuntal and harmonious discovery of ways to relate across a generation gap from which they may have previously felt cast adrift and segregated (ghose et al., 2005; keyes, 2004; 2005; reynolds et al., 1997). self-efficacy around having purpose and a place in humanity expands member perceptual, cognitive, spiritual, and social boundaries and offsets perceptions of aloneness, obsolescence, and self isolation. examples of activities include: a wellness education focus, caregiver supports, sharing vocational expertise and skills, life story reminiscence, parenting skill building (such as foster grandparents), tutoring school work, crafts, and volunteerism (seidel, smith, hafner & holme, 1992; vitaliano, 1995). using the medium of narrative self expression or ‘storytelling’ in its many natural forms, members come to appreciate and understand generational idiosyncrasies of expression around group tasks and reminiscent sharing, thus encouraging members to stretch themselves into a deeper appreciation of generational cultural diversity. mutual benefits are found in reducing age and culturally based stereotypes, building mutual respect, and increasing understanding of each other’s generations through ‘life story’ reminiscence and mentoring (kwan, love, ryff & essex 2003; laporte, 1999). a spiritual appreciation for all persons and accompanying lightness of mood in the group is often the product of this process (aranda, 1990). mutual assistance in both expressive and task oriented skill building can kindle faith, appreciation, and conviction in a common foundation for all humanity. cultural traditions and legacy can be passed on through positive reflective interaction and trustworthy companionship. such a cyclical mirror effect has lead to self evaluative ratings showing increased self-efficacy, sense of advances in social work, spring 2009, 10(1) 41 well being, and self-esteem (kwan et al., 2003; mcgowan, 1994; morris, 1984; raynes, 2003). in this regard, these community-based groups have primary and secondary prevention potential (health resources and services administration, 1993; korte & gupta, 1988). illustrative program – community connections community connections (cc) was launched in spring 2007 as a pilot program that included self-selected international exchange and multicultural students, self-selected older adults and caretakers, center for life experiences (a faith based community outreach program) staff, and community volunteers. cc was held every other friday beginning in the later afternoon and extending into the early evening. the program was structured to offer mutual opportunities for activities built around exchanging cultural and life experiences through the fine arts and small narrative story telling groups. it provided a “community” family style meal that included nutritionally healthy foods of both local and international cuisines. the goals of this community-based, intergenerational group program were : 1) to reduce the social isolation of older adults, caregivers, and international and multicultural students and offer them the opportunity to get out of a limited social environment due to age, culture, or confinement, caring for a family member or declining health, 2) to expand the opportunities for international and multicultural students to practice their english and learn more about local cultural and american traditions through interaction with community members in a social nonacademic setting, and 3) to build relationships between older adults needing to feel valued through sharing their life experiences and international students who are seeking the security of “extended family” relationships found in many of their cultures. background, rationale and significance of program framework cc was a community-based program, providing a gathering place for individuals to convene every other week. the first presbyterian church provided the space at no charge and placed no requirements on the cc groups. a room large enough to hold up to 100 participants had a kitchen for meal sharing. transportation through the generous support of the university was provided to the site for those unable to provide their own. the theme, structure of presentations and activities as well as the meal presentations were developed in monthly cc task force meetings. these were attended by representatives from a variety of community and university-based groups facilitated by a part time director of cc. the meeting lasted approximately three hours and included a culturally-based presentation and activity with participant involvement. this activity, as with so many culturally-based traditions, was an example of a universal theme with many counterparts throughout the world. dance and music was one such example. at various meetings, ethnic student and local resident groups would share their music and teach participants how to enjoy simple dance moves. cc participants may experience polka in one meeting, tai chi in another, and rap in yet a third. these presentations of universal themes anstadt, byster/intergenerational groups 42 illustrated through culturally-based activities provided a focus for conversation during a buffet style dinner enjoyed at small tables. here, for example, favorite music and dances participants do could be shared in dialogue. staff facilitators at these tables encouraged a narrative exchange of ideas. folks were encouraged to ‘tell their story’ about the universal theme. this rich sharing of past and present experiences encouraged deeper interaction where folks could relate to common themes, and emotions. this, according to many of the participants, seemed to help build continuing relationships. for example, many of the international students and older adults ‘adopted’ each other by keeping in touch by phone and regular visits. population groups served older adults 65 years of age and older represent the fastest growing segment of our population, about one half of which live below the federal poverty line, one out of three lives alone, and close to one half are disabled (national family caregivers association (2006). most older adults have traditionally relied upon informal support networks such as families which in recent years have been dwindling due to out-migration (u. s. census bureau, 2000; connelly, 2002; glasser et al., 2003; markello, 2002; mcdonald, 2001). caregivers of the older adults are also in need of social support, education, and social service coordination assistance. a recent research study conducted jointly by the national association of social workers and the new york academy of medicine (2008) described caregivers as the ‘sandwich generation’ referring to the stress related to taking care of and providing for both children and elderly parents (family caregiver alliance, 2006). international exchange students, through the local university international partners program, were a motivating force in the cc program. they came a long way to learn both the english language as used in fluid and colloquial conversation and the rich subtleties of a local u.s. culture. participation in local and down home activities within a helping context such as cc represented a very essential part of international students’ experience (barker & smith, 1996; harvey, 2007). targeted older adults, caregivers, and the multicultural students were somewhat isolated from the rest of the community; the older adults and caregivers by the physical conditions and limitations, and the students by their language skills and marginalized status in the predominantly european american community. program theoretical model the conception of the program started with a strong conviction in the strengths-based foundation of community-based outreach groups (carruthers, hood & parr, 2005). such a foundational approach allows application of a social exchange enhancement process designed to give isolated older adults, caregivers, and multicultural/international students in a rural community an opportunity to transcend their traditional social networks, and engage in a new and thought provoking interactive environment. the participatory culture-specific intervention model (pcsim), a community planning approach, was used in the inception and developmental phases of the cc advances in social work, spring 2009, 10(1) 43 intergenerational group program. pcsim is helpful in facilitating achievement of both individual and sociocultural (transcultural) goals related to the mental health of the participant generational groups. pcsim methodology provides an intervention model for translating mental health research into practice while incorporating the views of culturally diverse participants, providing a guideline for developing empirically based and culturally specific services (nastasi, moore & varjas, 2004). the following outlines with examples how this model was used in phase development of cc. phase 1: existing theory, research, and practice. the initial germ of an idea for cc came from students and staff at the university. this raised the question of what had been done in other communities where such a need existed. a literature review resulted. this lead to the selection of the pcsim approach as described here. nested within this approach is our integration of the values in action (peterson & seligman, 2003) framework of service to the community with reciprocal beneficial qualities. this is essentially a strength-based approach as applied to community action development using an adult education model of resident participation in building community capacity through organizing and networking local groups. phase 2: learning the culture. initial efforts concentrated on discovering what types of programs were currently being offered in the community which proactively addressed the mental health of older adults, caregivers and multicultural groups and whose aim was to strengthen diversity and multicultural acceptance. in addressing the multicultural aspects of the target populations, individuals with cultural expertise were approached to contribute to the early concept development of cc. the cc task force concluded there was a gap in services that could be provided simultaneously and in a synergistic manner to persons of various generations and cultural backgrounds. the university had its student international partnership organizations and the local community had various community-based groups including various houses of worship and the area agency on aging, but these groups had no activities in common and so remained segregated from each other. phase 3: forming partnerships. the cc program director assumed the responsibility of recruiting the cc task force with intention to fully involve community grass roots efforts. the participants of the task force were recruited through informal networking of key stakeholder groups in the community. these included community agencies, faithbased groups, community action groups, adult education, the university student coalition of groups, and the university administration. this allowed for publicity to be distributed throughout the community and a resulting growing buy-in of interest. for each of these groups, the extended commitment and involvement was negotiated. for example, a letter of support for the program’s development was secured from the university. this allowed cc to advertise on campus and to secure transportation through the university administration. phase 4: goal or problem identification. at the first task force meeting, findings of empirical research gathered in phases 1 and 2 were presented. agreement that the program was of benefit was solicited and received. discussion ensued regarding how each anstadt, byster/intergenerational groups 44 each team member’s expertise and interests could enhance the development of this program, and what efforts they could bring to the program to help ensure its success. an important part of this process is the continual refinement of consensus on the goals and general methods. it is in this identification phase that problem-solving skills were refined and normed. in this manner divergent ideas could be integrated. this process turned out to be as critical to the development of cc as the content of the cc meetings; it was the glue that held the whole project together. phase 5: formative research. additional constituent organization representatives were identified and encouraged to join the task force. some focus groups were formed in order to solicit feedback on potential cc activities to meet the primary goal of cultural sharing and enrichment within the community. for example, cc had a presentation on the universal theme of holiday celebrations featuring the chinese new year. for this to be truly meaningful, a focus group was formed headed by the chinese student association. the purpose was to explore amongst themselves what that holiday season really meant to them. they went on to speak to various other student and community groups to get a sense of which activities could have associated meaning for americans. phase 6: culture-specific theory or model. the culture-specific model was developed as a specific agenda item in task force planning meetings for each cc. based on targetspecific formative research such as used above, the considerations of why one method was chosen over another were refined. additional experts and stakeholders from the community were also identified to add further refinement where possible. for example, the preparation of the meals was done in an ethnic manner. however expert opinion had to be gleaned as to how various tastes and appetites might appreciate certain dishes. phase 7: program design (participatory generation). specific component activities for the groups were identified and began to take tangible form. this was a creative and at times frustrating phase with competing ideas that needed to be discussed and coalesced. it was necessary to form sub-committees and establish priorities. cc did not have the structure of programming described above at its inception. the format developed over time and with many intense and committed discussions of the task force. sticking with this process allowed the cc program structure to solidify. perhaps one of the most conscious group normative developmental aspects in all phases was the encouragement of all task force participants to feel welcome and appreciated for their contributions. phase 8: program implementation (natural adaptation). any proposed alterations in the program needed to be evaluated to ensure that enough was known about the shortcoming and determine whether a component could be enhanced (such as through training). since the cc task force was comprised of stakeholders, team building required continual affirmative buy-in to the cc program as it was evolving, including resolving subtle issues. one example involved the length of time for the cc meetings. since both young adults and older folks were involved, a balance of time and energy had to be found. the task force elicited comment from the participants and came up with the three-hour program. advances in social work, spring 2009, 10(1) 45 phase 9: program evaluation (essential changes and elements). in the development of the evaluation plan, we were careful to identify the goals stated at the project's inception, and to associate various stakeholders with each of those goals. by doing this, we were able to identify the appropriate parties to provide their estimation of the success of each goal as well as the overall program. pilot study data collection over the course of the first year and one-half of the cc program, a pilot study was conducted through the use of a simple four question satisfaction survey handed to the participants at the end of each meeting and completed before they left. the questions asked if participants felt the atmosphere welcomed social and cultural exchange provided an opportunity to meet new friends, share culturally based traditions and activities, and provided an opportunity for the international students to practice conversational english. collection included 400 student and 364 community participant surveys representing 69.6% of all participants who attended. students represented 21 nations with the highest number from china. the local older adult community ranged in age from 57 to 103. the data were used to give feedback to the task group as it was formulating and developing the cc program. the descriptive research question explored if cc provided an opportunity of positive social exchange, defined as creating a welcoming atmosphere, opportunity to meet potential friends, and share culturally based activities amongst younger and older adults from a variety of cultural backgrounds. results are shown in table 1. we plan to conduct interviews and focus groups with selected participants (and nonparticipants) to better understand their qualitative evaluation of the program or reasons for non-participation. it is hoped that our surveys in combination with these interviews and focus groups will provide data on which decisions may be made to monitor and improve the program in the future. anstadt, byster/intergenerational groups 46 table 1: percent of participants endorsing social exchange opportunities at community connections as a function of participant type social exchange items participant type welcoming atmosphere opportunity to meet friends cultural exchange practice conversational english international students 100% 96% 98% 97% older adults and caregivers 99% 98% 98% n/a intervention: program continuation or extension phase 10: capacity building (sustainability and institutionalization). the decisionmaking involvement of our stakeholders at every step has contributed to their sense of ownership, as well as their continued interest and involvement, and serves to empower them and sustain the program. as we are better known in the community, we have grown. donations and materials for the meetings are more available, allowing the programming to be more sophisticated. however, as new partnerships of support are developed, it is necessary to be creative concerning how the program can benefit them directly and to welcome the increased range of interest in program agenda. for example, a cc program on kwanza now involves not just the black student union but also several local religious and cultural organizations. its presentation involves a wide variety of traditions. phase 11: translation (dissemination and deployment). we do have plans in the near future to implement a next stage of the program which will involve group support for caregivers, as well as in-home visits as a vehicle for service learning experience for university students in the behavioral sciences (social work, counseling and psychology). these may include the gleaning of local oral histories. conclusion community connections, an intergenerational and multicultural strength-based community outreach group, used the application of pcsim throughout its development, implementation and ongoing evaluation. at each developmental phase of the pcsim model, a facilitated team-building approach sought out and honored the considerable input of various task force stakeholder groups to craft each cc community event. the task force has been a model of the intergenerational 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(1998). overcoming obstacles in providing mental health treatment to older adults: getting in the door. psychotherapy, 35, 498-505. http://www.helpstartshere.org/default.aspx?pageid=1342 http://factfinder.census.gov/servlet/gcttable?_bm=y&-context=gct&-ds_name=pep_2008_est&-mt_name=pep_2008_est_gctt1r_st2s&-context=gct&-tree_id=808&-redolog=true&-geo_id=04000us20&-format=st-2|st-2s&-_lang=en http://factfinder.census.gov/servlet/gcttable?_bm=y&-context=gct&-ds_name=pep_2008_est&-mt_name=pep_2008_est_gctt1r_st2s&-context=gct&-tree_id=808&-redolog=true&-geo_id=04000us20&-format=st-2|st-2s&-_lang=en http://factfinder.census.gov/servlet/gcttable?_bm=y&-context=gct&-ds_name=pep_2008_est&-mt_name=pep_2008_est_gctt1r_st2s&-context=gct&-tree_id=808&-redolog=true&-geo_id=04000us20&-format=st-2|st-2s&-_lang=en http://factfinder.census.gov/servlet/gcttable?_bm=y&-context=gct&-ds_name=pep_2008_est&-mt_name=pep_2008_est_gctt1r_st2s&-context=gct&-tree_id=808&-redolog=true&-geo_id=04000us20&-format=st-2|st-2s&-_lang=en http://www.gt.pitt.edu/ anstadt, byster/intergenerational groups 50 author’s note: address correspondence to: scott p. anstadt, ph.d., division of social work, college of professional studies, florida gulf coast university, fort myers, fl 33907. email: revscottaz@yahoo.com or sanstadt@fgcu.edu mailto:revscottaz@yahoo.com mailto:sanstadt@fgcu.edu introduction illustrative program – community connections background, rationale and significance of program framework population groups served program theoretical model pilot study data collection intervention: program continuation or extension conclusion references advances vol. 3, no. 1 46 african-americans and clinical trials research: recommendations for client engagement sharon e. moore wanda lott collins abstract: african-americans have, without their knowledge and consent, been used as human guinea pigs in scientific and medical experiments by private and governmental organizations. as a result many african-americans approach the health care industry with caution and apprehension. african-americans are admonished to remember the atrocities they once experienced and to approach participation in clinical studies with skepticism. this paper presents an historical overview of conspiracy theories, discusses various health issues that affect african-americans, identifies for whom participation in clinical trials could prove beneficial, and recommendsmethods that can be used to attract african-american clients as active participants in clinical studies. keywords: african-americans, conspiracy theories, clinical trials, research, patient rights many african-americans approach the health care industry and especially medical researchers with caution and apprehension. reese and ahern (1999) found that many african-americans fear they will “end up being a guinea pig in one of their experiments” (p. 554). various conspiracy theories contribute to their trepidation although not all of the common conspiracy theories are rooted in fact, some are. perhaps themost notable of these violations of human dignity occurred during the tuskegee syphilis study. during this united states public health service sponsored experiment, 107 of the 400menwhowere involveddiedbecause theywent untreated, even though penicillin had been proven to be effective in curing the disease (fairchild & bayer, 1999). they had been lured to participate in the experiment under the promise that they would receive free medical care to cure a variety of medical ailments fromwhich they suffered.tuskegee is symbolic of unjust practices of themedical community, unethical practices inhuman research, andgovernment mistreatment of african-american people. it has caused many african-americans to be suspicious of the medical and public health authorities and is a major factor in low participation among african-americans in human research (gamble, 1997). another incident of unethical research involving african-americans occurred in the 1970s. this well-publicized experiment was funded by the national institute sharon e. moore, ph.d. is associate professor andwanda lott collins, ph.d. is assistant professor at the raymond a. kent school of socialwork, university of louisville, louisville, kentucky. copyright© 2002 advances in socialworkvol. 3 no. 1 (spring 2002) 46-59. indiana university school of socialwork. of health. in that study, blood samples were taken without parental consent from 7,000 young, underprivileged boys from the baltimore area. they thought they were being tested for anemia (washington, 1994). in actuality, theywere screened to determine who among them had an extra “y” chromosome, under the assumption that individuals with an extra “y” chromosome were foreseeable criminal types. many of these young men were later labeled criminals. these are two of many examples of deceptive research practices that have contributed to the “healthy paranoia” that exists among many african-americans. the term healthy paranoia refers to a positive defense mechanism use by africanamericans in recognizing that racism exists and that white people must be approached cautiously until they prove that they are trustworthy (grier & cobbs, 1968). belief in conspiracy theories many of these theories assert negative actions by the government against africanamericans. turner (1993) indicates that theories of government conspiracy fall into twomain categories: malicious intent, in which the government purposefully causes or increases social problems with african-americans, and benign neglect, whereby the government takes a nonchalant attitude to addressing social problems. other concerns focus on contamination theories that maintain that efforts are made to harm the health of african-americans in various ways. pervasiveness of conspiracy beliefs in a survey of 2,000 african american residents from philadelphia and charlotte, north carolina, turner anddarity (1973) found that up to 62% of the respondents believed that the u.s. government was trying to decrease the african american population. parsons, simmons, shinhoster & kilburn (1999) conducted the first comprehensive empirical study of the beliefs of african-americans on a number of theories that asserted governmental wrong doings.they found that of the 1,104 african-americans questioned, most believed in conspiracy theories, particularly those involving government plots that target african-americans. more than half responded that the government directs genocidal efforts towards africanamericans. these beliefs are as common among africanamerican professionals as they are among nonprofessionals (parsons, et al., 1999). among the common conspiracy theories held by african-americans are that: 1. aids was developed by white scientists to be used as a form of africanamerican genocide (parsons, et al., 1999). 2. the national centers for disease control was involved in the atlanta child murders as part of an experiment to extract the cancer drug interferon from the tops of black boys’ penises (harris, 1996). 3. the ku klux klan has economic ties to troop sportswear, church’s fried chicken, and tropical fantasy fruit drink (turner, 1993). 4. illicit drugs are planted in the african-american community by the u.s. government for economic profit and as a form of racial genocide (parsons, et al., 1999; mcwhorter, 2000). 47moore, collins/african-americans and clinical trials research 48 5. the u.s. government purposefully investigates african-american elected officials in an effort to discredit them“in away it doesn’t dowithwhite officials” (ruffins, 1998, p. 27). 6. norplant implants are a mechanism to permanently sterilize africanamerican women (turner, 1993). 7. the sickle cell anemia screening program of the 1970s was a form of government directed genocide (wilkinson, 1974). the development of conspiracy theories what is known about these theories is that they began in response to the racism and mistreatment that african-americans suffered during slavery. the tuskegee study brought to light unethical research practices that had occurred for centuries. during slavery, both slaves and free african-americans were routinely exploited by the medical profession. their bodies were often used without consent for dissections andmedical experimentation (savitt, 1982). following emancipation, stories of “night doctors” were common in the african-american community. night doctor was the term applied to medical students who allegedly stole cadavers for training purposes and to professional thieves who sold living and dead africanamericans to doctors who used them formedical research. in 1882, it was exposed that african-american cemeteries were frequently pillaged by grave robbers who later sold the corpses to philadelphia medical schools (thomas & quinn, 1993). hence, conspiracy theories have become a part of the collective consciousness of african-americans and have been orally passed down through the informal grapevine for generations. many african-americans believe that that they are targeted for human experimentation because of their race. subsequently, many african-americans understandably approach the medical community with considerable apprehension. belief in these theories is not necessarily pathological. indeed, they may serve to solidify the community and move it toward social action. being encouraged to approach participation in research with skepticism and as a conscientious consumer is positive because it is empowering. alternatively, a negative consequence of this belief system is that africanamericans do not benefit from legitimate research in areas such as mental health and medicine (dhooper &moore, 2000). due in part to conspiracy beliefs, many african-americans delay or postpone seeking medical treatment, which often has dire consequences for them. numerous health problems disproportionately affect african-americans. effective treatment strategies for many of these conditions could be developed through clinical trials research that included african-american participants. health problems and african-americans there are approximately 35.5millionafrican-americans.they represent about 13% of theunitedstatespopulation (u.s.bureauof thecensus, 2001).onaverage,africanamericans live six fewer years thanwhites (thompson&chambers, 2000).nearly 75 million of all americans aged 12 and above report using illegal drugs at least once during their lifetimes (national institute ofdrugabuse, 1998). approximately 10%of these are african american. however, african-americans make up approximately advances in socialwork 36%ofu.s. citizenswhoaredrugdependent (national instituteofdrugabuse, 1998). african-american women, more than others, have disproportionately higher rates of death from diabetes, cancer, cardiovascular diseases, and breast cancer. they are alsomore likely to struggle are substance abuse, addiction,hiv, andaids. aids is now the leading cause of death among african-americanwomen between the ages of 25 and 44 years, representing a rate that is 12 times higher than that of their white counterparts (kumanyika,morssink&nestle, 2001; phillips, 1997,). generally, when they do present themselves for treatment, they are in more advanced stages of the disease and have more symptoms. cultural beliefs, such as conspiracy theories, coupled with socioeconomic variables are responsible for late diagnosis (kumanyika, morssink & nestle, 2001; raveis & siegel, 1998). gender specific problems african american men are 76 times more likely than white men to die of a stroke related to high blood pressure (dwyer, 1995).they havemore problemswith physical mobility after age 65 due to chronic diseases and have a 50% higher rate of prostate cancer than white males (herbert, hurley, olendzki, teas, et al., 1998; thompson & chambers, 2000). there are 2.8 million african-americans over the age of 65 (u.s. bureau of the census, 2000). although african-american elderly are living longer, they are more likely to be infirm, have chronic diseases at earlier ages, and be more physically limited in these illnesses (allen-kelsey, 1998). clinical trials are vital in health research and the development ofmedical knowledge. they are the measure by which new therapies are investigated. “they allow investigators to test biological hypothesis in living patients and they have the potential to change the standards of care” (davidoff, et al., 2001, p. 854). before 1994, most studies on the health of americans conducted through academic medical facilities using human subjects that were middle-class, white male, or married. african-americans were only minimally represented in these studies (flaskerud & nyamathi, 2000). when they did participate, they were sometimes injected with cancerous cells and cancer-producing substances, subjected to lobotomies, or injected with hazardousmaterials (dhooper &moore, 2000). as a result of limited, homogenous samples, research findings were sometimes erroneously generalized to the entire population without considering that cultural variables are important in diagnosing and treating health-related disorders in minority populations. additionally, african-americans are more susceptible to an increase in mortality and a decrease in quality of life when they are not included in health-intervention research. current controls that exist to minimize past abuses include the national research act of 1974, which was passed after the tuskegee study became public. this legislation established guidelines whereby all federally-funded research that involves human subjects requires prior approval from an institutional review board and a data monitoring committee that expeditiously identifies evidence of benefit or harm to research participants (lilford, braunholtz, edwards & stevens, 2001). other controls include the development of the patient’s bill of rights and the establishment of the national institute of health’s office of research on minority health in 1990.the office of research onminorityhealth oversees biomedical and behavioral research on underrepresented minorities (helmuth, 2000). even though these controls are in place, african-americans are still underrepresented 49moore, collins/african-americans and clinical trials research in clinical trials.what follows are suggestions for ways inwhich african-americans can be encouraged to participate in clinical research activities. prescriptions and implications for research lack of information, fear of experimentation, lack of familiarity with bureaucratic institutions, illiteracy, caregiver obligations, languagebarriers, and lackofbenefits are several hindrances to research participation (napoles-springer, grumbach, alexander&moreno-john,2000).thequestionthatbegsananswer ishowcanmedical, public health, and social science researchers attract african-american volunteers to participate in research studies. burrus, liburd, and burroughs (1998) document several strategies that can be useful in targeting and increasing african-americans participation in future public health research. they suggest 1) hiring a community organizer; 2) establishingacommunity advisoryboard; 3) soliciting community input; 4) schedulingpublicmeetings for formal and informal question andanswer sessions; 5) involving key african american personalities; and 6) including the black church. furthermore, they suggest approaches which can be used to eliminate barriers to participation and enhance trust among african-american research volunteers. those approaches focus on: 1) community engagement; 2) explanations of the “why” and the “what”; 3) purposeful community relationships; and 4) non-traditional, culturally sensitive communications. what follows is a discussion of how these approaches can be implemented. community engagement one strategy that can be used to maximize medical research participation among african-americans focuses on a model of community partnerships, which can be reflective of community needs, perspectives, and health priorities (napolesspringer, et al., 2000). there is agreement that community support is paramount in establishing credibility among researchers and minority groups (hatchett, holmes,duran&davis, 2000;mastin, 2000;witte,berkowitz, lillie&cameron,1998). burrus, et al. (1998) discuss the importance of informing the community about the proposed research to solicit their input. hiring a well-known and respected african-american health educator is another significant factor in organizing. equally important is the organizing of a community advisory board to serve as overseers for the community. its purpose is to question the process and to ensure that the community will not be exploited. the advisory board provides the research team with easier entry into the african-american community and reduces what can be a time intensive process. additionally, if at all possible, the research should be conducted in either the participants’ community or an environment where they are most at ease. furthermore, african-american recruiters or representatives who understand the task and can communicate the interest of both parties should be utilized. the black church is still the primary place where african-americans congregate to address cultural, economic, and social issues. the impact and important role of the black church in garnering and portraying the positive energy of africanamerican families is also recognized by mastin (2000) in her study of media use and civic participation in the african-american population. she wrote: 50 advances in socialwork the community church has long served as a facilitator of political action for african-americans. the african-american church enjoys a historical reputation of working to improve members’ socioeconomic and political conditions. unlike many social organizations that draw attention to social differences, often excluding individuals based on economic differences, many black churches do a good job of minimizing such differences. in short, the african-american church has been able to facilitate civic and political involvement among the economically diverse groups in the african-american community. (p. 117) in essence, mastin’s (2000) findings clearly indicate that interpersonal relationships and church involvement are strong predictors of civic participation among african-americans. this finding strongly suggests that including the black church as a key player in significant community events is a well-conceived strategic move for researchers. researchers have successfully approached african-american churches that have large memberships, to aid them in their mission to solicit african-american representation in public health studies (burrus, et al., 1998; hatchett, et al., 2000). however, researchers’ recruitment efforts must be more than superficial to maximize the availability of the church as a resource. it is not enough to make an announcement and request help. rather, individuals must be contacted and actively encouraged to participate (hatchett, et al., 2000). additionally, onsite informational meetings should be held with representatives of the church to explain the goals and objectives of the study and to answer questions. researchers would be wise to show sensitivity and take special care to address all questions to the satisfaction of potential participants with honest and forthright details. schoen (1999) proposes “giving investigators an opportunity to discuss their work with the public, through media interviews and community speaking engagements, canmotivate them to becomemore personally involved in the product’s trial, proving a compelling reason to prioritize it” (p. 52). another recommendation is to work closely with various community facilitators who have real and perceived positions of trust. these individuals can be recruited to encourage and lend an active voice for participation in research efforts. given their high visibility within the african-american community, their collaboration with the research teammay serve to enhance the validity of the study and heighten awareness regarding the importance of the study. in essence, they convey a seal of approval (hatchett, et al., 2000). rather than researchers representing themselves as the community authority, the power of “knowing” is maximized when shifted to the people. an often overlooked fact is that african-americans are weary of people who propose to know what is best for them (hatchett, et al., 2000). within the african-american community are resources, insights, and knowledge that are unknown to social science professionals (saleeby, 1996). in defining the role of “expert” or “professional,” saleeby (1996) indicates that “a helper may best be identified as a collaborator or consultant: an individual clearly presumed, because of specialized education and experience, to know some things and to have some tools at ready but definitely not the only one in the situation to have relevant, even esoteric knowledge and understanding” (p.14). rather than operate from concealed and predetermined agen51moore, collins/african-americans and clinical trials research das, researchers should consider a paradigm shift that allows african-americans to define their needs andhealth priorities.the community engagementmodel utilizes a “village” approach to inquiry and problem solving. explaining the “why” and the “what” medical research campaigns must provide clear and understandable information to potential participants. because of past experiences, african-americans often feel justified in their negative perceptions and feelings of unfair treatment. therefore, participants must clearly and truthfully be told the “why” as well as the “what” of their involvement in all verbal and written presentations. croyle (1998) advises that researchers “make sure that what subjects are being told is consistent across the trial’s stages–recruitment, consent and education, randomization and intervention–and across trial staff members” (p. 495). research participants who received limited information decreased their participation. conversely, when researchers provided people with detailed information concerning the nature of the research, the benefits, and research opportunities, recruitment results in ethnic populations were enhanced (napoles-springer, et al., 2000). target advertisements placed in newspapers and publications to recruit participants often emphasize the benefits of the trials without mentioning the risks. this is an identified concern and may raise questions about participants’ level of understanding regarding what they are reading and subsequently signing. “cash payments and other incentives are commonplace in medical research. but they are offered as compensation for a person’s time, not as a fee for accepting risk. when you see an emphasis on cash payments and benefits, and little or no mention of risks, that’s a real concern” (weiss, 1998, p.a05). napoles-springer, et al. (2000) found that respondents sometimes subjected themselves to potentially harmful research and exploitation out of their dire need for money. according to napoles-springer, et al. (2000) african-americans greatly value scientific knowledge that will improve their quality of life. additionally, if concerns are openly addressed, barriers to participation are reduced, and if tangible benefits of participation could be accrued by their communities, their interest in scientific knowledge will likely increase. hatchett, et al. (2000) found that the failure of african-americans to participate in researchwas not solely due to the legacy of the tuskegee experiment but because they were not approached to be involved. some african-americans feel that researchers take information and ideas about africanamericans out to the majority community without caring that those under study receive any significant or substantial benefit. in essence, some african-americans feel that they are exploited or that researchers do not give back to their community (napoles-springer, et al., 2000). the willingness of african-americans to participate in research seems strongly linked to whether or not the research has positive benefits and if participants are informed of the outcomes. purposeful community relationships leo j. o’donovan (1998) describes trust as “being vulnerable and taking a risk—a leap of confidence—sometimes without any evidence that you will land on your feet” (p. 178). he emphasizes that the heart of a professional relationship is trust. for example, “we trust scientists and researchers will give us the right information 52 advances in socialwork as we care for our aging bodies. we don’t question how exactly tylenol or the inderol we take works; we trust the medication to work—we trust the science behind it” (p. 180). yet, the biggest obstacle to clinical trial recruitment is public wariness (schoen, 1999). participants need researchers that are reliable and trustworthy. a paradigm shift in public health and medical research necessitates that research volunteers are informed of the true state of their health and given full explanations about the benefits or dangers of any research intervention (jennings, 1998). only then can researchers begin to engender trust and recruit africanamerican participants. mistrust is real and it is serious. are’an and gallagherthompson (cited in hatchett, et al., 2000, p. 667) found that during recruitment efforts with olderminority adults, “researchers’ willingness to address specific topics of interests created an attitude of trust.” informed consent informed consent is, of course, related to the issue of trust. bioethicist arthur l. caplan suggests that informed consent represents a moral challenge to researchers. research participants should always have access to second opinions from experts who do not stand to gain from the outcome of the study (jennings, 1998).the national association of social workers’ code of ethics addresses informed consent by prescribing that clientsmust be informed in clear andunderstandable language regarding purpose, risks, and limits of services, relevant costs, alternative to treatment, and the right to ask questions or to refuse or withdraw their consent for treatment (linzer, 1999; nasw, 1996, 1.03). informed consent originated in themedical field as amechanism for patients to receive detailed and pertinent information about medical procedures and their potential benefits and risks (dunn, 2000; linzer, 1999). linzer (1999) indicates that social work practice includes a burden for informed consent that extends far beyond superficial efforts. informed consent extends beyond obtaining signed release forms granting access to confidential information (kutchins, 1991). this legal and ethical duty entails providing clients with full disclosure relative to all service or treatment areas, which can have an impact on the client’s right to voluntarily participate or decline participation. therefore, it cannot be assumed that participants have given their full consent to participate in research studies until they receive full disclosure of all relevant information related to their participation. in cases where volunteers need support or assurance, croyle (1998) advises involving family members in the informed consent process and recommends strategies for clarity in the consent process including the use of: 1. various font sizes, subheadings, and bullets in the consent form instead of long unbroken text; 2. printed materials as a backup, but with preference given to oral and aural communications to explain information; or 3. cd-rom or audio tape presentations with the information to enhance volunteer understanding (p. 495). 53moore, collins/african-americans and clinical trials research 54 non-traditional culturally sensitive communications traditional generic approaches to the promotion of medical research projects often prove to be ineffective (mastin, 2000). empirical evidence suggests that those with lower socioeconomic status and ethnically diverse populations appear to respond less to traditional recruitment methods (mastin, 2000; napoles-springer, et al., 2000; witte, et al., 1998). non-traditional, culturally-sensitive communications that include the use of interpersonal networks (such as social gathering places, the black church, neighborhood organizations, beauty salons, barbershops) and african-american celebrities to bring important public health information to the african-american community should be adopted (mastin, 2000; napoles-springer, et al., 2000;witte, et al., 1998). in an effort to protect billions of investment dollars slated for new drugs, pharmaceutical companies are scrambling to recruit clinical participants for drug trials. many of the newer drugs will offer cures for or better management of conditions such as high blood pressure, diabetes, aids, cancer, and cardiovascular disease.to shift the negative perception about clinical trials, the pharmaceutical industry must recognize the need for relevant community campaigns. schoen (1999) indicates, “with all the pressure to implement trials and submit results quickly, companies sometimes treat effective communications as an after-thought, rather than a key strategic tool” (p. 51). schoen further suggests providing videos, brochures, and other information to clinical sites in order to raise the level of awareness among african-americans about disease. the readability of written materials may also affect recruitment. volunteers are not likely to risk embarrassment if they are semi-literate. rather than succumb to shame and humiliation, it is sometimes a natural response to decline involvement in an activity in order to save face. advertisements and other forms of promotional communications such as brochures, pamphlets, posters, letters, flyers, and banners have been proven more effective when written at fifth or sixth grade literacy levels (burrus, et al., 1998). according to fackelmann (1998), “about 90 million adults in theunited states have literacy skills rankingbelow7th grade” (p. 15).therefore, the readability level of written communication is an important consideration. summary of recommendations participation in research efforts by african-american populations may be enhanced through a strengths-based and empowerment framework (blundo, 2001; brun & rapp, 2001; early, 2001; saleeby, 1996; turner, 2001). the strengthsbased perspective is an empowerment approach that focuses on the strengths of individuals, families, and communities, rather than problems or pathology. saleeby (1996) points out that the strengths approach requires an accounting of what people know and what they can do (p. 297). in a strengths approach, practitionersmust engage individuals, families, and communities as equals. “theymust be willing tomeet clients eye to eye and to engage in dialogue and amutual sharing of knowledge, tools, concerns, aspirations, and respect” (p. 303). saleeby’s perspective provides an explanatory framework that highlights that when communities are providedwith information, resources, and support, helpers aswell as community residents are likely to benefit. the principles that saleeby (1996) believes particularly important to the strengths/empowerment perspective are: 1) language—the practice of using words to elevate or to lift and inspire; 2) empowerment—the process of assisting people to discover and to use the resources and tools within and around them; 3) resilience—the recognition that in spite of adversity, people accumulate skills, abilities, knowledge, and insight; 4) membership— the idea of valuing individuals as part of a viable group or community; 5) health and wellness—the belief that people’s innate resilience and knowledge can be used to help them overcome trauma and embrace community vitality; and 6) beliefs and emotions—the concept that personal health and emotions in the context of daily living can transcend to community health. recommendations for client engagement a strengths-based empowerment perspective may be used as a foundation for researchers who hope to engage african-americans in clinical trials or public health research. recommended strategies include the following: 1. approach african-americans from an empowerment perspective, believing that they can provide and interpret relevant information about their needs and priorities and can offer their expertise to researchers. 2. assume that african-americans want to be included in relevant research and that because of the unequal distribution of power, opportunities, rights, and responsibilities, their voices often go unheard. 3. convey a sense of reciprocity. expect to receive ideas and cooperation and also expect to give something of value back to the community (e.g., briefings regarding the research outcomes, an ongoing community presence, donations to related causes, technical or professional assistance with identified concerns or requests for specific help, and so forth). in other words, avoid a one-way dynamic and being invisible until something is needed. 4. honor the fiduciary relations. on a continuous basis, inform potential research volunteers of specific risks and benefits. 5. protect research volunteers. it is imperative that researchers are reliable and trustworthy. 6. increase the visibility of african-american researchers as well as african-american personalities within the community in all phases of research. 7. create public forumswithin theafrican-american community in familiar and comfortable environments, where honest dialog about the nature of the research can occur. 8. include representatives of the religious community in significant ways. 9. maintain candid and regular dialogue and a willingness to listen to, instruct, and reassure participants. 10.ensure that all written communications are compatible with the educational level of the participants. 55moore, collins/african-americans and clinical trials research 11.identify places within the african-american community (such as churches, laundromats, beauty salons, barbershops, and social organizations) that would be promising places to recruit, distribute information, and educate the community about research campaigns. implications for socialwork education the strengths-based empowerment perspective has implications and application for a broad range of professionals, including social work educators. “historically, the social sciences, which includes the profession of social work, have negatively stereotyped african-americans andmost american social institutions have related to african-americans from a white anglo middle-class orientation” (dhooper & moore, 2001, p. 123). additionally, traditional social work curriculum has focused on disempowerment, deficits (problem focus), individual disorders, and/or pathology (blundo, 2001; saleeby, 1997). similarly, a large percentage of agency field practicums followed a diagnosis and problem-focused orientation. themedical or pathology model was therefore reinforced for students in schools and in agency settings. the shift towards embracing clients’ strengths, individually and collectively, means acknowledging that clients’ are the best authorities in defining their tribulations. this is a transformational evolvement in social work education and practice. as social workers assist individuals and communities, they are challenged to use conceptual lenses that allow them to visualize people’s hopes and dreams, based on their assets and strengths. brueggemann (2002) asserts that: people who experience injustice, intolerance, or economic or political oppression need to define their own issues on their own terms, regardless of the size of their group, their influence, their perception, or the approval of the majority of the population.when the influential usurp their right, they not only steal people’s humanity but assume that people in the mass are incapable of understanding their own social situation; they exclude people from the process of making their own lives better. (p.43) blundo (2001) underscores this point of view and asserts that “the strengths perspective offers the profession an opportunity to change frames and to collaborate with individuals, families, and communities in a more egalitarian working relationship based upon their strengths and resilience” (p. 301). in social work practice, the use of the strengths and empowerment perspective with families can aid practitioners in identifying strengths to build on. they also increase their ability to gain knowledge regarding desired outcomes and clarity regarding what families want to achieve andunderwhat conditions.thismodel relegates the“expert” from the position of “all-knowing” to a more equal position of partnering. clients are positioned to share power, which permits them to demonstrate their strengths and resilience in a collaborative environment. in essence, this framework then prepares social workers to teach and to be taught. conclusion the inadequate participation of african-americans in research studies suggests implications that may negatively impact the understanding of health and social 56 factors among this population. the challenge for researchers is to be more aware of how socioeconomic factors and racism may discourage african-americans from participating in valuable research. in particular, social scientists need to be aware that fear, past medical and government practices, mistrust, and a lack of knowledge about bureaucratic practices are primary reasons that africanamericans do not participate in research studies. equally important is an understanding that mistrust of research is pervasive among african-americans. therefore, it seems reasonable to suggest that more concerted efforts to engage minority researchers, to address perceived and real barriers, and to improve awareness of racial and ethnic disparities would increase the level of african american participants in legitimate research studies. a strengths-based and empowerment approach allows individuals, families, communities, researchers, and other “helpers” to become co-participants with african-americans to discover the power within themselves and to develop consensus in working as change agents. references allen-kelsey, g.j. 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(1998). radon awareness and reduction campaigns for african-americans: a theoretically based evaluation.health education and behavior, 25(3), 284-303. author’s note: address correspondence to: sharon e. moore, ph.d., raymond a. kent school of social work, university of louisville, louisville, ky 40292 usa. e-mail: semoor02@gwise.louisville.edu. 59moore, collins/african-americans and clinical trials research microsoft word anstadt et al final _________________  scott anstadt, ph.d., is an assistant professor, and ashley burnette and shannon bradley are msw concentration year students, all in the division of social work at florida gulf coast university in fort myers. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 289-300 towards a research agenda for social work practice in virtual worlds scott anstadt ashley burnette shannon bradley abstract: due to the unique applications of virtual reality in many modern contexts, second life (sl) offers inimitable opportunities for research and exploration. a review of current research regarding sl has examined the influence of real world social influences in online interactions and what the effects on users may be. this suggests the importance of developing an understanding of the relationship between users’ real life and their second life, and how the two are related. some research has begun to reveal the effectiveness of telecommunication and computer simulation with certain clients in the fields of mental health and social work, yet there is a lack of sufficient research done within the context of virtual worlds. the implications for social work intervention in virtual reality could solve persistent concerns with transportation, distance, access to services and education, however questions about the relevance of social work practice in sl and the potential for implementation must be answered. keywords: social work, virtual world, second life introduction humans as social beings have been inventing ways to improve communication for hundreds of years; from letters to the telephone, from pagers to the cell phone, from email to video conference, and in the last ten years communication technology has taken a giant leap from the internet to computer simulation and virtual reality. the online virtual worlds of massively multi-user role play games (mmo-rpgs) are a new wave of interaction and offer to the discerning user a complete immersion in the social experience that transcends distance, language, and even the cultural mores of any given society. users can plug in anywhere and immediately begin interacting, playing, creating and chatting with other users without regard to their geographic location or even their physical appearance. time has no meaning in these virtual worlds, and the imagination is the limit as players learn the unique language and culture of this online universe. mmorpgs, or just rpgs as they are known by veteran players, can range from high-resolution action packed gaming, like world of warcraft, to intricately stylized virtual landscapes where users can gather for social networking, such as free realm, there, and second life (wood, 2009). imagine being able to enter a multifaceted world with seemingly unlimited opportunities of experience, in which one can create a completely virtual lifestyle, where one’s activities are only limited by the creativity of one’s inquiry. here one can learn to easily navigate through an array of experiences often beyond the reach of one’s real life means. second life is a place where a group can be composed of people who are sitting in their homes located half a world away from each other, where persons who have a advances in social work, fall 2011, 12(2) 290  real-life physical limitation can dance all night, where one can appear and disappear in an instant and one’s place of origin cannot be traced by anyone around, where people can control who sees and talks to them and where one can even disengage entirely from the virtual world at will. boellstorf (2008) states “second life is a chance to be someone beside yourself, which you can’t really do in real life unless you want to lead a double life” (p. 208). this is the beginning of one’s second life. second life (sl) was created by linden labs in 2003 as an online 3d virtual world where people can create “avatars” to interact within the environment and with other avatars (or “avs” as they are frequently known), not only for gaming, but more often for social contact, education, romance, industry, and hundreds of other activities which users can themselves create within the sl metaverse. second life is unique in that residents can create and change the virtual landscape by building houses or structures, buying land and adapting their environment to suit their individual needs and desires (mcintosh, 2008). individuals create avs as virtual representations of their real physical self, and though sometimes these are not accurate representations of their true appearance, the avs serve to navigate the virtual simulators (“sims”) in place of their human creators. unlike in real life (rl), sl avatars can transcend the physical boundaries of mere mortals and take the form of humans, animals, computers, mythical creatures, or even as “furries,” which are identified as hybrids of any of these forms (bell, castranova, & wagner, 2009). perhaps because there are no real social limits imposed upon the users of sl, it has become a hub of interaction for nearly 15 million users worldwide (gottschalk, 2010). of those users, there are hundreds of groups who participate in anything from genderbending avatars, artist guilds, and university students to vampire cults and warring factions of mystical elves. in the presence of the ever-expanding world of virtual reality and computer mediated interaction, it seems as though there is a place for everyone. even, perhaps, for social workers. however, it is important to remember that, as with all forms of technological advancement, there is a considerable learning curve. in the years since its inception, sl has seen numerous upgrades which have made it easier to use, but new users must still navigate sometimes unfamiliar, and impossibly vast, territory. many sl groups include tutorials for new users on their sims and sl itself has an island dedicated to an orientation of the virtual world. even these thorough classes are sometimes not enough, however, to help “newbies” become completely comfortable using the technology. at the most basic level this means understanding what a “teleport” is and how to use it, how to move between sims, join groups, and individualize the basic avatar given upon registering to use sl. as one becomes more immersed in sl, this means learning which groups one wants to join and which groups one would rather avoid, investing dollars for lindens (sl currency) to purchase “land,” and taking classes to begin building one’s own second home, along with other virtually endless activities. this can be an overwhelming process for new users, and sometimes this can even deter users from becoming permanent members of sl. this is one consideration that professionals, including social workers, who are looking to make an entrance into this new medium, must be aware of, for themselves and also for potential clients. anstadt, burnette, bradley/social work practice in virtual worlds 291      social workers often face barriers to service which include distance from clients, time constraints, transportation, and access to services. the virtual world offers a potential solution to many of these barriers. however, the vast expanse of the “metaverse” (internet universe of virtual reality) is still in its infancy, and little research has been done that can conclusively determine the users’ expectations of involvement in the virtual world. one of the many questions that remain unanswered is that of the relationship between users’ virtual lives and their real lives. for instance, researchers in the field of virtual communications have questioned just how strong the influence of social mores, norms and laws are in internet-based virtual realities like second life, and what role accepted institutions such as education play in online interaction and learning (boelstorff, 2008; eastwick & gardner, 2009; parti, 2008). understanding, or at least uncovering, the answers to these and other questions could help to determine the potential for using sl as an educational intervention tool and reveal just how the social work profession can exploit this venue for client-centered interventions. a review of the literature leads to exploration of relations between the real lives of users and their lives “inworld” (being actively signed in to second life), which might suggest the presence of a significant influence of users’ real life on the way they conduct their lives inworld. other questions we suggest concern the associations between what initially brings users to sl, what they do once they are there, and how or why this changes over time. with this information, research in the field of social work can further expand on relevant knowledge about virtual worlds. from there we can begin to explore and predict what role social work practice has in the virtual realm, and whether it could be executed as an effective form of intervention and service delivery. for example, many young adults struggle to come to terms with their sexuality in a society where homosexuality and transgender assimilation is viewed with derision and condemnation. their real life experiences might prompt them to join sl where using a “genderswapped” avatar is completely appropriate and accepted. in turn, these young adults can interact with other individuals with similar experiences and interests. this begs the question: could the inception of an inworld support group directed by a social worker be beneficial in creating a positive experience for this vulnerable population? other groups that meet in sl, and even those individuals who have not yet discovered this online resource, could benefit from similar support systems. this includes individuals without transportation to an agency or facility, individuals with disabilities, or those whose social interaction is limited due to personal illness or caregiver responsibilities. with second life, there is unlimited potential for these individuals to open the doors to a huge social network of support and assistance, just by accessing a computer. using online virtual communication, social workers could reach a larger population of individuals and more diverse groups. and because online meetings can take place at anytime from anywhere, there is a better opportunity for social workers to contact clients and monitor progress. this medium also has the potential to change the face of education for social workers, whether in the classroom or in the field, which could enhance learning and practice skills. advances in social work, fall 2011, 12(2) 292  technology and social work the potential for telecommunication as a method for medical, mental health, and social work practice and intervention has been a topic of research since before many of the modern rpg’s were launched to the masses. mccarty and clancy (2002) discuss the potential for “telehealth” technology in social work, asserting that care in mental health was the first telecommunication application used in social work. internet-based teleconference and videoconference have been established methods of effective communication and treatment for patients of psychiatrists, mental health professionals, and social workers. the authors support the use of online counseling in social work for a number of reasons, including as a solution to barriers of distance and time, as a way of recording client-worker interactions electronically, and even in some cases as a way to enhance personal empowerment of the client, because the physical interaction has been removed, leaving only the verbal, and not face-to-face, communication. however, some disadvantages remain, including confidentiality, informed consent, and liability issues, as well as the lack of non-verbal communication which many practitioners believe to be an integral part of the client-worker relationship (mccarty & clancy, 2002). still, the benefits may outweigh the barriers as redesigning the mental health delivery system could mean better intervention results, agency cost reduction, improved documentation and even distance home visits and employee/intern supervision. however, while telecommunication has been supported through research as a viable means of intervention and social work service, little has been done to determine whether online virtual reality realms are an equally effective tool. therefore, it is important to consider other types of technology-based programs that have been used effectively in social work. a recent study by smokowski and hartung (2003) analyzed current research on computer simulation games and virtual reality interaction in school social work programs for adolescents and determined that there was a significant improvement in social, behavioral, and problem-solving skills among the participants. they conclude that computer simulation and virtual reality-based interventions, used as a supplement to interpersonal interaction in small groups of adolescents, was an effective tool for school social workers to help the students reach their goals, despite certain barriers, such as access to this technology. further research in this area is necessary to determine how to implement these programs in schools and develop successful applications for agespecific, population-specific, and skill-specific interventions. if virtual reality communication interfaces can be implemented and have a significant effect on the outcome of therapy in settings such as school social work, the potential for applications of social work using online metaverses like sl could be great. the challenge in determining the potential effectiveness of this new generation of service is in understanding the various contributing factors and how they might impact the practice of social work in sl. one such factor is the willingness of individuals to participate in online counseling or support groups directed or sponsored by a social worker or mental health professional. tsan and day (2007) attempted to determine whether or not variables such as personality and gender can function as predictors of who will seek out or use online counseling in chat rooms with no face-to-face interactions. the findings of the study suggest that females were more likely to accept online services as a means of anstadt, burnette, bradley/social work practice in virtual worlds 293      counseling and only the extroverted personality type was accepting of online counseling services, however even the statistical significance of this particular finding was not strong. most respondents rated face-to-face services above those of online services (tsan & day, 2007). these findings must be considered for future research should social work interventions in virtual worlds become a viable option, though explosive technological advancements will certainly have an effect on clients’ willingness to participate in online counseling and group sessions. using the technology acceptance model (tam) to test several hypotheses based on participants’ performance expectancy, effort expectancy, and social influence on use of technology in virtual worlds, fetscherin and lattemann (2008) found that “the possibility to interact in a 3d environment in combination with voice over ip plays a pivotal role in user acceptance and technology adoption of virtual worlds” (p. 240). the results reveal that perceived value of communication, or the benefit the users felt could be attained, was more important to participants than perceived usefulness, or how able the users felt they were to learn and use the communication medium. this implies that the visual nature of the avatars as well as the voice technology present in metaverses like second life could have a large impact on whether individuals are accepting of online counseling services and find them effective. the findings of the study also suggest that social norms, as well as socio-demographics and the individual’s existing attitude toward technology, have an impact on user acceptance of technology (fetscherin & lattemann, 2008). therefore, the potential influence of these technology characteristics in sl and similar virtual worlds may indeed play a role in determining the presence and usefulness of social work interventions for users in the future. real life and virtual world influences much of the body of research emerging on this subject elicits excitement about the potential for sl as a new frontier for social workers to provide services to clients. consequently, it is imperative that factors such as social influences in virtual worlds and the characteristics and behavior of sl users must be explored. studies on the emerging world of rpgs and computer-mediated communication have centered on how real life (rl) social influences play a role in sl interactions, behaviors, and even the unique culture, language and etiquette rules present inworld. eastwick and gardner (2009) conducted a series of randomized controlled trials in second life in order to test an hypothesis that real-world social influence would be present inworld and that participants would display behaviors associated with racial prejudice. in order to test the presence of social influence inworld, researchers used a specific series of behaviors that induce a change in the action of an individual in real life, known as compliance techniques. racial prejudice was targeted using both an african american avatar and a caucasian avatar. the data gathered supported their hypotheses, revealing the social influence of the compliance techniques had an effect on the avatar-participants (presumed to be their human creators) and that they were more likely to respond with compliance to the caucasian avatar than to the african american avatar. these findings suggest the importance of gathering exploratory data on users’ rl and sl interactions so that any associations may be identified for use in further studies. advances in social work, fall 2011, 12(2) 294  with the strong likelihood that real social influences are present within the virtual world of sl, social workers can begin to explore how rl influences the creation of the sl experience and how this may be related to the real lives of sl users. however, there is some evidence that other social influences are absent within the virtual walls of second life and rpgs like it, which could have an impact on the implementation and effectiveness of social work interventions executed inworld. parti (2008) explores how the relative freedom of expression and creation inworld can both enhance and degrade real-world social mores. the author discusses the implications of social construction in virtual reality and how this relates to the legal system in the real physical world. bell et al. (2009) comment that there is a complete lack of government jurisdiction over virtual worlds as they, like the internet, are not a part of any country on earth and, therefore, do not fall under the typical auspices of the law. parti (2008) questions the integrity of the individual’s real personality as she/he continues to become immersed in virtual reality, even perhaps eroding without the user’s knowledge, as she/he places more attention, time, and energy into sl communications. because virtual reality is a replica of reality, and one highly guided by imagination and illusion, it is difficult to know how strongly traditional social moral-ethical norms apply inworld. in her meta-analysis of several qualitative case studies done on users of rpgs and muds (role play games and multi-user domains/dungeons), parti (2008) illuminates several examples of how the user dissociates from her/his avatar and considers the avatar to have a different personality, one that is enhanced, perfected, and capable of far more than the user her/himself. in doing so, belief in one’s own ability to perform these activities and interpersonal interactions deteriorates, and she/he experiences a de-empowerment of self. because the user does not identify with the avatar self, she/he does not necessarily feel satisfaction or a sense of success when the avatar succeeds, and she/he does not carry acquired social skills into rl interactions (parti, 2008). additional concerns include social learning and community mentality which can affect a moral attitude change and encourage negative deviant behavior such as computer hacking. this affects the population of children and adolescents most significantly, and teaches negative skills and behaviors that could carry into their real life future. this information carries serious implications for social work practice in rpgs such as second life. the role of the social worker in sl will need to be diverse and flexible, with social workers acting as counselors as well as advocates, and adapting guidelines for confidentiality and legality without detracting from ethical service. knowing the social and psychological barriers to service can help social workers to anticipate, and be prepared to address, the needs of their clients. furthermore, understanding who is most likely to use sl and in what capacities they use it will help to define the methods through which these individuals can be reached and helped. real life and second life relationships but what, if any, relationships exist between the individual in real life and the avatar in second life? whether or not any associations can be made between the actions of the one and the same user-avatar can be determined with further research in this area. with this knowledge as a foundation, further predictions based on the user-avatar relationship anstadt, burnette, bradley/social work practice in virtual worlds 295      can be made and implications for social work interventions explored. in a related study, belisle and bodur (2010) attempted to determine if personality types of sl users could be perceived by observing their avatar. they conducted a study in which 103 sl users sent in a picture of their avatar and filled out a questionnaire about their participation, personality traits and socio-demographic information. then, seven separate participants were asked to predict personality characteristics of the real person by looking at their avatar. these seven participants were selected on the basis of their high level of experience with sl and also filled out an online questionnaire. the findings of the study suggest that certain physical characteristics of avatars serve as cues to form impressions of the real personality of their creator, and that experienced users can form accurate impressions (belisle & bodur, 2010). the study also revealed an inverse relationship between some avatar characteristics and the demographic information of the creator. taking this information into account, it is conceivable that social workers could attempt counseling and group work with avatars as representations of clients. however, they would need to develop a high level of skill and experience with second life and develop an understanding of the real life circumstances of sl users. stalker (2007) predicted that in the real world social role diversity is determined by several factors that can affect the number of social roles of an individual, the strength of her/his social network, her/his adaptability to life circumstances, and her/his overall level of well-being. additionally, characteristics affect an individual’s opportunities as well as create barriers to reaching fulfilling interpersonal engagement. these barriers include social context, patterns of employment, and the amount of time spent engaging in pleasurable activities. through time-diary collection of data, stalker (2007) determined that role diversity was positively affected by marital status, the presence of children, employment, and gender. subsequently, the level of interpersonal engagement and the strength of the social support network of the individual were positively affected by these factors. ultimately, a less diverse social role resulted in a smaller social network, less time spent interacting and communicating with others, and weakened resiliency to varying life circumstances. in light of these findings, the consideration of social work practice within virtual reality must include an understanding of the relationship of the rl user to her/his sl avatar. research focusing on the relationship between the user’s ability to manipulate the physical appearance of her/his avatar, or change demographic information, and the level of effective communication attained between client and social worker could begin to uncover ways in which to equip the social worker to make assumptions about the user/client. in coming to an understanding about the potential motivations that bring users to sl, and how this could relate to the user’s real life, social workers can begin to formulate treatment options. for instance, an individual without a high degree of role diversity might be motivated to join sl to seek out interactions and a social network, and the reasons for limited role diversity could be an ongoing illness in the family or disability. this supports the need for a social work intervention that could potentially take place within second life itself. further research in the form of qualitative data analysis could examine the existence of a relationship similar to the one in this situation and advances in social work, fall 2011, 12(2) 296  provide an insight into the role of social work interventions in virtual reality-based communication. the impact of certain demographic factors on interactions within virtual worlds was explored by isabella (2007) in a study conducted to determine how ethnographic differences between players of muds (“multiple user domains”) might change their interactions and communication. the study was based on the assumption that online communities mirror to some extent their real-world counterparts. through covert and participant observation in two muds that were relatively isolated to two precise regions, one in italy and the other in canada, isabella (2007) first recorded group interactions before engaging players, and then proceeded to join a group of players and record interactions from within the group. her results indicated that there were certain differences in the communication and community engagement styles of each region. in the italian mud, with little effort, the researcher was able to observe covertly before engaging in the groups. after disclosing her identity and real motivations, the players did not seem to change their impressions of, or interactions with, her. however, in the canadian mud, the researcher had difficulty joining a group after her initial observations, and it was only when she disclosed her purpose to the leader of a group, and the leader informed all of the players that she was a researcher and needed their participation, that she was able to collect any data. these results indicate that the physical contexts of the users may have an influence on their attitude and the games that they play. evidence supports that there are indeed differences in the culture and communication of users from different demographic backgrounds, although the full extent of these influences has not been explored. additionally, the social context of the virtual world itself must be considered as its own entity and as a unique culture separate from that of the real-world culture. in gathering data on second life through participant observation, gottschalk (2010) discovered both a blurring of and a separation between the real lives of the users/avatars he interviewed and their life on sl. gottschalk (2010) also illuminates that while users can have many avatars that look nothing like them, they communicate in essentially the same ways with all of their avatars. based on the information gathered, gottschalk (2010) focuses on further suggestions for research on particular aspects of second life. these include the progression of the “newborn” avatar and the changes they make as they develop over time, as well as the vast potential for educating students inworld. finally, gottschalk (2010) suggests that factors such as gender, age, race, residence and physical appearance do not matter in second life as much as they matter in real life, and postulates that the real information worth gathering is “how they enact their identity, what their motivations are for participating in second life, what they typically do there, what they discover about themselves, and how they negotiate the boundaries between real life and second life” (gottschalk, 2010, p. 520). these themes will be discussed in light of their impact to research in the field of social work and social work practice. one of the drawbacks of the previous research on virtual worlds referred to above is that these data were collected outside of the virtual world instead of while users were still immersed in it. future research taking place within the context of sl could bridge this anstadt, burnette, bradley/social work practice in virtual worlds 297      gap in research design. currently, most data collection methods employ the use of listservs that invite virtual world users to access a database or website outside of the context of second life in order to provide survey or other quantitative data. however, by collecting data from participants while they are still inworld, the integrity of the unique culture of second life is simultaneously maintained while the data is being gathered, providing the possibility that answers to research questions will be more accurate and representative. these include questions about what motivates people to join second life, what activities and interactions they participate in inworld, what the context of their real lives is, and whether or not an association exists between the two. additionally, further examination of research results would relate these findings specifically to the field of social work in the future. in a study which illustrates data collection within the context of virtual worlds, bell and colleagues (2009) used a method of collecting data within second life called virtual assisted self interview (vasi) with a tool known as virtual data collection interface (vdci). the study collected results of a survey measuring demographics and quality of life of users given on a large scale to users all over second life while they were present inworld. what researchers discovered suggests that second life users are quite possibly unique from users of other virtual worlds and establishes that the vdci technology is an effective tool for gathering representative information from sl users inworld (bell et al., 2009). there is an assumption that gathering data while users are still present in second life not only inspires users to take and complete a survey, but also preserves the environment and culture that users are being surveyed about. this is presumed to increase the likelihood that answers will reflect participants’ mentality and perspective as a user of second life. therefore, further research is needed to explore similar methods of data collection. based on the social constructionist perspective, in which individuals base their understanding of, and participation in, their reality upon socially constructed views, the presence of a significant association between the participants’ real lives and their second life experience could play an important role in determining future research in this area. we suggest that among the variables being measured are included the users’ participation in groups in rl and sl, their attitudes toward meeting their sl friends in rl, their demographics and activities both in rl and sl, their relationships in rl and sl, their motivations in rl and sl, the frequency of participation in sl, and their rl social interactions. by examining the associations between these variables, predictions can be made which allude to important characteristics of users and their experiences and lead to insights into the potential implementation and efficacy of social work interventions in the virtual world of second life. discussion current research has developed a substantial base of understanding about many aspects of online virtual world use, including the cultural differences between second life and real life as well as the use of this technology for purposes such as marketing, anthropological research, and educational uses in online interactions (bell et al., 2009; eastwick & gardner, 2009; mccarty & clancy, 2002; smokowski & hartung, 2003). advances in social work, fall 2011, 12(2) 298  however, there is a gap in the current research regarding what motivates users to join in the online melee and how the real world and the online world interact with each other. this is mainly in regards to interpersonal communication and how individuals function (gottschalk, 2010). current research methods used inworld are improving the quality of the data collected and future advances in data collection can provide a more accurate representation of information. research in the field of social work is uniquely designed to examine how individuals and groups interact socially, and can be adapted to aid in the exploration of these interactions in second life and other similar online social venues. in order to advance and bridge barriers to social work practice through the utilization of modern technology, there must first be an understanding of the nature of online worlds such as second life and their potential as a tool for social work interventions in the future. implications for research some limitations exist in data collection in online virtual worlds, including concerns about maintaining participant confidentiality in a venue where computer hacking is somewhat prevalent (bell et al., 2009; mccarty & clancy, 2002). also, research in the field of social work must adhere to the code of ethics and remain cognizant of the unique context of online virtual reality use. additional considerations should be made toward users with developmental and physical disabilities. further limitations continue to persist due to the current state of technological advancements and constraints. computer-based research can only extend so far as modern technology allows it to, and there is a lack of established efficacy of online data collection within second life itself. this is evident in interactions with both sl users as well as the educational communities present within sl, especially in regards to the unique cultural aspects present inworld. additional considerations must also be made for the future of research protocols, and the policies and ethical requirements of the internal review board currently do not take into account the quickly advancing technology of online virtual worlds. given the unique technical potential of sl, this puts the responsibility on the researcher to take pains to be as ethical as possible when conducting research. avatars may not be humans, but the person controlling, and more importantly experiencing, the avatar most certainly is, and therefore is susceptible to all of the vulnerabilities of more typical research subjects. the future of sw research also means a new future for irb research protocols. should inworld data collection be successful, this opens the doors for further and more pertinent research which is capable of maintaining the integrity of the unique sociocultural atmosphere of second life and similar virtual worlds. this may become a key strength of the research in this area. implications for social work practice further research in the field of social work on the use of online virtual worlds like second life could illuminate the future of social work practice and interventions. social workers may be able to use this tool to advance and broaden their scope of practice, anstadt, burnette, bradley/social work practice in virtual worlds 299      bringing technology and social work together and redefining how we reach individuals and groups through interactions, counseling, and advocacy. for instance, individuals with disabilities or their homebound caregivers could benefit exponentially from this service, connecting them to social interactions and social support networks without taxing them physically (heron, gentle, personal communication, april 29, 2011). this could reduce the impact of their disability or the disability of a loved one on their overall well-being. special consideration must be made for ethical demands of practice, including issues of safety, prevention, and mandatory reporting. questions, such as what a social worker is responsible for if a client or group member expresses suicidal ideation while communicating via second life interactions, must be given the utmost consideration before beginning this potential venture. these questions are likely to produce opinions and concerns across the spectrum of professional social workers and will need to be defined ethically as well as legally. however, other questions still remain unanswered and may remain so for some time into the future. one major question that these researchers ask is: will online counseling and the use of upcoming technological advancements ultimately enhance real life interpersonal interactions and the development and use of social support networks and social skills in real life in the future? are social workers now participating in a medium that will eventually encompass and promote empowering clients to access their real life resources in the real world? only time will tell. references belisle, j. f., & bodur, h. o. (2010). avatars as information: perception of consumers based on their avatars in virtual worlds. psychology and marketing, 27(8), 741-765. doi: 10.1002/mar.20354 bell, m. w., castranova, e., & wagner, g. g. (2009). surveying the virtual world: a large scale survey in second life using the virtual data collection interface (vcmi). data documentation, 44, 1-61. boellstorff, t. (2008). coming of age in second life: an anthropologist explores the virtual human. princeton: princeton university press. eastwick, p. w., & gardner, w. l. (2009). is it a game? evidence for social influence in the virtual world. social influence, 4(1), 18-32. doi: 10.1080/15534510802254087 fetscherin, m., & lattemann, c. (2008). user acceptance of virtual worlds. journal of electronic commerce research, 9(3), 231-242. gottschalk, s. (2010). the presentation of avatars in second life: self and interaction in social virtual spaces. symbolic interaction, 33(4), 501-525. doi: 10.1525/si.2010.33.4.501 isabella, s. (2007). ethnography of online role-playing games: the role of virtual and real contest in the construction of the field. forum: qualitative social research, 8(3), 116. advances in social work, fall 2011, 12(2) 300  mccarty, d., & clancy, c. (2002). telehealth: implications for social work practice. social work, 47(2), 153-161. mcintosh, k. (2008). the social construction of virtual space. michigan sociological review, 22(1), 196-214. parti, k. (2008). deviances in the virtual reality or the character-altering power of virtual communities. european journal of crime, criminal law & criminal justice, 16(3), 325-343. doi:10.1163/157181708x333373 smokowski, p. r., & hartung, k. (2003). computer simulation and virtual reality: enhancing the practice of school social work. journal of technology in human services, 21(1/2), 5-30. stalker, g.j. (2007). measuring diversity in daily social contact: the contribution of social context, work and leisure on the opportunity for engagement. springer science+buisness media, 86, 275-295. doi: 10.1007/s11205-007-9115-5 tsan, j. y., & day, s. x. (2007). personality and gender as predictors of online counseling use. journal of technology in human services, 25(3), 39-55. wood, d. (2009). real life access to “second life” worlds: the potential, the problems and the possibilities for a barrier-free future. the international journal of diversity in organizations, communities, and nations, 8(6), 139-148. author note: address correspondence to: scott anstadt, ph.d., division of social work, florida gulf coast university, 10501 fgcu blvd., south, fort myers, fl 33965-6565. email: sanstadt@fgcu.edu aisw vol. 8, no. 2:aisw vol. 5, no. 2 the perceptions of mexican-american men as fathers jeffrey shears rich furman nalini junko negi abstract: this qualitative study explores the lived experience of self-identified mexican men as fathers. the sample consists of 47 biological fathers of children residing in denver, colorado, all whom are participating in the early head start research and evaluation project. the data suggests that these fathers engaged in traditionally conceptualized fathering roles. these men expressed the importance of being there, teaching, meeting the child’s needs, being a role model, offering emotional support, and giving affection and love. the fathers reported taking more responsibility, decreasing substance use, and limiting their leisure activities as a result of becoming a parent. the results suggest that, fathering in and of itself, may create resiliency and may have powerful positive influences on the lives of fathers. keywords: latino men, fathers, masculinity, fathering roles introduction empirical research has found a positive relationship between a father’s involvement and an infant’s early physical and psychosocial development (shears & robinson, 2005; lamb, 2002; palcovitz, 2002; federal interagency forum on child and family statistics, 1998a; 1998b). additional studies suggest that fathers contribute differently to infant developmental outcomes than do mothers (horn, 1999; lamb, 1997; yogman, 1981; lamb & lamb, 1976). while this link has been established, much of it has been through quantitative analysis that has merely identified the key variable and outcomes involved. while important, more information regarding the lived experiences of fathers is needed. by understanding the lived experiences of fathers themselves, family practitioners will be able to better understand how men construct their identities as fathers and will be able to more sufficiently provide services to them. several scholars have noted that much of what we know about a father’s parenting attitudes and experiences was collected from the mother’s reports (shears, 338 jeffrey shears, ph.d. is associate professor and bsw coordinator, department of social work, college of health and human service, university of north carolina at charlotte, charlotte, nc 28223. rich furman, msw, ph.d. is associate professor and director of the social work program at the university of washington, tacoma, wa 98402-3100. nalini negi, msw is assistant professor, school of social work, university of maryland at baltimore, baltimore, md 20850. copyright© 2007 advances in social work vol. 8 no. 2 (fall 2007) 338-352. indiana university school of social work. summers, boller, & barclay-mclaughlin, 2006; cherlin & griffith, 1998; tanfer & mott, 1997). as social service and other providers seek to support positive outcomes for children and families, the experience of fathers via-a-vis their parenting are essential to understand. given this importance, one might hypothesize that fathering attitudes and experiences might differ across race and ethnicity. however, much of what we know about fathering is from western middle-class, well-educated families; research is needed regarding the perceptions of fatherhood with ethnicallydiverse populations (palcovitz, 2002). too often, models of development and parenting derived from white middle-class families and men are constructed as socially normative and are viewed as the benchmark through which to view the experiences of other men. however, such over-generalizations can lead to misunderstandings at best, and stereotyping at worst (furman & collins, 2005). as the latino population in the united state continues to grow, social service practitioners and researchers are realizing that more must be done to understand the lived experiences of latinos (furman, & negi, 2007). this is particularly true for latino men. too often, cultural variables, such as machismo and paternalismo, are misunderstood by the social service community and others who work with latinos. the experience of latino men is often viewed through a lens of pathology, rather than by understanding their unique lived experiences through important latino values. this exploratory study seeks to join a growing body of research on the lived experience of latinos, in particular, mexican-americans. this study will specifically explore attitudes, experiences, and perceptions of self-identified mexicanamerican fathers of children residing in the denver, colorado metropolitan area. the study represents a component of early head start children and families, both of which shall be explored in a later section of this paper. research on fathers much of what we know of men’s experiences as fathers is derived from research in anglo communities (shears, 2007; jarret, roy, & burton, 2002; palcovitz, 2002; toth & xu, 1999). the focus of much of this research has been on examining the differences between fathering and mothering (shears & robinson, 2005; hernandez & brandon, 2002; kokkinaki & kugiumutzakis, 2000; bumpass, raley, & sweet, 1995), the effects of the father-infant relationship (storey, walsh, quinton, & wynneedwards, 2000; bader, 1995), exploring the experiences of fathers (shears, summers, boller, & barclay-mclaughlin, 2006; housaain, fields, pickens, malphurs, & del valle, 1997; parke, 1995), and how men learn to father (snarey, 1993; cowan & cowan, 1987; sagi, 1982). these studies also suggest that fathers are more likely to be involved in social activities, play, physical interactions, unusual, and unpredictable play. because of the types of interactions and activities fathers participate in, they may interact differently with their children than mothers do. these differences in interactions suggest that fathers offer something unique to early infant development. in addition, the research on father-infant relationships suggests that fathers are emotionally connected to their infants, even to the point of having hormonal changes around the birth of their child (storey, walsh, quinton, & wynne-edwards, 2000). 339shears et al./mexican american men as fathers another area of focus has explored how fathering is in a state of transition, as more fathers are embracing both traditional and contemporary roles. traditional roles embrace activities, such as provider, protector, role model, disciplinarian, entertainer/socializer, and teacher, while the more contemporary roles might consist of caregiver, as partner with the child’s mother, and as a source of affection and emotional support (shears, summers, boller, & barclay-mclaughlin, 2006). a number of studies have identified differences in these roles with ethnic minority fathers (shears, 2007; jarett, roy, & burton, 2002; mincy, 2002; toth & xu, 1999). these findings further strengthen the need for understanding how fathering experiences may be different among ethnic minorities. hispanic fathers studies suggest that hispanic families are more family-oriented than anglo families, and particularly that mexican-american families report more participation in large family networks (sabogal, marin, & otero-sabogal, 1987; vega, 1990). a few studies have examined how hispanic fathers’ attitudes differ from anglo fathers. sanchez (1997) found that mexican-origin families are egalitarian, in that fathers take an equal role in household responsibilities, including child rearing. shears (2007) found that hispanic fathers reported higher levels of socialization activities with their children than did anglo fathers. toth and xu (1999) suggest that hispanic fathers tend to reinforce the norms of family closeness and expect their children to show respect for and conform to authority. consequently, it is suggested that they monitor and supervise their children more closely than anglo fathers. a study by hofferth (2003) found that hispanic-american fathers mirror anglo fathers in the number of hours they reported spending with their child during the week, while also reporting higher levels of caring for their child than anglo fathers. the study concluded that hispanic fathers displayed higher levels of warmth and were more permissive in their parenting styles. although these studies highlight the positive aspects of hispanic fathers, a number of these studies compared them to anglo fathers. there is a need to expand our understanding of hispanic fathers and to understand their experiences in fathering within their cultural context. as a result, the current study explores mexican fathers as a single group, without comparing them to others. method early head start research and evaluation project early head start (ehs) designed to enhance a child’s cognitive, socio-emotional, and behavioral development, as well as the parental capacity to engage in educational support activity, ehs includes intensive services that begin before a child is born and supports the family throughout the early years of a child’s life from ages 0 to 3. a national team of researchers and federally-funded agencies collaborated with ehs programs to evaluate the program’s implementation and outcomes at 17 research sites across the united states. following a random assignment design, a sample of nearly 3,000 children and mothers were recruited while the children were 12 months of age or younger. the mothers completed a series of interviews, including a baseline 340 advances in social work enrollment interview, a parent services interview at 6, 15, and 26 months following random assignment, and an exit interview. data collection for the ongoing early head start national evaluation focused on the primary caregiver–the female parent in more than 95% of the cases–as the key respondent. although the responses from interviews with mothers yielded a wealth of data on fathers and father-figures, researchers also included an in-depth set of studies that focused specifically on fathers as the primary respondents. these studies helped to fill existing gaps in the body of knowledge by adding a further dimension to our understanding of how fathers, in the greater context of their family and the early head start program, influence infant and toddler development. the father study included measures parallel to the study of mothers. such measures included: 1) measures of family resources and supports, 2) knowledge of child development, 3) parent characteristics, such as education and depression, and 4) videotaped interactions of father and child. data for fathers who agreed to participate in the study were collected when their respective children were 24 months old. further, an embedded qualitative study involving audiotaped, open-ended questions was incorporated into the study and interspersed throughout the quantitative interview. thus, this study is part of a larger mixed-method research project, as reported in boller, cabrera, raikes, pan, bradley, shears, & roggman (2006). data for this report were taken from interviews with men who were verified as being the father or father-figure of the ehs child at 24 months. participants this study includes 47 fathers who completed a qualitative interview around their child’s 24-month birthday. the sample consisted of english, spanish, or bi-lingual speaking men who self-identified as mexican-american and who were more than 19 years old. these men were reported by the mother to be the biological father or father-figure of a young child participating in two early head start programs in denver, colorado, which were currently involved in a research and evaluation project. mothers who were enrolled in early head start initially identified the participants in this study as the father/father-figure of their child when the child was two years of age. as a result, these men were the father or father-figure of at least one child who was around two years old. because of the requirements of enrollment in early head start, the families and children are low income. however, the men associated with these families were not necessarily low income. the interview the interviews include a core set of qualitative questions designed to assist in the generation of new hypotheses about mexican-american fathers and their involvement in their children’s lives. this study consists of several open-ended, qualitative questions to explore the experiences and perceptions of mexican-american men on their fathering in low-income families. the study was designed not from a particular qualitative tradition, but from a generic qualitative perspective (caelli, ray, & mill, 2003) in which the researchers sought to inductively approach the experience of hispanic men. 341shears et al./mexican american men as fathers 342 thematic analysis was conducted to uncover themes based upon the data. the first author read each of the interviews and, with the assistance of a hispanic male qualitative researcher, developed initial codes and categories. subsequent readings lead to the development of more refined themes. the first author and the research assistant discussed the coding schemes that each developed and, through a process of negotiation and consensus building, developed themes that both believed accurately reflected the data. this type of peer-debriefing and triangulation has been found to be essential to ensuring the trustworthiness of the data (leitz, langur, & furman, 2006). the data are presented in two ways. first, passages that represent the major themes in the data are presented. the authors discussed these responses in comments designed to contextualize the findings. frequency tables are presented to help the reader understand which responses were typical of this population; the researchers recognize that any numerical presentation of qualitative data, based upon a sample such as this, should not be taken as representative of the general population. findings question #1: what does being a good father mean to you? thematic analysis revealed a set of five non-overlapping themes that describe fathers’ perceptions of good fathering. the key themes were “being there,” teaching, meeting the child’s needs, being a role model, and offering emotional support (table 1). the key themes listed in table 1 are highlighted and described below. “being there” respondents believe that an important component of good fathering includes being available for their children. this was the most popular theme, appearing in 32 of the total responses and underscored by 46 participants. the importance of being accessible to their children, or simply “being there,” was expressed in a variety of ways. one respondent states about his child, “i have to take care of my responsibilities, be there for him, make sure he knows i am part of his life, and will always be there.” similarly, another respondent describe “being there” for his child advances in social work responses # of men who responded percentage being there 32 70 teaching 23 50 meeting the child’s needs 17 37 being a role model 13 28 offering emotional support 7 15 paying attention to the child 5 11 being supportive 5 11 playing with 4 9 being patient 1 2 total responses 46 table 1: responses to being a good father as part of taking care of his responsibilities as a man but also to “make the child feel wanted.” fathers then expressed the importance of “being there” as not only fulfilling a responsibility but also providing emotional security for their families. teaching the second most popularly identified theme of being a good father was the importance of teaching the child. fathers underscored the importance of teaching their children to be able to distinguish between “right and wrong” as well as providing them with structure. one respondent relates: to me, it means being able to provide for her a well-structured avenue, so to speak, in terms of her growing up. giving her some value and making sure she knows exactly what is right and wrong, and giving her a sense of purpose for her being her. fathers then talked about the meaning of teaching their children life-lessons that will foster strong values and self-esteem as well as enable them to become functional adults. meeting the child’s needs fathers also identified the importance of financially meeting their child’s needs. one respondent stated, “you got a responsibility to work, to have the money to buy the baby stuff, and make sure the baby has everything he needs, because that baby’s special to you.” providing for the financial needs of the child is then underscored by some fathers, because it sustains the child’s physical well-being. being a role-model fathers further discussed their key role as role models and the importance of fostering supportive relationships with their children: first of all, that means representing a positive male role model. i came from a place where mothers can teach men how to be a better man, and fathers can teach daughters to be betters daughters. i always try to be a positive role model. i always try to show that i care about her and support her, do things for her, encourage her, play with her. let her know she’s special. i think it’s important for her to have that male role model, because her biological dad is choosing not to be part of what is going on. i try to be there to support things and really connect with her, bond with her. i feel that’s something she’s going to need. fathers then relay the importance of being a good role model or a “pillar of strength” for their child despite (or maybe because of) the less than ideal social conditions that their child may be growing up in. sometimes, the responsibility of striving to be a good role model for their child may be difficult. a respondent relays, “i was still young, so i had to start acting like a grownup, because i had a son to take care, and he has to have someone as a role model so he won’t go the wrong route.” offering emotional support fathers discuss the importance of emotionally supporting and validating their child, even if it may not conform to traditionally held ideas of masculinity: 343shears et al./mexican american men as fathers a lot of men probably have trouble being there emotionally when their child wants to be affectionate. i think, as he grows older, i’ll have to be there for him emotionally as he develops and as he learns and changes, especially when he enters adolescence. fathers then identify the importance of “listening to your kids, being active with your kids, being interactive with your kids, showing concern…” as a key component of fathering. after this general question, some men were asked more probing questions regarding their experiences of fathering. the following is how a number of men addressed some of these probing questions. question #2: what are the positive aspects of being a father? two themes emerged identifying a father’s perceptions of the positive aspects of fatherhood (table 2). a number of respondents (n=13) answered that the love and affection they give to and receive from their child are positive aspects of being a father. three respondents stated that, as a result of being a parent, they have matured, while one respondent answered that, as a result of being a father, he has learned about life. the two key themes are discussed below. affection/love fathers indicated that the love and affection they receive and give to their children is a significantly positive aspect of being a father. a respondent states, “just seeing that smile on his face mostly. just having that person there to love; i couldn’t live without him now. i couldn’t imagine life without him.” fathers then describe a nurturing and loving bond with their child that gives them immense happiness. fathers also further describe their loving bond with their child as solidifying family bonds, “it’s a blessing actually; it gives me a warm, loving feeling inside-a family-being-together feeling.” maturity fathers further identified becoming more mature as an important and positive aspect of becoming a father. it changed my life a lot. before ______ was pregnant, i was pretty wild, running around, partying, and stuff like that. i really had to take the time to think about my responsibilities and what it takes to raise a child and how it’s time consuming. you have to put him first before going out or buying clothes for myself or cds and stuff like that. 344 advances in social work responses # of men who responded percentage affection/love 13 76 maturity 3 17 learn about fathering 1 1 total responses 17 total responses 17/no response or not applicable 30 table 2: positive aspects of fathering becoming a father then dramatically altered the perceptions and life choices of some of the respondents, whereby they now began to place their child’s needs above their own needs. furthermore, becoming a father gave some respondents a reason to care for something, such as: like, at first, i didn’t work. i was just out there doing really bad stuff, not caring about nothing. when he came into my life, i knew i had another responsibility to my wife and him. i got a job.” fatherhood then instilled a sense of financial and emotional responsibility that some respondents indicated they lacked before their child was born. the procurement of a job and placing their child’s needs above their own needs, as well as a dramatic shift in life-styles (from partying to becoming responsible), was then identified as a positive aspect of becoming a father. questions #3: what are the negative aspects of being a father? three themes were identified in the respondents’ perceptions of the negative aspects of fatherhood (table 3). a majority of the respondents (n=10) did not associate negative experiences with fathering. some fathers (n=5) indicated that fathering may limit their flexibility to “pick up and go.” only one father stated that a negative aspect of becoming a father includes working more hours. no negative the bulk of the respondents indicated that there are no negative aspects of becoming a father. a respondent succinctly states, “i don’t see any downsides at all. i enjoy being a father; i don’t regret it.” their enjoyment of being a father then clearly overrides any negativity or “downsides” that may be associated with becoming a parent. limit activities some respondents indicated that becoming a father has limited their flexibility to be able to engage in recreational activities with their partner or by themselves. we’re not able to, my wife and i, do all the things we did before we had kids. we can’t just get up and go; we always have to worry about childcare if we want to go out—dancing or dinner or something. our respondents indicated the inability to “just pick up and go somewhere” is the primary expressed negative aspect of becoming a father. 345shears et al./mexican american men as fathers responses # of men who responded percentage no negative 10 63 limit activities 5 31 work more 1 1 total responses 16 total responses 16/no response or not applicable 31 table 3: positive aspects of fathering question #4: how has fatherhood changed you? the majority of the respondents (n=21) reported an increased sense of responsibility due to fatherhood (table 4). others (n=8) indicated that their intake of alcohol and drugs had been limited due to fatherhood. while others (n=3) stated that fatherhood has changed their lives by limiting their leisurely activities. one respondent indicated that fatherhood has made him more patient, and another respondent stated that fatherhood has made him grow up faster. had to take responsibility fatherhood had an altering effect upon most of the respondents who indicated that becoming a father has instilled a sense of responsibility in them. knowing you have a child makes you more responsible. it makes you think before you act. i never had much of a problem getting into trouble before he was around, but certain things were a lot less important before him—job security. nowadays, it’s… actually, it’s a lot of weight being responsible for a child and everything from, “does he have enough diapers and do we have enough milk in the fridge?” fatherhood, then, for some respondents, instilled the importance of job security in providing for their child’s needs. in addition, fatherhood also led some respondents to develop responsible decision-making, whereby “you think before you act.” irresponsible behavior, through potentially illegal activity, is then no longer seen as a positive life-choice for these respondents. for example, a respondent states, “i can’t run the streets like i used to. i can’t hang out all the time. gotta be there for the little one who needs you…” couldn’t drink or use drugs some fathers further indicated that fatherhood altered their substance usage. i was doing drugs up until her sixth month of pregnancy—partying, gangs, and whatever. i had my son and it was an awakening. i’m in college and should be entering the cadet program in a couple of months to become a police officer. for some respondents, the birth of their child indicated to them that substance and drug use is not viable. the birth of their child was then expressed as an “awakening” that led them to curtail their substance usage and other illegal activities. 346 advances in social work responses # of men who responded percentage had to take on more responsibility 21 72 couldn’t drink or use drugs 8 28 limits leisure activities 3 1 made them be patient 1 less than 1 made them have to grow up faster 1 less than 1 total responses 29 total response 29/no response or not applicable 18 table 4: fatherhood changed your life another father states, “i used to play in a band and be a heavy drinker. ever since i had my son, i drank for four months, and then i stopped drinking. it’s been over two years since i’ve drank.” fatherhood then facilitated the curtailment of substance use for some respondents. limits leisure activities respondents also indicated that fatherhood has limited their activities. i used to have a lot of time for myself. i used to be able [to do whatever i wanted] whenever i didn’t have kids. no, it’s kind of like everything is slowed down. i worked 40 hours a week and i used to have no problem staying over time at all. now that i have kids, that’s a definite thing i gotta do—make time for them. fatherhood then has shifted the focus from engaging in leisurely activities, “doing whatever,” or even putting in extra time at work, to individual time, to spending time with their children. the fathers’ lives are then starkly different than they used to be when they did not have children. one respondent states, “just day to day, i get to read less (laughs), i get to do fewer things i would normally like to do.” question #5: what are some of the obstacles that keep you from being the kind of father you want to be? a majority of the respondents (n=26) stated that their job’s time requirements are the biggest obstacle to being the kind of father they want to be (table 5). some respondents (n=8) indicated that lack of finances was an impediment to being the ideal type of father, while few reported that television or electronic games, their exwives, lack of transportation, family stability, parole/courts, and family were impediments to them being the kind of father they would like to be. the key themes were then their jobs and lack of money. 347shears et al./mexican american men as fathers responses # of men who responded percentage job/time 26 67 money 8 20 electronic games/tv 3 1 ex-wife, wife/in laws 3 1 nothing 3 1 lack of transportation 2 less than 1 family stability 2 less than 1 parole/courts 1 less than 1 family 1 less than 1 total responses 39 total response 39/no response or not applicable 8 table 5: obstacles to being a father job the bulk of the respondents discussed the time-consuming nature of their employment. some respondents talked about the long hours they worked or weekend employment, in addition to having to work two jobs. like i said, when i get off work, i’m usually in bed for the rest of the day; i don’t really feel like going anywhere or doing anything. i’m so tired—my job. i hate to say it, but there’s times when i don’t interact with her that much. employment then often places a physical as well as emotional strain on the father, leaving him exhausted and with little energy to interact with his child. some fathers then expressed the desire for more time to be able to spend with their children. one respondent states, “i wish i had more time, sometimes. keeping the ball rolling is stressful.” money some fathers expressed lack of finances are an obstacle to being the kind of father they would like to be. fathers expressed how having more money could potentially enhance their parenting. if i could make enough money so my wife could stay home with them, that would be great. there are certain things i’d like to do with them and that stuff costs money, and right now, we don’t have the extra money to do that. lack of finances is then perceived by some fathers as disallowing them from being involved in the type of activities they would like to be involved in with their children. one respondent states, “money. (laughs) finances. i’d like to be able to take them everywhere.” discussion the results indicate that mexican-american fathers feel that it is important to be involved in the lives of their young children. this idea of “being there” for their children is in agreement with other research on fathers (shears et al., 2006; allen & doherty, 1996). this suggests that fathers in low-income mexican-american families have similar perceptions of being a good father as men of other racial and ethnic backgrounds. with the exception of offering emotional support, these men generally held very traditional beliefs regarding their importance to childrearing. the responses of being there, teaching, meeting the child’s needs, and being a role model, all represent very traditional beliefs in fathering. this focus on traditional fathering attitudes is somewhat surprising, given the recent adoption of more contemporary attitudes of fathers. one area where there may be a shift from more traditional to contemporary attitudes is when men talked about the positive aspects of being a father. their responses indicated that these men were comfortable and enjoyed the affection they received from their child. this is an important finding, as men often may not be viewed as being important, affective models and providers of care in the lives of their children. contrasted to the above noted traditional roles, mexican-american men in this study clearly understand and value their importance to the affective lives of their children. 348 advances in social work when asked about negative experiences of fathering, a number of men stated there were no negative experiences. this is interesting, given that these are fathers in low-income families. however, it is certain that these men have similar ideas of good fathering as middle-income men, but generally they have fewer economic resources. one might expect that a negative experience for these men would be their difficulty in meeting their personal fathering expectations, but this was not the case. this clearly demonstrates the strength and resiliency of this population, and their recognition of the value of fathering within the context of various family constellations. a number of men expressed that, having a child was a positive, life-changing event. simply put, becoming a father changed their lives in a positive way. several men stated that they stopped or greatly reduced their participation in risky behaviors, such as doing illegal drugs or participating in illegal activities. one might question whether this finding is partly the result of the low-income status of several of these fathers. it has been suggested that illegal drug and alcohol use might be equally represented across economic levels, particularly during adolescence (schensul & burkholder, 2005). however, research in this area also suggests that many in middle-class communities tend to “grow out” of such risky behaviors (arnett, 2004; sehulenberg, o’malley, bachman, wadsworth, & johnston, 1996). being a father, then, may provide some inoculation against various psychosocial and behavioral maladies. one area that may address the issues of economic status and men’s perceptions of fathering is when the men were asked about the difficulty in being the kind of father they want to be. most men responded that lack of economic resources and their working to secure these resources were significant obstacles that are impeding them from becoming the type of father they want to be. given that mexican-american fathers held very similar ideas of fathering as anglo fathers suggests the possibility of a unifying theme in highly involved fathers. these results support similar findings of other studies (brayfield, 1995) that suggest fathering in low-income families is not very different from the role of fathering in other socioeconomic classes. future studies might examine how fathering might differ across racial and ethnic populations, attempt to understand how mothers influence the type and frequency of fathers’ involvement with their children, and explore how much fathers contribute to mothers’ involvement with children. implications for practice this study helps us to understand more about the fathering of young infants in self-identified mexican-american families. men involved in this study generally found value in both traditional male fathering roles and more contemporary affective roles. men in this study clearly were self-reflective about their own fathering and understood the importance of their affective contributions to the lives of their children. this study confirms that mexican-american fathers’ attitudes and activities might be changing similarly to contemporary fathers across ethnic and racial groups. although there has been an increase in fathering research studies and available literature, researchers must be cognizant that the 349shears et al./mexican american men as fathers process and topic under study is constantly changing. in addition, we need to be mindful that men from various economic levels and ethnic/racial groups might offer different views of their fathering roles, and we need to remain diligent to also hearing their varied voices. there are specific implications for family and social service practice, given the increased numbers of mexican-american families in the united states. we should be mindful that many of the families with which we work may be considered fragile families by virtue of their limited resources and/or unstable relationships. however, as this study demonstrates, fathering in and of itself may be a powerful factor in strengthening the lives and experiences of men, whether or not they are members of a traditional family constellation. fathering itself seems to provide men with powerful experiences that increase their desires and abilities to engage in prosocial behavior. practitioners may focus on helping fathers in traditional nuclear families and those who parent outside of these relationships to understand the powerful, positive influence fathering may have. practitioners must seek to validate the strengths of latino men and the many ways in which they positively contribute to the lives of their children. additionally, since it is clear that affective caretaking is an important component to the parenting experience of latino men, practitioners must understand this role in the context of latino culture. viewing latino men through a narrow understanding of machismo is limiting. machismo should be viewed more as a deep sense of obligation to the family, regardless of the particular family structure. the positive aspects of latino male fathering, which includes traditional, economic, and affective care, must be understood. practitioners who are unfamiliar with latino culture are encouraged to utilize a strengths-based lens through which to view the experiences of latino men as fathers. that is, they should seek to understand the lived experiences of their clients and how their clients possibly contribute to the lives of their children. having a clear understanding of the fathers’ unique contributions to early infant development and how it is vastly different from mothering would be a good start for practitioners and child-care providers. helping to educate parents on these issues is important, as many families may not understand the fathers’ importance in child rearing. families need to know and understand the importance of fathers to children’s emotional and financial well being. in many cases, young men may not understand their own importance; 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(1981). games fathers and mothers play with their infants. infant mental health journal, 2, 241–248. author’s note: address correspondence to: jeffrey k. shears, ph.d., associate professor and bsw coordinator, college of health and human services, department of social work, 9201 university city blvd., charlotte, nc 28223, usa. e-mail: jkshears@ uncc.edu. 352 advances in social work microsoft word 4. rice girvin_8766_engaging families copyedit final ______________ karen rice, ph.d., lsw, acsw, is an assistant professor and department chair and heather girvin, ph.d., m.s.s., is an assistant professor both in the department of social work at millersville university in millersville, pa. this study was partially supported through a grant from the millersville university faculty grants committee. the authors would like to thank the public child welfare agency and dependency court for providing us access to key stakeholders to conduct their observations and focus groups. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 306-317 engaging families, building relationships: strategies for working across systems from a social exchange perspective karen rice heather girvin abstract: in child welfare, the relationship between worker and client is viewed as the mechanism through which families may be engaged. certain settings may complicate the development of a helping relationship and require workers to counter these pressures by developing more effective means of engaging families. utilizing a social exchange framework, this qualitative study was conducted to explore interactions among parents and professionals in dependency court hearings. findings revealed that a lack of reciprocity hinders the development of collaborative relationships that could support and assist families. implications for social work practice are examined. keywords: child welfare, engagement, helping relationship, social exchange theory, strengths-based perspective the field of child welfare has moved toward the strengths-based perspective, with educators and practitioners emphasizing the importance of harnessing families’ strengths (alpert & britner, 2005). engagement is foundational in this process and can be conceptualized as a way to protect the rights of children and families to exercise agency in case planning. in child welfare, the relationship between worker and client is viewed as the mechanism through which families may be engaged. evidence suggests that the formation of a strong connection between the worker and client is prerequisite for effective intervention (holland, 2000). failure to establish a helping relationship has been associated with poor outcomes such as lack of reunification between the parent and child (landsman, groza, tyler, & malone, 2001; lee & ayon, 2004; trotter, 2002). though viewed as vital to optimal practice (dawson & berry, 2002; gockel, russell, & harris, 2008), engagement can be problematic in child welfare because of the involuntary context in which many services are delivered. workers are often viewed by clients as adversaries, a perception related to the accurate assessment that workers wield power over interventions and case decisions (sheafor & horejsi, 2009). other stakeholders—families’ attorneys, parents and caregivers, and guardians ad litem (attorneys appointed to represent the best interest of the child)—also maneuver within the context of child welfare with varying degrees of power and influence as well as pressure to achieve particular outcomes. when desired outcomes are at odds, as perceived or in actuality, the resultant conditions may create an environment in which family engagement is unlikely. decision-making time frames established by the adoption and safe families act (asfa, 1997) have increased pressure on workers to use efficient practices, underscored rice, girvin/engaging families 307 the need for collaboration among legal representatives, and raised expectations of parents, some of whom have only 12 months before a child’s permanency goal could be changed from return home to adoption (smith & donovan, 2003). workers may be expected to counter these pressures by developing more effective means of engaging families; however, little is known about the everyday work and courtroom interactions of stakeholders in dependency court hearings (smith & donovan, 2003). the study described here was prompted by evidence that the public child welfare system in one mid-atlantic county was not meeting desired outcomes (children’s bureau, 2005), as well as anecdotal evidence that conflictual relationships among representatives of the various systems (workers, clients, attorneys, judges, guardians ad litem, youth) limited the degree to which stakeholders collaborated to meet children’s needs. throughout this manuscript, the term caseworker is used to reference frontline child welfare workers who often, but not always, possess a social work degree. literature review child welfare agencies follow a bureaucratic organizational structure (fabricant, 1985), characterized by a hierarchical ordering of individuals with well-defined roles and responsibilities (gordon, 1970; wasserman, 1971). individual workers’ attitudes, values, and behaviors within an organization are determined by its organizational climate (gordon, 1970). according to solomon (1976), public bureaucracies have the ability to adversely influence the employees, clients, and service delivery. as a result, it is essential to consider the factors that influence the development of a helping relationship within a bureaucratic organization. contributing factors to engagement social work is a profession grounded in social justice and the empowerment of others. empowering families involved with child welfare may help keep children out of placement or may help reunify families (hegar & hunzeker, 1988). however, hegar and hunzeker (1988) argued that certain characteristics of child welfare agencies and workers prohibit the development of a helping relationship. a number of qualitative research studies (e.g., diorio, 1992; drake, 1994; kapp & propp, 2002; maiter, palmer, & manji, 2005; ribner & knei-paz, 2002) have documented specific caseworker skills, identified by both the client and the caseworker, as being associated with a helping relationship. reoccurring themes in these studies include worker supportiveness, genuineness, empathy, helpfulness, respect, non-judgmental attitudes, accessibility, and use of effective communication skills. winfield and barlow (1998) assessed the strength of the helping alliance between the client and caseworker, finding that 95.6% of clients reporting a positive relationship viewed their caseworker as friendly. a more recent study by kapp and vela (2004) also supported the need to develop a helping relationship. a sample of clients whose children were in foster care was surveyed to assess their perception of satisfaction with their caseworker. clients reported higher levels of satisfaction if they believed the caseworker was helping them in reuniting with their child, had clear expectations, prepared them for meetings, stood up for them in meetings, and respected their culture (kapp & vela, 2004). chapman, gibbons, barth, advances in social work, fall 2014, 15(2) 308 mccrea, and nscaw research group (2000) found that clients more often reported higher levels of satisfaction with their caseworker if they perceived the worker offered relevant and helpful services in a timely manner and if the caseworker maintained frequent verbal contact with the client. this would suggest that the client valued a worker who took the time to help the client accomplish his/her goals. yatchmenoff (2005) reminds us that organizational factors can influence clients’ level of satisfaction, and thus the ability to develop a helping relationship. findings revealed most clients’ perceptions of the “system” were negative as they did not “believe my family will get the help we really need from” child protective services (yatchmenoff, 2005, p. 95). therefore, more than ever, effective collaboration between the child welfare caseworker, family, and other service providers is an essential practice method to foster engagement and development of a helping relationship. social exchange theory social exchange theory (blau, 1964; homans, 1958) provides a lens through which human interactions and relationships can be examined. at the core of social exchange theory is the assumption that individuals seek to profit in their exchanges. individuals are considered to be rational actors who consider costs and benefits before interacting with another. as individuals desire to achieve benefits and avoid costs, self-interest is a key motivating force. homans (1958) argued that self-interest was a universal motive that made the world go around, and men and women modified their behavior in terms of positive or negative reinforcement provided by their environment (coser, 1977). consequently, individuals will do what they perceive to be in their best interest and that which moves them closer to achieving what they define as valuable. likewise, individuals will avoid actions that will cause them to lose what they value. hence, individuals are seen as rational calculators of pleasures, always intent on maximizing returns and minimizing losses (coser, 1977). in an attempt to explain group conformity and deviance, blau (1964) proclaimed that there is first an exchange transaction between individuals, which leads to a difference in status and power, which leads to legitimization and organization, which leads to opposition and change (ritzer, 1992). therefore, for groups to survive, each member must adhere to its predictable patterns of interaction within their ranks. thus, the group norms and individuals’ desire for social approval ensure conformity, which reinforces group cohesion and survival (robbins, chatterjee, & canda, 2006). when groups do not adhere to their predictable patterns, and there is an uneven exchange, then power of one person over another will prevail. ideally, norms of reciprocity triumph in an exchange. however, when one individual is not rewarded as expected, an imbalance is created, which threatens the operation of the social system. this leads to a differentiation in resources that individuals possess, creating a power base through which one becomes deprived or exploited (coser, 1977). individuals come to learn what is expected of them, and, in turn, this regulates their behavior. rice, girvin/engaging families 309 social exchange theory allows for the explication of social, contextual, personal, and organizational factors that structure relationships among stakeholders in dependency court processes. the theory contains key theoretical concepts that allow observers of human behavior to consider how social interaction is related to participants’ consideration of potential loss and gain, the impact of perceived rewards and their distribution, the role and function of power, the influence of norms, and reciprocity across exchanges (robbins et al., 2006). utilizing a social exchange framework, this qualitative study was conducted to explore interactions among parents and professionals in dependency court hearings with the objective of determining the degree to which families are engaged throughout judicial processes and actively involved in case decisions. method research design this exploratory study employed qualitative ethnographic strategies, using courtroom observations and focus groups with key stakeholders (judges, caseworkers, guardians ad litem, youth, and foster parents) to collect data. this approach was chosen to capture the complexity of social interactions among stakeholders from an emic perspective. permission to conduct the study was granted by the university’s institutional review board as well as from the public child welfare agency’s executive director and solicitor. sample this study was based on focus group interviews and dependency court observations. individuals observed during the dependency hearings comprised the judge, county solicitor, guardian ad-litem, parent’s/caregiver’s attorney, parents/caregivers, county caseworker, youth, and other professionals present in the courtroom (e.g., witnesses, sheriff). five separate focus groups were conducted with the following stakeholders: judges, guardians ad litem, county caseworkers, foster parents, and youth in foster care. the number of individuals within each focus group varied. table 1 shows the composition of these groups. table 1. composition of focus groups focus group male female total judges 2 1 3 guardians ad litem  3  3  6 caseworkers 2 6 8 foster parents 1 4 5 youth 7 7 14 advances in social work, fall 2014, 15(2) 310 except for the adolescent youth, who were selected by the county agency since they were a pre-existing group of youth in care who participated in the agency’s independent living (il) program, all focus group participants were recruited to participate in the study. an email was sent to all judges, guardians ad litem, and county caseworkers inviting them to participate in the focus group. an invitation was sent to the foster parents through the agency’s monthly newsletter. one hundred percent of the judges and guardians ad litem participated, 6% of the total number of foster parents participated, and 12% of the caseworkers participated. although the youth were pre-determined and represented 100% of youth involved in the il program, they represented only 7% of the total population of youth in foster care 12 years old and older, the age range of youth who are invited to attend their dependency hearings. having attended and/or testified in dependency court was the only inclusion criterion for the participants of the focus groups. data collection as a result of their professional relationship with the judge, the researchers gained access to the courtroom in order to obtain this emic perspective of the dynamics of dependency hearings. although this relationship may have potentially biased the study’s findings, the researchers used multiple methods of data collection and interpretation to enhance the trustworthiness of the results. these methods included prolonged engagement, peer debriefing, and multiple observations. over a three-month period in 2009, the researchers observed six hours of dependency hearings. to ensure trustworthiness, two observers attended multiple court hearings presided over by the primary dependency judge and took field notes throughout. the observers sat in the back of the courtroom and only the judge knew why they were present. there was no verbal interaction between the observers and individuals being observed. the field notes from the court observations were typed and analyzed. the focus groups were conducted by the authors, one acting as the primary facilitator. the focus groups were guided by a semi-structured interview guide that included open-ended questions on the participants’ perceptions of the court process, the level of preparation for court, the ability to testify in court, and the relationships between key stakeholders in attendance. each focus group lasted approximately 60 minutes and was conducted at a place of convenience for the participants (e.g., courthouse meeting room, local child welfare agency). the focus groups were audiotaped and transcribed. data analysis this study was purposefully designed so that data were triangulated, incorporating multiple viewpoints through focus groups and observations to avoid bias from any one group of stakeholders, including the researchers. trustworthiness was enhanced through continuous and prolonged engagement of the participants and immediate documentation of insights and thoughts regarding the court proceedings (padgett, 2008). further, after initial coding of the field notes, emergent ideas were authenticated through peer debriefing, a common method of establishing trustworthiness (padgett, 2008). peer debriefing involved a review of the typed field notes and codes by a colleague with rice, girvin/engaging families 311 numerous years of experience in child welfare to assess for authenticity in interpretation of data. following the transcribing of focus group data, each transcript was reviewed line by line and coded by both authors using open coding techniques (corbin & strauss, 2007). this first level coding utilized a constant comparison method of analysis (corbin & strauss, 2007) in which this process was repeated several times to compare, clarify, and organize codes to ensure consistency and credibility of the data. second level coding was performed to review and organize codes across all transcripts into common categories. results throughout the data analysis process, the theme of power, specifically power differences, quickly emerged. to elucidate this construct, the key concepts of social exchange theory became helpful in explaining and understanding the power differences. as a result, those key concepts (participants’ consideration of potential loss and gain, the impact of perceived rewards and their distribution, the influence of norms, and reciprocity across exchanges) are used to structure the discussion of results. potential loss and gain within the context of dependency court, key decisions are made that can alter the life of those involved. it was evident after examining the data, those responsible for making those key life-altering decisions weighed the potential losses and gains and were often influenced by personal biases. for example, data from focus groups with the judges pointed to a child-centered approach that marginalized families of origin and reflected tension across collaborating agencies. one judge described the presumed biases in dependency hearings, “birth parents complaining to high heaven that everything is just fixed.” through observations of dependency hearings, we noted that judges were critical of work done by “the agency,” but their negative perception of parents led them to trust a caseworker’s testimony over that of parents. judges expressed an inability to understand the poor decisions and risky behaviors of biological family members. one judge stated, parents “shouldn’t have had kids to begin with” and another stated, “we treat our dogs better.” supporting the notion that families involved with child welfare are “doomed,” another judge stated, “they are already wrecked by the time the agency gets involved.” these sentiments clearly influence judges’ decision-making process when weighing the potential losses and gains to keeping families together. perceived rewards and their distribution key to this theoretical concept is that each group member adheres to a predictable pattern. as a result, they expect to be rewarded and anticipate that the rewards will be equally distributed across group members who adhere to those expected behaviors. being part of the in-group affords one power, status, and alignment with the norms of the courtroom. members of the in-group are more likely to be perceived favorably by the judge and hence have their views and opinions (i.e., recommendations) hold more weight advances in social work, fall 2014, 15(2) 312 in the decision-making process. as parents are not part of the in-group, the testimony they provide is not weighted equally. it was immediately apparent during the observations of the dependency hearings that two types of “groups” existed, the “in-group” and the “out-group.” members of the outgroup were neither acknowledged nor engaged by members of the in-group. the in-group comprised the professionals, including the judges, attorneys, guardians ad litem, and caseworkers whose behavior reflected a disregard for the parents’ role in decisionmaking/case planning. negotiations among in-group members were observed being made before the hearing occurred. when it was time for the hearing, the professionals appeared to be “going through the motion,” as decisions and plans were already made and/or based on hearsay/reputation rather than first-hand testimony and concrete evidence. data received from the focus group with the caseworkers supported the observations reported above. caseworkers spoke at length about the unfair treatment received by “their families.” “so many side conversations going on between the attorneys and lack of professionalism…while clients are in there…they (clients) don’t feel that they are taken seriously.” another caseworker stated, “i feel like the parents are kind of standing there, like they’re already hopeless 'cause, you know, they don’t know what’s going on and sometimes they feel like i don’t feel like i can stand up for myself and it’s like if their attorney’s not even giving them the time of day, why should they feel any different than that.” this sentiment of unequal distribution was reiterated by the guardians ad litem who described an adversarial process that marginalized parents. “when you are in court, it is a very different atmosphere. it is very adversarial. parents, they feel like they are being attacked. a lot of times the parents are blindsided so i understand the frustration level and why there is mistrust now with the agency. unfortunately that happens a quite bit.” influence of norms the dependency court interactional norms and the physical layout of the area were exclusionary. professionals were “at ease” while caregivers were “shuffled” in and out. there was a lack of instruction or direction provided about courtroom rules or expectations. in-group members moved comfortably across barriers to chat with the clerk and clustered for informal conversation near the judge’s bench. parents’ space was restricted; family members remained standing and then were seated behind tables that were on the “right side” of the barriers that divide the judge from the courtroom audience. the professionals also used language that separated themselves from the parents and, at times, appeared to exclude parents from conversations thereby reinforcing professional solidarity. there was also an air of “nonchalance” that permeated the proceedings, rather than the sense of formality and respect that was expected given the serious nature of these cases. professionals’ perceptions of parents, coupled with the parents’ out-group status, minimizes parents’ chances of being “rewarded” regardless of whether or not the parent adheres to the expected behaviors. in part, the physical space conveys normative expectations related to conduct within the courtroom and interaction among the various rice, girvin/engaging families 313 stakeholders. however, these expectations were modified or overlooked if the individual was a member of the in-group. for example, it was noted that attorneys for all involved parties were the “insiders” and did not have to follow rules of decorum that were applied to families such as cell phone use within the courtroom. reciprocity across exchanges most relationships among the professionals were reciprocal in nature; however the relationships between professionals and parents were not. parents perceived less power in their exchanges with professionals. among professionals, there was a sense of solidarity expressed through casual in-group conversation. family members were not invited to participate. during focus groups, resource parents spoke at great lengths about judicial “power plays” and “the politics that nobody likes to admit,” noting that families of origin were treated unfairly. “every other person in the courtroom minus the biological parents has a working relationship with everybody else in the courtroom. all these people are on a first-name basis all the time.” youth also reported a lack of reciprocity as well as relationships with professionals that were characterized by mistrust and unfamiliarity. “you are not really a part; you are just there as a visitor to the court.” another youth spoke to the lack of reciprocal exchange in the relationships between inand out-group members. “they don’t really say a lot of positive things in there; they point out mostly negative stuff.” however, one youth had a different perspective, which reflects what occurs in reciprocal relationships. “when they see you are making an effort, they start to trust you and that really builds over time. you come 10% and they’ll come 10%.” discussion and implications relationships between parents/caregivers and key child welfare stakeholders were examined in this study to identify the degree to which families are engaged throughout the dependency court process. results illustrate that despite child welfare’s focus on strengths-based, family-centered practice (alpert & britner, 2005), a lack of reciprocity, supported by in-group/out-group dynamics, the culture of professionalism, and both actual and perceived courtroom norms and structure make it unlikely that collaborative relationships that support and assist families will develop. organizational conditions such as bureaucracy, large caseloads, legal and agency mandates, and both personal and professional biases create pressures against implementing best practices in the context of dependency court. under pressure to keep children safe and move through hearings quickly, an “us versus them” mentality emerges that underscores the differences between professionals and the families of origin with whom they work. the separatism of professionals and families is exacerbated by the cultural norms of dependency court, which begin to define the relationships between professionals and parents/caregivers. these courtroom norms (e.g., adversarial relationships, sterile environment) are contrary to social work’s strengths-based perspective that promotes advances in social work, fall 2014, 15(2) 314 collaboration and reciprocity (holland, 2000). therefore, parents/caregivers may learn to expect little from the relationship with their caseworkers. this learned expectation may limit the likelihood of their follow-through on their service plans as they do not anticipate the reward of being reunified with their child. social exchange theory would suggest that parents/caregivers might expect work required by their service plans to be fruitless, as the system appears biased toward professionals. put differently, agency and judicial demands and norms produce two groups—families and professionals—that are most distinguishable by differential access to power and markedly different expectations of rewards. limitations the primary limitation of this study is that parents/caregivers were not interviewed; therefore, the findings may not adequately reflect their perspective. the study’s results may only be representative of a particular place (one courtroom) and the time when the data were collected. further, while social exchange theory provides a useful analytic lens, further observation and interviews are required to explore stakeholders’ awareness of observed dynamics as well as their views on motivation. despite these limitations, this exploratory study contributes to the limited knowledge of child welfare practice within the context of dependency court. the findings highlight some challenges that may be associated with translating best practices into everyday practice. implications for social work practice though child welfare practice has moved toward intervention strategies that are strengths-based and centered on family engagement and worker-family collaboration, courtroom culture and systemic requirements have impeded the application of this approach to legal procedures and hearings. further research may help to illuminate barriers and point to training and education that would address them. social exchange theory suggests that there are rewards for adhering to group norms. rewards for the in-group (professionals) include professional validation, camaraderie, and the expediency of hearings. the degree to which members of this group are aware of this dynamic and/or pursue rewards strategically bears further investigation. cross-system training that engages social workers (i.e., caseworkers), attorneys, and judges in conversations about the reality of system pressures (e.g., caseloads, federal and state laws, and timelines) and the family-centered approach of child welfare practice may prove useful. the recognition that the cultures of court and child welfare may function at odds, though they are in pursuit of the same goal (child safety and well being), would be a fruitful starting point for ongoing dialogue and training across systems. a key goal of this training would be the teaching of strategies that build and/or strengthen qualities of a positive helping relationship between the professionals and parents/caregivers as well as providing tools that enhance advocacy skills. tools that strengthen advocacy skills assist professionals in learning how to navigate what may appear to be contradictory goals, protecting children and maintaining families, in a way that enhances rather than hindering the helping relationship. as previously stated in the literature, fostering a positive helping rice, girvin/engaging families 315 relationship is key to any successful outcome in social work, including child welfare. therefore, training that highlights power imbalances and ways to combat or manage them to foster a helping relationship and bring about positive change is essential in child welfare practice. conclusion an improved understanding of the social structure of dependency court may inform child welfare practice and policy to enhance family engagement throughout judicial processes. data may point to organizational, social, and/or personal factors that frustrate the attempts of workers to engage families and, more generally, impede the efforts of all involved parties to work collaboratively toward the goals of permanency and child wellbeing. better understanding the challenges faced by professionals and parents/caregivers involved in dependency court may inform training that builds and enhances skills that can foster a supportive, helping environment. references adoption and safe families act (asfa) of 1997, pub. l. no. 105-89, codified at 111 stat. 2115 (1997). alpert, l. t., & britner, p. a. 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(2009). techniques and guidelines for social work practice (8th ed.). boston, ma: allyn & bacon. rice, girvin/engaging families 317 smith, b. d., & donovan, s. e. f. (2003). child welfare practice in organizational and institutional context. social service review, 4, 541-563. doi:0037-7961/2003/77040003 solomon, b. (1976). black empowerment: social work in oppressed communities. new york, ny: columbia university press. trotter, c. (2002). worker skill and client outcome in child protection. child abuse review, 2, 38-50. doi:10.1002/car.719 wasserman, h. (1971). the professional social worker in a bureaucracy. social work, 16(1), 89-95. winfield, h. r., & barlow, j. a. (1998). client and worker satisfaction in a child protection agency. child abuse & neglect, 19(8), 897-905. yatchmenoff, d. k. (2005). measuring client engagement from the client's perspective in nonvoluntary child protective services. research on social work practice, 15(2), 8496. author note address correspondence to: karen rice, phd, lsw, acsw, assistant professor/ department chair, social work department, millersville university, po box 1002, millersville, pa 17551. email: karen.rice@millersville.edu advances vol. 1, no. 2 ppoowweerr iinn tthhee ppeeooppllee:: ssttrreennggtthhss aanndd hhooppee dennis saleebey abstract: the strengths perspective and resilience literature suggest that social workers may learn from those people who survive and in some cases flourish in the face of oppression, illness, demoralization, and abuse. social workers need to know what steps these natural survivors have taken, what processes they have adopted, and what resources they have used. in this article, written specifically for advances in social work, dennis saleebey discusses the central tenets of strengths-based practice. keywords: strengths, resilience, strengths-based, social work, hope, diagnostic strengths manual the wildly expanding resilience literature compels us to regard and respect the qualities, traits, virtues, and resources that people develop, acquire, and accumulate as they confront and struggle with the challenges in their lives. the strengths perspective acknowledges that reality, too. in addition, the strengths approach obligates us to understand—to believe—that everybody (no exceptions here) has external and internal assets, competencies, and resources. these may be a realized part of a person’s life or they may be inchoate—unrealized and unused. but the understanding and work of people who employ a strengths perspective is driven by the search for, the definition, and employment of peoples’ resources in helping them walk, however hesitatingly, in the direction of their hopes and dreams. we are called to venerate the remarkable abundance of human experience, to acknowledge that every individual, family, and community has an array of capacities and skills, talents and gifts, wiles and wisdom that, in the end are the bricks and mortar of change. we must assume the humble stance that we cannot know, except in the most obvious of cases, the upper limits of a person’s capacity to grow and change. the strengths perspective holds firm the idea that everyone who struggles learns something from their struggle and develops capacities and traits that may ultimately turn out to be bountiful resources in moving towards a better life. it is to assert that everyone has dreams, visions, and hopes even though they may currently be dashed on the shoals of disease, oppression, poverty, or muted by a run of rotten luck. the work of the strengths approach is the work of empowerment—helping individuals, families, and communities see and utilize their capacities; recognize the options open to them; understand the barriers and scarcities they may face; surface 127 dennis saleebey, ph.d. is professor, university of kansas school of social welfare, lawrence, kansas 66045 usa. copyright© 2000 advances in social workvol. 1 no. 2 (fall 2000) 127-136. indiana university school of social work. their hopes and aspirations; and align them with their inner and outer resources to improve the quality of their lives (cowger, 1994; rapp, 1998; saleebey, 1997). empowerment is both a process and a goal. as a goal, those who are empowered seek a firmer sense of purpose, a place to be and belong, an operating fund of esteem, the possibility of choice, connections to resources and ties to others, and a palpable awareness of their achievements—both in the short run and in the distant future. empowerment as a process is the collaboration between, say a social worker and a family or individual, working together on a mutually-crafted project that in some sense will move people closer to their visions and aspirations (rapp, 1998). the strengths perspective, then, is about “uncovering, naming, embellishing, and celebrating abilities, talents, and aspirations in the service of desired change”(weick & saleebey, 1995). the strengths perspective is a way of thinking about and looking at the people social workers help and the work they do with clients. in a sense it is a paradigm shift, although social workers have insisted for years that they build on the strengths of clients. but it is only recently that there has been any significant work—whether inquiry and research or clinical practice or community work— focused on developing a strengths perspective. in addition, there are concurrent developments in other areas that provide conceptual and ideological support for this framework for professional thinking and doing. these include, among others: empowerment and liberatory approaches (many of which have been built on liberation theology and the social activism of the ’60s and ’70s); the resilience literature; healing and wellness practice and inquiry; solution-focused orientations, as well as narrative approaches to practice (see saleebey, 1996). while these are all different in many ways, they include some common understandings: • people who confront stress almost always develop some ideas, capacities, traits, or defenses that may subsequently stand them in good stead. heretofore, social workers have been much too avid in looking at the impediments and injuries, the deficits, and desolation rather than people’s compensating and transformative responses to the challenges they confront. • even in the most demanding, tough, lean, and mean environments, there are natural resources—individuals and families, churches, associations, groups— available to individuals, groups, and families. while some are clearly more bountiful than others, all environments have assets (kretzmann & mcknight, 1993). • even though people may have labored under years of the blame and disapproving opinions of others or self-criticism, habitual pessimism, or unfortunate life decisions, at some level they almost always know what is right for them. • as a species, humanity surely has—or we would not have survived thus far—an innate capacity for health and self-righting. • healing, transformation, regeneration, and resilience almost always occur within the confines of a personal, friendly, supportive, and dialogical relationship. whether a physician, social worker, psychologist, friend, or relative, the more the power of a caring relationship is actualized with those served, the better for the individual’s future and for social work’s equipoise. 128 advances in social work • everyone has knowledge, talents, capacities, skills, and resources that can be used to help move them towards their aspirations, solve problems, meet their needs, and bolster the quality of their lives. • a positive orientation to the future is far more important in the long run for healing and helping than an obsession with a dark and disappointing past. • every maladaptive response or pattern of behavior may also contain the seeds of a struggle for health and self-righting. to sum up: imagine an equilateral triangle. the left angle is fronted by the letter c; the angle to the right by the letter r. the apex of the triangle is topped with the letter p—cpr, as it were. c represents capacities, competencies, and character. p stands for promise and possibility. r symbolizes resources, resilience, and reserves.1 these make up the dynamic core of a strengths-based approach to practice. all three must be a part of any kind of healing or helping. much of the impetus for developing and emerging a strengths/resilience-based practice comes from american society’s preoccupation and fascination with pathology, problems, moral and interpersonal aberrations, violence, and victimization. add to that the continuing penchant towards “medicalizing” and “pathologizing” almost every pattern, habit, trait, and inclination of human behavior and one has an intoxicating mix of diagnoses, labels, and identities at the ready—all broadcasting one’s abnormalities, disorders, weaknesses, fallibilities, and deficits (kaminer, 1993; peele, 1989; peele & brodsky, 1991; rieff, 1991). but important, too, has been the developing realization that the social worker’s focus on aberrations and problems has not yielded much in the way of social betterment or the lessening of the incidence and prevalence of various disorders (hillman & ventura, 1992). likewise, there is a growing body of evidence that the linchpin of many theories of disorder and mental illness—that childhood troubles of various kinds are fateful for the development of pathology in adulthood—is not very powerful or convincing (lewis, 1997). it needs to be understood that a strengths perspective does not require one to blithely ignore or mute the real pains and troubles that afflict children, groups, families, and classes of people. poverty is real.2 child sexual abuse is real. violence is real. cancer is real. schizophrenia is real. racism is real! the strengths perspective does not require one to discount the grip and thrall of addictions or the humiliating, frightening anguish of child abuse, or the unbidden disorganization and confusion of psychosis. but from the vantage point of a strengths perspective, it is as wrong to deny the possible just as it is to deny the problem. and the strengths perspective does decry the intemperate reign of psychopathology and illness as the central civic, moral, and medical categorical imperative. adherents of the strengths perspective do not believe, with good reason, that most people who are the victims of abuse or their own rampant appetites, or that all people who have been traumatized inevitably become damaged goods. followers of the strengths approach do believe that the recovery movement, now so removed from its original boundaries and intent, has: . . . pumped out a host of illnesses and addictions that were by earlier standards, mere habits, some good, some bad. everywhere publicly, social work129saleebey/power in the people: strengths and hope ers find people talking freely, if not excitedly, even proudly about their compulsions—whether it be gambling, sex, exercise, or the horrible desire to please other people. we are awash in a sea of codependency, wounded inner children, and intimacy crises. (wolin & wolin, 1993, p. 7) old paradigms die hard. theories about patients, clients, victims, and the disadvantaged have been around for a while.3 on the one hand, it is good that the attic door has been opened so that women and children who have been or who are abused can tell their story. on the other hand when that door has been opened, social workers have failed to see all that was in there—including a variety of resources and possibilities. defining these heretofore silent ones as victims seemed initially to be a service to them. but unfortunately, victim has become for far too many a master status (becker, 1972), a controlling set of expectations, norms, images, and behaviors that have become hardened over time, difficult to penetrate, and supercede every other element of identity (one becomes, for example, a schizophrenic violinist or a gay plumber). worse yet, many people are invited or persuaded to think of themselves as victims when they have experienced only the bumps and bruises that many can expect at some point in our lives. the same might be said of the recovery movement. in spite of the widespread good it has done, it has now spread so widely and captivated so many people that its good is obscured by its overweening dictates (kaminer, 1993; peele & brodsky, 1991). the core conditions of change one way to understand the orientation of those who adhere to a strengths-based approach to practice is to ask, what are the factors in life and in helping that make things go well? it is odd, when you think of it, that even though we know that most people in the midst of significant challenges and stresses do better than we might expect and do not eventually succumb to the pressures of their lives, that social workers know so little about them. on the other hand, they have a prodigious lore about those who, at least initially, fall or fail under these stresses and ordeals. social workers’ knowledge about those who change naturally and spontaneously everyday is trifling by comparison. so what does one know about discovering and building upon strengths? there are ideas, hints, and data everywhere but let us look at one perspective that this author finds rich in implication. in his review of the efficacy of psychotherapy studies conducted over many years, michael lambert (1992) says there are four factors that account for most of the positive change in individuals and families. these are plump with inferences for strengths-based approaches. the largest share of the benefit experienced by individuals can be attributed to their personal and social resources, as well as contingent factors (luck) that intercede in their lives. (lambert calls them extra-therapeutic change factors that aid in positive change, whether or not an individual ever experiences psychotherapy.) the matrix of clients’ lives goes a long way toward explaining how they might react: their strengths and assets, how they see their misery (their theory) and motivation, their social supports, and the contingent factors that move inexplicably in and out of their lives. this means being mindful of things in a person’s world—relationships, culture, opportunities—those conditions and people that might be positive, supportive, helpful, or even therapeutic. it also means listening and looking for 130 advances in social work evidence of the resources and aptitudes of clients as they tell their stories. these speak to the power of context as well—those micro-environments, the intimate spaces and places where people live and work, that have a powerful impact on how one acts, thinks, and feels. we are exquisitely sensitive to changes in context, says malcolm gladwell (2000). he claims that the power of context is revealed in the “broken windows” theory of harvard criminologists james q. wilson and george kelling. basically, the idea is that if windows are broken in a neighborhood, the walls are covered with graffiti, lots are filled with trash and refuse, etc., people conclude that no one is taking care of this place, no one cares, and no one is in charge. it is because of those very assumptions that these small environments then become targets for criminals—no one is concerned or has ownership and no one will notice. many cities, notably new york, have begun to look at this and by simply repairing windows, erasing graffiti, cleaning up lots, keeping at it, and involving neighbors in the project, they find things begin to change. a still more positive note: in many neighborhoods across the country, especially economically-distressed ones, people, without knowing its name, are beginning to put the brokenwindows theory into operation and taking it a step further: painting murals, growing community gardens, building sculptures, and refurbishing playgrounds and parks. the context becomes more livable, more humane, more interesting, and very importantly, more hopeful (delgado, 2000; gladwell, 2000). the second most powerful force for change is the character and tenor of the helping relationship (common factors, according to lambert). the quality of the relationship between helper, physician, and client and patient has always been understood (and in some cases undervalued) as a powerful tool for healing. hans strupp (1995), who has studied the effectiveness of psychotherapy for decades, said that the relationship is the sine qua non of all forms of therapy. it is the medium of change, a dynamic that is not to be underestimated. the important elements of that kind of relationship are well-known, thanks in large part to the pioneering work of carl rogers (1951): respect, genuineness, concern, collaboration, and empathy. in addition, release of tension, reassurance, the alliance forged with the client, and direct activity play a role here. if healers are seen as nonjudgmental, trustworthy, caring, and expert, they have some influential tools at hand, whether they are addressing the depths of a serious depression or the disappointments and pains of unemployment. a relationship of this sort provides a milieu and context for confronting the difficult and considering the imaginable. the third and fourth factors, roughly equal in their impact, are the placebo effect and the technical operations and methods of the theory employed by the helper (for example, family systems, cognitive, or behavior therapy). we will more closely examine the power of expectancy and the placebo below. the methods of theory carry with them assumptions about cause, the nature of the problem, as well as directives about what to do. but, to a significant extent, they succeed or fail because of the presence (or lack of it) of these other, apparently more salient, factors (for an excellent discussion of these factors, see miller, duncan, & hubble, 1997). of great interest to those who subscribe to a strengths-based orientation is the influence of expectancy, hope, and the placebo effect. consider the following. 131saleebey/power in the people: strengths and hope michael fisher (2000) reports that in the 1950s at the university of kansas medical center in order to test a new medical procedure for the treatment of angina, surgeons performed real operations on one group of male patients with angina and a “placebo operation” on the other group. the placebo group was told they were going to have heart surgery; they were given a local anesthetic and incisions were made in their chests. but no operation was done. the surgeons merely worked somewhat, and the patients had the scars and pain to indicate that they actually had surgery (the ethics of this are distressing, and this author assumes that such an experiment would not happen today, but he really does not know for sure). seventy percent of those who had the real surgery reported long-term improvement in their angina; but all of the placebo group did, as well. it is not at all uncommon in tests of psychoactive drugs for the placebo groups to show improvements ranging anywhere from 25 to 60%. the extent that the real drug is better than the placebo is thought to be the extent that the drug is effective. but one cannot say, for instance, just how much of the effect of the real drug is also a placebo phenomenon. in more recent years, people have been getting an “active placebo” from which they experience side effects. people are more likely to get better on active placebos because they experience side effects, which convince them that they are getting a real and powerful drug. joseph arpala reports that a study by fisher and greenberg revealed that in 30 to 40% of all the studies of antidepressant drugs and placebos they reviewed, the placebo was as powerful or therapeutic as the drug (arpala, 2000). so what is happening here? many things, no doubt. one possibility that many have proposed is that when people are sick and have an expectation, thanks to a procedure or pill, they get better. there is an “unconscious” mobilization of the healing systems within, whether it is the psychoneuroimmune system, endorphins (endogenous morphine produced by the body), or a parasympathetic nervous system relaxation response that lowers, among other things, cortisol, the production of which is related to stress, or some unknown process. perhaps even more important here is the expectation of the healer that the patient will get well, the gathering of hope and possibility that things will be different in the future. social workers spend much of their possible good will hinting or directly saying that things will not be better; that once stuck, hurt, disappointed, abused, or ill that clients will always suffer scars, or the effects of these will continue to reverberate in one way or another throughout our lives. it is not just the individual’s expectation that he or she will recover, rebound, or do better; it is the unmistakable expectation of the social worker, physician, healer, minister, teacher, coach, relative, friend, or parent that they will. this is the attitude and belief that “we” can make it, “we” can leap the hurdle, climb the wall, escape the burden. “we” may need help. it may take time, but this author’s belief in the individual is constant and unwavering. as a child, heretofore defined as “at-risk,” this author sees the patient, as beth blue swadener says, as a child “at promise” (swadener, 1995). this author thinks the two key ideas here are hope and possibility. oddly enough, there has been much conceptual work and actual application of ideas related to hope, anyway—more than one might think. c. r. snyder, the university of kansas, has done considerable work in this area. hope is also very much a part 132 advances in social work of the strengths perspective and the recovery and resilience movements. this author cannot “hope” to reflect the depth of work he and others have done but can begin with a quote from the late paulo freire, one of the most eloquent spokespersons for the oppressed worldwide. his book, pedagogy of the oppressed (2000), should be required reading for all social workers. in pedagogy of hope, freire wrote before his death: there is no change without the dream, as there is no dream without hope. (1996, p. 91) hope is about imagining the possible, the “untested feasible,” as freire would have it. but more specifically, it is about thinking of one’s self as an agent, able to effect some change in one’s life, having goals that not only have promise but also pathways to their accomplishment—pathways that may be short or long, full of ruts or smooth, well-lit or darkened. as social workers, we consort with the subjunctive, the possible, and help to assure the agency of others, working on fashioning their hopes into goals and finding, as partners with them, those pathways to promise. in one sense, it matters little whether one reaches the end of the journey but merely that one begins the journey and reaches some of the stops along the way (snyder, 2000). so, the expectation that one will get better; that there is a chance that the odds can be beat; that one has within the power to transform or at least fight the disease process; this author’s expectation as a friend, intimate partner, or social worker that the client will do as well as possible when confronted with whatever difficulties they have, are all extremely important elements in recovery or at least the progress of the illness. elements of strengths-based practice there are some root principles of strengths-based practice that should not be ignored. they are disarmingly simple but difficult to put into practice because they run counter to some of the thinking that characterizes some practices today. 1. believe the client and believe in the client. social workers are sometimes encouraged by our own experience or by the expectations of others to disbelieve clients. we are leery of being trumped or duped by the artful manipulator or the deft sociopath. but, until proven otherwise, believing the client and believing in the client are two of the most powerful tools for engaging clients in what is a most difficult and arduous task—making life better (de jong & miller, 1995). 2. affirm and show interest in the client’s view of things. it is the narratives and stories that clients bring to us and share with us that allow us to discover who they are, what they know, what virtues they possess, what troubles they have faced, and what dreams they have (hoyt, 1996). 3. a focus on the dreams, hopes, and visions of people encourages them to begin thinking subjunctively about what might be and how it might come about. troubles may trump their ability to do this, but at some point, it is the possible, the promise that drives the engine of change (snyder, 2000). 4. central, of course, to the strengths approach to practice is to begin making an accounting of the assets, resources, reserves, and capacities within the client and 133saleebey/power in the people: strengths and hope in the environment—family, extended family, neighborhood, and institutions (like churches, schools, and informal associations). this inventory of strengths should be every bit as detailed, descriptive, and refined as the diagnostic categories of the dsm-iv-tr (american psychiatric association, 2000). in that spirit this author offers an example of an imagined doppleganger of the dsm iv—the diagnostic strengths manual. under the section 300.00 estimable personal qualities, we find: 302.00 trustworthiness criterion a. for at least six months, nearly every day, the individual has exhibited at least three of the following: 1. has done what he or she promised. 2. kept at a task that needed to be done despite problems and obstacles. 3. did not reveal a confidence. 4. stuck by a colleague, friend, or relative during a difficult time. 5. did more than expected. criterion b. this is not better explained by co-dependency or the pathological desire to please. criterion c. such behavior must have improved the lives of other people at some cost to the person’s own comfort. criterion d. rule out the possibility of a self-seeking desire to cash in on these loyalties later. (saleebey, in press) social workers need to develop fully as lexicon, an encyclopedia of strengths so that they have a language and imagery as compelling and captivating as that found in the dsm-iv-tr. 5. believe that there are forces for healing, self-righting, and wisdom within or around the person or family and begin to search for and employ them in the service of achieving goals on the path to the dream. many observers, some clinicians, and researchers have begun to realize just how potent natural forces for recovery and transformation can really be (deegan, 1996; mills, 1995). in summary, to enlist participation, involvement, and to engage individuals, families, and/or communities: a) assume a positive, collaborative demeanor; b) radiate the resilience attitude (see above); c) rely on indigenous wisdom, resources, and natural assets, capitalizing on what people know, what they can do, and where they want to go; d) convey positive expectancies, affirmations of the possible; e) be engaging, likable, credible, responsive, working eyeball-to-eyeball, shoulder-to-shoulder with individuals, families, and community members and; f) be flexible and willing to assume many perspectives and take on many roles. to discover the strengths and health within: a) develop an enriched roster, an exceptional accounting of exceptions, resources, assets, and possible solutions or pathways to goals; b) find and celebrate, draw lessons from the times where the individual, family, or community has surmounted adverse conditions and bad luck, as well as their own harmful decisions; c) seek out “survivors pride” (wolin & 134 advances in social work wolin, 1993)—that spark of recognition and esteem that comes from having met challenges and survived them; d) always seek to discuss and imagine how things could be otherwise, what a dream fulfilled would feel, taste, smell, and look like; e) seek out, elaborate, and employ the client’s theory of change about how to make it to a better life; f) celebrate success; g) think small but think success when developing goals and; g) look around, look ahead, but try not to look back. conclusions at the very least, the strengths perspective and the resilience literature obligate us to understand that however downtrodden, beaten up, sick, or disheartened and demoralized, individuals have survived, and in some cases even flourished. they have taken steps, summoned up resources, coped, or maybe just raged at the darkness. social workers need to know what they have done, how they did it, and what resources provided ballast in their struggles. people are always engaged in their situations, working on them even if they just decide to resign themselves to their fate. circumstances can overwhelm and debilitate. we do know a lot about that. but dire circumstances can also bring a surge in resolve and resilience. we must know more about that and how to make an alliance with those forces. endnotes 1thanks to my daughter, meghan, a social worker, for this scheme. 2the designations “schizophrenia,” “poverty,” etc. are linguistic and social constructions that carry freight on their own, but the human anguish of the experience is unmistakable. 3we have a variety of designations for those whom we think of as “other” or “different” from the rest of us—either by their own doing or by the malfeasance of others. references american psychiatric association. (2000). diagnostic and statistical manual iv—text revision. washington, dc: the american psychiatric association press. arpala, j. (august, 2000). sweet sabotage: how sugar pills compromise drug trials. psychology today, 32, 66. becker, h. s. (1972). outsiders: studies in the sociology of deviance. glencoe, il: the free press. cowger, c. d. (1994). assessing client strengths: clinical assessment for client empowerment. social work, 39, 262-268. deegan, p. e. (1996). recovery as a journey of the heart. psychiatric rehabilitation journal, 19, 91-97. de jong, p., & miller, s. d. (1995). interviewing for client strengths. social work, 40, 729-735. delgado, m. (2000). community social work practice in an urban setting: the potential of a capacityenhancement perspective. new york: oxford university press. fisher, m. j. (october, 2000). better living through the placebo effect: it pays to believe. the atlantic monthly, 286, 16-18. freire, p. (1996). the pedagogy of hope: reliving pedagogy of the oppressed. new york: continuum. freire, p. (2000). the pedagogy of the oppressed (3rd ed.). new york: continuum. gladwell, m. (2000). the tipping point: how little things can make a big difference. boston: little, brown and company. 135saleebey/power in the people: strengths and hope hillman, j., & ventura, m. (1992). we’ve had one hundred years of psychotherapy and the world is getting worse. san francisco: harper san francisco. hoyt, m. f. (1996). introduction: some stories are better than others. in m. f. hoyt (ed.), constructive therapies 2 (pp. 1-32). new york: the guilford press. kaminer, w. (1993). i’m dysfunctional, you’re dysfunctional. new york: vintage books. kretzmann, j. p., & mcknight, j. l. (1993). building communities from the inside out. evanston, il: center for urban affairs and policy research, northwestern university. lambert, m. j. (1992). implications of outcome research for psychotherapy integration. in j. c. norcross & m. r. goldfried (eds.), handbook of psychotherapy and behavior change (pp. 94-129). new york: basic books. lewis, m. (1997). altering fate: why the past does not predict the future. new york: the guilford press. miller, s. d., duncan, b. l., & hubble, m. a. (1997). escape from babel. new york: w.w. norton. mills, r. (1995). realizing mental health: toward a new psychology of resiliency. new york: sulzburger & graham. peele, s. (1989). the diseasing of america. lexington, ma: lexington press. peele, s., & brodsky, a. (1991). the truth about addiction and recovery. new york: simon & schuster. rapp, c.a. (1998). the strengths model: case management with people suffering from severe and persistent mental illness. new york: oxford university press. rieff, d. (1991). victims all. harper’s magazine, october, 49-56. rogers, c. (1951). client-centered therapy: its current practice, theory, and implications. chicago: houghton-mifflin. saleebey, d. (1996). the strengths perspective in social work practice: extensions and cautions. social work, 41, 295-305. saleebey, d. (ed.). (1997). the strengths perspective in social work practice. new york: longman. saleebey, d. (in press). the diagnostic strengths manual? social work. snyder, c. r. (2000). hypothesis: there is hope. in c. r. snyder (ed.), handbook of hope: theory, measures, and application (pp. 3-24). san diego, ca: academic press. strupp, h. h. (1995). the psychotherapist’s skills revisited. clinical psychology, 2, 70-74. swadener, b. b. (1995). children and families “at promise:” deconstructing the discourse of risk. in b. b. swadener & s. lubeck (eds.), children and families "at promise": deconstructing the discourse of risk (pp. 17-49). albany: suny press. weick, a., & saleebey, d. (1995). a postmodern approach to social work practice. paper presented at adelphi university, school of social work, garden city, new york. wolin, s. j., & wolin, s. (1993). the resilient self: how children of troubled families rise above adversity. new york: villard. author’s note: address correspondence to: dennis saleebey, ph.d., professor, university of kansas school of social welfare, twente hall, lawrence, kansas 66045 usa. 136 advances in social work aisw vol. 5, no. 2 211 equal access to justice in a ruralwestern state monte miller abstract: twenty three inmates from a rural state penitentiary with mental retardation participated in a study on the differential treatment of persons with mental retardation by the criminal justice system. after obtaining informed consent, the inmates were screened for appropriateness for the study using the ppvt-r, a proxy test for iq. the inmates were interviewed to obtain a social history and given the cast-mr, an instrument that measures the competency of a person with mental retardation to stand trial. results suggest participants may not have been competent to stand trial, learnedmost ofwhat they knewabout the criminal justice systemwhile incarcerated,and had difficultywith interpersonal conflict and conflict with authority. the combination of these factors suggests that clients in the studymay have been vulnerable to being coerced into confessing to crimes they did not commit. the presence of an advocate during criminal justice system encounters may benefit persons with mental retardation. keywords: disabilities,mental retardation, rural, social justice, advocacy, criminal justice this article discusses one portion of a larger interdisciplinary study conducted in a rural western state. the study’s purpose was to determine whether persons with mental retardation understood the adjudication process. the study was exploratory in nature and sought to address the question: do persons with mental retardation understand the adjudication process? other concerns that were related to the initial question included the treatment of persons with mental retardation while interacting with the criminal justice system. persons with mental retardation may be vulnerable to verbal, physical, and sexual assault during their encounter with the criminal justice system. the larger study included men and women from several correctional settings; however, this article investigates the experiences of men with mental retardation who were serving time in a state prison. adjudication is defined as the ability to hear and settle a case by judicial procedure (american heritage dictionary, 2000). the adjudication process, for purposes of this paper, includes this definition and the various stages of monte miller is an assistant professor, division of social work, university of wyoming, laramie, wy 82071. copyright© 2004 advances in socialworkvol. 5 no. 2 (fall 2004) 211-224. indiana university school of socialwork. the process including initial questioning, arrest, interrogation, arraignment, trial, and sentencing. persons with mental retardation are over-represented in correctional facilities such as prisons, jails, and detention centers. although persons with mental retardation represent between 1% and 2% of the general population, persons with mental retardation represent as much as 30% of the population in correctional facilities (conley, luckasson & bouthilet, 1992; petersilia, 1997). ellis and luckasson (1985) state that the criminal justice system has been and continues to be a place where persons with mental retardation are warehoused simply because society does not know what else to do with them. despite societal progress indicated by legislation such as the americans with disabilities act (ada, 1990), the efforts of disability organizations, self-advocacy by persons with mental retardation, andmedia coverage of injustices towards persons withmental retardation, disproportionate numbers of persons with mental retardation in the criminal justice system persist in rural and urban environments (everington & fulero, 1999). the problem is pervasive and complex. literature review a review of the literature reveals a complex, systematic manner in which people withmental retardation become enmeshed in the criminal justice system. an initial concern is the definition of mental retardation. although the disproportionate incarceration of people with mental retardation continues, there has been recent disagreement about defining mental retardation in the field of disability studies (luckasson, 2000). a generally accepted definition is that persons with mental retardation have an iq of less than 70, childlike thinking qualities, and problems adapting to new situations (aamr, 1992; apa, 1994). it is worth noting that persons with iq scores over the 70-point cutoff, such as a personwith a score of 80, may have low cognitive functioning. such a person may have many of the same difficulties as persons with mental retardation even though he or she lacks the “advantage” of having a defined disability. people in this category are also vulnerable and may “fall through the cracks” of the judicial system. persons with mental retardation have several characteristics that put them at risk for abuse or mistreatment while interacting with the criminal justice system (keyes, edwards & perske, 1997). first, and perhaps most obviously, persons with mental retardation function at lower levels, both adaptively and intellectually, compared to persons without mental retardation. second, persons with mental retardation can be impulsive, which can result in their committing acts that those without mental retardation refrain from committing. finally, persons with mental retardation often become easily frustrated, exhibit a desire to please persons in authority such as law enforcement officers, and acquiesce to thewishes of individuals whom they perceive to be in positions of authority (conley, luckasson & bouthilet, 1992; everington & fulero, 1999; keyes, edwards & perske, 1997).while persons with mental retardation are certainly individuals and have individual characteristics, the previously listed tendencies are prevalent in the literature. the combination of these characteristics can lead to unfavorable outcomes during the initial encounter with law enforcement personnel during interroga212 advances in socialwork tion, arraignment, and adjudication, while serving time in a correctional facility, and after release. persons with mental retardation are less likely to question lengthy interrogations, be susceptible to being led by an interrogator, and are likely to confess in order to please persons in authority (petersilia, 1997). persons with mental retardation are vulnerable at all points of encounter with the criminal justice system and are more at risk for sexual and physical abuse once in the correctional system (pelka, 1997). finally, often, there is no distinction made between persons with mental retardation and persons without mental retardation during probation or parole proceedings (pelka, 1997; petersilia, 1997). thus, persons with mental retardation are released without a plan for supports and are reincarcerated at a higher rate than persons without mental retardation (pelka, 1997; petersilia, 1997). in a rural environment where many people know each other, this has the potential to play out in several ways. if the rural community perceives the person as a criminal, the chances of a lack of supports and reincarceration are greater. conversely, if the service providers in a rural community utilize their familiarity with the person, a system of supports may be developed that can reduce the chances for reincarceration. the studywas conducted to explore the experiences ofmale inmates withmental retardation who were already incarcerated in a rural state prison and increase the awareness of the criminal justice system to the unique needs of persons with mental retardation. persons with mental retardation are entitled to special accommodations by the americans with disabilities act (ada) during the adjudication process and while in correctional facilities (petersilia, 1997). this study was specifically designed to determinewhether the inmates understood the adjudication process. method the research team consisted of a project coordinator, a representative from the state’s division of developmental disabilities, a psychologist with a doctorate in law (j.d.), a psychology professor, a social work professor, and a researcher from a multidisciplinary university agency. the project was interdisciplinary and collaborative across many organizational and agency boundaries. the department of corrections (doc) played a crucial role in the research study. first, the doc conducted a file review of inmates in the state prison system to identify those with possible iqs of 80 or below. the doc selected inmates with possible iq scores of 80 or below, because the tests administered by thedocwere questionable in some cases. by raising the threshold for selection to 80, the research team sought to include as many appropriate inmates as possible in the study and ensure a sufficient pool of subjects for the research project. then, the doc asked these inmates for their initial consent to participate in this project. after obtaining the inmates’ consent, the doc allowed the research team to access the inmates’ files. the doc identified 65 men out of a total state population of 944 male inmates. this constitutes 7% of the male inmate population, indicating that the percentage of inmates with mental retardation in the state prison was approximately three times greater than the percentage of persons withmental retardation in the 213miller/equal access to justice in a ruralwestern state state’s general population. seven of themen chose not to participate in the study. thirteen men could not participate, because they were in segregation for disciplinary problems or they incarcerated in another state due to overcrowding problems. the number of potential participants was reduced to 45. the research team then examined the 45 files of the inmates who agreed to participate in the study. there were numerous problems with the files of the remaining 45 potential subjects. iq scores used by the doc were problematic, despite the willingness of the doc to share the inmate files. some files contained an iq score but no information about which iq test was used. other files contained iq scores from tests that were no longer considered valid. some of the files contained no iq score but indicated that the inmate had low cognitive functioning or possible mental retardation. due to time and budget constraints, the research team used purposive sampling to select 23 inmates for the study. these 23 inmates either had no iq score (n=6) or lower iq scores (n=17) than other potential subjects from the original pool of 45 inmates. the rationale for this purposive selection was that inmates with no iq scores or low iq scores were likely to have low iq scores and, thus, be at risk for having not understood their adjudication process. the peabody picture vocabulary test-revised (ppvt-r) was used as a proxy test to assess these inmates’ iq later in the study (dunn & dunn, 1981). after the research team reviewed the files of the 23 inmates, the doc arranged a time and place for individual interviews with each inmate. each inmate met with an interviewer who administered the competency assessment for standing trial for defendants with mental retardation (cast-mr). in an attempt to assist persons with mental retardation as they interacted with the criminal justice system, everington and luckasson (1992) developed the competency assessment for standing trial for defendants withmental retardation (cast-mr). the castmr was initially tested for reliability and validity by everington (1990) and again by everington and dunn (1995). both studies showed the test to be a reliable and valid measure of a person with mental retardation’s competency to stand trial with reliability and validity values of .80 or greater. although the cast-mr may assist some persons with mental retardation, there is concern that persons with low cognitive functioning may, in fact, score as competent to stand trial and yet not understand the adjudication process (everington & dunn, 1995). the cast-mr is administered through interview. it consists of three sections. section i is knowledge of basic legal concepts. section ii is skills to assist defense (client-attorney relationship). section iii is understanding of case events. sections i and ii consist of multiple choice questions for which only one answer is correct. section i contains 25 questions and section ii contains 15 questions. each question is worth one point, making the maximum score on section i 25 points and the maximum score on section ii 15 points. section iii consists of 10 open-ended questions that are scored 0, .5, or 1.0 based on the sophistication of the response. the maximum possible score on section iii is 10 points. the highest possible total score on the cast-mr is 50. clinical cut off scores for determining competency to stand trial are 14 points for section i, 10 points for section ii, 7 points for section iii, and 30 points for the total cast-mr (everington & dunn, 1995). 214 advances in socialwork the interviewer also conducted a social history interview with the inmate, including open-ended questions about the inmate’s family, education, employment, and memories about his most recent adjudication. the inmate was asked questions such as: can you please tell me about your family? the social history interview served two purposes. it provided the interviewer with information about the inmate’s cognitive and language abilities as well as documenting sources of support for the inmate such as family, friends, educators, and employers. the interviewer also asked the inmate to describe his last adjudication in as much detail as possible. this provided additional information to supplement the cast-mr scores. in some cases, the interviewer obtained permission from the inmate to contact other people such as teachers or friends in order to clarify the information provided by the inmate. finally, the interviewer administered the peabody picture vocabulary test–revised (ppvt-r) (dunn & dunn, 1981). the ppvt-r is a test of receptive language functioning and is highly correlated with iq. it was used as ameasure to assess the validity of the doc iq scores in the inmates’ files. the ppvt-r score was used as a proxy score for iq in cases where the doc could not provide an iq score. rationale for multiple research methods the cast-mr was given to determine the competency level of the inmate to understand the adjudication process and to assess the practicality of using the cast-mr as a screening test to assist criminal justice system personnel in identifying persons with mental retardation early in the adjudication process. the social history interview was used to further assess the inmate’s cognitive and language abilities and obtain information about the services and supports that the inmate had prior to incarceration. the ppvt-r was administered as a comparative measure to the iq scores in the inmates’ files or, in the case of inmates with no iq score in their files, to establish a baseline measure of cognitive functioning to serve as a screening instrument to identify potential study participants. results sample characteristics the inmates’ mean age was 39.5 (sd=15.3) years of age. forty percent of the inmates were from traditional ethnic minority groups including four african americans, three native americans, and two hispanics. the remaining inmates (n=14) were caucasian. fifty two percent (n=12) of the inmates had a history of special education involvement. seventeen percent (n=4) had received a ged. only one inmate had a high school diploma. the types of crimes for which the subjects were imprisoned included property related (43%), person-related (35%), and drug related (17%). these percentages do not cumulatively equal 100%, because some of the inmates were imprisoned for multiple types of crimes. iq and ppvt-r scores the iq scores obtained from doc files (m=73.3, sd=4.6, n=17) were comparable to the ppvt-r scores (m=72.9, sd=13.7, n=23) for inmates who had an iq score in their doc files. this would seem to indicate the possible presence of mild men215miller/equal access to justice in a ruralwestern state tal retardation or low cognitive functioning. an individual has mild mental retardation if his or her iq score ranges from approximately 50-55 to approximately 70 and does not demonstrate adaptive behavior towards his or her environment (aamr, 1992; apa, 1994). as explained by luckasson (2000), the definition of mental retardation is questionable but the standards provide a guideline. cast-mr scores scoring for the cast-mr includes a total score and scores for the three sections. the mean total cast-mr score for the sample was 45.1 (sd=5.25) out of a possible 50 total points. the mean score for section i: knowledge of basic legal concepts was 23.6 (sd=2.98) out of 25 possible points. the mean score for section ii: skills to assist defense (client/attorney relationship) was 12.2 (sd=2.32) out of 15 possible points. the mean score for section iii: understanding of case events was 9.3 (sd=2.98) out of 10 possible points. these means were comparable to scores for the original norming study for the castmr (everington, 1990). according to the cast-mr scores, all of the inmates should have been competent to stand trial when this study was conducted. item analyses revealed six questions in section ii: skills to assist defense (client-attorney relationship) that had high error rates. a high error rate was operationalized as 20% or greater. errors occurred when the inmate selected the wrong answer from the multiple-choice responses that were provided. for example, item 35 states, “let’s pretend that you are in court and the prosecutor tells a lie about you and it makes you really mad! what would you do?” the responses for item 35 are: a) “tell the prosecutor off,” b) “tell your lawyer,” and c) “refuse to answer anymore questions.” the correct response for item 35 was b) “tell your lawyer.” sixty five percent (n=15) of respondents checked b): “tell your lawyer.” thirty five percent (n=8) of the respondents checked response c): “refuse to answer any more questions.” thus, item 35 had an error rate of 35%. items 28, 31, 32, 35, 38, and 40 had error rates of 20 to 39%. these items are in appendix a. the error rates for the other items in section ii of the cast-mr were 11% or less. items with high error rates described interpersonal conflict situations involving the inmate and the defense attorney, judge, or prosecuting attorney. the items with high error rates also described conflict with a person in authority. returning to item 35, the correct answer was b): “tell your lawyer.” all of the inmates (n=8) who responded incorrectly to item 35 chose the passive response of “refuse to answer any questions.” none of them chose the confrontational response of “tell the prosecutor off.” for inmates who responded incorrectly, the passive answer accounted for 100% of the errors. item 38 demonstrates a similar pattern. item 38 states, “what if you are in the courtroom and you hear your lawyer and judge talking about you and you do not understand what they are saying. what would you do?” the responses for item 38 are: a) “pretend you understand,” b) “ask you lawyer about it,” and c) “demand that they talk to you.” the correct response, b) “ask you lawyer about it,” was checked by 65% (n=15) of the inmates. twenty six percent (n=6) of the inmates who responded incorrectly to item 38 checked response a) “pretend 216 advances in socialwork you understand,” while only 2 or 9% selected response, c) “demand that they talk to you.” once again, the majority of the inmates who responded incorrectly to item 38 (n=6, or 75%) chose a passive response instead of a confrontational response. correlations correlational analyses revealed no significant correlation between iq and total cast-mr score (r=.23, p>.10). this result was unexpected, as previous studies have shown relationships between iq scores and cast-mr scores (everington, 1990; everington & dunn, 1995). there was a correlation of .52 (p<.05) between the cast-mr and ppvt-r scores. cast-mr scores are usually related to ppvt-r scores. both competency to stand trial and receptive language ability were expected to be related. social history results the data from the social history interviews were analyzed using content analysis (rubin &babbie, 2000). the research teamused latent content analysis to look for consistent concepts in the transcripts. the interviews were audio recorded. members of the research team listened to and rated tapes from the first three inmates to check for inter-rater reliability. although the inmates scored well as a group on the cast-mr, the interview data obtained during the social history portion of the research indicated the possibility of a lack of competency. while the inmates were willing to participate in the research and eager to discuss their lives, they had problems providing details about their adjudication process. they seemed to have difficulty expressing themselves, and their confusion and limited ability to respond suggested the possible presence of a cognitive impairment such as mental retardation or low cognitive functioning. as an example from the transcripts, one inmate commented: he told the cop that i took a stereo…and i asked my lawyer to go back over to ask the court, and to have the cops go back over there and check this out… the judge….that there wasn’t, ah, that he couldn’t order that to be done. so they, he, judge…the one sends to me up here and i was trying to fight it but every time i do, i get, i get turned around on it the inmates did provide some insight into their understanding of the adjudication process beyond the information that was obtained from the cast-mr. more than half of the inmates (n=14, 61%) indicated that they had learned what they knew about how the criminal justice system works in prison rather than from their attorney or judge during the adjudication process. for instance, one inmate said: the attorney spent a little bit of time with me, uh, explaining…but at that time i really didn’t….i didn’t really…i understand the law a lot better now than when i did then. i didn’t really understand the law a whole lot then. and, well, i knew there was a right and wrong, but as far as the law goes, that’s about it. 217miller/equal access to justice in a ruralwestern state although the ability to learn about the adjudication process seemed to be present, the timing of the learning was unfortunate. many inmates (n=11, 48%) mentioned taking actions such as signing confessions, accepting plea bargains, or providing self-incriminating information. some inmates (n=8, 35%) reported a fear or dislike of their attorney, said they felt pressured into accepting plea agreements, and remembered being told that they should “take the deal.” these situations all involve interpersonal conflict or conflict with another person and conflict with a person in authority. the combination of interpersonal conflict and conflict with a person in authority may set up situations wherein persons with mental retardation are likely to acquiesce to the demands of criminal justice system personnel. discussion limitations before discussing the study’s findings, there are several limitations that must be addressed. first, this study utilized a small, purposive sample in a rural western state. the results of this small study are not generalizable. the data obtained from a rural sample may be different from data obtained from an urban sample. the small sample size may have skewed the data. second, despite the doc’s willingness to assist with the study, iq scores in the doc files were of questionable validity. some iq scores were not referenced to an iq test, while others used tests that are no longer valid. many of the files did not indicate who administered the iq test to the inmate, so the qualifications of the test administrator may have effected the scores. taking all these factors into consideration, the validity of the iq scores is questionable. finally, this was an initial exploratory study. this research process was new for the research team, the doc staff, and the inmates who participated. it is possible that the inmate interview process, including administration of the cast-mr, the ppvt-r, and the social history interview, may have varied as the research team became more familiar with the interview process. iq and ppvt-r scores despite these limitations, the findings of this study raise some questions. both the iq and the ppvt-r tests had similar means for the sample, which suggested that the sample may have had mental retardation or low cognitive functioning. this group of inmates scored slightly above the iq cutoff score of 70 for mental retardation. their scores on the ppvt-r were indicative of low cognitive functioning. many of them provided accounts of not being able to display adaptive behavior, as demonstrated by excerpts from the transcripts and information in their case records. this combination of iq and ppvt-r scores, along with a lack of adaptive behavior, indicate that this group had some level of mental retardation or at least low cognitive functioning. cast-mr scores with regard to the cast-mr test, as a group, the inmates’ scores indicated that they would have been competent to stand trial at the time of this study. their competency when they actually stood trial is unknown. their mean 218 advances in socialwork total score on the cast-mr of 45.1 (sd=5.25) is indicative of competency according to the cast-mr (dunn & dunn, 1981; everington, 1990). their scores on the subsections would also suggest that they were competent in knowledge of basic legal concepts (section i), skills to assist defense (section ii), and understanding of case events (section iii). cast-mr high error rate items the error rates on several cast-mr items in section ii were quite high, ranging from 39% to 22% and are presented in table 1. error rates were 39% for item 40, 35% for items 38, 35, and 31, and 22% for items 32 and 28. all of these items describe interpersonal conflict situations and conflict with authority with persons such as a defense attorney, judge, or prosecuting attorney. item 28 does not involve persons such as a defense attorney, judge, or prosecuting attorney, but it does involve conflict, as defendants are usually told to not discuss their case with other prisoners. these results are consistent with the inclination of persons with mental retardation to exhibit a desire to please persons in authority and acquiesce to the wishes of individuals whom they perceive to be in positions of authority (conley, luckasson & bouthilet, 1992; everington & fulero, 1999; keyes, edwards & perske, 1997). for instance, item 38 reads: “what if you are in the courtroom and you hear your lawyer and the judge talking about you and you don’t understand what they are saying.” the correct answer is b) “ask your lawyer to talk about it later.” response c) “demand that they talk to you,” is not acceptable during a court proceeding due to the risk of being placed in contempt of court. also, 219miller/equal access to justice in a ruralwestern state cast mr section ii item error rate item 40:what if you and your lawyer decide that you are going to 39% say certain things when you are on the stand; then later on, you decide to change your story.what would you do? item 38:what if you are in the courtroom and you hear your lawyer 35% and judge talking about you and you don’t understand what they are saying.what would you do? item 35: let’s pretend you are in court and the prosecutor tells a lie 35% about you and it makes you really mad! (emphasize) what would you do? item 31:what if your lawyer asks you to do something you don’t want 35% to do, like getting a haircut?what would you do? item 32: lets pretend that you are in court and your lawyer asks you 22% to tell a short part (emphasize) of your story. for example, he asks you to tell the court what you said to the police when they arrested you. what would you do? item 28:what if you are in jail and another prisoner tells you it’s ok 22% to tell him the whole story because he won’t tell anyone.what would you do? table 1: high error rate items in cast-mr section ii: skills to assist defense 220 and perhaps more importantly, response c) is not a likely response for someone who doesn’t understand the judicial process and is passive in order to avoid interpersonal conflict or conflict with authority. taking the avoidance of conflict into account, the error rate of 35% for item 38 is not surprising. the interview comments seemed to support the desire to avoid situations of interpersonal conflict or conflict with authority. approximately half (n=11) of the inmates made references to feeling coerced or pressured into accepting a plea agreement. being told that they should “take the deal” was a recurrent theme in the interviews with the inmates. some inmates expressed dislike or even fear of their attorney. social history results although the study’s findings are far from conclusive, the implication is that while the cast-mrmay have correctly indicated the inmates were competent to stand trial at the time of the study, they may not have been competent to stand trial at the time of their actual trial and during the adjudication process. the use of the cast-mr and the social history interviews provided a more comprehensive assessment of the inmates’ ability to understand the adjudication process than using just the cast-mr or just the social history interview. the social history also helped to better describe issues such as conflict with attorneys or prosecutors and situations in which persons with mental retardation are coerced into accepting plea agreements or “deals.” conclusion despite several limitations, this study provided some insight into areas of concern for persons with mental retardation who are interacting with the criminal justice system.the first concern is how to definemental retardation. it seems that there is some consensus that more than an iq test is required and adaptive behavior should be considered (luckasson, 2000). however, beyond these areas of agreement, the definition of mental retardation becomes nebulous at best. despite this lack of consensus, it would seem the lack of adaptive behavior was problematic for the inmates in this study. some inmates who may not be classified as having mental retardation because their iq score is above the cutoff score of 70, may still have problems demonstrating appropriate and adaptive behavior during the adjudication process. these inmates with low cognitive functioning are also at risk when interactingwith the criminal justice system. in fact, theymay be at greater risk, because the americans with disabilities act does not protect them because, technically, they do not have a disability. although previous studies have discussed differential impact for persons with mental retardation when they interact with the criminal justice system, currently, there are no standards for how to identify persons with mental retardation as they enter the system. the use of an instrument such as the cast-mr may be a starting point for identifying the competency of persons with mental retardation to stand trial. however, standing trial is a point at which the person has progressed past several steps into the adjudication process. questions remain concerning how to identify persons with mental retardation or low cognitive functioning as they enter the criminal justice system at points such as initial questionadvances in socialwork ing, arrest, interrogation, arraignment, standing trial, and sentencing. is it feasible to develop instruments or protocols to identify persons from this population at the numerous points of contact with the criminal justice system? yet another, and perhaps more important question is, after criminal justice system personnel identify persons with mental retardation, how can the criminal justice system provide accommodations for them? setting aside the definition, identification, and accommodation issues, the findings of this study seem to indicate that the inmates may not have been competent to stand trial at the time of their trial. many participants (n=14) reported learning about the criminal justice systemwhile in prison.while it is encouraging that these men could learn more about the system, the timing of the learning is not in their best interests. the situation certainly does not advance social justice, as these men learned about the criminal justice system after they had been imprisoned. the issues of conflict, both interpersonal and with authority, were recurrent themes in this study. the literature review illustrated that persons with mental retardation are prone to trying to please persons in authority and may acquiesce to the wishes of persons in authority in order to do so. the high error rates on the items that involved interpersonal conflict and conflict with authority in section ii of the cast-mr, skills to assist defense support this perspective. the social history data also supported the concepts of avoiding interpersonal and authority related conflict. the tendency to avoid conflict of multiple types places persons withmental retardation interacting with the criminal justice system in a very vulnerable situation. department of corrections personnel were very cooperative in facilitating the conduct of this research. however, despite their cooperation, it is not difficult to imagine a situation in which a person with mental retardation might acquiesce and confess to a crime he or she did not commit in order to avoid interpersonal conflict and conflict with authority.while members of the law enforcement community are ethical and attempt to uphold justice, it is feasible that not recognizing that a person has mental retardation, combined with standard interrogation techniques, might in fact result in coerced and inaccurate confessions to crimes. situations such as these put persons with mental retardation and the community at-large at risk by prosecuting innocent citizens and allowing criminals to remain free in the community. what can social workers in rural environments do to provide support for persons with mental retardation as they interact with the criminal justice system? the role of advocate (schatz, jenkins & sheafor, 1989) seems to be a logical place to start. a person withmental retardation could benefit greatly from an advocate, especially given that some of the participants in this study expressed dislike or even fear of their own defense attorneys. if persons with mental retardation sometimes fear their own defense attorneys, what level of fear might they have towards police officers, judges, or prosecuting attorneys? a social worker with knowledge about mental retardation and the adjudication process could be brought into the adjudication process at an early stage, such as 221miller/equal access to justice in a ruralwestern state when criminal justice system personnel think a person who is being questioned or arrested has limited cognitive abilities. in rural areas, the social worker is more likely to know at least some of the criminal justice systempersonnel , which could be advantageous to the client. having an advocate early on in the adjudication process could have a very positive impact on the way in which persons withmental retardation interact with the criminal justice system and further the cause of social justice for this population. social justice for persons with low cognitive functioning could be advanced in the same manner, although it would require additional social work skills at the mezzo and macro level to get recognition for this population. this issue leads to yet another question. if persons with mental retardation receive an advocate, why shouldn’t other populations who are over-represented in the correctional system have an advocate as well? from a social justice perspective, the answer would seem to be that many populations, such as people of color and persons of low socioeconomic status should in fact have advocates when interacting with the criminal justice system. the introduction of an advocate into the adjudication process is an intervention that is within the ability of social workers. the importance of such an advocate cannot be overemphasized as many states continue to use the death penalty on inmates with mental retardation (olvera, deaver & earnest, 2000; perske, 1997; steiker & steiker, 1998; everington & fulero, 1999). according to everington and fulero (1999), persons withmental retardation represent approximately 11% of the inmates on death row. persons withmental retardation are not only a population at risk but also a population at risk of death. the other populations mentioned also face the risk of unjust incarceration or death. as a profession, we must not only acknowledge social injustice, but also pursue interventions that can tip the scales of justice in favor of populations at risk. the cooperation across disciplines and professions, including the department of corrections in this rural study, demonstrate that at least in this rural environment collaboration was possible to conduct the study and start the process of advocacy. such collaboration may be more difficult in urban settings. this is an area in which rural social workers have the opportunity to take the lead on an important social justice issue. references. american heritage dictionary. (2000). boston: houghton and mifflin. american association on mental retardation. (1992). definitions, classification, and systems of supports. (9th ed.).washington, d.c.: author. american psychological association. (1994). diagnostic and statistical manual of mental disorders, (4th ed., dsm-iv).washington, d.c.: author. americans with disabilties act, (ada), (1990) 42nd usc 12101. conley, r., luckasson, r., & bouthilet, g. (1992). the criminal justice system and people with mental retardation. baltimore: brookes. dunn, l., & dunn, l. (1981). the peabody picture vocabulary test—revised. circle pines, mn: american guidance service. 222 advances in socialwork ellis, j., & luckasson, r. (1985). mentally retarded criminal defendants. georgewashington law review, 414, 416-421. everington, c. (1990). the competence assessment for standing trial for defendants with mental retardation (cast-mr): a validation study. criminal justice and behavior, 17(2), p 147-168. everington, c., &dunn, c. (1995). a second validation study of the competence assessment for standing trial for defendants with mental retardation (cast-mr). criminal justice and behavior, 22(1), p. 4459. everington, c., & fulero, s. (1999). competence to confess: measuring understanding and suggestibility of defendants with mental retardation.mental retardation, 37(3), 212-220. everington, c., & luckasson, r. (1992). competence assessment for standing trial for defendants with mental retardation: cast-mr.worthington, oh: international diagnostic services. keyes, d., edwards, w., & perske, r. (1997). people with mental retardation are dying, legally. mental retardation, 35(1), 59-63. luckasson, r. (2000). defining mental retardation. aamr news and notes, 13(5), 1-5. olivera, d., dever, r., & earnest, m. (2000). mental retardation and sentences for murder: comparison of two recent court cases.mental retardation, 38(3), 228-33. pelka, f. (1997). unequal justice: preserving the rights of thementally retarded in the criminal justice system. the humanist, (57), 28-32. perske, r. (1997). prisoners with mental disabilities in 1692 salem and today.mental retardation, 35(3), 315-317. petersilia, j. (1997). justice for all? offenders with mental retardation and the california corrections system. prison journal, 77(4), 358-380. rubin, a., & babbie, e. (2000). research methods for social work 4th ed.). pacific grove, ca: brooks/cole. schatz, m., jenkins, l., & sheafor (1989).milford redined: a model of generalist and advanced generalist social work. fort collins, co: colorado state university. steiker, c., & steiker, j. (1998). defending categorical exemptions to the death penalty: reflections on the aba’s resolutions concerning the execution of juveniles and persons withmental retardation. law and contemporary problems, 61(4), 89-104. author’s note: address correspondence to: monte miller, ph.d., division of socialwork, university ofwyoming, p.o. box 3632, laramie,wyoming 82071, usa. e-mail: millerm@uwyo.edu 223miller/equal access to justice in a ruralwestern state 224 appendix cast-mr items with high error rates; section ii: skills to assist defense error rate 40. what if you and your lawyer decide that you are going to 39% say certain things when you are on the stand; then later on, you decide to change your story.what would you do? a. say what you want when you are on the stand b. tell the court to get you a new lawyer c. *tell your lawyer you would like to change the story 38. what if you are in the courtroom and you hear your 35% lawyer and judge talking about you and you don’t understand what they are saying.what would you do? a. pretend you understand b. *ask your lawyer about it later c. demand that they talk to you 35. let’s pretend you are in court and the prosecutor tells a 35% lie about you and it makes you really mad! (emphasize) what would you do? a. tell the prosecutor off b. *tell your lawyer c. refuse to answer more questions 31. what if your lawyer asks you to do something you don’t 35% want to do like getting a haircut?what would you do? a. *tell him you don’t want to b. ignore him and do what you want c. fire the lawyer on the spot 32. lets pretend that you are in court and your lawyer asks 22% you to tell a short part (emphasize) of your story. for example, he asks you to tell the court what you said to the police when they arrested you.what would you do? a. don’t say anything about it b. *tell what you said to the police c. tell everything that happened 28. what if you are in jail and another prisoner tells you it’s 22% ok to tell him the whole story because he won’t tell anyone. what would you do? a. *tell him you can’t tell b. start a fight with him c. tell him the story advances in socialwork microsoft word shears copyedit3 _________________ jeffrey shears, ph.d., is an associate professor and bsw coordinator in the department of social work at the university of north carolina at charlotte. roe bubar, j.d., is an associate professor in the department of ethnic studies, and ronald c. hall, j.d., is a senior research scientist in the school of business, both at colorado state university. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 201-217 understanding fathering among urban native american men jeffrey shears roe bubar ronald c. hall abstract: this study explores fathering among self identified native american men who have been identified as father or father figure to children involved in the early head start research and evaluation project. this research study highlights united states policies and their effects on native american families particularly fathers. in addition, native american fathers in this study reported that “being there” for their child was important and described how the manifestation of being there ranged from traditional to contemporary models of fathering. the article concludes with a discussion of specific issues that are important when working with native fathers that may be of interest to social workers and social service practitioners. keywords: fathering, native american, race introduction there is a growing interest in the role of fathers and fathering in america. one could argue that fathering has become a contemporary social, as well as political, issue. this awareness is supported by an increased number of grassroots organizations supporting fathers, research in this area of scholarship, and the more visible, active roles fathers are taking with their children today. the study of fathering is important, given that research continues to indicate that fathers have a significant impact upon the lives of young children. although fathers are important, very little has been written or studied about fathering in some communities of color. this article uses qualitative data from the national early head start research and evaluation project (ehsrep) to explore native men and their perceptions of fatherhood. literature review the research shows there is a positive relationship between fathers’ involvement and infants’ early physical, mental, and social development (dubowitz et al., 2001; klitzing, simoni, amsler, & burgin, 1999; pedersen, 1987; pedersen, rubenstein, & yarrow, 1979; shears & robinson, 2005; toth & xu, 1999; yogman, kindlon, & earls, 1995). even though the parenting literature supports the importance of parents in general, lamb (1997), and magill-evans, harrison, and burke (1999) all agree that fathers contribute differently to infant developmental outcomes when compared to mothers. these differences in interactions suggest that fathers offer something unique to early infant development. the fathering research literature has suggested that fathering is in a state of transition as more fathers embrace contemporary versus traditional roles. shears, summers, boller, advances in social work, fall 2011, 12(2) 202 and barclay-mclaughlin (2006) suggest that the traditional view of fathers in american society is one of provider, protector, role model, and teacher. although men still find value in traditional roles, many fathers are currently articulating a more contemporary fathering role. some of these contemporary roles include father as caregiver, as a partner with the child’s mother, and as a source of affection and emotional support (lamb, 1997; white, godfrey, & moccasin, 2006). much of the link between positive child outcomes and fathering practices has been established through quantitative analysis that has merely identified the key variables and outcomes involved. while important, more information regarding the lived experiences of fathers is needed. by understanding the lived experiences of fathers themselves, family practitioners will be able to better understand how men construct their identities as fathers, and will be able to provide more sufficient services to them and their children. the issue of discussing fathering with fathers is essential because much of what is known historically about fathers’ parenting attitudes and experiences came from mothers’ reports (shears et al., 2006; tanfer & mott, 1997). in addition to the limitations of quantitative research and mothers’ reports on fathering, there is very little research on native fathers. historically, fathering has been examined more frequently in western middle-class and well-educated families; however, researchers have recently suggested a need for research on perceptions of fatherhood among minority populations (marsiglio, amato, day, & lamb, 2002; palcovitz, 2002). several studies have found differences in fathering roles across racial and ethnic groups (houssain, field, pickens, malphurs, & del valle 1997; mincy, 2002; toth & xu, 1999). this suggests that the roles that men embrace as fathers can also be impacted by one’s race and ethnicity. since research and documentation of fathering is based primarily on anglo communities, a predominantly anglo model for fathering is viewed as the benchmark and thus, socially normative for all other men (furman & collins, 2005). these social norms and fathering standards can be deceiving and, in many cases, lead to improper and misleading conclusions regarding fathering in communities of color. to this end, more research is needed in minority and, more particularly, tribal communities. native peoples and tribal communities (urban, rural, suburban, geographically isolated, etc.) are complex and present challenges for social work practitioners attempting to acquire more culturally competent practices. since most of the current fathering literature applies to non-native fathers, it is important to explore how fathering may differ in these communities. as a result, this qualitative study explores fathering within the urban native family context. historical overview historically, federal indian policies and colonization have had and continue to have a profound impact on the role of indigenous families and, in particular, on native fathers (noriega, 1992; white et al., 2006). loss of land, lifestyle changes, and role changes in traditional family organization, clan, and kinship have also impacted the role of male relatives, grandparents, and the specific role of fathers within the native family structure shears, bubar, hall/fathering among urban native american men 203 (diedrich, 1995; duran & duran, 1995; heller, cunningham, & heller, 2003; white et al., 2006). tribal societies in the u.s. were largely communal and self-sustaining prior to european conquest. as european dominance of north america escalated, treaties with tribes created a basis for non-tribal land title and established defined land areas reserved by the tribes. entire tribes were forced into dependency on the u.s. military for all means of daily sustenance. as the military role gave way to long term management of tribal people and lands, federal policies shifted toward forced assimilation of tribes into u.s. society. of particular concern to lawmakers was the persistence of tribal communal lifestyles as opposed to the individual capitalist ideal. the 1887 dawes act broke up tribally held land into individual allotments for agricultural development and grazing. this process disrupted extended family systems and altered the traditional role of fathers significantly. unallotted lands were made available for non-native homesteads; thus tribal communities were further impacted by the proximity of non-native practices and influences. despite this influence, many tribal societies resisted assimilation and were resilient despite oppressive federal indian policies. persistent poverty, acculturation, substance abuse, and historical trauma resulting from federal indian policy continue to impact native family life today (duran, duran & braveheart, 1998; garrett & pichette, 2000; lafromboise, medoff, lee, & harris, 2007). the cumulative impact from specific federal indian policies during relocation, allotment, forced boarding school, repression of native spirituality, and persistent poverty and unemployment contributed to the emasculation of native men (white et al., 2006). currently, father absence for native dads is significant and remains among the highest in the country (u.s. census bureau, 2000). at the same time natives have a higher percentage of male-maintained households than do other minorities, with 9% of native households being male-maintained where no female partner is present (u.s. census bureau, 2000). forced boarding school policies had a profound and traumatic impact on the native american family unit and the tribal community (duran et al., 1998; flemming, 1992; noriega, 1999; white et al., 2006). for almost a century, native american children were forcefully removed from their families, communities, and tribes and sent to boarding schools under oppressive assimilation policies with the goal of cultural/tribal eradication and assimilation into the dominant society. the indian reorganization act (ira) of 1934 ended the legal and federally sanctioned abduction of children, although children were still removed from their homes and sent to boarding schools or ‘foster families’ (noriega, 1992). some have theorized that this policy had a significant impact on native families, given the overrepresentation of native children in child abuse cases, placement in the child welfare system, and in child fatalities (petit & curtis, 1997). the coerced acculturation interrupted traditional fathering practices and extended family structures resulting in dramatic and immediate changes in tribal family life styles, as well as identity (hossain et al., 1999; mirandi, 1991; morrisette, 1994; weaver & white, 1999; white et al., 2006). the absence of adult family role models within the boarding school structure impacted emotional development in children, many of whom later developed significant problems with depression, alcoholism, and violent behavior as adults (swinomish tribal advances in social work, fall 2011, 12(2) 204 mental health project, 1991). one might hypothesize that, with the lack of native masculine role models for fathering, native boys were significantly affected in their understanding and access to native fathers as role models. forced relocation, allotment, boarding school practices, and loss of traditional roles forced tribal members to become dependent on government food distribution programs and welfare to sustain their families. this process undermined the role of fathers and increased the likelihood that native children would grow up in an uninvolved or absent father home. the loss of male influence within the family can be traced to a loss of cultural practices, traditions, and rituals that once sustained tribal communities. within many traditional native communities, fathers were neither the primary disciplinarian nor childcare provider, yet there were significant ways in which fathers contributed in child rearing activities (hossain, 2001; hossain et al., 1999). in male warrior societies, men’s traditional roles to provide, protect, teach, and bring honor, whether as hunter, healer, scout, or warrior, were fairly common within a myriad of precontact tribal communities. in some western tribes, a father’s role included taking over the primary role of instruction when sons turned eight or during latency-age years to train with him as a hunter and warrior (diedrich, 1995). being a warrior may not be viewed in a contemporary sense as an essential requirement for adulthood in all tribal communities, yet many contemporary tribal programs and initiatives encourage the reclaiming of warrior identities and are providing enculturation for young men as warriors (vanas, 2003; white et al., 2006). in the precontact milieu in a number of tribal communities, neither the father’s or mother’s role included negative interaction with their children; instead, extended family members served as the disciplinarians. thus native fathers and mothers were able to provide warmth and support for their children in unconditional ways (white et al., 2006). with the introduction of federal indian policies, particularly assimilation policies, implementing a rigid boarding school curriculum institutionalizing non-native gender identities and gender roles had significant impacts on the traditional roles for native men (hunter, warrior, scout, healer, etc.) and created barriers for them as fathers. however, the change in traditional male roles might also create other opportunities for fathers to spend more time in interaction with their children in non-punitive ways which, for many native men, may be a reclaiming of a traditional parenting style. today there is a resurgence of asserting tribal sovereignty via language reclamation, spiritual and healing practices, and cultural and tribal specific activities. interestingly, enculturation has recently been suggested as a protective factor for native adolescents (lafromboise, hoyt, oliver, & whitbeck, 2004). enculturation is embraced informally across all of indian country as a key aspect of treatment and healing initiatives. tribal communities throughout native america are bringing back traditional activities and exploring ways to reclaim positive native identities for their children. native hawaiian parents are learning the hawaiian language on the internet. northwest tribes have engaged youth with traditional paddling trips on the ocean to neighboring tribal communities. pueblos in the southwest continue to teach their youth tribal ceremonial dance and spiritual practices. men’s camp circles and reclaiming of warrior identities are shears, bubar, hall/fathering among urban native american men 205 two contemporary areas in which native men are specifically engaging in reclaiming traditional identities (vanas, 2003; white bison, inc., 2002). organizations like the native american fatherhood & families association (naffa, 2007) are working to strengthen native american families by increasing the involvement of native fathers. naffa uses the “fatherhood is sacred” model that encourages traditional native culture and beliefs. in british columbia, canada the indigenous fathers project was created to explore first nations and metis fathers’ experiences of becoming fathers. a documentary was created from the indigenous fathers project as the participants felt this was the best way to share with other indigenous peoples what had been learned in the fathering project. native fathers while there is both quantitative and qualitative research on fathering in mainstream populations, there is very little research available on contemporary native fathering practices and significantly less investigation of native fathering with preschool-aged children. there are, however, some trends reflected in historical and current literature that should be considered. in 1980, native adolescents from 24 different states participated in a study that examined their perceptions of their fathers; researchers found clear evidence that native adolescents want their fathers to become more involved in their parenting role (stinnett, king, & rowe, 1980). fifty-seven percent said they were not close to their dads yet most reported that they respected their dads in the way elders are respected across tribal communities. another historical study by french (1979) noted that similarly situated native junior high students had lower self-esteem than their white classmates. stinnett et al. (1980) suggest that lower self-esteem experienced by native adolescents could be related to the lower involvement that native dads had with their adolescents, suggesting that increased involvement could impact self-esteem for native youth. research supports the idea that father involvement has a positive effect on young native boys. radin, williams, and coggins (1993) conducted an exploratory study of ojibwa families to determine the relationship between father and mother involvement, academic performance, traditional values, and social performance. increased time spent with fathers as primary caregivers was associated with higher academic achievement, as well as better social development for boys, while the role of mothers was particularly salient given the strong leadership roles and the centrality of women in those communities. the study supports the idea that cultural identity promotes resiliency (lafromboise et al., 2004). fathers and mothers who are secure in their own native identities may help to provide a secure cultural identity for their children (radin et al., 1993). interestingly, in another study with navajo families, father involvement in caretaking activities and across genders was significant, yet there were noted differences in academic-related nurturance since mothers spent significantly more time with children in academic-related caretaking. in the navajo tribe there is significant tribal importance placed on maternal lineage. researchers in this study emphasized how critical it was to note the recent importance and emphasis placed on the value of education in navajo communities across class and education lines, since education is currently viewed as vital in terms of future economic security (hossain et al., 1999). it should be noted that advances in social work, fall 2011, 12(2) 206 historical governmental policy has brought a number of changes in tribal structure; such as the move from reservations to cities (first via federal policy and now for employment) which has created less time for many native fathers to spend with their children (hossain et al., 1999). despite these policies, a study by kaye (2005) shows that native fathers had a high level of involvement in early head start (ehs) center committees, by serving on advisory boards, working in the classroom, bringing children and picking them up, attending home visits, and helping in maintaining center grounds. to appreciate the fathering experience among native families, one must understand the historical policies that have had generational effects and the continued effects of those policies for native fathers today. methods this exploratory study seeks to join a growing body of research on the lived experience of non-white fathers by exploring attitudes, experiences, and perceptions of self identified urban native fathers of children involved in the ehsrep. this study used qualitative methods to analyze the qualitative questionnaire embedded in a larger data set. the guiding research question for this study asked, how do different fathers involved in early head start perceive fathering? early head start ehs focuses on enhancing the child’s development and supports the family during the critical first three years of the child’s life. as a result, it is a two-generation program that includes intensive services that begin before the child is born. a consortium of 17 researcher sites and federal funding agencies working in partnership with the national early head start office conducted a national evaluation of program implementation and impacts. the ehsrep centers on the mother as the source of information but also includes a set of studies that focuses specifically on fathers as the primary respondents. the father studies help to fill a significant gap in knowledge by increasing our understanding of how fathers, in the context of their family and the early head start program, influence infant and toddler development. data related to participating fathers were collected at the child’s age of 24 months at 12 sites. the father study contained an embedded qualitative study involving audio taped, open-ended questions, interspersed throughout the quantitative interview. thus, the overall design of this mixed-methods research could be characterized as predominantly quantitative, with an embedded qualitative component conducted parallel to the quantitative study (creswell, clark, gutman, & hanson, 2003). data for this report were taken from the interviews of men who were reported to be the father or father figure of the ehs child at 24 months. participants this study includes the narratives from 18 urban native fathers and father figures who participated in this qualitative study. each of these men was interviewed around the time their child was 24 months old. mothers involved in the ehs identified the shears, bubar, hall/fathering among urban native american men 207 participants in this study as the father or father figure of their two year old child or focus child in the ehsrep. given the requirements for enrollment in ehs, these men are considered to be fathers in low-income families. most of the fathers interviewed (67%) reported being the resident biological father of the focus child, while 22% reported being residential other father type. the focus child of these fathers was 39% female and 61% male. all eighteen fathers reported having completed high school with 40% reported at least one year of college or more. fathers reported a monthly mean income of $1392 with a standard deviation of $985 and a range of $0 to $3000 a month. fathers’ reported mean age was 31 years old with a standard deviation of 7.7 years and a range of 19 to 47 years. the interview this study included an embedded qualitative instrument designed to produce more open-ended narrative information about fathering. very little was known about lowincome native fathers, thus, this study was necessary to explore a general sense of the roles of native fathers in the lives of their children. the qualitative interview instrument included six primary areas of inquiry and was designed to assist in the generation of new hypotheses about fathers and their involvement in children’s lives. the qualitative instrument explored the perception of fathering and the areas of inquiry included: what does “being a good father” mean to you? how has becoming a father impacted your life? talk about your experiences with your own father. what kinds of help or support do you get to do your job as a father? what gets in the way of being a good father? and what are you proudest of about your child? interviewers follow up the fathers’ initial responses to these questions with additional probes to gather more details in each of six primary areas of inquiry. interviewers were trained in qualitative interview techniques and also participated on conference calls to discuss and make revisions to the additional probes being used. this type of peer debriefing and charting of the revised probes adds to the overall credibility of the study (anfara, brown, & mangione, 2002). two authors from the study did the coding. a native american studies scholar and third author, a native male researcher, developed initial codes and categories. data analysis involved describing trends in the data, as well as interpretative techniques. detailed information, the context in which responses were presented, integration across comments, agreement across participants, and meanings offered relative to cultural phenomena were all taken into consideration in the analysis. the researchers read through the data multiple times using a line-by-line analysis of comments in order to determine patterns and trends in the data, using the constant comparison method (lindlof & bryan, 2002; strauss & corbin 1998). using this approach, the data were coded, discussed, separated into categories, and further discussed as to the distinctiveness and difference of the categories. results this ehsrep qualitative study included participating native fathers and their responses to six open-ended questions regarding their experiences as fathers. these advances in social work, fall 2011, 12(2) 208 questions and an analysis of them are presented here for discussion and consideration for future areas of research on native fathers. availability and engagement fathers were asked, “what does being a ‘good father’ mean to you?” a consistent theme that native fathers identified as being a good father was being available and actively engaged with their children. in discussing “availability” fathers included being physically present, being emotionally available, and showing up for their children. being engaged included spending quality time, a willingness to actively engage, and to be in the moment with their children. availability and engagement also furthered a participant’s ability to provide, protect, and care for his child. when fathers talked about availability it often included an example of urgency in which they perceived their children needed them in that place and time for a specific reason. for example, one father explained, “like when they’re sick or don’t feel good or if they want something.” while a number of fathers included, “being there when they need you.” many of the fathers included ‘responsibility’, which several said their own fathers had not displayed, as important in being a good father. when fathers were available and engaged with their children, they viewed themselves as being responsible fathers. participants also identified teaching their children as a part of engagement in activities with their children as important to being a good father. throughout the interview many of the native fathers contextualized their answers in relation to what they experienced as sons from their own fathers. one father shared, “pretty much just spending all kinds of time with them, sharing your time, playing with them, and being there when they need you. in general, just being there ... for the good and the bad.” another dad added: i see people with their children. it’s inspirational to see fathers with their children. you very rarely see fathers in their children’s lives…you see the mother all the time, but not the father. you want to teach him something—teach him our culture and don’t take him down the wrong path. these native fathers generally defined their roles as fathers in traditional terms, as the provider and protector who has responsibility in these areas for children. however, fathers also acknowledged their role in a child’s emotional stability and daily activities such as cooking, reading stories, and taking care of a sick child. change in perspective fathers were also asked, how has becoming a father impacted your life? fathers discussed many different examples of how becoming a father changed their perspective with regard to responsibilities and changed their behavior to fit their role as a father. many of the fathers discussed the role of their child as central within their families. most fathers were reflective of how fathering gave new meaning to their lives. one dad shared, “my life changed a lot because everything has meaning to me now—not just being a father.” in reflecting on how their perspective has changed, a number of dads shared how they have changed past at-risk behaviors since becoming a father: shears, bubar, hall/fathering among urban native american men 209 yeah, it’s changed my life completely. i’m away from drugs and alcohol. i don’t hang around the bars like i used to when i was younger. i got something at home to look forward to; i don’t have to go out nowhere to get it. when considering how fatherhood has impacted their lives, these dads reflected upon their own childhoods and compared their fathering ability to their own dads. i kind of figured it wouldn’t be anything like it was when i was brought up. i knew it would be better than that. i knew it was going to work no matter what it took to do better than the way i was brought up. father figures and positive role models we later asked men to, talk about your experiences with your own father. all of the dads in this study identified a father or father figure with the exception of one participant who revealed that he didn’t have a male father figure growing up. the participants identified a father, stepfather, uncle, and, in one instance, a boyfriend of an auntie as significant father figures. in native families, people can be related by blood, clan, marriage, formal adoption, and, in some instances, in an “indian way.” while many of the participants in this study discussed serious challenges from their families of origin, most of the participants talked about the positive role models they experienced from their father or father figures. participants discussed the activities they did with their fathers, which provided meaning for them in considering the father figures in their lives. those activities included hunting, fishing, archery, walking, road trips, and three wheeling. other participants talked about their fathers as being present in their homes yet absent in their lives; this seems to have increased their own commitment as fathers to be present for their children as discussed above. in discussing missing fathers, some participants talked about how other father figures stepped in as positive role models. one participant shares: “my experience with him was pretty good. i liked him and he did a lot for me…more than what my real father did for me when i was younger anyway.” these dads acknowledged the positive role modeling they experienced with their own father figures, which seemed particularly important as participants themselves now understood the demands of being fathers themselves: he really wasn’t one to talk a lot. but when he said something, he usually said something quite important…kind of straight to the heart kind of thing. and just by his examples as well. he loved all his kids and provides for his wife and stuff as well. in their comments about the positive role modeling with their own father figures, participants discussed the importance of activities that their father figures engaged in with them and how that modeled for them how to engage with their own children: every weekend he would grab us up, put us in the car, take a little journey somewhere, places that we never experienced before. other parts of the city, upstate, out of town, farms. he did a lot with us you know and that’s what i like to do with my kids. advances in social work, fall 2011, 12(2) 210 participants, in describing their role in guiding or teaching their children, also shared the importance of teaching or conveying traditional cultural knowledge by teaching “culture”, “religion”, and language to their children. familial and interpersonal support systems we also asked participants about, what kinds of help or support do you get to do your job as a father? most of the participants in this study identified extended family, particularly their siblings, as their primary source of help or support in their roles as fathers and almost all of the participants identified relational support systems as being important. family by definition in native communities generally includes extended family; thus the role of siblings and other family members providing support for native fathers may be viewed as critical. participants also identified the child’s mom as a significant source of support for fathers in this study. being able to talk with the child’s mom and other relatives about fathering was acknowledged as particularly significant. one dad shared: yeah, my wife she’s been a big part of that...and my brother, talking to him, seeing how he does things. the combination of the two has played a major role in my life. for many tribes parenting historically included extended family relatives and fathers in this study acknowledged the importance of interacting and including family members in their role as fathers. a number of the participants indicated a program or service that assisted them in their roles as fathers including early head start, program parents, school psychologist, and medicaid. some of the fathers saw their friends as a source of support and two of the fathers identified themselves as their primary source of support in their job as a father. one dad responded that his children are his support: “my kids help me out in many ways cause i like to cook. my sons like to watch me cook. they help me cook, actually.” fathers identified various sources of support, both personal and institutional that were important to them as fathers. it is interesting to note that pollack and levant (1998) suggest that men are less likely than women to seek help or support. however it appears that these men utilized various support systems in their role as father. finances understanding the barriers to fathering is also important. as a result we asked men, what gets in the way of being a father? three of the fathers said there was nothing that got in the way of being a father. most of the fathers identified challenges in the expenses involved in raising children, the difficulties in dealing with illness and injuries, the developmental challenges they face as children grow and change, and the permanence of the responsibility of being a father. one father shared that: i think everything in life is challenging. as far as actual downsides of being a father, not really. i can’t think of anything bad about it. shears, bubar, hall/fathering among urban native american men 211 given the financial constraints and challenges for many of the fathers in this study, it is interesting to note that few mentioned negative experiences. this demonstrates the importance and cultural significance of being a father with less emphasis on materialism as a measure of success. another father said, “it’s really tough when you’re a student and working, to spend time with the family. my wife and i really do try to spend as much time as we can with her.” one father did not find any barriers and stated: it’s a lot of responsibility. i work to do the best i can to make them happy; it’s what makes me happy, the quality time is what’s important to me…. nah it’s pretty fun, it is. another dad pointed out the difficulty of the toddler years in saying: not really. this is my first kid. she hasn’t really been a pain until she got a little older…the potty training is the hardest part…. trying to get her off the pacifier. she won’t let that go for nothing. children are amazing we lastly asked fathers to share, what are you proudest of about your child? mostly, fathers were proud of and in awe of their children’s abilities to learn, as well as their intelligence and the connection of those gifts to their roles as their fathers. one proud father shared: the way she learns. she picks up so fast. she’s the smartest kid i’ve ever seen. our friend’s two year old don’t talk the way she does. she can sit down and talk to you—have a conversation. another father shared a difficult story about his son’s health: he went through four surgeries (he was born with cleft palette syndrome) before he was a year old and he’s taken it so well. every time he opened his eyes after surgery it was me and his mom he seen. he’s been real good. another father said: he’s a very intelligent, very active young man. he’s more—to me—he’s the youngest he speaks more, speaks his mind more. he tells—he gives them (siblings) advice that they listen to because of his intelligence. some things he surprises me with, the things he says. while another father reflected: there are so many things. we really didn’t set any formal expectations or anything like that with her. she’s never and never has, in our minds, let us down. engaging with fathers and conveying cultural knowledge engagement in activities with fathers is an overarching theme discussed by participants in a myriad of ways in this study. participants identified engaging in advances in social work, fall 2011, 12(2) 212 activities with their own children as important and a way in which they defined themselves both as fathers and natives. they also reflected and talked about their father figures and the activities they engaged in with them growing up, which included skipping rocks, walking the beach, road trips, making particular foods, going to market, hunting, fishing, using a bow, etc. understanding their own language, cultural activities, and native identity were also discussed. the impact of absent fathers was notable as was the importance placed on the fathering role. when father figures didn’t engage with their sons, this was a particular area where participants shared negative experiences: when i was in elementary school i was passing grades—i was in baseball league one year, and he really didn’t pay much attention to that. so i really didn’t pay much attention to him, and i started getting all (f’s?)e’s in school and everything and he grounded me to my room. discussion the results of this study indicate that native fathers feel strongly that it is important to be “present” in addition to “being there” in the lives of their children. since a number of fathers discussed the absence of their own fathers, even when those fathers were physically present, it is important to note in this study that the idea of “being present” was particularly important to native fathers as demonstrated in other research on fathers (shears, furman, & nalini, 2007). orientation in a native worldview is in the present and for native fathers, being present and engaged with their children was as important, if not more salient, as “being there.” at the same time, native fathers discussed the importance of engaging in activities with their children and increased father involvement, both of which are associated with better academic and social outcomes for native children. a number of fathers also seemed to communicate that fatherhood saved them from at-risk behaviors and gave them a sense of purpose in life. one might hypothesize that the relationship between father and child was mutually beneficial. although we know there are benefits to children of having engaged fathers present, we need to further explore the benefits to fathers of being an active father. given the high incidence of father absence in native populations, it is interesting that native fathers in this study evidence similar perspectives of good fathering to middle-income anglo fathers. one might question the amount of stress that is caused in the attempt to “be there” with fewer financial resources. as a result, one might ask if low-income fathers are more stressed in their attempt to be there for their child. native fathers also emphasized that they wanted to teach their children culture, language, and traditional activities. the importance of enculturation was an interesting finding, since other researchers have suggested that enculturation may serve as a protective factor and a way to encourage resiliency for native children in spite of persistent poverty and other challenges (lafromboise et al., 2004). several studies found that more than mere father presence was needed for native children to report a sense of closeness to their fathers and social success (radin et al., 1993; stinnett et al., 1980). when asked about the downside of fathering and the challenges in this role, most native fathers replied there were none; when they did list a challenge, it was often shears, bubar, hall/fathering among urban native american men 213 followed-up with how positive it was to be a father. shears et al. (2006) noted a similar finding with low-income mexican american fathers. the importance of children in native communities is well documented historically, as was the role of parenting, which may support the ways in which native fathers downplay the challenges in fathering their children. engagement in the role of fathering may serve as a form of resiliency for fathers, particularly low-income fathers experiencing other challenges in their lives. to this end, becoming a father may be a protective factor with some men in order to reduce their participation in at-risk behaviors, such as drug and alcohol use and membership in gangs. some men report feeling a sense of purpose and responsibility once they become a father. these men suggest that becoming a dad saved them from the life they had been leading and caused them to become more socially compliant. shears et al. (2007) found that many fathers perceived that becoming a father made them more responsible and accountable. we often cite how important fathers are to children and may need to explore how important becoming a father is to some men’s well-being. limitations all of the native fathers interviewed in this study were living in urban areas and, thus, may not be representative of fathers living in more rural, reservation, and geographically remote homeland areas in the united states. the results from this study are limited to young, urban fathers with primarily preschool-age children. interviewers were neither familiar with nor trained in interviewing around culturally cued information and, when participants responded in culturally nuanced ways, these cues were not followed up. for example, some respondents were able to provide culturally relevant information regarding cooking, hunting, and teaching language to their children yet interviewers didn’t follow up or explore their responses in any detail. lastly, the interview instrument itself did not include probes to explore particular differences among fathers from different racial or ethnic backgrounds. implications as natives continue to move into urban and suburban communities, social services practitioners and researchers need to understand their past histories and connection to homeland and cultural areas in order to provide more culturally relevant services. many of the current social and health problems facing native populations today have origins that refer to a history of trauma and oppressive federal policies which significantly impacted individuals, families, and communities. healing is an ongoing process for many tribal communities. social service practitioners need to acknowledge and be prepared to confront the grief experienced by the native families if they are to be successful in providing services and understanding lived experiences of native fathers (brown & shalett, 1997; morrissette, 1994). social service practitioners and researchers are realizing that more must be done to understand the lived experiences of natives and how that experience relates to contemporary and historical federal policies impacting indigenous peoples, specifically, native men. too often, cultural variables are misunderstood by the social service community and non-natives working with native populations. that is, the experience of native men is often viewed through a lens of advances in social work, fall 2011, 12(2) 214 individual pathology rather than contextualizing their personal and lived experiences as it relates to important cultural, family, tribal, and community variables and the historical, as well as political, context in which native men live their lives. it is notable that native men in this study exhibit an increased sense of self and accomplishment as a result of their engagement in fathering their children. the importance placed on the fathering role and experiencing success as a father is significant and could be incorporated by social work practitioners when working with native populations. a remarkable result of this research has been the way men expressed how becoming a father positively impacted other aspects of their lives. ehs programs that serve native american populations should assist men in understanding the importance of fathering from the traditional sense, that their relationship is important to their child. in addition, some attention should be given to the stories of men who share that they benefitted from being a dad, and that sense of purpose they feel has led them to revaluate their life’s purpose. as child care centers attempt to engage fathers and encourage them be more involved, they can put more emphasis on helping men to understand how important fathering is to them. in addition, these centers with fathering programs need to assist and provide support to young fathers who may be a “little rough around the edges” as they transition to being a more stable adult and parent. references anfara, v., brown, k., & mangione, t. 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(1995). father involvement and cognitive/ behavioral outcomes of preterm infants. journal of the american academy of child and adolescent psychiatry, 34(1), 58-66. author’s note: address correspondence to: jeffrey shears, unc charlotte, 9201 university city blvd. charlotte nc 28223-0001. email: jkshears@uncc.edu spring2005-095_page97 spring2005-096_page98 spring2005-097_page99 spring2005-098_page100 spring2005-099_page101 spring2005-100_page102 spring2005-101_page103 spring2005-102_page104 spring2005-103_page105 spring2005-104_page106 spring2005-105_page107 spring2005-106_page108 spring2001-017_page 12 spring2001-018_page 13 spring2001-019_page 14 spring2001-020_page 15 spring2001-021_page 16 spring2001-022_page 17 spring2001-023_page 18 spring2001-024_page 19 spring2001-025_page 20 spring2001-026_page 21 spring2001-027_page 22 spring2001-028_page 23 spring2001-029_page 24 spring2001-030_page 25 microsoft word bean_2131_disability content copyedit final   ______________  kristen faye bean, msw, ph.d., is an assistant professor in the department of social work at the university of hawaii at manoa. taylor krcek, msw, is a doctoral student at the university of tennessee in knoxville, ky. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 633-647   the integration of disability content into social work education: an examination of infused and dedicated models kristen faye bean taylor e. krcek abstract: disability content has been slowly integrated into social work curricula despite the large proportion of social workers supporting people with disabilities and its requirement in social work education by the council on social work education educational policy and accreditation standards. schools of social work offer disability content to their students in three ways: infused, dedicated (specialization), or a combination of both. a content analysis of 1620 course titles and descriptions from the top schools of social work was conducted to assess the integration of disability content into social work curricula. eighty percent of the schools included disability content in their curriculum. disability content was more likely to be integrated using the infused rather than the dedicated model. keywords: disability, disabilities, infused, curriculum, diversity disability content is important to social work education because social workers often serve people with disabilities and are required to advocate for vulnerable populations (national association of social workers, 2006). families of individuals with disabilities are often stressed, and are overrepresented in poverty statistics (denavas-walt, proctor, & smith, 2011; neely-barnes & dia, 2008). the oppression of this vulnerable population and the intersection of individual ability and social constraints surrounding disability issues justify social work’s role in disability issues and service provision. the council on social work education (cswe) 2008 educational policy and accreditation standards (epas) mandate that social work programs teach disability issues, which are included under mandates for education on diversity. in addition, the council on social work education requires disability content in social work education for accreditation (2008). social work researchers have assessed educational content in social work by conducting content analyses of course descriptions and syllabi (julia & kondrat, 2000; lacasse & gomory, 2003; laws et al., 2010; steen & mathiesen, 2005). these studies have each included a selection of a sample of courses and/or syllabi to analyze based on the identified research question in the study and the authors identified search terms or topics for the courses and/or syllabi. findings from these studies have revealed whether information is included in social work courses and the number of times a subject is covered in social work courses. findings from these studies have led to improvement in social work education by elucidating areas of social work education which were not covered adequately. previous research has found that only 27%-37% of schools of social work included disability content in their curriculum (laws, parish, scheyett, & egan, 2010; quinn, 1995). it is not only important to assess if disability content is included in social work education, but how it is included. the way in which disability content is included in curricula may impact its effectiveness in preparing social work students to bean, krcek/integration of disability content 634 work with people with disabilities. there are benefits and challenges to including disability content in dedicated or infused models throughout the social work curriculum. the current study conducted a content analysis of social work course titles and descriptions (n = 1620) of 25 schools of social work to assess the prevalence of disability content and use of the infused and dedicated models of integrating disability content into social work education. literature review importance of disability in social work education disability is a familiar social problem in the united states. census bureau statistics indicate that 29% of u.s. families have one or more members with a disability (2005). social workers provide many services to people with disabilities and their families. worldwide, social workers are engaged in service, policy, and research endeavors which are aimed at garnering rights for individuals with disabilities (deweaver, 1995). the national association of social workers (nasw) reports that social workers provide community-based housing, employment and training, education, medical, and psychological services for people with disabilities. the nasw concurrently found that a high proportion of social workers reported working with people with chronic medical (88%), neurological (80%), physical (79%), and developmental (75%) disabilities (national association of social workers, 2006). because of the high proportion of social workers who report working with individuals with disabilities, disability content is an exceptionally important component of social work education. this importance was emphasized in 2002 when the council on social work education (cswe) published a curriculum resource spurred by the acknowledgement of the lack of familiarity by social work educators on resources and models to guide disability education in social work (gilson, depoy, macduffie, & meyershon, 2002). disability content in social work curricula although the cswe epas did not mandate disability content in social work education until 2001, the americans with disabilities act (ada), enacted in 1990, brought attention to disability issues in social work. the ada (1990) expanded the protection of people with disabilities from discrimination in employment and access in public areas. quinn (1995) recognized the importance of social workers in providing services and advocating for people with disabilities after the enactment of the ada. quinn (1995) conducted a study of 93 schools of social work by reviewing their course titles and descriptions related to disability content and mailing a survey to the deans and directors of schools of social work inquiring about their number of students and faculty, faculty interest in disability and rehabilitation, and courses covering disability content. of the 42 schools that responded to the survey, 81% reported that they included specific content on disability in their curriculum, while the review of the course titles and descriptions found that 27% of schools of social work included disability content in their curriculum. a review of course titles and descriptions found that the majority of disability content was covered in practice courses (29%), policy courses (18%) and human behavior in the social environment courses (11%). quinn (1995) found that the only courses dedicated solely to disability content were policy courses. advances in social work, fall 2012, 13(3) 635 since the cswe epas in 2001 and 2008 mandated disability content in social work curricula, there has been one study that assessed curricula for content on developmental disabilities. laws and colleagues (2010) conducted an internet-based review of the curricula of top-50 schools of social work based on the u.s. news and world report rankings. course information was analyzed to see if courses covered broad discussion of disability or developmental disability issues, specific interventions for people with developmental disabilities, or policies associated with people with developmental disabilities. faculty expertise or interest in disability issues was also analyzed. laws and colleagues (2010) found that 37% of the reviewed schools included at least one course that covered a broad discussion of disability content. twelve of the schools (24%) offered courses that concentrated on disability related issues. fifty eight percent of the reviewed schools had at least one tenure-line faculty member with a research background in developmental disability studies or services. although these findings contribute to the understanding of disability content in social work curricula, the authors' primary focus on developmental disabilities is a limitation. more information is needed on social work curricula and the spectrum of disabilities. contrasting infused and dedicated models of disability education schools of social work offer disability content to their students in three ways: infused, dedicated (specialization), or a combination of both (gourdine & sanders, 2003). the dedicated model of education includes a purposeful course designated to teach a topic, such as disability. an infused model spreads disability content across the courses within a curriculum (knopf, 1996). several studies have demonstrated the benefits of infused and dedicated education on disability content in preparing social work students to work with people with disabilities (abrams & gibson, 2007; begab, 1970; cummings, cassie, galambos, & williams, 2006; dyeson, 2004; lee & waites, 2006; mama, 2001; nagda, et. al., 1999). some have proposed that the dedicated model is the preferred method of integrating diversity topics into social work curriculum (begab, 1970; mama, 2001; nagda et. al., 1999). for example, a course utilizing the dedicated model might be an advanced field practice course for bsw students, which purposefully addresses diversity issues in each class within the course (mama, 2001). there are several benefits to this approach. the professor of a dedicated course often has expertise in the specific area being taught. additionally, the professor of a dedicated course gains expertise in how to manage discussing diversity topics and has time to build the rapport with students needed to discuss these issues comfortably. moore (2004) described the use of a course project on disability that was conducted throughout a course on generalist practice. moore (2004) reported that students liked applying theories and course concepts to a project that would impact people with disabilities. others have proposed the use of the infused model (abrams & gibson, 2007; cummings et al., 2006; dyeson, 2004; lee & waites, 2006). dyeson (2004) reported that, because education on diversity issues is infused throughout social work curricula, social workers gain an extensive education on these issues. in gezinski’s (2009) curriculum framework for lgbtq content in social work, she argues for an infused model, positing that a holistic approach that examines the macro/micro and theoretical/practical is necessary for the integration of topics relating to oppressed bean, krcek/integration of disability content 636 groups. within the infused model, diversity content permeates the cswe’s educational policy and accreditation standard’s (epas) eight foundation curriculum content areas: values and ethics, diversity, economic justice, social work practice, policy, research, field education, and human behavior and social environment (hbse) (bergel, 2006). a benefit of the infused model is that most students taking courses in different concentration areas, such as direct practice or policy, will be exposed to diversity content in their classes. methods sample course titles and descriptions (n = 1620) from the top-25 schools of social work (as ranked by the u.s. news and world report in 2008) were collected in february 2010. data were collected from both bsw and msw programs. all schools had msw programs, while only 13 had bsw programs. data were also collected on both foundation/core and concentration/elective curricula, which were defined based on each school’s classification. course titles and descriptions were accessed through each institution’s website. schools were contacted via email if course titles and/or descriptions of the school’s bsw and/or msw curriculum were not available online. four schools of social work had only course titles available. the course titles and any available course descriptions from these schools were used. content analysis since 1952, when content analysis emigrated from mass communications research (berelson, 1952), it has continued to be a methodology of choice for researchers not only within social work, but also psychology, history, anthropology, and other related fields, who are interested in making valid inferences from text. content analysis can be defined as "a research technique for making replicable and valid inferences from data to their context" (krippendorff, 2004, pp. 21). this content analysis included unitizing, or distinguishing, segments of text that were of interest in the analysis (krippendorff, 2004). courses were coded by the first author. the second author coded a random sample of 10% of the courses separately to ensure inter-rater reliability. a kappa of .87 (p < .000) indicated almost perfect agreement among coders. kappa is the most widely used measure of agreement (orme & gillespie, 1986; viera & garrett, 2005). some studies which use kappa to measure agreement experience a high percentage of agreement with corresponding low kappa values, which is known as the kappa paradox (kuppens, holden, barker, & rosenberg, 2011). the current study did not experience this issue. courses were coded by level of education (bsw or msw) and course type (core/foundation or concentration/elective). other variables included “course title includes disability” and “course description includes disability”. the unitizing of course titles and descriptions was guided by the following search terms: ability, ableism, developmental abnormalities, disabilities, disability, disabled, special needs, the exceptional child, special education, special needs, and handicapped. these terms, in either the course title or description, were used as indicators of disability content. the courses that included these terms were reviewed to be sure that the terms represented disability content. four courses found in the search were not included in advances in social work, fall 2012, 13(3) 637 the study because they focused on “special needs” populations, such as elderly, rather than disability populations. fifty-nine courses that included the term “ability” did not refer to clients’ abilities. the majority of these courses referred to students’ abilities. these courses were not included. the main topic of the courses with disability content was assessed by whether or not the course included disability content in the title or not. if the course included disability content in the course title, then disability was the main topic of the course. if the course did not include disability content in the course title, then the course had a different main topic. cross-tabulations were conducted between level of course (bsw or msw) and the variables of “course title includes disability” and “course description includes disability content”. cross-tabulations were also conducted with course type and inclusion of disability content in either the course title or description. the course titles and descriptions with disability content were examined to assess the course type and disability type addressed in each course. results twenty of the schools of social work (80%) included disability content in course titles or descriptions in their curricula. table 1 lists the 20 schools that included disability content in courses and the number of courses with disability content that each school offered. among a total of 1620 courses from the top-25 schools of social work, 109 (7%) courses had disability related terms within the course title and/or course description. there were 22 bsw and msw courses (1%) with disability related terms in the course title. there were 87 courses (5%) that included disability content within the course description. only one out of 176 bsw courses had disability related terms within the course title and two (1%) bsw course descriptions included disability content, indicating very low coverage of disability content in bsw programs. out of 1444 msw courses, 21 (1%) had disability related terms within the course title and 85 (6%) msw course descriptions included disability content. eighty-seven (79.8%) of the courses that included disability content reflected an infused approach. of the 109 courses with disability content, there were 14 (12.8%) foundation/core course descriptions with disability content, and none of the course titles of the foundation/core courses included disability content. twenty-two (23.1%) elective/concentration course titles included disability related terms, and seventythree (76.8%) elective/concentration course descriptions included disability content. twenty-two (20.1%) of the 109 courses’ main topic was disability, which indicated the use of the dedicated education model. the descriptions of the courses with a main topic of disability differed based on approach to teaching. table 2 displays the course titles and descriptions with a main topic of disability. bean, krcek/integration of disability content 638 table 1: the number of courses with disability content in schools of social work schools of social work n university of michigan-ann arbor 26 columbia university 8 case western reserve university 8 university of washington 8 smith college 8 boston college 6 university of chicago 6 university of texas-austin 5 suny-albany 5 university of wisconsin-madison 4 university of california-berkeley 4 new york university 4 washington state 4 virginia commonwealth university 3 university of california-los angeles 2 university of maryland-baltimore 2 university of pennsylvania 2 university of pittsburgh 2 university of north carolina 1 university of illinois at chicago 1 advances in social work, fall 2012, 13(3) 639 table 2: dedicated courses with disability content course title course description intervention approaches for families with children who have developmental disabilities provides the knowledge and skills needed for social work practice with families with children who have developmental disabilities. focuses on the application of theoretical models and practice concepts for intervening with family systems, siblings, and parents. provides an understanding of the impact of disability on the family unit, family coping skills, and current practice approaches to family support, empowerment, and self-advocacy. emphasizes the development of assessment and intervention skills relevant to working with this specialty population. social work, education, and the exceptional child focuses on understanding the characteristics and the family and social context of the exceptional child, with an emphasis on educational settings. discusses practice approaches for working with exceptional children and their families. includes an overview of legislation and policies pertaining to exceptional children. emphasizes assessing children, working with them and their families to maximize social and educational potential, and supporting individual children in the school setting. topics in disability studies an interdisciplinary approach to disability studies, including focus on the arts and humanities, natural and social sciences, and professional schools. some topics include history and cultural representation of disability, advocacy, health, rehabilitation, built environment, independent living, public policy. team taught with visiting speakers. accessible classroom with realtime captioning. disability issues: obstacles and solution in today's world this course will examine the topic of disability from various perspectives, including the historical development of civil rights, the legal framework, the medical model, and how disability is viewed across various cultures. it will examine different types of disabilities, how people with disabilities are treated and denied equal access to programs and employment, and what political/legal recourse is available to address these inequities. the course will also review progress that has been made in the united states regarding the integration of people with disabilities by removing attitudinal and architectural, barriers that they face in daily life. the course will also address how to interact with individuals who have disabilities, the differences between visible and non-visible disabilities, and how disability can affect individuals depending on whether they are children, teenagers or adults. issues pertaining to dimensions of diversity (e.g., ability, age, class, color, culture, ethnicity, family structure, gender [including gender identity and gender expression], marital status, national origin, race, religion or spirituality, sex, and sexual orientation) will be given special attention, particularly in areas of policy development and service delivery for people with disabilities. bean, krcek/integration of disability content 640 the exceptional child this course focuses on categories of exceptional children as defined by federal and state legislation, including the individuals with disability education act (p.l. 94-142), the rehabilitation act (section 504), and policies and programs for children who have disabilities. the prevalence and description of childhood disabilities and chronic illnesses are discussed. the role of the social worker in providing appropriate services to children and their parents in a school setting is emphasized. methods of evaluating children as well as current research in the field are considered. disability: medical, ethical, and psychosocial issues this course examines a broad range of topics relating to disability and society. we will study traditional medical models of illness as well as social and minority paradigm models that arose from the disability rights movement. we will examine the impact of disability throughout the lifespan, review theories of adaptation, and discuss clinical practice concerns/interventions. participants will have opportunities to study specific disabilities that interest them within the framework of the course. social policy, disability-related entitlements, and recent legislation also will be covered, along with controversial disability ethics concerns such as physician-assisted suicide and health care rationing. health, mental health, and disabilities: issues, policies, research, and programs this course takes a problem-identification and problem-solving approach to the delivery of social work services in health, mental health, and disabilities, with content about the social policies and organization structures that characterize our current health-care system. empowerment practice with persons with disabilities this course is designed to provide students with a background in theories and models of support involving people with developmental disabilities and their families, across the lifespan and across practice settings. emphasis is given to understanding disability as a characteristic that is experienced on a spectrum as a natural part of the human condition and as a socially constructed category through which people experience discrimination and oppression. emphasis is also given to promoting personal empowerment in service planning and upon exploring how the disability civil rights movement has influenced current social work best practice. social work and disabilities this course will consider disability policy, laws, history, and major current issues. we will consider theoretical models for considering disability from both individual and societal frameworks. practice models will include the development of competence at each stage of the social work processes, and will focus especially on communication, access and barriers, resources, and current programs. disability identity theory will offer a framework for understanding the wide variations among clients with disabilities in relation to their disability. we will study various broad types of disabilities, such as sensory impairments, cognitive impairments, developmental disabilities, mental illness, mobility impairments, and others as students interests suggest. we will consider the effect of disability at different periods of an individual’s life from disabilities which are inherited or manifested in infancy or early childhood through disabilities which occur in the later years. advances in social work, fall 2012, 13(3) 641 social work and developmental disabilities definition, incidence, etiology, and prevention of mental retardation and other developmental disabilities. examines the lifecycle needs of this population, as well as social-welfare issues, social services available, and the social worker's role. p: jr st, soc work/welfare major. health, aging, and disability policy and services provides knowledge about the contemporary organization of health care, as well as policies and services for older adults and people with disabilities. developmental disabilities this course enhances the students' ability to practice social work with and on behalf of people with developmental disabilities and their families. the course provides a base of knowledge about developmental disabilities and differences, their causes and characteristics. students learn how disabilities and learning differences impact personal, familial, educational, social, and economic dimensions for the individual, family and society, with attention to the person's special life cycle needs and characteristics. the course also emphasizes legislative, programmatic, political, economic, and theoretical formulations fundamental to service delivery. comparative perspectives on disability and disability policy this course introduces students to social work with persons with disabilities and their families. we will consider the history, social construction, cultural perspectives, and demographics of physical, emotional, sensory, and cognitive disability. major national disability policies and programs are studied and critiqued, along with individual and collective strategies that foster empowerment and social justice. individual experiences of people with various types of disabilities and families are explored, followed by a discussion of issues of discrimination, equal access, universal design, and social integration. after gaining a sense of the personal experiences and social status of people with disabilities, implications for social work practice are addressed. bean, krcek/integration of disability content 642     thirty-four (31.2%) of the courses with disability related content specified a disability type that would be covered in the course. the courses described that they covered the following disabilities: 11 psychiatric (32.3%), 10 childhood (29.4%), 9 developmental (26.4%), 5 physical (14.7%), and 1 learning disabilities (3%). examples of courses that included developmental disability content referred to developmental delay or mental retardation in course descriptions. reference to the “exceptional child”, which is a reference to elementary school or middle school students with disabilities, is an example of childhood disability in a course. psychiatric disability refers to courses that specified experiencing a disabling condition due to a mental illness. courses with physical disability content usually mentioned “physical disability or handicap” within the course description. an example of a learning disability is a course that referred to “learning handicaps." only one course description reported content on the ada, while one other course reported content on the individuals with disabilities education act and the rehabilitation act, which are policies enacted prior to the ada that affect people with disabilities. limitations the sample in this study, the top 25 schools of social work, potentially represents model institutions for other schools of social work, which limits the generalizability of the findings. green, baskind, fassler, and jordan (2006) found that the u.s. news and world report rankings were consistent with objective indicators of program success and representative of the perspective of deans and faculty members. kirk’s (1995) constructive critique of the u.s. news and world report schools rankings showed that schools were ranked based on productivity, publications by professors at the school, and reputation, based on productivity and opinions of academics about the school. this indicates that the rankings may not be subjective, but that the top ranked schools are representative of schools that have good reputations from social work academics. although this sample is not representative of the overall population of schools of social work, it does document how the top-ranking schools have integrated disability into curriculum. since the sample is from the top-ranking schools, the results may represent schools with more disability content than the larger population of all schools of social work. this study gathered information about curricula based on course titles and descriptions. although previous studies assessing the impact of disability content in social work education have used similar methods, a review of syllabi, interviews with social work professors, or observations of social work courses would provide more information about social work curricula. this study can only conclude that the course titles and descriptions reported or did not report disability content. the results of this study provide information about the prevalence of disability content in social work curricula. this information is essential to have in order to ensure competency in disability service provision among social workers, which the nasw code of ethics mandates (2008). this data will also inform future research endeavors of disability content in social work education. discussion eighty percent of the top-25 schools of social work included disability-related terms in their course titles and descriptions. based on a review of course titles and descriptions, quinn (1995) found that 27% of schools of social work included advances in social work, fall 2012, 13(3) 643   disability content in their curriculum prior to cswe-epas mandate for social work schools to include disability content. also, based on a review of course titles and descriptions, laws et al. (2010) found that 37% of the top-50 schools of social work included developmental disability related content in curriculum. however, laws and colleagues (2010) defined developmental disability-related content as “broad survey or discussion of intellectual and/or dd and disability issues” (p. 325). the present study shows a 53% increase in schools showing any disability content in course titles and descriptions since the cswe-epas mandate to include disability content in social work curricula. as measured by course descriptions available online, 80% of the top 25 schools of social work included disability content in their curriculum and disability content were present in elective courses more than foundation/core courses. twenty percent of the courses with disability content used the dedicated model, while the remaining courses infused disability content into courses with other main topics. only one course description mentioned covering the ada. developmental and childhood disabilities were reported the most often in the course titles and descriptions. the majority of social work programs in this study infused disability content throughout many courses as indicated by course titles that did not include disabilityrelated terms. for example, a few of the infused course titles with disability content were: “ethnicity and social welfare”, “social work practice in health care settings”, and “clinical practice in schools”. the heterogeneity of the titles of courses that include disability content indicates that schools of social work believe that different kinds of social workers, such as clinical and policy, should have knowledge of people with disabilities. although social work has not yet defined a best practice of integrating disability content into curriculum, it appears that a large majority of schools believe that the infused approach is most appropriate for including disability content in curriculum. while the overall inclusion of disability in social work curricula appears to have increased, it is especially important to analyze the content of the curriculum. similar to quinn (1995) who found only one course covering the ada, this study also found only one course that included ada in a course description and another course that included previously important policies that impact people with disabilities in a course description. in order for social workers to competently provide services for people with disabilities, it is critical that they understand the policy and law that affect many aspects of their lives, including housing, employment, and transportation. this study examined the bsw and msw programs at the top 25 schools of social work. other studies have chosen to assess only msw programs’ integration of disability content (begab, 1970; quinn, 1995). while the sample of schools with bsw programs in this study was small (n = 13), it revealed that only a total of three courses within the bsw programs had disability content. bsw programs have been perceived as gatekeeping programs. gatekeeping is used to assess a student’s suitability for the social work profession. bsw programs use gatekeeping strategies, such as mandating a formal application into the bsw major before a student’s junior year in college. the belief in social justice and knowledge of diversity issues are critical issues in assessing the suitability of bsw students to become professional social workers (reynolds, 2004; urwin, van soest, & kretzschmar, 2006). if disability content is not integrated into bsw curricula, then students may not have an bean, krcek/integration of disability content 644 opportunity become proficient in disability issues. a lack of inclusion of diversity issues, such as disability, in the social work curriculum could affect gatekeeping decisions. implications for practice and research almost one-third of u.s. families experience disabilities and issues related to those disabilities, including stress and poverty (denavas-walt, proctor & smith, 2011; neely-barnes & dia, 2008; u.s. census bureau, 2005). not only are social workers mandated to receive education on disability content, people with disabilities and their families need social workers to be educated on issues impacting them, and, thus, provide appropriate services to meet their needs (council on social work education, 2008). while this study demonstrates an increase in disability content in social work curricula, it also shows that some schools of social work may not include any disability content in their curricula. this is concerning since social workers may graduate without basic knowledge of disability issues and may provide inadequate services for people with disabilities. for example, our study found that only one course description mentioned the ada. while this policy protects people with disabilities from discrimination, it is dependent on self advocacy skills among people with disabilities (ada, 1990). many people with disabilities struggle with self advocacy; therefore, they need service providers to help them to understand and stand up for their rights (downing, earles-vollrath, & schreiner, 2007; gerber & price, 2003). if social workers themselves are not knowledgeable of the ada, then they will not be able to help people with disabilities to advocate for their rights that are protected under the ada. this study’s findings advance knowledge of disability content in social work education. it found that disability content was more likely to be infused in curricula rather than contained in dedicated courses; however, as mentioned previously, it is unknown whether infused or dedicated models of education are more effective. future research should explore the effectiveness of integrating disability content using infused and dedicated models. though the sample was small, this study was also the first to assess for disability content within bsw curricula. it found that very few bsw courses included disability content in their titles or descriptions. because this is a first look at disability content in bsw programs, more research is needed that examines the amount and extent of disability and other diversity content within bsw curricula. while this study assessed only course titles and descriptions for disability content, it was the only study that has assessed for content regarding all types of disabilities within social work curriculum since the enactment of the ada (quinn, 1995). the most recent assessment of disability content conducted by laws and colleagues (2010) focused on developmental disability issues. their study also analyzed course data that was present on the internet with similar methodology to this study. more information using a broader methodological approach, such as analysis of course syllabi, is still needed to fully assess the integration of disability content in social work education. advances in social work, fall 2012, 13(3) 645   references abrams, l. s., & gibson, p. 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(2008). rankings: social work. retrieved from at http://rankings.usnews.com/best-graduate-schools/top-social-workschools/rankings viera, a. j., & garrett, j. m. (2005). understanding interobserver agreement: the kappa statistic. family medicine, 37(5), 360-363. author note: address correspondence to: kristen faye bean, phd, assistant professor, school of social work, university of hawaii at manoa, 1800 east-west road, henke hall, rm. 224, honolulu, hi. email: socialworker2you@yahoo.com spring2005-022_page24 spring2005-023_page25 spring2005-024_page26 spring2005-025_page27 spring2005-026_page28 spring2005-027_page29 spring2005-028_page30 spring2005-029_page31 spring2005-030_page32 aisw vol. 5, no. 2 why conduct a spiritual assessment? a theoretical foundation for assessment david r. hodge abstract: in spite of increased interest in spirituality, the concept of a spiritual assessment remains a questionable practice in the eyes of many social workers. this paper develops five rationales to underscore the importance of including spirituality in assessment. these reasons can be summarized as follows: spiritual assessment provides insight into clients’ worldviews, serves as a vehicle to identify strengths, and demonstrates respect for client autonomy. in addition, the profession’s ethics implicitly recommend the administration of a spiritual assessment and, for a growing number of accrediting organizations and agencies, it is explicitly recommended.this paper concludes by discussing the implications for practitioners and educators. keywords: assessment, spirituality, religion, spiritual assessment, religious histories assessment is a central component of direct social work practice. while numerous definitions exist, assessment can be understood as the process of gathering, analyzing, and synthesizing information into a concise picture that provides the basis for action decisions (hepworth, rooney & larsen, 2002; rauch, 1993). it is the assessment process that provides the foundation for the resulting therapeutic enterprise. the content areas explored during assessment provide the basis for, and give direction to, subsequent practice decisions. recently, interest in the topic of spiritual assessment has emerged, perhaps particularly among practitioners and students (canda & furman, 1999; derezotes, 1995; sheridan & amato-von hemert, 1999). traditionally, however, the assessment of spirituality has been ignored (decoster & burcham, 2002). many social work practitioners believe that “the notion of spirituality is irrelevant to everyday life” or is even harmful (gotterer, 2001, p. 191). time constraints limit the material that can be covered during assessment, and professional consensus has traditionally suggested that domains other than spirituality be explored during the assessment process. echoing this line of thought, clark (1994) has argued that social work education should not address spirituality.while many disagree with this perspective (canda & furman, 1999), clark’s views seem to reflect the professional 183 david hodge, ph.d., is a post-doctoral fellow with the program for research on religion and urban civil society, university of pennsylvania, philadelphia, pa 19104. copyright© 2004 advances in socialworkvol. 5 no. 2 (fall 2004) 183-196. indiana university school of socialwork. 184 reality that currently exists (decoster & burcham, 2002). studies have repeatedly demonstrated that most social workers have received little or no training in spirituality or religion during their graduate education (canda & furman, 1999; furman, benson, grimwood & franz, in press; murdock, 2004; sheridan & amato-von hemert, 1999). given the central role that education plays in socializing future practitioners into what is considered accepted social work practice, the profession sends the message that spirituality is, at best, a marginal content area to be considered during the assessment process. the question detractors implicitly ask—why should time be devoted to assessing spirituality?—is one that deserves an answer. the purpose of this paper is to answer this question. more specifically, this paper delineates the reasons why a spiritual assessment should be conducted, and concurrently, implicitly emphasizes the need for training so that social workers are equipped to perform such assessments in a spiritually competent manner. i begin by defining spirituality and religion, noting how these two constructs relate to spiritual assessment. definitions although various definitions of spirituality and religion exist, they are generally seen as distinct but overlapping constructs (canda & furman, 1999; carroll, 1998). ai (2002), for example, views them as interconnected but distinguishable concepts, a view shared by miller, the chair of the national institutes of health (nih) working group on research on spirituality, religion and health (miller & thoresen, 2003). consistent with this understanding, spirituality can be viewed as ontologically driven, striving for union or relation with god, or ultimate transcendent reality, while religion can be understood to be the external expression of faith that unites an individual with a moral community (joseph, 1988; stanard, sandhu & painter, 2000). debate exists over whether spirituality or religion is the broader construct (pargament, 1999), and much empirical work tends to treat the two constructs as synonymous (miller &thoresen, 2003).when referencing the others’ work, i have generally followed the usage developed by the underlying author(s). in general, however, i view spirituality as the broader construct, particularly when referring to spiritual assessment. based upon this understanding, a spiritual assessment incorporates religion. personally oriented spiritual dimensions are explored, along with any community oriented religious dimensions that may exist as an expression of one’s spirituality. the reasons why social workers should be equipped to conduct a spiritual assessment are discussed next. these reasons, which are inter-related, can be summarized as follows: knowledge of clients’ worldviews, interest in the strengths perspective, respect for client autonomy, professional ethics, and accrediting and agency requirements. knowledgeof clients’worldviews one of the purposes of assessment is to gather information about the client’s worldview. understanding how the client views reality assists practitioners in advances in socialwork building therapeutic rapport, suggesting interventions that are more likely to be adopted, and avoiding interactions that place the therapeutic relationship at risk. interactions that are incongruent with clients’ worldviews can result in clients terminating therapy or, in some instances, even cause harm to clients. for many people, spirituality provides an interpretive framework for understanding reality that informs them of who they are and how they should live (maslow, 1968). put differently, formany individuals, spirituality is central to their personal ontology (haynes, 2001). as observers have noted, clients’ spiritual worldviews can affect attitudes and practices in a number of areas, including animals, child care, diet,marital relations,medical care,military participation, recreation, schooling, andmany other areas of significance to social workers (pellebon & anderson, 1999; rey, 1997). it is important to note that spirituality is the salient organizing principle for a significant number of individuals. approximately 95% of the general public profess belief in god or the transcendent and 82% report that they feel the need to grow spiritually (gallup & lindsay, 1999). approximately 60% of the public report that religion is very important to them, and approximately a third consider religion to be themost important influence in their lives (walsh, 1999). furthermore, interest in spirituality appears to be increasing (miller & thoresen, 2003). in addition, the united states is becoming increasingly diverse in terms of its religious tapestry (melton, 1999). for instance, the number of muslims (smith, 1999) and hindus (williams, 1997) has increased dramatically since immigration policies were changed in themid-1960s.while secularists and adherents ofmainline protestant denominations may still dominate the centers of social power in the united states (hunter, 1991; mccullough, weaver, larson & aay, 2000), the underlying society is populated by an increasingly diverse array of religious worldviews. as pellebon and anderson (1999) note, it is essential to understand the meaning of life from the perspective of spiritually based clients. conducting a spiritual assessment provides a window into the client’s worldview. to provide effective, client-centered services for persons for whom spirituality plays an important role in shaping their perceptions, spiritual assessment is a prerequisite (richards & bergin, 1997). this is particularly the case for those who adhere to non-dominant worldviews (koenig, 1998; richards & bergin, 2000; van hook, hugen & aguilar, 2001). if spiritual assessment is disregarded, therapy may, at best, fail to be as effective as it might otherwise be and, at worst, result in harm to the client. as has been noted among hindus, for example, the application of typicalwestern secular values and related interventions may cause “confusion and further negative affect” (reddy & hanna, 1998, p. 393). put more positively, conducting a spiritual assessment affords practitioners the opportunity to gather the necessary information that can be used to build rapport and design strategies that clients may be more inclined to implement (gotterer, 2001). by suggesting interventions that are congruent with, and even resonate with clients’ spiritual worldview, clients’ sense of ownership is enhanced, resulting in greater likelihood of client implementation and follow185hodge/why conduct a spiritual assessment? a theoretical foundation for assessment 186 through (hepworth, et al., 2002). this dynamic may be even more likely to occur if interventions are based upon clients’ spiritual strengths. interest inthe strengths perspective interest in the strengths perspective has continued to grow (saleebey, 1997; 2000). this perspective emphasizes focusing on clients’ assets rather than deficits during the assessment process. a measure of the strengths perspective’s influence is that even traditional texts on social work practice emphasize that a key element of assessment is identifying clients’ strengths (hepworth, et al., 2002). once strengths are identified in the assessment process, they can be operationalized to ameliorate problems. while historically devout spirituality has often been equated with psychopathology (ellis, 1980; freud, 1964 [1927]), this opinion is no longer scientifically tenable. in the past few decades, a significant body of empirical research has developed, indicating that spirituality and religion are important assets (koenig, mccullough & larson, 2001; johnson, 2002; pargament, 1997; plante & sherman, 2001). in what is perhaps the best review to date, koenig, mccullough and larson (2001) examined more than 1,600 studies on the relationship between religion and physical and mental health outcomes. religion was associated with a wide array of salutary outcomes. general social survey (gss) data suggests that religious strengths are relatively common among the general population (davis, smith & marsden, 1998). some 42% of the general public report finding strength and comfort in religion at least every day, with an additional 17% indicating that they find strength most days. only 14% report that they never or almost never find strength in their religion. similarly, some 54% of the population feel that their religious community is very helpful. in addition, spiritual assets may be particularly salient among disadvantaged populations, which may help explain why historically spirituality has often been associated with psychopathology. relative to the general public, research indicates that spirituality plays a heightened role among african americans, hispanics, women, people who are elderly, and people who are poor (davis & robinson, 1997; gallup & lindsay, 1999; pargament, 1997). for instance, when respondents in 23 nations were asked to rank the importance of god in their lives on a 10-point scale, american blacks recorded the highest score of any group—9.04 (gallup & castelli, 1989). across an array of measures, black americans exhibit higher levels of religious participation than white americans (taylor, chatters, jayakody & levin, 1996). according to one study, approximately 70% of african americans attend church or a place of worship at least two or three times a month (chatters & taylor, 1994). as might be expected, various measures of spirituality and religion have been associated with a wide variety of salutary characteristics among african americans, including academic achievement (walker & dixon, 2002), civic engagement (smidt, 1999), empowerment (calhoun-brown, 1998), female leadership (robinson, 1996), manhood development (watts, 1993), recovery from advances in socialwork addiction (turner, o’dell & weaver, 1999), coping among the elderly (johnson, 1995), and women (mattis, 2002), as well as resiliency among children (haight, 1998), single mothers (brodsky, 1999), the poor (nelson, 1997), the elderly (wallace & bergeman, 2002), and victims of racism (bowen-reid & harrell, 2002). similarly, spirituality/religion have been associated with increased levels of interpersonal friendliness (ellison, 1992), life satisfaction (levin, chatters & taylor, 1995), physical and emotional health (stolley & koenig, 1997), positive self-perceptions (ellison, 1993), quality of family life (ellison, 1997), self-esteem (maton, teti, corns & vieira-baker, 1996), and the ability to handle the stress associated with having a child with disabilities (rogers-dulan, 1998) and having an infant hospitalized with a serious illness (wilson & miles, 2001). the importance of spiritual assetsmay becomemore pronounced during times of stress or difficulty, whichmay help explainwhy spirituality tends to play amore significant role among disenfranchised populations. research suggests that spiritual coping resources may becomemore salient in the face of difficult situations (pargament, 1997). this is important since social workers often encounter people when they are wrestling with problems. without a vehicle for identifying spiritual resources, however, spiritual strengths are likely to remain untapped, regardless of their importance in clients’ lives (ronnau & poertner, 1993). clients who are animated by their spirituality are often concerned about being misunderstood by social workers, who are often presumed to be secular and, consequently,may be disinclined to broach the topic themselves (furman, perry & goldale, 1996; lyles, 1992). clients who are adherents of subordinate faiths may be particularly hesitant to discuss spiritual strengths, unless practitioners create a context that suggests some degree of spiritual competency on the part of the practitioner (kelly, aridi & bakhtiar, 1996; richards & bergin, 2000). spiritual assessment helps create such a context by implicitly sending the message that spirituality is an important and valued resource that can be used to address problems. as cascio (1998) notes, it legitimizes the topic of spirituality in practice settings. furthermore, the skill sets employed in the assessment process (e.g., empathy, curiosity, and authenticity) can help set clients who may be worried about sharing an intensely personal topic at ease (pellebon & anderson, 1999). in short, spiritual assessment provides amechanism for identifying important spiritual resources that may otherwise lie dormant. as will be discussed subsequently, it can also demonstrate respect for client self-determination. respect for client autonomy respecting client autonomy is a central tenant of social work practice (regehr & antle, 1997). not only is a client’s right to self-determination a “hallmark of the profession” (cascio, 1998), but effective therapy is understood to be predicated upon a non-coercive therapeutic atmosphere in which the desires of the client are valued (cornett, 1992; richards & bergin, 1997). many clients desire to have their spiritual beliefs and values integrated into counseling settings (arnold, avants, margolin &marcotte, 2002; larimore, parker & crowther, 2002; privette, quackenbos & bundrick, 1994). according to gallup 187hodge/why conduct a spiritual assessment? a theoretical foundation for assessment 188 data reported by bart (1998), 66% of the public would prefer to see a professional counselor with spiritual values and beliefs, while 81% wanted to have their own values and beliefs integrated into the counseling process. among a sample of parents (n=70) whose children were receiving mental health services, 74% felt that spirituality was relevant to their child’s problems and more than half (53%) felt that therapists should consider spirituality in treatment (mathai & north, 2003). althoughmore outcome studies are needed, some clinical trails have examined the efficacy of incorporating clients’ spiritual beliefs into the counseling project. consistent with the research cited in the previous section, these studies indicate that spirituality is an important asset that can be marshaled to help ameliorate problems. with muslims, for example, cognitive/behavioral therapy modified with beliefs drawn from the koran has been effectively used to address anxiety disorders (azhar, varma & dharap, 1994), bereavement (azhar & varma, 1995a), and depression (azhar & varma, 1995b). this modality has also been effective in altering the characteristics and content of schizophrenic symptoms (e.g., auditory hallucinations) that have persisted despite the administration of anti-psychotic medications (wahass & kent, 1997). similarly, positive outcomes have been found when treating depression among christians (hawkins, tan & turk, 1999; propst, 1996), perfectionism among mormons (richards, owen & stein, 1993), neurosis among chinese taoists (xiao, young & zhang, 1998), and stress among a religiously heterogeneous sample (nohr, 2000). social workers have an obligation to respond to clients’ desires to integrate their spirituality into therapy (northcut, 2000). for those clients who want to integrate their spiritual beliefs and values into therapy, spiritual assessment provides a way to honor their right to self-determination. spiritual assessment provides a forum for identifying relevant spiritual beliefs and practices that can be incorporated into various co-selected action strategies. conducting a spiritual assessment demonstrates responsiveness to clients’ aspirations to integrate spirituality, allowing social workers to fulfill a primary ethical value. while clients’ right to self-determination is a central social work value, the profession’s ethical code also lists a number of other standards that are pertinent to spiritual assessment. ethics although professional codes of ethics are designed for many purposes, a primary function is to guide practitioners’ conduct (freeman, 2000). as the naswcode of ethics (1999) states, the code socializes new practitioners to the profession’s core values, which are manifested in a set of standards that should guide social work practice. every task, including assessment, should be informed by the profession’s ethical standards (morales & sheafor, 2004). thenaswcode of ethics (1999) lists four standards that explicitlymention religion (1.05c, 2.01b, 4.02, and 6.04d) and at least two standards that implicitly refer to religion (1.05a, 1.05b). social workers are ethically bound to obtain education about religious diversity and the oppression religious people encounter in various forums (1.05c), avoid unwarranted negative criticism and derogatory language based upon religion (2.01b; c.f. 1.12), refrain from facilitating any form of religious discrimination (4.02), and actively work to prevent and eliminate reliadvances in socialwork 189 gious discrimination (6.04d). social workers should also recognize the strengths that exist in religious cultures (1.05a) and demonstrate competence and sensitivity in their service provision to such groups (1.05b). the implementation of these standards in practice settings implicitly calls for a spiritual assessment. as noted above, it is difficult to recognize spiritual strengths without conducting a spiritual assessment to identify them (ronnau & poertner, 1993). similarly, to avoid inadvertently discriminating or oppressing people of faith, it is frequently necessary to have some understanding of the client’s spiritual worldview (reddy & hanna, 1998; richards & bergin, 2000). standards 1.05 and 6.04, in particular, have played a central role in the development of the nasw standards for cultural competence in social work practice (2001). cultural competence standard 4 instructs social workers to conduct a comprehensive assessment, noting clients’ cultural norms and strengths, and utilizing the resulting information gained during assessment to develop culturally relevant intervention plans. in keeping with the code of ethics, religious cultures are specifically mentioned in the cultural competence standards. in short, thenaswcode of ethics (1999) standards that address religion implicitly highlights the need for spiritual assessment. indeed, it is difficult to see how social workers can comply with the code of ethics in practice settings without conducting a spiritual assessment. spiritual assessment can provide the necessary information that facilitates compliance with the ethical standards. while supplementary information, (e.g., an understanding of clients’ spiritual cultures [richards & bergin, 2000]) and skill sets (e.g., knowledge of religious countertransference [genia, 2000]) may be required to fully comply with the standards that address religion, conducting a spiritual assessment plays a foundational role in assisting practitioners conform to the profession’s ethical values.while the values propagated in the code of ethics are intended to guide practitioners’ conduct, the code also acknowledges that other factors, such as accrediting regulations and agency polices, should also guide social work practice. accrediting and agency requirements as implied above, interest in spirituality has increased in many sections of society, including professional disciplines (gallup & lindsay, 1999). for instance, koenig, mccullough and larson (2001) report that more than half the medical schools in the united states are training physicians to address spirituality in the course of their medical practices. animated by many of the reasons discussed above, recognition seems to be growing among the helping professions regarding the importance of spirituality in client care (koenig, et al., 2001; miller & thoresen, 2003). accrediting organizations and agencies are reflecting this recognition by recommending that all clients receive a spiritual assessment. perhaps the most notable example is the joint commission on accreditation of healthcare organizations (jcaho), which is one of the major healthcare accrediting agencies in the united states. jcaho accredits most hospitals andmany other mental health providers in the united states. hodge/why conduct a spiritual assessment? a theoretical foundation for assessment 190 jcaho (2002) recommends that social workers conduct a spiritual assessment. at a minimum, assessment should determine the client’s denomination and any spiritual beliefs and practices that are important to the client. the purpose of the initial assessment is twofold: to identify the effect of clients’ spirituality on service provision, if any, and to determine if a further, more extensive spiritual assessment is required. thus, in an increasing number of instances, social workers are required to conduct a spiritual assessment. this rationale for conducting a spiritual assessment differs in character from the previously discussed reasons. the four reasons discussed above are based upon either an appeal to sound social work practice or professional ethics or some combination of the two.the final reason differs in the sense that appeal is absent. conducting a spiritual assessment is important, because, in many cases, it may be part of the job description. discussion and implications the theoretical rationales discussed above have direct implications for both practitioners and educators. ideally, social work practitioners should generally be conducting a spiritual assessment. in keeping with the jcaho (2002) recommendations, initial assessment might consist of a brief exploration of spiritual beliefs, practices, and degree of involvement in a religious community, focusing on how these factors relate to the precipitating event that resulted in the social worker’s presence. this brief assessment can be integrated into existing assessment protocols. in cases where the client’s spirituality seems particularly relevant to the present context, a more complete assessment can be administered. although the frequency with which practitioners administer spiritual assessments is unclear, broad support for conducting a spiritual assessment seems to exist among practitioners and students. among a national sample of nasw affiliated practitioners (n=2,069), almost 60% agreed that an exploration of spirituality and religion should be part of the intake/assessment process (canda & furman, 1999). among a sample of graduate students drawn from two universities (n=208), approximately 93% of respondent students considered it appropriate to gather information on clients’ spiritual backgrounds and roughly 68% reported conducting such as assessment themselves (sheridan & amato-von hemert, 1999). while social workers may be open to addressing spirituality in practice settings (canda & furman, 1999; derezotes, 1995; murdock, 2004; sheridan, bullis, adcock, berlin &miller, 1992), it remains an open question how well trained they are to engage in such activities. given that studies have repeatedly demonstrated that most social workers have received little or no training on spirituality or religion during their graduate education (canda & furman, 1999; furman, et al., in press; sheridan & amato-von hemert, 1999), it is unsurprising that research suggests that practitioners are unequipped to conduct a spiritual assessment. in the study of nasw affiliated practitioners cited above, only 17% agreed that social workers in general have the knowledge to address spiritual issues (canda & furman, 1999). summarizing their findings, the authors of the study concluded that, while many practitioners recognize the importance of spirituality, they do advances in socialwork 191 not feel adequately prepared to address the topic in practice settings. in their examination of graduate students’ attitudes about client religion (n=124), decoster and burcham (2002) came to a similar conclusion. these researchers suggested that educators had not effectively integrated religious content into the curriculum, resulting in respondents who were uncomfortable assessing clients’ religion. as cascio (1998) observes, in-service workshops, programs, and continuing educational forums are needed to acquaint practitioners with the information needed to conduct spiritual assessments in an ethically competent manner that respects client autonomy. perceptions that spirituality can be pathological still exist, with the spiritual worldviews affirmed by african americans, people who are elderly, and other disadvantaged populations likely being most at risk for being classified as pathological. sheridan and amato-von hemert (1999) found that roughly 62% of respondent students believed that it was appropriate to share their own spiritual beliefs with clients. while more research is needed to explore this finding, it is possible that students who feel that others’ spiritual beliefs are unhealthy may feel the need to challenge those beliefs in an attempt to convert clients to what they consider to be more beneficial beliefs. training is needed to ensure that social workers respect clients’ spiritual beliefs and refrain from attempting to change those beliefs that they consider pathological, dysfunctional, or simply wrong. by training practitioners to work within clients’ worldviews, partnering with clergy members from the clients’ faith, if necessary, the profession’s commitment to autonomy can be respected. similarly, training is needed for faculty members who may also be uncomfortable discussing spirituality. as has been widely noted (canda & furman, 1999), content on spirituality and religion needs to be integrated into graduate education curricula. while one of the purposes of spiritual assessment is to illuminate clients’ values, providing education about religious diversity as thenaswcode of ethics (1999) prescribes, assists future social workers in understanding the process by providing them with a working knowledge of commonly held beliefs and practices (richards & bergin, 2000). it is important to acknowledge that social work education is making progress in this area. the number of programs offering courses on spirituality is increasing. at least 50 programs now include content on spirituality, up from a handful in 1990 (miller, 2001). these efforts need to be expanded and built upon. while elective courses on spirituality serve an important purpose, ideally, all practitioners should be equipped to conduct a spiritual assessment in a spiritually competent manner as part of their graduate training. given that assessment is a topic already discussed in practice courses, content could be expanded to include spirituality with minimal restructuring. spirituality can be presented as one dimension of human existence, with students being taught to respect spiritual cultures in the same manner that they are taught to respect other cultures (cascio, 1998). as is the case with other expressions of diversity, an exploration of spirituality will not be relevant to some clients. for many clients, however, spirituality is an important life dimension, while for others, it is a central dimension that informs hodge/why conduct a spiritual assessment? a theoretical foundation for assessment 192 all other areas of existence. for clients who fall into the latter categories, a spiritual assessment is critical for the provision of client-centered services that reflect the profession’s ethical standards. also critical is the need for social work education to equip future practitioners with conducting such assessments in a spiritually competent manner. references ai, a.l. 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(1998). taoistic cognitive psychotherapy for neurotic patients: a preliminary clinical trail. psychiatry and clinical neurosciences, 52(supplemental), s238-s241. author’s note: address correspondence to: david hodge, ph.d., program for research on religion and urban civil society, university of pennsylvania, leadership hall, 3814walnut street, philadelphia, pa 19104, usa. email: dhodge@sas.upenn.edu 196 advances in socialwork spring2006-037_page33 spring2006-038_page34 spring2006-039_page35 spring2006-040_page36 spring2006-041_page37 spring2006-042_page38 spring2006-043_page39 spring2006-044_page40 spring2006-045_page41 spring2006-046_page42 spring2006-047_page43 aisw vol. 5, no. 2 editorial james g. daley this issue of advances in social work marks a significant transition for the journal. simply, this issue is the last hard copy issue that the journal will produce, as we become an electronic journal. the subsequent issues are all free-access and can be found at http://journals.iupui.edu/index.php/advancesinsocialwork. past and future issues are now available to any library or person that wants to tap into the rich diversity of top-quality articles that span the full range of social work topics. instructors can now have full-length articles as easy-access links to our website. no subscription fees. no charge to students. check us out! as is typical of our journal, this issue has a wide range of fascinating articles to whet your appetite. professor johnson-butterfield outlines a powerful partnership between a u.s. university and a university in ethiopia, describes their lessons learned, and the uniqueness of an international educational collaboration. dr. hostetter and colleagues explore the development of a learning community in higher education settings as a way to empower students. drs. lay and king focus on a rarely researched area of substance abuse, older adults with prescription abuse, and important unique factors to address in that population. professors sherr and jones tackle a neglected issue of the perspective of the family and significant others during the faculty recruitment process. dr. epple gives an in-depth discussion of her qualitative study on the potent use of journal writing in personal development and the theoretical underpinnings of this activity. professors jang and lamendola explain an intriguing retrospective study on people in taiwan who faced natural disasters and the role of spirituality in posttraumatic growth. professor levy offers a fascinating discussion of viewing homophobia through the lenses of social justice and lesbian feminism. dr. hall emphasizes the importance of better understanding arab families, while professor shears and colleagues describe a qualitative study on mexican american men and how they perceive their roles as fathers. the issue offers nine articles that cover different cultures, differentmethodologies, and a span fromeducational technology to personal growth to clinical settings. we hope that each reader enjoys the breadth and depth of this very special issue.we also invite other fabulous authors to submitmanuscripts and for scholars to seriously think about becoming a reviewer for the journal.we need both to keep this journal going strong. and remember, you need to submit manuscripts or sign up to be a reviewer at our website. see you in cyberspace! i aisw vol. 8, no. 1:aisw vol. 5, no. 2 complexity theory, nonlinear dynamics, and change: augmenting systems theory ralph woehle abstract: social work change processes are addressed in terms of complexity theory and nonlinear dynamics, adding the edge-of-chaos, as well as chaos to the entropy and homeostasis of ecosystems theory. complexity theory sees the edge-of-chaos as valuable to living systems. a logistic difference equation is utilized to model the nonlinear dynamics of the hypothetical contentment of an individual. the modeling suggests that substantial input would be required to move an individual from homeostasis to the beneficial stage at the edge-of-chaos, but that too much input might result in chaos. with good measurement and data observed over time, social work might benefit from complexity theory and nonlinear dynamics, which are already advancing in related disciplines. keywords: complexity, nonlinear, dynamics, systems, chaos social workers want to help clients make changes, but they are also concerned with stabilizing client situations. in various social work-related articles in recent years (dejong, 1995; warren, franklin, & streeter, 1998; bolland & atherton, 1999; hudson, 2000a, 2000b; warren & knox, 2000; warren, hawkins, & sprott, 2003; halmi, 2003; hudson, 2004), it has been suggested that complexity theory might add significantly to social work’s conceptualization of change, particularly to ecosystems theory. however, since much of the literature pertaining to complexity is of a general conceptual nature, the discussion must be framed in a way that more explicitly addresses social work change processes and describes how social work practice might be informed by complexity approaches to theory and associated nonlinear modeling. i begin that discussion with a review of the development of complexity theory and nonlinear dynamics as they apply to my paper. complexity theory and nonlinear dynamics complexity is a theory, with accompanying mathematical models, about the behavior of systems. the term complexity itself refers to the degree of elaboration required for a basic explanation. complexity theory is related to both ecosystems 141 ralph woehle, ph.d. is professor at the department of social work, university of north dakota, grand forks, nd 58202-7135. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 141-151. indiana university school of social work. and chaos theory, all three of which have been used to conceptualize biological, social, and psychological systems. however, to a greater extent than ecosystems theory, complexity theory attempts to explain why systems demonstrate emergent patterns that are greater than the summed effects of the original parts. in addition, complexity theory developed from computing ability, particularly where that ability allowed analysts to suspend strict logic and assumptions to model behavior realistically. complexity and the physical sciences at the beginning of the 20th century, newton’s laws of motion dominated science and described change as predictable. then, with the theory of relativity and quantum physics, physicists questioned newton’s laws and argued that they were insufficient to describe motion at extreme speeds or for very small particles (marion, 1999). more recently, prigogine (1997) has suggested an end of certainty in physics and chemistry in a world that is neither predicted nor arbitrary, but rather at the edge-of-chaos. a number of authors have written about complexity and nonlinear dynamics, including james gleick (1987) and roger lewin (1992). the history of nonlinear dynamics is the discovery that computers can go beyond mathematical proofs and theoretical assumptions to simulate a much wider array of behavior. gleick described the computer modeling of weather systems, conducted by edward lorenz in the early 1960s, whose nonlinear descriptions went beyond explaining any single particle to new understandings of the larger system. lorenz’s experiments identified attractors in systems that kept the transformation of patterns within a certain range of behavior—a new kind of order. lewin (1992) described the invention of the “game of life,” by british mathematician jon conway, as an early simulation. others—steve wolfram and chris langton among them—enhanced that technique to create various models with cellular automata, grids of cells in which each cell operated according to local rules, but global patterns emerged on the grid. watts’ (2003) description of the developments of network dynamics traced those ideas to such physical phenomena as the failure of the electrical power network, as well as to airline networks and their role in the rapid spread of disease. such dynamics have been explored by computer scientists, physicists, mathematicians, biologists, and engineers. complexity and psychology the application of the concepts of complexity and dynamic behavior of variables to psychology is a recent development, but with some older roots. watts (2003) credits stanley milgram with the idea that everyone in the world is just six relationships away from everyone else, solomon asch with the idea that our perceptions are dependent on the perceptions of others, and herbert simon with the idea of limited or bounded rationality. all three were social scientists from the mid 20th century, and all of the above ideas are important in computer simulations of human behavior. butz (1997) was an early advocate of the metaphorical application of chaos in psychoanalytic psychology. globus (2005) recently summarized the psychody142 advances in social work namic view of complexity. he said the brain self-organizes the “belonging together” of thoughts. the process takes place on a landscape where peaks represent repellers (a phobic object for example) and valleys represent the attractor areas where thoughts are likely to settle. the individual both self-organizes the settling process and tunes the landscape, according to globus. fredrickson and losada (2005) have recently identified several issues of relevance to my paper’s emphasis on contentment. they say that affect systems are dynamic, with increasing returns due to positive feedback. furthermore, they say that affect changes over time, as the various components within the affect system mutually influence one another. they add that this reciprocal causality and feedback within dynamic systems is best modeled with nonlinear equations, because it allows for interactive and bi-directional relations, and dynamic systems that characterize affect are nonlinear, with outcomes that are not always proportional to inputs. finally, they also point to local unpredictability and global stability. by being variable, individuals are adaptable at the edge-of-chaos. in brief, over time, affect is complex and nonlinear. fredrickson and losada (2005) go on to point out that positive affect broadens thought-action repertoires, whereas negative affect narrows those same repertoires. the variability of positive states over time yields resilience that allows people to adapt flexibly. people who feel positive emotions have a wider array of action urges. fredrickson and losada then test the hypothesis that a ratio of positive to negative affect at or above 2.9 will characterize individuals in flourishing mental health and find that it is supported. while i do not wish to make too much of their 2.9 figure, multiples of three do appear to be important in input ratios in complex systems. finally, fredrickson and losada say the literature and their findings suggest that a set of general mathematical principles may describe the relations between positive affect and human flourishing, a conclusion i will embrace. watts’ (2003) description of the development of network dynamics provided some substance to my assumptions about the environment. as seen below, i assume that all input to an individual’s contentment can be addressed with one general variable. watts’ use of milgram’s six degrees and asch’s dependence on the perception of others would help to explain fredrickson and losada’s (2005) assertions that greater marital happiness is associated with less predictability from moment to moment, as spouses interact and such marriages are more likely to last. similarly, in business teams, higher levels of expressed positivity among group members have been linked to greater behavioral variability within moment-tomoment interactions as well as to long-range indicators of business success. positivity and variability do not simply cause success, but positivity molds the environment, while variability tests it, thus promoting mutual adjustment and development of the person and the environment. the social environment is remarkably close, whether it consists of loved ones or strangers, all of whom are within six degrees or less. complexity and social work for social work, the origins of theory regarding systems may be traced to general systems theory (bertalanffy, 1972), later developed as ecosystems theory. 143woehle/complexity theory, nonlinear dynamics, and change: augmenting systems complexity theory surpasses ecosystems theory with conceptions of change. structure, epiphenomena inferred from observed behavior in systems theory (dale, smith, norlin, & chess, 2006), is seen by complexity theory as being in constant change or as process. complexity theory emerged contemporarily with wakefield’s (1996) criticism of social work’s use of ecosystems as unempirical. explaining the benefits of change and using mathematical models to describe change processes are the potential contributions of complexity to social work (hudson, 2000b). most of the social work articles related to complexity merely suggest that it may be conceptually applicable to understanding social work-related phenomena (warren, franklin, & streeter, 1998; hudson, 2000a, 2000b; halmi, 2003; hudson, 2004). a few others apply it metaphorically (dejong, 1995; bolland & atherton, 1999) or actually seek dynamic data patterns (warren & knox, 2000; warren, hawkins, & sprott, 2003). thus, the true power of complexity theory and nonlinear dynamics, namely the modeling of practice-like processes, has not been applied in social work. purpose complexity theory, like its predecessor, ecosystems theory, attempts to be a theory of everything. however, it adds prescriptions for data analysis absent from ecosystems theory. this paper connects that prescription to micro practice, illustrates the applicability of data modeling to highlight change processes, and suggests implications for social work. specifically, descriptions of change and simple mathematical models are used to construct a hypothetical case regarding a person’s contentment. i present comparisons of change processes to suggest ways in which social work interventions could be best implemented to contribute to that advance. while the example used here is psychological, complexity theory is applicable to all levels of systems within which social workers engage. i present a psychological case for simplicity’s sake, not with any intention to limit the application of complexity and nonlinear dynamics to microsystems. processes indicated by complexity theory the comparison of system functioning is best described across four processes. ranging from decline to apparent disorder, these four include 1) an entropic/equilibric process, 2) a homeostatic/equilibric process, 3) a complex change process at the-edge-of-chaos, and 4) a chaotic change process. these processes are described in table 1 and are loosely based on an earlier description of system states and change as described by anderson and carter (1990). table 1 cross-references the four processes with descriptions of four conditions. these are 1) the condition toward which the process tends, 2) information interchange with the environment, 3) resource interchange with the environment, and 4) change orientation. the first, the condition toward which a psychological system’s process tends, consists of patterns of psychological functioning in relation to well being. the next two conditions consider interchange with the environment, referring to both information and resource exchange, where information is the array of signals utilized for guidance, and resources are the commodities needed to fulfill basic needs. finally, change orientation refers to intention and readiness for change in relation to the environment and the enhancement of functioning. 144 advances in social work generally, ecosystems and complexity theorists agree that the entropic/equilibric process is the least desirable, because that process might bring pathology or death. ecosystems theorists see the stability of homeostatic/equilibric processes as desirable (anderson & carter, 1990). complexity theorists tend to group the stability-oriented entropic/equilibric and homeostatic/equilibric change processes together and see them as undesirable. they see the periodic iterations of complex change processes as particularly valuable and healthy and see the irregular chaotic change process as disruptive, but of occasional value for substantial change. each of the change processes can be considered in the context of a person’s contentment and are compared across the four conditions listed in table 1. in the entropic process, well being is in decline, because the person is unable to convince the larger system to provide needed resources (krossman & bullrich, 1997). in a homeostatic process, the second process in table 1, the person is able to maintain parameters of well being by communicating needs and obtaining at least basic resources. as a result, the person is stable if the environment remains stable. however, the complexity theorist would see this person as near equilibrium, and thus in danger of entropy (krossman & bullrich, 1997). the preferred process of the complexity theorist is the edge-of-chaos or complex process. in that process, limited variation of well being is apparent as feedback is utilized. this limited variation and informed effort guides an efficient resource exchange with the environment. finally, the chaotic process is overly variable and unpredictable, making complexity theorists cautious. measures of the person’s well being yield erratic values, though they might stabilize in the long run. people in chaotic processes are often demanding resources, but without being informed about the environment’s ability to provide resources or even being informed about their own needs in the immediate future. even though chaos might lead to entropy, there is some chance that the change orientation of a person in chaotic process is potentially capable of settling into improved conditions (krossman & bullrich, 1997). in brief, a conceptual contribution of complexity theory to social work is the addition of the nearly chaotic (or complex) change process and the chaotic change process to ecosystems theory, and thus a new change orientation. where the emphasis of ecosystems theory tends to be homeostasis, complexity theory applied to social work would embrace the benefits of change. modeling change with nonlinear dynamics the variation of a measure of a complex system—contentment, in my example— follows the patterns described in table 1. sometimes, the values of the variable decline and sometimes they settle into a homeostatic pattern, whiled the variable values hardly change. however, when the values of input variables are sufficiently high, the outcome variable value can move to the edge-of-chaos. there, the outcome variable fluctuates in balance between a few approximate values in concert with the environment or, when inputs are excessive, the system spins into chaos and undesirable fluctuation. 145woehle/complexity theory, nonlinear dynamics, and change: augmenting systems the mathematics of complexity is longitudinal, modeling the values of a small number of variables of a single system over time. often, this includes the past val146 entropic homoeostatic near chaotic chaotic functioning functioning or complex functioning functioning with possible breakthrough or collapse condition pathology, stable, but marginal erratic toward death of pathological but fluctuation which system fluctuating between the process well-being extremes of tends capable of well-being testing and pathology environment information system has system is system locates information interchange inadequate accepting of information for often not with need reinforcing correlation of accessed to environment communication feedback available fit rapid change to environfrom resources to to environment, ment environment needs, learns or rapid system provides but is not from assesschange makes excessive able to justify ments of self available damping demands for and environinformation feedback resources ment untimely from the environment resource inadequate system is system resource interchange resource able to efficiently exchange with inputs and maintain obtains often out of environment outputs, resource needed synchronicity unable to exchange resources, with system’s create sufficient for and dissipates fit in environown stability waste in environment mentally if environconcert with acceptable ment is changing exchange constant environment change resists system grows system is erratic orientation growth to a stable always ready system may based on level, but is not for growth and stumble into limited ready for change with better condition, resources, environmental periodic but erratic inability to change which variation which behavior and mount may put promotes environmental communicasystem at risk system insensitivity tion to expand learning and put it at resources, tests the constant risk accepts environment decline table 1: comparison of system functioning in various processes advances in social work ues of outcome variables that are used to estimate future values of outcome variables. in the modeling equations used here, input and output are assumed. some input is feedback generated by the environmental interaction of the values of outcome variables in the immediate past. some input stimulates the growth of the outcome variable values, while other input dampens its growth. the measure of input is probably a matter of the ratio of growth producing and damping input (fredrickson & losada, 2005). repeated iterations of the model equations can be called reciprocal causality, because the outcome variables are alternatively independent and dependent. in my example, this means that contentment at one time influences the next, but social work practice, along with other environmental influences, can modify that impact. a logistic difference equation is utilized to model variables in the present paper, following kiel and elliot (1997). this logistic equation has heuristic value, because it provides a simple view of variable change processes and has been introduced in the social work literature (warren, franklin, & streeter, 1998). however, fredrickson and losada (2005) point to the greater modeling sophistication social work should seek. measurement for considering the nonlinear dynamics of contentment, the generalized contentment scale (bloom et al., 2003) offers a useful model for the primary variable. this scale was designed to measure problems and, in the original version, would see increasing scores as problems intensify. individuals scoring in the top 70% of these scales were assumed to have problems. because i want to model the growth of contentment in a manner consistent with fredrickson and losada’s (2005) growth of positive affect, the scoring of the scale has been reversed, and low scores, 0-70, are assumed to indicate the problem’s end, while scores above 70 are assumed to be positive affect. it will be further assumed here that the scale represents the full possible range of the variables for the present analysis. modeling equations a common equation modeling nonlinear dynamics to model change is: xt+1=rxt(1-xt) where x=the level of contentment, xt=outcome variable in prior iteration, r=the rate of growth accounted for by the intervention combined with other inputs, (1xt)=the environmental and systemic damping of the effect of r and xt+1=the next iteration of the outcome variable x. this equation explains the successive values of the variable x over time. in the calculations below, the values of x are represented by decimals to two places, or the proportion of the 100 points awarded on the contentment scale. table 2 represents these scale scores as whole numbers, with x as the number of points achieved on the contentment scale and r as the rate of input that, when set at 1 or 100%, would tend to keep x at an unchanging value without considering environmental impact. the reader will note that the equation is structured so that the values of xt approaching the maximum value of 100% (100 points on the contentment scale) would cause the rxt product to be relatively large, while the 1-xt 147woehle/complexity theory, nonlinear dynamics, and change: augmenting systems term would approach zero. at a contentment score of 95, for example, a crash to a score of 19 on the next iteration is expected. the converse is true when xt approaches zero. thus, the equation tends to be self-balancing, encouraging growth when x is small and damping growth when x is large. this self-balancing characteristic makes the equation nonlinear, because equal increments of inputs do not yield proportional increases in the outcome variable x. in my contentment example, low levels of contentment would respond to large inputs and move higher, but higher values would be resistant to improvement, because they are already near the top of the scale and because every system and environment is likely to have some damping inputs that impinge upon the growth of contentment (fredrickson & losada, 2005). the inputs that affect contentment in the hypothetical example might be numerous and various, but r, or the rate applied to the previous levels of input, might be altered by interventions associated with social work practice. in the iterations of the basic equation presented above, each time a value of xt+1 is calculated, it can become the new xt for the calculation of the next x, xt+2. these iterations allow for the demonstration of reciprocal causality. that is, one can think of x as influencing itself and the environment, and the environment, in turn, influencing x and itself as one iterates the equation. however, the equation generally loses its modeling ability when r exceeds 4 (400%), because, at that point, it will generate unreal values of x less than 0 or greater than 100%, values that are not possible with the 100-point contentment scale assumed in this paper. analysis with the above discussion, i have laid the basis for hypothetical analysis utilizing the equation stated above. table 2 presents hypothetical data analysis that allows comparison of the change processes of table 1. the observations listed in table 2 assume that the data would really behave in the way that the logistic difference equations would project. that is, values of the contentment scale are laid out in successive times (values at the various ts) in the cells of table 2. these values were produced by iterations of the logistic difference equations programmed into a spreadsheet. table 2 also compares initial values of the contentment scale before iteration and compares input rates, which would reflect environmental and system inputs. the input rates, which would presumably be manipulated by social work intervention, have been set to 100%, 200%, 300%, and 400%. the initial value of the contentment scale at t is set at 7, a very low level of contentment. thus, the first row of the table shows us what would happen to clients if the input rate were left at 100% and the control condition, where the decline of contentment toward entropy would continue and, in fact, collapse to zero after numerous iterations. table 2 shows that one would want to increase the input rate for clients demonstrating low contentment scores and low input. at the 200% input rate, contentment increases but levels off at 50. this is a homeostatic process and, though it increases the value of the outcome variable, a homeostatic process is unsatisfactory, because it does not offer the advantages of the edge-of-chaos. arrival at the edge-of-chaos and a complex process are achieved with an input rate of 300%. 148 advances in social work inspection of the contentment values at 300% input shows that a periodic pattern of iteration is emerging, and the values of the contentment scale would eventually alternate between 62 and 71. this range of scores would still be marginally problematic, but the potential of the system at the edge-of-chaos would be positively valued from the complexity viewpoint. increasing the rate of input to 400% makes the process chaotic, however. the contentment values of the chaotic change process show no sign of settling down. this shows a danger of excessively high contentment scores and input rates, perhaps leading my individual to carefree, neglectful behavior that brings on discontentment. discussion this paper has suggested that social work needs the change processes of complexity theory in addition to the entropic and homeostatic processes it has considered in ecosystems theory. it also suggests a new view of client outcomes. rather than designating variable values at the positive end of the scale as desirable outcomes, the desirable outcome may be characterized by the more modest variable values, with variation that suggests the complex edge-of-chaos readiness for change. indeed, outcome values that are too high on the scale may bring on risky chaotic conditions. two qualifications are in order. first, the value of complex processes does not rule out at least the occasional value of the other processes. entropy resulting in death, chaos resulting in substantial change, or the occasional homeostatic relief from entropy or chaos might have value in some circumstances. continuing my contentment example, a chaotic trajectory dipping into deep sorrow resulting from a debilitating life experience may result in an ultimate bounce back to contentment, indicating the value of chaos. in addition, the equations used here are no doubt inadequate, therefore social work must do the theory and mathematics to examine fully the potential of complexity theory. the viability of the theory and mathematical models is ultimately an empirical question (sabelli et al., 1995), and fredrickson and losada (2005) point us in the direction that social work should take. i wish to state strongly that the unempirical 149woehle/complexity theory, nonlinear dynamics, and change: augmenting systems change input t0 t1 t2 t3 t4 t5 t6 t7 t8 t9 process rate entropic 100% 73 7 6 6 5 5 5 5 4 4 homoeostatic 200% 7 13 23 35 46 50 50 50 50 50 complex 300% 7 20 47 75 57 74 58 73 59 72 chaotic 400% 7 26 77 71 83 57 98 8 29 82 1 the 100 point contentment scale has the lowest contentment at 1 and the highest contentment at 100. 2 the xt+1= rx t(1-x t) logistic difference equation is used to calculate the successive scale values, where tn is the time period. 3 beginning with the low contentment score of 7 suggests a deeply troubled individual. table 2: modeling the behavior of the contentment scale change process1 by iterating the logistic difference equation2 over time with differing levels of input to demonstrate various change processes stance of traditional ecosystems theory (wakefield, 1996) is unacceptable. thus, social work must engage complexity theory and nonlinear modeling empirically. central to the empirical agenda must be the cycling behavior of data over time. people variously cycle through family generational cycles, school years, child developmental stages, and mood swings to name a few. social work’s research, however, is often based on experiments or surveys that are snapshots in time, rather than continuously moving pictures. to examine life’s cycles, social work needs a strong program that continues the development of good measurement, and good measures must be applied over time. nonlinear dynamic modeling can provide the hypotheses with which to test such data. the potential of complexity theory might be realized then, but not without an ambitious research agenda. fortunately, social work practice does not need to wait until the research agenda is accomplished. complexity theory suggests that reasonable people seeking knowledge and action will find order emerging and that the emerging order will be tested in the environment even if our understanding is incomplete (marion, 1999). perhaps, practice knowledge will be the key at least some of the time. scholarship in social work can provide a voice to the environmental test of complexity and can improve understanding by doing the theory, the mathematics, and the data collection. this is a lot to chew on, but social work should come to the complexity table to taste the rich menu it offers. references anderson, r.e., & carter. i. 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(1995). anger, fear, depression, and crime: physiological and psychological studies using the process method. in r. robertson & a. combs. chaos theory in psychology and the life sciences, (pp. 65-88). mahwah nj: lawrence erlbaum. wakefield, j.c. (1996). does social work need the eco-systems perspective? is the perspective clinically useful? social service review, 70(1), 1-32. warren, k., franklin, c., & streeter, c.l. (1998). new directions in systems theory: chaos and complexity. social work, 43(4), 357-372. warren, k., & knox, k. (2000). offense cycles, thresholds and bifurcations: applying dynamical systems theory to the behaviors of adolescent sex offenders. journal of social service research, 27(1), 1-27. warren, k., hawkins, r.c., & sprott, j.c. (2003). substance abuse as a dynamical disease: evidence and clinical implications of nonlinearity in a time series of daily alcohol consumption. addictive behaviors, 28, 369-374. watts, d. (2003) six degrees: the science of the connected age. new york: norton. author’s note: address correspondence to: ralph woehle, ph.d., professor, department of social work, box 7135, university of north dakota, grand forks, nd, 58202-7135, usa. e-mail: ralphwoehle@mail.und.nodak.edu. 151woehle/complexity theory, nonlinear dynamics, and change: augmenting systems microsoft word 05_forgey_and_ortega-williams_20877_can_social_work _________________ mary ann forgey, phd, lcsw, is a professor, graduate school of social work, fordham university, new york, new york 10023. anna ortega-williams, lmsw, is a doctoral candidate at the graduate school of social service, fordham university, new york, new york 10023. copyright © 2016 advances in social work vol. 17 no. 1 (spring 2016), 59-77, doi: 10.18060/20877 effectively teaching social work practice online: moving beyond can to how mary ann forgey anna ortega-williams abstract: schools of social work are increasingly developing online courses and programs. while the majority of research comparing online and face–to-face courses has found equivalent outcomes, skepticism still exists, particularly about the ability to teach practice courses effectively online. this study adds to the growing body of research within social work that specifically examines the comparative effectiveness of online and face-to-face practice courses. using an anonymous survey, 23 face-to-face and 12 online students enrolled in two separate sections of social work generalist practice rated the quality of the learning environment, the extent to which the course objectives were met, and the effectiveness of the teaching strategies from the students’ perspective. in addition, scores on assignment rubrics and student course evaluations were also compared. results indicate no significant differences in learning outcomes as measured by assignment rubric scores, student perceptions of the extent to which learning objectives were met, the quality of the learning environment, and the effectiveness of five of the six teaching strategies used. we recommend that research moves beyond determining if online practice courses are as effective as face-to-face courses, and instead focus on a closer examination of the factors responsible for teaching effectiveness. keywords: distance education; online education; social work; direct practice; asynchronous learning the platform of 21st century social work education is transforming. in particular, graduate schools of social work in the u.s. are developing online courses and programs that include curriculum components thought to be primarily taught on campus, such as practice (coe-regan & freddolino, 2008; khaja, ouellette, barkdull, & yaffe, 2008; kurzman, 2013; mcallister, 2013; roberts, irani, telg, & lundy, 2005; siebert, spaulding-givens, & siebert, 2006). the commission on accreditation of the council on social work education (cswe) does not keep an exhaustive list of all accredited online social work programs; however, they do list 40 master’s programs and 7 bachelor’s programs that are online, approximately 6% of the 775 accredited schools of social work (cswe, 2016). many social work programs also incorporate various forms of online learning into traditional face-to-face classes, including video conferencing, computer mediated technology, and facebook activities (barczyk & duncan, 2013; flynn, maiden, smith, wiley, & wood, 2013; forgey, loughran, & hansen, 2013; moisey, neu, & cleveland-innes, 2008; seabury, 2005). the impetus for online education in social work is varied and includes reaching students with geographical and time-related constraints (larsen, sanders, astray, & hole, 2008; vernon, pittman-munke, vakalahi, adkins, & pierce, 2001; wilson, brown, wood, & farkas, 2013). additionally, for institutions like the university of southern california, which created the first national online msw program, virtual learning centers are forgey & ortega-williams/can social work practice 60 considered strong business models that can expand enrollment in social work schools, which often struggle with sustainability due to scanty sources of revenue (flynn et al., 2013). the benefits of online social work education have been documented, and clear evidence has been mounting as to its effectiveness. over the past two decades, a significant body of research has accumulated within social work comparing online and face-to-face programs as a whole (e.g., cummings, chaffin, & cockerham, 2015; forster & rehner, 1998; freddolino & sutherland, 2000; wilke & vinton, 2006) as well as a range of individual courses, including practice (e.g., coe & elliot, 1999; cummings, foels, & chaffin, 2013; siebert et al., 2006; thyer, artelt, markward, & dosier, 1998) and research courses (e.g., faul, frey, & barber, 2004; petracchi & patchner, 2000). an early comprehensive review of the state of social work research on distance courses and programs provided guidelines for future research (macy, rooney, hollister, & freddolino, 2001). for the most part, based on the empirical evidence to date, comparable levels of effectiveness have been found in relation to learning outcomes and student satisfaction with the instruction and learning environment. these results mirror the overall findings from the 2010 u.s. department of education (us doe, 2010) meta-analysis of research from multiple disciplines. based on a review of 99 experimental or quasi-experimental studies contrasting online and face-to-face conditions in relation to the learning outcomes achieved, the study concluded that students in online conditions had modestly better outcomes, on average, than their face-to-face counterparts (us doe, 2010). despite these fairly consistent findings of comparable effectiveness across multiple fields, concerns about the effectiveness of online courses in social work continue. these concerns, which have been present within social work throughout the development of distance education, have often focused on practice courses (groshong et al., 2013; khaja et al., 2008; moore, 2005; siebert et al., 2006; siegel, jennings, conklin, & flynn, 1998; vernon et al., 2001).. for example, siegel et al. (1998), found that social work educators have a bias against offering practice or methods courses online emanating from a belief that practice skills can only be taught in person. similarly, moore (2005) found that faculty perceived online education to be less effective than face-to-face instruction, particularly in the teaching of practice courses and clinical skills. a more recent example of this skepticism in relation to online practice courses is the 2013 report released by the clinical social work association (cswa). cswa questioned the effectiveness of online social work education to prepare social work practitioners without face-to-face instruction (groshong et al., 2013). in particular, the report questioned if the nature of web-based learning was antithetical to the teaching of foundational practice skills, such as building empathy and conducting holistic assessments. the report also critiqued online education’s inconsistent delivery methods, lack of attention to implicit learning, and weak protocols around cornerstone pedagogical elements, like field education. within the report, asynchronous methods were viewed as a form of rote learning, and the authors raised concerns about the ability of this method to facilitate the development of critical thinking skills. lastly, in reference to online social work practice advances in social work, spring 2016, 17(1) 61 coursework, cswa recommended that the cswe review how much training should be completed in-person to best transfer knowledge (groshong et al., 2013). given the continued expression of concern about the use of online teaching methods in social work, particularly in relation to practice courses, and the rapid expansion of online education in social work, an urgent need continues for studies that examine the efficacy of online instruction (cummings et al., 2015). this study is an effort to respond to this need and in doing so, build specifically upon the research within social work on the comparable effectiveness of face-to-face and online practice courses. literature review there is a small but growing body of research that has specifically examined the effectiveness of online social work practice courses. these studies can be grouped into three design categories. the first group compared the effectiveness of an online practice course to its face-to-face counterpart. the second type of study compared the learning outcomes of students within a single online practice course, and the third type compared the learning outcomes in online practice courses to non-practice online courses. in the most recent face-to-face versus online comparative study found, cummings and colleagues (2013) compared online students (n=37) and face-to-face students (n=63) enrolled in a course on evidence-based practice with groups. no significant differences were found between face-to-face and online students in exam scores, log grades, or course evaluation scores. moreover, while both groups were found to have increased in leadership skills, as measured by a 22-item leadership pre-post scale, no significant differences were found between groups. however, cummings and colleagues (2013) did not look at the sense of classroom community or teaching strategies in comparing student outcomes. siebert and colleagues (2006) used a retrospective design to compare face-to-face (n=78) and online students’ (n=25) perceptions of their skill improvement using a fouritem likert scale. no significant differences between the two groups were found in the development of their brief treatment and crisis intervention skills. additionally, siebert and colleagues (2006), like cummings and colleagues (2013), found that face-to-face and online student learning outcomes were comparable, with no significant differences in mean scores on a common assignment graded by the same instructor using a standardized rubric. however, when assessing student satisfaction using a post-course survey with eight items, two items were found to be significantly different. compared to online students, face-toface students were significantly more satisfied with instructor availability and the course’s ability to facilitate their learning (siebert et al., 2006). the third comparative study of an online and face-to-face practice course, completed by coe and elliot in 1999, reflects the type of technology available at that time. it compared outcomes for 30 on-campus students with 47 students enrolled in a face-to-face satellite television instruction format. the experimental group attended class at either of two distance locations, with a live instructor present at each location. on average, on-campus learners were found to have higher assignment and final course grades when compared to distance learners; however, none of these differences were statistically significant. coe and elliot also found barriers to learning for the distance learners related to the problems forgey & ortega-williams/can social work practice 62 experienced with the technology. recommendations included more enhanced training for instructors and increased use of visuals such as powerpoint and video conferencing to enhance interaction both in and out of the classroom. in an earlier study by thyer and colleagues (1998), online and face-to-face delivery formats were compared; however, each format was delivered in separate intervals to students within two separate practice courses. no significant differences in quality of teaching were found among the students in the assessment and psychopathology class; however, the students in the treatment of substance abusers course evaluated the quality of the live instruction significantly higher than the televised teaching. technological factors, including sound and visual transmission, were recognized as difficulties that may have biased the results. in relation to the second type of study design, two studies were found that examined students’ perceptions of their learning and satisfaction rates within an online practice course. wilson and colleagues (2013) explored the impact of 3-d online technology to improve home visiting skills of social work practice students. debriefing sessions with students participating in virtual home visits indicated that the experience was considered meaningful for skill development. khaja and colleagues (2008) evaluated online social work practice students (n=21) using a participatory action research approach. they found that online social work practice students were impressed with the rigor of their online course, and the development of their skills throughout the process. however, student perception of learning was found to be contingent on comfort with technology and access to the software and hardware needed to participate (khaja et al., 2008). lastly, one study was found that compared the learning outcomes of multiple online foundation level courses including practice. noble and russell (2013) inquired into student satisfaction with their online social work program, surveying 242 students across multiple foundation courses using a pre-experimental, mixed method research design conducted over the course of three years. the primary measurement tool was a 41-item survey, through which they found that online social work practice students had the highest rate of satisfaction compared to research or policy online students. in addition to the three types of studies reviewed above, researchers have recognized the need to learn more about certain factors within online courses and how these factors compare to face-to-face courses (cummings et al., 2015). in particular, the ability of online academic environments to intentionally produce the level of social presence necessary to build community among students and support their learning has been considered crucial (bentley, secret, & cummings, 2015). an additional challenge identified for online practice courses is the need to increase understanding about how courses which require students to demonstrate skill competencies in every phase of practice can provide evidence of their effectiveness (khaja et al., 2008; siebert et al., 2006). advances in social work, spring 2016, 17(1) 63 study background description of course content the content of both the online generalist practice course and the face-to-face course evaluated in this study was the same, including the topics addressed, required readings, class exercises, and written assignments. the overall objective of both courses was to teach the knowledge and skills necessary to effectively engage in the beginning phase of the social work helping process with individuals, families, and groups. given this objective, emphasis in both courses was placed on teaching students the preparation, engagement, assessment, and contracting skills to intervene in an empathic and culturally responsive way with both voluntary and involuntary clients. an outline of the course content is shown in figure 1. figure 1. outline of content for generalist practice i preparation for practice  characteristics of a professional relationship  the parameters of practice: the role of the social work knowledge base, ethical code and laws and regulations  impact of the agency environment on practice  preparation tasks prior to meeting a client engagement of voluntary and involuntary clients  clarifying one’s professional role and responsibilities and boundaries with the client  exploration of the presenting issues  basic communication and interviewing skills  introduction to the stages of change and motivational interviewing social work assessment  overview of the phases of assessment o information-gathering o formulation of the issues o goal-setting and intervention planning  defining evidence-based assessment, strengths-based assessment, and culturallyresponsive assessment  methods of information-gathering (e.g., observation, interview, structured questionnaire, genogram, ecomap)  the problem formulation process  developing a contract with voluntary and involuntary clients case management  models of case management  social work roles and functions description of differences in the face-to-face and online course delivery methods while the content of the two courses mirrored each other, and both courses were taught by the same instructor, the way in which the content was delivered was very different. the face-to-face course was delivered over 15 class sessions lasting two hours each. the online forgey & ortega-williams/can social work practice 64 course was delivered asynchronously in eight modules each one week in duration. figure 2 presents an overview of how the same content was delivered within each format. a more detailed description of the nuances between each delivery method is provided in figure 2. figure 2. differences in the delivery of the face-to-face and online content face-to-face delivery online delivery time frame 15 sessions; two-hour sessions once per week 8 modules; one module completed asynchronously each week lectures powerpoint lecture delivered live with powerpoint made available online after class. powerpoint lecture delivered asynchronously online with instructor voice recording. remains available online. modeling of client engagement and social work assessment interviews in class video of practice interviews followed by an in-class structured analysis of the skills observed. videos of practice interviews delivered online followed by an online submission of a structured analysis of the skills observed. discussions live discussions of lecture material during and after delivery. asynchronous discussion boards of lecture material after online lecture made available online. practice exercises simultaneous role plays conducted within small groups within the classroom with student observers providing feedback to the small group followed by a discussion of each group’s learning with the larger group. synchronous small group role plays with student observer audio recorded through a free conference call followed by a review and analysis of the recording submitted by each group on the discussion board for class and instructor feedback. self-reflections on practice intermittent written reflections on questions about the application of the various skills within their practice setting submitted in hard copy by each student to the professor for feedback. intermittent written reflections on questions about the application of the various skills within their practice setting submitted as a journal entry by each student to the professor for feedback. assessment of knowledge and skill integration three written paper assignments that required the students to describe and critique their preparation, engagement, and assessment skills using a case(s) within their field agency. three written paper assignments that required the students to describe and critique their preparation, engagement, and assessment skills using a case(s) within their field agency. lectures the powerpoint lectures delivered in each course introduced the students to the same material on preparation, engagement, assessment, and contracting. however, the lecture was delivered in person to the face-to-face students whereas the online students heard a recorded lecture. both sets of students were provided the powerpoint lecture online, which allowed the face-to-face students to also have access to the lecture at any time and to potentially review it again. advances in social work, spring 2016, 17(1) 65 class discussions following each powerpoint lecture, the face-to-face students participated in live discussion and class exercises with the instructor, whereas the online students participated asynchronously via an online discussion board. the online asynchronous nature of the discussion board allowed the online students more time to think through their responses and to have their participation more systematically assessed by the instructor. for example, following the lecture on the parameters of practice, one of the discussion board assignments required the online students to make a preliminary post stating how they would respond to two different ethical dilemmas and to justify their responses based on what they had learned about their ethical obligations and any relevant laws and regulations. after all students had made their preliminary posts, they were required to read everyone else’s posts and then make a final post in which they could amend their responses incorporating what they had learned from their fellow classmates. the instructor then evaluated the quality of each student’s participation in this discussion and provided individualized feedback. this same ethical dilemma exercise was used in the face-to-face class as an in-class exercise, where each group worked together on their preliminary response and then had the opportunity to amend their response after hearing from the other groups. this more spontaneous discussion did not allow the same level of systematic evaluation or instructor feedback. modeling of practice skills to teach engagement and assessment, these processes were first modeled for both sets of students via sequential video clips of a social worker engaging an individual client, a family, and a group, and in a later session, a social worker conducting an assessment. following the viewing of these clips, the students in both courses analyzed what they observed through a series of questions. the face-to-face students shared their analyses in class as part of a class discussion. the online students submitted their analyses as journal entries, which again allowed for more systematic evaluation of their understanding and more opportunity to receive individualized feedback. practice exercises opportunities for students to assess their own ability to practice engagement, assessment, and contracting were also provided within each course through exercises that required the students to examine their practice on actual cases from their field work, as well as through role plays. the role plays in both courses were conducted synchronously in small groups. however, in the face-to-face course, the role plays were not recorded because they were conducted simultaneously within one classroom making the recording of all of them impossible. students in the online course conducted their role plays using a free conference call system, which allowed them to record the role plays, review them among themselves, and then submit them to the professor for review. assessment of student knowledge and skills students in both courses were given the same three written assignments that evaluated their understanding and ability to assess their own agency practice and their ability to engage, assess, and contract with clients. students in both courses who did not have forgey & ortega-williams/can social work practice 66 appropriate cases from their field work were given the opportunity to practice and critique their clinical skills by participating in an audiotaped phone interview with a standardized client played by a doctoral teaching assistant. the same doctoral teaching assistant, as well as the same standardized cases, adapted from real case situations provided by the professor, were used in both classes. method study design and procedure this study used a two group posttest only quasi-experimental design to compare the effectiveness of the face-to-face and online courses. all of the msw students enrolled in the face-to-face and online sections of the generalist practice with individuals, families and groups course were invited via email to complete an anonymous survey designed to evaluate the quality of the learning environment, the extent to which the course objectives were met, and the effectiveness of the teaching strategies from the students’ perspective. twelve out of 15 students in the online class and 23 out of 25 students in the face-to-face class completed the survey, yielding an online class response rate of 80%, a face-to-face class response rate of 92%, and an overall response rate of 87.5%. the online students completed the survey on surveymonkey. the face-to-face students completed paper and pencil versions of the survey in class at the end of the last session. in addition to the survey questionnaire, several unobtrusive measures were included in the study. to measure learning outcomes, rubrics were developed for each of the three integrative papers to assess students’ understanding of the impact of the agency and community environment on practice, the process of engagement, and the process of assessment. to measure student satisfaction within the course, the survey administered to all students in the program at the end of each course was used. measures survey measures the quality of the learning environment was measured using the classroom community scale (rovai, 2002), a 20-item measure designed to assess the concept of psychological community. the psychometric properties of the ccs are well-supported. rovai (2002) found strong internal consistency (cronbach’s alpha: a=.93) and reliability (split-half coefficient of reliability of .91). other studies using css have reported similar measures of reliability (rovai & baker, 2005; rovai & jordan, 2004). each question has a 5-point likert scale with ratings ranging from 0 (strongly disagree) to 4 (strongly agree) for a total possible score of 80. the extent to which course objectives were achieved was measured by asking students to rate each of the seven course objectives listed in the syllabus. each question has a 4-point likert scale with response ratings ranging from 0 (not at all) to 4 (a great deal). the effectiveness of the teaching strategies was measured by asking the students to rate the powerpoint presentations, videos, small group peer learning activities, class discussions, reflection assignments, and advances in social work, spring 2016, 17(1) 67 integrative papers. each question has a 4-point likert scale with response ratings ranging from 0 (not effective) to 4 (very effective). three open-ended questions were included at the end of the survey that asked students to reflect upon what they liked most and least overall about the course. one question asked for recommendations. at the end of the survey, as a way of assessing the equivalence of the two groups, the students were asked to report their number of years of practice experience, their comfort with technology, and the amount of time spent on the course each week. years of practice is a variable that has been previously examined in relation to its impact on effectiveness (coe & elliot, 1999; freddolino & sutherland, 2000). additionally, comfort with technology has also been found to be an important variable to consider when studying the effectiveness of distance education (khaja et al., 2008; larsen et al., 2008). rubrics the first assignment rubric consisted of five content areas for a total possible score of 15 and assessed the student’s ability to identify environmental factors within the agency and community that could have a positive or negative impact on the client population’s experience of help. the second assignment rubric, made up of five content areas for a total possible score of 20, measured the student’s ability to describe and critique their preparation process for a first meeting with a client and to identify and analyze, through the use of a process recording of the first interview, the tasks and skills accomplished. the third assignment rubric consisted of nine content areas for a total score of 25 and measured the student’s ability to critique a bio-psycho-social assessment that they had completed in their field placement. in this critique, the students were required to analyze the extent to which they had described relevant individual, family, and environmental strengths and limitations; the methods used in gathering this multi-level information; and the problem formulation, contracting process, and evaluation plan. student satisfaction the school-wide student satisfaction survey consisted of 15 items that asked students to rate their satisfaction with all aspects of the course, including the course content, assignments, grading system, instructor quality, and responsiveness. each question had a 5-point likert scale ranging from 1-5, one being the lowest (strongly disagree) to five (strongly agree). the measure has not been evaluated for its reliability or validity. results equivalency of the groups due to the small and unbalanced sample sizes, the non-parametrical mann whitney u test was used to compare the years of practice experience reported by the students. a significant difference was found between online (mdn=3) and face-to-face students (mdn=0) in years of practice experience (u=40.5, p=.039). using the chi square fisher’s exact test to compare the reported comfort level with technology and the reported hours of spent on classwork, there were no statistically significant differences found. most (72.7%) forgey & ortega-williams/can social work practice 68 of online students expressed being very comfortable/comfortable with technology as compared to 50% of face-to-face students (p=.275). most (80%) of the face-to-face students spent six or more hours on classwork compared to 90.9% of online students. quality of learning environment when comparing the median scores of the online students (mdn=60) and the face-toface student scores (mdn=57.5) on the classroom community survey (rovai, 2002) using the mann whitney u, no statistically significant difference was found (u=118.5, p=.626). student perceptions about learning objectives given the distribution of the responses, the categories a great deal and mostly were collapsed into one, as were the categories, somewhat and not at all. no statistically significant difference was found between online and face-to-face students in their perceptions of the extent to which the course learning objectives were achieved, using the chi square fisher’s exact test (see table 1). table 1. student self-report scores of meeting learning objectives (mostly/a great deal) items % rating mostly/a great deal p* face-to-face (n=23) online (n=12) demonstrate understanding of first session tasks with clients. 100% 100% no difference effectively engage voluntary and involuntary clients. 90.9% 100% 0.529 understand the role of diversity when working with clients. 77.3% 100% 0.137 articulate and critically apply strengths-based conceptual framework to guide assessment and evaluation. 86.4% 91.7% 1 demonstrate capacity during the assessment and case formulation process to distinguish, appraise, and integrate multiple sources of knowledge. 100% 100% no difference demonstrate capacity to develop collaborative and mutually agreed upon intervention goals. 86.4% 100% 0.537 understand relationship between goal-setting, intervention, and evaluation. 90.9% 100% 0.529 *p<.05, fischer's exact test effectiveness of teaching methods given the distribution of the responses, the categories very effective/effective were collapsed, as were the categories, somewhat effective/not at all effective. five of the six teaching methods measured for effectiveness were not found to have a significant advances in social work, spring 2016, 17(1) 69 difference between what was ranked very effective/effective and somewhat effective/not effective at all. however, a significant difference was found in one of the six teaching methods. this difference was found in relation to the reflection assignments, the goal of which was to have the students reflect upon the specific skills they were learning in relation to client engagement and problem exploration and if and how their prior or current experience impacted their practice. the very effective/effective rating was significantly higher for the online students (p=.030) using the fischer’s exact test (see table 2). table 2. scores for effectiveness of teaching methods (very effective/effective) items % rating very effective/effective p* face-toface (n=23) online (n=12) powerpoint 63.6% 91.7% 0.113 videos 90.9% 100% 0.529 small group peer learning activities 54.5% 41.7% 0.721 class discussions 95.5% 83.3% 0.279 integrative papers 90.9% 100% 0.529 reflection assignments 61.9% 100% .030* *p< .05, fischer’s exact test open-ended questions the qualitative data generated from the open-ended questions were coded for prominent categories, as is common in qualitative approaches such as phenomenology and grounded theory (creswell, 2013). the content analysis consisted of placing responses into the category that was best aligned. the number of times that a response was given was counted to arrive at larger themes, which is also considered best practice among qualitative approaches (creswell, 2013). overall, both online and face-to-face students made similar observations and recommendations. both online and face-to-face students liked the course videos. one face-to-face student remarked, “watching practitioners deal with various clients” was impactful. likewise, an online student said, “i really learned a lot from watching the videos that demonstrated certain interview skills.” group projects were liked the least, but each group gave different reasons. a few online students expressed frustration with the synchronous format, given that the majority of content was delivered asynchronously. an online student stated, “while i appreciated actually connecting with classmates, arranging a time for a conference call was incredibly difficult.” another online student expressed a preference for the activity to be delivered asynchronously, “they really served little purpose to me; none at any rate that couldn’t have been achieved via discussion board.” several face-to-face students also said being “put in random groups” was what they liked least. students in the face-to-face class also said that they wanted to “socialize with other people besides the people in the group.” students also commented on other class features. face-to-face and online students mentioned teacher responsiveness as what they liked most. “quick turn-around time” was forgey & ortega-williams/can social work practice 70 noted several times by online students. having “an open forum” to express oneself was noted as important in the face-to-face class. both online and face-to-face students noted that while the course work was rigorous, the readings, assignments, and “multimodal learning” were considered positive. rubric scores using the mann whitney u to compare the median rubric scores on each of the assignments, the median scores were found to be the same for the face-to-face and online students on the field entry paper (mdn=14) and on the engagement paper (mdn=18). the median rubric score for the online students on the assessment paper was 24 and for the face-to-face students it was 23. no significant differences were found when comparing the median scores for the field entry (u=183.5, p=.746), the engagement paper (u=159.0, p=.417), or the assessment paper (u=171.0, p=.788). see table 3. table 3. rubric scores assignment rubrics face-to-face median (n) online median (n) p* field entry paper 14 (26) 14 (15) 0.746 engagement paper 18 (25) 18 (15) 0.417 assessment paper 23 (24) 24 (15) 0.788 *p<.05 student satisfaction using the mann whitney u test to compare the median scores on the student satisfaction survey, the online score (mdn =5) and the face to face score (mdn = 4.9), although both quite high, were found to be significantly different (u=32.5, p=.001). however, given that the actual point difference was only 0.1, the practical significance of this finding is questionable. discussion while skepticism remains about the effectiveness of online courses for teaching social work practice, the results from this study suggest otherwise, and are consistent with previous studies. the learning outcomes, as measured by the rubric scores on the three integrative assignments, were found to be comparable, as were the students’ perceptions of the quality of the learning environment, the extent to which they believed the course objectives were achieved, and the effectiveness of five out of six teaching strategies used. the one difference found in relation to teaching strategies was a result of the online group reporting a higher rate of effectiveness in relation to the reflection assignments. high course satisfaction scores were also found for both groups, with the online group’s scores being slightly but significantly higher. the overall findings from this study provide a basis for continued optimism about the ability of online courses to teach social work practice concepts and skills as effectively as face-to-face classes. however, this optimism must be grounded in an understanding of this study’s strengths and limitations. advances in social work, spring 2016, 17(1) 71 many of this study’s strengths can be found in its design components, specifically the use of a comparison group that received the same course content within the same timeframe and was delivered by the same instructor. the only difference was the method of delivery. another design strength was the multiple measures used to understand three different dimensions of effectiveness: student perceptions of effectiveness, student satisfaction, and learning outcomes. furthermore, the study design and measures used were also fairly easy to implement, which allows for easy replication in the future. this last strength, ease of implementation, is of particular importance in light of this study's major limitation, the small sample size, which limits its generalizability. in addition to the small sample size, another limitation of the study is the way in which effectiveness was measured. while the students’ level of knowledge was measured and compared between the two cohorts using the assignment rubric scores, this measurement did not evaluate their actual skill level. to do so effectively would have required the students be rated on their skill levels. standardized client role plays are one method that could have been used to measure the students' skill levels. role plays were considered given the principal investigator’s previous experience with using this method to assess practice skills (forgey, badger, gilbert, & hansen, 2013). however, after considering the time and resources that would be required to develop role plays to assess specific practice skills, to hire and train standardized clients, to schedule the student role plays, and to implement a rating system including the hiring and training of raters, role play was deemed an unrealistic method for this study. another limitation was the lack of measurement of the actual change that occurred in relation to the students' knowledge. even though the findings indicated that the knowledge in both cohorts, based on the assignment rubric scores, was not significantly different at the end of the course, it is unknown to what extent, if any, that students’ knowledge changed over time as a result of the practice course. a preand posttest design would be needed to measure this variable. pretests were not pursued due to time and cost constraints and the desire to develop realistic and implementable evaluation procedures that had more of a chance to be replicated across the curriculum. the findings from this study also provide some guidance about what factors make an online and face-to-face course equally effective. gaining more insight into these factors and processes in future research will provide valuable information as to what it was about the curriculum or students themselves that resulted in the level of comparability found. one factor that may have contributed to the equivalent results was the level of curriculum consistency between the two formats. having the same instructor deliver both courses played a role in this consistency, but other strategies used in the curriculum design may have further assured the sameness of the content delivered. the same powerpoint lectures and practice model videos were used in both classes, and all students were able to download and reference the powerpoints. further, the major discussion questions, small group activities, course assignments, and material sequencing was the same for both classes. as online programs grow, concerns about the consistency across face-to-face and online courses will increase due to the greater likelihood of faculty teaching solely in one format or the other. while instructor training will always be a critical factor in achieving forgey & ortega-williams/can social work practice 72 curriculum consistency, course design strategies can be implemented by faculty to further ensure face-to-face and online course consistency. however, this will require organizational structures and resources that support both online and face-to-face faculty involvement in the early stages of course design and development. understanding what accounted for relatively high ratings for both sets of students on the classroom community scale and the lack of differences is another area for future exploration, given the importance of establishing a social presence within an online environment (bentley et al., 2015). a closer look at the way in which interactivity happened among the students and between students and instructor is necessary to accomplish this understanding. within both classes, interactivity occurred in response to the planned discussion questions, the video analysis questions, and the intermittent small group activities that required students to practice the skills together and to discuss among themselves how they were applying what they were learning to their specific cases. in addition, for small group activities, detailed instructions were used in both classes, with the only difference being the medium used to have the interaction. these interactive activities also took place within the same sequence within each class. the amount of individual student interaction with the instructor is also an important element to the student’s experience of classroom community and to the instructor establishing their presence within the class with each student. while the amount of student questions to the instructor cannot be planned for, the amount of other types of student/instructor interactivity can be planned by the type, amount, and timing of the assignments for which individual feedback is provided. within this class there were three major assignments where extensive feedback was provided individually to each student. in addition, the professor also provided individual feedback on the five reflection assignments. certain characteristics of the students themselves may also partly explain the comparability of the data. on two of the three student characteristics, the amount of time reportedly spent on classwork each week and comfort with computer technology, there were no significant differences. however, one of the student characteristics that was significantly different was the amount of practice experience. the online students were found to have significantly more years of practice experience. this one difference may be a possible explanation for the significantly higher value placed on the reflection assignments by the online students, who perhaps as a result of having more practice experience had more to share when asked to apply and discuss what they were learning in relation to their prior and current experience. attention needs to be given to ways in which the value of reflection could be increased for students with little or no practice experience. in the quest to identify factors that may help explain the level of comparable effectiveness, class size is another factor that deserves more attention in future studies of course effectiveness (jones, 2015). while this study found no significant differences in learning outcomes or the quality of the learning environment, it is not known how dependent these outcomes were on the particular class sizes in this study. as online social work programs expand, the question of how large an online class can be before impacting the quality of the learning environment and learning outcomes needs to be addressed. advances in social work, spring 2016, 17(1) 73 future program-wide evaluations involving multiple sections and courses need to explicitly examine this question by analyzing if and how class size impacts the learning outcomes in the class, as well as the faculty work load, which has been reported by some experienced online instructors to be 40% higher in online courses (jones, 2015; pelech et al., 2013). further investigation is especially important in light of the review of existing multidisciplinary research on the appropriate class size for online courses carried out by taft, perkowske, and martin (2011). they found mixed and at times contradictory results. and although none of the studies reviewed included graduate online social work programs, the review did identify a number of factors that may be responsible for the variation found in the studies on the impact of online class sizes on student outcomes. some of these include: a) the type of course and specifically the extent of factual information versus application, analysis and/or synthesis within it; b) the level of course and amount of teaching intensity and interaction expected; c) the extent to which the course is delivered synchronously vs. asynchronously; d) the presence or absence of technology support and teaching assistants; e) level of faculty expertise in online education; and f) the type of evidence of student learning. given that the practice course evaluated in this study was asynchronous with a high level of application, analysis and synthesis as well as interaction within it, it seems imperative that future effectiveness research examine if and how class size may impact the effectiveness of this type of course. conclusion online programs are developing rapidly within schools of social work. based on the findings in this study, as well as previous studies that have compared online and face-toface practice courses, the student learning experience in these courses appears to be comparable. however, learning outcomes in social work practice courses are difficult to measure effectively. to do so requires the measurement of both knowledge and skills, as well as the extent to which the skill levels changed as a result of the course. while there has been an increased focus on the need to measure learning outcomes in reaction to the proliferation of online social work courses, and in particular practice courses, this need also exists and deserves equal attention in the face-to-face curriculum. ironically, the development of online curricula and the 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(2006). evaluation of the first web-based advanced standing msw program. journal of social work education, 42(3), 607-620. doi: http://dx.doi.org/10.5175/jswe.2006.200500501 advances in social work, spring 2016, 17(1) 77 wilson, a. b., brown, s., wood, z. b., & farkas, k. j. (2013). teaching direct practice skills using web-based simulations: home visiting in the virtual world. journal of teaching in social work, 33, 421-437. doi: http://dx.doi.org/10.1080/08841233.2013.833578 author note: address correspondence to mary ann forgey, graduate school of social service, fordham university, 113 west 60th street, new york, n.y. 10023, forgey@fordham.edu from theology to practice: theological foundations of faith based organization practice a multiparadigmatic approach to judeo-christian religion in social work education jon e. singletary abstract: the attention given to faith-based human services in the past decade has created interest in pedagogical models of the ethical integration of spirituality, religion and social work practice. following a discussion of philosophical, theoretical, and theological perspectives, this paper explores different sociological paradigms of knowledge and practice that may be of value when seeking to utilize spiritual and religious content into social work education. the implications of this article relate to educational settings that seek to incorporate content on religion and spirituality in social work education as well as to social work practice in religious organizations. keywords: paradigm; religion; planning and administration introducing paradigms the language of paradigms has been used across disciplines to describe current and shifting understandings of knowledges, beliefs, assumptions, and practices. thomas kuhn (1962) made the term “paradigm” recognizable with his publication of structure of scientific revolutions. for kuhn, a paradigm is a collection of shared beliefs, a set of agreements about how the world may be understood. according to kuhn, the differences between newton's mechanical universe and einstein's relativistic universe represent a shift in paradigms. each of these two approaches to physical science represent a worldview, or a paradigm, that guides how scientists see the world. hans kung (1988) is among those who has applied kuhn’s understanding of paradigms to religion. he identifies several paradigms that have shaped religious history. among recent christian worldviews are the modern, enlightenment paradigm and an emerging ecumenical paradigm. in comparing these two paradigms, frederick schleiermacher’s (1996; 2001) contributions that shaped much of modern liberal theology are challenged by the pluralism of more recent ecumenical and interfaith theological understandings (cobb, 1982; hick, 1982). the new does not replace the old, yet it does provide an alternative foundation of thought for understanding contemporary religious practices. in organization practice: a social worker’s guide to understanding human services, netting and o’connor (2003) bring the matter of paradigms to relevance in social work organizational settings. they define paradigm as a worldview containing deep-seated assumptions that are so much a part of a person that it is often difficult to step back and see what the assumptions are. such assumptions and views of the world are central to a person’s belief system and to the ways that a person lives and acts in relation to others. netting and o’connor encourage social workers to be able to practice multi_________________ jon e. singletary, ph.d., is an assistant professor and director of the center for family & community ministries at baylor university. copyright © 2008 advances in social work vol. 9 no. 2 (fall 2008), 63-78 singletary/a multiparidigmatic approach 64 paradigmatically, to discern the assumptions most often used within an organization and then use critical thinking and practice skills to move across different paradigms to accomplish goals congruent with social work values. this contribution by netting and o’connor builds on another text that focuses on paradigms and has relevance for practice and research in social work and religion: burrell and morgan’s (1979) sociological paradigms and organisational analysis. burrell and morgan provide a discussion of four paradigms, as well as a philosophical understanding of each paradigm in terms of ontology, epistemology, human nature, and research methodology. in the same way that netting and o’connor utilize burrell and morgan as a foundation for their work in social work organization practice, i build on both texts to propose multiple paradigms that can be utilized when including religion in discussions of social work, particularly in educational settings. this paper includes a discussion of philosophical assumptions, paradigms that emerge from these assumptions, examples of these paradigms in social work practice in religious organizations, and implications of these paradigms for social work education. the multiparadigmatic framework offered by burrell and morgan, as well as the adaptation for social work by netting and o’connor (2003; see also martin & o’connor, 1989), will shape this effort to demonstrate the value of paradigms as heuristic tools for incorporating this approach to religious content in social work education and practice. there are several practical and theoretical elements to think about when considering this multiparadigmatic framework for social work education. while the material may lead some readers to approach paradigmatic assumptions from a clinical perspective (martin & o’connor, 1989), other readers may choose to approach this material from a generalist approach. with my interest and experience in planning and administration, i have found value in applying these paradigms with a focus on knowledge and skills relevant at the macro level of organization practice (netting & o’connor, 2003; netting, thibault, & ellor, 1990). it is from this organizational perspective that i present the integration of religion in the paradigms and provide examples of religious organizations whose purpose and programs fits within the four paradigms. to place the discussion of religion within the multiparadigmatic framework, a definition of religion may be of value. religion and spirituality have a range of meanings in social work literature and are discussed in educational settings in a variety of ways (bullis, 1996; ellor, netting, & thibault, 1999). for the purposes of this article, i understand religion to be a category for understanding the context of broad and diverse spiritual and sacerdotal practices engaged in by individuals and communities. i primarily discuss spirituality together with religion because so many spiritual practices traditionally developed within the context of a religion, yet because i also recognize that so many contemporary spiritualities are practiced outside the confines of a specific religion, i am attentive to the role of spirituality apart from religion (see bullis, 1996). these understandings of religion and spirituality, in part, reflect paradigmatic differences. issues related to defining religion and spirituality in social work education, as well as the advances in social work, fall 2008, 9(2) 65 issues related to the practices of religion, spirituality, and social work will be further discussed in terms of the framework of four paradigms to which i now turn. the multiparadigmatic framework of burrell and morgan burrell and morgan (1979) present a framework for understanding philosophical assumptions related to sociology and the place of organization theory in society. these foundations will be shown to be equally relevant to our discussions of faith, theology, religion, and spirituality. the core philosophical concepts they discuss are epistemology (the nature of knowing), ontology (the nature of what is known), and research methodology (processes for knowing). philosophical concepts of knowledge epistemology has to do with the nature of knowledge: how do we know what is true or real? traditional sources of knowledge include intuition, perception, testimony, experience, and rational thought. within religious history, there are four common sources: reason, revelation, tradition, and experience. there are, of course, variations on these sources and the weight they carry, with some sources dominating others. for example, the socially hegemonic force of authority seen in religious traditions tends to displace individual emotion as an experiential source of knowledge. here, we begin to see one important factor: the distinction between hard knowledge, which is capable of being transmitted in a tangible form (e.g. the tradition of sacred writings), and soft knowledge, which is more innate and personal. these issues continue to be relevant to religious and secular debates about the grounds of knowledge as well as the ways knowledge is used. ontology addresses the nature of reality. once we consider how we know, we then ask what we know. if we know about things divine through traditional sacred writings or through revelation, then what can be said about the nature of divine reality? different sources suggest different ontological statements. some traditional religious sources and many personal experiences allow people to present feminine characteristics of god; many sacred writings and other personal revelations describe masculine characteristics. which is true? which is real? you may say neither or both, but the issue is more than a matter of language. it is a matter of prayer, worship, service, and devotion and there are strong positions on either side arguing that gendered language for god does matter (ruether, 1993). another ontological theme relevant to religion is the discussion of whether our truths are external to the knower or the product of individual conscience; are they true or are they ‘t’rue? methodology relates to practical matters of how we know and what we know. how do we investigate what is real? how do we receive truths? consideration of subjective and objective ways of knowing points to both an epistemological question (e.g., what is the nature of how we know?) and a practical question (e.g., what are our processes for knowledge-building?). this and other relationships between these terms will be shown in the paradigmatic framework below. singletary/a multiparidigmatic approach 66 burrell and morgan (1979) arrange these concepts in terms of two dimensions that are presented as perpendicular linear continua. the result is a table of four paradigms (see figure 1). in considering various philosophical issues of epistemology, ontology, human nature, and methodology, burrell and morgan identify schools of thought, such as social theories, within these paradigms and to this list, i place comparable theological perspectives. first let us consider the nature of the two continua and the four paradigms. figure 1: burrell and morgan’s two dimensions (1979, figure 3.1, p. 22) sociology of radical change subjectivity radical humanism radical structuralism objectivity interpretive functionalism sociology of regulation radical change – regulation perspectives on the first continua, ranging from radical change to regulation, vary according to understandings of the inherent ordering or conflict present in a society. as you think about this continuum, there are a variety of issues to be considered: what role do both social work and religion have in a society? are these disciplines more oriented to radical change or regulation? should they be oriented otherwise? each reader will approach these questions differently, and as a result, there are multiple perspectives that will be identified showing change oriented approaches to both social work (acknowledging the role of theories) and religion (acknowledging the role of theologies). table 1 presents a variety of questions relevant to each side of this continuum. advances in social work, fall 2008, 9(2) 67 table 1: the continuum of radical change – regulation radical change regulation are our ways of knowing (epistemology) focused on knowledge for action? are our ways of knowing (epistemology) focused on knowledge for knowledge sake? are we focused on knowing in order to bring about revolution? is our focus maintaining traditions or conserving norms? is our understanding of reality (ontology) ever-changing? is our understanding of reality (ontology) relatively steady? are we free to understand differently or to change society as new knowledges arise? are we largely destined to know what we know? to know within limits? subjectivity – objectivity the second continuum, ranging from subjectivity and objectivity, relates to assumptions about the nature of social science, the nature of knowledge about the world around us. from a subjective perspective, theories tend toward nominalism with an understanding that reality is a product of one’s mind. this antipositivistic position regards knowledge as experienced and interpreted in a variety of ways according to different persons (consider constructivism or social constructionism). the objectivist perspective embraces realist and positivist views of the social world and of knowledge about the world. objectivity assumes the existence of truth with a capital “t” that can be firmly known through a best way or a right way (positivism) or that can be approached or approximated with careful attention to our knowledge-building processes (postpositivism). questions aligning us on this continuum are listed in table 2 below. table 2: the continuum of subjectivity – objectivity subjectivity objectivity are there multiple ways of knowing? is our knowledge dependent upon and limited to our processes? is knowledge best created by a scientific method? or, is knowledge granted to us by church tradition? are there multiple realities (subjectivity) is there a single ultimate reality (objectivity)? singletary/a multiparidigmatic approach 68 four paradigms from the matrix formed by the two continua, burrell and morgan offer their understanding of four paradigms that include: functionalism, interpretivism, radical structuralism, and radical humanism. each paradigm contains separate explicit, mutually exclusive assumptions which take into consideration one’s epistemology, ontology, human nature, and methodology as arranged on the two continua (see figure 1). the functionalist paradigm is found in the quadrant of objectivism and regulation. many theologians, social workers, and other professionals, at least in terms of what “the powers that be” have to say about these disciplines, are situated in this paradigm. a rational, orderly approach to work and a feeling that there is “one best way” or a commonly accepted “right way” to accomplishing tasks characterize functionalism (netting & o’connor, 2003). a postpositivist philosophy of science, central to social work research, depends on objectivity within standard quantitative methods. similarly, most assumptions and theories that have guided social work practice in the twentieth century are also central to a functionalist paradigm (burrell & morgan, 1979; martin & o’connor, 1989; netting & o’connor, 2003). in religion, theology is not dependent upon scientific epistemology, but the authority involved in much of christian orthodoxy assumes that there is a large amount of objective truth in its doctrine and practice making this paradigm seemingly appropriate to their beliefs about reality. if the focus on objectivity is central to your understanding of social work and/or religion, but you are more oriented toward radical change, then the radical structuralist paradigm may be a better fit for you. there is found here a firm foundation for universal knowledge, as with functionalism, but there is more of a focus on large systems changes rather than incremental changes within the status quo. jewish, christian and other theologies of liberation (ellis, 2004; gutierrez, 1988), which seek to address social structures that are oppressive, and socially-engaged evangelicalism (sider, 1999), which is a more theologically conservative approach still addressing social power and privilege, offer appropriate, but substantially different models for this paradigm. both make substantial theological claims of truth, yet realize that the practice (praxis) of this truth leads to social and economic change. radical feminist theory (calas & smircich, 1996) and theology (heyward, 1984), calling for institutional transformation, and critical theory (habermas, 1971; 1984), addressing conflict in societal power relations, are other perspectives that fall within the assumptions of a radical structuralist paradigm relevant to social work practice. the interpretive paradigm has as its focus the consensus and equilibrium of the regulation perspective (qua functionalism), but is subjectivist in nature so that social reality is based on human experiences and exists primarily as human social construct (burrell & morgan, 1979; netting & o’connor, 2003). similarly, interpretations of what is real reflect individual understandings and intersubjectively shared meanings. this paradigm may be a comfortable fit for christian educators with knowledge of biblical hermeneutics, particularly reader response criticism, and approaches shaped by ricoeur (1976) and gadamer (1989). whether seeking to understand written texts or the lived experiences of the populations served by social work, this paradigm assumes advances in social work, fall 2008, 9(2) 69 participation in a world of emerging, local truths. as such, constructive ethical relativism, influenced by situational ethics and cognizant of the importance of human relationships, can be valued in this paradigmatic perspective (netting & o’connor, 2003; rorty, 1999; welch, 1989). rather than seeing social issues in black and white, social workers who are comfortable with many shades of gray might see themselves in this paradigm. the final of the four paradigms, where subjectivity meets radical change, is known as the radical humanist paradigm. with a focus on emancipating the human consciousness, a major concern of this paradigm is releasing human development from the constraints of the status quo (netting & o’connor, 2003). postmodern philosophers who concentrate on individual changes rather than social change, including foucault (1980) and derrida (1981) may be relevant to this paradigm. due to their generalizing nature, few theoretical perspectives are found in this paradigm; rather, the individual focus of emerging spiritual, transpersonal and holistic practice modalities align with the assumptions of this paradigm (netting & o’connor, 2003). sufi mysticism is one of the developments from a major religion, namely islam, fitting within this paradigm. if you value the subjectivity of the interpretive paradigm, but feel that change emerging from understanding doesn’t match your understanding of societal and individual conflict and even contradiction, then the change-oriented and consciousness-raising relativism of this paradigm may be a more appropriate fit. integrating religion in the paradigms using this multiparadigmatic framework for understanding one’s view of religion and of the world, social workers may be able to recognize and articulate more readily their own assumptions, beliefs, and values as well as those of coworkers, clients, and the organizations and systems where they find themselves. this framework serves as a heuristic that can be useful for persons learning about the meanings found in the intersections of religion and social work practice because it addresses philosophical theological assumptions that often remain tacit for both teachers and learners. a brief analysis of religious organizations and some characteristics of their practice provide examples of social work practice in each paradigm. religious organizations have a wide array of functions from sacerdotal responsibilities to addressing human needs. these organizations can be studied according to theological orientation, service delivery, organizational development and structure, administration, including the role of faith in the activities of these organizations (cnaan, wineburg, & boddie, 2000; jeavons, 1998, 2001; wineburg, 2001). the following diagram (figure 2 below) includes both practice theories and theological perspectives that may be of relevance to religious organizations or social workers with an interest in religion. furthermore, it provides a way to visualize side by side the theory and theology (i.e., the knowledge, beliefs, and values) shaping intersections of religion and social work practice. following this diagram, i present brief descriptions of real organizations that serve as exemplars meant to illustrate the practical side of the paradigmatic concepts. the names have been changed to protect the identity of the agencies, but their characteristics remain true to my experiences with an singletary/a multiparidigmatic approach 70 ethnographic study of each of them (singletary, 2003). for each one, sources of knowledge and understanding are offered that may be explicit or implicit in the organization’s practice. also, individuals within the organizations approach practice and faith with different assumptions, but the principles guiding the organizations as a whole or their primary leaders are being considered. figure 2: theory, theology, and organization practice models in four paradigms radical change su bj ec tiv ity radical humanist paradigm theory: postmodern; critical; feminist; transpersonal theology: postliberal; pluralist; pagan; liberation or feminist with postmodern and pluralist emphases; some buddhist and sufi practices; reconstructionist judaism organization practice model: small religious nonprofit organizations; spirituality groups; some individuals within more traditional organizations radical structuralist paradigm theory: systems; critical; power & politics; feminist theology: feminist; liberation; neoorthodox; correlative; critical; reform judaism organization practice model: faith-based advocacy organizations; councils of churches; denominational bodies; mission/advocacy groups within congregations interpretive paradigm theory: organizational culture; sensemaking theology: postmodern; process; pagan; pluralistic; narrative; reform judaism organization practice model: congregations; small religious nonprofits functionalist paradigm theory: bureaucracy; scientific management; systems; cognitive and behavioral approaches; psychoanalytic; and many more theology: traditional; orthodox; neoorthodox; evangelical; & reformed christian organization practice model: religious (denominationally) affiliated organizations; congregations o bjectivity regulation advances in social work, fall 2008, 9(2) 71 christian ministries incorporated: an organization in the functionalist paradigm to begin with the functionalist paradigm, and an example relevant to current policy and practice, let us consider a christian perspective that fits with an objectivist approach to knowledge (epistemology) and assumptions about truth that is ultimately real (ontology). many traditional views of god’s revelation would provide an appropriate fit here. a functionalist approach to biblical texts may acknowledge subjectivity in reading, but assumes that ultimately objective truth will be maintained by god’s revelation through the bible, religious tradition, and authority. when seen from a modern mindset, we can identify christian and jewish organizations that align such a theology with their professional provision of social services. for example, there are catholic, mainline protestant, and jewish child welfare organizations that hold firmly to their doctrinal perspectives, and when it comes to providing social services, they hold equally tight to professional standards. as a part of this, they increasingly value evidence-based or theory-based practice. religious affiliated agencies provide an example of this type of setting as they hope to achieve effective outcomes that demonstrate their understanding of an ethical realism stemming from god’s love and justice, as well as, occasionally, from professional knowledge and values. commonly, their perspectives are based on common assumptions that we are to serve and help meet the needs of others as the proper way of serving god. christian ministries incorporated, a large traditional religiously affiliated organization, exemplifies these functionalist assumptions.1 a statement of values posted near the entrance reads that the love and grace of god revealed in the person and work of jesus christ is to be demonstrated by staff and volunteers in all client interactions. a few lines below, the statement proposes that professional standards of confidentiality, respect, and dignity are also to be shown. according to the executive director, religious and social work values are well aligned in this organization that strives to incorporate theological perspectives reflective of their denominational teaching, as well as professional rigor in assuring measurable outcomes in their interventions. in this, christian ministries incorporated affirms what has become commonly accepted in many social service organizations: the outcomes of human service programs can be evaluated by quantitative measures of effectiveness. true to a functionalist paradigm, these outcomes are said to be objective criteria for measuring the effectiveness of their theorybased interventions that also reflect “god’s desire for social justice”. while working for change in their clients’ lives, christian ministries incorporated rests in the functionalist paradigm because the organization assumes commonly accepted expectations for service delivery. as a result, christian ministries incorporated tends to promote change only in terms of what is expected and valued in their denomination’s belief system and its acceptable standards that are reflected in this conservative southern community. due to funding constraints and a variety of philosophical and leadership considerations, they are not radically challenging the status quo—that is not the best use 1 the examples all represent real faith-based organizations from practice experience, the names of which have been changed for this paper. singletary/a multiparidigmatic approach 72 of limited resources—yet they do meet a variety of real and growing needs in this community. religious women’s service organization: a radical structuralist organization in moving to the radical structuralist paradigm, where objectivity is valued as above, but where the goal of change is more radical, i present a recent program implemented in a feminist organization with a traditional religious name, but that has gone in very different directions from those originally conceived by the organization. religious women’s service organization operates an advocacy program to change legislation that would protect women who have experienced domestic violence. the combination of feminist theory and liberation feminist theology allow the center to some objective claims that are certainly of value; namely, that god has a preferential option for poor women and demands that we work to end the oppression and the experiences of abuse among low income women. these women work in protest against patriarchy and in solidarity with other women of various religions in the community. along with this position of objectivity in terms of what is true and right, one can see that they are also oriented toward radical change. on one hand, religious women’s service organization offers shelter programs that promote change in the women’s lives, but these commonly accepted programs fit into the status quo of what is acceptable for an organization such as this. on the other, more radical hand, the religious women’s service organization is seeking to raise public awareness and advocating for legislative changes; in doing so, they are engaging in a marketing campaign that promotes change in public perceptions about women who experience abuse. they stand solidly in claiming the truth of their convictions and in calling others to join in their change activities. this is an example of a radical structuralist organization because the assumptions are that the religious women’s service organization has a perspectives about women’s real needs and that their responses to the needs reflect god’s teaching about what is ultimately best for these women (and, as a result, what is best for all of society). the religious women’s service organization focuses their energy on changing other people’s points of view to be more aligned with their own in an attempt to change social policies and promote social justice. community ministry center: an organization in the interpretive paradigm a new organization is being developed in our community that may be understood as interpretive. let us consider this next as i move to a different set of assumptions about the nature of knowledge. subjectivity and local meaning-making will be shown to be relevant in this paradigm. the populations served, the programs that serve them, and the processes of the board structure at the community ministry center are all emergent in nature as this young organization continues to create itself. while the center does have a board and a director, the students and community members served by the center take an active role in the consensus-building processes related to what the center does and what it will become. while developing out of a mainline protestant christian tradition, there is no commonly advances in social work, fall 2008, 9(2) 73 accepted theory base or single theological perspective driving the programs or services— actually there may not be any programs or services offered in the traditional sense of the words! the center engages in a continual process of community praxis related at times to promoting social justice, but with an ever-present intentional focus on understanding the needs and desires of the multiple constituencies who occasionally gather at this space. this faith-based center receives funding from its denominational body, but matters of meaning found in the faith are left to the discernment of individual participants in the community. two groups met recently in this space--the leaders of one group were atheist and the other, catholic--for a consensus building activity related to an upcoming community event. a similar example among leadership of the organization is seen as one month’s board meeting began with a bible reading and another with a buddhist meditation. the community ministry center incorporates the consensus related perspective (of the regulation dimension) with subjective approaches to interpreting multiple realities (on the epistemological dimension) in ways that make a good fit in an interpretive paradigm. participants in the diverse religious and spiritual views found in the broader community find a safe place to dialogue and reflect in this organization. all god’s children: radical humanist leadership in a functionalist organization discerning a radical humanist approach to practice is not easy. the assumptions related to subjectivity and radical change relate more to individuals than organizations, particularly religious organizations. the closest organizational example is that of a small agency led by a woman trained in cistercian, or “trappist,” monasticism yet who engages in the earth-based spirituality of deep ecology. the director of all god’s children, a local transitional shelter, works in a style befitting some of the criteria of radical humanism. to demonstrate this paradigm, i will discuss her style and a program they offer women leaving the agency. consistent with the radical humanist paradigm, all god’s children seeks change within individuals, but it seeks radical change from within the women rather than according to societal standards that are more in line with a functionalist paradigm. the director encourages the women individually and subjectively to discern what is best for them in the communities where they find support. it could be that living in community (similar to what the program offers) is what they feel is best for themselves, or that they take next steps to achieve independent living. the termination program of all god’s children may be seen as a radical humanist service. she encourages the individual spiritual formation of the women through the practice of inner healing, a practice that encourages each woman to work toward her own transformation of mind, body, and spirit. the assumption is that spiritual formation leads to change and that it allows each woman her own subjective approach to meditative practice. these practices, allowing for individual change according to directions the women choose, provide some insight into radical humanist practice. the women feel a sense of power as they go, not “empowered” by the director but rather by their own singletary/a multiparidigmatic approach 74 process of spiritual direction. the approach is said to be a matter of consciousness-raising for the women with the potential for personal, social, and spiritual change. implications for integrating multiple paradigms a student beginning a placement in a religious organization recently realized that the questions she raised became more interesting (or confusing!) when she considered the assumptions that underlie the organization. while analyzing her organization in class, she identified the organization where she is placed as thoroughly functionalist because of programs offered and governance issues, yet states that the director is leading in an interpretive fashion that is more in line with her personality style. she observes the board president, who is expected to make a tough decision related to why things feel so dysfunctional and unproductive for everyone else, and a board vice president, who is content that everything will work out according to “god’s plan”. in this example and in many others, social work educators can formulate questions for students about guiding philosophical assumptions, sociological issues, approaches to knowledge, and overall views of the world. the multiple paradigms in this student’s service system may have her bewildered about what direction the organization should go, but they offered a valuable framework for learning not only about her own perspectives but the perspectives of others. one way to approach this example and others like it is to incorporate into classroom discussions some of the questions i raise above related to philosophical concepts of knowledge such as epistemology, ontology, and methodology. specifically, before addressing social work theory, i ask students about paradigms using philosophical concepts and questions to guide the conversation. subjectivity and objectivity are commonly discussed concepts in social work theory, practice and research, and as shown in table 2, they represent philosophical issues. these philosophical issues undergird theological issues. responses to these questions help students understand the differences between the four paradigms also discussed above. conversations about religion are about values and beliefs, but the paradigmatic issues related to philosophy and theology underlying these values and beliefs contribute to deeper meaning when seeking to understand the role of religion in practice. learning about multiparadigmatic practice, as netting and o’connor (2003) describe it, goes well beyond simply identifying for ourselves, or our students, a paradigm of best fit. realizing how we tire of being put in boxes, they suggest that this framework can be a guide for realizing that there is a range of alternative ways to know, experience, and engage the world (or worlds) around us. when we are able to recognize where we and others around us are “coming from,” then we will be able to identify when our assumptions align with and when they conflict with others. we will be able to validate the existence of differences, and we hope that we will be able to put these differences to use as strengths (netting & o’connor, 2003, p. 91-92). to help students recognize personally how they understand and function in different paradigms, the questions presented in tables 1 and 2 may be of value. from this conversation, we are able to shift the conversation to ask how these paradigms relate to advances in social work, fall 2008, 9(2) 75 religious perspectives. figure 2 can be used in classroom discussions as a way to consider where students are most comfortable personally, but also to help them see where other individuals and organizations might be represented. religious leaders in your community can serve as helpful resources for thinking about philosophical and theological themes that undergird practice. to interview religious leaders using some of the questions from this article may serve as a helpful way to teach this content. students may enjoy the process of finding the paradigm where they personally fit, but then struggle in realizing that their field placements, congregations, and universities may all be organized according to different assumptions and found in different paradigms. students should not feel forced to merge the parts of themselves that are in one paradigm with parts of themselves in another, but to understand the differences that exist even within themselves. on one dimension, the goal may be to help them understand how they may have a subjectivist perspective that values multiple realities, yet participate in an organization that affirms objective truth. on the other, they will occasionally be driven to radical change while in other situations and in response to other social or individual issues feel comfortable taking more incremental steps or maintaining accepted norms. there will, of course, be other questions that can arise from paradigmatic considerations—questions that move from philosophical education to professional practice. questions like these can be relevant not only to students, but to practitioners working with leaders of different religious backgrounds: how do we survive and thrive in organizations that promote incremental change supporting the status quo, when we value radical change? how do we design an intervention based on “one best way” when we feel that each individual must find her or his own way? this paper introduces questions that are likely to develop when tacit assumptions become explicit in the self-awareness and critical thinking processes that are a part of social work education. these are not just philosophical issues, for they undergird a wide range of professional questions and concerns. social work educators may consider not only how students respond to these issues, but also how practitioners utilize theology as well as theory in practice. for in the same way that we encourage critical thinking about theoretical perspectives in practice, we know that religious organizations, the people they employ and the people they serve, have beliefs and values that represent underlying theological perspectives. the multiparadigmatic framework can raise questions about theological foundations; it can also help us address the ethical integration of faith and practice. furthermore, this framework can provide guidance in shaping responses to philosophical and religious questions that arise in social work education and professional practice. discovering the assumptions related to multiple paradigms of practice and theory may encourage students to articulate and ask questions such as those raised here. it may provide educators with the language and knowledge to respond with a heuristic model. and, it may contribute to the journey of lifelong learning for professionals seeking appropriate responses rooted in contexts of faith. likewise, my hope is that the same implications can be found in practice settings. for organizations where religion is relevant, the themes addressed in singletary/a multiparidigmatic approach 76 this paper can help practitioners recognize the multiple ways in which religion and spirituality can be brought be bear upon organizational and community life. conclusion the multiparadigmatic approach offered here reflects one understanding of the complex intersections of theory and theology and the integration of religion and social work practice. with the knowledge and expertise that social workers develop, as well as their own religious understandings, the information in this basic introduction to different paradigms of practice hopefully provides a heuristic for considering issues of religion from diverse perspectives. i feel that the information in this multiparadigmatic framework can be of value to social work students and practitioners, particularly social workers who work with people who are religious or spiritual, in organizations with a faith-based identity, or who are themselves religious or spiritual. this understanding of paradigms may serve as a teaching tool for promoting increased self-understanding, for conducting organizational analysis, for evaluating practice theories, or for discussion related to the integration of religion and social work practice. the philosophical assumptions can be utilized in conversations about selfawareness and the professional use of self. the continua, as well as the paradigms, can also be of value in framing our use of practice theories and practice models. this framework may also serve to aid in understanding differences and similarities among student assumptions about the world. any time we say or hear, “well, god expects us to…,” “the bible says…,” or even, “the code of ethics demands…” we have an opportunity to reflect on our assumptions, and this matrix of paradigms provides a tool to aid us in considering these things. whether used in teaching human behavior, practice or research, in discussing the relationships between faith and knowledge, or in introducing social work ethics in relation to different religious perspectives, this framework can be built into existing curricular materials in an effort to encourage students to consider the role of our many underlying assumptions that often go unnoticed and unmentioned. references bullis, r. (1996). spirituality in social work practice. philadelphia: taylor and francis. burrell, g., & morgan, g. (1979). sociological paradigms and organisational analysis burlington, vt: ashgate. calas, m. b., & smircich, l. (1996). from "the woman's" point of view: feminist approaches to organization studies. in s. r. clegg, c. hardy, & w. r. nord, (eds.), handbook of organization studies (pp 218-256). thousand oaks, ca: sage. cnaan, r. a., wineburg, r. j., & boddie, s. c. (1999). the newer deal: social work and religion in partnership. new york: columbia university press. cobb, j. b. (1982). beyond dialogue: toward a mutual transformation of christianity and buddhism. philadelphia: fortress. advances in social work, fall 2008, 9(2) 77 derrida, j. (1981). positions. chicago: university of chicago. ellis, m. (2004). toward a jewish theology of liberation. waco, tx: baylor university. ellor, j. w., netting, f. e., thibault, j. m. (1999). understanding religious and spiritual aspects of human service practice. columbia, sc: university of south carolina press. foucault, m. (1980). power/knowledge. new york: pantheon. gadamer, h. g. (1989). truth and method. (rev. ed., j. weinsheimer & d. g. marshall, trans.). new york: crossroad. gutierrez, g. (1988). a theology of liberation: history, politics, and salvation (2nd ed., c. inda & j. eagleson, trans.). maryknoll, ny: orbis. habermas, j. (1971). theory and practice. (j. viertel, trans.). boston: beacon. habermas, j. (1984). theory of communicative action: reason and the rationalization of society vol. 1. (t. mccarthy, trans.). boston: beacon. heyward, c. (1984). our passion for justice. new york: pilgrim press. hick, j. (1982). god has many names. philadelphia: westminster. jeavons, t. h. (1998). identifying characteristics of “religious” organizations: an exploratory proposal. (program on nonprofit organizations working paper #197) new haven, ct: yale university. jeavons, t. (2001). being faithful. nonprofit quarterly, 8(2), 37-39. kuhn, t. (1962). the structure of scientific revolutions. chicago: university of chicago press. kung, h. (1988). theology for the third millenium. new york: doubleday. martin, p. y., & o’connor, g. g. (1989). the social environment: open systems applications. new york: longman. netting, f. e., & o’connor, m. k. (2003). organization practice: a social worker’s guide to understanding human services. boston: allyn & bacon. netting, f. e., thibault, j. m., & ellor, j. w. (1990). integrating content on organized religion into macropractice courses. journal of social work education, 26(1) 15-24. ricoeur, p. (1976). interpretation theory: discourse and the interpretation of meaning. fort worth: texas christian university. ruether, r. r. (1983). sexism and god-talk: toward a feminist theology. boston: beacon. schleiermacher, f. (1996) on religion: speeches to its cultured despisers richard crouter (editor). minneapolis: fortress. schleiermacher, f. (2001). the christian faith. (h. r. mackintosh, trans.). minneapolis: fortress. http://web5.silverplatter.com/webspirs/dols.ws?ss=journal-of-social-work-education+in+so http://www.amazon.com/exec/obidos/search-handle-url/index=books&field-author=mackintosh%2c h. r./102-9106197-6844103 singletary/a multiparidigmatic approach 78 sider, r. (1999). good news and good works: a theology for the whole gospel. grand rapids, mi: baker book house. singletary, j. e. (2003). a constructivist inquiry of the meaning of church-state relationships for faith-based organizations. unpublished dissertation. richmond: virginia commonwealth university. welch, s. d. (1989). a feminist ethic of risk. minneapolis: fortress. wineburg, r. (2001). a limited partnership: the politics of religion, welfare, and social service. new york: columbia university press. author’s note: address correspondence to: jon e. singletary, ph.d., school of social work, baylor university, one bear place #97320, waco, tx 76798-7320. e-mail: jon_singletary@baylor.edu. mailto:jon_singletary@baylor.edu radical change subjectivity objectivity regulation spring2001-031_page 26 spring2001-032_page 27 spring2001-033_page 28 spring2001-034_page 29 spring2001-035_page 30 spring2001-036_page 31 spring2001-037_page 32 spring2001-038_page 33 spring2001-039_page 34 spring2001-040_page 35 spring2001-041_page 36 spring2001-042_page 37 spring2001-043_page 38 aisw vol. 8, no. 1:aisw vol. 5, no. 2 psychodynamic theory kathleen holtz deal abstract: psychodynamic theory, a theory of personality originated by sigmund freud, has a long and complex history within social work and continues to be utilized by social workers. this article traces the theory’s development and explains key concepts with an emphasis on its current relational focus within object relations theory and self-psychology. empirical support for theoretical concepts and the effectiveness of psychodynamic therapies is reviewed and critiqued. future directions are discussed, including addressing cultural considerations, increasing research, and emphasizing a relational paradigm keywords: psychodynamic theory; empirical support; social work practice historical developments psychodynamic theory, a theory of personality originated by sigmund freud, has a long and complex history within social work. the young profession’s desire for a scientific base, mary richmond’s choice of a medical model to assess and treat client problems, and the wide impact of freud’s ideas on the popular culture, contributed to the prominent role of psychodynamic thought in the theory base of social work (germain, 1970; greene & ephross, 1991). in addition, the movement of large numbers of social workers into areas of practice heavily influenced by psychiatrists, including child guidance and work with war veterans and their families, exposed them to psychodynamic ideas (brandell, 2004; goldstein, 1995). the diagnostic or psychosocial school developed by such early contributors as mary richmond, charlotte towle, gordon hamilton, and florence hollis, used psychodynamic concepts to help explain complex human behaviors. these writers attempted to integrate concepts, such as the role of drives in human motivation, stages of psychosexual development, and ego defense mechanisms into a person-and-environment framework to explain the interaction of interpersonal and societal factors. these efforts resulted in social work widely utilizing psychodynamic concepts, while retaining the profession’s own identity and psychosocial focus (orcutt, 1990). when psychoanalysts such as hartmann, erikson, and white theorized a more autonomous role for the ego, social work adopted this theoretical shift as consistent 184 kathleen holtz deal, ph.d. is associate professor at the university of maryland, school of social work, baltimore, md, 21201-1777. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 184-195. indiana university school of social work. with the profession’s perspective that individuals actively interact with their environment and are capable of growth and change throughout their life times (greene & ephross, 1991). perlman’s development of the popular problem-solving model is heavily based on ego psychology (brandell, 2004; goldstein, 1995). during the 1960s and 1970s, psychodynamic theories fell out of favor. psychodynamic principles that explained human behavior were criticized as overly deterministic, resulting in “blaming the victim” (goldstein, 1995). their focus on intrapsychic phenomenon was seen as inadequate to explain the massive social problems of the day, including poverty, racism, sexism, and heterosexism. during this same period, alternative ways to understand individual and family behaviors arose, including behavioral, cognitive, existential, and family systems theories, greatly expanding the profession’s theoretical base. these expansions offer many theoretical options to social workers; however, psychodynamic theories continue to be included in hbse textbooks utilized by social work practitioners (saltman & greene, 1993) and provide the theoretical base for such journals as the clinical social work journal and psychoanalytic social work. the nasw standards for clinical social work in social work practice (national association of social workers, 2005) include psychodynamic theory in a list of theories on which clinical social workers base their practice. the persistence of psychodynamic theory within social work can be partially understood by changes within the theory itself, particularly the theory’s shift to a relational focus, which resonates with social work’s traditional emphasis on the importance of interpersonal relationships. key theoretical concepts and principles psychodynamic theory attempts to explain human behavior in terms of intrapsychic processes and the repetition of interpersonal patterns that are often outside of an individual’s conscious awareness and have their origins in childhood experiences. its long history reflects frequent modifications and differences among major theorists around key concepts and principles. given psychodynamic theory’s complex evolutionary history, this section is organized around the theory’s four major schools of thought, commonly conceptualized as drive theory, ego psychology, object relations theory, and self-psychology (greenberg & mitchell, 1983; mishne, 1993). drive theory psychodynamic theory began with sigmund freud’s belief that drives, biologically-based impulses that seek gratification, play a critical role in determining human behavior. freud originally hypothesized sex (eros) and self-preservation as the primary drives, later modifying his ideas to include a destructive or aggressive drive (greenberg & mitchell, 1983). the term sexual is understood broadly to include pleasure across the body’s erogenous zones. in psychodynamic theory, the zone of bodily pleasure shifts during the normal stages of psychosexual development (oral, anal, phallic, and genital). early libidinal stages arise “in connection with important nonsexual bodily functions, such as sucking (when feeding) or anus arousal (when defecating)” (mishne, 1993, p. 11). the phallic stage is particularly 185holtz deal/psychodynamic theory critical in personality development, because, during this period, the developing child experiences and ideally resolves the oedipus conflict, resulting in a mature, integrated identity (brandell, 2004). during the oedipus conflict, the child typically desires the opposite-sex parent, while wishing to eliminate the same-sexed parent, who is viewed as a rival. in resolving this conflict, the child fears retaliation for his or her wishes, relinquishes the desire for an exclusive love relationship with the opposite-sex parent, and identifies with the same-sex parent. family members other than parents, such as siblings, can become objects of desire, depending on family dynamics and configurations (brandell, 2004). in seeking gratification of their endogenous drives, individuals are confronted with the frustrations imposed by the external world (i.e., parents, society), which frequently oppose such gratification. freud (1946) viewed the conflict between the drives and the restraining forces that forbid, delay, or limit drive gratification as a necessary condition for the development of civilization. however, restraints on drive gratification are not only externally imposed on individuals, but they eventually come from within the individual, through the development of the psychic structures of the ego and superego. freud conceptualized the ego as developing from the id, the seat of the drives, in reaction to the frustrations of the external world (greenberg & mitchell, 1983). the ego performs functions that help the individual effectively adapt to reality, including the ability to accurately perceive the world, respond to both external and internal stimuli, and control the drives (mishne, 1993). the superego is a structure formed initially by the child’s internalization of parental ideals and prohibitions, which become transformed into abstract principles after the oedipal period (milrod, 2002). the superego has four functions: providing direction (based on the ego-ideal), limiting behavior, punishing unacceptable behavior, and observing and measuring the ego against the ego ideal (milrod). because the superego also contains early punitive tendencies, it can be harsh, intolerant, and demanding, if development does not proceed well (schamess, 2002). when an individual’s unacceptable drive-based wishes and fantasies threaten to become conscious, they trigger conflicts between the drives (residing in the unconscious id) and the superego and/or the ego. if the individual successfully represses these wishes, they return to the unconscious. if repression is unsuccessful, the individual experiences anxiety, activating the ego’s defenses, defined as “psychological activities that reduce the unpleasure of psychic conflict by blocking, inhibiting, or distorting awareness of disturbing mental contents” (brandell, 2004, p. 36). there may be a disguised breakthrough of the unacceptable impulse, which manifests itself as a symptom or compromise formation that both partially conceals and indirectly expresses the underlying conflict (mishne, 1983). for example, joe’s boss gives him a poor performance evaluation. joe reacts by assuring himself and his wife that, although he is disappointed, his boss is only doing his job and has joe’s best interests at heart (the defense of intellectualization). joe represses his unconscious wish to retaliate and injure his boss, which triggers an intrapsychic conflict between his id and his ego, which can understand and evaluate the negative repercussions of such an action and/or his superego, which views harming another person as wrong. subsequently, when joe is around his 186 advances in social work boss, he begins to experience prolonged coughing spells, which he feels unable to stop. joe’s symptom of loud, uncontrolled coughing is a compromise formation, because it partially conceals his wish to injure his boss (when he’s coughing, he feels vulnerable, rather than aggressive; he’s unable to physically attack or even speak to his boss), while allowing joe to indirectly express it (joe’s loud coughing itself is aggressive, in that coughing makes it impossible to hear his boss and it could spread germs to his boss, making him ill). ego psychology sigmund freud’s (1923/1961) structural theory conceptualized the ego as relatively weak in relation to the id. building on his work, later theorists expanded the role of the ego beyond drive regulation to include organizational and synthetic functions, including judgment, reality testing, thought processes, regulating internal and external stimuli, regulating self-esteem, and organizing the conflicting aspects of the personality (goldstein, 1995; schamess, 2002). in contrast to freud’s idea that the ego developed solely from the id, hartmann (1939) theorized that some aspects of ego functioning, such as perception, memory, intellectual ability, language ability, and motor activity develop autonomously, that is, they are free of intrapsychic conflict. white (1963) posited that individuals have a drive for mastery equal to the drives of sex and aggression, such that human beings derive satisfaction by exploring and manipulating their environment. he described this drive for competence or “effectance,” as implying “a primary positive interest in the world apart from its drive-reducing properties” (p. 47). through these modifications to psychodynamic theory, ego psychology changed the focus of inquiry from how pathology develops to how individuals grow, adapt, and master their environments (greenberg & mitchell, 1983; goldstein, 1995). this shift moved psychodynamic theory from a primary focus on intrapsychic phenomenon to include the significance of reality or the environment in individual development. this shift can be seen in the work of erikson (1959), who expanded freud’s earlier psychosexual stages by developing eight psychosocial stages that broaden the process of personality development to include the impact of social and cultural influences. by describing the stages from birth to old age, erikson emphasized the ongoing development of the individual across the entire life cycle, with each stage presenting unique tasks and opportunities for further identity development and refinement. object relations greenberg and mitchell (1983) describe a major shift in psychodynamic theory, from the use of drives and their derivatives to explain human behavior (drive/structure model), to understanding individuals as “object seeking,” that is, motivated to connect with others (relational/structure model). consistent with this focus, object relations theory has a particular interest in pre-oedipal relationships, including the nature of the attachment between infants and their caregivers and the process of separation-individuation. object relations theory posits that, through repeated interactions, children internalize representations of themselves and their caregivers. the term object relations, therefore, “refers not only to ‘real’ 187holtz deal/psychodynamic theory relationships with others, but also to the internal mental representations of others and to internal images of self as well” (flanagan, 2002, p. 128). these internalized representations of self and others begin as cognitive constructions based on experiences, ideas, and memories, but they take on emotional meaning, becoming cognitive-affective templates for future relationships (flanagan). because many factors can affect the internalization process, including the child’s early experiences, drives, needs, and perceptions, internal representations may not correspond to the objective characteristics of the self or the other person (fonagy & target, 1996; goldstein, 1995; greenberg & mitchell, 1983). the following example illustrates how self and other representations are formed, become internalized, and affect future relationships. through repeated interactions with a responsive caregiver who generally provides good care, an infant is able to internalize a sense of herself as safe and is able to affect her environment. for example, when she is hungry and cries, she is comforted and fed. through these repeated interactions, she also internalizes the caring and dependable “other” who is connected to her experience of herself. based on these internalized representations, the child will be able to enter future relationships, trusting that she is competent with interacting with her environment and that others can be depended upon. because representations of both the self and the other are internalized, both representations contribute to the formation of the self; therefore, this child is able to trust others (self-representation) and be dependable herself (other representation). object relations theory is not a unified theory, and major theorists differ on important major concepts and principles, such as the extent to which drives continue to play a role in motivating human behavior, the process through which internalization of objects occurs, and the importance of “real” relationships versus internalized representations (brandell, 2004; greenberg & mitchell, 1983; goldstein, 1995). key concepts developed by winnicott (1965), a member of the british school of object relations, are included in this section, because of his influence on social work from clinical practice (applegate & bonovitz, 1995; chescheir & schulz, 1989; seinfeld, 1993) to case management (kanter, 1990). winnicott’s collaboration with his wife, clare britton winnicott, a social worker, was one of mutual influence (kanter, 1990). winnicott (1965) described the holding environment as the physical and emotional environment offered by the infant’s caregiver, which serves to support the needs and wants of the developing infant. a good enough mother is one who can meet the child’s needs by responding appropriately to the infant’s spontaneous gestures or biologically-based aliveness, both which represent the infant’s core potential. if these environmental conditions are met, the child’s true self, a sense of being alive, creative, and genuine, is able to flourish. if the mother or caregiver consistently neglects the infant’s needs or impinges by substituting her own needs for those of the child, the child learns to ignore her or his own authentic needs, resulting in a false self, which shields the true self and is “prematurely and compulsively attuned to the claims and requests of others” (greenberg & mitchell, 1983, p. 194). gradual, small failures in responsiveness by the mother, however, help the infant’s ego develop through experiencing the world separate from the 188 advances in social work mother, thus facilitating the separation-individuation process (brandell, 2004; greenberg & mitchell, 1983). self-psychology in contrast to freud’s vision of human beings beset by intrapsychic conflict between their drives and the constraints of the ego and superego, kohut developed a deficit theory in which humans are seen as isolated, fragmented, and vulnerable (brandell, 2004). kohut wrote, primarily from the 1960s through the 1980s, a cultural period marked by an exaggerated emphasis on self-fulfillment. he encountered patients whom he viewed as having a fragile, fragmented sense of self and who were “extremely sensitive to failures, disappointments, and slights” (kohut & wolf, 1978, p. 413). kohut connected such deficits in these narcissistic individuals to their parents’ lack of empathic responsiveness. he explained that parents first serve as self-objects “in which the object is actually experienced as an extension of the self, without psychological differentiation” (brandell, 2004, p. 63). individuals need three types of self-object experiences to facilitate the development of a complete tripolar self. they need mirroring selfobjects who will praise and admire their unique capacities and characteristics to provide a sense of healthy grandiosity and self-confidence, self-objects who can be idealized (called the parent imago) as persons with whom the child can merge in order to feel safe and complete, and partnering self-objects to provide an experience of twinship, or being like others (brandell, 2004; flanagan, 2002). through the process of transmuting internalization, individuals gradually take in the functions initially performed by self-objects, so that these functions become part of the child’s self-structure (brandell, 2004). although the internalization process described by kohut is similar to how the “other” is internalized in object-relations theory, self-psychology emphasizes that empathic attunement is the key environmental condition facilitating the development of a healthy, cohesive, and secure self. another difference is that kohut believed that individuals continue to need self-objects throughout their lives, a contrast to the separation-individuation process described by object-relations theorists. goals and outcomes psychodynamic theory seeks to explain human behavior largely through understanding unconscious processes, that is, forces that lie outside of an individual’s awareness. referred to as depth psychology, psychodynamic thought attempts to explain phenomena that, on the surface, may appear unrelated or to serve no obvious purpose. the theory is considered deterministic in that early intrapsychic and interpersonal experiences shape personality and determine later-life choices. this theory’s primary emphasis is on individual behavior, although it is also used to explain dyadic relationships, particularly the parent-child dyad and small groups. while criticized as focusing on pathology, rather than on individuals’ strengths and capabilities (robbins, chatterjee, & canda, 2006), contemporary trends in psychodynamic theory, such as ego psychology, include an emphasis on ego mastery, competence, and normal development across the life cycle (brandell, 2004). 189holtz deal/psychodynamic theory object-relations theory seeks to explain how an individual’s external environment gets “taken in” and shapes the individual’s growth and development as well as how what is “inside” effects how the individual shapes her or his external world (flanagan, 2002). therefore, the individual’s interaction with his or her surrounding environment is critical to development. treatment modalities based on psychodynamic theory exist along a continuum, from those intended to modify or change personality structures, to those that aim to support, enhance, and strengthen the individual’s functioning. egosupportive approaches focus on the present situation and conscious processes to improve adaptive coping abilities, while ego-modifying approaches focus on the use of insight to understand preconscious and/or unconscious conflicts and their effects on behavior with the goal of modifying/reorganizing personality (goldstein, 1995). empirical support empirical support for psychodynamic theory can be divided into two related, and sometimes overlapping, areas: studies that test the effectiveness of psychodynamic treatment and those that support the validity of key theoretical concepts. empirical support for treatments based on psychodynamic theory suffers from numerous limitations. there is a paucity of well-designed studies; interventions identified as “psychodynamic” are frequently poorly defined, and standardized outcome measures are difficult to develop when the treatment focus is broader than symptom relief (fonagy, roth, & higgitt, 2005; lis, zennaro, & mazzeschi, 2001; messer & warren, 1995). a review of evidence-based practices for social workers by o’hare (2005) yielded little support for the effectiveness of psychodynamic treatments. bloom, yeager, and roberts (2006a) cite some support for brief psychodynamic treatment for depression in the elderly (niedereche as cited in bloom et al., 2006a) and chronic anxiety (crits-christoph as cited in bloom et al., 2006b), while concluding that brief cognitive behavioral treatments have generally been found to be more efficacious than brief psychodynamic treatments. by contrast, a recent social work study of psychiatric outpatients treated with psychodynamic psychotherapy, which used a psychodynamic outcome measure, found significant improvements in symptom distress, interpersonal relationships, and social-role functioning over the course of a year (roseborough, 2006). research reviews from related disciplines report greater, albeit limited, support for the effectiveness of psychodynamic treatment models. in an extensive review of psychodynamic treatments for adult mental disorders, fonagy et al. (2005) concluded that empirical studies provide limited support for the efficacy of shortterm psychodynamic psychotherapy (an average of 20 sessions) for some disorders: major depression (comparable to cognitive-behavioral therapy or problemsolving therapy in random controlled trials), anorexia nervosa (as effective as intensive behavioral and strategic family therapy), opiate abuse (one trial; better results at follow-up than cognitive behavioral therapy and drug counseling), posttraumatic stress disorder (despite methodological problems with the trials), and borderline personality disorder (models that offer a structured framework). this 190 advances in social work same review concludes that long-term psychodynamic treatment appears to be consistently helpful for individuals with neurotic disorders. a meta-analysis of 11 studies of brief psychodynamic therapy conducted by critschristoph (as cited in messer & warren, 1995), which used rigorous selection criteria, found that psychodynamic treatment produced outcomes much better than waiting-list controls, slightly better than non-psychiatric treatments (e.g., self-help groups), and equal to alternative psychotherapies and medication. leichsenring and leibing’s (2003) meta-analysis of 25 studies of psychodynamic and/or cognitive treatment of personality disorders found both approaches to be effective in improving personality disorder pathology. despite the wide use of psychodynamic treatments for children and adolescents, few sound empirical studies of their effectiveness have been conducted (fonagy, target, cottrell, phillips, & kurtz, 2002; lis et al., 2001). one comprehensive study involved a retrospective chart review of more than 700 children and adolescents treated with either psychoanalysis (4-5 times per week) or psychodynamic psychotherapy (1-3 times per week) at the anna freud centre (fonagy & target, 1996). for those patients who continued in treatment for a minimum of six months, 56% of those in psychoanalysis and 44% of those in psychodynamic psychotherapy, moved from the clinical to the normal range on the hampstead child adaptation measure (hcam). this research found the following variables to be associated with greater treatment effectiveness: longer treatment, age (children under age six showed the greatest improvement), treatment intensity (children did better in psychoanalysis, particularly seriously disturbed children; adolescents with less intensive treatment), and the presence of an anxiety disorder (either alone or combined with a disruptive disorder). children who showed relatively poor outcomes included those with mental retardation, pervasive developmental disorders, serious disruptive disorders, and depressive disorders. empirical studies show some support for several psychodynamic concepts. defense mechanisms are one area of considerable theoretical and empirical inquiry (conte & plutchik, 1995). consistent with the hypothesized relationship of defenses to overall ego functioning, vaillant’s (1993) longitudinal study found that the use of mature ego defenses was associated with better mental health, psychosocial adjustment, and life satisfaction, independent of gender, social class, and education. on the other hand, johnson’s (1991) critique of studies related to the psychodynamic concepts of unconscious processes, defense mechanisms, and developmental stages, concludes that empirical evidence for these concepts is weak and/or flawed. the concept of the therapeutic alliance, defined as “the observable ability of the therapist and patient to work together in a realistic collaborative relationship based on mutual respect, liking, trust, and commitment to the work of treatment” (foreman & marmar, 1985, p. 922) was first developed within psychodynamic theory (greenson, 1967). now widely accepted across theories and measured empirically, the therapeutic alliance has been found to exert a small but consistent influence on successful client outcome (crits-christoph & gibbons, 2003; roth & fonagy, 2005). psychodynamic theory posits that individuals repeat relationship patterns internalized in childhood in their current relationships, including their relationship with their therapist (transference). the development and testing of the core 191holtz deal/psychodynamic theory conflictual relationship theme method (ccrt) by luborsky and his colleagues (barber & crits-christoph; fried, crit-christoph & luborsky, both as cited in charman, 2003) offers support for the validity of these repetitious interactive patterns. recent research within neurobiology explains how infants’ repeated experiences with early caregivers shape structural connections within the brain. this research offers neurobiological support for such object relations and self-psychology concepts as internalized object relations, mirroring, and affect regulation as occurring through repeated interpersonal processes (applegate & shapiro, 2005; schore, 1997). for example, schore describes how interdisciplinary developmental research provides information on the mechanisms through which the orbitofrontal cortex of the infant’s developing brain integrates information from the emotions on the caregiver’s face with changes in the infant’s self-state to generate internalized object-relations consisting of self and other representations linked by affect. future directions: implications for social work current trends in psychodynamic theory include a vibrant interest in theory development, including cultural considerations, an emphasis on a relational paradigm, and increasing support for research, all of which have implications for social work. object relations theory and self-psychology helped move psychodynamic theory from a one-person psychology focused on the intrapsychic dynamics of an individual to a two-person psychology, focused on relationships between individuals, including the client and clinician. social work has a long history of emphasizing the importance of interpersonal relationships, including the client-worker relationship, in understanding how individuals develop and change (biestek, 1957; coady, 1993; sudbery, 2002). in fact, horowitz (1998) views psychodynamic theory’s relational paradigm as reflecting much of this decades long-tradition within social work, albeit without direct recognition of social work’s contributions. given the consistency of a relational emphasis in both social work practice and current psychodynamic theory, social workers are well-positioned to continue contributing to theory development in this area, particularly around the nature and importance of the client-worker relationship. psychodynamic theory has long been criticized for failing to adequately address the cultural context of human development (robbins et al., 2006). although this criticism still has some validity, there are increased efforts to address this gap. social workers, such as mattei (2002), use psychodynamic theory to explain such phenomena as racial dynamics and the symbolic significance of color and to explore cultural differences in identity development and the nature of boundaries between self and other. many social workers address the application of psychodynamic theory to clinical work with diverse populations (see, for example, perezfoster, moskowitz, & javier, 1996). the richness of theory development around the concept of intersubjectivity (atwood & stolorow, 1984), that is the mutual influence of client and clinician on each other, focuses on the contributions of both persons to the therapeutic process. this approach lends itself to examining the effects of such variables as culture and race within psychodynamic treatment. 192 advances in social work studies of community treatment settings suggest that many clients suffer from co-morbid disorders, rather than the single diagnosis desired for randomized controlled trials (westen, morrison, & thompson-brenner, 2004). such clients, including those with multiple psychosocial problems and those mandated to receive services, are frequently encountered by clinical social workers. psychodynamic theory offers a well-developed conceptual framework for understanding what may appear to be unrelated symptoms or the repetition of seemingly unrewarding intrapsychic and interpersonal patterns, suggesting its potential to address the complex, multiple problems of many clients served by social workers. a mutually informative process of research and theory development could add greatly to understanding these clients, who are frequently left out of treatment-effectiveness studies. such research should include determining which clients do better with ego-supportive versus insight-oriented psychodynamic treatment. for example, low-functioning clients do poorly when therapists make interpretations, suggesting that a minimal level of interpersonal maturity and stability may be needed for insight-oriented treatment to be therapeutic (roth & fonagy, 2005). case studies, the primary type of psychodynamic therapy research conducted in the past, have their strengths and weaknesses (aveline, 2005). current research on treatment effectiveness is much more diverse and includes quantitative and qualitative studies, despite the challenges in operationalizing psychodynamic concepts. for example, some researchers examine therapeutic processes, such as interactional patterns and the therapeutic alliance, rather than outcomes, as particularly suited to the nature of psychodynamic treatment (charman, 2003; lees, 2005). others suggest using a social constructivist research paradigm to study psychodynamic treatment. in this post-modern view, the goal of psychodynamic treatment is to understand truth as a narrative co-constructed by client and clinician, rather than an objective reality (lees, 2005). references applegate, j.s., & bonovitz, j.m. 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(2006). psychodynamic psychotherapy: an effectiveness study. research on social work practice, 16(2), 166-175. roth, a., & fonagy, p. (2005). what works for whom? a critical review of psychotherapy research. new york: the guilford press. saltman, j.e., & greene, r. (1993). social workers’ perceived knowledge and use of human behavior theory. journal of social work education, 29(1), 88-98. schamess, g. (2002). ego psychology. in j. berzoff, l.m. flanagan, & p. hertz (eds.), inside out and outside in (pp. 67-101). lanham, md: jason aronson. schore, a.n. (1997). interdisciplinary developmental research as a source of clinical models. in m. moskowitz, c. monk, c. kaye & s. ellman (eds.), the neurobiological and developmental basis for psychotherapeutic intervention (pp. 1-71). northvale, nj: jason aronson. seinfeld, j. (1993). interpreting and holding: the maternal and paternal functions of the psychotherapist. northvale, nj: jason aronson inc. sudbery, j. (2002). key features of therapeutic social work: the use of relationship. journal of social work practice, 16(2), 149-162. vaillant, g.e. (1993). the wisdom of the ego. cambridge, ma: harvard university press. westen, d., morrison, k., & thompson-brenner, h. (2004). the empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. psychological bulletin, 130, 631-663. white, r.w. (1963). ego and reality in psychoanalytic theory: a proposal regarding independent ego energies. psychological issues. monograph no 11., new york: international universities press. winnicott, d.w. (1965). the maturational processes and the facilitating environment. new york: international universities press, inc. author’s note: address correspondence to: kathleen holtz deal, ph.d., associate professor, university of maryland, school of social work, 525 west redwood street, baltimore, md 21201-1777, usa. e-mail: kdeal@ssw.umaryland.edu. 195holtz deal/psychodynamic theory spring2005-058_page60 spring2005-059_page61 spring2005-060_page62 spring2005-061_page63 spring2005-062_page64 spring2005-063_page65 spring2005-064_page66 spring2005-065_page67 spring2000-115_page107 spring2000-116_page108 spring2000-117_page109 spring2000-118_page110 spring2000-119_page111 spring2000-120_page112 spring2000-121_page113 spring2000-122_page114 spring2000-123_page115 spring2000-124_page116 spring2000-125_page117 spring2000-126_page118 spring2000-127_page119 spring2000-128_page120 spring2000-129_page121 spring2000-130_page122 spring2000-131_page123 spring2000-132_page124 spring2000-133_page125 advances vol. 1, no. 2 ssoocciiaall wweellffaarree ppoolliiccyy cchhaannggeess aanndd ssoocciiaall wwoorrkk pprraaccttiiccee doris mcgartland rubio julie birkenmaier marla berg-weger abstract: managed care, welfare reform, changes in government-sponsored health insurance, privatization, for-profit commercial activity, and increasing competition for charitable funding are affecting nonprofit social service organizations. this study of 244 nonprofit social service agencies explores the influence of social policy changes on nonprofit organizations. the effects of such changes on social work practice and social work field education within nonprofit organizations are explicated. guidance for social work field education departments is provided. keywords: nonprofit agencies, social work education, social work practice, social welfare policy, welfare reform, social work practicum the last decade has witnessed tremendous changes in social policy surrounding human service delivery systems. cost containment and reduced government spending in human services is affecting nonprofit organizational structures, services, and procedures. the impact of social policy forces such as managed care, welfare reform, and changes in government-sponsored health care cannot be understated. many organizations and social workers working within nonprofit organizations have discovered that drastic changes are needed to adjust and survive these contemporary social forces (rubio, birkenmaier & berg-weger, 1999). social workers face numerous challenges within this changing structure while trying to meet client needs. students completing their field education requirements in nonprofit agencies must be prepared to practice in agencies experiencing transition. this study examines how nonprofit agencies are impacted by recent social policy changes. in addition, the changing roles of social workers and social work students are explored. literature review nonprofit organizations financial performance has become increasingly important for nonprofit agencies in the past decade (bocage, homonoff & riley, 1995; jarman-rohde, mcfall, kolar & strom, 1997). due to federal and state funding cuts that began the mid-1980s, nonprofit organizations continue to reconfigure funding sources (motenko et al., 177 doris mcgartland rubio, ph.d. is assistant professor in the department of research methodology; julie birkenmaier, l.c.s.w. is assistant clinical professor; and marla berg-weger, ph.d., l.c.s.w. is assistant professor in the school of social service, saint louis university, st. louis, missouri, usa. copyright© 2000 advances in social workvol. 1 no. 2 (fall 2000) 177-186. indiana university school of social work. 1995). as recently as 1992, nonprofit social service agencies relied on government sources for 50% of their revenue (independent sector, 1997). due to the decreasing availability of public funds, nonprofit organizations are turning to private dollars, fee-for service, corporate philanthropy, and other sources for a growing portion of their budgets (zippay, 1992). however, the percentage of corporate philanthropic dollars distributed to social service organizations has also been decreasing for more than a decade (zippay, 1992). furthermore, many nonprofit organizations that contract with government sources under purchase of service arrangements find that the reimbursement rate fails to cover the full cost of the services provided (kettner & martin, 1996). nonprofit organizations are turning to new, creative strategies to ensure survival. many nonprofit organizations have been forced to “…reinvent themselves and operate more like businesses” (jarman-rohde et al., 1997, p.31). such efforts have included: 1) increasing workload for social workers; 2) marketing services and programs to special populations (ortiz & bassof, 1988); 3) decreasing the number of staff (bocage et al., 1995); 4) merging, decentralizing and reengineering (jarmenrohde et al., 1997); and 5) providing less costly services (strom-gottfied, 1997). commercial ventures are increasing among organizations. the shifting emphasis to commercialization for many nonprofit agencies can translate into a shift away from services for the economically disadvantaged to services for those able to pay fees (salamon, 1993). as a result of privatization and decreased funding, some social workers report cuts in essential services and the emergence of an erratic, unstable service delivery system. some social workers are facing dilemmas as clients seek services from agencies that are increasingly unable to meet their needs (motenko et al., 1995; rubio et al., 1999). the stakes are high. in many communities, long-stable nonprofit organizations have closed or terminated staff. managed care and welfare reform managed care and welfare reform are emerging as two social policy changes that are dramatically influencing nonprofit organizations. medicaid beneficiaries in managed care grew from 9.5% to 40.1% of the total medicaid enrollment between 1991 and 1996. some nonprofit hospitals that traditionally served the poor are experiencing a loss of medicaid patients and a corresponding loss of revenue (perloff, 1996). increasingly, health care and other nonprofit organizations are restructuring to respond to the demand from government entities to deliver services from programs that are comprehensive, interagency, and interdisciplinary (strom-gottfried, 1997). the professional concerns linked to managed care include: decreased professional autonomy; overlapped roles with other professions; increased emphasis on outcomes measurement; underserved populations (newsome, 1997); increased use of less costly services (jarman-rohde et al., 1997; strom-gottfried, 1997), and conflicting client-payer interests (strom & gingerich, 1993). another concern of nonprofit agencies is welfare reform. the 1996 personal responsibility and work opportunity reconciliation act (prwora) dramatically alters federal programs designed to provide income and food assistance. this legislation changed the funding structure for public assistance programs for families 178 advances in social work and mandated cuts in assistance to certain populations (federal funding impact collaborative, 1997). supporters of this policy contend that economic self-sufficiency for individuals and families will occur more effectively when regional, state, and local governments have increased control over the program design and resource distribution. initial reports indicate that welfare rolls are decreasing in many states, and nonprofit organizations are finding an increase in the number of clients seeking assistance with basic needs as poverty rates rise (kettner & martin, 1996; newsome, 1997). nonprofit agencies are concerned about the growing needs of the poor, their ability to meet the service goals mandated by the prwoa (federal funding impact collaborative, 1997), and the capacity of reimbursements rates to cover the cost of providing services (federal funding impact collaborative, 1997; kettner & martin, 1996). social work practice and education what effects do structural changes such as managed care and welfare reform have on the practice of professional social work and the training of social workers within the organization? motenko et al. (1995) report that social workers have increased productivity and accountability. bocage et al. (1995) report that budget cuts impact the training of social work interns by changing agency practice. agencies are finding that they maintain longer waiting lists, have fewer resources with which to serve clients, and have increased accountability expectations for both social work practitioners and students. this study builds upon previous research that explores the responses nonprofit organizations are making to managed care, welfare reform, and other factors affecting service delivery. research such as this is critical to ascertain the degree of impact that the recent policy changes have had on nonprofit agencies and social workers. the influence of forces on nonprofit administration, service delivery, and the social work profession is explicated and compared to the perspective of social work practitioners in the organizations. issues such as managed care and welfare reform are addressed as potential factors impacting agencies. changes in service delivery are explored as they impact the role of social workers. new skills needed by social workers and social work students working within organizations are addressed. methodology subjects a stratified random sample of 500 agencies was selected from the community service directory of an urban midwestern metropolitan area published by the united way. this book is a compilation of all 501-3-c nonprofit agencies. a number was randomly chosen from a table of random numbers in order to generate a starting place for agency selection. upon specifying a random starting place, every third agency was chosen for a total of 500 agencies. criteria for participation in the study included: 1) current nonprofit status and 2) designation as an organization that delivers social services. universities that did not qualify as a social service agency were eliminated from the study. typically included in the sample were organizations such as hospitals, mental health centers, and family service agencies. 179mcgartland rubio et al./social welfare policy changes and social work practice the number of agencies returning the survey was 287, for a response rate of 57%. of those returned, 43 were not completed, leaving 244 for analyses. materials focus groups were held with social work field instructors (see rubio et al., 1999 for study results) as a means for developing the instruments for this study. the results of the focus groups provided the basis for preparing the questions salient to nonprofit organizations. two surveys were developed for the study. one survey targeted agency administrative staff and focused on policies that impact the agency. the second survey was directed at social work personnel and inquired about the role of social workers and social work students in the agency. the survey was designed so that an administrator could complete the survey in the event that a social worker was not employed there. both groups were asked four common questions that inquired about social workers employed within the agency and their responsibilities. this duplication allowed for comparisons between the responses of the social workers and the administrators. procedure both surveys were addressed to the agency administrator and mailed in one packet to the organizations. the agency administrator and a social worker (if one was employed) were asked to complete a survey. when applicable, the social worker survey was to be completed by a field instructor. only a few questions on the role of social workers overlapped both surveys. the majority of the questions in each survey were germane to the respective discipline. after both surveys were completed, they were to be mailed to the principal investigator. two weeks following the initial mailing, reminder post cards were sent to agencies that did not respond. one month after the initial mailing a second follow-up reminder was sent to the non-responding agencies. findings description of agencies the administrative survey was completed by 244 agencies, with 120 completing the social work surveys. the low social work survey response was expected since approximately 40% of the agencies indicated that they did not employ a social worker. a diverse group of agencies was represented in the study. religious organizations, health services, family and counseling services, mental health centers, and hospitals all participated in the study, as did various social service-related associations and organizations. the size and scope of the agencies also varied. the number of staff members employed ranged from 0–2300 (mdn=18). agencies reported a wide range in the number of clients served each month (range 6–60,000, mdn=190). the number of social workers employed in the agency ranged from 0–600 (mdn=1). administrative survey the agency director (71%) primarily completed the administrative survey. other administrators or the chief executive officer completed approximately 180 advances in social work 14% of the surveys. presidents, vice-presidents, or coordinators completed the majority of the remaining surveys. effect of policy. sixty percent of the administrators indicated that changes in social policies have affected the agency’s operations over the past year. when asked about future operations, 74% indicated that changes in social policies will affect them. not surprisingly, a significant relationship exists between those administrators who believe that social policies have affected their agencies and whether social policies will affect them in the future (χ2 = 47.96; p<.001). welfare reform, managed care, and medicare/medicaid were noted as the administrators’ primary concerns. thirty-eight percent note that welfare reform has negatively affected their agency in the past year, while 48% indicate that the reforms will negatively affect their agency in the future. despite the increase in concern, those who think that welfare reform has affected their agency are more likely to view it as affecting their agency in the future (χ2 = 74.64; p<.001). the same increased concern is noticed with medicare/medicaid. twenty six percent note that policy changes in medicare/medicaid have negatively affected them and 40% anticipate these policy changes will have a negative effect in the future. concerns about managed care did not change significantly from the past year to the future. thirty-eight percent indicated that managed care has had a negative impact on their agency during the past year and 40% anticipate that managed care will continue to have a negative effect. this trend is significant because those who view managed care as negatively affecting their agency are more likely to see managed care as a problem in the future (χ2 = 92.35; p<.001). most of the agencies surveyed reported no positive outcomes have occurred as a result of current policy changes. in fact, welfare reform is the policy change that generated the most responses, with only 10% indicating that it has positively affected their organization over the past year. however, 18% believe that welfare reform will positively affect them in the future. response. the administrative survey included several questions regarding agency response to policy changes. interestingly, only a moderate relationship exists between those administrators who report being negatively affected by at least one social policy and whether they have had to expend more resources to generate revenue (χ2 = 6.00; p=.05). while agencies seem to be split on the issue of adequate resources (both monetary and non-monetary), 64% stated that they expended more resources in generating revenue over the past year, compared to 16% who did not. the majority of agencies (66%) reported spending more resources on evaluating and documenting the effectiveness of the services than in the past. despite expending more resources, an overwhelming percent (93%) reported that they have not merged or been purchased by another agency. however, 88% stated that they have collaborated with at least one other agency in order to deliver services. interestingly, the majority of agencies (77%) reported that they have not eliminated any services, but almost 60% stated that cost-effectiveness is a strong factor in determining service delivery options. there was no dominant response regarding the changes agencies made in service delivery, such as 181mcgartland rubio et al./social welfare policy changes and social work practice standardizing or specializing services or providing more case management services. social workers. the administrators’ survey included questions that addressed the number and role of social workers employed in the agency. approximately 45% of the administrators did not complete this section of the survey. this was expected, as 40% of the agencies do not employ a social worker. despite the changes occurring in nonprofit agencies, only 11% report that social workers are spending less time on direct services. however, the majority (63%) reported that social workers have more responsibility. personnel resources to provide social work supervision appear unchanged. almost half of the social workers currently report to and have been reporting to msw-level social workers for several years. in comparing the results of the administrators with that of the social workers, no significant differences emerged. the administrators’ responses significantly related to the social workers’ responses (p<.001) for all three tests. since all of the questions were significantly related, there are no differences in the way that social workers and administrators responded. social worker survey notably, social workers’ perceptions of their roles are congruent with administrators. social workers do not spend any less time on direct services but they do have more responsibilities than in the past. also, the person to whom the social worker reports has not changed from previous years. most social workers report to another social worker with a masters or baccalaureate degree. student supervision. of the 120 social workers who completed the survey, 80 (66%) indicated that their agency serves as a practicum site for at least one social work program. of those agencies that are not practicum sites, time constraints were cited as the reason for not offering practicum opportunities. social workers were asked about factors that influenced their decision to supervise students. student energy and enthusiasm were voiced most often (94%), with the desire to train new social workers a close second (91%). other reasons included having the student supplement staff resources (85%) and the skills and knowledge the student brings (77%). more than half (55%) of the respondents indicated that supervising a student enables them to develop a new program. half of the respondents (52%) see the desire for supervisory experience as favorable. social workers spend an average of 14% of their time supervising social work students in practicum (range 0%-75%, mdn=5%). only 17% of social work field instructors noted that this was an increase from previous years. despite increased time constraints and responsibilities being placed on them, only 19% indicated that more is expected of social work students. several items addressed skills that social workers find useful for the students to bring to the practicum experience. social workers most frequently referred to the utility of case management skills (87%) and assessment and diagnostic skills (87%). advocacy skills were also seen as useful (84%), as were counseling or therapy skills (79%). only 54% viewed research skills as useful and 47% perceived administrative skills as beneficial. 182 advances in social work when asked about the skills that students fail to bring to practicum, the majority of social workers did not indicate a particular skill. at least 30% of the social workers indicated four skills as needed, but currently missing in social work students. these included case management (32%), administrative skills (32%), counseling or therapy skills (31%), and assessment or diagnostic skills (30%). only 26% of the social workers reported that students failed to bring social work skills. advocacy skills were the last indicated, with only 18% of field instructors reporting that students failed to bring these skills to the agency. social workers were asked about the presence or absence of student professional skills in the practicum. writing skills were indicated as the most useful (94%). twenty-five percent indicated that students fail to adequately perform this skill in practicum. other skills that social workers noted as being useful were documentation skills (89%), presentation skills (87%), and computer skills (87%). thirty-one percent of the social workers reported that students’ documentation skills are lacking and 28% think that students are not prepared in the area of presentation skills. only 14% reported that students’ computer skills are inadequate. discussion nonprofit organizations the majority of nonprofit organizations have been affected by social policy changes and expect social policy to impact them in the future. welfare reform, managed care, and medicare/medicaid are the primary concerns. administrators reported a negative impact as a result of current policy changes. nonprofit agency administrators have clearly experienced changes in organizational operations. the majority of nonprofit organizations spend more time and resources generating revenue and evaluating and documenting services delivered. respondents reported that cost-effectiveness is a stronger factor in determining service delivery options, as well as collaborating with at least one other agency to deliver services. these findings mirror the results of previous research that found nonprofit organizations increasingly operating as for-profit businesses (bocage et al., 1995; motenko et al., 1995) and collaborating with other agencies to deliver a continuum of services (menefee, 1997). while the literature suggests that many nonprofit agencies are merging and eliminating services, these data show otherwise. the structure of nonprofit organizations in this study appears to be stable. what should nonprofit organizations do to survive and compete in this environment now and into the future? menefee’s (1997) interviews with 21 executive directors of nonprofit organizations suggest the future for these agencies include: 1) increased competition among nonprofit agencies and between nonprofit and for-profit social service agencies; 2) an increase in the demand for social services corresponding to an increase in the complexity of social problems and a decrease in the amount of resources; 3) a change in the role of government from service provider to service administrator with increasing accountability requirements; d) a shift in charitable funding priorities for corporations to ameliorate social problems in their immediate communities; 4) a dramatic increase in the influence of and use of technology in service delivery and communication; and 5) a decrease in the number of nonprofit agencies. nonprofit organizations must account for these changes if they are to remain viable into the future. 183183mcgartland rubio et al./social welfare polic changes and social work practice social work practice administrators and social work practitioners agree that social workers have increased responsibility without a commensurate decrease in time spent on direct services to clients. social workers are increasingly required to do more with less. skills that lend themselves to efficiency are crucial for practice within current realities, such as well-developed assessment skills (strom & gingerich, 1993) and practice evaluation (rubio et al., 1998). in the current environment, activities such as mediation, brokering, and client advocacy (motenko et al., 1995) are sacrificed for less costly services. the combination of increased managed care provisions, cutbacks in services, increased productivity, and documentation and fiscal restraints on services have led to low morale, a deterioration of the work environment, and increased burnout (bocage et al., 1995; motenko et al., 1995). social workers also report increased frustration with the shift to illness rather than presenting strengths of the client (motenko et al., 1995). with nonprofit organizations having moved into the 21st century, social workers must be attuned to the changes occurring at the administrative level. more social workers will be employed by for-profit social service agencies as this sector continues to expand (ortiz & bassof, 1988). while the potential advantages to a forprofit delivery system include increased productivity and greater competition in the social service marketplace (salamon, 1993), ethical questions also arise. social workers must be vigilant to assess the impact of increasing responsibility and productivity requirements on the delivery of quality services (kettner & martin, 1996). as for-profit agencies make inroads into the social services sector, a two-tiered system could become entrenched, with for-profits serving only the more affluent, leaving nonprofit agencies to serve the needy. social work field education overall, most respondents to the social work survey reported that students are prepared for their field experience. the majority believe that students bring needed skills to the agency. with less time and more demands placed on social workers, practitioners and their students are adjusting. time for supervision is a scarce resource; most field instructors are maintaining the amount of time spent on supervision despite the increased demands of practice. most respondents report that social work programs are preparing students with appropriate skills and knowledge for the field. despite constraints, however, field instructors see students as an asset and most organizations are still supervising students (bocage et al., 1995). field liaisons have a responsibility to ensure the integrity of student learning experiences as agencies struggle to do more with less. field education programs may find an increase in demand on the resources of the program as nonprofit organizations are challenged to deliver effective services to clients with fewer resources in a faster timeframe. some agencies increasingly rely on students to provide services, which can pose issues for field education. those organizations not involved in field education cite time constraints as a deterrent. social work field education programs need to monitor this trend to ensure the viability of current field agencies and to recruit sites that can offer a quality learning experience while negotiating the transitions derived from policy changes. 184 advances in social work research research must continually explore the effects of changing social policies on social work practice if social work education is to adequately prepare students for practice. while this study used a representative sample of nonprofit agencies in a midwestern city, the external validity of the study is limited to that population. research is needed on a national scale to assess the impact of social policy on social work practice relative to skills needed and role definition within the organization. the findings presented here are only representative of a limited area. whether the views of administrators and social workers are similar in other regions has not been tested. research in this area is lacking. more work is needed to provide insight into the survival strategies used by nonprofit agencies. as social workers’ roles within these agencies are changing, better information on social worker adaptation is needed. data regarding student satisfaction with practicum supervision should be collected and analyzed. longitudinal studies will generate valuable information as social welfare policies continue to change and evolve, thus influencing nonprofit agencies. as this is a cross-sectional study, a one-year follow-up of these agencies would offer a perspective on longitudinal change and outcome. acknowledgment this research was supported by the beaumont faculty development fund of the graduate school, saint louis university. references bocage, m.d., homonoff, e.e., & riley, p.m. (1995). measuring the impact of the fiscal crisis on human services agencies and social work training. social work, 40, 701-705. federal funding impact collaborative (1997, october). devolving responsibility: federal welfare reform and service delivery in the st. louis region. st. louis, mo: united way. independent sector. (1997). nonprofit almanac: dimensions of the independent sector. san francisco: jossey-bass. jarman-rohde, l., mcfall, j., kolar, p., & strom, g. (1997). the changing context of social work practice: implications and recommendations for social work educators. journal of social work education, 33, 29-46. kettner, p.m., & martin, l.l. (1996). the impact of declining resources and purchase of service contracting on private nonprofit agencies. administration in social work, 21, 211-238. menefee, d. (1997). strategic administration of nonprofit human service organizations: a model for executive success in turbulent times. administration in social work, 21(2), 1-20. motenko, a.k., allen, e.a., angelos, p., block, l. devito, j., duffy, a., holton, l., lambert, k., parker, c., ryan, j., schraft, d., & swindell, j. (1995). privatization and cutbacks. social work, 40, 456-463. newsome, m. (1997). social work change and social work education. social work education reporter, 45, 12-13. ortiz, e.t., & bassof, b.z. (1988). proprietary hospital social work. health and social work, 13, 114-121. perloff, j.d. (1996). medicaid managed care and urban poor people: implications for social work. health and social work, 21(3), 189-195. rubio, d.m., birkenmaier, j.m., & berg-weger, m. (under review). human service nonprofit agencies: studying the impact of policy changes. journal socionomia. 185mcgartland rubio et al./social welfare polic changes and social work practice salamon, l.m. (1993). the marketization of welfare. social service review, 67, 16-39. strom-gottfried, k. (1997). the implications of managed care for social work education. journal of social work education, 33, 7-18. strom, k., & gingerich, w.j. (1993). educating students for the new market realities. journal of social work education, 29(1), 78-87. zippay, a. (1992). corporate funding of human service agencies. social work, 37, 210-214. author’s note: address correspondence to: doris mcgartland rubio, ph.d, department of research methodology, saint louis university, 3663 lindell boulevard, st. louis, missouri 63108 usa. 186 advances in social work fall2005-002_i fall2005-003_ii microsoft word perron information and communication final _________________ brian e. perron, ph.d., is an assistant professor in the school of social work at the university of michigan; harry o. taylor, ba, is a master's degree candidate of public health and social work at the university of michigan; joseph e. glass, msw, is a doctoral student at washington university; and jon margerum-leys, ph.d., is an associate professor of educational technology at eastern michigan university. copyright © 2010 advances in social work vol. 11 no. 1 (spring 2010), 67-81 information and communication technologies in social work brian e. perron harry o. taylor joseph e. glass jon margerum-leys abstract: information and communication technologies (icts) are electronic tools used to convey, manipulate and store information. the exponential growth of internet access and icts greatly influenced social, political, and economic processes in the united states, and worldwide. regardless of the level of practice, icts will continue influencing the careers of social workers and the clients they serve. icts have received some attention in the social work literature and curriculum, but we argue that this level of attention is not adequate given their ubiquity, growth and influence, specifically as it relates to upholding social work ethics. significant attention is needed to help ensure social workers are responsive to the technological changes in the health care system, including the health care infrastructure and use of technology among clients. social workers also need ict competencies in order to effectively lead different types of social change initiatives or collaborate with professionals of other disciplines who are using icts as part of existing strategies. this paper also identifies potential pitfalls and challenges with respect to the adoption of icts, with recommendations for advancing their use in practice, education, and research. key words: information and communication technology, ethics, innovation, continuing education introduction information and communication technologies (icts) are broadly defined as technologies used to convey, manipulate and store data by electronic means (open university, nd). this can include e-mail, sms text messaging, video chat (e.g., skype), and online social media (e.g., facebook). it also includes all the different computing devices (e.g., laptop computers and smart phones) that carry out a wide range of communication and information functions. icts are pervasive in developed countries and considered integral in the efforts to build social, political and economic participation in developing countries. for example, the united nations (2006) recognizes that icts are necessary for helping the world achieve eight time-specific goals for reducing poverty and other social and economic problems. the world health organization also sees icts as contributing to health improvement in developing countries in three ways: 1) as a way for doctors in developing countries to be trained in advances in practice; 2) as a delivery mechanism to poor and remote areas; and 3) to increase transparency and efficiency of governance, which is critical for the delivery of publicly provided health services (chandrasekhar & ghosh, 2001). perron, taylor, glass, margerum-leys/information and communications technologies 68 with the growth of the internet, a wide range of icts have transformed social relationships, education, and the dissemination of information. it is argued that online relationships can have properties of intimacy, richness, and liberation that rival or exceed offline relationships, as online relationships tend to be based more on mutual interest rather than physical proximity (bargh, mckenna, & fitzsimons, 2002). in the popular book the world is flat, thomas friedman (2005) argues that collaborative technologies – i.e., interactions between people supported by icts – have expanded the possibilities for forming new businesses and distributing valued goods and services for anyone. educational theorist and technologist curtis bonk recently published a highly insightful and influential book called the world is open (bonk, 2009). bonk (2009) argues that, with the development of icts, even the most remote areas of the world have opportunities to gain access to the highest quality learning resources. proceedings from the 2004 international workshop on improving e-learning policies and programs also showed that icts are helping transform governments through workforce transformation, citizen education, and service optimization (asian development bank institute, 2004). innumerable accounts and data sources demonstrate that icts have reduced boundaries and increased access to information and education (see bonk, 2009; friedman, 2005), which has led the united nations educational, scientific, and cutural organization (unesco) to focus on assisting member states in developing robust policies in icts and higher education (unesco, nd). although icts and the growth of the internet are not without problems, a reality remains that both will continue to shape the global community. other disciplines have recognized the importance of ict and consider it to be a key part of professional development. for example, the national business education association (nbea) states: "mastery of technology tools is a requirement rather than an option for enhancing academic, business, and personal performance" (nbea, 2007, p. 88). resources are available that speak to the role of technology in the social work curriculum (e.g., coe regan & freddolino, 2008; faux & black-hughes, 2000; giffords, 1998; marson, 1997; sapey, 1997) and in research and practice (e.g., journal of technology in human services). the national association of social workers (nasw) and association of social work boards published a set of ten standards regarding technology and social work practice, which serves as a guide for the social work profession to incorporate technology into its various missions (nasw, 2005). despite this interest in technology, the attention that the field of social work has given to icts in research, education, and practice does not match the efforts of other national and international organizations that view icts as critical to improving the lives of disadvantaged and disenfranchised persons, and necessary for all forms of civil engagement. the council on social work education (cswe) calls for the integration of computer technology into social work education, but there are no explicit standards for integration or student learning (cswe, 2008; see also beaulaurier & radisch, 2005). asking other social workers, social work students, and social work educators can easily reveal that many are unaware of the nasw technology standards. a review of syllabi of social work courses will also show that icts, beyond e-mail communication, are generally not present in the educational environment. consequently, social work students advances in social work, spring 2010, 11(1) 69 are not being adequately prepared in the use of icts, which are integral in the workforce today and will become even more important over time (parrot & madoc-jones, 2008). in this paper, we argue that icts are of critical importance to advancing the field of social work. specifically, they provide effecient and effective ways for organizing people and ideas, offers greater access to knowledge and education, and increases the efficiency and collaboration of our work. this paper takes the position that many aspects of the nasw code of ethics (1999) can be advanced through careful and thoughtful application of icts. thus, competencies with icts and ict literacy should be required learning outcomes in social work education and continuing education. this includes having the knowledge and skills to understand and use icts to acheive a specific purpose (i.e., competencies), in addition to knowing the major concepts and language associated with ict (i.e., literacy). within this framework, this paper identifies specific aspects of the code of ethics (1999), showing how icts play a critical role in achieving the desired values and principles. recommendations on how icts can be more strategically incorporated in the classroom, along with potential pitfalls, are discussed. overview of icts icts in society computer technology is becoming more efficient, productive, and cheaper. advances in technology are producing more powerful computing devices to create a dynamic virtual network that allows people all over the world to communicate and share information with each other. the growth and importance of the technology and the virtual network are underscored by two important laws. first is moore's law, which states that “integrated circuit technology advancements would enable the semiconductor industry to double the number of components on every chip 18 to 24 months” (coyle, 2009, p. 559). essentially, this means that the speed and productivity of a computer increases two-fold every 1.5 to 2 years. while such growth may not be sustained indefinitely, the exponential growth of technology realized thus far has reshaped our society and will continue to be a dynamic force in future generations. it is important that social workers understand the role that technology plays in shaping the lives of clients and the services that are delivered. the second law, metcalfe’s law, states “the value of a network increases in proportion to the square of the number of people connected to the network” (coyle, 2009, p. 559). these rapidly developing technologies, and the individuals that utilize them, are producing virtual networks of greater size and value. at the time granovetter published his classic study on networks and employment (granovetter, 1973), icts played almost no role in developing and maintaining network relationships. today, internet sites such as linkedin (www.linkedin.com) produce vast social networks that provide opportunities for professionals and employers to advertise and communicate. to effectively use social networks, whether for obtaining employment, securing resources, or obtaining information, social workers need to understand the capabilities of these networks, and how they can be effectively understood, managed, and utilized within a digital environment. perron, taylor, glass, margerum-leys/information and communications technologies 70 icts in higher education applications of icts for instituations of higher education have grown tremendously and will continue to shape the delivery of social work education. this is already realized through emerging distance education courses and other strategies for using technology in the social work classroom (e.g., stocks & freddolino, 1999; wernet, olliges, & delicath, 2000). courses offered online greatly assist students who are long distance commuters or students with disabilities. in both distance and local learning, many educators utilize course management systems (e.g., sakai, moodle, and blackboard) for managing virtually every aspect of a course. these course management systems often provide students with tools to assist each other in learning the course material (e.g., synchronous and asynchronous communication). largely because of these opportunities, some have even predicted that icts may eventually eclipse the traditional college classroom (see bonk, 2009). within colleges and universities, icts serve both administrative and academic functions. students are able to accomplish a variety of tasks using computer networks that save the institution time and money, such as facilitating billing and payments to the school, requesting and obtaining financial aid and/or scholarships, class scheduling, requesting official transcripts, selecting housing locations, etc. with regard to social work research, icts are part of an infrastructure for newer research methodologies (e.g. geographic information systems, computer simulations, network modeling), making it crucial for universities to harness technology to advance their research missions (videka, blackburn, & moran, 2008). icts have the potential to help facilitate a more productive and effective learning environment for both social work students and professors. continued growth of icts technology innovations are encouraging a trend towards the digitization of the world's information and knowledge, essentially creating stores of the accumulated human experience (coyle, 2009). computer technology has become integrated into the modern global society, serving a wide range of functions and purposes. with such growth are extensive arguments that internet access is a human right because it is necessary to fully participate in today's society.1 the federal communications commission (fcc) announced plans, in conjunction with the us department of agriculture and rural development, to create a national broadband internet policy to help ensure all united states citizens have equal access to high speed internet (federal communication commission, 2009). this policy, made possible through the recovery and reinvestiment act of 2009, is specifically tailored for citizens who live in rural or underserved areas (federal communucations commission, 2009). as the use of icts continues to grow, it is important to realize the importance of convergence, and how convergence shapes the transmission of information and service delivery. this concept refers to “the coming together of information technologies 1 during the preparation of this manuscript, a search on google using the following expression resulted in 35,100 hits: "internet access" and "human rights". advances in social work, spring 2010, 11(1) 71 (computer, consumer electronics, telecommunications) and gadgets (pc, tv, telephone), leading to a culmination of the digital revolution in which all types of information (voice, video, data) will travel on the same network” (coyle, 2009, p. 550). the creation and utilization of smart phones (e.g., blackberry, iphone) is a key example of convergence, where one device has multiple functions and different applications, bringing technologies such as social networking, email, videorecording, and traditional cellular telephone service into one's pocket. individuals of all age ranges are heavily involved in maintaining social connections through internet networks. for example, social networking websites, such as facebook and myspace, are used widely and boast highly active visitor populations. facebook and myspace each reached over 100 million active visitors by april of 2008 (schonfield, 2008). the internet and other telecommunication networks have an enormous impact on defining the future of human interaction, and to date, these changes have largely been positive across social contexts (bargh, 2004). the field of social work needs to understand how these changes are influencing and will continue to influence all aspects of social work. as it relates to social work, it is critically important that such a research agenda builds an understanding of both the positive and negative impacts of human interaction. icts and social work ethics the growth of the internet and use of icts has changed how we interact with each other and how we work (bargh & mckenna, 2004). as the millennium generation (also known as generation y) is raised in an environment with highly complex networks that make use of technology, their importance will continue to grow (weller, 2005). the field of social work faces a critical need to incorporate icts into training social workers, delivering social work services, and the conduct of social work research. it is clear that icts, when thoughtfully and effectively used, can improve the various practice methods of social work (i.e., delivery of services, education, and research). although the potential uses of icts have been well defined, to date there has been little discussion of the impact of icts on the principles of social work ethics. provided below are specific examples of how icts appear necessary for ensuring the delivery of ethical social work practice. we highlight relevant aspects of the nasw code of ethics (1999) and provide specific examples. ethical principle: social workers recognize the central importance of human relationships. icts play a major role in human relationships, which has implications for social work practice. more specifically, increasing numbers of people are engaged in relationships that are mediated by some form of ict, including electronic messages (email), sms text message, social networking (e.g., facebook), instant messaging service, or video chat (e.g., skype). social workers need to have an understanding of the roles that such icts may play in the lives of their clients. this may involve understanding how communication processes are different compared to face-to-face interactions; such as the use of emoticons – that is, characters and symbols use to express non-verbals. perron, taylor, glass, margerum-leys/information and communications technologies 72 social workers also need to understand that many relationships develop and may occur exclusively online. for example, the internet allows groups to convene around a common purpose, including the provision of self-help, social support, and psychoeducation. depending on their format, such groups may be referred to as electronic groups, listservs, forums, and mail groups. the proliferation of these groups can be attributed to anonymity and their ease of access, particularly for persons with mobility problems, rare disorders, and those without access to face-to-face groups or professional services (perron & powell, 2008). a number of studies have tracked the patterns of communication within online groups, and have found that many of the processes used are the same as those used in face-to-face self-help groups (finn, 1999; perron, 2002; salem, bogat, & reid, 1997). given the prevalance of online relationships, social workers and other human service professionals must be aware of the positive (e.g., social support, see perron, 2002), and negative effects (e.g., cyber-bullying, see hinduja & patchin, 2008) they have on their individual clients, with a clear understanding of how relationships are mediated by icts. currently, the social work curricula emphasize the importance and development of in-person relationships, while little attention is given to understanding the role of online relationships and computer-mediated relationships. ethical standard 1.07: (c) social workers should protect the confidentiality of clients' written and electronic records and other sensitive information. (l) social workers should take reasonable steps to ensure that clients' records are stored in a secure location and that clients' records are not available to others who are not authorized to have access. increasing amounts of information are being saved and shared electronically (rindfleisch, 1997). while training social workers in in all aspects of information security would be impractical, it is necessary that they have requisite knowledge for raising fundamental questions about electronic security, and to know when and where to seek additional information. this is particularly true in agencies that lack funding and resources to support information technology specialists. without this basic knowledge, social workers can compromise the confidentiality of their client records or other important organizational resources, resulting in significant legal consequences and ethical violations. ethical standard 1.15: social workers should make reasonable efforts to ensure continuity of services in the event that services are interrupted by factors such as unavailability, relocation, illness, disability, or death. natural disasters and personal factors can easily disrupt the continuity of social work services, and clients living in highly rural areas experience lack of services. icts provide options to help maintain or re-establish services during times of personal or community crises, which is described in numerous disaster management reports (e.g., government of india, national disaster management division, nd; united nations, 2006; wattegama, 2007). for example, if a service can be delivered electronically (e.g., psychotherapy) the only service barriers are ensuring that the client and service provider have computers or a mobile device with an internet connection. furthermore, the utility of virtual services such as remote psychotherapy (or more generally, "tele-mental health") is not limited to times of disaster. in fact, tele-mental health is used nationally for routine care in the veterans health administration, in order to provide services to veterans in underserved areas (department advances in social work, spring 2010, 11(1) 73 of veterans affairs, 2008.) to further illustrate the opportunity to deliver clinical services over icts, recent surveys estimate that about 60% of americans used the internet to access health information in 2008 (fox, 2009), and about half of all healthcare consumers endorsed that they would be likely to seek healthcare through online consultations if these services were made available (pricewaterhousecoopers health research institute, 2009). ethical standard 2.05: social workers should seek the advice and counsel of colleagues whenever such consultation is in the best interests of clients. icts offer greater flexibility and support for seeking professional consultations, and numerous states permit online supervision. the sheer size of the online world suggests that no matter how specialized one's area of focus, like-minded colleagues can be located, and communities of practice may be established. for example, hoarding behavior is a fairly rare event in mental health services, particularly in comparison to other expressions of psychopathology (steketee & frost, 2003). thus, issues on treating this problem and working with family members are rarely covered in the classroom. in the absence of icts, few training or consultation opportunities exist, but a simple search of hoarding as a mental disorder can reveal a wide range of potentially useful resources (including, but not limited to): contact information for experts and directories on hoarding behavior; video lectures on treatment; extensive collection of youtube videos on providing information and personal accounts; and online support groups. similar searches of other highly specialized areas such as disaster planning in social work, forensic interviewing of abused children, and inhalant abuse have also revealed a wide range of resources that are unlikely to be available to social workers in their local area. ethical standard 3.07(a): social work administrators should advocate within and outside their agencies for adequate resources to meet clients' needs. creative uses of the internet are emerging to support advocacy. for example, the online service giveanon (http://givinganon.org/) uses the powers of ict to allow donors to connect with recipients, contributing financially, directly, and anonymously. ict's ability to mask the identity of an online person or entity is creatively used in this case to help donors to provide assistance without revealing their own identity. thus, they can serve as a powerful organizing and advocacy tool. social workers are positioned to use this tool, and many others like it, to address various needs and solve problems. further integration of technology in the curriculum on organizing and advocacy with icts can have potentially significant payoffs. a recent article in a leading health services journal, health affairs, hawn (2009) describes how twitter, facebook, and other social media are reshaping health care. at the time this manuscript was written, it was reported that chicago's department of human services began using a system that enabled human service providers, agency coalitions and the community to manage client and resource data in real-time (bowman systems, 2008). having real-time knowledge of available resources is critical for making effective and efficient referrals, particularly for crisis issues, such as psychiatric and substance use conditions, and housing. ensuring adequate resources to meet clients' needs must be considered within the overall budget of an organization. icts are a necessary part of most social work service agencies. many agencies have large expenses related to their ict needs, especially perron, taylor, glass, margerum-leys/information and communications technologies 74 software upgrades. however, organizations can take advantage of the benefits of open source software to decrease costs related to information technology. open source software "is a development method for software that harnesses the power of distributed peer review and transparency of process. the promise of open source is better quality, higher reliability, more flexibility, lower cost, and an end to predatory vendor lock-in permits users to use, change, and improve the software, and to redistribute it in modified or unmodified forms" (open source initiative, nd; see also lakhani & von hippel, 2003). from a user's standpoint, this software is freely available and can be modified to meet a given need. many agencies use microsoft office but cannot afford expensive software or hardware upgrades that are required over time. as an alternative, the same agency could use an open source software package (freely available), such as openoffice (www.openoffice.org), which is compatible with the microsoft office suite. cloud computing alternatives are another option – that is, software services that are provided over the internet. the premise of cloud computing is that full software packages (e.g. office suites, database applications) are provided over the internet, eliminating the need for expensive equipment to be purchased and maintained locally (e.g., intranet servers; hayes, 2008). google, for example, provides an entire set of office-related applications called google docs (http://docs.google.com) that can do word processing, spread sheets, and presentations. these applications do not ever need to be installed on a local computer or upgraded by the user. these applications are compatible with other proprietary software, most notably microsoft office. although not typical, this major cloud computing service is freely available to anybody with a gmail email account (also free), and the programs and files can be accessed from any computer with an internet connection. social workers should have knowledge of such resources and understand how they may be a reasonable alternative to address existing agency needs, in addition to understanding the legal issues of remote data storage and security. ethical standard 3.08. social work administrators and supervisors should take reasonable steps to provide or arrange for continuing education and staff development for all staff for whom they are responsible. continuing education and staff development should address current knowledge and emerging developments related to social work practice and ethics. a growing body of research shows that distance education can be as effective or more effective than face-to-face education (bernard et al., 2004). moreover, the educational literature is pointing to the changing characteristics of our students. for example, students of the net generation and millenial generation, who are the largest age group of consumers of social work education today, have different learning expectations and learning styles that will require social work faculty to change how they teach (see diaz et al., 2009). distance education is also increasingly relying on and innovating with icts, to facilitate student-to-teacher and student-to-student interactions, and collaborations. the field of social work could enhance its overall educational infrastructure through the effective use of icts. this would allow access to opportunities that would not be available or affordable using traditional face-to-face formats. the use of icts undoubtedly gives greater access to higher quality educational opportunities (asian development bank, 2004; bonk, 2009). advances in social work, spring 2010, 11(1) 75 ethical standard 4.01. social workers should strive to become and remain proficient in professional practice and the performance of professional functions. social workers should critically examine and keep current with emerging knowledge relevant to social work. social workers should routinely review the professional literature and participate in continuing education relevant to social work practice and social work ethics. social workers have a daunting task of remaining current with the research in their area of practice. the reality is that the majority of research findings are disseminated and accessed electronically via the internet. many of the barriers that social workers face in accessing and even understanding the research may be overcome, in part, through the efficient and effective use of icts. for example, while many journals require expensive subscriptions, a growing body of journals are available online in an open access format. this is an important and complex philosophy; the immediate relevance is that open access gives social workers free and unlimited access to scientific articles (e.g., www.biomedcentral.com) which have been traditionally been available on a subscription basis (see suber, 2003). social workers have access to a wide range of electronic video and audio recording, also known as videocasts and podcasts, that discuss recent research developments. for example, social workers interested in psychiatric issues can easily find collections of grand rounds lectures archived by departments of psychiatry at medical schools throughout the united states. many journals and other science-related newsrooms offer scientific findings in the form of emailed newsletters and electronic news feeds. social workers can identify and subscribe to specific news feeds using real simple syndication (i.e., rss feeders) that link to news articles in their area of practice. these resources, and many others, are freely available. however, social workers must have competencies with icts in order to identify and use quality resources. future directions developing ict competencies and literacy given the growth and impact of icts in society and their implications for social work ethics, it is critical that social workers have both competency and literacy with icts. while competency refers to being able to use a given technology, literacy refers to the ability to access, manage, integrate, evaluate, and create information (chinien & boutin, 2003). it is beyond the scope of this paper to provide a coherent and comprehensive strategy for developing social worker competencies and literacies with icts. however, the literature on icts and educational innovations in higher education provide extensive resources that are generalizable to the field of social work. social work educators will need to be proficient with icts in order to design assignments, activities, and projects that reflect the real-world use of icts. beyond higher education, continuing education opportunities that respond to recent technology advances are also necessary in order to help social workers stay current with the most relevant and useful technologies. for example, by having basic competencies and literacies, social workers and social work students who want further introduction to icts can review the complete curriculum materials for a course entitled icts in everyday life through the open university (http://www.open.ac.uk/), in addition to having access to materials for other courses. this is part of the open education movement that views education as a public good, and perron, taylor, glass, margerum-leys/information and communications technologies 76 internet technology provides the opportunity to share, use, and resuse knowledge (creative commons, nd). in absence of ict competency and literacy, social workers will miss important educational opportunities for themselves and their clients. challenges and pitfalls of icts despite the continued growth and expansion of technologies, many disenfranchised and disadvantaged persons still do not have access to icts or the internet. while initiatives in the united states, and other respective countries around the world, are attempting to provide access to everybody, significant disparities within and across countries exist, particularly in african regions that have low internet market penetration (alden, 2004). by developing a stronger focus and infrastructure around icts in social work education, social workers will be better prepared to participate in a range of policy initiatives to support activities that seek to address these disparities in social, economic and political participation. in the training of social workers in icts, it is also important to recognize that not all technologies have resulted in added value to education. for example, kirkup and kirkwood (2005) argue that icts have failed to produce the radical changes in learning and teaching that many anticipated. this underscores the importance of ensuring ict literacy among social workers – that is, having the ability to access and evaluate information using icts (chinien & boutin, 2003). this will help social workers select the optimal tools from a wide range of options. in the provision of clinical services, social workers must be aware that clinical needs can be (and currently are being) met through technologies such as telehealth and e-mail consultations (mccarty & clancy, 2002). recent surveys also suggest that clients welcome these new treatment options (fox, 2009). further research is still needed to better understand the effectiveness of internet-mediated services. for example, the effectiveness of online psychotherapy shows promise but the existing research to date remains inconclusive (bee et al., 2008; mohr, vella, hart, heckman, & simon, 2008). the social worker using such technologies must consider how legal, ethical, and social principles apply, in addition to the advantages and disadvantages of online health services (see car & sheikh, 2004). currently, the social work curriculum focuses almost exclusively on relationships in the absence of ict mediated exchanges, but the growth of technology within the health care system makes these matters a priority in social work education. if such issues aren't addressed, the field of social work is at risk of not remaining competitive in the provision of health and psychosocial services. moreover, without proper training, social workers in this arena of practice are at risk of delivering poor quality services or facing legal or ethical issues. social work researchers and practitioners should work in earnest to document both the successful and unsuccessful initiatives involving icts in the field. case examples can provide the basis for understanding how icts can be integrated to enhance various aspects of the process. unfortunately, the current method of disseminating new information and practice is primarily through professional journals, where the general timeline of an article (the time it takes to have a manuscript submitted, reviewed, and advances in social work, spring 2010, 11(1) 77 subsequently published) will likely not be quick enough to keep up with the advances in technology. it behooves the field of social work to explore options to connect with other researchers and practitioners to share knowledge, particularly with social media. conclusion the field of social work education, research, and practice is surrounded by rapid developments in icts. in order to ensure that social work practice upholds the standards and values of social work ethics, it is necessary that social workers are competent and literate in icts. this will position social workers at all levels of practice to help advance the lives of disenfranchised and disadvantaged persons through greater access to education, knowledge and other resources. while numerous icts have failed to realize their expected potential, the ongoing rapid growth of icts has created a context in which social workers cannot resist technology, but must understand the role it plays in everyday life. references alden, c. 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(2000). postcourse evaluations of webct (web course tools) classes by social work students. research on social work practice, 10(4), 487-504. author’s note: address correspondence to: brian e. perron, ph.d., school of social work, university of michigan, 1080 s. university avenue, ann arbor, mi 48109. email: beperron@umich.edu. hijacked by fear: the war on liberty ________________ fred h. besthorn, phd is associate professor at the department of social work, university of northern iowa. copyright © 2008 advances in social work vol. 9 no. 1 (spring 2008), 17-28. post 9-11 terror hysteria: social work practice and the us patriot act fred h. besthorn abstract. it was only weeks after the planes crashed into the twin towers on that bright, sunlit morning of september 11th, 200l, that it became apparent that the most important challenge now facing american democracy was how well would we strike a balance between liberty and security. this paper will look at the history of civil liberties in light of threats to national security. it will examine components of the us patriot act, how these provisions are being applied and the potential implication of the act on social work education and practice. suggestions of how social work might respond to these new realities will be discussed. key words: patriot act, social work, national security, civil liberty, education history teaches that grave threats to liberty often come in times of urgency, when constitutional rights seem too extravagant to endure. the world war ii relocation-camp cases, and the red scare and mccarthy-era internal subversion cases, are only the most extreme reminders that when we allow fundamental freedoms to be sacrificed in the name of real or perceived exigency, we invariably come to regret it --justice thurgood marshall’s dissenting opinion in skinner v.railway labor executives association the accumulation of all powers, legislative, executive and judiciary, in the same hands…may justly be pronounced the very definition of tyranny. --james madison, federalist papers, 47 days of terror ~ years of fear it was only weeks after the planes crashed into the twin towers on that bright, sunlit morning of september 11th, 200l, that it became apparent that one of the most important challenges now to face american democracy was how well would we strike a balance between liberty and security. adam curtis’s documentary, the power of nightmares: the rise of the politics of fear, which i am told has been shown on british tv, but which is unavailable in america, makes the same point: liberty is often the first casualty in the rush to maintain security. long before citizens or the government had any idea what had gone wrong in the security apparatus of the state, the assumption was, indeed, made that something had gone terribly wrong in the balance between security and liberty, and that this something was at least partially to blame for the attack’s success. the assumption, haphazardly stated, just weeks after those days of terror was this: an open society had made besthorn/ social work practice and the us patriot act 18 america less secure and in order to be more secure we had to choose to become a less open society. thus, one of the first non-material casualties of the war on terrorism and the rush to protect the united states from further attacks was the degree to which america, as a free society, had turned its democratic rights over to a new class of security elites who promised protection in exchange for cooperation (no dissent, restricted movement, summary imprisonment, indefinite detention and government sponsored eavesdropping). indeed, the days of terror were giving rise to unending years of fear. we americans, with much hubris and feigned humility, have been fond of referring to ourselves as “the last great hope on earth” in terms of democracy, rights, and freedoms. unfortunately, our rhetoric is far more polished than the dull glint of our burnished swagger. indeed, in many large and subtle ways, both at home and abroad, the american government, with the silent and often compliant assent of the majority of the public has cynically abandoned its obligation to a comprehensive commitment to protect democracy, freedom, and human rights. a good history gone bad the changes that have taken place in american civil liberties since 9-11 are all the starker because america played such an important role in creating the concept of international human rights in the aftermath of the carnage of world war ii. the us was a pioneer in the international human rights movement, providing most of the language, inspiration, and moral direction for these efforts to insure civil protections and equality to all (brown, 2003; reichert, 2003). in reality, eleanor roosevelt, wife of famed us president franklin delano roosevelt, was one of the principal drafters of the universal declaration of human rights—the first international document creating the framework for a vital international human rights movement. her efforts, along with those of other prominent americans of the post world war ii period, including such luminaries of the civil rights movement like w.e.b. dubois, walter white, mordecai johnson, and mary mcleod bethune, founder of the national council of negro women, fully participated as activists and observers in the early conferences that gave rise to the united nations—an international body of nations whose charter was founded upon a guarantee of fundamental human rights. but, from the very earliest days, the high rhetoric of human rights and civil liberties has always been, for american governments and the average citizen alike, a mixed story of some very profound contradictions. on the one hand, there is a clear emphasis on the necessity of worldwide respect for human rights. on the other hand, successive american governments from truman to bush ii have repeatedly stymied efforts to bring these rights home to our own oppressed or dispossessed minorities and, in recent years, has sought to force other nations into the so-called “freedoms of democracy” at the point of a gun. at the core of our collective moral identity as a world leader lurks the soft underbelly of hypocrisy that is clear to anyone willing to see. we began as a nation committed to a rights-based democracy, while at the same time we have attempted to collectivize this consciousness into a society largely built and maintained on the tortured and bloodied backs of slaves, native americans, latinos and pacific islanders (aguirre & turner, 2004). the commitment to grant basic human rights to some (whites, males, landholders and social elites) while denying them to others (african-americans, indigenous peoples, advances in social work, spring 2008, 9(1) 19 women, and the poor), has been a constant moral thorn into the side of america’s civic attitudes and responsibilities. we are still contending with the legacy and deep divisions of racism, sexism, and classism, manifested in a variety of different ways. we continue to embrace this historic double standard as we are one of the last remaining holdouts in the ratification of such important international initiatives as the international convention on the rights of the child; the international covenant on economic, social, and cultural rights; the movement to abolish capital punishment; and our government’s visceral opposition to the international criminal court (pearlstein, 2004). suppression in times of crisis unfortunately, the us has a checkered history in its sometimes very open disregard for its own human rights and civil libertarian heritage (chang, 2002; cole & dempsey, 2002; leone & anrig, 2003; mcdougall, 2004). several prominent examples will serve to illustrate this point. the sedition act of 1798—just over twenty years after the signing of the declaration of independence, and only seven years after the ratification of the bill of rights, the first assault on citizen’s freedom of expression began. the federalist controlled congress passed the sedition act, which made it a crime to criticize the government of, then president, john adams. the passage of this bill was justified in light of heightened tensions and talk of war between the united states and france. the intended targets of the bill all turned out to be members of the opposition party, the republican party, and many arrests and convictions were upheld that substantially supported a largely misguided grab for power among an elite group of hawkish internationalists within the federalist party. how history does seem to repeat itself. the habeas corpus act of 1863—this act was passed to give congressional backing to president abraham lincoln’s earlier executive order to suspend the constitutional guarantee of the writ of habeas corpus. habeas corpus is a legal principle that requires the government to prove the legality of a person’s imprisonment. in other words, it is a protection against the confinement of persons without legitimate reason and due process. but, in the early days of the american civil war, there was a very real belief among those in power that the conflict would spell the end to american democracy and that any means necessary was justified in protecting the state. thus, president lincoln suspended the writ of habeas corpus and, as a result, opened the door for the detainment, without cause and for trial by military tribunal, of any citizen suspected of being disloyal to the cause of the union. some unfortunate few were sentenced to death for their perceived, though largely unproven, complicity with the southern confederacy. arbitrary arrests and summary imprisonment became widespread until the close of the civil war when the us supreme court imposed limits on government’s wartime powers. the espionage and sedition acts of 1917 and 1918—the worldwide social and political unrest of the early 20th century and the ensuing world war led to the passage of these landmark bills. the espionage and sedition acts empowered the american government to suppress and punish disloyalty and subversion, which they broadly defined to include any publication or oral utterance that would impugn the motives of government and thus lead to political dissent among the citizenry. any publication or any person deemed to be radically disposed, socialistically inspired, or in any way contemptuous of besthorn/ social work practice and the us patriot act 20 the us government was subject to arrest and prosecution. the most notable examples were the arrest and imprisonment of socialist party members charles schenck and eugene v. debs for questioning american involvement in world war i. in a similar manner, the so-called palmer raids of early 1919, occurring during the height of america’s first great red scare, were also a response to hyper-exaggerated fears of communism and foreign born citizens. this represented the logical outcome of citizens scared into believing the worst about those different from themselves and the willingness of the average person to forfeit fundamental freedoms in the name of national security. these raids, precipitated by the bombing of attorney general a. mitchell palmer’s home by a foreign provocateur, led to the torture, forced detention, and summary arrest of nearly 10,000 resident aliens and the ultimate deportation of hundreds more. these government actions took place across the continental us and were supported by government sponsored vigilante groups, such as the american protective league and national security league. again, a not so strange parallel to current history that sees vigilante groups like the minutemen guarding america’s southern borders with mexico. brinkley (2003) notes that groups like these defined their mission as: …spying on their neighbors, eavesdropping on suspicious conversations in bars and restaurants, intercepting and opening the mail and telegrams of people suspected of disloyalty, and reporting to the authorities any evidence of disenchantment with the war effort. (p. 28) it was not unusual for these vigilante groups to spawn and otherwise support violent action against average persons and the legitimate activities of groups deemed to be un-american or un-patriotic. german, jewish, irish americans, bolsheviks, labor-unionists, pacifists, and political dissenters were favorite targets. reports of tar and feathering, public castration, and lynching were not uncommon. the smith act of 1940—the period up to and including world war ii was another chaotic time in american history when civil liberties came under challenge with the passage of the smith act. this legislation made it a crime to knowingly advocate for or abet the overthrow of any duly elected governmental institution or to organize any assembly of people to encourage the overthrow of any governmental unit within the us. the smith act was the catalyst for one of the saddest moments in recent american history: the forced evacuation, relocation, and internment of 110,000 men, women, and children of japanese ancestry. while no evidence was ever given for the necessity of the forced exile of this large group, two-thirds of which were american citizens, they were kept in harsh and often punitive conditions for much of the war. it was not until forty-four years later with the passage of the civil liberties act of 1988 that a public apology and modest financial reparation was granted to either the detainees or their descendants. while the smith act was passed during the imbroglio of world war ii, its reach extended far beyond that period. the immediate post world war ii period, much like the time immediately after the first world war, ushered in the second great red scare of the 20th century and was the flash point for what became known as the mccarthy era. junior united states senator joseph mccarthy of wisconsin capitalized on the fear and insecurity at the height of cold war hysteria by chairing the infamous house un-american activities committee (huac). its sole purpose was to expose and root out the incipient influence of communism in american society. during this sordid chapter in american history, advances in social work, spring 2008, 9(1) 21 communist party leaders, political dissenters, liberal academics, left-leaning entertainment personalities, radical labor-unionists, and leaders of a broad range of progressive political organizations were prosecuted and convicted based solely on their political views and/or their perceived association with a worldwide communist conspiracy. witnesses before mccarthy’s committee who refused to testify against other citizens or to provide names of their associates suspected of some connection to un-american groups were imprisoned for contempt of congress. guilt by association became the primary mechanism that insured anyone targeted by the committee would pay a high price—whether or not evidence was ever marshaled to support the claim of un-american activities. it was common to point to any political party association or activist group that questioned or criticized the prevailing political climate as a communist front or communist-action organization and thus becoming prima-facially suspect. “in november 1950, for example, the attorney general had nearly 200 groups on a list of communist and other subversive organizations” (cole, 2003, p.15). affiliation with any of these groups in any manner could lead to being called before the huac, and ongoing surveillance, blacklisting from employment, destruction of reputation, loss of job, or being subjected to vigilante violence. the execution of communist sympathizers and convicted spies julian and ethel rosenberg was but one of the most sordid results of this disastrous time in recent us history. cointelpro: 1956-1971—government efforts to suppress political dissent and restrict civil liberties under the guise of national security did not stop with the ending of world war ii or the ebbing of the cold war. indeed, the federal bureau of investigation (fbi) operated a highly secretive counterintelligence program (cointelpro) that covertly spied on, interfered with, and harassed law-abiding political organizations deemed to be a threat to the stability of the us government. its stated mission, according to an internal memo from controversial fbi director j. edgar hoover, was to expose, disrupt, misdirect, discredit, or otherwise neutralize activities of individuals and organizations perceived to pose a threat to domestic tranquility (chang, 2002, p. 30). this mission was carried out through a range of activities involving a roguish repertoire of dirty tricks, including frequent use of informants and agent infiltrators to disrupt political organizations; illegal wiretaps and break-ins; and spreading false rumors and character assassinations designed to ruin personal lives, split marriages, and leading to job loss and/or public shaming. while its original purpose was to ferret out and dislodge communist sympathizes in american society, during its fifteen years of covert operations, cointelpro also targeted labor unions, the civil rights movement, the black nationalist movement, the women’s liberation movement, the environmental movement, the new left, and, of course, a plethora of anti-vietnam war groups. many prominent americans and average citizens alike became the target of relentless fbi smear campaigns, including such people as the reverend dr. martin luther king, jr. of the civil rights movement, stokely carmichael of the black nationalist movement, david brower of the sierra club, paul ehrlich—a noted academic, and other prominent spokespersons in the feminist movement. the clandestine activities of the fbi and related counterintelligence groups was later and resoundingly repudiated in a scathing report from the senate select committee to study governmental operations with respect to intelligence activities, chaired by the late senator frank church. nonetheless, many serious social critics and legal scholars agree that the full extent to which cointelpro significantly altered the trajectory of american political life and weakened constitutional protection will never be fully known (brinkley, besthorn/ social work practice and the us patriot act 22 2003; brown, 2003; chang, 2002). but, unfortunately, it has not been the last attempt to circumvent the constitution and threaten civil liberties in the name of security and patriotism. a new and potentially even more virulent effort has recently begun, mostly notably authorized in the language and provisions of the us patriot act. the patriot act as our previous discussion has no doubt demonstrated, the patriot act is not a new or particularly novel approach to an external threat to american security. on october 26, 2001, president george w. bush, signed into law the so-called usa patriot act (uniting and strengthening america by providing appropriate tools required to intercept and obstruct terrorism act of 2001), and fourteen months later its sister legislation the homeland security act. the cumulative impact of these laws and similar administrative rules, executive orders, and judicial rulings is a radical and unprecedented departure from constitutional protections. in a matter of weeks, and with little congressional debate and even less public input, the patriot act sacrificed cherished civil freedoms in the name of national security and consolidates unheralded new police and intelligence powers into the hands of the president and the executive branch of government (cole & dempsey, 2002; foner, 2001; greider, 2004; hentoff, 2003). the act consists of ten titles, revises fifteen existing federal statutes, and deals with various activities related to both domestic and international terrorism. in general terms, the patriot act has three primary impacts on civil protections in america. one, the act places the guaranteed 1st amendment right of free speech and free association in jeopardy by creating a broad new crime of domestic terrorism that, in effect, gives the federal government the power to designate any person or political group a domestic terrorist if they are deemed a threat to the public order, are suspected of encouraging terrorist activities, or even if they are suspected of holding controversial views that run contrary to the current administration’s foreign and domestic policy (chang, 2002). environmental, anti-globalization, political, and welfare activists, in addition to arab and muslim philanthropic organizations are prime targets. recently, free-speaking academics, such as the case of university of colorado professor ward churchill, have also come under greater scrutiny and criticism, especially in those states that have passed or are considering passage of a so-called academic freedom bill of rights, a euphemistic name for a radical neo-conservative initiative to muzzle outspoken academics (american association of university professors, 2005; vanlandingham, 2005). secondly, the act reduces the increasingly low expectation of personal privacy by granting all branches of law enforcement increased powers of surveillance. these powers, which are unprecedented and often unchecked, include the ability to monitor all e-mail correspondences and internet usage; conduct so-called sneak and peak searches without probable cause or court orders; and force the disclosure of sensitive personal records from third parties, including private client information from doctors, social workers, educational institutions, libraries, hospitals, social service agencies, insurance companies or any business. it also authorizes the government to monitor all financial transactions and to conduct nationwide roving wiretaps without warrant as long as the snooping has a significant likelihood of gathering intelligence on terrorist activities. the 4th amendment has historically granted government the right to conduct searches and wiretaps only with a advances in social work, spring 2008, 9(1) 23 legally proscribed probable cause to believe an individual is or has engaged in criminal activity. but the patriot act allows government to evade that requirement altogether if it says based upon its good word only that the search has a chance of yielding significant foreign intelligence. these unheralded data mining techniques are already being organized into a national tracking system of domestic surveillance of every person in the united states. this system is being formulated under the department of transportation’s computer assisted passenger pre-screening system (capps ii) and is what the bush administration has referred to as total information awareness. of these kinds of programs new times columnist william safire (2002) wrote: every purchase you make with a credit card, every magazine subscription you buy and medical prescription you fill, every web site you visit and e-mail you send or receive, every academic grade you receive, every bank deposit you make, every trip you book and every event you attend—all these transactions and communications will go into what the defense department describes as a “virtual, centralized grand database.” to this computerized dossier on your private life from commercial sources, add every piece of information that government has about you—passport application, driver’s license and bridge toll records, judicial and divorce records, complaints from nosy neighbors to the fbi, your lifetime paper trail plus the latest hidden camera surveillance—and you have the supersnoop’s dream: a “total information awareness” about every u.s. citizen. (pg. 35) finally, the patriot act erodes the due process rights of non-citizens by allowing federal authorities to arrest foreign nationals, place them in mandatory protective detention, and even deport them based on the suspicion that their political activities may be construed as being terrorist in nature. as of late 2004, over 5,000 citizen aliens have been detained by the department of justice’s so-called anti-terrorist sweeps (cole, 2004). to date there have been exactly zero (0) convictions of any of these suspects for terrorist activities. in addition to these seminal provisions of the patriot act, which significantly impact us civil liberties, there is other less noticeable but equally invasive aspects of the act that deserve monitoring. the first relates to the issue of the guilt by association provision of the act that target immigrants for deportation and exclusion. this idea is a current iteration of the anti-communist witch hunts of the mccarthy era and earlier periods of us history and make citizen aliens suspect if they are associated in any way to a terrorist organization no matter how innocent or diffuse this association. terrorism is defined very generally by the act. its overly broad definition includes: (1) any act dangerous to human life that violates criminal law, (2) any acts appearing to be intended to influence policies of the government by intimidation or coercion, and (3) any acts occurring primarily in the territorial jurisdiction of the us (romero, 2003, p. 122). thus, the act’s very loose definition of terrorism and its proscription against associational activity makes anyone’s involvement with an organization that has ever been involved in civil disobedience or has ever been party to any crime of violence or attempted to influence a governmental policy suspect—whether it be a pro-life group, or the african national congress, or the american civil liberties union, or the irish republican army—since all besthorn/ social work practice and the us patriot act 24 have been involved at one time or another in acts of civil disobedience or some act of violence. …the new law contains no requirement that the alien’s support have any connection whatsoever to a designated organization’s violent activity. thus, an alien who sent coloring books to a day-care center run by a designated organization would apparently be deportable as a terrorist, even if she could show that the coloring books were used only by 3-year olds. indeed, the law apparently extends even to those who seek to support a group in the interest of countering terrorism. (cole & dempsey, 2002, p. 153) in another related provision, the patriot act authorizes the government to deny entry into the country of any foreign-born person based solely on acts of pure speech (chang, 2002). that is, aliens can be denied entry to the us for their political views if in the mind of the us secretary of state this speech undermines efforts to combat terrorism. thus, ideological exclusion is once again resurrected from the cold war era’s mccarthyism in a manner that intends to protect americans from hearing and thoughtfully considering ideas that may be viewed with disfavor by the government or that may run contrary to prevailing public opinion. finally, the patriot act dramatically reduces judicial oversight of intrusive information gathering powers and expands the role of both the fbi and cia—empowering them to blur the boundaries between law-enforcement and espionage activities. in the final analysis, the bush administration has chosen to ignore the lessons of history that democracy cannot survive in the absence of free and open debate. the administration has, instead, warned americans to watch what they say and to be careful who they associate with, thus threatening the very vitality of democracy they intend to protect. the patriot act and beyond: silencing dissent in the emerging debate between fighting terrorism and protecting liberty, many well-meaning americans strongly argue that civil liberties must be sacrificed in order to ensure public safety and maintain democratic institutions and practices. terrorism, in and of itself, as the logic goes, seems to require that we permanently suspend constitutional protections. the radical, neo-conservative right relies on the unquestioning logic that antiterrorism measures infringing upon civil liberties will, in fact, work. but, no one can ever be sure of these premises. in reality, the opposite is likely to be true. while it is perhaps too early to assess the long term implications of a new national security state now descending on american society, a brief glance will suggest at least one very important immediate impact. later generations may well conclude the most compelling legacy of the early 21st century’s war on terror was the silencing of political dissent. if the hard fought battles of the civil rights movement; the massive public outcry against the war in vietnam; and the multitude of dissenting acts of the early abolitionists, suffragists, and labor organizers has taught us anything, it is that freedom of expression and the right to criticize the government is fundamental to the survival of democracy. when these hard won rights are trampled under the banner of patriotism and national unity, then we are indeed close to realizing one of the gravest warnings of our early founders. these men knew well that freedom is lost not in a single, militant assault upon the rights of persons, but in a thousand small restrictive and subversive acts, which few notice and which most believe matter advances in social work, spring 2008, 9(1) 25 little. in the words of senator russ feingold, the only member of the us congress to vote against the patriot act: there is no doubt that if we lived in a police state, it would be easier to catch terrorists…but that wouldn’t be a country in which we would want to live, and it wouldn’t be a county for which we could, in good conscience ask our young people to fight and die…i think it is important to remember that the constitution was written in 1789 by men who had recently won the revolutionary war…they wrote the constitution and the bill of rights to protect individual liberties in times of war as well as in times of peace…preserving our freedom is the reason we are now engaged in this new war on terrorism. we will lose that war without a shot being fired if we sacrifice the liberties of the american people in the belief that by doing so we will stop the terrorists (hentoff, 2003, pp. 24-25) social work and the national security state any effective social work response to the new national security apparatus now emerging in american society must begin with the profession fully comprehending the fact that we cannot afford to sit idly by as civil liberties erode, and we cannot be silent even in the face of virulent opposition and threats to our personal safety and professional livelihood. we urgently need a coordinated and coherent view of social work education and practice in this emerging crisis and we need to find our collective voice in response. we cannot separate our professional ethics and responsibilities from the political climate around us. all things are political, as a familiar phrase goes, and we must be willing to assess and respond to the inherent friction between protecting safety and insuring freedom in this complex new world of global economism and heightened national security interests. there are a number of issues that are beginning to confront us social workers in this new environment. first, one increasingly hears reports leaking out of service agencies that suggest increasing efforts on the part of government agents pressuring social work personnel into informing on certain of their clients. this is especially true for young, impressionable and frightened social workers engaged with refugee and immigrant communities of either islamic or middle-eastern origin. recent reports from my home community by social workers involved with these clients substantiates this practice (k. ragan-pepper, personal communication, may 3, 2005). this intentional targeting of social service workers (especially those who are new to the profession) involved with specific immigrant groups is a breech of our professional code of ethics which has historically honored the worth and dignity of each person, client self-determination, personal privacy and protection of the confidentiality of client records. it amounts to the most repulsive kind of racial, ethnic, and religious profiling and puts social workers in the very untenable position of breaching confidentiality or risk intimidation and black-listing efforts to coerce their so-called voluntary cooperation. while reports like these are relatively few, it is likely this trend will continue because social workers are the ones who serve the most diverse groups in american society. and, of course, social work has had a checkered history of co-optation as agents of social control for the ruling establishment. the pressure will only increase for social workers to do their patriotic duty. this informal but corrosive pressure to conform is related to a second issue confronting social workers in america’s current social service besthorn/ social work practice and the us patriot act 26 delivery system: the stigma associated with negative labeling. the tag of unpatriotic or aiding the enemy can have powerful impacts on social workers just trying to do a good job, pay their bills, and be good citizens. the statement of former attorney general john ashcroft before the senate judiciary committee just months after 9-11 is still having a chilling effect on most professions’ willingness to challenge or circumvent the current administration’s draconian measures to protect liberty. ashcroft admonished that “those who scare peace-loving people with phantoms of lost liberty…your tactics only aid terrorists, for they erode our national unity and diminish our resolve”, and “they give ammunition to america’s enemies and pause of america’s friends” (senate judiciary committee, 2001, p. 10) in the social welfare services debate the new national security state also portends a third difficulty for social work educators, student practitioners, policy advocates and other public interest groups (piven, 2004). advocacy requires understanding and skill in the politics of change. but, a fear of personal attack or being labeled un-patriotic or unamerican tends to create an environment where political deliberation collapses or is subsumed under the umbrella of national unity. crucial social and domestic policy discussions, normally hammered out in the hot fires of contentious debate and opposing viewpoints, give way to political passivity as the smoldering fear factor is fanned into open flame and everyone is expected to fall in line to support the war effort. this is, of course, not new to american social work. the early years of the 20th century saw many social workers castigated and ostracized for their so-called communist leanings, which included such nefarious and socially destabilizing activities as calling for a forty-hour work week, the elimination of child labor, the provision of sanitation services for inner city immigrant groups, and the right of workers to organize (ife, 2001). for social work educators and field practitioners the new national security state offers new opportunities and creates new risks. increasingly, educators are being challenged to more fully prepare their students for the realities of practice in a climate fraught with new fears and uncertainties. section two of the patriot act virtually guarantees that government agents will have unprecedented access to a wide range of client records held by libraries, insurance companies, schools, and social service agencies. in this new environment, young social workers still unaccustomed to the rigors of working with marginalized clients and the applied ethics of protecting client rights will become prime targets of agents seeking information on questionable citizens and non-citizens alike. there a several things social work educators can do. first, we must do a better job in educating our students to the new realities of practice. we must make sure that they have a rigorous knowledge of the laws and ethical guidelines insuring confidentiality. and, we must work together to strengthen them. we must help our students understand that self-determination means more than encouraging personal choice but includes standing firm against efforts to clamp down on freedom of speech and freedom of association. the absence of these protections serve to isolate refugee/immigrant groups and make them more vulnerable to the onslaughts of intrusive government. we can also encourage our field students, fellow faculty and agency personnel to be involved in broad coalitions devoted to preserving and restoring privacy and civil protections. these activities might include lending expertise and vocal support for protecting personal and confidential information, helping agencies to draft and implement stricter policies on confidentiality advances in social work, spring 2008, 9(1) 27 and privacy, and becoming allies and advocates with other social service providers to fight any effort where citizens are asked to spy and inform on other citizens. conclusion a new form of rampant and unremitting insecurity has replaced civil freedoms and the constitutional protections of democracies. the united states has become the world’s newly aggrieved giant. it claims its absolute right to act on behalf of itself and its citizens—alone, always and in every circumstance—to wage pre-emptive war justified only by its own internal logic and store of facts and to force democracy at the point of a gun on any nation in the ideological belief that only brutal dictators sponsor terrorism. although the patriot act is currently undergoing review by the senate judiciary committee, there is still great pressure to permanently legalize increased government snooping on citizens and to enact ever tighter controls on political dissent and organized advocacy. the land of the free and home of the brave is giving way to the sobering realization that we are a nation perpetually at war, chronically frightened by unseen enemies and paralyzed by phantasms of fear. this paper has reviewed the sordid history of national security efforts to muzzle dissent and free speech in times of national crisis. it has provided a graphic picture of the high cost of allowing such efforts to go unchallenged. social work is in the front lines of this new domestic war on terrorism. it is being asked, paradoxically, to be both servants of the dispossessed and spies upon the marginalized. if the fearmongering triumphs in creating an environment where the innocent lives of the most vulnerable in our nation’s people are sacrificed in a delusional attempt to protect ourselves then we will have already lost the fight. long before any government succeeds in controlling and institutionalizing deeply undemocratic practices, the seeds of tyranny would already have been planted in the years and perhaps decades proceeding. our times are perilous not just because of the threat of terrorist attack but because of the slow and almost imperceptible erosion of civil liberties. this gradual decline, if left unchecked, will one day bear fruit in a society shunted away from freedom and burdened under the heavy yoke of centralized thought control and the criminalization of free speech. what role will social work play in this stealthily encroaching orwellian world? references american association of university professors, academic freedom and national security in a time of crisis. (n.d.). retrieved march 9, 2005 from http:// www.org/statements/reports/911report.htm aguirre, a., & turner, j. h. (2004). american ethnicity: the dynamics and consequences of discrimination (4th ed.). boston: mcgraw-hill. brinkley, a. (2003). a familiar story: lessons from past assaults on freedoms. in r. leone & g. anrig (eds). the war on our freedoms: civil liberties in an age of terrorism (pp. 23-46). new york: public affairs press. brown, c. (ed.). (2003). lost liberties: ashcroft and the assault on personal freedom. new york: the new press. chang, n. (2002). silencing political dissent. new york: seven stories press. http://www.org/statements/reports/911report.htm besthorn/ social work practice and the us patriot act 28 cole, d. (2003). the course of least resistance: repeating history in the war on terrorism. in c. brown (ed.). lost liberties: ashcroft and the assault on personal freedom (pp. 13-32). new york: the new press. cole, d. (2004, october 4). taking liberties: ashcroft 0 for 5,000. the nation, 279(10), 6, 20. cole, d., & dempsey, j., (2002). terrorism and the constitution: sacrificing civil liberties in the name of national security. new york: the new press. foner, e. (2001, october 8). the most patriot act. the nation. retrieved january 17, 2005, from http://www.thenation.com/docprint.mhtml?i=2001008&s greider, w. (2004, june 21) under the banner of the ‘war’ on terror. the nation, 278(24), 11-18. hentoff, n. (2003). the war on the bill of rights and the gathering resistance. new york: seven stories press. ife, j. (2001). human rights and social work: towards rights based practice. cambridge: cambridge university press. leone, r., & anrig, g. (eds.). (2003). the war on our freedoms: civil liberties in an age of terrorism. new york: public affairs press. mcdougall, g. (2004, october). shame on our own house: how segregation and racism has fed u.s. resistance to international human rights treaties. the american prospect, a21-a23. pearlstein, d. (2004, october). rights in an insecure world: why national security and civil liberty and complements. the american prospect, a7-a10. piven, f. f. (2004). the war at home: the domestic costs of bush’s militarism. new york: the new press. reichert, e. (2003). social work and human rights: a foundation for policy and practice. new york: columbia university press. romero, a. d. (2003). living in fear: how the u.s. government’s war on terror impacts american lives. in c. brown (ed.). lost liberties: ashcroft and the assault on personal freedom (pp. 112-131). new york: the new press. safire, w. (2002, november 2). you are a suspect. the new york times, 35. senate judiciary committee. (2001, december 6). department of justice oversight: preserving our freedoms while defending against terrorism—testimony on attorney general john ashcroft. retrieved april 24, 2005, from http://judiciary.senate.gov/testimony.cfm?id=121&wit_id=42 vanlandingham, j. (2005, march 23). capitol bill aims to control ‘leftist’ profs. the independent florida alligator. retrieved march 25, 2005, from http:// www.alligator.org/pt2/050323freedom.php author’s note: address correspondence to: fred h. besthorn, ph.d., associate professor, department of social work, sabin 33, the university of northern iowa, cedar falls, iowa 50614. email: fred.besthorn@uni.edu. mailto:fred.besthorn@uni.edu aisw vol. 5, no. 2 163 cross-cultural differences in preferred forms of address: implications forwork with african american adults wanda lott collins sharon e.moore abstract:using an individual’s last name indicates respect and contributes to positive interaction with african american clients and adults of african descent. this paper discusses the importance of using social titles as a proper form of address during, and sometimes after, the initial professional relationship. two case vignettes will highlight potential difficulties that non-african american practitioners may experience when using first names with african americans within the professional realm. the vignettes include a scenario for a supervisor and a client. keywords: african american, social titles, professional relationship, social work generally, people who are of african american heritage understand the importance of addressing african american adults with formal forms of address. this paper focuses on providing non-african american social work professionals with information regarding the intricacy of initially addressing african american clients and others of african heritage by their first names during the helping relationship. the current cultural trend is the over familiar use of first names by virtual strangers. salespeople seem to embrace this gesture as a way to help individuals feel relaxed and closer to them or to express a level of ease and general friendship. likewise, the social work community is a microcosmic reflection of larger social practices. because of the historical, political, and sociological context of slavery and racism, many african americans, especially the older generation, still prefer the titles of mr., miss, mrs., and dr. in light of this history, many african americans experience disrespect and feelings of invisibility. franklin (1999) defines invisibility as an“inner struggle with the feeling that one’s talents, abilities, personality, and worth are not valued or even recognized because of prejudice and racism” (p. 1). as social workers prepare to work in a variety of practice settings, their effectiveness in developing rapport will depend on their success in fostering practical client, community, and professional relationships during the helping process. similarly, social work schools should prepare students to understand how negative wanda lott collins, ph.d is an ordained minister and an assistant professor, raymond a. kent school of social work, university of louisville, louisville, ky 40292. sharon e. moore, ph.d. is associate professor, raymond a. kent school of socialwork, university of louisville, louisville, ky 40292. copyright© 2004 advances in socialworkvol. 5 no. 2 (fall 2004) 163-171. indiana university school of socialwork. 164 advances in social work interactions can originate from casually addressing african americans by their first names. in many instances, this blunder, which usually occurs during the initial phase of introductions and information gathering, may impede the worker’s ability to effectively engage and establish a helping relationship. this paper highlights the benefit of addressing african american adults, especially clients, prior to establishment of the worker/client relationship, by the appropriate title and surname unless otherwise granted permission. two case vignettes will highlight potential difficulties that practitioners may experience when using first names with african americans in a professional context. the vignettes include a scenario for a supervisor and a client. thehistorical and cultural significance of names and social titles modes of address for african american families have historical, cultural, and psychological significance.whether social work professionals use the first, last, nickname, or name with title should be evaluated in relation to the impact of establishing positive interpersonal and professional interaction with clients and community emissaries within the professional setting. it is helpful to understand the day-to-day challenges of feeling invisible, against the backdrop of slavery and racism, to maximize practitioners’ success in conveying respect and dignity to african american clients (bean, perry & bedell, 2002). research by leissner (1997; 1998) exposes the practice during slavery of denying slaves fixed names, because they were legally defined as chattel with no civil or social rights. in a show of control and power, slave owners often withheld naming a slave until the slave was bought and took the name of his or her master. in many instances, slaves were assigned names that were meant to demoralize and humiliate them. for example, names such as sambo, gamesome, and lies reflected slave owners’ perceptions of the name-bearer’s character (leissner, 1997; 1998; king, 1998). irrespective of age, and as another form of disavowing dignity, slaves were referred to as “boys” or “girls.” for example, young white girls were addressed as miss and slaves senior in years were called “boy” or “girl” as a way of stripping them of pride. in some cases, slaves were expected to answer to any name that suited the temperament or humor of the slave owner. the standard action was to give slaves only a first name. by stark comparison, white males and females were respectfully addressed formally and informally as mr., miss, or mrs. (leissner, 1997; 1998). jim crow era following the civilwar, slavery was replaced by other forms of subjugation called “jim crow.” this quasi-legal system segregated and discriminated against black people from reconstruction through the mid-1960s (rosenberg, 2002). it was based on the lead character in 19th century minstrel shows whose style of dance mimicked a prancing crow. jim crow was a system enforced with threats of jail or lynching that sheltered whites with impunity, while black americans were deprived of basic legal rights and dignities (parker, 2002). analogous to the established practices of slavery, the perpetuation of language that reinforced the inferior status of black people was equally promoted during this era.white people did 165collins, moore/cross-cultural differences in preferred forms of address not address black people with the customary courtesy titles of respect. the standard protocol was to address blacks by their first names. routinely, white children referred to older african americans as “uncle” and “aunt” or by their first names. the youthfulness of the white child and the advanced years of the black person demanded of blacks a deference in the presence of whites that whites were not expected to reciprocate. these time-honored practices were vivid reminders that jim crow was slavery in everything except name (yardley, 1998). professional respect using the last name and appropriate title with african american clients is a way to set the stage for showing respect and increases the likelihood of positive interactions and satisfaction among social work personnel and clients. a level of awareness and understanding regarding proper deference and respect can enhance the helping relationship and increase workers’ effectiveness. thwarted interventions, slow starts, and tense communications can be significantly curtailed in favor of greater client flexibility and cooperation. most experts agree that when you respect someone, you recognize and acknowledge their worth and value on some level. respect involves treating people in a way that reflects kindness and politeness. it means treating others as we would wish to be treated. buss (1999) explains that what makes someone valuable is not whether he or she is a member of a privileged class, but that he or she is a person. therefore, because human beings are worthy of being treated with dignity, treating them rudely undermines their belief in their own intrinsic worth. when a person is treated with disinterest, contempt, or a lack of respect, it conveys the message that the other person’s concerns, feelings, and point of view do not matter (buss, 1999). that is, that they have no intrinsic value. in examining respect from the perspective of good or bad codes of etiquette, it is suggested that the system of manners plays a pivotal role in one’s moral life, which helps us to avoid being discourteous, impolite, rude, inconsiderate, offensive, or insulting (buss, 1999). bad manners “undermine people’s ability to acknowledge one another’s dignity directly; it makes it difficult, if not impossible, for each person to assure every other that he appreciates the other’s intrinsic value” (p. 804). this was the problem with the racist code of behavior. according to buss (1999), the racist code of bad manners instructed whites, before and after the emancipation of slaves, not to acknowledge blacks as worthy of respect. carter’s (2001) article on rudeness also supports the point of view that respect is a right due to each person by virtue of his or her humanity. commenting on the informality of using first names, the following remarks were shared. “i was raised with the belief that calling a stranger by his first name is a privilege, not a right, and it is available only if bestowed. calling people we have met by their first names is said to be part of the new informality of our day. but it is, i think, actually part of the new incivility, or perhaps what we ought to call the new rudeness” (carter, 2001, p. 1). the helping relationship in general, the purpose of the client-social worker relationship is to help the client with identified needs and problems (biestek, 1994). with the diversity of today’s 166 advances in social work client population, empathy and good casework relationship skills are stressed by schools of social work as a way for graduates to establish openness and bring coherence to the task of cultural sensitivity (dyche & zayas, 2001). as in other human endeavors, the social work literature is replete with publications that promote the importance of worker relationships that foster warmth and cooperation with clients. social workers are taught to assume unconditional respect for the uniqueness of each client and the context of the client’s life. the worker and the client reflect on experiential history, biological propensities, and the community of shared meanings embedded in the language of the client’s everyday life. from this perspective, the use of first names may be social workers’ response to building strong working relationships by creating friendliness and an environment to help ease any anxiety related to problem-solving. casevignettes the following vignettes include a scenario of a supervisor and client with a person of other than african american heritage. these examples may help to clarify conceptualizations that have been previously discussed. these examples are based upon real experiences that have been shared with the authors. vignette #1—the agency supervisor mrs. jeanette wilson, age 60, has been a supervisor at a faith-based social service agency for the past 17 years. this agency operates under the auspices of the church of which she is a member. she manages a staff of 12 and has won numerous professional and community awards for her work in the area of children’s services. she serves in various capacities within her church, such as head of the women’s department, which is primarily responsible for the christian education of the females who attend her church. there are 300 women from her congregation who participate in thewomen’s department.mrs.wilson is regarded as a respected elder within her church and community. she has also been a field supervisor over 10 student interns throughout the years. the interns have come from various counseling professions such as social work, psychology, and counseling. amanda was assigned to mrs. wilson as a social work student intern. amanda interned with her for one year during her senior year in college. after receiving the student’s name from the field placement coordinator, mrs. wilson contacted amanda by telephone for introductory purposes. she introduced herself as mrs. wilson and referred to amanda by her surname. amanda quickly replied, “my surname is not necessary jeanette. feel free to call me mandy.” mrs. wilson did not request to be called by surname but thought that if she referred to herself repeatedly as such throughout the remainder of their conversation that the student would catch on, but this did not happen. at one point in the conversation, the student requested mrs.wilson’s agency address to send her some correspondence. as she repeated the address back to mrs.wilson, she began stating her name by spelling jeanette. mrs. wilson interjected “mrs.” to which the student did not reply. several days later, mrs. wilson received the correspondence. there was no “mrs.” preceding her name. she decided to address this with the student during their first supervisory meeting. although she had never had this problem with any african american student, this was not the first time that this issue surfaced with non-african american interns. 167collins, moore/cross-cultural differences in preferred forms of address this case poses several issues for consideration as well. social work internships are designed to engage “the student in supervised social work practice and provide opportunities to apply classroom learning in the field environment” (cswe, p. 7, 2001). although helping students to link social work theory with practice is the primary objective of social work internships, the practicum provides the students an opportunity to demonstrate “that they are capable of integrating and applying the theoretical material that they have learned …to a diversity of practice situations and populations” (moore & lott collins, p. 173, 2001). the african american church can provide a student with a wealth of learning experiences, among which is the opportunity to broaden his or her understanding about the customs, beliefs, and traditions that exist among african americans. although the services were provided in an african american religious environment, the student’s practicum supervisor was very instrumental for both secular and non-secular activities, for which her community applauded her. adullah (1998) noted that those within the counseling professions “must be able to appreciate the personal strength of black women, who have historically survived the physical enslavement period, the psychological enslavement and the self-preservation strategies of survival through assimilation” (p. 203). therefore, the practice of addressing african american adults by surname or title has a much deeper meaning within the african american community. it is done, in part, to symbolize the recognition of the numerous contributions that the elderly have made to the community. these contributions have been and are manifested in such ways as rearing grandchildren in the absence of biological parents and making their homes available to blood and fictive kin. they worked tirelessly towards the abolition of jim crow laws and during the pre-civil rights era in which they often lost their lives due to race-hate violence that was perpetrated against them. because of the great role that african american women have historically and presently play within their families and community, they are traditionally held in high esteem within their communities (dhooper & moore, 2001). that the student’s practicum occurred within an african american church is significant relative to the enormous social support that is provided by this institution to those it serves. second only in importance to the african american family, the african american church is a place where african american people are affirmed and where the elderly are treated with respect and dignity (mcrae, carey & anderson-scott, 1998). for instance, as head of the women’s department and superior of the faith-based initiative of her church, mrs. wilson may likely have direct and frequent contact with her pastor and other church officials. as such, she may be influential in programmatic and civic decisions that are made by church leaders. her voice may be important regarding the type of social work initiatives that her church supports. it could have proven beneficial to the student had she been made aware of this information by the person who coordinated her field experience prior to her initial contact with her practicum supervisor. the authors have been careful to qualify that this social blunder could possibly have been avoided. had this student’s lack of sensitivity been based on an assumption that she may have made about the value of her supervisor based on race, then the issue is one of her not respecting an african american person who 168 advances in social work assumes a supervisory role. or, the student’s behavior may have been demonstrating poor manners or a general practice of rudeness. this is an issue that she and her practicum supervisor need to explore. vignette #2—family services client mrs. ellen nance is a 69-year old grandmother with four grandchildren. faye and her six-year old son, jason, reside with mrs. nance, because faye has a debilitating physical disability. her disabling condition results in limitedmobility and reduced physical energy for day-to-day activities. however, mrs. nance maintains primary responsibility for her grandson. because of faye’s deepening depression and reduced parental involvement in school activities, jason’s grades declined. seeking a hardship waiver, mrs. nance requested assistance from the school’s social service unit so she could enroll jason in the after school-reading program. her request was two weeks past the deadline for applications. alvin, a 25-year old school social worker with six years of social work experience, was assigned to assess the family’s eligibility. although this was a self-referral, the social worker expressed exasperation in working with mrs. nance during his monthly supervisory conference. since supervisory conferences are utilized to foster professional growth,mrs.hendricks, a caucasian supervisor, requested that the social worker discuss his concerns with the intention of helping him to process some likely reasons behind mrs. nance’s terse response to questions during the home interview. the case review supported that the family met the eligibility requirements and were appropriate for the program. however, mrs. nance’s curt and passive engagement during the home interview created unnecessary delays in processing the paperwork for final approval. the assessment indicated that mrs. nance had retired from a job of 15 years as a housekeeper. the worker recalled that during his first contact mrs. nance referred to her former employers as those “so-called educated people that i worked for.” she continued by remarking, “i gave them the best of my years but to them i was just another black person . . . there to clean up their mess and to act invisible to their superior acting ways.” mrs. hendricks probed further for information regarding the initial stages of the interview, the kinds of questions asked during the information gathering process, and the type of closure displayed at the end of the home visits. mrs. hendricks further explored the manner in which the social worker had addressed the client during the first visit. the worker acknowledged that mrs. nance was referred to as “ellen” and considered that this might explain the communication barrier. following consultation with the supervisor, the worker used the final home visit to determine if the supervisor’s assumptions were plausible. practicing active listening, the social worker discovered that while mrs. nance referenced her employers as mr. & mrs., she instead was addressed as “ellen” even by the three children in the home, who ranged in age from three to twelve. inadvertently, in trying to show himself as being friendly, the social worker had created a replication of the same disrespect mrs. nance incurred in her employment with caucasian employers. verifying these perceptions with the client, the social worker was quick to offer a sincere apology for any unintended disrespect. this gesture reportedly lessened ten169collins, moore/cross-cultural differences in preferred forms of address sion towards the end of the home visit. because of these experiences, the social worker gained an understanding about historical and cultural social protocols from an african perspective. although alvin introduced himself by his first name, mrs. nance silently objected to him assuming that he could also call her by her first name. to take such prerogative was a flashback to her years of “invisible” existence at the home of her employers. although she was old enough to be a grandmother, her employment experiences relegated her to the role of a child. especially infuriating was the fact that the children in her employer’s home were not expected to show deference to her maturity and older age. therefore, she resented a younger white male acting so familiar as if to dismiss her struggle and entitlement to be treated in an esteemed manner. from her cultural perspective, as a senior citizen, her age should serve as a mark of reverence and honor. alvin’s reference to her as “ellen” sounded flip, informal, and lacking in dignity. mrs. nance openly shared that as a child she was taught to address all people over 18 by social title and surname and by“yes, sir, no, sir—yes, madam, no, madam.” she also said that by virtue of their greater life experience, wisdom, and maturity, adults should be accorded respect by word and demeanor. from this point of view, mrs. nance attributes disrespect to moral and social decay tainted by racism. but other factors could have contributed to the way in which the social worker addressed the client, such as a lack of understanding about the importance and use of surnames when addressing african american clients, or again, as in the first scenario, a demonstration of poor manners. implications for socialwork education among the basic ethical principles of the profession of social work is the belief in the inherent worth and dignity of every individual. to that end social workers are to “treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity” (longress, 2000). included in cultural differences are a group’s customs, traditions, and patterns of social interaction. as has been discussed, the use of surnames by african americans when referencing one another, particularly the elderly, has its roots in a history of being marginalized and purposeful humiliation by members of the dominant culture. it is an empowering gesture that signifies respect and value for the humanity of the individual. with respect to this issue, the task for social work educators is to: (1) educate themselves about the values and practices of diverse groups, (2) move students beyond being politically correct in their expression of “cultural sensitivity” to practicing cultural sensitivity wholeheartedly, and (3) convey to clients that difference does not mean deviant. martinez-brawley (2000) asserts, “while we have sought to teach ‘cultural sensitivity,’ we have often failed to make it more than ‘a bag of tricks’ or a cloak we carry around but do not necessarily apply from the heart” (p. 198). basic to the issue of the failure or refusal to address an individual in the manner in which he or she requests is lack of etiquette. “good etiquette means knowing the rules that apply in any situation” (masson, 2001, p. 18). etiquette or the lack 170 advances in social work thereof among college students is an issue that has been discussed for decades (trout, 1998, a40j). a number of factors have been attributed to this. they include the lack of collegiality that students sometimes observe among faculty, the examples set for them by parents, the lowering of educational standards, and the effects of living in a capitalistic society where individuality and the preservation of self are esteemed over collectivism (damon, 1995, owen, 1995). whatever the reasons for this insensitivity, it becomes the task of social work educators to make students aware of the cultural expectations of the clients with whom they work, provide them with avenues to experience the culture of others, and make them aware of the consequences of their behavior for both their clients and themselves. clients may feel demeaned by a worker who shows limited understanding about their traditions. this can subsequently lead to negative perceptions about social workers and an unwillingness to enter into a helping relationship. the fact that this task is not easy cannot be overstated. however, the challenge remains. if the profession is to produce individuals who can work effectively with a diverse array of populations, then “social work in the academy must take more seriously the link between character and everyday behavior” (martinez-brawley, 2000, p. 208). practitioners should therefore recognize the value of respectfully addressing african american adults, especially since such actions can build intercultural connections to african american clients, community networks, and professional stakeholders in culturally acceptable ways. references abdullah, a.s. (1998). mammy-ism: a diagnosis of psychological misorientation for women of african descent. journal of black psychology, 24(2), 196-206. anderson, l.s. (1996). unique names and naming practices among african american families. families in society, 77(5), 290-296. bean, r.a., perry, b.j., & bedell, t.m. (2002). developing culturally competent marriage and family therapists: treatment guidelines for non-african therapists working with african-american families. journal of marital and family therapy, 28(2), 153-164. biestek, f.p. (1994). an analysis of the casework relationship. families in society, 75(10), 630-634. buss, s. (1999). appearing respectful: the moral significance of manners. ethics, 109(4), 795-826. carter, s. (2001). rudeness has a first name. christianity today, 45(13) 108-109. conroy, s.b. (1993). a century of being sisters: they saw jim crow come and go—and so much more. the washington post, pp. b01-b05. council on social work education. (2001). curriculum policy statement for baccalaureate degree programs. retrieved july 22, 2001 from: http:www.cswe.org/accreditation/curriculum. damon, w. (1995). greater expectations: overcoming the culture of indulgence in america’s homes and schools. ny, ny: free press. dhooper, s.s., & moore, e. (2001). social work practice with culturally diverse people. thousand oaks, ca. dyche, l., & zayas, l.h. (2001). cross-cultural empathy and training the contemporary psychotherapist. clinical socialwork journal, 29(3), 245-260. franklin, a.j. (1999). invisibility syndrome and racial identity development in psychotherapy and counseling african american men. counseling psychologist, 27(6), 761-793. 171collins, moore/cross-cultural differences in preferred forms of address king, d.w. (2001). deep talk: reading african-american literary names. charlottesville, va: university of virginia press. leissner, o. (1997; 1998). naming the unheard of.national black law journal, 15(1), 109-141. longress, j.f. (2000).human behavior in the social environment. (3rd ed.). itasca, il: peacock publishers. masson, l. (2001). ask an expert: explaining the etiquette effect. camagazine, 134(3), 18. mcrae, m.b., carey, p.m., & anderson-scott, r. (1998). black churches as therapeutic systems: a group process perspective.health education & behavior, 25(6), 778-790. martinez-brawley, e. (2000). social work, transculturality, and etiquette in the academy: implications for practice. families in society, 81(2), 197-210. moore, s.e., & lott collins, w. (2002). a model for social work field practicums in african american churches. journal of teaching in socialwork, 22(3/4), 171-188. owens, l.a.a. (1995). the role of teachers education in nurturing honorable and principled teaching. educational horizons, 74, 43-48. parker, l.o. (2002). days of jim crow: an oral history project fleshes out the meaning of the segregation era. thewashington post, pp. c01-c05. rosenberg, j. (2002). the long war for freedom after the civil war ended. the christian science monitor, pp. 19-21. trout, e.a. (1998). incivility in the classroom breeds “education lite.” the chronicle of higher education, 44(46), a40. yardley, j. (1998). the bad old days. thewashington post, pp. x03-x06. author’s note: address correspondence to: wanda lott collins, ph.d., assistant professor, raymond a. kent school of socialwork, university of louisville, louisville, ky 40292, usa. e-mail: wanda.collins@louisville.edu microsoft word descartes et al copyedit final _________________ lara descartes, ph.d., is an associate professor in family studies at brescia university college in london, ontario, canada. marysol asencio, drph, is an associate professor and thomas o. blank, ph.d., is a professor, both in human development and family studies at the university of connecticut, storrs. this research was supported by the anthony marchionne foundation, the center for health intervention and prevention, and the neag comprehensive cancer center of the university of connecticut. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 218-225 paying project participants: dilemmas in research with poor, marginalized populations lara descartes marysol asencio thomas o. blank abstract: this paper presents a case study about issues that can arise in research with marginalized populations. we use our experiences during a focus group conducted with low-income men to discuss how using monetary incentives can lead to ethical and methodological dilemmas, including participants’ misrepresentation of their demographic backgrounds to match study criteria. we address difficulties caused by the institutional review board process’ inability to account for unanticipated circumstances during fieldwork. we note that any resolution of such dilemmas must prioritize responsible research practice and protecting participants. we also note the need for more research on the impact and ethics of monetary and other incentives in recruiting participants for studies such as ours that include populations from diverse socioeconomic backgrounds. the issues raised in this paper have implications for those considering research design, especially concerning incentives and screening questions. keywords: marginalized populations, recruitment, research design, research incentives, research participation introduction one of the principles of the code of ethics of the national association of social workers [nasw] (nasw, 2008) is social justice. social justice requires that all people receive equitable access to information and services. however, a great deal of the research that forms the basis for providing such information and services, especially those that are health-related, is conducted with white, middle-class, heterosexual respondents (fredriksen-goldsen & hooyman, 2007). many of the resultant articles end with recommendations to include more diverse populations in future samples, but few investigators actually do this. our project was one attempt to rectify this situation. our original intent was to investigate gay men’s perceptions of prostate health and prostate cancer and their perceptions of the effects of prostate cancer on sexuality and relationships. most prior work had been done with presumptively heterosexual men. we also wanted a sample that was racially and socioeconomically inclusive, as, with the exception of heslin, gore, king, & fox (2008), there are few studies on this topic conducted with non-white or low-income gay men. when we recruited low-income marginalized men using protocols established with middle-class men, however, complications arose. primarily, our participation incentive of $40, modest by middle-class standards, proved problematic when advertised among lowadvances in social work, fall 2011, 12(2) 219 income populations. some of our volunteers seemed to misrepresent themselves, presumably motivated by the financial incentive and their own economic needs. the nasw code calls on social workers to “educate themselves, their students, and their colleagues about responsible research practices” (nasw, 2008, 5.02p). our experience raises several issues related to responsible research practices that are pertinent to social work and health-related fields, as well as other disciplines. the topics we address in this paper include: incentives and the possibility of participants misrepresenting their demographic background to match study criteria; the limits posed by protocols approved by institutional review boards (irbs), which cannot be immediately altered as issues arise in the field; and research ethics. we conclude with recommendations for fieldwork arising out of our experiences. research methodology research subjects and method the design and protocols of our study (asencio, blank, descartes, & crawford, 2009; blank, asencio, descartes, & griggs, 2009; descartes, asencio, blank, & crawford, forthcoming) replicated standard procedures used in typical prostate-related research (eton & lepore, 2002; sanda et al., 2008). the major difference was that, as stated, we intended our sample to be gay men and we hoped for racial, ethnic, and socioeconomic diversity. participation eligibility was limited to those who were gay, male, and 40 years old or older (the age demographic most likely to face prostate healthrelated issues). these criteria were stated clearly in all our advertisements and reiterated to those who contacted us. our research was exploratory, and a qualitative approach thus was deemed most suitable. we decided to use focus groups to bring diverse groups of gay men together to talk about their knowledge of and share their experiences with prostate health issues. we set the participation incentive at $40, well within the range of incentives commonly given in health-related research (grady, 2005; klitzman, albala, siragusa, nelson, & appelbaum, 2007). site, recruitment, and participants we conducted the study in hartford, connecticut, a small city that has a significant latino and black population. we distributed flyers announcing the focus groups to community organizations that had programming for gay men and at the local pride celebration. postings also were placed on relevant electronic mailing lists. in the first four (out of five) focus groups these methods recruited gay men who fit our criteria. the participants in the first four groups included a significant number of low-income men. these men revealed particular needs and issues that we wanted to explore more fully. we thus decided to specifically recruit low-income men for a fifth group. we contacted an outreach worker from a local organization serving poor latino and black men and women, many of them homeless and with a history of drug use. some, he descartes, asencio, blank/paying project participants 220 believed, were gay men. with our flyers in hand and our criteria in mind, the outreach worker set about recruiting for our next group. dilemmas in the field: the fifth focus group each of our first four focus groups had six to eight participants. in this fifth group, however, a total of 22 people were waiting for us when we arrived a half hour before the scheduled start. many of them had been waiting an hour for us to arrive. as we looked around the room, we noted with concern that some people looked much younger than 40, a few were instantly recognizable as having attended earlier groups, and one appeared to be a biological female. based on (admittedly unreliable) cues, we did not even get the sense that all those in the room actually were gay. some seemed unusually uncomfortable, some seemed to avoid eye and physical contact with those around them, and so forth. because irb procedures are established well before the study begins and any changes need to be approved ahead of time (sometimes with a lag of several weeks), unanticipated challenges in the field such as these cannot be addressed easily or in a timely manner. requesting a driver’s license or identification card would have helped us to establish sex and age. our irb-approved protocol, however, did not include this step. when developing the research protocol, we thought that asking for identification might be threatening for some of the men, such as those engaged in illegal activities or those who might be undocumented immigrants. some, being poor and homeless, might not even have had access to identification documents. a driver’s license or identity card would not have answered the question of sexual orientation anyway. there thus was no way to determine who met our criteria. cancelling the focus group and starting fresh did not make sense as we likely would have lost the participation of the waiting men who did fit the criteria. such a move also might have initiated confrontations with this large, increasingly impatient, group. we decided to continue and provide the study information and consent forms. as we did so, we reinforced how important it was that participants fit the criteria. we gently queried those who appeared not to fit the study’s requirements, as well as those we recognized as prior participants. we were concerned that anything beyond requests for confirmation might violate the men’s rights to ethical treatment. if we had gone further in questioning those we were concerned about, we would have been attacking their self-representations in front of the large group gathered. this clearly would have violated the nasw code of ethics statement concerning “due regard for participants’ wellbeing, privacy, and dignity” (nasw, 2008, 5.02e). we recognized one man in particular from a prior focus group, but he gave a different first name this time. he vehemently denied being the same man, even though he was not easily forgotten because of unusual tics and mannerisms. when he was told that one of the investigators distinctly remembered him, he said the “other” man had been his twin brother. he was adamant that he was going to stay. we wished to avoid further confrontation, and as always, we wished to treat all participants with sensitivity, so we moved on. advances in social work, fall 2011, 12(2) 221 we then approached a potential participant who appeared to be a (non-transgender) woman dressed in baggy, figure-obscuring clothing, sitting with a man who appeared to be the person’s partner. this incident highlights the challenge in trying to confirm someone’s sex. this person could have been transgender, given that visual cues are unreliable. the person identified as male when we asked. given the awkwardness of the question and having no way to determine otherwise, we accepted the response. while we understand that issues of sex and gender are complicated, for the purpose of this study, participants needed to have a prostate. there were also several men who looked younger than 40, including one particularly youthful looking man. when he was reminded of the age criterion, he told us that he had just turned 40. at this point, all those about whom we were concerned seemed completely comfortable in maintaining that they fit the study’s criteria. reminders of how important the criteria were for the research goals did not result in any voluntary withdrawals. we had a group at least half of which we suspected to be not 40, not gay, and/or not male. to complicate matters more, we also had the repeat attendee. given our concerns, the importance of protecting our participants’ privacy and dignity, and our inability to change irb-approved procedures in the field, we decided that there was only one way to proceed. we did not question anyone further. we gave the participation incentive of $40 before the focus group commenced, which was a regular step of our protocol. we then announced that anybody could leave if they wanted to, without being asked to return the money. although we made similar statements in previous focus groups, no one had ever taken the money and walked out. this time, however, the room quickly started to clear. all those we were concerned about, whether we’d spoken to them directly about it or not, left immediately, as did several others. at the end, seven remained. we presume (and visual cues indicated) that those who stayed did so because they actually fit the gay, male, age 40-and-over category. we were distressed, as we lost funds that might have enabled an additional focus group, but we felt we had maintained integrity with our participants, the validity of our data, and our ethical stance. issues in research with marginalized populations despite this challenging experience, we continue to believe that it is crucial that hardto-reach and marginalized people are included in all research. although human services research does this as a matter of course, health-related research often does not. as we found, (descartes, asencio, blank, & crawford, forthcoming; also see augustus et al., 2009; diebert et al., 2007), the perspectives, knowledge, and attitudes of poorer and/or less educated people can differ from those of the middle-class, highly educated populations more often included in such work (augustus et al., 2009; eton & lepore, 2002; sanda et al., 2008). studies that have been conducted with middle-class populations should be extended to incorporate more diverse people, rather than simply accepted as being non-representative. yet, inclusion of poor and marginalized populations presents very real issues around recruitment and financial incentives. these issues include the potential for participants to misrepresent themselves. at least one death is attributable to this—in an nih sleep study, one woman died as a result of her descartes, asencio, blank/paying project participants 222 participation, after giving false medical information in order to be included (kolata, 1980, as cited in ripley, 2006). the related issue of “professional” research participants, those who make part or all of their living by participating in any study they can, is a problem in academic investigation. indeed, two of our participants subsequently contacted one of us with rather aggressive requests for other paid research opportunities. market researchers, however, seem to be among the few publicizing concerns about professional focus group attendees (focusgrouptips.com, n.d.). their suggestions on how to address this issue (take names, request identification, keep databases that record identifying information) are not always practicable for academic researchers, however. this is especially the case for social workers, health researchers, and others who research sensitive topics with marginalized populations. much of what has been published about ethics and financial incentives to vulnerable populations comes from addiction, homelessness, and adolescent studies. concerns expressed in this literature include what the participants will do with their money—for example, the potential for drug users to use their money to purchase drugs (noted by ensign & ammerman, 2008). although we feel participants’ spending is their own business, the literature observes that the prospect of buying drugs might influence decisions to participate and violate voluntary and informed consent, because of the nature of addiction (fry, hall, ritter, & jenkinson, 2006). the nasw code of ethics indeed requires that there not be “undue inducement to participate” in research (nasw, 2008, 5.02e). both fry et al. (2006) and ripley (2006) provide guidelines for considering whether researchers should provide payments as incentives, and both note the possibility that some people might misrepresent themselves to participate in research. fry et al. (2006) raise the possibility of screening procedures to address such issues. some factors, however, as noted, are difficult to screen for. participants motivated by monetary considerations can easily lie, as for example, when a heterosexual man says he is homosexual or a biological woman dresses in obscuring clothing and insists that she is a gay man. age can be verified, but a person’s sexual history (or, as other examples, addiction history or mental health symptomatology) are not necessarily easily confirmed. ways out of such dilemmas are difficult if not completely impossible to implement fully. incentives are difficult to consider giving up. studies have shown that they raise the participation of low-income people in research (mack, huggins, keathley, & sundukchi, 1998; martin, abreu, & winters, 2001, both as cited in singer & kulka, 2002). reaching populations who are low-education and low-income is critical. it is precisely in those populations, however, that incentives can be transformed from a simple “thank you” to reasons to do whatever it takes to obtain the money. recommendations it is imperative that marginalized populations be included in research. by attempting to recruit non-white and low-income gay men we obtained important data about the diverse experiences of a range of men who are confronted with prostate health issues. our experiences, however, highlight the difficulties that such efforts can bring. even with advances in social work, fall 2011, 12(2) 223 knowledge of potential challenges, investigators can be taken unaware when they are actually in the field. some of our issues arose due to the inflexibility of the irb process, which is unlikely to change much in the near future. we had a serious predicament in the field and could not change our protocols in a timely manner. the only solution is to try to foresee awkward and ambiguous situations and incorporate those into the irb submission. the impetus behind this article was to add to the resources available for anticipating such circumstances. in our own case, we could have tried using identification to establish eligibility but foregone any recording of names and addresses. private time with each focus group participant also might have made a difference. we did not reserve separate rooms in which to give the participants their initial consent forms. the men came together in one large room, and consent was gone over with them individually or in small groups, in front of the others waiting. privacy for this stage of the research process would better have enabled potentially sensitive topics to be addressed more freely. along those lines, screening questions need to be thought through thoroughly regarding criteria that are not easily verifiable, such as sexual identity. “describe how you came to realize you were gay” for example, might have been a better way of encouraging only gay men to stay for the focus group, as a narrative requires more from a respondent than simply showing up for a group advertised as being for gay men. those truly committed to getting the money no matter what, however, might still have fabricated something in order to get the incentive. financial incentives with marginalized populations do need to be considered in terms of their coercive potential. forty dollars is minimal to a middle-class person and hardly worth lying for. for a homeless person, however, it may be a very attractive sum. we do want to note that concerns about monetary incentives are not something only involving the poor. one of the few articles in the social work literature addressing monetary incentives and unethical behavior involved doctors who received $1000 from pharmaceutical companies to recruit patients (fast, 2003). what our research experiences show is that what is considered a small amount of money by middle-class participants may be seen as a lot by less well-off participants. unfortunately, determining the appropriate and ethical level of monetary incentive, particularly in a study recruiting participants with a mix of socioeconomic backgrounds, has not been researched. to avoid the issue of the coercive potential of money altogether, some researchers have used prepaid phone cards as incentives for those who are homeless (e.g., ensign, 2003). such incentives, however, may not be particularly appealing to those who are middle-class, who are likely to own cell phones. for a study recruiting people of different socioeconomic statuses, as ours did, this would be a problem. incentives that appeal primarily to members of a specific identity might have been a better solution for our work. gift cards to a gay bookstore or gift shop or for entry to a gay-themed event might have worked well to reduce the likelihood of misrepresentation and the potential coercion of a monetary inducement. descartes, asencio, blank/paying project participants 224 conclusion our focus group taught us a number of lessons about the challenges that can arise in a project where both middleand low-income participants are included. in our case, we confronted issues not indicated by our initial literature reviews that were difficult to deal with given the timeframe of irb approvals. although some of the situations we encountered can be avoided by us in the future and by other researchers who take our experiences into account, some of the issues likely have no solution. there is no way to verify sexual orientation, for example. it is a completely self-reported, non-measurable categorization and thus entirely falsifiable. therefore, the participant’s truthfulness on the subject of identity is crucial. making sure that truthfulness is not subverted by the incentive of payment will likely remain a challenge. the sharing of these types of research experiences, however, highlights: 1) issues and problems that need to be anticipated before commencing fieldwork; 2) measures that may help reduce some of the challenges encountered; and 3) the need for more research addressing the use of incentives when dealing with both privileged and marginalized populations in the same study. it also adds to a continuing conversation on how to support the commitment, as called for in the nasw code of ethics, to advance social justice and responsible research practice. references asencio, m., blank, t., descartes, l., & crawford, a. (2009). the prospect of prostate cancer: a challenge for gay men’s sexualities as they age. sexuality research and social policy, 6(4), 38-51. augustus, j. s., kwan, l., fink, a., connor, s. e., maliski, s. l., & litwin, m. s. (2009). education as a predictor of quality of life outcomes among disadvantaged men. prostate cancer and prostatic diseases, 12, 253-258. blank, t. o., asencio, m., descartes, l., & griggs, j. (2009). aging, health, and glbtq family and community life. journal of glbt family studies, 5, 9-34. deibert, c. m., maliski, s., kwan, l., fink, a., connor, s. e., & litwin, m. s. (2007). prostate cancer knowledge among low-income minority men. the journal of urology, 177, 1851-1855. descartes, l., asencio, m., blank, t. o., & crawford, a. (forthcoming). gay men’s knowledge of prostate cancer. in g. perlman (ed.), what every gay man needs to know about prostate cancer. new york: magnus books. ensign, j. (2003). ethical issues in qualitative health research with homeless youths. journal of advanced nursing, 43, 43-50. ensign, j., & ammerman, s. (2008). ethical issues in research with homeless youths. journal of advanced nursing, 62, 365-372. doi: 10.1111/j.1365-2648.2008.04599.x eton, d. t., & lepore, s. j. (2002). prostate cancer and health-related quality of life: a review of the literature. psycho-oncology, 11, 307-326. advances in social work, fall 2011, 12(2) 225 fast, j. (2003). when is a mental health clinic not a mental health clinic: drug trial abuses reach social work. social work, 48, 425-427. focusgrouptips.com. (n.d.). the dirty secret of the research industry what to do about professional focus group participants. retrieved from http://www.focusgrouptips.com/focus-group-participants.html fredriksen-goldsen, k. i., & hooyman, n. r. (2007). caregiving research, services, and policies in historically marginalized communities: where do we go from here? journal of gay & lesbian social services, 18, 129-145. fry, c., hall, w., ritter, a., & jenkinson, r. (2006). the ethics of paying drug users who participate in research: a review and practical recommendations. journal of empirical research on human research ethics, 1, 21-36. grady, c. (2005). payment of clinical research subjects. journal of clinical investigation, 115, 1681-1687. heslin, k. c., gore, j. l., king, w. d., & fox, s. a. (2008). sexual orientation and testing for prostate and colorectal cancers among men in california. medical care, 46, 1240-1248. klitzman, r., albala, i., siragusa, j., nelson, k., & appelbaum, p. (2007). the reporting of monetary compensation in research articles. journal of empirical research on human research ethics, 2(4), 61-67. national association of social workers. (2008). code of ethics of the national association of social workers. retrieved from http://www.naswdc.org/pubs/code/code.asp ripley, e. (2006). a review of paying research participants: it's time to move beyond the ethical debate. journal of empirical research on human research ethics, 1, 9-20. sanda, m. g., dunn, r. l., michalski, j., sandler, h.m., northouse, l., hembroff, l. . . . wei, j. (2008). quality of life and satisfaction with outcome among prostate cancer survivors. new england journal of medicine, 358, 1250-1261. singer, e., & kulka, r. a. (2002). paying respondents for survey participation. in m. ver ploeg, r. a. moffit, & c. forbes citro (eds.), studies of welfare populations: data collection and research issues (pp. 105-128). washington, dc: national academy press. author note: address correspondence to: lara descartes, phd, division of sociology and family studies, brescia university college at the university of western ontario, 1285 western road, london, ontario, canada, n6g 1h2. email: ldescart@uwo.ca microsoft word lietz_evaluating qualitative research final _________________ cynthia a. lietz, ph.d., and luis e. zayas, ph.d., are assistant professors in the school of social work at arizona state university in phoenix. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 188-202   evaluating qualitative research for social work practitioners cynthia a. lietz luis e. zayas abstract: in the field of social work, practitioners must remain well informed regarding research advances in their respective areas. proponents of evidence-based practice expect social workers to engage in practice informed by the best available evidence. research studies conducted through the lens of qualitative inquiry provide important contributions to the social work knowledge base. in many cases, these studies can represent the best available research regarding emerging problems or application of evidence to diverse populations. yet, despite the relevance of qualitative research, many social workers receive minimal training regarding qualitative methodology hindering their ability to conduct and evaluate research that uses qualitative methods. the purpose of this article is to provide students and practitioners some orientation regarding qualitative research methods and to highlight potential strategies researchers and consumers of research may use to evaluate the trustworthiness and quality of qualitative research. specifically, the concept of trustworthiness is defined in the context of qualitative inquiry and questions social work practitioners can ask when evaluating the quality and applicability of a qualitative research study are provided. keywords: qualitative, research methods, trustworthiness introduction as social workers intervene with individuals, families, and communities, it is critical to remain informed regarding the literature base and research advances specific to one’s field of practice. the national association of social workers (nasw)’s code of ethics (1999) asserts the importance of engaging in practice informed by prevailing research when it states “social workers should critically examine and keep current with emerging knowledge relevant to social work.” similarly, the council on social education (cswe) recently identified ten core competencies of social work practice, one of which involves engaging in “research-informed practice and practice-informed research” (holloway, black, hoffman, & pierce, 2009, p. 2). moreover, the evidence-based practice (ebp) movement has increased the expectation that social workers actively seek research findings related to their particular domain of practice (howard, mcmillen, & pollio, 2003; jenson, 2005). specifically, ebp asserts social workers make decisions guided by research evidence working in conjunction with clinical expertise and client preferences (gambrill, 2007; gilgun, 2005; mcneece & thyer, 2004). although most would agree with the importance of identifying and reading research articles related to one’s area of practice, there are many challenges social workers face as they seek to achieve this goal (adams, matto, & lecroy, 2009). first, social workers are under increased pressure to do more in less time. caseloads are increasing and budget advances in social work, fall 2010, 11(2) 189 cuts in many agencies require social workers to serve multiple roles. additionally, many practitioners do not have access to library databases and other resources that may have been available to them while pursuing their education. coupled with the challenges of finding the needed time and resources, even once social workers identify current research articles related to their field of practice, many struggle to ascertain the quality and applicability of a particular study to their work. the purpose of this article is to address the question of quality and applicability as it relates to qualitative research in social work. a growing literature base stemming from qualitative research studies produce findings of relevance to social work practice. however, a recent study reviewing master’s level social work syllabi found content regarding qualitative methods was “generally very limited” (drisko, 2008, p. 89) suggesting many social workers receive limited education about evaluating qualitative methods. to help overcome this limitation, this article seeks to provide social work practitioners some guidance when assessing the methodological quality of studies that employ qualitative methods. qualitative methodology qualitative research represents a “family of methods” stemming from a variety of traditions (padgett, 2008 p. 1). denzin and lincoln (2008) explain, “qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them” (p. 4). qualitative inquiry developed through a rich history of research seeking contextualized, in-depth descriptions that offer increased understanding. although qualitative inquiry is consistent in its naturalistic approach, researchers adopt a variety of perspectives that inform their work. many qualitative research articles will identify or implicitly embrace a philosophical stance or paradigm to frame their work, such as post-positivist, social constructivist, or critical theory (creswell & miller, 2000; morrow, 2007). understanding the perspective used to guide the study will help the reader understand the epistemological position of the researchers and the methods used to answer the research question (drisko, 1997). for example, post-positivist research seeks methods that are systematic, constructivist research asserts all knowledge is co-constructed thus prioritizing depth over methodological structure, and the critical paradigm calls for collaboration and corroboration with research participants (creswell & miller, 2000). these paradigmatic stances impact the way researchers conceptualize their qualitative studies (morrow, 2007). therefore, as caelli, ray, and mill (2003) suggest, “each qualitative approach needs to be evaluated in a manner that is congruent with its epistemological and methodological origins” (p. 7). creswell (1998) identifies five qualitative inquiry traditions: ethnography, phenomenology, biography/narrative, grounded theory, and case studies. others also discuss critical, feminist, and action research (denzin & lincoln, 2008; depoy, hartman, & haslett, 1999; olesen, 2000), and new approaches continue to emerge. many suggest embracing one of these approaches when conceptualizing a qualitative study is one way of enhancing the quality of the project as these frameworks rest on established lietz, zayas/evaluating qualitative research 190 philosophical foundations. also, certain strategies for rigor are deemed more suitable than others based on the study’s approach (padgett 2008). however, there has been a recent increase in qualitative studies using generalized qualitative methods rather than a specific tradition. some suggest these generalized studies can produce useful findings when conducted systematically, even if they do not embrace one of the recognized qualitative approaches (caelli et al., 2003; patton, 2002). qualitative and quantitative research: commonalities and differences research seeks the development of knowledge derived from empirical evidence. data are collected and analyzed through procedures that are reported for review and evaluation, an important part of the scientific tradition. despite these commonalities, there remain some specific differences between quantitative and qualitative research (frankel, 1999; lincoln & guba, 1985; rubin & babbie, 2010). first, their purposes are often different. quantitative research often seeks through measurement to test hypotheses, to determine outcomes and to draw generalizable conclusions to a defined population. qualitative research tends to be interpretivist and seeks to understand a phenomenon in its context in greater depth (denzin & lincoln, 2008; morrow, 2007). it seeks to elucidate the nature of social practices, relationships, and beliefs along with the meaning of human experiences from the participants’ point of view. generally, qualitative studies differ from quantitative studies in that they are inductive rather than deductive, and they consider experiences within context rather than controlling for variables as in an experiment (bogdan & biklen, 2007; lincoln & guba, 1986). quantitative studies may administer a standardized instrument to measure a variable with closed-ended items developed and tested for their ability to produce valid and reliable data. on the other hand, qualitative inquiry employs data collection strategies such as indepth interviews, participant observation, and archival reviews (polkinghorne, 2005). understanding these differences is the first step in evaluating research articles as it is essential that there is congruency between the purpose of the research and the methods chosen to achieve those aims (frankel, 1999). once practitioners gain some clarity regarding the fundamental commonalities and differences between quantitative and qualitative research, social workers need to develop an understanding regarding how to evaluate the quality of studies conducted within each methodological tradition. critique is a part of the research tradition. it is expected that researchers conduct their projects through procedures that are presented to the research community allowing readers to draw conclusions from findings that are appropriate considering each study’s limitations. in quantitative research, studies are evaluated according to the level of reliability and validity related to the measurement procedures, the internal validity established through the design of the study, and the external validity or the degree to which the sampling procedures allowed for generalizability (creswell, 2008; lincoln & guba, 1986; rubin & babbie, 2010). in qualitative research, the process for ascertaining the quality of research is quite different according to its varied purposes and methods. the following section describes criteria used to evaluate qualitative advances in social work, fall 2010, 11(2) 191 research along with the strategies used by researchers to increase the quality of their qualitative studies. evaluating qualitative research the issue of evaluating qualitative research can prompt a lengthy debate about varied perspectives regarding epistemology and whether the activity of truth finding is even possible (emden & sandelowski, 1998; 1999; kincheloe, 2001; whittemore, chase, & mandle, 2001). although we acknowledge the importance and relevance of this ongoing debate, our purpose here is not to engage in a philosophical discussion regarding ways of knowing, but to instead provide practitioners some practical ways for looking at the quality of qualitative research. we acknowledge there are differences of opinion on these issues. therefore, we chose to utilize the ideas of lincoln and guba (1985) when discussing the topic of evaluating quality. whittemore, chase, and mandle (2001) conclude lincoln and guba’s (1985) criteria to be the “gold standard” with “staying power” (p. 527). their conceptualization represents the most cited standards for evaluating qualitative work and provides some practical direction for practitioners. lincoln and guba’s (1985) seminal work identified criteria evaluating qualitative research. they suggest that qualitative studies should achieve “trustworthiness;” a study that represents as closely as possible the perspectives of the research participants. consider that a research team wants to understand the experience of youth who age out of foster care and choose to conduct a series of in-depth interviews with a sample of young adults who identify with this experience. the researchers may have some preconceived ideas regarding what these participants might share. despite these ideas, the study is trustworthy if steps are taken in the research procedures to ensure the perspectives of these participants are authentically gathered and accurately represented in the findings. lincoln and guba (1985) address this by considering four concepts that work together to achieve trustworthiness – credibility, transferability, auditability, and confirmability. these concepts are defined further to provide guidelines practitioners can use when evaluating qualitative studies. a series of strategies researchers can use to enhance the quality of qualitative research are also discussed. credibility credibility refers to the degree to which a study’s findings represent the meanings of the research participants (lincoln & guba, 1985). drisko (1997) suggests qualitative “interpretations must be authentic and accurate to the descriptions of the primary participants” (p. 191). padgett (2008) explains that, to achieve credibility, qualitative research must manage the risk of research reactivity and bias. research reactivity refers to the potential for the researcher or the study procedures to exert an impact on the participants thereby changing the findings of the study. for example, a researcher interested in family violence may design a study that videotapes family interactions for the purpose of understanding the nature of relationships shaped by aggression. however, the presence of the camera when researching a socially undesirable behavior will likely affect the way families interact. when researchers analyze these tapes, they will observe a family’s interaction while being recorded, not a true representation of how that family lietz, zayas/evaluating qualitative research 192 may have behaved if the camera were not present. research reactivity can also occur based on how researchers develop and ask interview questions, display affirming or nonaffirming non-verbal communication, or even through their degree of participation when engaging in observations. in order to manage this threat, qualitative researchers need to remain aware of how the research procedures may exert an influence on the credibility of the data. in addition to reactivity, researchers also remain mindful regarding the potential impact of their own bias. researcher bias involves how researchers’ socio-political locations and preconceived ideas may shape the way they design the study and engage in analysis, thereby potentially leading to a misrepresentation of the data (lietz, langer, & furman, 2006). for example, if a researcher wants to explore client satisfaction with a parent training program, the researcher may conduct a focus group in which participants discuss their experiences. if the researcher has a stake in the outcome, she may be tempted to engage in interviewing that encourages discussion of successful outcomes while failing to attend or draw out comments related to negative impressions of the program. researcher bias can affect other aspects of a research project beyond data collection. the research question, decisions about research procedures, and the process of data analysis are all influenced to some degree by the experience, knowledge base and standpoint from which one comes to a research project (horsburgh, 2003). as qualitative researchers seek to achieve credibility, there are strategies that can be used to manage the threats of research reactivity and bias. to manage research reactivity, researchers may try to make their data gathering efforts less conspicuous and intrusive without deception. for example, video-recorders may be concealed or employed more discretely with knowledge of the participants. researchers conducting participantobservation may choose at times to act less as a ‘participant’ and more as an ‘observer’ to minimize reactivity. junker (1960) describes a continuum of degrees of engagement that ranges from complete participant to observer as participant to participant as observer and to complete observer. remaining mindful regarding the potential impacts research procedures can have on the findings is an important part of conceptualizing a qualitative research study. in addition to reactivity, qualitative researchers manage the threat of researcher bias as they seek to achieve credibility. to manage such bias, researchers engage in reflexivity and seek to build self-awareness regarding their own influence on the research project (drisko, 1997). reflexivity is defined by horsburgh (2003) as “active acknowledgement by the researcher that her/his own actions and decisions will inevitably impact upon the meaning and context of the experience under investigation” (p. 308). reflexivity involves a thoughtful consideration of one’s standpoint through reflection that may occur through keeping a written journal and engaging in dialog with peers (johnson & waterfield, 2004). lietz and colleagues (2006) conducted a study that analyzed autobiographical accounts regarding jewish identity. the researchers describe extensive efforts to remain reflexive. specifically, a journal was kept during the analysis process that recorded the analysts reactions to what was being read. in addition, the research team met and engaged in lengthy debates about how the differences in spiritual identity within the research team brought diverse perspectives of the transcripts. ultimately, the journal and meetings advances in social work, fall 2010, 11(2) 193 brought a spirit of openness and accountability to the research process that the authors found highly important to their ability to offer a credible portrayal of the qualitative data. reflexivity is not an activity that occurs at one point in time, but instead represents a process that unfolds throughout the entire research process (guillemin & gillam, 2004). evidence of reflexivity may be discussed in the methods section of an article. some authors may also include a statement of self disclosure where the researchers acknowledge their own bias and report their potential influence on the findings. reflexivity is a critical part of managing research reactivity and bias and should be evident in the research article. creswell and miller (2000) suggest this is particularly relevant for studies stemming from a critical paradigm, although we contend reflexivity is an appropriate strategy to enhance trustworthiness in any qualitative research regardless of approach. other strategies to increase credibility include triangulation, member checking, and thick descriptions. padgett (2008) defines triangulation as a concept adapted from navigational science involving the use of “two or more sources to achieve a comprehensive picture of a fixed point of reference” (p. 186). by gathering data from multiple sources (data triangulation) or utilizing multiple analysts to review the data (observer triangulation), qualitative researchers are able to achieve what drisko (1997) refers to as “completeness” or an exhaustive response to the research question. data triangulation might involve gathering data at multiple points in time or using varied data collection strategies such as interviews, focus groups, or observations (creswell & miller, 2000). triangulation by observer involves having more than one researcher analyze the data to be sure important ideas are not missed and that there is some consistency to how data analysis is linked to the findings. some projects may involve multiple observers and interviewers working independently to collect the same type of data. for projects stemming from a post-positivist perspective, training should be provided to standardize their approach and minimize bias and variability in the way data is collected. having a list of guiding questions, for example, helps to focus the observations of multiple observers in recording the phenomenon of interest. padgett (2008) suggests that triangulation is particularly relevant with case studies and grounded-theory approaches, including mixed method studies (methodological triangulation). when performing certain qualitative data analyses, such as content analysis, it may also be important to compute the intraor inter-rater reliability of coders or analysts (shek, tang & han, 2005). particularly studies coming from the post-positivist perspective prioritize the use of systematic procedures (creswell & miller, 2000). however, for qualitative traditions which assert reality is constructed intersubjectively, computing inter-rater reliability is not consistent with the philosophical underpinnings of this position. when evaluating qualitative research, it is important to remember that credibility stems from the “intended inquiry purposes;” thus credible research decisions are consistent with one’s purpose (patton, 2002, p. 266), requiring practitioners to think critically and contextually when judging methodological decision making. member checking involves corroborating the research findings by seeking feedback from the research participants (creswell & miller, 2000; padgett, 2008). member lietz, zayas/evaluating qualitative research 194 checking can involve including selected research participants in the data analysis or returning to a sample of participants with a draft of the findings to ascertain their sense of agreement with the findings (shenton, 2004). for example, a researcher interested in resilience may interview adults who grew up in high risk circumstances to understand how some individuals come to cope effectively with adversity over time. the research team may identify a subset of their sample to provide feedback about the analysis. these individuals are provided a description of the preliminary analysis and are encouraged to offer feedback regarding whether the findings appear to reflect their own experiences. in some cases, specific questions may be used to guide this discussion when the researchers are seeking to clarify the meaning of certain quotes or accounts. while some identify member checking to be one of the most valuable strategies for increasing trustworthiness in qualitative research (lincoln & guba, 1985; lietz et al., 2006), others acknowledge that member checking can raise practical concerns such as not being able to locate research participants or assuming that a sample of members’ experiences are similar enough that they will all agree to the findings (padgett, 2008). despite these concerns, member checking is particularly important for studies stemming from the critical paradigm as these studies seek collaboration and corroboration with research participants (creswell & miller, 2000). the notion of thick description derives from the tradition of interpretive ethnography in anthropology, and involves “deep, dense, detailed accounts” of a phenomenon of inquiry with particular consideration of the context(s) in which it occurs (denzin, 1989, p. 83). according to geertz (1975), cultures are “webs of significance” and their analysis involves “an interpretive one in search of meaning” (p. 5). in this tradition, to adequately study a phenomenon, it is important to obtain ample and contextual documentation from which to derive knowledgeable and insightful interpretations. specifically, creswell and miller (2000) explain: the purpose of thick description is that it creates verisimilitude, statements that produce for the readers the feelings that they have experienced, or could experience, the events being described in a study. thus credibility is established through the lens of readers who read a narrative account, and are transported into a setting or situation (p. 128-129). thick description is deemed particularly significant in constructivist research and in ethnographic studies. however, adequate description of the context and research procedures is relevant for qualitative research regardless of paradigmatic positions. one strategy used to support the process of obtaining thick descriptions includes prolonged engagement. this involves conducting multiple interviews or spending extended time observing participants to achieve a complete look at the experience (lincoln & guba, 1986). while seeking to establish credibility, researchers may document the training of interviewers or observers, the frequency, duration, and intensity of data collection efforts, probing techniques, whether interviews were audio-recorded or notes were taken, and whether data saturation was achieved. ample use and discussion of examples of thematic findings is also helpful. although many journals cannot advances in social work, fall 2010, 11(2) 195 accommodate lengthy descriptions, it remains the author’s responsibility to adequately describe efforts taken to thoroughly account for the participants’ experiences. transferability transferability refers to the degree to which the findings are applicable or useful to theory, practice and future research (lincoln & guba, 1985). sandelowski (1986) refers to this concept as “fittingness” suggesting transferability has to do with the degree to which findings fit situations outside of the study and are found meaningful. qualitative research studies are not generalizable according to quantitative standards, because probability sampling is not employed. instead, qualitative studies typically use purposive sampling to seek a specific group of participants who have experienced the phenomenon being studied. the number of research participants is typically smaller than quantitative studies, because as researchers seek to study experiences in-depth, the quality and exhaustive nature of each case becomes more important than the number of participants (polkinghorne, 1995). in addition, constructivists challenge the relevance of generalizability in qualitative research, “arguing that an emphasis on generalizing strips away the context that imbues a qualitative study with credibility” (padgett, 2008, p. 182). although qualitative researchers do not seek generalizability, transferability is achieved when the findings have applicability to another setting, to theory, to practice, or to future research. devers (1999) suggests for findings to achieve transferability, “…the contexts must be similar. therefore, it is the role of the researcher to identify key aspects of the context from which the findings emerge and the extent to which they may be applicable to other contexts” (p. 1165). therefore, as researchers seek to achieve transferability, thick descriptions are again relevant allowing readers to understand ways findings may be applicable to other settings (creswell & miller, 2000; lincoln & guba, 1986; shenton, 2004). the study’s context should be described in detail and should relate to the context of other groups or settings (devers, 1999). for example, in a current study, zayas and colleagues are documenting the challenges that quality assurance professionals experienced in performing their functions in community-based behavioral health agencies. these study findings along with the suggestions that followed may be applicable in and transferable to other community agencies that provide similar services with comparable staff, resources, and clientele. finally, when assessing transferability, credibility is again important. just as a study that produces reliable, but invalid data is not useful in quantitative research, qualitative studies that produce transferable findings that are not credible do not contribute to the knowledgebase. auditability lincoln and guba (1985) identify the third criteria for evaluating qualitative research projects as auditability. auditability refers to the degree to which research procedures are documented allowing someone outside the project to follow and critique the research process (padgett, 2008). while quantitative research requires strict adherence to study procedures, qualitative methodology does allow for some flexibility. in fact, some lietz, zayas/evaluating qualitative research 196 suggest high quality projects should demonstrate an iterative process that changes as the study unfolds (davies & dodd, 2002; drisko, 1997; frankel, 1999; morrow, 2007). for example, interview instruments may be revised during early stages of data collection if questions are not yielding quality information. proposed sample sizes may be increased or decreased based on data saturation. also, codebook development involves painstaking deliberations among analysts based on their assessment of a certain number and type of data sources. when, why and how are such consequential decisions made? one way of addressing the need to make decisions and changes along the way is to provide detailed documentation throughout the research project. projects stemming from a post-positivist perspective will commonly prioritize systematic procedures such as these (creswell & miller, 2000). however, we contend keeping an account of the research procedures and decisions seems relevant for all approaches. the strategies used to increase auditability include keeping an audit trail and engaging in peer debriefing. an audit trail is a written account of the research process that includes a reporting of what occurred throughout the research project along with a demonstration of reflexivity. mullins, cheung, and lietz (under review) recently conducted a project that involved describing families’ descriptions of family preservation services. in this project, the authors chose to maintain the audit trail through google docs. this document included detailed accounts of each research meeting, the research decisions that were made throughout the process, and each member’s reactions after engaging in any coding of the transcripts. by using an online document, any member of the team was able to go into and add to the document at any time, providing an efficient way to maintain a detailed account of the project from beginning to end. although a copy or excerpts from the audit trail are rarely included in the research article, many authors will report the maintenance of an audit trail to demonstrate auditability. it can help to clarify concerns and increase the confidence of other researchers and reviewers about the conduct of the study. additionally, peer debriefing involves consulting with colleagues experienced in qualitative methodology (padgett, 2008). by discussing research decisions and procedures, important feedback can be provided enhancing the quality of the project (shenton, 2004). peer debriefing can help to promote reflexivity allowing researchers to become more sensitized to the effects of their socio-political position. it can also enhance the research process by generating new ideas and identifying potential pitfalls related to the methodology. for example, in the study referenced earlier of jewish identity (lietz et al., 2006), the researcher engaged in the analysis of these autobiographical accounts did not personally identify with this spiritual tradition. in order to increase reflexivity and accountability, a decision was made to consult with another qualitative researcher who was jewish to provide an insider’s perspective to the data analysis process. an audit trail is of particular relevance for post-positivist qualitative research while peer debriefing is seen by some as necessary for projects stemming from a critical standpoint (creswell & miller, 2000). however, some suggest that peer debriefing and auditing may represent “…potentially contaminating influences that interfere with the search for deep structures of meaning” in phenomenological approaches (padgett, 2008, advances in social work, fall 2010, 11(2) 197 p. 194). in other words, these approaches are divorced from the lived experience, possibly leading the researchers away from their intimate interaction with data. confirmability confirmability refers to the ability of others to confirm or corroborate the findings (drisko, 1997; lincoln & guba, 1985). shenton (2004) asserts “steps must be taken to help ensure as far as possible that the work’s findings are the result of the experiences and ideas of the informants, rather than the characteristics and preferences of the researcher” (p. 72). to achieve confirmability, a study demonstrates that the findings and data are clearly linked. there are several strategies that a researcher can use to increase a study’s confirmability. already discussed were the benefits of member checking, peer debriefing, and audit trails. these strategies allow collaborators external to the research team an opportunity to evaluate or confirm the research procedures. in addition, negative case analysis is a strategy used when a researcher deliberately seeks contrasting evidence, a strategy commonly employed in a grounded theory approach (padgett, 2008). frankel (1999) suggests looking at “deviant cases” is “perhaps most important” when determining whether the qualitative researcher achieved an adequate look at the research question (p. 344). an example might include a researcher who is exploring diverse perspectives regarding immigration policy. if the sample included a group of citizens who favored a particular policy position, negative case analysis would require a researcher to continue recruitment into the study until alternative or contrasting perspectives were represented in the findings. negative case analysis is relevant not just during sampling but also throughout data analysis. it requires that analysts seek disconfirming evidence when analyzing their qualitative data. creswell and miller (2000) note that this strategy is especially useful for constructivist research. drisko (1997) suggests seeking contradictory evidence and diverse experiences is essential to achieving a complete or exhaustive exploration of a phenomenon. table 1 provides a summary of research strategies available to increase the trustworthiness of a qualitative research project. notwithstanding, no project is expected to employ all of these strategies. there may be some projects where triangulation seems particularly relevant, such as mixed-methods studies, whereas member checking may be critical in another, such as participatory inquiry. as one evaluates the quality of a qualitative project, while it is not necessary or even appropriate for a researcher to engage in all of the strategies provided in table 1, there should be evidence that the researcher addressed research reactivity/bias and enhanced credibility, transferability, auditability, and confirmability in accordance with the paradigmatic lens of the project (creswell & miller, 2000). lietz, zayas/evaluating qualitative research 198 table 1. research strategies for increasing trustworthiness of qualitative research reflexivity a thoughtful consideration of how a researcher’s standpoint can influence the research. observer triangulation using more than one researcher to analyze the data. data triangulation collecting data from multiple sources such as interviews, focus groups and interviews. prolonged engagement conducting multiple interviews or spending extended time with participants to achieve an exhaustive look at the experience. member checking including participants in analysis or returning to a sample of participants to corroborate the findings. thick descriptions a thorough representation of the phenomenon of inquiry and its context as perceived and experienced by study participants. audit trail keeping a detailed written account of the research procedures. peer debriefing meeting with mentors or other researchers engaged in qualitative research to dialogue regarding research decisions. negative case analysis seeking contrasting evidence through sampling and analysis. sources: lincoln and guba (1985); padgett (2008); shenton (2004) evaluating qualitative research for practitioners when evaluating qualitative research, lincoln and guba (1985) suggest researchers plan and conduct their studies seeking to achieve trustworthiness. trustworthiness is evaluated according to the degree to which the study is credible, transferable, auditable and confirmable. table 1 summarizes ten strategies researchers can use to increase the quality of their qualitative studies and table 2 provides a list of questions practitioners may ask to determine a study’s trustworthiness. important to remember is that not all strategies need to be utilized for a study to be trustworthy. it is for the reader to determine whether the strategies chosen align with the purpose, epistemological positioning, and design of the project, and whether they adequately manage threats to research reactivity and bias. in addition, evaluators of qualitative research articles should remain mindful of the impacts of these threats on both data collection and the analysis of the data. regardless of how rigorous data analysis strategies are, data collection procedures must first collect data that are authentic and as exhaustive as possible, taking a comprehensive look at an experience in spatio-temporal context. once a researcher has established that advances in social work, fall 2010, 11(2) 199 data are “thick” and complete, strategies are once again taken to ensure that analytic processes lead to an accurate representation of the participants’ perspectives. table 2. questions practitioners can ask to evaluate trustworthiness of qualitative research articles did the research study identify a paradigmatic lens or research tradition in the article? if there was no tradition, were the purpose and epistemological positions made clear? were the methods consistent with the tradition and/or purpose? how was research reactivity and bias managed in the study? what strategies were used to establish the credibility? how extensive or ‘thick’ were the descriptions supporting findings? was the context adequately described? were the findings applicable or useful for your population, setting or area of practice? was there evidence of an audit trail and/or peer consultation on the project? how did the researchers corroborate their conclusions? to what degree do you find the research procedures increased the trustworthiness of the findings? considering heightened expectations that social work practitioners are able to identify, evaluate, and use research in their practice, knowledge of research procedures has become an essential part of being a social work practitioner. rigorous qualitative research can offer important implications for social work practice. the 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(2001). validity in qualitative research. qualitative health research, 11(4), 522-537. author’s note: address correspondence to: cynthia a. lietz, school of social work, arizona state university, 411 n. central ave, suite 800, phoenix, az, 85004-0689. email: clietz@asu.edu   editorial i editorial william h. barton welcome to the spring 2009, volume 10(1) issue of advances in social work. the academic year has ended; for many of us, the summer brings a welcome change of pace, and a chance to devote time to those manuscripts that we’ve placed on the back burner. i encourage you to take this opportunity to add to the knowledge base of our profession, and to submit your work to advances. the journal’s online format makes submitting manuscripts quick and easy – just check out the author guidelines. you can view these by clicking on the word “about” at the top of the journal’s home page and scrolling down to the items under “submissions.” i assure you that we will continue to try to provide a quick turnaround for the peer reviews, even during the summer. if you happen to be reading this and have not yet registered with the journal, it’s free and easy to do. benefits include email notification whenever a new issue is published, the opportunity to serve as a peer reviewer for manuscripts received by the journal, and easy access to manuscript submission. just click on the word “register” at the top of the home page and provide the requested information. i encourage you to select the “reviewer” role and to include a list of review topics of interest to you as part of the registration process. the current issue contains a combination of research reports on a variety of topics using diverse methods, as well as several articles related to social work education. it begins with the report of a quantitative study by robin ersing, richard sutphen and diane loeffler, “exploring the impact and implications of residential mobility: from the neighborhood to the school.” this article examines the relationship between residential mobility among fifth graders and academic and disciplinary problems in school as well as protective services involvement. in “child welfare workers’ connectivity to resources and youth’s receipt of services,” washington university researchers alicia bunger, arlene stiffman, kirk foster and peichang shi use administrative and survey data to measure child welfare workers’ service actions on behalf of youth. their results suggest that child welfare service delivery to youth may be improved by training workers in the signs and symptoms of behavioral health problems and enhancing their awareness of other service providers in the community. a promising model of community-based groups connecting older adults with international exchange and multicultural students is described by scott anstadt and deb byster, in “intergenerational groups: rediscovering our legacy.” the authors frame these groups in a theoretical model of participatory, community-based outreach and then describe the process stages of the program’s development and some preliminary pilot outcomes. next, in “clinical social workers: advocates for social justice,” anne marie mclaughlin presents qualitative results from interviews with a sample of canadian clinical social workers regarding how they conceptualized and incorporated advocacy in their work. from the results, the author develops a matrix describing instrumental, _____________ william h. barton, pd.d., is a professor at the indiana university school of social work. copyright © 2009 advances in social work vol. 10 no. 1 (spring 2009), i-ii ii educational and practical advocacy strategies aimed at micro (individuals), mezzo (marginalized groups) and macro (society) targets. the last three articles address issues relevant for social work education. in “addressing the mental health problems of chinese international college students in the united states,” meirong liu systematically describes the specific sources of mental health problems and stressors facing chinese students in the united states and then presents several culturally sensitive recommendations for ways that health providers, mental health social workers, university faculty and staff can better serve these students. in the next article, “examining predictors of social work students’ critical thinking skills,” kathleen deal and joan pittman surveyed a sample of social work students at all three degree levels, looking at the relationship between background characteristics, personality factors, curricular choices and level of critical thinking skills. their results suggest that higher levels of critical thinking skills are found among students with more highly educated parents, personalities more open to experience, and a background in science courses. they also found that critical thinking skills were higher as academic degree level increased. in the final article, “addressing sexual minority issues in social work education: a curriculum framework,” lindsay gezinski advocates for the use of constructivist strategies to help students critically assess their own beliefs/attitudes, knowledge and skills to promote more culturally competent practice with the lesbian, gay, bisexual, transgender, and queer community. i ended my inaugural editorial in the previous issue with the hypothesis that no one reads the editorial in an issue of an online journal and invited readers to disprove it by sending me an email indicating that they had indeed read the editorial. so far, my hypothesis has not been disproven. to do so, send me an email at wbarton@iupui.edu. please also feel free to provide feedback about the journal’s format or contents. mailto:wbarton@iupui.edu spring2005-041_page43 spring2005-042_page44 spring2005-043_page45 spring2005-044_page46 spring2005-045_page47 spring2005-046_page48 spring2005-047_page49 spring2005-048_page50 advances vol. 4, no. 2 94 advances in socialwork booked for theweek: a survey of the use of bibliotherapy by licensed clinical socialworkers richvodde danny r. dixon martha m. giddings abstract: despite its general acceptance, there has been no research exploring the actual use of bibliotherapy by licensed clinical socialworkers (lcsws). this study sought to determine the extent to which lcsws, represented by a random sample from one state, used bibliotherapy for specific problems, identified relevant variables that influence bibliotherapy use,and compiled a list of books currently used by respondents. results suggest that bibliotherapy is used for numerous specific problems and lcsw endorsement of bibliotherapy by lcsws is similar to that of respondents in other disciplines. unlike studies involving other disciplines, lcsw usage patterns were not related to gender and less related to employment settings. keywords: bibliotherapy, self-help, clinical socialwork,behavior change the prevalence of books on the topic of self-improvement is apparent to those who spend time in the burgeoning “self-help” sections of popular bookstores. likewise, an examination of recent lists of non-fiction best sellers attests to strong consumer interest in self-help through reading. individuals in the helping professions have noted the value of therapeutic reading, otherwise known as bibliotherapy (riordan &wilson, 1989). in fact, there appears to be an increase in clinicians’ use of bibliotherapy (riordan &wilson, 1989; starker, 1988) both in a wide range of clinical settings and with a wide array of problems (pardeck, 1998). bibliotherapy has been defined as“using books in clinical intervention” (pardeck & pardeck, 1984, p. ix), although the literalmeaning of the term is “to treat through books” (p. 241). bibliotherapy can be described as the prescription and/or recommendation of particular books to clients, followed by subsequent reading, for the purpose of ameliorating the effects of particular problems. the technique can be used “to provide information, to provide insight, to stimulate discussion about rich vodde, ph.d. is associate professor, division of social work, valdosta state university, valdosta, ga 31698; danny r. dixon, ph.d. is assistant professor, georgia southern university, statesboro, ga 30460; martha m. giddings, ph.d. is associate professor, division of social work, valdosta state university, valdosta ga 31698. copyright© 2003 advances in socialworkvol. 4 no. 2 (fall 2003) 94-114. indiana university school of socialwork. 95 problems, to communicate new values and attitudes, to create awareness that others may have similar problems, to provide solutions to problems and to provide realistic solutions to problems” (pardeck, 1998, p. 5). although bibiliotherapy is sometimes used as a stand-alone treatment approach, it is used most often as an adjunct to other forms of direct treatment. despite the popularity of bibliotherapy, there are few studies of its use by practitioners andno studies that can be found in the area of clinical social work practice. with this inmind, the authors have engaged in research to examine the prevalence and usage patterns of bibliotherapy by licensed clinical social workers in a southern state. there will be a brief review of the empirical literature on this topic, and the results and implications of the current study will be presented. appended to the article is a list of booksmost commonly used by clinical social workers.this list is divided according to specific problem area. reviewofthe literature effectiveness of bibliotherapy the efficacy of bibiliotherapy as an adjunct for helping individuals change their behavior in a number of different areas has been amply demonstrated over the last 20 years (pardeck, 1998). bibliotherapy has been found to be effective in the treatment of panic disorder (lesser, 1991; lidren, et al., 1994), relapse prevention in panic disorder (wright, clum, roodman & febbraro, 2000), depression, (cuijpers, 1997), depression in the elderly (guirguis, 2001), children’s behavior (klingman, 1985), health-related problems (starker, 1992), cancer (pardeck, 1992), insomnia (mimeault & morin, 1999), childhood aggression (shechtman, 1999), self-harm in children (evans, et al., 1999), the effects of separation and divorce on children (pardeck & pardeck, 1983), agoraphobia (gould, clum & shapiro, 1995), personality changes (ellis, 1993), and attention deficit disorder (long, rickert & ashcraft, 1993). halliday (1991) reported that 43% (n=43) of adult clients entering psychotherapy for the first time had read at least one self-help book prior to their first appointment. of this number, 86% (n=37) reported that they had benefited from the readings. after reviewing numerous studies of bibliotherapy, riordan and wilson (1989) discoveredmixedresults regarding itsuseasaprimaryclinicalapproachtoworkingwith clients. however, those same authors state that “bibliotherapy is a tool—among many—to be usedwhen it can contribute to overall satisfactory outcome” (p. 507). more recently, a meta-analysis of 70 samples used in studies of bibliotherapy revealed that bibliotherapy is as effective as therapist-administered treatmentwith a mean effect size of +0.565 (marrs, 1995). such effect sizes fall within the range of medium effect sizes as defined by cohen (1988), suggesting that bibliotherapy is a significant factor in treatment when used. use of bibliotherapy by professionals despite the attention given to the effectiveness of bibliotherapy, patterns of use by practitioners have received less attention. starker (1988) administered a questionnaire to psychologists in sandiego and boston (n=268) surveying “attitudes, experiences and prescriptive practices in the matter of self-help books” (p. 143). there vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers 96 was a 44% return rate resulting in a total of 119 usable questionnaires. using a fivepoint likert-type scale (ranging from harmful to often helpful), on a global rating of general helpfulness, 60.5% (n=72) reported that self-help books were somewhat helpful as an adjunct to therapy and 5.9% (n=7) found them to be often helpful. sixty percent (n=73) prescribed self-help books to clients. among the latter group, 53% did so occasionally, 7% regularly, and 9% often. parenting was the area most frequently reported for book prescription (54.8%), followed by personal growth (39.7%), and relationships (38.4%). quackenbush (1991) examined books that were most commonly prescribed for particular problems and created a subject index in order to survey 100 universityaffiliated counseling psychologists across the united states. approximately 47 usable questionnaires were returned, enabling compilation of an extensive bibliography of books organized by problem area. no further univariate or bivariate analyses were reported. marks, gyorky, royalty and stern (1992) investigated the use of bibliotherapy among practicing psychologists (n=209). they found that the vast majority of psychologists (88%) reported using bibliotherapy with at least 1% of their clients. of the group who reported using bibliotherapy, 55.5% (n=100) used bibliotherapy only rarely (defined as ranging from 1% to 25% of clients), 19% (n=34) used it sometimes (defined as ranging from26% to 50%of clients), 10%used it often (with 51% to 75% of clients), and 3.4% (n=6) always used it. additionally, the researchers found that female practitioners were more likely to use bibliotherapy than males and that psychologists in private practice were more likely to use bibliotherapy compared to psychologists in other employment settings. santrock, minnett and campbell (1994) attempted to determine those books that weremost often used by practitioners and found to bemost helpful. to do so, they compiled an extensive list of specific book titles in a questionnaire format. approximately 4,000 members of the american psychological association (apa) were asked to rate books that they used in practice. only 600 (15%) fully usable questionnaires were returned. the authors compiled the results of their survey in a text that provided a comprehensive list of books according to subject area and frequency of use. recently, adams and pitre (2000) assessed the use of bibliotherapy by mental health practitioners. they surveyed all mental health practitioners within a rural community (n=112) in order to determine reasons for the use of bibliotherapy and also the types of books recommended. among the 62 questionnaires returned, 68%of the practitioners reported using bibliotherapy.the authors anticipated that counselors with larger caseloads would use bibliotherapy more frequently compared to those with smaller caseloads. they also anticipatedmore use of books by paraprofessionals than professionals. neither hypothesis was supported. however, counselors with more years of practice experience tended to be significantly more likely (p<0.05) to utilize bibliotherapy with clients compared to those with less practice experience. counselors indicated that the major reasons for using the technique were to encourage self-help, enhance therapy, and respond to client requests for reading material. advances in socialwork 97 in an attempt to update a survey conducted by santrock, minnett and campbell (1994), norcross, et al. (2000) developed a revision of the original questionnaire that included anupdated list of self-help bookswith the addition of three new subject areas, schizophrenia, attention deficit hyperactivity disorder, and dementia/alzheimer’s disease. aswith the original study, an attemptwasmade to randomly sample psychologists who were current members of the apa. two discrete surveys, each with a different set of 15 problem areas, were mailed to groups of 1,500 randomly selected psychologists comprising a total of 3,000 respondents. respondents were asked to evaluate specific books in each area using a five point likert-type scale ranging from extremely good to extremely bad. researchers reported a response rate of 22% and 25% for the two samples in which a total of 57%weremale and 43%were female.twenty eight percent (n=192) identified their theoretical orientation as cognitive, 28% (n=188) were eclectic, 16% were psychodynamic (n=107), and 10% (n=67) identified themselves as behavioral. approximately 42% (n=284) were engaged in private practice and 25% (n=166) were affiliated with universities. among respondents to both surveys, global ratings of helpfulness indicated that 19% rated bibliotherapy as very helpful, whereas, 74% found it somewhat helpful. no bivariate comparisons involving respondents were noted. the complete ratings of individual books by subject area likewise were included. as suggested by the review of the studies cited above, most of the bibliotherapy research has focused on compiling and evaluating lists of books for use in specific problem areas. some attention has been given to exploring practitioners’ usage patterns, including reasons for use, extent of use, and relations between demographic variables and use. few of the studies reported bivariate data and none reported practitioners’ reasons for excluding bibliotherapy. more importantly, the research review indicates that the above studies have tended to sample clinical psychologists, counseling psychologists, or generic mental health practitioners. use of bibliotherapy by socialworkers pardeck (pardeck, 1991; pardeck & pardeck, 1984) has been a consistent advocate for the use of bibliotherapy within the profession and has pointed to the need for continued research into the use of bibliotherapy (pardeck, 1998). however, despite the recognized prevalence of bibliotherapy, the authors were able to find only 14 citations for bibliotherapy in social work abstracts. of these, eight were by the same authors (pardeck, 1991; pardeck & pardeck, 1984) and none presented evidence of use by social workers obtained through inquiry. addressing the need for research on the deployment of bibliotherapy by social workers, the authors undertook the present investigation. this inquiry: 1) determined the extent to which clinical social workers in one state used bibliotherapy; 2) appraised their perceptions of its effectiveness and value; 3) explored their patterns of usage; 4) explored the effects of age, gender, practice experience, andpractice setting on usage; and 5) compiled and classified volumes used by the practitioners. in an attempt to add to the existing literature on usage and deployment, the authors incorporatedmethodological strategies, variables, and research questions from previous research in this area. vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers 98 method in addition to demographic data, the survey included a combination of questions requiring likert-type responses, categorical responses, and written responses in which subjects were asked to supply specific information regarding their use of particular books or readings. questions requiring likert-type responses asked respondents to evaluate the frequency of their use of bibliotherapy, the perceived value of bibiliotherapy, and their perception of its effectiveness. answers requiring categorical responses highlighted demographic data including area of practice specialization, employment setting, and problem focus. similar to previous surveys, themajor body of the questionnaire presented respondents with 30 possible problem areas such as depression, relationship problems, parenting, schizophrenia, developmental issues, career issues, personal growth, and physical illness. because the survey was designed to identify books that practitioners use rather than evaluate particular books, researchers decided to omit a list of specific book titles. rather, each topical area was presented with sufficient space for respondents to write in the names of books and authors that they used in the particular area. problem areas were determined using templates fromprevious studies and a review of the literature. completion of the questionnaire took from 25 to 70 minutes, depending on the number of books and categories that respondents reported. subjects were selected by using a randomly generated list of licensed clinical social workers purchased from a statewide nasw database of licensed clinical social workers. one thousand questionnaires weremailed to names on the list and no follow-up mailings were used. one thousand surveys were mailed out, and of these, 417 were returned as undeliverable. of the remaining 583, 122 questionnaires were returned and 107 were usable. the low rate of response (21%) was of some concern to the researchers. however, as is apparent in the aforementioned studies, low response rates tend to be common in this area, and other studies on bibliotherapy likewise have relied on samples within a similar range. of the 107 usable questionnaires, females completed 81, 23 were completed by males, and three were of unspecified gender. in terms of race and ethnicity, 95 respondents were caucasian (89%), 11 african-american (10%), and 1 hispanic. the age of respondents ranged from 30 to 67, with a mean age of 49 years and median of 50. the average age for themales was 53.7 and 47.4 for the females. the mean number of practice years was 19.1, with amedian of 18 and average years of clinical licensure was 10.8. for males, the average number of practice years was 24.8 compared to 17.7 for females. themost common area of practice was private practice (40.2%, n=43), followed by mental health (23.4%, n=25), and medical social work (9.3%, n=10). the values for age, gender, and race/ethnicity in this sample are quite similar to those in the most recent samples of nasw members (gibelman & schervish, 1997; nasw, 2003). however, themedian years of respondents' practice experiencewas slightly higher than the 16 years reported fornasw members (nasw, 2003). likewise, practitioners in private practice were over-represented in comparison with nasw reports of 25%, andmental health practitioners were under-represented in contrast to the 39% reported by nasw (nasw, 2000). advances in socialwork 99 analysis andresults because the purpose of the study was to determine the extent to which social workers in one state used bibliotherapy, areas in which bibliotherapy was used, and identification of the most frequently used readings, data analysis was both quantitative and qualitative. quantitative analysis consisted mainly of univariate data. based on the literature review, the authors formulated only three a priori hypotheses requiring bivariate analyses: 1) female licensed clinical social workers (lcsws) would value and use bibliotherapy more than males; 2) lcsws with more practice experience would use bibliotherapy more frequently than less experienced workers; and 3) lcsws in private practice would use bibliotherapy more often than those engaged in other employment settings. usage,value, and effectiveness among all respondents, 86% (n=93) reported using bibliotherapy at least once. seven and one-half percent (n=8) rated using the technique almost always, 30.8% (n=33) frequently, 33.6 % (n=36) occasionally, 13.9% (n=16) infrequently, and 12% (n=13) never used bibliography. among those clinical social workers using bibliography infrequently or almost never, reasons for the low rate of use were examined. the major reason for the low use given by 38.4% of respondents (n=10) was that their clients could not read the resources. a second reason given by 34.6% (n=9) indicated that the social workers did not believe that their clients would read the material. fifteen percent (n=16) of respondents reported bibliotherapy to be greatly effective, 51% (n=55) moderately effective, 21% (n=23) mildly effective, and 11% (n=12) ineffective. bibliography was found to be of unlimited value to 4.5% (n=5), 42% (n=45) reported it to be very valuable, 45% (n=48) found it to be of limited value, and 6.5% (n=7) found it to be of little or no value. patterns of use thirty-one percent of respondents (n=32) used a single book in more than one area. in other words, they used one book for at least two different types of problems. however, only 13 books were used more than once, indicating that more than half of those using one book in more than one area were relying on the same titles. in comparison, 18.5% of the respondents (n=20) usedmultiple books (ranging from 2 to 7) in a single area. more than 30% of respondents used texts in each of the following seven areas: 1) co-dependency and acoa, 2) anxiety/anxiety disorders, 3) non-specific relationship problems, 4) anger management, 5) intimacy issues, 6) grief and loss, and 7) depression. table 1 provides frequencies of respondents using a book in each problem area. types of books the respondents listed a total of 229 different book titles. in surveys of this type, there is typically no distinction among types of self-help titles. for example, some titles may be more informative than prescriptive, whereas, others may be more inspirational. the authors wished to attempt such a classification. to do so, two of the authors independently examined all of the titles and their synopses using existing comprehensive reviews of self-help books (pardeck, 1998; norcross, et al., vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers 100 advances in socialwork type of problem total % of sample used percentage of addressed book (used at least one sample used book in area) more than one books area acoa/codependency 34 (n=35) 13.6 (n=14) issues anxiety 34 (n=35) 4.9 (n=5) relationship problems 34 (n=35) 11.7 (n=12) anger management 33 (n=34) 7.8 (n=8) intimacy issues 31.1 (n=32) 6.8 (n=7) grief and loss 30.4 (n=31) 8.8 (n=9) depression 30.4 (n=31) 4.8 (n=5) parenting 29.1 (n=30) 12.7 (n=13) incest/shame/recovery 28.2 (n=29) 5.9 (n=6) child abuse 26.2 (n=27) 3.8 (n=4) self-esteem and/or self-worth issues 25.3 (n=26) 7.8 (n=8) alcohol and/or drug abuse 23.4 (n=24) 1.9 (n=2) personal growth 21.4 (n=22) 4.9 (n=5) divorce and/or separation 18.5 (n=19) 7.8 (n=8) assertiveness training 18.5 (n=19) .9 (n=1) bipolar illness 17.5 (n=18) 1.8 (n=2) rape/sexual assault 16.5 (n=17) .9 (n=1) career issues 15.5 (n=16) 3.9 (n=4) developmental issues 15.5 (n=16) 2.9 (n=3) family problems 14.6 (n=15) 4.9 (n=5) perfectionism and/or obsessive 13.6 (n=14) 3.9 (n=4) compulsive behavior suicide 13.6 (n=14) .9 (n=1) values/goals 13.6 (n=14) 4.9 (n=5) women’s issues 13.6 (n=14) 1.9 (n=2) men’s issues 12.6 (n=13) 3.9 (n=4) domestic violence 12.6 (n=13) 2.9 (n=3) care-giving 11.7 (n=12) 2.9 (n=3) sexual dysfunction 11.7 (n=12) 2.9 (n=3) ptsd 11.7 (n=12) .9 (n=1) aging 9.7 (n=10) 2.9 (n=3) academic issues 8.8 (n=9) 3.9 (n=4) weight concerns 7.7 (n=8) .9 (n=1) minority issues 5.8 (n=6) 1.9 (n=2) sexual abuse 5.8 2.9 (n=3) mental illness (including 4.9 (n=5) 1.9 (n=2) schizophrenia) table 1: percentage of respondents using books in each problem area and percentage of respondents using more than one book in a particular area 2000). those titles not contained in existing compendiums were further examined through the use of a bookseller’s publication index on the world wide web (www.amazon.com). the authors then compared classifications using a threegroup classification system, self-help, educational, and inspirational. disparities were resolved with consensus. one hundred and sixty-one of the books examined appear to be practical, manualized, behavioral-oriented books, supplying prescriptions and “how-to” information. although providing material that was educational and informative, these books appeared to focus primarily on facilitating actual change, with titles containing descriptors such as “how to,” “step-by-step,” “guide,” “workbook,” “behavior,” and “practical strategies.” fifty-three of the titles were more generally “educational,” containing information and data on a specific topic such as co-dependency or bipolar illness. fifteen titles were determined by the authors to be inspirational. these titles contained material that was typically comforting, spiritually uplifting, or focused on overcoming adversity. several of these titles were autobiographical. only nine of the 229 titles were fictional. seven were written for children on particular topics such as anger and were classified as educational. not surprisingly, the list contained numerous titles that were popular bestsellers. hypotheses testing males and females were compared on a number of demographic variables including race and ethnicity, area of practice, problem focus, age, years of practice, and years of licensure. they differed significantly only on the dimensions of age f(47.4)=3.43 p=.001, and practice experience f(101)=3.75 p=.000, withmales being older and having more practice experience. for this reason, any gender group comparisons on bibliotherapy were made controlling for both age and years of practice experience. results indicated that there were no differences between male and female social workers’ use of bibliotherapy, their perceived value of bibliotherapy, or the perceived effectiveness of bibliotherapy when age and years of experience were held constant. a one-way analysis of variance was conducted comparing lcsws in a variety of employment settings including private practice. comparisons were made among lcsws in the following employment settings: private practice (n=43), medical/hospital social work (n=10), family and children services (n=12), mental health services (n=25), and“other,” which includes corrections, school social work, 101vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers social skills training 3.8 (n=4) 0 medical issues 2.9 (n=3) 1.9 (n=2) sexual identity issues 2.9 (n=3) 1.9 (n=2) adoption 1.9 (n=2) 0 boundary issues 1 (n=1) 1 (n=1) empathy 1 (n=1) 1 (n=1) isolation/loneliness 1 (n=1) 1 (n=1) table 1: percentage of respondents using books in each problem area and percentage of respondents using more than one book in a particular area (cont.) 102 eap, and university settings (n=10). a significant difference was found among the groups, f(4, 95)=3.00, p=.022. post hoc pairwise comparisons were conducted using a bonferroni test that controls for overall experimental error by dividing the experiment-wise error rate by the total number of tests for each comparison. despite homogeneity of variance, the differences in sample size required employing the harmonic mean of the two groups in each comparison as the sample size estimate. results indicated that the only difference was between those in private practice and those employed in medical/hospital social work. it was also hypothesized that social workers with more years of practice experience would find bibliotherapy to be more effective, more valuable, and would use the techniquemore frequently than those with fewer years of practice experience. because age was found to have a significant interaction in the preceding tests of difference, age was included as a second variable in the analyses. not surprisingly, age and years of practice were found to be significantly correlated, r=.623, p=.000. for this reason, the researchers wished to determine which of the two predictors had the greater predictive power on each of the three criterion variables. multiple regression analyseswere conducted in order to predict the perceived effectiveness, perceived value, and the degree of bibliotherapy use from the amount of prior practice experience of the respondents. in these equations, years of practice experience was the predictor variable. the degree to which respondents found bibliotherapy to be effective, valuable, and the degree to which respondents reported using bibliotherapy served respectively as the criterion variables on the three analyses. the results of the analyses indicated that previous years of practice experience was not a significant predictor of perceived effectiveness of bibliotherapy, perceived value of bibliotherapy, or the degree to which respondents used bibliotherapy. a second series of analyses were conducted to evaluate whether respondents’ age predicted perceived effectiveness, value, and use of bibliotherapy over and above years of practice experience. age accounted for a small but significant proportion of the variance in the respondents’ perception of bibiliotherapy’s effectiveness, r_=.077, r_ change =.053, f (2, 100)=5.1, p=.018, and the degree to which respondents valued bibliotherapy, r_=.078, r_ change =.06, f (2, 100)=6.5, p=.012. age accounted for only 3% of the variance in the degree to which respondents used bibliotherapy, r_=.03, t (2, 100)=-1.7, p=.07. perhaps more significant than the predictive power of age is the direction of the relationship. reverse slopes for effectiveness, b=-.29, value, b=-.31, and use, b=-.22 indicate that younger workers perceive bibliotherapy to be more effective, value it more, and use it more than older workers. discussion results suggest that bibliotherapy use, as endorsed by the lcsws in this sample, is perceived by respondents to be an effective and valued adjunctive tool in clinical encounters. reports of usage (86%) exceeded most other studies and were comparable to rates (88%) reported by marks, et al. (1992). notably, the reasons most cited for not using bibliotherapy suggest that practitioners avoid using bibliotherapy because of their doubts that thematerial will be read rather than doubts about its usefulness. advances in socialwork 103 frequencies of use according to problem area suggest that clinical social workers use bibliotherapy for numerous problems. not surprisingly, bibliotherapy use for both anxiety and depression appears high, perhaps reflecting the pervasiveness of both problems and general awareness of the problems as well as the popularity of cognitive treatment approaches for both. perusal of table 1 also suggests that bibliotherapy may often be used for problems that appear to be more interpersonal in nature (such as co-dependency, relationship and intimacy issues, parenting, and grieving). the list suggests usage in areas similar to the findings of others. it also appears to reflect usage in areas wherein consumer familiarity with issues may be more common. findings also suggest that a moderate number of clinicians may judge a single book to have utility and value in more than one problem area. in the future, bibliography surveys might consider rating books on the construct of "impact." importantly, nearly 20% of the respondents (n=20) reported that they used from two to seven books for a particular problem. this finding suggests that some practitioners have considerable familiarity with numerous books in specific problem areas. likewise, a future construct for consideration in such a surveymight be bibliotherapy “saturation” in a particular area. overall, it appears that clinical social workers endorse a preference for practical, action-oriented titles that promote some formof behavior change.this type of use is similar to usage schemes that are considered by others to be effective methods of bibliotherapy practice (pardeck, 1998). unlike others’ findings regarding gender differences (marks, et al., 1992), male and female social workers appear to approach bibliotherapy similarly. also, the difference in use of bibliotherapy between social workers in private practice and those not in private practice is accounted for solely by the difference between private practitioners and those employed in medical/hospital settings. the finding suggests that social workers employed in areas such as family and children services andmental health servicesmay not differ fromprivate practitioners in their use of bibliotherapy. one suspects that the significant difference found between private practice and medical/hospital settings may reflect a more narrow healthrelated focus in themedical setting, wherein, many of the specified problemsmay be encountered or identified less often.the lack of a relationship between practice experience and bibliotherapy use in addition to an unanticipated inverse relationship with age suggest that bibliotherapy use may be a more recent phenomenon in clinical social work practice than in psychology. the paucity of studies on the use of bibliotherapy by social workers, when compared to deployment studies by psychologists, tend to support this conjecture. limitations there are notable limitations to this inquiry. although a random sample was employed, it was drawn from a list of lcsws in one southeastern state. furthermore, the response rate (21%)was quite low. it is possible that the length of the questionnaire and the inability to use any follow-up mailings to stimulate response may have attenuated the response rate. however, the high number of respondents who reported using bibliotherapy (86%) in conjunction with the low vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers 104 rate of response suggests a response bias favoring those who employ bibliotherapy in their work. the percentage of respondents who found bibliotherapy to be of great value (46.5%) would indicate that those who responded were fervent in their opinions regarding its use. also, the over-representation of private practitioners and the under-representation of mental health workers, in comparison with nasw membership, restrict generalizations and could indicate an inflated number of returns by those favoring bibliotherapy. consequently, amajor question that remains unanswered is the degree towhich the results of this survey reflect the use of bibliotherapy within the general population of licensed clinical social workers. thus, generalizations are discouraged. nonetheless, it is noted that other surveys of this kind have used samples of this size and have also reported similar response rates. in addition, measurement of effectiveness is limited to the global perceptions of respondents. this is problematic for several reasons: 1) exclusion of treatment recipients’ appraisals restricts any assessment of treatment effectiveness; 2) similarly, self-reports often tend to be biased favorably and perceptions are subject to distortion (miller & ross, 1975). in cases where practitioners favor a particular intervention, it is possible that the perceptions of the intervention’s success are a function of a self-serving bias (fiske &taylor, 1991); 3) empirical verification or corroboration of effectiveness warrants the scientific rigor found in experimental designs, wherein, participants are randomly selected and bibliotherapy is randomly assigned as an addition to a standardized treatment. as a result, the nature of this study must be considered exploratory and the results considered prudently. more importantly, the lack of research on usage patterns of bibliotherapy in social work underscores the need for additional studies of this kind and outcome research. conclusions this study sought to explore the use of bibliotherapy by clinical social workers and compile the resources used in their efforts. results suggest that the lcsws in this survey strongly endorsed the use of bibliotherapy, its value, and its effectiveness. it would appear that the general endorsement of bibliotherapy by lcsw respondents in the study is similar to that of respondents from other disciplines represented in previous studies of this type. however, specific hypotheses regarding usage patterns related to gender, practice experience, and employment settings that are supported in other studies were not corroborated in this study. with the notable exception of younger social workers using bibliotherapy more than older social workers, the findings suggest that patterns of usage among lcsws aremore evenly distributed between males and females. bibliotherapy has been proven to be a viable and effective adjunct in clinical settings. as with other practice interventions, it is important that there is more empirical data to support its use and it is essential to learn more about its use within the profession. if more social workers are to use bibliotherapy, theywill require access to the practical knowledge and resources of experienced colleagues. advances in socialwork 105 references adams, s.j., & pitre, n.l. 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(1994). a comparison of bibliotherapy and group therapy in the treatment of panic disorder. journal of consulting and clinical psychology, 62, 865-869. long, n., rickert, v., & ashcraft, e. (1993). bibliotherapy as an adjunct to stimulant medication in treatment of attention-deficit hyperactivity disorder. journal of pediatric health care, 7, 82-88. marks, j.a., gyorky, z.k., royalty, g.m., & stern, t.e. (1992). use of self-help books in psychotherapy. professional psychology: research and practice, 23(4), 300-305. marrs, r.w. (1995). a meta-analysis of bibliotherapy studies. american journal of community psychology, 23(6), 843-870. miller, d. t., & ross, m. (1975). self-serving biases in the attribution of causality: fact or fiction? psychological bulletin, 82, 213-225. mimeault,v., &morin, c.m. (1999). self-help treatment for insomnia: bibliotherapywith andwithout professional guidance. journal of consulting and clinical psychology, 67(4), 511-519. nasw. (2003, february). membership profile sees little change.nasw news, 48(2), 9. nasw. (2000). nasw practice research survey 2000. nasw practice research network, 1. 3. retrieved september 8, 2003 from: http://www.socialworkers.org/naswprn/default norcross, j.c., santrock, j.w., campbell, l.f., smith, t.p., sommer, r., & zuckerman, e.l. (2000). authoritative guide to self-help resources in mental health. newyork: the guilford press. pardeck, j.t., & pardeck, j.a. (1983). using bibliotherapy in social work practice with children of separation and divorce. arete, 8(2), 10-17. pardeck, j.a., & pardeck, j.t. (1984). an overview of the bibliotherapeutic treatment approach: implications for clinical social work practice. family therapy, 11(3), 241-252. pardeck, j.t. (1991). bibliotherapy and clinical social work. journal of independent socialwork, 5(2), 53-63. pardeck, j.t. (1992). bibliotherapy and cancer patients. family therapy, 19(3), 223-232. vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers 106 pardeck, j.t. (1998). using books in clinical social work practice: a guide to bibliotherapy. new york: the haworth press. quackenbush, r.l. (1991). the prescription of self-help books by psychologists: a bibliography of selected bibliotherapy resources. psychotherapy, 28(4), 671-677. riordan, r.j., &wilson, l.s. (1989). bibliotherapy: does it work? journal of counseling and development, 67, 506-508. santrock, j.w., minnett, a.m., & campbell, b.d. (1994). the authoritative guide to self-help books. new york: guilford press. shechtman, z. (1999). bibliotherapy: an indirect approach to treatment of childhood aggression. child psychiatry and human development, 30(1), 39-53. starker, s. (1988). do-it-yourself therapy: the prescription of self-help books by psychologists. psychotherapy, 25(1), 142-146. starker, s. (1992). self-help books: ubiquitous agents of healthcare. medical psychotherapy: an international journal, 3, 187-194. wright, j., clum, g.a., roodman, a., & febbraro, g.a.m. (2000). a bibliotherapy approach to relapse prevention in individuals with panic attacks. journal of anxiety disorders, 14(5), 483-499. appendix bibliotherapy resources accordingto area academic problems/concerns/study skills/timemanagement allen, d. (2001). getting things done: the art of stress-free productivity.newyork: viking press. bradshaw, j. (1992). homecoming: reclaiming and championing your inner child. new york: bantam books. buzan, t. (1991).use both sides of your brain (3rd ed.). newyork: e. p. dutton. covey, s.r. (1990). the seven habits of highly effective people.newyork: simon & schuster. flick, g.l. (1997). add/adhd behavior change resource kit: ready to use strategies and activities for helping children with attention deficit disorder. san francisco: jossey-bass publishers. hallowell, e.m., & ratey, j.j. (1995).driven to distraction:recognizing and coping with attention deficit disorder from childhood through adulthood.newyork: touchstone books. mooney, j., & cole, d. (2000). learning outside the lines: two ivy league students with learning disabilities and adhd give you the tools for academic success and educational revolution.newyork: fireside press. radencich,m.c., schumm, j. s., & espeland, p. (eds.). (1997).how to help your childwith homework:every caring parent’s guide to encouraging good study habits and ending the homework war.minneapolis,mn: free spirit publishing. rechtshaffen, s. (1997). time shifting: creating more time to enjoy your life.newyork: doubleday. acoa/codependence/family dysfunction al anon family group. (1988). one day at a time in al-anon.houston, tx: al anon. beattie, m. (1996). beyond codependency: and getting better all the time. center city, mn: hazelden information education. beattie, m. (1996). codependent no more: how to stop controlling others and start caring for yourself. center city, mn: hazelden information education. black, c.a. (1982). “my dad loves me, my dad has a disease:” a workbook for children of alcoholics (10th ed.). denver, co: medical administration company. bradshaw j. (1996). bradshaw on the family: a new way of creating solid-self esteem. deerfield beach, fl: health communications. cloud, h., & townsend, j. (1992). boundaries (rev. ed.). grand rapids, mi: zondervan publishing house. ellis,a., &velten , e. (1998). optimal aging. chicago, il: open court publishing company. advances in socialwork friedan, b. (1994). the fountain of age.newyork: touchstone books. friel, j.c., & friel, l.d. (1990). an adult child’s guide to what’s normal. deerfield beach, fl: health communications. friends in recovery. (1996). 12 steps for adult children. san diego: recovery publications. grollman, e.a., & kosik, k.s. (1997). when someone you love has alzheimer's: the caregiver's journey. boston, ma: beacon press. gruetzner, h. (2001). alzheimer's: a caregiver's guide and sourcebook (3rd ed.). newyork: johnwiley & sons. leite, e., & espeland, p. (1989).different like me: a book for teens who worry about their parent’s use of alcohol/drugs.minneapolis, mn: johnson institute. mace, n., &. rabins, p.v. (2001). the 36 hour day (rev. ed.). newyork:warner books. manning, d. (1983).when love gets tough: making the nursing home decision.oklahoma city, ok: in sight books. pipher, m. (2000). another country: navigating the emotional terrain of our elders. new york: riverhead books. silverstone, b. (1990). you and your aging parent (3rd ed.). newyork: pantheon books. vanvonderen, j. (1992). families where grace is in place.minneapolis, mn: bethany house. woititz, j.g. (1986). struggle for intimacy. pompano beach, fl: health communications. woititz, j.g. (1990). adult children of alcoholics.deerfield beach, fl: health communications. add/adhd gehret, j., & covert, s. (1996). eagle eyes: a child’s guide to paying attention.newyork: verbal images press. gordon, m. (1991). jumpin’ johnny get back to work! a child’s guide to adhd/hyperactivity.newyork: gsi publications. adoption rosove, l. (2001). rosie’s family: an adoption story.ontario: asia press. schooler, j.e. (1993). the whole life adoption book: realistic advice for building a healthy adoptive family. colorado springs, co: navpress publishing group. alcohol/drug problems alcoholics anonymousworld services. (1991). alcoholics anonymous big book. aaworld services. carnes, p. (1989). gentle path through 12 steps.minneapolis, mn: compcare pub audio. ferguson, t. (1998). the no-nag, no-guilt, do-it-your-own way guide to quitting smoking. new york: ballantine books. gorski, t.t. (1992). the staying sober workbook (rev. ed.). independence, mo: herald publishing house. may, g.g. (1991). addiction and grace. san francisco: harper san francisco. toby d. (1989). getting them sober:you can help! (3rd ed.). san diego, ca: recovery communications. anger management bosch, c.w., & strecker, r. (1988). bully on the bus. seattle,wa: parenting press. boulden, j., & boulden, j. (1994). push and shove: bully and victim activity book.weaverville, ca: boulden publishing. duncan, r. (1989).when emily woke up angry.hauppauge, newyork: barrons juveniles. lerner, h.g. (1997).the dance of anger: a woman’s guide to changing the patterns of intimate relationships. newyork: harpercollins. masters, a. (1992). the angry child. santa monica, ca: psychiatric hospital division of national medical enterprises, inc. 107vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers mckay, m., mckay, j., & rogers, p. (1997).when anger hurts.oakland, ca: fine communications. potter-effron, p., & potter-effron, r. (1995). letting go of anger.oakland, ca: new harbinger publications. preston, e.m., & bennett, r. (1976). the temper tantrum book.newyork: viking press. shapiro. (1995). sometimes i like to fight, but i don’t do it much anymore: a self-esteem book for children with difficulty in controlling their anger (our sometimes). plainview, ny: childswork/childsplay. shapiro, l. (1994). the very angry day that amy didn’t have. plainview, ny: childswork/childsplay. warren, n.c. (1999).making anger your ally.wheaton, il: tyndale house. anxiety/stress management blanchard, k.h., & johnson, s. (1998).who moved my cheese? an amazing way to deal with change in your work and in your life.newyork: putnam publishing group. bourne, e.j. (2000). the anxiety & phobia workbook (3rd ed.). oakland, ca: new harbinger publications. cameron, j. (2002). the artist’s way: a spiritual path to higher creativity (10th ed.). los angeles, ca: j.p. tarcher. carlson, n. (1991). take time to relax.newyork: viking press. craske, m.g. (1992).mastery of your anxiety and worry: client workbook. san antonio, tx: psychological corporation. davis, m., eshelman e.r., & mckay, m. (2000). the relaxation and stress reduction workbook (5th ed.). oakland, ca: new harbinger publications. garth, m. (1991). starbright, meditations for children. san francisco: harper san francisco. matsakis, a. (1996). i can’t get over it: a handbook for trauma survivors (2nd ed.). oakland, ca: new harbinger publications. peurifoy, r.z. (1995). anxiety, phobias, and panic: a step-by-step program for regaining control of your life. newyork:warner books. viorst, j. (1987). alexander and the terrible, horrible, no good, very bad day. oakland, ca: new harbinger publications. wilson, p. (1999). instant calm: over 100 easy-to-use techniques for relaxing mind and body. new york: plume. assertiveness/social skills davis, m., eshelman, e., & mckay, m., (2000). the relaxation & stress reduction workbook. oakland, ca: new harbinger publications. gabor, d. (1994). speaking your mind in 101 difficult situations.newyork: fireside press. goldstein, a.p., & mcginnis, e. (2000). skillstreaming the elementary school child: new strategies and perspectives for teaching prosocial skills (rev. ed.). champaign, il: research press. mckay, m., davis, m., & fanning, p. (1983). messages: the communication book. oakland, ca: new harbinger publications. smith, m.j. (1975).when i say no, i feel guilty.newyork: bantam books. bipolar disorder duke, p., pinckert, m.l., & hochman, g. (1993). a brilliant madness: living with manic-depressive illness. newyork: bantam books. papolos, d., & papolos j., (2002). the bipolar child: the definitive and reassuring guide to childhood’s most misunderstood disorder.newyork: broadway books. career development/job search allon, j. (1999). the business of bliss: how to profit from doing what you love.newyork: hearst books. andrews, c. (1998). the circle of simplicity: return to the good life.newyork: harper collins publisher. bolles, r.n. (1995).what color is your parachute. berkeley, ca: ten speed press. bridges,w. (1995). jobshift:how toprosper in aworkplacewithout jobs.cambridge,ma: perseuspublishing. 108 edwards, p., & edwards, s. (1996). finding your perfect work: the new career guide to making a living, creating a life. los angeles, ca: j.p. tarcher. louden, j. (1992). the woman’s comfort book: a self-nurturing guide to restoring balance in your life. san francisco: harper san francisco. miedaner,t. (2000).coach yourself to success: 101 tips fromapersonal coach for reaching your goals atwork and in life.newyork: mcgraw-hill/contemporary books. saltzman, a. (1991).downshifting: reinventing success on a slower track.newyork: harper collins. sinetar,m. (1989).do what you love and the money will follow:discovering your right livelihood.newyork: dell publishing. care-giving capossela, c.,warnock, s., & miller, s. (1995). share the care: how to organize a group to care for someone who is seriously ill.newyork: fireside press. haigler, d.h., mims, k.b., & nottingham, j.a. (1998). caring for you, caring for me: education and support for caregivers (participant’s manual). athens, ga: university of georgia press. lustbader,w., & hooyman, n.r. (1994). taking care of aging family members: a practical guide.newyork: free press. mace, n.l., & rabins, p.v., (2001). the 36-hour day: a family guide to caring for persons with alzheimer's disease, related dementing illnesses, and memory loss in later life (rev. ed.). newyork:warner books. child abuse/healing bass, e., & davis, l. (1994). the courage to heal.newyork: harper perennial child development ames, l.b., ilg, f.l., baker, s.m., & haber, c.c. (1989). your ten to fourteen year old. new york: delacorte press. barkley, r.a. (2000). taking charge of adhd (rev. ed.). newyork: guilford press. barkley, r.a., & benton, c.m. (1998).your defiant child.newyork: guilford press. dreikurs, r. (1991). children: the challenge.newyork: plume. communication/intimacy ailes, r. (1995). you are the message.newyork: bantam books. markman, h.j., stanley, s.m., & blumberg, s.l. (2001). fighting for your marriage: positive steps for preventing divorce and preserving a lasting love, new and revised. san francisco: jossey-bass publishers. shen, s., & surrey, j.l. (1999).we have to talk:healing dialogues between men and women.newyork: basic books. depression bourne, e.j. (2000). the anxiety and phobia workbook.oakland, ca: new harbinger publications. copeland, m.e., & mckay, m. (2002). the depression workbook: a guide for living with depression and manic depression.oakland, ca: new harbinger publications. dowling, c., hudson, j.i., & pope, h. (1993). you mean i don’t have to feel this way? new help for depression, anxiety, and addiction.newyork: bantam books. gold, m.s., & morris, l.b. (1995). the good news about depression: cures and treatments in the new age of psychiatry.newyork: bantam books. greenberger, d., & padesky, c.a. (1995).mind over mood.newyork: guilford press. huber, c. (1999). the depression book: depression as an opportunity for spiritual growth.mountain view, ca: keep it simple books. james, j. (1990).woman and the blues: passions that hurt, passions that heal. san francisco: harper. johnson, j. (1982). freedom from depression.newyork: logos associates. kramer, p.d. (1997). listening to prozac. newyork: penguin usa. 109vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers mitchell, a., & herring, k. (1998).what the blues is all about: black women overcoming stress and depression.newyork: perigee. developmental issues/life transitions imber-black, e., & roberts j. (1998). rituals of our times: celebrating, healing, and changing our lives and our relationships (the master work series).northvale, nj: jason aronson. magid, k., mckelvey, c.a., & schroeder, p. (1990). high risk: children without a conscience. new york: bantam books. newman, b.m., & newman, p.r. (2002). development through life: a psychosocial approach. brea, ca: anaheim publishing company. register, c. (1989). living with chronic illness. days of patience and passion.newyork: bantam books. sheehy, g. (1984). passages.newyork: bantam books. wells, c. (1995).dear old man: letters to myself on growing old.unknown. divorce/separation gardner, r.a. (1985). the boys and girls book about divorce, with an introduction for parents. new york: bantamyoung reader. mcwilliams, p., bloomfield, h.h., & colgrove, m. (1993).how to survive the loss of a love. los angeles, ca: mary book/prelude press. shapiro, r.b. (1992). separate houses.newyork: simon & schuster. wiener-davis, m. (1993). divorce busting: a revolutionary and rapid program for staying together. new york: fireside press. domesticviolence/battering evans, p. (1996). the verbally abusive relationship: how to recognize it and how to respond.holbrook, ma: adamsmedia corporation. forward, s., & torres, j. (2002).men who hate women and the women who love them:when loving hurts and you don’t know why.newyork: bantam books. geffner, r., & mantooth, c. (2001). ending spouse/partner abuse: a psychoeducational approach for individuals and couples.newyork: springer publishing company. kivel, p. (1999).men’s work: how to stop the violence that tears our lives apart. center city, mn: hazelden information education. loring, m.t. (1998). emotional abuse: the trauma and the treatment. san francisco: jossey-bass publishers. norwood, r. (1991).womenwho love toomuch:when you keepwishing andhoping he’ll change.newyork: pocket books. sonkin, d.j., & durphy, m. (1997). learning to live without violence: a handbook for men. volcano, ca: volcano press. family problems/life-cycle transitions/individuation carter, e.a. & mcgoldbrick, m. (1998). the expanded family life cycle: individual, family, and social perspectivies (3rd ed.). boston, ma: allyn and bacon. carter, e.a., mcgoldrick, m. & ferraro, g. (1989). changing family life cycle: a framework for family therapy. englewood cliffs, nj: prentice hall. markman, h.j., stanley, s.m., & blumberg, s.l. (2001). fighting for your marriage: positive steps for preventing divorce and preserving a lasting love, new and revised. san francisco: jossey-bass publishers. roger, f. (1996). the new baby: a mister rogers’ first experience book.newyork: paper star. viorst, j. (1998). necessary losses: the loves, illusion, dependencies, and impossible expectations that all of us have to give up in order to grow.newyork: fireside press. grief/loss bolton, i., & mitchell, c. (1983).my son…my son: a guide to healing after a suicide in the family. atlanta, ga: bolton press atlanta. 110 caine, l. (1990). being a widow.newyork: penguin usa. callanan, m., & kelley, p. (1997). final gifts: understanding the special awareness, needs, and communications of the dying.newyork: bantam books. chance, s. (1994). stronger than death/when suicide touches your life: a mother’s story. macmillan co., ny: avon. colgrove, m., mcwilliams, p., & bloomfield, h.h. (1992). surviving, healing, and growing: the how to survive the loss of a love workbook. los angeles, ca: mary book/prelude press. fisher, a.q., & rivas, m.e. (2001). finding fish: a memoir.newyork: harper perennial. fitzgerald, h. (1995). the mourning handbook: the most comprehensive resource offering practical and compassionate advice on coping with all aspects of death and dying.newyork: fireside press. fitzgerald, h., & kubler-ross, e. (1992). the grieving child: a parent’s guide.newyork: fireside press. fumia, m. (1992). safe passage:words to help the grieving hold fast and let go. berkeley, ca: conari press. kaplan, l.j. (1995).no voice is ever wholly lost.collingdale, pa: diane publishing company. kelley, p. (1997). companion to grief: finding consolation when someone you love has died. new york: simon & schuster. krementz, j. (1988).how it feels when a parent dies.newyork: knopf. kushner, h.s. (2001).when bad things happen to good people: twentieth anniversary edition. new york: schocken books. lewis, c.s. (2001). a grief observed. san francisco: harper san francisco. manning, d. (1984).don’t take my grief away:what to do when you lose a loved one. san francisco: harper san francisco. mcwilliams, p., bloomfield, h.h., & colgrove, m. (1993).how to survive the loss of a love. los angeles, ca: mary book/prelude press. tatelbaum, j. (1984). the courage to grieve.newyork: harpercollins. viorst, j. (1998). necessary losses: the loves, illusion, dependencies, and impossible expectations that all of us have to give up in order to grow.newyork: fireside press. weiss, b.l. (1988).many lives, many masters.newyork: fireside press. westberg, g.e. (1986).good grief: a constructive approach to the problem of loss. philadelphia, pa: fortress press. wolfelt, a.d. (1996). healing the bereaved child: grief gardening, growth through grief, and other touchstones for caregivers.bristol, pa: accelerated development. incest/shame/recovery bass, e., & davis, l. (1994). the courage to heal: a guide for women survivors of child sexual abuse. new york: harper perennial. bradshaw, j. (1988).healing the shame that binds you.deerfield beach, fl: health communications. forward, s., & buck, c. (2002). toxic parents:overcoming their hurtful legacy and reclaiming your life.new york: doubleday. kunzman, k. (1990). the healing way. center city, mn: hazelden information education. lew, m., & bass, e. (1990). victims no longer.newyork: harper collins. maltz,w., (2001). the sexual healing journey: a guide for survivors of sexual abuse.newyork: quill. men’s issues/roles bly, r. (1992). iron john: a book about men.newyork: vintage books. dalbey, g. (1991).healing the masculine soul.dallas, tx:word publishing. morley, p., & sproul, r.c. (2000). the man in the mirror. grand rapids, mi: zondervan publishing house. morris, l., bolton, f., & maceachron, a. (1989).males at risk.newbury park, ca: sage publications. 111vodde et al./a survey of the use of bibliotherapy by licensed clinical socialworkers minority concerns/issues bailey, c., & bledsoe, c. (2001). god, dr. buzzard, and the bolito man.newyork: knopf. goldberg, b. (1997). tengo un adolescente en casa. que hago? sudamericana/argentina. mcgoldrick, m. (1996). ethnicity and family therapy.newyork: guilford press. tan, a. (1992). the kitchen god’s wife.newyork: ivy books. thomas, a., kenneth, c., & sillen, s. (1991). racism and psychiatry. new jersey: lyle stuart. parenting skills/effectiveness clark, l., & robb, j. (1996). sos! help for parents. berkeley, ca: parents press. cloud, h., townsend, j., &guest, l. (1998).boundaries with kids.grandrapids,mi: zondervan publishing house. dinkmeyer, d., & mckay, g. (1997). parenting young children: systematic training for effective parenting (step) of children under six. circle pines, mn: american guidance service. dobson, j. (1994). parenting isn’t for cowards.dallas, tx:word publishing. dobson, j. (1996).dare to discipline.wheaton, il: tyndale house publishing. eldrige, s. (1999). twenty things adopted kids wish their adoptive parents knew.newyork: dell publishing. faber, a., mazlish, e., & coe, k. (1999). how to talk so kids will listen & listen so kids will talk. new york: macmillian co., ny: avon books. ginnot, h. (1993). between parent & child.newyork: macmillian co., ny: avon books. gordon, t. (2000). parent effectiveness training–the road less traveled.newyork: three rivers press. mccartney, s., wooderich, k. & bauer, a. (1995). the parent’s guide: solutions to today’s most common behavior problems in the home. columbia, mo: hawthorne educational services. nelsen, j., duffy, r., & erwin. c. (1998). positive discipline: the first three years—laying the foundation for raising a capable, confident child. rocklin, ca: prima publishing. papkin, m., & cox, m. (1998). active parenting of teens.marietta, ga: active parenting publishers. pipher, m. (1995). reviving ophelia: saving the selves of adolescent girls.newyork: ballantine books. pipher, m. (1997). the shelter of each other.newyork: ballantine books. woititz, j. (1992). healthy parenting. newyork: fireside press. perfectionism/obsessive-compulsive tendencies anthony, m., & swinson, r. (1998).when perfect isn’t good enough: strategies for coping with perfectionism.oakland, ca: new harbinger publications. burns, d. (1999). feeling good.newyork: plume. kushner, h. (1997).how good do we have to be: a new understanding of guilt and forgiveness.newyork: little brown & company. personal growth bolles, r.n. (2002).what color is your parachute? berkeley, ca: ten speed press. cameron, j. (2002). the artist’s way: a spiritual path to higher creativity. los angeles, ca: j.p. tarcher. covey, s. (1990). seven habits of highly effective people.newyork: simon & schuster. foster, r.j. (1998). celebration of discipline: the path for spiritual growth. (3rd ed.). san francisco: harper san francisco. simpkins, a.m., & simpkins, c.a. (1996). principles of meditation: eastern wisdom for the western mind. boston, ma: charles e. tuttle company. wheelis,w. (1985).how people change.newyork: harpercollins. post traumatic stress mason, b.a.(1986). in country. southyarmouth, ma: john curley & associates. 112 matsakis, a. (1996). i can’t get over it: a handbook for trauma survivors (3rd ed.).oakland, ca: new harbinger publications. woolley, f.r.,woolley, s., jackson, d., & richards, r.m. (2000). sudden trauma!when life will never be the same again: revolutionary principles for healing emotional wounds. fortwalton beach, fl: goldmind publications. relationship problems crabb, l. (1992). the marriage builder. grand rapids, mi: zondervan publishing house. dobson, j.c. (1996). love must be tough.dallas, tx:word publishing. fanning, p., mckay, m., & paleg, k. (1994). couple skills: making your relationship work.oakland, ca: new harbinger publications. gray, j. (1992).men are from mars, women are fromvenus: a practical guide for improving communication and getting what you want in your relationships.newyork: harpercollins. hendrix, h. (2001). getting the love you want: a guide for couples.newyork: owl books. hemfelt, r., meier, p., & minirth, f. (1996). love is a choice: breaking the cycle of addictive relationships. nashville, tn: thomas nelson. markman, h.j., stanley, s.m., & blumberg, s.l., (2001). fighting for your marriage: positive steps for preventing divorce and preserving a lasting love. san francisco: jossey-bass publishers. martin, a.m. (1993). rachel parker, kindergarten show-off.newyork: holiday house. packer, a. (1992). bringing up parents: the teenager’s handbook. minneapolis, mn: free spirit publishing. rathman, p. (1997). ruby the copy cat.newyork: scholastic trade. scarf, m. (1996). intimate partners: patterns in love and marriage.newyork: ballantine books. smalley, g. (1997).making love last forever.dallas, tx:word publishing. self-worth/esteem/eating disorders boskind-white, m.,white,w.c., &white,w.c., jr. (1987). bulimarexia: the binge/purge cycle (2nd ed.). newyork:w.w. norton & co. breathnach, s.b. (1995). simple abundance: a daybook of comfort and joy.newyork:warner books. burns, d.d. (1999). ten days to self-esteem.newyork: quill. johnson, j., & lorning, p. (1994). lucy lettuce.omaha, ne: centering corporation. latimer, j.e. (1990). living binge-free: a personal guide to victory over compulsive eating.denver, co: living quest. lerner, h. (1997). the dance of anger: a woman's guide to changing the patterns of intimate relationships. newyork: harpercollins. mcgee, r.s. 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(1995). reviving ophelia: saving the selves of adolescent girls.newyork: ballantine books. author’s note: address correspondence to: rich vodde, ph.d., lcsw, division of social work, pine hall, oak street, valdosta state university, valdosta, ga, 31698, usa. e-mail: rvodde@valdosta.edu 114 microsoft word 19. hunter and mileski_2514_emerging leaders copyedit_final ______________ rosemarie hunter, ph.d., lcsw, is a special assistant to the president for campus community partnerships at the university of utah and director of university neighborhood partners in salt lake city. kara mileski, msw, is a doctoral student and graduate assistant at the university of utah. this work was supported by the lowell bennion community service center. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 613-628 emerging leaders project: connecting university resources to communitybased organizations supporting refugee resettlement rosemarie hunter kara mileski abstract: in recent decades, populations seeking refuge have underscored the limitations of what have been standard approaches to resettlement. shrinking resources, post-9/11 increase in security measures, and the diverse needs and assets of new arriving populations have exacerbated existing weaknesses in u.s. social service delivery systems and challenged neighborhoods inexperienced in these areas with complex issues of integration (kerwin, 2011). in response to these issues, the university of utah, the utah state refugee services office, and salt lake city community college started an initiative to support the development of community-based organizations (cbos) and provide leadership and organizational training to existing leaders within these communities. the project created a shared space for community capacity building and integration as a twoway process. this paper will describe the formation and impact of the emerging leaders project, a community-based participatory action research (cbpr) project focused on capacity building with new arriving communities in salt lake city. keywords: university-community partnerships, refugee resettlement, capacity building, community-based research while the united states has resettled more individuals with refugee status than all other 13 members of the organization for economic cooperation and development (oecd) combined, the context of resettlement and the continuum of diverse needs across populations seeking refuge have significantly changed (haddal, 2009). since 1975, over 75% of u.s. refugee populations have come from vietnam (and other parts of southeast asia) and the former soviet union (singer & wilson, 2007). in recent years, the u.s. resettlement priorities have changed from large-scale special interest populations to smaller groups identified as being among the most vulnerable populations. this shift in focus has resulted in a broader range of diverse populations. at the same time, the post9/11 decade has seen an increase in security measure and limitations on programs and financial resources that previously supported immigrant and refugee integration (kerwin, 2011). the office of refugee resettlement (orr) provides the funding for refugee cash assistance (rca) and medical assistance (rma) for up to eight months after arrival in the u.s. individuals must meet income and resource eligibility requirements and cannot be eligible for other temporary assistance programs such as tanf and medicaid (kerwin, 2011). with a focus on employment and self-sufficiency, federal programs are dependent on state refugee service offices and local resettlement organizations to achieve success. at the same time, local resettlement agencies and their partners are dependent on hunter, mileski/emerging leaders project 614 securing other resources to fulfill their mission under state department guidelines. during the first 90 days, resettlement agencies are already busy connecting families to other federal and state support programs. once the initial benefit from the state department’s reception and placement has expired, the family is responsible for their own rent, food, health, and transportation needs. in response to these issues, the utah state refugee services office (rso) started an initiative to support the development of community-based organizations (cbos), also referred to as mutual assistance associations (maa) (i.e. united african association, sudanese association of utah, somali organization, etc.). the goals of these organizations are to provide a first response to the new arriving individuals and families and to act as an information, referral, and crisis response network connecting new arriving populations to existing resources and systems. training and empowering community leaders from each population are successful vehicles for reducing system barriers and supporting the whole community (kretzmann & mcknight, 1993). these individuals are already identified as leaders in their communities; therefore, they are often in the best position to understand the needs and strengths of their communities, the cultural issues involved, and begin from a space of trust and familiarity that many social service providers do not have. in this way, community-based ethnic leaders are the first contact for successful integration of new arriving populations that will ultimately connect new americans to existing systems (hunter, mai, hollister, & jankey, 2011). while community-based leaders come with a strong skill set, they too may lack an understanding of the resources and systems in the u.s. as a group, they have requested training on what systems and services are available to the community and appropriate ways of making referrals and accessing services. in addition, they are not familiar with how to organize and run associations and non-profits in the u.s. as part of this movement, the rso has brought together community and university partners to develop partnerships that will support the training and leadership development for these community-based leaders. context the emerging leaders project was conducted within the framework of universitycommunity partnerships that emphasize the role of higher education to work in ways that are relevant to the communities where they are located (maurrasse, 2001; reardon, 2000). at the university of utah, university-community partnerships are defined by tying community engagement to the academic cornerstones of research, teaching, and service. this approach to community engagement and scholarship values the community as a site of learning and community residents as holders of knowledge (moll & gonzález, 1997). similarly it provides multiple opportunities for higher education to be present with the community in addressing community-identified issues while still meeting its primary academic mission (holland, 2005; hunter, munro, dunn, & olsen, 2009). university neighborhood partners (unp), a university-community outreach partnership center and department of the university of utah, is focused on building longterm collaborations between university departments, state and local government, nonadvances in social work, fall 2013, 14(2) 615 profits, and social service systems of all kinds. its mission is “to bring university and west side resources together for reciprocal learning, action and benefit…a community coming together” (university neighborhood partners, 2012). unp programs serve seven neighborhoods on salt lake city’s west side. these neighborhoods comprise 15 census tracts. almost 30% of the city’s total population lives in these neighborhoods (perlich & li, 2013). the population in this area grew by 10.7%, compared to 2.6% growth for salt lake city. unlike the homogeneous neighborhood of rural utah, 56.4 % of the west side population is of minority background, which is 65.2% of the city’s minority population. over 46% of the population in west side neighborhoods is hispanic. these 26,129 residents are 72% of the city’s total latino population (perlich & li, 2013). the latino population in the west side area grew by 32.4% between 2000 and 2010, compared to just 21.6% for salt lake city. eighty-three percent of the city’s pacific islander population, and 60.8% of the city’s black population, live in the unp target area (u.s. census bureau, 2010). in contrast, 31.6% of the city’s asian population, and just 20.4% of the city’s white population live in this area (u.s. census bureau, 2010). salt lake city has also served as a preferred city for refugee resettlement with over 46,000 in the state and 1,000 new arrivals each year. ninety-nine percent of individuals of refugee status in utah live in salt lake valley (utah refugee coalition, 2013). project goals in fall 2010, the university of utah’s institutional review board approved the protocol for the emerging leaders project. the first phase of the project, and the focus of this paper, was to meet with community leaders of cbos and other stakeholders to assist with the development of a leadership-training curriculum to support refugee populations with organizing their communities. the second phase of the project was to connect student learning to ongoing community capacity-building partnerships with these groups by building integrative engaged learning projects into a graduate level required course on social work community practice. during fall semester 2010, we conducted focus groups with ethnic leaders and representatives of the utah refugee services office and local resettlement organizations to gain a better understanding of community needs and partners’ goals. by connecting community-based research methods with models of leadership development, the project provided a vehicle for centering the knowledge of local leaders to inform curriculum development for the leadership trainings (minkler & wallerstein, 2003). once the training materials were completed, the trainings were reviewed by a stakeholder curriculum committee and taught by a variety of community partners and faculty members currently involved with the new arriving populations. leadership trainings were conducted at a community site identified by community partners and leaders. as the first group of leaders completed the training, they became involved with the future trainings and mentoring of new emerging leaders in subsequent years. during phase ii of the project, the findings from phase i were critical to informing the university of utah social work community practice curriculum and connecting hunter, mileski/emerging leaders project 616 graduate students directly with communities of immigrant and refugee background. beginning spring semester 2011, graduate students from the social work community practice course partnered with cbo leaders to conduct community assessments. following the assessment phase, students worked in teams with identified leaders to develop and implement community action plans utilizing an assets-based approach (kretzmann & mcknight, 1993). study design and methods qualitative methods were used in order to better understand the effectiveness of the curriculum and current teaching methods, the dynamics of community leadership within these cbos, and potential mechanisms for empowerment of these leaders. qualitative methods further enhanced the ability for multiple sources of knowledge (from all partners) to be valued and understood in relation to creating holistic opportunities for leadership within a university-community partnership context (denzin & lincoln, 2008; minkler & wallerstein, 2003). action methodology was coupled with community based participatory research (cbpr) to provide support for issues of trustworthiness and value of the research (maiter, simich, jacobson, & wise, 2008). as herr and anderson (2005) describe, the goals of action research are to (a) generate new knowledge, (b) achieve action oriented outcomes, (c) educate both researcher and participants, (d) generate results relevant to the local setting, and (d) create a sound and appropriate research methodology. overarching project goals sought to evaluate the current training and develop the curriculum with feedback from participants themselves in order to create curriculum that was relevant to populations in resettlement. in addition, the project sought to identify the priorities of the cbos. central to this investigation was to develop a better understanding of how individuals with refugee experiences could be supported in holding leadership roles in their own communities. the research questions for this study were: rq 1 what are the strengths and weaknesses of the existing curriculum? rq 2 what content areas need to be developed and included in the new curriculum? rq 3 how could community leaders with refugee experiences be better supported in having leadership roles within their own communities? rq 4 what community issues are of highest priority to community leaders and stakeholder participants? rq 5 what curriculum and teaching methods are best suited to empowering ethnic community leaders from each population? focus groups were utilized in order to elicit a range of participant opinions. similarly, the group dynamics allowed for reactions and conversations that could provide greater breadth and depth of conversation due to the diversity of participants (mack, woodsong, macqueen, guest, & namey, 2005). focus group questions were developed in collaboration with a subset of cbo leaders who participated in early training programs and partnership development. the questions were provided in a semi-structured format. advances in social work, fall 2013, 14(2) 617 the goals of the interview/focus group questions were to guide the discussion in ways that kept it connected to the overarching research questions. utilizing a capacity-building theoretical framework, qualitative data were shared with participants for the purpose of member checking and identifying and discussing major themes that surfaced. peer debriefing sessions were conducted for the purpose of questioning and/or clarifying aspects of the inquiry that might otherwise remain only understood by the researcher (lincoln & guba, 1985). in addition to focus groups, the principal investigator (pi) collected observation data. the researcher attended the training sessions and maintained field notes in order to provide additional understanding of training context and experience. observing and participating are integral to understanding the breadth and complexities of the human experience (mack et al., 2005). participants for this study were 18 years old and older and included representatives of the state refugee services office curriculum committee (rsocc) and current leaders and members of local cbos. using flyers, emails, and project information meetings, participants were recruited from the list of attendees in the two previous training cohorts. the initial cohorts were entirely male, reflecting male dominant leadership in the cbos representing refugee communities. male-dominant leadership, the emerging nature of the cbos, and traditional gender roles were all barriers to supporting gender equality in the cbos during the formative years. however, in the most recent cohorts there has been an increase in female participants and conversations emerged that have been more inclusive and supportive of female participation in the cbo structure. this study was comprised of participants from the first two cohorts, involving 20 male leaders from community-based organizations (representing resettled communities from africa, the middle east, and asia) and 5 members of the curriculum committee (1 woman and 4 men) of the office of refugee services, department of workforce services. focus groups with curriculum committee members were conducted from a collaborative framework where participants serve as key informants to the research by reflecting and sharing history and past training experiences. two semi-structured focus groups were conducted with the leaders of the cbos, resulting in a total of twenty participants (8 and 12 in each group, respectively). the purposes of the focus groups were to provide feedback about the previous training experiences and identify the strengths and weaknesses of the curriculum. in addition, participants were asked to discuss the priority needs of each of their communities and where they thought they required additional training and resources. the pi and a graduate student were available for the focus group and observations and participatory notes were taken at each of the interviews and focus groups. during spring 2011, study participants were invited to return for two additional focus groups that actively involved them in constructing the leadership-training curriculum and brainstorming around identified priority areas. these focus groups (action phase) had the primary purpose of bringing participants together to discuss next steps, recommendations, and suggested mechanisms for supporting leadership training – hence connecting methods to the goals of action inquiry wherein leaders have the time and space to develop hunter, mileski/emerging leaders project 618 potential solutions and recommendations. figure 1 depicts phases i and ii of the project. the focus of this paper is phase i. figure 1. project overview the curriculum the curriculum evaluated by community members was titled the refugee management training course (rmtc). this was a 15-week program that began with introductory material describing the reasons for organizing communities, including developing mission and vision for the organizations, as well as a series of steps for starting and managing a non-profit organization. while there was some content on organizing communities, the majority of the material focused on non-profit management, such as: organization mission and vision, the purpose of by-laws, board structure and governance, budgets, record keeping, grant writing, and fund raising. in addition, one unit on case management was included. the office of refugee services and the curriculum committee initially defined the content for the first two cohorts. the course was taught once a week for 3 hours in an evening class format and dinner was provided. the grantwriting unit was taught in a half-day format on a saturday morning. the emerging leaders project was conducted in year 3 of the program. phase i emerging leaders project research methods and timeline spring 2010 ‐ public service professorship fall 2010 irb obtained recruit participants gathering and analyzing the data interviews with key informants conduct focus groups begin data analysis action phase action planning meetings for curriculum development member checking, clarify findings, discuss recommendations shared final recommendations and plan for implementaiton phase ii student‐ community action teams (scat) community capacity building engaged students (21 graduate social work students) students and leaders of cbos formed 7 cmmunity action teams. conducted community assessment and assest mapping outcomes & impact spring 2011 ‐ implemented community‐ identifed projects community resource development for cbos professional development for social work students curriculum development for stakeholders (cbos and csw). advances in social work, fall 2013, 14(2) 619 findings focus groups importance of training. one of the initial findings of the study was that the participants were generally very positive about the content of the rso supported trainings (rq 1). they felt the content included important information and were all interested in learning more about how to organize and run non-profits that could support their communities. the leaders discussed how there were many gaps in the social service delivery systems and these micro-nonprofits were essential in assisting with resettlement of new arriving communities. the leaders were also in agreement that the content needed more information about how to organize their communities and get individuals involved as active members in the organization (rq 2). for example, several of the participants had also attended the westside leadership institute (wli), a community-based training supported by the university of utah and neighborworks salt lake. based on an adaptive leadership model (heifetz & linsky 2002), the wli supports residents’ efforts to take civic action for positive change in their communities (neighborworks salt lake, 2012). participants who had been involved in both trainings discussed the importance of connecting these programs in order to develop a more comprehensive skill set and a yearlong training experience. as leaders continued to discuss the need for community organizing skills, they shared that most new arriving populations were already organized according to tribal or regional communities in their native country. however, these same groups were now living throughout the valley and not able to easily connect with each other. case management. focus group participants (cbo leaders) became very animated when discussing the unit on case management. there was a wide variety of reactions to having this topic as part of the training. for example, while all of the leaders expressed that one unit on case management training was not enough, some leaders went on to question if this was even an appropriate role for the cbos. there seemed to be differing opinions around whose job it was to do case management: social service providers and resettlement organizations, or cbos. other leaders pointed out that it did not matter, as they were the ones who had community trust, access, and language capabilities. even if they did not want to be case managers, in effect there was no way around this. still for others, there were dual relationships when the leader of the cbo was also employed as a case manager by one of the resettlement organizations and worked with families in both settings. comments included: we have one class on case management. this should be a whole course! we need help. we need help to better understand our role (as case managers)…we are responding to everything and often we do not have the necessary relationships in organizations to make referrals…and there is the issue of trust. our community expects us to take them to the doctor and to dws and to register for school, so even if we do not want to be case managers, we have to. hunter, mileski/emerging leaders project 620 sustainability and self-care. when examining how community leaders could be better supported in holding leadership roles within their own communities (rq 3), complex issues of sustainability & self-care were discussed. in order to provide greater access and distribute resources across several communities, the rso supported one leader from each community to attend the training annually. the following year, a second member from each community would attend the training and so on (one from the somali group, one from the sudanese group, etc.) focus group participants explained how these individuals would have to meet with their respective communities and try to explain what they were learning, and in effect spend a lot of time convincing the community that this was a good thing to do. consequently, these individuals were spending a lot of time in class, followed by additional time with their community re-telling what they had learned in the training. issues of sustainability were also tied to themes of self-care and burnout. building community capacity. participants also expressed the need for more time to practice the new information they were receiving and needed more individuals in the community to be involved. leaders of the cbos who participated in the focus groups expressed great frustration and feelings of being overwhelmed with trying to address issues of resettlement and integration for their communities: the skills and trainings are concentrated in a few people…. this causes many problems, we need to build the capacity of our whole community. i am part of training teams, community workshops, adult education and i have a job! i cannot continue to do this, i have a family and they are paying the price. my community expects a lot of me, but i am only one person. youth and families. supporting youth and families was identified as the highest community priority (rq 4). participants discussed how difficult it is for families to maintain their traditional roles. adjusting to a new language and a new culture came at a great cost to family stability. youth were learning english faster than their parents and at the same time, caught between different cultural norms. the youth are out of control. there is a big problem with youth learning english and u.s. culture more quickly than parents and then they become the parents…or dominate and manipulative. we have some youth threatening their parents that they will call the police on them because they do not let them do what they want. we have trouble with our youth in almost every area. they are not fitting in at school and they are vulnerable to get in with the wrong groups. these issues were tied to complications of resettlement, system barriers, and institutional racism. for example, as new arriving youth enter the school system they are placed at a grade level appropriate to their age. this placement often does not match their educational level and/or their language abilities. in other instances, participants shared stories of youth of refugee background who were academically strong and yet tracked into vocational programs rather than college preparatory courses. below, participants shared similar frustration with accessing services: advances in social work, fall 2013, 14(2) 621 it is difficult to access services, understand schools, get jobs, transportation, housing. it is hard to get help if you look different and/or have an accent. the youth are lost and we need to have more activities for them. …we are different and we are treated differently…even me, i am here almost 10 years, i am a citizen, but when i walk into the school or the hospital, i am always a refugee. curriculum and teaching methods. data related to rq 5 identified curriculum and teaching methods that were best suited to empowering community leaders from each population. focus group participants were in strong agreement regarding their recommendations to address concerns related to the process and methods of teaching the material. community leaders shared that this was not only new material that required time to understand and process, the trainings also required new skills and they needed opportunities to practice these skills. to complicate matters, there were issues of language and literacy levels. while the eligibility criteria to participate in the trainings required a certain level of english, the participant language level was primarily evaluated on conversational english, or in some cases, by who in a particular community had the “most” english language skills. for example, when a particular group is newly arriving, this language ability may be relative to others in the community who have no english proficiency. focus group participants’ recommendations included: the trainings are good, but we need more. they go quickly with one week on grant writing or bylaws…. we need time to practice, a place or person to go to and ask questions, somewhere to get feedback and advice. just because you show me how to write a grant one time does not mean i can write a grant…. i need you to do the grant with me and to do many, many grants together. where can we go to ask questions and get help…. of course this is the same with running the board and now i have to do home visits too…so let’s first begin by writing a grant for a case manager. i need them to go slower, i am translating in my head…also, and i do not know all the words and what they mean. language is a problem. i know most of the words…but not when you say them that fast and the teacher is constantly talking…. i need more time, i need to hear it again and again…. sometimes i get stuck trying to understand one part and now they are on part 3 or 4…i am still at 1. writing and reading the material is slow…. participant observations language. data collection during participant observations corroborated the themes identified by the focus group participants. for example, participants’ attentiveness was markedly different in training sessions that were interactive, including hands-on team work or role play as opposed to those that were content-heavy, with a lot of technical language, using power points as the main instructional method. in addition, throughout the training sessions, it was necessary for instructors or peers to “break down the hunter, mileski/emerging leaders project 622 english” by providing more examples, using words other than those listed on the worksheets. also, where possible, peers provided translation. while there were many different languages and dialects present across the group, there were opportunities to use a common language such as arabic, french or burmese across several groups. interestingly when meeting with members of the rso curriculum committee, they did not identify language issues as a concern; however, they did express concerns that the content contained new concepts that many participants were being exposed to for the first time: participants are having difficulty applying what they learned and staff (of the rso) often need to go over much of the material on a more individual basis. for many participants these concepts are totally new and this is their first time trying this. remember, many of these leaders come from countries that had corrupt government, so the idea of having a board of directors is a totally foreign concept. teaching methods. participant observation provided several insights into teaching methods that are best suited to empowering this group of community leaders. for example, throughout the course when participants were invited to share their experiences, this almost always resulted in storytelling. these stories served as powerful teaching tools, allowing participants to switch from student to teacher. similarly, participants embraced any opportunity to share information about their native countries, culture, and tradition. cultural preservation was a dominant theme during the training sessions. even for those participants who had lower english literacy levels, when given the opportunity to use art illustrations or symbols, they created a visual story map that shared their history and hopes for the future. because a different instructor taught each session, it was easy to observe how teaching styles affected participant learning. active teaching methods that incorporated art, role play, partner or small group work were preferred and appeared to provide additional support for a participant with beginning english language skills. collaboration and competition also served as effective methods for empowering leaders. working together in small groups was effective to divide tasks and get more accomplished, while small group presentations provided accountability and set high expectations across groups. action phase during the action phase, study participants reviewed the findings of the data and applied this information to re-construct the leadership training curriculum. as previously mentioned, overall, the curriculum content was perceived as satisfactory; however, there were two recommendations specific to content areas. the remainder of the group recommendations focused on teaching methods and ways to incorporate more skillbuilding activities into the curriculum. the following recommendations were identified by the participants and submitted to the curriculum committee. advances in social work, fall 2013, 14(2) 623 curriculum recommendations 1. community organizing – participants were in agreement that there needed to be content, and likely a different training course, on community organizing. inclusion of the wli as the first training content was recommended. 2. case management – leaders were unanimous that there was a need for more case management training. however, they remained in disagreement about the role of cbos in providing these services. the group recommended that a different case management curriculum be developed and a larger conversation regarding the role of cbos be facilitated with the rso advisory board. teaching methods recommendations 1. lead teacher – while the participants were supportive of keeping multiple instructors, as this assisted them with establishing more relationships and networks for ongoing support, they suggested that there be a lead teacher who would be responsible for, and attend, the whole training. this would provide for greater consistency and integration of learning objectives across the curriculum. 2. case studies – participants discussed that they had many case examples they needed assistance with that could serve as suitable teaching examples. similar to this was the idea that one organizational case could be used throughout the course. 3. interactive teaching methods – the participants’ valued opportunities for applied learning and also to work on their own organization’s task. rather than completing a fictional grant application, they recommended time to work with instructors on current grant opportunities. 4. training community teams – participants expressed that much would be gained if they could attend the trainings as community teams (4 5 individuals from each group). this would provide opportunities for greater organizational capacity building and teams could make actual progress on the needs of the organization. 5. mentoring and ongoing support – while the leaders gain much from these trainings, they expressed that the real challenge came when trying to apply what they had learned. they recommended having mentors who would be willing to assist them with applying these concepts and available for consultation and support. the following year, the majority of these recommendations were implemented and several, such as the case management discussion, are still underway. as a result of the leaders’ input, the resettlement agencies are now providing an extended case management period of up to two years for new arriving populations. areas of mutual learning the project provided strong opportunities for mutual learning and action. indeed, both cbpr and university-community partnerships prioritize reciprocity and mutually hunter, mileski/emerging leaders project 624 beneficial outcomes. at a very fundamental level, trusting relationships were developed and social capital extended. for example, as participants became more familiar and comfortable with the research process, they also became more active in meetings and with wanting to engage with the data. as themes emerged, they were ready and wanting to move toward action. similarly, the pi’s role changed, moving from researcher and teacher to consultant, facilitator, and assistant. social capital and networks grew at all levels. for example, several participants were interested in access to higher education for themselves and family members. they utilized their growing relationships with the academic partners to build new networks. the pi also saw growth in social capital within the communities of refugee background and the addition of new relationships that moved from individual to family and community, while often enjoying a wide range of flavorful cuisine. as trust and mutual learning grew, a strong presence of mutual responsibility emerged. there was also new learning at the academic institution. for example, in response to the concerns regarding the need for case management training, representatives of the college of social work (csw) met with leaders of cbos, representatives of the office of refugee services, and local resettlement organizations to develop case management trainings that could be utilized by multiple social service organizations across the valley. in the past, the csw offered a human service worker certificate program; however this has not been available for over a decade. these stakeholders formed a subcommittee and are in the process of updating the curriculum and plan to offer this certificate program beginning in fall 2013. similarly, the recommendation for mentoring and ongoing support has stimulated the development of a non-profit incubator project at the university. this is a partnership between university of utah, the csw, the department of public administration (pa) and utah nonprofit association. still in its pilot stage, the project represents a new structure for the academic institution and includes matching graduate students from the csw with cbos to conduct community needs assessments and asset mapping. during the second semester, cbos partner with graduate students from pa who assist them with building the capacity of their organizations. this also provides opportunities for interdisciplinary practice across social work and public administration. the university of utah offers a dual degree program in these disciplines, although students from these two disciplines seldom engage in shared practice in the field. discussion and future research while this project was conducted with specific goals of connecting the university resources (teaching and research) to community-identified priorities for reciprocal action, the data has engaged new conversation and complexities around identifying the role of these cbos serving communities of immigrant and refugee populations. while the need for additional support in assisting with resettlement and integration is obvious, whose responsibility is this? at the same time, focus group participants were clear that they wanted to play a role in assisting their communities with integration, but they had differing views on what approach would best achieve this. for some leaders, the need to serve as first responder to new arriving populations was a priority and indeed several advances in social work, fall 2013, 14(2) 625 leaders expressed that this could not be done effectively without participation of the cbos. other leaders shared that ideally they want to be supporting their communities through cultural preservation activities, such as native language instruction for youth, classes in traditional dance, and understanding the historical and political issues related to their migration. importantly, and as a result of utilizing a cbpr framework, discussions regarding gender equity surfaced during the research process. for some participants this was a new area and often not included as part of organizational management, as management was not viewed as a traditional female role. however, with other members there was an increasing awareness of the need to include and address women’s issues, yet there was disagreement around whether this meant including women or just “women’s issues.” these gender issues have a complex context including historical and cultural issues becoming naturalized over time. nevertheless, conducting a cbpr project with the leaders of the cbos created a space of inquiry where these questions could surface. indeed, the third year cohort experienced the inclusion of female participants, and the office of refugee services organized a women’s committee with representation of women from a variety of diverse communities. it will be important to continue this research with more meaningful involvement of female community leaders and participants. including dialogues on gender awareness and active participation in the cbo structure is a priority for future research and mainstreaming gender perspectives. additional areas for future research surfaced when examining how to best support community leadership. these comments focused around leaders who felt isolated and overwhelmed in their roles. as the conversations evolved, however, it was clear that these comments also surfaced larger questions related to individual versus collective societies. how could these communities benefit from a more inclusive approach to these trainings? what are opportunities for growing understanding on both sides, allowing for two-way integration? while the leaders are learning new information and skills, how are u.s. systems involved in these relationships, incorporating new knowledge gained in ways that improve social service delivery? if resettling populations are changed as they integrate, are host societies also not changed? how is this information changing how we practice? even more complex were discussions about who is leader? participants discussed the role of elders in the community as traditional leaders and the need for board members to include elders in their decision making process. of course, this was not entirely supported by the organization by-laws; nevertheless, this traditional role of positional power was active in many of these organizations and added to the confusion and frustration of leaders and community members. finally, two additional areas requiring more investigation were issues of trust and gatekeeping. when the cbos experienced conflict or confusion, the community would hold the leader responsible. while this may not be true in all organizations, the ethnic leaders associated this experience with the way things were back home. participants expressed how corruption in their native countries and inside refugee camps had an effect on how resources were distributed. leaders shared stories of how government and hunter, mileski/emerging leaders project 626 refugee camp leaders served as gatekeepers and often required additional compensation for the distribution of basic resources. when things here did not go as expected by community members, the cbo leaders were suspected of leading the organization for personal gain. these doubts and conflicts added to the feelings of frustration on the part of the leaders. conclusion the privilege of assisting diverse communities’ integration into the fabric of u.s. society comes with the responsibilities of applying the new knowledge gained in ways that benefit community well-being. building on the work of kretzman and mcknight (1993), the major contribution of the emerging leaders project is to reaffirm that the solutions to community issues begin with the community itself. this asset-based framework separates place and circumstance from individual and community capacity. it thinks of new ways to incorporate the talents of people and the culture of the community with the existing issues and opportunities (morse, 2011). the emerging leaders project reminds us that resettlement is an ongoing process and does not end with arrival to a new country. understanding integration as a two-way learning process necessitates that host societies embrace resettlement as an opportunity to evaluate and change system practices that are no longer effective. similarly, this project demonstrates the power of university-community partnerships as effective vehicles for investing university resources in issues relevant to local stakeholders while simultaneously developing valuable teaching and research opportunities. references denzin, n. k., & lincoln, y. s. (2008). introduction: the practice and discipline of qualitative research. in n. k. denzin & y. s. lincoln (eds.), strategies of qualitative inquiry: the sage handbook of qualitative inquiry (3rd ed., pp. 1-44). thousand oaks, ca: sage publications, inc. haddal, c. c. (2009). refugee and asylum-seeker inflows in the united states and other oecd member states. washington, dc: congressional research service. retrieved from http://www.ntis.gov/search/product.aspx?abbr=pb2009107176 herr, g. l., & anderson, k. (2005). the action research dissertation: a guide for students and faculty. thousand oaks, ca: sage publications. heifetz, r. a., & linsky, m. (2002). leadership on the line: staying alive through the dangers of leading. cambridge, ma: harvard business school press. holland, b. a. (2005). reflections on community-campus partnerships: what has been learned? what are the next challenges? in p. pasque, r. smerek, b. dwyer, n. bowman, & b. mallory (eds.), higher education collaboration for community improvement and engagement (pp. 10-17). ann arbor, mi: national forum on higher education for the public good, school of education, university of michigan. retrieved from http://www.thenationalforum.org/docs/pdf/wingspread_05_final_monograph.pdf advances in social work, fall 2013, 14(2) 627 hunter, r., mai, t., hollister, l., & jankey, o. (2011). a university-community partnership model for capacity-building and collective learning with individuals of immigrant and refugee experience: the example of the hartland partnership center. journal of global social work practice, 4(1). published online may/june 2011. retrieved from http://www.globalsocialwork.org/vol4no1/hunter.html hunter, r., munro, s., dunn, l., & olsen, k. (2009). bridging university and community: the power of collaborative partnerships for social change. in k. mohrman, j. shi, s. e. feinblatt, & k. w. chow (eds.), public universities and regional development (pp. 289-311). sichuan, china: sichuan university press. kerwin, d. (2011). the faltering us refugee protection system: legal and policy responses to refugees, asylum seekers, and others in need of protection. washington, dc: migration policy institute. kretzmann, j., & mcknight, j. (1993). building communities from the inside out. chicago, il: acta publications. lincoln, y. s., & guba, e. g. (1985). naturalistic inquiry. newbury park, ca: sage publications. mack, n., woodsong, c., macqueen, k. m., guest, g., & namey, e. (2005). qualitative research methods: a data collector's field guide. research triangle park, nc: family health international. maiter, s., simich, l., jacobson, n., & wise, j. (2008). reciprocity: an ethic for community-based participatory action research. action research, 6, 305-325. doi: 10.1177/1476750307083720 maurrasse, d. j. (2001). beyond the campus: how colleges and universities form partnerships with their communities. new york, ny: routledge. minkler, m., & wallerstein, n. (eds.). (2003). community-based participatory research for health. san francisco, ca: jossey-bass. moll, l., & gonzález, n. (1997). teachers as social scientists: learning about culture from household research. in p. m. hall (ed.), race, ethnicity and multiculturalism: policy and practice (vol. 1, pp. 89-114). columbia, mo: university of missouri. morse, s. (2011). communities revisited: the best ideas of the last hundred years. national civic review, 100, 8-17. doi: 10.1002/ncr.20042 neighborworks salt lake. (2012). westside leadership institute. salt lake city, ut: author. retrieved from http://www.nwsaltlake.org/community-building/20-westsideleadership-institute perlich p. s., & li, d. (2013) community data for policy, planning, and community investment: salt lake city case studies. utah economic and business review, 73(1), 1-11. retrieved from http://www.bebr.utah.edu/documents/uebr/uebr2013/uebr2013no1.pdf hunter, mileski/emerging leaders project 628 singer, a., & wilson j. h. (2007, march). refugee resettlement in metropolitan america. migration information source. washington, dc: migration policy institute. retrieved from http://www.migrationinformation.org/feature/display.cfm?id=585 reardon, k. m. (2000). an experiential approach to creating an effective communityuniversity partnership: the east st louis action research project. cityscape: a journal of policy development and research, 5(1), 59-74. united states census bureau. (2010). census 2000 gateway. washington, dc: author. retrieved from http://www.census.gov/main/www/cen2000.html university neighborhood partners. (2012). home. salt lake city, ut: university of utah. retrieved from www.partners.utah.edu. utah refugee coalition. (2013). retrieved from http://utahrefugeecoalition.wordpress.com/13-2/frequently-asked-questions/ author note: address correspondence to: rosemarie hunter, ph.d., ph.d., lcsw, director, university neighborhood partners, 1060 south 900 west, salt lake city, ut, 84104. email: r.hunter@partners.utah.edu. dual degree programs in social work: _____________ shari e. miller phd is an assistant professor at the school of social work, university of georgia, athens. karen m. hopkins phd is an associate professor and geoffrey l. greif dsw is a professor at the school of social work, university of maryland, baltimore. copyright © 2008 advances in social work vol. 9 no. 1 (spring 2008), 29-43. dual degree social work programs: where are the programs and where are the graduates? shari e. miller karen m. hopkins geoffrey l. greif abstract. this article presents results of an exploratory study designed to survey the dual degree graduates of one large school of social work, and to report on the prevalence and types of dual degree programs offered at accredited schools of social work in the u.s. quantitative and qualitative data were gathered from 72 dual degree graduates. income, career trajectories, identification with social work, satisfaction with the decision to obtain a dual degree, whether graduates would encourage others to follow the dual degree path, and implications for the social work profession and social work education are discussed. key words: dual degrees; social work education; interdisciplinary study; job market how prevalent are dual degree programs? and what happens to the graduates of these programs after they complete their studies? though the number of dual degree programs linking social work and other professions continues to grow, little published research exists about the prevalence of these programs and the impact of such an education on the social work graduate’s professional development. this article presents the results of a two fold-exploratory study including findings from a web site search of all council on social work education (cswe) accredited masters programs (cswe, 2003) to determine which schools offer dual degree programs, what types of dual degree programs they offer and whether programs have proliferated between 2005 and 2007, as well as the findings from a survey mailed in 2005 to 181 dual degree graduates from one school of social work’s multiple dual-degree programs. the dual degree programs offered by this large urban school of social work are consistent with the types of dual degrees found in other urban social work schools. therefore, the authors were interested in learning if these graduates are pleased with their decision to pursue a dual degree, to what extent they are using their msw and their other degree, what advice they might have for other social work students considering the dual degree, and the implications for teaching in social work. interdisciplinary education and dual degree programs interdisciplinary education can be understood as the precursor to dual degree education. combining fields of study reaches back, in the broadest sense, to a liberal arts education (brubacher & rudy, 1976). the early scientists/philosophers, trying to understand the nature of the universe, sought new and crosscutting contexts in which to locate their areas of inquiry. obtaining multiple degrees by studying at different universities or in different departments was common practice for hundreds of years. interprofessional education was less common however because other than theology, law, and miller, hopkins, greif./ dual degree social work programs 30 medicine, professions per se were virtually non-existent prior to the mid-19th century (stein, 1968), as was graduate education. graduate education for the professions and in other areas of study blossomed in the u.s. after the civil war when american society became increasingly industrialized, urbanized, specialized, and secularized (brubacher & rudy, 1976, p. 177). by the beginning of the 20th century, graduate degrees were being offered by fifteen major graduate schools (brubacher & rudy, 1976, p. 193) as professional schools, which often were free standing, began to attach themselves to universities. it is only relatively recently that universities and departments began to join together to offer distinct programs of study that eliminate specific course overlap by transferring in credits from one program to the other. these programs provide a more formalized means of sharing knowledge between disciplines and of preparing students for employment in an increasingly complex world. they also offer a way for graduates to become more marketable in a tight job market (mcclelland, 1985). now there are dual degree options wholly within undergraduate programs, between master’s and bachelor’s programs, between master’s programs, between doctoral and master’s programs, and between medical and phd. degree programs. it appears that almost every field of study holds the possibility for a dual degree. examples of such fields are: engineering, history, fine arts, middle eastern and north african studies, environmental sciences, anthropology, political science, germanic languages, criminal justice, and information sciences. for the purposes of this study only those programs offering dual degrees concurrent with the master of social work degree (msw) have been considered. the msw and phd in social work continuum has not been considered. the sharing of information between professions has long been common in the form of transdisciplinary work (e.g. tourse, mooney, kline, & davoaren, 2005), collaborations (e.g. forgey & colarossi, 2003), and interdisciplinary studies, with some universities offering degrees in interdisciplinary studies. universities promote interdisciplinary collaboration between their departments and schools to foster academic collegiality and to lay the groundwork for interdisciplinary grants. when it comes to a little understood profession like social work, interdisciplinary collaboration requires a specific delineation of the field’s identity and of the contributions that can be made to the partnering profession (falck, 1977). social work faculties have called for collaboration with other professions for years (reichert, 1970). for other fields, social work can help to foster a holistic or ecological view of the client (e.g. lee, 2005; meenaghan, 1984), an awareness of the interdependency of practice (falck, 1977), and offer a social justice perspective. collaborations work best, dana and sheps (1968) argue, when the schools or departments involved actualize interprofessional behavior. for example, a law clinic where social work students are placed would compel lawyers and social workers to understand each other’s work more clearly than if interaction only occurred in a classroom setting. the impact of other fields’ knowledge on social work has also long been acknowledged. boehm in the early 1970s, noted that increasingly…schools are moving to the position that courses in related fields of practice such as urban planning or public administration or in theory such as sociology, economic, or psychology, if their content is consistent with the educational goals and philosophy of social work, should become available to students (1971, pp., 260-261). advances in social work, spring 2008, 9(1) 31 berg-weger and schneider (1998) surveyed accredited graduate and undergraduate social work programs and found two-thirds of the respondents had interdisciplinary collaborations (though not specifically dual degree programs) that spanned research, community service, and teaching. sociology/social science was the most common with psychology/psychiatry being a close second. thus sharing of information between disciplines is common and is shaped by a variety of formal and informal structures. here the focus is on the more formal structures that lead to the granting of two combined degrees. review of the literature little published research focused on social work dual degree programs is available. in the earliest identified article published over thirty years ago hartford (1976) described the university of southern california’s msw/mpa program with its focus on gerontology, which was initiated for the purposes of meeting the needs of an increasingly aging population. she outlined the different skills needed in each profession and the steps taken to socialize students to two different skill sets. a capstone, integrating seminar that included community practitioners from both fields was seen as a key element of the educational process. mcclelland (1985) described the inner workings of a joint msw/mph degree at the university of minnesota. as compared with serial degrees (first one than the other), he argued, a combined program reduces overlap and allows for more active integration of material. a danger though, he pointed out, is that social workers will identify with the higher status degree upon graduation. he also pointed out potential conflicts with dual degrees in relation to application. for example, with regard to the msw/jd, the understanding of confidentiality for the social worker is different from the privileged information gained by the lawyer. for those students who have undertaken the msw/mba dual degree, he stated that, “students who have attempted to combine social work with business administration have noted the lack of a code of professional ethics in business. they experience conflicts over questions of social responsibility and interdependence, especially in regards to unanticipated negative impacts of business decisions on innocent people." (p. 24). canda (2005) raised similar issues about the combining of divinity and social work. his concern was that practitioners in any one religion might believe in proselytizing, something the national association of social workers (nasw) code of ethics forbids. a survey of 182 jewish communal agency directors was designed to determine, among other things, how important dual degrees were when considering potential employees in hiring decisions. while graduate education was ranked as highly important, a second degree was viewed as not nearly as important as personality and work experience in the field (bubis, phillips, reitman & rotto, 1985.) ruth, wyatt, chaisson, geron, & bachman (2006) compared 30 of boston university’s msw/mph graduates with 30 msw-only graduates. they found no significant differences between the two groups in terms of salaries and career satisfaction. nelson-becker (2005) compared 45 social work and divinity dual degree graduates with 36 msw-only graduates. one of the differences in the groups was that the dual degree graduates were more apt to inquire about the religious views of their clients leading her to conclude that, “a dual degree does make a difference in social work” (p. 123). miller, hopkins, greif./ dual degree social work programs 32 methodology this study is exploratory in nature, designed to provide a foundation for future research regarding social work dual degree programs. to begin to lay a foundation, multiple modes of data collection were utilized including: archival research and a selfreport survey that contains both quantitative and qualitative type questions. the research focus is two-fold: (1) to present a picture of the current distribution of dual degree programs at accredited masters conferring schools of social work and, (2) to survey graduates from one large school of social work’s dual degree programs about their experiences, job trajectories and demographic characteristics. the web search sample for the purposes of the web search, the sample included the web sites of all cswe accredited masters programs based on 2003 data (cswe, 2003). thus, the total sample for the web survey included the web sites of 167 accredited social work programs (including branch campuses). the survey sample the participants included the graduates of one large mid-atlantic school of social work’s dual degree programs spanning thirty-two years (1973 through 2005). the four dual degree options offered through the social work program are: msw/ma (jewish studies), msw/jd, msw/mba, and msw/mph. these programs are each structured differently and are located extra-university (with another university), intra-university (with another school on the same campus) and, inter-university (with another school that is part of the same university system but is on a different campus) depending upon the dual degree option. the sample included a total of 227 dual degree graduates. of those 227, contact information for 46 was inaccurate and not able to be updated. thus, the total sample included 181 alumni who graduated between 1973 and 2005. of the 181 surveys mailed, 72 were returned (40.0% response rate). archival data for a random sample (60.2%) of the total sample was searched to gather information about the characteristics of the dual degree graduates to determine if there were any differences between those who responded to the survey and those who did not. findings of that search will be discussed later in the article. because the msw/ma program is the longest standing of the four programs, a majority of the respondents graduated with that dual degree. the msw/mph program, with the fewest respondents, graduated its first student in 2003. of the 72 respondents, 75.0% graduated with the ma, followed by 18.0% with the jd, 6.0% graduated with the mba and lastly, 1.0% with the mph the web search procedure initially, in the fall of 2004, the authors contacted cswe to request their most recent data on dual degree programs. the data were received through a personal email advances in social work, spring 2008, 9(1) 33 communication in the form of an excel database (personal communication, november 2004). then, all cswe accredited master of social work programs were identified using cswe’s 2003 listing. the web site for each of these programs was located using the google search engine. the process of searching each web site varied depending upon the web site’s design. information about dual degree programs was located in different places on different web sites. if no link to dual degree program information appeared on the home page, the link to academic programs was followed, when such a link appeared. following the academic programs link in some cases led to further links specific to dual degree programs. if no relevant information or link to dual degree programs could be found, the search option was utilized when available. search terms included, dual degree, joint degree, concurrent degree, and programs. if a search option did not exist on the particular school of social work’s web site, the entire university’s web site was searched using the same combinations of search terms as above, as well as the search terms, social work, msw, and masters in social work. if all search avenues led to no matches, it was understood that dual degree programs were not offered through that school of social work. when dual degree programs were noted to exist at a school of social work, all links to respective programs were followed. the university and its dual degree offerings were then logged in a table. once all 167 web sites were searched, and complete data were synthesized, the set of dual degree offerings was organized by type of degree and university in an excel database. the survey procedure a 24-item self-report survey was created for the purposes of this study. a combination of qualitative and quantitative questions centered on, respondents’ work history and professional affiliation, whether or not they believed the dual degree had helped them, whether one of the degrees has been more beneficial over the course of employment than the other, the reasons they chose to pursue a dual degree, whether they had any advice for dual degree graduates, and their demographic background. after irb approval, the survey was initially mailed to respondents in may 2005 with a cover letter indicating that surveys were confidential but not anonymous. surveys were coded and paired with a list of respondent names for the purpose of facilitating follow-up mailings. the letter also indicated that the respondent would receive a second mailing of the survey in the event that they did not return the first. because 76 of the initial surveys mailed were returned due to change of address, a subsequent set of first mailings was sent when updated contact information could be obtained for those respondents. updated contact information was located for 30 of the 76 returned, thus 30 surveys were re-sent. subsequently, the second round of mailings was sent in july 2005 to all those who had not responded to the initial mailing. once completed surveys were received, data were entered into an spss database. descriptive and bivariate statistical analyses were performed. an alpha level of .05 was used for bivariate analyses. the survey contained qualitative questions designed to gather more detailed and subjective information from respondents about their dual degree experiences. following weber (1990) content analysis was applied to written responses to the four open-ended questions. responses were organized under themes that emerged from the data, and the miller, hopkins, greif./ dual degree social work programs 34 number of responses under each theme was counted to determine the intensity of participants’ experiences. results the web search findings in reviewing the data received via an email communication with cswe, (personal communication, november 2004) the web search revealed that the data collected by cswe is not current. as of january 2005, 58 of the 167 schools of social work (34.7%) offered at least one dual degree program, with 35 schools (20.9%) offering two or more. in february of 2007, in order to learn how rapidly programs were growing, a randomly selected 10% of the original 167 schools’ websites were re-searched (six of those schools that offered programs and 11 of those that did not) to see if the schools that had programs were maintaining them and/or continuing to develop them, and if those that did not had started any. by 2007, the number had increased. one additional school had developed a dual degree program in social work and law for a total of 59 schools offering programs (35.3%). those schools that had dual degree programs in the previous search have maintained them and in one case two programs have been added. in january of 2005 there were a total of 48 different dual degree options – by february of 2007 there were 49. some of these degree options bear similar titles, however are considered separately as the degree titles vary slightly (i.e., urban planning and urban and regional planning, or pastoral studies and pastoral counseling). the most common program is the msw/jd, followed by the msw/mph, msw/mdiv and the msw/mba. table 1 lists the nine most frequently occurring dual degree programs and the percentage of the 59 schools that offer each program. the criterion for inclusion in table 1 is that the program was offered at 5% or more of the 59 schools at the time of data collection. percentage data for all 49 of the dual degree programs located in this search is available from the authors. other dual degree options include bio-ethics, pan-african studies, city and regional planning, architecture, government administration, child development, sociology, gerontology, health administration, information science and women’s studies, to name some. the web search also revealed that dual degree programs are offered at schools of social work throughout the country, that range in size from small (under 50 graduates per year) to large (over 150 graduates per year) (lennon, 2004). the survey findings descriptive and bivariate statistical analyses were performed; however, the solitary mph graduate was not included in the bivariate analyses. tables 2 through 4 summarize the descriptive data. demographics. seventy-two dual degree respondents completed a survey, of which 52 (73%) were female and 65 (91%) were white. these statistics are representative of the total sample that also included 73% women and 90% white students. the sample contained fewer females and more white students than does the overall student body, which is approximately 80% female and 66% white. about half (38, 53%) of the respondents were older than 40, with a mean age of 41 years. almost 20% of the respondents reported annual earnings of less than $30,000 dollars, another 26% reported earnings of more than $100,000, and the remaining respondents reported earning amounts somewhere within that advances in social work, spring 2008, 9(1) 35 table 1 most frequently offered dual degree programs by percent type of program % of schools offering program juris doctorate 62.7% master of public health 34.5% master of divinity 31.0% master of business administration 20.7% master of public affairs 15.5% master of arts in jewish communal service 6.9% master of public policy 6.9% master of science in education/special education 6.9% master of criminology and criminal justice 5.2% note. percentages are based on the total number of schools of social work that offer dual degree programs. table 2 summary of descriptive data by dual degree: demographics survey items msw/ma (n = 54) msw/jd (n = 13) msw/mba (n = 4) msw/mph (n = 1) female gender male 41, 76% 13, 24% 10, 77% 3, 23% 2, 50% 2, 50% 0 1, 100% mean age (years) 41 37 33 31 mean annual income median annual income $82,000 $75,000 $75,000 $65,000 $95,000 $80,000 $55,000 --------- annual income > $100,000 10, 19% 3, 23% 1, 25% 0 current social work license 13, 24% 4, 31% 0 0 msw clinical concentration: macro 7, 13% 47, 87% 8, 62% 5, 38% 2, 50% 2, 50% 1, 100% 1, 100% range. the mean income reported was $60,000. only 17 (24%) of the dual degree respondents currently hold a social work license although 31 (45%) were licensed in the past. the majority (78%) of dual degree respondents enrolled as “out-of-state” students when they applied for admission to the msw program. dual degrees. fifty-four (75%) of the msw’s were awarded an ma dual degree, 13 (18%) earned a jd degree, 4 (6%) had an mba, and 1 received an mph (1%). the respondents graduated between 1974 and 2005 with 1989 representing the mean year of graduation. there was a significant (p < .05) difference in the type of dual degree by respondents’ age. those who were 40 or older were more likely than younger respondents to have obtained an ma degree instead of the jd and mba degrees. there were no other significant differences among respondents in terms of age and year of graduation related to miller, hopkins, greif./ dual degree social work programs 36 table 3 summary of descriptive data by dual degree: current employment survey items msw/ma (n = 54) msw/jd (n = 13) msw/mba (n = 4) msw/mph (n = 1) degree primarily used msw = 52% ma = 48% msw = 38% jd = 62% msw = 25% mba = 75% msw = 0% mph = 100% work setting: public nonprofit for-profit 1, 2% 36, 67% 8, 15% 6, 46% 2, 15% 5, 38% 0% 3, 75% 1, 25% 1,100% 0% 0% director/upper management position 32, 59% 5, 38% 3, 75% 0 note: 7 (9.7%) of respondents are currently unemployed. table 4 summary of descriptive data by dual degree: career trajectory survey items msw/ma (n = 54) msw/jd (n = 13) msw/mba (n = 4) msw/mph (n = 1) first work setting: public nonprofit for-profit 0, 0% 52, 96% 2, 4% 7, 54% 5, 38% 1, 8% 0% 1, 25% 3, 75% -------------- first job: management position 26, 48% 0 3, 75% --------------- mean years in first job 4.86 3.31 1.62 ---------------- both degrees equally beneficial 41, 80% 11, 85% 3, 75% ---------------- the type of dual degree they selected. the majority (53, 77%) of the respondents were enrolled in the social work “macro” concentration while pursuing their dual degrees. current employment. as shown in table 3, more dual degree respondents are currently employed in the not-for-profit sector (41, 65%), than in the for-profit (12, 19%) and public (8, 13%) sectors. specifically by dual degree msw/ma’s and msw/mba’s were more likely (p < .0001) than other respondents to be employed in the not-for-profit sector; msw/jd’s were more likely (p < .0001) than other respondents to work in the public sector. fifty-six percent of dual degree respondents in the not-for-profit sector make over $50,000 compared to 21% in the public sector, and 24% in the for-profit sector. as mentioned, 19% of the respondents reported earning over $100,000. of those 14, most were men (64%), over 40 years old (79%), who hold an msw/ma dual degree (71%), and work in a senior management position (100%). half of the higher earners work in the notfor-profit sector (50%), and the rest work in the for-profit sector. seven respondents reported being currently unemployed; six of those were women who dropped out of the workforce to care for young children. over half of all the survey respondents (40, 61%) currently hold management positions (i.e., executive director, vice-president, etc.) within their employment settings. advances in social work, spring 2008, 9(1) 37 these management positions are significantly more likely to be held by respondents who are male (86%, p = .01), who have an msw/ma dual degree (80%, p < .01), and who make over $50,000 (76%), p < .01). the respondents were almost equally divided in reporting that they are currently employed primarily in the social work field (53%) or in the field that corresponds to their other degree (47%). younger respondents (under 40) were more likely (p = .01) than older respondents to report that they were employed in a setting primarily using their “other” degree. additionally, respondents working in settings primarily using their other degree were significantly less likely (p < .0001) than those in the social work field to have a current social work license. career trajectories. many of the dual degree respondents reported an employment history that included moving to several different job settings over time. the mean number of years that 68 (94%) dual degree respondents spent in their first job after graduating with a dual degree was four years. sixty-one of those respondents moved to a second job and remained for a mean of 4.5 years. another 48 moved to a third work setting for a mean of 5.6 years. thirty-one of those respondents took a fourth job and stayed for a mean of 6.5 years. finally 22 more respondents obtained a fifth job remaining for a mean of 5 years. most of the respondents (55, 81%) reported that both degrees were equally beneficial to their career. the data indicated that there were no differences among respondents by gender, age, or type of dual degree regarding the amount of time they remained in their first job. interestingly 30 (42%) of the respondents were hired into management positions for their first job after graduating with a dual degree. most of these respondents had an msw/ma degree (87%) with equal percentages (50%) of men and women in management positions early in their careers. this suggests that men and women with dual degrees (particularly the msw/ma) start out with similar opportunities for leadership positions but more men than women either stay in management or are promoted into these positions over time. nonresponse bias. there appeared to be no differences between respondents who returned the survey and nonrespondents by gender, race, age, or degree. there was however a significant difference between respondents and nonrespondents by “year graduated” with the dual degree. the respondents who graduated earlier, prior to 1989, were more likely (p < .05) to return surveys than respondents who graduated in 1989 or later further contributing to the higher number of respondents with the msw/ma dual degree. survey qualitative findings the survey contained four qualitative questions including a) reason(s) for selecting a dual degree, b) how the dual degree education was financed, c) whether or not respondents would encourage others to pursue a dual degree and why, and d) “words of wisdom” for students who might be considering a dual degree program. the number of respondents who chose to answer each question varied slightly with 71 (98.6%) respondents answering the first, 72 (100%) answering the second, 69 (95.8%) answering the third, and 52 (72.2%) answering the fourth. because there was only one msw/mph respondent the majority of the data discussed applies primarily to the msw/ma, msw/jd, and msw/mba respondents. miller, hopkins, greif./ dual degree social work programs 38 for the first question “what was your reason for selecting a dual degree?” some themes emerged that were consistent across the dual degree programs, in addition to other themes that were program-specific. across all programs three primary reasons for selecting a dual degree were, the flexibility that having both degrees might provide in the job market, enhanced marketability/more competitive resume, and the multiple perspectives provided by the two degrees. some discipline-specific themes that emerged included, for jd’s, a desire to do advocacy and promote social change as a motivating factor, for mba’s, the wish for enhanced interpersonal skills and the desire to engage in non-profit leadership, and for the ma’s, the desire to do social work specifically in a jewish setting. regarding the second question “how did you finance your dual degree education?” student loans, part-time employment, familial/parental support, and savings were noted as the key means of financing across dual degree programs. scholarships/fellowships/grants were also mentioned by 65% of the ma’s but only rarely by the jd’s and mba’s. in response to the third question “would you encourage others to pursue a dual degree? why?” 69 (95.8%) of the respondents said “yes”, while three of the 72 respondents (4.1%) said “no” – the three negative responses came from jd’s. again, some consistent themes emerged across disciplines among those respondents who said “yes” including, the opportunity to integrate interests and talents, the benefit of multiple perspectives and a wider skill set to broaden thinking and problem-solving approaches, increased marketability and competitiveness in the job market, and a wider array of job opportunities. some discipline-specific thoughts among those who said yes were that, for jd’s, social work and law provide a good balance, for mba’s, “anyone can make use of strong business skills”, and for the ma’s, the dual degree “gives professional shape to a passion”, provides excellent preparation for jewish communal work, and provides a core peer group of fellow students from whom to draw support. lastly, among the three jd’s who said “no they would not encourage others to pursue a dual degree”, the key reasons were that, “it is impossible to practice certain kinds of law and social work together”, it is “extremely difficult to use both degrees at once”, and “for most, the msw ensures a low paying law job”. regarding the fourth question, “can you offer any ‘words of wisdom’ to students who might be considering a dual degree program?” many of the respondents began their responses by saying, “go for it”. again, a series of themes emerged both across disciplines and also within individual disciplines. one response that was consistent was to carefully consider career goals before beginning a program and to do research related to those career goals and the relevance of the dual degree before engaging in the program. other emergent themes were, to be aware of costs, to learn how to advocate within the administration of both programs, and to use time management skills. a number of additional thoughts emerged within each different program – only those that appeared most frequently are discussed. for jd’s, the idea of staying connected to the school of social work and the values of the social work profession was a recommendation. for mba’s there emerged the theme that the “mba is more highly valued on the market than the msw” and in some cases, the msw was misunderstood and not appreciated in the business world. for ma’s a frequent recommendation was to focus on the field placement and to be sure to apply skills learned in both sets of classes to the field. another recommendation specific to the ma’s was that relationships to fellow dual degree students are very important – it was noted that “single degree students” could not relate to the experience. advances in social work, spring 2008, 9(1) 39 discussion implications the purpose of this study was to determine the prevalence of social work dual degree graduate programs, whether they are proliferating, and to assess what happens to the graduates of these programs after graduation. findings provide insight into the experiences and career paths of msw graduates with a dual degree. based on the longitudinal outcomes of the web search, it appears that dual degree programs continue to proliferate. as educational and professional opportunities for graduates grow in kind, it is important to understand the career trajectories of those who have graduated and the implications for social work and dual degree education. the overwhelming majority of dual degree graduates (95.8%) would recommend dual degree programs to other students. though a high percentage of jd’s and mba’s reported that they are using their “other” degree more in their current position 93.4% of the sample noted that their msw was equally as beneficial or more beneficial to them during the course of their whole career. these findings have implications for marketing and recruiting activities. while dual degree programs are proliferating based on the data gathered for this study, the proportion of students graduating from dual degree programs is comparatively small. one reason may be the difficulty in locating dual degree program information on some of the social work schools’ web sites. this study demonstrated that web searches did not always lead down intuitive paths. students making their way to msw programs may not even know the dual degree option exists so will not know to look for it. perhaps nasw could include a link to information regarding dual degree programs on their website to inform perspective students. information provided by nasw would be contingent upon each school keeping their program information up to date and available. since one of the findings indicated that a significant proportion of dual degree students came from out of state, and so are potentially searching nationally for a program that best fits their needs, it makes sense for schools to include a link in an easily accessible space on their web sites. it would be helpful if schools of social work kept cswe abreast of their dual degree programs so that data on the nature and growth of these programs can become more accessible. other implications for social work and dual degree education are related to integration of programs, faculty involvement, licensure, career paths in management, and income. a number of respondents in this sample recommended that it is essential for dual degree students to advocate for themselves with the administrations of both programs. it seems that administrative and curricular efforts to join the two programs might make for an enriched dual degree experience. potential options include an integrative seminar (offered at some universities and advocated for by canda (2005)) that provides an opportunity for students to share in a collective experience, or, an enhanced administrative structure that supports communication between the two programs and alleviates the need for students to have to advocate for themselves. giving consideration to the way in which programs are integrated could contribute to how students identify with, integrate, and utilize both degrees jointly. based on the updated website search, an increasing number of schools of social work offer a dual degree option(s). as such, information about dual degree-oriented miller, hopkins, greif./ dual degree social work programs 40 students’ needs should be of interest to social work faculty. there are a number of issues for students to negotiate when they are simultaneously enrolled in two programs, or perhaps two institutions, and having faculty available for focused feedback or advice may be important for dual degree students’ success. social work faculty can play a pivotal role in helping dual degree students make clear conceptual and practical linkages between programs of study. for example, in the classroom social work faculty can encourage dual degree students to share relevant information or experiences from “other degree” coursework that can inform or enhance discussion. few respondents in this sample have a social work license. many of the dual degree graduates reported a macro (vs. clinical) concentration while in school, and many took on management positions immediately after graduation. as a result they may not have considered licensure a necessary path. because the licensing requirements are changing such that licensure is expected and encouraged for all social workers this will be an important activity to track. over time dual degree graduates may be just as likely to obtain social work licensure as non-dual degree graduates and this may contribute to the strength of their continued identification with the social work profession. given the high percentage of dual degree graduates in nonprofit management positions it is also important to make sure dual degree students are exposed to relevant administrative coursework during their social work education to adequately prepare them for these types of positions. unlike ruth et al’s (2006) findings, this study did locate some potential differences between dual degree and msw-only graduates. besides the seemingly increased opportunities for management positions the mean salaries of dual degree graduates in this sample ($60,000) are reported to be higher than the nasw published mean for social workers ($47,200). therefore perhaps more social work students may opt to pursue a dual degree education. limitations while the researchers attempted to do a comprehensive search of the web sites of all accredited master of social work programs and of those programs in candidacy, it is possible that some of the web searches may not have located all dual degree offerings. because this search was web-based and did not include direct contact with each university it is possible that the information gathered from web sites was not current. in addition, this study was exploratory in nature as there is a paucity of published research regarding dual degree programs in social work. the overall sample was small and the study captures the experiences of graduates from one school of social work’s dual degree programs so findings may not be representative. however the school is one of the largest schools of social work in the country and serves an urban and rural statewide population. because the four dual degree programs offered each emerged at different points in time the number of graduates from each degree grouping varied significantly with the overwhelming number representing one dual degree experience. it was not possible to utilize sophisticated statistical techniques to analyze the data and to make comparisons across degrees. another limitation of this approach is that the survey may more likely have been returned by those who continue to identify with the social work profession, or those who had a positive dual degree experience, and therefore might not fully represent the experience of the dual degree graduates. advances in social work, spring 2008, 9(1) 41 future research because there has been such limited research around dual degrees in social work further research is needed to explore the experiences (both during and beyond the course of study) and the job trajectories of social work dual degree graduates. future studies should include alumni surveys similar to the one discussed herein as well as national surveys designed to gather cross-sectional data about dual degree graduates and the designs of dual degree programs. one issue about which little is known includes the structure and potential impacts of sequencing of the dual degree programs, meaning, in which order students take courses in each of the programs. for example it would be helpful to see if those who started or ended one program first tilted their career in one direction or the next. the msw/jd is the most frequently occurring dual degree program and there has been no documented research on this group of students. of the participants in this study the only ones to respond in the negative to the question of whether they would recommend a dual degree were the jd’s. there seemed to be a perception by some jd respondents that the two professions are mismatched in certain ways and cannot be combined effectively. one concern in particular was related to the potentially conflicting value systems. mba’s also noted some potential discontinuity between value systems. both of these findings support mcclelland’s (1985) concerns. it would be useful to explore the perspectives of these students further to gain an understanding of their experiences while in the dual degree programs and also in the work world. because research in the area of social work dual degrees is sparse, yet dual degree options appear to be proliferating, it is essential for the profession to tease apart what variables impact satisfaction with these programs. some variables to consider include: sequential structure, licensure, perceived professional status, income potential, and the nature of coursework. in describing how social work's influence is being diminished in policymaking circles, reisch (2006) warns, "graduates from other disciplines, such as public policy, business, law, and public health, are increasingly favored for such jobs over their social work counterparts." if this is the case, dual degrees are one way for social workers to continue to have an influence. in an increasingly well-educated society where there is a growing focus on inter-disciplinary collaboration, multiple degrees will likely be a constant. with its history of collaborative effort, and with its broad scope of practice options, social work is well positioned to benefit from dual degree programs and to contribute to their evolution let's understand how to make our programs as strong as possible. miller, hopkins, greif./ dual degree social work programs 42 references berg-weger, m., & schneider, f. d. 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(1968). professions and universities. journal of education for social work, 4(2), 53-65. tourse, r. w. c., mooney, j. f , kline, p., & davoren, j. (2005). a collaborative model of clinical preparation: a move toward interprofessional field experience. journal of social work education, 41, 457-477. weber, r. p. (1990). basic content analysis (2nd. ed.). newbury park, ca: sage. advances in social work, spring 2008, 9(1) 43 author’s note: address correspondence to: shari e. miller phd, school of social work, the university of georgia, tucker hall, 310 east campus road, athens, ga 30602. e-mail: semiller@uga.edu. mailto:semiller@uga.edu nonresponse bias. there appeared to be no differences between respondents who returned the survey and nonrespondents by gender, race, age, or degree. there was however a significant difference between respondents and nonrespondents by “year graduated” with the dual degree. the respondents who graduated earlier, prior to 1989, were more likely (p < .05) to return surveys than respondents who graduated in 1989 or later further contributing to the higher number of respondents with the msw/ma dual degree. microsoft word 8-3581 maxwell factors in latino youth college enrollment final ______________ sarah p. maxwell, ph.d., is an associate professor of public affairs and social policy at the university of texas at dallas. this research used public data from the texas higher education opportunity project (theop) and the author acknowledges the following agencies that made theop data available through grants and support: ford foundation, the andrew w. mellon foundation, the william and flora hewlett foundation, the spencer foundation, national science foundation (nsf grant # ses-0350990), the national institute of child health & human development (nichd grant # r24h0047879), and the office of population research at princeton university. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 125-145 parental and familial factors among latino youths’ successful matriculation into postsecondary education sarah p. maxwell abstract: extant research focuses on the “educational attainment gap,” documenting the lack of parity among latino youth and other high school graduates in college matriculation. this study reversed that question, and asked instead, what factors, and specifically what parental or family-related factors, contribute to latino youth enrolling in four-year post-secondary institutions where future earnings tend to be higher than two-year colleges. data from the texas higher education opportunity project (theop, 2004) were analyzed to identify parental contributors to successful matriculation into post-secondary education. findings indicate that parents attending college was one of the most important indicators of latino enrollment in either a twoor four-year college or university. also significant, and potentially critical in social welfare policy, was rewarding students for grades. parents helping with and checking homework were not helpful in youths’ progression to postsecondary education. keywords: latinos, higher education, parental involvement, homework, grades, policy scholarly work repetitively paints a picture of an educational attainment gap between latino youth and their non-latino counterparts.i latinos are less likely to attend college than non-latino whites or african americans (brindis, driscoll, biggs, & valderrama 2002). latino youth are also more likely to enroll in two-year, rather than four-year colleges. yet, latino youth and their parents overwhelmingly believe that going to college, whether a two-year or four-year institution, is important after high school (lopez, 2009). disparities in family income such as first-generation college experiences, poor preparation for college, and difficulties financing college are all well-documented challenges confronting latino youth (hurtado, sáenz, santos, & cabrera, 2008). the result is a clear underrepresentation of latino youth in accredited institutions of higher education (national center for education statistics [nces], 2003). this trend becomes more apparent at four-year institutions, which realize lower matriculation rates among latinos than two-year colleges (fry, 2011). fry (2011) notes that “although the college enrollment rate of young hispanics is at a record (32%), black (38%), asian (62%) and white (43%) young adults continue to be more likely than young hispanics to be enrolled in college” (p. 3). even with a recent boom in latino enrollment in post-secondary education, latinos continue to be the population least educated by the united states, as only 13 percent of latino adults complete a bachelor’s degree (national center for educational statistics, 2011). in comparison, 53% percent of asians, 39% of whites, and 19% of african americans complete a bachelor’s degree (fry, 2011). maxwell /parental and familial factors in successful matriculation 126 fortunately, a new wave of latino youth is entering college. enrollments in two-year colleges are increasing among latinos (as well as other groups) as a result of the lower costs associated with community colleges versus four-year institutions. just as women’s earnings are generally below men’s in the aggregate, minorities too must outperform whites in the world of education to level the playing field. us news and world report states: “latinos and african-americans with master's degrees earn nearly the same in their lifetimes—roughly $2.5 million—as white workers who have bachelor's degrees” (burnsed, 2011, p.1). therefore, earning at least a bachelor’s degree becomes critical for women and minorities. latinas seem dually at risk without a four-year college degree. thus, the educational gap continues, but so do the outcomes of public policy. in other words, education is a necessity, but not a sufficient means to ameliorating the earnings disparities for latinos. rather than continuing the discourse about the educational and earnings gaps for latinos, this study employed a “what works” approach. indeed, one of the few studies examining latinos’ successes noted that, “less is known about what distinguishes individual latinos who enroll in college from those who do not. as a result, there is limited information on ‘what works for the latino population’” (zarte & gallimore, 2005, p. 384). scholars contend that student-related activities are successful in leading latino and minority youth to post-secondary education, such as mentoring, cultural competence in schools, and improved student engagement activities (maxwell & connell, 2013). defining the positive variables in the educational pipeline is critical. this study, therefore, applied critical race theory (crt) to known factors that influence college enrollment: family dining, parental involvement, parental education, and rewarding grades. literature review education matters, but culture, education, and expectations are intricately linked crt as a framework depicts the cumulative effect of educational experiences on student matriculation outcomes into postsecondary education. crt is applied to known factors that influence college enrollment for youth generally: family dining, parental involvement, parental education, and parental reward for grades. for social workers, advocacy and implementation of cultural competence are key, but overcoming multiple challenges involves schools, families, and students themselves. the lack of understanding around education, culture, and pathways to success may not rest in one macro-focused answer such as discrimination, however, education, culture, and expectations are intricately linked. thus, crt is employed as an overarching analytical framework, which allows for a more nuanced approach to questioning why parental and familial differences might be present among varying groups. crt, as a theoretical framework in this study, did not imply outright discrimination, but rather a more nuanced application taken from delgado and stefancic (2012), which suggested that racism is defined as the “ordinary daily life of people of color, and the way society goes about daily life” (p. 7). racism, or purposeful discrimination, as an advances in social work, spring 2013, 14(1) 127 advocacy approach was not the intended outcome of this paper. rather, the theory highlighted the notion that latinos face daily differences in school that help define the educational gap to improve “what works.” some factors available included those that might distinguish among groups. for example, some scholars commented that immigration status, and therefore discrimination, was not the true perpetrator in the educational gap, noting that those from asian countries with the same immigration status as those from latin american countries tended to equal or surpass native-born americans in college enrollment (baum & flores, 2011; portes, fernández-kelly, & haller, 2009). but delgado and stefancic (2102) offered an interesting scenario: suppose the term “asian” was used to describe both a recent hmong immigrant from a rural background, or a chinese student who has lived in the united states her entire life with highly-educated parents. baum and flores (2011) explained that more research was needed to assess differences among immigrant groups, as well as effective policies to improve secondary education for immigrants or generations of families. factors such as time in the united states, parental education, and immigration status served as appropriate indicators of such differences under the framework of crt. the data set in this study allowed for examination of parental education, but not immigration status. yet, as tienda and mitchell (2006) pointed out, the vast majority of hispanics in the united states (about 70%) are born abroad or are born to immigrant parents. without a doubt, cultural and familial factors were important in the research findings regarding latinos in postsecondary education, but educating parents or offering support to families has historically been ignored as a policy response. crt takes the stance that the daily lives of latinos are lived in a discriminatory world. a modified crt approach takes into account not only the daily lives of other cultures in a mostly white world, but also the inherent struggles any group might face when entering a culture with a different language. consequently, both immigrant and native-born hispanics found the college experience elusive in relation to native-born whites. tienda (2009) stated: one manifestation of low parental education is the delayed school enrollment of hispanic preschool-age children. although the share of hispanic 3and 4-year olds enrolled in a preschool program rose slightly between 1980 and 2000, from 28 to 36 percent, the hispanic-white differential rose, placing larger numbers of hispanic children at a relative disadvantage during the crucial early years (p. 18). in a social work context, secondary educators may face burdens that could be addressed by working with families in the home or through after school programs. educators also faced challenges in finding “what works,” as they too succumbed to myths about immigrant, and specifically, latino families. although studies consistently showed that latino parents held high expectations of their children, teachers and administrators often believed the opposite; that latino parents were ambivalent about educational attainment. indeed, one study found that the simple failure of schools to send newsletters, lunch menus, and other correspondence in spanish was one of the primary reasons latino parents were not involved in their children’s education (smith, stern, & shatrova, 2008). maxwell /parental and familial factors in successful matriculation 128 research also contended that familial factors included a lack of parental involvement in children’s education. parental involvement was defined in a variety of ways, including the lack of formal education among latino parents; the lack of participation in children’s education (national women’s law center, 2009); the frequency of parent-teacher contacts; the quality of parent-teacher interactions (izzo, weissberg, kasprow, & frendrich, 1999); and attendance at parent-teacher conferences and back-to-school nights, as expressed by teachers and administrators in another study (zarate, 2007). schneider, martinez, and owens (2006) reported that hispanic students, more so than either african american or white students, tended to have poor relations with their middle school teachers. additionally, the unfortunate combination of lower literacy from inadequate primary schooling, concentrated populations in urban middle schools, and lack of a quality rapport with their teachers only reduced the hispanic student’s motivation levels, which created a cycle of potential life points where poor performance might result. tienda (2009) summarized: “several risk factors that undermine college success, including low parental education, limited financial resources and insufficient access to information about college. each has direct implications for the likelihood of completing the baccalaureate degree” (p. 21). these simple, yet recurring “daily life” aspects as connoted in crt, can easily be addressed through policy. culturally, one study pointed to the reluctance of latino families to question authority or advocate for their children within the school system (smith et al., 2008). a picture begins to form that paints expectations, two-way communication, and myths about latino family involvement that is solidified in daily life for latinos in a sometimes rigid american educational system. educational and social welfare policy public policy is now recognizing the cultural-educational link. education as a means to upward mobility is a concept that has recently weaved its way into the u.s. immigration policy fabric. president obama proposed a number of programs for latinos in 2011 aimed at improving educational attainment (koebler, 2011). among the programs are funding increases for head start, as well as the training of latino teachers, who are believed to be more effective with latino students (koebler, 2011). education matters. although federal, state, and university policies are changing to accommodate latinos, regardless of their immigration status, the familial factors that define the educational gap have not been widely researched or reported. additionally, policies regarding college admissions, scholarships, and other enrollment benefits vary from state to state. findings related to low educational attainment have spawned a considerable amount of research on student engagement, with limited focus on family life. parental and familial factors have also been ignored in public policy. of course, the underlying reasons for any lack of involvement by latino parents run deeper than what can be captured in many studies, including this one. parental factors as public policy problems are potentially exasperated when the total number and proportion of latinos in the united states are considered. the u. s. census reports that by 2036, one third of all u. s. school-aged children will be hispanic (u. s. census bureau, 2008). advances in social work, spring 2013, 14(1) 129 zarate and burciaga (2010) explain that although an increase in latino college enrollment is taking place, that increase is explained primarily by significant growth in community college enrollment. they suggest that enrollment into four-year degree programs may be more beneficial. “the low college enrollment and skewed distribution of enrollment into community college is the consequence of disparate educational experiences between white and latino students” (zarate & burciaga, 2010, p. 25). another recent study points to a significantly lower rate of life time earnings for latinos, predominately at lower educational levels (carnevale, rose, & cheah, 2010). in this study, all racial and ethnic groups with either some college or an associate’s degree earned significantly less than those with a bachelor’s. at the bachelor’s level, however, latinos grossed lifetime earnings at approximately the same rate as african americans, but below both whites and asians (carnevale et al., 2010). education is simply essential for earning more, but even with the additional education, social barriers to lifetime earnings remain a factor in the lives of latinos. policy recommendations, as a result of these barriers, include strategies to help ameliorate the perceived problems. these include mentoring, improving teacher quality, or occasionally expanding parental involvement in schools. however, many of these concepts have yet to be fully tested. do strategies such as helping with homework, punishing or rewarding grades, or spending more time with one’s children improve outcomes for latino youth? many studies demonstrating the positive benefits of improved parental involvement failed to address the issue by race or ethnicity. this study examined the diverse factors in the literature, and specifically analyzed positive indicators of latino youths’ matriculation from high school to postsecondary enrollment at the bachelor’s level. parental and familial factors in college matriculation family dining crt supports the assumption that broader societal and economic forces are at play in education. perna (2006) and rowan-kenyon, bell, and perna (2008) offer a comprehensive contextual model for assessing pathways to college enrollment. these include: “students and their families; k–12 schools; higher education institutions; and broader societal, economic, and policy contexts” (rowan-kenyon et al., 2008, p. 566). crt supports this model by assuming that broader societal and economic forces are at play. family dining literature suggests that the relationship within families is an important determinant in postsecondary matriculation. given the nature of crt, family dining is a potential protective factor against daily life in schools and the potentially negative societal factors that limit success for racial or ethnic groups struggling to fit into the school milieu. multiple studies over the years have pointed to the importance of family dining in educational attainment. regular family dining was one indicator of the amount of time families spend together in general. one of the most authoritative studies on family dinners, the importance of family dinners at the national center on addiction and substance abuse (casa) at columbia university (national center on addiction and substance abuse, 2003, 2011) found that students who share family dinners with their maxwell /parental and familial factors in successful matriculation 130 parents are more likely to earn higher grades. according to the study, the benefits extend far beyond grades, showing reductions in stress and boredom, and thus, reductions in alcohol and substance abuse (national center on addiction and substance abuse, 2003, 2011). other studies demonstrated clear inverse relationships between family meals and a variety of negative outcomes, not at one point in time, but sometimes years later (eisenberg, olson, neumark-sztainer, story, & bearinger, 2004). the problems often associated with preventing college matriculation such as low grades, substance abuse, depressive symptoms, and suicide attempts were shown to be mitigated with more frequent family dinners during the week. to date, the research examining race and ethnicity, which might disaggregate the family dinner data, is virtually nonexistent. a few studies distinguished gender differences, with females generally experiencing positive benefits further in time (eisenberg et al., 2004). yet, differences among race or ethnicity were assumed to be constant. on the strength of existing research, these hypotheses are offered:  h1a: the more frequently latinos eat dinner with their family, the more likely they will be to enroll in college at any level.  h1b: the more frequently latinos eat dinner with their family, the more likely they will be to pursue bachelor’s degrees. parental involvement in academic preparation extant research on parental involvement in a student’s success crossed two areas of interest that suggest latinos, and other immigrant groups, deserve a separate analysis. first, parental involvement in homework as an indicator of successful college matriculation was found to be positive and significant in studies of college-bound high school students (henderson & mapp, 2002; smith et al., 2008). second, latinos warrant a separate analysis as a result of the role crt plays in the lives of students and parents. latino parents were susceptible to misunderstanding their role in their children’s education as a result of school communication policies and procedures, as well as language fluency. checking homework, helping with homework, and meeting with teachers were not clearly defined involvement activities for parents in most instances. language barriers also played a role. zarate (2007) stated, “for many [latino] parents, language [is] an insurmountable barrier to participation in their children’s academic tasks. moreover, as their children [in the study] progressed through school, the content and course material became increasingly difficult to understand” (p. 9). parental involvement usually encompassed two factors: life participation and academic involvement (zarate, 2007). life participation was defined as monitoring peer groups, school attendance, exercising discipline, and observing the school environment (zarate, 2007). academic participation was separate and distinct and included attending parent-teacher conferences, helping with homework, and keeping track of report cards, among other variables (zarate, 2007). in this study, the focus was academic, employing analyses that reflected levels of parental involvement with teachers and homework. advances in social work, spring 2013, 14(1) 131 involvement was operationalized as helping with homework, checking homework, and meeting with teachers. parental involvement and college matriculation generally speaking, lower parental involvement in schooling led to lower achievement for students, while higher parental involvement resulted in improved achievement (henderson & mapp, 2002; smith et al., 2008). such involvement began early, and research demonstrated that parental expectations and literacy development as early as kindergarten could influence academic outcomes much later in school (froiland, peterson, & davison, 2013). across the board, researchers generally agreed that parental involvement resulted in improved expectations for attending college, as well as actual matriculation (cabrera & la nasa, 2001; perna & titus, 2005). perna and titus (2005) succinctly summarized the need for continued research, noting that, “the college enrollment process varies across racial/ethnic groups,” but the research remains limited regarding the amount and nature of parental involvement in determining successful outcomes for students from varying racial and ethnic groups (p. 486). perna and titus (2005) found that parental involvement, defined as discussing academics with their children and volunteering at the school, was positively associated with college enrollment; interaction with the school over behavioral problems had the opposite effect. altshul (2011) supported these notions, “findings show that the positive effects of parental involvement among mexican american parents occur through involvement in the home, whereas parental involvement in school organizations is not associated with youths' achievement” (p. 159). frequent meetings were presumed to be a result of behavioral problems for purposes of this study, resulting in a decreased likelihood that the student whose parents frequently meet with teachers would go to a twoor four-year college. latinos and parental involvement crt suggests that the daily lives of latinos are operationalized similarly to any other student applying for college, but the outcomes should not be expected to be the same. indeed, the educational gap literature paints a picture of uninvolved parents in the latino community; while a more nuanced approach suggests that parents are intimidated and reluctant to get involved as a result of language barriers and other school-home communication barriers. latino parents reported feeling like they could not communicate with school officials if they were not communicating effectively in english (zoppi, 2006). latino parents faced additional burdens to involvement such as transportation, child care, and a general lack of communication from schools, which did not offer encouragement or support (smith et al., 2008). views from the students themselves painted an even more complicated picture. according to the pew hispanic center (lopez, 2009), a survey of latino students revealed the students themselves blamed poor parenting, rather than poor teaching, for the educational attainment gap. such survey questions did not take into account larger questions such as students’ responsibility or their ability to recognize poor teaching. in the pew survey, 47% of respondents said, “parents of hispanic students not playing an maxwell /parental and familial factors in successful matriculation 132 active role in helping their children succeed is a major reason [for students not performing well]” (lopez, 2009, p. 5). yet, the question could have been interpreted differently, as “almost two-thirds (65%) of latino youth strongly agree that their parents play or played an active role in their education” (lopez, 2009, p. 4). thus, it appears that some parents may be active in their children’s education, yet there lies a disconnect among the 18% who also stated that their parents were not necessarily helping them to succeed. it is conceivable that parental assistance does not automatically translate into positive educational outcomes for youth, latino or otherwise (barge & loges, 2003). yet, simultaneously, students appeared to want or need that involvement. another recent study by the higher education research institute painted a picture of latino students believing their parents are not as involved as the respondent would like, especially in college decision making and post-college matriculation decisions such as choice of classes (hurtado et al., 2008). forty-three percent of latino freshmen reported that their parents were involved “too little” in selecting college courses, compared to 18% of whites (hurtado et al., 2008, p. 2). parental involvement is difficult to quantify and disaggregate. reading to one’s children might be as important as helping with homework, but few studies ever compare the various meanings applied to parental involvement. extant research, for example, pointed to a widening gender gap occurring within the latino student community as a result of parents reading more frequently to their female children (freeman, 2004). thus, even the phrase “parental involvement” has a variety of childhood, teenage, and postcollege enrollment meanings. parental involvement might apply to reading to children, helping with homework, assisting with college preparation, and participating in postsecondary enrollment, among many other factors. altshul (2011), in a study specific to mexican american youths’ academic achievement, found a negative relationship between parents helping with homework and children’s success. the author stated, “parents helping with homework and whether the child was male were both negatively related to test scores (altshul, 2011, p. 165). checking homework could work differently than helping with homework, as checking simply implies accountability or commitment to educational requirements from the school. separating concepts within the parental involvement literature may ameliorate the puzzle, as latino teens expressed differences in expectations and definitions of parental involvement in different surveys. moreover, the history of lower levels of college attainment by latinos in the united states puts parents in a double bind: latinos are more likely than whites to be parenting a first-generation college student, and thus have no personal experience to rely on when being asked for advice about selecting courses, developing strong study habits, and addressing personal concerns about issues such as roommates, relationships with professors, or joining clubs. their children express desire for their help, and they want their children to succeed, but they may feel that no (uninformed) advice is better than their best guesses. given the operational definition offered by zarate (2007) and others, separating academic involvement from life involvement, the following academic hypotheses are offered: advances in social work, spring 2013, 14(1) 133  h2a: the more frequently parents check homework, the more likely latino youth will be to enroll in college at any level.  h2b: the more frequently parents check homework, the more likely latino youth will be to enroll in bachelor's degree programs.  h3a: the more frequently parents meet with teachers, the less likely latino youth will be to enroll in college at any level.  h3b: the more frequently parents meet with teachers, the less likely latino youth will be to enroll in bachelor's degrees.  h4a: the more frequently parents help their children with homework, the less likely latino youth will be to enroll in college at any level.  h4b: the more frequently parents help their children with homework, the less likely latino youth will be to enroll in bachelor's degree programs. rewarding grades given the need to disaggregate and operationalize parental involvement in more concrete terms, researchers are specifically reviewing how parents help or interfere with their children’s ability to earn good grades. clearly, a solid grade point average is a precursor to college enrollment and a strong stride in the educational pipeline. earning solid grades requires a level of commitment and motivation. can external financial rewards motivate teens, resulting in the improved likelihood of attending college? the answer appears promising. levitt, list, neckermann, and sado (2011) found that differing levels of financial rewards (larger rewards like $20, as opposed to $10, were more effective, particularly for male teens), as well as timing, (delayed rewards are virtually never effective) both made a difference in student success on standardized tests. fryer (2011) examined financial incentives in three cities, and found that financial rewards were “not a panacea,” but the author did find some potentially modest effects. interestingly, financial rewards in both studies were distributed through the study, and not by parents. there is reason to suspect that financial incentives alone may not lead to college enrollment, but that rewards by parents may be more meaningful:  h5a: latinos whose parents reward good grades will be more likely to enroll in college at any level.  h5b: latinos whose parents reward good grades will be more likely to enroll in bachelor's degree programs. socioeconomic status, parental college attainment, and student outcomes numerous studies link ses with college enrollment, typically using variables such as parental income or parental education (zarte & gallimore, 2005). in surveys of latino youth, financial stress and pressure to work were consistently cited as major factors in dropping out of school. castellanos and jones (2003) explained that many latino parents were unable to assist their children with finances in college, especially in comparison to white families. the lack of financial assistance caused added strain on latino students. maxwell /parental and familial factors in successful matriculation 134 repeatedly, low ses was associated with being raised in a single-parent family, being held back one grade, having siblings who dropped out of high school, changing schools more than twice, and having a c average (cabrera & la nasa, 2000). importantly, cabrera and la nasa (2000) found that parental involvement mitigated the effect of ses in many instances, effectively narrowing the gap between lower and upper ses students. however, lower ses students, in general, lagged behind upper ses students by almost 25% with respect to high school graduation, and over 50% for those who applied to college (cabrera, la nasa, & burkum, 2001). importantly, ses is improving for every immigrant generation that succeeds the first. in other words, second and third-generation immigrants of any race or ethnic group surpass their parents on many ses indicators, especially wages (haskins, 2007). differences in ses are not clearly linked to race or ethnicity, but are significantly more complex. for example, wage increases across generations are associated with the economic situation of the country of origin. so, immigrants from less developed countries face hardships that those from developed countries never experience. the result is slower improvements in wage earnings across generations. however, mexican immigrants, in comparison to nonimmigrants, are closer to narrow the wage gap than their parents. in 2007, a 15% wage gap existed for second generation mexican immigrants compared to a 32% gap between their parents and non-immigrants in the united states (haskins, 2007). parents who go to college are simply more likely to have children who go to college (choy, 2001). the educational pipeline consists of a few key steps, starting with the decision to go to college and ending with the act/sat and college application process. in each stage in the pipeline, from making the initial decision to preparing academically, parents’ college attainment levels are indicative of potential success. choy (2001) states “graduates whose parents did not go to college were much less likely than their peers with more educated parents to complete each step" (p. 9). lower parental college attainment is related to multiple ses factors such as the greater likelihood of being a female, a single parent, and earning a lower income (engle, 2007). across the board, studies indicated that first generation college students who are lower income, female, and have parents with less than a high school education were considerably less likely to enroll in postsecondary education themselves (kuh, kinzie, buckley, bridges, & hayek, 2006). parental education was not only a key contributor to student educational outcomes, but was perhaps the most important variable in the educational pipeline.  h6a: latinos whose mother or father attended college will be more likely to enroll in college at any level.  h6b: latinos whose mother or father attended college will be more likely to enroll in bachelor's degree programs. advances in social work, spring 2013, 14(1) 135 methods instrumentation and survey objectives this study uses data from wave 2 of the texas higher education opportunity project (theop). wave 1 of theop included surveys of over 13,000 high school seniors in a random sample of texas public schools. in 2003, 5,836 of those seniors were reinterviewed following their senior year of high school. the second wave captured information about postsecondary education and provided information about parental involvement, family time, such as eating dinners as a family and many other variables consistent with the educational gap literature. the survey itself was given to public high school seniors who were not attending charter schools and were not in special education. the current study followed the stated survey objectives by separately considering whites, latinos, african americans, and asians. it also separately analyzed those who attended postsecondary education after high school and those who did not attend college after high school (theop, 2004). respondents self-identified their membership in the four ethnic groups, and as male or female. measures the frequency of family dining was measured by asking "during your senior year [in high school] did you and your parents/guardians eat dinner together as a family?" (1) rarely or never, (2) sometimes, or (3) often or always. the frequency of homework-checking by parents was measured by asking, "during your senior year did your parents or other adults check on your homework?" (1) rarely or never, (2) sometimes, (3) often or always. the frequency with which parents met with their children's teachers was measured by asking, "during your senior year, did your parents or other adults meet your teachers?" (1) rarely or never, (2) sometimes, (3) often or always. the frequency with which parents helped with their children's homework was measured by asking, "during your senior year, did your parents or other adults help you with your homework?" (1) rarely or never, (2) sometimes, (3) often or always. parents' college attendance was measured by asking "has your mother/father ever attended college?" (these were two separate items.) (1) yes, (2) no. parents' practice of rewarding good grades was measured by asking "during your senior year did your parents or other adults reward you for good grades?" (1) rarely or never, (2) sometimes, (3) often or always. students' attendance of college was measured by asking "since september of 2002 have you attended a vocational/technical school or taken university courses for credit?" (1) yes, (2) no. at your current institution, what type of degree, certificate, or license are you pursuing?" (0) none, (2) associates degree, (3) bachelors degree, (4) a license, (5) a maxwell /parental and familial factors in successful matriculation 136 certificate, (7) other. responses to this second item were recoded in the present analyses to (0) non-bachelors degree, (1) bachelors degree. analysis logit regression, estimating the likelihood of latino respondents attending college, was conducted. the independent variables were regressed simultaneously on: attending college at all, and attending college in pursuit of a bachelor’s degree. a concern was that the variables may be correlated at a level which could create a multicollinearity problem. to examine this issue, a correlation analysis was run on the independent and dependent variables used in the study. for the correlation analysis, results were reported using the “bachelor’s degree,” but similar results using “any college” as the dependent variable was also found. the correlation analysis was reported in table 1. a number of the independent variables were correlated. not surprisingly, the highest correlation between two independent variables was between “parents check homework” and “parents help with homework” (ρ=0.42). to account for any possible multicollinearity that this might induce, a new variable was created, “homework,” which was a linear combination of the two. the other independent variables, while correlated, did not rise to the level that warrants concern regarding multicollinearity. results the first hypotheses predicted that: in families that eat together regularly, latinos were more likely to enroll in college. this hypothesis was not supported in either the "any college" (b =.10, p = .12) or "bachelor's degree" (b = .05, p = .07) condition. (see table 2). h2a-4b involved parental involvement in latinos' high school education, predicting that more involvement is generally associated with less likelihood of college attendance. the test of the second and fourth hypotheses relied on the new variable, “’homework,” which was the combination of the two homework variables. the separate homework hypotheses, checking homework and helping with homework, were not supported. this finding could be related to a correlation between the two variables, both capturing the same underlying construct. using the combined homework variable, that parents’ regular involvement in homework should predict college attendance, was strongly significant and negative in both the "any college" condition (b = -.12, p <.001), or in the "bachelor's degree" condition (b = -.13, p < .001). checking and helping with homework are, therefore, taken as one construct, and they pointed to a negative association between parental involvement in homework and college matriculation. the fifth hypothesis predicted that latinos whose parents rewarded good grades were more likely to attend college. for this hypothesis the coefficient on "any college" (b = .07, p = .15) was positive, but insignificant. however, it was significant and positive when measuring the outcome as "bachelor's degree" (b = .15, p = .03). advances in social work, spring 2013, 14(1) 137   table 1 correlation analysis bachelor degree family dines together parents check homework parents meet teachers parents help with homework mother attended college father attended college family dines together 0.01 parents check homework -0.06* 0.23*** parents meet teachers -0.02 0.11*** 0.24*** parents help with homework -0.03 0.17*** 0.42*** 0.29*** mother attended college 0.13*** -0.04* 0.01 -0.02 0.05* father attended college 0.17*** -0.01 0.00 -0.02 0.02 0.49*** parents reward good grades 0.03 0.20*** 0.32*** 0.15*** 0.25*** 0.03 0.01 *p<.05 **p<.01 ***p<.001 maxwell, loges/latino matriculation into postsecondary education 138   table 2 logit analysis of effects of family circumstances on latinos’ odds of attending college or a bachelor’s degree program (n=1,607) any college bachelor degree program family circumstance odds std. error odds std. error family dines together 0.10 0.07 0.05 0.07 parents check homework -0.12*** 0.04 -0.13*** 0.04 parents meet teachers -0.07 0.07 -0.01 0.07 mother attended college 0.39*** 0.15 0.36*** 0.15 father attended college 0.54*** 0.09 0.70*** 0.15 parents reward good grades 0.07 0.07 0.15** 0.07 constant -0.05 0.22 -0.69*** 0.22 pseudo r-square 0.03 0.03 chi-square 59.01*** 49.20*** **p<.01 ***p<.001 finally, the sixth hypothesis predicted that parents' college attendance increased the likelihood of latinos attending college. the results were strongly consistent with this hypothesis. using "any college" as the outcome variable, the coefficients for both parents having a college degree were strongly positive (mother, b = .39, p < .001; father, b = .54, p < .001). the results when measuring the outcome as "bachelor's degree" also strongly supported the hypothesis, mother (b = .36, p = .01) and for father (b = .70, p < .001). limitations the limitations of this study fall under three main categories: disaggregating race and ethnicity, quantifying the parent-teacher relationship, and the lack of ses-related parental variables in the dataset. first, race is socially constructed according to crt, and this component of the framework highlights one of the main limitations of the current study. given the existing data set, it is virtually impossible to distinguish among different groups of latinos. the experiences of those from different countries and ethnic backgrounds would present a more meaningful analysis. by grouping all latinos in the study, along with the fact that the data are limited to the state of texas, the analytical framework itself becomes limited; that is to say, a nuanced approach is not offered, and therefore presents the social construction of latinos as one monolithic group. another limitation of the current study is the lack of clarity in the survey regarding parental interaction with teachers. unfortunately, the data do not offer details on the quality or types of interactions that occur when parents meet with teachers. advances in social work, spring 2013, 14(1) 139 the current study is also limited in ses analyses, as parental income is not a variable in the dataset. however, parental education is analyzed. implications for social workers, parents, and educators parents attending college and parents rewarding for good grades are both positive factors in latino youths’ matriculation into postsecondary education. when parents helped with homework or met with teachers, the odds of college attendance diminished. the message to parents is that modeling education oneself and positively rewarding for their children’s accomplishments is important. the message is not that parents should avoid teachers and not check homework. the results most likely indicate that those parents who felt the need to meet frequently with teachers, or were overly involved in homework, may have been doing so to ameliorate poor academic performance. however, those attempts by parents are potentially less useful than rewarding their children given the findings in this study. the measures of parental involvement in this study (help with or checking homework, and meeting with teachers) were, in all cases, negatively related to college attendance. barge and loges (2003) found complex differences in understanding the role and benefit of "parental involvement" in children's schooling between parents, middle school students, and teachers. students clearly distinguished different kinds of "help with homework" and rewards for good performance; therefore it could be that the present study's measures of the role of parents in homework was too blunt an instrument to capture the different ways children interpret parents' attempts to help. barge and loges (2003) reported that teachers and students distinguished between parent/teacher meetings that were generally helpful and those that were not. for instance, students reported embarrassment if parents appeared at school in situations where the students were being punished, and teachers reported that parents who only appeared at school when their children were in trouble were not generally helpful. parental involvement may, therefore, include very simple accommodations by educators, such as: weekly communication regarding assignments, grades, and school functions written in english and spanish. simply receiving the information more frequently allows parents to ask, as well as, reward positive performance. for parents who cannot afford to reward, programs that do reward grades are being implemented through grants and school initiatives. rewarding for grades is a relatively new programmatic innovation that is taking root across the country. a few federal and foundation-funded grants are including grade rewards in the program implementation process. as a matter of policy, blindly rewarding for grades may not produce the intended results. further examination by policymakers should entail consideration of the source. are financial incentives as meaningful coming from a federal program or one’s own parents? such questions require further examination, but this study suggests that parental involvement in rewards is meaningful. in addition to grade rewards, the national conference of state legislatures now recommends financial rewards for latinos’ successful graduation from high school (camacho liu, 2011). maxwell /parental and familial factors in successful matriculation 140 policymakers, public managers, and social workers should also be aware of such recommendations, as implementation of public policies requires consideration across race or ethnicity. this study is limited in its ability to assess school-factors in the crt framework. would parents be more involved if schools were more accommodating? or, are latino parents working long hours and are simply prevented from becoming overly involved in schools during limited school hours? indeed, one study of a promising program that involved latino parent involvement proved puzzling to the program operators. parents who said they would attend an evening session at the school failed to show. social workers quickly learned that the local factory had let the workers out late that evening. “the situation highlighted the tenuous working conditions that latino parents in the country face” (belliveau, 2011, p. 89). in another study, the overwhelming majority of latino fathers reported that their job was the single biggest obstacle to parenting (shears, furman, & negi, 2002). public and school-based policies that consider cultural aspects of families offer promise. for example, the national conference of state legislatures recommends that schools in the united states accommodate latino families by offering classes in the evening, on weekends, or online to help working teens who may be expected to help the family (camacho liu, 2011). zarate (2007) recommends public policies allowing flexible work time for parents of school age children. the college board also recommends rewarding high schools that send more latinos to college (nevarez & rico, 2007). what works? cultural sensitivity is clearly important, but structural changes to a generally inflexible educational system as demographics shift in the united states is a topic that warrants some thought as well. indeed, many families, latino or otherwise, across the united states face employment pressures that interfere with parental involvement. rather than continuing to rely on parents to augment their children’s education, some schools are already lengthening the school day, providing free tutoring after school, and allowing children to complete their homework at school. some innercity schools are now open on the weekends. washington, dc, for example, opened the first public boarding school in the country (http://www.seedschooldc.org). the move away from parental involvement to an educational system ready to serve more than the educational needs of students is a quickly growing phenomenon. the seed school, as one example of a lottery-based system, is associated with increased earnings and reduced chances of being involved in a crime for students after one year of attendance (curto & fryer, forthcoming). students in seed must also apply to at least five colleges as a condition of graduation (curto & fryer, forthcoming). policymakers and social workers might also consider the most important variable in this study and in so many others: parental education. working with youth to promote college may translate into working with families to improve overall educational attainment. programs that work with both youth and their parents are commended as promising programs. southern methodist university, for example, offers a master’s in bilingual education that has graduated over 300 latino students who now work with over 60,000 youth and their parents. the factors that help students find their way through the educational pipeline are inherently present in the middle and upper classes of society. in the last decade, federal initiatives to create individualized development accounts advances in social work, spring 2013, 14(1) 141 (idas) or savings accounts for education or entrepreneurship are on the rise. encouraging and supporting educational attainment cannot be understated. programs such as, advancement via individual determination (avid) or puente project are recognized in educational circles as best practices (nevarez & rico, 2007). such programs, designed specifically for youth whose parents did not attend college, offer day-to-day instruction regarding college matriculation. these programs attempt to combat negative influences experienced by students in a crt framework. these programs, and many others like them, can be adopted in more formal settings in schools to promote college matriculation. realistically, large-scale changes in public policy are always difficult. but given the findings from this research, smaller, close-to-home approaches are viable. providing allowances for grade rewards through existing federal and private programs could conceivably improve both parental involvement, as well as continued success in school. gradual changes by schools, government, and families have potential to increase success for young students in the college matriculation process. finding “what works,” rather than repeatedly focusing on “the educational gap” can become the new policy focus for latinos in the united states. references altschul, i. 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(2010). latinos and college access: trends and future directions. journal of college admission, 209, 24-29. retrieved from http://www.eric.ed.gov/ericwebportal/search/detailmini.jsp?_nfpb=true&_&eric extsearch_searchvalue_0=ej906627&ericextsearch_searchtype_0=no&accno= ej906627 zarate, m. e., & gallimore, r. (2005). gender differences in factors leading to college enrollment: a longitudinal analysis of latina and latino students. harvard educational review, 75(4), 383-408. zoppi, i. m. (2006). latino parental involvement in students’ school attendance and achievement. region ii district of prince george’s county public schools research report. retrieved from http://www.education.umd.edu/mimaue/documents/publications/latparinvstd.pdf                                                              i the theop data used the terms “mexican, mexican american, or chicano.” i am using the term latino to represent the cultural reference to spanish-speaking populations or their descendants. author note: address correspondence to: sarah p. maxwell, ph.d., associate professor of public affairs, school of economic, political & policy sciences, the university of texas at dallas, 800 w. campbell road, gr 31, richardson, texas 75080-3021. email: sarah.maxwell@utdallas.edu _______________ sara l. schwartz, phd, msw is a senior lecturer, school of social work, university of southern california, los angeles, ca 90015. june l. wiley, phd, msw is clinical associate professor and director of the virtual academic center, school of social work, university of southern california, los angeles, ca 90015. charles d. kaplan, phd is research professor and associate dean of research, school of social work, university of southern california, los angeles 90015. copyright © 2016 advances in social work vol. 17 no. 1 (spring 2016), 15-30, doi: 10.18060/20875 community-building in a virtual teaching environment sara l. schwartz june l. wiley charles d. kaplan abstract: in 2010, the university of southern california school of social work launched its virtual academic center (vac) to deliver online msw programming to students located around the country. usc’s platform is a significant innovation in offering online education and has transformed the traditional educational model for both students and faculty. this research explores the experiences of faculty teaching via the vac. twenty-five in-depth, semi-structured interviews were conducted with usc faculty of different ranks. inductive data collection using a grounded theory approach with thematic analysis examined experiences teaching in an online program, revealing the strengths and challenges associated with geographic diversity and community-building. findings warrant the development of innovative practices to build community and to facilitate collaboration among geographically diverse faculty and students in a virtual education program. keywords: virtual education; virtual community; geographic diversity the virtual delivery of education is a widely discussed topic in the field of social work. while many schools of social work have offered online curriculum to rural and underserved communities for years, the profession is rapidly expanding its use of technology to educate and train a diverse workforce. advances in technology have created exciting opportunities for both education and practice, broadening boundaries, reducing access barriers, and helping social work become more sustainable in the 21st century. this is an important moment in social work and flynn, maiden, smith, wiley and wood (2013) identify it as an emerging paradigm shift in the field. virtual education creates opportunities for knowledge-sharing and collaborative efforts that can build strong, socially sustainable communities locally and around the world (james, murray, & pacheco, 2013; rautenbach & black-hughes, 2012; shorkey & uebel, 2014). a rapidly evolving literature evaluates the impact of online education and details the many successes of virtual social work programs. much of this research has focused on the student experience, finding that students are largely satisfied with online education and that learning outcomes have little variance across delivery structures (ayala, 2009; cappiccie & desrosiers, 2011; chan, tsui, chan, & hong, 2009; thyer, artlet, & markward, 1998; woehle & quinn, 2009; york, 2008). while debate exists about teaching relational and clinical skills to students via an online platform, research indicates that teaching clinical skills virtually is an effective modality with no demonstrated differences among students receiving traditional versus online training (cummings, chaffin, & cockerham, 2015; cummings, fouls, & chaffin, 2013). schwartz et al./community building 16 a separate line of inquiry focuses on faculty experiences of delivering virtual education and the critical role that instructors perform in the successful achievement of student learning outcomes (beauchamp & kennewell, 2010; horvath & mills, 2011). a growing body of literature identifies specific resources needed for effective online instruction, discusses challenges faced, and evaluates instructor satisfaction (ayala, 2009; cappiccie & desrosiers, 2011; douville, 2013; hill jones, 2015; horvath & mills, 2011; huang & hsiao, 2012; larsen, sanders, astray, & hole, 2009; liechty, 2012; pruitt & silverman, 2015; siegel, jennings, & conklin, 1998). identified challenges include comfort with technology or adjusting to technology glitches (horvath & mills, 2011; levin, whitsett, & wood, 2013), guidelines to facilitate synchronous communication (huang & hsiao, 2012; martin & parker, 2014), time commitment (lloyd, byrne, & mccoy, 2012), and community-building with other faculty (dolan, 2011). suggested resources to support online faculty include technology training, round-the-clock technological support (cappriccie & desrosiers, 2011), and mentoring (smith, 2015). online social work programs adhere to different instruction delivery modalities. webbased technology offers a broad range of options for social work programs to combine asynchronous content, synchronous classroom time, traditional face-to-face time, and onsite field placement training (madoc-jones & parrott, 2005; shorkey & uebel, 2014). according to cswe (2016), as of 2015, 39 schools of social work had adopted a range of curriculum delivery options. for example, some programs require monthly face-to-face meetings combined with weekly asynchronous content. others provide few live synchronous meetings, relying on other forms of classroom communication via forums, blogs, and email. some programs combine regularly scheduled synchronous sessions with asynchronous work. while research demonstrates that instructors are largely satisfied with a host of delivery options, there has been limited inquiry into how faculty experience different modalities of online teaching and build virtual relationships with each other as well as their students. the usc virtual academic center the university of southern california (usc) school of social work launched its virtual academic center (vac) in 2010, providing 80 students the opportunity to earn an msw degree via a fully online, interactive platform that combines weekly asynchronous assignments, weekly synchronous classroom time, and on-the-ground field experiences in each student’s local community (flynn et al., 2013). the virtual campus enables students and faculty living in communities outside of southern california to participate in usc’s highly ranked msw program (u.s. news, 2012). as of april 2015, 2,230 students have enrolled in the program and have been taught by over 375 full-time and part-time instructors (adams, maiden, & wind, 2015). the usc program was one of the first elite research universities to offer its highly ranked msw program via an entirely online platform (usc online, 2016). the program delivers excellence in education internationally, reduces access barriers and frequent military moves, overcomes situational factors preventing relocation, and removes disability-related barriers (anstadt, burnette, & bradley, 2011; madoc-jones & parrott, 2005; tandy & meacham, 2009). advances in social work, spring 2016, 17(1) 17 while geographic diversity is an important strength of the program, it raises unique challenges related to training and supervising faculty, as well as relationship and community-building (smith, 2015). given the profession’s emphasis on understanding the person-in-environment, it is important to uncover the experiences of usc’s virtual faculty in order to inform best practices. this paper presents findings from qualitative research exploring usc faculty experiences teaching via the virtual campus. this research examined the instructor experience in a geographically diverse fully online program. while literature considers online educator experiences, less attention has been given to the social work educator in the fully virtual environment and no attention has been given to faculty living and working from distant locations. an inductive grounded theory approach (charmaz & henwood, 2008; glaser & strauss, 1967) using nvivo10 software guided the initial data collection of 25 semi-structured faculty interviews. thematic analysis (braun & clark, 2006) was used to analyze the data. the specific aims of this research were to: a) characterize instructor motivations for online teaching, b) learn about instructor experiences and teacher-student relationships in virtual classrooms, c) understand community-building and relationships among faculty in virtual social work education, and d) uncover opportunities and challenges for virtual classroom instructors. knowledge gained from this research was expected to strengthen the vac and facilitate understanding of faculty delivering education in online communities. methods an exploratory cross-sectional design utilizing qualitative methods was developed to meet the specific aims of the study. given that usc employs over 300 faculty members to teach in the virtual social work program, an initial step in this project was formulating an appropriate sampling strategy. the inclusion criterion for selection in the sample was having taught a minimum of at least one year in the vac to capture perspectives of faculty familiar with the platform. in addition, it was important to represent the different types of online instructors: 1) tenure line, 2) non-tenure track faculty (nttf), clinical teaching, 3) nttf adjunct, and 4) field. forty-eight faculty members were recruited for participation using a combination of purposive and quota non-probability sampling strategies to ensure representation from the four lines presented above. this sampling strategy captured the points of view of all faculty lines, each of which play an essential role in curriculum development and delivery. following approval from the usc’s institutional review board in may 2014, the director of the vac sent an introductory email to all 48 individuals selected for participation. this email included information about the research, protection of human subjects, consent procedures, and contact information for questions and comments. in june 2014, a second email was distributed to schedule interviews. thirty-three individuals (69%) responded to email recruitment, with five refusals and twenty-five faculty successfully scheduling interviews (three did not follow-up after expressing interest). the first author electronically responded to interested participants to schedule an interview day and time. during these initial contacts, participants were informed that their identity would remain anonymous and that no identifying information would be collected. candidates schwartz et al./community building 18 learned that their telephone interviews would be recorded, transcribed, and stored in a password-protected dropbox file accessed only by the researchers. interviews occurred between august 6, 2014 and october 21, 2014. the researcher contacted each participant via telephone. once permission to turn on the audio recording was received, the interviewing began. participants were reminded that their participation was voluntary, that their identities would remain anonymous, and that no harm was anticipated as a result of their involvement. informed consent was collected and recorded for each individual. the interviews adhered to a semi-structured interview schedule that was comprised of fifteen questions, with eight of the questions collecting demographic information on variables such as gender, race, and years of teaching experience. the other seven questions were open-ended with prompts designed to elicit information about online teaching experiences. for example, question #5 asked participants to “describe the relationships that you have with your students on the vac.” an associated prompt is “have you noticed a difference in your vac student relationships as compared to your other teaching experiences?” see appendix a for the complete interview schedule. data analysis data collection and interview selection adhered to traditional grounded theory techniques (charmaz, 2014; glaser & strauss, 1967). data analysis followed principles of thematic analysis (braun & clark, 2006) using nvivo 10 software for data management and organization. the iterative analysis was completed in four steps. the first step of open coding was concurrent with early data collection to ensure that the data encompassed content related to the specific aims of the study. the analysis of interviews 1-12 resulted in an initial codebook of 48 nodes that was developed by the first author and approved by the two co-authors. selective coding of interviews 13-16 comprised step 2, resulting in theoretical saturation and a reduced codebook of 21 nodes and three overarching themes. in step 3, the two co-authors independently selectively coded interviews 17-22, validating the nodes and themes. the final step of the analysis was an analytic seminar attended by all three authors, reviewing the codebook for completion and selectively coding interviews 23-25 collectively. the seminar concluded with agreement on the thematic schema presented in this paper. results sample the initial sample was comprised of 20 adjunct, 18 clinical teaching, 8 tenure line and 2 field faculty members. twenty-five individuals (52% of the invited sample) completed telephone interviews with the first author. the final sample represents 12 (48%) adjuncts, 7 (28%) clinical teaching, 5 (20%) tenure-track and 1 (4%) field faculty member. twentyone individuals (84%) identify as female, 17 (68%) identify as white, and four (16%) identify as african-american. sixteen individuals (64%) were over the age of 50 years, with nine (36%) in their 60s, 7 (28%) in their 50s, 7 (28%) in their 40s, and 2 (8%) in their 30s. the sample had an average of 14 years teaching experience, with a spread of 1 to over 30 years. advances in social work, spring 2016, 17(1) 19 overarching themes data analysis resulted in the identification of three over-arching themes that emerged from the data: geographic diversity, community-building among faculty, and community-building among faculty and students. theme 1: building a geographically diverse academic community almost all faculty verbalized appreciation for the geographic diversity that the virtual platform brings to the classroom. unlike many online social work programs, the vac does not limit program acceptance by region. thus, students are located in 49 of the 50 united states and some live abroad, generally on military bases located in guam, germany, and france. many related that the inclusion of this form of diversity deepened the learning experiences for both students and faculty alike. as one female instructor in her mid-40s relates: i think it has provided an opportunity to bring diversity – more of a diversity spectrum or framework to the classroom. you know, we often think of diversity in religion, sexual orientation, gender or what not but we really, i mean, to get a sense of how it’s actually different to live in the south than it is in the west and in the east…there’s just a difference in some respects. i think that diversity is valuable in the classroom. another male instructor who has taught in the vac for almost four years echoes this sentiment: …it makes for really fascinating discussions where the students can get really engaged. policies, legislation and all that plays out very differently across the country, whereas if all the students are in san diego county there is not as much variety with that. i think that having the riches of all the different experiences and communities as well as orientations, backgrounds of the students. there's a lot more variety so you can do a lot with diversity discussions, policy and all that. that’s some really rich material for a professor teaching on the vac. a relatively new part-time female instructor in the vac relates her thoughts that summarize the general feeling of the vac faculty: “i think that it is phenomenal to be able to reach people around the world.” the majority of the participants clearly appreciated the geographic diversity of the student body and how it impacts classroom discussions and dynamics. however, only two considered the opportunities that a geographically diverse faculty bring to the program, as reflected in the following perspective provided by a long-time female usc school of social work instructor with experience teaching both on the ground and in the vac: from an organizational standpoint, i think it’s given us an opportunity to attract some really stellar folks to teach for us, that we otherwise wouldn’t have been able to do. but they are really amazing practitioners and leaders in the profession and they’ve been attracted to what we are doing here. so, organizationally, it’s been an amazing thing that we’ve been able to achieve by doing this. schwartz et al./community building 20 theme 2: community-building among faculty community-building was a frequent topic discussed during the interviews, with participants representing different points of view. one perspective held by several individuals is that the usc school of social work has become so large that there are inherent challenges to maintaining a sense of community on one campus let alone across several. one person notes that it is “not realistic” to expect a campus so large to have a shared sense of community. others offer that the large number of part-time instructors in the vac create separate challenges for building community. for example, many adjunct faculty members elect to teach part-time so they can also have a clinical practice or alternative career. these individuals may not have the time or inclination to be involved with the school community outside of their teaching responsibilities. despite these perspectives, most participants reported concern about relationship building among faculty across the campuses. many expressed feelings of isolation in their work and from other instructors. some identified difficulties developing connections with faculty who live outside of los angeles. those living afar noted feeling alienated from the school of social work. the geographic diversity that makes the vac so unique can also pose barriers to informal networking and can cultivate feelings of isolation for some faculty. as one female professor with over 20 years of teaching experience expressed: teaching on the vac, for me, having been based in both los angeles and san diego prior to being in the virtual program, has felt pretty isolating. i have felt like i don’t have enough communication and interaction with colleagues. several individuals identify missed opportunities for informal relationship-building at faculty meetings or simply having a chance to engage in “water cooler talk” between classes. these informal get-togethers help people recognize each other and, over time, may encourage community-building. while vac instructors are invited to attend faculty meetings virtually, they sometimes conflict with other schedules or time zones. additionally, although meeting attendance creates opportunities for faculty to interact on the platform, several weeks or months can pass between meetings. this lapse in time creates barriers to nurturing new relationships and keeping the dialogue moving forward. as one female los angeles-based faculty member reflects: it’s like, you and i can have a really great rapport, but if we don’t ever….you know, we many never interact again. so, it was just a really nice conversation but it does not build community. others note that this lack of consistent communication and ability for informal interaction limits opportunities for faculty to collaborate on research or communicate about shared students. a suggestion made by many is for usc to find opportunities to bring faculty in person together once or twice a year. as one female instructor with over three years' experience teaching in the vac suggests: i think it’s key to at least provide opportunities for faculty members to come together as a full body of faculty as we do on the ground. i’ve found that that’s been the way that connections have been established, research opportunities have opened up, writing, all those types of things. there are opportunities that just advances in social work, spring 2016, 17(1) 21 happened just in conversations walking in the same physical space in the hallway. ‘i’ve done that – if you’re interested in this, i’m on this research project would you like to participate?’ you know there are things like that that happen by the nature of being in the same physical space but i don’t know how that happens to the vac – so i think creating some opportunity for that. another idea introduced is to host bi-annual faculty meetings by region so that people living in the same part of the country can get to know each other. others recommend developing alternative methods for community-building that do not require meeting in person. this perspective considers establishing virtual opportunities for connection using the adobe connect platform built for the vac. considering alternative strategies is exemplified by a male tenure line instructor: there should be ‘here is one strategy for engaging students and faculty’ but it doesn’t…because to me it always ends this message that meeting in person or on the ground, coming to campus, is always best. and that maybe is the case but it feels premature to me, at this point. to me, it seems like we should explore more and be open to the fact that, yeah, it’s just different. you get to engage in that way when it’s live, but how do you build a sense of community that is as rich, as rewarding, with your students and your colleagues when you do it online and feel that it is just as good, if not better, than meeting on the ground. theme 3: community-building among faculty and students while there is general consensus about challenges faced building community among faculty, participants held varying opinions on community-building between faculty and students. using adobe connect technology, faculty facilitate weekly 75-minute synchronous class discussions. for some, community-building with students in the classroom and over email has been a productive experience. several reflect that there is little difference in their ability to build community with students online as compared to their experiences teaching in a traditional setting. one male instructor in his mid-40s with over ten years teaching experience shares: i develop relationships with the students totally online at the same quality i would say as on the ground. again, the modality of interaction on the phone, or office hours, not in the same air space that’s a little bit different but in terms of the person-to-person connection or the professor-to-student connection its absolutely just as good. another male teaching both on the ground and in the vac indicates: i wouldn’t say that there’s any difference based on geographical location, no. i think that the relationship is the same regardless of whether they are on the east coast, or whether they are international, or in the south, or midwest or north. i don’t necessarily see any difference. others identify challenges building community with students that are commonly associated with geography. as with community-building among faculty, some participants feel that not having informal interactions around campus limits their ability to get to know schwartz et al./community building 22 their students outside of the classroom. along a similar vein, some suggest that it can be challenging to mentor students that are taking virtual classes in a traditional sense. for example, if living across the country from each other, an instructor would not be able to connect students with local resources or professional contacts. one tenure-line female professor with over 30 years teaching experience reflects: there is no way that i could have the same connections in their different cities to help them. there’s no way you can develop the same kind of rapport and that they can benefit from some of the relationship with me in the same way as if they’re on the ground and walking around and dropping in. another instructor, a tenured female teaching both on the ground and in the vac shares: on campus you can see people on the quad…you can see people formally in the classroom and you see people informally. and i didn’t have that opportunity with the online students. kind of more came to class and then if they needed something, i was in touch with them but it was never…like we were all attending the same lecture, we went to this lunch, or they were, you know, tabling in the quad and i was able to go talk to them about their cause. while a handful of participants identified barriers to community-building with students, the majority reported that geography does not limit their ability to know or mentor students. some reflect that, regardless of modality, there are always going to be some students who seek mentorship and deeper relationships with their professors more than others. several participants acknowledged that it is easier for students to be anonymous in a virtual classroom, thus faculty need to develop strategies to engage students throughout the term. one instructor requires all of her students, regardless of campus, schedule a private meeting at some point in the term. she explains: one of the things that i like to do with the students that were a bit of a surprise with the vac students was try to have a quick individual meeting with everybody – private – just to get to know them a little bit. make them more comfortable talking to me so i have students that have to come see me in my office or make a vac appointment before the midterm. others relate that they use synchronous class time to stimulate group discussions and build community. as one female professor in her mid-sixties shares: what i try to do in the synchronous portion is to really sort of ask the kinds of questions that stimulate discussion among students. i always start my course talking about who i am and why i’m teaching this course and then i ask them about who they are. i really try to get to understand where they are coming from. several respondents noted that features of the virtual classrooms successfully facilitate relationship-building among the students and with faculty. most participants appreciate the smaller classroom size on the vac, and many value the ability to use the breakout rooms for small group exercises and the chat pod to build community. as one female instructor with over a decade of teaching experience reflects: advances in social work, spring 2016, 17(1) 23 i do like the smaller classes and i see a great deal of collegiality that is built and respect for each other and interest….like you have the little chat box that’s going on at the side and i always look to see, for example, how someone shared something and others will jump in and comment. that doesn’t happen in the ground classes, where people give feedback immediately to their peers. i think in many ways the peer support is greater on the vac even though they are not in the same physical space. discussion this qualitative research study aimed to explore the specific experiences of instructors in usc’s vac. an especially significant motivation of the faculty was the opportunity to teach a geographically diverse body of students that stretches across the entire u.s. and into other countries. in teaching in traditional on-the-ground classrooms, instructors may experience a diversity of sociodemographic characteristics, but the students are all constrained to one geographic location. in contrast to traditional programs, vac instructors virtually interact with students embedded in different locations with various perspectives that would be difficult to experience otherwise. existing literature touches on the unique characteristics of students attracted to virtual education, including students being older, representing rural communities, and having financial and family responsibilities that prohibit traditional graduate education programs (flynn et al, 2013; hill jones, 2015; madoc-jones & parrott, 2005; reamer, 2013; stotzer, 2012). however, participants in this study consider an alternative type of classroom diversity that is largely unrepresented in the literature. as an example, one participant identified the unique ability to examine the implementation of social policies in different communities around the country. future examination of vac student diversity and its impact on educational and career outcomes of graduates may create greater understanding of how to build and sustain national and international social work educational communities. while study participants largely appreciated the diversity of their virtual students, the limited attention given to the geographic diversity of the faculty was surprising. in fact, in many ways, the distance among faculty was considered a limitation to relationship building and collaboration as was illustrated by the statements related in theme 2, communitybuilding among faculty. usc is one of the first schools of social work to employ faculty who are not based in the same location as the ground campus, representing a unique education delivery system (shorkey & uebel, 2014). research suggests that, even with the most advanced technology, the lack of shared physical spaces for interaction is a challenge for both students and faculty (madoc-jones & parrott, 2005; smith, 2015). voices represented in this study echo existing literature suggesting that virtual educators can experience a sense of isolation and alienation from colleagues, students, and the larger organization (smith, 2015). while a growing body of research considers a developing pedagogy for virtual education and for using technology to facilitate community-building with students (hill jones, 2015; horvath & mills, 2011), there is less emphasis on faculty perspectives and experiences. examining how to transcend these challenges and reframe geographic diversity of faculty is something that warrants investigation in the future. schwartz et al./community building 24 the instructor experiences of community-building with faculty and students in virtual classrooms were seen to have many similarities but also significant differences in physicality. establishing and working with this difference in student-faculty and facultyfaculty community-building in the vac provides both opportunities and challenges for the future growth of the program. apart from the physicality, the scale of the vac can be daunting, and there may be emergent challenges to programming and community-building presented by the mere size and rapid growth of the program (bentley, secret, & cummings, 2015; pruitt & silverman, 2015; reamer, 2013). future research should explore what might be the optimal size of the vac platform in terms of numbers of students and faculty to build effective community. getting all students and faculty, particularly the pool of parttime adjunct instructors, together in one physical or virtual meeting is probably not realistic; however, smaller regionalized meetings should be considered as should virtual opportunities for community-building. study limitations the study was primarily limited by the extent of its analysis, which was restricted to a qualitative methodological approach that identified themes that were largely descriptive. this qualitative methodology precludes quantitative inferences about the relationships among the themes and perspectives described in this paper. it would have been useful to conduct more analysis mapping of the identified themes to abstract concepts grounded in the data, and to systematically relate them to specific concepts found in the literature. the use of non-probability purposive and quota sampling limits our ability to generalize the findings beyond the usc faculty members interviewed for the study. comparison of cases representing the different strata of the purposive sampling design would have provided one way to increase the extent of the analysis and move from description to explanation. the fact that only one interviewer was used to complete all of the interviews and that this individual is an instructor in the vac creates the potential for interviewer bias. lastly, quite a few programmatic changes have been made since the original interviews took place. many of these changes were designed to create more opportunities to connect faculty across campuses and build a more cohesive community. the data presented in this paper do not represent programmatic changes made after the data collection. conclusion the vac challenges the basic assumptions that have guided social work education from its beginning as a profession. our research has shown that certain basic assumptions of social work education concerning geographical uniformity, physicality, and scale of community-building among faculty members with each other and their students have been challenged by the vac. the program has undoubtedly increased access to and opportunities for quality msw education as well as introduced a model for the wider social transformation of education. but with this innovative model specific unintended consequences and lessons learned have emerged that need to be investigated and applied in future research on the vac and similar internet-based models of social work education. at bare minimum, the formative research presented in this paper documents that social work has entered into a new design of the classroom in which everyone is seated in the advances in social work, spring 2016, 17(1) 25 front row. in this new design, the opportunities and challenges for community-building are impressive, but need to be specifically addressed in order to determine future directions of social work education in the virtual environment. references adams, b., maiden, r. p., & wind, l. h. 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(2008). comparing three modes of instruction in a graduate social work program. journal of social work education, 44(2), 157-172. doi:http://dx.doi.org/10.5175/jswe.2008.200700031 author note address correspondence to: sara l. schwartz, university of southern california school of social work; saraschw@usc.edu, 510-384-0997 http://dx.doi.org/10.1080/08841230903249745 http://dx.doi.org/10.5175/jswe.2008.200700031 mailto:sam.cotton@louisville.edu advances in social work, spring 2016, 17(1) 29 appendix a vac faculty interview schedule thank you for participating in this study! we are eager to learn about your experiences as an instructor in the virtual academic center. the information that you and your colleagues share will be completely anonymous and will help develop a knowledge base around the instructor experience in an online social work community. your identity will remain completely confidential. while your interview will be tape recorded and transcribed, your personal identity will not be attached to the interview. your identity for the purposes of this study will be your interview number (e.g., interview #1, interview #2, etc.). the only individual who will be able to link your name with your interview transcript will be the person conducting the interview. this information will be held in the strictest confidence. your participation in this study is completely voluntary and no harm is anticipated to occur as a result of this interview. do you consent to participate? o yes date: _____________ o no date: _____________ 1. what motivated you to get involved with teaching in the vac? i. prompt: have you had prior experience teaching online? ii. prompt: have you taken online classes? 2. how did you prepare for teaching in a virtual community? i. prompt: did you receive any special training? ii. prompt: did you feel prepared to teach online? 3. what has your experience been teaching in the vac? i. prompt: what have your classroom experiences been like? ii. prompt: if you have taught on the ground before, how is this different? iii. prompt: what lessons have you learned about teaching online? 4. given our large number of student veteran population, how prepared do you feel with managing student veteran issues that may come up in the classroom? i. prompt: do you have a personal or professional history with the military community? please explain. ii. prompt: have you received special training or mentorship? 5. describe the relationships that you have with your students on the vac. i. prompt: have you noticed a difference in your vac student relationships compared to your other teaching experiences? ii. prompt: the vac has small classrooms. how has this been for you? iii. prompt: do you feel as if you to get to know your students? iv. prompt: do you mentor students on the vac? schwartz et al./community building 30 6. in your experience, what are the opportunities and challenges of being an instructor in the vac? i. prompt: what works for you regarding teaching in the vac? ii. prompt: is there anything that you think could enhance your experience as a vac instructor? 7. how do you experience community in the vac? i. prompt: do you interact with other instructors? ii. prompt: do you attend faculty meetings? if yes, do you attend in person or log on to the vac? iii. prompt: do you feel as if you are part of a larger virtual community? if so, what does that feel like to you? iv. prompt: do you feel satisfied with your connection to the larger usc school of social work system? 8. what is your age range? o 25-29 o 30-39 o 40-49 o 50-59 o 60 + 9. what is your gender? 10. your ethnic/racial background:  asian/pacific islander  black/african-american  hispanic/latino  native american  white  other (please specify): _________________________ 11. what is your terminal degree? 12. what is your position at usc? o tenure/tenure track o clinical teaching faculty o clinical field faculty o research faculty o adjunct faculty 13. how many years of teaching experience have you had? 14. how many years have you been teaching in the usc school of social work? 15. how many years have you been teaching in the vac? microsoft word 09 lee_and_walsh_18134_using_technology_in_social_work_au_ce.docx ______________ shawna j. lee, phd, msw, is an associate professor at the university of michigan school of social work, in ann arbor, michigan. tova walsh, phd, msw, is an assistant professor at the university of wisconsin, school of social work, in madison, wisconsin. copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 107-124 using technology in social work practice: the mdad (mobile device assisted dad) case study shawna j. lee tova b. walsh abstract: mobile technology presents an exciting opportunity for social workers to reach populations that are typically underserved by interventions and services. we present one application of technology that is particularly relevant to social work practice. the mdad (mobile device assisted dad) smartphone application (app) was developed to augment existing social work practices by providing a father-friendly tool to help new fathers learn about and engage with their infants and toddlers. we discuss the process of developing the smartphone app content and conducting usability testing of the mdad app. we conclude with a discussion of the lessons learned from the mdad project and the challenges of implementation and dissemination of technology-based interventions in community contexts. keywords: father, fathering, parenting, intervention, prevention, child welfare mobile phones are ubiquitous: 91% of americans own a mobile phone (pew research center, 2014), and 61% of mobile phone owners have a smartphone (nielsen, 2013). smartphones are extremely versatile and are an increasingly important part of people’s daily lives. one study showed that smartphone users had their device with them or in the same room 90% of the time (dey et al., 2011). moreover, mobile phones, smartphones, and tablets are starting to bridge the “digital divide” of economic and social inequality in access to technology-based information (chang et al., 2013; ginossar & nelson, 2010). smartphone ownership rates are actually higher among african americans (33%) and hispanics (45%) than whites (27%) (nielsen, 2011). young people have especially high rates of mobile technology use; for example, 77% of 18-29 year olds with an annual household income of less than $30,000 are smartphone owners, and rates of smartphone ownership in this age range are between 80-90% among those with higher incomes (pew research center, internet and american life project, 2013). in response to the growing use of online and mobile technology, there has been unprecedented growth in efforts to use technology as a tool to improve health outcomes. although much of this research is in its early stages, technology-based interventions using the internet, smartphones, and text messaging are increasingly being applied to promote psychosocial wellbeing as well as physical health. for example, currently available interventions aim to alleviate depression and mental illnesses (burns et al., 2011; depp et al., 2010; granholm, ben-zeev, link, bradshaw, & holden, 2012), promote happiness and emotional self-awareness (della porta, pierce, zilca, & lyubomirsky, 2012; morris et al., 2010), increase relationship satisfaction (kalinka, fincham, & hirsch, 2012), increase prosocial behavior and reduce aggressive behavior (rajabi, ghasemzadeh, ashrafpouri, & lee & walsh/using technology 108 saadat, 2012), and promote parenting skills and reduce child maltreatment (baggett et al., 2010; evans, wallace, & snider, 2012; jordan, ray, johnson, & evans, 2011; mast et al., 2014; ondersma, svikis, thacker, beatty, & lackhart, 2014; thraen, frasier, cochella, yaffe, & goede, 2008; walters et al., 2014; whittaker et al., 2012). furthermore, findings from pilot studies suggest that mobile technology can be an effective tool to deliver behavioral health interventions to at-risk populations (e.g., aguilera & munoz, 2011; carta, lefever, bigelow, borkowski, & warren, 2013; gazmararian, elon, yang, graham, & parker, 2013). thus, the use of mobile technology may present an opportunity for social workers to reach typically underserved or hard-to-reach populations. in this paper, we discuss one application of technology with particular relevance to social work practice. the mdad (mobile device assisted dad) app was conceived of as an innovative way to augment existing social work practices by providing an accessible, father-friendly tool to help new fathers learn about and engage with their infants and toddlers. the mdad app incorporates educational content on child development with suggestions of simple activities that fathers can engage in with their infants and toddlers. in this paper, we describe the initial development and usability testing of the mdad app and implications for social work practice with fathers and families. usability testing is a practice that analyzes early implementation processes and evaluation procedures before they are finalized (akin et al., 2013). because the field of technology-based interventions is growing at breathtaking speed, explicating our experience with the content development and usability testing processes of developing the mdad app will help researchers and practitioners interested in the application of technology to social work. in our case, the process of usability testing included extensive examination of the acceptability of mdad content to the target population, as well as examining users’ interactions with the app interface. this process of extensive usability testing was particularly important because social workers and other service providers have had little success engaging fathers in traditional parenting education approaches. therefore, we used qualitative interviews and focus groups to better understand how men reacted to and engaged with the content of mdad, with the long-term goal of learning how to more effectively tailor mobile interventions for new fathers to their unique parenting needs. why focus on fathers? in focus groups and discussions with diverse fathers including young fathers, military fathers, and low-income african american fathers, men have voiced a genuine desire to be involved with their children and to be positive parents and partners (lee et al., 2013; lee, yelick, brisebois, & banks, 2011; walsh, dayton, et al., 2014). however, fathers have also articulated challenges in understanding how best to engage with their children, especially infants. concerns about being a positive, engaged parent were particularly salient among two groups: (a) military fathers, who experienced long separations from their children because of deployment, and (b) urban african american fathers, who voiced the desire to “step up” in ways that their own fathers had not. motivated by the desire to be a good parent and the experience of significant parenting challenges, many fathers are interested in receiving support for building their parenting skills (walsh, dayton, et al., 2014). advances in social work, spring 2015, 16(1) 109 despite the interest of most fathers in being a good parent, practitioners and researchers usually face difficulties when trying to engage fathers in interventions to promote positive father-child relationships (mcallister, wilson, & burton, 2004; stahlschmidt, threlfall, seay, lewis, & kohl, 2013). generally, parenting education and intervention programs have been designed for and evaluated using mothers (bilukha et al., 2005; lundahl, tollefson, risser, & lovejoy, 2008; mikton & butchart, 2009), with notable exceptions (e.g., cornille, barlow, & cleveland, 2005; fagan, 2008). thus, the content of most parenting programs might have little direct relevance to the experiences of most fathers. for example, few programs account for the needs or experiences of nonresidential fathers. moreover, some providers have conflicting feelings about fathers’ participation in parenting programs and services. because few practitioners are trained in methods for engaging fathers, service environments often lack a “father-friendly” atmosphere (o'donnell, johnson, d'aunno, & thornton, 2005). in addition, evidence has indicated fathers have low levels of interest in traditional parenting programs (cornille et al., 2005; duggan et al., 2004; fagan & iglesias, 1999; o'donnell et al., 2005; raikes, summers, & roggman, 2005). one study of early head start-sponsored efforts to engage fathers indicated 17% of fathers participated in at least one parenting education program; however, fewer than 10% of fathers participated in father-only events (raikes et al., 2005). moreover, when parenting services are available only during traditional weekday business hours, fathers’ work schedules often prevent their participation. an additional participation barrier stems from the stigma associated with asking for assistance, but scant data are available on stigma specific to parenting programs. technology-based approaches designed for mothers although the use of technology to deliver parenting education and interventions to fathers is an emerging practice, using technology to engage mothers is a fairly wellestablished approach, including computer-based (ondersma, grekin, & svikis, 2011; ondersma, svikis, & schuster, 2007), web-based (feil et al., 2008; thraen et al., 2008), and mobile phone-based approaches (bigelow, carta, & lefever, 2008; carta et al., 2013; jabaley, lutzker, whitaker, & self-brown, 2011). one study used text messages as an enhancement to home visitation services and found lower rates of attrition among the mothers who regularly received text messages from service providers. in addition, as compared with mothers who did not receive text messages, mothers who received textenhanced services reported lower levels of depressive symptoms (carta et al., 2013). the text4baby program has been widely used to promote maternal and child health during pregnancy and infancy. results from text4baby are promising, and initial program evaluation has shown users felt more prepared to be new mothers and were more opposed to alcohol use during pregnancy (evans et al., 2012). other notable findings showed over 600,000 pregnant women and new mothers have enrolled in text4baby, demonstrating tremendous reach and dissemination of a text messaging-based intervention (gates, stephens, & artiga, 2014). more important, many of the mothers reached by text4baby would have received little, if any, parenting education via traditional means. however, to our knowledge, to date no technology-delivered parenting approach has focused on fathers. lee & walsh/using technology 110 mdad rationale and preliminary studies multiple factors motivated the development of mdad. first, there are relatively few existing parenting interventions designed for and tested with fathers, including nonresidential fathers. second, stigma associated with asking for help and education may prevent fathers from accessing existing services. third, prior research suggests that technology-based parenting interventions with mothers are effective, yet few or no technology-based approaches have been designed for and tested with fathers. given that fathers are unlikely to participate in traditional parenting education services, technologybased approaches hold promise for extending service provision to an underserved population. fourth, we believe that technology-based approaches have great potential for reaching specific at-risk groups of fathers, such as young fathers, who might be disconnected from services but well connected to technology. fifth, our approach was informed by evidence that pregnancy and the birth of a new child present a moment of high parental motivation when fathers are likely to be more receptive to parenting information and services. therefore, the perinatal period presents a window of opportunity to engage fathers in intervention to promote the development of positive father-child relationships (dubowitz, 2002; mclanahan, garfinkel, mincy, & donahue, 2010; walsh, tolman, et al., 2014). our survey of the research illuminated the many real and perceived barriers that fathers face in engaging with services, including lack of availability of parenting education specific to fathers and lack of father-friendly content. foremost in our minds was the need to make mdad content father-friendly. our preliminary studies underscored the importance of these issues. prior to development of the mdad smartphone app, the authors conducted focus groups and interviews with fathers representing a range of parenting contexts, including low-income fathers and military fathers (reported elsewhere: lee, neuget, et al., 2013; lee, yelick, et al., 2011), selected in part because they represent fathers who may lack needed supports and experience significant parenting stressors, including complex family structures, socioeconomic disadvantage, and periods of separation from their child (e.g., due to extended military deployment). these discussions were a part of the principal investigator’s ongoing research agenda and took the form of more general conversations about fatherhood, parenting, barriers to father engagement, and fathers’ perception of whether technology would be a suitable tool to meet their parenting support needs. in other words, these focus groups and interviews were not about the mdad app per se, but served as preliminary studies to inform its development. a key take-home point from both studies was that fathers felt unsure how best to engage with young children, particularly during infancy when child care is often thought of as primarily the role of mothers. results further suggested that fathers tend to rely more on informal sources of parenting information (e.g., spouse/partner, family members, friends) than on formal sources of information (e.g., pediatricians and social workers). the fathers who participated in focus groups were interested in a range of parenting information related to children's growth and developmental milestones, as well as effective co-parenting and communication. furthermore, most of the participants in these groups reported high levels of technology use and seemed amenable to the possibility of using technology such as a smartphone app to learn about caring for their baby. sample demographics and characteristics and more advances in social work, spring 2015, 16(1) 111 detailed analysis of the results are reported elsewhere (lee, neuget, et al., 2013; lee, yelick, et al., 2011). mdad content development we assembled a multidisciplinary research team to develop the “beta” version of mdad. the team included social workers and psychologists with expertise in father engagement, early child development, and parent support programs, as well as a technology-development team who specialize in developing and delivering internet-based and mobile health interventions. the social workers and psychologists reviewed the early child development and father engagement literature and developed the father-friendly parenting education and support that constitutes the content of the app. the technology specialists were responsible for development of the application software, tailoring technology, and creative design. the mdad beta app was designed to send push notifications to users’ smartphones two times per week. the push notifications link to parenting education messages within the app containing information on the development of infants and toddlers and developmental milestones. this information is presented in conjunction with suggested activities to help fathers think of new ways to engage with their baby. in addition, the parenting education prompts users to use the app to document their child’s development by creating logs and uploading pictures and videos. the mdad app is designed so that fathers can use it with their partner (such as the child’s mother or caregiver, or another significant person) or independently. our preliminary research helped to guide the development of mdad content (e.g., lee, neuget, et al., 2013; lee, yelick, et al., 2011; walsh, dayton, et al., 2014). for example, we used a multi-pronged approach to enhance the father-friendly nature and the relevance of mdad content (see figure 1). in contrast to programs such as text4baby that primarily focus on messages related to maternal and child health, mdad was designed with an explicit focus on opportunities for paternal engagement; that is, mdad focused on presenting simple, concrete ways for fathers to interact with their baby through providing care, playing games, or reading and talking to the baby. this focus was informed by our preliminary studies in which fathers described challenges and uncertainty related to engaging with their infant. research has shown that when users received messages tailored to their individual needs and characteristics, the messages were perceived as more relevant, were more likely to be read and recalled, and were more effective at changing behavior (hawkins, kreuter, resnicow, fishbein, & dijkstra, 2008; kreuter & strecher, 1996; kreuter, strecher, & glassman, 1999; noar, benac, & harris, 2007). therefore, a key design element of mdad was to implement message tailoring to enhance the relevance of the content to individual fathers (see figure 1). specifically, content was tailored to the age of the target child and to whether the father was a residential or non-residential father. lee & walsh/using technology 112 figure 1. design elements of mdad further, the content was designed to be father-friendly and personalized to each user. we consulted with a fathering expert and a comedian, both of whom made numerous suggestions to enhance the accessibility and father-friendly nature of the content by using humor and “buddy language” (i.e., the voice of a dad talking to another dad). the fathering expert also made suggestions for fun father-child engagement activities. methods introduction to usability and acceptability testing while the research team worked on multiple rounds of content development, we also engaged in acceptability and usability testing of “beta mdad” with fathers. usability testing examines the user experience in navigating through the features of an app, whether the technical aspects of the app function well, and whether features of the app are intuitive to the user. another goal of usability testing is to identify potential challenges or barriers that participants might encounter in using the technology (kaufman et al., 2003). acceptability testing examines if the content resonates with the intended user; in our case, we focused on whether men found the content of the push notifications and engagement activities to be relevant, useful, and consistent with their fathering experiences. the next section describes the data gathered through several rounds of usability and acceptability testing with fathers, using a convenience sampling approach. data collection included (a) in-depth, one-on-one interviews to gather fathers’ response to mdad messages and other content as it was being developed; (b) in-depth, one-on-one interviews with individuals who used and provided feedback on the beta version of the app; and (c) focus groups and small group discussions on the final version of mdad content, using screenshots gleaned directly from the app. our preliminary studies, described above, examined fathers’ access to parenting information and sources of parenting support in early fatherhood, whereas the usability and acceptability testing focused on fathers’ engagement with the actual content of the mdad beta app. all research procedures were reviewed and approved by the university of michigan institutional review board. study procedures all interviews and focus groups used a semi-structured format, covering a list of topics and questions defined by the research team in an interview guide. different questions were asked in the interviews conducted as usability testing than those conducted as acceptability testing. one-on-one interviews were conducted by a member of the research team who was either involved in the tech development or in the content development. interviewers took detailed notes on the conversation. focus group were usually facilitated by trained male advances in social work, spring 2015, 16(1) 113 facilitators who were not members of the research team or authors of this study. often, a member of the research team observed the focus groups and took notes. when a member of the team was not available to observe and take notes, focus groups were audio recorded for review by the research team. data analysis plan for analysis, the two study authors independently reviewed notes from the interviews to identify important concepts and themes in the data, read and reread each transcript in an iterative fashion to discern any previously unrecognized concepts and themes, and arrived at a consensus on themes emerging from the transcripts and interviews. it is important to note that the goal of our usability and acceptability testing was to inform and refine development of mdad, not necessarily to derive research hypotheses, answer research questions, or generate generalizable conclusions. this is reflected in our methodology, which uses an exploratory data collection method and data analysis approach that is highly descriptive and specific to the context of our study only. measures usability interviews a male member of the technology development team conducted the first iteration of usability testing. these interviews used a semi-structured usability testing script. the interview opened with the statement, “i am going to show you some screen shots and sketches that we have made of our design ideas. i’d like to discuss these ideas with you and get your opinions.” participants were presented with a series of scenarios and asked, “i am going to give you a scenario and ask you to do some tasks. as you are completing each task i want you to 'think out loud' as you decide which button to push and where to go within the site. i am going to ask you as much as possible to try and understand how you are looking at it, what you are trying to do, and what you are thinking.” a small number of young men (n=4) recruited from the university of michigan student population examined mock-ups of the mdad user interface. acceptability of mdad content to military fathers (team rwb) following the first round of usability testing, a member of the research team conducted in-depth acceptability interviews with military fathers (n=9) who had at least one child 3 years or younger. these interviews focused on the acceptability of mdad content, including usefulness and relevance to their experiences as service members and fathers of young children. respondents were recruited through the facebook page for the nonprofit veterans’ organization team red, white, and blue. the fathers who provided feedback were either active military personnel or recent veterans. to gather feedback on a broad range of content, the fathers were sent samples of parenting education content to review, including messages for a father of a 1to 2-month-old child and a father of an 11to 12month-old child. each father offered his feedback during a brief (15 to 30 minutes) phone call as part of a semi-structured interview with a member of the research team who took detailed notes during the phone call. the interviewer followed an interview guide that lee & walsh/using technology 114 asked participants to describe their overall impression of the sample messages; whether the content was interesting and relevant; whether the language and the tone was accessible and engaging; and what topics they would like to see added, expanded, or excluded. these fathers were also asked for suggestions for making content more relevant, accessible, and engaging. two researchers reviewed this initial feedback and used it to refine the parenting content. acceptability and usability testing with mdad beta users in the next iteration of testing, we conducted in-depth assessment of usability and acceptability of mdad content with fathers (n=4) who used the app for 8 weeks. semistructured interviews regarding acceptability of content were conducted over the phone, and usability questions were delivered via a brief online survey. a member of the research team conducted the interviews and took detailed notes on the feedback provided. following an interview guide, the interviewer asked fathers whether they found content useful and relevant to their parenting, if there were specific components of the mdad app that they particularly did or did not like, if the tone in which information was delivered was appealing, whether they found the app easy or difficult to navigate, whether there were content areas not covered that they would like to see included in the app, whether they would recommend the app to a father friend, and if they had suggestions to make the app something they would be more likely to use or recommend to a friend. the four fathers who participated in this iteration of testing were again recruited through veterans’ organization team red white & blue, and all were fathers of young children who were either currently serving in the united states military or had a history of military service. three respondents were interviewed at the conclusion of the 8-week pilot test, and one was interviewed in the middle of the testing period, prior to a scheduled deployment. acceptability focus groups with urban, african american fathers the research team also conducted six focus groups with a total of 27 men. respondents were all african american and ranged in age from 21 to 62 years. all of the men identified as having experience with parenting, and all except one participant self-identified as a father or surrogate father. the majority had at least one child currently living at home, and the ages of the children currently living at home ranged from newborns to 32 years of age. in this phase of the project, we created a detailed handout about mdad. we used screen shots of the mobile app to show key functions of the app. we also highlighted several parenting education messages from the app. the goal was to get feedback from men regarding the acceptability of the content and functionality of mdad. again, we used a semi-structured format and all focus group facilitators followed an interview guide. questions included, “mdad provides functions like uploading pictures of your baby and recording when they accomplish milestones, like their first tooth or eating new foods. what do you think about this function? would you use a function like this?” and “mdad also provides dads the option of creating 'logs' which are little notes about your baby, such as 'baby’s favorite things to do' and 'things dad did to make baby smile.' do you think you would use a function like this?” to examine the acceptability of the mdad messages, we provided sample messages directly from the app and said: “this is the kind of information advances in social work, spring 2015, 16(1) 115 that mdad provides. is this information interesting to you? do you think it would help you as a dad? do you think it is engaging to you as a father?” results usability interviews in the first round of usability interviews focusing on the layout of the app features and functionality of the app, men made several suggestions for how to improve the user interface and the features of the app to make it easier to use and navigate. in general, these young men rated themselves as very familiar with and comfortable using computers and other electronic devices. respondents provided feedback on how to improve ease of use, reduce visual clutter, and make cues more intuitive, for example, making the camera icon easier to access. acceptability of mdad content to military fathers (team rwb) fathers indicated that their overall impression of mdad content is that it is interesting and relevant to them. they found the information provided on developmental milestones to be interesting and accessible, liked the friendly, non-pedantic tone, and appreciated the brevity and specificity of the messages. they liked the features that allow shared participation with a co-parent and virtual tracking of their child’s development and said that these features make the app highly engaging. fathers were most enthusiastic about the activity suggestions offered by mdad; they reported that these suggestions were useful and appealing and gave them new ideas for things to do with their young children. for example, the sample content for the father of a 1to 2-month old explained that “it may seem like babies can't do much... but they come pre-wired with some amazing abilities.” a brief explanation of baby reflexes was followed by suggestions of how fathers could test and observe their baby’s reflexes (e.g., test and observe the grasping reflex by touching the palm of the baby’s hand and seeing if the baby grabs onto their finger). several fathers reported trying the suggested activities with their young children and enjoying them and said they had tried things they would not have thought to do without the prompt from mdad. fathers who reviewed sample content suggested the content could be improved in future iterations through increased tailoring. for example, the father of a child with special needs said that it would be very helpful for him if mdad offered specific ideas for activities suited to children with diverse needs. a father of two said that he would appreciate ideas for activities that he could engage in with both his young child and older child because he is usually with both children together. acceptability and usability testing with mdad beta users feedback was positive and suggested that a broad cross-section of military fathers (including first-time and experienced fathers of varied ages and relationship status) found the app content interesting, useful, and relevant to their parenting experiences. for example, one father said the content was relevant to him even as an experienced father: lee & walsh/using technology 116 i love the app. at first i thought it would be more useful for first-time fathers, but it turned out to be so helpful even though i already have kids it reminded me all kids aren’t the same and helped me try new things. fathers who both were and were not at home with their children at the time of using mdad found the app useful and the content relevant. for example, one military father who was away from his family on a temporary duty assignment said he used the app to keep up with his spouse about what their baby was doing. functions such as logging a child’s developmental milestones and receiving tailored parenting education were perceived favorably. fathers found the personalization and customization of the app to be a great strength. fathers indicated that they found the activity suggestions useful, the tone of the messages appropriate and appealing, and the features of the app easy to navigate. they appreciated the tone of the app for being both educational and humorous. moreover, they found the content well suited to their needs and interests as fathers of young children. in particular, these fathers noted that they valued the suggestions of developmentally appropriate activities for engaging with children at a specific age. the mdad brief messages were described as more useful than long books or dense websites that the fathers would have to sift through for information relevant to their particular circumstances. fathers reported that the frequency of messages and level of detail provided met their needs. in the words of one father: i get sick of apps that send too much information or send things too often. this app didn't send too much, so i never got tired of it. when i saw i had an update, i wanted to see what it was, and i went straight into the app. i always found information that was relevant for me and my son. specifically, fathers liked the app medium of delivery because it made relevant parenting information available and accessible whenever and wherever they had time and interest. fathers described looking through mdad activity suggestions and reading through app content as a productive thing to do (replacing less productive online activity) when they had a few spare moments such as waiting for an appointment. the timing of the messages – delivered on tuesdays and fridays – was rated as highly favorable; fathers reported that the messages helped to plant the seed for things to do over the weekend when they had the most family time. participants varied in their assessment of the relative importance of specific message topics but agreed that, overall, the topics were on point. they felt the app would be especially useful for first-time fathers but would also be useful for more experienced fathers. all participants agreed they would use mdad and would recommend the app to other fathers. acceptability focus groups with urban, african american fathers similar themes emerged in our discussion with urban, african american fathers. for example, participants indicated that they liked the language in the app and found the humor to be engaging as well. they liked the functionality of receiving push notifications as a reminder. in general, these fathers expressed enthusiasm about mdad and about having advances in social work, spring 2015, 16(1) 117 readily accessible parenting resources in the form of information on their phone. participants noted that even when parents are not together, it is important for dads to learn about and connect with their baby, and they liked the accessibility of the app. furthermore, they favorably rated the tailoring and personalization of mdad. when we asked fathers to rate the acceptability of specific mdad messages, respondents rated favorably content on baby proofing, child development, and ideas for engaging with the baby or toddler. numerous fathers indicated that some of the content, such as the notion of swaddling, was new to them. these fathers also had suggestions for ideas that they thought would improve the app, including a social networking feature that would allow users to share photos and videos with a wider network of friends and family, for example, connecting the app to facebook or instagram. other suggestions included content for parents with children who have special needs. discussion as noted in the introduction, smartphone use in american society is increasingly widespread and especially common among those individuals whom social workers are often trying to more effectively reach with social work interventions – for example, young people, low-income individuals, and members of racial and ethnic minority groups. however, many barriers still exist to the implementation and dissemination of technologybased interventions in community contexts. for a variety of reasons, those most in need of intervention might be less likely to receive such services. for example, factors such as low health literacy have been shown to hinder receptivity to text4baby messaging (gazmararian, yang, elon, graham, & parker, 2013). in our case, focus groups and interviews with men suggested that a pedantic tone would hinder fathers’ receptivity to mdad messages, so we focused on making the messages more engaging by using a warm and humorous tone. specifically, we used a humor consultant to transform the tone—and hence the user experience—of the app so that fathers find mdad engaging. in addition, each member of our multidisciplinary research team contributed content-specific expertise to mdad development. however, the numerous rounds of revising content by each team member were time and resource intensive. in parallel with the research team developing and revising content, we conducted four separate rounds of acceptability and usability testing, as detailed above, which took well over a year. an advantage of technology-based approaches is the option of tailoring interventions to the individual user. e-health research focusing on improving physical health outcomes has shown that tailoring messages can enhance intervention effectiveness (hawkins et al., 2008; kreuter, lukwago, bucholtz, clark, & sanders-thompson, 2003; kreuter & strecher, 1996; kreuter et al., 1999). participants in our study provided positive feedback about the personalization and tailoring of mdad messages. some feedback suggested that more extensive tailoring would make the app even more acceptable to fathers. for instance, one father whose child has developmental delays said he would have found it helpful to receive content addressing parenting a child with special needs. similarly, several divorced fathers suggested adding content on co-parenting after divorce. however, tailoring can present several challenges. given the extent of possible dimensions on which to tailor messages, priority areas must be determined. each tailoring element requires extensive lee & walsh/using technology 118 research to identify how content should be adapted to maximize relevance in response to the specific tailoring element. the current understanding of how best to tailor content of technology-based psychosocial interventions to underserved individuals is still quite limited. researchers will appreciate the possibility of enhanced data collection using technology. technology-based interventions can both facilitate traditional forms of data collection and support new approaches. website analytics enable researchers and developers to collect user data passively and track a variety of user interactions such as the type of content participants read and return to most (and least) frequently. site analytics can also track whether users follow links to additional resources, including who and how many follow each link; the frequency with which fathers write in the log and what they write about; how often fathers upload pictures and videos and what they document; and which users use the app independently and which use it with a partner. survey data and user data can be integrated to inform better understanding of under what conditions the intervention is most effective, and whether dosage (frequency with which fathers engage with the app) corresponds to gains in father engagement as measured via survey. last, although technology has enormous potential to reach individuals with great ease, dissemination remained a challenge in our experience. the ability to engage a large number of potential users requires buy-in from stakeholders. traditional methods of recruitment (e.g., flyers and bulletin board postings) are unlikely to be effective for an app. the approach most likely to be effective is leveraging a close connection to community collaborators who can help with the dissemination process. recruitment was challenging, but the fathers we reached were overwhelmingly positive and recommended the app to others. the positive participant response suggests it is not only worthwhile to invest in varied and creative recruitment strategies but also a promising strategy to invite early adopters to support dissemination by recruiting friends. reaching even a small number of people is meaningful if they would otherwise not be served because existing interventions are either inaccessible or unappealing to them; technology-based interventions thus hold great promise for expanding access for underserved populations. once taken to scale, technology-based interventions offer a cost-effective approach because the major costs are in the initial outlay and many additional users can be added at minimal costs. conclusion this study has a number of implications for the use of technology in social work practice. it suggests that delivery of tailored parenting information via smartphone app has the potential to make psychosocial interventions more engaging, more efficient, and less expensive, while reaching clients who might otherwise not be served by traditional parenting programs and services. however, challenges associated with this type of approach include the substantial investment needed up front to develop a high-quality, technology-based intervention. the mdad app and similar uses of technology in social work practice are in the early stages, and further studies are needed to evaluate and enhance the efficacy of this type of highly promising intervention. advances in social work, spring 2015, 16(1) 119 references aguilera, a., & munoz, r. f. 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(2013). smartphone ownership 2013 update. washington, dc: pew research center. retieved from http://www.pewinternet.org/files/oldmedia/files/reports/2013/pip_smartphone_adoption_2013_pdf.pdf pew research center. (2014). mobile technology fact sheet. washington, dc: author. retrieved from http://pewinternet.org/commentary/2012/february/pew-internetmobile.aspx raikes, h. h., summers, j. a., & roggman, l. a. (2005). father involvement in early head start programs. fathering, 3(1), 29-58. doi:10.3149/fth.0301.29 rajabi, a., ghasemzadeh, a., ashrafpouri, z., & saadat, m. (2012). effects of counseling by mobile phone short message service (sms) on reducing aggressive behavior in adolescence. procedia-social and behavioral sciences, 46, 1138-1142. doi:10.1016/j.sbspro.2012.05.263 stahlschmidt, m. j., threlfall, .j, seay, k. d., lewis, e. m., & kohl, p. l. (2013). recruiting fathers to parenting programs: advice from dads and fatherhood program providers. children and youth services review, 35, 1734-1741. doi:10.1016/j.childyouth.2013.07.004 thraen, i. m., frasier, l., cochella, c., yaffe, j., & goede, p. (2008). the use of telecam as a remote web-based application for child maltreatment assessment, peer review, and case documentation. child maltreatment, 13, 368-376. doi:10.1177/1077559508318068 walsh, t. b., dayton, c. j., erwin, m. s., muzik, m., busuito, a., & rosenblum, k. l. (2014). fathering after military deployment: parenting challenges and goals of fathers of young children. health & social work, 39, 35-44. doi: 10.1093/hsw/hlu005 walsh, t. b., tolman, r. m., davis, r. n., palladino, c. l., romero, v. c., & singh, v. (2014). moving up the "magic moment": fathers' experience of prenatal ultrasound. fathering, 12(1), 18-37. doi:10.3149/fth.1201.18 walters, s. t., ondersma, s. j., ingersoll, k. s., rodriguez, m., lerch, j., rossheim, m. e., & taxman, f. s. (2014). mapit: development of a web-based intervention targeting substance abuse treatment in the criminal justice system. journal of substance abuse treatment, 46, 60-65. doi:10.1016/j.jsat.2013.07.003 whittaker, r., matoff-stepp, s., meehan, j., kendrick, j., jordan, e., stange, p., . . . rhee, k. (2012). text4baby: development and implementation of a national text lee & walsh/using technology 124 messaging health information service. american journal of public health, 102, 2207-2213. doi:10.2105/ajph.2012.300736 author note address correspondence to: shawna j. lee, msw, phd, university of michigan school of social work, 1080 south university avenue, ann arbor, mi 48109. email: shawnal@umich.edu. the authors would like to thank the university of michigan curtis research and training center for funding to support this research. fall2005-063_page290 fall2005-064_page291 fall2005-065_page292 fall2005-066_page293 fall2005-067_page294 fall2005-068_page295 fall2005-069_page296 fall2005-070_page297 fall2005-071_page298 fall2005-072_page299 fall2005-073_page300 fall2005-074_page301 fall2005-075_page302 fall2005-076_page303 fall2005-077_page304 aisw vol. 8, no. 1:aisw vol. 5, no. 2 an analysis of afrocentricity as theory for social work practice dwain a. pellebon abstract: afrocentricity is developing rapidly within the social work profession as a theory for practice with african americans. afrocentric practitioners claim the theory provides a basis for understanding african americans from an african perspective and cultural value system, and it is the most effective approach to address racial oppression. however, social work has not critically analyzed the merits of afrocentricity as a source of knowledge to inform the profession. this article takes the initial step to determine whether afrocentricity is in-fact a theory. afrocentricity is described, discussed, and analyzed based on current and accepted definitions of theory. the analysis reveals afrocentric epistemology lacks the rigor to be accepted as an empirically-based theory for practice. the author concludes that afrocentricity is more accurately categorized as an ideology. research and practice implications of this conclusion and the need for further critique are discussed. keywords: afrocentricity, african-centered, empirically-based theory, cultural competent social work introduction human service professions must constantly adapt to the dynamism of societal change as it relates to politics, culture, technology, and knowledge. for example, political climates can produce legislative outcomes harmful to populations-at-risk (alzate, 2006). cultural trends influence inter-group relationships, including race, class, gender, and age cohorts. medical advances in health and mental health require all helping professions to assess and develop treatments and interventions that produce optimal outcomes. for these reasons and more, social work must be self-critical and adapt to the realities of society. one of the profession’s responsibilities to clients and to the profession is to “…critically examine and keep current with emerging knowledge relevant to social work practice (national association of social workers [nasw], 1996, section 4.01-b).” as the profession examines new ideas, social workers must be willing to accept or reject knowledge based on objective criteria. practice approaches developed from untested trends, appeals to emo169 dwain a. pellebon, ph.d. is associate professor at the university of oklahoma school of social work, norman, ok 73069. copyright© 2007 advances in social work vol. 8 no. 1 (spring 2007) 169-183. indiana university school of social work. tion, and/or oppressor guilt do not promote the well being of client systems or influence change in target systems. ethical social workers use the most current and verifiable knowledge-base, resources, and skills for competent practice. for all of the above reasons, this article examines the contribution of afrocentricity to social work knowledge. it specifically analyzes whether afrocentricity is technically a theory useful for social work practice. despite afrocentricity’s brief history, it is described as both a theory and an essential perspective for social work practice with african american clients (graham, 1999, 2000, 2002, 2005, 2006, 2007; schiele, 1996). in addition, several social work practice textbooks recognize afrocentricity as a practice perspective to use with african americans (devore & schlesinger, 1996; kirst-ashman & hull, 2006; mccroy, 2007; miley, o’melia, & dubois, 2007; poulin, 2005; weaver, 2005; zastrow, 2003). regarding afrocentricity’s contribution to theory, social work textbooks in research (dudley, 2003) and human behavior in the social environment (zastrow & kirstashman, 2004) assert afrocentricity as a perspective and worldview for african americans. interestingly, afrocentricity’s growing recognition in social work does not result from the profession’s scholarly examination of its merits. in fact, the social work literature neglects any critical analysis regarding the perspective’s scientific rigor or effectiveness with african american clients. considering the relatively new scholarship of afrocentricity in social work, the profession must assess its standing as a theory and its implications. afrocentricity’s founder encourages such analysis; he suggests that an “afrocentrist is a scientist… interested in reason, evidence, and falsifiability and in submitting her or his interpretations to rigorous analysis if she or he is studying human behavior” (asante, 2003, p. 648). thus, this paper critically examines the merits of afrocentricity as a theory in terms of its rational conceptualization, scientific rigor, and utility within social work. afrocentricity’s system of interest is to africans worldwide. to focus the analysis, this article concentrates on afrocentricity’s relevance and application specifically to african americans as a client system. after a brief history of afrocentricity, this article describes its goals and central components. this writer then assesses afrocentricity using currently accepted standards of theory and knowledge as described by the commission on accreditation (council on social work education [cswe], 2003) and the profession’s values based on the national association of social workers (nasw, 1996). a brief history of afrocentricity molife kete asante is the “founder, principal theorist, and authority of afrocentrism…” (turner, 2002, p. 712). in a published interview, he describes his initial inspiration came during his travels in africa when he realized that it was “crazy” for a black man to have a european name (asante, 2003, p. 716). he accepts the conclusion that the primary social crisis for black americans is one of culture. a crisis is based on the notion that eurocentric misrepresentation of african history psychologically dislocates black americans (karenga, 1980). karenga’s philosophy and work to reconstruct african american history in the 1960s was a major influence on asante’s development of afrocentricity (asante, 2003, p. 30). 170 advances in social work asante’s (1980) first comprehensive description of his theory laid the foundation for afrocentricity’s development. within a few years, scholars from history, education, and anthropology criticized the theory’s analytical methods and epistemology (lefkowitz, 1996; howe, 1999; ratvich, 1992). these debates prompted asante (1987, 1988, 2000, 2003) to further develop and defend this new theory. regardless of the disagreements, afrocentricity’s growing influence is undeniable. it has become a framework to articulate an alternate voice for understanding african culture; it has led to the founding of the journal of black studies, and it has influenced several disciplines, most notably black studies/african american studies programs in the united states (turner, 2002, p. 712). now, afrocentricity has emerged as a theoretical perspective for social work practice (schiele, 1996; graham, 1999). the theory of afrocentricity it is important for social workers to understand the theory of afrocentricity. this writer paraphrases and quotes prominent afrocentric writers to provide a detailed understanding of the theory and a sense of afrocentricity’s rhetorical style. asante (2003) defines afrocentricity: “afrocentricity is a mode of thought and action in which the centrality of african interests, values, and perspectives predominate. in regards to theory, it is the placing of african people in the center of any analysis of african phenomena. thus, it is possible for any one to master the discipline of seeking the location of africans in a given phenomenon. in terms of action and behavior, it is a devotion to the idea that what is in the best interest of african consciousness is at the heart of ethical behavior. finally, afrocentricity seeks to enshrine the idea that blackness itself is a trope of ethics. thus, to be black is to be against all forms of oppression, racism, classism, homophobia, patriarchy, child abuse, pedophilia, and white racial domination” (p. 2). afrocentricity has several broad goals, but four are pervasive in its literature: 1) afrocentricity exposes and actively resists “white racial domination” over african americans; 2) it transforms african americans toward their cultural center; 3) it converts african americans to an ideology of values, spirituality, and rituals; and 4) it analyzes disciplines, such as literature, history, linguistics, politics, science, religion, and economics from an afrocentric perspective (asante, 2005, pp. 1-13). the first goal to expose and resist white racial domination is the centerpiece connecting the other three. according to afrocentricity, this goal is foundational, because african americans will never thrive until they recognize that the western world only examines social phenomena from a white perspective, while actively negating african culture. another problem of eurocentric thinking is an assumption of universality so pervasive that european americans place their culture at “the center of the social universe” (asante, 2003, pp. 2-5). the reason to focus on european culture in america is the belief that culture is the most powerful influence on social, political, educational, economic, scientific, and religious structures 171pellebon/an analysis of afrocentrcity as theory for social work practice within society. thus, the united states, a society built upon the racist domination of other groups, is incapable of developing a humane, pluralistic, or multicultural society. in the end, eurocentric hegemony “…creates a fundamental human crisis” of unavoidable domination” (asante, 1998, pp. 5, 22-23). according to abarry (1990), the primary objective of afrocentricity “… is to liberate the research and study of african peoples from the hegemony of eurocentric scholarship…” (p. 123). afrocentricity bluntly declares that current methods of inquiry, logic, and research in academia are inappropriate methods to study african americans. in fact, such approaches to knowledge are “based on an ideology of racial superiority and racial privilege” (asante, 2006, p. 653). so-called theoretical development through empirical research intentionally oppresses africans by imposing a racist and sexist interpretation to knowledge. furthermore, the academy’s intentional contrivance of language is an important tool to maintain the hegemony. for example, terms, such as “multicultural,” “inclusive,” and “ethnic minority” actively promote the dominance and superiority of white americans. only the analytical tools of afrocentricity can discover the truth regarding the african american condition. afrocentricity’s primary tools of analyses are “the twin towers” of tradition and reason (pp. 651-652). even african american scholars, educated in the academy, are ineffective using eurocentric research methods (asante, 2006, pp. 648-649). african american scholars using empiricism to understand the experience of his or her own culture are “enemies” of african americans (turner, 2002, p. 723). these scholars “don’t normally speak from a sense of centeredness and intellectual background of africa or of african america. they speak out of european centeredness…. [asante] thinks centeredness has to be a sense of fidelity and… integrity… out of your own culture” (turner, 2002, p. 724). therefore, a non-afrocentrist, regardless of race or scholarship, is incapable of developing knowledge that accurately represents the african american collective experience for self-determination and self-definition. the ineffectiveness of african american scholarship is symptomatic of the misorientation resulting from eurocentric hegemony. asante (2006) believes that many african american scholars “…are victims of the hegemonic influences of their teachers and are therefore caught in a uniquely stifling bind.” in fact, many african american scholars “… write as if they are not just conceptually european but also possess an anti-african agency.” asante maintains his position is not racist or anti-white. on the contrary, it is pro-african to expose the racist and oppressive effects of european mythology (pp. 657-658). the second goal of afrocentricity is to return all african americans to their cultural center. the term “cultural center” refers to the unique african cultural system, which “… is the first and only reality for african [american] people.” the african cultural system comprises main elements of african symbolism, language, rhythm, spirituality, and values that have always been african culture. however, the system has varied manifestations among africans globally, because no cultural system is unaffected by new environments (asante, 2003, pp. 4-5). variation exists in terms of levels of awareness, manifestation, and participation, but the african cultural system has not eroded. in fact, africans “… respond to the same rhythms of the universe, the same cosmological sensibilities, the same gen172 advances in social work eral historical reality as the african descended people” (p. 4). therefore, unless african americans are “mis-educated, de-centered, or culturally insane,” most participate in the african cultural system” pp. 3-5. afrocentricity seeks to facilitate african america’s connection to the african cultural system by raising the collective consciousness (pp. 33-37). according to afrocentricity, becoming part of the african collective consciousness goes beyond a mere acceptance and understanding of one’s african ancestry. the nature of this consciousness involves a collective acceptance of commitments, similar reactions to eurocentric assaults, cultural destiny, and respect for african ancestors. only full acceptance pulls the individual to the african cultural center and begins the emergence of afrocentricity within the person. this comprehensive response is a step towards psychological health and cultural assertiveness, which prevents cultural insanity (azibo, 1989, p. 178). finally, the goal of all african americans, to cross the threshold into collective consciousness, transcends the notion of group unity without afrocentricity as the organizing paradigm (asante, 2003, pp. 34-35, 53). this is a logical progression, because it is futile for afrocentrists to unite with de-centered or mis-oriented african americans. people of african descent must first experience the transformation to become agents of african culture. afrocentricity’s transformation is analogous to the christian notion of religious conversion. asante (2003) emphasizes, “what [christians] meant is what i mean … your conversion to afrocentricity becomes total… it supersedes any other ideology because it is the proper sanctification of your own history” (p. 12). accepting afrocentricity is a conversion of mind and action. a transformed mind analyzes the world through an african-centered lens and assesses self in relation to that center. after self-examination, analysis extends to all african people in every cultural context. ultimately, afrocentrists interpret all social phenomena from this perspective. asante (2003) points out the “afrocentrist… studies every thought, action, behavior, and value, and if it is contradictory to [african] culture or our history, it is dispensed with quickly…. our problems come when we lose sight of ourselves, accept false doctrines, false gods, mistaken notions of what is truly in our history, and assume an individualistic, anti-humanistic, and autocratic posture” (p. 10). in terms of action, it is a continuous process of rejecting the eurocentric social reality, while embracing all aspects of afrocentric reality in the midst of a racist society. afrocentrists assertively challenge eurocentric perspectives as applied to, or experienced by, african people (p. 35). transforming to afrocentricity leads african americans to their cultural center and allows them to reach their full potential. in fact, afrocentricity is an essential reality for african americans to participate in american society. if one recognizes the power of culture to dominate the minds and behavior of a people (e.g., african americans), it follows that african americans must operate within their own culture to respond to european oppression. without afrocentricity, black americans bring “… nothing to the multicultural table but a darker version of whiteness” (asante, 1998, p. 8). the solution to white ideological domination is the literal construction of “another reality” to expose, contrast, and critique eurocentric domination; this alternate reality is the theory of afrocentricity (asante, 1998, p. 2). 173pellebon/an analysis of afrocentrcity as theory for social work practice the third goal of afrocentricity is to convert african americans to an ideology of values, spirituality, and ritual. asante (2003) developed a belief system referred to as njia. translated as “the way,” “njia is the collective expression of the afrocentric worldview which is grounded in the historical experience of african people… njia represents the inspired afrocentric spirit found in the traditions of africanamericans, and the spiritual survival of an african essence in america” (p. 30). asante (pp. 137-148) concretely organizes the reconstructive attitudes, values, and behaviors into 10 quarters of teachings, for a total of 234 precepts to learn and internalize. six examples of precepts from njia are: “feeling is before belief and to everyone who feels is given belief” (p. 137); “refuse to be dogmatic in all things except the way;” “the revelation of the way is pure. this is the truth” (p. 144); “beware of what you eat because you so easily become what you eat;” “when you feel the wind you are feeling the presence. therefore, never ask, where is the presence? it is everywhere,” and “at thirteen years of age every child shall be required to participate in the mfundalai rite of the coming of age” (p. 147). practicing njia in whole is central to developing the fullness of afrocentricity. an important ritual in afrocentricity is “the gathering” ceremony (asante, 2003). members meet on sundays to participate in this meeting, which consists of several rituals. the gathering begins with a libation, which is the pouring of a liquid to invoke the presence of african ancestors, honoring their deeds and accomplishments. with that inspiration, participants engage in forms of creative expression, such as poetry or music. in the rituals called nommo, participants discuss world problems and consider creative solutions in a manner that validates the way. a leader reads from njia’s precepts to affirm afrocentricity’s survival and one’s own god-force. a second libation, accompanied by a collection of money, affirms prosperity, followed by the final libation that calls upon the next generations of africans to witness and learn from the current generation. finally, each attendee raises his and her “right hand into the air for harambees.” the word “harambee” means “pulling together” in kiswahili. a designated person performs the ritual seven times before engaging in fellowship (p. 32). in addition to this weekly celebration, those who follow the way also celebrate the annual kwanzaa (p. 114). the fourth goal of afrocentricity is to provide a culturally appropriate method of analysis for african americans. afrocentricity exposes the eurocentric historical practice of analyzing african americans as objects. placing african americans into the position of subject allows them to examine phenomena from an african perspective or “location” (asante, 1993, p. 22). in essence, afrocentricity is “… a radical critique of the eurocentric ideology that masquerades as a universal view in the fields of intercultural communication, rhetoric, philosophy, linguistics, psychology, education, anthropology, and history” (asante, 1998, p. 1). afrocentricity’s approach to the analysis of these disciplines is to interpret and understand information and phenomena using african tradition, history, and culture (turner, 2002, p. 718). in summary, asante presents afrocentricity as a worldview, paradigm, theory, and ideology of thought and action in which the centrality of african interests, values, and perspectives predominate. it opposes the white domination of africans by exposing and resisting eurocentric hegemony. the primary method to over174 advances in social work come european oppression is to convert african americans to afrocentricity and to return them to their african cultural center. this transformation includes indoctrination into njia, which provides values, spirituality, and rituals by which the afrocentrist actualizes his or her potential. finally, the afrocentrist uses these truths and knowledge to analyze all social phenomena for the interests of african people. an analysis of afrocentricity as a theory the task of analyzing afrocentricity as theory presents a logical dilemma. specifically, this article uses analytical approaches antithetical to afrocentricity’s unique epistemology. as previously described, afrocentricity characterizes current conceptualizations of theory, science, and empirical research as oppressive eurocentric hegemony (asante, 1998, p. 18). any assertion that social work research promotes oppression requires examination, because social workers are obligated “to prevent ethical problems from occurring in their studies” using “a variety of safeguards” to protect clients (dudley, 2003, p. 10). though afrocentric writers passionately argue that empirically-based theoretical development is racist and oppressive, they provide no supportive evidence beyond opinion. the social work profession is aware of the potential biases related to politically-driven research, realizes the need for cultural competency in research design, and is aware of the limitations of science measuring social phenomena (cournoyer & klein, 2000, pp. 24-27; dawson, klass, guy, & edgley, 1991, p. 72; dudley, p. 56; rubin & babbie, 2005, pp. 89-94). an interesting observation of asante’s (2003) critique of empiricism is his use of both scientific and nonscientific terminology; for example, asante describes afrocentricity as a theory (p. 2), a philosophical perspective (p. 3), an ideology (pp. 3, 12, 28), and a paradigm (turner, 2002, p. 718). this article’s primary analytical goal is to determine whether afrocentricity is a theory. the analysis examines afrocentricity in the context of accepted definitions of theory, epistemology, and paradigm. first, this writer describes the essential components of theory, using religion as an analogy, to determine whether afrocentricity meets its essential criteria. second, the article examines and comments on afrocentric epistemology. third, by understanding its epistemology, the author argues that afrocentricity’s paradigm is ideological. a discussion follows the analysis to consider the implications of accepting afrocentricity as a paradigm for social work practice. is afrocentricity a theory? despite afrocentricity’s unique epistemology, accepted definitions of theory must provide the analytical framework. the council on social work education’s (2003) educational policy accreditation and accreditation standards guides social work programs on foundation content essential for social work practice. one stated objective is that graduates are able to use “theoretical frameworks supported by empirical evidence” (program objectives, sec. 3.0). though knowledge is not limited to theoretical frameworks, accepting a premise of empirical support for theory is a logical method to prepare social workers to competently develop and use social work knowledge (cswe, foundation curriculum content, sec. 4.3). knowledge challenged by critical thinking skills and science provides systematic 175pellebon/an analysis of afrocentrcity as theory for social work practice methods for social workers to develop interventions, convey their methods to clients, and measure practice outcomes (cournoyer & klein, 2000, p. 2; dudley, 2003, p. 3; thomas, 2007, pp. 1-14). dawson, klass, guy, and edgley (1991) note variation across definitions of theory; however, they share “…the idea that theories, in as logical terms as possible, [are] a set of general statements that explain or account for some phenomenon…” (p. 70). examining the definitions of several social science researchers, this observation appears valid (dudley, 2003; cournoyer & klein, 2000; neuman & kreuger, 2003; rosenthal, 2001; rubin & babbie, 2005). of the research writers reviewed, kerlinger’s (1986) definition is the most comprehensive: “a theory is a set of interrelated constructs (concepts), definitions, and propositions that present a systematic view of phenomena by specifying relations among variables, with the purpose of explaining and predicting the phenomena” (p. 9). this definition details the components and nature of theory. afrocentricity has defined concepts, propositions, and statements that explain phenomena. however, it is important to realize that rational organization of concepts into explanatory statements is insufficient to conclude their ideas are theory (dawson, et al., 1991, p. 70; neuman & kreuger, 2003, p. 7). on this basis, one can argue religions are theories. consider christianity as an illustration. christianity has numerous concepts, such as god, creation, sin, grace, repentance, salvation, and sanctification. vine’s (1966) dictionary provides sufficient information to develop these conceptual definitions: 1) god is the creator spirit possessing attributes of omniscience, omnipotence, and, perfection; 2) supernatural creation is god’s ability to bring physical matter into existence independent of nature. the human race exists though the supernatural creation of two progenitors (adam & eve), who are the common ancestors to all humanity; 3) the sinful nature is a universal spiritual condition of evil resulting from adam and eve’s disobedience to god’s law; 4) grace is god’s conditional spiritual response and solution to forgive human sin; 5) repentance is the conscious rejection of sin and condition of god’s grace; 6) salvation is the conversion from unbeliever to believer through grace; and 7) sanctification is the believer’s progressive transformation toward perfection. these are a few of the numerous concepts in this complex worldview. using these conceptual definitions, many variations of christianity have developed coherent perspectives to explain social phenomena. a brief description of one variation of evangelical christianity follows: because god created humanity, he has the authority to determine morality and power to judge his creation by that standard. the universal human crisis is the sinful nature, which separates humanity from relationship with god. knowing the propensity for humans to sin, god preordained a plan to forgive sin through the agency of grace, based on the human decision to repent from volitional sin. anyone who accepts god’s grace by faith in this truth experiences salvation. salvation frees believers from the curse of sin; constrains the sinful nature; and, allows one to live the christian lifestyle. with power from god’s holy spirit, the christian undergoes the sanctification process. this process develops the christian’s ability to obey and please god (martin, 1975). the logic of this theology is internally consistent, that is, there are no fallacies of reason within the body of statements. however, it is fallacious to assert that the 176 advances in social work description of reality is objectively true, because it clearly lacks external consistency (warnick & inch, 1989, pp. 75-77). besides christian believers, would most grant the premises of god’s existence, creation, the sinful nature, grace, or christianity’s conceptualization of morality? what are the observable evidences to support these concepts? if the primary evidences are church tradition, personal testimonies, or biblical authority, then the fallacy of premise arises. on what basis should non-christians accept church tradition? are all personal testimonies reliable and consistent? would most accept the bible as authoritative valid evidence? the requirement that a valid argument must have external consistency and empirical evidence exposes why religion is not theory. this is philosophically moot for afrocentricity, because it does not apply empirical methods to examine its central constructs. truth is “self-knowledge,” and many important concepts in afrocentricity are beyond measurement (mazama, 2001, pp. 399-400). operating under the presumptions that, concepts, such as african cultural system, afrocentric transformation, collective consciousness, african centeredness, african interests, ancestral communication, and eurocentrism are valid constructs, afrocentrists are not compelled to formulate operational definitions or examine hypothetical relations. from an empirical perspective, without operational definitions, such relations are beyond scientific inquiry (kerlinger, 1986, p. 4). afrocentricity’s acceptance as empirically-based theory requires internally consistent logic, a broad acceptance of its premises, adequately conceptualized and operationalized constructs, and the ability to test relations between those constructs (dawson et al., 2002, pp. 70-72; kerlinger, pp. 19-20; neuman & kreuger, 2003, p. 7; rubin & babbie, 2005, p. 11; warnick & inch, 1989, pp. 75-77). under such conditions, this analysis concludes that afrocentricity is not a theory. afrocentric epistomology accepted epistemology for social work practice is not limited to science (dawson et al., 1991, p. 64; dudley, 2003, p. 3). several ways of knowing often produces accurate knowledge about the social world, but epistemological perspectives differ in terms of bias, structure, and reliability (dudley, 2003, p. 4; neuman & kreuger, 2003, p. 2). non-scientific ways of knowing influence social work decisions based on informal hypotheses about clients in the environment (neuman & kreuger, 2003, p. 6). because the social work profession is grounded in empirically-based theories and accepted perspectives, other ways of knowing augment knowledge developed through the scientific method. in place of empiricism, afrocentricity’s epistemology consists of truth based on authority, cultural tradition, and mysticism. authority claims knowledge is true, because someone of expertise or importance makes the statement (kerlinger, 1986, p. 6; neuman & kreuger, 2003, p. 3; rubin & babbie, 2005, p. 13). one limitation of knowledge by authority is the fact that expertise does not guarantee accuracy. for example, asante (2003) proclaims himself as an authority in african worldviews. the basis of this authority is personal study and his having received the revelation of afrocentricity as immutable truth (pp. 10, 137-140). stated expertise in african history and culture alone is insufficient to accept afrocentricity. when social work confronts theoretical differences, the profession depends upon quantitative and qualitative research to refine 177pellebon/an analysis of afrocentrcity as theory for social work practice knowledge; whereas, afrocentricity has no self-correcting mechanisms based on evidence. to assert afrocentricity is truth solely on authority is to accept conclusions based on circular reasoning. for example: major premise: afrocentricity was revealed to dr. asante as the only reality for african americans. minor premise: afrocentricity teaches that african americans must be africancentered for psychological health. minor premise: afrocentricity is the only way to become african-centered. conclusion: therefore, dr. asante’s afrocentricity is the only cultural reality for african americans psychological health. evidence: dr. asante developed the one reality for african americans, i.e., afrocentricity. without evidence for each premise, the conclusion depends upon the major premise resulting in an invalid argument (warnick & inch, 1989, p. 139). even less reliable is an individual who is an expert in one field but speaks with authority in another. some of dr. asante’s views may inform the profession, however, his expertise in african american studies does not assure his views are relevant to social work practice with african americans. this conclusion in no way marginalizes disciplines of ethnic study. in the interest of serving populations-atrisk, social work has historically looked to other disciplines to identify knowledge to inform the profession. some considerations are how the discipline conceptualizes humans in the environment, defines social problems, its philosophical premises, the line of reasoning that follows, and, the practicality of its solutions. for example, asante (1998) claims that eurocentric hegemony is a “crisis” for african americans (p. 23). afrocentricity’s solution is for african americans to enter the african collective consciousness and pursue psychological liberation through the total acceptance of afrocentricity (asante, 2003, p. 62). given that solution, social work must ask a fundamental question: is an african american’s well being at-risk because she or he does not accept afrocentricity? one cannot answer the question without determining the validity of two related afrocentric premises: 1) de-centered african americans are outside their only cultural reality and, 2) the collective consciousness leads de-centered african americans to their essential african reality (asante, 2003, pp. 3-4). accepting these premises could lead one to conclude the most critical need for african americans is transformation to afrocentricity. if converting african americans to afrocentricity is a social work goal, what feasible role does a eurocentric dominated profession (white and de-centered black professionals, alike) have to participate in the intervention? according to asante (2003), the role is to move aside so that african americans can rise “… from the intellectual and spiritual pit that has held our mighty people! let each person take his post in the vanguard of this collective consciousness of afrocentricity! teach it! practice it! and victory will surely come as we carry out the afrocentric mission to humanize the universe” (asante, 2003, p. 11). though humanizing the world is compatible with social work’s mission, a simple call to convert african americans to afrocentricity illustrates how non-professional disciplines may oversimplify com178 advances in social work plex social issues. to summarize, knowledge from authority can be accurate or false, depending upon the source of information; the given context; external support for the stated claims; and whether that knowledge can critically inform social work. accepting knowledge by tradition is stating that a belief is true because it was true in the past or that tradition is continuing a practice because it was effective in the past (dawson, et al., 1991, p. 3; kerlinger, 1986, p. 6; neuman & kreuger, 2003, p. 3). sources of traditional knowledge are the family, culture, and historical practices (rubin & babbie, 2005, p. 12). asante (2003) explicitly grounds afrocentricity’s truth in cultural tradition (p. 30). however, there are several difficulties using cultural tradition as the basis of truth. first, it is questionable whether tradition is a stable reality. according to glassie (1995), tradition is a social perception of beliefs and behaviors from which individuals or groups create a future from the past (p. 409). in other words, tradition has aspects of continuity and discontinuity based on an interpretive process imposed by the observer (handler & linnekin, 1984). asante (2003) believes african cultural tradition transcends social change, thus, it is bounded and equally applicable to all africans over the centuries (p. 30). this deterministic view suggests an axiomatic bond between corresponding races and cultures in nature (azibo, 1989, p. 175). this naturally occurring bond, however, is vulnerable to the unnatural interference of group domination. this explains the danger of european hegemony to africans. as spencer (2000) points out, “afrocentricity… suggests that philosophy is at root a racially determined enterprise, with the immediate implication that all epistemology becomes racially relative (p. 191).” second, knowledge about ancient traditions depends upon written record, oral testimony, or indirect evidence. without extant records or reasonable agreement on the original knowledge, tradition is unreliable and is open to challenge and interpretation. for example, lefkowitz (1996) and howe (1999) offer challenges to afrocentricity’s interpretations of african history and culture. a third difficulty, using tradition as truth, is an evident reality that truth changes over time. according to tradition, it was once known that the earth was flat and spirits were the cause of disease and hallucinations (neuman & kreuger, 2003, p. 3; rubin & babbie, 2005, p. 12). science provided evidence to replace erroneous traditions; likewise, modern social work uses evidence to develop knowledge, not mythology. afrocentricity provides no evidence that african ancestors can guide living descendants (pp. 8, 32). nevertheless, this belief qualitatively differentiates de-centered african americans from afrocentrists, “… the non-afrocentric person operates in a manner that is negatively predictable…. unable to call upon the power of ancestors, because one does not know them; without an ideology of heritage, because one does not respect one’s own prophets; the person is like an ant trying to move a large piece of garbage only to find that it will not move” (p. 3). the ant moving a large piece of garbage is an interesting metaphor. african americans with various cultural and spiritual worldviews moved institutionalized segregation from its foundation during the 1960s civil rights movement without an afrocentric tradition. the extraordinary changes brought about by the civil rights movement suggest that there is no direct correlation between african mythologi179pellebon/an analysis of afrocentrcity as theory for social work practice cal homogeneity and social power. philosophy and religion can use mythological and metaphysical frameworks to function within their disciplines; whereas, social work must be grounded in sound theory and observation. mysticism is a way of knowing unobservable phenomena without evidence or a valid logical argument (cournoyer & klein, 2000, p. 5). many people believe in an invisible supreme being, curses, and spirits through faith in place of empirical evidence. this is the primary reason most religions do not classify as theory. though many religions suggest spiritual existence explains paranormal or supernatural events, it is impossible to forward a valid line of logical reasoning to support the conclusion. as previously pointed out, afrocentricity has central constructs that are beyond direct measurement and logic. afrocentricity as an ideology afrocentric epistemology depends upon non-scientific knowledge, predominately authority, tradition, and mysticism. the final section of this analysis looks at the similarities and differences between theory and ideology to determine whether afrocentricity’s assumptions and conclusions are ideological constructions. an ideology is a quasi-theory without the essential features of scientific theory. this closed system explains the social world using fixed assumptions, beliefs, and values that shape its believers. ideological truth is fixed and immovable by evidence (neuman & kreuger, 2003, p. 45; rubin & babbie, 2005, p. 40). ideologues promote their views in the popular media, cults, politics, academic disciplines, and religion. scientists become ideological when they remain fixed in their positions despite contradictory evidence. social work has ideologues on both sides of many social issues, such as abortion, gay rights, transracial adoption, and evidence-based practice (rubin & babbie, 2005, p. 40). unlike ideologues, scientists follow accepted norms of the scientific community; that is, an ethos of open and diverse investigation, rigor, organized skepticism, neutrality, communalism, and honesty (neuman & kreuger, 2003, p. 9). according to neuman and kreuger (2003), theory and ideology have similarities and differences. afrocentricity generally satisfies the similarities between ideology and theory. both afrocentricity and scientific theory operate under assumptions, explain social phenomena, provide a system of concepts, discuss conceptual relationships and causality, and, offer an interconnected system of ideas. based on neuman and kreuger’s (2003, p. 45) differentiation between theory and ideology, at each point, afrocentricity diverges from theory and becomes ideological. asante (2003) supports the conclusion that afrocentricity is an ideology. “as the highest, most conscious ideology it makes its points, motivates its adherents, and captivates the cautious by the force of its truth” (pp. 11-12). without the conditional and negotiated understanding that theory requires, afrocentricity touts the absolutes of njia in response to the certainty of eurocentric hegemony. while theoretical development presumes incompleteness and uncertainty, the collective consciousness leads one closer to the one reality of the african cultural system. as theoretical knowledge openly expands, afrocentricity’s closed system is primarily committed to conversion into its ideology. while asante suggests openness to positive and negative testing, he vilifies findings that were produced by so-called 180 advances in social work western research. such denunciation restricts objective testing, thereby reducing the likelihood of discrepant findings. it follows that, if the only acceptable evidence supports the structure, there is no basis to change. science seeks to be objective and detached; whereas, afrocentricity is an immutable belief system of values that direct attitudes and behavior. “the way” is not a negotiated system of beliefs, because it presumes to be true. theory seeks logical consistency, while this analysis finds many issues of internal and external inconsistency within afrocentricity. finally, theory transcends social positions. afrocentric ideology is clearly rooted in a cultural position with predetermined conclusions. given the ideological nature of afrocentricity, this analysis has demonstrated the profession must debate its appropriate role in social work practice. discussion this critique challenges the presumption that afrocentricity is a practice perspective that is generally applicable to african americans. by definition, afrocentricity is an ideology that promotes itself as a valid culture, not a practice paradigm. mazama (2001) correctly points out that many scholars, claiming adherence to afrocentricity, clearly misunderstand the paradigm. he points out that some authors do not define the term. other authors define afrocentricity, yet misrepresent it as being culturally african, promoting pure african values to benefit all people, or as a worldview with variation (p. 389). those who would force an ideology into a practice perspective should accurately represent afrocentricity. graham (2007) accurately observes the marginalization of african-centered knowledge in social work. considering the ideology’s goal to liberate african americans from eurocentric hegemony, one expects its supporters to assert their perspective. in the spirit of open debate, these views are welcome. however, nonafrocentrists are minimizing the importance of determining the most appropriate role for this perspective, which suggests a double standard. on one hand, social work insists that empirically-based theories are necessary for competent social work practice; on the other hand, ideology and culture are accepted as sufficiently rigorous for practice with african americans. there must not be any cultural exceptions for competence practice guided by recognized and empirically-based knowledge (nasw, 1999, section 4.01). social work should acknowledge afrocentricity in light of the above analysis. there is sufficient evidence to conclude that some african american clients accept afrocentricity. hence, social workers will require insight into the culture to be competent practitioners with an afrocentric client. this approach affirms afrocentricity as one of many cultures that social workers may be required to understand, depending upon the client (nasw, 1999, section 1.05). as social workers prepare for clients with that worldview, the implications for research are to identify the prevalence of afrocentricity in african american communities, the degree of its cultural variation, and potential barriers for cultural competency working with afrocentric clients. implications for practice would emerge as research produces answers to these and other research endeavors. finally, afrocentricity’s views on multiculturalism, cross-cultural practice, gay rights, racially-based personality structures, and self-determination are beyond the 181pellebon/an analysis of afrocentrcity as theory for social work practice scope of this article. however, these issues are salient and deserve the profession’s attention in the literature. references alzate, m.m. 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(2004). understanding human behavior and the social environment (6th ed.). belmont, ca: brooks/cole. author’s note: address correspondence to: dwain a. pellebon, ph.d., the university of oklahoma, school of social work, 1005 s. jenkins avenue–rhyne hall, norman, ok 73069, usa. e-mail: dpellebon@ou.edu. 183pellebon/an analysis of afrocentrcity as theory for social work practice microsoft word 16. gallagher et al_16845_impact of drug court on recidivism_copyedit final ______________  john r. gallagher, ph.d., is an assistant professor in the indiana university school of social work, south bend campus; eric ivory, bs, is the drug court coordinator; jesse carlton, bs, is the adult chief probation officer; and the hon. jane woodward miller, jd, is the drug court judge, all in south bend, in. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 507-521 the impact of an indiana (united states) drug court on criminal recidivism john r. gallagher eric ivory jesse carlton jane woodward miller abstract: this study evaluated a drug court located in a metropolitan area of indiana (united states), focusing specifically on identifying variables that predicted recidivism among drug court participants and comparing criminal recidivism patterns among drug court and probation participants. drug court participants were most likely to recidivate if they were younger, had a violation within the first 30 days of the program, had a previous criminal record, and were terminated unsuccessfully from the program. furthermore, drug court participants were less likely to recidivate than probationers who had similar offense and demographic characteristics. implications for drug court practice, policy advocacy, and future research are discussed. keywords: drug court, logistic regression, criminal recidivism, substance use disorders, probation the national survey on drug use and health (nsduh) is an annual survey that assesses the rate of illicit drug and alcohol use in the united states (substance abuse and mental health services administration [samhsa], 2013). there are several notable findings that came out of the 2012 survey. first, findings suggest that an estimated 24 million americans, or 9% of the population, used illicit drugs and 136 million americans, or 52% of the population, used alcohol. second, of all the americans that used illicit drugs or alcohol, about 9%, or 22 million, met the diagnostic criteria for substance abuse or dependence; however, few actually received treatment for their substance use disorder. specifically, of the 22 million americans that needed substance abuse treatment, only 3 million received this type of intervention. third, 34% of parolees and 37% of probationers met the diagnostic criteria for substance abuse or dependence, whereas only approximately 8% of their counterparts who were not on parole or probation met the same diagnostic criteria. as a result of the large criminal justice population that has experienced problems related to personal illicit drug and alcohol use and the apparent limited availability of substance abuse treatment, society has relied on the judicial system to offer rehabilitative services to arrestees to minimize their risk of reoffending. one of the ways that the criminal justice system has addressed the high rate of substance use disorders with their population has been through the development of drug courts. this article will conceptualize drug courts, present a review of the literature related to the effectiveness of drug courts, present findings that identify the most predictive factors of drug court advances in social work, fall 2014, 15(2) 508 participants’ recidivism during and after the program, discuss how drug court compares to traditional probation in regards to reducing criminal recidivism, and explore implications for drug court practice, policy advocacy, and future research. indiana (united states) drug court this section provides an overview of the drug court evaluated for this study, which will be called the indiana drug court. the indiana drug court began in 1997 and the court’s mission is to “reduce repeated criminal behavior and reverse the destructive effects of drugs upon the individual abuser and health and public safety of the community at large” (st. joseph county drug court, 2014, para. 3). the court’s philosophy is that “long-term sobriety involves not only quality substance abuse treatment, but also the prospect for an improved quality of life through better education, employability, and the support of a sober community” (st. joseph county drug court, 2014, para. 4). in order to meet the program’s mission and philosophy, the drug court employs a multidisciplinary judicial team, commonly known as the drug court team. the drug court team consists of the judge, drug court coordinator, two drug court case managers, the chief of adult probation, a compliance officer, prosecuting attorneys, defense attorneys, a researcher, and local substance abuse treatment providers. the drug court team meets once a week to discuss the status of participants. the length of a drug court participant’s assignment ranges from 12 to 24 months (st. joseph county drug court, 2014). during this timeframe, participants complete interventions consistent with the key components of a drug court (national association of drug court professionals [nadcp], 2004), such as attending substance abuse counseling, maintaining abstinence from illicit drug and alcohol use, submitting random urinalysis drug tests approximately 1 to 3 times a week, attending status hearings with the drug court judge approximately 1 to 4 times a month, and completing other interventions that the drug court team may assign due to individualized needs, such as hiv and aids education or budgeting classes. if participants are not employed at the time of admission into drug court, they are required to undergo vocational training while in the program. similarly, if participants do not have at least a high school diploma or equivalent at admission, they are expected to work towards their ged during the program. in order to graduate from the program, participants must have completed their substance abuse counseling, been in the program for at least 12 months, have at least 6 months of consecutive negative drug tests, and pay all program fees, which include a $500.00 program fee and the cost of drug testing. based on a participant’s economic status, all or a portion of the program fee and drug testing fees can be waived by the drug court team. prior to admission into drug court, participants plead guilty to the charges filed against them. upon graduation, the charges are dismissed; however, if a participant is terminated from the program, he or she is convicted of the charge or charges and sentenced accordingly. literature review since their inception in 1989, drug courts have seen tremendous growth. there are over 2,700 drug courts and 1,122 other problem-solving courts, such as mental health and gallagher, ivory, carlton, miller/impact of drug court on recidivism 509 veterans courts, operating in the united states (nadcp, 2014a), and is it estimated that there are over 30 international drug treatment courts operating throughout 11 countries including ireland, australia, and the united kingdom (nadcp, 2014b). in the united states, the proliferation of drug courts is partially explained by a growing trend where states, such as texas, are beginning to mandate that certain counties have drug courts because policymakers view drug courts as an efficient and effective alternative to incarceration (gallagher, 2012). drug courts are perhaps the most researched criminal justice program, and as they continue to increase throughout the united states and internationally, drug court evaluations should continue to be a major part of the criminal justice, forensic social work, and addiction studies literature. recent meta-analyses of drug court evaluations have suggested that drug courts are more effective than other types of criminal justice programs, such as traditional probation, at reducing criminal recidivism (mitchell, wilson, eggers, & mackenzie, 2012; shaffer, 2011). mitchell et al. (2012) completed a meta-analytic review of 92 adult drug court evaluations and found that drug court participants were less likely than nonparticipants to recidivate. specifically, the average recidivism rate of drug court participants was 38%, compared to a recidivism rate of 50% for non-participants. it is also important to mention that mitchell and colleagues found that the positive effect of drug court participation on recidivism lasted for three years following admission into the program. shaffer (2011) calculated 82 effect sizes from drug court evaluations and found that drug court significantly reduced recidivism. the effect sizes suggested that drug court participants had a recidivism rate of 45.5%, whereas the recidivism rate for the comparison group would have been 54.5%. overall, both meta-analyses provide evidence that the expansion of drug courts and continued funding of these programs is warranted. meta-analyses offer valuable insight into the effectiveness of drug courts; however, the majority of studies evaluate single drug court programs. for example, an evaluation of the douglas county (omaha), nebraska drug court found that drug court participants were significantly less likely to be rearrested than a comparable group of felony drug offenders (42% versus 61%) (spohn, piper, martin, & frenzel, 2001). furthermore, spohn and colleagues found that younger offenders, males, and those with a prior criminal record were more likely to be arrested during the follow-up period. in a similar evaluation of the los angeles county drug court, fielding, tye, ogawa, imam, and long (2002) found that only 24% of drug court participants recidivated within the one year follow-up period, whereas 37% of participants from the drug diversion education program and 51% of felony defendants not in either program recidivated. fielding and colleagues also note that graduating from drug court decreased the likelihood of recidivating; only 20% of graduates recidivated, compared to 33% of terminated participants. brown (2011) completed a recent evaluation of a wisconsin drug court and found that drug court participants were less likely to commit a new crime than a matched comparison group (30% versus 46%), and when a new crime was committed, drug court participants had a longer time to when they recidivated than the matched comparison group (614 days versus 463 days). while there is a large body of literature suggesting that drug courts are more effective than other types of criminal justice programs, it is important to mention that these advances in social work, fall 2014, 15(2) 510 findings are not universal (bavon, 2001; listwan, sundt, holsinger, & latessa, 2003; wolfe, guydish, & termondt, 2002). in an evaluation of the tarrant county (fort worth), texas drug court, bavon (2001) found that about 13% of drug court participants and 17% of the comparison group were rearrested within one year after last contact with their respective programs, results that were statistically insignificant. wolfe et al. (2002) also found in their evaluation of the san mateo county, california drug court that drug court and non-drug court participants had equal likelihoods of recidivating. however, consistent with the findings from fielding et al. (2002), bavon (2001) and wolfe et al. (2002) both found that, when comparing just drug court graduates and unsuccessfully terminated participants, graduates were noticeably less likely to recidivate than those who were terminated from the program. wolfe and colleagues, for example, found that 53% of terminated participants and only 19% of graduates recidivated within the two year follow-up period. methodologically, the present study contributes to the existing literature in several ways. first, the follow-up period to measure recidivism in this study is 36 months, which is noticeably longer than previous studies were the norm is to evaluate recidivism at a one (fielding et al., 2002) or two year (wolfe et al., 2002) follow-up period. additionally, mitchell et al. (2012) found in their meta-analysis of 92 adult drug court evaluations that, for the articles where the information was available (n = 79), 82% measured recidivism with a follow-up period of 24 months of less, further supporting the need to have a longer follow-up period to assess the long-term impact of drug court on recidivism. second, this study utilizes a comparison group of offenders who were eligible for drug court but chose probation instead, and while it is common for drug court evaluations to use probationers as a comparison group (krebs, lindquist, koetse, & lattimore, 2007), previous studies have typically developed comparison groups based on participants having a drug use history, not the fact that they met the admission criteria for drug court and chose to do another program. the method of developing a comparison group for this study, perhaps, may minimize selection bias. third, this study assessed two variables that are theoretically associated with drug courts, yet not found in the previous research. a key component of the drug court model is to admit participants as soon as possible after an arrest; theoretically, this will improve outcomes because participants are more motivated to change following the arrest experience (nadcp, 2004). therefore, this study included a variable labeled “arrest and admission”, defined as the total number of days from an individual’s arrest to admission into drug court. next, the variable “first 30 days”, which measured whether a participant had a violation within the first 30 days of drug court participation, was added to the analysis because recent evidence has suggested that compliance within the first month of drug court can predict graduation outcomes (newton-taylor, patra, & gliksman, 2009); however, this variable has not been used to predict post-program recidivism outcomes. the other variables included in the analysis are consistent with those used in previous research that tested logistic models to predict recidivism and other drug court outcomes, such as graduation. drug of choice, for example, was dichotomized as cocaine versus all other drugs because previous research has suggested that participants who identify gallagher, ivory, carlton, miller/impact of drug court on recidivism 511 cocaine as a drug of choice are less likely to have successful drug court outcomes than those who identify other drugs of choice (dannerbeck, harris, sundet, & lloyd, 2006; hickert, boyle, & tollefson, 2009). methodology design and sample the research design used for this study was approved by the institutional review board (irb) at indiana university. this study employs a nonequivalent comparison group, quasi-experimental design to evaluate a drug court located in indiana; two research questions guided this evaluation. first, what variables most strongly predict recidivism among drug court participants? second, do drug court participants have a lower rate of recidivism than probation participants? to identify the variables that predicted recidivism among drug court participants, data were collected on all drug court participants (n = 197) who graduated or were unsuccessfully terminated from the program from 2006 to 2009. to compare the recidivism patterns of drug court and probation participants, recidivism data were retrieved for the same sample of drug court participants and the electronic charts of probation participants. a list of all probationers (n = 995) who were arrested for a class d felony and completed their probation or had their probation revoked from 2006 to 2009 was generated. from this initial list, 194 (19%) were included in the final sample because they had a class d felony that made them eligible for drug court but they had chosen probation instead. based upon his experience as the drug court coordinator of the program evaluated in this study, one of the authors suggests that potential participants may be more likely to select probation over drug court because drug court tends to cost more than probation and drug court is more time consuming. drug court, for example, typically requires drug testing 1 to 3 times a week, whereas probationers may be drug tested only one time a month. additionally, at the beginning of the program, drug court participants appear before the judge once a week while probationers typically only attend court once every several months. criminal cases eligible for drug court include: (1) i.c.35-48-4-6 possession of cocaine or a narcotic drug, class d felony; (2) i.c. 35-48-4-7 possession of a controlled substance, class d felony; (3) i.c. 35-48-4-8.3 possession of paraphernalia, class d felony; (4) i.c. 35-48-4-11 possession of marijuana, class d felony; (5) i.c. 35-48-4-13 maintaining a common nuisance, class d felony; and (6) i.c. 35-48-4-14 acquiring possession of a controlled substance by fraud, class d felony. due to the quasi-experimental nature of this research design, participants were not randomly assigned to drug court or probation; therefore, selection bias may compromise the comparability between the groups in the study. to assess the comparability between the drug court and probation groups, demographic data, including gender, ethnicity, age, education status, and employment or student status, were collected and analyzed. this process of comparing the two groups is similar to that used in previous research (brown, 2011). the results of the comparison are noted in table 1. there was no difference between the drug court and probation group in regards to gender, ethnicity, age, and employment or student status. the drug court group, however, was less likely to have a advances in social work, fall 2014, 15(2) 512 high school diploma or equivalent at admission than the probation group (41% versus 54%). table 1. demographic comparisons between drug court and probation participants  variables drug court (n = 197) probation (n = 194) χ² and t scores gender male = 73% (n = 143) female = 27% (n = 54) male = 72% (n = 140) female = 28% (n = 54) χ² = 0.01 ethnicity white = 51% (n = 101) black/hispanic = 49% (n = 96) white = 51% (n = 98) black/hispanic = 49% (n = 96) χ² = 0.02 age range = 18 to 57 years old mean = 32 years old sd = 10.52 range = 18 to 69 years old mean = 33 years old sd = 12.54 t = 1.30 education * have high school diploma or equivalent at admission = 41% (n = 80) do not have high school diploma or equivalent at admission = 59% (n = 117) have high school diploma or equivalent at admission = 54% (n = 105) do not have high school diploma or equivalent at admission = 46% (n = 89) χ² = 7.16 employment or student employed or student at admission = 38% (n = 75) not employed or student at admission = 62% (n = 122) employed or student at admission = 42% (n = 81) not employed or student at admission = 58% (n = 113) χ² = 0.72 note. *p < 0.05 variables and analysis all data were recorded and analyzed using spss 21 software. there were twelve independent variables and one dependent variable for the logistic regression. the dependent variable was (0 = not rearrested, 1 = rearrested). the conceptualization and coding of the independent variables were as follows: gender (0 = male, 1 = female), ethnicity (0 = white, 1 = african american and hispanic), age (age at time of admission into drug court), education (0 = have a high school diploma or equivalent at time of admission into drug court, 1 = do not have a high school diploma or equivalent at time of admission into drug court), employment or student (0 = employed or a student at time of gallagher, ivory, carlton, miller/impact of drug court on recidivism 513 admission into drug court, 1 = not employed or a student at time of admission into drug court), drug of choice (0 = all other drugs, 1 = cocaine), positive drug tests (total number of positive drug tests while in drug court), first 30 days (0 = did not have a violation within the first 30 days of drug court, 1 = had a violation within the first 30 days of drug court), arrest and admission (total number of days between arrest and admission into drug court), mental health (0 = do not have a mental health diagnosis, 1 = have a mental health diagnosis), criminal history (0 = do not have a criminal history prior to the arrest that resulted in admission into drug court, 1 = have a criminal history prior to the arrest that resulted in admission into drug court), and outcome (0 = graduated drug court, 1 = terminated from drug court). logistic regression was used to identify which variables significantly predict drug court participants’ recidivism. multicollinearity was assessed by conducting correlations between all of the independent variables. if the phi coefficient was greater than .80, multicollinearity was suspected (orme & combs-orme, 2009). last, to compare the recidivism rates of drug court and probation participants, the percentage of drug court and probation participants who recidivated during and after their respective programs were collected through a government software program that tracks and records arrests, charges, and dispositions. recidivism was defined as any new local (county) arrest for a felony or misdemeanor offense that resulted in charges being filed during drug court / probation and up to 36 months post drug court / probation discharge. the definition of recidivism was provided by the drug court and approved by the indiana judicial center, which is an indiana supreme court agency that certifies indiana problem-solving courts. the recidivism data were collected in 2013 to assure a follow-up period of 36 months. results for the drug court sample, chi-square tests of independence were used to determine if statistically significant differences existed in recidivism outcomes for the dichotomous variables of gender, ethnicity, education, employment or student, drug of choice, first 30 days, mental health, criminal history, and outcome. the variables of gender (χ² = 0.64, p = .43), ethnicity (χ² = 1.10, p = .29), education (χ² = 1.20, p = .27), drug of choice (χ² = 0.17, p = .68), and mental health (χ² = 1.88, p = .17) were not significantly related to recidivism. the variables of employment or student, first 30 days, criminal history, and outcome, however, did show statistically significant associations with recidivism. first, drug court participants who were neither employed nor a student at the time of admission were more likely to recidivate (54%) than participants who were employed or a student at time of admission (36%) (χ² = 6.10, p < 0.05). second, drug court participants who had a violation within the first 30 days of the program were more likely to recidivate (65%) than participants who did not have a violation with the first 30 days of the program (35%) (χ² = 17.12, p < 0.05). third, drug court participants who had a prior criminal history were more likely to recidivate (59%) than participants with no prior criminal history (30%) (χ² = 16.27, p < 0.05). fourth, for the drug court sample (n = 197), 108 (55%) participants graduated successfully form the program and 89 (45%) were advances in social work, fall 2014, 15(2) 514 terminated unsuccessfully. drug court participants terminated from the program were more likely to recidivate (65%) than were those who graduated from the program (32%) (χ² = 21.01, p < 0.05). multicollinearity statistics were not in the problematic area; therefore, all independent variables were included in the logistic regression analysis. the findings from the logistic regression analysis are noted in table 2. table 2. logistic regression of drug court participants’ recidivism (n = 197)  independent variables (ivs) b s.e. wald df sig. exp (b) gender -.268 .379 .498 1 .481 .765 ethnicity .043 .352 .015 1 .903 1.044 age -.045 .017 6.870 1 .009* .956 education -.274 .357 .587 1 .444 .761 employment or student .470 .356 1.748 1 .186 1.600 drug of choice -.247 .370 .447 1 .504 .781 positive drug tests -.003 .022 .015 1 .904 .997 first 30 days 1.221 .356 11.752 1 .001* 3.391 arrest and admission .004 .007 .332 1 .565 1.004 mental health .444 .508 .765 1 .382 1.559 criminal history .938 .375 6.270 1 .012* 2.554 outcome .846 .379 4.986 1 .026* 2.331 note. *p < 0.05. note. -2 log likelihood (221.77). note. nagelkerke r square (0.30). note. hosmer and lemeshow test (χ² = 8.86, p = .35). note. dependent variable was (0 = not rearrested, 1 = rearrested). as noted in table 2, four of the twelve independent variables were statistically significant. first, for each year of increase in age, participants’ chances of recidivating decreases by about 4%. second, participants who had a violation within the first 30 days of drug court were 3.4 times more likely to recidivate than those who did not have a violation during this timeframe. third, participants with a criminal history were 2.6 times more likely to recidivate than participants who did not have a criminal history. fourth, participants terminated from drug court were 2.3 times more likely to recidivate than were program graduates. a chi-square test of independence revealed a statistically significant difference in recidivism patterns between the drug court and probation groups (χ² = 18.26, p < 0.05). gallagher, ivory, carlton, miller/impact of drug court on recidivism 515 of all the drug court participants (n = 197), the majority (104; 53%) did not recidivate. conversely, of all the probation participants (n = 194), the majority (133; 69%) did recidivate. discussion this study adds to the existing literature by identifying the variables most predictive of drug court participants’ recidivating. participants were most likely to recidivate if they were younger, had a violation within the first 30 days of the program, had a prior criminal history, and were terminated unsuccessfully from the program. consistent with previous research (brown, 2011; krebs et al., 2007), younger participants are more likely to recidivate than older participants. additional demographic variables, however, were not significant predictors of recidivating, including gender, education status, and employment or student status. while previous research has suggested that being female (brown, 2011; listwan, shaffer, & hartman, 2009; wolfe et al., 2002) decreases the likelihood of rearrest, this study found no difference in recidivism patterns by gender. similarly, no difference was found in the likelihood of recidivism for participants who were or were not employed or a student at the time of admission into drug court, which contradicts the findings from listwan and colleagues (2009) and shaffer, hartman, listwan, howell, and latessa (2011). consistent with previous evaluations (krebs et al., 2007; listwan et al., 2009; shaffer et al., 2011), this study found that education status was not a significant predictor of recidivism. perhaps the variables of education and employment or student status did not reach statistical significance because they were only assessed at admission. specifically, data were only collected on whether or not a participant had a high school diploma or equivalent or was employed or a student at the time they were admitted to drug court. this method of coding does not account for participants who increased their education or employment status while in drug court or by the time they graduated or were terminated from the program. additionally, despite the evidence that identifying cocaine as a drug of choice may decrease the likelihood of successful drug court outcomes (dannerbeck et al., 2006, hickert et al., 2009), this study did not find cocaine to be a predictor of recidivism. this finding is similar to gallagher’s (2014) recent evaluation of a texas drug court where equal recidivism rates were found among drug court participants who identified stimulants, including cocaine, and nonstimulants as drugs of choice. a noticeable strength of this study is that recidivism was measured up to 36 months. with the longer timeframe to measure recidivism, the results remained consistent with those from previous studies. specifically, drug court participants were less likely to recidivate than probationers who had similar characteristics (brown, 2011; fielding et al., 2002; mitchell et al., 2012; shaffer, 2011; spohn et al., 2001). although drug court participants were less likely to recidivate than probationers, there are important demographic variables that were not assessed when comparing the two groups and these variables may have impacted the results. for example, the variable of socioeconomic status was not available for this study. a majority of probation participants may have come from lower socioeconomic backgrounds and they may have chosen not to enroll in drug court because it was more expensive than probation. consequently, the higher advances in social work, fall 2014, 15(2) 516 likelihood of recidivating for probation participants may be more associated with socioeconomics than with the type of intervention. racial disparities in drug court outcomes is a concern for many drug courts and the national association of drug court professionals (nadcp) has recently encouraged drug courts to evaluate their programs to see if racial disparities exist (marlowe, 2013). therefore, the results for the indiana drug court are promising because white and minority participants (african american/hispanic) had equal likelihoods of recidivating, which is consistent with findings from an evaluation of a nebraska drug court (spohn et al., 2001). researchers have speculated that drug courts in which minority participants are underrepresented are more likely to experience racial disparities in graduation and recidivism outcomes (gallagher, 2013a). white and minority participants were equally represented in the indiana drug court (each group made-up about 50% of the program), and this may possibly explain why the variable of ethnicity did not reach statistical significance. interestingly, participants with no positive drug tests in drug court and those with multiple positive drug tests had equal odds of recidivating. presumably, drug court participants who had positive drug tests would be more likely to recidivate because they were continuing to engage in illegal behaviors. however, these same participants would have also received multiple sanctions throughout the program because of the positive drug tests and these sanctions, consistent with the drug court model, would have been therapeutic in nature, as compared to punitive interventions. perhaps having positive drug tests increased participants’ attendance in substance abuse treatment and the knowledge and skills they learned in treatment supported their recovery beyond drug court, hence lowering their risk of recidivism. similarly, the variable of days between arrest and admission did not reach statistical significance, suggesting that shorter times between arrest and program entry do not result in better outcomes. this finding fails to support a key component of drug court; specifically, key component three recommends that drug courts enroll participants as soon as possible following an arrest, as this will result in better outcomes related to graduation and avoiding recidivism (nadcp, 2004). of all the variables assessed in this study, the strongest predictor of recidivism was having a violation within the first 30 days of drug court. this finding adds to the existing literature because the level of participants’ compliance during the first month of drug court has not been commonly measured in previous research. only two known studies have used this variable and these studies predicted completion outcomes, not recidivism. newton-taylor et al. (2009) found in the toronto drug treatment court that participants who had better compliance within the first month of the program were more likely to graduate. gallagher (2013b), however, found that compliance within the first 30 days of a texas drug court had no impact of graduation. limitations the findings from this study need to be interpreted within the context of the study’s limitations. the most noticeable limitation is that an experimental research design was not used. randomly assigning arrestees to drug court or probation would have provided gallagher, ivory, carlton, miller/impact of drug court on recidivism 517 maximum control for the threats to internal validity. as with all research that does not use random assignment, there is the potential for selection bias. while attempts were made to develop a probation group that had characteristics similar to those of the drug court group, the matching process was limited to the data available to the researchers. for example, probation participants were compared to the drug court group based on having similar arrests and comparisons were then assessed on several demographic variables. last, while the findings from this study can inform other drug courts, they should only be generalized beyond the research sample with caution. while all drug court operate under the same ten key components (nadcp, 2004), the implementation of each component varies from court-to-court based on a community’s needs, the type of offenders the drug court serves, the political climate of the community, and the availability of resources in the area. evaluation of individual drug courts is recommended to assess what predicts recidivism for a specific jurisdiction. drug court practice one of the main characteristics of drug courts that differentiates them from probation is that drug court defendants appear before the judge for judicial status hearings more frequently. the indiana drug court, for example, requires its participants to see the judge weekly at the beginning of the program and no less than once a month during the later phases of the program. for certain populations, however, drug court programs may require more intensive supervision. participants in this study who had a criminal history were more likely to recidivate than their counterparts without a criminal history, and research has suggested that participants with personality disorders that increase their criminogenic risk factors, and likelihood of having a criminal history, benefit most from frequent contact with a judge (festinger et al., 2002; marlowe, festinger, dugosh, & lee, 2005). in order to improve outcomes in drug courts for those with criminal histories, it is recommended that assessment tools be used, like the texas christian university (tcu) criminal thinking scales (knight, garner, simpson, morey, & flynn, 2006), and that interventions be tailored to participants based on the findings from the assessment. participants, for example, with multiple criminal thinking patterns and histories of criminal convictions may have improved outcomes if they appear before the judge at least two times per week. this recommendation of increasing judicial status hearings for high-risk participants is also associated with the finding that participants who had a violation within the first 30 days of drug court were more likely to recidivate than those that did not have a violation during this timeframe. participants who see the judge more frequently may reduce their risk of having program violations, and based on this study, even delaying violations until after the first 30 days seems to result in lower recidivism rates. policy advocacy drug courts throughout the united states continue to demonstrate effectiveness at reducing criminal recidivism; as a result, policymakers are beginning to establish laws that require certain counties to have drug courts and require drug courts to become certified through the state. texas, for example, requires counties with a population of advances in social work, fall 2014, 15(2) 518 more than 200,000 to have a drug court program (texas legislature, 2007). in indiana, drug courts are required to be certified through the state, which helps promote fidelity to the drug court model (indiana general assembly, 2010). only five states (colorado, iowa, kansas, massachusetts, ohio) have no drug court legislation or state appropriations dedicated to drug court (huddleston & marlowe, 2011). it is recommended that policy advocacy efforts focus on establishing drug court laws and funding in all states. advocates can use the findings from this study and the evidence from previous research to support the development and expansion of drug courts in their communities. in this study, drug court participants were 22% less likely to recidivate than probation participants (47% versus 69%) and this finding is consistent with metaanalyses of 92 (mitchell et al., 2012) and 82 (shaffer, 2011) drug courts that also found drug court to be more effective than similar programs, such as probation, at reducing recidivism for offenders with substance use disorders. policymakers from the five states that do not have drug court laws or state appropriations may respond favorably to evidence from other states demonstrating that drug courts reduce recidivism, which naturally saves taxpayers money. in indiana, for example, a statewide evaluation indicated that having drug courts saved state taxpayers 3.5 million dollars a year, and for every $1.00 invested in drug courts, there can be a return of $5.37 dollars (wiest et al., 2007). additionally, as drug court laws continue to be amended and implemented, it is important that policymakers collaborate with professionals who have expertise in drug court programming to assure helpful laws are being created. it is important that laws require drug courts to offer participants culturally competent, evidence-based treatments to avoid negative unintended consequences, such as racial disparities in graduation and recidivism outcomes (gallagher, 2012). future research the majority of drug court research has used quantitative methods to predict graduation and recidivism outcomes, and to compare the recidivism rate of drug court to that of other judicial programs. often, the quantitative studies leave many questions unanswered. in this study, the data demonstrated that the risk factors for recidivating were being younger, having a violation within the first 30 days of drug court, having a criminal history, and being terminated unsuccessfully from the program. while these findings are informative, they do not offer insight into the challenges participants experience with being successful in drug court. with this said, it is recommended that future research use qualitative methods to answer some of the unanswered questions that arose from this study. for example, what are some of the challenges younger participants face that increase their risk of recidivating? facilitating individual interviews with different age groups may allow researchers to compare and contrast the experiences of younger and older participants, which may offer an in-depth understanding on how drug court can be enhanced. this compare and contrast method can also be used to explore the barriers participants face in the first month of the program or the factors that contribute to higher recidivism rates for those with criminal histories. terminated participants are a little more than 2 times more likely to recidivate than graduates; through the use of gallagher, ivory, carlton, miller/impact of drug court on recidivism 519 qualitative methods, researchers may be able to capture the lived experiences of participants which may inform practice and improve graduation outcomes. conclusion findings from this study, coupled with the plethora of evidence from previous research, suggest that drug court is more effective than similar types of criminal justice programs at reducing criminal recidivism rates for offenders with substance use disorders. participants from the indiana drug court recidivated at a rate of 47%, whereas the recidivism rate for a comparable group of probationers was 69%. additionally, drug court participants were most likely to recidivate if they were younger, had a violation within the first 30 days of the program, had a criminal history, and were terminated from the program. in order to improve outcomes for drug court participants, especially those more likely to recidivate, the use of assessment tools, such as the texas christian university (tcu) criminal thinking scales, may help drug courts tailor interventions to participants’ needs. furthermore, advocating for effective drug court laws throughout the united states is recommended to support the expansion of these valuable programs. last, future research focused on the use of qualitative methods may help develop an in-depth understanding of drug court from participants’ lived experiences, such as focusing on the challenges participants face during the first 30 days of the program or the factors that may contribute to younger participants being more likely to recidivate. references bavon, a. (2001). the effect of the tarrant county drug court program on recidivism. evaluation and program planning, 24, 13-22. brown, r. (2011). drug court effectiveness: a matched cohort study in the dane county drug treatment court. journal of offender rehabilitation, 50, 191-201. dannerbeck, a., harris, g., sundet, p., & lloyd, k. (2006). understanding and responding to racial differences in drug court outcomes. journal of ethnicity in substance abuse, 5(2), 1-22. festinger, d. s., marlowe, d. b., lee, p. a., kirby, k. c., bovasso, g., & mclellan, a. t. (2002). status hearings in drug court: when more is less and less is more. drug and alcohol dependence, 68, 151-157. fielding, j. e., tye, g., ogawa, p. l., imam, i. j., & long, a. m. (2002). los angeles county drug court programs: initial results. journal of substance abuse treatment, 23, 217-224. gallagher, j. r. (2012). a policy analysis framework for drug courts. southwest journal of criminal justice, 8, 2-16. gallagher, j. r. (2013a). african american participants’ views on racial disparities in drug court outcomes. journal of social work practice in the addictions, 13, 143-162. gallagher, j. r. (2013b). drug court graduation rates: implications for policy advocacy and future research. alcoholism treatment quarterly, 31(2), 241-253. advances in social work, fall 2014, 15(2) 520 gallagher, j. r. (2014). predicting criminal recidivism following drug court: implications for drug court practice and policy advocacy. journal of addictions & offender counseling, 35, 15-29. hickert, a. o., boyle, s. w., & tollefson, d. r. (2009). factors that predict drug court completion and drop out: findings from an evaluation of salt lake county’s adult felony drug court. journal of social service research, 35(2), 149-162. huddleston, w., & marlowe, d. b. (2011). painting the current picture: a national report on drug courts and other problem-solving court programs in the united states. alexandria, va: national drug court institute [ndci]. indiana general assembly. (2010). house enrolled act no. 1271. retrieved from http://www.in.gov/legislative/bills/2010/he/he1271.1.html knight, k., garner, b. r., simpson, d. d., morey, j. t., & flynn, p. m. (2006). an assessment for criminal thinking. crime & delinquency, 52, 159-177. krebs, c. p., lindquist, c. h., koetse, w., & lattimore, p. k. (2007). assessing the long-term impact of drug court participation on recidivism with generalized estimating equations. drug and alcohol dependence, 91, 57-68. listwan, s. j., shaffer, d. k., & hartman, j. l. (2009). combating methamphetamine use in the community: the efficacy of the drug court model. crime & delinquency, 55, 627-644. listwan, s. j., sundt, j. l., holsinger, a. m., & latessa, e. j. 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(2014b). about international association of drug treatment courts (iadtc). retrieved from http://www.nadcp.org/about-us?q=about-us gallagher, ivory, carlton, miller/impact of drug court on recidivism 521 newton-taylor, b., patra, j., & gliksman, l. (2009). toronto drug treatment court: participant intake characteristics as predictors of “successful” program completion. journal of drug issues, 39, 965-987. orme, j. g., & combs-orme, t. (2009). multiple regression with discrete dependent variables. new york: oxford university press. shaffer, d. k. (2011). looking inside the black box of drug courts: a meta-analytic review. justice quarterly, 28, 493-521. shaffer, d. k., hartman, j. l., listwan, s. j., howell, t., & latessa, e. j. (2011). outcomes among drug court participants: does drug of choice matter? international journal of offender therapy and comparative criminology, 55, 155-174. spohn, c., piper, r. k., martin, t. j., & frenzel, e. d. (2001). drug courts and recidivism: the results of an evaluation using two comparison groups and multiple indicators of recidivism. journal of drug issues, 31, 149-176. st. joseph county drug court. (2014). st. joseph county drug court program. [brochure]. south bend, indiana: author. substance abuse and mental health services administration. (2013). results from the 2012 national survey on drug use and health: summary of national findings. retrieved from http://www.samhsa.gov/data/nsduh/2012summnatfinddettables/nationalfinding s/nsduhresults2012.htm#ch7.1.7 texas legislature. (2007). h.b. no. 530. retrieved from http://www.capitol.state.tx.us/tlodocs/80r/billtext/html/hb00530i.htm wiest, k. l., carey, s. m., martin, s. j., waller, m. s., cox, a. a., & linhares, r. (2007). indiana drug courts: a summary of evaluation findings in five adult programs. portland, or: npc research. wolfe, e., guydish, j., & termondt, j. (2002). a drug court outcome evaluation comparing arrests in a two year follow-up period. journal of drug issues, 32, 11551171. author note address correspondence to: john r. gallagher, ph.d., assistant professor, school of social work, indiana university-south bend, 1700 mishawaka avenue, northside hall 420, p.o. box 7111, south bend, in 46634-7111. email: johngall@iupui.edu spring2006-024_page20 spring2006-025_page21 spring2006-026_page22 spring2006-027_page23 spring2006-028_page24 spring2006-029_page25 spring2006-030_page26 spring2006-031_page27 spring2006-032_page28 spring2006-033_page29 spring2006-034_page30 spring2006-035_page31 spring2006-036_page32 influenced by the national direction of treatment for youth with serious emotional disturbance (sed), children’s psychosocial longitudinal evaluation of outcomes for youth with serious emotional disturbance during two years of children’s psychosocial rehabilitation nathaniel j. williams michael e. sherr abstract. this study assessed the course, rate, and significance of change in participants’ day-to-day functioning during two years of children’s psychosocial rehabilitation (cpsr). hierarchical linear mixed models were used to analyze child and adolescent functional assessment scale (cafas) outcome data for 49 youth with serious emotional disturbance, aged 7 to 17 years. the authors estimated participants’ change trajectory, difference in initial versus 16-month status, and difference in rate of change between the first 12 and last 8 months of the study. controlling for age, participants improved by 13.73 points on the cafas every four months, generating a statistically and clinically significant improvement from intake to 16 months. the rate of change decreased significantly to 1.37 points per wave during the last 8 months of the study. cpsr participants improve significantly during treatment, with the majority of changes occurring in the first year. keywords: serious emotional disturbance; children’s psychosocial rehabilitation; community-based treatment; child and adolescent functional assessment scale influenced by the national direction of treatment for youth with serious emotional disturbance (sed; duchnowski, kutash, & friedman, 2002; ringeisen & hoagwood, 2002; stroul & friedman, 1986), children’s psychosocial rehabilitation (cpsr), a medicaid-funded, homeand community-based treatment for youth with sed, quietly sprung up in the state of idaho in the mid-1990’s and has grown into a $38 million-a-year enterprise (idaho department of health and welfare, 2007; williams, in press). cpsr bears many hallmarks of a quality sed-specific treatment and has shown promise empirically (williams, in press). despite its widespread use in idaho, however, cpsr is understudied, with only one uncontrolled investigation of outcomes (williams, in press). in order to determine whether or not cpsr is effective, and whether other states should adopt it, additional and more rigorous research is needed. this study advanced the evidence base on cpsr by using a retrospective longitudinal design to estimate participants’ rate of change in functioning during 24 months of treatment, and differences in the rate of change between the first 12 and last 8 months of the study. context for children’s psychosocial rehabilitation within the idaho medicaid system, private, for-profit providers deliver cpsr services under a managed-care arrangement. privatization, combined with broadly written rules which govern the program, resulted in a proliferation of providers and cpsr treatment models, all with their own treatment philosophies, staff training and supervision practices, models of intervention, and most likely, differential outcomes. _________________ nathaniel j. williams, lcsw, is children's psychosocial rehabilitation program director, centerpointe, inc., nampa, idaho. michael e. sherr, ph.d., lcsw, is an assistant professor in the school of social work at baylor university. copyright © 2008 advances in social work vol. 9 no. 2 (fall 2008), 126-141 advances in social work, fall 2008, 9(2) 127 unfortunately, despite mandates in the idaho administrative code directing the idaho department of health and welfare to evaluate the effectiveness of cpsr (idaho administrative code, dept. of health and welfare, code number 16.03.09.701 – 16.03.10.199, 2006), no statewide efforts have been implemented to date to assess the outcomes of this innovative but expensive program. in the absence of a statewide evaluation or any literature on cpsr, staff at one large clinic in southwestern idaho initiated a program of research to assess the efficacy of their specific cpsr program model (williams, in press). in an open trial design (e.g. piacentini, bergman, jacobs, mccracken, & kretchman, 2002; vernberg, jacobs, nyre, puddy, & roberts, 2004), williams (in press) compared participants’ intake scores on the child and adolescent functional assessment scale (cafas; hodges, 2000a) or the preschool and early childhood functional assessment scale (pecfas; hodges, 1994) to their most recent cafas/ pecfas scores across an average treatment time of 13 months. findings were positive—78% of participants evinced clinically significant change, defined by a drop of 20 points or more on the cafas or pecfas, with a large effect size of 1.29 on cafas/ pecfas total score, and significant improvements on all but the substance use subscales. although the study was an important first step in evaluating cpsr, methodological issues limited the inferences that could be drawn. first, the trial was uncontrolled, prohibiting causal inferences as to cpsr’s efficacy (kazdin, 2003). second, the length of treatment varied widely between participants (min = 4 months, max = 36 months), muddying the interpretation of mean changes in functioning. third, the study lacked longitudinal data points. pre-post evaluation models have been criticized in the literature (bereiter, 1963; linn & slinde, 1977), with experts now calling for longitudinal analyses to provide more valid estimates of changes in symptoms, functioning, or other outcomes of interest (rogosa, brandt, & zimowski, 1982; singer & willett, 2003; willett, 1989). finally, the study was of limited duration compared to the average length of cpsr treatment; the mean treatment time was 13 months (sd = 8.89) with nearly half the sample receiving 8 months of treatment or less. conversely, williams (in press) reported that most participants remain in the program for 18 months. further evaluation was therefore necessary to improve our understanding of cpsr’s effectiveness over time and the nature of participants’ change during treatment. the current study took several logical steps forward in empirically evaluating cpsr. first, we focused our evaluation on the same cpsr program williams (in press) examined in the original trial. second, we employed a retrospective longitudinal design that redressed several shortcoming of the earlier report. treatment time was held constant, easing interpretation of mean changes in functioning, and was long-term, aligning more closely with practice realities. the longitudinal design allowed us to assess the course, rate, and significance of participants’ changes in functioning over time through the use of hierarchical linear mixed models (singer & willett, 2003). third, we sought to inform utilization management decisions by comparing children’s intake to 12-month change trajectory to their 16to 24-month change trajectory. one of the crucial practice questions in an open-ended service like cpsr is, “how long should treatment last?” to date, no empirical literature has addressed this issue. we therefore sought to inform the question williams, sherr/longitudinal evaluation of outcomes for youth 128 of service duration by looking for differences in children’s change trajectories during different periods of treatment. taken together, these features produced a better understanding of participants’ changes as they moved through the program and provided useful information for evaluation, treatment planning, and policy. research question and hypotheses in sum, the current study asked “what was the course, rate, and significance of change in children’s day-to-day functioning during two years of cpsr as measured by the cafas (hodges, 2000a)?” we tested three hypotheses. the first related to participants’ rate of change during cpsr: participants’ functioning will improve significantly during their participation in the program. the second focused on the course of change: participants’ functioning will improve rapidly during the first 12 months of treatment and slowly during the subsequent 8 months of treatment. our third hypothesis related to the difference in participants’ level of functioning at two points in time: after 16 and 24 months of cpsr, participants’ day-to-day functioning will be significantly improved over their initial status. method design this study used a retrospective 7-wave panel design diagrammed as o1 x o2 x o3 x o4 x o5 x o6 x o7 (x = cpsr). outcome observations (cafas ratings) were conducted by cpsr treatment staff during the course of treatment; specifically, at intake and every four months thereafter. these data were subsequently gathered from clients’ medical charts by the researchers. the study period spanned 24 months; this timeframe was deemed sufficient to capture significant trends and counter-trends in participants’ functioning during cpsr. in order to inform questions of service duration (i.e. “how long should cpsr treatment last?”) we compared children’s change trajectory during the first 12 months of the study (o1, o2, o3, o4) to the trajectory during the last 8 months of the study (o5, o6, o7). the comparison periods were chosen after visual inspection of children’s change trajectories suggested that functioning leveled off significantly beyond the 12-month mark. participants participants were 49 clinic-referred children, aged 7 to 17 years (m = 11.5, sd = 2.9, min = 7, max = 17), who participated in cpsr. inclusion criteria limited the study to cpsr participants aged 7 years or older, with two years or more of treatment. the sample included all youth who met inclusion criteria at the study site as of october 2007. participants were diagnosed with sed, as defined by (a) one or more psychiatric diagnoses according to the most recent edition of the diagnostic and statistical manual of mental disorders (4th ed. text revision, american psychiatric association, 2000), (b) a total cafas score of 80 or higher, and (c) a 20 on any one of three cafas subscales: moods/ emotions, self-harm, or thinking. the most common primary psychiatric diagnoses were any type of attention deficit/ hyperactivity disorder (31%) or anxiety advances in social work, fall 2008, 9(2) 129 disorder (31%), including posttraumatic stress disorder. mood and depressive disorders were also common (14% and 12%, respectively). the mean number of diagnoses in the sample was 1.61 (sd = .67, min = 1, max = 3). diagnoses came from community practitioners who saw the children during the course of routine clinical practice in a community mental health clinic. the sample was predominantly caucasian (82%) and male (63%). the racial diversity of the sample was limited (10% hispanic, 8% “other”), reflecting a lack of diversity in the surrounding geographic area (u.s. census bureau, 2008). a large majority of participants lived with their biological families (84%); 12% lived in foster care, and 4% were adopted. all participants’ families had low annual incomes which met guidelines to qualify for idaho medicaid. study site the study took place at a large, for-profit, children’s mental health clinic that specializes in the treatment of youth with sed. located in southwestern idaho, the clinic primarily serves canyon county (estimated 2006 population = 173,302; u. s. census bureau, 2008), one of the more populous regions in a largely rural state. clinic referrals came from pediatricians, schools, juvenile justice, child welfare, and word-of-mouth. the majority of participants served at the clinic meet income guidelines to qualify for idaho medicaid. in order to ensure the protection of human subjects, we obtained ethical review, oversight, and approval for the study from the administrative oversight committee at the clinic where the study took place. because the data were archival, stored in a retrieval system without identifiers, and not originally intended for research purposes, the risk to participants was minimal. children’s psychosocial rehabilitation cpsr programs differ considerably across the state of idaho and beyond. idaho state guidelines require that cpsr providers undergo a credentialing process in which their records are audited to ensure appropriate documentation of services and compliance with idaho administrative code (idaho administrative code, dept. of health and welfare, code number 16.03.09.701 – 16.03.10.199, 2006). in addition, all cpsr services must be prior authorized by regional mental health authorities, which ensure that clients meet enrollment criteria for cpsr and that proposed cpsr service plans comply with code. the practice parameters outlined in idaho administrative code (2006) define minimum standards for program quality and practice; they do not operationally define cpsr interventions or program features in great detail. as an example, the code specifies minimum educational requirements for cpsr specialists (bachelor’s degree or higher in behavioral science, education or medicine), but does not outline specific preservice training requirements. the code requires cpsr specialists to be supervised weekly, but does not dictate the format or amount of supervision they should receive. because of this, cpsr programs vary considerably in terms of quality, staffing, training williams, sherr/longitudinal evaluation of outcomes for youth 130 practices, and outcomes. the following description applies only to the cpsr program evaluated in this study. children’s psychosocial rehabilitation is a homeand community-based program for youth with sed who need more intensive treatment than weekly outpatient psychotherapy, but who do not need to be psychiatrically hospitalized or placed in residential treatment. the goals of the program are to prevent youth from moving into more restrictive levels of care, to minimize the impact of mental illness, and to maximize their positive developmental trajectory. the focus is on reducing the impact of functional impairments associated with symptoms of sed. treatment is here-and-now focused, ecologically valid (occurs in the child’s home and community), and emphasizes building a positive alliance with the client and caregiver, teaching and building skills, and behavior modification. within cpsr, psychiatric symptoms and functional impairments are thought to arise from combinations of biological, psychological, and environmental factors unique to each child and family. similarly, each child and family is viewed as possessing unique strengths and skills that aid in remedying the presenting problems. each child who participates in cpsr undergoes a thorough clinical assessment that covers nine areas: psychiatric/ substance use, medical, educational, financial, social, family, housing, basic living skills, and community. the child’s functioning is assessed in each area and specific strengths and weaknesses are identified. the focus is on how the psychiatric symptoms impact functioning in each area. based on the assessment, a cpsr service plan is developed that describes (a) the child and family’s broad goals, (b) concrete, measurable objectives that serve as benchmarks toward the goals, and (c) specific tasks that the cpsr specialist, client, and family will do to achieve the objectives and goals. tasks describe specific intervention strategies that will be used. for example, a task might state “the psr staff will teach, practice, and review with the client skills for redirecting his anger when upset.” the psr worker then tailors the specific teaching, practicing, and reviewing activities to the interests, developmental level, and needs of the specific client. interventions are cognitive and behavioral in nature, and occur in relevant community settings, enhancing their ecological validity. ideally, cpsr specialists deliver interventions within the context of a strong therapeutic alliance with the child and family; workers are intentional about fostering such alliances. a typical cpsr service plan includes 4 to 8 hours of face-to-face skill-building intervention time per week, with an additional 2 hours per week for “collateral contacts” with important adults in the child’s life (e.g. parents, teachers, coaches, youth pastor, extended family). during skill-building sessions, the cpsr specialist works one-on-one with the child, in the context of his or her natural ecology, to teach and rehearse skills. skill-building sessions can, and often do, include the child’s parents when skill deficits involve functioning in the home. during collateral contacts, the cpsr specialist receives information and updates from important adults in the child’s life, provides education and intervention strategies to the adults, and coordinates interventions across settings. in cases where children receive additional clinical services (e.g. psychotherapy) efforts are made to coordinate intervention approaches and treatment targets. anecdotally, cpsr treatment tends to last from 4 to 36 months, with an average of 18 to 24 months. advances in social work, fall 2008, 9(2) 131 cpsr specialists are the primary intervention agents in cpsr. these individuals possess a bachelor’s degree in social work, psychology, or a human services related field with 21 semester credits or more of coursework on human behavior. cpsr specialists receive 10 hours of pre-service training, including didactic and written instruction, roleplays, and opportunities to “shadow” more experienced cpsr specialists. specialists receive weekly one-on-one supervision with a master’s-level clinician in which they staff cases and receive guidance on clinical aspects of the work; typically this lasts from 15 to 45 minutes per week. finally, specialists receive 20 hours per year of continuing education related to the field of children’s mental health. standardized training materials and a manual are being developed for the cpsr program under study. fidelity to the intervention was not quantified in this study as no rating scales exist. instead, as a community-based study, we relied on the clinical judgment and guidance of cpsr supervisors to ensure that treatment was provided in accordance with program standards. outcome measures child and adolescent functional assessment scale (cafas). the cafas is a clinician-administered paper-and-pencil measure designed to assess the day-to-day functioning and psychological symptoms of children ages 7to 18-years-old (hodges, 2000a). the cafas includes eight subscales which correspond to various areas of functioning or psychological well-being and include: school, home, community (primarily assesses delinquent acts), behavior toward others, moods/ emotions, substance use, self-harm, and thinking. children receive a score on each subscale ranging from 0 (minimal to no impairment) to 30 (severe impairment); subscale scores are summed to generate a total cafas score which can range from 0 to 240. guidelines published on the cafas indicate that total scores of 50 or higher indicate the need for additional services beyond traditional outpatient care. the cafas is in wide use across the united states; several states, including idaho, use it to determine eligibility for services and to monitor outcomes in public systems of care (bates, 2001). the psychometric characteristics of the cafas have been thoroughly evaluated and it has been found to have good inter-rater reliability in different samples of raters, as well as construct, concurrent, and predictive validity (hodges, doucette-gates, & liao, 1999; hodges & wong, 1996; 1997; hodges, wong, & latessa, 1998). cafas ratings for this study were completed by bachelor’s and master’s-level clinicians during the course of cpsr treatment. ratings reflected the child’s worst level of functioning during the preceding three months. cafas scoring guidelines encourage raters to gather as much information about the client as possible in order to make the most accurate rating (hodges, 2000b); accordingly, cafas ratings were based on parentand child-report and on information from collateral contacts, including the child’s cpsr specialist once treatment was initiated. all cafas raters had successfully completed the cafas inter-rater reliability training and passed the inter-rater reliability test to be considered reliable cafas raters (hodges, 2000b). williams, sherr/longitudinal evaluation of outcomes for youth 132 analyses we performed univariate, indicator, and multivariate analyses on the data. univariate analyses assessed the significance of changes in functioning from intake to each subsequent wave and from wave to wave, using a series of dependent t tests. because these were preliminary analyses we did not adjust our probability values. indicator analyses revealed the number of participants who achieved clinically significant change from intake to 24 months. hodges, xue, and wotring (2004) defined a change of 20 points or more on the cafas as a marker of clinically meaningful improvement; they note this corresponds to half a standard deviation on the cafas and a medium effect size according to cohen’s criteria (1988). taken together, the univariate and indicator analyses provided a rough picture of the pattern and significance of participants’ pre-topost, and inter-wave changes. our main analysis sharpened the picture using hierarchical linear mixed models (a.k.a. random coefficients regression or the multi-level model for change; singer &willett, 2003). the hierarchical linear mixed models provided estimates of participants’ initial status (intercept), and slope of change over time, including differences in slope between the first 12 and last 8 months of the study. hierarchical linear mixed models allow participants’ individual growth parameters (intercept and slope) to vary, an important feature in clinical work where all participants will not respond the same to an intervention (gibbons et al., 1993; gibbons, hedeker, & davis, 1987). mixed models also allow participants’ individual growth parameters to represent a random population sample of all possible growth parameters (singer & willett, 2003), thereby permitting more accurate and generalizable estimates of changes in participants’ functioning. prior to our analyses, we centered age on its mean (11.5 years), forcing the parameter estimates to represent the intercepts and slopes of an average-age child in the study. all analyses were run using spss version 15.0 for windows. results univariate analyses table 1 presents participants’ mean cafas scores and standard deviations at waves one through seven, mean difference and standard deviation values from intake to each subsequent wave, mean difference and standard deviation values from wave to wave, and the effect size for intake to subsequent wave changes. cafas total scores at waves 2 through 7 were significantly lower (improved) than the cafas total score at intake, all p < .001. this finding supported hypothesis (c). the effect sizes for these changes were all large, according to criteria specified by cohen (1988). participants improved significantly from wave to wave in succession up to 12 months after intake, all p < .05; after that, scores did not improve significantly between waves. advances in social work, fall 2008, 9(2) 133 table 1. child and adolescent functional assessment scale means, standard deviations, mean differences from intake to subsequent waves, and mean wave to wave differences. wave m (sd) intake to wave difference m (sd) wave to wave difference m (sd) intake to wave effect size (cohen’s d) intake 119.36 (26.08) 4 months 91.91 (27.32) 27.45 (32.47) *** 27.45 (32.47) *** 1.03 8 months 84.04 (32.95) 35.32 (39.39) *** 7.87 (25.28)** 1.19 12 months 73.40 (25.73) 45.96 (34.30) *** 10.64 (27.22)* 1.77 16 months 71.70 (25.73) 47.66 (36.90) *** 1.70 (23.89) 1.84 20 months 66.17 (25.33) 53.19 (33.76) *** 5.53 (22.54) 2.07 24 months 68.72 (30.40) 50.64 (38.41) *** -2.55 (24.36) 1.79 note: n = 47 due to missing data points for two cases. probabilities based on dependent samples t tests. error rate inflated due to the use of unadjusted p-values. *** p < .001. ** p < .01. * p < .05. indicator analyses the average participant’s cafas score improved by 47.35 points (sd = 42.17) from intake to 24-months, a score well-above the 20 point “clinically significant” criterion suggested by hodges et al. (2004). in total, 77.6% of the sample achieved clinically significant change from wave 1 to wave 7. multivariate analyses participants’ overall change trajectory, initial status, and difference in change trajectory between the first 12 and last 8 months of the study were estimated using hierarchical linear mixed models. we used maximum likelihood estimation with an unstructured covariance structure and random slopes. we first ran an unconditional growth model, which estimated participants’ overall change trajectory with no predictor or control variables. in subsequent models we included control and predictor variables in a theoretically-driven fashion, using goodness-of-fit statistics and changes in the random covariance parameters to determine which model best fit the data. based on children’s medical charts, available control variables included: age, gender, ethnicity, and living arrangement status. previous work indicated living arrangement status does not significantly moderate outcome in cpsr (williams & sherr, in press) and therefore was not included in any analyses. gender and ethnicity did not contribute significantly to the model and were therefore excluded, leaving age as the only control variable. age significantly impacted participants’ initial status, but not their slope of change (wave x age interaction term); consequently, we included age as a fixed effect for the intercept only. williams, sherr/longitudinal evaluation of outcomes for youth 134 table 2 presents parameter estimates, standard errors, and confidence intervals for the best fitting and final model. the model was based on 348 observations for 49 participants. model coefficients represent the value for an average age participant (11.5 years old). the average cafas score at intake was 127.58, a figure significantly different from zero, p < .001, and reflective of a severely impaired group of youth. each year of age predicted a significant increase in initial cafas score of 3.44 points, p = .001. participants experienced a statistically significant improvement in cafas score of 13.73 points per 4 months, p < .001. after 16 months of treatment, the average participant’s cafas total score had dropped significantly by 47.63 points, p < .001. finally, the rate of change worsened significantly, by 12.36 points, p < .001, during the last 8 months of the study, as compared to the first 12 months, for an average improvement in cafas score of (13.73 12.36) 1.37 points per four months during the last three waves of the study. these findings support hypotheses (a) through (c). table 2. hierarchical linear mixed model parameter estimates, standard errors, and 95% confidence intervals for cafas outcome data during two years of cpsr. 95% confidence interval variable b se lower bound upper bound intercept initial status 127.58*** 4.53 118.61 136.55 age (centered) 3.44*** 0.92 1.58 5.29 16-month -47.63*** 13.32 -73.87 -21.38 rate of change wave -13.73*** 1.48 -16.65 -10.82 first 12 vs. last 8 mos 12.36*** 2.50 7.44 17.28 note: n = 49; cafas = child and adolescent functional assessment scale. pseudo-r2 (predicted x observed values) = .71. *** p < .001 in order to get an idea of the total variance accounted for by our model, singer and willett (2003) suggest computing a pseudo-r2 statistic by examining the correlation between the predicted and observed dependent variable values. the resultant correlation, r = .84, p < .001 (two tailed) indicated our model accounted for 71% of the variance in outcome. discussion this study provided reliable estimates of the rate, course, and significance of change in children’s day-to-day functioning during two years of cpsr at the study site. findings suggest the cpsr program under study is an efficacious form of treatment for children and youth with sed. children who participated in cpsr achieved statistically and clinically significant improvements in functioning over 24 months of treatment, with advances in social work, fall 2008, 9(2) 135 the brunt of progress occurring during the first year. the variance accounted for by the final regression model was substantial. as practice realities have so far prevented the implementation of a randomized controlled trial (rct) of cpsr, this evaluation was a logical next step in empirically testing our cpsr program; the findings provide further support of its effectiveness. findings presented here suggest cpsr may be as effective as other more thoroughly evaluated and disseminated forms of treatment for sed, such as wraparound (burchard, bruns, & burchard, 2002; burns & goldman, 1999; grundle, 2002) and multisystemic therapy (mst; henggeler, schoenwald, rowland, & cunningham, 2002). table 3 compares our findings to the mean 18-month cafas scores reported in a recent study of wraparound, mst, and wraparound plus mst (stambaugh et al., 2007). findings from the current study are comparable at 12 months (and thereafter), falling between the average cafas scores for wraparound and mst participants at 18 months post-intake. by comparison, participants in the stambaugh et al. (2007) study received an average of 15 months of wraparound, 5.5 months of mst, and 10.2 months of wraparound plus mst. although preliminary, this finding warrants further investigation because cpsr may require less start-up and maintenance costs than mst and may be more compatible with medicaid reimbursement guidelines than wraparound. these findings are significant given the current push for dissemination of evidence-based treatments for sed (duchnowski, kutash, & friedman, 2002; hoagwood, burns, kiser, ringeisen, & schoenwald, 2001). table 3. comparison of current findings to outcomes from other forms of sed-specific treatment. outcome cpsra m (se) wraparoundb m (se) mstc m (se) wraparound + mstd m (se) pre cafas total score 119.4 (3.80) 113.6 (2.41) 109.3 (5.76) 131.3 (5.06) post cafas total score 73.4 (3.75) 79.4 (nr) 61.5 (nr) 82.3 (nr) mean change 46.0 34.2 47.8 49.0 note: cafas = child and adolescent functional assessment scale; nr = not reported. comparison data reported in stambaugh et al. (2007). a scores differ from table 1 due to rounding; post-score is mean 12-month cafas; n = 47. b n = 213; average length of treatment was 15 months. c n = 54; average length of treatment was 5.5 months. d n = 53; average length of treatment was 10.2 months. despite their significant improvement, cpsr participants’ mean cafas total score after two years of treatment was still in the clinically impaired range (i.e. above the 50 point criterion indicating the need for services beyond traditional outpatient care). this is typical of trials involving youth with sed (duchnowski, hall, kutash, & friedman, 1998; greenbaum et al., 1996; henggeler et al., 1999; hodges, et al., 2004; kazdin, bass, williams, sherr/longitudinal evaluation of outcomes for youth 136 siegel, & thomas, 1998), even amongst empirically supported interventions like wraparound and mst (stambaugh et al., 2007). such findings underscore the importance of continued support and services for this vulnerable population and their families throughout the lifespan. importantly, participant age had a significantly negative impact on severity of impairment at intake but did not moderate participants’ rate of change during treatment, suggesting that youth between the ages of 7 to 17 years benefit similarly from the program. this finding differs from other child treatment outcome literature which shows older youth, especially those with conduct or externalizing behavior problems, tend to respond less favorably to treatment (dishion & patterson, 1992; ruma, burke, & thompson, 1996). the non-significant difference in rate of change is a positive preliminary finding that should be interpreted cautiously given our small sample size. unfortunately, practice realities prevented inclusion of a control group in the study; consequently, we cannot conclude that cpsr caused participants’ functioning to improve. however, longitudinal studies exploring the trajectory of change in this population’s functioning suggest that youth with sed typically experience a worsening of symptoms and functional impairments over time (armstrong, dedrick, & greenbaum, 2003; greenbaum et al., 1996; wagner, 1995; zigmond, 2006). combined with the similar performance of cpsr to other targeted, sed-specific interventions (e.g. stambaugh et al., 2007) the current findings appear promising. because cpsr services are open-ended, with no limits on duration posed by statute, the current findings inform utilization management decisions at the study site. our results suggest participants in this cpsr program experience rapid improvement during the first year of treatment, followed by minimal change during the subsequent eight months. the obvious conclusion might be to limit services to 16 months. however, such a conclusion may be flawed, if the latter phase of treatment is viewed as a “maintenance” phase which provides necessary, ongoing support to youth with serious emotional and behavioral problems. moreover, these findings are limited to a single cpsr program at one site. future research is needed to replicate our findings in a larger cross-section of cpsr participants and providers, and to experimentally evaluate the effect of setting limits on the duration of cpsr services. although the findings from this study do not generalize to other cpsr programs in the sense of describing their outcomes, the findings do provide a comparative baseline against which other cpsr program sites might compare their outcomes. if some sites do not achieve outcomes comparable to those presented in this study, it may be that certain agency, programmatic, or organizational factors could be targeted for change at the comparison site as a means of improving client outcomes. conversely, if another program is shown to have outcomes superior to those documented in this study, research might compare and contrast the programs to determine what factors contribute to enhanced functioning for children in the comparison program. findings also provide support, at the practice and policy level, for the use of evidence-based cognitive and behavioral interventions for youth with sed. at the practice level, practitioners are guided toward treatment choices that favor here-and-now advances in social work, fall 2008, 9(2) 137 focused skill building, behavior modification, cognitive interventions, and an ecologically valid, coordinated, collaborative, multi-system approach. for policy-makers seeking to increase system efficiency and accountability, these findings offer support for community-based, multi-system, coordinated, cognitive and behavioral interventions with child and adolescent populations. based solidly in the medical model, third-party payers have been slow to reimburse newer forms of community-based treatment such as cpsr; the current findings offer another round of empirical support for this new wave of services. this study was not without methodological limitations related to the conduct of research in a community practice setting. first, findings from this study cannot be generalized to other cpsr programs as we employed a small sample from a single cpsr program. as noted above, cpsr programs vary considerably on many important agencylevel variables that may impact client outcomes. second, our retrospective design and reliance on existing medical records prevented us from examining the impact of important covariates such as the level of family engagement, family functioning, and/ or organizational factors, such as the quality of cpsr specialist supervision, worker experience level, or other program quality indicators. these variables represent important potential sources of variation in cpsr outcome and should be addressed in a planned, prospective longitudinal study. third, the study was not controlled or randomized, preventing causal inferences. fourth, outcome ratings included information from intervention agents, introducing the possibility of rater bias. finally, due to our retrospective design, we lacked standardized measures of intervention fidelity; 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(2008). state and county quickfacts. retrieved may 25, 2008, from http://quickfacts.census.gov/qfd/states/16/16027.html. vernberg, e. m, jacobs, a. k., nyre, j. e., puddy, r. w., & roberts, m. c. (2004). innovative treatment for children with serious emotional disturbance: preliminary outcomes for a school-based intensive mental health program. journal of clinical child and adolescent psychology, 33, 359-365. wagner, m. m. (1995). outcomes for youths with serious emotional disturbance in secondary school and early adulthood. the future of children, 5, 90-112. willett, j. b. (1989). some results on reliability for the longitudinal measurement of change: implications for the design of studies of individual growth. educational and psychological measurement, 49, 587-602. http://quickfacts.census.gov/qfd/states/16/16027.html advances in social work, fall 2008, 9(2) 141 williams, n. j. (in press). preliminary evaluation of children’s psychosocial rehabilitation for youth with serious emotional disturbance. research on social work practice. williams, n. j., & sherr, m. e. (in press). children’s psychosocial rehabilitation: clinical outcomes for youth with serious emotional disturbance living in foster care. child and adolescent social work journal. zigmond, n. (2006). twenty-four months after high school: paths taken by youth diagnosed with severe emotional and behavioral disorders. journal of emotional and behavioral disorders, 14, 99-108. author’s note: address correspondence to: nathanial j. williams, lcsw, children’s psychosocial rehabilitation program director, centerpointe, inc., 915 park centre way, suite 7, nampa, idaho 83651. e-mail: nwilliams@centerpointeinc.com. mailto:nwilliams@centerpointeinc.com context for children’s psychosocial rehabilitation research question and hypotheses method design participants study site children’s psychosocial rehabilitation outcome measures analyses results univariate analyses indicator analyses multivariate analyses discussion references microsoft word luby article revised copyedit bb __________ christi duette luby is a doctoral candidate in the interdisciplinary health sciences ph.d. program at the college of health sciences/school of nursing, university of texas at el paso. the views expressed in this document are those of the author(s) and do not reflect the official policy of william beaumont army medical center, the department of the army, or the united states government. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 67-82 promoting military cultural awareness in an off-post community of behavioral health and social support service providers christi duette luby abstract: due to u.s. military base realignment and closure (brac) efforts and ongoing overseas contingency operations, the number of military servicemembers and veterans seeking civilian-based services has increased. as the military presence grows in previously underrepresented areas, the need for culturally competent providers will also increase both on and off military installations. the purpose of this article is to promote military cultural awareness, while suggesting ways to enhance existing community behavioral health and social support services. it builds on a review of the extant literature and findings from a community assessment to introduce civilian providers to some specific issues affecting servicemembers and their families. a framework describes ways to increase military cultural competence and build community capacity to enhance civilian-based services. in addition, two appendices list some common military terminology and multiple training resources available through military organizations and websites. keywords: military cultural competence, community capacity building, resources according to the department of defense (dod), since 2001 almost 2 million military personnel have deployed in support of operation enduring freedom (oef) and operation iraqi freedom (oif) (iom, 2010). in addition, due to us military base realignment and closure (brac) efforts, servicemembers and their families are relocating throughout the united states (dod, 2005). these sustained military activities have increased the number of servicemembers, veterans, and their families seeking behavioral health and social support resources in civilian communities. the dod believes the civilian sector will answer this call to duty and help meet this demand (us medicine institute (usmi), 2005). the purpose of this paper is to promote awareness of the support necessary to improve the health of servicemembers and their families and identify resources available to providers to help meet those needs. the military represents a unique cultural group with its own language, behaviors, and beliefs (reger et al., 2008). issues faced by returning troops and their families may be unfamiliar to civilian providers, which may present challenges. how civilian providers respond to this increased need for services will determine their ability to offer ethical, culturally competent care (reger, etherage, reger, & gahm, 2008). according to defense centers of excellence (dcoe) (2009), to serve military communities better, qualified resource providers should be sensitive to and willing to learn about the military culture. gaining cross-cultural competence is an ongoing process that requires the application of professional practice standards to this unique population advances in social work, spring 2012, 13(1) 68 (nasw, 2006). as one model suggests, providers must continuously integrate new information gathered through cultural awareness, knowledge and sensitivity to achieve cultural competence (papadopoulos, tilki, & taylor, 1998). method this call to action originated from ideas generated during direct practice and involvement with military installations, as well as results from an assessment of a community affected by returning troops and brac. a convenience sample of 184 civilian-based resource providers received an online survey to assess their services available to military personnel, veterans, and their families. the assessment established baseline data for an ongoing evaluation of this community’s capacity to provide behavioral health and related support services and to determine what civilian-based services need to better support this diverse group. for example, 78% of respondents stated they would like to receive more knowledge on military culture, organizational structure, and terminology, which resulted in the creation of a resource directory (luby, 2010). in response to this community’s needs and others like it, this manuscript promotes awareness about specific issues affecting the military and gathers various resources for civilian practitioners to fill any knowledge gaps that may exist. building on a review of the extant research literature and practice methods used by civilians engaged in military partnerships, this manuscript develops a framework that delineates ways to increase military cultural competence and build community capacity to enhance civilian-based services (see figure 1). this model reinforces many of the 2007 standards for cultural competence in social work practice, and encourages an ongoing process of cultural awareness, adaptation of skills, active involvement, and providing peer-support. next, this review identifies specific cultural issues relevant to the military population and discusses implications for practice. lastly, a table summarizes some common military stressors and two appendices introduce a brief military lexicon and examples of resources available to improve the care of servicemembers and their families. conduct a self-inventory to increase cultural competence, first the civilian-based service provider needs to conduct a self-inventory (hall, 2008). this includes using self-awareness and honesty to evaluate his or her position on military issues, so that political opinions and personal values do not affect the care, services, or social support provided to special populations (hall, 2008; nasw, 2006; slone & friedman, 2008). this pre-assessment will help ensure professionals remain impartial and empathetic even when worldviews differ. luby/promoting military cultural awareness 69 figure 1: methods to increase military cultural competence adapt care to military culture mission and values when working with diverse groups, providers may need to adapt their services and care to be consistent with the client’s culture, whatever that culture may be (nasw, 2006). engaging in military cultural competence requires both an awareness of the client’s behaviors and values, as well as a willingness to develop a multicultural perspective as providers (hall, 2008). each military branch has developed its own primary mission, lexicon, and set of core values. these commonalities serve to develop cultural identity and facilitate communication and cohesion among its members (abbe, gulick, & herman, 2007; dcoe, 2009). as professionals learn and develop crosscultural skills, the delivery of services becomes more population specific, and therefore, more effective (abbe, et al., 2007; nasw, 2006). many cultural minorities express greater comfort in receiving treatment from healthcare professionals of the same or similar backgrounds (chassman & cave, 2011). in addition, some studies suggest that military members and their families respond better to help from providers that are either military affiliated or when providers attempt to understand them. for example, combat soldiers, who feel comfortable and supported by their community, heal faster and better because they are in a trusted place (garcia, 2009). this suggests that if the civilian provider or a family member has served in the military, it advances in social work, spring 2012, 13(1) 70 may create a stronger provider-client connection if the servicemember is aware of this common bond. when providers acquire a basic knowledge of military values, the ability to offer culture-specific care improves. this in turn will build a stronger therapeutic alliance and lead to better clinical care. all servicemembers are trained using concepts of honor, mission first, and belief in sacrificing oneself for others and the greater good (buck, 1981; hall, 2008). words such as honor, integrity, courage, and strength are at the heart of the military culture and affect every aspect of the cultural identity. these words build morale--esprit de corps--within the unit and often influence how, when, and whether or not a servicemember will seek help (samhsa, 2006). in practice, sensitivity to these values establishes a critical link from the civilian-based service provider to the military client. organizational structure and rank hierarchy it is advantageous for practitioners to have a basic understanding of the us military organizational structure, as well as rank hierarchy (e.g., officers, enlisted) and titles, which vary with each service branch (i.e., army, air force, navy, marine corps, and coast guard) (dcoe, 2009). therefore, providers may wish to acquire cultural-specific knowledge to the military branches they serve. providers that understand the differences between the classifications (e.g., active duty, inactive duty, reserve, national guard, and veteran) will appreciate how this status may influence the stressors to which servicemembers and their families may be exposed. for example, this status determines when, how often, and for how long a servicemember will deploy. demographics another way to augment an understanding of military culture is to examine general demographics of the population (dcoe, 2009). servicemembers’ current characteristics (age, gender, marital status, race/ethnicity, rank, and occupational area) may affect their military experience and level of stressors (dod, 2010; rand, 2007). having cultural sensitivity includes knowing the military member’s career or occupational specialty, which helps identify the potential occupational hazards or factors that may influence his or her experiences, and therefore, behavior. cultural-specific adaptation of care developing cross-cultural knowledge and skills to effectively meet the needs of military client groups will enhance civilian-based care models. for example, professionals without prior experience with military personnel will become more familiar with general military terminology, as well as deployment related expressions. being able to converse with military and civilian treatment teams is a vital part of psychological assessments and command consultations (reger, et al., 2008). therefore, it is also beneficial for civilian staff to be qualified to assess post-traumatic, combat stress, depression, deployment, and reintegration issues in military members and their families (cozza, 2011; franklin, 2009; usmi, 2005). luby/promoting military cultural awareness 71 combat-related treatment requires a multidisciplinary team, culturally sensitive to the diverse political, socioeconomic, and environmental factors affecting military populations (hall, 2008). this interdisciplinary practice experience offers civilian providers an opportunity to practice intercultural competence and exhibit cross-cultural leadership skills (abbe, et al., 2007; nasw, 2006). one study suggested that when general physicians had knowledge of military culture and the impact of war on combat veterans, this resulted in earlier diagnosis and successful psychotherapeutic treatment outcomes (lee, gabriel, & bale, 2005). due to stigma and other related issues, barriers to seek and receive care may exist for servicemembers and their families (samhsa, 2006). some soldiers have expressed concerns that seeking behavioral healthcare will harm their career or opportunity to promote (hall, 2008; ruzek, et al., 2004; samhsa, 2006). in addition, military rank determines the pay grade, which may affect the availability of resources. providers need strategies to decrease these barriers, and be prepared to address any confidentiality concerns the servicemember may have. civilian providers help make decisions before and after combat about fitness for duty and mental health status. this involves privacy issues for the solider, as well as assuring military commanders that the soldier is prepared to meet mission readiness (kennedy & moore, 2008). therefore, an understanding of military medical care, principles, practice, and policies is very important when treating this population. for example, specific diagnoses can prompt a review by a military medical evaluation board. certain codes assigned for diagnoses or reimbursement of services may affect a servicemember’s ability to perform certain duties, maintain certain military occupational specialties and security clearances, which in turn will affect his/her ability to deploy (us army, 2011). guidance on filing claims is available for both civilian and military providers to address these issues through the dod healthcare benefits program, tricare. cultural-specific adaptation of care for military families culturally competent care also includes appreciating and addressing the issues and challenges that affect military families. the ability to effectively interact, understand and communicate with servicemembers and their families improves the quality of care (dcoe, 2009). military families are similar to civilian families in many ways; just some of their challenges differ. civilian professional interested in including this group in their client base need to understand these unique challenges. everyone in the family makes personal sacrifices for the mission, in support of their servicemember’s call to duty. some military issues and stressors are common and affect most military personnel and their families (see table 1). there are other stressors experienced by some family members, which require special attention and understanding. for example, those who help care for returning wounded, ill, and injured (wii) soldiers have additional challenges (wtc, 2011). whether servicemembers are active-duty or veterans, civilian providers can help by ensuring continuity of care, which creates smoother transitions for the entire family. advances in social work, spring 2012, 13(1) 72 table 1: common stressors affecting military families top three concerns for deployed service member: (rabb, 2010) 1) exposure to combat 2) home-front concerns 3) peer/leaders relationship military service member stressors: (rabb, 2010) 1) high risk occupation; 2) mobility; 3) authoritative work environment; 4) effects on families; 5) high degree of living with uncertainty; 6) impact of separation; 7) absence of community support; 8) loss of income; 8) minority status (w/in civilian pop); 9) sense of isolation or not being understood behavioral expectations: military members (and their families) are expected to conform to professional and personal behavior, both on and off-duty. deployment: service member is called to duty (without his/her family) somewhere other than the permanent duty station (ex. humanitarian effort, support of a conflict.) time varies by: service branch, career field, mission permanent change of station: (pcs) active duty service members and their families are required to move to different duty stations (approx. every 2-4 years) to meet mission’s needs, increase leadership opportunities and career development. this is a stressful time for military families (change schools; jobs; separate from family/support systems; new area) risk of injury or death: concern for a loved one’s safety temporary duty: (tdy) service member travel assignment away from duty stations (approx. few days to few months—less than yr). (ex. trainings, conferences/meetings, temporary fill in) each member of the family handles military stressors differently; therefore, it may be beneficial to provide military sensitive, support services for each age group (slone & friedman, 2008). this previously understudied area has recently received greater attention. a growing body of literature now focuses on age-specific issues and the effects of deployments and reintegration on military spouses and children. additionally, regional online training covers a variety of military subjects to assist military and civilian-based practice providers. these free programs deliver professional education to enhance familiarity and build community capacity. providers helping families of deployed servicemembers may want to learn more about family readiness groups (frg). these groups activate as a part of the reardetachment, which includes those in the unit that stay at the home base during deployments (operation ready, 2010). the frg meets regularly to provide social support for the unit’s military families and offer assistance to those with special needs while the servicemember deploys. luby/promoting military cultural awareness 73 attend military activities another way to learn about the military culture is to attend military activities, including programs and military health conferences. for example, army posts often open their gates to the local community by sponsoring special events and inviting the public. social interaction and community outreach events held on military installations provide a unique opportunity for civilian providers to see the priority population in surroundings where the group works and lives. in addition, resource providers that go to where the target community gathers will have a better understanding of the issues that affect their cultural identity and environment (minkler, 1997). there are also online activities available that address current military care issues. for example, the military’s defense centers of excellence for psychological health and traumatic brain injury (dcoe) provides monthly web-based seminars on relevant topics affecting military members and their families. there are numerous opportunities to serve military servicemembers, veterans, and families both on and off military installations. in fact, the current presidential administration advertises a website to aid local communities and providers in finding ways to get involved (cncs, 2010). when providers participate in these efforts to advocate for and empower others, the overall community capacity increases (minkler, 1997; nasw, 2006). increase civilian organizations’ involvement and provider social support both military and civilian professionals can help facilitate civilian social support. these community capacity-building efforts may include networking with other military and civilian providers to champion for prevention and educational interventions for health promotion within the civilian community. to increase acceptance and sustainability of these public health initiatives, it is recommended that the target participants and community members be invited to be part of the development process (minkler, 1997). if these providers work together to share knowledge and create a directory of the local and national resources available, this will improve referral networks and overall service delivery (nasw, 2006). as for the provider’s own self-care and social support, he or she should be aware that compassion fatigue and secondary traumatic stress are very real phenomena. it is important to realize and respect that some military member’s experiences will differ from that of the average citizen. when working with traumatized servicemembers, symptoms of post-traumatic stress and combat stress may be present. the stories they share with providers may contain more violent or graphic information than the traumatic experiences of the average civilian population (bride & figley, 2009). the experiences described may involve life or death situations, such as watching someone be harmed or killed, or the soldier may have had to kill someone. without proper training, those trying to help veterans may be injured psychologically due to secondary traumatic stress affects (bride & figley, 2009). by listening to military stories, helpers become susceptible to vicarious traumatization from these horrific experiences (figley, 1995). therefore, healthcare professionals may benefit from forming advances in social work, spring 2012, 13(1) 74 a peer-to-peer support group to encourage other providers, or by attending professional continuing education that cover these specific trauma topics to develop coping skills. discussion the purpose of this paper is to promote awareness of the issues that affect military servicemembers and their families, to build the civilian community capacity to better serve this population, and to identify resources available to providers to help meet those needs. military organizations do not expect civilian practitioners to completely change their mode of practice; but it seems providers who serve, treat, and care for servicemembers and their families should be sensitive to this unique culture and gain competence to provide optimal care. this article develops a framework that depicts an ongoing process requiring time and commitment on the part of the provider. it promotes awareness of basic knowledge of policies, structure, and values to build a stronger alliance and promotes a responsive and comprehensive model of care. it addresses barriers to care, improving access to services and engaging family members, educators, and health providers in the unique needs of this population to help establish this comprehensive care model. the military culture is unique in its core values, organizational structure, and terminology. though made up of multiple diverse cultures, the us military cultural identity enhances uniformity amongst its members and conformity to the rules, policies and procedures that guide the overall mission. this article offers civilian-based services exposure to these distinct qualities, and promotes an awareness of the need to consider these issues during practice. it is understood that civilian providers are busy and probably lack the necessary time to engage in every suggestion outlined in the model. therefore, to save time for those interested in gaining familiarity with the military culture, this article provides an introduction and assembles information gathered from the research literature and used in the practice. if providers would like more information, numerous journals focus on a variety of military specific topics such as principles and practice, research, psychology, and medical ethics. in addition, multiple television dramas and movies have addressed a range of military issues to increase familiarity with this population; as well as, a military channel that reports current military news. when behavioral health and social support resource providers serving this community learn more about their issues, it will advance their level of understanding and improve their ability to help. implications for practice military installations and veteran centers are preparing for the influx of personnel and their families. surrounding local communities affected by brac and returning veterans need to prepare as well. an assessment of the community would focus these efforts, provide a more complete picture of the community’s healthcare and social support systems, and help to identify strengths, needs, and priorities. one of the ways to bridge the gap between military and civilian sectors is through empowerment and advocacy initiatives (cncs, 2010). in addition, civilian-based providers engaged in luby/promoting military cultural awareness 75 strategic partnerships with military installations and the veterans’ administration will find many funding opportunities available to organizations and universities interested in working with military families. the national association of social workers (2006) has policy statements and a code of ethics that urge social workers to be culturally competent. universities that offer social work and licensed professional counselor programs will need a broad approach that reaches beyond the populations they usually serve. developing course curriculum specific to the issues affecting active-duty military and veteran populations will prepare future providers and current providers through continuing education. in addition, courses that address compassion fatigue and secondary trauma stress that include evidence-based practice to increase coping skills and build resiliency may reduce the future risks of providers suffering from work related burnout. primary and secondary public schools who teach military children might look for collaborative approaches within the state school systems to make military transitions less difficult. for example, parents may deploy for twelve months at a time, which is longer than an academic school year. in addition, military families move approximately every three years. when educational systems and teachers are more aware of the issues, they can become actively involved in addressing these challenges. if they help and prepare families to adjust and avoid unnecessary distress, this focus will enhance military children’s overall academic success. conclusions the u.s. military base realignment and closure (brac) efforts and ongoing overseas contingency operations have increased the number of service veterans seeking care in civilian communities. professionals located in areas previously underrepresented by servicemembers and their families now have new opportunities to increase their practice to include this unique population. since civilian providers will likely address the needs of the military population—both currently and into the near future—regional training should be a high priority. the purpose of this article is to aid in expanding the provider’s toolbox and enhance the care model to include cultural-specific awareness. it offers those providers less familiar with military customs and traditions ways to build their cultural competency and understanding of combat-related issues through several training resources. appendix 1 provides a list of common military acronyms and terminology to facilitate familiarity with this culture’s language diversity. in addition, appendix 2 contains links to some practical tools and military-sponsored websites for training on military specific issues. please note this is not an exhaustive list, it is just some examples of how the department of defense fosters coordination between military and civilian resources. there are multiple military organizations collaborating with civilian-based services to enhance and advance the available care for military members and their families. behavioral health and social support providers that get involved and make positive changes will not only be better prepared for the arrival and advances in social work, spring 2012, 13(1) 76 treatment of military members and their families—but will ultimately improve the care and support for the entire civilian community. references abbe, a., gulick, l. m. v., & herman, j. l. (2007). cross-cultural competence in army leaders: a conceptual and empirical foundation. washington, dc: u.s. army research institute. bride, b. e., & figley, c. r. (2009). secondary trauma and military veteran caregivers. smith college studies in social work, 79(3), 314-329. buck, j. h. (1981). professional ideals and military behavior. air university review, mar-apr. retrieved from http://www.airpower.au.af.mil/airchronicles/aureview/1981/mar-apr/buck.htm chassman, j., & cave, c. (2011). cultural, ethnic and racial groups. office of mental health. retrieved from http://www.omh.state.ny.us/omhweb/savinglives/volume2/cultural_groups.html corporation for national and community service (cncs). (2010). retrieved from http://www.serve.gov/ cozza, s. j. (2011). children of military service members: raising national awareness of the family health consequences of combat deployment. archives of pediatrics and adolescent medicine. doi: 10.1001/archpediatrics.2011.117 department of defense. (2011). base realignment and closure 2005. retrieved from http://www.defense.gov/brac/ department of defense (dod). (2010). population representation in the military services fy2010 report. retrieved from http://prhome.defense.gov/rfm/mpp/accession%20policy/poprep2010/ defense centers of excellence (dcoe). (2009). military cultural competence. retrieved from http://www.essentiallearning.net/student/content/sections/lectora/militarycultureco mpetence/index.html/ figley, c. r. (ed.). (1995). compassion fatigue: coping with secondary traumatic stress disorder in those who treat the traumatized. new york: brunner/mazel. franklin, e. (2009). the emerging needs of veterans: a call to action for the social work profession. health & social work, 34(3), 163-167. garcia, m. (2009). combat to community: needs and resources for post-september 11 veterans. cultural competency: iraq and afghanistan veterans. podcast retrieved from http://www.uctv.tv/search-details.aspx?showid=15597/ hall, l. k. (2008). counseling military families: what mental health professionals need to know. new york: taylor and francis group. luby/promoting military cultural awareness 77 institute of medicine (iom). (2010). returning home from iraq and afghanistan: preliminary assessment of readjustment needs of veterans, service members, and their families. committee on the initial assessment of readjustment needs of military personnel, veterans, and their families; board on the health of selected populations, 1-193. retrieved from http://www.nap.edu/catalog/12812.html/ kennedy, c. h., & moore, b. a. (2008). evolution of clinical military psychology ethics. military psychology, 20, 1-6. lee, h. a., gabriel, r., & bale, a. j. (2005). clinical outcomes of gulf veterans' medical assessment programme referrals to specialized centers for gulf veterans with post-traumatic stress disorder. military medicine, 170(5), 400-405. luby, c. (2010). behavioral health and social support resources-el paso region. university of texas at el paso, college of health sciences & school of nursing. retrieved from http://chs.utep.edu/pdf/behavioralhealthandsocialsupportresourceselpasoregionju ne2010.pdf/ national association of social workers. (2006). indicators for the achievement of the nasw standards for cultural competence in social work practice. retrieved from http://www.socialworkers.org/ operation ready. (2010). the army family readiness group leaders handbook. retrieved from http://www.au.af.mil/au/awc/awcgate/army/frg_hdbk.pdf/ papadopoulos, i. (2008). the papadopoulos, tilki and taylor model for developing cultural competence. intercultural education of nurses and medical staff in europe [from papadopoulos, i., tilki, m., & taylor, g. (1998), transcultural care: a guide for health care professionals. wiltshire, uk: quay books]. retrieved from http://www.ieneproject.eu/download/outputs/intercultural%20model.pdf rabb, d. (2010). military cultural competency. cultural competency: iraq and afghanistan veterans. retrieved from http://www.cominghomeproject.net/node/152/ rand national defense research institute. (2007). demographic characteristics. retrieved from http://www.rand.org/pubs/monographs/2007/rand_mg599.pdf/ reger, m. a., etherage, j. r., reger, g. m., & gahm, g. a. (2008). civilian psychologists in an army culture: the ethical challenge of cultural competence. military psychology, 20(1), 21-35. ruzek, j. i., curran, e., friedman, m. j., gusman, f. d., southwick, s. m., swales, p., … & whealin, j. (2004). treatment of the returning iraq war veteran. in: iraq war clinician guide, ncptsd manual. retrieved from http://ncptsd.va.gov/ncmain/ncdocs/manuals/iraq_clinician_guide_v2.pdf/ substance abuse mental health services administration (samhsa). (2006). stigma in the military: strategies for reducing stigma among veterans and active duty personnel. training teleconference. retrieved from advances in social work, spring 2012, 13(1) 78 http://www.stopstigma.samhsa.gov/teleconferences/archive/training/teleconference03 3006.aspx/ slone, l. b., & friedman, m. j. (2008). after the war zone: a practical guide for returning troops and their families. philadelphia, pa: da capo press. u. s. army human resource command. (2011). us army physical disability agency. retrieved from https://www.hrc.army.mil/site/active/tagd/pda/pdapage.htm/ u. s. medicine institute (usmi). (2005). the changing military direct-care system: impact and implications. executive summary-usmi roundtable discussion. washington, d.c. u. s. army warrior transition command (wtc). (2011). families and caregivers. retrieved from http://wtc.army.mil/families/families.html/ author’s note address correspondence to christi duette luby , doctoral candidate, college of health sciences/school of nursing , university of texas at el paso, utep interdisciplinary health sciences ph.d. program, 500 w. university ave., el paso, tx 79968. e-mail: cdluby@miners.utep.edu luby/ promoting military cultural awareness 79 appendix 1: common term/acronym definitions http://www.dtic.mil/doctrine/dod_dictionary aar after action report: after a mission, senior enlisted noncommissioned officers go through what happened and make a report to refer problems out to the appropriate resource providers. active duty full-time job as part of a military force for a specified time period (enlistment) acu-army combat uniform, bdu-battle dress uniform, dcu-desert combat uniform: military issued camouflage clothes used in various environments amc army medical center aor area of responsibility awol absent without leave base air force or navy installation battlemind resiliency training every soldier goes through battlerattle body armor bct brigade combat team: army's basic deployable unit of maneuver bog boots on the ground--personnel deployed under military command brass breathe, relax, aim, slack, squeezemarksmanship training steps for shooting a gun camp marine corps installation cbern chemical, biological, explosive, radiological and nuclear hazards may be present citizen soldier reserve and national guard service members called up to active-duty co commanding officer combat ready service member status when eligible for deployment/capable of performing duty commissioned officer derives authority “commission” by sovereign power, outranks enlisted personnel conus continental united states cosc combat/operational stress control: deployment related stress problems cosr combat operational stress response: a normal response to an abnormal situation demob demobilization: disassembling troops from combat-ready status; discharge of troops deployment service member called to duty away from home base, not accompanied by family dwell time the amount of time a soldier spends at home between deployments down range deployed usually overseas, often in a combat zone enlisted personnel (rank or grade) any rank below a commissioned or warrant officer; includes higher ranking enlisted non-commissioned officers (nco), and petty officers (navy) eod explosive ordinance disposal: safe and technical disposal of high explosive munitions advances in social work, spring 2012, 13(1) 80 fac family assistance center: national guard family program assists families of all branches fisher house free/low cost housing provided for family members of military patients fob forward operating base: secured area used in support of tactical operations. grade refers to “pay grade” used for personnel and pay functions gwot global war on terrorism hbct heavy brigade combat team hemtt heavy expanded mobility tactical truck re-supplies combat vehicles/weapons system hmmwv high mobility multipurpose wheeled vehicle – pronounce “humvee” military 4wd homefront back at home, where their families are while they are deployed ibct infantry brigade combat team ied improvised explosive device inactive duty after active duty, solider remains under contract, can be called back up for service inside the wire on the base (on the fob) itos invitational travel orders: provided by command to allow wounded warrior family visits kevlar typically, the helmet made of the material kevlar made for ballistic protection leave off duty (usually vacation) lsa logistical supply/support area: military facility, depots, r & r area, support to fob meb medical evaluation board (medboard) determines continued military service, referrals to peb medevac medical evacuation emergency evacuation of sick or wounded from combat area mhc medical holding company facility care/support active-duty patients not combat-ready mob mobilization: assembling combat-ready troops and supplies for service deployment mos military occupational specialty (career specialty) used by army and usmc. usaf uses afsc (air force specialty code); navy uses nec (navy enlistment code). mre meal ready to eat mst military sexual trauma: sexual assault/harassment that occurs in military setting mtf military treatment facility ntc national training center oconus outside continental united states oif/oef operation iraqi freedom (iraq) / operation enduring freedom (afghanistan) oorah! pronounced “who-rah” what marines say for “i get you/i hear you/i copy/i agree” hooyah! pronounced “who-yah” what navy seals say for “i get you/i hear you/i copy/i agree” hooah! pronounced “who-ah” what army says for “i get you/i hear you/i copy/i agree” opsec operational security –being careful how use, say, and share critical information luby/ promoting military cultural awareness 81 optempo operations tempo: pace of an operation or operations in terms of equipment usage outside the wire going off the forward operating base (fob) protected by razor wire perstempo personnel tempo: time an individual spends away from home station. pcs permanent change of station: move from one duty station to another (relocating) peb physical evaluation board determines member’s fitness for duty, disability, or medical separation post army installation pxpost exchange army department store; air force “base exchange” (bx); “navy exchange” (nex) rank status and authority of personnel in relation to other military members rate used by navy and coast guard for sailors, means same thing as rank redeploy to move military forces from one combat zone to another, or to return to home base reserve members liable for active duty recall to augment active duty in war/national emergency rpg rocket propelled grenade: hand-held, shoulder-launched rocket r & r: rest and relaxation time off for service member approx halfway through deployment sandbox, sandpit iraq sbct stryker brigade combat team sick call time allotted to see doctor or other healthcare provider. tdy temporary duty “three hots and a cot”: service members in theater are provided three hot meals & a bed umt unit ministry team: chaplain (officer) and a chaplain assistant (enlisted soldier) usa united states army; branch of military, personnel: “soldier” usaf united states air force; branch of military, personnel: “airman” uscg united states coast guard; branch of military, personnel “sailor” usmc united states marine corps; branch of military, personnel: “marine” usn united states navy; personnel: “sailor” uxo unexploded ordinance vbedvehicle borne explosive device vbiedvehicle borne improvised explosive device veteran status served in military, discharged/released with other than a dishonorable discharge warrant officer officer who derives authority from a warrant, as opposed to a commission xo executive officer assists commanding officer (co); second in command in military unit advances in social work, spring 2012, 13(1) 82 appendix 2: military cultural competence resources and fact sheets 1) center for deployment psychology (2009) trains military and civilian behavioral health professionals to provide high quality care necessary to address deployment-related needs of military personnel and their families. http://www.deploymentpsych.org/ 2) the combat injured family: guidelines for care for providers http://www.cstsonline.org/csts_items/rfr_combat_injured_family_guidelines_care_provider_she et.pdf 3) the impact of military duty and military life on individuals and families: resources and intervention http://www.sagepub.com/booksprodtoc.nav?prodid=book232979 4) “10 things military teens want you to know” http://support.militaryfamily.org/site/docserver/toolkit_8.5x11_proof6.pdf?docid=15601&js ervsessionidr002=nro0dds6 5) understanding the experience of military families and their returning war fighters: military literature and resource review http://www.familyhomelessness.org/ 6) the combat injured family: guidelines for care http://www.cstsonline.org/csts_items/rfr_combat_injured_families_guidelines_care_patient_she et.pdf 7) caring for america’s children: military youth in time of war http://pedsinreview.aappublications.org/content/vol30/issue6/index.dtl 8) military officers association of america http://www.moaa.org/usergroup/usergroup_fam/usergroup_fam_spouse/default.htm 9) casualty assistance information: meeting the needs of military families and children http://66.92.43.14/focus/csts_casualty_assistance_information.pdf 10) operations security (opsec) guide for family and friends http://www.armymedicine.army.mil/sfrc/opsectrifold.pdf 11) “reach for diversity”: respect individual differences, cultures, customs; education of diversity adds to organization; awareness of how people are similar, different, and unique; collaboration with diverse providers build strong partnerships; and honesty be honest with others, and ourselves its normal to fear people/ideas not understood. learn to respect and appreciate differences, uniqueness. (adapted from dept of veterans affairs program) http://www1.va.gov/diversity/page.cfm?pg=7 12) civilian provider web resource for ptsd and tbi http://www.health.mil/education_and_training/civilian_provider_education.aspx 13) intransition (dcoe program) provides service members currently receiving mental health treatment with support as they transfer between health care systems or providers. www.health.mil/intransition 14) wellness resources for the military community—service members, veterans, families, and providers. www.afterdeployment.org microsoft word bean disproportionality copyedit2 _________________ kristen faye bean, m. a., msw, is a ph.d. student in the school of social work at arizona state university in phoenix. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 363-375   social workers’ role in the disproportionality of african american students in special education kristen faye bean abstract: there is an overrepresentation of african american students in special education. research on this phenomenon has primarily focused on educators within schools. school social workers are in unique positions to impact the disproportionality. patricia collins’ domains-of-power framework is used to demonstrate how school social workers can practice transformational resistance to eliminate the overrepresentation of african american students in special education. school social workers should: 1) attend iep meetings and conduct home visits and biopsychosocial evaluations with students who are being assessed for special education services, 2) offer to evaluate and conduct home visits with students whom teachers deem to be “at-risk” to prevent inappropriate assessments for special education, 3) create a school culture of acceptance of difference, and 4) ask themselves how they individually foster racial domination or emancipation in their daily actions. keywords: disproportionality, special education, domains-of-power framework, individuals with disabilities education act, african american students there is an overrepresentation of african american students in special education classrooms (artiles, kozleski, trent, osher, & ortiz, 2010; blanchett, 2006; harry & anderson, 1994; mills, 2003; skiba, poloni-staudinger, gallini, simmons, & fegginsazziz, 2006; skiba et al., 2008). african american students have been historically disadvantaged in public education and have suffered poorer outcomes in rates of school retention, employment, and poverty status than other people (chemerinksy, 2002; u.s. census bureau, 2010). although special education is designed to provide personalized support for students with disabilities, inclusion of students with disabilities in regular education settings is preferred. the preference for inclusion is due to research that demonstrates detrimental effects for students who are separated from regular education and their typical peers (brown, higgins, pierce, hong, & thomas, 2003; freeman & alkin, 2000; hanushek, kain, & rivkin, 2002; harry & anderson, 1994). for over two decades, previous research on the disproportionality of african american students in special education has primarily focused on teachers and schools as the target of intervention to decrease the disproportionality (artiles et al., 2010). a new technique to impact disproportionality is necessary. school social workers need to take advantage of their unique role in students’ lives that empowers them to impact the disproportionality. patricia collins’ domains-of-power framework will be used to demonstrate how school social workers can practice transformational resistance to eliminate the overrepresentation of african american students in special education. advances in social work, fall 2011, 12(2) 364 background of the disproportionality of african american students in special education african american students are overrepresented in special education classrooms (artiles et al., 2010; skiba et al., 2006). while african american students represent only 17% of school-age children, they represent one-third of students identified as experiencing mental retardation (skiba et al., 2008). the identification of a disability alone does not cause students to be placed in special education classrooms. the decision to place a student in a regular education, special education, or part-time resource classroom depends on the opinion of students, teachers, school principals, and students’ families. african american students in indiana who experienced an emotional disturbance, mild mental retardation, moderate mental retardation, learning, speech, or language disability were more likely to be placed in a restrictive setting, such as a special education classroom, than other students with similar disabilities (skiba et al., 2008). while statistics about the disproportionality exist, debates occur on whether or not disproportionality is a problem. scholars who argue that disproportionality is a problem report the negative impact of inappropriately placing african american students in special education. for example, a study of 222 students in special education found that they were more likely than students in regular education to experience alienation in school, felt like their education would not contribute to their future and that breaking rules in school was fine (brown et al., 2003). another study showed that students in general education performed better on measures of academic achievement and social competence than students in restrictive classrooms (freeman & alkin, 2000). longitudinal data shows that students with disabilities in special education are not improving their outcomes at the same rate as their peers in regular education (artiles et. al., 2010). those who posit that disproportionality is not a problem argue that special education is a safety net for students who are falling behind in regular education classes. for example, freeman and alkin (2000) found that children with mental retardation in general education did not attain social acceptance ratings as high as their typically developing peers. the individuals with disabilities education improvement act (idea, 2004) mandated that special education classrooms have low teacher-student ratios, individualized education, and high expenditures per pupil, which are desirable characteristics. historical disadvantage of african american students in public education while examining the exclusion of african american students in education, it is important to reflect on their history of segregation in public education. african american students in public education were legally segregated into different schools than white students prior to 1954, when the brown v. board of education declared that it was unconstitutional for state laws to establish separate public schools for white and black students (chemerinsky, 2002). a decade later, title iv of the civil rights act tied federal funds to the elimination of segregation. it mandated that students should be assigned to public schools regardless of race, color, religion, or national origin bean/disproportionality in special education 365 (chemerinksy, 2002). the integration of white and black students in the south rose to 32% in 1968 and to 91% by 1973 (chemerinsky, 2002). although the trend of desegregation showed potential, scholars have documented a resegregation that has occurred in public schools since the 1970s due to white flight to suburbs, disparities in school funding, and recent supreme court decisions (chemerinksy, 2002). historical disadvantage has impacted african americans; they lag behind in rates of school retention, employment, and poverty (u.s. census bureau, 2010). the overrepresentation of african american students in special education may represent another form of segregation that has detrimental effects on student outcomes. research focused on teachers and schools the majority of research on the overrepresentation of african american students in special education has focused on teachers and schools. the process of identifying a child with a disability and the decision of classroom placement occur primarily within the school environment. the identification of a disability is first initiated by a teacher. the teacher makes a referral to a school psychologist to assess the child (harry & anderson, 1994; skiba et al., 2008). ideally, the school psychologist objectively administers valid and reliable intelligence tests. if the tests determine that the student has a disability diagnosis, an individualized education plan (iep) meeting is scheduled with a special education teacher, regular education teacher, local educational agency representative, campus administrator, the student with a disability if he or she is at least 14 years old, and other people who are familiar with the student (individuals with disabilities education improvement act, 2004). the iep meeting is held to discuss the student’s disability status and classroom placement. the iep team decides if the student should be placed in a regular education classroom, special education classroom, and/or receives resource hours. classroom placement and hours are negotiated during the meeting (individuals with disabilities education improvement act, 2004). because of the teacher’s knowledge about the student’s progress in his or her classroom, the teacher’s opinion is given much weight during the negotiation of the student’s classroom placement (harry & anderson, 1994). school social workers’ role in the disproportionality most research has focused on how teachers can impact the disproportionality of african american students in special education, yet school social workers are not constrained within schools and are uniquely situated to understand students’ environmental factors that impact their development and use the students’ environment as a resource. teachers and school administrators are primarily limited to supporting students within schools, which can lessen their access to and understanding of students’ families and communities. social workers’ roles and responsibilities, ethical responsibility for social justice, and participation in child study teams enable them to make a difference in the disproportionality. literature that has discussed social work and disproportionality presents structural, disciplinary, cultural, and interpersonal methods in which social workers can decrease the overrepresentation of african american students in special education. advances in social work, fall 2011, 12(2) 366 the roles and responsibilities of school social workers span from micro interventions, such as direct prevention and intervention activities with students, to macro interventions, such as creating positive school climates. a study of 606 school social workers found that most reported the use of three-tiered interventions with students, including primary, secondary and tertiary interventions. primary interventions included prevention efforts, such as coordinating services for students in the community. secondary interventions were described as early identification of nonacademic barriers and targeted interventions to address the barriers. tertiary interventions include direct counseling and mental health support after a student has an identified need (bronstein, ball, mellin, wade-mdivanian, & anderson-butcher, 2011). based on their training, social workers should view students in their social environment, including school climate. school social workers have the responsibility to use their knowledge of multi-systemic and ecological perspectives to create positive school climates, resulting in caring and responsive schools (hopson & lawson, 2011). although social workers are trained in ecological and systemic influences on development, a majority of school social workers have focused on the child or micro level and report little communication with teachers (kelly, frey, & andersonbutcher, 2010). in addition to social workers’ education in the ecological perspective, social workers have an ethical responsibility for social justice. one of the ethical principles determined by the national association of social workers’ (nasw) code of ethics (national association of social workers, approved 1996, revised 1999) is that social workers challenge social injustice. the nasw code of ethics reports, “social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people” (national association of social workers, approved 1996, revised 1999). this section of the code of ethics illustrates the professional responsibility that social workers have to practice transformational resistance to the disproportionality of african american students in special education. transformational resistance includes a critique of oppression and a desire for social justice (solorzano & bernal, 2001). social workers must be aware of the oppression of african american students in special education and critique the oppressive conditions and structures that dominate african american students. the few articles that have been published about social work’s role in the disproportionality of african american students in special education have researched and discussed structural, disciplinary, cultural, and interpersonal means in which social workers can decrease the disproportionality. for example, social workers have a potentially strong voice in deciding the diagnosis and placement of students in special education due to their role in child study teams, yet structural issues limit their participation. the child study teams determine if a student is eligible and needs special education services (individuals with disabilities education improvement act, 2004). school social workers are assigned to complete a social and developmental study to ensure that specific diagnostic criteria have been met (ebersole & kapp, 2007). the social and developmental study of students includes a home visit to gain an understanding of the child’s context and environment. although it is not mandatory, school social workers may be invited to attend an iep meeting, where the child’s bean/disproportionality in special education 367 diagnosis is reviewed and classroom placement is determined. social workers may be the only member of the team to have visited the student’s home environment, met extended family members, and have knowledge of community resources that can support the student. social workers can express their understanding of the student’s home environment, which could reveal how the environment impacts the student’s developmental and educational progress. this unique knowledge has the potential to decrease the overrepresentation of african american students in special education. as joseph, slovack, and broussard (2010) reported in their conceptual article on social work’s privilege and duty to confront the segregation of students by curriculum: “if not us, then who?” (p. 17). for example, if a student’s parents are going through a divorce, the student may exhibit externalizing behaviors and be easily distracted. even though the student may appear to have a learning disability, the social worker’s knowledge of struggles in the student’s home might determine that the student needs therapeutic support, rather than special education services. although social workers have the potential to make a difference in disproportionality by conducting social and developmental studies for child study teams, research has shown that child study teams do not always follow strict criteria and social workers are not mandated members on iep teams. ebersole & kapp (2007) conducted an analysis of all students identified as mentally retarded in a large midwestern city during may 2005 to assess if the child study teams adhered to district policy in certification of students served under the category of mental retardation. the guidelines to determine a student as mentally retarded included: 1) reported iq of less than 70 and 2) at least two scores less than 70 on each of the vineland adaptive behavior scale (vabs) domains: communication, daily living skills, socialization, and motor skills, or 3) one set of the domain scores and/or the composite score on the vabs and an academic achievement score less than 70. the study found a significant difference between the rates of placement as mentally retarded using precise criteria between african american (24.1%) and white (52.3%) students (ebersole & kapp, 2007). in addition, they also found that only 16% of the child study teams that did not adhere to district policy received an evaluation of the certification from a supervisor. ebersole & kapp (2007) suggested that strict adherence standards must be followed in all child study teams. the disciplinary and cultural aspects of social workers’ role were discussed concurrently by scholars. mills (2003) expressed that culture impacts the disciplinary aspect of social work services. mills (2003) explained that social workers can help to “rule out” the impact of culture and other aspects of a student’s social environment as explanations for a student’s inability to be successful in a general education classroom. for example, a student’s cultural norms may differ from a teacher’s cultural norms, which could negatively result in the teacher’s disciplinary action of the student. social workers can help to “rule out” this cultural impact by learning about the student’s culture and communicating with the teacher about cultural differences. before students are identified as falling behind in the general education classroom, social workers should engage in preventative practices by responding to students’ behaviors (mills, 2003). the interpersonal ways in which social workers can decrease the overrepresentation of african american students in special education is to recognize our own racial bias and advances in social work, fall 2011, 12(2) 368 discriminatory acts. discussions of racism are ubiquitous in the literature about social work and disproportionality in special education. as joseph, slovak, and broussard (2010) explain, “‘race’ and ‘ability’ have a powerful hold over some in society” (p. 9). this includes social workers. in order for social workers to advocate for structural change and play a larger role in decreasing the disproportionality, they must be able to recognize their own racial bias and discriminatory acts, no matter how subtle the biases or acts may be. domains-of-power framework patricia collins created the domains-of-power framework in response to other theories that dichotomized racial inequality as caused by either institutional or personal factors. collins’ framework posits that racial inequality is caused by both institutional and personal factors. domains-of-power framework posits that racism is a system of power with four domains: structural, disciplinary, cultural, and interpersonal (collins, 2009). according to the framework, to impact the disproportionality of african american students in special education, the power within and across all four domains must be addressed. the structural domain of power demonstrates how racial practices are organized by social institutions. collins (2009) explains that “this is the structure of how racism as a system of power is set up, and how it is organized without anybody doing anything. this is the structure into which we are all born and we will leave behind when we die” (p. 53). the public school system is a structural domain of power that can manifest racist practices. one example of how the public school system manifests racial inequality is funding. school funding provided by property taxes is a structure that is set up in a way that impacts racial inequality. a school receives funding by taxes of property surrounding the school. schools in lower socioeconomic neighborhoods receive less funding than schools in higher socioeconomic neighborhoods due to the lower property taxes in the area surrounding the schools. minority students are more likely than white students to live in lower socioeconomic neighborhoods (ladson-billings, 2009). the disciplinary domain of power includes rules and regulations organized by bureaucracies, but relies on people to practice surveillance of the system. to examine this domain of power, collins (2009) suggests that we might ask the question, “how do implementation strategies reflect the racial and class composition of the classroom?” (p. 55). for example, assessments for special education are initiated by teachers, who are required by law to request evaluations of students who are unable to successfully accomplish school work at similar levels to their peers due to learning, emotional, or behavioral disabilities (individuals with disabilities education improvement act, 2004). this policy may cause teachers to request evaluations for students even if they demonstrate a minor delay of understanding class material or present behavioral issues that distract from their learning in class. parent participation is necessary during evaluations for special education services. student classroom placement is determined during iep meetings. as blanchett (2006) explains, “educators tend to see whiteness as the norm and consequently the academic skills, behavior, and social skills of african american and other students of color are constantly compared with those of their white bean/disproportionality in special education 369 peers” (p. 27). this can be intimidating and may impact the willingness of minority students’ parents to advocate for their child’s classroom placement during iep meetings (blanchett, 2006). the disciplinary domain of power implies the need for an assessment of how the implementation strategies for special education placement might be impacting the disproportionality. the cultural domain of power explores how people’s ideas justify racial inequalities. collins (2009) argues that popular media contain strong representations of the cultural domain of power. racial stereotypes are represented in songs and music videos. the majority of media represent young women of color as “hos” and young men of color as “pimps” (collins, 2009). because adolescent students spend much of their time listening to music and watching television, they are highly influenced by the stereotypes of young men and women of color represented in the media. if minority students believe in the stereotypes, they may be less likely to try to succeed in school. professionals within schools are also influenced by stereotypes of minority students portrayed in the media. the stereotypes may make people believe that the overrepresentation of minority students in special education is justified. the interpersonal domain of power is where experiences shape race relations among one-on-one encounters between individuals in everyday life. people are given the opportunity to accept or resist racial inequality in their interactions with others (collins, 2009). regular education classes are more likely to be taught by female educators who may produce the norm of whiteness (blanchett, 2006). this could have a negative impact on the understanding of the content taught among minority students and boys in the classroom. female norms, such as being clean and quiet, may impact the behavioral success of boys, who are more likely to be rambunctious and louder than their female peers. white female teachers may be more likely to request a minority, male student to receive disciplinary actions and be assessed for disabilities than other teachers (harry & anderson, 1994). conceptual assumptions the domains-of-power framework provides spheres in which social workers can practice transformational resistance of the overrepresentation of african american students in special education. in order for social workers to be able to resist the disproportionality they must be knowledgeable of diversity and disability issues, believe in an ethical responsibility to advocate for social justice, and have a role in the diagnosis and placement of students in special education. drawing on social work education and ethics and educational policy, i make three assumptions: assumption no. 1 social work education provides social workers with education on diversity and disability content. as prescribed in the council on social work education (cswe) educational policy accreditation standards (epas) social workers should learn how to engage in diversity and difference in practice. dimensions of diversity taught in social work education should include the intersectionality of age, class, color, culture, disability, advances in social work, fall 2011, 12(2) 370 ethnicity, gender, gender identity, immigration status, political ideology, race, religion, sex, and sexual orientation (council on social work education, 2008). it is assumed that social work students receive an education on diversity issues, such as culture, disability, ethnicity, and race, and continue to remember their education as they practice social work. assumption no. 2 social workers are knowledgeable of and believe in the nasw code of ethics. the cswe epas also requires that social work education include engagement in ethical decision-making using the nasw code of ethics (council on social work education, 2008). the nasw code of ethics states that social workers have an ethical responsibility to advocate for social justice (national association of social workers, approved 1996, revised 1999). it is an assumption that all schools of social work teach courses using the nasw code of ethics and social workers believe in and plan to follow the nasw code of ethics. assumption no. 3 social workers are members of the child study teams as prescribed in the idea. as demonstrated by ebersole and kapp (2007), child study teams have not always followed strict criteria established in the idea; therefore, it is an assumption that social workers are members of each child study team and conduct a social and developmental study for children. domains-of-power framework and the future role of social workers school social workers can bring about transformational resistance and eliminate overrepresentation of african american students in special education by creating change within and across the structural, disciplinary, cultural, and interpersonal power domains. structural the process of determining that a student has a disability is a structure that has manifested racial inequalities. although social workers have been on child study teams, they have not been mandated members of iep teams. the child study team decides whether or not a student fits the criteria for a disability diagnosis. the iep team decides the student’s classroom placement. the idea should mandate that school social workers are included in iep team meetings. social workers’ unique position, which enables them to visit the student’s home and community, is valuable in both child study and iep team meetings. ensuring that school social workers are on the iep teams is just the first step to change the structure of determining a disability diagnosis and classroom placement. school social workers must be required to conduct home visits and biopsychosocial evaluations prior to child study team meetings. during a biopsychosocial evaluation, social workers assess a person’s biological, psychological, and social condition. this bean/disproportionality in special education 371 would allow the social workers to learn about the student’s home life, culture, and developmental achievement and provide the iep team with more knowledge about how the student’s family and environment may impact his or her development. disciplinary school social workers should engage in preventative practices with students, teachers, and administrators in schools. as mills (2003) suggests, the impact of culture and other aspects of a student’s environment need to be “ruled out” before determining that a student has a disability. not only do social workers need to rule out environmental impacts on students’ academic achievement and provide preventative services, they need to assess the appropriateness of the disciplinary actions of teachers and administrators for students who are labeled as “at-risk”. minority students are often labeled as “at-risk”, which causes educators to participate in disciplinary practices with minority students more often than with white students (o’connor, hill, & robinson, 2009). the “at-risk” label can have detrimental effects on african american students. if educators believe all african american students are “at-risk” academically, any slight reason african american students demonstrate that they may need special education services could cause an educator to refer students to receive assessments. social workers can request that teachers refer students to the school social worker if the teacher perceives the student is struggling academically. collaborating with teachers may be new to school social workers, since a majority of them reported that they had little communication with teachers (kelly, frey, & anderson-butcher, 2010). social workers can prevent inappropriate referrals to special education services by conducting home visits with students who are labeled “at-risk” to determine if student needs are not academically based. if the student’s needs are due to non-academic reasons, such as socioeconomic, social workers may be able to provide resources to resolve the issue. cultural school social workers can impact the cultural domain of power by becoming knowledgeable about culture and creating a culture of acceptance of difference. social workers should seek out knowledge about how different cultures perceive the importance of formal education. this may occur through informal conversations with students’ families and/or community representatives. social workers can help to create a culture that prevents racial inequality through shaping ideas and ideologies. an example of a cultural idea is that minority students are “at-risk”. this idea perpetuates inequality in schools (o’connor et al., 2009). social workers should prevent placing students in categories based on race. they can also create a culture of addressing each student’s academic progress individually. social workers can advocate for using individualized, rather than categorized language. an example of a cultural ideology is the belief in the medical model, which focuses on individual diagnosis. alternatively, social workers can promote the humanistic perspective, which posits that differences are contributions to the richness of educational settings (mills, 2003). advances in social work, fall 2011, 12(2) 372 interpersonal as collins (2009) elucidates, people are given the opportunity to accept or resist racial inequality in daily interactions. this is also true for social workers in their professional practice. even though social workers are ethically responsible to advocate for social justice based on the code of ethics, they may not always conduct their work in ways that create social justice. to practice transformational resistance school social workers need to recognize how their daily action and interactions with others might reinforce the dominant culture. collins (2009) explains that we need to ask ourselves how we individually foster racial domination or emancipation in our daily actions. implications african american students have continued to be overrepresented in special education classrooms as strategies to eliminate the disproportionality have focused on teachers and schools as targets of intervention. it is critical to promote the inclusion of african american students with disabilities in classrooms with their typical peers, because the research has shown that students who are separated from regular education classrooms experience negative outcomes (brown et al., 2003; freeman & alkin, 2000; hanushek et al., 2002; harry & anderson, 1994). although few scholars have discussed it, school social workers have a unique role in students’ lives that empowers them to practice transformational resistance to the disproportionality of african american students in special education (ebersole & kapp, 2007; furr, 1993; joseph et al., 2010; mills, 2003). school social workers should participate in transformational resistance to eliminate disproportionality by creating change within and across the structural, disciplinary, cultural, and interpersonal power domains in the following methods: 1) attending iep meetings and conducting home visits and biopsychosocial evaluations with students who are being assessed for special education services, 2) offering to evaluate and conduct home visits with students whom teachers deem to be “at-risk” to prevent inappropriate assessments for special education, 3) creating a school culture of acceptance of difference, and 4) asking themselves how they individually foster racial domination or emancipation in their daily actions. this call for school social workers to change their practices also indicates that policy change is needed to empower social workers to eliminate disproportionality. because the idea only mandates social workers to be members of child study teams and not iep teams, school social workers may not be invited to iep meetings or knowledgeable of when iep meetings are being held. the idea and/or local educational agencies need to mandate school social workers to be members of iep teams and to conduct home visits and biopsychosocial evaluations. as demonstrated with previous policy changes that were intended to impact african american students in education, mandates as well as funding are needed to create change. idea and local educational agency policy changes must also be matched with funding to hire the appropriate number of school social workers needed in each district to attend student iep meetings. this would make it easier for school social workers to create change. in the meantime school social workers need to work collaboratively with teachers to change the structure of student assessments for special education. bean/disproportionality in special education 373 though there are a few conceptual articles about social workers’ role in the disproportionality of african american students in special education, this author found no empirical studies on social workers’ participation in the diagnosis or classroom placement of african american students in special education. more research is needed to learn about school social workers’ current role in special education diagnosis and placement and methods that social workers can improve their professional practices to eliminate the disproportionality. collins (2009) provides a framework 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(2010). current population survey, annual social and economic supplement. retrieved from http://www.census.gov/population/www/socdemo/race/ppl-ba10.html author note: address correspondence to: kristen faye bean, m.a., msw, arizona state university school of social work, 411 n. central avenue, suite 800, phoenix, az 85004. email: kfbean@asu.edu ______________ thomas mackrill is an assistant professor; frank ebsen is a senior reader, and helle antczak is an associate professor at the institute for social work at metropolitan university college in copenhagen, denmark . copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 67-77 developing scales for smartphone applications together: youth and municipal case worker perspectives thomas mackrill frank ebsen helle antczak abstract: this article reports the initial findings of a danish action research project aiming to develop a digital tool that young persons can use to inform their municipal case workers about their well-being. the project vision is an integrated system with a smartphone interface for youth clients and a web interface for case workers, whereby both parties can track how the young person is doing. three meetings were held between researchers, software developers, young persons, and their case workers. the young persons rejected self-monitoring on a normative scale. they rejected a scale proposed by case workers that encouraged them to focus on a positive future, favoring a scale that enabled them to focus on their well-being being low. the young persons and case workers disagreed about how data regarding change should be presented. case workers preferred a graph that highlighted risk, whereas young persons favored a graph that emphasized positive change. key words: social work, apps, innovation, scales, youth, action research. this pilot study addresses an important field – the use of outcome measures as collaborative tools in social work. in recent years there has been an increased focus on implementing routine outcome measurement into counseling practice with the aim of improving effectiveness (lambert, 2010). much of the literature on this has concerned the psychometric properties of the various scales developed and significance of using these methods for outcomes. a key finding has been that the use of routine measurement reduces drop out in routine practice (lambert, 2010). some developers of measures note that routine outcome measurement is not just a matter of measurement and that such tools also aim “to give youth a voice in the services they receive” (duncan, sparks, miller, bohanske, & claud, 2006, p. 72). the tools are seen as ways clients can communicate about their experiences of progress with their counselors. they can be viewed as part of collaboration about an intervention. securing the incorporation of the clients’ voice by means of a standardized tool may be central to why the use of such tools can reduce drop out. the steering committee of the american psychological association division 29 task force identified goal consensus and collaboration between client and counselor as a “demonstrably effective” element of the therapeutic relationship (steering committee, 2002). they based this conclusion on a review of studies of the goal consensus and collaboration (tryon & winograd, 2002) and on research into the working alliance based on bordin’s (1979, 1994) pan-theoretical concept. central elements of bordin’s concept are agreement about counseling goals and agreement about the tasks occurring during counseling, with the third and final element being the bond between the client and the counselor. as well as using routine outcome measurement to enhance outcomes, other brief collaborative tools have been developed. the most widely researched of these is the session rating scale (duncan et al., 2006), a four item measure based on bordin’s mackrill et al./developing scales for apps 68 (1979) concept of the working alliance. the session rating scale is generally used alongside a brief outcome measure called the outcome rating scale (miller, duncan, brown, sparks, & claud, 2003). another noteworthy collaborative tool is the therapy personalisation form (bowen & cooper, 2012), where the client, prior to counseling, reports how they would like their counseling in relation to a wide range of parameters. when self-report scales are used alongside interventions, they are not mere research or evaluation tools; they are an intrinsic part of an intervention (mackrill, 2008, 2011). there are very few studies of clients’ experiences of using routine outcome measurement. anker, sparks, duncan, owen, and stapnes (2011) asked a group of clients (n=377) to rate their experience of using the outcome and session rating scales as either “disturbing,” “not important,” “useful/helpful,” or “do not remember.” of these clients, 60.7% reported the scales were “useful/helpful,” 30% noted “not important” and 6.6% experienced the scales as “disturbing.” in a similar quantitative study of 300 clients using the core tracking system (barkham et al., 2010), 47% were “quite happy,” 45% “didn’t mind,” 3% were “not keen” and 0.8% “disliked it” (unsworth, 2009). in a qualitative study of family therapy, sundet (2011) noted that families generally found the outcome rating scale a feasible tool for conversation that gave a good image of how different family members were doing and offered an opening for conversations about progress. sundet (2011) also noted that one family rejected the use of the scale as they would rather give feedback verbally and some clients found the subscales on the outcome rating scale too broad and found it difficult to point to where they were on the scales. in a further qualitative study of individual psychotherapy with six clients where the outcome and session rating scales were used, pedersen (2012) found differences among clients, noting: some clients experienced the outcome rating scale (ors) as a great therapeutic tool to think through their situation and decide what to focus on. they liked how the ors structured the opening of the session and saw the ors as a good way to quickly give the therapist a lot of information about their condition and situation. other clients scored the ors without attaching much meaning to it, but some clients experienced the ors as distracting. it undermined the presence and removed focus from more important issues. (p. 25) pedersen (2012) also noted that clients found expressing a variety of experiences on the subscales of the outcome rating scale difficult, and that while many found tracking their progress using a scale across sessions meaningful, some did not feel this approach to evaluation was meaningful and in line with their therapeutic goals. in a qualitative study using brief core outcome measures, unsworth (2009) found that clients generally felt that a visual representation of their condition and progress was helpful and they were positive about using the scales in dialogues with their counselors, although some clients found it hard to complete measures if they were distressed. the above studies all focus on client experiences of outcome measurement in routine counseling practice. to our knowledge, no studies have been conducted of young persons’ experiences of routine self-report tools in the context of collaborative tool development. furthermore, the above studies all focus on the use of outcome measurement in clinical settings. the context of the present pilot study is the advances in social work, spring 2015, 16(1) 69 development of a routine outcome measure for use in municipal case management settings, which is also new territory. this article reports differences in young person and case worker perspectives on the design of a single item self-report well-being scale for communication purposes. the data are from the first cycle of a danish action research project aiming to improve communication between young people and their municipal case workers from social services. the action research project is a collaboration between researchers, software developers, and young persons and their municipal case workers. it aims to develop a digital communicative tool that young persons can use to inform their case workers about their well-being as well as about specific, agreedupon behaviors and activities. the project vision is an integrated system with a smartphone interface for young persons and a web interface for case workers. the project is inspired by psychotherapy research into practice-based evidence where a range of similar systems have been built for use in psychotherapy (see for example barkham et al., 2010; lambert, 2010; miller et al., 2003). the project is also inspired by a local copenhagen project, “minvej,” where a recovery-supporting smartphone application has been developed not just for, but with psychiatry users. the challenge in this action research project is to develop a system that serves both the interests of young social service users and their caseworkers. as well as providing caseworkers with feedback about their young clients’ life, the app interface also aims to offer the young person the opportunity of tracking their own change for personal development purposes. developers of self-report scales are generally interested in whether scales are reliable, that is to say consistent in their ability to measure, and valid, referring to whether they measure what they intend to measure. instead, this pilot study focuses on whether young persons who use a tool find it meaningful and appropriate. this issue is particularly important if a self-report scale is to be used routinely by a young person, not in the immediate vicinity of a professional prompting them to self-report. this is a key way in which the tool developed in this project differs from those used in routine outcome measurement in clinical settings. in this project, action researchers, software developers, caseworkers, and young persons were a participatory community of inquiry engaging in the practical problem of developing a tool to enhance communication (reason & bradbury-huang, 2008). rather than addressing client and professional experiences of using an outcome measure, this study addresses client and professional participation in developing an outcome measure. method six caseworkers, who were all qualified social workers with bachelor degrees in social work, were recruited from three municipalities in denmark, with two social workers from each municipality, five women and one man. all the social workers worked with youth clients in a family or youth social service setting. the social workers recruited six young persons whom they had contact with to participate in the project: three young women aged 14, 16, 17 and three young men aged 16, 17, and 18. the young persons were recruited primarily because their social workers judged they had the resources and willingness to participate. they were not recruited because they had a particular type of problem. the researcher leading the project had a background in counseling research. mackrill et al./developing scales for apps 70 three group meetings were held where the participants discussed a design presented to them as a microsoft powerpoint© presentation. the counseling researcher led the first two meetings, and a second researcher took detailed field notes where the perspectives of the participants, the topics of discussion, the atmosphere in the meeting, and the decisions made were noted. the final meeting was led by the software developers. the young persons were asked to give their opinions about the design but also to consider what other young people, who they knew, might think about the design. the social workers were similarly asked to consider what their colleagues might think about the design, as well as themselves. after each meeting, the design was revised based on the input from participants, and a new version was presented at the following meeting. the meetings were divided into two stages. first, social workers provided feedback on the design without the young persons being present. then, the young persons provided feedback on the design with half of the social worker group present. the social workers were instructed to be silent when the young persons gave their feedback so the young persons could voice their opinions without interference. towards the end of the meetings, there was dialogue between the social workers and young persons. the meetings were generally lively, and all participants voiced their views about the designs. the counseling researcher facilitated the process so all voices were heard. there was a general sense of excitement about having the opportunity of developing the system. the young persons were offered food and drink during the meetings, and they were given cinema vouchers for two, including a drink and popcorn, as a gift for participating in the project. the findings presented in this paper were fed back to the participants during later meetings to check their validity (reason & rowan, 1981), and the participants confirmed that we had understood their perspectives correctly. the analysis thus was conducted by reflecting on discrepancies between youth and social worker perspectives, by examining the contents of the field notes after the meetings, and by playing perceived differences in perspectives back to the participants in subsequent meetings to develop, confirm, or challenge the analyses. in denmark, there are no ethics committees that approve social science research such as this. there are only ethics committees in the field of medicine. young persons participated voluntarily, and parental consent was obtained for young persons under the age of eighteen. some young persons who were asked to participate declined without this affecting their access to social support in any way. all data were secured according to the regulations of the danish data protection agency. the identities of the social workers and young persons are concealed. results the young clients rejected the normative scale figure 1 shows the initial draft version of the well-being scale. color-coding with red, orange, and green sections was proposed to enhance the intuitive communicative aspect of tool, drawing on the image of a traffic light where red signals stop, orange signals that a stop may be imminent, and green signals go. the counseling researcher proposed that the green section should take up most of the scale, arguing that a satisfactory overall experience of well-being during the week, which is neither “good” nor “bad,” should be in the middle of the scale. the counseling researcher argued that this was important to avoid giving the young persons an unrealistic advances in social work, spring 2015, 16(1) 71 expectation about how good a week could be expected to be. according to the counseling researcher, a week with well-being in the middle of the scale was a sign of success. the young people all rejected this view. they said, “we know we can’t expect to have a fantastic time all the time,” “we know our lives aren’t as good as other people’s lives,” and “we don’t need to be reminded about it by a scale.” they wanted a scale where they had a chance of progressing from one side of the scale to the other, rather than a normative scale where they might just make it to the middle. figure 1. well-being first version. figure 2. well-being – case worker version. figure 3. well-being young person version. the young clients rejected a strengths focus the social worker group also disagreed with the initial design, but for different reasons. in their view, the green section had the right length, but they argued that it should be on the left side of the scale rather than on the right. see figure 2. they were unanimous in this view. they argued that they had been trained in focusing on client strengths. when the red section was on the left, this was what first caught their eye, as they read from left to right. they wanted their clients first to focus on the green section as a way of drawing their clients’ attention to the potential for improved weekly well-being, that there was hope for a better future, and that they could have better life. the young clients rejected the social workers’ design unanimously, stating that their well-being was generally dissatisfactory, and that a design that intuitively made them focus on how good a week could be was provocative and demotivating, as such a life was such a long way off. they wanted their social workers to appreciate how difficult their lives were. in collaboration with the young persons, we developed the scale that can be seen in figure 3. mackrill et al./developing scales for apps 72 a positive change versus a risk reduction focus the social worker group and the young person group also disagreed about how past data should be viewed. while they agreed that a graph might be an appropriate way of viewing changes in well-being over time, they disagreed fundamentally about how data should be presented. the social workers favored the red zone being up and the green zone being down on the y axis. figure 4 shows this, with a positive change as a curve sloping down from left to right. the social workers preferred this view as they felt it represented a change in the level of risk. for them, “low” well-being was a “high” risk, and it should therefore be positioned at the top of the viewing. a “high” level of well-being was a “low” risk that should be positioned at the bottom of the graph. this was intuitively most correct from their perspective. this was the opposite of the initial draft. the social workers' version of the graph with red at the top and green at the bottom was then presented to the young persons who unanimously dismissed this graph. they wanted the red section representing “low” well-being to be at the bottom of the y axis. they wanted to be able to record “positive change,” which for them intuitively meant movement in an “upwards” direction from left to right. see figure 5. the young people focused on increases in well-being, while the social workers focused on reducing risk. figure 4. well-being graph – case worker version. advances in social work, spring 2015, 16(1) 73 figure 5. well-being graph young person version. discussion the young person and social worker groups were surprisingly unanimous in their viewpoints. at a glance, this may seem to suggest that the results presented were the result of groupthink (janis, 1982). however, this is not the case as both the young persons and social workers voiced a range of views at the meetings, and there were frank exchanges of views in each group. the counseling researcher made sure there was space to reflect on one’s own perspective during meetings, and participants also had the opportunity to reflect on their views between meetings. the counseling researcher supported and repeated the many different perspectives that were expressed, so they could be discussed. it was only after a discussion of the many viewpoints that the groups reached a consensus. the counseling researcher was not aiming for consensus in any way and questioned the unanimity in the groups’ perspectives. the counseling researcher was actually surprised by the extent of the participants’ agreement, particularly as the groups were not characterized by dominant members imposing their views on others. the young clients had very clear opinions about how the self-report scale should be designed. thus, this study highlights the importance of user involvement in scale development. this is particularly important when dealing with a vulnerable group whose perspectives are often ignored. when using self-report scales for routine assessment, it is important to follow advice about using an established instrument rather than one with less scientific credibility (paulhus & vazire, 2007), but at the same time it is also important to check whether users have been involved in scale mackrill et al./developing scales for apps 74 development or whether their experiences of using the scale routinely have been studied. there may be a difference between asking clients about their experiences of using a scale after a scale has been developed and asking them their experiences during the development of a scale, when they know their views will be taken into consideration in the development of the scale. the young person’s rejection of the normative scale is significant. when using scales in routine self-assessment with vulnerable groups, the young person needs to be able to see their own personal development in relation to the scale as a whole. using norm-based scales for groups who have trouble living up to the norms inherent in the scales is a poor choice, as the group will consistently be reminded of their failure to live up to the norms. the difference between the social workers’ wish to have a scale that drew attention to the young persons’ strengths and possibilities of attaining a positive future and the young persons' wish to have a scale that reflected that their lives were difficult was a surprise to the social workers. the social workers argued that this was a perspective they had been trained in. the key assumption in a strengths perspective is that “every human being has, within or around, resources, capacities, and assets that can be mobilized to overcome adversity or to inspire a better quality of life” (saleebey, 2008). most of the social workers who took part in the study were trained in this perspective at the institute where the researchers were employed. thus this finding reflected back on the educational practices of the researchers’ place of work. the strengths perspective is a reaction to social work that was overly focused on client problems rather than client resources. striking a balance between recognizing client problems and maintaining hope for a more positive future is a constant challenge in social work. this study showed that the social workers’ strengths perspective was out of synch with their clients’ perspectives. a discrepancy in perspectives, where social workers maintain hope for clients who have little or no hope for themselves, is an intrinsic part of social work. however, if social workers are so hopeful that clients do not feel their social workers appreciate or understand the problems they face, the strengths perspective becomes a hindrance and a problem in itself. a strengths perspective can perhaps get out of hand if not appropriately combined with a problem focus. the discrepancy between the young clients’ focus on positive changes in wellbeing and the social workers’ focus on risk reduction is not surprising. risk reduction is a primary goal for municipal case workers, which reflects the legal foundation on child protection that underlies their work. the young persons do not reflect on the law in the same way as the social workers but have a more general interest in change for the better. in their book, metaphors we live by, lakoff and johnson (1980) argue that metaphors shape our perceptions. one metaphor they point to is the metaphor of direction, suggesting that we generally perceive “good” and “more” as “up,” and “bad” and “less” as “down.” in some ways, this corresponds with the findings presented in this study. on the graph, the young persons intuitively want “more” well-being to be “up,” and the social workers similarly want “more” risk to be “up.” however, high risk is not “good,” and the social workers agreed that high risk should be “up.” this suggests that “more” may take precedence over “good” when intuitively determining what is “up.” advances in social work, spring 2015, 16(1) 75 we used the above analysis in the further development of the tool. we changed the well-being scale so it was in line with young persons’ wishes as seen in figure 3. we also developed the graph in accordance with the young persons’ wishes as seen in figure 5. we discussed the possibility of having a positive change focused graph (figure 5) on the young person’s smartphone interface and a risk-oriented graph (figure 4) on the case workers’ web interface. we choose to have a positive change focus (figure 5) on both interfaces, as we wanted the social workers and young persons to have the same view, so the web interface could be easily used for talks about how things were going at meetings between the young persons and their case workers, without having to explain why the graphs looked different. this pilot study is obviously limited by its small sample size and the fact that participants were all willing participants. some young people in contact with municipal social services would not want to participate in such a project, and we cannot be sure that participants who are willing to participate can represent the perspectives of the unwilling, even though the young persons were asked to consider what other young people, who they knew, would think. this pilot study is a first step in tool development. we plan to run a test-retest of the single item scale and test it against other scales such as the outcome rating scale (miller et al., 2003) and the young person core (twigg et al., 2009). this would enable the scale to be used both for monitoring change and for collaboration. further studies of youth and social worker perspectives will take place in connection with testing a trial version of the scale in the second cycle of this action research project. references anker, m., sparks, j., duncan, b., owens, j., & stapnes, a. (2011). footprints of couple therapy: client reflections at follow up using a mixed method design in routine care. journal of family psychotherapy, 22, 22-45. barkham, m., mellor-clark, j., connell, j., evans, c., evans, r., & margison, f. t. (2010). clinical outcomes in routine evaluation (core) – the core measures and system: measuring, monitoring and managing quality evaluation in psychological therapies. in m. barkham, g. e. hardy, & j. mellor-clark (eds.), developing and delivering practice-based evidence: a guide for the psychological therapies (pp. 175-220). chichester, england: wiley. bordin, e. s. (1979). the generalizability of the psychoanalytic concept of the working alliance. psychotherapy: theory, research and practice, 16, 252-260. bordin, e. s. (1994). theory and research on the therapeutic working alliance: new directions. in a. o. horvath & l. s. greenberg (eds.), the working alliance (pp. 13-37). new york: john wiley. bowen, m., & cooper, m. 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(2011). collaboration: family and therapist perspectives of helpful therapy. journal of marital and family therapy, 37, 236-249. tryon, g. s., & winograd, g. (2002). goal consensus and collaboration. in j. c. norcross (ed.), psychotherapy relationships that work: therapist contributions and responsiveness to patients (pp. 109-125). oxford, uk: oxford university press. advances in social work, spring 2015, 16(1) 77 twigg, e., barkham, m., bweick, b. e., mulhern, b., connell, j., & cooper, m. (2009). the young person’s core: development of a brief outcome measure for young people. counselling and psychotherapy research, 9, 160-168. unsworth, g. (2009). therapists’ and clients’ perceptions of using core-net and arm-5 in the nhs (doctoral thesis, faculty of health and medical sciences, division of health and social care, university of surry, uk). available from http://ethos.bl.uk/orderdetails.do?uin=uk.bl.ethos.510359 author note correspondence concerning this article should be addressed to thomas mackrill, metropolitan university college, institute for social work, kronprinsesse sofies vej 35, 2000 frederiksberg, denmark. thma@phmetropol.dk. ph. +45 72489341 _____________ andrew quinn, phd, lcsw is an associate professor, department of social work, university of north dakota, grand forks, nd 58202 copyright © 2016 advances in social work vol. 17 no. 1 (spring 2016), i-iv, doi: 10.18060/21092 special issue editorial andrew quinn social work professors have been reviewing the fit of technology in education since the 1950s when audiovisual materials were used for training (shorkey & uebel, 2014). throughout the early to late 1980s, the social work field began to see a push to use internet technology in the classroom. this led to a gathering of social work educators (the 1998 information technologies for social work education and practice group, hosted by the college of social work at the university of south carolina) interested in using technology for educational purposes. such gatherings led to an increase in publications debating what courses we should teach, how we should teach them, and how to best use technology to our advantage to reach our students. now almost 20 years after the first gathering of social work educators for the sole purpose of discussing technology, we are entering our second iteration of the conference (now hosted by indiana university and the council on social work education [cswe], beginning in 2015) and another opportunity for social work professors to gather and discuss the role of technology in social work education. technology has changed since the first south carolina technology conference. compared to the use of interactive television discussed at the conference by the likes of petracchi and patchner (2000, 2001) and haga and heitkamp (2000), where a student had to drive to a location to receive real-time education through a television screen, we can now deliver from anywhere to anyone in the world in the convenience of the students’ home or workplace (or our home or workplace) using synchronous technologies like adobe connect professional (quinn, regan, & schoech, 2008) or asynchronous approaches such as virtual role plays delivered through a course management system (levine, 2013). the ever-changing face of technology has allowed us to become creative in our delivery methods and really offer our content to those at a distance, those who are place bound, or those who do not have reasonable access to a campus for classroom instruction. in fact, according to the cswe's most current information, over 40 programs offer distance education (cswe, n.d.). however, regardless of the type of technology used in the delivery, the debate remains: a) what courses can we teach using technology (including practice and field, b) what are the best practices in teaching our courses, c) what are the technology competencies that we should teach our students, and d) how can we best use technology to reach a broader population of students? this special edition of advances in social work includes articles based on presentations at the 2015 social work distance education conference hosted by indiana university and cswe and offers some insight to the debate. articles in this edition this special issue contains seven articles that emerged from presentations made during the conference. one of the challenges in offering distance education is engagement. two of the articles in this edition focus on engagement, whether it was direct engagement of the student or engagement of faculty who teach in the distance program. first, rapp-mccall quinn/special issue editorial ii and anyikwa focus on which active learning strategies are best used to engage students in an online research methods course and to reduce anxiety while increasing student perceptions of knowledge. these strategies include contact with the professor, synchronous class sessions, and synchronous activities such as games and discussions. second, schwartz shares outcomes of interviews with several faculty and adjuncts about their experiences teaching for a large program on the west coast. her qualitative analysis demonstrated that the respondents appreciated the diversity that distance education offerings bring, although there were some challenges related to community-building among faculty, especially those far from campus and those who only taught part-time, and there were also some challenges building community between students and faculty. for example, not having the ability for informal discussions that typically occur in campus offices and hallways was seen as a hindrance to engagement. however, when synchronous technologies were used along with email communication, schwartz reports that some faculty felt like their distance teaching experience was no different than the on-campus experience. this comparison, distance versus campus, was also the focus of several articles in this special edition. cotton, faul, and yankeelov examined differences between distance students and campus students related to demographics and performance variables (cumulative gpa, critical thinking scores, and cswe educational policy and accreditation [epas] competency scores). while they ultimately found subtle differences between campus and distance demographics, there were no significant differences between the two in terms of performance variables. brown and park compared students’ practice evaluation knowledge and their research self-efficacy, both within and between a campus class and a distance online class. like cotton and colleagues, brown and park found no differences between the two types of offerings. next, forgey and ortega-williams examined the much debated question of “can practice be taught online?” the authors compared a face-to-face and an online generalist practice course on several outcome measures, including but not limited to learning outcomes, student perception of how learning objectives were met, the quality of the learning environment, and teaching strategies. for the most part, no significant differences were seen between the face-to-face and the online sections. these aforementioned demonstrations of no significant differences between face-to-face and distance education offerings adds support to the existing suggestions that we can move our educational practices online without affecting learning outcomes. this, in turn, creates opportunities to move away from the comparison and focus on the types of courses, the pedagogical approaches best suited for distance education, and best practices for the types of technology that can be used in distance education. while an actual comparison between face-to-face and distance classes was not undertaken, fitch, canada, cary, and freese offered their thoughts on using technology to conduct online role plays that according to the authors demonstrated there was “no distinguishable time and effort demands associated with the online video conferencing compared to classroom role plays.” the final paper in this special edition comes from sage and sage, who describe the results of a survey that asked child welfare workers about the use of social media. while their particular research was not necessarily rooted in a distance education classroom, social media is becoming a presence in education and in the advances in social work, spring 2016, 17(1) iii profession. in fact, sage and sage demonstrated the need for training on proper use of social media in social work. they noticed that very few of their participants received any lengthy training (greater than an hour) in their respective social work programs. their findings raise questions regarding the proper training on technology competency since technology has become such a substantial part of social work practice. this special edition concludes with a reflection piece written by jo ann coe regan, a mentor, co-author, and the vice president of education at cswe. dr. regan was involved in the south carolina conference and is now heavily involved in the indiana conference. her piece, which was commissioned for this special edition, reflects back on the early years of technology adoption in social work and offers tribute to dean frank raymond, an innovator and educator, who desired to bring the technology conversation to the forefront. she reminds us that we need educators like dean raymond who are willing to engage in conversation about best practices related to technology and social work education. dr. regan, in concluding her reflections, also reminds us that conferences and special editions (such as this one) are absolutely necessary to keep the conversation about the use of technology in social work education alive. conclusion the landscape of social work education is changing, and distance conferences such as the social work distance education conference hosted by indiana university and cswe allow for conversations to occur. we as social work educators need to continue to research best practices in distance education, so that we can learn which approaches are most efficient to implement and the most effective for instructing distance learning students. in doing so, we need to move beyond comparing classroom to online, asking questions about whether practice can occur online, and move toward some of the upcoming challenges such as virtual field placements. as a social work educator who is invested in the use of technology in education, i encourage us to continue the debate about best practices as it relates to distance education in social work. we hope to see you april 14-17, 2017 in san antonio for the 3rd annual social work distance education conference. andrew quinn, phd march 2016 references council on social work education. (n.d.). council on social work education (cswe)online and distance education.retrieved from http://cswe.org/accreditation/information/onlineanddistanceeducation.aspx haga, m., & heitkamp, t. (2000). bringing social work education to the prairie. journal of social work education, 36(2), 309-324. levine, j. (2013). teaching groupwork at a distance using an asynchronous online roleplay. groupwork 23(1), 56-72. doi: http://dx.doi.org/10.1921/1601230104 http://cswe.org/accreditation/information/onlineanddistanceeducation.aspx http://dx.doi.org/10.1921/1601230104 quinn/special issue editorial iv petracchi, h. e., & patchner, m. e. (2000). social work students and their learning environment: a comparison of interactive television, face-to-face instruction, and the traditional classroom. journal of social work education, 36(2), 335-346. petracchi, h. e., & patchner, m. e. (2001). a comparison of live instruction and interactive televised teaching: a 2-year assessment of teaching an msw research methods course. research on social work practice, 11(1), 108-117. doi: http://dx.doi.org/10.1177/104973150101100107 quinn, a., regan, j., & schoech, d. (2008). online synchronous audio and video environments for education, training, and human service delivery: a review of adobe connect professional, elluminate, and flash meeting. journal of technology in human service, 28(1), 89-104. doi: http://dx.doi.org/10.1300/j017v26n01_07 shorkey, c. t., & uebel, m. (2014). history and development of instructional technology and media in social work education. journal of social work education, 50(2), 247261. http://dx.doi.org/10.1177/104973150101100107 http://dx.doi.org/10.1300/j017v26n01_07   00_quinn_21092_editorial ad for swde 2016 program _______________________________________________________________________________________________ carrie w. rishel, msw, phd is professor and helen p. hartnett is associate professor, school of social work, west virginia university, morgantown, wv 26506. brandi l. davis, msw is the child & family services supervisor at the children's home society, morgantown, wv 26501. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 151-165, doi:10.18060/18765 preparing msw students to provide integrated behavioral health services in rural communities: the importance of relationships in knowledgebuilding and practice carrie w. rishel helen p. hartnett brandi l. davis abstract: the provision of behavioral health care services is dramatically changing. specific components of the affordable care act (aca) encourage states to develop integrated models of service delivery that emphasize preventative services. this shift prompts the need for providers who understand the interrelationship among physical and behavioral health and who are prepared to practice in an interprofessional and teambased approach. this article presents preliminary evaluation results from the initial implementation of the integrated mental and behavioral health training program (imbtp) within an msw program which emphasizes rural practice. the imbtp is funded through federal grants aimed at increasing the number of behavioral health providers nationwide. results suggest that an intentional focus on relationships enhances the knowledge-building and skill development that are inherently emphasized in most training programs. including opportunities for relationship-building both among trainees and with program faculty, clinical supervisors, and interprofessional colleagues may improve learning outcomes in behavioral health training programs. keywords: behavioral health services; behavioral health training; integrated health; workforce development; rural practice; social work education behavioral health services are becoming more widely accepted as an integral component of overall health and well-being. estimates indicate that approximately 20% of adults and children meet criteria for at least one behavioral health disorder (substance abuse and mental health services administration [samhsa], 2013), and nearly 50% of the population will develop at least one behavioral health disorder in their lifetime (kessler, chiu, demler, & walters, 2005). behavioral health problems contribute to substantial losses in productivity and are associated with many other costly chronic diseases (kessler et al., 2008). the national institute of mental health (nimh, 2002) estimates over $300 billion in total annual costs associated with behavioral health problems. exacerbating this crisis is the national shortage of providers of behavioral health services, with estimates suggesting over 90 million people live in areas designated mental health professional shortage areas (health resources and services administration [hrsa], 2012). access to behavioral health services is even more limited in rural communities where qualified behavioral health providers are scarce (rishel, morris, colyer, & gurley-calvez, 2014). recent work addressing the behavioral health workforce indicates that the vast majority of behavioral health professional shortage areas are rural, with 80-90% of behavioral health providers located in urban areas (mackie, 2015). moreover, several rishel et al./ preparing students to provide 152 studies illustrate the unique challenges of recruiting and retaining rural behavioral health providers, noting limited access to resources and supervision, geographic isolation, and fewer social and professional opportunities (mackie, 2012; mackie & simpson, 2007). efforts to address the national workforce shortage of behavioral health providers will need to specifically address these challenges in order to increase access to behavioral health services for rural populations. predictors shown to improve hiring and retention of rural providers include: that the providers grew up in a rural area, the providers' education focused on rural concepts, and that the providers completed their internship(s) in a rural location (mackie, 2015). the provision of behavioral health care services is dramatically changing. historically, mental health and substance abuse treatment have been isolated from physical health care and considered a separate sector of service. implementation of the patient protection and affordable care act (aca), however, is leading to wide-scale changes in the delivery of health care services in the united states. the expansion of medicaid and development of health insurance exchanges have led to millions more americans accessing health insurance (congressional budget office, 2012). the aca mandates that essential benefits packages include coverage for “mental health and substance use disorder services, including behavioral health treatment” (the patient protection and affordable care act, sec 1302 (b)(1)(e), 2010). new healthcare policy promotes a shift from fragmented health care delivery towards coordinated and integrated care. specific provisions of the aca encourage states to develop integrated models of physical and behavioral health service delivery that emphasize preventative services (cogan 2011; koh & sebelius, 2010; wotring & stroul, 2011). implementation of these policy changes has led to widespread efforts to integrate behavioral health services in primary care settings, resulting in a pressing need for more well-trained behavioral health providers (horevitz & manoleas, 2013; mechanic, 2012). the shift in service delivery prompts the need for providers in primary care, specialty treatment clinics, and behavioral health service systems who understand the interrelationship among mental health, substance use, and physical healthcare and who are prepared to address these needs through an integrated approach (rishel, 2015). as part of efforts to address the national shortage of behavioral health providers, the hrsa of the u.s. department of health and human services awarded mental and behavioral health education and training (mbhet) grants to 24 programs in 2012. these 24 grants were awarded to 11 social work programs and 13 psychology programs. west virginia university (wvu) received a mbhet grant to prepare graduate students in master of social work (msw) and doctoral psychology programs to pursue mental and behavioral health care roles with high need and high demand populations, including rural, vulnerable, or underserved populations. the training grant funded the development and implementation of the integrated mental and behavioral health training program (imbtp) within the msw program at wvu. integrated models of service delivery are emphasized throughout imbtp training, with interprofessional collaboration as a key component. advances in social work, fall 2016, 17(2) 153 the first cohort of this training program at wvu completed their msw degree and imbtp requirements in the spring of 2014. a comprehensive plan was established to evaluate all aspects of the training program. due to the innovative nature of the program, one key question of interest was how training program components contributed to the overall learning experience and outcomes of the program trainees. to answer this question, qualitative data were collected from the first graduating cohort of students regarding their experiences throughout the training program. the purpose of this study was to identify what elements of an advanced training program in mental and behavioral health are most critical in achieving positive learning outcomes for participants. as current training programs expand and new ones develop, information on specific elements of training models that contribute to successful outcomes is critically needed. overview of the training program the integrated mental and behavioral health training program (imbtp) was developed with the explicit purpose of preparing students to provide high quality mental and behavioral health services with a particular emphasis on integrated models of service delivery. in the newly evolving era of health care, integrated models of practice offer the most promise in terms of effectively and efficiently meeting clients’ mental and behavioral health needs. this is especially true in rural communities where financial and personnel resources may be limited and effective methods of integrating care across service sectors are necessary. while there are many possibilities for integrating services, the five emphasized in the imbtp include the integration of: a) mental and behavioral health services with primary care, b) treatment and prevention services, c) child and parent services, d) mental health and substance abuse treatment, and e) school and community services (rishel & hartnett, 2015). content specifically addressing rural practice is addressed throughout all aspects of the training program. the training program consists of four core elements: a) specialized field placements in mental and behavioral health settings working with rural populations; b) advanced course work in specific areas of mental and behavioral health practice; c) required training workshops targeting mental and behavioral practice knowledge and skill development; and d) continual efforts in mentorship, leadership development, professional networking opportunities, and employment placement support. each of these components is intended to help establish relationships that support competency development. stipend support is awarded to support trainee field placement/internship experiences via federal grant funding. one of the criteria for imbtp field placements is the availability of strong mentorship by field instructors who have built connections with others in the local service delivery system. the field instructors are established professionals in their field, with the ability to promote trainee leadership development and foster the development of professional relationships with other leaders in the local service delivery system. an additional criterion for imbtp field placements is the opportunity for interprofessional collaboration and teamwork. a complete description of the training program is provided in rishel and hartnett (2015). the program emphasizes interprofessional relationships as an important part of mental and behavioral health practice. in addition, the ability to work across disciplines and in teams is paramount to successful outcomes for clients. rishel et al./ preparing students to provide 154 the role of relationships in professional practice research consistently demonstrates that who the therapist is, along with the quality of the therapeutic relationship developed with the client, impacts change outcomes far more than the model or technique applied (duncan & miller, 2008). factors associated with the therapeutic relationship are estimated to account for 30% of the change achieved in the therapeutic process (hubble, duncan, & miller, 1999). the relationship (or alliance) formed by the client and therapist is defined as an agreement between the client and therapist on goals, treatment methods, and the bond between client and therapist. although it is typically a goal of the therapist to develop a strong therapeutic relationship, the effectiveness of the relationship is primarily based on the perception of the client rather than the perception of the therapist (horvath & symonds, 1991; shaw & murray, 2014). this article builds on existing literature demonstrating the importance of the therapeutic relationship in clinical outcomes by examining other types of relationships in social work practice. previous work suggests that what we know about the therapeutic relationship may translate to other types of relationships as well. for example, the importance of a strong relationship has been shown to be a critical component of effective clinical supervision. early work suggests that the quality of the supervisory relationship is the most critical component of fostering positive trainee outcomes and professional development (bordin, 1983). a more recent study reinforces early findings noting that effective clinical supervision provides a “secure and reliable base from which the trainees can explore and develop their professional identities, skills, and competencies” (dickson, moberly, marshall, & reilly, 2010, p. 329). additional research suggests that one of the key issues to address in clinical supervision is trainee role transition to advanced practice. recommendations for supervisors include fostering a systemic perspective in order to assist trainees to consider the broader systemic factors that impact their roles and responsibilities in advanced practice (sharrock, javen, & mcdonald, 2013). the growing movement of interprofessional education (ipe) also emphasizes the importance of relationships in preparing professionals for practice. preparing behavioral health social workers for interprofessional team-based practice is an emerging goal in social work education (pecukonis et al., 2013). for example, the council on social work education (cswe) and the national association of social workers (nasw) foundation) recently implemented the social work heals (social work healthcare education and leadership scholars) project. the goal of social work heals is to prepare health care social workers to lead efforts to address system-level changes in the new era of healthcare (cswe, 2015). previous research illustrates that relationships with members of other disciplines is a key component in the development of interdisciplinary practice skills among social work students (supiano & berry, 2013). moreover, students report that training experiences that provide the opportunity to work with those from other disciplines increase their comfort level related to interprofessional practice (pecukonis et al., 2013). literature addressing the therapeutic alliance, the clinical supervisory alliance, and interprofessional education all demonstrates that relationships play a key role in successful outcomes. educational programs that prepare students for practice in mental and behavioral advances in social work, fall 2016, 17(2) 155 health settings should consider the importance of relationships in learning and professional practice when developing effective training strategies. this may be particularly important when preparing professionals for rural behavioral health services, as strong communitybased relationships are essential to rural practice (daley, 2010). fostering opportunities for relationship-building and strengthening may be an important aspect of effective training programs that is underdeveloped. method the evaluation plan included both quantitative and qualitative components. the exploratory, qualitative portion of the evaluation is presented in this article. the intent was to allow the five trainees the opportunity to describe key aspects of the training in their own words. the qualitative component aimed to describe trainees’ perceptions of: a) the level of knowledge and skill gained, and b) how training program elements contributed to knowledge and skill development. data were collected just prior to students’ graduation and completion of the program. the first step consisted of a free-write. to begin the freewrite, trainees were given the initial prompt, “how has the training influenced your knowledge of integrated practice?” trainees were asked to write their responses within a 10-minute time frame. once the time had elapsed, the second prompt “how will you take this knowledge into practice?” was read and trainees were given another 10-minute time frame. once completed, the papers were collected and redistributed in the group. this allowed the trainees to read the responses of their fellow participants and reflect on the similarities and differences with their own responses. the next step was a guided discussion about not only the free-write process but also about the trainee experience. this discussion lasted approximately one hour. during this discussion notes were taken for later analysis. all written responses and notes from the guided discussion were examined by two reviewers to identify themes or commonalities in experience using constant comparison. themes were then member-checked with the group of trainees to ensure accuracy and obtain feedback. the themes that emerged from the freewrite and guided discussion are presented in the results section that follows (kapp & anderson, 2010). the final step was to examine the content of field assignments in order to further refine one of the themes identified. trainees were asked in quarterly field assignments (a total of four over the academic year) to address how the training program impacted their learning in coursework and field and their preparation for practice. responses from these assignments were examined in order to further specify one of the themes that was unexpected. the students were also given the opportunity to participate in the preparation of this manuscript; one of the authors is a former trainee. results results reported below are based on data from: 1) the free-write and guided discussion and 2) trainee written field placement assignments. three distinct themes emerged from the analysis of the free-write data and the guided discussion: knowledge, practice, and relationships. the intent of this phase of the evaluation was to learn from trainees’ experiences in order to further develop the training program and refine the assessment processes. rishel et al./ preparing students to provide 156 free-write and guided discussion the first theme that emerged was knowledge. the trainees described key concepts they had learned about the meanings of integrated practice. the statements indicated that the trainees understood that integration occurs among systems, presenting problems, and across levels of social work practice (micro-mezzo-macro). these are all emphasized in the imbtp. examples from various respondents include: most of the time the client does not come in with just one issue – mental health, physical health, financial, housing problems, etc. integrative practice: holistic approach, multi-system, help client by addressing as many systems as possible but impossible to do all so prioritizing what is most important. integrative approach does not necessarily mean team approach; integrated can be involved in finding housing, medical care etc., but each agency has its own agenda and may not agree on priorities. the second theme discussed at length by the trainees was practice. the trainees were able to provide concrete examples of what an integrated approach means in practice. as indicated by the examples provided, the trainees were able to relate the practice aspects to their field placement sites. again, there is evidence that they understand that integration occurs across systems and across levels of practice. examples from various respondents include: awareness of current practices being used, it has allowed for critical thinking about what may evolve and what may need to be tweaked to better serve clients. to identify integrated practice within my field site such as integrating primary care and mental health services or mental health services within the school system. helping organizations understand and apply integrated practice. obviously, this will be done at our place of employment. in other words, i will advocate for the use of integrated practice by educating co-workers, striving for continued knowledge regarding integrated practice, and promoting the research aspect. example of a hospital where all decisions are made by a team (no decision made just by a doctor) so collaborative approach and have to be ‘forced to check egos at the door’ and it’s tough. the final theme that emerged was relationships. while the initial themes were somewhat expected given the prompts, this theme was somewhat unexpected given the less tangible nature of this training program goal. the trainees articulated the importance of relationships, not only in the training program but also in practice. the cohort model of training was intended to foster relationships among the students, but the value and importance placed on these relationships by the trainees was an unintended outcome. as demonstrated in the literature, relationships are important to building effective therapeutic and supervisory alliances, as well as in effective interprofessional education. the trainees noted the importance of relationships in practice with colleagues: advances in social work, fall 2016, 17(2) 157 need respect for all other fields – as professionals we don’t necessarily respect others’ points of view (as we do with different cultures, etc.) but not necessarily with other professionals. networking here with co-trainees – have built such strong relationships as part of this program; will call on them in the future to ask for help with professional practice issues. focus of seminars on integrative practice – get different perspectives from each other. trainee written field assignments the first two themes of knowledge and practice were somewhat expected, as the freewrite and guided discussion prompts specifically addressed these areas. the importance of relationships, however, emerged as a strong theme in the free-write and guided discussion but was unexpected as the prompts given did not specifically inquire about the impact of relationships in the training program. we felt it important to further examine this theme, as the prompts had not allowed for trainees to fully address it in their writing or discussion. therefore, written field assignments from throughout the academic year were examined to reach a more refined understanding of the theme of relationships. results suggest that several categories of relationships positively impacted the trainee learning experience and outcomes. relationships with co-trainees. providing opportunities for building and strengthening relationships with co-trainees in the program was highlighted by participants as one of the most valuable aspects of the training experience. this sentiment is exemplified by the following written statements: one unexpected outcome of program participation included the relationships that were developed with my cohort and the rich discussions we were able to have thanks to the ties of the training program. looking back, many valuable moments of learning in action academic-wise took place during my interactions with the cohort. the imbtp has been an excellent supplement to my academic and professional goals. it has helped place me in a small, but motivated cohort that assists in helping deepen my understanding of the barriers to care that are unique to the rural community. i really liked our last seminar and discussing some of our cases. although supervision is great, talking with peers and receiving an outside perspective is extremely helpful. it also seemed like we were all able to decompress together. i have also enjoyed being a mentor to the new imbtp class; it is exciting to help them in their educational journey to reach their goals too. relationships with training program faculty. in reflecting upon their msw learning experience, trainees emphasized the important role of the specialized training program in their overall academic learning experience. in their role as mentors, training rishel et al./ preparing students to provide 158 program faculty assist each student in recognizing their own potential and career interests. the outcome of these specialized mentoring relationships is illustrated in the following comments from various respondents: at this point in [the program] i believe i feel as ready as one can feel to start conquering my post-graduation goals. when i look back on my graduate training the imbtp was an essential piece of my academic learning experience. the workshops and clinical details have vastly helped inform my practice knowledge. the imbtp experience has been extremely beneficial. the focus on integrated care has highlighted the need [for and] success of this approach. most importantly though, without the imbtp experience, i do not know if i would have realized my desire to work with children, adolescents, and their families. for this reason alone, the imbtp experience has been extremely beneficial for me. relationships with clinical supervisors and colleagues. trainee responses also highlighted the importance of their relationships with clinical supervisors and colleagues at their advanced field placement locations. comments from various respondents related to these relationships included: there are opportunities for a lot of interdisciplinary collaboration; even if there are not scheduled times for these interactions, many opportunities are presented organically. it has been incredibly valuable to me to share an office with psychologists and interact regularly with psychiatrists, as well as other seasoned counselors and social workers. [the imbtp] allowed me to be the first msw student to obtain an internship position in the mental health outpatient clinic at this facility, where i had an optimal learning experience with opportunities to work with a variety of clients, practice settings and feel more than prepared to begin my professional career. [i] build alliances with other providers by showing them the importance of working with every entity involved with the client. professional relationships. trainees are provided with multiple opportunities for professional networking throughout the training program, including attending at least two training workshops per year and presenting at the state chapter of the national association of social workers' (nasw) continuing education annual conference at the end of their advanced year. for trainees, this culminating experience provides both an opportunity to share lessons learned from their training and to network with potential employers as they approach graduation. this focus on the development of professional relationships is exemplified in the following trainee statements: i feel that there are many resources, both tangible (like clinical workbooks, manuals, etc.) and intangible (attending trainings, imbtp-specific seminars, and workshops, etc.) and the final opportunity to present at our state social work conference that have provided a truly unique opportunity and helped me begin to show professionals my goals in a more visible way, even before i graduate. i would not have had any of these opportunities had it not been for this program. advances in social work, fall 2016, 17(2) 159 i am eager to use our experience and build on all we’ve learned to give a succinct presentation at the end of our master’s program. i feel like that will kind of be a turning point, being able to organize/gather all that we’ve learned and disseminate it with others at the state conference. drawing from experience with the development, implementation, and evaluation of the imbtp, it appears that the purposeful fostering of relationships in several areas of the program contributed to successful outcomes for the first cohort of graduates. program graduates were deemed successful in that the overall goal, i.e., that graduates would secure post-graduation employment in mental and behavioral health settings serving their target population, was met. at the time this article was written, all five of the trainees who had completed the msw and imbtp programs secured employment following graduation in positions where they provide mental and behavioral health services in rural areas. at this point, the extent and role of interprofessional relationships in post-graduation employment is not yet clear. future work will examine how the training focus on interprofessional relationships affects post-graduation employment experiences of trainees. discussion prior to discussing the results of this study, it is important to note the study’s limitations. the first cohort of five trainees participated in this evaluation. the group was few in number, all located on the same campus setting, and formed a strong bond early in the training experience. this may have decreased diversity in thought and expression, narrowing the range of responses. nonetheless, the information gathered from these processes is valuable in creating and evaluating future training programs. feedback from participants indicate they perceive relationships to be a key component in the success of their training. while educators might expect that two of the three themes identified in this study (knowledge and practice) would be critical aspects of successful training programs, the purposeful fostering of relationships may not typically be considered in training program development and implementation. this might be especially relevant to the practice of integrated mental and behavioral health that requires collaborative and cooperative work across disciplines and in teams. results suggest that relationships formed as part of the training program played a key role in supporting the knowledge and practice skills identified as the two other themes in this study. comments shared by the trainees, both as part of the focus group discussion and from their advanced field written assignments, illustrate how relationships were instrumental in both their learning (building knowledge) and their implementation of this knowledge in their field placement settings (practice). the following discussion outlines examples of the strategies employed to foster and develop the various types of relationships highlighted in trainee responses. relationship-building in the rural context the training program was implemented in a rural state within a graduate program that focuses on practice in small towns and rural communities. while the development of strong relationships is likely important in many types of training programs, it may be particularly rishel et al./ preparing students to provide 160 instrumental in rural settings in which building strong relationships is an inherent part of effective practice. the statewide network of social service professionals is relatively small in a rural state and is interconnected in a variety of ways. strong relationships initiated as part of the training program are expected to be an asset to trainees as they move on to professional positions within the state and region. training within the program focuses on the rural context of practice; this context is recognized by trainees as illustrated by the following trainee statement: the majority of our clients are from rural areas of [the state] and there are very few facilities like [this one] in their areas/state that can assist these clients. additionally, the environment of our clients reflects rural appalachian culture. all of the types of relationships highlighted and comments by trainees should be considered within the rural context in which they occurred. fostering relationships with co-trainees one of the major strategies used in the imbtp to foster relationships among the cohort is the facilitation of imbtp-specific advanced field seminars during the trainees’ final year in the program. the imbtp project director (first author) served as the faculty field liaison for the five students in this cohort. each of the four advanced field seminars throughout the academic year focused on various models of integrated practice and provided trainees with an opportunity to discuss specific ways to apply integrated models of service delivery in their field placement experiences. in the open-ended discussion following the free-write activity, trainees identified these advanced field seminars as instrumental in facilitating cohort cohesiveness and mutual support. additional strategies to foster relationships among co-trainees included small group advising sessions facilitated by the project director, cohort collaboration on a final presentation of their learning outcomes at the state nasw conference, and an electronic mailing list used to facilitate communication about imbtp-related training opportunities. the purposeful fostering of these relationships by program faculty led to trainee-initiated relationship-building as well. among the first graduating cohort, trainees often went to lunch together between classes, traveled together to attend training workshops, and created peer consultation meetings at specific field placement settings. fostering relationships with program faculty the project director of the imbtp served as the formal academic advisor for all imbtp trainees, and more informally, as their mentor. much of the mentoring relationship development overlapped with the fostering of relationships among co-trainees as the mentor met with all trainees in each cohort through small group advising sessions and advanced field seminar meetings. small group advising occurred, on average, once per semester for two hours each session. advanced field seminars occurred twice per semester in the advanced year for three hours each session. in addition to these group experiences, the mentor met individually with trainees as needed, including visiting trainees in extended campus sites and/or arranging periodic phone meetings. in the role of faculty field liaison, the mentor visited each trainee at their advanced placement site twice during the academic advances in social work, fall 2016, 17(2) 161 year. other faculty members who were closely involved with the implementation of the imbtp also served as informal mentors with trainees, including the msw program director and the field education coordinator. each of these faculty members provided additional mentoring to imbtp trainees throughout their tenure in the program and worked collaboratively with the imbtp director to ensure their training needs were met. fostering relationships with clinical supervisors and colleagues promoting strong relationships within the field placement site was proactively addressed through the imbtp field placement selection process. two of the five criteria of field placement selection included relationship-based components. specifically, placement sites must offer opportunities for interprofessional collaboration and teamwork and provide strong mentorship by field instructors and connection with leaders in the local service delivery system. the project director and field placement coordinator worked collaboratively with trainees in the field placement selection process to ensure these components were included in each imbtp field placement experience. all imbtp field instructors were added to an imbtp electronic mailing list and received program updates and information regarding imbtp-related training opportunities. another strategy used to strengthen relationships with clinical supervisors was to offer free continuing education credits as part of the imbtp’s co-sponsored specialized training workshops with the school's office of professional and community education. these workshops were offered at no cost to imbtp trainees and their field instructors and further promoted integration of field instructors and trainees within imbtp training opportunities. informal feedback suggests that the free continuing education credits (two to four full days of training annually) were a valuable benefit to field instructors and assisted in the recruitment and retention of quality field instructors for the program. fostering professional relationships trainees were provided with multiple opportunities for professional networking throughout the training program. all trainees attended at least two training workshops per year. these workshops were open to the wider professional community through the school of social work’s professional and community education program. trainees were introduced at the workshops and had the opportunity to network with the greater social service community. trainees also presented at a large, state-wide social work conference with their cohort, highlighting their learning throughout the imbtp and how it applies to rural practice. implications a large body of literature documents the important role of relationships in achieving positive outcomes in therapeutic settings, clinical supervision, and interprofessional education. results from this preliminary study regarding specific elements of an advanced training program suggest that relationships play an important role in successful training programs as well. previous work identifies trainee role transition to advanced practice as one of the key areas to address in clinical supervision (sharrock et al., 2013). trainee feedback illustrates that relationships formed with fellow trainees, as well as with other rishel et al./ preparing students to provide 162 professionals, were instrumental in supporting this role transition to advanced practice. based on these initial findings, the authors plan to continue to proactively foster relationship-building throughout all aspects of the training program. the msw program that houses the imbtp serves students in six campus locations across the state. the five graduates from the first cohort happened to all attend the main campus setting and met face-to-face for seminar activities. for subsequent imbtp cohorts, in which some trainees are based in extended campus locations, skype is being used via large monitor screens placed in seminar rooms at various campus sites so trainees in all sites can connect in real time and participate in seminar discussions. as the evaluation of the effectiveness of the training program continues, the authors will be especially cognizant of the use of technology to connect trainees and its impact on trainee learning outcomes. in response to increased federal funding, more programs focused on preparing students for behavioral health practice are developing nationwide (see hrsa, n.d.). results from this study may be used to inform decisions regarding specific components that contribute to successful outcomes. results suggest that a focus on fostering relationships among trainees, with program faculty, clinical supervisors and interprofessional colleagues, and networking with the broader behavioral health and social service community enhances the knowledge-building and skill development that are inherently emphasized in most training programs. future research should examine the importance of relationships in students’ educational and practice outcomes with larger and more diverse samples. studies using control groups and quantitative measures assessing interprofessional teamwork and relationship quality would further this area of scholarship. references bordin, e. s. 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(2011). issue brief: the intersection of health reform and systems of care for children’s behavioral health care. washington dc: georgetown university center for child and human development, national center for children’s mental health. author note: address correspondence to: carrie rishel, school of social work, west virginia university, po box 6830, morgantown, wv, 26506, 304-293-6377, carrie.rishel@mail.wvu.edu acknowledgement: this project was supported by the health resources and services administration (hrsa) of the u.s. department of health and human services (hhs) under m0125201, mental and behavioral health education and training grant. this information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by hrsa, hhs or the u.s. government. http://bhpr.hrsa.gov/grants/mentalbehavioral/index.html http://bhpr.hrsa.gov/shortage/ mailto:carrie.rishel@mail.wvu.edu microsoft word weber copyedit final _________________  bret a. weber, ph.d., msw, lcsw, is an assistant professor in the department of social work at the university of north dakota in grand forks, nd. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 391-407 social work and the green economy bret alan weber abstract: this is an ethnographic account of a social worker’s efforts to create a local “energy alliance” to help moderate-income residents reduce energy costs in a small, urban, northern plains community in the united states. additionally, the initiative would help create jobs, increase energy efficiency, and reduce carbon outputs. while the project met with mixed results, lessons learned are relevant to the emergent intersections of community practice, sustainable community development (economic and social), and social work. the benefits of social work education and experience to this work are highlighted, as are the challenges inherent in planning and implementing green community development. keywords: community economic and social development, energy alliance, environmental social work, sustainability, green economy, community practice introduction this article is an ethnographic exploration of a social worker’s efforts to create a local “energy alliance.” the purpose of this community project was to help moderateincome residents reduce energy costs, while increasing energy efficiency in a small, urban, northern plains community in the united states. these efforts sought local benefits for the immediate community while helping to make some small contribution toward reducing carbon outputs that affect climate change. it was also an effort to engage the perspectives and skill set of social work with the challenges of the ‘green economy.’ the volunteers who participated in this project were successful in creating a new organization within the city government and in procuring energy efficiency and conservation block grants. however, the new program did not perform as well as was hoped in relation to providing economic relief for moderate-income families or spurring local economic development. rubin and sherraden’s (2005) conceptualization of cesdos (community economic and social development organizations) is employed to illustrate key issues facing the energy alliance at its inception and over the longer term. community practice models also provide insights into tasks, challenges, and practitioner roles. this article is written in the spirit that mistakes and less-than-optimal outcomes also provide valuable lessons. it also highlights the strengths that social workers may bring to local “green” initiatives. this is fairly unknown territory for social workers in the united states, however, it is hoped that sharing this case example will offer relevant insights and encouragement to the growing number of social workers who consider global environmental sustainability to be relevant to social work practice. advances in social work, summer 2012, 13(2) 392  theoretical context for the project the author’s active participation and leadership in this project were simultaneously grounded in the intersections of social work, environmental sustainability, and community and economic development work. first and foremost, social workers know that people need to be understood within the broad context of their environment. this person-in-environment perspective encompasses all the diverse aspects of social work practice and distinguishes it from other helping professions. however, especially in the united states, the term too often fails to consider the natural and physical environment. this is particularly unfortunate in the face of ongoing environmental and climatic shifts that disproportionately threaten vulnerable populations both around the globe and in the wealthiest nations. this is a matter of global concern that requires local solutions and is directly relevant to social work practice. zapf (2009) noted that social workers “have been strangely silent” about issues related to the natural, physical environment and the related “serious threats to human well-being and continued existence” (p. 18). environmental sustainability is also a social justice issue. the wealthiest populations tend to be the greatest consumers and producers of the products and activities damaging to the global environment, yet the impoverished are most likely to suffer the consequences. for instance, the united states is the world’s top emitter of carbon dioxide, but the cost of climate change is disproportionately borne by those least able to either afford the costs or recover from the effects. extreme weather events between (1990-2009) as noted in the global climate risk index 2011 most seriously impacted “developing countries in the low-income or lower-middle income country group” (harmling, 2010, p. 5). indeed, as a result of climate change, tens of millions of bangladeshis could be displaced by rising sea levels over the coming decades, and that nation’s agriculture is already suffering from sanitization as rising sea levels contaminate the nation’s delta regions (chopra, 2009). throughout the developing world, social workers tend to focus on social development and issues of sustainability directly related to environmental issues including population, food supplies, and disasters connected to natural devastation. however, in the united states, social workers are largely silent on environmental issues, even though they can make a significant difference by bringing their unique set of values, ethics, and skills to make a difference locally. rubin and sherraden (2005) and their formulation of community economic and social develpoment (cesd) have offered a critical redefinition of traditional community economic development models that too-frequently had ignored social and economic justice implications, and posit the need for a “humane capitalism” that is holistic, focused on those who are left out of traditional economic development efforts to build and harnesses community assets in ways that result in both economic improvement and social change (p. 475). innovation is a hallmark of cesd, which also positions it well as a framework for environmentally sustainable community development. additionally, the use of community practice models also (rothman, 2007; weil & gamble, 2005) guide this work and this analysis. weber/ social work and the green economy 393 early green organizing efforts by the city this community project was undertaken in an area dominated by flat, flood-prone plains in a basin that drains into the arctic waters of the hudson bay. the area has little deciduous foliage to capture solar heat, cold winds that sweep across the plains from the canadian rockies, and arctic high pressure systems that produce frigid temperatures from october through march—low temperatures dip below 0°f fifty days per year. residents burn a lot of fossil fuels to keep their homes warm during these notoriously cold winters. aware of the increasing financial costs for local citizens and the related global damage, the city’s mayor signed on to a national sierra club program with the somewhat ironic title of cool cities during the spring of 2007. since 2005, the cool cities’ initiative has facilitated collaborations “to implement clean energy solutions that save money, create jobs, and help curb global warming” (sierra club, 2011). within a few years, over one thousand cities and counties had joined the commitment to reduce their community's carbon footprint. additionally, in announcing his decision the mayor noted concerns in the united states conference of mayors’ energy and environment best practices guide describing “america’s vulnerability to an uncertain energy future,” a policy environment that was “not sustainable” and references to national leadership that was either denying global warming or simply not acting on these broadly recognized concerns. the document noted “fortunately . . . mayors from across america are taking the lead” (u.s. conference of mayors, 2007). some of the volunteers who joined what came to be known as the mayor’s “g-3 environmental initiative” in 2007 included a professor from the local university’s earth system science and policy department, along with the produce manager at the local food co-op who also happened to be one of the state’s leading activists on behalf of energy and environmental issues. the effort was also joined by “a key author” of the intergovernmental panel on climate change (ipcc) report on climate change. his work had been part of the 2007 nobel peace prize awarded jointly to former vice president al gore and the ipcc for raising global awareness about the human impacts on the environment and climate. in a press release, he expressed the hope “that my grandchildren will not blame my generation for our stupidity of spending nature's capital while leaving the payments to them” (university of north dakota, 2007). altogether, the group eventually included some five dozen individuals including university professors, local activists, and various other community members and city officials (bonzer, 2008). given the amount of talent assembled to work in this modestly-sized community, the work started in a spirit of great optimism. g-3 membership consisted of approximately three dozen individuals. a majority of these were university faculty, environmental activists (including a large number of students), and a few city employees. official meetings began during the fall of 2007at a time when the author was teaching a class. nonetheless, through e-mail and informal connections, it was clear that group members were passionate about the topic, and willing to volunteer their time to identify feasible tasks that could be accomplished by city government in partnership with other stakeholders. advances in social work, summer 2012, 13(2) 394  when i did begin attending meetings, the larger group had been meeting for about three month before i was able to come to my first meeting, yet i was surprised at how little had been accomplished. beyond an enthusiastic report read by a student intern who had been assigned to the committee, not much else was accomplished at my first meeting. the next meeting that i attended was for the policy sub-committee, a smaller group of six individuals, which included a veteran city council member and a senior aid to the mayor. the main decision made at that meeting was that each member would individually review a long list of programs and ideas from other cities around the region, and return with recommendations. the list was dominated by ‘low-hanging fruit’ ideas such as changing to more energy efficient lighting, coordinating the city’s stoplights for more efficient traffic flows, and directives to get city employees to reduce their use of paper. for the most part, it was disappointing that these efforts had not already been implemented. four months into the effort, the g-3 initiative and its subcommittees still seemed to be at the “brainstorming” stage; however, as a relative newcomer to the community, the effort afforded me an opportunity to develop relationships and mutual trust with community members and city staff, and an understanding of the city’s political landscape and stakeholder interests. an opportunity came in the form of an e-mail circulated by the president of the local chapter of the sierra club, containing a link to the cambridge energy alliance (cea), a group that was just forming in cambridge, massachusetts. the basic principles of the cea were not particularly revolutionary, but they provided an outline of a program sufficiently simple in its concept to be taken on by a community practitioner with only limited training in environmental issues and limited technical and engineering knowledge. the idea also seemed well-suited to a medium-sized and fairly wellorganized community. it promised to simultaneously promote local economic development, bolster families’ economic well-being, and reduce local greenhouse gas emissions. becoming increasingly concerned that the g-3 was imperiled by decision avoidance psychosis (tropman, 1997), i proposed to the policy subcommittee that we bring a formal proposal to the next meeting, and adopt the creation of an energy alliance as one of our goals. authorization to develop the energy alliance at the next meeting of the g-3, the proposal was made to create a program similar to the cambridge energy alliance. the idea was well received, and the group thought it should be included in the g-3’s upcoming formal report to the mayor. furthermore, the committee authorized me to go ahead and pursue development of a local energy alliance independent of the larger g-3 initiative. it was further suggested that i work in conjunction with other local and regional players especially the city’s housing authority and urban development office, the main utility company for the region, and a local foundation. on may 16, 2008, i met with administrators at the local housing authority and the office of urban development. they were generally supportive, but it was decided to weber/ social work and the green economy 395 postpone further talks until after the june 12, municipal election—from the beginning, the work had an inescapable political component. after the mayor and aforementioned council member were both reelected, a contract was signed on june 27 with the housing authority and office of urban development each contributing a modest allocation ($4,000) for an estimated 150-250 hours toward the development of a feasibility study. initial energy alliance planning efforts rothman’s (2007) planned capacity development model dictates the need to link efforts to national-level technical assistance and regional players. rothman (2007) further notes that “interweaving people, economic forces, and ecological protection in a common policy framework” (p. 26) is a hallmark of this model, and these indeed remained the dominant dynamics of the planning phase. accordingly, i started by contacting a staff member at the cambridge energy alliance; he offered his mentorship, leads for other contacts, and welcomed future assistance if the city made some sort of commitment to the idea. efforts also included meetings with the only city council member who had served on the original g-3 committee. he suggested a three-step process for moving forward: 1) a feasibility study to determine if an energy alliance would be a viable idea for the city; then, dependent on the outcome of the first step, 2) the design of an organizational structure and development of budgets and funding needs; and, finally 3) the actual creation and implementation of an energy alliance. my next step was to recruit assistance with the writing of the feasibility study. one person that i brought in was a ph.d. anthropologist with extensive project management expertise who taught at the university’s school of business. the other member was a community organizer from chicago with both grassroots community-level work and professional lobbying experience. the work during this phase was wedded to rothman’s (2007) planned capacity development model with its emphasis on expert-led technical planning to spur development that will both include and benefit more disadvantaged community residents. i felt that this would be the “best fit” for a change effort which required a high level of technical expertise and support from local government officials. additionally, within the eight-part community practice model elaborated by weil and gamble (2005), early efforts to promote the energy alliance could accurately be described as a blend of social planning and community social and economic development. the framework also includes a helpful description of social worker roles; within this iteration of social planning, roles consist of and include “researcher,” “proposal writer,” “communicator,” “planner,” and “manager” (p. 128). i felt this accurately encapsulated the work up to that point and over the coming months. while the explicit purpose was to determine if an energy alliance was technically, financially, and logistically viable, team members were also aware that the work would need to include public education and promotion efforts akin to a political campaign. the roles of “educator,” “promoter,” and “negotiator,” included under community social and economic development, aptly covered the breadth of roles for team members (weil & gamble, 2005, p. 128). advances in social work, summer 2012, 13(2) 396  foundational to successful cesd planning is identification of a community need that can be addressed in a way that, in turn, creates a ripple effect of additional improvements (rubin & rubin, 2001; rubin & sherraden, 2005). similarly, careful planning is key to successful community practice, but a less-mentioned necessary skill is awareness of the larger social and environmental contexts, and how external events may open (or close) windows for action. at the time of the energy alliance’s inception, al gore’s movie, an inconvenient truth, was dominating a great deal of discussion across the county. the idea of an energy alliance offered a politically ‘soft’ approach to concerns about global warming in that everyone could do their part to help reduce carbon emissions--‘soft’ because it included aspects that could appeal to the array of ideologies dominating the political landscape at that time. for those who accepted the idea of climate change, this was not a difficult sell. for those who did not, we shifted the conversation to being good stewards of the land and the inherent foolishness of wasting resources unnecessarily: regardless of political inclinations, few tend to support unnecessarily burning resources with no benefit. on the local level, the release of a report undertaken by another local social worker with sponsorship from the local united way and other foundations, highlighted the increasingly difficult economic challenges facing the community’s lowto moderateincome residents, who were eligible for little or no public assistance, but whose wages had stagnated while facing the state’s highest housing costs (barkdull, 2007). the report made a bit of a stir in the local media and press, and alarmed city officials who did not want to see their community unfavorably compared to others. timing was good locally to promote the need to make living in the community more affordable; this approach had added appeal by speaking to the need to help individuals who were not able to receive help from often-maligned social programs. the next event to dominate the headlines came with the approaching heating season. energy prices began to escalate, and by the middle of that summer the nation was paying an average of $4.12 per gallon for regular gas at the pump. in the face of rising fuel costs, both the immediate and long-term benefits of an energy alliance were even more attractive. more efficient homes would immediately result in lower energy bills, and savings would continue to increase if energy prices continued to rise. furthermore, what had by this time become the feasibility team’s proposal could now be explained to conservatives as a mechanism for reducing domestic dependence on foreign oil. this readily enabled the team to build broader support among local elected officials. as if global climate change and record high oil prices were not enough, 2008 threw yet another crisis at the world in the form of the mortgage crisis in the united states with its ripple effects on the global banking industry and national economies. as we continued to complete the very technical work of the feasibility study, we were also able to point out the value of an energy alliance’s promise to create local jobs as unemployed individuals could be trained a hired to weatherize homes. there were approximately ten thousand homes in our city, and most had been built during or previous to the 1970s; indeed, the housing stock near the city’s core was over a century old and had not been adequately rehabbed in relation to energy efficiency. some weber/ social work and the green economy 397 homes had received a new layer of insulation during the 1970s, but since that time, materials, techniques, and the collective understanding about energy efficiency had all improved. few local homeowners enjoyed the surplus finances to take advantage of these new technologies, nor did they have the tools or necessary training to do this work themselves. as noted previously, successful cesd planning is enhanced by identification of a community need that can be addressed in a way that creates a ripple effect of additional improvements (rubin & rubin, 2001; rubin & sherraden, 2005). our early efforts achieved this objective. within a brief, 18-month period, we had the exciting prospect of launching an organization that could reduce the economic burden of households with modest incomes, produce good-paying blue collar jobs for the local economy and reduce greenhouse gas emissions—while enjoying broad support across the political spectrum. the team continued to engage local and elected officials formally and informally, gathering detailed information about the political landscape, and devising promotional appeals that would be effective in neutralizing potential ideological opposition to the effort. although much of the work on the feasibility study was technical, team members contributed an equal amount of energy and attention to the highly political nature of the enterprise, and the honing of political skills by team members was essential to the early phases of this project. this aspect of local development work is also strongly emphasized by rubin and sherraden (2005). definition of an energy alliance at this point it is helpful to briefly offer a description of what an energy alliance is, and how it works, along with the key players and the basic steps. the basic principle of an energy alliance is to make greater use of existing technologies to reduce residential energy use. while factories and suvs are often the targets of those interested in addressing issues of global climate change, in many communities the greatest consumption of energy takes place in individual homes. in addition to constantly running refrigerators and ‘energy vampires’ (computers, dvd players, etc), one of the single greatest uses of energy is home heating. all of these can be done more efficiently, and the work to accomplish that generally requires only simple technologies with quickly recouped costs. more specifically, energy alliances provide a ‘one stop shop’ resource for homeowners by connecting them to energy audits, trained contractors, and financing. energy auditors employ various technologies to give homeowners information about the least efficient components of their overall energy system that could be more easily corrected, for the least expense, and with the greatest potential return on dollars invested. trained contractors then confirm, correct, and add to that information and provide either specific bids for completing necessary work, or advice for do-it-yourself enthusiasts who may want to take on part or all of the work themselves. the combined information from the auditor and the contractor results in various options for making the home more efficient and estimates for projected savings. the resulting energy savings average close to 30% and the savings immediately offset the costs with total payoff of the original advances in social work, summer 2012, 13(2) 398  investment in as little as two to seven years, after which time the homeowner continues to enjoy savings that increase as energy prices rise. the final step in the energy alliance process is to help make financing arrangements so that the cost can be spread over an appropriate time period with the result that homeowners incur no actual out-of-pocket expense—reductions in utility bills are generally greater than the resulting loan payments. the overall result is that an energy alliance helps connect available technologies and resources with no ‘cost’ to homeowners while simultaneously reducing carbon emissions. it is a model that is consistent with social work perspectives and benefits from the insights of community development theory. inter-organizational, multidisciplinary and crosssector planning cesd initiatives require cross-disciplinary and cross-sector collaboration to successfully attend to the myriad of economic, social, and technical details that arise. while rubin and sherraden (2005) emphasize this aspect of work at the implementation and management phase, it was equally true in this author’s experience during the planning phase. while the three-member feasibility team brought an array of managerial, organizational, interpersonal and political skills to the mix, the list of stakeholders had to be broadened to successfully undertake the feasibility study. in addition to meeting with auditors, contractors, and bankers, the team met with two different organizations that had already been doing work that overlapped that of the proposed energy alliance: the local community action agency (caa) and a private business. both of these entities were critical to helping the team define a more specific focus for the energy alliance, and how it could complement and not duplicate what was already available in the community. the area caa runs a weatherization program. making use of federal funding, they had been retrofitting an average of about 100 homes per year in their four-county area. their program was similar to an energy alliance in that they began with an audit employing the latest technologies including a blower door and an infrared camera. the blower door is draped across an open, outside door and has a large fan that blows air out of the building. the resulting negative pressure emphasizes any cracks or other weaknesses that might exist around closed windows or doors, and even voids where insulation had slumped inside walls. the infrared camera adds to this by allowing a quick scan of all areas to ‘see’ where those problems exist, which often include: improperly sealed electrical outlets, cracks around windows and doors, and problems in and around the foundation. these energy efficiency problems too often have no visible evidence and without the combination of the blower door and infrared camera it is unlikely homeowners could finds these weaknesses on their own. however, the caa’s program is different from the energy alliance model as they only serve those who fall below certain income guidelines—and they offer homeowners little choice. indeed, spending limits dictate the work that can be completed (the cap of $3,500 per home was raised in 2009). generally speaking, caa weatherization programs always spend the full amount whether or not it provides the best return on investment, but weber/ social work and the green economy 399 most often, they are not able to spend the necessary amount to address the unique problems of each house. additionally, they are only able to complete work on a limited number of homes compared to estimates indicating much greater numbers that could benefit. the team also met with a businessman who had leveraged his sheet metal business and personal relationship with the mayor into contracts with local government to perform audits and upgrades for public buildings. his organization had already enjoyed favorable local press for work on some of the larger city and county buildings. the feasibility study team had originally imagined serving commercial, public, and residential buildings, but became dissuaded as we learned that doing this work with big, non-residential buildings was more complex on several levels. more importantly, the team was not interested in duplicating services or creating unnecessary competition. the city was already being served by a business addressing large government and commercial buildings, and the caa weatherization program was serving a modest number of low-income home owners; but neither was set up to serve thousands of middle-income homeowners. due to the feasibility study team’s effective educational and inter-organizational efforts, these stakeholders were supportive of the energy alliance proposal and were convinced that this was a good idea for the city. they saw an energy alliance as an essential service that could reduce the city’s carbon output, stem the flow of local dollars to an energy company headquartered in another state, and produce numerous jobs in the local economy. completing the planning phase based on the responses the team was receiving and the data we were gathering, it seemed increasingly clear that the idea of an energy alliance for our community was viable. however, while auditors, contractors, and banks were already operating in the community in ways that contributed to the overall goals, none of those players could pursue this work unilaterally. and while it all appeared relatively simple, without an energy alliance to coordinate the process, the necessary steps that would result in significant reductions in residential greenhouse gases and the resulting community development were rarely taking place. energy audits had been available for years—often for free or at reduced costs—but the few people who took the time to have their homes audited rarely took the next steps: indeed, there was no clear guidance about what those steps might be. contractors had always been available to do the work, but without the audit and the intervention of an objective third party, many homeowners were unsure about who to hire or about what work to have done. for instance, homeowners could contact a window installer or someone in the business of putting insulation in their attics—and, generally speaking, the contractor was more than happy to sell windows or more insulation—but it was unclear what should be done to assure the most effective changes, in what order, and in what amounts to assure the most favorable ratio of investment to savings. without the audit, coordination, and objectivity provided by an energy alliance, the homeowner had little sense of what repairs made the most sense from a financial advances in social work, summer 2012, 13(2) 400  perspective. finally, without the authority of an energy alliance, financing was rarely available for such endeavors and homeowners were left to invest with insufficient, object information about likely returns. while various tax incentives helped to encourage some improvements for homeowners, these were generally performed in an ad hoc serving the profits of contractors and suppliers. but, without a specific, intentional effort to maximize investments for consumers, the activity was less than it could have been. ironically, the market-driven system was not serving local business interests or consumers. very little was being done to reduce carbon emissions in a similar fashion, the energy alliance model promised to move beyond the tired paradigms of government versus private sector, or keynesian versus supply side economic theories. the government-sponsored weatherization programs carried out by the caa imposed strict means testing on potential consumers, while the private sector pursued only the most profitable ventures, (generally large commercial buildings over residential dwellings). there was no incentive for either to serve the large number of homes that actually offered the greatest community-wide need, the broadest opportunity for reducing carbon outputs, and the most likely possibility of creating jobs while keeping money in the community. to fill the gap, the feasibility team proposed a hybrid organization composed of government, private, and non-profit elements as a “one-stop shop.” essentially, local government would house and support a staff person to coordinate the work of energy auditors, local contractors, local banks, and homeowners. such a position could be sustained with a mix of public sector funding and foundation grants. it was further recommended that the organization be structured as a nimble and flexible social enterprise (yunus, 2009) that would be mission-driven; its governance structure should carefully ensure cross-sector alignment and accountability (lawson & barkdull, 2001). a cesdo’s ability to balance its social mission with business concerns is critical to its viability (rubin & sherraden, 2005). our recommendation for launching the energy alliance met no opposition. instead we received enthusiastic support from the various stakeholders we engaged—from conservative bankers and independent contractors, from visionary energy auditors imagining new ways of meeting energy needs in the most efficient fashion possible, and from homeowners seeking lower energy bills and greater comfort during the long winter. in august, the team completed an interim report with a clear recommendation for a necessary ‘awareness-raising’ process—part marketing and part political campaign—to gain support for the idea and to create a sufficient customer base. this report was distributed to all stakeholders including the city. one of the mayor’s assistants expressed his appreciation for the interim report, noting that it gave him something concrete to take with him to a meeting in washington, dc to report on the progress of the city’s cool cities program. work continued on the complete feasibility study with numerous meetings with community groups and government officials. a gant chart was presented to the mayor’s staff demonstrating a carefully coordinated and detailed schedule to secure seed funds and begin pilot projects to test the practical logistics of the model, and to screen weber/ social work and the green economy 401 and hire staff. the feasibility study team had clearly exceeded the original obligation of 150-250 hours in the contract. in october of 2008, a completed feasibility study was distributed to the various city government offices and to local county commissioners, whose support we had also won. moving from planning to implementation the next stage of the work, accomplished over the next year, took the most time, was the most frustrating, and yielded the fewest gains. a long series of meetings—some involving multiple stakeholders, others limited to direct talks with the mayor’s staff— resulted in little more than confusion. through the long winter and spring, the feasibility study team tried to generate support for implementation among city officials who had been beaten down by the vicissitudes of the fall 2008 elections that swept a number of anti-government tea party activists into office locally and nationally. despite having just won reelection, the mayor’s staff felt under attack and was preoccupied with political vulnerability. while the team felt that we were simply asking for permission to write grants on behalf of the city to enter the next phase of the work—the implementation of pilot programs and the initiation of a marketing and education campaign for the public-we instead found ourselves on a treadmill chasing promises. at one point the feasibility study served as the center piece of a ‘dog and pony’ show for a u.s. congressman where the city wanted to demonstrate the innovative things it was doing to promote a green economy. our presentation was rewarded with a high level endorsement from the congressman’s office recommending that the city support our efforts. the city was proud of the endorsement but remained wary of actually taking the necessary steps. their delaying tactics included repeated requests for additional information that had already been provided, meetings that concluded with vague promises to “move forward,” and the absence of decision-makers at crucial junctures. in the process of gaining cross-sector support, we had failed to manage the relationships as well with the city government—an entity on which we were completely dependent for success. in retrospect, the first two lessons to be taken from the whole experience might be 1) to keep the message simple and clear, and 2) to not become overly dependent on a single course of action. in meetings with the other parties, it was easy to keep the message simple as the focus was on just the portion pertaining to each individual group: auditors quickly understood what their role would be; contractors were hungry for work; bankers wanted to make loans; homeowners wanted warmer homes and lower energy bills. but in the process of explaining to the city how that would all fit together, the description became more complex. overworked staff members had not actually read the feasibility study and were unwilling to take the risk of moving forward in what had become a suddenly politically-fraught environment. values conflicts and misunderstandings are typical challenges in cesd work (rubin & sherraden, 2005), and they increased the very real emotional and physical fatigue of the three feasibility team volunteers. the team got mired in this unproductive relationship because, for two different reasons, we failed to understand the need to avoid dependence on a single course of action. the first involved the reality that connecting ourselves to the city was the most advances in social work, summer 2012, 13(2) 402  promising place to start, including start-up funds and an office, along with other resources. after all, it was the mayor’s office that had initiated our work, even if only indirectly. the other misunderstanding may have resulted from the fact that none of the feasibility team members was looking for jobs. none of us was interested in actually managing the energy alliance—though we considered ourselves to be the best positioned to get it started—and each of us had other, full-time obligations. our unwillingness to take a more active role in the implementation phase was a likely concern to the alreadyoverworked city staff and the natural fear that the whole project might land in their laps. assurance that we would remain involved as citizen volunteers as part of a strong supervisory board (rubin & sherraden, 2005) was a strategy that we thought would prove effective to overcome such concerns, but it was insufficient. our dependence on the city’s active engagement had hamstrung the initiative at the end of the planning phase. the city was either reluctant or unwilling to make any further commitment at that time, but they kept requesting additional meetings and continued to talk about the energy alliance (ea) as though they both supported it and were involved in shepherding its development over the next 6 months. window of opportunity, co-optation, and disappointing results the feasibility study team members had mostly moved on to other projects. as the lead, i continued minimal engagement during this period, until the city received an unexpected boon in the form of american recovery and reinvestment act (arra) federal stimulus funds. the mayor’s office had applied for and received several hundred thousand dollars in federal, energy efficiency funds. while the arra had included additional monies for weatherizing low income housing (and was a fantastic boon to the local community action agency), the arra had led to the development of energy efficiency and conservation block grants (eecbg), including $3.1 billion to help states invest in energy efficiency and the green economy. the energy alliance had been one of the major parts of the city’s eecbg application. after receiving word that the application had been approved, in may of 2009 the city council voted to support development of the local energy alliance through an allocation of $175,000; further, the new organization would be housed in the office of urban development. the county commission had also received $64,000 in eecbg funding, and opted to devote those funds to the effort. between the two branches of government, the ea now had $239,000 to implement the new cesdo, only $3,000 below what had been recommended for startup in the feasibility study. according to the plan outlined in the study, the next phase was to include sorting out the various legal issues, developing an accounting process, and creating the necessary boards. i was included as a member of the advisory board, although i was still concerned that the organizational structure for the effort did not resemble the recommendations for the nimble and accountable hybrid organization proposed in the feasibility study. indeed, what seemed at the time like the long awaited victory turned out to be the beginning of a weber/ social work and the green economy 403 series of disappointments: few of the recommendations in the study were followed; funds were not allocated for the public education campaign or to generate citizen involvement; and the need for twenty-four pilot audits in advance of the 2009 heating season— essential to the next developmental steps—were essentially ignored. first, the job search dragged on through the summer months, and as fall approached the city explained that the grant money, though approved, had not yet been released by the federal government. this was discouraging as the city could have provided short-term funding in anticipation of being repaid when the grant finally arrived—certainly, they had sufficient discretionary funds in the spring of 2008 to fund the feasibility study. the window of opportunity to initiate work in advance of the coming heating season was lost. near the end of 2009 an individual was hired to serve as the energy sustainability coordinator for the city. while she brought some limited experience necessary for such a role, the breadth of skills needed to accomplish the extremely complex work of starting up and managing the new energy alliance: project management, planning, and development skills, marketing, grassroots citizen involvement, along with personal, political, and inter-organizational skills (rubin & sherraden, 2005)—proved a daunting list. some health-related problems in the new employee’s family further hampered the effort. there continued to be periodic meetings in which a dwindling number of the same individuals would arrive to rehash matters and to watch the initiative lose momentum. a series of training sessions were made available to create additional auditors, but this contradicted the reality that there was not yet sufficient work for those already trained— often at their own expense—to do that work. similarly, contractors were being instructed on matters related to energy efficiency without any corresponding development of a customer base. bankers were the first to stop coming to the meetings, and—most important of all—there was never any significant presence from homeowners or representatives of neighborhood organizations despite frequent references to long waiting lists of people wanting to make use of the energy alliance’s services. efforts to educate and engage citizens remained minimal. over the next two years, only about a dozen homes were audited. some had repairs completed along with loans from a portion of the original grant to finance the upgrades. at one particularly disappointing meeting, the advisory board was informed that a large portion of the budget was going toward work on public buildings, though the feasibility study had stressed the need to focus on private residences. indeed, the bulk of the budget was going to the sheet metal business owned by someone with personal connections to an elected city official. at that point it was made explicitly clear that the advisory board was not, in fact, being asked for advice at all, and that the energy alliance had become little more than another layer within the bureaucracy at the office of urban development. by the end of 2011, the original funding for the energy alliance was mostly spent. while some of that money went into loans to a handful of homeowners, much of it went to pay for a large retrofit of a public building and for two-years of salary for a single job. no meaningful process had been piloted or developed in relation to the energy alliance model. no equipment had been purchased. no extensive public education or marketing advances in social work, summer 2012, 13(2) 404  campaign had been engaged; and visibility is foundational to successful cesd (rubin & sherraden, 2007). rather than creating a new process to coordinate community resources addressing community needs, and developing a local model for dealing with a global crisis . . . $239,000 in stimulus funding had gone to create a sleepy bureaucratic office and a single job. in an october 21, 2011 story by patrick springer, it was noted that the state where this work had occurred had “finished last among the states in a ranking of progress in striving toward energy efficiency.” the same article noted that the state was among “the 10 states ‘most in need of improvement (springer).’” the director of the great plains institute noted that the state stands “out for a lack of leadership (springer).” conclusions and connections to social work although the tangible results were disappointing in relation to the expectations of the feasibility study and its authors, the fact is that the work had multiple direct and tangential benefits. the efforts to create an energy alliance were central to the city’s receipt of eecbg moneys. fed by those funds the larger, umbrella effort known as the g-3 produced multiple projects that benefitted the city, including traffic light coordination, more efficient public buildings, development of a greenhouse gas inventory (updated annually), an improved recycling program, along with various other projects, awards, and additional eecbg funds. the director that was hired specifically to run the energy alliance did not fulfill the hopes outlined in the feasibility study, but she came to be seen as the lead for the g-3 and was able to leverage that work into a job with the state as vice chairwoman of the state chapter of the u.s. green building council. utilizing rubin and sherraden’s concept of cesdos (community economic and social development organizations) helped to benefit the community. the volunteers who participated in this project were successful in creating a new organization within the city government and in procuring energy efficiency and conservation block grants. the program did not perform as well as was hoped in relation to providing economic relief for moderate-income families or spurring local economic development, but the energy alliance continues to exist, which may provide an avenue for future change efforts (though it has not had a customer for over a year). the city has also maintained the alliance’s website, and support for a more sustainable community is still broad within city government. there is a widely held misconception that global issues like climate change can only be solved at the international level. while international cooperation may be a necessary component of the multi-layered solutions required, it is a mistake to neglect the need for local action. furthermore, the reality is that international corporations and treaties, along with national policies have largely been—directly and indirectly—the cause of global climate change. large governments, corporations, and various international institutions will inevitably seek to protect their interests with the result that, as noted by rothman (2007), there is always a “danger that the large-scale components will dominate” and that national and even international objectives will receive greater support from institutions such as the world bank “at the expense of the grassroots component (p. 26).” weber/ social work and the green economy 405 similar to rothman’s caution above, kretzmann and mcknight (1993) warn community practitioners about the dangers inherent in handing off grassroots efforts too soon to more-powerful institutions. the efforts to develop a community-focused energy alliance were indeed largely co-opted by the municipal government and its needs, and buffeted by a national election and the chase for federal funds. while aware of this potential danger, volunteers were concerned that to delay further to build and strengthen their grassroots effort would have been too risky; the window of availability to receive federal funds necessary to launch the alliance, and the very short time to react to this unexpected opportunity, seemed more compelling at the time. issues of timing also played out in the very real (and too frequent) context of volunteer burnout. the early phases of the energy alliance clearly had compelling ideas, the offer of professional services, and a near abundance (at least according to our budget proposals) of necessary capital. however, most of the other components were largely dependent on the second ingredient—capable leaders. the team had developed a strong base of support during the first phase, but as we handed off the project there was a corresponding decrease in that support. the new director aligned herself with the most immediate dayto-day interests and concerns of her employers in city government rather than the auditors, contractors, bankers, and most importantly the homeowners necessary for an energy alliance. the limited education and marketing efforts engaged by the energy alliance were largely directed by technocrats who did little to go beyond basic messages about the need for energy efficiency—there was no connection to global issues or the possibility of new ways to organize communities. instead of building a process independent of city government, the energy alliance became part of a perpetual bureaucracy with its inherent tendencies toward self-preservation and limited innovation. as had been anticipated during the writing of the feasibility study, instead of creating jobs, assisting thousands of homeowners, and making a real reduction in greenhouse gas emissions, the city was nominally involved in completing work on little more than a dozen homes—at tremendous relative expense—and then celebrated its success. energy alliances offer a model to move beyond the tired paradigms of government versus market forces and offer a promise to meet the “growing need to build human and social capital, develop employment and training opportunities, and ensure basic rights” (weil & gamble, 2005, p. 142). this type of innovative idea represents just one avenue for social work engagement in sustainable community development—an opportunity that gamble and hoff (2005) predict will continue to expand over the next two decades or so. further, they note the unique role that social workers are positioned to play as ethical facilitators and mediators for “citizens forced to choose among competing values and development approaches” (gamble & hoff, 2005, p. 184). this work had begun with a model deeply embedded in social work values, including efforts “to enhance human well-being” . . . “with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty (nasw, 2008, code of ethics, preamble).” furthermore, it was a model to connect communities around the world. it remains possible that a successful pilot could be replicated in similar communities in the united states, to the north in canada, and on the other side of the world in china or bangladesh where increasingly industrialized economies are generating advances in social work, summer 2012, 13(2) 406  growing energy demand, and where the results of climate change are potentially most threatening. it is a model that embraces self-determination and understands that the person exists in their environment, including their social and their physical environment. this paper began by chiding social workers, especially in the united states, for not paying sufficient attention to environmental issues. the model of coordination and collaboration inherent in an energy alliance offers hope for transforming other aspects of community both on the local and the global level, and a way to operate beyond restrictive paradigms that such work must fall under either government-led efforts or be driven completely by capitalist markets. social workers have a moral obligation to involve themselves in such work, and to take leadership (macy & brown, 1998; orr, 1994; zapf, 2009). what joanna macy (macy & brown, 1998) refers to as the ‘great turning became clear:’ …if there is to be a livable world for those who come after us, it will be because we have managed to make the transition from the industrial growth society to a life-sustaining society. when people of the future look back at this historical moment, they will see, perhaps more clearly than we can now, how revolutionary it is (p. 17). references barkdull, c. (2007). making ends meet in grand forks and east grand forks: are area families working harder? unpublished manuscript. bonzer, m. (2008). green3 grand forks action plan. retrieved from http://www.grandforksgov.com/reports/draft%20g3%20grand%20forks%20actio n%20plan%20%28oct%2008%29.pdf chopra, a. (2009, march 26). how global warming threatens millions in bangladesh, u.s. news. retrieved from http://www.usnews.com/news/energy/articles/2009/03/26/how-global-warmingthreatens-millions-in-bangladesh gamble, d. n., & hoff, m. d. (2005). sustainable community development. in m. weil (ed.), handbook of community practice (pp. 475-493). thousand oaks, ca: sage publications, inc. harmeling, s. (2010, december). global climate risk index 2011: who suffers most from extreme weather events? weather-related loss events in 2009 and 1990 to 2009. retrieved from http://germanwatch.org/de/download/2183.pdf kretzmann, j. p., & mcknight, j. l. (1993). building communities from the inside out: a path toward finding and mobilizing a community's assets. evanston, il: institute for policy research. lawson, h., & barkdull, c. (2001). gaining the collaborative advantage and promoting systems and cross-systems change. in a. l. sallee, h. a. lawson, & k. briarlawson (eds.), innovative practices with vulnerable children and families (pp. 245270). dubuque, ia: eddie bowers publishing, inc. weber/ social work and the green economy 407 macy, j., & brown, m. y. (1998). coming back to life: practices to reconnect our lives, our world. gabriola island, bc, can: new society publishers. national association of social workers. (2008). code of ethics. retrieved from http://www.socialworkers.org/pubs/code/code.asp orr, d. w. (1994). earth in mind: on education, environment, and the human prospect. washington, dc: island press. rothman, j. (2007). multi modes of intervention at the macro level. journal of community practice, 15(4), 11-40. rubin, h. j., & rubin, i. s. (2001). renewing hope within neighborhoods of despair: the community-based development model. albany: suny press. rubin, h. j., & sherraden, m. s. (2005). community economic and social development. in m. weil (ed.), handbook of community practice (pp. 475-493). thousand oaks, ca: sage publications, inc. sierra club. (2011). solving global warming one city at a time. retrieved from http://coolcities.us/about.php?sid=c80a9c633df6a1f3b7bbd9de41c64fa1 springer, p. (2011, october 21). north dakota gets failing grade for energy efficiency. grand forks herald, p. b1. tropman, j. e. (1997). successful community leadership: a skills guide for volunteers and professionals. washington, dc: national association of social workers. united states conference of mayors. (2007, june). the united states conference of mayors’ energy and environment best practices. retrieved from http://www.usmayors.org/uscm/best_practices/eandebp07.pdf university of north dakota. (2007). 2007 nobel peace prize connects with und climate scientist. retrieved from http://www2.und.edu/our/uletterarchive/print_article.php?uletterid=3156 weil, m., & gamble, d. n. (2005). evolution, models, and the changing context of community practice. in m. weil (ed.), handbook of community practice (pp. 475493). thousand oaks, ca: sage publications, inc. yunus, m. (2009). creating a world without poverty: social business and the future of capitalism. new york: public affairs. zapf, m. k. (2009). social work and the environment: understanding people and place. toronto, can: canadian scholars’ press inc. author note: address correspondence to: bret a. weber, phd, msw, lcsw, assistant professor, department of social work, university of north dakota, gillette hall, room 109-b, 225 centennial dr. stop 7135, grand forks, nd 58202-7135. email: bret.weber@email.und.edu  microsoft word herz_johansson_1976_copyedit final ______________ marcus herz is a social work ph.d. student in the department for law, psychology, and social work at örebro university in örebro, sweden. thomas johansson, ph.d., is a professor of education in the department of education, communication, and learning at göteborg university in göteborg, sweden. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 527-540 ‘doing’ social work: critical considerations on theory and practice in social work marcus herz thomas johansson abstract: social work is a multi-dimensional and contradictory field of practice, which often leads to theoretical confusion. another tendency within social work today is the development of an evidence-based practice. this kind of social engineering, together with the theoretical confusion, might lead to the reproduction and strengthening of dominant discourses and perspectives. pointing out the need for critical theory to transgress and resist hegemonic practices, the article aims to present ideas on how to theoretically position social work practice within a framework of critical theory. the question is how to combine an ambition to develop suitable methods and to anchor social work in a sound social-scientific context with critical theories concerning, for instance, gender, ethnicity, and class. it is suggested that a movement towards a more deconstructive and reflexive mode of thinking and practicing social work, ‘doing social work’, would enable the field to become more ethical and reflexive. keywords: critical theory, doing gender, evidence, reflexivity introduction feminists and postcolonial theorists have formulated a massive critique of social work, accusing it both of being gender blind and of neglecting critical perspectives on power, ethnicity, and the social situation of immigrants (herz & johansson, 2011). an increasing number of academic studies on these issues show that social work practices often are influenced by stereotypical views on gender and ethnicity (burck & gwyn, 1995; dominelli, 2008; sue, 2006). although a critical tradition in social work has a long history, often known as critical social work, it has often focused mainly on creating awareness among, and strengthening, clients (fook, 2002) or sometimes on how to work directly with clients (englar-carlson & shepard, 2005; white, 2004). in order to be able to meet the challenges stated above, our framework is directed toward producing change in the social worker’s thinking, and to seek a possible convergence between critical social work and evidence-based practice (ebp). what we are suggesting is a development towards a meta-reflexive way of thinking, where social workers examine their own work. this differs from other critical approaches which often seem to completely seek to reject and replace ebp (fook & gardner, 2007; pease & fook, 1999). another reason for this need is the appearance of new emerging challenges. one such emerging challenge is the strong tendency within social work to develop evidence-based and scientific methods, methodologies, and approaches to social problems. this kind of social engineering often leads to an ambition to promote certain methods and methodologies singled out as superior, and to discard ‘unscientific’ methods. while this may very well be a necessary way to proceed in a field of practice and research populated by a diversity of methods and approaches, herz, johansson/‘doing’ social work 528 there is also a risk that critical methods and alternative ways of working with social problems are thrown out with the bathwater. as we know, social engineering and critical theory are not compatible perspectives – rather the opposite (marcuse, 1964). whereas social engineering often leads to the reproduction and strengthening of dominant discourses and perspectives, the ambition of critical theory is to transgress and resist hegemonic practices and ideologies. social work is deeply embedded in hegemonic practices, taken-for-grantedness, and everyday-life commonsense views. therefore, it is even more important to reflect upon and constantly scrutinize this professional practice. social work is to a great extent a normalizing practice (payne, 2005; payne, adams, & dominelli, 2002). social workers are not on a mission to change society and resist power structures; nevertheless they do have to confront and reflect upon these structures. their profession is therefore stuck between upholding societal norms and practices and needing to confront and change some of these structures. feminist and postcolonial critiques of social work have focused on the strong tendencies of essentialism and naturalism inherent in this clinical field of practice. in this article we will investigate and explore the potential conflict between, on the one hand, social engineering and evidence-based social work, and on the other, critical social work. we will suggest an alternative way to approach and deal with social work practice and theory. our ambition is not to criticize the ambition to base social work on more firm scientific grounds, but to present some thoughts and considerations on how to develop theoretical and scientific approaches to social work as a critical practice. this article is mainly a theoretical work, and we will use examples and pertinent literature in order to develop our thoughts. the purpose is to present some ideas about how to theoretically position social work practice within a framework of critical theory. how can we combine the ambition to develop suitable methods and to anchor social work in a sound social-scientific context with critical theories of gender, ethnicity, and class? our position is that it is important to use a constructivist, contextual and societal approach to enable these questions. often an evidence-based, social engineered social work and a critical stance are kept and described as separated because of their built-in differences. for instance the first approach often focuses on the individual and lacks knowledge about the context; it also addresses knowledge as something essential regarding how subjects “are”. a critical approach on the other hand focuses on society and is based on contextawareness. the subject and society are seen as social, historical and cultural constructions (herz & johansson, 2011). our ambition is to get these different approaches to converge by contributing to a development of increased self-criticism and reflexivity in social work. we will explore this in three sections. first we develop our critique of contemporary fallacies and problems in the theory and practice of social work, after which we present and discuss theories of ‘doing’ as used in relation to, for instance, gender, ethnicity, families, and class. thereafter follows a section in which we explore the possibility of introducing the concept of doing into social work; and the final section is devoted to the conclusions to be drawn from this critical exploration and reflection. advances in social work, fall 2012, 13(3) 529 fallacies in social work a strong tendency in contemporary social work is the movement towards a social practice based upon scientific evidence of what actually works. this has led to an increase of so-called evidence-based methods, systems, and manuals in social work practice (blom, 2009). this development could be seen, to varying degrees, in countries like sweden, australia, england, canada and in the usa (gray, plath & webb, 2009; kufeldt, vachon, simard, baker, & andrews, 2000; wise, 2003). criticism of this movement often concentrates on problems in measuring what really works. but some criticism has also been directed towards the neo-liberal individualization of ‘social problems’ that seems to follow upon the implementation of evidence-based practice (ebp) (webb, 2001). although it is by no means clear or uncontroversial what ebp is or how to interpret it (morago, 2006; payne, 2005), the requirement to implement ebp has in part had some real consequences. one such primary consequence is what could be called the increase of a manual-based social work. these manuals and systems are based on specific theoretical assumptions regarding both the individual and society (garrett, 1999a, 1999b, 2002; herz & johansson, 2011). the underlying theoretical assumptions are often barely mentioned and they are definitely not elaborated or visible in the different methods of measuring the effects of social work (socialstyrelsen, 2006). in britain the so-called munro report, on behalf of the department for education, recently presented its final report. the report argues for a move away from these kinds of assessments often used as part of ebp. instead it is a clear push towards the use of locally emerged knowledge and the social work expertise. rather than using systems increasing rules, prescription, and bureaucratisation, munro advocates social workers meeting with children and families, and the profession’s own development of knowledge and skills (munro, 2011). this critique and the upcoming work in britain are interesting and might even lead towards a social work where parts of the problems we suggest here can be avoided. however, many systems, manuals, and methods are still in use, and the future social work implied in the report still needs to take these fallacies into account. in social work, materials that are in use and are considered evidence-based often are based upon psychological or psychiatric knowledge. this tendency reflects a psychologization of society at large (johansson, 2006, 2007, 2008; rose, 1999). in itself this need not be a problem, but it does seem to shift the focus of social work more or less exclusively towards the level of the individual. ‘social problems’ are seen as personal shortcomings and therefore as best addressed on an individual level. this eventually leads to other levels that affect different individuals’ social lives, such as positional and structural levels, being diminished or even completely forgotten (herz & johansson, 2011). social work has been criticized for strengthening a static, ‘traditional’, and sometimes even repressive view on positional power-asymmetries, such as for instance gender, sexuality, and ethnicity (burck & gwyn, 1995; dominelli, 2002, 2004, 2008; sue, 2006). others have criticized social work’s lack of interest in the impact structural issues actually have on people’s lives (järvinen & mik-meyer, 2003; mik-meyer, 2004). the implementations of ebp in social work risk further reinforcing this development. many of the manuals and systems that are being used lack a critical view of positional factors and tend to ignore structural impact. instead, evidence-based methods are supposed to work more or less regardless of the impact herz, johansson/‘doing’ social work 530 of structural circumstances (see ward, 2000, on the supposed universality of the looking after children system, lacs, and the criticism by garrett, 1999a, 1999b, 2002). social work is performing on the one hand moralizing work on the behalf of society, and on the other hand supportive work with individuals, groups, and on the societal level. given this background it is hard or even impossible to ignore the demands for evidence-based social work, since one of its tasks is to present good results. but on the other hand, there is a risk that unwanted effects – such as strengthening gender-relations that do not mesh with gender-equal opportunity policies – will be reproduced. one such example is how gender is handled in the widely used system looking after children (lac or sometimes lacs), in which it is stated that children need positive same-sex role-models to develop a positive identity (horwath, 2000; socialstyrelsen, 2006). this idea tends to strengthen rather static images of gender, and has been heavily criticized by feminist researchers (hicks, 2006). it is important to remember that all knowledge is constructed in a political and historical context, and the systems, manuals, and tools used in social work are, of course, no exception (nylund & nylund, 2003). the systems and manuals therefore contain theoretical assumptions about, for instance, gender, ethnicity, and other positional power asymmetries. this means that it is important to retain a critical stance in social work. there is clearly a rift between on the one side more psychologically influenced and evidence-based social work and on the other side structural and critical social work. while structural social work obviously integrates a structural level into practical social work, and critical social work further includes a positional level, these levels are often lacking in more psychologically influenced social work. social work faces the challenge of integrating, for instance, ebp-models with a more critical approach to different levels of analysis. the literature in the field of social work sometimes approaches this gap between individually-oriented social work and critical social work. however, it is seldom properly analysed (payne, 2005). often the various different approaches to social work are presented and the reader is left with a simple choice of which theory or method to use in different situations. one way to begin loosening this tension could be to introduce the concept of ‘doing’ within social work. in the next section we will turn our attention to theories on doing gender, ethnicity, class, and families before returning to how this concept could be put to use in social work practice. doing instead of being the phrase ‘doing gender’ was originally coined in an article by candace west and don zimmerman in the 1980s (west & zimmerman, 1987). initially this term/concept was developed within the fields of symbolic interactionism and ethnomethodology. the term ‘doing’ conveyed the socially constructed nature of gender. rather than viewing gender as something fixed, as being, gender and sexuality were seen as ongoing processes of doing. these authors, however, are still working within the paradigm of gender differences. there is a marked difference, for example, between west and zimmerman’s concept of doing and judith butler’s concept of doing gender. in a recent article, west and zimmerman (2009) comment upon the historical development of the concept. although they celebrate its manifold advances in social work, fall 2012, 13(3) 531 uses and elaborations within feminist theory, they also reaffirm that gender cannot be totally undone, with reference to judith butler’s use of undoing gender, though it can be redone. the structures responsible for upholding a specific way of doing gender cannot be fully eradicated, but it is possible to develop less oppressive ways of doing gender (connell, 2010). when butler talks about undoing gender she talks about a rearticulation of gender as something new that includes groups of people previously excluded from normative assumptions of gender (butler, 2004). the main difference between the two seems to lie in to which degree how we do gender could change. reading the literature on ‘doing gender’ is actually quite confusing. an entire issue of gender & society was recently devoted to the concept of ‘doing’ (messerschmidt, 2009). in fact, many nuances and versions of the concept and its application are used in gender studies. sometimes it is used to designate quite stable processes of ‘doing’ gender, and at other times we find it twisted to denote a more radical transformation, with both ‘undoing’ and ‘redoing’ of gender. in short, our take on ‘doing’ is that these kinds of tools and concepts make it possible to focus on processes and on the ongoing construction of gender. it is, of course, possible to similarly speak of ‘doing family’ or ‘doing class’, for instance. the charm of the concept mainly lies in its ability to capture movement, processes, and the flavour of transformations in everyday life. when using the concept of doing, we also get closer to the actual processes going on in families and the intimate sphere of everyday life. before returning to the question of the connection between the concept of doing and social work, we will introduce a possible model and way of discussing and analysing processes of doing at different levels. we will use the concept in a much wider sense than is the case in gender theory. doing will here be a part of different processes of constructing and doing gender, class, ethnicity, family, and so on. this makes it possible to understand doing as vertically differentiated; in other words, doing must be understood as something layered and comprising different analytical levels. of course, these levels influence and affect each other. moreover, doing also has to be understood as differentiated horizontally with different positions being made differently. finally, doing takes place within a framework consisting of everyday reflexivity. some appraisals of the concept of ‘doing’, however, have viewed it as neglecting structural injustice. fraser (2007) for instance, points out the importance of a ‘twodimensional approach to gender justice’. by that she means that one cannot merely focus on recognition (i.e. identity politics) without also theorizing distribution (i.e. differentiated status based on gender). we consider it important to take both dimensions into account simultaneously – to pay attention to structural injustice at the same time as you pay attention to the subject standing in front of you – but without needing to assume that either of these two levels is the determinant. both structural as well as individual gender relations are still being made and are constantly a part of ‘doing’, though sometimes in different ways. they both have to be analysed like this in order not to risk strengthening and reproducing undesired power-relations and positions. our model of ‘doing’ therefore takes both levels into account. vertically, the concept of doing is understood through different analytical levels (see figure 1). at a cultural level, doing will be expressed in the form of language games (wittgenstein, 1953/1973). the identity process will be constituted by these language games, and by the naming of different social and cultural phenomena. herz, johansson/‘doing’ social work 532 through language, and in a performative fashion, sexuality, gender, and identity are constructed. bodies are not merely described – in language and by naming – they are also constituted and constructed (butler, 1990, 2004). at a social level, doing is expressed as social interaction. when we meet people face-to-face, we also become part of a social game in which bodies, movements, and contact between different people lead to certain scenarios. at this level, identity takes the form of different rituals (collins, 1997). these rituals are, of course, also constituted and developed in language games, but they are also social in the sense of being a rudimentary form of social exchange preceding the creation of groups, organizations, and institutional settings. finally, we also have physical aspects of doing. doing, to a great extent, is also a bodily phenomenon. through movements in space, clashes between bodies, and the identity process of embodiment, practices are also very physical and concrete (ahmed, 2004, 2007). these three different levels certainly interact and make up complex patterns of doing. figure 1: different levels of ‘doing’ however, different positions are being done differently. this means that apart from understanding the different levels of doing, we also have to understand and know about the different power-relations connected to positions, such as gender, class, ethnicity, race, or sexuality. the reason is that different positions are constructed, staged, and embodied differently. gender, and more importantly differences based upon gender (such as femininity and masculinity), are in many ways connected to bodily differences, as might not be the case with sexuality, for instance. when walking through town, the act of doing difference based on gender advances in social work, fall 2012, 13(3) 533 may more easily crystallize through practices and embodiments such as style, clothes, or hair. doing differences based on sexuality could manifest itself in another way. a form to be filled out at the local social services office that is marked ‘the man’s signature’ and ‘the woman’s signature’ could instead point at sexuality, and not first and foremost at gender, although they are of course interrelated. differences and power-asymmetries based on race are also done differently than those based on class, for example (mattsson, 2010). in addition, this means that we might need different theories to understand and be able to analyse different positions. to be able to understand gender we need to turn to feminist research and theories on ‘doing gender’; to comprehend ethnicity and race, we might have to go to postcolonial research and its attendant theories. this should not be read as meaning that doing gender is completely separated from doing ethnicity, family, or sexuality. on the contrary, positions are intersectionally connected to each other, interrelate with each other, and could both strengthen certain patterns as well as eclipse each other (crenshaw, 1989, 1991; staunæs, 2003; yuval-davies, 2007). for instance, gender and race could reinforce certain power-relations and thereby, for example, affect black women’s lives and opportunities in a specific way (hill collins, 1998), while in other situations one position could be given more importance than the other. the reason for distinguishing between different levels of doing is first and foremost to put the concept in relation to different theories of the construction of identity and practices. in doing this, we will promote a multilayered understanding of doing social work. this will help us to discern and analyse different aspects of social practices and attempts to intervene in social life. the reason for bringing doing into social work practices is that this will lead to better and richer analyses of the complex work being done. doing is a part of everyday life reflexivity, and thus instead of locking ourselves into a certain understanding of situations, people, and ‘social problems’, we will be able to set social reality and social practices in motion. by implementing this perspective on doing, we will also find better ways of dealing with ‘social problems’. social problems are not stable phenomena, but instead are defined, constructed, and named. what we are dealing with, briefly stated, are social processes of doing social work. doing social work social worker 1: he’s a boy, for starters. boss: mmm social worker 1: everyone knows about the case, right? we don’t have to say too much about their background. so, where should we start? social worker 2: alright, risk-factors... on an individual level. ok, he is a boy. actually we don’t know that much more about him. social worker 1: he’s been a problem at school. social worker 2: mmm. he has difficulties at school. social worker 1: that was improving, just before his mom passed away, but now... we don’t know social worker 2: is it that he’s having difficulties learning, and such? herz, johansson/‘doing’ social work 534 social worker 1: not that we... no, he hasn’t had any problems relating to people and stuff like that boss: easy relating to people, does that mean he is a nice boy? social worker 1: he is a bit of a tough kid. well, he looks trendy and is most likely good-looking in the eyes of his girl peers. or, well, you might say [...] it depends on who’s looking at him, because an older person might think he’s a brash, cool guy, you know, with a cap sidewise with some brand-name on it and a hoodie. so i don’t know, you might. this conversation took place at a social services office during a meeting about a young boy under consideration for an intervention by the social services.i the quote shows how different positions interrelate and are used by the social workers to make an assessment in the case. at this meeting, the social workers used two different but compatible evidence-based systems, bbic (‘barns behov i centrum’, the swedish version of the british ‘looking after children system’, lacs) and ester. ester is a system for assessing young people’s risk of developing antisocial behaviour (andershed & andershed, 2010). we will not dwell on the systems themselves, but rather point out some interesting statements and conceptions they are based on. after doing this we will suggest how the concept of ‘doing social work’ could be of help in avoiding some of the pitfalls an uncritical and unreflexive approach to positional power-asymmetries might entail. first of all, gender is being highlighted. the fact that, biologically, the client is a young male is made important and is treated as synonymous with being at risk. when the social worker stresses that the client is a boy, this is noted on a whiteboard by the supervisor under the heading of ‘risk’. one reason why the social workers put so much emphasis on this is that the assessment-system ester states that boys are more likely to be exposed to and get involved with antisocial behaviour (andershed & andershed, 2010). even if this may be statistically valid in general, on an individual level the social workers’ assessments and decisions based on this assumption might lead to these constructions of masculinity being constantly reproduced. for example, boys in sweden receive treatment and other interventions to a greater extent than girls (brunnberg, 2002). an assumption of risk based solely on gender might cause this imbalance to continue or even grow. later in the conversation, another aspect of different power relations based on positions is brought up. first they say the boy is good looking in the eyes of female peers. this is a heteronormative assumption, based on the conception that attraction solely occurs between men and women (butler, 2004). the boy is considered beautiful in the eyes of girls, not other boys. but then something further happens, when the social worker adds age as a factor. now, the boy might not be seen as beautiful anymore, but instead as arrogant, cool, and maybe a bit cocky. here the combination of different positions creates different assessments. one possible reason why appearance is given so much attention in the discussion could be because it is stressed as an important factor in both the swedish bbic and the british lacs, for instance regarding clients’ awareness of how other people might perceive their looks (department of health, 2000). the above example shows us how different positions, such as age and gender, might be used and interpreted differently. the manuals and systems used for the advances in social work, fall 2012, 13(3) 535 assessments provide the social workers with statistical information and point them in certain directions regarding questions to ask and possible outcomes. by doing so, and by not going any further than this point they might lead to certain notions of, in this case, gender and age being reproduced. for instance, the belief that boys, because of their biological self, need more support to avoid developing anti-social behaviour might in itself lead to an increase in statistics on boys coming to the attention of the social services. therefore, social work needs to develop a more dynamic view of gender, race, ethnicity, sexuality, and other positions. when engaging in ‘doing social work’, these above-mentioned assumptions must therefore be put into context and analysed as being parts of constructions on different levels; and most importantly, as being precisely that: constructions. what on one level seems to be clear, could under the influence of another be understood as exactly the opposite, or rather, as something complex and fluid. we will suggest that social work needs to turn towards a view of theory and practice as being part of everyday reflexivity. instead of relying heavily on psychological conceptions and stable notions of personality/identity, we would like to see a movement in the direction of processes and reflexivity. by introducing the concept of doing social work, we aim to promote changes in how social workers approach, evaluate, and assess ‘social problems’. instead of taken-for-granted social appearances and behaviors, we propose that social workers use a process perspective, and focus on bodily practices, social interaction, and language games. while race, gender, age, sexuality, and class, for example, are often treated as stable categories, almost as parts of a personality, we suggest that these ‘categories’ are constantly evaluated, deconstructed, and put into motion. doing social work would then be a demanding social practice, with critical and ongoing discussions about changes at the physical, social, and cultural levels as an important tool and practice. through questions such as: ‘what does gender mean here?’ ‘what is a modern family?’ and ‘what does cultural difference mean?’, we could set social work in motion. this means that social work needs to develop a practice in which critical evaluations are a part of everyday social work. by raising reflexive questions on the meaning of positions such as gender, and actively relating to different notions of these positions, social work could avoid static assumptions that can lead to an unreflective reproduction of positions. when analysing and questioning different approaches to, for instance, ‘doing family’, and putting this into the context of the current client’s life, it is possible to both acknowledge differences on a structural level and differences in people’s approaches to these discourses. by doing this it is also possible to avoid the trap pointed out by fraser (2007) above: to either presume that people unreflectively live their lives in conformity with structural elements; or to do the opposite: to believe that people can live their lives free from the influence of the same elements. instead, our concept of ‘doing social work’ makes possible a reflexive analysis of how the client, under the influence of different levels, does gender, for instance. doing social work means being in constant contact with everyday reflexivity, and being prepared to engage in critical discussions on processes. this would be a vital herz, johansson/‘doing’ social work 536 and highly relevant alternative to the sometimes careless use of categories and the problems of reification that trouble the profession. what we are suggesting is a development towards a meta-reflexive way of thinking, where social workers put their own practice under the microscope. categories of differences and power-asymmetries have to be understood theoretically through different analytical levels, not as static notions. gender could for instance be given different significance depending on which level; bodily, societal or cultural, and how it is being related to other categories. through the use of a meta-reflexive approach, social work might be able to set static notions in motion, towards a social work more sensitive towards changes and differences. conclusions our ambition has been to identify, investigate, and explore some dubious developments within social work. we also had the purpose to suggest and develop a method to use for a reflexive approach to practice. our center of attention has therefore been on the social workers themselves, suggesting the development of a meta-reflexive approach. this, of course, does not mean that our proposal in extension cannot get clients to benefit as well. the critique thus serves as a starting point for the development of a reflexive mode of thinking about and relating to social work practice. in order to counteract tendencies towards individualization, fragmentation, and psychologization – however weak or strong these are in different settings – we have introduced the concept of doing social work. instead of locking social workers into certain conceptual frameworks and notions of being a social worker, we suggest a movement towards a more deconstructive and reflexive mode of thinking and performing social work. further we also suggest that this way of reflexive thinking and performing also could be employed by social workers who already make use of postmodern and critical approaches. this could somewhat be seen as a way of work compatible with the results from the british munro-report, changing focus from “a compliance to a learning culture” (munro, 2011, p. 129). contemporary social work faces a number of challenges, the first of which being the above-mentioned criticism that it strengthens specific hegemonic notions of positions, for instance gender. another is the implementation of evidence-based social work, which presents new challenges like the requirement of measurability and the sometimes static positions that may be adopted to meet this requirement. these parallel developments increase the importance of developing a form of social work that does not rely on imaginative or common assumptions regarding people’s identities and lives. instead of locking people into static positions and closed identities, ‘doing social work’ makes it possible to develop a truly ethical and reflexive position and a new professional identity. another challenge for contemporary social work is to meet the demands of a more solid scientific practice. however, it is equally important that social work find ways of keeping an ongoing critical discussion alive, on what evidence is and what effects it can have. the question is how to combine the ambition to anchor social work in this sound scientific context with critical theories concerning, for instance, gender, ethnicity, and class. we suggest that a movement towards a more advances in social work, fall 2012, 13(3) 537 deconstructive and reflexive mode of thinking and practising social work, ‘doing social work’, would enable the field to become more ethical and reflexive. references ahmed, s. 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(2000). the developmental needs of children: implications for assessment. in j. horwath (ed.), the child’s world: the comprehensive guide to assessing children in need (pp. 167-179). london: nspcc and the university of sheffield. webb, s. a. (2001). some considerations on the validity of evidence-based practice in social work. british journal of social work, 31(1), 57–79. west, c., & zimmerman, d. h. (1987). doing gender. gender & society, 1(2), 12551. west, c., & zimmerman, d. h. (2009). accounting for doing gender. gender & society, 23(1), 112-22. white, m. (2004). folk psychology and narrative practices. in l. angus & j. mcleod (eds.), the handbook of narrative and psychotherapy: practice, theory, and research (pp. 15-51). thousand oaks, ca: sage publications. wise, s. (2003). an evaluation of a trial of looking after children in the state of victoria, australia. children & society, 17, 3-17. wittgenstein, l. (1953/1973). filosofiska undersökningar. stockholm: bonnier. herz, johansson/‘doing’ social work 540 yuval-davies, n. (2007). intersectionality, citizenship and contemporary politics of belonging. critical review of international social and political philosophy, 10(4), 561–574. author note: address correspondence to: marcus herz, department for law, psychology, and social work at örebro university, sweden. email: marcus.herz@oru.se i the quote is taken from one of the authors’ ongoing phd-thesis on how gender and ethnicity are made, used, and understood in social work. this specific quote was collected during an ethnographic study conducted in 2010 at a meeting with a group of social workers responsible for conducting investigations in a municipality in sweden. the use of the bbic-system (equivalent to the british lac system) is common in sweden, and the state supports the implementation (www.socialstyrelsen.se). the estersystem, however, is relatively new, but the number of municipalities using it is steadily increasing (www.ester-bedomning.se). advances vol. 3, no. 2 146 poetry therapy as a tool for strengths-based practice rich furman eleanor pepi downey robert l. jackson kimberly bender abstract: this article explores the congruence between poetry therapy and the strengths perspective of social work. it demonstrates the ways in which poetry therapy is consistent with the strengths perspective and discusses methods for its utilization in direct practice settings. case examples are provided to help the practitioner learn how to utilize poetry therapy with clients from diverse backgrounds. as a tool in strengths-based practice, poetry and poetry therapy can help empower clients and help to focus practitioners on clients’ capacities and resilencies. this article seeks to expand upon the growing literature of strengths-based social work, addressing how the theory can be applied to clinical practice situations. keywords: poetry therapy, strengths perspective, social work practice currently, the strengths perspective is rising to the forefront as one of themost important and influential guides to practice for social workers (chapin, 1995; lewis, 1996; logan, 1996; perkins & tice, 1994; saleebey, 2002; vanwormer, 1999).while many of the values and principles of the strengths perspective are not new (maluccio, 1981; robinson, 1949; smalley, 1967; taft, 1939), its development and conceptualization as a separate perspective dates back only slightly more than a decade (graybeal, 2001;weick, rapp, sullivan, & kishardt, 1989).while the underlying assumptions, values, and precepts have been well articulated (early, 2000; saleebey, 2002), intervention techniques and practice methods related to the perspective need further development and articulation (de jong &miller, 1995). there are techniques that readily lend themselves to possible inclusion under the rubric of the strengths perspective. one such approach is poetry therapy, the structured and therapeutic use of reading and writing poems that seeks to draw out the innate resources andhealing power that liewithin each individual. as such, it is highly congruentwith the basic assumptions of a strengths-based approach to clinical practice. this article demonstrates the ways in which poetry therapy is consistent with the strengths perspective and discussesmethods for its utilization in clinical settings. rich furman, ph.d. is assistant professor, school of socialwork, colorado state university. eleanor pepi downey, ph.d. is assistant professor, school of socialwork, colorado state university. robert l. jackson, ph.d. is associate professor, university ofwashington-tacoma. kimberly bender, m.s.w. is a social worker at university counseling services, colorado state university. copyright© 2002 advances in socialworkvol. 3 no. 2 (fall 2002) 146-157. indiana university school of socialwork. 147 several issueswill be explored. first, a discussion of the healing and growth inducing aspects of poetry and poetry therapy are presented. second, the nature of the strengths perspective as complimentary with poetry therapy are discussed. third, the congruence between poetry therapy and the strengths perspective are explored by discussing key elements of the strengths perspective andhow these elements can be actualized through the use of poetry andpoetry therapy. fourth, case studies that demonstrate the integration of theory and practice vis-a-vis poetry therapy and the strengths perspective are explored. the curative natureofthe poemandpoetrytherapy as tools, poetry and poetry therapy have been successful in drawing out the inner capacities of individuals frommany different populations, including the chronically mentally ill (goldstein, 1987), the elderly (edwards & lyman, 1989), troubled children and adolescents (alexander, 1990; langosch, 1987; mazza, 1987, 1996; mazza, magaz&scaturro, 1987), veterans (geer, 1983), the terminally ill (mcloughlin, 2000), substance abusers (bump, 1990; leedy, 1987), and families (gladding, 1995). practitionersworkingindiversesettingsincludingwomen’sshelters(hynes,1987),nursing homes(edwards,1990;kazemek&rigg,1987),andelementaryschools (gladding,1987) have made use of poetry and poetry therapy. in addition, poetry has even been incorporated into family work (mazza, 1996), diversity work (holman, 1996), communitywork consciousness raising (kissman, 1989), and research (poindexter, 1998). poets and philosophers have been aware of the curative and healing nature of poetry for millennia. long before there were social workers or other helping professionals, poets and storytellers helped people deal with their deepest fears by echoing the struggles of humanity in their poems, myths, and stories (harrower, 1972). in hearing these works, people have learned that they are not alone with their pains; they are part of a greater struggle. the aristotelian concept of psychagogia (lerner, 1981), “the leading out of the soul through the power of art” (p. 8) predates freud’s notion of sublimation by more than a thousand years. aristotle discovered that through the process of creating poetry, people were able to transform their problems into power and their sadness into strength. many poets have discovered the liberational power of the poem in helping them maximize their own emotional and spiritual resources. for example, american counter-culture poet charles bukowski (1991) saw poetry as the “ultimate psychiatrist.” while poetry has been therapeutic to many “professional” poets, poetry can be therapeutic and used therapeutically withmany different groups of people. as a discipline, poetry therapy falls into the broader classification of bibliotherapy, the intentional use of poetry and other forms of literature for healing and personal growth (reiter, 1997).whilemany types of therapy are poetic in nature, poetry therapy is a separate entity (rothenberg, 1987), with several professional organizations and journals devoted to its development (napt, 2001). those who identify themselves as poetry therapists include psychiatrists, psychologists, counselors, substance abuse specialists, and social workers. table 1 shows some useful resources for exploring poetry therapy. lerner (1981) defines poetry therapy as the structured use of reading andwriting poetry and similar literary genres to facilitate therapeutic goals. he draws a disfurman et al./poetry therapy as a tool for strengths-based practice 148 advances in socialwork tinction between a poetry therapy group and a poetry workshop in that the former uses poetry as a means to accomplish treatment goals, whereas, poetry therapy uses poetry as a means to an end. gladding & heape (1987) note that popular music such as rap can be used to make the mediummore accessible. the strengths perspective and implications fortherapy to many, the construct of therapy represents an activity of practice that necessitates hierarchical patterns of practice that perpetuate or even accentuate social inequities.manymodels of therapy are associatedwith themedicalmodel of practice where the professional therapist seeks to help the patient “fix” some deficit or problem that lies within them. in many ways, the strengths perspective has been developed as a reaction against such approaches that pathologize instead of empower. unfortunately, therapy itself is now often identified with practice that disempowers and blames.this is unfortunate because therapy does not have to be conceptualized as a relationship between unequals that blames a client’s problems on personal deficits. finding a newmeans of reframing the process of therapy is essential, as this is one of the most common tasks that social workers undertake in their practice (gibelman, 2000). fook (1993) has explored therapy and casework as a means of overcoming oppression and altering social and personal inequities. creative uses of therapy and therapeutic arrangements can assist clients explore the social causes of their struggles and find themeans to overcome their structurally created bonds, thus, freeing energy for personal and social growth and transformation (fook, 1993; lee & pithers, 1980; mullally, 1993.) one principle of the strengths perspective is that the social worker is encouraged to work in collaboration and dialogue with the client. therapy need not be something that is done “to” people (saleebey, 2000) but can be conducted as a collaborative experience guided and driven by clients as a means of helping them maximize their internal and external resources and achieve their dreams. based upon the literature of resiliency, the strengths perspective challenges social workers to name address website national association for 5505 connecticut ave., www.poetrytherapy.org poetry therapy northwest, #280, washington, dc 20015; telephone: (202) 966-2536 the center of journal 12477w. cedar dr., #102, www.journaltherapy.com therapy lakewood, co 80228 journal of poetry therapy editor; nicholas mazza, ph.d., florida state university, school of socialwork, tallahassee, fl 32306 the arts in psychotherapy editor; irma dosamantesbeaurdy, ph.d.,world arts and cultures department, box 951608, los angeles, ca 90095-1608 table 1: useful resources for poetry therapy 149 help people utilize their skills and competencies in overcoming life’s problems. the strengths perspective does not deny the existence of problems, but asserts that maximizing the strengths and resources of individuals and groups is the best means of helping them overcome life’s challenges. saleebey (2002) describes the strengths perspective in the following way: practicing from a strengths orientationmeans that everything you do as a social worker (or therapist) will be predicated, in someway, on helping to discover and embellish, explore, and exploit clients’ strengths and resources in the service of assisting them to achieve their goals, realize theirdreams,andshed the ironsof theirown inhibitionsandmisgivings. (p. 3) the strengths perspective and implications fortherapy the strengths perspective rests upon a number of assumptions including empowerment, dialogue, and collaboration between social worker and client, membership, resilience, healing, and wholeness (saleebey, 2002). these assumptions are also consistent with the use and application of poetry in therapy and poetry therapy. the very engagement in the creative process can tap into inner strengths that are not always apparent and can draw out well-hidden resilencies (makin, 1998). in his expansion of maslow’s hierarchy of needs, gil (1990) postulates that creative expression is an essential human drive. it has been argued that when the drive is expressed, humans are freer to solve their problems, think creatively, and maximize their potential. if creative expression is difficult for clients with multi-stressors and overwhelming responsibilities, engaging clients in creative processes such as creating poetry can help liberate energy that can be utilized for growth and healing (wade, 1997). talerico (1986) notes that engagement in the creative process encourages the development of many skills that social workers attempt to instill in their clients, such as expressing feelings, confidence through risk-taking, developing new insights, problem solving, conflict resolution, and reducing anxiety. other skills and resources can be maximized to develop writing and verbal abilities essential to successful participation in most social institutions. johnson (1983) asserts that the process of creation unleashes the healing potential within each person. as a key precept in strengths-based practice, this idea can find its roots in social work practice with the early functionalist scholars and practitioners. poetry therapy is not something done “to” people; it is ameans of engaging them in the process of maximizing their strengths and helping them achieve their hopes and desires. the strengths-based approach is entwined with constructivist practice insights and ideas. in both theories, one can view the lives of people as stories that are constantly evolving and changing. as authors of the stories of their own lives, people can reposition themselves and other characters and change the script to better reflect their visions and dreams. in therapy and other helping experiences, the social worker, thus, helps the client develop new ways of envisioning their future. themetaphors that lie at the heart of client stories and the narratives that guide howwe see people are extremely powerful in shaping our behavior (mazza, 1999). furman et al./poetry therapy as a tool for strengths-based practice cowger and snively (2002) discuss the powers of how certainmetaphors of disease have greatly shaped social work practice. deficit, disease and dysfunction metaphors have become deeply rooted in the helping professions, shaping contemporary social work practice through the emphasis on diagnosis and treatment of abnormal and pathological conditions within individuals. (p. 106) one effective way of helping clients re-author their lives is through helping them develop alternative metaphors for their lives. metaphor and metaphoric language are key therapeutic elements to poetry and poetry therapy.themetaphor, the symbolic use of language where an object or event represents another object or event, is a core means of organizing the human experience. people hold core metaphors that represent their images of themselves, their lives, and their futures. when disability or hopelessness characterizes themetaphors that clients hold for their lives, they see little hope in changing their lives. it is important to note that the use of metaphor is not appropriate to all client populations. for example, people with chronic and persistent mental illnesses such as thought disorders might find metaphoric language confusing and frustrating. in such cases, poetry that is concrete is far more acceptable and useful. often, metaphors are how clients talk about their lives. by speaking inmetaphoric language, clients are able to safely discuss issues that are often too painful to address directly. an example from the practice of the first author illustrates this point clearly. onemale clientwith a history of addiction anddepression envisioned himself as a bird that was locked in an iron cage. as he pounded his head against the bars day after day, year after year, he imagined that somehow this desperate act would free him from the agony of his enslavement. metaphorically, he was able to discuss howheusedhis teenagedrughabit to escapehismemories ofmolestation. by constructing such a metaphor, he was allowed to explore events that he was not ready to face directly. poetic explorations such as these enable clients to test their ability to deal with painful events and feelings slowly and safely. by helping clients discuss their prevailing metaphors and stories and affirming their creativity and courage in sharing, social workers can help them learn to see themselves as having strengthsandtheability toconquer theirpasts (rothenberg,1987;zahner-roloff,1987). guidelines fortheuseof poetrytherapy in practice some guidelines for social work practitioners who want to integrate a few of the techniques of poetry therapy into their strengths-based practice are discussed here. in regards to structure, lerner (1981) suggests that no table be placed between group members in order to avoid artificially distancing members. typically, the first author organizes the setting for poetry therapy groups using the same principles that guide more traditional groups, making sure that there is also comfortable space for people towritewhen asked to do individualwork. a fewdesks or a table should be provided, as not everyone is comfortable writing in their laps. as previously discussed, the very idea of writing poetry can be anxiety producing for some clients. houlding and holland (1988) have designed several creative methods for reducing client anxiety. in the first group session, they pass out poems with certain phrases blocked out. clients are asked to fill in the blanks with their 150 advances in socialwork 151 own words. the authors had found that this exercise eliminates the anxiety created by the forebodingness of a piece of blank paper. in early sessions, the authors utilized poems characterized by concreteness and neutrality, progressing to more metaphorical and emotionally laden work asmembers becamemore comfortable with each other and with the processes of poetry therapy. collaborative poems are useful in creating group cohesiveness (mazza, 1985), maximizing communication abilities and interpersonal skills and establishing a culture of productivity. one activity that is useful to groups is for the therapist to ask group members to identify feelings they want to handle better and resolve. members are broken off into pairs based upon the feelings that they chose. each subgroup is then given a poem that relates to the theme they had chosen, which they read and discuss together. the pairs are then instructed to write a poem together, exploringwhat the poemmeant to them.this process encourages empathy, as members who want to gain acceptance from their peers usually try to include the ideas of others. participants also learn that they can learn to work with each other and that other groupmembers can facilitate their healing and recovery. this helps to reinforce healthy patterns of mutual interdependence, an important concept in strengths-based practice. in one group session with veterans attending group therapy in an inpatient substance abuse treatment center, a group of three men choose to work on fear. this triad read a poemabout the topic, thenwrote an 11-line poemwith each line startingwith“fear is… .” as they completed each line, they provided feeling and insight with that line. some of the lines were, “fear is getting old, not knowing who i am,” “fear is dying young, not knowing my children,” “fear is failure on life’s own terms,” “fear is the future we don’t know,” “fear is the past we know too well.” after writing this poem, the triad shared its work with the larger group. they discussed the poem’s content and the process of working together. group members were encouraged to explore and were helped to identify their own style of communication, the areas of relating that are difficult to them, and the behaviors of others that trigger difficult feelings or behaviors. the poemelicited a discussion on ways of copingwith fears, a particularly difficult issue for veterans who suffer from post traumatic stress disorder triggered by combat experiences. the first author, as the therapist in this group, helped the group focus on acceptance of this fear as a natural and normal consequence of having witnessed such horrors and on recognizing the enormous strength that it takes to live with such memories. creating a collective poem is a collaborative exercise that usually centers on a theme discussed previously in the group. each member writes a line to a poem in process (first lines can be created by the therapist, a group member, or can be taken from an existing poem). an interesting extension of this exercise involves each group member writing a first line, then passing the poems around so that eachmember adds a line.this often results in useful feedback for the creator of the first line. applicationsof poetrytherapy andcase exam geer (1983) helped a vietnam veteran redefine his self-concept by using poetry therapy techniques to reconstruct his core life metaphor. during the intake, the furman et al./poetry therapy as a tool for strengths-based practice client described himself as a “marine/machine” who was only able to experience his emotions violently as a marine or repress them as a machine. he saw himself as powerless over his feelings and clearly saw how limiting these two options were. the more he tried to control his feelings, the more his feelings controlled him. as a machine, he saw himself predetermined to act in a mechanistic, rote manner. the therapist encouraged him to search for a new metaphor for himself, a metaphor of the person he was capable of being and wanted to be. the therapist helped the client explore other possible ways of viewing himself, encouraging him to find a more flexible and expansive metaphor. in time, the client began to call himself the “poet of the rocks,” referring to his newfound discovery of his creative, feeling self and his growing love of nature.with this as his new guiding metaphor, hewas able to explore newbehaviors that weremore congruent with this new selfconcept. he learned tomaximize existing strengths andworked to create newones. hynes (1987) utilized poetry therapy in her work with battered women. in strengths-based practice, it is important for the social worker to help normalize a client’s feelings. while the ultimate aim of strengths-based practice is to help clients discover and develop strengths and resilencies in the service of meeting their goals, it in no way implies denying current feelings. therefore, before stories can be re-authored, theymust be explored and constructed. sometimes this is difficult for clients. poems that approximate their experiences or that can be used as jumping off points for dialogue about their personal stories are valuable in helping clients begin the process of growth and healing. to this end, hynes reads a poem to help battered women feel less isolated in their experiences. the poem has very intense images such as, “the emptiness ofmy future cutsme like a knife,” “i am begging to understand the joke life played on me,” and “the absence of my anger, the silence of my screams.” after the poem was read allowed, each member was asked to identify what was significant to them about the poem or to identify an issue that needed to be discussed.the process allowed thewomen to express similar feelings in a safemanner. in further expanding on hynes’ work from a strengths perspective, several other questions and experiences can be presented to such a group. members can be asked to discuss how the person who wrote a poemmight transform their experiences.what inner capacities and strengths has each group member learned from their oppressive and even abusive histories? how can they use the experiences to become more fully human and complete? each group member can also be asked to write a follow-up poem of transcendence or reframing. for instance, howmight the poem sound if one focused on positive, compensatory behaviors developed in the process of coping with abuse? how might the poem sound different if it were written one year later after more healing had taken place? the feelings of helplessness and powerlessness associatedwith oppression, such as racism and institutionalization, may lie at the heart of many emotional difficulties (fanon, 1963; gil, 1990;vanwormer, 1997). helping people become conscious of the roots of such oppression can lead to powerful emotional and behavioral changes (freire, 1970). again, poetry can be utilized to help people re-author their lives. poems can be used to help explicate what people have learned about themselves from their history, then challenge these messages. 152 advances in socialwork poetry, often seen as being written for and by society’s intelligencia, can be used as a powerful tool in empowerment oriented practices. feminist and minority writers have used poetry in therapy to build community empowerment (kissman, 1989). through using poetry techniques, clients can learn to understand their struggles in the context of institutionalized oppression, which can mark the first step away from self-rapprochement and towards empowerment. when the mystique of poetry is deconstructed for clients and they learn not only to understand it, but also create it, an amazing sense of accomplishment and empowerment is achieved. clients begin to realize that they can accomplishmany of the things that that their internalized oppression has taught them they could not. even clients who cannot read or write, who need to recite their words for others to write down, can begin to acquire an increased sense of mastery and accomplishment. the first author has used poetry therapy techniques with former patients of the state psychiatric hospital system, patients who lived in community residences and attended a partial hospital program. having suffered through years of institutionalization, most of these clients learned entrenched patterns of helplessness and experienced feelings of worthlessness and expendability. these feelings clouded their perceptions and led them to attribute their marginalized socialization solely to their mental illnesses and not to the affects of years of isolation and loneliness of institutional life. by helping themunderstand the etiology of their feelings, these clients started to blame themselves less and make real changes. the group consisted of eight mental health consumers, age 25 to 60. each was a member of a half-day partial hospitalization program that they attended anywhere from three to five days a week. no one in the group had any previous experience with writing poetry and all reported a significant history of academic failures. the members also ranged in functional ability from one who planned to return to college, to another who could not remember how to read or write. they met once a week for one and a-half hours for three months. each session consisted of three phases. the first phase consisted of a simple didactic discussion on the elements of language andpoetry.topics, such as the use of adjectives, nouns, metaphors, and sentence structure, were explored to help each member improve the technical aspects of their writing and to help improve their sense of mastery. during the second phase of each session, poetry was read aloud. readings tended to be thematic, chosen by the therapist in consultationwith the clients to reflect themes of therapeutic value to the clients or they were selected by the participants as they expressed the need. themes included friendship and support verses isolation, love versus hate, prejudice verses acceptance, and apathy verses overcoming adversity. trips to the local library and university libraries led to the selection of many poems by the groupmembers. this, alone, was empowering, asmany group members did not know how to use a library. learning to navigate the library helped several members feel a sense of efficacy. one member realized that if he could negotiate a library, he could perhaps return to work one day. group members were given much control over their group. the structure was only meant to provide order and a sense of safety. during a session one member asked the group to read a poemonhelplessness. he had started to realize that dur153furman et al./poetry therapy as a tool for strengths-based practice 154 advances in socialwork ing his 15 years of confinement at the state hospital that he learned to rely on the staff to meet all of his needs. he started to realize that many of the decisions and choices he continued tomake emanated from the core belief that he was helpless. during the discussion of a poemby a paraplegic, several groupmembers said they felt similarly trapped and confined by their limitations. in time, they recognized that these limitations were not, in fact, truth, but stories they learned about themselves that were open to analysis. during this particular group session, members began to write about the themes of institutionalization and helplessness. each member who was now comfortable and capable of working independently would work on a poem that reflected his/her response to the previous discussion or his/her reaction to the work. members not capable of writing on their own dictated their thoughts to the therapist or worked with another member of the group. both flexibility of structure and acceptance of where each member is at during each session are crucial factors in order for poetry groups to be safe and therapeutic environments. after sufficient time had elapsed in order for all members to feel finished (with the previously established understanding that creative work often requires many revisions, if the author so desires), the members were encouraged to share their work with others. by this time, the eighth session, groupmembers had progressed to the point where each either read their works or had others read them aloud. a poem written by a member was read to the group. the theme focused on being medicated and the poem was vivid. as the member read the poem, the words included the statement, “i can’t move my hands, but they work o.k.,” “i was not that bad before their rooms, and their drugs, and their thugs,” and “it will cost quite a lot to get back all that i lost.” the author of this poem began to cry after reading this aloud. he said that it was one of the first times that he had gotten in touch with the effects being medicated had upon him. themembers of the group shared in his pain and they encouraged each other to explore how they could change some of those effects. the idea that they were changingmany of their learned patterns of helplessness was both liberating and frightening, asmany of those patterns hadbecome simultaneously comfortable and depressing. subsequent group sessions focused on group members finding or creating poems that focused on their transforming themselves. additional considerations several additional implications and limitations of poetry therapy need to be addressed. first, claims of efficacy in this article are based upon unsystematic, clinical observations of individual cases and not on systematic research. while many contributors to the field of poetry therapy have noted the effectiveness of the approach with various client populations, little generalizable, empirical research exists. for those who utilize poetry therapy, mazza (1999) has noted the importance of conducting evaluations of their practice. he calls for the use of various methodologies, including single-system design, ethnographic, and conventional experimental designs to improve upon the knowledge base. the research that exists tends to focus on process issues, such as group cohesion and positive interactions and not on client outcomes (mazza, 1999; rossiter & brown, 1988). 155 similarly, little research exists on the efficacy of the strengths perspective in direct social work practice. future research should also seek to validate the concepts and suppositions of the perspective. poetry and poetry therapy can also be valuable tools in social work education. using poetry in classroom settings can lend variety to teachingmethods. teachers are encouraged to explore literature and poetry that has value to them and think of creative ways of using this material. when poetry that has an emotional connection is used, students aremore likely to find value in it. the first author of this article has used poetry to help students understand various client situations. poetry is especially helpful in teachinghumanbehavior in the social environment, as poetry can help to convey various psychosocial issues from the perspective of those experiencing them. writing poetry can also help students to understand various issues on a personal level, thus, improving their “professional use of self.” conclusion using poetry therapy allows clients, in conjunctionwith their social worker, to create a sense of freedom, accomplishment, insight, and connection with others. clients who are dealing with issues that are difficult or painful to discuss in treatment can use poetry as a vehicle toward developing new capacities and resilencies. this article explores the connections and congruence between poetry therapy and strengths-based practice. the ability to use poetry therapy to help empower individuals to master their emotions and experiences can aid the strength-based practitioner with assisting his or her clients toward growth and wellness. similarly, the poetry therapist canwork from a strength-based framework by guiding clients’ creative expression toward future achievements, desired outcomes, and help them maximize their internal resources. the social work field and other helping professions can benefit from integrating poetry therapy and the strength-based approach, two effective and complementarymethods that can be linked in creativeways to help social workers bettermeet the needs of clients. references alexander, k.c. 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(1987). social despair in adolescent boys: poetic therapies and metaphoric diagnoses. american journal of social psychiatry, 7(2): 101-105. author’s note: address correspondence to: rich furman, ph.d., assistant professor, department of social work, colorado state university, fort collins, co 80523-1586, usa. e-mail: furman@cahs.colostate.edu. furman et al./poetry therapy as a tool for strengths-based practice microsoft word briar-lawson social work workforce copyedit final ______________  katherine briar-lawson, ph.d., msw, is dean and professor in the school of social welfare at the university at albany, state university of new york, in albany, ny. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 21-33 building the social work workforce: saving lives and families katharine briar-lawson abstract: this article depicts a journey over the decades to address some of the needs of children and families in the child welfare system. recounting a few key milestones and challenges in the past 40 years, it is argued that workforce development is one key to improved outcomes for abused and neglected children and their families. major events and several turning points are chronicled. emerging workforce needs in aging are also cited as lessons learned from child welfare have implications for building a gero savvy social work workforce. funding streams involving iv-e and medicaid are discussed. it is argued that workforce development can be a life and death issue for some of these most vulnerable populations. thus, the workforce development agenda must be at the forefront of the social work profession for the 21st century. key funding streams are needed to foster investments in building and sustaining the social work workforce. keywords: workforce, iv-e, medicaid, child welfare, aging, social work, universityagency partnerships this article chronicles efforts to advance the leadership role of social workers to address the challenges of the most vulnerable children and families as well as the aging. change strategies have involved the promotion of university–agency partnerships, workforce development, funding streams for social work education and new service delivery models. while much of the focus of my journey is centered on vulnerable children and families, by extension, inclusionary social work needs to comprise all ages. thus, efforts at adapting some of these strategies to gerontological social work are delineated as well. i first briefly recount child welfare workforce challenges, crises, several firsthand accounts of developments in workforce agendas and historical markers. efforts to promote service innovations related to vulnerable children and families are offered. following this, a brief overview of implications for gerontological social work is presented with similar attention to both workforce funding and some innovations in service delivery. lessons learned are offered as are action steps for future developments in the field, including educational and professional supports for social workers. workforce development is not often thought of as a key facet of social work practice, let alone one that would be seen as a life and death issue for those we serve. yet when workforce issues are overlooked, horrific consequences can occur. children may die of abuse and neglect because a caseworker did not detect or understand domestic violence and its effects on the caregivers who subsequently cannot protect their child. an elder may leave the hospital with 921 different pills and may be unprepared for self-care in the community. absent a trained social worker, the consequences may be toxic if not life threatening. briar-lawson/building the social work workforce 22   this paper attempts to make the case that more attention is needed to promote workforce development, the partnerships that help incubate professional development of social workers and the potential funding streams that can attract social workers to the field and to working with some of the highest need populations. my journey has been one that has addressed some of these challenges. at the outset it is important to note that no journey is without partners along the way who open doors and make change synergistically possible. as change collaborators and facilitators we are always working with and through others. it is to them, gratefully, that i dedicate this article. child welfare: partnership movement we begin with child welfare, a field of practice that has long been the province of social work. from its inception as a field of practice for social workers over a century ago, social workers have been at the forefront of innovations to address the needs of the most vulnerable children and families (briar-lawson, mccarthy, & dickinson, 2013). while opportunities have abounded for social workers to be leaders in child welfare, the very architecture of this field of practice has hinged on a well prepared and sustained social work workforce. historically, from the emergence of the children’s bureau 100 years ago to the present, social work has been identified as the profession with the most stake and professional alignment with the most vulnerable children, namely those who are abused and neglected. as spearheads for and leaders in the development of the children’s bureau in 1912, social workers have worked to advance numerous reforms and innovations (dickinson & barth, 2013). these included mother’s pensions to prevent the need for institutional care for children whose mothers worked. in more recent decades, social workers have led innovations in home based services to prevent out of home placements (landsman, 2013). in many cases such as these, social workers have been at the forefront, shaping many advances in child welfare. yet, much of this capacity to build the field of practice in child welfare has been compromised by setbacks. one such impediment in progress, from my point of view, involved the declassification or deprofessionalization movement in public child welfare. this occurred in the late 1960s through the mid to late 1980s. from this setback, as the next section illustrates, the profession has tried to regain its foothold and, even more, to advance a reprofessionalization movement. some might argue, in fact, that reprofessionalization also requires more integrated services such as those that once dominated public sector social services and public welfare services, prior to the separation of income from services (berns, briar-lawson, & kim, 2013). from integrated social services to deprofessionalization of public child welfare public child welfare services in the 1960s relied on social workers in afdc or income maintenance roles to provide an integrated array of services including foster care, and special need grants to high need families to prevent out of home placement for their children. i learned, first hand, that through my welfare work (or income maintenance) advances in social work, spring 2014, 15(1) 23 service role (as a social work intern) in the 1960s that i was able to provide “long term care” for chronically fragile families with children at risk of out of home placement. this was made possible by casework services that included the ability as a caseworker to award “special needs” grants (beyond the basic welfare grant) to address unique family support needs. with the demise of such integrated services (casework and income supports) in the late 1960s and early 1970s (due to the separation of income support and social services) a radical role change occurred (piliavin & gross, 1977). caseworkers, who had previously provided prevention as well as family preservation through income maintenance services, were either shifted over to newly emerging child protection services (cps) or adult protection services (aps). my frontline work and that of others at the time made it possible for families to remain intact due to the supports, extra financial resources and ongoing casework services for mothers and children. the separation of income maintenance from services severed families from such family preservation supports. instead of these long term family support roles that were possible in the former welfare caseworker model or public social services, emergent new roles in child welfare comprised predominately cps. foster care and adoption services, once part of welfare services, also moved over into the new public child welfare system. meanwhile, instead of social workers being sought after and recruited for newly emerging investigatory roles in cps, other kinds of hiring occurred. this meant that the roles and jobs that might have been held by social workers were now going to others, many of whom had no relevant human services preparation. moreover, in many if not most civil service bureaucracies, social work was not recognized or prioritized as the preferred skill base for work with these cps families. in fact, by the early 1990s and continuing on to this day, only a handful of states require social work as the degree for practice in public child welfare. not surprisingly as public child welfare deprofessionalized, this field of service encountered many tragedies. high profile cases, media attention to horrific child deaths led, in many cases, local and state child welfare leaders to seek out help from schools of social work. such help included delivery of training to caseworkers needing some exposure to social work knowledge and skills. it seemed so paradoxical that instead of hiring social workers, in many cases, untrained and uncredentialed applicants with a ba degree would be hired, only to face skill, practice and service crises that then resulted in requests to schools of social work to train these workers with “on the job” supports. prior to this, one of the most popular and sought after jobs in social work at the time, at least as i recall from the late 1960s, was private adoption services. one might ask how is it possible that the child welfare field could have gone from being a destination for social workers, to a time in which to this day, since then, some 40+ years later, some county agencies in child welfare may not have seen a trained social worker in decades. how is it possible that the most vulnerable and highest need children and their families might be served by someone whose credentials, in some cases, were no more than a high school diploma? had hospital operating rooms been purged of physicians there would be an outcry. this deprofessionalization movement, on the heels of the separation of income maintenance from services, constituted two strikes against the most vulnerable children and families. this more silent and hidden crisis for our most vulnerable children and briar-lawson/building the social work workforce 24   families needed to be exposed. moreover, when a high profile child welfare crisis occurred, such as a brutal beating or death of a child from abuse and neglect, the caseworker was often misrepresented and mislabeled in the media as being a “social worker.” such public crises and tragedies compounded the recruitment and retention problems in public child welfare agencies. thus not only did the crisis involve human and very public tragedies, workforce churning and turnover, but catapulted into the media and to the forefront of the public the denigration if not demonization of social work as a profession. in the late 1950s it had been estimated that more than half of public sector social service workers were trained social workers (coll, 1995). now the rates were very low, with prevalence rates of not more than 20-30% (see ellett & leighninger, 2006) being the norm. such purging of the ranks of social work not only created skill, practice and service gaps but also eradicated or eroded social work values and knowledge as system drivers and redesign tools to address and improve practices. such deprofessionalization processes may have been a cost-saving device for some agencies. moreover, the bureaucratization of services with rule driven and prescribed approaches to serving these highest need children and families, while loathsome to some social workers, may have seemed to some bureaucrats an efficient alternative to the more discretionary, advocacy oriented and professionally informed casework practice of the past. in the absence of social workers, trained to assess and solve problems, an emergent practice model evolved involving case management. (depending on the skill level of the worker, this model may encourage an under-emphasis on engagement and assessment while over emphasizing “handing off” to other service providers the responsibility for problem solving). such case manager referrals might involve up to 14 service providers to whom the family was known. thus the untrained caseworker may “hand off” families to other service providers to address their abuse and neglect, mental health, addiction, domestic violence, disabilities, health, parenting skills, housing, income, employment, education , criminal and juvenile justice, child care and related needs and issues. crisis in cps: crisis in the workforce insufficient assessment and engagement skills, a by-product of some untrained workers, reached a turning point when crack cocaine epidemics hit impoverished communities in the late 1980s. child abuse deaths abounded. there were rumors that some cities had a death a day. recruited away from a faculty post to lead a state based child welfare agency in these times, i was able to see firsthand how the rising challenges of the highest need children and families eluded many of our schools of social work. few schools at the time had a specialization in child welfare and even fewer prepared or encouraged graduates to enter public child welfare. moreover, not all agreed in our profession that cps services were the right or proper paradigm for the use of social work skills and talents, given the investigatory and often adversarial role of cps workers (pelton, 1991). at the time i wondered, too, why families needed to maim themselves and those they loved to get help that then was seen as potentially hurtful. this was because cps was emerging as a stigmatized service, frightening to many families and communities, especially diverse families and communities. advances in social work, spring 2014, 15(1) 25 it is not surprising that vacancy rates of up to one third of the workforce in cps were emerging in many states and counties across the country. cps work units churned with turnover among caseworkers, in part because many had no preparation for human services work. many were rightfully daunted by the unpredictability of the effects of drugs on their clients. others experienced vicarious trauma. one child welfare administrator later recalled that when he was able to get caseloads down to the nationally recommended safety level of 15 families per worker, many of his caseworkers did not know what to do as problem solvers with their families as they had no social work preparation. it was then that he built a campaign to reprofessionalize the workforce with social workers being hired throughout his state public child welfare agency. absent a skill base capable of addressing and delivering services tailored to the multiple challenges faced by vulnerable families, such turnover was not only predictable but an endemic indicator of the need for a workforce development campaign. in effect, the crisis among abused and neglected children culminating in high rates of child fatalities became a workforce crisis. nasw commission on families addresses the child welfare workforce crisis to address this crisis i was fortunate to be able to have nasw as a change vehicle and a foundation for institutional reform. in fact, i was able to leverage change in my role as a newly appointed chair of the commission on families for nasw and to approach, with joan zlotnik, staffing the commission, the acting associate commissioner of the children’s bureau. we made the case that there was a staffing crisis in child welfare, especially in cps. such findings had emerged at a national conference in washington state, hosted by the american humane association. the panel, of which i was a part, had been assigned the task of addressing needed competencies for cps. yet each speaker representing a state or county system around the country spoke about the staff vacancy crisis in cps. it seemed to me that the crisis was the opportunity to redouble the efforts of social work to become reinvolved and reinvested in public child welfare. university-agency iv-e partnerships emerge when dr. zlotnik and i approached the children’s bureau, in the late 1980s, we had identified the staffing crisis as the problem and came with a solution. we had evidence that federal funds, supporting the training of child welfare workers, through section iv-e of the social security act, were being used in illinois with schools of social work to educate social workers for public child welfare. at the time, very little in the field was known about iv-e and the potential to support the preparation of the workforce for child welfare. the children’s bureau response resulted in the funding of a national workshop at nasw on the workforce needs in child welfare. the nasw commission on families hosted this and other nationally significant meetings to advance a partnership agenda between schools of social work, nasw and public child welfare agencies (briarlawson, 2012)  . briar-lawson/building the social work workforce 26   it seemed to me that the skills of social workers among the national association of public child welfare administrators (napcwa) leaders were also untapped. as i served as a member of napcwa and its executive committee, it seemed imperative that these leaders in child welfare be mobilized to support and facilitate iv-e partnerships. it was a moving moment when i asked the napcwa executive committee how many of them were social workers. to the surprise of many, there was a sizable number. during declassification and deprofessionalizaton, the profession itself had been sidelined in its leadership of public social services, which seemingly included the suppression of our social work identities. once our social work identities were transparent we could begin to further the discussion about partnerships with schools of social work. then i became the principal investigator on two national children’s bureau grants to forge partnerships between state and county agencies and schools of social work. this partnership movement began as a substantive problem solving agenda given the crisis and child deaths that were headlines around the country. presentations were made at the national association of deans and directors (nadd) and then i was funded to convene two national conferences on partnerships. two publications resulted from these conferences (briar, hanson, & harris, 1992; hooper-briar & lawson, 1996). entities like calswec, first funded by the ford foundation, emerged as a national model on addressing workforce needs in child welfare (and in subsequent years adding mental health, aging and related fields of service). what began as an exploratory meeting with a leader at the children’s bureau to advance the ways in which iv-e could help solve the vacancy crisis and build the workforce, has since evolved into an ever deepening workforce development agenda in social work. over 130 schools and educational departments of social work across the country now draw down about $80 million a year in iv-e funds in support of the preparation of social workers for public child welfare (cswe, 2011). iv-e funds cover student stipends, tuition, faculty costs for teaching specialty public child welfare courses, competency progress charting, evaluation, and field instruction. it should also be noted that since the mid-1970s to the present the children’s bureau has funded traineeship grants to schools of social work to prepare students for public child welfare and to develop effective curricula (briar-lawson, 2012). from a financial standpoint, iv-e funds are the predominant drivers of explicit workforce development for frontline staff in child welfare. protecting iv-e and deepening the workforce development agenda at one time, when congressional threats to iv-e looked ominous, we were able to quickly underscore the effectiveness of iv-e funded partnerships with two journal publications (also books, briar-lawson & zlotnik, 2003a, 2003b). these culminated in a new journal that i was able to help co-found: public child welfare. it seemed to me at the time that too many fine evaluation studies of iv-e and public child welfare were not being published and another journal was needed to advance the evidence base for practice, workforce and organizational development. moreover, parallel gao (2003) and annie e. casey foundation (2003) related reports emerged arriving at conclusions about the need for recruitment and retention innovations in child welfare. these reports and advances in social work, spring 2014, 15(1) 27 studies helped to propel a new kind of grant program at the children’s bureau. furthering this work was the systematic review done by dr. zlotnik and colleagues with the institute for the advancement of social work research on recruitment and retention (zlotnik, depanfilis, daining, & lane, 2005). by 2002 new five year retention and recruitment grants were awarded by the children’s bureau. these became the foundation for even deeper capacity building in workforce development. by 2008, workforce issues became a more visible focus for the children’s bureau culminating in the development of the national child welfare workforce institute (ncwwi), for which i serve as a co-pi. while just a dream in 1987 that workforce would become a national focus in child welfare, the children’s bureau now has made workforce issues a major focus of its work. ncwwi provides 11 traineeship grants to schools; leadership academies for directors of public and tribal child welfare and deans of social work, middle managers, and supervisors; knowledge development; developmental evaluation and state level saturation models of organizational redesign to build a work culture conducive to effective practice and workforce retention. this newly refunded $21 million investment in ncwwi (over a five year period) sends a signal nationally and internationally that effective outcomes require a well-trained and sustained workforce. as the child welfare milestone graph depicts some of the major developments of the past several decades, much work lies ahead. thus, while there are counties in the country that still may not have a trained social worker in child welfare and where some workers may only have a high school degree, the move toward capacity building and investments in the organizational context for effective workforce supports is a major 21st century milestone. this is essential since some social work graduates complain that they cannot use their skills or feel alienated in compliance driven and sometimes toxic bureaucratic systems. moreover, while the field still has a mixed workforce of social workers and non-social workers, significant progress has been made on a renewed workforce development campaign. personally and professionally, for this author, much of my career has been invested in seeing this workforce focus evolve as one of the overriding paradigms for child welfare reform. challenges that lie ahead include the ways in which workforce investments can be definitively linked to improved outcomes for child welfare families and children. while we know that length of stay and reunification are affected by turnover (flower, mcdonald, & sumski, 2005); and have some evidence that iv-e trained social workers make better prepared caseworkers than non-iv-e trained practitioners (leung & willis, 2012), closing the research gaps remain another vista for activism for the 21st century. other challenges involve the goodness of fit between well trained social workers and work conditions that problematically prize case management over sound clinical practice by caseworkers. work roles of child welfare caseworkers comprise some of the most challenging social work jobs known to our profession. yet the work conditions and workplace supports for such challenges are often insufficient, and some might say that they feel violated by their work conditions, which are often exacerbated by rule driven bureaucracies. ideally every child welfare worker would be a trained social worker. at this time it is estimated that up to 40% of the workforce in public child welfare involves trained social workers (dolan, casanueva, smith, & ringeisen, 2012). thus, progress has briar-lawson/building the social work workforce 28   been made with this workforce development journey through iv-e stipends and funding as well as children’s bureau traineeships. training administrators, middle and supervisory managers to be change leaders, a goal of ncwwi, will help build some of the necessary or preliminary conditions for organizational redesign. ncwwi change projects also involve the use of design teams, relying on the talents of frontline and supervisory staff and others to build change from the ground up. this may help with retention of staff and re-culturing of the workplace. workforce issues: lessons learned and adapted to aging it may seem curious that an advocate for child welfare practice and careers would emerge as one of the champions and spokespersons for building gerontological social work. yet one of the great challenges facing the profession is the need to advance excellence in workforce development across all ages. this “inclusive excellence” agenda requires a parallel focus on aging. often marginalized, like child welfare, from such mainstream fields of practice in social work as mental health, or school social work, it has been essential that some of the lessons learned from the child welfare workforce development campaign be brought to a parallel gerontological social work capacity building effort. the john a. hartford foundation has made this possible, advancing gerontological social work as a mission for schools of social work as well as promoting aging and intergenerationally focused research, education and university-community partnerships. in fact, the john a. hartford foundation has invested over $70 million into social work to build a gero savvy workforce. dismal baseline data show the need (scharlach, damronrodriguez, robinson, & feldman, 2000). the vista for social work leadership in community based systems of care in aging, including wrap around services, is very bright. that said, like child welfare, it has been important to find a funding stream beyond the funds from the john a. hartford foundation. to that end the john a. foundation recruited me early on to bring some of the workforce development principles and passions involving child welfare to gerontological social work. while the foundation has given grants and now is working to build capacity through several national centers, the need for a federal funding stream like iv-e seems ever pressing if we are to expand social work educational opportunities and also close the workforce gap. it also seems curious that over $3 billion a year in medicaid and medicare funds go to medical schools for medical education. one would think that such funds could be also used for gerontological social work education. despite a study of medicaid funding to schools of social work and attempts to bring such funding into stipends for field work in gerontology, the growth of medicaid investments in social work is small (behrman et al., 2006). however, given the affordable care act, it may be possible to re-initiate efforts to build such educational investments in social work education. of all fields social work probably is the most aligned with medicaid populations and thus is the most likely to be in line for investments that are related to improved outcomes for medicaid populations. advances in social work, spring 2014, 15(1) 29 thus, like iv-e, medicaid remains an important workforce development funding stream, but currently relatively untapped. comparing opportunities for gerontological social workers with public child welfare workers the affordable care act focuses on medical and behavioral health care in the community for all ages and invites more creative use of peers, community health workers and related supports including those for family centered care teams. thus the role for social workers as design leaders in these new community based systems of care will be enhanced. even more, the opportunity for social work as a profession to be aligned with quality care, community based support tailored to one’s personal home based needs, underscores the image of social work as a profession on the cutting edge of reform and new 21st century designs for improved life quality. there is a parallel need for social workers to redesign public child welfare organizations and, in some cases, systems of care. both fields of practice (in aging and in child welfare) can learn reciprocally about the ways in which “wrap around,” home based services are essential to more well supported individual and family well-being. abuse and neglect dynamics are risk factors across the lifespan. thus the preventive tools and resources that ensure support and preempt these risk factors are system and service design opportunities for social workers. just as laws such as pl 96-272 moved us away from an over reliance on out of home placement and into more family preservation oriented practices so too will the affordable care act and medicaid redesign models ensure more community based systems of care and supports. social workers may develop and implement more tailored care systems to lead, organize and build evidence-based family supports with psycho-educational and related interventions. social work as a profession depends on workforce supports from iv-e, traineeships and related ncwwi supports, and on john a. hartford foundation investments. such supports for our workforce help to build innovations replacing unhelpful systems and services with more tailored, accountable and family centered strategies. social work: the architect and architecture for systems redesigns the profession of social work cannot be a design leader for new 21st century systems unless the profession has workforce development leadership and supports as its backbone for these newly designed programs and services. thus improved outcomes for the most vulnerable require both the leadership of the profession around new service models as well as workforces comprised of trained social workers to make innovative practice possible. the work that lies ahead includes more systematic summits and national work plans for developing the workforce. the social work reinvestment act, still pending before congress, ignites such a planful approach and offers one such blueprint for our profession’s future. at the state and local level, advocacy must occur on behalf of social briar-lawson/building the social work workforce 30   workers whose debts are high for their schooling and who need investments in their education. this is especially pressing for students who come from diverse communities and who will return to serve them. in sum, workforce efforts need to increase for the profession and the highest-needs communities we serve to ensure a more effective future for all. references the annie e. casey foundation. (2003). the unsolved challenge of system reform: the condition of the frontline human services workforce. retrieved from http://www.aecf.org/upload/publicationfiles/the%20unsolved%20challenge.pdf baskind, f., & briar-lawson, k. (2005). advancing social work with older adults. families in society (special issue), 86(3), 424-430. behrman, g., rizzo, v. m., mancini, m., briar-lawson, k., baskind, f., & valentine, c. (2006). exploring strategies to advance public-sector funding in geriatric social work education. journal of social work education, 42(1), 37-48. berns, d., briar-lawson, k., & kim, w. h. (2013). addressing poverty as a child welfare strategy. in k. briar-lawson, m. mccarthy, & n. dickinson (eds.), the children’s bureau: shaping a century of practice, programs and policies (pp. 4358). washington, dc: nasw press. briar-lawson, k. (2012). from a staffing crisis to the building of a national workforce agenda for social work. in e. f. hoffler & e. j. clarke (eds.), social work matters: the power of linking policy and practice (pp. 53-58). washington, dc: nasw press. briar-lawson, k., mccarthy, m., & dickinson, n. (2013). the children’s bureau: shaping a century of child welfare practices, programs and policies. washington, dc: nasw press briar-lawson, k., & zlotnik, j. l. (eds.). (2003a). charting the impacts of universitychild welfare collaboration. new york, ny: haworth press. briar-lawson, k., & zlotnik, j. l. (eds.). (2003b). evaluation research in child welfare. new york, ny: haworth press. briar, k., hanson, v., & harris, n. (1992). new partnerships. miami, fl: institute on children and families at risk, florida international university. coll, b. (1995). safety net and social security, 1929-1979. new brunswick, nj: rutgers university press. council on social work education. (2011). 2010 statistics on social work education in the united states: a summary. retrieved from http://www.cswe.org/file.aspx?id=52269. dickinson, n., & barth, r. (2013). lessons learned and the way forward. in k. briarlawson, m. mccarthy, & n. dickinson (eds.), the children’s bureau: shaping a advances in social work, spring 2014, 15(1) 31 century of child welfare practices, programs and policies (pp. 1-20). washington, dc: nasw press. dolan, m., casanueva, c., smith, k., & ringeisen, h. (2012). nscaw ii wave 2 report: child and families receiving child welfare services post-baseline. opre report #2013-08. washington, dc: office of planning, research and evaluation, administration for children and families, u.s. department of health and human services. ellett, a. j., & leighninger, l. (2006). what happened? an historical analysis of the deprofessionalization of child welfare with implications for policy and practice. journal of public child welfare, 1(1), 3-34. flower, c., mcdonald, j., & sumski, m. (2005). review of turnover in milwaukee county private agency child welfare ongoing case management staff. unpublished monograph. general accounting office. (2003). child welfare: hhs could play an even greater role in helping child welfare agencies recruit and retain staff. (gao-03-357). washington, dc: retrieved from http://www.gao.gov/new.items/d03357.pdf. hooper-briar, k., & lawson, h. (eds.). (1996). expanding partnerships for vulnerable children, youth and families. washington, dc: council on social work education. landsman, m. j. (2013). family centered practice. in k. briar-lawson, m. mccarthy, & n. dickinson (eds.), the children’s bureau: shaping a century of child welfare practices, programs and policies (pp. 59-78). washington, dc: nasw press. leung, p., & willis, n. (2012). the impact of title iv-e training on case outcomes for children serviced by cps. journal of family strengths, 12(1), article 9, 1-16. retrieved from http://digitalcommons.library.tmc.edu/jfs/vol12/iss1/9/ pelton, l. h. (1991). beyond permanency planning: restructuring the public child welfare system. social work, 36(4), 337-343. piliavin, i., & gross, a. e. (1977). the effects of separation of services and income maintenance on afdc recipients. social service review, 51, 389-406. scharlach, a., damron-rodriguez, j., robinson, b., & feldman, r. (2000). educating social workers for an aging society: a vision for the 21st century. journal of social work education, 36(3), 521-538. zlotnik, j. l. (2013). university-agency partnerships to advance child welfare. in k. briar-lawson, m. mccarthy, & n. dickinson (eds.), the children’s bureau: shaping a century of child welfare practices, programs and policies (pp. 275-292). washington, dc: nasw press. zlotnik, j. l., depanfilis, d., daining, c., & lane, m. m. (2005). factors influencing retention of child welfare staff: a systematic review of research. institute for the advancement of social work research. washington, dc: nasw press. briar-lawson/building the social work workforce 32   author note address correspondence to: katharine briar-lawson, ph.d., dean and professor, school of social welfare, university at albany, state university of new york, 1400 washington avenue, albany, ny 12222. email: kbriarlawson@albany.edu katharine briar-lawson is dean and professor in the school of social welfare, university at albany, state university of new york. she is a co-pi of the national child welfare workforce institute. among her books (co-authored) are family-centered policies & practices: international implications (2001), and (co-edited) innovative practices with vulnerable children and families (2001), evaluation research in child welfare (2003), charting the impacts of university-child welfare collaboration (2003), social work research (2010), social work practice research (2010), globalization, social justice and the helping professions (2011) and the children's bureau: shaping a century of child welfare practices, programs, and policies (2013). she co-chairs the gerontological task force for the national association of deans and directors of schools of social work and has served as a past president. advances in social work, spring 2014, 15(1) 33 appendix a child welfare workforce agenda: selected milestones mid – late 1980s  national workforce crisis in child welfare 1987 – 1990  nasw commission on families addresses workforce crisis 1988  k. briar-lawson & j. zlotnik approach and apprise children’s bureau of iv-e solution 1988 – 1990  nasw fosters workshops and publications on child welfare workforce and university-agency solutions; beginning calls for police to replace caseworkers in cps 1990  children’s bureau promotes iv-e as a partnership and workforce development resource with schools of social work/child welfare agencies 1990 – 1998  children’s bureau funds two national conferences on iv-e partnerships; two books published on partnerships 2000-2005  institute for the advancement of social work research with the children’s bureau facilitate series of national meetings to address workforce 2001 – 2003  iv-e funds threatened in congress ($80m to schools of social work) 2002 – 2003  two special issues of journals / books published on iv-e impacts and benefits 2002 – 2014  numerous conferences, national meetings on workforce issues led by nasw, child welfare league of america, iv-e roundtable, universities, children’s bureau 2003  anne e. casey foundation and gao reports focus on recruitment and retention 2005  zlotnik et al. at institute for the advancement of social work research publishes systematic review on factors influencing retention of child welfare staff 2006  new journal created on public child welfare 2003 – 2008  children’s bureau funds 8 recruitment and retention grants 2008 – 2018  children’s bureau funds (and refunds from 2013-2018) the national child welfare workforce institute microsoft word curiel_parent group education copyedit final ______________ herman curiel, ph.d., is a professor in the anne & henry zarrow school of social work at the university of oklahoma in norman, ok. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 51-62 parent group education to enable “barrio” parents herman curiel abstract: this paper describes a 1960s “war on poverty” parent group education program that brought together three national private voluntary agencies with federal funding by the office of economic opportunity (oeo). project enable (education neighborhood action for a better living environment) sought to direct professional efforts to help/empower the poor and societal members of ethnic minority groups. group education as a preventive modality was used to strengthen parents’ problem solving skills in their roles both as parents and as community leaders. the author describes his group leadership role together with that of the indigenous case aides who helped direct/enable the collective power of a group of poor spanish speaking mexican origin families living in barrios (neighborhoods) of a major metropolitan southern city. project enable embraced a strengths-based perspective characteristic of social work’s historical empowerment traditions. despite its brief existence, project enable functioned as a demonstration program in 62 communities across the united states. ironically, its prevention focus and demonstration nature served to undermine its ability to compete with other oeo initiatives like head start and job training programs. the author cites a combination of historical and logistic factors that contributed to the short life and ultimate demise of a once promising outreach program. keywords: empowerment, enable, war on poverty, mexican-origin, indigenous case aide, promotora, economic opportunity act, whitney young, blacks, outreach, barrio created during the mid 1960s, project enable (education, neighborhood action for a better living environment) was one of the federal programs of the so-called war on poverty. the project was envisioned as an outreach prevention demonstration model designed to serve impoverished families living in minority communities through a collaborative strategy that utilized private social agencies supported with public funding. project enable was a partnership initiative between the child study association of america (csa), the national urban league (nul) and the family service association of america (fsaa) with funding from the u.s. office of economic opportunity (oeo). the economic opportunity act was part of president lyndon baines johnson's social and economic initiatives known as the "great society" in which we were waging a “war on poverty." sargent shriver, a key architect of the economic opportunity act served as director of oeo until 1969. although the architects of project enable did not use the term “empowerment,” it was the aim of the collective initiative to empower families living in poverty. simon (1994) rightly reminds us that the profession of social work has a long history of empowerment traditions. the empowerment perspective, she says, seeks to help clients draw on personal, interpersonal and political strengths to enable them to gain greater control, individually and collectively, over their environment. despite its brief existence, this is exactly what project enable hoped to achieve. it utilized nonclient groups to develop and strengthen the participants’ parental coping skills, and the advances in social work, spring 2014, 15(1) 52 leadership skills needed to solve neighborhood concerns. the formative challenges for leaders of this innovative demonstration project were significant. the basic processes of the empowerment perspective are used to analyze project enable within the context of its developmental stages. the author concludes by relating a combination of historical and logistical factors that contributed to the relatively short life span of project enable. formative before the birth of project enable in 1961, leaders from the child study association of america (caa) and family service association of america (fsaa) had begun collaborative discussions that led to a three year training project funded by the national institute of mental health. the purpose of the project was to train fsaa case workers in group-discussion techniques for parent education. family life education was envisioned as a preventive strategy to forestall family breakdown (morris, 2004). the success of this training program led to further interest and discussions by oscar rabinowitz (csaa), project director and ellen p. manser, project coordinator for fsaa on ways to extend training to many more agencies through utilization of people already trained in the nimh project (manser, 1968). in 1965 leaders from fsaa and the child study association proposed a joint venture with leaders from the national urban league to use the family life education model to reach minority families with oeo funds. national urban league staff had had previous inquiries on the use of the family life education methodology with csaa and fsaa nationally and locally at various times. the more militant members of the war on poverty, particularly those working within the community action programs, were viewed as advocates for the poor seeking to change bureaucracies that were seen as barriers or were not consumer user friendly. voluntary agencies were not immune from criticism. richard cloward, professor at columbia university, maintained that social welfare institutions and the people who staffed them were in many instances barriers, rather than aids, to the progress of poor people. in 1963 he singled out voluntary-sector “family service” agencies as examples of how the poor had been abandoned by the institutions intended to serve them (cloward, 1963). project enable director, ellen manser (1968) describes the back and forth leadership communication challenges between public (oeo) administration levels and private agencies. federal funds for projects were funneled through state, regional and local community action agencies (caa) which added additional hurdles for family service, child study & national urban league administrators. in 1965, conducting agency meetings across locations was frustrating for administrators who did not have access to cell phones, computers, e-mail, faxes or other modern day communication tools. after extensive negotiations between partner agencies and the new oeo, funding for project enable was approved september 10, 1965 in washington (manser, 1968). in retrospect, the creation of these partnerships by whitney m. young, jr., clark w. blackburn and alfred d. buchmueller and others represented a significant political and logistics achievement. whitney m. young was executive director of the national urban league, inc., alfred buchmueller, was executive director of the child study association curiel/project “enable”: group education with “barrio” parents 53 of america and clark w. blackburn was general director of family service association of america. critics of the partnership initiative questioned the competence of private agencies serving the poor. private social service agencies, such as fsaa and csaa, were viewed by critics as elite white agencies with limited experience working with the poor. historically, they had established a reputation based primarily on serving middle class families and professional knowledge building. private agencies attracted a large number of new social work graduates seeking continued professional mentorships. the national urban league, although a private agency, was viewed less critically due to its long history serving black families in their communities. the war on poverty presented opportunities for private agencies to acquire public funding to test innovative group strategies to work with the “hard to reach” poor families. the leadership of private agencies expressed fears as well. board members were concerned about administrative control and possible consequences of accepting public funding and engaging in social action activities. the formative leadership challenges for fsaa and partner initiative agencies were obviously considerable. on becoming a group leader in 1966 there was no national urban league affiliate in houston, thus requiring local trainees to learn group leadership roles for conducting both parent and community education (community organization) groups. this was fortunate for me because i was assigned a seasoned mentor in felton alexander. felton, a msw staff member for the dallas, texas national urban league office and regional community organization trainer became my community organization supervisor. in addition to felton, alline del valle, another msw, supervised my parent group education learning. she directed the family life education program at my home agency in addition to being parent education regional staff-trainer for project enable. alline del valle was a gifted group leader who loved teaching that role to others. seemingly, she could do anything with groups and group members loved her instantly. her group interaction style reminded me of virginia satir’s work with families (satir, 1976). alline frequently expressed pride in my group work efforts on behalf of spanish speaking parents. i still picture her reaching for a cigarette as she eagerly arranged her chair to listen to my weekly group session report. in addition to my project enable roles i had a counseling caseload that required additional supervision. before my weekly supervision conference i had to record and submit case process recording notes. process recordings, for readers unfamiliar with this form of clinical training, read like a play script. they were exceedingly labor intensive for both supervisee and supervisor. at the time, i shared my peers’ dislike of process recording, but in retrospect i have learned to appreciate its educational value and how it contributed to my increased self-awareness. ruth searls, a msw from smith college with many years of clinical social work experience, supervised my direct client work. ruth’s supervision, like alline’s, was supportive and growth oriented. as i reflect on my extensive supervision i feel privileged to have had so much support. my supervision was a formative process that definitely contributed to my successful work with agency clients and group leadership work in project enable. what is not known is whether similar supervision was missing for project colleagues at other sites. advances in social work, spring 2014, 15(1) 54 innovative outreach the use of “indigenous” neighborhood case aides was a significant innovative outreach strategy. neighborhood case aides with “on the job” training and on-going close supervision were key contributors to successful projects. being neighborhood residents, the case aides had the kind of knowledge and personal connections to neighbor residents the social workers typically lacked. the case aides solicited potential group participants at local venues such as churches or by door to door neighborhood contacts. the social worker, with the help of the case aides identified community needs. the aides found local meeting space and made arrangements for child care at the neighborhood sites. the social worker, on the other hand, had social service resource knowledge the social work case aide lacked. together their shared knowledge increased their power as helpers and as a team. the role of the case aides was similar to that of promotoras (promoters) in health care prevention programs in mexico and in some u.s.-mexico border states (see curiel, 2013 on promotoras). the indigenous case aides extended the group leader’s credibility with “hard to reach” families most of whom had little experience with professional social workers. these families were mainly from ethnic or racial minority populations that traditionally have had trust issues with non-minority members of the larger society and little or no experience with professional social workers. the social work aides symbolically became a psychological bridge for trust building between the professional social worker and parent group members and/or their community counterparts. training group leaders training consisted of social workers attending two regional one week training sessions, one held in april 1966 before the project began, and a second in july 1966 timed to coincide with the completion of the first eight week series of enable groups. whitney young, executive director of national urban league, was present for the initial project orientation. he described the initiative goals and the role expectations of trainees and indigenous case aides. he introduced the program area expert-trainers who in turn described their respective background experiences and project roles. alline del valle, parent group educator, demonstrated group leadership techniques by leading a live parent education group. felton alexander, a community organization expert, explained role of community organizer and principals of community organization plus techniques for forming and maintaining groups. dr. aaron rosenblatt, project research director, described purpose of project enable research and explained how to train and supervise social work aides whose role included the collection of data during home visits. his handouts included a research manual, “supervising the research interviewing of social work aides” and questionnaire forms that would guide data collection. his book, attendance and attitude change: a study of 301 project enable groups (rosenblatt, 1968) describes data and results by regional sites. curiel/project “enable”: group education with “barrio” parents 55 race climate in the 1960s recruitment of project enable (1966-1967) parent groups occurred at a time when race relations between blacks and whites were at a boiling point. president john f. kennedy’s response to national violence and his desire to end racial discrimination was the focus of his june 11, 1963 civil rights address. his assassination on november 22nd of that same year represented a serious symbolic and substantive blow to the civil rights movement, but did serve to bring about the nation’s resolve for change. during the early 1960s the city of houston was in the process of desegregating public facilities that had barred blacks from white establishments such as hotels, theaters, restaurants, public schools, colleges, parks, jails, and hospitals (scott, 1967). kennedy’s death undoubtedly helped lyndon b. johnson achieve the landmark passage of the civil rights act of 1964 as well as the voting rights act of 1965. the august 11-17, 1965 watts riots in south central los angeles was one more manifestation of the tense racial climate. these events, occurring in close time proximity to the introduction of project enable, likely had an effect on team work at some sites. however, as morris (2004) notes, the african american and mexican american teams worked closely and smoothly in houston. while this was true with respect to team relationships in general, recruitment and attendance were a consistent problem for the houston black community team leader. there was an unanticipated initial leadership change for the black community team. the original african-american group leader learned she was pregnant during the group leadership training phase. fortunately, she was able to hire two indigenous african-american case aids before vacating her position. a non-hispanic white social worker with extensive group work practice experience assumed the vacated leadership role with the help of case aides hired by her predecessor. in a recent telephone interview with the group leader’s successor (m. kleymeyer, personal correspondence, august 20, 2013) conducted for purpose of this manuscript, said: “being white, without a doubt, introduced trust issues for neighborhood parents that her case aides could not bridge.” her case aides were not able to recruit members for a single group. however, they did identify a small number of families for whom help was provided directly by her case aides with her direction. as indicated earlier, the parent recruitment phase of project enable, which occurred during a national period of racial crisis, almost certainly contributed to group recruitment and retention problems particularly at sites where racial differences existed between group leaders and the indigenous community. reaching barrio families apart from the national racial crisis, whenever the characteristics of the group leader, the case aides, and the community were similar, the group was free to pursue the intended learning objectives of project enable. auerback (1968) contended that while the general field of parent education was identified as a middle class movement, its methodology, as evident in project enable, could be applied to virtually all socioeconomic levels and educational backgrounds. project enable sought to give parents an opportunity to discuss family issues and community concerns with a social worker either directly or through the case aides. del valle and alexander (1967) maintained that the basic philosophy of project enable was to help poor people change advances in social work, spring 2014, 15(1) 56 their environment, not to simply adjust to a miserable set of environmental circumstances (p. 637). manser (1968), the director for project enable, noted that the bulk of participants in the program were among the poorest in society, generally falling one level above the lowest category on hollingshead’s classification of social status. the parent groups that were the focus of this barrio community were spanish speaking mexicanorigin hispanics. the term “barrio,” spanish for neighborhood, is generally analogous to the concept of “ghetto” as it appears in the literature for describing inhabitants in an ethnic poverty community. i was raised by a non-english speaking grandmother in a poor mexican barrio where my early formal education began as a non-english speaking student. i was fortunate to have had many caring non-hispanic white teachers who cared and were patient with my learning english. i must have had some instruction in spanish because i was able to read and write in spanish by the time i enrolled in middle school. knowing spanish and sharing a similar ethnic-cultural world view with the case aides and parent group members was a definite advantage. as a bilingual group leader, i was able to conduct sessions for both spanish speaking groups as well as those comprised of both spanish and english speaking members. the initial orientation meetings for project enable groups included information on its purpose as well as description of the discussion format that would be employed during the ninety-minute sessions over the eight weeks. the various roles of key actors, the discussion leader and the social work case aides were explained. the research need for informed consent to permit case aides to collect information to evaluate project outcomes was also explained. all the parent meetings were held during the evening hours in local neighborhood facilities with child care and transportation provided. the composition of the groups consisted primarily of mexican origin spanish speaking mothers. fathers were more likely to be present in the groups formed to address community concerns. group member attrition was not a significant problem at any of the five neighborhood group sites. one multi-ethnic group was held at a public integrated housing project. this diverse group of twenty mothers included three sub-groups represented in almost equal numbers, women of mexican origin who spoke only spanish, non-hispanic white women, and black women who were new to integrated housing. given the bilingual composition of this group, the leader served as interpreter for both the spanish and english speaking participants. again, member drop-outs were rare and no obvious conflict among the subgroups was observed. the term “parent education” is often used interchangeably with “family life education” (auerback, 1967). in this context, parent education is viewed as only one aspect of family life education. project enable utilized principles of parent education as articulated by auerback (1967). the role of the leader was not to lecture, but to facilitate discussion. during the initial session, themes based on expressed parental concerns or interests were identified for subsequent topics for discussion. these parent discussion groups were used to help parents talk about child rearing concerns or family problem solving approaches. other discussion groups were formed to help parents curiel/project “enable”: group education with “barrio” parents 57 develop problem solving skills to improve quality of life in their neighborhood communities (physical environments). the acronym enable meant just that – to enable or empower the participants. simon (1994) in her book, the empowerment tradition in american social work: a history, identifies five basic processes associated with the empowerment approach: (1) constructing collaborative client partnerships; (2) emphasizing client strengths; (3) focusing on social and physical environments; (4) recognizing client-group rights, needs and responsibilities; and, (5) directing professional energies toward helping historically disempowered groups and their members. in the following section the project enable processes are examined within the context of these five basic processes as identified by simon (1994), with a primary emphasis on the first three. (1) constructing collaborative partnerships to achieve collaborative partnerships with prospective parent group members, we first had to create and function as a collaborative team. both case aides were spanishenglish bilingual parents themselves with a high school education. both had a history of doing volunteer work in their respective communities, and after their initial training, readily identified with the team concept. i quickly learned to appreciate their indigenous skills for recruiting group members and collecting data during home visits as well as their interpersonal skills for relating to members between meetings. weekly team meetings were used to exchange information on group member needs and progress on tasks such as acquiring meeting space and data collection. it was through the case aides that i was able to gain the trust of poor families who had little or no experience with professional social workers. while the impoverished background that characterized my formative years mirrored that of many of the participants, my subsequent professional education created a social distance characteristic of professional care providers who work with clients from impoverished backgrounds. in addition, since virtually all of the participants were female, my gender difference could have potentially introduced trust issues with male family members if i were to visit homes during the father’s absence. the inclusion on the team of female case aides who had had similar life experiences to group members proved to be an important factor in gaining the parents’ trust. during home visits, and with the permission of the parents, the case aides were able to explore in depth many of the specific family needs or concerns that were part of the group identified general themes discussed during the weekly team meetings. the commitment to the team philosophy was evident in the level of the case aides’ excitement during weekly team supervision meetings. i suspect this collaborative spirit contributed significantly to our continued success with respect to the high level of retention among group members. (2) strengths emphasis the group paradigm employed in project enable intentionally placed primary emphasis on the parents’ coping strengths. there were no taboo discussion subjects and all ideas were found to have merit. participants were not viewed as clients; they were advances in social work, spring 2014, 15(1) 58 voluntary group members seeking to learn how to improve their parenting skills. despite their limited formal education and the crippling conditions of poverty that enveloped their lives, the innate resilience of these parents was readily evident in their day-to-day coping skills. project enable aimed to help poor families help themselves. the “hard to reach,” target population of project enable were poor ethnic/racial minority parents and families. the use of indigenous case aides helped poor families overcome their trust barriers with the social workers, which in turn ultimately helped facilitate the social worker’s efforts on behalf of the “hard to reach” poor. (3) persons in their environment project enable’s dual goal was to help members as parents and as change agents in the context of their neighborhood environments. as indicated earlier, the focus of the parent discussion groups was to help parents become more effective in their role as parents. when members in the parent group expressed a community concern of mutual interest, the group leader would typically explore their interest in forming a new group to address the issues engendered in the expressed concern. the existing group would continue with its focus on parenting related issues. the new group with a macro problem solving focus would meet separately and at a different time. the macro-focused groups frequently included males who had been absent in the parent education groups. according to johnson and johnson (2013), problem solving is the process of finding an answer to a perceived difficulty. the six steps to problem solving identified by them, paraphrased here, characterized the process of community focus group meetings: (1) problem identification, (2) contextual issues, (3) alternative strategies, (4) pro and con merits of alternative potential strategies, (5) implementing the most appropriate strategy, and (6) evaluating outcomes. the following actual community case illustrates the problem solving process: case example: a community action group was formed motivated by parental anger with a neighborhood park manager who routinely called police to report their children for alleged use of profane language. the group identified the problem as the park manager’s unwillingness or inability to handle the children’s behavior, or at least involve them before escalating the problem by invoking police intervention. the subsequent group process explored the scope of the problem, including the number of such incidents in which children were sent to juvenile detention and the number of parental attempts at multiple levels to resolve or call attention to the problem. group members claimed the park manager and her immediate supervisor were not responsive to their repeated complaints. after several group meetings, a range of potential strategies were explored, including a possible park boycott, a group meeting with both the park manager and her supervisor, publicizing the problem in the public media, and scheduling a meeting with the mayor and city council. the group ultimately decided a joint group meeting with the director of parks & recreation and local park manager would be the most propitious strategy. with the group’s permission, the group leader met with the director of parks & recreation to convey the substance of the group’s complaint and to schedule a meeting. in curiel/project “enable”: group education with “barrio” parents 59 anticipation of the actual meeting with the director and park manager, the group leader helped the members prepare for the experience by engaging them in a role play. before meeting with the park director and park manager, some group members expressed doubts that the meeting would ever take place as well as concern as to what might happen if it actually did. not only did the meeting with the director of parks and recreation take place, but it proved to be a pleasant and empowering experience for the group members. two unexpected outcomes occurred. one was the resignation of the park manager with whom they had had so many negative prior experiences, and the other was the director’s invitation to have the group screen applicants and ultimately approve the final candidate for the new park manager position. (4) recognizing client-group rights, needs, and responsibilities the park director’s willingness to involve the group members in the decisionmaking process involving the selection of the new park manager gave meaning and substance to simon’s (1994) fourth empowerment principle, namely the “recognition of client rights, needs and responsibilities.” it not only served to affirm them as individuals capable of making a meaningful difference in their own lives, but also helped allay some of the debilitating cynicism that tended to characterize their attitudes toward the existing power structure. it provided a compelling argument that constructive change was indeed possible when they exercised their individual and collective right to act responsibly on their own behalf. part of the challenge in working with the so-called “hard to reach” is that many of them have little or no hope that meaningful change is even possible. they simply had no prior life experiences that give them reason to believe that the investment of time and energy in trying to change the status quo would make any difference. as noted earlier, that very attitude had been expressed in one of the community group sessions. following their success with this particular issue there was a renewed sense of hope and optimism that laid a beginning foundation for the possibility of meaningful future systemic changes. (5) directing professional energies toward helping historically disempowered groups and their members without the careful planning and subsequent training of the members of the project enable team, it is unlikely that any of the benefits accrued by this group experience would ever have been realized. it was only because of the systematic training that preceded the actual group discussions, including the commitment to a collaborative team philosophy, that it was possible for the parents to gain the courage necessary to act on their own behalf. to the extent to which this is true, it confirms the validity of simon’s fifth empowerment process that emphasizes the importance of professional training as a necessary prerequisite to facilitate the group problem solving learning process. summary and conclusion project enable, a 1960s war on poverty program was a short lived outreach prevention demonstration effort designed to reach poor communities. it became a model advances in social work, spring 2014, 15(1) 60 for private/public joint efforts. having a group leader and social work case aides that shared the groups’ cultural world view contributed to positive outcomes for one successful site. although the concept of empowerment was not in the vocabulary of project enable, the processes of the empowerment approach later identified by simon (1994) were present in the actual objectives of project enable. group members in project enable were not treated as clients, but as free agents capable of shaping and controlling their own lives. group members came from historically underrepresented population groups. the partnership initiative was an effort to direct professional energies to help, enable or empower members of societal groups who had historically experienced societal oppression and discrimination. the use of indigenous case aides was innovative for its time and proved to be a key contributor to successful outreach efforts. the program was short lived because it was judged to be a low priority compared to job-training and other educational programs like head start that were simultaneously competing for limited federal funds. the multiple funding level decision making structure was problematic and the short term funding cycle proved to be short sighted. new programs require more than one year for stable implementation. it takes time to hire, train and implement staff program roles across multiple agencies. the contentious climate that existed between public and private agencies did not help. the timing of the project in the mid 1960s, when racial tensions were at a peak, contributed to recruitment and retention problems in some sites. evidence of the program’s successful operation in one site has been presented. on this basis, the author submits that the fundamental concepts and principles that informed the original project enable experiment merits our serious re-consideration. implications of project enable for contemporary practice as indicated above, the fundamental concepts and principles that informed project enable merit re-consideration for working with today’s impoverished minority populations. preventing social problems is always challenging and a desirable objective for the social work profession. all parents regardless of social class will need help with child rearing and parenting concerns. agencies continue to be challenged with reaching populations that are labeled “hard to reach.” to prepare students to engage in this kind of preventative group work, social work schools need to provide content that will prepare students to work with groups, including community action groups. the training and use of indigenous paraprofessionals with close supervision is an effective means to extend the social worker’s reach to clients who fear and have little knowledge of professional helping. given the increasing growth of the hispanic population and limited number of social workers fluent in spanish, the use of bilingual spanish speaking indigenous paraprofessionals offers a potential source to extend the power of social work services to non-english speaking clients. references auerbach, a. b., & the child study association of america (1968). parents learn through discussion: principles and practices of parent group education. new york, ny: john wiley & sons inc. curiel/project “enable”: group education with “barrio” parents 61 birnbaum, m. l., & jones, c. h. (1967). activities of the social work aides. journal of social casework, 40, 626-632 birnbaum, m. l., harm, m. g., & ortof, s. b. (1967). the content for training in project enable. new york, ny: family service association of america. civil rights act of 1964, teaching with documents: the civil rights act of 1964 & equal employment opportunity commission. college park, md: national archives and records administration. retrieved from http://www.archives.gov/education/lessons/civil-rights-act/  cloward, r. a. (1963). social class and private social agencies. in council on social work education, eleventh annual program meeting, proceedings (pp. 123-137). new york: council on social work education. curiel, h. (2013). latinos & latinas: mexicans. in t. mizrahi & l. e. davis (eds.), encyclopedia of social work (20th ed., pp. 48-54). washington, dc: oxford university press del valle, a., & alexander, f. (1967). effects of the project enable on family service agencies and urban league. journal of social casework, 40, 637. gale encyclopedia of us history. (2006). office of economic opportunity, encyclopedia of american history. the gale group, inc. retrieved from http://www.answers.com/topic/oeo#ixzz2z2jqbwy2 johnson, d. w., & johnson, f. p. (2013). joining together: group theory and group skills. boston, ma: pearson education, inc. manser, e. p. (1968). project enable: what happened? new york: family service association of america, oeo, cap grant no. 9064. morris, a. (2004). the voluntary sector’s war on poverty. the journal of policy history, 16(4), 275-305. rosenblatt, a. (1968). attendance and attitude change: a study of 301 project enable groups. new york, ny: family service association of america. satir, v. (1976). making contact. millbrae, ca: celestial arts. scott, a. (1967). twenty-five years of opinion on integration in texas. southwestern social science quarterly, 48(2), 155-163. simon, b. l. (1994). the empowerment tradition in american social work: a history. new york: colombia university press. voting rights act of 1965, america’s historical documents. college park, md: national archives and records administration. retrieved from http://www.archives.gov/historicaldocs/document.html?doc=18&title.raw=voting%20rights%20act www.history.com. this day in history. aug 11, 1965: watts riot begins. retrieved from http://www.history.com/this-day-in-history/watts-riot-begins advances in social work, spring 2014, 15(1) 62 author note address correspondence to: herman curiel, ph.d., professor, university of oklahoma school of social work, 700 elm avenue, norman, ok 73019. email: hcuriel@ou.edu  herman curiel was co-principal investigator (2000-2006), with the us/mexico border health evaluation center, a health resources & services administration’s (hrsa) spns project. he is professor at the anne & henry zarrow school of social work, university of oklahoma. his research and publications focus primarily on minority issues with emphasis on hispanic/latino population concerns related to education, health and hiv/aids. in 2005 he was the recipient of the “social work educator” award by the social work school’s board of visitors. in 2011 he was named an “nasw social work pioneer” by nasw’s foundation. he has served on the editorial board of social work, and as consulting editor for the journal of social work education and the journal of hiv/aids & social services. his publications can be found at http://socialwork.ou.edu/ ______________________ sharlene allen milton, edd, lcsw-c is a lecturer , school of social work, morgan state university, baltimore, md 21251. michael sinclair, phd, mssw is an assistant professor, school of social work, morgan state university, baltimore, md 21251. halaevalu f. ofahengaue vakalahi, phd, msw, is a professor and associate dean, school of social work, morgan state university, baltimore, md 21251. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 285-303, doi:10.18060/21014 organizational identification: perspectives of dispersed social workers sharlene allen milton michael m. sinclair halaevalu ofahengaue vakalahi abstract: human service organizations are often challenged to become more efficient while maintaining the quality of their services. as a result, more organizations have restructured, adopting the practice of dispersed work, which allows employees more freedom and flexibility to meet organizational goals outside of the traditional workplace. while dispersed work allows social workers to engage in work activities beyond the traditional office environment, it may also impact their sense of belonging to the organization. eleven dispersed social workers were interviewed to understand how interaction via new communication technology impacts organizational identification. overall themes gleaned from this study suggest that although dispersed social workers perceive themselves as having more autonomy and flexibility, they also can feel socially isolated and disconnected from their peers and supervisors, which may negatively impact organizational identification. despite the enhanced efficiency that technology can bring, human service organizations must strive to understand the unintended consequences of a dispersed workforce. keywords: dispersed social work; organizational identification; new communication technology the manner in which social work is executed is changing. in an effort to maintain a competitive edge, many human service organizations have adopted the concept of dispersed work, ultimately changing traditional coworker dynamics. dispersed work allows for social workers to not only engage in social work activities but meet organizational objectives outside of the traditional office environment through the use of new communication technology (allen & vakalahi, 2013; pearce, yoo, & alavi, 2004). subsequently, with dispersed work, there is a decrease in face-to-face presence, opportunities for socialization, peer interaction, consultation with supervisors, or simply water cooler conversations (kurland & egan, 1999). for the dispersed social worker, interaction with coworkers and supervisors is reduced to communication via the use of email, text, video conferencing, and cell phone. additionally, dispersed work may have some bearing on employees’ attitudinal states (allen, lambert, pasupileti, cluse, & ventura, 2004), such as a sense of belonging to an organization or the manner in which employees relationally link themselves to an organization (i.e., organizational identification). given the dearth of studies in the social work literature pertaining to organizational identification in the case of the dispersed worker, we analyzed the emerging literature on organizational identification, including the advantages, disadvantages, and importance of organizational identification to dispersed workers. this study focused on dispersed social allen et al./organizaiontal identification 286 workers’ experiences with interaction via new communication technology and its impact on organizational identification. literature review dispersed work definition. dispersed work is synonymous with telework, telecommuting, virtual work, and remote work. the dispersed worker could be a part of a department or organization yet be working at a host site, away from the centralized office, engaging, for some or all of his or her work schedule, in job tasks that would normally be done in a traditional work environment by using new communication technology to interact with others inside and outside of the organization (bailey & kurland, 2002; baruch, 2001; gajendran & harrison, 2007). since its genesis in the 1970s, there has been a significant increase in the practice of dispersed work. currently, at least 50% of us employers allow telecommuting as a benefit to their employees (lister, 2016). dispersed work arose as a way for organizations to decrease real estate expenses and address environmental stressors (i.e., traffic, air pollution), federal regulations (i.e., the telework enhancement act, the americans with disabilities act of 1990, and the 1990 amendment to the clean air act), and employees’ work-life balance demands (gajendran & harrison, 2007; raghuram, tuertscher, & garud, 2010; siha & monroe, 2006). in addition to home-based dispersed work, other types of dispersed work consist of satellite offices, host offices, and mobile work (boell, campbell, cecez-kecmanovic, & cheng, 2013). new communication technology is the primary means of communication for the dispersed worker; examples include synchronous and asynchronous technology such as cell phones, laptops, internet, intranet, email, texting, video conferencing, and teleconferencing (allen & vakalahi, 2013). characteristics. several personal and job traits may influence an employee’s motivation and success as it pertains to dispersed work (henquinet, 2001; nilles, 1994). individual traits of valuable dispersed workers that are predominantly cited in the literature include the ability to be diligent, organized, and work autonomously and the possession of basic computer and time management skills (o'neill, hambley, greidanus, macdonnell, & kline, 2009). the spatial context of dispersed work impacts social, psychological, and managerial processes and may decrease the desire to engage in dispersed work (haddon & brynin, 2005; hislop & axtell, 2007; sullivan, 2003). bailey and kurland (2002) reported that the desire to engage in dispersed work is evenly split between men and women. advantages. according to boell and colleagues (2013), there are advantages to dispersed work for both the organization and the individual employee. the organization may benefit from increased morale, productivity, and financial gains. individual advantages may include work-life balance, autonomy, and flexibility, increased job satisfaction and productivity, and a reduction in commuting time. a number of studies indicate that a better balance of home and work life allows dispersed workers to spend less time away from home and more time with family and children (hilbrecht, shaw, johnson, & andrey, 2008; mann & holdsworth, 2003; maruyama, hopkinson, & james, 2009). advances in social work, fall 2016, 17(2) 287 dispersed work also allows for opportunities to be present for domestic crises and home service calls. according to mann, varey, and button (2000), flexibility is associated with the freedom of managing one’s schedule. freedom and flexibility are also related to the ability to work for multiple employers or the opportunity to gain employment despite a disability. reduction in workers’ commute has the capacity to positively influence cost, time, and stress and is a primary reason people choose to telecommute (mann et. al, 2000). montreuil and lippel (2003) posited that productivity is higher among dispersed workers than traditional workers because of fewer interruptions, prolonged work hours, and flexibility in planning their work schedule. individuals who willingly engage in dispersed work tend to be self-motivated, which may also increase productivity (mann & holdsworth, 2003). disadvantages. one noted disadvantage of dispersed work is social and professional isolation. studies conducted by mann and holdsworth (2003) and mann et al. (2000) concluded that dispersed work has a considerable emotional impact on employees, related to loneliness and isolation, as compared to their centralized coworkers. a psychological connection, or a sense of belonging to an organization, referred to as organizational identification, has been found to be compromised as a result of social and professional isolation (thatcher & zhu, 2006; wiesenfeld, raghuram, & garud, 2001). the negative emotional impact of professional and social isolation can threaten the psychological connection between dispersed workers and the organization, possibly impacting job satisfaction, productivity, and quality of work (golden, veiga, & dino, 2008; wiesenfeld et al., 2001). as social work organizations expand to include more dispersed work, the impact on employees’ organizational identification must be considered. with the heavy reliance on new communication technologies for interaction with centralized coworkers and the accompanying decreased face-to-face interaction and possible feelings of isolation, it may be important to consider ways to increase a sense of connection to the organization. organizational identification organizational identification is a “self-definitional process through which individuals relationally link themselves to the organization, coming to understand and influence the organizational logic through discourse, including the integration of organizational and personal goals and values” (parker & haridakis, 2008, p. 110). according to parker and haridakis (2008), there are three approaches to achieving organizational identification: communication, cognition, and affect. the communication approach suggests that the process of identification is primarily achieved through interaction with others. organizational identification is established by and through communicating a shared interest in organizational goals, objectives, and rules (parker & haridakis, 2008; ravasi & van rekom, 2003). cognitively rooted conceptualizations of organizational identity stem from social identity theory (tajfel & turner, 1979). social identity theory encompasses the evaluation allen et al./organizaiontal identification 288 of others as either in-group or out-group (i.e., us or them). social identity theory as manifested in the organizational identification context was viewed by ashforth and mael (1989) as perceived oneness with or belonging to the organization, where individuals define themselves in terms of the organization. pratt (1998) suggested that this cognitive or perceptual construct reflects the extent to which the organization is incorporated into one’s self-concept. whereas the cognitive element of organizational identification focuses on perception, the affective element concentrates on emotions and the feeling of oneness. emotions of pride, joy, shame, and guilt are often associated with affective aspects of organizational identification (ashforth, harrison, & corley, 2008). organizational identification is “a psychological linkage between the individual and the organization whereby the individual feels a deep, self-defining affective and cognitive bond with the organization as a social entity” (edwards, 2005, p. 227). organizational identification is established by and through communicating shared interest in organizational goals, objectives, and rules (parker & haridakis, 2008; ravasi & van rekom, 2003) and is created and recreated by employees through the communication of shared interests (tompkins & cheney, 1985). advantages. there are advantages of organizational identification for both the organization and the employee. for the organization, organizational identification has the benefits of decreased attrition, improved job satisfaction, and increased cooperation, participation, and organizational citizenship behaviors (barker & tompkins, 1994; dukerich, golden, & shortell, 2002; edwards, 2005; mael & ashforth, 1992). for employees, organizational identification aids in the maintenance of their consistent selfconcept and collective self-esteem (ashforth et al., 2008; dutton, dukerich, & harquail, 1994). additional employee advantages are psychological attachment, emotional links, and a feeling of belonging and oneness (ashforth & mael, 1989; barker, 1993; barker & tompkins, 1994; cheney, 1983; dutton et al., 1994; pratt, 2000). van knippenberg and sleebos (2006) reported that increased organizational identification leads to the incorporation of the organization’s values, norms, and interests into one’s self-concept. some of the ways increased organizational identification is achieved are through job autonomy and supervisory communication and support (apker, ford, & fox, 2003; bamber & iyer, 2002; stinglhamber et al., 2015). disadvantages. one of the noted disadvantages or risks of organizational identification is overidentification. overidentification involves an individual becoming overly engrossed with the identity of the organization to the point of a negative impact on personal and organizational well-being (avanzi, van dick, fraccaroli, & sarchielli, 2012; galvin, lange, & ashforth, 2015). overidentification can lead to distrust and paranoia, as well as extreme dependence and reliance on organizational dictates. additional disadvantages are lack of organizational flexibility; antisocial and hostile behaviors by leaders and followers; automatic trust in organizational members, leading to a decrease in creativity; and erosion of an independent sense of self-worth (ashforth et al., 2008; dukerich, kramer, & mclean parks, 1998; mael & ashforth, 1992). advances in social work, fall 2016, 17(2) 289 in summary, organizational identification sets the foundation for understanding the relational nature of connection and influence as well as feelings of inclusion and belongingness to the organization and its members. this construct is critical, as organizational identification allows for communicative, cognitive, and affective links for the dispersed social worker towards an organization. while the positive and negative attributes of dispersed work have been studied in various organizations, few studies have been conducted with social workers. focusing on this population gives voice to the experiences of dispersed social workers, providing insights for both practitioners and scholars. methods research design to develop a complex, detailed understanding of the essence of dispersed work and organizational identification via the use of new communication technology, it was necessary to speak directly with the participants and allow them to share their experiences, laying aside any personal assumptions (creswell, 2007). creswell (2007) recommended a qualitative research approach when the purpose of the study is to gain an understanding of the essence of the experience for several individuals. “when researchers conduct qualitative research, they are embracing the idea of multiple realities” (p. 16) with the intent of reporting these multiple realities. this study employed a qualitative methodology that supported both the constructivist and interpretative paradigms regarding the experiences of organizational identification via the use of new communication technology for dispersed social workers. data were collected via in-depth interviews, which were recorded and transcribed. a manual process was used to cluster and thematize the invariant constituents. the interview data were reduced to meaningful clusters, and themes emerged. those themes helped guide a description of each participant’s experience, which were captured to help draw conclusions around dispersed workers’ views of what contributed to or detracted from organizational identification. site and participant selection this study recruited participants from a single site, a human service organization in maryland. the organization provides substance abuse, mental health, psychiatric, and prevention and educational services to adults, children, and adolescents from various socioeconomic backgrounds. at the time of the study, the site had 51 employees, 48 of whom were dispersed employees working at state and in-school settings. this study used purposeful homogenous sampling. selection criteria included being employed by the organization full-time, having at least 6 months of experience as a dispersed licensed social worker, and being engaged in dispersed work full-time. the executive director served as the gatekeeper for the study and provided contact information for the social workers who met the study criteria. a recruitment letter was sent via email to each dispersed social worker who met the study criteria, describing the study and inviting their participation. following the initial recruitment letter, two additional attempts to allen et al./organizaiontal identification 290 recruit participants were made over the course of five weeks. once participants were identified, communication with the executive director was discontinued for the purpose of maintaining participants’ confidentiality. out of the 48 dispersed employees, 11 social workers met the study criteria and agreed to participate. all participants worked out of a host site, either a state agency or a school, and relied on technology to communicate with their centrally located supervisor, centralized coworkers, and other dispersed workers. opportunities to engage in face-to-face interaction with their supervisor and other dispersed workers within the agency occurred monthly during department meetings, as well as during semiannual agency activities. data collection and analysis data were collected over a 4-week period through semi-structured, recorded, openended interviews that lasted 40 to 60 minutes each. each participant provided informed consent and was assigned a pseudonym to protect his or her identity. data were analyzed according to saldana’s (2012) formal coding process and moustakas’ (1994) phenomenological analysis reduction method. the process of phenomenological reduction was initiated in epoché or bracketing. epoché required the researcher to set aside prejudgments or preconceptions of the phenomenon being studied so as to be completely open in thinking about the phenomenon and to naively listen to participants describe their experience and understanding of the phenomenon in order to uncover the meaning of being a dispersed worker (moustakas, 1994). phenomenological reduction was used to identify the themes and sub-themes. the goal of this analysis was to describe the experiences of dispersed social workers and to elucidate the impact of those experiences on their organizational identification. methods of trustworthiness to ensure trustworthiness, this study employed peer review, saturation, and member checks and addressed researcher subjectivity. creswell (2007) indicated that peer review or debriefing provides an external check of the research process. it keeps the researcher honest; challenges the researcher via inquiry of methods, meanings, and interpretations (creswell, 2007; lincoln & guba, 1985); and provides the researcher with an advocate to listen to thoughts and feelings that emerge in the process. in this study, two research colleagues served as peer reviewers. over the course of three sessions, they assisted with coding the data and asking challenging questions. seidman (2006) posited that saturation of information refers to a “point in the study at which the interviewer begins to hear the same information reported. he or she is no longer learning anything new” (p. 55). saturation was achieved during data collection. in addition, 10 of the 11 participants completed member checks by reviewing and verifying their individual textural descriptions, individual structural descriptions, individual texturalstructural descriptions, and a composite textural-structural description. finally, since qualitative researchers are the key instrument in their research studies, the researchers made a conscious effort to be aware of any biases, values, and experiences brought into this study and to make them explicit (creswell, 2007). advances in social work, fall 2016, 17(2) 291 results participant characteristics participants comprised 10 women and one man; two were supervisors. their length of service with the human service organization ranged from 1 to 10 years. all participants were licensed social workers. seven were licensed certified social workers-clinical (lcsw-c), and the remaining four were licensed graduate-level social workers (lgsw). participants had spent 1.5 to 10 years in dispersed work. seven worked in a public service agency setting, while the remaining four worked in a school setting. themes the dispersed social workers shared a number of factors that positively contributed to organizational identification as well as other factors that diminished organizational identification. table 1 presents the two main themes with corresponding sub-themes and exemplars derived from the coding and thematic analysis. table 1. summary of themes and connected elements main theme sub-themes exemplars 1. positive organizational identification a. autonomy non-micromanagement, independence, own boss b. flexibility freedom to manage work schedule c. face-to-face meetings opportunity to increase connection to organization and staff, receive support and feedback, receive administrative communication, and engage in case reviews d. face-to-face social activities fosters connection to organization and staff increased interaction e. responsiveness from supervisor availability, support, quick response, and openness to talk 2. diminished organizational identification a. limited supervision limited availability, impersonal, not available by phone, selective responses to questions asked via email b. lack of peer consultation inability to consult with social work coworkers in the office or over lunch c. isolation feeling isolated, “like on a boat out to sea” or a “stepchild”; no place in the organization to work when host site is off on holiday; not integrated into the mothership theme 1: positive organizational identification participants identified autonomy, flexibility, face-to-face meetings, face-to-face social activities, and responsiveness from supervisors as aspects that contributed positively to organizational identification. allen et al./organizaiontal identification 292 autonomy. dispersed workers described the autonomy that stemmed from nonmicromanagement as well as independence. brook (3 years as a dispersed social worker) conveyed the manner in which autonomy was viewed as a benefit of dispersed social work: the big benefit—and this is a huge one and i’m not going to lie—is that i don’t have effectively a boss on a day-to-day basis. this is my practice, i run it; for the most part i work for them under the expectations i’m aware of. you know, i have an extreme amount of flexibility, an extreme amount of autonomy; it’s really nice. i get to work in this school and i don’t have to answer necessarily to the principal. even though it’s obviously good to keep a good relationship with him, he’s not my boss. virtually no one in this school can tell me what to do. i am my own boss on a day-to-day basis, and that is really cool. birch (dispersed social worker of 4.5 years) discussed the benefit of independence: i guess the independence: you don’t feel like there’s somebody breathing down your neck. there’s no micromanagement, so you do get the autonomy and you feel like, i’m trusted to show up at my office and do my job, and i don’t have to have someone look over my shoulder. that’s nice; i do like that. autonomy seemed to evoke positive feelings toward their employing organization. in addition to the experience of independence and not feeling micromanaged, autonomy allowed dispersed workers to feel trusted and embrace being their own bosses. flexibility. in addition to autonomy, many of the dispersed social workers felt that flexibility was a positive benefit of dispersed work. genevieve (dispersed social worker for 9.5 years) expanded on the beneficial aspects of flexibility, particularly as it pertained to shifting her schedule to attend to work-life issues: i really like [organization]. they’re so flexible, and i think that’s really helpful too or i wouldn’t be here for 9 years unless i liked that. . . this is a good example. so i had a child 3 years ago and i decided that i wanted only to work 2 days a week, and someone else in school basically had a child the same time and only wanted to work 3 days a week, so we basically job-shared. and my supervisor was so cool that she was like: ‘well, which school are you going to go to? does she want to come to yours, or do you want to go to hers?’ and i was like: ‘well, i really want to stay at mine and i have seniority’. and my supervisor was like: ‘well, we’ll just hire someone that will go to the two different schools for your other time.’ so we both got to stay at our own schools and we just had someone else shuffle between the two schools. ms. jackson (dispersed social worker and supervisor for 6 years) commented: flexibility, independence, autonomy, yeah, i would say that’s the thing. yeah, just not having somebody paying attention to what you do, when you do it, and how you do it. as long as your results are appropriate and fitting with our performance measures, then people don’t really bug you. advances in social work, fall 2016, 17(2) 293 having the liberty to adjust time or work schedules to accommodate family needs allowed participants to feel appreciated and trusted and seemed to enhance participants’ positive feelings toward their organization. face-to-face meetings. though infrequent, face-to-face meetings were an element that appeared to contribute to organizational identification. these meetings were viewed by participants as an opportunity to receive support from other dispersed coworkers and supervisors. roxy (dispersed social worker for 5 years) shared: well, how supportive people are, how often i see them, what we talk about. if it’s just work or if it’s personal things too, how much support given through supervision or meetings or trainings. it helped me to feel more connected when i was going to [another site where dispersed coworkers were present] because i would have a whole day with a lot of the staff there because a lot of [host site staff] i didn’t really know. terry (dispersed social worker for 1.5 years) indicated that despite their time constraints of two hours, monthly meetings represented a time to meet with their support system and connect with coworkers: the only time i feel connected, i would say, is when we meet monthly for our monthly supervision meetings. that’s the time we can have an opportunity to engage in having that support system and get that feedback from each other on different things. however, it’s only for 2 hours, and a lot of times there is an agenda that we have to go through. these dispersed workers saw face-to-face meetings as an opportunity to experience connection to the organization through interaction with coworkers and supervisors. face-to-face social activities. social activities were an additional means for participants to foster a connection with the organization, coworkers, and supervisors. social activities allowed participants to feel a part of the headquarters organization and increase the sense of “buy-in” to the organization according to terry (dispersed social worker for 1.5 years). these activities also served as a bonding agent, allowing centralized staff and dispersed staff opportunities to experience a sense of “connectedness” according to barbie (dispersed social worker for 5 years). responsiveness from supervisor. participants viewed responsiveness from their supervisor as contributing positively to organizational identification. roxy (dispersed social worker for 5 years) described this responsiveness: she [supervisor] has more time, i guess, to answer my questions. she’s been supportive; she’s been responsive quickly and helpful. she doesn’t take days to respond to me. she responds pretty quickly, and if she can’t, she’ll call me and say “i can’t” or email me and say “i’m in a meeting. can i get back with you tomorrow?” or something. she’s good about letting me know if she can’t talk or she has to change the meeting. ms. jackson (dispersed social worker and supervisor for 6 years) stated, allen et al./organizaiontal identification 294 i have communicated with her [supervisor] at all hours and received communication back at almost all hours. i mean short of 2 or 3 in the morning, i’ve communicated late because i’ve been able to, maybe about something for the next day, and i’ve got response from her as late as 11 at night or as early as 5 in the morning. that’s when she gets up to read emails and responds right away. ..i don’t have to worry if i’m trying to get through. the supervisor’s responsiveness, availability, support, and openness to talk were aspects that were seen as positive by participants and seemed to enhance workers’ sense of organizational identification. theme 2: diminished organizational identification a second theme that emerged from the data analysis was diminished organizational identification. unfavorable aspects identified by participants that hindered organizational identification included limited supervision, lack of peer consultation, isolation, and working off-site. limited supervision. limited supervision was seen by participants as a negative element related to organizational identification. limited supervision was connected with feeling isolated and unsupportive, as expressed by peebles (dispersed social worker for 2.5 years): no fault on my supervisor, but just because of her schedule and her job role, she wasn’t there, and a lot of times we had to do like phone supervision and things like that. and sometimes that was a little bit more challenging because i felt like, just because in my own personal style i like that face-to-face interaction, so sometimes that made it a little bit more—i guess sometimes i felt really like, man, i’m like isolated. i felt like sometimes i was on a boat kinda out to sea. . .it was a little bit challenging in some situations that i had over at [off-site location] where i felt like having a backup or someone with me would’ve been supportive and helpful. limited availability, non-responsiveness by phone, and selective responses via email were also experienced by participants and deemed unsupportive, impersonal, and isolating, which appeared to compromise organizational identification. as terry (dispersed social worker for 1.5 years) stated: but far as with [supervisor], sometimes it can be impersonal when you are looking for feedback, support, and supervision because it’s mostly through email. i have attempted to call but no answer, so i’ll email, and you’ll get a quick response on one end but you may not get the information you were seeking. or, my experience has been i’ll ask a couple questions in that email, and i would get one or two questions answered in the reply back. it’s kind of frustrating because you’re feeling lost. so it’s like: what do i do now? so i will email again asking the questions that weren’t answered, email coworkers for feedback, or bring it up in monthly supervision. and when we have our monthly meetings, it’s not the here-and-now kinda thing where if we were onsite you can go next door and pop in and ask a question to your supervisor. you have to wait for a response. advances in social work, fall 2016, 17(2) 295 lack of peer consultation. the lack of peer consultation was another element that seemed to diminish organizational identification among participants. the inability to access professional peers from agency headquarters prevented participants from discussing aspects of a case (due to professional ethics) for the purpose of getting insight, support, socialization, or feedback. as birch (dispersed social worker of 4.5 years) explained: i like to have somebody else’s opinion. . .i trust my own judgment, but i always like to have the consult. that’s a drawback, and like the camaraderie, just even like if i’m off site i eat my lunch in my room, i don’t really talk to anybody. you know, i’ll say hi in the halls, but i don’t like sit and have a conversation with anybody during the day. tracy (dispersed social worker for 3.5 years) stated: you don’t have the, i guess, like the girlfriend, your work girlfriend or your lunch buddy. sometimes i try. i’ve made colleagues and i guess friends with some of the staff here, but it’s still not [the headquarters office] of [agency] staff member or peer, someone here, so you have to be very careful of what you’re sharing and what you’re talking about and things of that nature. so say, for instance, a staff member might be frustrated about a student that’s one of your clients or just a student in general, and so i’m very conscious and aware of what type of conversations we’re having, what type of questions that they may be asking prior for me like: so what’s wrong with him? what’s this or why did he do this? did his mom say something to you? so those types of things where even still if i was an agency member, because you’re kind of cloaked with the agency title, there’s more of the ability to kind of communicate and discuss clients within your agency. peer consultation afforded social workers the opportunity to process, consult, or discuss cases as well as procedural or ethical situations. peer consultation also gave social workers a sense of camaraderie and support, especially if the supervisor was unavailable. therefore, the absence of peer consultation as experienced by these dispersed social workers was seen as a lack of support. isolation. most participants felt that isolation was a drawback to organizational identification. isolation made participants feel like an “outsider” without “a place in the organization.” birch (dispersed social worker of 4.5 years) expressed feelings of isolation as follows: i just feel like an outsider. . .the onsite staff is like the regular children, you know;li they’re loved. everyone’s like a little team over there, and then we come in and we’re like the outsiders. we’re sorta second favorite; we kinda get the leftovers, you know. like one time somebody brought in some food to the office and some of our staff took the food and it was like we’re in the main office, like here i’m sharing my cake with you. and so some of our staff took the piece of cake and then we got in trouble because the cake was for the main office staff and it wasn’t for us, you know. there’s no spot for us to work. there’s like a conference room, and then they’re like: oh, we have a meeting here. can you move over there? and oh, there’s allen et al./organizaiontal identification 296 something going on there; can you move over here?—which of course there’s things going on, but we just sometimes get shuffled here and there. like there’s no place where you can go at the main office to work, so it’s just sort of like you feel sort of like moved around. . .it’s sort of like a metaphor, you know, like you don’t have a place in the organization. ms. jackson (dispersed social worker for 6 years) expressed that she felt lonely for multiple reasons, including proximity and not working with like-minded individuals: it can be lonely if you’re not a real, if you’re not gregarious. i am gregarious and even i can be kind of isolated if i don’t get myself out of my door and chat and make friends with [host site] people. so it can be lonely. you can kind of feel isolated, not a part, and the drawback is you’re not working with like-minded people. like in an agency you are, like within our agency, we’re all like-minded. . . . i’m not here on a full-time basis, so i’m not as integrated to the mother ship, as it were, you know. because of proximity, all of that has changed at least a little bit for me now, but being over here just for like meetings and coming over for certain reasons as opposed to seeing folks on a daily basis. not having a connection with headquarters staff and not feeling integrated were connected to the negative experience of isolation. these experiences seemed to diminish organizational identification among participants. discussion this study sought to understand the experiences of dispersed social workers, and in particular, how interaction via new communication technologies impacts organizational identification. the primary objective of this study was to understand the essence of the experience through a phenomenological lens (moustakas, 1994). the participants’ experiences as dispersed social workers had both positive and negative influences on their sense of organizational identification. interaction via new communication technologies facilitated a varied sense of organizational identification based on the affective, communicative, and cognitive elements that encompass organizational identification. when participants communicated or socialized with other dispersed workers via technology, those interactions allowed them to feel a sense of oneness or belonging to the organization, as posited by ashforth and mael (1989). according to parker and haridakis (2008), “organizational identification is visible in the relational nature of connection and mutual influence” (p. 110). participants experienced a sense of relational connection and mutual influence through the social interaction and communication that occurred primarily through email and secondarily by phone within their respective departments. lack of face-to-face interactions with centralized coworkers seemed to diminish cognitive organization identification. cognitive organizational identification has a fundamental base in social identity theory (tajfel & turner, 1979). this theory suggests a three-part mental process (social categorization, social identity, and social comparison) that encompasses the evaluation of others as either in-group or out-group (i.e., us or them). advances in social work, fall 2016, 17(2) 297 frequent socialization and communication among centralized coworkers, along with being located at the headquarters organization, created an in-group perception among participants. participants felt that they were not fully a part of the organization. they did not necessarily experience being integrated with the organization. the lack of social interaction with some dispersed coworkers, lack of connection and lack of social inclusion among centralized workers, limited availability, limited responsiveness from supervisors via email or phone, and lack of space to work when in the headquarters office caused participants to perceive themselves as “the step-child, unintegrated, separated, an outsider and unwelcomed”—the out-group. according to past studies (apker et al., 2003; bamber & iyer, 2002; stinglhamber et al., 2015), supervisory support and job autonomy are positively related to organizational identification. this practice was supported by this study, as many of the dispersed social workers expressed that their autonomy and their supervisors’ responsiveness and availability via email made them feel trusted and supported, contributing to participants’ positive organizational identification. while participants enjoyed the autonomy associated with dispersed work, the inability to have immediate access to supervisors and peers to process decisions or client issues and concerns created tension. this tension may be linked to challenges of dispersed work, such as social isolation, loneliness, and lack of support (mann & holdsworth, 2003). additionally, decreased supervision can result in demoralization, decreased motivation, and decreased commitment (farmer, 2011; mann & holdsworth, 2003; mann et al., 2000). another reason for tension could be the professional obligation to ensure competent, professional, and ethical practice within the field of social work (kaiser, 2004; munson, 2012). even though supervision and opportunities for peer consultation occurred once a month for some participants, despite their licensure level they preferred additional contact. limitations this study was limited by boundary and scope. the sample of participants came from two departments within one agency. broadening the boundary and scope to include dispersed social workers from other agencies would have enhanced understanding of the phenomenon. this study concentrated only on social workers who were working in mental health services. most participants were women. diversifying participants as well as the area of concentration would have also added to the understanding of the phenomenon. this study did not take into account the perspective of the centralized worker. the level of analysis was limited to the individual level, not accounting for an understanding of the phenomenon at the organizational level. this study was cross-sectional and did not account for possible various stages that dispersed workers may go through in viewing the nature of their work. implications for research participants did not choose to be dispersed workers when they were hired. research on the voluntary vs. involuntary nature of being a dispersed worker is needed. allen et al./organizaiontal identification 298 at the organizational level, future research can explore the change of an organizational paradigm shift from a traditional social work setting to a dispersed social work setting. organizational linkage theory can provide insight into organizational change on multiple levels. essentially, the theory posits the conditions under which change of an activity at one level of an organization will ultimately affect the outcomes or activity at yet another level (fu et al., 2015; goodman, 2000; wilson, 2009). using the framework of organization linkage theory, a quantitative study could explore the relationship between changes in agency policies, organizational culture, and their impact on dispersed social workers’ organizational identification. implications for practice and policy supervisors typically serve three functions—administrative, supportive, and educational (caspi & reid, 2002; kadushin & harkness, 2002; schulman, 1993; tsui, 2005)—and can impact the workplace in numerous ways. as discussed by landsman (2008) and smith (2005), satisfaction with supervision enhances retention of frontline workers. in addition to workforce effects, supervision can also impact the quality of practice. as indicated by study participants, factors that seemed to decrease organizational identification were the limited availability of supervisors, being dispersed, and feeling isolated, which did not allow for integration into the “mothership.” based on this study, we suggest three ways to increase interdependence as well as foster and facilitate one or multiple aspects of organizational identification (edwards, 2005; parker & haridakis, 2008; pratt, 1998; tompkins & cheney, 1985) for the dispersed social worker. first, organizational identification, or lack thereof, can impact productivity and quality of services. if human service organizations are going to adopt the practice of dispersed work, they need to be aware of not only the advantages but also the drawbacks of dispersed work, with the creation of policies and procedures that support the dispersed worker. second, these organizations must also be able to communicate to potential employees how the organization is establishing norms to offset the negative impact of dispersed work. finally, state social work boards should create new policies around supervision that consider the impact of new communication technology. as human service organizations and social work delivery evolve to encompass dispersed work, concentrated efforts are needed to decrease the challenges of 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(2009). leading practice improvement in front line child protection. british journal of social work, 39(1), 64-80. doi:http://dx.doi.org/10.1093/bjsw/bcm093 author note: address correspondence to: sharlene allen milton, edd, lcsw-c, department of social work, morgan state university, jenkins building room 441c, 1700 east cold spring lane, baltimore, md, 443-529-6805, sharlene.allen@morgan.edu http://dx.doi.org/10.1108/14637150610678078 http://dx.doi.org/10.1016/j.childyouth.2004.08.013 http://dx.doi.org/10.1371/journal.pone.0123955 http://dx.doi.org/10.1111/1468-005x.00118 http://dx.doi.org/10.5465/amr.2006.22528174 http://dx.doi.org/10.1002/job.359 http://dx.doi.org/10.1177/014920630102700205 http://dx.doi.org/10.1093/bjsw/bcm093 mailto:sharlene.allen@morgan.edu microsoft word 6-3551 martinez-ramos et al-latina breast cancer survivors final ______________ gloria p. martinez-ramos, ph.d., is an associate professor in the department of sociology, mary jo garcia biggs, ph.d., is an associate professor in the school of social work, both at texas state university, and yvonne lozano, ph.d., is an assistant professor and program chair of gerontology at ashford university. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 82-101 quality of life of latina breast cancer survivors: from silence to empowerment gloria p. martinez-ramos mary jo garcia biggs yvonne lozano abstract: breast cancer is the most common form of cancer among latinas living in the united states. this article reports the findings of a qualitative study aimed at understanding the experiences of 25 latinas, between the ages of 28 and 83, who are long-term (at least five years post diagnosis) breast cancer survivors. the findings revealed three key issues and concerns: (a) fear of being stigmatized and being treated differently if they talked about their breast cancer experience; (b) overcoming the perceived negative effects that breast cancer has on their femininity; and (c) the effects of breast cancer recovery and survivorship on social relationships of family and community. family support and peer advocacy helped survivors in several areas: (a) to cope with the fear of recurrence; (b) to combat the fear of social stigma; (c) to become stronger as they dealt with the permanent life changes as a latina breast cancer survivor; (d) to support them in the struggle for the provision of culturally sensitive health care; and (e) to provide social support in the form of advocacy for other latina breast cancer survivors. keywords: latina, breast cancer, survivorship, social support, health while breast cancer affects many individuals, particularly women, studies on breast cancer survivorship focus on describing how women experience many processes and problems after their breast cancer treatment has ended. for example, women experience the fear of recurrence and permanent changes to their bodies, their social roles, their intimate relationships, and their families (ashing-giwa, rosales, lai, & wietzel, 2013; ashing-giwa et al., 2004; ferrell & dow, 1996; fobair et al., 2006). breast cancer survivors report that although family, friends, and health care professionals perceive their experience to be over, they experience new challenges as a result of complex changes such as living with the fear of recurrence, uncertainty, social stigma, disruption of intimacy, changes in self-perceptions, altered bodily appearance, and function (ashinggiwa et al., 2004; carver, smith, vida, & antoni, 2006; cimprich, ronis, & martinezramos, 2002; fobair et al, 2006; sammarco & konecny 2010). women’s individual experiences of health and illness potentially transform them, bringing new meanings about themselves, their bodies, their health, and their future. living through and surviving breast cancer can be a catalyst for social change; provide a greater appreciation of time, life, and social relationships; and can lead to a healthier lifestyle and behavior (vickberg, 2001; zebrack, 2000). for some women, the process of advances in social work, spring 2013, 14(1) 83 surviving breast cancer includes a search for meaning in their lives, the construction of a new sense of self and role responsibilities, and self-transformation (breadan, 1997; carpenter, brockopp, & andrykowski, 1999; ferrell, grant, funk, otis-green, & garcia, 1998). some breast cancer survivors describe their struggle for self-transformation happening as a result of connecting with their family and friends. carpenter et al. (1999) reported that perceptions of personal awareness, mortality, coming of age, and life reassessment were described as positive changes, because they led women to become more aware of themselves. as a result, they reported changing various aspects of their social relationships and their work to help them feel stronger, more courageous, and more satisfied with themselves as breast cancer survivors. in some cases, pelusi (1997) noted that breast cancer survivors managed the stigma they experienced by “mediat[ing] the expectations of others” (p. 1348). in other words, they had to control how others were affected by their breast cancer, particularly their husbands’ responses to their mastectomy scar, and the side effects of chemotherapy. however, for some women, the breast cancer diagnosis was not a stressful event. in cases where women did not feel an intense awareness about their breast cancer experience, they reported very little or no changes with their self-perception after breast cancer. these women were less apt to engage in a process of self-examination and introspection, and did not report increased selfawareness. carpenter et al. (1999) identified key psychological and social factors that contributed to the inability of breast cancer survivors to experience self-transformation, which included lack of courage or strength related to mental and physical stamina; lack of information and support from health care providers; not having social support from family and friends; lack of income; and age. in addition, she noted that breast cancer survivors reported psychosocial problems such as coping with the death of one or more family members, the imprisonment of a child, loss of a job, divorce, or relocation. these obstacles interfered with the ability to devote the time and energy necessary to examining the self and moving toward making desired changes for self-transformation and selfempowerment. researchers have found that breast cancer survivors report a variety of family-related concerns. for example, women tend to report concerns about not being able to see their children grow up, the emotional impact that their breast cancer has on their children, feeling isolated, problems with fertility, and intimate sexual relations (cimprich, ronis, martinez-ramos, 2002; dunn & steginga, 2000; fobair et al., 2006). resources such as peer social support do have a positive impact because people can access the information to learn how to cope with the changes and uncertainty after breast cancer and how to communicate with health care providers (sammarco, 2001; zebrack, 2000). studies on latina breast cancer survivors have reported that latina breast cancer survivors experience different outcomes compared to non-hispanic white women. in a study conducted by carver et al. (2006) on long-term breast cancer survivors, latinas reported more negative feelings about having been diagnosed with breast cancer, more social avoidance, more distress about their families’ futures, and more distress about the possibility of recurrence compared to white non-hispanic women. in another study by lopez-class et al. (2011), latina breast cancer survivors reported secrecy and shame about their breast cancer diagnosis, feelings of isolation, the need for family and social martinez-ramos, garcia biggs, lozano/latina breast cancer survivors 84 support, challenges with developing social relationships, challenges with navigating the u.s. medical care system, and language barriers when interacting with health care professionals. similarly, ashing-giwa et al. (2004) found that latinas reported greater concerns relating to fear of death, pain and suffering, body image and sexual relations, and financial burdens when compared to other racial and ethnic groups who were breast cancer survivors. uncertainty is an important factor shaping a persons’ ability to make sense of the meaning of illness-related events such as their disease process, treatment, or hospitalization (mishel, 1988). when an individual lacks information or experiences the unexpected or unfamiliar, they may experience uncertainty; and for breast cancer survivors, uncertainty can cause stress (mast, 1998). sammarco and konecny (2008) researched the relationship between quality of life and uncertainty and found that latinas with less formal education (less than a college education) reported greater uncertainty. in a follow-up study, sammarco and konecny (2010), seeking to understand quality of life, social support, and uncertainty, found that latinas had higher levels of spousal support and slightly greater family social support than their counterparts; but they also reported lower quality of life and higher levels of uncertainty related to breast cancer. furthermore, latinas who perceived receiving less social support, or who lacked access to resources such as information in spanish or support groups in spanish, reported greater uncertainty and lower quality of life compared to latinas who reported feeling supported. understanding how social well-being and quality of life is impacted by breast cancer survivors aids professionals in understanding how social roles and social relationships affect women’s adjustment to breast cancer. ferrell, grant, funk, otis-green, and garcia (1997) define social well-being as “a way to view not only the cancer or its symptoms, but also the person surrounding the tumor; it is the means by which we recognized people with care, their roles, and relationships” (p. 400). more research is needed that focuses on how social and cultural values shape latina breast cancer survivors’ social well-being and quality of life. this study examines the perceptions of latina long-term breast cancer survivors (five years or more since diagnosis) and aims to understand their breast cancer survivorship experiences. lastly, this study generates findings useful for the provision of culturally sensitive health care and support services to benefit breast cancer survivors and their families. literature review latina breast cancer survivors in the united states in 2010, the u.s. census estimated 50.5 million latinos were living in the united states, comprising approximately 16% of the u.s. population (ennis, rios-vargas, & albert, 2011), and the latino population continues to grow in the united states. although the incidence of breast cancer is lower for latinas compared to whites (non-latinas), latinas diagnosed with early stage breast cancer are 20% more likely to die from breast cancer than white non-hispanic women (american cancer society, 2010). extensive research in health care shows that latinas experience many barriers to health care treatment and diagnosis such as poverty, lack of health insurance, lack of a regular source of health care, lack of breast cancer prevention information in spanish, advances in social work, spring 2013, 14(1) 85 racial discrimination, and misconceptions about the disease (ramirez et al., 2005; schiller, lucas, ward, & peregoy, 2012; soni, 2007). studies on the use of screening mammography for early prevention and detection show that older women who speak primarily spanish are less likely to adhere to mammography screening guidelines compared with non-hispanic white women (borrayo et al., 2009). some studies have noted that being undocumented, low-income, low in english proficiency, and uninsured negatively impact latinas’ abilities to access quality health care (documet, green, adams, & weil, 2008; vega, rodriguez, & gruskin, 2009). researchers campesino, ruiz, uriri glover, and koithan (2009) found that mexican american breast cancer survivors reported that immigrant women tend to lack insurance, which resulted in limited access to treatment and neglect by medical staff. these problems are often reproduced in health care settings structurally because of the lack of culturally and linguistically sensitive health care. for example, physicians tend to rely on untrained individuals and family members or friends to translate and help discuss breast cancer treatment options for patients with limited english-proficiency. this practice contributes to disparities in the delivery of breast cancer care (ashing-giwa et al. 2006; campesino et al., 2009; rose et al., 2012), and may put many women at risk of being diagnosed with advanced stage tumors requiring mastectomy and chemotherapy (american cancer society, 2010; li, malone, & daling, 2003; singh, miller, hankey, & edwards, 2003). for example, a study that examined ethnic differences between hispanic women and non-hispanic women with equal access to health care found that differences existed in the size, stage, and grade of breast cancer. hispanic women were more likely to be diagnosed at a younger age; at a later stage of disease; present with larger, higher grade tumors; and with less treatable estrogen and progesterone negative tumors than non-hispanic women (watlington, byers, mouchawar, sauaia, & ellis, 2007). juarez, ferrell, and borneman (1998) found that latino/a cancer patients experiences are embedded in culturally-based values of family life and religious beliefs that are interrelated and culturally bound. they concluded that, “culture influenced all domains; physical, psychological, social and spiritual of quality of life…and no issue is exclusively a physical, psychological, social or a spiritual one” (p. 318). the study also identified that the most difficult changes to psychological well-being included anxiety, uncertainty, a lack of acceptance of the illness by family members, loss of independence, changes in family roles, and the financial impact of illness on the family. napoles-springer, ortiz, o’brien, diaz-mendez, and perez-stable (2007) found that one third of latina breast cancer survivors never utilized support groups; mainly because they had no knowledge of existing support groups and instead received support primarily from their family. however, when family members encouraged them to attend a support group, they were seven times more likely to attend a support group than women who received very little or no encouragement. galvan, buki, and garces (2009) found that latinas reported the following as important: needing support from family (primarily spousal support), professionals (doctors and nurses), peers, and spiritual sources. in this study, participants who participated in social support groups valued exchanging their personal experiences about cancer with other women, reported feeling emotionally supported, and had an optimistic outlook compared to those who did not. martinez-ramos, garcia biggs, lozano/latina breast cancer survivors 86 conducting interviews with latina breast cancer survivors about the long-term impact their breast cancer experience has had on their lives is important to capture their interpretations of those experiences with being a latina breast cancer survivor. it is recommended by the national cancer policy board that: the psychosocial needs of women with breast cancer must be understood in the context of other issues that affect women’s coping, quality of life, and wellbeing, such as socioeconomic factors and cultural factors, the quality of social support, access to health care, and the presence of other chronic illness or life crises. (national cancer policy board, 2004, p. 23) in this study, qualitative methodology lends well to understanding women’s perceptions and responses about the significance of breast cancer in their lives and the cultural values and beliefs that impose unique meanings. ethnicity and gender socially and culturally shape latinas’ experiences with breast cancer. qualitative in-depth studies of latina breast cancer survivors provide a unique opportunity to understand how latinas link their past experiences of breast cancer with their present concerns and future possibilities. the documentation of their experiences is important in understanding the implementation of cultural and linguistic sensitivity in breast cancer services and advocacy. methodology grounded theory, as a research method in qualitative research, was utilized to develop a well-integrated set of concepts leading to a thorough theoretical explanation of social phenomena under study (glaser & strauss, 1967). feminist qualitative research asserts that women’s life experiences are embedded in the particular historical forms of social relations that shape their experience. when women’s perspectives are at the center of inquiry, we learn how social structures influence women’s experiences with breast cancer (kasper, 1994; langellier & sullivan, 1998). these principles informed the researchers to conduct a qualitative study of 25 latina long-term breast cancer survivors (beyond five years of diagnosis) living in california who were interviewed in spanish or english depending on the preference of the participant. the interviewer and one of the researchers developed a survey instrument containing basic demographic questions and various quality of life questions related to breast cancer, which were approved by the university institutional review board. over an 18-month period, respondents were recruited through advertisement flyers (in spanish and english), from contacts at community organizations, and from breast cancer support groups in california. the recruitment flyer, which described the purpose of the research and included information and contact details of the researcher, was posted at health care organizations. respondents contacted the researcher over the phone, and when they agreed to participate in the study, the researcher mailed the informants a packet consisting of a letter introducing the study, a copy of the english and spanish (ltbcs) version of the questionnaire, a copy of the institutional review board (irb) approval, an english and spanish consent form, and the researcher’s certificate of completion of the national institute of health human subjects protections education. respondents contacted the interviewer after they had received the packet and read the materials. the respondent determined the location of the interview, either at the researcher’s office or a location advances in social work, spring 2013, 14(1) 87 convenient to the respondent, as well as provided a date and time to meet for the interview. respondents were informed of confidentiality and anonymity, and, with their permission, interviews were tape-recorded. most of the interviews were conducted in english, one third were in spanish, with the majority occurring in the home of the respondent. interviews ranged between 60-90 minutes. during the initial part of the interview, respondents were asked if they experienced any social, psychological and/or physical side effects as a result of having breast cancer. most women began telling their story from the point when they were first diagnosed. then they discussed the type of treatment that they received. they were specifically asked, “after having had breast cancer, how would you describe your quality of life socially?” initially, respondents reported that they were doing fine, but when asked if breast cancer had affected their relationships, the women began to discuss how breast cancer had changed them. the second part of the interview entailed questions that asked survivors to identify what, if any, were the positive effects of being diagnosed with breast cancer, as well as key demographic background information. after the interviews were completed, they were transcribed by the researcher and a research assistant who are bilingual spanish and english speakers. interviews conducted in spanish were translated into english, and then coded. each interview was read twice before it was coded. the initial coding process involved coding for topical categories relating to the social aspects of quality of life. the initial codes served to summarize and sort out many issues relating to coping with diagnosis; surgery, including breast reconstruction; treatment relating to chemotherapy and radiation; and the long-term physical and social side effects. the coded “conglomerates” of data were sorted into categories of recurring patterns and issues: health status, relationships, body image, family, friends, and communication. then, utilizing kathy charmaz’s (1983) focused coding method, the researchers analyzed each new category systematically, utilizing lineby-line in-vivo coding, sorting out a series of repetition in statements, patterns, or inconsistencies relating to an issue in the topical categories, which provided more detailed codes relating to talking and expressing their fears, their feelings about their bodies, femininity, sexuality, and the need for social support. this method of analysis does have limitations because the process involves discarding a lot of the data during the coding process and presenting only parts, or slices of the narrative. however, this qualitative analysis allows for a nuanced understanding of the meaning-making process in coping with the long-term effects of a breast cancer. sample demographics latinas’ average age of diagnosis was 47 years old, with mean age of 57 at the time of the interview. most of the latinas were first-generation bilingual, in spanish and english, but one third of the women were spanish monolingual. sixty percent of the latinas interviewed were college-educated, with 40% reporting incomes higher than $60,000; 44% of the sample reported earning less than $30,000. most latinas (80%) identified themselves as being of mexican origin and other latinas (20%) identified themselves as being from guatemala, honduras, peru, and argentina. sixty percent of the women interviewed were not born in the united states, but were raised in the united martinez-ramos, garcia biggs, lozano/latina breast cancer survivors 88 states. the other 40% were born in the united states. most latinas stated that they received a mastectomy, but more than a third of the women had breast reconstruction (see table 1). table 1 demographics of sample (n=25) n % have health insurance 24 96 type of treatment mastectomy 21 84 lumpectomy 6 24 chemotherapy 15 60 radiation 4 16 hormone therapy 8 32 breast reconstruction (yes) 10 40 nativity born in the united states 9 36 not born in the united states 16 64 education high school graduate or less 10 40 some college or college graduate 15 60 employed (yes) 15 60 household income less than $15,000 3 12 $15,000 but less than $30,000 8 32 $30,000 but less than $60,000 4 16 $60,000 or more 10 40 note: mean age = 57 (34-84 years old); mean age at diagnosis = 47 (27-75 years old); mean years post diagnosis = 10 years there are limits to this sample because referrals were made nonrandom, primarily from a snowball sample. recruitment patterns may reflect similar social ties, and respondents were similar to each other in their age, education, class, and ethnicity. neither the women’s narratives nor the researchers’ observations and interpretations can be generalized to represent the experiences of all latina breast cancer survivors. advances in social work, spring 2013, 14(1) 89 results most of the respondents in the study reported that being diagnosed with breast cancer was a major life event that brought about new meaning in their life and their health. key concepts identified by the respondents were the difficulty of being able to talk about the loss, fear of recurrence as a recursive mindset, stigma, and uncertainty about their futures. they also reported that, although they received social support, they needed more assistance with being able to cope with the fear of recurrence. another key concept that emerged was that breast cancer made them more aware of their health, their roles in their families, their body images, and their femininity. they reported needing more support coping with the impact that breast cancer had on their body and their social relationships, particularly, their intimate relationships. some of the women reported that sharing ideas and opinions with others who had similar or comparable experiences helped them understand their own illness. lastly, the respondents reported that surviving breast cancer was a process of having to face new challenges, yet when they were supported by a friend, a family member, or someone who shared a similar experience, they were able to adapt. in some cases, women discussed feeling “empowered,” mainly because they became more empathetic toward other women like themselves who had been diagnosed with breast cancer. the long-term impact of having a breast cancer diagnosis and treatment subjects reported that they found it difficult to discuss with others how their diagnosis impacted them. many of them reported a fear of recurrence, a fear of stigma, and a fear of being treated differently. most of the women stated that they had to socially negotiate their self-disclosure about the emotional impact that breast cancer had for them. my friends, my family, and my husband are very supportive. i still measure how much i let them know, because you don’t want to upset them. y te puedo decir que nunca se acaba porque siempre tienes el miedo que regresa [cancer] verdad? pero yo seguí luchando porque yo soy una mujer que siempre me dediqué a mis hijos y a mi esposo. [i can tell you that it never ends; because i can tell you that you always have fear that it (cancer) will return, right? but, i continue to fight because i am a woman who has always been dedicated to my children and my husband]. el cáncer te cambia toda tu vida. cuando a mi me preguntan “y a ti como te ha ido?” pues tú tienes que ser positiva si tú quires seguir aquí. eso es lo que yo siempre les digo. pero tampoco les digo que es la maravilla y que vas a regresar a tu vida. yo no mas digo “tienes que ser positvia si queres estar aqui.” pero la verdad es que para mi ha sido una hebra que nunca he podido acabar de jalar… para mí ha sido traumática. sigo con el temor de cancer. [cancer changes all of your life. when they ask me, “how did it go for you?” well you have to stay positive if you want to survive. that is what i always tell them. but, at the same time, i don’t tell them everything is marvelous and that you are going to return to your previous life. but the truth is, for me, it has been like an unwinding thread martinez-ramos, garcia biggs, lozano/latina breast cancer survivors 90 that i have never been able to stop pulling. i pull, and pull and pull…it has been a traumatic experience for me. i continue to fear cancer]. you feel. wow, i made it to five years, but all you feel so fearful. you know, i am numb from going from the perception of myself as a healthy person to now, i am dealing with cancer, and there is a stigma to it. there is a lot of different things, even the way people look at you at work. i get asked more often, when i am going to retire. often respondents stated that they were very cautious how they speak about having breast cancer to their spouses or family members and about their fear of recurrence because they did not want to “burden” them with negative emotions or “worry” them. they did not want to bring other people “down,” upset them, or be treated differently because they had breast cancer. most women stated that they often concealed and did not share or express their emotions about breast cancer out of fear that people would perceive them negatively. a majority of the respondents stated that they had never been approached by anyone to discuss the impact that breast cancer had on them initially and the continued suffering from the long-term effects of their breast cancer treatment and surgery. perceptions of the impact that breast cancer has on femininity the women who had a mastectomy or a permanent procedure on their bodies reported no longer “feeling the same” after breast cancer. many of the women reported that the changes to their body affected their femininity and sexuality. latina women who had mastectomies reported that breast cancer treatment and surgery had a negative effect on their body image, which also had a negative effect on their social relationships. si, la recuperación si fue duro pero lo más difícil fue la aceptación de que cuando vi que yo no tenía el pecho porque yo he sido una mujer que siempre me gusta arreglarme, lucirme y una de las cosas que más me gustaba usar eran mis vestidos, a sentirme atractiva y para mi fue muy dificil cada vez que yo salia y miraba una mujer asi como yo me vestia. [yes, the recovery was hard, but what was more difficult was the process of accepting that i did not have a breast because i was the type of woman who liked to get dressed up, to show off (my beauty), and one of the things that i liked most was to wear my dresses to feel attractive. so, for me, it was very difficult every time i would go out and see a woman dressed the way i used to dress]. i think i had two very nice looking breasts. i am sorry that is not the case now. i do a lot of ballroom dancing, and some of the latin dancing dresses that are cut low in the front, you know that it looks nice, but i will never be able to wear a dress like that. so, there is a degree of grieving that went along with losing my breasts. i am saddened that my body has had to look different and i feel it is part of the sacrifice that one makes to get well. the grief period, the thought of losing your breast or the possibility of losing the breast is very traumatic to all women. advances in social work, spring 2013, 14(1) 91 mira cuando me hicieron la lumpectomia, para mi era desagradable verme. porque… veía deforme mi seno. ¿si? en primera significó una herida en mi cuerpo. una deformación en mi cuerpo. [sighs] en segunda imaginate si me hubieran quitado el seno. hubiera sido una mutilación. para mi eso es, una mutilación. si una mutilación ya que es una parte que falta de tu cuerpo que todas las demás mujeres tienen. look, when i had the lumpectomy, for me, it was unpleasant to see myself because i saw my breast deformed. yes, [at] first, it meant a scar [would be] on my body…a deformation on my body… a mutilation. it would have been a mutilation. imagine if they had removed my breast. for me, what it’s a mutilation -a mutilation to your body! a part of your body, that all women have, is missing]. the women reported that they did not discuss their sadness, loss, and anxiety about their body image with others because they feared being stigmatized and they were reluctant to discuss how breast cancer impacted their body. some women said that they did not want to be perceived as being vain or “too much into her body image.” they were concerned that if they spoke about their experience, they would also be inviting insensitive comments from others, particularly family, friends, co-workers, and health care providers. some people made some insensitive comments; they were often women. one teacher, when she learned that i had reconstructive surgery said, “how fortunate you are; how lucky you are; you know, you got to pick your size.” and i said, “you know what? i much rather have the ones god gave me, thank you very much,” and i walked out of the room. and another one, i tried to explain to her that i was grieving and that i was sad about the loss of my breast, and she said, “i didn’t think you were into your body that way.” and i said, “well, it wasn’t the defining factor of my being, but it’s still a loss of your body.” it’s just not the same. let alone people just do not understand it when you have reconstructive surgery. you lose. all the nerve endings are shot, so that sense of touch is gone. it is a whole other ball game. that is a big loss. or, i thought that is a big loss. need for social support and information latinas found themselves having to negotiate a new social landscape and often stated that they sought out the support of close friends and family, followed by clergy (or their religious group), and social support groups. most latinas stated that the health care system fell short of providing and assisting them in understanding the impact that breast cancer has in their lives and their well-being. my sisters were very supportive and people at my church prayed for me. i remember calling around to see if there was a church base support group, and there wasn’t one. and i had a visit from the priest; he basically told me, “life’s rough get over it.” siento que allí [groupo de apollo] aprendes. o sea, aprendes porque una dice una cosa y a lo mejor a la misma vez te esta pasando a ti. y a lo mejor la misma duda que tu tienes la otra persona la… la hizo y ya sabe la respuesta. o sabe martinez-ramos, garcia biggs, lozano/latina breast cancer survivors 92 expresar ese sentimiento y uno no lo sabe expresar o no lo dice. entonces allí aprendes bastante. aprendes que tu no eres la única que sufres. sino que, hay otras mujeres que son completamente distintas a ti que vienen de otra familia. que es la misma cultura y que lo sienten [igualmente]. y no te sientes tan culpable tampoco. ¿no? entonces aprendes bastante. [i feel that at the support group, you learn. i learn because one person may say one thing that you are experiencing. the same doubt that you have, another person may have or have experienced it, and they have the answer. they know how to express their feelings [when] one does not know how to express those feelings. so, you learn a lot. there are some women who have very unique experiences from different family backgrounds. they come from the same cultural background and can feel similarly. you do not feel guilty. right? thus, you learn a lot]. in this sample, a majority of the women stated that information and communication about life after breast cancer should be improved for bilingual and spanish-speaking latinas. when asked how a doctor or health care provider can be sensitive to latinas needs, one survivor stated: if you don’t have dialogue with your doctor, then he is not sensitive to all of your needs that you might have, and you are unable to tell him what is actually transpiring in your body and your mind. most women, particularly women who spoke limited english, stated that their communication with their doctor was poor, and they lacked information on how to adapt to the long-term side effects of breast cancer. yo le preguntaba al doctor, y el me preguntaba, y el me ignoro, me ignoro. el no me dio la informacion. [i would ask the doctor, and he would question me, and he would ignore me. he ignored me. he did not give me information]. the women in the sample stated that bilingual social support groups were needed to assist long after their breast cancer surgery and treatment were completed, to assist in coping with the challenges they faced as breast cancer survivors. when asked how social support groups helped after their treatment was over, they reported that they attended support groups to talk about how breast cancer affected their status as women, and they identified the need to build a community of support. women utilized various forms of social support, including their families, church members and clergy, trained therapists or counselors, and support groups to help them cope. i dealt with some things i haven’t dealt with from my past, like my folks, my place in the family, my value as a woman, and my culture. my sisters and i told my folks that it is not ok that the men in our family seemed to be much more valued than the women in the family. i am better affirming my own value and my own worth in different arenas. i am better able to just stand up for myself. i think my husband had the perspective “once we get through it, she can go on and be the same person that she was.” you know, my attitude toward house cleaning changed, my attitude towards the way i spend my energy has changed, and my ability to say “no” got stronger. i remember telling a friend that [when they] advances in social work, spring 2013, 14(1) 93 took my breast, my heart opened; because everybody was looking at my breast, nobody could look at my heart. i have shown my body (to), i don’t know to how many women. i wouldn’t like another woman to go through that because it was horrendous; because even though i have a wonderful family and friends, but it is like they just hear the word “cancer” and it’s like a death sentence. talking to others and sharing their experiences helped women understand how to cope with the long-term social and physical effects of breast cancer. the respondents stated that, as they became more engaged when listening to other women’s experiences, they were able to talk more about the impact of breast cancer in their own lives, seek out more information about breast cancer, and were likely to see their future as surviving breast cancer instead of a death sentence. perceptions of the impact that breast cancer has on intimate relationships when asked about the long-term effects on their quality of life, they connected it to body image and femininity, but found it difficult to talk about. most stated that they thought about the impact that breast cancer surgery and treatment would have on their sexual intimacy. the women reported that they rarely spoke about how breast cancer compromised their sexual intimacy. the issue of sexuality and intimacy became apparent when they engaged in intimate social relationships. their main concern was the fear of being rejected or being stigmatized by their partner’s or by their spouse’s perception of them as being disfigured or deformed. in a few cases, women said that they did not engage with another person intimately because they felt ashamed of how they looked. i have not liked having relationships with another person. even when i have had suitors, well, i feel, i feel bad, do you understand me? because a man, when he sees one like this they say, “no, you are no longer complete.” they make you [feel] ugly and it hurts oneself. you are no longer complete. my fiancée, he started coming less around and calling me less and i knew that this was going to be the end. i remember one day confronting him, and i said, ‘i know what is happening, and i think i know why, but i just want you to tell me. tell me in my face that you don’t want me because i am missing a breast.’ and, he didn’t have the guts to say that. i said, “i just want you to tell me.” he finally admitted, “yes, i am having a terrible time, and maybe, if they [had] cut off your foot instead of your breast, maybe that may [would] have been different.” although many women were supported by their spouses, latinas reported that breast cancer surgery and treatment has had long-term effects on their ability to experience intimacy. i have been able to talk to him and say, “i don’t have my breasts now, so i feel half of my joy is gone, but why don’t we make up this way? more stimulation in other areas.” sometimes, he says, “i am not very creative, but you tell me what to do.” which is good. you know, a lot of women, they cannot even speak of it, or mention anything. martinez-ramos, garcia biggs, lozano/latina breast cancer survivors 94 perceptions of self transformation and empowerment in this study, latinas reported that breast cancer made them become more introspective about their futures. they stated that being diagnosed with breast cancer made them think about their lives, their health, and well-being. the process coincided with rethinking and becoming more conscious about their roles in their families as mothers, wives, sisters, and grandmothers. some women said that breast cancer made them think about their gender and cultural roles in their communities as well. when you get the diagnosis of cancer, you realize that your time is limited. i started focusing more on the quality of my life. i changed my diet, and it’s changed the way i value relationships. many women reported that talking to and connecting with other women, especially latinas who could relate to them culturally and who had breast cancer helped them to adapt to the challenges and changes of breast cancer. however, most women reported that they were aware that breast cancer support, which addresses the unique needs of latina breast cancer survivors, was lacking in the health care system. most latinas perceived a lack of outreach and sensitivity by the health care system and felt that women who feel unsupported may feel helpless or alone. over half of the latina women became involved in breast cancer prevention advocacy efforts and engaged in public speaking by sharing their personal stories with other latina breast cancer survivors. many of the women said that they became involved in raising awareness and breast cancer education and prevention to help break down the stigma of shame and silence and to promote the message that being diagnosed with breast cancer doesn’t mean that a woman has to die from breast cancer. as one latina stated, “i am a survivor. i tell everybody. i tell them [other breast cancer survivors] so that they’ll know that there is a second chance.” being diagnosed with breast cancer was perceived as a turning point in the women’s lives. in discovering their authenticity, the women reported focusing on their present living conditions, changing their values and beliefs, and achieving more self-confidence and self-empowerment. people have told me, and i think it’s somewhat like a light was turned on inside me and i’m radiating. well, you know, i just consider myself as a survivor. what changed is how i live my life, you know. i always thought i was a good person. i learned to live more one day at a time. i learned to live to make the best of my days. you don’t do things that are foolish or needless anymore. discussion and conclusion the long term effects of breast cancer made it difficult, and in some cases impossible, to return “back to normal” and feel fully embodied. this study describes key social and cultural issues that latina breast cancer survivors experience. after their surgery and treatments, these latinas faced many challenges, including communicating their needs and concerns, especially the fear of recurrence of their breast cancer, and the long-term effects and changes to their body, femininity, sexuality, and personal empowerment. furthermore, latinas reported that their quality of life, after being diagnosed with breast cancer, depended on their relationship with their family and friends advances in social work, spring 2013, 14(1) 95 and access to resources including social support. however, it was difficult for them to talk about their concerns because they did not want to burden their families. family values and roles, the expectations as a mother and wife, and ideas about femininity shaped their breast cancer survivorship experiences. in some cases, breast cancer permanently changed their bodies and their social identities, including how they related to their families and friends. the findings in this study add to understanding the relationship between family relationships and social relationships, including gender roles and expectations that have not been addressed by previous research. in this study, latinas reported that being a breast cancer survivor included coping with the challenge of having to negotiate their social roles and social identities. prior research has found that familism, or having a strong identification and attachment with one’s family, is a key factor for providing social support, but also can hinder a woman’s ability to share her experience (lopez-class et al., 2011). a key theme that emerged in this study is that latina breast cancer survivors live with fear and the stigma of discussing their breast cancer with others because they are afraid of being treated differently. many of the women stated that they did not share the emotional impact that breast cancer had on them because they did not want to “burden” their families or friends, or simply because they thought others would not be able to provide the emotional support that they were seeking. this finding is consistent with the findings of lopez-class et al. (2011) also found that latinas reported feeling supported by their families, but did not share their emotional responses with them; or they had difficulty communicating with their spouses and their health care professionals about their illness experiences. yet, most latinas in this study reported seeking social support from family, friends, and clergy before participating in formally-organized support groups or working with a therapist. furthermore, they reported that although nurses and doctors were supportive, communication, information, and educational services about breast cancer and survivorship were inadequate and needed to be improved for bilingual and spanishspeaking latinas. studies on latina breast cancer survivors have noted that they have different needs, and the lack of access to social support results in latinas’ having a decreased awareness of information and less access to information needed to reduce isolation and promote healthy breast cancer adjustment (buki et al., 2008; campesino et al., 2009; galvan et al., 2009; zambrana & thornton dill, 2006). the process of becoming empowered did emerge as a result of reflective thinking and self-transformation. many respondents reported that becoming an advocate helped them gain a sense of empowerment in facing their personal challenges as breast cancer survivors. ten of the women reported that they became involved in providing social support and advocacy to help other latinas understand that breast cancer is not a death sentence and that there is life after breast cancer. according to gutierrez (1994), empowerment is a process of increasing self-efficacy; developing a critical consciousness; skill building that allows the individual to develop resources to be more powerful on an individual, interpersonal, or political level; and involvement with similar others. this empowerment process is a “continual process of growth and change which can occur throughout the lifecycle” (p. 205). gutierrez (1994) argues that, if social workers are to create structures and programs to mediate the effects of stress and martinez-ramos, garcia biggs, lozano/latina breast cancer survivors 96 encourage empowerment, they should consider the empowerment process perspective; particularly, she notes, when working with marginalized groups who are likely to experience stress due to societal injustice and inadequate access to resources (gutierrez, 1994). personal empowerment is difficult to measure, but researchers have found it to be effective in promoting lay health education programs that go beyond providing access to health care to provide culturally appropriate health education programs to underserved communities (booker, robinson, kay, najera, & stewart, 1997). this research has generated useful information about the social and cultural context and nuances of breast cancer survivorship among latinas. there are not enough studies that have examined latinas’ perceptions on how breast cancer affects their social relationships. in this study, latinas reported that being diagnosed with breast cancer made them rethink their social roles. moreover, having access to social support helped them talk about their experiences and become advocates for other breast cancer survivors. studies have shown that social support such as the provision of information and peer group support can help cancer survivors change their perceptions of the threat of cancer and reduce stress (zebrack, 2000). social support can help women and their families find meaning, minimize fears when facing breast cancer, mobilize resources to aid them in adapting to the changes, and feel more “in control” and empowered (hilton, 1988; lee, 1997). klawiter (2008) noted that breast cancer survivors experienced positive changes by becoming pro-active in their well-being and health care. the perception of social support improved their quality of life (sammarco, 2001), while social support, in the form of financial assistance, counseling, and support services, facilitated effective coping skills, enhanced socioeconomic resources, and motivated breast cancer survivors to engage in adaptive behaviors (galvan et al., 2009). several caveats should be considered in evaluating our results, including the sampling approach, the clinical diagnosis, and the participants. the sample was primarily from california and recruited from various community health care organizations, and many do not reflect the experiences of women who have not connected to or utilized community-based health care facilities. in addition, this sample does not reflect a nationally-represented sample of diverse latinas living in the united states; thus the results of this study cannot be generalized to all latinas. the experiences of the women in this sample reflect women who had some access to health care since health care facilities were the locations utilized to recruit participants. despite these limitations, our study builds upon and adds to the existing literature about latina breast cancer survivorship. this qualitative study shows how social and cultural values shape the experiences of breast cancer survivors and how breast cancer survivors redefine and are resilient in the face of societal constraints and barriers. latina breast cancer survivors prefer care-giving, social support, and educational interventions by latinas who can relate to their survivorship experience. it is in this way that latina breast cancer survivors can begin the process of recovery and healing and become empowered through building community. advances in social work, spring 2013, 14(1) 97 interventions should be designed to address cultural needs specific to latina women. while this study utilized a small sample, it offers a glimpse into breast cancer survivorship experiences and how they are shaped by a variety of factors including the importance of family, immigration, language, outreach and education, and social support. overall, a heightened awareness of cultural differences in program and policy development is critical in the development of interventions to include spanish and english inter-cultural communication social support programs. doing so will allow women to speak freely about how breast cancer affects their bodies, femininity, social relationships, and sexuality without anxiety or shame. another option includes utilizing latina breast cancer survivors in staffing and program development, as they seem to be more compassionate toward women and their families when discussing breast cancer. at the familial level, social role conflict can be addressed by educating spouses and family members about the long-term effects of breast cancer to facilitate their learning about how they can communicate and provide social support. for latinas, the process needs to include an open dialogue about their social and cultural roles in the family, their femininity, and sexuality. interventions that address sexual intimacy may best be implemented with individual and couples counseling, and with support groups led by therapists sensitive to ethnicity, diverse cultures, and gender (buki et al., 2008; 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(2009). health disparities in the latino population. epidemiologic reviews, 31(1), 99-112. advances in social work, spring 2013, 14(1) 101 vickberg, s. m. j. (2001). fears about breast cancer recurrence: interviews with a diverse sample. cancer practice, 9(5), 237-243. watlington, a. t., byers, t., mouchawar, j., sauaia, a., & ellis, j. (2007). does having insurance affect differences in clinical presentation between hispanic and nonhispanic white women with breast cancer? cancer, 109(10), 2093-2099. zambrana, r. e., & thornton dill, b. (2006). disparities in latina health: an intersectional analysis. in a. j. schultz & l. mullings (eds.), gender race, class, & health intersectional approaches (pp. 192-227). san francisco, ca: jossey-bass. zebrack, b. (2000). cancer survivor identity and quality of life. cancer practice, 8(5), 238-242. author note: address correspondence to: gloria p. martinez-ramos, ph.d., associate professor, department of sociology, texas state university, san marcos. email: gm21@txstate.edu microsoft word 03 gillingham_18244_electronic_information_systems_au_ce.docx ______________  dr philip gillingham, senior research fellow, school of social work and human services, university of queensland, st lucia campus, brisbane, queensland, australia. copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 31-42 electronic information systems and social work: principles of participatory design for social workers philip gillingham abstract: the introduction of electronic information systems (is) to human service organizations has been heavily critiqued, most notably for the ways that is may undermine frontline social work practice. socio-technical design has been proposed as one way to redesign is, and a key element of this approach is the involvement of practitioners in the design process. social workers, though, may be ill-prepared to engage in such processes. reflecting on the findings of a program of research which aimed to contribute to future designs of is that support frontline practice, this article aims to provide some guidance for social workers to help them be active and effective participants in the future development of is. keywords: electronic information system, participatory design problems and limitations of the use of electronic information systems (is) in social work have emerged from research internationally. examples include child protection services (huuskonen & vakkari, 2013) and psychiatric care (saario & stepney, 2009) in finland and victim and offender mediation in belgium (bradt, roose, bouverne-de-brie, & de schryver, 2011) and australia (ombudsman, 2009; wood, 2008). some critical literature about the state automated child welfare information systems in the usa has also emerged (see naccarato, 2010). however, the current forms of is, also known as management information systems or client management systems, being used in england have been mostly heavily criticised (see, for example, broadhurst et al., 2010; peckover, white, & hall, 2008; pithouse, hall, peckover, & white, 2009; shaw et al., 2009), particularly for how they impair the decision-making of workers and re-order their priorities away from providing services to children and families (see munro, 2011; white et al., 2009). in a review of child protection services, munro (2011) concluded that is present “substantial obstacles to good practice” (p. 114). the reasons why problems have arisen with is have been widely debated in the literature. in summary, it has been suggested that is designers have lacked sufficient knowledge about frontline social work practice (damodaran, 1996), social work agencies have struggled to define their needs (senyucel, 2008), the needs of managers have prevailed over those of frontline social workers (tregeagle & darcy, 2008), and social workers have not been sufficiently involved in the design of is (wagner & piccoli, 2007). socio-technical systems design, which follows the core principles of user participation (gillingham, 2011; kujala, 2008), minimum critical specification, and the optimization of local autonomy, supported by ethnographic observation of how work is actually achieved (wastell & white, 2013), has been proposed as a way forward. social workers, however, may be ill-prepared to engage in the design processes for is, yet their participation is vital to ensure that future design meets their needs. there is ample guidance within the literature to assist is designers (for example, lamendola & krysik, 2008), yet there is little to assist social workers. therefore, the gillingham/electronic information systems 32   aim of this article is to address this gap in the literature and provide some guidance for social workers to engage in the design processes as active and effective participants in the future development of is. the research the author is engaged in a program of research which aims to generate knowledge that will inform the future design of is for use in human service organizations (hso). partnerships with child protection agencies in england as well as five australian ngos, which are government funded to provide services to a range of service users, are contributing to detailed studies. these studies are examining how agencies are using and transforming current and emerging forms of is and engaging with information and communication technology more generally. permission to conduct the research has been provided by relevant ethics committees at the author’s university and the agencies. the research design is ethnographic and has involved participant observation of practice and meetings and interviews with key stakeholders (for full details about research methods see gillingham, 2011). theoretically the research is guided by concepts drawn from social informatics, defined broadly as ‘‘the interdisciplinary study of the design, uses and consequences of information technology that takes into account their intersection with institutional and cultural contexts’’ (kling, 1999, p. 205). in this article, concepts and ideas have been drawn from previous research about participatory design and the joint cognitive systems approach developed by hollnagel and woods (2005). of particular pertinence to this article, the author has been a participant observer in 12 participatory design workshops at two different social welfare agencies. twenty follow-up interviews with some of the participants, including administrative staff, frontline practitioners, team leaders, and managers, were conducted. during both the periods of observation and interviews, extensive notes were taken and later typed up in a field diary. drawing from a "grounded theory approach,” data were analysed as the research proceeded, with the author using a form of memo writing in the field diary (lempert, 2007). emergent themes assisted with focusing subsequent data collection. identifying, understanding, and interpreting themes in the data was an iterative process in which “ideas [were] used to make sense of data and data [were] used to change . . . ideas” (hammersley & atkinson, 2007, p. 159). agencies have been recruited on an ongoing basis throughout the research with selection based on their interest in developing, implementing, and evaluating is. one of the two main agencies referred to in this article provides a wide range of services to children and families, children in state care, people with physical and intellectual impairment, and older people requiring support in their own homes and residential nursing care. this range is typical of non-government agencies in australia which have diversified as funding has been made available by state and federal governments for services to be provided outside of the government sector. the other agency specializes in supporting adults with intellectual disabilities and provides vocational and residential services. though both sets of workshops were described as participatory design, they differed in that one agency aimed to decide on the functionality required of an is for different workgroups across the agency prior to matching identified need with what advances in social work, spring 2015, 16(1) 33   was on offer from vendors. at the other, the is had already been chosen, and the aim was to map the activities and needs of different workgroups in terms of how they could be molded to fit the functionality of the chosen is. this article summarizes the findings of this stage of the research with reference to research and theory from disciplines other than social work to provide both practical and theoretical guidance for social workers. changing the dynamics of participatory design participatory design has long been used as an approach to involve the end users of computer-based technology in its design (kujala, 2003; schoech, 1982). clearly, in terms of socio-technical design, the aim is to match the needs of participants with the is. however, this may not be the main aim from the perspectives of is designers and vendors. participatory design has been used to gain the acceptance of end users in the shift to the use of technology in the workplace (wagner & piccoli, 2007) and thereby minimise "technology shock" (johnson, hinterlong, & sherraden, 2001). more cynically, it has also been used as a way to gain end user buy-in for a particular piece of technology, the reasoning being that users have less reason to complain when they have been involved in the processes of design and implementation (kujala, 2008; wagner & piccoli, 2007). within the literature, it has also been noted that little attention has been paid to whether the participation of end users can actually improve is, possibly because designers tend to think of themselves as "the experts" (wagner & piccoli, 2007). it is also the case that designers, and especially vendors, are attempting to promote and/or sell a commercial product and so cannot be expected to be neutral or critical about the effects of introducing new technology to an agency. one of the main difficulties for designers has been interpreting the detailed knowledge supplied by end users, particularly in capturing the context for the final use of technology. kujala (2008) observes that "user involvement is not simple information gathering…users and developers have different vocabularies, interests, and values, which makes the communication and interplay complicated" (p. 458). there is, however, reason to be optimistic that the gap between designers and participants can be closed and that the power imbalance can be shifted more in favor of participants. in the 1990s, social workers' negativity towards adopting digital technology was referred to as "computer phobia," and a key concern of managers and designers was finding ways to get social workers to use computers (neugeboren, 1996). nowadays, as laptops, tablets, and smartphones become more ubiquitous in everyday life (gillingham, 2014a), users are more adept at discussing digital technology. certainly, designers and vendors, when challenged by participants, may defend themselves with technical language beyond the knowledge base of most social workers. however, this tendency can be countered by adherence to the guidance outlined in the next sections. key principle – technology has to amplify the ability of users. the joint cognitive systems (jcs) approach “offers a principled approach to studying human work with complex technology and provides a conceptual framework for analysis with concrete theories and methods for joint system modelling” (mouloudi, morizet-mahoudeaux, & valentin, 2011, p. 110). the author has applied these concepts to explore the reasons why problems have arisen generally with is in human services organizations (gillingham, 2014b). a key principle from the jcs gillingham/electronic information systems 34   approach is that an important measure of success in the implementation of technology is the extent to which it can demonstrably amplify the ability of workers to do their jobs (hollnagel & woods, 2005). although this applies most readily to an evaluation of an is after it has been implemented, it can also be used by participants during participatory design in the form of a critical question. speculation about how an is might amplify or hinder ability is crucial to guard against what wastell (2011) describes as “magical” thinking: the uncritical belief that technology can only solve, rather than create, problems. the pitfalls of participatory design 1. the over-complication of practical tasks as hollnagel and woods (2005) have stated: “[u]nfortunately, the extensive use of computers has created an equally large number of possibilities for making simple tasks unnecessarily complex” (p. 37). how such possibilities can arise was amply demonstrated in some of the design workshops attended in this research. in both cases, designers or vendors were keen to demonstrate how their is could be used to record data in a number of situations where, hitherto, no data was being captured. for example, it was proposed by an it manager that residential and day care staff could communicate about service users via an is instead of a verbal exchange supplemented with notes. however, this system would require much more staff time and keep staff away from service users at busy times of the day. this example illustrates that attempts to maximize the use of an is may just create new tasks and layers of complexity with no clear purpose and no amplification of ability. 2. solving organisational problems changes within organizations when an is is introduced have been well documented and have been accepted as inevitable (mengesha, 2010). however, as the critiques mentioned in the introduction demonstrate, many of these changes may be unintended and unconstructive (gillingham, 2015a). markus (2004) proposes that technology can be used as a catalyst for organizational change, but only if it is considered part of initiative to promote organizational change with clear aims and methodology. therefore, introducing an is cannot be considered a panacea that will solve organizational problems (gillingham, 2015a). for example, in one agency, a stated aim of introducing an is was to “break down silos” between different parts of the agency. an is that enables transparency across an organization may contribute to this process, but only as part of a more focused strategy to promote greater communication and cooperation between managers and their departments. another agency aimed to reduce bureaucracy, but unless underlying organizational attitudes changed, the tendency to create forms for every instance might be transferred or even magnified within a new is. what information, why and who and how a particular challenge in the workshops, especially for frontline practitioners, was deciding what information should be recorded, why, who should record it, and how it should be recorded. given previous restrictions about the amount of information that could be recorded in paper files, the default position, encouraged by managers and administrators, was to record everything. this was reinforced in one of advances in social work, spring 2015, 16(1) 35   the agencies by the representative of the is company constantly repeating “you can’t report on what you don’t record.” however, as noted in the critiques of is, a particular problem with is has been that the amount of time that practitioners are required to spend entering data on is has become disproportionate to time spent with service users. in both this and other research (see gillingham, 2009; parton, 2008), some participants have estimated that they spend up to 80% of their time engaged in data entry. it was also clear to the author and participants that insufficient time had been allocated to make decisions about information in the workshops, as this task was never completed. the suggestion here is that the process of deciding how information should be categorized should be finalized well in advance of participatory design processes. it is to be expected that there will need to be some trade-offs between the needs of management and administrators and those of practitioners. the following is a summary of the key points to be considered in the process. what information? clearly, there is a base level of information about service users and service activity that needs to be recorded, but the amount of detail required in relation to service activity is less clear. both external and internal factors may influence what is required to be recorded. a key external factor that affects how much information needs to be recorded in an is is accountability. in the australian context, this involves how non-government agencies report on their activities to their main funding bodies (state and federal governments). according to participants, this process can be time consuming. organizations expect that is can make this task less onerous by drawing together in one system all information about service users and user activity. however, while is can make reporting easier, they also raise expectations about what can be reported on. as munro (2011) has argued in the context of england and wales, this can lead to an "audit culture" which distracts from professional practice. there is also the danger that the reporting abilities of is distract from the fact that the reports are only as good as the data that exists within them (carrilio, packard, & clapp, 2004). frequent and detailed reports require the consistent and timely entry of accurate and reliable data. negotiating required levels of reporting to funding agencies may be considered beyond the remit of a participatory design process, but the need to do so may arise from reflection on how much detail about service activity needs to be recorded in a new is. this may be an important strategy in addressing the potentially ongoing tension between time spent entering data about service activity and time spent working with service users. the other key external factor is that professional associations have both ethical and practical guidelines about what they expect their members to record about service users and their activities in relation to them (see british association of social workers, 2012; national association of social workers, 2008). internal factors which affect what information needs to be recorded may be agency guidelines or organizational culture governing how tasks are carried out and how various organizational roles are enacted (jones & may, 1992). a participatory design project, in offering the possibility of recording new or different information, prompts reflection on these particular aspects of organizational culture. however, the scale of organizational change that might be required at the same time that a new is is being implemented should not be underestimated. gillingham/electronic information systems 36   by whom? the advent of desktop computing has changed the role of both social workers and administrative staff within hsos (gillingham, 2014c). much of the administrative work that was previously done by clerks and secretaries, such as typing letters and reports, filing and arranging paperwork, and minuting meetings, is now being done by social workers, to the detriment of direct work with service users. given the problems associated with making social workers primarily responsible for administrative tasks, a participatory design process may be an opportunity to reconsider who should adopt those responsibilities. for example, one agency decided that only team leaders, managers, and administrative staff would engage with the is. team leaders and administrative staff were responsible for uploading, organizing, and summarizing the casenotes emailed to them by frontline staff. similarly, in the london hackney borough, a new approach to organising social work practice involved small teams of practitioners, each with an administrative officer designated to support data entry into the is (cross, hubbard, & munro, 2010). social work staff in these units report that they spend significantly less time on administrative tasks than previously (20% rather than 70%) (cross et al., 2010, p. 21), leaving them more time to work with children and parents. encouraging and supporting service users to contribute to the information about their participation in an intervention is not new, as participatory approaches to social work practice have demonstrated (see for example, tregeagle & mason, 2008). the advent of web 2.0 and the ability to access is through the internet may create new opportunities for such engagement for service users. giving service users access to their electronic case files is clearly on the agenda in australia. from their survey of social service agencies, grundy and grundy (2013) found that there was a "mixed response" to such a development, though "most were positive." overall, agencies believed that service users might benefit from being able to follow their progress and receive reminders about appointments and meetings. the main concerns expressed were service user access to computers, security of information, and the potentially damaging misinterpretation of information by service users. for what purpose? as observed in the workshops, there is a tendency to design is in ways that capture ever more information, with the underlying rationale that more information is better than less (gillingham, 2014c). this practice may lead to frontline practitioners spending a disproportionate amount of their time entering data. to counter this tendency, the rationale for capturing data about service activity and service users must be made explicit in the design of is. aside from the need to account for public expenditure, there may be other rationales that can capitalise on the abilities of is to collate and organise information. in particular, these abilities might sit well with increasing demands for social work and social care practice to be evidence based or evidence informed (littell & shlonksy, 2010) as is can be powerful tools in both the formative and summative evaluation of service delivery (o'connor, laszewski, hammel, & durkin, 2011). however, a plan for what to evaluate and how to go about evaluating must be clearly articulated to guide the design and implementation of an is. advances in social work, spring 2015, 16(1) 37   the workshop discussions provided another purpose for recording data: the importance that participants attached to the case files for children in the care of the state. as goddard, murray, and duncalf (2012) describe, it is common for adults who were in the care of the state to request access to the case files held by the organizations that cared for them. creating meaningful case files for children and meeting the needs of a range of stakeholders is clearly a complex task, but researchbased approaches have been developed (see kertesz & humphreys, 2013). how is information to be recorded? how information about service users is recorded is an important consideration. as mentioned above, is can now be accessed through the internet. with the advent of mobile internet technology, there is less need for social workers to return to the office to enter data. decisions therefore need to be made about staff members' mobile access to an is. o'connor et al. (2011), for example, found that the use of mobile devices by practitioners to enter data about children and families in a home visitation program saved time (and money) and led to a more complete set of data. making these decisions in the agencies in this research has proved to be difficult as concerns have been raised about data security and how accessing the is from home might upset the work/life balance of workers. after the is has been fully implemented, future research can explore how the resolution of these concerns will affect both frontline and management practice. at a more abstract level, how information about service activity and service users is recorded affects how staff at all levels understand and think about their work. as aas (2004) and parton (2008) have argued, the demands of current forms of is have undermined the traditional narrative approach that has been used in social work. this has led to significant effects on how decisions are made and what interventions are offered to service users. categorization having decided what information needs to be captured in an is, a number of decisions need to be made about how the information is categorized within it (gillingham, 2015b). this caused much debate in the workshops, reflecting the observation that the significance of descriptive language in shaping the behaviour and experiences of those to whom it has been applied has been a long-term concern for social work (heffernan, 2006). labeling people in particular ways has consequences for their construction of identity, how they are treated by others, and the expectations placed on them (barn & harman, 2006). more broadly, the language used to describe social problems and those who are experiencing them reflects and reinforces the ideology that guides how we understand problems and subsequently respond to them (vojak, 2009). for example, an agency which employs a range of professions experienced considerable debate about whether service users would be known in the is as clients, patients, or, as suggested by the is vendor, customers. another challenge was how information should be arranged and labelled within an is. each profession reflected its own orientation in suggesting different labels, and it was clear that ambiguity between different tabs or folders, such as “health” and “medical,” might lead to data being entered incorrectly. at a finer level of detail, there were myriad decisions to be made about drop-down lists and automatically populated areas of case files, both to gillingham/electronic information systems 38   describe the attributes and problems of service users and the types of intervention that were offered. though such functionality can save much time and effort, participants questioned whether binary choices about whether a service user is experiencing a particular problem, such as mental illness or illicit drug use, were really helpful. conclusion reflecting on the insights provided in this article, participatory design for social workers emerges as a complex and perhaps daunting activity and, most certainly, not a task to be taken lightly. it is essential that social workers make a significant contribution to, and, increasingly take the lead in the design of technology that will shape, guide, and ultimately support their practice. the insights provided in this article will promote greater preparedness in social workers to engage with participatory design, but no claim is made that they are exhaustive. the implementation of is raises both ethical and moral concerns which are beyond the scope of this article, and future technologies will present new opportunities and challenges. the main contribution of this article is the promotion of a critical and constructive stance in relation to the adoption of digital technology in social work practice. this approach includes raising questions about whether and how digital technology amplifies the abilities of social workers, how it is related to organizational change, and how information about service users and service activity is handled and categorized. social workers taking a more informed, proactive, and assertive stance will alter the dynamic in participatory design processes and ensure that is functionality is developed to meet the specified needs of practitioners, rather than practice being fitted to available functionality. in turn, greater clarity about the needs of practitioners will assist designers in their task of developing tailored and situationspecific is. references aas, k. f. 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(2008). report of the special commission of inquiry into child protection services in new south wales. retrieved from http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0008/33794/executive_summ ary_and_recommendations__special_commission_of_inquiry_into_child_protection_services_in_new_sou th_wales.pdf author note dr philip gillingham, senior research fellow, school of social work and human services, university of queensland, st lucia campus, brisbane, queensland, australia. phone: 66 7 3365 1842. email: p.gillingham@uq.edu.au funding statement the research that informed this article was supported by the australian research council through a discovery early career research award (de13010004). acknowledgements the author wishes to acknowledge the contribution of the participants in this research. microsoft word bowles-hopps_vulnerable_populations_copyedit final ______________  dorcas davis bowles, ed.d., msw, is a distinguished scholar of social work in the department of social work and human services at kennesaw state university in kennesaw, ga. june gary hopps, ph.d., msw, is the thomas m. parnham professor of family and children studies in the school of social work at the university of georgia in athens, ga. the authors wish to thank dr. obie clayton, asa edmund ware distinguished professor and chair, department of sociology and criminal justice at clark university for his critique of the article. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 1-20 the profession’s role in meeting its historical mission to serve vulnerable populations dorcas davis bowles june gary hopps abstract: this article provides an historical account of how the profession of social work met or failed to meet its mission in the provision of services to those who were poor, oppressed, and vulnerable to societal injustices from the mid-twentieth century, including the turbulent civil rights era, to the early twenty-first century. the profession’s growth and expansion and the challenge of mediating resistance to change are highlighted based on eyewitness accounts. keywords: professional mission, cswe standards, civil rights era, poverty, race, injustice, social work theories, women, people of color, sexual orientation and gender expression in 1903, w. e. b. dubois, one of the first writers to speak of oppression based on skin color stated, “the problem of the twentieth century is the problem of the color line – the relation of the darker to the lighter races of men in asia and africa, in america and the islands of the sea” (p 16). forty years later, gunnar myrdal was commissioned by the carnegie corporation to study race relations in the united states. myrdal painstakingly detailed obstacles to full participation in american society that negroes faced which he saw as a white man’s problem. he articulated that the race problem in the united states presented a great dilemma that, if not resolved, threatened the ultimate success of the country’s democratic experiment (myrdal, 1944). some thirty years ago in an editorial entitled oppression based on color, hopps (1982) stated that people of color face a pervasive kind of oppression and discrimination because of racial stereotypes associated with and indelibly marked by the color of their skin. although many forms of exclusion and discrimination exist in this country, none is so deeply rooted, persistent, and intractable as that based on color. do these statements on race, over many years, continue to explain why certain societal conditions have not been improved despite greater national wealth and power? does the claim by other groups – women, gays and lesbians, physically and mentally challenged, and at times even “white males” – minimize the challenge faced by “traditionally oppressed groups?” the geopolitical landscape is one that makes it attractive to be disadvantaged, even when the term is elusive and thus hard to define. for example, in the last presidential election, several candidates for the republican presidential nomination described their “disadvantaged heritage.” as compelling as those stories were, none of them had to face the abject racism with which the democratic candidate and sitting president had to live. secret service protection to presidential candidate obama began after the senator received a death threat in 2007, when he was advances in social work, spring 2014, 15(1) 2 still serving as the junior senator of illinois. this marked the first time that a presidential candidate received secret service protection before being nominated by his party (obama placed under secret service protection (friedman & maggs, 2008). the increased number of death threats and subsequent need for additional security was unprecedented in american presidential campaigns. social ethicist daniel maguire (1980) provided a framework for determining which groups are so disadvantaged that they need preference. he offered the following conditions: “(1) no alternatives to enforced preferences are available; (2) prejudice against the group has reached the level of depersonalization; (3) bias against the group is not private or narrowly localized but is rather entrenched in the culture and distributive systems of the society; and (4) the members of the victim groups are visible and thus lack an avenue of escape from their disempowerment” (maguire, 1980, pp. 129-30, as cited in hopps, 1982, p. 3). a report compiled by the transnational racial justice initiative (2001) concluded that the government has not taken “special and concrete measures to ensure the adequate development and protection of certain racial groups (article ii) (2) despite a preponderance of evidence of racism from both non-governmental organizations and governmental agencies. there are many documented examples of bias, racial discrimination and disparate racial impact in a wide range of policy arenas. there has been both governmental and private opposition to nearly every measure that would reduce white privilege and create greater development and advantage for disenfranchised racial groups” (p. 12). within the national context on race noted above, our task in this paper is to highlight the profession’s role in the preparation of practitioners in the delivery of services as well as how the field has historically delivered services to people of color and vulnerable populations. our observations are drawn from our eye witness accounts from the latter part of the twentieth century, particularly from the 1960s to the 1980s. our connection to the field spans more than four decades covering a period when we were considered colored, negro, black, afro-american or african american. we were children of “race women” – those women who advocated the “uplift” of the race in the early 20th century and who were determined that conditions that emerged from enslavement – overt racism and economic deprivation -needed to be challenged. they had a deep awareness of the liberating role of education, the need to nurture strong families and to build caring communities. our fathers (and grandfathers) were family and community oriented and subscribed to the values of education, strong work ethic, business orientation, and civil rights advances. during our elementary and high school years, we lived under the 1896 supreme court decision of plessy v. ferguson which upheld the legality of separate but legal and where “jim crow laws” were treated as legal. we were young students when, on may 14, 1954, the supreme court concluded that in the field of education, the doctrine of separate but equal had no place, that separate educational facilities are inherently unequal. in celebration of the brown v. board of education decision, the choirs sang and the bells rang out in segregated churches, notably the strongest institution, aside from the family, in the black community (clayton, 1996). school children, even from poorly equipped schools, knew about the warren court and that it had spoken. no, “colored people” felt that god had spoken! bowles, hopps/the profession’s mission to serve vulnerable populations 3 we were arrested as students at tuskegee institute and spelman college and were moving into the profession during the civil rights struggle for freedom and equality in the 1960s. we witnessed far too many deaths of both blacks and whites who fought for justice and spoke out for civil rights:  june 12, 1963 murder of medgar evers, a black civil rights activist in jackson, mississippi, in the driveway of his home – by a member of the white citizens council.  september 15, 1963 mass murder of four black girls (addie mae collins, age 14; cynthia wesley, age 14; carole robertson, age 14 and denise mcnair, age 11) by a bomb placed under the steps at the sixteenth street baptist church in birmingham, alabama while they were attending sunday school classes.  november 22, 1963 the assassination of john fitzgerald kennedy, the 35th president of the united states in dallas, texas.  june 21, 1964 murder in nashoba county mississippi of one black and two white civil rights workers (james cheney, andrew goodman, and michael schwerner) by members of the mississippi white knights of the ku klux klan as they were driving to register blacks to vote as part of the “freedom summer” campaign.  february 18, 1965 shooting of jimmy lee jackson, a black civil rights activist, from marion, alabama by an alabama state trooper when he joined a group of african americans who were protesting the jailing of a southern christian leadership conference official. jackson died on february 26, 1965 and on march 3, 1965 dr. king eulogized jimmy lee jackson and called for a march from selma to montgomery to protest jackson’s death and advocate for voting rights. dr. king publicly admonished president lyndon johnson, asking why the government could spend millions defending democracy in south vietnam, but not do the same for its own u.s. citizens. it was at this time that king began to link the civil rights movement with the anti-vietnam war movement.  february 26, 1965 malcolm x was assassinated after repudiating the nation of islam and its teachings by three of its black members. he was preparing to address the organization of afro-american unity in new york city at manhattan’s audubon ballroom.  march 7, 1965 attempted selma to montgomery march known as “bloody sunday.” demonstrators, including u.s. congressman john lewis, were brutally beaten, when they attempted to cross the edmond pettus bridge. this event prompted federal lawmakers to pass the 1965 voting rights act.  march 21-25, 1965 demonstrators completed the selma to montgomery, alabama march protected by the alabama national guard under federal control. advances in social work, spring 2014, 15(1) 4  march 25, 1965 murder of mrs. viola liuzzo, a white civil rights activist from detroit michigan by ku klux klan members on the last night of the selma to montgomery march while transporting students from historically black colleges and universities and other marchers to their homes after the march. one of the klansman in the car, from which the shots were fired, was a federal bureau of investigation (fbi) informant.  april 4, 1968 the assassination of dr. martin luther king, jr., prominent leader in the advancement of civil rights, on the balcony of the lorraine hotel, memphis tennessee as he was preparing to march for sanitation workers.  june 5, 1968 the assassination of senator robert kennedy (d. n.y.), brother of the assassinated president john f. kennedy, during the campaign season for the u. s. presidential election, at the ambassador hotel in los angeles, ca. we were witnesses to all of the above murders and assassinations and indeed many more. we, together with other americans, experienced trauma as we mourned and attempted to understand and deal with these losses. writing about this time frame and these losses for this paper reactivates the stress and pain, and even so we have no choice but to move on. we have seen, during the autumn of our professional life, the election (2008) and re-election (2012) and twice inaugurated first african american president, barack obama, something neither of us thought would occur during our lifetime. societal turbulence and the profession’s move to public programs in the course of the twentieth century, the country flirted with progressivism, was impacted by world war i, the boom of the “roaring twenties” and economic chaos of the 1930s, enacted social security and other legislation as a hedge against financial insecurity and, rebuilt the economy during and after world war ii, only to “discover” real poverty in the 1960s. in the 1960s, 1970s and 1980s the rights of colored people, women, gay, lesbian, transgender individuals and physically and mentally challenged were acknowledged. at this time, new immigrants as well as traditionally oppressed groups fight for a voice and recognition but the struggle for affirmative change continues. the profession, since its inception, seems to have been challenged by a “push-pull” or ambivalence vis-a-vis power and powerlessness, wealth and inequality, and social control and benevolence. prior to the great depression, services were delivered primarily through private auspices and largely to urban populations. the great depression, when at least a quarter of the population was unemployed and therefore poor, required massive intervention and changed the face of the profession. the social security act was enacted as the nation’s response to economic distress that affected so many. the economic loss had to be managed by many and so was the case with our own families: farm assets and income, wages from labor, college scholarships; and the beginning ideological shift from the gop (lincoln’s party or hoover’s party?) to fdr. so we learned about the “great” democratic president who tried to help “our people, colored people.” we knew about eleanor roosevelt, the first lady, and respected her because she respected mary mccleod bethune, the great “colored” matriarch who founded bethune-cookman college and served as advisor to president franklin d. roosevelt. bowles, hopps/the profession’s mission to serve vulnerable populations 5 the new deal changed the social welfare landscape, making services and benefits available to greater numbers of needful people including rural people and eventually people of color. initially, social security programs followed the general societal model of racial discrimination. the social insurance aspects of social security were related to employment and early on, those in marginal, low-wage work settings, were excluded, including domestic workers, farm laborers, and restaurant and hotel workers, and a large number of these groups were negroes. the profession was not initially enamored by the new deal and its sweeping, undergirding ideological shift where major new resources (money, employment opportunities, and legislative clout) would be centered in the public domain, away from traditional private auspices. world war ii, which pulled the country out of the depression, helped usher social work’s movement to the mental health domain where there was emphasis on freudian psychological theories which was referred to as casework (i.e., interventions with individuals and families, case by case). these theories placed the focus on the individual (garrett, 1942; hollis, 1949; perlman, 1979). however, from the profession’s beginning, there was scant attention given to people of color – native americans, african americans, puerto ricans, and mexicans. similarly, little attention was given to poor southern whites and so called “hill people.” the mental hygiene movement prevailed; casework became king, or perhaps queen since the profession is predominantly female. from the 1920s to the 1950s, social casework focused on the person in the context of his/her environment, and the therapeutic relationship between the social worker and the client was seen as key to facilitating change. warmth, caring, genuineness, a nonjudgmental attitude, and empathy, among other qualities, were seen as “the soul of casework” (biester, 1957) and as the “heart” of the helping profession (garrett, 1942; hollis, 1965; perlman, 1979). in seeking a language to understand behaviors, social workers turned to freud’s theories of development which offered them terms such as resistance, transference and counter-transference. with the emergence of ego psychology during the late 50s, social workers found the concepts ego functions, defense mechanisms, and adaptation useful language in their work with clients (erikson, 1950; freud, 1936; hartmann, 1958; parad, 1958; parad & miller, 1963). cultural values, economics, and public policy are inextricably linked aspects of the human experience. hence, public and private policies can encourage or discourage behavior. the 1960s ushered in great social, cultural, and economic upheavals that had a profound impact on marriage and family among african americans. shifting occupational structures (from manufacturing to services), stagnating real wages, and the declining relative demand for low-skilled labor undermined the economic status of many and especially african americans. welfare policies that focused on helping mothers and children, to the exclusion of fathers, had the practical effect of keeping or driving men out of the household. housing discrimination that facilitated the movement of whites out of the city while hampering the mobility of african americans, the increasing suburbanization of employment, inadequate urban school systems, and the growing incarceration of african american men, played crucial roles in undercutting opportunities for african americans and contributed to blighted inner city neighborhoods. social work advances in social work, spring 2014, 15(1) 6 as a profession was not geared to address these structural issues and continued to use the casework model which was popular at the time. systems theory, family therapy, and the ecological systems perspective were pushed by many in the profession (hopps & lowe, 2012). ego psychology was followed by object relations theory which enhanced and provided greater depth to the understanding of the relational dynamic that occurred between worker and client and provided social workers with greater appreciation of the multi-layers of the social worker/client relationship (blanck & blanck, 1974; blanck & blanck, 1979; bowlby, 1969; edward, ruskin, & turrini, 1981; kernberg, 1975, 1976; mahler, pine, & bergman, 1975; masterson, 1976; tolpin, 1972; winnicott, 1965). during the 1970s, heinz kohut (1971) launched self psychology which focused on disorders of the self and provided the profession with concepts such as mirroring, idealization of others, and twinship. as the 1980s came to a close, researchers began to understand the relationship between the brain and the mind. as explained by siegel (1999), “the mind develops at the interface of neurophysiological processes and interpersonal relationships” (p. 21). understanding the brain can facilitate change at a bio-psychological level in the right brain hemisphere where emotional experiences are processed to include non-verbal communication such as touch, tone of voice, gestures, etc. (applegate & shapiro, 2005; perry, 2006). weick, rapp, sullivan, and kisthardt (1989) were the first to generate the concept “strengths perspective.” these authors offered that a focus on clients’ strengths would better engage and support clients’ growth. in the strengths perspective in social work practice (saleebey, 1992), several authors explained, in detail, the theoretical underpinnings of strengths based practice, especially in one’s work with diverse, at-risk populations, and, in so doing, helped to move social work from a problem-focused-deficit model to a view that emphasized strengths, capabilities, and resilience. evidence-based practice (edp) was formally introduced in 1992 with a focus on the medical profession which later crossed over to other professions, including social work. it should be noted however, that practice evaluation and accountability was by no means new to the field which was challenged with the push for evidence since the late 1960s (sze & hopps, 1973, 1978). as seen from the underpinning theories above, social casework was the dominant thrust of the profession for years, and there was limited attention to content that focused on how environmental factors impacted the client’s daily functioning let alone how to affect change in the environment. the theories, as effective as they were thought to have been for individual change, did little to address questions related to client empowerment, structural inequality and/or institutional racism (austin, 2000; hopps, pinderhughes, & shankar, 1995; solomon, 1976). moreover, there was not sufficient awareness of the impact of freudian theories as related to the changing roles of women, many now educated and work place savvy since the late 1800’s and certainly after two world wars. similarly, the resentment of black military personnel who had fought so bravely in segregated units was growing deeper and not well noticed by the country or the bowles, hopps/the profession’s mission to serve vulnerable populations 7 profession. several had gone to school and college using the gi bill. they went into the professions, moving away from farming, and several became teachers, physicians, morticians and attorneys. they told stories about the war, the battle of the bulge, the great tuskegee airmen. they expressed wariness relative to the slow road to equal rights. a new rhetoric was growing: why would we wait so long for rights? freedom? students listened to their teachers, their preachers, their doctors. moreover, there was minimal attention to race related issues and/or race relations. poverty, discrimination and legal oppression persisted. jim crow laws that were so strong in the early 20th century were overlooked and unchallenged even when they were a central component of the structure and organization of social welfare and the delivery of social work services. for example, we witnessed that in some agency settings, white social workers could serve all clients while black social workers could only serve black clients. the atlanta university school of social work had block placements so that second year msw students were not limited to field experiences in segregated agencies in atlanta and the southern region where case assignments were made on the basis of race (bowles & hopps, personal observations). the profession and the poor it was the 1960s civil rights movement and civil unrest, aided by michael harrington’s (1962), the other america, which highlighted the persistence of poverty in the country and challenged the supremacy of the casework mantra. the profession had to make accommodations to serve the poor and acknowledge discrimination, forcing it to examine its positive affinity for services to the middle class – those who were verbal, those who could come for an office appointment, those who could keep scheduled appointments, those deemed capable of developing insight about their problems, etc. the profession was confronted to think back to its founding mission and concern for the real poor. african-american protest, based on the denial of rights and discriminatory practices, introduced this new era of civil rights protests and later civil unrest during the kennedy/johnson years. the rights protests, the assassinations of president kennedy and the killing of a number of civil rights workers, led to the passage of the 1964 civil rights act which outlawed discrimination against racial, ethnic, national and religious minorities and women, and the 1965 voting rights act which outlawed unfair voter registration laws imposed on blacks. in a brief period, racial barriers in public facilities, the workplace and the ballot box were struck down by law. these new laws were enacted ten years after brown v. board of education (1954), the supreme court ruling that struck down school segregation. prior to brown v. board of education (1954), the law of the land was separate but equal as set forth in plessy v. ferguson in 1896, but the practice was separate and unequal. white resistance to the 1954 landmark supreme court ruling of brown v. board of education was unbelievably strong. to wit, 19 senators and 81 representatives from the south, including all of georgia’s congressional delegation, signed the southern manifesto, which re-enforced segregation in political ideology and discourse. the southern manifesto on integration, signed in march 1956 to counter and defy the brown v. board of education ruling read in part as follows: advances in social work, spring 2014, 15(1) 8 we regard the decision of the supreme court in the school cases as a clear abuse of judicial power. it climaxes a trend in the federal judiciary undertaking to legislate, in derogation of the authority of congress, and to encroach upon the reserved rights of the states and the people. . . it is destroying the amicable relations between the white and negro races that have been created through 90 years of patient effort by the good people of both races. . . we pledge ourselves to use all means to bring about a reversal of this decision which is contrary to the constitution and to prevent the use of force in its implementation (southern manifesto on integration, 1956). owing to the lawmakers’ recalcitrance, the desegregation of schools reached a stand still until 1957 when it became necessary for the federal government to intervene in the little rock central high school case to uphold brown v. board of education and allow nine children, who had been subjected to abuse, to enroll. the protests of the 1960s were mostly peaceful; however, there had been growing tensions, especially since world war ii, over entrenched inequality and the inability of the social structure to effectively respond to demands for change, voiced by activists, a growing number of whom were young people. hundreds of riots in the freedom summer of 1964, the “long hot summer” of 1967, and the tumultuous years of 1970-71, brought attention to entrenched poverty and a panoply of ills, including unemployment, poor housing, inadequate education, and lack of health care including maternal and child health and needs of the elderly. on july 28, 1967, president lyndon baines johnson formed an 11-member national advisory commission on civil disorder to examine and explain the riots that plagued major cities. the commission’s 1968 report, known as the kerner report, concluded that the nation was “moving toward two societies, one black, one white – separate but unequal.” the report affirmed that discrimination and segregation that had permeated much of american life, threatened the country’s future and unless conditions were remedied, the country faced a “system of ‘apartheid’” in major cities. the report further stated: “what white americans have never fully understood but what the negro can never forget – is that white society is deeply implicated in the ghetto. white institutions created it, white institutions maintain it, and white society condones it.” (national advisory commission on civil disorders, 1968, p. 1) the report firmly implored the country to deal with its unfinished business and “make good the promises of american democracy to all citizens-urban and rural, white and black, spanish-surname, american indian, and every minority group” (national advisory commission on civil disorders, 1968, p. 2). many college and graduate students, some of whom were social workers, participated in peaceful civil rights demonstrations and marches along with mental health professionals, ministers, and community persons of all ethnic and racial groups. in fact, the authors observed that hundreds of persons who applied for and were accepted into social work programs during this time, participated in these civil rights protests and entered the profession so that they could become “change agents.” bowles, hopps/the profession’s mission to serve vulnerable populations 9 the black power movement came to the fore shortly after dr. king’s assassination in 1968, when more militant blacks took over the leadership of the student non-violent coordinating committee. although the civil rights movement, led by dr. king, was guided by the teachings of gandhi, non-violence christian theology, and the social gospel, the black power movement was largely guided by the work of malcolm x, who argued the need for organizations to push for liberation and political and economic power based on black separatism (day, 2009). the movement became increasingly more militant, and in the process, lost some middle class support across racial lines. dr. king was missed. during this time period, as in others, over eighty eight percent (88%) of students who applied to schools of social work selected the casework track as opposed to fewer than five percent (5%) who selected that of community organization (morris, 2000). those students who selected the community organization track were interested in ways in which they could use advocacy and community action to bring about needed structural changes in the environment for people of color, the poor, and the oppressed. the economic opportunity act (eoa) of 1964 required that community action agencies (caas) be established to run community action programs (caps). caps were developed to advocate for the poor who faced discrimination in employment, service delivery from social agencies that were receiving federal funds, to build and expand head start and accelerate the re-building of older urban communities. funds were allocated directly to local grassroots organizations, passing over established agencies as well as city halls. this would not last long. maximum feasible participation of the poor as prescribed in the economic opportunity act was subsequently described as maximum feasible misunderstanding (moynihan, 1969). nevertheless, there was growth in community organizations, aided by caas and caps, some taking on a more aggressive posture, drawing on the organizing methods used by saul alinsky in the 1930s and 40s behind the stock yards in chicago (hopps & lowe, 2012). growing recognition of the need for structural change and community based advocacy brought renewed attention to macro interventions, especially community organization but also community development, social planning and policy and their value within the profession and in poor communities. mobilization for youth, the new york demonstration project funded by private foundations and federal government agencies, particularly the national institute of mental health, generated theories and intervention strategies for examining urban reform and changing democratic processes that influenced the design of the war on poverty. the model cities program followed the war on poverty in the late 1960s and both were signature programs of the johnson administration’s great society. the fair housing act was passed in 1968 striking at discrimination in that domain and adding more teeth to anti-discrimination and civil rights laws passed earlier in 1964 and 1965. an important facet of professional activity included opening up opportunities for blacks and other people of color to pursue professional education and also the establishment of many new schools of social work to serve the newly discovered poor, needful population, along with the middle class (memorandum from jo ann regan, director, office of sw accreditation, cswe, september, 2013). these new schools with their influx of students changed the social work demographic. over 20% of enrolled advances in social work, spring 2014, 15(1) 10 students were people of color, a major shift in the profession. student activists, many of whom were students of color, pushed for a more relevant curriculum and diverse faculty. some professors made alliances with the poor and found pathways to help change the social work academic establishment (schiele & hopps, 2009). federal funding became more available to schools of social work after world war ii and had influence on the curriculum, funding for faculty and financial aid to students. in fact, the development of baccalaureate social work programs in public institutions, funded by federal agencies, provided access to a more racially and socio-economically diverse cohort of students (austin, 2000). following formal approval by cswe in 1974 of a set of accreditation standards for baccalaureate social work programs, the number of bsw programs grew dramatically during the next decade and beyond. in its most recent statistics, cswe (2013) reports that the number of accredited bsw programs more than doubled that of accredited msw programs – 489 vs. 227. the baccalaureate programs became entry ports for blacks, other people of color as well as those from lower socio-economic classes. the students looked different from earlier periods. despite a continued preponderance of women, there was clearly much greater diversity within the student body in most programs. this increased diversity was fueled in part by an infusion of federal funding from the national institute of mental health (nimh) which also helped accelerate the growth in the number of accredited bsw programs. federal funding also provided resources for graduate education at both the master’s and doctoral levels (austin, 2000). federal funding for social work was important and continued during the kennedy, johnson, nixon administrations, but became more limited under carter and was drastically curtailed under reagan and bush (austin, 2000; day & schiele, 2013; hopps, 2000; morris, 2000). reagan’s philosophy towards the social work establishment and clients was guided not only by conservatism but also by right wing ideology; the administration’s tone toward the poor and sexual minorities was harsh, for example demeaning commentary about the “welfare queen and the cadillac.” although president “bill” (william j.) clinton voiced different sentiments about the poor and seemed to understand structural and institutional causation, he followed much of the reagan/bush ideology of laissez-faire civil rights and demolition of social welfare and particularly “ending welfare as we know it.” (day & scheile, 2013). george w. bush moved back to the reagan philosophy although advocating a softer conservatism he characterized as “compassionate conservatism.” the george w. bush legacy toward the poor is undoubtedly reflected in the debacle that surrounded the delivery of emergency relief services after hurricane katrina. in effect, the “golden age” of funding for social welfare and its professional arm, social work, slowly morphed into one of resource constriction. this pattern, started under carter, is apparent even in president obama’s signature domestic achievement, the patient protection and affordable care act (ppaca) signed into law on march 23, 2010. while this law does create new opportunities within the healthcare domain, there are no funds specifically allocated for social work education with respect to the profession’s role in the delivery of health care services. bowles, hopps/the profession’s mission to serve vulnerable populations 11 today, there are no grassroots groups pushing the profession toward greater progressivism as there were in the late 1960s. during this prior period, the major welfare organizations focused on the poor and their rights. the national welfare rights organization (nwr0) was led by a chemist, the late dr. george wiley, not a social worker or cognate professional. nevertheless, the group was forceful, maybe even militant in pushing established agencies and public welfare offices to better serve the poor, granting them their lawful benefits. frances fox piven (new york university) and bill cloward (columbia university school of social work) became known for providing much of the theoretical orientation for the expanded direct participation of the poor in activism for greater access to social services, including voter registration. sensing a need for a collective voice and action, a group of black social workers convened in san francisco, california on may 8, 1968 to establish a national social work organization that would advocate for and address social issues and concerns of the black community. the group formed the national association of black social workers (nabsw) and put pressure on the national conference of social welfare (ncsw), the national association of social work (nasw), and the council on social work education (cswe) to increase the number of persons of african ancestry to serve on various committees and hold office in these organizations. nabsw also emphasized the need for accountability of social welfare systems serving black families as well as the development of service delivery strategies that would better serve black communities. the organization also pressured cswe to live up to the mission of the profession by examining content in the social work curricula so that it would become less euro-centric and more accurately reflect the black experience and that of other people of color, the poor and oppressed, as well as the forces that supported structural inequality. schools of social work were also pressured to add persons of african descent to their faculties. once in rank, new black faculty members, though few in number, added their voices to the importance and need for greater and non-stereotypical content on racial and ethnic groups. in the second special edition of social work, focused on people of color, entitled racial and ethnic minorities, it was reported that some eighty-nine articles were published between 1960 and 1975 that addressed “race relevant questions” (schiele & hopps, 2009). prior to the earlier special edition of social work entitled people of color (hopps, 1982), the profession had evidenced some concern about issues relevant to people of color and the articles were generally referred to as “the negro problem;” and from 1969 to 1975, as “the black phenomenon”(schiele & hopps, 2009). nabsw held its first annual conference in philadelphia in 1969. the theme was “the black family” in response to the moynihan report on the disintegration of the negro family as the cause of lower socio-economic status and the limits of government intervention for positive change unless negroes took more responsibility for self improvement. the moynihan report, delivered in a speech by president johnson at howard university on june 4, 1965, had stirred controversy among those in the civil rights movement because it seemed to place blame for family formation and lifestyle, poverty and unemployment on individual choices which were greatly limited due to the economy. there was not sufficient weight given to structural inequality. opposition literature, from blacks and other scholars, evolved and grew with the intent of showing advances in social work, spring 2014, 15(1) 12 the strengths of oppressed blacks in the face of intractable structural discrimination and inequality. one prominent contributor to this debate was robert hill (1972) whose book, the strengths of black families, was in direct response to the moynihan report. several african-americans who entered social work education in the 1960s-1970s found a way to move up in academe becoming tenured professors, deans, associate provosts and provosts. many also became key administrators and executive directors of national organizations. although there was generally a positive response from the profession, albeit a slow one, it was not without controversy and competition from those in power, mostly privileged males and those wishing power, mostly privileged females. the change strategies and arguments here were not unrelated to those which informed and influenced all of the subsequent movements. the movements: women, sexual orientation and gender expression the first era of the women’s movement was in the 1800s and focused on women’s suffrage, the right of women to vote, and abolition. day (2013) observed that women, although not owned were: almost treated like negro slaves inside and outside the home. both were expected to behave with deference and obedience towards owner or husband; both did not exist officially under the law; both had few rights and little education; both found it difficult to run away; both worked for their masters without pay; both had to breed on command and to nurse the results (p. 183). the first phase of the feminist movement occurred during the 1940s and continued through the 1950s, advancing the “suffrage” theme. the publication of betty friedan’s (1963) classic treatise on the feminine mystique heralded the onset of a second era in the women’s movement during which the primary focus shifted to issues of social and cultural concerns. the book sought to awaken the conscience of middle class american women whose roles in society were limited mostly based on gender. friedan, a 1942 graduate of smith college, based her book on survey data from smith college alumnae, class of 1942 for their 15th college reunion in 1957. her systematic survey showed that many of her classmates were unhappy, felt entrapped and that their ambitions were thwarted despite living in material comfort. this prompted her to conduct interviews with other suburban housewives which led to the publication of the feminine mystique. how many black, hispanic, native american or eastern european women do we suppose were included in the study? we know that many of these women were in the workforce, and without choice. another feminist activist and smith college graduate, class of 1956, gloria steinem, helped create ms. magazine in 1971 which provided a sounding board for the voices of contemporary women. the feminist movement was criticized by many black women who voiced that the movement represented the viewpoint of white, middle-class, educated women and ignored or marginalized the voices and lived experiences of other women. some black feminists argued that sexism, class, oppression, and racism were inextricably bound; hence, black women experienced a different and more intense kind of oppression from that of white women. in short, black feminists felt that white bowles, hopps/the profession’s mission to serve vulnerable populations 13 feminists minimized or ignored oppression based on race and class thereby marginalizing and excluding them from the “movement.” some black feminists thought that white feminists even colluded with their men – their fathers, husbands, brothers, uncles and sons – and therefore held “deferred power” (hopps, 1982). black women had a long history of self-help, social activism and “race uplift.” in fact, self help organizations date back to the late 1700s and were active at the local level where black women provided extensive mutual aid assistance. this continued until the 1890s as a more political agenda evolved focusing on suffrage and anti-lynching. the national association of colored women was founded in 1896, only three decades after the civil war, pre-dating the founding of the national association for the advancement of colored people (naacp) by some fifteen years. (it is well to be mindful of the roles of jane adams and w. e. b. dubois in this historic development that began with discussions at henry street settlement in new york city). equally important was w. e. b. dubois leaving the progressives and jane addams when she did not support suffrage for blacks. race “up-lift” work required black women to be politically savvy in relation to black men. since race progress was conventionally defined as male dominance and distinction not only within the family, but also within such masculine domains as politics, the market, and the military. black women’s public activities, independence, and leadership were controversial within uplift ideology insofar as they departed from the only legitimate realm for black women’s activity, their reproductive capacity within patriarchal black families (gaines, 1996, p. 42). the social situation of black women corresponded with that of white women but with the added forces of racism and economic and social disadvantage. both populations of women had a political struggle, but black women’s struggle was so much harsher owing to race and economics. the feminist agenda was not viewed as inclusive. although black women did not begrudge the quest by white women for advancement, they were stunned when some white women did not understand the gravity of racism, historical economic and social disadvantage and the need for affirmative social justice. a few black women in the profession did move up. there seemed to have been a convergence among lesbian women who would “coalesce,” supporting and advocating for one another for faculty and decanal positions as well as executive positions in professional organizations. their affiliation and orientation seemed more powerful than race, class or social background. although they may have identified with oppressed people, and many did, this perspective became moot in instances where there was competition with an oppressed person for positions of power they sought. in response to the feminist movement, a more economically diverse group of women began to demand affordable child care, birth control and the creation of rape crisis and domestic violence centers which could serve as places where their sisters might be helped to deal with the abuses they received in safe environments. research in these areas by social workers and other mental health professionals emerged. significant contributions included the boston women’s health book collective, women and their bodies (1970), our bodies, ourselves (1971), and others that have continued to proliferate. many of advances in social work, spring 2014, 15(1) 14 these more recent contributions also include content relevant to the needs of pre-teen and adolescent girls and boys. much of this content found its way into the social work curriculum; however, was there content on eugenics which was experienced by severely oppressed women, often in prison? at issue was whether the curriculum lagged behind the practice environment. women students began exposing and teaching faculty about issues relevant to their reality related to growth and development including women’s health, rape, and domestic violence. similarly, black students and poor people exposed and taught the faculty about their reality encompassing race, discrimination, and poverty. gay liberation became an active issue in the profession during the 70s and 80s. this population drew upon first amendment rights and the civil rights act of 1964. the lambda defense and education fund was active in the pursuit of civil rights for gays and lesbians in employment, child custody, and education paying for legal representation and developing a network of legal experts. the work of this fund was aided significantly by the national gay and lesbian task force and was the major mover of the march on washington for lesbian and gay rights in 1979. gains for same sex persons include the repeal of existing sodomy laws as well as repeal of the “don’t ask don’t tell” policy on september 20, 2011 by president obama. the “don’t ask don’t tell” policy was adopted by the clinton administration and prohibited same sex persons from disclosure of their sexual orientation while serving in the u. s. military. on june 26, 2013, the supreme court, by a vote of 5 4 ruled unconstitutional a 1996 law denying federal benefits to legally married same-sex couples and permitted gay marriage in california which increased to 13 the number of states that allow for same sex marriage. ironically, the day before glbt rights advocates celebrated this land mark 5 to 4 supreme court reversal, the same court deemed as unconstitutional section 4 of the 1965 voting rights act. this ruling cut at the very core of the voting rights act leaving it to a divided congress to redefine criteria to determine which states need preclearance by the justice department for electoral changes. obviously, in this instance there was no celebrating among people of color and liberal pundits. earlier in this paper, we noted the deaths of civil rights advocates. it is similarly important to reflect, as we and other professionals did, on the deaths of:  san francisco board supervisor, harvey milk and mayor george moscone, both of whom were gay, in 1978 by dan white another city supervisor who had resigned his job and wanted it back;  matthew shepard, a white gay student, near laramie, wyoming by 3 white men; and  james byrd, jr., a black man tied to a truck by 2 white supremacists and decapitated in jasper, texas in 1998. the latter two deaths resulted in the passage of the matthew shepard and james byrd, jr. hate crimes prevention act, the country’s first hate crime bill that was signed into law by president barack obama on october 28, 2009. this was an amazing feat since the 3445 lynchings in the 19th and 20th centuries did not result in the passage of a national anti-lynching law. now hate groups, including the aryan nation, are increasing bowles, hopps/the profession’s mission to serve vulnerable populations 15 and there is growing concern by members of the profession over angry white people, especially males. new faculty, new theorists prominent new social work theorists came to the forefront starting in the 1960s, many of whom were women of color whose writings added authenticity, thick context and fresh perspectives (see, 2002): elaine pinderhughes, barbara solomon, deloris norton, harriette mcadoo, rosina bacerra, joyce ladner, jewel taylor gibbs, wynetta devore, martha ozzawa, among others. there were also men of color who made contributions: leon chestang, robert hill, lawrence gary, andrew billingsley, harry aponte, juan longress, brig mohan, julio morales, and wade nobles, among others. black psychiatrists such as james comer, alvin poussaint, william grier and price cobbs also added to the body of knowledge that was used by the profession. it was after the assassination of dr. king and the subsequent riots that grier and cobbs (1968) wrote black rage which described the insidious effects and psychic stresses black people experienced in response to slavery, jim crow and discrimination which was the basis of their anger and rage. john turner became the first african american editor-in-chief of the encyclopedia of social work and june gary hopps became the first african american named editor-in-chief of social work, the profession’s flagship journal. others also added scholarship helping to advance theory and practice about people of color and race (for example, carol stack, monica mcgoldrick, effie schlesinger and jeane giovanni). the cswe curriculum standards: mission driven or mission drift? the council on social work education curriculum policy statements did not include the need for the study of oppression and injustice in the curricula of schools of social work until 1983. there was no mention of the concepts of oppression and social justice in the cswe curriculum policy statements of 1952, 1962 and 1969, “although they noted links between destructive social and economic conditions and the problems that motivate people to seek help” (gil, 1995, p. 258). the 1982 curriculum policy statement is the first to make reference to the promotion of “social and economic justice” and that “social workers hold that people should have equal access to resources, services and opportunities.” under the heading “special populations,” the 1982 policy statement noted that “the profession has also been concerned about the consequences of oppression and that the “curricula must give explicit attention to the patterns and consequences of discrimination and oppression” (gil, 1995, p. 258). the “1992 revision of the cswe curriculum policy statement is clearer than the 1982 statement concerning oppression and injustice,” and stresses that schools of social work have the responsibility to teach about social justice and approaches to overcome oppression. however, like the 1982 policy statement, the 1992 revision reflects the fallacious assumption that discrimination, oppression, and injustice affecting women, minorities and other discrete social groups can be overcome without eradicating their sources in the occupational and social class divisions of contemporary capitalism” (gil, 1995, pp. 258-59). the 1992 cswe draft curriculum policy statement did not include material on poverty and the poor. the issue advances in social work, spring 2014, 15(1) 16 was debated and later added. could this critical issue have been the result of a simple oversight? not likely! within the context of the heated debate that engulfed it, one of the profession’s highly respected thinkers asked in a provocative co-authored work, unfaithful angels: how social work has abandoned its mission, if the profession had indeed abandoned its mission to the poor and drifted to a psychodynamic orientation (specht & courtney, 1994; haynes & mickelson, 1986). obviously, it was a long, hard path from earlier educational policy accreditation standards (epas) to the standards for 2001 and 2008 where programs are expected to attend to diversity in both the explicit and implicit curricula. the most recent 2008 epas recognizes that the education of social work students extends beyond the classroom and field internship; hence elements such as the program and institutional policies, faculty, student resources and activities that impact students must be addressed. the movement to diversity, representing all groups who claim oppression, is not without considerable debate. the question is: when all are considered oppressed, is anyone oppressed? although the 2008 curriculum statement moved social work to a competency-based outcomes approach, and includes educational policy 2.1.4 – engage diversity and difference in practice the question raised at the beginning of this discussion around a framework (see maguire, 1980) for determining which groups are so disadvantaged that they need preference, based on the four conditions set forth, is still relevant. it seems that what the profession has to do now is step back and debate the components of this framework, starting with the premise that if available “alternatives to enforced preferences” have not worked, then why? harvard law professor derrick a. bell (1980) asserts in his theory of “interest convergence” that black rights are recognized and protected only when it advances the interest of whites. he further asserts that “white institutions have not historically advanced the interests of african americans through integration or inclusion without accruing equal or greater benefit to themselves or their interest in the process” (1980, p. 526). hence, an emphasis on diversity lessens or negates the more challenging issues of race and class inequality. bell clarifies this by focusing on affirmative action, a construct that many whites interpret to mean diversity policies designed to benefit white students rather than a means of benefitting those who have been negatively impacted by skin color, jim crow and the insidious culture of discrimination that pervades in this country. hence, the word diversity, and not the words race and class, is more comfortable to whites because, in the narrow way in which they construe it, they inevitably become the unwitting beneficiaries. rather than using the word diversity, it may be important to use the words race and class so that those who have been most marginalized in society also gain benefits. additionally, it speaks to the reality of what has occurred in this country, i.e., the country has been engaged in a conflict about race and class, not a conflict about diversity. thus, society’s propensity to focus on the more benign notion of diversity may actually be serving as a diversion with respect to the achievement of the more substantive (albeit controversial and ideal) goal of racial justice on which this country is founded and which we, as americans, seek to achieve. 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(1965). the maturational processes and the facilitating environment: studies in the theory of emotional development. new york, ny: international universities press. author note address correspondence to: dorcas davis bowles, msw, ed.d., distinguished scholar of social work, dept. of social work and human services, 1000 chastain road, kennesaw, ga 30144-5591. email: dbowles3@kennesaw.edu dorcas davis bowles serves as distinguished scholar of social work at kennesaw state university, kennesaw, ga. earlier, she served as assoc. and interim dean, smith college school for social work; dean, university of texas at arlington school of social work; dean, clark atlanta university school of social work, and provost and vice president of academic affairs at clark atlanta. she has published several book chapters and articles and received the distinguished day garrett award from smith college school for social work. june gary hopps is the thomas “jim” parham professor at the school of social work, university of georgia and dean and professor emerita, boston college school of social work. she has served as editor-in-chief, social work; associate editor-in-chief, encyclopedia of social work (19th ed.). she has authored/co-authored six books and numerous articles. she also served as chair of the board, spelman college and board member, wheelock college. she is the recipient of numerous awards, including several from nasw which inducted her into the pioneer society in 2013. ______________ dory ziperstein is program manager at circle surrogacy, in boston, ma; betty j. ruth is clinical professor and director of the msw/mph program, boston university school of social work; ashley clement is research associate at boston university school of social work; jamie wyatt marshall is project director for the group for public health social work based at boston university of social work, in boston, ma; madi wachman is program manager at boston university center for innovation in social work & health, in boston, ma; esther e. velásquez is a doctoral student at the harvard school of public health and a pre-doctoral research fellow at brigham and women's university in boston, ma; she is supported by an nih-funded t32 training grant (ag000158) copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 406-421, doi: 10.18060/18372 mapping dual-degree programs in social work and public health: results from a national survey dory ziperstein betty j. ruth ashley clement jamie wyatt marshall madeline wachman esther e. velasquez abstract: dramatic changes in the health system due to national health reform are raising important questions regarding the educational preparation of social workers for the new health arena. while dual-degree programs in public health and social work can be an important response to what is needed educationally, little is known about them. the national msw/mph programs study surveyed msw/mph program administrators to better understand the prevalence, models, structure, and challenges of these dual-degree programs. forty-two programs were identified, and 97.6% of those contacted participated (n=41). findings indicate that msw/mph programs are popular, increasing, geographically dispersed, and drawing talented students interested in trans-disciplinary public health social work practice. challenges for these programs include the need for greater institutional support, particularly funding, and a general lack of best practices for msw/mph education. while findings from this study suggest graduates appear especially well-prepared for leadership and practice in the new health environment, additional research is needed to assess their particular contributions and career trajectories. keywords: msw/mph programs, public health social work, trans-disciplinary practice, health-related social work education as the patient protection and affordable care act (aca) implementation unfolds, it is clear that dramatic changes in the health system will continue to profoundly impact the social work profession (andrews, darnell, mcbride, & gehlert, 2013; collins, 2013; gorin, 2013). the aca’s broad aims of increasing access to care, bettering patient care outcomes, controlling costs, and improving population health are expanding social work opportunities in navigation and care coordination. this is seen especially in the integration of behavioral health and primary care and in patient-centered health homes (allen, 2012; bachman, 2011; darnell, 2013; golden, 2011; spitzer & davidson, 2013). the aca’s goal of improving population health outcomes and reducing health inequities is of particular importance to social work, resonating deeply with the profession’s commitment to social justice (ruth, wachman, & schultz, 2014). as has been broadly observed, these intended improvements in population health and in health justice are central to the aca’s success and will require systemic, public-health-oriented, wide-lens approaches that focus on ziperstein et al./mapping dual degree 407 impacting the social determinants of health (beddoe, 2013; braverman, edgerter, & williams, 2011; moniz, 2010). as described by beddoe (2013), wide-lens public health approaches are population-level efforts to create healthy communities and environments, including prevention, health promotion, health advocacy, and the integration of health into all policies and systems. there is general agreement within the public health field and beyond that wide-lens public health approaches have the greatest impact on human health and are especially important in understanding and responding to the social determinants of health, such as racial, socioeconomic, and gender inequities, which contribute to poor health outcomes (beddoe, 2013; frieden, 2010; turnock, 2011). social work practice in prevention, advocacy, community health empowerment, and public health social work exemplifies the profession’s ongoing use of wide-lens approaches and provides an important base upon which to expand health social work in the aca era (reisch, 2012). logically, profound shifts in the practice environment should quickly and directly affect the education of social workers at the graduate level. yet the interplay between education and practice is not always clear-cut. tension between academics and leaders in the health practice environment regarding social work graduate readiness for health practice is not new (spitzer & davidson, 2013). despite recent articles in social work journals calling upon the academy to teach specific health competencies—interprofessional teamwork, care coordination and integration, prevention and health promotion, advocacy, the ability to work within accountable care organizations, community-based practice, program evaluation, and cost-effectiveness—little is known about whether and how social work educates for contemporary health practice (mccave & rishel, 2011; pecukonis, doyle, & bliss, 2008; reisch, 2012; ruth et al., 2014; zabora, 2011). one recent effort to assess current health content in msw programs analyzed mission statements, courses, and concentrations listed on msw program websites. the authors found that while most msw programs offered health courses, the majority focused on clinical practice with individuals in health settings, not wide-lens approaches. in addition, most health concentrations framed health as a niche area of practice, not as a broad approach to promoting human well-being (ruth et al., 2014). the authors observed that the failure to broadly educate students in multiple contemporary health approaches could hinder the impact and development of new social work roles in the current environment (ruth et al., 2014). given the stakes and the rapid pace of change, scholars have argued that preparing the next generation of social workers requires a critical assessment of social work education for health practice (andrews et al., 2013; reisch, 2012; spitzer & davidson, 2013). dual-degree programs in public health and social work amid the call for a changing approach to health in social work, msw/mph programs, which educate students in the integrated practice of public health and social work, deserve consideration. first established in the mid-late 20th century, dual-degree programs appear to have been developed in response to several phenomena: first, as an effort to formalize the sharing of knowledge and skills between schools of social work and other departments; second, as a way of increasing the marketability of both programs and graduates; and finally, as a method for preparing graduates for increasingly complex practice advances in social work, fall 2015, 16(2) 408 environments (mcclelland, 1985; miller, hopkins, & greif, 2008). general interest in cross-disciplinary education appears strong at the graduate level; a recent review found that 35.3% (n=59) of accredited msw programs offered a variety of dual-degree programs, with msw/mph programs the second most popular type (miller et al., 2008). indeed, msw/mph programs appear to be proliferating (ruth et al., 2014). in 2008, about twenty programs existed; recent estimates suggest that there are now more than three dozen (council on social work education [cswe], 2012; mccave & rishel, 2011; ruth et al., 2008). msw/mph programs are, in part, a reflection of the ongoing collaboration between the two fields. social work has deep roots in public health. it shares a history and natural overlap with public health on many issues of mutual concern, such as improving quality of life, achieving social justice, and engaging in interventions aimed at addressing the social determinants of national and global health (ruth et al., 2008). the traditional term used to describe the integrated practice of social work and public health is public health social work (phsw), which involves social work use of epidemiological approaches to prevent, address, and solve health problems (ruth & sisco, 2008). the total number of public health social workers in the us is unclear; it is estimated that less than 10% of the more than half million u.s. social workers describe themselves as “public health social workers” (clark, 2006). however, it has also been noted that many social workers practice within public health without fully recognizing it or labeling it public health social work (marshall, ruth, sisco, cohen, & bachman, 2011; ruth & sisco, 2008). over the years, social work scholars have raised general questions about the structure and outcomes of dual-degree programs, including msw/mph programs (mcclelland, 1985; ruth, marshall, velásquez, & bachman, 2015). concerns included the potential tensions of dual professionalism, the absence of proof for the added value of an additional degree, and the fear that dual-degree graduates do not develop or sustain strong identification with the social work profession (mcclelland, 1985; miller et al., 2008; ruth et al., 2015). due to the minimal research literature on dual-degree programs, it is impossible to draw definitive conclusions about any of these concerns or to firmly determine whether social workers trained in dual programs experience a conflict of values or drift from the profession (miller et al., 2008). in recent years, as additional programs have been developed, these topics have begun to garner more attention. a study conducted at the university of maryland (miller et al., 2008) suggests that satisfaction with dual-degree programs is high and remuneration appears higher than for msw-only graduates; notably, this study did not include their then-new msw/mph program. another study from boston university compared 30 msw-only and 30 msw/mph alumni and, consistent with miller et al. (2008), found no significant differences in career or program satisfaction (ruth, wyatt, chiasson, geron, & bachman, 2006). when asked about their identification with the profession--as measured by whether they called themselves a “social worker,” held membership in social work organizations, or had obtained social work licensure--the msw/mph and msw alumni respondents were similar (ruth et al., 2006). a third study (ruth et al., 2015) attempted to better understand the self-reported outcomes associated with a large cohort of msw/mph alumni (n=294). again, the findings did not support the assertion that dual-degree graduates were less identified with the profession of social work. ziperstein et al./mapping dual degree 409 in fact, a large majority called themselves “social workers” or “public health social workers,” were licensed to practice social work, and belonged to the national association for social workers (nasw)—signals of connection to the profession. generally, little is known about best practices in dual-degree education. there are multiple topics crucial to dual-degree program administration that remain largely unstudied, including the coordination and integration of knowledge and skills from both fields, the role of advising and faculty involvement, how best to organize coursework, and the need for dedicated financial aid (miller et al., 2008; ruth et al., 2015). one small qualitative study of msw/mph alumni from four established programs identified key areas for msw/mph program improvement, including: 1) the need for greater university investment, 2) coordination of dual degree programs, and 3) the strengthening of integration opportunities (ruth et al., 2008). clearly, there is much more to know about the profession’s dual-degree programs, particularly msw/mph programs. some have suggested that a return to the profession’s public health roots is a key response to the changing national health landscape (reisch, 2012). a better understanding of msw/mph programs is an important step in determining their relevance to the profession’s changing educational needs and to the revitalization of public health approaches in the profession. the purpose of the national msw/mph programs study the purpose of the national msw/mph programs study is to examine the prevalence, content, models, and challenges of current msw/mph programs by surveying current msw/mph program directors and associated faculty members. a team of four msw/mph professionals at boston university undertook this study with the following goals. first, we wanted to identify the total number and location of all msw/mph programs. second, we wanted to assess various program facets: mission and structure, faculty and university motivations, institutional support for programs, the number of students enrolled and number of alumni, and any program outcomes associated with each program. third, we wanted to understand the strengths, successes, challenges, and trends in msw/mph programs, as identified by program directors, associated faculty members, or other key informants. finally, the research team sought to understand whether individual programs identified their goals as related to the education of public health social workers. methods because there is no one source of information on msw/mph programs, multiple sources for identifying msw/mph programs were consulted, including the council on social work education’s (cswe) list of dual-degree programs and the american public health association’s public health social work section list of msw/mph programs. additionally, all msw programs on the cswe membership list were compared with all mph-granting schools and programs listed by the association of schools and programs in public health (aspph). all schools with both a school of social work and a program in or school of public health were identified and their websites examined for evidence of an msw/mph program. finally, key informants from several well-established msw/mph advances in social work, fall 2015, 16(2) 410 programs were consulted and shared suggestions for identifying programs under development. a comprehensive list of msw/mph programs was developed by spring 2013. all schools that hosted msw/mph programs were eligible to participate in the study; a total of 42 programs were identified. schools’ websites were reviewed, and the contact persons or offices listed were contacted by email for the names of each msw/mph program’s key informants, including directors and faculty members involved with the msw/mph program. if there was no response to email, then phone calls to admissions offices were made and email addresses of each program’s key informants obtained. researchers reached out to all administrators and faculty members who were involved with msw/mph programs at each school. for some programs, there was more than one key informant; data from all key informant responders was included in the analysis. the team created an electronic survey consisting of 27 questions; 24 were quantitative and 3 were open-ended. the scope of questions included logistics (location, number of students, number of graduates, when the program began, and number of credits); program details (support for students, career services available); student funding (scholarships, financial aid packages, loan information); students’ motivation for enrollment; and specific questions about alumni. the open-ended questions focused on key informants’ views of trends and directions. to enable all key informants from any one school to participate, we provided each msw/mph program with its own individual survey, and all key informants involved with each program were invited to participate. surveys were distributed from fall 2013 through summer 2014. three follow-up reminder emails were sent to all key informants. after data collection was complete, all schools’ responses were aggregated in order to be able to report findings on all programs. the surveys were compiled and analyzed using microsoft excel 2010 to calculate frequencies. narrative comments were analyzed using thematic content analysis (neuendorf, 2002). findings sample respondents from a total of 41 out of 42 identified programs participated in the study, for a response rate of 97.6%. one school, unable to answer any survey questions because its newly launched program had no curriculum or enrolled students, was eliminated from the sample. we report below on a total sample of 41 schools. in some cases, respondents declined to answer items due to lack of information or skipped them altogether. we report on those who answered to give as clear a picture as possible of available information. respondents included directors of programs, faculty associated with the programs, and graduate assistants who helped with program administration. of the 48 total respondents, 27 of 48 (56.2%) were based in schools of social work, 14 of 48 were based in public health (29.2%), 2 of the 48 respondents had dual appointments in social work and public health (4.2%), and 5 of 48 programs did not answer this question (10.4%). ziperstein et al./mapping dual degree 411 program demographics the majority of responding programs (n=29, 70.7%) were housed in public universities; 10 were in private universities (24.4%). two programs were hybrids, or public-private university collaborations. overall, programs were almost equally distributed around the regions of the united states with eight programs located in the west, 10 in the midwest, 11 in the south, and 12 in the north. (see table 1 below). table 1. list of msw/mph programs and geographic location west (8 programs) midwest (10 programs) 1. new mexico state university 2. portland state university 3. san diego state university 4. university of california – berkeley 5. university of california – los angeles 6. university of southern california 7. university of utah 8. university of washington 1. indiana university 2. michigan state university 3. ohio state university 4. university of illinois – chicago 5. university of missouri 6. university of minnesota 7. university of nebraska 8. saint louis university 9. university of michigan 10. washington university south (11 programs) north (12 programs) 1. tulane university 2. university of alabama 3. university of georgia 4. university of houston 5. university of maryland (johns hopkins university) 6. virginia commonwealth university 7. university of oklahoma 8. university of north carolina chapel hill 9. university of texas 10. university of south carolina 11. university of south florida 1. boston university 2. bryn mawr college 3. columbia university 4. fordham university 5. new york university 6. simmons college (harvard university) 7. temple university 8. university at albany 9. university at buffalo 10. university of connecticut 11. university of pennsylvania 12. university of pittsburgh program development and enrollment the oldest responding program began in 1979, and the newest responding program was added in 2014, creating a range of 35 years in the sample. the median year of program establishment was 2005 (see figure 1 below). advances in social work, fall 2015, 16(2) 412 figure 1. year msw/mph programs established most programs (75.6%, n=31) reported steady or increasing enrollment. msw/mph programs graduate an average of seven individuals per year, with a range of 0 to 25 graduates per year. almost ten percent of all msw/mph programs estimated that there were no graduates from the program at all in the past year (9.7%; n=4); another 7.3% (n=3) did not know if anyone had graduated in the past year. another 9.7% (n=4) had graduated only one msw/mph graduate in the past year. together, this amounts to almost one-fifth of programs with one or fewer graduates per year (19.5%, n=8). when asked about the total number of graduates from the program, a little over 12% (n=5) programs reported never having anyone graduate from their msw/mph program. another 19.5% did not know if anyone had ever graduated from the program (n=8), suggesting a lack of program history in a substantive minority of programs. almost half of respondents agreed/strongly agreed that the msw/mph program was their most popular dual-degree program at their school (46.3%; n=19). almost all agreed that the program brought in high quality students (90.2%; n=37). program structure and requirements the average length of time to complete an msw/mph program was three years, although a few schools (14.6%; n=6) reported that students could complete all the 12.1% (n=5) 19.5% (n=8) 43.9% (n=18) 21.9% (n=9) .02% (n=1) 0 2 4 6 8 10 12 14 16 18 20 1970s/80s 1990s 2000s 2010s no answer # of m sw /m ph p ro gr am s year program established ziperstein et al./mapping dual degree 413 requirements for both degrees in less than three years and six schools reported that it took longer than three years (14.6%). nearly half (48.8%; n=20) of msw/mph programs required their students to major or concentrate in a particular area of practice. examples of required majors include macro practice within the school of social work and maternal and child health or health policy within public health. most schools (73.2%; n=30) had specialized field internships that emphasized public health and social work, and about 15% (n=6) hosted a required integrative seminar in public health and social work. perceptions of students’ motivation for msw/mph programs when asked why students enroll in the msw/mph program, 82.9% (n=34) of respondents strongly agreed/agreed with the statement that “students believe it will make them more marketable” as the primary reason for enrollment. other motivations were also endorsed; 78.0% of respondents (n=32) agreed/strongly agreed that students were motivated by the desire to combine the skills and competencies of both fields, while the wish to “become a public health social worker” was considered a motivating factor for nearly half (48.8%, n=20) respondents. similarly, 61% (n=25) agreed/strongly agreed that students drawn to this program were interested in “tackling big trans-disciplinary issues.” institutional support for programs institutional support for programs varied widely, and some schools lacked even the most basic support such as coordinators and advisors (see table 2). about 81% of schools (n=33) stated that there were faculty coordinators for the msw/mph program, two schools (4.9%) did not know if there were faculty coordinators, and still others reported that there were no faculty coordinators or directors for the msw/mph program (14.6%; n=6). roughly 61.0% of programs had faculty coordinators with specific interest or expertise in public health and social work (n=25). only one school (2.4%) reported that the faculty coordinators received course release for coordinating the program. only three schools had any budgets to support their msw/mph programs, and these budgets were modest (n=7.3%). table 2. msw/mph program faculty support (n=41) yes no unsure/did not respond faculty coordinator at both schools 33 (80.5%) 6 (14.6%) 2 (4.9%) faculty advisors at both schools 38 (92.7%) 2 (4.9%) 1 (2.4%) faculty course relief for msw/mph program leadership 1 (2.4%) 35 (87.5%) 5 (12.5%) despite these findings, most respondents agreed that msw/mph programs were important to both their schools. a little over 73% (n=30) agreed/strongly agreed that msw/mph programs were important to schools of social work, while 82.9% (n=34) agreed/strongly agreed that they were important to schools of public health. a total of 25 responding schools agreed/strongly agreed that there was “strong support” for the program advances in social work, fall 2015, 16(2) 414 at their school of social work (61.0%), while 65.9% (n=27) agreed/strongly agreed that schools of public health were in strong support of the program. still, nearly a third of respondents reported that, despite support, collaborative problem-solving between the two schools was difficult (29.3%; n=12). public health social work as noted above, “becoming a public health social worker” was not viewed as a particularly robust motive for student enrollment in most programs. this may relate to the finding that the “public health social work” model was not being widely used; less than a quarter (17.1%; n=7) reportedly used this as an organizing concept for their programs. only half (51.2%; n=21) strongly endorsed the statement that the goal of their program was to “train public health social workers” (see figure 2). figure 2. msw/mph program use of phsw as an organizing concept (n=41) student support almost all schools (90.2%; n=37) had established program guidelines which specified the program requirements for students, and 92.7% (n=38) provided advisors for students at both schools. though dual degree programs are likely to be significantly more expensive, only 12.2% of schools (n=5) provided targeted financial aid for msw/mph students. most 0 10 20 30 40 50 60 70 80 90 100 phsw as a motivating factor phsw training as a program goal using phsw as a conceptual model pe rc en ta ge o f p ro gr am s 17.1% (n=7) 51.2% (n=21) 45.9% (n=17) ziperstein et al./mapping dual degree 415 respondents (58.5%; n=24) did not appear to know how much student loan debt msw/mph students acquired in the course of their programs. of those who responded to these questions (n=17), the estimated student loan debt ranged broadly from 11,000 to more than 70,000. of the 17 schools responding, more than half of them private, the majority estimated student loan debt upon graduation to be greater than 51,000 (52.9%, n=9) (see figure 3). figure 3. estimated msw/mph student debt (n=17) after graduation for alumni, only a handful of programs (12.2%; n=5) reported providing specific career services to msw/mph graduates, and only three programs (7.3%) reported offering continuing education tailored to msw/mph graduates. less than a third of schools described systematic efforts to stay in contact with alumni (29.3%; n=12), and only 29.3% (n=12) reported engaging in any form of program evaluation. almost half of respondents did not know whether graduates pursued social work licensure (51.2%, n=21). similarly, more than half (58.5%, n=24) did not know whether graduates pursued public health certification. narrative findings the respondents were asked to describe program successes, challenges, and future trends, and many themes emerged. several schools reported their greatest success was that successful msw/mph alumni tended to find leadership roles in the field after graduation. similarly, another common response to the success question was the report of a continuous 0 1 2 3 4 5 6 7 8 11k 30k 31k 50k 51k 70k 71k or more n um be r of p ro gr am s thousands of dollars private public 23.5% (n=4) 23.5% (n=4) 41.2% (n=7) 11.8% (n=2) advances in social work, fall 2015, 16(2) 416 stream of strong applicants applying to the program. one responder noted: “graduation rate for completion of both degrees is high… our alumni have gone on to great positions (in) which (they) combine the two fields well.” other responders noted that collaboration between the two schools was successful. since the sample included some newer programs, multiple responders noted that thus far, their biggest success was simply the establishment of the program. when asked to describe challenges, the most common theme reported was the inflexibility within programs, especially lack of electives. one responder reported “neither program has very much flexibility nor elective credits …so the combination does not save a student very much time or course work.” another frequently noted challenge was the need to build good working relationships across schools, particularly with admissions departments. another responder stressed the need “to improve coordination between both schools, make faculty more responsive to needs of dual-degree students, and improve tracking systems for dual-degree students/logistics.” multiple responders reported a lack of program support, including lack of general funding and financial aid for students. other concerns included the absence of an integrated seminar for msw/mph students, a shortage of msw/mph knowledgeable faculty, and insufficient support for students while they navigate complex programs. responders provided valuable insight into the future of their specific programs. most observed that the future would include continued program maintenance and growth. multiple participants reported they were hoping to refine their marketing and increase visibility as a program. most wanted to increase enrollment in their msw/mph programs. many reporters mentioned the ongoing need for mutual collaboration between schools of social work and public health, and finally, the perennial need for funding and financial support. discussion our data helps to answer questions related to one aspect of social work education in health: the growth and prevalence of msw/mph programs. the data indicate that msw/mph programs have increased steeply since 2000. geographically well-dispersed throughout the country, the majority of msw/mph programs are housed in public universities. while programs vary in size, the total number of annual msw/mph graduates is modest. there are some consistencies across programs: it was widely agreed that these programs are valuable to their institutions, and attract high-quality, mission-driven students interested in trans-disciplinary health practice. respondents also agreed that these programs promote collaboration across schools of social work and public health at a time when inter-professional activities are ever more critical. most msw/mph programs have established program guidelines, program coordinators, and faculty advising at both schools. in addition, the length of time to msw/mph program completion is generally three years. programs differ widely in a number of areas. half of programs limit students’ choice of majors at one or both schools. only a quarter of schools use “public health social work” ziperstein et al./mapping dual degree 417 as an organizing concept for their programs, even though most respondents agree that students are drawn to the public health social work model. programs also differ in how much institutional support they receive. some enjoy budgets (small though they may be), course release for faculty coordinators who are encouraged to provide leadership, and institutional cooperation regarding marketing and administrative infrastructure. the vast majority, however, do not. financial support for students is uniformly identified as a key challenge facing msw/mph programs and students, especially in light of the increased costs associated with two degrees. despite this concern, most program coordinators knew little about student loan indebtedness of msw/mph students in their programs, perhaps because so few programs track alumni. the lack of systematic program evaluation also makes it difficult for program coordinators to speak to the employment, career trajectories, licensure, or continuing professional development needs of msw/mph alumni. limitations the purpose of the national msw/mph programs study was to examine the prevalence, content, models, and challenges of current msw/mph programs by surveying current msw/mph program directors, coordinators, and associated faculty members. as with all research, there were limitations. the lack of an accurate compilation of msw/mph programs created sampling challenges, and while every effort was made to identify all msw/mph programs, it is possible that some were omitted. in addition, many programs lacked identifiable contacts in either school, and although efforts were made to identify and survey all involved faculty and administrators, in some cases the most knowledgeable people may not have been the ones who responded to the survey. additionally, while all administrators or faculty associated with msw/mph programs were invited to participate, most surveys were completed by respondents from the social work side, which may have biased the findings toward a more social-work-centric view of msw/mph programs. despite these limitations, the overall response rate was high (97.6%), and the findings provide a needed initial overview of existing msw/mph programs. implications this study represents an initial effort to better understand one facet of social work education in health during the aca era. clearly, interest in msw/mph programs is high, and programs are being developed with increasing frequency, reflecting the continuing interest in health social work. the benefits of these programs can be substantial to all involved if opportunities are recognized and developed. many prospective students believe they will be more marketable in a competitive job environment with additional degrees and are prepared to make the investment in a dualdegree program (miller et al., 2008). but this is likely not the only motivation for those drawn to msw/mph programs. most current msw/mph students came of age at a time when global health, health equity, and health reform were subjects of popular heated debate and discussion. many are frustrated by the medical model emphasis on diagnosis and advances in social work, fall 2015, 16(2) 418 treatment and seek to integrate prevention and population health into their skill sets. finally, perhaps more than at any other time, a large subset of students appear to recognize the limitations of any one profession in addressing major issues such as obesity and health inequities. to be more effective, these students seek new ways to combine the skills of trans-disciplinary practice in prevention, population health, and other wide-lens approaches with social work. for this group, programs that combine public health and social work have a particular appeal. to strengthen msw/mph graduates and to help maximize their contribution to the social work profession during this time of accelerated change, the intentional and focused integration of skills, values, concepts, and practices across the fields is needed. the use of the public health social work model is one method for organizing this integration and retaining the social work focus. given its historic and contemporary relevance, msw/mph programs should consider anchoring their programs in this model. the benefits to sponsoring schools and their faculty members can be substantial. the affordable care act has put a high premium on trans-disciplinary and inter-professional collaborations. msw/mph programs offer a natural mechanism for building alliances and promoting the visibility of both fields and can provide faculty with initial opportunities to work across academic boundaries. finally, at a professional level, powerful forces are calling on social work to increase its impact in the wider arena of health justice. the growing cadre of msw/mph practitioners, skilled in both social work and public health, can play important leadership roles in our profession’s response to the major health issues of our day. because msw/mph practitioners emerge prepared to practice at the population health level, strengthening msw/mph programs is an already-existing mechanism for building the profession’s capacity for action and impact in all aspects of population health. popular and plentiful, it is likely that msw/mph programs are here to stay. the attention and focus of social work educators is needed to better understand both potential and actual challenges and contributions. to that end, directions for additional research emerged from this project. first, schools would be wise to systematically track and evaluate their msw/mph programs to better understand the career trajectories, opportunities, workplace challenges, and benefits of msw/mph programs. second, a national study of msw/mph alumni would yield important information on the challenges and obstacles of the integrated practice of public health and social work. because a true understanding of the financial costs and benefits of msw/mph programs does not yet exist, an important goal of a national study would be to better understand the financial experiences of graduates who may be emerging from these programs with significant debt, along with their experiences of repayment on msw/mph salaries. this issue needs urgent attention. if we, as a profession, value the growing importance of the integrated practice of public health and social work, it is important to financially support students who commit to msw/mph education. finally, the conceptual model of public health social work, used by some msw/mph programs, can be studied for its particular relevance to social work goals such as interprofessional education, health equity, health reform, and addressing the social determinants ziperstein et al./mapping dual degree 419 of health. the concepts, skills, and practices of public health social work, which integrate prevention and other wide-lens approaches into social work, may be a particularly powerful organizing framework for msw/mph programs. centering msw/mph programs on the historic and current practice of public health social work can help to ensure that dual practitioners emerge committed to the social work profession. to reach these goals, msw/mph program directors and faculty may benefit from increased affiliation at conferences or other forms of cross-institutional support. with evaluation and enhancement, it is likely that msw/mph programs will be one of the profession’s best efforts for developing leaders for a new era of social work in health. references allen, h. (2012). is there a social worker in the house? health care reform and the future of medical social work. health and social work, 37(3), 183-186. doi: http://dx.doi.org/10.1093/hsw/hls021 andrews, c. m., darnell, j. s., mcbride, t. d., & gehlert, s. (2013). social work and implementation of the affordable care act. health and social work, 38(2), 67-71. doi: http://dx.doi.org/10.1093/hsw/hlt002 bachman, s. s. (2011). accountable care organizations: opportunities for social workers. health and social work, 36(4), 245-247. doi: http://dx.doi.org/10.1093/hsw/36.4.245 beddoe, l. (2013). social work education and health: knowledge for practice. in b. crisp & l. beddoe (eds.), promoting health and well-being in social work education (pp. 6-23). new york: routledge. braverman, p., edgerter, s., & williams, d. r. (2011). the social determinants of health: coming of age. annual review of public health, 32, 381-398. doi: http://dx.doi.org/10.1146/annurev-publhealth-031210-101218 clark, e. j. (2006, may). public health social work in the 21st century: where do we go from here? paper presented at public health social work in the 21st century: a national conference, boston, ma. collins, s. (2013, june). strategies for strengthening health care social work in the health reform era. practice perspectives newsletter. retrieved from http://www.socialworkers.org/assets/secured/documents/practice/health/strength eninghealthcaresocialwork.pdf council on social work education. (2012). 2012 statistics on social work education in the united states. retrieved from http://www.cswe.org/file.aspx?id=68989 darnell, j. s. (2013). navigators and assisters: two case management roles for social workers in the affordable care act. health & social work, 38(2), 123-126. doi: http://dx.doi.org/10.1093/hsw/hlt003 frieden, t. r. (2010). a framework for public health action: the health impact pyramid. american journal of public health, 100(4), 590-595. doi: http://dx.doi.org/10.2105/ajph.2009.185652 http://dx.doi.org/10.1093/hsw/hls021 http://dx.doi.org/10.1093/hsw/hlt002 http://dx.doi.org/10.1093/hsw/36.4.245 http://dx.doi.org/10.1146/annurev-publhealth-031210-101218 http://www.socialworkers.org/assets/secured/documents/practice/health/strengtheninghealthcaresocialwork.pdf http://www.socialworkers.org/assets/secured/documents/practice/health/strengtheninghealthcaresocialwork.pdf http://dx.doi.org/10.1093/hsw/hlt003 http://dx.doi.org/10.2105/ajph.2009.185652 advances in social work, fall 2015, 16(2) 420 golden, r. (2011). coordination, integration, and collaboration: a clear path for social work in health care reform. health & social work, 36(3), 227-228. doi: http://dx.doi.org/10.1093/hsw/36.3.227 gorin s. (2013). the future of the affordable care act—a social work perspective. social work today, 13(1), 22. marshall, j., ruth, b.j., sisco, s., cohen, m., bachman, s. (2011). social work interest in prevention: a content analysis of the professional literature. social work, 56(3), 201211. doi: http://dx.doi.org/10.1093/sw/56.3.201 mccave, e. l., & rishel, c. w. (2011). prevention as an explicit part of the social work profession: a systematic investigation. advances in social work, 12(2), 226-240. mcclelland, r. (1985). joint degrees: do they strengthen or weaken the profession? journal of social work education, 21(1), 20-26. miller, s. e., hopkins, k. m., & grief, g. l. (2008). dual degree social work programs: where are the programs and where are the graduates? advances in social work, 9(1), 30-43. moniz, c. (2010). social work and the social determinants of health perspective: a good fit. health & social work, 35(4), 310-313. doi: http://dx.doi.org/10.1093/hsw/35.4.310 neuendorf, k. a. (2002). the content analysis guidebook. thousand oaks, ca: sage. pecukonis, e., doyle, o., & bliss, d. l. (2008). reducing barriers to interprofessional training: promoting interprofessional cultural competence. journal of interprofessional care, 22(4), 417-428. doi: http://dx.doi.org/10.1080/13561820802190442 reisch, m. (2012). the challenges of health care reform for hospital social work in the united states. social work in health care, 51(10), 873-893. doi: http://dx.doi.org/10.1080/00981389.2012.721492 ruth, b. j., & sisco, s. (2008). public health social work. in t. mizrahi & l. davis (eds.), national association of social workers encyclopedia of social work (20th ed.). new york: oxford university press. retrieved from http://socialwork.oxfordre.com/view/http://dx.doi.org/10.1093/acrefore/97801999758 39.001.0001/acrefore-9780199975839-e-324?rskey=upzgzc&result=1 ruth, b. j., marshall, j., velásquez, e. e., & bachman, s. s. (2015). teaching note— educating public health social work professionals: results from an msw/mph program outcomes study. journal of social work education, 51(1), 186-194. ruth, b. j., sisco, s., wyatt, j., bethke, c., bachman, s., & markham piper, t. (2008). public health and social work: training dual professionals for the contemporary workplace. public health reports, 123(2), 71-77. http://dx.doi.org/10.1093/hsw/36.3.227 http://dx.doi.org/10.1093/sw/56.3.201 http://dx.doi.org/10.1093/hsw/35.4.310 http://dx.doi.org/10.1080/13561820802190442 http://dx.doi.org/10.1080/00981389.2012.721492 ziperstein et al./mapping dual degree 421 ruth, b. j., wachman, m., & schultz, n. (2014, october). health in all programs? findings from a website analysis of msw programs. oral presentation at the council on social work education annual program meeting, tampa, fl. ruth, b. j., wyatt, j., chiasson, e., geron, s., & bachman, s. (2006). social work and public health: comparing graduates from a dual-degree program. journal of social work education, 42(2), 429-439. doi: http://dx.doi.org/10.5175/jswe.2006.200404117 spitzer, w. j., & davidson, k. w. (2013). future trends in health and health care: implications for social work practice in an aging society. social work in health care, 52(10), 959-986. doi: http://dx.doi.org/10.1080/00981389.2013.834028 turnock, b. j. (2011). public health: what it is and how it works. sudbury, ma: jones & bartlett. zabora, j. (2011). how can social work affect health care reform? health and social work, 36(3), 231-232. doi: http://dx.doi.org/10.1093/hsw/36.3.231 author note address correspondence to: betty j. ruth, msw, mph, boston university school of social work, 264 bay state road, boston, ma 02215. e-mail: bjruth@bu.edu http://dx.doi.org/10.5175/jswe.2006.200404117 http://dx.doi.org/10.1080/00981389.2013.834028 http://dx.doi.org/10.1093/hsw/36.3.231 mailto:bjruth@bu.edu _________________ christa c. gilliam, phd, msw is assistant professor, department of social work, west chester university of pennsylvania, west chester, pa, 19383. marquis a. chandler, msw, huda al-hajjaj, msw, and angelica n. mooney, msw, are a phd candidates, school of social work, morgan state university, baltimore, md, 21251. halaevalu f. o. vakalahi, phd, msw, med is the associate dean and professor, school of social work, morgan state university, baltimore, md, 21251. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 330-339, doi:10.18060/18606 intentional leadership planning and development: the collective responsibility to educate more social work leaders christa c. gilliam marquis a. chandler huda a. al-hajjaj angelica n. mooney halaevalu f. o. vakalahi abstract: social workers have the capacity and skills to assume leadership positions in social service agencies. social work educational institutions must continue to prepare and encourage graduates to seek leadership roles in social service agencies. social work curriculum and post-graduate professional development are significant avenues to ensure social workers will be excellent choices as organizational leaders and administrators. this article offers a review of the literature to identify gaps and ways to cultivate leaders through intentional recruitment and continuous training of social workers in human service leadership and administration. keywords: succession planning; human services; social work; leadership; administration as leaders and administrators in public social service agencies begin to reach the age of retirement, an urgent need to develop and implement succession plans for social work leadership is emerging. a 2003 study by birdfell and muzzio affirmed this need, pointing to “…a looming crisis in nonprofit management, with many nonprofit leaders on the verge of retirement and few potential leaders poised to take over” (nesoff, 2007, p. 283). due to the aging population, demand for management positions in social and community service agencies is expected to rise about 21% from 2012 to 2022, an increase higher than the average for all other occupations (u.s. bureau of labor statistics, 2014). moreover, according to frick (2011), succession planning and strategic leadership development is insufficient to meet current demands in state and nonprofit organizations. thus, efforts to recruit and develop leaders must be intentional. due to the lack of leadership planning, agencies find themselves with unintentional interims rather than a permanent leader (frick, 2011). searches, recruitment, training, and retention of multiple interims can cost at least ten times the base salary of a permanent executive. without some intentional leadership planning and development, this process can become an ongoing cycle and financial burden on the agency’s time and resources (frick, 2011). succession planning as the means by which to identify, recruit and train high potential employees to assume leadership roles is essential to the organization’s success (wilkerson, 2007). organizational performance and change in leadership often leads to compromised organizational performance (leland, carman & swartz, 2012). succession planning is a form of stewardship necessary to influence and change policy. good governance depends upon developing the strategic leadership competencies and values of leaders (wilkins, 2014). yet in a study of 110 nonprofit administrators, leland and colleagues (2012) advances in social work, fall 2016, 17(2) 331 reported that a majority of the participants (75%) did not embrace succession planning as one of their central tasks as a leader. reid (2011) further indicated that the continuous crises in management exist as a result of leaders being uninterested in taking on leadership tasks, the assumption that succession planning is beyond a leader’s scope of work, confusion about how the succession task should be framed, and the lack of information about how to carry out such planning. however, leadership planning and development is a collective responsibility. agencies need to address the issue of succession planning, and schools of social work need to prepare and equip graduates to take on leadership roles. de-emphasizing macro-level administration and leadership training in schools of social work in favor of direct service and clinical training is well-documented (de saxe zerden, sheely, & despard, 2016; ezell, chernesky & healy, 2004; rank & hutchison, 2000). as a result, an increasing number of human service agencies are being led by executives with degrees from disciplines other than social work (packard, 2004; patti, 2003). although critical thinking and decisionmaking are core competencies in social work curricula and professional development, social workers interested in leadership and administrative positions are often in competition with those trained in nonprofit and law degree programs (ezell et al., 2004). the terms leadership, management, and administration are used interchangeably throughout the literature. however, there are important distinctions. as such, “the overriding function of management is to provide order and consistency to organizations, whereas the primary function of leadership is to produce change and movement” (northouse, 2010, p.10). furthermore, administration is responsible for policy and decision-making, whereas the manager or leader is responsible for the implementation of policy within the limits set by the administration (kettner, 2002). this article offers a critical analysis of existing literature pertaining to the role schools of social work play in preparing social work students to assume leadership positions in human services agencies. although the literature is sparse, available information affirms the significance of preparing trained social workers as viable candidates for leadership, management, and administrative positions in social service agencies. review of relevant literature status of social work leadership while social work leadership is not a new area, it remains an emerging research topic, as there is a large gap in the literature in terms of evidence-based practices. the existing literature is limited in relation to studies that examine the perceptions of social work executives, academics, practitioners, and students regarding leadership. in a study of 150 social work leaders by rank and hutchison (2000), 77% of participants indicated that a social work leader is unique compared to leaders from other professions. for instance, participants believed their social work background contributed to their role as a leader. themes identified as contributing to their leadership role included a commitment to the nasw code of ethics, a systemic perspective, altruism, and concern about the public image of the profession. these themes not only represent the strengths of social work gilliam et al./taking social workers to the top 332 leadership, but may also generate challenges when social workers are considered for traditional leadership roles in human service agencies. the development of social work leaders is a collective responsibility that includes schools of social work, social service agencies, and professional organizations. currently, most social work schools across the country fail to offer a focus on social work administration. of the 710 baccalaureate and master's level programs accredited by the council of social work education, only 37 offer a concentration in management and planning (cswe, 2015). day (2011) found that many managers of human service organizations lack advanced degrees and thus the additional knowledge and skills needed for effective leadership and administration. the limited number of management-oriented degrees presents a challenge in meeting the demand for leaders prepared to address today’s challenging social and economic environments. the need for investment in training social workers for leadership and management positions has become a significant issue for several reasons. first, the gerontologic shift in the u.s. population has resulted in a rising need for social workers. second, the inherent foundation of social work in leadership values such as advocacy, social and economic justice, and competency-based practice leads to a strong base for training leaders. the fields of business and public administration have successfully trained administrators for a variety of organizations. however, the emphasis in social work on multidimensional systems and the commitment to a distinctive code of ethics offers a unique framework for training future leaders and administrators of social service agencies (nesoff, 2007). the literature on social work leadership is limited. available information suggests that in general, social workers are effective leaders. for example, day (2011) observed that leaders of medical centers rated social work leaders higher on measures of management skills than the social workers rated themselves. while respected by their medically trained colleagues for their managerial competencies, it is clear that social work leaders may experience self-doubt and personal insecurities about their ability to lead, manage, and administer a social service agency. similarly, collins-camargo, chuang, mcbeath, and bunger (2014) found private child welfare agencies were better equipped than public agencies to meet the needs of their clientele due to excellent management performance and strategies. preparing social work leaders schools of social work have a significant role in partnership with professional organizations such as the national association of social workers and the council on social work education to educate and prepare competent leaders to lead social service agencies (fisher, 2009). social work graduates who are placed in leadership positions without sufficient preparation often struggle to meet the standards of the positions. as a result, this lack of experience and mentorship can contribute to social workers being passed up for leadership and management positions in social service agencies (bliss, pecukonis, & snyder-vogel, 2015). there is a national shortage of social-work-trained practitioners and an even larger shortage of social-work-trained leaders who are well-prepared to manage and lead social service agencies (nasw, 2011; u.s. bureau of labor statistics, 2015). a advances in social work, fall 2016, 17(2) 333 reason for this shortage is the small number of schools of social work training graduates specifically as leaders and administrators of social service agencies. in addition to increasing leadership and administration concentrations, there is a need for universities to offer more comprehensive, innovative, and interdisciplinary curricula to their social work students. emphasizing social work’s value of lifelong learning, social work curricula must also include components of post-graduate/continuing education and professional development specifically focused on leadership and administration of social service agencies (fisher, 2009; wuenschel, 2006). in training social work leaders, many relevant models of leadership are available for consideration by schools of social work. a number of studies have explored the various models of leadership used in social work and social service agencies. for instance, williams-gray (2014) examined an innovative approach to preparing professional social workers for real-world nonprofit leadership roles. results indicated that virtual asynchronous classroom experiences were effective for teaching msw students and that students who are prepared in generalist practice and social work administration are overlooked for nonprofit leadership (williams-gray, 2014). furthermore, bliss et al. (2014) support the principled leadership development model for addressing the gap in social work leadership. this model can create adaptable leadership development initiatives for social workers in their professional careers. this model introduced six integrated components: a) underpinning ethical principles, b) core leadership competencies, c) domain-specific leadership competencies, d) integrative practice opportunities and mentoring support, e) ongoing self-reflection and continued growth, and f) evaluation (bliss et al., 2014). these components can be applied to leadership development among individuals pursuing a master’s of social work degree and/or continuing education and professional development. several studies have explored social work leadership from an international perspective. mcnabb and webster (2010) compared the leadership approaches used in health policy initiatives in new zealand and the united states, finding that social workers played the role of the emergent leader, supporting their ability to contribute to leadership positions effectively. in canada, butcher (2013) studied 15 female community leaders in waterloo regarding their journey to leadership. themes that emerged from the study included responding to injustice, making a lasting difference, and the importance of fostering independence and developing social consciousness at an early age. the impact of leadership in the community, sustaining factors of family and peer support, and the role of formal and informal recognition were also identified. rejection of traditional models of leadership and redefining community leadership were areas identified for further exploration relative to developing female leaders. the butcher study also points out that women comprise the greatest proportion of social workers in the united states. the study concludes that women are in a position to become effective leaders of human services organizations. the urban leadership program (ulp) was developed in 1998 by simmons college in massachusetts to address the leadership needs of social service organizations in urban communities (mittell, 2012). this certificate program provides students with an in-depth opportunity to develop their leadership abilities in order to assume social service leadership gilliam et al./taking social workers to the top 334 roles in urban areas. in addition to the required msw courses, students in the ulp are required to complete two leadership skills courses and four skills-based mini-courses which provide them with the theoretical and practical foundation for building leadership skills. the program is designed to teach students how to comprehensively assess an organization and the obstacles that impede the delivery of effective, cost-efficient services. field instruction provides hands-on leadership practice with supervision by community leaders of urban agencies. faculty members in schools of social work play a crucial role in not only teaching the curriculum, but also modeling leadership values and practices to students. the commitment of faculty to educate social work leaders is important; their own experiences with academic and non-academic leadership contribute to their utility. call, owens, and vincent (2013) found that faculty believed academic leaders demonstrated transformational leadership qualities, such as a collaborative style that encouraged shared governance, ethical practices, inspirational presence, mentoring activities, relationship-enhancing communication skills, and visionary perspectives. these qualities are consistent with the core values of social work. drawing upon these experiences with strong campus leaders, faculty can develop social work leadership curricula, and nurture graduates who exhibit leadership traits, such as professionalism, advocacy, and commitment to social justice. leadership challenges among social workers, leadership challenges are multi-faceted, multi-dimensional, and inclusive of individual experiences and organizational challenges. management and supervisory positions in social service agencies are commonly filled by non-social-work professionals. this poses a challenge as the decisions of social workers are being evaluated by leaders with little insight into the profession and the populations served (nasw, 2011). non-social-work staff may not share the same professional values and ethics, which can present a barrier to understanding the holistic approach to social work practice. furthermore, social workers seek to enhance the capacity of people to address their own needs, as well as promote the responsiveness of organizations, communities, and other social institutions to the problems and needs of individuals (nasw, 2011). such endeavors may not be at the forefront of a non-social-work leader’s agenda. as suggested by wuenschel (2006), leadership in social work academia needs to develop a theoretical perspective for leadership and management that is unique to social service agencies. a major barrier to advancement in leadership within a social service agency is the high level of burnout among supervisory and case management social workers. such burnout could be contributing to the low numbers of social workers available for leadership and administrative positions (webb & carpenter, 2012; williams, nichols, kirk, & wilson, 2011). wells (2006) also comments that, due to burnout resulting from individual circumstances or a non-supportive organizational system, social workers are not retained in positions long enough to acquire the necessary skills for promotions. the high workforce turnover rates resulting from the intensity of a social worker’s daily life, the shortage of social-work-educated professionals, and the associated negative impacts on service users and agencies have been long-standing concerns in many developed countries, especially the united states (webb & carpenter, 2012). nonetheless, some workforce turnover is advances in social work, fall 2016, 17(2) 335 both natural and inevitable, especially when considering that not all who enter the social work profession should or will remain in practice, and those who leave do so for a variety of reasons (webb & carpenter, 2012). moreover, the life of a modern-day social work leader clearly is not easy given the social and economic crises experienced by individuals, families, and communities in the past several years. inside social service organizations, social work leaders must lead and motivate a diversified group of people, work across organizational boundaries, improve efficiency, and achieve growth. externally, these social work leaders face a complex and globalized environment, and yet must manage the requirements of government and keep up with competitors. within this global environment, there are many cultural considerations that social work leaders must grapple with in order to be effective. today’s social work leaders must work across cultural boundaries with others who likely have different ways of working (gentry, eckert, stawiski & zhao, 2014). overall, the literature suggests several major gaps, including: a) the need for specific training in leadership, management, and administration for social workers and b) the lack of evidence-based best practices for social work leadership. analysis and discussion social workers serve in leadership roles across different environments, but not in sufficient numbers, and not always as the first choice for leadership positions. the reasons for the low numbers of social work leaders are complex and multi-dimensional. a comprehensive training approach that includes personal and professional interests and confidence in one’s preparation and competence is imperative. social workers can become effective leaders in social service agencies if they are fully prepared through social work curriculum and post-graduate professional development that focuses on leadership and administration. the most effective social work leaders receive leadership training and education that prepares them to provide effective services to underserved populations. available information attests to the qualifications and capacity of social workers as leaders and administrators of social service agencies. social workers with the appropriate background in terms of education and work experience in macro-level practice and administration are excellent candidates for leadership positions in social service agencies. schools of social work are in prominent positions to educate, train, and graduate wellprepared social work leaders. additionally, a need for more comprehensive, interdisciplinary, and cross-cultural leadership training for social work leaders is affirmed. social work leadership curriculum can provide opportunities to develop transformational leadership qualities, shared governance, communication skills, and visionary perspective. for example, social workers can develop the leadership competencies recommended by the network for social work managers and adopted by the council on social work education which include an emphasis on the business side of leading an agency, including knowledge and skills in budgeting, fundraising, marketing, and governance (wimpfheimer, 2004). the field education component of social work also provides a real-world setting for training social work leaders. for instance, field education can offer opportunities to gilliam et al./taking social workers to the top 336 develop administrative skills such as organizing, budgeting, communication, group work, research and evaluation, and other management skills. schools of social work can redefine community leadership to be relevant for the 21st century in diverse contexts including both rural and urban settings. overall, social workers have demonstrated their capacity to lead organizations. an investment of resources in training additional social work leaders to replace retiring leaders is urgently needed. an intentionally well-developed succession plan will sustain continuity and increase the quality of services provided. analysis of the literature generated several significant implications that may contribute to future understanding and initiatives that promote the education, training, and retention of social work leaders in social service agencies. first, social work scholars must increase the knowledge base on theories and best practices to support social workers in leadership positions in social service agencies. such research endeavors can also identify areas where further expertise is needed. second, intentional recruitment and retention of social work leaders from schools of social work and within social service agencies is imperative. incentives such as monetary rewards and programs that create opportunities for retention of top talent, promotion, and growth need to be instituted in social service agencies. third, human services agencies can create the conditions for successful development and retention of social work leaders by creating a supportive organizational culture and providing training opportunities that align with the agency’s current needs and future directions for leadership (gothard & austin, 2013). policies that support opportunities and allocate funding for social work leadership development would increase the likelihood of more social work practitioners pursuing leadership careers. recruitment strategies within agencies may include collaborating with schools of social work to identify candidates and instituting internal recruitment and grooming of practitioners with a knack for leadership. within agencies, mentoring strategies may include one-on-one coaching, group mentoring and professional development opportunities including partnering with local schools of social work on research and publication (germak, 2012). fourth, schools of social work must reconsider the current dichotomizing of social work as micro or macro practice, instead of social work as inclusive of both micro and macro practice. the link between micro and macro level practice should be sustained in the development of social work leaders. schools of social work must also increase the number of concentrations offered in social work leadership and administration to increase the number of students prepared to enter the workforce in leadership positions with social service agencies. these concentrations must also be culturally and linguistically relevant for leading an increasingly diverse workforce. the multidimensional systems perspective, code of ethics, a focus on leading social change efforts, and advocating for social and economic justice for all, provides a unique framework and promising opportunities to develop well-rounded leaders. finally, advancing the conversation requires a cultural shift in leadership and administration perspectives, theories, and best practices. with the diversity in the workforce, particularly in terms of the 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(2006). the diminishing role of social work administrators in social service agencies: issues for consideration. administration in social work, 30(4), 518. doi:http://dx.doi.org/10.1300/j147v30n04_02 author note: address correspondence to: christa c. gilliam, phd, msw, department of social work, west chester university of pennsylvania, 700 s. high street, west chester, pa, 19383, 610-436-1000, cgilliam@wcupa.edu http://dx.doi.org/10.19030/jber.v3i6.2782 http://dx.doi.org/10.1037/a0017459 http://www.bls.gov/ooh/management/social-and-community-service-managers.htm http://www.bls.gov/ooh/management/social-and-community-service-managers.htm http://dx.doi.org/10.1093/bjsw/bcr144 http://dx.doi.org/10.1016/j.childyouth.2005.11.009 http://www.4cleanair.org/chicago/ http://dx.doi.org/10.1108/ijlps-07-2014-0009 http://dx.doi.org/10.1016/j.childyouth.2010.08.028 http://dx.doi.org/10.1080/08841233.2014.892050 http://dx.doi.org/10.1300/j147v28n01_04 http://dx.doi.org/10.1300/j147v30n04_02 mailto:cgilliam@wcupa.edu microsoft word 671_ericson_manuscript_copyedit2 _________________ carolyn bartick ericson, ph.d., is an is an associate professor and director of the social work program in the department of sociology, social work and anthropology at christopher newport university, newport news, virginia. the author would like to acknowledge rachel rigual wilson, msw, brianna young, msw, and amber hartley, b.a. social work student for their thoughtful reflections and contributions to this research. copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), 63-78 pura vida with a purpose: energizing engagement with human rights through service-learning carolyn bartick ericson abstract: this paper examines the effects of an international service-learning course with a strong human rights component. human rights have social justice as an essential component and advancing both are considered core competencies in social work. international education in colleges and universities has gained in popularity as has service-learning. research has been carried out in both these areas. however, less research has been done on the combination of the two. in this paper a course is described during which students spent three weeks in costa rica, the land of pura vida, learning about its human rights efforts, its language, getting to know its people, and providing service to some of its citizens. an analysis of student surveys and journals revealed a strengthened belief on the part of the participants that they are competent to have an impact on the world as well as having a responsibility to do so. keywords: international education, service-learning, international service-learning, human rights, competencies and so the story goes, fifteen kids got the chance of a lifetime in an unknown place…and they were never, ever the same. home may be where the heart is, but a little piece of it is missing now because it’s been left in costa rica. pura vida! (closing statement in the journal of an undergraduate social work student.) pura vida! the pure/good life. this common phrase in costa rica took on a new meaning for two groups of 15 students and their professors from the united states who came, learned, and contributed. this paper examines the effects of an international social work course with a service-learning component. the research was designed to expand the existing knowledge of the impact of international service-learning. it assesses the effect on students in several areas relevant to social work competencies, including cultural competence, engagement with diverse populations, commitment to social justice and human rights, awareness of international issues and civic engagement. this paper will also address best practices in designing international service-learning courses. review of the literature service-learning service-learning has become increasingly common across disciplines, including social work, on many college campuses. students in campus compact member schools performed 366 million hours of service through organized service-learning at an estimated value of 7.4 billion dollars to communities in the 2008-2009 academic year (campus compact, 2009). students at other colleges and universities provide countless ericson/pura vida with a purpose 64   additional hours of service. service-learning is a special type of course, providing unique opportunities to the learner and the recipient of the service. it is not simply a course that has a volunteer requirement. “service-learning combines service objectives with learning objectives with the intent that the activity change both the recipient and the provider of the service. this is accomplished by combining service tasks with structured opportunities that link the task to self-reflection, self-discovery, and the acquisition and comprehension of values, skills, and knowledge content.” (national service-learning clearinghouse, n.d.) reflection is a key part of service-learning. only through reflection can students process their experience in such a way that it is integrated into their understanding of the populations they are serving, the environment in which they live and the course curriculum. “experiential education is inductive, beginning with raw experience that is processed through an intentional learning format and transformed into working, usable knowledge” (national society for experiential education foundations document committee, 1998, p. 3). a review of studies on the effects of service-learning from 1993-2000 (eyler, giles, stenson, & gray, 2001) found a number of positive effects of service learning on personal, social, learning and career outcomes. these included development of cultural and racial understanding and reduced stereotyped thinking. batchelder and root (1994) found students who participated in service-learning, compared to those who did not, evidenced greater increases in pro-social decision-making and pro-social reasoning. ericson and ford (2008) found that students gained an increased appreciation for the universality of childhood from students’ service learning experience with children; that is, that there are common experiences that children can share despite their circumstances. this helps students relate to children of all backgrounds and facilitated connections between social policy and direct practice issues. wakefield and ericson (2003), in a qualitative analysis of journals of students involved in service-learning with children, found that the students developed an appreciation for the children as unique individuals who cannot be classified according to specific expectations. closson and nelson (2009) found that during an experience with habitat for humanity, students were able to learn cognitively, affectively and pragmatically. however, they did not find that the students developed an increased understanding of social justice issues, despite an increase in awareness of their middle-class privilege. in social work education, service-learning is distinct from field practica although the two have sometimes been confused (lemieux & allen, 2007). in field practica, the emphasis is on the students’ development of knowledge and skills. although learning is a core part of service-learning and it is not simply volunteerism, the service to the community and the development of the value of civic engagement are also core goals. curriculum and service must be integrated. more recently, philips (2007) found publication about civic engagement “sporadic but present” (p. 7). she sees social work as a relative late-comer in using the servicelearning pedagogy, but that it is increasing in usage. she has a strong belief that the “social change for social justice” model should guide the development of service-learning advances in social work, spring 2011, 12(1) 65     in social work, lemieux and allen (2007) determined that there was insufficient rigorous evaluation research in the social work literature regarding service-learning pedagogy. it was their belief that “research on service-learning has not kept pace with the idealism that permeates much of the scholarly literature on social work community practice, as well as the advances in knowledge development in the broader service-learning field” (p. 316). they advocated for further research to strengthen the use of service-learning in social work. the research described in this article had as its goal to determine outcomes of service-learning in an international context, including its potential to foster the development of core social work competencies. the course particularly addresses education policy and accreditation standards 2.1.4, “engage difference and diversity in practice”, and 2.1.5, “advance human rights and social and economic justice” (council on social work education, 2008). international education like service-learning, international education has also become increasingly popular. in the 2008-2009 academic year, 260,327 american college students studied abroad for academic credit from their home institutions, a 100% increase in the last decade (institute of international education, 2010). the commission on the abraham lincoln study abroad program called for sending 1,000,000 students to study abroad by 2016-2017 stating that this needed to happen to further “global competence” and “national needs.” (year of study abroad, n.d.). in comparison to other studies of academic programs, however, the research is less developed in the area of the effects of study abroad programs. positive effects that have been found include language acquisition, personal and professional development and positive academic outcomes (dolby, 2007). ford and ericson (2003) found that social work students, participating in an international experience in the netherlands, showed changes in self-perceptions that were still present six months later, most notably for students who had never left the country before. all student participants were more aware of global issues and expressed interest in to travelling more for professional reasons. according to long (2009), “social work has been pursing and building momentum for international work based on the profession’s long-standing devotion to principles of human rights and social justice” (p. 5). it is his belief that social work must think about justice from a worldwide perspective. international courses offer a special opportunity for students to do this, particularly in courses with service-learning components. international service-learning international service-learning combines international education with a servicelearning component. in their article, going global with service-learning, hartman and rola (2000) described their experiences with students in mexico and found that they were “transformed as individuals and re-evaluated themselves as persons” (p.21). these students often study second languages, become involved in additional international service-learning courses, and maintain contact with host families. kiely and nielsen ericson/pura vida with a purpose 66   (2002/2003) emphasized the importance of partnerships, noting that recognition of partners’ needs supports the creation of a program with service-learning course objectives for mutual benefit. as a result, students were able to achieve, among other things, intercultural competence, language skills, and an appreciation of difference. many studies of international service-learning are in the form of case studies. monard-weissman (2003) found that students in ecuador became more sensitive to the needs of citizens in other parts of the world and were able to examine their own roles as citizens of the world, developing an enhanced sense of social justice. using a longitudinal case study design, kiely (2005) concluded that a transformational learning experience occurred for students performing service-learning in nicaragua. students experienced transformative learning in one or more of the following areas: political, moral, intellectual, cultural, personal, and spiritual. students were less likely to adapt to the status quo, reflecting a greater sense of social justice. gorka and niesenbaum (2001) stress the importance of interdisciplinary courses that support language immersion in other countries as a way of showing the relevance of learning a foreign language to non-language majors. they also emphasize the importance of a partnership with organizations in other countries. this partnership allows for opportunities for students beyond traditional tourism or study abroad programs without a partnership. international service-learning may also generate profound questions such as: why are so many people poor? why is there so much inequality and injustice? (grusky, 2000). service-learning provides the opportunity for “teachable” moments, noting that the real power of international service-learning is at the “critical juncture where experience meets study, critical analysis, and reflection” (p.861). she cautions, however, against exploiting poor nations to provide a life-enriching experience for students. consistent with this, porter and monard (2001) emphasize reciprocity (or the bolivian term “ayni”) as imperative. they describe several aspects of ayni based on their experience with students building a school in bolivia, including that “service programs must be based upon a foundation of genuine need as expressed by the recipients” and “ayni cycles involve a different conception of time and place, and place participants in an ongoing relationship that extends across both generation and geography” (p.8). monard-weissman (2003) also found that students developed a deeper sense of social justice in her case study of an international service-learning experience in ecuador. in addition to promoting an understanding of human rights, international service learning has also found to impact students’ cultural competency. through an analysis of reflective journals of graduate students performing service in peru, porter (2003) found that students engaged with others, not only with the head but with the heart. as they constructed a new head start-like preschool building along with local residents, students were able to fulfill wegner’s charge that “educational design must engage learning communities in activities that have consequences beyond their boundaries, so that students may learn what it takes to become effective in the world” (wegner, 1998, p. 274 as cited in porter, p. 61). boyle, nackerud and kilpatrick (1999) determined that, following a service-learning experience in mexico, students showed an increase in cultural competence. they stress advances in social work, spring 2011, 12(1) 67     the need for preparing students to interact with the hispanic/latino population because of the ongoing increase in this population in the u.s. this international experience was designed, in part, to support the students’ competence in working with the hispanic/latino population. although not completely consistent, research in service-learning shows positive outcomes in the development of an increased understanding of human rights and commitment to social justice. international service-learning is not unique in its ability to do this but provides an opportunity for students to immerse themselves in another culture and understand the need for a universality of human rights. a social work international service-learning course has definite potential to build competencies around diversity and difference as well as human rights and social justice. this research was designed to determine the effectiveness of one international service-learning course at accomplishing those things. methodology the course this research was carried out during two three-week international courses with service-learning components in costa rica. the implementation of the two courses took place two years apart. the social work course title was human rights: the costa rican perspective. all goals of the course reflect the educational policies and accreditations standards (epas) (council on social work education, 2008). as noted earlier, the course particularly addresses standards 2.1.4, “engage difference and diversity in practice”, and 2.1.5, “advance human rights and social and economic justice”. the goals of the course were for the students to: 1. understand the concept of human rights. 2. understand the historical development of global human rights. 3. understand the role of the united nations in working towards the protection of human rights. 4. understand what governmental and non-governmental organizations are doing to advance human rights. 5. have an understanding of the rights of women, minorities, indigenous peoples, children and other vulnerable populations. 6. develop self-awareness with respect to one’s own perception of human rights. 7. understand efforts that have been put forth in costa rica in the service of human rights. 8. understand the importance of language within a culture. 9. increase facility in the spanish language at the appropriate level. 10. understand cultural norms and traditions within costa rican society. ericson/pura vida with a purpose 68   11. understand the culture that the immigrant central american population brings to the u.s. 12. understand the relationship of the u.s. to other countries in the process of enhancement of global human rights. the international experience was designed to quickly immerse the students in the culture and life of costa rica and was developed in partnership with a language school. during their language education, students were housed with costa rican “tico” (local) families with whom they lived for two weeks. most of the family members spoke little or no english which allowed for a full immersion experience. upon arrival in costa rica, students were tested for placement in spanish classes and began those classes the next morning. the students had 24 hours of small group instruction. although the course was not intended to be a spanish language course, language is a critical part of a country’s culture and was intended to support the development of students’ cultural competence. a total of three weeks was spent in costa rica. during the first two weeks, the students stayed with their tico families, studied spanish, visited social service agencies and area neighborhoods and met with costa rican university students and faculty. the second group to participate in this course also developed a program for older adults in a day treatment center and did a beach cleanup. the third week was spent at a residential center for 80 children in the mountains about an hour outside of san jose, the capital city of costa rica. the center provides services for children and adolescents who have little access to social services and few economic resources or opportunities for their healthy development. the children at the center were temporarily living apart from their families as a result of abuse, neglect, or extreme poverty and ranged in age from preschoolers to teenagers. students shared one of the many houses on the grounds of the center and were assigned to have meals with the children as well as interact with them after dinner. while the children were in school during the day, the students performed several service activities at the request of the partner staff of the center. this insured that the needs of the partner organization were clearly met. service activities included painting the interior of a building which was to be used as an art center, painting the playground equipment, preparing lunch for the children and staff, painting of houses and reconstruction of one of the houses. two students requested the opportunity to volunteer in the school which was eagerly accepted. in fact, their second day in the school, they were substitute teachers for the first grade! this occurred despite their limited spanish ability and lack of prior teaching experience. prior to leaving for costa rica, all students were asked if they would be willing to participate in a research study designed to assess the impact of an international servicelearning experience. the proposed research had undergone review and been approved by the university’s review board for the protection of human subjects. all students agreed to participate and signed consent forms. during the second trip, one student was unable to complete the program and therefore, did not complete her research participation and was not included in the study. the research design was a pre/post study to measure the impact of the international service learning course, with specific attention to issues of cultural advances in social work, spring 2011, 12(1) 69     competency and commitment to social justice, including quantitative surveys and qualitative data from student reflection journals. the students/participants the students were 29 undergraduates enrolled in a small liberal arts university in one of the middle atlantic states. all students were traditional age students, reflecting the demographics of the university as a whole. six had never traveled outside the country before but the majority had and most had some prior service-learning experience. only one had volunteer experience outside the country and this was not service-learning. a summary of participant demographics are included in table 1. table 1: student participant demographics demographic gender m 3 (10.3%) f 26 (89.7%) age 18-19 2 (6.9%) 21-22 25 (86.2.7%) 22-23 2 (6.9%) family income wealthy 2 (6.9%) middle class 21 (72.4%) working-class/poor (13.7%) other 2 (6.9%) childhood home rural 5 (17.2%) suburban 24 (82.8%) ethnic background caucasian 23 (79.3%) hispanic 2 (6.9%) multiethnic 3 (10.3%) asian 1(3.4%) previous international trips 0-2 16 (55.5%) 3-5 6 (20.7%) 6+ 7 (24.1%) surveys surveys were administered just before the start of the course and before departing from costa rica. the survey was adapted from markus, howard, and king (1993) and the civic attachments and public life survey (the walt whitman center, 1997) and utilized a four point likert-type scale. items one through sixteen were self-rating items on a list of skills and activities. students were asked to rate themselves as compared to most people on a scale of one to four with one being not as good and four, much better. items 17 through 24 asked the students to rate the importance of a number of items to them. items 25 through 34 asked students to what extent they agreed or disagreed with statements. these items were chosen because they are reflective of a commitment to human rights and social justice. journals the students’ reflective journals provided qualitative data about their reactions and were analyzed for content themes. students were required to use the “what? so what? ericson/pura vida with a purpose 70   and now what?” model of journal reflection. they described what they observed and experienced, what they thought about it, and how they might incorporate this into their thinking about human rights as well as actions they might take as a result. this is a method favored by many experiential educators and is designed to foster reflection and promote an understanding of how the insights gained through service-learning might be applied (campus outreach opportunity league, 1993). results paired samples t-tests were run using spss 17 on all items in the survey. of the 34 items in the survey, significant differences pre and post test were found on 21 items. results are shown in tables 2, 3 and 4. there was a significant statistical change in 21 items and all changes were in the direction that indicates an increased awareness and commitment to human rights on the part of the students and a sense of competence in their belief that they are able to make a change. table 2: comparison of pre-post measures of self-rating of personal characteristics pre-test post-test mean sd mean sd t respecting views of others 3.17 .6017 3.62 .5615 -3.882*** attentive to social issues 2.52 .8709 3.17 .7105 -4.335*** thinking critically 2.65 .7688 2.89 .7243 -1.367 communicating ideas to others 2.55 .8274 3.00 .7559 -2.776** engaging in discussion with others 2.79 .8610 3.24 .7862 -2.041 ability to compromise 2.75 .8304 3.03 .6804 -1.864 listening skills 3.03 .6804 3.27 .5914 -1.653 moral or ethical judgment 2.96 .8230 3.13 .6394 -1.543 identification of social issues or concerns 2.58 .9070 3.14 .7427 -2.911** thinking about the future 2.82 1.002 3.20 .9775 -2.807** ability to take action 2.82 .8048 3.17 .6584 -2.415* tolerant of people who are different 3.37 .7415 3.70 .5417 -2.360* effective in accomplishing goals 2.96 .7310 3.24 .6894 -2.117* empathetic to all points of view 3.00 .9258 3.24 .7394 -1.885 feeling responsible for others 3.00 .8864 3.10 .8596 -.648 knowing where to find information 2.62 .7752 2.96 .6804 -2.774** n=29 * p<.05, **p<.01, ***p<.001 advances in social work, spring 2011, 12(1) 71     table 3: comparison of pre and post ratings on the importance of behaviors pre-test post-test mean sd mean sd t working toward equal opportunity for all u.s. citizens 3.38 .6768 3.44 .6316 -.812 working toward equal opportunity for all citizens of the world 3.06 .9610 3.48 .6876 -3.550*** developing a meaningful philosophy of life 2.76 .9876 3.27 .7510 -4.050*** becoming involved in a program to improve communities, including those in other countries 3.24 .6894 3.59 .5680 -2.281* being very well off financially 2.34 .7209 2.37 .7277 -297 volunteering my time helping people in need 3.20 .6750 3.59 .5680 -4.137*** giving 3% or more of my income to help those in need 2.34 .8974 2.83 .9284 -3.136** finding a career that provides the opportunity to be helpful to others or useful to societies 3.45 .8695 3.55 .6316 -2.254* n=29 * p<.05, **p<.01, ***p<.001 table 4: comparison of pre and post agreement with statements pre-test post-test mean sd mean sd t adults should give some time for the good of their community or country 3.34 .4837 3.59 .5012 -3.360** adults should give some time for the good of other countries 2.93 .5298 3.27 .7018 -1.468 most misfortunes that occur to people are frequently the result of circumstances beyond their control 2.64 .6214 3.21 .5681 -5.279*** if i could change one thing about the world, it would be to achieve greater social justice 2.96 .7784 2.96 .7310 .000 i make quick judgments about homeless people 2.24 .6324 1.90 .5936 3.025** people, regardless of whether they have been successful or not, ought to help those in need 3.06 .7036 3.17 .6584 -1.140 people ought to help those in need as a “payback” for their own opportunities, fortunes, and successes 2.06 .7799 2.41 .5680 -3.035** i believe that i can make a difference in the world 3.41 .5680 3.62 .4938 -1.797 having an impact on the world is within reach of most individuals 3.03 .7444 3.39 .6852 -2.785** having an impact on the world is within my reach 3.21 .5681 3.64 .4879 -3.576*** n=29 * p<.05, **p<.01, ***p<.001 ericson/pura vida with a purpose 72   journals entries in student journals were done on a daily basis and journals were collected at the end of the course. they were reviewed for recurring themes. several themes emerged. themes are identified and supported by student journal quotes. human rights human rights, the major focus of the course, emerged in all journals. students were able to think about the importance of human rights in their own country as well as others. we also talked about human rights in the u.s. and how social workers should realize the importance of human rights. we talk about cultural relations and how it is difficult to decide on basic human rights standards for the whole world when culture varies so greatly. i think it is impossible to hold everyone to the same standards, especially american standards. who are we to judge other countries and their problems when we haven’t even accepted the un convention? america really needs to accept those conventions and be a good example for other countries. language language emerged, without exception, as an important ingredient of the course. this supports the assertion by gorka and niesenbaum (2001) that it is important to engage non foreign-language majors in immersion experiences to help them see the importance of learning a foreign language (only one of the participants was a spanish major). language competency is not essential for cultural competence but this experience demonstrated how it may contribute to it in very important ways. the students felt more empowered and competent as a result of their increased language ability and also developed an understanding of the difficulty a new language poses for people entering a new country. today in class we were able to learn important expressions such as hello and thank you. these phrases will help me in getting around when i am talking to the locals. it actually gave me a sense of hope that i could contribute in the conversations that my fellow student and host family are engaged in every minute. when i am in a position where i don’t understand the language it makes me believe that americans in general go to countries expecting everyone to speak english. not only internationally but also in the united states. having expectations of others is placing judgment and assumptions that can hinder the services when working with a client who is racially different or even speaks only one language. existence of poverty students made frequent observations of the poverty within which many citizens have to live. rather than turn their eyes away from it, they took it in, processed it, and wanted to share their experiences with others. advances in social work, spring 2011, 12(1) 73     after viewing downtown and all of the historical landmarks, the professor from the university of costa rica took us into the slums. this was a very sad part of the day for me. there was trash all in the streets….the houses of the people who lived in the slums were made of boxes and dirt. their ceilings consisted of old boxes and metal that they could find laying around. what hit me the hardest was to see all of the school children in the streets. no one deserves to live like that. …it is one thing to see stuff like that on tv, but when you see it with your own eyes it is totally different. i wish that everyone could have seen what we saw today. personal growth many of the students were aware of personal growth while on the trip. they were thoughtful about changes taking place within themselves and the impact it would have on them in the future. i am truly growing as a person on this trip. the way i view life, people, and happiness has all changed for the better. i no longer take for granted the life that my parents have provided for me. i am so grateful! all i can really say is that i am changed due to this experience….i shouldn’t limit myself to only working in the u.s., especially when so many people in other countries need help. overall, this three-week adventure in costa rica has made me tremendously more culturally competent with costa ricans. i can’t wait to learn more about other cultures! needs of children students were very affected by the children with whom they interacted. they attempted to understand the children’s behavior within the context of their experiences. we got assigned to the house of jessie which was a house of all boys aged from probably nine to twelve years old. from the second we met them i was receiving huge hugs and high fives and acceptance without even having to prove myself which is something i haven’t ever really seen…..i just don’t understand their attachment to us but i guess that’s what they really need. discussion students participating in this international service-learning course evidenced important gains which contributed to their development of social work competencies. although the implications of this study are limited by the fact that there was no control group, it seems unlikely that students who spent their first three weeks of the summer pursuing more typical summer experiences or even those who studied similar content without the international service-learning experience would show similar gains. it is important that the students were immersed in the culture and language of costa rica before they began their service experience. by the time they entered the service sites, the students had completed basic spanish instruction, had visited some of the neighborhoods ericson/pura vida with a purpose 74   from which the children in the center came, and had learned about social services in the country. they had also learned about and examined the human rights approach of the government and citizens of the country. the combination of the course content with cultural immersion and service activities contributed to the overall gains and contributions made during this experience. the survey results indicated that students believed more strongly that they could have an impact on the world and showed an increased sense of responsibility to do so. the change in their sense of their own capacity, as well as the capacity of all people, to make a difference was empowering to them. rather than become overwhelmed by what they experienced, they developed an increase sense of their own competence to help to improve the lives of others. further evidence of these changes was visible when they began a university-approved club to support the children’s center in costa rica where they had done a week of service. they are developing fund-raising activities to buy new playground equipment that they observed to be old and unsafe. this club will recruit members from the general university population and will go on after the trip participants graduate. in addition to the changes in their competency around social justice, they also demonstrated increases in competencies around dealing with diversity and difference. they believed that they became more tolerant and less judgmental. if students are to develop a sense of how to support the rights of other, they cannot be judgmental of others. the importance of volunteering and making financial contributions, another form of action to promote social justice, was also strengthened. in fact, some of the students chose to become continuing sponsors of children in the center which is often difficult to manage on a student budget. in addition to the survey findings, the student journals also demonstrated the students ‘sense of the importance of human rights overall, particularly of children, and, for those who were in the group that went to the older adult center, of that population as well. they recognized the importance of language to a country’s culture and a need to learn how to communicate in that language to be most effective in serving others. students evidenced in both journals and in the surveys development which will enhance their ability to serve other world populations in the future. there was growth in all students even though most were social work majors who came into the service experience with a pre-existing strong commitment to others. this was a small sample involving one course and the results cannot be generalized. however, it supports the belief that service-learning has tremendous potential to help students recognize the value of service as well as to enhance their learning in many areas, particularly human rights and social justice and diversity and difference, in direct support of the related epas competencies (cswe, 2008). international experiences have the potential to broaden student thinking in ways that are hard to replicate domestically. combining the two has even greater potential to strengthen the competencies identified above. advances in social work, spring 2011, 12(1) 75     however, there are certainly challenges to maximizing the opportunity for learning in international service-learning courses. each course must be designed to prepare students adequately for the experience, incorporate reflection, and have a strong academic component. several meetings were held with the students prior to the inception of the course to familiarize the students with costa rica, its people, its culture, as well as the behavioral and academic expectations of the service-learning course. students may see a summer international experience as a vacation and it is not. in this course, students were involved with course content at least 8 hours a day, however, weekends were left for recreation to allow students to take advantage of the many opportunities available. in addition to journaling, students were required to do an oral presentation on human rights to the group and were required to write a paper after completion of the trip comparing and contrasting costa rican and u.s. policies with human rights implications. a continued examination of the effects of these experiences and the best way to design courses which provide them is important to social work. in addition, this type of course is not without its challenges for the educator. there is a tremendous amount of preparation time. practical matters such as housing, meals, flights and in-country transportation have to be planned. universities increasingly have protocols for issues of safety and legal liability that must be followed. it is very important for the instructor to have familiarity with the country, have visited the country previously, and ideally to have had the opportunity to go there ahead of time for planning purposes. a strong relationship with the service-learning site and sensitivity to their needs of the organization is critical. the primary instructor for the course had a pre-existing relationship with the university of costa rica, the spanish school and the service site which was very helpful. faculty have a great deal of responsibility when taking students out of the country to an unfamiliar environment. behavioral expectations need to be made very clear to the students and cultural sensitivity needs to be emphasized. on only one occasion was a student blatantly culturally insensitive on this trip and the language school partner (a citizen of the host country) was able to effectively challenge her misconception, but it is often the role of the instructor to facilitate recognition of cultural insensitivity on the part of the student. the post-service evaluation completed by the partner organization staff who came into contact with the students during the service experience revealed that there were several areas that were important to them. these included coordination of efforts between the service site personnel and university faculty as well as the leadership of the faculty. the work which the partner organization requested was accomplished and relationships developed between the program participants, site personnel and older adult children to the benefit of all. the importance of respect for the host institution and coordination with them both before and during the experience was clear. it seems that the ayni described by porter and monard (2001) was present, based on the partner comments and those of the students. it did not come easily, however. much work had to take place for this to be possible. ericson/pura vida with a purpose 76   benefits outweigh the challenges and careful planning and preparation for the students can result in students’ enhanced cultural competence and awareness of social justice on an international scale. these qualities and skills support student achievement of the epas (cswe, 2008) competencies as well as becoming citizens of the world. the world benefits also when well-prepared students who are sensitive to the culture with whom they are engaging dedicate themselves to service. references batchelder, t., & root, s. (1994). effects of an undergraduate program to integrate academic learning and service: cognitive, prosocial cognitive, and identity outcomes. journal of adolescence, 17, 341-355. boyle, d. p., nackerud, l., & kilpatrick, a. (1999). the road less traveled: crosscultural, international experiential learning. international social work, 42, 201-214. campus compact. (2009). 2009 annual survey executive summary. retrieved from http://www.compact.org/wpcontent/uploads/2008/11/2009_cc_annual_survey_exec_summary.pdf campus opportunity outreach league. (1993). into the streets campaign manual. boston: author. closson, r., & nelson, b. m. (2009). teaching social justice through community engagement. international journal for the scholarship of teaching and learning, 3. retrieved from http://academics.georgiasouthern.edu/ijsotl/ council on social work education. (2008). educational policy and accreditation standards. retrieved from http://www.cswe.org/file.aspx?id=13780 dolby, n. (2007). reflections on nation: american undergraduates and education abroad. journal of studies on international education, 2, 141-156. ericson, c. b., & ford, k. (2008). energizing engagement through service-learning. academic exchange quarterly, 12(3), 249-255. eyler, j., giles, d., stenson, c., & gray, c. (2001). at a glance: what we know about the effects of service-learning on college students, faculty, institutions and communities, 1993-2000 (3rd ed.). http://www.compact.org/wpcontent/uploads/resources/downloads/aag.pdf   ford, k., & ericson, c. b. (2003). an international social work exchange: what, so what, and now what? journal of baccalaureate social work, 8, 97-108. gorka, b., & niesenbaum, r. (2001). beyond the language requirement: interdisciplinary short-term study abroad programs in spanish. hispania, 84, 100-109. grusky, s. (2000). international service learning: a critical guide from an impassioned advocate. american behavioral scientist, 43(5), 858-867. hartman, d., & rola, g. (2000). going global with service-learning. metropolitan universities, 11, 15-23. advances in social work, spring 2011, 12(1) 77     institute of international education. (2010). opendoors fast facts 2010. retrieved from http://www.iie.org/en/research-and-publications/open-doors/data kiely, r. (2005). a transformative learning model for service-learning: a longitudinal case study. michigan journal of community service learning, 12, 5-22. kiely, r., & nielson, d. (2002/2003). international service-learning: the importance of partnerships. community college journal, 3, 39-41. lemieux, c., & allen, p. (2007). service-learning in social work education: the state of knowledge and practice conundrums. journal of social work education, 43, 325342. long, d. (2009). international social work education and practice. in c. tice & d. long (eds.), international social work, policy and practice (pp. 1-22). hoboken, nj: john wiley & sons, inc. maria.abroad. (n.d.). retrieved from www.maria.abroad.com markus, g., howard, j., & king. d. (1993). integrating community service and classroom instruction enhances learning: results from an experiment. educational evaluation and policy analysis, 15, 410-419. monard-weissman, k. (2003). fostering a sense of justice through international servicelearning. academic exchange quarterly, 7(2), 164-172. national service-learning clearinghouse. (n.d.). retrieved from www.servicelearning.org national society for experiential education foundations document committee. (1998). foundations of experiential education. raleigh, nc: national society for experiential education. philips, a. (2007). social work and service-learning: a natural but tenuous connection. in m. nadel, v. majewski, & m. sullivan-cosetti (eds.), social work and servicelearning: partnerships for social change (pp. 3-20). lanham, md: roman & littlefield publishers, inc. porter, m., & monard, k. (2001). ayni in the global village: building relationships of reciprocity through international service-learning. michigan journal of community service-learning, 8, 5-17. porter, m. (2003). forging l.i.n.c.s. among educators: the role of international servicelearning in fostering a community of practice. teacher education quarterly, 30(2), 52-67. the walt whitman center. (1997). civic attachments and public life survey. new brunswick, nj: rutgers, the state university of new jersey. wakefield, m. o., & ericson, c. b. (2003). pathways to intergenerational understanding. academic exchange, 7(2), 203-330. year of study abroad. (n.d.). retrieved from www.yearofstudyabroad.com ericson/pura vida with a purpose 78   author note: direct correspondence to: carolyn bartick ericson, ph.d., associate professor and director of the social work program, department of sociology, social work and anthropology, christopher newport university, 1 university place, newport news, va 23606. email: carolyn.ericson@cnu.edu microsoft word 3-3795 madrigal_ colombians in the us final ______________ cándida madrigal, ph.d. msw, is an assistant professor in the department of social work at san francisco state university. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 26-48 colombians in the united states: a study of their well-being cándida madrigal abstract: this study examined the extent to which four factors—acculturation, ethnic identity, self-esteem, and resilience—can explain the well-being of colombian immigrants in the united states across three waves of immigration (wave 1, from 1945– 1964; wave 2, from 1965–1989; and wave 3, from 1990–2008). the results indicate that of the four factors, self-esteem most correlated with and was a predictor of well-being. participants exhibited high levels of well-being as their level of self-esteem increased. ethnic identity negatively predicted well-being, especially for men who entered during wave 3; as the extent of their ethnic identity increased, their well-being decreased. correspondingly, colombians who entered as political refugees reported a lower level of well-being. this research was groundbreaking in assessing factors contributing to the well-being of colombian immigrants and assisting in the search for appropriate scales to study this population. although its results have to be considered with caution, the study opens doors to future research, policies, and programs regarding the mental health assessment and treatment of colombians in the united states. keywords: colombians, immigrants, well-being, ethnic identity, self-esteem people leave their country of origin for numerous reasons such as political refuge, economic advancement, religion, adventure, educational opportunities, or just to take an extended vacation (segal, 2002; segal, elliott, & mayadas, 2010). the reason for migration affects the immigrant’s intent to stay permanently in another place, and may have both positive and negative consequences to the person’s well-being, as the resettlement experience affects psychosocial adjustment. many factors influence immigrant health and psychological well-being, including some specific demographic and migration characteristics, coping resources, and perceptions of life circumstances (christopher & aroian, 1998). moving to a new country may contribute to improvement in the quality of life, which in turn can influence a person’s psychosocial adjustment, or it can have adverse consequences, creating new unresolved psychosocial consequences for the well-being of an immigrant. the united states of america is comprised of diverse and heterogeneous ethnic and racial groups, including those called minorities and the dominant european american majority group (zhou & bankston, 1998). multiculturalists view immigrants as actively participating in the shaping of their lives and consider them integral segments of american society. the well-being of immigrants has been widely documented on the basis of existing theory and research. early research sought to better understand the relationship between conditions in society, in the family, and how healthy individuals adjust to their environments. several models have been developed, recommended, and tested to further understand psychological and health-related outcomes for diverse immigrant groups (abouguendia, 2001; campbell, 1981; christopher & aroian, 1998; dupuy, 1977; kuo-jackson, 2000; mahoney, 2004; phinney, 2003). advances in social work, spring 2013, 14(1) 27 colombians have been arriving in the united states since the 1930s. initially they came to advance their education or economic situations, and in some cases, to search for adventure. since the late 1990s, they have arrived primarily to escape violent internal armed conflict. the political and economic turbulence in colombia has involved an internal/external political crisis with an alarming connection among drug traffickers, the guerilla groups, and the paramilitary groups, who work together in attempting to control either the land or the drug trade (collier & gamarra, 2001; reimers, 2005; sanchez, 2003; shifter, 1999; u.s. department of homeland security, 2012). the increasing violence, threats of extortion, kidnapping, murder, and an “undeclared civil war” have caused a large number of colombians to leave their country in hopes of finding a safer home. although colombians represent one of the largest groups of immigrants from south america in the united states, much of the research available is based on groups with ethnic labels such as “hispanics” or “latinos.” most of these studies are conducted with cuban, cuban american, puerto rican, mixed mexican, or mexican american populations; central/south american populations combined; or under an “other hispanic” category (infoplease, 2011; longres & patterson, 2000; rumbaut, 1996). other studies have been conducted with unspecified groups of spanish-speaking or spanish-surnamed populations. this research approach is misleading because there are very important ethnic and cultural differences among groups, whether latin american or caribbean (longres & patterson, 2000; rumbaut, 1996). this article discusses acculturation, ethnic identity, resilience, and self-esteem as a framework to study the well-being of colombian immigrants residing in the united states. it provides a background history of their reasons for leaving their country and their immigration patterns. it explains the results of the study, the limitations, as well as implications for social work practice, policy, education, and research. importance of the study it is of prime importance to study the well-being of latinos in the united states because their presence is significant. as of july 1, 2011, 52 million people in the united states were latinos, representing 16.7% of the total population and making them the largest ethnic or racial minority in the country. by the year 2050, it is estimated that there will be 132.8 million latinos in the united states, comprising 30% of the total population (infoplease, 2011). the connection between latino/hispanics and the united states extends to all areas, political, social, cultural, and economic. it is also important to study the nationality groups individually since their immigrant trajectory may be different. this study focuses on colombian immigrants. the greatest number of immigrants who have entered the united states from south america are colombians, accounting for 23.3 % of the overall south american-born population in the country (acosta & de la cruz, 2011). however, there are limited available historical references concerning colombian immigrants to the united states. more specifically, there is little information regarding their immigrant experience and the factors that affect their well-being in the host country. in 1999 guarnizo, sanchez, and roach stated that, madrigal/colombians in the united states 28 "while colombians constitute an important wave of immigrants; nonetheless they are an understudied ethnic group" (p. 5), and today, in 2013, they continue to be understudied. colombians play a very important role because they continue to arrive to the united states and are integral to this country. therefore, it is appropriate to explore the immigration waves of colombians to the united states and understand the factors that contribute to their well-being. furthermore, because social services and financial resources for immigrants have been limited, it is imperative that the social programs developed to assist immigrants in the united states, specifically colombians, be based on a concrete understanding of the factors that contribute to their overall well-being in the united states. literature review immigration patterns as waves records show that colombians began arriving in the united states in the 1930s when there were 1,233 colombians residing in the country; by the 1940s this number had reached 3,858 (united states immigration and naturalization service, [usins], 1970). although there is a consensus in the available literature about the immigration patterns of colombians to the united states unfolding in three waves, there is a discrepancy regarding the exact periods and limited information about the reasons that led to these patterns. collier and gamarra (2001) list the time periods as 1950 to the end of the 1970s, late 1970s to the mid 1990s, and the mid 1990s to the present. however, sanchez (2003) suggests the three periods of immigration to the united states were from 1945–1965; 1966–1990; and 1991–2000. he links the time frames to the internal conditions in colombia, the united states’ immigration policies, and the overall receiving context. nevertheless, there are indications that wave 3 extended to the year 2008, given the sociopolitical situation both in colombia and the united states. for a detailed description of the characteristics of the migration of colombians to the united states by wave, from 1945 to 2008, see table 1. the years between 2008 and 2013 have been impacted by different social and political situations both in the united states and colombia, including newly elected presidents, and the efforts of president juan manuel santos calderón (elected in 2010) to reach peace agreements with the diverse armed groups in colombia. specific information regarding the characteristics of this new wave of colombian immigration to the usa, although of great interest, is beyond the scope of this paper. advances in social work, spring 2013, 14(1) 29 table 1 characteristics of colombian migration to the united states by waves wave reasons for leaving colombia. pushed factors: conditions in colombia reasons for migrating to usa. pulled factors: cultural attraction, united states’ immigration policies and the overall receiving context wave 1 1945–1965 -political turmoil in the country. -1949. assassination of jorge eliecer gaitan, a young political leader from the liberal party. -period known as la violencia, (the violence), a civil war between the two political parties in the country that killed more than 200,000 colombians1 and destroyed most of the agriculture in the country.2 -thousands of colombians lost their land and were forced to move to major cities.3 -searching for a solution to this internal crisis, the elite political parties agreed on a pact that created an “exclusionary political system,”4 which, in addition to the political violence in the country, the absence of economic opportunities, and the cultural magnetism to the united states, including financial prospects, precipitated the exit of colombians from their country. -by the 1950s, there were 18,048 colombian nationals in the united states, and by 1960 there were 72,028 permanent colombian residents.5 -cultural magnetism to the united states, including financial prospects. the primary factors that have attracted colombians to the united states throughout their migratory patterns include “the promise of jobs, peace, and stability. . .these immigrants have sought to escape the political violence, while searching for economic opportunities” (collier & gamarra, 2001, p. 4). while the unstable economic and political situation in the home country were the primary push factors, collier and gamarra (2001) contend that during this period individuals from the middle, uppermiddle, and upper classes—primarily from the large cities of bogotá, medellin, and cali—not only came in search of better economic prospects, but also to look for adventure. they state that “colombians are risk-takers, have a sense of adventure and a history of migrating” (collier & gamarra, 2001, p. 3). wave 2 1966–1990 -the situation in colombia got worse, both economically as well as politically -by 1964, and through the 1970s, a large percentage of the country’s revenue was controlled by a small number of families and the inequality and inability to earn income diminished the capacity to buy goods.6 -levels of internal political violence in the countryside had increased. -the weak political and economic conditions of the country were additionally complicated by the reality that colombia was rising as a major manufacturer, trafficker, and provider of marijuana and cocaine7 as well as heroin to many parts of the world. -during this period, colombia surfaced as the most important actor in the dispensation and circulation of cocaine’s succession of global commodity.8 -migration of colombians to the united states rose significantly during this period. -by the end of the 1980s, there were 122,849 colombians residing in the united states.9 -amendments to the immigration laws in the united states. -the u.s. immigration and naturalization act’s 1965 amendments, which allowed every country a quota of 20,000 new immigrants per year (collier & gamarra, 2001, hing, 2004) and also had a provision for family reunification (hing, 2004) that made it possible for many relatives to immigrate, thereby, creating a great influx of colombians and other latin americans during the late 1960s and 1980s (sanchez, 2003). many colombians who came to the united states during these years were affected by the stereotyping and stigmatizing of the drug epidemic. colombians were often referred to as drug traffickers (collier & gamarra, 2001; jones-correa, 1998; sanchez, 2003; tazi, 2004). this was a particular language used to support the ideas held about colombians that created biased judgments towards all colombians since they were perceived according to this image of drug traffickers. madrigal/colombians in the united states 30 table 1 (cont.) wave reasons for leaving colombia. pushed factors: conditions in colombia reasons for migrating to usa. pulled factors: cultural attraction, united states’ immigration policies and the overall receiving context wave 3 19912008 the decade of the 1990s was marked not only by the emerging internal/external political crises in colombia, but also by a disturbing connection among drug traffickers and the guerrilla groups, especially the revolutionary armed forces of colombia – people’s army (farc) (fuerzas armadas revolucionarias de colombia). this group sought total power of the drug trade.10 -in august 1989, the undeclared civil war became bloodier when the drug lords gunned down luis carlos galán, the leading liberal contender for the 1990 presidential election. the economic and political turmoil in the country, the escalating violence, and the personal safety threats of extortion, kidnapping and murder predisposed many individuals and families to leave, including numerous wealthy and professional colombians.11 -december 1993, palo escobar, colombian’s feared drug lord, was killed by colombian military forces backed by the usa. 2002: álvaro uribe vélez was elected 58th president of colombia. 2006, álvaro uribe wins re-election for second term as president. -many credit president uribe for his role in fighting the guerrilla groups. in 2008, there were reports that the violence in the country was decreasing. -although terrorist groups, including the farc and other criminal organizations, continued to kidnap civilians and political people who they hold for ransom or use as bargaining when negotiating with the government, the farc had lost several of its top leaders. -the killing and capture by colombian security of several senior guerrilla commanders and the rescue on july 2, 2008, of colombian’s ex-presidential candidate, ingrid betancourt who had been in captivity for more than 6 years, 3 government contractors from the united states, and 11 colombian policemen and soldiers, reportedly allowed president uribe’s government to reestablish some sense of security and safety in the country, especially in the larger cities. -the situation in colombia during these years produced considerable apprehension for the u.s. government and its military. -as a result, colombia and the u.s. administration established “plan colombia” to support the colombian government in eradicating the drugs, combating the rebel groups and strengthening the military, with millions of dollars (collier & gamarra, 2001, reimers, 2005; sanchez, 2003; shifter, 1999). by the 1990s, many middle, uppermiddle, and upper-class individuals and trained professionals entered the united states on tourist visas but stayed without legal documents after their visas expired (collier & gamarra, 2001; reimers, 2005). -2003. the department of state refused to grant tps to colombians, stating that the home conditions had improved and that a significant number of colombians had already been granted asylum (reimers, 2005). -if undocumented, colombians who entered during this wave have found themselves experiencing concerns and frustrations at their inability to obtain legal status, regardless of their educational and socioeconomic background. they find it difficult to understand the u.s. system and accept that they cannot obtain licenses and permits to work in their line of business or profession. for example, they are not used to “competing for jobs based upon their qualifications; instead, they are used to gaining employment through close networks of family and friends” (collier & gamarra, 2001, p. 9). -2008 was an election year in the united states, therefore the “department of homeland security's widening immigrant round-up,” and president bush’s antiimmigration laws and regime were left to be dealt with by the next administration (barry, 2008, p. 1). advances in social work, spring 2013, 14(1) 31 table 1 (cont.) colombians in the united states: present situation statistics from the u.s. census indicate that there were 471,000 documented colombian-born immigrants residing in the country in the year 2000 (guzmán, 2001), however, in 2003 it was estimated that there were approximately 2 million colombians in the usa (bérubé, 2005). per the migration policy institute tabulations from the u.s. census bureau’s 2011 american community survey, there are 658,667 colombian born residents in the united states (american factfinder, 2011). many contend that this is not an accurate count since it does not capture the undocumented who, because of fear of deportation, avoid the census count. consequently, the exact number of colombians in the united states is difficult to determine, especially through the u.s. census (collier & gamarra, 2001; reimers, 2005; sanchez, 2003). the primary states where colombians live are florida, new york, and new jersey. table 2 shows the states with the largest colombian population, per the migration policy institute tabulations from the us census bureau’s 2011 american community survey (american factfinder, 2011). despite these statistics, available empirical data regarding the reception of colombians in the united states continue to be limited. wave reasons for leaving colombia. pushed factors: conditions in colombia reasons for migrating to usa. pulled factors: cultural attraction, united states’ immigration policies and the overall receiving context wave 3 (cont.) -many colombian activists worldwide called for peaceful demonstration against the guerrilla groups, the kidnappings, the violence in the country, and in favor of the release of the many other (approximately 700) colombians who remained captive. -thus, the incidence of kidnapping reportedly decreased considerably and the dream for peace in colombia seemed closer to being a reality facilitating the return of many colombians. -given the severe consequences faced by undocumented immigrants as a result of “tighter immigration controls and security issues raised after september 11, 2001” (bérubé, 2005, p. 1), the uncertainty of the immigration laws in the united states and the hope that the home situation would improve in colombia, it can be said that 2008 signified the end of wave 3 of colombian immigration to the united states. 1(collier & gamarra, 2001; dix, 1987; osterling, 1989; reimers, 2005; sanchez, 2003); 2(reimers, 2005); 3(collier & gamarra, 2001; dix, 1987; osterling, 1989; reimers, 2005; sanchez, 2003); 4(sanchez, 2003, p. 58); 5(united states immigration and naturalization services [usins], 1970); 6(dix, 1987; osterling, 1989; sanchez, 2003); 7(osterling, 1989; sanchez, 2003); 8(wilson & zambrano, 1994); 9(usins, 1995); 10(collier & gamarra, 2001, reimers, 2005; sanchez, 2003; shifter, 1999); 11(collier & gamarra, 2001; reimers, 2005). madrigal/colombians in the united states 32 table 2 states with the largest colombian population in the united states: 2011 state colombian population 2011 florida 228,619 new york 97,623 new jersey 80,659 california 35,976 texas 35,013 georgia 20,591 massachusetts 18,417 connecticut 12,811 pennsylvania 12,224 illinois 15,260 north carolina 11,283 virginia 11,205 louisiana & other states 127,773 total 658,667 data obtained with authorization from migration policy institute, 2011. there are primarily two studies that address the migration of colombians to the united states. while sanchez’s (2003) time periods of the waves are historically linked to the domestic circumstances that surrounded their migration, his study focused mostly on the “new york context of reception” (p. 54). collier and gamarra (2001), on the other hand, focused on some elements of the immigration of colombians in south florida. their findings were published as a white paper titled “colombian diaspora in south florida” (p. 1). sanchez (2003) interviewed numerous community leaders and attended meetings to gather the information he presented in his dissertation. collier and gamarra (2001) conducted a research study, together with a team of eight students. although they did not clearly specify the method they used to collect their data, their report concentrated primarily on the immigration experience of colombians who arrived during wave 3. in their study, wave 3 colombian immigrants reported that the reasons for leaving colombia included an intricate mix of economic and political factors, but the political factors were dominant. many economically and politically influential people in colombia expressed their concern that the exit of these immigrants was causing a brain drain in colombia and advocated for colombians to stay in the country. overall, wave 3 immigrants from the advances in social work, spring 2013, 14(1) 33 upper classes “tend to feel that they have dropped one or more social classes since their arrival in the united states” (collier & gamarra, 2001, p. 9). other studies (duquepáramo, 2004; gonzalez-eastep, 2007) explored specific issues with colombians in particular regions in the united states, but they did not address the immigrants’ experiences. previous studies on the well-being of immigrants the well-being of immigrants has been widely documented on the basis of existing theory and research. phinney, horenczyk, liebind, and vedder (2001) suggest an “international model for understanding psychological outcomes for immigration [and assertthat the] combination of a strong ethnic identity and a strong national identity promotes the best adaptation” (p. 1). they state that the relationship between the characteristics and attitudes of immigrants, in addition to the response of the host society, are the best determinants of psychological well-being. this relationship is also affected by the status of the particular immigrant group the person belongs to (phinney et al. 2001). the psychosocial well-being of immigrants has also been studied by using a framework of acculturation, ethnic identity, and racial identity (kuo-jackson, 2000). that author asserts that individuals from a minority culture must deal with four psychosocial issues: (a) conflict between cultures, (b) racism and discrimination, (c) protection of their cultural and ethnic traditions, and (d) facing/confronting their minority status (kuojackson, 2000). other studies have looked at the relationship between acculturation, ethnic identity, and psychological well-being with diverse communities. abouguendia (2001) studied the acculturative stressors, ethnic identity, and psychological well-being among immigrants and second-generation individuals in the north american population. psychological wellbeing has also been considered in the realm of specific demographic characteristics and life satisfaction (christopher & aroian, 1998). it has also been documented that ethnic identity positively correlates with well-being, self-esteem, and resilience. zhou and bankston (1998) found that high levels of ethnic identity and attachment were linked to behaviors that allow for stronger academic performance and greater motivation. also, in a meta-analysis conducted by sam (2000), a moderate but consistent relationship was found between ethnic identity and self-esteem. given the review of the theories and empirical studies with regard to the well-being of immigrants, and specifically colombians in the united states, the importance of understanding immigrant adjustment to the receiving country from different theoretical perspectives has been documented. however, no research was found that studies the psychosocial well-being of immigrants from the acculturation, ethnic identity, resilience, and self-esteem perspective as proposed in this study (figure 1). madrigal/colombians in the united states 34 conceptual framework guiding the present study in this study it was hypothesized that (a) there is a positive relationship between the well-being of the participants and their level of acculturation, self-esteem, resilience, and ethnic identity for all subjects in the sample, (b) there are different predictors of wellbeing for colombians in the study sample, and (c) there are different predictors of wellbeing for participants in each of the waves. (see figure 1) well-being, the dependent variable on which the influence of the other four factors was sought, is described as the position of being joyful, in good physical shape, or wealthy (morris, 1981). the world health organization (who) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (who, 1948, p. 100). psychological well-being includes emotional feelings of pleasure related to the current life experience of the individual (campbell, 1981; dupuy, 1977). furthermore, psychosocial well-being addresses the relationship between conditions in society (i.e., social factors, demographic factors, ses), how healthy individuals can adjust to their environment, and the psychological state of the individual. acculturation is defined as the changes that groups and individuals experience when they come into contact with two or more cultures. acculturation includes the psychological, social, and cultural aspects of the adaptation process and outcome (williams & berry, 1991). although changes occur in the dominant culture and the minority group, it is usually the non-dominant or minority group that experiences the most change. the minority group often voluntarily accepts or is forced to accept the language, religion, laws, and educational institutions of the host culture. acculturation reflects the degree of agreement with the norms, values, attitudes, beliefs, and preferences of a particular group to the host society and culture (berry, 1990; berry, 1992; marino, stuart, & minas, 2000). ethnic identity is defined as the degree to which the individual understands his or her culture and is self-assured of the choices made about upholding or not upholding the country of origin’s customs and values (phinney, 1998). according to phinney, each person’s attitude toward their own cultural group is essential to their psychological wellbeing; therefore, ethnic identity becomes a basic part of acculturation. ethnic identity is not a static construct and varies over an individual’s life span. phinney proposes that ethnic identity develops over time as a result of the individual’s exploration and decisionmaking process regarding what part they want culture to play in their lives. resilience has been defined as the capacity to withstand life stressors, thrive, and make meaning from challenges (greene, 2012). cultural resilience refers to the capacity of specific human cultures to endure stressors such as contact with other cultures and disasters, and the ability to uphold critical cultural knowledge all the way through generations, regardless of challenges and complexities. resilience is also a personal characteristic of an individual who is able to make the required psychosocial adjustments when faced with adversity (richmind & bearslee, 1988; wagnild & young, 1990). figure 1 framework of well-being of colombian immigrants in the united states. well-being wave 2 1966 1990 wave 1 1945 1965 wave 3 1991 2008 acculturation self esteem resilience ethnic identity colombian immigrants in the u.s. madrigal/colombians in the united states 36 resilience is an inferred process because it implies that the individual is presently doing fine and that there have been exceptional circumstances that threaten positive outcomes (masten & reed, 2002). self-esteem is defined as the ability to form an identity and attach a value to it (mckay & fanning, 2000). self-esteem has also been defined as that aspect of selfconcept that evaluates the self. hewitt (2002) posits that self-esteem has been entrenched in the psychological ideas of acceptance of the child early in life, receiving positive evaluation from people significant to the person, being compared with others in a favorable way, being compared with the ideal self, and having the ability to take successful action. he argues that self-esteem is a socially constructed emotion that could be called mood, and as such, can be an indicator of well-being. method research design this study used an exploratory survey design to examine the extent to which acculturation, ethnic identity, self-esteem, and resilience explain the well-being of colombian immigrants in the united states across the three waves of immigration (wave 1, from 1945–1964; wave 2, from 1965–1989; and wave 3, from 1990–2008). it was hypothesized that (a) there is a positive relationship between the well-being of the participants and their level of acculturation, self-esteem, resilience, and ethnic identity for all subjects in the sample, (b) there are different predictors of well-being for colombians in the study sample, and (c) there are different predictors of well-being for participants in each one of the immigration waves. because the study of colombians in the united states is a relatively new area, especially investigating their psychosocial well-being, this exploratory study yielded new insights into the well-being of colombians in this country. however, because of the specific research design of this study, its results cannot be statistically generalized to the population from which the data were drawn. sample and sampling technique for the purpose of this study, respondents born in colombia who were 18 years old, or older, at the time of participation, who immigrated to the united states between the years 1945 and 2002, and who were 5 years old, or older, at the time of arrival were eligible to participate. it was stipulated that participants had to have arrived in the country after age 5, since, according to park (1999), individuals who immigrated to the receiving country before the age of 5 were considered to be part of the second generation of immigrants because of the similarity to the number of years of education and socialization of the people who were actually born in the receiving country. it iwas also considered that those individuals migrated at a time when they had not been fully acculturated into their heritage (sam, 2000). to facilitate the collection of the data, research assistants were sought out from california, pennsylvania, florida and texas. these research assistants were chosen for advances in social work, spring 2013, 14(1) 37 their connection to the colombian community in their respective areas and their desire to assist in collecting the data for this study. research assistants were given an oral orientation over the phone and guidelines in writing. the researcher prepared all documents, which were placed in brown envelopes that could be sealed. each research assistant received the envelopes via mail. due to the fact that they were not conducting structured interviews, but were only giving the envelopes out to the respondents and picking them up, inter-rater reliability was not considered necessary. a non-probability, snowball sampling technique was used in this study. variables and measurements five scales were used in this investigation to establish instruments appropriate to study colombians in the united states. a challenge in cross-cultural research is obtaining reliable and valid instruments that are not culturally biased. despite an extensive literature review, as reported earlier, no validated measures were found that tested all of the specific variables used in this study with colombians; therefore, well-being, the dependent variable (dv), was tested using the general well-being schedule (gwb), (taylor, et al., 2003) a schedule used to measure the well-being of a number of different populations. the independent variables and the respective measures were acculturation (modified marino acculturation scale for colombians [marino et al., 2000]), ethnic identity (multigroup ethnic identity measure [meim], phinney, 1992), resilience (resilience scale [wagnild & young, 1987, 1990]), and self-esteem (rosenberg selfesteem scale [rosenberg, 1965]). statistical analysis the data were entered and analyzed using the statistical program for the social sciences (spss). descriptive statistics (e.g., m, sd, frequencies) were computed and a pearson product moment correlational matrix was generated for all variables, for all three waves, to determine if level of acculturation, ethnic identity, resilience, self-esteem, and well-being are correlated; and if so, the strength of this correlation and which characteristics are significantly correlated. also, a multiple regression analysis was conducted to determine what amount of variation in well-being is accounted for by the degrees of acculturation, ethnic identity, resilience, and self-esteem, whether this differs by wave, and if any of these variables are significant predictors of well-being for the studied population. study findings demographic characteristics two hundred and forty-eight questionnaires as designed for this study were returned to this researcher, that is, 24.8 % of the approximate total number of questionnaires distributed. the geographical distribution of the sample is as follows: 97 (39.1%) of the respondents resided in florida, 72 (29%) in california, 40 (16.1%) in pennsylvania and 39 (15.7%) in texas. the final sample consisted of 30 (12.1%) participants from wave 1, 133 (53.6%) from wave 2, and 85 (34.3%) from wave 3. their ages ranged from 19 to 79 madrigal/colombians in the united states 38 years old. the median age for the participants in the study was 48 years. the range of the participants’ ages at the time of entering the united states was from 5.5 to 67 years; the median age being 25, and the mode 18 years. however, due to missing data and participants not responding to some questions because they felt it did not apply to them, many questionnaires could not be used for statistical analysis. statistical findings a pearson’s correlation co-efficient was calculated for the relationship between all subjects in the sample, the well-being of the participants, and their level of acculturation, self-esteem, resilience, and ethnic identity. two positive and significant relationships were found for resilience (r (106) = 0.194, p < 0.05) and self-esteem (r(106)=0.397, p <0.01), indicating that resilience and self-esteem are correlated with well-being for all participants in the sample (see table 3). table 3 correlation between well-being and all independent variables: all participants (n = 108) well-being resilience self-esteem ethnic identity acculturation well-being pearson correlation 1.000 0.194* 0.397** -0.076 -0.162 sig. (2-tailed) 0.000 0.044 0.000 0.434 0.094 resilience pearson correlation 0.194* 1.000 0.219* 0.155 -0.325** sig. (2-tailed) 0.044 0.000 0.023 0.109 0.001 self-esteem pearson correlation 0.397** 0.219* 1.000 0.269** -0.106 sig. (2-tailed) 0.000 0.023 0.000 0.005 0.276 ethnic identity pearson correlation -0.076 0.155 0.269** 1.000 -0.188 sig. (2-tailed) 0.434 0.109 0.005 0.000 0.051 acculturation pearson correlation -0.162 -0.325** -0.106 -0.188 1.000 sig. (2-tailed) 0.094 0.001 0.276 0.051 0.000 * correlation is significant at the 0.05 level (2-tailed). ** correlation is significant at the 0.01 level (2-tailed). to determine if any of the independent variables were significant predictors of wellbeing for colombians in the study sample, a multiple linear regression was performed (see table 4) controlling for all independent variables (resilience, ethnic identity, selfesteem, and acculturation). regression results (r2=0.225, r2adj=0.195, f[4,104]=7.493, p <0.05) showed that some of the independent variables in the model are significant predictors. per the results, it can be concluded that all four independent variables account for 22.5% of the variance in well-being. the results indicated not only that self-esteem significantly predicts well-being for all colombians in the study, but also that there is a significant but negative relationship between ethnic identity and well-being. participants’ well-being increased by 1.461 units for each unit increase of self-esteem. furthermore, advances in social work, spring 2013, 14(1) 39 the results indicated that colombians’ well-being decreases by -.484 for each unit increase of ethnic identity. table 4 multiple linear regression—well-being (dv) and acculturation, self-esteem, resilience, ethnic identity (iv): all participants (n = 108) unstandardized coefficients standardized coefficients model b std. error beta t sig. (constant) 49.635 20.354 --2.439 0.016 acculturation -0.115 0.083 -0.129 -1.394 0.166 self-esteem 1.461 0.315 0.424 4.632 0.000 resilience 0.058 0.057 0.095 1.012 0.314 ethnic identity -0.484 0.193 -0.229 -2.507 0.014 to determine if there is a significant predictor of well-being for those individuals by wave, a multiple linear regression was performed, controlling for other independent variables (resilience, self-esteem, ethnic identity, and acculturation). regression results (r2=0.388, r2adj=0.304, f [4, 29]=4.596, p <0.05), indicated that for wave 3, the overall model significantly predicts well-being (see table 5). this model accounts for 38.8 % of the variance in well-being. the results revealed that self-esteem significantly predicts well-being for all colombians who entered the united states during wave 3. additionally, there is a significant but negative relationship between ethnic identity and well-being. per the results, it can be concluded that participants’ well-being increased by 1.580 units for each unit increase of self-esteem when all other ivs are held constant. furthermore, the results indicated that the well-being of colombians in wave three decreases by -0.907 units for each unit increase of ethnic identity when all other ivs are held constant. table 5 multiple linear regression—well-being(dv) and acculturation, self-esteem, resilience, ethnic identity (iv): wave 3(n = 34) unstandardized coefficients standardized coefficients model b std. error beta t sig. (constant) 45.455 44.757 --1.016 0.318 resilience 0.125 0.097 0.246 1.282 0.210 self-esteem 1.580 0.771 0.394 2.048 0.050 ethnic identity -0.907 0.315 -0.486 -2.883 0.007 acculturation -0.072 0.161 -0.080 -0.448 0.658 madrigal/colombians in the united states 40 to determine if there are any differences by gender, a multiple linear regression was performed (see table 6) to determine whether any of the four independent variables (resilience, ethnic identity, self-esteem, and acculturation) was a significant predictor of well-being for colombians, divided by gender. the results (r2=0.377, r2adj=0.316, f [4, 41] = 6.1936, p <0.05) indicated that the overall model significantly predicts well-being for male participants in the study. this model accounts for 37.7.0% of the variance in well-being. per the results, not only does self-esteem significantly predict well-being for all colombian men in the sample, but also there is a significant but negative relationship between ethnic identity and well-being for male participants. it can be concluded that male participants’ well-being increased by 1.687 units for each unit increase of selfesteem when all other ivs were held constant. furthermore, the results indicated that the well-being of the colombian men decreases by -0.975 units for each unit increase of ethnic identity when all other ivs are held constant. table 6 multiple linear regression*—well-being (dv) and acculturation, self-esteem, resilience, ethnic identity (iv): men (n = 48) unstandardized coefficients standardized coefficients model b std. error beta t sig. (constant) 69.207 30.444 --2.273 0.028 resilience 0.073 0.068 0.147 1.079 0.287 self-esteem 1.687 0.476 0.489 3.546 0.001 ethnic identity -0.975 0.291 -0.465 -3.348 0.002 acculturation -0.175 0.121 -0.199 -1.446 0.156 this study also looked at the well-being of colombians who entered the united states as political refugees to determine if the way colombians entered the country was a predictor of well-being for all participants in the study, and divided by wave. a multiple linear regression was performed. when designating “political refugee” as the referent group, and all others as the base group, regression results (r2=0.319, r2adj=0.283, f [5, 95] = 8.898, p <0.05) indicated that the overall model significantly predicts well-being and accounts for 31.9% of the variance in well-being (see table 7). the results denoted that there is a negative relationship between well-being and having entered as a political refugee, -17.140 units lower than colombians with other entry statuses. to determine if there was a significant relationship between well-being and entering as a political refugee by wave, a multiple linear regression was performed controlling for all independent variables. colombians who entered as political refugees between the years 1966 and 1990 reported a lower level of well-being. regression results (r2=0.343, r2adj 0.279, f [5, 51] =5.330, p <0.05) indicated that there is a negative relationship between well-being and having entered as a political refugee during wave 2 (see table 8). advances in social work, spring 2013, 14(1) 41 table 7 multiple linear regression—well-being (dv) and acculturation, self-esteem, resilience, ethnic identity, entry status—political refugee (iv): all participants (n = 101) unstandardized coefficients standardized coefficients model b std. error beta t sig. (constant) 45.146 19.776 --2.283 0.025 acculturation -0.129 0.081 -0.145 -1.591 0.115 ethnic identity -0.452 0.196 -0.208 -2.302 0.024 self-esteem 1.679 0.310 0.492 5.418 0.000 resilience 0.052 0.055 0.086 0.938 0.351 dummy entry status-pr -17.140 5.353 -0.275 -3.202 0.002 table 8 multiple linear regression—well-being (dv) and acculturation, self-esteem, resilience, ethnic identity, entry statuspolitical refugee (iv): wave 2 (n = 57) unstandardized coefficients standardized coefficients model b std. error beta t sig. (constant) 47.969 23.952 --2.003 0.051 acculturation -0.167 0.101 -0.199 -1.664 0.102 ethnic identity -0.064 0.266 -0.029 -0.242 0.810 self-esteem 1.427 0.382 0.455 3.736 0.000 resilience 0.033 0.071 0.055 0.463 0.645 entry status-political refugee -23.483 6.787 -0.402 -3.460 0.001 the overall model accounts for 34.3% of the variance in well-being. it can be concluded that colombians who entered the united states as political refugees during wave 2 report a decrease in well-being, -23.483 units lower than colombians who entered with other statuses. discussion as stated earlier, this study examined the extent to which acculturation, ethnic identity, self-esteem, and resilience explain the well-being of colombian immigrants in the united states across the three waves of immigration, that is, wave 1, years 1945– 1964; wave 2, years 1965–1989; and wave 3, years 1990–2008. madrigal/colombians in the united states 42 the participants in this study represented a diverse sample of colombian immigrants in the united states, as evidenced by the demographic characteristics previously presented. the findings show that self-esteem correlated with and was a predictor of well-being. participants in the sample, both as a group and divided by waves, exhibited high levels of well-being as their level of self-esteem increased. additionally, significant variance was found in the well-being of colombians in the study. in previous studies done with latinos (gonzalez-eastep, 2007), self-esteem has had a strong correlation with family functioning (green & way, 2005), ethnic-racial identity (phinney, 1992), and having good family support and high family functioning (gonzalez-eastep 2007); but given the strong association, researchers have wondered if the reported high levels of self-esteem have been a barrier against the effects of other variables, in this case, acculturation, ethnic identity, and resilience. the results of the present study indicate that ethnic identity negatively predicts wellbeing for all participants in the sample, and for colombian men who entered the united states during wave 3 specifically; consequently, to the extent that their ethnic identity increased, their well-being decreased. thus, male participants from wave 3 seem to have a strong identity with the colombian culture or ethnic group, but this identity seems to create a decrease of well-being. studies have found that ethnic identity decreased between firstand secondgeneration immigrants (buriel, 1987), and that an increase in acculturation to the host culture leads to a decrease of identity with one’s own culture. only first-generation colombians participated in this study, and their degree of acculturation was not significant. it can be concluded that the men in this study, as first-generation immigrants, did not show a significant degree of acculturation to the mainstream society due to a strong attachment to their ethnic group, which in turn negatively affected their wellbeing. although a strong ethnic identity can be a safeguard for experiences of racial discrimination (cross, 1995), it can also be an impediment to well-being. the finding that ethnic identity has a significant but negative effect on well-being was not expected, but can be explained by exploring feelings of discrimination, marginalization, or exclusion from mainstream society, dissatisfaction outside the country of origin, and cultural uncertainty. as colombian men feel they belong to their nationality, their ethnic identity is delineated by their subjective personal knowledge about their country, and the pride colombians feel for being members of that ethnic group. a strong ethnic identity of men in the sample does not seem to be a safeguard for their overall well-being; therefore, it affects them negatively. in the present study, the well-being of colombians who entered the united states as political refugees was lower than colombians with other entry statuses. given the continued violence in colombia, these findings are not surprising. this specific study did not ask any other questions regarding the exposure to trauma; therefore there is no other reference to the degree of suffering or the respondents’ attempts to seek mental health services. after further analysis, men who entered during wave 2 as political refugees reported a lower level of well-being. although colombians have lived amid violence for more than 40 years, the literature points out that it was in the late 1980s (last part of wave advances in social work, spring 2013, 14(1) 43 2) and the 1990s (wave 3) that most colombians sought to leave the country because of the violence. limitations this study used a snowball sampling technique; therefore the results may be biased towards one group of respondents with similar characteristics. the questionnaire presented limitations due to its length and did not have an option of “not applicable” which could have helped reduce the large number of missing data. the scales used were developed in the english language and were validated with other ethnic groups. additionally, the use of triangulation, including one-on-one interviews, would have yielded more in-depth responses and provided richer information about the immigrant trajectory. conclusion given the many challenges immigrants face before and after immigration, social workers need to be prepared to serve this population at the individual and macro levels, particularly given the existing stereotypes and polarized views about immigrants and the impact they have on the country. as the social work profession is challenged to gain a further understanding of diversity, social workers need to be culturally sensitive and competent to work effectively with clients and people from all different backgrounds. latinos, as a group, share many characteristics, however upon closer examination, those born in south american exhibit great variations according to the country of birth (migration policy institute, 2006). therefore, it is necessary to examine, treat, and study latino groups individually, as proposed in the literature (kouyoumdjian, zamboanga, & hansen, 2003; portes & rumbaut, 1996), and not solely as a collective ethnic group. a significant contribution of this investigation was the inclusion of variables not previously explored with colombians in the united states. additionally, this research was innovative in assessing the factors contributing to the well-being of colombian immigrants and in the search for scales that are appropriate to study this population. although the results have to be considered with caution, the study opens doors to future research and the provision of human services for colombians in the united states. the findings of this study suggest that in working with colombians, it is important to keep in mind that their well-being is impacted by their self-esteem and their ethnic identity, especially for colombian men. with this in mind, social work educators have the professional responsibility to train social workers to understand an immigrant’s pre-departure experiences and the relationship between an immigrant’s adjustment and his or her subsequent well-being. specific to colombian immigrants, it is important that social workers understand, plan, and implement appropriate services for these clients. for example, many colombian immigrants suffered the consequences of the undeclared civil war in their country; therefore, they may experience ptsd or other mental illnesses that require special mental madrigal/colombians in the united states 44 health programs. clearly, there is also a need for social workers to be familiar with immigration laws and policies to be able to advocate for immigrants and to assist in policy development and implementation that will address the specific needs of colombians and other immigrants. future research is needed to measure the generational status of colombians and assess their psychosocial well-being. it would be of great interest to further study the plight of the colombian political refugees in the united states and what kind of services are available for this population. references abouguendia, m. 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(1948). preamble to the constitution of the world health organization as adopted by the international health conference, new york, 19-22 june, 1946; signed on 22 july 1946 by the representatives of 61 states (official records of the world health organization, no. 2, p. 100) and entered into force on 7 april 1948: author. retrieved from: http://www.who.int/about/definition/en/print.html zhou, m., & bankston, c. l. (1998). growing up american: the adaptation of vietnamese children in american society. new york, ny: russell sage foundation. author note: address correspondence to: cándida madrigal, ph.d., assistant professor, department of social work, san francisco state university, 1600 holloway ave., san francisco, ca 94132. email: candymadrigal@yahoo.com this work is licensed under a creative commons attribution 4.0 international license. “i feel like i am finding peace”: exploring the use of a combined art therapy and adapted seeking safety program with refugee support groups gretchen e. ely samantha koury kim bennett cari hartinger susan green thomas nochajski abstract: this paper describes the creation and implementation of a trauma support group intervention which combined aspects of the seeking safety model with an art therapy technique in an effort to reduce trauma-related symptoms in a population of refugees. a preliminary assessment was carried out to evaluate the potential effectiveness of the combined approach with trauma-exposed refugees. based on facilitator notes from 8 sessions of two women’s refugee groups and one men’s group, three themes were identified: mandala creation enhanced the seeking safety content, language barriers impacted the potential for implementation, and the trauma support group was a means of personal growth for participants. reports from facilitators and participants also suggested a reduction in trauma-related symptoms and an increase in participant use of safe coping skills as a result of group participation. while additional research is needed, these exploratory results suggest that this combined approach holds promise for positively impacting trauma symptoms in trauma-exposed refugees. keywords: seeking safety; mandala; art therapy; ptsd; trauma-exposed refugees; trauma symptoms by the end of 2014, 59.5 million individuals had been forcibly displaced around the world because of persecution, violence and conflict. approximately 19.5 million of these people were refugees (united nations high commissioner for refugees [unhrc], 2015). it is estimated that, in the united states alone, there are 267,222 refugees/people in refugeelike situations, and an additional 224,508 asylum seekers (unhcr, 2015). and, refugees are continually arriving. given the increasing number of refugees coming to the united states, there is an increasing need for services and interventions to address their unique concerns—particularly around mental health. the recommended treatments available for refugees who have been exposed to trauma include cognitive behavioral therapy (cbt), testimonial psychotherapy, eye movement desensitization and reprocessing (emdr), and narrative exposure therapy (ehntholt & yule, 2006). however, these interventions are not appropriate for every client, and more research examining treatment options for trauma-exposed refugees is needed (ehntholt & ____________ gretchen e. ely, phd, is associate professor, school of social work, and affiliated faculty at the institute for trauma and trauma informed care (ittic), university at buffalo (ubssw), state university of new york (suny), buffalo, ny 14260. samantha koury, msw, is project manager at ittic. kim bennett, msw, is affiliated staff at ittic. cari hartinger, lcsw, is admissions counselor, horizon services, 3020 bailey ave., buffalo, ny 14215. sue green, lcsw, is clinical associate professor at ubssw and ittic co-director. thomas nochajski, phd is research professor at ubssw and ittic co-director. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 103-115, doi: 10.18060/21130 https://creativecommons.org/licenses/by/4.0/ ely et al./i feel like i am finding peace 104 yule, 2006). it is also possible that some combination of existing techniques could be appropriate for interventions with refugees, but few possibilities have been explored to date. one intervention that has shown promise with trauma-exposed populations is seeking safety, which is a type of cbt that is present-focused and appropriate for those with posttraumatic stress disorder (ptsd) and other comorbid disorders (najavits et al., 2013). this technique has shown promise in impacting ptsd and substance use symptoms in adolescents, veterans, and incarcerated populations, which are populations commonly exposed to trauma (boden et al., 2012; najavits, gallop & weiss, 2006; zlotnick, najavits, rohsenow, & johnson, 2003). the possibility of adapting this technique for use with trauma-exposed refugees warrants exploration. also of interest are mandalas, circular art forms that carl jung asserted in 1973 could have calming and centering effects on those who used them (slegelis, 1987). as such, mandalas have been adapted into colored “feeling wheels” and employed as art psychotherapy techniques (slegelis, 1987; sorkes, 1991). the literature suggests that the use of mandalas may be promising in the reduction of anxiety, and there is evidence of their effectiveness as a part of art therapy with pediatric oncology patients (curry & kasser, 2005; sorkes, 1991). mandala art therapy is considered a promising art therapy technique for addressing a variety of symptoms in various age groups. the associated calming effects make it particularly appropriate for use with trauma-exposed clients (slayton, d’archer, & kaplan, 2010). given the promise of both seeking safety and mandala creation in terms of intervening with trauma, anxiety and comorbid symptoms, it seems plausible that combining these techniques might be a natural fit for working with trauma-exposed refugees. despite the potential promise of these techniques with trauma-exposed populations, to our knowledge, there is no documented information in the literature that explores the use of this technique with trauma-exposed refugees. thus, the purpose of this paper is to describe the exploratory use of seeking safety adapted with mandala creation for the purpose of reducing traumarelated symptoms in groups of trauma-exposed refugees. review of the literature it is well established in the literature that refugees and asylum seekers are likely to have a trauma history. many are exposed to extreme stress and multiple traumatic events such as forced migration, torture, rape, injury, starvation and/or the witnessing of the death of friends and family members (lambert & alhassoon, 2015; palic & elklit, 2011). further, refugees are also likely to experience an array of new stressors during travel and upon their arrival in new countries, including separation from family and friends, exposure to disease, refugee camps, problems assimilating in new cultures, difficulty obtaining asylum status, housing problems and social isolation (lambert & alhassoon, 2015; shannon, wieling, mccleary, & becher, 2015). exposure to various traumas compounded by psychosocial stressors has implications for the overall mental health of refugees and asylum seekers. the prevalence rate of ptsd in the refugee and asylum seeker populations varies in the literature depending on the advances in social work, spring 2017, 18(1) 105 population of interest. however, research suggests that refugees are 10 times more likely than the general population to have ptsd and ptsd, depression and substance use have been found to be the most common mental health conditions in populations exposed to mass conflict and displacement (delker & freyd, 2014; fazel, wheeler, & danesh, 2005; steel, 2009). more specifically, researchers have reported various symptoms of ptsd and depression in trauma-exposed refugees, including separation anxiety, worrying, poor concentration, disorientation, flashbacks, nightmares, hypervigilance, violent outbursts, crying, anhedonia, suicide attempts and using substances for coping (dupont, kaplan, verbraeck, braam, & van de wijngaart, 2005; shannon et al., 2015; tay, rees, kareth, & silove, 2016). treatment and challenges studies of therapeutic interventions specific to trauma-exposed refugee populations are limited (nickerson, bryant, silove, & steel, 2011) and include variations of cbt, emdr and narrative exposure therapy (net, lambert & alhassoon, 2015). according to a systematic review done by palic and elklit (2011), refugee-adapted net and culturally sensitive cbt for southeast asians have the strongest evidence of effectiveness. despite existing evidence of potentially beneficial treatments, there are still challenges in treating ptsd in the refugee population. this population may not speak english well, or at all, and may have additional unique barriers, including: educational deficits, problems accessing services, cultural differences that impact treatment, stigma and fear associated with mental health issues and treatments, lack of confidence in treatment, fear of being perceived as unstable, a desire to hide mental health symptoms, and lingering effects from political oppression (hinton, rivera, hofmann, barlow, & otto, 2012; shannon et al., 2015). shannon and colleagues (2015) further assert that those who have experienced trauma from political strife and oppression may have difficulty talking about their experiences and symptoms, and they may require more time to trust and feel safe. such findings have implications for traditional trauma-focused therapies that rely heavily on the client talking about and processing their experiences. additionally, concerns exist around exposure techniques, which are central to treatments like net and cbt. exposure may not be well tolerated by refugee populations and can be difficult to use because they are often aimed at only one traumatic experience when refugees often have complex, intersecting trauma histories (hinton et al., 2012; lester, resick, young-xu, & artz, 2010; palic & elklit, 2011). further, nickerson and colleagues (2011) argue using cbt to treat ptsd in the refugee population can also be challenging because it is based heavily on extinction learning, which assumes the treatment is occurring after the threat is over. unfortunately, refugees often receive treatment while still facing real threats such as living in confinement, living in refugee camps, or living with the uncertainty of gaining legal status in their new country (nickerson et al., 2011). as a result, there is a need for further research of novel, culturally-sensitive adaptations of empirically-supported treatment approaches to meet the needs of the refugee population (hinton et al., 2012; nickerson et al., 2011). ely et al./i feel like i am finding peace 106 seeking safety given the need to expand treatment offerings for trauma-exposed refugee populations, treatment techniques that have not been previously used with this population need to be explored. one such option is seeking safety, which is a present-focused form of cbt treatment originally designed for individuals with comorbid ptsd and substance use disorder (najavits et al., 2013). seeking safety helps individuals establish a greater sense of safety through psychoeducation and the use of effective coping skills (najavits, 2002). positive results in both individual and group formats have been demonstrated, with a wide variety of clients who have both diagnoses, one of the two diagnoses, as well as those that have symptoms not severe enough for either diagnosis (brown et al, 2007; lynch, heath, matthews, & cepeda, 2012; najavits, 2002, 2009). seeking safety has 25 independent topics that can be flexibly applied in any order depending on the needs of the clients and the treatment timeframe allotted (for sample curriculum see najavits, 2002). although to our knowledge there is no existing literature documenting the use of seeking safety with refugees, various aspects of the model lend itself well to the unique treatment challenges of the trauma-exposed refugee population. given that there is evidence that traditional exposure-based therapies might not be as effective for refugees with ptsd, as previously mentioned, a ptsd intervention that is present-focused and emphasizes the use of coping skills and psychoeducation was needed. thus, seeking safety was adapted for this population, given that it has been shown to be flexible and adaptable for a variety of groups, which potentially lends itself to being adapted to the specific needs of the refugee population as well. art therapy/use of mandalas the use of art therapy as a treatment for different types of trauma allows space for individuals to explore various thoughts and feelings in a non-threatening way by removing focus on self (naff, 2014; skeffington & browne, 2014). however, evidence suggests that art therapy seems to be most effective in combination with trauma-focused interventions (naff, 2014; schouten, de niet, knipscheer, kleber, & hutschemaekers, 2015). not only is the combination more effective in comparison to art therapy as a standalone intervention, a review done by schouten and colleagues (2014) found that trauma-focused psychotherapy in combination with art therapy was more effective in reducing trauma symptoms than a trauma-focused psychotherapy control group. given the need for innovative and culturally sensitive ways to adapt treatment for refugees, combining evidence-based treatments for ptsd with art therapy may be useful in addressing trauma symptoms in the refugee population. thus, adapting a trauma-focused therapy like seeking safety to include aspects of art therapy may help refugees begin to process feelings and thoughts around their trauma in a safe space until they are more comfortable or able to verbalize them. the creation of mandalas is commonly used in art therapy (stinley, norris, & hinds, 2015). henderson, rosen and mascaro (2007) argue that the mandala is a task particularly suited to individuals with a trauma history, as it functions as a symbolic representation of difficult emotions while also providing personal meaning, order and integration. mandalas advances in social work, spring 2017, 18(1) 107 have also been found to decrease anxiety, distress and negative mood state (babouchkina & robbins, 2015; stinley et al., 2015; van der vennet & serice, 2012). after considering the unique challenges of working with refugees who have ptsd, the need for innovative treatment approaches, and the strengths of both seeking safety and mandala creation, a trauma support group for refugees was created by adapting seeking safety and integrating it with mandala work. the purpose of this paper is to describe the trauma support group modality and the facilitators’ experiences implementing the adapted seeking safety/mandala technique with three different groups of trauma-exposed refugees. description of the intervention participants and group formation participants in the trauma support groups were adults currently residing at a nonprofit humanitarian organization in western new york that provides food, shelter, clothing and legal assistance to refugees seeking protection in the united states or canada. all participants volunteered to participate in the trauma support group. participants were screened into the program by an lcsw, who used the dissociative experience scale (des; carlson & putnam, 1993), and the post traumatic checklist (pcl; blanchard, jonesalexander, buckley & forneris, 1996) as a guide for determining participant goodness of fit for the group. the lcsw considered factors such as motivation, country of origin, gender, and levels of ptsd symptoms. individuals who experienced dsm-iv-tr, (the version of the dsm in use during the time that this intervention was conducted) symptoms of ptsd that they themselves believed were related to current and/or previous trauma were ruled in for inclusion. individuals with dissociative symptoms were screened out. gender specific support groups were created and clients were referred to the groups based on several factors, including: similarity in countries of origin and availability of agency support services outside of the group. groups were closed after the second session, in order to promote a sense of trust. one group of four women and another with three men was offered in 2014, with an additional group with 11 men was offered in 2014. some participants missed a session due to illness or appointments. at least one group facilitator or group participant was skilled in translation in the participants’ native language. intervention techniques adapting seeking safety. with najavits’ (2002) (the original developer of the seeking safety curriculum) permission, treatment topics from seeking safety were modified into an eight-week trauma support group. the sessions mirrored seeking safety with regard to structure of content and time allotted for each session, activity and discussion, and session length. also consistent with seeking safety, each session opened with a “check-in” to ask how participants were doing and what pressing needs participants wished to prioritize, and to allow participants to share brief examples of good coping they used since the previous session (najavits, 2002). the facilitators then presented the seeking safety quotation for that week’s treatment topic to stimulate the discussion, provided psychoeducation around that week’s topic, discussed how the topic related to the participants’ lives, and checkedely et al./i feel like i am finding peace 108 out at the end by having participants describe benefits of the session and then describe the new commitment for the following week (najavits, 2002). the facilitators chose eight of the original 25 seeking safety treatment topics based on the intended purpose of the group, which was to address trauma, encourage coping skills, help participants build their own tools for coping, help participants understand trauma and its impact, encourage self-reliance and provide a safe space for participating. the following topics were covered: taking back your power; detaching from emotional pain; grounding; compassion; creating meaning; coping with triggers; healthy relationships; and self-nurturing (najavits, 2002). for the full list of treatment topics, see najavits (2002). while several topics overlapped in the three separate groups, the topics chosen, the order they were presented in, and the number of sessions spent on each topic was based on the needs of the group. the safety and ptsd: taking back your power topics were considered key to moving forward with subsequent topics, so these were covered first in all three groups. more than one session was allotted to these topics if the facilitators could not cover all the material in one session. the other treatment topics were chosen based on the number of remaining sessions and were tailored to the needs of the group. group needs ranged from needing more information about ptsd to enhancing skills for functioning in day-to-day life. treatment topic handouts from the seeking safety manual were modified to make the language easier to understand for those who had difficulty with english. textheavy handouts were condensed, pictures were added, and the language in more complex topics was purposely simplified. use of mandalas. the seeking safety treatment groups were further adapted by adding an art therapy component in the form of mandala creation to each session. the mandala was purposely chosen as the form of art-making so participants could create their own meaning for their experiences using creativity and self-expression through the use of words, pictures, symbols, and colors. mandalas also lend themselves towards facilitating transfer of emotions into the art form, and result in a tangible product at the end of each session so participants can gauge their progress, even for those not participating in other forms of group sharing during the session. ultimately, the mandala is intended to be uniquely meaningful for each participant. unique meanings for each individual evolve through the creative process. the intervention team the team was supervised by one lcsw and two student facilitators. the team received six hours of mandala specific art therapy training from a certified art therapist. the training informed the facilitators how the mandalas were to be integrated into the adapted seeking safety material. the intervention process during the first session of the trauma support group, participants were given an overview of the mandala, and were encouraged not to comment on each other’s work. facilitators also emphasized to participants that the process of getting their feelings out advances in social work, spring 2017, 18(1) 109 was more important than the product itself. in-between the discussion of content and the check-out of each session, group participants were given between 15 and 20 minutes to create a mandala based on the topic for that session. participants were provided with precut circles in different colors, magazines, markers, pencils, crayons, stencils, staples, tape, glue, fabric, and scissors in order to make their mandala in any way they chose. soft background music accompanied the mandala creation time. participants were then invited to share their mandala and its meaning with the group if they felt comfortable doing so. in the first session of all three groups, participants were instructed to create a mandala that represented them or told a story about them. depending on the topic used for subsequent sessions, participants created mandalas around themes of safety, reclaiming personal power, self-compassion, and self-nurturing. an additional mandala activity on the topic of grounding was offered and facilitators provided participants with a pre-made, blank mandala. participants were instructed to choose a mandala, to select colors, shapes, images, sizes, and materials, and to notice the process of creating something beautiful while focusing their senses on the mandala. participants could also add pictures or words if they chose to. the mandala activity for the final session had participants reflect on coming “full circle” by asking them to take out their mandala from the first session. they were asked to create a mandala that represented who they were that day and where they were on their healing journey overall. each participant was provided with one wedge of a full circle in this session, so the facilitators could collect the wedges to make a group mandala. figures 1 and 2 show examples of mandalas created in the women’s group. preliminary observations in order to assess whether the adaptation of seeking safety with the use of mandalas seemed to be helpful for participants, the three facilitators were asked to write up detailed progress notes after each session. facilitators noted the goals for the session using the adapted model, the content covered, their affective experience and thoughts around what happened during the session, what went well and what could have gone better, and what the participants took away from each session. the progress notes also included quotes and descriptions of what group participants thought of each session and of the group overall. figure 2example mandala figure 1 example mandala ely et al./i feel like i am finding peace 110 after all sessions were completed, a member of the research team examined the progress notes from each facilitator and extracted common themes around the group members’ and facilitators’ thoughts, feelings and experiences about the group. common themes were identified as those that were mentioned by at least two different facilitators. the progress notes were then re-examined in order to track how many times each of the common themes were mentioned throughout all of the progress notes. common themes that were mentioned at least three times were grouped together into major themes. table 1 below depicts the themes and subthemes. table 1. identified themes and subthemes of the trauma support group 1. mandala creation enhanced the seeking safety material  mandalas were a symbol of personal reflection and meaning. (11)  participants were actively engaged in mandala creation. (10)  participants wished to create/created mandalas outside the group as a coping skill. (6)  mandalas were a way to express difficult feelings and thoughts. (5) 2. language barriers posed important considerations  extra time was required for translation. (9)  needed to use more deliberate, simple and concise language. (6)  concern that those who struggled with english benefitted less from the group. (6)  tension between covering the material and ensuring concepts were clear. (5)  facilitators found some topics difficult to explain. (3)  group felt fragmented due to translation occurring while content was delivered. (3) 3. trauma support group was a means of personal growth  participants reported personal growth as a result of the group. (9)  participants talked about using what they learned to help others/wanting to help others. (4) note: numbers in parentheses indicate the frequency of each sub-theme as noted by group facilitators. facilitators were also instructed to note any anecdotal reports from participants about the impact of the trauma support group. participant quotes from the progress notes were grouped into two overarching categories: reduction of symptoms and use of safe coping skills. examples of these quotes are presented in table 2. limitations this paper details the results of a case observation and is not a formal study. the adaptation of the model was created to offer additional techniques to help the traumaimpacted group to further process their trauma experiences. participants were volunteers and the observed outcomes were practice observations and not conclusions from a study designed with formal research principles. therefore, more research in this area is needed. while the technique seems to have been promising for this one group, we cannot assume that the positive process that was observed will transfer to other groups, or that it will be maintained over time. we also did not conduct a formal follow-up to determine the advances in social work, spring 2017, 18(1) 111 long-term impact of this intervention. because this was an actual treatment group being observed, there was only one facilitator available to observe and record the reactions of the group. future studies of this adapted technique should employ multiple raters to allow for inter-rater reliability when recording and categorizing the observations. moreover, we recommend recording the therapy sessions to allow a supervisor to review sessions with facilitators and give them feedback, thus enhancing their training. formal recording of sessions would also permit study personnel to measure fidelity to the intervention. it is unknown if the positive effects observed were attributable to the intervention or attributable to some other form of therapy the client was receiving, and therefore future research studies should take this into account in their design. a pre-test/post-test research design where participants are randomly assigned to groups would allow the exploration of the impact of the specific intervention. if this is done, the research design should use clinicians who are blind to the subjects’ trauma status. table 2. anecdotal participant reports as reported by observers reduction of symptoms use of safe coping skills  “i feel so happy…i feel like i am finding peace” (description of what was overheard)  sleeping better, feeling better, focusing better and feeling happy  slowly trying to let men back into her life again  blood pressure has gone down  feels free and “so good”  helped her love and engage in life fully again  comfortable with telling her story to others without crying  truly thinking about safe coping skills  did some grounding techniques right before she attended her doctor’s appointment  learned that one can have power over one’s emotions and safe coping skills  using positive, safe coping (including going to the gym, surrounding self with positive people rather than being isolated, reaching out to supports)  expressed she was able to deal with memories of her trauma by going out with friends, talking with people she trusted and doing positive self-talk discussion initial results of this exploratory evaluation suggest that there is potential for this adapted version of seeking safety with the inclusion of mandalas to reduce trauma symptoms in refugee populations. given that seeking safety has improved symptoms in other trauma-exposed populations and that mandalas are considered a flexible means by which participants can safely express and explore their own experiences (boden et al., 2012; lynch et al., 2012; parris, 2008), these outcomes are not surprising. our observations are consistent with gerteisen (2008) who found that mandala art therapy was useful for impacting trauma symptoms in children, as it facilitated non-verbal expression at the child’s own comfort level. non-verbal expression was also a goal of the current intervention, which was one prominent reason for originally integrating mandalas with this seeking safety adaptation. ely et al./i feel like i am finding peace 112 these preliminary results are also consistent with literature regarding the effectiveness of art therapy for treating trauma, which concluded that the use of trauma-focused mandala drawing in art therapy was associated with a reduction in trauma symptoms in adults (schouten et al., 2015). additionally, allen (2011) found that mandalas were useful in impacting severity of ptsd symptoms, anxiety, and physical health issues in college students. directions for future research future research efforts should be directed towards examining the effectiveness of this adapted technique with various refugee populations over time. the development of fidelity measures such as a client self-report survey, semi-structured interviews and/or evaluation of the model through observations or video recording would further clarify and validate the dynamics, implementation, and effectiveness of the model. further, a training manual and means of coaching practitioners using the validated fidelity measures is also needed. future studies can be designed to assign some participants to the adapted seeking safety group and others to a standard treatment group to allow comparison of which groups facilitate the greatest reduction of trauma symptoms. conclusion trauma-exposed refugees are diverse in background and experience and may suffer from a wide variety of trauma symptoms. currently established treatment protocols may be useful for some refugees, and not as beneficial for working with others. as such, innovative treatment modalities must be explored in greater detail, which was the purpose of the treatment adaptation presented in this paper. we recommend that social workers who practice with trauma-exposed refugee populations consider incorporating art therapy and the seeking safety content into group treatment sessions, given the potential for reducing trauma symptoms and the relative low cost of integrating this approach into existing programming. references allen, j. k. 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(2015). unhcr mid-year trends 2015. retrieved from doi: http://www.unhcr.org/56701b969.html van der vennet, r., & serice, s. (2012). can coloring mandalas reduce anxiety? a replication study. art therapy: journal of the american art therapy association, 29(2), 87-92. doi: https://doi.org/10.1080/07421656.2012.680047 zlotnick, c., najavits, l. m., rohsenow, d. j., & johnson, d. m. (2003). a cognitivebehavioral treatment for incarcerated women with substance abuse disorder and posttraumatic stress disorder: results from a pilot study. journal of substance abuse treatment, 25, 99-105. doi: https://doi.org/10.1016/s0740-5472(03)00106-5 author note: address correspondence to: gretchen e. ely, phd, school of social work, university at buffalo, state university of new york, 685 baldy hall, buffalo, ny 14260, 716-6451243, geely@buffalo.edu https://doi.org/10.1080/17454832.2014.910816 https://doi.org/10.1080/07421656.2010.10129660 https://doi.org/10.1016/0197-4556(87)90018-9 https://doi.org/10.1016/0197-4556(87)90018-9 https://doi.org/10.1300/j077v09n02_06 https://doi.org/10.1300/j077v09n02_06 https://doi.org/10.1001/jama.2009.1132 https://doi.org/10.1080/07421656.2015.1028871 https://doi.org/10.1037/ort0000126 http://www.unhcr.org/56701b969.html https://doi.org/10.1080/07421656.2012.680047 https://doi.org/10.1016/s0740-5472(03)00106-5 _____________ pauline jivanjee is an associate professor at portland state university’s school of social work. kimberly pendell is an assistant professor at the portland state university library. laura nissen is the dean and a professor at portland state university’s school of social work. charlotte goodluck (deceased) was a professor at portland state university’s school of social work. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 260-275, doi: 10.18060/18407 lifelong learning in social work: a qualitative exploration with social work practitioners, students, and field instructors pauline jivanjee kimberly pendell laura nissen charlotte goodluck abstract: in the context of rapid change in social work practice related to policy, research findings, and theoretical developments, faculty are challenged to prepare students to engage in lifelong learning, a concept that has not been well-articulated in social work education. this article reports on an exploratory study of students,’ social workers,’ and field instructors’ perspectives and experiences of lifelong learning. based on focus group discussions, findings reveal the multi-faceted nature of lifelong learning, the personal characteristics and motivations of lifelong learners, and the roles of social work faculty and workplace environments in supporting learning. implications address the roles of instructors and social work programs in giving students and social workers tools and opportunities to engage in continuous learning and professional growth. keywords: social work education, workplace, lifelong learning, motivation social work practice occurs in the context of rapidly changing community needs and policies, as well as new research findings and theoretical developments. lifelong learning enables social workers to continually update their knowledge and skills in order to provide relevant and effective services. social workers encounter ongoing expectations to serve new populations experiencing emerging social problems. at the same time, they experience pressures to engage in evidence-based and culturally-responsive practices, and are required to be accountable for outcomes in environments of shrinking public resources. therefore, it is essential for social workers to be lifelong learners. the council on social work education (cswe) has recognized this need. the 2015 cswe standards include the statement, “social workers recognize the importance of lifelong learning and are committed to continually updating their skills to ensure they are relevant and effective” (cswe, 2014, p. 3). lifelong learning in social work addresses the continuous learning and transformation needed to be an effective social worker in the changing social, economic, and political environment. however, there is little research on lifelong learning in social work and few guidelines about how lifelong learning is viewed or embraced by social workers or social work students. as social work education has shifted from using a knowledge-based curriculum structure to a competency-based structure (petracchi & zastrow, 2010a; 2010b), the cswe adopted educational policy assessment standards (epas) to assess the competencies believed to be necessary for effective social work practice. these standards include an expectation that students begin their professional lives recognizing that they will need to renew their knowledge and skills continually. definitions of lifelong learning reflect this jivanjee et al./lifelong learning 261 explicit link with performance on the job. for example, the professional association research network articulated lifelong learning as “… the purposive maintenance, improvement and broadening of your knowledge, skills and personal qualities in order to perform your professional activities successfully throughout your working life” (as cited in frost, 2001, p. 12). gustavsson (2002) connects lifelong learning with the personal qualities needed for effective professional performance: “…what counts is flexibility, sensitivity, and openness to the world” (p. 22). these definitions are useful as a foundation for considering how social workers engage in lifelong learning and how educators and others can best promote and facilitate lifelong learning. nissen, pendell, jivanjee, and goodluck (2014) described the varied emphases in definitions of lifelong learning for social work. for example, lifelong learning has been defined as intentional learning that people engage in throughout their lives for personal and professional fulfillment (dunlap & grabinger, 2003), a socio-personal process (billet, 2010), a self-directed process (bolhuis, 2003), and a reflective process (frost, 2001). according to daley (2001), social workers described continuing education as a meaningmaking process and reported using it to gain new information to advocate for clients and to create renewed momentum and inspiration in their work. cournoyer and stanley (2002) offer what appears to be the most comprehensive definition: lifelong learning for social work refers to ongoing processes associated with the acquisition or construction of information, knowledge, and understanding; the development, adoption, and reconsideration of values and attitudes; and the development of skills and expertise… from the time someone first explores social work as an educational or professional career choice to the time that person no longer considers himor herself a social worker. (p. 4) social work literature addresses aspects of the learning needed for contemporary social work practice but to date, there has been little attention as to how social workers engage as lifelong learners throughout their professional lives. licensed social workers are required to participate in continuing education to maintain their licensure (nissen et al, 2014) and some studies examined how social workers gain and apply new information immediately following their participation in continuing education offerings, for example, trainings on evidence-based practices (gira, kessler, & poertner, 2004; wharton & bolland, 2012). an exploratory study reported positive outcomes of continuing education on social workers’ understanding of and use of evidence-based practices (parrish & rubin, 2011). other studies have examined the effects of continuing education on improving social workers’ knowledge and skills. for example, smith and colleagues (2006) showed that higher motivational orientation toward professional knowledge was associated with selfperceived changes in knowledge, attitudes, and behavior of social workers. lam and colleagues (2006) demonstrated that problem-based learning boosted social work students’ ownership of self-directed learning at the end of their formal training. following a comparative study of learning across professions, daley (2001) reported that to make new knowledge meaningful, participants integrated it with previous professional experience “in a recursive, transforming process” (p. 50). in the same study, daley also found social workers motivated to seek new information to improve their support and advocacy on advances in social work, fall 2015, 16(2) 262 behalf of clients as well as gaining renewed inspiration and commitment to their profession following continuing education. assessment of the content and nature of lifelong learning among social workers has been limited to date. returning to cournoyer and stanley (2002), the authors reported on the development of an instrument to measure lifelong learning in social work including seven dimensions: regular review of professional literature; enjoyment of learning; regular pursuit of learning activities and opportunities; openness to feedback from others that learning may be needed; knowledge of one’s personal learning style and preferences; active engagement with, and responsibility for one’s own learning plan; and enjoyment of teaching others. however, this scale has not been used in additional research or program development in schools of social work or practice settings (cournoyer, professor, february 22, 2014, personal communication). in summary, the literature on lifelong learning provides little information on social workers’ motivation toward lifelong learning, how they engage with and apply new learning, and what supports they might need. this exploratory study addresses the identified gap in the literature by examining the perspectives and attitudes of social workers, field instructors, and social work students regarding lifelong learning. the study was designed with guiding research questions derived from a review and synthesis of existing literature (nissen et al., 2014): what does lifelong learning mean to social workers, field instructors, and social work students? what is the role of a school of social work in promoting lifelong learning? what factors are reported to support or impede lifelong learning in social work practice settings? what kinds of information and experiences contribute to lifelong learning in social work? observing the limited literature focused on this topic, a research team of three social work faculty members and the university’s social work librarian sought to better understand lifelong learning in social work, and the roles of social workers, social work educators, supervisors, and students related to lifelong learning. by eliciting the perspectives of current students, as well as social workers in the community, the study aimed to promote understanding of what motivates students and social workers to learn, and thereby provide useful information for social work educators, field instructors, professional leaders, and social work practitioners to enhance social work’s relevance and effectiveness in meeting community needs. methods this exploratory qualitative study employed focus groups of bsw students, msw students, alumni/practitioners, and field instructors to investigate perceptions of lifelong learning in social work. focus groups were selected as the medium for data collection to elicit participants’ attitudes and frameworks for understanding their experiences (kitzinger, 1994). to enhance the trustworthiness of the findings, the researchers followed recommended strategies for focus group inquiry (creswell, 2013; padgett, 2008; polkinghorne, 2007). the university’s institutional review board approved the study. jivanjee et al./lifelong learning 263 participants using email listservs and social networks, researchers recruited a convenience sample of bsw and msw students, social work alumni/practitioners, and field instructors associated with one university to participate in focus groups for this exploratory study. separate focus groups were held for all four participant types. social work faculty members were also interviewed; however, due to the significant difference in the interview protocol for faculty and the different emphases in their responses, their responses will be reported in a separate article. potential participants volunteered using an online form. when a sufficient number (5-7) of participants had volunteered, the groups were scheduled. email reminders were sent to participants the day prior to their focus group. due to absences, a total of 13 volunteers participated in four focus groups: two bsw students, five msw students, two alumni who worked as social work practitioners, and four field instructors who were engaged in agency-based social work practice as well as supervising students. while the researchers had hoped for larger groups, the smaller focus groups proceeded to respect the time of participants who had attended. the discussions with pairs of participants proved to be extremely rich. ten participants were females and three were males. participants indicated their age in categories: 18-24, 25-34, 35-44, and 45 years old and above. each age group was represented in the focus groups overall, with the majority of participants being 35 years old and above. one participant identified herself as mexican-american; the remaining participants identified as either white or did not identify their ethnicity. two participants indicated gay or queer sexual orientation. one participant noted the presence of a disability. none of the student participants were currently taking classes with the researchers conducting the study, although some had taken classes with one faculty researcher in the past. procedure separate focus groups were facilitated by two team members, one of whom took the role of lead facilitator while the other managed logistics and asked clarifying questions. before beginning the focus group discussion, each participant reviewed and signed an informed consent. focus groups ranged from 60 to 90 minutes. focus group discussions were audio-recorded and were subsequently transcribed for analysis by the researchers. the questions asked in the focus groups were similar, but students were asked one additional question and alumni/practitioners and field instructors were asked a few different questions to address their professional perspectives. all groups opened with an icebreaker question about the participants’ most passionate areas of social. subsequent questions focused on the types and sources of information they need for social work practice, how they use information, and how they deal with challenges in trying to find or use new information. another set of questions inquired about what participants do when faced with a professional situation they do not feel prepared for, what motivates them to learn, how they define lifelong learning, and what would help them to become lifelong learners. for students, a closing question asked for their opinion on what other questions related to the topics of information and lifelong learning the social work profession should be asking. additional questions asked of alumni/practitioners and field instructors were: do you note advances in social work, fall 2015, 16(2) 264 any changing trends in the kinds, types, or forms of information you use or will use as a social worker? has your definition of lifelong learning changed since you left school? how do you stay engaged in your practice and profession? describe the organizational culture that you work in with regard to capacity and practices for the flow of new information, methods, or ideas into social work practice. near the end of each focus group we paused to invite participants to share ideas related to what had been discussed already, a form of member checking. all four researchers participated in collaborative data analysis guided by the constant comparison approach of glaser and strauss (1967) as modified by charmaz (2005) and morse (1994). following each focus group, each pair of team members met to debrief and identify major areas of themes. after transcription, each member read all the transcripts independently and noted key themes and categories in content related to aspects of lifelong learning in social work, using the major topics to guide the preliminary analysis. within these broad categories, team members identified themes and categories in an inductive analysis process. team members subsequently held a series of meetings to describe and explain our rationales for assigning specific categories and selecting exemplary quotes that illustrated them. this process resulted in a set of consensus-determined categories and themes and a preliminary code list. individual members then took responsibility for analyzing the data linked to one or two major themes across all focus groups and shared this analysis with other members, followed by additional meetings in which each member responded to questions about their analysis and made changes, resulting in team agreement on the final analysis. findings researchers explored four topics: participants’ definitions of lifelong learning; information access and processing; the role of schools of social work in promoting lifelong learning; and lifelong learning in the workplace environment. the following summarizes each topic explored in the focus groups and the themes that emerged through narrative analysis. participant quotes inform and illustrate each theme. what is lifelong learning? during the focus group process, all informants were asked to define lifelong learning as they currently conceptualize it. although the concepts they described varied, their comments reflected a few core ideas: personal commitment to learning; humility as a guiding perspective; and differentiating knowing and doing. the definitions focus group members offered were a fluid combination of personal qualities and attitudes, such as openness and engagement. overall, participants appeared to be familiar and engaged with the concept of lifelong learning and aware of its importance to their education and practice, which may have been expected since the participants were self-selected. they spoke enthusiastically about the idea of lifelong learning, and described lifelong learning as a personal characteristic as opposed to an external, premeditated action: “i just love being around new knowledge and hearing people talk about things” (social worker) and “i think for me learning is easy, jivanjee et al./lifelong learning 265 learning is a way of life. it is who i am. it is part of my identity” (msw student). a key element of lifelong learning appeared to be related to the affective aspects of the learning process. participants noted a variety of positive motivations for their involvement in lifelong learning such as being excited, eager, engaged, and curious. participants emphasized the need for personal commitment and taking responsibility for lifelong learning. in relationship to lifelong learning, both bsw and msw students reported a sense of dissatisfaction with current beliefs and a commitment to challenging oneself: “i think it is a commitment to not being satisfied with what you believe…lifelong learning is a commitment that you are not going to allow those easy thought patterns to be your only thought patterns” (bsw student); and “[lifelong learning] is being engaged and continuing to be curious and to push myself out of my comfort zone” (msw student). in focus group discussions, humility surfaced as a guiding stance or quality needed for lifelong learning. an msw student described learning as, “…just curiosity with humility and openness to learning.” participants implied that humility is closely tied to the qualities of curiosity and openness, reflecting the idea that—even with the best of intentions—one must have the willingness to take chances that may result in mistakes. these mistakes will, in turn, inform ongoing learning: lifelong learning is really having the ability to be open to new ideas, different ways of thinking, whatever it may be, just being open to that… you have to remain a bit humble…that reserved piece of just saying ‘tell me more…’ (field instructor) another field instructor also commented on the humility and openness required for lifelong learning, defining a lifelong learner as a person who is: “willing to try new things, willing to look at new things, willing to try new ways of doing business, willing to ask questions, willing to take risks...[and] also willing to make mistakes.” participants described social work practice as a larger commitment to ongoing learning extending over one’s life. acceptance, and even delight, could be found in this aspect of learning: “i know less now than when i began. i don’t mean that in a bad way. i mean that lifelong learning is exactly what it means. there is no plateau here and there never, ever will be” (alumnus/practitioner). respondents differentiated “knowing things” from applying information; they emphasized the roles of integration and application in lifelong learning. for example, an msw student noted: i could read a million books, but i think it is integration that makes it learning. it is the how i am using it? how i am applying it? how i am working, how it is changing me and the way that i work, that makes it learning, instead of knowledge. participants described different motivations for their desire to gain skills needed for social work, which were linked with their curiosity, social connections, and fear or shame about not knowing. numerous respondents described motivations guiding the ways they defined and thought about lifelong learning such as the realization that knowledge is continually evolving, and that professional effectiveness is linked to ongoing professional development. for example, one field instructor shared: advances in social work, fall 2015, 16(2) 266 part of wanting to be a strong practitioner is being open to the fact that there is so much i don’t know. that kind of drives my interest; particularly in a field where social justice is part of our core values. that’s so dynamic. it’s going to involve needing to continue to learn. participants described lifelong learning as their commitment to the processes of engagement and change, and a sense of power in learning about new topics and having access to resources that provide them with knowledge and competencies for social work. lifelong learning as a form of social connection also surfaced in the focus groups. several participants described how they created new and strong connections to others through learning. for example, a bsw student addressed the benefits of learning for relationship-building: “i like to be able to connect with people and i feel learning about them makes it easier. i think the promise of being able to connect with people better is kind of my reward for learning.” this theme also touches upon the sharing of information as a way of building a professional social network. social work students and practitioners reported that they strategically build professional and social networks in order to discover, share, and discuss new information. students referred to the importance of fellow students, researchers, and practitioners as vital sources of information. information acts as a starting point for relationships, a catalyst for social and professional networks that then form a strong basis for ongoing learning. an msw student commented: i just flail, so oftentimes i end up googling and looking at scholarly research, which is so not enough. we need to really know and have an internalized level of how to find information and find alliances and kinships and other like-minded people who can help us continue in our work as we move into the world. another student offered: “sometimes using that information [regarding social justice] to ask questions to strategic people and build strategic relationships has been a big thing for me” (msw student). less positive motivations also emerged, such as shame or feeling apologetic in regards to not knowing or feeling safe with not knowing. a bsw student posited: i think safety [is important] because sometimes when you don’t know something you are kind of shamed by it. i feel like that when my career kind of develops, i am going to be hesitant to allow other people to know that i don’t know about this. i think there is kind of a shame in that, like you should know about this. an msw student admitted, “i didn’t want to admit to the group that i was totally incompetent.” information access and processing in response to an exploratory question, participants talked at length about how they discover and use new information and research in their academic and professional work. while social work journals and other scholarly publications were frequently cited as sources of information for their work, participants also discussed the importance of continued access to research literature; how they build networks for sharing information jivanjee et al./lifelong learning 267 among colleagues and mentors; the value of alternative information sources; and how they evaluated and applied new learning. continuing access to current research was reported as an ongoing concern for social work practitioners in the community and as a future concern for students. students predicted accurately that their access to journal articles would significantly change or even disappear upon leaving the university. an msw student lamented their future loss of access to scholarly journals: i love libraries, but i know that my access to this library in particular is going to be next to nil once i graduate… there isn’t much out there for those of us that like research and want to base it [practice] on research. we are a little bit in a hole. alumni/practitioners and field instructors expressed appreciation for workplaces that provide access to relevant academic journals. field instructors also cited the benefit of their affiliation with the university, which provides off-site library access to academic journals that would not otherwise be available to them. social work students and practitioners reported that they seek out a variety of information sources. scholarly research is valued, but information from sources outside the traditional and dominant discourse is also sought and incorporated into practice: i definitely would start with a lot of journals, but then also i feel that because the population that i’m most interested in, there is not a lot written about them. because they can be so small, i look for a lot of blogs and more nontraditional sources of information….it is usually research by white folks or analysis by white folks, so it is always interesting to find perspectives on it from the communities that it is affecting the most. (alumnus/practitioner) students and practitioners consistently demonstrated their awareness and concern that scholarly research did not present a full enough picture of a social problem or situation to apply to their practice, and they also sought information from community informants. focus group participants described using new information as a process that involves balancing sources, reflection, building the context or macro view, and understanding the information’s impact on practice. responses from participants formed a continuum of steps from receiving new information to shaping new learning and practice, using phrases such as: rehearse, reflect, discuss, dialog, test, and evaluate. for example, one msw student described his imaginative process of taking new information and constructing a new scenario based on a previous experience: “i think just like rehearsing information learned, thinking back to past situations and how i would have acted differently if i had known and then preparing for the future if i run into the same situation.” the role of social work education in lifelong learning while participants reported a lifelong learning disposition before entering their social work program, they also expressed appreciation for the lifelong learning foundation built during their program and the inspiring influence of faculty members. an alumnus/practitioner commented, “i wouldn’t be as successful as i have been in this program if it wasn’t for the foundations you gave me…it is up to me to do the rest.” another advances in social work, fall 2015, 16(2) 268 alumnus/practitioner described learning a critical perspective as a foundation for future learning: the school does such a good job of embedding that in you, it really allows you to grow and flourish kind of naturally without even having to think about it… it is kind of implicit… the degree has really helped me to continue to want to learn and be inspired. some faculty members were reported to be particularly effective in promoting lifelong learning. for example, a few participants commented on a specific faculty member who had “reinforced” lifelong learning by being so “passionate about it” and “instilled as a thing that you are just going to continue to do and it is your responsibility to do it.” an msw student commented on the importance of faculty members modeling lifelong learning: when you see people who have been in the field for a long time or whatever and they know the latest stuff and they are able to throw it out and engage people, young people, that is exciting to me… just seeing it in them inspires it even further to me. returning to the importance of feeling safe in the learning process, a student participant added, “i think that is perfect when they are like, you know, ‘i don’t know it all yet, either,’ and that’s okay and it is safe not to know it.” another msw student commented that instructors promote lifelong learning when they “share their passions in the classroom” and especially when they create a learning environment in which students feel safe “to bumble around.” during their time in a bsw or msw program, students create professional and social networks with peers and faculty members, and these networks are viewed as vital to lifelong learning. social work programs provide an environment rich with networks that support learning and “all of us will take for the rest of our lives.” student participants reported that social work education had stimulated lifelong learning by offering new and challenging ideas and theories as well as opportunities to do research on topics that students had not thought about previously. they spoke enthusiastically about ongoing dialogue with faculty members and peers, and maintaining relationships with former instructors as a way of continuing the learning process. lifelong learning in the workplace focus group participants discussed several aspects of lifelong learning in the workplace environment, including learning from the community and working with students. sharing information with workplace colleagues and attending conferences to meet licensure requirements for continuing education were also key aspects of workplace learning. participants described characteristics of workplace cultures that both promote and inhibit lifelong learning. limited time due to heavy caseloads and other responsibilities was frequently mentioned as a hindrance to ongoing learning in the workplace. some participants were thankful that they work in organizations that promote lifelong learning and where other staff are also eager to learn: “i enjoy my career and i enjoy what i do and a lot of that is due to the fact that there is so much opportunity to learn things” jivanjee et al./lifelong learning 269 (field instructor) and “within our agencies, there are a lot of people who just yearn for more information” (field instructor). for field instructors and alumni/practitioners, the presence of social work students in their workplace was viewed as a lifelong learning strategy both for sharing their knowledge and skills with the next generation of social workers, as well as contributing to their own continuing learning: “training people who are new and excited about the field helps me to feel excited again,” and “being a field instructor also helps me to maintain my edge” (alumnus/practitioner). practicing social workers agreed that finding a supervisor who supports lifelong learning is essential in large bureaucratic organizations. an alumnus/practitioner cited the positive impact of his workplace supervision: every time we would have supervision, i literally would have five new articles that i had to read and have to be done and talked about and discussed at the next supervision or the next group…i’ve been very grateful and lucky that both of the agencies…have been really, really strong on continuing learning because they know that is what keeps people going. participants referred to lifelong learning as an attitude or frame of mind of openness to learning in the workplace and in busy or stressful workplaces, such as public child welfare, as an antidote to burnout, as exemplified by one participant: the work we do is so taxing, so learning different ways to try to alleviate – there is such high burnout, as we all know, and stress in all the work that we do, so just really trying to learn ways… to eliminate some of that stress because there is so much responsibility. (field instructor) limited time in the workplace may prevent practitioners from digesting new information and continuing their learning. several participants identified challenges in their busy work environments related to time and organizational pressures: “i think some barriers for me are sometimes lack of time to actually sit down and get the information i need, particularly if things are in a crisis mode” (field instructor) and “i have to literally spend my weekends if i want to gather information on anything” (alumnus/practitioner). as noted by a participant in public child welfare, other concerns such as large caseloads, overwork, and fear of making a mistake may inhibit learning: “people intend to use strengths, but because of those fears, really do limit them” (field instructor). students in field placement discussed their disappointment in discovering the lack of a learning culture in some social work practice settings: sometimes the system works against us to actually be prepared and to get the knowledge. ‘oops, sorry, in and out, sorry, we are in fast-food social work here.’ there are not too many jobs unless you are in academia where they are going to say, ‘yes, take the time, do some research, we really care about your learning’. (msw student) discussion participants in this study expressed a range of personal motivations for continuing learning from embracing learning as a way of life characterized by curiosity, engagement, and excitement to a passion for critical thinking that compels them to continually learn advances in social work, fall 2015, 16(2) 270 about the political context of their work in order to improve advocacy for clients. participants described how their lifelong learning stance strengthened their practice and engaged them more fully in their work. participants’ definitions of lifelong learning reflected those reported in the literature (e.g., billet, 2010; bolhuis, 2003; cournoyer & stanley, 2002; dunlap & grabinger, 2003; frost, 2001; gustavsson, 2002) and included three dimensions: psychological, related to personal characteristics of curiosity and humility; organizational or contextual factors that affect the availability of opportunities for learning and applying new learning; and thirdly, the professional need to continually update their expertise and competence in order to better serve clients. participants discussed the environmental contexts that supported and contributed to their learning, particularly their social work program and workplace. the primary limitations associated with the study are the small convenience sample derived from self-selected, non-representative social workers and students associated with an individual school of social work. the self-selection process is likely to have resulted in a sample of participants that are more engaged and enthusiastic about lifelong learning than others. while the research team took steps to assure the trustworthiness of findings, we also recognize that researcher biases in framing the questions, conducting focus groups, and analyzing data may have inadvertently influenced our results. despite these limitations, we believe that the study yielded a useful preliminary picture of how some social work students, practitioners, and field instructors think about and engage in continuing learning and the conditions that support learning with implications for further research and tentative implications for social work education programs. implications for social work education findings highlight the important roles of faculty members as role models who demonstrate a commitment to ongoing learning in their own professional lives, who model the skills of finding learning opportunities and resources, and who share resources with students. based on findings from this study, social work faculty will need to continually upgrade their technological skills to integrate the wealth of available electronic media into their teaching, which is likely to enhance students’ access to information after graduation. as noted by participants, and recognizing that bsw and msw programs provide only foundations for professional development, instructors need to support students who are highly motivated learners and to inspire students who are not intrinsically curious. critical thinking and a social justice orientation emerged as motivations for lifelong learning, and these emphases in social work programs are likely to inspire continued learning. as social work programs engage in competency-based education, the use of portfolios to document student learning and promote the development of learning goals after graduation, holds promise that students will continue to increase their knowledge and improve their skills subsequently (cournoyer & stanley, 2002). also, understanding that access to scholarly publications and research journals is heavily influenced by affiliation with an academic program or the workplace environment, faculty may consider publishing their work in open access journals, blogs, and other publicly accessible formats in order to support ongoing learning in the field. jivanjee et al./lifelong learning 271 participants described the benefits of social networks created in their social work program for continuing learning after graduation and throughout their professional careers. for students who are less connected socially, have competing responsibilities and demands on their time, or are less motivated to be self-directed learners, social work faculty are faced with the challenges of facilitating the development of motivation for lifelong learning, assessing students’ commitment to career-long learning, and creating the conditions for this to occur. therefore, instructors are encouraged to increase opportunities and supports for the development of learning networks, particularly for students who are less likely to engage in groups whether because of personality or cultural factors, time constraints, or other factors. a small number of student participants voiced shame-based motivations for learning which merits further investigation. even if this is a challenge experienced by only a few students, we suggest that faculty normalize this response and create learning environments in which all students can feel safe when disclosing their lack of knowledge or experience. implications for social service organizations participants reported that busy agency contexts and high caseloads constrain the time available for further learning, resulting in their need to devote their personal time to learning. as noted by participants, a workplace’s low tolerance for risk slows adaption of new information into practice, limiting the opportunities for staff to share innovative practices they have learned with their colleagues. conversely, even though resources are limited in most social service organizations, supporting opportunities for ongoing learning may provide benefits in increasing skills, re-energizing staff, reducing burnout, and improving services to underserved client groups. the roles of supervisors in supporting learning were emphasized as well as the benefits of offering field placements to students as ways of introducing new ideas into the work environment. implications for future research while this study was exploratory and based in one school of social work, it provides a beginning understanding of social workers’ and social work students’ perspectives on lifelong learning, and led to the identification of further questions for future research. for example, how are schools of social work and specific instructors preparing students to have the attributes, motivations, and skills to be lifelong learners? our sample was self-selected and expressed their passion for lifelong learning, but a challenge to be explored is how to motivate students who are less oriented to lifelong learning to continually upgrade their knowledge and skills. explorations are needed to identify what curricula and teaching modalities are best suited to facilitating the skills for ongoing learning. the use of portfolios is gaining popularity in social work programs but little is known about whether this approach promotes ongoing learning. while not specific to social work, one study indicated positive outcomes of the use of e-portfolios to foster integrative knowledge development (peet et al., 2011), a topic that merits further research in social work. social networks were also appreciated for sharing new information and ideas, which led the research team to speculate about how learning groups and learning communities are best created and used in both advances in social work, fall 2015, 16(2) 272 schools and the workplace. we recommend further research to explore the phenomenon of social networks as important media for sharing knowledge and learning resources, and to understand how social workers who are less well-connected to networks gain the expertise they need. though many social service organizations provide or encourage access to continuing education, others may stifle employees’ desires for learning opportunities with demanding workloads. participants expressed concern about the “fast food” climate in some busy agencies and reported thinking of their ongoing learning as “subversive” which raises questions about how social service organizations can best serve the community and achieve their mission while also promoting lifelong learning. research has shown that learning organizations are highly effective (senge, 2006), providing support for organizational leaders to embrace lifelong learning. further research is needed to understand costeffective strategies for promoting learning opportunities to continually enhance staff skills while also assuring that necessary work is completed. additionally, research is needed to understand the developmental trajectories of lifelong learners across social work fields of practice and areas of expertise. finally, studies are needed to explore the links between continuing learning and social work practice. specifically, in what ways does ongoing learning improve the quality, responsiveness, and effectiveness of social work services? conclusion the imperative to remain engaged in continuing learning is central for the social work profession to be effective in delivering interventions that are relevant to community needs and responsive to the cultural groups served by social workers. while small in scope and exploratory in design, this study provides a preliminary examination of the perspectives of social workers and social work students in one community on lifelong learning. participants in this study addressed the psychological, organizational, and professional dimensions of lifelong learning and expressed eagerness to learn, appreciation for the learning opportunities they had received or sought for themselves, and some frustration about limitations in access to scholarly resources and the time needed for learning on the job. rapid technological change is creating new pathways for learning and personal social networks are a valuable medium for communication among social workers. faculty members have key roles in promoting and supporting lifelong learning, as role models, social connectors, inspiration, and as springboards for lifetimes of learning and growing. palmer (1999) has articulated the faculty role well as it applies to social work education: …this profound human transaction called teaching and learning—is not just about getting information or getting a job. education is about healing and wholeness. it is about empowerment, liberation, transcendence, about renewing the vitality of life. it is about finding and claiming ourselves and our place in the world. 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(2012). practitioner perspectives on evidence-based practice. families in society, 93(3), 1-8. doi: http://dx.doi.org/10.1606/10443894.4220 author note address correspondence to: pauline jivanjee, phd, msw, the school of social work, portland state university, 1800 sw 6th ave., ste. 600, portland, or 97201. email: jivanjee@pdx.edu http://dx.doi.org/10.1606/1044-3894.4220 http://dx.doi.org/10.1606/1044-3894.4220 mailto:jivanjee@pdx.edu microsoft word des marais 7242 copyedit2 _________________ eric a. des marais, msw, lcsw, is a doctoral student in the university of denver graduate school of social work. subhasis bhadra, ph.d., is an assistant professor in the department of social work, school of humanities and social sciences at gautam buddha university, india. allen r. dyer, md, ph.d., is professor of psychiatry and behavioral sciences at the george washington university. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 340-357 in the wake of japan’s triple disaster: rebuilding capacity through international collaboration eric a. des marais subhasis bhadra allen r. dyer abstract: natural disasters occur when the destructive forces of natural events, such as earthquakes, flood, and volcanoes, overwhelm the capacities of communities. in the winter of 2011, japan, a model for disaster-preparedness, was shaken by one of the largest earthquakes on record, a ten-story tsunami, and a nuclear emergency on par with chernobyl. in the acute stages of the disaster, the japanese government officially asked for help from a number of countries. during this time period, international collaboration played a key role in providing help to survivors in the form of medical assistance, food aid, and psychosocial support. as provision of aid evolved into capacity building, national and local japanese government agencies, in partnership with local grassroots non-profits, assumed most responsibilities, and international organizations transitioned into new roles. this paper will present a study of the collaboration facilitated by a global non-profit humanitarian organization between international faculty and local partners in japan. keywords: japan, natural disaster, international collaboration, capacity building introduction when natural events such as earthquakes, floods, and volcanoes overwhelm the capacity of communities to respond, natural disasters are the result. natural disasters can result in a massive loss of lives and property for those involved, and it is forecasted that these losses will continue to rise as global population increases and people are forced to move into higher risk regions (bourney, 2005; cutter & emrich, 2005). international collaboration around natural disaster mitigation and recovery is typically associated with disasters in developing regions such as sub-saharan africa, the indian sub-continent, and southeast asia. comparatively, developed countries generally have policies, strategies, programs, and resources in place for disaster mitigation and response. yet they too can be overwhelmed by natural hazards when the devastation is sufficiently extreme. in these situations, even the best-prepared countries can benefit from international collaboration, especially in the acute and early capacity-building stages of disaster recovery. such was the case for the japan’s triple disaster of 2011. the goal of this paper is to draw attention to the role that international collaboration can play in the management of massive disaster in developed countries. as a case in point, des marias, bhadra, dyer/in the wake of japan’s triple disaster 341 it will focus on collaborations facilitated by international medical corps between its partners in japan and international disaster specialists both in the early emergency response phase and the following stage of capacity building efforts. the article will first sketch the events and severity of japan’s triple disaster along with the relevant aspects of japan’s disaster management infrastructure. this will be followed with a description of international medical corps, a non-profit organization dedicated to strengthening health care capacity after disaster, the international guidelines it follows, and the research base for the psychosocial programs that were introduced in the japanese context. the next section will describe the collaboration that resulted in the conference, and this will be followed by reflections on the role that social work can play on international and transdisciplinary teams within the context of international disaster response. methodology since the purpose of this article is to describe the collaboration between local partners and international faculty as facilitated by an international organization in the context of japan’s triple disaster, a case study approach was adopted. case studies are particularly good for providing “holistic and context sensitive” analyses (patton, 2002, p 447). the construction of a case study generally involves three steps: 1) the collection of case data; 2) the organization of the data into a case record; and 3) the development of the case record into a narrative (patton, 2002). data was collected from sources including publicly available reports and documents, presentation materials, and the observations and reflections of the authors, all of whom participated in the organization and presentation of the “healing a community: what can we do for our children?” conference held in sendai, japan and hosted by tohoku university school of education’s department of clinical psychology. the collected data was then organized into the following narrative describing the evolution of the collaboration. japan’s triple disaster on march 11, 2011, a magnitude 9 earthquake, the largest in the history of japan, occurred 130 km off the coast of the main island of honshu (asian disaster reduction center, 2011). within ten minutes, a wall of water swelled up, in some places as high as a ten-story building, and slammed into the coast, wiping away bridges, homes, and even entire communities that traced their history back hundreds of years (earthquake research institute, university of tokyo, 2001; cited in norris, 2011). news sources estimated that over 400,000 people were left homeless with approximately 25,000 dead, injured, or missing (central broadcasting system/associated press, 2011). in contrast, the kobe earthquake of 1995 resulted in approximately 6500 deaths. advances in social work, summer 2012, 13(2) 342 figure 1. map of the disaster area as of march 29th, 2011 (from http://file.jishin.yamatoblog.net/map_damage.jpg) despite being one of the most prepared nations for massive natural disaster, difficulties were compounded by the meltdown of at least three of the six reactors of the fukushima dai-ichi nuclear power station, creating a nuclear emergency on par with that of chernobyl. plumes of radioactive material drifted over large portions of japan, with radioactive cesium recorded as far north as japan’s northern island of hokkaido and increased radioactive readings at least as far south as tokyo. another 170,000 people were forced to evacuate from a 12-mile radius due to the uncontrolled radiation releases (harlan & mufson, 2011; physicians for social responsibility, n.d.). one government estimate put the total cost of rebuilding at over 300 billion usd, making it the most expensive natural disaster of all time (zhang, 2011). in the words of prime minister naoto kan, “in the 65 years after the end of world war ii, this is the toughest and most difficult crisis for japan” (cnn wire staff, 2011). des marias, bhadra, dyer/in the wake of japan’s triple disaster 343 japan requested aid from australia, new zealand, south korea, and the united states. by the following week, 128 countries and 33 international nongovernmental organizations (ngos) had offered support (nebehay, 2011). international medical corps, a global leader in disaster response, was one of the earliest responders to the call for help, beginning the first stages of coordination with the japanese government, japanese nonprofit organizations, and local communities within 48 hours (international medical corps, 2011b). in the immediacy of the first few weeks, international medical corps worked along with local partners peaceboat, second harvest, bond & justice, kamaishi emergency response center, and kesennuma emergency response center to deliver food, medical supplies, and communications equipment to areas affected by the disasters. a needs assessment concluded that one of the best ways international medical corps could collaborate was to provide support and training for mental health and psychosocial support. partnering at the request of the japanese government with the tokyo english lifeline (tell), international medical corps thus started the first stage of the train the trainers model for psychological first aid and facilitated collaborations between international faculty and local partners, culminating in a conference on mental health and psychosocial support for children after the disaster hosted by the graduate school of education of tohoku university in sendai. japan’s model for disaster preparedness japan is an epicenter for natural disasters. located on multiple active faults, having multiple active volcanoes, experiencing typhoons every summer, and being prone to flooding, it is a country that couldn’t survive without disaster mitigation and response planning and infrastructure in place. due to its careful planning, it is considered a model for disaster preparedness (suganuma, 2006). at the top of japan’s disaster management infrastructure is the central disaster management council (cdmc), established by the disaster countermeasures basic act of 1961 to “ensur[e] comprehensiveness of disaster management and to discuss matters of importance with regard to disaster management” (government of japan, 2005; as cited in pacific disaster center, 2006). the cdmc is the major policy engine for disaster management in japan and is comprised of the prime minister, the entire cabinet, local leaders, and experts in the field (government of japan, 2005). it is responsible for designing and implementing national risk management strategies regarding issues of safety, mitigation, and risk reduction (government of japan, 2005). through the cdmc, the government has engaged in a variety of knowledge building, information dissemination, and capacity building investments (pacific disaster center, 2006). risk assessments have been performed throughout the country involving public, private, and academic partners. this has resulted in an early warning and monitoring system covering the country. information products geared for educating a variety of fields and education settings are also in place. this is rounded out by local and national public and private partnerships that mitigate risk through insurance programs, grants, and special loans. advances in social work, summer 2012, 13(2) 344 thus, for japan, risk management has been integral to its planning and development processes; yet, there is the issue of what to plan for. resources are always limited and must be utilized to balance a complexity of needs. the probability of risk and the cost of mitigating it must be balanced against other needs for a society. in the end, the triple disaster of earthquake, tsunami, and nuclear meltdown overwhelmed the preparations that japan had spent decades putting in place. many structures, including the fukushima daiichi nuclear complex, were prepared for only a magnitude 8 earthquake; it was inconceivable that a magnitude 9 earthquake would occur. levees and flood barriers were not designed withstand a tsunami that reached 40 meters tall and traveled nearly ten kilometers inland. while japan had the infrastructure to deal with multiple disasters, it was overwhelmed by the sheer magnitude of the triple disaster. thus, the government of japan reached out to the embassies of australia, new zealand, south korea, and the united states for assistance. international medical corps: background and involvement in japan as a result of the request for assistance made to the united states embassy, international medical corps, a global humanitarian non-profit organization dedicated to providing health care and training in areas affected by emergency situations, sent a disaster team to japan within 48 hours to meet with government officials and begin assessing hospitals, government offices and identifying potential partners (terahata, 2011). while some health care non-profit organizations build their mission around an approach of relief of immediate needs, international medical corps focuses on building local capacity in a “relief to self-reliance” framework (international medical corps, 2011a). that is, instead of merely providing aid in emergency situations, international medical corps focuses upon building or rebuilding the health care structures of devastated areas. over the last 25 years, international medical corps has responded to many of the greatest humanitarian disasters, including the soviet invasion of afghanistan, the famine in somalia, the genocides in rwanda, bosnia and darfur, the conflicts in the democratic republic of congo and iraq, the indian ocean tsunami, the earthquakes in pakistan and haiti and most recently conflict in libya and the drought in east africa. since its founding in 1984, international medical corps has delivered more than $1.1 billion in program services and training to tens of millions of people in more than 65 countries on four continents (international medical corps, 2011a). international medical corps participates in a wide range of global collaborations. in 2011, it was a co-chair of the inter-agency standing committee’s global health cluster and is a part of the policy and strategy team of the world health organization. it participated in the global humanitarian platform, which brings together ngos, the united nations, and red cross and red crescent. it is also active in a wide-range of ngo coalitions and networks, including interaction, the international council of voluntary agencies, and the humanitarian caucus of the global health council. des marias, bhadra, dyer/in the wake of japan’s triple disaster 345 in light of its goal of building health care capacity with the active involvement of its partners, international medical corps first collaborated with the government of japan on how to interface with local partners. international medical corps was paired with tokyo english lifeline, a phone line counseling service that provides services to foreigner communities. with its partner, international medical corps then worked to build further relationships with other agencies, both in tokyo and within the affected area, while also performing a needs assessment to identify potential areas for collaboration that matched both international medical corps’ expertise and the needs of the local communities. in the first few days, it became clear that there were a variety of hurdles to be overcome, including difficulty in reaching the affected area due to fuel shortages and damage to transportation infrastructure, difficulties in obtaining accurate information, and lack of communication equipment between evacuation centers and prefectural offices (terahata, 2011). thus, in the first days, it was difficult to reach the affected area. as the days wore on, international medical corps prioritized work with local agencies and nonprofits engaging in relief efforts (terahata, 2011). the international medical corps team met with miyagi prefecture officials, administrators at local hospitals, evacuation centers, city council members, search and rescue teams, the prefectural health response coordinator, and attended japan platform and janic meetings (terahata, 2011). this first phase of intervention focused on relief efforts. international medical corps worked to improve data and communication infrastructure by providing prefectural offices, regional coordination centers, and evacuation centers with computers and data cards (terahata, 2011). working with local partners, the disaster team also provided and dispersed medical supplies and hot meals to over 20,000 people living in five evacuation centers (terahata, 2011). japanese ngos were also supplied with rental cars and computers to build their capacity to provide health services in the affected area (terahata, 2011). as the needs assessment reached completion, international medical corps then began to move its focus to capacity building. adhering to the inter-agency standing committee’s guidelines for mental health and psychosocial support (iasc, 2007), international medical corps engaged with its partners to build capacity for mental health support. these included, at the request of the japanese government, partnering with the tokyo english lifeline (tell) to start the cascade of training the trainers for psychological first aid (pfa), and a sensitization to psychosocial support needs workshop hosted by tohoku university’s graduate school of education in sendai, japan. psychological first aid and psychosocial support psychological first aid (pfa) is the most accepted approach widely used to facilitate psychological healing of the survivors of any disaster or critical event. in international guidelines, the provision of pfa is recommended for survivors as well as for the disaster intervention workers. “psychological first aid is an evidence-informed modular approach for assisting children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism. psychological first aid is designed to reduce the advances in social work, summer 2012, 13(2) 346 initial distress caused by traumatic events, and to foster shortand long-term adaptive functioning” (national child traumatic stress network and national center for ptsd, september, 2005). there is a range of standards for which persons should practice psychological first aid, but the essential principle is that the person should be trained in psychological first aid and be supervised by a mental health professional. psychological first aid is a culturally competent approach and is applicable across populations of different age groups. the inter-agency standing committee’s (iasc) mental health and psychosocial support (mhpss) guidelines recommend making available psychological support for survivors of extreme stressors (inter agency standing committee (iasc), 2007). the guidelines also outline the basic features of pfa. psychological first aid identifies key techniques for helping survivors of mass trauma including: 1) protecting them from further harm; 2) providing opportunities for survivors to talk; 3) listening carefully, patiently, and conveying genuine compassion; 4) identifying and providing basic needs; 5) encouraging positive coping and participation in daily routine activities; and 6) facilitating local support mechanisms. the personnel trained in providing pfa are also encouraged to consider mental health referral in the case of higher distress or for the vulnerable sections of the surviving community. psychosocial support for disaster survivors is a range of work that has gained a lot of momentum as a disaster intervention in the past two decades and subsequently more importance is given to facilitate psychosocial recovery of the survivors. psychosocial support is “any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder” (iasc, 2007). in the 2011 sphere handbook, psychosocial support is considered as one of the important cross cutting themes, a step forward from the previous version in which psychosocial support was considered under health sector interventions. “some of the greatest sources of vulnerability and suffering in disasters arise from the complex emotional, social, physical and spiritual effects of disasters” (sphere project, 2011) that need to be supported with a structured psychosocial support program. the guidelines for mental health and psychosocial support in emergency settings (iasc, 2007) considered four aspects as core to psychosocial support interventions, namely 1) community mobilization and support, 2) health services, 3) education, and 4) dissemination of information. community mobilization focuses on developing community participatory processes of recovery, developing self-help among the survivors, resiliency-building activities, and culturally appropriate methods of healing practices. in contrast, approaches within the health sector emphasize integrating mental health support into the general health care system by multiple layers of training of health professionals, facilitating specialized care for the mentally ill, collaborating with local mental health resources, and reducing the harmful use of alcohol and substance use. regarding educational intervention, safe and supportive education should be promoted. providing the right information at the right time is an important precondition as lack of actual information causes stress and worry for survivors. further, giving practical and appropriate information can ensure actual use of resources as well as providing knowledge to the survivors about their future. the community based psychosocial support training manual describing psychosocial support refers to the des marias, bhadra, dyer/in the wake of japan’s triple disaster 347 dynamic relationship between the psychological and social dimension of a person, where the one influences the other (international federation reference centre, 2009). the psychological dimension includes the internal, emotional and thought processes, feelings and reactions. the social dimension includes relationships, family and community networks, social values and cultural practices. psychosocial support refers to the actions that address both the psychological and social needs of individuals (hansen, 2008). the provision of psychosocial support ensures reduction of distress, associated disability and facilitate psychosocial wellbeing. psychosocial wellbeing is considered as a combination of three domains of human life: 1) human capital (which deals with physical and mental health and an individual’s capacity to realize his own strength); 2) social ecology (social connections, networks, and relationships that promote cohesion and equilibrium in society); and 3) culture and values (societal norms and behavior connected with social expectations) (psychosocial working group, 2003). psychosocial wellbeing is largely connected with environmental, economic and physical resources that support existence and wellbeing (psychosocial working group, 2003). psychosocial support strategies in india and japan psychosocial support, while being accepted as the most crucial aspect of psychological recovery for the disaster survivors across the world, equally stresses cultural adaptability in the approach. the indian ocean tsunami of 2004 was a unique disaster impacting about seven countries that lead to a major change and wider acceptance of psychosocial support activity at this region. for a long period of time, psychosocial support was meshed with the identification and treatment of patients with severe mental disorders, which was replaced with the community-oriented approach that focused on wellness rather than illness and proved that, for every survivor of disaster who are exhibiting higher stress reactions, mental health support is needed. this was a major paradigm shift from the medical model to the psychosocial model (satapathy & bhadra, 2009). india was one among the worst hit countries in south asian tsunami of 2004 and focused a great deal on the facilitation of large-scale mental health care in communities and schools by mobilizing large numbers of volunteers and workers from different government departments as well as by continuous capacity building and follow-up (world health organization, 2006). india, being a developing nation, was clearly in need of multiple supports for rebuilding and, as is generally the case, a huge international response arrived that mainly prioritized the physical needs. mental health and psychosocial support was still not a focus outside of a few international organizations. the national institute of mental health and neurosciences in bangalore (nimhans), being the premier institute and nodal center for psychosocial support, took a major initiative of facilitating technical support for psychosocial work with national, international and government organizations (sekar, 2006). as a basic strategy of work for psychosocial support, local ngos and government departments were engaged through the involvement of a large number of community level workers (e.g. teachers, child care personnel, health workers, community leaders, representatives of local self-government, student volunteers, volunteers from different forum, self help group members, members of religious institutions). it was this active interest and engagement of the survivors in the program that lead to an agenda for long-term support. during this phase it was also advances in social work, summer 2012, 13(2) 348 realized by the indian government that lack of accepted indian guidelines hampered the flow of services and desired outcome that called for immediate government action for national level guidelines on mental health services and psychosocial support for disaster response (government of india, december, 2009). indian coastal communities and administrative systems were grossly unaware of the tsunami and an absolute lack of a warning system caused a major damage and vulnerability even after the disaster. the long-term psychosocial support program supported by various funding sources showed a major change in the condition and created awareness about wellbeing, practicing safety measures, and developing community strength to deal with adversity. japan, one of the countries most prepared for disaster, has a long history of withstanding multiple disasters and has developed a strong system of governance to deal with the effects of disaster. japan is well equipped with a tsunami-warning infrastructure along with earthquake and flood safety measures, and its core knowledge and skill have progressed far ahead of many asian countries in its technology and its implementation. the government of japan, as well as local professionals, has dealt with a number of disasters events very effectively. it is considered a model for dealing with adversity by developing resiliency within its communities. therefore, community engagement in disaster safety measures and disaster preparedness is a practiced approach in japan. however, the triple disaster that stuck northern japan was much more than what its communities were prepared for. in these overwhelming events, psychosocial support for the community becomes a critical need as the disasters shook the confidence of the communities. usually, the physical aspect of disaster preparedness ensures a major psychological strength that encourages the survivors to deal with the adversities. the triple disaster exposed survivors to conditions they were unable to cope with, namely the traumatic experience and the need for external support (levin, 2011). the experience of international medical corps in responding to tsunami survivors worldwide has shown that the community-based mental health care and support for the disaster survivors is not a widely practiced approach; hence the clinical infrastructure wouldn’t be sufficient to deal with the emotional needs of the survivors. further, for all people, emotional needs can be immense in cases of traumatic experiences, grief, or loss, irrespective of the advancement of the society in socioeconomic or technological spheres. therefore, the applicability and essence of community-based psychosocial support to reach out to all the survivors to facilitate mental health care should have some similarity to the 2004 indian tsunami experience. a comparison between india and japan regarding post-tsunami psychosocial support would suggest that the indian model of psychosocial support that worked at individual, family, and community level through various interventions would also be effective in japan, as many cultural factors are similar, such as strong community and family relationships, living with extended family networks, family decision-making processes and cohesive living. at the individual level, the sense of responsibility to family members is very high and gender roles are more defined; thus, it is likely there are similar pattern of stress among the survivors in both countries. hence, a model of psychosocial support that encourages rebuilding the eroded support system, reducing stress reactions, des marias, bhadra, dyer/in the wake of japan’s triple disaster 349 encouraging positive coping, restoring normalcy, and developing sustainable communitybased mental health care is crucial. however, there are also cultural differences that must be considered. first, india is an amalgam of ethnicities and religious orientations with two official languages and multiple regional languages. japan, on the other hand, is homogeneous with 98.5% of the population being ethnic japanese. there is of course regional distinction and pride in japan, but this has resulted in little overt competition between groups. while this amount of social cohesion leads to accusations of over-conformity by critics, it appears to have been a factor in community resilience in the case of the triple disaster. unlike many disasters, there has been no rioting, and only minor instances of looting. while there is no clear evidence of how these cultural differences would affect the implementation of a psychological first aid or psychosocial support program, it is important that iasc guidelines for cultural respect and inclusion of local organizations and groups be kept in the forefront. another key distinction between the cases of india and japan is the level of health care infrastructure between the two countries. japan in relation to india has a much more developed health care system. in the 2000 ranking by the world health organization (2000), japan ranked in the top ten while india was ranked much lower on the scale. thus, while the dissemination innovations spearheaded by nimhans were fitting for the indian context, it is likely that adjustments would need to be made based on the differing context of japan’s public health system. implementation of psychological first aid and psychosocial support international medical corps’ needs assessment identified need in the area of building capacity for managing psychological stresses resulting from the triple disaster. as one of the key factors in successful implementation of mental health and psychosocial support programs is that the programs be shaped by the needs of the community, it was incumbent upon international medical corps to work with its local partners during this phase. key facets of this stage involved starting the “cascade” of the training of the trainers model for psychological first aid and organizing a sensitization workshop for psychosocial support for teachers, community and school mental health practitioners, and graduate students offering volunteer support to survivors and relief workers. cascading training of trainers psychological first aid is an evidence-based practice that is designed for immediate implementation after a disaster. it is designed in such a way that training is efficient and practical, allowing it to be spread quickly and widely. it uses a training of trainers (tot) model, ideally creating a cascade that results in implementation on a meaningful scale. once the training is completed, participants have an understanding of how to deliver pfa, how to engage with survivors, how to address safety and comfort, stabilization, gathering information from survivors, providing practical assistance, advances in social work, summer 2012, 13(2) 350 utilizing social supports, coping, and self-care to prevent secondary trauma for the care providers (brymer, et al, 2006). an international medical corps advisor in mental health and psychosocial support (mhpss) was sent to japan to train the tokyo english lifeline (tell) counselors in pfa and to guide the first phase of the intervention. once the counselors at tell had completed the training, they were then able to offer appropriate support to their client base and tell was able to begin training others in the affected communities. while the preliminary training occurred in tokyo, the next trainings were more directly focused on care providers in the disaster area. as tell gained confidence with the material and the training, responsibility shifted to their organization to carry on the training of trainers model. tell integrated iasc guidelines into their training curriculum through the pfa trainings. when tell took over the training, they quickly began training a wide range of volunteers, phone counselors, company employees, teachers, and parents. international medical corps supported these capacity efforts by funding nine workshops for 150 employees on coping strategies and eight workshops for parents and teachers focused on creating supportive environments for children after disaster (terahata, 2011). sensitization to psychosocial support conference while psychological first aid is appropriate for immediate responses to psychological and emotional needs after a disaster, longer-term psychosocial needs become evident after the initial stages of disaster. thus, at the request of the graduate school of education of tohoku university, international medical corps and tokyo english lifeline worked in collaboration to hold a two-day conference geared for sensitizing school teachers, community-level mental health workers, social workers, clinical psychology graduate students, academics, and other community members on what might be expected in terms of helping children in the middle term of the next few months and over the long term of the next few years. the team that organized and presented the conference consisted of mental health practitioners and faculty from india, the united states, and japan who all have expertise and experience in interventions for managing the psychosocial needs of adults and children who have faced traumatic experiences. while much of the material covered was perhaps not new to this specific audience, in the words of one of the conference organizers, the workshop, “gave us hope.” that is, it helped reassure them in their own abilities and knowledge base in dealing with overwhelming amount of work to be done, and showed them that they are not alone in dealing with the trials and tribulations of natural disasters. the first day of the workshop provided a basic overview of range of considerations that arise after a disaster, focusing specifically on the psychosocial needs of survivors. sessions focused on outlining lessons learned from previous disasters including what to expect in terms of the epidemiology of trauma, the stages of grief, life skills for disaster, an introduction to psychological first aid and psychosocial support, and delineation between clinical-level mental health care versus psychosocial support techniques (bhadra & kasi, 2011; bharath, 2011; dyer, 2011). des marias, bhadra, dyer/in the wake of japan’s triple disaster 351 the second day of the workshop reinforced and expanded many of the ideas presented on the first day. the humanitarian charter and minimum standards in disaster response (which defines standards for humanitarian response and rights of survivors) and iasc guidelines for mental health and psychosocial support were presented, highlighting that the guidelines were not treatment manuals, but a baseline from which to start (iasc, 2007; sphere project, 2011). further sessions focused on children’s stages and expression of grief, creating classroom environments that helping children heal from trauma as opposed to punishing them for acting out, and differentiating between clinically significant posttraumatic stress syndrome (ptsd) and stress as a “normal reaction to abnormal circumstances” (bhadra, 2011; bharath, 2011; des marais, 2011; dyer, 2011, kasi, 2011). the final afternoon had four tracks. one track provided an experiential presentation for working with children by using art and play to help them express and process their emotion (bhadra, 2011). another track focused on life skills for managing stress from disaster (bharath, 2011). a third track provided a more in-depth exposure to pfa (takahashi, 2011a, 2011b). the final track, which focused on policy and planning, was based upon the experiences of the nimhans in managing psychosocial care in the early (days to weeks), middle (months), and long terms (years) of the response (dyer, 2011; kasi, 2011; kasi, bhadra, & dyer, 2007; kasi, dyer, & bhadra, 2011). it identified four stages of psychosocial care, moving from psychological first aid for the acute stages of the disaster, to psychosocial support and psychosocial care for managing longer terms symptoms of trauma, and finally the stage of psychosocial rehabilitation for those experiences the more extreme cases of ptsd. this track provided policy makers with a way to look forward and begin to prepare for the next stages of intervention. unlike the psychological first aid training, the conference was not designed as a train the trainers model. its purpose was to provide a frame and context for anticipating what issues are likely to arise in the middle and long terms and to examine possible options for addressing those mental health and psychosocial needs. especially important in terms of looking forward was the future policy considerations that were presented in track four. while the presenters’ previous experience in disaster management in india and china were designed to be helpful for the participants, there are a wide range of unknowns in any major catastrophe as well as gaps in knowledge regarding individual and community resilience in the face of disaster, managing stress and trauma, and cultural differences in dealing with psychosocial stress. advances in social work, summer 2012, 13(2) 352 figure 2. sensitization to psychosocial support sessions (this figure illustrates the sessions and tracks of the workshop.) day 1 day 2 time plenary sessions plenary sessions morning 11.00-11.10 11.101.45 11.45-2.15 12.151.00 welcome address introduction to imc and japan work nimhans at a glance introduction of tell a decade of disasters: lesson from indian and us experiences normalization of reactions 11.00-11.30 11.30-12.15 12.15-12.40 12.4001.00 to remember or to forget sphere and iasc guidelines on mhpss in emergency settings children, adolescents, and traumatic events: managing behaviors in the classroom ptsd or not? time plenary sessions workshops (02.00-05.00) afternoon 02.00-2.45 02.45-3.30 03.40-4.30 04.30-5.15 05.156.00 stages of grief and loss psychosocial support in disaster management (principles) psychosocial support in disaster management introduction to pfa introduction to life skills education track 1 pfa for disaster care track 2 life skills education track 3 working with children track 4 policies and programs 05.10-05.40 05.40-05.50 05.50-06.00 presentation by each group evaluation concluding remarks and thanks social work, disaster intervention, and international collaboration the definition of the social work profession given in the final document adopted at the general assemblies of iassw and ifsw in adelaide, australia in 2004 states the imperative of social workers to aid the survivors of disaster: the social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance wellbeing. utilizing theories of human behavior and social systems, social work intervenes at the points where people interact with their environments. principles des marias, bhadra, dyer/in the wake of japan’s triple disaster 353 of human rights and social justice are fundamental to social work. (sewpaul and jones, 2005, p. 218). in a disaster where death, destruction, and damage are common, human life is affected severely in many dimensions. the material needs of food, clothing, housing, livelihood and medical care are common, but there are a number of non-material needs, which must also be recognized to ensure the well-being of the survivors. disaster imposes problems not only for the survivors but also for government organizations, professionals, and others. therefore, disaster intervention work is a major problem solving effort to re-establish social support and human relationships to empower people to achieve a sense of well-being, necessitating trans-disciplinary collaboration. the core skills of social work are needed on these inter-professional teams, along with those of psychiatrists, physicians, nurses, psychologists, and other disaster workers to support the psychosocial well-being of the disaster survivors in different phases of the disaster, i.e. rescue, relief, rehabilitation and rebuilding (bhadra, 2010). social workers are particularly well-prepared for the rehabilitation phase, which is usually from three months until 1 to 2 years post-disaster. during this phase, there is a strong need for contextualized culturally appropriate materials, capacity building for psychosocial support/ psychological first aid (requiring clinically trained social workers and other master trainers), specialized program for the vulnerable (women, children, disabled, families with diseased member, etc), support for translation of the knowledge of capacity building to actual skills, stress management for the disaster intervention workers, and action research and case studies to develop more focused programs. in the case of the “healing a community” conference, the objective was towards enhancing the confidence of the participants to respond to the rehabilitation needs more effectively and efficiently. japan after the triple disaster as the case of japan’s triple disaster shows, even the most highly developed and well-prepared nations can be overwhelmed by cataclysmic events. in this case, an earthquake began a cascade of events that culminated in one of the worst nuclear disasters in history and the displacement of over 500,000 people. one year after the triple disaster, japan is on the road to recovery – everyone has been moved out of shelters, towns are being rebuilt, resettlement projects are being formulated, and even more advanced disaster preparations are being put in place. however, it is a long road, and without key international collaboration in the early stages, it is hard to imagine that japan would be even this far along. whether termed “wicked problems”, “cascades of failure”, or “complex emergencies”, when the resilience of social and ecological systems is overwhelmed by multiple stressors, interventions must be applied on multiple levels. while this paper highlights the development of one such set of collaborations that was geared specifically for reinforcing and increasing psychosocial support in the devastated tohoku region, it must be stressed that it occurred within a context of many other interventions also being put in place. volunteers, health and mental health practitioners, logistic specialists, government officials, and others from multiple nations, domestic and international nonadvances in social work, summer 2012, 13(2) 354 profit organizations, businesses, and civil society groups have all worked together for a common goal of the restoration of the tohoku region. looking at the broader context of increased globalization, continued population growth, depletion of non-renewable resources, losses in biodiversity, and predicted increases in natural disaster due to climate change, international and inter-professional collaboration are key to managing systems so that all people can flourish. no one country or profession possesses the resources, expertise, or wisdom to address these systemic issues on their own; the path to solutions lies in cooperative exchanges like those presented here. at the same time, it is important that these exchanges serve to reinforce local residents and support their decision-making capabilities. as is the case in japan’s triple disaster, those affected by the events should be the final arbiters of the evolution of these collaborations. references asian disaster reduction center, international recovery platform. 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(2011, march 30). top 5 most expensive disasters in history. accuweather.com. retrieved from http://www.accuweather.com/blogs/news/story/47459/top-5-mostexpensive-natural-d.asp. author note: address correspondence to: eric a. des marais, university of denver graduate school of social work, 2148 south high street, denver, co 80208. email: eric.desmarais@du.edu microsoft word ahmed _jv_1966-copyedit2 ______________ saleh ahmed is a doctoral student in the department of sociology, social work and anthropology at utah state university. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 358-374 development innovations through entrepreneurial microfinance and the attempt to achieve the united nations millennium development goals in bangladesh saleh ahmed abstract: as one of the countries in the global south, bangladesh has experienced numerous development challenges since its liberation in 1971. bangladesh has showcased how to fight against poverty and to initiate meaningful change and development in human lives. nobel prize (2006) winner grameen bank is one of the popular development innovations in the country. since the beginning of this bank in the early 1970s, microfinance and entrepreneurship development with small amounts of money have proliferated to nearly every corner of the globe with the paramount goal of alleviating global poverty and ensuring human development. like all other new social science techniques, the societal revolution brought about by microfinance expansion has left substantial room for refinement and further support by empirical evidence. this article critically evaluates a non-governmental initiative to empower extremely poor women through entrepreneurial microfinance, and examines the socioeconomic impacts in achieving the united nations millennium development goals (unmdgs). this article covers both primary and secondary information. the aim is to demonstrate how countries of the global south can use carefully designed microfinance projects to address major development challenges and meaningfully contribute to creating a more equal, humane society. keywords: bangladesh, extremely poor women, microfinance, smes, unmdgs background in the recent generations we have experienced enormous advances and development among the human societies, but still a large portion of world population is living in and struggling with poverty. with transitional economies and weak political institutions, many countries in global south are suffering from poverty, inequality and exclusion. in this context, microfinance has appeared as one of the effective development instruments to address these societal challenges. at the beginning of 1970s, microfinance meant giving a small amount of credit money to the poor people, but now the impact it produces goes beyond just business loans at hand. poor people use the financial resources for various purposes ranging from their daily living to expenses like entrepreneurship development or the associated costs for education or health. presently, in most of the cases, micro-financial services include services like loans, savings facilities, insurance, transfer payments, and even micro-pensions or micro-insurance. evidence from the millions of microfinance beneficiaries around the world shows that access to financial services helps poor people to increase their household incomes, build their assets, develop social networks and reduce their vulnerability to different forms of manmade or natural crises. microfinance has also had positive impacts on better nutrition intake and ahmed/ development innovations in bangladesh 359 improved health outcomes, such as higher immunization rates. several experiences demonstrate that access to microfinance helps people to plan for their future and also acts as an incentive to send their children to schools. microfinance has positive impacts on confidence building and helps women to confront gender inequalities (cgap, 2002). confronting many of the human development challenges in the global south, 189 world leaders signed the millennium declaration in september 2000, popularly known as the united nations millennium development goals (unmdg). unmdg aim was a world free of hunger, poverty and disease, and ‘human dignity for all’ (pimple, 2009). the millennium goals address multiple dimensions of poverty, including income poverty, hunger, and disease; lack of education, infrastructure and shelter; and gender exclusion and environmental degradation. these goals are particularly important in the global south, where the countries and societies are struggling with different forms of human suffering. unmdgs in a way initiate change in human lives so that they can prosper and live with dignity. microfinance can play a critical role in framing the solution in this context. it can enhance access to capital and at the same time can help to develop entrepreneurial capacity, and this enhanced capacity can contribute to achieve the millennium development goals. the initial timeline for these goals are 2015, when the world leaders would like to review how their development plans and goals have positively impacted the world population. the government of bangladesh has signed onto these goals. in recent years, the bangladeshi government’s annual development plans (adps) are aligned with the stated development targets of unmdgs. in countries like bangladesh, where a majority of the population are poor, it is very difficult for the traditional financial institutions to ensure loans for most loan applicants. for the poor it is most desirable if they can get collateral-free working capital loans to initiate their small and medium size enterprises (smes). in low-income developing countries, entrepreneurship and smes have been recognized as important factors that contribute to the local employment creations and economic development. smes and entrepreneurial microfinance are closely intertwined. without entrepreneurial microfinance it is difficult for the poor to initiate smes, and when they have both, the entrepreneurial microfinance and smes, they can work to increase their income and employability, accumulate assets, and contribute to their socioeconomic inclusion. all these factors together not only contribute to the lives of the beneficiaries, but also create multiplier impacts on the community. it creates local business and generates local consumer demand. in a typical rural community, smes also contribute to developing social relations or networks, civic engagement, community solidarity, and social capital (ssewamala, lombe, & curley, 2006). promotion of smes also work function as the ‘safety net’ for unemployed people, particularly in the societies where unemployment insurance is not available (tokman, 1996). in the low-income developing countries during droughts, grain stock may be depleted by ongoing consumption to the extent that little is left over for the next planting cycle, effectively cutting off the possibility of future consumption (mckenzie & woodruff, 2006). this creates food security problems and can contribute to generate a regional poverty trap, and in turn this poverty trap creates a continual dependence on external injections of resources such as food aid without the potential for a community to reach advances in social work, summer 2012, 13(2) 360 endogenously stable consumption/production equilibrium (adams & raymond, 2008; mckenzie & woodruff, 2006). therefore, it could be a way to break the poverty trap by encouraging smes through the entrepreneurial microfinance among the poor for ensuring their productivity surplus (varghese, 2005). this is the core argument why a country like bangladesh needs to pursue entrepreneurial microfinance as well as smes. in bangladesh the entrepreneurial microfinance through different microfinance programs has come to occupy a central place in poverty-oriented strategies. it has a number of features in common. it mostly aims to serve poor rural women; lend small amounts of money to individuals as members of groups, and rely on group liability for ensuring loan repayment. this can also subsidize the administrative costs rather than interest rates, and loans are repaid generally in weekly installments. apart from these, poor credit recipients also receive different types of capacity and skill development trainings (kabeer, 2001). during the last two decades, hundreds of nongovernment organizations (ngos) have emerged in bangladesh with the motivations to support poor rural women by providing collateral free small loans. these ngos also provide and organize various social services like social mobilization, health care, literacy and education, sanitation, water supply, agriculture, etc. grameen bank and brac (bangladesh rural advancement committee) are two of the most successful and the largest ngos in bangladesh that have created opportunities for the poor women to become small and medium entrepreneurs. in most of the cases smes made positive impacts on the women’s socioeconomic lives. however, the mechanism is also not out of criticism. it is not very uncommon that microfinance generates dependency on credit for poor women, and so they are trapped on the credit cycle, creating a new form of dependency and poverty. this paper highlights a case study from southwest bangladesh, where poverty is pervasive, and women are particularly in disadvantaged situations. the critical research question is to investigate how entrepreneurial microfinance is contributing to achieve the targets of unmdgs locally, and what are the mechanisms of this microfinance program. study area the regional focus of this paper is chuadanga district, which is in the southwest part of bangladesh (see figure 1). district is the smaller local administrative unit of central government. bangladesh is divided in 64 districts. chuadanga has an area of 1157.42 sq km (banglapedia, 2012). ahmed/ development innovations in bangladesh 361 figure 1: chuadanga district source: banglapedia (2012) one of the major spatial features of this district is that it has an international political border with india, which actually shapes the patterns and features of local economy and economic pattern, particularly for poor women, who are heavily dependent on crossborder smuggling (nawaz, 2007). there are not much local employment opportunities for the poor women. education is low among them and very few government services are available to them, so it is not surprising that they are involved with small-scale crossborder smuggling. usually they smuggle women cloths or salts. they usually have a hard time smuggling when the border security is strict, and without smuggling many have no way of earning income. they get entrapped with hunger and utmost poverty. these poor women usually have a very precarious socioeconomic life, which makes them very advances in social work, summer 2012, 13(2) 362 vulnerable to any forms of uncertainties. to some extent this region also suffers from a spatial poverty trap due to its remoteness, isolation and geographic positions. the major portions of the population are muslims and partly hindus. but poverty is relatively severe among the hindu minorities. most of the village people are dependent on farms, however, 37% of them are landless or the marginal farmers. they have very limited access to modern agriculture technologies. these districts or regions have multiple development barriers, such as local, regional, social, economic or even structural. government officials believe that they might not be able to achieve regional development targets due to the region’s backwardness. in this context, it is interesting to see how the region is behaving with the presence of entrepreneurial microfinance. these two contrasting scenarios therefore contribute to make this region a worthwhile study area for this type of research. project description like many other low-income countries in the global south, bangladesh also faces challenges to provide sufficient financial and institutional supports to its poor citizens. therefore ngo initiatives emerged as a response to this development gap. ngo initiatives became visible at the birth of bangladesh in 1971, when the country was severely devastated during its’ liberation war. reconstruction and humanitarian efforts were the initial agenda for the ngos. however, at that time there were almost no national ngos. most of the visible ngos were international humanitarian ngos. grameen bank or brac formed by the early 1970s with the same agenda as international humanitarian agencies. slowly national ngos became involved with different forms of development works. but the contemporary criticisms highlights that ngos are mostly interested to work with the moderate poor, who have least collateral or who have some forms of collateral to pay back the loan. the question arises then who and how will work for and with the extremely poor people, who have no forms of collateral. in places like in chuadanga a major share of poor people are extremely poor, and usually they don’t get any access to traditional ngos’ services. here the definitions of moderate and extreme poor follow the international standards: moderate are those who earn more than 2 usd in a day and extreme are those who earn less than 2 usd a day respectively. however, local people distinguish categories of poor people by their food security status: those who can eat twice a day are moderately poor and those who cannot afford even that are extremely poor (dietzel, 2006). jagorani chakra foundation (jcf) is one of the very few national ngos in southwest bangladesh, which works with the poorest segment of society, extremely poor women. project funding comes from a non-profit german organization “netz e.v.partnershaft fuer entwicklung u. gerechtigkeit” (in eng.: netz partnership for development and justice). this german organization has been working in bangladesh with several local ngos since 1989. their working philosophy is not to prescribe solutions to the people to get away from the poverty, but instead to support and encourage the initiatives of the underprivileged and their true will for meaningful and lasting change. ahmed/ development innovations in bangladesh 363 the name of the project is ‘extreme poor women’s development project’ (epwdp), and it involves different types of capacity building trainings with different objectives and contents. the ultimate goal is to increase the entrepreneurial capacity of extremely poor women and to empower them socially, economically and politically. as a whole the projects goals are very much similar to the targets of unmdg. the project itself was divided into two phases: first phase (from 2002 to 2006) – aimed to help the 3,300 poor women, who are particularly extremely poor. however, in most of these cases, female-headed households without any other income earner, poor, disabled and the poor from ethnic minorities were included in the target groups. apart from developing entrepreneurial capacities, the goal was also to improve their living condition by developing strong and self‐sustaining community based organizations (cbo). in the local understanding, cbo are the building structures, which are expected to be the center for all women’s social & entrepreneurial knowledge-sharing platforms. second phase was the consolidation phase (3 years from 2006 to 2009) – inclusion of at least 1,650 additional extremely poor women in total of 4,950 women in the established 33 cbo, and sustained with the process of institutional as well as individual level capacity building, so that even after the phase out, they women can sustain with their cbo and can share their knowledge on different aspects of their lives and challenges. this project involved different components such as a) normal credits, b) flexible credits, c) sanitation credits, d) different types of capacity building programs, and e) risks fund. brief discussions on these types of products are given below: a. normal credits are those credit amounts that were distributed among the women for initiating different forms of entrepreneurial activities. jcf used to charge 10% interest rate on the overall distributed capital money. according to jcf’s, 4% interest rate is used for maintaining the administrative cost, such as office maintenance, and staff salary, and 5% interest rate is used for service charge and adjustment with national inflation and rest 1% was reserved by jcf as part of r ‘risk fund’. risk fund is very much similar to micro-insurance concept, which is now becoming popular in different parts of the global south. b. flexible credits were new innovative credit products designed by jcf and netz. these products aimed for those extremely poor and vulnerable women, who didn’t agree to participate with any ngo microfinance programs due to the fear of weekly repayment. within the framework of flexible credit, women didn’t get any money in their hand, rather one jcf field staff used to go with the women to the market to buy any livestock; in most of the cases, their preference was for a cow. however, they could also choose goats, if they wished. after one year of maintaining that cow (or goat), the women could sell them and earn with some profits. then the women would pay back the capital money along with 10% interest. in most of the cases, the women can sell at least at double price. jcf provided them with relevant types of support trainings. but if in any case, there was any damage, such as the death of that animal, jcf refunded by buying another animal. the women didn’t pay anything for this. jcf named this concept as ‘asset transfer model’. advances in social work, summer 2012, 13(2) 364 c. ‘sanitation credit’ was interest free credit with the aim to make access to the poor to hygienic sanitary facilities. in rural localities, most of the poor households usually have unhygienic sanitary situations. in most of the cases they can’t afford the hygienic toilet, and they were not aware about the health hazards of unhygienic toilets. jcf encouraged the poor beneficiary women to avail themselves of this opportunity. the beneficiary women did not need to pay any cost for installation. participating women who took 100 taka (70 taka = 1 us$) as sanitation credit needed to pay the 2 taka per week. so if anyone took 500 taka as sanitation credit, then the beneficiary woman needed to pay (2*5 taka) 10 taka per week. this was actually additional money that the beneficiary women needed to pay back with her regular credit returns. sanitation credit was interest free. d. capacity building programs and skill development trainings were provided by jcf to ensure increased capacity of employment and overall empowerment. the spatial selection of any specific training depended on the choices of the beneficiaries based on the needs assessment of that specific location. e. risk funds are provided by jcf for use in any emergency situation, such as floods or losses in crops due to heavy monsoon rains. this was a type of microinsurance for poor women. however, in reality, availability of this fund was not very easy. the financial sources of ‘risk funds’ come from the women’s contribution through weekly interest and jcf contributions in emergency cases. at the first phase of the project the approximate number of beneficiaries was 3300 extremely poor women. 33 cbo were initially developed and the spatial locations of these cbo were decided based on the patterns of clients’ spatial distribution. in usual cases, 12-15 women initially formed a group, as this was a group-based initiative, which is quite similar to traditional micro-finance institutions (mfi). but on the contrary to other mfi, this project is a cbo focused initiative and usually 5-9 groups form a cbo. major concentration of project beneficiaries were near the border region (1-4 kilometers), which actually demonstrates jcf’s intention to work with and work for the extremely poor and vulnerable women and community. in the community, however, it is not possible for all women to take part with project activities or supports, as the number of extremely poor women is much higher than the institutional and financial capacities of jcf or netz. they actually followed a logical selection procedure for identifying the really socially and economically deprived and vulnerable women. the women who met the criteria for participation in this project were mostly those who had no cultivatable land or saleable assets and often are the sole provider of their families with a very small or irregular income. food insecurity was a common phenomenon among the project beneficiaries. apart from this project, there were also some other ngos, more particularly, brac (bangladesh rural advancement committee), asa (association for social advancement), caritas, grameen bank, janakallayan, palli unnayan sangsstha (rural development organization, in english), pratyasha, srijani, wave (welfare association for village environment), usha and intercooperation were active with the local people, ahmed/ development innovations in bangladesh 365 with the broader agenda of poverty reduction, increased employability and local economic development. however, most of them had no project particularly for extremely poor women in the specific area; rather they were focused on the moderately poor women. the beneficiary women of jcf’s project epwdp were closely involved with the annual planning, implementation and monitoring of the entire project. representatives from local government and local people were also aware about jcf’s involvements through different organized activities. by regulations, jcf sent each month their program update and outputs to the local government representative and netz country office in dhaka (bangladesh) as well as netz headquarter (hq) in germany. so government and netz hq are also informed with the progress of field activities. research questions and methods this research aimed to focus on two parallel issues: (1) how entrepreneurial microfinance works in a difficult situation when the community is excessively poor and the region suffers from the spatial poverty trap, and (2) how entrepreneurial microfinance contributed to achieve the targets of unmdg in this situation. to address these research questions, two types of data were collected: (1) primary data, and (2) secondary data. then each type of data was divided into two categories, such as (a) qualitative data and (b) quantitative data. the details of the data patterns are as follows: (1) primary data: a. qualitative data: the qualitative data were collected from the field discussion and interviews without any structured questionnaire. the inputs were enormous. the qualitative information gave an idea about several socio-cultural aspects of regional features, such as what are the reasons of regional poverty and why it matters for the women and what they would do if they get more financing. several group discussions along with discussions with single women were organized during the field research to identify the major feature of local poverty, with special emphasis on gender aspects. to identify the effectiveness of the jcf microcredit and support program in the local context, several pra (participatory rural appraisals) were also conducted among beneficiary women. in different times and in different places, informal discussions were also conducted with local people (men and women, who are not the beneficiaries of jcf program) about their thoughts regarding local employability and economy. this information was useful in different steps of the field research and report writing. without this acquired background information, it would be almost impossible to identify the background reasons of poverty and how jcf projects can contribute to achieve the targets of unmdg. b. quantitative data: the quantitative data were acquired from close-ended questionnaires. there were attempts to get information on various socioadvances in social work, summer 2012, 13(2) 366 economic aspects through close-ended questionnaire. final intention was to analyze this information to have a clear observation of the local scenarios. (2) secondary data: a. qualitative data: during the field research, several structured and unstructured interviews were done with concerned local experts on microfinance and rural development. these discussions helped to identify the relevant literatures and also contributed to develop research arguments and methodologies. b. quantitative data: secondary quantitative data and information were also used in this research work. for example, jagorani chakra along with netz country office conducted baseline surveys to identify the beneficiaries and to survey the “entire poverty scenario”. however, to conduct the questionnaire survey (collection of primary data: quantitative), the interviews were done with the beneficiary women. 5% women were taken as sample for the interview. the women were selected by following some systematic procedures, such as their level of income, their engagement with the jcf project, their location and their religious identity. in most of the cases the attempt was to avoid any forms of selection biases of the sample women. however, in some situations, few women were selected randomly, as they were identified as exceptional or interesting cases for this research. findings it is always a challenge for the countries like bangladesh to achieve major national and international development targets. entrepreneurial microfinance programs are not rare in bangladesh. but very few researches have yet addressed how entrepreneurial microfinance has contributed to achieve the targets of unmdg. the unmdg comprises 8 major goals: (1) end poverty and hunger, (2) universal education, (3) gender equality, (4) child health, (5) maternal health, (6) combat hiv/aids, (7) environmental sustainability, and (8) global partnership. detailed discussions of how entrepreneurial microfinance can contribute to achieve these goals are given below: mdg 1: eradicate poverty and hunger target: halve, between 1990 and 2015, the proportion of people whose income is lesser than $ 1 a day. bangladesh must reduce the proportion of population with income less than one us dollar (ppp) a day from 58.8% in 1990 to 29.4% by 2015 if bangladesh wants to achieve the mdg 1(undp, 2010a). however, bangladesh, especially the southwest part, will not achieve the targets by the desired timeline unless there are some additional interventions (undp, 2010b). in this context, projects like epwdp contributed directly to reduce extreme poverty by improving the income of poor women. previously in the epwdp area, most extremely poor women were involved only in household work or in some illegal work such as smuggling. but after, with the jcf project involvement, they have ahmed/ development innovations in bangladesh 367 engaged in different forms of wage employments along with different sme, like cattle rearing, small village shops and handicrafts. these entrepreneurial activities indicated women’s increased income and confidence and engagement with mainstream economic activities. the women reported that 96% of their investments were successful and profitworthy. however, the average income has also increased over the time. average income increased by 22% in 2009 compared to 2006 value. considering the per capita income per month, 8.7% beneficiaries have passed over the international poverty line of income per capita per month 1,125 taka (1 us$=70 taka). additionally the savings have also increased. figure 2: savings among the beneficiary women these types of income-related outcomes have also been confirmed by panjaitandrioadisuryo and cloud (1999), who identified bank rakyat indonesia (bri) clients’ incomes increased by 112%. this income increase helped the poor women to move above the poverty line. in people’s republic of china (prc), microfinance programs have helped lift 150 million people out of poverty since 1990 (united nations, 2005). it has been proved that the beneficiaries of microfinance, who mostly invested their credits as well as their savings to different types of sme, and had the opportunity to shift from precarious, low-paid daily jobs to more secured employment (simanowitz, 2003; zaman, 2000). epwdp opens the avenue for the poor rural women to engage themselves in different types of farm and non-farm activities. these types of engagements enhance the chances of employability and on the other hand ensure local food security. regionally chuadanga district suffers food insecurity problems. when this epwdp was started, 99% of beneficiaries took meals 2 times per day and 1% took 1 meal per day. 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2002 2006 2010 savings (taka) advances in social work, summer 2012, 13(2) 368 after 1 year, 47% beneficiary women took meals 3 times per day and only 53% could take meals 2 times a day. by mid-2007, 50% of microfinance members could eat more sufficient meals per day than before. however by 2009, all the members were able to secure three meals a day. this was a remarkable improvement regarding local food security. in another similar study chowdhury and bhuiya (2000) explained that usually microfinance borrowers suffer less from severe malnutrition (relative to the control group), and the extent of severe malnutrition declined as the length of membership increased. mdg 2: achieve universal primary education development regarding mdg 2, universal education, is based on a comparison of poor women before enrolling in the project and after enrolling in the project. it is clear that beneficiary women are more aware and keen to send their children to the school than before entering the program. as well, women who were fully illiterate, could neither read nor write, or even could not sign their own name, showed remarkable progress. due to their microfinance activities and related management works, they learned how to calculate small amounts of money, along with signing their names. the children of epwdp beneficiary women were likelier to attend and stay in school longer. student drop-out rates were also much lower than the other poor rural families. figure 3: present educational status of the family members greater access to financial services and increased incomes allow poor people to invest on their children’s future. 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% girls 0-5 years boys 0-5 years girls 6-10 years boys 610 years girls 1118 years boys 1118 years enrolled (%) not enrolled (%) ahmed/ development innovations in bangladesh 369 mdg 3: gender equality and women’s empowerment the abilities to borrow, save, and earn enhances poor women’s confidence by enabling them to better confront systemic gender inequities. cgap (2002) highlights different forms of empowerment across regions: a) in indonesia, female beneficiaries of bri were more likely than non-clients in the position to make joint decisions with their husbands concerning allocation of household money, children’s education, use of contraceptives and family size etc.; b) in nepal, 68% of women’s empowerment program members mentioned that they take their decisions on buying or selling property, sending daughters to school or family planning; c) in india, sewa clients have lobbied for higher wages, the rights of women in the informal sector, and resolving neighborhood issues; and d) in bangladesh, bolivia, nepal, the philippines and russia, clients of microfinance programs have run even for local government office and won. similarly, at this epwdp, the beneficiary women get skills or capacity building trainings that help them not only to develop their entrepreneurship or entrepreneurial capacities, but also prepare them for the lasting development. these trainings are quite versatile in nature and address different components of empowerment and gender equality. figure 4: offered capacity building trainings these types of skill development trainings and opportunities have direct positive impacts on the women’s empowerment. in addition to this, these trainings also help to develop women’s shock resiliency in response to unprecedented crises or vulnerabilities. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% advances in social work, summer 2012, 13(2) 370 figure 5: usefulness of received capacity development trainings skill development trainings and opportunities contributed in the jcf project area to develop social capital, awareness, peer-group mentoring and enhanced employment capacity. mdgs 4, 5 & 6: reduce child mortality; improve maternal health; and combat hiv/aids, malaria, and other diseases child mortality and maternal health are among some of the major development challenges in bangladesh, and the government has taken these issues very seriously. in recent years, there has been some demonstrable progress, even though outcomes vary across regions, communities, ethnic or minority groups. the maternal mortality ratio should be reduced by three-quarters between 1990 and 2015, if bangladesh is to achieve the mdgs 4, 5 & 6. vaccination is one of the major initiatives to reduce mother and child mortalities. in the epwdp out of 312 eligible cases pregnancy, 83% mothers were vaccinated while 17% mothers were not vaccinated. many of the components of mdg 4, 5 and 6 are closely interlinked with improved food security, increased income, access to health services and awareness. jcf epwdp participants have appeared to have better nutrition, living conditions, and preventive healthcare than comparable non-participant women. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ahmed/ development innovations in bangladesh 371 mdg 7: ensure environmental sustainability sanitation credit was an innovative concept of jcf, and this was also an important component of the entire project. sanitation credit directly contributes to achieve the unmdg 7. in rural bangladesh, the predominant sources of drinking water are tube‐wells, and these are often identified as the safe drinking water sources. in the project areas and among the beneficiaries, access to safe drinking water was 100%. the improved sanitation among the beneficiary households is evident from the fact that more than 4/5th of the households (82%) were using hygienic latrines against 9% in 2002 and 80% in 2006, 17% are using unhygienic latrines against 24% in 2002 and 16% in 2006. in addition, still 1% families are defecating in open places behind bushes or banks of the rivers compared to 67% in 2002 and 0.5% in 2006. mdgs 8: develop a global partnership for development providing financial services to the poor and development cooperation are some of the major components of mdg 8. in the local context, epwdp was the key to development of microenterprise operated by extremely poor women. jcf services allow the poor to produce products for the market. very often, these products are sold in extra-local markets and therefore, in a way, entrepreneurial microfinance enhances global and regional partnership for development. criticisms most of the ngo that work with microfinance are not immune to criticism. however, microfinance participants have experienced several generations of improvement. ngo programs have moved from microcredit, where the poor were given only interest-bearing credit to microfinance. participants now receive trainings to use credit. this concept got further improvement and it turned into micro-financial services, where poor people were offered not only credits or skill development trainings, but also services like microinsurance or awareness trainings for their rights to services. right now in many parts of the global south, this development product is known as rural financial services, where poor people get credit, training, supports (i.e. legal or health) and also are offered supports within the bigger framework of inclusive development strategy at the local and regional level. critics of microfinance might assume that epwdp created some forms of dependency among extremely poor women by continuous dependency on jcf credits or services. in addition to this, there were also some other areas of concern, such as: (a) weekly repayment schedule started usually a week after a credit was taken; (b) sometimes savings among the beneficiary extreme poor women were not sufficient for their sme development; (c) developing the capacity was never a linear process for every woman, e.g. the capacity to receive knowledge or to develop skills differs from person to person; (d) lack of motivations to participate in the offered training programs; (e) underutilization and mishandling of credit amounts by beneficiaries or project staffs. advances in social work, summer 2012, 13(2) 372 in addition, epwdp also suffered from several types of risks, such as probabilities of harmful consequences or unexpected losses (deaths, injuries, property, livelihoods, economic activity disrupted or environmental damaged) resulting from the interactions between natural or human induced hazards and vulnerable conditions. it was not certain whether the women could develop themselves within that time frame with proper management and leadership capacities. nevertheless women always faced societal risks due to the strict attitude of religion and local conservative rural culture regarding the interactions with others except their family members. summary jcf entrepreneurial microfinance demonstrates how development innovations can contribute to achieve the overarching unmdg. unmdg as a development framework are now an integral part of national annual development plans in bangladesh. without an innovative development approach, it will be difficult to achieve sustainable levels of human development among extremely poor women. the jcf project is subject to numerous criticisms and is not in perfect shape. this project as well as approach might go further with a number of refinements or improvements so that people can experience the benefits more holistically. this research addresses how to improve the quality of life and wellbeing of extremely poor women in a particular region that already suffers from a spatial poverty trap. jcf projects address the real and perceived social injustices and in some way the violations of basic human rights. in the case of bangladesh, the state has failed due to its limited financial and institutional capacity to ensure those basic human rights to its citizens. therefore, this project can be identified as a rights-based approach to development in the rural community. welfare and services are at the core of this concept. the work conducted by jcf, which included theories from different social science disciplines, demonstrates how to implement those theories into practice. different components of poverty influence each other in a typical rural community in bangladesh. this intra influence creates a spiral of insecurity, which produces multiple deprivations. deprivations usually begin with the loss of employment, which in turn leads to a significant degradation in living standards. this ultimately increases the risks of poverty and impoverishment. living in poverty creates additional difficulties in the search for employment and contributes to a long-term unemployment trap for many individuals. concurrence of unemployment and poverty are some of the major obstacles for victimized persons regarding their participation in social activities. due to the lack of money and social stigmas, social ties are weakened and that increases the risks of being socially isolated. extremely poor woman in the rural bangladesh are a precise example of this phenomenon. no single intervention can defeat poverty. therefore a continuous process of development innovation is necessary. poor people need employment, trainings, skills, schooling, and health care or some additional livelihoods supports. some extremely poor women might require immediate income transfers or relief to survive. this is not an exceptional phenomenon only in the global south. more developed societies also have ahmed/ development innovations in bangladesh 373 similar challenges. access to financial services and thereby entrepreneurship development, form the fundamental basis on which many of the other essential interventions depend. moreover, in practical situations, improvements in health care, nutritional advice and education can be sustained only when households have increased earnings and have greater access and control over financial resources. financial services, such as entrepreneurial microfinance thus reduce poverty and meaningfully contribute to reach the targets of unmdg, which are some of the major policy targets to ensure human development. however, even though there are some mixed experiences regarding the role of microfinance on entrepreneurship development and their combined impacts on achieving the unmdg, there is clear evidence from the findings that jcf projects and social commitments have enormous impact on the socioeconomic empowerment of extremely poor women. conceptually the project might have relevance in other parts of the world with similar socioeconomic context and challenges. references adams, j., & raymond, f. (2008). did yunus deserve the nobel peace prize: microfinance or macrofarce? journal of economic issues, 42(2), 435-443. banglapedia. (2012) chuadanga district. retrieved from http://www.banglapedia.org/httpdocs/ht/c_0260.htm cgap. (2002). helping to improve donor effectiveness in microfinance: microfinance and the millennium development goals. retrieved from http://www.cgap.org/gm/document-1.9.2422/donorbrief_09.pdf chowdhury, a.m.r., & bhuiya, a. (2000). do poverty alleviation programmes reduce inequality in health: the bangladesh experience. in d. leon & g. walt (eds.), poverty, inequality and health (pp. 312-332). oxford: oxford university press. dietzel, p. (2006): ein leben lang genug reis. in p. hesse (ed.), solidarität die ankommt ziel effizientemittelverwendung in der entwicklungszusammenarbeit. hamburg: global marshal plan initiative. kabeer, n. 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(2003). appraising the poverty outreach of microfinance: a review of the cgap poverty assessment tool (pat). retrieved from http://ageconsearch.umn.edu/bitstream/23743/1/op030001.pdf ssewamala, f. m., lombe, m., & curley, j. m. (2006). using individual development accounts for microenterprise development. journal of developmental entrepreneurship, 11(2), 117-131. tokman, v. (1996). regulation and the informal economy: micro-enterprises in chile, ecuador, and jamaica. boulder: lynne rienner publishers. united nations. (2005). un human development report 2005. new york: author. united nations development programme. (2010a). bangladesh. a baseline for needs assessment and costing. a situation analysis report on poverty and hunger (mdg 1). retrieved from http://www.undp.org.bd/projects/prodocs/prs_mdg/situation%20analysis_poverty %20and%20hunger.pdf united national development programme. (2010b). bangladesh. a baseline for needs assessment and costing. a situation analysis report on health (mdg 4,5 and 6). retrieved from http://www.undp.org.bd/projects/prodocs/prs_mdg/situation%20analysis_health.p df varghese, a. (2005). bank-moneylender linkage as an alternative to bank competition in rural credit markets. oxford economic papers, 57(2), 315-335. zaman, h. (2000). assessing the poverty and vulnerability impact of micro-credit in bangladesh: a case study of brac. retrieved from http://wwwwds.worldbank.org/external/default/wdscontentserver/iw3p/ib/1999/09/10/00009 4946_99082405303974/rendered/pdf/multi_page.pdf author note: address correspondence to: saleh ahmed, ph.d. student, department of sociology, social work & anthropology, utah state university, 0730 old main hill, logan, ut 84322-0730. e-mail: saleh.ahmed@aggiemail.usu.edu microsoft word rubin sw research copyedit final ______________ allen rubin, ph.d., holds the kantambu latting college professorship for leadership and change at the university of houston graduate college of social work in houston, tx. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 182-195 a half-century of social work research: advances and new challenges allen rubin abstract: this article provides an autobiographical account of the evolution and role of social work research since the beginning of my career as a social worker in the late 1960s. it traces the bumpy road from the days when the profession’s attitude about research was, at best, ambivalent to today’s emphasis on evidence-informed practice and empirically supported treatments. it ends by identifying several new challenges and their implications for future efforts to help further bridge the gap between research and practice in social work. keywords: social work research, evidence-informed practice, empirically supported treatments, bridging the research-practice gap by the time this special issue appears in print, it will be almost a half a century since i was earning my msw degree and beginning my career as a professional social worker. in discussing the evolution and role of research within the profession over these many years, it might help to begin with some of the research-related experiences i had at the start of my career – things that moved me to change from being exclusively a practitioner to pursuing a research focus in my career. those were the days when social workers and other mental health practitioners still embraced the notion that dysfunctional family dynamics and schizophrenogenic mothers were the prime and perhaps only cause of all mental illnesses, including psychotic disorders. years of absurdity in my first job as a social worker – in a community mental health program – i received in-service training in family therapy. the trainers were fond of saying things like, “there are no crazy people, only crazy families,” and “do not focus on any individual as the patient, just the family.” one of the published articles that my cotrainees and i were assigned to read was a case report written by a famous family therapist which focused on an incident in which the author wrote his initials on the shoes of a patient suffering from schizophrenia. he claimed that doing so was at least partially curative because by doing something absurd himself he helped the patient gain insight as to the absurdity of her own behavior. huh?! i wanted to believe what i read and become an effective therapist, but i could not get over my skepticism about it all and my sense that even if i accepted the ideas i was “learning,” i was not receiving enough specific guidance as to how to incorporate these things in my own practice. should i write ar on the shoes of my clients? should i engage in other absurd behavior with them? should i continue to try to get the parents of children with emotional problems to realize that the root of the child’s problem lay in their relationship with each other or in the way one or more of them related to their child, especially since my doing so did not seem to be helping the child? rubin/a half-century of social work research 183 my uneasiness with all this was compounded by the in-class behavior of my cotrainees who were accepting without question all that they were being told. after seeing films of family therapy sessions, for example, they sat starry eyed and praised what they had witnessed in the films. was i the only one in the class who did not get it? one day at the conclusion of a video i summoned the courage to ask the two prestigious psychiatrist trainers (the social worker trainer was not there that day), “what was the evidence supporting the effectiveness of the therapy sessions we had been watching?” they reacted by asking the rest of the class to discuss the personal dynamics that made me need so much certainty. that did it! i decided to enter the university of pittsburgh’s social work doctoral program so i could learn how to research the effectiveness of all this stuff. program evaluation: an avant-garde idea…really? during my doctoral education in social work i was fortunate to take a course taught by joe eaton, who at that time was considered a pioneer in program evaluation. i was struck by how avant-garde the notion was thought to be at that time that the outcomes of programs should be evaluated with rigorous research designs. why, more than six decades after mary richmond (1917) advocated the need for practice to be guided by research, was this notion considered to be avant-garde?! i was also struck by the lack of content in the course on overcoming the obstacles to being able to get practitioners and administrators to permit rigorous outcome studies to be implemented and successfully completed (without bias) in their real world practice settings. (i will return to this latter point shortly.) joel fischer and gerard hogarty: two evidence-based pioneer provocateurs those were the days when joel fischer jolted the social work profession with his provocative research review in social work suggesting that social casework was not effective (fischer, 1973). to many in our profession, at least those who did not want facts to get in the way of their cherished beliefs and vested interests, fischer was a pariah. but his review was backed up by several other reviews with similar conclusions (wood, 1978). slowly but surely, the profession began to learn about the need for critical thinking and questioning about the evidence supporting our beliefs and interventions, and realizing that being on the side of the angels was not enough – we needed to find out if our altruistic efforts were actually helping people. in fact, thanks to emerging outcome studies, the profession began to learn that sometimes our efforts – despite our best intentions – were harmful. perhaps the most influential social work researcher at that time whose work alerted the profession to this notion was gerard hogarty. although hogarty’s highest degree was his msw (he never pursued doctoral education), he had been completing rigorous randomized control trials (rcts) – well funded by nimh – on the impact of social casework and psychotropic medication on the course of schizophrenia. he found that when the casework was advances in social work, spring 2014, 15(1) 184 provided without medication, relapse was hastened. but when it was combined with medication, it helped (hogarty, 1979). given what we know now about the biological basis of schizophrenia, hogarty’s results might seem expectable and maybe even humdrum. but in those days many really believed that medication might not be needed and that psychosocial interventions might be sufficient. thus, learning that psychosocial intervention when provided alone might not only be insufficient, but actually harmful to people with schizophrenia, was quite an eye opener. hogarty followed those studies up with rigorous rcts showing that also harmful to clients with schizophrenia were interventions based on the notion that schizophrenia was rooted in faulty family dynamics. his research showed that to be helpful, we need to provide psychoeducational interventions that support families and help them learn how to cope with their relative’s biologically based disorder – rather than blame them for the disorder (anderson, reiss, & hogarty, 1986). a bumpy road given our current evidence-based practice (ebp) era, we have come a long way in the four decades since hogarty’s research impacted the way we help people suffering from schizophrenia and the people who love them and care for them. but it has been a bumpy transition. fast forwarding for a moment to 1998, nasw convened a national summit meeting with the purpose of uniting the diverse elements of our profession and identifying what issues and priorities social work organizations could agree upon. despite that unification purpose, in the summit’s keynote speech one of our profession’s most renown scholars said that he is “insulted” by the notion that we need to research the outcome of our efforts to provide care (rubin, 1999). returning to in the early 1970s, as i was completing my doctoral education on a parttime basis i got to know and briefly work with gerry hogarty when he accepted a position at the psychiatric institute that i would soon leave after completing my coursework. i was in awe of his work and felt i needed to get a lot more experience doing research before i deserved to teach it. but in seeking a career as a program evaluator, i found that nobody who wanted to hire me wanted me to carry out rigorous, unbiased studies that might not reflect well on the impact of their agency. instead, they wanted “program evaluators” whose “evaluations” would merely focus on crunching and massaging data to portray their agency in a favorable light. thus, my interest was piqued when my dissertation chair alerted me to a new position announcement from the council on social work education (cswe) to work on a nimhfunded national research project evaluating the ways in which schools of social work were implementing their nimh-funded community mental health curricula. the research purpose of the study attracted me to the position, but another attractive feature was that the position would help me learn whether i wanted to pursue a career in academia while giving me the research experience to feel more qualified to teach research. thus, i was delighted to be offered and to accept the position (although the prospect of moving from pittsburgh to new york was quite daunting. had i known that in 1977 i would end up rubin/a half-century of social work research 185 living a block away from the son of sam serial killer in yonkers, i guess it would have been significantly more daunting and with a strong effect size!) among the many things i learned from that experience pertained to the politics of program evaluation. a main conclusion of my study was that many schools of social work were merely using the nimh funds to increase their budgets without adding much community mental health content to their curricula. to my naïve surprise, the staff at nimh did not want to hear that their funds were not achieving their aims because they feared that if some members of congress were to read my report they would cut their funding for social work education. i had to soften the wording of my report in order for it to be published (rubin, 1979). a landmark project and two landmark conferences at the conclusion of that project, cswe assigned me to an nimh-funded project on research utilization. as i began to work on that project, i read emerging studies showing that social workers rarely examined research studies as a basis for informing their practice. instead, they preferred to be guided by professional consensus and the practice wisdom of respected consultants, supervisors, and revered clinical gurus (casselman, 1972; kirk & fischer, 1976; kirk, osmalov, & fischer, 1976; rosenblatt, 1968). i also learned that an extreme research-practice gap existed in social work education as well. research content was isolated in research courses and not being infused in other parts of the curriculum. practice courses, for example, were being taught without content on the empirical support (or lack thereof) for the practice methods and interventions being taught. practice instructors typically made little to no effort to show how research can and should inform practice decisions. the gap, however, existed not only in other parts of the curriculum, but also in the research curriculum itself. research courses were being taught in ways that had little relevance to practice and consequently little relevance to students, who took research courses only because they were required to do so. the research methods textbooks used in those courses typically were written by scholars from other disciplines, such as sociology, and contained very little in the way of social work illustrations and examples – and were devoid of social work practice applications. in fact, social work research courses often were taught by faculty members from other (social science) departments. what i learned and did on that project had a profound impact on my career as a social work researcher and educator – both in terms of the way i teach research and in the way i write about it. for example, it influenced me to write a research methods textbook loaded with social work research applications and social work practice applications. at the time of this writing that book is in its eighth edition and continues to be widely required in social work research courses (rubin & babbie, 2013). i have long appreciated the feedback i have received regarding the book’s impact in making social work research more relevant to students. one of the ways in which the project attempted to alleviate the research-practice gap in social work education was by convening a national conference and several regional advances in social work, spring 2014, 15(1) 186 conferences on research utilization. around the same time, in 1978, the national association of social workers (nasw) held a national conference on “the future of social work research,” which also intended to bridge the gap through a dialogue between leaders in social work research (who primarily worked in academia) and leaders from the social work practice community (fanshel, 1980). the attendees at these conferences developed strategies and tactics for bridging the gap between research and practice in the social work practice community as well as in social work education. by and large, the most emphasized recommendations pertained to the key features of the empirical clinical practice movement, which emerged in social work soon after the completion of the two national conferences. the empirical clinical practice movement a major aim of the empirical clinical practice movement was to bridge the gap between research and practice in social work education as well as in social work practice by providing students and practitioners with research tools and designs that they could use as part of their practice and to enhance their practice effectiveness. in fact, the movement provided a new social work practice model. called the empirical clinical practice model, it contained two major components: 1) employing single-case designs to idiographically evaluate one’s own effectiveness with each case; and 2) making practice decisions in light of the research evidence that can inform those decisions. of the above two key components of the model, the first – regarding single-case designs – received the most attention and stirred the most controversy. at that time, proponents of the model expressed a great deal of optimism that these designs would provide practitioners with a research tool that they would find feasible and useful. some schools of social work developed research courses devoted to these designs, while others revised their existing research courses to increase the amount of emphasis on these designs. several textbooks emerged devoted primarily to the use of these designs. however, the results of these efforts were disappointing. study after study found that social work practitioners who graduated from programs that emphasized the empirical clinical practice model rarely utilized single-case designs in their practice. those who wrote about this disappointing outcome at the time – mainly during the late 1980s and early 1990s – seemed to agree that the main reasons why more practitioners weren’t using those designs had to do with a lack of agency resources – especially regarding caseload sizes and time – necessary to implement the designs and a lack of administrative and supervisory support and incentives for implementing them (kirk & reid, 2002). sswr, iaswr, and the task force on social work research three other developments that occurred during the latter years of the 20th century impacted the way social work research is practiced and taught today: the emergence of the institute for the advancement of social work research (iaswr); the birth and growth of the society for social work and research (sswr); and the federal funding of the task force on social work research. those developments were interrelated in that they supported each other and attempted to improve the social work research enterprise – especially as defined by an increase in federal research grant applications. rubin/a half-century of social work research 187 the iaswr was born with seed money from the ford foundation and from the national institute of mental health (nimh). its main mission was to implement efforts to enhance the preparedness and inclination of social work faculty members and doctoral students to conduct rigorous research and compete for research grants from federal funding sources. the iaswr lasted for about a decade before funding losses caused its demise. one reason for those funding losses was the success of sswr, which eventually duplicated the efforts of iaswr. at the same time that nimh provided seed money for iaswr it provided seed money for the birth of sswr, which became the first professional membership organization for social work researchers per se. as a charter member of sswr – as well as its second vice president, third president, and later board member – i observed the way it grew and evolved. sswr was born at a small charter conference held in washington, dc in 1994. two years after that conference some of my colleagues and i wondered whether it still existed. i learned that it did still exist upon receiving a phone call from a dear colleague, tony tripodi, asking if i would support his nomination to become its second president, succeeding its first president and sswr founder: janet williams. i enthusiastically agreed to do so. shortly after that i received another phone call, this one from a sswr board member asking me to agree to be the other nominee for sswr president. i declined, noting that i had already promised tony that i would support him. the caller then asked if i would agree to be nominated to run for the vice presidency, and to that i agreed. one of my key influences on the growth of sswr was to persuade tony and other board members that if the organization was to survive and grow, it needed to convene an annual sswr conference. during the next three years, several of my colleagues on the sswr board and i volunteered an enormous amount of time and effort in pulling off these annual conferences, which turned out to be huge successes in building the financial base enabling sswr to become what it is today. by the end of the 1990s, its membership had quadrupled from its initial 250 charter members, and the registration fees from its conferences provided the resources for later board members to hire professional conference planners to do the work that we had volunteered during sswr’s early years. as sswr’s membership grew and became more diverse, so did its mission. instead of focusing primarily on an opportunity for social work researchers to share their works, it became more and more like the cswe annual conferences. for example, at the early sswr conferences, the focus was exclusively on attending the session presentations. today, however, many of the hundreds of attendees are doctoral students seeking faculty positions and deans and faculty members who focus much of their time at the conference on scouting and interviewing prospects for faculty positions. another way in which sswr evolved was to increase its efforts to duplicate (and eventually replace) iaswr efforts to promote federal funding of social work research grant applications and to increase the number of such applications being submitted by social workers. during sswr’s early years during the 1990s these efforts were enhanced by the work of an nimh-funded task force on social work research, chaired by david advances in social work, spring 2014, 15(1) 188 austin. as david’s faculty colleague at the time, and in my leadership roles in sswr, i was kept well informed of the task force’s efforts. one of the task force’s successes was in promoting the nimh funding of research development centers in a handful of prestigious schools of social work. by improving the research infrastructure in those schools, nimh and the task force sought to increase the submission of competitive mental health research grant proposals from social work researchers. today we see an increased submission of such proposals from social work faculty members, especially from those in research 1 universities. it is debatable, however, whether the impetus for this increase came primarily from the work of the above nimh-funded efforts versus the increased pressure from university administrators on deans of schools of social work to bring in more research funding. i suspect that the latter pressure had the greater impact, especially when i hear about some deans today telling their junior faculty that securing a well-funded research grant is a prerequisite for getting tenured. in my opinion, this trend has a downside to which i shall return in the final section of this article. the ebp movement and empirically supported treatments (ests) i am going to assume that the readers of this issue already are familiar with concept of ebp and don’t need me to go over its definition and procedural steps. instead, i will discuss it in terms of its implications for the focus of this article: advances and emerging challenges in social work research. i’ll consider the advances first. the ebp movement has influenced the nature of social work education and practice. in several surveys that i conducted pertaining to ebp, my coauthor danielle parrish and i found grounds for optimism that more and more social work educators and practitioners these days favor the notion that professional practice decisions should be informed by scientific evidence (parrish & rubin, 2012; rubin, 2007; rubin & parrish, 2007). as one outcome of a national symposium that i organized and led in 2006 on improving the teaching of ebp, cswe increased its emphasis on ebp in its educational and policy accreditation standards (rubin, 2007). one of the foci of that conference was the need to distinguish between ebp and ests. the former is a process for the purpose of having one’s practice informed by empirical evidence. the latter is a type of empirical evidence that one may find. the emphasis we see today among funding sources and agencies regarding developing and selecting policies, programs and interventions based on their empirical support (often in the form of ests) suggests that we have come a long way since the start of my career, when my asking an instructor about evidence prompted him to question my neediness! these are indeed exciting times! rigorous systematic reviews and meta-analyses – including but not limited to those sponsored by the cochrane and campbell collaborations – are making it easier for practitioners to be guided by research supporting the effectiveness of programs and interventions for more and more problems that rubin/a half-century of social work research 189 confront social workers and other helping professionals. some of the programs and interventions with at least promising empirical support are as follows:  for adults with ptsd or other anxiety-related disorders we have prolonged exposure therapy, cognitive processing therapy, and emdr  for traumatized children we have trauma-focused cognitive behavior therapy (tfcbt)  for substance use disorders we have motivational interviewing, cognitive behavioral skills training, and seeking safety  for borderline personality disorders there is dialectical behavioral therapy  for people with schizophrenia or their families we have psychoeducational family groups, cognitive behavioral therapy, assertive community treatment, supported employment, and critical time intervention  for families at risk for child maltreatment there are programs like the incredible years, parent-child interaction therapy, and triple-p  for depression we have interpersonal therapy and cbt information about many of these interventions is now available at the click of a mouse, as many intervention manuals and support materials are provided online. moreover, practitioners no longer have to go to a university library to obtain access to books or journal articles – almost all of this information is available remotely at one’s home or office on various websites and public libraries. in addition, i have co-edited a series of volumes summarizing the evidence-base for these programs and interventions as well as guidelines for practitioners who want to employ them (see, for example, rubin, springer, & trawver, 2010). new challenges: implementation science despite the great strides that have been made regarding evidence-based practice and the promising implications of those strides for bridging the gap between research and practice, however, the gap is still wide. various studies have found that ests often are being implemented inappropriately and with unsuccessful outcomes in the real world practice of social work and allied professions (embry & biglan, 2008). the emerging field of implementation science is developing recommendations for alleviating this problem by studying factors associated with whether ests are implemented properly and with good outcomes. for example, some of the recommendations include utilizing respected peer opinion leaders to persuade practitioners as to the value of implementing the est and providing ongoing coaching to help maintain the practitioner enthusiasm and self efficacy regarding the est (damschroder et al., 2009; embry & biglan, 2008; glisson & schoenwald, 2005; weisz, ugueto, herren, afienko, & ruff, 2011). one challenge for the future of social work research involves conducting studies to learn more about such factors – especially in real world social work practice settings. i’ll return to this issue later. advances in social work, spring 2014, 15(1) 190 new challenges: common factors a school of thought has emerged in recent years that argues that engaging in the ebp process to try to select ests is a waste of time because common factors, such as the relationship skills of the practitioner and the quality of the treatment alliance, have a much greater impact on treatment outcome than does the choice of intervention. in its extreme form, this argument is referred to as the dodo bird verdict (from alice in wonderland), in which all are winners. the dodo bird verdict argues that the choice of intervention has no bearing whatsoever on treatment outcome. one problem with the dodo bird verdict is that it is based on a controversial metaanalysis (wampold, 2001) that has been criticized for its methodology and has not been supported by some other meta-analyses (beutler, 2002; craighead, sheets, & bjornsson, 2005; lilienfeld, 2007). a less extreme form of the common factors argument maintains that the choice of intervention has some impact on outcome, but its impact is much weaker than the impact of common factors (graybeal, 2007). although i am skeptical about the dodo bird argument and its more moderate version, i believe that we need more research on this issue to settle the argument. for the time being, however, we should recognize that the either/or argument of common factors versus choice of intervention is a false dichotomy. as is evident in every est treatment manual that i have examined, a good therapeutic alliance is emphasized as a prerequisite for an est’s success. indeed, every one of these manuals identifies establishing a good treatment alliance as an important and necessary component of the est itself! thus, recognizing the importance of common factors need not demean the importance of choice of intervention. new challenges: common elements another emerging line of inquiry involves identifying the core essential and indispensible elements of each est as well as their adaptable elements. the purpose of doing so is to give practitioners more flexibility to make the est fit their organization and clientele and also reduce the costs of practitioner training (galinsky, fraser, day, & rothman, 2013; sundell, ferrer-wreder, & fraser, 2012). part of the rationale for the common elements approach is the recognition that even when ests are implemented with good fidelity, they often have unsuccessful outcomes because the est’s ideal treatment conditions and relatively homogeneous clientele differ significantly from the far less than ideal treatment conditions and very diverse clientele in real world practice settings (weisz et al., 2011). although the common elements approach holds promise for improving the effectiveness of social workers in real world practice settings, it also poses some risks. for example, two intervention approaches with substantial empirical support for treating trauma symptoms are exposure therapy and cognitive processing therapy. and yet, in a meta-analysis aimed at identifying the common elements for effectively treating “disruptive behavior and traumatic stress among adolescent girls,” bender and bright (2011) omitted any mention of those two approaches in their identification of eight common elements in which practitioners working with such girls should be trained. rubin/a half-century of social work research 191 instead, they recommended only that practitioners be trained in: goal setting, monitoring, communication skills, praise, problem solving, psychoeducation with parents, social skills training, and tangible rewards. in seeking to understand how these two capable researchers could have made such an important omission, i surmise it is because of the broadness of their search boundaries. by combining disruptive behaviors with traumatic stress in their search, the proportion of the 430 rcts they reviewed that dealt with disruptive behavior only perhaps far outweighed the proportion of rcts that focused exclusively on traumatic stress. that would explain why the eight common elements that they identified appeared much more frequently, across far more studies, than the ests for traumatic stress. (i surmise that there are far more ests on behavioral interventions for various behavior problems than there are for traumatic stress only.) consequently, i recommend in our future research on common elements that we keep the search boundaries narrow, such as limiting the search to a single est and looking at what elements of the est need to be kept across different practice settings and target clientele, which elements can be adapted, and which (if any) elements need not be kept at all. or we might aim to identify the common elements across a few ests that target the same problem. but to the extent that we broaden the number of ests and target problems in our search we risk omitting some important intervention approaches from our list of the elements that appear most frequently in the studies we find. new challenges: an inductive strategy for researching adaptations of ests in real world social work practice settings earlier i mentioned the need to study factors associated with whether ests are implemented with fidelity and good outcomes in real world social work practice settings. however, as suggested above, even when ests are implemented with fidelity in real world settings their outcomes might be disappointing because the ideal rct conditions under which they gained their research support may have limited transferability to real world social work practice settings. in those rcts, their effectiveness typically is assessed with the intervention being provided by practitioners who are well trained and closely supervised – perhaps by those who developed the intervention and their key associates – and who have small caseload sizes and relatively homogeneous clientele. expensive training and expensive supervision – as well as low caseload sizes with homogeneous clientele – are likely to be infeasible and unaffordable in most real world social work practice settings. therefore, we need to investigate the conditions under which adaptations of ests in real world social work settings are and are not effective. we need to assess variability in outcome associated with such variables as:  how ests are tweaked to fit the setting  clientele and practitioner characteristics  nature of training and supervision advances in social work, spring 2014, 15(1) 192  agency resources and other characteristics (including caseload sizes) given the significant practical obstacles, it is hard to imagine using rct designs to conduct such investigations in real world social work practice settings. however, control group designs might not be necessary to investigate those associations because threats to internal validity have already been ruled out in the rcts that provided the empirical support for the ests. moreover, a study need not meet all of the criteria for establishing causality to have value in supporting the plausibility of a causal hypothesis. moreover, if various pretest-posttest studies, without control groups and conducted at different points in time, show that when an est is adapted in a similar way a desirable outcome follows, then the plausibility that history is the real cause of the outcome is reduced. therefore, i urge social work researchers to conduct such studies (after connecting with agencies interested in or already adapting an est in their setting). such studies do not require large sample sizes or major funding. for example, i have been able to conduct similar studies with virtually no funding as long as the agency agrees to have clients complete self-report pretests at intake and termination of treatment. to limit social desirability bias, the clients would complete their self-reports without their practitioner seeing their answers. the researchers could couple the client self-report results with a descriptive case study of agency and practitioner characteristics, how the est was adapted, and the nature of the training and supervision practitioners received in the adapted intervention. as such studies are published over time, an inductive process could be employed to develop and test hypotheses about the conditions under which ests can be adapted so that they are more feasible and more effective when provided in real world practice settings. i urge social work research journals (such as research on social work practice) to encourage researchers to conduct and submit such studies, with the assurance that if they conduct the kind of case study i have described above, a control group would not be a necessary prerequisite for publication. i believe that this would be a sufficient incentive – especially in institutions where obtaining major research funding is not a prerequisite for earning tenure or promotion. i also urge social work faculty and deans in research 1 universities to try to enlighten their university administrators as to the value of such studies and to the unique and valuable contribution that social work can make in conducting them. if faculty members can be successful in getting major research funding, then pursuing my recommended strategy may not be in their best interest. but how many junior faculty members in research 1 universities are now devoting their precious tenure-earning years writing, submitting, rewriting, and resubmitting proposals that may never be funded? although i am not disparaging the value of obtaining major research funding, i would like to see pursuing the strategy that i am recommending as an additional way to gain tenure and promotion. if only we can overcome the dollar signs in the eyes of university administrators who so often today perceive fund raising as the most important criterion regarding how their own performance will be evaluated. rubin/a half-century of social work research 193 references anderson, c. m., reiss, d. j., & hogarty, g. e. (1986). schizophrenia and the family: a practitioner’s guide to psychoeducation and management. new york, ny: guilford press. bender, k., & bright, c. l. (2011, january 13). a review of common elements of effective interventions for reducing disruptive behavior and traumatic stress among adolescent girls. paper presented at the annual conference of the society for social work and research, tampa, fl. beutler, l. e. (2002). the dodo bird is extinct. clinical psychology: science and practice, 9, 30-34. casselman, b. (1972). on the practitioner’s orientation toward research. smith college studies in social work, 42, 211-233. craighead, w. e., sheets, e. s., & bjornsson, a. s. (2005). specificity and nonspecificity in psychotherapy. clinical psychology: science and practice, 12(2), 189-193. damschroder, l. j., aron, d. c., keith, r. e., kirsh, s. r., alexander, j. a., & lowery, j. c. (2009). fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. implementation science. retrieved from http://www.implementationscience.com/content/4/1/50 embry, d. d., & biglan, a. (2008). evidence-based kernels: fundamental units of behavioral influence. clinical child and family psychology review, 11, 75-113. fanshel, d. (ed.). (1980). future of social work research. washington, dc: nasw. fischer, j. (1973). is casework effective? a review. social work, 18, 5-21. galinsky, m., fraser, m. w., day, s. h., & rothman, j. m. (2013). a primer for the design of practice manuals: four stages of development. research on social work practice, 23(2), 219-228. glisson, c., & schoenwald, s. k. (2005). the arc organizational and community intervention strategy for implementing evidence-based children’s mental health treatments. mental health services research, 7(4), 243-259. graybeal, c. t. 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(1917). social diagnosis. new york, ny: russell sage foundation. rosenblatt, a. (1968). the practitioner’s use and evaluation of research. social work, 13, 53-59. rubin, a. (1979). community mental health in the social work curriculum. new york, ny: council on social work education. rubin, a. (1999). presidential editorial: a view from the summit. research on social work practice, 9(2), 142-147. rubin, a. (2007). epilogue: the austin initiative. research on social work practice (special issue on evidence-based practice), 17(5), 630-631. rubin, a., & babbie, e. r. (20013). research methods for social work (8th ed.). belmont, ca: cengage. rubin, a., & parrish, d. (2007). challenges to the future of evidence-based practice in social work education. journal of social work education, 43(3), 405-428. rubin, a., springer, d. w., & trawver, k. (eds). (2010). psychosocial treatment of schizophrenia. hoboken, nj: john wiley & sons, inc. sundell, k., ferrer-wreder, l., & fraser, m. w. (2013). going global: a model for evaluating empirically supported family-based interventions in new contexts. evaluation & the health professions. retrieved from http://ehp.sagepub.com/content/early/2013/01/03/0163278712469813.full.pdf+html wampold, b. e. (2001). the great psychotherapy debate: models, methods, and findings. mahwah, nj: erlbaum. weisz, j. r., ugueto, a. m., herren, j., afienko, s. r., & ruff, c. (2011). kernels vs. ears and other questions for a science of treatment dissemination. clinical psychology: science and practice, 18(1), 41-46. wood, k. m. (1978). casework effectiveness: a new look at the research evidence. social work, 23(6), 437-458. author note address correspondence to: allen rubin, ph.d., kantambu latting college professorship for leadership and change, university of houston graduate college of social work, 110ha social work building-room 342, houston, tx 77024-40. email: arubin2@central.uh.edu rubin/a half-century of social work research 195 allen rubin, ph.d., is the kantambu latting professor for leadership and change at the university of houston graduate college of social work. his approximately 150 publications have focused on research methods, statistics, severe and persistent mental illness, trauma treatment, evidence-based practice, and other areas. a founding member of the society for social work and research (sswr), he served as its president from 1998 to 2000. his awards include the university of pittsburgh, school of social work's distinguished alumnus award (1993), the sswr award for outstanding examples of published research (1997), the cswe significant lifetime achievement in social work education award (2007), and fellow of the american academy of social work and social welfare. microsoft word 1315-burke_manuscript_copyedit3 _________________ tracey kathleen burke, ph.d., is an associate professor in the school of social work at the university of alaska anchorage. copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), 21-32 educating citizens as well as professionals: using service-learning to enhance the civic element of social work education tracey kathleen burke abstract: schools of social work have put considerable energy into civic engagement and community partnership. despite the attention paid to the civic mission of the university and/or of the profession, however, very little attention has been paid to the civic education of social work students. it will be argued here that social work education must include discussions about citizenship and democracy, about participating in our communities apart from our work. service-learning, with its emphasis on civic learning and a complementary focus on social justice, provides both a lens and a pedagogy for accomplishing this. keywords: service-learning, citizenship, civic education, social justice, professionalization introduction schools of social work have put considerable energy into civic engagement and community partnership. published accounts of such activities describe research linked to community development initiatives (allen-meares, 2008), an msw concentration organized as a partnership effort (ishisaka, farwell, sohng, & uehara, 2004), even an entire msw program with a single community partnerships concentration (wertheimer, beck, brooks, & wolk, 2004). programs that have not wholly restructured still are likely to offer community-based service-learning courses, which feature a reciprocal relationship between the classroom and the community (furco, 1996), in addition to the student-centered internships that are the “signature pedagogy” of social work education. despite the attention paid to the civic mission of the university and/or of the profession, however, very little attention has been paid to the civic education of social work students. a growing body of literature attests that service-learning enhances students’ mastery of and engagement with professional (academic) material (anderson, 2006; faria, dauenhauer, & steitz, 2010; kapp, 2006; knee, 2002; l. a. lowe & medina, 2010; rocha, 2000; scott, 2008; see also numerous chapters in nadel, majewski, & sullivan-cosetti, 2007). as illustrated in this special journal issue, servicelearning can provide the means for assessing key social work competencies. servicelearning also promotes certain personal traits and attitudes social work educators deem important (l. a. lowe & medina, 2010; williams, king, & koob, 2002). yet, particularly at the bachelor’s level, we are “educating citizens” (colby, ehrlich, beaumont, & stephens, 2003) as well as social workers. service-learning has the potential to promote civic learning as well. a review of social work’s partnerships and service-learning literature, however, reveals that even when on occasion civic education is acknowledged in course design (droppa, 2007; poulin, kauffman, & silver, 2006), it is conspicuously absent in discussions of outcomes (lemieux & allen, 2007). burke/educating citizens as well as professionals 22 why has social work neglected this element of education? perhaps we assume that social work values categorically incorporate civic values (king, 2003; lucas, 2000). certainly we highlight our professional commitment to social justice and social change, even identifying the ability to “advance human rights and social and economic justice” and the ability to “engage in policy practice to advance social and economic well-being” as two of ten core professional competencies (council on social work education, 2008). there is evidence to support the use of service-learning in promoting a social justice orientation (poulin et al., 2006; sather, weitz, & carlson, 2007). some suggest that social work should be a leader in service-learning because of our long-established commitment to social justice (campbell & bragg, 2007). instead, social work is a relative newcomer to service-learning (though not to other forms of community-based education) and a minor player on the national service-learning stage. it will be argued here that social work education must include discussions about citizenship and democracy, about participating in our communities apart from our work. we must attend to our students’ civic education because the most intractable issues that social work has claimed as its professional purview – such as poverty, violence, and discrimination – are, in the civic engagement parlance, “public issues.” everyone has a stake in addressing them. by reducing them to social work issues, we risk communicating to our students that they need only care about them during business hours; we risk communicating a myopic vision that only professional social workers can legitimately resolve them. service-learning provides a platform from which to resist such a message. jane addams as civic role model it is common in the social work and service-learning/civic engagement discourse to see references to founding mother jane addams, and indeed, addams is an exemplar for what we might wish our students to become. crucially, however, she did not establish and lead hull house as a social worker. she saw herself and was seen by contemporaries as a sociologist, albeit a female sociologist based in the community rather than the university, one who was relegated to the margins as (male) disciplinary sociology solidified (deegan, 1988). more importantly, she also saw herself as a citizen whose lot was intrinsically tied to that of the people around her (elshtain, 2002; knight, 2005). her first book, a collection of reflective essays she wrote and re-wrote over the course of a decade, she tellingly called democracy and social ethics (addams, 2002/1902). being a member of a democratic society means much more than voting to addams, who as a woman could not vote for most of her life. it means openness to “perplexity” and rethinking one’s certainties given new experiences; it means valuing the contributions of all, not just those who share her elite background. she begins her essay on education: as democracy modifies our conception of life, it constantly raises the value and function of each member of the community, however humble he [sic] may be….we are gradually requiring of the educator that he shall free the powers of each man and connect him with the rest of life. we ask this not merely because it is the man’s right to be thus connected, but because we have become convinced that the social order cannot afford to get along without his special contribution (addams, 2002/1902, p. 80). advances in social work, spring 2011, 12(1) 23 even before addams’ ideas of democracy were fully formed, she intuited its importance. she frames the “subjective necessity for social settlements” in an 1892 speech as more about the democratic impulse of the upper-class settlement residents (including herself) than the concrete and cultural needs of the neighborhood. settlement residents “are taking to the notion of human brotherhood…. these young men and women, longing to socialize their democracy, ...[live in the settlement as] an experimental effort to aid in the solution of the social and industrial problems which are engendered by the modern conditions of life in a great city” (addams, 1961/1910, pp. 75, 76, 83). addams became president of the national conference of charities and corrections, a precursor to the national association of social workers (nasw), arguably a signal that she did eventually identify with social work. still, in her presidential speech, addams (1910) downplays “relief and charity” and elevates “prevention, amelioration and social justice” (p. 441/3) – not words associated with emerging efforts to build the profession. “social work” for addams was coalescing into a compelling means of addressing public problems, but professionalizing social work was not itself an end.i since addams’ time, professionalization has become an end, some would say an obsession. numerous accounts trace the relationship between social work’s professional identity and its relative emphasis on services or reform (ehrenreich, 1985; g. r. lowe & reid, 1999; walkowitz, 1999). in periods of increased anxiety over social work’s professional status, the pendulum has favored services or direct practice. the suggestion is that in these times, the commitment to social justice is diminished. it has been argued, too, that social work’s professional project has subsumed its social justice project (olson, 2007). the best-known indictment of social work’s turn away from poverty and related issues to psychotherapy remains unfaithful angels (specht & courtney, 1994). if we are consistent in following addams’ lead, however, these critiques prove to be distractions. it is not enough for social work to renew its commitment to reform-oriented, macro practice, if social workers still think of it merely as a job.ii it is exactly this compartmentalization that threatens the integrity of social work’s role within a social justice project that is bigger than the profession. professionalism in social work sullivan (2005) examines the public, or civic, commitments of the professions, and argues that the status of the professions is threatened because the social contract is not being kept. professionals must meet “expectations of high standards of competence coupled with public responsibility” (p. 3) to the citizenry served. in return, the manner in which professions are structured grants more autonomy and more discretion for making judgments than occupations organized strictly as part of bureaucracies or only as a function of market forces (i.e. freidson’s ( 2001) “third logic”). social work, like other professions, is increasingly subject to bureaucratic regulation and the market. nonetheless, in sullivan’s analysis, the professions remain distinctive (social work, for example, largely regulates itself as through nasw, licensure, and accreditation), and he burke/educating citizens as well as professionals 24 argues that there is at least the perception that professionals are betraying the public trust, that expert knowledge has been put up for sale. on the face of it, it seems absurd to accuse social work of not keeping its contract with the public. surely it is we, more than most others, who do the dirtiest work with the people of least status, for relatively little remuneration and status ourselves. it is here that unfaithful angels (specht & courtney, 1994) and similar critiques become pertinent: is social work, in fact, doing this kind of work? a study commissioned by nasw (whitaker, weismiller, & clark, 2006) answers, in effect, “yes, but.” of the licensed social workers sampled, fewer than 2 per cent identify working with homeless/displaced people, income assistance, or community development as their primary practice area. likewise, in the description of social workers’ clientele and their challenges, poverty is not identified. we know that members of the client-groups that are named (e.g. people with behavioral health issues, people involved with the criminal justice system, families involved with child welfare) are disproportionately likely to be poor and from historically oppressed racial and ethnic backgrounds. perhaps the social workers most committed to community work and/or work with the poor do not pursue licensure, and thus are excluded from this study. nonetheless, licensed social workers’ apparent neglect of poverty as a practice area in its own right, combined with the relatively high proportion of these workers who identify as in mental health and particularly in private practice, does suggest that social work is not immune to sullivan’s (2005) critique. perhaps there is confusion as to what exactly our contract with the public is. as social work has wrestled for turf within a system of helping professions (abbott, 1988), there have been few arenas over which social work can claim exclusive authority. mental health, child welfare, gerontology, etc. are contested domains, but they are more contained – and the battle for jurisdiction over them is more winnable – than social justice issues such as poverty and discrimination. social justice is firmly ensconced in the professional code of ethics and now accreditation competencies, and this core value is central to why many people become social workers in the first place. but because social justice cannot be restricted to one profession, or even to the expert knowledge of the professions more broadly, it must undergird how social work approaches its work rather than be the focus of polarized debates over what the work is. “the great promise of a profession is the possibility of institutionalizing vocation in the modern economy. professionals have traditionally been ascribed vocation as well as a career or job. besides earning a living and striving to distinguish themselves in their domain of activity, professionals have been expected to carry out their work as part of a larger collective project,” sullivan asserts (2005, p. 15). the challenge for social work education is to remind ourselves and our students of what jane addams understood: social work can be a powerful means of enacting a social justice vocation, but a social justice project is a “larger and collective” one, not social work’s own. service-learning provides both a lens and a pedagogy for accomplishing this. advances in social work, spring 2011, 12(1) 25 service-learning for civic education most definitions of service-learning include a civic dimension, such as the oft-cited definition from bringle & hatcher (1996): “a credit-bearing educational experience in which students participate in an organized service activity that meets identified community needs and reflect on the service activity in such ways as to gain further understanding of course content, a broader appreciation of the discipline, and an enhanced sense of civic responsibility” (p. 222, italics added). civic responsibility includes a recognition of oneself “as a member of a larger social fabric” (colby, ehrlich, beaumont, rosner, & stephens, 2000, p. xxvi) and therefore takes public problems seriously and engages in “behaviors that produce public benefits” (perry & katula, 2001, p. 333; cf. saltmarsh, 2005). it is no coincidence that we hear echoes of addams here – though most commentators cite the influence of john dewey, her friend and contemporary (seigfried, 1999). across disciplines, many faculty use service-learning to foster civic dispositions in their students (chickering, 2006; eby, 2001; o'meara & niehaus, 2009). others use service-learning to promote social justice (cuban & anderson, 2007; farnsworth, 2010), though there is not uniform support for faculty choosing pedagogical strategies for political purposes (butin, 2010). in short, faculty members from myriad fields find service-learning to be a useful means of responding to boyer’s call to increase the civic importance of academic work (boyer, 1990). reflection activities are a key component to service-learning, linking the service experience to the broader questions of the class. although instructors can use reflection to focus only on narrowly-defined academic issues and/or personal growth (e.g. confidence), commentators generally assume a focus on civic learning as well (ash & clayton, 2009; eyler, 2002). the ways in which civic learning is operationalized sound a lot like social work. civic skills include “collective action, community/coalition building, and organizational analysis” (saltmarsh, 2005, p. 55). measures of civic commitment include “understanding of service users” and “concern for disadvantaged groups in society” (ngai, 2009, p. 381). “[c]ivic professionals are those who work with citizens, rather than acting on them” (boyte & fretz, 2010, p. 83; emphasis in the original) we are told, arguably summing up a social work empowerment orientation. what distinguishes the civic dimension of the service-learning literature from social work is the emphasis on the public realm. many civic skills, values, and bodies of knowledge mirror social work skills, values, and knowledges – but their import is at a different level of magnitude. what students learn in class matters not only in relation to that course and that discipline or profession, but in relation to students’ shared lives in community. it matters to democracy, as jane addams pointed out over a century ago. an example is in order. a community partner, a local elementary school in a lowincome neighborhood, has requested language arts tutors for its students. education majors and english majors who tutor learn lessons related to teaching and language, important issues for their disciplines, and perhaps the principal reason their instructors include this service-learning component. they also may learn some value-added lessons about the lives and concerns of fellow citizens. reflection activities can be structured to burke/educating citizens as well as professionals 26 highlight the importance of resource distribution for the children and their families – a civic lesson that may carry over into how these college students engage with their communities, and how they vote. in social work, learning about the lives of the children and their families might be the intended outcome of the same tutoring activity, but the same lesson about resources is framed in a professional/academic context rather than a civic one. the children and their families are positioned as clients, not fellow citizens. there are risks here for students interested in both direct practice and macro practice. first, for students and instructors focusing on direct practice, the lesson from the tutoring may be reduced to one of finding resources for these children. the issue of resources is addressed, but in a narrow way that does not require questioning how they were distributed in the first place. social justice issues may be sidestepped entirely. for students and faculty interested in macro practice, the risk is more subtle. issues of resource development and policy change may be seen as social work-specific issues rather than as public issues regarding which social work is one player. at worst, social work students may not consider – may not even welcome – the participation of their educationand english-major colleagues in addressing these issues because they do not see the other students as having a legitimate role. later, a similar attitude toward nonsocial workers may limit social workers’ willingness to collaborate with others, be they professionals or not.iii the civic component of service-learning directs attention outward; for social work students, it directs attention beyond the profession. through structured reflection in particular, social work faculty can bid students (in line with the previous example) to notice other volunteers; how do their contributions differ, what motivates them, how do they conceive of the (public) problem and their stake in the well-being of the clients? in other contexts, civic-oriented reflection may challenge students – and faculty – to articulate the public purposes that led them to social work. what has been their nonsocial work involvement in addressing the issues about which they are most passionate? if they should decide that the social work profession is not for them after all, how will they remain involved; would they still have an interest and a stake; in what ways? what does it mean to address social justice issues as a social worker – or not? community-university partnerships are embedded within a web of interpersonal relationships (bringle & hatcher, 2002). schools of social work have pre-existing relationships with many social service agencies through their field education programs. this provides a foundation for growing those relationships in new directions, but also puts the scope of such growth at risk of being defined too narrowly – i.e., only in “professional” terms. even if social work faculty are committed in principle to civic education, community partners may assume that social work service-learning students seek field-specific experiences. faculty may need to work harder with service-learning partners to create projects or tasks that move beyond social work skills, and that lend themselves to a citizenship dimension. advances in social work, spring 2011, 12(1) 27 conclusion research suggests that holding “a combination of career attitudes that incorporates favorable perceptions of one’s ability to express oneself in the world of work through a successful career” is negatively correlated with aspects of burnout among some social work students (ngai & cheung, 2009, p. 115; italics added). in other words, engaging in social work as an expression of a larger commitment rather than as an end in itself may foster professional satisfaction. in contrast to medicine, where some doctors are consciously moving away from seeing medicine as a vocation in favor of seeing it as “a job and part of a work-life balance” (jones & green, 2006, p. 937), social work educators may want to re-emphasize the vocational aspects of social work. social work is a powerful means of participating in a social justice project that encompasses but is bigger than social work itself. taking sides in polarized debates about micro vs. macro practice misses a key point: poor people, old people, victimized people need both services themselves and changes to the structures that shape their social environments (hugman, 2009). social work does all of this. but it does not do it alone, and social work educators must take care not to let students think that only social work should be doing it, or that they need not worry about it after they leave the office. other professionals and other citizens have a stake in each others’ well-being and in the health of their communities. emphasizing the civic component of service-learning, already a valued pedagogy within social work education, helps us frame social work issues as public issues so that our students can view their activities both as social workers and as citizens. references abbott, a. 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(2010). social work and civic engagement: the political participation of professional social workers. journal of sociology and social welfare, 37(3), 107-129. saltmarsh, j. (2005). the civic promise of service learning. liberal education, 91(2), 5055. advances in social work, spring 2011, 12(1) 31 sather, p., weitz, b., & carlson, p. (2007). engaging students in macro issues through community-based learning: the policy, practice, and research sequence. journal of teaching in social work, 27(3/4), 61-79. doi:10.1300/j067v27n03_05 scott, d. l. (2008). service learning: the road from classroom to community-based macro intervention. journal of policy practice, 7(2-3), 214-225. doi:10.1080/15588740801938068 seigfried, c. h. (1999). socializing democracy: jane addams and john dewey. philosophy of the social sciences, 29(2), 207-230. specht, h., & courtney, m. e. (1994). unfaithful angels: how social work has abandoned its mission. new york: the free press. sullivan, w. (2005). work and integrity: the crisis and promise of professionalism in america (2nd ed.). san francisco: jossey-bass. walkowitz, d. j. (1999). working with class: social workers and the politics of middleclass identity. chapel hill, nc: university of north carolina press. wertheimer, m. r., beck, e. l., brooks, f., & wolk, j. l. (2004). community partnerships: an innovative model of social work education and practice. journal of community practice, 3/4, 123-140. doi:10.1300/j125v12n03_08 whitaker, t., weismiller, t., & clark, e. j. (2006). assuring the sufficiency of a frontline workforce: a national study of licensed social workers, executive summary. washington, dc: nasw center for workforce studies. williams, n. r., king, m., & koob, j. j. (2002). social work students go to camp: the effects of service learning on perceived self-efficacy. journal of teaching in social work, 22(3/4), 55-70. author note: direct correspondence to: tracey kathleen burke, school of social work, university of alaska anchorage, 3211 providence drive, anchorage, ak 99508. email: tkburke@uaa.alaska.edu i the decision to exclude other specific social workers from the discussion is made not to minimize their contributions to the profession or to broader society, but to acknowledge addams’ prominence in the social work/civic engagement discourse and to challenge the assumption that her activities demonstrate something about social work per se. ii two recent studies support the notion that paid social work may undercut other community engagement activities. gibelman & sweifach (2008) identify a pattern of licensed social workers volunteering less than in the past. focusing on political engagement, rome & hoechstetter (2010) find a pattern of nasw members being very engaged but “most often [in] those [activities] that require the least amount of effort” such as following the news and knowing their elected representatives (p. 118). the more actively engaged social workers are those whose jobs incorporate the “engaged” activities. burke/educating citizens as well as professionals 32 iii the concern described here is inspired by karger & hernandez’s (2004) analysis of social workers as public intellectuals. again the legacy of jane addams is evoked; now she is a model public intellectual. she was engaged with the issues of her day not just at hull house but through her speeches and writings, sharing her observations and thoughts with public audiences. karger & hernandez argue that more recently, social work’s quest for professional status has led to parochialism, such that we no longer engage with a generalized public audience. this work is licensed under a creative commons attribution 4.0 international license. male survivors of sexual abuse: becoming gender-responsive and traumainformed jennifer elkins katherine crawford harold e. briggs abstract: while there is a wide body of literature examining the behavioral, emotional, and social consequences associated with being sexually abused, comparatively few studies have focused on males. sexual abuse victimization among males remains largely underreported, under-treated, and under-recognized by researchers, practitioners, and the public. researchers trying to clarify why sexual abuse in males has been overlooked point to prevailing cultural norms, myths, assumptions, stigma, and biases about masculinity. consequently, there is often an assumption that males are not negatively affected by sexual abuse. drawing extensively from the literature, this article provides a critical review of: (1) the nature, experience and impact of sexual abuse victimization for males; and (2) the multidimensional processes that promote and inhibit resilient outcomes. it concludes with a discussion of trauma-informed and gender-responsive recommendations and future directions for social work practice, policy, and research. keywords: sexual abuse; males; gender; trauma-informed care over the past 20 years a growing body of literature has documented the enduring behavioral, emotional, and social consequences associated with being sexually abused. despite this increased attention to sexual abuse, males are significantly less likely to disclose sexual abuse victimization, less likely to seek help, less likely to be suspected of being a victim, less likely to be believed upon disclosure, more likely to be blamed, and more likely to be perceived negatively when they do disclose sexual abuse than their female counterparts (banyard, williams, & siegal, 2004; holmes & slap, 1999; o’leary & barber, 2008; paul & paul, 2016; speigel, 2003). researchers trying to clarify why sexual abuse in males has been overlooked have pointed to prevailing cultural norms, myths, assumptions, stigma and biases about victimization of males in general and sexual abuse of males in particular. as a result of these traditional notions of masculinity, there is often an assumption that males are not negatively affected by sexual abuse (heru, 2001; kiakeating, grossman, sorsoli & epstein, 2005; mcguffey, 2005; teram, stalker, hovey, schachter, & lasiuk, 2006). sexually abused males report significantly higher rates of posttraumatic stress disorder (spataro, mullen, burgess, wells, & moss, 2004; wolfe, francis, & straatman, 2006), depression (gover, 2004), substance abuse (bergen, martin, richardson, allison & roeger, 2004; dilorio, hartwell, & hansen, 2002) and suicidality (bergen, martin, richardson, allison, & roeger, 2003; easton, renner, & o’leary, 2013; miller, espositosmythers, wismoore, & renshaw, 2013). other internalizing and externalizing problem behaviors are also common. for example, using a population-based sample of 136,549 ______________________ jennifer elkins, phd, mssw is an associate professor, school of social work, university of georgia, athens, ga 30602. katherine crawford, phd, lmsw is an instructor, school of social work, university of georgia, athens, ga 30602. harold e. briggs, phd is a professor, school of social work, university of georgia, athens, ga 30602. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 116-130, doi: 10.18060/21301 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 117 students in minnesota, duke, pettingell, mcmorris, and borowsky (2010) found that for males, sexual abuse victimization was associated with a 45-fold increase in dating violence, a 4.5-fold increase in fighting, and a 6 to 15-fold increase in self-harm and suicidality. high risk sexual behavior is also more common (homma, wang, saewyc, & kishor, 2012; jones et al., 2013). in a meta-analysis, homma et al. (2012) found that sexually abused boys were significantly more likely than non-abused boys to father a child, to have multiple sexual partners, and were more likely to have unprotected sexual intercourse. great strides have been made in advancing research approaches that reflect the reality of sexually abused males’ experiences and also tackle the challenges and complexities endemic to high quality research in this field. nevertheless, there remains a great deal of work to be done. drawing extensively from existing research, this critical review: (1) examines the nature, experience and impact of sexual abuse victimization for males; and (2) identifies key multilevel risk and protective factors influencing the nature, experience and impact of sexual abuse for males. the review concludes by offering trauma-informed and gender-responsive recommendations for social work practice, policy, and research. multidimensional risk and protective factors abuse-related factors timing (e.g., onset, frequency, duration) is an important source of variability in outcomes (manly, 2005). though the research is preliminary, some studies suggest that males are more likely to report an earlier onset (ompad et al., 2005; stevens, ruggiero, kilpatrick, resnick, & saunders, 2005; walrath et al., 2003) and shorter duration of sexual abuse (ullman & filipas, 2005). there is some evidence to suggest that sexually abused males have worse outcomes if they report co-occurring physical abuse (dong, anda, dube, giles, & felitti, 2003) or an earlier onset of sexual abuse (ohene, halcon, ireland, carr, & mcneely, 2005; ompad et al., 2005; stevens et al., 2005; walrath et al., 2003). frequency, duration and severity of sexual abuse have also been associated with worse outcomes for male youth (banyard et al., 2004). characteristics of the perpetrator have emerged as an important factor influencing the impact of sexual abuse. several studies have found that male survivors are more likely to have extrafamilial perpetrators (banyard et al., 2004; feiring, taska, & lewis, 1999), and female perpetrators (briere & elliott, 2003; dube et al., 2005; newcomb, munoz, & carmona, 2009). our knowledge in this area is complicated by the underrepresentation of female perpetrators in the literature (mcleod, 2015) and the underreporting of female-perpetrated sexual abuse. regardless of the gender of the perpetrator, males experience a unique double stigma that impacts self-definition and self-disclosure of the abuse: with male perpetrators they often face misconceptions, stereotypes and assumptions regarding their sexual orientation; whereas femaleperpetrated sexual abuse is often regarded as benign, normative, or a rite of passage that is something to be bragged about. intrapsychic factors because physical evidence of sexual abuse is rare (heger, tison, velasquez, & bernier, 2002; kelly, koh, & thompson, 2006), self-disclosure takes on increased importance in elkins et al./male survivors of sexual abuse 118 the identification of sexual abuse. however disclosure is a complex and lifelong process happening mostly in adulthood (gagnier & collin-vézina, 2016; hunter, 2011). a victim’s cognitive appraisal and self-definition of the sexual abuse experience contributes to the probability of self-disclosure. this is particularly true for males. stander, olsen, and merrill (2002) found that females were nearly 6 times more likely than males to self-define being sexually abused. of the 2,010 participants who met the behavioral definition for childhood sexual abuse, only 15% of the men identified as sexual abuse survivors in comparison to 49% of the women. males were more likely to acknowledge and define their experience as sexual abuse if deviated from accepted societal norms. for example, men were 17 times more likely to define themselves as sexually abused if their perpetrator was a family member. this illustrates the difficulty in obtaining an accurate picture of the scope and impact of sexual abuse among males. other intrapsychic factors such as cognitive appraisal, self-esteem and self-worth, spirituality and/or religion, coping strategies, and attribution style (i.e., locus of control; self-blame) also play a central role in interrupting the pathway between sexual abuse and later adaptive or maladaptive outcomes (bal, van oost, de bourdeaudhuij, & crombez., 2003; crete & singh, 2015; feiring, taska, & chen, 2002; hebert, parent, daignault, & tourigny, 2006; quas, goodman, & jones, 2003; holmes, 2008). the coping strategies (simon, feiring, & mcelroy, 2010) and cognitive appraisals (lab & moore, 2005; stander et al., 2002) sexual abuse survivors use are critical ingredients in how men and boys understand, define, and experience victimization. avoidant coping strategies, which are associated with worse outcomes, are more common among sexually abused boys (simon et al., 2010). however, problem behaviors can also be a successful, adaptive, coping strategy. for example, a complex trauma framework classifies these self-protective responses as tension-reduction behaviors (briere & lanktree, 2013; masten et al., 2005; richardson, henry, black-pond, & sloane, 2008). family, school and sociocultural factors sexually abused males frequently face very real and entrenched problems both inside and outside of the home—including poverty, domestic violence, community violence and racial discrimination—that place them at higher risk for maladaptive developmental outcomes. focusing on school can serve as a protective mechanism for sexually abused children living in chaotic, stressful, and unstable home environments. however, the array of characteristics, problems, and consequences associated with sexual abuse victimization can also translate into problems in academic achievement (avery, massat, & lundy, 2000; buckle, lancaster, powell, & higgins, 2005) and social skills (bal et al., 2003; feiring, rosenthal, & taska, 2000; hebert et al., 2006). family-level risk and protective factors that potentially play a role influencing resilient adaptation include parental substance abuse, maternal education, parent-child relationship, family functioning, and parental support and belief (kim & cicchetti, 2004; pintello & zuravin, 2001; rosenthal, feiring, & taska, 2003; stevens et al., 2005). however, the parent-child relationship is a particularly critical protective factor considering it is typically tied into the parent’s belief in and support of their child subsequent to the disclosure of the abuse. advances in social work, spring 2017, 18(1) 119 given the individual and society level stigma, prejudice, stereotypes, and taboos surrounding homosexuality in the united states, many male survivors experience unique issues related to fears of becoming or being seen as a potential perpetrator, fear of being perceived or labeled as gay, and confusion about sexual identity that can lead to hypermasculinity and attempts to reassert masculinity (alaggia & millington, 2008; dhaliwal, gauzas, antonowicz, & ross, 1996; teram et al., 2006). in addition to sexual identity and gender role stereotypes and norms surrounding masculinity, many sexually abused males also contend with the interlocking influences of racial socialization, racial stress, and racial appraisals (hughes et al., 2006; mcguffey, 2008; yasui & dishion, 2007). racial appraisal refers to the process of “how and why trauma victims construct their interpretations of trauma when there is already an excess of stigma due to their racially marginalized positions in the social order” (mcguffey, 2008, p. 219). comparatively little research has focused on sexual abuse victimization for males who are members of racial, ethnic, cultural, religious and sexual minority populations (kenny & mceachern, 2000). still fewer studies have examined intragroup differences and how multiple identities intersect, particularly for males. for example, what does it mean to be a gay, african american male victim of sexual abuse? while the racial, ethnic, cultural and religious meanings ascribed to sexual abuse can be a potent risk or protective factor, little research to date has focused on sexually abused males. trauma-informed and gender-responsive care a trauma-informed care approach is an essential component in service provision. in traditional systems of care, trauma is not well understood or taken into consideration, which leads client problems or behaviors to be viewed as separate, discrete, and unrelated to past trauma experiences (clervil & decandia, 2013; harris & fallot, 2001) with a traumainformed approach individuals are viewed through a ‘trauma lens’ that views behaviors, emotions, responses, and attitudes as an accumulation of survival skills created in response to trauma experiences (clervil & decandia, 2013). hopper, bassuk, and olivet (2010) describe a consensus-based definition of trauma-informed care as: a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment. (p.82) although males and females may experience the same kinds of trauma, how they process and respond to these experiences may present differently based on the social expectations of each gender role (crable, underwood, parks-savage, & maclin, 2013; fallot & bebout, 2012). thus, there is also a need for trauma-informed and genderresponsive care (crable et al., 2013; fallot & bebout, 2012). given the low rates of selfdisclosure, this overarching framework is imperative in creating a safe and supportive environment for male survivors being served in the various public systems (corbin et al., 2011; fallot & bebout, 2012; harris & fallot, 2001). difficulty can also arise when working with male survivors because the social expectations of men to be strong and independent can influence and restrict the range of emotions men are allowed to express in public and even recognize privately (fallot & bebout, 2012). this is especially pronounced elkins et al./male survivors of sexual abuse 120 for african american and hispanic/latino males. however, ultimately there is a need for vulnerability and the ability to process a range of emotions when recovering from trauma experiences. a safe and supportive environment is a necessary component in this process. future directions and recommendations despite the increased attention to sexual abuse, victimization of males continues to be overlooked. consequently, it is crucial that practitioners and researchers incorporate a developmentally and contextually-sensitive focus on: (1) the nature, experience, and impact of sexual abuse for males, (2) the multidimensional processes that promote and inhibit resilient outcomes, and (3) trauma-informed and gender-responsive approaches to care. one of the most straightforward ways to do this is for researchers to be intentional in including males in studies focusing on sexual abuse and testing for gender as an effect moderator. researchers and practitioners working with specialized populations of males with appreciably higher rates of sexual abuse victimization should also be aware of the higher likelihood for sexual abuse and include this as part of the initial and ongoing screening and assessment process. recognizing some of the unique issues males experience, and taking this into account in study designs, may increase the chances for larger samples and/or subsamples of sexually abused males. this includes: (1) increased attention to sexual abuse victimization for males who are members of racial, ethnic cultural, religious, and sexual minority populations, and (2) awareness of and sensitivity to how questions about sexual abuse are constructed. questions should be gender-neutral and avoid labels and instead use behavioral definitions of the sexual abuse. finally, more research is needed to better understand the impact of sexual abuse on males across multiple domains of functioning. accounting for the influence of confounding factors in the family, peer, school, and neighborhood environment is also critical given that sexual abuse rarely occurs apart from other risk factors. micro-level implications for trauma-informed care practitioners and service providers should use a trauma-informed and genderresponsive framework as a guide in practice and service provision (crable et al., 2013; fallot & bebout, 2012). gender role expectations impact the initial trauma experience as well as the narrative explanation and reactions of the survivor (crable et al., 2013; fallot & bebout, 2012). for male survivors it is essential that providers take into consideration the influence of male gender role socialization on their experience (fallot & bebout, 2012; foster, boyd, & o’leary, 2012; sorsoli, kia-keating, & grossman, 2008). issues and expectations based on gender role socialization regarding sexuality should be addressed directly, and normative male expectations should be actively examined and challenged (fallot & bebout, 2012; foster et al., 2012; sorsoli et al., 2008). social workers should explore prevalent messages that boys and men learn about how “real” men think, act, and feel (fallot & bebout, 2012; foster et al., 2012; sorsoli et al., 2008). these messages and expectations need to be discussed openly, so males are able to learn how to integrate all parts of self (fallot & bebout, 2012). by acknowledging these gendered messages, social workers communicate that they are not blaming the victim and create a sense of safety and advances in social work, spring 2017, 18(1) 121 trustworthiness for the male client (fallot & bebout, 2012; foster et al., 2012; sorsoli et al., 2008). it is important males be asked about a history of exposure to violence as soon as possible in the intake process, with sensitivity to using labels that denote victimization (fallot & bebout, 2012). there is, however, also a need to directly ask questions related to sexual abuse (sorsoli et al., 2008). if specific questions regarding sexual abuse are not asked, it is unlikely these experiences will be disclosed (sorsoli et al., 2008). these questions may need to be raised several times over the course of service provision (fallot & bebout, 2012; sorsoli et al., 2008). social workers should also be careful not to push for details prior to establishing a safe and supportive therapeutic relationship (fallot & bebout, 2012; foster et al., 2012; sorsoli et al., 2008). for example, if a man is receptive to responding to broad questions regarding discussion of a trauma history, it would make sense for a service provider to move forward with a more comprehensive trauma assessment, which should include a recovery plan and referral to specific trauma services (fallot & bebout, 2012). however, if the social worker is met with a negative response to initial questions regarding a trauma history, more emphasis should be placed on forming rapport and a collaborative relationship with the individual so questions regarding trauma can be revisited (fallot & bebout, 2012). prefacing with the prevalence and widespread occurrence of exposure to violence can validate and normalize male survivors’ experiences and feelings (fallot & bebout, 2012; knight, 2015). once past sexual abuse has been disclosed, it is essential it be taken seriously. this includes responding calmly and empathetically, with affirmation and attentiveness (foster et al., 2012; knight, 2015; sorsoli et al., 2008). this initial response to the disclosure can serve as an initial boundary-setting activity and can provide an emotionally restorative experience that aids in counteracting a client’s previous vulnerability in relationships (sorsoli et al., 2008). if the response to initial disclosures are inappropriate or not protective, there can be increased difficulties (foster et al., 2012; knight, 2015). this includes: avoiding addressing the trauma entirely, probing for too much detail too soon, pushing for expression of feelings when it is not appropriate, and minimizing the impact of the trauma (knight, 2015). it is also necessary for males to gain support and security in growing their emotional vocabulary and to be assisted in cultivating the necessary skills to identify, label, and describe emotions that may sometimes be perceived as more stereotypically feminine (fallot & bebout, 2012). male survivors should be assisted in developing a wider range of options when expressing emotions (corbin et al., 2011; fallot & bebout, 2012). for example, men may be reluctant to discuss emotions or relationships and this should not be viewed as a lack of engagement in services. instead, service providers should enhance the client’s sense of safety by slowing the rate of expectation in regards to open communication and level of disclosure (fallot & bebout, 2012). furthermore, male trauma survivors often encounter a dilemma related to the conflict between the identity of being a man and the experience of being powerless and a victim. these two identities can be in direct contradiction with one another and can lead to the display of all-or-nothing responses (corbin et al., 2011; fallot & bebout, 2012). it is elkins et al./male survivors of sexual abuse 122 important for service providers to recognize that these all-or-nothing responses can come in the form of overt aggression or withdrawal (fallot & bebout, 2012; foster et al., 2012). if a male client is engaging in aggressive behavior, it needs to be understood in the context of survival skills and adaptive behaviors that have protected the individual when they felt threatened in the past (fallot & bebout, 2012). this understanding can help reduce a counterproductive response by service providers (fallot & bebout, 2012). the extent to which male survivors participate meaningfully in clinical treatment is often dependent on the extent to which the social worker addresses the manifestations of the legacy of sexual abuse, explores the degree of internalization of the abuse experience, and the impact of the abuse on relationships with others. in furthering the change process with male survivors, the social worker can explore the meanings male survivors attach to their abuse experiences and change the narrative they have internalized about themselves, others, and the world. the following capacity-building practice recommendations are ways social workers can help clients identify how sexual abuse experiences manifest in relational themes and patterns across relationships:  learning to operationalize the practice of self-acceptance, emotional awareness and regulation by establishing and defining personal boundaries.  engaging in self-acceptance through daily self-affirmations and cognitive restructuring of negative self-talk.  aiding clients in thinking through places and times in their schedule to inventory, nourish and care for emotional, physical, social, and psychological well-being. (fallot & bebout, 2012). the strengths and skills of trauma survivors should also be emphasized and used as a way of promoting hope and empowerment and highlighting resilience (fallot & bebout, 2012). offering choices throughout service provision should be made a top priority in decreasing issues of power within the therapeutic relationship (fallot & bebout 2012; foster et al., 2012; sorsoli et al., 2008). for example, offering the male client a choice of practitioner, such as having a male or female, can increase the client’s comfort and help decrease power dynamics (foster et al., 2012). clients must be included in decision-making and should work collaboratively with the service provider in the development of any treatment plans or service referrals. for example, a social worker might ask the client “how can we work together to meet your goals?” (fallot & bebout, 2012). although there are several trauma-informed strategies and techniques that social workers can use with male sexual abuse survivors, an underlying sense of safety in the environment and therapeutic relationship is an essential first step (fallot & bebout, 2012; foster et al., 2012; knight, 2015). a focus on the male survivor’s strength and resilience and the awareness of how gender socialization impacts recovery are central components of all service provision. it is also important for social workers to understand the differences in how men access and utilize services, as well as the best techniques and strategies to begin and maintain this engagement (foster et al., 2012). because men can be hesitant about accessing services, sometimes life crises present an opening or opportunity for sexual abuse to be identified in a context that can lead to referrals and linkage to appropriate support. another important factor that should be considered is to create a male-friendly advances in social work, spring 2017, 18(1) 123 environment in the entrance or waiting room, which may include relevant posters or information (foster et al., 2012). macro-level implications for trauma-informed care effective male-specific sexual abuse advocacy, outreach, and training can influence more proximal factors related to the prevention and amelioration of maladaptive outcomes for male survivors. this includes challenging and confronting the homophobia and traditional gender role norms that frequently silence male survivors. social media, the internet and web-based technology are increasingly critical tools. mandated reporting policies, requirements, and training are another area that needs greater attention. in the wake of the penn state sexual abuse scandal (chappell, 2012), many states began to reexamine and revise existing mandatory reporting requirements (persky, 2012; kelly, 2012), which vary from state to state (child welfare information gateway, 2012; pietrantonio et al., 2013). while this stricter legislation is well-intentioned, it often neglects two components integral to achieving its goal: (1) adequate mandated reporter training; and (2) funding to ensure proper investigation of these reports in already understaffed, underfunded, and overburdened child welfare agencies. emerging evidence suggests that the majority of mandated reporters do not receive adequate training regarding how to identify the signs of abuse and neglect (pietrantonio et al., 2013; wekerle, 2013). one way to address this is through minimum training requirements for all mandated reporters using a standardized, evidence-informed curriculum that all states are required to adopt (kenny & abreu, 2015). this is one way to ensure that mandated reporters are more knowledgeable and comfortable about recognizing sexual abuse in general, and sexual abuse in males in particular. because school-aged male youth are surrounded all day by peers and non-relative adults, it is an ideal location for individual and group treatment aimed at enhancing social support and building positive relationships. for these reasons, the school context in particular represents a unique and potentially crucial entry point for trauma-informed support, prevention, and intervention throughout the disclosure and recovery process. faith-based and youth-serving organizations also have the opportunity to play a similarly important role, particularly for outreach and engagement within historically marginalized communities. religion/spirituality can provide a sense of community, meaning and purpose that can be helpful in coping with trauma (bryant-davis et al., 2012). at the same time, traumatic events often shatter core assumptions and beliefs about the world in ways that can lead to religious/spiritual discontent, disillusionment, and rejection. this can be exacerbated when sexual abuse occurs within religious institutions (john jay college research team, 2004). in sum, recommendations for trauma-informed and gender-responsive approaches with male survivors of sexual abuse should bridge the micro-macro spectrum. this includes an emphasis on: (1) increased awareness of sexual abuse and its impact; 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(2007). the ethnic context of child and adolescent problem behavior: implications for child and family interventions. clinical child and family psychology review, 10(2), 137-179. doi: https://doi.org/10.1007/s10567-007-0021-9 author note: address correspondence to: jennifer elkins, school of social work, university of georgia, 279 williams street, athens, ga 30602, 706-542-5473, jelkins@uga.edu https://doi.org/10.1192/bjp.184.5.416 https://doi.org/10.1037/0022-006x.70.2.369 https://doi.org/10.1177/1077559505274675 https://doi.org/10.1080/01612840600599994 https://doi.org/10.1016/j.chiabu.2005.01.005 https://doi.org/10.1016/s0145-2134(03)00035-8 https://doi.org/10.1016/j.chiabu.2012.11.005 https://doi.org/10.1016/j.chiabu.2005.08.015 https://doi.org/10.1007/s10567-007-0021-9 mailto:jelkins@uga.edu microsoft word maceachron_gustavsson_2391_copyedtit final ______________  ann maceachron, ph.d., is a professor and nora gustavsson, ph.d., is an associate professor, both at the college of public programs, school of social work, arizona state university in phoenix. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 586-602   peer support, self-efficacy, and combat-related trauma symptoms among returning oif/oef veterans ann maceachron nora gustavsson abstract: the incidence of ptsd and other combat-related trauma symptoms among more than 2 million veterans returning from operation iraqi freedom (oif) and operation enduring freedom (oef) in afghanistan suggests that many will experience psychological challenges in adjusting to civilian life. however, the literature is sparse about this new group of veterans. this study examined the relationships between peer support, self-efficacy, and ptsd symptoms among 216 oif/oef veterans who had attended 1 of 17 vets4vets peer support weekend retreats. vets4vets is a national grassroots program whose mission is to improve the psychological well-being of returning oif/oef veterans. analysis of posttest changes indicate the generalizability of previous research findings, based on other groups of trauma-affected groups, to oif/oef veterans. as predicted, increased perceived peer support and self-efficacy reduced ptsd symptoms. from a theoretical perspective, we found that both models of self-efficacy, situation-specific (bandura, 1997; benight & bandura, 2004) and general self-efficacy (schwarzer & fuchs, 1996), mediated or explained the relationship between peer support and ptsd symptoms. implications for social work are discussed. keywords: veterans, peer support, ptsd, social support, self-help, self-efficacy, general self-efficacy introduction after more than a decade of war in iraq (oif, operation iraqi freedom) and afghanistan (oef, operation enduring freedom) and with more than 2.6 million troops deployed, a continuing challenge is taking care of veterans who have endured these wars. while it is known that veterans may experience multiple physical challenges, recognition is growing in regards to the psychological and social consequences of deployment, extended or multiple tours of duty, and combat (burnam, tanielian, & jaycox, 2009; eibner, 2008; institute of medicine, 2010). reviews of the literature (schell & tanielian, 2011; tanielian & jaycox 2008) indicate that the prevalence of posttraumatic stress disorder (ptsd) ranges from about 5 to 15 percent for returning oif/oef veterans. recurrent ptsd symptoms often interfere with, if not impair, functioning in personal, social, and work realms. another recently publicized risk is the increasing prevalence of suicide among both soldiers and veterans. the center for new american security (2011) recently estimated that a veteran dies from suicide about every 80 minutes. peer support is increasingly recognized as an important component of mental health services for improving psychological well-being among veterans. peer support is viewed as being congruent with veterans’ common experience of military culture where a high value is placed on camaraderie and unit cohesion (barber, rosenheck, armstrong, & advances in social work, fall 2012, 13(3) 587 resnick, 2008; center for new american security, 2011; poole, 2010; schell & tanielian, 2011; seligman, 2011; tanielian & jaycox, 2008). from a social cognitive perspective of self-efficacy theory, the effectiveness of peer support may be explained in terms of an individual’s improved self-efficacy due to peer learning about how to cope with and manage a stressful environment (bandura, 1997; benight & bandura, 2004). the focus of our study is evaluating a national, grassroots peer support veterans program, called vets4vets. founded in 2004, vets4vets is among the 50 outstanding nonprofits to receive an award through the 2006 iraq-afghanistan deployment impact fund (nbc nightly news weekend edition, 2009). the award was for using intensive peer support weekend retreats to help veterans “heal from the psychological injuries of war” (vets4vets, 2011). in this pretest-posttest study oif/oef veterans who participated in the weekend peer support program, the first research question focuses on the potential generalizability of previous research findings among trauma-affected groups to oif/oef veterans: do ptsd symptoms of oif/oef veterans lessen with increased peer support and self-efficacy? from a conceptual perspective, the second research question examines self-efficacy as a mediating explanatory variable: does self-efficacy explain the predicted relationship between peer support and ptsd symptoms. peer support kurtz (1997) defined a self-help group as “a supportive, educational, usually changeoriented mutual-aid group that addresses a single life problem or condition shared by all members” (p. 4). the condition shared among peer support groups is often a traumatic experience. mead, hilton, and curtis (2001) define peer support as “a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful…it is about understanding another’s situation emphatically through the shared experience of emotional and psychological pain” (p. 135). brown and lucksted (2010) suggest that there are multiple, overlapping dimensions to peer support. it is not just a common experience but also a healing and empowering process. the experiential principle is key to peer support because it creates a relationship based on a shared life experience to foster understanding, trustworthiness, and safety in helping relationships (hegelson & gottlieb, 2000; mead et al., 2001; solomon, 2004). the peer group process offers the opportunity to learn from the coping competency of others. peers not only model and demonstrate coping and adaptive skills but also offer contextual wisdom through personal stories of recovery or adaptive coping (solomon, 2004). overall, peer support is a well-established pathway to reduce vulnerability to stress and depression by emphasizing strengths and coping resilience to overcome trauma and rebuild one’s life (bandura, 1997; calhoun & tedeschi, 2006; saleebey, 2006; schwarzer, 1992; seligman, 2011). a meta-analysis by brewin, andrews, and valentine (2000) showed a strong relationship between greater peer support and reduced ptsd symptoms among high-risk populations. a later meta-analysis of ptsd predictors by ozer, best, lipsey, and weiss (2003) found that this inverse relationship was strongest in studies of combat trauma among american veterans of the vietnam war and the persian gulf war. more recently, a cross-sectional mail survey of oif/oef veterans (pietrzak, maceachron, gustavsson/peer support, self-efficacy, and ptsd symptons 588 goldstein, malley, rivers, & southwick, 2010) reported that reduced social support was related to increased ptsd symptom severity. the pietrzak et al. study is the only study to investigate and demonstrate this inverse hypothesis for oif/oef veterans. we also examine this inverse hypothesis among oif/oef veterans but from a change perspective. it is expected that participants who experienced increased peer support from the vets4vets weekend peer support program will report reduced perceived ptsd symptoms. self-efficacy from a conceptual perspective of social cognition, peer support is effective because peers together demonstrate and learn how to be self-efficacious in coping. peers “model coping attitudes and skills, provide incentives for engagement in beneficial activities, and motivate others by showing that difficulties are surmountable by perseverant effort” (benight & bandura, 2004, p. 1134). however, self-efficacy has been conceptualized in two distinct ways by bandura (1997) and by schwarzer and jerusalem (1995). from bandura’s perspective, perceived self-efficacy in coping is the “core belief that one has the power to produce desired effects by one’s actions” and “plays a key role in stress reactions and quality of coping in threatening situations” (benight & bandura, 2004, p. 1131). self-efficacy reduces the effect of a stressor by enabling individuals to use proactive coping strategies. individuals with high self-efficacy see challenges as mastery tasks, focus on strengths, and recover more quickly from setbacks. individuals with low self-efficacy see challenges as areas of personal failure, focus on their failings, and have low confidence in themselves. self-efficacy is thus a key component of resilience to trauma (bandura, 1994). combat traumatization, as discussed by benight and bandura (2004), has received very limited attention in the research literature. among the very few available studies, benight and bandura found that low perceived selfefficacy among israeli soldiers was related to more trauma symptoms experienced. our second hypothesis is that increased situation-specific self-efficacy reduces perceived ptsd symptoms among oif/oef veterans. self-efficacy as defined by bandura (1997) is situation-specific, that is, depends on the particular context and activity. it focuses on an adaptive functioning relative to the surrounding circumstances, context, and goals. an alternative conceptualization is that of an omnibus or general self-efficacy. general self-efficacy is an optimistic “self-belief that one can perform … difficult tasks or cope with adversity – in various domains of human functioning” (schwarzer & jerusalem, 1995, p. 1). it is a stable adaptive strategy if not trait based on an optimism regarding one’s coping ability (schwarzer, 1992). vernon, dillon, and steiner (2009), found general self-efficacy to be one of several proactive coping factors in reducing ptsd symptoms among undergraduate women with trauma backgrounds. this conceptualization suggests that people higher in general self-efficacy are more likely to have less intense trauma symptoms, set higher goals, persist towards their goals despite obstacles, and create opportunities for personal growth. however, there is no available literature in this regard in terms of combat traumatization. our third hypothesis is that increased general self-efficacy reduces perceived ptsd symptoms among oif/oef veterans. advances in social work, fall 2012, 13(3) 589 from a social cognitive perspective, individuals are proactive both in adapting to the multi-causality inherent to environmental challenges and risks and in developing competencies and regulating their actions (bandura, 1997). resilience to adversity is viewed as relying “more on personal enablement than on environmental protectiveness” or on proactivity rather than reactivity (benight & bandura, 2004, p. 1133). to the extent that peer support enables learning of adaptive knowledge and coping skills within a multi-causal context, it fosters what bandura calls self-efficacy. peer supporters provide a social learning context in which they model a variety of coping skills across multiple situations as well as encourage perseverance in achieving mastery over trauma-related symptoms or other goals. the explanatory link between support and reduced traumarelated symptoms is self-efficacy. self-efficacy requires a proactive approach to find, maintain, and learn from peers. benight and bandura’s 2004 review of the literature discussed the important mediating role played by self-efficacy: “social support produces beneficial outcomes only to the extent that it raises perceived self-efficacy to manage environmental demands” (p. 1134). as benight and bandura noted, much more research is needed to evaluate selfefficacy as a mediator especially in regards to explaining the relationship between social support and combat-related trauma. our fourth hypothesis is that bandura’s situationspecific self-efficacy will play a mediator role in explaining the relationship between peer support and perceived ptsd symptoms at posttest. interestingly, no study has yet compared the explanatory power of situation-specific self-efficacy and general selfefficacy in terms of peer support and such trauma outcomes as combat traumatization. while schwarzer and fuchs (1996) do not highlight the distinction, bandura (1997) believed that situation-specific self-efficacy would be a stronger predictor and mediator variable than would general self-efficacy. our fifth hypothesis is that schwarzer’s concept of general self-efficacy will also play a mediator role in explaining the relationship between peer support and perceived ptsd symptoms at posttest. vets4vets program since world war ii, peer support and peer services have grown exponentially (brown & lucksted, 2010; campbell, 2005; clay, 2005; davidson et al., 1999). this growth is especially evident in the mental health and addictions field with many anonymous programs for alcohol, drugs, gambling, and other issues (solomon, 2004). since the 1970s, peer support has been a component of the community support system in mental health as well as other mental health services (goldstrom et al., 2006; solomon, 2004). peer support in mental health services is also expanding in the veteran’s administration (barber et al., 2008; resnick & rosenheck, 2008). there is substantial variation in the purpose, format, and setting for peer support, for example, one-on-one sessions, small to larger groups, face-to-face versus online, therapeutic or personal growth, and short-term intensive retreats versus ongoing sessions (hirschhorn & gilmore, 2004; liteman, cambell, & liteman, 2006; martone, 2010; orloff, armstrong, & remke, 2009; rains & young, 2009). vets4vets is a national grassroots organization that works with oif/oef veterans to develop local peer support groups and to coordinate these groups to become a national maceachron, gustavsson/peer support, self-efficacy, and ptsd symptons 590 network. one part of their peer support program is to hold regional intensive weekend retreats. the residential retreats start on friday afternoon and end on sunday noon. the leaders are also oif/oef veterans and ongoing members of local vets4vets peer support groups. they receive 40 hours of classroom training, co-facilitate several retreats before leading a retreat, and follow a manualized script for the scheduling and content of each retreat hour. each retreat emphasizes peer support through engagement in multiple group sessions throughout the weekend. the groups encourage members to talk openly about and re-evaluate their military experiences, to use active listening skills, to re-experience camaraderie or social connectedness of peers, discuss challenges to reentry to civilian life, and recognize common issues for advocacy within their veteran communities. methods sample a total of 325 of 466 oif/oef (70%) veterans completed either a pretest or posttest while attending one of 17 vets4vets weekend retreats between january 2010 and january 2011. most groups were led by the same leader but 5 of the 17 groups had two different leaders. however, there were no significant mean differences between groups in terms of perceived peer support or ptsd symptoms at the pretest or posttest as assessed by oneway analyses of variance. given veteran reluctance to share information about combat-related trauma (e.g., schell & tanielian, 2011), anonymous identifiers were chosen by participants to selfidentify each test. using these identifiers, a total of 216 participants (46% response rate) completed both the pretest and posttest. to maintain the anonymity of participants, the only background information collected was for age, gender, and race/ethnicity. participants were 37 years old on average (sd = 11). about 40% of participants were married and 60% were single. the majority were males (70%). most participants were white (58%), and then hispanic american (14%), african american (13%), native american (3%), asian american (less than 1%), or others who did not report their race or ethnicity (9%). there was no significant difference on background characteristics for participants who either completed both tests or just one test. research design vets4vets followed a pretest-posttest, one group design (rubin & babbie, 2010). a pretest was given to participants during the first evening (friday) of the weekend retreat and a posttest the following sunday at the end of the retreat. vets4vets staff designed the survey and collected the pretest-posttest data, but the authors coded the data. the university irb reviewed and approved use of this secondary data for this study. measures peer support. a key theme of peer support is the feeling of social connectedness, a theme that we measured in this study by the social connectedness scale (sc). sc is advances in social work, fall 2012, 13(3) 591 based on kohut’s (1984) concept of belongingness or closeness with others in contrast to social isolation or “emotional distance between self and others” (lee & robbins, 1995, p. 236). the sc scale is the average of 8 items such as, “i have little sense of togetherness with my peers.” each item is assessed by reverse scoring of a 6-point scale ranging from 1= “strongly agree” to 6 = “strongly disagree.” a higher score represents higher perceived social connectedness. cronbach’s alpha of reliability is .96 in the pretest and .95 in the posttest. these reliabilities are consistent with the high reliabilities of .91 reported in lee and robbins (1995) and .94 reported in lee, draper and lee (2001). general self-efficacy. the general efficacy scale (gse) measures an individual’s general sense of self-efficacy in coping with daily hassles and adapting to stress across domains of human functioning (schwarzer & fuchs, 1996; schwarzer & jerusalem, 1995). the gse is the average of ten items such as “i can always manage to solve difficult problems if i try hard enough.” each item is rated on a 4-point scale ranging from 1= “not at all true” to 4 = “exactly true.” a higher score represents a higher perceived general self-efficacy. cronbach’s alpha of reliability is .92 for both the pretest and posttest and is thus consistent with previously reported reliabilities in the high .80s (schwarzer & fuchs, 1996; schwarzer & jerusalem, 1995). situation-specific self-efficacy. the situation-specific self-efficacy (se) measure is the average of four items developed by the vets4vets staff to tap coping with combatrelated trauma. an example is: “i feel confident that i can manage any ptsd and related symptoms, or any effects of military service – such as sometimes feeling bad or guilty about my military service, getting angry easily, feeling isolated.” each item is measured on a 6-point scale ranging from 1 = “strongly disagree” to 6 = “strongly agree.” a higher score represents higher perceived situation-specific self-efficacy. the cronbach’s alpha is .82 for the pretest and .84 for the posttest. ptsd. perceived ptsd is measured by the global screening instrument called sprint (connor & davidson, 2001; davidson & colket, 1997). sprint contains 8 items such as, “how much have you been bothered by unwanted memories, nightmares, or reminders of the event.” each item is measured on a 4-point scale ranging from 1 = ”not at all” to 4 = “quite a bit.” a higher average score represents a higher perceived risk of experiencing ptsd symptoms. the sprint has been reported as responsive to change over time and has high diagnostic accuracy and internal consistency. in this study, the cronbach’s alpha of reliability is .93 for the pretest and .94 for the posttest. control variables. previous research has found that age, gender, and marital status may influence perceived ptsd symptoms (e.g., carter-visscher, et al., 2010; worthen, 2011), self-efficacy (e.g., bandura, 1997), and/or social support from peers (e.g., brown & lucksted, 2010). thus, our analyses control for gender (0 = male, 1 = female), age, and marital status (0 = not married, 1 = married). the measurement of change requires adjusting posttest scores for pretest differences. dimitrov and rumrill (2003) recommend using ancova with a pretest-posttest design that regresses each posttest on its pretest covariate. thus, in addition to the control variables of gender, age and marital status, we entered pretests scores as covariates in maceachron, gustavsson/peer support, self-efficacy, and ptsd symptons 592 regression analyses before evaluating posttest change for peer support, gse, se, and ptsd symptoms. statistical analysis. pasw statistics 20 was used for all statistical analyses. for descriptive purposes, pearson correlations evaluated the strength and significance of bivariate relationships between all measures, while paired t-tests evaluated pretestposttest mean differences of each independent and dependent variable. we used hierarchical regression to test our hypotheses. model 1 of each hierarchical regression analysis is the posttest dependent variable regressed on the control variables (e.g., age, gender, marital status, and the covariate pretests for the dependent and independent variables). model 2 is the posttest dependent variable regressed on the posttest independent variable. r2 for each regression equation is the amount of variance explained in the adjusted posttest dependent variable. change in r2 (r2) between model 1 and model 2 is our measure of effect size, or the strength of association between the posttest independent and dependent variables when holding control and covariate variables constant. there are multiple criteria to test for mediation of the relationship between an independent variable (peer support) and dependent variable (perceived ptsd symptoms) by mediator variables (se and gse) (kenny, kashy, & bolger, 1998). to demonstrate partial mediation, a) the independent variable and dependent variable must be significantly related, b) the mediator variable and dependent variable must be significantly related, and c) the independent variable and mediator variable must be significantly related. to demonstrate complete mediation, an additional criterion is that after controlling for the mediator, the independent variable has no significant effect on the dependent variable. results the mean, standard deviation, and sample size for each measure and their bivariate inter-correlations are reported in table 1. descriptive bivariate statistics show that there are significant (p < .001) and strong, positive pretest-posttest correlations for peer support (r = .73), gse (r = .65), se (r = .60), and perceived ptsd symptoms (r = .87). the paired t-tests for each pretest-posttest mean difference are significant (p < .001) for peer support (t = 5.15), gse (t = 5.31), se (t = 7.18), and perceived ptsd symptoms (t = -5.19). higher pretest scores for peer support, general self-efficacy, and situation-specific selfefficacy predict higher scores on their respective posttests, whereas for perceived ptsd symptoms, a higher pretest score predicts a lower posttest score. these findings offer support that change occurred in these measures over the course of weekend retreats. advances in social work, fall 2012, 13(3) 593 table 1. means, standard deviations, sample sizes, and pearson inter-correlations variable mean sd n 1 2 3 4 5 6 7 8 9 10 pretest (1) 1. support-1 3.6 1.4 211 -- 2. ges-1 3.1 .6 211 .51** -- 3. se-1 4.1 1.2 208 .55** .52** -- 4. ptsd-1 3.0 .8 182 -.60** -.53** -.68** -- posttest (2) 5. support-2 4.0 1.3 212 .73** .34** .41** -.48** -- 6. ges-2 3.2 .5 211 .42** .65** .40** -.37** .51** -- 7. se-2 4.7 1.0 185 .45** .54** .60** -.52** .56** .59** -- 8. ptsd-2 2.7 .8 185 -.55** -.44** -.64** .87** -.51** -.38** -.56** -- background 9. age 36.9 11.2 212 .08 .01 .11 .00 .04 -.03 .06 .02 -- 10. gendera .3 .5 212 .04 -.03 -.04 .03 .11* .06 .08 -.02 .12* -- 11. marriedb .4 .5 208 .21* .12* .21** -.12* .16* .11 .19** -.14 .27** -.25** --------------------------------- * p < .05; *** p < .01 a. male = 0, female = 1 where 70% were male and 30% were female b. single = 0, married = 1 where 60% were single and 40% were married   maceachron, gustavsson/peer support, self-efficacy, and ptsd symptons 594 table 2 shows the hierarchical regression analyses for evaluating the influence of peer support on perceived ptsd symptoms, se, and gse. tables 3 and 4 show the hierarchical regression analyses for evaluating the influence of se and gse on ptsd symptoms. in tables 2 through 4, model 1 for each analysis regresses the dependent variable only on the control and covariate variables. note that, unlike previous studies, the control variables of age, gender, and marital status are consistently insignificant in predicting ptsd symptoms, gse, or se. model 2 for each analysis regresses the dependent variable on the independent variable in addition to the control and covariate variables. hypothesis 1 is that increased peer support reduces perceived ptsd symptoms. as shown in table 2-part a, the amount of change in variance explained is very small but significant (r2 = .01, p < .05) in comparing model 1 (r1 2 = .79) and model 2 (r2 2 = .80) where posttest peer support is added to the regression equation with the control and covariate variables. the standardized coefficient (beta = -.15, p < .001) shows that one standard deviation increase in posttest peer support is necessary to reduce posttest ptsd symptoms by only .15 standard deviations when holding control and covariate variables constant. these finding supports the hypothesis. hypothesis 2 is that increased situation-specific self-efficacy reduces perceived ptsd. as shown in table 3, the amount of change in variance explained is very small but significant (r2 = .01, p < .01) in comparing model 1 (r1 2 = .80) with model 2 (r2 2 = .81) where se is added to the regression equation with the control and covariate variables. the significant standardized coefficient (beta = -.14, p < .01) indicates that a one standard deviation increase in posttest gse reduces perceived posttest ptsd symptoms by only .14 standard deviations when holding other control and covariate variables constant. these findings support the hypothesis. hypothesis 3 is that increased general self-efficacy reduces perceived ptsd symptoms. as shown in table 4, the amount of change in variance explained is very small but significant (r2 = .01, p < .01) in comparing model 1 (r1 2 = .78) with model 2 (r2 2 = .79) where gse is added to the regression equation with the control and covariate variables. the significant standardized coefficient (beta = -.12, p < .01) indicates that a one standard deviation increase in posttest gse reduces perceived posttest ptsd symptoms by only .12 standard deviations when holding other control and covariate variables constant. these findings support the hypothesis. the last two hypotheses are that situation-specific self-efficacy (hypothesis 4) and general self-efficacy (hypothesis 5) will play a mediator role in explaining the relationship between peer support and perceived ptsd symptoms. kenny, kasher, & bolger (1998) defined the criteria for demonstrating mediation. the first criterion is the same as the supported hypothesis 1, namely that the independent variable of posttest peer support reduces perceived ptds symptoms. the second criterion is the same as the supported hypothesis 2 and hypothesis 3, namely that the mediator variable of se and gse respectively reduces perceived ptsd symptoms. the third criterion is that the relationship is significant between the independent variable of posttest peer support and the mediator variables of se and gse respectively. as shown in table 2-part b and part advances in social work, fall 2012, 13(3) 595   table 2. hierarchical regressions with posttest peer support as the independent variable betas r2 for model 1 and model 2 with change in r2 from model 1 to 2 dependent variable (dv) pretest dv pretest support age gender married posttest support r1 2 r2 2 r2 f a. posttest ptsd model 1: controls .86*** -.03 .01 -.02 -.07 .79*** 125.26 model 2: add posttest support .85** .08 .01 .00 -.05 -.15** .80*** .01* 7.31 b. posttest self-efficacy model 1: controls .50*** .14 -.03 .11 .03 .38*** 19.19 model 2: add posttest support .51*** -.20* -.03 .04 .10 .47*** .48*** .10*** 31.94 c. posttest general self-efficacy model 1: controls .59*** .12 -.07 .05 .06 .45*** 32.36 model 2: add posttest support .61*** -.23** -.05 .00 .04 .48*** .55*** .10*** 43.70 * p<.05; ** p<.01; *** p<.001     maceachron, gustavsson/peer support, self-efficacy, and ptsd symptons 596   table 3. hierarchical regressions with posttest “situation-specific” self-efficacy as the independent variable  betas r2 for model 1 and model 2 with change in r2 from model 1 to 2 dependent variable (dv) pretest dv pretest se age gender married posttest se r1 2 r2 2 r2 f posttest ptsd model 1: controls .73*** -.20*** .04 -.03 -.04 .80*** 109.46 model 2: add posttest selfefficacy .72*** -.12* .04 -.01 -.03 -.14** .81*** .01** 7.45 * p<.05; ** p<.01; *** p<.001   table 4. hierarchical regressions with posttest general self-efficacy (gse) as the independent variable betas r2 for model 1 and model 2 with change in r2 from model 1 to 2 dependent variable (dv) pretest dv pretest gse age gender married posttest gse r1 2 r2 2 r2 f posttest ptsd model 1: controls .86*** -.03 .01 -.02 -.07 .78*** 125.18 model 2: add posttest gse .86*** .05 .01 -.02 -.06 -.12** .79*** .01** 5.56 * p<.05; ** p<.01; *** p<.001   advances in social work, fall 2012, 13(3) 597 c, this criterion is supported by the strong significant relationship of peer support to both se (beta = .47, p < .001) and gse (beta = .48, p < .001). a one standard deviation increase in posttest peer support increases se or gse respectively by .47 or .48 standard deviations when holding other control and covariate variables constant. a fourth criterion is necessary to demonstrate full mediation, namely that the relationship between posttest peer support and perceived ptsd symptoms must be reduced to insignificance when controlling for posttest se or gse respectively. this criterion is satisfied when controlling for the control variables for posttest se (beta = -.07, p > .05) and posttest gse (beta = -.12, p > .05) respectively. the findings for all four criteria together support hypotheses 4 and 5. discussion this study contributes to the limited empirical knowledge about the effectiveness of peer support for veterans who have returned to civilian life, especially in regards to oif/oef veterans (ozer et al., 2003). perceived increases in peer support foster a significant but small reduction of perceived ptsd symptoms, as do increases in situation-specific self-efficacy and general self-efficacy. from a conceptual perspective, as benight and bandura (2004) report, little is known about the role of self-efficacy as a mediator variable between combat-related trauma and peer support. the strong, significant relationship between peer support and self-efficacy here suggests that peer support as change-oriented process provides an enabling environment that promotes selfefficacy beliefs regarding proactive, adaptive coping with ptsd symptoms. this mediator role was played by both situation-specific self-efficacy and the more futureoriented, optimistic concept of general self-efficacy. these findings must be balanced with a number of study limitations. although all hypotheses are supported, the strength of relationship is small between reduced ptsd symptoms, peer support, and self-efficacy. this change in ptsd symptoms may have resulted for reasons other than increased peer support or self-efficacy. for example, it may be that an intense weekend retreat created a positive ‘bounce’ effect in selfevaluation that will shortly diminish. the literature does suggest, however, that the effect of peer support for veterans is cumulative over time (ozer et al., 2003). longitudinal, follow-up studies are needed to compare the initial and cumulative effects of different peer support formats. another study limitation, perhaps best corrected by randomization to different groups when possible, is selection bias of participants in terms of attending a weekend retreat. measurement could be improved by, for example, a) additional peer support measures to enhance understanding of the emotional, cognitive and social meanings of peer support, and b) increasing the range of outcomes to include more about the management of combat-related trauma and pain, social relationships, and instrumental needs such as use of veteran benefits, education, and employment to indicate how peer support is most helpful. maceachron, gustavsson/peer support, self-efficacy, and ptsd symptons 598 implications for social work recognizing the behavioral health needs of veterans is an essential first step in the design of services. the recognition needs to be followed with referral for appropriate services. social workers need to advocate on behalf of veterans to ensure they receive the benefits they and their families are entitled to. this requires assessing support systems and resources. encouraging agencies to develop peer support programs that are sensitive to the needs of veterans can be a proactive strategy. peer support plays a role in wellbeing and is consistent with the bio-psycho-social model and client-centered practice. this model assumes the client possesses strengths such as self-efficacy and resources that can be used to ameliorate current challenges in the fit between person and environment. veterans face serious challenges as they integrate into civilian life after exposure to the multiple traumas associated with combat. reliance on peer support, a core component of military culture and camaraderie, can play a critical role in re-integration. using the resources they had in civilian life as well as the acquired coping skills such as selfefficacy that they developed during their military service, they can now go about the seemingly daunting task of returning to civilian life. the behavioral health needs of the increasing number of returning veterans may strain services at the community level. engagement in the political process can ensure that the funding for these services is available. in addition, there is growing empirical evidence that peer support may be an important “extra-therapeutic” factor in psychotherapy outcomes generally (roehrle & strouse, 2008) and for veterans (barber et al., 2008) including oif/oef veterans (price et al., 2011). augmenting professional services by using such cost-effective strategies as peer support groups that rely on the strengths of the veterans should be pursued. from an ecological perspective, veterans are often not alone in coping with their ptsd symptoms. about 40% of participants in this study were married. as sherman, blevins, kirchner, and ridener (2008, p. 443) summarize, there are “often complicated, multi-layered family issues of people living with posttraumatic stress disorder.” for married veterans or veterans with partners, vets4vets might expand the social support network by including a family focus through psycho-education and concurrent peer support for family members. this may facilitate recognizing the potential impact of untreated behavioral health problems on all family members and information about available resources. from a broader community perspective, social workers in schools or other family-oriented settings may see family members who are trying to deal with hyper-vigilance or the emotional numbness of veterans without being aware these are ptsd symptoms. here information and referral for veteran benefits and services would further assist families of veterans with their struggles. lastly, the weekend retreat potentially has much to offer the social service community. weekend retreats allow for an intensive amount of bonding time in a short time frame, which is often how veterans experience camaraderie. moreover, as time pressures of family, work, and other responsibilities increase, the weekend can 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(2011). the relations between traumatic exposures, posttraumatic stress disorder, and anger in male and female veterans. journal of feminist family therapy, 23, 188-201. author note: address correspondence to: nora gustavsson, arizona state university, college of public programs, school of social work, 411 n. central ave, suite 800, phoenix, az 85004. email: nora.gustavsson@asu.edu microsoft word 0-queiro-tajalli editorial final ______________ irene queiro-tajalli, ph.d., is a professor and chair of the department of labor studies in the indiana university school of social work. professor queiro-tajalli would like to express her appreciation for the important contributions made by craig campbell, msw, department of labor studies student services coordinator, who was like a co-editor through the process of compiling and assembling this issue. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), i-viii  editorial: the impact of socio-economic, cultural, political, and international factors on latinos/latinas in united states irene queiro-tajalli special issue editor this special issue has the potential to make substantive contributions to the existing literature on latinos. the issue presents the assets, challenges, and opportunities latinos face in this country. it also highlights the impact that the quality of the socio-politicaleconomic latin america-united states relations has on this population. it contributes to the discourse on latinos in areas of interest to social workers and other human services providers and offers an understanding of the latino experience in this country. we are mindful that the use of the terms spanish, latinos, hispanics, or country of origin may express different personal, political, or governmental views. therefore, the choice was left to the contributors to select the terminology used to represent the population they addressed. as an immigrant from argentina, i was first classified as a hispanic. then the 2000 census gave me the choice to check the spanish/hispanic/latino box, however, when i travel to central and south american countries, i am an argentinean. it is no wonder that “who am i” has been the subject of attention by latino authors for many years. latinos are the fastest growing population in the united states due to immigration and high birth rates, two factors that are dramatically changing the diversity composition in this country. an important aspect of this population is that latinos have lived on parts of this land since colonial times while others are recent immigrants. the challenges, needs, and the means by which they identify with latin america vary greatly, indeed, intra-group differences are many. as a result, the authors have avoided generalizations by focusing on particular groups and the specific generations the immigrants represent. in this special issue, we want to emphasize the fact that large numbers of latinos are impacted by events in latin america, as well as by the u.s. government’s position on immigration and foreign policies toward latin america. an example of the serious nature of the disagreements between the latin american countries and the united states was reflected in the discouraging outcome of the 2012 summit of the americas (a gathering of the heads of state of the countries of the americas) when the united states opposed the acceptance of cuba to the next summit meeting. another example is the neutral position taken by the united states on the long-standing conflict between argentina and england regarding the sovereignty of las islas malvinas (falkland islands). the lack of u.s. solidarity with latin american countries is a critical issue, particularly when there is an emerging move among latin american countries to seek trade agreements and other queiro-tajalli/editorial ii  collaborative enterprises with nontraditional international partners, particularly those in the middle east, east and south asia. it is beyond the scope of this issue to thoroughly address the debate over immigration from latin america, or attempt to answer the perennial questions of “do undocumented workers take jobs from residents?” “do they lower wages?” “why don’t they stay home?” yet the issues are woven in several of the articles. and indeed, these writings try to give a human face to latinos and their efforts to be part of this country. to add a personal touch to this editorial, i would like to share one of my experiences as an immigrant. years ago, a colleague and i were conducting a training session on diversity for human services providers. as i was presenting on the struggles of latino immigrants trying to survive on this land, one of the participants bluntly asked me, “if you do not like it here, why don’t you go back to your country?” the remark has kept me wondering to this day, who is serving our most vulnerable populations? as the reader will notice, finding adequate employment to support a family, obtaining educational and social services, maintaining a sense of well-being, and living a healthy lifestyle all depend on gaining access to the larger society and being surrounded by a nurturing environment of acceptance and connectedness within the larger community. humans acting as cultural liaisons can provide ample transitional benefits to immigrants. it is through human connections that latino students experience mentoring and tutoring, which helps them succeed in the american school system, that parents learn how to support their children entering college as first generation students, that graduating latino social workers find support in locating suitable employment, that workers unite to find a common empowering voice, that minors find a voice in the child welfare system, that policymakers understand the real impact of emerging immigrant legislation, and that vibrant communities are built and sustained for the benefit and well-being of their members. our connections with others define our lives and help bring direction and focus when things are not clear. helping others succeed in life is deeply rooted in the social work profession and is practiced on a daily basis. unlocking the door to cultural acceptance and holding it open for the next generation is one of the ways that social workers can promote the well-being of latinos in the united states. this issue draws from practitioners and educators well versed on a wide range of current latino topics to enhance our understanding about this complex population group. i anticipate it will motivate others to continue the critical discussion about the challenges faced by latinos in the united states and the impact events occurring in latin america have on them. i hope that the seventeen articles included in this issue add to the knowledge base on the latino population and encourage our readers to further explore the assets, challenges and opportunities of this population. i would also like to extend sincere thanks to the authors for selecting advances to share their knowledge and scholarly work, our devoted reviewers, and dr. bill barton for his ongoing assistance with this project. the following summaries for this introduction are organized by subject matter. latin american activism while organized labor is under attack in the united states, it is refreshing to read about a brazilian approach to labor education based on the tenets advanced by paulo advances in social work, spring 2013, 14(1) iii  freire. “workers, education, and social change in brazil” by william mello examines the influence of educational programs organized by social movements and labor organizations in brazil. the article looks at new ways to conscientize workers based on freire’s pedagogical approach. programs like projeto integrar, organized by the national confederation of metalworkers, seek to expand the political and social consciousness of workers to help them understand their roles as actors in a democracy. furthermore, the project provides education to strengthen future generations of working class activists for the purpose of sociopolitical transformation that supports working class political influence in society and increases labor’s role in deciding public policy issues. the conclusion highlights the pivotal role of unions in advancing the cause of workers in specific trades and their organized efforts to support the plight of other popular movements. this reading also reminds us how easy it is to lose ground on labor achievements given a growing international neoliberal agenda. in “globalization, inequality, and transnational activism: a case study on chile,” moctezuma garcia examines the influence that globalization has had on reinforcing inequality and transnational activism. it also brings to the forefront the dark history of that country during the government of pinochet. the author suggests that chile be considered a model for activists in understanding how to coordinate initiatives that hold local governments accountable. this historical perspective on chile highlights how economic, political, and social events influenced the development of a nation. a section on transnational activism provides a useful model for social workers who want to mobilize efforts, locally as well as abroad, to advocate for highly vulnerable populations. the effects of acculturation and cultural integration on well-being in “colombians in the united states: a study of their well-being,” cándida madrigal examines the effects of four factors: acculturation, ethnic identity, self-esteem, and resilience among immigrants in the united states, specifically colombians, to understand which factors contribute to overall well-being. in controlled studies of three waves of colombian immigrants, madrigal explores the reasons for leaving colombia, to better understand the relationship between the overall climate of the receiving country and the immigrant’s sense of well-being. the results of the study indicated that a strong ethnic identity negatively predicted well-being for all participants in the sample. consequently, as the extent of ethnic identity increased, well-being decreased. in contrast, madrigal’s study revealed that high self-esteem, obtained by feeling integrated into the receiving culture, correlated with and predicted higher levels of well-being. madrigal concludes that while latinos share many characteristics, there are great variations in responses according to the country of birth and reasons behind immigration. therefore, it is necessary to examine, treat, and study latino cultures individually and not as a collective group. the process of acculturation may cause conflict within individuals and families who experience competing pressures in adopting new cultural norms and maintaining cultural traditions. the connection between life satisfaction and successful integration into a new culture, which includes employment, stability of familial relationships, and community roles are explored in “acculturation and life satisfaction among immigrant mexican queiro-tajalli/editorial iv  adults.” flavio f. marsiglia, jaime m. booth, adrienne baldwin, and stephanie ayers address the impact of acculturation and familismo on reported life satisfaction and resilience among mexican american adults living in the southwest, many of whom are immigrants. marsiglia et al. sampled latino/a parents of seventh grade students enrolled in american educational institutions to help identify predictors of general life satisfaction, resilience, familism, and acculturation. their findings indicate that individuals with a bilingual orientation report significantly higher levels of life satisfaction and resilience than their strictly spanish-speaking counterparts. therefore, creating spaces that facilitate multicultural identities for mexican immigrants, in both social work practice as well as the larger society, may be crucial to promoting a quality mental health system for populations that face stressors in the process of acculturation. understanding health issues affecting latino populations and quality of life in “addressing older latinos’ spiritual needs in hospital settings: identifying predictors of satisfaction,” david r. hodge, robert j. wolosin, and robin p. bonifas sought to identify the factors likely to determine older latinos’ satisfaction with the process that health care workers employ when addressing their spiritual needs during hospitalization. hodge et al. point out the need for health care providers to feel comfortable discussing the spiritual needs of the latino patients, if that is of importance to them. the authors contend that spirituality needs to be a consideration in all the processes of the hospitalization experience. social workers are considered instrumental in addressing patients’ spirituality while going through treatment and at time of discharge. the authors propose the inclusion of content on spirituality, including spiritual assessment, in the training of social workers and other human services providers. in “quality of life of latina breast cancer survivors: from silence to empowerment,” gloria p. martinez-ramos, mary jo garcia biggs, and yvonne lozano interviewed long-term latina breast cancer survivors to understand the effects of the cancer experience on the women, their families, and their communities. the authors skillfully give a voice to the survivors concerning their experiences, challenges, fears, and courage through an empowering dialogue between interviewer and interviewee. the authors asked the tough and sensitive questions of living as a cancer survivor as well as the “positive” effects of such a diagnosis. fears and concerns about femininity, roles, and relationships, as well as a lack of support from the health care system are some of the challenges expressed by the women. martinez-ramos et al. found that latinas who found appropriate support among their communities often became stronger as a result and saw themselves more capable of helping others in similar circumstances. this manuscript provides rich content for social workers concerning their interventions with cancer survivors and it highlights the importance of advocating for culturally sensitive health care options and post operative support. the authors provide recommendations for practice at the individual, family, and community levels. they call for creativity when developing resources for the latina breast cancer survivors and their families. advances in social work, spring 2013, 14(1) v  educational attainment opportunities in “leadership development for latino community emancipation: an integrative approach in social work education,” authors antonia elizabeth cordero and lirio k. negroni outline the importance of leadership development within the social work community, and in latino communities in particular. the authors assert that strong leadership is needed in and among the latino communities as a response to a history of encountered invisibility, oppression and discrimination in the united states; and their struggle to achieve fair treatment and emancipation. they highlight the latino project at the new england school of social work as a model to demonstrate how higher education promotes leadership and acts as a springboard toward the acquisition of effective leadership skills. cordero and negroni note that sustained institutional commitments in the form of support and resources; the creation of leadership opportunities that include mentoring and modeling; and leadership efforts for community emancipation must coincide to create a collective, culturally-attuned, and transformative leadership process that will prepare individuals and groups to lead collectively with others whose cultures and practices differ from their own. in search of “what works,” sarah p. maxwell considers what parental or familyrelated factors contribute to latino youth enrolling in four-year post-secondary institutions, where future earnings tend to be higher than two-year colleges with fewer opportunities. in “parental and familial factors among latino/a youths’ successful matriculation into post-secondary education,” maxwell uses critical race theory to examine the strong influence that latino families have in affecting the choices made by degree-seeking latinos. although discrimination is certainly a factor in the ongoing gap between what latinos can achieve educationally and what they do achieve, it is not the leading impediment to attaining an education. maxwell found that beliefs and the subsequent actions that affirm the importance of education play a much larger role in determining students’ educational abilities. family dining, parental educational attainment, parental participation and involvement in academic preparation combined can improve a latino youth’s potential success in attaining higher education. among other findings, the article underscores the importance of understanding the relationship between the realities of daily living and the limited availability of parents to have quality meeting times with teachers. the author also highlights the importance of schools showing flexibility to accommodate the families’ realities. understanding the complexities of bringing innovation to the public school system, the author calls for gradual innovations at the local level. even when latino students successfully attain and complete degree programs in the united states, their options for employment can be limited by their lack of employment resources and access to the professional networks crucial to finding quality employment opportunities. nelly rojas schwan, lirio k. negroni, and annette santiago-kozmon, in “culturally-attuned mentoring for graduating latina/o social workers to foster career advancement,” present an innovative mentoring program for latina/o social work professionals conceptualized and led by the latina/o network of the connecticut chapter of the national association of social workers. schwan et al., in studying the benefits of mentoring latino college students, found that culturally-attuned mentoring, attained by queiro-tajalli/editorial vi  connecting students with mentors who share similar cultural backgrounds, works by taking advantage of common cultural values to build relationships that foster trust and acceptance. culturally-attuned mentoring helps students become bicultural, that is, to maintain their latino culture and function successfully within the educational institutional environment, a process that allows them to develop resources to improve their chances of employment. in “reducing barriers to career entry for latinos: an examination of pathways into social work,” anthony de jesús describes program models that seek to address obstacles to latinos’ successful entry into social work careers. the study analyzes the program components of three career pathway initiatives focused on supporting latinos in enrolling and completing twoand four-year undergraduate and graduate degrees in social work. areas of need identified by the programs for latino adults include tuition support, academic support, and other support services to students. key program components offered by these models include academic advising, language proficiency assistance, positive student-faculty relations, and mentoring and tutoring geared toward addressing the specific academic needs of latino students. the author concludes that career pathways create potential for latinos who are already employed in social work fields, but who have not completed their undergraduate or graduate social work degrees. he points out the dual opportunity of helping latinos complete their degrees to better serve both the latino and the general communities. in “the role of acculturation in the civic engagement of latino immigrants,” cristina michele tucker and anna maria santiago conducted focus groups and utilized data from the latino national survey (2006) to examine how variations in levels of multidimensional acculturation, demographic characteristics, socioeconomic status, and characteristics of the immigrant experience might influence the civic engagement of latino immigrants in american society. specifically, tucker and santiago found that citizenship, english language proficiency, length of residence in the united states, and higher socioeconomic status enhanced civic engagement, while brown skin color, migration for economic reasons, and mexican ancestry decreased participation. understanding the impact that various factors have on an immigrant’s integration into the political landscape may improve initiatives that seek to enhance latino cultural experiences and enrich the quality of life in latino communities. impacts of immigration legislation cecilia ayón and david becerra consider the impact that all forms of discrimination have on mexican american families living in arizona. in “mexican immigrant families under siege: the impact of anti-immigrant policies, discrimination, and the economic crisis,” the authors assert that in the wake of recently passed legislation targeting undocumented immigrants in arizona, institutional and horizontal discrimination, as well as micro-aggressions, place latino immigrants (both documented and undocumented) at greater risk for lower educational attainment, higher rates of unemployment, family disintegration, reduced access to healthcare, lowered social participation, and higher rates of antisocial behavior, stress, and depression. advances in social work, spring 2013, 14(1) vii  sylvia romero and melissa romero williams examine recent immigration legislation in order to highlight the detrimental effects that laws designed to enforce national immigration policy can have on immigrant families living in the united states. in “the impact of immigration legislation on latino families: implications for social work,” romero and romero williams address the effects of racial profiling and the targeting of undocumented immigrants in latin american communities. the authors emphasize the ways in which latin american children who are born in the united states suffer as a result of the detention and deportation of their parents. the authors conclude with a discussion of the components of the dream act, prosecutorial discretion, immigrants as job creators and tax contributors, and the implications for social work practice, education, research, and for policy. navigating economic and employment challenges resilience is measured in one’s ability to navigate not only the normative social structures, but also to invent new methods of survival apart from established social constructs. in “social networks that promote well-being among latino migrant day laborers,” nalini junko negi, lynn michalopoulos, javier boyas, and adrianna overdorff explore the social service and public health needs of a high risk sub-population of immigrants comprised mainly of single, young, latino transmigrant men who travel back and forth across the mexican/american border in search of informal economic opportunities as day laborers. these latino day laborers (ldls) are generally employed in construction or demolition work and are often at risk for exploitation and worker’s rights abuses, including wage theft and dangerous working conditions. their vulnerability is heightened due to their undocumented immigration status, and as such, they are considered easily deportable and beyond the protection of the law. the authors found that the ldls in this study used their social networks, particularly those developed with their peers at the day labor corner, as well as with families, employers, and church members to improve their well-being, which is seriously compromised due to their precarious conditions, lack of service use options, and fear of the police. the authors highlight the need for integrating the voices of ldls when planning for social services and advocating for the human rights of this vulnerable population. many recent latino immigrants have found employment in north carolina’s agricultural and construction-related job sector. the increase in labor-driven transnational migration is often attributed to the economic restructuring of the region. lisa de saxe zerden, arianna taboada, and quentin joshua hinson explore the inherent implications of racially segregated labor in “carolina del norte and the new south: social work practice with new latino immigrant communities.” the authors found that despite the active recruitment of latino/latina workers by select industries, the local reception of immigrants has been fraught with anxiety, fear, acculturative stress, and larger sociopolitical challenges. specifically, the authors highlight key social demographics of latino populations, as well as theoretical concepts and methodological issues related to the complex needs of this diverse population group. zerden et al. offer an overview of social workers engaging with immigrant communities and argue that the profession brings strengths and unique knowledge, value, and skills to address the needs of latinos queiro-tajalli/editorial viii  in the south. at the same time, the authors highlight the need to develop multi-level interventions that indicate a thorough understanding of the local and global issues affecting latino immigrant groups. puerto rican perspectives the graying of the population is a phenomenon that, although foreseen by scientists and policy makers for several decades, reveals that the degree of preparedness for this population shift varies from country to country. in “family assistance for older adults in puerto rico,” paul-jesús fericelli discusses a progressive government legislation that aims at safeguarding the wellbeing of the elderly with the support of relatives and significant others and applying fiscal responsibility at a time of dwindling resources. the author examines the act for the improvement of the family assistance and for the support of the elderly, act no. 193 of 2002, based on the values of fairness, familism, fraternity, and accountability, indeed, four fundamental values of the latino culture. the act also prescribes the processes involved in case the caregivers do not fulfill their responsibilities. this journal issue concludes with an article in spanish, “voces de los menores inmigrantes en el sistema de cuidado sustituto de puerto rico.” in this article evelyza crespo-rivera gives voice to immigrant minors who are under the custody of the government of the estado libre asociado de puerto rico. through the review of agency records and personal interviews with the minors, the author constructs the immigrant experience and compares their treatment to that of the statutes that establish the protection, security, quality of life, and nondiscrimination of minors. crespo-rivera concludes that the minors themselves are an important source of information for practitioners interested in grasping the realities of the lives of displaced minors, which in her study includes a perceived lack of support from the receiving country, as well as human services organizations, and a unanimous outcry for the system to respond to their needs. crespo-rivera found an undeniable need for closer supervision of the foster homes, more dialogue with the minors during home visits, and more culturally-sensitive training for foster families. she also recommended that in the future, immigrants who were under the custody of the state as a minor be part of advisory committees, interdisciplinary groups, and help integrate evaluation teams of child welfare organizations. author note: address correspondence to irene queiro-tajalli, ph.d., indiana university school of social work, department of labor studies, 902 w. new york st., indianapolis, in 46202-5156. e-mail: itka100@iupui.edu microsoft word 01_rapp-mccall_and_anyikwa_20871_active_learning_strategies _______________ lisa rapp, phd, msw, professor, graduate social work program, saint leo university, saint leo, fl 33574-6665. victoria anyikwa, phd, lcsw, associate professor, graduate social work program, saint leo university, saint leo, fl 33574-6665. copyright © 2016 advances in social work vol. 17 no. 1 (spring 2016), 1-14, doi: 10.18060/20871 active learning strategies and instructor presence in an online research methods course: can we decrease anxiety and increase perceived knowledge? lisa rapp victoria anyikwa abstract: research methods courses elicit more anxiety than usual for graduate social work students, and the online environment may pose an even greater challenge as the personal interaction between instructor and student is reduced or absent. it is therefore incumbent on research instructors to creatively engage students, reduce anxiety, and foster learning. there is a dearth of evidence, particularly regarding online education, explicating specific teaching strategies. this exploratory study sought to provide some answers. first-semester msw students were invited to participate in a voluntary, anonymous, online survey at the end of a research methods course to determine which online teaching strategies were most effective in decreasing anxiety and increasing perception of knowledge. strategies used in the class include asynchronous activities such as discussion questions, powerpoint lectures, and email and telephone contact with instructors in addition to synchronous class sessions. three tactics were rated by the 43 respondents as being most helpful for both decreasing anxiety and enhancing the perception of knowledge: personal contact with the instructor either via email, phone, and/or online meetings; the instructor’s synchronous class sessions; and active learning strategies employed during the synchronous class sessions. implications for teaching and future research are discussed. keywords: teaching strategies; active learning; instructor presence; online learning; anxiety reduction online learning in higher education has proliferated in recent years resulting in the adaptation of courses from traditional to online formats without much consideration for the course content or learning process (tsai, 2012). a study by castaño-muñoz, duart, and sancho-vinuesa (2014) noted that to encourage student learning, cooperative and interactive learning strategies which are effective in face-to-face courses must also be incorporated in online courses. likewise, xu and jaggars (2014) found that students generally view online courses as isolating and lacking in instructor presence. in these courses, students feel that they must teach themselves. consequently, most students report trying to avoid taking “difficult” or “important” courses online. besides a delivery barrier, some courses pose more challenges than others for the online environment of students. in graduate-level social work programs, the research methods course is often a concern in both traditional and online formats. this is a difficult course requiring students to learn a vast amount of new knowledge and skills in a short time frame. in addition, the students in graduate social work programs come from a wide variety of undergraduate majors and backgrounds, and many have never been exposed to the terms and concepts of research. rapp & anyikwa/active learning strategies 2 the situation is exacerbated by the students’ attitudes towards research, which have been reported as disinterested, irrelevant, bored, and annoyed (lundahl, 2008; schulze, 2009). studies have noted that research courses also provoke anxiety in students (devaney, 2010; green, bretzin, leininger, & stauffer, 2001). green et al. (2001) compared research anxiety across various disciplines and found msw students had higher anxiety than their counterparts regarding research methods and analysis. student anxiety is a serious concern in the learning environment as it has been found to have a negative relationship to learning outcomes (jiao, onwuegbuzie, & waytowich, 2008). chan and lee (2005) noted that student anxiety creates a barrier to learning, and ramsden (1992) found it affects learning styles and can inhibit deep learning. while gal and ginsberg (1993) suggest students’ preconceived ideas about the subject are the root cause of anxiety, this was found most frequently for math, statistics, and science courses. as such, research methods delivered in an online environment may be experienced as even more daunting than traditional formats, making the use of effective teaching strategies critical. active learning pedagogical approach active learning strategies have been found to be very effective in traditional classrooms (bonwell & eison, 1991; freeman et al., 2014). active learning strategies are based on earlier constructivism theories that are rooted in the works of psychologists jean piaget, who focused on individuals' cognitive development processes (lefmann & combsorme, 2013), and lev vygotsky, who focused on socio-cultural learning and meaning making through social interaction, problem-solving, peer facilitation, and questioning (jaramillo, 1996). constructivism learning theories posit that individuals learn through cognitive processes, thereby building and creating their own understanding and knowledge of a phenomenon based on experiences, and through social constructivism, learning from each other and building on their own cognitive schemas, thus broadening knowledge and understanding (drew & mackie, 2011; powell & kalina, 2009). when applied to the classroom, active learning pedagogical strategies go beyond the traditional delivery of lecturing on the part of the instructor by engaging students through interactive activities where they can apply what they have learned (berry, 2008). lundahl (2008) noted that deeper-level learning occurs when students are directly involved with the material. watkins, carnell, and lodge (2007) define active learning as having three components. the first is behavioral, where students are engaged in instructor-created activities; the second is cognitive, where students are engaged in critical thinking and decision-making, thus making use of critical thinking skills; and the third component is social, as students engage with each other. building upon the work of watkins et al.(2007), drew and mackie (2011) added affect as a fourth component, drawing on the classic model of bloom’s taxonomy (1965) that recognizes students’ motivational capacity in the affective domain. this implies the importance of the instructor’s role or presence in explicating the pertinence of the content for students and creating an environment in which students want to learn. it also suggests that instructors need to be attentive to students’ anxiety towards the content, as well as the format of the course. advances in social work, spring 2016, 17(1) 3   instructor presence instructor presence, as described by garrison, anderson, and archer (2000), involves instructors facilitating course flow and content, encouraging student participation, directly interacting with students, providing timely responses to questions, and promoting involvement with discussion questions. studies suggest that the instructor is essential to the learning community and have found learning outcomes directly tied to active instructor presence in the course (picciano, 2002; swan & shih, 2005). interaction with instructors has been found to have a strong positive effect on satisfaction and learning (swan, 2001). boettcher and conrad (2010) go as far as proposing that instructor presence is one of the most important practices for online teaching. most educators strive to reduce students’ anxiety and enhance learning outcomes but are not sure which strategies can accomplish these goals (schacht & stewart, 1990). this is especially true for courses such as research methods, which is not easily taught in an online format. several studies found success in teaching traditional social work research courses with active learning strategies (barrakat, 2005; marek, christopher, & walker, 2004; walsh, 1998), but little has been reported for online courses. currently, there is scant evidence regarding what specific teaching strategies assist in reducing research anxiety and augmenting research knowledge, especially in online social work research courses. this exploratory study begins to fill some gaps in this area by seeking to answer the following: a) what online teaching strategies are effective for decreasing students' anxiety? b) what online teaching strategies are effective for increasing students' perception of acquiring research knowledge? methods research methods course this study was conducted at a liberal arts university with an online msw program. all students take online courses which include a variation of synchronous and asynchronous components. the foundation level research methods course was delivered online over 16 weeks and included both synchronous and asynchronous formats. synchronous sessions were held each week for 90 minutes and were delivered using the blackboard collaborate platform where the instructor and students interacted via audio and webcam. complementing the webcam sessions, the asynchronous platform was delivered using learning studio. weekly modules were listed in tandem with the syllabus, outlining tasks for students to complete independently (e.g., assigned readings and homework) or with each other (e.g., discussion questions and online exercises). each week students were expected to complete the asynchronous activities (via the learning studio site), and to read and prepare for the live blackboard collaborate sessions. synchronous class sessions included review of the content and active learning strategies relating to the three components indicated by watkins et al. (2007): behavioral components (e.g., games promoting knowledge and understanding), cognitive components (e.g. application exercises), and social components (e.g., group activities where students worked together in small groups). asynchronous delivery also included the three components, such as voicedrapp & anyikwa/active learning strategies 4 over powerpoint lectures, discussion questions, and homework assignments. weekly announcements and email within the class were also used. additional contacts with instructors were made through phone calls, emails, and/ or online individual meetings with students who requested assistance. eight sections of the course were taught by four different instructors, with approximately 12 students in each section. to remain consistent, all sections used the same syllabus, book, format, and course materials. however, each instructor decided on the degree to which they used phone calls, emails, and meetings via webcam. procedures upon approval of the university institutional review board (irb), an email was sent at the end of the semester to all students (n=105) enrolled in the eight sections of the course during the fall and spring semesters. the email explained the study procedures and invited students to participate. it also included an implied consent form with a hyperlink to the survey. the web-based survey was administered via the secure qualtrics website, which ensures that data remain private and encrypted. students chose to participate by clicking on the hyperlink in the invitation email or in two subsequent reminders. the students were ensured that the survey was in no way related to their course work or grade. the voluntary and anonymous survey was offered to students at the end of the course. they were asked to rate their level of anxiety and their perception of research knowledge before and after the course. design msw students who completed the research methods course were invited to participate in a voluntary, anonymous, online survey. a posttest only design was used at the end of the fall 2013 and spring 2014 semesters to determine students’ perceptions of which online teaching strategies were effective for decreasing their anxiety and increasing their research knowledge. measures the researcher-created measure asked students to rate their level of anxiety as well as their level of perceived research knowledge before and after the course. they were also asked to rate the effectiveness of teaching strategies in reducing their anxiety and increasing their perception of research knowledge separately. the measure consisted of 20 items with ten focusing on anxiety and ten focusing on knowledge using a likert-type scale (see appendix). an example question was, “prior to the beginning of the course, how would you rate your level of anxiety about social work research methods?” students responded on scale ranging from 1 (not anxious at all) to 5 (extremely anxious). another example included, “how helpful were the online discussion questions on learning studio in increasing your knowledge of social work research methods?" students responded on a scale ranging from 1 (they caused more confusion) to 5 (extremely helpful). to test the internal reliability of the measure, a cronbach’s alpha was calculated for the ten items regarding anxiety and separately for the ten items regarding knowledge. the advances in social work, spring 2016, 17(1) 5   results for both tests were α=0.82, which suggests good internal consistency of the measure (tavakol & dennick, 2011). analytic plan descriptive analysis and paired sample t-tests were used to compare differences in students’ reported anxiety and knowledge. forty-three students completed the survey over two semesters for a response rate of 41%. according to sue and ritter (2007), email surveys generally have response rates between 27-71%, indicating this response rate to be typical. results the analysis of the survey results indicated a significant difference between students’ preand posttest perception of knowledge t(43)=14.05, p<0.001 and pre and post levels of anxiety t(43)=6.47, p<0.001, with knowledge increasing and anxiety decreasing by the end of the course. the effect sizes, as determined by cohen’s d for paired measures, were 0.91 for knowledge and 0.71 for anxiety (see table 1). table 1. descriptive statistics for students’ knowledge and anxiety and t-tests of prepost differences with effect sizes pretest posttest m (sd) m (sd) t df p d perception of knowledge 1.93 (0.68) 3.38 (0.54) 14.049 42 <.001** 0.91 anxiety 3 (1.22) 1.91 (0.65) 6.465 42 <.001** 0.71 p< .01** the effectiveness of the various teaching strategies were indicated by students’ mean ratings. all of the strategies were rated as more than moderately helpful with some having greater impact than others. the same three strategies were rated as the most helpful by students for both increasing perception of knowledge and reducing their: personal contact with the instructor either via email, phone, and/or online meetings (m=4.37; m=4.40); the instructor’s synchronous class sessions (m=4.28; m=4.16); and active learning strategies employed during the synchronous class sessions (i.e., games, exercises, discussions, cases, etc.; m=4.05; m=3.72). the strategies rated the least helpful by students in both increasing perception of knowledge and reducing their anxiety were homework assignments (m=3.53; m=3.23), the online voice-over powerpoint lectures (m=3.57; m =3.29), and online discussion questions (m=3.56; m=3.33). the textbook was rated as helpful for learning but less helpful for reducing students’ anxiety (m=3.79; m=3.26). see table 2 for the complete results. rapp & anyikwa/active learning strategies 6 table 2. student ratings of the effectiveness of teaching strategies for increasing knowledge and reducing anxiety (n=43) knowledge m (sd) anxiety m (sd) contact with the professor 4.37 (0.95) 4.40 (0.85) synchronous class session 4.28 (0.80) 4.16 (0.89) synchronous activities (games, discussions, etc.) 4.05 (0.87) 3.72 (0.91) weekly announcements 3.81 (0.71) 3.63 (0.88) discussion questions 3.56 (0.88) 3.33 (0.94) textbook 3.79 (0.71) 3.26 (0.96) online power point lectures 3.57 (0.91) 3.29 (0.84) homework assignments 3.53 (0.85) 3.23 (0.83) note: each item was rated on a 5-point scale in which 1=caused more confusion/anxiety and 5=extremely helpful. discussion overall, the results were positive for this course, as students’ anxiety decreased and their perception of research knowledge increased by the end of the course. the findings were similar to picciano (2002) and swan and shih (2005) who found students’ anxiety and knowledge attainment were negatively correlated. this is not surprising as most people feel less anxious learning content with which they have some familiarity. this study confirms that student anxiety is a crucial variable which must be considered when teaching research methods courses, especially in an online format where direct contact is limited and students must perform some activities independently. it is interesting that the same three teaching strategies were responsible for reducing anxiety and increasing perception of knowledge in the students’ views but not surprising that all three strategies were active learning strategies and/or involved the instructor. this is especially compelling since not all students had the same instructor for the course or took it during the same semester. likewise, the strategies rated as least helpful were less interactive. on average, students rated all of the teaching strategies used in the course as effective (3 or above) however, students still need contact from the instructor, even at the graduate level of education. while active pedagogical strategies require a change in the instructor’s approach to teaching so as to include behavioral, cognitive, and social learning opportunities, there is also an implication that the students must also shift their understanding of learner as receiver of information to active and independent participant. future studies should consider the concept of students’ independence or need for validation and how it relates to anxiety and learning. the results suggest that instructors’ involvement and connection with students is essential. instructor presence in the online environment can be created in ways other than physical presence and ways that increase students’ independence. this is particularly important in the asynchronous environment where there is no direct contact with the instructor. advances in social work, spring 2016, 17(1) 7   limitations there were several limitations to this study. the first is that anxiety was self-reported and both preand post-data were gathered at the end of the course. this means that students were asked to remember how anxious they were several months earlier, which can result in inaccurate responses. another primary concern is that students were asked to rate their perception of knowledge gained, as opposed to using actual course or test grades. in addition, there is a small sample size and lack of a comparison group, thus generalization of our findings is limited. the study is also limited by the use of multiple instructors in the courses and study. although all were using the same syllabus, course materials, and teaching approach, there is no way to standardize human educators, or control for the instructor in an anonymous survey. the results should be interpreted as exploratory and should be considered as beginning knowledge to initiate more studies regarding the effectiveness of online teaching strategies. future studies should consider using a traditional preand posttest, using course or test grades as a measure of knowledge, having a comparison group, and possibly using a standardized anxiety measure that allows for more objective data on anxiety levels. students’ learning independently from sources other than the instructor should also be assessed. implications and conclusions this preliminary study maintains that research methods courses continue to be anxietyprovoking for social work students. however, educators’ use of the various components (i.e., behavioral, cognitive, and social) of active learning teaching strategies can assist in reducing anxiety and increasing students’ knowledge of research, especially for courses taught in an online format. in addition, instructors’ frequent engagement with students could help facilitate learning and reduce anxiety. some suggestions include short voice messages or video clips for announcements in asynchronous environments. in addition, educators may help students change their beliefs about learning away from a receptor or passive learner to an independent and active participant by assigning activities that facilitate learning apart from the instructor. for instance, activities that can be added include small group projects and peer interactions/exercises which then allow for instructors’ positive and frequent feedback individually to students. scaffolding (hammond & gibbons, 2005) is another instructional strategy which assists in strengthening confidence as students slowly build their knowledge and skills as the content progressively increases in difficulty. online learning has reduced many logistical hassles and availed educational opportunities to many students who may not have been able to complete traditional class formats. however, learning is not necessarily easier or less anxiety-provoking online, and classes require well-planned strategies by both instructors and students for success. whether education occurs in a face-to-face format or online, the instructor is still responsible for understanding where each student is situated and integrating strategies that reach them. so that learning may occur, educators are still responsible for reducing barriers (e.g., anxiety) and for being present in the learning 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(2007). effective learning in classrooms. london: sage. doi: http://dx.doi.org/10.4135/9781446211472 xu, d., & jaggars, s. (2014). performance gaps between online and face-to-face courses: differences across types of students and academic subject areas. the journal of higher education, 85(5), 633-659. doi: http://dx.doi.org/10.1353/jhe.2014.0028 author note address correspondence to: lisa rapp-mccall, graduate social work program, saint leo university, p.o. box 6665, saint leo, fl 33574-6665, lisa.rappmccall@saintleo.edu advances in social work, spring 2016, 17(1) 11   appendix 1. prior to the beginning of the course, how would you rate your level of anxiety about social  work research methods?  o not anxious at all  o a little anxious  o anxious  o very anxious  o extremely anxious    2. prior to the beginning of the course, how would you rate your knowledge of social work  research methods?  o not knowledgeable at all  o some knowledge  o moderately knowledgeable  o very knowledgeable  o extremely knowledgeable    3. how helpful were the online powerpoint lectures on learning studio in increasing your  understanding of social work research methods?  o they caused more confusion  o not helpful  o moderately helpful  o very helpful  o extremely helpful    4. how helpful were the online powerpoint lectures on learning studio in decreasing your  anxiety about social work research methods?  o they caused more anxiety  o not helpful  o moderately helpful  o very helpful  o extremely helpful    5. how helpful was the review of course content by the professor on collaborate in increasing  your understanding of social work research methods?  o it caused more confusion  o not helpful  o moderately helpful  o very helpful  o extremely helpful    6. how helpful was the review of course content by the professor on collaborate in decreasing  your anxiety about social work research methods?  rapp & anyikwa/active learning strategies 12 o it caused more anxiety  o not helpful  o moderately helpful  o very helpful  o extremely helpful    7. how helpful were the active collaborate activities (cases, games, discussions, exercises) in  increasing your knowledge of social work research methods?  o it caused more confusion  o not helpful  o moderately helpful  o very helpful  o extremely helpful    8. how helpful were the active collaborate activities (cases, games, discussions, exercises) in  decreasing your anxiety of social work research methods?  o it caused more anxiety  o not helpful  o moderately helpful  o very helpful  o extremely helpful    9. how helpful was the textbook in increasing your knowledge in social work research  methods?  o it caused more confusion  o not helpful  o moderately helpful  o very helpful  o extremely helpful    10. how helpful was the textbook in decreasing your anxiety about social work research  methods?  o it caused more anxiety  o not helpful  o moderately helpful  o very helpful  o extremely helpful    11. how helpful were the weekly announcements on learning studio from the professor in  increasing your knowledge of social work research methods?  o they caused more confusion  o not helpful  o moderately helpful  advances in social work, spring 2016, 17(1) 13   o very helpful  o extremely helpful    12. how helpful were the weekly announcements on learning studio from the professor in  decreasing your anxiety about social work research methods?  o they caused more anxiety  o not helpful  o moderately helpful  o very helpful  o extremely helpful    13. how helpful were the online discussion questions on learning studio in increasing your  knowledge in social work research methods?  o they caused more confusion  o not helpful  o moderately helpful  o very helpful  o extremely helpful    14. how helpful were the online discussion questions on learning studio in decreasing your  anxiety about social work research methods?  o they caused more anxiety  o not helpful  o moderately helpful  o very helpful  o extremely helpful    15. how helpful were the learning studio exercises in increasing your knowledge of social work  research methods?  o they caused more confusion  o not helpful  o moderately helpful  o very helpful  o extremely helpful    16. how helpful were the learning studio exercises in decreasing your anxiety about social work  research methods?  o they caused more anxiety  o not helpful  o moderately helpful  o very helpful  o extremely helpful    rapp & anyikwa/active learning strategies 14 17. how helpful was the personal contact you had with the professor (phone call, email,  collaborate) in increasing your knowledge in social work research methods?  o it caused more confusion  o not helpful  o moderately helpful  o very helpful  o extremely helpful  o n/a    18. how helpful was the personal contact you had with the professor (phone call, email,  collaborate, skype) in decreasing your anxiety about social work research methods?  o it caused more anxiety  o not helpful  o moderately helpful  o very helpful  o extremely helpful  o n/a    19. how would you rate your current knowledge of social work research methods?  o not knowledgeable at all  o some knowledge  o moderately knowledgeable  o very knowledgeable  o extremely knowledgeable    20. how would you rate your current level of anxiety about social work research methods?  o not anxious at all  o a little anxious  o anxious  o very anxious  o extremely anxious    microsoft word wedel_mental health_ruth irelan knee copyedit final ______________  kenneth r. wedel, ph.d., is a professor emeritus and coordinator of the knee center for strong families in the anne and henry zarrow school of social work at the university of oklahoma in norman, ok. the author wishes to give recognition to the following individuals for their assistance in gathering information and reviewing draft versions of the manuscript: ina javellas, retired mental health social worker and social work pioneer; stephanie winfrey and chloe kliewer, graduate msw students and knee scholars. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 246-260  ruth irelan knee: influencing progress in mental health kenneth r. wedel abstract: ruth irelan knee (1920-2008) was a major player and eyewitness observer of dramatic changes in the treatment of the mentally ill. early on in her career she experienced interdisciplinary treatment for the mentally ill and organized efforts for addressing mental health and other afflictions, which confront families and communities. she believed that social work could be at the forefront in developing rational approaches to addressing mental health and other social issues through community development. and she placed great value in having social workers at the table with other disciplines to accomplish needed change. throughout her career and life she stood out as an extraordinary advocate for her chosen profession. keywords: ruth knee, mental health legislation, treatment for mental illness, social work in mental health, long-term care ombudsman ruth irelan knee was born and raised not far from tulsa, in sapulpa (creek county), oklahoma. she took pride in the fact that she grew up in what had been indian territory and maintained a great respect for the tribal people that had earlier been relocated there. ruth and her older sister, marie, enjoyed the advantages of a happy childhood provided by caring and educated parents during a period of relative prosperity for middle-class families in her locality. her father was a newspaperman, oilman, church and civic leader. her mother was a member of several civic clubs, school board member and active church member. throughout her life ruth maintained contact with sapulpa classmates and made regular pilgrimages to her beloved home town. by the time ruth had passed the teenage years, she had witnessed dramatic changes in the social conditions of her home state; one that suffered greatly as the result of the “dust bowl” and “great depression.” in preparation of editorials for the paper, her father shared stories about the effects of economic stress that had a strong influence on ruth and her sister. her mother’s activities in charitable causes further shaped a character trait for “assisting people in need.” when ruth entered the university of oklahoma, she followed her sister’s choice to major in social work, where she received the bachelor of arts degree in 1941, and following a year of graduate work, the certificate in social work in 1942. she graduated phi beta kappa. it was during her college days that ruth met a fellow social work student through activities in the “social work club,” junior k. knee, who eventually became her husband and lifetime companion in social advocacy. at the university of oklahoma the school’s director and professor, dr. j. j. rhyne, stressed the importance of social statistics in advocating for improving the state’s welfare. students were required to become involved in collecting statistical indicators to define social problems of their communities as a prerequisite in fashioning potential wedel/ruth irelan knee: influencing progress in mental health 247 solutions. dr. rhyne led by example with his book, social and community problems of oklahoma, a publication filled with oklahoma statistical data at that time (rhyne, 1929). the use of statistical data in advocacy remained a feature of ruth’s work. she recalled her first field work experience as an undergraduate student during the depression in the depravation of so-called “hoovertown,” along the river in oklahoma city. “just getting food was a major problem” (stephenson, 1986). ruth earned her master’s degree in social service administration from the university of chicago. there she gained academic exposure to renowned faculty: charlotte towle, edith abbott, helen wright, and wilma walker, among others. the credo of that era was “responsible, accountable public service: help out where the people need you” (coyne, 1986). ruth reminisced about her graduate education experience at an award banquet held by the university of chicago club of washington dc: i enrolled in ssa in june 1942 – as a second year student (my earlier graduate work had been at the university of oklahoma). it was a total cultural change. of course, the whole country was changing. it was wartime. this was reflected everywhere in chicago. chicago was a very large city. for the first time in my life, i was in an integrated setting – in the classroom, in stores, and streetcars – in the fieldwork setting. there were many adjustments to be made in daily living-as well as in how i studied. in ssa – we were not just studying textbooks – we were being taught by the authorities who had written the texts. about half our time was spent in field work – i was assigned to the illinois neuropsychiatric institute – then a very new research/teaching hospital of the university of illinois (knee, 2000). that field experience led to her first professional employment, which was with the neuropsychiatric institute. the institute had recently been established (1942) under the auspices of the illinois department of public welfare and the university of illinois, chicago (uic). it was a joint venture between the uic departments of neurology and psychiatry. ruth recalled that charlotte towle had recommended that she accept a position there. ruth held the job titles of psychiatric social worker and assistant supervisor, social work service. this early work history exposed ruth to an interdisciplinary approach to the treatment of the mentally ill. the mission of the institute was to study mental and nervous disorders and provide psychiatric training for practitioners. francis gerly, md, first chairman of the department of psychiatry, brought together an interdisciplinary group that included franz alexander, founder of the chicago psychoanalytic institute; w. s. mccullough, md, dph, who developed computational models of brain function; ladislas van meduna, md, developer of metrazol, convulsive shock therapy, and other organic therapies for medical psychosis; and abraham low, md, who developed the recovery method of selfhelp for recently discharged psychiatric patients (uic department of psychiatry, n.d.). advances in social work, spring 2014, 15(1) 248 the value of an interdisciplinary approach for addressing mental illness and other social ailments remained a focus of her advocacy throughout the years. later, ruth would reminisce that “family work was the focus then, when 25-page social histories were commonplace and the worker really got to know the whole family fabric after hours and hours of intense interview” (coyne, 1986, p. 4). the federal government in mental health in 1944, ruth moved to the nation’s capital and began a distinguished career in the federal service. she and her husband, junior knee, built their lifetime home in fairfax, virginia, on the property they named “okie acre,” in affection for their common roots in oklahoma. throughout their lives this home became the meeting place for family and friends, colleagues, and visitors from throughout the world. during this time she began networking through involvement in professional associations and social organizations. she was a member of the national society of daughters of the american revolution and became involved in the vienna presbyterian church, vienna, virginia, where she would eventually become a deacon; the oklahoma state society of washington, dc; and the mantua woman’s club, fairfax, virginia. while some social workers would later become critical of their colleagues who were involved in what appeared to be “uppity conservative” organizations, ruth believed such organizations would be positively influenced by the progressive philosophy that a social worker could bring to that environment. ruth began her career in dc when she was offered a position in the u.s. public health service. in that setting, she became chief psychiatric social worker, federal employees mental hygiene clinic, public health service dispensary, washington, dc. ruth’s reflection on the experience is noted in the following (dumez, 2003): this wartime program had been established at the behest of eleanor roosevelt. she had become aware of the many physical and mental health problems experienced by the young people (mostly young women) from all over the country who had left their home for the first time in their lives in order to help the war effort in the nation’s capital. the mental hygiene control unit was one of the first industrial mental health clinics in the country. it was a forerunner of employee assistance programs, as they are known today. one of our goals was to minimize job absenteeism in the federal agencies. as a social worker, i spent most of my time in intake evaluations and interpreting clinic recommendations to the referring agency counselor or nurse. they were very few community social or mental health resources that could be used for follow up (p. 85). employment in the agency served ruth with the opportunity to sharpen her skills in clinical practice. in 1949, ruth’s career took a significant turn with her appointment as psychiatric social work associate, walter reed army hospital. walter reed at the time was one of four training centers for military social workers, and “much of her time there was spent in working out a professional development program for military social workers, officers, and technicians” (university of oklahoma association, 1961, p.3). the walter reed wedel/ruth irelan knee: influencing progress in mental health 249 program serves as one timid example of federal involvement in funding and promoting mental health. in 1851, u.s. president franklin pierce, vetoed legislation that would have provided federal funding in the form of land grants and income derived therefrom for states’ public care of the indigent mentally ill. federal support for mental health languished for the next century, until modest increments appeared, mostly for research relating to psychiatric disorders and the development of more effective methods of prevention, diagnosis, and treatment. as noted by levine (1981), “[f]rom 1830 to 1945, there were no real developments in mental health services affecting the general public” (p. 31). mental health policy and programming can be seen as connected to health promotion principles. it was a theme promoted throughout ruth’s career, and quite naturally reinforced by the fact that her husband dedicated his career in public health. vandiver (2009) categorizes the health promotion principles as involving individual and community level change. at the intersection of health promotion principles, processes and public mental health policies are three processes: (1) legislative, (2) regulatory, and (3) judicial. an example of the legislative process is the national mental health act of 1946. an example of the regulatory process is title v of the public health services act, requiring states’ plans for comprehensive community mental health services. examples of judicial processes include court cases such as wyatt v. stickney [1970], involving criteria for evaluation of care in psychiatric hospitals. each of the processes and examples identified above (vandiver, 2009) would play a key role in ruth’s career path in mental health. a significant legislative breakthrough occurred before the decade of the 1940s closed. as a result of the national mental health act of 1946, the national institute of mental health (nimh) was formally established in 1949. in 1955, the mental health study act with leadership from nimh called for “an objective, thorough, statewide analysis and reevaluation of the health and economic problems of mental health” (national institute of mental health, 2013). as a result, the joint commission on mental illness and health was formed. it was in that same year (1955) that ruth’s career with nimh began. once again she would be involved in a collegial relationship with interdisciplinary professionals in a newly formed agency with fresh energy and creative ideas. this setting became the centerpiece of ruth knee’s career. there she observed and was involved in the changes in mental health that occurred until her retirement form nimh in 1972. during this phase of ruth’s career, a decline was occurring in the use of state public mental hospitals as the sole resource for the care of the mentally ill in the united states. contributing factors were several, but especially the discovery of psychoactive drugs which became available to stabilize patients with psychotic disorders. another major contributing factor was the involvement of the federal government in funding community mental health centers throughout the u.s. and financing services through title xviii and xix of the social security act—medicare and medicaid. reporting on recent advances at the time in the care and treatment of the mentally ill (knee, 1959), ruth identified emerging patterns. in the report, she noted that the concept of change over the past fifteen years was “perhaps the most significant in the care for the mentally ill – because for too long, things had appeared to be frozen and immobile” (p. advances in social work, spring 2014, 15(1) 250 51). a ray of hope, however, was seen in her work on a multidisciplinary team whose responsibilities included the provision of staff services for the initiation and development of the mental health project grant’s program under title v of the mental health act. ruth could proudly relate the involvement of social workers regarding the program. there are social workers involved as staff members on a majority of all-current projects with many different functions and roles. in a number of projects, a social worker is the program director or codirector. in others, social workers are working in case finding, community organizations, and in the development of therapeutic programs. in a few, social workers are responsible for the evaluation of service (knee, 1959, p. 59). regarding current developments in treatment at that time, the following listing was given by ruth (knee, 1959) as specific contributing factors in advancing understanding of mental illness from biological, social, and psychological standpoints and of the interrelationships of these influences upon behavior: 1. impact of the contribution of social science theory to the understanding of mental illness upon the practice of psychiatry as a branch of medicine, and upon the other mental health professions. 2. awareness of the importance of social relationships in the etiology of mental illness and in its treatment. 3. study of the mental hospital as a social institution. 4. recognition that certain practices that had long been accepted as a part of treatment (or hospitalization) probably contributed more to chronicity and social crippling than the disease itself. 5. development of a broader philosophy of rehabilitation. 6. recognition of the importance of a therapeutic environment – in the hospital, in the family, and in the community. 7. increased use of group techniques in treatment. 8. extension of the traditional “clinical team” of doctor, nurse, social worker, and psychologist to include persons with many other skills – the psychiatric aide, the rehabilitation specialist, the occupational therapist, the industrial therapist, the recreational worker, the volunteer, the social scientistwith concomitant changes in roles and responsibilities of team members. 9. differential services related to the concept of comprehensive care and the continuum of the patient's needs as he moves from health to illness – and returns to health – or remains chronically disabled. closer integration between the mental hospital and the total community is a prerequisite to continuity of care. 10. utilization and availability of tranquilizing drugs. wedel/ruth irelan knee: influencing progress in mental health 251 11. introduction of public health concepts in the planning for, and development of, treatment and rehabilitation services as well as in efforts toward prevention and promotion of health. 12. recognition of the unique needs of special problem areas, such as, aging, alcoholism, and mental retardation (pp. 51-52). the following were also observed by ruth (knee, 1959) as patterns pointing to areas in which exploration and experimentation were being concentrated and gave promise for lasting acceptance: 1. changes in the traditional mental hospital from the advantage of hindsight, it almost appears that the social movement, which encouraged each state to assume responsibility for the care and the treatment of the mentally ill through the establishment of state tax supported hospitals, carried with it certain negative aspects. the hospitals became larger and larger – and like malignant tumors, were not really interacting, functioning organisms within society. the concepts of the “open” hospital, increased patient freedom and improved staff-patient relationships are major themes in the transition from concentration on custody to emphasis on treatment and rehabilitation. 2. treatment of acute illness twenty years ago there were fewer than fifty psychiatric units in general hospitals throughout the united states. in 1958, there were almost a thousand general hospitals – that would accept psychiatric patients. 3. alternatives to hospitalization a variety of treatment and rehabilitation services are being developed that are designed to shorten or to make full-time hospitalization unnecessary, or to be used before or after hospitalization for an acute phase of illness. these include day hospitals, “half-way” houses, social therapeutic clubs, and rehabilitation workshops. 4. community planning for mental health services there is increased recognition of the imperative need for coordinated planning of services for the mentally ill. 5. long-range planning several major studies have been in process in recent years which will have far-reaching effects in the direction of planning and establishment of services for the mentally ill. the world health organization, the u.s. joint commission on mental illness and health (1956), and in england, the royal commission report in 1956 were cited (pp. 56-57). the next decade (1956-1966) was witness to what may be considered the greatest expansion of federal funding for the mentally ill. in 1963 congress passed the advances in social work, spring 2014, 15(1) 252 community mental health centers act (p.l. 89-97) authorizing construction grants for community mental health centers. a year later (1965), medicare and medicaid (title xviii and title xix of the social security act) were enacted. together, these laws and the regulations which followed changed dramatically the venues and funding for treatment. community level treatment and deinstitutionalization of state hospitals access to mental health treatment facilities was expanding between the late 1940s and 1960s. as an administrator of the mental health project grant’s program under title v of the mental health act, ruth played an important role in influencing the increase of local access to mental health treatment that could be observed during the decades following passage of the above program (rice, knee, & conwell, 1970). in 1946, there were about 586,000 beds for the care of the mentally ill in the united states. about 80 per cent of these beds were located in state and county hospitals; the remaining 20 per cent were in private psychiatric hospitals. at that time, they constituted 42 per cent of all the hospital beds in the united states. there were known to be 315 public hospitals, 265 private hospitals, 109 general hospitals with psychiatric units, and 524 outpatient psychiatric clinics – a total of over 1,000 facilities. by 1967, the number of such psychiatric facilities had increased to over 4,000, including 1,316 general hospitals with psychiatric services and 2,213 outpatient psychiatric clinics. in addition, there were over 500 partial hospitalization services, mostly day hospitals. funds for the construction and/or staffing of 351 comprehensive community mental health centers had been awarded by 1969 (rice et al., 1970, p. 2247). as noted above, while facilities for treatment of the mentally ill were expanding, traditional state hospitals experienced significant deinstitutionalization. in 1955, there were 559,000 beds in state mental hospitals in the u.s., representing 339 beds per 100,000 population. by december, 2000, the number of state mental hospital beds had dropped to 59,403. the change represented a drop to 22 beds per 100,000 population (lamb & weinberger, 2005, p. 530). funding for treatment and quality of care in 1966, mandated mental health services were included in medicare, and while the federal law does not contain explicit provisions concerning the exact types of mental health services that can be provided, all state medicaid programs provide some mental health services to enrollees. medicaid has become the single largest payer for mental health services in the united states (medicaid, n.d.). following passage of medicare and medicaid in 1965, ruth continued in a leadership role at nimh in activities related to the regulatory process emanating from title v of the public health services act. specifically, she was in charge of planning and implementing the oversight of medicaid funding for psychiatric facilities. at the time, the joint commission on accreditation of hospitals had no specialized standards for psychiatric hospitals. few hospitals were accredited wedel/ruth irelan knee: influencing progress in mental health 253 and general hospital standards were applied. an nimh grant resulted in convening stakeholders for the purpose of drafting standards for psychiatric hospitals. included in the efforts were participants from the american psychiatric association, american psychological association, national association of social workers, american nursing association, occupational therapy association, mental hospital administrators and public and private mental health programs. the draft that emerged described the documentation and staffing necessary to assure the psychiatric patients’ effective treatment. the proposal was accepted by the health insurance benefits advisory council and the then secretary of health, education, and welfare, wilbur j. cohen. the ongoing efforts resulted in the development of the special conditions of participation for psychiatric hospitals. in addition, nimh, through collaboration with other governmental agencies within the public health service, the social security administration and the social and rehabilitation services provided consultation to state and local mental health programs for the interpretation and implementation of medicaid standards. these efforts focused upon specific needs and unique approaches of mental health services delivery systems/programs. policy makers as well as administrators of third-party payment programs participated. nimh staff training programs, national and regional conferences for both state and mental health professionals and administrators in public and private sectors were held. reimbursement studies, utilization review problems, approaches for quality assurance and therapeutic approaches for the elderly mentally ill were addressed. finally, in 1969, the bureau of health insurance, social security administration and the then health care financing administration (hcfa) requested nimh to recruit a panel of specialized psychiatric consultants to conduct surveys of psychiatric facilities. two conditions were required for the facilities to receive federal medicare reimbursement for mental health services provided. the conditions concerned adequate standards for staffing and for record keeping (centers for medicare & medicaid, n.d.). these “survey teams” would determine whether or not the hospital met the five special conditions of participation. initially a joint interagency agreement was enacted between then hcfa and nimh; later it became solely hcfa, and most recently the centers for medicare and medicaid services. initially nimh agreed to provide qualified mental health professionals to assist the state’s licensure and certification agencies and the then hcfa regional offices in the actual performance and assessment of medicare surveys of psychiatric hospitals. the survey program continues to this date and is administered by the centers for medicare & medicaid (i. javellas, personal communication, august 21, 2013). mental health professionals (e.g., ruth and her colleagues) found a guiding philosophy for professional standards for quality care in the statement of chief judge david l. bazelon of the u.s. court of appeals, washington, dc. advances in social work, spring 2014, 15(1) 254 to provide adequate treatment, the critical requirement is, that the hospital pay individual attention to each patient and make an individualized effort to help him. there may be certain gross benchmarks to which a court may look in scrutinizing the adequacy of treatment at a hospital – the ratios of professional and paraprofessional staff to patients, the physical facilities for treatment, the overall level of expenditures within the hospital. but there is only one way to measure treatment provided. if there is an individualized treatment plan created at the inception of treatment and modified as treatment progresses, a reviewing court can hope to assess whether a bona fide effort to provide a meaningful amount of some appropriate form of treatment has been made. to perform this task, the judge need not be or even pretend to be a psychiatrist. his role is not to make independent judgments concerning treatment, but rather to scrutinize the record to insure that an expert more qualified than he has made a responsible exercise of his professional judgment (burris, 1969, p. 3). a particularly significant outcome for patients’ right to treatment, and quality of care conditions set forth for the survey process resulted from the court case of wyatt v. stickney. the case involved ricky wyatt, who at fifteen was institutionalized at bryce hospital in alabama. wyatt had been incarcerated for “delinquency” but had never received any other diagnosis of mental disability or condition. he and his aunt (a former employee) testified about the intolerable conditions and lack of therapeutic treatment at the hospital under supervision of state mental health commissioner, stonewall stickney (carr, 2004). the suit initially was prompted by layoffs at bryce hospital, with attorneys alleging that insufficient staff at the hospital would prevent involuntarily committed mentally ill patients from receiving adequate treatment, a violation of their civil rights under the fourteenth amendment of the u.s. constitution. federal district court judge frank m. johnson jr. ruled in favor of the plaintiffs, concluding from evidence submitted during litigation that standards for adequate treatment did not exist (encyclopedia of alabama, 2009). during the lawsuit, ruth knee and other mental health professionals gave expert testimony on standards for care of people with mental health and mental retardation residing in institutional settings. the standards which became known as the “wyatt standards,” cover three fundamental areas: individualized treatment plans, qualified staff in numbers sufficient to administer adequate treatment, and humane psychological and least restrictive environments (prigmore & davis, 1973). advocacy for social work with federal funding for expansion of mental health facilities and services, social work experienced a rise in services for the mentally ill. social work originally was formally undertaken in psychiatric hospitals, and with a limited function. but the infusion of federal funds presented an opportunity for the profession to create an area of turf. “the social worker was first added to the staff of the hospital to follow patients discharged from care in order to assist with their adjustments when they returned to their families wedel/ruth irelan knee: influencing progress in mental health 255 and communities” (vourlekis, edinburg, & knee, 1998, p. 573). interest in aftercare for the mentally ill surfaced in the united states in the late 19th century, and expanded in some states in the first decades of the 20th century. as noted previously, by the 1940s and 1950s, with the advent of the mental health project grants program, social workers as staff members of new projects began fulfilling increasing functions and roles. however, by 1998, ruth and her colleagues would advocate: as state medicaid programs move to private managed care models, it is critical that the profession promote understanding, strongly advocate for this population, and build social work functions – among them case management – that adequately and realistically address the comprehensive biopsycho-social needs of people with serious and persistent mental illness. social work has a clear and compelling action agenda with significant implications for client care and for professional turf (vourlekis et al., 1998, p. 573). as a social work pioneer, ruth gave perspective to her career in mental health and the developments through the years: my federal career provided me with many interesting challenges. when i joined the staff of the national institute of mental health in 1955, my focus became mental health issues of concern across the country. this was the advent of the use of psychotropic drugs in the treatment of psychiatric problems. state hospitals were filled to overflowing with chronically mentally ill patients. i was the psychiatric social worker on a ‘mental hospital improvement’ team, which included a psychiatrist, a clinical psychologist, and a psychiatric nurse. our mission was to identify useful approaches and new modalities that were being used effectively and to communicate these ideas to administrators and staff of hospital and community programs throughout the country. the new approaches included after-care programs, social rehabilitation units, halfway houses, and vocational rehabilitation programs. we traveled a lot, identified positive change, and documented serious problems. some said we were like honeybees, gathering the pollen of ideas and then spreading it around. development of community-based mental health resources became the national priority for mental health service in the 1960’s. this is still a work in progress. deinstitutionalization, third-party payments, changes in federal and state mental health and social service responsibilities and funding, and advances in knowledge about mental disabilities have brought about many changes in community care systems. i suppose one of the things that i am most proud of was my role in networking and in facilitating innovative approaches to ‘improvements’. in addition to being ‘honeybees,’ my colleagues and i were ‘mental health missionaries’ (dumez, 2003, p. 85). through her professional leadership, ruth was in an advantageous position to advocate for social work in mental health and other emerging areas. she was a member of a number of professional organizations and emerged as a leader of several. as a member of the american association of psychiatric social workers, she served as president from 1951 to 1953. in the two years following, she was active in efforts to merge that advances in social work, spring 2014, 15(1) 256 association and several others into the national association of social workers (nasw) in 1955. ruth remained a dedicated and active member of nasw until the time of her death. among the numerous leadership functions she fulfilled in nasw, the following are included: the organization’s first secretary; member of the executive committee and board of directors in 1955-57, and again in 1984-86; and representative from region v, the metropolitan washington, dc chapter. at the conclusion of the latter office, she received a salute from members of the region: a “founding mother” of nasw, ruth i. knee is more than just a footnote in the annals of social work history. this extraordinary woman, who just turned 66, has recently received a certificate of recognition from the nasw board of directors. her multifaceted resume is full of councils, and committees, task forces and research projects, running the gamut from quality care issues to mental patients and long term care for the aged (coyne, 1986, p. 4). the ruth knee/milton whitman health/mental health achievement awards program was established in 1989 by the board of directors of nasw to honor the outstanding careers of these two pioneering social workers. since its inception, this distinguished awards program has annually recognized individuals for their lifetime achievement in health/mental health practice and for outstanding achievement in health/mental health policy. ruth was a co-founder and recipient of the social work pioneer program, created in 1994 to honor members of the social work profession who have contributed to the evolution and enrichment of the profession. the pioneer program identifies and recognizes individuals whose unique dedication, commitment and determination have improved social and human conditions, and serve as role models for future generations of social workers. following her retirement from nimh in 1972, ruth would relentlessly continue in advocacy roles in the federal service. during the decade of the 1970s and beyond, ruth occupied positions that related to concerns of the aged and their experiences with mental illness and long-term care. out of that work ruth revealed a strong passion for societal safeguards to enhance quality of care and protection for the elderly. in a 1977 document, ruth relates to the national concern as to how best provide long-term care that is responsive to the idiosyncratic needs of a rapidly aging population, including individuals with disabilities and chronic “inabilities” who become dependent. …many professionals, consumers and members of the community-at-large are demanding that more than sustenance be provided in long-term programs. “custodial” is now an unspoken, unpopular word, as people have come to recognize that even a bleak and marginal existence can be improved through concentration on “quality of life,” through humanizing the process of institutionalization, de-institutionalization, the delivery of services, routine and otherwise, in any environment to the ill, the infirm, the poor, and the isolated (health resources administration, 1977, p. vii). wedel/ruth irelan knee: influencing progress in mental health 257 ruth and her social work colleagues were influential in promoting patient rights for individuals as they enter and interact with health and mental health care systems. they especially focused on supporting a “bill of rights” for nursing home patients, which in 1980 were contained in the civil rights of institutionalized persons act (cripa). amendments to that act in 1987 are collectively known as the federal nursing home reform act included as part of the omnibus budget reconciliation act (obra). closely related to patient rights was promotion of an ombudsman function for nursing homes. the long-term care ombudsman program (oaa, title vii, chapter 2, sections 711/712) began in 1972, and is included in the older americans act (administration on aging, 2013). as a public servant working for the u.s. public health service, ruth knee became the first coordinator of this nationwide program which was later transferred to the u.s. administration on aging. ruth continued her highly respected work with the program until she retired. her guidance was fundamental to the continued successful expansion of the innovative program. the national citizens’ coalition for nursing home reform (nccnhr) (which i founded in 1975) established a national advocacy award in the early 1980’s. ruth, who was often referred to fondly as ‘the grandmother’ of the ombudsman program was an early recipient of this award. soon after this, ruth began giving an annual donation to fund the award which would always honor a local or state ombudsman. ruth herself later requested that the award be renamed as the cenoria johnson advocacy award when her former co-worker in the ombudsman program died (e. holder, personal communication, august 23, 2013). a close colleague sums up the contributions ruth made in her untiring efforts as a mentor and advocate for improving the lives of individuals requiring institutional care. “ruth was one of the greatest mentors of all time for those of us who worked with her. her role in the federal government improved the quality of life for people of all races in the u.s. requiring services of long term care, especially for the mentally ill (b. harper, personal communication, july 29, 2013). ruth’s professional values correlated with her personal commitments and generosity. in 1982, she donated the irelan family home of her youth in sapulpa, oklahoma, to the sapulpa handicapped opportunity workshop corporation. the home serves as a group home living arrangement for the developmentally disabled. endowment funds were provided to the social work educational programs from which she had graduated. at the university of chicago, school of social service administration, she provided funding for a lectureship in spirituality. and, at the university of oklahoma, anne and henry zarrow school of social work, she willed her estate in 2008. as a result, the school has established the knee center for strong families, dedicated to building theory, knowledge, practice and education for development of strong families in their diverse forms. during her lifetime, ruth received many honors and awards related to her advocacy for mental health, the profession of social work, and quality of care for individuals in advances in social work, spring 2014, 15(1) 258 long-term care. appropriately, late in her career she was one of the first women to be admitted to the prestigious cosmos club of washington, dc. the cosmos club is a private social club that through the years has included as members u.s. presidents, vice presidents, supreme court justices, nobel prize winners, pulitzer prize winners and recipients of the presidential medal of freedom. membership in the club is reserved for persons of “distinction, character and sociability.” criteria for membership include persons who have “done meritorious original work in science, literature, or the arts; though not professionally occupied in science, literature or the arts, is well known to be cultivated in some field thereof; or, is recognized as distinguished in a learned profession or in public service” (cosmos club, n.d.). ruth served on the program planning committee, and enjoyed the opportunity to suggest topics of social awareness at program events. today, a mental health challenge can be observed in the dismal statistics that reveal a trend for incarceration of the mentally ill. severely mentally ill individuals who formerly would have been psychiatrically hospitalized when there were a sufficient number of psychiatric inpatient beds are now entering the criminal justice system for a variety of reasons. those most commonly cited are: (1) deinstitutionalization in terms of the limited availability of psychiatric hospital beds; (2) the lack of access to adequate treatment for mentally ill persons in the community; (3) the interactions between severely mentally ill persons and law enforcement personnel; and (4) more formal and rigid criteria for civil commitment (lamb & weinberger, 2005, p.530). if ruth knee were living today, she would likely be at the forefront with her social work colleagues in her words to “rattle a few cages” for change. references administration on aging. (2013, july 18). long-term care ombudsman program (oaa,title vii, chapter 2, sections 711/712). retrieved from http://www.aoa.gov/aoa_programs/elder_rights/ombudsman/index.aspx burris, d. s. (ed.). (1969). the right to treatment: a symposium. new york, ny: springer publishing company, inc. carr, l. w. (2004, july). wyatt v. stickney: a landmark decision. alabama disabilities advocacy program. retrieved from http://www.adap.net/newsletters/2004adapnews/newsletter7-04.pdf centers for medicare & medicaid services. (n.d.). medicare benefit policy manual: chapter 2inpatient psychiatric hospital services. retrieved from http://www.cms.gov/regulations-andguidance/guidance/manuals/downloads/bp102c02.pdf cosmos club (n.d.).membership. retrieved from https://www.cosmosclub.org/default.aspx?pageindex=1&pageid=67&status=1 wedel/ruth irelan knee: influencing progress in mental health 259 coyne, b. l. (1986, june-july). metro washington chapter salutes ruth knee. the bulletin. national association of social workers: metropolitan washington chapter, p. 2. dumez, e. w. (2003). ruth knee. in e. w. dumez (ed.), celebrating social work faces and voices of the formative years (pp. 84-85). alexandria, va: council on social work education. encyclopedia of alabama. (2009). wyatt v stickney. retrieved from http://www.encyclopediaofalabama.org/face/article.jsp?id=h-2375 health resources administration, division of long-term care. (1977). the future of long-term care in the united states – the report of the task force. national conference on social welfare (ntis no. hrp-0016874). knee, r. i. (1959). recent advances in the treatment of the mentally ill. in education for social work: proceedings of the seventh annual program meeting, philadelphia, pa, (pp. 51-61). new york, ny: council on social work education. knee, r. i. (2000, april). awards banquet. unpublished notes, the university of chicago club of washington, dc. lamb, h. r., & weinberger, l. e. (2005). the shift of psychiatric inpatient care from hospitals to jails and prisons. the journal of the american academy of psychiatry and the law, 33(4), 529-534. levine, m. (1981). the history and politics of community mental health. new york, ny: oxford university press, inc. medicaid.gov. (n.d.). mental health services. retrieved from http://www.medicaid.gov/medicaid-chip-program-information/bytopics/benefits/mental-health-services-.html national institutes of health. (2013). national institute of mental health: important events in nimh history. retrieved from http://www.nih.gov/about/almanac/organization/nimh.htm prigmore, c. s., & davis, p. r. (1973). wyatt v. stickney: rights of the committed. social work, 18(4), 10-18. rhyne, j. j. (1929). social and community problems of oklahoma. guthrie, ok: cooperative publishing co. rice, d. p., knee, r. i., & conwell, m. (1970). financing the care of the mentally ill under medicare and medicaid. american journal of public health, 60(12), 22352250. stephenson, m. (1986, may 26). a woman with a mission. tulsa world, p. 2. uic department of psychiatry college of medicine. (n.d.). history, neuropsychiatric institute. retrieved from http://www.psych.uic.edu/aboutus/history advances in social work, spring 2014, 15(1) 260 university of oklahoma association. (1961, november). knee key team member of multidisciplinary group. sooner news-makers, 3(2), 2. norman, ok: the transcript press. vandiver, v. (2009). integrating health promotion and mental health. new york, ny: oxford university press. vourlekis, b. s., edinburg, g., & knee, r. (1998). the rise of social work in public mental health through aftercare of people with serious mental illness. social work, 43(6), 567-575. author note address correspondence to: kenneth r. wedel, ph.d., university of oklahoma, anne and henry zarrow school of social work, 700 elm avenue, norman ok 73019. email: kwedel@ou.edu kenneth r. wedel is professor emeritus and coordinator of the knee center for strong families at the anne and henry zarrow school of social work, university of oklahoma. he received an msw degree from florida state university, and a ph.d. in public administration from the university of pittsburgh. he joined the faculty at the university of oklahoma in 1979 and served as the school's director (1979-86 and interim director 2000-2001). his professional practice experience includes social work practitioner, planner and administrator of social service programs. his teaching and research covers social policy and social program administration. microsoft word 2. twill lowe_12063 copyedit final ______________ sarah e. twill, ph.d., msw, is an associate professor of social work at wright state university in dayton, oh. laura a. lowe, ph.d., msw, is an associate professor and social work program director in the department of sociology, anthropology, and social work at texas tech university in lubbock, tx. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 278-293 social workers as civic-minded professionals sarah e. twill laura a. lowe abstract: this study examined civic-mindedness among a sample of social work educators, community practitioners and new graduates. using a web-based survey, researchers administered hatcher’s (2008) civic-minded professional scale. results indicated that traditional and field faculty were more civic-minded than new graduates and other practitioners. social work educators who focused on raising civic awareness in courses were more civic-minded than colleagues. new graduates who had participated in club service events were more civic-minded; however, there was no significant differences between groups based on number of community service courses completed. social workers, whether faculty or not, who had participated in collaborative research were more civicminded. the authors conclude that how social workers view their commitment to civic engagement has implications. social workers need to be vigilant in our commitment to well-being in society. intentional practices could be implemented to strengthen the partnership among groups. keywords: civic-mindedness, community service, social work profession, social work education most famously documented in putnam’s bowling alone (2000), civic life and investment in social capital has deteriorated in the united states. membership in civic organizations (putnam, 2000), attendance at religious services (pond, smith, & clement, 2010), voter turnout (bipartisan policy center, 2012), and marriage rates (cohn, passel, wang, & livingston, 2011) have all waned. others suggest that reliance on individual rather than public transportation (gillham, 2002), the proliferation of consumption of media entertainment at home rather than in public (taylor, funk, & craighill, 2006), and working long hours (organization for economic cooperation and development [oecd], 2011) have weakened individuals’ connections to others. in a time when individuals are more likely to be electronically connected to each other via the internet, smart phones, facebook, twitter, instagram, and other social media, how we view connectedness to others is increasingly complicated (gil de zuniga & valenzuela, 2011; hampton, goulet, marlow, & rainie, 2011, 2012; zhang & chia, 2006). perhaps related, putnam (2000) even suggests that americans are a people who over-estimate the value of individual contributions rather than collective influences. the oecd’s better life index (2011) may help explain americans’ focus on the individual. this index goes beyond the gross domestic product (gdp) to examine 11 topics (e.g., education, housing, life satisfaction) that are related to material earnings and contribute to quality of life. in looking at the index on work-life balance, 11% of employees in united states work “very long hours”, defined as over 50 hours a week. in some countries (e.g., netherlands, sweden), only 1-2% of employees work over 50 hours a week. twill, lowe/social workers as civic-minded professionals 279 hours spent working directly impacts time available for leisure activities. according to the oecd data, americans have an average of 14.3 hours per day to use for personal care (e.g., eating, sleeping) and leisure (e.g., socializing with friends and family, watching tv). the u.s. ranks 30th out of 36 countries in availability of free time. individuals in countries such as estonia, poland, japan, and mexico have less leisure time, while citizens of norway and denmark enjoy an average of 16 hours of leisure time per day. in spite of more employees working long hours, and identifying little free time, americans still use part of their leisure time to volunteer (oced, 2011). they volunteer about one hour per week, double the oced average. the oced index also examines civic engagement; however, only rates of voter turnout, participation in political activities, confidence in macro systems (i.e., judicial system, government, the media), and consultation in rule-making are considered in the index. however, the authors still draw the conclusion that there are differences in how the citizenry practice civic engagement. older individuals with more education and higher incomes participate in political activities, including turning out to vote, more than those with fewer of these assets. the civic-minded professional and social work hatcher (2008) defined the civic-minded professional as one who, “a) is skillfully trained through formal education b) with the ethical disposition as a social trustee, and c) the capacity to work with others in a democratic way, d) to achieve public good” (p. 21). so, measuring this concept involves determining to what extent a person knows about issues impacting his or her community, and how he or she acts on that knowledge for the betterment of the community. a civic-minded professional sees him or herself as a trustee of knowledge (colby & sullivan, 2009; sullivan & rosin, 2008). building on that work, hatcher (2008) demands that civic-minded professionals act on that knowledge in order to promote the public good. as such, the concept of the civic-minded professional consists of the intersection of three domains: self-identity, one’s work-career-profession, and civic attitudes and actions (hatcher, 2008). based on this assumption, hatcher developed the civic-minded professional scale; five factors are included in the scale (voluntary action; identity and calling; citizenship; social trustee; and consensus building). the definition of a civic-minded professional parallels many of the values of the social work profession. therefore, the question of civic-mindedness and engagement has unique ramifications for social workers because the values of the profession imply that such commitment and action is a requirement, not an optional skill to be developed. most specifically, the social work values of social justice and service (national association of social workers [nasw], 2008) are embedded in hatcher’s (2008) definition of a civicminded professional. the call of ethical engagement for the public good overlaps with social work’s commitment to creating a just world where all individuals are allowed to thrive and achieve their full potential. however, not all social workers embrace the values of the profession in the same way. the profession’s move away from groupwork, affiliated with the settlement houses and a focus on social change, towards a model centering on individual cases, permitted social advances in social work, fall 2014, 15(2) 280 work (and those educating future social work professionals) to concentrate resources towards micro issues (morris, 2000; specht & courtney, 1994). morris (2000) wrote, “by 1990 the field was primarily involved in interpersonal and mental health kinds of careers, while work to change conditions remained at the rhetorical level rather than providing jobs and institutional opportunities to work for change” (p. 45). similarly, specht and courtney (1994) argued that social workers became “unfaithful angels” as they attended to the psychotherapeutic needs of the individual, rather than addressing the original purpose of the social work profession as change agents. they state: social workers should not be secular priests in the church of individual repair; they should be the caretakers of the conscience of the community. they should not ask, “does it feel good to you?” they should help communities create good. there must be a profession that provides a vision that enables us to direct our energies to the creation of healthy communities. (pp. 28-29) how social workers, who have the ability to influence social work practice, see their roles not just as social workers, but as citizens, is important. social workers have a long history of commitment to the community beginning with the work of jane addams and ellen starr (kenny & gallagher, 2002). the philosophy of the settlement house movement called for a commitment to community outreach. today, that same commitment to community can be seen in higher education’s commitment to service-learning pedagogies. king (2003) wrote about social work’s history with the pedagogy and the positive outcomes it creates for students, faculty, and the community groups with whom they partner. “experiential learning, civic responsibility, and evidenced-based practice is the very foundation of social work practice and education” (p. 376) postulated norris and schwartz (2009). further, the use of service-learning as a pedagogy may influence social work practice outcomes (bransford & choi, 2012; lowe & medina, 2010; mink & twill, 2012; rocha, 2000; williams, king, & kobb, 2002). likewise, as field experience is the signature pedagogy of the profession (council on social work education [cswe], 2008), field supervisors also have educator roles in shaping the next generation of social workers. mary (2001) surveyed msw field educators about their political involvement. she found that social workers in public agencies were more active than those in private agencies. the values and behaviors exhibited by field instructors may be transmitted and modeled to students whom they supervise. related, ritter (2008) surveyed licensed social workers about their political participation. using verba, schlozman, and brady’s (2000) citizen participation model to explain why individuals engage in the political process, she found that national association of social workers (nasw) membership (classified as a recruitment network under the verba et al. model) was a significant predictor of political participation. gibelman and sweifach (2008) studied nearly 1,550 licensed social workers’ volunteer behaviors and charitable giving. they found that nearly 90% had volunteered during their lifetimes; however, only about 50% had volunteered in the past two years. those who had never volunteered indicated that their professional obligations as a social worker was a kind of volunteering. financially, social workers gave under $1,000 per year to charitable causes. the primary motivation for both volunteering and giving was to “help others.” twill, lowe/social workers as civic-minded professionals 281 finally, the attitudes of graduating social work students may set the tone for the future of the profession. while not focused solely on social work students, fenzel and payrot (2005) found that being civically engaged during college increased post college attitudes about social responsibility, political participation, and volunteerism. participants who engaged in service-learning courses had higher engagement scores that those who participated in general community service experiences. similarly, astin, sax, and avalos (1999) examined behavioral indicators and found that those who had volunteered in college were more likely to donate money to their undergraduate institutions, continue to volunteer after college, and socialize with more diverse people than those who were not civically engaged. methods this study sought to explore civic-mindedness among social workers. particularly, the researchers were interested in whether social work educators who used pedagogies that emphasized civic responsibility were different from faculty members who did not, in terms of civic-mindedness. additionally, the researchers were interested in how civicmindedness might differ between different groups of social workers, such as educators, community practitioners and newly practicing social workers. permission to conduct the research was granted by the institutional review boards (irb) of each author’s university. between june and december of 2012 information was collected from social work educators, community social workers, and graduating social work seniors. because the research presented no more than minimal risk of harm to subjects and involved no procedures for which consent was normally required outside the research context, participants gave implied consent when they completed the online survey. some students filled out paper surveys; these participants gave written consent. all respondents were informed that their participation was not required and would have no impact on their relationship with the researchers or their universities. participants were provided with irb contact information. survey the researchers administered the survey using qualtrics, a web-based survey service. respondents answered up to 84 questions. the majority of survey items were closed-ended with forced choice response options. attitudinal items were primarily likert-type items with response options from strongly agree to strongly disagree. the survey used a skip pattern based on a qualifying question that inquired about respondents’ status as a university-based faculty member, a community practitioner with significant field faculty experience, a community practitioner without that status, and students finishing a bachelor’s degree in social work. some survey items were unique for each of these groups. it was estimated that the survey took about 15 minutes for most respondents to complete. topics of the survey included demographic items, such as gender and ethnic belonging, questions asked about respondents’ participation in a variety of activities, such as volunteering or supervising a social work student in field placement, and other questions that asked about the frequency of certain behaviors, such as donating money to charity or advances in social work, fall 2014, 15(2) 282 going to religious services. forty-four of the survey items made up the dependent variable, civic-mindedness. missing responses making up the cmp scale were replaced with a series mean if individuals skipped 1 (n = 7), or 2 (n = 42) items; seven surveys were dropped because they skipped more than two questions on the cmp scale. civic-minded professional scale. the civic-minded professional (cmp) scale was developed by hatcher (2008). her initial scale was made up of 32 items and had an alpha reliability coefficient of .95. since that time, the scale has been revised to include 45 questions with three constructs. for this study, the researchers used a modified version of hatcher’s scale, which included 44 items and demonstrated good reliability (chronbach’s alpha = .93) in the sample. therefore, the dependent variable, cmp scores, had possible values from 44 to 308, with lower scores on the scale indicating higher levels of civic-mindedness. participant recruitment the researchers sought the participation of three main groups of social workers. social work educators were primarily recruited through the association of baccalaureate social work program directors (bpd) listserv; approximately 1,000 people are registered for this listserv. an invitation was posted in september 2012, with a follow-up posting a few weeks later. community social workers were recruited through two lists in september of 2012 with a follow-up contact a few weeks later. at the first author’s institution, an email distribution list maintained by the department of “friends of the department” (e.g., alumni, donors, adjuncts) was used, and in the second author’s community, an invitation was posted on the listserv for the local chapter of nasw. in order to increase participation, invitations requested that readers forward the information to colleagues who might be interested in participating in the study. graduating social work students were recruited in spring of 2012 but differently by institution. graduating seniors from the first author’s institution were asked to participate in the survey approximately two weeks before graduation. the students signed an informed consent in order to participate. the students were asked to participate during the last 15 minutes of a session in a course that enrolled only graduating seniors. those who did not wish to participate engaged in study activities. at the second author’s institution, an announcement was made in senior seminar, which was followed by an e-mail, with a link to the online survey. participant description demographic data on respondents is presented in table 1. most of the respondents were from either ohio (27.4%) or texas (29.2%), the researchers’ states; however, 34 other states were also identified and one respondent did not live in the continental u.s. in the sample, the minimum cmp score was 49 and the maximum was 170 (m = 91.1, sd = 24.3). twill, lowe/social workers as civic-minded professionals 283 table 1. demographic characteristics of respondents full sample (n = 269) educators (n = 111) community (n = 103) new grads (n = 41) gender % male 13.7 20.2 10.5 4.9 % female 86.3 79.8 89.5 95.1 marital status % married 58.3 67.3 61.7 22.0 % long partner 9.4 9.7 10.6 7.3 % divorced 10.2 9.7 9.6 12.2 % widowed 3.1 4.4 3.2 0.0 % never married 18.9 8.8 14.9 58.5 children under 18 years residing with respondent % yes 28.2 28.3 31.6 24.4 ethnicity % black 7.1 2.7 7.4 17.1 % white 83.1 88.5 80.0 78.0 % latino/a 3.5 2.5 3.9 4.8 % other 5.9 5.3 7.4 4.9 % bi-multi 3.9 3.5 5.3 0.0 membership in professional organization % cswe 34.0 72.6 1.1 0.0 % bpd 26.4 58.4 0.0 0.0 % nasw 52.4 75.2 32.3 31.6 % other 33.6 49.6 25.8 5.3 age % 21-30 14.5 1.8 14.7 51.2 % 31-40 16.9 18.6 11.6 26.8 % 41-50 26.3 25.7 32.6 12.2 % 51-60 26.3 34.5 24.2 9.8 % 61+ 16.1 19.5 16.8 0.0 of the 114 social work educators (45% of the sample), 17.5% reported their rank as professor, 28.9% associate, 21.1% assistant, and 33% reported a different educator rank. the largest proportion reported having a doctorate in social work (41.2%), while 36% had an msw and others reported degrees in related fields. while 97% of the educator sample believed that preparing students for responsible citizenship was integral during advances in social work, fall 2014, 15(2) 284 undergraduate education, only 65% said there was a high level of commitment at their campus towards this effort. among the community social workers (39.3% of the sample), 42 respondents reported that they regularly supervised field students, while 61 respondents said they did not regularly serve in this function. community practitioners had a spread of years of social work experience with 29.5% having less than 10 years, 33.6% with 11-20 years, and 36.9% with 21+ years. about 34% had a bsw only, while 48% had an msw, 3.2% a doctorate in social work, and 14.8% reported that their highest degree was in a related field. graduating students (n = 41) made up 15.2% of the overall sample. only about 5% had taken and passed the association of social work board’s national bsw licensing exam; most had not yet scheduled an appointment to take it. about 31% were currently seeking social work employment, 26% had already secured such employment, 21% were starting a graduate program in social work and 23% were engaged in some other employment or personal pursuit. students had completed their field placements in a variety of different settings including child welfare, family services, mental health, corrections, health, school social work, aging, veterans, cash assistance program and other non-profit settings. results to begin the examination of civic-mindedness, the researchers conducted some preliminary analysis for the full sample. standard multiple regression was conducted to determine the contribution of gender, non-dominant status, age, education, and attendance at religious services in predicting cmp scores. the resulting model was significant [r2 = .069, r2adj = .050, f(4, 199) = 3.67, p = .007]. however, only age and education made contributions to the model and little variance was explained. nevertheless, these variables were inversely related to cmp scores. cmp scores were also lower (more civic-minded) among respondents who reported more political activity. these differences were found to be statistically significant [f(3, 246) = 4.0, p = .008]; those who reported they had not participated in the past 3 years had significantly higher cmp scores than those who had done so frequently. this influence had a small to moderate effect size (eta-squared = .05). a significant relationship was also indicated between cmp scores and membership in nasw [t = 3.08, p = .002]. nasw members (m = 86.3, sd = 20.8) scored significantly lower (more civic-minded) than non-members (m = 95.8, sd = 27.3). the effect size for this result was small to moderate (cohen’s d = .39). not surprisingly, volunteering appeared to have a stronger impact on cmp scores; this effect size was large (eta-squared = .13). post-hoc comparisons for this significant anova analysis [f(3, 246) = 11.9, p < .001] indicated that those respondents who said they volunteered frequently scored statistically lower (more civic-minded) than those who did so less than occasionally. further, those who volunteered occasionally scored lower than those who never volunteered. next, the researchers addressed the central questions of whether different groups of social workers (educators, field supervisors, community workers, new graduates) were twill, lowe/social workers as civic-minded professionals 285 different in their attitudes. first, the researchers compared the groups on their attitudes towards volunteering and financial donation. overall, more than half of the sample indicated that their jobs fulfilled their obligation to volunteer. an anova analysis indicated that there was no significant difference (p = .07) between groups on this issue. fewer social workers thought that their jobs fulfilled their obligation to donate money (31% of sample). the anova analysis for differences between groups on this issue did reach significance [f(3, 258) = 2.91, p = .04], though post-hoc comparisons indicated no significant contrasts. in this case, social work educators indicated the least agreement with the idea that their jobs fulfilled their obligation of financial donation while new graduates indicated the most agreement. the researchers also addressed the central question of whether different groups of social workers scored differently on cmp (see figure 1). results of an anova analysis indicated that there were significant differences between groups [f(3, 258) = 9.7, p < .001]; this effect size was large (eta-squared = .10). post-hoc comparisons suggested that both university-based and field faculty had significantly lower scores (more civic-minded) than either new graduates or “other” community social workers (those without significant field supervision); however no significant difference was found between faculty (whether university or field) or between new graduates and community social workers without regular field students. figure 1. mean plot of civic-mindedness by type of social worker faculty participants research participants who indicated that they were faculty members at educational institutions were asked some unique questions. an anova analysis comparing cmp scores by different types of faculty positions (instructors, assistant professors, associate professors, etc.) was not statistically significant (p > .05). additionally, no difference in cmp scores were found when comparing faculty members who had memberships with cswe or baccalaureate program directors (bpd) (related professional organizations) to those that did not. faculty respondents were asked how often they had participated in particular activities during the past three years. faculty who used community service in their pedagogy scored lower (more civic-minded) on the cmp scale (see figure 2). however, because 61% of the 75 80 85 90 95 100 105 full‐time educator regular field instructor new bsw graduateother social worker c m p  s co re s advances in social work, fall 2014, 15(2) 286 sample indicated that they frequently used this method in their teaching, the researchers combined the less than frequent users into one group for statistical comparison. an independent sample t-test indicated that the difference between the two resulting groups was significant [t(112) = 2.72, p = .008]; this effect size was moderate (eta-squared = .076). further, social work educators who indicated more frequent use of materials or activities intended to promote student civic engagement also had lower cmp scores (more civicminded). however, because 61% of faculty reported that they frequently did so, other groups were again collapsed. an independent sample t-test indicated that there was a significant difference (t = 5.72, p < .001) between the mean score of the frequent group (m = 77.1, sd = 18.0) and the less than frequent group (m = 98.0, sd = 20.4). this effect size was large (eta-squared = .23). figure 2. mean plot of civic-mindedness of faculty by use of community service pedagogies faculty members were also asked how often they engaged in research collaborations with community partners. post-hoc comparisons for the significant anova [f(3, 110) = 5.71, p = .001] indicated that those who never engaged in such projects scored significantly higher (m = 99.1, sd = 25.4) on the cmp scale than those who did so frequently (m = 76.7, sd = 21.4). this effect size was large (eta-squared = .13). new graduates new bsw graduates were also asked some unique questions regarding their educational experiences. sixty-three percent of this subsample indicated that they had completed five or more courses that included community service. these students were compared with those who said they had taken fewer courses with community service components, but no statistically significant difference in cmp scores was indicated. however, new graduates who reported that they had frequently participated in service events as part of a social work club had significantly lower scores (more civic-minded) [f(2, 38) = 5.07, p = .011] than those who had not. this effect size was large (eta-squared = .21). no significant differences in cmp scores were found between students who were seeking full-time employment, had secured employment, or were starting a graduate program. community social workers social workers in the community (not educators or new graduates) were also asked some unique questions. no significant relationship was indicated between years of 70 80 90 100 never 1 or 2 times occasionally frequently c m p  s co re s twill, lowe/social workers as civic-minded professionals 287 experience and cmp scores [f(6, 88) = 2.0, p = .07]. group differences based on frequency of experience acting as field supervisors for social work students were not statistically significant (p = .079) either; however, examining the trend in the mean plot (see figure 3), it appears that the relationship may approach significance. figure 3. mean plot of civic-mindedness by frequency of field supervision most community social workers indicated that they had never collaborated with faculty on research. nevertheless, those who had were more civic-minded (m = 88.1, sd = 22.6) than those who had not (m = 100.8, sd = 27.0). this difference was statistically significant [t = 2.4, p = .02) and the effect size was moderate (cohen’s d = .51). discussion the results of the analysis appear to indicate that there are some important differences in civic-mindedness among social workers. in the overall sample, social workers who belonged to nasw and who participated in political activities with more frequency were more civic-minded. this finding is similar to ritter’s (2008) that indicated that nasw members were more likely to participate in political activities. faculty rank or membership in an educationally related professional organization appeared to have no relationship with civic-mindedness among social work educators in the sample. however, faculty members who reported that they made efforts to engage their students in civic issues through community service or class materials were also more civicminded themselves. this matched expectations, based on previous research; hatcher (2008) found that faculty members who were nominees for national service awards were more civic-minded than those not nominated, and that faculty members who utilized service-learning pedagogy were more civic-minded than those who did not employ this strategy. additionally, more civic-minded faculty members in our sample were more likely to have engaged in research with community partners. this result seems to make sense based on the assumption that faculty who partner with community agencies to conduct research value the knowledge and expertise of the practitioner partners. hatcher (2008) also found that faculty engaged in collaborative research were more civic-minded than those who did not conduct this type of research. in spite of a professional expectation of pro bono service (nasw, 2008), more than half of the sample respondents indicated that their jobs fulfilled their obligation to volunteer. faculty members were least likely to endorse this idea; however, statistical comparisons were non-significant. social work educators were the least likely to agree that their jobs fulfilled their obligation to donate financially while new graduates were the most 60 80 100 120 never occassionally frequently c m p  s co re s advances in social work, fall 2014, 15(2) 288 likely to agree. perhaps new graduates have fewer financial resources than faculty or community social workers. other comparisons were more surprising. the researchers found it particularly interesting that while there appeared to be differences between educators and community practitioners in civic-mindedness, there appeared to be little difference between traditionally-defined “faculty” members and field faculty (community practitioners of social work who regularly supervised social work students in field placements but are not formally employed by the college or university). while the researchers cannot establish whether more civic-mindedness professionals are attracted to teaching or the act of teaching impacts civic-mindedness, social workers who have higher levels of contact with students also appear to be more focused on civic responsibility. this has interesting implications and deserves further attention. while civic-mindedness among faculty did appear to differ based on their use of community service in pedagogy, the results did not pick up on the same difference for social work learners. faculty members who used specific methods to influence the civic engagement of students were more civic-minded than their colleagues. however, students with more “community service courses” were not more civic-minded than their peers. but those who frequently did community service activities in a social work club were more civic-minded than students who did not. these findings appear different from other research results; fenzel and payrot (2005) found that course-related service had more impact than general service. it is possible that social work students have significantly different educational experiences than students in other disciplines. less than 5% of the student sample reported they had never taken a course with a service component and the majority indicated they had taken 5 or more of these courses; therefore, subtle differences on the impact of this pedagogy would be hard to detect. additionally, this may not be a linear relationship, there may be a saturation point, or students may define what community service means differently than faculty members or researchers. perhaps social work students place more significance on community engagement activities that occur outside the classroom and are therefore more “voluntary”. civic-mindedness was also higher among social workers who engaged in collaborative research projects, whether faculty or community practitioners. this finding would seem to reinforce the idea that more of this type of activity is needed. limitations as with all research, there were limitations to the study. the researchers used a crosssectional design; all the data was collected from participants at one point in time. because of this, time order cannot be established. this is an important point with this research as the direction of relationships cannot be determined. for example, does a higher level of civic-mindedness lead professionals to join nasw or does belonging to nasw lead to being more civic-minded? are civic-minded students more likely to join student clubs or do student clubs build civic-mindedness? the researchers cannot answer these causal questions with this study design. social desirability could also be a significant limitation in the study. the respondents may have answered questions in a way that indicated the way twill, lowe/social workers as civic-minded professionals 289 they thought they should act or think as social workers, rather than the way they actually do. this problem would probably be more of an issue with the social work profession, with our strong value base and code of ethics, than with other professions on which civicmindedness has been explored. other limitations include a non-random sampling method, a relatively small sample size, and the possibility of self-selection bias. however, the similarity between some of the findings and those of other related studies increases our level of confidence in the representativeness of our sample. implications these findings suggest several ways in which the social work profession can strengthen civic-mindedness. social workers have the opportunity to create spaces with their colleagues to engage in community action for the common good. thinking deliberately about these opportunities, many of which are already in place at universities and in the community, may help nurture the next generation of social workers. social work educators were the most civic-minded group in the sample. they also come in contact with other social workers as part of their daily work. one way faculty could promote civic-mindedness is to conduct action research with community partners. ideally, a community social worker or a student would be a co-investigator on the research project. participation with the faculty member in action research gives the community social worker or student an opportunity to learn or enhance research skills, while at the same time creating knowledge that is practical for the agency setting. action research benefits the faculty member and the social service agency; a faculty member gains access to a population or data set needed in order to create scholarly knowledge, and the community agency gets the research experience of a faculty member. often community agencies want to conduct research, but lack the time, expertise, and access to the scholarly literature that faculty members have. the finding that field supervisors had similar levels of civic-mindedness to social work educators was an interesting outcome that deserves additional attention. social work programs can use this to their advantage; most programs have traditionally seen field supervisors as in integral part of a student’s education, but have focused their educational role and scope to helping students develop practice skills. social work programs could host a training for field supervisors that emphasizes cswe competency #1, “identify with the social work profession and behave professionally” and the associated practice behaviors (cswe, 2008). the reinforcement of the civic-minded attitudes that field supervisors already have could help them explicitly emphasize this professional obligation to the students with whom they work. having field supervisors purposefully model and discuss civic-minded behaviors with their students would further promote the values and expectations of the profession. community social workers were less civic-minded than educators, their colleagues who were field supervisors, and graduating seniors. one might expect that levels of civicmindedness would have influenced beliefs that formal employment fulfilled obligations to volunteer or financially give; however, that was not the case. there were no differences in these behaviors between the groups. future research is warranted to determine factors, such advances in social work, fall 2014, 15(2) 290 as burnout or job duties, which may contribute to differences in community social workers’ civic-mindedness, as well as willingness to volunteer and donate monies. one way to combat declining civic-mindedness among community social workers may be to increase opportunities to engage with social work programs and students. in many cases, community social workers may be alumni of local universities and social work programs. social work departments could work with the alumni association to host a community service event. for example, on martin luther king (mlk) day of service, social work faculty, community social workers, and the social work club could partner to complete a community service project. nasw membership was high in this sample, and the local chapter may be another willing participant in such an event. bringing together social workers from different backgrounds and stages of professional development could produce multiple positive outcomes such as reconnecting alumni with their universities, creating networking opportunities for community social workers, and providing students at all stages of their academic careers with a chance to meet and interact with practicing social workers, while at the same time, serving the community. finally, students who participated in community service as part of the social work club were more civic-minded than their peers who did not. social work clubs have traditionally been seen as a co-curricular opportunity for students to develop leadership roles and engage in community service. being intentional about club advising, the variety of opportunities that the club offers, and making sure pre-social work majors are invited to club activities might be a step in the right direction. giving consideration to the times of day the club meets or the type of service opportunities that are planned (e.g., one-day vs. ongoing volunteer commitment) may encourage more students, including non-traditional or other diverse groups, to participate. conclusion how social workers view their commitment to civic engagement and the public good has implications for the profession. the results of this study suggest that social workers see themselves as agents who engage in work necessary for social change. as such, revisiting the work of specht and courtney (1994) to contemplate how civic-minded attitudes can translate into behavioral change is warranted. using their writings as a framework to examine professional obligations, intentional practices, such as the service learning projects and research collaborations examined in this study, could be implemented to reinforce and strengthen the partnerships between the groups in order to better adhere to the values of the profession. references astin, a. w., sax, l. j., & avalos, j. 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(2006). the effects of mass media use and social capital on civic and political participation. communication studies, 57(3), 277-297. doi:10.1080/10510970600666974. author note address correspondence to: sarah e. twill, ph.d., 270 millett hall, wright state university, dayton, oh 45435. email: sarah.twill@wright.edu microsoft word 16-3809 fericelli_family assistance for older adults in puerto rico final ______________ paul-jesús fericelli, lmsw, is an instructor in the college of arts & humanities, department of social work at the pontifical catholic university of puerto rico in ponce, puerto rico. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 276-288 family assistance for older adults in puerto rico paul-jesús fericelli abstract: global aging is a growing issue in most countries, including puerto rico. the well being of the older adult population depends mainly on a collaborative government initiative that uses both public assistance and the engagement of family members. puerto rican policymakers are searching for alternatives to care for the expanding elderly population as well as to protect the country’s economy, avoid the financial cliff, and reduce the high cost of public assistance. the purpose of this article is to analyze the act for the improvement of the family assistance and for the support of the elderly, act no. 193 of 2002, under the criteria-based model (gallagher & haskins, 1984) with a valuecritical appraisal (chambers & wedel, 2009). i suggest act no. 193 of 2002 as a model for policymakers who are seeking ways to improve assistance for older adults, by promoting the following values: fairness, familism, fraternity, and accountability. keywords: family assistance, policy analysis, latino older adults, global aging many older adults depend on the support of public assistance and extended family members to meet their needs. according to bearon (2003), and shirley & summer (2000), more than 57.6% of the puerto rican population, age 80 years or older, requires assistance with their activities of daily living (adl) such as food preparation, transportation, doctor appointments, socialization with others, exercise, bathing, eating, and dressing. for example, the national fire data center (2008) indicated that the risk of dying in a fire is 2.6 times greater for adults over 65 years of age than for the general population. public assistance programs fill a void and ensure that older adults do not fall below the threshold of poverty; however, this population frequently asks for other types of support that public assistance cannot supply. examples of this type of support are: companionship with community members and their extended family, transportation to medical appointments, grocery shopping, church activities, quality of life decisions that require consultation with family members, and designating parties for power of attorney. (coates, 1994; dobelstein, 2003; hartman, 2011). the number of people 65 years of age or older increased to approximately 420 million worldwide in 2000 (kinsella & velkoff, 2001), and for many countries managed care for older adults is a growing policy concern. for american, european, and asian societies, the elderly population is growing at higher rates than developing countries, such as those in latin america (center for strategic and international studies, 2010; jackson, howe, & nakashima, 2010a). policymakers seek information from policy analysts to create innovative ways to address the needs of older adults, globally, and to lower the high costs of public assistance, resulting from the instability of financial markets, and losses in tax-based revenues at the federal, state and municipal levels throughout the world. economic instability puts public benefits earmarked for older adults like social security, medicare and medicaid at greater risk (lav, 2005; rodriguez, 1999). this means that older adults would depend more on their direct relatives for care advances in social work, spring 2013, 14(1) 277 and assistance. as life expectancy in the population of adults age 60 years and older increases, the need for public policy also changes (bearon, 2003; shirley & summer, 2000). older adults’ reality with social security, public assistance, and poverty: united states and puerto rico the united states provides social security benefits to assist older adults, and in 2005 research showed that almost 13 million u. s. senior citizens were lifted from the ranks of poverty because of social security (sherman & shapiro, 2005). additionally, by 2010, this number increased to 36 million (van de water & sherman, 2010). other studies showed that about 9% of the population of the united states, age 65 years or older, is still living in poverty (denavas, proctor, & smith, 2010). furthermore, for each 10% cut in public assistance, approximately 3% of america’s older adult households slip into poverty (center for strategic and international studies, 2010). when considering income levels alone, at least 40% of people, age 65 years and older living in puerto rico are on the poverty borderline. (ortiz, abreu, torres, & vera, 2010b; puerto rico community survey, 2009). puerto rican older adults utilize social security, medicare and public assistance as their main sources of income (ortiz et al., 2010b). the united states census bureau (2009) has forecasted that puerto rican older adults will top 1 million in 10 years. the projection suggests that an additional one million puerto ricans will depend on public assistance, however, such support is questionable given cuts in federally funded programs. direct relatives as caregivers it is projected that direct relative caregivers will pay more than they can afford for the care and living costs of older adults because of the economic downturn (dobelstein, 2003; shrieves, 2009). according to shrieves (2009), around 78 million baby boomers were moving in with direct relatives because they lacked the financial resources to support themselves. research has identified that around 52 million relatives, including adult children, spouses and relatives of aging adults have become caregivers in united states (bearon, 2003). additionally, caregivers are more likely to be adult children rather than spouses (family caregivers alliance, 2005). other studies indicated that the likelihood of receiving care from a spouse is higher as the age of an older adult increases. research found that ethnicity plays a role with respect to caregivers in the united states. stewart, russonello, and belden (2005) used a sample of 1,247 caregivers who provided services to seniors over 80 years of age, and found that 21% of caregivers were white and african-american, 18% asian american, and 16% hispanic american. in another study, adult children whose progenitors were hispanic were most likely to provide care to their older adults in their homes, while african american older adults were more likely to have non-family members providing care (shirley & summer, 2000). care from significant others saved the u. s. government about $350 billion in services for older adults in 2006 (american association of retired persons, [aarp] 2007). these fericelli/family assistance for older adults in puerto rico 278 results highlight the extremely important role of the caregivers in the lives of older adults and their positive contributions to the economy. puerto rican context although puerto rico has been a u.s. territory since 1898, the country’s status since 1952 has been one of a commonwealth association with the united states (u.s. department of the interior, nd). puerto ricans became u.s. citizens in 1917, and have all of the same benefits, services, and privileges as any other u.s. citizen except that they cannot vote for the president, unless they live on the mainland (deane, 2013; levinson, 1998). the puerto rican population is fairly homogeneous, yet it is made up of three cultures: the native taíno (in spanish), the spanish, and the african (levinson, 1998). this fusion of cultures has promoted essential cultural traits including spirituality, fraternity, familism, to mention but a few. around 85% of puerto ricans are roman catholics (culture grams, 2009), and religion promotes community engagement with friends, neighbors, and family. puerto ricans are fraternal, which is evidenced by the way relatives and neighbors support each other; and they are resilient and pull together in times of need to support elders within the family structure. puerto rican caregivers are sons, daughters, and women from the community (delgado & tennstedt, 1997), who comparatively spend more time taking care of their elders than the mainland caregivers do (sberna hinojosa & rittman, 2007). in puerto rico, many neighbors are also considered members of the extended family. certainly, faith-based organizations, social service associations, government agencies, and public service agencies promote a culture of caring and accountability in the care of the elderly in puerto rico. in the global arena, not all countries are prepared for global aging. the well being of the older adult population more often than not depends on public assistance. consequently, policymakers are searching for alternatives to save their country’s economy, avoid downturns, and reduce the high cost of public assistance, globally. this article presents the case of puerto rico. it analyzes the act for the improvement of the family assistance and for the support of the elderly, act no. 193 of 2002, under the criteria-based model (gallagher & haskins, 1984) using a value-critical appraisal (chambers & wedel, 2009). the author suggests act no. 193 of 2002 as a model for policymakers who are seeking ways to improve assistance for older adults, promoting the following values in the population of their country: fairness, familism, fraternity, and accountability. policy selection: act no. 193 of 2002 the government of puerto rico, in preparing for global aging, strives to attend to the population of older adults. for example, the creation of the position of the advocate for older adults (position of the advocate for the elderly act no. 203 of 2004) and the act for the improvement of the family assistance and for the support of the elderly, act no. 193 of 2002 are both efforts to deal with the issue. however, the economic downturn led to the passage of act no. 7 of 2009 (special act declaring a state of fiscal emergency advances in social work, spring 2013, 14(1) 279 and establishing comprehensive fiscal stabilization plan to save the credit of puerto rico), which terminated employment for over 30,000 workers in public agencies, and affected programs within the puerto rico department of family and the advocates for the women, patient, veterans, disabled, and oppea (oficina del procurador(a) de las personas de edad avanzada). despite all of these changes, the program for the support of people of advanced age (prospera, in spanish) was unaffected by act no. 7 (caro, 2009). the act for the improvement of the family assistance and for the support of the elderly, act no. 193 of 2002 created prospera; one of the programs managed by the administration for child support enforcement and one of the five initiatives directed by the puerto rico department of family. act no. 193 of 2002 is a public policy that addresses the duty of direct relative caregivers who provide assistance to their older adults, with consideration to their available resources. this policy borrowed canadian regulations regarding financial assistance for older adults living in canada (ramos, 2008). proposed models for analyzing act no. 193 of 2002 the criteria-based model, which was proposed by james gallagher and ron haskins (1984), served as a policy framework to develop a policy model to analyze act no. 193 of 2002. this framework includes the following steps: (1) defining the problem with respect to available policy alternatives, (2) establishing universal and selective criteria for ordering the alternatives, (3) gathering data, (4) weighing the costs and benefits of each alternative against each criteria, and (5) recommending the alternative that maximizes the criteria. gallagher & haskins (1984) defined alternatives as policies available to address the social problem and to promote the desired criteria in the population. in addition, the value-critical appraisal, which was suggested by chambers and wedel (2009) helped to analyze the adequacy and cost-effectiveness of the education, mediation, and adversary processes proposed by act no. 193 of 2002. the criteria-based model incorporates three values: universal, selective, and efficiency. the universal criterion refers to the values promoted by the policy to address a social problem. the selective criterion refers to the values position promoted by the policy related to a particular aspect of a social problem. the efficiency criterion provides a summary to assess the value position of the policy. dobelstein (2003) suggests that paradigms based on the criteria-based model match with policies addressing issues in the population of older adults. application of policy analysis models for act no. 193 of 2002 definition of the problem with respect to available policy alternatives social indicators. around 500,000 individuals over 60 years of age represent the population of older adults in puerto rico (ortiz et al., 2010b). the percentage of puerto rican older adults has increased rapidly as a result of increases in life expectancy (on average 78 years of age) due to advances in medicine and improvements in diet and fericelli/family assistance for older adults in puerto rico 280 lifestyle (ortiz et al., 2010b), as well as other demographic trends faced by the younger generation. a closer look shows that in puerto rico, almost 1,000 young people were murdered during 2010 (figueroa & hernández, 2011), and more than 100 died in the first month of 2011 (colón, 2011), and, many youngand middle-age puerto ricans relocated to the united states for better employment opportunities (el nasser, 2012), which contributed to a decrease in birth rates. puerto rico has a higher proportion of older adults in comparison with all of the u. s. territories (administration on aging, 2010; united nations, 2009). by 2015, the population of older adults will be greater than that of children aged 15 years or under (ortiz et al., 2010a; tendencias project, 2006). sadly, a recent survey notes that 16.5% of puerto rican older adults have been victims of maltreatment or abuse, 40 % are living below poverty standards, and 50.3% are disabled living in their homes (puerto rico community survey, 2009). if these trends continue, they will clearly affect the cultural assets of the families and neighborhoods. social problem. as previously discussed, puerto ricans are family oriented and try to support each other in difficult times; however some direct relatives are unwilling and/or unable to support their older adults. given societal shifts, the puerto rican government took a more active role to protect the elderly and developed the civil code of puerto rico, article 143 (1930) and the act no. 193 of 2002 to address the care of its older citizens. in sum, article 143 defined the responsibility of relatives in sharing the duty of maintaining the welfare of the family, while act no. 193 of 2002 particularly focuses on the duty that direct relatives have in taking care of their older adults. establishing universal and selective criteria for ordering the alternatives the policymakers used accountability, fairness, fraternity, and familism values as criteria for ordering alternatives. first the criterion of accountability is the value that both policies promote with direct relatives who are particularly unwilling to provide assistance to their older adults. second, fairness is the value projecting what is right on the distribution of duties for taking care of older adults. third, fraternity, a strong value among puerto ricans, represents brotherhood/sisterhood and upholds the concept of responsibility towards relatives and significant others. last, familism holds the family members responsible for providing economic and emotional support to the elderly (fried & mebrotra, 1998).these four values were chosen to implement state public policy to improve support to the elderly. gathering data civil code art. 143. this code instructs the direct relatives to address the needs of the older relatives, by defining the relatives who are responsible for providing alimony (e.g. spouses and adult children). according to this policy, alimony includes those items needed to maintain the well-being of the older adult such as food, clothing, and medical assistance, in accordance with the socioeconomic status of the family. in addition, family members can ask the government for alimony, if it is necessary for the welfare of a particular family member. this code does not provide guidelines for how alimony would be claimed. the policy proposed the adversary process for dealing with this social advances in social work, spring 2013, 14(1) 281 problem, and grants power to the civil court for implementing alimony. occurrences of the use of this policy are infrequent; however, act no. 193 of 2002 recognizes the existence of civil suits under the civil code of p.r. art. 143 of 1930. act no. 193 of 2002. this act presents three phases. the first is an administrative process known as mediation. although any relative who wants to provide care to the older adult is welcomed, a mediator arranges an appointment with direct relatives to clarify roles. the second phase is known as the adversary process, which is implemented if the direct relatives cannot come to an agreement on who will care for the older adult. in the third phase, prospera was created to implement an education program to promote the responsibility of direct relatives for the welfare of their older adults and to provide services to people age 60 years and older (act no. 193, 2002). older adults receive economic and non-economic assistance as act no. 193 of 2002 defines alimony. noneconomic assistance refers to any other type of support to promote an older adult’s welfare. examples of non-economic assistance are transportation, companionship, visitation, and attention. mediation process. mediation is an alternative dispute resolution approach to resolve conflicts between older adults and direct relatives. participants receive help from a certified mediator to discuss their differences about an issue. the mediator does not decide what is right or wrong, but instead serves as a neutral moderator who takes into account the choices presented by participants. mediation is an informal and confidential process (coulson, 1996) that has helped resolve family disputes (roberts, 2008). recognizing the power that mediation provides to reconcile disagreements, puerto rico practices mediation in courts and other public agencies. for example, in 2006, the judicial branch of puerto rico resolved 97% of 3,314 disputes through mediation, where prospera, working under act 193, resolved 80% (827 cases of 1,026 cases) of family disputes through mediation (ramos, 2008), which resulted in alimony agreements for older adults. adversary process. government, as an institution, regulates human behavior by determining what is right or wrong by exercising social power on human societies via the courts (villalobos, 2005). for the most part, the government gives the court the power to distribute justice, and state agencies the responsibility to bring those not following the law before the court (rivera, 2006). the adversary process brings before the court adult children, or direct relatives and a judge uses his/her recourse to make adult children comply with act no. 193 of 2002. for example, if adult children do not follow court orders, they can go to jail for at least six months. in addition, they can be fined at least $500 u.s. dollars. on the other hand, the prospera program administrators can fine direct relatives up to $5000 u.s. dollars. this act also has an advocate position where a lawyer can represent the older adult before the court. ramos (2008) reported that prospera had 1,026 cases; 16% (171 cases) that were referred to the advocate for assistance, but only 3% (28 cases) were presented before the court. and of those 28 cases, gerontologist and social workers recommended the mediation process to achieve alimony agreements for each (ramos, 2008). fericelli/family assistance for older adults in puerto rico 282 education process. psycho-educational programs promote change in human functioning and coping skills (dubanoski & tanabe, 1980; gerris, van as, wels, & janssens, 1998; lawrence, 1998). act 193 of 2002 utilizes the psycho-educational concept to promote values such as familism, accountability, fairness, and fraternity, and to carry out its mandate of encouraging relatives to accept responsibility for their older family members. the educational process also includes the provision of public information by the agencies and organizations composing the aging network. for example, prospera trains judges to be effective and efficient when working with older adults. in addition, social workers play a professional role by educating direct relatives on the values promoted by act no. 193 of 2002. act no. 193 of 2002 also includes a requirement to bring before the courts those direct relatives who were unwilling to deliver assistance to their older adults. this act has an advocate position where a lawyer can represent the older adult before the court. ramos (2008) reported that prospera had 1,026 cases; 16% (171 cases) that were referred to the advocate for assistance, but only 3% (28 cases) were presented before the court. and of those 28 cases, gerontologist and social workers recommended the mediation process to achieve alimony agreements for each (ramos, 2008). weighing the costs and benefits of each alternative against each criteria although the implementation of the civil code of p.r. art. 143 of 1930 presents no cost to the executive branch of puerto rico, it does involve a cost to the judicial branch (e.g. the salary of judges). older adults are expected to pay for their defense before the court. even though this policy promotes all criteria, the question remains whether older adults can afford a civil suit, particularly when in puerto rico, 40% of the older adult population lives below poverty standards. therefore, the benefit of implementing this alternative is questionable. the implementation of act no. 193 of 2002 through prospera creates costs to the executive branch of puerto rico. art. 10 (act no. 193, 2002) makes available an advocate who provides legal services free of cost to older adults. however, prospera contracts for professional services from mediators to help offset the costs to the executive branch. the education phase varies in costs. art. 8.1g (act no. 193, 2002) includes the use of the media, which involves payments for advertisements on the radio, internet, and television. education also covers orientations, conferences, and presentations in different communities and public or private agencies. the cost of advertising on television and radio tends to be higher than promotional tours in public or private agencies and communities. selection: the alternative that maximizes the criteria the act no. 193 of 2002 addresses the social problem despite the costs of prospera. indeed, the civil code of p.r. art. 143 of 1930 cannot be a policy alternative given that the majority of the population of older adults cannot afford legal services. research suggested that older adults prefer the mediation process instead of the advances in social work, spring 2013, 14(1) 283 adversary one (ramos, 2008). mediation allows direct relatives to create a plan to share duties to increase the quality of life of their older adults. to enhance the clarity of the plan, act. no. 193 of 2002 provides a definition of alimony which is preferable to older adults. value-critical appraisal for the act no. 193 of 2002 equality and adequacy act no. 193 of 2002 promotes equality through the creation of prospera. the equality value in this policy represents a leveling approach for sharing duties between relatives and older adults, the government, and human service agencies. the education, the mediation, and the adversary processes address the roles and responsibilities of all parties involved. the processes mentioned above may have unintended consequences. for example, it has been observed that direct relatives may also bring unresolved past family conflicts to the mediation process, which may provide an opportunity to air, and in some cases, resolve old emotional wounds. social workers may play an important role by preparing direct relatives for the mediation process. this is also known as therapeutic mediation. in doing so, social workers serve as facilitators in the implementation of equality between direct relatives and older adults. cost effective art. 19 (act no. 193, 2002) assigns prospera $500,000 u.s. dollars from the fiscal budget of puerto rico. in addition, art. 6 created a special fund for the program, which receives deposits from services, gifts, incentives, income, fines, charges, interest, penalties, costs, expenses, and fees. prospera uses all of these funds to run the program and to pay professional service contracts. the administrator, who acts as chief of the administration for child support enforcement, provides the fiduciary oversight of these funds and determines how they are going to be distributed. the cost-effective factor is a concern promoting equality under the act no. 193 of 2002. due to the demographic increase of older adults on the island, the currently assigned budget to run prospera is insufficient to provide adequate services. hence, the need for the special fund to supply the education program of prospera and to provide better services for older adults. prospera can also ask for assistance with creating practicum centers for bachelor and graduate social work students and certified mediators in training. these centers promote a community partnership approach between public agencies and the academic community. prospera can also solicit non-profit organizations for volunteers to work with the older adult population. conclusion puerto rico, as with other countries in the world, is experiencing significant increases in the number of people living longer due to a combination of factors. fericelli/family assistance for older adults in puerto rico 284 undoubtedly, longevity has created challenges in the care of older adults, particularly the very old, for family members, practitioners, and policymakers. this article offers an analysis of act no. 193 of 2002 as a guide to partially address the challenges of promoting the responsible care of older adults by their direct relatives through a leveling approach with the involvement of the extended family, generous neighbors, and friends. in addition, the policy improves family assistance by bringing an innovative definition of alimony, and it introduces the concept of non-economic payments such as transportation, companionship, visitation, and attention. the application of the act no.193 facilitates processes to safeguard the welfare of older adults by creating a partnership between families and public assistance. it should be said that prospera needs to create job positions for social workers who can benefit by becoming certified as mediators for older puerto rican adults. in addition, social workers may contribute to program evaluation. there is little question that act. no. 193 is based on the four fundamental latino values of: fairness, familism, fraternity, and accountability as discussed in the body of this manuscript. the older adult population will continue to grow in the near future, and it will be pertinent to continue 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(2009). department of economic and social affairs, population division. supplemented by official national statistic published in the united nations demographic yearbook 2008. retrieved from http://unstats.un.org/unsd/demographic/products/indwm/tab1b.htm united states census bureau, population division. (2009). table 1: annual estimates of the resident population for the united states, regions, states, and puerto rico: april 1, 2000 to july 1, 2009 (nst-est2009-01). retrieved from http://www.census.gov/popest/data/historical/2000s/vintage_2009/ united states department of the interior. (nd). puerto rico. retrieved from http://www.doi.gov/oia/islands/puertorico.cfm van de water, p. n., & sherman, a. (2011). social security keeps 20 million americans out of poverty: a state-by-state analysis. washington, dc: center on budget and policy priorities. retrieved from http://www.cbpp.org/cms/index.cfm?fa=view&id=3260 villalobos, p. (2005). las estructuras de poder max webber [max webber power hierarchy]. juridicas, law resources web site. retrieved from http://www.juridicas.unam.mx/publica/librev/rev/jurid/cont/13/pr/pr38.pdf author note: direct correspondence to: paul-jesús fericelli, department of social work, college of arts & humanities, pontifical catholic university, 2250 blvd. luis a. ferré aguayo, suite 578, ponce, puerto rico, 00717–9997. email: paulj_fericelli@pucpr.edu microsoft word 14. wang et al_16477_social distancing_international sample of sw students copyedit final ______________ donna s. wang, ph.d., msw, is an associate professor in the social work department at long island university, brooklyn campus; scott smith, phd, lcsw, is and assistant professor in the school of social work at texas state university in san marcos; chris r. locke, ph.d., lcsw, is a social worker in fort pierce, fl.. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 480-494 social distancing of depressive and panic disorders in an international sample of social work students donna s. wang scott smith chris r. locke abstract: using an international sample, this study examined what variables were associated with social distancing among social work students. a total of 1,042 students from seven universities in the united states, united kingdom, and australia participated in a cross-sectional paper and pencil survey that applied the social distancing scale to case vignettes describing an individual with panic disorder or major depressive disorder. the results show that levels of social distancing were related to age, knowing someone with a mental illness, type of disorder, level of conservatism, race, country, professional interest in mental health, level of student, and sex. overall, 16.8% of the variance was accounted for with these significant variables. implications for social work education and future research are discussed. keywords: stigma, mental health, mental illness, social distance, social work education, international social work stigma, as with any social construct, is multifaceted and complex. the merriamwebster’s dictionary defines it as “a mark of shame or discredit; a stain, or an identifying mark or characteristic and when associated with mental illness, involves feelings, attitudes and behaviors” (penn & martin, 1998, cited in overton & medina, 2008). there are several theories of stigma, such as social identity theory, which describes how people use social constructs to judge or label someone who is different or disfavored (overton & medina, 2008). from a psychological perspective, the process in which one stigmatizes involves four social-cognitive processes: cues, stereotypes, prejudice, and discrimination (corrigan, 2004). this process of stigmatizing is described further by overton and medina (2008) as the following: the cue as a social cognitive process in which a person recognizes internally that something is different about an individual, which then activates a stereotype. if the stereotype is negative, it is considered a prejudice. lastly, that prejudice can then lead to a behavioral response, often discrimination or social distancing. within the four processes of stigmatizing, the first three are internal responses, and the fourth, a behavioral response, is external. although stigma and social distancing are not interchangeable or synonymous, there is a relationship between the two. social distancing can be one behavioral consequence of stigmatizing attitudes. because social distancing is manifest and not latent, it is often used by researchers as a measurable indicator of possible stigma (covarrubias & han, wang, smith, locke/social distancing of depressive and panic disorders 481 2011; faulkner, irving, paglia-beck, & adlaf, 2010; feldman & crandell, 2007; link, yang, phelan, & collins, 2004; reavley & jorm, 2011). measuring an increased desire for social distance is considered an important measure of stigma (couture & penn, 2003) as social distancing can have consequences for employment for those with mental illness. for example, those with mental illness can experience employer discrimination during the hiring process (feldman & crandall, 2007; overton & medina, 2008). one study conducted with social work students found that the majority (78.9%) said they would not hire a person with severe and persistent mental illness as a babysitter for their child (covarrubias & han, 2011). this form of employer stigma (i.e., not hiring one for a job) is an example of social distancing or, put another way, a lack of desire to include people with serious mental illness in one’s personal network (link et al., 2004). however, it should also be noted that social distancing can also occur for reasons other than stigma, such as fear (theriot & lodato, 2012). unfortunately, mental healthcare service providers are not excluded from stigmatizing and social distancing of clients. provider stigma can be defined as “the negative attitudes, beliefs, and behaviors that mental health providers possess and enact toward clients they serve, even unknowingly or subtly” (charles, 2013, p. 361). mental healthcare providers, including social workers, may harbor prejudices against those with mental illness (covarrubias & han, 2011), which may pose a threat to the effective provision of social services. moreover, although social workers are one of the largest providers of mental health services in the united states, few studies have explored social work students’ attitudes towards mental illness (theriot & ladato, 2012). theriot and ladato (2012) stated that at the time of their contribution, only one study (eack & newhill, 2008) had specifically looked at social work students and their attitudes towards mental illness. thus, the attitudes toward mental health clients of social work students, who are future practitioners, are largely unknown. service delivery to individuals with mental illness or any other vulnerable population is integral to the social work profession. this responsibility to our clients requires social workers to perform effectively and ethically, which requires awareness of one’s own inherent biases. the purpose of this current study was to investigate what personal factors among social work students are associated with social distancing towards individuals with mental illness, and more specifically, depression and anxiety. social distancing was chosen because it is manifest rather than latent, and it may have a direct impact on how clients are treated. rationale past research has been suggested that it would be beneficial to disaggregate various mental illnesses to determine differences of mental health stigma (covarrubias & han, 2011). much of the literature around social distancing focuses on schizophrenia (e.g., faulkner et al., 2010; reavley & jorm, 2011) and other mental illnesses perceived as dangerous. reavley and jorm (2011) state that it may not appropriate to generalize stigmatizing attitudes about schizophrenia to anxiety disorders, and that there is a need to explore specific attitudes towards anxiety disorders. thyer and wodarski (2007) also noted that panic disorder, a type of anxiety disorder, is relatively common in the general advances in social work, fall 2014, 15(2) 482 population. these conditions are not generally thought of as dangerous, and individuals experiencing these conditions function fairly well in the community, as opposed to conditions typically viewed as “dangerous (also known as peril),” such as schizophrenia (corrigan, 2005). thus, for this study, both panic and major depressive disorders were chosen for four reasons: 1) these disorders represent illnesses from the most common diagnostic categories: anxiety disorders (sadock & sadock, 2003) and mood disorders (corrigan, mueser, bond, drake, & solomon, 2008), and thus are common conditions that social workers encounter and treat; 2) these conditions are not typically “associated” with violence, so subtle and covert social distancing may be present; 3) to compare anxiety and depression and their underlying assumptions as suggested by reavley and jorm (2011); and 4) to expand the literature around stigma and social distancing to include additional disorders. stigma may operate differently according to variables associated with social distancing and attitudes, such as age, gender, and culture (reavley & jorm, 2011). because stigma is a multi-dimensional construct, the researchers included in this study variables thought to be associated with social distancing and attitudes, based on past research and theory. variables in the current study included demographics such as age, race, and gender (covarrubias & han, 2011; faulkner et al., 2010; theriot & ladato, 2012). the study also included other personal and educational factors thought to be related to attitudes in general, such as increased contact (covarrubias, & han, 2011, cummings, alder, & decoster, 2005), student interest in a practice area (kane, 2004), graduate or undergraduate level of a student (curl, simons, & larkin, 2005; theriot & ladato, 2012; wang, ihara, chonody, & krase, 2012), knowing someone (cummings, alder, & decoster, 2005; kane, 2004), religion and importance of religion (anderson & wiscott, 2003), and country (angermeyer, holzinger, carta, & schomerus, 2011). because sexual orientation and level of conservatism are also believed to be related to attitudes and perspectives, they were also included. the researchers of this current study also chose to include an international sample of social work students. mental health can be conceptualized differently among various cultures and may impact career choices. for example, limb and organista (2003) found that students of color and american indians were more likely than whites to choose poverty as their area of practice. this finding may reflect a priority of social justice and advocacy over direct mental health services among various racial and cultural groups. thus to explore various differences, our study included an international sample of social work students from three westernized countries (us, uk, and australia) in our study. although diversity would be better investigated by examining differences among cultures within and between countries of varying financial and economic development, the similarities and differences that exist between groups in these westernized countries could help to clarify cultural differences and perhaps lead to larger-scale studies that include both eastern and western countries. method the data for this study were collected from september 2010 through december 2011 from five universities in the us, one suburban university in the uk, and one suburban wang, smith, locke/social distancing of depressive and panic disorders 483 university in australia. all of the universities were home institutions of the research team at that time. of the universities located in the united states, three of the universities were located in large cities (new york, ny and philadelphia, pa) and two were located in the rural south (texas and alabama), and were chosen for both access as well as an effort to diversify the sample in terms of rural/urban, religion, and culture. approvals were obtained from all the universities’ institutional review boards (or its equivalent). this study was a cross-sectional, self-administered, in-person paper and pencil survey that targeted social work students. members of the research team or research assistants recruited students from various undergraduate and graduate social work classes. course schedules were obtained and instructors were contacted for permission to administer the survey during class time. attempts were made to administer the survey in as many of the classes as possible. students were instructed that if they already completed the survey in another class they were not to fill it out again. students were given the option of completing the survey during the time it was administered or returning it to the investigator in his/her faculty mailbox at a later time. the survey took approximately 1015 minutes to complete. for this study, stigma was conceptualized as social distancing from those with mental illness and the conditions targeted were panic disorder and major depressive disorder. social distancing is used as a proxy for behavior to help approximate how students would respond to these individuals. the inclusion of social distance as a dependent variable was first introduced when bogardus (1925) examined the construct in relation to race and ethnicity. bogardus’ scale was later modified to be more applicable to the mental health population (link, cullen, frank, & wozniak, 1987). vignettes are utilized in the present study in order to better understand how attitudes differ based on the diagnostic label. vignettes have been used in numerous studies related to mental health stigma (feldman & crandall, 2007), including the general social survey (link, phelan, bresnahan, stueve, & pescosolido, 1999; pescosolido et al., 2010). the advantages of using vignettes as an independent variable in stigma research have been well documented and permit the researcher to provide a more thorough description of an individual as opposed to simply presenting a diagnosis (link et al., 2004). moreover, a diagnosis is typically more methodologically rigorous than generic references to “mental illness” as a descriptor. two researcher-created vignettes (one for panic disorder and one for major depressive disorder) were used that were consistent with the criteria of the diagnostic and statistical manual of mental disorders iv-tr (dsm-iv-tr; american psychiatric association, 2000). the following is the vignette developed to reflect a client experiencing panic disorder: for the past two months, mike has been feeling very nervous almost every day. there are times during the day when he has trouble catching his breath and fears he is losing control. during these times, he also reports sweating and trembling. mike has had to leave work early a few days because of this. he frequently worries about having future “attacks” because they seem to come about for no reason. mike has also been having difficulty sleeping and has become more moody. advances in social work, fall 2014, 15(2) 484 the following is the vignette developed to reflect a client experiencing major depressive disorder: for the past two months, mike has been feeling very sad almost every day. he often feels fatigued and does not feel like doing things with friends that he used to enjoy. he has arrived late to work a few days because he barely had enough energy to get out of bed. mike often has trouble sleeping at night. during the day, he feels worthless and feels guilty about things that are not really his fault. sometimes, when mike feels down, he will eat a lot more food than usual, which has resulted in weight gain. measures dependent variable: social distance scale (sds). each student was randomly given either the major depressive disorder vignette or the panic disorder vignette that applied the sds. the version used in this study was adapted from one created by link and colleagues (1987), which had an internal consistency reliability (or cronbach’s alpha) estimated at .92. students in the present study were asked how willing they would be to: 1) rent a room to the client, 2) have him as a coworker, 3) have him as a neighbor, 4) have him as a caretaker for the respondent’s children, 5) have him marry the respondent’s child, 6) have him date a friend of the respondent (the original item is stated as “introduce him to a young woman”. this was re-worded in the current study in order to not bias heterosexuality), and 7) recommend that he work for a friend of the respondent. a fivepoint likert scale was utilized with higher scores indicating greater social distancing (i.e., a less favorable attitude); lower scores indicating less social distancing (i.e., a more favorable attitude). a total composite score was calculated, creating a possible range of 7 to 35 with a higher score indicating a higher level of social distancing (corrigan, edwards, green, diwan, & penn, 2001). for this current study, cronbach’s alpha was estimated at 83.9%. independent variables. the independent variables were age, asked as “what is your age?”; whether or not they know someone with a mental illness (yes/no); diagnosis— whether they received the depression or anxiety vignette; what they consider their social political beliefs to be (mostly liberal, slightly liberal, moderate, slightly conservative, and mostly conservative were collapsed and treated as nominal level variables: liberal, moderate, and conservative); country (usa, uk, or australia); whether or not they had a primary social work interest in mental health (yes/no); level of the student (graduate or undergraduate); sex (choices given were male, female, and intersexed/transgender. due to cell sizes, these were collapsed into male and female); sexual orientation (choices were gay/lesbian, bisexual, heterosexual, neither heteroor homosexual, and unsure. due to cell sizes, these were dichotomized into heterosexual and sexual minority); race (seven options were offered, but they were collapsed into four categories: white, black, hispanic/latino(a), and other); religious affiliation (several choices were offered, but they were collapsed into not religious at all, spiritual only, and having a religious affiliation). the importance of religious/spiritual beliefs was asked with choices offered of very important, important, moderately important, of little importance, and wang, smith, locke/social distancing of depressive and panic disorders 485 unimportant, again measured on a five-point likert scale with a higher number indicating a higher level of importance. results a total of 1,042 students participated in this study. the majority of the participants in the sample (94.8%) were social work students or majors; however, all students were included because they were enrolled in a social work class and may not yet have declared their majors. undergraduates comprised most of the sample (63.3%, n = 653), with the average age reported as 27.44 years (sd = 9.04). respondents were mostly from the usa (80.1%, n = 835) followed by the uk (10.2%, n = 106) and australia (9.7%, n = 101). the sample was mostly female (86.4%, n = 894); race/ethnicity was mostly white (57.1%, n = 595), followed by black (22.5%, n = 234), other (11%, n = 110), and then hispanic/latino(a) (5.8%, n = 58). the respondents tended to be more liberal, with 53.9% of the sample identifying themselves as mostly or slightly liberal. finally, the sample was primarily heterosexual (89.1%, n = 928). most of the respondents (84.6%, n = 882) indicated that mental health was not their primary interest in practice, with 15.4% (n = 160) indicating that working in mental health was their intended area of practice. the majority (68.8%, n = 717) reported that they knew someone with a mental illness, and the average social distancing score for the overall sample was 22.57 (sd = 5.28). anxiety (50.6%, n = 527) and depression (49.3%, n = 514) vignettes were approximately evenly distributed (see table 1 for sample characteristics). a hierarchal linear regression was conducted to test which factors were associated with social distancing. the categorical variables were dummy coded to improve interpretation: level of student (1 = undergraduate, 0 = graduate), whether or not they knew someone with a mental illness (1 = yes, 0 = no), diagnosis (1 = anxiety, 0 = depression), sexual orientation (1 = heterosexual, 0 = sexual minority), sex (1 = female, 0 = male), race (1 = white, 0 = non-white), country (1 = united states, 0 = other), importance of religion (1 = yes, 0 = no), and whether or not they identified mental health as their intended area of practice (1 = no, 0 = yes). the three levels of the political affiliation and the religious affiliation variables were separated into three separate dummy variables (e.g., liberal = 1, 0 = other). there were sixteen variables inserted into the hierarchical regression model (model 1) that included variables that were theoretically linked to social distancing and each subsequent model only included variables that remained significant. table 2 represents the final three models. in the first model, the liberal and spiritual variables were removed, and the moderate, sexual orientation, religious importance, not religious or spiritual, and religious affiliation variables were not significant, and therefore removed. importance of religious beliefs, liberal political affiliation, sexual orientation, spiritual variable, not religious or spiritual variable, and religious affiliation variables were all not significant in the model. these variables were removed leaving age, knowing someone, diagnosis, political affiliation, white, country (united states), interest in mental health, gender, and level of student (undergraduate) in model 2 to be tested. advances in social work, fall 2014, 15(2) 486 table 1. characteristics of the sample variable m sd % na age (range 18–64) 27.44 9.04 1,023 sex male 13.1 135 female 86.8 894 race african american/black 23.5 234 hispanic 5.8 58 caucasian/white 59.7 595 other 11.0 110 political affiliation liberal moderate conservative diagnosis (anxiety/depression) anxiety know someone with mh issues yes mental health interest (yes/no) no country australia united states united kingdom 53.9 33.2 12.9 50.6 68.8 84.6 9.7 80.1 10.2 545 336 130 527 717 882 101 835 106 religious affiliation not religious or spiritual spiritual only religious affiliation 13.1 23.6 63.3 133 239 641 sexual orientation heterosexual sexual minority 89.1 10.9 928 114 undergraduate/graduate undergrad 63.3 653 stigma total 22.57 5.28 957 a sample sizes are different on each variable due to missing data advances in social work, fall 2014, 15(2) 487 table 2. summary of regression for the social distancing scale model 1 model 2 model 3 variables b se b β b se b β b se b β age .054 .021 .094* .051 .021 .088* .050 .021 .087* know someone -1.933 .380 -.171*** -1.925 .377 -.170*** -1.965 .376 -.174*** diagnosis: depression 2.215 .331 .218*** 2.296 .331 .225*** 2.302 .331 .225*** liberala moderate .517 .382 .047 -.478 .373 .201 conservative 1.147 .528 .077* 1.185 .512 .079* 1.011 .493 .067* white -.959 .396 -.087* -.945 .386 -.086* -.985 .385 -.089* united states 2.517 .507 .178*** 2.250 .487 .159*** 2.235 .487 .158*** non-mh interest .772 .483 .054* .995 .478 .070* 1.018 .477 .071* undergraduate -.897 .395 -.084* -.809 .393 -.076* -.784 .393 -.073* female 1.183 .510 .076* 1.017 .507 .065* 1.039 .507 .067* sexual orientation .101 .557 .006 religious importance -.014 .153 -.004 spirituala not religious or spiritual .936 .700 .056 affiliation .336 .411 .031 r2 .415 .406 .404 f change in r2 11.798*** 15.935*** 17.51*** notes: a removed from model; *p< .05, **p< .01, ***p< .001 wang, smith, locke/social distancing of depressive and panic disorders 488 in the second model, only the political affiliation of moderate was not significant so it was removed from the model. model 3 included the following significant variables: age, know, diagnosis, conservative, race, country, mental health interest, level of student, and sex. when tested, all variables were significant and no items were flagged for removal indicating that the final model was model 3, accounting for 16.3% of the variance. discussion overall, the participants reported more social distancing towards major depressive disorder than towards panic disorder. it is not entirely clear why student participants viewed anxiety more favorably than depression; therefore the interpretations are offered with caution. however, one possible explanation could be that anxiety and panic are more socially accepted than depression. a second possible explanation is that anxiety and panic are more consciously experienced than depression, in that people often recognize when they are anxious about day-to-day events. thus, this could result in a normalization of these emotions. a third explanation is that a depressive disorder may be perceived as more severe than a panic disorder. another potential explanation for the difference in attitudes between depression and panic disorder is the link between depression and excessive reassurance seeking (ers) behavior and resulting interpersonal rejection (evraire & dozois, 2011; starr & davila, 2008). in other words, individuals with depression may constantly seek reassurance from friends and family that that they are loved and cared about, which can unknowingly lead to “burning out” their support system. thus, it is possible that participants in the present study endorsed more favorable attitudes (i.e., less interpersonal rejection) toward the panic disorder vignette because they do not associate people with anxiety as constantly seeking reassurance as a person with depression might. the difference between depression and anxiety do suggest that further inquiry into differentiation of various conditions is critical in understanding how to address stigma and social distancing. for example, when studying severe and persistent mental illness, covarrubias and han (2011) found that depression was less stigmatized than bipolar disorder or schizophrenia, suggesting that depression may be more socially acceptable than the others. this comparison has been substantiated elsewhere (mann & himelein, 2004, cited in theriot & ladato, 2012). these disparities clearly exist between various conditions and have direct implications for social work practice, values, and ethics. deeper inquiry into these disparities will help to determine strategies and interventions at both the educational and workforce levels. the various causes of social distancing would determine approaches to amelioration. for example, educational efforts would differ if depression is seen as more stigmatizing based on fear of dangerousness rather than a result of burnout for excessive reassurance. additionally, continual introspection into managing one’s own personal biases may need to be encouraged and taught in order to not reduce detrimental effects to individuals with mental illness. comparisons have been made in the past between western and non-western countries, and it was found that certain cultures held less favorable attitudes towards mental illness, possibly based on notions of guilt and individual blame (angermeyer et wang, smith, locke/social distancing of depressive and panic disorders 489 al., 2011). our results found that the students from united states exhibited greater social distancing than the students from the uk and australia. given that all the countries in this current study were westernized, it is interesting that these differences were found. one factor may be that the us is less homogenized and more diversified than the uk or australia. additionally, cultural or policy influences may contribute to the perception or treatment of people with mental illness. as provision of mental health services may vary from country to country, social workers in other countries may play less of a role in direct assessment and treatment than they do in the united states. for example, in the uk services for less severe conditions are generally provided by a general medical practitioner. our study found differences between sexes, which is in congruence to previous the finding that women exhibited greater social distancing than males (chung, chen, & liu, 2001, cited in theriot & ladato, 2012), and contrary to finding that women were more tolerant and sympathetic to mental illness (hinkelman & granello, 2003, cited in theriot & ladato, 2012), and no differences between sexes (covarrubias & han, 2011). the contradiction in previous findings warrants closer attention to determine under which circumstances sex contributes to social distancing and stigma. one possible explanation for our findings is that the majority of our sample were female (86.8%), whereas the vignette presented featured “mike,” a male. a gender bias towards males with mental health issues may account for some of the findings. another possibility might be that male social work students are not representative of males in the general population (e.g., they might be more accepting of persons with smi). future research can seek to include either gender neutral vignettes, vignettes with both sexes, or vignettes with randomized sexes to make further distinctions. additionally, to the authors’ knowledge, this current study was one of the first to include sexual orientation, which was also found to be unrelated to levels of social distancing. the logic that sexual minorities are often stigmatized themselves and thus are less stigmatizing of mental illness was not supported in our findings. past research has suggested that examining a practitioner’s past professional and/or personal experiences with mental health services would be useful (charles, 2013). knowing someone with a mental illness as well as having an interest in mental health were both related to lower levels of stigma in our current study. these findings support that perspectives are not “fixed” (e.g., demographic variables such as age or gender) and solutions can be offered to correct stigmatizing attitudes. it may not be surprising that students interested in pursuing a career in the mental health field viewed mental health clients as more socially acceptable than those who do not desire a career path in mental health. in other words, in general, those students who possessed negative attitudes toward mental health clients would most likely not express an interest in wanting to work directly with such clients. exposure has been cited as a mechanism to increase interest, as in the study that showed that individuals who have more knowledge about and contact with people with schizophrenia had more positive attitudes (eack & newhill, 2008) and in another study that demonstrated the effectiveness of the use of contact to reduce stigma in the construction of anti-stigma interventions (corrigan, 2005). these findings show advances in social work, fall 2014, 15(2) 490 promise and opportunities for the profession to implement ways of reducing stigmatizing attitudes. graduate level students showed more social distancing than undergraduate students. a similar finding was that new social work students generally held more positive attitudes towards serious mental illness than did other students (theriot & ladato, 2012). although undergraduates have patterns of concerns that differ from those in the general population (feldman & crandall, 2007), the findings that undergraduate students and those who know someone with a mental illness displayed less social distancing support the idea that early exposure to intervention and education about mental illness could help to reduce negative stereotypes about mental illness (theriot & ladato, 2012). additionally, understanding the trajectory of career choices among students may shed light to how ideas and interests are formed. the findings of our study have other implications for practice and social work education. because the factors related to social distancing were largely related to nonfixed demographics such as being an undergraduate student, knowing someone with mental illness, and having an interest in mental health, anti-stigma education efforts may be helpful in correcting stigmatizing attitudes (covarrubias & han, 2011). for example, exposure to individuals with mental illness who exhibit a range of functioning may demonstrate that mental illness is not always debilitating. this may serve as a model for students’ subsequent contact with clients in the field. further, efforts earlier rather than later in social work education could help students formulate interest and understanding in working with individuals with mental illness. perhaps exposure even prior to field placement may be helpful. second, various attitudes towards different mental health conditions and different levels of severity of mental illness may also be useful in determining where and why certain biases exist. it has been noted that social workers may be disillusioned because of exposure to clients who are experiencing the most severe symptoms of mental illness during periods of decomposition (covarrubias & han, 2011). this idea may be comparable to death anxiety among geriatric social workers, as greene (1984) found that geriatric social workers had higher levels of death anxiety than non-geriatric social workers and greater number of years in the field was correlated with a higher level of death anxiety (although this leveled off after six or seven years). this supports the notion that working with individuals with mental illness may result in seeing severe and persistent behaviors as norms. this phenomenon is also called the “clinician’s illusion”, which is the belief that people with severe mental illness are always low functioning; cannot get along in society; and exhibit socially undesirable behaviors, like being violent (cohen & cohen, 1984, as cited by covarrubias & han, 2011). social workers may displace their own biases onto their clients causing harm that could be curbed through further education or training. addressing issues of counter-transference could also help to reduce stigmatizing attitudes (ahmedani, 2011). this may be critical prior to exposure in the field to clients with severe mental illness. social work pedagogy that addresses these deficiencies in exposure, diversity, and training should be evaluated. wang, smith, locke/social distancing of depressive and panic disorders 491 there are some limitations to our study that need to be highlighted. one limitation is that we were only able to simply describe social distancing given the cross-sectional nature of our study. we were not able to explain how or where perceptions of mental illness were formed, the impact of stigma in terms of a person’s behavior, or the treatment of clients with mental illness. how stigma and social distancing actually affect direct practice is an important research issue. a second limitation of our study is that although this is one of the few studies that includes a diverse sample in terms of urban/rural and different countries, the way the survey was administered still limits generalizability: we cannot be certain that a student did not complete the survey twice, or that students did not report in a way that was socially desirable. lastly, another limitation of our study is that it only compared major depressive disorder and panic disorder. other forms of severe and persistent mental illnesses were not assessed or compared. further research that explores the relationships between stigma or social distancing and various mental illnesses is warranted. replicating the current study with students or the general public would help to advance the stigma literature by potentially supporting this current study’s findings or identifying other explanations for the differences in attitudes based on disorder type. in sum, the findings that undergraduate students, those with an interest in mental health, and those who knew someone with a mental illness all showed less social distancing indicate a potential for opportunities to create meaningful experiences within social work practice and education. these factors that are associated with social distancing all suggest ways we can intervene to increase awareness and sensitivity towards individuals with mental illness. social workers play an extremely important role in treating and advocating for consumers with mental illness. one study found that social workers held the second lowest amount of stigma (behind psychiatric nurses/nursing students) among seven professional groups (kassam, papish, modfill, & patten, 2012). we further our mission of improving the lives of individuals who are vulnerable if we are able to ensure that social workers possess destigmatizing attitudes towards clients and can educate and advocate within the general population and policy arenas. references ahmedani, b. 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(2012). social work faculty interest in aging: impact of education, knowledge, comfort, and experience. gerontology and geriatrics education, 34, 257-271. advances in social work, fall 2014, 15(2) 494 author note address correspondence to: donna wang, ph.d., lmsw, associate professor, social work department, long island university, brooklyn campus, 1 university plaza, health sciences building 248, brooklyn, ny 11201. email: donna.wang@liu.edu microsoft word agbenyiga et al_expanding_our_community-service copyedit2 _________________  debrenna lafa agbényiga, ph.d., lmsw, is an assistant professor in the school of social work, stephanie j. nawyn, ph.d., is an assistant professor in the department of sociology, and salamatu barrie is a graduate student in the department of sociology, all at michigan state university. valentina djelaj is a graduate student at wayne state university in detroit, mi. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 306-324 expanding our community: independent and interdependent factors impacting refugees’ successful community resettlement debrenna lafa agbényiga salamatu barrie valentina djelaj stephanie j. nawyn abstract: evidence suggests that despite the aid from resettlement agencies, many refugees find the resettlement process extraordinarily stressful and have reported significant negative mental and physical health outcomes. the literature on refugee resettlement often focuses on the challenges that these individuals encounter in their new environment. however, less research has focused on community barriers and lack of support issues that can prevent refugees from resettling in the u.s. using qualitative data collected from burmese and burundian refugee groups, this article examines the impact of social structures on the resettlement process. results indicate that gaps in service delivery such as employment and housing are affected by support from the resettlement agencies and the refugees’ social support network. results of this study contribute to the knowledge based on how best to assist refugee families. keywords: refugee resettlement, refugee families, service provision, community, and socialization introduction according to the latest united nations high commission for refugees [unhcr], (2010) statistics, there are 43.3 million forcibly displaced people worldwide. of the millions who are displaced, 15.2 million people are classified as refugees. the unhcr (1951) defines refugees as: anyone who, owing to a well-founded fear of being persecuted for reasons of their race, religion, nationality, membership in a particular social group or political opinion outside of their country of nationality, and is unable to, or owing to such fear, is unwilling to avail themselves of the protection of their country (article 1a[2]). unlike other immigrants who have a choice about their future environments, many refugees have little knowledge of the location or the culture of their new host nations. most have been forced from their home countries, living in transitional housing, and are uncertain about their future before they resettle in a new country (singer & wilson, 2006). while residing in refugee camps, many are tortured, starved and beaten, exposed to a variety of infectious diseases, raped, and/or experience harassment before coming to their new environment (costa, 2006; weinstein, sarnoff, gladstone, & lipson 2000). when refugees arrive to their resettled communities, they often have significant physical agbényiga, barrie, djelaj, nawyn/refugees’ successful community resettlement 307 and mental health needs that must be acknowledged during the resettlement process. furthermore, they must also deal with the loss of extended family and kinship networks, which are imperative to successful resettlement. resettlement process in the u.s resettlement in the u.s. is an arduous process that can cause significant strain on the individual. according to the latest department of state statistics, the united states is the largest host nation for resettled refugees with an estimate of 3 million individuals in 2010 (u.s. department of state, 2010). as part of an agreement between the government and refugee agencies, upon arrival, refugees are met at the airport in the united states by resettlement agency personnel. at this point, refugees are provided with furnished apartments, appliances, climate-appropriate clothing and some foods typical of the refugee’s culture. shortly after arrival at their new environment, the agencies are required to assist the refugees with applying for a social security card, registering children for school, enrolling adults in english as a second language (esl) courses, arrange medical and psychiatric appointments (if applicable), and connect them with needed social or language services. the resettlement agencies also collaborate with the department of health and human services’ office of refugee resettlement to connect families with long-term cash, medical, and food assistance programs that provide support to refugees for six months (u.s. department of state, 2010). given the trauma that refugees are exposed to before their arrival in the u.s., it is imperative that they receive the appropriate resources and services from resettlement agencies. for families from non-western countries, issues such as new language acquisition, employment training, medical attention, education and access to community resources are a high priority (deacon & sullivan, 2009; lewig, arney, & salveron 2010; nawyn, gjokaj, agbényiga, & grace, 2012; willis & nkwocha, 2004). this article assessed the services that refugee families received from several resettlement agencies in a mid-western state during the resettlement period. primarily, we focused on the impact of support structures on the community of two different ethnic groups, burmese and burundians, and propose solutions that can increase refugees’ wellbeing and quality of life in their new community settings. furthermore, we delved into discussions of how support from agencies and social networks assist refugees to ensure their well-being. refugee support structures research suggests that interactions with family members, peers, friends, and professionals play an essential role during transitional periods (simich, beirser, stewart, & mwakarimba, 2005). more specifically, support from social networks can improve individuals’ wellbeing, provide assistance, and bring comfort during times of uncertainty (bosch & bergen, 2006; carlson, mcnutt, choi, & rose, 2002; oetzel, duran, jiang & lucero, 2007). these studies demonstrate that perceptions of support and/or actual supportive networks can mitigate harmful outcomes such as substance abuse, alcohol use, and mental health issues. the absence of social support have been linked to heightened advances in social work, summer 2012, 13(2) 308  levels of stress, anxiety, depression, suicide, as well as an increase in physical health problems (goodkind, gillum, bybee, & sullivan, 2003; oetzel et al., 2007). studies on immigrant populations indicate that during resettlement, informal sources of support such as friends and family reduce stress, improve well-being, increase access to employment, education, and other basic needs, and foster a strong sense of belonging amongst members of similar ethnic background (simich et al., 2005). in the context of refugees, very few studies exist that focus specifically on the importance of social networks and other support structures in refugee development. however, schweitzer and colleagues (2006) found that the presence of kinship networks and social support were better determinants of sudanese refugees’ mental health than the utilization of support from a wider community. they also found that refugee kinship ties with their extended family were important sources of both emotional and instrumental support (schweitzer, melville, steel, & lacherez, 2003). similar results were reported by simich and colleagues (2003) who found that informational, instrumental, and emotional support are ranked as high priority during resettlement. both these studies suggest that refugees were comfortable seeking aid from a member of their community than from resettlement agencies and other community organizations. furthermore, this study also suggested that the lack of meaningful supportive relationships from both formal sources, such as resettlement and community agencies, and informal sources, such as friends and family, decreases refugees’ wellbeing. for example, participants who were isolated from relatives and peers in their new environment often experienced depression symptomatology, often taking medication to cope with the challenges of resettlement. results also indicated that refugees who were able to find individuals and agency staff who empathized and shared their experiences were better able to cope with the stress that occurs during resettlement (simich, beiser, & mawani, 2003). another study by simich and colleagues (2005) highlighted the importance that service providers and policy makers who work with refugees place on the importance of good supportive networks during the resettlement process. results from focus groups with service providers and policy makers demonstrated that refugees with social support are better able to share their experiences and problems, reduce stress, and feel empowered. they are also more effective at building community supports to assist other newcomers from similar ethnic backgrounds facing comparable circumstances. service providers and policy makers also recognized the importance that different types of support have on refugees’ successful resettlement. for example, information support was seen as critical because refugees are better able to share and disseminate information about resources in the community. emotional support decreased isolation and loss of kinship ties, helping build connections with others in their new environment, particularly with those who may have also experienced similar issues. affirmation from other peers and family members allowed refugees to become empowered to meet new challenges. the results from the aforementioned studies illustrate the importance of supportive structures to assist refugees’ in their well-being and adjustment to new communities. given there is limited knowledge about newly resettled refugees from different ethnic agbényiga, barrie, djelaj, nawyn/refugees’ successful community resettlement 309 groups in the united states, this study adds to the research knowledge on experiences of refugees from diverse ethnic groups. resettlement history of burmese and burundians burmese and burundians were chosen for this study for three reasons. first, they represented the two largest newly resettled refugee groups currently residing in neighboring mid-west cities. research indicates that cultural barriers make it difficult to recruit study participants from refugee populations. thus, recruiting from populations that are highly represented in the area increases the likelihood of having a representative study sample. second, there is limited knowledge of the burmese and burundian’s adaptation patterns. finally, the emphasis on burmese and burundian refugees was due to the differences in migration histories between and within both groups. differences such as ethnicity, education level, and socio economic status (ses) are believed to be contributing factors that lead to different adaptation patterns in the resettlement process. the culmination of these three factors led to a larger study which investigated various resettlement factors from an individual, family, and group perspective as a means to understand and provide recommendations for agencies who work with these newly resettled populations. historically, refugee resettlement in the united states was typically linked to european and central asian countries. current estimates indicate that the u.s. has resettled over 900,000 refugees from former soviet union countries, and neighboring nations (u.s. department of state, 2010). however, given the political turmoil, economic instability, and religious persecutions that have impacted east asian and african countries, reports indicate that there are new waves of refugee populations that are entering the u.s. (adepoju, 2006; docquier, lohest, & marfouk, 2007). in particular, over 1.3 million refugees from vietnam, laos, cambodia, and burma (currently known as myanmar), and other neighboring asian countries are currently residing in the u.s. with recent reports estimating that the u.s. will grant an additional 18,500 ethnic minority burmese asylum in 2011 (u.s. department of state, 2010). burmese refugees were displaced from what is now called myanmar. under orders from the burmese government, the military perpetrated gross human rights violations such as forced labor, arbitrary execution, destruction of food crops and forced relocation of villages that belonged to ethnic minority groups such as the karen and chin (lang 2002; wright, 2008). many of the refugees fled to camps in thailand or malaysia where they lived as unauthorized immigrants until the united nations made them eligible for resettlement processes. while residing in refugee camps, the burmese faced discrimination, forced labor and relocation, poor wages, killing of family members and a lack of basic human rights protection from the thai or malaysian governments (draminsky-petersen, worm, zanderolsen, ussing, & harding, 2000). another study found that many burmese refugees in thai camps reported experiencing high levels of depression, anxiety and post-traumatic stress disorder (cardoz, talley, burton, & crawford, 2004). refugees from africa who have resettled in the u.s. have primarily been from somalia (nearly 95,000) or ethiopia (over 45,000) as reported by recent statistical data advances in social work, summer 2012, 13(2) 310  (u.s. department of state, 2011). since gaining its independence from belgium in 1962, burundi has been rifted with ethnic tensions, civil wars and coups d'état. ethnic tension, class warfare, and military coups between the bahutu and batutsi have led to destruction, death, and displacement. as is typical in most conflict situations, hundreds of thousands of people were killed; rape was used as a strategic weapon, and numerous violations of human rights were committed (hoofnagle & rothe, 2010). those who were not killed fled to neighboring rwanda, tanzania, and the democratic republic of congo (daley, 1991). it is estimated that more than 150,000 refugees fled from burundi in 1972 and another 400,000 in 1993 (haver, hatungimana, & tennant, 2009). similar to the burmese refugees, burundians from rwanda and tanzania encountered several challenges such as lack of food, little security, exposure to high stress, and constant harassment from government officials during their time in camps (international crisis group [icg], 1999; verwimp & van bavel, 2005). for example, whitaker (2002) found that many refugees living in western tanzania experienced a shortage of food, water and proper health care facilities. in fact, rising food prices for staples such as sugar, salt, and grain had resulted in further financial instability. many refugees were forced to work as cheap laborers for tanzanian farmers often taking food as payments rather than money. furthermore, whitaker (2002) found that the camps were associated with drunkenness, sexual promiscuity, increased incidence rates of hiv and stis, and illegal activities. while the literature on refugee resettlement is sparse, particularly with respect to specific groups’ adaptation processes, studies have highlighted the importance of support from peers and formal institutions in refugees’ successful resettlement. this pilot study examined the impact of newly formed interpersonal relationships on resource acquirement. our aims were to: (a) examine the impact of formal and resource support on refugee well-being; (b) study the extent to which informal support impacts successful resettlement and; (c) compare ethnic difference in support structures. given that both groups, burmese and burundians, have experienced years, in some cases, decades of instability, research must look beyond individual level challenges and focus on the impact of agency support and social networks on resettlement from a group perspective. method the data analyzed for this paper was part of a larger qualitative study that examined the adaptation and resettlement experiences of refugees from burma and burundi. from the overall sample (n=36), seventeen were female and nineteen were male. the mean age at the time of the interviews was 39 years old with a range between 19 and 58 years old. from the total sample, thirteen participants (5 women and 8 men) were burmese. all burmese women were married and three of the men were single. of the married couples, four had at least one child (µ= 1.75) and none of the single males had children. all of the burmese participants with children resided with all of their children in the same household. the mean age for the burmese was 29.8 with a range between 19 years old and 38 years old. most of the participants in the sample had been displaced from myanmar for less than three years and were either ethnic karen or chin. all of the burmese had at least a primary school education with an average of eight to nine years of agbényiga, barrie, djelaj, nawyn/refugees’ successful community resettlement 311 formal schooling. many of them had professional jobs or were students prior to fleeing burma or thailand. all of our participants spoke the chin dialect or burmese. twenty-three adult burundians (12 women and 11 men) were recruited for this study. of the total number of burundian participants, nine were couples with children, two were single parent families, one male had no children, and two did not mention children in their interviews. most had been farmers or small trades people with little or no formal education, and many were young (under 21 years of age) when they fled burundi. the mean age was 45.2 years old at the time of the interviews with a range between 33 and 58 years old. many of the families (95%) in the sample still had family members back in burundi or had children from other relationships (adults and small children) that were not currently residing with them. often, these parents were and continued to be financially supporting families (i.e. parents, siblings, and other children) in burundi, tanzania, or rwanda. overall, our participants from burundi had spent 30-35 years in exile before being resettled in the united states. all of the burundian participants spoke kirundi and very little english. since the focus of the study was to examine refugee resettlement, all participants (both burmese and burundians) had to have been in the u.s. for more than 120 and less than 180 days. this is because after six months, refugees are viewed as being independent and not in need of or eligible for guided services through the refugee resettlement agencies. recruitment and selection potential participants were recruited through two mid-western state resettlement agencies. the principal investigators (pis) of the study worked with agency staff to recruit burmese and burundian refugees. to be eligible, participants had to be 18 years or older and had been resettled in the area within the last 180 days. a list of potential participants was compiled by agency staff and sent to the pis. all identifying information was replaced with case numbers (not connected to their agency specified case number), so the investigators only saw demographic information such as country of origin, gender, and the number of people in their household. the pis targeted matched pairs (husband and wife) as potential participants for their study. this criterion was included in the sampling frame because the investigators were interested in examining the gender differences related to the resettlement process. by examining the experiences of couples, the pis hoped to capture the dynamics of family relationships. once a potential participant was selected, the agency staff contacted the individual and provided detailed information about the study. the prospective participant was told that the purpose of the study was to examine the services they received and to learn more about the support given within and outside the agency during their resettlement period. they were then asked if they would like to be part of the study, knowing that their participation was voluntary with no penalty if they chose not to take part. in addition to the description of the study, potential participants were also told of the benefits which included a $40 gift card as compensation and the opportunity to have their experiences heard. if the individual wanted to participate in the study, the agency staff asked their permission to share their contact information with the pis. this recruitment protocol was necessary because of the agency’s irb requirement. confidential information such as advances in social work, summer 2012, 13(2) 312  names and contact information could not be given without the permission of the individuals. in an effort to protect the rights of the participants, the pis were required to obtain irb approval from the agencies and the university. during the recruitment process, the pis worked with one person of contact at each agency. this was done to build and facilitate trust between the researchers, participants, and agencies. by using one person to contact participants, the pis hoped to ease the fears of participants about the research process and build a relationship between the agency and participants. data collection and analysis participants were interviewed individually in their homes by either upper-level undergraduate or graduate students, who had been trained to converse with these specific refugee populations and the translators. all interviewers received training on the interview protocol, background information about the cultures of the participants, and text transcription. furthermore, all interviewers had a strong research, academic, and community practice background. the students had taken courses in working with culturally, ethnically, and racially diverse populations. the interviews were conducted in the chin dialect or burmese (for the burmese) or kirundi (for the burundians). interviews were digitally audio recorded (time ranged from one to two hours) and then transcribed. at the beginning of each interview, the purpose of the research and the focus of the interview were explained. since literacy was an issue for some of the participants, verbal consent was required. the interviews were semi-structured in that they focused on a series of open-ended questions related to participants’ adaptation and resettlement experience. participants also responded to questions that were related to their lives prior to coming to the united states, the services they received from the resettlement agencies, outcome experiences, family interactions, cultural support (e.g., sources and types of support , recommendations related to service delivery and demographic information). there was no tension between the interviewer, translators, and interviewees. this was also true even in cross-gendered interviews. data collection spanned over seven months and also included focus group sessions as a part of the larger study. after the interviews were transcribed, they were entered into nvivo qualitative coding software (bazeley, 2008). three members of the research team were responsible for the data analysis. using qualitative content analysis, coders read the interviews to get a general sense of the content. next, a coding scheme based on the interview framework (e.g. needs, barriers, and support) was developed. for this study, meaningful themes were any statements that two or more participants mentioned related to the established coding scheme. coding for the first interview had low (33%) inter-rater reliability. this led coders to revise the coding schema and the inter-rater reliability for the same first interview changed to 88%. this process was repeated for the second and third interviews, with inter-rater agreement at 91% and 90% respectively. each coder coded the rest of the interviews separately. findings the purpose of this study was to examine the impact of interpersonal relationships in refugee resettlement; specifically, the impact of agency and social support that agbényiga, barrie, djelaj, nawyn/refugees’ successful community resettlement 313 individuals receive. the results of this study are presented in three parts. first, we discuss the impact of agency support; second, the types of resource support received and finally, network support on refugees’ well-being. furthermore, the unique experience of two ethnic groups, burmese and burundian, are also discussed. in order to protect participants’ identity, the researchers have used pseudo-names in the findings section. impact of agency support not surprisingly, refugees’ biggest and primary source of support came from resettlement agencies and staff members. as mentioned in the previous paragraphs, these agencies were the first to meet with refugees when they arrived and were responsible for providing adequate housing, employment, and healthcare services to families. in addition to providing and connecting refugees to resources, agency staff also provided emotional support and acceptance. ernest, a 50-year-old burundian male, echoed the voices of many refugees who looked to the agencies as part of their support system in their new environment: this place where the refugee resettlement agency settled me, and then accepted me and then accepted to help me. so i doesn't want to move to somewhere else that i doesn't know anybody, i doesn't know if i gets help when i move... the first part was love. the refugee service people in refugee service they showed what love towards me and towards my family. they provided food. they provided me the house to stay in and then this house we are living in. i can't even mention all kind of good stuff they give, they provided then to us… health assistance, okay. when i arrive here for the first few days they give us malaria medication. and then they took us to the hospital for screening and then for vaccine, different shots. now we are over the six months they will have to be by their own, we don't speak english, we don't know even how to make appointment, how to follow up the appointment, we will have a big problem if they can be by themselves, we will not going to be able to take care of ourselves to go especially for to the hospital, follow up the doctor appointment. i still, i may still need help for that [doctor’s appointment]. they provided the service but it's not yet time to tell us go by yourself because the english... we came here, we didn't know anybody, and we didn't know what, but now. the refugee [agency] was able to help us, to resettle us. ernest’s excerpt illustrated refugees’ dependence on their resettlement agencies. whether it was finding housing, connecting them to health care services, or providing courses to learn english, these agencies were the first to contact refugees during their resettlement. more importantly, agency staff represented a new type of family. for instance, in the case of ernest and his family, who have been displaced from family and friends for decades, staff members become part of their extended family. agency staff showed them love and acceptance following their arrival in a foreign country. in some instances, refugees often cited their caseworkers as their friends who visited them when they were ill. kwan, a burmese male, recalled his caseworker coming to visit him at midnight when both he and his roommate had food poisoning. thus, when the resettlement period is over and agencies deem refugees independent and not in need of advances in social work, summer 2012, 13(2) 314  extensive aid, refugees lose more than resources, they also lose a pivotal member of someone they now consider part of their family, and an important extension of support. donathe, ernest’s wife, recalled that after the agency stopped supporting them, she could not leave her house. she said, “i don’t know what to do, i don’t know [anyone]”. for individuals who have spent years (some decades) displaced, the loss of contact with agency staff adversely impact their wellbeing. the loss of agency support as a source for access to services and a supportive network was a prevalent theme in most interviews. the typical resettlement period spans six months. the participants interviewed for this study were nearing or were beyond the six-month mark for receiving support from the agencies. this loss impacted burmese and burundians differently. for the burmese participants, they were more likely in need of additional assistance with finding english classes or employment services. for instance, aung expressed concerns about the agency’s upcoming six month deadline. he said: and the other difficult thing for me is that job, finding a job… there are several burmese clients here now but only couple of people who have a job so the rest of them are here still [working with the agency] and then after 6 months our case will be ended then who will continue to help us. the agency may not be responsible for us when the case is over to find a job and things so job is so difficult. the burundian participants also struggled with learning a new language, and obtaining employment. however, their needs compounded with additional requirements such as food, appliances, and subsidized rent assistance, placing the burundians in a more vulnerable position. elizabeth and martin, a burundian couple, both mentioned that they have asked for extended help from the agency given that both were unemployed with six children living with them in the u.s. with a baby on the way, and a son to support in tanzania. elizabeth said: i'd tell them just to extend time or just to teach people like me a lot of time, not like six months not like something like that. or to help people like me who come here, like in this situation, to help me just to extend help that they give us. like those, that money that they give us to buy food or i need to buy soaps, everything cause six months [is] not really enough for somebody like me. the excerpt above illustrates the importance of resource support even after the sixmonth deadline. due to a sluggish economy and low employment opportunities, only 64% of sampled participants (burundians and burmese) were employed. most of them were employed either part-time or on a sporadic basis. knowing that the agencies would soon withdraw support and services or knowing they had already withdrawn support led the burmese to express disheartenment. one participant mentioned that due to his lack of employment opportunities, he may be perceived by others in his community as lazy despite his efforts to gain employment. furthermore, the emphasis that the asian culture places on the husband to be the provider for the family had led to some male participants to feel shame and discouraged because they could not provide the necessities for their families. agbényiga, barrie, djelaj, nawyn/refugees’ successful community resettlement 315 the feelings of inadequacy were also expressed by the burundian participants. their families were larger than the burmese, thus the loss of resource support was more detrimental. furthermore, many of the burundians financially support family members in africa with the aid they receive from the agencies. thus, the loss of agency support is also linked to their inability to provide assistance to other family members still living in refugee camps. impact of resource support in addition to losing agency support, issues related to language acquisition, employment, obtaining community resources and housing were common service gaps noted in most of the interviews. results indicated that some of these gaps were a result of lack of support that many refugees encountered during the resettlement period. the biggest concern for the burmese and the burundians was language acquisition as part of the agreement with the federal government stipulates that agencies are required to provide english courses to refugees. however, our data revealed that while all were enrolled in esl courses, the majority had stopped attending classes before the courses were over. the lack of support that both ethnic groups experienced played a role in their discontinuation of the courses. below are excerpts from two participants, one burmese and one burundian who expressed frustration related to the english courses in which they were enrolled. aung, a burmese participant said: um even though [the agency] has provided esl classes that have been good, but i wish they way they provided us [the classes] ,,,,for instance okay nobody can speak burmese language [in the classroom] then we’re not allowed to speak burmese language in the class than… all [of us are at ] different levels and then some of us don’t know anything, even one word that what they’re talking, what they’re talking [in the classroom]… then when they [other people in the class] explain to us what the teacher was saying in burmese then the teacher give us punishment again so then nothing is really beneficial so for [the] future. ornella, a burundian participant said: yes, they show me the class where i can took[take]english classes but the problem was the communication. i was in the class, but when the teacher talk about something i don’t know what is that [what is being taught]… from esl classes, there is no help for me. because even the teacher tried to teach me, i don’t understand anything. so, but, for sewing circle, it’s okay. because i had an interpreter in the sewing circle. but in the esl class no, there is no interpreter. many participants expressed concern about how the classes were taught and so they stopped attending the course even before their six month resettlement period ended. more importantly, the instructor’s insistence that the class only be taught in english indicated that they felt little support attending the classes. in the case of ornella, she stopped attending the english classes and instead found a sewing group in which she could communicate with other members of her ethnic group. the sewing groups, which were not created to teach english, however, were a source of social support for her. emmanuel, advances in social work, summer 2012, 13(2) 316  a 47 year-old burundian man, found the class and the instructor disrespectful because his unique needs were not being heard: they [the staff at the resettlement agency] don’t respect me. this [esl instruction] doesn’t match my culture. because they know that and we told them that we really need somebody who speaks our language to tell, but they didn’t look for somebody who, they didn’t even want to look for somebody who can [speak our language]. yeah and teach us. it’s doesn’t really, it’s not, they didn’t, it’s not respect for us or they didn’t listen to us, something like that. the lack of support that our participants received during these esl course led to feelings of frustration and disrespect. this, in turn, dissuaded them from attending the esl classes. speaking english is an integral part of acculturating in the u.s. it is linked to finding employment, increasing people’s social support and a host of other resources. it was not surprising that many of the participants from both ethnic groups stated that their lack of experience with the english language prevented them from becoming independent u.s. residents. housing was another concern also linked to the support that refugees received during the resettlement period. common issues related to housing included paying rent, living in dangerous neighborhoods, or not having any furniture in their homes. for instance, mintun and her family mentioned that they stopped receiving resource support from the refugee agencies three months after their arrival. due to the lack of assistance, they struggled to pay their rent and buy food. she said: oh, so no i didn’t get anything starting from after three months… i would be very happy if somebody ask me, you know “how can i help, something” because right now i want to get assistance to cover for the living stuff, i mean, the basic thing is the food stamp for the whole family because right now only my husband has a job and after they are paying renting fees all [the money] is gone. victor and his wife, kamariza, both mentioned that the house they stayed in had no furniture, microwave or other basic necessities such as soap, or adequate food. victor said: i think that we can follow the american culture, yeah um but um [in the] house you have chair [s], you have tables, but we don’t really they didn’t give us those chairs [or] tables. everything you see [here] they are even broken. i took them (pointing at chairs) from the outside, people they throw them away and then i took them and put them in the house. we didn’t get the support we supposed to get like we don’t have microwave, we don’t have toaster or something like that. kamariza echoed her husband’s words and further mentioned that the lack of furniture in their home impacted their family’s ability to associate with other burundians. the link between housing and social support highlights several challenges to refugees’ wellbeing. first, the agencies have placed families in housing they cannot afford. in min-tun’s case, she repeatedly asked for her agency’s support in either paying the rent or helping to find affordable housing. she mentioned that she would welcome agbényiga, barrie, djelaj, nawyn/refugees’ successful community resettlement 317 someone from the agency asking her if she needed help. the second challenge was the poor state of the apartments and lack of furniture in refugees’ homes. this problem was not limited to individual functioning, but also linked to social support and isolation. kamariza and her family do not socialize with other families due to their embarrassment over not having a place for guests to sit. this may not seem important from an american perspective. however, in some cultures around the globe, not being able to welcome guests into their home can be viewed as disrespectful and lead to individuals being ostracized within their own cultural groups. furthermore, victor, kamariza’s husband, links his lack of furnishings to being non-american. this is due to his assumption that real americans have furniture and his lack of furniture meant he did not see himself as part of the dominant group and culture. from his perspective, although he and his family have finally made it to the united states—a free and safe country, they have not found a home, community or identity that fits them. social support and supportive networks while needs across the two groups were parallel, as noted in the previous sections, we did notice a disparity in access to resources that was directly linked to refugee groups’ social ties. overall, we noticed that the burmese participants were better able to meet most of their basic needs, while the burundians were struggling to obtain basic resources such as adequate shelter, sufficient food, or proper medical care. this disparity may be rooted in the perceived preferential treatment that some refugees received over others. for instance, ninnette, a burundian woman, expressed her frustration with the agency that resettled her family: they give me no money they were giving others so they didn’t help me. i don’t trust them cause they didn’t help me like others. they didn’t treat me like others…. i was dreaming of speaking out to [the agency] to, yeah, cause to say, we came under same condition as other refugees. i go in their house i found they have money you [the agency] give that money to them you always give them money every week but you didn’t give that money to me. if i knew english i should come to court. ninnette, like many burundians, does not understand why her family’s rent is not subsidized, why she does not have workable appliances, or why she does not receive employment aid? even the burmese participants noticed the preferential treatment that they received over others. min-tun recalls meeting another refugee couple who were not receiving any assistance from their resettlement agency. like us they resettle some of our friends and um some relatives also in the city, but totally different from the way from us. so they [the other agencies] don’t care, it seems to me that they don’t care [about] their clients that much, they don’t visit them. because, my wife, a place where we attended esl together with the other couple [re] settled by the other agency, they told us that one day in the class, esl classes they didn’t have anything to eat, even rice. rice is staple food for asians and they didn’t even have rice to eat, nothing. they [the agency] just brought them to the apartment; they just left [them] there. no food, no telephone advances in social work, summer 2012, 13(2) 318  and nothing so they [the other couple] almost um they were starving… the[ir] black neighbors who are also immigrants probably [dealt with the same issue] and then they almost beg for food. these two excerpts illustrated the amount of support that refugees received differed by families, ethnic groups and within agencies in the same area. in the case of ninette, she expressed that she would like to take the agencies to court due to perceived unfair treatment. however, her limited grasp of english prevented her from seeking judicial action and equality in fair access to resources and supports. due to inequality in obtaining resources from the refugee agencies, participants were actively seeking help from their supportive networks. for the burmese, supportive networks are typically family and church members. min tun mentioned that due to the large burmese community in the area, she is able to attend school and plan for the future. for instance, she mentioned, “our plan, so far, is that my mother-in-law would take care of the kids when i go to school and once we can save money, we want to support [provide] some money to my mother-in-law”. furthermore, she expressed that due to the services she received from her agency, she is able to host other families at her home. this is a role that she enjoys because she is able to provide assistance to newly arrived families. providing support, either emotional or tangible, was a common theme within the burmese community. often the burmese utilized their support systems to provide childcare assistance, emotional support and requisite services. lwin mentioned that his neighbor, who was sponsored by another resettlement agency, relied on him to provide support: because the lady whom i just said who is living across the street, across hall, and she was sick because she's pregnant you know like couple months; she's sick and she called the case manager at [the other agency] and then they told her that um if she were dying [to call] and if she’s just like regular sick don't call us [the agency], but only if you're really, really emergency and really dying then call us. so that's what that lady told me again, [this is] the way [other agency] responded to her so that made me so upset. lwin and his family stepped in to aid the pregnant woman often taking her food and helping her get prenatal medical care. all of these services were supposed to be provided by the agencies. instead, the burmese community is coming together to help each other. the burmese, in addition to providing support to family and friends, also received support through religious institutions. although the burmese participants knew few people when they first arrived, their common religion and language allowed them to connect with other burmese families. through this networking opportunity they were able to receive clothing, food, furniture, and emotional support. for instance, both aung and his wife, suu-kyi, mentioned multiple opportunities that burmese have to engage in networking. aung said, "we, our burmese community, have worship services saturdays, every saturday night. we call [go to this church]… even among chin different dialects agbényiga, barrie, djelaj, nawyn/refugees’ successful community resettlement 319 and different opinions”. these churches were places that burmese families could connect with each other and share integral services and needs. in contrast, the burundians did not receive the same support from the community agencies as the burmese. to counter this lack of assistance, the burundians often relied on other people outside of their family unit to provide resources. previous excerpts illustrated that burundians got assistance from their neighbors to acquire material goods such as food and furniture. others got items they needed from the streets often picking necessities like furniture from other people’s garbage. one major source of support for many burundians was the interpreters used in this study. in one interview, the interpreter mentioned that as the only burundian living near participants, he sometimes brings the families food. he said, “i [the interpreter] give them food, i bought food for them when they were hungry and i give them clothes, shoes. i was advising them, i was telling them many things about life”. the interpreters were responsible for coordinating any social gathering between the central african refugees. these gatherings were often a collage of different african people. however, due to barriers such as transportation, language, and communication, the events were often cancelled or had low attendance. for instance, the interpreter mentioned: the reason why i say no [the reason why there were no cultural events is] i work with them [i coordinate the cultural events] most of the time… so, hmm, that event never happen, didn't happen… i don't know the date yet [for the next cultural event], but we're trying to do that but for now no. the reliance that many burundians have on the interpreters does present a challenge for the interpreter. in one interview, the interpreter expressed remorse that he had to cancel a scheduled appointment to help another burundian the day his wife went into labor. as illustrated above, help-seeking strategies differ by ethnic groups. our burmese participants had more sources for support than the burundians. this difference in supportive network is due to the proximity in which the agencies resettle ethnic groups. the burmese were more likely to be resettled close to each other; while the burundians were spread apart. given that many refugees do not have adequate transportation, often relying on buses for travel, the burundians had a harder time forming connections with other families from their ethnic group. furthermore, the burmese community had access to religious institutions, which tailored services to their ethnic group. as stated in previous excerpts, services were held in multiple languages and dialects for the burmese. this was not the case for the burundians; in fact, none of our participants mentioned attending church services held in their native language. several reasons could be attributed to the lack of community resources available to burundian families. the language barrier that many refugees encountered may have hindered burundians from learning about services available to them. while the burmese also encounter these language challenges, the fact that they were resettled (in large numbers) near each other may have caused better organization in the community to tailor some of their services to the group. advances in social work, summer 2012, 13(2) 320  limitations there are several caveats to the findings of this study. first, the interviews were collected with interpreters recruited from the resettlement agencies. as stated earlier in this research, interpreters were hired because of their connections and knowledge of their respective communities. although participants provided valuable information about their experiences with the agencies, they may have felt some pressure to frame their responses in a more positive light due to the relationship between the interpreters and the agencies. the researchers were aware of the precarious position that the participants were placed when hiring interpreters connected to the agencies. thus, the importance of confidentiality was emphasized at various phases of the study to both the interpreters and the participants. in addition to issues of confidentiality, concerns over recruitment may also be a limitation. recruitment of participants was done with the help of the resettlement agencies. thus, these results only reflect the perspectives of refugees who rely or have relied on resettlement agencies. there is anecdotal evidence from our interviews that suggests that not all refugees utilize the agencies’ services. however, due to our recruitment strategies, we were not able to capture such experiences in this study. finally, this study failed to capture the long-term relational impact of social support on both populations. future research should examine the long-term impact of these challenges on refugees and their families. discussion despite the limitations found in this study, the interviews do illuminate several important findings. first is the importance of “the agency” as a source of emotional and resource support during the resettlement period. as illustrated in the excerpts, agency staff represents a new family for refugees. back in their home countries, it would not be unheard of for families to depend on their kinship ties to help get valuable resources and emotional support during times of war and displacement. this practice is continued when refugees come to the u.s., and often the agency staff becomes family. as pivotal as the resources are to refugees, the emotional support that the agency provides is just as vital. the six-month deadline removes an integral part of their resettlement-the agency worker who is viewed as family member who is a central link to refugees creating a community may not be available anymore. during the first year of resettlement, many refugees do not know other families. the agency staff fills in this gap. thus, when that support is gone, the loss is doubly impactful in that families have lost a networking resource and a key person who is their connection to vital emotional support. the second important finding from our data is impact of agency support on individual functioning and extended family ties. individuals from non western families typically depend on familiar ties to help them cope during times of need. so, when families move to the u.s., they often support other relatives in their countries of origin. in our sample, the burundian families mentioned that they supported children, parents, siblings and in-laws back in tanzania using funds given to them by the agencies. when the agency is no longer financially supporting or providing rental subsidizes to families, many relatives in the country of origin are also negatively impacted. while it is not the agbényiga, barrie, djelaj, nawyn/refugees’ successful community resettlement 321 agency’s responsibility to provide aid to extended families, it is important to understand the cultural context that influences this behavior. both ethnic groups respect traditional values, which encourage them to put the community’s needs first ahead of their own. to delineate from this tradition means that the individual rejects their cultural heritage and is turning their back on other people who have assisted them in times of crisis. if it becomes known within the american refugee community that an individual is withholding or not giving support to relatives who are struggling to survive back in their home countries, that individual could be ostracized and cut off from his or her ethnic community. the third important finding from our interviews is the importance of community ties to refugees’ well-being. the excerpts above indicate that when agency support ends, individuals depend on other family members, friends, and churches to fill in the support gap. our burmese participants were resettled close to each other; thus, they were able to provide resources and emotional support to other families. furthermore, since they received adequate help, they were able to provide same to other newly resettled members of the community. this was not the case of the burundian participants who were resettled away from each other. due to distance, the burundian participants were not able to form community ties with each other. thus, they had more difficulties creating a home and a community with individuals of the same ethnic background. furthermore, the link of support observed in the burmese sample did not develop in the burundian community. taken together, these findings also highlight the need and importance of social workers in the resettlement process. first, social workers in their interactions with refugees know the unique challenges that each ethnic group encounters during and after the resettlement period. their firsthand knowledge could be used to inform policy related to successful resettlement for families. in our sample, social workers like the first author of this article could inform policy makers about the importance of developing a community in order to help families get resources and support from community organizations. furthermore, social workers also have the capacity to locate and work with key individuals in these marginalized groups who can be trained to become leaders for their respective communities. working with the leaders, social workers could help bridge the gaps in service delivery and foster new avenues in which refugees can get services from the community while staying connected to their ethnic groups. to conclude, community and mutual support are necessary aspects for well-being. in cases where individuals have undergone tremendous trauma, strain and upheaval, these ties become doubly important as it is now connected to resources and acculturation. refugees typically leave their home countries due to lack of resources and are in need of a safe community environment. coming to the u.s., the loss of these community ties and social support make it difficult for them to acclimate to the new culture and community environment. when resettling refugees in the u.s., agencies must take into account the importance of these factors. as suggested in the excerpts, having proximal support such as having family members or others from the same ethnic group nearby helps refugees cope with the stress of resettlement. thus, future resettlements must work toward building a community for these families. this can be accomplished by resettling members of similar ethnic groups in close proximity to each other, facilitating more networking within ethnic groups, and encouraging other community organizations to advances in social work, summer 2012, 13(2) 322  provide services that fit the cultural expectations of refugee groups while giving them an opportunity to sustain and create new anchors that will ultimately strengthen their community connections. in conclusion, social workers and other service providers need to better understand the diverse array of experiences that refugees face so they can better tailor service and supports that will fit the unique needs of different ethnic groups. references adepoju, a. 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(proquest dissertations & theses database). retrieved august 25 2011 from pro quest database. author note: address correspondence to: debrenna lafa agbényiga, phd, lmsw, assistant professor, michigan state university school of social work, 104 baker hall, east lansing, mi 48823-1118. email: agbenyi1@msu.edu microsoft word 1-3742_mello workers education and social change in brazil final ______________ william j. mello, ph.d., is an associate professor, indiana university school of social work, department of labor studies, iu northwest campus. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 1-12 workers, education, and social change in brazil william j. mello indeed the interests of the oppressors lie in changing the consciousness of the oppressed, not the situation which oppresses them, for the more the oppressed can be led to adapt to the situation the more easily they can be dominated. --paulo freire, pedagogy of the oppressed abstract: this article examines how brazilian labor organizations developed educational programs that simultaneously confronted the issues of large scale illiteracy, particularly among young workers, while at the same time seized the opportunity to educate new generations of social movement and labor activists. specifically, it explores the educational program projeto integrar, organized by the national confederation of metalworkers (cnm/cut), and its importance for the broader process of political transformation presently underway in brazil. keywords: social movements, unions, education, latin america over the past two decades, latin america and brazil in particular have undergone deep sociopolitical transformations driven by a process of substantial economic growth and the consolidation of democratic governance. while most of the globe has suffered a long term economic crises since 2008 (mello, 2008; queiro-tajalli, 2010); in brazil, the consequences of the crisis have been slight compared to the effects experienced in the united states and europe. for example, in brazil, large-scale employment and state redistributive measures have helped significantly reduce historic, large-scale poverty and income inequality over the past few years. the current success of many latin american countries is due in large part to the emergence and continuous re-election of left-led governments. in brazil, this process is illustrated by the emergence of the partido dos trabalhadores (pt) /workers party, first with the election of president luis inácio lula da silva for two terms starting in 2003, and currently under the presidency of dilma rouseff, the country’s first woman president. the popular support enjoyed by the workers party reflects the expansive influence of social and labor movements, such as the movimento dos trabahadores sem terra (mst) /landless peasant movement (sem terra magazine, 2007), as well as a myriad of labor unions and left-led political parties. over time, the convergence of social forces helped develop the conditions for deep-rooted social change. while many acknowledge the importance of strong social and labor movements in transforming contemporary latin america, one aspect of change rarely examined is the influence of educational programs organized by social movements and labor organizations. these programs seek to expand the political and social consciousness of workers and provide education for future generations of working class activists. mello/workers, education, and social change in brazil 2 in 1996, the confederação nacional de metalúrgicos (cnm/cut) / brazilian national confederation of metalworkers affiliated with the central workers council / central única dos trabalhadores (cut), initiated programa integrar (lopes, 2006), a radical educational program that proposed to advance working class political influence in society. integrar contested prevailing notions of how and why workers were educated in brazil. in a broad sense, the program was a response to elite ideological domination within the context of an increasingly privatized educational structure. at the same time, integrar sought to expand labor’s participation in deciding the future of education in brazilian society. integrar is a counter-hegemonic movement and therefore part of a larger struggle for the social and political consciousness of the brazilian working class. the union’s educational program helps increase labor’s role in deciding public policy issues. many of brazil’s social movements have developed educational programs that not only provide primary and secondary education, but, in the process, form future social activists whose work moves beyond the scope of the organized labor movement. the brazilian metalworker’s experience in education provides an important resource for understanding the role labor unions play in building vibrant and influential social movements in latin america. this article is a case study that draws on the authors’ multiple trips to brazil; observing adult education classes and visiting with program organizers, participants, and political and community activists. the research also explores literacy data from the ministry of education of the brazilian government and the central workers council, as well as pedagogical reviews of integrar by brazilian academics in the field of education. literacy and social change addressing large-scale illiteracy in brazil is a monumental undertaking. it is a pervasive social problem that reflects years of elite domination and a fragmented public educational system that fails to provide equal access to schools and universities. even taking into consideration the current government’s attention to the problem, brazilian authorities recognize the insidious existence of large-scale illiteracy. according to government study reports the illiteracy rate in 2003 was 11.6%, which is a 32% reduction, from the 1992 illiteracy rate of 17.2%. even so, the current rate represents an expressive sector of the population, approximately 14.6 million brazilians. moreover, illiteracy among the brazilian population is clearly delineated by region, class, race, and gender. for example, in 2003, the illiteracy rate in the northeastern region of the country was 3.4% higher than the industrialized region of the southeast (secretaria de educação continuada, alfabetização e diversidade (secad), ministério de educação programa brasil alfabetizado, 2005). current census results illustrate that coinciding with the country’s economic growth, brazil continues to experience a decline in illiteracy rates, particularly among youth and adults under 60 years of age. according to the 2010 general census, there was a significant decline in illiteracy among the population 15 years or older from 13.63% in 2000 to 9.6% in 2010 (instituto brasileiro de geografia e estatística, ibge, 2010). advances in social work, spring 2013, 14(1) 3 the primary focus of the educational program, integrar concerns the unemployed adult population and is a response to the country’s expansive illiteracy rates and the imposition of global neoliberalism on the economy. a recent government survey indicated that the illiteracy rate among the population between 50 and 64 years was almost 7 times greater than among young people (age 15-24), and that when race was considered, illiteracy was almost 2.5% greater among blacks than whites, indicating that two thirds of the illiterate population was black (secretaria de educação continuada, alfabetização e diversidade (secad), ministério de educação programa brasil alfabetizado, 2005). integrar was organized as a response to long periods of economic recession, high levels of unemployment, and historically elevated illiteracy rates among the working class population. these conditions placed severe constraints on the battle for union organization and working class political power. global neoliberal transformations of the brazilian economy set in place at the onset of the 1990s introduced rapid technological changes in the workplace, along with large-scale poverty. this process led to the marginalization of significant sectors of the working class from political and socioeconomic processes. marginalization, in this context, is understood as the social exclusion of considerable sectors of the working class and their subsequent alienation. in this process, workers are not only constrained politically; but as a result, the development of working class political consciousness is curtailed as well. marlene goldenstein (2002) argues that: “the flexible and precarious nature of work destroys social rights and does not create alternatives… there is a shift in how poverty is conceived from the public and political sphere to the non-political, where poverty is viewed as a fact to be resolved through purely technical measures or through private philanthropy” (p.18). for the metalworker’s union, the education and literacy of workers could not simply replicate existing norms and parameters that prepare workers for the global workplace; to do so would legitimize the process of marginalization. education and the program’s pedagogical methods were viewed as a singular process that raised the social and political consciousness of workers, while simultaneously preparing them to advance their demands in the sphere of politics. an important aspect of the program argued that the struggle against marginalization and the demand for social inclusion were integral aspects of a process essential for expanding working class power. in this sense, education was not viewed as charitable work for the underprivileged. for the metal workers union, education was the backdrop for the deep ideological conflict emerging in contemporary society between market and non-market views of socioeconomic development. freire argues, admitting the existence of men ‘outside of’ or ‘marginal to’ structural reality, we may legitimately ask: who is the author of this movement from the center of the structure to its margin? do so-called marginal men, among them the illiterates, make the decision to move out of the periphery of society? …alienated men, they cannot overcome their dependency by ‘incorporation’ into the very structure responsible for their dependency. there is no other road to humanization – theirs mello/workers, education, and social change in brazil 4 as well as everyone else’s – other than the authentic transformation of the dehumanizing structure. (1970, p. 48) in this context, marginalization was not just an economic casualty of global economic restructuring; it was the result of social and political alienation inherent to capitalist development. incorporating the victims of socioeconomic and political marginalization into the political process seemed critical because the logic of neoliberal globalization led disenfranchised sectors of the working-class to adopt the logic of capital. as a result, workers failed to recognize those responsible for large-scale poverty and subsequently placed the burden on those who were in fact its victims. in this process, workers internalized their long-term unemployment as a personal failure rather than viewing it as a systemic effect of elite domination. similarly, social inclusion was not simply the reintroduction of marginalized sectors of society into the very structure which led to their marginalization. the re-entry of workers into the productive process was an important moment in the political process where alternative socioeconomic models of organization expanded the power of those currently relegated to the fringes of the prevailing social structure. consequently, this process strengthened popular organizations, among which unions figured prominently. as a result, education and political activism developed concomitantly and interfaced in multiple spheres of social engagement. social change and working class education in order to better understand the comprehensive underpinnings of integrar, both politically and methodologically, it is important, even if only briefly, to revisit the basic pedagogical concepts developed by paulo freire (1970). in a broad sense, freire’s pedagogical concerns were a response to elite domination. he saw the transformative role of education as a process for building critical consciousness among politically disenfranchised sectors of the population. he drew extensively on the notion of education as a dialectical relationship where the interrelations between subjective and objective consciousness are central conditions for social change. for freire, education was a political-pedagogical process where individual and collective critical awareness were essential for social transformations, and where non-elites increasingly expanded their political power (scocuglia, 2003). critical consciousness, in this way, is not just knowledge, but more importantly, the way in which knowledge is achieved and the subsequent action it elicits. freire (1970) argues, to achieve critical consciousness of the facts, that it is necessary to be the “owner of one’s own labor,” that labor “constitutes part of the human person,” and that “a human being can neither be sold nor can he sell himself” is to go a step beyond the deception of palliative solutions. it is to engage in authentic transformation of reality in order, by humanizing that reality, to humanize men (p.185). an essential aspect of freire’s political-pedagogical project focused on the role of the learner and a classroom that acted as an extension of the broader socio-political process underway. in this process, learning is not devoid of what is occurring in society, rather it requires a deep understanding of the context in which both learner and educator live and advances in social work, spring 2013, 14(1) 5 work. he argued that education begins by initiating a dialogue between learners and educators where they talk to each other rather than at each other. as a result of this dialogue, social location, conflict, problems, and the life experiences of learners and educators are all important aspects to learning. dialogue becomes an intricate part of learning; it is a measure of critical consciousness. the process of social transformation occurs when learners increasingly gain greater understanding of their role in the world around them through the intersection of the subjective and objective conditions of their situation in society (freire, 1985). education is a continuous process of building consciousness that links knowledge to the broader struggle for political freedom. freire (1985) noted that, for man this process of orientation in the world can be understood neither as a purely subjective event, nor as an objective or mechanistic one, but only as an event in which subjectivity and objectivity are united. [sic] orientation in the world so understood, places the purposes of action at the level of critical perception of reality. (p.44) in his view, pedagogy takes on broad implications and stands as a political alternative that contests elite domination, socioeconomic hierarchies, and the perceived invincibility of global neo-liberal forces predominant in present-day society. with the mounting pressures of global neo-liberalism shaping all aspects of working class life, developing pedagogical approaches that contest growing economic inequality and corporate control of everyday life, and help expand the political power of social movements is an increasingly important task for organized labor. the development of class-based alternatives to the prevailing logic of capital helps workers break away from conformity and domesticity, and in the process, develop an alternative to the prevailing socioeconomic process. by the mid-1980s, rapid neo-liberal, socioeconomic, and political transformations in brazil, juxtaposed against the backdrop of historically high levels of income inequality and an enduring return to democracy, brought to the forefront the demands for working class power in very direct ways. building labor’s political power implied blocking the predatory process of global neo-liberal reforms that were redefining the basic structure of society. for the union, the education of the working-class in its multiple formats was a strategic issue present in the most crucial of labor’s political battles and vital for the future of the brazilian labor movement. education was a process through which workers expanded their role as citizens and activists, organized, mobilized, and subsequently strengthened their capacity to influence the political decision-making process. the program expanded organized labor’s constituency to broad sectors of the working-class (not just union members), developing class consciousness and the critical mass necessary to advance labors’ political and economic demands. mello/workers, education, and social change in brazil 6 integrar program educate for labor militancy the inception of integrar reflected a broader notion of class and labor militancy adopted by significant sectors of the labor movement in the struggle against the military dictatorship from 1964 to 1985. the program was conceived to widen the scale and scope of traditional labor education and apprenticeship programs that had been in place for some time, moving the targeted audience from the limited membership role of the unions to the notion of workers as a class within society. fernando lopes (2006), adjunct general secretary of the international federation of metalworkers explained: the experiences of the union movement are not new. in the seventies many training schools were open…these schools were aimed at training militants so that they could be better prepared to carry on organizational work in the plants. there was little public involvement in these activities and with the expansion of the workers movement these activities were relegated to a secondary level. whatever their ideological position, unions offered skill training to their members in the same way they offered barber shops and dental clinics. (p.1) in this sense integrar breaks with traditional models of union education and the structural-ideological constraints that limit working class organization. the program assumes a fundamental importance in a country where illiteracy and social exclusion are major constraints to socioeconomic development. the program rapidly grew both structurally and politically. four years after its inception, in 1996, integrar expanded from a primary education and literacy program to a comprehensive educational and training institute; training workers, union activists, social movements, cooperatives, and popular organizations. basic instruction was just one of the many activities developed by the metal workers confederation. the institute provided courses for organizing cooperatives, administration, economics, politics, and society; and linked the daily lives of workers to the larger struggle for socioeconomic justice and equality. integrar was financed through a combination of public funds provided by the ministry of education, and state and local governments. unions, in particular are eligible to receive federal funds from the ministry of labor through a program called fat (fundo de amparo ao trabalhadorworkers support fund), specifically developed to support labor’s educational activities. the pedagogy of class the organizers of integrar argue that the battle for class hegemony occurs in three essential spheres of society: on the shop floor, in the larger political organization of society, and in the struggle to shape public policy. in this way the program’s political objectives are the basis for the pedagogical organization of the project. integrar is comprised of three basic educational programs: integrar for employed workers (programa integrar para trabalhadores (as) empregados), integrar for unemployed advances in social work, spring 2013, 14(1) 7 workers (programa integrar para trabahadores (as) desempregados), and integrar for union leadership training (programa integrar formação de dirigentes). the course disciplines are not organized as distinct subjects examined individually; instead students complete modules that draw intermittently on the various disciplines. each of the programs has program-specific political-educational objectives that shape the curriculum content and practicum. for example, the objectives of integrar for employed workers focus on building workers’ knowledge of the production process, developing the collective action of workers, and expanding worker power at the point of production. the political-pedagogical objectives of integrar for unemployed workers focus on creating alternative forms of generating income, economic solidarity, and expanding the influence of the union among broad sectors of the unemployed, both young and old. finally, the pedagogical objectives of integrar for union leadership training, centers its attention on reinforcing working class organization on the shop floor, enhancing the political-ideological capacity of workers, and shaping public policy by strengthening labor’s strategic alliances with broader sectors of society (formação na ótica dos trabalhadores). according to the programs organizers approximately 300,000 workers have participated in one or more of the many courses organized by integrar. most of the courses are held in union halls, union vocational training schools, and community centers. the program’s primary education course is one year in duration, divided into segments of 25 hours per week, for 100 hours per month, for a total of 800 hours. the secondary education program is two years in duration, similarly with segments of 25 hours per week, for a total of 1600 hours. considering the extreme poverty faced by many of the programs’ participant-learners, everyone receives textbooks and other educational material at no charge, as well as daily bus passes to ensure their presence in the classroom. the concept of an integrated education is not just a method through which knowledge is delivered, but a process of enhancing a learner’s critical view of society. the curriculum draws on the major questions that define working class life such as unemployment, cost of living, political rights, and organization, as well as the workers’ particular life experiences. in this process, students are active participants in building a body of knowledge and not just passive recipients of information. learners quickly realize a clear and useful purpose to the study of math, science, economics, social studies, and history, and the relation between their education and their daily struggles. students are provided pedagogical materials such as textbooks that address the methodological and political concerns of the program, so that all modules have a defined yet continuous flow of content. some of the textbooks used in the modules are: the economy and social exclusion, transformations of the world of work and modern civilization, social relations and work in brazil, and work, race and inequality. pedagogy and structure the program’s basic activity provides primary, secondary, and professional education for workers, young and old, independent of union affiliation or employment status. a mello/workers, education, and social change in brazil 8 fundamental aspect of the program re-conceptualizes the curriculum content of primary and secondary education, restructuring the way in which workers learn. the core curriculum questions what knowledge is and how critical thinking is developed, reinforcing the correlation between learning and broader social, economic, and political transformations under way in brazil. the primary objective of the program is not simply the transference of information, but the development of a participatory citizenry. integrar provides the necessary wherewithal through which workers expand their power in society and reinforce the structures of participatory democracy, both locally and nationally. the basic principles of integrar are useful in understanding the program’s fundamental political objectives and mission: political objectives: 1. it is the obligation of the state to guarantee a free and quality public education. 2. public resources must be invested in activities that support working-class interests. 3. unemployment is the result of the current model of political-economic development and not an individual problem or a lack of qualification. mission: 1. coordinate the articulation between education and action to strengthen the notion of citizenship and the labor movement. 2. articulate the process of professional and basic education. 3. elevate the value of workers’ acquired knowledge. (maia, 1999) teaching social change the program’s organizers argue that education is a process of political literacy where both educator and student must remove themselves from their traditional roles, to free the process of education from its domesticating tendencies. freire points out: “education for domestication is an act of transferring ‘knowledge,’ whereas education for freedom is an act of knowledge and a process of transforming action that should be exercised on reality” (1970, p. 102). the fundamental objective of education is the transformation of people from the objects of history to the subjects of history. this radical transformative process does not exist in a world different from the one in which we live, nor is there a neutral approach to the object of study. the process of education does not occur devoid of societal influences and constraints, nor do students and educators exist in isolation from the prevailing socioeconomic structure (freire, 1985). action is an important aspect of the learning process; that is, real learning is demonstrated by the participant’s capacity to translate their intellectual understanding into concrete action. a particularly important aspect of the program’s methodological structure is that the communication and debate of ideas at the center of the learning process is not limited to speech and writing. knowledge can be ascertained through advances in social work, spring 2013, 14(1) 9 various mediums: art, music, dance and cinema; even physical education is considered a form of communication. for example, the instruction of communication skills is introduced in various disciplines and is not just the responsibility of the language instructor (mascellani, 1999). rather than delivering strictly delimited areas of knowledge, such as math, history, etc. like that in traditional schools, subjects are infused into pedagogical units where the learning process develops by integrating multiple areas of knowledge into a single module. learning occurs in phases developed concomitantly over the course of the modules’ presentation. by adopting this methodological practice, the program’s participants develop an understanding that there is a crossover of subject matter and that the acquisition of knowledge occurs in many forms and moments, using multiple mediums, and the results of which are measured in both intellectual and practical ways. evaluation as a component of learning another critical aspect of the program’s educational structure is the use of pedagogical evaluations as permanent aspects of the learning process. continuous evaluations are an important part of building a body of knowledge for both students and educators. evaluations allow all those involved in the process to continuously measure the effectiveness of the program, recognize problems, and make changes to modules already in progress. consequently, much like the program’s methodological structure, systemic and continuous evaluations are an intricate aspect of the learning process that allows educators and students alike to reach their defined goals. integrar’s evaluation process is based on the comparative examination of learning through the lens of the program’s objectives. it is a critical and self-critical process between students and educators measuring individual and collective participation in the program (mascellani, 1999). in the evaluation process students and educator critically examine course content and delivery as well as a self critical anaysis of the participants. in this process student success is measured by reaching the objectives set out in the initial class. individual intellectual developments, as well as general capacities of students collectively are the parameters used to determine success. labor’s politics and public policy the political resolutions approved at the metalworkers’ convention in the early 1990s argued that the fundamental conflict in brazilian society was the contradiction between two competing political projects: on one side, the political agenda of “capital and large corporations,” and in the opposite camp, working class political interests allied with smalland mid-sized entrepreneurs. integrar coordinator marco aurelio spall maia (1999) pointed out, […their analysis acknowledges] a dispute for the hegemony of society and as a result of this dispute the need for unions to expand working class political interests. to achieve these goals the union’s activity should focus on two major courses of action, both of which are distinct and complimentary components of the larger struggle to transform society. first, expand the unions’ effective mello/workers, education, and social change in brazil 10 involvement in the general political struggles of public policy issues, such as agrarian reform, employment, industrial policies, economic reform, social security, and education, healthcare, housing, professional training among others should be placed at the forefront of the unions concerns. it was within this logic that integrar began. (p. 31) the strategic objectives of integrar seek to reinforce the political interests of workers and reflect a broader transformation in the day-to-day work developed by unions. state and local metalworker’s unions have expanded their participation to address a broad array of political battles throughout the country. as a result of the unions support for popular social movements, the practice of mutual solidarity among different sectors of the working class has become increasingly visible. for example, in some regions, local metalworker’s unions help sustain popular movements such as peasant land occupations and community housing cooperatives. the daily activities of the unions are combined with shop floor activism, and struggles of other sectors of the working class are viewed as part of a larger process of building an alternative working class political project. on one hand, for the national confederation of metal workers (cnm/cut), education is a means of building the social consciousness necessary for organization and mobilization. all aspects of learning are an intricate part of an alternative political project that contests the neoliberal political alternatives being imposed on the working class. on the other hand, education, both for unions, as well as for workers in general, is a comprehensive part of labor’s struggle for greater political power. for the union, the defense of working class interests in defining the structure of public education is an immediate, as well as a long-term strategic goal. maia contended, both educational programs for unemployed workers and the unions’ leadership training programs are indicators that we have surpassed traditional notions of working-class education…education is a continuous process that draws simultaneously on basic knowledge as well as the day-to-day experience of the union as a process that helps define the unions strategic planning and political practices… [in contrast] to the asymmetrical practice of union education with no self-critical analysis, no continuity of content or evaluation of the process. (p. 41) in this way, the process of building working class political power is achieved by consolidating symmetrical relationships between education, union organization, and political action; they are all components of a singular process with multiple focal points. in spite of integrar’s expansive undertakings, motivating local and state unions and the unemployed to engage in the strategic educational program has not always been met with success. the daily pressures placed upon unions to respond to the advances of neoliberal political strategies, limited or declining resources and changes in the union leadership have all constrained the program’s ability to expand beyond the geo-political constituency of the union and its immediate allies. moreover, the expansion of the program, after implementation, often requires the re-election of favorable local and state governments. changes in public administration can lead to discontinued efforts, since many traditional political forces do not view the program’s objectives favorably. advances in social work, spring 2013, 14(1) 11 integrar, as an alternative for working-class education, is not viewed as a substitute to the public education system. the program is an alternative model to the current market driven neo-liberal educational model that is rapidly being introduced. it is a means through which organized labor can intervene in defining the public policy for education while simultaneously advancing broader class political interests. references freire, p. (2005, 1993,1970). pedagogy of the oppressed. new york, ny: continuum internacional publishers. freire, p. (1985). the politics of education, culture, power and liberation. westport, ct: bergin & garvey publishers. goldenstein, m. s. (2002). o instrutor do programa integrar desempregado. (unpublished masters thesis). universidade estadual de campinas/faculdade de educação, são paulo. instituto brasileiro de geografia e estatística (ibge) (2010). population census. retrieved from http://www.brasil.gov.br/ lopes, f. (2006). program “integrate:” a proposal for union intervention in questions of employment, development and education. retrieved from www.integrar.org.br/paginas/ver_textos.asp?49 maia, m. a. s. (ed.) (1999). trabalho, educação e cidadania: reflexões sobre programa integrar, rs. rio grande do sul, brazil: cut/integrar. mascellani, m.(1999). procedimentos metodológicos, ensino médio. rio grande do sul, brazil: cut/integrar. mascellani, m. (1999). sistema de avaliação, ensino médio. rio grande do sul, brazil: cut/integrar. mello, w. j. (2008). citizens and activists: civil society in democratic brazil. in r. dibie (ed.), civil society in a comparative perspective (pp. 45-63). washington, dc: lexington books. queiro-tajalli, i. (2010). in search of economic and social justice: the piquetero movement in argentina. in w. j. mello & t. iverson (eds.), trabalhadores, novas perspectivas e comparações. fortaleza, brasil: editora da universidade estadual do ceara. secretaria de educação continuada, alfabetização e diversidade (secad), ministério de educação programa brasil alfabetizado (2005). a evolução da alfabetizaçã de jovens e adultos e o programa brasil alfabetizado. republica federativa do brasil. programa integrar (1998). avaliação pedagógica. rio grande do sul, brazil: cut/integrar. mello/workers, education, and social change in brazil 12 batista, j., & da silva, g. f. (2007, january 24). the peqrspectives and actions of the mst for 2007. journal dos trabalhadores sem terra magazine, #269, january 2007. retrieved from www.mst.org.br/journal/269 scoculglia, a. c. (2003). a historia das ideas de paulo freire e a atual crise de paradigmas. joão pessoa, paraíba, brasil: editora universitária joão pessoa. author note: address correspondence to: william j. mello, ph.d., associate professor, indiana university school of social work, department of labor studies. iu northwest, 3400 broadway, lindenwood, gary, in 46408. email: wmello@iupui.edu microsoft word thomas_2600_copyedit final ______________  jacky t. thomas, phd, is an assistant professor of social work in the department of anthropology, sociology, and social work at eastern kentucky university in richmond, ky. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 561-585   does personal distress mediate the effect of mindfulness on professional quality of life? jacky t. thomas abstract: personal distress is an aspect of the empathy construct which has been negatively associated with a range of psychological and behavioral problems. however, it is unclear whether mindfulness serves to buffer these negative relationships. this study examines direct effects and mediation effects of personal distress and mindfulness among three measures of professional quality of life: compassion fatigue, burnout, and compassion satisfaction. this model was tested using a sample of clinical social workers (n = 171). results indicated that higher personal distress is significantly associated with higher compassion fatigue and burnout and lower compassion satisfaction, while mindfulness is significantly associated with lower compassion fatigue and burnout and higher compassion satisfaction. mediation analyses showed significant indirect effects on all three measures of professional quality of life, with effect sizes in the small to moderate range. the indirect effects of mindfulness via the personal distress path accounted for 1422% of the total effect of mindfulness on the three measures of professional quality of life. implications for the education and training of social workers are discussed. keywords: personal distress, mindfulness, empathy, compassion fatigue, burnout empathy and personal distress empathy social cognitive psychologist daniel batson, one of the most prominent and prolific researchers examining empathy, altruism and the determinants of the urge to help, wrote in 1987, “we psychologists are noted for using our terms loosely and with multiple definitions, but in our use of empathy we seem to have outdone ourselves” (batson, fultz, & schoenrade, 1987, p. 19). batson was referring to the divergent definitions of the term empathy, and the consequent difficulty in conducting, reporting, and comparing research. this difficulty with precise definition and labeling continues, and is not limited to the discipline of psychology (see discussion in batson et al., 1987; decety, 2011; eisenberg & eggum, 2009; gerdes, 2011). however, despite significant semantic differences, broad conceptual agreement exists regarding important ideas about empathy. these basic ideas which emerged from social and developmental psychology have been elegantly explicated, reinforced, and enriched by a wealth of sophisticated research emerging from social neuroscience and the neuroimaging techniques currently available. while it is not possible in this article to detail the full history of empathy research, or to adequately explain many of the important elements of the empathy construct (for excellent reviews see decety, 2011; decety & meyer, 2008; eisenberg & eggum, 2009; gerdes, 2011), two ideas are particularly relevant to the research study that will be thomas/does personal distress mediate the effect of mindfulness 562 reported in this article. the first idea is that empathy should be viewed as a multidimensional process involving both affective and cognitive components. as opposed to the typical lay understanding of the construct, empathy is not just a feeling, a state, or a product. the empathy process begins with an affective response born quite naturally from the biologically based/evolutionally adaptive tendency of one human being to respond to another (emotional resonance). when observing others’ behavior, mirror neurons (sensorimotor neurons which respond to behavior that is observed) trigger similar autonomic responses in the observer associated with bodily and facial expressions of the person observed (decety & lamm, 2009). some degree of affective resonance and emotional involvement is needed for the process of empathy to begin (eisenberg & eggum, 2009), but this initial affective component is then processed cognitively, using differentiated neural circuits and complex “computational processes” (decety & moriguchi, 2009, p. 35). the varied cognitive operations (which follow the initial affective response) optimally allow for a clear sense of self as separate from the person observed, flexible perspective taking, and regulation of emotional responses (decety, 2011; decety & meyer, 2008; decety & moriguchi, 2009; singer & lamm, 2009). the empathy process is not linear, but occurs in dynamic, iterative, reciprocal feedback loops; the outcome of these processes is variable (decety, 2011; singer & lamm, 2009). personal distress the second idea about which there is broad agreement is that the process of empathy does not always result in pro-social behavior. among people with certain clinical diagnoses (e.g., persons with autism, or persons with antisocial personality disorder) there may be impaired affective perception or processing, or the use of empathic processes to manipulate or take advantage of others (decety & moriguchi, 2009). however, even among the non-clinical population, the process of empathy does not always result in helping behavior. in fact, some people, upon observing another person who is suffering, experience care and concern for the suffering other, and a consequent urge to help. others experience personal distress, an aversive reaction to another’s pain that is self-focused rather than other-directed and is associated with anxiety, withdrawal, or avoidance rather than an urge to help the suffering person. unlike the response of care and concern (labeled as empathic concern in this paper), personal distress has been negatively related or unrelated to prosocial behavior (batson & shaw, 1991; davis, 1983; decety & lamm, 2006; eisenberg & eggum, 2009) . different researchers and theorists use a variety of names to describe the otherfocused concern and urge to help, including empathy (batson et al., 1987; gerdes & segal, 2011); empathic concern (davis, 1983; decety & lamm, 2009); or sympathy (eisenberg & eggum, 2009; eisenberg, wentzel, & harris, 1998). however, the term personal distress is fairly consistently used to describe the anxious, self-focused, aversive response experienced by some when witnessing others who are in pain or suffering. what determines empathic concern or personal distress? a variety of personal, social, and contextual/situational factors may influence the likelihood of an observer experiencing personal distress rather than empathic concern when witnessing the suffering of another. these include the degree to which the observer identifies with the advances in social work, fall 2012, 13(3) 563     suffering person, the meaning assigned to the suffering, the attribution of responsibility for the suffering, and so on (decety, 2011; decety & lamm, 2009). however, eisenberg and eggum (2009) suggest that the strongest predictor of personal distress is high affective arousal and weak emotional regulation. without adequate regulation of resonant emotional responses when witnessing another’s pain or suffering, observers are likely to become over-aroused and experience personal distress, with the consequent urge to turn away or escape the situation. people who do have effective strategies for modulating their vicarious experience of another’s distress may be able to stay empathically engaged without experiencing personal distress (decety & lamm, 2009; eisenberg & eggum, 2009). it is important to emphasize that though the automatic, bottom-up perception of affective states and behavior in others activates similar neural circuits in the observer, this unconscious empathic responding can be influenced by intentional cognitive activity. according to decety and lamm (2009), the ability of the observer to use top-down strategies to down-regulate emotional responses is especially important when observed distress is intense or the situation is extreme (pp. 206-207). for social workers and other helping professionals, learning effective skills for preventing and/or managing empathic over-arousal (and the consequent experience of personal distress) may be critical for sustaining effective and satisfying careers in highly stressful human service contexts (e.g., child protection). and for professional training programs, developing strategies for helping students develop and strengthen such skills should be an important goal. consequences of personal distress. empirical studies have shown relationships between personal distress and a host of social and psychological difficulties, including negative verbal and expressive parental behavior with children (valiente et al., 2004), increased risk of child maltreatment (de paul, perez-albeniz, guibert, asla, & ormaechea, 2008; perez-albeniz & de paul, 2003, 2004; wiehe, 2003), symptoms of psychopathology in children and adults (psychogiou, daley, thompson, & sonugabarke, 2008), deficits in effortful control and self-regulation (eisenberg et al., 1996; guthrie et al., 1997; valiente et al., 2004); delinquency and juvenile sex offending (lindsey, carlozzi, & eells, 2001); lower self-esteem (joireman, parrott, & hammersla, 2002) lower scores in care-based moral reasoning (skoe, 2010), more negative perception of students by teachers (barr, 2011), low emotional regulation and greater negative affect among elderly hospital volunteers (eisenberg & okum, 1996), and lower support among married couples (devoldre, davis, verhofstadt, & buysse, 2010). personal distress is associated with shame (joireman, 2004), self-rumination (joirman, 2004; jorieman, parrott, & hammersla, 2002) and neuroticism (mooradian, davis, & matzler, 2011). higher personal distress scores are found among persons with post-traumatic stress disorder relative to non-traumatized control group participants (nietlisbach, maercker, rossler, & haker, 2010) and to depressed patients relative to healthy controls (thoma et al., 2011). frequency of clinical errors and speed of recognizing errors in practicing professionals is significantly associated with personal distress (larson, fair, good, & baldwin, 2010; west et al., 2006). professionals higher in personal distress may have more difficulty relating well to clients (riggio & taylor, thomas/does personal distress mediate the effect of mindfulness 564 2000). finally, personal distress is associated with increased compassion fatigue and burnout, and lower compassion satisfaction (thomas, 2012, in review). these unhappy associations with personal distress are broad, and probably occur as a result of a combination of high emotional reactivity and deficits in cognitive skills such as flexibility of attention and perspective and capacities for self-regulation of affective responses. it makes sense that helping professional who experience higher personal distress might be more vulnerable to work-related stress reactions such as compassion fatigue and burnout. understanding factors which contribute to improved flexibility and emotional regulation capacities and reduced personal distress may have important implications for professional quality of life. professional quality of life work-related stress reactions such as compassion fatigue and burnout negatively influence quality of life for social workers and other helping professionals. clinical decision making and quality of care provided to clients and may be compromised when workers experience compassion fatigue and/or burnout (conrad & kellar-guenther, 2006; huggard, 2003; killian, 2008; radey & figley, 2007; valent, 2002). worker satisfaction and retention in helping professions are also negatively affected (bride, 2007; depanfilis, 2006; figley, 1995; yankeelov, barbee, sullivan, & antle 2009). cunningham (2004) and bell, kulkami, and dalton (2003) speak of the ethical responsibility of employers and educators to address these issues. figley (2002) and stamm (2009) have suggested that the term “compassion fatigue” be used to describe secondary stress reactions among helping professionals who work with traumatized and suffering populations, as it may be a less stigmatizing term than “secondary traumatic stress disorder.” burnout, another negative state often experienced by helping professionals, is generally related more to organizational or institutional factors and is “associated with feelings of hopelessness and difficulties in dealing with work or managing your job effectively” (stamm, 2005, p. 5). compassion satisfaction, also an important concept in understanding professional quality of life, refers to the positive feelings of meaning and fulfillment experienced by many practitioners when doing helping work effectively (stamm, 2005). risks and protective factors. reported rates of compassion fatigue/secondary traumatic stress among helping professionals have varied, with studies showing as many as half (and as few as 13%) of practitioners affected (bride, 2007; conrad & kellarguenther, 2006; sprang, clark, & whitt-woosley, 2007), while reported rates of burnout are somewhat higher. for example, among mental health workers who provided treatment to the victims of the oklahoma city bombing, over 41% were rated as being at high or extremely high risk for burnout (wee & myers, 2002). siebert (2006) examined a probability sample of 1000 national association of social work members, and found lifetime rates of burnout at 75%, and a current rate of 39%. risk and protective factors for compassion fatigue include level of exposure to traumatized clients, social support, supervisory support, and personal coping strategies such as a sense of humor (bride, 2004); and female gender, caseload percentage of ptsd advances in social work, fall 2012, 13(3) 565     clients, and rural location (sprang et al., 2007). regarding burnout, age is a significant predictor of risk; research regarding the effect of gender, however, showed mixed results (maslach, schaufeli, & leiter, 2001). though occupational variables traditionally assumed to be important (such as type of caseload and supervision) were significant predictors for burnout in siebert’s (2006) research, she contends that certain personal variables should be examined as well. these include feeling overly responsible for clients and having difficulty asking for help, which her study also showed to be significant predictors of burnout (siebert, 2006). sprang and colleagues (2007) found that specialized knowledge and training was associated with higher compassion satisfaction and lower compassion fatigue and burnout among practitioners. while empathy is commonly considered a primary path of vulnerability for the development of secondary stress disorders (decety & lamm, 2006; figley, 2002; rothschild, 2006), little empirical research has examined this relationship in light of the multi-dimensional nature of the empathy construct. what might protect? most of the studies examining work-stress related problems (secondary traumatic stress, compassion fatigue, and burnout) have examined demographic variables and organizational or institutional factors (such as caseload, training, and supervision, etc.). fewer studies have looked at intrapersonal factors like empathy or mindfulness which may influence the worker’s capacity to sustain an engaged therapeutic presence without falling victim to the negative effects of witnessing the suffering of others (thomas & otis, 2010). although epidemiological studies show high rates of professional distress, most helping professionals, even those who work in very high-stress settings, do not experience problematic levels of distress. it is likely that there are multiple factors influencing this differential response to stress, but an examination of the literature regarding resilience indicates that professional training programs should carefully consider their practices regarding clinical training in order to encourage positive coping. is it possible to develop habits or capacities in students and workers that may have a protective effect on their experience of work-related strain? are there ways to increase the odds that particular workers/students can remain empathically engaged with clients, but with increased resilience to the potential negative effects of witnessing their clients’ pain, and with reduced vulnerability to the patterns of emotional numbing and experiential avoidance that accompany secondary trauma responses? and, is it possible to increase the likelihood that practitioners experience the kinds of work satisfaction associated with longevity in the profession (yankeelov et al., 2009) and the concomitant accumulation of practice wisdom and experience that no technology can replace? mindfulness mindfulness has been defined as “focusing one’s attention in a nonjudgmental or accepting way on the experience occurring in the present moment” (baer, smith, & allen, 2004, p. 191). secular mindfulness training is increasingly used in clinical settings and is associated with successful intervention with various client populations and problems (see reviews in baer, 2003; brown, ryan & creswell, 2007; chambers, gullone, & allen, 2009; chiesa & serretti, 2009). an increasing number of empirically thomas/does personal distress mediate the effect of mindfulness 566 validated clinical approaches include training in mindfulness as a central part of the treatment protocol. these include dialectical behavior therapy (linehan, 1993), mindfulness-based stress reduction (kabat-zinn, 1990), mindfulness-based cognitive therapy (segal, williams, & teasdale, 2002), and acceptance and commitment therapy (hayes, strosahl, & wilson, 1999). not surprisingly, research has emerged which suggests that mindfulness practice offers various benefits to practicing helping professionals, including improved metacognitive abilities and reduced cognitive errors (epstein, siegel, & silberman, 2008; ludwig & kabot-zinn 2008); improved affect regulation and stress management (baer, 2007; brown & ryan, 2003, creswell, way, eisenberger, & liebeman, 2007); improved empathetic attunement with clients (shapiro, schwartz, & bonner, 1998); improved cognitive flexibility (moore & malinowski, 2009); facilitation of positive re-appraisal, in which events are viewed as less negative (garland, gaylord, & park, 2009); and reduced rumination (jain et al., 2007). most relevant to the research reported in this paper are several studies which have found decreases in aspects of burnout after mindfulness interventions with practicing physicians (krasner et al., 2009) healthcare workers (galantino, vaime, maguire, szapary, & farrar, 2005), and nurses and nursing assistants (mackenzie, poulin, & steidman-carlson, 2006). thomas and otis (2010) found mindfulness was associated with lower levels of compassion fatigue and burnout among clinical social workers, as well as higher levels of compassion satisfaction. the qualities (and benefits) associated with mindfulness may be relevant to social workers and other human service providers who are regularly exposed to the suffering of others, often in intense and repeated doses, and who are vulnerable to experiencing personal distress in the absence of sufficient emotional self-regulation strategies research question this study examined the relationship between personal distress, mindfulness, and professional quality of life, including compassion fatigue, burnout, and compassion satisfaction, and explored whether personal distress may function as a mediator for the relationship between mindfulness and professional quality of life. methods sample and procedures the study used data from a survey of 400 licensed clinical social workers (lcsws) in one midwestern state. the original survey was mailed to 400 lcsws randomly selected from the list of all (approximately 1600) lcsws obtained from the state board of social work. in addition, recruitment letters, consent forms, and postage-paid return envelopes were included. one hundred thirty-two usable surveys were returned with the original mailing, and a second mailing resulted in another 39, for a total of 171, a 42% response rate. all data were collected between march 8, 2008 and may 29, 2008. the study was approved by the author’s university affiliated institutional review board. advances in social work, fall 2012, 13(3) 567     the final sample consisted of 171 licensed clinical social workers ranging from 31 to 80 years of age (m = 50.34, sd = 10.85). eighty-one percent were female (n = 139), with an average of 21.26 years of social work experience (sd = 10.12, range = 5 53 years). almost 85% (n = 145) of the sample reported that they had worked the longest in mental health/substance abuse counseling, with 39.8% (n = 68) currently working fullor part-time in private practice, 24% (n = 41) in community mental health, and 23% (n = 40) in hospital/medical settings. approximately 43% (n = 71) indicated that they had experienced some type of trauma in adulthood, and 55% (n = 91) reported some childhood trauma history. measures this study included three established scales measuring professional quality of life (professional quality of life r-iv, stamm, 2005); aspects of empathy (interpersonal reactivity index, davis, 1983); and mindfulness (five facet mindfulness questionnaire, baer, smith, hopkins, krietemeyer, & toney, 2006). in addition, demographic information (age, gender, and years of social work practice experience) and two single item questions inquiring about child and adult trauma histories were included to be used as control variables. alpha values, means, and standard deviations from the current study for the three scales and/or their relevant subscales are included in table 1 below. it should be noted that both the professional quality of life scale (proqol) and the interpersonal reactivity index (iri) are composed of distinct subscales, and are not meant to be used cumulatively; consequently, subscale scores are reported and there is no total score for empathy or for professional quality of life. finally, since this study only used the total scale on the five facet mindfulness questionnaire (ffmq) and not the individual subscales, mindfulness subscale information is not included. table 1: study proqol iv-r, iri (empathy subscales), and ffmq (mindfulness) alphas, means, and standard deviations. scale no. of items range of scores alpha mean sd professional quality of life compassion fatigue 10 0–50 .86 11.67 7.10 burnout 10 0–50 .78 18.80 6.56 compassion satisfaction 10 0–50 .91 39.46 6.69 interpersonal reactivity index—empathy empathetic concern 7 0–28 .67 20.13 3.76 perspective taking 7 0–28 .75 19.39 3.86 fantasy 7 0–28 .77 12.87 5.20 personal distress five facet mindfulness questionnaire 7 39 0–28 39-195 .75 .93 7.44 144.80 4.30 18.35 thomas/does personal distress mediate the effect of mindfulness 568 professional quality of life: compassion fatigue, burnout, and compassion satisfaction. the professional quality of life scale (proqol iv-4) is a 30-item selfreport measure with three, distinct 10-item scales measuring compassion fatigue (cf), compassion satisfaction (cs), and burnout (b). stamm (2005) reported alpha coefficients for the compassion satisfaction, burnout, and compassion fatigue scales as, respectively, .87, .72, and .80. reliability coefficients in this study were .91 for compassion satisfaction, .78 for burnout, and .86 for compassion fatigue. musa and hamid (2008) found similar reliability statistics when using the measure with a sample of international aid workers. the proqol has been translated to multiple languages and used in various countries and populations, and is one of the measures used by the national child traumatic stress network (nctsn, 2011). response options for each of the thirty items range from 0 (never) to 5 (very often). compassion fatigue refers to symptoms (such as intrusive thoughts and images, avoidance of reminders of the stressor, and fearfulness) related to work-related, secondary exposure to very stressful events. items such as “as a result of my helping, i have intrusive, frightening thoughts” are used to measure the concept of compassion fatigue. burnout is defined as those symptoms related to difficulties in dealing with work or managing one’s job effectively, such as hopelessness, discouragement, and exhaustion. items such as “because of my work as a helper, i feel exhausted” are included in the burnout scale. finally, compassion satisfaction refers to the positive feelings experienced by many practitioners when doing helping work effectively (stamm, 2005). questions such as “i get satisfaction from being able to help people” and “i feel invigorated after working with those i help” (stamm, 2005) explore this sense of accomplishment and positive affect. possible scores for each of the three 10-item subscales range from 0-50. mindfulness. in this study, mindfulness was defined as “focusing one’s attention in a nonjudgmental or accepting way on the experience occurring in the present moment” (baer et al., 2004, p. 191). baer and colleagues (2006) reviewed the existing literature and completed a factorial analysis of a combined dataset consisting of all items from five existing mindfulness scales. this analysis differentiated five distinct factors of the mindfulness construct which the authors included in the 39-item five facet mindfulness questionnaire. these include observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience. baer and colleagues (2008) suggest that it is important that researchers be able to investigate particular facets of mindfulness in order to refine the understanding of how specific skills relate to psychological adjustment, but their analysis also supports using the total score to measure the combined, overarching construct of mindfulness. this total score was used in this study, with a possible range of 39-195. baer and colleagues (2006, 2008) report reasonable construct validity, with an alpha coefficient for the total scale of .93. the alpha coefficient for the total scale in this study was also .93. response options ran from 1 (never or very rarely true) to 5 (very often or always true). empathy subscales. davis’s interpersonal reactivity index (iri) used in this study defines empathy multi-dimensionally as both cognitive and affective reactions of one individual to the experiences of another (davis, 1983). the iri consists of four, distinct, seven-item scales measuring different components of dispositional empathy, including advances in social work, fall 2012, 13(3) 569     empathic concern (ec), perspective taking (pt), fantasy (f), and personal distress (pd). the scales are not intended to be used cumulatively (m. davis, personal communication, april 2, 2010). response options in the survey instrument range from 0 (does not describe me well) to 4 (does describe me well). the range of scores for each subscale is 0-28. davis (1983) conducted validation studies which showed subscale correlations in expected directions with measures of cognitive or affective empathy and with conceptually related measures of social and emotional functioning. internal consistency was acceptable for each of the four subscales. davis found cronbach’s alphas which ranged from .71 to .77; reliability statistics were somewhat higher in some other studies (cliffordson, 2002; pulos, elison, & lennon, 2004). in this study, alpha coefficients were .67 for empathic concern, .75 for perspective taking, .77 for fantasy, and .75 for personal distress. davis defined empathic concern as “other oriented feelings of sympathy and concern for unfortunate others” (davis, 1983, p. 114). this concept was explored with items such as “i am often quite touched by things that i see happen.” perspective taking, “the tendency to spontaneously adopt the psychological point of view of others” (p. 113) included items such as “i sometimes try to understand my friends better by imagining how things look from their perspective.” fantasy, “tendencies to transpose themselves imaginatively into the feelings and actions of fictitious characters in books, movies, and plays” (p. 114) consisted of statements such as “i day dream and fantasize with some regularity about things that might happen to me.” finally, the personal distress subscale, of primary interest in this study, measures, “self-oriented feelings of personal anxiety and unease in tense interpersonal settings” (p. 114) and included items such as “i sometimes feel helpless when i’m in the middle of a very emotional situation” and “i tend to lose control during emergencies.” control variables. age (in years), gender, years of practice experience, and selfreported history of trauma in childhood and in adulthood were all included as control variables in this study. the child and adult trauma variables were dummy coded (past history of trauma = 1). data analysis after examining zero-order correlations, simultaneous entry ordinary least squares (ols) regression was used to initially address the research questions and examine associations of control and predictor variables with each of the three outcome variables, compassion fatigue, burnout, and compassion satisfaction. mindfulness and the four empathy subscales were included in each model. each model was adjusted with the aforementioned control variables. following the examination of main effects, hierarchical regression analyses were completed for each of the dependent variables in order to further explicate the relationships between variables. additional regression analyses were used to explore indirect (mediation) effects, and sobel tests were used to test for the significance of mediation effects. data analysis was conducted using pasw statistics for windows, version 18.0. thomas/does personal distress mediate the effect of mindfulness 570 while mediation models are designed to be used to explain causal paths with experimental data, they are also commonly used with correlational data for the purposes of theory development (rucker, preacher, tormala, & petty, 2011), with the understanding that causality cannot be proved with correlational data. results simply suggest theoretically coherent and statistically viable paths which then should be tested with experimental designs. nonetheless, tests for mediation effects in correlational studies can offer important insight about relationships between variables, and provide direction for future research (rucker et al., 2011). consequently, the decision was made to use mediation analyses in this study in order to test whether the effect of mindfulness on the dependent variables (compassion fatigue, burnout, and compassion satisfaction) occurs partly through the effect that mindfulness has on personal distress. that is, does mindfulness influence personal distress in a way which then impacts professional quality of life? results bivariate correlations. zero-order correlations (table 2) showed moderate correlations between mindfulness with all three measures of professional quality of life (compassion fatigue, burnout, and compassion satisfaction) with correlations between .43 and .55 (all at p < .001). the personal distress subscale of the empathy construct was significantly correlated with all three dependent variables (pearson’s r ranging from .36.39). personal distress was correlated with mindfulness (-.47, p < .001). in addition, the perspective taking and fantasy (empathy) subscales showed weak but significant correlations with two of three dependent variables, and with mindfulness. age and work experience were weakly but significantly associated with both burnout and compassion satisfaction.   regression analyses. simultaneous-entry ols regression analyses were run by regressing each of the dependent variables (compassion fatigue, burnout, and compassion satisfaction) on the independent variables (mindfulness and the four empathy subscales) and the control variables (table 3). in the regressions for compassion fatigue and burnout, personal distress was the only empathy subscale with significant associations, with higher personal distress predicting higher compassion fatigue and burnout. in the regression for compassion satisfaction, higher personal distress predicted lower levels of compassion satisfaction, and higher empathic concern was associated with higher compassion satisfaction. the only control variable significantly associated with any of the dependent variables was female gender, which was associated with higher levels of burnout. higher mindfulness was moderately associated with lower compassion fatigue and burnout, and higher compassion satisfaction. when variables are entered into a regression equation sequentially, it is possible to see what each variable or set of variables adds to the predictive power of the model over and above what the previously entered variables have shown (tabachnick & fidell, 2001). therefore, in order to better understand the relationships between variables, hierarchical regression analyses (using the enter method) were run for each dependent variable (table 4). the control variables (child and adult trauma histories, age, female gender, and years work experience) were entered first, followed by the four empathy advances in social work, fall 2012, 13(3) 571     table 2: zero-order correlations for study variables   variable cf b cs m pt f ec pd a (cf) compassion fatigue -------- (b) burnout .646** ------- (cs) compassion satisfaction -.368** -.725** ------- (m) mindfulness -.429** -.551** .490** _____ (pt) perspective taking -.134 -.212* .290** .357* -------- (f) fantasy .211* .160* -.096 -.227* -.067 ------ (ec) empathic concern .125 .006 .146 .004 .346** .184* ----- (pd) personal distress .364** .392** -.392** -.471** -.379** .320** .005 ------ (a) age -.074 -.210* .196* .235* .087 -.044 .010 -.075 ------ (we) work experience -.031 -.191* .178* .182* .074 .015 -.031 -.107 .746** * p < .05; ** p < .001   thomas/does personal distress mediate the effect of mindfulness 572 table 3: regression analysis of factors associated with compassion fatigue, burnout, and compassion satisfaction compassion fatigue burnout compasssion satisfaction unstandardized b std. error β unstandardized b std. error β unstandardized b std. error β child trauma -.525 1.049 -.035 -.313 .969 -.024 -.109 1.034 -.008 adult trauma 2.202 1.149 .153 -.167 .975 -.013 1.645 1.041 .122 age -.042 .072 -.063 -.007 .061 -.011 .006 .065 .010 gender .503 1.414 .026 2.652 1.199 .154* -1.552 1.282 -.087 yrs experience .074 .077 .100 -.041 .066 -.060 .043 .071 .062 persp. taking .097 .159 .053 .088 .136 .053 .021 .145 .012 fantasy .036 .107 .026 .002 .090 .002 .032 .096 .025 emp. concern .235 .147 .113 -.029 .127 -.017 .282 .136 .160* pers. distress .306 .145 .185* .267 .123 .192* -.350 .132 -.226** mindfulness -.131 .034 -.334*** -.157 .029 -.447*** .133 .031 .365*** r 2 (adj. r 2 ) .265 (.214)*** .353 (.309)*** .308 (.261)***   advances in social work, fall 2012, 13(3) 573     table 4: hierarchical regression analyses showing associations with compassion fatigue, burnout, and compassion satisfaction models compassion fatigue burnout compassion satisfaction          model 1: controls ch. trauma -.051 -.055 -.036 -.022 -.052 -.024 -.043 .015 -.008 ad. trauma .244** .191* .153 .107 .038 -.013 .003 .081 .122 age -.128 -.123 -.063 -.120 -.099 -.011 .125 .082 .010 gender .043 .014 .026 .159 .138 .154* -.083 -.074 -.087 wk. exp. .080 .097 .100 -.070 -.064 -.060 .057 .065 .062 model 2: empathy perspective taking -.032 .053 .027 .002 .004 .025 fantasy .052 .026 .027 .002 .004 .025 empathic. concern .146 .125 .016 -.017 .133 .160* personal distress .301*** .185* .348*** .192* -.053*** -.226** model 3: mindfulness mindfulness -.334*** -.447*** .365*** r 2 .062 .192 .265 .082 .220 .353 .045 .220 .308 r 2 ∆ .062 .130*** .073*** .082* .138*** .132*** .045 .175*** .088*** total model f 5.332*** 8.067*** 6.624*** r 2 (adj. r 2 ) .265(.215) .353 (.309) .308 (.261)   thomas/does personal distress mediate the effect of mindfulness 574 subscales, and finally mindfulness. in each of the three hierarchical regressions, the addition of mindfulness to the equation resulted in a significant reduction in the strength of the relationship between personal distress and the dependent variables, suggesting a possible partial mediation effect. mediation. variables are thought to function as mediators when they “account for the relation between the predictor and the criterion variables…and speak to how and why such effects occur” (baron & kenny, 1986, p. 1176). the hierarchical regression analyses showed that the effect of personal distress on compassion fatigue, burnout, and compassion satisfaction was smaller when mindfulness was included in the equations, supporting the proposed theoretical path from higher mindfulness to lower personal distress to improvements in the three measures of professional quality of life. that is, the results of the hierarchical regressions suggested the possibility that some of the effect that mindfulness has on the dependent variables may occur through its influence on personal distress. there are four requirements for mediation to be established (baron & kenny, 1986; preacher & leonardelli, 2006): (1) the independent variable must be significantly related to the mediator; (2) the independent variable, without the mediator, must be significantly related to the dependent variable; (3) the mediator significantly affects the dependent variable; and (4) the influence of the independent variable on the dependent variable must be reduced when the mediator is added to the model (baron & kenny, 1986; preacher & leonardelli, 2006). a series of regression analyses were completed, indicating that all four of these requirements were met. figures 1, 2, and 3 below show standardized beta coefficients (β) for the relevant paths, and indicate the difference in the relationship between mindfulness and the three dependent variables with and without controlling for personal distress (direct effect, or c(dir) and total effect or c(tot)). figure 1: compassion fatigue: standardized beta coefficients   the coefficient above the line from mindfulness to compassion fatigue is for the total path without controlling for personal distress, while the coefficient below the line is for the direct path when personal distress is controlled. the total path minus the direct path equals the indirect path *p > .05; **p > .01; *** p > .001 mindfulness personal distress compassion fatigue path a -.471*** path c (dir) -.333*** path c (tot) -.429***  path b 201* advances in social work, fall 2012, 13(3) 575     figure 2: burnout: standardized beta coefficients   the coefficient above the line from mindfulness to burnout is for the total path without controlling for personal distress, while the coefficient below the line is for the direct path when personal distress is controlled. the total path minus the direct path equals the indirect path. *p > .05; **p > .01; *** p > .001 figure 3: compassion satisfaction: standardized beta coefficients      the coefficient above the line from mindfulness to compassion satisfaction is for the total path without controlling for personal distress, while the coefficient below the line is for the direct path when personal distress is controlled. the total path minus the direct path equals the indirect path. *p > .05; **p > .01; *** p > .001 mindfulness personal distress compassion satisfaction path a -.471*** path c (dir) .396*** path c (tot) .490*** path b -.200** mindfulness personal distress burnout path a -.471*** path c (dir) -.475*** path c (tot) -.551*** path b .163* thomas/does personal distress mediate the effect of mindfulness 576 an online sobel test calculator was then used to assess the significance of the mediation effect (preacher & leonardelli, 2006). the calculator uses the unstandardized regression coefficients for the association between the independent variable and the mediator, (a); the unstandardized coefficient for the association between the mediator and the dependent variable (b), controlling for the independent variable; and finally the standard error of both of these coefficients. the calculator performs three versions of mediation tests, the sobel, aroian, and goodman tests for significance of mediation. results of the three tests are similar, and in this study the sobel test statistics are reported as the sobel test generally is considered to be a very conservative measure of mediation (kenny, 2012). all of the sobel tests were significant, indicating that personal distress partially mediates the relationship between mindfulness and all three dependent variables (see table 5, below). in each of the three figures above, path a is the standardized regression coefficient (β) for the path between mindfulness and personal distress; and path b is the standardized regression coefficient (β) for the path between personal distress and the relevant outcome variable (compassion fatigue, burnout, or compassion fatigue) controlling for mindfulness. path c (tot) shows the total effect of mindfulness on the outcome variables, (without controlling for the mediation path), while path c (dir) shows the direct effect of mindfulness on the outcome variable with the indirect path partialed out. table 5: mediation of relationship of mindfulness with compassion fatigue, burnout, and compassion satisfaction by personal distress dependent variable mediator/ independent variable a se a b se b sobel (p) compassion fatigue mindfulness/ personal distress -.111 .016 ..328 .128 -2.404 (p < .05) burnout mindfulness/ personal distress -.111 .016 -.245 .110 -2.121 (p < .05) compassion satisfaction mindfulness/ personal distress -.111 .016 -.310 .116 2.494 (p < .05) a = unstandardized regression coefficient of iv & mediator; sea = standard error of a; b = unstandardized regression coefficient of mediator & dv, controlling for iv; seb = standard error of b; sobel (p) = sobel test statistic and p value kenny (2012) suggests two ways to measure mediation, the total indirect effect (the mediation path), and the proportion of total effect mediated. the total indirect effect is measured alternately as the difference between the total effect, c (tot), and the direct effect, c (dir), or as the product of paths a and b. the total indirect effect was .096 for compassion fatigue; .077 for burnout; and .094 for compassion satisfaction. while these are very small effects according to the usual cohen (1988) standards, kenny (2012) and preacher and kelley (2011) suggest that because this indirect effect is actually a product of two effects (path a x path b), cohen’s (1988) standards of .1 for small, .3 for medium and .5 advances in social work, fall 2012, 13(3) 577     for large effects should be squared, as they are in calculating effect sizes for r2, resulting in effect sizes of .01 for small effects, .09 for medium, and .25 for large. according to this measure, the effect sizes are in the small to medium range for the indirect effects. the second commonly used effect size measure in mediation analysis is the proportion of the total effect, c (tot) that is mediated (kenny, 2012; mackinnon, fairchild, & fritz, 2007). this measure is usually expressed as a ratio of indirect effect over total effect (indirect effect divided by the total effect). according to this formula, the percentage of the total effect of mindfulness on compassion fatigue explained by the mediating effect of personal distress is 22%, for burnout, 14%; and for compassion satisfaction, 19%. that is, about a fifth of the total beneficial effect mindfulness has on compassion fatigue, burnout, and compassion satisfaction is due to the positive influence mindfulness has on personal distress.   discussion in this study, higher levels of personal distress were associated with higher compassion fatigue and burnout, and lower compassion satisfaction, while higher mindfulness was associated with lower compassion fatigue and burnout, and higher compassion satisfaction. mindfulness had an inverse relationship with personal distress. the negative influence of personal distress on compassion fatigue, burnout, and compassion satisfaction was significantly lower when mindfulness was included in the model. these results suggest that mindfulness may be an important construct in understanding ways to mitigate the negative effects of the naturally-occurring experience of personal distress on professional quality of life among social workers and other helpers. a broad array of benefits seems to occur as a result of mindfulness practice. however, understanding the processes and mechanisms that result in these beneficial effects is important in order to focus research and target change strategies. mediation analysis allows us to explore these processes and mechanisms and move from “merely descriptive to more functional understanding of the relationships among variables” (preacher & hayes, 2004, p. 720). empathy has been called a “double-edged sword” because of the potential for harm to the empathizer from frequent or intense empathic encounters (decety, 2011; figley, 2002). results in this study, however, suggest that it is the aspect of empathy labeled as personal distress which may result in harmful effects for practitioners. successfully negotiating the complex, multi-dimensional process of empathy with the outcome of empathic concern rather than personal distress requires several things, including a capacity to remain differentiated from the person observed, flexibility of attention and perspective, and the ability to intentionally regulate emotional reactivity (decety & lamm, 2009). mindfulness may contribute to reduced personal distress and improved resilience and quality of life by influencing all of these processes. and, importantly, mindfulness is a skill which can be learned, with benefits that increase with practice (baer et al., 2006). thomas/does personal distress mediate the effect of mindfulness 578 social workers and other helping professionals are regularly in situations where they are witness to the suffering of others. their ability to stay empathically engaged is critical to effective practice, yet when the empathy process results in personal distress, practitioners are more likely to disengage or turn away (in one form or another) in order to protect themselves. the existing literature already makes a strong case for the potential benefits of mindfulness training for social workers and other helping professionals; this current study has specific implications regarding the potential for mindfulness to have a protective effect on professional quality of life for practitioners. it may be that mindfulness may assist practitioners to better manage their own reactivity to stressful work experiences and allow for increased intentional top-down management of bottom up emotional responses, resulting in lower personal distress and improved professional quality of life. although correlational data cannot prove causality, these results suggest a theoretically coherent path by which the beneficial effects of mindfulness on professional quality of life may be partially explained. however, alternate methods to examine causal paths such as structural equation modeling which would better handle measurement error, allow for a clearer examination of the proposed mediation model, and allow for comparison with other possible explanatory models should be considered in future studies. limitations this research has several limitations, including the limited sample and the 42% response rate on the original survey. it is also important to acknowledge as a limitation the lack of agreement among researchers regarding precise operational definitions of the constructs of empathy and mindfulness, and the sometimes inconsistent measurement of those constructs. researchers also disagree regarding the best methods for determining and reporting effect sizes in mediation models (hayes, 2009; mackinnon et al., 2007; preacher & kelley, 2011), and criticisms of both the total indirect effect method (deheuse, 2012) 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(2003). empathy and narcissism in a sample of child abuse perpetrators and a comparison sample of foster parents. child abuse & neglect, 27(5), 541-555. doi:10.1016/s0145-2134(03)00034-6 yankeelov, p. a., barbee, a. p., sullivan, d., & antle, p. f. (2009). individual and organizational factors in job retention in kentucky’s child welfare agency. children and youth services review, 31, 547-554. doi:10.1016/j.childyouth.2008.10.014 author note address correspondence to: jacky t. thomas, ph.d., department of anthropology, sociology, and social work, eastern kentucky university, 521 lancaster ave, richmond, ky 40475. email: jacky.thomas@eku.edu ____________ benjamin j. roth, phd, msw, is an assistant professor at the university of south carolina college of social work, columbia, sc 29208. seo yeon park, phd, is a researcher at hanyang university in south korea. breanne g. grace, phd, is an assistant professor at the university of south carolina college of social work. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 682-703, doi: 10.18060/21642 this work is licensed under a creative commons attribution 4.0 international license. advocating for structural change? exploring the advocacy activities of immigrant-serving organizations in an unwelcoming policy context benjamin roth seo yeon park breanne grace abstract: the growth of the immigrant population in the united states has prompted a recent increase in the number of restrictive immigration policies at the state and local levels. the literature on policy advocacy and social service organizations suggests that these local providers can engage in political activities that challenge the restrictive nature of these contexts. this qualitative study explored how immigrant-serving social service organizations engage in policy advocacy in a state with restrictive, anti-immigrant policies. in-depth interviews with directors of 50 service providers in south carolina clearly indicate a tension between the need for policy advocacy and the risks associated with engaging in such activities. fifty percent (50%) of the providers in our sample reported engaging in some form of policy advocacy. however, their policy advocacy activities were often indirect, non-confrontational, and episodic. most were engaged in coalitions and other forms of indirect advocacy tactics. we discuss implications for the social work profession and recommendations for future research, including the need to further explore the impact of policy advocacy efforts on changing the policy landscape in places that are unwelcoming to immigrants. keywords: immigrants; immigration; policy advocacy; social service organizations; immigrant new destinations the size of the immigrant population in the united states has grown dramatically in recent decades. for the first time in over a century, u.s. immigrants now represent 13.5% of the total population, including an unprecedented 11 million who are unauthorized (migration policy institute, 2018). these demographic changes have converged with shifts in immigrant settlement patterns such that immigrants are increasingly moving to “new destinations” such as small midwestern towns and the american southeast, injecting new diversity into places that have not been home to immigrant newcomers in recent memory (massey, 2008). however, the convergence of these factors has also prompted a flurry of restrictive immigration policies at the state and local levels (varsanyi, lewis, provine, & decker, 2012). in effect, while federal laws exclusively control the flow of legal immigrants into the united states, a patchwork of state and local policies regulating processes of immigrant integration have fundamentally altered the places where immigrants settle—i.e., the local receiving context. these laws include english-only ordinances, agreements between local law enforcement and federal immigration authorities that target unauthorized immigrants, and policies that restrict immigrant access to driver’s licenses and higher education. the assemblage of local anti-immigrant policies and practices form an influential https://creativecommons.org/licenses/by/4.0/ roth et al./advocating for structural change 683 aspect of the local receiving context, which shapes whether and to what extent immigrants adapt economically, socially, and culturally to their new home (portes & rumbaut, 2006). just as more “welcoming” contexts can facilitate processes of immigrant integration, places with restrictive anti-immigrant policies can pose an impediment. local immigrant-serving organizations can provide a buffer against unwelcoming policy environments, offering services and resources that help immigrants with the process of adjusting socially and economically (cordero-guzman, 2005). there is some evidence that local immigrantserving organizations may also engage in policy advocacy to challenge state and local antiimmigrant laws (de graauw, 2008), but these studies tend to focus on more traditional receiving contexts such as san francisco (de graauw, 2008, 2014) or washington, d.c. (frasure & jones-correa, 2010) where there is a relatively large concentration of such organizations (de leon, maronick, de vita, & boris, 2009). limited research has focused on the policy advocacy activities of immigrant-serving organizations in new destination areas that have adopted restrictive anti-immigrant policies. to address this gap, we explore how immigrant-serving organizations engage in policy advocacy activities in south carolina, a state with some of the harshest anti-immigrant laws in the country. in keeping with the literature on this topic, we define the term “social service providers” to include local entities that deliver an actual service or program (such as mental health treatment) and “immigrant-serving organizations” to be the subset of social service providers that report delivering services to immigrants (roth & allard, 2016; roth, gonzales, & lesniewski, 2015). by “local” we mean that the service delivery model is direct, not through the phone, internet, or mail. clients must travel to these organizations to access services (or the provider must travel to the community to meet with the client) (see allard, 2009). we use the terms “social service providers”, “immigrant-serving organizations” and “providers” interchangeably throughout this article given that all of the organizations referenced in this study identify as local organizations that deliver services to immigrants. we aim to address two primary questions: why do some immigrant-serving organizations engage in policy advocacy activities to advance the rights of immigrants in a harsh immigration policy context, while others do not? and, among those who are active in policy advocacy, what types of actions and strategies do they take? our framework draws on the literature of immigrant integration (alba & nee, 2003; portes & rumbaut, 2006) and social service providers as policy advocates (mellinger, 2014b; mosley, 2012). this article provides empirical insights into the field of immigrant-serving social service providers engaged in policy advocacy, as well as recommendations for how the field of social work can advance immigrant rights in a restrictive policy environment. background international migration and theories of integration international migration (or immigration) is the movement of people across nation-state borders (massey et al., 1994). the literature on immigration spans all aspects of the migratory process, including why immigrants leave, their experience through transit countries, and what happens when they arrive in the destination country (castles & miller, advances in social work, spring 2018, 18(3) 684 2009). the latter is often referred to as immigrant integration: the process by which immigrants adjust socially, economically, and politically to the places where they settle (marrow, 2005). contemporary sociological theories of immigrant integration emphasize that this process unfolds incrementally and at different rates, depending on a range of factors at various levels, whether individual, familial, or institutional (alba & nee, 2003; portes & zhou, 1993). importantly, contemporary theories of immigrant integration emphasize that this adaptive process is also impacted by the structural characteristics of the receiving context—the places where immigrants settle. factors such as racial discrimination, xenophobia, residential segregation, and the uneven quality of public schools all influence the opportunities for integration that are available to immigrants, and they will look different depending on the national context where they settle. thus, according to portes and rumbaut (2006), the social mechanisms that perpetuate exclusion for certain members of a given host society mean that some immigrant groups are able to more easily integrate into different social strata depending on characteristics such as phenotype and human capital, as well as the federal laws governing which immigrants are allowed to enter the country. for instance, the pace of integration and opportunities for social mobility are more constrained for labor migrants and undocumented immigrants than for those who arrive on work visas to fill professional jobs in the tech sector (portes & rumbaut, 2006). immigrant new destinations theories of immigrant integration have traditionally conceptualized the receiving context at the national level, because federal governments are typically responsible for enacting legislation that governs migratory flows (portes & rumbaut, 2006). however, with the emergence of immigrant new destinations, a rapidly growing literature has begun to examine how local and state authorities are passing laws that influence immigrant settlement patterns and the process of integration. in contrast to traditional immigrant gateways such as new york and los angeles, immigrant new destinations are places that have only recently become home to immigrant newcomers (massey, 2008; singer, 2013). immigrants have moved in growing numbers to suburbs, small towns, rural areas, and regions such as the midwest and southeast in search of employment and a lower cost of living (massey, 2008). the dispersion of immigrant settlement in the 1990s and early 2000s rapidly changed the demographic balance across the united states (massey, 2008), and their presence stirred a mixture of responses from established residents. at one extreme were state and local governments that enacted laws and policies meant to deter immigrants from settling permanently (mitnik & halpern-finnerty, 2010; varsanyi, 2008), a strategy referred to as “attrition through enforcement” (kobach, 2008). a combination of local government policies (de graauw, 2014; mitnik & halpernfinnerty, 2010; ramakrishnan & wong, 2010; varsanyi, 2008), anti-immigrant activism (varsanyi, 2011), and resistance by public bureaucrats (lewis, provine, varsanyi, & decker, 2013; marrow, 2009) has come to obstruct immigrant integration in new destinations with a restrictivist response to immigrants. as a result, immigrants in new destinations with harsh anti-immigrant laws experience higher levels of neighborhood segregation than in traditional gateways (hall, 2013; lichter, parisi, taquino, & grice, roth et al./advocating for structural change 685 2010), and face pronounced barriers to services such as healthcare, bilingual education, housing, and english-language classes (cabell, 2007; marrow, 2009). intermediary organizations as policy advocates while poverty and legal status create common obstacles to the social and economic inclusion and well-being of immigrants, immigrant-serving organizations can play a significant role in aiding immigrants’ lives as they provide immigrants with practical help, represent immigrants for political or cultural purposes, and advocate for them as needed (cordero-guzman, 2005). such organizations provide services related to educational, medical, religious, and other practical needs, but they can also be agents of political incorporation, as they work to shape political agendas and facilitate immigrants’ political participation (de graauw, 2008). therefore, understanding these local organizations and their impact is critical to how we conceptualize immigrant integration in unwelcoming policy environments, and by extension, how we understand the role of social service organizations in advocating for and protecting immigrant rights. there is general agreement among scholars about the importance of policy advocacy by “nonprofit organizations” (a broad term that is often used in this literature which includes local social service providers as we defined them) (berry, 2005; reid, 2000). yet, there appears to be less consensus on what policy advocacy actually is. reid (2000) states “there is no agreement on which activities constitute advocacy,” but “it broadly describes the influence of groups in shaping social and political outcomes in government and society” (p. 6). boris and mosher-williams (1998) argue that the definition of advocacy is often too narrow, restricted to rights-oriented groups, and limited to legislative advocacy. for example, many organizations assume that policy advocacy is limited to lobbying. lobbying is one type of policy advocacy, defined by the irs as direct or indirect appeals to governing bodies in order to influence specific legislation (mosley, 2013). however, the growing literature on this topic suggests that nonprofit organizations engage in a wider range of activities related to policy advocacy. although nonprofits cannot engage in certain lobbying activities, such as endorsing specific candidates, they are allowed to advocate for causes, programs, and populations and to lobby elected officials to adopt certain positions on particular policies or issues. while nonprofit organizations are able to hold forums, sponsor debates, host candidates at their offices, register voters, and engage in other nonpartisan activities, these organizations tend to find such rules vague (mosley, 2013). to avoid any unintentional violations, they tend to steer clear of political advocacy altogether (berry, 2005). the potential implications of this inaction are significant given that, in our current devolved welfare state, “these are the only organizations that have an incentive to organize, mobilize, and advocate on behalf” of marginalized groups (berry, 2005, p. 571). for the purposes of our study, mosley (2013) adopts a broader definition of policy advocacy among social service organizations as “advocacy that is directed at changing policies or regulations that affect practice or group well-being” (p. 231). this definition of policy advocacy is not necessarily confrontational. berry and arons (2003) contend that less aggressive tactics (through partnership with government, for example) are still an effective way to shape policies and programs. based on mosley’s (2013) definition, then, advances in social work, spring 2018, 18(3) 686 policy advocacy might be focused on getting additional funding to serve clients, or on the interests of clients themselves. policy advocacy may also take place within organizational collaborations, coalitions or associations, particularly for smaller organizations with fewer resources to participate in policy advocacy (see mellinger, 2014b). mosley (2013) identifies three trends in contemporary policy practice that are influencing the way social service providers engage in advocacy and help explain why a growing number are doing so. first, increased reliance on government funding means that these providers are more often interacting with political actors whose decisions impact the clients they serve (mosley, 2010, 2011). second, shrinking availability of government funding, especially state and local units, means that the local safety net must increasingly rely on social service providers for assistance and expertise (allard, 2009; mosley, 2013). third, the growth of public agencies working together with private stakeholders is associated with growth in the number of advisory boards, task forces, and other such partnerships (mosley, 2013). the goal of this type of collaborative governance is to improve transparency, efficiency, and government accountability, but a byproduct is that social service providers have more influence in the policy process. based on this broad definition of policy advocacy, many organizations engage in these types of activities. mosley (2010) found that 57% of social service organizations report some type of advocacy involvement, and qualitative interviews revealed that the majority (93%) were involved in policy advocacy in some way (mosley, 2013). similarly, mellinger (2014a) found that 65% engaged in advocacy. however, the service providers in these studies do not engage in policy advocacy very frequently (mellinger, 2014a; mosley, 2013)—a pattern corroborated across the literature (almog-bar & schmid, 2014)—despite its importance for the well-being of the clients they serve. while important scholarly work has advanced our understanding of policy advocacy and why social service providers engage in it (or not), these studies tend to focus narrowly on specific service domains (such as homelessness) in large cities (mosley, 2010), or more broadly across organizations in a given region with little consideration for the specific policy context that may be the focus of their advocacy efforts (mellinger, 2014a). we are unaware of research that has examined the policy advocacy activities of local immigrantserving organizations in restrictive policy contexts, how they interpret the particular local and national challenges they face, or how they integrate advocacy into their array of organizational activities. south carolina context south carolina is a new immigrant destination that has adopted restrictive, antiimmigrant policies in response to rapid growth of its immigrant population. the number of immigrants in south carolina doubled from 2000 – 2015. this was nearly three times the national rate during this period (39%), and five times the rate of the state’s native-born population (20%) (see table 1; migration policy institute, 2018). nearly one in five immigrants in south carolina (18%) has arrived since 2010; 61% are non-citizens, and an estimated 42% are unauthorized. immigrants in the state are more likely than their nativeborn neighbors to be poor, and 37% do not have health insurance. while the data for roth et al./advocating for structural change 687 unauthorized immigrants is not available, the disadvantages are even greater for immigrants who are non-citizens (marrow, 2013; yoshikawa & kalil, 2013). table 1. south carolina immigrant demographics, 2015 sc united states # % # % demographics immigrant (foreign born) 232,749 5% 43,290,372 14% non-citizen 140,748 61% 22,593,269 52% unauthorized 98,000 42% 11,009,000 25% immigrant % change 2000 2015 101% 39% native born % change 2000 2015 20% 11% region of birth africa 8,771 4% 2,062,257 5% asia 58,362 25% 13,249,179 31% latin america 118,663 51% 22,111,409 51% period of entry 2000 – 2009 81,288 35% 12,069,227 28% since 2010 42,100 18% 6,746,822 16% poverty rate foreign born 21% 17% foreign born non-citizen 28% 23% native born 17% 14% source: migration policy institute, 2018 in response to the rapid growth of the immigrant population and in the wake of federal inaction on comprehensive immigration reform, south carolina enacted the illegal immigration reform act in 2008 and senate bill 20 in 2011. the first law restricts undocumented immigrants from public benefits and bars them from public higher education (illegal immigration reform act, 2008). the second law is fashioned after arizona senate bill 1070, and includes a “papers please” provision which requires police to report individuals who do not have identification indicating they are in the country legally (national immigration law center, 2014). the law also includes a provision for a statewide immigration enforcement unit—the only one of its kind in the u.s. (largen, 2012). in 2014 a civil rights coalition successfully challenged senate bill 20, permanently blocking key provisions that criminalized interactions with unauthorized immigrants (national immigration law center, 2014). however, other aspects of the law were not overturned, and both laws remain. in sum, south carolina provides a useful empirical window into the policy advocacy activities of immigrant-serving social service providers because it has one of the fastest-growing immigrant populations in the country and some of the most hostile anti-immigrant policies of any state in the nation. data and methods data for this analysis comes from the immigrant access project (iap), a mixed methods study of social service providers conducted by the authors in 2015. the advances in social work, spring 2018, 18(3) 688 quantitative portion of the project was an on-line survey of immigrant-serving organizations across south carolina. we then conducted in-depth interviews with executive directors and program coordinators from a purposive sub-sample of 50 immigrant-serving organizations. this paper is based on analyses from the qualitative portion of the study. sample it can be difficult to identify immigrant-serving organizations (gleeson & bloemraad, 2012), in part because so few identify as such when reporting to the irs (hung, 2007). this is also the case in south carolina because there is no comprehensive database of immigrant-serving organizations in the state. therefore, we used a range of data sources to identify immigrant-serving organizations (allard & roth, 2010), which we defined functionally as direct service providers that serve immigrant clients (cordero-guzman, 2005; martin, 2012). this definition includes both ethnic and immigrant organizations (hung, 2007), as well as mainstream providers (roth & allard, 2016). sources for building our sample included irs 990 data that identified immigrant and ethnic organizations; regional and state resource guides that listed organizations that serve immigrants; and the referral database of a statewide immigrant-serving organization. this yielded a database of 599 service providers comprised primarily of nonprofits (both secular and faith-based), as well as a small number of public agencies (such as county food pantries) and for-profit entities. we then narrowed the sample to 319 entities by eliminating organizations that did not provide direct services in south carolina, or for which no current contact information was available. we emailed executive directors of these 319 entities with an invitation to participate in the on-line survey. in all, 183 providers responded, for a response rate of 57%. data for this study came from in-depth interviews with a purposive sample of 50 survey respondents which we selected based on organization type, size, and primary service focus (e.g., anti-poverty, education, legal services, etc.) to maximize variation (table 2). table 2. sample characteristics of organizations in qualitative phase (n=50) # % type of organization public 11 22% secular non-profit 31 62% faith based non-profit 6 12% for-profit 2 4% type of service provider health (health, mental health and substance abuse) 10 20% anti-poverty (housing, employment, cash assistance, food, general referral) 14 28% education (ged, afterschool, parenting classes, early childhood, esl) 16 32% legal services 4 8% child and family welfare (youth programs, domestic violence, etc.) 6 12% organization size small (fewer than 5 full-time employees) 20 40% medium (between 5 20 full-time employees) 19 38% large (more than 20 full-time employees) 11 22% roth et al./advocating for structural change 689 data collection and analysis we conducted in-depth interviews with executive directors, program administrators, and other leaders at these organizations. all interviews were conducted by phone. interviews ranged in length from 30–60 minutes and were audio-recorded and transcribed. interview questions addressed organizational history and mission; capacity (budget, revenues, and number of clients served); and details about general services. we also explored the nature and scope of their services for immigrants, and how these programs had evolved. finally, and most relevant to this analysis, we asked questions about their view of south carolina as a receiving context for new immigrants, their involvement with policy advocacy, and their involvement with coalitions that address immigrant rights concerns. all transcripts were coded by the authors and analyzed using nvivo11, a qualitative data analysis software. our codebook was informed by theories of immigrant integration (portes & rumbaut, 2006) and social service organizations as intermediaries (mosley, 2013). codes included “advocacy,” “barriers,” “mediating role,” “strategies,” and “organizational partnerships.” analysis focused on text where respondents discussed their view of south carolina as an immigrant-receiving context and policy advocacy broadly defined (mosley, 2013). this included respondents’ answers to questions such as “how would you describe south carolina and the welcome that it gives to immigrants?,” as well as several questions about advocacy, including “have you ever participated in organizational activities or conversations related to immigrant rights in south carolina?” and “do you think advocating for immigrant rights differs from advocacy for other issues or populations in south carolina?” these broad questions were followed by a series of probes that asked respondents to describe the nature of these activities, their motivation for participating in them (or not), and their perceptions of the effectiveness these efforts. looking across code domains we constructed a series of matrices to identify themes and patterns that guided subsequent analyses (miles & huberman, 1994). themes emerged using the constant comparative approach (glaser, 1965) which involved comparing data from different respondents to identify common indicators. we structured our findings section based on the themes that emerged from this analysis. themes include structural barriers to advocacy that are conditioned by the restrictive context of south carolina, as well as the strategies organizations take in response to these barriers, including indirect advocacy through coalitions and networks. all three authors were intimately involved with each stage of the data collection and analysis phases. the first two authors were primarily responsible for the coding process. this included weekly meetings to discuss the development of the theory-informed codebook and inconsistencies in how each author applied it to the data. regular meetings during all phases of the project addressed code book development, the coding process, and interpretation, ultimately enhancing the confirmability of the research findings (lietz & zayas, 2010). findings we have organized our findings based on the key themes that emerged from our data. advances in social work, spring 2018, 18(3) 690 in this section, therefore, we begin by providing insights into the context of south carolina from the perspective of the social service providers in our study. this provides an important backdrop for understanding whether they engage in advocacy activities. we then summarize the types of advocacy activities they identify, as well as the barriers they perceive to engaging in advocacy on behalf of immigrants. the final theme addresses their strategies for overcoming these barriers. south carolina: a context for immigrant advocacy there was general agreement among the providers in our study that south carolina is an unwelcoming receiving context for immigrants. some respondents said the receiving context is nuanced rather than monolithic, describing south carolina as a place that, while primarily unwelcoming, has—as one respondent stated—“pockets of welcome.” these providers tended to describe parts of their respective city as more receptive to discussing immigration and immigrant rights. however, the majority of our respondents were more sweepingly negative in their assessment. for example, the executive director of an antipoverty organization explained that the climate towards immigrants is “hostile” in south carolina so you need to “tread lightly” before even broaching the topic. because tension over the issue “involves everything from religion to politics,” he explains, “sometimes you feel like your hands are tied or your mouth is taped closed.” the director of a small health clinic stated that the unwelcoming nature of the state context means that “people don’t fight for immigrant rights as much as they do for other people’s rights.” respondents repeatedly emphasized that the biases against immigrants are pervasive. the executive director of a child welfare agency stated the predominant perspective in south carolina is that “all immigrants are from mexico [and] they think all immigrants are illegal…so it’s just the fact that we have so much to teach.” advocating for immigrants we asked respondents “have you ever participated in organizational activities or conversations related to immigrant rights?” we probed for more information, asking about the nature of their involvement and why they got involved, or why they have not gotten involved. we also asked whether they are involved with any coalitions that engage in advocacy for immigrants, followed by a similar series of probes. consistent with other studies of social service providers and policy advocacy activities (macindoe & whalen, 2013; mellinger, 2014b; mosley, 2012), 50% of the providers in our sample reported engaging in some form of policy advocacy (table 3). we organized these activities into “independent” and “coalition” based on whether organizations were engaged in policy advocacy on their own or in collaboration with other entities. some organizations reported both types of activities, but certain types of organizations were more likely to report involvement in at least one type. among faith-based providers, for example, 67% reported engaging in at least some type of policy advocacy, and anti-poverty and legal service providers were more likely than some other provider types to report involvement in policy advocacy. some organizations stated that they were involved in immigrant rights coalitions, while others stated their organization independently engaged in advocacy efforts to address immigrant rights. still other participants reported engaging in both roth et al./advocating for structural change 691 independent activities and coalition-based activities. table 3. types of immigrant-serving organizations and their advocacy activities n engaged in policy advocacy activities # % type of organization public 11 3 27% secular non-profit 31 18 58% faith based non-profit 6 4 67% for-profit 2 0 0% type of service provider health 10 5 50% anti-poverty 14 8 57% education 16 6 38% legal services 4 4 100% child and family welfare 6 2 33% organization size small 20 8 40% medium 19 12 63% large 11 5 45% total 50 25 50% *percentages represent the share of organizations of a given type that reported at least one type of advocacy activity (independent, coalition, or both). however, while half of the immigrant-serving providers in our sample reported engaging in some form of policy advocacy, many qualified the nature or extent of their involvement. therefore, in the sections that follow we explore first why more providers do not participate in policy advocacy. we then take up the case of those organizations in our sample that engage in advocacy to better understand the types of advocacy activities they engage in, and how they are able to avoid common barriers to advocacy. why some providers do not engage in policy advocacy if there is general agreement among the organizations in our sample that immigrant rights in south carolina are particularly vulnerable, why do half of the providers report that they do not engage in policy advocacy to address these structural concerns? the most common reason was a lack of resources. the executive director of a small child welfare organization said that she is aware of some current anti-immigrant legislation but has not stayed abreast of the larger question of policy advocacy and immigrant rights. she has “not had the time, [and has] chosen not to be stressed out by it,” even though she views that these policies are problematic. her view is that they “are written by people who have no idea” of the reality experienced by immigrants. another respondent stated more bluntly that her organization does not have the resources: “i really think that an agency like ours should be involved in advocacy, but you need support for that and you need time to do that and you need to dedicate a staff person to that.” she is the executive director of an advances in social work, spring 2018, 18(3) 692 organization that addresses the basic needs of immigrants and other clients, but has only three full-time staff members. consistent with other studies (mellinger, 2014a; mosley, 2010), larger providers in our sample were more likely to engage in some form of policy advocacy (see table 3), but the rationale for noninvolvement among these organizations was similar—even for involvement on local coalitions focused on immigrants and immigrant rights. according to the director of a literacy center, he refuses to join a coalition if he cannot be actively involved. contributing in this way would demand time that he currently does not have: “right now i work about 60 hours a week and, you know, just stepping into another group is hard.” several organizations stated that it would be politically risky for them to speak out about immigrant rights, inconsistent with their organizational mission, or potentially problematic for (some) members of their board. this was the case for the program manager for an organization that provides esl services for immigrants. she pointed out that immigration is “controversial” at the state and federal levels and “that’s why we’re not involved.” another executive director stated that some organizations in her city plan advocacy events, but, from her perspective, “there is some fear about doing that and how that is going to end up representing the organization.” engaging in policy advocacy can also be perceived as risky for the organization, especially if it is a departure from what has been done in the past or outside the scope of the organization’s mission. in south carolina’s relatively small cities and towns, an organization’s activities are noticed. advocating for immigrant rights has implications for how the community in general—and potential clients, in particular—view one’s organization and who it serves. the literacy center director introduced above stated, “it’s not a spoken rule here, but the previous director didn’t want us branching into [advocacy] because we had such a public relations problem about being viewed as a, you know, an immigrant-only resource.” another respondent avoids policy advocacy because immigration is controversial, particularly because much of the debate concerns legal status. taking a position on this issue can be problematic, she explains. by advocating for immigrant rights, she is concerned she might be “advocating for unlawful behavior” of unauthorized immigrants, with the implication that the community will view her and her organization as morally inconsistent. another respondent balked when asked if she is aware of state or local policies that affect immigrants in south carolina. she answered that she knows of these policies but “would rather not comment.” she is concerned that answering that question would affect the reputation of her organization as “neutral” and “impartial.” similarly, other reasons for noninvolvement in policy advocacy boil down to a calculation of risk rather than ignorance of need. for example, a school social worker stated “i’m working for a school district—i could get in trouble.” another respondent explained “as a state employee sometimes it's not—sometimes it can be very uncool to be politically active. and not necessarily dangerous for you as an individual, but dangerous for your institution.” a few respondents said that policy advocacy activities were outside of their role or their organization’s mission. a medium-sized health services organization had been involved with statewide coalitions in the past, but was too busy at the time of our interview roth et al./advocating for structural change 693 to be involved. the executive director sees the topic of immigration “as controversial right now with some of the dialogues going on at the state level and national level,” but his organization does not engage “in the justice stuff” because “we don’t really see that as our focus.” he explains that the controversy itself is not the reason why his organization chose not to engage in policy advocacy. rather, “we’re trying to focus on our mission.” until the board decides that this is an issue which falls within their organization’s purview, the organization will not pursue it. another director clarified that advocating for immigrant rights requires an understanding of “the legacy of the politics of oppression here [in south carolina], and the stereotypes and how people are pretty comfortable with the stereotypes.” miscalculating these politics can be risky for an organization. one program manager stated that she has not participated in organizational activities or conversations related to immigrant rights because her role is to “teach and manage the english as a second language program,” not engage in advocacy. like many respondents who are not involved with coalitions, she knows about a local coalition and her organization has a relationship with them but is not involved. in other instances of noninvolvement, however, respondents stated that they had not been “invited” to join, or had not even heard of any such coalitions. although these organizations serve immigrants, respondents were unaware of efforts in their area or across the state to coordinate services, build network connections, and address structural factors impeding immigrant access to support. these organizations may still be reluctant to join, for some of the same reasons described above. a manager of a local food pantry explained that their organization might be open to attending a future event aimed at helping the immigrant community, but not at the cost of prioritizing one client group over another. as an organization, they are “concerned with making sure everybody gets food,” not just immigrants. similar to the concerns articulated earlier about misrepresenting an organization’s mission, allocating time and resources to join a coalition focused on immigrant rights might signal that a provider is more invested in this demographic than other groups they serve. in sum, there are important stakes these organizations take into consideration when it comes to policy advocacy: capacity of an organization, political and organizational risks involved in political activities in the immigrant-restrictive context, and recognition of their roles in a limited manner. overcoming barriers to advocacy immigrant-serving organizations in south carolina that participate in policy advocacy also acknowledge that there are barriers to this form of work, but they tend to find ways around these obstacles, or identify the extra steps required to addressing them. the director of a legal advocacy organization explained that policy advocacy efforts in south carolina require challenging the perception that civil rights belong only to citizens: “when we’re advocating for the civil rights of the undocumented community we have to have that extra step of explaining that the reason that these are rights is that they’re human rights.” for others, explaining why they engage in advocacy is less about additional steps, and more a shift in tactics. for example, the lead case manager at one organization generally adopts a “positive perspective” to the possibility of changing the larger structures that impede immigrant integration. her perspective is guided by the belief that individuals who are advances in social work, spring 2018, 18(3) 694 opposed to immigrants and immigration may reconsider their views. however, she admits “i can’t just be positive all the time. there are times when we have to fight for our clients’ rights.” among the 50% of organizations in our sample that participate in policy advocacy activities, the majority take an indirect approach to influencing policy. if insider tactics aim to change policy through direct contact with policymakers, indirect tactics represent a category of policy advocacy activities that aim to raise awareness about a policy issue and to help shape a possible solution through means such as public education, writing letters to the editor, and joining advocacy coalitions (mosley, 2011). this indirect approach is not uncommon among organizations in other service sectors. for example, mosley (2011) finds in her study of homelessness service providers that 84% participated in coalitions for the purposes of influencing public policy, and 58% provided public education on policy issues. coalitions and public education were most common forms of policy advocacy among immigrant-serving providers in our study. the organizations who have been engaged with advocacy state that they have reaped numerous benefits from these partnerships, including information sharing, knowledge building, efficient labor division, organizational growth, and bringing about more structural changes. for example, a nonprofit organization that primarily serves children and families reported working closely with the local police department to raise awareness about immigrant rights. they also organize outreach events and information sessions to improve community relations with immigrants, started a local group aimed at promoting higher education among immigrant youth, and held a week-long conference on the topic. coalitions can provide networking opportunities that facilitate other forms of indirect advocacy. this can be particularly useful for small organizations that lack the resources to engage in advocacy, or providers that may perceive policy advocacy as risky, outside their organization’s mission, or both. among these organizations are those that were able to engage in advocacy because they partnered with other coalition members that were more outspoken about immigrant rights. one organization that provides educational services explained this indirect approach offers some “cover” given that advocacy is not strictly part of her organization’s mission: it's tricky because our organization—we're not an advocacy organization, so those conversations [about policy advocacy] don't really take place here. but i have definitely had those kinds of conversations with other organizations and other community partners. it's interesting the way that [my organization] is moving. we can't directly advocate, but one thing that i'm very excited about that we're doing is in conjunction with [another local provider]. we’re hosting a community forum…that is geared towards business leaders…[to] educate those business leaders about the economic contributions of a latino community—which is not advocacy, per se, but at least it is a kind of awareness-building for people who may not be very knowledgeable about the [immigrant] community. as this project coordinator notes, she did not view her collaborative efforts to raise awareness about the immigrant community as “advocacy” per se. however, her more roth et al./advocating for structural change 695 narrow definition of advocacy also allows her to justify that this indirect tactic is still within (or at least not in contradiction with) her organization’s mission. similarly, many of the respondents that reported participating in indirect forms of advocacy explained that more direct forms of advocacy were out of reach, or did not view their coalition work as advocacy. for example, a medium-sized provider that works with children and families participates in a local provider networking meeting aimed at serving latino immigrants. however, the organization is wary of more direct forms of policy advocacy, or of even describing their coalition work as a form of policy advocacy at all. the executive director explained that they have to “answer to a board” and advocating more publicly for immigrant rights would be politically contentious. doing so would “probably hurt my organization from a private funding perspective…and then, ultimately, that would hurt the families that i’m trying to serve.” as a result, their organization does not “take a stance on immigrant rights.” indeed, this rationale is an echo of why the noninvolved organizations (described above) do not engage in advocacy at all. to overcome this barrier to joining coalitions focused on immigrant services and immigrant rights, some respondents who joined coalitions sometimes did so personally rather than as representatives of their organization. the executive director of a mediumsized nonprofit was hesitant to engage in advocacy because his organization is affiliated with the county. this fact, combined with the problem that there were no existing coalitions in his county that addressed the policy advocacy concerns of immigrants, prompted him to personally start his own coalition. he was careful to explain that this effort was unrelated to his capacity as executive director: “actually, i shouldn’t mention the [name of his organization]—it’s just something that i’m doing on my own as a private citizen.” his strategy is to work with the latino community rather than other organizational partnerships: i have a 9 to 5 job like everyone else. i’m passionate about the [immigrant] community, but things change. people go, positions change, organizations come and go. but if we could ignite that passion for advocacy in our clientele…i think we are leaving the community better off. he views this grassroots approach to coalition-building as a way to give immigrants “voice” so they can “rise up and take ownership of the situation.” his grassroots approach might also help avoid the possibility that coalitions, however well-meaning, may erroneously assume that they rightfully speak on behalf of the interests of immigrants (mosley, 2013). however, his primary motivation for starting his own coalition is because the organization with which he is formally affiliated would be unwilling to let him do so. respondents in our sample were organizations involved with local coalitions do not even attend monthly meetings regularly. at times, limited involvement was attributable to organizational capacity, but others stated that the coalitions themselves were inconsistently active or ineffective. coalitions are not always able to keep member organizations engaged and involved. one program manager stated that she is interested in working with a statewide coalition on policy advocacy, “but since i signed up probably a year and half ago i have not heard anything. i don’t know if there’s a glitch with that or if they haven’t done anything.” a number of providers stated that they had been involved with local or stateadvances in social work, spring 2018, 18(3) 696 wide coalitions in the past, but no new information had been shared about coalition activities, so they were not sure where things stood. for others, the added burden of coalition-related tasks is untenable. the court liaison for an organization that addresses domestic violence explained that she feels inspired when she attends statewide coalition meetings, and finds the conversation productive. however, upon returning to her office the weight of other demands makes it difficult for her—and other coalition members—to carry that momentum out: “i’ve gone there [to coalition meetings] and really gotten excited about some new ideas, and then just come back and been so overwhelmed that i can’t concentrate any of my time on it.” others admit that they have dropped out of some coalitions, especially if they do not seem to be “really moving forward on things.” an attorney at a nonprofit legal justice organization admits that this is a difficult bar for many policy advocacy coalitions in the state to meet, but this particularly true in the case of immigration rights. her organization helped to found a statewide coalition in response to the antiimmigrant legislation that was passed in south carolina in 2011. the coalition was successful because there was a clear target, but when the threat of this policy subsided the coalition lost momentum: it [the coalition] was very effective because we had something going on. we had something tangible for people to do…i do think that when people have something to do, when there is something big going on, they will pull together. but it’s that down time where people have a hard time getting together. as a result, several organizations in our study that have a history of involvement with coalitions express an openness to future collaborations even if they are not currently engaged in policy advocacy. for example, the director of a large health services organization said he is familiar with the work of some local coalitions engaged in political advocacy on behalf of immigrants and has partnered with some members of a local coalition in the past. however, his organization was not formally involved in the coalition at the time of the interview. he stated that he would be willing to host a community event related to immigrant rights advocacy, but another organization would need to initiate the event and plan the details. that is, like other organizations in our sample, their involvement in policy advocacy is only periodic. this could change, however, if the issue of policy advocacy becomes more salient in the future. the same director reflected that his organization joined a statewide advocacy effort when south carolina enacted antiimmigrant state policies: “and so it [immigration] seemed to be more of a divisive issue, and we continued to treat people and to work with them as we had before, but the conversation and all things changed.” policy shifts in the future may trigger more coalition involvement because there is a clearly-defined issue around which coalition members can rally. discussion and conclusion in this paper, we explored the policy advocacy involvement of immigrant-serving organizations in south carolina, a state with restrictive immigration legislation. the process of immigrant integration can be difficult and destabilizing for immigrant newcomers no matter where they settle, but those who live in receiving contexts with harsh, anti-immigrant laws such as south carolina may be in even greater need of support. our roth et al./advocating for structural change 697 study is premised on the notion that local organizations that engage in political activities can influence public policy (marwell, 2004; mosley, 2012). to the extent that this is the case, these organizations can function as intermediaries between vulnerable groups and restrictive policy structures (reid, 2000)—minimizing this barrier to immigrant integration. consistent with the literature on social service organizations as intermediaries, we find that immigrant-serving social service providers in our study are positioned to mediate between immigrants and the restrictive policy context. however, not all organizations engage in advocacy activities to advance the rights of immigrants in south carolina. we find that organizations that engage in advocacy adopt a variety of tactics, but most respondents reported that their advocacy approach was indirect and non-confrontational. coalition membership was one of the most common forms of advocacy, but even this was limited. consistent with other studies, we find that involvement depends on factors such as organizational size, funding sources, the willingness of organizational leaders, and their willingness to collaborate (mosley, 2010, 2013). we also find that while some local social service providers may engage in policy advocacy, others engage in advocacy efforts focused only on the needs of the clients they serve rather than the larger community of which their clients are a part—a common pattern among service providers in other contexts (garrow & hasenfeld, 2014). still other providers in our study do not engage in policy advocacy at all, despite their acknowledgement of harsh anti-immigrant laws in south carolina. the limitations of our study prevent us from generalizing these findings to immigrantserving organizations across the entire state. our sample of immigrant-serving organizations is not representative, and the self-report nature of the data introduces the possibility of response bias. in addition, our study does not measure the impact of these policy advocacy activities on the laws and other structures that impact immigrant integration in south carolina. however, other studies suggest that participation in coalitions can be an effective indirect form of policy advocacy (fyall, 2016), particularly when individual organizations see more independent forms of advocacy to be risky. indeed, these types of collaborative practices have increased within the field of policy advocacy (mosely, 2013), and this is common practice for many organizations in our sample. however, because of data limitations in this study, it is unclear the extent to which these coalitions are actively pursuing a social justice agenda to advance immigrant rights in the state. rather than engaging in serious policy advocacy activities, it is possible that these coalitions merely provide opportunities for sharing information about resources and discussing case-specific problems concerning immigrant clients. yet, given that many organizations in this study report episodic involvement in policy advocacy, it is possible that the coalitions are similarly responsive to changes in the policy environment. for this reason, staying involved with coalitions when there is a “lull” may lead to more policy advocacy activities in the future if and when the coalition is compelled to take up a policy advocacy cause. likewise, organizations that are not currently active in coalitions may rejoin when the coalition rallies around a pressing need for policy advocacy. for these reasons, coalition meetings focused merely on networking may perform an important function in the service of future policy advocacy activities by maintaining organizational advances in social work, spring 2018, 18(3) 698 ties and working relationships. given this possibility, future research should explore the elasticity of policy advocacy activities in response to changes in the policy environment. consistent with other studies, we also find that many organizations in our sample do not participate in policy advocacy. some respondents stated that they do not participate in advocacy at all simply because they do not think advocacy involvement should be central— or even peripheral—to their activities. other reasons they offered were also consistent with the literature, including a lack of knowledge about policy and the policymaking process, organizational capacity, concern for displeasing an external funder, and fear of violating laws (bass, arons, guinane, carter, & rees, 2007; mosley, 2010; schneider & lester, 2001). recognizing the general trend that advocacy is regarded as a peripheral function of a service provider’s operations, future research must continue to assess noninvolvement among immigrant-serving organizations by comparing different receiving contexts. this includes examining differences between new destinations and traditional immigrant gateways, as well as places with active statewide coalitions, such as illinois and tennessee, relative to places without a unifying mechanism that can channel resources and strategically address immigrant rights concerns. finally, research should explore whether there is a tipping point for immigrant-serving organizations—when the balance of cost/benefit considerations prompt a provider to decide to engage in advocacy. if so, what are the factors and conditions that predict this type of organizational behavior? it is critical for the social work profession to pursue these questions in light of current immigration trends and policy. social workers uphold social justice as a defining feature of professional practice, yet social service organizations are only modestly engaged in policy advocacy vis-à-vis immigrant rights. through their daily work, social workers often directly witness or hear about the injustices immigrants face and are well-situated to explain these injustices to the broader society. consequently, social workers and the administrators of social service organizations should be actively engaged in coalitions that advocate for immigrant rights. this is particularly important in places such as south carolina with restrictive anti-immigrant laws. providers should also continue to expand their policy advocacy actions to more directly address policy inequalities facing immigrants. for some organizations that assume certain types of advocacy activities are impermissible, this might require that they begin by reviewing what types of direct and indirect actions are allowed within the laws which govern what is defined as “lobbying” by the irs. given the importance of policy advocacy to challenging and improving the structural conditions for immigrant integration, it is critical that social workers bridge the gap between what we profess to be important and what we prioritize in practice. this yawning gap is particularly noticeable in the face of 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(2012). a multilayered jurisdictional patchwork: immigration federalism in the united states. law & policy, 34(2), 138-158. doi: 28thttps://doi.org/10.1111/j.1467-9930.2011.00356.x28t yoshikawa, h., & kalil, a. (2013). the effects of parental undocumented status on the developmental contexts of young children in immigrant families. child development perspectives, 5, 291-297. author note: address correspondence to: benjamin j. roth, phd, college of social work, university of south carolina, 1512 pendleton st., columbia, sc 29208. 28trothbj@sc.edu28t https://doi.org/10.2747/0272-3638.29.1.29 https://doi.org/10.1111/j.1467-9930.2011.00356.x mailto:rothbj@sc.edu abstract: the growth of the immigrant population in the united states has prompted a recent increase in the number of restrictive immigration policies at the state and local levels. the literature on policy advocacy and social service organizations su... keywords: immigrants; immigration; policy advocacy; social service organizations; immigrant new destinations background intermediary organizations as policy advocates south carolina context data and methods findings why some providers do not engage in policy advocacy overcoming barriers to advocacy microsoft word simmelink_kk_1963_copyedit3 _________________  jennifer anne simmelink is a doctoral candidate and patricia shannon, ph.d., l.p., is an assistant professor, both in the school of social work at the university of minnesota in st. paul, mn. this work was supported by the minnesota state refugee coordinator. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 325-339   evaluating the mental health training needs of community-based organizations serving refugees jennifer anne simmelink patricia shannon abstract: this exploratory study examines the mental health knowledge and training needs of refugee-serving community based organizations in a midwestern state. a survey was administered to 31 staff members at 27 community based organizations (cbos) to assess the ability of staff to recognize and screen for mental health symptoms that may interfere with successful resettlement. of the 31 respondents 93.5% (n=29) see refugees with mental health issues and 48.4% (n=15) assess refugees for mental health symptoms – primarily through informal assessment. mainstream organizations were more likely than ethnic organizations to have received training related to the mental health needs of refugees. results indicate that while refugee led cbos recognize mental health symptoms of refugees they may be less likely to assess mental health symptoms and refer for treatment. policy recommendations for improving cbo services to refugees are offered. keywords: refugees, community based organizations, mental health training, ethnic organizations introduction since the passage of the refugee act in 1980, more than 2 million refugees have resettled in the united states (united states department of health and human services, 2010). by definition, refugees are fleeing chaotic and cataclysmic events (united nations high commissioner for refugees, 2008). those who flee war and political instability may have faced torture, imprisonment, rape, beatings, witnessed the killing of family members and the destruction of their homes. many refugees have spent years in refugee camps where conditions can be just as brutal as in the country from which they fled (unhcr, 2008). as a result of these traumatic experiences, refugees resettling in the united states are at increased risk of post-traumatic stress disorder (ptsd), depression and other psychosocial symptoms (johnson & thompson, 2008). resettlement stressors such as the lack of english language skills, living wage jobs and affordable housing can exacerbate mental distress (corvo & peterson, 2005) and untreated mental illness in newly arriving refugees can limit successful resettlement (mitschke, mitschke, slater, & teboh, 2011; potocky-tripodi, 2003). it can be difficult for health or social service professionals who work with refugees to recognize mental health symptoms, make appropriate referrals or treat mental health symptoms because of differences in language and culture (kirmayer et al., 2011). advances in social work, summer 2012, 13(2) 326  the united states provides federal funding to community based organizations (cbos) and non-governmental organizations (ngos) to provide support to resettling refugees through a range of social services including job training, english language classes, and assistance with housing. to secure and maintain funding, cbos must ensure their refugee clients meet federal measures of successful resettlement outcomes including finding stable employment with health insurance, reducing reliance on public welfare, learning english and making progress toward citizenship (office of refugee resettlement, 2010b). federal guidelines stipulate that funding to cbos for resettling refugees must be used primarily for employment related activities and mental health services are not included in approved employment related activities, leaving little money left in budgets to address issues like mental health or exposure to trauma and torture (public welfare, 2006). in addition, there is little funding for or provision of technical support and training in serving the mental health needs of refugees. consequently, cbos may struggle to recognize and meet the mental health needs of resettling refugees, leading to difficulties in successful resettlement. proper recognition, assessment and treatment of mental health symptoms in newly resettling refugees has the potential to increase successful resettlement outcomes, but cbos need to be properly trained and supported in this endeavor. this paper presents findings from an exploratory study of the mental health skills and training needs of staff at mainstream and ethnic cbos that serve resettling refugees. a better understanding of the training needs of federally funded social service agencies that serve refugees can lead to more targeted and effective technical support. literature review refugees in the united states in 2011 56,419 refugees from more than 20 different countries resettled in the united states (united states department of health and human services, 2012). this number is down from 74,602 in 2009 (united states department of health and human services, 2010). the primary countries of origin for incoming refugees were iraq, burma and bhutan. nearly one-half of all incoming refugees resettled in california, texas, new york, arizona, florida or michigan. many refugees resettling in the united states have been living in refugee camps for many years with little access to employment or education (unhcr, 2008). many refugees come from rural, agriculture-based communities and have few employment skills that translate to an urban, post-industrial society like the united states. these conditions can further prolong successful resettlement, particularly for older refugees. exposure to trauma and risk of mental health symptoms refugees, by definition, are fleeing violence, oppression, civil war or, increasingly, famine and natural disasters. many refugees have been exposed to traumatic events like violence, rape, torture, imprisonment or forced relocation. exposure to these events increases risk of developing mental health symptoms including ptsd, depression and simmelink, shannon/mental health training needs of refugee cbos 327 anxiety (johnson & thompson, 2008). as refugees languish in refugee camps for five, ten or even twenty years, the lack of employment or access to adequate education can contribute to mental health symptoms like depression (johnson & thompson, 2008). even after resettlement in a third country refugees can face long and difficult periods of acculturation. language barriers, lack of employable skills, lack of transportation, culture shock, generational gaps and isolation can all contribute to difficulties in resettling and exacerbate war-related trauma or resettlement related depression and anxiety (porter & haslam, 2005). several studies describe prevalence rates of trauma and torture, as well as symptoms of war and resettlement related mental and emotional distress among refugees. between 25 and 69% of somali and oromo refugees in the study reported experiencing torture (jaranson et al., 2004). karen refugees from camps in thailand report multiple traumatic experiences including forced relocation, hiding from soldiers in the jungle, missing family members, torture and rape (cardozo, talley, burton, & crawford, 2004). exposure to these types of traumatic experiences increases the risk of ptsd, depression, anxiety and other mental health issues in resettling refugees. prolonged exposure to trauma or the experience of multiple traumas is highly correlated with the development of ptsd in refugees. in a meta-analysis of 181 surveys that included 81,000 refugees from multiple countries steel and colleagues (2009) found rates of ptsd at 30.6% and rates of major depression at 30.8%. recent research on the long-term effects of exposure to war trauma and torture indicates that ptsd and depression can be longlasting and debilitating (carlsson, olsen, mortensen, & kastrup, 2006; marshall, schell, elliott, berthold, & chun, 2005). left untreated, these mental health symptoms can prevent stable resettlement (beiser & hou, 2001; kirmayer et al., 2011; marshall et al., 2005). mental health symptoms that developed during flight and in refugee camps can interfere with successful resettlement in the united states and are often undiagnosed and untreated. challenges to recognizing mental health symptoms in refugees include language and communication difficulties, cultural differences in health beliefs and behaviors, differences in family structures, intergenerational conflict, and social status (kirmayer et al., 2011). mental and emotional distress from pre-flight and migration as well as from the acculturation process can interfere with successful resettlement in third countries. often during resettlement war-related trauma is one of several issues facing refugees (davidson, murray, & schweitzer, 2008). past trauma is often ongoing because many refugees have left friends and family members behind in home countries or refugee camps. upon arrival in the united states refugees need to quickly learn a new cultural, legal, social and economic system. at the same time, they are coping with multiple losses of home, family, culture and language. many refugees experience acute mental health symptoms upon arrival in a resettlement country that decrease over time (beiser, 1988; tran, manalo, & nguyen, 2007). other refugees, frequently those who have experienced higher levels of war trauma, have a greater risk of developing mental health disorders after resettlement (steel, silove, phan, & bauman, 2002). advances in social work, summer 2012, 13(2) 328  there is evidence that refugees who have difficulty with acculturation and resettlement have worse resettlement outcomes. these difficulties include changes in social roles (colic-peisker & walker, 2003), unemployment and financial difficulties (beiser & hou, 2001), and social isolation (miller et al., 2002; mollica et al., 2001). in a large meta-analysis porter and haslam (2005) found that refugees from countries with continuing or flaring violence and refugees with a marked decrease in social status after resettlement did worse in terms of markers of successful resettlement than refugees who resettled with material security and stable housing. mental health symptoms, if left untreated, can continue to interfere with resettlement even decades later. in a study of 568 cambodian adults interviewed two decades after resettlement, marshall et al. (2005) found that refugees continued to have high rates of ptsd (62%, weighted) and depression (42%, weighted). in addition, the study found that people who are older, have low english language proficiency, are unemployed or are poor have higher levels of ptsd and depression. supporting successful refugee resettlement the united states recognizes the unique needs of resettling refugees and us refugee admission policies have been adapted to provide funding for resettlement-related social services. the refugee act of 1980, which created the first permanent statutory basis for refugee admissions, also created the office of refugee resettlement (orr), a department of the us department of health and human services (hhs). the us department of state allocates funds annually based on refugee admission numbers to orr. the orr then awards these funds to states through grants to community based agencies that provide resettlement services including reception, housing, employment, english language training and education. in fiscal year 2010 orr awarded a total of $171 million in discretionary grants (office of refugee resettlement, 2010a). to receive grants through orr, cbos must demonstrate that they have met certain outcome goals related to refugee economic self-sufficiency. these goals include ensuring a significant number of resettling refugees enter employment, remain employed for 90 days or longer, reduce or terminate their reliance on cash assistance, and receive health benefits through full-time employment (orr, 2010). this heavy emphasis on employment-related activities can prevent agencies from having time and resources to address mental health symptoms related to war trauma, torture or the stress of resettlement that may interfere with employment. development and focus of ethnic community based organizations ethnic community based organizations, often called mutual assistance agencies (maas) in the academic literature, have a long history in the united states and the us has long relied on ethnic community based organizations to provide social services and to support incoming refugees (hein, 1997). ethnic solidarity theories (breton, 1964) posit that these organizations provide a base for leadership, welcome and support newcomers through employment and financial resources, and facilitate successful resettlement (hein, 1997). ethnic solidarity theory has been challenged by research that indicates immersion simmelink, shannon/mental health training needs of refugee cbos 329 in ethnic communities has a negative long-term impact on refugees’ economic selfsufficiency (majka & mullen, 2002). ethnic organizations may lack access to mainstream resources making it more difficult for refugees to achieve self-sufficiency. in addition, by providing federal funding with specific criteria about how the money should be spent and on what, the federal government ends up setting priorities for ethnic communities that may not match their needs. for example, funding may prioritize employment-related activities, channeling an organization’s efforts towards training rather than other services, including mental health services (hein, 1997). while ethnic organizations provide essential supportive services for refugees, particularly in the first few months of resettlement, by accepting federal resettlement funds, their programs become significantly limited to government-determined outcomes. the omission of mental health services from federal definitions of successful refugee resettlement means ethnic organizations are less likely to provide these services. training and technological support from the federal government also focuses on employment related services, meaning ethnic organizations are less likely to receive training in recognizing and addressing mental health issues in refugees. although ethnic led cbos might recognize the effects of trauma in refugees, they may lack the knowledge and resources to address these issues. untreated mental health symptoms interfere with meeting the outcomes outlined by the federal government in defining successful resettlement. cbos and refugee social service agencies lack training to provide support for refugees with mental health symptoms. refugees who struggle with mental health symptoms long after resettlement are at risk of ending up on long-term disability. research indicates that early intervention can significantly reduce the risk of long-term mental health symptoms such as posttraumatic stress disorder (foa, keane, friedman, & cohen, 2009). providing cbos with training and material support to address refugees’ mental health needs may significantly improve resettlement outcomes. method this study is an exploratory examination of the mental health skills and training needs of mainstream and ethnic community based organizations that serve refugees. the purpose of the survey was to determine if community based organizations are serving refugee clients with mental health issues and if so, to assess the knowledge and ability of staff to recognize and screen for trauma-related mental health symptoms that may interfere with the successful resettlement of refugees. sample this study uses a convenience sample of 31 staff members at 27 community based organizations that have contracts with the office of refugee resettlement to provide services to refugees in a midwestern state. in 2009 the orr provided formula or discretionary grants to about 70 cbos in this state. the survey was given at a quarterly meeting of agencies convened by the office of refugee resettlement. the survey was introduced and endorsed by the state refugee coordinator as part of a community based advances in social work, summer 2012, 13(2) 330  needs assessment and was exempt from institutional review board approval. job titles of individuals completing the survey included program manager, executive director, staff attorney, and direct service personnel. the sample favors metro-based organizations; however, some rural organizations are represented. survey instrument the survey was designed by the authors and self-administered via pencil and paper. participation in the survey was not mandatory and information about organizations that were present at the meeting but chose not to complete the survey was not collected. identifying information including name of the person filling out the survey and job title was collected with the survey. respondents took about 20 minutes to complete the survey. the survey contained primarily yes/no questions including: “do you ask your clients if they have been exposed to war trauma or torture in their home countries?”, “do you see clients who suffer with mental health or stress related problems that affect their ability to successfully adjust to living in the united states?”, “does your agency assess clients for mental health problems or symptoms either formally through a questionnaire or informally through conversation?”, “would you find it useful to have a tool for identifying mental health symptoms that your clients struggle with?”. three questions asked about referring clients for treatment for mental health issues. first, respondents were asked: “do you refer clients to other agencies for assistance with treatment of mental health symptoms?” next, respondents were asked to rate their clients’ success at connecting with those referrals on a likert scale of 0 (not at all successful) to 3 (always successful). finally, respondents were asked to list any barriers their clients experience when trying to access services for mental health concerns. three questions asked about training related to the mental health needs of refugees. first, respondents were asked: “has your agency received any training on serving the needs of war trauma/torture survivors?” second, respondents were asked to rate how knowledgeable their staff is in understanding and serving the needs of war trauma and/or torture survivors on a likert scale from 0 (not at all knowledgeable) to 3 (extremely knowledgeable). third, respondents were asked to rate their interest in receiving training or consultation for their agency staff on specific topics related to torture and war trauma on a likert scale from 0 (not at all interested) to 3 (extremely interested). respondents were given space to add additional written comments after each question and were given space at the end to write additional thoughts, comments or suggestions. analysis because this is an exploratory study and data is limited, descriptive statistics and crosstabs were performed. analysis was completed using stata statistical software, version 11. responses were analyzed in two ways. first, responses were aggregated and analyzed as a whole. second, responses were categorized by organization type. organizations that responded to the survey were divided into two categories: mainstream community based organizations (cbos) and ethnic community based organizations. simmelink, shannon/mental health training needs of refugee cbos 331 mainstream cbos were defined as community-based non-profit or government agencies/departments established for purposes other than refugee resettlement but that now provide significant services to refugees. these include schools, legal services, housing services, voluntary resettlement agencies and other social service agencies. ethnic-led cbos are community-based non-profit organizations that were founded by and are run by refugee communities to provide social services to resettling refugees. findings demographics the sample included 31 respondents from a total of 27 organizations; 13 mainstream community based organizations were represented and 13 ethnic organizations were represented. one respondent did not identify their organization. the 31 respondents were evenly split between the organizations with 15 respondents from mainstream organizations and 15 from ethnic organizations. table 1 outlines descriptive statistics of responses to the survey. table 1: description of survey sample (n=31) organization demographics n % mainstream cbo 15 50.0% ethnic cbo 15 50.0% no response 1 3.3% mental health see clients with mental health symptoms 29 93.5% ask about exposure to trauma/torture 18 58.0% assess mental health symptoms 15 48.4% culturally valid screening tool would be useful 27 87.0% referrals refer for mental health treatment 23 74.2% rated likely or extremely likely to connect with referrals (n=23) 17 74.0% knowledge and training have received mental health training 11 35.5% rated knowledgeable or extremely knowledgeable about serving war trauma survivors (n=27) 12 44.0% rated interested or extremely interested in training (n=24) 21 88.0% advances in social work, summer 2012, 13(2) 332  assessing war-related mental distress overall, 93.5% (n=29) of respondents see clients with mental health symptoms while 58% (n=18) ask clients about exposure to trauma or torture and 48.4% (n=15) assess for mental health symptoms either with a standardized questionnaire or through informal conversation. need for a culturally grounded mental health screening tool respondents were asked if they would find it useful to have a culturally relevant tool for identifying mental health symptoms in their clients. eighty-seven percent (n=27) of respondents indicated that a tool would be useful. the majority of respondents who indicated they currently assess clients for mental health symptoms reported doing so through either informal conversation or with the state’s tanf program self-report questionnaire. the questionnaire is a self-report depression screening tool used with the state’s application package for tanf grants. this tool was not designed for use with refugees and is not cross-culturally validated. referring clients for treatment respondents were asked about referral practices. twenty-three (74.2%) cbos refer their clients for treatment for mental health symptoms. respondents were asked to rate their clients’ success at connecting with these referral agencies on a scale of 0 (not at all likely to connect with referrals) to 3 (extremely likely to connect with referrals). seventeen (74%) agencies reported their clients are likely or extremely likely to connect with referral services. nineteen respondents identified barriers to accessing stable psychosocial treatment. this was a short answer question and most participants gave multiple responses. nine respondents (47.4%) identified a lack of interpreters or linguistically appropriate provides as a barrier to accessing treatment. nine (47.4%) respondents identified stigma as a significant barrier. five (26.3%) respondents identified cultural differences in definitions and treatment of mental health symptoms as a barrier. other barriers listed included lack of transportation (n=5, 26.3%), cost or lack of health insurance (n=3, 15.8%), lack of culturally appropriate treatment or providers (n=3, 15.8%), and difficulty navigating complicated mental health systems (n=3, 15.8%). knowledge and training eleven respondents (35.5%) reported received training related to serving refugees with war trauma/torture exposure. respondents were asked to rate their knowledge of serving the needs of war trauma/torture survivors on a likert scale of 0 (no knowledge at all) to 3 (extremely knowledgeable). twenty-seven respondents answered this question and 44% (n=12) reported they are knowledgeable or extremely knowledgeable about serving the needs of war trauma/torture survivors. twenty-four organizations rated their interest in receiving training about serving refugees with war-related mental health symptoms on a scale of 0 (not at all interested) simmelink, shannon/mental health training needs of refugee cbos 333 to 3 (extremely interested). twenty-one (88%) reported they are interested or extremely interested in receiving training. differences between mainstream and ethnic cbos crosstabs show areas where differences may exist in responses between mainstream and ethnic cbos. these crosstabs indicate areas for further study. mainstream cbos may be more likely than ethnic cbos to want a tool for identifying mental health symptoms that clients struggle with. mainstream cbos may be more likely to refer clients for mental health treatment. mainstream organizations may be more likely to have received training on serving the needs of war trauma/torture survivors. it is important to note that these differences are not statistically significant and simply point out areas for future investigation, rather than real differences. table 2 below displays differences between mainstream and ethnic cbos in this particular study. table 2: differences between mainstream and ethnic cbos mainstream cbo ethnic cbo [% (n)] [% (n)] ask clients about exposure to trauma/torture 78.6% (11) 53.3% (8) assess mental health symptoms 53.3% (8) 46.7% (7) would like a culturally validated screening tool 100% (15) 73.3% (11) refer clients for mental health treatment 92.9% (13) 60% (9) have received training 53.3% (8) 13.3% (2) note. overall n for mainstream cbo = 15 and for ethnic cbo = 15. mainstream and ethnic organizations also identified different types of barriers to successfully connecting to mental health services. eight mainstream organizations identified refugees’ stigma against mental illness as a barrier to successfully connecting with referral resources whereas ethnic cbos did not identify this issues as a barrier. mainstream organizations cited language issues, transportation, fear, lack of culturally appropriate providers and lack of knowledge about how the mental health system works as the primary barriers to accessing services. ethnic organizations listed language, lack of culturally appropriate providers and cultural differences in refugees’ perceptions of mental illness and treatment as the primary barriers to accessing services. short answer responses each question allowed space for respondents to write short answer comments and there was space at the end of the survey for additional thoughts or comments. respondents were also asked to write short answer responses to the type of assessment tool they used for screening refugees for mental health issues and to the barriers that their refugee clients might face when trying to access services for mental health treatment. advances in social work, summer 2012, 13(2) 334  these responses were analyzed thematically, making note of both similarities and frequencies of responses as well as anomalies or disparate responses. three themes emerged in these comments: identification of training needs, lack of culturally appropriate referral services, and specific barriers to accessing treatment for mental health symptoms. although the survey did not ask for written comments in the questions about training needs both in this section and in the general comments section multiple organizations mentioned training needs as being a salient issue. one agency commented that a culturally grounded mental health assessment tool would be helpful “if staff are trained [to use the tool] and can take next steps”. four organizations that had received training in the past commented that it was several years ago and while they appreciated the knowledge, they felt they needed more. in the general comments section of the survey three organizations commented that they were seeing growing numbers of refugees in their areas and needed training to address their specific needs. one of the respondents wrote “in our community we have a growing somali and sudanese refugee population and we basically have no culturally competent referral system. i would love to be a part of any upcoming trainings on mental health.” discussion this study explores whether cbos who serve resettling refugees see clients with war-related mental health issues and whether or not they have adequate training and knowledge to assess and refer refugees for mental health issues. results indicate that most of the respondents do see refugees with war-related mental distress at their agencies. however, only about half of respondents’ agencies actually assess refugees for mental health issues and when they do, they use informal conversation rather than a standardized instrument. while many organizations refer refugees to treatment for mental health issues, they identify significant barriers to successfully connecting with those referral services. there appears to be a strong interest in having a culturally relevant, brief, accessible screening tool for assessing mental health issues, and training on refugee mental health issues is needed. few agencies, particularly ethnic agencies have received training on refugee mental health issues, and perceived knowledge of how to meet refugees’ mental health needs is low. study results indicate some significant differences between mainstream and ethnic organizations. mainstream organizations are more likely to refer clients to treatment for mental health issues, more likely to have received training on refugee mental health issues, more likely to want a culturally relevant tool to assess refugee mental health issues, and more likely to name stigma as a barrier for refugees to receiving mental health treatment. the commonly held belief that mental health stigma prevents refugees from connecting with services was not confirmed by the ethnic cbos in this survey. these findings are not surprising given the structure of federal funding for refugee resettlement services. guidelines for federal refugee resettlement funds focus primarily on employment-related activities and leave little room for programs or activities that address mental health issues. while the office of refugee resettlement has committed simmelink, shannon/mental health training needs of refugee cbos 335 funding for training cbos to meet employment-related needs of refugees, little commitment has been made to training organizations to recognize and address symptoms of war related mental distress that may interfere with obtaining and retaining employment. by earmarking most of federal resettlement funds for employment-related activities, federal guidelines significantly influence the focus and programmatic planning of refugee-serving cbos. despite the fact that refugee led cbos recognize mental health symptoms that their clients are struggling with, ethnic cbos are less likely to have received training, less likely to refer their clients to mental health services, and less likely to want a culturally relevant tool for assessing mental health issues. this is not surprising considering ethnic cbos are less likely to be connected to mainstream resources and agencies from which mental health training typically comes and may be unaware that treatment resources exist to help their clients. the competitive nature of federal grants for resettlement services makes it difficult for mainstream and ethnic cbos to be motivated to collaborate and share their unique knowledge with each other (majka & mullen, 2002). mainstream organizations are more likely to have had training but this does not significantly impact their perception of agency knowledge. it is clear that more training is needed for both mainstream and ethnic organizations. however, this training cannot be a “one-size-fits-all” model. ethnic organizations have specific training needs, as do mainstream organizations. mainstream organizations might have more training and access to mental health resources, but less knowledge of cultural expressions of distress and language ability. ethnic organizations may be well-steeped in cultural knowledge but lack information about mental health issues and resources. training programs need to be targeted to the specific needs of each type of organization. implications for policy and practice the findings of this exploratory study have a number of implications for refugee resettlement policies and for social work practice with refugees. federal funding for resettlement services prioritizes employment and employability as a primary indicator of successful and stable resettlement. research on the traumatic experiences and related mental health symptoms of refugees that are currently resettling in the us indicates such symptoms are likely to interfere with successful resettlement for a significant portion of new arrivals (carlsson et al., 2006). unrecognized and untreated mental distress in refugees could be a significant barrier to gaining and maintaining stable employment. addressing refugees’ mental health needs in the initial stages of resettlement could lead to more robust resettlement outcomes. this is only possible if there are funds available to support the requisite training and referral needs of cbos that work with resettling refugees. federal funds could be earmarked for a more broad definition of employmentrelated activities to allow funding to be spent on mental health programs connected to employment success. social work practitioners who work with refugees are uniquely positioned to provide training and referral resources to cbos. there is a significant shortage of trained social workers from refugee communities. if more people from refugee communities are advances in social work, summer 2012, 13(2) 336  recruited and trained in meeting the mental health needs of resettling refugees they could effectively integrate evidence based models of care with culturally competent practice at both mainstream and ethnic cbos. finally, there appears to be a missing link between ethnic and mainstream cbos. mainstream cbos with long histories in social services may have significant knowledge and awareness of general mental health issues, but lack the cultural grounding or training in recognizing those symptoms in refugees from non-western backgrounds. conversely, ethnic organizations are uniquely positioned to serve refugees from a culturally grounded and linguistically relevant base but lack access to and knowledge of mainstream mental health resources. both types of organizations may stand to gain significantly by learning from each other. study limitations this study was limited by the small sample size and the exploratory nature of the survey. about half of the total number cbos receiving orr funding in this state are represented, giving a low response rate which further limits the study. sophisticated statistical analysis of results is limited. the use of a convenience sample of participants in a quarterly meeting also limits the study. some of the organizations represented in the study are large with multiple departments and staff. to gain a more full understanding of the training needs of an entire organization, this survey would need to be administered to more than one representative from more than one department. despite these limitations the study points to the need for targeted training for cbos that work with refugees at risk of war-related mental health symptoms. future research research about the mental health training needs of mainstream and community based organizations serving refugees is limited. research needs to focus on a better understanding of the unique training needs of ethnic community based organizations as well as mainstream organizations. research and programs that foster communication and interaction between mainstream and ethnic community based organizations is needed. a better understanding of the variability in training needs within organizations, particularly large organizations with multiple departments and programs, could foster more targeted and effective training programs. many cbos report a need for brief, culturally relevant mental health screening tools, indicating a need for future research on the development and utility of such tools. cbos would also need training and support in using these tools as well as support in referring and following up with refugees who screen positive 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(2012). office of refugee resettlement: data. retrieved from http://www.acf.hhs.gov/programs/orr/data/index.htm author note: address correspondence to: jennifer simmelink, msw, school of social work, university of minnesota, 1404 gortner avenue, 105 peters hall, st. paul, mn 55108. email: simm0055@umn.edu 2015 and 2016 advances in social work reviewers and affiliations we would like to acknowledge the contributions of the following individuals who reviewed manuscripts for advances in social work in 2015 and 2016. without their time and expertise, advances in social work would not be possible. thereasa eilene abrams, university of tennessee knoxville tina abrefa-gyan, george mason university ziblim abukari, westfield state university robert ackerman, university of nevada shauna p. acquavita, university of cincinnati margaret e. adamek, indiana university a. christson a. adedoyin, samford university debrenna lafa agbenyiga, michigan state university kylie agllias, university of newcastle, callaghan, new south wales jemel aguilar, university of saint joseph dale albers, university of kentucky karen m. allen, indiana university jane g. allgood, university of southern california david alonso gonzalez, universidad complutense madrid, spain james william amell, james madison university kim m anderson, university of missouri scott p. anstadt, florida gulf coast university steven applewhite, university of houston arlene marie arias, connecticut department of mental health and addictions services vicki ashton, the city university of new york jieru bai, university of nebraska at omaha adrienne baldwin-white, arizona state university neil ballantyne, open polytechnic kurantin tuwhere, new zealand jessica l. banslaben, fordham university john r. barner, university of north georgia christine e. barnes, louis stokes cleveland va medical center salamatu barrie, michigan state university emily beerbower, indiana university bob bennett, indiana university larry bennett, indiana university rosalyn bertram, university of missouri kansas city andrea black, university of louisiana at monroe carolyn j. black, indiana university lisa v. blitz, binghamton university kori r. bloomquist, winthrop university pam h. bowers, humboldt state university shane ryan brady, university of oklahoma natasha wine miller bragg, indiana university noorie brantmeier, james madison university james roger brown, indiana university samantha brown, university of denver alice k. butterfield johnson, university of illinois at chicago jeffrey alan butts, cuny-john jay college of criminal justice christine r. call, university of st. francis peter camilleri, australian catholic university school of allied health, australia joan marie carlson, indiana university gerrie casey, indiana university jason castillo, the university of utah samson bwalya chama, southern adventist university charmayne champion-shaw, indiana university jill m. chonody, indiana university patricia coccoma, florida gulf coast university michel a. coconis, wright state university jo ann coe regan, council on social work education susan a. comerford, university of vermont lisa conradi, rady children's hospital san diego jonathan cook, rhodes college john cosgrove, fordham university sheila cotton, university of alabama, department of sociology derek coursen, new york university marcus crawford, university of texas at arlington marcus crawford, university of texas at arlington bronwyn cross-denny, sacred heart university sara czaja, university of miami james g. daley, indiana university bruce dalton, east tennessee state university robert h. daugherty, aurora university vaughn decoster, university of southern indiana tara v. dejohn, university of arkansas at little rock elena delavega, university of memphis sheila dennis, indiana university david s. derezotes, university of utah patricia louise desrosiers, western kentucky university mery f. diaz, new york city college of technology/cuny hillary rose dolinsky, albany state university of new york eileen anne dombo, the catholic university of america amy doolittle, university of tennessee chattanooga phillip dybicz, valdosta state university james william ellor, baylor university susan e. elswick, university of memphis gretchen e ely, university at buffalo rafael jacob engel, university of pittsburgh carolyn bartick ericson, christopher newport university robin ersing, university of south florida lorena m. estrada-martinez, university of massachusetts michelle evans-chase, rowan university kathleen j. farkas, case western reserve university phil farmer, jarvis christian college thomas patrick felke, florida gulf coast university joseph ferrandino, indiana university robyn findlay, university of queensland, australia amy killen fisher, university of mississippi dale fitch, university of missouri gail folaron, indiana university karen a. ford, james madison university nicholas forge, georgia state university lessie jo frazier, indiana university paul freddolino, michigan state university susan gair, james cook university, australia alejandro garcia, syracuse university michelle d. garner, university of washington tacoma trevor gates, brockport state university of new york carolyn s. gentle-genitty, indiana university purnima george, ryerson university, canada erlane k. ghani, universiti teknologi mara, malaysia allison k gibson, winthrop university barbara gilin, widener university philip gillingham, the university of queensland, australia lauri goldkind, fordham university tomi gomory, florida state university m. teresa granillo, university of texas at austin susan a. green, university of buffalo joan groessl, university of wisconsin green bay seth gurell, utah valley university marten haesner, charité universitätsmedizin berlin, germany james alan hall, indiana university jayme hannay, carnegie mellon university karen harper-dorton, west virginia university kate hendricks thomas, charleston southern university robert l. herman-smith, university of north carolina jocelyn hermoso, san francisco state university santos h. hernandez, university of texas at arlington robin hernandez-mekonnen, stockton university janna heyman, fordham university laura degive hickey, new york university dawn higgins, walden university amy hillier, carnegie mellon university david hodge, arizona state university michin hong, indiana university carol hostetter, indiana university patricia howes, indiana university grafton h. hull, university of utah janise hurtig, university of illinois at chicago monique eileen hyman, university of new england jeremiah w. jaggers, indiana university odireleng mildred jankey, university of botswana, south africa ninad jhala, institute of language studies & applied social sciences, united kingdom jenny l. jones, clark atlanta university dennis kao, university of houston laura kaplan, university of northern iowa saliwe moyo kawewe, southern illinois university carbondale khadija khaja, indiana university michael killian, university of texas at arlington hea-won kim, indiana university andrzej klimczuk, warsaw school of economics, poland karen m. kolivoski, howard university david c. kondrat, indiana university christian krageloh, auckland university of technology, new zealand debra kram-fernandez, empire state college (suny) jeffrey r. lacasse, arizona state university susan l larimer, indiana university kathy r. lay, indiana university christopher m. layne, university of california, los angeles shawna j. lee, university of michigan amanda j. lehning, university of maryland zeno leung, hong kong polytechnic university, hong kong jill levenson, barry university laura lewis, university at buffalo meirong liu, howard university diane nicole loeffler, university of kentucky carmen geanina luca sugawara, indiana university darlene lynch, indiana university paul force-emery mackie, minnesota state university velusamy madasamy, alagappa university, karaikudi, india virginia majewski, indiana university arati maleku, the ohio state university trevor jay manthey, university of kansas jennifer martin, rmit university, australia christie mason, loyola university chicago carol rippey massat, indiana university sarah maxwell, university of texas at dallas lynn milgram mayer, the catholic university of america carolyn anne mcallister, california state university san bernardino damian mccabe, united states air force heather a. mccabe, indiana university irene searles mcclatchey, kennesaw state university lisa elizabeth mcguire, james madison university john g. mcnutt, university of delaware alysse melville, university of connecticut goutham menon, university of nevada, reno shari e miller, university of georgia kathleen monahan, stonybrook-suny amber moodie-dyer, north carolina justice center brenda moore, texas a&m university brenda ardyce moore, texas a&m university deana f. morrow, winthrop university heather mullins-owens, indiana university peg munke, murray state university amy b. murphy-nugen, western carolina university randall clifford nedegaard, university of north dakota debra s. norris, university of south dakota peter j. o'brien, calgary zone alberta health services david okech, university of georgia leah olson-mcbride, university of wisconsineau claire robert michael ortega, university of michigan philip ouellette, indiana university gerri outlaw, governors state university manoj pardasani, fordham university juyoung park, florida atlantic university phu tai phan, california state university domiguez hills amy phillips, minot state university barbara jean pierce, indiana university cathy king pike, indiana university gerald t. powers, indiana university asutosh pradhan, central university of himachal pradesh, india irene queiro-tajalli, indiana university magaly queralt, humboldt state university del quest, university of north dakota sophie c. reid, university of melbourne, austrailia larry r. reynolds, marian university karen rice, millersville university eprise richardson, indiana university eprise richardson, indiana university elaine rinfrette, edinboro university of pennsylvania marinilda rivera-diaz, university of puerto rico roy william rodenhiser, university of west florida virginia rondero hernandez, california state university fresno jennifer root, wilfred laurier university, canada diana rowan, university of north carolina melanie sage, university of north dakota gregory d. saxton, university at buffalo bassima hussein schbley, topeka, ka beverly cynthia sealey, simmons college sandro serpa, university of the azores, ponta delgada, portugal janki shankar, university of calgary, canada dee ann sherwood, western michigan university micheal l. shier, university of toronto, canada erica shifflet, michigan state university jennifer anne simmelink, tulane university jennifer simpson, the open university, scotland, united kingdom melissa singh, university of southern california heather sloane, university of toledo richard j. smith, wayne state university alexa m. smith-osborne, university of texas at arlington nancy smyth, university of buffalo carla sofka, siena college emma sorbring, centre for child and youth studies university west, sweden william spence, university of glasgow, scotland, united kingdom noelle m. st.vil, university at buffalo vincent r. starnino, indiana university marlys staudt, university of tennessee virginia strand, fordham university sabrina sullenberger, belmont university patrick sullivan, indiana university andrea g. tamburro, indiana university sarah tarshis, university of toronto, canada jeffry w. thigpen, indiana university jacky t. thomas, california state university san marcos amanda toler woodward, michigan state university linda turner, dalhousie university ‑ halifax, nova scotia wendy turner-frey, university of southern indiana sarah e. twill, wright state university md. emaj uddin, university of rajshahi, bangladesh tien ung, simmons college karen marie vandeusen, western michigan university kati vapalahti, university of jyväskylä, finland daniel velez ortiz, michigan state university robert vernon, indiana university gary l. villereal, western kentucky university amy vliek, western michigan university holly danforth vugia, california state university east bay elizabeth a. wahler, indiana university misty wall, boise state university n. eugene walls, university of denver patricia g. walls, arkansas state university tova b. walsh, university of wisconsin ineke way, western michigan university patricia weldon, marywood university allison west, johns hopkins university david j. westhuis, indiana university joanne westwood, university of salford, manchester united kingdom tracy c wharton, university of central florida joanne whelley, barry university darren l. whitfield, university of pittsburgh julie williams, birmingham city university celia williamson, university of toledo leila wood, texas state university joanne yaffe, university of utah jimmy young, california state university san marcos karen zgoda, bridgewater state university tarek zidan, indiana university karen zilberstein, smith college microsoft word gelman_context of sw education copyedit final ______________  sheldon r. gelman, ph.d., acsw, msl is a professor in the wurzweiler school of social work at yeshiva university in new york, ny. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 91-104   the evolution and changing context of social work education sheldon r. gelman abstract: the nature of social work education has changed dramatically over the course of my academic career: from the degree(s) required for a faculty position to the number of years of practice experience; from expectations for research and publication, to criteria for promotion and tenure; from residential instruction to distance education; from an emphasis on foundation curriculum to practice competencies and outcomes; and, from a commitment to service to a quest to be the highest “ranked” program within the highest ranked institution. given that change is an ongoing phenomenon, it is difficult to anticipate curriculum direction or plan one’s career path with a high degree of certainty. the future is often determined by external events, fate, where you are at a specific time, the assistance of others, and the opportunities that are presented. these changes and the evolution of social work education as a field of professional practice can best be demonstrated by reflecting on my own experiences in becoming a faculty member and serving in various academic positions over the last 45 years. the contrast between my personal experiences and those of the typical student in 2014 may help demonstrate some of the changes that have occurred in social work education over the intervening years. keywords: social work education, academic careers, professional development, mentoring i did not begin my professional career with the intent of becoming an academic. when i received my msw in 1967, i was a group worker with a special interest and expertise in the field of disabilities. yet i have served as a full time tenured faculty member in two universities, one public (baccalaureate program), the other private (master and doctoral programs), as a graduate school dean for 21 years, and for 12 of those 21 years as a university academic administrator. my interest in social work began in high school through my involvement with a local community center, where i later served as a club leader and eventually as director of youth programming following my graduation from the university of pittsburgh (pitt) with a bs in psychology. during my junior year, i had the opportunity to participate in a summer internship program that exposed me more formally to careers in various fields of social work practice. i was assigned as a case aide in a public assistance office where i made home visits and recertified eligibility of recipients for financial assistance and food stamps. as a college senior i worked as a child care worker in the child psychiatric unit at the university’s teaching hospital. this experience working with a multidisciplinary team with special needs children helped me realize the value of pursuing an msw degree. advances in social work, spring 2014, 15(1) 92 contrasting educational realities as a group work major, my first year field placement had been at the industrial home for crippled children. my second year placement was at pressley ridge, a residential treatment center for emotionally disturbed children. in both field placements i was part of a small student unit, staffed by doctoral students from the university, who provided weekly individual and group supervision with a heavy emphasis on the use of “process recording” as a learning tool. it was my first year field instructor, the late mildred sirls pratt (university of illinois, normal) who taught me to set realistic and achievable goals for clients and to evaluate the outcomes of practice interventions. while the msw program at the university of pittsburgh required the completion of 60 credits (including field work), i had the opportunity to schedule two additional elective courses, one within the school in program evaluation and the other in the school of education in special education. by contrast, today’s students in addition to selecting a method, population or social problem as their area of concentration, typically have a range of options to choose from among various specializations or certificates (e.g., gerontology, child welfare, veterans, and substance abuse). while my msw studies required completion of four semesters of group work methods courses, today’s students usually complete two semesters of foundation methods and only two semesters of the advanced methods or concentration courses. the focal point of student life in the social work program at pitt was the library, where, in the absence of the internet, students actually congregated to read assigned and recommended readings, a phenomenon that contributed significantly to both an atmosphere of informal learning as well as socialization to the profession. during the sixties and prior to the onset of the era of entitlement, classes were rarely missed and requests for extra time to complete assignments were unusual. despite the many benefits associated with the internet, unfortunately, many students see little need to enter a library to access its resources. similarly, for many schools, socialization to the profession is not necessarily a conscious or structured experience beyond familiarity with the nasw code of ethics. at that time, it was the rare student who simultaneously held down a job, and most students attended school full time. in order to finance my msw education at the university of pittsburgh, i entered the professional education program (pep) offered by the commonwealth of pennsylvania. the program provided tuition and a biweekly stipend for individuals willing to commit themselves for two years of post masters practice in an institutional setting serving those with mental and developmental disabilities. consequently, the cost of my education was not an issue. i was able to attend full time and it was not necessary for me to take out a student loan. unfortunately, today’s graduate students do not have access to the same funding sources to cover the cost of tuition. they often can only afford to attend school part time and juggle personal obligations and responsibilities with their educational and field work commitments. gelman/evolution and context of social work education 93 post-masters practice following graduation i began my professional social work career at the laurelton state school. because of my training and experience as a group worker, i was retained as a consultant by a local school district and by the northeastern federal penitentiary at lewisburg. the penitentiary also included a prison camp located in allenwood (pa), which housed large numbers of young conscientious objectors to the vietnam war. the population at the camp was difficult for the staff to relate to, given that many of their own children had been drafted and were serving overseas. the majority of the professional staff at federal penitentiaries were commissioned officers of the us public health service. several of my colleagues at the penitentiary encouraged me to apply for a public health service commission. this was an interesting career option in that i had received two previous draft notices for which i had received temporary deferrals. my application to the public health service was successful and i was offered a commission as an officer with an assignment at the federal penitentiary at lexington, kentucky upon completion of my employment commitment at laurelton. i mention this simply to point out that often our careers take interesting and unanticipated turns ultimately forcing us to make choices we never anticipated ever having to confront. while at laurelton i was involved in a number of program initiatives where my group work skills and innovative program ideas impacted my planned career path. one of the programs i developed was an orientation group for newly admitted residents of the facility. because this was an approach that had not been previously utilized with this population, my supervisor, william delaney, acsw, and elizabeth treadway, acsw the coordinator of the pep program encouraged me to write about my work. they also encouraged me to join the american association on mental deficiency (aamd) as well as maintain my transitional student membership in nasw. the social work section of aamd was sponsoring a writing competition for new professionals. i submitted my program description to the competition and was selected as one of the winners. in addition to a very small cash award and conference registration, i was invited to present my paper at the annual meeting of the association in san francisco. this paper was ultimately published in a major mental health journal, my first publication. laurelton was utilized by nearby universities as an internship site. in my role as director of a special unit for aggressive and acting out high functioning residents, i was requested to provide task supervision to undergraduate students from the social work program and the special education masters program at the pennsylvania state university (penn state), as well as undergraduate students in psychology and sociology from several other colleges in the area. this was my first academic exposure in a non-student role and i found it both interesting and gratifying. the performance evaluations i received from the students i supervised, resulted in an unexpected offer of a faculty position in the sociology department at penn state. the baccalaureate social work program, housed within this department, was directed by margaret b. matson phd, who encouraged me to pursue this opportunity following the completion of my obligation to the pennsylvania professional education program. advances in social work, spring 2014, 15(1) 94 growth of social work education when i started my academic career in 1969 there were approximately 65 accredited msw programs and 120 registered bsw programs in the united states (bsw accreditation did not begin until 1974). by 1979 the number of msw programs had grown to 86 and accredited bsw programs to 178. by 1989 the number of msw programs stood at 91 and bsw programs numbered 230. program growth continued through the 1990’s reaching a combined total of 391 bsw and msw programs by 1999. growth in programs continued into the 21st century reaching a combined total of 516 accredited programs in 2004. today there are a total of 718 accredited social work programs at the baccalaureate and masters levels, with an additional 29 baccalaureate and masters programs in candidacy. while enrollment has fluctuated over time, shifting from full time residential instruction to part time study, and now to online learning, the one thing that is clear is that the number of social work programs has quadrupled in the last 45 years. similarly, the number of institutions offering doctoral programs in social work/social welfare has doubled during that same time period. teaching positions have grown exponentially. yet, membership in professional social work organizations like nasw and cswe has not kept pace with this program expansion. interestingly, only a relatively small number of individuals trained as social workers identify or affiliate with these two major social work organizations. the membership of both these organizations reflects only a small proportion of faculty teaching in social work programs. while the growth in programs has created new opportunities for aspiring academics, the positions are increasingly parttime or non tenure track. practice or an academic career? the importance of mentoring this was my first career dilemma. i had two appealing competing offers of employment, one as a commissioned officer in the us public health service assigned to the federal penitentiary in lexington, kentucky; the other as an assistant professor at a public prestigious land grant university. with my msw degree, well established clinical and interpersonal skills, and experience working with diverse populations, i was qualified for both positions. penn state was only 50 miles from our home in lewisburg, pa and 130 miles from our families in pittsburgh. kentucky was a long way from everyone and everything we knew. i accepted the penn state offer in late spring of 1969 and attended the aamd conference in san francisco two weeks later. at the conference i met meyer schreiber, formerly of the us children’s bureau who had chaired the aamr writing competition mentioned earlier. he explained what i would need to do if i were serious about pursuing a career in academia. he cautioned me, from his own personal experience, that i would need my doctorate if i was going to succeed. without a doctoral degree i would have limited opportunities in academia. he was convinced that there was only one doctoral program that would meet my needs and interests and that there was only one person who could guide my specific interests in disabilities and corrections. the program was the florence heller school for advanced studies in social welfare at brandeis university, in waltham, massachusetts. the faculty member was gunnar dybwad, an gelman/evolution and context of social work education 95 attorney who was also a social worker. during the conference, schreiber facilitated my introduction to professor dybwad, who in turn encouraged me to apply to the heller school. from the day i started my academic career at penn state, margaret b. matson, a sociologist by discipline and widely recognized as a pioneer in baccalaureate social work education and field work education in particular, encouraged me to write and to pursue my doctorate. her guidance and mentoring coincided with the advice and encouragement i was receiving from mike schreiber. penn state graciously granted me a leave-ofabsence after only one year of service to enroll in the doctoral program at brandeis’ heller school, but not before margaret matson had arranged for me to meet lillian ripple, acting executive director at cswe. cswe contracted with me, as part of a federal grant it had received, to compile an annotated bibliography entitled toward building the undergraduate social work library. as i reflect on this series of serendipitous events i am convinced more than ever that quality guidance and mentoring are critical to creating opportunities for professional growth and career development. yet opportunities for meaningful mentoring may no longer be available as students spend less time in residential instruction. i returned to penn state in september of 1972 with my dissertation completed. with margaret matson’s ongoing mentoring and my phd in hand, i was promoted to associate and then full professor and granted tenure. when margaret retired in 1978, i assumed her position as director of penn state’s accredited baccalaureate social work program, a position i held through the 1989/90 academic year. during my time at penn state, program structure and curriculum were modified to conform to changing cswe accreditation standards. by that time, newly hired full time faculty members were expected to have earned their doctorate prior to applying for an academic position. the historical and political evolution of social work accreditation in 1919, seventeen schools with baccalaureate and masters training programs in social work/social welfare came together to form the association of training schools for professional social work. several of these programs were agency based rather than college or university based and all reflected urban settings. this organization later came to be known as the american association of schools of social work (aassw). interestingly, in 1939 aassw voted to limit its membership to graduate training programs. rural masters and the majority of baccalaureate programs, comprised primarily of land grant colleges and state universities with a strong public service mission, then formed their own organization in 1942, the national association of schools of social administration (nassa). aassw retained sole responsibility for accrediting graduate social work programs through 1943 when nassa was recognized as the accrediting authority for undergraduate programs and the first year of graduate education leading to an m.a. or m.s. degree. the overlapping authority, confusion, and tension continued in the field with the publication of the hollis-taylor report in 1951, which advocated for a graduate model of professional social work training. professional social work training developed along two separate paths characterized by differing philosophies of education that reflected differences in status, role, and mission. advances in social work, spring 2014, 15(1) 96 the year 1951 was also significant because of the founding of the council on social work education (cswe), which replaced aassw and nassa. while the creation of a “big tent” for social work education was the product of years of negotiation with input from the educational establishments, professional membership organizations, and employing social service agencies, the tension between graduate and undergraduate education remained with baccalaureate programs being viewed by many graduate programs and faculty as being less than professional. during the late 1970’s and early 1980’s the annual program meetings (apm) of cswe were filled with open hostility between baccalaureate program directors and graduate school deans. however, the responsibility for accreditation of social work programs now rested with one organization, the council on social work education. in 1959, the council’s 13volume curriculum study, known as the boehm report, became the blueprint for all professional social work education, with the exception of doctoral studies. curriculum policy guidelines were issued by the council every ten years beginning in the early 1960’s with combined education policy and accreditation standards (epas) being promulgated in 2001, 2008, and 2015 (forthcoming). nasw first recognized the bsw degree as a professional social work degree in 1968 and cswe began accrediting bsw programs along with msw programs in 1974. the role of baccalaureate social work education was further defined and specified in 1978 with the publication of educating the baccalaureate social worker: report of the undergraduate social work curriculum development project (baer and federico). throughout my first 20 years in social work education, i maintained membership in both nasw and cswe, yet i identified primarily with bsw educators, clearly recognizing that bsw educators and bsw graduates were not valued by many of my social work education counterparts. as i indicated above the historic tensions between the program levels continued even though we now lived in the same “big tent.” from 1983-1985, i served a three year term on the cswe commission on educational planning. the subcommittee of which i was a member, attempted to define the elements of a social work education “continuum.” while the subcommittee reached agreement on roles, functions, and overlapping areas of bsw and msw knowledge and skills, the organization declined to formally adopt the notion of a “continuum” of preparation for professional practice. doctoral social work programs, while clearly part of an educational “continuum” remained outside of the jurisdiction of epas. while the group for the advancement of doctoral education (gade) has adopted a set of principles for doctoral social work education, doctoral programs remain outside the purview of cswe’s specialized accreditation. while social workers are now licensed or certified in all 50 states, there are still states that do not offer licensure to baccalaureate social workers, including new york, because of continuing opposition from the clinical societies, some graduate faculty, and public employee unions. this is an interesting phenomenon given that there are three times as many accredited baccalaureate programs in new york than accredited msw programs and about a quarter of the bsw programs are in institutions also offering the msw. gelman/evolution and context of social work education 97 doctoral studies: being at the right place at the right time doctoral education is more than completing a set of required courses, passing comprehensive exams, and writing a dissertation. doctoral education is a process that is as important as the degree received at the end of the process. my doctoral education at the heller school was far from ordinary or routine. while the course work was for the most part stimulating and instructive, it was my classmates, the mentoring by faculty, and my external involvements that brought my education to life. i entered the program as one of eleven doctoral students, all of whom had extensive policy, practice or teaching experience and more than half of whom would go on to become deans of graduate social work programs. my wife and i arrived in waltham in late august of 1970 with two small children, a graduate student loan (for help with living expenses), and a fellowship that covered tuition and provided a small stipend. within one week as a doctoral student, i was offered a position as an adjunct faculty member to teach a policy course at the boston university school of social work. within two months i was volunteering with groups of teenagers, working with and advocating on behalf of institutionalized individuals with intellectual disabilities. within three months i was co-coordinating, with a heller classmate, a prison reform program at the concord reformatory. finally, within four months i was working on a federal grant that provided the data for my dissertation. networks and relationships are critical in creating professional and career opportunities. the opportunities for informal learning at heller and with professor dybwad and his wife rosemary were unbelievable. it is important to understand the context in which my informal learning occurred. the late 1960’s and early 1970’s were a critical time in establishing and defining the rights of the mentally disabled in this country and the world. the “right to education,” the “right to treatment,” the “right to habilitation in the least restrictive setting,” the deinstitutionalization/community care movement, and the principle of “normalization” in the care and treatment of the disabled were taking place around me. gunnar dybwad was a key player in these events, including an advisor or expert witness in most of the landmark court cases of the day. he had been the first director of the arc (association for retarded children) and was a consultant to the president’s committee on mental retardation (pcmr). rosemary was the secretary general of the international league of societies for persons with mental handicaps. their home was a stopping place for like-minded advocates from around the world. at least once a month, notes would appear in the study carrels of the doctoral students with interests in the disabilities field, inviting us to appear after dinner (they wanted us to have dinner with our families) at their home. there was no agenda and rarely did we know in advance who the visitor would be. we were never disappointed and often did not return home until well after midnight. to what and to whom we were exposed in this informal learning environment was priceless and provided unbelievable networking opportunities. we not only learned about the “normalization” principle, but we interacted with those who had formulated the principle in scandinavia and actually implemented it there. we met with parents and teachers who were developing innovative education and treatment programs in developing countries. we also met with justice department officials, parent advocates, and attorneys who were filing litigation aimed at advancing the rights of the disabled. advances in social work, spring 2014, 15(1) 98 periodically, a note would appear in my study carrel asking that i stop by professor dybwad’s office. the conversation often included a request that i ask my “good wife” to pack me an overnight bag—destination unknown. the most unusual of these requests involved being picked up at 5 am on a friday morning by professor dybwad and dennis haggarty, esq., a member of the president’s committee on mental retardation. we drove to logan airport and flew to new york’s laguardia airport. we were met by an unmarked van and driven to a monastery on staten island to meet with an unusual gathering of advocates, attorneys, educators, and media personalities. that planning meeting resulted in the filing of litigation that led to the eventual closing of the infamous institution known as willowbrook. over the course of my doctoral education i had the opportunity to meet and interact with most of the authors i cited in my dissertation as well as the majority of class action attorneys involved in litigating right to treatment cases. my exposure and relationship with foreign visitors later provided introductions and access to practitioners abroad. one of those connections led to my 30 plus year involvement with barnardo’s, england’s largest children’s charity. no extra credit was received and no tuition charges were incurred, but the learning/mentoring process and research opportunities were priceless. in addition to the coursework required for the degree, i was also encouraged to enroll in an interdisciplinary course led by a boston university law professor along with graduate students from harvard, boston college, and boston university. the seminar was offered under the auspices of judge david bazelon of the washington, dc court of appeals. judge bazelon had decided the landmark st elizabeth hospital right to treatment case. when it became time to form my dissertation committee i included professor dybwad, dr. kenneth jones, whose federal grant i was coordinating, and dr. david gil. dr. gil had just completed his volume unraveling social policy. during my first year policy seminar with dr. gil, the students actually critiqued every idea and construct of the draft manuscript during his class prior to its publication. i was the first student to utilize part of his analytic policy framework in a dissertation. the outside member of my committee came from the harvard school of public health, william c. curran, an attorney. the involvement of professor curran once again almost altered my career path when he invited me to enroll in the public health program at harvard. my experiences as a doctoral student were unique to the times and the individuals involved. the opportunities and connections facilitated by my mentors required a total immersion in the process. it is difficult or impossible to replicate those experiences and learning opportunities when doctoral study is part time and spread out over extended periods. my philosophy of education the form and nature of my master and doctoral education had a significant influence on my philosophy of education and my career path. i had the luxury of being a full time student in both my msw and phd programs. i was able to benefit from classroom and unusual informal learning and earning opportunities. i was fortunate to have had the exposure to and influence of a significant number of individuals who served as mentors gelman/evolution and context of social work education 99 and who guided my learning and development as an academic scholar. how i relate to and interact with students, colleagues, and bureaucracies has been shaped by those experiences. throughout my academic career i have attempted to mentor my own students in the way that i was mentored. i provided exposure, access, and involvement by maintaining an “open door” policy for students and colleagues and involving them in the work i was doing. my development as a scholar developed over time and was enhanced by my association with numerous mentors, collaboration with scores of colleagues, and involvement in several professional organizations. as i have indicated, i was fortunate not to have to worry about the cost of tuition or the burden of student loans. i was a product of the times, a time before the profession was impacted by the wonders and burdens of technology, changing sets of expectations for academics, and educational delivery systems driven by economic mandates, budget shortfalls, and increasing demands for accountability. unfortunately, future academics will not have the options or opportunities that were available to me. they will be faced with excessively high tuition, a heavy debt burden, limited access to mentors and the networks and connections they generate, and a learning environment that is shifting away from residential instruction. technology is wonderful. it provides access to resources and materials instantaneously. one can explore new ideas, review literature, and have access to cutting edge research being conducted around the world without leaving one’s office. it is possible to “skype” with colleagues around the world, collaborating on research and writing. technology has eliminated the need to spend endless hours in the library searching for primary sources. but with all its benefits, it has made many of our students look for the quick and expedient way to complete assignments. many students do not know how to write and they prefer to communicate in “tweets.” they accept as gospel what they find on the internet, and feel comfortable lifting entire sections of material they discover in their perfunctory online searches, even though they know it can and will be detected. they record class lectures verbatim on their laptops or tablets, but are reluctant to engage in thoughtful class discussions. they “text” in class and cannot be separated from their i-phones or androids. they enroll in on-line courses, not because of access issues, but because they believe it is more convenient or easier. they also often have conflicting obligations or responsibilities that take precedence over their education requirements. many avoid involvement in the informal opportunities that are made available by the program or faculty mentors. academic expectations and scholarship entry into and advancement in an educational setting is determined by a faculty member’s educational achievement (completion of a specified degree(s)), level of scholarship (the number quantity and quality of publications in professional journals), grant funding, service to the university and community, and teaching effectiveness. while these are universal attributes across all institutions of higher education, the interpretation and weighting of each attribute is a moving target within and among institutions. when i started my graduate education i knew that my msw was accepted as the terminal or highest degree in the field. while some faculty members held doctorates, they were the advances in social work, spring 2014, 15(1) 100 exception rather than the norm. therefore, even though i had never thought about teaching or about doctoral studies, i was offered an academic position. i quickly learned however, that to advance in academia one needed to have a doctorate. today, the completion of the doctorate in addition to the msw is a prerequisite for a faculty position in most accredited bachelor and all master social work programs. when i began my academic career, i had two articles accepted and in press. by the time i completed my doctorate, those two articles had been published, and a third article had been accepted. i also had published a book chapter, and a cswe monograph. by the time i was promoted to full professor in 1981 my publication record included eight articles (single author), three book chapters, two monographs, and three research reports. by today’s standards, i probably would not have been promoted or granted tenure. in the early years of my deanship, i was able to facilitate the promotion/tenure of several faculty members whose teaching and occasional publications clearly enhanced the education of our students. as time went by and expectations changed, it became increasingly more difficult or impossible to promote and retain similar contributing faculty. providing an opportunity for a faculty member to mature over time is no longer an option. today, newly minted doctoral graduates applying for entry level faculty positions in top tier social work programs are expected to have an established record (six or more) published articles in top tier journals as well as a number of research grant submissions. they are expected to hit the ground running. while my early scholarly submissions appeared in top quality journals, the bulk of my scholarly contributions did not occur until well after i had been promoted and granted tenure at penn state. during my first ten years as a graduate school dean, i published more than twenty articles and ten book chapters a well as my first co-authored book with arthur frankel. over the course of my academic career, i have had more than 100 articles and book chapters published in addition to three editions of my co-authored book on case management. i have been the sole author of more than half of those publications. my professional writing has included research and writing collaborations with numerous professional colleagues and almost two dozen were with my late colleague margaret gibelman. my point is that scholarship develops at different rates for different people and is informed and must be guided by solid practice experience. while a record of publication achieved during doctoral studies may be an indicator of future productivity, it is not the only indicator. being well published is also not an indicator of teaching effectiveness. similarly, the ability to successfully compete for grants and contracts are important expectations for a faculty member, but access and success may depend on whether a social work program is under public or private auspices, the faculty member’s teaching load, the presence of institutional infrastructure to support grant submission, funding cycles, and funding sources. many outstanding grant submissions never get funded because of reduced research budgets and/or political trends which limit funding. future full time tenured faculty will be a unique group. gelman/evolution and context of social work education 101 service (institutional/community) service expectations, while important, have never been clearly defined for faculty and too much or too little service can limit academic advancement. while not as important as scholarship and successful grant experience, excessive committee work and university service can interfere with or limit time for research and writing. community service can also have a limiting effect unless the service activities lead to expanded research opportunities and scholarship. during my second decade as an academic, i conducted numerous one or two day continuing education or in-service workshops, off campus, for agencies and their employees on topics ranging from confidentiality and record keeping to risk management and agency liability. the topics were directly related to my research interests and are reflected in many of my publications. many of those workshops were conducted in collaboration with richard levine, esq., director of the pennsylvania child advocate program. community service activities reflect a faculty member’s commitment to the profession of social work and are critical in maintaining current knowledge of practice and developments in the field. however, community service that does not benefit a faculty member in more than a monetary way does not make academic sense given current expectations and demands. professional development involvement with professional associations has been an integral part of my growth as an academic and my career in academia. in addition to my participation in cswe on educational policy, the accreditation process, and board service, i also co-chaired three annual program meetings (apms), served on the commissions of program information management and research and conferences & faculty development, the committee on spirituality, and the committee that developed the code of responsible research behavior for social workers (cswe, 2008). i have served on local, state, and national committees of nasw including the new york city latino task force, and as secretary/treasurer of the american association on mental retardation (aamr), now the american association on intellectual and developmental disabilities (aaidd). i have also served and held office with the national association of deans and directors of schools of social work (nadd) and the new york state association of social work schools of social work. i am still active with the middle states association for colleges and schools and serve on the national board of case management (nbcm). none of these activities would have been possible without the financial support and released time provided by penn state and yeshiva university. given what i have said previously about the current state of academic funding, support for such involvement may no longer be possible for many faculty members trying to build their academic careers. travel, especially international travel, which such involvement often requires, has become an academic luxury, not a necessity. as academic programs expand their reliance on adjunct faculty, to reduce personnel costs and eliminate the benefits associated with employing full time faculty, participation in professional associations and conferences will suffer, further limiting academic advancement for promising faculty. advances in social work, spring 2014, 15(1) 102 professional affiliations: a double-edged sword the decision to identify and affiliate with a professional association is a personal one. while nasw and cswe are the largest and most well known of the social work professional associations, there have always been specialized associations that represented various practice settings (i.e., hospitals, public health settings, schools, child guidance, disabilities, corrections, family services). when nasw was created in 1957, it was out of a coalition of such associations. the goals were consolidation and strength in numbers. yet the specialized groups continued to exist and additional specialized associations have emerged. this phenomenon exists within practice settings (i.e., oncology, transplant, dialysis, mental health) and within the context of social work education. undergraduate social work educators identify with the association of baccalaureate social work directors (bpd); social work researchers with sswr, the society for social work research; group workers with aaswg, now the international association for social work with groups (iaswg); community workers with acosa, the association for community organization and social administration; doctoral social work directors with gade, the group for the advancement of doctoral social work education; and social work deans in research intensive institutions with the st louis group. there are even associations for social work admissions officers, field work directors, and development officers. while these associations clearly address issues of concern for their members, they effectively limit membership in both nasw and cswe. there exists no single organization with sufficient membership to advocate effectively for the social work profession. life long learning i need to point out that the completion of the doctoral degree has never been the end of learning for a faculty member. knowledge is constantly evolving and new technology facilitates and enhances teaching and the educational process. attending conferences and workshops as well as presenting papers at professional meetings are integral to a faculty member’s growth. having those opportunities available and having the time and financial resources to participate are essential. as mentioned, given the uncertainties in academic funding, it will be more difficult for faculty to participate in structured development activities. as departmental resources for professional development become less available to faculty, expectations for promotion and tenure will undoubtedly become more daunting, and for some, virtually unattainable. knowledge continues to evolve as does the need to remain current with the rapid changes taking place within both practice and academic arenas. in a research class during my msw education, i learned how to wire a “mother board” that facilitated the sorting of data that was punched on cards. the cards had been coded to represent the answers to questions from a questionnaire and were processed on a mainframe computer. pc’s did not exist, there was no internet, and the cell phone was merely a fantasy in the imagination of people like steve jobs. students and faculty actually had to enter a library to access information. with the proliferation of our body of validated research, together with the emergence of new theories, revised conceptual frameworks, a better gelman/evolution and context of social work education 103 understanding of how racism, cultural competence, genetics, and spirituality affect human development, and changing accreditation standards impact what educators and practitioners have to know. the need for continuing education has never been greater. the amount of knowledge required of students continues to expand exponentially, while the opportunities and resources available to master that knowledge has continued to erode. it is incumbent on every faculty member to know what they don’t know and to act affirmatively to acquire new knowledge and maintain the currency and relevance of their knowledge and skills. i previously shared that during my doctoral studies i worked with attorneys involved in class action litigation. when i returned to full time teaching after completing my doctoral degree, i continued those legal collaborations in my policy research in the areas of disabilities and community reintegration. while i was familiar with legal language and process, i was never fully comfortable with the level of my understanding of the law. therefore i applied to and was accepted into a unique master degree program at yale university law school for my 1977/78 sabbatical year. not only did i fill the gaps in my knowledge and understanding of the law, but i completed the program with five papers that were later published as articles. the added knowledge enhanced my research skills, prepared me to better prepare testimony for legislative hearings, and to serve as an expert in more than a dozen legal proceedings. advancement in academia in 1990 i was offered the position of dean and professor at the wurzweiler school of social work of yeshiva university in new york city. my new school had a history of issues with cswe dating back to its initial accreditation in 1959. the school was founded in 1957 as a school for training social group workers; required courses in ethics, religious philosophy and spirituality; stressed experiential learning; and generally avoided adhering to the requirements of a scripted curriculum. the charge given to me by the university’s president and provost was to “fix” the schools relationship with cswe and raise the school’s reputation. provided with both financial resources and administrative support, and a willing faculty of outstanding teachers, those goals were achieved. my serving a three year term on the cswe board of directors, followed by a three year term on the commission on accreditation helped in anticipating and responding to emerging curricular and accreditation issues. the accreditation process has evolved over my academic career, becoming more complex. maintaining program accreditation is an ongoing process that today must involve all program faculty and administrators. the program’s structure and its relationship with both the university and the community must be identified and clearly articulated. learning objectives must be operationally defined and practice competencies identified. the program must also demonstrate how the identified practice competencies are measured. syllabi must be updated regularly and reflect not only course content and readings, but the relationship of specific assignments to desired learning outcomes. grading criteria, attendance expectations, statements regarding citations and plagiarism, advances in social work, spring 2014, 15(1) 104 accommodations for disabilities, hipaa requirements, appeal procedures, and the estimated cost of course materials must be included. this is totally different from my first syllabus that was two pages long including: the course description, a list of topics, the assigned text book, and several suggested readings. my success in meeting university expectations and developing a highly respected program led to additional unanticipated administrative responsibilities. what started out as a 13 month assignment turned into twelve years in the office of the provost changing my academic focus. while my scholarly research and writing continued, my presence in the classroom disappeared. where you are, what you do, and where your career goes is rarely planned, and often out of your personal control. my career has been guided and facilitated by an endless cast of mentors who showed interest in me as a person and developing social work professional. if it was not for their advice and counsel, i would have never entered or progressed in academia. my interpersonal skills and the relationships that resulted, along with my willingness to learn and risk were only possible in an environment in which face to face contact and opportunities for interaction were possible. while technology certainly provided new kinds of learning opportunities, many of the most meaningful opportunities that were open to me, unfortunately may no longer be available to our new generation of academics. references baer, b. l., & frederico, r. c. (1978). educating the baccalaureate social worker. cambridge, ma: ballinger publishing company. gelman, s. r. (1971). toward building the undergraduate social work library. new york, ny: council on social work education. gil, d. g. (1973). unraveling social policy: theory, analysis, and political action. cambridge, ma: schenkman publishing company. author note address correspondence to: dr. sheldon r. gelman, yeshiva university wurzweiler school of social work, 2495 amsterdam ave., new york, ny 10033. email: srgelman@yu.edu dr. sheldon r. gelman, dean emeritus, is a member of the academy of certified social workers and a fellow of the american association on intellectual and developmental disabilities (aaidd) and the new york academy of medicine (nyam). he has held office and served on national commissions of the council on social work education (cswe), including the board of directors and commission on accreditation, the national association of social work deans (nadd), the american association on intellectual and developmental disabilities (aaidd) and the national association of social workers (nasw). the author of more than 100 professional articles and book chapters, he has served as a consultant to many social welfare organizations, presented testimony before legislative bodies and served as an expert witness in more than a dozen cases. he was named a ''social work pioneer'' by nasw in 2009. microsoft word westbrook_simic_1955_copyedit final ______________ tonya m. westbrook, ph.d., is an assistant professors and josie crolley-simic, ph.d., is an associate professor, both in the department of social work at western carolina university in cullowhee, nc. this work was supported by the u. s. administration for children and families. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 603-617 perceptions of administrative and supervisory support in public child welfare tonya m. westbrook josie crolley-simic abstract: using the child welfare organizational culture inventory (cwoci) in a public child welfare agency, perceptions of administrative and supervisory support held by employees with social work degrees (bsw and msw) were compared to perceptions of administrative and supervisory support held by employees without social work degrees. child welfare employees with social work degrees reported lower administrative and supervisory support than employees without social work degrees. implications for social work educators, public child welfare administrators and supervisors, and future research are presented. keywords: child welfare workforce, administrative support, supervisory support, social work education america’s public child welfare system investigated 3.7 million reports of child abuse and/or neglect in 2008, finding that 772,000 children were victims of abuse, neglect, or both (u.s. department of health and human services, administration on children, youth, and families, 2010). employees of the public child welfare system are responsible for determining the validity of child abuse and neglect reports, determining the safety of potential victims of abuse and neglect, making decisions about removal of children from their homes and placements in foster care and other out-of-home settings, and providing abuse/neglect prevention services (crosson-tower, 2002; knudsen, 1988; samantrai, 2004). researchers have found the public child welfare workforce has been inexperienced, undereducated, and inadequately trained and has been plagued with high turnover rates and low employee retention (cyphers, 2001; dickinson & perry, 2002; drake & yadama, 1996; ellett, ellett, & rugutt, 2003; general accounting office {gao}, 2003). turnover rates in public child welfare agencies have been estimated to be between 20% and 40% annually (american public human services association, 2005; cyphers, 2001; gao, 2003), with turnover rates over two-year periods as high as 90% (drake & yadama, 1996). these workforce problems have overwhelmed the child welfare system, ultimately diminishing the quality of services provided to children and their families (cyphers, 2001; gao, 2003). causes associated with high turnover in public child welfare include inadequate supervision, lack of supervisory support, and lack of training (cyphers, 2001; ewalt, 1991; gao, 2003; samantrai, 1992). a costly implication of high turnover has been the large number of caseworkers assigned to each supervisor. in turn, supervisors have not been able to provide adequate supervision. this deficit in supervision may be especially problematic for new workers who need adequate mentoring and support to learn to perform such a complex job. another implication of high turnover is that workers are westbrook, crolley-simic/administrative and supervisory support 604 often promoted to supervisory positions within three years of beginning employment, providing child welfare agencies with a cadre of inexperienced supervisors (gao, 2003). one way the child welfare system has responded to high turnover is to reprofessionalize the field by increasing the number of employees with social work degrees with the purpose of hiring workers who would remain in the job longer and be better prepared for the job tasks than persons without social work degrees (barbee et al., 2009a; dickinson & perry, 2002; landsman, 2001). research indicated that child welfare employees with social work degrees were more satisfied in their jobs (barth, lloyd, christ, chapman, & dickinson, 2008), more effective in their jobs (barbee et al., 2009a), and were more dedicated to the field of child welfare (curry, mccarragher, & dellmanjenkins, 2005) than employees without social work degrees. to better understand employees in this overburdened system it is important to investigate employees’ perceptions of administrative and supervisory support, with particular attention to possible differences in perceptions of employees with social work degrees and employees without social work degrees. literature review this section will discuss significant literature in the areas of administrative and supervisory support for child welfare workers. also included was a review of differences between public child welfare employees with social work degrees and those without social work degrees in effectiveness, job satisfaction, and retention and turnover. administrative support in public child welfare agencies the role of child welfare administrators has been given much less attention by researchers than that of front line supervisors. administrative support has been linked to child welfare employees’ commitment to the job and correlated with workers’ intentions to remain employed in the field (ellett, 2000). samantrai (1992) reported varying employee views of administrators, with some employees finding administrators to be “doing the best” they could while others viewed administrators as “nonsupportive and adversarial” (p. 455). other studies have indicated that employees would like to have more input regarding policy decisions made by administrators (lieberman, hornby, & russell, 1988) and that administrators focused more attention on policy implementation than on practice with families and children (ellett, ellis, westbrook, & dews, 2007; westbrook, ellis, & ellett, 2006). the characteristics of effective administrators were reported in a study using focus groups of child welfare employees who had been employed in the field for at least eight years (westbrook et al., 2006). the most effective administrators were characterized as accessible, helpful, supportive, caring, flexible, knowledgeable, experienced, and understanding of the daily activities taking place in the agency. good administrators were also described as those who worked to promote a positive public image of the agency; were quick to respond to agency vacancies, using creative resolutions when necessary; and served as a buffer between the local public child welfare staff and outside entities such as the community and state level administrators and leaders. good administrators advances in social work, fall 2012, 13(3) 605 were both trustworthy and trusting of their employees and the decisions their employees made; gave priority not only to clients, but also to agency employees as well; valued the professional development of employees; placed a greater emphasis on people than on agency policies; and promoted an atmosphere of teamwork in which employees developed a sense of responsibility for each other. effective administrators were seen as an essential element of an organizational culture that generates long term employees (westbrook et al., 2006). supervisory support in public child welfare agencies supervisors tend to be more involved in employees’ daily jobs than administrators; consequently, the supportive relationships with employees may be different than those of administrators and were critical to employee retention, morale, and job satisfaction (american public human services association, 2005; cyphers, 2001; dickinson & perry, 2002; ellett, ellett, & deweaver, 2007; gao, 2003; rycraft, 1994; samantrai, 1992). public child welfare employees have reported that having a supportive supervisor was important in assisting them through poor working conditions. on the contrary, supervisors described as critical, unsupportive, and uncaring can make working conditions intolerable (samantrai, 1992). a recent nationwide study (barth et al., 2008) found the strongest predictor of job satisfaction among public child welfare employees to be quality of supervision. interestingly, child welfare employees generally perceive their supervision as high in quality, with those holding social work degrees reporting more satisfaction with supervision than those with other types of degrees (barth et al., 2008). supportive supervisors have been described in numerous studies (aphsa, 2005; barth et al., 2008; dicksinson & perry, 2002; ellett et al., 2003; rycraft, 1994; samantrai, 1992). supportive supervisors are considered to be those who are caring, helpful, sympathetic, available, good listeners, flexible, and respectful. supportive supervisors also provide emotional and instrumental support. quality in supervision includes understanding the responsibilities and demands placed on front line workers, providing fair and equitable distribution of workload, and being knowledgeable of the child welfare system and daily child welfare practice (dickinson & painter, 2009; lee, forster, & rehner, 2011; miseung, 2010; scannapieco & connell-carrick, 2007). good supervisors treat their employees like professionals; provide information to employees to help them improve their skills; set high, but realistic expectation for their employees; and offer praise to employees when it is deserved. it has been suggested that supervisors can also increase employee retention by offering clear incentives for high quality job performance; providing emotional support in addition to case guidance; encouraging continuing education; promoting efforts to increase staff morale; helping employees develop effective, constructive coping skills; and encouraging enthusiasm for the job (dickinson & painter, 2009; lee et al., 2011; miseung, 2010; scannapieco & connellcarrick, 2007). child welfare employees with and without social work degrees in the past, a social work degree, most often a msw, was the preferred minimum qualification for caseworkers in child welfare; by 2000 a bsw was required in only four westbrook, crolley-simic/administrative and supervisory support 606 states and a msw was required of supervisors in only two states (steib & whiting blome, 2003). today most child welfare agencies require only a bachelor’s degree in any field; only about one quarter of child welfare services are provided by caseworkers with a bsw or msw (steib & whiting blome, 2003). in 1987, 15% of child welfare employees held a bsw degree, 13% held a msw degree, while 56% had a non-social work bachelor’s degree and 13% had a non-social work graduate degree (lieberman et al., 1988). the number of child welfare workers with social work degrees increased slightly by 2008 to 39.5%, lowering the number of public child welfare workers with non-social work bachelor’s degrees to 48.8% (barth et al., 2008). among professionals in public child welfare, it is widely believed that it is imperative that efforts be made to recruit and retain professionally educated employees with social work degrees for public child welfare systems (barbee et al., 2009b; dickinson & perry, 2002; risley-curtiss, 2003). over the last several years, many efforts have been made to increase the number of social work degreed employees and specifically social work degreed employees with education and training in public child welfare through the use of title iv-e funded programs (barbee et al., 2009b). several studies have found relationships between the type of degree child welfare workers hold and various factors of importance to the field including effectiveness, job satisfaction, and retention. degree and effectiveness of work. numerous studies have found that child welfare employees with a social work degree were more competent and effective in their jobs than employees with other degrees or no degree (child welfare league of america, 1998; dhooper, royse, & wolfe, 1990; scannapieco & connell-carrick, 2007). in a study comparing child welfare employees with title iv-e training to other employees, barbee et al. (2009a) found several differences in the two groups. for example, workers with iv-e training were more likely to accept a report as an investigation, were more aggressive in case interventions, were more likely to substantiate a report of child abuse and/or neglect, were more likely to accurately assess risk of harm, and were more likely to provide continuing services to families more often. furthermore, iv-e trained workers were more cost efficient at their jobs and more likely to place foster children with relatives rather than in foster homes and residential facilities; iv-e workers made more adoptive home placements and used fewer emergency placements. these workers visited foster children on their caseloads more often, and more often established a permanency plan for foster children in their caseload than did workers without iv-e training. foster children in caseloads of employees in this study without iv-e education had longer stays and more moves within the foster care system than foster children whose workers held a iv-e education (barbee et al., 2009a). degree and job satisfaction. studies have also found that public child welfare employees with social work degrees are more satisfied in their jobs than those without social work education (barbee et al., 2009b; barth et al., 2008). barth and colleagues (2008) found that those with non-social work undergraduate degrees were less satisfied in the job than those with a bsw degree, a msw degree, or any graduate degree. of those public child welfare employees in this study with a bachelor’s degree, those with a bsw advances in social work, fall 2012, 13(3) 607 were more satisfied than those employees with a non-social work bachelors degree (barth et al., 2008). degree and turnover/retention. numerous studies have posited that the overall lack of social work degreed employees is a contributing factor in child welfare turnover and that improved employee retention is related to social work degree or title iv-e supported social work education among child welfare staff (dickinson & perry, 2002; ellett et al., 2003; robin & hollister, 2002; rycraft, 1994; scannapieco & connell-corrick, 2003). however, employee retention studies have found mixed results. in a recent study, barbee and colleagues (2009b) evaluated kentucky’s public child welfare certification program (pcwcp) and ten years of bsw graduates of the program. those who completed the pcwpc child welfare social work education program reported feeling highly prepared for the job, had high levels of commitment to the field of public child welfare and had increased retention over a two-year period as compared to those who entered child welfare employment without pcwcp training. however, the study also found a drop in retention at the four-year mark for pcwcp graduates (barbee et al., 2009b). dickinson and painter (2009) found employees with bsw and ba degrees were less likely to leave their jobs than employees with msw degrees. strolin-goltzman, auerbach, mcgowan, and mccarthy (2008) found that employees having a social work degree and working in an urban area were more likely to leave than employees in urban areas without social work degrees. auerbach, mcgowan, and heft laporte (2008) also found employees with msw degrees were more likely to leave child welfare employment than those without a social work degree. the above literature review demonstrates the importance of administrative and supervisory support in public child welfare it examines many studies over the past several years that have found connections between supervisory and administrative support and employees’ satisfaction, morale, and retention in public child welfare jobs. moreover, the literature review examines research finding that employees with social work degrees provide more effective services to children and their families in public child welfare. this highlights the importance of hiring and retaining employees with social work degrees. these ideas provide the rationale for the current study: to examine differences in administrative and supervisory support as perceived by employees with and without social work degrees in an effort to determine if employees with social work degrees need additional support in order to raise job satisfaction and intentions to remain on the job so that those with the best education for the work are more likely to remain in the job. purpose of the study given the importance of administrative and supervisory support, the purpose of this study was to examine differences in employees’ perceptions of administrative and supervisory support in a southern state’s public child welfare system as reported by employees with social work degrees compared to employees without social work degrees. this study was part of a larger research project involving examination of organizational culture and child welfare employees’ intentions to remain in their jobs. the data set for the analyses completed for this study was the same as that used in prior research westbrook, crolley-simic/administrative and supervisory support 608 (westbrook, ellett, & deweaver, 2009). institutional review board approval for the study was obtained (project approval number 2005-10756) before the following study procedures were initiated/completed. methodology sample this study was part of a larger research project that examined organizational culture in a statewide public child welfare system. more detailed information about the study, the sample, and the survey can be found in westbrook, ellett, and deweaver (2009). the sample for the larger research project of which this study was a part was defined as all caseworkers, supervisors, and administrators employed in a southern state’s one hundred fifty-nine county department of family and childrens services (dfcs) offices who provided services to maltreated and alleged maltreated children and their families. due to vacant positions and ever changing staff allocation figures, the exact number of dfcs employees in the population for this study could not be determined. however, according to the most recent dfcs staffing allocation statistics available prior to this study, the agency was allocated to employ 3,227 individuals in child welfare caseworker, supervisor, and administrator positions across the state. in general, most respondents were female (872 or 84.4%), with males accounting for only 12% (124) of the sample. most respondents were caucasian (617 or 59.7%) or african american (373 or 36.1%) with ages fairly evenly distributed (34.2% being 30 years old or younger; 34.6 being 41 years old or older, and 29.5% between the ages of 31 and 40). most respondents in this study were frontline caseworkers/case managers (763 or 73.9%). supervisors made up 16.6% (171) respondents and 6.8% (70) respondents were county office level administrators. a large portion of respondents reported possessing non-social work baccalaureate degrees (569 or 55.1%) and non-social work master’s degrees (127 or 12.3%). only 24.3% of respondents possessed a social work degree; 164 (15.9%) of those possessed a baccalaureate of social work degree and 87 (8.4%) possessed master’s of social work degrees. only 75 (7.3%) respondents reported no four-year college degree (44 or 4.3% with a high school education or ged only, and 31 or 3% with an associate or two year degree). two respondents (0.2%) reported having non-social work doctoral degrees. as previously reported in westbrook, ellett, and deweaver (2009), 3227 surveys were sent to child welfare workers; a total of 1,123 surveys were returned and subsequently scanned into a data file. surveys from 90 respondents were excluded from the data analyses (23 from dfcs employees in positions other than child welfare services such as adult protective services and the office of family independence, and 67 with excessive missing data). surveys were removed from analysis for missing data if nine or more item responses (10%) were missing on the child welfare organizational culture inventory or if more than one item response was missing from the intent to remain employed measure. removal of surveys from data analysis that were missing 10 percent or more of responses allowed for analysis to be completed without using statistically generated answers for missing data. this procedure also did not severely impact the advances in social work, fall 2012, 13(3) 609 return rate or number of surveys available for data analysis. these procedures resulted in a final return rate of 32% (n = 1,033 usable surveys). it should be noted that this return rate was not exact. the return rate percentage (32%) was calculated for 3,227 potential dfcs child welfare employees. the return rate was somewhat lower than desired. however it is important to note that the demographic results, with few exceptions, reasonably mirrored those of other recent, large sample, statewide workforce studies in the state (ellett et al., 2003; ellis, ellett, & deweaver, 2007). study measures participants of this study were asked to answer ten demographic questions (providing information regarding subjects’ county of employment, position and work assignment, gender, age, ethnicity, education, number of years of child welfare work experience, caseload size, and number of persons for which supervisory and administrative participants provide supervision), complete the child welfare organizational culture inventory (cwoci), and complete the intent to remain employed-child welfare scale (ellett, 2000). this study was part of a larger study that included scales not relevant to the study reported here (westbrook et al., 2009). the cwoci is an 84 item self-report measure of organizational culture in public child welfare agencies. each item is responded to using a forced-choice four-point likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree). principal components analysis procedures determined that the cwoci consists of seven dimensions; this study focused on two dimensions, administrative support and supervisory support. the administrative support subscale consists of 10 items and has been found to have a cronbach’s alpha coefficient of internal validity of .94. the supervisory support subscale consists of 20 items with a cronbach’s alpha coefficient of .97 (westbrook et al., 2009). the conceptual definitions of administrative support and supervisory support used in this study are explicated below. definition of administrative support. administrative support refers to the frequency and quality of professional child welfare staff’s interactions and relationships with agency heads that frame, encourage, and reward persistence, commitment, and excellence in professional practice. administrative support is evidenced in the agency in several ways such as the quality of interpersonal relationships between administrators and subordinates; development, explication, and enforcement of rules and policies; administrative guidance and leadership; and the provision of resources. examples of administrative support include administrators ensuring their staff have adequate resources (supplies and equipment) to complete their work and showing concern and sensitivity to staff needs and feelings (westbrook et al., 2006). definition of supervisory support. supervisory support refers to the frequency and quality of professional child welfare staff’s interactions and relationships with immediate superordinates that frame, encourage, and reward persistence, commitment, and excellence in professional practice. supervisory support is evidenced in the agency in several areas such as the quality of interpersonal relationships between supervisors and subordinates; internal and external advocacy on behalf of staff and clients; explanation of westbrook, crolley-simic/administrative and supervisory support 610 and monitoring of compliance with rules and policies; work assignments and professional decision making; and personal and organizational professional development, learning, and guidance as seen in mentoring and job orientation. examples of supervisory support are supervisors’ recognition and rewards for workers’ quality work, helping, advocating for, mentoring their workers when needed, and recognizing individual workers’ strengths and needs (westbrook et al., 2006). data collection procedures survey packets were created for all 3,227 potential participants (plus an additional 10% overage to cover miscalculations in staffing allocation, lost surveys, etc) and were mailed to county office directors with a request to distribute the packets to all child welfare employees. each packet contained a demographic questionnaire, the child welfare organizational culture inventory (westbrook et al., 2009), and the intent to remain employed – child welfare measure (ellett, 2000) all in a scannable format. a follow-up reminder letter was sent three weeks after the surveys were mailed and a second reminder letter was mailed two weeks after that. data analysis descriptive statistics (frequencies and percentages) were computed for the demographic characteristics of the sample. means and standard deviations were calculated for the administrative support and supervisory support factored dimensions of the child welfare organizational culture inventory as reported by those with social work degrees (bsw and msw) and those without social work degrees. a two-tailed t test was computed to explore statistically significant differences between social work (bsw and msw) and non-social work degree groups. all statistical analysis was performed using spss version 14. results comparisons of social work degree and non-social work degree groups descriptive statistics (means and standard deviations) were computed for the two subscales of the cwoci used in this study for respondents with and without social work degrees. administrative support was found to have a mean score of 26.38 (sd 6.65) for those with social work degrees and a mean score of 27.37 (sd 5.28) for those without social work degrees. supervisory support was found to have a mean score of 56.62 (sd 11.59) for those with social work degrees (bsw and msw) and a mean score of 58.50 (sd 9.18) for those without social work degrees. the maximum possible scores for the two subscales were 40 and 80 respectively. the results of these comparisons are shown in table 1. two tailed t tests were computed to explore statistically significant differences between social work (bsw and msw) and non-social work (all other) degree groups on the administrative support and supervisory support factors of the cwoci. statistically advances in social work, fall 2012, 13(3) 611 significant differences between the two degree groups were evident for both administrative support (t(1022) = -2.409, p<.05) and supervisory support (t(1022) = -2.69, p<.05). the mean difference between the two groups for administrative support was -.99 favoring the non-social work degree group. the mean difference between social work and non-social work degree groups for supervisory support was -1.88 favoring the non-social work degree group. table 1: summary of t test comparisons between social work (bsw and msw) and non-social work degree groups for supervisory support and administrative support factored dimensions of the child welfare organizational culture inventory factor bsw/msw non-social work degree cwoci factor mean sd mean sd mean differencea t p supervisory support (20)b 56.62 11.59 58.50 9.18 -1.88 -2.692 .009 administrative support (10) 26.38 6.65 27.37 5.28 -0.99 -2.409 .016 amean difference score calculated by subtracting non-social work degree mean from bsw/msw degree mean. bnumber of items in factored dimension discussion and implications for social work this study examined administrative and supervisory support as reported by employees in a southern state’s public child welfare system using two subscales of the cwoci. these subscales measured child welfare workers’ perceptions of the administrative and supervisory support they received. comparisons were made between the perceptions of child welfare employees with social work degrees and employees without social work degrees. the results indicated child welfare employees with social work degrees perceived less support from administrators and supervisors in the agency than employees without social work degrees perceived. this section will discuss this finding in relation to current research on administrative and supervisory support. this is the first known study to examine differences in how public child welfare employees with social work degrees and employees without social work degrees perceive both administrative and supervisory support. several prior studies have focused on examining and describing good supervisory (aphsa, 2005; barth et al., 2008; dickinson & perry, 2002; ellett et al., 2003) and administrative support (ellett, 2000; ellis et al., 2007; lieberman et al., 1988; samantrai, 1992). other studies have found links between supervision and employee retention, morale, and job satisfaction (aphsa, 2005; cyphers, 2001; dickinson & perry, 2002: ellett et al., 2003). also research studies suggest that child welfare employees with social work degrees are more effective in their westbrook, crolley-simic/administrative and supervisory support 612 jobs (cwla, 1998; scannapieco & connell-carrick, 2007) and are more satisfied with their jobs (barbee et al., 2009b; barth et al., 2008). numerous studies have examined the relationship between degree type (social work degree and non-social work degree) and retention or turnover. the results of these studies have been mixed with some finding social work degreed employees more likely to remain in their jobs (dickinson & perry, 2002; ellett et al., 2003; scannapieco & connell-carrick, 2003) and others finding that employees with social work degrees are more likely to leave their jobs (auerbach et al., 2008; strolin-goltzman et al., 2008). in summary, supervisory and administrative support is important in retaining child welfare workers (dickinson & perry, 2002; ellett et al., 2003; gao, 2003) and the number of child welfare workers with social work degrees has risen over the years (barth et al., 2008). the perception of supervisory and administrative support could very well be important in retaining these employees. the results of this study should be understood within the context of some strengths and limitations. first, this survey was administered to a statewide public child welfare system with every employee in the statewide system having an opportunity to participate. second, although the study was completely voluntary, it was supported by the director of the statewide public child welfare agency. a letter from the director, indicating her support and requesting that all employees complete and return the study, was included with the survey for all participants. finally, the pen and paper style survey provided in a scannable format was found through a time and clarity study (westbrook et al., 2009) prior to this administration to take only about twenty minutes to complete, making it fairly easy for all employees to be included. the study should be considered in the light of several limitations as well. first, participation was completely voluntary and responses to the surveys should be considered in that light. thus, it is possible that those employees choosing not to participate in the study might be more dissatisfied (or satisfied) with the agency than those who did complete and return the survey. as well, employees who did not participate in the study might have had larger or more challenging and timeconsuming caseloads that prevented them from having the time available to complete and return the survey than those with fewer job demands. second, the response rate (32%) was somewhat lower than desired. however, the demographic characteristics of respondents were highly similar to other large-scale studies of child welfare professionals in the state with much higher to slightly higher response rates (e.g., ellett et al., 2003; ellis et al., 2007). finally, surveys with excessive missing data were omitted from data analysis. given the large sample size and the limited effect this had on results, the authors felt this was an appropriate strategy for handling those few surveys with more than 10% of answers missing. implications this study has raised several implications for the profession of social work, specifically in the areas of education, practice, and research. first, social work educators could help address the issue of unmet supervisory needs by ensuring that students develop skills in identifying their supervisory needs and skills to advocate for those needs. social work education could also focus more on teaching students about organizational culture in large agencies, particularly child welfare agencies. studies of advances in social work, fall 2012, 13(3) 613 professional organizational culture in public child welfare agencies (ellett, 2000; ellett et al., 2003) suggest that employees are more likely to remain employed in public child welfare if there is congruence between actual and preferred perceptions of administrative support. in order to better prepare students about the realities of large agencies and better prepare them for the workforce, social work education could include current research on organizational culture and child welfare. second, there are several practice implications. child welfare agencies could focus efforts on improving administrative and supervisory support, particularly for employees with social work education. for instance, agencies could utilize existing research to inform training efforts for administrators and supervisors. ideally, supervisors should be aware of the varying needs for support of their employees, and facilitate their educational and skill development (scannapieco & connell-carrick, 2007), as well as attend to their emotional needs (miseung, 2010). for instance, those without a social work degree may benefit more by supervisory support that focuses on training and education, and those with social work degrees may benefit from equal amounts of supervisory support that focuses on emotional support (lieberman et al., 1988). several explanations could account for the reasons child welfare employees with social work degrees perceived less support from both administrators and supervisors than employees without social work degrees in this study. first, employees with social work degrees may have different expectations or needs from administrators and supervisors. second, administrators and supervisors could be providing different types and/or amounts of support and supervision to employees with social work degrees than to those without social work degrees. recommendations for future research that explore these hypotheses are explicated below. research has documented a connection between supervisory support, job satisfaction, and intent to leave (barth et al., 2008; ellett et al., 2007). in this study, employees with social work degrees perceived less administrative and supervisory support, which may indicate less satisfaction in their job and reduced intentions to remain in the job. research has also clearly indicated that public child welfare employees with social work degrees have better job performance than those without social work degrees (barbee et al., 2009a; barbee et al., 2009b). therefore, child welfare agencies may be at risk of losing their best performing employees. future research exploring these possible connections could offer insights into how child welfare agencies might improve retention of employees and outcomes for families and children. because several explanations could account for the reasons child welfare employees with social work degrees perceived less support from both administrators and supervisors than employees without social work degrees in this study, future research should compare the supervisory needs of employees with social work degrees with those without social work degrees. still other research could explore whether administrators and supervisors provide different amounts and types of support to employees with social work degrees and those without. if employees with social work degrees have different needs and expectations of administrators and supervisors, an explanation could be that through their educational westbrook, crolley-simic/administrative and supervisory support 614 training, social workers likely developed expectations of administrators and became familiar with their own supervisory needs. for instance, those with social work education likely enter the job with knowledge that receiving emotional support and support for selfcare can be just as important in a job as receiving case consultation and instrumental support, whereas those without social work degrees would not have this understanding. this hypothesis could be explored in future research studies by exploring and comparing the supervisory and administrative needs of child welfare employees with and without social work degrees. if social work educated employees have differing needs and expectations than those without social work degrees, it could be because those with social work degrees have identified as social workers through their choice of educational attainment giving them occupational commitment (landsman, 2001). therefore, the job and the position of “social worker” is a part of their identity. whereas those without social work degrees likely see their work in public child welfare as simply a “job,” not as an integral part of their identity. therefore, those with social work degrees might perceive greater need for administrators and supervisors to be involved in promoting a positive public image of the agency. if administrators are not working toward positive community relations and public image, those with social work degrees might feel more slighted by this because of their stronger identification with and commitment to the organization and profession (ellett et al., 2007; landsman, 2001; strolin-goltzman, mccarthy, & caringi, 2007). research of administrators’ efforts in improving public relations and employees’ needs and perceptions of those efforts could explore this hypothesis. the second possible reason that child welfare workers with social work degrees perceived less supervisory support could be that administrators and supervisors provided less support to employees with social work degrees than to those without. supervisors often believe the most important aspect of their job is teaching and training employees (ellett, 2006). employees with social work degrees are typically more competent and effective in their jobs (barbee et al., 2009a; scannapieco et al., 2007) and likely are seen as having the knowledge, skills, and abilities to perform the job well. to complicate matters further, those with social work degrees may even seek advice less than employees without social work degrees (lieberman et al., 1988). therefore, as bachelor and master level social workers enter positions in child welfare, supervisors and administrators may assume those employees require less time and attention in order to perform their job well. research is needed to determine if supervisors and administrators provide differing amounts or types of support to employees based on perceived educational differences. finally, little research has examined the role of public child welfare administrators overall. research studies could examine administrator roles, employees’ expectations of administrators, and satisfaction with administrative support. references american public human services association. 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(2003). current challenges and future directions for collaborative child welfare educational programs. journal of human behavior in the social environment, 7(1/2), 207-226. robin, s. c., & hollister, c. d. (2002). career paths and contributions of four cohorts of iv-e funded msw child welfare graduates. journal of health and social policy, 15(3/4), 53-67. rycraft, j. r. (1994). the party isn’t over: the agency role in the retention of public child welfare caseworkers. social work, 39(1), 75-80. samantrai, k. (1992). factors in the decision to leave: retaining social workers with msws in public child welfare. social work, 37(5), 454-549. advances in social work, fall 2012, 13(3) 617 samantrai, k. (2004). culturally competent public child welfare practice. pacific grove, ca: brooks/cole-thomson learning. scannapieco, m., & connell-carrick, k. 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(2010). child maltreatment 2009. retrieved from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can westbrook, t. m., ellis, j., & ellett, a. j. (2006). improving retention among public child welfare workers: what can we learn from the experiences of committed survivors? administration in social work, 30(4) 37-62. westbrook, t. m., ellett, a. j., & deweaver, k. w. (2009). development and validation of a measure of organizational culture in public child welfare agencies. research on social work practice, 19(6), 730-741. author note: address correspondence to: tonya m. westbrook, department of social work, health and human sciences, 4121 little savannah rd., room 322, western carolina university cullowhee, nc 28723. email: twestbrook@wcu.edu microsoft word cho_police intervention in domestic violence final _________________ hyunkag cho, ph.d., is an assistant professor in the school of social work at michigan state university. dina j. wilke, ph.d., is an associate professor in the college of social work at florida state university. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 283-302 does police intervention in intimate partner violence work? estimating the impact of batterer arrest in reducing revictimization hyunkag cho dina j. wilke abstract: a variety of societal interventions in intimate partner violence have been established for decades, including the police actively arresting perpetrators. however, it is difficult to find consistent study results to show if arrest is effective. moreover, there are far fewer studies on victims than on perpetrators. this study utilized the national crime victimization survey to examine if victims whose partners were arrested were less revictimized than those whose partners were not arrested. results clearly showed that arrest of perpetrators was effective in reducing revictimization, controlling for victims’ characteristics and the nature of violence incidents. also, separated or divorced women showed the highest risk of revictimization. comparisons with previous studies and implications on police policies are discussed. keywords: intimate partner violence, domestic violence, criminal justice, police, revictimization introduction violence against women by their male intimate partners has been recognized as a serious social problem for decades. according to the national violence against women survey, approximately one quarter of women have been victimized by intimate partners in their lifetime compared with only 8% of men (tjaden & thoennes, 2000). victims of intimate partner violence (ipv) suffer severe physical, mental, and psychological consequences of violence (goodman, koss, & russo, 1993a, 1993b; monahan & o'leary, 1999; schumacher, feldbau-kohn, slep, & heyman, 2001). more tragically, 33% of the women killed in the u.s. in 2004 were murdered by their male partners (fox, 2006). a variety of societal interventions were established to address ipv throughout the 1970s and 1980s. domestic violence shelters have provided supportive services for victims and their children such as a temporary safe refuge, childcare, and legal advocacy. police departments have encouraged officers to arrest perpetrators, while prosecutors have proceeded with charges against batterers without victims’ participation. victim protection orders have been issued by courts to prevent batterers from being in close physical proximity to the victim, and voluntaryor court-ordered batterer treatment programs have been developed (cho & wilke, 2005; roberts & kurst-swanger, 2002). historically, the police disregarded ipv as a private and family matter (r. berk, berk, loseke, & rauma, 1983; browne, 1995; dobash & dobash, 1979; lafree, 1981), and had taken “a do-nothing approach” by just “cooling off” the batterer (roberts & kurstswanger, 2002, p. 103). more recently though, since ipv was recognized as a crime, the police moved from the traditional passive approach to ipv into taking a more active role cho, wilke/does police intervention in intimate partner violence work? 284 in controlling it. upon arriving at a reported domestic violence incident, the police are expected to arrest the batterer if necessary and provide victims with emergency aid and relevant information. major intervention strategies of the police include warrantless arrest and pro-arrest policies which have increased arrest rates up to 70% from 1984 to 1989 following the implementation of pro-arrest policies (baumer, felson, & messner, 2003). when 111 grantees funded by the arrest policies program established under the violence against women act of 1994 were reviewed, the arrest rates significantly increased across all grantees (archer, dupree, miller, spence, & uekert, 2003). another study that looked at ipv incidence and arrest data from maryland also found that the warrantless arrest policy had a significant positive impact on arrest likelihood (simpson, bouffard, garner, & hickman, 2006). the major theoretical framework supporting the arrest of batterers in response to ipv is deterrence theory. this theory contends that when police impose a meaningful reward or punishment (e.g., arrest) for ipv, batterers will be deterred from perpetration (pate & hamilton, 1992; salazar, baker, price, & carlin, 2003; williams, 2005). such deterrence is accomplished in two ways; specific deterrence and general deterrence (gibbs, 1985; mcguire, 2002; stafford & warr, 1993). specific deterrence refers to “the deterrence of potential offenders who have been legally punished” (gibbs, 1985, p. 88) or “effects on those who have suffered” (stafford & warr, 1993, p. 123), and general deterrence refers to “the deterrence of potential offenders who have not been legally punished” (gibbs, 1985, p. 88) or “effects on the general public” (stafford & warr, 1993, p. 123). deterrence is believed to occur when a potential offender avoids criminal behavior out of a desire to avoid the legal punishment of the behavior (gibbs, 1985; williams, 2005). while arrest is supposed to affect batterers through deterrent effects, victims are also affected by arrest of the batterer. for instance, arrest may send a strong message to victims that domestic violence is a serious social problem and handled by the police seriously. positive experiences with the police may lead victims to actively seek assistance from the police and others, which will increase their future safety and decrease revictimization. another effect of arrest to victims would be the increased number of arrests of female victims along with male perpetrators (dual arrest; finn, blackwell, stalans, studdard, & dugan, 2004; martin, 1997). it is not clear whether the increase resulted from women’s increased perpetration of ipv, or reflects police officers’ interpretations of pro-arrest policies. there may be loopholes in pro-arrest policies that may disadvantage victims rather than protecting them. if the victim were dissatisfied with, or disadvantaged by, the involvement of the police, victims would be less likely to report future ipv incident to the police and seek help from others, which may make victims more vulnerable to revictimization than before the police involvement. in this context, revictimization after arrest would be a good way to estimate the impact of arrest on victims. it is difficult to find consistent study results to show if arrest is effective. while some argue that more batterers are arrested (archer et al., 2003), others suggest that the police are still unwilling to arrest the batterer (dugan, 2003). some contend that police began to effectively control ipv as shown by reduced recidivism rates (maxwell, garner, & fagan, 2001), but others suggest that arrest has failed in deterring batterers from future violence, advances in social work, fall 2010, 11(2) 285 providing victims safety, and reducing incidents of ipv (danis, 2003). one of the challenges facing social workers who serve a variety of clients affected by ipv—victims and perpetrators—is the lack of consensus on how the criminal justice system should deal with ipv. social workers often find it hard to decide on the best actions to stop the perpetrator’s abusive behaviors, ensure the victim’s safety, and provide a better environment for their families (danis, 2003). the current study attempts to fill this gap by using nationally representative data to examine whether victims would be less revictimized if the perpetrator were arrested, when compared with those whose partners are not arrested. review of the literature effects of arrest on batterers one of the most famous and influential studies on the effect of batterer arrest is the minneapolis domestic violence experiment conducted from 1981 to 1982, the first randomized and controlled test of the effectiveness of arrest (sherman & berk, 1984). a total of 314 cases were randomly assigned to one of three police choices; arresting the batterer and detaining him overnight (43% of 314 cases), separating the couple by having the batterer leave for eight hours (28%), and just providing advice and information (28%). repeat offenses of each of three options were measured 6 months after the treatment both by official police records and victim interviews. the findings show that arrest was the most effective option as the recidivism rate for arrest cases was 10% based on official police records, compared with 19% for advice cases and 24% of separation cases. recidivism rates based on victim interviews were somewhat different; 19% of the victims reported revictimization for arrest cases, 37% for advice cases, and 33% for separation cases. these results significantly contributed to the nationwide adoption of active police policies. five replication studies of the minneapolis experiment were conducted between 1985 to 1990. the first study was conducted in omaha, ne, and overall experiment conditions were similar to the minneapolis experiment (dunford, huizinga, & elliott, 1991). this study failed to find a statistically significant difference in recidivism rates among the three police choices. in milwaukee, wi, cases were assigned to somewhat different police choices: arrest for 12 hours, arrest for 4 hours, or simple warning of future arrest (sherman, schmidt, rogan et al., 1992). recidivism rates for both arrest conditions were lower than a warning at 6 months, with no difference between the two types of arrest. however, there was no difference among three choices in recidivism rates 11 months later. a third study in charlotte, nc also used somewhat different police options: providing advice or separating the couple, issuing a citation for court appearance, and arresting the batterer at the scene (hirschel & hutchison, 1992). in this study, there was no significant deterrent effect of arrest. the fourth study conducted in colorado springs, co utilized a large sample of 1,658 cases assigned to one of four options: emergency protective order only, emergency protective order and crisis counseling, emergency protective order and arrest, and restoring order at the scene (r. a. berk, campbell, klap, & western, 1992). while official police records showed no difference among the options, cho, wilke/does police intervention in intimate partner violence work? 286 victim interviews found that arrest had deterrent effects. further, police records showed that arrest had a slightly higher deterrent effect for employed batterers than those unemployed, although this was not confirmed through victim interviews. finally, a study in miami, fl involved two stages of police intervention; stage 1 compared arrest with no-arrest, and stage 2 compared a follow-up assignment to specialized service units with no follow-up (pate & hamilton, 1992). significant deterrent effects of arrest were found based on both police official records and victim interviews 6 months after the arrest. arrested batterers showed a significantly lower recidivism rate (15%) than those not arrested (27%), but also fewer violent episodes than those not arrested. the follow-up services showed no difference in recidivism rates. clearly the results of studies on arrest are inconclusive. methodological limitations may account for some of these results. maxwell and colleagues (2001) attempted to control for some of these limitations by completing a meta-analysis of these studies. they reported that after pooling these studies and controlling for the differences, overall recidivism rates for arrested batterers were significantly less than those not arrested based on victim interviews, although no difference was found based on the police official record. while the empirical data are inconclusive, the ideological debate is heated. for example, opponents of arrest suggest that the assumption of an active police response to protect victims is largely an untested ideological assertion (danis, 2003; ford, 2003; travis, 1998), and question the effect of arrest on long-term victim safety. proponents of pro-arrest policies argue that the best way to address ivp is arrest, especially since no other police response is more effective (r. a. berk, 1993), and the problem lies with lenient law enforcement and sentencing rather than arrest by itself (baumer et al., 2003; stark, 1996). broadly speaking, it might be plausible to think that arrest cannot be studied independently because it is just one part of the broader criminal justice system (gondolf, 2002). effects of arrest on victims research examining the relationship between arrest of batterers and victims’ revictimization rarely includes victim characteristics. this may partly be related to concerns that, rather than establishing a context in which violence occurs, including victim-related variables in a study connotes blaming victims for the violence (cattaneo & goodman, 2005). nonetheless, several victim-related variables have been suggested as either predictors of revictimization or moderators of the relationship between arrest and revictimization, including age, race, marital status, educational attainment, and injury. while age is often included in a list of control variables in studies of ipv, it does not appear to be a consistent predictor of revictimization (cattaneo & goodman, 2005; mears, carlson, holden, & harris, 2001). some insisted that older women are more likely to be revictimized than the younger because they often stay in the abusive relationship due to low self-esteem, dependency, or fear of retaliation (chaudhuri & daly, 1992; ferraro, 1997; flowers, 1996; giles-sims, 1983). others contended that older women might have more experience with ipv than the younger and more active in utilizing resources and services for victims to avoid revictimization (klein, 1996). advances in social work, fall 2010, 11(2) 287 race has been a controversial issue in ipv research, although ipv occurs across all races and ethnicities. some research reported high victimization rates among racial minorities (carlson, harris, & holden, 1999; mears et al., 2001). on the one hand, it may be because they reported ipv to the police more frequently than the white. the minority groups may have limited access to legal and socio-economic resources, and the police may be the only way for them to deal with ipv (s. l. miller & wellford, 1997). on the other hand, it may be because of their experience of oppression. the minority groups may consider the police as “one of them” and be reluctant to report ipv to the police, which may make them vulnerable to ipv (kingsnorth & macintosh, 2004; sampson & wilson, 1995). however, one study reviewing sixty-four studies concluded that race and ethnicity were not associated with ipv victimization (cattaneo & goodman, 2005). overall, researchers have been cautious of proposing any relationship between race and ipv because it is hard to properly contextualize race within the overall social environment (mears et al., 2001). studies that examine the relationship between the victim’s marital status and revictimization are inconclusive. some suggest that revictimization rates are higher for married victims because they cannot end the abusive relationship due to their lack of independence and personal power, which leads to the higher risk of revictimization (mccloskey, 1996), while others fail to show any relationship (cattaneo & goodman, 2005). educational attainment has been identified in many studies as being negatively related to revictimization (cattaneo & goodman, 2005; farmer & tiefenthaler, 2003; schumacher et al., 2001; tjaden & thoennes, 2000). higher education attainment will be related to higher independent incomes and more access to economic resources, which will help victims take active coping strategies in dealing with violence (rusbult & martz, 1995; waldrop & resick, 2004). however, there are also studies showing that revictimization is positively associated with higher educational attainment (wooldredge & thistlethwaite, 2002). some studies reported no relationship between injury and revictimization (holt, kernic, lumley, wolf, & rivara, 2002), but others suggested that revictimization rates were less for victims suffering severe ipv incidents than others (j. l. miller & krull, 1997). victims of severe ipv may develop more active forms of behavioral coping skills (e.g., ending the violent relationship, seeking legal help, and avoiding potentially abusive new partners), which may reduce the risk of revictimization (waldrop & resick, 2004). one study reported that revictimization rates decreased when the police arrested batterers seriously assaulting victims, which suggests that an effect of arrest may be greater for severe ipv (harrel & smith, 1996). there are, at least, two studies that utilized the national crime data to examine the relationship between reporting to the police and revictimization. langan and innes (1986) using the national crime survey (ncs) from 1978 to 1982 found that calling the police reduced subsequent assaults by 62% during a 6-month time period following an ipv incident. felson, ackerman, and gallagher (2005) analyzed the national crime victimization survey (ncvs) from 1992 to 2002. they found that not reporting to the police increased the odds of revictimization by 89%, but the effect of arrest was cho, wilke/does police intervention in intimate partner violence work? 288 statistically non-significant. no victim characteristics such as race, education, poverty or marital status were associated with revictimization. previous research did not succeed in yielding consistent results on the effectiveness of arrest, and focused mainly on the effects of arrest on batterers, ignoring effects on victims. although the major beneficiary of arrest should be victims who are supposed to be safer after their partners could no longer perpetrate violence due to arrest, there are far fewer studies on victims than on perpetrators. moreover, results from a few studies on victims are inconclusive. this study attempts to fill a gap by examining the effects of arrest on victims after controlling for several victim characteristics. specifically, this study examines if, according to victim self-report, batterer arrest prevents revictimization after accounting for age, marital status, education and injury. it is expected that victims whose partners are arrested will experience lower rates of revictimization than those whose partners are not arrested. method data this study used the national crime survey (ncs) from 1987 to 1992 combined with the ncvs from 1993 to 2003. the ncs collected crime victimization information since 1973 and was replaced with the redesigned ncvs in 1992. the purpose of the survey’s redesign was twofold. first, screening questions were enhanced to improve reporting of crime by stimulating respondents’ recall. second, additional questions were included to capture more about the nature and consequences of victimization (kindermann, lynch, & cantor, 1997). the ncs before 1987 did not collect data on arrest, and therefore was excluded from the analysis. the u.s. census bureau conducts the ncs and the ncvs annually on behalf of the bureau of justice statistics, gathering detailed crime data from a nationally representative sample of households that consist of about 100,000 individuals living in about 50,000 households. the dataset provides three levels of information; household-level, personlevel, and incident-level data. further, each respondent in the sample is followed for three years, allowing the revictimization of individuals to be detected longitudinally. the ncvs asks respondents if they were criminally victimized during the previous six months. for each victimization incident, respondents are asked detailed questions including perpetrator arrest. population and sampling the target population of the analysis is women age 18 and over who reported being a victim of intimate partner violence. the sample for the ncvs was selected with a stratified, multi-stage, cluster design, and respondents are selected using a rotating panel sample design (u.s. department of justice, 2004). households are randomly selected and all age-eligible individuals become part of the panel. once in the sample, respondents are interviewed every six months for a total of seven interviews over a three year period. the first and fifth interviews are face-to-face; the rest are by telephone. after the seventh advances in social work, fall 2010, 11(2) 289 interview the household leaves the panel, and a new household is rotated into the sample. the ncs and ncvs have consistently obtained a response rate of about 95%. since this study was to examine if victims whose partners were arrested were revictimized less frequently than those whose partners were not arrested, the study sample consisted of respondents who reported being a victim in one interview and had been followed up for a year. the one year follow up was selected for two reasons. first, most of the previous experimental research examined recidivism rates 6 months to one year after the intervention (i.e., arrest). using one-year follow-up rates would be most comparable to those studies. second, a preliminary analysis of the original ncvs data before selecting the study sample showed that most revictimization (94%) occurred within the first year following an ipv incident. relatively few cases were missed, therefore, when limiting the follow-up period to one year thus maximizing sample size. variables ipv is defined in the ncvs as a violent crime against women, including rape, sexual assault, robbery, aggravated assault, and simple assault, committed by a current or former male spouse or boyfriend (catalano, 2008). as a result, this study includes only violence against women by men, excluding same sex couples, as there appear to be differences from heterosexual relationships that could influence arrest (griffin, 2001; island & letellier, 1991; a. j. miller, bobner, & zarski, 2000). also, psychological and emotional violence are also excluded, for they are not usually considered by the police as criminal conduct, and the severity and degree of physical assaults and injuries are associated with judgment regarding arrest (nicholls & dutton, 2001). the study utilizes one dependent variable (revictimization), one independent variable (arrest), and six control variables (age, race, educational attainment, marital status, injury, and survey time). this study did not include other perpetrator-related information from the ncvs, such as offenders’ age, race, alcohol or drug use, and use of a weapon, because the main interest of the study was in victims’ characteristics. revictimization is defined as a woman being victimized a second time within one year following an ipv incident (this may include multiple partners), and is measured through self-report (1 = a victim was revictimized, 0 = a victim was not revictimized). arrest is defined as the police taking a batterer into custody, and is also assessed according to the victim (1 = the police arrested the batterer, 0 = the police did not arrest the batterer). the first control variable, age, is entered as a continuous variable. race is a categorical variable with three categories; white as the omitted category, black, and others. educational attainment is a categorical variable with three categories; less than high school diploma, high school diploma, and at least some post-secondary education as the omitted category. marital status is a categorical variable that has five categories; married, widowed, divorced, separated, and never married as the omitted category. injury is a categorical variable with three categories; minor injury (bruises, black eye, cuts, scratches, swelling, chipped teeth, and other injuries suffered), severe injury (gunshot wounds, knife wounds, internal injuries, broken bones, and knocked unconscious), and no injury as the omitted category. finally, the instrument itself went through a redesign in changing from the ncs to the ncvs. in an effort to control for potential differences due cho, wilke/does police intervention in intimate partner violence work? 290 to instrumentation, survey time was included in the analysis as a dichotomous variable (0 = those who were first interviewed by the ncs, 1 = those who were first interviewed by the ncvs). results sample characteristics a total of 3,495 cases were included in the analysis; 1,162 from the ncs data (1987 to 1992) and the remaining 2,333 cases from the ncvs (1992 to 2003). a brief summary of sample characteristics is shown in table 1. more than half of victims were widowed, divorced, or separated (51%) and almost one third were never married (32%). the majority of victims were white (84%), followed by black (14%), and had a high school education or more (81%). more than two thirds of victims were injured from an ipv incident (70%). while the majority of injuries was minor, 8% of the victims reported severe injury. about one of five batterers (22%) was arrested, while 18% of victims reported being revictimized. finally, the mean age of victims was 31. table 1: sample characteristics arrest revictimization yes 774 (22%) yes 620 (18%) no 2,721 (78%) no 2,875 (82%) marital status educational attainment married 603 (17%) under high school 669 (19%) widowed 42 (1%) high school 1,415 (41%) divorced 871 (25%) over high school 1,411 (40%) separated 870 (25%) race never married 1,109 (32%) white 2,919 (84%) injury black 488 (14%) minor 2,167 (62%) others 88 (2%) severe 298 (8%) age: mean = 30.87 sd = 9.49 no injury 1,030 (30%) logistic regression analysis results the forced entry method was adopted for the logistic regression analyses as many researchers have recommended this method for theory testing (studenmund, 2000, as cited in field, 2000). results of the logistic regression analysis are reported in table 2. arrest, age, marital status, and survey time were shown to have a significant impact on advances in social work, fall 2010, 11(2) 291 the odds of revictimization, while race, injury and educational attainment were nonsignificant. as expected, arrest was shown to have a significant effect in preventing revictimization. the odds of revictimization for victims whose partners had been arrested were 43.2% less than those whose partners had not been arrested, after controlling for age, race, marital status, educational attainment, injury, and survey redesign (exp(β) = .568). age had a small preventive effect on revictimization (exp(β) = .984). for each additional year, the odds of revictimization declined by 1.6%. revictimization rates varied depending upon marital status. divorced or separated women were more likely to be revictimized than those never married (exp(β) = 1.511 and 1.525, respectively). the odds of revictimization for separated women were 47.5% higher than unmarried women, and divorced women were 48.9% more likely than unmarried women to be revictimized. finally, redesign of the survey from the ncs to the ncvs had an impact on revictimization reports. victims who were interviewed using the ncvs showed odds of revictimization 45.8% greater than those interviewed with the ncs (exp(β) = 1.458). table 2: logistic regression analysis summary β s.e. wald df p-value exp(β) arrest -.566 .104 29.815 1 .000 .568 age -.016 .005 10.965 1 .001 .984 race1) 2.583 2 .275 black .269 .363 .548 1 .459 1.308 others .023 .391 .003 1 .953 1.023 marital status2) 14.387 4 .006 married .228 .129 3.120 1 .077 1.256 widowed .171 .409 .175 1 .676 1.186 divorced .413 .166 6.182 1 .013 1.511 separated .422 .114 13.704 1 .000 1.525 injury3) .319 2 .853 minor -.044 .079 .312 1 .577 .957 severe -.015 .163 .008 1 .929 .986 educational attainment4) 2.574 2 .276 under high school -.120 .125 .908 1 .341 .887 high school .078 .097 .653 1 .419 1.081 survey time5) .377 .176 4.599 1 .032 1.458 * omitted category: 1) white, 2) never married, 3) no injury, 4) over high school, 5) ncs cho, wilke/does police intervention in intimate partner violence work? 292 a look at the cross-tabulation of arrest and revictimization may help to intuitively understanding the effect of arrest on revictimization (table 3). although the majority of victims were not revictimized regardless of arrest, 19.2% of victims whose partners had not been arrested were revictimized, compared to 12.7% of victims whose partners had been arrested. table 3: cross-tabulation of arrest and revictimization was she revictimized? total yes no was he arrested? yes 98 (12.7%) 676 (87.3%) 774 (100%) no 522 (19.2%) 2,199 (80.8%) 2,721 (100%) total 620 2,875 3,495 discussion the logistic regression analysis of the effect of arrest on victims’ chance of revictimization showed that arrest reduced the odds of revictimization by 43.2%, after controlling for age, race, marital status, educational attainment, and injury. this result is consistent with results of some experimental studies (r. a. berk et al., 1992; pate & hamilton, 1992; sherman & berk, 1984; sherman, schmidt, rogan et al., 1992), and particularly with maxwell et. al.’s (2001) meta-analysis of five replication studies on effects of arrest. the meta-analysis found that although official records showed no significant effect of arrest, victim interviews revealed that if batterers were arrested, recidivism rates were reduced by 25%. note that in the current study, the reduction of revictimization related to arrest was 39.6%. although direct comparisons of results between this study and maxwell et al.’s might be inappropriate because of methodological differences (e.g., national survey sample versus local experimental samples), a conjectural comparison can be made for future research. the difference in the size of arrest effect between 25% for maxwell et al., and 39.6% for this study might result from the difference in the time frame when the two sets of data were collected. the five replication studies used in the maxwell et al., study were conducted between 1985 to 1990, while this study used the ncvs data from 1987 to 2003. deterrence theory suggests that arrested batterers would be deterred by the punishment (specific deterrence), but potential batterers who have not been punished would not be affected much by an arrest unless they become aware of legal punishment for ipv (gibbs, 1985) and avoid committing the offense (r. a. berk & newton, 1985). therefore, there would be a time lag before such a general deterrent effect could be realized. the arrest of batterers has steadily increased since the mid 1980s (archer et al., 2003; baumer et al., 2003), which in turn could suggest that through a general deterrent effect, there would be a time-lagged increase in size of arrest effect. while the specific deterrent effect of arrest is clearly shown by the study results, the general deterrent effect advances in social work, fall 2010, 11(2) 293 is less clear. one previous study attempted to measure the general deterrent effect by examining the temporal relationship between ipv incidence rates and arrest rates over time, and found the former decreased as the latter increased (cho, 2007). table 4: change in arrest effect before and after 1990 β s.e. wald df p-value exp(β) until 1990 (n = 798) -.142 .321 .196 1 .658 .868 after 1990 (n = 2,697) -.627 .160 15.334 1 .000 .534 to explore the possibility of general deterrence, two separate logistic regression analyses were run using ncvs data through 1990 and after 1990, respectively (table 4). from 1987 through 1990, arrest had no significant effect in preventing revictimization. after 1990, however, the odds of revictimization following arrest were 46.6% less than compared to those whose partners had not been arrested, when controlling for age, race, marital status, educational attainment, and injury (exp(β) = .534, p < .001). these results may suggest that the effect of arrest has increased over time, particularly since 1990, which may help to explain the difference in size of arrest effect between this study and maxwell et al.’s meta-analysis. however, it must not be overlooked that the positive changes in ipv after 1990s may be the results of a variety of efforts to address ipv, including improvements both in services for ipv victims (e.g., shelters, children’s program, and counseling programs) and in women’s socio-economic status, the increased provisions of legal services for victims, and numerous state and federal laws enacted to address ipv, as well as the active police intervention (cho & wilke, 2005; farmer & tiefenthaler, 2003). another difference between this study and maxwell et al.’s is a focus on revictimization versus recidivism rates. the current study examined arrest effect by revictimization rates and found these rates to be 12.7% for arrest cases and 19.2% for unarrested cases. however, maxwell et al. used recidivism rates and found them to be 36% for arrest cases and 48% for unarrested cases, which were at least two times higher than our study. this difference might result partly from a variation in measurement. recidivism in the maxwell et al. study included reoffense committed only by the same batterer, while revictimization in the current study included reoffense by another batterer as well as the same one. it is not certain which one would show higher rates. revictimization rates may be less than recidivism rates because the victim might have left the batterer after the violent episode so that reoffense by the previous partner would not have occured. in other words, victimization might have been transferred to another victim without being revealed. on the other hand, revictimization rates may be higher than recidivism rates because the former includes victimization from a new violent partner as well as the previous one. this possibility could not be tested with the ncvs because it did not distinguish the new partner from the previous one. finally, the difference in revictimization rates between the two studies could also have resulted partly from different definitions of ipv which was defined more broadly in the maxwell et al. cho, wilke/does police intervention in intimate partner violence work? 294 study than it was in this study. while they included verbal threats of physical or property damage in addition to physical violence, this study included only physical violence. consequently, revictimization rates in the current study should be less than recidivism in the maxwell et al. study. again, this possibility could not be further tested with the ncvs as it did not include verbal threat of property damage in the survey. it is worth noting that the deterrent effect of arrest shown in this study was not found in a previous study that used a research method similar to this one. felson et al. (2005) used the ncvs from 1992 to 2002 and found that reporting to the police, which was not included in this study, significantly reduced the odds of revictimization but arresting the batterer did not. for the purpose of comparison, reporting to the police was added as a independent variable to the analysis (data not shown). similar to felson et al. (2005), arrest did not have a significant effect on revictimization, but reporting to the police did. this indicates that reporting to the police and arrest have mostly overlapping impacts on revictimization, and arrest effects may be a subset of reporting effects. future research is needed to further examine how reporting to the police interacts with arrest to lead to reducing revictimization. in addition to finding that arrest has had an effect in reducing revictimization and that effect has increased over time, this study revealed other important aspects of an arrest effect; that is, the chance of revictimization varies according to characteristics of victims. specifically, the victim’s age and marital status were shown to have effects on revictimization, while race, educational attainment, and injury were not. the study found a negative relationship between age and odds of revictimization indicating that not only is lower age a significant predictor of victimization, but it predicts revictimization as well. regarding marital status, separated women showed the highest odds of revictimization, followed by divorced women, while married or widowed women were not different from the unmarried. these results did not support previous data which found higher revictimization rates for married women than unmarried women (mccloskey, 1996), or no relationship between a marital or cohabitation status and revictimization (felson et al., 2005). one reason for the higher risk of revictimization for separated or divorced women may be their vulnerability to being contacted by their violent partners after separation. however, this possibility could not be tested as the ncvs data did not allow an examination of whether victims were separated or divorced after victimization, or whether they were revictimized by the same partner. while separated or divorced women have a higher risk of revictimization, requiring targeted prevention efforts for them, marital status alone may not be a good predictor of revictimization. for the quality and context of the relationship may play a greater role in ipv dynamics than the type of relationship between the batterer and victim (e.g., legal marital status, cohabitation, and dating; cattaneo & goodman, 2005; cole, logan, & shannon, 2008). given the mixed evidence with regard to the relationship between batterer and victim, future research may need to pay more attention to contextual factors of the interpersonal relationship than the status of relationship itself. the ncs was replaced with the redesigned ncvs in 1992 to collect more accurate and detailed information of criminal victimization. in order to develop an adjustment advances in social work, fall 2010, 11(2) 295 factor that would be used to make two surveys comparable, half of the data were collected with the ncvs, and half were collected with the ncs for an 18-month period from 1992 to 1993. the ncvs has produced higher violent crime rates than the ncs after the adjustment was made (e.g., 50% increase from 32 to 48 per 1,000 persons in 1992; rand & catalano, 2007). the current study found 45.8% higher odds of revictimization for the victims interviewed using the ncvs compared to those interviewed with the ncs. given that there is no known study to suggest a large increase in criminal revictimization after 1992, this study’s result is likely a reflection of the higher crime rates produced by the redesigned survey. conclusion this study found that arrest of batterers had an effect in reducing revictimization, which was different for different victims, providing support for the deterrent effect of arrest. the specific deterrent effect was realized when the chance of revictimization decreased after the batterer had been arrested by the police. further, there may be some evidence to suggest a general deterrence effect as well, as there was an increase in the effect of arrest effect after 1992. however, these conclusions should be viewed within the context of the study’s limitations. first, the overall effect of arrest will most likely be different according to the subsequent actions of the criminal justice system after arrest. however, this study did not examine those differences, but only considered characteristics of victims and ipv incidents. some researchers have suggested that a particular intervention such as arrest cannot be isolated from other factors and truly be studied independently. arrest is just one part of the broader criminal justice response that also includes prosecution, adjudication, probation, victims service, and other coordinated community services (gondolf, 2002). to comprehensively understand the effect of arrest, future research needs to examine ipv victims from incident to arrest through prosecution to determine the effect of criminal sanction on a victim’s long term safety. this study examined the effect of arrest, controlling for victims’ age, race, marital status, educational attainment, and injury, but did not control for other important victimrelated factors including income and employment. consequently, differential effects of arrest according to different victims’ characteristics could not be further examined. with all major victim-related factors included, future research can comprehensively examine in what conditions, and with whom, police intervention in ipv is most effective. in addition, it should be noted that policies on ipv and police officers’ implementation of them vary across police jurisdictions as well as states. however, this study could not control for those issues as the public-use ncvs does not provide any geographical information of respondents. finally, the data in the ncvs de-contextualizes a violent episode in that the level of fear or on-going intimidation in a relationship are not assessed, something that johnson and ferraro (2000) in their typology of ipv referred to as intimate terrorism. the johnson and ferraro typology also includes a classification referred to as common couple violence which is more minor in nature and can be perpetrated by either partner in a relationship. it may be that the low arrest and revictimization rates found in this study are related to cho, wilke/does police intervention in intimate partner violence work? 296 the perpetration of common couple violence. however, that concern is somewhat moderated by the fact that 70% of respondents in this study indicated they were injured during the violent episode indicating a degree of severity. overall, this study demonstrated important relationships between arrest and revictimization. first, arresting batterers significantly reduced revictimization regardless of different victims’ characteristics, and this effect has grown stronger over time. proarrest policies have been questioned by some researchers on the grounds that arrest has no effect on repeat, unemployed batterers and therefore even increased the risk of revictimization for some victims (hirschel & hutchison, 1992; maxwell et al., 2001; sherman, schmidt, & rogan, 1992). the study results provide clear support for pro-arrest policies, although perpetrator characteristics were not examined. age has a negative relationship with revictimization, in that older victims have lower odds of being revictimized than younger victims. also, considering separated or divorced women showed the highest risk of revictimization, strict enforcement of protective orders may be an important strategy for protection. further, the lack of relationship between injury and revictimization indicates that police need to consider all available information in responding to a domestic violence call, and not over-emphasize one factor, such as injury. the police have actively intervened in ipv since the 1980s. many research results, including this study, support that police intervention helps in reducing revictimization of ipv. along with other societal responses, police intervention may have contributed to a 52% decline in ipv between 1993 and 2003 (cho & wilke, 2005). also, it might have contributed to the increase in ipv incidents reported to the police from 48% in 1993 to 60% in 2005 (catalano, 2008). while a great deal of work needs to be done to reduce ipv, the positive effect of police intervention, demonstrated by this study, is encouraging and provides several implications for social work research, practice, and policy. this study found that arrest effects varied, depending on the sociodemographic characteristics of the victims and, potentially, of the perpetrators. future research needs to include information on both victims and perpetrators in examining the effects of perpetrator arrest on victims’ future safety, and to identify factors that influence those effects. social work practitioners will benefit from the research through an increased ability to make informed decisions that will better serve clients affected by ipv; client characteristics should be taken into consideration to judge whether those clients would be helped by certain types of criminal justice interventions. in this context, coordinated community intervention is particularly relevant to social work policy. this intervention model was developed in the 1980s, to better meet the needs of clients affected by ipv. it facilitates communication, and the sharing of resources and information among a variety of agencies in the community: the criminal justice system, social workers, and providers of health care and other human services (pence & mcmahon, 1997; pennington-zoellner, 2010; worden, 2001). given that social workers have utilized a variety of collaboration models over the years— including group work and community organization—social workers can play, and indeed have played, a critical role in community coordination (saleebey, 2004). the current advances in social work, fall 2010, 11(2) 297 study results can be used to improve current procedures for coordinated community interventions and to develop new policies that can, in turn, address ipv more effectively. references archer, c., dupree, c., miller, n., spence, d., & uekert, b. 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(2004). coping among adult female victims of domestic violence. journal of family violence, 19(5), 291-302. williams, k. r. (2005). arrest and intimate partner violence: toward a more complete application of deterrence theory. aggression and violent behavior, 10(6), 660-679. wooldredge, j., & thistlethwaite, a. (2002). reconsidering domestic violence recidivism: conditioned effects of legal controls by individual and aggregate levels of stake in conformity. journal of quantitative criminology, 18(1), 45-70. worden, a. (2001). models of community coordination in partner violence cases: a multi-site comparative analysis. washington, dc: u.s. department of justice, national institute of justice. author’s note: address correspondence to: hyunkag cho, ph.d., msw, assistant professor, school of social work, michigan state university, 254 baker hall, east lansing, mi 48824. email: chohyu12@msu.edu microsoft word 20. acquavita and tice_3160_peer review in a social policy course copyedit_final ______________ shauna p. acquavita, ph.d., msw, is an assistant professor in the school of social work at the university of cincinnati. carolyn j. tice, dsw, is professor and associate dean of the school of social work at the university of maryland, baltimore county. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 629-641 peer review in a social policy course: lessons learned shauna p. acquavita carolyn tice abstract: peer review is a tool that provides students with a sense of how their work is perceived by others. built on refection and feedback, peer review assesses the quality of academic processes and products based on well-understood criteria. peer review was implemented in a baccalaureate social work policy course to enhance writing and critical thinking skills. students were surveyed on their experiences and indicated that peer review activities provided beneficial learning exercises. the information gathered suggests methods for future implementation of peer review in social work education. keywords: peer review, education, social work, writing skills, critical thinking writing assignments are an active form of learning, especially when students receive feedback and have the opportunity to revise their work (althauser & darnell, 2001). the structural process of peer review advances learning as students contemplate ideas and transfer their thoughts to words (althauser & darnell, 2001). thus, peer review connotes a process in which students assess one another’s work using specific criteria and provide feedback to each other designed to improve writing and critical thinking skills (van den berg, admiraal, & pilot, 2006). while peer review is common in the professional world with activities such as journal articles and grant proposals, few students have the opportunity to engage in the peer review process (liu, pysarchik, & taylor, 2002). peer review is an important tool in social work education because it promotes selfexamination, assessment, interpersonal interaction, and verbal and written communication—fundamental skills necessary for professional social work practice (lemieux, 2001). although useful strategies for incorporating peer review in the classroom setting are available for instructors (fitzgerald, 1989; topping, 1998; van den berg et al., 2006), there is little research found on students’ perception of the peer review process as a tool for learning in social work. literature review peer review process and background peer review has its roots in ancient greece as a method of evaluation; it was the physician ishaq bin ali al-rahwl (854–931 ce) of syria who first described the peer review process as a method to evaluate the care provided by physicians in the context of a patient’s recovery (burnham, 1990). during the 17th century, scientific clubs of scholars debated the origin and validity of theoretical frameworks, establishing processes of announcing, validating, and accrediting scientific discovery. however, the review process was not considered standard practice until the mid-20th century (fitzpatrick, 2009). acquavita, tice/peer review in a social policy course 630 the practice of peer review emerged in the social science community with the publication of professional journals; it ensured that only valid and reliable evidence was published. thus, much like scientific scholars, social scientists saw peer review at the heart of good scholarly publishing and a standard practice for all reputable journals. peer review is used in social work practice through: systems of policy development; program implementation; intervention or service plans; monitoring; evaluation; and the dissemination of evidence or findings. social work research also requires peer review in grant funding, internal review boards, research methodologies, data collection and interpretation, and the publications of evidence or findings. social work educators have used peer review informally for many years as a way to enhance students’ writing skills. the review process involves students in a collaborative learning effort whereby they benefit from commenting on the work of others, and use critical thinking skills to nurture the development of their classmates’ writing skills. more recently, with the need for evidence to validate that peer review is related to the efficiency and effectiveness of learning, educators began conducting research on this pedagogical method. falchikov and goldfinch (2000) concluded that peer review involves a judgment of work based on standards whereby students assess their own work and that of peers. to paraphrase, peer review is sometimes known as peer response (gillam, 1990), peer assessment, peer marking, or peer feedback (topping, 1998). whatever the name, the process of peer review remains somewhat consistent across disciplines. namely, grading rubrics or open-ended questions are used to assess the quality of such writing elements as the expression of ideas and content, general organization, and fluency. over the last several years, there appears to be an increased use of peer review to mark learning and achievement (hattie & timperley, 2007). topping (1998) performed a literature review of 31 studies on peer review conducted from 1980 to 1996. topping’s account of the research is qualitative, descriptive, and based primarily on the interpretation of researchers. the summary findings indicate that peer review is capable of outcomes equal to or better than teacher assessment when objectives, expectations, and the collaborative nature of the process are communicated. it was also found to be reliable and valid in many applications (topping, 1998). falchikov and goldfinch (2000) conducted a meta-analysis of 48 quantitative peer assessment studies, of which 30 were not included in topping’s review, to investigate student-teacher agreement in marking. results indicated that global assessments based on clear, concise criteria were essential to peer review. moreover, multiple ratings were not found to be better than ratings by singletons (falchikov & goldfinch, 2000). lemieux (2001) used peer review in a graduate-level social work practice class to revise assignments. high correlations were found among instructor, peer, and selfevaluation scores. students reported peer review was challenging, but helpful (lemieux, 2001). a similar finding was reported by althauser and darnall (2001) who used peer review to evaluate draft answers to take-home essay questions using a web-based advances in social work, fall 2013, 14(2) 631 conference system. results indicated the better the peer review, the higher the quality of revised essays. reese-durham (2005) facilitated a peer review process in an applied research education course with 19 students. students reported the feedback was helpful because they learned that more substantial information was needed in their research paper. further, the instructor found the quality of papers received was much higher than those submitted by students from previous classes that did not use peer review (reese-durham, 2005). an experimental study of peer review consisting of 168 history students was conducted by van den berg and colleagues (2006) to determine the best combination of design features. it found the optimal size of feedback groups seemed to be three or four, with sufficient time between peer and teacher assessment for students to revise their drafts. peer review, however, was not found to lead to higher grades as compared to those who did not have peer review, but the majority of students who utilized peer review found their revised papers better than the drafts. this outcome was supported by price, o’donovan, and rust (2007) who were unable to demonstrate any statistically significant differences in grades between 503 students who attended an optional workshop on peer review and 91 students who did not. students, however, felt the peer review workshop was valuable (price et al., 2007). saito and fujita (2009) provided strong support for peer review within the context of group presentations. their study of 83 japanese first-year college students found overall similarity between peer and instructor assessments, along with some notable differences in item difficulties. their results also suggest that students appreciated the support offered through the peer review process (saito & fujita, 2009). perspectives associated with peer review reasoned thinking and effective writing are critical competencies of social work practice (council on social work education [cswe], 2008). peer review, as a vehicle to enhance student competency development in these two areas, is underpinned by compatible perspectives that highlight the values and principles of the social work profession. it is the experience-based learning of peer review that integrates these perspectives into a pedagogical approach. social constructionism is integral to peer review because it facilitates learning by encouraging people to make sense of their own realities and accept responsibility for their beliefs and values (gibbons & gray, 2004). sharing ideas through social dialogues, engaging in reflection, and considering alternative perspectives are distinguishing features of social constructionism and subsequently, peer review. indeed, the contention is that students learn through their interactions with others in an environment that encourages the social conditions for experiences and provides the resources to enhance their informed understanding of the world. experiential learning, another perspective associated with peer review, links critical thinking to the “iterative process of doing-critiquing-doing-critiquing” (doll, 1993, p. acquavita, tice/peer review in a social policy course 632 174; gibbons & gray, 2004). dewey (1910) and later freire (1994), both proponents of experiential learning, recognized that students need to engage in an independent, selfdirected approach to learning whereby the teacher is a facilitator of knowledge, not the expert. peer review does this through the processes of writing, reading, reviewing, discussing, and revising in the context of independent study and working relationships. dialogue and reflection lead students to different points of view and expand their fund of knowledge by exploring various interpretations, giving and providing feedback, and communicating ideas. the strengths perspective based on the ecological theory, with its focus on dynamic interactions and active participation, contributes to peer review by suggesting that clarity of thought and communication adds power and control to students as they work toward a sense of self as professional (saleebey, 2006; tice & perkins, 1996). components of the strengths perceptive, collaboration, reciprocity, acknowledging individual realities, and building upon unique characteristics, give voice to students’ ideas as they discover their power to influence through thought and word. social constructionism, experiential learning, and the strengths perspective suggest that peer review complements the values of social work and offers educators a pedagogical approach that enhances a nurturing classroom environment in which students integrate their learning with that of others. thus, implied in peer review is the notion that students are empowered to direct changes in their thinking and writing through a dynamic process. method peer review is widely used in a variety of course subjects and learning activities. however, in order for peer review to be successful for students, their thoughts on the process are needed. the purpose of this study was to examine social work students’ perceptions of the peer review process. the peer feedback activity consisted of reviewing a policy-related paper in a social work social policy class. students were then surveyed at the end of the class on the peer review experience. participants enrolled in a mid-size united states honors university, the student participants (n = 64) ranged from sophomore to senior undergraduates majoring in social work, sociology, political science, or psychology. participants were selected from three baccalaureate social policy classes taught over the span of three years in the spring semester (table 1). initially, 66 surveys were returned; however, two surveys from different years did not have responses to five or more questions on different scales. those two surveys were excluded from analysis. procedure the study’s method, participant description, and procedures were defined and submitted to the university’s institutional review board. approval to conduct the study was received. advances in social work, fall 2013, 14(2) 633 table 1. sample for peer review (n = 64) class number of students percent of sample 1 12 18.8% 2 16 25.0% 3 36 56.3% total 64 100.0% for several reasons, the second course in a two-course social policy sequence was selected for the study. first, the course examined the current american social welfare system by analyzing state and federal policies related to a range of social issues. thus, the purpose of the course supported a significant writing assignment that required problem recognition, critical thinking, research, and the integration of multiple sources of knowledge. secondly, because of the course’s writing assignment, it was considered “writing intensive” by the university. more specifically, scholarly research, writing frequently in and/or out of class, feedback on writing, and discussions of the work students were doing as writers occurred at various points during the semester. lastly, the assignment, in the context of course content, encouraged students to reflect upon and understand the importance of conveying thoughts and policy positions to a varied audience. consequently, writing was seen as a vehicle of knowledge acquisition and distribution. at the beginning of the spring semester a major writing assignment, consisting of approximately 15 pages, was introduced to the students. the assignment, divided into three distinct components, involved using a framework to analyze a current social policy. the peer review process included: 1) providing students with a 30-minute lecture on american psychological association style writing, expectations for peer review, and components for good introduction and conclusion paragraphs; 2) distributing examples of introduction and conclusion paragraphs and asking students to consider how to improve them; 3) dividing students into pairs and exchanging drafts of the assignment components according to a specified timeline; 4) assessing the drafts according to the same standardized form, or rubric, the instructor would use; 5) providing the instructor with the reviewed drafts for review and comments; and, 6) returning the drafts to students by the following class with the peer review and instructor comments. at the end of the course, students were surveyed on their experiences of peer review for course improvement. measures the measurement tool consisted of 14 survey questions previously used in two other studies to assess the peer review experience. a comment area was also provided for written feedback in the study. authors’ permissions were received to use both measures. peer evaluation. students’ perspective on the helpfulness of the peer review experience was measured by a peer evaluation (pe) scale (reese-durham, 2005). six acquavita, tice/peer review in a social policy course 634 likert-type response scale questions (1 = strongly disagree, 5 = strongly agree) were used for this study. examples of items are “this activity was helpful in my revisions for this paper” and “my feedback should be useful for revising the paper.” information on psychometric properties from the previous study was not available. in this study, cronbach’s alpha was found to be .90. positive attitude subscale. students’ overall attitudes to peer review were assessed by the positive attitude subscale (pos) (wen & tsai, 2006). it is an eight-item, selfreport questionnaire with a five-point likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree). cronbach’s alpha was found to be .86 in the wen and tsai (2006) study and .93 in this study. results using spss 15.0, a kruskal-wallis test and frequencies were used to examine peer assessment feedback. there were no variables with 5 percent or more missing values; thus, hot decking was used as a procedure for handling missing data. hot decking is the process of replacing missing values with a response from a participant who provided similar answers on non-missing items (andridge & little, 2010). the kruskal-wallis test was chosen to test for differences among groups on the pe and pos measures, since data were not normally distributed. the results of these tests were not statistically significant, indicating no differences among the three groups of students. results indicate that overall, students found peer review to be beneficial (table 2). specifically, peer assessment was found to be helpful to their learning. they reported peer assessment activities increased the interaction among themselves and their classmates, the highest mean in the survey. students felt the feedback they received was clear, understandable and constructive. students felt the feedback they provided to their peers would be useful for revising the student’s paper they reviewed. however, students rated the peer review activity lower for being helpful to revise their own paper. this was interesting, as the mean for students reporting they understood their role as peer reviewer was quite high. students seemed to think peer review was fair to assess performance. seventeen baccalaureate students provided written comments. the majority of the feedback was positive, such as “peer review worked for me” and “i haven’t done it in a while, and it helped keep me on track.” a student thought the peer review process reduced anxiety about submitting the paper: “i felt better because it was less pressure to have a classmate review the paper first.” the peer collaboration was also enjoyed by students: “i love the peer interaction and feedback. it really helps for the paper.” there were, however, four comments about the lack of participation from their partner in the peer review process. another student reported they did not find it valuable: “i like the idea of peer assessment, but honestly i didn’t get a lot of useful information.” advances in social work, fall 2013, 14(2) 635 table 2. survey responses (n = 64) scale item mean median mode sd 1 (pe) helpful for revisions 3.78 4.0 4.0 1.03 constructive feedback received 3.92 4.0 4.0 .93 feedback was clear and understandable 3.78 4.0 4.0 .95 understood role as peer reviewer 4.11 4.0 5.0 .94 able to give constructive feedback 3.92 4.0 4.0 .98 feedback given should be useful 4.06 4.0 4.0 .83 2 (pos) helpful to my learning 3.89 4.0 5.0 1.05 understood more about requirements 3.77 4.0 4.0 1.05 improved verbal communication skills 3.78 4.0 4.0 1.02 motivated learning 3.38 3.0 3.0 1.15 increased interaction between teacher and student 3.30 3.0 3.0 1.16 developed a sense of participation 3.81 4.0 4.0 .99 increased interaction between classmates and student 4.14 4.0 5.0 1.10 fair to use to assess performance 3.71 4.0 4.0 1.13 discussion the objective of this study was to collect students’ responses to and assessment of the peer review process so as to improve the process for future classes. results from the study corroborated wen and tsai’s (2006) findings that peer assessment increases interactions among classmates. additionally, the outcome that peer review increases verbal skills supports gillam’s (1990) report that peer assessment improves students’ ability to communicate. these results demonstrate how peer review contributes to the strengths perspective, as students are engaging with one another and collaborating on a specific educational assignment, helping to develop a professional identity. the findings were also consistent with prior studies’ claims that students found peer review helpful to promote effective writing (lemieux, 2001; price et al., 2007). this conclusion indicates students considered alternate perspectives through their interactions of others, demonstrating social constructionism. it is interesting to note that while the respondents thought their feedback would be helpful to others, they did not view the feedback they received to be as useful as what they had provided to their peers. an explanation of this could come from a lack of exposure to experiential learning, whereby students have limited experience giving and acquavita, tice/peer review in a social policy course 636 providing feedback to their peers. furthermore, perhaps this response reflects the first stage in reynolds’ (1985) five-step model of learning, where danger or hesitation is associated with new skill acquisition. with this idea as a backdrop, it would be essential that students receive ongoing written and verbal encouragement throughout the peer review process. ideally, such supportive comments would increase the confidence of students to experiment with and improve their writing skills. feedback on the peer review process provided an opportunity for the course instructor to incorporate different pedagogical strategies to improve the course’s writing assignments. the overall goal of the following strategies is to make student writing more infused in the course’s design and classroom activities. lessons learned included: consider writing a group effort, not an individual task. unlike the peer review process associated with the publication of professional articles or the funding review of grants, peer review with students in the context of the classroom necessitates supportive relationships where candor and constructive criticism are received within a framework of confidence and understanding. to nurture the establishment of collegial relationships, the earlier in the course that instructor-assigned or student-selected pairs or groups are formed, the more time there is for meaningful communication and trust to develop. ideally, a learning environment emerges from those relationships that are less focused on individual achievement and more directed toward group improvement of writing as an interconnected process. share copies and sections of the assignment to set a standard. as in the peer review process where good introduction and conclusion paragraphs are reviewed and criteria for excellence is discussed, students should have the opportunity to read and discuss noteworthy examples of written assignments (gehr, 2005). this is a characteristic of social constructionism. it allows for analysis of various writing styles, self-reflection and a sense of support for judgments (gibbs & gambrill, 1996). further, questions regarding the expectations and criteria associated with the assignment can be addressed before students engage in their writing. sequence assignments. written final assignments often loom over a course in an overwhelming manner. breaking a major writing assignment into discrete components, allowing for peer review of those components, providing feedback, and requiring synthesis of the components into a comprehensive whole underlines a process of writing comprised of drafts, reflection, revision and integration, a hallmark of experiential learning. this process also encourages students to work on the writing assignment over time in a thoughtful manner (sterngold, 2004). designate inand out-of-class time for peer review and discussion. introducing peer review assumes a commitment to writing as a process of thinking, drafting, revising, rethinking, and editing (vourlekis & hall, 2007). the allocation of class time to this process signifies its importance and the integral role writing has to the course content. the course syllabus should specify when class time will be devoted to peer review, thus allowing students to think ahead and prepare. assigning a grade to peer review also highlights the significance of participation. advances in social work, fall 2013, 14(2) 637 design a feedback rubric for peer review. as stated in the peer review process, the drafts of assignments were reviewed according to the same standardized form, or rubric, that the instructor used. creating a rubric for peer review forces consideration, in an objective fashion, of the major and minor elements of the writing assignment. it also supports the use of the strengths perspective, as students actively engage in the peer review process. a standard format also provides the instructor and students with a guideline for knowing the content and writing expectations and marking improvement in both areas over time. highlight the role of the instructor in the peer review process. peer review broadens the audience to whom student writers are responsible because someone other than the course instructor will review their writing (reid, 2006). however, it is the instructor who can connect comments on writing skills with a demonstrated understanding of course content. consequently, the instructor’s comments should be prompt and thorough, affording students the opportunity to meet with the instructor as needed. connect with university student support services. students with different writing skill levels and academic experiences enroll in a course. peer review involves active learning whereby students conduct ongoing analysis, synthesis, and evaluation of presented material (bronwell & eison, 1991). the anticipated benefits of active learning include improved attitudes toward the acquisition of new information, enhanced critical thinking, improved writing skills, and increased retention of material (bronwell & eison, 1991). therefore, through the peer review process, students might recognize their academic strengths as well as their needs to seek assistance from a writing center or some sort of tutoring. in this way, collaboration between the class instructor and supportive ancillary services is seen as an important alliance in developing academic capacity, including writing skills. issues relating to peer review while the positive aspects of peer review have been highlighted in this study, it is also important to consider some shortcomings, including: student anxiety, social embarrassment, possible plagiarism, and an unwillingness to provide feedback to peers or accept peer feedback (topping, 1998). for example, one student from the study reported, “if a person has poor writing skills, they may not want it to be known by their peers.” peer review may encourage those students having difficulty to meet with the instructor before problems occur and seek outside tutoring in order to improve their writing. a proactive approach is sequencing sections of papers. it can help with this issue because students can be identified early on in the semester if they are experiencing difficulties. another student in the same class stated, “some peers do not hold the same level of skills as others.” following van den berg and colleagues’ (2006) suggestion of having feedback groups consisting of three or four students may help this problem. incorporating student feedback in the peer review process is suggested, as well as training students on the application of peer review, giving and receiving feedback, and incorporating feedback into their work (topping, 1998). instructors also need to model how to give comments (fitzgerald, 1989); it is important for social work students to learn acquavita, tice/peer review in a social policy course 638 how to give and receive criticism because this will occur throughout their social work career. implications for social work this study suggests that peer review is an important process for students for several reasons. first, it exposes them to other writing styles. it allows students to give and receive feedback, a vital skill set to master in the social work field. in addition, it prepares students to work in groups. further, peer review teaches self-examination (lemieux, 2001). students receive comments on their work, and they then choose whether or not to incorporate the feedback in their writing. as future social workers, it is important for students to become familiar with the peer review process since it will occur in their career. grant proposals, conference proposals and journal manuscripts are all peer reviewed. further, some agencies incorporate a peer review in the hiring process. for social work educators, peer review presents an opportunity to shift emphasis from instructor-directed learning to active learning. in the resulting learning environment, course design, time allocation, and class discussions affirm student contributions and skill improvements while providing continuous constructive feedback. thus, by assuming a more facilitative role, instructors support active learning in which students simultaneously reflect on course content as they improve their writing skills. furthermore, there is a direct relationship between peer review and the educational policy and accreditation standards established by the council on social work education (cswe, 2008). specifically, peer review supports educational policy 2.1.3 which discusses critical thinking and the need to demonstrate written communication skills in professional relationships. a rubric designed for the peer review can be used to report student competency in this standard and also benchmark both individual and aggregated grades. the findings of this study have several implications for future research. namely, data supports the need for research that evaluates if differences or similarities on receptiveness of peer review exist in relation to students’ skill levels and demographic characteristics. the study also raises important issues as to whether peer review is powerful enough to assist students with significant writing challenges. evaluating students’ writing skills before and after receiving peer review would shed insight into this issue. furthermore, a question for consideration is whether the value of peer review is advantageous in one course, or should the pedagogical approach be applied more broadly across curriculum for maximum benefit. for example, should peer review only be used in policy or research courses, or in all assignments in courses that require journal articles and other scholarly sources? moreover, examining instructors post-peer review and the changes that occur to the process would be helpful to improve the overall quality of this teaching method. study strengths and limitations strengths of this study include the use of an anonymous survey, decreasing the likelihood of response bias. additionally, the findings are consistent with those from advances in social work, fall 2013, 14(2) 639 several previous studies. furthermore, this study provided information on peer review from a student’s perspective, adding to the literature. some limitations to this study include the small sample size and a fluctuating sample size from year to year. also, conclusions drawn from the study findings and attempts to generalize them must be treated with caution because the data is based on a survey from a small population of students in one university system. moreover, the results must be understood as student perceptions rather than actual effects on student learning. finally, peer review was only used in a social policy course, thus limiting the study’s findings and its relevance to other courses. conclusion this exploratory study offers ideas for consideration. through the application of peer review, students become aware of their capabilities in writing, critical thinking, selfreflection, and nonjudgmental inquiry. the instructor needs to be mindful of the interrelationship among these components of learning, and strive to present course content, design assignments, and provide feedback in an integrative manner. by doing so, there is a more complete assessment of skill and knowledge acquisition. conceptualizing peer review in the context of social work practice is another point for consideration. social work practice demands clear, concise writing coupled with critical thinking (cswe, 2008). the process of review engages students in a change effort that encourages seeking assistance, following a plan of action, and evaluating outcomes. furthermore, peer review prepares students for their social work career by knowing how to successfully provide and receive feedback, a key component in providing services to others. while prior studies on peer review have reported positive effects on students’ writing skills (van den berg et al., 2006), this study encourages social work educators to further examine the peer review process based on student perceptions and experiences. not unlike the process of seeking help in other arenas, peer review encourages students to improve their academic performance by examining limitations and strengths in a candid fashion. social work educators can lead by example: by soliciting feedback from their students to improve upon their pedagogy. references althauser, r., & darnell, k. 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(1917). social diagnosis. new york, ny: russell sage foundation. saito, h., & fujita, t. (2009). peer-assessing peers’ contribution to efl group presentations. relc journal, 40(2), 149-171. saleebey, d. (ed.). (2006). the strengths perspective in social work practice (4th ed.). boston, ma: pearson/allyn & bacon. sterngold, a. (2004). confronting plagiarism: how conventional teaching invites cybercheating. change, 36(3), 16-21. tice, c. j., & perkins, k. (1996). mental health issues and aging: building on the strengths of older persons. belmont, ca: brooks/cole publishing. topping, k. (1998). peer assessment between students in colleges and universities. review of educational research, 68(3), 249-276. van den berg, i., admiraal, w., & pilot, a. (2006). design principles and outcomes of peer assessment in higher education. studies in higher education, 31, 341-356. vourlekis, b., & hall, d. m. h. (2007). outcomes from a baccalaureate program’s writing improvement initiative. the journal of baccalaureate social work, 13, 6780. wen, m. l., & tsai, c. c. (2006). university students’ perceptions of and attitudes toward (online) peer assessment. higher education, 51, 27-44. author note: address correspondence to: shauna p. acquavita, ph.d., msw, assistant professor, school of social work, university of cincinnati, 1515 west french hall, po box 210108, cincinnati, oh 45221-0108. email: acquavsa@ucmail.uc.edu ______________ ralph woehle is a professor emeritus at the university of north dakota. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 422-438, doi: 10.18060/18426 united they’re cited: impact of a social work coauthor network ralph edward woehle abstract: social work has emphasized the importance of the social environment, and social networks are an important means of understanding the social environment. the scholarship of a journal coauthor network provided important findings and an example. prior theory and research suggested there are more citations from the center of coauthor networks than at the periphery. using abductive logic, complexity theory, social network analysis, and tabular analysis of a social work coauthor network, the center of the network was found to produce more citations than the periphery. both the prestige of coauthors’ setting and position were modestly associated with network centrality and citations. the functionality of citations, which includes the contribution to good scholarship, is questioned. areas of further research and issues of evaluating coauthored scholarship are discussed. placing greater value on coauthoring and publishing with less prominent coauthors for tenure and similar decisions is recommended. keywords: network analysis, coauthored articles, citation achievement, complexity theory, abductive logic, social work scholarship social work scholarship has become increasingly collaborative. computer models of social interaction have produced theory and logic of social networks, and a common area of study of such networks has been that of academic coauthors. research has found that coauthor network centrality has been associated with citations, though there have been contending interpretations of citations. from such work and with publically available data, the present study examined the development of a social work coauthor network and the impact of that network on scholarship. using exploratory abductive research, this study examined whether network centrality measures were associated with authors’ citation advantages and if those measures and citations were related to academic prestige. importance for social work long-standing critiques of social work and social science might be addressed with the study of social networks as complex systems. though social work is a profession that is social by name, specht and courtney (1995) claimed social workers abandoned their social mission with a trend toward clinical work. further, barton (1968) likened research methods such as random sampling to understanding the biology of cells by studying ground meat because randomization stripped out social relationships. finally, and to the point of the present research, scholarship has become an increasingly social endeavor, and the implications of that development for our knowledge base must be understood. more specifically the present research has begun to address shuai’s (2014) assertion that quantitative study of scholarly communication can help improve effectiveness and assess the quality of scholarship. before that promise can be fulfilled, the emerging patterns of scholarly communication in social work must be identified; such identification was the central purpose of the present inquiry. woehle/united they’re cited 423 complexity theory, research methods, and coauthor networks considerable theory of social networks has been developed, much of it from computerized simulations called agent-based modeling (macy & willer, 2002) (see table 1 for definitions of key terms). macy and willer (2002) point out that on-going network relationships have had future impact, and that agents’ partners tended to interact with each other, which in turn has diffused reputations, created bandwagons, and promoted monitoring and enforcement of conformity to norms. drawing on complexity theory that evaluated social work literature, hudson (2000, 2005) defined self-organization as spontaneous development of new, unique larger phenomena from the interaction of parts, similar to coauthor interaction in the present research. hudson asserted that self-organized structures could be functional. likewise, börner, dall’asta, ke, and vespignani (2005) indicated coauthor networks functioned as a social brain, greater than the sum of individual authors and able to dynamically respond to increasing demands. other assertions of functional coauthor networks included zaccala’s (2004) sharing and developing new ideas, or sharing expertise (gelman & gibelman, 1999; moody, 2004). uzzi and spiro (2005) theorized that coauthor networks enabled the material to develop and become credible, and burt (2004) argued that structural holes, the gaps between cliques filled by one person, provided unique vision and brokerage. rivera, soderstrom, and uzzi’s (2010) review pointed to homophily, or similarity, as well as complementary or differing abilities as a basis for coauthoring and to clustered cliques that favored norm development. coauthor networks might be functional if they produce citations that advance scholarship, and coauthor networks and network properties have been shown to be related to the volume of citations. rivera et al. (2010) noted that people with more ties were likely to be more successful in general, and baldi (1998) and beaver (2004) indicated coauthors produced more citations than single authors. börner, maru, and goldstone (2004) claimed citation and coauthoring networks have coevolved. further, börner et al. (2005) as well as yang, jaramillo, and chonko (2010) found that authors’ central location in the network produced a large numbers of citations. uddin, hossain, and rasmussen (2013) examined the network centrality measure called degree, or the number of coauthors. they found these measures were correlated with the number of citations. such findings guided the present research. literature also provided guidance for the methods of the present research. power-law distributions have a few extreme values at one end and many common values at the other end (clauset, shalizi, & newman, 2007). barabási et al. (2002) claimed network growth patterns approximated power-law distributions, meaning that a normal distribution of variables cannot be assumed. tol (2009) found this to be true for citations of economists, as did ho (2013) for social workers. further, the complex adaptive nature of networks (aydinoglu, 2013) has made networks unsuitable for linear analysis. thus, visual and tabular analyses were used in the present investigation. as aydinoglu indicated, complex adaptive systems have had limited predictability, and social network variables have also had uncertain time-order (kadushin, 2012). abductive reasoning is the logic of agent-based modelling (halas, 2011), and can be used to interpret findings (kaag, 2014). traditionally, theory-hypothesis-finding was the order of deduction and finding-generalization-theory advances in social work, fall 2015, 16(2) 424 was the order of induction. however, abductive logic has begun with theory and generalization, developed from computerized simulations in the present instance, as one possible explanation of a particular finding. for example, abductive logic is the logic used in mental health diagnosis. thus, abductive logic, limited causal interpretation, and approximate power-law distributions were methodological considerations in the present investigation. table 1. general definitions of key terms term definition used in this study abductive logic logic that proceeds from modeling-derived generalizations to a possible explanation of a finding. agent-based modeling computer modeling that simulates the actors (authors) and interaction (coauthoring) to develop theoretical generalizations. betweenness the number of paths (chains of coauthorships) between nodes (authors) on which a particular node (author) lies. clustering the proportion of actualized relationships (coauthorships) among a node’s (author’s) possible ties (coauthorships). complementarity differences of attracting value between actors (authors). degree the number of direct ties (coauthorships) of a node (author) to other nodes. homophily similarity of attracting value between actors (authors). network centrality the central placement of a node (author) in a network indicted by measures such as degree or betweenness. node network locations (authors) connected by ties (coauthorships). power-law distributions skewed distributions characterized by a few extreme values at one end and many common values at the other end. self-organization development of new phenomena (coauthor network) from interaction (coauthoring) of parts (authors). social network analysis or sna analysis of networked nodes (authors) and the ties (coauthoring) with maps and statistics describing the attributes of the nodes, ties, and the network. tie a line (coauthoring) that connect nodes (authors) in a network. coauthor networks have been studied widely, but not in social work. coauthoring has been increasing in many disciplines for some time (bozdogan & akbilgic, 2013), including sociology (moody, 2004), physics (martin, ball, karrer, & newman, 2013), and highimpact finnish medical research (riikonen & vihinen, 2008). in economics, the average number of coauthors almost doubled between the 1970s and 1990s as the coauthor network grew by a factor of six (goyal, van der leij, & moraga‐gonzález, 2006). increased coauthoring in social work was noted by gelman and gibelman (1999), and resulting networking was studied by the present author (woehle, 2012). some attention to other kinds of networks included baker’s (1992) documentation of a social work network based on citations; martínez, cobo, herrera, and herrera-viedma’s (2014) map of social work literature themes; blakeslee and keller’s (2012) study of coauthors in the social work related area of youth mentoring; and williams et al.'s (2008) mention of, “a network for woehle/united they’re cited 425 social work education and research.” however, the social work network literature is less extensive than other studies of networks. in brief, complexity theory and research in various fields have suggested that coauthor networks can be functional systems that can have impact on and improve scholarship via citations. complexity theory, abductive logic, and attention to power-law distributions, as well as variables associated with the coauthoring-citation relationship, have been identified as research issues. however, coauthor networks have been mostly ignored in social work and are thus ripe for study. methods three major analyses for the present investigation included: (1) mapping a social work coauthor network for a set of articles and their associated citations, (2) description of the association of networked authors’ network centrality with citations, and (3) description of the association of authors’ university, school, and academic rank with network centrality and the citations they achieved. across these tasks, the variables studied were located in a time order that limits the ways that influence might have operated, as indicated in table 2. university and school characteristics were first in time. coauthors came together prior to publication, and citations followed publication. therefore, while claims of linear causality are not made here, questions explored in the present research assumed that time order. table 2. time frame and source of variables in the analyses variable source origination time university rank shanghai jiao tong university (2003) prior to 2003 school rank feldman (2006) 1990-2003 academic rank article or online source prior to publication network variables articles studied prior to publication publication time dates from google scholar 2006-2008 citations of articles google scholar article publication through 2013 discovering and describing the network the identification of networked authors and articles involved social network analysis (sna), developed as a method for analyzing objects (nodes) connected by lines representing relationships (ties). sna has designated actors as nodes and relationships as ties (kadushin, 2012; knoke & yang, 2007), or authors and their coauthoring respectively in the present investigation. the nodes or authors were used in a manner similar to units of analysis in traditional research, but sna has conceptualized ties as though they were another kind of unit of analysis with variable attributes. for example, in the network diagrams in this article, the width of the ties represented the amount of coauthoring. börner et al. (2005) applied sna in a somewhat similar manner to the present analysis. while conducting an earlier study (woehle, 2012), a particularly well-connected group of coauthors was documented, and the association of those authors with citations was described generally. in that earlier study, a centrality measure called eigenvector centrality was used to identify a central network skeleton. that skeleton was the initial basis of the advances in social work, fall 2015, 16(2) 426 network in the present research, and it suggested that the network in the present endeavor was one of the most highly connected social work coauthor networks at the time. for the present study, those authors’ coauthor relationships were followed to reveal the full network of coauthors who had addressed social work. the coauthor ties were followed from one coauthor to another, until the trail expired as far as 10 consecutive relationships from an initial author. google scholar was utilized to search for coauthors in the social science area covering the years 2006-2008. the search required inclusion of the term “social work,” or a term that translated literally to social work by googletranslate, in the journal title or statement of purpose. to be included, both authors in a pair had to be listed as a seventh author or higher. authors’ names were checked manually for spelling variations and secondary characteristics like work settings to assure identity. nodexl (smith et al., 2009), an sna template for microsoft excel, was used to diagram the coauthor network. the primary data were the authors’ names, entered by listing each pair of coauthors in nodexl in horizontally adjacent cells. nodexl allowed coding of node and tie attributes and calculation of network-derived attributes. nodes or coauthors were attributed weights for being variously cited. coauthor ties were given weights according to year of first use and total amount of use. coauthors were weighted equally in a given article and summed for multiple uses of the tie in all included articles to establish the total use of a coauthor tie. age of network ties was used to diagram shades of gray, with lighter shades indicating greater age, that is, longer publication tenure in the network. nodexl then created a diagram, arranged for visualization, using an algorithm in the program. the drag-and-drop capabilities of the program were used to further separate authors. the diagrammed network was based on 134 articles and 258 coauthors representing 584 coauthor relationships. the journals, and the number of articles included from each journal, are listed in table 3. the authors of the articles form a network, but the articles do not form a thematic whole beyond the social-work-related limitations described above. research was a possible theme, with 42 articles from the research journals social work research and research on social work practice. in addition, eight more article titles mentioned research topics. however, the articles varied from methodological discussions to reports of research projects and applications of research findings. while 14 articles mentioned evidence-based practice in the titles, that topic was variously approached, including discussion of problems, as well as attempts to implement evidence-based practice. with 21 articles, child welfare was another popular topic. many of these articles were research-based, and 12 were published in child welfare journals. twelve other articles addressed health, five of which addressed mental health. articles in other areas included seven on spirituality, six on gerontology, and four on latino issues. woehle/united they’re cited 427 table 3. journals and number of articles in the analysis journal # networked authored articles administration in social work 2 advances in social work 3 affilia 1 american journal of community psychology 1 child & adolescent social work journal 3 child & youth care forum 2 child abuse and neglect 3 clinical social work journal 1 families in society 1 health and social work 4 international journal of social welfare 2 international social work 6 journal of community practice 4 journal of community psychology 3 journal of comparative social welfare 1 journal of evidence-based social work 2 journal of family issues 1 journal of gerontological social work 5 journal of hiv /aids and social services 1 journal of human behavior in the social environment 3 journal of public child welfare 1 journal of religion & spirituality in social work 4 journal of social work education 12 journal of social work in disability & rehabilitation 1 journal of social work practice in the addictions 1 portularia 1 qualitative social work 1 research on social work practice 21 residential treatment for children & youth 3 social work 9 social work & society 1 social work in health care 2 social work in public health 6 social work research 21 women in social work 1 total articles 134 citations were allocated to authors with self-citations removed. self-citations were calculated in two ways--a conservative method which subtracted every instance of selfcitation from an article’s total, and a fractional method, in which a self-citation reduction was calculated as the product of the fractions of shared authors in the cited and citing articles. an author’s coauthoring share for each article was multiplied by an article’s citations and summed for all of an author’s articles, with self-citations subtracted, to allocate an author’s citations. citation counts with both self-citation measures are reported in tables 4 and 5, but an average of the two citation measures was used to allocate node advances in social work, fall 2015, 16(2) 428 size in the diagrams. citations of articles were counted using google scholar. as with the articles above, citations were limited to citations in journals with the term social work, or a literal google translate translation to that term, in their title or statement of purpose. citations accumulated by an article by the end of 2013 were counted, a period of five through seven years. that was longer than baldi’s (1998) generally expected period but shorter than hodge and lacasse’s (2011) expected period for social work, resulting in continuing growth of citations as the present study progressed. there were 626 citations by the whole self-citation removal measure and 710 citations by the fractional removal method. analysis of authors nodexl was used to develop network variables and then to explore how the network might produce citations. sna provided the author attributes of degree, clustering, and betweenness. degree was the count of a given author’s coauthors, clustering was a measure of the extent to which an author’s coauthors form a clique using the possible relationships, and betweenness was the extent to which an author lies on paths of ties between other networked authors. these variables, as well as the citation variable, approximated powerlaw distributions, non-normal highly skewed distributions characterized by numerous similar values at one end of the distribution, and infrequent but extreme values at the other end. clustering had the highest values at the low ends of the degree and betweenness distributions. for an analysis of these variables in relation to status variables, and for network diagrams, an index was created which divided each centrality variable by its largest value, thus standardizing each to values of 0 to 1, then summing the degree and betweenness standardized variables, subtracting the clustering variable, and dividing that result by 3. the resulting index approximated a power-law distribution in which a few very central authors approached a maximum value of 0.50 and a large number of clustered and peripheral authors approached a minimum value of -0.29. though the raw network centrality variables were also used in some analyses, the index provided a more continuous variable to analyze the relationships between networking and status variables on one hand and citations on the other. the authors, or nodes, were depicted in network diagrams as rectangles labeled with the author’s name for more central authors by the indexed measure, and xs for the less central. greater size of the rectangle and font represented larger numbers of citations, measured by an average of the two measures. for example, in figure 1 below, bledsoe and hodge were among the more central and cited authors and thus are named with large font size in large rectangles of the diagram. measures of authors’ setting and professional status were also examined. most of the authors were at universities. university rankings based on accumulated citations developed by shanghai jiao tong university institute of higher education (2003) were used. a highly ranked group spanned by harvard to emory was designated as the top rank here, as opposed to all other settings which were designated as the lower rank. feldman’s (2006) analysis of doctoral programs in social work provided the basis for school rank. his list ranged from 1 to 69 and allowed a dichotomous measure of the top 30 as opposed to all other settings. that dichotomy, based on feldman’s survey-based scale, may have resulted in measurement problems from a combination of respondent unfamiliarity with social work woehle/united they’re cited 429 schools and author location outside of a doctoral school of social work. it should also be noted that both the university and school measures were ecological and perhaps were weak measures of the coauthors’ actual situation. finally, author rank at first publication was used to create a dichotomous variable. deans, chairs, and professors at or above the associate professor level were considered high rank, and less prestigious positions were considered low rank. author rank information was either reported in the first network article published or gleaned from curriculum vitae or similar on-line postings for each coauthor. ten of the 258 networked coauthors could not be so identified and were assumed to be in low-status positions. in brief, the methods included identification of an article-based social work coauthor network, and the authors of the network were compared by citation production to network centrality, prestige of research setting, and author’s academic position. findings the questions described in the introduction were tentatively answered by the present research: power-law distributions of degree, betweenness and clustering were associated with similarly distributed authors’ achievement of citations, and, high university, school or academic rank of an author slightly favored greater network centrality and citations. the network, citations, centrality, and author status figure 1 depicts the network constructed of the coauthors studied. the network diameter, or the number of consecutive ties between the most distant authors, was 18, with an average distance between coauthors of more than seven degrees. figure 1 revealed the full network as a central structure and attached cliques. clustered cliques were apparent throughout the structure, but large nodes that represent highly cited authors were frequently notable between two or more cliques, indicating comparatively more centrality but less clustering of those authors. table 4 presents relationships between the citations of authors and the network variables. the 258 authors were sorted into roughly equal quintiles, from those allocated the most citations to those with the least. as table 4 shows, authors’ median degree and betweenness were skewed similarly to citations, and median clustering was inversely skewed compared to citations. in particular, having had a high degree, or many coauthors, and greater betweenness, or lying on paths between other authors, resulted in greatly enhanced citations. the first quintile had more than four times the citations of the second quintile. alternatively, authors in a cluster at the periphery approached zero citations. the broad ranges of the variables suggested exceptions to these generalizations. a notable exception is parrish, who was much cited despite only coauthoring with rubin (see figure1). advances in social work, fall 2015, 16(2) 430 table 4. association of network variables with citations among authors (n= 258) # of aus degree median (range) betweenness median (range) clustering median (range) citations/ au minus whole selfcitations citations/ au minus weighted self-citations 52 6.0 (1-16) 634 (0-7,290) 0.3 (0-1) 8.7 9.6 57 4.0 (1-12) 0 (0-7,063) 0.7 (0-1) 2.0 2.2 49 4.0 (1-17) 0 (0-7,383) 0.9 (0-1) 0.8 1.0 52 3.0 (1-12) 0 (0-5,170) 1 (0-1) 0.3 0.4 48 3.0 (1-10) 0 (0-4,895) 1 (0-1) 0.0 0.1 au=author figures 2 and 3 further show the relationship of network variables and citations. the authors in the top 34% of scores on the networking index are shown with their coauthoring relationships in figure 2, with the less connected of the coauthors and their ties removed. by either citation measure, the authors in figure 2 accounted for about 66% of the citations, or almost twice the share that would have been expected from a random distribution. a few figure 1. the complete coauthor network. font and node size represent the author’s share of citations. the gray ties were older, and the wider ties were more heavily used. named authors were most central. woehle/united they’re cited 431 individuals or small cliques were disconnected in figure 2, either because they were not central or not cliquish, and some specialized groups were connected by one important tie, such as the spirituality-oriented group around hodge at the top, or the research-oriented group around bledsoe at the bottom right. however, a large interconnected component at the center of the diagram pulled most of these authors together. figure 3 depicted the 66% of authors that together accounted for 34% of the citations, about half of the expected amount. small numbers of citations were indicated by the many small rectangles, and that is clearly associated with the absence of central ties shown by the fragmentation of figure 3. while there were some networked segments, more obvious were the triads, dyads, and single authors scattered throughout figure 3. together, figures 2 and 3 illustrate that authors who eventually would be most cited often were initially likely to be in the central and large connecting structures of the coauthor network. figure 2. network analysis showing the 34% most highly connected and most cited coauthors. the font and node size represents the author’s share of citations. the gray ties were older, and the wider ties were more heavily used. advances in social work, fall 2015, 16(2) 432 table 5 presents the relationship between network centrality, citations, university rank, school rank, and academic rank of authors. as shown, the emergence of networking was more probable under high status conditions. however, the network index was more strongly related to citations which suggested that citations emerged primarily out of network centrality compared to the status measures, though limitations of status measurement raised questions regarding that assertion. table 5. network index by citations, university rank, school rank, and faculty rank (n= 258) n network index median, range citation/ au*, whole measure citation/ au, fractional measure % in ↑x ranked univ. % in ↑ ranked schools % ↑ ranked faculty 89 .07 (.02 to .50) 4.6 5.1 33% 65% 46% 87 -.24 (.00 to -.25) 1.6 1.9 32% 55% 38% 82 -.27 (-.27 to -.29) 0.8 0.9 20% 48% 20% *au= author, x↑=highly figure 3. network analysis showing the 66% least connected and least cited coauthors. the font and node size represent the author’s share of citations. the gray ties were older, and the wider ties were more heavily used. woehle/united they’re cited 433 discussion the findings of the present research appear to be consistent with complexity theory when they are interpreted abductively in light of that theory. the network appears to be self-organized by authors. university settings which are known to favor such selforganization are likely to encourage and sanction rules for scholarship. the impact of the network on citations suggests diffused reputations of authors from structural holes, resulting in citation bandwagons. the approximate power-law distributions of the network variables and citations resemble those found in complex systems. however, the research presented here should be regarded as tentative; more research is needed. there are shortcomings of the present research which should be addressed. the public data used here limited which variables could be considered and may have resulted in poor measurement of variables, especially school and university prestige. given that, more research is needed with improved measurement of authors’ situations. power-law distributions generate questions regarding statistical analysis, and research should move beyond the tabular approach used here with improved statistical analysis. further, the present research should be validated in other social work coauthor networks because the network displayed here may be an aberration. some future research might be done with public data. for example, the content of articles, or the journals in which they were published might be studied for their impact on citations. other questions might be answered by a survey of authors. did the authors have pressure to publish or research support that encouraged collaboration? in addition, the connection of coauthor and citation networks to teaching and practice networks is an important area of future research. because evidencebased practice is being advocated, it has become important to understand how evidence flows to practice. another very important unanswered question is that of the function of citations. hudson (2000, 2005) noted that emergent structures can be dysfunctional as well as functional. network bandwagon effects (macy & willer, 2002), as shown by greenberg (2009), could be the source of distortions and lead to cascades of false information. the functional interpretation would have been what bornmann and daniel’s (2008) literature review called normative, where citations were correlated with awards and honors, but they wrote that was questioned by constructionists who suggested a community whose claims might be based on social agreements among authors, not empirical science. bornmann and daniel report that constructionists pointed to the relationship of citations to prior connections as found here. in a profession moving toward evidence-based practice, such construction could be dysfunctional if it departs from the evidence. that makes the study of possible distortion of evidence via networks and citations an area that needs attention. given the need for more research, the rush to collaborative scholarship might seem premature. however, the rush is on, it appears to have been underway for some time, and it seems to lead to self-organized complex systems that will not wait for direction from network researchers. meanwhile, it appears that first and single authoring have been valued most in universities (seipel, 2003), apparently assuming less prominent coauthors play an unimportant role. as a result, some speculation about such evaluation of coauthors’ scholarship is in order. advances in social work, fall 2015, 16(2) 434 first, scholars are judged when they might be hired, tenured or promoted, and increasingly their scholarship will be coauthored. if collaboration has contributed to high quality scholarship, then the scholar should be valued for finding a way to produce work of high quality. second, scholarship should be judged fairly in the process of publication. perhaps blind review processes should limit reviewers’ knowledge of the coauthoring with techniques such as limiting the use of singular versus plural pronouns. additionally, scholarship is sometimes judged when it is cited. if citations are made for reasons other than improving scholarship or are in error, the citer may contribute to poor quality literature. thus, citers and reviewers should be attentive to the use of citations. scholars at the beginning of a publishing career might want to note the choices that networks present. one choice might be to associate themselves with a well-connected scholar to immediately become a part of a recognized and cited network. however, if such scholars find themselves at the periphery of a network, the choice may be to either unite their cluster by coauthoring with another cluster on a mutually interesting and creative topic or to work in one of the many valued academic positions at the periphery or even outside of coauthor networks. there may be reasons for coauthoring beyond the accumulation of citations. uncited coauthors located in practice settings or in less prestigious colleges or universities may help to communicate scholarship to the teaching-oriented community and the practice community. in any case, scholars should be cautious about the pursuit of citations. martin et al. (2013) found that publication success was more unequal than wealth, or in other words, highly unequal. as a result, a scholar’s achievement of highly cited publications is unlikely. because most authors will have few if any citations, other measures will be necessary for evaluating scholarship in some settings. if the coauthor community is of value for the social work profession, coauthoring itself might be valued as takeda, truex, and cuellar (2010) suggest. should social work scholars use coauthoring? social work values seem to favor such collaboration. however, the inequality of network centrality and citations may not rest as well with social work values. if coauthoring can improve our scholarship, these conflicts will be worth our engagement and our careful consideration of their costs and benefits. in any case, the growth of coauthoring gives us no choice but to confront the issues it brings. references aydinoglu, a. u. 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(2004). revisiting the invisible college: a case study of the intellectual structure and social process of singularity theory research in mathematics (unpublished doctoral dissertation). university of toronto, toronto, canada. author note address correspondence: ralph woehle, ms, msw, phd, professor emeritus, university of north dakota, 18619 park lane, glenwood, mn 56334. email: ralphwoehle@charter.net http://dx.doi.org/10.1093/swr/32.4.208 http://dx.doi.org/10.5175/jswe.2012.201000088 http://dx.doi.org/10.2753/pss0885-3134300104 mailto:ralphwoehle@charter.net microsoft word gair copyedit3 _________________ susan gair, is a senior lecturer in the department of social work at james cook university in queensland, australia. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 329-344 exploring empathy embedded in ethics curricula: a classroom inquiry susan gair abstract: empathy is considered to be a crucial ingredient in social work practice. research on empathy is abundant although literature describing the teaching and learning of empathy, and in what contexts empathy might be taught best, is less common. the primary aim of this exploratory, classroom-based research undertaken in 2011 was to explore empathy with second year, social work students, thereby building on previous research, and linking it to education and practice. the findings suggest students may acquire a conceptual and definitional understanding of empathy by early in their course, but may need more proactive support to transform that learning into deeper empathy. a key speculation underpinning this exploratory inquiry, that cultivating empathy within an ‘ethics’ unit might prove more potent than within a ‘skills’ unit, was not supported. the need for further research into empathy, particularly cross-cultural empathy, is a recommendation of this research. keywords: empathy, ethics, social work education, social work practice introduction as social workers, to be empathic is to experience the affect, process it, and then take appropriate, empathy-driven action (gerdes & segal, 2009, pp. 121-122). empathy is defined as vicariously perceiving or feeling the experiences and emotions of another person. literature on promoting the importance of empathy is plentiful and empathy is considered to be an indispensable ingredient in helping (alma & smaling, 2006; batson, chang, orr & rowland, 2002; duan & hill, 1996; eckermann et al., 2006; figley, 2002). yet comprehensive discussion about how to cultivate, teach, and learn empathy is not easily found in the social work literature. specifically, exploring with social work students what are the issues or contexts that might trigger, or conversely inhibit their empathy and, from their perspectives why this might be the case, is uncommon in the literature. the aim of this article was to illuminate my efforts to further explore and cultivate empathy for improved classroom learning and advanced, empathy-driven social work practice. understanding empathyhistory and definitions lipps is attributed with advancing the theory of ‘einfuhlung’, a german term used in the late 19th century meaning a person’s spontaneous projection of feeling into other people and things. in 1909 titchener coined the term ‘empathy’, deriving from another german term ‘verstehen’ for empathic understanding, and the greek ‘empatheia’ meaning appreciation of another’s pain (alma & smaling, 2006; davis, yeager & foster, 2001; duan & hill, 1996; wispe, 1987). for german philosopher edith stein (1917, translated in 1989), empathy involved objective tuning-in; deeper, subjective connection; and conveying the combined objective and subjective back to the client in a way that centralised our common humanity. later, key psychoanalytic theorists such as kohut (1977) saw important links between introspection (reflection) advances in social work, fall 2011, 12(2) 330 and empathy, and, like rogers (1956/1992), kohut thought that empathy was a cornerstone for psychological change. western concepts of ‘empathy’ and ‘sympathy’ often are considered in tandem in the literature. in social work literature trevithick (2005) and boulton (1987) define empathy as ‘feeling with’ the client, rather than ‘feeling for’ the client (sympathy). some authors conceptualise empathy as ‘getting into the skin of’ another person (schell & kayser-jones, 2007, p. 146), although conceptualizing empathy in this way may be offensive to some indigenous groups (l. muller, personal communication, august 27, 2009). discussing indigenous health care, eckermann et al. (2006) stated that empathy and sympathy are closely related, usage in most cultures overlaps, and that empathy is often portrayed ‘as walking a mile in another person’s shoes’ (p. 113). while use of empathy is most often associated with positive therapeutic outcomes (hojat, 2007), a common view is that too close an engagement with clients’ lived experiences (over empathizing) leads to transference, burnout, or compassion fatigue (figley, 2002). other terms used in relation to empathy in the literature include compassion, caring, imagination, kindness, intuition, pity, and emotional intelligence (davis, 2003; howe, 2008; hugman, 2005). research on empathy key themes evident in past empathy research include cognitive understanding and motivation, affective capacity and perceptive taking, similarities and differences, and other contextual influences. however some researchers point to the co-existence and multidimensionality of these elements (duan & hill, 1996). key empathy researchers such as hoffman (1982) and eisenberg (1982) were interested in the role of altruistic motivation, symbolic cues, a helper’s past experiences, perspective taking, and in-group preferences and they noted evidence of children behaving more empathically towards other children of the same race or sex and adults responding more towards others perceived as similar. more recently, researchers focusing on mirror neurons and neural networks in the brain reported similar conclusions (de vignemont & singer, 2006; gutsell & inzlicht, 2010). although empathy in general is a well-researched topic, research is less common in relation to cultural, ethno-cultural, and cross-cultural factors (rasoal, eklund, & hansen, 2011). empathy research in an australian cross-cultural context appears to be almost non-existent. exceptions include pedersen, beven, walker, and griffiths (2004) and pedersen and barlow (2008) who examined prejudice, empathy, and collective guilt. they identified that interventions that induce empathy would likely produce reductions in racial prejudice (pedersen & barlow, 2008). critiques of empathy a review of the empathy literature reveals a number of critiques. noddings (2003) argued that empathy, defined as ‘projecting’ oneself into another’s shoes, reflects a western, masculine rationale, and noddings prefers the term ‘caring’, and the idea of ‘receiving’ another person’s experiences. harris and foreman-peck (2004) argued that our empathy is informed by what people generally do and feel in such circumstances combined with our own personal life experiences. therefore, empathy might not be elicited if the experiences seemed outside what the helper knows, can understand, or can imagine. however, lather (2009) questioned whether that gair/exploring empathy 331 commonly understood act of empathy was legitimate if the listener must be able to recall similar personal experiences, that is, centre themselves, before giving empathy. furthermore, giving empathy may mirror dominant social and cultural norms and ideologies where only certain groups deserve our empathy (bryant & clark, 2006; krulewitz, 1982, cited in duan & hill, 1996). a small number of authors speculate on an increasing erosion of empathy in modern society, driven by dominant marketdriven ideologies, although not all authors agree (bennett, 2001; white, perlman, fantone, & kumagai, 2010). teaching and learning empathy according to pike, bennett, and chang (2004), before graduating as social workers, students need to acquire basic practice skills including empathy. while empathy is mentioned very frequently in the helping literature, how to teach and learn empathy is less readily articulated. well-known psychologist carl rogers described empathy as a skill that can be taught alongside positive regard and a non-judgemental, client-centred approach (rogers, 1956/1992). with specific regard to tertiary students learning empathy, pedersen and barlow (2008) identified that psychology students need a safe space to speak about prejudices and enhance empathy, furman (2006) recommended poetry writing to cultivate social work students’ empathy, and white et al. (2010) reported on a successful project with medical students designed to help learners incorporate the viewpoints of patients. empathy and ethics dolgoff, loewenberg, and harrington (2009, p. 8) define professional ‘ethics’, from the greek ethos, meaning custom or habit that helps guide practitioners to act ethically when working through value conflicts that can impact on helping relationships. some authors note past separation of core values, such as moral reasoning, goodness, autonomy, and impartiality, from emotions, while noddings and tong speak of an ‘ethic on caring’ (hugman, 2005; maxwell & racine, 2010; noddings, 2003; tong, 1997). maxwell and racine (2010) recommend a combined approach to teaching values, ethics and empathy to reduce the likelihood of students’ acquiring a superficial notion of empathy, although they caution against overgeneralizing about when empathy is absent. hojat (2007) links empathy and ethics but cautions that empathic, helping relationships may increase the potential for unethical boundary crossings. similarly, van den hoofdakker (cited in alma & smaling, 2006) suggests that empathy is not intrinsically good, and that accurately identifying vulnerabilities in others can make them more vulnerable to unethical practice. as a social work educator it occurred to me that empathy had been given insufficient attention in my ‘skills’ unit in the past, and in 2009 i undertook a classroom inquiry exploring empathy (gair, 2009; 2010). most recently i pondered whether embedding empathy within a ‘values and ethics’ unit would better facilitate students’ learning of empathy. in 2011 i undertook a second classroom empathy exploration, this time embedded within ethics curricula. methodology this inquiry used a qualitative, postmodern, phenomenological approach (exploring deep, reflective ways that individuals create meaning and understanding) advances in social work, fall 2011, 12(2) 332 to help students describe their definitions and understandings of empathy and allow me to ponder them (davis, 2003; fook, 1999; schutz, 1972). the approach is underpinned by adult life long learning (ramsden, 1992), and by critical thinking and narrative approaches to transformative learning (garrison, 1991; mezirow, 2003), through use of a method of vignettes and writing. therefore this inquiry sought both research and reflective learning outcomes. the research question underpinning this inquiry was: would exploring empathy within an ‘ethics and values’ unit help illuminate how empathy might be best taught in social work education? the specific aims of this classroom-based inquiry were: i) to explore and reflect on teaching and learning empathy embedded within an ethics and values curriculum, and ii) to use the findings to inform social work education. in particular, students’ definitions of, conceptual understandings of and reasoning about their empathy as related to the presented vignettes were important points of exploration. while a slightly larger number of students participated in the classroom-based workshop (22), a final sample of 19 self-selected into this research study. the students were all distance education (de), second year, social work students enrolled at a regional australian university who were attending on-campus block workshops. to protect their anonymity, no identifying information was requested from students. the class was predominantly a cohort of mature-age women (over 25 years old); most students were non-indigenous australians; there was a small number of male students (4) and a small number of younger female students who had enrolled in university studies in the year following completion of secondary school. this group profile reflects our larger social work student body and our graduate profile. the small amount of content on empathy that normally was taught in the interpersonal communication skills workshop remained there (scheduled prior to this workshop), while the focused, comprehensive content included in 2009 as a part of previous, classroom-based empathy research, was transferred from the skills workshop to the values and ethics workshop, amid content over three days of exercises, dvd’s and group discussion on professional values and ethics. beginning the empathy workshop, all students were given consent forms and information sheets that explained that they could opt into the study at the completion of the class by handing in their work; otherwise it represented a scheduled values and ethics workshop for them (university human ethics approval was gained to conduct the study). first, students were asked to write a definition of empathy. students then were presented with comprehensive information about empathy. the information presented in the workshop duplicated the literature review discussed above, and consisted of key points and arguments from the literature, historical research and philosophical writing about empathy, contrasting definitions from social work, health and medical literature, the ‘skill’ of empathy, critiques and theories from a multidisciplinary selection of empathy literature, and available literature on cross cultural empathy including definitions from indigenous australian health literature. finally, they were given four written vignettes. the four real life vignettes were: a narrative from an inter-country adoptee describing his grief, felt rejection, and perceived, inadequate adoptive parenting (harris, 2006); two brief narratives about family violence, one depicting a victim’s and one a perpetrator’s story (department of aboriginal & torres strait islander policy and development, 2000); and a narrative about a father’s grief over his stillborn son (phellps, 2011). these factual vignettes were chosen for their range of explicitness of emotion, the gender and cultural mix of gair/exploring empathy 333 the characters for an australian practice context, and their links to past and present biases, stigma and stereotypes within contemporary society. in a previous, aforementioned study in 2009, some social work students had identified a lack of empathy for an aboriginal elder’s narrative and an adoption-related (birth mother) vignette, and also identified perceived difficulties giving empathy to perpetrators of abuse (gair, 2010). therefore, i was interested to further explore these topics although not necessarily to duplicate that previous study. vignettes are a common tool in education and research, although most often vignettes are constructed fiction, based on life-like circumstances, rather than factual vignettes as were used here. hughes (1998) notes that vignettes are “stories… that make reference to perceptions, beliefs and attitudes” (p. 381), and barter and renold (1999) suggest that vignettes are useful in researching sensitive topics. after writing and sharing their definitions and receiving comprehensive content about empathy, students were asked to read and reflect on whether they felt empathy (yes or no) for characters in the four vignettes (students were asked two different questions about vignette one, pertaining to the adoptee and the adoptive parents); and what was their meaning-making of their own responses. only students willing to participate in the research submitted their written work (n = 19). findings defining empathy empathy, as noted earlier, is often portrayed as ‘walking a mile in another person’s shoes’ (boulton, 1987; eckermann et al, 2006), and although noddings (2003) rejected this notion, many students made reference to that familiar adage. the quotes below exemplify the definitions written by most students: empathy is trying to walk a mile in another person’s shoesviewing the world, and situations from their perspective to fully appreciate, try to understand what the person’s going through, feeling, experiencing (student 8). empathy is another person’s or living being’s pain, anguish, fear, or loss. connecting on an emotional level that arouses feelings of compassion. connecting on an experience level also impacts on empathy. arouses very emotional feelings (student 16). empathy is looking at a situation from a different person’s perspective, putting yourself in another person’s shoes, trying to imagine how that person is feeling and what they are possibly thinking (student 4). in contrast to the above definitions of empathy that feature feelings, relating and understanding, this student’s definition suggested a more surface, or objective problem-based approach that was otherwise uncommon in students’ empathy definitions: empathy in some cases, regarding with clients, is considering as our own (the) problems and thinking what we will do if we are in the same situation (student 5). the notion of surface and deep empathy is revisited later in this paper. advances in social work, fall 2011, 12(2) 334 students who said they could empathize only 6 students empathized with characters in all the vignettes. thirteen students (n = 19) identified that they could not empathize with at least one of the scenarios, although they could empathize with the other vignettes. four (4) students could not empathize with multiple scenarios. in total there were 22 responses where ‘no’ was their answer. ten students could not empathize with vignette one (adoptive parents), representing the highest number of ‘no’ responses, or stated differently, this was the character that attracted the least empathy. vignette one (adoptee) attracted 2 ‘no’ responses, vignette two (victim) attracted 2 ‘no’ responses, vignette three (family violence perpetrator) attracted 5 ‘no’ responses, and vignette four (stillbirth) received a total of 3 ‘no’ responses. immediately below, students offer their meaning-making about when they nominated they could empathize with the characters in the vignettes: vignette one (adoptee): i know that cultural differences need to be acknowledged. the child must have felt so very alone, being different and having no adequate support (student 8). vignette one (adoptive parents): they tried to protect and do the right thing by the child. easy to look back in hindsight and realize the wrong choice was made (student 12). vignette two (family violence victim): sounds like she has been brave to strive for another life after leaving dv. i feel distress to think that she has been placed in unsafe poor quality housing where she and her child still do not feel safe (student 1). vignette three (family violence perpetrator): yesthe person in the scenario was in a pickle about doing right and wrong. he gave in and did what he believed was expected of him in his culture but ended up getting into trouble and going to jail (student 15). vignette four (father of stillborn baby) i do feel empathy because i know what it is like to lose a child (student 3). students who said they could not empathize the students offered quite diverse explanations about why they answered ‘no’ to whether they felt empathy for the characters in the vignettes: gair/exploring empathy 335 vignette one (adoptee): i think what i feel is more like sympathy. i feel sorry that she had that experience but without more informationcannot imagine…i wouldn’t feel empathy if i didn’t believe it. i need more discussion (student 18). vignette one (adoptive parents): no i never felt empathy for the parents at all they should have never told the kid that he will be taken away if they loved him (student 2). vignette two (family violence victim): i think (i) didn’t feel empathy for her because she already got a house and she is not at all satisfied with it… a suffering person but she’s got a baby with her and she starts to drink too muchis really not good for both of them (student 5). vignette three (family violence perpetrator): because we all have the freedom to make choices. and he chose to do something even though he knew it was bad (student 9). vignette four (father of stillborn baby) no i struggle to feel i can fully empathise as i have never had the experience (student 8). taking a deeper look it occurred to me that the vast majority of students demonstrated that they could respond to a task requiring them to write a meaningful definition of empathy. however, their subsequent answers belied any deeper understanding or learning about empathy. with a more discerning lens applied to their responses, it seemed that some students seemed to forget or disconnect from their definitions of empathy almost immediately after writing them. there appear to be many instances in the data of this ‘empathy gap’ between students’ defining and giving empathy. for example, one student defined empathy as follows: empathy is a skill that allows someone to be able to understand another person’s experience … an attempt to deeply understand how the other person must feel (student 17). yet that definition was immediately followed by a ‘no’ empathy response to vignette one with this explanation (adoptee): no, i would listen to try to understand but i can’t relatei would only be able to give feeling to the words the story describes. another student offered an insightful definition: empathy involves feeling another person’s or living being’s pain, anguish, fear, or loss. connecting on an emotional level that arouses feelings of compassion.... arouses very emotional feelings (student 16); followed by a ‘no’ response to vignette one (adoptive parents) with this explanation: advances in social work, fall 2011, 12(2) 336 i do not hold a lot of empathy for the adoptive parents as they made a choice to adopt a child from a different cultural background. they have not been supportive or shown compassion for a child who clearly has mental health issues and cultural issues. here is a second example relating to the same vignette; first a definition: for me empathy means looking out for someone else when they are doing something by putting yourself in that person’s shoes (student 10). this definition was followed by a ‘no’ response with this explanation: because they should have paid more attention to the child or maybe they were not good at communicating to the child or maybe they just want adoption money. in the next example a detailed definition is followed by ‘no’ responses to two different vignettes (family violence victim and perpetrator narratives): empathy is showing an appreciation and concern for a client’s circumstances. it involves being genuine about the feeling or expression you display to the client as the object is to gain their confidence and trust to enable change or the ability to assist effectively (student 14); followed by a ‘no’ response to the victim vignette with this explanation: no, when you reach the point when you could die or persons’ lives become at risk then i think it is quite rational to assume that the right to life supersedes other ideas; and this explanation to the family violence perpetrator vignette: i would need to seek supervision or work in a different field. i have strong values about a man hurting a woman. finally, this definition: empathy is trying to walk a mile in another person’s shoesviewing the world, and situations from their perspective… try to understand what the person’s going through, feeling, experiencing (student 8); was followed by a ‘no’ response to vignette four (stillbirth) with this explanation: i struggle to feel i can fully empathise as i have never experienced anything similar to this. harris and foreman-peck (2004) identified that empathy is informed by what the helper thinks people might do in such circumstances combined with their own life experiences, and that empathy might not be elicited if the experience seems outside what the helper knows or can imagine. in a range of responses, whether those responses represented a ‘no’ response (see the last example above, or a ‘yes’ response (for example ‘as a parent i know that raising children is a hard job and can only try to imagine …’), students appeared to draw on, at least in part, their own past experiences to inform their answers. clearly this concept of empathy has shortcomings when there are many contexts that social workers will not have personally experienced. gair/exploring empathy 337 when comparing the above definitions to those definitions offered by students who gave ‘yes’ responses (n = 6) to all vignettes, there appears to be very little discernable difference. however, what may be evident, although admittedly this sub-group is very small (n = 6), is that some students appeared to theorize in a compassionate, reflective way that enacted their definitions, perhaps asking themselves what else might be happening, how else could it be understood, or what might be influencing their understanding. for example: maybe the parents were trying to protect the child … and because it was a new and different situation … (student 4); i think it is easy to read this article and condemn but… (student 13); as a consequence of the character’s racialisation process he has become involved in family violence, sounds like now he is beginning to see different perspectives that may enable him to make different choices (student 1). discussion mezirow (2003) defined transformative learning as learning that transforms assumptions, meanings, reasoning, or perspectives to make them more inclusive, open, and reflective. mezirow (2003) identified that it includes learning skills, sensitivities, and insights, having an open mind, and learning to listen empathically. in considering students’ comments above, it may be that while some students were familiar with how to define empathy, they subsequently appeared to forget to enact that empathy, and instead reverted to past experiences, understandings, or personal values to inform their empathy. according to meyer and land (2005), while “the deep learning of otherness implies abilities of empathetic engagement and self reflexivity” (p. 383, citing cousin, 2003 and williamson, 1992), there are risks of ‘mimicry’ and ‘faking it’ without students full engagement with the personally transformative potential of empathy. of interest, some students’ responses may hint at rhetoric of deserving or undeserving, for example, regarding the adoptive parents in vignette one: ‘they made a choice to adopt a child from a different cultural background’, and they ‘…should have paid more attention to the child’. admittedly, vignette one is told from an adoptee’s perspective. nevertheless, this factor seems to be a somewhat inadequate explanation for students’ lack of empathy towards adoptive parents. trotter (1998, as cited in stitt & gibbs, 2007) illuminated the existence of a deserving/undeserving discourse inhibiting empathy when he found non-abusing mothers of sexually-abused children were treated with a dismissive lack of empathy (mother blaming) by professionals. a different but related explanation is that students were aware that perceiving cross-cultural adoption as an acceptable social policy conflicted with a human rights stance in australia of not removing children from their culture, although this was not a nominated explanation (hollingsworth, 2003). clearly these are complex issues. kirton (1999), in seeking to explore perceived ‘political correctness’ influencing second year social work students’ support of ‘transracial’ adoptions, found a ‘great divergence’ of views, and recommended that more dialogue during social work education could ‘lessen the extremes’ (p. 794). advances in social work, fall 2011, 12(2) 338 it is an unexpected finding that the family violence perpetrator narrative attracted the second lowest empathy response rather than the lowest, as was tentatively speculated. in a similar aforementioned 2009 study a majority of social work students identified that perpetrators of domestic violence or child abuse were groups with whom they would find it most difficult to empathize and the literature supports such findings. for example, according to humphries (1999) and others, child protection workers do not work in effective, holistic ways with domestic and family violence, rather they swing in a polarized way between minimizing men’s violence and women’s experiences of violence, through to demonizing men (dolgoff, loewenberg, & harrington, 2009; milner, 2004). naming and addressing domestic and family violence can be a controversial issue in australia, and mainstream approaches that are useful in addressing non-indigenous domestic violence have been identified as problematic for justice, healing, and reduction of violence against aboriginal women (bell & nelson, 1989; cripps, 2010). in the case of the family violence vignettes used here, it was evident that the victim and perpetrator characters were indigenous, and this factor might have influenced students’ perceptions. as conjectured by kirton (1999), ‘political correctness’ can be an operating factor, and political correctness, or even misplaced cultural empathy, may have informed students’ ‘yes’ responses to the family violence perpetrator narrative. for example, one student responded: yesthe person in the scenario … did what he believed was expected of him in his culture but ended up … going to jail (student 15). future targeted research on teaching empathy, particularly in relation to crosscultural adoptions, family violence, and more broadly, cross-cultural therapeutic engagement, seem warranted. indeed, while acknowledging that empathy for all persons, by all persons, in all situations might not be possible (tong, 1997), nevertheless the ‘no’ responses in this study are worthy of deeper reflection. pondering the ‘empathy gap’ identified in the findings above, between students’ demonstrated objective learning of what is empathy, and a deeper, reflective, enacted empathy, ramsden (1992) may offer some direction. ramsden (1992) notes that learning is less about deep or surface learners and more about different ways adult learners are facilitated to learn specific content in a deep or surface way. a surface approach requires students to learn (memorize) words, concepts and tasks unreflectively as generalizable, external, objective learning. in contrast, deep learning requires students to try to understand, and engage in a reflective, internal process that models and reflects what is an “essential part of their work as professionals” (ramsden, 1992, p. 50). it would seem self-evident that a deep approach to learning empathy would be preferable to a surface approach, in order to produce effective practitioners. such positioning of empathy, as requiring a reflective, inner process, aligns with the work of stein (1917, translated in 1989) who recommended objective listening, followed by deeper subjective connection through listening to the story told, and then conveying back these combined objective and subjective responses to the person in a way that centralized a common humanity rather than a common experience. there appear to be identifiable similarities between the work of stein on deep listening, the concept of transformative learning as discussed by mezirow (2003), and deep and surface learning as identified by ramsden (1992). moreover, it is noted here that these concepts have much in common with the concept and process of gair/exploring empathy 339 mindfulness. such literature was not introduced to students at the time of this inquiry and admittedly the term ‘mindfulness’ in some ways “has been fraught with the same vagaries … as empathy” (block-lerner, adair, plumb, rhatigan, & orsillo, 2007, p. 506). nevertheless, it is concluded here, after reviewing such literature as a part of my own reflective learning, that deeper listening facilitated through mindfulness approaches, in a way that incorporated deep learning models, may prove successful in cultivating greater empathy (wong, 2004). the work of gerdes and segal (2009), noted in the opening quote, reflects some of these aspects in a three level model of affective and cognitive responses informing our empathic concern. overall, it would seem detrimental to client groups if some students are forgetting, ‘feigning’ (sherborne, 2011, p. 20), or ‘faking’ their empathy (meyer & land, 2005, p. 383) because educators have not facilitated a deeper, more transformative empathy. highly desirable are graduates who can respond in flexible, open ways that involve a “deepening of the human empathic response” (ridley & lingle, cited in rasoal et al., 2011, p. 6). when considering the findings from this empathy project, together with findings reported from a 2009 study (gair, 2009), teaching empathy within a skills unit may be the better context (erera, 1997), although it seems relevant to consider ethics and empathy as interrelated. more research in this area may be useful. it is acknowledged here that limitations of this inquiry may include the small, exploratory sample, and as such its limited generalizability, and the limited data collected regarding the characteristics of the participants that may have limited the richness of the analysis. my own critical reflection about how to advance students’ empathy is ongoing. nevertheless, i recommend increased opportunities, including within assessment, for social work students to explore empathy through narratives, shared personal stories, and vignettes (furman, 2006). providing cognitive, experiential, and perspectivetaking opportunities for students to explore how they might empathically, mindfully, and compassionately engage with diverse client groups in practice are recommendations from this research. conclusion a review of the empathy literature, together with the findings from this explorative classroom-based research, suggests that teaching and learning empathy needs much more emphasis in social work education. while acknowledging the limitations of this inquiry, it may be that the notion of ‘walking a mile in another’s shoes’ may be unhelpful if students do not advance 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(2004). knowing through discomfort: a mindfulness-based critical social work pedagogy. critical social work, 5(1). retrieved from http://www.uwindsor.ca/criticalsocialwork/2004-volume-5-no-1 author note: susan gair, ph.d., department of social work, james cook university, queensland, australia. e-mail: susan.gair@jcu.edu.au microsoft word 07 anderson_and_cook_18132_challenges_and_opportunities_au_ce.docx ______________ kim m. anderson, ph.d., lcsw, is an associate professor in the school of social work at the university of missouri. jonathan r. cook, ph.d., is an assistant professor of psychology, rhodes college. copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 78-89 challenges and opportunities of using digital storytelling as a trauma narrative intervention for children kim m. anderson jonathan r. cook abstract: this article address the challenges and opportunities of implementing a webbased digital storytelling (ds) curriculum to supplement the trauma narrative component of trauma-focused cognitive behavioral therapy (tf-cbt) for traumatized young people, ages 9-17, receiving mental health services at a rural domestic violence (dv) agency. digital storytelling, as the term suggests, combines storytelling with technology that integrates a mixture of digital images, text, audio narration, and music. ultimately, implementing the ds curriculum empowered participants to process and develop their trauma narratives in a multi-sensory, accessible, and coherent manner. in doing so, they gained tools (writing, narrating, illustrating, and ultimately assembling their own stories) to form adaptive responses regarding their family violence experiences in the immediate aftermath and possibly over time. agency implications are discussed regarding training, technical, and confidentiality issues related to the implementation of a web-based ds curriculum. keywords: digital storytelling, narrative, children exposed to domestic violence, traumafocused cognitive behavioral therapy this article focuses on the use of digital storytelling (ds) as a narrative intervention for traumatized young people, ages 9-17, receiving mental health services at a rural domestic and sexual violence agency. in particular, we developed a web-based ds curriculum to supplement the trauma narrative component of trauma-focused cognitive behavioral therapy (tf-cbt), an evidence-based intervention for children with emotional and behavioral difficulties associated with violence exposure and trauma. tf-cbt is typically delivered in 12-16, weekly 90 minute sessions (60 minutes with the child, 30 minutes with the parent to recap the child’s session). the core components of tf-cbt make up the acronym practice: psycho-education, relaxation skills, affect modulation, cognitive coping, trauma narrative development, in-vivo exposure, conjoint parent-child meeting, and enhancing safety (cohen, mannarino, & deblinger, 2006). we sought to understand the elements (i.e., digital images, text, audio narration, and music) of ds and their individual and collective narrative and mental health benefits (gubrium, 2009; lambert, 2006). ds was intuitively recognized by agency staff as a good fit with the cognitive, emotional, and linguistic needs of children, yet it was a novel intervention. therefore, we chose not to use it as a stand-alone protocol and instead integrated it into the existing tf-cbt protocol. the ds curriculum is presented, along with a discussion regarding the challenges and opportunities of implementing it as a narrative intervention for youth traumatized by family violence (e.g., domestic violence, child sexual abuse/violence). anderson & cook/challenges and opportunities 79 children’s trauma narrative construction processing family violence experiences is complicated as children may repress one or more aspects, perceptions, or feelings. this chaos of fragments is difficult to understand and is associated with confounding emotions and negative appraisals of self and others, thus overwhelming children with experiences they cannot process and, consequently, inhibiting their ability to construct a coherent self-narrative (simon, feiring, & mcelroy, 2010). processing, organizing, and integrating traumatic memories is challenging due to encoding in a dissociated and often sensory rather than a verbal manner; thus, they cannot be effectively communicated or organized (niederhoffer & pennebaker, 2009). integrated functions such as cognition, memory, and emotion become disconnected, particularly in cases of prolonged exposure to interpersonal trauma such as with domestic violence or child sexual abuse (simon et al., 2010). failure to adequately integrate trauma-related information underlies several psychological and physical problems including posttraumatic stress disorder (ptsd), low self-esteem, and destructive coping mechanisms (cohen et al., 2006; dube, anda, felitti, edwards, & williamson, 2002). creating a written trauma narrative is a critical component of standard tf-cbt, and general guidelines are provided in a published treatment manual (cohen et al., 2006). during the trauma narrative component, the child develops a storybook (using words, pictures, and/or drawings) or uses other creative expressions (e.g., poetry, song, art techniques) to tell the story of their trauma (cohen et al., 2006; cohen, mannarino, & iyengar, 2011). the goal of the trauma narrative is to disentangle unpleasant associations between reminders, thoughts, and discussion of the trauma from overpowering emotions, such as horror, fear, or helplessness. thus, over the course of several sessions, children are encouraged to write in increasing detail about the trauma, including their thoughts and feelings about it. in our experience, we found that young people often avoided the trauma narrative component because of the nature of the content and difficulty with speaking or writing plainly about their childhood trauma, as the experiences were often fragmented, difficult to understand, and associated with overwhelming emotions. we believed that digital storytelling might help them find another avenue to discover their voice during the development of the trauma narrative because of its multi-sensory nature and cultural congruence with young people’s connection to digital media. thus, we added digital storytelling to the trauma narrative component of tf-cbt, as a child-friendly, multi-media narrative alternative that integrated images, narration, and music to tell one’s trauma narrative. digital storytelling as a narrative intervention digital storytelling, as the term suggests, combines storytelling with technology (lambert, 2006). ds involves a computer-based program that integrates a mixture of digital images, text, audio narration, and music. such modalities are highly customizable, interactive, and allow the user to control how individual digital media elements interact with one another. in addition, the user can personalize digital stories with pan and zoom effects that create a sense of movement and highlight areas of importance in an image. the process of ds involves the individual assessing and making decisions regarding how the story interacts with the images, narration, or music/sounds (gubrium, 2009). the technical advances in social work, spring 2015, 16(1) 80 process is user-friendly; both youth and adults often catch on quickly (davis & weinshenker, 2012). once the story is created and saved, one can view, edit, and continue to add to it until the final version is completed. after completion, all pictures, narrations, and music are compiled and exported into a single video file that one can then view in increments or in its entirety. the end result is the creation of a two to five minute film of one’s story (gubrium, 2009; lambert, 2006). traumatic memories are more disorganized than other memories, and narrative interventions aimed at organizing memory may be particularly effective for children because more organized memories are easier to integrate into existing ones (foa & rauch, 2004; hanney & kozlowska, 2002). digital storytelling allows for gradual exposure to one’s life traumatic experiences through the use of storyboards—a means of planning out, creating, and telling one’s story in a compelling and emotionally engaging form (lambert, 2006). ds embodies the narrative approach of “emplotment,” which involves arranging temporal elements into a whole by connecting them together and directing them toward a conclusion or ending (polkinghorne, 1991). essentially, storyboarding transforms a sequence of disconnected images juxtaposed with narration into a unified story with a point or a theme (anderson, 2010). for traumatized youth, ds provides a good balance between giving a basic structure to construct one’s story that allows immersion into story material (e.g., family pictures) while also providing disengagement opportunities as the child learns technical tools for movie making. such balance allows them to shift between reexperiencing negative memories while developing mastery over the traumatic experiences and its portrayal in their narrative. consequently, traumatic reactions that young people otherwise might carry with them throughout their lives may be prevented, lessened, or ameliorated. rural dv agency and case example the ds curriculum outlined below developed out of the tf-cbt services offered by the only victim service provider for a rural county (population approximately 43,000) in a midwestern state. the youth therapy program (ytp) was comprised of the first author as clinical coordinator, the second author as program coordinator, and a licensed professional play therapist. in response to the difficulty young people were having in constructing traditional written trauma narratives, a ds web-based curriculum was created and added to the trauma narrative component of practice. we wanted to better understand the capacity of ds to facilitate recovery and promote resiliency in clients, ages 9-17, exposed to familial domestic and/or child sexual violence who were experiencing post-traumatic stress disorder (ptsd). of 41 agency referrals, 28 met criteria for ptsd and 25 of those followed through after intake to begin ds within the context of tf-cbt. of the 25 who started tf-cbt services, 16 (9 male and 7 female, all caucasian, ranging in age from 716 years old, m=12; sd=3.28) completed treatment (63%). non-completion (n=9) was most often due to life crises such as loss of housing, transportation, and/or employment. we modified the protocol for ds from a 3-day standard workshop model for community participants (see center for digital storytelling, n.d.) to one integrated into an evidence-based therapeutic model (tf-cbt) for young people with ptsd. this adaptation resulted in a web-based ds curriculum for the trauma narrative component (see digital anderson & cook/challenges and opportunities 81 storytelling, 2015) that provided direction and guidelines that were not sufficiently delineated in the professional literature regarding trauma story construction with children. the ds curriculum consisted of three structured sessions covering the purpose, process, and technical tools of ds and two to three unstructured sessions for them to complete their digital stories. the ds curriculum added essential structure to the trauma narrative component of practice, and it helped the children process and develop their stories of family violence in a less threatening and more approachable manner. initially, we used a personal computer program (windows moviemaker); eventually, an ipad was used (applications: pinnacle studio, imovie) as it was more user-friendly for participants and less costly for the agency. the clinician provided children with technical assistance and encouraged them to use their tf-cbt skills. embedded throughout the ds curriculum were digital story examples (downloaded from public sites) of children who had survived, persevered, and even thrived despite adversity (e.g., parental death, domestic violence, alcoholism). the first ds session began with the rationale for making a trauma narrative: for young people to tell their stories and say the things they needed to express, even if they did not know how to do so at the moment. the concept of ds was introduced by explaining that participants would create a brief movie about their lives and the difficult experiences (i.e., family violence) they had endured. they were told they would take on several roles: author, narrator, director, and editor. they were encouraged to write scripts or condensed (i.e., 100250 words) versions of their life stories. the script-development process addressed components of narrative therapy and resilience theory, along with elements of storytelling to guide each youth’s script. their scripts highlighted the important people and events in their lives, including experiences of family domestic and sexual violence, along with their strengths, coping skills, and ways of healing despite enduring adversity. although participants were given a good deal of latitude in content, the ds curriculum provided a guide to create coherent narratives that had beginnings, middles, and ends. in ds session two, young people finished their scripts and were introduced to how images, narration, and music/sounds would be used to complete their stories. participants were encouraged to use personal artifacts (e.g., pictures, drawings) that could be scanned and digitized. as part of the ds curriculum, several pictures of various people, places, and landscapes were provided to help them identify associated emotions and convey how text (e.g., the word sad) was not always needed to distinguish such feelings. different types of music were added to these pictures, and participants were asked to notice if their emotions changed as a result. in doing so, music was highlighted as another medium to convey emotion. next, they were shown a ds of a young person’s experiences with bipolar disorder and the loss of his supportive father; upon viewing it, they were asked to identify the emotions expressed through the pictures and music represented in his story. in ds session three, participants further explored their difficult experiences (i.e., family, domestic, and/or sexual violence); the terms “difficult experiences” or “hard times” resonated more with them than the word “trauma.” they viewed a digital story of a youth who used rap to tell his experiences of witnessing his father harming his mother. the clinician reiterated that the youth did not have to relive scary experiences; he/she had advances in social work, spring 2015, 16(1) 82 control over portraying as much or as little of his/her adversity in their ds. if participants seemed stuck, they were encouraged to focus on the end of their stories —where they were in the present moment— and to think about how they got there. to further underscore the concept of resilience, participants watched a ds in which a youth used music to cope with family alcoholism. this allowed them to see how difficult experiences were a part of their stories but did not have to define them. in ds session three, participants also created audio-recordings of their scripts. although some young people were hesitant, gradually they became more accepting of their voices as they read and reread their scripts aloud. for an example of the use of one’s voice, participants viewed an animated ds of a youth with asperger’s syndrome interviewing his mother about being his parent. as they audio-recorded their scripts, they played back the recordings to make changes as they saw fit. they were encouraged by the clinician to consider that their audio recordings did not have to be perfect; in other words, it was okay to hesitate, get choked up, or pause. after finishing their audio recordings, participants were asked to collect pictures (a maximum of 15) related to their script to bring in for their next session. the clinician helped them focus on the overall purpose of their stories and how one unique picture was not needed to match each word, sentence, or paragraph. in fact, a digital story could include as few as one or two pictures to accompany the narration. they were also asked to bring in music/sounds (a maximum of three) to complement their narration. the agency also had an itunes account for participants without access to music. instrumental music, as a background soundtrack for the audio recordings, often worked best as it did not compete with or override the audio narratives. also, the use of silence was introduced as a compelling way to emphasize the visual narratives. during subsequent ds sessions, participants worked on finalizing their digital stories as they interacted with different images, narratives, and background soundtracks, including decisions regarding timing and placement, allowing for as much immersion and disengagement of story material as necessary. upon completion of the digital stories, the audio recordings, images, and music were exported into brief videos. the youth often expressed enthusiasm and pride in their finished work. working with digital media allowed them to more easily approach their difficult family experiences than what we had observed in our previous attempts of addressing the “t” (e.g., trauma narrative) aspect of practice through the written format only. the use of a multi-sensory approach (as opposed to writing/drawing only) allowed these young people to engage in an interactive dynamic process that ultimately allowed them to use technical tools to create their stories while controlling how they were expressed. in addition to script development, other ds elements – voiceover, images, sound track – drew on their own inherent semiotic “grammar” (kress, 2003) to expand upon the storytelling process. as with all aspects of practice in tf-cbt, the child’s digital story sessions were also shared with the non-abusing parent/guardian with the youth’s understanding and consent (foster, 2014). caregivers often assisted them with collecting pictures and music for their ds, and observing its construction helped prepare the young people to view it in its entirety at the conjoint session (i.e., when the child and parent view the finished digital story together). the conjoint session, an important component of tf-cbt, was often powerful as parents came to new understandings and appreciation of their children’s anderson & cook/challenges and opportunities 83 trauma, recovery, and resilience. as one parent stated in regard to her daughter’s digital story, “the recorded voice of a young person with such a big story has a huge impact.” upon completion of tf-cbt services, each participant was given a dvd of his/her digital story. during the final session, the clinician, participants, and parents discussed guidelines, particularly safety and confidentiality issues, regarding the sharing of one’s video with others. the use of ds as a trauma narrative intervention was well-received by all participants (n=16), and allowed them to process very difficult experiences in a manner that offered them creative control and various ways to portray their stories. during exit interviews, participants completed a likert-type questionnaire asking about the process and outcome of ds in the framework of tf-cbt. these young people found that creating a digital story that included their most difficult, along with their more positive, experiences was an enjoyable process even though the material was challenging. hearing their voice (reading their story aloud and recording their story) became an integral part of their trauma narrative process. they reported valuing the creative process along with having control over the story they wanted to tell. participants also completed standardized instruments on ptsd, depression, self-esteem, and coping at pre(intake session) and post-intervention (exit interview); results indicated a clinically significant difference in psychological distress and well-being over the course of treatment for all participants. see anderson and wallace (2015) for additional information regarding our research design and findings. case example: mary a case example of a nine-year-old caucasian female, pseudonym “mary,” is presented to highlight how the ds process facilitated her recovery from sibling incest. mary resided with her 40-year-old stepfather and 34-year-old biological mother, both of whom brought her to weekly tf-cbt sessions. approximately nine months prior to initiating agency services, mary disclosed to her mother that her biological brother (age 13) and stepbrother (age 12) had repeatedly sexually abused her. both boys were removed from the home and placed in an inpatient facility for sex offenders. as a result of these experiences, mary’s parents reported that she was emotionally distressed, withdrawn, and feared reminders of her brothers and the abuse (e.g., avoiding parents’ bedroom where she was abused). mary’s mother reported, “my biggest fear is that my daughter will never be okay again.” during the intake process for services, mary and her parents were introduced to the components of tf-cbt, including how mary would use ds to tell her story of the abuse. she was shown the ipad and the ds application and was very excited about using it. in the first four sessions, mary developed mastery of introductory tf-cbt components (i.e., psycho-education on trauma, relaxation methods, affect modulation, and cognitive coping skills). she also spent a few minutes on the ipad at the end of each session playing video games and exploring the ds program. mary then began six consecutive sessions creating her digital story. throughout the ds process, mary viewed videos created by children who had faced adversity presented in the ds curriculum. in doing so, she learned how others used specific ds elements such as voice, photographs, sound, music, and pacing to tell their stories. advances in social work, spring 2015, 16(1) 84 during the first and second ds sessions, mary finished her storyboard and began to write her script. mary’s storyboard included the most meaningful events in her life before, during, and after the abuse took place (a narrative with a beginning, middle, and end). she chose to first write about the happiest times in her early life followed by the abuse itself including its emotional impact, her personal strengths and resiliency capacities, and how she had learned to cope after the abuse. she wrote about the abuse and the embarrassment, fear, worry, anger, and guilt that she felt regarding it. the clinician and mary further reviewed the ds curriculum regarding how to represent emotion and discussed how she could use specific photographs in her ds trauma narrative to illustrate particular feelings or experiences related to the abuse rather than verbally labeling the emotion. as part of the script development, mary identified a previously unverbalized dysfunctional belief—that she was to blame for the abuse and the subsequent removal of her brothers from their home. her challenging this belief, with the support of the clinician and her parents, became an important aspect of her therapeutic process. in the third ds session, mary completed her script and narrated it. listening to her recorded story was a powerful and emotional experience for mary. initially, she described listening to her own voice as “really weird.” after listening to herself several times, she stated that she liked it, especially the narrated ending: “i’m learning to be okay even though i was abused. i can think about the abuse and talk about it and cope and not be as upset as i used to be. i feel happy. i feel safe. i feel loved. my parents are there for me.” the audiorecording process provided mary with some distance from the abuse while simultaneously empowering her through the control she had narrating her own story. her voice became louder, stronger, and less tentative towards the narration of the abuse she experienced. during the fourth through sixth ds sessions, mary brought in family photographs that she had selected with the assistance of her parents and sequenced them to her audiorecording. she chose photographs based on literal rather than abstract meanings (i.e., showing a picture of her home when describing what it was like growing up there). she sequenced the images chronologically according to the specific events she described in her narration (i.e., growing up, the abuse, and current coping/resiliency). next, she assembled the content using the ipad. mary was particularly excited about this stage of the ds process because she was excited to be working on an ipad, and the technical process appeared to be intuitive for her. mary chose to not use background music and instead let her voice be the focal point. after she completed the assembly of digital media, it was exported as a video file. implementing ds specifically for the trauma narrative aspect of tf-cbt enabled mary to negotiate a balance between representing her traumatic experiences with her words and pictures while simultaneously learning technological skills. by the time mary viewed the final exported video, she had listened to the audio and her digital story more than a dozen times. initially, mary found it difficult to watch and listen to the ds, particularly during the sequence where the photographs of her brothers were paired with her narration of the abuse. however, with repeated viewings mary was able to watch the entire digital story with minimal or no distress due to desensitization during the ds process. when the clinician asked mary about this change she said, “i’m learning how to cope with the hard anderson & cook/challenges and opportunities 85 times i’ve been through.” through multiple forms of repeated exposure embedded in the development of the ds trauma narrative, mary’s distress decreased (as in all aspects of practice, participants are asked to rate their distress on a subjective units of distress of scale, suds) and her mastery of technical and storytelling increased as indicated in her coherent, integrated, and completed story. throughout the creation of mary’s digital story, the clinician shared it with her parents (without mary present but with her knowledge and consent) so they could process their own feelings and reactions about the abuse as well as have a sense of her narrative progress. initially, both parents found listening to and viewing the digital story difficult, particularly the sections in which mary described the abuse. during these meetings, the clinician talked to mary’s parents about their feelings of guilt and responsibility regarding the abuse, as well as how they could support their daughter’s coping and resiliency abilities. similar to mary’s own experience, her parents found the digital story less distressing with repeated exposures. ultimately, they came to view mary’s concluding comments on her coping, resiliency, and hope for the future as an especially powerful component of her story. next, a conjoint parent-child session was held with the clinician to view the completed digital story together. this was an emotional but positive experience for both mary and her parents, who expressed their love and support for her. they also discussed the positive changes they had seen mary make over the course of treatment. the in vivo (e.g., in-session desensitization to trauma stimuli) component of practice ended up not being necessary as ds construction exposed mary to triggers, such as pictures of her abusers and the location of the abuse, to which she became desensitized. upon completion of tf-cbt services, mary and her parents were given a dvd of her digital story, and guidelines regarding the sharing of her story, particularly safety, legal, and confidentiality issues, were addressed. discussion and implications several studies demonstrate the relation between formulating an integrated and coherent story after experiencing traumatic events and enhanced trauma recovery and growth (e.g., anderson & hiersteiner, 2008; van minnen, wessel, dijkstra, & roelofs, 2002). the organization of stressful memories, particularly in a narrative structure, is a critical factor in the beneficial effects of children processing their stories about stressful events (hanney & kozlowska, 2002; simon et al., 2010). when children process the story of their family violence experiences in depth and detail, their recent and traumatic memories are transformed and more easily incorporated into their life narratives. ds empowers children to address difficult experiences in a deliberate manner while giving them creative control and a variety of ways to tell the story. the sequential process of script development, audio-recorded self-narrative, selection of photographs, and assembly of the video incorporates multiple sensory modalities (i.e., visual, auditory, tactile) to help youth tell one’s story in manageable doses. such processing allows children to elaborate and organize their trauma memories while tolerating the negative emotions associated with it. our research findings indicate that being able to gain insight and understanding into a personally traumatic event for these participants enhanced feelings of efficacy and control over the event, one’s emotions, and life in general (anderson & wallace, 2015). advances in social work, spring 2015, 16(1) 86 ds as a trauma narrative intervention provides young people with a structured, interactive, and empowering method of processing traumatic experiences. we were amazed by the facility with which participants learned and developed digital storytelling skills while processing their traumatic life experiences. we found that they were more willing to revisit the past and address present emotions than they had been with the written narrative as they had the structure and tools to regulate exposure to trauma material. participants often addressed their difficult experiences with interest rather than avoidance even though they experienced discomfort regarding abuse-related memories, emotions, and cognitions. as in the example of mary’s case, the inclusion of her voice and family photographs was initially distressing, but she quickly habituated to these new stimuli and no longer found them to be upsetting. ds provided a good balance between giving a basic structure to construct her story that allowed immersion into story material (e.g., family pictures) while also providing disengagement opportunities as mary learned technical tools for movie making. despite the seriousness of the abuse, mary fully participated and even came to enjoy working on her story, particularly when it came time to use the ipad. working on a tablet-sized device may also have increased mary’s feelings of self-efficacy because she could sit comfortably and hold it in her lap as opposed to having to work at a table and use a larger desktop computer. the addition of a web-based ds curriculum in the context of tf-cbt provides mental health clinicians with practical information on narrative development to use in their own practices. the clinician’s role is to provide a safe environment for each youth to develop his/her digital story and to support the process. because of the way trauma affects children’s processing, their story creation can appear random and non-linear at first. however, over time they can often create meaningful and profound stories about their experiences. we found that young people have an intuitive sense of how they want their stories to develop. they knew how they wanted their stories portrayed in regard to the sequencing of images, music selected, and the use of their voice, even though they may not have been able to articulate the “why” and “how” of their process. consequently, we learned that it was best to not inquire about the construction process, e.g., asking them to talk about what their digital images represent. instead, it was better to focus on the written script and ask questions regarding how selected images, songs, etc., helped to complete their stories. a few areas to consider before clinicians adopt ds as a trauma narrative intervention include training, technical, and confidentiality issues. in addition to staff being educated on tf-cbt, the first author, who was trained at the center for digital storytelling, also provided instruction and guidance on digital storytelling. although our ds curriculum is a useful tool for clinicians, it may not be sufficient for their technological needs without oversight from someone skilled in ds. in addition, agencies will need internet access and personal computers with moviemaking programs. if ipads are used, the applications are relatively inexpensive (e.g., $5.00); however, the agency still needs to have a personal computer to download and burn the video to a dvd. also, technological failures may result in the loss of digital data gathered during the trauma narrative sessions. for example, in mary's case, her voice recording was unusable as the audio file was corrupted. fortunately, mary was good-natured about re-recording the narrative, but this could be upsetting for anderson & cook/challenges and opportunities 87 some clients. using a built-in audio recorder found on most smartphones and subsequently importing the file onto the ipad might be one potential solution to avoiding lost data. furthermore, teaching clients how to use the software can constitute an additional time commitment, especially for less technologically savvy clients. however, as younger generations are raised in increasingly technologically immersive environments, the need for such training may be minimal. confidentiality guidelines must be considered when using any electronic device to collect and assemble digital stories. a portable device containing ds materials should be password protected and not include the clinician’s personal photographs or videos. in addition, an electronic album of photos should be created for each client to prevent clients from seeing the images of others. agency administrators will also need to make decisions on how the videos will be stored upon termination of services and if clients will receive a copy of their completed stories. the dv agency for the current project, after much staff discussion, decided that clients had a right to their digital stories and provided them with copies. however, the clinician met with all participants and caregivers to discuss the implications of having their videos, including possible legal and confidentiality ramifications. although implementation of ds requires careful agency consideration, the benefits include a powerful, highly personal, and multisensory method for clients to process traumatic events. conclusion trauma is a deeply personal experience, and no one child will tell his/her story the same. narrative approaches, such as digital storytelling, can influence trauma recovery and resilience by offering a means of owning and being able to tell one’s story. young people not only learn to process and integrate the traumatic experience into the larger context of their lives but are also empowered through the process of writing, narrating, illustrating, and ultimately assembling their own story. in doing so, they have the storytelling and technical tools to form adaptive responses regarding their family violence experiences, both in its immediate aftermath and over time, possibly preventing the trauma cycle from continuing. references anderson, k. m. (2010). enhancing resilience in survivors of family violence. ny: springer. anderson, k. m., & hiersteiner, c. (2008). recovering from childhood sexual abuse: is a storybook ending possible? the american journal of family therapy, 36(5), 413424. anderson, k. m., & wallace, b. (2015). digital storytelling as a trauma narrative intervention for children exposed to domestic violence. in j. cohen & l. johnson (eds.), film and video-based therapy (pp. 95-107). new york: taylor & francis/routledge. center for digital storytelling. (n.d.). retrieved from http://storycenter.org advances in social work, spring 2015, 16(1) 88 cohen, j. a., mannarino, a. p., & deblinger, e. (2006). treating trauma and traumatic grief in children and adolescents. ny: guilford press. cohen, j. a., mannarino, a. p., & iyengar, s. (2011). community treatment of posttraumatic stress disorder for children exposed to domestic violence: a randomized control trial. archives of pediatrics and adolescent medicine, 165(1), 1621. davis, a., & weinshenker, d. (2012). digital storytelling and authoring identity. in c. c. ching & b. foley (eds.), technology and identity: research on the development and exploration of selves in a digital world (pp. 47-64). cambridge, uk: cambridge university press. digital storytelling. (2015). what is digital storytelling therapy? retrieved from http://digitalstorytherapy.com/ dube, s. r., anda, r. f., felitti, v. j., edwards, v. j., & williamson, d. f. (2002). exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services. violence and victims, 17(1), 3-17. foa, e. b., & rauch, s. a. (2004). cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. journal of consulting clinical psychology, 72(5), 879884. foster, j. m. (2014). supporting child victims of sexual abuse: implementation of a trauma narrative family intervention. the family journal: counseling and therapy for couples and families, 22, 332-338. gubrium, a. (2009). digital storytelling: an emergent method for health promotion research and practice. health promotion practice, 10(2), 186-191. hanney, l., & kozlowska, k. (2002). healing traumatized children: creating illustrated storybooks in family therapy. family process, 41(1), 37-65. kress, g. (2003). literacy in the new media age. london: routledge. lambert, j. (2006). digital storytelling: capturing lives, creating community. berkeley, ca: digital diner press. niederhoffer, k. g., & pennebaker, j. w. (2009). sharing one's story: on the benefits of writing or talking about emotional experience. in s. j. lopez & c. r. snyder (eds.), oxford handbook of positive psychology (2nd ed., pp. 621-632). ny: oxford university press. polkinghorne, d. e. (1991). narrative and self-concept. journal of narrative and life history, 1(2 & 3), 135-153. simon, v. a., feiring, c., & mcelroy, s. k. (2010). making meaning of traumatic events: youths’ strategies for processing childhood sexual abuse are associated with psychosocial adjustment. child maltreatment, 15(3), 229-241. anderson & cook/challenges and opportunities 89 van minnen, a., wessel, i., dijkstra, t., & roelofs, k. (2002). changes in ptsd patients’ narratives during prolonged exposure therapy: a replication and extension. journal of traumatic stress, 15(3), 255-258. author note address correspondence to: kim m. anderson, phd, lcsw, school of social work, university of missouri, 705 clark hall, columbia, missouri, 65211. email: andersonki@missouri.edu. microsoft word 14. majiros_1941_social_exchange_mentoring_copyedit_final ______________ chad majiros, msw, is a doctoral student in the national catholic school of social service at the catholic university of america in washington, dc. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 531-543 beyond social exchange theory: a theoretical shift for mentoring relationships in the federal workplace chad majiros abstract: this paper examines the principles of social exchange theory associated with the application of mentoring for knowledge transfer in the federal workplace. specifically, federal workplace is intended to mean any u.s. government agency defined by bureaucratic processes in its operations. max weber’s comparison of a bureaucracy to an iron cage is both classical and paramount to this discussion. within the iron cage, weber posed the further the organization perfects its operation, the more dehumanized the interaction between players (farganis, 2011). most important, due to the hierarchical structure and emphasis on career progression associated with the bureaucracy, mentoring relationships are often forged in a knowledge economy. over time, mastery of skill is supported by a grasp of institutional history and organizational knowledge. contemporary social work is aptly suited for investigating the barriers to, behavioral elements of, and best practices for fostering effective mentoring relationships in facilitating knowledge transfer between federal employees. keywords: mentoring, mentoring relationships in the federal workplace, social exchange theory, mentoring dynamics, mentoring for knowledge transfer a large turnover in the federal civilian workforce is expected over the next 10 years. the united states office of personnel management (opm) found that, by 2016, over 60% of employees will be eligible to retire (united states office of personnel management, 2008a, p. 6). this mass exodus of retirees will have a direct impact on the working environment left behind at many federal agencies, perhaps compromising the ability of these agencies to fulfill their civic missions and provide services to the american public (united states general accounting office, 2001). as a result, government leaders must pay closer attention to the ramifications of lost knowledge (davidson, 2010; delong, 2004; godwin, 2009; leuenberger & kluver, 2005/2006; mason, 2010; reeves, 2010; talley, 2008). in response to losing contextual, historical, and operational knowledge, federal leaders have drafted the federal supervisor training act (2010). this legislation mandates mentoring practices for “transferring knowledge and advice in areas such as communication, critical thinking, responsibility, flexibility, motivating employees, teamwork, leadership, and professional development” (federal supervisor training act, 2010, p. 4). however, the proposed law fails to address how these mentoring programs are developed, evaluated, and implemented within the federal workplace. this paper examines concepts and themes associated with the application of mentoring for knowledge transfer in the federal workplace. specifically, federal workplace is intended to mean any u.s. government agency defined by bureaucratic processes in its operations. max weber’s comparison of a bureaucracy to an iron cage is majiros/beyond social exchange theory 532 both classical and paramount to this discussion. within the iron cage, weber posed the further the organization perfects its operation, the more dehumanized the interaction between players (farganis, 2011). most important, due to the hierarchical structure reinforced by authority and routinization, government employees are encouraged to develop “technical superiority” (farganis, 2011, p. 85) and through consistent daily practice develop a level of expertise (farganis, 2011; hughes, sharrock, & martin, 2003; reeves, 2010; schroeder & swedberg, 2002). ultimately, the wealth of experience and knowledge developed within the confines of the bureaucratic workplace afford the more seasoned government employees varying degrees of power and status (darwin, 2000; farganis, 2011; fiol, o’connor, & aguinis, 2001; fouché & lunt, 2010; reeves, 2010). social work has a unique contribution to make in this area. examining the psychosocial aspects in mentoring relationships, specifically the necessity to promote mutual respect and trust, among employees is a novel idea that requires further study within the context of individual, group, and organizational culture. social work is aptly suited for investigating the cultural (gender, generation, race), contextual (physical proximity, increased use of telecommuting, time), and structural (technology, hierarchical vs. horizontal) barriers to knowledge transfer within bureaucratic mentoring dyads (cunningham, 1999; heimann & pittenger, 1996; matson & prusak, 2010). mentoring dynamics in the workplace the premise behind successful implementation of workplace mentoring programs is based on two assumptions. first, can we assume employees have the competency or know-how to mentor and facilitate learning relationships? the inherent danger in assuming that every employee entrusted with supervisory authority can mentor others as a result of receiving some level of mandated training has the potential to exacerbate barriers already hindering workplace development. second, can we truly assume employees want to share their knowledge? especially when precedence suggests that in some bureaucratic organizations knowledge possession is more culturally valued than knowledge sharing. the consensus throughout the literature is that the concept of mentoring first originated in homer’s odyssey. odysseus, king of ithaca, fights in the trojan war and entrusts the care of his household to mentor, who serves as teacher and overseer of odysseus' son, telemachus. the word mentor evolved to mean trusted advisor, friend, teacher, and wise person. coincidentally, opm defines mentoring as “a formal or informal relationship between two people—a senior mentor (usually outside the protégé’s chain of supervision) and a junior protégé” (united states officer of personnel management, 2008b, p. 2). the common elements in mentoring relationships include formal or informal dynamics, interpersonal skill, mutual respect, professional knowledge, reciprocity, time commitment, trust, and an understanding of adult learning principles (cohen, 1999; fouché & lunt, 2010; higgins & kram, 2001; shea, 2002; zachary, 2000). for instance, zachary (2000) emphasizes the importance of mentor preparation and reflection as a means to better facilitate a learning environment. shea (2002) emphasizes the importance of mentor-like behavior in developing a mentoring relationship based on modeling behavior and teaching skills with varying levels of advances in social work, fall 2013, 14(2) 533 formality and duration. as well, cohen (1999) emphasizes a mentor’s ability to exercise flexibility within the relationship by assuming various roles in dimensions. taking a more holistic approach, higgins and kram (2001) define mentoring using multiple relationships, based on diversity and strength of association, to articulate a developmental network perspective. similar to higgins and kram, fouché and lunt (2010) published results after looking at tertiary relationships between social service providers in new zealand. their study tested the concept of nested mentoring relationships whereby relationship development was not restricted to the horizontal or vertical structures within organizations, but where participants established connections across agencies (fouché & lunt, 2010). organizational culture and structure are critical factors in supporting the sharing of knowledge by whatever means. to illustrate, donaldson, ensher, and grant-vallone (2000) used a longitudinal framework to examine relationships between mentoring, organizational commitment, and citizenship behavior among a sample of nonprofessional protégés comprised of 70% women with an average age of 34 (n=408; 45% latino american; 22% european american; 15% african american; 10% asian american; .05% american indian; 5.5% other; 2% did not report). the results support the hypothesis that diverse, non-professional protégés in high quality mentoring relationships report greater organizational commitment than protégés in low or moderate quality mentoring relationships (donaldson et al., 2000). considering the context of the federal workplace and the potential ramifications for the federal supervisor training act, the concept of leader-member exchange will be essential to differentiating the roles of supervisor and mentor. specifically, wayne, shore, and liden (1997) suggest that some degree of leadership responsibility is inherent in the mentoring relationship. the application of leader-member exchange frames the mentoring relationship around transformational and transactional currency (howell & hall-merenda, 1999; scandura & schriesheim, 1994; sparrowe & liden, 1997). on one hand, the leader as mentor transforms the employee as mentee by means of change management and socialization. on the other hand, the leader provides emotional support and critical insider information based on the degree of followership received. to this point, raabe and beehr (2003) surveyed mentors and mentees in two companies while exploring the leader-member exchange framework further. the study deployed a questionnaire to 175 established mentor-mentee pairs. the response rates were 57% for mentors and 49% for mentees. findings suggest “there was no evidence that the mentoring relationships were perceived in the same way by the two members of the mentor-mentee dyads” (raabe & beehr, 2003, p. 284). interestingly, this study also identifies a potential barrier in that “the lack of agreement about reciprocal relationships across vertical organizational boundaries” may reinforce a power differential (raabe & beehr, p. 284). in this context, the elements and essence when defining the relationship, such as openness, respect, and trust, may be compromised by the duality of roles assumed by the supervisor as mentor. further research in examining mentor and mentee perspectives within the leader-member framework is warranted (ensher, thomas, & murphy, 2001; raabe & beehr, 2003). conversely, payne and huffman (2005) surveyed 1,334 u.s. army officers to measure levels of affective and continuance commitment as majiros/beyond social exchange theory 534 it related to mentoring effectiveness and organizational turnover. in this study, 81% of the participants report having at least one mentor with 68% of participants identifying supervisors as mentors and 85% report receiving career and job-related guidance from mentors (payne & huffman, 2005). findings suggest the relationship between mentoring and commitment is enhanced when supervisors serve as mentors. interestingly, the authors suggest that future research examine the factors that influence a protégé’s “attractiveness” (based on professional potential) implying that a mentor has a choice when engaging in a mentoring relationship (payne & huffman, 2005, p. 166). as leader-member elements impact the structural integrity for mentoring relationships, cultural barriers around gender appear just as concerning. literature suggests that women of color have been marginalized when it comes to maximizing the benefits from participating in formal workplace mentoring programs. in fact, katz (2013) brings to light the equal employment opportunity commission’s report (2010) that found “unconscious biases, insufficient training and mentoring and outdated recruiting and hiring practices have stymied african americans in federal government” (p. 1). with limited mentoring resources, female mentor-seeking behavior is polarized in label as either being “too dependent” (sandberg, 2013, p. 66) or “assertive…sometimes misdirected” (sandberg, 2013, p. 67). although mentoring trends show that access to higher-level, managerial females has been improving (combs, 2003), the existence of “perceived sexual intimacy” and “gender stereotypes” in some workplaces are obstacles to forming cross-gender mentoring relationships (o’neill & blake-beard, 2002, p. 52). further exploration into how this group negotiates informal mentoring dynamics while creating workplace social capital is crucial (gillies & edwards, 2006; khosrovani & ward, 2011). theoretical underpinning for mentoring relationships social exchange theory states that “interactions between persons are an exchange of goods, material and non-material” (farganis, 2011, p. 233). mentor’s and mentee’s participatory behaviors are based on the perceived benefits and costs in the relationship (ensher et al., 2001). exchange theory, as articulated by homans and blau, moved beyond the function of the environment and deployed the use of the self in creating expectations, obligations, and reciprocity with the other. blau developed “macrostructural theory” (homans, 1985, p. 396) to explain the importance of proximate position as the primary means of sanction within an organizational group. interestingly, norms and values were viewed as mediating forces contributing to exchange principles when face-to-face interaction was not an option (blau, 1955). for blau, individual selfincentive governs social interaction in the workplace while norms and values serve as reinforcers in understanding exchange behavior (blau & meyer, 1971). emerson was recognized for advancing the psychological framework of social exchange theory in his presentation of power and social influence (ritzer, 2010). emerson restricted the exchange label by defining it as either reciprocal exchange or negotiated exchange. he defines reciprocal exchange as the “sequential giving with unspecified terms and obligations”, and negotiated exchange as the “agreement with specified terms and obligations” (lawler & thye, 1999, p. 219). this concept led to advances in social work, fall 2013, 14(2) 535 cook’s work in identifying exchange networks. cook contends that individuals make rational decisions to engage in workplace interactions with the goal of career and professional benefit (cook & whitmeyer, 1992). consequently, the interaction between self and other within a socially constructed environment results in the strengthening of approval and prestige as significant commodities or rewards. in farganis (2011), coleman is credited with developing the concept of social capital. conceptually, the meaning of self is altered as it assumes the identity of the collective. the collective norm becomes a powerful body of selves that acts to reward all in allegiance while minimizing the dichotomy of self and other. for coleman, the choice to join the collective requires a significant level of trust by each individual member. conformity in the here and now is defined by short-term social acceptance and long-term network benefits (cook & whitmeyer, 1992; farganis, 2011; yair, 2007). conversely, allegiance to the collective establishes a paradox in that individual choice is significantly influenced by forces of the environment or system (lovett, 2006; yair, 2007). ultimately, interests, resources, and rewards are determined by “macro-level institutional factors” (rambo, 1999, p. 319) and controlled by the individuals in power (blau & meyer, 1971; lovett, 2006). the praxis of social exchange theory the bureaucratic process lends itself to placing technical job expertise into the category of commodity. formal mentoring is seen as a way to prepare an employee for career growth while developing internal human capital for filling job vacancies. this application of mentoring is reinforced by the vertical structure of a bureaucratic organization in which mostly explicit or codified knowledge is transferred. knowledge, both explicit and tacit, is bartered, traded, and exchanged between employees making new employees especially vulnerable during any socialization processes. the disposition of a knowledge economy helps to reinforce status while establishing a social exchange for transferring knowledge. once a specialist level of expertise is achieved, the agency becomes dependent on the hierarchical process where change is stifled and longevity becomes the primary means for security and self-preservation. unfortunately, formal mentoring practices emphasize the inherent, didactic attributes in establishing the power relationship between mentor and mentee. for this reason, many scholars have framed workplace mentoring (formal) in social exchange theory. for instance, unlike explicit knowledge, tacit knowledge is the know-how gained from experiential learning and not easily taught or learned in a traditional training sense. simply put, since tacit knowledge is hard to come by, it is elevated to a commodity and assigned value based on the premise that individual success (career progression, higher paying jobs, etc.) is related to higher levels of technical expertise and advanced operational knowledge (farganis, 2011; hughes et al., 2008; reeves, 2010; schroeder & swedberg, 2002). this dynamic reinforces dyadic power relationships, creates a foundation for leader-member exchange principles (scandura & schriesheim, 1994; sparrowe & liden, 1997), and establishes closed system boundaries inhibiting the sharing of knowledge. as tacit knowledge is rationed, reliance on explicit knowledge stifles “creativity and inventiveness” and may even lead to “corruption” (martinez-brawley & zorita, 2007, p. 537). most important, it majiros/beyond social exchange theory 536 creates an ideology within the organizational culture that suggests knowledge is currency. from a bureaucratic standpoint and exchange perspective, the more seasoned mentor offers inside historical knowledge, career guidance, and technical tutelage to the inexperienced mentee who is limited in reciprocal resources. tragically, the mentee’s only recourse might be to offer loyalty, praise, and prestige in return. at the core of the mentoring question is curiosity to better understand the motivation for participating in a relationship framed by competition and rite of passage. social exchange theory in an organizational context, as presented by homans and blau, suggests that the mentoring relationship is defined by connection with temporal and emotional dimensions (colley, 2002; dutton & heaphy, 2003) whereby participants agree to rules of reciprocity (cropanzano & mitchell, 2005) and a social ledger (labianca & brass, 2006) in the workplace. the application of social exchange theory differs from darwin’s (2000) stance in radical humanism to account for the sharing of tacit knowledge where participants are seen more as peers instead of mentor and mentee (darwin, 2000). under the right structural circumstances, the social exchange is deepened by cultural and relational interactions where all parties benefit by contributing (fouché & lunt, 2010; liu, liu, kwan, & mao, 2009). the capacity of social exchange theory to guide planned change in workplace mentoring relationships is related to organizational structure. the change effort is directed at the environment. the environment creates the organizational culture which reinforces the operational structure and assigns value to behavior. when considering how bureaucratic organizations are internally aligned to accommodate and facilitate knowledge transfer, the metaphor serves as a reminder in advocating for a restructuring of the workplace. the literature suggests that a decentralized, horizontal structure supports knowledge building and sharing, especially tacit-based knowledge (hurley & green, 2005; philipson, 2006; united states general services administration, 2009). in order for mentoring relationships to be an effective method for knowledge transfer, upper-management buy-in and support is required for the creation of a workplace culture that values sharing while considering the adverse impact of cultural, generational, and social barriers. simply put, the organization must accommodate open and honest communication, encourage respectful and trusting relationships, and express value in effective mentoring relationships (lam & lambermont-ford, 2010; levy, hadar, greenspan, & hadar, 2010; mcnichols, 2010). see figure 1 for a visual representation of internal and external factors influencing mentoring relations. due to its birth in economics, the exploitation of behavior for power and status will be forever associated with social exchange theory (robbins, chatterjee, & canda, 1998). according to emerson, the dyadic relationship is defined by mutual dependence where one participant exerts power over the other and the other exercises a level of tolerance in response (ritzer, 2010). the normative change effort is reinforced by the concept of fair exchange. in the bureaucratic context, the implied role of the mentor is best described as omnipotent. in order for the sharing of knowledge to be valued, a contemporary definition for mentoring must be centered on mutual engagement and empowerment. thus, exchange values associated with social capital must be shaped by the environment. unfortunately, a change in the environment does not guarantee a change in individual advances in social work, fall 2013, 14(2) 537 behavior. social exchange principles are rooted in self-interest which reinforces the fact that federal grade levels (salaries) are linked to expertise. until the question of what’s-init-for-me can be answered with an altruistic tone, the mentoring exchange will be reduced to power and status. figure 1. structural change due to internal and external factors cultural shift to knowledge transfer by: formal mentoring goal: human capital workplace structure: bureaucratic (hierarchical) communication: closed boundary system value: knowledge possession > knowledge sharing knowledge transfer by: informal mentoring goal: social capital workplace structure: less-bureaucratic communication: open boundary system value: knowledge sharing > knowledge possession majiros/beyond social exchange theory 538 implications for knowledge, practice, and further development due to the reliance on dynamic relationships, the author suggests that further examination to better identify a theoretical frame for grounding workplace mentoring relationships is required. while facilitating federal workplace mentoring programs is one potential example of a social work application, the aim of this paper was to introduce the reader to the concepts of mentoring and social exchange for utility across the profession. with that said, creating an organizational work climate that encourages and supports informal relationships between employees is paramount. structurally, a paradigm shift from formal to informal mentoring will require a change in organizational culture and theoretical context. simply, while federal employees gain technical knowledge, they should equally receive opportunities to develop or enhance interpersonal skills. cultural context may be just as important as organizational structure. for instance, in the chinese organizational context, mentoring supports the collectivist culture and confucian value system. regardless of the structure, mentoring is shaped by the cultural concept, “quanxi”, defined by a societal interpersonal connection that supports mutual interests and benefits (liu et al., 2009). in the workplace, mentoring must be seen as the reflexive process by which colleagues enter into mutual engagements for continuous, experiential learning in support of achieving superior performance through the transfer of empowerment, knowledge, and perspective. from this point forward, to marginalize the effects of attrition, budgetary restraint, and retirement on federal agencies, organizational learning must be centered on routine transfer and sharing of tacit knowledge through informal relationships. in fact, the sharing of knowledge must be seen as a core value, embedded within in the workplace, and supported by the upper echelons of leadership. in place of human capital, social capital through open communication will support the natural development of informal mentoring relationships based on mutual respect, shared values, and trust (swigonski, 1993). mentoring relationships for knowledge transfer in the bureaucratic workplace may benefit from using a social work approach. social work is in the business of facilitating and fostering meaningful relationships (graybeal, 2007). as outlined in the national association of social workers (nasw) code of ethics, social workers understand that relationships between and among people are an important vehicle for change. social workers engage people as partners in the helping process. social workers seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the wellbeing of individuals, families, social groups, organizations, and communities. 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(1987). reconceptualizing the philosophical perspective of social work. the social service review, 61(2), 218-230. yair, g. (2007). existential uncertainty and the will to conform: the expressive basis of coleman’s rational choice paradigm. sociology, 41(4), 681-698. doi: 10.1177/0038038507078923 zachary, l. j. (2000). the mentor’s guide: facilitating effective learning relationships. san francisco, ca: jossey-bass, inc. author note: address correspondence to: chad majiros, national catholic school of social service, the catholic university of america, 620 michigan avenue ne, washington, dc 20064. email: 97majiros@cardinalmail.cua.edu microsoft word 9. young_mcleod_5227_disproportionality of hiv transmission bmsm copyedit_final ______________ stephen m. young, msw, is a phd candidate in social work at the university of georgia in athens, ga, graduating in may of 2014. timothy mcleod, bs, mfa, is a mph student in the college of public health at the university of georgia. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 442-457 the disproportionality of hiv transmission among black men who have sex with men (bmsm): recommendations for an effective prevention model stephen m. young timothy mcleod abstract: the black community shoulders the heaviest hiv/aids burden of any racial or ethnic group in the united states, with black men who have sex with men being the most impacted subpopulation (cdc, 2011). health determinants (i.e., behavior, social environment, physical environment, and healthcare) of black men who have sex with men are examined for consideration in the creation of innovative hiv prevention programs specific to the community. the only two intervention strategies targeting this population approved by the centers for disease control and prevention, the 3mv and d-up:defend yourself programs, are scrutinized, and the theoretical underpinnings of these evidence-based programs (i.e., social cognitive theory, diffusion of innovations) will be examined in order to recommend strategies for future interventions to reach greater numbers within the community. keywords: bmsm, hiv, prevention, health determinants thirty years have passed since the appearance of the first aids cases, and within the first 25 of those years, more than 65 million people worldwide have been infected with hiv and over 25 million have died from aids-related complications (merson, 2006). since 1981, in the united states alone the descriptive epidemiology of the aids pandemic has witnessed shifts regarding hiv/aids incidence among various subpopulations in light of known behavioral risk factors for the disease (karon, fleming, steketee, & de cock, 2001). established populations with higher rates of hiv transmission, in hierarchical order of risk, include men who have sex with men (msm), intravenous drug users (idus), msm who are also intravenous drug users, hemophiliacs, heterosexual contacts with high-risk partners, and blood transfusion recipients. the trends in the united states over the last two decades, with the inclusion of all known risk factors, reflect a dividing line in hiv/aids demographics along racial lines (karon et al., 2001). the number of all newly diagnosed cases of aids increased from 1990, peaked in 1992 and began a steady decline from 1993 to 1999 (karon et al., 2001). up until 1993, aids incidence remained the highest among whites compared to other races, even as the steep decline began in 1992. the trend continued until 1999, when incidence rates among whites dropped below that of blacks and hovered just above that of latinos (centers for disease control and prevention [cdc], 2011; karon et al., 2001). however, the majority of all newly diagnosed cases since 1995 in the united states had been among blacks. by 1999, nearly twenty years into the aids pandemic, this trend continued until half of all newly diagnosed cases were comprised of blacks (karon et al., 2001). a decade later in 2009, blacks accounted for an estimated 44% of newly diagnosed cases of hiv in the united states (cdc, 2011). black men accounted for advances in social work, fall 2013, 14(2) 443 70% of new cases among the black population, with 73% of new cases among black men being msm, more known in the hiv prevention sphere as black men who have sex with men (bmsm). while the number of new hiv diagnoses for white msm was slightly higher, the overall rate of infection was 6.5 times higher for bmsm by comparison and 2.5 times higher than latino msm. the black community now shoulders the heaviest hiv/aids burden of any racial or ethnic group in the united states, with bmsm being the most affected subpopulation (cdc, 2011). while the centers for disease control and prevention (cdc) acknowledges various evidence-based hiv prevention interventions for most subpopulations, an obvious gap of interventions for the bmsm population has emerged (cdc, 2011). multiple systematic reviews have acknowledged a lack of effective interventions for bmsm (beatty, wheeler, & gaiter, 2004; millet & peterson, 2007; wheeler, lauby, liu, van sluytman, & murrill, 2008). too few interventions focus on the impact that health determinants have on the risk of hiv transmission for bmsm (millet & peterson, 2007), and too little research has addressed the challenges of delivering prevention services to a community that may be seen by others, as well as by itself, as hidden or ostracized. therefore, this paper seeks to prepare social work practitioners, educators, and policy makers to promote the creation of innovative hiv prevention programs to target the bmsm community. the paper will examine the magnitude of the crisis, explore potential barriers deriving from health determinants of bmsm (i.e., behavior, social environment, physical environment, and healthcare), and analyze the tenets of the only hiv prevention programs approved by the cdc, 3mv and d-up:defend yourself (cdc, 2012). lastly, recommendations will be outlined that are geared towards social work practitioners and researchers for future hiv prevention programs specific to the bmsm community. magnitude the morbidity and mortality weekly report (mmwr) reported that an estimated prevalence of 2% of the entire united states' population is msm (cdc, 2011). the true prevalence is difficult to obtain however, as convenience and snowball sampling dominates attempts to define the population and may not reach those that wish to conceal their sexual behavior (cole, 2006). statewide studies report prevalence to be 4-10%, taking into consideration that msm estimates vary between urban, suburban, and rural areas (gasiorowicz & stodola, 2011; lieb et al., 2009; lieb et al., 2011; magnus et al., 2011). despite the black population composing around 15% of the u.s. population, they represent nearly 50% of known cases (mimiaga et al., 2009). specifically, disproportionate numbers of bmsm are reported as hiv positive. gasiorwicz and stodola (2011) found that within their study of hiv rates of msm in wisconsin, 14 to 28% of bmsm were hiv positive, as compared to 2-4% of white msm and 5-9% of latino msm. magnus and colleagues (2011) reported that although bmsm on average have fewer sexual partners and engage in fewer risk behaviors historically associated with infection, they have greater rates of infection than whites (26% v. 8%). at 38%, bmsm are the largest racial minority group of persons infected with hiv who are unaware of their serostatus (cdc, 2011). although a decrease in new infections among bmsm 30 years and older has been young, mcleod/disproportionality of hiv transmission 444 reported, there has been a substantial increase among men aged 15-29 since 2008 (cdc, 2011). the most frequently reported risk behaviors associated with hiv infection are unprotected anal intercourse, substance use (most commonly reported as alcohol, crystal methamphetamines, marijuana, and/or amyl nitrite), transactional sex (i.e., sex exchanged for money, drugs or other needs), or seridiscordant sex (cdc, 2012). other factors associated with hiv infection include a history of incarceration, educational attainment of less than or equal to a high school diploma, depressive symptoms, social isolation, age of sexual debut, and lack of healthcare coverage (cdc, 2012). bmsm have been found to report less unprotected sex but are more likely to have sex with a partner of unknown serostatus, be younger at the time of study, and have lower income and less educational attainment (dorell et al., 2011; eaton, kalichman, & cherry, 2010; outlaw et al., 2011). health determinants more and more attention is being focused on health determinants influencing the health status of individuals or populations to efficiently and effectively provide treatment and prevention efforts (matthews, gallow, & taylor, 2010). many factors contribute to disparities in the distribution of hiv. such factors include behaviors, social environment, physical environment, and healthcare. historical oppression is intertwined with all of these factors (cargill & stone, 2005; williams & jackson, 2005). for example, racial and ethnic discrimination in employment may restrict access to higher paying jobs, making it difficult to pay for health care. along with historical oppression, a strong correlation exists between black men and an underutilization of healthcare services, which has strong implications for their health determinants. compared to white men, black men attend fewer preventative health visits and face premature mortality from illnesses amenable to early interventions (ravenell, whitaker, & johnson, 2008; wong et al., 2006). studies of black men’s preventative health services, which are primarily qualitative, have linked the lack of access to health care to socioeconomic barriers (ravenell et al., 2008; whitley, samuels, wright, & everhart, 2005), limited health knowledge or awareness (cheatham, barksdale, & rodgers, 2008), masculinity (cheatham et al., 2008; wade, 2008; whitley et al., 2005), fatalism (ravenell et al., 2008), and medical mistrust (cheatham et al., 2008; hammond, matthews, & corbie-smith, 2010; wade, 2008; whitley et al., 2005; wong et al., 2006). behaviors due to the reported findings that bmsm participate in less sexual risk-taking behaviors compared to white and latino msm, the significance of choosing sexual partners of the same race coupled with preexisting prevalence rates among bmsm (mimiaga et al., 2009; vandevanter et al., 2011) seems to be more important than individual behaviors. however, behavioral characteristics that intersect with hiv positive status, such as minority stress and/or stigma, are important to remember. several reports have emphasized racial and/or ethnic discrimination as having a strong correlation with poor mental health outcomes (mimiaga et al., 2009; reisner et al., 2009; safren & pantalone, 2006; vandevanter et al., 2011). for example, the phenomenon of depression and presence of sexually transmitted infections (stis) advances in social work, fall 2013, 14(2) 445 may be bidirectional in nature; reisner and colleagues (2009) assert that bmsm with moderate to severe depression have an elevated risk of contracting hiv, other stis, and engaging in seridiscordant unprotected anal intercourse. a combination of social isolation and low self-esteem has been suggested as a contributor to depression in self identified non-heterosexual racial minority men, while components of social oppression (i.e., homophobia, racism, financial hardship) have been shown to independently predict both depression and social isolation (diaz, bien & ayala, 2006; safren & pantalone, 2006). social environment social networks, especially sexual networks, greatly impact a person’s risk of acquiring hiv. the term sexual network refers to people who are linked directly or indirectly through sexual contact (flom, friedman, & kottiri, 2001). a recent network analysis found that young bmsm who were hiv positive are generally linked by a small number of venues (oster et al., 2013). research suggests that there are differences between blacks and whites in the type and number of partners they include in their sexual networks (adimora, schoenbach, & doherty, 2006; thomas, 2006). these differences have been influenced by some of the same factors that contribute to health disparities (i.e., residential segregation by race, high incarceration rates among black males, and poverty). social stigma also contributes to health disparities (cargill & stone, 2005). like racial minorities, sexual minorities including gay and bisexual men also experience health disparities (lombardi & bettcher, 2006; wolitski & fenton, 2011). negative societal attitudes and policies against homosexuality may contribute to social stigma experienced by bmsm that contribute to health disparities. although homophobia cuts across racial lines, black men may remain secretive about their sexual minority status because of a historical lack of acceptance by leaders and religious institutions within their communities (wolitski & fenton, 2011). internalized homophobia can also be a barrier to care and treatment, as persons with hiv who do not identify as a sexual minority may shy away from health providers for fear of being identified as a gay or bisexual man (eaton et al., 2010). internal homophobia may fuel keeping secrets, particularly concealing one’s own sexual orientation, and can have a negative effect on the individual’s health (strachan, bennett, russo, & roy-byrne, 2007; ullrich, lutgendorf, & stapleton, 2003). for example, research has shown that hiding sexual orientation is associated with more rapid progression of hiv-related illness (strachan et al., 2007; ullrich et al., 2003). in addition, some men also have sex with women but do not disclose their sexual relationships with men. the high prevalence of hiv in the black community and the greater likelihood of bisexuality among black men place black heterosexual women at greater risk for hiv infection (mimiaga et al., 2009). due to the discrepancy between “historically reported” risk behaviors and hiv infection in bmsm (as compared to wmsm), the nature of bmsm sexual networks, it has been suggested, is fundamentally different (mimiaga et al., 2009). in the united states, blacks are more likely to have a sexual partner that shares her/his race than latinos or whites (mimiaga et al., 2009), and as previously suggested (eaton et al., 2010; outlaw et al., 2011), cultural/racial identity influences what kind of risk behaviors are engaged. mimiaga and colleagues (2009) state that overlapping factors young, mcleod/disproportionality of hiv transmission 446 associated with race, substance use, and sexual practices are more likely to explain discrepancy than simply racial identity. identification with and reporting of male-tomale sexual activity is also likely to be racially bound. while 53% of participants in mimiaga and colleagues’ (2009) study identified as straight or bisexual, every person reported anal or oral sex with a man within the previous 12 months (mimiaga, et al., 2009). non-disclosure of sexual practices and/or identity to a healthcare provider in bmsm has been linked with a positive hiv status (eaton et al., 2010). in a casecontrol study of bmsm, hiv positive men were seven times as likely as their negative counterparts to have concealed their sexual behavior from their healthcare provider (dorell et al., 2011). additionally, a lack of physician's cultural competence and comfort with discussing sexual identity with patients was suggested as a hindrance to hiv prevention (dorell et al., 2011). cultural interpretations of gender identity, particularly how male-to-male sexual behavior is viewed in terms of masculinity, obfuscate what researchers look for in terms of “msm” (behel et al., 2008). nearly every available study of msm sexual behaviors has been conducted at gay bars, a venue-based convenience sampling, which does not necessarily capture all bmsm behavior, if indeed nearly half, by mimiaga's estimate, of said population does not identify as gay or bisexual (mimiaga et al., 2009). physical environment the physical locations (e.g., cities, prisons) within which people interact can promote or encourage risky health behaviors (schensul, levy, & disch, 2003) and may account for some health disparities. population estimates of msm and bmsm (particularly the estimate of 1% of the total population in rural areas, 4% in suburban areas, and 9% in urban areas) have been widely cited by researchers in the field of hiv prevalence among sexual minorities (lieb et al., 2011). noting the disparity of hiv prevention delivery to racial minorities in the southeast, the 2011 study's findings of a large gap between white and latino msm compared to bmsm may come as little surprise. promotion and treatment efforts among rural msm are impaired given the relative lack of rural findings among any group (lieb et al., 2011). one well-documented challenge among urban populations addresses housing and healthcare access. the compounded variables of lack of education and low income, which commonly impact people living in urban government housing, have been shown to negatively influence knowledge of hiv risks and treatment (djokic et al., 2009). discrimination in education that affects literacy skills can mean that messages regarding risk and prevention are inaccessible (fenton, 2004). among participants living with hiv recruited for a housing study conducted in new york city, 53% identified as non-hispanic black and 28% identified as msm (no racial identity data was collected among msm). of all respondents, 36% reported insufficient housing, and housing need was found to be the strongest influential factor for sustaining medical care (aidala, lee, abramson, messeri, & siegler, 2007). compared with the general population, persons incarcerated in correctional systems have a disproportionately greater burden of infectious diseases, including hiv, viral hepatitis, stis, and tuberculosis infections (national commission on correctional health care, 2002). generally, research suggests that while sex and drug use decrease overall among incarcerated persons, sex and drug use behaviors are advances in social work, fall 2013, 14(2) 447 conducted in a riskier manner inside prison than outside (inciardi, 1995; wohl et al., 2000). although it is difficult to assess whether blacks and whites have different risks of transmitting stis while in prison, some studies indicate that there are few differences in their risk behaviors during incarceration (kassira et al., 2001; wohl et al., 2000). therefore, any association between incarceration and black-white disparities in stis relating to prisons as a risky environment results from the greater likelihood that blacks will be exposed to this environment (blankenship, smoyer, bray, & mattocks, 2005). healthcare a disconnect between number of racial minority hiv positive diagnoses and prevention services directed toward the same clients has been reported (cdc, 2011; dorell et al., 2011; gasiorowicz & stodola, 2011). black populations may have poor access to health and medical services and inconsistent relationships with health care providers because doctors historically do not practice in minority communities (smedley, stith, & nelson, 2002). a study of physician practice found that wealthier areas had 33 to 50 times more physicians than poorer areas (ginzberg, 1994). demographics collected by gasiorowicz and stodola (2011) indicated that bmsm accounted for nearly 60% of cases, but only 20% of targeted testing. one indicator given is that training for such preventive services has been focused on heterosexual women and men rather than black or latino msm (gasiorowicz & stodola, 2011). as both healthcare services and racial demographics vary by state, access to healthcare on a regional basis should be evaluated. for example, data collected in jackson, mississippi indicated that hiv positive bmsm were more likely to be without health insurance coverage or a primary-care physician, and that individuals without health insurance were more likely to report a lack of access to adequate care (dorell et al., 2011). in comparison, a sampling of five major metropolitan cities with large hiv prevalence rates concluded that racial minority msm with healthcare access were more likely to consume preventive services and believe in the importance of preventive care than their white counterparts (behel et al., 2008). although similar access was reported, black and latino msm were more likely to use hospital or community clinic care. this study analyzed msm who reported access to healthcare or were hiv negative. interestingly, msm who reported access to healthcare who were hiv positive and unaware of their infection reported a similar assessment of utilization and preventive care beliefs as those that were uninfected (behel et al., 2008). the comparison of the two studies strengthens the notion that lack of access to healthcare is a larger problem for minority msm than a lack of utilization. effective programs and interventions since the eruption of hiv in the united states, constructing sound hiv prevention interventions to hiv/aids service agencies to be implemented in their local communities has proven to be a challenge. in response to an outcry from service providers requesting such information, the cdc launched the diffusion of effective behavioral interventions (debi) project in 1999 to disseminate empirically tested prevention programs that are effective in preventing hiv transmission (effective interventions, 2012). young, mcleod/disproportionality of hiv transmission 448 an evident gap of evidence-based prevention interventions specifically for the bmsm population has emerged, despite many evidence-based interventions for hiv prevention interventions for most other subpopulations (cdc, 2012). multiple systematic literature reviews have affirmed a lack of effective interventions for bmsm (beatty et al., 2004; millet & peterson, 2007; wheeler et al., 2008). too few studies focus on the effects sociocultural predictors, such as racism, homophobia, religion, or dual minority status, have on the risk of hiv transmission for bmsm (beatty et al., 2004; millet & peterson, 2007). additionally, too little research has addressed the structural challenges (e.g., low economic status, high incarceration rates, limited access to antiretroviral therapy, etc.) that impact bmsm (millet & peterson, 2007). further investigation is needed to identify factors that may inhibit high-risk behaviors (e.g., connectedness to family, spirituality, strong racial identity) and incorporate those factors into hiv prevention strategies that either encourage or sustain preventive behaviors. to better build future prevention efforts to intervene with bmsm, it may be helpful to break down the only two cdc recommended interventions that have demonstrated effectiveness in reducing sexual risk-taking in bmsm (i.e., the many men, many voices (3mv) project and d-up: defend yourself!). though not developed by the cdc, these recommended interventions were evaluated by the department of hiv/aids prevention at the cdc as best-evidence, which is defined as “behavioral interventions that have been rigorously evaluated and have been shown to have significant and positive evidence of efficacy” (cdc, 2001, p. vii). the studies where these recommended interventions originated are outlined below and should be replicable. many men, many voices (3mv) many men, many voices (3mv) is a group-level intervention that addresses behavioral and social health determinants influencing hiv/sti risk-taking (wilton et al., 2009). the program focuses on the effects of racism and homophobia on the sexual, substance use, and health decision-making behaviors of bmsm. participants select from a menu of options to reduce hiv/sti transmission designed for this population. the 3mv intervention was developed at two community-based organizations in ny state (brooklyn and buffalo) in cooperation with the university of rochester. theoretical underpinning. the social cognitive theory underpinning in the many men, many voices (3mv) project explores the dynamic manner in which personal characteristics, environmental factors, and human behaviors influence each other (fishbein, 2000). the theory purports that these factors are neither static nor independent, but rather, they are all reciprocal. for example, each behavior witnessed can change a person’s way of thinking. similarly, the environment where one is raised may influence later behaviors, just as a father’s mindset will determine the environment in which his children are raised (fishbein, 2000; jones et al., 2008a). within its tenets, social cognitive theory purports that three primary factors affect the probability that a person will change a health behavior: self-efficacy, goals, and outcome expectancies (fishbein, 2000). the theory integrates concepts and processes from cognitive and emotional models of behavior change. logistics. in the wilton et al. (2009) study, one of the two community centers involved in developing the intervention (people of color in crisis of brooklyn, ny) spent 15 months recruiting black msm in new york city through a variety of means advances in social work, fall 2013, 14(2) 449 (i.e., street outreach, black gay pride events, snowball sampling, connection with cultural gatekeepers identified by the community organization, nightlife venues, and print media). eligible participants lived in the new york city area, self-identified as a bmsm (for the purposes of this study: gay, bisexual, same gender loving, sexually involved with other men or sexually or emotionally attracted to men), were 18 years or older, were either hiv-negative or did not know their hiv status, and willing to attend and participate in an hiv/sti prevention intervention retreat without their primary partner. participants (n = 338) were randomly assigned to one of two groups, the many men, many voices (3mv) intervention group (n = 164) or the wait-list control group (n = 174). the control group was scheduled to receive a delayed intervention six months following the completion of their baseline assessment (wilton et al., 2009). a baseline of sexual behavior data was collected from the men about their past three months of activity, and participants were measured again at three and six months after the intervention (wilton et al., 2009). study participants were asked the number of male sex partners, number of episodes of unprotected insertive or receptive intercourse acts with main or casual partners, condom use during anal intercourse with main or casual male sex partners, and the number of episodes of unprotected and protected vaginal and anal sex with women (wilton et al., 2009). intervention setting. the intervention consisted of six consecutive 2 to 3 hour sessions delivered during a weekend retreat (i.e., half-day friday and all day saturday and sunday). however, according to the 3mv curriculum, the intervention sessions can also be delivered over the course of six weekly sessions. rather than a singular emphasis on condom use, 3mv uses a menu of behavior change options for hiv/sti prevention. the program was delivered by two trained bmsm peer co-facilitators through discussions, role-plays, and by creating a risk-reduction plan (wilton et al., 2009). findings. relative to the control group participants, 3mv participants in the wilton et al. study reported a 25% reduction in the number of male sex partners, a 66% reduction in unprotected anal intercourse with casual male partners, a 51% reduction in insertive unprotected anal intercourse, and a 33% likelihood of being tested for hiv and other stis. the study was a milestone in hiv prevention research as it was the first randomized trial to demonstrate the efficacy of an hiv/sti prevention intervention designed for bmsm (wilton et al., 2009). the only other cdc recommended intervention is d-up: defend yourself!. d-up: defend yourself! d-up: defend yourself! (d-up!) is a community-level intervention that seeks to mobilize an existing social network of bmsm to support condom use and improve their sense of self-worth (jones et al., 2008a). the program was specifically adapted for bmsm from the popular opinion leader (pol) intervention used with all msm. d-up! uses specific social network members, called opinion leaders, who are respected and trusted by their peers, to promote the benefits of consistent condom use and increase self-worth among their friends and acquaintances. the cdc cites a study by jones et al. (2008a) to substantiate their support of the intervention. theoretical underpinning. the d-up: defend yourself! intervention applied the diffusion of innovations theory, an underutilized theory in social work, which young, mcleod/disproportionality of hiv transmission 450 suggests that if key members of the community endorse a practice or behavior, community members will adopt that practice or behavior over time (wilton et al., 2009). in order for success, community members must believe that there are some advantages to adopting the practice or behavior. additionally, the behavior change must be observable, easy to execute, compatible with existing community values, and able to be integrated into social norms (wilton et al., 2009). within the bmsm population, a key member of the community would need to be socially significant within specific segments of the social network (wilton et al., 2009). this member should have influence and credibility with those in their social networks. for example, once key members are identified, they would openly endorse safer sex practices while highlighting the benefits and ease of adopting such practices. these messages are communicated throughout social networks, and others’ behaviors are impacted as the social norms become operant within the community (e.g., consistent condom usage, regular hiv testing, etc.) (wilton et al., 2009). logistics. the research study was conducted in three north carolina cities (raleigh, greensboro, and charlotte) that had nightclubs in which bmsm could be accessed, recruited, and trained for the intervention (jones et al., 2008a). skilled local prevention specialists used ethnographic techniques to identify opinion leaders (n =299) at local nightclubs frequented by the target population. according to the article, 15% of those in the target population of the community were trained as opinion leaders (jones et al., 2008a). intervention setting. once recruited, opinion leaders participated in four 2-hour sessions facilitated by two skilled trainers covering local and state epidemiology of hiv/aids, stis, facts/myths of hiv/aids, and how to reduce one’s risk (jones et al., 2008a). intervention sessions discussed topics such as racism, homophobia, bisexuality, employment, poverty, and religion, while incorporating culturally relevant messages, materials, and activities. using role-play scenarios, opinion leaders learned how to deal with challenges facing bmsm should such conversations arise in their social networks. to ensure that the learning objectives were met, participants were given tests measuring their knowledge before and after the intervention sessions (jones et al., 2008a). over the next year researchers convenience sampled self-identified bmsm, aged 18 to 30 years, who were permanent residents in the area at the same bars from which opinion leaders were recruited (jones et al., 2008a). no effort was given to recruit the same individuals from subsequent waves. the eligible men were asked to take a selfadministered assessment of their sexual practices over the last two months (jones et al., 2008a). findings. jones et al. (2008a) found significant reductions in risky behaviors and an increase in consistent condom use. unprotected receptive anal intercourse was significantly decreased at 4 months (24%), 8 months (25%), and 12 months (44%). also at 12 months, the average number of partners and episodes of unprotected insertive anal intercourse decreased by 40% and 53%, respectively. additionally, the number of bmsm who reported that they always used condoms for intercourse increased by 23% for insertive and 30% for receptive (jones et al., 2008a). advances in social work, fall 2013, 14(2) 451 recommendations for future prevention models growing evidence supports that well-designed, targeted, and theory-based behavior change interventions can be effective in reducing the spread of hiv (fishbein, 2000; jones et al., 2008b; wilton et al., 2009). although each person’s thinking about their risk-taking behavior is unique, understanding the theoretical variables behind a specific subpopulation’s health determinants can guide the development of an effective intervention (beatty et al., 2004). social cognitive theory and diffusion of innovations theory, which were used in the many men, many voices (3mv) project and d-up: defend yourself! interventions, are also recommended for future intervention programs. additionally, researchers found that promoting individual self-worth and racial pride were essential in both programs (jones et al., 2008a; wilton et al., 2009). with the social aspect in mind, it may be beneficial to include a community-based participatory research (cbpr) approach to future interventions and their subsequent evaluations to emphasize participants’ self-efficacy and racial pride. a cbpr approach could take the diffusion of innovation theory to the next level. cbpr is conducted as an equal partnership between both formally trained researchers/trainers and members of the community (minkler & baden, 2008). equitable partnerships require sharing power, resources, credit, and knowledge, as well as a reciprocal appreciation of each partner’s knowledge and skills at each stage of the project. specifically with hiv prevention, it may be helpful for bmsm to be closely involved with the problem definition/issue selection, implementation and research design, conduct of the evaluation, interpretation of the results, and decisions regarding how the results should be used for action. one of the principle ways in which cbpr differs from traditional research is that cbpr is an iterative process, incorporating research, reflection, and action in a cyclical process (minkler & baden, 2008), which takes the d-up: defend yourself! intervention one step farther by including leaders in the community in the entire process, not just spreading the information provided by trainers who may not be part of that community. along the same lines, social work researchers and practitioners who create prevention interventions should consider soliciting support through online local bmsm communities to better understand the impact of the similar interventions with these men, as venue-based sampling in areas such as bars and pride events tend to recruit individuals that identify as gay or bisexual, which may cause overrepresentation in a group that does not uniformly identify as a sexual minority. prevention programs are encouraged among diverse bmsm populations, in assorted delivery settings, and in various geographic areas. as social networks play a large role in the bmsm community, prevention programs should incorporate networking into their intervention strategies similar to the d-up: defend yourself! program. also, future research should focus on the degree to which intervention programs facilitate a sense of community among bmsm and whether these social networks help reinforce hiv/sti risk reduction. however, even if such gaps in intervention research are addressed, hiv prevention programs may not be directly transferable to other bmsm communities. the overall black community in the u.s. is not homogenous, and similarly, neither is the bmsm community (beatty et al., 2004). lastly, bmsm often have poor access to health and medical services and inconsistent relationships with health care providers (smedley et al., 2002). young, mcleod/disproportionality of hiv transmission 452 therefore, future prevention efforts should include linking participants with health services, including hiv testing. programs can include education and discussions about feelings of fear or mistrust of medical institutions and encourage participants to be knowledgeable about their health. in fact, a high percentage of hiv-infected men who have sex with men (msm) do not know they are infected (cdc, 2008). the cdc’s national hiv behavioral surveillance system (nhbs) found that of 1,562 men who tested positive for hiv, 44% were unaware of their infection (cdc, 2008). future intervention programs should link hiv testing with other prevention efforts. individuals who know their infection status can take additional measures to ensure that they are not spreading the virus to others. implications for social work practitioners although some intervention strategies have been shown to be effective with the bmsm community, social work practitioners and researchers who implement prevention strategies should build upon, broaden, and modify these strategies to reach greater numbers within the bmsm community. new interventions should be crafted by incorporating health disparities specific to bmsm population(s) that exist within a variety of contextual settings and/or geographical areas. in addition to these grouplevel and community-based interventions, other settings where bmsm reside could provide an open door to other levels of interventions. for example, advocating for hiv prevention education aimed at incarcerated young black men within a prison setting could have resounding implications both within that institutional framework and in the streets beyond. social workers should also stress the importance of knowing one’s hiv status and knowing the status of one’s sexual partner(s) with their clients. men who know their current hiv infection status can be linked to appropriate medical care and prevention services and ensure that they are not spreading the virus to others. the sooner someone finds out they are hiv positive, the sooner they can receive lifeextending treatment. additionally, more research involving an equal partnership between both formally trained researchers and members of the community is desperately needed to understand at which level such prevention interventions are most effective and bring about lasting change. regardless of which methods are utilized, the message remains the same: increasing awareness about hiv risk and prevention within the bmsm community as a whole is critical, no matter how disjointed the population appears to be (cdc, 2011; dorell et al., 2011; gasiorowicz & stodola, 2011). conclusion while statistics clearly indicate the existence of a health disparity between the races, many pieces of the bmsm/hiv prevention puzzle are obscured from view. this population, more than any other, requires a skilled approach and intricate knowledge of health determinants in order to facilitate the most effective intervention strategies. efforts will not be met without challenges, as this population represents a community within a community that may be seen by others, as well as by itself, to be disenfranchised and therefore, incapable of identifying with a larger specific group. beneath a seemingly impenetrable layer of racial/ethnic boundaries, there exists a plethora of sub-cultural norms, practices, beliefs, and prejudices commingling to advances in social work, fall 2013, 14(2) 453 influence hiv infection and prevalence trends that must be better understood by social work researchers and practitioners if successful hiv prevention is to be achieved. references adimora, a. a., schoenbach, 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(2000). high-risk behaviors during incarceration in african american men treated for hiv at three los angeles public medical centers. journal of acquired immunodeficiency syndrome, 24(4), 386-392. wolitski, r. j., & fenton, k. a. (2011). sexual health, hiv, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the united states. aids and behavior, 15(1), 9-17. wong, m. d., chung, a. k., & boscardin, w. j., li, m., hsieh, h. j., ettner, s. l., & shapiro, m. f. (2006). the contribution of specific causes of death to sex differences in mortality. public health report, 121(6), 746-754. author note address correspondence to: stephen m. young, 310 e. campus dr., athens, ga 30602. email: stephenmarkyoung@gmail.com microsoft word lucas-darby_manuscript_copyedit3 ________________ emma t. lucas-darby, ph.d., lsw, ncgc, is a professor in the department of social work at carlow university in pittsburgh, pa. copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), 113-125 the new color is green: social work practice and service-learning emma t. lucas-darby abstract: attention to saving the environment is gaining momentum daily. citizens have a fundamental right to protect the environment from harm due to human activities. the profession of social work has a role to play in greening and sustaining the environment. the inclusion of this content in social work courses is a natural fit given the profession’s person-in-environment perspective which emphasizes the relationship between individuals, their behavior and the environment and advocacy for preservation of human welfare and human rights. participatory environmentalism considers the role of community members in demonstrating their civic responsibility toward preservation of the natural environment and resources. social work students must be encouraged to accept vital leadership roles that address environmental concerns in addition to serving client populations. a community practice course which includes a service-learning requirement chose “greening” as a theme. students worked with communities to identify and implement semester-long “green” projects. keywords: service-learning, environmental concerns, greening community practice introduction environmental issues cross micro, mezzo and macro levels of social work practice and are begging for increased attention. growing concerns for the environment are positioning social workers and educational institutions alike to be proactive. environmental conservation efforts have been documented since the 19th century (cronin & kennedy, 1999), and recent decades of public consciousness have pushed the environment to a more recognized societal value, one that must be acknowledged and preserved. generally, global citizens believe they have a fundamental right to protect themselves and their communities from technological intrusions and environmental abuse. thus, they are entitled to clean air, clean land, clean water, good health, safe transportation and water, among others amenities (cronin & kennedy, 1999; mckinnon, 2008; national association of social workers, 2009; scabecoff, 2000; schwartz, 2006). more citizens also believe they have a fundamental right to protect the environment from the harm of excessive and careless activities. students are among these citizens who have a growing interest in saving our environment. expanding students’ knowledge about the expansive volumes of information available and many ways they can become more engaged will contribute to saving the earth, as well as local environments within their communities. educational institutions are responding to the increasing interest in environmental conservation and sustainability with new and expanded curricula, outreach and service efforts, policies and timely planning. lucas-darby/the new color is green 114 social workers are advocates for change and all aspects of social justice including concerns for the environment in which groups and communities exist. a healthy environment is viewed as a human right and is specifically related to human dignity and nondiscrimination in a socially just world (wronka, 2008). the future health and survival of humans is directly impacted by the consciousness of all humans regarding the global world. increasing students’ awareness of their role in protecting and saving our environment is critical for the future. internationally known environmentalist jones (2009) and hembd and silberstein (2011) note the importance of engagement by students. jones further suggests that students’ energy and enthusiasm have already “turned up the heat” in the movement to prevent catastrophic climate change. most important is his observation that the “sky is the limit” for the next generation‘s leadership role. this paper discusses the inclusion of environmental issues, specifically “greening” in a community practice social work course. students completed “green” projects as part of the course requirements. this course was also designated as a service-learning course and satisfied the core curriculum requirement. greening, the environment, and social work links although historically primary attention has been given to social, cultural and economic issues, more social workers now give consideration to the natural environment. according to the national association of social workers (2009), concern for the environment is a critical component of the person-in-environment (pie) perspective. the pie concept emphasizes the relationship between individuals, their behavior and the environment, the social ecology. thus, this perspective begs for a holistic consideration of one’s functioning in the environment. mounting environmental preservation concerns require an emphatic response from social workers, according to park (1996). evidence of a consciousness of the connection between the environment and social work exists in responses and reactions to population growth, synthetic organic compounds and changes to the earth’s surface. as humans regard the earth and her components as an artist’s tapestry, park (1996) correctly suggests a need to eliminate the partition separating the artist’s studio and everyday life. social work must build on its historical roots and, therefore, is a natural advocate of environmental preservation and sustainability. social work has historically been dedicated to the betterment and preservation of human welfare (berger & kelly, 1993). they further identify a new ethic that human societies need, one that is consistent with an emerging awareness of our connectedness to the natural world and our understanding of nature’s limits of tolerance. updated information regarding human connection to the environment piques increasing interest as humans realize the responsibility they have to address this concern. an extension of these connections to nature is critical. human behaviors can impact the situations client populations face from global warming to health issues and from technological and manufacturing to employment issues. jones (2010) and the united nations environment programme (2000) indicate environmental changes affect human development options, with poor populations disproportionately impacted. therefore, the robustness of social work as a helping profession positions itself as a natural connect to the environment, ecological preservation and humanity. this achievement is inevitable if social work is to maintain its relevance as a profession during this time of escalating environmental crises. this advances in social work, spring 2011, 12(1) 115 transformation pushes social workers to better understand ways in which not only economic but also environmental factors affect the lived reality of the people with whom they work. reformed curricula through connections made between theory, practice and environmental issues will shift the profession to real-time expansion and integration of environmental knowledge and engagement (jones, 2010; mckinnon, 2008). global citizens are more aware today of the impact of the environment on their daily lives and the extent to which their daily survival is affected. what are the rights of citizens regarding the environment? robert kennedy jr. states: i recognized that environment is not something distant and inaccessible to most americans. it is not an issue that can be separated out and dealt with on its own. the environment is our neighborhood, our community. it is our quality of life. i began to see the environment not as a privilege that was part of my affluent background, but as a right for every american, one that was being subverted by greedy, powerful, and corrupt interest in our society (as cited in cronin & kennedy, 1999, pg. 116). expansive personal consumption and possession drive habits where individual fulfillment is addressed without consideration of consequences of this behavior. shabecoff (2000) believes this thinking springs from the systems, institutions, values, and habits of thought created by humans through the centuries to manage, sustain, and order our civilization. efforts to establish environmental standards have a long history including smoke abatement laws in the 11th century to regulatory actions and more recent policies including the u.s.’s clean air act, clean water and waste management acts and international efforts such as canadian environmental assessment act. each of these regulations has addressed the rights of industry, as well as citizens, and has led to disclosures by industry while establishing far-reaching environmental standards (cronin & kennedy, 1999, p. 154-155). the immensity of environmental concerns requires more than a top-down regulatory approach. global citizens are concerned and desire to be actively engaged in ways that embrace environmental activism. in their classic study citizens and politics: a view from main street america, the harwood group (1991) identified citizens’ desire for involvement in civic life where they can make a difference and where they may choose to sit out a situation unless they “feel they can bring about or witness change.” this notion of participatory environmentalism endears community-based action where communities actively demonstrate civic responsibility toward saving, preserving and restoring our natural environment and resources. the upsurge of environmentalism is due to societal recognition of the fact that human activities are causing a deterioration of the quality of the environment and that environmental deterioration in turn has negative impacts on people (shabecoff, 2000). as concerns for the sustainability of the environment increase, the role of education has become more involved and now includes strategies for increased public awareness and engagement. environmental concerns are buttressed by choices citizens make about transportation patterns, water distribution, housing developments, hazardous waste disposition, energy usage, and control of air and water pollution (park, 1996; stapp, wals lucas-darby/the new color is green 116 & stankorb, 1996). incorporating environmental awareness into courses highlight the importance of this topical area while providing students with opportunities to identify the role they can play in saving the environment. stapp, wals, and stankorb (1996) recommend an inclusive view of environmental education, one that includes political, social, economic, and bio-physical aspects (p. 4). they further state that environmental issues involve ethical questions that focus on the sharing of the world’s natural resources (p. 5). encouraging reformation of thinking regarding the environment led shabecoff (2000) to conclude, “it is in the classrooms, from preschool and kindergarten through graduate school, that a major part of the struggle to achieve a sustainable, livable habitat and society in the 21st century will be won or lost” (p. 70). addressing the preservation of all natural resources is timely for citizens in an effort to become more responsible regarding current personal thinking and habits and usage for future generations. such an educational process not only aims to better understand symptoms of current irresponsible actions but also ecological dysfunction behavior (shabecoff, 2000, p. 178). hoff (1997) also asserts courses in ecological science and interdisciplinary environmental studies would deepen one’s understanding of how human health and differing cultures are grounded in various ecosystems. mckinnon (2008) identifies an important statement from the west australian council on social service that appeals to social workers and their role in sustainable communities: for social workers, in particular, social sustainability is a functional approach that encompasses a myriad of processes, systems, and structures, and supports the capacity of current and future generations to create healthy and livable communities (p. 265). communities have joined the environmental justice movement and are addressing environmental insults that impact their daily lives. most often communities confronted with these issues tend to be poor, people of color and inner city residents. these are the same communities where social workers are entrenched and deeply involved with service provision. community sustainability must include a focus that supports development as opposed to only intervention service. a developmental approach (homan, 2011), recognizes potential and strength which may prevent problems from happening in the first place. social workers must work to develop communities while also responding to immediate personal needs. the link between community development and environmental justice is highlighted by alice shabecoff, a community developer: environmental protection and economic development, frequently described as contradictory goals, have in fact proved mutually reinforcing at the neighborhood level…the environmental initiatives developed by community groups are prime examples of “sustainable development,” that is development that clearly takes into account three elements – the economy, ecology and community (as cited in shabecoff, 2000, p. 60). as an advocate for the inclusion of all local residents in the environmental movement, jones (2008) asserts that people of color and other disadvantaged communities must be involved in the struggle for a green economy and their voice in this area can possibly lead to solutions for some of their problems (p. 109). such involvement is also aligned with the concept of self-empowerment. advances in social work, spring 2011, 12(1) 117 interactions with community members allow students to focus on local environmental concerns that have immediate as well as far-reaching implications. social interaction theory underscores the complexity of aspects of local life. the myriad of concerns in a community provide a rich source for social interactions around common concerns. involvement in activities that meet common needs and interests give direction to collective action with local well-being as an ultimate outcome (bridger, brennan, & luloff, 2011; shandas & messer, 2008). addressing environmental concerns starts with awareness at the individual and community levels. linking global concerns to local behaviors is jettisoned by increasing interdependence and requires good governance and accountability (miekle & green, 2011). greening defined a wide range of individuals are working, thinking, buying, advocating, designing and legislating green. greening may be based on one’s personal perspective and level of awareness. definitions of greening fit well with diverse areas (micro to macro) within the social work profession. aspects of protecting the earth, and more specifically local communities, are deeply rooted in an understanding of greening. a global definition of greening is one’s consciousness of the impact one makes on the planet. with this understanding expected behaviors include taking steps to try to minimize one’s carbon footprint, or the amount of environmental damage that one causes (middletown thrall library, 2008). re-claiming and promoting an investment in the future allows local residents to reinvest in the future. jones (2008) declares: greening is not just throwing away stuff not longer needed or wanted. it should be about reclaiming thrown-away communities. it should be about recycling materials to give things a second chance…also, our youth deserve the opportunity to be a part of something promising. across this nation, let’s honor the cry of youth in oakland, california, for “green jobs, not jails” (p. 19). social workers are concerned about community sustainable development on both the domestic and international fronts. sustainable development emphasizes “the meeting of needs, as opposed to wants, and places a clear focus on intergenerational equity” (hembd & silberstein, 2011, p. 262). sustainability may be defined both narrowly as the longterm protection and health of the natural environment and broadly as the triple bottom line of environmental health, economic viability, and social well-being (calder & dautremont-smith, 2009). this implies making decisions on behalf of those yet unborn and unable to participate in the process but who will nonetheless be affected by the outcomes of the process. current behavior about the environment will indeed affect future generations. aspects of greening also involve preserving environmental quality at all levels of society including the promotion of renewal resources that support a green economy. social workers have daily contact with varying aspects of a green economy and its impact on client populations. for example, stone (2010) identifies workforce development areas including transportation, energy efficiency, energy generation, construction, environment protection, and waste reduction – areas that effect vulnerable clients. social work lucas-darby/the new color is green 118 curricula must include materials that highlight environmental preservation and green economy and their impact on client population. the integration of these topics into social work courses promotes an increasing aware of individual responsibility to environmental preservation and the long tentacles of the ‘greening” concept that impacts client populations in myriad ways. increasing students’ exposure to the importance of environmental preservation is possible through a social work curriculum. a description of the course the author developed follows. while student awareness of global concerns is highlighted, the immediate focus in the course described in this paper is “greening”, a short-term approach. this term-defined approach may be readily structured to the semester length of the course. information regarding the need for more sustained interest in “greening” is emphasized. local presenters involved in the green movement covered topics including leed buildings, urban gardening, food deserts, work force development and green jobs, solar energy, and recycling. throughout the semester, students are also encouraged to think about more personal habits and focus not only on immediate greening efforts but also on fostering energy independence. students are residents of communities wherever they live, and as such they play important roles in building assets that improve their quality of life especially around social and economic issues at the local level (robinson & green, 2011). the course the course, community practice, is the macro practice course in a three-course practice sequence for the undergraduate social work major. the course includes content on groups, organizations, and communities inclusive of their development, structure, and effectiveness within society. specifically, one question presented to students is: do these entities respond to human needs that are relevant to their quality of life in culturally competent ways? local residents are critical actors in changing conditions that exist in their communities. students, as future macro social work practitioners, are reminded of their roles as change agents and advocates of social justice. green innovations compel important global considerations, and social workers must find their niche in making these focal points for the profession as well. one strategy is to include greening concepts in social work courses. the course, community practice, requires a community project that involves a detailed study or analysis of a community/agency problem, need, or concern and addresses the implementation of a change process. the service-learning project simultaneously increases students’ awareness of community life while also providing engagement on a small scale and time-limited (one semester) basis. these activities support jones’ (2010) suggestion that additional inclusive strategies for ecological awareness and preservation content must be forthcoming. the impetus for choosing a theme grew out of the recognition that “greening” is critical to social work course content. the presentation of information on local and national efforts led to a realization by students that they could play a more immediate role in and address complex environmental issues. this provides the framework for identifying a course theme each year. such a focused theme enriches opportunities for oral in-class reflection sharing and serves as the common link between projects. projects advances in social work, spring 2011, 12(1) 119 identified in this paper were implemented to correspond with the “goingreen” course theme. students selected a community of their choosing, worked with them to identify a greening/environmental need or concern, and implement a “green” service-learning project. project criteria included the following guidelines: • why is this viewed as a problem or issue? • what is the history or background of the problem? • what are the anticipated changes? • with respect to community change, what are the major strengths and weaknesses of this organizing, development, or planning effort? • what are the obvious benefits to the community? • what is the role of a macro social worker? • what kinds of leadership skills (strategies) do you anticipate needing to address this problem/issue? • what are the most effective strategies used for addressing this social problem? this course responds to the 2008 epas. specifically, the following educational policies (ep) are identified: • ep 2.1.4 – engage diversity and difference in practice. • ep 2.1.5 advance human rights and social and economic justice. • ep 2.1.9 – respond to contexts that shape practice. • ep 2.1.10(a). – engage, assess, intervene, and evaluate with individuals, families, groups, organizations, and communities. the ability of social workers to recognize the many dimensions of practice and basic human rights regardless of a person’s position in society is an integral part of the profession’s skills. social workers also recognize basic human rights, while acknowledging global interconnections of oppression and theories of justice and strategies that promote human and civil rights. further, social work must incorporate social justice practices in organizations, institutions, and society to ensure that these basic human rights are distributed equitably and without prejudice. the engagement of social workers to substantively and affectively prepare for action with individuals, families, groups, organizations, and communities is highlighted as contemporary issues affect service provision to vulnerable populations. attention to environmental preservation is critical to social work at all practice levels – micro, mezzo, and macro. social work is a “best fit” for addressing this area given its attention to the impact of ecological issues on individuals, advocacy actions that target environmental injustices against vulnerable populations both domestically and internationally, and engagement that targets changing oppressive situations for improved future outcomes. lucas-darby/the new color is green 120 selected projects – employing the goingreen theme descriptions are provided for three service-learning projects that were completed during a recent semester (see table 1, next page). students worked with local residents to determine the “green” project that met an existing need and could be completed in a semester. students provided reflections of their learning experience and also recorded a critical analysis of the experience in a journal. assessment of learning outcomes driving this interest in civic engagement is the belief that each student could initiate and plan an activity that would result in an identifiable level of change. students were encouraged to give careful thought to all engagement activities and seek their meaning. critical reflection, a decisively important exercise that employs critical thinking skills and allows for the assessment of the learning, assists this process. further, jones (2010) indicates this approach also allows social work students to consider socio-cultural assumptions that have led to the crisis, ways they have viewed these, and how they can actively address these concerns. students recorded reflections of their service-learning greening project in journals that were submitted monthly. guidelines that helped students to focus on the learning, rather than pure, straightforward descriptions of activities, were identified. key questions used as guides for reflective writing included: what did you learn from each moment, interaction, observation, and/or activity? were additional questions or challenges raised? what did you enjoy most? what was most challenging? were personal goals relating to this experience met? if so, how? what’s next regarding this experience? how can the engagement continue after this experience ends? there is no absolute template for reflective writing; however, with trigger questions and critical thinking, students were able to provide in-depth analysis of the service-learning experience. such triggers transcend a recounting of every minute interaction or activity to deeper and meaningful considerations. in-class reflection sessions allowed students to share their weekly service-learning experiences. the sharing of students’ project experiences provided information about individual and community “greening” engagements across all practice areas – micro, mezzo and macro. these exchanges identified new and different engagement opportunities and helpful community resources. students also used powerpoint presentations with pictures of their project. this sharing exercise actually excited additional sharing of specific project activities that involved the planning involved, community interactions, self-evaluation, and a review of expected outcomes. student comments indicated connections made regarding an expanded role of social workers, greening and sustainability. even those students who were focused on careers as micro level practitioners made connections with their personal actions, workforce development and green jobs, environmental injustices and dumping, and global concerns. advances in social work, spring 2011, 12(1) 121 table 1. selected student goingreen service learning projects project title problem plan outcome polluting the community: a concern for dog waste neighbors walking their dogs without pick up their waste. dog waste is a public health hazard, aesthetically unappealing and causes tensions between neighbors. the student worked with local residents who shared her concern. they concluded that the local government should be involved and requested sign postings along the main walk areas used by dog owners. funds were also sought to purchase posts with free dog waste bags. the student testified before the local governing council regarding this growing problem and health hazard. one councilman agreed to assist in this effort to find a funding source for posts and bags. signs were posted. together they are exploring funding sources and will write a grant proposal. greening a school’s grounds the grounds around a local public school included dead shrubs, other plants, and barren space due to walking paths made by students. the school’s principal asked the social work student to coordinate this project after learning of the student’s interest in greening efforts. the project planned to uproot existing dead and sparse plantings, cleared spaces, and plant fresh shrubbery and trees. the project sought partners including the public school system, a local conservancy, and a local foundation. students, teachers and the principal worked with local landscaping experts on a chilly fall saturday to beautify their campus and also received information on soil types, measurements, and plant placement exposure to natural elements. a more aesthetically pleasing outdoor environment was created. other benefits included slowed storm water drainage, improved air quality, and reduced outdoor maintenance. promoting greening in residence halls the university had provided recycling bins specifically for paper, glass or plastic and another bin for aluminum. however, students were not using the bins, cross-mixing the items placed and throwing food products and other dirty containers in the bins. presentations that focused on the importance of recycling to the campus community and society were scheduled during 10 dorm floor meetings. students would be encouraged to properly discard recyclables and were informed of implications of local actions on global communities. resident floor counselors would publicize the meeting and encourage maximum attendance. the attendance at each meeting was 10 15 students. with increased awareness students became aware of the role they could play in environmental preservation and eliminated wasting valuable recycling items by not placing them in the correct bin. the social work student stressed opportunities for exhibiting leadership qualities by championing this effort. lucas-darby/the new color is green 122 by employing critical reflection students consider the meaning of all aspects of the experience. after all, service-learning is a learning process with expectations of immediate and future actions. the deal model (describe, examine and articulate learning) is presented as a critical template that maximizes the reflection process. ash and clayton (2009) note that critical reflection generates, deepens, and documents learning and further supports the learning that results from thinking about the experience. students more readily identify the function of systems affecting the particular experience, provide more definitive responses and dissect social issues to determine future involvement (reed-bouley & reed-bouley, 2007). thinking deeply about each experience or activity encourages more comprehensive analysis and critical thinking of each occurrence. this deeper reflective process also promotes an examination of personal values and long-held beliefs. by the end of the semester, the journal should provide a good retrospective picture of intellectual growth that occurred during the service-learning experience. students are urged to be cognizant of their writing style, to employ all proper mechanics, and to carefully proof their journals. conclusion the new ethic referenced earlier by berger and kelly (1993) identifies an emerging awareness of the connectedness to the natural world and our understanding of nature’s limits on tolerance. environmental preservation is not a fad and kinzie (2008) declares it is fully entrenched in academic life and effects not just how students live but what they learn and as graduates how they change workplaces and neighborhood. she further notes, as does kosnik (2008) students are advocates for curriculum infusion and research have environmental consciousness. the real challenge we face in embracing a more sustainable future, according to orr (as cited in aashe, 2010, p. 1), rests with our ability to educate students differently. aashe (2010) fully supports forward thinking regarding inclusion of greening and sustainability in the curriculum and states the fundamental problem faced in meeting the goal of education for a healthy and sustainable society for all students is that the existing curriculum in higher education has not been developed to examine how we shape a sustainable world. much of the curriculum has been developed to provide students with an increasingly narrow understanding of disciplines, professions and jobs and is focused on specific knowledge and skills employed in the given area. what is needed is a curriculum that prepares learners for living sustainably, both professionally and personally, and that explicitly helps the learner deeply understand the interactions, inter-connections, and the consequences of actions and decisions (p. 2). the integration of green concepts into social work courses is critical. resources exist that provide assistance for this at the local, state, national and international levels. as green-aware stewards of our environment, social work students can contribute to a growing consciousness regarding the need to save the earth and the more-immediate communities in which we work. becoming more aware of individual contributions to the green movement is another strategy by which social workers provide potential benefits to populations they serve. this knowledge encompasses energy conservation, future advances in social work, spring 2011, 12(1) 123 employment, health and wellness awareness and other survival possibilities. incorporating a “greening” theme in a community practice course provided students with information about the contributions they and their clients can make to advance this environmental priority. direct engagement in the green movement through servicelearning experiences provided immediate opportunities to become engaged in a hands-on experience. encouraging students to consider their current and future contributions to environmental preservation uncovers various leadership roles as well. while working with students who were engaged in “green” projects torrise (2010) observed enhanced leadership roles as they made contributions through community s-l placements. with increased knowledge about greening, environmental preservation and sustainability, social work students can use this information to better serve clients and communities alike. the profession of social work, asserts hoff (1997), has a role to play in the restoration of a viable physical environment and the development of norms and practices to support sustainable communities. the pie perspective and the profession’s grounded values provide a solid framework from which to continue to build. additionally, servicelearning courses offer prime opportunities for social work programs to give more attention to this topic and for students to advance their knowledge of sustainable concepts, implement projects, think critically, and problem solve about existing concerns and future opportunities for making continuous contributions. references ash, s., & clayton, p. (2009). learning through critical reflection: a tutorial for servicelearning students (instructor version). raleigh, nc. association for the advancement of sustainability in higher education (aashe). (2010). sustainability curriculum in higher education: a call to action, retrieved from http://www.aashe.org/files/a_call_to_action_final(2).pdf berger, r., & kelly, j. (1993). social work and the ecological crisis. social work, 38(5), 521-526. bridger, j., brennan, m., & luloff, a. (2011). the interactional approach to community. in j. robinson & g. green (eds.), introduction to community development: theory, practice, and service-learning (pp. 85-100). los angeles: sage publications, inc. calder, w., & dautremont-smith, j. (2009). higher education: more and more laboratories for inventing a sustainable future. in j. dernbach (ed.), agenda for a sustainable america (pp. 93-107). retrieved from http://usp.umfglobal.org/resources/0000/0070/esdhigheredamericacalder2009.pdf cronin, j., & kennedy, r. (1999). the riverkeepers: two activists fight to reclaim our environment as a basic human right. new york: simon & schuster publishers. green jobs and cte. (n.d.). retrieved from http://www.careertech.org/uploaded_files/green_jobs_and_cte_-_final.pdf haglund, b., & still, t. (2005). hands-on environmentalism. san francisco: encounter books. lucas-darby/the new color is green 124 harwood group. (1991). citizens and politics: a view from main street america. dayton, oh: kettering foundation. hembd, j., & silberstein, j. (2011). sustainable communities: sustainability and community development. in j. robinson & g. green (eds.), introduction to community development: theory, practice, and service-learning (pp. 261-277). los angeles: sage publications, inc. hoff, m. (1997). social work, the environment, and sustainable growth. in m. hokenstad & j. midgley (eds.), issues in international social work: global challenges for a new century (pp. 27-44). washington, dc: nasw press. homan, m. (2011). promoting community change: making it happen in the real world. belmont, ca: brooks/cole. jones, p. (2010). responding to the ecological crisis: transformative pathways for social work education. journal of social work education, 46(1), 67-84. jones, v. (2009). the green collar economy: how one solution can fix our two biggest problems. new york: harpercollins publishers. kinzie, s. (2008, june 22). higher learning adapts to a green attitude: students lead drive reshaping curricula. the washington post, a1. kosnik, l. (2008). the greening of higher education. retrieved from http://ssrn.com/abstract=1016153[1].pdf mckinnon, j. (2008). exploring the nexus between social work and the environment, australian social work, 61(3), 256-268. meikle, p., & green, g. (2011). globalization and community development. in j. robinson & g. green, introduction to community development: theory, practice, and service-learning. los angeles: sage publications, inc. middletown thrall library. (n.d.). going green: sustainable living resource guide. retrieved from http://www.thrall.org/special/goinggreen.html park, k. (1996). the personal is ecological: environmentalism of social work. social work, 41(3), 320-323. reed-bouley, j., & reed-bouley, k. (2007). introducing students to social analysis and theological reflection: foundations for facilitators of service-learning at colleges and universities founded and sponsored by the sisters of mercy. omaha, ne: conference for mercy higher education. robinson, j., & green, g. (2011). introduction to community development: theory, practice, and service-learning. thousand oaks, ca: sage publications. shabecoff, p. (2000). earth rising: american environmentalism in the 21st century. washington, dc: island press. advances in social work, spring 2011, 12(1) 125 shandas, v., & messer, w. (2008). fostering green communities through civic engagement: community-based environmental stewardship in the portland area. journal of american planning, 74(4), 408-418. national association of social workers. (2009). environment policy. social work speaks. washington, dc: nasw, 121-126. stapp, w., wals, a., & stankorb, s. (eds.). 1996. environmental education for empowerment: action research and community. dubuque, ia: kendall/hunt publishing co. stone, j. (2010, march). it isn’t easy being green, or is it? techniques. retrieved from http://www.acteonline.org/uploadedfiles/publications_and_e-media/files/filestechniques-2010/feature_1%282%29.pdf torrise, m. (2010, january/february). role of the library media specialist in greening the curriculum: a community-based approach to teaching 21st century skills outside the school library through the practice of urban agriculture. library media connection, 18-20. united nations environment programme. (2000). overview geo-2000: global perspectives. retrieved from http://new.unep.org/geo/geo2000/ov-e/0002.htm wronka, j. (2008). human rights and social justice: social action and service for the helping and health professions. los angeles: sage publications. author’s note: address correspondence to: emma t. lucas-darby, phd, lsw, ncgc, department of social work, carlow university, pittsburgh, pa 15213. email: etlucasdarby@carlow.edu microsoft word fitzgerald_fair trade_copyedit2 ______________ charity samantha fitzgerald, ma, is a doctoral candidate in the school of social welfare at the university of california, berkeley. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 375-390 fair trade as a community development initiative: local and global implications charity samantha fitzgerald abstract: this paper examines fair trade as a community development initiative that challenges unjust global trading conditions. on a local level, fair trade aims to create a sustainable livelihood for farmers, to strengthen agricultural cooperatives, and to fund community-based projects. fair trade also purports to engender global solidarity through linking southern producers and northern consumers in a concerted effort to direct the market towards social aims. the paper examines the strengths and weaknesses of fair trade as a social welfare intervention. recommendations are provided to strengthen the fair-trade movement in light of social work values. keywords: fair trade, community development, cooperatives, social development in 2009, 110 million pounds of coffee were certified with a mark in locations across the united states (transfair usa, 2010). this mark on coffee represents more than a clever marketing tactic; it represents the efforts of southern coffee-farming communities as well as the efforts of northern businesses and consumers to challenge unjust global trading relations through fair trade. this paper defines fair trade and examines the imperfect global trading relations that provided impetus for the movement. the paper then turns to the evidence that fair trade provides a number of benefits to producers, cooperatives, and coffee-farming communities. next, the paper draws attention to the growing body of critical literature that suggests that fair trade does not deliver what it promises. finally, the paper considers how social work can contribute to the fair-trade movement to ensure that it delivers what it promises. fair trade defined the term fair trade signifies more than establishing a higher price for certain goods than free-trade mechanisms would prescribe; it is more than “we pay more/they get more” (ronchi, 2002, p. 1). fair trade has been touted as a tool of sustainable development, a global community capacity-building project, a social capital cultivator, and a civil society strategy to alleviate rural poverty in the global south, and a transnational advocacy movement. fair trade encourages communities in the south to become protagonists in their own development by engaging in just trading arrangements with northern businesses. thus, fair trade operates as a community development initiative on two levels. on the one hand, fair trade defines community as a territorially specific entity. fair trade requires that producing communities employ sustainable development practices and are compensated for doing so. additionally, fair trade defines community broadly as global citizenship. as a global unit, the fair-trade discourse attempts to bridge the spatial and social distances between the north and the south, geopolitical terms used to loosely signify the distinction between developed nations (many of which are in the northern hemisphere) and developing nations (many of which advances in social work, summer 2012, 13(2) 376 are in the southern hemisphere), respectively. this paper makes references to both the local and the global constructs of community. the most commonly cited definition of fair trade comes from the european fair trade association (2006), which notes the following: fair trade is a trading partnership, based on dialogue, transparency and respect, that seeks greater equity in international trade. it contributes to sustainable development by offering better trading conditions to, and securing the rights of, marginalized producers and workers – especially in the south. fair trade organizations (backed by consumers) are engaged actively in supporting producers, awareness raising and in campaigning for changes in the rules and practice of conventional international trade (p. 1). fair trade makes demands of traders, a collective term that nicholls and opal (2005) use to refer to importers, exporters, and manufacturers, and of producers. of traders, the fair-trade movement requires they adequately compensate producers for their crops and their goods (sick, 2008a). the established price ostensibly reflects the summation of three costs: (1) the cost of production (which includes social and environmental externalities), (2) the cost of living, and (3) the cost of complying with fair-trade standards (nicholls & opal, 2005). if the free-trade price rises above the fair-trade floor price, which is $1.40/lb for coffee arabica (washed), traders are to pay the free-trade price in addition to the social premium (fairtrade labelling organization, 2011b). the social premium for coffee amounts to $0.20/lb (fairtrade labelling organization, 2011b). second, fair-trade practices involve a long-term commitment of traders to producers (sick, 2008a). these long-term relationships lower transaction costs for producers since they do not have to continually search for someone to whom to sell their coffee. additionally, because of these long-term relationships, traders are to provide producers up to 60% of the invoice prior to product delivery if requested (nicholls & opal, 2005). third, traders are to provide technical support to producers to enable them to increase their production capacities and to encourage environmentally sustainable practices. finally, traders are committed to consumer education in the global north, thereby raising social awareness and increasing the market for fair-trade goods (sick, 2008b). of producers, fair trade demands that they be organized into democratic cooperatives that utilize environmentally sustainable practices. it is believed that cooperative organization increases collective bargaining power vis-à-vis large buyers (sick, 2008a), thereby engendering empowerment (milford, 2004). it is also reported that having a voice in the decision-making processes of the cooperative encourages social inclusion of marginalized groups, such as women. the aforementioned social premium paid by traders is to be earmarked and allocated democratically by cooperatives for community projects, such as health and education initiatives. environmentally sustainable practices constitute another requisite for fair-trade producers (sick, 2008a). environmentally sustainable practices do not necessarily signify organic coffee farming, although sometimes products are both fair-trade and organically certified. environmentally sustainable practices match innovative technology with rural realities. farmers in costa rica, for example, have experimented with two alternative sources of power: solar and fitzgerald/fair trade as a community development initiative 377 methane from cow manure (sick, 2008b). the majority of producers belonging to fairtrade cooperatives must be small-scale farmers. the fairtrade labelling organization (2009) defines small-scale farmers as those who are not “structurally dependent” on hired labor (p. 4). child labor that interferes with school attendance or educational attainment is not permissible (fairtrade labelling organization, 2009). finally, producers are to aim for gender equity in all activities and organizations (fairtrade labelling organization, 2009). this paper focuses specifically on fair-trade coffee. coffee has been the driving force behind the fair-trade movement. in fact, of all commodities—whether freely or fairly traded—coffee is the second most valuable commodity exported by developing countries (talbot, as quoted in pendergrast, 2009). within the fair-trade movement, coffee sales are greatest in value of any commodity (nicholls & opal, 2005). coffee meshes well with fair-trade principles because of the requirement that production operations be small scale. coffee is a crop that is conducive to small-scale farming, and this quality is reflected by the fact that small-scale producers grow 70% of the world’s coffee (bacon, 2005). another reason to explain the intimate connection between fair trade and coffee is that at the time of the fair-trade explosion in the 1990s and the 2000s, coffee farmers were receiving historically low prices, the lowest prices since 1882, to be precise, for their crop (fridell, 2004). coffee producers experienced net losses several years in a row, and international nongovernmental organizations (ngos) took note of the dire poverty in coffee-growing regions. it was estimated that the coffee crisis affected up to 125 million people (murray, raynolds, & taylor, 2003). thus, coffee became the ideal fair-trade commodity. today certified fair-trade goods (including, but not limited to, fair-trade coffee) constitute a hot market. in spite of a global recession, sales have continued to increase during each of the past 4 years (fairtrade labelling organization, 2011a). at the end of 2010, there were 905 producer groups in the global south affiliated with the fair-trade movement (fairtrade labelling organization, 2011a). these groups employed 1.2 million workers, meaning that the total number of direct beneficiaries is about 6 million people accounting for workers’ family members (fairtrade labelling organization, 2011a). the social premium paid to producer groups in 2010 totaled €51.5 million (about $70 million) (fairtrade labelling organization, 2011a). thusly described, fair trade appears to offer a promising way for producers and consumers to challenge conventional market mechanisms. for coffee producers in the global south, fair trade offers a way to manage risk. for businesses and consumers in the global north, fair trade offers a way to express solidarity with producers. the next section turns to the global conditions, namely unfair trading relations and the endemic failures of the free market that gave rise to the fair-trade movement. advances in social work, summer 2012, 13(2) 378 fair trade: a challenge to unjust global trading relations in the 1960s, there was an emerging theoretical argument that trade agreements were often crafted on terms unfavorable to countries in the global south, which exacerbated inequality and poverty. brown (2006) reported that those often perceived to be “left behind” were actually well integrated into global trade agreements. it was believed that the terms of trade, not the lack of trade, created the conditions for certain countries to be left behind and to share inequitably in the distribution of global wealth. the world had been divided into rich and poor, remarked barratt brown (1993) in his groundbreaking fair-trade text, and trade had driven the wedge between the two regions. thus, an intellectual underpinning of fair trade stems from dependency theory, a body of literature that argues that resources are directed from the global south to the global north, thereby relegating the former to a persistent condition of so-called underdevelopment. the deconstruction of free-trade theory and the assertion that it cannot deliver what it promises deepened the theoretical underpinning of fair trade. michael barratt brown noted that rural producers do not benefit from free trade because several market failures are endemic to the free-trade system and that the neoliberal assumption of a level playing field is erroneous. these market failures are the norm rather than the exception. he blamed market failures on large transnational companies that dominate agricultural markets because they have access to finance, and they can easily switch from one supplier to another. in the coffee industry, five transnational companies controlled 69% of the instant and roasted markets, and eight exporting companies controlled 56% of the coffee trade in 1998, whereas an estimated 20 to 25 million families were involved with its production (bacon, 2005). trading power is concentrated; producing power is dispersed. given the concentration of trading power in the hands of a few, traders stand at a negotiating advantage over producers (nicholls & opal, 2005). transnational companies also control most of the value-adding processes, specifically roasting, which means that coffee farmers only receive about 2% of the value of a cup sold in a coffee shop (petchers & harris, 2008). thus, the political economy of coffee production and consumption seems to offer terms that are more favorable to traders in the north than to the producers in the south. in addition to the market distortions introduced by the concentrated power of traders, hutchens (2009) notes additional market failures that small-scale producers face, such as a lack of market access (or access through coyotes who cut into the profits of producers), imperfect information about markets (which is often distorted by coyotes who are looking to maximize profit), lack of access to financial markets and credit, and an inability to switch to other sources of income generation. fair trade attempts to draw trade theory and trade practice together by correcting for these market failures (nicholls & opal, 2005). the fair-trade movement, as discussed in the first section, attempts to help local communities confront global market conditions as discussed in this section. however, how does fair trade operate at the grassroots level? are fair-trade practices and fair-trade discourses congruent? the next two section addresses this question. fitzgerald/fair trade as a community development initiative 379 fair trade: strengths as a community development initiative fair trade focuses on capacity building at the local level and on helping cooperatives integrate into the global economy on just terms. because of its development focus, fair trade is claimed to be a long-term strategy to alleviate poverty rather than a mere stopgap aid measure. a critical review of the literature reveals three broad categories of fair-trade beneficiaries: producers, cooperatives, and communities. fair-trade producers receive steady income in contrast to reliance on the volatile conventional market (kohler, 2006; macdonald, 2007; murray, raynolds, & taylor, 2006). even though they often cannot sell the entirety of their crop to fair-trade markets (kohler, 2006), receiving at least a partial guaranteed salary created a sense of economic security (taylor, 2002; kohler, 2006; lemare, 2008; bacon, 2005; utting-chamorro, 2005; nicholls & opal, 2005), which can obviate the need for migration (taylor, 2002; lemare, 2008), although one study (jaffee, 2007) found that migration among fair-trade producers was equivalent to that of conventional-market producers due to the “healthy migrant” selection bias. estimates of how much more fair-market producers receive than conventional-market producers range from 10% (macdonald, 2007) to 40% (raynolds, 2002) to 100% (uttingchamorro, 2005). with the increased income, producers can keep their children in school (lyon, 2007; macdonald, 2007; murray et al., 2006; nicholls & opal, 2005; ruben, fort, & zuniga-arias, 2009; taylor, 2002; utting-chamorro, 2005), repay debts (lyon, 2007), maintain and improve homes and farms (lyon, 2007; macdonald, 2007; raynolds, murray, & taylor 2004; ruben, fort, & zuniga-arias, 2009; utting-chamorro, 2005), improve the quality of coffee grown (murray et al., 2006; taylor, 2002), access credit (murray et al., 2003), access training (murray et al., 2003) and consume adequate diets (lemare, 2008; utting-chamorro, 2005). these differences are reflective that fair-trade producers are able to invest in assets that will provide security over the long term (ruben, fort, & zuniga-arias, 2009). they can also use the increased income to hire other laborers, which benefits others in the community (ruben et al., 2009; taylor, 2002). on a final note, producers have also reported higher self-esteem (nicholls & opal, 2005; raynolds et al., 2004; taylor, 2002). a requirement of fair trade is that communities in the global south be organized into democratically managed cooperatives in order to participate. the idea is that a group of producers is more powerful than a single producer and that there are advantages in pooling resources. together, it is believed that community members are more effective at solving common problems than individuals’ unlinked efforts (decarlo, 2007). additionally, it is believed that combined efforts not only are more effective at solving problems but also at opening opportunities (decarlo, 2007). the invocation of the cooperative conjures such buzz terms as participation, empowerment, capacity building, social capital, and solidarity. fair trade promotes community cohesion and coordination through cooperative strengthening. it is noted that fair trade does not set up cooperatives but rather works with advances in social work, summer 2012, 13(2) 380 already existing cooperatives and strengthens those cooperatives. researchers note that fair trade has perhaps had the greatest impact at the cooperative level as it strengthens their organizational capacities to supplement functions and services inadequately provided by the state (jaffee, 2007; macdonald, 2007; ruben, fort, & zuniga-arias, 2009; simpson & rapone, 2000; taylor, 2002; taylor, murray, & raynolds, 2005; utting-chamorro, 2005). participation in fair trade ensures a degree of economic stability for cooperatives based on the promises of a floor price and a long-term commitment. by increasing the capacities of cooperatives, they can fulfill and multiply their roles in the community, such as providing credit to members at low interest rates (renard & perezgrovas, 2007). also, cooperatives have deepened their involvement with the coffee trade to extend vertically up the commodity chain, thereby capturing more of the profits associated with value-added processes. strong cooperatives have been able to construct processing facilities. they have also been able to expand into other niche markets, such as organic (lemare, 2008; taylor, 2002). participation in a cooperative associated with fair trade also enables producers to pool resources through sharing transportation costs, thereby benefiting from economies of scale (utting-chamorro, 2005). integration into fair trade provides cooperatives with access to information about recent market trends and technological innovations, thus attempting to ameliorate a persistent market failure noted earlier. beyond the economic strengthening afforded by fair-trade certification, there are also social and networking implications for fair-trade cooperatives. looking downward, being fair-trade certified enhances perceptions of the cooperative’s legitimacy to members (raynolds et al., 2004; ruben, fort, & zuniga-arias, 2009). looking within, cooperative involvement thickens the social capital of the members (mendez, 2002; rice, 2001; simpson & rapone, 2000). looking upward, fair-trade-participating cooperatives can connect with other fair-trade-participating cooperatives, thereby creating secondary-level cooperatives that augment advocacy strength (rice, 2001; ronchi, 2002; taylor et al., 2005). additionally, obtaining fair-trade certification status serves as a signaling function and enables cooperatives to more easily partner with nongovernmental agencies, which can provide additional resources and information (raynolds et al., 2004; ruben et al., 2009; taylor, 2002). cooperatives play an important role in administering the social premium towards collective purposes. in coffee, the social premium price associated with a pound of coffee is $0.20 (fairtrade labelling organization, 2011b). the social premium is earmarked for social, environmental, and/or economic development programs to be decided democratically by the cooperative. when the social premium was initiated, often it was returned to producers in the form of income. recently, however, the fairtrade labelling organization has been strongly urging that cooperatives use the premium explicitly for community development projects. this social premium is more attractive to fund community development projects than loans from institutions like the world bank because it comes with no strings attached. though several authors noted above that organizational capacity building is the greatest strength of fair trade, others (e.g., smith, 2009; nicholls & opal, 2005) contend that community development projects executed through the social premium are its most impactful intervention. fitzgerald/fair trade as a community development initiative 381 some of the community development projects refer back to the cooperatives, strengthening their organizational capacity, while others attempt to fill the void left behind in the wake of public and social service retrenchment. community projects brought about as a result of this social premium include transportation (simpson & rapone, 2000; taylor, 2002), conversion to organic practices (raynolds et al., 2004), health services (raynolds et al., 2004; simpson & rapone, 2000; utting-chamorro, 2005), sanitation projects (raynolds et al., 2004), education and training (ronchi, 2002; simpson & rapone, 2000; smith, 2009; taylor, 2002; utting-chamorro, 2005;), investment in women’s groups (taylor, 2002), environmental improvements (nicholls & opal, 2005; ronchi, 2002; taylor, 2002; utting-chamorro, 2005), construction of warehouses and other cooperative facilities (smith, 2009), and ecotourism (uttingchamorro, 2005). fair-trade literature often uses the terms community and cooperative interchangeably. some community members are not cooperative members. the literature that acknowledges that the terms cooperative and community are not necessarily synonymous still purports that both cooperative strengthening and the social premium provide benefits not just for fair-trade producer participants but also have positive externalities from which non-cooperative members benefit. that is, not all community members might be members of fair-trade cooperatives, yet all receive the benefit of these community projects via the multiplier effect (daviron & ponte, 2005; lyon, 2007; nicholls & opal, 2005; ruben et al., 2009). non-cooperative members, for example, can use the market information provided by fair-trade cooperatives as a bargaining advantage with the coyotes. the provision of information regarding environmentally friendly practices, such as organic farming, is also transferable to non-cooperative members through the demonstration effect. in sum, fair trade is about strengthening local organizations, thickening social capital, and addressing a locality’s needs comprehensively. it helps local communities manage unjust global trading terms and to be actively involved in creating a more just global trading order. fair trade: weaknesses as a community development initiative when implemented, deneve, luetchford, and pratt (2008) suggest that the moral framework of fair trade can be distorted, thus leading to unanticipated outcomes. in general, this critique asserts that community is often portrayed as being unproblematized and unitary, which leads to outcomes that do not mirror what fair-trade discourses purport. specifically, fair trade does not engage with or affect all community constituents in the same way. it is important to acknowledge the heterogeneity within communities. additionally, fair trade as a development project has varying degrees of success, depending on whether development is defined in terms of process or outcome. fair trade interjects the possibility of the reinforcement, exacerbation, and/or the production of community splintering, and the fair-trade discourse whitewashes over the potential production of stratification. there are two concrete examples that illustrate advances in social work, summer 2012, 13(2) 382 community stratification, one relating to gender and the other to class. the first illustration of strained relations within a community relates to gender equity. nowhere does fair-trade rhetoric describe exactly what is meant by the term gender equity. this paper contends that gender equity as a fair-trade goal has intentionally been left nebulous to retain symbolic value. it is difficult to discern whether gender equity in fact is achieved through fair trade since there is no standard to which to compare it. nevertheless, this paper suggests that gender equity, however defined, is not being brought about by fair trade. prima facie, fair trade as a development initiative perpetuates an agriculturally reliant local economy, one that men tend to dominate (murray et al., 2006). sick’s (2008b) ethnographic research in perez zeledon, costa rica, explores women’s tenuous connection to coffee production. her research suggests that strengthening the role of coffee in the local economy is likely to increasingly distance women from household income-generating activities, thereby reinforcing their traditional household roles. land, notes sick, is unevenly distributed between men and women. due to cultural norms, men are the primary purchasers of land. purchasing, however, is not the main practice through which land is acquired in costa rica. land has grown increasingly scarce in costa rica, and thus it is mainly obtained through inheritance. even though legislation mandates that land be passed down equitably among sons and daughters, in practice sons are the main inheritors of land. given few employment opportunities apart from agriculture in rural costa rica, whoever owns land controls the purse strings of household finances. thus, promoting the perpetuation of coffee production prima facie privileges a labor activity in which women are not key actors. lyon (2010) concurs that traditionally male agricultural activities are privileged through fair trade over other non-farm income-generating activities where women might play important roles. in an article published in 2008, she describes the inner-workings of a cooperative in guatemala. in this cooperative, a majority of the members were men. to be specific, only 7 of the 116 members were women (p. 262). as an implicit social norm, these seven women almost never spoke during cooperative meetings (a claim that lyon buttressed by noting the shushes a woman received when she spoke). in fact, lyon notes that women’s main participation in cooperative meetings was to serve lunch. no women have ever served on the board of the cooperative that lyon researched. she suggests that their participation in a leadership capacity is impeded both by social norms and by the demands of household duties. in contrast, 77% of the 53 surveyed cooperative members (a sample that included 5 of the 7 women members) have served on the board. as such, the strengthening of cooperatives reinforces men’s roles vis-à-vis those of women, thus undermining the purported fair-trade goal of gender equity (fort & ruben, 2008a). lyon (2008) also makes note of the one-family, one-vote policy of many cooperatives throughout latin america, such as the one she studied. because of patriarchal customs, the men often get to cast the one vote to represent the family. even though cooperatives might be complying with the fair-trade requirement of democratic processes (another purported fair-trade goal), this particular democratic practice might undermine gender equity. lyon’s account of women’s marginalization within the cooperative is buttressed by other similar accounts (fridell, 2007; ronchi, 2002; uttingfitzgerald/fair trade as a community development initiative 383 chamorro, 2005). thus, fair-trade practices relating to gender equity at times do not map onto fair-trade discourse. the second example of community stratification within community relates to the treatment of landless laborers. fair-trade discourses do not fully address the class differences and the concomitant power imbalances between small-scale producers, and landless laborers. fair trade as it relates to coffee production keeps the landless laborer invisible. jaffee (2007) notes that often fair-trade farmers must hire day laborers to comply with the labor-intensive, environmentally mindful practices prescribed by fairtrade certification processes. there are no specifications regarding the compensation of landless laborers employed by small-scale producers. landless laborers are given short shrift in fair-trade discourses, yet they are active participants in fair trade. for example, luetchford (2008b) critiques sick’s ethnographic work in costa rica. sick briefly notes that during coffee harvesting season about 25% of family farmers, a sizeable percentage, will contract with landless laborers. nevertheless, she mentions this only as an aside. she focuses instead on the small-scale producer. fair-trade studies make few commentaries of how and/or if landless laborers benefit from fair trade aside from the community projects, such as road maintenance, that benefit all community members irrespective of their affiliation or lack thereof with the cooperative. though landless laborers might benefit from the community projects via the multiplier effect, they do not get a voice with regards to which community projects are realized. thus, the concerns that are most pressing to them might not be addressed. there also seems to be a gap between discourse and practice in terms of the social premium. fair trade claims that decisions regarding what to do with social premiums are to be determined through a democratic, inclusive process. nevertheless, producers seem strangely unaware of the existence or the use of a social premium. in one cooperative (fort & ruben, 2008b), over 10% of producers were unaware of the existence of the social premium. in this same study, only 23% claimed to have derived any benefit from the premium. in an evaluative study of banana production (zuniga-arias & saenzsegura, 2008), 71% of respondents said they had not been consulted about the use and the allocation of the social premium. ronchi (2002), too, reported the odd finding that, in spite of the perceived sense of augmented community welfare, cooperative-affiliated producers did not link the positive outcome to fair trade. in fact, they seemed unaware of fair trade. again, there appears to be a gap between fair trade’s inclusive community construct and what unfurls on the ground. these critiques of the rosy portrayal of cohesive, inclusive communities also have implications for the conceptualization and the operationalization of development within local communities. at times, the certification standards seem to be at odds with each other. the one-family, one-vote policy employed by many cooperatives upholds the standard of democratic processes but without thorough consideration as to how it can undermine gender equity. in the case of environmental standards, the need to adhere to certain labor-intensive criteria is privileged without robust consideration as to how landless laborers should be compensated and treated. the emphasis on implementing community projects also comes at the expense of educating producers about the facets of fair trade. neither gender equity and democratic processes, nor just compensation and advances in social work, summer 2012, 13(2) 384 environmental standards, nor community projects and extensive community participation are inherently contradictory. rather, because they have not been adequately conceptualized and operationalized, in practice these standards can undermine each other. examining fair trade at the meso level, fair trade must exclude certain communities from participation. the requisites are such that only well organized communities, often those that already have flourishing cooperatives, can participate. because of the cooperative requisite, the most disadvantaged communities are excluded from participation in fair trade. communities are also intentionally excluded from certification because the fair-trade market cannot absorb all goods that are produced for it. in the coffee segment, for example, often only 20% to 25% of fair trade farmers’ coffee is sold on the fair-trade market (jaffee, 2008). elsewhere, goodman (2008) reported that the export capacity of fair-trade producers is seven times that of fair-trade sales. fair-trade producers must sell the remaining portion on the conventional market. to control fairtrade supply, the fair-trade certification bureaucracy has been reticent to certify more cooperatives. the discursive project of fair trade obscures these slippages of inclusion and exclusion. the whitewashing of inclusion and exclusion becomes even more salient at the macro level. as global citizenship, fair trade uses language such as stakeholders and partners. even framing fair trade as an intervention is eschewed for terms like collaboration. mere rhetorical slight, however, does not make for good practice. though the propagators of fair-trade discursive practices in the north claim that the project embodies trade not aid, some participating producers in the south perceive the project quite differently. in fact, some southern small-scale producers, such as those in ronchi’s (2002) study, seem to understand fair trade only in terms of augmented income and not as global solidarity. moreover, emerging research suggests that producers have perceived a need to protect themselves from fair trade, which has been attributed to the relatively recent introduction of certification schemes that disrupt local social norms through their surveillance mechanisms (wilkinson & mascarenhas, 2007). the certification system designed to scale up fair trade perhaps has undermined the pursuit of key movement values, such as trust and solidarity. the certification system has institutionalized imbalances in power by creating non-democratic, top-down decisionmaking structures (hutchens, 2009). in this nascent bureaucratic structure, traders have had more voting power than producers in determining the course of fair trade (murray et al., 2003). in fact, it was only recently that producers were promoted from observer status to having 4 representatives on the newly expanded 14-person board of the fairtrade labelling organization (jaffee, 2007). producers have reported feeling that their presence is merely symbolic rather than substantive (renard & perez-grovas, 2007) and that certification standards are largely determined by the northern stakeholders (luetchford, 2008a). southern producers have also expressed disenchantment with other facets of fair trade. for example, some have reported wanting more access to information about northern markets (wilkinson & mascarenhas, 2007). though fair trade claims to ameliorate the endemic market failure of imperfect information, some producers feel that fitzgerald/fair trade as a community development initiative 385 they are only given certain information that continues to relegate them to the position of aid recipients rather than being trade partners. producers have also reported feeling ignorant about what happens to their products (renard & perez-grovas, 2007), and they have expressed a desire for more communication with northern consumers (murray et al., 2003). though elaborate marketing schemes discussed above provide information to northern consumers about southern producers, information does not flow in the reverse direction. finally, producers have expressed disgust with certification criteria and fees, which are perceived as being unduly. mutersbaugh (2002) goes so far as to liken certification criteria to ecological neocolonialism. some producers perceive a dearth of opportunities to express their disgust. when they do voice their frustrations, they report a lack of responsiveness by the fair-trade labeling regime. in short, rather than challenging and transforming the market, parts of the fair-trade movement seem to have been absorbed by it to the point that producers report that there is very little that is alternative about the fair-trade market (zuniga-arias & saenz-segura, 2008). in so doing, some producers have experienced fair trade as yet another practice of marginalization. write kruger and du toit (2007), “the prospect continually exists that fair trade, far from being a way of challenging the power imbalances between north and south, can function as a way of commodifying political concern and deflecting challenge, renormalizing consumption and legitimizing a ‘kinder, gentler’ food regime that is perhaps more paternalistic and less nakedly exploitative” (p. 215). the certification system reflects and reproduces the disconnect between fair-trade discourse and practices. the focus on scaling up the fair-trade movement through the certification scheme perpetuates power imbalances albeit in subtle, gentle terms. the preceding critique of fair trade is not meant to diminish all confidence in the community development initiative. this author concurs with lyon’s (2006) assessment that although the fair-trade system is imperfect, it should not be discarded given few (if any) alternatives to just trade relations. rather, fair trade can be strengthened as a local and global community development initiative, perhaps with support from social workers, through robust consideration of the critiques presented above. thus, the paper concludes with several suggestions that might give due consideration to the constructs of community and development as they pertain to fair trade. potential social work contributions to fair trade the certification system is not inherently bad. it has been credited with expanding the market for fair trade by placing goods in places that consumers frequent. however, the certification system can be tweaked to maximize fair trade’s potential to help local communities contend with global trading. the certification system can be made more participatory from the micro to the macro level, and social workers can engender robust participation across levels. first, when certifiers visit fair-trade cooperatives, they can speak with a vast cross-section of producers and community members including women and landless members to ensure that all community members, not merely those preselected by cooperative management, are given a voice. the fairtrade labelling organization can also be more proactive in helping producers address the concerns raised by the cross-section of community members. being attentive to various dimensions of advances in social work, summer 2012, 13(2) 386 diversity, social workers in local communities can ensure that no one is excluded from participating. participatory evaluation and collaborative problem-shooting can also serve to clarify certification standards, which hopefully would give producers a stronger position from which to negotiate the standards set forth by the fairtrade labelling organization on the macro level. creating more participatory processes might make fair trade more messy, and it might expose unflattering aspects of fair-trade practice. nevertheless, it serves to focus on making community into an inclusive construct, and it highlights the potential of development as both a process and an outcome. in sum, participatory evaluation, in which many social workers have experience facilitating, can also serve to align fair-trade practices with fair-trade discourses. fair trade might also be strengthened by breaking down dichotomies. one such dichotomy is the one that exists between consumers and producers. this dichotomy can be eroded by encouraging countries in the global south to form their own fair-trade labeling national initiatives so that inhabitants of the south can become consumers. northern fair-trade labeling initiatives can also consider certifying producer groups within their selfsame region so that northern workers, too, can become fair-trade producers. commixing consumer and producer status serves to breakdown the historical relations established by colonialism. the recent certification of south africa as both a consuming and producing nation is a step towards eroding binaries. as advocates, social workers can consider pressuring flo to consider continuing to revise these purchasing and consuming limitations. the provision of comprehensive information can also serve to erode binaries. northern participants can be provided multi-dimensional information about producers and producing communities. complex information does not make for friendly marketing sound bytes, but portraying fair-trade southern participants as unidimensional producers in “ethnic” apparel on marketing ploys serves to reify the other rather than to create genuine global solidarity. additionally, southern producers can be given more information about northern consumers and northern markets so that information flows bidirectionally (or, even better, multilaterally if the rigid north-south, consumerproducer binary were to be eroded). advocating for the provision of information in both the north and the south reflects social work’s commitment to self-determination. in the fair-trade movement, the present-day is a point of inflection. the movement is at a juncture that exposes the contradictions between fair-trade discourses and fair-trade practices (fisher, 2009). rather than representing the demise of the movement, these growing pains are an opportunity for reflection and action. and in spite of the growing pains experienced by the movement, fair trade sales have not only weathered the recession, but have even expanded in the face of it (fairtrade labelling organization, 2011a). fair-trade organizations are looking to broaden and to deepen the movement. expansion into new markets and the deepening of existing markets have increasingly required institutionalization (doane, 2010). what is needed is reflective research and action that informs the institutionalization to ensure that fair-trade discourses and fairtrade practices map onto each other and that the movement reaches its maximum potential. it is hoped that these critiques as facilitated by social workers and other allies will serve to shape the present point of inflection. fitzgerald/fair trade as a community development initiative 387 references bacon, c. 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(2008). the impact of fair trade in banana production of costa rica. in r. ruben (ed.), the impact of fair trade (pp. 117-136). the netherlands: wageningen academic publishers. author note: address correspondence to: charity samantha fitzgerald, university of california at berkeley, 120 haviland hall #7400, berkeley, ca 94720-7400. email: sfitzgerald@berkeley.edu microsoft word devoe copyedit bb _______ ellen r. devoe, ph.d., and ruth paris, ph.d., are associate professors at boston university school of social work, boston, ma. abigail m. ross, msw, mph, is project director of strong families strong forces at boston university school of social work. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 149-165 build it together and they will come: the case for community-based participatory research with military populations ellen r. devoe abigail m. ross ruth paris abstract: in this article, we describe the methodology broadly known as communitybased participatory research (cbpr) and identify its relevance to social work intervention research with families serving in operation enduring freedom/operation iraqi freedom (oef/oif). since the inception of oef/oif, much has been written about low rates of service utilization among military service members and families to address deployment and combat-related concerns. barriers to participation include difficulty accessing programs, mistrust of clinicians/researchers, concerns about confidentiality, stigma, and career implications, and perceptions of program effectiveness. because cbpr values the community’s inherent resilience and expertise about its own needs, this method can be important for the development of feasible, culturally-relevant and evidence-based prevention and intervention models for military populations. to illustrate, we provide an overview of our implementation of cbpr to develop and test a home-based reintegration program for military families with very young children. implications for social work practice and research are discussed. keywords: military families, community-based participatory research, oef/oif introduction to community based participatory research community-based participatory research (cbpr) is an orientation to the research process rather than a specific methodology or research design. it assumes collaboration between the researcher and the community of interest in all phases of the research process (viswanathan et al., 2004) and aims to enhance community outcomes and capacity (minkler & wallerstein, 2003). in practical terms, the community actively participates in defining the research questions, aims, and outcomes, rather than serving only as a context and source of data collection and/or a means to further the researcher’s goals (lantz, israel, schulz & reyes, 2006). indeed, cbpr as a method emerged from participant action and empowerment strategies developed to respond to marginalized communities that had been prey to “hit and run” research, in which researchers obtained data from a study sample for their own purposes and did not directly or immediately transfer useful or usable knowledge to benefit the community (franco, mckay, miranda, paulino, & larwrence, 2007). cbpr is also highly consistent with the current focus on translational research as a cutting-edge priority in developmental prevention and intervention science. specifically, cbpr not only conforms to the fundamental tenet of translational research, advances in social work, spring 2012, 13(1) 150 to ensure that all findings derived from the research process have “end usability” (guerra, graham, & tolan, 2011), but prioritizes ongoing researcher collaboration with communities that are intended to benefit from research results. we suggest that cpbr approaches in partnerships between civilian academic researchers and military collaborators can result in timely development of effective prevention and intervention strategies that have strong ecological validity, community buy-in, and relevance to the diverse needs of military families. in the context of the military community, a cbpr approach views service members, veterans and their families as the experts on their own military-related experiences and struggles who can inform both the research world and service providers of their specific strengths and needs. in our own work as academic researchers, we approach our status as civilian-outsiders from a position of cultural humility, in which we take responsibility for and are committed to a dynamic learning process in which our education about military culture and families is open-ended. the notion of cultural humility is highly consistent with cbpr in that we assume that new knowledge about military families will influence and change the direction of our research and intervention development throughout the research process (tervalon & murray-garcia, 1998). our contributions as researchers to the cbpr enterprise include sharing information and securing resources (e.g., grant support) with the community that may not be readily available. as part of this process, we are responsible for understanding and translating the state of the research regarding the needs of young children in military families and the availability and status of prevention and intervention initiatives targeting this population. what we know about military families with very young children in january 2011, the obama administration identified military families as an “enduring” priority for the u.s. (president's commission, 2011) with more than two million troops having served at least one tour in operation enduring freedom and/or operation iraqi freedom. an estimated 55% of the total force is married and a substantial number of active duty and national guard/reserve (ng/r) are parents of dependent children (43.2% and 41.9% respectively) (office of the deputy under secretary of defense, 2010). currently, there are approximately 1.9 million children with a military parent. of children who have experienced at least one parental deployment, those ages birth to 5 years comprise the largest age group (41.5%), followed by 6-11 year olds (31.2%), and 12-18 year olds (23.4%) (office of the deputy under secretary of defense, 2010). war operations in iraq and afghanistan have required intense and ongoing involvement by u.s. troops. in fact, the deployment demands of these conflicts are unprecedented in recent history (president's commission, 2011). the unique characteristics of these “fourth generation” wars (scott, mccone, & mastroianni, 2009), including high operational tempo, ambiguous front lines, ubiquitous enemy, and terrorist tactics have resulted in elevated combat exposure for all troops and increased rates of physical injuries and disabilities specific to contemporary combat strategies (e.g., ieds, devoe, ross, paris/community-based participatory research with military 151 roadside bombs, suicide bombs, blast impacts). while the survival rate, enabled by technological advances in medicine, communication, and transportation, is the highest of any war in history, so too are the resulting demands on all systems of care for veterans and their families. the heavy engagement of national guard/reserve units in war-related operations as opposed to the more traditional ng/r role in the national emergency response system also represents a significant departure from all earlier conflicts (council on social work education, 2010) and has important implications for supporting ng/r service members and their families. specifically, because ng/r families are embedded in the civilian community, they may experience difficulty accessing supports and resources available to deploying or reintegrating families due to geographic dispersal. our service delivery systems, both military and civilian, are not yet equipped to respond to the volume and range of concerns within military and veteran populations. for example, although social workers constitute the largest professional discipline serving military communities, the majority of social workers do not receive specialized training through social work curricula in the classroom or field about military culture, the deployment cycle, and war trauma and its impact on families. furthermore, because 63% of military families live in diverse communities all over the country (president's commission, 2011), they are likely being served by community-based agencies including health and mental health clinics, hospitals, schools, and child care agencies that may not be aware of a family’s military status or trained to support families who have served. taken together, the numbers of children, parents, and communities affected, combined with the often urgent and sustained needs resulting from oef/oif deployment, separation and combat, necessitate a comprehensive social work response. social work is positioned to implement cbpr given the profession’s strong foundation in ecologically-based and multi-level practice. through collaborative research partnerships between social workers and military communities, community-based participatory approaches to prevention and intervention research can expand the profession’s capacity to anticipate and offer effective and relevant services for military families. we present our experience in applying a cbpr approach to begin addressing gaps in knowledge about oef/oif families with very young children and developing evidence-based interventions to support them. parenting very young children during deployment and reintegration our rationale for focusing on the birth to five year age range is multi-pronged. as noted above, children under age five are disproportionately represented among oef/oif families relative to older age groups and are highly vulnerable in the face of prolonged separation from a primary caregiver. while a growing body of literature also has begun to recognize resilience in military families with older children and adolescents (chandra et al., 2010; huebner & mancini, 2005; macdermid, samper, schwarz, nishida, & nyaronga, 2008), few studies have explored resilience in babies, toddlers, and preschoolers. one study of oef/oif children ages 1.5-5 years old during deployment indicates that preschool children of deployed parents were more likely to exhibit increased behavioral symptoms than children in non-deployed families (chartrand, advances in social work, spring 2012, 13(1) 152 frank, white, & shope, 2008). infants and toddlers may become more irritable, demonstrate increased vulnerability in sleep disruption, and develop eating problems or separation anxiety in response to at-home caregiver depression, anxiety or parental absence (lincoln, swift, & shorteno-fraser, 2008). discipline problems, increased need for attention, sleep difficulties, confusion, sadness, repeated questioning about the deployed parent, and fear that the deployed parent may not come home may occur in as many as 50% of children under age five with a parent currently deployed (blount, curry, & lubin, 1992; jensen, martin, & watanabe, 1996; kelley et al., 2001; rosen, teitelbaum, & westhuis, 1993). the possible effects of deployment on very young children may result in increased and more complicated demands on parents as they work to support their babies, toddlers and preschoolers throughout and after the separation. we also know that for children of all ages, quality of parenting has emerged consistently as the most robust predictor of adaptive coping and resilience in adverse contexts (luthar, 2006; luthar, sawyer, & brown, 2006). the very young child’s ability to cope with lengthy separation from a primary caregiver is heavily influenced by how well the at-home caregiver manages the many transitions and challenges inherent throughout the deployment cycle (chartrand et al., 2008; cozza, chun, & polo, 2005; cozza & lieberman, 2007; williams & rose, 2007). for the at-home parent with young children, maintaining child care routines and handling expanded responsibilities can be exhausting and may contribute to increased stress levels in children and parents (kelley et al., 2001). there is also some evidence of increased risk of maltreatment, primarily neglect, during deployment (gibbs, martin, kupper, & johnson, 2007; rentz et al., 2007). these findings suggest that non-deployed parents caring for very young children could benefit from targeted prevention and intervention services throughout the period of deployment separation and beyond. post-deployment adjustment presents unique challenges for military families with children under five. babies and toddlers may not recognize the returning father or mother and often need a period of slow transition to become familiar and comfortable with their service member parent. routines developed during deployment, such as co-sleeping, may be difficult to disrupt and may be challenged or misunderstood by the reintegrating parent. toddlers and preschoolers may manifest more separation anxiety in response to either parent’s comings and goings (barker & berry, 2009) and can become dysregulated when reminded of the deployment (e.g., when a parent wears his or her uniform for work). while many military families are able to anticipate and weather the strains of the post-deployment period, reintegration becomes more highly fraught when a returning parent is suffering from adverse psychological outcomes such as combat stress, depression, anxiety and/or injury or disability (huebner, mancini, wilcox, grass, & grass, 2007). recent findings indicating a high prevalence of sub-threshold mental health distress (range from 22-50% of returning oef/oif veterans), in particular partial ptsd, are especially concerning and may substantially compromise parenting in the returning service members (jakupcak et al., 2007; pietrzak, goldstein, malley, johnson, & southwick, 2009). devoe, ross, paris/community-based participatory research with military 153 transition to parenthood during deployment when a first baby is born during a tour of duty, families grapple with the transition to parenthood in the context of the separation and uncertainty of deployment realities. a service member father’s ability to support his partner is clearly constrained by the circumstances of deployment and he is unable to participate instrumentally (e.g., night feedings, etc.) in the daily routine of infant care. on balance, first-time mothers become single parents as they must manage all aspects of parenting without their partner. in our study sample we have been concerned that mothers who give birth to their first baby shortly before or during the separation period may be at greater risk of developing postpartum depression than mothers whose partners are not deployed. this was demonstrated in one study where postpartum depression (ppd) was found at a higher rate in military families as compared to those in the general civilian population (16.9% vs. 13%) (haworth, 2010). for fathers, becoming a parent in absentia can be disorienting and distracting (macdermid et al., 2005; macdermid, 2006). consequently, the returning father must simultaneously reintegrate into the couple relationship, family and community, and move immediately into fatherhood with a baby he does not yet know. unfortunately, there is very little information about this unique and potentially at-risk subgroup of oef/oif parents and the specific challenges they face throughout the deployment cycle. what is available? lack of services. until very recently the department of defense and veteran’s administration (v.a.) have provided a comprehensive array of health and mental health services to the military service member or veteran with the goals of readiness and rehabilitation. since oef/oif, however, there have been important changes in federal policy that focus greater attention to the health and well-being of the totality of u.s. forces, specifically families of military service members and veterans (department of defense task force on mental health, 2007; office of the under secretary of defense (comptroller) cfo, 2010; president's commission, 2011). while these critical shifts in mandate begin to take root at the level of implementation, the current structure continues to be uneven with both redundancies and significant gaps in services. for oef/oif families with very young children, the most basic challenge is the relative absence of developmentally-appropriate and military-sensitive programs in communities. for active duty families and those living on or near installations, the new parent support program within the family advocacy umbrella has long been an important resource for new parents through the baby’s first year of life; however, for ng/r families living in nonmilitary connected communities and families with babies older than 12 months, such services may not be available or accessible. additional challenges for families with babies, toddlers and preschoolers can include geographic barriers, difficulties with accessibility (e.g., hours, locations), insurance coverage red-tape, and confusion about eligibility (gould et al., 2010; kim, thomas, wilk, castro, & hoge, 2010; pietrzak, johnson, goldstein, malley, & southwick, 2009). advances in social work, spring 2012, 13(1) 154 we built it so why won’t they come? top-down vs. bottom-up. the command structure of the u.s. military necessarily relies heavily upon leadership dictating action and directions to lower ranking personnel in support of mission readiness and success. while a top-down strategy is highly effective in the context of war operations, the “ivory-tower” imposition of research agendas and/or mental health expertise on service members and their families has not always been wellreceived and may not be responsive to service members’ perceived needs. for example, although there are well-tested evidence-based models of treatment available for service members with mental health concerns, current help-seeking among oef/oif veterans remains much lower than documented need (pietrzak, johnson et al., 2009; thomas et al., 2010) despite the fact that the suicide rate in the military reached an all-time high in 2009 (department of defense task force, 2010). researchers have identified the specific barriers of negative beliefs about or previous experience with mental health providers (pietrzak, johnson et al., 2009; thomas et al., 2010), and anecdotal evidence indicates that younger service members and veterans may be less likely to use va-based programs. for ng/r service members, accessibility to existing programs is often a significant barrier. with these considerations in mind, we aimed to build a reintegration program for oef/oif families that would eliminate known barriers to participation and help-seeking, including accessibility, stigma, relevance to the military context, and developmental appropriateness. our particular focus is the ng/r families, who represent a significant but underserved demographic in the ongoing conflicts. building it together: cbpr case exemplar strong families strong forces, the program we have been developing, has been working within a cbpr framework since the commencement of our project. as nonmilitary researchers and clinicians funded to develop a program for military families with young children where one parent recently returned from a deployment in iraq or afghanistan, we were fully aware of the need to collaborate with military service providers and families in our region. collectively, the leadership team had both research and clinical experience with trauma, families, and young children. we were very experienced and familiar with evidence-informed and evidence-based models to address traumatic stress and violence-exposure in children, infant mental health, and family therapy prevention and intervention strategies. one team member had substantial familiarity with the family advocacy program and the new parent support program specifically through involvement with an earlier program evaluation effort. working within a cbpr frame, one of our first tasks was to begin to understand the complexities and needs of the military communities we hoped to support. we anticipated that with the community’s expertise combined with our knowledge of existing programs and resources in academia, we could achieve our ultimate goal of creating a viable and effective intervention that would be immediately useful for military families. phase one: doing our homework we intentionally built into our research plan adequate time and resources to develop our program with the systematic input of military families and health, mental health and devoe, ross, paris/community-based participatory research with military 155 child/family program providers from both military and civilian services. consistent with a primary tenet of community collaboration, we endeavored to do our “homework” prior to entering the military community (franco et al., 2007). more specifically, we immersed ourselves, to the extent possible, in all available sources of information related to oef/oif families and context, including conferences, workshops, webinars, and the existing literature. simultaneously, we conducted extensive outreach to professionals and researchers in diverse systems of care both locally (veteran’s administration, family support programs, regional vet centers, family readiness groups, regional military family life consultants and child care providers both on base and in the community) and nationally (director of psychological health for the national guard, national center for ptsd; operation homefront national, zero to three national center for infants, toddlers and families; and the national military family association). through this intensive process, the breadth of the new england military population was clarified for us. we understood that while there were bases that continued to have smaller active duty components with a range of missions, the largest regional military populations were national guard members and reservists from all branches. national guardsmen and reservists currently represent approximately 50% of those serving in the wars in iraq and afghanistan and bring needs and strengths distinct from those of active duty units living on or near installations. given these characteristics, learning the cultures of the ng/r components and the perceived needs of ng/r families with young children became and continues to be a major focus of our work. to that end, we initiated our formal exploratory work (phase 1) in which we engaged in countless phone conversations, email exchanges, and ultimately face-to-face meetings and interviews with key informants in our region. we began what is now our strongest collaborative relationship with the national guard family program in massachusetts (ngfp-ma). interviews with both military and civilian providers within the ngfp-ma proved to be vital links for our contacts with families and providers in other parts of massachusetts and other states (e.g. rhode island and new hampshire). in addition, key informant interviews with v.a., mental health, social service and family support personnel deepened our sophistication regarding the needs of military families with young children from the provider perspective. interviewees shared their perceptions of the challenges facing service members, partners, and children throughout the deployment cycle. they also shared frustration about the services they could not provide even though they could identify the needs. in general, the key informants seemed to view our funding as positive and appreciated the department of defense’s commitment to developing and testing innovative interventions for military families coping with the strains of deployment. however, these leaders and experts also expressed their appropriate concerns about potential for burden on military families given the explosion of research on the military and considered very carefully whether our involvement with families would be beneficial. earning the trust throughout the process of “doing our homework,” we needed to earn the trust of the military community and to demonstrate that we had something to offer. a critical aspect advances in social work, spring 2012, 13(1) 156 of earning the trust of the community has been showing up and spending time in and with the military community and offering full transparency about our intentions and resources (franco et al., 2007). specifically, after receiving invitations from our colleagues in the national guard and reserve in all branches of the military, we began attending yellow ribbon and similar pre and post-mobilization events to share our expertise with respect to young children, parenting and families. we offer briefings on our developing program, the impact of long separations on young children, and parenting guidance focused on both the at-home caregivers and service members. these presentations have been well received and we are often asked to present to a variety of groups, such as those focused on family readiness or veteran’s affairs. to give a sense of the intensity of our community involvement, research staff have participated in approximately 140 formal events representing all military components over the course of 28 months. at these same events, and through informal follow-up, we began ongoing conversations with members of the military and support personnel, including chaplains and community organizations among others, who assist service members and their families. through conversations and shared concerns we continue to build our collaborative network and to deepen our understanding of military families and the providers who support them. our initial contacts with service members and their families began at these same pre and post-mobilization events. through individual exchanges with service members and their families, we described our goal to develop a program for military families with children birth to five and our interest in hearing directly from oef/oif service members and partners about their experiences of separation and reintegration. if interested, they were asked to sign a “consent to contact” form, granting us permission to call them, explain the process in greater detail, and ultimately visit them at home for an interview. service members and partners were offered stipends for their time (where allowed), an essential component to demonstrate the value of their contributions. in-depth interviews with military families focused on their stories of preparing for deployment, the actual separation, experiences of the service member in theater and of the parent at home with children, communication during the separation, reactions of children to a parent being absent, reunification when the service member returned home, and the reintegration process. we conveyed clearly that we did not have military experience and were not looking for particular answers. families were willing to share the sometimes ingenious and myriad ways they have coped with the challenges that the deployment and separation presented. for example, we learned of service members calling for snow plows from iraq, arranging for monthly flowers to be sent to a partner at home, and an at-home parent showing a father (via skype) his 12 month old baby who was now walking. one mother sent regular care packages to her deployed husband that included a piece of string representing the height of each child so that he could track his children’s growth while he was away. we also heard about 4year olds who wanted to return to a mother’s bed, a 2-year old who stopped talking for the duration of deployment, and a toddler who waited by the window for daddy to come home from work every night for several months after the departure. in this exploratory phase, we listened intently to the array of family experiences and strategies, marveled at their devoe, ross, paris/community-based participatory research with military 157 abilities to manage the complexities of deployments, and heeded their wishes for supports that could alleviate particular stressors during and post-deployment. building the intervention best practices. while completing interviews with key informants, child care providers, and military families, we simultaneously began developing our intervention. as scholars experienced in research and clinical work with trauma, families, and young children, we searched the literature regarding evidence-informed and evidence-based models that addressed traumatic stress and exposure in children, infant mental health, and family therapy prevention and intervention initiatives. we knew that literature focused on work with military families with young children was not available, but we examined models that had been tested with similar populations using promising strategies. in the infant mental health literature, we looked to the works of lieberman (lieberman & van horn, 2005), mcdonough (2004), slade (2005) and dozier (dozier, peloso, lewis, laurenceau, & levine, 2008), all of whom described interventions for caregivers and young children addressing trauma, separations, and/or attachment concerns. cohen (cohen, mannarino, berminger, & deblinger, 2000) and scheeringa (scheeringa et al., 2007) have developed cognitive-behavioral interventions that address frank trauma in children older than three years of age. lester and her colleagues (2011) developed a family-focused resiliency building program, focus, within the military using evidencebased models as their templates (beardslee, gladstone, wright, & cooper, 2003). although several of the above programs are being adapted currently to work with military families, none except focus was developed with military families in mind. existing best and promising practices for both infant mental health and trauma in older children and adolescents are based primarily on the child’s victimization or exposure to ‘frank’ trauma which, in our view, does not characterize a young child’s experience of deployment separation. rather, we take the position that any family experiencing prolonged parent-child separation, including deployment, will be stressed by the experience and that traditional mental health models, typically focused on psychopathology, do not universally apply to military families. for our purposes, we envisioned our program as a universal intervention with preventive as well as therapeutic components focused on the impact of deployment separation and the legacy of warrelated experiences on parenting and parent-child relationships. our military partners also endorse this view: that a family-focused program would be well received and that access has been an important issue. furthermore, given our understanding of the impact of separation on the parent-child relationship, we found the work of slade and colleagues (2005) to be particularly relevant for military families due to the focus on building parental reflective capacity, in this case, about children’s experiences of deployment and reintegration. we also elected, from the beginning, to build a home-based program for oef/oif families in part due to the logistical challenges all families with very young children face and with the hope of reducing concerns about stigma and confidentiality. in addition, because our national guard and reserve families live in different communities across several states, a home-based model would allow us to serve families who would not advances in social work, spring 2012, 13(1) 158 otherwise be able to access site-based programming. hence, we were drawn to the homebased interventions described in the literature that tended to focus on the youngest children as viable models and we were hopeful that families in our region would be receptive to a home-based program. with these basic principles—accessibility, familyfocus, building parenting capacities, and awareness of the impact of separation and combat stress—we looked to our key informants and military families to help guide and shape the focus and details of our intervention. applying new knowledge from the community to build strong families strong forces. our task in building the program was to integrate the diverse contributions of knowledge from the research and practice literatures, our own expertise, and most importantly, the dominant concerns of families we interviewed. the data we collected from our interview participants were replete with details about all aspects of managing one or more deployments. oef/oif families’ concerns spanned the entire deployment cycle including preparing children during the pre-deployment period, managing children’s reactions and supporting communication during the separation, and reintegrating the service member back into family life when s/he returned from theater. not surprisingly, interview participants shared that there were multiple perspectives on deployment from various family members. we worked to address all major interview themes with an emphasis on honoring each family member’s deployment experience over the course of an eight module home-based program that involved the service member, the partner, and the child(ren) under five. guided by our theoretical grounding in building reflective parenting capacities (slade, 2005) we strove to focus our program on helping parents understand the emotions, perceptions, behaviors, and needs of their very young children who were too young to share their experiences in words and to encourage the couple to engage in honest discussion about the differences in their deployment narratives. phase two: piloting strong families strong forces. throughout the first phase of our research, we continuously vetted plans with our military collaborators through an advisory board and provided feedback about implementation and findings. with substantial support for our ideas and program from phase 1 families and our collaborators, we moved forward with piloting the intervention with nine military families who had experienced at least one deployment and had a child under five. all nine families completed strong families strong forces and were given the opportunity to provide substantial and specific feedback about all aspects of the program. overwhelmingly, families felt helped by the services, comfortable with the members of our team who had met with them weekly for two months, and would recommend the program to other parents in their units. in fact, several pilot families reported that they stood up during drill weekends and at family readiness groups to share their stories of participation in our program and to encourage their fellow service members to consider enrolling. phase 1 and pilot families have consistently reported that there was no other program that they knew of, in or out of the military, which addressed the unique issues for families with young children at home. devoe, ross, paris/community-based participatory research with military 159 this last piece of information presented a particular ethical quandary for us as researchers. we had designed our study as a simple clinical trial to include a treatment group and a control group that would receive “treatment as usual.” however, it became clear to us by the end of our pilot that there was no “treatment as usual” for military families with young children in our region. because our cbpr approach demanded that we incorporate new learning about community needs into the research process, in this case the significant ethical concern of offering no services, we modified the design of our randomized trial to replace “treatment as usual” with a “waitlist control” condition with the option of receiving the program at the end of the wait period. this decision has had significant implications on budget, workload, and study scope because we have now committed to offering the program to any study family who meets eligibility criteria. the change in design was received very positively by our funders and military collaborators as we can now assure that all referred families who so desire will receive our intervention. phase three: randomized clinical trial and next steps at the time of this writing, we are conducting the randomized clinical trial to test the strong families strong forces program. on the basis of our pilot and earlier community work, we began our clinical trial with some confidence that our program was feasible and that we would find families to participate. however, we did not expect the level of interest in the program among oef/oif families and have been overwhelmed with the volume of potential participants. surprisingly, we also have not yet had any attrition from the study and had not anticipated that the vast majority of waitlist families would elect to ‘opt in’ at the end of the waiting period. though we will not be able to report on the actual effectiveness of the program from a quantitative standpoint until the completion of the trial, we suspect that success in recruitment and retention with the military population stems directly from our cbpr approach. the fact that we teamed with our military collaborators to build our program from the bottom up, that concerns shared by military families became the focus of our work, and that we were willing to bring the program to the participants are a few of the cbpr methods that have contributed to the success of our study thus far. the next significant challenge for our work, if the evidence supports the effectiveness of strong families strong forces, will be the dissemination of the program model into existing systems of care and across diverse communities where military families live. reflections on cbpr process with military partners partnering with the military, especially given our civilian status, during active war operations has presented interesting challenges and opportunities in the cbpr process. in the request for proposals, the department of defense discouraged investigators who did not already have existing partnerships with the military from attempting to establish potential collaborative relationships during the proposal preparation stage. this prohibition is unusual, in our experience, in that we could not develop recruitment and sampling strategies nor were we required to propose them until or unless we received funding. as a result, we could not begin our collaborative efforts with military partners advances in social work, spring 2012, 13(1) 160 until our proposal had been recommended for funding. although we planned specifically for time necessary to begin and consolidate community relationships, gaining approval at all relevant institutional review boards for community outreach proved challenging. a second issue unique to working with the military during active war operations is the tension between the goal of maximum involvement of oef/oif families and community collaborators in the research and intervention development process and the realities of war-time demands on our military partners. that is, we understand and respect that military and acute systems needs are necessarily the focus of our collaborators’ work. for these reasons, much of the iterative process in refining the strong families strong forces model has been based on feedback and observations from the families who have participated as opposed to genuine co-authoring of the program manual. overall, however, our work with and on behalf of oef/oif families and their young children has been supported and well-received. implications for social work research with military communities cbpr approaches, especially with military populations, require sustained commitment to community collaboration – which implies time and meaningful presence within the community. social work researchers who undertake community-based work must expect to engage in an iterative and sustained process of engaging, incorporating and honoring community partners’ perspectives and expertise into all aspects of the research enterprise. while we believe that cbpr and similar approaches to research and evaluation lead to more ecologically valid, culturally-relevant and effective interventions, there is not yet mainstream support for and recognition of this kind of work. for many academic researchers, this degree of “leg work” is disadvantageous within the narrow parameters of types of research supported because of the time required to enter a community, collect and analyze data, and publish/disseminate findings. on balance, family members and professionals who support them may feel burdened by researchers who seek knowledge and explore possible collaboration, particularly when they have experienced opportunistic or hit and run researchers in the past. furthermore, given the protracted length of time from data collection to usable information (e.g., a viable and evidence-based intervention), researchers must be mindful of the current need for immediate services that families and community providers experience. the interests of our partners may not always be well served by participating in collaborative research endeavors. financial remuneration may be one way to help ameliorate this tension, as providers are always accountable for their time in terms of dollars spent. cbpr methodology also has been criticized for its lack of rigor, number of (uncontrolled) variables, involvement of “non-experts,” the interpretation of qualitative data, and cost-effectiveness, among others. given the presence of social workers in nearly all services relevant to the care of the military community, social work researchers should be on the forefront of generating new knowledge that can be applied to the development of effective and immediately usable psychosocial and community-based prevention and intervention for oef/oif populations. few evidence-based approaches are available that address the intersecting layers of contemporary military life, family devoe, ross, paris/community-based participatory research with military 161 systems, and community ecologies in support of oef/oif families. although we are only one case, our preliminary work suggests that community-based participatory approaches may be especially promising toward achieving these goals in social work 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[journal]. zero to three, 27(6), 13-19. author’s note: address correspondence to professor ellen devoe, boston university school of social work, 264 bay state road, boston, ma 02215. e-mail: edevoe@bu.edu microsoft word 16. park et al_2953 -attitudes towards ipe copyedit_final ______________ juyoung park, ph.d, is an assistant professor, while wesley hawkins, ph.d., michele hawkins, ph.d., and elwood hamlin, ph.d., are each professors, all in the school of social work at florida atlantic university in boca raton, fl. the authors would like to acknowledge drs. ouslander and henson of the college of medicine and shirley gordon of the college of nursing, florida atlantic university, for their support in recruitment and data collection for this study. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 556-572 attitudes toward interprofessional collaboration among students in the health care professions juyoung park wesley hawkins michele hawkins elwood hamlin abstract: this study investigated differences in attitudes expressed by medical, nursing, and social work students regarding interprofessional collaboration (a) between physician and nurse, (b) between nurse and social worker, and (c) between physician and social worker. a self-administered cross-sectional survey was presented to participants online. the jefferson school of attitudes toward physician-nurse collaboration (jsapnc), a modified jsapnc, and a demographic questionnaire were completed online by 80 students from medicine, nursing, and social work. significant (p = ≤ .005) differences in attitudes toward interprofessional collaboration (ipc) were noted among social work, medical, and nursing students. attitudes toward ipc in the health care setting were generally positive, with social work and nursing students showing more positive attitudes than medical students. additional psychometric tests are required to obtain sound reliability and validity scores for the modified jsapnc. keywords: interprofessional collaboration, educational program, attitude many older adults have multiple chronic diseases that require long-term treatment and social services (tsukuda, 1990). given the numerous needs of older patients, studies have related effectiveness of interprofessional collaboration with successful patient outcomes and enhancement of the health care system (paul & peterson, 2002). specifically, interprofessional collaboration for elder care has resulted in comprehensive follow-up care (tsukuda, 1990), reduced morbidity, and reduced health care costs (hirth, baskins, & dever-bumba, 2009; jencks, williams, & coleman, 2009; leipzig, berkman, ramirez-coronado, & pignotti, 2001; robertson, 1992; tsukuda, 1990). interdisciplinary teamwork is important to the delivery of quality care (gaboury, lapierre, boon, & moher, 2011; leipzig et al., 2001). interprofessional collaboration in the health care setting is a partnership among multiple professionals to improve health care services to patients (paul & peterson, 2002). interdisciplinary teamwork has improved clinical outcomes and levels of patient satisfaction (baggs et al., 1999), as well as practitioners’ job satisfaction and retention rates (rosenstein, 2002). most significantly, patients are more likely to receive the highest quality of care as health care professionals understand each other’s roles, appreciate each other’s skills (d’amour & oandasan, 2005; hall, 2005), and work together effectively as a team (barnsteiner, disch, hall, mayor, & moore, 2007; hall & weaver, 2001). advances in social work, fall 2013, 14(2) 557 success in interprofessional collaboration is influenced by attitudes toward collaboration (hind et al., 2003; king, lee, & henneman, 1993). researchers (e.g., howe, hyer, mellor, lindeman, & luptak, 2001; leipzig et al., 2002; mackay, 2004; sommers, marton, barbaccia, & randolph, 2000) have reviewed components of interprofessional collaboration, including attitudes toward interprofessional practice. mackay (2004) suggested that the attitudes of professionals from one discipline influence how they perceive and behave toward professionals from other disciplines. collaborative practice may decrease hospitalization and readmission rates and improve health care for older adults with chronic illness (sommers et al., 2000). in particular, hospital readmissions were most frequently decreased when nurses, social workers, and physicians were satisfied with their interprofessional relationships on the care team (leipzig et al., 2002). however, physicians, nurses, and social workers have not been adequately trained to collaborate on health care teams for treating patients (howe et al., 2001; hyer, 1998). also, despite its identified importance in the health care setting, students’ attitudes toward interprofessional collaboration and the significance of education of health professionals have not been clearly explored (skinner, 2001). interprofessional education (ipe) has been designed to prepare students to collaborate in order to provide safe and high-quality services to older adults (goldberg, koontz, rogers, & brickell, 2012). previous research has demonstrated that students’ exposure to ipe generally results in positive outcomes, in particular their responses to ipe and improvement in knowledge and skills (hammick, freeth, koppel, reeves, & barr, 2007). leipzig and colleagues (2002) reported that students from health care professions exhibited diverse attitudes toward ipe in geriatric care; among students in medicine, nursing, and social work, medical students demonstrated the least positive attitude. a majority of the students reported that the interprofessional team approach benefits patients; however, internal medicine and family practice residents consistently rated collaboration lower than did advance practice nursing and master’s-level social work students. interprofessional difference was greatest for beliefs about the physician’s role; 73% of residents, 44% of nurse practitioner trainees, and 47% of master of social work students agreed that a team’s purpose was to assist physicians in achieving treatment goals for patients (leipzig et al., 2002). in a pilot program for medical and nursing students measuring medical students’ perceptions of the nurse’s role, medical students were less convinced of the importance of the training program than were nursing students (croen, hamerman, & goetzel, 1984). despite increasing research on students’ attitudes toward collaboration between nurse and physician (baggs et al., 1999; carpenter, 1995; hojat et al., 1999; reeves & pryce, 1998), little is known about students’ attitudes toward interprofessional collaboration in programs among physicians, nurses, and social workers or other health care providers on the health care team (leipzig et al., 2002). there is a need for increased emphasis on interprofessional collaboration by health care providers in their educational programs (barnsteiner et al., 2007; hojat et al., 2001; leipzig et al., 2002). it has been established that students need appropriate programs of collaboration, and educators have been encouraged to develop interprofessional training sessions as a part of a curriculum to promote interprofessional collaboration (hojat et al., young, hawkins, hawkins, hamlin/interprofessional collaboration 558 2001). however, there have been few opportunities to bring educators and students together in programs from multiple professions for the purpose of learning about each other’s roles and practicing collaborative teamwork (barnsteiner et al., 2007). interprofessional education ipe has been advocated as a way to improve communication and collaboration among professionals in health care (institute of medicine, 2001). ipe enhances students’ understanding of other professionals’ roles and responsibilities while fostering mutual respect and understanding among members of the health care team (freeth, hammick, reeves, koppel, & barr, 2005). in order to develop interprofessional learning curricula and provide adequate experiences and skills for students before they work in the health care setting, it is important to understand students’ attitudes toward interprofessional collaboration (freeth et al., 2005; institute of medicine, 2001). four competency domains the influence of the interprofessional collaboration (ipc) model presented by the interprofessional education collaborative expert panel (iecep, 2011) on patient outcomes has been identified. collaboration requires mutual respect for each other’s professional roles. the iecep identified four competency domains: (a) values and ethics for interprofessional practice, (b) roles and responsibilities for collaborative practice, (c) interprofessional communication practice, and (d) interprofessional teamwork and teambased practice. first, the domain of values and ethnics implies respect for the patient’s dignity and privacy, as well as confidentiality in the delivery of team-based care. second, the domain of roles and responsibilities refers to understanding other health care providers’ roles and responsibilities and how the team can work effectively to provide the best care. third, the domain of interprofessional communication involves choosing effective communication tools and techniques and facilitating discussion and interactions that improve teamwork. fourth, the domain of interprofessional teamwork and teambased practice involves leadership practices that consider professional authority and autonomy and improvement strategies for collaborative practice and team effectiveness (iecep, 2011). to function interdependently, professionals from these diverse areas should understand the distinction between their own and their collaborating professionals’ role and fulfill them appropriately (goldberg et al., 2012). study purpose and research question although the terms interdisciplinary and interprofessional were used interchangeably in many peer-reviewed articles (goldberg et al., 2012), this study uses the term interprofessional collaboration because nursing, social work, and medicine are considered to be professions as well as disciplines, with greater emphasis on profession than discipline. the purpose of the current study was to measure and compare attitudes expressed by social work, medical, and nursing students toward interprofessional collaboration. the research question was: is there a difference in attitude among students of medicine, nursing, and social work toward interprofessional collaboration (a) between advances in social work, fall 2013, 14(2) 559 social worker and physician, (b) between physician and nurse, and (c) between social worker and nurse? methods study design and procedure after obtaining approval by the institutional review board (irb) of the target university, surveymonkey™ (surveymonkey, inc., 2010), an online survey tool, was used to administer an internet-based, self-administered questionnaire. an email was sent to 251 students (64 medicine, 137 nursing, and 50 social work) who were planning to attend the university’s ipe program in order to invite their participation in the study by responding to the survey. the email included an invitation to complete the survey and a consent form that contained the title of the study and descriptions of the purpose of the study, its voluntary nature, study procedures, risks and benefits of study participation, and confidentiality of collected data. students who agreed to participate in the study were directed to the surveymonkey site and asked to complete a consent form and the survey. participants were informed that they could decline to complete the survey with no adverse consequences. among a total of 251 students, 80 completed the survey, which contained demographic items, the jefferson school of attitudes toward physician-nurse collaboration (jsapnc), a modified version of the jsapnc, and the aging semantic differential (asd). however, since this paper focuses on interprofessional collaboration, the data from the asd were not included in analysis. participants participants met two inclusion criteria: (a) full-time student in the target university’s school of social work, college of medicine, or college of nursing; (b) participation in the university’s ipc seminars and senior aging and geriatric educator (sage) mentoring program. data collection the jsapnc was originally developed to measure attitudes toward nurses and nursing services (hojat & herman, 1985). the original scale, with 20 items, was modified to investigate attitudes toward physician-nurse alliances (hojat et al., 1999). five of the original 20 items did not have a significant factor coefficient (hojat et al., 1999). therefore, the final version of jsapnc, with 15 items answered on a 4-point likert-type scale (4 = strongly agree to, 3 = agree, 2 = disagree, 1 = strongly disagree) was used in the current study (table 1). two items (items 14 and 15) are a reflection of a negative attitude toward physician-nurse collaboration and were reverse scored (1 = strongly agree, 2 = agree, 3 = disagree, 4 = strongly disagree; hojat et al., 1999). a total score was calculated for the 15 items and attitudes toward collaboration were reflected by the total score on the jsapnc (range 15 to 60), with higher scores indicating a more positive attitude. the 15 items addressed four constructs (subscales): (a) shared young, hawkins, hawkins, hamlin/interprofessional collaboration 560 educational and collaborative relationships, (b) caring as opposed to curing, (c) nurse’s autonomy, and (d) physician’s authority (hojat et al., 1999). reliability coefficients for this 15-item (modified) scale were .84 and .85 (hojat et al., 1999). in the current study the modified version of the 15-item scale and the original 15-item jsapnc were used: (a) physician-nurse collaboration (original scale), (b) physician-social worker collaboration (modified version 1), and (c) social worker-nurse collaboration (modified version 2). for example, in the modified version for physician-social worker collaboration the term nurse in the original jsapnc was replaced by the term social worker, in the modified version for social worker-nurse collaboration the term nurse in the original jsapnc was replaced by the term social worker, and the term physician in the original jsapnc was replaced by the term nurse (table 1). reliability of the jsapnc, the modified jsapnc (version 1, physician/social worker), and the modified jsapnc (version 2, social worker/nurse) was calculated; the cronbach’s alpha of the jsapnc was .80 and the modified version of the jsapnc (social worker/nurse) was .90, and the modified version of the jsapnc (physician/social worker) was .91. data analysis descriptive statistics consisted of means (m) and standard deviations (sd) for continuous variables (e.g., age) and frequencies for other demographic categorical variables (gender, ethnicity/race, education, religion, work experience, experience with older adults). one-way between-groups analysis of variance (anova) was performed to compare the students’ attitude toward interprofessional collaboration, as measured by the jsapnc and the modified jsapnc. participants were divided into three groups according to profession (group 1 = medicine, group 2 = nursing, group 3 = social work). results sample demographic characteristics of the 80 participants, 45% (n = 36) were medical students, 28% (n = 22) were nursing students, and 28% (n = 22) were social work students. the nursing students’ response rate (16%) was significantly lower than that for medical students (56%) or social work students (44%). the participants ranged in age from 20 to 59 years, with a mean age of 29 years (sd = 9.95). the majority of the students were women (70%, n = 56). among the 80 participants, over two thirds (70%, n = 56) reported as caucasian/white. the highest proportion of minority students was hispanic (15%; n =12); 8% (n = 6) were asian or pacific islander, 4% (n = 3) were african american, 3% (n = 2) identified with another ethnic group, and 1% (n = 1) did not report an ethnic group. among 251 students who attended the ipc seminars and the sage mentoring program, 80 completed the survey (32% response rate) by providing demographic information, and responded to the survey items. regarding the highest level of education, 84% (n = 67) were college graduates, 12% (n = 10) had earned a graduate degree, and 4% (n = 4) had completed only high school. almost two thirds (64%, n = 51) of the students reported full-time work experience and 58% (n = 46) reported volunteer experience with advances in social work, fall 2013, 14(2) 561 older adults. in addition, 49% (n = 39) reported that they had spent extensive time with older relatives. sample characteristics of each profession are presented in table 2. table 1. original and two modified versions of the jefferson school of attitudes toward physician-nurse collaboration (jsapnc) administered in this study original version: physician-nurse components items (a) shared educational and collaborative relationships (7 items) 1. during their education, medical and nursing students should be involved in teamwork in order to understand their respective roles. 2. interprofessional relationships between physicians and nurses should be included in their educational programs. 3. a nurse should be viewed as a collaborator and colleague with a physician rather than his/her assistant. 4. there are many overlapping areas of responsibility between physicians and nurses. 5. physicians should be educated to establish collaborative relationships with nurse. 6. physicians and nurses should contribute to decisions regarding the hospital discharge of patients. 7. nurses should also have responsibility for monitoring the effects of medical treatment. (b) caring as opposed to curing (3 items) 8. nurses are qualified to assess and respond to psychological aspects of patient's needs. 9. nurses should be involved in making policy decisions affecting their working conditions. 10. nurses have special expertise in patient education and psychological counseling. (c) nurse’s autonomy (3 items) 11. nurses should clarify a physician's order when they feel that it might have the potential for detrimental effects on the patient. 12. nurses should be involved in making policy decisions concerning the hospital support services upon which their work depends. 13. nurses should be accountable to patients for the nursing care they provide. (d) physician’s authority (2 items) 14. the primary function of the nurse is to carry out the physician's orders.a 15. doctors should be the dominant authority in all health care matters.a young, hawkins, hawkins, hamlin/interprofessional collaboration 562 table 1. (continued) modified version 1: physician-social worker components items (a) shared educational and collaborative relationships (7 items) 1. during their education, medical and social work students should be involved in teamwork in order to understand their respective roles. 2. interprofessional relationships between physicians and social workers should be included in their educational programs. 3. a social worker should be viewed as a collaborator and colleague with a physician rather than his/her assistant. 4. there are many overlapping areas of responsibility between social workers and nurses. 5. physicians should be educated to establish collaborative relationships with social workers. 6. physicians and social workers should contribute to decisions regarding the hospital discharge of patients. 7. social workers should also have responsibility for monitoring the effects of medical treatment. (b) caring as opposed to curing (3 items) 8. social workers are qualified to assess and respond to psychological aspects of patient's needs. 9. social workers should be involved in making policy decisions affecting their working conditions. 10. social workers have special expertise in patient education and psychological counseling. (c) social worker’s autonomy (3 items) 11. social workers should clarify a physician's order when they feel that it might have the potential for detrimental effects on the patient. 12. social workers should be involved in making policy decisions concerning the hospital support services upon which their work depends. 13. social workers should be accountable to patients for the nursing care they provide.  (d) physician’s authority (2 items) 14. the primary function of the social worker is to carry out the physician's orders.a 15. doctors should be the dominant authority in all health care matters.a  advances in social work, fall 2013, 14(2) 563 table 1. (continued) modified version 2: social worker-nurse components items (a) shared educational and collaborative relationships (7 items) 1. during their education, nursing and social work students should be involved in teamwork in order to understand their respective roles. 2. interprofessional relationships between nurses and social workers should be included in their educational programs. 3. social workers should be viewed as a collaborator and colleague with a nurse rather than his/her assistant. 4. there are many overlapping areas of responsibility between social workers and nurses. 5. nurses should be educated to establish collaborative relationships with social workers. 6. nurses and social workers should contribute to decisions regarding the hospital discharge of patients. 7. social workers should also have responsibility for monitoring the effects of medical treatment.   (b) caring as opposed to curing (3 items) 8. social workers are qualified to assess and respond to psychological aspects of patient's needs. 9. social workers should be involved in making policy decisions affecting their working conditions. 10. social workers have special expertise in patient education and psychological counseling. (c) social worker’s autonomy (3 items) 11. social workers should clarify a physician's order when they feel that it might have the potential for detrimental effects on the patient. 12. social workers should be involved in making policy decisions concerning the hospital support services upon which their work depends. 13. social workers should be accountable to patients for the nursing care they provide. (d) nurse’s authority (2 items) 14. the primary function of the social work is to carry out the nurse’s orders.a 15. nurses should be the dominant authority in all health care matters.a aresponses were reversed scored. young, hawkins, hawkins, hamlin/interprofessional collaboration 564 table 2. demographic characteristics by profession (n = 80) characteristic medical students (n = 36) nursing students (n = 22) social work students (n = 22) n (%) n (%) n (%) gender male female 20 (55.6) 16 (44.4) 1 (04.5) 21 (95.5) 3 (13.6) 19 (86.4) race/ethnicity african american caucasian/white hispanic/latino asian/pacific islander other missing 1 (02.8) 25 (69.4) 3 (08.3) 5 (13.9) 1 (02.8) 1 (02.8) 1 (04.5) 13 (59.1) 6 (27.3) 1 (04.5) 1 (04.5) 0 (00.0) 1 (04.5) 18 (81.8) 3 (13.6) 0 (00.0) 0 (00.0) 0 (00.0) highest education high school graduate only college graduate graduate degree 31 (86.1) 5 (13.9) 0 (00.0) 3 (13.6) 17 (77.3) 2 (09.1) 0 (00.0) 19 (86.4) 3 (13.6) item and subscale analyses in the item physicians should be educated to establish collaborative relationships with nurse, in the subscale of shared educational and collaborative relationship, 78% (n = 62) of the 80 respondents strongly agreed. in particular, 64% (n = 23) of the medical students strongly agreed, indicating that more education is needed among physicians to establish collaboration relationships with nurses. in the modified version of the jsapnc (physician-social worker), 36% (n = 13) of the medical students strongly agreed with the item physicians should be educated to establish collaborative relationships with social worker. in contrast, 91% (n = 20) of the social work students strongly agreed with the item. in terms of an educational program, 58% (n = 21) of the medical students strongly agreed with the item interprofessional relationships between nurses and social workers should be included in their educational programs and more nursing students (73%, n = 16) strongly agreed with the item. in the modified version of the jsapnc (physiciansocial worker), only 33 % (n = 12) of the medical students strongly agreed with the item interprofessional relationships between physicians and social workers should be included in their educational programs and 68% (n = 15) of the social work students agreed with this item. regarding the item social workers should be involved in making policy decisions concerning the hospital support services upon which their work depends in the subscale of caring as opposed to curing, only 17% (n = 6) of the medical students strongly agreed with the item, whereas 73% (n = 16) of the social work students strongly agreed with it. advances in social work, fall 2013, 14(2) 565 for the jsapnc item doctors should be the dominant authority in all health care matters, 55% (n = 44) strongly agreed or agreed and 36% (n = 29) strongly disagreed or disagreed. in particular, 75% (n = 27) of the medical students strongly agreed or agreed while 6% (n = 2) disagreed regarding the doctor’s dominant authority. on the other hand, 86% (n = 19) of the nursing students strongly disagreed or disagreed with the item regarding the doctor’s dominant authority. in addition, 64% (n = 14) of the social work students agreed regarding the doctor’s authority in all health care matters. on the subscale of physician’s authority in physician/nurse collaboration, 36% (n = 13) of the medical students agreed that the primary function of the nurse is to carry out the physician’s orders, but 86% (n = 19) of the nursing students disagreed or strongly disagreed with the item. in the subscale of physician’s authority in the physician-social worker collaboration, 17% (n = 6) of the medical students agreed that the social worker’s primary function is to carry out the physician’s orders, while 91% (n = 20) of the social work students disagreed or strongly disagreed with the item. one-way between-groups anova in order to examine which professional students showed significant differences in mean scores on interprofessional collaboration (physician-nurse, nurse-social worker, or physician-social worker), one-way between-groups anova was conducted. social work and nursing students showed the most positive attitudes toward these interprofessional collaborations. tables 3a, 3b, and 3c show frequencies, m, sd, f, and p levels for medical, nursing, and social work students’ attitudes toward interprofessional collaboration as measured by the jsapnc and the modified jsapnc. comparisons by profession showed that nursing and social work students had significantly higher average scores on the jsapnc and modified jsapnc than medical students. significant difference between medical, nursing, and social work students regarding attitudes toward physician-nurse collaboration was observed at p = ≤ .005, f [2. 68] = 9.757, df = 2 (see table 3a). compared with social work students (m = 51, sd = 3.8) and nursing students (m = 53, sd = 4.3), medical students scored lower (m =48, sd = 4.1) on attitude toward physician-nurse collaboration. this result indicates that medical students had a less positive attitude toward physician-nurse collaborative relationships than did social work and nursing students. table 3b presents results regarding attitudes toward nurse-social worker collaboration (the modified jsapnc). a statistically significant difference in mean scores among groups was identified (p = ≤ .005, f(2, 64) = 10.813, df = 2). social work students (m = 54, sd = 3.6) showed a more positive attitude toward nurse-social worker collaboration than did nursing students (m = 51, sd = 6.7) or medical students (m = 47, sd = 5.6). regarding attitudes toward physician-social worker collaboration, table 3c shows a statistically significant difference in scores (the modified jsapnc) among the three groups (p = ≤ .005, f(2, 63) = 26.631, df = 2). nursing students (m = 54, sd = 3.6) had slightly higher scores in collaboration than social work students (m = 53, sd = 4.5) and significantly higher scores than medical students (m = 45, sd = 5.9). nursing students young, hawkins, hawkins, hamlin/interprofessional collaboration 566 showed more positive attitudes toward physician-social worker collaboration even though the nurse was not included in that relationship. table 3a. means, sd, df, f, and p for collaborations between physicians and nurses collaboration, students, item mean sd df f p physician-nurse 2 9.757 < .005 medical students (total) 48.0 4.1 shared education/collaborative relationships 24.0 caring/curing 8.7 nurse autonomy 10.7 physician authority 4.6 nursing students (total) 53.0 4.3 shared education/collaborative relationships 25.4 caring/curing 9.1 nurse autonomy 12.0 physician authority 6.3 social work students (total) 51.0 3.8 shared education/collaborative relationships 25.7 caring/curing 8.9 nurse autonomy 11.0 physician authority 5.6 table 3b. means, sd, df, f, and p for collaborations between nurses and social workers collaboration, students, item mean sd df f p nurse-social worker 2 10.813 < .005 medical students (total) 47.0 5.6 shared education/collaborative relationships 22.0 caring/curing 9.6 social worker autonomy 10.0 nurse authority 5.0 nursing students (total) 51.0 6.7 shared education/collaborative relationships 23.0 caring/curing 10.0 social worker autonomy 11.5 nurse authority 6.4 social work students (total) 54.0 3.6 shared education/collaborative relationships 25.8 caring/curing 11.0 social worker autonomy 6.4 nurse authority 11.0 advances in social work, fall 2013, 14(2) 567 table 3c. means, sd, df, f, and p for collaborations between physicians and social workers collaboration, students, item mean sd df f p physician-social worker 2 26.631 < .005 medical students (total) 45.0 5.9 shared education/collaborative relationships 21.0 caring/curing 9.5 social worker autonomy 9.7 physician authority 4.6 nursing students (total) 54.0 3.6 shared education/collaborative relationships 25.1 caring/curing 11.0 social worker autonomy 11.0 physician authority 6.4 social work students (total) 53.0 4.5 shared education/collaborative relationships 25.0 caring/curing 11.0 social worker autonomy 11.0 physician authority 6.0 discussion overall findings from this pilot study are congruent with those from previous studies (e.g., hojat et al., 2001; leipzig et al., 2002; ward et al., 2008), indicating that attitudes toward collaboration are generally positive among students from medicine, nursing, and social work. when compared to nursing and social work students, medical students were less positive toward interprofessional collaboration in all three combinations. nursing and social work student students had the most positive attitudes, with similar scores. specifically, nursing students had the most positive attitude regarding nurse-physician collaboration and social work students had the most positive attitude toward nursingsocial work collaboration. it is interesting that nursing students showed the most positive attitude toward physician-social work collaboration although though nurses were not included in the item. there are possible reasons that social work students earned positive scores on the interprofessional collaboration; it is plausible that social work education emphasizes the importance of inteprofessional collaboration approaches, as indicated in the national association of social workers code of ethics (nasw, 2008): “professional and ethical obligations of the interdisciplinary team as a whole and of its individual members should be clearly established.” second, social work students are trained to work in group projects in class and reach decisions as a group. this team approach is central to interprofessional collaboration. in terms of physician and social worker collaboration, only one third of the medical students (36%) strongly agreed with the item physicians should be educated to establish collaborative relationships with social worker. on the other hand, almost twice as many young, hawkins, hawkins, hamlin/interprofessional collaboration 568 medical students (64 %) agreed with the physician/nurse collaboration, physicians should be educated to establish collaborative relationships with nurse. the findings may indicate that the medical students were less enthusiastic about collaborating with social workers than with nurses. it is also possible that physicians work more closely with nurses than with social workers and that more emphasis is placed on physician-nurse collaboration than on physician-social worker collaboration in the health care setting. it has been demonstrated that increasing discrepancies between physicians’ and nurses/social workers’ attitudes may contribute to increasing levels of conflicts in health care settings by the interdisciplinary care team (leipzig et al., 2002). although a large number of medical students strongly agreed with items describing collaborative relationship, they were less positive than social work or nursing students about adding interprofessional relationships to their education programs. most of all, an educational program for medical students would help them to understand why interprofessional collaboration is important and to learn about other health care professionals’ values and roles in the health care team to increase competence in collaboration. there has been little research on attitudes toward collaboration between nurses and social workers and between physicians and social workers. the current study expanded this research by adding social workers in the collaborative relationships in the health care setting. this may lead to an increase in interprofessional learning opportunities and curricula to promote ipe. clearly, there should be more research on collaboration between social workers and other health care professionals as members of the health care team. the study findings indicate that medical students’ attitudes toward physician authority and leadership were more positive than those of nursing and social work students, who were less inclined to agree with that leadership principle. however, medical students were less positively inclined toward the nurse’s or social worker’s autonomy and their involvement in policy decisions concerning hospital supportive services than were nursing or social work students. given the current emphasis on improving collaborations among health professionals and study findings of attitudes among students, it is important to develop effective education programs to improve interprofessional relationships. limitations and implications the current study’s findings should be understood in light of several methodological limitations. a relatively small number of students participated in the survey study. the online survey may have been ignored by students who skipped the email, resulting in a relatively low response rate. email-distributed surveys have produced considerably lower rates of return than mail surveys and in-person surveys (truell, bartlett, & alexander, 2002). the small sample size imposed limits on the external validity (generalization) of the results. further studies, especially prospective and longitudinal projects, are needed to explore whether interprofessional education programs can improve attitudes toward interprofessional collaboration among students in health care fields. advances in social work, fall 2013, 14(2) 569 modified versions of the jsapnc were used; reliabilities of these instruments were good in the current study. although the reliability (cronbach’s alpha) of each version of the jsapnc was calculated, we did not establish face and content validities of the instruments. while the original jefferson survey is a psychometrically sound tool, with good construct validity and internal consistency reliability (hojat et al., 1999), use of the modified versions of the jsapnc was exploratory and additional psychometric tests are required to obtain sound reliability and 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(2008). the jefferson scale of attitudes toward physician-nurse collaboration: a study with undergraduate nursing students. journal of interprofessional care, 22, 375-386. doi:10.1080/13561820802190533 young, hawkins, hawkins, hamlin/interprofessional collaboration 572 author note: address correspondence to: juyoung park, ph.d., assistant professor, florida atlantic university school of social work, 777 glades road, social science building, room so # 319, boca raton, fl 33431-0900. email: jpark14@fau.edu microsoft word deka copyedit2 ______________ ankita deka, msw, ph.d., is an assistant professor in the department of social work at augsburg college in minneapolis, mn. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 471-483 local and global poverty: insights using a rights-based approach ankita deka abstract: social workers have proposed various conceptual models to explain the relationship between structural oppressions and poverty. these models are grounded in critical social work and each provides an understanding of how systemic issues impact the sustenance and reinforcement of poverty. with rapid economic globalization and further social and economic exclusion faced by people, poverty has become even more deep and complex. this paper argues for the adoption of a rights-based framework in social work to address issues of endemic structural poverty. grounded on the principle of the inalienability of basic human rights, the rights-based approach changes the discourse on poverty by creating accountability, equality, transparency and participation from welfare states and civil society. the paper also provides a critique against traditional human rights perspectives in poverty alleviation. the paper provides a context in which the rights-based approach could be pursued in global as well as local contexts. keywords: poverty, rights-based approach, social exclusion, human rights in the last few decades, social work professionals have used various conceptual and theoretical approaches in understanding and addressing global and local poverty as it relates to social inequities and structural injustice (krumer-nevo, 2008; weiss, 2003). many of these approaches have their roots in critical perspectives which allow practitioners to develop anti-oppressive practices that challenge the historical and contemporary subordination of marginalized groups (morley, 2008). given the tenuous relationship of neoliberalism and capitalism with the role of the welfare state, it has become fairly apparent that social services for the most marginalized have become an unnecessary victim. in the context of this volatile body politic, social work educators, practitioners and researchers have to facilitate strategies for change that can counter the marginalizing effects of poverty both in the local and global sphere. the purpose of this paper is to propose a conceptual framework based on the rights-based approach that will be able to integrate critical social pedagogies even as it advocates for the restoration of the inalienable rights of individuals and groups who are most vulnerable in society. this approach has been used in countries of the global south with marginalized populations; however this approach is somewhat new to the anti-poverty interventions in social work in the united states. the paper also argues against the more conservative rights-based approaches applied in social work that uses the notion of rights and obligations as a dualistic, reciprocal function. rights-based approach a rights-based approach to address poverty in social work would imply the focus and attention on the attainment of a human life with respect and dignity for those that face much vulnerability in society as an outcome of being poor. in the development literature where this approach has been widely used, the approach is multi-thronged with advances in social work, summer 2012, 13(2) 472 implications for legal, socioeconomic and political rights (insightshare, 2011). historically, the rights-based approach was used by development organizations because the earlier models of delivery of goods and services by the welfare state to address systemic problems of poverty and marginalization was deemed unsuccessful on various fronts (offenheiser & holcombe, 2003). research has also indicated that over reliance on the market forces to ‘lift all boats” when it comes to poverty alleviation has not been particularly successful either. studies suggest that in most countries the chasm between the rich and the poor is ever widening, and many groups are unable to make it out of the poverty traps (nambissan, 2010). therefore, given that the shrinking welfare state is much less accountable to deliver for the poor and the marginalized, and where marketfriendly policies are creating wealth concentration in the hands of few, poverty alleviation is best approached from the rights-based perspective. essentially, the rightsbased approach re-conceptualizes our understanding about poverty by elaborating a fundamental difference in our understanding of the ‘poor as helpless victims’. it explains poverty as an outcome of social exclusion and marginalization and envisions that the poor are stakeholders who are capable of shaping their destiny. therefore the poor are no longer perceived as vulnerable citizens who merely need public goods and services to alleviate their suffering, but they are stakeholders who challenge the fundamentals of how resources and goods are allocated and distributed in society. the rights-based approaches have been used and understood in many different ways in the development literature with some of the fundamental principles of this perspective including; participation, accountability, equality and non-discrimination, transparency, and empowerment (gready, 2008). rights-based approaches have their root in the fundamentals of human rights perspectives that address issues of inalienable political, economic, legal and social rights for those that are disenfranchised in the society. however, it is widely acknowledged that the human rights perspective in general has been unable to address poverty and pro-poor policy related issues for a very long time (gready, 2008). for example, poverty related issues were not central to the human rights discussion early on mainly because of the over emphasis on civil and political rights for most of the 20th century (lauren, 1998). even in countries of the global north humans rights perspectives frequently sidelined the emphasis on economic, social and cultural rights (frediani, 2010). the main reason that was argued against inclusion of these rights was that they were not enforceable by law. therefore, the centrality of human rights approaches were often based on the workings of the legal systems, implying the precedence of rights that could ultimately be enforced through legislation. in the late 20th century and early 21st century, rights-based approaches have been able to broaden their scope of addressing issues of social disenfranchisement. gready (2008) says that in the post globalization era, various stakeholders such as non-governmental organizations, civil society organizations were able to argue for a more comprehensive set of rights. these rights focused on the “indivisibility of civil–political and economic– social rights, process and outcomes, engagement on multiple levels from the local to the global, top-down and bottom–up approaches, public and private spheres, individual and collective rights, service delivery or emergency responses, and structural change” (gready, 2008, p. 736). these complex set of rights have provided opportunities for deka/rights-based approach to poverty 473 various stakeholders to engage in interventions that helps establish a more concrete approach to poverty, which can challenge systematic structural barriers that impact the lives of those living in poverty. rights-based approaches are based on a shift from a technical understanding of rights to a politically motivated understanding which is premised on three key components: that individuals have rights, the state or government is obliged to safeguard those rights, and people need to participate for the attainment of those rights (eyben, 2005). amartya sen’s critical work on the relationship between poverty and human rights has also influenced the development of the rights-based approaches. sen (1999) puts a new emphasis on the relationship between entitlements, opportunities, freedoms and poverty (eyben, 2005). he suggests that ‘functioning and capabilities’ which also refer to achievements and access to resources and goods in society are crucial components in explaining well being of individuals (frediani, 2010). the capabilities approach of amartya sen informs the rights-based approach in several ways. first it allows for the non-utilitarian understanding of poverty as a mere outcome of material deprivation. second it can provide the framework for expansion of freedoms for those who are deprived, and those other actors such as the state needs to play a pro-active role to facilitate the enhancement of freedoms (frediani, 2010). the rights-based approach is a viable strategy for addressing poverty as it supports the notion of universality that all human beings share a common humanity that needs to be realized irrespective of their national origin, gender, ability, religion, racial ethnic identity or culture. however, this tenet of universality does not strip away the fact that all rights are rooted in the context of being; therefore rights are essentially local in nature. ife and fiske (2006) have further developed the idea of localization of universal rights by stating that although most universal rights have been widely critiqued for their over dependence on western philosophical tradition, while the universality of rights does not necessarily imply a homogenizing effect. they argue that the moral humanity associated with the concept of rights does not mean sameness where every individual needs to fit a certain normative ascription of the attainment of rights (ife & fiske, 2006). the rights-based approach is consistent with social values and ethics, the social work profession is committed to the idea of creating equity and justice for individuals and groups that are at the margins of society. the inclusion of rights decenters the mainstream debate on poverty where poverty is seen as an outcome of individual pathologies rather than as an outcome of exclusionary social structures. the rights-based approach also allows us to explore that poverty also co-exists with other forms of social oppression such as racism, sexism, ableism, and ageism (davis & wainwright, 2005). the fight against poverty therefore is clearly a political strife that looks into historical and contemporary forces that perpetuate, reinforce and sustain social inequities. in that sense the rights-based approach is premised on the belief that it is a counter to top-down policies and programs that have attempted to alleviate poverty without taking into context the lived experiences of those living in poverty. this paper argues that a rights-based approach has to be understood as a critical social intervention against poverty that uses a bottom up strategy with stakeholders. this approach allows for room to explore the advances in social work, summer 2012, 13(2) 474 intersectionalities of structural oppressions and how they create advantages for few and lack of privileges for others. exploration of poverty discourse in social work the professionalization of social work has simultaneously led to more focus of the discipline on systems and processes of social exclusion (davis & wainwright, 2005). since its inception the late 19th century social workers have been interested in issues related to the poor (krumer-nevo, weiss-gal, & monnickendam, 2009). the professional code of ethics also clearly outlines the commitment of the profession in addressing poverty (national association for social workers, 2000). at the international level social workers are committed to addressing issues related to poverty and social justice. much of this commitment is seen as a response to the growing number of poor within countries, and also the country to country differences when it comes to poverty rates (krumer-nevo, et al., 2009). the market friendly policies and structural adjustment programs initiated in the last two decades in countries of the global south have also created significant hardships for the poor within countries (nambissan, 2010). conceptualizing and measuring poverty is also considerably difficult as different institutions and entities have varying interpretations of poverty. most definitions of poverty are expert driven, and have very little perspective from the poor themselves (serr, 2004). poverty is usually defined in terms of absolute and relative terms; absolute poverty refers to lack of sufficient income for basic needs and relative poverty refers to poverty in relation to income levels of others in the society (serr, 2004). the global poverty rate, or percentage of people living under less than $1.25 a day has declined, absolute poverty rates have remained steady (woolcock, 2008). the regional differences both within and outside the countries however have a huge influence in the interpretation of this data. while china and india have experienced the decline of poverty in both relative and absolute terms, very little has changed in latin america, and africa continues to have high numbers of people experiencing absolute poverty (woolcock, 2008). in the united states, in the post recession period from 2007-2008, about 47 million people lived below the government defined poverty line (abramsky, 2012). within these figures, there are huge disparities by race as well; while a quarter of blacks and latinos live under the government defined poverty estimates, about 12% of asian-americans and less than 10% of whites live under the poverty line (abramsky, 2012). poverty continues to pose a serious threat to populations living both in the united states and other parts of the world. around the world social work professionals continue to interface poverty through their clients, since significant number of social work clients even when they have other overt problems also experience poverty (healy, 2008). social work literature on poverty related issues often takes a critical view of individualized interventions and models of practice that are incapable of explaining the structural issues and their causal relation with poverty (krumer-nevo, et al., 2009). poverty interventions in social work in the united states is not altogether new, the 19th century charity organizing societies (cos) and settlement house (ch) movements deka/rights-based approach to poverty 475 are some of the earliest known organized efforts to address poverty within the profession. the two approaches differed in outlook on poverty, with the cos focusing on the pathology of individuals experiencing poverty and how aid from the state could create long term dependency (weiss, 2003). the shm focused on understanding how structural issues created challenges for an individual to achieve their full potential including their material and financial well-being. modern casework largely evolved from the cos orientation that put emphasis on orienting an individual to the environment by improving their psychological health (weiss, 2003). on the other hand shm significantly influenced the development of advocacy and activist strategies that critically examines the role of the state and other agencies in the financial deprivation and marginalization of certain groups (abramovitz, 1998; weiss, 2003). contemporary social work practice on poverty alleviation is clearly influenced by the historical ideological orientations. neo-conservative values and assumptions within social work challenge individuals facing poverty to take personal accountability of their condition; they advocate that the welfare state should restrict its role of service delivery and should allow the market to provide opportunities for all (weiss, 2003). radical social workers have critiqued the over-emphasis on the psycho-pathology of individuals living in poverty and have instead advocated for state level interventions through policies and programs to address systemic and structural causes of poverty. social work practice is heavily influenced by values, assumptions and ideologies; therefore it is not surprising that the literature is ripe with varying approaches and orientations toward issues related to poverty. the long standing tension between individual versus structural causes of poverty is often blurred by the normative assumptions of social workers. international literature on poverty has also enlisted the idea of poverty as a process of social exclusion, whereby individuals are denied access to full participation in civil society, which restricts their ability to seek and benefit from social, economic and cultural goods (davis & wainwright, 2005). the concept of social exclusion takes into account the various factors such as age, race, gender and ability, it also throws light on the compounding effect of exclusions and how it creates economic and social vulnerability (becker, 2002). poverty as social exclusion paradigm was popularized in britain because of growing social inequities that could not merely be attributed to income disparity, hence a more holistic approach of understanding poverty as the loss of dynamic access to individual, social, cultural and political goods was later developed (barry & hallett, 1998). poverty research in recent years has also shifted its vision to include the lived experiences of those living in poverty in the centre stage of poverty discourse. this perspective alters the traditional understanding of viewing the poor as lacking any legitimate understanding and input on the conditions that impact their lives (krumernevo, 2008). economic globalization in recent years discourses related to the impact of economic globalization and its impact on the vulnerable populations, particularly the poor have received much attention. neo-liberal policies and structural adjustment programs introduced in countries of the global south have had profound influence on national policies, particularly on pro-poor advances in social work, summer 2012, 13(2) 476 policies (triegaardt, 2008). economic globalization has allowed for the capital mobility and the proliferation of capitalist growth, while the poorest people on the planet have been adversely affected by the fallouts of globalization such as low paying jobs, loss of social safety nets, and loss of sources of livelihoods (dominelli, 2010). as a phenomenon, globalization has been described in various ways such as the integration of global economies, social and cultural transactions, transference of western individualistic values around the world and the likes. economic globalization has resulted in the nation states cutting back on subsidies and assistance to the poor. in south africa, for example, the poor have mobilized to demand access to basic services such as housing, sanitation and water (ballard, habib, & valodia, 2006). globalization has transformed the modernist idea of a welfare state as a proactive agent in the development and enforcement of social welfare policies (ahmadi, 2003). globalization has created a shift in roles, where international relief and aid agencies are taking over the role of nation states in addressing problems of endemic poverty (jordan, 2008). social workers in many countries of the global south are highly critical of anti-poverty programs fostered in conjunction with economic liberalization. their main contention is that globalization intensifies the economic and social disparities between groups, particularly between those who hold privilege in society and those that have been historically sidelined. globalization does not operate in value neutral or gender neutral ways; therefore in countries such as africa where women are subjugated to the very bottom ranks in society, the economic benefits of globalization of women are usually never accessible to women (sawpaul, 2001). social work research and practice has put significant efforts in developing and implementing various strategies for poverty alleviation, the approaches mentioned are some of the most recent innovations in the literature, while the discussion is not comprehensive it provides some insights into the poverty and social work literature internationally. rights-based approach and poverty alleviation strategy community based movements around the world have become very active in response to growing levels of income and wealth disparity, environmental degradation, lack of sustainable growth (gooden, 2008; pyles & lewis, 2007). these movements have often taken the issues of the poor to the center stage of the political landscape. much of this community work is geared toward transformation of systems and structures that allow inequities to thrive in society (mizrahi, 2001). social work practice particularly in recent years has come under a lot of fire for losing the firebrand activism and radical thoughts that was the hallmark of the profession in its early years. the increasing tilt of the profession toward micro interventions following the lead of evidence based medicine is a historic reinforcement of the cos methodologies. although, clinical social work will always be a key aspect of the profession’s identity, it is unfortunate that social workers are abandoning the pursuit of the ideals of structural equity and justice (jewell, collins, gargotto, & dishon, 2009). resource constraints, growing backlash from conservative legislators are some of the key reasons that keep social workers disengaged from public deka/rights-based approach to poverty 477 discourse on disenfranchisement of our key constituencies (jewell, et al., 2009). although the construct of social justice for all is adequately addressed in the nasw code of ethics, there is a functional treatment meted out to the concepts vis-à-vis practice. many social workers are not engaged in massive social transformation efforts through advocacy and mobilization, therefore they are not presented with opportunities to apply their expertise in achieving social justice (abramovitz, 1998). with growing populations of people living in poverty around the world it is imperative on social workers to reactivate our synergies of working to transform institutions and structures that allow inequities to thrive. the rights-based approach is rooted in critical pedagogy that challenges essentialist ideas of poverty as a phenomenon of those who are lazy, irresponsible and therefore unworthy of social support (sidel, 2000). the rights-based approach challenges the hopelessness that is embodied in this rhetoric, which fails to account for how historical and contemporary policies and structures allow for intergenerational poverty to thrive. rights-based approaches provides a tool for social workers to identify and name the social inequalities that perpetuate social injustice and inequities (offenheiser & holcombe, 2003). a rights-based approach in social work could pay particular attention to issues of vulnerability and disempowerment in specific local contexts. all social identity groups face discrete challenges depending on how and where they interface dominance and subjugation. therefore, it is important to understand that although the paper argues for a universal appeal toward integrating rights-based approaches in social work, the fundamental marker of this approach is that the interventions are only contextual and local in nature. therefore, a rights-based strategy to fight rural poverty in india could differ significantly from the strategies of combating urban poverty in the united states. the argument here is that as a philosophical, moral, value orientation rights-based approach provides a radical context for social workers to understand and challenge the status quo on the plight of the poor. in order to outline the basic framework of a rights-based intervention on poverty, i adopted kapur & duvvury’s (2006) assumptions about the approach . although, kapur & duvvary’s work focuses mainly on the development agenda, the framework outlined below pays specific attention to poverty intervention. the framework provides an opportunity for the dualistic reciprocal function of rights and responsibilities outlined in the human rights perspective to be revisited. the critical piece about this framework is that it lends legitimacy to the rights of an individual, which are otherwise often dubbed as entitlements by the welfare state. in order for an individual to live a life of human dignity (human rights principle), the individual is entitled to access and exercise those rights. it also puts onus on the welfare state as well as civil society organizations to provide access to the rights. the reciprocal dualism envisaged through this framework is distinctly different from the human rights perspective in general, which does not acknowledge the complexity in which rights and duties are often manifested. some key areas to explore are as follows:  exploring and understanding the locale of vulnerability, who are the perpetrators, existing power imbalances, and recognizing power hierarchies.  building accountability and transparency in right holders and duty bearers. advances in social work, summer 2012, 13(2) 478  strengthening local capacities through training and support (critical community mobilization) that will allow right holders exercise their right vis-à-vis their vulnerability, and duty holders to seek and meet obligations.  facilitating stakeholder participation, particularly those whose lives are adversely affected by poverty.  empowering stakeholders to critically appraise how violation of their social, political, economic and cultural rights has contributed to their state of poverty. consciousness rising is a key outcome of this approach.  developing competence among stakeholders to articulate and advocate effectively about other intersecting forms of oppression that compound their state of poverty. this framework is a versatile tool for social workers to engage in anti-poverty interventions, when they are fully cognizant that various social identity groups such as women face varying levels of oppression that compounds their poverty. rights-based framework of understanding gendered poverty for example in countries of the global south can for example focus on how women often lack decision-making power in the formal and informal sphere, they have little or no access to markets, and they continue to share the highest burden of poverty (ruwanpura, 2004). understanding this critical nexus of material deprivation with structural oppressions such as race, gender, class, sexual orientation, employment and income can provide significant breakthroughs in poverty alleviation strategies by social workers. a feminist redefinition of this approach has often highlighted few key components: focus on social versus individual nature of rights; rights are often pursued in relational and communal contexts; rights should reinforce the need for redistribution of resources; and right bearers need to be identified in regards to their multiple social identities (kapur & duvvury, 2006). for example in the work with girls education in india, the approach facilitated a shift in cultural patterns where traditionally girl’s education was opposed simply because it was established cultural norm (kapur & duvvury, 2006). this approach facilitated windows of opportunity for the community to take control on their collective destinies (kapur & duvvury, 2006). additionally, in a study by jewell et al. (2009), the authors described an anti-poverty program that used a human rights perspective for critical education and appropriate intervention on poverty. several aspects of this intervention had close orientations with the rights-based framework. the women in transition (wit) group made up of former welfare recipients used their leverage to educate and develop support against poverty, developed a strong toolbox of skills for members such as programs on strength and resilience to combat poverty in their lives (jewell, et al., 2009). the rights-based approach provides an apt context for social workers interested in anti-poverty work. although the orientation of the framework is philosophical in nature given its value orientation in the inalienable rights of individuals, the framework can provide concrete community mobilization strategies. in that sense unlike other approaches that are merely of esoteric significance, the rights-based a approach can be used as a tool for consciousness raising and social change as it relates to poverty. the deka/rights-based approach to poverty 479 framework also provides a great platform to understand the complex nature of american poverty with its intersectionalities in race, class, gender, sexual orientation, ability and age. the specific analyses on power structures in society can help pin-point the locales of many forms of systematic oppressions and their impact on poverty. the key aspect of the approach is that it is a process geared toward social change, in that sense it is not an end in itself (kapur & duvvury, 2006). as with any other approach, particular attention needs to be given on the planning strategy, community organization, consciousness raising and social action, empowering communities by building capacities, networking with other stakeholder groups and organizations, organizational growth and development, and finally an ongoing evaluation and monitoring of strategies (kapur & duvvury, 2006). the key distinction is that most stakeholders will remain stakeholders in the process, this entire design and execution of strategies toward poverty alleviation must be driven by stakeholder participation. in sum, the rights-based approach is a strategy for anti-poverty work and it fits naturally with social work interventions and our professional values. limitations of the rights-based approach although the rights-based approach presents several opportunities for social workers to understand and address issues of structural injustice and inequity as it relates to poverty, it is not without its challenges. jewell et al. (2009) state that there are specific challenges in implementing a human rights perspective in anti-poverty interventions. the three challenges they identified were: identity politics, legitimization from other organizations, and organizational barriers. while the rights-based perspective differs in its value orientation from human rights in that it focuses much less on the dualist reciprocal function of rights and duties of citizens, nevertheless there are overlaps in the approaches. hence, it is legitimate to expect some of the same concerns impacting the rights-based initiatives. jewell et al. (2009) point out that given the historic nature of marginalization and identity formulations, it is hard to find common ground and language to address poverty concerns among many groups. on one hand the identity formulations provide visibility to subordinated groups, on the other hand it is harder for the groups to see how different issues can be connected to multiple identities (jewell, et al., 2009). therefore, it is a practical challenge to incorporate the intersection of the poverty phenomenon with the intersections of identities in a framework. the other challenge in incorporating a rights-based approach in anti-poverty work is that institutions are generally classist in nature, and because this perspective confronts the basis of this institutional classism, it is possible that institutions may alienate themselves from poverty movements (jewell et al; 2009). as with any movement or organization fighting against structural injustice, rights-based advocates are likely to face resource constraints particularly given the nature of the work. although, the rights-based approach differs significantly from a human rights perspective, there is some confusion among professionals about the distinction. since the human rights perspective focuses more on a universal set of rights that are presumed to be enforceable by law, there is some unease among certain constituents about its commitment in addressing systemic causes that causes the violation of rights in the first place. also the human right perspective tends to rely heavily on civil and political rights advances in social work, summer 2012, 13(2) 480 and pays much less attention to economic, cultural and social rights. rights-based approach advocates have to be mindful about creating a framework whereby there are able to explain the similarities and difference between the approaches. finally, rightsbased approaches like many other advocacy and social change strategies requires a certain kind of political will from various stakeholders including social workers for it to be successful. given the complexity of the nature of this intervention in unearthing power and oppressions, and mobilizing stakeholders for social action, there are considerable challenges in steering the work. although, the limitations need to be carefully examined, it is imperative that social workers do not get dissuaded from this approach of poverty alleviation. the challenges can be outweighed by the significant opportunities that the approach can present to many vulnerable social work constituents. implications for social work practice the rights-based approach will provide social workers engaged in anti-poverty intervention work a perspective of interrogating systemic structures and processes that perpetuate poverty. using this type of strategy, social workers can create new foray and linkages between traditional community organizing and direct social action. the rightsbased approach is an effective strategy that has both universal and local appeal. in other words, although the philosophical arguments in favor of the approach may might initially appear somewhat universal in nature, nevertheless in reality the approach is grounded on diverse local contexts. rights-based approaches although widely popular in countries of the global south such as india, can be relevant in understanding poverty in western contexts. furthermore, the rights-based approach offers a critical social perspective even for clinical social workers by creating a compelling argument in favor of exploring the larger context in which social work clients seek services. the rights-based approach provides a critical framework to social work professionals to advocate for a just and equitable society where systems of oppressions based on social exclusions can be dismantled. the character of social work needs to be redefined by our active engagement in such public discourse and social workers should be in the frontline of this work (mackinnon, 2009). references abramovitz, m. 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(2008). globalization: what impact and opportunities for the poor and unemployed in south africa? international social work, 51(4), 480-+. doi: 10.1177/0020872808090241 deka/rights-based approach to poverty 483 weiss, i. (2003). social work students and social change: on the link between views on poverty, social work goals and policy practice. international journal of social welfare, 12(2), 132-141. woolcock, m. ( 2008). global poverty and inequality: a brief retrospective and prospective analysis. the political quarterly, 79(s1), 183-196. author note: address correspondence to: ankita deka, department of social work, augsburg college, 2211 riverside ave, cb 51, minneapolis, mn 55113. email: deka@augsburg.edu _____________ robert h. keefe, phd, acsw, lmsw is associate professor, school of social work, university at buffalo, state university of new york, buffalo, ny 14260-1050. carol brownstein-evans, phd, acsw, lmsw is associate professor, department of social work, nazareth college, rochester, ny 14168. sandra d. lane, phd, mph, ma is laura j. and l. douglas meredith professor, public health and anthropology, syracuse, university, syracuse, ny 13244-1030. d. bruce carter, phd, is associate professor, department of psychology and department of child & family studies, syracuse university, syracuse, ny 13244-1030. rebecca s. rouland polmanteer, lmsw is doctoral candidate, school of social work, university at buffalo, state university of new york, buffalo, ny 14260-1050. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 202-213, doi: 10.18060/18502 postpartum depression and the affordable care act: recommendations for social work educators robert h. keefe carol brownstein-evans sandra d. lane d. bruce carter rebecca s. rouland polmanteer abstract: the patient protection and affordable care act (aca) mandates ongoing research on postpartum depression; however, very little research has been published in social work journals and in advanced-level textbooks on this topic. this article describes the problem of postpartum depression and argues that social work educators and researchers must pay greater attention to this issue in light of the aca mandates, so that social workers can provide effective services to postpartum mothers and their children. the council on social work education’s recently published educational policy and accreditation standards are considered while making curriculum recommendations on postpartum depression for social work educators. keywords: patient protection and affordable care act, maternal and child health, postpartum depression, perinatal mood disorders, social work education approximately six million pregnancies occur in the united states each year, and up to 25% of the mothers develop postpartum depression (gaynes et al., 2005; schaar, 2012). mothers with postpartum depression typically experience sadness; loss of interest in activities; noticeable changes in eating and sleeping patterns; problems in thinking, concentrating, and making decisions; feelings of worthlessness, shame, or guilt; thoughts of harming themselves (centers for disease control [cdc], 2013); and increased need for psychiatric hospitalizations for depression and suicidality (georgiopoulos, bryan, wollan, & yawn, 2001; kennedy, beck, & driscoll, 2002; lucero, beckstrand, callister, & sanchez birkhead, 2012). the symptoms are persistent, eventually affecting not only the mother but her infant, spouse/partner, and extended family as well (letoruneau, tramonte, & willms, 2013; ngai & ngu, 2015). babies born to mothers with postpartum depression often develop numerous longstanding problems including decreased cognitive skills (mcgarry, kim, sheng, egger, & baksh, 2009), poor attention (ramchandani, stein, evans, o’connor, & the alspac study team, 2005), and social withdrawal (boyd, zayas, & mckee, 2006). the fathers complain of feeling left out and less satisfied in their relationship with the mother (mitnick, heyman, & slep, 2009). keefe et al./postpatum depression 203 unlike symptoms of major depressive disorder, which manifest within two weeks of the precipitating stressors (american psychiatric association, 2013), symptoms of postpartum depression may not become evident until several months after the mother has given birth (chaudron et al., 2010; parade, blankson, leerkes, crockenberg, & faldowski, 2014). consequently, practitioners may avoid giving a diagnosis of postpartum depression due to what they perceive as the late onset of symptoms. moreover, social work journals provide practitioners with limited guidance on postpartum depression. we searched various social work databases for articles published in social work journals focusing on perinatal mood disorders published between the years 1980 to 2015. the search resulted in 101 published articles of which 80 used the term “postpartum depression” in the title. of the existing articles, only 26 were published in social work journals. consequently, although the literature on postpartum depression has grown substantially over the past 35 years, only a limited body of the literature has been published in social work journals. the majority of the research has been published in the fields of nursing, psychology, psychiatry, and medicine. as a result, much of this research has focused on individual-level approaches to treatment such as antidepressant medication, interpersonal and cognitive-behavioral therapy, and relapse-prevention strategies. there is very little research on community-level factors to help social workers address the problem of postpartum depression at all levels of intervention and even less on how social work educators can infuse content on postpartum depression into their courses. the adoption of the patient protection and affordable care act (aca), section 2952: support, education, and research for postpartum depression mandates ongoing research to better understand the frequency and course of postpartum depression, address differences in treatment needs among racial and ethnic groups, and develop culturally competent evidence-based treatment approaches (u.s. department of labor, 2012). given their direct practice, policy development, and research skills, we argue that social workers are among the most skilled professionals providing services to postpartum mothers and should take the lead in addressing the problem of postpartum depression. the purpose of this article is to bring attention to this problem and offer recommendations to social work educators to better prepare students to meet the needs of new mothers affected by postpartum depression. the varying rates of postpartum depression prevalence estimates for postpartum depression vary widely across studies. the discrepancy is due in part to varying definitions of the disorder, different conceptualizations of the postpartum time period, and varying assessment and diagnostic approaches (banti et al., 2011). although the rates vary, much of the existing research indicates that up to 25% of new mothers experience postpartum depression (gaynes et al., 2005; schaar, 2012). additionally, rates of postpartum depression may be higher in diverse or vulnerable groups. while some researchers have found the rates of postpartum depression to be higher in rural areas (villegas, mckay, dennis, & ross, 2011), others have reported the prevalence to be higher in urban areas (clare & yeh, 2012). likewise, various researchers have found differences among racial and ethnic groups (gress-smith, luecken, lemery-chalfant, & howe, 2012; savitz, stein, ye, kellerman, & silverman, advances in social work, fall 2015, 16(2) 204 2011) and the likelihood that the rates for low-income mothers and for mothers of color are higher than estimated (cdc, 2008; dolbier, et al., 2013; gress-smith et al., 2012; lara et al., 2015). some researchers have suggested that mothers of color face more elevated rates of postpartum depression than white mothers because of greater life stressors, including economic factors known to affect postpartum depression. to date, research has concluded that compared to white mothers and mothers from privileged backgrounds, mothers of color have lower incomes (dagher, mcgovern, dowd, & gjerdingen, 2012; feder et al., 2009; kozinsky et al., 2012; lara et al., 2015), lower levels of education (dagher et al., 2012; lanes, kuk, & tamim, 2011), higher rates of unemployment (boyce & hickey, 2005; dagher et al., 2012; janssen, heaman, urquia, o’campo, & thiessen, 2012), greater likelihood of single parenting (boyce & hickey, 2005; lewin, mitchell, & ronzio, 2013), and worse housing conditions (cutrona et al., 2005; jacobs, 2011; redshaw & henderson, 2013). moreover, mothers of color generally have higher rates of chronic diseases such as diabetes mellitus and hypertension (kim et al., 2014), are more likely to have inadequate health insurance (blumenthal & collins, 2014), and have poorer access to adequate healthcare (orr, reiter, james, & orr, 2012) than other mothers. coupled with higher exposure to community violence (miller et al., 2012), it is understandable that mothers of color are at increased risk of clinical depression. a further problem is the preponderance of research has considered primarily white women who are married, well-insured, from middle-class backgrounds, and have access to healthcare. the few studies that have focused on mothers of color concluded their rates of postpartum depression to be higher than among white mothers (cdc, 2008; surkan, peterson, hughes, & gottlieb, 2006). yet, social workers employed in maternal and child health settings looking to advance their skills in working with mothers with postpartum depression from non-white backgrounds have a limited body of social work literature to draw upon. working with mothers who have postpartum depression social workers employed in health and mental healthcare settings often face various difficulties in working with mothers living with postpartum depression. many mothers are reluctant to seek treatment, and those who do are often reticent to disclose their symptoms to health care providers (abrams & curran, 2009; cdc, 2008; ko, farr, dietz, & robbins, 2012), particularly women from diverse cultures (dennis & chung-lee, 2006; kozhimannil, trinacty, busch, huskamp, & adams, 2011). because many of the symptoms of postpartum depression mimic signs of pregnancy including fatigue, anxiety, and irritability, many providers are hesitant to screen for depression (seehusen, baldwin, runkle, & clark, 2005). due to inconsistent screening procedures, depressed pregnant and postpartum women may go without effective treatment until the depression has advanced, which can result in further health risks including poor adherence to prenatal and postnatal care plans, preterm delivery, and low infant birth weight (littleton, bye, buck, & amacker, 2010). keefe et al./postpatum depression 205 the american college of obstetricians and gynecologists (acog, 2006) argues that psychosocial screening and feedback performed at an initial visit and every three months thereafter may reduce the risk for persistent depression and improve birth outcomes. screenings should include an assessment of obstacles to care, unstable housing, unintended pregnancy, barriers to communication among family members, problems with nutrition, ongoing tobacco and other substance abuse, depression, safety, intimate partner violence, and stress (acog, 2006; dobson & dozois, 2008). the national association of perinatal social workers (napsw, 2009) the largest social work organization that most directly addresses the gap in social work education and practice on postpartum depression, consists of roughly 275 members (l. r. baker, personal communication, july 8, 2015). the napsw provides 10 standards for perinatal social workers working with patients experiencing post partum depression. each standard includes specific roles for social workers. most important among the standards are for msw-prepared social workers to conduct full psychosocial assessments of women during the perinatal period for depression (standard 2); use standardized screening tools to screen for depressive symptoms (standard 7); provide resources and referrals for all women in the perinatal period, including culturally and linguistically appropriate support groups and evidence-based counseling services (standard 5); and provide information on postpartum depression to the woman’s partner/spouse and family members (standard 6). in addition, napsw (2009) advocates for social workers to be an integral part of the interdisciplinary health teams providing support and education to medical and support staff and to assist in developing and formulating hospital policies and decisions related to the assessment and treatment of postpartum depression (standards 9 and 10). although there are no federal policies that require screening of new mothers for postpartum depression (rhodes & segre, 2013), 12 states have adopted either state legislation, developed awareness campaigns, or convened tasks forces. states that require screening include new jersey (findings, declarations relative to postpartum depression, 2006), illinois (perinatal mental health disorders prevention and treatment act, 2008), and west virginia (uniform maternal screening act, 2009). other states require education about postpartum depression including texas (relating to information provided to parents of newborn children, 2005), virginia (certain information required for maternity patients, 2003), minnesota (postpartum depression education and information, 2015), and oregon (relating to perinatal mental health disorders and declaring an emergency, 2011). washington has passed statewide awareness campaigns, and california, michigan, and oregon have postpartum depression awareness months (rhodes & segre, 2013). finally, maine, massachusetts, and oregon have appointed perinatal depression task forces (rhodes & segre, 2013). the remaining 38 states have yet to pass any type of legislation or develop any campaigns to bring the problem of postpartum depression to the public’s awareness. how social work educators can take the lead in working with mothers with postpartum depression given that postpartum depression affects mothers from all backgrounds, incorporating course content on postpartum depression into each curriculum area would be a significant advances in social work, fall 2015, 16(2) 206 step forward in helping social workers take the lead in addressing this growing problem. the council on social work education (cswe, 2015), competency 2 mandates social workers to engage in diversity and difference in practice. with this in mind, social work educators must include research studies and evidence-based treatment approaches aimed at eliminating health and mental health disparities across all areas of health care. students need to understand various barriers to care that members from oppressed groups face, as well as the limitations of traditional health and mental health treatment and community services (ley, copeland, flint, white, & wexler, 2009). students need to understand how social location (i.e., the groups to which individuals claim membership based on their sex, socioeconomic class, religion, and sexual orientation) may inhibit people from traditionally oppressed backgrounds from seeking care, particularly when the research on approaches to care is based on mothers from privileged backgrounds. bringing the focus to postpartum depression specifically, social work students should be prepared to address barriers to services and facilitate mothers’ access to child care, transportation, and prenatal appointments that accommodate inflexible work schedules. social work students should also be prepared to advocate for mothers who will likely experience delays in appointments, particularly for mothers who receive public insurance (u.s. department of health and human services, office of the surgeon general, substance abuse and mental health services administration 1999). social work research courses. competency 4 states, social workers are expected to engage in research-informed practice and practice-informed research (cswe, 2015). instructors can help students develop and test interventions with individuals, families, groups, and communities and later evaluate those interventions by using various assessment tools. program evaluation courses should evaluate services postpartum mothers use including women, infants, and children (wic) clinics, prenatal care agencies, and pediatric clinics. additionally, students can be taught how to work with cultural brokers to access communities where they can facilitate focus groups and conduct community-based participatory research to help community agencies evaluate the cultural appropriateness of their services. finally, students can learn to employ qualitative and quantitative methods to obtain client feedback about the experience of postpartum depression and services received. human behavior and the social environment courses. competency 6 states social workers are to engage with individuals, families, groups, organizations, and communities by applying knowledge of human behavior and the social environment (cswe, 2015). among the ways educators can help students develop these skills is by including course content on risk and protective factors of postpartum depression in course units focused on the developmental stages of pregnancy, childbirth, and infancy. students should study theories of societal oppression and how oppression affects women and children. students can then investigate which theories best explain the lived experiences of new mothers affected by postpartum depression. instructors can also include content on family systems theory to gain greater understanding of the effects of postpartum depression on the family. social work practice courses. competency 8 requires social workers to intervene with individuals, families, groups, organizations, and communities (cswe, 2015). instructors can develop various case scenarios and encourage students to evaluate practice approaches keefe et al./postpatum depression 207 and interventions for working mothers living with postpartum depression. the modules can emphasize relationship-building, engagement, contracting, validation, and resource acquisition. interventions that highlight supportive counseling and problem-solving, and use strengths-based and women’s empowerment approaches applicable across settings are needed. given the impact of postpartum depression on external systems, curriculum modules on family therapy that address the needs of spouses/partners, children, and extended family members as well as group therapy/counseling course modules that address both psychotherapeutic and mutual-aid group strategies for working with mothers who have postpartum depression are needed. finally, course modules are needed to teach students how to form coalitions with service providers caring for new mothers. these coalitions will help communities to advocate for new, culturally relevant services that enhance formal and informal support systems. working with agencies to develop brochures that are easy to read and help mothers and families access appropriate services are also needed. social policy courses. competency 5 requires students to engage in policy practice that advances human rights and social justice (cswe, 2015). instructors can provide course content on the aca with specific focus on section 2952. students can trace the development of the aca while considering other legislation focused on bringing to light the needs of mothers and children including the sheppard-towner and melanie blockerstokes acts. students can also write policy statements in their field agencies on how to better provide services to new mothers with postpartum depression in light of the aca. fieldwork. educational policy 2.2 requires field educators to provide students with opportunities to integrate classroom content with practical experience. field educators can assign students in maternal and child healthcare placements to work with first-time mothers, provide education to the mother’s partner/spouse and other family members about the signs and symptoms of postpartum depression, explore the use of informal supports, and make referrals to appropriate community resources. students’ cultural competence can be enhanced by field education experiences and service-learning opportunities that involve working with diverse populations across the lifespan (ley et al., 2009). finally, better screening methods should be incorporated into agency practice to include not only use of postpartum depression scales (e.g., edinburgh postnatal depression scale; cox, holden, & sagovsky, 1987), but also predictors of postpartum depression that would help prepare students for working with new mothers who may develop postpartum depression. students should also be instructed in the use of standardized screening instruments and on how to advocate with hospitals for developing written plans that provide specialized social work services related to postpartum depression (napsw, 2009). students can be assigned tasks that investigate strategies for how best to remove barriers to care that postpartum mothers of color face including the lack of culturally appropriate and relevant brochures on postpartum depression. students can develop in-service discussions on the predictors of postpartum depression and assess the agency’s readiness to provide services that are affordable, adequate, and accessible to all mothers. advances in social work, fall 2015, 16(2) 208 summary and conclusion despite being an ongoing problem for many years, postpartum depression has only begun to receive public attention within the past two decades. accounts of new mothers harming their newborn babies have brought additional focus to the rationale for developing new services. many services, however, are being developed without the input of social workers who, given their training in cultural competence, advocacy, and policy development as well as multi-system interventions, can bring a much-needed perspective to address this problem. although the social work profession has contributed to the development of services and policies on maternal and child health, it needs to take a more decisive step forward in addressing postpartum depression. the adoption of the aca affords an excellent opportunity for social work educators to provide learning opportunities for students to address this significant problem so that new mothers and their children can live healthy and productive lives. references abrams, l. s., & curran, l. 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(2011). postpartum depression among rural women from developed and developing countries: a systematic review. the journal of rural health, 27(3), 278-288. doi: http://dx.doi.org/10.1111/j.17480361.2010.00339.x author note address correspondence to: robert h. keefe, phd, acsw, lmsw, school of social work, university at buffalo, suny, 685 baldy hall, buffalo, ny 14260-1050. email: rhkeefe@buffalo.edu http://dx.doi.org/10.1007/s10995-005-0056-9 http://mentalhealth.samhsa.gov/cre/ch3.asp http://www.dol.gov/ebsa/healthreform/ http://dx.doi.org/10.1111/j.1748-0361.2010.00339.x http://dx.doi.org/10.1111/j.1748-0361.2010.00339.x mailto:rhkeefe@buffalo.edu lara, m. a., navarrete, l., nieto, l., martin, j. p. b., navarro, j. l., & lara-tapia, h. (2015). prevalence and incidence of perinatal depression and depressive symptoms among mexican women. journal of affective disorders, 175, 18-24. doi: 34thttp://... microsoft word manthey copyedit final _________________  trevor jay manthey, lmsw, is a graduate research assistant, consultant, trainer, and doctoral student, bryan knowles, lmsw , is a consultant and trainer for the integrated dual disorders treatment (iddt) model, and dianne asher, lscsw, is the project manager for iddt, all in the school of social welfare at the university of kansas in lawrence, ks. stephanie wahab, ph.d., is an associate professor in the school of social work at portland state university. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 126-151   strengths-based practice and motivational interviewing trevor jay manthey bryan knowles dianne asher stephanie wahab abstract: there has been recent concern that many practices and programs erroneously claim to be strengths-based. in reaction some have called for researchers to make systematic comparisons to the tenets of strengths-based practice (sbp) before making the contention that an intervention is strengths-based. motivational interviewing (mi) is an intervention which has been described as being strengths-based; however, no systematic efforts have yet been made to compare the two. this article takes a methodical approach to comparing sbp and mi to determine level of cohesion and how they might be used together. a case-example is used to illustrate how mi and sbp may be used in conjunction and implications for social work practice and education are discussed. keywords: strengths, strengths-based practice, intervention, motivation, motivational interviewing introduction there has been recent concern that social work agencies, programs, practices, and therapies that claim to be strengths-based often misperceive what it means to operate from a strengths-based practice (sbp) (rapp, saleebey, & sullivan, 2005). operating from a sbp does not mean someone is merely being nice or ignoring problems, rather sbps contain distinct ideological underpinnings and principles which guide practice (saleebey, 2006). many interventions which make claim to being strengths-based do not make a systematic effort to corroborate what they actually do with authentic sbp. conducting sbp requires dedication and a depth of commitment and often the principles, though simple on the surface, are complex in operation (e.g. marty, rapp, & carlson, 2001). in response to the discrepancy between what is sometimes professed about interventions and what actually occurs, rapp et al. (2005) developed six standards to evaluate whether or not a practice is strengths-based. motivational interviewing (mi), an intervention used to facilitate behavior change, has gained international attention and is often described as a sbp (chung, burke, & goodman, 2010; clark, 2006; corcoran, 2005; van wormer & davis, 2008). while articles have alluded to consistencies between mi and sbp (e.g. clark, 2001; 2005), no published methodical efforts have yet been made to link the two. the authors believe mi advances in social work, fall 2011, 12(2) 127   does fit into a strengths-based paradigm and the goal of this article is to engage the challenge issued by rapp et al. (2005) in advances in social work by systematically comparing mi with sbp. we begin by reviewing the origins of both approaches. this review is followed by a systematic examination of the principles of mi through the lens of the qualifying standards put forth by rapp et al. (2005) that assesses the goodness of fit of mi to the principles of sbp as described by saleebey (2006). a potential reciprocal relationship is acknowledged and a case-scenario is used to describe how both sbp and mi can be used together. implications are discussed for social work education and practice. origins and definitions strengths-based practice has been conceptualized as an overarching perspective and as a set of principles. specific models such as strengths-based case management (sbcm) have also been developed (brun & rapp, 2001; rapp & goscha, 2006). these multiple levels of conceptualization create difficulty in drawing definitions and comparisons (probst, 2009) and some have critiqued sbp because it can be difficult to operationalize (mcmillen, morris, & sherraden, 2004; staudt, howard, & drake, 2001). for the purpose of this article we draw specifically from the principles guiding sbp as defined by saleebey (2006) and the qualifying standards put forth by rapp et al. (2005). strengths-based practice a definition of sbp put forth by saleebey (2010) posits that operating from a sbp means that “everything you do as a helper will be based on facilitating the discovery and embellishment, exploration, and use of clients’ strengths and resources in the service of helping them achieve their goals and realize their dreams (p. 1)” in addition, central to sbp is the belief that clients are most successful at achieving their goals when they identify and utilize their strengths, abilities, and assets (rapp, 2006). sbp assists clients in recognizing and utilizing the strengths and resources they may not recognize within themselves, thus aiding clients in regaining power over their lives (greene, lee, & hoffpauir, 2005). although aspects of sbp have been discussed in the social work literature periodically throughout much of its history, strengths-based work wasn’t formalized into a set of practice principles until the 1980s (rapp et al., 2005). the formalization came in response to the pathology-laden treatments available for individuals with psychiatric disorders prevalent at that time (weick, rapp, sullivan, & kisthardt, 1989). sbp was a stance taken to oppose a mental health system that overly focused on diagnosis, deficits, labeling, and problems (saleebey, 2000; 2001). initially implemented in casemanagement, sbp then moved into other areas of social work and the helping professions (saleebey, 1996). sbp contains explicit practice principles; however, sbp is not explicit about what skills workers should use. it describes processes that are important but doesn’t necessarily describe in detail how to practice those processes. instead, sbp can be perceived as a way of conducting oneself during any practice interaction (saleebey, manthey, knowles, asher, wahab/strengths-based practice and mi 128 2006). sbp can be used in a majority of the situations workers may find themselves in because it is a framework by which one sees and interacts with others. a profound belief in an individual’s potential is intrinsic to any strengths-based interaction (rapp & goscha, 2006). strengths-based practice begins with understanding what goals and dreams a client has and then helping the client to reflect on the possibilities and hopes that their lives hold (saleebey, 2006). helping clients reflect on their goals and dreams facilitates the discovery and development of new possibilities for, and change toward, a better quality of life (saleebey, 2006). motivational interviewing motivational interviewing was originally developed in the addictions field in the 1980s as an alternative to the coercive and confrontational approaches used in the substance abuse field at that time (miller & rollnick, 2002). mi has since moved into many helping fields, including social work. william miller reported that the formulation of mi was facilitated through individuals in norway asking him why he interacted with clients in some ways (that produced positive results) rather than others (miller & rose, 2009). this forced miller to make explicit the approach he had learned from his clients. therefore, mi was developed through practice wisdom first (e.g., what appeared to be working to help facilitate change) and then moved toward attaching theory about why it worked later (miller & rose, 2009), as is consistent with a practice-based evidence research methodology (e.g., tilsen & nylund, 2008). miller and rollnick (2002) defined mi as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (p. 25). this approach accepts that ambivalence toward behavioral change is normal. argumentation is avoided because trying to persuade a person to make a behavioral change usually results in the person verbally defending the status quo. intrinsic motivation is achieved when a person sees a conflict between their current behavior and other goals or values that they hold. the role of the counselor, therefore, is to explore those goals and values and to elicit statements or perspectives that support behavioral change (miller & rollnick, 2002). there are a variety of skills outlined in the use of mi, and an explanation of all these skills is beyond the scope of this article. however, one interesting and critical facet of mi is that the intervention outlines not just what skills to use but how the skills are to be implemented. there is a spirit associated with mi that grounds how a counselor approaches people. miller and rollnick (2002) are clear that the spirit of mi is integral to its successful practice, as they have encountered practitioners and trainers “mimicking…component techniques without understanding their overall context” (p. 33). the spirit of mi is comprised of three components: collaboration, evocation, and autonomy. these components are described as follows: 1. collaboration. counseling involves a partnership that honors the client’s expertise and perspectives. the counselor provides an atmosphere that is conducive rather than coercive to change (p. 35). miller and rollnick contrast collaboration to its opposite approach: confrontation, in which overriding the advances in social work, fall 2011, 12(2) 129   client’s perspective and correcting his or her view of reality are central components. an individual may decide to personally confront behavior change issues during the mi process; however, it is not the role of the worker to be confrontational. 2. evocation. the resources and motivation for change are presumed to reside within the client. intrinsic motivation for change is enhanced by drawing on the client’s own perceptions, goals, and values. evocation is in turn compared with education, in which there is an assumption of a deficit in the client’s “knowledge, insight, and/or skills” that must be corrected by the counselor (p. 35). education, such as normative feedback, may be a tool used within mi, but it is not the goal. 3. autonomy. the counselor affirms the client’s right and capacity for self-direction and facilitates informed choice. autonomy is contrasted with authority, in which the client’s role is to be told what he or she should do. these elements of the spirit of mi are important when considering how this approach may or may not be consistent with strengths-based practice. systematic comparison this article compares mi and sbp to assess the commensurability of the two approaches and to determine the degree to which mi is consistent with sbp. it is important to make this comparison in order to respond to the call for individuals to make systematic efforts to corroborate a given intervention with sbp before making the contention that an intervention is strengths-based (rapp et al., 2005). conducting this comparison is also important because not every intervention is appropriate for social work (even with empirical support) if the intervention is not consistent with social work values and ethics. recognizing strengths is a key component of social work’s code of ethics (nasw, 2006). therefore, comparing mi to sbp is an important step in determining if the intervention is appropriate for social work. comparison of sbp and mi occurred across eight domains which were created by combining rapp et al.’s (2005) standards and saleebey’s (2006) principles of sbp. if a standard or principle overlapped we combined them into one domain. three researchers were used as a panel to determine if a standard or principle was overlapping. motivational interviewing was then compared to each domain of sbp. if there was disagreement, meetings continued to be held and concepts studied until consensus was reached. motivational interviewing was rated explicitly consistent, philosophically consistent, or not consistent to each of the developed sbp domains. the three-level rating scale (explicitly, philosophically, or not consistent) was developed by the research team in order to provide for a more nuanced analysis than a simple yes/no regarding consistency. at the conclusion of each of the following comparative sections a sentence is included which describes what rating motivational interviewing was given for the sbp domain described. manthey, knowles, asher, wahab/strengths-based practice and mi 130 goal orientation strengths-based practice is goal oriented. encouragement is given to individuals to set goals they would like to achieve in their lives. goal setting becomes a foundation or backdrop for which strengths are assessed and mobilized (saleebey, 2006). there are some situations where a worker helps an individual to define and articulate his or her goal(s); however, it is still the individual’s values that drive the goal setting process (rapp & goscha, 2006). motivational interviewing is focused on the exploration of goals and values. individuals are invited to explore what their ultimate goals are and how they imagine themselves achieving them (e.g. corrigan, mccracken, & holmes, 2001). exploring what values are important to an individual is also incorporated into mi. the goals and values are elicited from the individual and not imposed upon them from outside (miller & rollnick, 2002). the goal setting process is person-centered (rollnick, miller, & butler, 2008). conclusion: motivational interviewing is explicitly consistent with sbp’s goal orientation principle. strengths assessment strengths-based practice contains a systematic means of assessing strengths (rapp et al., 2005). assessment for, and documentation of, strengths occurs in a methodical way that avoids a primary focus on problems, pathology or deficits (e.g. rapp & goscha, 2006). the means to overcoming barriers to goal attainment are seen as being tied to an individual’s strengths such as talents, assets, resources, and skills. attention is also given to what is already working, searching for instances when there are exceptions to problems, and identifying coping strategies that an individual has already obtained. focus is more often on the current situation rather than past pathology; although, the past can be explored for talents, resources, and assets (saleebey, 2006). motivational interviewing provides workers with skills to assess client confidence in their ability to make behavioral change (miller & rollnick, 2002). when a client lacks confidence to make behavior change, the mi practitioner uses skills to elicit clients’ belief in their own ability. for instance, individuals using mi facilitate discussion which enables individuals to look back over their lives and identify past successes (miller & rollnick, 2002). what is working currently and how individuals can imagine things working better are also explored. affirmation skills are developed which allow workers to specifically identify and affirm strengths, encourage autonomy, and provide support (rollnick et al., 2008). excessive exploration of the history of the problem is discouraged; rather the focus is on past success, self-confidence and self-efficacy (rollnick et al., 2008). conclusion: motivational interviewing is philosophically consistent with the sbp principle of strengths assessment. advances in social work, fall 2011, 12(2) 131   environmental resources strengths-based practice sees the environment as rich in resources. it is highlighted that the natural community is the principal source of resources, opportunities, people, and supports (saleebey, 2006). a tenet of sbp is that often goal attainment occurs through the matching of client desires and strengths with naturally occurring resources in the environment (rapp & goscha, 2006). strengths-based practice assumes every individual, group, family, and community has strengths and resources (saleebey, 2006). in strengthsbased practice explicit methods link client and environmental strengths to goal attainment. after the goal has been identified and strengths have been assessed, a clear means for utilizing and mobilizing strengths is identified. the identification and use of resources, therefore, becomes essential and may be one of the most important principles of sbp (e.g. davidson & rapp, 1976). the plan is derived from the goals and strategically incorporates strengths (rapp & goscha, 2006). the idea is to build from strengths and aspirations, agree on a set of goals, and match these goals with natural resources in the community. the idea within motional interviewing is to focus on exploring client goals and values, build motivation to achieve the explored goals and values, determine how current behavior fits or doesn’t fit with goals and values, and develop a change plan based on client preferences. the change plan is meant to help individuals live more consistently with the values they hold dear and achieve their goals. both mi and sbp assume that every individual group or family has strengths. motivational interviewing assumes individuals know their personal environment and its resources better than the worker (miller & rollnick, 2002). it is central to mi that the plan be developed based on how individuals see themselves most likely succeeding (rollnick et al., 2008). it is up to the worker to listen carefully for strengths and resources and strategically affirm them or their use (miller & rollnick, 2002). in this way, the worker helps the individual to selfidentify and use their strengths and environmental resources in a productive fashion within their change plan. therefore, the change plans facilitated through mi often include naturally occurring resources, such as family members, friends, or a community group. the worker who uses mi is also purposeful in eliciting client strengths and change language in order to help mobilize confidence and importance for behavior change (miller & rollnick, 2002). conclusion: mi is philosophically consistent with the sbp principle of using environmental resources. the relationship the strengths-based relationship is hope-inducing. the relationship is clearly attuned to increasing the hopefulness of the individual, family or group (rapp et al., 2005). being accepting, empathetic, and having a collaborative purpose are all part of the strengthsbased relationship (saleebey, 2006). the hope inducing qualities of the strengths-based relationship can be destroyed through spirit-breaking behaviors, such as labeling, having a problem or diagnostic focus, or pathologizing (deegan, 1990). the focus of the helping process is on strengths, interests, knowledge, and capabilities, not on diagnosis, deficits, manthey, knowles, asher, wahab/strengths-based practice and mi 132 symptoms, and weaknesses. the relationship is also empowering in that it increases individuals’ perceptions of their abilities, increases choices and options, and increases confidence to choose (rapp & goscha, 2006). the motivational interviewing relationship facilitates hope, confidence, and motivation for change. as noted previously, mi provides skills for supporting an individual’s self-efficacy which often can be hope-inducing (miller & rollnick, 2002). self-efficacy can be defined as a person’s belief in his or her personal competence and ability to achieve his or her goals. the mi spirit includes maintaining a positive and supportive relationship that emphasizes the evocation of an individual’s ideas, increasing an individual’s autonomy, and collaboration (miller & rollnick, 2002). mi also focuses on increasing the importance of, and confidence to, change. attention is given to how individuals describe their situation, not on diagnosing or labeling the problem (rollnick et al., 2008). the supportive and accepting nature of the relationship in mi can be negatively impacted if the worker starts to label, give unsolicited advice, or becomes confrontational. conclusion: mi is explicitly consistent with the sbp principle of developing a hopeinducing relationship. meaningful choice in strengths-based practice the provision of meaningful choices is central and individuals have the authority to choose (rapp et al., 2005). throughout the strengthsbased process the worker is expanding choices and options for the client. the worker helps to clarify choices and encourages the individual to direct the process. the generation of alternatives is a mutual process and individuals are seen as the experts in their own lives (rapp & goscha, 2006). the work in sbp is client-directed. individuals are encouraged to generate solutions and alternative courses of action (rapp et al., 2005). motivational interviewing supports autonomy and choice (miller & rollnick, 2002). individuals are empowered to make choices, set the agenda, prioritize their goals, and function independently. specific skills and tools are utilized to increase an individual’s perception of autonomy and control (e.g. manthey, 2011). clients are perceived as being the experts in their own lives and are empowered to make choices and provide direction within the interaction. motivational interviewing helps individuals increase their confidence in their ability to make decisions and changes (rollnick et al., 2008). conclusion: motivational interviewing is explicitly consistent with the sbp principle of meaningful choice. collaboration strengths-based practice assumes that we best serve clients by collaborating with them. workers who use sbps approach individuals as collaborators who have specific skills and experiences to offer, while remaining open to the wisdom, experience and knowledge of individuals (saleebey, 2006). this allows the practitioner to work with advances in social work, fall 2011, 12(2) 133   individuals rather than on them. the individual’s voice should be heard and valued throughout all levels and aspects of intervention and practice (rapp & goscha, 2006). motivational interviewing assumes that we best serve individuals by collaborating with them. a large part of the spirit of mi includes the collaborative relationship that should be present between the worker and the individual (miller & rollnick, 2002). mi views both the worker and the individual as equally important to the process. if a worker drifts away from being collaborative with an individual (e.g., starts to give unsolicited advice or suggestions, or becomes confrontational) the worker is no longer providing motivational interviewing (rollnick et al., 2008). collaboration is considered one of the essential aspects of the relationship that facilitates positive change (miller & rollnick, 2002). conclusion: motivational interviewing is explicitly consistent with the principle of collaboration. trials and opportunity strengths-based practice assumes that trauma, abuse, illness, and struggle may be harmful but they may also be sources of challenge and opportunity (saleebey, 2006). often individuals have misperceived sbp as ignoring problems (rapp & goscha, 2006). instead, sbp focuses on aspects of humanity that indicate that despite adversity individuals are often resilient and resourceful (saleebey, 2000). workers acknowledge problems and struggles; however the workers’ focus is to explore and learn from individuals’ strategies to overcome traumatic and adverse events (saleebey, 2006). motivational interviewing is focused on helping people mobilize commitment to change despite historical problems (miller & rollnick, 2002). mi is primarily present and future focused. the past informs why someone wants to change and may be used to help build self-efficacy, but it is not the focus of the work with the client (miller & rollnick, 2002). mi attempts to clarify current and future objectives and develop discrepancy between current behavior and important goals (rollnick et al., 2008). in a way similar to sbp, mi respects an individual’s wisdom gained through prior experience and draws on that wisdom to explore why the individual might consider behavioral change. conclusion: motivational interviewing is explicitly consistent with the sbp principle that trials can also be sources of opportunity. change/growth potential strengths-based practice assumes that the worker does not know the upper limits of individuals’ capacity to grow and change (saleebey, 2006). serious consideration is given to individual, group, and community aspirations (rapp & goscha, 2006). individuals often feel bound by past experiences, assessments, diagnoses, or judicial sentences. by purposefully avoiding labels and by having high expectations, workers empower individuals to believe in their own capacity to obtain their goals (rapp & goscha, 2006). this is accomplished through keeping a close alliance with the individual’s hopes, values, and aspirations (saleebey, 2006). manthey, knowles, asher, wahab/strengths-based practice and mi 134 motivational interviewing assumes that individuals truly can change and achieve their goals (miller & rollnick, 2002). these goals are often extensively explored in order to increase motivation for change (e.g corrigan et al., 2001). the worker values and closely aligns with individuals’ long term goals. the worker’s belief in a person’s capacity to change is considered fundamental in the practice of supporting self-efficacy (rollnick et al., 2008). beyond the underlying assumptions of mi, there is a skill base for increasing individuals’ belief in their capacity for change (miller & rollnick, 2002). mi selectively reinforces language that reflects the person’s desires, abilities, reasons, and needs for change (e.g. amrhein, miller, yahne, palmer, & fulcher, 2003). conclusion: motivational interviewing is explicitly consistent with the principle that the worker does not know the upper limits of an individual’s capacity to grow and change. areas of divergence based on this systematic comparison it was determined that mi is either explicitly or philosophically consistent with the primary principles of sbp (see table 1). while the “not consistent” category was not appropriate to be used in comparing mi to the principles of sbp, there were several areas of nuanced divergence also noted. for instance, mi does not express a particular preference between naturally occurring vs. formal resource use (e.g. governmental programs), while sbp contains a preference towards using naturally occurring resources (e.g. neighbors, friends or community groups) (rapp & goscha, 2006). in addition, mi may or may not include a problem focus depending on the context. mi may avoid a problem focus in situations where it is being used to resolve ambivalence and increase motivation to obtain a specific pro-social goal, such as resolving ambivalence regarding obtaining a job (e.g., larson, 2008) or attempting education (e.g. manthey, 2011). in other situations mi attempts to develop discrepancy between current problem behaviors and an individual’s long term goals. these include situations such as substance abuse (miller & rollnick, 2002) or child abuse and neglect (forrester, mccambridge, waissbein, emlyn-jones, & rollnick, 2008). for example, an individual may have a desire to be a good parent but finds that drug addiction becomes a barrier to accomplishing that goal. it should be noted that mi does not blame, label, or diagnose people (which would also be contrary to sbp). instead, mi attempts to help an individual change behavior toward being more consistent with the individual’s long term goals and values. another area of nuanced divergence may be in the domain of concrete resource acquisition. as described earlier, a major component of sbp is its emphasis on pragmatically using current resources, talents, and skills to form a plan for goal attainment. linking and using strengths for goal attainment moves well beyond simply knowing about or recognizing strengths, it is at the heart creative social work practice. where claims about spb sometimes go awry is when practitioners only become familiar with strengths and do not actually utilize them in action. motivational interviewing does advances in social work, fall 2011, 12(2) 135   more than just devote some attention to strengths. for instance, mi includes both goal planning and action step components that are related to strengths such as desires and table 1: depiction of the consistency of motivational interviewing with strengths-based practice. strengths principles explicitly consistent* philosophically consistent* 1. strengths based practice is goal oriented mi is focused on goals and values exploration. 2. strengths-based practice contains a systematic means of assessing strengths mi provides skills to assess individuals’ own confidence in their ability to make change. affirmation skills are used to reinforce strengths. 3a: strengths-based practice sees the environment as rich in resources mi assumes individuals know their environment and its resources better than anyone else. plans for change may or may not include naturally occurring resources. 3b: in strengths-based practice explicit methods are used for using client and environmental strengths for goal attainment although explicit methods are not always used, mi assumes that every individual group or family has strengths. the worker affirms personal and environmental strengths which can be used for goal attainment. the worker uses affirmation of strengths for the purpose of building self-efficacy. 4. the strengths-based relationship is hope-inducing the mi relationship facilitates hope, confidence and motivation for change. 5. in strengths-based practice the provision of meaningful choices is central and individuals have the authority to choose mi supports autonomy, choice and personal control. 6. strengths-based practice assumes that we best serve clients by collaborating with them collaboration is considered one of the essential aspects of the mi relationship that facilitates change. 7. strengths-based practice assumes trauma and abuse, illness and struggle, may be injurious but they may also be sources of challenge and opportunity mi is focused on helping people mobilize commitment to change despite historical problems. mi is primarily present and future focused, the past is informative but it is not the focus of the intervention. 8. strengths-based practice assumes that the worker does not know the upper limits of individuals’ capacity to grow and change belief that individuals truly can change and achieve their goals is considered basic to mi and clinical skills are developed meant to increase clients’ belief in their capacity for change. *the available category of not consistent was never used and therefore is not included in this table. manthey, knowles, asher, wahab/strengths-based practice and mi 136 abilities. however, mi does not go as far as other practices, such as strengths-based case management (rapp & goscha, 2006) which assists clients in developing very detailed strengths assessments and utilitarian goal attainment plans. these plans are then revisited repeatedly to help increase the likelihood that goals are met. while there is a lot of overlap between sbp and mi in this area there is also difference. the difference may be present because mi has a greater focus on building motivation while sbp’s such as sbcm have a greater focus on planning and action. therefore, because of their divergent foci, sbps such as sbcm and interventions like mi may benefit each other. finally, mi is described as a way of being with people (miller & rollnick, 2002) and is primarily used as a tool or intervention to address behavior change issues. it is a means for achieving positive behavior change ends. in other words, sbp provides an overarching perspective (saleebey, 2006) while mi is an approach that may not be appropriate for every situation (miller & rollnick, 2009). therefore, when workers are highly trained in mi they learn to smoothly move in and out of the mi intervention as needed (miller & moyers, 2006). in contrast, because of its overarching perspective, it has been contended that sbp may be appropriate for any human service interaction (saleebey, 2006). as discussed previously, sbp does not ignore barriers to goal attainment, but rather focuses on what is working well, coping strategies already developed, and on hopes for the future. mi may provide individuals who use sbp with skills to navigate situations where individuals want to change behaviors that get in the way of their long-term goals and desires. a good fit for social work research on sbp and mi suggest that there may be a potential useful alignment between the two approaches. we begin this section by reviewing empirical support for sbp and mi. we then discuss ways in which they may be used in conjunction. we conclude this section with a case-scenario which illustrates the potential reciprocal relationship between mi and sbp. empirical support for strengths-based practice strengths-based work is most explicitly articulated in case management practice (e.g. rapp & goscha, 2006); otherwise the notion of sbp is predicated on a set of values and principles. this conceptualization of sbp as an overarching perspective has garnered critique from researchers (e.g., staudt et al., 2001) who contend that it is difficult to assess a direct relationship between sbp and outcomes (for a detailed discussion on this topic see probst, 2009). despite this critique, there are several areas which show promise. the primary sbp research has been conducted on sbcm. four experimental, three quasiexperimental, and three non-experimental design studies have been conducted on sbcm which show positive results (barry, zeber, blow, & valenstein, 2003; bjorkman, hansson, & sandlund, 2002; kisthardt, 1994; macias, farley, jackson, & kinney, 1997; macias, kinney, farley, jackson, & vos, 1994; modcrin, rapp, & poertner, 1988; rapp & chamberlain, 1985; rapp & wintersteen, 1989; ryan, sherman, & judd, 1994; advances in social work, fall 2011, 12(2) 137   stanard, 1999). in addition, implementation of sbp has been attempted in a variety of fields such as substance abuse (brun & rapp, 2001; redko, rapp, elms, snyder, & carlson, 2007), school counseling (saleebey, 2008), gerontology (sullivan & fisher, 2004; whitley, white, kelley, & yorke, 1999), corrections (clark, 1997; leukefeld et al., 2003), and at-risk youth (arnold, walsh, oldham, & rapp, 2007; werrbach, 1996). there are also hundreds of conceptual or theoretical articles describing potential applications of sbp to a variety of populations and circumstances. further support comes from secondary sources. for instance, similar to the efforts presented in this article, rapp et al. (2005) systematically compared several intervention models to the tenets of sbp and proclaimed them strengths-based. these models include asset building, solution-focused therapy and supported employment (rapp et al. 2005). each of these related models have been studied in their own right, the results of which provide secondary support for sbp. for example, see kim’s (2008) meta-analysis on solution-focused therapy. sbp is further supported by complementary research in other fields such as resiliency, positive psychology, and common change factors research (norman, 2000; saleebey, 2006). empirical support for motivational interviewing mi has a very large evidence-base including over 200 empirical studies and over five meta-analyses showing positive outcomes (wagner & conners, 2010). a meta-analysis can take studies conducted in a variety of situations and with a variety of populations and combine the results to determine if there is a significant effect across studies, rather than just in isolated instances. an important meta-analysis conducted by hettema, steele, & miller, (2005) found that mi has an additive effect when combined with other interventions. the additive effect found by hettema et al. shows an increased length of intervention potency for individuals who receive a combined intervention approach across a variety of mi and other intervention combinations. in other words, it was found that when mi is combined with other interventions it may increase the effectiveness of both mi and the other approach. for instance, it may be that intervention models based on sbp (such as sbcm) may become more effective when used in combination with mi than either intervention might be when used alone. the additive effect finding lends weight to the contention that mi and sbp may be a good fit. for example, it may be easier to implement and learn mi skills if the overarching system that supports the worker functions from a strengths perspective. it may also be of benefit for workers who use sbps to build skills that increase hope and motivation within their clients. a combined approach there is some initial support for a combined sbp-mi intervention approach in the literature. while there are methodological weaknesses, some studies have shown a potential positive linkage between motivational interviewing and strengths-based work. one study, which focused on using mi to improve treatment entry for substance misusing adolescents, audio-taped and coded 54 sessions of workers utilizing the strengthsoriented referral for teens (sort) (smith & hall, 2007; smith, hall, jang & arndt, 2009). they found that when the worker had higher adherence to sort there was greater manthey, knowles, asher, wahab/strengths-based practice and mi 138 use of mi, a greater discussion of client strengths, and more utilization of solutionfocused language. another study which was designed to help offenders obtain employment had 500 drug court participants take part in mi and sbcm as pieces of an overall vocational intervention (leukefeld et al., 2003). the participants reported increased confidence and increased feelings of capability of finding employment or obtaining education. in addition, sbp may inform the worker trained in mi on how best to work with strengths during an action stage. sbp would provide workers trained in mi the ability to smoothly transition from mi skills into strengths-based skills appropriately matched to the individual’s readiness. sbp would complement mi as the individual receiving services moves into action planning. for instance, a large part of sbp is linking resources and strengths to a specific goal and creating initial tasks. sometimes an individual may be reluctant to pursue a strengths-based action plan because of low confidence. if this is the case, the worker’s ability to drop back and use mi skills which focus on building confidence may be beneficial. conversely, if a worker is using mi and a client becomes very motivated to change and is ready to develop an action plan, having that plan grounded in client strengths in a detailed and methodical fashion will likely increase success. both mi and sbp support personal empowerment and hold the belief that the individuals already have the skills necessary to solve their problems and achieve their goals. motivational interviewing and sbp place emphasis on the relationship as foundational to the change process and hold the belief that engendering hope is essential. sbp and mi do not expect workers to be experts in charge of how an individual changes. instead, both approaches enable the worker to become skilled at facilitating a process of exploring and reinforcing the client’s own goals, values, and strengths. mi may be an important aspect of strengths-based practice, particularly as one goes about conducting an assessment and then helping the individual hone in on a goal or set of goals important to him or her. concluding this section is a case-example which illustrates how sbp and mi may be used together. however, prior to the case-scenario it is helpful to note some of the microskills which are used in mi: (1) open-ended questions, (2) affirmations, (3) reflections and (4) summary statements. these micro skills are used to elicit change talk, in other words, desires, abilities, reasons, or needs for change (miller & rollnick, 2002). one of the unique characteristics of mi is that it is designed to elicit change talk rather than simply waiting for it to occur. this practice is similar to a worker listening for and affirming strengths. miller and rollnick (2002) have described many methods for eliciting change talk, including asking questions which often lead to answers containing change talk (e.g., in what ways might change be a good thing?) and avoiding questions which are likely to lead to resistance (e.g., why haven’t you changed?). when change talk is elicited, the worker may use reflection, affirmation, or requests for elaboration to elicit further change talk. the fundamental principles of motivational interviewing include: rolling with resistance rather than confronting it, expressing empathy for individuals’ experiences, advances in social work, fall 2011, 12(2) 139   developing discrepancy between where they currently find themselves and their long term goals and values, and supporting their self-efficacy (miller & rollnick, 2002). the fundamental principles of mi are supported through learning the behavioral micro skills. case-example julie is a mother of two who has been diagnosed with a psychiatric disability, has had history with the child welfare system, and has had difficulties with substance use. her children are aged two and five and are currently staying with julie’s older sister. julie is currently unemployed; however, she receives $570 a month in ssi. she rents a basement apartment from a long-term friend familiar with her situation. julie receives case-management services at her local community mental health center. her casemanager is assisting her in filling out a strengths assessment. the strengths assessment includes three domains: (1) current strengths (2) individual desires/aspirations, and (3) past resources. these three domains are present across seven categories: (1) home/daily living, (2) assets/financial/insurance, (3) employment, education/specialized knowledge, (4) supportive relationships, (5) wellness/health, (6) leisure/recreation, and (7) spirituality/culture. the purpose of the strengths assessment is to identify personal goals through exploration of the desires and aspirations domain, these goals are then linked with the current strengths and past resources domains (rapp & goscha, 2006). the eventual aim is to utilize the identified strengths and resources for goal attainment. the following transcript picks up after initial greetings are made and the strengths assessment is beginning to be filled out. worker: to start out julie, what would you like to see differently in your living situation? (open question) julie: i don’t know. i like where i live, nick’s known me a long time and understands me and my situation. i don’t think someone else would be as understanding. worker: having a landlord that understands what it’s like to have a psychiatric disability is important to you. (reflection) julie: yeah, he’s been a friend of my family for years, he knows my sister and my mom, and understands when things aren’t going well. i don’t think i’d get that kind of leeway if i rented an apartment from someone else. worker: so one of your strengths is having a relationship with nick who helps you out with housing and other things when you need him to. (reflection) julie: yes! he and mary even used to babysit for me sometimes when i still had my kids. he really is a nice guy. worker: he’s a good friend and you’ve really maintained a positive relationship with him. (affirmation) julie: yeah manthey, knowles, asher, wahab/strengths-based practice and mi 140 worker: so things are going pretty good and you don’t really have a goal for changing your housing or your living situation right now. (reflection). julie: i guess for my housing. but i really want my kids back. they live with my sister because supposedly i can’t take care of them. which i don’t think is true. stupid social workers taking away my kids! these people don’t have a clue what it’s like to be me. i’m a good parent! worker: so your kids were taken away and you think you’re a good mom and you want them to live with you. (reflection) julie: yeah! what else do you think i want? i’m a mom! i love my kids. worker: it’s a natural drive for mothers to want to take care of and be with their kids. (reflection). julie: yeah. it is. worker: what would it be like if you had your kids back living with you? (open question) (writes “i would like to gain custody of my kids” in the individual desires, aspirations domain of the daily living category on the strengths assessment). julie: it would be awesome! i wouldn’t have to visit them at my sister’s and we could be alone together. last time i got my kids back i tucked them into bed every night and sang songs to them. i was a good mom. i took them to the park all the time and i made really good meals, not like when i’m living alone and only cook for myself. worker: you’ve taken care of them most of their lives and you’ve been successful at getting your kids back before. (reflection) julie: yes. worker: what was it that happened that made it possible for you to get your kids last time? (open question) julie: well the main thing was that i was clean and sober. that’s really what the court wanted me to do. when i’m not using my kids are able to stay with me. worker: so the biggest barrier to you achieving the goal of having custody of your kids is drug use. (reflection) julie: yes, they told me that as long as i was using i couldn’t keep my kids. worker: and you really want your kids back because being a mother is a big part of who you are as a person, you love your kids, and you think you would be a good at taking care of your kids. (reflection) julie: yeah, i would be good at taking care of my kids. no one else should parent my kids. i’m a good mom. worker: having your kids live with you would be the best thing for your kids. (reflection). advances in social work, fall 2011, 12(2) 141   julies: yes! they tell me they want to come back and live with me and they miss me so much. i love my sister, but she isn’t their mother. i am their mother and i know them best and how to take care of them best. worker: what else did you do that made you feel like you were successful at being a parent. (open question) julie: well, everything wasn’t always great, sometimes things were hard. but we always got by. i never hit my kids, and i always told them i loved them. we might not be perfect but we’ve always been a close family. worker: good for you! it can be hard not to take out your frustrations on others when things are hard, but you try really hard not to do that to your kids. (affirmation and reflection) julie: yeah, i do try really hard not to do that. worker: that’s important to you. (reflection) julie: yes it is. worker: and you’re a close family. (reflection) julie: yeah, like when we watch tv together, we all cuddle together in a big group. i know some families who can’t stand being in the same room together, but we like to cuddle and talk and watch tv. it used to be my favorite time of the day. worker: you love your kids a lot and they love you. (reflection) julie: i miss them so much. worker: so one thing you are considering is attempting to stay sober so that you can get your kids back. and you’ve done it before so you think you’ll be able to do it again. (reflection) julie: yep, that’s what i’m going to try to do. worker: and you have a lot of strengths that might help you with that goal, such as your past success as a parent, some skills you’ve developed that help you deal with frustration, and maybe even having stable housing with your friend nick. (summary) julie: i guess i do. note that the worker used the open-ended questions strategically to elicit strengths and then affirmed them. even though the initial topic was ultimately about a selfidentified problem (julie having her kids taken away) the problem was also a positive life goal about being a good parent. the strength of desiring to be a good parent may even drive other positive changes in the future (such as obtaining a job or obtaining an education in order to better provide for her children). just as saleebey (2004) and weick, kreider, and chamberlain (2006) point out, often one has to start out with a problem and then listen carefully for desires, talents, resources, and other strengths that may be glimmering in the background. the worker was careful to listen for the strengths that were in julie’s story and sometimes reframed perceived problems as strengths. manthey, knowles, asher, wahab/strengths-based practice and mi 142 the worker also elicited change talk such as julie’s past successes and her desires to have her kids back. in some cases the worker elicited strengths and change talk that were the same, such as when julie discussed her ability to avoid taking out her frustrations on her kids and other positive parenting skills. the worker strategically used reflections and open questions to obtain these types of responses rather than focusing on deficits or diagnoses or asking questions that might engender resistance. motivational interviewing as with sbp breaks ties with the past and changes to focus on a future beyond the problem (miller & rollnick, 2002; weick et al., 2006). in this scenario the worker, together with julie, filled out the rest of the strengths assessment. they discussed many topics during a relatively short period of time in order to get a snapshot of what julie’s ultimate goals and desires were. however, as with all sbps it is intended that the strengths assessment will be an ongoing and dynamic process over time. together, julie and the worker also identified strengths and resources. the following is julie’s sample strengths assessment (format and content adapted from rapp & goscha, 2006). table 2: julie’s strength’s assessment current strengths: what are my current strengths? (i.e. talents, skills, personal and environmental strengths)? individual’s desires, aspirations: what do i want in my life? past resources – personal, social, & environmental: what strengths have i used in the past? home/daily living rents basement apartment good relationship with landlord nick have most of the physical things i need (furniture, cooking utensils etc.) has good parenting skills “i want to gain custody of my kids” “i’d like a computer or laptop” -was able to gain custody of kids last year. knows a guy that can get electronics at a discount assets financial/insurance currently receives $570 in ssi has medicaid receives food stamps “i want to earn more money so i have the freedom to do more things and get a computer” i pay most of my bills on my own and on time. employment/education/specialized knowledge knowledgeable and skilled with the food industry “i am learning more and more about recovery all the time” “i want to get a job where i get to cook things i like” “i might want to get a chef or other cooking certification” “i think i would be a good peer support worker” has worked in several fast food positions, and once as a waitress. graduated from high school advances in social work, fall 2011, 12(2) 143   supportive relationships sister (megan) listens to me and cares for my kids mom (susan) take me places when i can’t get there by bus nick (landlord) has known me a long time and tries to understand me neighbor (fran) used to watch my kids sometimes and very friendly rose (case manager) helped me believe in myself and learn about recovery “i would like to have more friends” -“i have always been close with my mom and sister” ex-boyfriend (bob) used to be a good support (“he made me feel good inside”) stewart (children’s father) used to be a good financial support for a while. wellness/health lamictal helps with my mood “i don’t feel suicidal as much” -“talking to others about how i’m feeling helps” -“i have started exercising when my sister lets me borrow her pool pass” “i want to continue to be healthy and stay in recovery” “going out and doing things made me feel better about myself” (e.g. movies, dancing, shopping, etc.) leisure / recreational enjoys music (salsa and swing) and dancing (swing) "i like watching murder mysteries and other tv shows, especially with my family” “i want to make more friends and spend time with them” used be involved with the high school dance club. went out for track in high school used to love to swim spirituality/culture -“god has been with me even when everyone else wasn’t” “i would like to find a church where i feel accepted for who i am” -“going to church on sunday and going to bible study on wednesdays was important in my childhood” after the strengths assessment is completed, the worker attempts to help julie prioritize which goals she would like to work on. worker: we’ve talked about quite a few things today, julie. is it okay if i talk with you a little bit about what others have found helpful in similar situations? (closed question asking permission) julie: sure worker: a lot of people find that they don’t need help with all of the goals that they put on the strengths assessment. many people just want help with a few big things and then they attempt to achieve other goals on their own or at a later time. for some manthey, knowles, asher, wahab/strengths-based practice and mi 144 it’s also been easier to attempt only a few goals at a time so that they don’t get pulled in too many directions at once. but that’s really up to you. you have lots of options. what do you think? (giving information and open question) julie: this sounds fine to me. i don’t really need help finding a new church anyway. i can do that on my own. worker: so what are the top two or three goals that we’ve discussed today that you might like my help with? (closed question) julie: i definitely want to get my kids back. they’re the most important people in my life. i also need help getting a job as a cook or chef or something…but not waitressing, i want to cook, not work tables or the register. those are the two biggest things. i might also like a computer, but i can’t afford one right now. worker: so managing your sobriety so that you can get your kids back and getting a job as a cook so that you can do more things and perhaps get a computer really top your list. (reflection). julie: yep! in this section the worker was careful to not give unsolicited advice, but instead consciously chose to instill autonomy and choice throughout the process. the worker helped julie to prioritize and set the agenda for their future work. from here the worker can: (1) help julie to link strengths (e.g. desires, resources, abilities, and skills) to a practical plan for goal attainment, as well as move into motivational interviewing and elicit change talk when needed (e.g. desires, abilities, reasons and needs for change) in order to increase motivation, confidence and hope. implications for social work based on our systematic comparison we contend that mi and sbp are highly compatible. given the wide use of sbp, implications from this analysis include that mi may be of benefit for social work agencies, researchers, educational institutions, and practitioners. these implications are detailed in the following subsections. social work agencies agencies who want to more closely operate from a sb approach may benefit from motivational interviewing skillset acquisition which may augment their sb efforts. if agencies struggle to determine hands on skill development that include strengths-based elements and is evidence-based, they may turn to mi. it is also recommended that systemic barriers to implementation of mi (such as programs that emphasize external motivators, confrontation, and problem focus) may find that those barriers are overcome if they develop an overarching strengths-vision and culture. as described previously a combined mi-sbp approach may have the potential of sustaining good outcomes longer (e.g. hettema et al., 2005). agencies that report that they frequently have issues with client “compliance” may want to consider utilizing a combined mi-sbp approach to reduce adversarial interactions between staff and participants. programs that find that advances in social work, fall 2011, 12(2) 145   they sometimes sacrifice long term behavior change for short term compliance may also want to use this approach. social work research social work has distinguished itself from other helping professions through its focus on facilitating change (fraser, 2004) and, at its most basic element, research in the social work field entails the study of intervention and the development of systematic change strategies (fraser, 2004; thyer, 2007). motivational interviewing is an intervention geared toward helping individuals talk themselves into behavior change. strengths-based practice is meant to envision, explore and assist individuals in achieving their goals. both approaches are not only compatible with each other but are consistent with this important fundamental aspect of social work research. we echo the rapp et al. (2005) recommendation that researchers who wish to contend that a given intervention is strengths-based conduct a systematic analysis in order to support such an assertion. the eight domains used here may be beneficial for researchers who wish to conduct a similar comparison of other interventions. the additive effect of mi (hettema et al., 2005) described previously is intriguing and lends support for further research aimed at measuring the outcomes of a combined mi-sbp approach. researchers may use this analysis as a launching point for future studies. in addition, further analyses and research into each of the above eight domains would benefit both mi and sbp researchers as they attempt to refine their approaches. social work education schools of social welfare may want to include mi in their curriculum as is currently the case in schools such as portland state university, university of utah, and eastern washington university, among others. some social work professors have suggested that mi may fit well within hbse coursework (van wormer, 2007) while others have suggested that mi could play a larger role in social work practice and education (hohman, 2011; wahab, 2005). it is important for social work educators to be able to measure a student’s competency when teaching skills-based interventions. while there is an instrument available that measures an agency’s fidelity to sbcm (rapp & goscha, 2006) there are no instruments which measure an individual worker’s skills or competence at providing sbp. in contrast, there are several different instruments which can be used to measure a student or worker’s ability to provide mi. for example, the motivational interviewing skills code (misc) (miller, moyers, ernst, & amrheim, 2003) and the motivational interviewing treatment integrity manual (miti) (moyers, martin, manuel, miller, & ernst, 2007) provide valuable information about the degree to which an individual provides practice which is adherent to mi. if schools were to utilize such instruments not only would they be able to contend that they teach content on sbp but that students graduate with a demonstrable ability to utilize a practice that contains sb elements. manthey, knowles, asher, wahab/strengths-based practice and mi 146 teaching sbp content is a requirement for reaccreditation by the council on social work education (cswe) and the infusion of sbp into social work bsw and msw programs has been a central theme for many schools of social work (cox, 2001; donaldson, early, & wang, 2009). in addition, the recent move away from content-based school accreditation toward competence-based school accreditation by cswe means that a practical means of measuring whether a practitioner is delivering sbp needs to be developed. until this occurs, adding mi into practice coursework or adding a standalone mi class may be beneficial. social work practitioners identifying and affirming strengths is key to the value stance of the social work profession (wilson, 2006); therefore, using sbp and mi may provide an effective practice approach for professionals who find the values consistent with their personal practice vision. using interventions that are consistent with social work values and ethical principles is an important additional criterion workers should use when selecting an approach. mi is consistent with sbp and is also consistent with other principles and values described in the nasw code of ethics such as self-determination. using an mi-sbp approach may help both the worker and the client feel less tension within the helping relationship. a combined approach may also help the worker develop skills to more easily align with client goals. social work practitioners are progressively becoming burdened by increasing case load sizes and other demands. mi has been recommended as a possible means for professionals to reflexively assess their own practice in order to potentially prevent burnout and avoid compassion fatigue (parks, 2007). therefore, using an mi-sbp approach may not only reduce tension in the helping relationship but reduce tension for the worker in other ways through reflective practice. most importantly, using an mi-sbp approach may increase the likelihood that clients will achieve lasting behavior change and goal attainment. references amrhein, p. c., miller, w. r., yahne, c. e., palmer, m., & fulcher, l. 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(1999). strengths-based case management: the application to grandparents raising children. families in society, 80(2), 110-119. wilson, s. z. (2006). field education: linking self-efficacy theory and the strengths perspective. the journal of baccalaureate social work, 12(1), 261-274. author note: address correspondence to: trevor jay manthey, 3 twente hall, lawrence, ks 66044. email: trevormanthey@gmail.com microsoft word 9. luna et al_15692-writing across the curriculum_copyedit final ______________ naelys luna, ph.d., and e. gail horton, ph.d., are associate professors in the school of social work, and jeffrey r. galin, ph.d., is an associate professor and director of the university center for excellence in writing, all at florida atlantic university in boca raton, fl. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 390-408 the effectiveness of writing across the curriculum in a baccalaureate social work program: students’ perceptions naelys luna e. gail horton jeffrey r. galin abstract: effective social work practice requires strong writing and communication skills; however, social work students often experience difficulties performing academically at expected levels. this article presents findings from a student survey that was collected for two years to assess perceptions of the effectiveness of writing across the curriculum (wac) strategies on writing skills and social work knowledge acquisition in an introductory social work class that is taught every semester at a school of social work located in southeastern florida. students reported that wac strategies substantially improved their abilities to write in the discipline and learn course content. based on our findings, it is recommended that schools of social work infuse wac throughout their curriculum, a process that requires cross curricular collaboration, intra-departmental support, and faculty commitment to course development and implementation. keywords: wac, baccalaureate curriculum, writing skills, communication skills, social work content effective social work practice requires sound writing and communication skills. students entering social work programs, however, experience difficulties performing these skills at expected levels. it is imperative to identify, implement, and assess pedagogical techniques that will address these problems, thereby increasing student engagement and preparing them for successful performance of their professional responsibilities in the field. writing across the curriculum (wac) programs provide pedagogical techniques that are promising for improving writing and critical thinking skills among college students (bean, 2001). beginning in 2006, we developed a course that introduces students to social work values, ethics, and practice areas through the use of wac techniques. the course continues to be taught every semester in multiple sections. when the course was first developed, we asked students to complete a student selfreport survey to assess and describe their perceptions of the wac course to determine its effectiveness and provide students with an opportunity to reflect on the development of their writing across the term. we used a self-report survey in this study because selfreport instruments have been described in the literature as usual methods of measuring learning strategies (veenman, 2011) and collecting information about respondents’ perceptions and attitudes about a particular subject (schellings & van hout-wolters, luna, horton, galin/effectiveness of writing across the curriculum 391 2011; veenman, 2011). in line with suggestions by multiple authors (robinson & burton, 2009; rubin & babbie, 2008; schellings & van hout-wolters, 2011; veenman, 2011) concerning the utility of self-report measures, the self-report format allowed us the flexibility to include multiple questions about the efficacy of the course with minimal loss of class time. in addition, since the students were already familiar with surveys utilizing likert-like scales, the format produced minimal distress for them and, at the same time, made the project both costand energy-efficient for the researchers. the results of the survey showed that nearly all respondents reported substantial to moderate improvement in writing and critical thinking skills. students also reported that the process of writing facilitated acquisition of social work knowledge. these findings are highly encouraging for educators in our discipline, even though the high expectations for effective writing of this labor-intensive course challenged both students and faculty. this paper presents survey findings on the perceived benefit of selected wac strategies and techniques (substantive professor feedback, multiple drafts, peer review) on students’ writing skills and social work knowledge acquisition. we have identified four themes within the survey for data reporting, including student perceptions of: 1) the general benefit of this course in improving their ability to write in the social work profession; 2) specific elements of composition, structure and style that they believed were improved (e.g. writing thesis statements, reorganizing and/or clarifying ideas, apa format, and proofreading for patterns of error) or needed further improvement after taking the wac course (e.g. introduction, organization, argument); 3) specific wac techniques that they believed were most effective in improving their writing skills; and 4) specific wac techniques that facilitated their learning of social work content. the authors hypothesized that students would indicate substantial improvement in their writing skills after completion of the course and would indicate that wac techniques facilitated knowledge acquisition of different content areas in social work. we offer a brief explanation of wac principles, followed by a description of the profession of social work wac course and ways we examined its perceived benefits. writing across the curriculum since researchers and educators agree that social work students entering the field must be able to express their professional opinions and judgments in writing (alter & adkins, 2006; knight, 1997; rompf, 1995; simon & soven, 1990), it is important to examine pedagogical techniques that can ensure that students’ writing skills are adequate for the work that they will be doing in the field. the wac movement, which emerged in the 1970s, provides pedagogical techniques that faculty use to enhance the educational outcomes of students (mcleod & maimon, 2000). proponents of the movement believed that writing could and should be used not only as a way to deliver some message that one wants to communicate, but also as a way to develop critical thinking that enhances the learning experience (bean, 2001). today, the main purposes of writing assignments based on wac principles are “to use writing as a tool for learning rather than a test of that learning, to have writers explain concepts or ideas to themselves, to ask questions, to make connections, to speculate, to engage in critical thinking and problem solving” (mcleod & maimon, 2000, p. 579). assignments should be developed so that they do not advances in social work, fall 2014, 15(2) 392 allow a single right answer, but rather require students to develop and utilize critical thinking skills in a discussion of multiple points of view (bean, 2001). thus, while students refine their writing skills, they also learn course concepts through the writing process itself. description of the wac class the introductory wac social work course that was developed in our school resulted from an emerging culture of support for writing in the school of social work. over the course of six years, half of the social work faculty, including the chair, participated in wac seminars and made a commitment to integrate wac principles throughout the curriculum. the wac course developed by the authors is a three-credit, upper division class that is taught in multiple sections every semester. all undergraduate social work majors must pass it before they can enter practice courses and go into their field internship placements. the course combines traditional elements such as lectures, videos, in-class discussions, quizzes, midterm, and final exams with wac writing assignments. these assignments require multiple drafts, substantive instructor feedback on drafts, and peer review. the class includes information on the various practice areas in social work, an introduction to basic social work values and ethics, and an explanation of the generalist intervention model. students are expected to complete two wac writing assignments. the first is a short paper (5 to 6 pages including title page, abstract, and reference page). it requires them to compare and contrast the institutional (conservative), residual (liberal), and person-inenvironment perspectives concerning the provision of social welfare services as they apply to a case study. the second is a longer paper (10 to 12 pages including title page, abstract, and reference page). it requires students to read an article on the problems that can arise from engaging in dual relationships with clients and apply the concepts in that article to another case study. these two papers comprise 60% of students’ final grade. both assignments are considerably more complex than students expect when they enter the class, requiring them to write their papers using logical organization, acceptable professional language, and adequate apa formatting. we made a conscious choice to focus on academic writing rather than practice writing in this introductory course because we wanted students to learn how to read and think critically and express themselves clearly and coherently within the discipline. students have opportunities to acquire field writing skills in later practice courses. to support the students’ efforts as they refine their drafts over the semester, the teachers provide instruction during every class on how to organize a paper, write adequate introductions and conclusions, and argue and support their ideas. a grading rubric that incorporates these ideas is supplied to the students during the first class that they use for writing their papers and self-evaluation. the rubric helps them see exactly what is expected of them as they write each section. it was developed by faculty members teaching the course to help them organize both their thinking and their writing. for example, the rubric specifies the writing elements that need to be included in the abstract, introduction, body, and conclusion of the paper (e.g., purpose, importance, thesis, and luna, horton, galin/effectiveness of writing across the curriculum 393 organizational statements in the introduction). in addition, it specifies the required apa format and grammar and punctuation rules (see appendix for the rubric itself). in addition, students use the rubric for a peer review process. first, a formal peerreview process is introduced by modeling it for students once in class; then students work in pairs outside of class, providing written feedback to each other using the grading rubric to ensure that they are addressing all of the elements of the paper. this process enables them to work with each other informally throughout the semester. from this explanation of the class structure, readers may surmise that this course is challenging to both students and instructors. students may have entered class with english as a second or third language or may never have been held to such high standards for writing performance. students are frequently concerned about the complexity of the assignments, as well as the high expectations of their professors because they are encountering professional writing in the discipline of social work for the first time. faculty also find the course challenging because they read and comment on multiple students’ drafts, which require substantial time and attention. approximately 50% of class time is devoted to the content and organization of the two written assignments and to writing strategies and techniques. early drafts may require up to 35 minutes per paper to evaluate, and there are up to 25 students in a class. the time instructors spend responding to revised drafts is nearly cut in half as a result of substantial revision. however, given the survey results and the authors’ perceptions of their students’ improvement, the authors concur with light (2001) that “writing plays a pivotal role in the academic lives—and the academic success—of most students” (p. 55). more specifically, integrating writing—and specific writing strategies in particular—is instrumental to the professional development of social work students. method design and sample this descriptive cross-sectional study utilized a self-report survey developed to determine students’ perceptions regarding the effectiveness of wac strategies on their writing skills and social work content knowledge acquisition. the survey was developed during the spring semester of 2008. upon institutional review board approval, the survey was administered at the end of each semester during fall and spring terms 20082010. participants included students attending the wac course on the date the survey was distributed. one hundred eighty-two students completed the survey. students survey questionnaire the survey components were grouped into four categories: 1) the general benefit of the course in improving students’ ability to write in the social work profession; 2) specific elements of composition, structure and style that students believed were improved or needed further improvement after taking the wac course; 3) specific wac techniques that students believed were most effective in improving their writing skills; and 4) specific wac techniques that facilitated students’ learning of social work content. advances in social work, fall 2014, 15(2) 394 data were collected concerning demographic characteristics including respondents’ age, gender, ethnicity, marital status, employment status, and place of birth (born in the united states). general benefit of the course improving writing. students used a 5-point likerttype scale to indicate their overall impression regarding the perceived benefit of the wac techniques employed in the course on their writing skills. for example, students were asked to rate the degree of writing improvement (0 = no improvement to 4 = substantial improvement). they were also asked to rate what contribution the writing component made to their overall learning (0 = none at all to 4 = substantially). other questions included rating the extent to which students’ critical thinking skills (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation) will transfer to future courses (0 = not at all to 4 = substantially), and the degree of confidence that they have improved their ability to write for the social work profession (0 = not confident at all to 4 = very confident). specific elements of composition, structure, and style improving writing. students used a 4-point likert-type scale to indicate their perceptions regarding their improvement of specific writing elements in their writing skills. for example, students were asked to rate the degree to which the wac revision process helped them to: 1) change focus or thesis; 2) reorganize substantially; 3) clarify ideas; 4) correct misinterpretations; 5) strengthen the relationships between ideas; 6) respond more effectively to the assignment; 7) proofread patterns of error; 8) correct citations; 9) provide additional evidence; and 10) reformat paper (0 = not at all to 3 = to a substantial degree). a separate question asked students what writing skills needed further improvement after taking the wac course (i.e., introduction, organization, transitions, arguments, analysis). a single question using a 5-point likert-type scale (0 = no improvement to 4 = substantial improvement) assessed students’ perceptions about learning apa format. specific wac techniques improving writing. students used a 4-point likert-like scale to indicate their perceptions about the effectiveness of three wac techniques on their writing skills. the first technique was the use of multiple drafts for each assignment. respondents were asked to rate the degree of improvement from the first draft to the final draft (0 = no improvement to 3 = substantial improvement). students were also asked to identify the primary sources for the changes in their revisions (i.e. professor, writing center, classmates’ feedback, response from outside readers). the second technique involved the professors’ feedback. respondents were asked to rate their perceptions about how successful their assignment was before and after receiving feedback from their professor (0 = not very successful to 4 = very successful); students were also asked how many of the professors’ comments they attempted to address (0 = none to 5 = all). the last technique involved the peer review process in which students were asked to review and comment on a classmate’s assignment using the grading rubric. respondents were asked to rate the usefulness of classmates’ comments on the revision process (0 = not useful at all to 4 = very useful). luna, horton, galin/effectiveness of writing across the curriculum 395 specific wac techniques facilitating learning content. respondents were asked five questions concerning to what extent the writing assignments in the class helped them learn about social work ethics and values, generalist practice, different areas of practice, and comprehending academic articles (0 = none at all to 4 = substantially). data analysis quantitative analyses consisted of descriptive statistics and bivariate analyses using a likert scale to determine the perceived benefits of wac on writing skills. frequencies, percentages, means, and standard deviations were reported. it is noteworthy that the number of students in some analyses (i.e. gender, ethnicity) do not correspond with the number of students in the total sample because not all students responded to all questions. thus, n varies from 182 in several examples below. results demographics of participants there were 182 student respondents: 89% females (n = 159), and 11% males (n = 20). age ranged from 19 to 55 years old, with a mean of 27. twenty-five percent of the sample was born outside of the united states. approximately 26% (n = 48) of the respondents identified themselves as european american, 23.6% (n = 43) as african american, 15.9% (n = 29) as latino, 16.5% (n = 30) as caribbean/west indian, 3.3% (n = 6) as native american, and .5% (n = 1) as asian american. more than half of the sample (n = 99) reported being single, while 19.5% (n = 34) indicated being legally married, 10.3% (n = 18) cohabitating with partner, 8.6% (n = 15) divorced, 3.4% (n = 6) separated, and 0% were widowed. approximately 13% (n = 22) reported working more than 40 hours per week, 20.6% (n = 36) reported working 40 hours per week, 41.7% (n = 73) worked fewer than 40 hours per week, 17.7% (31) were unemployed, and 7.4% (n = 13) were homemakers or retired. general benefit of the course improving writing thirty-six percent of the sample reported substantial improvement in writing, while 54% reported moderate improvement. a little over 13% (n = 24) of students reported minimal improvement, and only 1.7% reported no improvement at all. similarly, 38% (n = 68) reported that they were very confident that this course improved their ability to write for the social work profession; 49% (n = 88) reported being moderately confident about this skill; 11.2% reported being somewhat confident; and 1.7% (n = 3) were not confident at all. concerning critical thinking skills, approximately 62% of students reported that their efforts put into the writing assignments will help them substantially apply the knowledge learned in the course to other situations, break down information into component parts, and critically evaluate ideas and information. figure 1 shows the results of questions concerning specific ways in which the course was beneficial. at least half of the respondents reported that this course will help them substantially remember, comprehend, and synthesize information while about 60% of the respondents indicated advances in social work, fall 2014, 15(2) 396 that the course would help them apply knowledge to future courses and analyze and evaluate information. figure 1. students’ response to survey item: how much will the efforts you put into writing assignments help demonstrate the following skills in the future? specific elements of composition, structure and style improving writing results show that 62% (n = 113) of students reported that their use of apa format substantially improved as a result of this course, 31% (n = 57) reported a moderate improvement, 5% (n = 10) reported minimal improvement, and only 1% (n = 2) reported no improvement. figures 2 and 3 present the results of questions concerning skills students felt still need improvement after taking the wac course. approximately half (n = 84) reported that they need to improve the use of apa style; 43% (n = 78) reported grammar and punctuation; 37% (n = 68) indicated the development of a strong thesis statement; 29% (n = 52) organization; 26% (n = 47) arguments; 22% (n = 40) use of paraphrase and direct quotation; and 20% (n = 37) conclusions. 50% 50% 54% 58% 60% 62% 38% 41% 39% 34% 33% 33% 11% 7% 6% 7% 6% 4% 1% 2% 1% 1% 1% 1% 0% 20% 40% 60% 80% 100% knowledge(remembering information) synthesis (putting pieces back togther in a new way or fresh ways) comprehension (establishing basic understanding) evaluation (critically evaluating ideas, information, or texts) analysis (breaking information down into component parts) application (applying knowledge learned in the course to other situations) not at all minimally moderately substantially luna, horton, galin/effectiveness of writing across the curriculum 397 figure 2. students’ response to survey item: i still think i need to improve _____ in my writing students also reported that they wished they could improve their writing in the following ways: 35% (n = 63) organize thoughts; 27% (n = 49) edit; 25% (n = 45) think critically; 24% (n = 43) communicate; 19% (n = 34) paraphrase; 11% (n = 20) summarize and evaluate; and 10% (n = 18) persuade. 1% 6% 6% 13% 16% 16% 20% 21% 22% 26% 29% 37% 43% 46% 0% 20% 40% 60% 80% 100% no improvement needed understanding of plagiarism other introductions analysis case study analysis conclusions transitions use of paraphrasing and quotation arguments organizations development of a strong thesis grammar and punctuation apa style advances in social work, fall 2014, 15(2) 398 figure 3. students’ response to survey item: i wish i could _____ more effectively in my writing figure 4 presents the results of the analyses concerning the writing elements students used more frequently as they revised their work. students reported that the following wac writing elements were used to a substantial degree during the revision process: 1) 61% (n = 104) proofread for patterns of error in grammar, punctuation, spelling, and word choice; 2) 58% (n = 100) corrected misinterpretations; 3) 56% (n = 95) responded more effectively to the assignment; 4) 55% (n = 95) clarified ideas; 5) 52% (n = 90) corrected citations and references; 6) 50% (n = 85) clarified sentences; 7) 40% (n = 68) strengthened relationships between ideas; 8) and 9) 38% (n = 65) provided additional evidence and reorganized the assignment substantially; 10) 37% (n = 64) reformatted the assignment; and 11) 29% (n = 50) changed the focus or thesis of the assignment. 10% 11% 11% 19% 24% 25% 27% 35% 0% 20% 40% 60% 80% 100% persuade summarize evaluate paraphrase communicate think critically edit organize thoughts luna, horton, galin/effectiveness of writing across the curriculum 399 figure 4. students’ response to survey item: rate how much you used each of the following revision elements. specific wac techniques improving writing forty-seven percent (n = 79) of students reported that the multiple revisions of the writing assignments helped them improve their writing substantially from the first draft to the final draft, 42% (n = 71) reported moderate improvement, and 4% (n = 7) of students felt that they had fulfilled the assignment very successfully before the professors’ feedback. in comparison, 19% (n = 33) of students felt that after receiving professor feedback, they had fulfilled the assignment very successfully. thirty-four percent (n = 62) felt that they had been successful in fulfilling the assignment before professor’s feedback, and 51% (n = 92) reported feeling that they had been somewhat successful. in comparison, 33% (n = 58) and 29% (n = 51) reported feeling successful or somewhat successful, respectively, after the feedback. seventy-seven percent (n = 135) reported 29% 37% 38% 38% 40% 50% 52% 55% 56% 58% 61% 36% 32% 42% 38% 44% 40% 35% 38% 42% 35% 35% 35% 31% 20% 24% 16% 10% 13% 7% 3% 7% 5% 0% 20% 40% 60% 80% 100% changed focus or thesis reformatted (margins, titles, headersm footnotes, etc.) reorganized substantially provided additional quotations or evidence strengthened relationships between ideas (transitions) clarified sentences corrected citations and references clarified some ideas responded more effectively to assignment corrected misinterpretation/misreading proofread for pattterns of error in grammar, punctuation, spelling,… not at all to some degree to a substantial degree advances in social work, fall 2014, 15(2) 400 attempting to respond to all the professor’s comments, while 17% (n = 30) responded to most, 5% (n = 8) responded to some, and 1% (n = 2) responded to none. eighty-nine percent (n = 162) also reported that the primary source for the changes made on their papers came from the professors’ comments. twenty-six percent (n = 32) and 35% (n = 44) of students reported the peer review process to be very useful or somewhat useful respectively, 26% (n = 33) reported it to be minimally useful, and 13% (n = 16) not useful at all. thirty-three percent (n = 60) of students reported that they used their classmates’ responses during the peer review process as a primary source for making revisions of their assignments. specific wac techniques facilitating learning content forty-one percent (n = 73) of students indicated that this wac course, compared to non-wac courses, substantially contributed to the overall learning of course material, 44% (n = 80) reported moderate contribution, 13% (n = 24) reported minimal, and 2% (n = 3) reported none at all. in addition, 73% (n = 132) of students reported that the writing assignments in the course substantially helped them to learn about social work ethics and values, 51% (n = 91) about generalist practice, and 42% (n = 75) about different areas in social work practice (e.g., criminal justice, schools, children and families) (see table 1). forty-seven percent (n = 85) of students indicated feeling very confident, 41% (n = 75) moderately confident, 11% (n = 19) somewhat confident, and 1% (n = 2) not confident at all about comprehending academic articles after taking this class. table 1. extent to which writing assignments helped student to learn different social work content areas substantial moderate minimal none at all social work content areas n % n % n % n % ethics and values 132 73 39 22 10 6 0 0 generalist practice 91 51 73 41 15 8 0 0 different areas of practice (i.e., children and families, school, etc.) 75 42 71 39 26 14 8 5 discussion the purpose of this paper was to present survey findings on the perceived benefit of wac strategies and techniques on students’ writing skills and the acquisition of social work knowledge. effective social work practice requires sound writing and communication skills. previous studies have indicated concerns among social work educators resulting from their students’ academic difficulties. furthermore, the council on social work education has changed accreditation standards to emphasize educational outcomes demonstrating students’ competencies for the practice of social work (council on social work education, 2008). thus, it is crucial to identify, implement, and assess luna, horton, galin/effectiveness of writing across the curriculum 401 pedagogical strategies that improve the skills of future practitioners. the findings of this study are promising because participants reported that the wac strategies and techniques employed in the course were effective in improving their ability to write professionally and to think critically about important social work concepts. in regard to the perceived general benefit of the wac course, 36% of 172 participants reported substantial improvement in their writing skills, and an additional 54% indicated moderate improvement. thirty-eight percent of the sample reported being very confident that this course helped them to improve their ability to write for the social work profession. sixty percent of the sample reported that the skills they learned, developed, or improved in this course will transfer to future courses. the three wac techniques examined in this study appeared to be effective. approximately half of the sample reported that the multiple revision process helped them substantially to improve their assignment. eighty-nine percent of the respondents indicated that professors’ feedback was the primary source for revisions they made in their writing. in addition, more than half of the sample reported that the peer-review process was very useful or somewhat useful. respondents identified multiple writing skills that were improved as a result of the wac course. some of these skills included correcting patterns of errors in grammar, punctuation, spelling, word choice, responding more effectively to assignments, clarifying ideas, reorganizing the assignment, and providing additional evidence to support claims. furthermore, the wac course appeared to be effective in helping students learn the apa format and social work content (e.g., sixty-two percent of the sample reported that their use of apa format substantially improved). the course writing assignments were fundamental in helping students learn social work content. seventy-three percent of the respondents indicated that the writing assignments substantially helped them learn about social work ethics and values, fiftyone percent about generalist practice, and forty-two percent about different areas in social work practice including criminal justice, schools, and children and families. these results confirm light’s (2001) general claims for undergraduate perceptions of student writing and their engagement in course material. he reports that there is a stronger relationship between the amount of student writing in a course and student engagement than with any other factor, including impressions of faculty, whether the course was required or not, or whether the course fulfilled a requirement in a major. light found that courses with more than twenty pages of “final draft writing” take about twice as much time as courses with no formal writing assignments (p. 56). students also reported that the greater amount of writing required, the greater they found the intellectual challenge of the course. finally, they reported that the impact of writing assignments on their engagement was dramatic. implications for teaching and curriculum development the results of this study suggest that the school’s commitment to writing is justified. the integration of wac into the social work curriculum involved extensive faculty training, including a three-day intensive wac seminar, several months of planning and designing the course’s written assignments, and development of writing assessment tools. advances in social work, fall 2014, 15(2) 402 in addition, the authors received a wac grant to develop and produce a dvd for orienting students to the importance of writing in the field of social work. the school also provided wac workshops for adjunct faculty teaching non-wac courses to familiarize them with the school’s writing expectations and to help them introduce writing strategies into all of their courses. these efforts have resulted in social work students earning the second highest scores in a university wide assessment of writing assignments across eight different departments. figure 5 shows the results of a stratified random sample of student papers submitted from 10 to 15 wac classes a semester across the university. each paper was rated using a 12trait rubric on a four point scale, with 4 representing highest ability, and 1 representing least ability. social work and nursing were the only departments whose scores were rated statistically significantly higher than the other departments. given the difficulty and high expectations of the course, this outcome is particularly noteworthy. figure 5. results from an assessment of wac programs across the university there are three significant factors that may account for the positive outcomes of this course: 1) the commitment of the core faculty members who initiated, developed, and continue to teach the course; 2) the ongoing support of the school’s director; and 3) the collaboration with the university wac program. the authors believe that all of these factors were essential to the success and sustainability of this curriculum. 0 0.5 1 1.5 2 2.5 3 3.5 4 enc 1101 n = 25 enc 1102 n = 46 enc 3213 n = 26 lit courses n = 14 nur courses n = 29 sow 3302 n = 25 com 1930 n = 7 phi 2010 n = 6 luna, horton, galin/effectiveness of writing across the curriculum 403 commitment of core faculty the curriculum development and the success of this course have been dependent upon the commitment of the faculty who designed and now teach sections of the course. for this writing-intensive course, faculty members must spend significant amounts of time responding to drafts and must devote class time and office hours to helping students improve their writing. in addition, faculty members meet at least two to three times a semester to norm and reevaluate teaching strategies. as a result of these ongoing meetings, we have developed on-line learning modules for basic writing and apa formatting skills to provide additional support for students. furthermore, one faculty member leads half-day workshops for adjunct instructors each semester to infuse wac techniques across other courses in our curriculum. this ongoing commitment ensures quality and consistency of the curriculum, allowing the school of social work to maintain high writing standards. the increased writing standards have impacted students’ evaluation of teachers’ performance, particularly when the new course was implemented. most incoming social work students do not anticipate a strong emphasis on writing nor the significance of writing in the field. initially faculty members experienced resistance from students because of the writing demands of the course. however, over time the culture of the program has changed, and students now tend to know in advance that writing is a central component of the social work curriculum. as the teaching of the course has been refined and faculty confidence has increased, the quality of students’ writing has improved as demonstrated by students’ perceptions of their own writing. in addition, results from a recent university-wide wac assessment study indicated that social work students scored second highest in terms of the quality of writing among students from seven other disciplines. other social work programs that implement a similar emphasis on writing should, however, expect some level of resistance from students at first because of the higher writing expectations and demands that the new course requires. these attitudes will likely improve as the new culture emerges. director of the school of social work support in addition to the commitment of the core faculty, the support of the director was essential to the successful development and implementation of this course. the director participated in one of the first wac seminars and carried her enthusiasm back to the faculty. recognizing the difficulties in learning how to teach this course, she was available to discuss faculty concerns about students’ performance during the semester and their evaluation of it at the end. she recognized that students did not expect writing to be such a fundamental component of the course. therefore, they tended to give lower teacher evaluation scores to the instructors for the first few terms it was taught, which is a salient factor given the instructors’ tenure-seeking status. when the faculty submitted their tenure portfolios, she defended the lower student evaluations of the course while highlighting the work and commitment involved in teaching the course. in an effort to validate the instructors’ commitment and effort, she has ensured that the faculty accomplishments have received public recognition at the school, college, and university levels. for schools considering implementation of a writing program such as the one advances in social work, fall 2014, 15(2) 404 presented here, it should be noted that without the support of administration, it would be very difficult to initiate and maintain the required time and effort in the face of the challenges presented by a class such as this one. collaboration with the director of the ucew collaboration with the director of the university center for excellence in writing, who also serves as the director of the wac program for the university, was also essential to the success of the course. he has been an active partner throughout this process, leading the workshops that faculty have attended and substantially contributing to the course development. he has met regularly with social work faculty over the course of four years, provided feedback on strategies for grading papers, offered recommendations about the development of the course syllabus, and helped develop assignments and wac student surveys. in addition, he encouraged social work faculty to submit a grant, which was accepted, to develop a promotional dvd on the importance of writing. furthermore, he has collaborated as a partner in writing research manuscripts and presenting them at national conferences. social work programs that develop a writing program similar to the one presented here should consider carefully the need for collaboration with a wac director or other departments within the university. these collaborations provide essential support, credibility, and incentive to sustain such initiatives. limitations several methodological issues and limitations related to the design of the study and the use of self-report must be considered when interpreting the findings. there were no baseline measures before the wac course was implemented. therefore, it would be difficult to determine if improvements in students’ writing skills resulted from the wac course. however, there were no substantial curriculum changes in the school of social work during the data collection period. while we could have employed other methods for examining the perceived benefit of the course, we used students’ perceptions only. although we developed a survey to examine faculty perceptions of students’ writing and critical thinking, the response rate was insufficient for data analysis. we had no resources to support independent reviews of students’ drafts by external reviewers outside of the discipline. in addition, this study involves a cross-sectional design, which does not provide information about the long-term effect of wac techniques on students’ writing skills. one concern involving self-report is that students exhibit problems assessing their information skills and accurately recollecting what they have done (schellings & van hout-wolters, 2011; schilling & applegate, 2007). however, in this study we administered the surveys during the last weeks of the semesters when the skills and knowledge we inquired about were being practiced in the classrooms and instructors were giving extensive feedback to the students about those areas. thus, our students had a clear notion and awareness as to the content of the questions included on the survey. despite these limitations, the current study has several strengths. this study is the first of its kind to examine social work students’ perception of the effectiveness of wac luna, horton, galin/effectiveness of writing across the curriculum 405 techniques. in addition, the sample size was relatively large (n = 182), and it included students attending different sections of the course and different semesters. due to the scarcity of research with respect to pedagogical techniques beneficial to social work students, this study fills an important gap in the literature. future research should continue to examine the perceived benefit of wac techniques on educational outcomes and the long term sustainability of such programs. it is crucial to improve the communication and writing skills of social work students and better prepare them to be successful professionals in the field. furthermore, faculty members’ perceptions of students’ improvement and baseline data on students’ outcomes should be included in future studies to establish validity of perceived benefit of wac techniques. future studies should also have a longitudinal design to examine the long-term effect of the writing improvement and knowledge acquisition. lastly, this paper was a descriptive study intended to present the multiple factors related to the perceived helpfulness of wac techniques. a future publication will include findings examining the impact of demographic variables on the perceived benefits of wac. conclusion while most mental health practitioners, educators, and other professionals recognize that writing skills are essential for effective social work practice, few social work programs have published information concerning the implementation of curricula that address these needs. the primary purpose of this paper was to present survey findings on the perceived benefit of the wac strategies and techniques on students’ writing skills and social work knowledge acquisition. findings indicated that students perceived substantial improvement in their writing skills after the completion of this course. in addition, wac techniques facilitated knowledge acquisition from different content areas in social work. these results support the implementation of wac into social work curricula and suggest a potential model that other programs might use to better prepare future practitioners in the field. the sustainability of our program, and any that follow, requires: 1) departmental support and recognition by both faculty and administration of the importance of writing within the 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(2007). evaluating library instruction: measures for assessing educational quality and impact. paper presented at the acrl 13th national conference, baltimore, maryland. retrieved from http://0www.ala.org.catalog.wblib.org/acrl/sites/ala.org.acrl/files/content/conferences/confsa ndpreconfs/national/baltimore/papers/206.pdf simon, b. l., & soven, m. (1990). the teaching of writing in social work education: a pressing priority for the 1990s. journal of teaching in social work, 3(2), 47-63. veenman, m. v. j. (2011). learning to self-monitor and self-regulate. in r. mayer & p. alexander (eds.), handbook of research on learning and instruction (pp. 197-218). new york, ny: routledge. author note address correspondence to: naelys luna, school of social work, florida atlantic university, 777 glades road, so314, boca raton, fl, 33431. email: ndiaz10@fau.edu advances in social work, fall 2014, 15(2) 407 appendix grading rubric student: score: requirement rating key: = unsatisfactory + = satisfactory ++ = outstanding abstract apa writing/grammar/editorial style purpose transitions key points tense conclusion (findings) conciseness (no wordiness/redundancy importance (of findings) sentence/paragraph length opening of the body word choice purpose spelling importance of the topic pronoun/antecedent agreement key definitions provided no colloquial expressions thesis statement subject/verb agreement organizational statement complete sentences body (argument) key definitions provided punctuation: terminology used correctly commas after introductory elements claims commas after items in a list evidence commas to set off nonessential items analysis, explanation compound sentences (no run-on/ fused) counterargument and rebuttal colon(s) material from other sources semicolon(s) quotations no unnecessary commas paraphrases apostrophes credible. relevant sources cited quotation marks credit given capitalization conclusion of the body italics conclusion (findings) numbers key points revisited importance (of the findings) apa reference/manuscript comments: title page: required items no unnecessary items capitalization citations in paper font, spacing (continued) advances in social work, fall 2014, 15(2) 408 indentation, margins headings reference page: required items capitalization italics alphabetization page headers microsoft word stauss et al copyedit final _________________  kimberly stauss, ph.d., and yvette murphy-erby, ph.d., are assistant professors in the school of social work at the university of arkansas in fayetteville, ar. javier boyas, ph.d., is an assistant professor in the school of social work at the university of texas arlington. van bivens, lmsw, is a mental health therapist with arkansas counseling associates. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 181-200 parent-child communication related to sexual health: the contextual experiences of rural latino parents and youth kimberly stauss yvette murphy-erby javier boyas van bivens abstract: understanding how parent-child communication occurs within the cultural context is an important consideration in sexual health given that culture plays a major role in the development of various beliefs and attitudes. this qualitative study explores the perceptions of first-generation, immigrant rural latino parents and youths (n = 19) regarding parent-child communication related to sexual health. specifically, the article explores their perceptions on (a) the process of such communication when and if it occurs; (b) the content of such discussions when they occur; and (c) whether the content and process are guided by cultural scripts that stem from traditional gender and familial norms. results suggest that parents provided gender-specific messages about sex to their children; meanwhile, these messages were delivered in strict gender concordance. going against religious and father’s expectations, the mothers also discussed birth control facts in greater frequency. as for youth, they expressed the need to have more conversations about sex with their parents, especially with boys. we discuss implications for latino teen pregnancy prevention efforts. keywords: sex-related communication, latino parent-child interactions, culture, latino teen pregnancy, gender roles introduction after years of steady decline, teen pregnancy rates in the united states have risen (guttmacher institute, 2010). the rate of incidence rose by 3% in 2006 (guttmacher institute, 2010). the overall teen pregnancy rates decreased by about 29% between 1990 and 2000 (guttmacher institute, 2006); however, that level of decline was not evident for latinas. between 1990 and 2000, the teen pregnancy rates only decreased 15% to 20% for latinas, a much lower decrease compared to non-hispanic whites and african americans (national latino resource center, 2005; ryan, franzetta, & manlove, 2005). this rate of incidence partially explains why some estimates suggest that 53% of latinas will become pregnant at least once before turning 20 (national campaign, 2009; ryan et al., 2005). thus, we maintain that pregnancy prevention efforts have not had the same degree of influence on latinas as on other racial and ethnic groups. although teen pregnancy rates are similar between rural and urban communities, teenagers in rural communities account for a greater percentage of all nonmarital births than those in urban settings (36.2% v. 29.2%) (litchter, rascigno, & condron, 2003). the birth rate for females ages 15–19 in all regions was 52.4 births per 1,000 female advances in social work, fall 2011, 12(2) 182  adolescents. however, in rural counties, the birth rate is higher at 57.9 births per 1,000 female adolescents (national center for health statistics, 2001). among latinas, some estimates suggest that the rate of incidence is nearly double that of non-hispanic whites (guttmacher institute, 2006). these statistics demonstrate a disparity in occurrence of teen pregnancies that should call for more attention in understanding how and why these differences exist. in the state of arkansas, early teen sexual behavior is a major health concern. as a rural state, arkansas boasts some of the highest teen pregnancy rates in the country (annie casey foundation, 2003; guttmacher institute, 2006). in 2009, arkansas had the third-highest teen pregnancy rates in the nation (centers for disease control and prevention, 2009). the rate for girls ages 15–19 was 106 per 1,000 girls compared with the united states average of 78 per 1,000 girls (annie casey foundation, 2003). in 2007, arkansas also reported a significant problem of the incidence of sexually transmitted diseases in adolescents living there. the reported totals for those under age 19 were as follows: gonorrhea – 1,391; chlamydia – 4,056; syphilis – 22 (arkansas dhhs, 2005). in polk county, where the current investigation took place, adolescent sexual behavior is prevalent. among 9th and 12th graders, 48% reported they have had sexual intercourse and 15% reported having sexual intercourse before the age of 13. moreover, 17% of 9th grade respondents reported having sex in the past 30 days (arkansas dhhs, 2005). parent-child communication is posited as critical to preventing early teen sexual behavior and teen pregnancy. albert’s 2010 study using data from the national survey of family growth, found that teens perceive the influence of their parents on their decisions about sex is greater than the influence of their peers, siblings, and media. additionally the study found that over 80% of teens in the study believed that more open and honest conversation with their parents would help youth to make better decisions about sex. consequently, understanding how parent-child communication occurs within the cultural context is an important consideration in sexual health given that there is growing recognition that culture plays a major role in the development of various beliefs and attitudes (andrulis & brach, 2007; institute of medicine, 2004). yet few studies have attempted to understand the specifics of latino parent-child communication in relation to sexual health (guilamo-ramos et al., 2006; guilamo-ramos, bouris, jaccard, lesesne, & ballan, 2009). very limited research exists that seeks to understand the process and content about sexual health communication within the latino cultural context that can inform prevention efforts that aim to reduce teen pregnancy rates. to address this knowledge gap, multiple focus groups of latino participants living in a rural community in arkansas were brought together to discuss their perceptions of (a) the typical process of parent-child communication when and if it occurred; (b) the content of such discussions when they occurred; and (c) whether the content and process is guided by cultural scripts that stem from traditional gender or familial norms. background and significance research suggests that sexual attitudes and beliefs are highly influenced by the cultural and familial context (blake, simkin, ledsky, perkins, & calabrese, 2001). for latinos, culture may be a salient source that prescribes attitudes and beliefs regarding stauss, murphy-erby, boyas, bivens/parent-child communication 183       sex, especially because of the high importance placed on family, or familialismo (marin, sabogal, van oss marin, otero-sabogal, & perez-stable, 1987; sabogal, marin, oterosabogal, van oss marin, & perez-stable, 1987). one qualitative study found that among 11th and 12th grade mexican-american youths in san francisco, parental and cultural prohibitions were important reasons cited for not engaging in sexual activity (flores, eyre, & millstein, 1998). one manner in which familialismo takes place within the family is by socializing the youth through communication (guilamo-ramos et. al., 2009). guilamo-ramos and colleagues (2009) suggest that this process happens through dialogue, when parents convey to their children their rules and expectations. existing evidence posits parentchild communication as an influential factor in shaping a youth’s decision to engage in or abstain from early teen sexual activity. parent-child communication about sex-related themes is highly relevant for youth because the information and values received from such conversations can shape an adolescent’s way of thinking and increase his or her likelihood of adopting safe and healthy sexual behavior (martino et al., 2008; schouten, van den putte, pasmans, & meeuwesen, 2007; whitaker & miller, 2000). increased parent-child communication is correlated with lower levels of youth risk-taking behaviors (mcbride et al., 2005), less conformity to peer norms, and a greater belief that parents provide the most useful information about sex (whitaker & miller, 2000). however, several studies report that such discussions between parents and children do not happen frequently, or if they occur, they focus only on the basic biological facts (el-shaieb & wurtele, 2009). the one qualitative parent-child communication study we located that focused specifically on latinos reported that latina mothers were able to talk with their children about the consequences of having sex, but not about more taboo topics such as sexual intercourse and birth control (guilamo-ramos et al., 2006). among latinos, talking about sex-related topics is uncomfortable and may also violate a cultural taboo, which may partially explain why it happens less frequently than it does among other racial and ethnic groups (hutchinson, 2002; national campaign, 2001; o’sullivan, meyer-bahlburg, & watkins, 2001). another plausible reason why latinos may not frequently speak about sex-related topics could be the influence of religion. mccutcheon (2003) suggests that through religion, moral codes, practices, values, institutions, customs, and rituals associated with its belief system are transmitted to the individual. among latinos, religion continues to play a significant role as a socialization agent (regnerus, 2009), in particular around issues of sex. gonzalez-lopez (2003) suggests that to some degree, sexuality for latinas is shaped by the preservation of premarital virginity, which complies with the catholic sexual moral code. however, the moral standards of catholicism are only one factor that imposes such notions of social and moral control (gonzalez-lopez, 2003). this is evident in a national study that found that among latino youths, relative to african american and non-hispanic white youths, both boys and girls were least likely to report that religion and morals were a reason why they did not have sex (abma, martinez, mosher, & dawson, 2004). nonetheless, we cannot discount the fact that there may be segments of latinos that believe sex-related talks with their children may not be consistent with religious teachings and therefore abstain from engaging in such discourse. advances in social work, fall 2011, 12(2) 184  existing research has also found that among latinos, gender differences exist when it comes to various facets of parent-child dialogues of sex-related topics. for example, guilamo-ramos and colleagues (2006) found that among a group of latinas in new york city, there was a belief that conversations about sexual-related topics should be based on gender concordance (mothers should talk to daughters and fathers to sons) and concerns about pregnancy outcomes were more germane to girls than to boys. although conflicting, some studies have found that gender predicts whether discourse about sexrelated topics takes place in the home. youths were more likely to have dialogues about sex with mothers than fathers and these conversations happened more with daughters than sons (miller, kotchick, dorse, & forehand, 1998; o’donnell et al., 2007; raffaelli, bogenschneider, & flood, 1998). for example, epstein and ward (2008) found that latino college-aged men had the lowest levels of parental communication about sex compared with other racial and ethnic groups. conversely, romo, lefkowitz, sigman, and au (2001) found that latina mother-son dyads reported more communication around sex than mother-daughter dyads. however, in non-latina samples mothers report more communication about sex and daughters report more than sons (dilorio, kelley, & hockenberry-eaton, 1999). collectively, these findings may speak to the traditional gender roles prescribed in the latino community that define and limit the behavior of men and women (raffaelli & suarez-al-adam, 1998). there are certain roles and expectations that create gender differences that create a double standard for boys and girls in how sex-related topics are discussed and delivered. faulker (2003) suggests that these cultural scripts delineate behaviors that correspond with latino culture in ways that put forth expectations about what are appropriate and acceptable sexual beliefs and behaviors for latinas and latinos. the above literature highlights the importance of gaining a better understanding of parent-child communication in latino families relative to sexual health within their cultural context. the few studies exploring sexual health have been conducted in urban settings and have focused less on the contextual experiences of latinos living in rural communities (guilamo-ramos et al., 2009). even fewer studies have incorporated the perspectives of latino males (guilamo-ramos et al., 2009). through a qualitative inquiry, we contribute to the literature by exploring the breadth and scope of the content and process of sexual health communication among latino mothers, fathers, and children living in a rural arkansas community. methods the methodology for this study is grounded in a constructivist theoretical framework, in which themes and patterns in collected data are discovered rather than predetermined. given that this topic has not previously been explored in depth, researchers took a qualitative, exploratory approach using a grounded theory methodology (bryant & charmaz, 2007; patton, 2002). through a constructivist lens, we sought to elicit the personal meanings and understandings of the participants’ experiences around latina/latino parent-child communication of teen sexual behavior, sexual health, and pregnancy prevention. the research team consisted of three university professors and two master’s degree students. there were two males and three females total. team members stauss, murphy-erby, boyas, bivens/parent-child communication 185       included a latino male, an african american female, an african female, a non-hispanic white female, and a non-hispanic white male. sample and recruitment a community-based abstinence program called voices 4 healthy choices (v4hc) was recently completed in rural arkansas that included 19 latinas/os that participated in the treatment group during the first year. although the program was developed with the idea of being culturally sensitive to latina/o participants (i.e., spanish-surveys and translators available), it was not designed to focus exclusively on this group’s needs but rather on the rural community as a whole. focus groups were completed from the pool of year-one latina/o participants to gather more in-depth data on the parent-child communication process in latina/o families so that the program could better meet their needs. this manuscript reflects the data from these focus groups. purposeful sampling procedures were used to identify possible candidates for the focus groups. a family was eligible to participate if the child and at least one parent was of latina/o descent, the child took part in the v4hc program, and the mother or father of the child participated in at least one of the parent activities sponsored by the program. all eligible latino families were invited to partake in a focus group. of the 19 latina/o children who participated in year-one of the program, only 10 children had a mother or father who also participated in at least one of the parent activities associated with the full project. as a result, 10 families were eligible to join the focus group component; however, only 7 agreed and were scheduled to participate. on the day of the focus group, one of the parents was delayed at work and our group count consisted of 7 youths and 6 parents. recruitment of the participants occurred through telephone calls to the youths’ homes. the study’s purpose and procedures were outlined during these phone calls. the day the focus groups took place, informed consent forms were distributed explaining the purpose and procedures again. the university’s institutional review board approved the procedures for recruitment and participation used in the current study. all participants were given a $20 gift card for contributing to the focus group. the focus groups were assembled according to family roles and resulted in the following five groups: a group of fathers (n = 3), a group of mothers (n = 3), a combined group of boys and girls (n = 7); a girls-only group (n = 5) and a boys-only group (n = 2). the youths who participated in the combined boys and girls group were the same ones who participated in the boys-only and girls-only focus groups. the adolescent focus group was also split by gender so that we could focus our inquiry on examining specific gender-related topics. the parent focus groups were conducted with a spanish translator (who was foreign born) and the mothers and fathers in the group represented different children. all six parent-participants had emigrated from mexico and all but one of these participants stated that spanish was the only language they spoke and read. all the youthparticipants were fluent in english; therefore, their focus groups were conducted in english. issues and cautions relative to the small focus group size are discussed in the limitations section. advances in social work, fall 2011, 12(2) 186  data collection the focus groups were conducted at the middle school the youths attended. every focus group lasted approximately one to two-and-a-half hours. after the consent process was completed, a short demographic questionnaire was administered, which included a validated instrument to measure acculturation levels among the parents (marin et al., 1987). the interview guide (see the appendix) was created with the intent of capturing the participants’ perspective on parent-child communication in regards to sex. some specific areas of interest were exploring how this communication occurred, what was discussed, and how gender affected this process. the semi-structured interview guide was followed by each facilitator for consistency, but each facilitator went into depth with questioning when appropriate. the focus group discussions were audio-taped and later transcribed by a transcriptionist not affiliated with the study. data analysis the five members of the research team read all of the transcripts. every member coded the transcripts independently to generate a first series of emergent themes and subthemes. using a constant comparative method (merriam, 1998), the team held a number of meetings to discuss the findings and look for research consistency. notes were taken as part of the process and a journal was established that detailed our discussions. the data recorded in the journal were used during the final analysis as an additional source. for a more exhaustive reanalysis, two ph.d. researchers from the team continued to reread each transcript and review the process journal using the notes and emergent themes identified from previous team meetings. reanalysis of each narrative entailed a sentence-by-sentence appraisal, seeking and extracting open codes. the theoretical/conceptual framework of the study also served as a frame for the analysis process (miles & huberman, 1994). during open coding, possible themes were identified and short segments of text were underlined (ryan & bernard, 2000). codes or categories were written on the right-hand side of the transcript. after open coding, axial coding was completed. this process linked relationships among codes and these codes then formed core categories. finally, selective coding occurred when broad, more inclusive categories were found that encompassed several core categories. to ensure that themes were not misstated or misconstrued, the two researchers collaborated in the discussion of emerging themes and categories. great importance was placed on coalescing these themes into suppositions made about the participants’ experiences. trustworthiness trustworthiness is an important element in determining the level of rigor in qualitative research. credibility, confirmability, and transferability are three factors often used to assess the trustworthiness of qualitative findings (lincoln & guba, 1985; padgett, 2008). credibility and confirmability pertain to the rigor in which the data and findings were obtained and transferability pertains to how the findings can be generalized to other contexts, settings, and practices (lietz & zayas, 2010; padgett, 2008). to this end, our analysis included several techniques to increase credibility, clarity, and transferability of the results. triangulation was used, which involves using multiple methods and stauss, murphy-erby, boyas, bivens/parent-child communication 187       informants to analyze the data and results (denzin & lincoln, 1998). we used three different types of triangulation strategies (berg, 2009). first, investigator triangulation was used, in which each of the members of the research team independently coded the transcripts and determined emergent themes and later compared their findings. the fact that all research team members generated similar themes increases the validity of the key themes. second, we used participant triangulation by exploring the data to determine if points existed at which the data in one group corroborated data in other groups. there were numerous cases in which this occurred. using theory-based triangulation, we also looked for points where existing research, theory, and literature suggested the perceptions of the different participant groups (i.e., mothers vs. fathers, parents vs. children, or boys vs. girls) were projected to converge and diverge. we also enhanced transferability by using thick descriptions that provide readers with information regarding the research context and protocol and the research participants (lietz & zayas, 2010; lincoln & guba, 1985; padgett, 2008). the fact that our findings were consistent with expected situations enhances the credibility and transferability. using a process journal throughout the analysis, the researchers established an audit trail that included a sensitive narrative of the emerging themes and categories, which enhanced the confirmability and transferability of our results (lietz & zayas, 2010). furthermore, the confirmability of the data analysis was established by having multiple coders and a peer research team. cultural sensitivity was also promoted by incorporating a latino male in the data analysis process. as the focus groups progressed, the researchers were able to explore the preliminary themes emerging from the previous groups to enhance clarity of the findings. due to the semi-structured interview format, the researchers were able to check these preliminary themes with the participants in each subsequent focus group, thereby enhancing the level of confirmability and credibility. major importance was again placed on every individual’s narrative, his or her experiences, and subsequently, the representations of these experiences. results latina/o is not a monolithic label and there are significant differences between individuals, often based on their country of origin and level of acculturation. as a result, it is important to note that all of the parent-participants had emigrated from mexico. the fathers had been in the united states an average of 23-24 years, while the three mothers had emigrated approximately 14 years ago. the level of parent-participants’ acculturation was also taken into account. we utilized a commonly used measure of acculturation (marin et al. 1987) to determine the extent to which our participants’ attitudes and beliefs had been modified by living in the united states. all but one of these participants commented that spanish was the only language they spoke and read, only spanish was the language in which they think, and only spanish was spoken at home and to their friends. the sixth participant said that she spoke, read, and thought in spanish, but spoke both spanish and english. based on these results, all of the parent-participants reported low levels of acculturation (marin et al. 1987). the youth appeared to be more acculturated. most were born and raised in the united states and all of them had a good mastery of the english language. advances in social work, fall 2011, 12(2) 188  all participants were specifically asked about communication between parents and children relative to sex. the responses resulted in discussions about process (how they go about talking about sex) and the content (what they actually talk about). under the theme of process, responsibility for communication and communication style emerged as key points of discussion. under the theme of content, protection, teen sex, responsibility, goals, consequences, and ambitions emerged as key points of discussion. traditional gender-specific messages were also focused on under this theme. there was a convergence of opinions between the individual participants and focus groups, but also a divergence of communication style and content. process there was a divergent attitude on who should be responsible for communicating information about sex to children. the mothers jointly believed that fathers need to be more involved in this communication process, but they often are not. when trying to get her husband involved in sexual discussions one mom stated that her husband said, “oh, you know how to do it. you do it. you know how to do it.” one mother expressed, “sometimes my kids go to the bedroom when he is there, then i’ll start the conversation about sex with my kids there. then maybe i will say something that i know makes him want to say something. that’s the only way i can get him to participate. he would rather watch his tv show.” another mother stated, “i am more open to talk about sex with my kids than my husband is. if my husband knows anything it’s because i tell him about it. because if not, he would never know.” two of the fathers confirmed this belief in the mothers being more responsible for this communication. the third father disagreed and expressed his belief that both mother and father are responsible. he stated, “i believe we as parents need to educate ourselves. in my case, i love to read. it’s a very important thing.” while the fathers did not take credit for being the primary communicators with their children, they all consistently perceived that their responsibility for parent-child communication in regards to sex had changed from how it was communicated to them. because of their children’s increased knowledge about sex they too had to be more knowledgeable. one father stated, “but they already know, they learned that in school. they learned on the internet. they watch on the internet.” nonetheless, they also perceived that their children trusted them enough to come to them and talk and to confirm the information. one father said, “if they ask us, they may already know it, but if they come to us to ask us—to confirm what they already know—because of the trust he has. they come to us because they trust us even if they know it, they come to us.” while mothers thought it was important for them to talk to both the boys and girls, the fathers perceived it was the mother’s role to talk to the girls and their role to talk to the boys. in reviewing the data, it was also clear that the mothers’ communication styles were more direct, explicit, and detailed. the fathers perceived their discussions of sexual issues to be informal, implicit, and superficial, particularly with their daughters. when discussing how he communicates to his teenager about sex, one father stated, “but we don’t exactly go to the table and talk about it. sometimes we do. sometimes we talk about this subject but not really deeply.” another father said, “we talk about the subject stauss, murphy-erby, boyas, bivens/parent-child communication 189       but not really deeply.” the fathers also confirmed what the mothers and teens said about the more explicit conversations occurring with mom. the spanish interpreter confirmed what one of the fathers was trying to say. she said, “they coat what the mom has to say, they put in the last layer.” another father said, “the mom tells the girl when they get their period and what they need to do. we just support them.” when questioned about what leads to the conversations and how they come up, the fathers reported play and work as the two avenues. with regard to play, one father stated, “oh like kidding and joking” and another said, “little by little we just keep joking and we start talking about it.” with regard to work and play, another father stated, “and we’re working together, and we just start talking. or at home when they put on the lotion, deodorant, they fix their hair. ‘hey where you going?’ “oh i’m going to the park.’ oh the boys and the girls, so that’s how we start talking.” confirming the parents’ reflections, the children consistently agreed that the parentchild conversations about sex were primarily with their mother versus the father. only one girl reflected that her father discussed any sexual topics with her. this was consistent with the data from both the mother and father focus groups where one father indicated that he talked to his daughter. the boys also reported experiencing the dads talking with them about sex and expressed more comfort with this; but again, it was described as an informal discussion, usually in a work or outdoor setting. one teenage boy stated, “i think with my dad. because most the time you’re with him and not nearly as much with your mom. because we spend time working outside and because he’s the man.” when directly asked what the fathers talked to the boys about, the boys were unable to come up with any topics. all of the mothers perceived themselves as the primary initiators of the conversations with their children. on the contrary, most of the youth believed that they themselves brought up these conversations. one teenage girl commented that her friends at school would bring up something “nasty” and she would not know what they were talking about. she went on to say, “so i would ask my mom. what does that word mean and she would tell me.” interestingly, the youth thought that they were cleverly getting their parents to talk about sex by bringing up topics that they knew would lead to discussions of sex. a teenage boy said, “sometimes i would ask my parents ‘when can i have a girlfriend?’ they would go like, whenever you have the responsibility and you’re at the right age. then that would lead into other things about girlfriends, then it leads to sex and goes from there.” the youth who perceived that their parents initiated sex conversations confirmed that such conversations usually started informally with both the mothers and the fathers. for example when discussing how the conversations get started one girl said, “well they always start it off by saying ‘when i was a kid’ and i’m like here we go again.” one female adolescent also stated, “when i’m interested in a guy, they talk, they explained everything that happens when you fall in love.” lastly, even though the adolescents agreed that conversations around sex occurred periodically, usually with the mothers, both the girls and the boys wanted these conversations to occur more frequently. when reflecting on parents not wanting their kids to learn about sex from other sources one girl advances in social work, fall 2011, 12(2) 190  stated that she would tell parents, “well i would say, ‘then you should talk to them about it.’” another girl stated, “in my opinion it’s ok for them to know (about sex) when they start growing up. so they will know what’s going on. if it’s a girl and a boy is messing with her. they need to know what he is doing to her.” interestingly, both boys and girls made the point that because there is a gender difference in this process, boys are often not included in these conversations and need to be. when questioned about the genderdifferences in these conversations one teenage boy expressed, “make sure the parents know that you are having a relationship.” when asking for clarification the interviewer asked, “so you think parents should investigate more with boys?” he then went on to confirm, “yeah.” content when talking with their children about sex-related topics, the fathers reported talking primarily about relationships, responsibility, and good moral character. the fathers consistently believed they are responsible for their child’s attitudes about sexual behavior but these attitudes should be transferred by being a good role model. one father said, “it’s mostly the parents how they direct them. because a lot of parents get home and all they do is go watch tv, and then go to bed. then on weekends all they do is drink, drink, drink.” another said, “you don’t see us as having so many women, or drinking alcohol, drugs. if they don’t see that in us and then they’re not going to look for it. they’re going to be quiet and peaceful because they know we’re quiet. they’re going to see that in us.” the third stated, “we try to be good parents, good fathers. talking and keeping them busy in activities and on the weekends. so not just thinking about parties, parties, parties….we are like the brain of the family, we’re wrong and everything else will be wrong. more than anything, we are the ones that have to go on the good path. take the boat in the right direction.” even though the fathers knew that the mothers’ conversations with the children, especially the daughters, were more explicit and direct, they assumed the mothers were delivering messages to the children that were similar to their messages of good character, moral values, and achieving goals and ambitions. as a matter of fact, one father expressed that people who teach youth to carry condoms would send the wrong message “…what are they saying? here, go. they are inviting them to have sex before they get married. what is the moral authority that is involved in this to do that?” ironically, the mother participants were communicating different messages to their daughters. reflecting this, one mother stated, “usually the father may have different opinions.” the mothers reported talking primarily about protection from pregnancy and sexually transmitted diseases (stds). an example is apparent in the following quote from a mother talking about what she most wished to communicate to her child: "for me, it’s how to protect themselves against std. to protect themselves from getting pregnant so early in life. to have a goal in their life. so they know what they’re going to be when they grow up.” another mother stated, “for me it’s very important for them to protect themselves and to not start having sex so early in life either. and then to fight for whatever they want to be, to pursue their dream.” the third mother echoed, “for me it’s the same.” another example of the divergent parent attitude was when one mom was stauss, murphy-erby, boyas, bivens/parent-child communication 191       talking about birth control. she said, “i do [talk about specific forms of birth control]. the only thing he says is that she has to protect herself. but he doesn’t actually believe that. but i do.” another responded passionately, “for me, they’re going to have sex whether they have the information or not. the difference is they need to know how to protect themselves.” according to both the mothers and fathers, common secondary themes were the topics of goals, aspirations, and consequences. they wanted their children to realize that having a child at a young age could hinder them from obtaining their goals and dreams. when asked about the content of conversations with their children, one father indicated that he talked about the “consequences of having sex on you. what can happen? they mess up their lives—not totally, but their studies, their efforts. they have to work at tysons all their lives—that sort of thing.” another father stated his message to his daughter was, “just don’t have a kid so young. you get a disease in the system, be messed up.” the youths seemed to grasp that a key component of parent-child topics of sexual health communication was talking about the negative consequences of teen pregnancy. an example of these negative consequences is clearly seen in one of the father’s previous comment to his daughter, “if you come out on the bad side, everything falls apart. if you behave you will get what i promised. if not all will be broken.” similarly, a teenage girl said, “my mom would always tell me if you get with a guy and you have a baby, ‘you get out of this house!’ i am like, what the heck!” consistently, the youth said their parents followed the traditional cultural script in regards to gender when discussing topics of sex (murphy-erby, stauss, boyas, & bivens, 2011). they reflected that these conversations and house rules were different based on the gender of the teen, and that it was okay to have different discussions and expectations. in describing this difference one teenage boy said, “they don’t let my sister, she is sixteen, have a boyfriend. yet, i ask my parents, can i have a girlfriend, and its like if you ask your parents first, you can have a girlfriend.” when explaining why it was okay to treat girls and boys differently, the youth consistently reflected that the girls would be the ones left with the baby. as one girl remembered her mother’s statement to her she commented, “if you get pregnant you have to take care of this. she’s been showing me my whole life how to take care of a kid.” another stated, “coz the boys will not want to take care of a baby.” a third said, “they will just leave. that happens a lot here.” in discussions regarding gender specific messages, both girls and boys heard from their parents that boys were always focused on sex and, therefore, unable to make good decisions in regards to initiation of sexual contact. examples from the girls include: “she (her mother) says that guys are different because they have hot hormones,” and “girls are different cause they are more mature, and they have to learn how to speak like do not touch me up here or down there. guys don’t have to worry about someone touching them. cause they are guys of course.” another female reflected, “some families will tell their boys, yeah, you can go off and have sex with this girl as long as you use protection but then they will tell their daughters, no, you shouldn’t have sex or you can’t even have advances in social work, fall 2011, 12(2) 192  a boyfriend.” confirming these gender-specific messages one of the boys stated, “it’s okay to be different (conversations), because we’re different. if they want to have a baby they could have it. the boys have to depend on girls saying yes.” the other boy confirmed, “because if the girl didn’t want to do it she could say no. what if he really wants to and she doesn’t.” discussion minimal research has been conducted with rural latina/o families in relation to sexual health, particularly among first-generation immigrant families. through our study this group was given an opportunity to give first-hand accounts of the ways in which parent-child sex communication occurs. the findings suggest that the parents of this study, particularly the mothers, recognize the need to change the process of sexual communication with their own children. they want to connect more with their children by broadening their conversations to include delicate subject matters such as sex. this is a change in parental norms from how older generations have handled the issue of sex, which could be a result of the evolution of the acculturation process to the united states. in previous studies, lower levels of acculturation (driscoll, biggs, brindis, & yankah, 2001), being from mexico (driscoll et al., 2001; raffaelli & green, 2003), being male (raffaelli & green, 2003), and coming from a lower socioeconomic status (raffaelli & green, 2003) resulted in decreased sex communication. contrary to other studies (elshaieb & wurtele, 2009; guilamo-ramos et al., 2006), the sample of mothers in this study were invested in talking to their children about more than biological facts in regards to sex but they were also passionate about discussing birth control. going against more traditional cultural norms, both mothers and fathers also recommended that the fathers need to be more involved in this process. consistent with existing research (kirkman, rosenthal, & feldman, 2002), our findings suggest that there was a strong belief in gender concordance when it comes to sexual health communication. in other words, there was a belief among fathers and mothers that conversations about something as sensitive as sex should be based on fathers talking with their sons and mothers talk to their daughters. fathers and mothers agreed that they each had a responsibility to talk with their sons and daughters about sex, but that this should be done through strict traditional gender role expectations. while this was a practice that was more in line with traditional cultural thinking, these parents still believed it themselves. even though the youth established that conversations with their parents should be gender-specific, both the boys and girls also agreed that boys need to be brought more into the conversations and that parents need to be more cognizant of the boys’ behavior. implications the participants’ accounts and insights into their perceptions and experiences offer guidance and hold specific implications for teen pregnancy prevention efforts. as current statistics indicate, programming and policy efforts aimed at reducing teen pregnancy are not as effective with the latino/a population in comparison with other populations. although many sex education programs have attempted to integrate culturally competent stauss, murphy-erby, boyas, bivens/parent-child communication 193       interventions, none has applied a theoretical framework that addresses the complex and interlaced dimensions of underserved populations (kreinin, 2004). taking these dimensions of the latino experience into account, we used the multi systems life course (mslc) perspective (murphy-erby, christy-mcmullin, stauss, & schriver, 2010) as our theoretical framework. as conceptualized by murphy-erby and colleagues (2010), the mslc perspective is a dynamic, integrative, and holistic assessment and intervention approach that attempts to synthesize four disparate yet interrelated and complementary theoretical frameworks. recognizing the need for a framework that is sensitive to the intricacies of human experience, mslc makes a shift from traditional reductionist, linear, one-dimensional models to a postmodern, emergent, holistic, nonlinear, and multilayered view. mslc accomplishes this by incorporating the frameworks of ecological/systems perspectives, symbolic interactionism, life-course theory, and social change theory. in accordance with the mslc perspective, the studies on sexual health communication should also reflect an understanding of the complexity of the latino experience. to this end, we present several implications for practice and programming efforts relative to teen pregnancy prevention efforts with latino families that capture a great deal of this. with regard to practice with latino families, there are several implications for clinicians. assessment is an important and ongoing process for clinicians. it is important for clinicians to explore each family’s process for discussing sensitive topics such as sex. in implementing the assessment, it will be important for the clinician to triangulate data sources by conducting a mix of individual, family and couples work as a way to determine if the mother and father are delivering conflicting messages in communicating with their children about sex. in working directly with the parents and youth, clinicians may sense a need to help the youth and parents challenge traditional beliefs and practices such as the cultural belief that the responsibility of pregnancy and sex decisions should be shouldered more so by girls than by boys and the parenting strategy of focusing heavily on consequences with minimal use of parenting strategies that involve the use of support and trust, particularly with regard to their daughters. it important for clinicians to be aware that challenging such traditional beliefs and practices may present a cultural discord. therefore, it is important for clinicians to ensure their work is grounded in an empowering and culturally relevant perspective. similarly, one of the major differences in the perspectives of parents and children centered on acculturation levels, and subsequently, the differences in how each perceived the process and content of discussions relating to sexual health. on the one hand, most parents who were not highly acculturated reported that this topic was hardly discussed when they were younger in their native country of mexico. they perceived this to be a divergent practice in the united states—everyone talks about sex in the united states with more ease. youth on the other hand, believed that their parents needed to be more “laid back” and “cool” about this topic. thus, we believe this to be a sign of an acculturation gap that has been noted in parent-child relationships, where one or both parents were born outside of the united states (birman, 2006). it is important to recognize that such a gap can have negative implications in the household because neither can fully relate to the other. because of the importance of sexual health, it will be advances in social work, fall 2011, 12(2) 194  important that clinicians working with such family dynamics identify and/or develop strategies that could be implemented in their work to bridge this cultural gap. doing so could open and enhance the communication between mexican-origin parents and children about a sensitive topic that is rooted in cultural divergence. with regard to programming, incorporating opportunities for latino parents to talk about their immigration experiences and their relation to parenting and talking with their children about sex and other risky behaviors, providers of teen sex prevention programs can validate the experiences of latino participants while also gaining a better understanding of the challenges they face in communicating with their children about sex. although many teen pregnancy prevention efforts incorporate a parent component, programs that target the latino population would probably benefit by using additional strategies to specifically recruit and engage latino fathers. the significance of fathers in achieving positive well-being outcomes for children has been well documented over the last decade (popenoe, 1996; yeung, duncan, & hill, 2000). consistent with existing research (kirkman et al., 2002), our findings suggest that while the fathers in our study understood the importance of their role, they were less involved than mothers in communicating with their children about sex, less informed about the topic, and felt they needed more education on the topic. the mothers and the fathers both felt that collaborative efforts involving the fathers were needed. according to the fathers and mothers in our study, one reason for the low involvement of fathers is that the fathers spend much of their time working. therefore, it is important for program leaders to consider creative ways such as embedding education and information into fun and social activities that are planned during the times that fathers are off from work to welcome and engage the fathers into the program’s efforts. as one of the fathers in our study suggested, potluck gatherings where the fathers could bring dishes they like to make might serve to motivate the fathers to participate. in addition, given that the connection between time and earning is salient for the fathers, honoraria that recognize the value of their participation and time are important. also, recognizing the divergent perspectives and comfort levels between the latino mothers and fathers in talking with their children about sex, teen pregnancy prevention programs may also benefit by using a hybrid of father-only and mother-only groups in conjunction with combined parent groups. given the focus that the fathers placed on informal and more indirect styles of communication and social interactions, incorporating experientially-based and active learning strategies into the parent-only and father-only sessions may be helpful. also, given the importance that the latino parents placed on responsibility and good moral character, incorporating strategies to promote youth asset and character development in both the youth and parent components of prevention efforts may be beneficial. limitations two study limitations warrant attention. first, although the focus groups reflected the experiences of 7 of the 10 latino children whose mother or father also participated in the program and were therefore eligible to participate in this study, the individual focus group sizes were less than the recommended 6–8 participants (krueger & casey, 2000). even if the number of eligible families were larger, the researchers and parent stauss, murphy-erby, boyas, bivens/parent-child communication 195       participants believe that perceived language communication concerns and fears may prohibit many latina/o parents from participating in research. to minimize the limitation of small focus group sizes, the researchers paid particular attention to triangulating the responses between the various focus groups and the current literature. second, while analysis of data from the larger study suggests there were no obvious demographic differences between the eligible latino parents who participated in the focus group and those who did not, it is plausible that differences do exist that are not captured by the demographic data collected for the larger study. for example, although our demographic results suggest that all of the participants were immigrants of mexican ancestry with relatively low levels of acculturation, it is highly possible that the parents who participated were in general more comfortable communicating about sex and participating in research. additionally, since the latino population is not a monolithic cultural group, the transferability of our findings are limited as each subgroup may have a different social experience in the united states. understanding that a great deal of heterogeneity exists within this population with regard to cultural, legal, and socioeconomic differences, there is a need for developing interventions that are more culturally specific in order to produce better health-related outcomes. while the study was not designed to produce findings that are generalizable, they are transferable and add value to the study participants and those working with the participants in a number of ways. first, the study highlights the voices and contextual experiences of latino families in the v4hc program. second, it informs the program’s efforts by providing concrete recommendations for adapting the program to better serve the latino population. finally, our study is an initial step in addressing a major gap in the literature and provides a much-needed impetus for researchers, funders, practitioners, public policy makers, and others committed to reducing teen-pregnancy rates to further explore the experiences and highlight the voices of latino parents and youths relative to parent-child communication about sex. references abma, j. c., martinez, g. m., mosher, w. d., & dawson, b. s. 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(2000). putting fathers back in the picture: parental activities and children’s adult outcomes. in h. e. peters, g. w. peterson, s. k. steinmetz, & r. d. day (eds.), fatherhood: research, interventions and policies (pp. 97-113). new york: hayworth press. advances in social work, fall 2011, 12(2) 200  appendix interview guide 1) before you were involved in the program did you talk to your child/parent about sex related topics? 2) what messages did you get from your own parents about communication about sex? (question to parents) 3) what role do you see mothers and fathers needing to take when helping youth not get pregnant? 4) how did these conversations occur or come up? 5) do you talk to your daughters and sons/mothers and fathers differently when it comes to sex? 6) if answer is yes to above question then…does that communication process need to change or does that work for your family or situation? 7) are there things that girls need to learn from their fathers and boys need to learn from their mothers? 8) what kinds of things do you talk about? 9) how does their culture affect how they communicate with their kids in regards to sex? 10) what are the challenges that latina/o people face in a rural community as far as teen pregnancy? 11) what types of knowledge or information would help you with these discussions? 12) any suggestions for future programming in regards to prevention of teen pregnancy? author note: address correspondence to: kimberly stauss, 106 asup, university of arkansas, fayetteville, ar 72701. email: kstauss@uark.edu microsoft word yarvis article revised copyedit bb _________ lieutenant colonel jeffrey s. yarvis, ph.d., lcsw, is deputy commander for behavioral health, dewitt healthcare network, fort belvoir, va. eunkyung yoon, msw, ph.d., is associate professor at the school of social work, jackson state university, jackson, ms. margaret amenuke, mph, and sandra simien-turner, lcsw, are doctoral students at the school of social work, jackson state university. grace landers, ens, mc, usn, is a medical student at f. edward hebert school of medicine, uniformed services university, bethesda, md. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 185-202 assessment of ptsd in older veterans: the posttraumatic stress disorder checklist: military version (pcl-m) jeffrey s. yarvis eunkyung yoon margaret amenuke sandra simien-turner grace d. landers abstract: the posttraumatic stress disorder (ptsd) checklist: military version (pclm) is a 17-item, self-report measure of ptsd symptomatology in military veterans and provides one total score and four subscale scores for older veterans’ ptsd (reexperiencing, avoiding, numbing, and hyperarousal symptoms). study subjects are 456 male veterans over 55-years old with deployed experiences selected from a larger survey data by veterans’ affairs canada (vac). this study found that overall scale reliability was excellent with alpha of .93 and subscale alphas ranging from .81 to .90. confirmatory factor analysis (cfa) confirmed the best fit of four first-order factor model. criterion validity was confirmed through significant associations of the pcl-m scores with well-established measures of depression, substance abuse, and general health indices. the pcl-m is recommended as a reliable and valid tool for the clinical and empirical assessment of screening ptsd symptomatology, specifically related to older veterans’ military experiences. keywords: military veterans; ptsd; retrospective study; pcl-m; canadian introduction since the 1970s, there has been a vital demographic trend in the veterans administration (va). although the total number of veterans is declining, the proportion of older veterans is increasing dramatically (richardson & waldrop, 2003). additionally, the proportion of older persons in the veteran population far exceeds the proportion of older persons in the u.s. population. much of the va’s efforts are rightly focused on the emerging needs of recent veterans from the wars in afghanistan and iraq. however, there is a paucity of research on the psychological and physical needs of aging veterans. in 2000, the median age of veterans was fifty-seven years, fifty-four in canada (veterans affairs canada, 1999), compared to only thirty-six years for the general u. s. population and 39 years for canadians (administration on aging, 1999). over 37 percent of the veteran population (9.5 million of the total 25.5 million veterans) was age sixtyfive or older, compared to 13 percent of the general population. by 2020, nearly half of the entire veteran population (7.6 million, or 45 percent, of the total 16.9 million advances in social work, spring 2012, 13(1) 186 veterans) will be age sixty-five or older. although most are male, the number of female veterans is growing. in 2000, over 5 percent (1.4 million) of all veterans and 3 percent (325,000) of veterans age sixty-five or older were female. by 2020, over 9 percent (1.6 million) of all veterans and 4 percent (316,000) of veterans age sixty-five or older will be female. among female veterans, the proportion age sixty-five or older was 23 percent in 2000 and is projected to be 20 percent in 2020. as in the general u.s. population, the ‘‘old-old’’ are the fastest-growing segment of the veteran population. by 2020, 6 percent of all veterans and 13 percent of veterans age sixty-five or older will be age eighty-five or older (1.1 million). thus, va and vac will continue to encounter a very large group of potentially frail, older veterans in the next twenty years (fitretoglu, liu, pedlar, & brunet, 2007). one of the significant psychiatric conditions resulting from exposure to traumatic events such as conflict and war zone exposure is ptsd. the diagnostic and statistical manual of mental disorders-iv-tr 2000 (american psychiatric association, 2000) criteria for ptsd requires exposure to a traumatic event involving actual or threatened death or serious injury. multiple categories of traumatic events have been considered for ptsd that includes cancer, sexual harassment, hurricanes, and military peacekeeping operations (asmundson, stein, & mccreary, 2002; dirkzwager, bramsen, & van der ploeg, 2005; duhamel, et al., 2004; forbes, creamer, hawthorne, allen, & mchugh, 2003; gray, bolton, & litz, 2004; palmieri & fitzgerald, 2005; richardson, naifeh, & elhai, 2007). categories, notwithstanding, the event must produce a response of intense fear, helplessness, or horror (criteria a), and the experience of as many as 17 symptoms that are categorized in three symptom clusters: re-experiencing (criteria b), avoidance or numbing (criteria c), and arousal (criteria d). the formal diagnosis of ptsd requires that an individual experience at least one of five re-experiencing symptoms, three of the seven avoidance or numbing symptoms, and two of five arousal symptoms and that the symptoms experienced have a duration of greater than one month (criteria e). additionally, the psychological disturbance causes significant distress or impairment in important areas of functioning such as social and occupational (criteria f). ptsd is associated with other psychological and emotional problems (asmundson, frombach, mcquaid, pedrelli, lenox, & stein, 2000; asmundson, wright, mccreary, & pedlar, 2003; mehlum & weisaeth, 2002). frequently co-morbidity with depression, anxiety, and alcohol and substance use has been studied (asmundson, et al., 2002; forbes, et al., 2003; yarvis, bordnick, spivey, & pedlar, 2005; yarvis & schiess, 2008). major depression was the most common co-morbid diagnosis, occurring in just under half of men and women with ptsd in the national co-morbidity survey (kessler, sonnega, bromet, huges, & nelson, 1995). additionally, ptsd was the primary diagnosis associated with the majority of cases in the development of affective disorders and substance use disorders (kessler, et al. 1995). persons with preexisting major depression had an increased and twofold risk for subsequent exposure to traumatic events and pre-existing depression increased the risk of ptsd among exposed persons more than threefold (breslau, davis, peterson, & schultz, 2000). further, the wars in afghanistan and iraq have resulted in higher mental health utilization by u.s. veterans (hoge, auchterlonie, & milliken, 2006). yarvis et al/ptsd in older veterans 187      as wars and conflicts continue, there is increasing concern for soldiers in combat zones, many of whom are at high-risk for ptsd (e.g., gray, bolton, & litz, 2004; helmer, rossignol, agarwal, teichman, & lange, 2007). given rising deployments of military forces on asymmetric missions to various conflict zones, it is important to better understand the risk factors for ptsd of these veterans. research on the prevalence of traumatic exposure has tended to focus on younger populations. specifically, there is a need for research regarding ptsd identification in older veterans (cook, elhai, cassidy, ruzek, ram, & sheikh, 2005). the goal of this study about trauma and its effect in older adults, especially veterans and recent war veterans is to contribute to a knowledge gap. the specific purpose of the present study is to evaluate the overall psychometric properties of the pcl-m using the sample of old canadian peacekeepers. materials the ptsd checklist (pcl) was developed by frank w. weathers and colleagues at the national center for ptsd (weathers, litz, herman, huska, & keane,) and has three adult versions, the military (pcl-m), civilian, unspecified event (pcl-c), and the civilian, specified event (pcl-s). the pcl-m is an adult 17-item self-report instrument that assesses ptsd symptoms in relation to stressful military experiences. respondents rate each item from 1 (“not at all”) to 5 (“extremely”) to indicate the degree to which they have been bothered by that particular symptom over the past month. thus, total possible scores range from 17 to 85. ptsd symptom severity scores are determined by summing the participants’ answers to all 17 items. the standard procedure for determining ptsd is to compute the questionnaire’s three subscales: re-experiencing, avoidance/numbing, and hyper-arousal. when the pcl-m is used as a continuous measure, a cut-off score of 3 or more for each item is the most appropriate (forbes, creamer, & biddle, 2001; 1993weathers et al., 1993). a cutoff score of 50 on the pcl-m yielded a sensitivity of .82, specificity of .83, and a ќ = .64 in the original sample of u.s. vietnam and gulf war veterans (weathers, et al. 1993). however, other subsequent studies with different populations have suggested that lower cutoff scores, 30, 31, 37, and 38 more accurately identify individuals with ptsd respectively (andrykowski, cordova, studts, & miller, 1998; cook, elhai, & arean, 2005; dobie, et al., 2002; yeager, magruder, knapp, nicholas, & frueh, 2007). the pcl has proven to be a psychometrically sound instrument for screening ptsd (weathers, et. al, 1993). the test retest reliability was .96, α = .93 for criteria b symptoms, α = .92 for criteria c symptoms, α= .92 for criteria d symptoms, with an overall α = .97 for all items (weathers, et al., 1993). another study reported similar internal consistency values (blanchard, jones-alexander, buckley, & forneris, 1996). it is noted that there has been no normative data published. according to asmundson’s study (asmundson, et al., 2000), the pcl-m has good contrasted-groups validity and sound convergent validity. strong correlations have been shown between the overall pcl-m and other scales designated to measure ptsd (i.e., r = .93 with the mississippi scale for combat-related ptsd (keane, caddell, & taylor, 1988); r = .90 with the impact of events scale (horowitz, wilner, & alvarez, 1979)). advances in social work, spring 2012, 13(1) 188 there are constant debates on the construct validity. the dsm-iv’s factor structure of ptsd is a higher-order 3-factor model with three first-order symptom factors and a second order ptsd factor. some researchers using confirmatory factor analysis (cfa) find that ptsd data fits 4-factor models better (asmundson, et al., 2002; asmundson, et al., 2003; simms, watson, & doebbelling, 2002). elklit and shevlin (2007) tested a fourfactor ptsd model that was re-structured using the dsm-iv’s 3-factor structure. these factors include re-experience, avoidance, dysphoria, and arousal. there is also evidence that two-factor solutions may have utility as well. two studies reported that a 2-factor model consisting of one overarching (second-order) latent factor (posttraumatic stress) and two first-order factors of re-experiencing and avoidance (items b1-b5 and items c1c2) and numbing and arousal (items d1d5 and c3c7) was a better fit (buckley, blanchard, and hickling, 1998; taylor, kuch, koch, crockett, & passey, 1998). simms and colleagues (2002) predicted that factors representing non-specific components of ptsd would have the highest associations with variables representing depressive symptomatology. asmundson and colleagues (2003) suggest that ptsd symptoms in military veterans can be adequately conceptualized using hierarchical two-factor or fourfactor inter-correlated models. several recent studies have focused on measuring ptsd symptomatology in older adults as an indicator of the impact of trauma using the pcl (cook, elhai, & arean 2005; cook, riggs, thompson, coyne, & sheikh, 2004; cook, elhai, cassidy, et.al., 2005; schinka, brown, borenstein, & mortimer, 2007; schnurr, spiro, vielhauer, findler, & hamblen, 2002). a cfa of the pcl conducted with a sample of elderly hurricane survivors (schinka, et al., 2007) revealed the strongest model support for an intercorrelated 4-factor model comprised of re-experiencing, avoidance, numbing, and arousal factors. similarly, this array of factors, supported by keen (keen, kutter, niles, & krinsley, 2008) in their study of male veterans suggested the avoidance and numbing symptoms of cluster c are more distinct than they are similar. however, there have been limited studies, which have specifically investigated ptsd in veterans of peacekeeping missions and from the conflicts in iraq and afghanistan (richardson, et al., 2007). few have studied the pcl-m with older veterans. additional research is needed to further the understanding and knowledge base regarding the ptsd symptom structure in the context of chronic, repeated, and varied trauma exposures in peacekeeper populations. the purposes of this study are to (1) investigate the prevalence and severity of ptsd among older canadian peacekeepers with deployed experiences, (2) evaluate the overall psychometric properties of the pcl-m with older male veterans, and (3) confirm factor structure of the pcl-m with testing alternative cfa models drawn from previous studies. source of data the present study used the secondary data as part of a health status assessment conducted by vac. with permission from the department of national defense canada and the research director of vac, prince edward island, vac provided data to the first author in 2004. the data used was based on a mail-out survey conducted september through december, 1999 by the review of veterans’ care needs project, vac. the yarvis et al/ptsd in older veterans 189      dataset received from the vac contained 1968 observations (1856 male, 112 female) consisting of 411 variables from a questionnaire given to canadian military personnel in the fall, 1999. this survey was restricted to vac pensioners living in canada and was originally conceptualized to address gaps in support and services. creatic+, a montreal based research firm, reported a 72 percent response rate, and 96 percent of the respondents filled out the questionnaire on their own. thus, the current sample of respondents is considered to be representative of the vac canadian force (cf) population (asmundson, et al., 2000). for the present research, study subjects included 456 male united nations peacekeepers over the age of 55 years. this sample was selected from a larger sample of 1968 regular and reserve force canadian military personnel with three criteria: being male, having been deployed overseas to a conflict more than one time, and being 55 years or older. measurement the original survey was comprised of 411 variables with seven domains. for the purposes of this study, in addition to the pcl-m, only major selected variables were described as below. center for epidemiologic studies-depression (ces-d) scale (radloff, 1977): canadian veteran’s depression was assessed with the ces-d, a 20 item self-report scale of depressive symptoms according to frequency of occurrence from less than 1 day per week to 5-7 days per week. the ces-d has been reported to have good reliability in studies with the elderly (radloff & terri 1986) and provided good agreement with other measures of depression. total scores range from 0 to 60, with higher scores indicating more depressive symptoms. the mean score for both younger and older adult subjects in the general population respectively is 9, with 16, a useful cut-off for screening subjects who likely experience a significant level of depression (radloff & terri, 1986). in this study, the cronbach alpha is .905 and the mean ces-d score for older male veterans with deployed experience is 13.84 (sd =7.53, range = 0 60), indicating that overall older veterans were more depressed than that of the general population. accordingly, with the 16 cut-off score, approximately 27.8 % of the total sample can be diagnosed as seriously depressed. alcohol use disorders identification test (audit) was developed by the world health organization for multinational use in primary care settings and evaluated over a period of two decades (world health organization, 2001). as a core screening assessment tool, the original audit consists of 10 questions about recent alcohol use, alcohol dependence symptoms, and alcohol-related problems. the audit was validated on primary health care patients in six countries. in comparison to other screening tests, the audit has been found to perform equally well or at a higher degree of accuracy across a wide variety of criterion measures such as mast (r=.88) and cage (r=.78) (who, 2001). a test-retest reliability study indicated higher reliability (r=.86) in a sample consisting of non-hazardous drinkers. in this study, two domains were created to separately assess frequency of use and dependency. alcohol use and problems via the audit are summarized in the 1999 regular forces dataset by the variables qfindex and alcprob. the qfindex included questions pertaining to how frequently alcohol advances in social work, spring 2012, 13(1) 190 is consumed during a specific time period and how many drinks are consumed on a typical drinking occasion. the alcprob focused on “alcohol-related” problems with questions related to problems with alcohol and negative consequences linked from alcohol consumption (i.e. going to work intoxicated). the overall alpha level is .802. general health indices consisted of three components. a single question was used to measure self-rated health status. for example, the question (“compared to other people your age, would you say that in general your health is?”) had four possible answers from 1 (excellent) to 4 (poor). in a previous study, a one-item measure of perceived health was found to be correlated positively and significantly with the overall score of a 20-item health-related quality of life measure with established validity and reliability (musick, 1996). the second component included queries of older veterans on the possibility of them having any long-term conditions diagnosed by a health professional among 21 specific conditions on a list. this list included common physical problems among older adults, such as arthritis and rheumatism, depression, diabetes, high blood pressure, vision and hearing problems. consistent with the other outcome variables, a higher score on the scale indicates a worse overall perceived health status. lastly, the respondents were asked to answer how many medications, both prescribed and non-prescribed they are currently taking. data analysis data analysis consisted of a cfa of the two, three, and four factor, latent variable models. cfa involved a structural equation model (sem) using the prelis 2.8 and lisrel 8.8. by default, the lisrel uses the maximum likelihood (ml) method of parameter estimation. several researchers supported the argument that ml is found to perform well under less than optimal analytical conditions (for example, small sample sizes and modest departures from multivariate normality) (kline, 2011). thus, considering a moderate abnormal distribution of the data, ml is adopted to be a reasonable estimation method for this study. several measurement models were tested using lisrel version 8.80 with a covariance matrix generated by prelis version 2.8. the goodness of fit statistics used in the present study to assess model fit are as follows: (1) chi-square (χ²) and degree of freedom (df), (2) the goodness-of-fit index (gfi), (3) the comparative fit index (cfi), (4) the non-normed fit index (nnfi), (5) the root mean square error of approximation (rmsea) which all fit measures that are well explained in most cited textbooks (kline, 2011). chi-square (χ²) as the traditional absolute fit measure is used to test the closeness of fit between the hypothesized model and the perfect fit (kline, 2011). a smaller χ² value is indicative of good fit, whereas a large value reflects poor fit (hu & bentler, 1999). as with the gfi, values of cfi range from zero to 1.00, with values closer to 1.00 and are indicative of good fit, and .90 is the ‘critical value’ that indicates acceptable fit (mueller & hancock, 2007). similar to the cfi, the nnfi compares how much better the model fits compared to a baseline model (hu & bentler, 1999; kline, 2011). finally, by taking into account the error of approximation in the population, the rmsea’s values of less than .05 indicates a good fit, values as high as .08 represent reasonable errors of approximation in the population, and values above .10 indicate mediocre fit (hu & bentler, 1999). because different yarvis et al/ptsd in older veterans 191      indices reflect different aspects of model fit, researchers typically report the values of multiple indices as mentioned above. results table 1 presents sample characteristics. the majority of the selected sample is anglo (88.2%). in the highest level of education and training, persons not completing secondary schooling are 34.7% (n=150), completed high school (n=98, 22.7%), some postsecondary education (n=85, 18.6%), completed diploma and post secondary (n=74, 16.2%). around 90% of participants are married under common law. regarding present rank or rank on their release, non-commissioned officers are the majority (n=308, 67.5%) and both senior and junior officers are 25% (n=103). the average number of unique deployment is 1.37 (sd = .647) with the average number of years served being 20 years (sd = 12 yrs). forty-two percent have a total individual income of less than $20,000 in the previous year, 24.3% have an income between $20,001 and $30,000, 18.2% between $30,001 and $40,000, and 13.2% between $40,001 and $50,000. table 1 also consists of descriptive statistics of selected variables. in the single-item reporting self-rated health condition, the majority of respondents assessed their general health condition as either good (37.5%) or fair (37.9%), while 71 persons (15.6%) rate ‘poor’. out of a total of 21 physical health conditions, the mean number is 3.63 (sd = 2.17) with a score range between 0 and 14. forty-one percent of respondents report having unspecified other long-term conditions (n=175), the top three of which are arthritis or rheumatism (62.9%), back problems excluding arthritis (60%), and high blood pressure (30.8%). concerning more critical chronic conditions, 14.4% of respondents are suffering with diabetes, while with heart disease (20.3%), even cancer (7.1%), and stroke (6.6%). table 2 summarizes descriptive results of individual items for each factor, the mean and standard deviations with score range and distribution. as stated earlier, instruction starts with how each problem may or may not have affected you and following questions like “had repeated disturbing dreams of your military experiences?” and score ranges from 1 to 5, with 1 indicating no and 5 indicating extremely. the mean score for the severity ratings on the total score is 23.73 (sd = 8.72, range = 17~83). the descriptive statistics on the subscales are as follows: re-experiencing (m = 6.80, sd = 3.78), avoiding (m = 2.60, sd =1.58), numbing (m=7.03, sd = 3.5), and hyper-arousal (m=8.39, sd = 4.40). among individual items, the rating of two items – sleep difficulties and diminished interests – are relatively higher than others. advances in social work, spring 2012, 13(1) 192 table1: descriptive statistics of selected variables (n=456) variables number (%) range mean (sd) demographics age 55-76 years old 60.53 (3.116) education: secondary not completed 150 (32.9) completed secondary 98 (21.5) some post-secondary 85 (18.6) completed diploma 74 (16.2) complete bachelor + 25 (05.5) individual income less than $19,999 78 (17.1) $20,000 and $29,999 111 (24.3) $30,000 and $39,000 83 (18.2) $40,000 and 49,000 60 (13.2) $50,000 over 55 (09.3) marital status married/common law 407 (89.3) not married 48 (10.5) military-related number of years served 1-45 19.89 (11.86) number of deployments 1-4 1.74 (0.942) health-related general health index 1-4 2.62 (0.846) excellent 37 (08.1) good 171 (37.5) fair 173 (37.9) poor 71 (15.6) number of health problems 0-14 3.63 (2.175) arthritis or rheumatism 275 (62.9) back problem 263 (60.0) high blood pressure 135 (30.8) cancer 31 (07.1) number of medications 0-25 3.02 (3.171) alcohol problems (audit) 9-35 11.61 (2.65) qfindex 2-10 3.60 (1.61) alcprob 7-35 7.57 (1.54) depression (ces-d) 0-60 13.84 (7.53) yarvis et al/ptsd in older veterans 193      table 2: prevalence of the ptsd (n = 456) items (pclm1-17) range mean sd skewness kurtosis re-experiencing (factor 1) 20 6.80 3.77 1: intrusive memories 4 1.49 1.01 1.928 2.406 2: nightmares 4 1.39 .91 2.299 4.200 3: flashbacks 4 1.25 .73 3.095 9.064 4: psycho. distress 4 1.48 1,04 2.069 3.097 5: psycho. reactivity 4 1.32 .84 2.609 5.885 avoiding (factor 2) 8 2.60 1.57 6. thoughts/feelings 4 1.31 .85 2.749 6.512 7: activities/places/people 4 1.31 .87 2.844 6.997 numbing (factor 3) 19 7.03 3.52 8: trauma-related amnesia 4 1.33 .84 2.648 6.058 9: diminished interest 4 1.69 1.14 1.354 0.360 10: detachment 4 1.38 .90 2.392 4.828 11: restricted affect 4 1.27 .78 3.050 8.565 12: foreshortened future 4 1.46 1.05 2.149 3.266 hyper-arousal (factor 4) 20 8.39 4.39 13: sleep difficulty 4 2.23 1.46 0.610 -1.218 14: irritability/anger 4 1.63 1.06 1.585 1.436 15: difficulty concentrating 4 1.63 1.009 1.549 1.134 16: hypervigilance 4 1.41 .98 2.259 3.787 17: exaggerated startle 4 1.52 1.06 1.880 2.236 pclm total 66 23.73 10.25 2.260 5.780 table 3 lists internal consistency established by means of cronbach’s alpha coefficients for frequency total and subscale scores, which were very good (.810) and excellent (.926). the alphas represent the shared variance of the items within each factor. in contrast, the squares of intercorrelations of the subscales represent the shared variances across scales. this suggests that the subscales measured independent and distinct phenomena (mueller & hancock, 2007). similarly, intercorrelations among subscales are lower than internal consistency alphas. advances in social work, spring 2012, 13(1) 194 table 3: correlation matrix among subscales with reliability factor names 1 2 3 4 total reexperiencing (f1) 1.00 avoiding (f2) .676** 1.00 numbing (f3) .702** .622** 1.00 hyper-arousal (f4) .654** .540** .795** 1.00 pclm total reliability (cronbach’s alpha) .902 .838 .810 .835 .926 ** correlation is significant at p< .01 (1-tailed) table 4 presents structural elements of the model such as factor loadings with tvalues, and squared multiple correlations. each ptsd item loads on its latent factor with factors ranging from .38 to .87, which are all statistically significant with t-values ranging from 10.71 to 17.34. the r² values range from .32 to .68, indicating between 32% and 68% of the variance on individual items can be accounted for by the latent factor to which they are consigned. considering results that the selected fit indices reflect a goodfitting model and the factor loadings are statistically significant, the result confirms the factor structure of the pcl-m. table 5 summarizes the fit statistics comparing the results of different models. as most experts in sem (kline, 2011) have addressed that good model fit should not be interpreted as having ‘truly proven’ the hypothetical model, we tested several equivalent models which were published in previous studies with different samples. considering theoretical and practical provision among five competing models, the four-factor intercorrelated model (4-factor 1st order model) is the best fitted model ( χ2 / df = 3.663, rmsea = .080, cfi = .97, ifi =.97) based on the cut-off mentioned above. the 3-factor model and 4-factor second-order model are also found to have a satisfactory fit with a cut-off of cfi, nfi, & ifi >.95. to establish convergent validity, a further pearson correlation matrix (table 6) shows statistically significant relationships between the four sub scales and related psychological and physical health conditions. as expected, the relationship between ptsd and depression are strongly and significantly correlated (r =.726). with one insignificant relation between alcohol problems and avoiding symptoms, the total ptsd score is also statistically significantly associated with alcohol problems (r=.219), general health (r=.359), and total number of medications (r =.435) at the significance level of .001. to test concurrent validity, a t-test and f-test were used to clarify the relationship between the mean score on the pcl-m and the selected demographic variables. yarvis et al/ptsd in older veterans 195      table 4: factor loadings (path coefficient (β), t-values (t), and r2) items (pclm 1-17) re-experiencing avoiding numbing hyper-arousal r² 1: intrusive memories .70 (17.42) .66 2: nightmares .59 (16.94) .64 3: flashbacks .48 (15.52) .56 4: psychological distress .76 (17.34) .66 5: psychological reactivity .54 (16.09) .59 6: thoughts/feelings .58 (15.64) .63 7: activities/places/people .56 (16.04) .66 8: trauma-related amnesia .44 (10.71) .32 9: diminished interest .75 (13.89) .48 10: detachment .59 (14.82) .53 11: restricted affect .38 (11.78) .37 12: foreshortened future .71 (15.35) .56 13: sleep difficulty .87 (11.82) .38 14: irritability/anger .64 (13.35) .46 15: difficulty concentrating .85 (17.59) .68 16: hypervigilance .60 (14.45) .51 17: exaggerated startle .75 (15.34) .56 note: all path coefficients are significant table 5: summary of fit statistics with ml estimation method from different models models χ2 df χ2/df ratio srmr gfi agfi aic rmsea cfi nfi ifi 2-factor a 607.02 118 5.161 .070 .81 .75 727.23 .118 .95 .93 .95 2-factor b 663.07 118 5.619 .074 .79 .72 825.09 .128 .94 .93 .94 3-factor 486.09 116 4.190 .059 .86 .81 540.28 .096 .96 .95 .96 4-factor a 374.57 113 3.315 .047 .89 .85 433.22 .080 .97 .96 .97 4-factor b 421.29 115 3.663 .057 .88 .84 471.52 .086 .97 .95 .97 advances in social work, spring 2012, 13(1) 196 table 6: convergent and discriminant analyses variables name full pclm re-experience avoiding numbing hyper-arousal convergent depression .726** .570** .464** .715** .721** alcohol problem .219** .165** .063 ns .210** .342** general health .359** .245** .189** .396** .413** total # of medication .435** .277** .182*** .373*** .437*** discriminant education .003 ns .008 ns .054 ns -.025 ns -.055 ns income -.195** -.170** -.059 ns -.214** -.203** marital status .114* .024 -.027 ns .210** .103** # of household .058 ns .050 ns .033 ns .293 ns .084 ns notes: **correlation is significance 0.01 level (1-tailed) * correlation is significant at the 0.05 level (1-tailed) ns = not significant discussion the present study provides additional support for the pcl-m as a highly reliable and valid measure of ptsd symptomatology. further, the cfa result supports other research suggesting that avoidance and numbing symptoms of cluster c are more distinct than they are similar. the use of valid and reliable self-report ptsd instruments such as the pcl-m can improve the recognition, identification and diagnosis of ptsd. consequently, the pcl-m may aid in the design of subsequent treatments for trauma survivors. an alternative model of ptsd indicating the separation of the dsm-iv symptoms of avoidance and numbing may be useful in structuring and developing treatment plans. the interrelationships between ptsd symptoms in designing and implementing treatment interventions may be important to consider given the support for factor solutions that link re-experiencing and avoidance or hyper-arousal and numbing as second order. consideration of alternative models of the structure of ptsd has important implications for clinical practice. recently, researchers have suggested that treatment for persons diagnosed with ptsd may need to be customized to particular types of symptom presentations (palmieri & fitzgerald, 2005). for example, there is some evidence to suggest that cognitive-behavioral treatment for ptsd may be less effective for individuals with higher levels of pre-treatment emotional numbing (taylor, federoff, koch, thordarson, ecteau, & nicki, 2001). in subsequent research, taylor and his colleagues found that using exposure therapy may show greater utility in symptom reduction for effortful avoidance than with symptoms of emotional numbing (taylor, thordarson, maxfield, federoff, lovell, & ogrodniczuk, 2003). because the conflicts in iraq and afghanistan are ongoing, the full impact on the mental health of service members is not yet accurately known. according to the u.s. yarvis et al/ptsd in older veterans 197      department of veterans affairs, ptsd affects 6.8 percent of the general population. however, iraq and afghanistan veterans are returning with ptsd rates as high as 50 percent (helmer, et al., 2007). affected veterans can have multiple difficulties in daily functioning both at home and in their jobs. many veterans may also face self-medication risks with alcohol and drug abuse (yarvis, 2008). at a time of increasing ptsd among returning veterans from iraq and afghanistan, clinical social workers must pay special attention to the growing problem of untreated and undertreated war-related trauma as we know from the abundance of literature on vietnam veterans that untreated ptsd contributes to significant health problems in older veterans (kulka, et al., 1990). the military has worked hard to inform returning veterans about what they might experience emotionally and how it may affect their families (yarvis, franklin, & dungee -anderson, 2009). however, most veterans do not ask for help with ptsd symptoms out of shame or fear that it will negatively affect their career advancement. even when taking into account the effect of combat exposure, it is critical to consider that a negative homecoming reception may prevent veterans from talking about their experiences or expressing their feelings about what happened while deployed. further, veterans may also have a difficult time adjusting to their pre-deployment roles in the family as much as the family feels the pressure to adjust to a soldier’s homecoming. accordingly, family members can be instrumental in seeking out needed help if veterans are experiencing symptoms of ptsd, depression, or substance abuse (cabrerra, yarvis, & cox, in press; jordan, et al., 1992). while the present study has much strength, several limitations should be addressed. first, the study was a relatively small and purposeful sample restricted to older male veterans. second, the missing cases were quite large even though we purposely selected, and we are curious whether it may be due to possible systematic or random errors. additional research is required to further our understanding of the ptsd symptom structure in the context of varied, multiple, and chronic trauma exposure in peacekeeper populations. a population based longitudinal study should be conducted to assess returning troops’ emotional experiences. because the “post” in ptsd means that symptoms begin months or years later, some veterans as they age are experiencing late onset ptsd symptoms – memories, flashbacks, and nightmares – triggered by watching television news about the war or exposures to stimuli not previously experienced as aversive by the veteran. future study direction should target more extensive diagnostic evaluation of the veteran’s co-morbidity of psychological and social stressors including poorer health, unhealthy coping behaviors, and conflicts in family relationships, which may be led from unresolved past traumatic experiences. references administration on aging. 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(2008). subthreshold ptsd in veterans with different levels of traumatic stress: implications for prevention and treatment with populations with ptsd. saarbrucken, germany: vdm verlag dr. muller publishers. yarvis, j., bordnick, p., spivey, c., & pedlar, d. (2005). subthreshold ptsd: a comparison of depression, alcohol and physical health problems in canadian peacekeepers with different levels of traumatic stress. stress, trauma, & crisis: an international journal, 8(2-3), 195-213. yarvis, j. s., franklin, k., & dungee-anderson, d. (2009, november). the triple trauma matrix of military conflict: deployment, ptsd and reintegration. paper presented at the council of social work education annual meeting, san antonio, tx yarvis, j. s., & schiess, l. (2008). subthreshold ptsd as a predictor of depression, alcohol use, and health problems in soldiers. journal of workplace behavioral health, 23(4), 395-424. yeager, d. e., magruder, k. m., knapp, r. g., nicholas, j. s., & frueh, b. c. (2007). performance characteristics of posttraumatic stress disorder checklist and span in veterans affairs primary care settings. general hospital psychiatry, 29(4), 294-301. advances in social work, spring 2012, 13(1) 202 author’s note: address correspondence to: lieutenant colonel jeffrey yarvis, deputy commander for behavioral health, dewitt healthcare network, fort belvoir, va 22060. e-mail: jeffrey.yarvis@us.army.mil. microsoft word rapp-sullivan strengths model copyedit final ______________  charles a. rapp, ph.d., is a research professor in the school of social welfare at the university of kansas in lawrence, ks. w. patrick sullivan, ph.d., is a professor in the indiana university school of social work in indianapolis, in. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 129-142  the strengths model: birth to toddlerhood charles a. rapp w. patrick sullivan abstract: the strengths model/perspective was developed by social workers and the profession continues to be the leader in its practice, research and refinement. this article traces the three decades of evolution of this approach and the continuing expansion of its use around the world. cautionary notes are provided and an agenda for future development is proposed. keywords: strengths model, strengths perspective, case management, strengths model fidelity, strengths model and social work the strengths model/perspective has just passed its 30th birthday and has continuously attracted the interest of many practitioners, administrators, and scholars. while social work remains the lead profession interested in the strengths model/perspective and mental health its most well-developed field of practice, the breadth of its appeal has been quite surprising, involving various helping professions, and a wide group of fields of practice. the new millennium has been marked by a broadening of worldwide interest in strengths based approaches (francis, pulla, clark, mariscal, & ponnuswami, in press; pulla, chenowith, & francis, 2012). it might be a propitious time to reflect on the origins of the model and its evolution. thirty years, from the perspective of human development, is a significant time span. however, when it comes to the world of big ideas, things we call perspectives or paradigms generally take far more than three decades to simply sketch out the questions that need to be addressed. we see the strengths perspective in just that light. unquestionably for some, thinking in terms of strengths, particularly in direct practice settings has become routine and accepted. because of this, there is the inevitable quest to search for what is new and novel, and some may now view this once radical approach as passé. even the most fervent strengths model adherents must avoid being caught in a trap. nothing can breed complacency more than success. indeed, in some respects, given humble beginnings in pilot mental health projects, to expansion to other fields of practice, and from adoption by few bold organizations across the country, to application across the globe, the strengths model has been an unqualified hit. this creates two significant challenges. first, because the adoption of some strength principles in practice has become so commonplace it may be assumed that the messy development work has been completed. it has not. not only are there questions left to be answered, but there is evidence of the predictable drift and reinvention that follows any innovation. such modifications can be positive, but at times the slightest of changes can fundamentally alter the basic values and behaviors that undergird a process or practice. advances in social work, spring 2014, 15(1) 130 the second challenge is to continue to develop and refine the core principles through solid research and draw from this intelligence to develop a reliable litmus test to discriminate what is truly strength-based approaches from those that do little more than merely draw on a subset of principles and practice. the reason for this is simple. over time it has become apparent that there are many individuals and organizations who claim to draw from the strengths model when their values, attitudes, and behaviors tell a different tale. because there is so much left to do, we believe that the strengths model has only moved from infancy to beginning toddlerhood. toddlerhood is generally characterized as a period of rapid learning, improved skills, and greater ability to precisely articulate one’s thoughts. these challenges for the toddler are somewhat parallel to the challenges that confront the future of the strengths model and we will offer thoughts on the agenda that lies ahead. gestation of an idea february 5, 2013 marked the 50th anniversary of a noteworthy benchmark in the history of mental health care in this nation. in a 1963 special message to congress, president kennedy introduced what he deemed a bold new approach to mental illness. after contentious debates and exhaustive reports had been offered, community mental health centers were opened for business across the land. unquestionably, kennedy’s remarks reflected the optimism of the times – an era where dreaming big was nearly commonplace. in his message, the president confidently asserted that new tools and new methods were in place to offer care to those facing emotional disorders closer to home, and in fact, that prevention and early treatment could reduce the reliance on a state psychiatric system. what’s more, it was felt in some quarters that some state psychiatric hospitals, both by virtue of their physical condition and overall quality of care, had become a national disgrace (foley & sharfstein, 1983). soon after the doors of these centers opened to the public, it became clear that there was a strong demand for local mental health services. people arrived troubled by depression and anxieties, marital woes, and concerns about their children. judged by popularity alone, the new community mental health centers were an unqualified success. yet, as is always the case in new ventures like this, the bottom line was far more nuanced. what became painfully clear was that community mental health centers were not well-positioned to effectively serve those facing schizophrenia, bi-polar disorder, major depression and the host of serious illnesses that were found on the rolls of every state psychiatric hospital. additionally, within a decade, key legal decisions rendered entrance to institutional care more difficult, and with relatively new programs like medicaid and medicare now operational, state authorities seized on the opportunity to reduce budgetary pressure by closing and downsizing institutions under their purview (mechanic & rochefort, 1990). as a result of these and other forces, the glow that once surrounded communitybased mental health services began to fade. all social problems emerge from myriad causes, but in the act of accounting and assessing causation it seems simplistic rapp, sullivan/the strengths model 131 explanations are always embraced. therefore, homelessness, crime, the growth of so called psychiatric ghettos, and even the existence of a young cohort clearly struggling but resistant to care was laid at the doorstep of community mental health, as well as a diverse set of circumstances labeled retrospectively as deinstitutionalization (mechanic & rochefort, 1992). clearly there was no single policy, department, or institution to blame for what appeared to be a crisis. those challenged by serious mental illness were no longer hidden in far away institutions but found in suburbia and main street. families were increasingly called upon to care for loved ones, often by the same authorities who once erroneously blamed them as the cause of illness. many of these same weary and frustrated family members spearheaded the creation of an organization called the national alliance for the mentally ill and demanded that changes be made. clearly, something had to be done. einstein was said to have remarked that we cannot solve the problems we currently face with the same thinking we used in creating them. however, in so many ways this appeared to be the operating manual as community mental health ramped up services to deal with those who had once resided in state psychiatric hospitals, and those who would have once been an inpatient in a different age. therapy, treatment and skills groups, and medications management however were the same as what had been offered before. the hospital, as a total institution, ensured that an individual’s basic needs were met, and daily life was marked by a predictable routine and structure. in the community, the basic necessities of life were no longer guaranteed, and beyond family, few were tasked with the responsibility to help. it became apparent to many stakeholders that if we were to be successful, standard treatment services alone were insufficient. indeed, to be successful, attention must be devoted to the total life of the individual. in response, by the late 1970s the national institute of mental health introduced the community support program, an early attempt to develop a system of care model designed to address the needs of those deemed chronically mentally ill (turner & tenhoor, 1978). a centerpiece of this new model of care was case management. birth sometimes things just fall into place. the forces described above stimulated efforts to develop new practice models and new systems of care. in 1982, the university of kansas school of social welfare secured a $10,000 grant from the state mental health authority to develop a model of case management. ronna chamberlain had arrived as a ph.d. student after years of experience in the mental health field, particularly with those we now deemed psychiatrically disabled. once in lawrence, ronna joined faculty member charlie rapp who came to kansas with experience in child welfare working with those children whom others were prepared to cast aside. working backwards, rapp and chamberlain first devised a list of desirable client outcomes based on the most common goals stated by clients. it was noteworthy that these went beyond compliance and maintenance but looked to real life outcomes in key areas such as vocational activity, independent living, social support including satisfying use of leisure time and affiliation. what became clear when analyzing the state of the art in case management was how ill suited current models were positioned to address these basic human needs let alone help advances in social work, spring 2014, 15(1) 132 attain goals that went beyond the necessities for survival. instead, most models viewed a case manager as a broker of service with a primary role of linking people to standard mental health services and a truncated set of auxiliary social services. embedded in these models were low expectations for client success. the focus here was on maintenance and protection, and any notions of the possibility of recovery and citizenship were well over the horizon. it was time to roll up the sleeves and try to do something totally different. during the earliest stages of their work, chamberlain and rapp discovered that there were more commonalities in their past experiences than differences. chamberlain had been experimenting with a strengths perspective while a social worker in a state psychiatric hospital. as chamberlain (1992) wrote about an early attempt: jack, a lovable guy with more hospitalizations than anyone could count, wanted to work but had no job skills. he was quite adept at group therapy, however, having had more experience than even the clinical staff. in fact, he was wonderful at supporting other clients, helping to assuage their anxiety. with a lot of help he ultimately landed a job as a work crew supervisor in a vocational training program for people with psychiatric disabilities. there he spent his days helping people through their anxiety and symptoms so that they could accomplish their tasks. he stopped using the hospital. when that program lost its funding, he went on to a different job and eventually got married (p. xiii). her focus was on the strengths of the individual but implicit in her work was an unrecognized view of the environment. rapp, based on earlier work in child welfare and juvenile justice, had proposed that all environments contain a wealth of resources, that a person’s behavior is mightily influenced by the resources available to people, and that our society values equal access to resources (davidson & rapp, 1976). both sets of ideas from chamberlain and rapp placed the client’s wishes and desires front and center. thus, less attention was directed to the identified challenge or problem, and more effort was expended towards the practical and tangible assistance and support people needed in the quest to reach their individual goals. chamberlain and rapp firmly believed that merely linking clients to low expectation services that focused on remediating perceived deficits and often separated people from the community, and then blaming them for not doing better was a poor basis upon which to design a helping service. what later became known as the strengths model was based on six fundamental ideas or principles: 1. people with psychiatric disabilities can learn, grow and change 2. the focus is on individual strengths rather than deficits 3. the community is viewed as an oasis of resources 4. the client is the director of the helping process 5. the worker-client relationship is primary and essential 6. the primary setting for our work is the community rapp, sullivan/the strengths model 133 these ideas were different (if not the opposite) from the prevalent beliefs and practices at the time. armed with a mimeographed set of principles, a new tool devoted to identifying individual and environmental strengths, and a simple form used to record and monitor individual goals, the resource acquisition model of case management was launched. it was an interesting marriage as undergraduate and graduate social work students began to build a caseload, take the nearly unprecedented step of working in the home and community, and work on goals that the clients identified as important. even more radical for the times, project case managers were never informed of the diagnosis of individuals they served to avoid negative expectations and stereotypes that inevitably accompanied these terms. mental health center leadership was, at times, uneasy. for example, early into the project, concerns were raised when it became apparent that clients began calling student-case managers when they were in need or in crisis rather than their primary therapist. the significance of this piece of data was that it underscored the power of the case management relationship, one that was fostered by work driven by a partnership and enacted in real world settings. after the initial project showed promise (rapp & chamberlain, 1985), additional pilots were established in greater kansas city and in topeka, kansas. soon it became clear that this unique model of case management was enjoying some success, and to the surprise of many, often with individuals deemed by others to be the most impaired and the most in danger of returning to institutional care (modrcin, rapp, & poertner, 1988; rapp & wintersteen, 1989). not without struggle, others began to see the utility of this approach to case management and by the mid-1980’s the state of kansas required that all case managers be trained in the model. before long, others took notice of what was happening in kansas. the appeal of the new model of case management was buttressed by its fidelity with predominant social work values. soon the core participants in the development of the model were offering two-day workshops across the country. to say that ideas like working in the home and community instead of the office, focusing primarily on strengths in people and the world around, and building care plans from the stated goals of the recipients was a hard sell is a vast understatement. there were moments when the resistance was palpable. it was not uncommon for people to walk out of training sessions shaking their heads and visibly angry. however, some key stakeholders did get on board, and many began to feel deeply that the new model held much promise. infancy what followed from here was perhaps unexpected. as ph.d. students at the university of kansas school of social welfare, who were involved with the strengths model projects, began to describe their work, others began to take notice. ann weick, who held a longstanding interest in philosophical frameworks that undergird social work practice, became intrigued by this new model of case management and foresaw implications that went beyond work with those facing serious mental illness. she challenged her students to dig deeper into the work, and began to take a greater interest in advances in social work, spring 2014, 15(1) 134 the work being done in mental health. soon these ideas were codified in a paper that appeared in the journal social work titled “a strengths perspective for social work practice” (weick, rapp, sullivan, & kisthardt, 1989). this article would serve as the first statement for what is now known as the strengths model. not surprisingly it was soon clear that kindred spirits abounded. to that end a group of educators, researchers, and practitioners were invited to participate in a small conference at the union building at the university of kansas to present papers and engage in discussion. other disciplines were represented and the potential power of a strength perspective became obvious to all attendees. many of these papers were included in a collection edited by dennis saleebey and presented for the first time as the strengths perspective for social work practice (1992). for many, the notion of focusing on individual and environmental strengths had intrinsic appeal and resonated with a humanistic style germane to social work. additionally, specific aspects of case management practice, from the strength assessment, to the goal and case planning method had clear utility in a range of practice settings and with the diverse populations commonly served by social workers. before long, the strengths model was adopted in substance abuse treatment (sullivan, wolk, & hatmann, 1992). the late harvey siegel, richard rapp and colleagues at wright state university began to extensively study the strengths model in substance abuse treatment, often with some of the most difficult of clients (siegal et al., 1995). from that point on the possibilities were nearly endless, and ultimately went beyond direct practice to include treatises on leadership (poertner & rapp, 2007) and social policy (chapin, 2010; rapp, pettus, & goscha, 2006). in 1998, the strengths model: case management with people suffering from severe and persistent mental illness was published as the first practice text on the model (rapp, 1998). towards toddlerhood as the strengths movement enters toddlerhood, there are many critical developmental tasks to be undertaken. the following section proposes those tasks we deem most important in three areas: research, fidelity and practice. toddler: strengths model research the research on the strengths model is far from conclusive yet promising. in substance abuse treatment, the strengths model has shown to improve treatment retention which is often a prerequisite for positive outcomes (siegal, li, & rapp, 2002). in other studies, improved employment outcomes and decreased involvement with the criminal justice system were found (rapp & lane, 2013; siegal et al., 1996). strengths case management with people with psychiatric disabilities has been investigated the most. there have been 10 studies testing this approach. four of the studies employed experimental or quasiexperimental designs (modrcin et al., 1988; macias, farley, jackson, & kinney, 1997; macias, kinney, jackson, & vos, 1994; stanard, 1999) and six used non-experimental methods (barry, zeber, blow, & valenstein, 2003; fukui et al., 2012; kisthardt, 1993; rapp & chamberlain, 1985; rapp rapp, sullivan/the strengths model 135 & wintersteen, 1989; ryan, sherman, & judd, 1994). these studies have produced positive outcomes in the areas of hospitalization, housing, employment, reduced symptoms, leisure time, social supports, and family burden. the most recent study (fukui et al., 2012) investigated the relationship between fidelity of strengths model case management implementation and the client outcomes of psychiatric hospitalization, competitive employment, involvement in post secondary education, and independent living. it found a statistically significant association between fidelity and all but independent living. this study strongly suggests that improved client outcomes are achieved as adherence to strengths model behaviors occur. strengths based practice continues to broaden its reach in terms of both practice applications and global interest. the principal drivers seem to be the practice community. while this is exciting, it does contribute to the paucity of research that has been published on the model. in fact, there are few areas that offer more possibilities for intervention research as the strengths perspective. a myriad of attempts to design and implement strengths based interventions with a variety of different client groups in a wide spectrum of settings (pulla et al., 2012; saleebey, 2013) provides many opportunities. we need to apply rigorous (as possible) research designs and measurements to these experiments. initially, this could involve pre-post designs as a precursor to more rigorous experimental testing. the strengths perspective is fertile ground for qualitative explorations. in its full flowering, the strengths perspective requires different approaches to engagement, assessment, case planning and interventions. there are many different pieces yet we only have one study (kisthardt, 1993) that systematically studied clients’ experience of receiving strengths-based services. if mounted in conjunction with quantitative outcome data, such an inquiry could help us explain the results we find. toddler: fidelity a prerequisite for the proposed research agenda is the development of fidelity measurement. for experimental and quasi-experimental research to be able to attribute results to the intervention, we need to know that the intervention was delivered as designed. for the qualitative research proposed, capturing the client experience must be based on the fact that they did receive the strengths-based intervention. currently, there is only a single fidelity instrument for strengths case management that has been tested (fukui et al., 2012). the development of fidelity measures would also enhance strengths-based practice in two related ways. first, fidelity measurement requires us to be precise about the salient methods and elements of the intervention model. it is common for people to treat the strengths perspective as merely a slogan where such superficial behaviors as “being nice to clients” or adding two lines on strengths to an otherwise deficit based assessment is seen as being a strengths approach. we need to be better at separating the fraudulent from the real. increased preciseness would also mightily help the design of staff training programs. second, fidelity measurement would enhance practice by improving quality assurance. at its core, quality assurance is a process for assessing how well service advances in social work, spring 2014, 15(1) 136 delivery matched the agency’s prescriptions for it. fidelity instruments would allow strengths-based service to be included in such a process. in many organizations, the frontline supervisor is a de facto core component of quality assurance and periodic fidelity measurement can be a tool for the supervisor. toddler: practice over the last 30 years, the strengths model has gained the interest and favor by increasing numbers of practitioners, social administrators and scholars. several books have documented the wide range of applications to different populations struggling with different challenges in a variety of countries on five continents (francis et al., in press; pulla et al., 2012; saleebey, 2013). journal articles describe additional applications (arnold, walsh, oldham, & rapp, 2007; cox, 2006; yip, 2005, 2006). there are pilot projects for strengths case management being implemented in new zealand, hong kong, japan, australia, and canada. the growth of the strengths model belies the forces that discourage its adoption. the situation described by saleebey (1996) almost two decades ago still stands: our culture and the helping professions are saturated with an approach to understanding the human condition obsessed with individual, family, and community pathology, deficit, problem, abnormality, victimization, and disorder (p. 296). this perspective is often reflected in government rules and regulations, funding patterns and training programs for future human service personnel. while progress continues to be made, there remains two strengths model skill sets that seem particularly challenging to develop: 1. translating strengths into personal plans (i.e., case plans, action plans, etc.); 2. exploiting the strengths of the natural environment. the purpose of an assessment is to gather information necessary for the development of a plan and its implementation to occur. we have found that teaching people to assess strengths is often attainable but more daunting is teaching them to use these strengths to fashion more powerful personal plans. in brief, a well-done strengths assessment can and should be used to identify client goals, provoke various options for pathways to goal attainment, help define specific tasks, and identify resources and social supports that can be pursued (rapp & goscha, 2012). the link between the content of an individual’s strength assessment and their case plan should be unambiguous. a second area of difficulty is identifying and using naturally occurring resources in service to the client’s goal. this is particularly important for populations for whom community integration is a desired purpose (e.g., various disabled populations and individuals on parole). it is still too often the case that people’s perception of the strengths model is narrowly focused on the strengths of the individual excluding the strengths of the environment as the necessary compliment. similarly, many professionals believe that segregated programs are preferred. as sullivan (1989) wrote over two decades ago: rapp, sullivan/the strengths model 137 many urban areas hire recreational therapists to develop recreation programs and provide clients with a variety of opportunities to participate in active leisure-time activities. while recreation therapists clearly serve a valuable function in these programs, most rural programs do not have the luxury of hiring this type of staff person. yet nearly every community has a gymnasium. in many small communities one can find exercise classes, and even aerobic instruction. softball teams and leagues can be found everywhere. we must resist ideas that clients must engage in segregated activities. while the client may need help in making initial contacts and periodic support throughout the experience of engaging in community recreational activities, success is possible. key personnel are also available to provide support for clients. high schools employ physical education instructors. local athletes may be willing to help. all of these resources can be used to develop a good recreation program (p. 22). the importance of recognizing and exploiting strengths in the natural environment is vitally important to social work, and is one clear area that distinguishes this disciple from others in the helping professions. first, it affirms the long standing person-inenvironment perspective that informs all phases of social work practice. yet, so often we use this lens to help gain a greater understanding of troubling behavior, or to consider how modifications in the environment can compensate for a problem or malady. many social programs serve as a social prosthesis to aid a person who is viewed as damaged or flawed. there is little question that this can be an important aspect of successful practice in some instances. however, rarely do we simply see the outside world as a source of strength and match the goals and desires of the person with what exists in the world around them. the idea here is to match strength with strength. second, because we know full well that many of those with whom we work are shunned by others, the world becomes a closed shop to them. in the case of those with serious mental illnesses, the impress of stigma is pervasive; in fact often there are only half-hearted efforts to hide this. in other populations, for example in services with older adults, the rejection can be far more subtle. we forget that the furloughed or retired banker, teacher, or older homemaker still has viable skills that can be used to their benefit and to the benefit of others. when this happens it calls forth the long standing social work commitment to advocacy and action. at issue is what kretzmann and mcknight (1993) deemed the contribution of strangers, those who are often hidden away at the margins of society. when social resources are denied others because of their differences or due to oppressive policies and attitudes it is incumbent on social work leaders and practitioners to challenge these head on. indeed, executed faithfully the strengths model puts the social squarely back in social work. the following modest example demonstrates the successful use of strengths assessment information and natural community resources to help a person achieve a longstanding goal. dave, a 49 year old veteran of the state psychiatric system, had lived marginally and unhappily in the community for the past 7 years. it was a situation most accepted to be part and parcel of dealing with schizophrenia. in that time, he had advances in social work, spring 2014, 15(1) 138 been served by three case managers, lived in a squalid board and care home, and often attended a day program at the community mental health center though participating minimally. he was assigned to a new case manager who diligently, over the period of several sessions, completed a strengths assessment. unbeknownst to the staff, and never noted in the chart, dave had actually completed an associate of arts degree in business and was enrolled in an accounting program at a state university when he was first hospitalized. it began a series of revolving door treatment episodes that was finally stabilized with the help of a newer psychotropic medication. the case manager listened intently to dave’s story and asked a lot of questions about his educational experiences. the case manager noted that when talking about accounting and numbers, that dave came alive. he liked things such as reading sports statistics, paid attention to the ups and downs of the stock market and other things that involved numbers. he said when bored he would do math problems in his head. he admitted that he was unsure if he could return to school but had always dreamed of working in a bank. when the case manager shared what he had discovered in a team meeting others tried to quell his enthusiasm. they noted that dave had been ill for years, his hygiene skills were minimal and he barely kept awake in groups. they suggested reluctantly that he attend a class that dealt with life skills and budgeting to see if he was truly ready to take any significant steps in his life. in short order, dave quit coming to the center all together. when the case manager tracked him down, dave said he was bored and had no interest in ever going to a group again. the case manager, getting to basics asked “what do you want, and how can i help you get it.” reluctantly, dave noted that he had made it clear numerous times, and to untold numbers of professionals, that he wanted to work in a bank. taking him seriously the case manager and dave began outlining steps to reach that goal. together the case manager and dave practiced interviewing, considered options for jobs in the area that were reasonably close to home and near a bus line. it was noteworthy that dave’s grooming began to improve without a single prompt from others. with the use of “flex funds” the case manager and dave went to a local goodwill where two suits were purchased. in time, and with the case manager’s help, an interview was arranged at a local bank. the manager who interviewed with dave was cognizant that some challenges existed, but was impressed with the effort that was extended and the clear desire to work. he agreed to let dave do a part-time job he sometimes had difficulty getting done. every day dave came to the bank and was responsible for putting bags of loose change through a sorting machine. he loved it. he loved putting on a suit. he loved having a job. soon he began talking about the possibility of getting his own apartment and even began contemplating returning to school part time. the case manager honored dave’s goal and his talents with money, and exploited community resources (goodwill, bus lines, and the bank) on behalf of achieving the goal. rapp, sullivan/the strengths model 139 conclusion there continue to be forces that impede the future development of strengths-based approaches. on the other hand, there seem to be at least four factors supporting it. first, there continues to be a high level of dissatisfaction with the effectiveness of current methods, interventions and programs that seek to address the difficulties of the poor, the disabled, children and youth, offenders, the elderly and other populations served by social workers. second, continued reductions in human service funding could force us to embrace the primacy that the strengths model places on the use of natural community resources. third, at least in mental health, the recovery movement, now codified in the policies of the united states and many other countries, has moved the strengths model from an insurgency to main line thought. recovery places a premium on selfdetermination, human rights, and empowerment which are all precepts of the strengths model. in fact, the samhsa consensus statement on recovery (2006) included “strengths-based” as one of its 10 essential components. recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities and inherent worth of individuals. by building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, and employee). fourth, the strengths approach seems to have an inherent appeal to many people. for them, the approach is hope inducing, energizing, and often highly congruent with the motivations many possessed as they entered social work and other helping professions. the future will be determined by the people we serve. if the research shows that they achieve their goals at significantly better rates than other approaches, strengths based approaches will spread. if clients view the experiences of receiving strengths-based services as congenial, helpful and uplifting, then strengths-based approaches will continue to diffuse. references arnold, e. m., walsh, a. k., oldham, m. s., & rapp, c. a. (2007). strengths-based case management: implementation with high-risk youth. families in society: the journal of contemporary social services, 88(1), 86-94. barry, k. l., zeber, j. e., blow, f. c., & valenstein, m. (2003). effect of strengths model versus assertive community treatment model on participant outcomes and utilization: two-year follow-up. psychiatric rehabilitation journal, 26(3), 268-277. chamberlain, r. (1992). forward. in d. saleebey (ed.), the strengths perspective in social work practice (pp. xiii-xiv). new york, ny: longman. chapin, r. (2010). social policy for effective practice: a strengths approach. new york, ny: routledge. cox, k. f. (2006). investigating the impact of strength-based assessment on youth with emotional or behavioral disorders. journal of child and family studies, 15(3), 278292. advances in social work, spring 2014, 15(1) 140 davidson, w. s., & rapp, c. a. 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(1993). building communities from the inside out. evanston, il: northwestern university. macias, c., farley, o., jackson, r., & kinney, r. (1997). case management in the context of capitation financing: an evaluation of the strengths model. administration and policy in mental health and mental health services research, 24(6), 535-543. macias, c., kinney, r., jackson, r., & vos, b. (1994). the role of case management within a community support system: partnership with psychosocial rehabilitation. community mental health journal, 30(4), 323-339. mechanic, d., & rochefort, d. a. (1990). deinstitutionalization: an appraisal of reform. annual review of sociology, 16(1), 301-327. mechanic, d., & rochefort, d. a. (1992). a policy of inclusion for the mentally ill. health affairs, 11(1), 128-150. modrcin, m., rapp, c. a., & poertner, j. 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(2013). “knowing” the effectiveness of an evidence-based practice: strengths-based case management with substance abusers. in d. saleebey (ed.), the strengths perspective in social work practice (6th ed., pp. 149-160). saddle river, nj: pearson. rapp, c. a., pettus, c. a., & goscha, r. j. (2006). principles of strengths-based policy. journal of policy practice, 5(4), 3-18. rapp, c. a., & wintersteen, r. (1989). the strengths model of case management: results from twelve demonstrations. psychosocial rehabilitation journal, 13(1), 2332. ryan, c. s., sherman, p. s., & judd, c. m. (1994). accounting for case manager effects in the evaluation of mental health services. journal of consulting and clinical psychology, 62(5), 965. saleebey, d. (ed.). (1992). the strengths perspective in social work practice. new york, ny: longman. saleebey, d. (1996). the strengths perspective in social work practice: extensions and cautions. social work, 41(3), 296-305. saleebey, d. (ed.). (2013). the strengths perspective in social work practice (6th ed.). boston, ma: allyn and bacon. siegal, h. a., fisher, j. h., rapp, r. c., kelliher, c. w., wagner, j. h., o'brien, w. f., & cole, p. a. (1996). enhancing substance abuse treatment with case management its impact on employment. journal of substance abuse treatment, 13(2), 93-98. siegal, h. a., li, l., & rapp, r. c. (2002). case management as a therapeutic enhancement: impact on post-treatment criminality. journal of addictive diseases, 21(4), 37-46. siegal, h. a., rapp, r. c., kelliher, c. w., fisher, j. h., wagner, j. h., & cole, p. a. (1995). the strengths perspective of case management: a promising inpatient substance abuse treatment enhancement. journal of psychoactive drugs, 27(1), 6772. stanard, r. p. (1999). the effect of training in a strengths model of case management on client outcomes in a community mental health center. community mental health journal, 35(2), 169-179. substance abuse and mental health services administration. (2006). national census statement on mental health recovery. rockville, md: national mental health information center. sullivan, w. p. (1989). community support programs in rural areas: developing programs without walls. human services in the rural environment, 12(4), 19-24. sullivan, w. p., wolk, j. l., & hartmann, d. j. (1992). case management in alcohol and drug treatment: improving client outcomes. families in society, 73(4), 195-203. advances in social work, spring 2014, 15(1) 142 turner, j. c., & tenhoor, w. j. (1978). the nimh community support program: pilot approach to a needed social reform. schizophrenia bulletin, 4(3), 319-349. weick, a., rapp, c., sullivan, w. p., & kisthardt, w. (1989). a strengths perspective for social work practice. social work, 34(4), 350-354. yip, k. s. (2005). a strengths perspective in working with people with alzheimer’s disease. the international journal of social research and practice, 4(3), 434-441. yip, k. s. (2006). a strengths perspective in working with an adolescent with self-cutting behaviors. child and adolescent social work journal, 23(2), 134-146. author note address correspondence to: charles rapp, university of kansas school of social welfare, 1545 lilac lane, lawrence, ks 66045. email charlier@ku.edu charles a. rapp is research professor at the university of kansas school of social welfare and former director of the office of mental health research and training. he holds a ph.d. and m.s.w. from the university of illinois and a b.s. from millikin university. he was one of the senior researchers with the national evidence-based practice implementation project (2002-2005) and has been involved since in the implementation and study of evidence-based practices. he is the co-developer of strengths model of case management and the client-centered performance model of social administration. the third edition of his book, the strengths model: case management with people with psychiatric disabilities with rick goscha, was published by oxford press in 2011. w. patrick sullivan serves as professor at the indiana university school of social work. he was also the director of the indiana division of mental health and addiction from 1994-1998. while earning a ph.d. at the university of kansas, sullivan helped develop the strengths model of social work practice, and has extended the model in mental health and addictions treatment and policy. he has over 70 professional publications on a diverse range of topics. he received the distinguished hoosier award from governor frank o’bannon in 1997, and earned the sagamore of the wabash from governor joseph kernan in 2004 for his work in mental health and addictions. sullivan currently serves as a steering committee member for the samhsa/cswe recovery to practice initiative and also serves on the samhsa/cswe integrated behavioral healthcare project. microsoft word 1174-twill manuscript_copyedit3 _________________ sarah e. twill, ph.d., msw, is an associate professor in the department of social work at wright state university; kathy elpers, ed.d., msw, is an associate professor of social work at the university of southern indiana; and kathy lay, ph.d., is an associate professor in the indiana university school of social work, indianapolis. copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), 49-62   achieving hbse competencies through service-learning sarah e. twill kathy elpers kathy lay abstract: service-learning pedagogy allows social work educators to create meaningful learning opportunities for students and better prepare them for practicum, while at the same time, meeting a community need. this paper outlines the relevance of incorporating service-learning into the social work curriculum, specifically the human behavior and the social environment (hbse) area. using bloom’s taxonomy as a guide, the authors propose how the cswe competencies and practice behaviors specific to hbse may be assessed using service-learning pedagogy. an example is reviewed to illustrate how service-learning can assist faculty and students achieve the hbse competencies and practice behaviors. finally, implications for service-learning as a pedagogical strategy for social work education are discussed. keywords: service-learning, human behavior in the social environment curriculum, cswe competencies introduction the concept of service-learning in higher education as well as in social work education is not new and is frequently utilized as an experiential form of teaching to connect students in the community in a variety of formats. service-learning has a long history in higher education beginning with the morrill act establishing land grant institutions and continuing through the passage of the national and community service trust act (phillips, 2007; titlebaum, williamson, daprano, baer, & brahler, 2004). based on early involvement with the community beginning with the establishment of the hull house, the values of the social work profession, and the council on social work education (cswe) practicum requirements, service-learning and social work complement one another in that they serve to assist students achieve competencies. how service-learning is defined and incorporated as a pedagogical methodology has varied in social work education, depending on the course and the instructor’s perspective on service-learning methods (bringle & hatcher, 2002; king, 2003; larson, 2008; palm & toma, 1997; teater & baldwin, 2009; todd, 2008; waters & moran, 2001). “servicelearning (sl) is a collaborative teaching and learning strategy designed to promote personal growth, civic learning, and academic enhancement” (ash & clayton, 2009, p. 11). jacoby (1996) defined service-learning as “a form of experiential education in which students engage in activities that address human and community needs together with structured opportunities intentionally designed to promote student learning and development. reflection and reciprocity are key concepts of service-learning” (p. 5). twill, elpers, lay/achieving hbse competencies 50  mccrea (2004) reviewed and summarized the commonality of service-learning definitions to include the following components: “the service must meet an actual community need; the learning from service must be clearly integrated with course objectives; reflection about the service experience is essential; and the relationship between service recipients and learners must be reciprocal” (p. 5). these service-learning components are similar to those discussed by ash and clayton (2009) which highlighted community partnerships, meaningful activities, and guided critical reflection. ash and clayton also postulated that the impact of service-learning will enable students to have a better understanding of their personal and professional learning while better understanding how the world works, as well as their place and responsibility to the world. social work has a long-standing tradition of community-based service that dates back to the early settlement houses (blank, 1998). service is essential to the mission of the social work profession. the core values designated by the national association of social workers are: “…service, social justice, dignity and worth of the person, importance of human relationships, integrity, [and] competence” (nasw, 1999). service as an ethical principle demands that social work practitioners put service to others above their own interests and use their professional skills throughout their careers in a volunteer capacity (nasw, 1999). the model utilized for service-learning in social work courses should include connecting and collaborating with a community partner so that the students and community partner benefit in a meaningful way from the service-learning activity and uphold the values and ethics of the profession. moreover, students should be guided on how to develop professionally and personally from the service-learning experience through critical reflection on the knowledge, skills, and social work values integrated in bridging theory and practice. service-learning, from this pedagogical approach, parallels the paradigm shift of postmodernism in social work education. postmodern approaches emphasize understanding the world of others through their lens, which encompasses culture, history, personal, and social constructs rather than objectifying individuals through theory or cause-and-effect alone. in other words, social workers need to practice with a stance of open-mindedness rather than a deterministic or linear view of knowing what is best or needs to happen (greene, 2009; payne, 2005). by incorporating servicelearning within this framework, social work education can provide an integrative approach for students to understand social work from a real world context, connect with the profession, develop social work competencies, and critically reflect on their personal and professional growth. in summary, social work students, through service-learning, are provided with “active, relevant, and collaborative learning…” (bringle & hatcher, 2000, p. 274.) in a agency or community context. the focus of the engagement benefits the community, while at the same time, the context provides a rich learning environment for the student. service-learning creates a learning experience in which students and community members engage in collaboration with social work’s “…emphasis on social justice and the amelioration of social problems…” (lemieux & allen, 2007, p. 309). advances in social work, spring 2011, 12(1) 51  service-learning is not synonymous with volunteerism and practicum service-learning is often used synonymously and intertwined with volunteer work, community service, and field placements (larson, 2008). essential to service is volunteerism. many agencies and community organizations rely on volunteerism and in the current economy volunteerism may mean the continuation of services to those in need. lundahl and wicks (2010) document the benefits of volunteerism related to the value of professional skills for agencies and also the importance to individuals and groups who have a life-long commitment to service. lowe and reisch (1998) acknowledged that social work programs, for over a century, have developed educational models linking the classroom to community-based learning. these early service-learning models were influenced by the work of john dewey and paul freire which stemmed from an “apprenticeship model of education” (p. 292). building on these previous models, schools or departments of social work have adapted and expanded their educational programs to include a repertoire of communitybased learning activities including volunteering, community service, and field placements. however, it is service-learning that most often serves to reinforce a commitment to future civic engagement (bringle & hatcher, 2000). although all of these types of community-based activities are often described as service-learning, there is some disagreement among social work educators regarding the differences between volunteering, social work practicums, and service-learning (king, 2003; lemieux & allen, 2007). as part of assignments for social work courses, faculty often require students to perform a number of hours to volunteer or provide community service for a community project or with a social service organization. practicum requires a certain number of hours a student must work in a social agency to meet the course requirements. nevertheless, although all of these community-based educational activities involve students and a connection with the community in some form, either on a micro or macro level, not all of these course activities are service-learning. the principles of service learning including engagement for the public good, reciprocity with the community partner, the public dissemination of knowledge with those outside of the academy, and students’ critical reflection of experiences differentiates service-learning from other teaching pedagogies (heffernan, 2001). performing community service or volunteering largely focuses on service, field placements primarily focus on student learning while service-learning emphasizes both service and learning. larson (2008) viewed field placements as developing learning objectives based primarily on the student, faculty, and social work program’s goals as opposed to developing common goals and service activities that are mutually beneficial. although some would argue that both the student and the agency benefit from volunteering and student field placement, these types of activities do not always include components of organized and collaborative partnerships with community agencies, critical reflection, civic engagement, personal growth, as well as integrating social work knowledge, skills, and values with practice. in summary, service-learning is a pedagogical strategy, in the context of a course, which requires intentional planning, partnering with community organizations, and focusing on both service and learning for twill, elpers, lay/achieving hbse competencies 52  the benefit of the agency and student within the framework of social work values and course outcomes (ash & clayton, 2009; bringle & hatcher, 1995; king, 2003; lemieux & allen, 2007). additionally, students “reflect on the service activity in such a way as to gain further understanding of course content, a broader appreciation of the discipline, and an enhanced sense of civic responsibility" (bringle & hatcher, 1995, p. 112). hbse and service-learning students often begin their social work educations with limited practical experience or formal study of human behavior and the social environment (hbse). many are from other disciplines that do not incorporate contextual influences or the dynamic interaction between individuals and their environment. kropf and tracey (2002), writing specifically about msw students negotiating the transition from the foundation year to the concentration curriculum, postulated that service-learning can be an “educational bridge” that enable students to understand and apply social work concepts (p. 63). social work is a discipline that demands the practitioner acknowledge and take into account the social, political, environmental, and historical contexts of human strengths and challenges. this calls for real world examples along with academic content. service-learning provides experiential learning through civic engagement. theory for hbse facilitates how individuals make meaning of human behavior and their social environments. how individuals make meaning influences how others and the social world are viewed, as well as how human strengths and struggles are defined. social work practitioners, as life-long learners, must maintain a rigorous and current study of hbse theory that is relevant to the historical, cultural, political, and global societal influences. faculty are often challenged to choose a pedagogy that prepares future practitioners for this on-going task of theory application to the real world. understanding hbse theory should not be an abstract endeavor that has no relevance or influence on social work practice; therefore, connections for the learner with the real world are essential. we all theorize by constantly making meaning of everyday life experiences (flax, 1999). however, all theorizing and theory are not created equal. personal meaning making and theorizing are subject to bias and judgments that are often absent of critical reflection. service-learning, along with the presentation of academic content and critical reflection, facilitates an examination of value judgments that shape our thinking. it is essential to make explicit those implicit assumptions that ultimately influence our practices (flax, 1999). a mere understanding of human behavior theory through knowledge acquisition does not prepare students for real world practice. therefore, instructors strive to challenge students to move from a basic understanding of hbse theory to synthesis and evaluation (bloom, 1956), as well as think critically about the potential harm of applying abstract theory to individuals and the social environment. in order to facilitate this learning, students must be provided with experiences that allow application of theory in the real world as well as oral and written structured critical reflection on their experiences (ash & clayton, 2004; lay & mcguire, 2010). this brings theory alive for the learner as opposed to abstractly studying theory in a classroom that is void of real world advances in social work, spring 2011, 12(1) 53  experiences and the challenges of the social world. active and relevant learning experiences (bringle & hatcher, 2000) have the potential for deeper learning and require direct contact with the subject matter (lundahl, 2008). in this case, the subject matter is theory regarding human behavior and the social environment. theory is not truth. it is an abstraction that seeks to predict, explain, and make meaning of the social world. theory is constructed in a historical, social, and political context (finn & jacobson, 2003). because it is subject to certain contexts in its construction, faculty may become partial to theoretical understandings that are a reflection of popular cultural explanations of hbse. for example, erickison’s psychoanalytically oriented developmental theory was based solely on the male developmental experience, yet it is generalized as if it is applicable to all (schriver, 2011). life stage theory, like many human behavior theories, provides a metaphor for understanding development; however, it does not tell us the terrain of life experiences. social problems may influence individual and collective experiences. for example, the experience of homelessness may alter one’s developmental process in ways that both strengthen and challenge. by focusing our lens only on the individual living in homelessness, the struggle may be framed as belonging to the person and the struggle viewed as a “…result of personal deficiencies, such as substance abuse…” (cronley, 2010, p. 319). in that theories are abstractions with the potential for cultural, historical, and political biases, our pedagogy must include opportunities for students to reflect and examine theory in the real world service-learning brings real world experiences into the classroom. the application of theory is no longer a mere abstraction. these student experiences challenge linear and reductionist approaches that strip individuals, groups, families, and communities of their social context. human behavior does not happen in a vacuum where abstractions can simply be applied. our theories must reflect the complexity of the social environment. the factors discussed above position human behavior and the social environment as a course that is ideal for service-learning. theory is abstract and can be difficult for students to appreciate without real world experiences. in order to be relevant, practical application is necessary with the inclusion of critical reflection that seeks to bring into focus the social work mission of social justice and the social change. service-learning provides settings where the context of people’s lived experiences challenge abstractions that may be removed from the realities of practice. operationalizing the hbse competencies in 2008, the council on social work education (cswe) redesigned the social work competencies used for program accreditation (council on social work education, 2010). human behavior in the social environment (hbse) content was defined and practice behaviors were established. the following is the core competency for foundation education in hbse and the practice behaviors which stem from it: twill, elpers, lay/achieving hbse competencies 54  educational policy 2.1.7—apply knowledge of human behavior and the social environment. social workers are knowledgeable about human behavior across the life course; the range of social systems in which people live; and the ways social systems promote or deter people in maintaining or achieving health and well-being. social workers apply theories and knowledge from the liberal arts to understand biological, social, cultural, psychological, and spiritual development. social workers: • utilize conceptual frameworks to guide the processes of assessment, intervention, and evaluation; and • critique and apply knowledge to understand person and environment. (council on social work education, 2010). along with the other competencies, social work faculty have begun reshaping curriculum and programs to meet the new competencies. based on the authors’ personal experiences at three different universities, conversations with other faculty around the country, and postings on the association of baccalaureate social work program directors (bpd) listserve, we contend that programs have faced challenges in conceptualizing, creating, and assessing the new competencies. for example, at the 2011 baccalaureate program directors meeting, many sessions were devoted to the new competencies. faculty reported multiple ways of operationalizing practice behaviors and their assessments. some programs have developed competencies exams and rubrics, while other programs have approximately four hundred assessments of students’ knowledge and behaviors. in this paper, we suggest that service-learning is one pedagogy that will assist social work faculty in addressing the competencies and practice behaviors. in order to provide a framework for identifying and assessing practice behaviors using service-learning pedagogy, we propose that a framework from bloom’s taxonomy be utilized. bloom (1956) articulated six classifications in the cognitive domain that are essential to learning. the classifications are knowledge, comprehension, application, analysis, synthesis, and evaluation. during the development of the taxonomies, bloom found that the majority of testing students were exposed to required recall of facts, the lowest level of intellectual engagement. bloom believed that the classifications were sequential and represented a cumulative hierarchy. the higher levels represent more sophisticated and critical thinking. since its introduction, critiques have been made and revisions proposed; these include considering critical thinking as a continuum rather than hierarchical, that there is some overlap in the categories, and that the taxonomy should be multidimensional (anderson, et al., 2001; marzano & kendall, 2007). changes were also made to rename the categories to be verbs (remember, understand, apply, analyze, evaluate, and create) (anderson, et al., 2001). for the purpose of this paper, we recognize that readers can debate the critiques and modifications to the original taxonomy, but contend that the basic premise that there are differences in the complexities of critical thinking and that these differences aid in planning curriculum, instruction, and assessment make rational sense for examining our topic. advances in social work, spring 2011, 12(1) 55  an example will best illustrate how to connect the cswe competencies in hbse to the taxonomy. examples of learning objectives for practice behavior a (utilize conceptual frameworks to guide the processes of assessment, intervention, and evaluation) and practice behavior b (critique and apply knowledge to understand person and environment) are given for each category in the taxonomy (see table 1, next page). hbse service-learning example the following is an example of a service-learning experience that permits students to demonstrate hbse competencies. this experience focuses on a mentoring program in a public school, but a range of settings including homeless shelters, assisted living facilities for seniors, and child development centers have all been used as service-learning sites by the authors. engaging in service-learning experiences requires students to use higher level cognitive domains such as applying, analyzing, evaluating, and creating knowledge related to hbse theory and social work practice. in the next section, the level of bloom’s taxonomy in which the students were thinking and performing will be highlighted in italics or an explicit example will be given. overview of the mentoring experience the college students engaged in the service-learning are juniors in the baccalaureate social work program. the course takes place prior to the senior practicum. the hbse course includes both micro and macro theories of hbse and is taught over a ten week quarter. staff from the office of service learning orients the college students to the philosophy of service-learning and the policies and procedures of the tutoring program. this service-learning experience takes place at a k-8 school in an urban center. students in the school struggle with academic proficiencies as measured by standardized testing (ohio department of education, n.d.). the subject proficiencies range from a low of 2.9% for 8th grade social studies to a high of 55.8% for 6th grade reading (75% pass rate is considered proficient). over 96% of the k-8 student body identifies as black or biracial, 100% of the students are classified as “economically disadvantaged,” and over 20% of students are identified as having a disability. the social work students interact with each assigned k-8 student for 30 minutes each week over the course of seven weeks; at the end of seven weeks, social work students have interacted with each student for a minimum of 3.5 hours. the k-8 students may benefit from the tutoring/mentoring because they have an opportunity to have positive adult interactions and receive assistance with academic material. social work students may benefit from the service-learning because they have the opportunity to apply hbse course content, practice beginning social work skills like rapport building, and be exposed to challenges faced by a public education system in a local, urban community. twill, elpers, lay/achieving hbse competencies 56  table 1. practice behaviors and learning objectives practice behavior: a. utilize conceptual frameworks to guide the processes of assessment, intervention, and evaluation b. critique and apply knowledge to understand person and environment * examples of theories are given; however, students were often given the choice of selecting a theory discussed in class or the textbook. this is especially true at the higher levels of the taxonomy. this was purposeful to allow students to begin to develop their theoretical orientation. learning objective #1: remember (skills: recognize, recall) a. students will identify the levels in maslow’s hierarch of needs. * b. students will list the feminist critique of freud’s psychodynamic theory. learning objective #2: understand (skills: explain, classify, summarize) a. students will explain the key characteristics of social capital in their own words so that someone not familiar with the concepts could understand them. b. students will summarize the postmodern critiques of kohlberg’s stages of moral development. learning objective #3: apply (skills: execute, implement) a. based on their servicelearning experiences, students will demonstrate how social learning theory applies to the students they are mentoring. a. based on their servicelearning experiences, students will articulate how the systems perspective guides their practice. b. based on their servicelearning experiences, students will chose which theory best helps guide social work practice with a student who they are mentoring. learning objective #4: analyze (skills: analyze, differentiate ) a. based on their service-learning experiences, students will analyze if the tenets of the erickson’s stages of development are true of today’s children and youth. a. based on their service-learning experiences, students will analyze if using the family life cycle perspective is appropriate with the service-learning population. b. based on their service-learning experiences, students will consider person-in-environment factors influence human development. learning objective #5: evaluate (skills: critique) a. based on their service-learning experiences, students will critique how the social constructionist perspective either supports or opposes social work values. b. based on their service-learning experiences, students will articulate why/how some theories are appropriate to use in guiding practice with one client, but not another. learning objective #6: create (skills: plan, produce, generate) a. based on their service-learning experiences, students will pick a theory discussed and propose modifications to it to incorporate changes in modern society and social work values. a. students will compare and contrast how such changes to the theory may impact assessment, intervention, and evaluation. b. students will demonstrate their understanding of a theory by appropriately engaging with the student they are mentoring. advances in social work, spring 2011, 12(1) 57  social work students are expected to select one of the students they tutor to use as the “client” for their application of hbse theory. through the tutoring (e.g. assessing developmental milestones and learning tasks), guided learning activities (e.g., writing a story about family or completing sentences about likes/dislikes), and spontaneous interactions, the social work students learn about the k-8 students and the social environment. this requires students to apply the knowledge they are learning in the classroom to a practice setting. students are encouraged to listen and make observations of the student, the school personnel, and the larger community in order to evaluate and think critically about the value of hbse in facilitating meaning making. in addition to the service-learning in the school, the students organize and participate in a canned food drive that benefits the tutored children. based on feeding america’s backpack program, which recognizes that school children often go hungry on weekends, the college students organize a food drive of kid-friendly foods. using hbse theory as a guide to analyze why american children live with hunger and the community’s response to the problem, they participate in the food drive to provide the k-8 students with additional food over the thanksgiving and winter holidays. description of the assignments that help achieve the hbse competencies students complete a portfolio over the course of the quarter. the portfolio has twelve assignments, which account for over 60% of the course grade (the remaining points are achieved from reading and lecture quizzes). as part of the portfolio, students select one of the k-8 students with whom they have been working for the focus of their servicelearning experiences. before they began to apply the theoretical perspectives, students complete a brief review of the literature based on a topic related to urban youth. students also complete an ecomap which sets the stage for the theoretical analysis. the literature review assignment requires students to understand and summarize current knowledge about at-risk youth, while the ecomap assignment requires students to create a comprehensive pictorial representation of person-in-environment factors that influenced their “client’s” life. students then complete portfolio assignments regarding the application and evaluation of two micro theories (e.g., developmental), one mezzo theory (e.g., family systems theory), and one macro theory (e.g., the social capital approach). in completion of the portfolio, students choose one theory to evaluate using the criteria (e.g., coherence and conceptual clarity, comprehensiveness) set forth by hutchison (2008, p. 31). this assignment also asks students to create knowledge by suggesting changes to a theory that would be more inclusive of their experiences working with atrisk urban youth. throughout the aforementioned application of theory assignments, the students are using their work with their k-8 student to inform their social work analysis. students complete scholarly reflection assignments at the beginning and end of the service-learning experience and twice during the course of the quarter. the first reflection assignment is a pre-write to establish baseline knowledge about their understanding of the population with whom the student will be serving. the final reflection requires students to grapple with professional issues of social justice and service. the other two reflection assignments allow students to choose from guided reflection topics such as addressing cultural competence, ethical dilemmas faced during the service-learning, and a national twill, elpers, lay/achieving hbse competencies 58  and global comparison of youth and public education; all of which serve to demonstrate competencies relevant to hbse. the second reflection assignment requires that students contextualize their comments by applying, analyzing, evaluating, and (sometimes) creating knowledge related to hbse theory and social work practice. discussion social work is primarily a practice profession; social workers are licensed professionals working in all arenas in society, in a variety of roles, at the micro and macro practice levels to ensure that all members of society receive the necessary services to function at their highest capacity. incorporating service-learning pedagogy as a integral part of the curriculum provides social work educators an opportunity to create meaningful learning opportunities for students and better prepare them for practicum (kropf & tracey, 2002), while simultaneously benefiting the community and increasing their understanding of and commitment to the public good. service-learning philosophies also align with the values and ethics of the profession, as well as council of social work education’s (cswe) standards. the cswe’s educational policy and accreditation standards state the following as the goal of social work: the purpose of the social work profession is to promote human and community well-being. guided by a person and environment construct, a global perspective, respect for human diversity, and knowledge based on scientific inquiry, social work’s purpose is actualized through its quest for social and economic justice, the prevention of conditions that limit human rights, the elimination of poverty, and the enhancement of the quality of life for all persons (cswe, 2010). according to zastrow (2010) social work is unique from other professions in its mandate and primary focus on providing social services and advocating for the social welfare of others. from our experiences, service-learning in hbse courses typically occur in agencies serving vulnerable populations. when this is true, in addition to mastering the hbse content, social work students have the opportunity to practice their values of service, while at the same time, focusing on an issue of social inequality. further, service-learning complements academic content and the achievement of competencies. service-learning can facilitate the promotion of social work values, provide opportunities for personal and professional growth, and foster civic responsibility. as faculty rethink social work education in light of the cswe 2008 changes in hbse competencies and practice behaviors (council on social work education, 2010), designing learning objectives and the assignments that measure them will be important in helping programs demonstrate a competency based education. the shift to addressing the competencies through a demonstrated practice behavior aligns with the methodology of service-learning. interactions with clients are fluid, dynamic, and unpredictable. students must learn to determine if a given theory helps explain human behavior and formulate a hypothesis under such conditions. providing a real life setting in which to practice these skills has pedagogical value. what better evidence of competency is there than when advances in social work, spring 2011, 12(1) 59  students can demonstrate that they understand theory by applying it in a real person-inenvironment setting? in a well designed hbse service-learning experience, students will be able to utilize complex critical thinking skills. bloom’s (1956) taxonomy provides a structure for assessing higher level thinking. using the new hbse competencies and practice behaviors, students will be able to apply and evaluate the effectiveness of a theory. the nuances of a theory, including identifying situations in which a theory does not apply, may become illuminated when working with a person rather than a textbook example. students will also gain practice in identifying a shortcoming or needed modifications of a historical theory which often fails to take into account perspectives of women, people of color, individuals with disabilities, or issues faced by non-western individuals. table 1 is intended to give readers at framework for designing hsbe service-learning projects that increase critical thinking and allow a way to measure practice behaviors. since the ultimate goal of social work education is to prepare social workers for competent professional practice in their work with individuals, families, groups, organizations, communities, and society at large, taking the classroom into the community is an important and necessary component 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(2004). annotated history of service learning. national service learning clearinghouse. retrieved from http://www.servicelearning.org/filemanager/download/142/sl%20comp%20timelin e%203-15-04_rev.pdf twill, elpers, lay/achieving hbse competencies 62  todd, s. (2008). community service learning: introduction. canadian social work review, 25(1), 87-88. retrieved from http://www.casweacfts.ca/en/canadian_social_work_review waters, s., & moran, a. (2004). working partnership links ‘different worlds’. adults learning, 13(4), 17-21. zastrow, c. (2010). introduction to social work and social welfare: empowering people. belmont, ca: brooks/cole. author’s note: address correspondence to: sarah e. twill, department of social work at wright state university. email: sarah.twill@wright.edu   microsoft word 07_sage_and_sage_20880_social_media_use _________________ melanie sage, phd, licsw, is assistant professor and bssw program director, department of social work, university of north dakota, grand forks, nd 58202. todd sage, lcsw, lac, is assistant professor of social work, university of north dakota. copyright © 2016 advances in social work vol. 17 no. 1 (spring 2016), 93-112, doi: 10.18060/20880 social media use in child welfare practice melanie sage todd edward sage abstract: the scholarly child welfare literature offers little information about the use of social media by child welfare workers. we conducted a study of 171 child welfare workers across several states using an online survey. the resulting data offer insights from workers about current practices related to social media use in a child welfare work setting. most respondents see social media as an acceptable tool for conducting child welfare assessments. respondents describe strains and benefits of social media use. it is recommended that agencies provide guidance on ethical decision-making for using social media as a work-related tool. agencies should also provide policy clearly defining social media use and misuse. keywords: administration; supervision; child welfare policy; child welfare workforce; social media there exist untapped opportunities for technology in child welfare settings, including improving and increasing interaction between families and workers (tregeagle & darcy, 2008). social media sites, such as facebook, twitter, and snapchat, are used by 74% of online adults (pew research center, 2013). little is known about how caseworkers use social media in the field of child welfare; however, literature about professionals who use social media in other work settings suggest that tensions can arise about the boundaries between one’s public and private presentation on social media. clients, co-workers, and supervisors can easily search out social media profiles, and off-duty or work-related behavior on these sites may impact the perceptions of those who conduct searches (mcdonald & thompson, 2016). although tension is a risk, child welfare workers can also use social media to carry out their roles, such as family finding and assessment (sage & sage, 2016). two empirical studies contribute to what is known about the use of social media in child welfare (breyette & hill, 2015; mcroy, 2010). they suggest that child welfare workers use social media for both personal and professional reasons. a 2010 study of 746 child welfare workers reported that a third of respondents used social media for professional and personal purposes and would like to make more use of it to assist in adoptions and permanency planning for children in foster care (mcroy, 2010). additionally, a recent survey of 136 child welfare workers in minnesota found that 12% used social media directly with clients, 44% used social media indirectly with clients, and 22% believed that child welfare workers should monitor their clients’ social media activities (breyette & hill, 2015). more than half of child welfare workers involved in this study reported seeing a client’s personal social media page, and a similar number reported that a client had requested to friend them on social media. the current study surveyed child welfare workers about their beliefs, values, activities, and training related to social media. we attempt to expand knowledge about how child welfare workers use social media in the workplace, uncover tensions about social media use in child welfare work, and learn which educational or organizational practices might impact child welfare workers’ professional use of social media. sage & sage/social media use 94 defining social media sites and understanding privacy settings social media sites allow users to build personal profiles that typically share userprovided content such as age, occupation, location, and interests, and users can then make portions of their profiles accessible to select people or the public. users are then encouraged to identify others who use the social media site with whom they have a preexisting relationship to make an online connection (boyd & ellison, 2007). there are hundreds of social media sites with various user-base sizes, some catering to niche audiences, and used for various purposes, such as business networking, communicating with friends, or re-sharing information from news sites (boyd & ellison, 2007). social media sites, such as facebook, snapchat, twitter, and linkedin, each have different formats and norms regarding self-presentation and communication. social media users considerably underestimate the reach of their online posts (bernstein, bakshy, burke, & karrer, 2013) and misunderstand who can see the information they share. some social media sites have complex privacy settings, and default settings commonly allow public profile view (watson, lipford, & besmer, 2015). additionally, some users may have reduced capacity to understand the way their information is shared due to their age, mental health, or cognitive abilities (batchelor, bobrowicz, mackenzie, & milne, 2012). thus, a user, whether child welfare worker or client, may assume their information is more private than it is or not understand who might access it. this is a complicating factor when one makes a decision about what information was shared publicly and therefore meant for others to discover. social media in the workplace mcdonald and thompson (2016) cite three sources of strain related to social media use in the workplace: a) troublesome use of social media by employers to profile job candidates or employees, which threatens employees' rights to privacy and may lead the searcher to false assumptions; b) social media posts made by employees related to work, especially derogatory posts about the workplace; and c) private use of social media in the workplace, which may be seen as wasting time. these three issues are all potentially amplified in a child welfare setting: a) profiling extends to the profiling of clients by child welfare workers and vice versa; b) social media posts related to work may not only reflect poorly on an agency, but may also reveal confidential information about clients; and c) private use of social media on agency equipment may be difficult to delineate from agencysanctioned use. breyette and hill (2015) examined the extent to which these strains are present in the child welfare workplace, and note that child welfare workers see themselves as uninvited recipients of client searches and also admit to searching out clients on social media. social media as an assessment tool in child welfare settings, caseworkers use several professional and investigative assessment tools to make decisions about whether children are safe at home, including information about personal backgrounds of family members. for many of these tools, such as psychosocial assessments and forensic interviewing, child welfare workers receive both advances in social work, spring 2016, 17(1) 95 initial and ongoing training. the issue of social media as an agency-sanctioned assessment tool in child welfare setting has not been addressed in the scholarly literature; however, government agencies sometimes have specific policies or practices that condone or disallow its use as an investigative tool. for instance, erie county, ny, implemented a child protective services policy that allows designated staff to search for child safety information on social media; this information is then evaluated with specific criteria (erie county, 2014). presumably, erie county provides worker training for designated staff about these criteria. although no guidance exists on the use of social media in child welfare assessments, forensic mental health investigators perform a similar role, in that they are employed by governments and courts to conduct an unbiased assessment of risks related to safety. pirellli, otto, and estoup (2016) suggest that forensic mental health evaluators who have an investigative role in assessing a patient’s danger to self or others should: a) conceptualize this data as collateral information like that drawn from outside interviews, rather than as self-report; b) weigh the utility versus the prejudicial effects of use in each case, especially when no standards exist for the assessment of such data; c) inform clients about the intent to search for this information; d) allow clients to see and respond to the information found, just as they would other collateral information such as police reports; and (e) be explicit in documentation and testimony about their reliance upon this type of information in decision-making. these principles could similarly apply to the use of client information found via social media in child welfare assessments. on the other hand, law enforcement authorities have investigative roles somewhat different in that the focus of child welfare workers is on assessment of child safety and risk, and the role of police is to assess evidence of a crime. a growing body of literature reports on appropriate ways to gather and use social media evidence during police investigations. private social media posts can be accessed by law enforcement agencies through subpoenas and search warrants, whereas many police agencies access public information on social media without informed consent, including the use of deception such as creating fake profiles to connect with a suspect and gain access to their friends-only postings (murphy & fontecilla, 2013). however, several court challenges have centered on the admissibility of this type of data and issues related to a person’s right to privacy and freedom of speech (taylor, 2014). whereas standard police officer training requires 48 hours of education on criminal and constitutional law and 40 hours of investigations training (stanislas, 2013), which should inform the appropriate use of social media evidence, child welfare workers have little training related to legal standards of evidence and may not be comfortable with court processes (faller, grabarek, & vandervort, 2009; vandervort, pott gonzalez, & coulborn faller, 2008). it is unknown whether child welfare workers currently present social media evidence in court or know how to formally document findings related to social media evidence. tensions of social media use in child welfare: safety versus well-being child welfare workers are faced with constant tension between child safety and child well-being: that is, a worker must do all that is possible to assess risks to a child but also make decisions from a family-centered approach that promotes holistic family well-being sage & sage/social media use 96 (spratt, 2001). given a risk-focused orientation, child welfare workers should be thorough in their family assessments, exploring any resource available, including social media. client privacy and confidentiality is seen as secondary to child safety from this lens. however, in a child-well-being-centered model (fargion, 2014), family strengths, parent support, trust and relationship building, and engagement are central. if a client finds out about a social media search it may be seen as a boundary violation (lannin & scott, 2013) and disrupt goals related to family engagement. this lens suggests that child welfare workers might avoid social media searches in cases where social media does not have a clear role in child safety. on the other hand, several opportunities exist for the family-centered use of social media by child welfare workers, including enhanced communication with foster youth (breyette & hill, 2015), peer support for foster parents or direct communication with foster parents (dodsworth et al., 2013), maintaining relationships for foster youth and supporting access to resources (denby brinson, gomez, & alford, 2015), and promoting positive foster youth development (gustavsson & maceachron, 2015). child welfare organizations also have opportunities to use social media to promote agency transparency, recruit workers and foster parents, and promote child adoption (sage & sage, 2016). given the practice tensions and potential benefits of social media use, from a safety and well-being perspective, it may be difficult for a worker to know when and how to use social media to meet work-related goals. social media training, agency policy, and supervision given the ubiquity of social media use that seems to span personal and professional settings, it would be helpful to understand what training child welfare workers receive and need and how the training is enforced. there is no published evidence that describes child welfare workers’ access to training about social media use in practice. one may assume that social media training is not necessary given its widespread use amongst adults. however, professional use of social media differs from personal use (hrdinová, helbig, & peters, 2010) and may require different boundaries and selfrepresentation (kimball & kim, 2013). human service professionals generally have limited exposure to training and education about effective agency use of technology, and especially about its best practices (berzin, singer, & chan, 2015). few studies have attempted to explore the best pedagogical ways to teach about social media use for professionals (pander, pinnilla, dimitriadis, & fischer, 2014). however, several studies that describe ways to teach digital professionalism focus on didactic sessions and then assess professional beliefs (e.g., george, 2011; kung, eisenberg, & slanetz, 2012), rather than assessing the effects of post-training behavior. while carrying out child welfare assessments, workers are guided by local, state, and federal policies. however, workers may experience ethical conflicts when their personal values collide with an agency’s policy (lee, sobeck, djelaj, & agius, 2013), and this may be especially true when there is no agency policy to guide decision-making. although there advances in social work, spring 2016, 17(1) 97 is no national data about how many child welfare agencies have formal policies to guide decisions about social media use in child welfare settings, young (2012) found that although many organizations were using social media, few had a policy that governed their use of social media. a wealth of research exists, however, that suggests supervisors in child welfare settings reinforce the agency’s practice model and play a vital role in ensuring workers utilize learned skills (frey et al., 2012). curry, mccarragher, and dellman-jenkins (2005) document the lack of evidence that training alone directly enforces practice behavior in child welfare and report that both co-worker and supervisor support can enhance the transfer of learning to practice. thusly, any direct delivery of training to child welfare workers about the use of social media will likely be best reinforced when shared with supervisors, who may have generational differences in their expectations about social media use (watson, 2013). professional ethics, agency expectations, and social media use child welfare workers are not members of a distinct profession. although very recent national workforce statistics are unknown, a 1988 study reported that about a quarter of child welfare workers held a social work degree (lieberman, hornby, & russell, 1988). in some states, a social work license is required to hold certain child welfare positions. child welfare workers who also hold social work degrees and are members of the national association of social workers (nasw), a professional association, are asked to adhere to a set of ethical principles. these principles provide guidance for social media use by addressing issues such as informed consent, boundaries and dual relationships, documentation, practitioner competence, privacy, and confidentiality (reamer, 2013). nasw also published a 2005 pamphlet on ethical technology standards for social workers, but it has not kept pace with new technologies such as social media (lopez, 2014). regardless, a minority of child welfare workers are held by these standards due to the lack of a requirement in most states to hold a social work license to work in child welfare practice. organizations, even when they do not have explicit policies for social media use, often have broad technology and professional behavior polices that may inform practice. they also have expectations about technological competency. quinn and fitch (2014), for instance, found that employers expect new social work graduates to be proficient in the use of technology to access or produce information related to work. the expectations about technology competencies of child welfare workers are unknown; however, child welfare workers frequently work with complex databases, computer software, and technology communication tools related to searching for and documenting information, conducting assessments, facilitating visitation, and creating case notes (dellor, lovato-hermann, wolf, curry, & freisthler, 2015; quinn, sage, & tunseth, 2015; white, hall, & peckover, 2009) . in fact, technology and data issues are so prevalent in child welfare that naccarato (2010) argues for a child welfare informatics subspeciality in social work education that would help address the complex needs related to workers’ use of agency technology, as well as address data-related needs in child welfare agencies. despite their frequent exposure to technology, child welfare workers are often frustrated by their lack of sage & sage/social media use 98 involvement in decision-making about agency technology adoption (gillingham, 2015). methods based on the review of literature, a semi-structured questionnaire was developed by the authors to answer questions about child welfare workers’ experience with social media. this survey aimed to address several gaps in the literature review, including:  what beliefs about social media inform child welfare worker’s practices?  do workers use social media as an assessment tool?  where do workers receive training about social media?  what agency guidance do workers receive about social media?  do workers experience strain related to use of social media at work, as described by mcdonald and thompson (2016)? instrument in addition to demographics, participants were asked about their social media activity as it relates to social media platforms. social media platforms are constantly changing and may bring differences in privacy features and norms about social media activity. for instance, personal familial information is infrequently posted on the linkedin networking platform, and the snapchat platform is mostly person-to-person limited-duration communication, whereas facebook is mostly message board style communication. participants were asked to report on whether they access social media from work computers or personal devices, as access may have different implications related to privacy, oversight, and agency liability. by knowing which platforms child welfare workers commonly use, educators or administrators can adjust training or policy. we also asked participants to share the frequency of their search activities to understand the prevalence of social media use among child welfare workers. participants were asked about the education or guidance they received in college, at their agencies, from policy, or from their supervisors. additionally, participants were asked whether social media has caused an ethical concern in their agencies. we expected these questions to highlight whether more education or guidance is necessary within agencies. finally, participants were asked about their beliefs, activities, and exposure to specific social media practices as they relate to their personal-professional lives. the practices listed were drawn from specific social-media-related activities that the authors heard about while conducting training about social media use, including searching and becoming friends with clients or others that they know from their work environments. the survey was posted on the qualtrics online survey platform. during pilot testing, the survey took about ten minutes to complete. the use of human subjects for this research was approved by the university institutional review board (irb). informed consent was provided through a detailed explanation on qualtrics, and participants could opt out of all or portions of the survey they did not wish to answer. no compensation was offered or provided to survey participants. data was exported from qualtrics to ibm spss statistics version 23. advances in social work, spring 2016, 17(1) 99 recruitment participants were recruited via non-probability snowball sampling: the authors sent links to their child welfare contacts and asked participants to pass the web link on to other workers who would be eligible to complete the survey. the study participants were selfidentified child welfare direct practice social workers. participants were invited to complete the survey if they worked at state, tribal, or county child welfare agencies, contracted agencies that worked in a child welfare capacity, or if they identified as students completing a university-approved field placement at a child welfare agency. the survey link was also made available through postings on several social media sites frequented by child welfare direct practice workers, through emails to students in field placements at one university, and distributed through contacts at child welfare training centers in minnesota, north dakota, and oregon. the screening question asked workers if they are a current child welfare worker or in a child welfare field placement in a social work program. those who answered no were taken to the thank you page of the survey, ending their participation. participants who met inclusion criteria were asked if they had current active social media accounts on sites such as facebook, google +, twitter, linkedin, or snapchat. if the participant did not have a current active social media account, they were excluded from analysis. the link was public from june 1, 2014, through november 1, 2015. participants the online survey was started by 269 respondents. of those, 98 were removed from analysis due to reporting that they do not work in child welfare (n=21), did not have social media accounts (n=14), because they did not answer any questions before submitting (n=3), or because they did not finish the survey (n=60). this left 171 cases for analysis. eight states were represented in the final analysis with the majority of respondents (95.6%) coming from three states. the three states were minnesota (n=74, 43.3%), north dakota (n=68, 39.9%), and oregon (n=20, 12.4%). not all respondents answered all questions; the number of responses per question varied from 141-171. most respondents were employed in state or county government, and over half were under 40 years old. over half worked in roles related to investigating allegations of child abuse or neglect. many workers performed multiple job roles. almost half of respondents had over ten years of child welfare experience. participants' characteristics are displayed in table 1. table 1. demographics agency type (n=171) n (%) employed as a child welfare worker in state/county government. 161 (94%) private agency that delivers child welfare services. 2 (1%) child welfare field placement supervised by a university. 8 (5%) sage & sage/social media use 100 age (n=170) 19 to 24 years 16 (9%) 25 to 29 years 28 (16%) 30 to 34 years 33 (19%) 35 to 39 years 28 (16%) 40 to 44 years 18 (11%) 45 to 49 years 16 (9%) 50 to 54 years 17 (10%) 55 to 59 years 8 (5%) 60 to 64 years 5 (3%) 65 to 69 years 1 (1%) job tasks related to (n=168) [check all that apply] assessment, protective services, investigative, or front-end services addressing allegations 97 (58%) reunification services for families with children in foster care 99 (59%) foster care case management services to youth in long-term placement 75 (45%) providing therapeutic in-home or mental health services 54 (32%) supervision of child welfare workers 46 (27%) other/specialized services 67 (40%) foster parent licensing, recruitment, or other administrative services 46 (27%) degree (n=148) [check all that apply] bachelors of social work degree completed 99 (67%) masters in social work degree completed 30 (20%) currently bachelors in social work student 4 (3%) currently masters in social work student 11 (7%) i do not have a degree in social work and am not a current social work student 4 (3%) bachelor's degree in another field 35 (24%) master's degree in another field 8 (5%) years child welfare experience (n=151) none 5 (3%) less than one 14 (9%) 1-2 23 (15%) 3-5 20 (13%) 5-10 38 (25%) 10 or more 71 (47%) results social media use respondents were asked to complete the survey only if they had at least one social media account. nearly all respondents (98%, n=167) had a facebook account; the next most frequently used social media account was snapchat (32%, n=55). a third of respondents checked their social media accounts from their work computers at least once a week. about half (48%, n=82) of respondents reported they do not check their social media accounts from work, whereas 7% (n=12) checked their accounts from work computers multiple times a day versus 23% (n=39) check their social media from their smart phones multiple times a day at work. over half (54%, n=93) of respondents checked advances in social work, spring 2016, 17(1) 101 their social media accounts from their smartphones at least daily. eighty percent (n=136) of respondents reported that they search for client information on social media sites. table 2 reports detailed information about reported social media use. table 2. social media use (n≈171) n (%) type of sms use: active account on a social media site (facebook, google +, twitter, linkedin, snapchat). [check all that apply] facebook 167 (98%) google + 28 (16%) twitter 48 (28%) livejournal 1 (0%) personal blog 4 (2%) snapchat 55 (32%) linkedin 34 (20%) other 4 (2%) instagram 59 (34%) check your social media page at work/field placement from the agency multiple times a day 12 (7%) daily 27 (16%) weekly 18 (11%) less than weekly 31 (18%) never 82 (48%) check your social media page at work/field placement from your smartphone multiple times a day 39 (23%) daily 54 (32%) weekly 26 (15%) less than weekly 29 (17%) never 23 (13%) post to your social media page multiple times a day 10 (6%) daily 19 (11%) weekly 45 (26%) less than weekly 78 (46%) never 18 (11%) search for client information via social media multiple times a day 8 (5%) daily 14 (8%) weekly 43 (25%) less than weekly 71 (42%) never 34 (20%) social media training and policy experiences twenty-two percent of respondents reported that they received at least some training on social media use in college, and 32% received some training from their agency. in both sage & sage/social media use 102 of these cases, the training received usually totaled less than an hour. forty-three percent of respondents reported training on social media through continuing education. most respondents were either not sure their agency had a social media policy (27%) or reported no policy (30%). only 11% (n=18) of respondents reported that the agency completely restricts social media use. over half (56%, n=96) of respondents reported that their supervisors approve of work-related social media use, although 23% (n=40) reported that they did not know how to document social media information in case files, and 31% (n=53) reported that social media has caused an ethical concern in their agency. several respondents (16%, n=28) reported that a colleague has been reprimanded for social media use in the workplace. table 3 illustrates additional data about social media agency practices. table 3. social media agency practices (n=171) n (%) n (%) n (%) training received no yes, less than an hour yes, more than an hour in college 132 (77%) 28 (16%) 11 (6%) continuing education 98 (57%) 34 (20%) 39 (23%) from agency 115 (67%) 40 (23%) 16 (9%) agency guidance no yes not sure agency has policy 52 (30%) 73 (43%) 46 (27%) agency trains workers 109 (64%) 21 (12%) 41 (24%) agency restricts sm use 135 (79%) 18 (11%) 18 (11%) sm experiences no yes not sure sms has caused ethical concerns in agency 72 (42%) 53 (31%) 46 (27%) i know how to document sm info 40 (23%) 91 (53%) 40 (23%) supervisor approves of sm use 9 (5%) 96 (56%) 66 (39%) colleague has been reprimanded for sms use 52 (30%) 28 (16%) 91 (53%) social media beliefs and practices more than half of respondents (55%, n=94) reported that, at least in some situations, they felt it was acceptable to search for clients via social media just out of curiosity. nearly half (43%, n=73) of respondents reported that they have searched for clients via social media out of curiosity, and half (n=86) reported that their colleagues have done this. respondents reported greater acceptability and frequency of client searches when the search was for work-related reasons, such as locating a missing parent or contacting a relative. few (7%, n=12) reported that their colleagues have accepted or initiated an online friend request from a client. about half (49%, n=84) of respondents reported that they felt it was acceptable to have a social media relationship with foster parents. several respondents (18%, n=30) reported that their colleagues have created fake profiles to gain access to client information, and 14% (n=24) of respondents reported that they have used social media to vent about their workdays. advances in social work, spring 2016, 17(1) 103 table 4. social media beliefs and practices social media in the workplace (n=140-171) how acceptable? i have done this cw workers at my agency have done this never acceptable acceptable in some situations always acceptable search for a client on a site like facebook out of curiosity? (n=143) 49 (34%) 83 (58%) 11 (8%) 73 (51%) 86 (60%) search for a client on a site like facebook who your agency would like to locate, such as a missing parent? (n=140) 4 (3%) 74 (53%) 62 (44%) 83 (59%) 94 (67%) search for a client on a site like facebook when you think the information might give you insight in to the client’s risk factors? (n=147) 19 (13%) 90 (61%) 38 (26%) 79 (54%) 87 (59%) search for a client on a site like facebook when you think the information might give you insight in to the client’s lifestyle, hobbies, or interests? (n=148) 48 (32%) 75 (51%) 25 (17%) 57 (39%) 65 (44%) search for a client on a site like facebook when conducting an assessment, for instance, a child welfare investigation? (n=146) 20 (14%) 95 (65%) 31 (21%) 47 (32%) 76 (52%) accept/initiate a “friend” invite from a current client? (n=171) 161 (94%) 8 (5%) 2 (1%) 1(1%) 12 (7%) accept/initiate a “friend” invite from a former client? (n=169) 130 (77%) 38 (22%) 1 (1%) 9 (5%) 15 (9%) interact with clients through a facebook page you created just for this purpose (which contains none of your personal information)? (n=163) 71 (44%) 80 (49%) 12 (7%) 10 (6%) 33 (20%) accept/initiate a “friend” invite from a family member of a current client? (n=171) 144 (84%) 26 (15%) 1 (1%) 2 (1%) 14 (8%) accept/initiate a “friend” invite from a family member of a former client? (n=171) 120 (70%) 50 (29%) 1 (1%) 7 (4%) 15 (9%) provide child welfare services to a person that you have an existing relationship with on social media site? (n=168) 128 (76%) 38 (23%) 2 (1%) 8 (5%) 12 (7%) accept/initiate a “friend” invite from a foster parent you work with professionally? (n=157) 73 (46%) 81 (52%) 3 (2%) 16 (10%) 47 (30%) accept/initiate a friend invite with a foster youth on your caseload? (n=168) 135 (80%) 32 (19%) 1 (1%) 4 (2%) 21 (13%) attach printouts of client social media records to a court proceeding as evidence? (n=156) 40 (26%) 98 (63%) 18 (12%) 23 (15%) 55 (35%) find and use evidence from a social media site to confirm allegations of child risk? (n=157) 23 (15%) 106 (68%) 28 (18%) 25 (16%) 48 (31%) use a fake name/fake profile to make a friend request in order to view private client profiles? (n=163) 129 (79%) 33 (20%) 1 (1%) 4 (2%) 30 (18%) “vent” about your workday on social media (without disclosing client details)? (n=158) 104 (66%) 47 (30%) 8 (5%) 24 (15%) 43 (27%) be friends with coworkers via social media? (n=151) 12 (8%) 70 (46%) 69 (46%) 99 (66%) 78 (52%) be friends with attorneys, judges, or law enforcement agents who you work with professionally via social media? (n=151) 22 (15%) 107 (71%) 22 (15%) 55 (36%) 71 (47%) advances in social work, spring 2016, 17(1) 104 illustrative narrative responses respondents were given opportunities several times throughout the survey to input open-ended responses. these responses were guided by the prompt, “please share context that might help us understand your answers.” the responses illustrate some of the tensions associated with social media use. workers often do not feel prepared to make a decision about their social media use given competing values and personal beliefs. o my major issue is friending foster parents. it leads to too many boundary issues and makes it impossible to address concerns that may arise about them as foster parents. o i had a 17 year old adopted. she wanted to be my friend on facebook after the adoption. she initiated all contact. i feel this is okay as she had no other connection to her past and requested it. o i am never really sure that "facebook stalking" is appropriate. however, facebook is an open media. if an individual does not put privacy parameters in their own account then is the information fair game. o i have searched for clients on social media, especially when a client runs. i feel this is unethical, but continue to do so, and i believe many child welfare workers feel the same. o i believe social media is a very gray area but can be very helpful when trying to locate families that have children at risk. i do believe you have to keep professional and ethical boundaries. i'm not sure how i feel about using social media as "evidence." i know law enforcement uses it but for child welfare stuff i'm not sure. o we live in a small community, and it often happens that our workers are friends with the family of current and former clients such as prior classmates, neighbors, kids go to school together, etc. i do believe that looking at facebook profiles is acceptable in most all situations for child welfare purposes. o it's complex. using social media to assess risk is sometimes really helpful! taking an occasional break at my desk to use social media on my personal phone helps keep me sane and reconnects me to the rest of the world when i'm feeling really overwhelmed or helpless. o i believe that training centered around the ethical use of social media as it relates to the social welfare settings is important. social media can be helpful in fact checking the information we are receiving from clients as well as locating clients that we have previously been unable to find. discussion this article set out to describe the use of social media by child welfare workers in a small sample of workers. it confirms previous findings by breyette and hill (2015) and mcroy (2010) that child welfare workers regularly use social media for work-related purposes, and beyond that, experience several tensions related to the professional use of social media. advances in social work, spring 2016, 17(1) 105 what beliefs about social media inform child welfare workers' practices? in this sample workers have disparate beliefs about the acceptability of social media use with their clients. the majority of respondents report that social media searches for clients are acceptable when it can help meet case goals, such as finding a missing family member, conducting an investigation, or assessing risk. however, most respondents also thought it was acceptable to search for clients out of simple curiousity and report that they and their colleagues engage in these types of searches. this may suggest that workers do not see social media searches as a factor that may impact goals of engagement, as suggested by lannin and scott (2013), or do not see a client privacy concern related to this behavior. on the other hand, respondents have more congruence in their responses about friend relationships on social media that may raise boundary issues related to child welfare work. they are most clear that initiating a friendship with a current client is not acceptable, but most also would not engage in social media friendships with former clients or their family members. likewise, most would not conduct a child welfare assessment on someone they are friends with on social media. however, respondents have more permeable relationship boundaries when it comes to colleagues and foster parents; most respondents think it is acceptable to engage in social media friendships with foster parents, and more than half of respondents report existing social media relationships with co-workers. the narrative comments demonstrate some of the tensions surrounding dual roles: workers expect dual relationships, especially in small communities, but realize the difficult impact of these dual roles on their child welfare practice, and sometimes are clear that their work-related social media activity is inappropriate. one question in the survey asked workers their experiences with using a fake name or profile to access private client information. although 75% (n=129) said that this was not an acceptable practice, others thought it was acceptable in some situations, and 18% of respondents (n=30) reported that their colleagues have engaged in this practice. this use of deception is likely inconsistent with most agency policies and raises legal questions about accurate self-representation. do workers use social media as an assessment tool? survey respondents report the use of social media to aid in their assessments of child risk. sixteen percent of respondents (n=25) reported they have used social media to confirm allegations, and a similar number (15%, n=23) reported that they have presented social media evidence to court. most of the respondents affirmed that this type of use of social media is acceptable. although we did not ask whether respondents have a structured assessment tool for the use of social media in evidence, as reportedly used in erie county, ny’s 2014 policy, only 43% (n=73) of respondents reported that their agency has a social media policy. this likely means that workers are using social media as an assessment tool without clear guidance from their agencies. although respondents widely condone the use of social media in the assessment of clients, 46% (n=80) report that they do not know how to document information discovered sage & sage/social media use 106 on social media. this suggests a training opportunity in which the guidelines offered by pirelli and colleagues (2016) can be beneficial: social media findings can be used on a caseby-case basis, and when used, categorized as collateral information; the client can be given the opportunity to review and respond; and agency documentation can clearly outline the extent to which the social media evidence is used in decision-making. a delineationcan be drawn in policy between the use of social media searches for assessment and social media searches for the sake of curiousity. where do workers receive training about social media? respondents have had little training in social media, which probably means that they apply what they know from personal use of social media to their professional settings, and this likely also contributes to the very disparate perspectives of respondents as it relates to the appropriateness of certain kinds of social media use. respondents reported they were most likely to receive social media education through continuing education (43%, n=73), followed by their agencies (32%, n=56), and lastly in college (22%, n=39). given that most respondents report work-related social media use, and many report use of social media as an assessment tool, these data raise concern about where workers derive their information about the appropriate use of social media. what agency guidance do workers receive about social media? less than half of respondents report that their agencies have social media policies (43%, n=73), but only a small number of those with policies report that they are trained in the policy (12%, n=21). few respondents (11%, n=18) report that their agencies completely restrict social media use. the content of the social media policies was not explored in this survey; it is unclear how many respondents work in agencies with social media policies that address issues such as client searches or contact. given the previous findings that workers use social media as an assessment tool, this finding about policy likely identifies an agency need. do workers experience strain related to use of social media at work, as described by mcdonald and thompson (2016)? mcdonald and thompson (2016) describe three types of strains presented by social media in the workplace: a) profiling via social media, b) posts related to work, and c) private use of social media at work. regarding profiling, about half of respondents endorsed viewing the profiles of clients for some reason, assumedly to draw conclusions about the clients. mcdonald and thompson point to this as problematic when it creates a privacy issue or is intrusive. in the case of child welfare workers searching out of curiosity or without a work-related need, or especially in the case of using a fake profile to misrepresent one’s self, this use of social media likely falls under the category of intrusive use. regarding the strain of social media posts related to work, these types of posts about child welfare work may be especially problematic because of the sensitive nature of the work and the risks of revealing private client information. negative posts may affect not advances in social work, spring 2016, 17(1) 107 only the reputation of families, but also that of the profession. in this survey, 61% (n=104) of respondents reported that it was never appropriate to vent about work on social media, but 14% (n=24) of respondents said that they had engaged in this behavior, and 25% (n=43) said that their colleagues have engaged in this behavior. this is one of the most public forms of social media misbehavior and has led to employee termination and discipline across fields, including teachers, flight attendants, and medical students (sánchez abril, levin, & del riego, 2012). finally, regarding the strain of social media in the child welfare workplace as it relates to time spent on social media sites, our findings indicate that workers are probably engaged in social media use of clients not related to assessment (but instead out of curiosity), and that almost a quarter of respondents (23%, n=39) check their social media at work from their smartphones multiple times per day. although this is insufficient information to know whether this workplace use of social media is wasteful or causing strain, it raises some concerns about personal/professional boundaries. implications for practice this report offers a first look at work-related social media use in a sample of child welfare workers. the data reveal that child welfare workers frequently utilize social media as a tool for their work, although they are often not guided by agency policy or training. given the rates at which child welfare workers report social media use related to work, education should be offered to prepare child welfare workers for appropriate use of social media. although technology policies often exist in government agencies, they may not address the unique roles of child welfare workers related to assessment, client contact, and family finding. child-welfare-specific policies should respond to these unique types of settings and also keep in mind relevant legal and privacy issues (sage & sage, 2016). our literature review suggests that any education and policy should be accompanied by a plan for the transfer of learning to the practice setting and should include the supervisor as a key connecter between policy and practice. because most child welfare workers who completed this survey currently receive their social media training via continuing education instead of directly in their agencies, and given that there may be generational differences in expectations between supervisors and child welfare workers, it is unlikely that most workers currently receive supervisor support that reinforces their training about practice using social media. narrative responses indicated polarized views about the appropriate use of social media in child welfare practice and illustrate the ethical dilemmas that arise for workers. for instance, workers are encouraged to be supports to clients and foster parents, and social media relationships may be seen as a way to offer support, but they also create dual relationships. similarly, social media searches may feel like a boundary violation to the worker conducting them but may also provide useful information about clients. the reported incidence of ethical problems caused by social media use in the child welfare workplace raise red flags about unmet needs of child welfare workers who face dilemmas in the field. social work educators and child welfare trainers can use practice scenarios that sage & sage/social media use 108 involve dilemmas like those presented in this article to help future child welfare workers think critically about potential benefits and risks of social media use. this study indicates that social media has both problematic and beneficial outcomes in the child welfare workplace. given the beneficial uses, it behooves agencies to carefully consider avoiding complete restriction of social media use by workers. social media may replace age-old tools such as the phonebook for important family-finding work. however, given that the respondents in this study report that social media has caused concerns in their agencies, guidance about ethical decision-making is justified. conclusion this survey reports the responses of a small sample of child welfare workers, most of whom live within a three-state region. because policies and experiences with social media may be geographically bound or related to the shared agencies in which respondents work, the sample provides only a snapshot of child welfare worker experiences. this data has not yet been statistically analyzed to report relationships between variables. future analysis will explore relationships between training, supervision, policy, education, and beliefs and behaviors about social media use. we also did not explore the differences in beliefs between people who report supervisory roles. future research is also needed to explore the content of social media policy and trainings. given that this research has helped to establish the use of social media in child welfare settings, further research may be beneficial to understand more about the actual utility of client searches, the perceived impact on child safety of conducting a social media search, and on the actual risks and benefits to vulnerable families related to child welfare agency social media use. finally, we did not explore the breadth of issues related to social media in the child welfare workplace. a number of unexplored issues exist, especially around youth in foster care and their relationships. social media may provide an invaluable resource for helping youth maintain vital links, and child welfare workers may be able to facilitate this beneficial use, but only if they have the requisite skills. as new technologies emerge, so will new questions regarding the best use. given that social media is unique in that it presents a worker-driven technological innovation in practice, as opposed to the typical top-down technological mandates in child welfare, social media offers a unique opportunity to explore workers’ perceptions about how to best utilize technology for the benefit of families. agencies must join workers in shaping standards for the most beneficial uses of social media tools. references batchelor, r., bobrowicz, a., mackenzie, r., & milne, a. 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(2009). the descriptive tyranny of the common assessment framework: technologies of categorization and professional practice in child welfare. british journal of social work, 39(7), 1197-1217. doi: http://doi.org/10.1093/bjsw/bcn053 young, j. (2012, may 10). the current status of social media use among nonprofit human service organizations: an exploratory study. virginia commonwealth university. retrieved from https://digarchive.library.vcu.edu/handle/10156/3775 author note: address correspondence to: melanie sage, department of social work, university of north dakota, gillette hall room 301c, 225 centennial drive stop 7135, grand forks, nd 58202, 701-777-1224, melanie.sage@und.edu ______________ amy vliek, lmsw, is the director of admissions and student services in the school of social work and a current phd student in the interdisciplinary health sciences phd program at western michigan university. kieran fogarty, phd is a professor of interdisciplinary health sciences phd program at western michigan university. robert wertkin, dsw is the director and professor of school of interdisciplinary health programs at western michigan university. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 390-405, doi: 10.18060/20822 are admissions models working? an analysis of msw admissions models as predictors of student success amy vliek kieran fogarty robert wertkin abstract: admissions models facilitate the selection of msw candidates who are both academically prepared for graduate study and professionally suited to social work, characteristics often referred to as fit-to-the-profession. this study attempted to identify the relationship between the criteria used in the admissions model of a medium-sized msw program and student success in the program. specific criteria and the associated measurement tools within the model were evaluated in relation to student success. the study found that undergraduate grade point average is significantly associated with msw grade point average while neither academic criteria nor fit-to-the-profession criteria were predictive of graduation. the study also offered new information regarding the admission of students with a criminal history. students with a criminal history were eight times less likely to graduate than their non-offending peers, even when controlling for age, gender, race, and program type. the study supports the development of new fit-to-the-profession criteria with the possible elimination of the written statement. keywords: admissions criteria, student success, fit-to-the-profession ideally, the admissions models used by master of social work (msw) programs ensure the selection of the best candidates for advanced social work practice. admissions models facilitate the selection of msw candidates who are both academically prepared for graduate study and professionally suited to social work, characteristics often referred to as fit-to-the-profession. in this manner, admissions models enable msw education programs to meet many administrative and professional standards including adherence to requirements of the council on social work education (cswe), values and ethics of the profession, and the gatekeeping role for the profession. in general, cswe’s educational policies and academic standards (epas) require admissions models of msw programs to be made public and to be easy to understand. historically, cswe required msw programs to develop admissions models allowing only for the admission of the most highly qualified applicants who show evidence of fit-to-theprofession (cswe, 1994). however, this language was removed from the epas in 2002 and replaced with less selective language (cswe, 2002). the most recent epas standards use even less selective language, but still require that admissions models promote “an educational culture that is congruent with the values of the profession” (cswe, 2015, pp. 14). the national association of social worker’s (nasw) code of ethics also outlines and details the professional values of social work in the united states and its outlying territories (nasw, 2008). the nasw code of ethics states that social work is grounded advances in social work, fall 2015, 16(2) 391 in core values including service, social justice, integrity, and competence (nasw, 2008). the admissions process is a built-in form of gatekeeping with a loosely defined process which msw programs use to select the best candidates for study with an expectation that graduates will master the basic competencies for beginning-level msw practice (grady & s., 2009; reynolds, 2004; ryan & habbis, 1997). admissions models attempt to fulfill the gatekeeping mandate by providing a framework which facilitates the selection of the most qualified applicants. gatekeeping is also grounded in the professional belief that social workers must protect current and future clients from harm (leedy & smith, 2005), guiding social work educators, practitioners, and professional organizations in safeguarding those served by the profession. literature review: admissions models and criteria although the research on admissions models is outdated, it provides some insight into admissions models and their effectiveness. the limited research supports the findings that msw programs use similar admissions models which assess two primary areas: an applicant’s readiness for graduate study and an applicant’s fit-to-the-profession (dailey, 1974, 1979; dunlap, 1979; dunlap, henley, & fraser, 1998; fortune, 2003; glenmaye & oakes, 2001; johnson, 1980; pelech, stalker, regehr, & jacobs, 1999; pfouts & henley, 1977; shubert, 1963; thomas, mccleary, & henry, 2004). fit-to-the-profession was typically defined by how well an applicant understands social work and demonstrates an ability to apply the nasw code of ethics. undergraduate grade point average (ugpa) was also frequently reported to measure an applicant’s academic readiness for graduate study (bogo & davin, 1989; dunlap, 1979; dunlap et al., 1998; glenmaye & oakes, 2001; pelech et al., 1999; thomas et al., 2004). an applicant’s written statement, human services experiences, reference letters, and criminal background have been used to measure an applicant’s fit-to-the-profession and field performance (dailey, 1979; glenmaye & oakes, 2001; pelech et al., 1999; schubert, 1963; thomas et al., 2004). table 1 summarizes the statistically significant correlations found in the twelve studies (signified with x) between specific criteria and student success in msw programs (type of success denoted by asterisk, if no asterisk the study did not specify type of student success). faculty rating is defined as the faculty rating of the fit-to-the-profession criteria. undergraduate gpa (ugpa) as can be seen in table 1, ugpa is the only criterion that has consistently correlated with student success in graduate school. more often than not, it is correlated with academic success, showing that as ugpa increases so does an individual’s academic success in the program (bogo & davin, 1989; dunlap, 1979; dunlap et al., 1998; thomas et al., 2004). however, two of the studies reviewed did not differentiate between academic success and fit-to-the-profession (glenmaye & oakes, 2001; pelech et al., 1999). the research supporting ugpa is consistent and generalizable due to the large sample sizes, lack of selection bias in the studies, and the examination of multiple academic years. the studies are spread over 25 years and span four decades (bogo & davin, 1989; dunlap, 1979; dunlap et al., 1998; thomas et al., 2004). pelech et al. (1999) summarized it well saying “undergraduate gpa continues to be one of the most valid predictors of subsequent academic performance and success in the overall program” (p. 219). vliek et al./are admissions models working? 392 table 1. statistically significant correlations between admissions criteria and student success in msw programs author ugpa written statement reference letters work experience faculty rating bogo & davin, 1989 x* dailey, 1974, 1979 x*** dunlap, 1979 x* x dunlap, henley, & fraser, 1998 x* fortune, 2003 glenmaye & oakes, 2001 x x** x** johnson, 1980 pelech, stalker, regehr, & jacobs, 1999 x x pfouts & henley, 1977 shubert, 1963 x**** thomas, mccleary, & henry, 2004 x* x x *=significantly correlated with academic performance **=significantly correlated with field performance ***=faculty ratings unreliable and inconsistent ****= for marginal students only graduate record examination (gre) the large majority of msw programs do not currently require the gre for admission or they require it at the university level and not the program level (national association of deans and director of social work admissions membership, personal communication, october 15, 2014). this trend reflects the concerns of social work educators about the bias of the gre, the content validity of the reading comprehension section of the gre, and evidence that the gre is not predictive of performance in social work programs (donahue & thyer, 1992; milner, mcneil, & king, 1984; thomas et al., 2004). two popular studies in social work influenced the trend. the first of these studies made the bold statement that the “gre is largely irrelevant in social work education” (milner et al., 1984, p. 949). the study compared two groups of students in one msw program-one group that was required to take the gre before admission and one group that was not. the study found no significant difference in the students’ field performance, retention rates, or graduation rates. milner et al. (1984) also pointed out that the admission rate of minority students increased from 9.8% in schools which required the gre to 17.5% in schools that did not require the gre. the second study questioned the validity of the reading comprehension portion of the gre. this study showed that factors other than reading comprehension, such as guessing ability or general knowledge, greatly impact an individual’s score (donahue & thyer, 1992). donahue and thyer (1992) caution against using a tool that is shown to discriminate against minorities and does not correlate with msw student’s performance in the program. advances in social work, fall 2015, 16(2) 393 written statement the written statement is highly valued in social work admissions as it is the most commonly used tool for assessing fit-to-the-profession (gibbs, 1994). however, there is a lack of consistency in the examination of written statements (bogo & davin, 1989; dailey, 1979; fortune, 2003; glenmaye & oaks, 2001; pelech et al., 1999; pfouts & henley, 1977; thomas et al., 2004). many studies lump the analysis of written statements with the analysis of other criteria used to measure fit-to-the-profession making it difficult to discern the individual relationship between a student’s written statement and fit-to-the-profession performance (bogo & davin, 1989; fortune, 2003; pfouts & henley, 1977; pelech et al., 1999; thomas et al., 2004). the rubrics for fit-to-the-profession criteria are also varied, and many studies showed inter-rater reliability was weak (dailey, 1979; fortune, 2003; glenmaye & oakes, 2001). this makes it difficult to examine the effectiveness of written statements in predicting an applicant’s fit-to-the-profession. regardless of how the studies assessed the written statement as an admissions indicator, the results do not support its use as an effective criterion for fit-to-the-profession. although eight studies examined written statements, only one found a correlation between it and fit-to-the-profession, which the study equated with field performance (bogo & davin, 1989; dunlap, 1979; dunlap et al., 1998; fortune, 2003; glenmaye & oakes, 2001; pelech et al., 1999; pfouts & henley, 1977; thomas et al., 2004). one study found that faculty ratings of written statements did not increase the predictive value of the application, stating that the remaining criteria were as effective at predicting student success as the application as a whole (fortune, 2003). the remaining studies either examined written statements as they related to academic performance or lumped written statements with other fit-to-the-profession criteria. therefore, the results do not provide helpful information in discerning the effectiveness of written statements as a fit-to-the-profession criterion. work and life experience work and life experience, specifically in human services, is another criterion often used in msw admissions models (gibbs, 1994; miller & koerin, 1998; vliek, kothari, huizen, & curtis 2011) although research supports that it is inconsistent at predicting student success (dailey, 1974, 1979; dunlap, 1979; dunlap et al., 1998; glenmaye & oakes, 2001; johnson, 1980; pelech et al., 1999; shubert, 1963; thomas et al., 2004). previous experience has not been as widely studied as ugpa or written statements; however, it is commonly viewed by admissions professionals as a positive attribute of applicants (johnson, 1980). two studies found that work experience in the human services field significantly correlated with field performance; as an applicants’ experience in human services increases, their performance in field improves (glenmaye & oakes, 2001; thomas et al., 2004). in contrast, a third study found that students who experienced problems in their msw programs were more likely to have human services related work experience (pelech et al., 1999). this was not true of students who had non-human-services work experience, even when the work time equaled the human-services-related students’ work time (pelech et al., 1999). vliek et al./are admissions models working? 394 faculty rating/interview margaret schubert (1963) was the first to publish an article about msw admissions models. her article was published in the social services review and focused primarily on individual faculty ratings of admissions criteria, specifically the impact of interviews on changing faculty ratings. schubert’s study is consistent with the other five published studies that examine faculty ratings and interviews. four of the five studies found that faculty ratings and interviews were related to student academic success, showing that as faculty ratings increased, a student’s msw gpa also increased (dailey, 1974, 1979; dunlap, 1979; pelech et al., 1999; schubert, 1963). however, the studies were not consistent in how or what the faculty rated and thus should be viewed with caution. the studies were all consistent in showing that faculty ratings and interviews did not correlate with fit-to-theprofession performance (dailey, 1974, 1979; dunlap, 1979; fortune, 2003; pelech et al., 1999; schubert, 1963). this is important because faculty ratings align with fit-to-theprofession criteria and are meant to predict student success in professional performance. there is some evidence in the literature that faculty ratings are inconsistent and unreliable. dailey’s 1979 study was a repeat of his 1974 study. the studies were done at different universities; however, they used the same study design which was developed using a published validation paradigm. both studied admissions data over multiple academic years (dailey, 1974, 1979). both studies found that faculty ratings were unreliable and inconsistent with inter-rater reliability .47 in the earlier study and .22 in the second study (dailey, 1974, 1979). both scores are far too low to indicate any reliability in faculty’s ability to rate in a consistent manner. dailey (1979) suggested the examination of faculty as a variable in admissions models stating that: …it seems reasonable to conceive of the decisional process as including faculty with high variability making judgments about students with equally high variability. couple this with the apparent weakness and contradiction in admissions criteria and the suggestion that faculty make differential inferences from the same admissions material, and the decisional process is likely to be subject to a good deal of slippage. (p. 21) although these studies are somewhat dated, these findings should be seriously considered given that admissions models have not changed substantially since 1979 and faculty still rank applications in the large majority of programs (fortune, 2003). criminal history while msw programs consistently review criminal history, it is not used in a unified manner (vliek et al., 2011). criminal history is reviewed for two main reasons: as a gatekeeping tool and because of state and federal regulations regarding an individual’s ability to work as a professional social worker if said individual has a criminal history. in some states, individuals with a criminal background are limited by state law as to where and with what populations they can practice. for example, in michigan individuals with a criminal background are held to the standards in public health code 333.16221 which outlines the criminal convictions, such as criminal sexual conduct, assault, or obtaining, possessing or selling controlled substances, that limit employment for health care workers (vliek, 2013). the variances in state laws cause msw programs to review criminal history advances in social work, fall 2015, 16(2) 395 in different ways. the program examined in this study does not deny admissions due to criminal history, but instead reviews an applicant’s history and informs the applicant of the impact said history may have on field placement, licensing, and future employment as a professional social worker (vliek & way, 2014). literature summary as can be seen in the above cited literature, there has been little consistency in the results of past studies regarding admission models in msw programs. only one criterion, ugpa, has consistently correlated with student academic performance (dunlap et al., 1998; glenmaye & oakes, 2001 pelech et al., 1999; thomas et al., 2004). the majority of msw programs have consistently ranked ugpa as the most important factor in admissions academic criteria (bogo & devin, 1989; glenmaye & oakes, 2001 mcneece, 1978). however, the majority of programs also include criteria that examine fit-to-the-profession, emphasizing the importance of assessing an applicant’s fit to social work (dailey, 1974, 1979; dunlap, 1979; fortune, 2003; glenmaye & oakes, 2001; johnson, 1980; pelech et al., 1999; pfouts & henley, 1977; shubert, 1963; thomas et al., 2004). the research clearly indicates that the ability of admissions models to predict fit-to-the-profession needs improvement (miller & koerin, 1998). further evidence-based study is imperative in order for programs to determine which measures to include in admissions models, enabling them to increase the effectiveness of gatekeeping, meet educational standards, and safeguard future clients. research questions in order to offer new information that will enhance the body of research evaluating the standard msw admissions model, this study examined the following research questions: 1) are academic-readiness admissions criteria associated with msw academic performance?, 2) are fit-to-the-profession admissions criteria associated with professional competence?, and 3) are fit-to-the-profession and academic-readiness admissions criteria associated with graduation? methods the purpose of this study was to identify the relationship between the admissions model used at a medium-sized msw program and student success in the program. specific criteria within the model were evaluated in relation to student success. student success was measured by graduate grade point average, professional competence, and whether or not students successfully graduated from the program. sample the current sample consists of all applicants to one msw program from the academic year 2004/2005 through the academic year 2008/2009. the program had 657 applications during these years. one hundred thirty-five of these applications were left out of the final sample as they were denied admission, leaving a sample size of 522 admitted applicants. vliek et al./are admissions models working? 396 measures we received human subjects institutional review board (hsirb) approval to examine data for students who enrolled in the academic years 2004/2005 through 2008/2009. two sets of secondary data were analyzed. the school’s student information system provided data related to grades, grade point average, and graduation dates. the social work admissions office provided information on admissions criteria scores, professional review committee meetings, leaves of absence from the msw program, and criminal history. the study examined five independent measures for each application, three of which were reviewed by faculty members, resulting in 4,557 separate ranking scores. written statement scores ranged from 0 to 35, work and life scores ranged from 0 to 30, and reference scores ranged from 0 to 5, with higher scores indicating better performance. the admissions office evaluates the final two remaining independent measures. undergraduate grade point average scores are calculated based on the last 60 credit hours and given a point value ranging from 0 to 20 with 0 equaling a gpa below 2.5 and 20 equaling a gpa between 3.89 and 4.0. criminal history is a dichotomous variable (yes/no) and is asked on the application and evaluated by the admissions director. a section of the rubric including the rating of the first two sections of the written statement can be seen in figure 1. figure 1. excerpt of rubric for admissions decisions written statement: maximum score is 30 (5 points per category) the reader rates the applicant’s coverage of required areas. each part is rated 0–5. readers are advised to begin with examining the personal statement with a rating of “average” and then examine whether this statement section is stronger or weaker than “average.” category points a) understanding of problems and concerns relative to social work. discussion absent; does not refer to social problems; or expresses misunderstanding of social problems � 0 briefly identifies a social problem but does not provide detail � 1 briefly identifies a social problem, and provides little/less than satisfactory depth of understanding � 2 identifies details about a social problem and provides a basic/satisfactory understanding � 3 identifies details about a social problem and provides an advanced/more than satisfactory understanding � 4 articulates an exceptionally thorough and detailed understanding of 1 or more social problems and implications for social workers � 5 b) understanding of diversity. discussion absent; does not refer to diversity issues � 0 does not identify a personal philosophy, or does not provide discussion or understanding of diversity issues � 1 does identify a personal philosophy, but does not provide discussion or understanding of diversity issues � 2 identifies a personal philosophy, and provides a satisfactory discussion and understanding of diversity issues � 3 identifies a personal philosophy, and provides a more than satisfactory discussion and understanding of diversity issues � 4 identifies a personal philosophy, and provides an exceptional discussion and understanding of diversity issues � 5 advances in social work, fall 2015, 16(2) 397 the dependent measures reflect student success as defined by the school of social work. problems in professional competence were measured by participation in a professional review committee (prc). a prc is the procedure employed by the school when a student shows evidence of problems with professional competence in either the classroom or field education. it is a dichotomous variable and a student is considered successful if they do not have a prc. masters of social work academic performance is a continuous measure ranging from 2.00-4.00. a higher gpa equates to student success. graduation is a dichotomous variable, and students are considered successful if they graduate from the msw program. the dataset contained demographic information on age, race, gender, and program type (table 2). the age of accepted applicants ranged from 20 to 64 with a mean age of 30. race had six categories, with 86% of enrollees identifying themselves as caucasian and 14% identified in the remaining five categories. eighty-five percent of the population was female, and 15% was male. four percent of the population had a criminal history. fiftyeight percent of the students in the population were part-time; 42% were full-time. table 2. demographic data of study sample (n=522) demographic variable mean(sd) age 30 (9) race n (%) caucasian 433 (86%) other 70 (14%) female 445 (85%) criminal history 14 (4%) program type advanced standing 82 (16%) part-time 282 (54%) full-time 134 (26%) part-time advanced 24 (4%) table 3 presents the mean admissions scores for the 522 applicants. table 3. mean admissions scores of study sample (n= 522) admissions criteria possible score range minimum score given maximum score given mean (sd) undergraduate gpa score 0-20 0 20 13 (5) work & life score 0-30 14.5 30 24 (3) written statement score 0-35 15.5 35 28 (4) reference score* 0-5 2 5 4.28 (.61) * 75% of references rated potential students as the highest possible score (5) statistical analyses frequencies and descriptive statistics were obtained for all data. if potential confounders, such as age, gender, and race, were shown to have statistically significant vliek et al./are admissions models working? 398 correlations with the dependent measures, they were included in the final models. research question one had a continuous dependent variable; therefore, a linear regression model was used for analysis. for the remaining questions both dependent measures were categorical variables; therefore, logistic regression was used. results rq1: are academic-readiness admissions criteria associated with msw academic performance? the sample size of 522 exceeds the minimal sample size of 400 using green’s formula for the overall model, 50+8(k) where k represents the number of predictors (green, 1991). the model met the assumptions of multicollinearity (tolerance=0.953 and vif=1.05), independent errors (durbin-watson=1.590), and cross validation (f change=73.21, p<.001). the final model did show evidence of heteroscedasticity (breusch-pagan test=173.68, p<.001). therefore, the regression analysis was run using heteroscedasticity-consistent estimators of the regression coefficient standard errors (hc3) as outlined by hayes and cai (2007). table 4 shows the change in standard errors. table 4. changes in standard errors in linear regression adjusted beta olse se olse p value hc3 se hc3 p value constant 3.542 .052 <.001 .059 <.001 gender .036 .028 .260 .031 .240 age -.001 .001 .058 .001 .313 race -.22 .01 <.001 .042 <.001 gpa score .018 .002 <.001 .002 <.001 the linear regression showed that undergraduate grade point average is significantly associated with msw grade point average (f=12.96, p <.001). as the undergraduate grade point average increased by 1 unit (2.5 gpa points) the msw grade point average increased by .02 (table 5). rq2: are fit-to-the-profession admissions criteria associated with professional competence? sample sizes for each criterion varied due to missing data. however, all sample sizes exceeded the minimal requirements per green’s formulas for sample size for the overall models and individual predictors (green, 1991). all models met the assumptions of linearity of the logit and multicollinearity. as seen in table 5, there was no significant relationship between problems in professional competence and fit-to-theprofession criteria. rq3: are fit-to-the-profession and academic-readiness admissions criteria associated with graduation? sample sizes varied due to missing data. however, all samples exceeded the minimal requirements per green’s formulas for sample size for the overall models and individual predictors (green, 1991). all models met the assumptions of linearity of the logit and multicollinearity. as reflected in table 5, there was a significant relationship between criminal history and graduation (f=8.36, p=.018). applicants without a criminal history were 8.4 times more likely to graduate than those with a criminal history. also, in the crude model gpa score was significantly associated with graduation. however, the advances in social work, fall 2015, 16(2) 399 association became non-significant in the adjusted model which accounted for race, gender, age, and program type. table 5. results of linear and logistic regressions (n= 522) na crude ß (95% ci)b p adjusted ß (95% ci)c p rq1: msw academic performance ugpa 522 .2(.018-.022) <.001 .02(.013-.022) <.001 rq2: problems in professional competence work & life 247 .79(.82-1.16) 0.824 .94(.78-1.14) 0.515 statement 234 .96(.83-1.11) 0.583 .95(.82-1.11) 0.512 references 249 .87(.38-1.99) 0.746 .93(.36-2.38) 0.875 criminal hx 322 1.49(.18-12.07) 0.71 1.79(.20-15.74) 0.601 rq3: graduation gpa 522 1.076(1.007-1.150) 0.03 1.055(.986-1.129)c 0.122 work & life 247 .920(.805-1.052) 0.224 .961(.831-1.112)d 0.595 statement 234 .911(.809-1.026) 0.124 .921(8.14-1.041)d 0.188 references 249 1.380(.385-4.949) 0.621 1.105(.289-4.221)d 0.884 criminal hx 322 5.790(1.674-20.030) 0.006 8.363(1.434-48.764)d 0.018 a. population size for regression. regression population demographics are statistically similar to full population. b. ci=confidence interval c. adjusted model accounts for age, race, and gender d. adjusted model included race, gender, age, and program type discussion the current study differs significantly from previous studies in four important ways. it is the first study since the 1970s to use a reasonably large sample size when analyzing admission criteria (see also dunlap, 1979). secondly, it looks at admissions over time by examining four academic years. third, the admissions committee used the same rigorous scoring rubric for reviews during all four academic years, increasing the consistency of the admissions ratings. lastly, the fit-to-the-profession criteria were evaluated by examining professional competence problems in multiple domains whereas current published studies only associated fit–to-the-profession criteria with field performance. the study offers new and important information regarding graduation rates for students with a criminal history. the study findings show that students with a criminal history are less likely to graduate than students without a criminal history, even when controlling for age, gender, race, and program type. social work is a profession that values selfdetermination and rehabilitation. future research investigating why students with a criminal history are less likely to graduate is important to ensure that social work education remains true to these values. the study findings are consistent with past literature examining the academic criteria used in admissions models. the study supported ugpa as an academic criterion with results showing that as an applicant’s ugpa increased, the applicant’s academic performance in the msw program improved. this is consistent with seven of the twelve published studies which support upga as a predictor of msw grade point average (bogo & davin, 1989; dunlap, 1979; dunlap et al,, 1998; glenmaye & oakes, 2001; pelech et al., 1999; thomas et al., 2004). given the consistent support of ugpa as an effective predictor, msw programs may want to consider relying more heavily on undergraduate vliek et al./are admissions models working? 400 grade point average. however, this should be done with great fortitude and care and with strict adherence to the social work values of social justice and cswe’s educational competencies. the study findings do not support current fit-to-the-profession criteria as effective predictors of professional competence. in fact, findings strengthen the argument that fit-tothe-profession criteria are poor indicators of professional competence as consistent with nine of the twelve published studies (bogo & davin, 1989, dailey, 1974, 1979; w. dunlap, 1979; fortune, 2003; johnson, 1980; pelech et al., 1999; pfouts & henley, 1977; shubert, 1963). these findings, which are consistent over a fifty year period, challenge the widely held belief among social work educators that certain fit-to-the-profession criteria, including written statements and human services work experience, should be used to assess fit-tothe-profession (johnson, 1980). given the large amount of resources needed to evaluate these criteria-faculty/reader time, development of scoring systems, time devoted by applicants to write statements, recommenders' time, it makes sense that we further examine how these measurements tools can be useful. further, many studies showed that faculty ratings of criteria were, in and of themselves, inconsistent and ineffective at predicting student success (dailey, 1974, 1979; dunlap, 1979; fortune, 2003; pelech et al., 1999; schubert, 1963). if programs are looking for inter-rater reliability, it may be wise for researchers to follow dailey’s (1979) suggestion and examine faculty as a variable in the admissions process. if faculty members are to continue rating applications, then tools that allow for consistency and accuracy in faculty ratings must be designed. strengths and limitations there is limited research on admissions criteria for msw programs, with only 12 published studies conducted since 1963. in an increasingly important area, this is the first study of its kind to have a sample size over 200, review applicants from four or more academic years, and to have the consistency of a rubric for admissions ratings. this study is also the first to examine fit-to-the-profession in both the classroom and field placements, allowing for a more comprehensive examination of fit-to-the-profession criteria. because demographic and graduation data is not available regarding all msw applicants, it is difficult to generalize the results of this study. it could be that the admissions process is working effectively and applicants who are not a good fit for social work are being denied admission. however, it was not the goal of this study to examine if admissions models were denying applicants appropriately but rather to examine if models were admitting students appropriately. generalizability is also a limitation but was not a goal for this study. instead, the study adds to the body of evidence that will offer evidence of the appropriateness and effectiveness of current admissions models. recommendations in sum, the research indicates that fit-to-the-profession criteria consistently fail to predict student professional performance. msw programs need to seek out effective criteria and their associated measurement tools for predicting professional performance and competence. perhaps programs should consider building admissions models based on applicant competencies, specifically social work competencies. in 1977, duehn and advances in social work, fall 2015, 16(2) 401 mayadas published an exploratory study examining a competency-based direct practice curriculum. they recommended five knowledge skills for use in the development of competency-based direct practice curriculum (duehn & mayadas, 1977). although this study is related only to direct practice, it has implications for msw admissions models as it could serve as an outline in how to develop competency-based admissions criteria. this change would be consistent with cswe’s epas standards which are based on measurement of student competencies. it may be appropriate for msw programs to examine competency-based admissions criteria and re-examine duehn and mayadas’s work. another possibility is to model fit-to-the-profession criteria after stein, linn, and furdon’s work (1975) which studied non-academic factors and intelligence as predictive factors of student professional performance. the study examined scores on three attitude scales and one intelligence scale. the study was small, with a sample size of 58; however, it yielded some interesting and relevant information. overall, the study found that student's professional performance could be predicted by attitude ratings. further, it showed that attitude ratings that are desirable to the social work profession (i.e., less dogmatic, less authoritarian, and less alienated) are associated with higher intelligence. interestingly, the study also found that students who are closed-minded become less interested in social work values as their careers progress. the study provides some information regarding effective fit-to-the-profession criteria, which warrants study replication. johnson (1980) supports retaining written statements as an admissions criteria despite the fact that her research did not find any significant correlations between written statements and student performance. in fact, none of the publications reviewed for this study support written statements as valid criteria (bogo & davin, 1989; dailey, 1974, 1979; dunlap, 1979; dunlap et al., 1998; fortune, 2003; glenmaye & oakes, 2001; johnson, 1980; pelech et al., 1999; pfouts & henley, 1977; shubert, 1963; thomas et al., 2004). johnson’s suggestion is based on the fact that admissions committee members felt better about their recommendation when the written statement was included in the application. the author can only surmise that this is the main reason written statements continue to be included in admission applications. however, as we move toward evidence-based admissions models, we must acknowledge that models should not include criteria that have continuously been shown as ineffective. perhaps written statements can serve a different purpose in admissions models. it is possible that written statements could contain ‘red flags’ for students who are more likely to have problems related to professional competence. more studies replicating pelech et al.’s (1999) regression model may discover evidence that would give justification for continuing to use written statements in admissions models. however, it may be time to consider more drastic changes to the admissions models currently used by most msw programs. it may be time to acknowledge that our fit-to-theprofession criteria are not effective and we need to start over. other healthcare professions use well-studied admissions models, some of which contain fit-to-the-profession criteria. a meta-analysis of other health care admission models, focused specifically on fit-to-theprofession criteria, may help social work educators build an effective model. many health programs, including nursing, physician’s assistant, and speech pathology, use centralized vliek et al./are admissions models working? 402 application systems (cas). the cas require all u.s. applicants to use the same base application. these systems are not designed to improve the effectiveness of admissions models. however, having a national application may increase social work educators’ interest in improving the admissions model. research into the impacts of a cas is certainly warranted. perhaps fit-to-the-profession cannot be adequately measured before admission. social work programs can focus more diligently on fit-to-the-profession criteria while students are matriculating. this would allow programs to examine, over time and in a comprehensive manner, a student’s fit-to-the-profession. through licensing requirements, the social work profession acknowledges that social work education alone does not fully prepare someone for social work practice. fit–to-the-profession requirements can also be added to licensure requirements. for example, as part of the application procedure, an applicant could be required to provide evidence of the application of the nasw code of ethics in their practice. in an increasingly competitive applicant pool, it is important to have evidence-based admission models to guide decision-making. cole (1991) addresses arbitrary admissions decisions as one of the largest legal issues faced by social work programs. cole argues “there should be some evidence that there are relationships between admission standards, likely program success, and alumnae ethical and responsible conduct as professionals” (p. 23). born and carroll (1988) emphasizes the need to be ethical in the process of admitting students to msw programs, which includes using admissions models that are evidencebased. the literature indicates that current admissions models do not meet these standards. this leaves educational institutions at risk for legal action, and more importantly, it leaves social work clientele vulnerable to practitioners who are not competent and do not adhere to professional social work values. further research examining admissions models will ensure that schools of social work are using evidence-based admissions models that effectively meet cswe standards, ensure gatekeeping, and reflect core principles of 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(2014). western michigan university school of social work admissions committee manual of policies and procedures: 2014-2015. unpublished document, school of social work, western michigan university, kalamazoo, mi. http://dx.doi.org/10.1177/0013164484444015 http://dx.doi.org/10.1080/00220612.1977.10671457 http://dx.doi.org/10.1080/03124079708414092 http://dx.doi.org/10.1086/641418 http://dx.doi.org/10.1080/00220612.1974.10671307 advances in social work, fall 2015, 16(2) 405 author note address correspondence to: amy vliek, msw, bsw, school of social work, western michigan university, 4430 health and human services building, mail stop 5354, 1903 w michigan ave, kalamazoo mi, 49008-5354. email: amy.vliek@wmich.edu mailto:amy.vliek@wmich.edu keywords: admissions criteria, student success, fit-to-the-profession literature review: admissions models and criteria methods sample the current sample consists of all applicants to one msw program from the academic year 2004/2005 through the academic year 2008/2009. the program had 657 applications during these years. one hundred thirty-five of these applications were left out of ... statistical analyses results discussion strengths and limitations microsoft word 4. powell et al_2227_policymaking opportunities copyedit final ______________ thomas j. powell, ph.d, is a professor, eve garrow, ph.d., and michael r. woodford, ph.d., are assistant professors, and brian perron, ph.d., is an associate professor, all at the university of michigan school of social work in ann arbor. this study was supported by a grant from the national institute on alcohol abuse and alcoholism (niaaa; aa019575) of the national institutes of health. the niaaa had no role in the preparation, review, or approval of the manuscript. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 367-378 policymaking opportunities for direct practice social workers in mental health and addiction services thomas j. powell eve garrow michael r. woodford brian perron abstract: direct practice social workers have potentially significant policymaking opportunities as mediators of top-down policy and as creators of policy where none exists. the power they possess stems from their ‘on the ground’ expertise and the discretion available to them in making practice decisions. by understanding their power as “street-level bureaucrats” they can significantly improve policy. drawing on policy issues in mental health and addictions services, this article illustrates how social workers can use their power in an ethically sensitive manner to enhance policy outcomes for clients. keywords: policymaking, social policy, direct practice, mental health services, addiction services, social work education many direct practice social workers tend to ignore or dismiss their role in policymaking; they think of it as a top-down process for elite governmental and organizational policymakers and not something they should be concerned with (sherraden, slosar, & sherraden, 2002; weiss-gal & levin, 2010). they tend to overlook opportunities to shape policy as they implement it or to provide input into the larger policy development process (westhues, 2003). when social workers are not aware of their power to influence policy, they may inadvertently reinforce dysfunctional policies or fail to utilize opportunities to make positive changes. but when they are aware of their power they can use their on-theground expertise and discretion in an ethically sensitive manner to positively impact policy. they can a) provide input to policy planners, b) shape existing policy as they provide services, c) create policy in their practice domain where none exists, and d) encourage clients to become involved in policymaking. to impact policy, social workers must understand the nature of policy, their power to influence policy, and the strategies available to them to make policy. the mental health and addictions field will be used to illustrate the ways in which practitioners can shape policies. similar opportunities are likely available in other fields of practice. policy and the direct practitioner policy is often misunderstood to be solely the domain of the elite. according to this view, the president, congress, the courts, major federal agencies such as the national powell, garrow, woodford, perron/policymaking opportunities 368 institutes of health (nih) and substance abuse and mental health services administration (samhsa), in concert with their counterparts at the state level determine policy (gerston, 2004). at the local service-providing level, policy is often misunderstood as solely the responsibility of agency staff occupying roles such as organizational leaders, managers, and policy analysts. the source of these misunderstandings is the assumption that policy is what is promulgated. instead policy should be understood as the typical course of action or what is actually implemented. the pivotal importance of implementation is reflected in definitions of policy that refer not only to what is promulgated or intended but also to what actually happens. pressman and wildavksy (1979) make implementation the key as they assert that socalled policy is only “a collection of words” and “exhortation.” written policy, they argue, “is a point of departure for bargaining among implementers” (p. 180). it is not necessary to fully accept this proposition to appreciate the importance of implementation. unintended or unforeseen outcomes (some favorable and many not) are a consequence of the implementation of policy. both the intended and unintended outcomes flow from the numerous decisions social workers and others make as intermediaries shaping policy outcomes (westhues, 2003). whether aware or not, direct practice social workers inevitably mediate the intended policy because the policy rarely comes down the chain of command with instructions detailed enough to implement the policy. discretion is inevitably involved as decisions must be made to interpret the policy or adapt it to the present circumstance. even medicaid rules and regulations, which are numerous and explicit, leave room for discretion as decisions are made about what services the person's need justifies. most other policies come with fewer directives and constraints. for example, person-centered planning, a broad policy framework endorsed by many agencies relies even more heavily than medicaid does on social workers’ and others’ discretion as they mediate the policy. thus, in mediating top-down policies or taking concrete action to implement a general guide, social workers influence the “what happens” or the on-the-ground course of action. the policymaking power of direct practice social workers as policy implementers, social workers have been held up as wielding considerable power to influence policy (schorr, 1985; scott & davis, 2007). lipsky (1980) suggested this power arises from their role as “street-level bureaucrats,” whom he defined as “lower participants in the organization.” earlier mechanic (1962, p. 352) had observed that these lower participants impact policy outcomes owing to their “commitment, effort, interest, willingness to use power, skills, and attractiveness.” the power of street-level bureaucrats has been explored in a large body of research. in their authoritative text scott and davis (2007) conclude that: while it is widely presumed that policies are determined by political leaders and high-ranking officials, a vast body of research on [policy] implementation suggests that a variety of factors—poorly specified or conflicting objectives, inadequate budgets, weakness of authority, misdirected incentives, existing work routines of operational personnel—transform policies so that the actions of advances in social work, fall 2013, 14(2) 369 “street-level bureaucrats” differ markedly from the intentions of those who designed the programs but establish the meaning of the policies. (pp. 318-319) lipsky (1980) specifically included social workers among street-level professionals, along with lawyers, doctors, and teachers, who he said were expected to use their discretion on behalf of their clients. that discretion is inherent in social work roles has been documented by evans and harris (2004). discretion, however, is not always a ‘good thing.’ its misuse has also been observed particularly in under-resourced public agencies settings (brodkin, 1997; smith & donovan, 2003). counter observations, however, have been made. evans’ (2011) research suggests that a professional culture promotes the positive use of discretion. he found that the professionalism of mental health workers protected clients from managerialist values that would undermine client interests. an illustration of the positive use of discretion is when direct service practitioners use their discretion to address shortcomings of established policies by creating new ones. for example, social workers have initiated harm reduction policies out of concern for clients unable to commit to abstinence-based programs. similarly, social workers and other mental health professionals have created programs to re-engage relapsing clients in addiction-related services (white & kelly, 2011). establishing informal policies is another way discretion is positively exercised by social workers. the decisions they make to create referral patterns or procedures for inter-agency coordination have significant consequences for clients. other informal or unwritten policies may affect clients who, for example, decline to take prescribed psychiatric medications, or show up in a drug treatment program with signs of having used. to the extent that direct practice social workers decide how to handle these situations they are policy makers. finally, social workers can also shape policy by participating in online surveys and community meetings, and where available, directly in policy deliberations. however, since the meaningfulness of these options varies, social workers will need to think carefully about when these opportunities represent effective input strategies (woodford, 2010). three policymaking strategies for social workers providing input to “top” policymakers. since elite policymakers are usually far removed from the situations the policies are meant to address, they need to tap the experience of those immersed in the situation (king, feltey, & susel, 1998; samhsa, 2011). elites need to know the answers to several questions: what needs exist? what options would be most effective? when policy already exists, how well is it working? are the intended outcomes being achieved? what modifications or revisions should be considered? without input and feedback, including client feedback, from the practice level, these questions cannot be answered. needs assessments and client satisfaction surveys fulfill some of this function but since they have limited utility in determining service effectiveness or explaining why things happen they need to be supplemented. social workers with first-hand experience need to share their insights with policymakers being careful to ensure that their clients' interests, and not their own, get the emphasis. powell, garrow, woodford, perron/policymaking opportunities 370 this form of input and feedback is what c. wright mills (1959) insists is necessary to solve problems. know that many personal troubles cannot be solved merely as troubles, but must be understood in terms of public issues … know that the human meaning of public issues must be revealed by relating them to personal troubles—and to the problems of individual life. (p. 226) providing input to policy elites is something that all social workers should consider. and yet it is something that not all social workers are prepared to do. however, all direct practice social workers are inevitably involved in mediating policy and they must make wise use of their discretion. mediating existing policy. effective use of discretion requires social workers to be aware of the play or degrees of freedom in human service organizations (dolgoff & gordon, 1981). play in the system or places where practitioners make choices are everywhere and often intentional since no policy can cover all contingencies. a number of guides are available to “street-level” social workers who wish to use this freedom to tailor programs to the individual needs of their clients (e.g., dodson, 2009; maynardmoody & musheno, 2000; watkins-hayes, 2009). two evidence-based samhsa programs—assertive community treatment (act) and family psychoeducation—illustrate the play in the system (samhsa, 2008, 2009). act, an intensive, 24/7 outreach program for people with severe mental illness leaves many choices to the discretion of the social worker implementing the program. to be considered a faithful model, a panel of clients (about 100) is served by a multiprofessional staff in a low client to staff ratio (about 10:1). the program design favors work at the client’s residence or in other community settings. staff often work side-byside with clients engaged in tasks such as shopping and getting to doctor’s appointments. despite design features that are more concrete than what is found in most programs, several key program characteristics are not specified. for example, social workers and other mental health professionals are (wisely) left to decide the frequency of client visits. the choice of program theory backing up the service activities is also left to the discretion of the social workers and other professionals. even the basic requirement of 24/7 coverage is subject to interpretation and mediation as practitioners (along with managers) decide how they will cover the peak and low demand times of the day. and while the model calls for a variety of professionals, there is considerable discretion at the agency level in deciding the final mix of professions and peer support specialists. the basic idea is that every local adaptation, even those adhering to fidelity requirements, results in a unique interpretation of the model. at first glance, another of samhsa’s mature and more fully developed, evidencebased programs, family psychoeducation might seem to provide less room for discretion than act. family psychoeducation specifies that programs must be offered for a period of at least six months. additional standards and guidelines are set forth in several detailed booklets, each of which runs to more than 20 pages covering the following topics: supporting evidence, getting started, building the program, training, evaluating, and using multimedia (samhsa, 2009). but even in the faithful implementation of these detailed advances in social work, fall 2013, 14(2) 371 guidelines, many important decisions are left to the discretion of social workers and other professionals. they decide, for example, on the relative priority and sequencing of the educational topics, and they decide who will present on these topics. thus, they decide in a substantial way the educational content of the program. many of the guidelines or recommendations associated with the other four samhsa evidence-based practices kits (supported housing, supported employment, illness management and recovery, and integrated treatment for co-occurring substance use and psychiatric disorders) require similar choices on the part of those implementing the policy. thus, much of what actually happens is determined by social workers and others implementing the program. and in programs more generally, there is the paradox that the more numerous the rules, the more the discretion practitioners have in deciding which ones to follow (evans & harris, 2004). on the other side many social workers will find themselves in situations where there are few rules and policies to guide them. creating policy where none exists. since policies cannot cover every eventuality, social workers must develop policies. with online technology, for example, social workers have choices to make about emailing clients, recommending treatment-related internet sites, and advising about online self-help groups or chat rooms (edwards & hoefer, 2010). as another example, they may enact a policy (perhaps wisely left unwritten) to suspend paper work when it interferes with client services. on a smaller scale they may decide when it is appropriate to send notes or cards such as birthday greetings to children or sympathy cards to adults. larger scale decisions offer choices about what services to offer, and in what priority, which in turn often force choices between case management, education, therapy, and resource development. then decisions must be made about whether these services will be offered in individual, family, or group formats and what theories will be used to guide them (e.g., attachment, psychodynamic, cognitive, social learning, etc.). still more decisions must be made about the location of the services—in the home, agency office, or community site such as a park or coffee shop. in all of these decisions social workers, making wise use of their discretion, can affect positive policy outcomes. in choosing theories and service models, social workers must not assume that a commitment to evidence-based practices simplifies choice and reduces opportunity to contribute to policy (cohen, 2011). even if preference is given to certain theoretical frameworks, social workers need to be aware of variables such as relationship quality that need to be managed (duncan & miller, 2006; wampold, 2006). in their review, norcross and lambert (2006) conclude that therapist characteristics and therapist commitment to the particular treatment combined with the quality of the relationship account for the largest part of the variance in treatment outcome. the specific treatment intervention, they conclude, accounts for a smaller part of the variance (baker, mcfall, & shoham, 2009). thus, social workers need to understand that commitment to evidence-based practice does not exempt them from decisions to be made about the development and maintenance of an effective relationship (luborsky & barrett, 2006). scaling up and looking ahead, decisions must be made about how to recruit social worker therapists with powell, garrow, woodford, perron/policymaking opportunities 372 the appropriate characteristics and help them acquire a confidence inspiring theoretical system to guide their therapy (duncan, miller, wampold, & hubble, 2010). from the standpoint of choosing interventions, hundreds have been designated as empirically supported or evidence based (chambless & ollendick, 2001; samhsa, 2013. choosing among them involves considerable judgment given the ambiguous and often-contested nature of the empirical support associated with particular interventions (shedler, 2010) and the need to adapt them to local circumstances (greenhalgh, robert, macfarlane, bate, & kyriakidou, 2004). inevitably the decisions about which treatments to master among the unmanageably large number must take into account the situations in which they are likely to be used (staller, 2006). thoughtful decisions about these matters can have a profound positive effect on client outcomes (glasner-edwards & rawson, 2010). the ongoing evolution of managed care is another arena of policymaking opportunities. the current bias favoring psychopharmaceutical drugs stands out as requiring examination. but even when psychotherapy is readily available, it is constrained by a subtle bias favoring designs modeled after dose-response pharmaceutical interventions rather than a mutual client-therapist process (bohart, 2006; greenberg & watson, 2006). social work values and research mandate that clients cannot be treated as merely passive responders to psychotherapeutic interventions. they must be engaged in morale enhancing, resource generating, self-efficacy building practices (duncan et al., 2010). such practices embedded in empowering models are needed to tackle the range of complex person-in-environment problems, such as homelessness, unemployment, interpersonal violence, and relationship disruption. in contrast, models narrowly tied to dsm iv problem definitions limit and distort the way many real-world problems can be understood and addressed (cohen, 2011). social workers must use their discretion to move toward policies more attuned to the realities of practice. implications for practice practitioners are well positioned to influence policy. they can provide input to elite, top-down policy makers. because of play in the system they make policy in their own service agencies and the field of organizations within which their agencies are situated. even in well-developed programs like act, they make choices and thus shape the course of action for clients. lastly, they create policy where none exists or where directives or rules conflict. social workers need to be aware of how these opportunities manifest themselves in an agency context. the following list of questions is meant to raise awareness about the opportunities to influence policy in mental health and addiction service agencies. agency policy questions client demographics. from a social justice perspective, who are the clients, and who are not clients? what barriers block access for certain groups of people? are minorities affirmatively included? are people from all socioeconomic backgrounds treated equitably? are criteria about severity of illness or level of functioning appropriate? advances in social work, fall 2013, 14(2) 373 mission/vision. are agency mandates firmly focused on recovery rather than limited to the control of symptoms and maintenance of functioning? do clients with substance use disorders have the option to pursue recovery with and without the assistance of medication? has the agency drifted from its core mission? organizational climate. do clients experience the climate as warm and friendly or cold and bureaucratic, proactive or reactive, generous or withholding, orderly or chaotic, and efficient or inefficient? services. is there an appropriate mix of services (e.g., medication, counseling or psychotherapy, act, clubhouse, psychoeducation, and transitional housing)? are there gaps? are the values guiding programs appropriate (e.g., is the family viewed as a resource in psychoeducation programs and act programs)? is employment a goal in case management? does staff facilitate client involvement in nami, the depression and bipolar support alliance, and other self-help groups? when substance use disorders need to be addressed are clients linked to the recovering community and 12-step groups? quality of services. is there appropriate fidelity to evidence-based program models? is there an appropriate balance between fidelity and adaptation to local circumstances? is attention paid to client preferences, enhancing motivation, and building healthy relationships? are appropriate feedback mechanisms in place to monitor and correct problems? are staff qualifications appropriate? are workloads appropriate? budgetary priorities. are the allocations to various service units appropriate? are they in proportion to service demand and needs? governance issues. do consumer, self-help and recovery community representatives participate in board, task, and advisory groups? does nami, for example, participate in search activities for key staff? do consumer and family representatives participate in the awarding and monitoring of contracts? does the agency coordinate with other key agencies and the recovering community? organizational field policy questions social workers and their organizations interact in a field of organizations. the field or network of organizations is defined “by rules, conventions and expectations that define appropriate activities and legitimate positions” (owen-smith & powell, 2008, p. 601). within the field, organizations are linked to some as partners and rivals on the horizontal plane, and to others as subordinates or super ordinates on the vertical plane. those above on the vertical plane are often involved in funding or standard setting for the organization (scott & davis, 2007). the questions below describe opportunities to effect changes in the field of organizations. justice system. are there intercept and diversion programs along the criminal justice continuum—police, prosecutor, court, jail, probation and parole? does the probate court seek alternative solutions to involuntary treatment or criminal trial (munetz & griffin, 2006)? powell, garrow, woodford, perron/policymaking opportunities 374 the network of disability agencies. do the community mental health and addictions agencies participate in programs to integrate people with disabilities in the community? is there an effective relationship with the local center for independent living? education and rehabilitation services. does the agency coordinate with community and four-year colleges to provide supportive educational service? are clients provided effective vocational rehabilitation services? are supportive employment services offered in conjunction with rehabilitation agencies? income support agencies. are social security disability insurance (ssdi), supplemental security income (ssi) and medicaid applications efficiently and equitably processed? are there open channels of communication to relevant offices to facilitate the application process? housing. are supportive housing services available? is transitional housing available? is permanent housing the goal? are there additional opportunities to create more affordable housing units? general medical services. do clients have appropriate access to primary care? do they have a health care home? are outreach programs effective? do services meet quality standards? are there special programs for people at risk for, or struggling with, diabetes, coronary disease, hepatitis, hiv, or other chronic diseases? state mental health and addiction agencies. are relationships in place to take advantage of special incentive programs and training resources? samhsa. do agencies regularly access electronic resources and take advantage of opportunities for in-person consultation? insurance organizations. are communication channels available to address issues such as benefit eligibility, definition of service, and reimbursement procedures? safeguards against the misuse of discretion notwithstanding the potential for positive uses of discretion, it should be understood that discretion intrinsically is neither good nor bad and can be misused. its use must be monitored and conditions must be established to ensure its effective and ethical use. research can be used to identify a number of conditions associated with the risk of misuse. workers in situations with limited resources and poor work conditions may be at risk to use their discretionary power to disentitle clients and privilege their own interests (brodkin, 1997; smith & donovan, 2003). high caseloads may incline workers to ration services or triage clients based on informal categories of “deserving” and “undeserving” (lipsky, 1980). workers may also be at risk for sharing among themselves practice ideologies that rationalize their discriminatory practices (hasenfeld, 1987). the result may be, for example, racial or gender bias that systematically disadvantages entire categories of people (fording, soss, & schram, 2007). to safeguard against these risks, a culture of professional accountability and support needs to be cultivated within agencies. this culture is more likely to be found in an agency that employs professionally educated social workers who are personally advances in social work, fall 2013, 14(2) 375 committed to the agency’s mission and their profession’s code of ethics (evans, 2011). the culture is also more likely to flourish in adequately resourced agencies that incentivize quality services. this culture is often associated with agencies that have a relatively flat power structure, reasonable caseloads, and a culture that values the voice of direct practitioners and their clients (shera & paige, 1995). conclusions direct practice social workers, whether they are cognizant of their policymaking role or not, influence what actually happens to clients as they inevitably make decisions that mediate or implement top-down policies. social workers are also policymakers insofar as they make decisions in areas where there is play in the system and policy is absent. the effective and ethical use of discretion in implementing and creating policy is a 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(2011). recovery management: what if we really believed that addiction was a chronic disorder? in j. f. kelly & w. l. white (eds.), addiction recovery management theory, research and practice (pp. 67-84). totowa, nj: springer science+business media, llc. woodford, m. r. (2010). successful community-government collaborative policymaking: a case study of a workgroup to improve income support services to victims of intimate violence. journal of policy practice, 9(2), 96-113. author note: direct correspondence to: thomas j. powell, ph.d., university of michigan school of social work, 1080 south university avenue, ann arbor, mi 48109-1106. email: tpowell@umich.edu this work is licensed under a creative commons attribution 4.0 international license. perceptions of recidivism among incarcerated youth: the relationship between exposure to childhood trauma, mental health status, and the protective effect of mental health services in juvenile justice settings jamie r. yoder kelly whitaker camille r. quinn abstract: research suggests that youth involved in the juvenile justice system have trauma histories that are two times higher than youth in the general population. juvenile justiceinvolved youth also have high rates of mental health symptoms. fewer studies have examined how trauma links to mental health symptoms among youth offenders, and even less research focuses on how mental health status and service delivery can impact their perceived likelihood for success. this study examines the effects of mental health screening and service delivery on perceived future criminal justice interactions—arrest and incarceration—among adjudicated youth (n=7,073) housed in correctional facilities. secondary data were used to examine trauma histories, mental health needs, and mental health screening and service delivery. significant relationships between traumatic events and mental health problems were found, along with relationships between mental health problems and mental health screening and service delivery. most interestingly, results pointed to the strong inverse relationship between mental health service delivery and youth’s perceived likelihood for recidivism. these findings show the promise of juvenile justice systems appropriately responding to the mental health concerns of youth. keywords: trauma, mental health services, juvenile justice, incarceration, youth trauma exposure, violence, and victimization are common experiences among youth. estimates of a national sample of youth in the general population suggest that more than half of all youth have experienced childhood traumatic events and half of those youth experience multiple traumatic events (mclaughlin et al., 2012). a traumatic event “is one that threatens injury, death, or the physical integrity of self or others and also causes horror, terror, or helplessness at the time it occurs” (apa presidential task force on posttraumatic stress disorder and trauma in children and adolescents, 2008, p. 2). examples of childhood traumatic events include early life victimization such as sexual, physical, or emotional abuse (costello, mustillo, erkanli, keeler, & angold, 2003; finkelhor, ormrod, turner, & hamby, 2005; ford, chapman, mack, & pearson, 2006). while traumatic experiences can lead to a host of negative emotional, behavioral, and psychological outcomes (mcgloin & widom, 2001), the cycle of violence theory (smith & thornberry, 1995; widom, 1992) and ensuing research (becker & kerig, 2011; bennett & kerig, 2014; evans & burton, 2013; kerig & bennett, 2013) suggest that youth exposed to early trauma are at an increased risk for delinquency and involvement in the criminal justice system. in epidemiological reports, juvenile justice involved youth have trauma ______________________ jamie r. yoder phd, msw is an assistant professor, school of social work, colorado state university, fort collins, co 80523. kelly whitaker, phd is a postdoctoral fellow, school mental health assessment, research, & training (smart) center. department of psychiatry & behavioral sciences. school of medicine, university of washington, seattle wa 98105. camille r. quinn, phd, am, lcsw is an assistant professor, college of social work, the ohio state university, columbus, oh, 43210. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 250-269, doi: 10.18060/21305 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 251 histories that are 2 to 3 times higher than youth in the general population (coleman, 2005; coleman & stewart, 2010; ford, chapman, connor, & cruise, 2012). two independent studies revealed analogous rates of elevated trauma among detained youth relative to general population youth; approximately 90% of the detained youth reported a history with at least one traumatic event (abram et al., 2004). specifically, 35% of detained youth indicated at least one experience of physical assault (ford, hawke, & chapman, 2010). more recent research supports and expands upon the prevalence data to suggest juvenile justice youth have histories of poly-victimization and complex trauma (ford et al., 2012; ford, grasso, hawke, & chapman, 2013). exposure to traumatic events in childhood may also be linked to mental health symptomatology. trauma accounts for 45% of mental health disorders starting in childhood, 32% mental health disorders starting in adolescence, 29% of mental health disorders starting in early adulthood, and 26% in mid-later adulthood (green et al., 2010). furthermore, there are disproportionately high rates of mental health symptoms among youth involved in the juvenile justice system; approximately 50-70% of these youth have a diagnosable mental health condition (skowyra & cocozza, 2006) relative to approximately 40% of the general youth population who meet diagnostic criteria at some point in childhood and 20% who have a severe mental health condition (merikangas et al., 2011). the relationship between trauma and juvenile justice involvement, therefore, may be partially explained by associated mental health symptomatology (kerig, 2012; kerig, ward, vanderzee, & moeddel, 2008). research has widely acknowledged the effects of early physical, sexual, and emotional abuse on various mental health conditions including anxiety, depression, suicidal ideation, post-traumatic stress disorder (ptsd), and anger (bolger & patterson, 2001; green et al., 2010; hazen, connelly, roesch, hough, & landsverk, 2009; higgins & mccabe, 2003; martin, bergen, richardson, roeger, & allison, 2004; runyon & kenny, 2002). there is even a documented association between longer duration and frequency of traumatic events and co-occurring mental health disorders (sabri, 2011). given the disproportionately high rates of mental health problems among youth involved in the juvenile justice system, there are concerns that external or internal manifestations of mental health symptoms within facilities can lengthen stays leading to suicide attempts, and even pose greater danger to others (u. s. house of representatives committee on government reform, 2004, 2005). furthermore, with early identification and screening, mental health symptoms can be treated at juvenile justice entry (burke, mulvey, & schubert, 2015). left untreated, however, mental health conditions can also create re-integration and rehabilitative challenges (teplin, abram, mcclelland, dulcan, & mericle, 2002). there is a dearth of research on the relationship between trauma and mental health symptoms among youth involved in the juvenile justice system, and how screening for mental health and mental health service delivery can impact youth’s perceived likelihood for success. using a nationally representative sample of youth housed in correctional facilities, this study endeavors to (1) test the relationship between traumatic events and mental health symptoms, (2) test the effects of traumatic events and mental health symptoms on perceived likelihood for recidivism, and (3) test how the introduction of yoder et al./perceptions of recidivism 252 mental health screening and service delivery can influence youth’s perceptions of recidivism. literature review although trauma exposure is associated with juvenile justice involvement (abram et al., 2004; ko et al., 2008), the system has historically ignored trauma or mental health symptomatology in service delivery (donisch, bray, & gewirtz, 2016). to effectively address the needs and improve outcomes for youth in juvenile justice systems, it is essential to recognize, assess, and provide treatment for trauma symptoms (ko et al., 2008). recently, there has been noteworthy attention paid towards standardizing trauma-informed care models in various child service settings including juvenile justice (donisch et al., 2016; ko et al., 2008). trauma-informed care is conceptualized as an organizational change process based on principles intended to promote healing and reduce the risk of re-traumatization for vulnerable individuals including those in correctional facilities or under correctional supervision (wolf, green, nochajski, mendel, kusmaul, 2013). although there is some debate around the definitions of trauma-informed care, some common elements of traumainformed or specific care include screening for trauma exposure, assessment of trauma impact, and increasing access to mental health treatment (berliner & kolko, 2016). screening, assessment, and treatment are characteristics of broader behavioral health service provision (sacks, ries, & ziendonis, 2005), and can address the underlying mental health needs associated with exposure to early childhood trauma (cohen, mannarino, & deblinger, 2006). it may be less demanding or complex to target trauma as an external experience rather than the multiple residual and associated effects of mental health problems; traumabased interventions largely fall under the broader category of mental health interventions. as such, to overcome trauma reminders, events, and to avoid retraumatization, cognitive behavioral techniques and narrative dyadic therapies, such as trauma-focused cognitive behavioral therapy, are employed (cohen et al., 2006). there is substantial variation in the rate and manner in which juvenile justice facilities systematically screen youth for mental health problems. a meta-analysis of prevalence of mental health conditions among youth in correctional facilities noted great variability in the instruments used, inter-rater reliabilities, and what constituted a mental health disorder (fazel, doll, & långström, 2008). for example, some facilities may use clinical arbitration while others used mental health screening tools, and still yet, others may use diagnostic criteria. some examples of tools include the diagnostic and statistical manual of mental disorders (dsm-v; american psychiatric association, 2013) the massachusetts youth screening inventory (maysi; grisso, vincent, & seagrave, 2005), or the diagnostic interview schedule for children disc (shaffer, fisher, lucas, dulcan, & schwab-stone, 2000). furthermore, there are disparate ways these instruments are administered to youth with some being interview and others are self-report (fazel et al., 2008). furthermore, this meta-analysis did not include youth who were screened for mental health problems at entry into juvenile justice settings, nor did it link the mental health screening with early experiences of traumatic events. as such, there may be an advantage to considering nationally representative datasets that gather data on rates of screening across juvenile advances in social work, spring 2017, 18(1) 253 justice settings. mental health service delivery in juvenile correctional facilities is inconsistent at best; some facilities may deliver services, some facilities may not have specialized staff or mental health professionals adequately trained to treat mental health symptoms (maschi, hatcher, schwalbe, & rosato, 2008; swank & gagnon, 2016). the juvenile justice system relative to the education or child welfare systems provides very little mental health resources and support to youth (farmer, burns, phillips, angold, & costello, 2003). research has also qualitatively identified inconsistencies in the delivery of traumainformed mental health care within the juvenile justice settings (donisch et al., 2016). in fact, the philosophies of treatment for youth involved from the juvenile justice system differ greatly from other systems in that the juvenile justice system is largely focused on culpability and community safety (maschi et al., 2008). incarcerated youth have been found to have lower engagement in mental health services relative to other populations of youth with similar mental health needs (liebenberg & ungar, 2014; pumariega et al., 1999). nevertheless, mental health treatments delivered in juvenile justice settings can be associated with positive outcomes including reduced mental health symptoms, ptsd, and reductions in recidivism. for example, correctional mental health treatment has been linked to reductions in suicidal ideation, emotional disturbances, and anger (kaslow & thompson, 1998; kendall, reber, mcleer, epps, & ronan, 1990; underwood & washington, 2016). several randomized studies found trauma-focused cognitive behavioral interventions in juvenile justice facilities improved ptsd and depression symptoms among adjudicated youth (cohen et al., 2016; ford, kerig, desai, & feirman, 2016). cognitive behavioral interventions offered in juvenile correctional facilities have also been connected to decreased recidivism (dowden & andrews, 1999; lipsey, 1999; lowenkamp, makarios, latessa, lemke, & smith, 2010). recidivism can be operationalized in many ways, and official record data designating a new arrest or conviction is typically the most common (lowenkamp, latessa, & smith, 2006; lowenkamp et al., 2010). however, research studies have infrequently considered prospective perceptions of youth’s future involvement with the criminal justice system. youths’ self-conceptions are powerful indicators of behavioral change. these are narratives that can link to one’s core self-representation and are largely selfor socially constructed, rooted in internal or external messages (bandura, 1986). these selfrepresentations are based on what the individual believes are facts or truths about themselves, their abilities, and subsequent behavioral change (wallis & poulton, 2001). indeed, cognitive behavioral theorists have argued there is a substantial link between selfperception and behavior (bandura, 1986; wallis & poulton, 2001). so, it may be imperative to understand a youth’s perception in an effort to accurately assess behavioral changes; yet, very little research has explored the relationship between trauma incidents, mental health problems, and mental health service screening and service delivery on the perceptions of youths’ likelihood for recidivism. recognizing how mental health can influence youth’s convictions towards behavioral change, and perhaps trauma can skew those beliefs, this study seeks to explore how perceptions of recidivism are influenced by mental health, traumatic events, and mental health screening and service delivery. yoder et al./perceptions of recidivism 254 current study the current study draws from nationally representative data on pre-and postadjudicated youth (n=7073) that are housed in correctional facilities. we examined whether mental health screening and service delivery reduced perceived future interactions -arrest and incarceration-with the juvenile justice system. we proposed two hypotheses: a) youth with early exposure to trauma and current mental health problems will indicate increased likelihood for future interactions with the juvenile justice system, and b) youth who receive mental health screening and receive mental health services within correctional facilities will indicate reduced likelihood for future interactions with the juvenile justice system. method sample and procedures this study analyzed data from the survey of youth in residential placement (syrp) that was developed and funded by the office of juvenile justice and delinquency prevention (sedlak, 2003). the syrp is an anonymous youth self-report survey taken by pre-and post-adjudication youth aged 10-20 living in juvenile correctional facilities. the survey captures information on youth’s criminal history, early traumatic experiences, and experiences in the facility. it is a nationally representative survey that used a probability proportional-to-size sample design, pooled from the census of juveniles in residential placement (cjrp) and the juvenile residential facility census (jrfc). a total of 290 facilities were selected, but 71% of those facilities participated (204). of the eligible 9,495 youth, 74.5% or 7,073 youth participated in the survey (sedlak & mcpherson, 2010). some youth did not participate for various reasons including failure to obtain parental consent or unwillingness to participate (sedlak & mcpherson, 2010). surveys were completed between march and june of 2003 and were administered on computers using an audio-assisted self-interview (acasi) methodology. weights have been assigned to the data and design effects were used to adjust for the nested structure of the data and youth and facility non-response rates. these methods included weight trimming, final weighting adjustments, and sampling variance calculations via jackknife replication. once data were secure with minimal risk for participant detection, survey responses were made available to the public. the overall sample (n=7,073) averaged 16.5 years of age (sd= 1.5), were primarily male (n= 5,378; 76.0%), with slightly more hispanic youth (n= 2,368; 33.5%) than black youth (n= 2,068; 29.2%) or white youth (n= 2,005; 28.3%). the data have been distributed through the inter-university consortium for political and social research (icpsr) at the university of michigan. access to the data was granted through approvals from the university institutional review board and the national archive of criminal justice data (nacjd) through the icpsr data access request system (idars). advances in social work, spring 2017, 18(1) 255 measures dependent variables. two scaled dependent variables were likelihood for future arrest and likelihood for future incarceration. the youth were required to respond to two independent items “in the future, how likely do you think it is that you will be arrested?” and “in the future, how likely do you think it is that you will be locked up?” responses ranged from 1= definitely will not to 4= definitely will. on average, youth reported they will probably be arrested in the future (m=3.20; sd=1.22) and reported future incarceration between probably and definitely (m=3.80; sd=1.08). independent variables. exploratory factor analyses were run to determine the factorability of items in generate composite scales that were used as independent variables for this study. there were several independent variables of interest that included youth mental health status (e.g., emotional disturbances, suicidal ideation, and anger), trauma incidents, mental health screening, and mental health service delivery. youth mental health status. various items related to youth’s mental health status were used in this in study. the syrp included select questions on mental health status that were derived partially from the massachusetts youth screening instrument (maysi; grisso & barnum, 2006; grisso, barnum, fletcher, cauffman, & peuschold, 2001; sedlak & mcpherson, 2010). because all items were not included in the syrp measure, exploratory factor analysis was conducted using principle axis factoring and promax rotation to determine the factorability of the set of items and how many factors loaded under each construct. the kaiser-meyer-olkin measure of sampling adequacy (kmo) was .915 indicating there were high correlations among variables caused by a common factor. the eigenvalues (>1) indicated a three-factor solution, suggesting suicidal ideation, anger, and emotional disturbances were separate constructs. the communalities, or the percentage of variance explained was acceptable (ranging from .340 to .830), the factor loadings were high, and the scale reliabilities were good (see table 1 for factor loadings and alpha scores). the mental health questions were prefaced with, “in the past few months, have you…” example items included “wished you were dead”, “felt angry a lot”, and “had bad thoughts or dreams”. the binary responses (0=no; 1=yes) were cumulated for each item to create an overall score for each factor. trauma incidents. the syrp included select questions on early life trauma events that were not derived from a standardized or validated instrument. as such, exploratory factor analysis was also conducted using principle axis factoring and promax rotation to determine the factorability of a set of early life victimization items. the kaiser-meyerolkin measure of sampling adequacy (kmo) was .924 indicating there were high correlations among the variables caused by a common factor. the eigenvalues (>1) indicated a one-factor solution, suggesting all items loaded on one common factor labeled trauma incidents. this latent construct consisted of three disparate forms of trauma incidents (physical, sexual or forced sexual, or emotional). an example item was, “were you physically abused when you were growing up?” the binary responses (0=no; 1=yes) were combined to form a composite with a score ranging from 0 to 3 (0=none; 1=1 type; 2= 2 types; 3=3 types). the alpha for this scale was good (α=.748). yoder et al./perceptions of recidivism 256 mental health screening and mental health service delivery. mental health screening was a variable that was based on facility administrators’ answers to the 2002 juvenile residential facility census questions that asked, “are all young persons evaluated or appraised by a mental health professional inside the facility?” the response items were (0=no; 1=yes). mental health service delivery was linked directly to the preceding mental health status questions. it consisted of one item that asked youth, “since you have been in this facility, have you received counseling to help you deal with any of your feelings and emotions?” the response items were (0=no; 1=yes). control variables. controls included gender, race/ethnicity, age, and program type. gender was dummy coded to indicate male or female (0= female; 1= male). youth’s race/ethnicity was measured in five categories (1= black; 2= any hispanic; 3= american indian/alaska native/asian/native hawaiian/other; 4= white; 5=two or more groups (non-hispanic)). two different race dummy variables including black (0=else; 1=yes) and hispanic (0=else; 1=yes) were created to better understand the relative influence of each race. these variables were chosen because they represented the majority of the youth in the sample. age was a continuous variable of the number of years old at the time the survey was administered. the final control variable was program type and was measured in five categories (1= detention unit; 2= correctional unit; 3= communitybased unit; 4=camps; 5=residential treatment unit). this variable was dummy coded to reflect a correctional or detention setting (0=else; 1=correctional or detention). the variables’ frequencies and distributions, and relative factor loadings provided in tables 1a and 1b. table 1a. sample characteristics and factor loadings endorsed n (%) factor loadings trauma incidents (α=.748) youth was physically abused when growing up 2548 (36%) 0.733 youth experienced emotional abuse when growing up 2217 (31.3%) 0.721 youth experienced sexual abuse/ forced sex when growing up 1030 (14.6%) 0.501 suicidal ideation (α=.879) thought about killing self 1113 (15.7%) 0.951 thought about hurting self 1242 (17.6%) 0.841 life is not worth living 1950 (27.6%) 0.674 wished i was dead 1519 (21.5%) 0.845 anger (α=.753) temper 4327 (61.2%) 0.746 easily upset 4938 (69.8%) 0.704 often angry 4396 (62.2%) 0.729 emotional disturbances (α=.681) nightmares 1384 (19.6%) 0.565 lonely 3851 (54.4%) 0.57 non-fun friends 2422 (34.2%) 0.47 bad thoughts 2473 (35%) 0.625 nervous or worried feelings 3800 (53.7%) 0.517 therapeutic services for mental health problems 3544 (50.1%) screening by mental health professional 3129 (44.2%) advances in social work, spring 2017, 18(1) 257 table 1b. sample characteristics controls n(%) gender male 5378 (76%) race white 1951 (27.6%) black or african american 2026 (28.6%) any hispanic 2308 (32.6%) american indian/alaska native/ asian/ native hawaiian/ other 197 (2.8%) two or more groups (non-hispanic) 421 (6%) program type detention unit 2061 (29.1%) correctional unit 2806 (39.7%) community-based unit 768 (10.9%) camps 753 (10.6%) residential treatment unit 685 (9.7%) mean (sd) age 16.2 (1.57) analyses complex survey methods were used to analyze the data using stata 13.1 (statacorp, 2013). two types of sampling weights were used in the analysis. the final youth weight (fywt) was used due to the complex sampling design in the syrp survey, while the 74 replicate weights (r_fywt1 to r_fywt74) generated in the syrp database were used in the variance estimation methods. specifically, for our analyses, a balanced repeated replicate (brr) variance estimator was used to generate standard errors used in the development of p-values and confidence intervals. brr is a variance estimation technique used with complex designs with two primary sampling units (facility and youth) (mccarthy, 1996). it provides reasonable variance and standard error estimations that would otherwise be artificially inflated. the authors of the original project (see: sedlak et al., 2012) require the use of survey weights for all analyses to account for nesting of youth within facilities and oversampling of females and hispanic youth. we ran bivariate linear regressions to test the first hypothesis; there is a statistically significant positive relationship between trauma incidents and mental health problems among incarcerated youth. then, we ran bivariate logistic regressions to test the relationships between mental health problems and mental health screening and service delivery. next, we ran two stepwise linear regressions with the goal of testing the first hypothesis and then adding therapeutic services in the model to determine its mitigating effects on the variables of interest and effects on the outcome. results relationship between trauma incidents and mental health status. all bivariate regression models revealed a good fitting model with the f-statistic p<.001. the results revealed that there was a statistically significant positive relationship between trauma incidents and all three outcomes of mental health status. youth with more trauma incidents reported more emotional disturbances (b=.52, p<.001), more suicidal ideation (b=.57, yoder et al./perceptions of recidivism 258 p<.001), and more anger (b=.28, p<.001). the results from these analyses are provided in table 2. table 2. bivariate analyses regressing trauma incidents independent variable: trauma incidents outcomes b t(se) 95% ci model fit r2 emotional disturbances .52* 144.07(.01) .51-.52 f(1,73)=20756.22 .1041 suicide .57* 234.00(.01) .56-.57 f(1,73)=54755.57 .1712 anger .28* 142.09(.01) .27-.28 f(1,73)=20189.91 .0485 *p<.001 relationship between mental health status and mental health screening and service delivery. all bivariate logistic regression models revealed a good fitting model (p<.001). the results revealed that youth with emotional disturbances had a greater likelihood of being screened for mental health (b=.06, p<.001) and receiving mental health services (b=.03, p<.001). youth with suicidal ideation had a greater likelihood of mental health screening (b=.03, p<.001) and receiving mental health services (b=.02, p<.001). youth with anger had a greater likelihood of being screened for mental health (b=.06, p<.001) and a reduced likelihood of receiving mental health services (b=-.06, p<.001). the results from these analyses are provided in table 3. table 3. bivariate analyses regressing mental health problems relationship between trauma incidents, mental health status and future interactions with the criminal justice system. the results revealed that youth with more trauma incidents report a greater likelihood of arrest (b=.24, p<.001) and incarceration (b=.13, p<.01). nevertheless, youth who report more emotional disturbances (b=-.22, p<.001), suicidal ideation (b=-.12, p<.01), and anger (b=-1.20, p<.001) reported a lower likelihood of future arrest. youth with more emotional disturbances (b=-.38, p<.001) and anger (b=-1.42, p<.001) reported a lower likelihood of future incarceration, but youth with greater suicidal ideation reported greater likelihood of future incarceration (b=.09, p<.001). the results addressing the second hypothesis are provided in table 4 and 5. emotional disturbances suicidal ideation anger outcomes b t (se) 95% ci b t (se) 95% ci b t (se) 95% ci mh screening .06* 16.20 (.00) .06.07 .03* 4.32 (.01) .01-.04 .06* 18.54 (.00) .05-.07 mh service delivery .03* 15.81 (.00) .03.04 .02* 5.23 (.01) .01-.02 -.02* -4.64 (.01) -.02-.01 legend mh= mental health, *p<001 advances in social work, spring 2017, 18(1) 259 table 4. likelihood of arrest hierarchical linear regression model relationship between mental health screening, mental health service delivery and future interactions with the criminal justice system. the results revealed that mental health screening was associated with reported reduced likelihood of future arrest (b=-.29, p<.001) (table 4) and incarceration (b=-.31, p<.001) (table 5). furthermore, youth who reported receiving mental health services reported a reduced likelihood of future arrest (b=1.71, p<.001) and incarceration (b=-1.34, p<.001). table 5. likelihood of incarceration hierarchical linear regression model model 1 model 2 b t(se) 95% ci b t(se) 95% ci age -.07* -2.20 (.03) -.14 -.07 -.04 -1.17(.03) -.10.03 african american .60*** 4.90 (.12) .84.35 .84*** 7.39 (.11) 1.06 .61 hispanic .33*** 4.73 (.07) .47.19 .36*** 5.20 (.07) .50 .22 male .05 .31(.16) -.37.27 -.05 .31 (.16) .27-.37 trauma incidents .13** 3.26(.04) .05-.22 .19*** 4.51 (.04) .11.27 emotional disturbances -.38*** -11.34(.03) -.45-.31 -.34*** -9.84(.03) -.41-.26 suicide .09* 2.26(.04) .01.17 .09* 2.18 (.04) .01.17 anger -1.42*** -40.27 (.04) -1.49-1.35 -1.35*** -40.18(.03) -1.42-1.29 program type 1.68*** 12.88(.13) 1.42-1.94 1.68*** 12.32 (.14) 1.41-1.96 mh screening -------.31*** -13.16 (.02) -.36-.27 mh service delivery -------1.34*** -12.86(.10) -1.50 -1.13 model fit f(9,65)=476.06, p<.001 f(11, 63)=450.34, p<.001 r-square .71% .90% legend *p<.05, **p<.01, ***p<.001 mh= mental health discussion the results from this study add to extant research on trauma, mental health, screening, and service delivery among youth involved in the juvenile justice system. this study found significant relationships between trauma incidents and mental health disturbances. this largely coincides with research suggesting that youth with previous trauma histories have model 1 model 2 b t (se) 95% ci b t (se) 95% ci age -.25*** -6.69 (.04) -.32-.17 -.22*** -6.22 (.04) -.29-.15 african american .04 .38 (.12) -.29.19 .28** 2.50 (.11) .50-.06 hispanic .02 .80 (.07) .16.12 .03 .45 (.07) .17-.11 male .44* 2.46 (.17) .80-.08 .32 1.82 (.17) .68-.03 trauma incidents .24*** 5.84 (.04) .16-.33 .30*** 7.09 (.04) .22.38 emotional disturbances -.22*** -6.77(.03) -.29-.16 -.18*** -5.44 (-.03) -.24-.11 suicide -.12** -2.92 (.04) -.20.04 -.14** -3.27 (.04) -.22-.05 anger -1.20*** -33.45 (.04) -1.27-1.13 -1.12*** -33.14 (.03) -1.20-1.06 program type 1.42*** 10.27 (.14) 1.14-1.71 1.31*** 8.82 (.15) 1.01-1.60 mh screening -------.29*** -11.91 (.02) -.34-.24 mh service delivery -------1.71*** -17.46 (.09) -1.90-1.51 model fit f(9,65)=366.62, p<.001 f(11, 63)=365.79, p<.001 r-square .0048 .0069 legend *p<.05, **p<.01, ***p<.001 mh= mental health yoder et al./perceptions of recidivism 260 associated mental health problems including anxiety suicidal ideation and anger (bolger & patterson, 2001; hazen et al., 2009; higgins & mccabe, 2003; martin et al., 2004; runyon & kenny, 2002). while this may not be new information, it is important to contextualize these associations for youth offenders. these findings help isolate some of the reasons underlying disproportionately high levels of mental health problems among juvenile justice involved youth (fazel et al., 2008; teplin et al., 2002; wasserman, mcreynolds, lucas, fisher, & santos, 2002). the results also pointed to the relationships between mental health problems and mental health screening and service delivery. these findings largely suggest that the more mental health problems reported by youth, the more likely they are to receive screening and service delivery, with the exception of the inverse association between anger and service delivery. while these relationships are marginally strong, they generally show the promise of juvenile justice systems appropriately responding to the mental health concerns of youth. it is not surprising that youth who have more anger are less likely to receive mental health services. perhaps anger or the manifestations through externalizing behavior problems (delisi et al., 2009) warrants the use of control or force to mitigate problems (day, 2002), rather than therapeutic responses; physical or psychological controls are common reactions by juvenile justice staff encountering anger and aggression (hodge & yoder, 2017; mason & magnan, 1995; schwalbe & maschi, 2011) and corresponds closely with the ideologies of juvenile justice – to remediate or control (maschi et al., 2008). the findings from this study revealed that trauma incidents were positively associated with perceived likelihood for future arrest and incarceration. this finding is not surprising in light of theory and research indicating substantial links between early exposure to trauma and the propensity for juvenile justice involvement (coleman, 2005; coleman & stewart, 2010; smith & thornberry, 1995; widom, 1992; widom & maxfield, 2001). this adds to the extant research on this topic, and informs the wider literature base indicating direct relationships between these two constructs. yet, there were some surprising findings that revealed associations between mental health and perceived likelihood of recidivism. in most of the models, with the exception of suicidal ideation and likelihood for incarceration having a positive relationship, the results are somewhat antithetical; the more youth report mental health problems, the less likely they are to report interactions with the juvenile justice system. this finding is unexpected, but perhaps can be understood through the lens of social cognitive theory; one’s perceptions of mental health problems contrast with the realistic implications of the problems on their behavioral outcomes. scholars have talked about the notion of the social construction of cognition and how one’s perception, while considered their “truth” may in all actuality be juxtaposed with reality (caprara, vecchione, barbaranelli, & alessandri, 2013). in fact, some research has revealed that it may be more common for youth to have “self-serving cognitive distortions” relative to adults that link to antisocial behavior (wallinius, johansson, lardén, dernevik, 2011, p. 288). youth with mental health problems may not be aware of how these problems can impact their criminal behavior, and, conceivably, the self-serving distortions could be playing a role in their reports. another consideration is the role and impact of social desirability on youth offenders that supports a greater tendency to provide socially desirable responses on surveys and risk assessments. specifically, prior research suggests advances in social work, spring 2017, 18(1) 261 that african american males have a greater tendency to provide socially desirable responses, so this could also be a factor with these findings (mccoy, 2011). this finding highlights the necessity to triangulate data sources and examine racial differences in future research. most interestingly, this study pointed to the strong inverse relationship between mental health service delivery and youth’s perceived likelihood for recidivism. this finding suggests that perhaps even if the mental health symptoms are present, mental health screening and service delivery can lead to changes in self-constructed narratives. although mental health screening demonstrated moderate effects, it suggests that this can be a coordinating mechanism to link to service delivery and advance rehabilitative efforts (fazel et al., 2008). the addition of mental health services marginally mitigated the trauma incidents and mental health symptoms, and led to perceived recidivism reduction. the mental health services youth receive can impact the underlying trauma incidents and mental health symptoms, and may be considered helpful towards altering distorted cognitions (dowden & andrews, 1999; lipsey, 1999; lowenkamp et al., 2010). with more research identifying the promise of juvenile justice therapeutic services (lowenkamp et al. 2006; lowenkamp et al., 2010; wallis & poulton, 2001), this study may support the use of both screening and mental health service delivery. implications this study reveals findings regarding the association between mental health screening and service delivery and perceptions of recidivism, indicating the necessity to provide mental health services in juvenile justice settings. further, the high numbers of incarcerated youth who have trauma histories suggests that trauma-informed or trauma-specific services may be warranted. trauma-informed care may be subsumed under current mental health practices but trauma specific interventions may be more effective and contextually appropriate for this population of youth. there have been several calls to develop systems that identify and treat traumatized youth (berliner & kolko, 2016; crosby, 2016; ko et al., 2008). interventions such as trauma-focused cbt have led to improved outcomes for adjudicated teens including reduced depression, ptsd, and recidivism (cohen et al., 2016). there is a great need for juvenile justice systems to comprehensively address trauma. this may include a shift from a punitive to a more rehabilitative philosophy (crosby, 2016). to do this the system must create an organized assessment and intake process that are sensitive to trauma and that avoid re-traumatization, that identify trauma histories through screening, and ensuring that once identified, youth receive appropriate treatment (crosby, 2016; ford et al., 2006). implementing changes may require organizational oversight to ensure quality assurance for practice changes as well as incentives and reinforcement to ensure sustainability of practice changes (berliner & kolko, 2016). because there have been recent changes in the ptsd and other mental health criteria according to the american psychiatric association diagnostic and statistical manual of mental disorders (dsm-v; american psychiatric association, 2013) since this data was collected, juvenile justice personnel can be trained on how to diagnose and screen according to the most up-to-date criteria. yoder et al./perceptions of recidivism 262 ideally, standardization in mental health practices across juvenile justice systems will be developed to prepare youth for re-entry. re-allocation of funds to develop appropriate resources related to mental health screening and service delivery is necessary to prepare youth in multiple domains of life. pursuing educational opportunities and employment can be difficult with unaddressed mental health conditions. looking at outcomes differently and according to youth’s perceptions of success can be the next step in translational research. behavioral change occurs through mental state transformation. this may be the first step in making determinations of “rehabilitation” for release readiness or during transitional service integration. while not a robust measure of recidivism, it can help us determine the mental statuses of our youth in facilities. limitations there are several limitations that this study must address. for one, this is a secondary dataset, and the authors had no role in the study design or data collection process. the survey data was cross-sectional, and the authors cannot guarantee the time-order sequence of the factors under investigation. further research should account for this and be designed to longitudinally and prospectively measure these constructs. the findings from this study do no imply causality; rather, they are reflective of associations and relationships between the variables of interest. the survey items were not representative of validated measurement tools, and statistical methods to ensure the validity of the composites were used. further, mental health screening and service delivery were a somewhat reductive way to measure this complex phenomenon. mental health treatment was used as a proxy for trauma-informed treatment because there was no assessment of trauma-informed models in this study, and there is a need for a more robust measure. additionally, the dichotomous (yes/no) response format failed to account for the frequency of the events being measured; all such instances could change the nature of the outcomes we found. future studies could include additional measures through convergent tools or multiple informants to increase the validity and reliability of the data, thus leading to more nuanced analyses. further, this discussion and literature portions of this paper may be more relevant to a more contemporary sample of juvenile justice involved youth, as a significant limitation of this study is the aged data set. the authors acknowledge little can be done regarding the age of the dataset. also, it can be extremely difficult to collect data on juvenile justice involved youth because of the added complexities surrounding their protections. this study is the only self-report nationally representative sample of incarcerated youth to date that encapsulates measures around trauma and mental healthanother difficult concept to study among this group of youth. lastly, in our attempt to test a basic model by only including race/ethnicity, gender, and age as covariates, we have left out other variables that may also be worth considering, such as perceptions of staff or time in facility. despite these limitations, these study findings provide some clinical implications. the large sample size allowed us to explore a relatively understudied field of research with high practical relevance. advances in social work, spring 2017, 18(1) 263 conclusion this study has yielded findings that support the linkages between trauma and mental health and the use of mental health screening and service 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(2013). ‘we’re civil servants’: the status of trauma-informed care in the community. journal of social services, 40(1), 111-120. doi: http://dx.doi.org/10.1080/01488376.2013.845131 author note: address correspondence to: jamie yoder, phd, school of social work, colorado state university, 127 education, 1586 campus delivery, fort collins, co 80523-1586. jamie.yoder@colostate.edu http://doi.org/10.1001/archpsyc.59.12.1133 https://doi.org/10.3390/ijerph13020228 https://www.hsgac.senate.gov/download/incarceration-of-youth-who-are-waiting-for-community-mental-health-services https://www.hsgac.senate.gov/download/incarceration-of-youth-who-are-waiting-for-community-mental-health-services http://doi.org/10.1177/0093854810396139 https://doi.org/10.1097/00004583-200203000-00011 https://doi.org/10.1126/science.2704995 https://www.ncjrs.gov/pdffiles1/nij/184894.pdf http://dx.doi.org/10.1080/01488376.2013.845131 mailto:jamie.yoder@colostate.edu microsoft word 5. hodge and limb_3607_spiritual histories of lds copyedit_final ______________ david r. hodge, ph.d., is an associate professor in the school of social work at arizona state university in phoenix and senior nonresident fellow at the university of pennsylvania’s program for research on religion and urban civil society. gordon e. limb, ph.d., is an associate professor in the school of social work at brigham young university in provo, ut. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 379-394 spiritual histories and latter-day saints: a mixed-method preliminary validation study david r. hodge gordon e. limb abstract: spirituality plays a primary role in health and wellness for many latter-day saints (lds). despite being one of the largest religious cultures in the nation, few, if any, spiritual assessment tools have been validated with this population. this mixed-method study modifies an existing spiritual assessment approach—spiritual histories—that may be congruent with lds culture. using a national sample of experts in lds culture (n = 100), this study identifies: 1) the degree of cultural consistency, strengths, and limitations of the approach at a conceptual level, and 2) a culturally valid question protocol to operationalize the concept for use with lds clients. the results suggest that spiritual histories represent a highly appropriate assessment method for lds clients. the paper concludes by providing suggestions to administer an assessment in a culturally competent manner in clinical settings. keywords: spirituality, assessment, spiritual history, latter-day saints, mormons mormons, or latter-day saints (lds) as they often prefer to be called, now represent the fourth largest religious denomination in the united states (linder, 2011; melton, 2009). lds can be found in every state in the union, although they are concentrated in the mountain west states and utah in particular (pew research center, 2012). from their origin in the us in the 1820s, the church of jesus christ of latter-day saints has grown to the point that more members now reside outside the us than inside (haynes, 2001). this growth is fueled by comparatively high birth rates and conversions, and is expected to continue. the projected growth of the church suggests that therapists will increasingly encounter lds clients in the future regardless of their state of residency (ulrich, richards, & bergin, 2000). lds comprise a distinct cultural population (cnaan, evans, & curtis, 2012; marks, 2004). as haynes (2001) notes, lds’ spiritual identity serves to frame life experience in much the same way that race or ethnicity often do for other people. this spiritual identity provides a worldview that functions to shape, order, and interpret life experiences. put differently, for lds spirituality is not so much a sunday morning event as it is a distinct way of life, a cultural grid through which reality is experienced (anderson, 2008). this is not to say that lds are the only faith group for which this is true. muslims (hodge, 2002), native americans (hodge, limb, & cross, 2009), hindus (hodge, 2004), and many other spiritual groups (van hook, hugen, & aguilar, 2001) also view reality through a spiritual lens. rather, as is the case for many people of faith, lds religious culture provides a grid through which events are understood and interpreted. hodge, limb/spiritual histories and latter-day saints 380 for example, loser, klein, hill, and dollahite (2008) examined the way in which religion affected day-to-day activities among a sample of lds families. respondents typically reported that religion was strongly integrated into their lives. analysis indicated that religion influenced every ecological system examined: individual, familial, structural, and social. in turn, lds cultural values can play an important role in service provision. thomas, cunningham, and donnell (2011) examined the pattern of symptom reduction among lds and non-lds clients. the results revealed differential efficacy between the two groups, a finding that underscores the importance of considering lds values when providing services to this population. indeed, it is essentially impossible to work effectively with lds clients without understanding the role that spirituality and religion plays in clients’ lived realities (haynes, 2001). as the nasw standards for cultural competence in social work practice (2001) imply, effective service provision is contingent upon understanding the role of clients’ spiritual beliefs and values. a spiritual assessment that explores the role of spirituality and religion in clients’ lives is indispensable if practitioners hope to work effectively with lds clients (canda & furman, 2010; haynes, 2001; loser et al., 2008; marks, 2004). in spite of its importance, little research has been conducted on spiritual assessment from a lds perspective. a search of social services abstracts (5/18/2012) using the keywords “mormon” or “latter-day saint” or “lds” yielded 45 articles, none of which focused on spiritual assessment. this is consistent with research indicating most social workers report receiving little, if any, content on spirituality and religion during their graduate educations (canda & furman, 2010; sheridan, 2009). the lack of culturally relevant spiritual assessment tools is disconcerting. as noted above, lds have unique cultural values that can (marks, 2004), if not taken into account, lead to differential treatment outcomes (thomas et al., 2011). in addition, lds have a history of being oppressed by dominant groups (ulrich et al., 2000). misconceptions and biases among the general population continue to exist as seen in public polling data indicating that the mormon faith is one of the least liked and/or understood religions in the nation (chen, 2011). latter-day saints also report that extensive misinformation exists about their beliefs and values. approximately 62% of lds report that americans are misinformed about mormonism (pew research center, 2012). when asked to describe the most important problems facing lds, 56% report misperceptions about their beliefs, discrimination, lack of acceptance in american society, and similar themes (pew research center, 2012). in light of these data, it is unsurprising that some commentators report that lds clients may be hesitant to trust practitioners due to concerns about lack of cultural competency (ulrich et al., 2000). the need for culturally relevant assessment approaches is accentuated by the fact that spiritual assessments are now mandated in many settings frequented by lds. the joint commission—the largest health care accrediting organization in the united states— advances in social work, fall 2013, 14(2) 381 requires the administration of spiritual assessments in, for example, hospitals, long term care facilities, and behavioral health care organizations providing addiction services (hodge, 2006). since practitioners are required to conduct spiritual assessments with lds clients, it is imperative that assessment tools are developed that are valid, relevant, and consistent with lds culture, especially given the lack of training on spirituality and religion reported by most practitioners (canda & furman, 2010; sheridan, 2009). to provide effective, ethical services to lds clients, it is necessary to explore clients’ spirituality with tools that have been shown to be culturally relevant by members of this population. accordingly, this study modifies an existing spiritual assessment tool for use with lds clients. in the following section, the tool is overviewed and research questions are delineated. spiritual histories one assessment approach that may be congruent with lds culture is the concept of a spiritual history. spiritual histories are among the more widely used approaches to assessment (canda & furman, 2010; furness & gilligan, 2010; pargament, 2007). with this approach, a particular set of questions is used to elicit a client’s spiritual story in a manner analogous to eliciting a family history. for lds clients, spiritual histories are similar in nature to the idea of family histories—an important lds church doctrine (haynes, 2001). table 1 features one approach to operationalizing a spiritual history. this approach consists of two question sets, which are used to help practitioners explore clients’ spiritual stories (hodge, 2001). the narrative question set provides practitioners with some possible questions to help clients relate their spiritual stories, typically moving from childhood to the present. the anthropological question set is designed to elicit spiritual information as clients relate their stories. based upon the work of nee (1968), this anthropological framework posits the existence of three dimensions of personality—affect, behavior, and cognition— and three dimensions of spirit—communion, conscience, and intuition. communion refers to the ability to bond or relate to god (or the transcendent). conscience relates to one’s ability to sense right and wrong. intuition refers to the ability to know—to obtain insights that bypass normal cognitive channels. in each of these six intertwined dimensions, questions are provided to explore clients’ spiritual strengths and values. as clients relate their spiritual narratives (prompted, if needed, by items from the narrative question set), they often touch upon some of the six anthropological dimensions (hodge, 2001). if the area warrants further clinical exploration, practitioners can use items from the anthropological question set to explore clients’ spiritual reality in greater depth. in short, the narrative questions help clients tell their stories while the anthropological questions assist practitioners to draw out clinically salient spiritual information as the stories unfold. hodge, limb/spiritual histories and latter-day saints 382 table 1. spiritual history question sets for general population ____________________________________________________________________________________________________________________________________ 1. narrative question set describe the spiritual/religious tradition in which you grew up. how did your family express its spiritual beliefs? how important was spirituality to your family? extended family? what sort of personal experiences (rituals, ceremonies, or practices) stand out to you during your years at home? what made these experiences noteworthy? how have they informed your later life? how have you changed or matured from those experiences? how would you describe your current spiritual or religious orientation? is spirituality currently a personal strength? if so, how? 2. anthropological question set  personality affect: what aspects of your spiritual or religious life give you pleasure? what role does your spirituality play in handling life’s sorrows? enhancing life’s joys? coping with life’s pain? how does your religion or spirituality give you hope for the future? what do you wish to accomplish in the future? behavior: are there particular spiritual beliefs, ceremonies, or practices that help you deal with life’s obstacles? what is your level of involvement in spiritual communities, such as church, spiritual groups, etc.? how are they supportive? are there spiritually encouraging individuals that you maintain contact with? cognition: what are your current spiritual/religious beliefs? what are they based upon? what beliefs do you find particularly meaningful? what does your faith say about personal trials? how does this belief help you overcome obstacles? how do your beliefs affect your health practices?  spirit communion: describe your relationship with god (or father in heaven, etc.). what has been your experience of god? how does god communicate with you? how have these experiences encouraged you? have there been times of deep spiritual intimacy? how does your relationship help you face life challenges? how would god describe you? conscience: how do you determine right and wrong? what are your key values? how does your spirituality help you deal with wrongdoings or guilt? what role does forgiveness play in your life? intuition: to what extent do you experience intuitive hunches (flashes of creative insight, premonitions, spiritual insights)? have these insights been a strength in your life? if so, how? ____________________________________________________________________________________________________________________________________ adapted from hodge (2003). ____________________________________________________________________________________________________________________________________ as implied above, the purpose of this present study was to modify this assessment tool for use with lds. toward this end, this mixed-method study sought to answer two broad questions regarding the tool and its operationalization. first, as a general concept, how consistent was this particular assessment approach with lds culture and what were its strengths and limitations for working with lds clients? second, in terms of operationalizing the concept, how consistent were the questions featured in table 1 with advances in social work, fall 2013, 14(2) 383 lds culture and how might they be improved or changed to be more valid, relevant and consistent with lds culture? method participants to answer these two questions, the study surveyed a sample of practitioners with extensive practice experience with lds clients. to identify “experts” in lds culture, a hybrid purposive/snowball sampling strategy was used (babbie, 2010). the second author served as the director of the school of social work at brigham young university, an lds university, at the time the study was conducted. this author, who has numerous professional contacts in the lds community through his professional affiliation, contacted a number of potential participants in different geographic regions throughout the united states. the purpose of the present study was explained to these individuals, and they were asked to identify other practitioners with extensive knowledge of lds culture. all correspondence was conducted via email and was personalized in keeping with research suggesting that this practice enhances response rates (heerwegh, vanhove, matthijs, & loosveldt, 2005). using this approach, 125 social work practitioners with at least five years of practice experience with lds clients were identified. of these, 100 participated in the study, resulting in an 80% response rate. participant solicitation continued until the number of practitioners from a given geographical area was roughly proportional to the national lds population residing within the same area, according to data obtained from the church’s official website (www.lds.org). table 2 lists the demographic characteristics of the sample. a majority of respondents resided in the western united states. most of the respondents were lds and white, with a slight preponderance being male. the average respondent was approximately 44 years-old and reported working in the profession for just over 13 years since obtaining their social work degree, suggesting that the participants were well situated to complete the survey. apparatus to develop the mixed-method survey, the authors first modified the questions featured in the original spiritual assessment instrument to eliminate obvious inconsistencies with lds culture. the first author has expertise in different spiritual traditions and, as alluded to above, the second author works in an lds cultural context. only very clear inconsistencies were revised. for example, the original question set used the term “the ultimate” to refer to an entity that holds ultimate sacred or transcendent meaning within a particular spiritual narrative (i.e., “describe your relationship to the ultimate.”). both authors agreed that this terminology is foreign to lds culture, where individuals talk about “god’ rather than “the ultimate.” in addition, rather than having a relationship to god, people have a relationship with god in the lds narrative. thus, the hodge, limb/spiritual histories and latter-day saints 384 question “describe your relationship to the ultimate” was changed to “describe your relationship with god.” table 2. participant characteristics (n = 100) characteristic % m sd region west southwest northwest midwest east 59 10 8 9 14 religion lds other 98 2 race white other 89 11 gender male female 55 45 social work degree yes 100 yrs. in profession 13.27 7.69 age 43.76 9.92 this initial survey was then pilot tested with six lds faculty at brigham young university. these individuals were asked to assess the survey’s content and design for clarity and face validity. minor changes were made based on the provided feedback. for example, individuals noted that a widely used synonym for god in lds culture is “father in heaven” or “heavenly father.” thus, the survey was revised to include the phrase “father in heaven” in brackets after god at one point in the instrument to clarify to potential respondents that practitioners operationalizing the assessment had the freedom to use such terms [i.e., “describe your relationship with god (or father in heaven, etc.)”]. in keeping with the two research questions, the final survey included 1) a general conceptual overview of the spiritual history instrument discussed above and 2) the questions designed to operationalize the concept featured in table 1. after being presented with an overview of the general concept, participants were asked to assess the consistency of the concept with lds culture on an 11-point scale in which 0 corresponded to the complete absence of consistency with lds culture, while 10 corresponded to complete consistency with lds culture (hodge & gillespie, 2007). advances in social work, fall 2013, 14(2) 385 two open-ended questions were used to identify the strengths and limitations of the concept in work with lds clients. the question concerning strengths asked, “in terms of working with lds clients, what are the strengths of spiritual histories?” this was followed by a similar item using the term “limitations” instead of “strengths.” as implied above, the survey also included the question sets listed in table 1 for the narrative framework: affect, behavior, cognition, communion, conscience, and intuition. each of the seven question sets was followed by two questions. a quantitative item was used to assess the overall consistency of the question set with lds culture using the 11point scale discussed above. this question was followed by a qualitative item designed to identify ways in which the questions could be modified to be more congruent with lds culture. more specifically, the item asked, “how could these questions be improved to be more valid, relevant, and consistent with lds clients?” procedures the survey instrument was placed online and the url link was emailed to practitioners who agreed to participate in the study. individuals were concurrently informed that a paper copy of the survey was available, although no one requested this option. this result is consistent with research indicating that educated professionals prefer web surveys over mail surveys (barrios, villarroya, borrego, & olle, 2011). although studies suggest the data obtained is generally similar for both formats, some research indicates that web surveys may yield somewhat higher quality data in answer to qualitative questions (barrios et al., 2011; shin, johnson, & rao, 2012). participants received a $50 honorarium for their time spent in completing the survey. data analysis after cleaning the quantitative data, tests of associations were conducted between the dependant variables and the demographic variables reported in table 2 when statistical assumptions were met. for the qualitative data, a constant comparative methodology was used (corbin & strauss, 2008). in this approach, data are examined for similarities, patterns, and common themes (dye, schatz, rosenberg, & coleman, 2000). in a recursive process, the emerging themes are continually compared to similar phenomena across survey instruments. primary themes were identified, organized, and labeled. direct quotes are used to illustrate the themes. as a final supplementary step, the data were synthesized to develop an alternative question protocol to operationalize spiritual histories with lds clients in a more culturally valid manner. results the results are presented in two subsections that reflect the study’s two research questions. the first subsection reports the findings on the cultural consistency, strengths, and limitations of spiritual histories at a conceptual level. the second subsection reports on the operationalization of the concept, specifically the cultural consistency of the various question sets and how they might be improved. this sub-section concludes with an alternative spiritual history protocol, based upon respondents’ suggestions. hodge, limb/spiritual histories and latter-day saints 386 general concept: consistency, strengths, and limitations as a group, respondents reported the concept of conducting a spiritual history was generally consistent with lds culture, as indicated by the mean of score of 8.06 on the 0 to 10 scale (see table 3). the mode was 10, indicating a plurality of respondents believed the concept was completely consistent with lds culture. these perceptions were stable across the demographic characteristics. region of residence, gender, years of professional experience, and age were all unrelated to perceptions of cultural consistency. table 3. perceptions of consistency with lds culture (n = 100) area m sd spiritual histories as a general concept 8.06 1.68 narrative question set 8.48 1.45 anthropological question set affect 8.70 1.47 behavior 8.39 1.61 cognition 8.94 1.30 communion 8.71 1.53 conscience 9.03 1.15 intuition 8.15 1.62 the qualitative question regarding strengths helped illuminate the relatively high cultural consistency score. analysis indicated that the most prominent asset of the concept is its narrative format. as various respondents stated, “it allows clients to tell their story and be validated in the story telling,” and “allows clients to tell their stories in their own words.” others noted that sharing one’s spiritual story or testimony is a common practice in lds culture and, correspondingly, the approach should resonate with lds clients. additional themes included the approach’s ability to provide: insights into important beliefs and practices; information about coping strategies and resources, and points of spiritual tension; opportunities to build rapport with clients; and the therapeutic benefit of being able to relate one’s story in a supportive context. the question regarding limitations served to qualify these strengths. the three most widely mentioned concerns were intertwined and centered upon: a) the sensitive nature of lds spirituality, b) practitioners’ lack of cultural competency, and c) the use of terminology that is inconsistent with lds culture. as respondents noted, many dimensions of lds spirituality are highly sacred and/or personal in nature. consequently, clients may be hesitant to share their spirituality with non-lds practitioners for fear of being misunderstood, labeled irrational, or otherwise disparaged. other, less prominent limitations cited include: the unreliable nature of memories, the time required to conduct a complete assessment, the potential to elicit too much detail, and the approach’s relatively poor fit with clients who are less verbally or spiritually oriented. advances in social work, fall 2013, 14(2) 387 operationalization: consistency and improvements as can be seen in table 3, the means for the narrative framework and the six dimensions of the anthropological framework indicated a relatively high level of consistency with lds culture. as was the case above, perceptions were stable across the demographic variables. the mode was 10 for each question, with two exceptions (9 for both the narrative framework and the intuition dimension). reflecting the high mode values, many respondents endorsed the present operationalization (e.g., “these are great questions”), which was a theme that emerged for all the subsequent questions. accordingly, only unique themes are reported below to conserve space. narrative framework—analysis revealed three themes: eliminate language that is inconsistent with lds culture, use less intellectual terminology, and less frequently, talk about religion rather than spirituality. regarding the first theme, many respondents noted terms such as “rituals, ceremonies, or practices” are not common in lds culture and can even have negative connotations with some clients. accordingly, respondents recommended terms that have specific meaning within the lds tradition (e.g., “family home evenings,” “baptisms,” “blessings,” “missions,”). respondents also recommended replacing more intellectually oriented language (e.g., “informed,” “orientation,” & “matured”) with direct, clear terminology that reflects typical lds practice. for instance, it was noted that lds frequently talk about levels of activity in church functions. others suggested that talking about religion, rather than spirituality, would be more commonplace in lds culture. affect—two prominent themes emerged from the analysis. first was the use of “pleasure.” many respondents noted that the term “pleasure” is inconsistent with lds values. as one person observed, “it often has negative connotations.” in its place, respondents recommended using terms such as “joy,” “meaning,” “purpose,” “endure,” “happiness,” and “comfort.” another theme concerned the need to create space for negative emotions. for example, one respondent noted that some clients may wrestle with guilt if they do not successfully live up to the teachings of the church. behavior—analysis yielded three themes. respondents noted that many of the questions were too vague and lacked resonance with lds culture. for example, one respondent noted that “spiritual groups is not a common lds term.” in a closely related theme, respondents recommended using familiar lds terms to set clients at ease. for example, instead of “ceremonies,” terms such “ordinances,” “temple worship,” and “prayer” were suggested; instead of “spiritual communities,” respondents suggested using “ward,” “branches,” and “stakes”; instead of “spiritually encouraging individuals,” using “religious leaders” or more specifically “bishop,” “stake president,” or “relief society president.” a less frequently mentioned theme was the sensitive nature of some lds practices. as one respondent noted, some practices are sacred and should not be discussed with non-lds members. cognition—analysis produced two themes. first, respondents noted that the question about health practices intersected with a specific lds teaching called the “word of wisdom” (i.e., abstinence from tobacco, coffee, tea, and harmful drugs). some recommended eliminating this question or asking a more direct question if the hodge, limb/spiritual histories and latter-day saints 388 practitioner was interested in clients’ health (e.g., “how do your beliefs affect your … physical health?”). another theme that emerged was the broad nature of the first question—what are your current spiritual/religious beliefs? to keep the session focused in light of the expansive nature of lds teaching, respondents recommended asking a more focused question. communion—analysis yielded four themes. respondents noted the personal nature of this content area and raised questions about the willingness of clients to answer the questions for fear of being judged. another theme that emerged was the centrality of the concept of one’s relationship with god or heavenly father in lds culture. in keeping with this value, respondents recommended phrasing questions in a way to explore this relationship. thus, a related theme was the importance of exploring times of both closeness and distance in clients’ relationship with god. finally, a number of respondents indicated that the concept of “spiritual intimacy” was inconsistent with lds culture and recommended asking about one’s connection or closeness to god or heavenly father. conscience—four comparatively minor themes emerged regarding this question set. first, it was noted that repentance and forgiveness are generally linked concepts in lds culture. second, mentioning the term “sin” might help in normalizing this teaching for clients. third, it was mentioned that some lds clients may struggle with shame, guilt, and perfectionism; hence it is important to be sensitive to these issues during the assessment process. finally, it was observed that the concept of values might not resonate with some lds clients. intuition—analysis yielded one prominent theme. the language used to express the underlying concept was widely thought to be inconsistent with lds culture. as a result, respondents recommended expressing the underlying ideas using terms such as “promptings from the holy ghost,” “personal revelation,” and to a lesser extent, “spiritual insights,” and “dreams.” respondents suggested many helpful questions in the processing of answering the above qualitative items. table 4 represents an attempt to synthesize many of the recommendations. it is important to note that this question set represents one of many that could have been constructed. the questions used to explore clients’ spiritual stories should be adapted to correspond to each individual client’s reality. the question set presented in table 4, however, may serve as a useful starting point in work with many lds clients. advances in social work, fall 2013, 14(2) 389 table 4. alternative spiritual history question sets for lds clients ____________________________________________________________________________________________________________________________________ 1. narrative question set was your family part of a religious group? what religious practices did your family do together? how involved was your family? how did you feel about your level of involvement? what sort of religious experiences (family home evenings, baptisms, blessings, temple, missions) stand out to you during your childhood and teenage years? how have these religious experiences influenced your later life? did you embrace them as your own? why or why not? do your current religious beliefs and practices differ from those in which you were raised? if so, how have they changed? was there a time when your religious beliefs helped you through a particularly difficult time in life? at present, what religious beliefs are most important to you? 2. anthropological question set  personality affect: what aspects of your religious life give you joy? what role does your faith play in handling adversity? coping with life’s challenges (fears)? are there aspects of church involvement that are difficult for you? or cause you guilt? how do you feel about your church leaders? how does your religion give you hope for the future? what religious goals do you hope to accomplish in the future? behavior: are there particular religious practices, which you would be comfortable sharing with me, that help you deal with challenges (e.g., prayer, temple attendance, scripture reading, family home evening, or other religious practices or ordinances)? how active are you in your ward or branch? how does this compare to your past level of involvement? are there individuals in your ward or branch (e.g., bishop, home or visiting teacher, relief society president) that are especially supportive? in what ways are they supportive? cognition: what religious beliefs are most important to you? what beliefs do you find particularly meaningful? what does your religion teach about personal trials? does this belief help you overcome problems and difficulties? if so, how?  spirit communion: describe your relationship with god or heavenly father. what has been your experience with heavenly father? how have these experiences influenced you? when have you felt especially close (distant) to heavenly father? describe the last time you felt angry with or disappointed by heavenly father. how does your relationship with heavenly father help you face challenges? how would you describe your father in heaven? (his characteristics?) how would heavenly father describe you? (your strengths? limitations? personality?) conscience: how do you determine right and wrong? can you describe a time when you followed (did not follow) what you felt was right? to what extent are your behaviors consistent with your religious beliefs? do you ever struggle to know the difference between right and wrong? how did you resolve the confusion? how do you feel when you have done something wrong or sinful? what have you learned from such experiences? how does your religion help you deal with guilt? (shame? sin?) to what extent has the church (your relationship with heavenly father) helped (hindered) your ability to forgive yourself (others?) intuition: to what extent have you had experiences where you felt heavenly father revealed things to you? are there times when you are more (less) sensitive to receiving personal revelation? how do you distinguish between your own thoughts and the promptings from the holy ghost? to what degree have these spiritual insights influenced your life (the lives of others?) have these insights been a strength in your life? if so, how? ________________________________________________________________________________________ hodge, limb/spiritual histories and latter-day saints 390 discussion lds clients report the administration of a spiritual assessment is among the most effective interventions practitioners can employ in clinical settings (martinez, smith, & barlow, 2007). yet few, if any, assessment methods have been validated for use with this population. the present study addressed this gap in the literature by modifying an existing spiritual history assessment tool for use with lds clients. the results suggest that spiritual histories represent a highly appropriate assessment method for lds clients. at the conceptual level, respondents reported that this approach is congruent with lds culture. the notion of telling one’s spiritual story or religious testimony was perceived to be one that would resonate with most clients from this tradition. concurrently, considerable apprehension also emerged in this study. as noted in the introduction, the lds population is very sensitive to biases regarding their beliefs and values in the broader society (pew research center, 2012). similar views were expressed in the present study. respondents emphasized the importance of using culturally relevant language, the sensitive nature of lds spirituality, and client concern about being misunderstood or disparaged by practitioners unfamiliar with the culture. the findings underscore the importance of developing cultural competency prior to engaging clients (haynes, 2001). effective service provision is contingent upon developing a certain level of cultural competence with clients’ spiritual beliefs and values (nasw standards for cultural competence in social work practice, 2001). this is particularly important in light of the repeated finding that most practitioners report receiving minimal training on spirituality and religion during their graduate educations (canda & furman, 2010; sheridan, 2009), in tandem with the growing emphasis on addressing spirituality by accrediting organizations such as the joint commission (hodge, 2006). to enhance their level of competency, practitioners might obtain specific resources that have been written with this aim in mind (haynes, 2001; ulrich et al., 2000). forming relationships with lds clergy, known as bishops, can often be helpful. for example, such religious experts are well positioned to assist in the process of distinguishing between symptoms of psychopathology and authentic expressions of faith. practitioners may also consider establishing relationships with other colleagues who have more experience working with lds clients. such individuals can provide valuable therapeutic insights as well as offer options for referral (reamer, 2006). when administering assessments with lds clients, it is critical to develop an atmosphere of trust and respect (canda & furman, 2010). toward this end, it is helpful to approach the assessment process with an attitude characterized by openness, humility, and a desire to learn from clients. to create a proper context for the assessment, one might begin by acknowledging that religious beliefs and practices are often highly personal and sensitive, explain the purpose for administering the assessment, ask for permission to proceed, and request forgiveness in advance for asking any questions that might inadvertently be offensive (hodge & limb, 2009). as one respondent suggested, advances in social work, fall 2013, 14(2) 391 one might conclude by asking “are there spiritual taboos you would like me to be sensitive to?” (e.g., discussion of specifics relating to temple attendance). it is important to reiterate that the question sets featured in table 4 represent a working, rather than a definitive, assessment framework. the questions should be adapted to reflect each individual client’s beliefs and values. while common lds beliefs and practices should be legitimized, language that resonates with the client’s worldview should be incorporated into the therapeutic dialogue. caution is warranted when using items from the anthropological question set, which can elicit a considerable amount of information. it is important to ensure that the dialogue remains focused on exploring data that is therapeutically relevant. the goal of the assessment should always remain on enhancing the client’s wellness. limiting the scope of the assessment in this manner also helps to safeguard sensitive dimensions of lds spirituality. in some cases, it may seem as if clients’ beliefs and practices may be contributing to the presenting problem. social workers, however, must respect clients’ autonomy, including their right to self-determination in religious matters (nasw code of ethics, 2008). as the nasw standards for cultural competence in social work practice (2001) stipulates, social workers do not have to agree with clients’ values in order to provide effective, culturally relevant services. as alluded to above, practitioners should exercise discernment and focus upon those dimensions of clients’ spirituality that ameliorate the presenting problem (garner, 2012; hill & pargament, 2003). the results must be interpreted in light of the study’s limitations. the use of a nonprobability sampling methodology precludes generalizing the results. although the regional representation helps to safeguard against any extant geographic bias, using a different sample of experts may produce a different set of findings. the use of a hybrid purposive/snowball sampling strategy, however, is an appropriate choice in light of the difficulty of obtaining a random sample of individuals with specialized knowledge of lds culture (babbie, 2010). conclusion spirituality plays a central role in lds culture (loser et al., 2008). in therapeutic settings, addressing spiritual beliefs and practices can play an instrumental role in enhancing outcomes among this population (martinez et al., 2007; thomas et al., 2011). yet, few spiritual assessment approaches have been validated for use with this group, despite the profession’s commitment to culturally competent practice (nasw standards for cultural competence in social work practice, 2001). to assist practitioners address spirituality in a culturally competent manner, this study validated one spiritual assessment tool—spiritual histories—for use with lds clients. given the growth in this culturally distinct population, this study fills a significant gap in the literature. by providing practitioners with a validated tool for conducting culturally relevant assessments with lds clients, practitioners are better equipped to hodge, limb/spiritual histories and latter-day saints 392 utilize a strengths perspective and fulfill their mission of providing ethical and effective services. references anderson, s. v. (2008). rhetorical footing in latter-day saints counseling. journal of religion & spirituality in social work, 27(2), 323-339. babbie, e. (2010). the practice of social research (12th ed.). belmont, ca: wadsworth. barrios, m., villarroya, a., borrego, a., & olle, c. (2011). response rates and data quality in web and mail surveys administered to phd holders. social science computer review, 29(2), 208-220. canda, e. r., & furman, l. d. (2010). spiritual diversity in social work practice: the heart of helping (2nd ed.). new york, ny: oxford university press. chen, c. h. (2011). marketing religion online: the lds church's seo efforts. journal of media and religion, 10, 185-205. cnaan, r., evans, v., & curtis, d. w. (2012). called to serve: the prosocial behavior of active latter-day saints. philadelphia, pa: university of pennsylvania, school of social policy & practice. corbin, j., & strauss, a. 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(2012). mormons in america: certain in their beliefs, uncertain of their place in society. washington, dc: pew research center's forum on religion & public life. reamer, f. g. (2006). social work values and ethics (3rd ed.). new york, ny: columbia university press. sheridan, m. (2009). ethical issues in the use of spiritually based interventions in social work practice: what we are doing and why. journal of religion and spirituality in social work, 28(1/2), 99-126. shin, e., johnson, t. p., & rao, k. (2012). survey mode effects on data quality: comparison of web and mail modes in a us national panel survey. social science computer review, 30(2), 212-228. thomas, a., cunningham, k., & donnell, a. j. (2011). differential efficacy of standard inpatient treatment between mormon and non-mormon patients. mental health, religion & culture, 14(9), 935-943. ulrich, w. l., richards, p. s., & bergin, a. e. (2000). psychotherapy with latter-day saints. in p. s. richards & a. e. bergin (eds.), handbook of psychotherapy and religious diversity (pp. 185-209). washington, dc: american psychological association. van hook, m., hugen, b., & aguilar, m. a. (eds.). (2001). spirituality within religious traditions in social work practice. pacific grove, ca: brooks/cole. author note: address correspondence to david r. hodge, ph.d., school of social work, mail code 3920, 411 n. central, suite 800, phoenix, arizona, 85004-0689. microsoft word sheafor_bsw education_copyedit final   ______________  bradford w. sheafor, ph.d., is a professor emeritus of social work at colorado state university in fort collins, co. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 196-206   the professionalization of baccalaureate-level social work bradford w. sheafor abstract: we are occasionally privileged to observe an important event in the history of some aspect of life, but one is rarely an eyewitness to the birth of a profession – or even a specific division of a profession. nevertheless, along with others, i had the privilege of participating in a series of events over several years that, with hindsight, i realize made me a witness to the birth of baccalaureate social work. this article reflects the perspective of one person engaged in these events and may differ from the observations of other participants. yet, it represents my best recollection of events that began nearly fifty years ago. keywords: social work education, baccalaureate social work, association of bacca laureate social work program directors, social work as a profession the emergence of a profession: social work professions emerge over time and efforts to pin down the date an occupation became a profession depends on the pace of the development of the occupation and the definition one uses to determine professional status. for example, in my view the national association of social workers (nasw) jumped the gun in 1998 when, based on the date of the initiation of the first training program at the new york school of philanthropy, nasw celebrated the 100th birthday of social work. in reality, in 1898 we were far from being a profession. the title, social work, was not coined by jeffery brackett (sheafor & horejsi, 2012, p. 3) until the early 1900s and it was not until 1915 that abraham flexner constructed generally accepted criteria for concluding that an occupation has indeed become a profession (flexner, 1916). at that time flexner concluded that social work did not meet the expectations for being recognized as a profession. i would argue that somewhere in the 1930s would be the first time a defensible argument could be made for having achieved professional status. by that time social work had in place an accreditation process (at the msw level), required that academic preparation for social workers must be in institutions of higher education, and had created a stable national membership organization (the american association of social workers, a predecessor the national association of social workers). then, like a cell dividing into separate but related structures, social work moved in the 1960s and 1970s to carve out a place for a professionally prepared baccalaureate social worker. personal background: establishing my vantage point in the late 1950s i stumbled into social work thanks to opportunities derived from leadership roles i played in a few human service-related organizations while in high school and college – and the influence of several mentors who were social workers. sheafor/professionalization of baccalaureate-level social work 197 these events shaped my recognition of the need for baccalaureate-level social work education and my appreciation of the “generalist” model of social work. as an undergraduate student making the decision to enter social work, i looked at what courses i would need in order to complete a social work major. at that time undergraduate programs were restricted from offering much substance – and certainly not practice courses and sound field experiences. further, there was not recognition of the degree in the human services employment market or upon entering a master’s program. i decided to complete my default major (business administration) and apply to the msw degree program at the university of kansas. i wonder how many undergraduates were similarly diverted from social work and then never returned. initially being most interested in community and organizational levels of practice, i was out-of-step with the dominant casework/psychiatric social work orientation of that era, but was forced into a “casework” curriculum with only introduction to group work, administration, and community organization. fortunately, my macro interests were supported by a few faculty members and through independent study courses and i was able to gain some depth in community practice. the combination of direct and indirect practice prepared me to embrace the generalist model later in my career. upon completion of my msw in 1961, i fell into a job for which i was only marginally prepared: executive director of a community health and welfare planning council in topeka, kansas, my hometown, with an impressive $450 per month salary. thus began my career as a professional social worker. we had some surprising successes in the community planning council and three years later the head of the school of social welfare at the university of kansas offered me a two-year lectureship to create a bachelor’s-level social work program – one that would have substance and meet the emerging national standards. i hadn’t even considered becoming an educator, but with no application needed, no interview to suffer through (who had even heard of affirmative action?), and a nine-month salary that exceed my twelve-month salary with the planning council, i jumped at the job. it was from this background that i had the rare opportunity to observe and participate in the development of a new level of the social work profession. first steps in bsw emergence the war on poverty in an effort to implement the war on poverty programs in the mid-1960s, the u.s. department of health, education, and welfare (hew) recognized that the msw programs would be unable to graduate enough social workers to meet the expected demand and, further, a large percentage of the psychiatric social workers they graduated were not interested in staffing the poverty programs. yet, hew insisted that persons with preparation in applying knowledge and skills in the delivery of human services were needed to serve this vulnerable population – more than was found in the preparation of psychology or sociology undergraduate majors. therefore, hew created incentives for universities and colleges to create undergraduate social work education programs, but also realized that there must be recognition of that degree in the employment market if advances in social work, spring 2014, 15(1) 198 the effort was to succeed. thus nasw was prevailed upon to designate graduates from bachelors-level social work education programs as first-level professional social workers. immediate opposition was expressed by many masters-level programs that had previously flat-out rejected herb bisno’s insightful volume on a blueprint for the future of baccalaureate social work education, volume 2 in the council on social work education’s (cswe) multi-volume curriculum study chaired by werner boehm (bisno, 1959). the nasw referendum in 1969 nasw put forth the referendum to recognize as professional the graduates of accredited baccalaureate programs (bsws). in addition to having responsibility for building the bsw program at the university of kansas (my position magically turned into a tenure-track position), i served as chair of the topeka (kansas) nasw chapter and president of the kansas council of nasw chapters. thus i was deeply embroiled in the controversy surrounding this contentious resolution. as i recall, five major themes dominated the discussion. theme #1: the demand for practitioners with basic social work knowledge and skill exceeds the supply of msw social workers and if social work fails to change, another discipline will take this over as a baccalaureate-level specialty> versus <social work has worked 50 years to achieve professional recognition and now approving a lower educational level as professional is a step backward. theme #2: many social work activities do not require the depth of msw preparation> versus <professionalizing the bsw with lesser knowledge and skill than the msw will diminish the reputation of the profession and reduce the ability of msws to function as peers with other helping professions. theme #3: bsw programs will attract qualified traditional and non-traditional age students who otherwise will drift into other disciplines> versus <the immaturity of undergraduate students will prevent them from understanding the complexity of social problems and reduce respect for the social work profession. theme #4: by creating social work jobs addressing client needs requiring only bachelor’s-level preparation the agencies can be more efficient and stretch limited resources to serve more clients> versus <agencies will substitute bsws for msws because they command less salary and the distinction between the two levels will disappear. theme #5: beyond obtaining a general education, it doesn’t make sense for undergraduate students intending to become social workers to fill credit hour requirements with courses from other disciplines> versus <content will be commandeered from the msw level and there will be problems in distinguishing between the levels – and even with master’s sheafor/professionalization of baccalaureate-level social work 199 programs completely redesigning their curricula there will inevitably be overlap. to the surprise of many (including me), the referendum passed and the task of operationalizing this new professional level required the formulation of standards for the education of undergraduate students that would lead to accreditation of the programs that demonstrate inclusion of necessary content and provide high quality instruction. cswe develops a curriculum policy statement and accreditation standards responsibility fell to the council on social work education (cswe) to generate a set of accreditation standards, coupled with a curriculum policy statement that recognized the two levels of social work practice. during this time i had the opportunity to serve on cswe’s educational planning commission where an effort was made to identify content that would be purely bsw (there was not much), content that would overlap the two programs (about the equivalent of a year of msw education), and specialized content that belonged at the master’s level only. in regard to accreditation, the first step was a set of “approval” standards that did not yet meet the more substantive requirements necessary for recognition as “accreditation” by the interdisciplinary body granting accreditation authority for the professions, then the council on post-secondary accreditation (copa). the approval standards largely addressed structural requirements for such things as financial support from the schools, having social work faculty members prepared to teach social work content (the sociologists and psychologists thought they could teach this material just as well), and some degree of control over curriculum. application of these standards reduced the number of baccalaureate social work education programs previously “listed” by cswe from 207 to 158 “approved” programs in 1974 (cswe, 1973, 1974). full accreditation standards, to be implemented in 1974, were approved by cswe with the expectation that each school would develop its own generalist/specialist concept and build a curriculum to match. beginning in 1975 i served on cswe’s commission on accreditation and saw first-hand the frustration the inexperienced bsw program directors faced in being expected to define generalist and build a defensible curriculum. by the time the cycle was complete, the 158 “approved” schools had declined to 135 “accredited” programs (cswe statistics, 1976). facing the realities of a new practice level the unrest about professionalizing the baccalaureate level of social work was evident in both social work practice and education. for example, the bsw graduates didn’t find job descriptions that recognized the degree as a valid job credential. in fact, many agencies were not aware that degree even existed and if they did, they did not appear to appreciate the advantages a social worker with such preparation would bring to a job. nasw seemed paralyzed by the opposition to professionalizing the bsw graduate and did little to promote this new practice level. in return, few bachelor’s level social workers joined nasw. further, the war on poverty had ended (with little success) and hew leadership changed, leaving few champions for baccalaureate-level social workers in high advances in social work, spring 2014, 15(1) 200 places. even in federally mandated programs the bsw was not treated as a valued job credential. in social work education, too, there was foot-dragging, if not outright hostility about operationalizing the bsw level of education. as a member of the accreditation commission it was evident to me that msw programs received far less scrutiny than bsw programs. in a behind-the-scenes move a few of us who were primarily identified with the bsw level joined a few msw-identified commissioners in an agreement to apply equal rigor in reviewing both levels. my impression was that indeed this strategy worked and the quality of accreditation review improved at both levels. other examples of inequality in the education realm were that the budget, allocation of staff time, focus of journal articles, and lobbying efforts supported by cswe gave little attention to the bsw level. it was evident that the deans of graduate schools of social work called the shots and their leadership was not favorable to the new practice level, although a number of schools had both bsw and msw programs. in an attempt to counter the deans’ dominant role in social work education, a few of us primarily identified with bsw education concluded that we must form our own organization if this practice level was to be represented and heard when critical decisions were being made. thus a set of bylaws for the baccalaureate program directors association (bpd) was drafted and presented to the baccalaureate program director’s constituency group during the cswe annual program meeting in chicago in 1975. to this day i can picture the large stainless steel refrigerators and counters in the kitchen of the conference hotel--the only affordable (i.e., free) meeting place available to this group that had no resources. i vividly remember trueheart titzl (1st president of bpd), kay dea (2nd president of bpd), betty baer, ron federico, millie charles, will scott, and many others leaning against the stainless steel kitchen equipment as we discussed and voted approval of the first bpd bylaws. a baccalaureate-level membership organization now existed, although it was entirely made up of educators and did not meaningfully engage bsw practitioners. engaging the constituency in 1979 bpd determined that it could further strengthen baccalaureate social work education programs and build commitment to bachelor’s level social work by organizing a national conference where people could interact on a face-to-face basis without the distraction of tagging on to a cswe conference. ann mclean and i agreed to co-chair a conference focused on “competency-based education.” held at a mountain resort near estes park, colorado (i had become baccalaureate program director at nearby colorado state university by that time), 52 program directors from all parts of the u.s. attended the three-day event. off-season rates at aspen lodge were very reasonable; faculty from three programs using a competency-based approach presented papers; the colorado state university media center made a videotape of the presenters being interviewed by other participants, as well as videotaping interviews with representatives from four important pre-bsw projects; scenes from a play, “jacques brel is alive and well,” were reheated from on-campus performances by my university’s theatre department; and an entertainment night brought out music, dance, and other artistic talents of the participants. we even made a little money off donations for soft drinks, beer, and wine that went to the sheafor/professionalization of baccalaureate-level social work 201 paltry bpd treasury. i like to think that the goodwill and free sharing of ideas at this conference set the positive, non-competitive tone that has characterized subsequent bpd conferences and, later, the bpd listserv (i.e., the baccalaureate social work education list). another example of unequal treatment for bsw programs was evident in an annual workshop concerned with leading a school of social work and understanding accreditation requirements sponsored by cswe for deans, but not baccalaureate program directors. pressure was applied and cswe agreed to organize such a workshop for undergraduate programs in 1983. cswe asked dr. titzl to manage local arrangements (which resulted in staying at the infamous convent in nazareth, kentucky) and i was asked to lead the program on chairing an academic department. cswe staff addressed understanding the bsw accreditation requirements. this conference attracted 53 participants. the next year cswe again invited me to lead a similar workshop with a slightly broader program addressing other issues experienced by bsw programs. we upgraded only slightly from the convent to dormitories on the colorado state university campus as accommodations for the 77 participants. a party in my backyard generated an informal friendly atmosphere that is often remarked on by the few participants still involved in social work education. in subsequent years cswe faced serious financial problems and in order to reduce expenditures and reallocate staff time, the sponsorship of these annual meetings was shifted to bpd. through the leadership of barbara shank (now chair of the cswe board of directors), these meetings began to attract high attendance and became money-making events for bpd – funds that sustained the organization in its early years. the drive to professionalize the baccalaureate level of social work by 1957 ernest greenwood (a social worker/sociologist) concluded that social work was now a profession based on five criteria he had synthesized from the sociology of professions (greenwood, 1957). these criteria were 1) a systematic body of knowledge to underpin the work, 2) authority to determine who is a recognized professional and what the educational preparation should be, 3) sanction from the community to do this work, 4) a code of ethics, and 5) a professional culture where members had a sense of identification with the profession. three of greenwood’s criteria were not contentious when the effort to build a professional baccalaureate level of social work was undertaken. one was criterion #2, as it was clear that nasw had the authority to determine who were the members of the profession and had already voted to include the baccalaureate level social worker. further, cswe had the authority to establish any educational requirements. also, criterion #4, the profession’s code of ethics was applied equally to all members of the profession and was not an issue for differentiating the practice levels. finally, the creation of bpd satisfied criterion #5 by creating a membership organization representing this level of social work. although i don’t think any of us saw the challenges so clearly at the time, the work that needed to be promoted by bpd was to identify the knowledge needed for this level of practice and to help build high quality social work education programs to deliver that knowledge (criterion #1), and to gain sanction from our practice communities (criterion #3). advances in social work, spring 2014, 15(1) 202 defining appropriate bsw content and competencies a major effort to further flesh-out the content of bsw-level work was known as the “west virginia project,” a hew funded effort located at west virginia university and led by betty baer and ron federico. i was privileged to be a participant in that rigorous examination of previous efforts to spell out legitimate “less than master’s level” human services positions and then cull out the content appropriate for social work. the project interfaced with the fledgling bpd organization which helped build political support for the results. the first phase of the west virginia project focused on content with a sample curriculum model developed that helped program directors gain a perception of what might go into curriculum at this practice level. this model relieved some of the pressure on the schools. the second phase addressed knowledge baccalaureate program directors would need to be savvy enough to build strong programs within their universities and develop the classroom and field instructor skills needed to transmit this content students (baer & federico, 1978, 1979). for example, my chapter was titled “the social work program: its place in higher education.” nevertheless, the major sticking point in the implementation of education at the baccalaureate level continued to be identifying the components of generalist practice. leslie leighninger helpfully framed the debate (leighninger, 1980, 1984), but agreement about the content a school should build into its curriculum did not exist. perhaps a love/hate relationship inherently exists between schools wanting to become accredited and the accrediting bodies. in this case the schools knew that rigorous standards were necessary for accreditation to be considered viable, but how the requirements should be operationalized was at issue. some schools wanted clear definitive instructions regarding what content and what courses should be required, while others wanted only general guidelines with room to adapt curriculum to regional practice variations. the latter view was adopted and cswe’s commission on accreditation became the arbitrator as it made judgments about each school’s concept of generalist, its ability to distinguish generalist from specialist content, and its infusion into a curriculum. gradually some common elements in generalist (sometimes called generic) social work practice began to shake out. in 1983, anne minahan (editor-in-chief for a new edition of the encyclopedia of social work) asked me to write an item for the encyclopedia on “the generalist perspective.” my colleague at colorado state university, pamela landon, joined me in this effort and we scoured the developing literature on the topic with our summary of the state of the art at that time appearing in the new edition (sheafor & landon, 1985). in that summary was evidence that there were varying perspectives on generalist and that there was a need to identify where there was consensus and where there were wide variations. two other colleagues at colorado state university, mona schatz and lowell jenkins, were interested in helping to pin-down a generally accepted conception of generalist social work and i joined them in conducting a very elaborate delphi study involving three rounds of critique and clarification of the concepts that emerged from nearly 50 social work educators. through this effort we were able to filter out some elements of social work that are generic/foundation material for all social workers, the central components of a generalist perspective and the initial sheafor/professionalization of baccalaureate-level social work 203 competencies needed at the first practice level, and then (somewhat vaguely) the additional competencies needed for practice as an advanced generalist social worker (schatz, jenkins, & sheafor, 1990). i may be overstating the impact of this research, but i think that perhaps as much as anything it provided a sufficient summary of areas of agreement regarding a conception of generalist that the topic dropped down on the list of problems the bsw programs experienced. another problem rested in how to avoid unnecessarily redundant content for bsw graduates who matriculated to msw programs. were they to pay tuition just to repeat the content from their baccalaureate program? should schools be required to avoid redundancy and waive part of the msw requirement? if so, how much? one year? one term? should schools require students to test-out of each course? i had nothing to do with this decision, but cswe concluded that schools should be allowed to implement some form of wavier, called “advanced standing,” to address this problem. only about one-half of the msw programs initially implemented advanced standing and this became one more point of contention between the leadership of the council of deans (now the national association of deans and directors) and the council on social work education. as president of cswe in the mid-1980s (the two most trying years of my career), it was clear that advanced standing added to the accumulation of issues and motivated the council of deans to encourage its members to withhold their annual dues to cswe in protest – if not in an effort (as some conspiracy theorists contended) to bankrupt the organization so that a new accrediting body (sans a bsw level) could be created. about one-half of the graduate programs delayed paying their dues and indeed the organization almost collapsed. it is my view the 100 percent dues payment by undergraduate programs and the negotiating skills of the interim director of cswe, diane bernard, kept the organization alive – barely. promoting the bsw baccalaureate educators and bpd appeared to be effective in promoting the bsw on their campuses, but they were not effective in creating a job market for the graduates. nasw made one valiant stab at upgrading recognition of this practice level in the early 1990s by creating a parallel recognition to the masters-level academy of certified social workers (acsw) – the academy of certified baccalaureate social workers (acbsw). bob teare and i were commissioned by nasw to extend a task analysis study of msw social workers we had developed to underpin the acsw exams, to now address the bsw practice level. barbara shank joined us in collecting and analyzing the bsw-level data. using these data as the blueprint, nasw developed an innovative acbsw exam in 1991. however, the practice agencies did not buy into this academy, did not recognize the acbsw as a job credential, and thus students saw little merit in taking the exam and paying the acbsw fee. the acbsw subsequently was discontinued by nasw. did the partitioning of social work last? indeed, there were many trials and tribulations as the baccalaureate level of social work became a legitimate professional practice level. so what evidence is there today that this effort succeeded? advances in social work, spring 2014, 15(1) 204  the cswe website (http://www.cswe.org, july, 2013) indicated that there were 472 accredited bsw programs and 19 more in candidacy – a significant increase from the 135 programs in 1974.  the 2012 annual survey (also on the cswe website) reports 52,598 full-time and 7,297 part-time majors. that exceeds the msw enrollments of 34,484 fulltime and 19,351 part-time students.  the annual survey also indicated that of the new students admitted to msw programs in 2012, 5,898 were admitted with advanced standing.  amanda scott (bpd staff member) reports that the bpd membership has grown to a substantial number – from 101 charter members to 698 members in 2013.  scott also reports that the attendance at the bpd annual meetings has increased exponentially – from 52 at the first meeting in estes park, colorado to 900 at myrtle beach, south carolina in 2013.  to be a profession, a certain amount of common work must be done by all practitioners, but if there are multiple levels of the profession there also must be some differentiation. in 1995, bob teare and i merged comparable data from the nasw sponsored bsw and msw task analysis studies, yielding 7,000 usable responses which allowed for a comparison of practice activities at the two levels. chapter 4 in our cswe published book, practice-sensitive social work education (teare & sheafor, 1995), identifies similarities and differences in what social workers do at the two professional levels. there was a clear distinction in that bsws somewhat exceed msws in the empirically derived task clusters of risk assessment, protective services, case planning and maintenance, service connection, tangible service provision, and dispute resolution. the msws exceeded the bsws in group work, individual/family treatment, and staff supervision. in the remaining clusters of practice activity (i.e., interpersonal helping, professional development, staff deployment, staff information exchange, organization maintenance, community delivery system knowledge, program development, research and policy development, and instruction) there was virtually no difference between the two levels. conclusion in my judgment the above data indicate that social work has become one profession with two somewhat distinct practice/education levels. looking back on these developments, the opportunity to participate in and contribute to the emergence of a new practice level of a profession was a unique and rewarding experience. the efforts of many colleagues throughout the united states made this possible and, perhaps, the rich interpersonal relationships developed among the bpders did the most to make the time and effort spent on this personally worthwhile. on a far more important societal level, the outcome of now having nearly 15,000 new and well-prepared baccalaureate level educated professional social workers available each year to serve the most vulnerable u.s. population groups truly has made a difference. sheafor/professionalization of baccalaureate-level social work 205 the single element of greenwood’s criteria for a profession that i believe has not been sufficiently realized is the requirement to gain sanction from our professional communities. to better achieve this important goal, cswe, bpd, nasw, aswb and the many human services employers must again undertake carefully planned and articulated strategies to strengthen recognition of these graduates in the employment market. too often this this rich resource still goes unappreciated. references (author’s note: in addition to references cited in the body of this article, sources documenting the events associated with these personal observations are also included in the references list.) baer, b. l., & federico, r. (eds.). (1978). educating the baccalaureate social worker (vol. 1). cambridge, ma: ballinger. baer. b. l., & federico, r. (eds.). (1979). educating the baccalaureate social worker (vol. 2). cambridge, ma: ballinger. bisno, h. (1959). the place of the undergraduate curriculum in social work education. new york, ny: council on social work education. council on social work education. (1973). statistics on social work education in the united states: 1973. new york, ny: author. council on social work education. (1974). statistics on social work education in the united states: 1974. new york, ny: author. council on social work education. (1976). statistics on social work education in the united states: 1976. new york, ny: author. council on social work education. (2012). 2012 statistics on social work education in the united states. alexandria, va: author. retrieved from http://www.cswe.org/centersinitiatives/datastatistics/programdata/68987.aspx. flexner, a. (1916). is social work a profession? in proceedings of the national conference on charities and correction, 1915 (pp. 576-590). chicago, il: national conference on charities and correction. greenwood, e. (1957). attributes of a profession. social work, 2, 45-55. leighninger, l. (1980). the generalist-specialist debate in social work. social service review, 54(1), 1-12. leighninger, l. (1984). graduate and undergraduate social work education: roots of conflict. the journal of education for social work, 20(3), 66-77. leighninger, l., & stuart, p. (1999). bpd is launched: a history of the association of baccalaureate social work program directors, part i. the journal of baccalaureate social work, 4(2), 37-58. advances in social work, spring 2014, 15(1) 206 schatz, m. s., jenkins, l. e., & sheafor, b. w. (1990). milford redefined: a model of initial and advanced generalist social work. journal of social work education, 26(3), 217-231. sheafor, b. w. (2001). three decades of baccalaureate social work: a grade card on how the professionalization of baccalaureate social work has played out. the journal of baccalaureate social work 6(2), 25-43. sheafor, b. w., & horejsi, c. r. (2012). techniques and guidelines for social work practice (9th ed.). boston, ma: allyn and bacon. sheafor, b. w., & landon, p. s. (1987). generalist perspective. in a. minahan (editorin-chief), encyclopedia of social work (18th ed., pp. 660-669). silver spring, md: national association of social workers. sheafor, b. w., morales, a. t., & scott, m. e. (2012). social work: a profession of many faces (12th ed.). boston, ma: allyn and bacon. (see chapters 3 and 4.) sheafor, b. w., & shank, b. w. (1986). undergraduate social work education: a survivor in a changing profession. austin, tx: university of texas school of social work, social work education monograph series, #3. stuart, p., & leighninger, l. (2000). bpd matures: a history of the association of baccalaureate social work program directors, part ii. the journal of baccalaureate social work, 5(2), 127-143. stuart, p., leighninger, l., & donahoe, j. n. (1993). reviewing our past: a history of the association of baccalaureate social work program directors. eau clair, wi: association of baccalaureate program directors. teare, r. j., & sheafor, b. w. (1995). practice-sensitive social work education: an empirical analysis of social work practice and practitioners. alexandria, va: council on social work education. author note address correspondence to: bradford w. sheafor, 1426 w. mountain avenue, fort collins, co 80521, bradford.sheafor@colostate.edu   brad sheafor recently retired after 48 years as a social work educator at the university of kansas and colorado state university. a consummate generalist, dr. sheafor dabbled in many aspects of social work and social work education. his service activities included substantial involvement with nasw, aswb, bpd, and cswe. he also served as a fulbright lecturer in new zealand and a visiting scholar in australia. major publications included social work: a profession of many faces (12 editions), techniques and guidelines for social work practice (10 editions), practice-sensitive social work education, quality field instruction in social work, and undergraduate social work education: a survivor in a changing profession. microsoft word androff _jv_ 1970-copyedit2_8-13-12 ______________ david k. androff, msw, ph.d., is an assistant professor in the school of social work at arizona state university in phoenix. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 408-419 adaptations of truth and reconciliation commissions in the north american context: local examples of a global restorative justice intervention david k. androff abstract: truth and reconciliation commissions (trcs) are restorative justice mechanisms for addressing human rights violations and injustice at the macro level. mainly applied in the global south, they have only recently been adapted within north america. the greensboro, nc trc was launched by grassroots and community-based organizations in 2004 to examine the causes and consequences of a 1979 incident of racial violence. the canadian trc was established in 2008 to address the legacy of colonial policies of assimilation and the forced schooling of indigenous populations. through a comparison of these two cases, this paper will investigate how the north american context shapes the nature of the problems that these trcs address, how they are organized, their relationship to the legal system, the role of civil society, and their relationship to poverty and reparations. implications for social work, restorative justice and the potential for additional trcs in north america are discussed. keywords: truth and reconciliation commissions, restorative justice, human rights trcs, social work and the north american context truth and reconciliation commissions (trcs) are a popular human rights intervention based upon restorative justice principles that entail investigations into past human rights violations (hayner, 2001). trcs have been implemented around the world in diverse settings such as south and central america, africa, and asia. while each one is unique, a trc may be defined as a national or community-based intervention to repair social fabric damaged by violence and oppression through investigation (truth seeking) (androff, 2012a) and dialogue (reconciliation) (androff, in press). the first trcs in the 1970s and 80s emerged in africa and south america as tools to assist societies transitioning from dictatorships and regimes of political oppression. the most famous trc occurred in south africa, and was part of the political compromise in the transition from apartheid to democracy (minow, 1998). the high profile and perceived success of the south african trc in contributing to the peaceful transition and forestalling a civil war inspired many subsequent trcs around the world, including sierra leone, timorleste, peru, morocco, and the solomon islands. trcs focus on providing the victims of human rights violations with information about the nature and details of crime; this serves to clarify the nature of the violence and to create opportunities for closure and healing for victims (androff, 2012b). trcs can include multiple forms of justice, but are centered on the restorative justice principles of responding to victims’ needs, engaging multiple stakeholders, and attempting to rebuild the relationship and social fabric that are damaged by violence (androff, 2010a). through bringing together victims, perpetrators and community members to share their androff/adaptations of truth and reconciliation commissions 409 experiences before a public and supportive commission, trcs contribute to reconciling formerly divided and antagonistic people. trcs often incorporate elements of local or traditional culture, such as indigenous conflict resolution or community justice to facilitate reconciliation (androff, 2008). trcs conclude their work by publishing a final report with detailed findings from their investigation and participants’ testimonials; these reports also make recommendations for moving forward, promoting further reconciliation, and institutional reform. trcs and social work trcs are multi-disciplinary interventions, drawing upon theory and practice from diverse fields such as law, theology, psychology, political science, anthropology, sociology, and social work. androff (2010b) has explored the connection between trcs and social work. trcs are relevant to social work in the problems that they respond to and seek to ameliorate, such as assisting disempowered and vulnerable populations, confronting racism, and improving the social welfare of victims of violence and oppression; their methods, such as community practice, civic engagement, narrative recovery from trauma; and their goals, such as reconciliation and peace-building, building strong sustainable communities, and promoting social justice and human rights. social workers in south africa provided therapeutic support and social services to victims as part of the trc (hamber, 1998; sacco & hoffman, 2004). in addition, social workers in south africa contributed to the trc through professional advocacy; social work educators and professional organizations submitted statements to the trc detailing their complicity in apartheid policies, such as not admitting black students to social work schools and maintaining different standards of practice between white and black south africans (loffell, 2000; lombard, 2000). social workers from australia and new zealand were involved in the timor-leste trc in assessing the mental health needs of the largely traumatized population and designing a mental health services delivery system and policies. the trc in canada is holding public events at schools of social work, and coordinating outreach efforts to ensure the participation of indigenous populations (www.trc.ca). despite these connections, there are many missed opportunities for social workers to supplement and improve the work of trcs (androff, 2010b). there is a natural relationship between the values and goals of trcs with the profession of social work’s code of ethics. social workers could contribute their professional knowledge and practice skills of assessing and working with vulnerable people by facilitating interviews and eliciting testimonials before trcs, and providing therapeutic and social support to victims. trcs represent an opportunity for social workers to deliver culturally competent psychosocial services, and to engage in advocacy on behalf of oppressed and vulnerable populations. north american context north america differs in many regards from the settings where past trcs have been implemented. five characteristics of previous trcs guide this comparative analysis of advances in social work, summer 2012, 13(2) 410 trcs: the background context of violence that they address; the nature of how trcs are initiated, usually through a political transition; the level of cooperation with the legal system; the role of civil society; and the economic context of poverty, inequality, and development. each characteristic is discussed in the contrast between the global south and north. are the problems that trcs respond to in north america qualitatively different than those faced in the global south, or are they variations of the same problems? the global south is a term that loosely applies to less developed countries, emerging nations, and what used to be commonly referred to as the third world. trcs in the global south have addressed the problems of military dictatorships, political oppression, civil wars, "dirty" wars, ethnic cleansing, foreign invasion and occupation (hayner, 2001). nations in the global north, typically industrialized, democratic, and situated in western europe and north america, are less often associated with the violence, strife, and corruption of the global south. yet there remain structural problems of violence, oppression, poverty, and injustice that trcs can address. most trcs have occurred in the context of a political transition (hayner, 2001). trcs are one mechanism that societies use to facilitate transitions from oppressive political states to democracy, and are often part of a new government’s attempt to reckon with the past and set the stage for a new social contract with the people. trcs are a part of the field of transitional justice; much of the discussion and debate about trcs involves reforming social institutions; promoting national healing, reconciliation, and unity; and achieving accountability for perpetrators and effective justice for victims (minow, 1998). however, governments in the global north may be less likely to experience a political transition. if there is no overt or otherwise shift in power relations – can trcs in the global north still be called transitional justice? after a political transition, the new government often confers legitimacy upon the trc; in post-conflict settings, trcs can suffer from being perceived as overly sympathetic with particular interest groups. when there is no political transition, trcs are sometime initiated and operated by the same government that was in power during the contested period, and may even bear responsibility for some of the abuses. how is the legitimacy of trcs affected when the same government responsible for perpetrating abuses and injustice is implementing a trc or similar intervention for its own past abuses? transitional justice mechanisms often compensate for the lack of or weak judiciaries. trcs are frequently called “hybrid” interventions where they operate in tandem with legal systems. in timor-leste, the trc referred “serious crimes” to the formal legal system, and perpetrators of “less serious crimes” could avoid prosecution by participating in community reconciliation ceremonies (androff, 2008). in south africa, perpetrators who made a full confession for their politically motivated crimes under apartheid could receive legal amnesty (minow, 1998). however, western nations pride themselves on the rule of law and are characterized by strong independent legal systems that address a wide range of civil and criminal offenses. do the functioning legal systems of the in the west diminish the role that a trc can play, and how does such a system change the way that a trc could operate? restorative justice scholars and practitioners advocate for the reform androff/adaptations of truth and reconciliation commissions 411 of criminal justice systems in the west, perhaps trcs could add to such efforts (beck, kropf, & leonard, 2011). priscilla hayner (2001) has called civil society the “essential ingredient” of trcs. civil society groups have influenced the work of many trcs to ensure their responsiveness and sensitivity to victims groups, women’s groups, and children. in the west, there is a historical tradition of civil society groups organizing, advocating and influencing social and political institutions. should civil society play a greater role with trcs in north america, or is there less of a need due to the pre-existence of community based and grassroots organizations? most trcs have occurred in the global south, in many settings that have been characterized by mass poverty and deprivation, inequality, and economic and social underdevelopment. these conditions often exacerbate conflict or are causal factors in the precipitating violence. there is a growing recognition that economic and social development is a crucial component to post-conflict reconstruction and reconciliation. research from the balkans (stover & weinstein, 2004) indicates that economic recovery can contribute to pro-social relations between antagonistic parties. trcs have been increasingly concerned about the conditions of inequality and deprivation that must be remedied in order to achieve sustainable peace, and have given greater attention to the “positive” human rights, such as the right to development and material welfare. early trcs in latin america made efforts to include reparations and restitution for victims of human rights violations and their families, yet also suffered criticism that they were “buying off” victims as a substitution for justice. how should trcs in industrialized, developed nations focus on issues of reparations? in the context of a “richer” nation with higher standards of living and social welfare policies, is there less of a need for trcs to include these issues? of course, poverty exists in developed economies, and victims of violence and other human rights abuses also suffer material consequences of lost income and decreased standards of living regardless of the overall economic context. having raised several questions about how the differences between the historical, political, legal, civil, and economic contexts of past settings of trcs contrast with that of many nations in the global north, two case studies will provide examples to further investigate how trcs may be adapted to various settings. the two case studies are drawn from the only trcs to have been implemented in north america: in the united states and in canada. north american trcs greensboro, nc the gtrc was a community’s response to the 1979 ‘greensboro massacre’. on november 3, 1979 a caravan of kkk and american nazi party members fired into a labor demonstration that was being held in a low-income neighborhood of greensboro, north carolina (gtrc, 2006; magarrell & wesley, 2008). five people were killed and 10 were injured. the demonstrators were a racially mixed group with ties to the communist worker’s party. they had been organizing for labor rights and social justice advances in social work, summer 2012, 13(2) 412 in north carolina, and had gained union leadership roles in local textile mills. they had previously confronted the klan, and there was an escalation of provocative rhetoric leading up to the attack. the city of greensboro did not react well to the shooting. they arrested and harassed the victims, and distorted the media coverage of the violence to portray the incident as an equal shootout between two radical fringe groups rather than a one-sided attack. the victims were portrayed as dangerous communist agitators, outsiders without community ties. many suspected greensboro police complicity in the attack; later it was learned that the greensboro police department and the fbi had an informant inside the kkk – and knowledge that they were arming themselves in advance of the demonstration, however there was no police presence on the day of the attack. distrust of the city government deepened, particularly among low-income and african american residents. there were three subsequent legal trials. two criminal trials resulted in acquittals for the perpetrators by all white juries, even though the attack was videotaped in broad daylight. however, the district attorney wasn’t supportive of the victims, equating the killing of communists in the usa to the vietnam war. the victims felt that the criminal justice system did not produce any meaningful justice for those killed. these events negatively affected economic, social and political dimensions of life in greensboro, and the lingering racial tensions contributed to a climate of animosity. in 1985, the victims won a federal civil suit against the perpetrators and the greensboro police department for the wrongful death of one of the victims, and used the settlement to fund their organizing efforts and to expose their story, discover the truth behind the violence, and pursue justice for the victims. greensboro truth and reconciliation commission (gtrc) 25 years later, community-based organizations, grassroots groups, churches, and civil rights organizations partnered to create a trc as a means of re-investigating the greensboro massacre and to promote reconciliation in the community (gtrc, 2006; magarrell & wesley, 2008). the international center for transitional justice provided consultation, and the gtrc received funding through philanthropic organizations and individual donations. although initiated in part by the victims of the greensboro massacre and their supporters, a selection process was implemented to ensure that the commissioners who led the gtrc would be objective and independent. the gtrc was launched in 2004; its seven commissioners were mandated to examine the context, causes and consequences of the events of november 3, 1979, and to promote dialogue and reconciliation in the community. although their focus was only one day, they used this one event as a lens through which to investigate patterns of racism, anti-union activity, and white supremacy over decades. in their investigation, the gtrc reviewed the evidence from all three legal trials, local and federal law enforcement records, newspaper articles and academic literature. in addition, they took approximately 200 statements given in personal interviews and public hearings. the gtrc held three public hearings; the first was focused on the events leading up to 3 november 1979, the second on the events of that day, and the third on the consequences androff/adaptations of truth and reconciliation commissions 413 of the violence. in 2006, the gtrc finished its work by releasing a comprehensive final report, with recommendations for the community (gtrc, 2006). the gtrc was a grassroots or community-based trc. some have called it an “unofficial truth project” (bickford, 2007). throughout the process, the mayor and city council of greensboro officially opposed the gtrc, however all the african american city council members voted to support it. while being a grassroots commission had some benefits, there were some clear limitations associated with the lack of state sponsorship. chief among them was that the gtrc lacked subpoena power, and thus could not compel the participation of individuals, nor obtain official records. another obstacle to the investigation was the strict control of information by federal agencies. several documents released to the gtrc under the freedom of information act were substantially blacked out. there was no question of amnesty – however the widows and survivors of the attack signed an agreement that they would not pursue prosecution if any new evidence was uncovered in the re-investigation. while the majority of gtrc participants were victims and concerned community members, groups critical of the victims and the gtrc also participated. greensboro police personnel, lawyers from the criminal trials, and some kkk members and a former nazi came forward, giving statements and attending the public hearings. although one perpetrator came forward, expressed remorse and apologized to the family of the demonstrator that he had murdered, many felt that the failure of more perpetrators to participate or disclose details about law enforcement complicity in the attack hindered a broader reconciliation in the community (androff, 2010a). despite these criticisms and its limitations, the gtrc became a powerful example of participatory democracy and for what citizens could achieve to face their community’s past in spite of government resistance. many participants felt that the gtrc’s ability to bring people together in a peaceful setting who used to be violently antagonistic demonstrates the potential for reconciliation built on mutual tolerance and peaceful coexistence. the gtrc, as a community based restorative justice intervention, made important contributions and the grassroots coalitions forged in its creation and implementation have continued to work for political and social change in greensboro. canada the canadian truth and reconciliation commission addresses the legacy of the indian residential schools which operated over 100 years as part of a national policy of forced assimilation (ictj, 2008). the residential schools, begun in 1874, were run first by churches and charity organizations and then by the state, primarily the child welfare system (fast & collin-vézina, 2010). the policy of forced schooling separated first nations, inuit, and other aboriginal children from their families and placed them into institutional boarding schools. children were not allowed to speak their native languages or practice their cultural and spiritual beliefs. these policies were aimed at changing the cultural identity of the child, or to “kill the indian in the child”. the schools were overcrowded and underfunded; children faced high rates of disease, malnutrition, physical and sexual abuse, and death. over 150,000 indigenous children attended the indian residential schools, the last of which closed in 1996. advances in social work, summer 2012, 13(2) 414 this experience was deeply traumatic to the indigenous populations of canada, which continue to struggle with numerous social problems such as high rates of poverty, disease, family violence, substance abuse and over-representation in the child welfare and criminal justice systems (trocmé, knoke, & blackstock, 2004). historical trauma refers to traumatic events that are not limited to individuals, but affect social groups, to communities (fast & collin-vézina, 2010). based on research with holocaust survivors and their children, the concept of historical trauma also attends to how trauma is passed down inter-generationally. in addition to collective distress, it is also about harm that was intentionally perpetrated by outsiders. historical injustices and traumatic events have been connected to contemporary social problems. indigenous populations in canada suffer many disparities and disproportionalities across many domains of wellbeing; they experience lower life expectancy, high rates of disease, high incidence and concentrations of poverty, high rates of substance abuse and family violence (trocmé, knoke & blackstock, 2004). in canada, 30 to 40% of all children in the child welfare system are indigenous (farris-manning & zandstra, 2003), and the rate of suicide among indigenous youth is 5 to 7 times greater (health canada, 2006). canadian truth and reconciliation commission (ctrc) the 2006 indian residential schools settlement agreement (irssa) was the result of years of advocacy, legal suits, and negotiation with indigenous communities and survivors of the indian residential schools (ictj, 2008). in 2008, prime minister harper made a formal apology on behalf of the state to all indigenous communities for the policies of forced schooling and assimilation, acknowledging that government policy was to separate and isolate indigenous children from their families and communities; churches and professional social work organizations have also apologized for their role in the indian residential schools. the judicial agreement included $2 billion in reparations to be paid by the canadian government and the 4 churches that also administered the schools. the common experience fund pays a lump sum of $10,000 to any survivor who spent any part of a year in one of the schools, and $3,000 for each additional year. the independent assessment process allows for victims of physical and sexual abuse additional reparations of up to $275,000, but the burden falls upon the victim to document the abuse. the irssa also set up funds for healing and commemorative programs to address cultural and collective harms through the promotion of spiritual renewal, public education, memorials, and museums. the irssa established a national level truth and reconciliation commission with a 5-year mandate, allocating $60 million in funding. supplementing the other aspects of the irssa, the trc was created to allow the survivors to tell their story and to educate the public about the nature of the abuses suffered in the indian residential schools. the purpose includes unearthing the previously silenced stories and providing validation and emotional relief for the survivors, as well as to combat the widespread ignorance about the history. the canadian trc is unique; it is the first to be established at a national level in a western nation, the first to be initiated through the judicial system, and the first to focus colonial harms against indigenous people. androff/adaptations of truth and reconciliation commissions 415 the ctrc began in 2008, and is currently ongoing, but has faced several significant challenges. there have been changes in personnel, funding cuts, delays, and tensions between the twin goals of accountability for perpetrators and reconciliation and healing. the ctrc does not have subpoena power to compel the participation of perpetrators, and its mandate does not allow for the naming of individual perpetrators. furthermore, the ctrc faces the challenge of ensuring that victims perceive the process as legitimate. it is conducting outreach among indigenous communities across canada to educate survivors about the process and to ensure that they have the opportunity to participate. as this trc has been implemented relatively late in the history of the indian residential schools, many survivors are passing on. the timor-leste trc also faced challenges in conducting outreach to rural participants; many communities were wary of participating at first and regrettably many only felt confident about coming forward after the official process concluded (androff, 2008). despite these challenges, the ctrc is an opportunity to raise awareness about the impact of colonialism and atrocities committed against indigenous peoples, and has the potential to result in political and social change that benefits the indigenous population of canada. the north american context revisited having explored the two case examples of north american adaptations of trcs, a return to the characteristics of this unique context provides insights into the viability and future for how this global restorative justice intervention could be implemented locally. how do the underlying problems and background contexts addressed by the gtrc and ctrc compare with previous trcs? the gtrc was focused on one episode of racial violence between two groups, yet also was concerned with the nature of the state’s involvement in the violence. the gtrc was particularly interested in the degree of complicity of the greensboro police department, the fbi, and the atf: how much foreknowledge did they possess about what the kkk and nazis were planning? what could they have done to prevent the attack, either through neglect if not tacit approval? some in greensboro questioned if these law enforcement agencies had a more active role in planning the attack, and that perhaps the economic interests that were threatened by the demonstrators’ success in labor organizing, such as the owners of local textile mills, also bear some responsibility. the ctrc also addressed an issue of state abuse, albeit much larger, that of essentially the colonization and forced assimilation of the indigenous population. the harms recognized in the irssa and the subsequent government apologies were the direct consequence of state policy; a concerted and organized effort to destroy a people, their culture, their communities, and their future through their children. from these examples, it may be that trcs in the north american context can be effective at addressing the abuses and excesses of the modern state such as institutional racism and the effects of colonialism. this may be a relevant direction for future trcs in north america or other western, developed nations in the global north. given that many nations in the global north are characterized by strong government states, trcs may serve as a vehicle for addressing the unequal distribution of power in society, overlooked problems that the state has failed to address, and historical abuses that remain contemporarily significant. furthermore, as advances in social work, summer 2012, 13(2) 416 many nations in the west have significant minority populations (for example, the us is rapidly becoming a minority-majority country), trcs could be important tools for dealing with conflict between groups within a pluralistic state. in addition, as the pressures of immigration into developed countries increase, potential conflicts around race, ethnicity, religion, language, and culture may present opportunities for applying trcs to promote a positive vision of diversity and co-existence. one relevant example may be police abuse; community discord often follows episodes of police brutality and violence. trcs could be effective tools for grappling with the issues of minority relations with state power. trcs in the north american context are not likely to be generated through a process of political transition. these governments are more stable, and less likely to engage in transitions from oppression to democracy. most are democracies, and therefore open to social and political change from within the system. how does the lack of a political transition affect trcs? the gtrc was limited in many ways be the lack of official state sanction, and in fact by the contemporary city administration’s resistance. many participants in the gtrc felt that its work was hampered and a fuller reconciliation was impeded by a lack of political change in greensboro, because the same political, economic, and social interests that influenced the local government in 1979 essentially remained in power in 2004. without the resources or stamp of legitimacy of state support, the gtrc’s investigation and its outreach to all city residents was limited. the ctrc is also limited in some ways by the lack of political transition, and indeed many indigenous communities in canada have questioned the authenticity and genuineness of the ctrc as it comes from the same source that perpetrated the original injustice. some first nations tribes have protested the ctrc for this reason. based on these examples, it is clear that trcs in the global north will face challenges of legitimacy connected to the lack of a transition context. trcs in north america that are organized by or in concert with the government will be challenged to overcome perceptions and cynicism about being an exercise in political expediency. these trcs are also at risk of being co-opted for ulterior political motives. trcs that are not connected to the political system may suffer from enjoying less political support or be more likely to be resisted by the political structure. at the same time, political transitions can be messy and confusing, and there can be a benefit to efforts to address past violations within a stable economic and political framework. trcs may be a tool to shift power within an existing democratic system. how can trcs in the north american context cooperate with existing legal and social service systems? unlike previous trcs, trcs in north america are not likely to be implemented in a legal vacuum. however, the existing legal system, and in particular the criminal justice system is far from perfect and could benefit from significant reform. the gtrc was in part a response to the failure of the legal system to provide justice for the victims and hold the perpetrators accountable. the so-called functioning legal system resulted in acquittals for the killers, although there was a civil settlement in federal court. the ctrc was also the result of a civil settlement; in both cases there was no criminal sanction for the parties responsible for the abuses. despite the shortcomings of current legal systems, the canadian judicial system did render the irssa, which may point to androff/adaptations of truth and reconciliation commissions 417 future possibilities. neither the gtrc nor the ctrc has an official relationship with the legal system. the potential for hybrid trcs, working in tandem with the courts, has not been explored. however there is a precedent for hybrid courts, possible examples include drug courts, mental health courts, and perhaps most appropriately tribal courts. these models may indicate how trcs can partner with courts to provide a more meaningful justice for victims by promoting accountability while still attending to the restorative justice principle of restoring the social fabric. there is a great opportunity for civil society organizations to make use of the trc model in north america. the presence of a vibrant civil society can strengthen the work of trcs, regardless if they are operated with or without state sanction. either way, civil society groups have the potential to influence and support trcs in north america. civil society must be more active to ensure that trcs are responsive to victims’ rights, and can work to prevent their co-option by political institutions. trcs in north america can be a vital tool for participatory democracy; a means for citizens to engage in civic action to address the problems of their community and society. can trcs be a tool for addressing poverty and inequality in western democracies? obviously, poverty still exists in western nations. yet the relative high standards of living may mean that trcs will focus less upon victims’ economic welfare and place more emphasis upon reconciliation or healing. however, trcs can serve an important function in addressing inequality by calling attention to the often overlooked, marginalized populations that exist, if somewhat hidden, in rich countries. through participant testimonials, public hearings, and dissemination of final reports, trcs can publicize the plight of poor and vulnerable people, drawing public support for supportive policies what is the future for trcs in north america or other western democracies? there are several possibilities. communities across the u.s. south have begun to explore organizing trcs to address their own histories of racial violence and oppression, including in eastern north carolina, mississippi, and one in new orleans to address the causes and consequences of the disaster following hurricane katrina (magarrell & gutierrez, 2006). a group of descendants from a preeminent new england family that profited from the trans-atlantic slave trade have suggested that the trc model may be useful for grappling with their legacy in the history of enslavement in the u.s. (dewolf, 2008). scholars such as walters (2008) have called for a trc to examine the contentious issue of reparations for slavery in the u.s. trcs may be useful for addressing other issues of indigenous rights; the u.s. shares a history of forced schooling and destructive assimilation policies of indigenous people with canada. senator leahy from vermont, the chairman of the senate judiciary committee, made national news when he called for a commission to investigate torture, questionable interrogation techniques, and wrongdoings committed in the “war on terror” (cnn, 2009). it is a sad reality that there is no shortage of human rights violations, even in the global north for which trcs may be a useful intervention. anywhere that there is community trauma, or an abuse of state power, trcs can contribute to the recognition of harm to victims and the reconciliation of divided societies. advances in social work, summer 2012, 13(2) 418 references androff, d. 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(1998). between vengeance and forgiveness: facing history after genocide and mass violence. boston: beacon. sacco, t., & hoffmann, w. (2004). seeking truth and reconciliation in south africa: a social work contribution. international social work, 47(2), 157-167. stover, e., & weinstein, h. (eds.). (2004). my neighbor, my enemy: justice and community in the aftermath of mass atrocity. cambridge: cambridge university press. trocmé, n., knoke, d., & blackstock, c. (2004). pathways to overrepresentation of aboriginal children in canada’s child welfare system. social service review, 78(4), 577-600. walters, r. (2008). the price of racial reconciliation. ann arbor, mi: university of michigan press. author note: address correspondence to: david k. androff, msw, ph.d., arizona state university, school of social work, mail code 3920, 411 n. central ave, ste. 800, phoenix, az 85004-0689. email: david.androff@asu.edu this work is licensed under a creative commons attribution 4.0 international license. a call to action: reimagining social work practice with unaccompanied minors kerri evans kylie diebold rocío calvo abstract: in the decade leading up to 2012, approximately 8,000 unaccompanied minors (uam) arrived annually at the southwestern border of the united states. since then, the number of arrivals has drastically increased, surpassing 14,000 between october 1, 2017 and january 31, 2018 alone. the needs of uam concerning mental health, education, social, and legal counseling often differ from the needs of other latinx and immigrant populations. however, recent instability in the protections and services tailored to uam are channeling these youth and their families into mainstream agencies. this article is a call to action for social workers who may now encounter uam for the first time in their practice. drawing from almost twelve years of practice experience working with uam and their families, as family case managers, community liaisons, program managers, grant administrators, and training facilitators, we review needs, services, and promising practices for social work practice with uam. recommendations include providing education to parents and caregivers about uam’s rights, u.s. laws and regulations, and service availability; building trust and rapport with families; creating welcoming schools; practicing cultural openness; hiring diverse staff; and fostering partnerships with local service providers. keywords: migrant; unaccompanied minor; unaccompanied child; promising practices; central america; northern triangle, family reunification unaccompanied minors (uam)p p(also known as unaccompanied children (uc) and unaccompanied alien children (uac)) are a growing population in the united states (u.s.). although they hold membership in both the latinx and the undocumented communities, uam come to the u.s. with a specific history that sets them apart from other latinx and undocumented persons. their pre-migration circumstances, migration journey, integration into life in the u.s., and legal status, lead unaccompanied children to struggle with acculturative stress, social isolation, discrimination, and criminalization (de genova & peutz, 2010; perreira & ornelas, 2011). these circumstances make youth vulnerable to depression, anxiety, low self-esteem, irritability, aggression, and post-traumatic stress disorder (carlson, cacciatore, & klimek, 2012; perreira & ornelas, 2011). the presence of uam in the u.s. is increasing, but funding for services specifically tailored for this population fluctuates significantly annually. for instance, the president’s fiscal year (fy) 2019 budget requests $1,148 million for the uam program, an increase of $206 million above the fy18 continuing resolution, but $267 million below the fy17 ________________________ kerri evans, msw, lcsw is a doctoral student at boston college, chestnut hill ma02467. kylie diebold, msw is a children’s services specialist for foster care at the united states conference of catholic bishops, migration and refugee services. rocío calvo, phd is an associate professor at boston college school of social work. the opinions expressed herein are those of the author alone and do not necessarily represent the opinions or positions of the united states conference of catholic bishops copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 788-807, doi: 10.18060/21643 https://creativecommons.org/licenses/by/4.0/ evans et al./a call to action 789 budget (department of health and human services [hhs], 2018). the fy19 funding request for similar programs and services for refugees was decreased to $515 million, approximately 25% lower than the fy18 continuing resolution (hhs, 2018). given funding uncertainties and proposed rollbacks to uam protections and services, uam youth and their families are being channeled into mainstream services. consequently, social workers should be prepared to work with this population regardless of their role or specialty. the article proceeds as follows, first we provide a brief overview of uam including who they are, where they come from, and the federal programs tailored to address uam needs post-arrival. then, we discuss how these services meet the needs of uam, as well as the gaps in service, followed by a review of uam outcomes. we conclude with a call to reimagine social work with uam where we provide recommendations and promising practices for social workers in a variety of settings, such as community health care centers, schools, and the child welfare system; and about a number of topics such as the importance of education regarding u.s. laws, culturally and linguistically appropriate service delivery, and strengthening community partnerships. unaccompanied minors: who are they, where do they come from, and what happens after their arrival in the u.s.? the homeland security act of 2002p ppublic law 107–296, 6 u.s.c. § defines uam as individuals under the age of eighteen who arrive at the u.s. border without lawful immigration status or a parent or legal guardian to provide care and physical custody. most of these children come to the u.s. from the central american countries of el salvador, guatemala, and honduras, collectively known as the northern triangle (administration for children and families [acf], 2017a). many uam are apprehended by the department of homeland security upon arrival at the u.s. border. children from the contiguous countries of mexico and canada who do not demonstrate signs of trafficking or fear of persecution (about six percent annually) are repatriated back to their country of origin, as required under the william wilberforce trafficking victims protection reauthorization act (tvpra) of 2008 public law 110-457 (ramirez, mckenna, & somers, 2015; united states conference of catholic bishops [usccb], 2012). the remaining 94 percent are placed under the care and custody of the u.s. department of health and human services, office of refugee resettlement (orr), and are subject to removal. in the decade leading up to 2012, the average number of uam arriving at the u.s. border annually ranged from 7,000 to 8,000 (acf, 2016). escalating persecution, economic hardship, and violence in the northern triangle caused the number to increase drastically between 2012 and 2016 (customs and border protection [cbp], 2016; acf, 2017b). while the number of arrivals tapered off in fy2017, there has been a steady increase since the start of fy2018, with 14,444 uam arriving between october 1, 2017 and january 31, 2018 (cbp, 2018). see table 1 for a breakdown of uam arrival statistics between fy2012 and fy2017, as complete 2018 data is not yet available. advances in social work, spring 2018, 18(3) 790 table 1. uam arrival information fy2012-fy2017 fiscal year sw border apprehensions gender* age* male female 0-14y 15-17y fy2012 24,403p a 77% 23% 22% 77% fy2013 38,759p a 73% 27% 27% 74% fy2014 68,541p a 66% 34% 37% 63% fy2015 39,970p a 68% 32% 31% 68% fy2016 59,692p b 67% 33% 32% 68% fy2017 41,435p b 68% 32% 30% 69% note: gender and age columns represent youth referred to the orr (text in this table is adapted from: *acf, 2017b; p a pcbp, 2016, p b p2017 while reasons for fleeing are complex and unique for each child, most youth seek protection from various forms of persecution, abuse, deteriorating social and economic conditions, as well as gang and generalized violence in their home countries (crea, hasson, evans, berger cardoso, & underwood, 2017a; piwowarczyk, 2006; united nations high commissioner for refugees [unhcr], 2014). the long and dangerous journey to the u.s. adds to the risk of traumatic outcomes for uam (pine & drachman, 2005). many uam are victims or witnesses to sexual or physical violence, go without food or water for days at a time, walk and take trains under harsh conditions, and are forced to negotiate with smugglers (griffin, son, & shapleigh, 2014; unhcr, 2014). upon arrival in the u.s., uam require specialized interventions and services to overcome their trauma and work towards positive life outcomes. legal status and legal relief. the u.s. government is not mandated to appoint attorneys to uam who are in removal proceedings. due to financial and time constraints, only about half of the uam who face deportation secure legal representation (kids in need of defense [kind], 2016). when navigating the complex u.s. immigration system, uam who have an attorney are much more likely to be granted some form of protection than children without representation (kind, 2016). seventy-eight percent of uam who attend their scheduled hearings receive some form of relief and remain in the u.s. undocumented (migration policy institute [mpi], 2015). the most common form is administrative case closure, a status that means the child is no longer in active removal proceedings (mpi, 2015). less than five percent of uam are granted legal status through one of the following forms of immigration relief for which they may be eligible: asylum, special immigrant juvenile status (sijs), u nonimmigrant visas, and t nonimmigrant visas (mpi, 2015). federally mandated services for uam the orr provides shelter care, post-release services (prs), and foster care to uam who are apprehended at the southern border. these federally funded services are mandated by the flores settlement agreement of 1997 case no. cv 85-4544-rjk (c.d. ca, 1997), the homeland security act of 2002, and the trafficking victims protection reauthorization act of 2008 (usccb, 2012). evans et al./a call to action 791 shelter care. upon arrival to the u.s., apprehended youth are transferred to the custody of the orr and placed into shelters that are funded by the orr and operated by child welfare agencies licensed by the state in which they are located. these shelters provide children with access to education, health care, mental health services, legal screenings, and case management, as well as assistance with family finding and reunification services (acf, 2017a). most uam stay in shelter care for an average of 34 days (acf, 2017b), after which, around 90 percent of children are reunified with an adult relative or caregiver in the u.s., referred to as a sponsor (acf, 2017c). approximately one percent of uam meet eligibility for the long-term foster care (ltfc) program. the remaining uam, around ten percent, are returned to their home country through voluntary departure or removal (usccb, 2012). post-release services (prs). approximately 20 percent of children who are reunified with a sponsor receive prs to help with the transition into their new home and community (acf, 2017b). these services, which include case management and linkages to education, health care including mental health, and legal representation, are coordinated by social workers who help address the unique needs of reunified uam (roth & grace, 2015). uam qualify for prs according to their assessment of needs, their relationship to the sponsor, and the motivation and ability of the sponsor to adequately care for the child (usccb & lutheran immigration and refugee service, n.d.). services generally last for 90 days, but on some occasions are provided for the duration of the child’s removal proceedings, or until the child turns eighteen years old. foster care. the long-term foster care (ltfc) program consists of a network of local agencies that provide culturally sensitive foster care and group home services to less than three percent% of uam, those who do not have a qualified and appropriate sponsor to care for them and who have been identified as eligible for immigration relief (acf, 2015a). in most instances, uam who qualify for ltfc were abused, abandoned, or neglected by one or both parents in their home country, have an asylum claim, or are victims of human trafficking (usccb, 2012). to aid in the integration process, the agency providing care must ensure that uam are placed in a licensed foster home or group home, enrolled in school, and have access to medical care, counseling, recreation, and legal representation (acf, 2015a). children are eligible to remain in ltfc until a viable reunification option becomes available, they turn eighteen, or until they are granted legal relief and transition into the unaccompanied refugee minor (urm) program. the urm foster care program is uniquely tailored for foreign-born youth and is subject to the child welfare laws and guidelines in the state in which it is located. as such, it is designed to help unaccompanied migrant and refugee children develop the skills to become self-sufficient and successfully transition into adulthood (acf, 2015b). do services meet the needs of uam? services rendered by the prs and ltfc programs are mandated by federal legislation (flores settlement agreement, homeland security act, and tvpra), but are contingent upon funding availability, and the current situation leaves thousands of uam underserved advances in social work, spring 2018, 18(3) 792 every year. historically, eligible uam and their families were offered assistance through the prs program for at least six months. however, for most uam and their families, this period of assistance was reduced to three months during 2016. the shorted eligibility time frame has led to many unresolved needs at the end of services, and to increased risks for uam for poor educational outcomes, ongoing mental health concerns, and immigration issues (roth & grace, 2015). a concern with the ltfc program is that there are not enough funded slots for the youth who meet the eligibility criteria. additionally, as with domestic foster care, there are not enough families willing to take and be trained to serve culturally diverse youth (dinitto, 2011). for uam this is compounded by people’s preconceived notions of helping an undocumented child, hate, fear, and the perceived challenges of housing a child who speaks a different language (american federation of teachers, n.d.). eligible uam who are unable to access the ltfc program remain in shelters long-term, which violates the child welfare best practice of placing children in the least restrictive setting. the lack of services tailored to meet the needs of uam has channeled these youth and their families into social welfare programs and community-based services. roth and grace (2015) note that uam encounter many service providers and that social workers in schools, hospitals, legal clinics, and elsewhere “need to develop a broader recognition of the unique challenges that varying immigration statuses pose for children and their families” (p. 251). for mixed immigration status families with children born in the u.s., the natural citizens may be eligible for programs such as medicare, supplemental nutrition assistance program, and temporary assistance for needy families (haider, schoeni, bao, & danielson, 2004). however, the personal responsibility and work opportunity reconciliation act of 1996 bars undocumented immigrants from receiving federal welfare benefits, and even uam who obtain legal relief must wait five years before they are eligible to apply for benefits (haider et al., 2004). as a result, many uam and their families rely on the support of family and local nonprofit services not aimed at the uam population. uam in the u.s. literature suggests that negative experiences of children prior to migration influence their behavior after arrival (crea, lopez, taylor, & underwood, 2017b). however, there is little systematic research that specifically discusses the needs, or the long-term outcomes of uam who do not receive services tailored to their needs. this lack of information is compounded by a lack of indicators and instruments for caseworkers to both assess mental health concerns and make appropriate referrals (cardoso et al., in press; crea et al., 2017b). the discussion below summarizes the limited research on these topics. health and mental health children who have experienced forced migration are particularly vulnerable to mental health concerns (kennedy, 2013; piwowarczyk, 2006). most uam enter the u.s. with preflight trauma, and fewer than 20 percent had access to health care in their home country (kennedy, 2013). a study of pre-flight trauma among uam showed that almost half of participants were displaced by drug cartel or gang related violence, or by government evans et al./a call to action 793 actors. almost a quarter of uam were victims of abuse and violence within their family, and ten percent of participants were exploited by smugglers (unhcr, 2014). untreated historical trauma, combined with the trauma suffered during migration and the difficult adjustment post-arrival, places uam at risk for undesired mental health outcomes if the trauma is unaddressed (kennedy, 2013; pine & drachman, 2005). accessibility of treatment is a significant challenge for this population due to language barriers, lack of transportation, lack of health insurance, cost, and cultural norms around seeking professional mental health services (hacker, anies, folb, & zallman, 2015). utilization of medical services such as blood transfusion, organ transplant, and immunizations also vary for people of some religious and cultural backgrounds (blood weekly, 2016; grabenstein, 2013). finding culturally competent organizations that offer no-cost and low-cost health services for uninsured, undocumented immigrants can be problematic; long wait times, complex paperwork, and fear of discrimination and deportation often reinforce the barriers that prevent access (hacker et al., 2015; redden, 2017; roth & grace, 2015). education equal access to opportunities for advancement is key for the integration of immigrants. education is at the forefront of such opportunities (calvo, teasley, goldbach, mcroy, & padilla, 2018; waters & pineau, 2015). all children in the u.s. have a right to attend public schools regardless of country of birth (u.s. department of education [u.s. doe], 2014). however, uam are often denied enrollment, diverted to alternative schools, or face delays in the enrollment process when they lack the required documentation (i.e., birth certificate, proof of residence, immunization records, and transcripts (booi et al., 2016; bridging refugee youth and children’s services, 2016). unfortunately, the circumstances which force most uam to leave their countries also prevent these youth from obtaining important documentation and personal records prior to migration (unhcr, 2016). these experiences with the school system heighten the risk of experiencing discrimination and social isolation, which in turn may influence academic outcomes (oxman-martinez & choi, 2014). additionally, immigrant children with little or no formal education have unique academic needs for which schools and educators across the country are sometimes unprepared (booi et al., 2016). these factors widen the achievement gap between uam and their english-speaking peers (lópez & radford, 2017). permanent legal status has been found to increase graduation rates for uam in high school (crea et al., 2017a; kohli, 2011). child welfare the orr has a federal foster care program that serves a small percentage of uam annually, but uam and their families may also interact with the state-based child welfare system through investigations, family preservation services, foster care, or adoption. for youth who are released from the orr care into the community, the prolonged family separation (roth & grace, 2015), adultification (trickett, jones, & nagayama, 2007), and adjustment to a new community, can result in family breakdown and involvement with the advances in social work, spring 2018, 18(3) 794 child welfare system. additionally, many uam enter the child welfare system when their parents are either detained or deported (applied research center, 2011). cultural norms of immigrant families may alter social worker’s ability to accurately identify problems or conflict (patil, mcgown, nahayo, & hadley, 2010). relatedly, permanency and family finding can be slightly different for uam in the foster care system because their family may not speak english, may not have legal status in the u.s., or may not reside in the u.s. (socha, 2014). as with any other child in the foster care system, when reunification is not possible, adoption may be considered as an option for uc even if they entered the country without authorization as legal immigration status is not required to be eligible for adoption in the u.s. (department of state, 2017). however, the largest challenge in pursuing adoption for uam is that they often have a biological parent in home country with whom they maintain contact so termination of parental rights may not be feasible, and/or in the child’s best interest. proving the death of a parent can also be a challenge in countries where formal death certificates are not kept, the cost of paperwork is prohibitive, or if the death happened in transit when fleeing the home country (international human rights clinic, 2015). u.s. laws and regulations laws are stringent and better enforced in the u.s. than in some central american countries (usccb, 2013a), and violation of any u.s. law by an undocumented person can have harsh implications, including deportation (catholic legal immigration network, 2016). it is not uncommon for immigrant families to be unfamiliar with u.s. laws, especially among recent arrivals. important laws that can be a source of concern include activities such as driving without a license; alcohol consumption under the age of 21; purchasing tobacco products under the age of eighteen; and illicit drug use (usccb, 2013a). in addition, using physical harm to discipline a child and using physical aggression towards a spouse or partner is prohibited in the u.s., and school attendance is mandatory in most states for children between the ages six to sixteen (usccb, 2013a). a call for action uam are now more likely than ever to interact with mainstream social services. the authors of this manuscript draw from their direct practice experience with uam, as well as from their experience administering programs that serve uam, to prepare all social workers for work with this population. at the direct practice level, the authors have experience in case management for the prs program where support was given to families to ensure their connection to local community services at the time of reunification. additional direct practice experience included partnership-building with community organizations and schools to increase awareness and service availability for uam. at the macro level, the authors’ experience has been gained via employment for the orrcontracted agencies that provide oversight for federally mandated uam programs across the u.s. in this role, the authors engaged in program development, program management, training facilitation for direct care staff, and quality assurance of case management, and foster care services specifically for uam youth. a thorough understanding of uam programming requirements, child welfare best practices, and the unique needs of uam evans et al./a call to action 795 was acquired over almost 12 years of combined social work practice with uam. given the current shift in funding and priorities for uam, the authors worked together to reflect upon their experiences and draw out the most salient themes as advice for other social workers. recommendations for social workers based on the gaps identified above, and on many years of social work practice experience with uam held by the authors, the following sections outline promising practices to improve social work practice with uam for mainstream service providers. we focus on: (1) access to health and mental health services, (2) navigating the educational system, (3) involvement with the child welfare system, (4) understanding u.s. laws and regulations, (5) ensuring culturally relevant service delivery, and (6) building community partnerships. health and mental health services when working with undocumented families without healthcare coverage, we recommend utilizing no-cost and low-cost health services whenever they do not require proof of residency (ciaccia & john, 2016). in communities where low-cost mental health options are scarce, we suggest utilizing alternative services such as mentoring programs and church support groups and activities as these were found to be successful for unaccompanied minors from eritrea (socha, mullooly, & jackson, 2016). in emergency situations, hospital services are always available to families without insurance. however, we recommend that social work agencies build partnerships with local medical providers so they may be more willing to serve populations outside of their typical clientele. social workers may also be instrumental in advocating for healthcare expansion within their own communities and at the national level by making a case for benefits to be extended to undocumented individuals. the educational system we recommend that social workers advocate for the enrollment of uam to ensure that all youth are given the opportunity to learn and grow. this can be done through the flexibility of the mckinney-vento act of 2001 to overcome residency requirements (u.s. doe, 2004), and use of the orr’s case documents for evidence of immunizations, age, and to explain the absence of a legal guardian in the u.s. (evans, perez-aponte, mcroy, in press). case documents can be also used to inform the system about the educational systems in the countries of origin, and thus, to overcome transcript requirements. social workers also play a vital role in ensuring that uam are properly assessed upon entering school and are provided with the appropriate english language learner (ell) supports as required under the equal educational opportunities act of 1974, and every student succeeds act of 2015 (u.s. doe, 2016; equal educational opportunities act of 1974) when parents/caregivers are unfamiliar with local resources. booi et al. (2016) discussed the nuances of disability testing and individual education plans (iep) for undocumented youth. advances in social work, spring 2018, 18(3) 796 after enrollment, social workers should provide, or work with community organizations to provide teachers and administrators with training on the background of uam, cultural norms in central american countries, and the impact of childhood trauma (morland, duncan, hoebing, kirschke, & schmidt, 2005; evans, perez-aponte, &mcroy, in press). when schools adopt a welcoming environment and staff understand the ways in which uam are similar to and different from other refugee and immigrant children, they may be better equipped to meet their needs (barillas, 2010). school personnel should engage parents and caregivers of uam early to build trust and create a culture of support in integrating immigrant children because school is often the first place that uam interact with community members outside of their ethnic or cultural group. encouraging the use of the co-teaching model in schools with high numbers of uam and other ells enables one teacher to “determine the learning target, pacing of content, and alignment to standards” while the other facilitates learning, enabling non-english speakers to better learn (beninghof & leensvaart, 2016). lastly, social workers must play a role in the detection and consequences of discriminatory behaviors in the school setting and in the community at large. the child welfare system when social workers encounter uam and their families in the child welfare system, we recommend that they be responsive to sociocultural background (pottie et al., 2011), and avoid stereotyping, especially during child welfare investigations. dettlaff and rycraft (2010) describe best practices for working with latino families in the child welfare system that honors the cultural values and differences. we recommend that workers be cognizant of cultural differences and family constraints; making assumptions can be dangerous. whenever possible, researching the culture of the family before a home visit can enable the caseworker to be more confident and allow for a deeper conversation with the family regarding how behaviors or norms are different in the u.s. versus in the family’s home country. morland et al. (2005) also recommend working alongside ethnic leaders and cultural brokers to gain trust. for example, methods of discipline vary widely around the world and caregivers may lack skills for behavior modification, as deemed appropriate in the u.s., without assistance. it is also not uncommon for immigrant families to live in what may appear to be crowded, multi-generational households (booi et al., 2016; halpern, 2008). lack of space should always be carefully weighed with the benefits of living with family prior to removing a child from a home. we recommend using an ecological systems theory to help the family expand their network, mobilize support and increase coping skills (paat, 2013). this can also be done through actions such as providing referrals for all family members to services such as english classes, community activities, family mentoring, internet safety courses, and mock court sessions. for uam who enter foster care, social workers should persist in attempting to locate family members to provide care for them. social workers should ask for extensions in the standard family finding process and repeat the search process every couple of months, being creative in their approach each time. family tracing should be ongoing because uam may have new family members who arrive to the u.s. over time. similarly, using the cultural definition of “family” can extend the potential caregiver pool to include fictive kin, evans et al./a call to action 797 neighbors, godparents, and the like (socha, 2014). when searching for family in other countries and assessing them as potential caregivers, conducting online searches, (i.e., through social media platforms), or using the services of agencies such as the international committee of the red cross (icrc) restoring family links program or international social service’s family tracing services can be invaluable (icrc, n.d.; international social service, 2017). language barriers, poor conditions in home country, and legal status are not appropriate reasons to overlook family in the search or assessment process. when considering adoption for a uam youth, we recommend carefully weighing all the options and ensuring that family reunification options both in the u.s. and abroad have thoroughly been explored. if uam are being considered for adoption in the u.s. or to return to family in home country, social workers should encourage appointment of a child advocate to conduct a best interest determination (bid) which can help to examine the advantages and disadvantages to living in each country (evenhuis, 2013). u.s. laws and regulations we recommend that social workers provide education to uam and their families regarding ways that american laws and customs differ from those in their home country. in many communities, social workers can refer clients to existing classes that provide this information to new community members. in other cases, they can create classes and resources, or provide ad hoc education. the refugee cultural orientation program is a resource that could be used as a model in developing a training plan (cultural orientation resource center, 2018). always keep in mind that it is better to be proactive in providing information on u.s. laws rather than reactive. culturally relevant service delivery to ensure effective service delivery for uam, mainstream service providers and social workers should obtain training about the specific needs of this population, so services can be adapted. more specifically we saw that service providers enjoyed training specific to this population (usccb, 2013b) and therefore recommend training on trauma-informed care, cultural competency, and human trafficking for staff that interact with uam (morland et al., 2005). additionally, we recommend that agencies hire culturally diverse staff who can relate to uam to ease the adjustment process. this could include latinxs, spanish speakers, adults who came to the u.s. as a uam, people who have lived and worked abroad, or family members of uam. we often found that service delivery is most effective when culturally-relatable paraprofessional staff work alongside trained social workers to provide complementary aspects of holistic care (linsk, 2014), so that the uam have different people from whom they can seek guidance. client satisfaction surveys can be an excellent way to assess the perspectives of uam and their caregivers on their experience with the agency. it is important to note that these surveys should be made available in multiple languages, and administered verbally rather than in written form when necessary to better gauge each uam’s experience and feedback. advances in social work, spring 2018, 18(3) 798 community partnerships both managers and frontline staff play an important role in the development of formal and informal community partnerships. these relationships are crucial to ensure access to services for uam clients. a social worker’s ability to facilitate referrals to services for uam improves when there are pre-existing relationships between the social worker, their agency of employment, and external organizations. we recommend building and maintaining partnerships with community organizations such as legal providers, mental health clinics, health clinics, food banks, schools, and adult learning programs. additionally, churches can provide a wealth of assistance including financial support, volunteers, temporary housing assistance, child care, clothing, and food. morland et al. (2005) recommend partnerships with refugee service agencies and hosting “cross-service training” events that facilitate interagency communication, resource sharing, and coordination between local agencies. when a gap in resources or services is identified, seeking new opportunities for collaboration can ensure the need is met. this might mean reaching out to an existing organization to extend services to uam. in exchange for increased referrals, request that staff at the partnering organization partake in uam-related training and offer assistance with interpretation services for the child during appointments. these can be very fruitful partnerships as they create opportunities to develop new programming crafted to the specific needs of uam. for example, an agency that provides legal services to uam released from federal custody recently started to contract social workers after realizing that their uam clients need more than just legal help. this partnership has enabled uam and their families to connect with local services and resources in the community. while many uam encounter legal service providers, very few receive post-release services, so having a social worker on staff makes a significant impact. general recommendations in addition to specific recommendations linked to particular social work areas above, there are other recommendations that span all practice settings. for instance, all social workers should build trust and rapport with uam and their families so that they feel comfortable asking for help and referrals to the services they need (roth & grace, 2015). establishing a relationship requires that social workers are familiar with their client’s culture (aggarwal et al., 2016), respect their right to self-determination (nasw, 1996), and work with the client to resolve issues. additionally, social workers can educate families on their rights, dispel myths, and assist families in finding safe ways to engage with the community they live in. social workers and case managers should also help uam and their families to increase their knowledge of local resources and where to seek help in the community. social workers should first connect uam and their families to agencies that focus on services for latinxs, as these service providers will be best equipped to meet their cultural and linguistic needs. however, practitioners should not hesitate to refer families to mainstream services when a need cannot otherwise be met. when using mainstream providers, social workers should advocate that the agency (such as doctor’s offices, courts, and schools)provide evans et al./a call to action 799 interpretation for families who may need it. however, it is important to ask the family about their preferred language first because while spanish is the first language of many uam, some arrive with little or no familiarity with spanish and instead speak an indigenous dialect such as k’iche’ or mam (crea et al., 2017a). refer to the civil rights act of 1964, the affordable care act of 2010, and the court interpreters act, 28 u.s.c. §1827 to make providers aware of their obligation to provide interpretation (administrative office of the u.s. courts, n.d.; cme learning, 2017). if this is unsuccessful, social workers can connect uam to pro-bono language services such as college interns studying languages, community volunteers, telephonic interpretation, or web-based applications as needed. it is important to ensure that these individuals have received the required training to comply with the confidentiality regulations of interpreters. discussion grounded in years of experience working with uam across a variety of settings, this manuscript reimagines social work practice with these youth, highlights lessons learned, and proposes promising practices for social workers who may encounter uam in their daily practice. because uam are a relatively recent population, professional social workers who have been practicing for a while may not have learned about uam during their social work education. with the appropriate training, we can adapt mainstream service delivery to guarantee that the needs of uam are successfully addressed. it takes a community to provide uam with the full range of services that they may require. our recommendation to build community partnerships with other agencies is consistent with other areas of social work practice. for example, alter (2009) found that the sustainability of human service organizations today is highly dependent on the extent of their partnerships within the local community. moreover, few organizations that attempt to operate completely independently can function long-term. collaboration plays a critical role in strengthening the services available, meeting previously unmet needs, and achieving positive long-term outcomes (alter, 2009; shore, hammond, & celep, 2013). establishing relationships with places of worship for various religions is also highly recommended, as connecting unaccompanied minors with the appropriate faith-based institution can help them cope with their new surroundings and prevent feelings of isolation (raghallaigh, 2011). ensuring effective service delivery falls to supervisors, program managers, and macro social workers in most agencies. hiring both bilingual/bicultural paraprofessional staff (roth & grace, 2015; linsk, 2014) as well as trained social workers plays an important role in service delivery. similarly, earner (2005) recommends that specialists in child welfare and refugee and immigrant serving agencies be cross-trained to ensure that they are aware of the nuances of serving this population (morland et al., 2005); the advice for cross-training can span beyond child welfare. when thinking about adapting services to uam we also need to be cognizant of the differences among uam themselves. for example, a study found that uam from guatemala were eight times more likely to only achieve a k-12 education by time they discharged from foster care than youth from other advances in social work, spring 2018, 18(3) 800 countries (crea et al., 2017a), suggesting that cultural and linguistic differences have an impact on uam educational attainment. considering what we know about uam education, the ideas of prompt enrollment in local schools and welcoming school environments is key to their educational success. research shows that racism, xenophobia, acculturative stress, and behaviors of cultural discrimination can hinder immigrant students’ ability to succeed in the classroom (kumiyeboah & smith, 2017). however, when placed in positive school environments with supportive teachers, these students show incredible resiliency to succeed (kumi-yeboah & smith, 2017). furthermore, a study found that uam and other ells experience increased educational outcomes when they are integrated into classrooms with native englishspeaking students, rather than isolated into classrooms for newcomers for an extended period of time (beninghof & leensvaart, 2016; pardini, 2006). conclusion the number of central american uam in the u.s. has increased considerably since the early 2000s. these children flee their home countries for various reasons, including community violence, persecution, and economic hardship. their home situation and journey to the u.s. often includes traumatic experiences such as abuse, abandonment, violence, and involvement with smugglers. some services such as shelter care, post-release services, and long-term foster care are mandated by federal legislation and are designed to help uam when they arrive to the u.s. however, these services are limited in funding and scope, and therefore mainstream service providers need the knowledge and tools to appropriately adapt their services to meet the needs of uam. all social workers have a vital role to play in helping uam to process, overcome, and thrive in their new communities. references administration for children and families [acf]. 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(n.d.). child advocate program. retrieved from 28thttps://www.theyoungcenter.org/child-advocate-program-youngcenter/28t author note: address correspondence to: kerri evans, msw, lcsw. boston college school of social work, mcguinn hall room 204. 140 commonwealth avenue, chestnut hill, ma 02467 kerri.evans@bc.edu https://www2.ed.gov/policy/elsec/leg/essa/essatitleiiiguidenglishlearners92016.pdf https://travel.state.gov/content/adoptionsabroad/en/adoption-process/how-to-adopt/who-can-be-adopted.html https://travel.state.gov/content/adoptionsabroad/en/adoption-process/how-to-adopt/who-can-be-adopted.html https://doi.org/10.17226/21746 https://www.theyoungcenter.org/child-advocate-program-young-center/ https://www.theyoungcenter.org/child-advocate-program-young-center/ aggarwal, n. k., farias, p. j., becker, a. e., like, r., lu, f., oryema, n., & lewis-fernández, r. (2016). the role of cultural psychiatry in improving the policy response to central america’s unaccompanied minors at the american border: local and glo... kohli, r. k. s. (2011) working to ensure safety, belonging and success for unaccompanied asylum-seeking children. child abuse review, 20(5), 311-323. doi: https://doi.org/10.1002/car.1182 kumi-yeboah, a., & smith, p. (2017). cross-cultural educational experiences and academic achievement of ghanaian immigrant youth in urban public schools. education and urban society, 49(2), 434-455. doi: https://doi.org/10.1177/0013124516643764 linsk, n. (2014). strengthening families through para professionals in the social service workforce. presentation for global social service workforce alliance symposium. retrieved from http://www.socialserviceworkforce.org/system/files/resource/files/... lópez, g., & radford, j. (2017). facts on u.s. immigrants, 2015: statistical portrait of the foreign-born population in the united states. retrieved from the pew research center website: http://www.pewhispanic.org/2017/05/03/facts-on-u-s-immigrants-cu... ___________________ allison l. west, phd, msw is assistant scientist at the johns hopkins bloomberg school of public health, baltimore, md 21205. shari miller, phd, msw is associate professor, school of social work, university of georgia, athens, ga 30602. judith leitch, msw is a phd student at the school of social work, university of maryland, baltimore, md 20201. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 134-150, doi:10.18060/19809 professional socialization and attitudes towards interprofessional collaboration among graduate social work and health professions students allison west shari miller judith leitch abstract: although there is an aggressive push towards interprofessional collaboration in higher education as well as in practice, the traditional culture and organization of higher education, as well as the need for and history of disciplinary distinction, may impede these efforts. using an online survey, this study explored the relationship between professional socialization of 157 graduate students in four disciplines and their perceptions and attitudes about interprofessional collaboration. results indicate that first year students had more positive perceptions and attitudes about interprofessional collaboration than more advanced students. furthermore, social work students perceived themselves as having lower prestige than graduate-level nursing, pharmacy, and medical students. these findings suggest that, unless managed strategically, professional socialization may diminish positive perceptions and attitudes towards interprofessional collaboration. thus, social work educators should pay careful attention to the role of professional socialization and how it is manifest in both the explicit and implicit curriculum. keywords: interprofessional education; interprofessional collaboration; professional socialization collaborative interprofessional practice (ipp) is increasingly viewed as a critical means of addressing complex multidimensional problems in health and human services. in 2010 the world health organization (who) published a framework for action on interprofessional education & collaborative practice specifically recognizing collaboration between professions as “an innovative strategy that will play an important role in mitigating the global health crisis” (p.7). the institute of medicine (iom; 2003), the american public health association (2009), and the council on social work education (2012) have also articulated strong support for ipp. as an emphasis on ipp has gained ground, a necessary focus on education for ipp has emerged. centers, institutes, and other centralized structures focused on effective education for ipp have been proliferating at universities across the u.s. in 2012, the importance of this endeavor was underlined by the health resources services administration (hrsa) of the u.s. department of health and human services. hrsa, in conjunction with four private foundations, awarded $12 million to the university of minnesota’s academic health center to “provide national leadership in the field of interprofessional education and collaborative practice among health professionals” via the establishment of the national coordinating center for interprofessional education and collaborative practice – or cc-ipecp (hrsa, 2012, para.1). advances in social work, fall 2016, 17(2) 135 evidence suggests that ipp is associated with lower costs, decreased lengths of hospital stay, reduced medical errors, and enhanced quality of patient care (iom, 2003). research has consistently demonstrated that interprofessional collaboration is also essential in translating findings from research to practice and improving client outcomes (curran, sharpe, forestall, & flynn, 2008; mabry, olster, morgan, & abrams, 2008; syme, 2008). in research settings, interprofessional collaboration creates opportunities for improved access to funds, expertise, and instrumentation; it has also been shown to enhance researchers’ productivity and the extent to which they enjoy their work (van rijnsoever & hessels, 2011). in the context of the global arena, social workers are well-suited to be leaders in teambased collaborative processes. yet, there is little systematic research regarding social worker’s participation in and contributions to interprofessional endeavors. few studies have examined social workers’ attitudes towards or involvement in interprofessional collaboration (curran et al., 2008; ko, bailey-kloch, & kim, 2014; leipzig et al., 2002) or the idea of differential professional cultures and ways in which they have bearing on interprofessional relationships (hall, 2005). interprofessional practice and social work there is a growing body of literature that supports the value of interprofessional collaboration within the field of social work (bronstein, mizrahi, korazin-korosy, & mcphee, 2010; matto & strolin-goltzman, 2010; sharland, 2012). the practice of integrating research from other disciplines is increasingly encouraged in light of mounting evidence linking the biological and social sciences. matto and strolin-goltzman (2010), for example, suggested that increased integration of neuroscience into social work will help advance practice-based research. in addition, studies have demonstrated that inclusion of social work services increases effectiveness in health care prevention and treatment (freshman, rubino, & chassiakos, 2010; kenny, sparks, & jackson, 2007). some research has examined factors associated with interprofessional collaboration among social work and other allied health professional students. results from two studies demonstrated that social work students had more positive attitudes towards teamwork than medical students (curran et al., 2008; leipzig et al., 2002). hawk et al. (2002) found that attitudes towards interprofessional collaboration differed among graduate professional students depending on their program of study but not race, age, or gender. however, in a study of research collaboration, van rijnsoever and hessels (2011) found that female students were more likely than male students to engage in collaboration. the vast majority of social workers are female (u.s. bureau of labor statistics, 2014), thus gender may be a confounding factor in studies examining collaboration. further, when considering the cultural and historical contexts within which professions emerge and evolve, the very reasons why there are such notable gender disparities among the population of social workers in and of itself may have bearing on attitudes toward collaboration. west et al./professional socialization 136 interprofessional education and social work growing appreciation for the value of interprofessional collaboration in social work practice has led to a subsequent increase in interest in interprofessional education (ipe). with the publication of the council on social work education’s (cswe) 2015 educational policy accreditation standards (epas), interprofessional collaboration was codified as a necessary element of social work education and practice. ipe is a pedagogical approach that involves educators and learners from two or more professional disciplines learning about, from, and with each other to develop attitudes, knowledge, and skills with the ultimate goal of improving collaboration and client care (barr, freeth, hammick, koppel, & reeves, 2006; buring et al., 2009; who, 2010). the authors of the who framework (2010) suggest that ipe can play a significant role in the development of a collaborative practice-ready workforce, which can help reduce barriers to optimal care faced by health systems around the world. ipe does not simply entail students from multiple disciplines receiving the same learning experience, nor is it faculty from one field teaching or mentoring students from another; rather, it is a fully integrated or shared learning and decision-making process (buring et al., 2009). whereas interest in promoting ipe within bsw and msw programs appears to be increasing, evidence suggests that few social work programs incorporate interprofessional learning as an integrated component of the curriculum (bronstein et al., 2010; mcpherson, headrick, & moss, 2001; reeves et al., 2010). a literature search using the terms “social work” and “interprofessional education” identified numerous articles concerning specific curricula or approaches to ipe. though most of these articles are exclusively conceptual or descriptive, they represent efforts at organized collaboration between social work and a wide variety of disciplines including nursing, medicine, dentistry, occupational therapy, physical therapy, pharmacy, chaplaincy, education, nutrition, and law. in social work, dual degree programs and/or formal teaching arrangements are particularly common approaches to ipe (bronstein et al., 2010; simms, 2011). other popular strategies found in the social work literature include one-time seminars and year-long field education experiences, although examples of more longitudinal, integrated programs also exist (pecukonis et al., 2013). yet despite growing interest in ipe, there remains a dearth of evidence regarding the most effective format and structure for ipe learning experiences. a recent systematic review of studies examining the effectiveness of ipe programs demonstrated mixed results; whereas some programs evidenced positive outcomes, others appeared to have no impact on health care processes or patient outcomes (reeves et al., 2010). professional socialization and social work when considering ipe, it is also essential to recognize that professions are cultures unto themselves, replete with values, attitudes, and norms into which practitioners are socialized (miller, 2010, 2013). given the complex matrix of factors that define each profession’s culture, and the likely differences between professional cultures, interprofessional efforts may then become exponentially more complex. in order to better understand these interprofessional efforts, and how to deploy educational and practice advances in social work, fall 2016, 17(2) 137 models effectively in the context of current and potentially shifting structures, the need to factor in the dynamics of professional socialization becomes essential. professions are characterized as cultures into which students and practitioners are continually socialized over the course of their careers (barretti, 2004b; miller, 2010, 2013). in the context of ipe and practice, consideration for the intersection of these professional cultures, and the need to understand them with proficiency, if not fluency, becomes elemental. the process of becoming professionally socialized emerges through a complex system of formal and informal processes and relationships (barretti, 2004a) that begin before formal professional education and continue as professionals make dynamic adaptations in practice (barretti, 2004b; miller, 2010, 2013; shuval, 1980). notions of professional socialization have been infused in the culture of social work education since its inception; however, it was not until 2008 that the construct was articulated in cswe’s educational policy and accreditation standards (miller, 2013). professional socialization is generally considered a positive and vital process. studies of doctoral students have indicated that professional socialization is essential to a successful graduate school experience and that inadequate socialization may lead to attrition (clark & corcoran, 1986). a framework for understanding professional socialization in 2010, miller presented a multi-dimensional framework for understanding the professional socialization of social workers adapted from a long-developing and wellestablished body of knowledge in medicine and nursing. this adapted theoretical model incorporates aspects of both symbolic interactionism and structural functionalism, suggesting that socialization results from both intended and unintended influences, and that role modeling and critical self-reflection may play key roles. the framework organizes professional socialization as a process of ongoing change that includes three stages: presocialization, formal socialization, and practice after formal socialization. pre-socialization is inclusive of the influence of both prior (primary, early) socialization and anticipatory socialization, both of which have bearing on the choice to pursue formal social work education. as students anticipate entering the culture of social work, they begin a process of internal and external reorganization around role identity, attitudes, norms, and values that they believe are emblematic of the professional culture into which they are about to enter. according to the literature, this phase seems to have a strong relationship to the continued process of professional socialization (abbott, 1988; bargal, 1981; barretti, 2004b; miller 2010, 2013; shuval, 1980). formal socialization encompasses the period of time during which a student is engaged in earning a social work degree. this phase is influenced by a number of factors including course content and relationships with others, including professors, field instructors, colleagues, clients, and fellow students. the third phase, practice after formal socialization, recognizes that professional socialization is not a concrete and static outcome, but is a process with discrete cultural components that continues to unfold over time. this phase presumes that practitioners have adequate agency and are active decisionmakers in how they locate themselves in the culture. this phase also presumes that practitioners are nimble in situationally adapting to varying practice contexts. research west et al./professional socialization 138 suggests there are number of potential factors that relate to how social workers are professionally socialized and ways in which that socialization influences chosen practice pathways and ways of engaging in practice (miller, 2013). with this framework as a backdrop, there are additional factors to consider, in particular when trying to understand the complex interactions necessary for effective interprofessional collaboration. interactions with people outside the field of social work may also impact the socialization process. for example, interactions with professionals from other disciplines may influence how a social work student views her/himself as well as others within her/his profession. miller’s (2010) framework suggests that, through the lens of symbolic interaction, students (and later practitioners) construct their professional identity in some ways by choosing who to include in their generalized other. this professional generalized other could include colleagues, peers, classroom instructors, field instructors, and clients from within the culture of social work, and it can also include other professionals with whom they have contact in the field. the framework suggests that social workers actively make choices about what messages and information to reject or incorporate, and those choices can also evolve over time. building in an explicit facet of role theory may help inform our understanding of role expectations as well as the value each profession places on autonomy within an interprofessional setting. although a strong sense of professional role is an imperative component of both professional socialization and successful collaboration, placing too high a value on one voice may inhibit effective collaboration as well as effective client care (clark, 1997). because social workers often work in interprofessional teams in which theirs may not be the dominant voice, social work educators are challenged to nurture a strong sense of autonomy, respect for the contributions of other disciplines, and a well-honed ability to effectively negotiate some of these challenges. the nexus of professional socialization and interprofessional collaboration if not carefully facilitated, instead of encouraging understanding and interactions with other disciplines, the process of professional socialization could widen the gap between social workers and other types of professionals and thus may contribute to the creation of silos of learning, practice, and research (syme, 2008). discipline-specific boundaries are often further solidified via involvement in professional societies and professional publications (boden, borrego, & newswander, 2011). thus, a natural tension appears to exist between discipline-specific socialization and the need for interprofessional collaboration. notably, two social work scholars have written about the tension that lies at the intersection of disciplinarity and interdisciplinarity. sharland (2012) suggested that the distinction between disciplinarity and interdisciplinarity is muddled by the heterogeneous nature of the social work profession, a general lack of internal cohesion as a profession, as well as confusion as to the nature of social work as a discipline. a portion of this confusion stems from the heavy reliance on knowledge from other disciplines, as well as social workers’ presence in a diverse range of practice settings. couturier, gagnon, carrier, and etheridge (2008) took a more philosophical stance, asserting that epistemological advances in social work, fall 2016, 17(2) 139 differences between disciplines are an “unavoidable condition” of collaboration, and that the true value of interdisciplinarity stems from a meeting of epistemologies that results in a transformation in “the very act of knowing” (p. 341). when considering the evolution of professional cultures, the role of epistemological orientation has direct relevance to professional socialization. thus disciplinarity and interdisciplinarity can be understood as two sides of the same coin, with one unable to exist without the other. a better understanding of how attitudes towards interprofessional collaboration change over the course of a graduate program will provide valuable insight into current educational practices as well as potential curricular needs. such insight is crucial if we hope to equip social workers with the requisite skills and abilities to effect significant positive change within multidisciplinary settings. the purpose of this exploratory study was to examine the relationship between stages of professional socialization of social workers and attitudes towards interprofessional collaboration. this study explored differences in attitudes towards collaboration between the first (pre-socialization) and later years of graduate study (formal socialization) of different professional graduate-level disciplines. the study addressed the question: do stage of socialization and graduate program of study predict students’ attitudes towards interprofessional collaboration? based on the theoretical framework of this study, we expected that as graduate students became increasingly socialized to their disciplines over time, greater professional socialization would be associated with less positive attitudes towards interprofessional collaboration. method participants and procedures this exploratory study was part of a larger study that examined attitudes, perceptions, and experiences related to interprofessional collaboration among graduate professional students. an internet questionnaire was distributed through a student government association to all students enrolled in graduate professional degree programs at a large public mid-atlantic university. because the focus of this research was on collaboration among professionals from allied health care disciplines, the sampling frame was limited to a subset of students who were pursuing masters or professional doctorate degrees in nursing, social work, pharmacy, or medicine (n=3,396). the survey was disseminated via an e-mail link to the entire student population during the first week of the fall semester with a reminder and link distributed two weeks later. no incentive was provided to students for survey completion. of the students who met the eligibility criteria, 228 completed the survey (response rate of 6.7%). seventy-one cases were removed from the analyses because students failed to clearly indicate the year in which they entered the program, whether they were full or part-time students, and/or they did not complete at least 50% of the items on the interdisciplinary education perception scale (ieps; luecht, madsen, taugher, & petterson, 1990). the final sample included 157 graduate professional students. although the response rate was low, the sample size was deemed sufficient in light of the exploratory nature of this research. this is one of the first studies to begin to consider the relevance of professional socialization to ipe and provides a useful foundation for future research. west et al./professional socialization 140 measures demographics. respondent’s self-reported age was a continuous variable included as a covariate based on prior research and theory. programs of study (social work, medicine, nursing, pharmacy) were dummy-coded, with social work serving as the reference group. professional socialization. though this construct overall is quite complex, as a beginning point for the purposes of this exploratory research, year of study served as a proxy for professional socialization, given that there is an expectation that socialization to a profession will develop over time. respondents indicated the year that they began their graduate program (2009-2012) and whether they were attending as fullor part-time students. part-time students in the first or second year of study were re-coded as being in year one of their graduate program, as this label was felt to represent the level and number of courses in which they would be enrolled, time spent in coursework, and interaction with student peers. similarly, part-time students who entered in years 2009 or 2010 were recoded as year two. perceptions of interprofessional collaboration. the interprofessional education perception scale (ieps; luecht et al., 1990) is a commonly used self-report perceptual/attitudinal inventory designed to assess concepts related to successful interprofessional teamwork. the original scale was comprised of 18 items divided into four subscales: competency and autonomy, perceived need for cooperation, perception of actual cooperation, and understanding others’ value. subsequent research seeking to refine the measure has produced alternate versions which have demonstrated stronger psychometric properties (leitch, 2014; mcfadyen, maclaren, & webster, 2007; vaughan, macfarlane, dentry, & mendoza, 2014; williams & webb, 2013). recently, leitch (2014) proposed a 16-item version of the ieps that is grounded in current theory and research in the area of interprofessional collaboration. this revised version contains three subscales: competency and autonomy, cooperation, and prestige. the competency and autonomy subscale contains items designed to tap feelings about competence of self and others within their profession such as, “individuals in my profession trust each other's professional judgment.” the cooperation subscale contains items tapping attitudes about working with other professions such as, “individuals in my profession need to cooperate with other professions.” notably, this is the first iteration of the ieps to include a scale that isolates perceived prestige as a factor presumed to influence collaboration. an example item from the prestige subscale is, “individuals in other professions respect the work done by my profession.” the instrument is a likert-type scale with response options ranging from “strongly disagree” (1) to “strongly agree” (6). items within each subscale are added to create a sum score, with higher scores indicating more positive perceptions of interprofessional collaboration. subscale scores were used as dependent variables in analyses in lieu of the total scale score to allow for a more nuanced understanding of attitudes towards collaboration. in this study, the ieps subscales demonstrated good internal consistent reliability for competency and autonomy (α=.82) and prestige (α=.80), with lower reliability for cooperation (α=.64). advances in social work, fall 2016, 17(2) 141 data analysis a series of three two-step hierarchical multiple regression analyses assessed the effects of age, program of study, and year of study on each of the three subscales of the ieps: competency and autonomy, prestige, and cooperation. age and program of study were entered in step one. year of study was entered in step two. for cases with missing data on individual ieps items, item scores were imputed using regression imputation. statistical assumptions for multiple regression analyses were tested and met for all variables. data analyses were conducted using spss v. 20. results the mean age for all 157 students was 30.6 years (sd=10.05, min=19, max=59). just under half of the students in the sample were in their first year of graduate study (n=74, 47.1%), and just over half were in their second, third, or fourth year of study (n=83, 52.9%) (see table 1). medical students had the highest competency and prestige scores while pharmacy students had the highest scores for cooperation (see table 2). bivariate correlations for each of the ieps subscales, age, program of study, and year of study are provided in table 3. table 1. participant characteristics by program of study (n=157) social work (n=52) medicine (n=24) nursing (n=36) pharmacy (n=45) f (%) f (%) f (%) f (%) gender (male) 2 (3.9) 4(16.7) 2 (5.6) 8 (18.2) enrollment status (full-time) 46 (88.5) 24(100) 17 (47.2) 37 (84.1) year* first 26 (50) 8 (33.3) 20 (55.6) 20 (44.4) second, third, or fourth 26 (50) 16 (66.6) 16 (44.4) 25 (56.8) *year incorporates ft/pt status table 2. ieps subscale scores by program of study (n=157) subscale social work m (sd) medicine m (sd) nursing m (sd) pharmacy m (sd) competency 28.5 (3.9) 30.8 (2.8) 29.4 (3.9) 30.4 (3.7) prestige 14.4 (3.2) 20.0 (2.5) 17.6 (3.8) 16.7 (2.9) cooperation 29.8 (3.3) 28.4 (2.4) 30.9 (3.1) 31.3 (2.4) west et al./professional socialization 142 table 3. correlation matrix for model variables 1 2 3 4 5 6 7 8 9 1. age 1 2. first year of study .09 1 3. nursing .49** .09 1 4. medicine -.20* -.12 -.23** 1 5. pharmacy -.17* -.03 -.35** -.27** 1 6. social work -.12 .04 -.38** -.30** -.45** 1 7. competency & autonomy -.02 .12 -.03 .14 .13 -.20* 1 8. prestige .13 .22** .14 .39** .01 -.43** .39** 1 9. cooperation .14 .14 .12 -.27** .22** -.11 .56** .24** 1 * p ≤ .05, **p ≤ .01 (2-tailed). competency and autonomy results from multiple regression analyses are presented in table 4. in step one, age and program of study accounted for only 5.6% of the variance in competency and autonomy, f(4, 152)=2.25, p=.07. adding year of study to the model explained an additional 2.2% of the variance. although the change in r2 from step one to step two was not significant, the final model including all predictors was significant, f(5, 151)=2.55, p=.03. results from the final model indicated that medical students, b=2.29, t=2.49, p=.01, and pharmacy students, b=1.86, t=2.46, p=.02, scored higher on this subscale relative to social work students after controlling for age and year of study. there were no differences between nursing and social work students. the positive coefficient for year of study suggested that there was a trend for first year students to score higher than second year students on the competency and autonomy subscale after controlling for age and program of study, b=-1.13, t=-.15, p=.06. table 4. unstandardized multiple regression results (n=157) competency and autonomy prestige cooperation δr² b δr² b δr² b step 1 .06 .28*** .12** age 0.01 0.06† 0.03 nursing 0.77 2.54*** 0.86 medicine 2.29** 5.70*** -1.34† pharmacy 1.86* 2.34*** 1.54** step 2 .02 .06*** .01 age 0.00 0.05† 0.02 nursing 0.74 2.47*** 0.84 medicine 2.47** 6.01*** -1.23† pharmacy 1.92** 2.44*** 1.58** first year of study 1.13† 1.87*** 0.66 total r² .08* .34*** .13** note. social work is the reference group. note. coefficients are from final the model including all predictors. † p ≤ .10, *p<.05, **p<.01, ***p≤.001 advances in social work, fall 2016, 17(2) 143 prestige for the prestige subscale, in step one age and program of study accounted for 28% of the variance, resulting in an overall significant model, f(4, 152)=14.77, p <.001. adding year of study explained an additional 6.4% of variance and resulted in a significant change in r2 and a significant model overall, f(5, 151)=15.84, p <.001. results from the final model indicated that medical students, b=6.01, t=7.97, p <.001, pharmacy students, b=2.44, t=3.96, p <.001, and nursing students, b=2.47, t=3.44, p=.001, scored higher on the prestige subscale relative to social work students after controlling for age and year of study. in addition, first year students scored significantly higher on prestige than second year students on this subscale after controlling for age and program of study, b=1.87, t=3.84, p < .001. cooperation for the model predicting scores on the cooperation subscale, in step one age and program of study accounted for 11.9% of the variance, resulting in an overall significant model, f(4, 152)=5.15, p=.001. adding year of study explained only 1.2% additional variance. this change was not significant. results from the final model indicated that pharmacy students scored higher on the cooperation subscale relative to social work students after controlling for age and year of study, b=1.58, t=2.71, p=.008. year of study did not account for a significant amount of unique variance in cooperation after controlling for age and program of study. discussion results of these analyses suggest that both field of study and year of study may be associated with perceptions of and attitudes toward interprofessional collaboration. overall, graduate students in this sample reported positive attitudes toward collaboration. this finding is encouraging, as prior research has shown that health professionals’ attitudes towards their own and other professions influence effective interprofessional collaboration (hind et al., 2003). the results, however, revealed differences by field of study on all subscales of the ieps. on the prestige subscale, social work students scored lower than medicine, nursing, and pharmacy students. the prestige subscale includes items that tap into students’ perceptions of how others view their profession; for example, “people in other professions seek the advice of people in my profession.” this finding raises important questions regarding the self-perceptions of social work students and the possible ways in which professional socialization may contribute to deficits in perceived value and status. this set of perceptions, which may be an artifact of the profession’s historical evolution and endemic to the culture of social work, may have serious implications for both ipe and practice. on the cooperation subscale, social work students’ scores were similar to those of nursing students, lower than pharmacy students, and slightly higher than medical students. this subscale includes items that reflect concepts likely to foster collaboration such as “individuals in my profession are able to work closely with individuals in other professions” and “individuals in my profession must depend on the work of people in other west et al./professional socialization 144 professions.” on the competency and autonomy subscale, medical and pharmacy students rated themselves higher than social work students on items reflecting perceptions of their own competency. the finding that students from some fields of study exhibited more positive attitudes and perceptions than others is consistent with prior research (curran et al., 2008; hawk, byrd, & killinger, 2001). these results also add to the understanding of differences among professions because most prior studies focused on or included undergraduate students as participants or lacked the necessary statistical power to detect differences between multiple health professions. consistent with our expectations, year of study was also associated with perceptions and attitudes towards collaboration. the findings revealed that year of graduate study was associated with variability in scores on the prestige subscale. there was also a marginal effect of year of study on the competency and autonomy subscale. specifically, first year students rated themselves higher on questions related to prestige and competency relative to more advanced students. this appears to be one of the only studies to date that examines differences in ieps scores based on year of graduate study, as well as one of the only studies to include the dimension of prestige when considering attitudes towards interprofessional collaboration. the findings suggest that first year students have more positive perceptions of and attitudes towards interprofessionalism than more advanced students. these results are consistent with the stage-based framework of professional socialization (miller, 2010), in which students in the anticipatory or pre-socialization stage are filled with enthusiasm and idealism towards their intended profession, which then may shift or narrow as they move further out into practice (miller, 2013). since administration of the ieps occurred during student orientation and extended into the first week of graduate school classes, first year students in this study could be thought of as still in this anticipatory phase. in contrast, second year students have progressed into the formal socialization phase. in this phase, students are confronted with the realities of their profession, which may in turn result in a decrease in idealism (miller, 2013). participants in this study were graduate professional students, many of whom engaged in field experiences that exposed them to other professions. thus, it is possible that this exposure to and interactions with professionals from other disciplines may have also influenced their thoughts and feelings regarding interprofessionalism. limitations results of this study should be interpreted with caution due to a number of limitations. first and foremost, response bias may be a concern due to the low response rate, as well as the possibility that students who have had interprofessional experiences may be more invested in collaboration and thus may be more likely to participate in a related research study. in addition, analysis of the sample demographic characteristics suggested that the study sample may not accurately represent the student population at large. male students were underrepresented in the current sample, which precluded the ability to include gender as a covariate in the analyses. future research should address this gap, particularly since some prior studies have demonstrated relationships between gender and collaboration (van rijnsoever & hessels, 2011). the fact that the sample was drawn from a single graduate school limits the generalizability of the results. independence of observations cannot be advances in social work, fall 2016, 17(2) 145 guaranteed as there was no way to be certain that every student received the survey and/or that they completed the survey only once. it is also important to note that professional socialization is a complex process and this study uses only one variable as a proxy for that process. although the results from this study demonstrate a decrease in positive perceptions of collaboration from year one to years two to four, the findings do not address potential changes in attitude over a longer period of time. it is possible that positive attitudes increase into later years of study or upon entry into a professional position. implications this exploratory study begins to lay the groundwork for further research investigating the relationship between ipe and practice, and the impact of differential professional socialization. given the global trends toward ipp, models of effective ipe are becoming increasingly important. with its history and overall ethos, social work is well-situated to not only be at the interprofessional table, but also to take a leadership role in developing and facilitating effective means of both ipe and practice. the findings from this study raise a number of questions and highlight the need for more systematic inquiry into the role of social work in ipp and in building effective models for ipe. the results suggest that challenges associated with ipe and practice may have roots in the complex process of professional socialization. how practitioners make their way into, and then locate themselves within the context of their respective professional cultures, which are informed by long and rich histories, may be key to understanding how to maximize the benefits of ipe. efforts to develop conceptual models that clarify pathways to interprofessional socialization will be important next steps in informing further research in this area, but also in developing innovative and effective models of ipe. whereas social work students in this sample perceived their profession to be of lesser prestige in the realm of ipp, medical students perceived their profession to be one that fosters less effective collaborative skills. if one considers the differences between social work and medicine historically and culturally, these findings are not at all surprising. over the course of its lifetime in the u. s., social work has struggled with its own identity from within (flexner, 2001), and has also struggled to be understood from without. whereas medical doctors have garnered a reputation as experts whose decisions may have immediate life and death impact, they have also been acculturated to make those expert decisions in isolation. social workers also scored relatively low on their perceptions of the importance of collaboration compared to pharmacy students. this finding raises practical concerns regarding social workers’ interest in and commitment to activities that require high levels of collaboration. some of these activities, including advocacy and community organizing, are thought to be hallmarks of the social work profession. there is also the possibility that the ways in which social workers are being socialized to understand their perceived roles in interprofessional teams has bearing on the perceived importance of collaboration. future studies should attempt to untangle the associations among how social work students and practitioners understand collaboration, their expected explicit and implicit roles in that process, and the possible intersection with perceived professional prestige. west et al./professional socialization 146 further research is needed to better understand the relationship between disciplinespecific socialization and attitudes towards interprofessional collaboration over time. this study points to the potentially problematic relationships between these two constructs during the first years of graduate education; however, the nature and direction of potential changes over time is unknown. understanding how attitudes fluctuate over time will indicate whether this pattern is resolved as a consequence of additional education and exposure or whether the circumstances require targeted intervention. interventions may include models of ipe with explicit content about professional socialization, along with explicit and implicit curricula that simultaneously facilitate and integrate both professional and interprofessional socialization. the finding that medical, pharmacy, and nursing students evidence higher scores on prestige after controlling for year of study hints at elements of professional culture and where they fit within the larger context of professions. these fields may also be incorporating aspects of ipe in effective ways that can potentially inform efforts in social work education. the aim of this study was to explore the relationship between aspects of professional socialization and attitudes towards interprofessional collaboration in a sample of graduate professional students. the study also explored social work students’ attitudes relative to other graduate professional students with whom they are likely to interact in interprofessional settings. the results highlight both the need for efforts to build effective models of ipe that integrate professional and interprofessional socialization as well as future research in this area. with the world health organization’s (2010) recognition that interprofessional collaboration will 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(2010). framework for action on interprofessional education & collaborative practice. retrieved from http://whqlibdoc.who.int/hq/2010/who_hrh_hpn_10.3_eng.pdf author note: address correspondence to: allison west, department of population, family, and reproductive health, johns hopkins bloomberg school of public health, 615 n. wolfe street, baltimore, md 21205, awest25@jhu.edu. http://www.bls.gov/cps/cpsaat11.htm http://dx.doi.org/10.1016/j.respol.2010.11.001 http://dx.doi.org/10.5959/eimj.v6i3.259 http://dx.doi.org/10.1016/j.nedt.2012.10.015 http://whqlibdoc.who.int/hq/2010/who_hrh_hpn_10.3_eng.pdf ________ sara makki alamdari, ma, msw, phd, west texas a&m university, canyon, tx. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 114-131, doi: 10.18060/23687 this work is licensed under a creative commons attribution 4.0 international license. civic attitudes and engagement among middle eastern and north african refugees and immigrants in the u.s. sara makki alamdari abstract: given the importance of civic engagement to the well-being of immigrants and refugees and their communities, the goal of the current study was to investigate civic attitudes among immigrants and refugees from the middle east and north africa (mena). first, the researcher examined predictors of civic attitudes. second, the mediating effect of attitudes between the potential predictors (i.e., gender, health status, english proficiency, and the u.s. length of stay) and level of civic engagement was investigated. the researcher recruited 145 respondents to complete online and paper-based surveys. using linear regression models, the results show that health and english language proficiency significantly predict civic attitudes among this group. attitudes also mediated between health status and level of civic engagement. this study provides some implications for social work, resettlement programs, health policies, and civic organizations that can be beneficial for the target group as well as for the host communities. keywords: civic engagement; civic attitudes; refugees; immigrants; middle east; north africa civic engagement refers to the ways in which community members or people take collective action with the purpose of addressing community or public challenges and improving conditions for others (adler & goggin, 2005; checkoway, 2009). civic activities can have a variety of forms such as volunteering, donation, group involvement, political action, community service, and media use (gastil & xenos, 2010; keeter et al., 2003; uslaner & brown, 2005). civic engagement can bring many benefits for individuals and communities. individuals’ social skills and networks can be improved as a result of being civically engaged in their communities (chan, 2011; hope & jagers, 2014; weng & lee, 2016). individuals’ well-being, health, and life satisfaction can also be enhanced by civic engagement (dabelko-schoeny et al., 2010; gele & harsløf, 2012). on a larger scale, civic engagement is beneficial in improving social and human capital, citizenship, and democracy as well as the quality of public life (handy & greenspan, 2009; makki alamdari & jalaiepour, 2012; putnam, 1995; tucker & santiago, 2013). taking into account its benefits for individuals and societies, studying civic engagement among different groups is valuable and can provide important implications for the social work profession. in this vein, this research was interested in immigrants and refugees living in the u.s. although refugees and immigrants leave their home country for different reasons and have different lived experiences, they still have much in common in terms of culture, religious beliefs, history, language, and some post-migration experiences such as under-employment, language barriers, and discrimination (aroian et al., 2008). every year, a considerable number of immigrants enter the u.s. for various reasons. in 2017, nearly 1.9 million individuals obtained lawful permanent residence, were naturalized in the u.s., or entered the u.s. as a refugee (department of homeland security, 2019). immigrants and refugees from the middle east and north africa https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2020, 20 (1) 115 (mena) are the particular focus of this study as they are understudied (read, 2014; zarpour, 2013). there are 20 countries in this region including algeria, bahrain, djibouti, egypt, iran, iraq, jordan, kuwait, lebanon, libya, morocco, oman, qatar, saudi arabia, palestine, sudan, syria, tunisia, united arab emirates, and yemen (office of the high commissioner for human rights [ohchr], 2019). almost 6% of the world’s population lives in this area (world bank, 2019). these countries share many cultural commonalities. for example, the dominant religion is islam (pew research center, 2015) and collectivism is the more valued culture (schwartz et al., 2010). unfortunately, negative perceptions regarding this immigrant community are prevalent in the u.s. (makki alamdari, 2020; strabac et al., 2014). considering the rise of negative public perceptions regarding muslims (abu-ras, 2013; emami, 2018; vergani et al., 2017), examining civic engagement among this group is imperative especially given the limited number of studies with this group (makki alamdari, 2017; makki alamdari & bishop, 2020). literature review civic engagement can be examined in terms of skills, attitudes, knowledge, goals, and behavior (crocetti et al., 2012). for the purpose of this study, the researcher was interested in examining attitudes towards civic engagement. civic attitudes include the sense of social responsibility and commitment (i.e., a sense of duty to community), tolerance of diversity, civic pride, civic faith, and civic efficacy (i.e., belief that one is able to impact the community; crocetti et al., 2012; gastil & xenos, 2010; o'leary, 2014). the purpose of this study was twofold. first, the researcher examined the factors that may predict the civic attitudes among the target population. in association with civic engagement behavior such as volunteering and organizational membership, studies have examined a variety of predictors such as educational level, length of stay in the host country, health status, age, employment, family income, acculturation, gender, marital status, social networks, and identity (chan, 2011; handy & greenspan, 2009; sundeen et al., 2009; tucker & santiago, 2013; weng & lee, 2016). although these factors have not been particularly examined regarding civic attitudes, they are critical to consider. examining all these factors was out of the scope and resources of this study. for purposes of this study, the researcher examined four factors including gender, health status, local language proficiency, and the length of stay in the host country. health status and gender are frequently discussed and underlined as important factors in the study of immigrants and refugees (bishop & makki alamdari, 2018; makki alamdari et al., 2016; sundeen et al., 2009). the last two factors—language proficiency and length of stay—are specifically relevant to the condition of immigrants and refugees. gender. in a study of high school students in italy, crocetti et al. (2012) conceptualized civic attitudes as social responsibility, and found significantly higher scores among females. although the study by crocetti et al. (2012) was not specific to immigrants and refugees, it was relevant because it investigated civic attitudes in regard to gender. similarly, emami (2018) examined about 350 iranian diaspora in the u.s. and highlighted that women were more active than men in joining interest groups for the purposes of advocacy. studying monetary donations among nearly 1,300 adults in chile, luengo kanacri et al. (2016) reported that women were significantly more involved than men in this form of civic engagement. while their study was not makki alamdari/civic attitudes & engagement 116 specifically regarding immigrant or refugee population, it is an important study for examining the effect of several factors on civic engagement among a large population of adults (luengo kanacri et al., 2016). health status. most studies in this area investigated the effects of civic engagement on health (brown et al., 2017; chandra et al., 2016). however, a few considered the effects of health on civic involvement, which are mainly in the western context. for example, ding, berry, and o'brien (2015) and emerson, hatton, robertson, and baines (2014) conducted secondary analyses with nationally representative samples in australia and the uk, respectively, and found that higher levels of civic and social participation and more positive perceptions of neighborhood were predicted by higher levels of self-reported health and mental well-being. emerson et al. (2014) also found a significant difference in membership in civic organizations between those with intellectual disabilities and non-disabled peers. examining political participation in wisconsin, burden, fletcher, herd, moynihan, and jones (2017) reported cognitive and physical well-being as powerful factors influencing voting behavior. local language proficiency. the host country’s language is a critical factor for immigrants and refugees in their civic engagement because it allows for improved communication, resilience, and integration in the new society (pieloch et al., 2016; voicu & rusu, 2012). boyd (2009) studied immigrants in canada and found that language skills are significantly associated with types and levels of civic engagement. similarly, van londen, phalet, and hagendoorn (2007) examined nearly 1,200 turkish and moroccan immigrants in the netherlands and reported dutch language mastery as a significant factor contributing to political participation. studying obstacles to civic engagement in miami’s haitian immigrant community, stepick, stepick, and kretsedemas (2001) found language difficulties as a major challenge. length of stay in the host country. voicu and rusu (2012) and gidengil and stolle (2009) studied immigrants in spain and canada and indicated the length of stay in the host country as a factor influencing immigrants’ involvement in civic associations and political participation through increasing exposure to such activities. using mixed methods, handy and greenspan (2009) studied immigrants in four cities of canada and reported that established immigrants were more likely to be involved in community volunteering activities. the second purpose of this study was to investigate the mediation effect of attitudes between the aforementioned four factors and level of civic engagement behavior. according to psychological theories, civic attitudes and behaviors can have complex reciprocal causal relationships (crocetti et al., 2012; gastil & xenos, 2010). civic attitudes are considered as an important factor that potentially predicts level of civic engagement. this is consistent with several studies that consider civic or sociopolitical attitudes as a mediator or predictor of civic engagement behavior (ahmadu et al., 2016; crocetti et al., 2012; hope & jagers, 2014; luengo kanacri et al., 2016). for example, crocetti et al. (2012) studied around 400 italians and reported attitudes as a mediator between identity and civic engagement. in this study, they conceptualized attitudes as a sense of social responsibility (crocetti et al., 2012). ahmadu et al. (2016) and hope and jagers (2014) studied nigerians and african-americans, respectively, and found sociopolitical attitudes and political efficacy belief as significant predictors of the level advances in social work, spring 2020, 20 (1) 117 of civic engagement. in a study of 1,300 chileans, luengo kanacri et al. (2016) found beliefs about poverty as a predictor of monetary donations. the examination of civic attitudes and its mediating effects among mena refugees and immigrants is a research area that remains understudied. in sum, the purpose of this study was to address these gaps in our knowledge of civic engagement among immigrants and refugees to the u.s. from mena. the primary research questions were: 1. what factors predict civic attitudes among the target group? 2. does attitude mediate between its potential predictors and civic engagement behavior? method participants and procedures four inclusion criteria were used to identify participants for this study: a refugee or immigrant from mena; a u.s. citizen or permanent resident; having the ability to read english; and age 18 or above. because of the inaccessibility of this population sub-group, non-probability convenience sampling was applied. the researcher recruited individuals from facebook pages created for the target population as well as from locations such as restaurants and ethnic grocery stores that this group was more likely to visit. these locations were in the capital city of an eastern u.s. state. before posting flyers, permission was obtained from the managers at these venues. for those recruited through facebook, an online version of the survey was offered. the first recruitment phase was followed with two reminders in subsequent weeks. those recruited in groceries or restaurants filled out the paper version in the location. the researcher had a table and sat in the location in three different time slots for the purpose of survey administration. the researcher obtained institutional review board (irb) approval to ensure ethical considerations. those eligible and interested in participating were given/presented a study information sheet summarizing the purpose and requirements of the study. measures the survey was in english language and included four sections: screening questions; demographics; civic attitudes; and level of civic engagement (behavior or involvement in civic activities). screening questions were to check age, if the person was a u.s. citizen or permanent resident, and if they were originally from one of the 20 mena countries. demographics. five demographic variables were included for the purpose of describing the respondents. gender was asked using three options of male, female, and other. the researcher used a closed-ended question to ask month and year of entrance to the u.s. this question was used to calculate the length of u.s. stay. education level was assessed using six options including “less than high school” to “phd”. health status and english language proficiency were asked using one question with five-point likert scale from 1 (very poor) to 5 (excellent). civic attitudes. the researcher used six statements from existing scales (table 3) to measure civic attitudes in terms of self-efficacy and social responsibility (bobek et al., 2009; doolittle & faul, 2013; zaff et al., 2010). example items were “i can make a difference in my community” (bobek et al., 2009, p. 620) and “it is important to make makki alamdari/civic attitudes & engagement 118 sure all people are treated fairly” (zaff et al., 2010, p. 742). the items were approved in terms of face and content validity. for this purpose, the researcher sought the feedback of five colleagues who are experts in the field of civic engagement and were familiar with mena countries. a cronbach’s alpha of 0.91 was found for these items, indicating strong internal consistency. response choices were a five-point likert scale, with the options from 1 (strongly disagree) to 5 (strongly agree). a summary score was computed for each respondent. higher scores indicated more positive civic engagement attitudes. civic engagement. civic involvement during the prior 12 months was examined using seven statements derived from existing scales (doolittle & faul, 2013; finlay et al., 2011; keeter et al., 2003; zaff et al., 2010). table 4 presents the statements. these examined different dimensions of civic engagement including volunteering, donating money, helping neighbors, community problem-solving, membership in organizations, staying informed about the community, and participating in events. if a respondent was involved in volunteering, one additional question was asked to investigate the area of volunteering with response options including educational programs, health programs, homeless services, etc. (keeter et al., 2003). table 5 shows the areas of volunteering included in this study. “how often have you helped out your neighbors?” (zaff et al., 2010) and “how often have you donated money to groups?” (keeter et al., 2003) were some sample questions. the researcher consulted the same group of experts to confirm face and content validity of this section. strong internal consistency was found (cronbach’s alpha of 0.84). a five-point likert scale with responses from 1 (never) to 5 (always) was used. a summary score was computed for each respondent indicating the level of civic engagement during the last 12 months. greater scores reflected higher levels of civic engagement. data analysis for analysis, the researcher ran descriptive statistics for each variable depending on its level of measurement. to examine the first research question, multiple linear regression analysis was conducted using gender, u.s. length of stay, language proficiency, and health status as potential predictors with civic attitudes as a dependent variable. to investigate the mediation effect for the second question, the researcher implemented three linear regression models. the first model included the primary independent variable (gender, health status, language proficiency, or length of stay) and the mediator (civic attitudes). the second included the primary independent variables and civic engagement as the dependent measure. the third regression model included civic attitudes and civic engagement while controlling for the primary independent variables. to confirm the mediation effect, in the first two models, the association of variables must be significant. in addition, in the third model, not only the association of the mediator and the dependent variable must stay significant, but also the relationship of the primary independent variable and the dependent one must significantly decrease. figure 1 illustrates the relevant conceptual model. results participants one hundred and forty-five mena immigrants and refugees participated in this study. facebook pages used for recruitment had hundreds to thousands of members. it is not possible to estimate what percentage of members visited the posted messages. advances in social work, spring 2020, 20 (1) 119 therefore, it is not easy to determine the response rate in this type of recruitment. ninety-eight people completed the online survey, just over two-thirds (67.6%) of all respondents. for in-person recruitment, the researcher provided 100 copies of the survey. forty-seven, 32.4% of respondents, completed paper-based surveys. as the number of people available was not possible to determine, the response rate could not be calculated in this kind of recruitment. respondents were from 12 countries. iran (n=52, 35.9%), tunisia (n=21, 14.5%), jordan (n=16, 11.0%), and egypt (n=15, 10.3%) had the highest number of participants. table 1 presents the number and percentages of participants by country of origin. table 1. descriptive information of participants (n=145) characteristic n (%) country of origin (n=145) algeria 4 (2.8%) egypt 15 (10.3%) iran 52 (35.9%) iraq 7 (4.8%) jordan 16 (11.0%) lebanon 3 (2.1%) morocco 6 (4.1%) state of palestine 9 (6.2%) sudan 3 (2.1%) syria 6 (4.1%) tunisia 21 (14.5%) yemen 3 (2.1%) residency status (n=145) u.s. citizen or permanent resident entered as a non-refugee 119 (82.1%) u.s. citizen or permanent resident entered as a refugee 26 (17.9%) gender (n=138) male 90 (65.2%) education (n=139) less than high school 1 (0.7%) high school/ged 11 (7.9%) some college 23 (16.5%) bachelor degree 51 (36.7%) master degree 33 (23.7%) phd 20 (14.4%) health status* (n=140) excellent 56 (40.0%) good 61 (43.6%) fair 21 (15.0%) poor 2 (1.4%) english language proficiency** (n=139) excellent 68 (48.9%) good 55 (39.6%) fair 15 (10.8%) poor 1 (0.7%) *range 2-5, mean (sd) 4.2 (0.8); ** range 2-5, mean (sd) 4.4 (0.7) makki alamdari/civic attitudes & engagement 120 table 2. descriptive information of participants and key variables (n=145) range mean (sd) age (n=145) 19-66 37.6 (10.2) length of stay (months) (n=135) 4-608 174.5 (136.8) civic attitudes (n=140) 6-30 26.0 (4.8) civic engagement (n=132) 11-35 22.7 (5.7) twenty-six (17.9%) participants came to the u.s. as refugees and the others (n=119, 82.1%) entered as immigrants. on average, respondents were 37.6 years of age. ninety (65.2%) participants were male. on average, the length of stay in the u.s. was 174.5 months (nearly 14.5 years). in terms of education level, having an undergraduate degree or higher was the most common (74.8%). the majority of respondents reported a high level of english language proficiency (88.5%) as well as good or excellent health status (83.6%). demographic information of participants and a profile of the study’s key variables are presented in tables 1 and 2. civic attitudes as shown in table 2, very positive civic attitudes were reported by study participants (n=140; m = 26.0; sd = 4.8). the mean (m), frequency, and standard deviation (sd) of each item are presented in table 3. the items have a mean between 4.1 and 4.5. nearly 80% of participants endorsed every item. conducting a t-test (t(131) = -0.9, p = 0.37), no significant differences in civic attitudes were found between males (n=86, m = 26.1, sd = 4.9) and females (n=47, m = 26.8, sd = 2.9), as well as between those who entered the u.s. as a refugee (n=25, m = 25.5, sd = 5.9) and those who entered as a non-refugee (n=115, m = 26.1, sd = 4.5; t(138) = 0.6, p = 0.56). all assumptions required for conducting the t-test were met. civic engagement as indicated in table 2, participants reported engagement in various civic activities (n=132, m = 22.7, sd = 5.7). the researcher conducted a t-test and found no significant differences in civic engagement between men (n=83, m = 22.4, sd = 6.0) and women (n=46, m = 23.4, sd = 5.2; t(127) = -0.9, p = 0.38), as well as between those who entered the u.s. as a refugee (n=23, m = 24.8, sd = 6.8) and those entered as a nonrefugee (n=109, m = 22.2, sd = 5.4; t(130) = -2.0, p = 0.05). the descriptive statistics of each item including mean, sd, and frequency are presented in table 4. the items have a mean between 2.6 and 3.8. the most popular area of civic engagement was to stay informed about the community followed by helping neighbors. ninety-five respondents reported volunteering in the community during the last 12 months. most of these volunteering experiences were in educational programs (n=37, 38.9%), services for homeless and economically disadvantaged people (n=36, 37.9%), children’s programs (n=32, 33.7%) followed by youth programs (n=26, 27.4%), health programs (n=24, 25.3%), international charities (n=23, 24.2%), religious groups (n=23, 24.2%), and refugee and immigrant services (n=21, 22.1%). programs for elderly people (n=12, 12.6%), environmental programs (n=9, 9.5%), and labor unions (n=5, 5.3%) were the least popular volunteering areas. see table 5 for more details. advances in social work, spring 2020, 20 (1) 121 table 3. civic attitudes item frequency (%) m (sd) n strongly disagree disagree neither agree nor disagree agree strongly agree it is important “to make sure all people are treated fairly”* 6 (4.2%) --4 (2.8%) 35 (24.3%) 99 (68.8%) 4.5 (0.9) 144 it is important “to make the world a better place to live in”* 8 (5.5%) 1 (0.7%) --35 (24.1%) 101 (69.7%) 4.5 (1.0) 145 it is important to help out at your local community* 5 (3.4%) 2 (1.4%) 7 (4.8%) 52 (35.9%) 79 (54.5%) 4.4 (0.9) 145 “i often think about doing things so that people in the future can have things better”* 5 (3.5%) 1 (0.7%) 9 (6.2%) 54 (37.5%) 75 (52.1%) 4.3 (0.9) 144 “i can make a difference in my community”** 5 (3.5%) 2 (1.4%) 13 (9.0%) 63 (43.8%) 61 (42.4%) 4.2 (0.9) 144 “i have a responsibility to help the poor and the hungry”*** 9 (6.3%) 4 (2.8%) 16 (11.3%) 49 (34.5%) 64 (45.1%) 4.1 (1.1) 142 *(zaff et al., 2010, p. 742) **(bobek et al., 2009, p. 620) ***(doolittle & faul, 2013, p. 4) table 4. civic engagement item frequency m (sd) n never rarely sometimes often always how often have you stayed informed of what is going on in your community?* 3 (2.1%) 13 (9.3%) 31 (22.1%) 52 (37.1%) 41 (29.3%) 3.8 (1.0) 140 how often have you helped out your neighbors?** 3 (2.1%) 18 (12.9%) 55 (39.3%) 34 (24.3%) 30 (21.4%) 3.5 (1.0) 140 how often have you donated money to groups?*** 5 (3.6%) 22 (15.9%) 53 (38.4%) 25 (18.1%) 33 (23.9%) 3.4 (1.1) 138 how often have you been a member of any organization?*** 18 (12.9%) 24 (17.1%) 46 (32.9%) 22 (15.7%) 30 (21.4%) 3.2 (1.3) 140 how often have you “participated in events such as meetings, celebrations, or activities in the community?”**** 9 (6.5%) 22 (15.9%) 58 (42.0%) 34 (24.6%) 15 (10.9%) 3.2 (1.0) 138 how often “have you worked together informally with someone or some group to solve a problem in the community where you live?”*** 11 (7.9%) 20 (14.4%) 62 (44.6%) 28 (20.1%) 18 (12.9%) 3.2 (1.1) 139 how often have you volunteered in community services for no pay?*** 47 (34.3%) 13 (9.5%) 40 (29.2%) 23 (16.8%) 14 (10.2%) 2.6 (1.4) 137 *(doolittle & faul, 2013) **(zaff et al., 2010) ***(keeter et al., 2003) ****(finlay et al., 2011, p. 1732) makki alamdari/civic attitudes & engagement 122 table 5. volunteering by areas (n (%)) educational programs 37 (38.9%) services for homelessness and economically disadvantaged people 36 (37.9%) children programs 32 (33.7%) youth programs 26 (27.4%) health programs 24 (25.3%) international charities 23 (24.2%) religious groups 23 (24.2%) refugees and immigrants services 21 (22.1%) programs for elderly people 12 (12.6%) environmental programs 9 (9.5%) labor unions 5 (5.3%) factors associated with civic attitudes the first research question examined factors predicting civic attitudes. multiple linear regression was conducted to investigate the impact of u.s. length of stay, health status, language proficiency, and gender (as a control variable) on attitudes. the assumptions of this test including the variables’ level of measurement, normality of dependent variable, independence of observations, multicollinearity, homoscedasticity, linearity, and no-outlier were met. bivariate correlation was checked using pearson correlation (table 6). based on this test, health status (r(135) = 0.3, p < 0.01) and english language proficiency (r(134) = 0.3, p < 0.01) were significantly correlated with level of civic attitudes. better health and greater english proficiency were associated with more positive civic attitudes. that is, those who were healthier or more proficient in english language had stronger civic attitudes. table 6. pearson correlation matrix 1 2 3 4 5 6 1. gendera 1.0 0.0 -0.1 -0.2* 0.1 0.1 2. length of stay 1.0 0.0 0.1 0.0 0.1 3. health 1.0 0.4** 0.3** 0.2* 4. english language 1.0 0.3** 0.1 5. civic attitude 1.0 0.4** 6. civic engagement 1.0 ** p < 0.01. * p < 0.05. a. gender (0= male; 1=female). the regression model was significant (f(4, 122) = 5.2, p < 0.01). this model explained 15% of the variance in civic attitudes with these four variables (r = 0.4, r2 = 0.15). health status (b = 1.1, β = 0.2, se = 0.5, t = 2.0, p < 0.05) and english language proficiency (b = 1.7, β = 0.3, se = 0.6, t = 2.9, p < 0.01) were significant factors. unstandardized coefficients indicated that for a one unit improvement in health status or a one unit increase in language proficiency, attitudes toward civic engagement significantly improved by 1.1 or 1.7 units, respectively (table 7). advances in social work, spring 2020, 20 (1) 123 table 7. regression analysis b std. error beta t sig. length of stay 0.0 0.0 0.0 0.3 0.80 health status 1.1 0.5 0.2 2.0 <0.05 english language proficiency 1.7 0.6 0.3 2.9 <0.01 gender 1.2 0.8 0.1 1.5 0.10 mediation effect of civic attitudes in order to examine the second research question, the mediation effect of civic attitudes was analyzed using three linear regression models. first, pearson correlation was checked. according to this test (table 6), health status was significantly associated with both civic attitudes (r(135) = 0.3, p < 0.01) and civic engagement (r(131) = 0.2, p < 0.05). other independent variables (i.e., language proficiency and u.s. length of stay) were not significantly correlated with civic engagement. therefore, these could not be examined in mediation analysis. civic attitudes and engagement were also significantly correlated with each other (r(129) = 0.4, p < 0.01). thus, the mediation effect of civic attitudes between health status and civic engagement was examined. first, bivariate regression analysis was conducted to see if health status predicted civic attitudes. including health status as the only independent variable, the regression model was significant (f(1, 133) = 9.3, p < 0.01). health status explained 7% of variability in civic attitudes (r = 0.3, r2 = 0.07). for a one unit increase in health status, civic attitudes improved by 1.5 units (β = 0.3, se = 0.5, t = 3.1, p < 0.01). the second regression model was also significant (f(1, 129) = 5.5, p < 0.05) with health status explaining 4% of the variance in civic engagement (r = 0.2, r2 = 0.04). in this model, a one unit increase in health status led to a 1.5 unit improvement in civic engagement (β = 0.2, se = 0.7, t = 2.3, p < 0.05). finally, multiple regression analysis was conducted with civic attitudes as an independent variable, controlling for health status, and civic engagement as the dependent variable. this regression model was also significant (f(2, 125) = 11.8, p < 0.01). these two variables explained 16% of the variance in civic engagement (r = 0.4). health status was no longer a significant factor (p > 0.05) but attitudes were significant; for each one unit increase in civic attitude, engagement improved 0.4 units (β = 0.3, se = 0.1, t = 3.8, p < 0.01). this analysis demonstrated that civic attitudes mediate between health status and civic engagement. statistical assumptions for all regression models were met. figure 1 illustrates the standardized regression coefficients. makki alamdari/civic attitudes & engagement 124 figure 1. the mediation model (a) no mediator (b) civic attitudes as a mediator notes. ** p < 0.01. * p < 0.05; a, b, c, c’: standardized regression coefficients (betas) discussion this study examined factors predicting civic attitudes as well as the mediation effect of attitudes between those factors and civic engagement. descriptive statistics demonstrated strong feelings of social responsibility toward community members among the target group, which is consistent with other studies of immigrants in the u.s. (jensen, 2008; makki alamdari et al., 2016; makki alamdari & bishop, 2020). in addition, the participants reported active engagement, especially in terms of staying informed about the community, helping neighbors, and donating money. two-thirds of respondents had volunteering experiences during the previous 12 months. this is in line with other studies on immigrants’ civic engagement in the u.s. (abu-ras, 2013; jensen, 2008; makki alamdari, 2017; read, 2014; tucker & santiago, 2013), which reported active involvement. this study shows that refugees and immigrants from the mena region are not isolated and have high capability to contribute to their communities. the results of the study showed that the length of stay was not a significant predictor of civic attitudes. more studies should examine this factor in the future. in addition, gender did not predict civic attitudes, which is consistent with the study of handy and greenspan (2009) indicating no significant association between gender and volunteering among immigrants in canada. however, the study found health status and english language proficiency as significant factors predicting civic attitudes among mena refugees and immigrants. that is, those who were more competent in the english language and those with better health status had more positive attitudes toward civic engagement. immigrants and refugees with higher levels of language proficiency are more likely to communicate and learn about the host communities. this is consistent with the existing literature. stepick et al. (2001) studied the haitian immigrant community in florida using focus groups and interviews and reported language difficulties as a barrier to civic participation. similarly, boyd (2009) and van londen et al. (2007) examined immigrants in canada and the netherlands and confirmed the importance of language skills in civic and political participation. civic engagement c = 0.2* health health civic engagement c’ = 0.2 civic attitudes a = 0.3** b = 0.3** advances in social work, spring 2020, 20 (1) 125 furthermore, the direct and positive effect of self-rated health on civic and political participation was acknowledged in the existing literature conducted in the uk, australia, and the u.s. (burden et al., 2017; ding et al., 2015; emerson et al., 2014). in line with existing literature, this study supported the finding that civic attitudes predict civic engagement. gastil and xenos (2010) studied approximately 3,000 americans and found attitudes about one’s efficacy in political areas were a predictor of political participation. luengo kanacri et al. (2016) examined 1,300 people in chile and found beliefs regarding poverty as a significant factor predicting financial donation. these findings suggest that improving civic attitudes can lead to higher levels of participation in civic activities. with this in mind, education and awareness-raising are critical to improve attitudes. based on a representative sample of black youth in the u.s., hope and jagers (2014) reported that formal and informal civic education can significantly act as a moderator and strengthen the association between sociopolitical attitudes and civic engagement. community agencies can educate mena refugees and immigrants regarding their activities, participation opportunities, and benefits of civic engagement. the findings of this study have a number of implications for social work practice. augmenting their civic attitudes and consequently their civic engagement, refugees and immigrants can experience better health, greater life satisfaction, stronger social networks, more effective integration in the new community, as well as address their feelings of isolation and loneliness (gele & harsløf, 2012; weng & lee, 2016). this will also improve communities through increasing human capital, diversity, democracy, and the quality of public service (handy & greenspan, 2009; makki alamdari & jalaiepour, 2012; tucker & santiago, 2013). the social work profession emphasizes such individual and societal improvements as its core values (national association of social workers, 2017). improving english language skills can help enhance the target population’s civic attitudes. in this case, especially for refugees, providing english as a second language classes through resettlement agencies or religious institutions is beneficial. improving the accessibility and effectiveness of such classes for the target population is recommended (steele, 2017). in addition, if possible, marketing regarding community events or volunteer opportunities can be undertaken through ethnic social networks, so that immigrants and refugees can communicate around these topics in their own language. finally, having civic learning programs or flyers in refugees and immigrants’ native language can aid in developing stronger civic attitudes. moreover, no mediation effect of civic attitudes was found between factors of english language proficiency or length of stay and civic engagement. however, the results indicated civic attitudes as a mediator between health status and civic engagement. improving health among immigrants and refugees through culturallyappropriate practice and support groups, health information provision, counselling, and evidence-based policies can enhance the level of civic engagement through strengthening civic attitudes (de bocanegra et al., 2018; shishehgar et al., 2017). in other words, health status not only directly predicts civic attitudes, but also indirectly influences the level of civic engagement. this has important implications. at the policy and program level, providing diverse, equitable, and affordable health services that meet the health needs of immigrants and refugees is fundamental (burden et al., 2017; newbold & mckeary, 2017). additionally, community agencies and organizations that makki alamdari/civic attitudes & engagement 126 conduct civic participation activities can offer specific programs that, in addition to the general purposes, render some incentives or benefits for those who may experience health issues. for example, if there is a community event, the convener agency can have a booth or a table to offer health-related information or basic services such as blood pressure examination. this might encourage those with lower health status to participate in programs. more studies are needed to investigate what kinds of community programs might be of interest for those immigrants and refugees with lower health status. this study has several limitations. the assumption of the researcher in this study was that attitudes form and influence civic engagement. however, it is critical to acknowledge that the reverse direction is possible as well. that is, higher levels of civic engagement can improve civic attitudes through exposing individuals to diverse populations (o'leary, 2014; pascarella & terenzini, 2005). immigrants tend to have a higher health status upon arrival in the host country, which declines over time during their stay because of negative acculturation effects (ablow measelle et al., 2019; gorman et al., 2010). this study did not examine the impact of this declining health on civic attitudes and engagement. using a longitudinal design, future studies can address this limitation. further, many potential factors were not investigated. for example, factors such as age, religious and cultural identity, family income, education, and whether the members of the target population hope to return home one day (choi, 2003; handy & greenspan, 2009; jensen, 2008; read, 2014; tucker & santiago, 2013) can be considered in future studies. this study examined many forms of civic engagement such as volunteering, community problem-solving, and monetary donation under one broad label of civic engagement. for future studies, it could be more beneficial to look at each of these forms individually. in terms of validity, confirming other forms such as construct and factor validity could increase rigor. using self-report measures of health status and english language proficiency was also an issue in this study. one constraint was social desirability bias. that is, respondents might have answered in a way that is desired by others. participants were recruited mainly from facebook pages or convenient locations. this posed sampling bias and limited the generalizability of the findings as this sample was not representative. most participants had a high levels of language proficiency, education, and health status. there were also some mena countries that were not represented in this study’s participants. for future studies, recruiting more diverse participants is recommended. conclusion this study contributes to the existing literature by examining civic attitudes and engagement of an understudied group of immigrants and refugees. english language proficiency and health status were found to be significant factors for improving civic attitudes. health status was also found as a critical factor indirectly increasing the level of civic engagement through enhancing attitudes. these findings are useful to enhance resettlement programs, health policies, and services as relevant to this group as well as civic events in a way to advance civic attitudes and engagement of mena refugees and immigrants. promoting civic engagement of this group could help to counter antimuslim viewpoints that are common in the u.s. advances in social work, spring 2020, 20 (1) 127 references ablow measelle, e., mcclure, h. h., snodgrass, j. j., martinez jr, c. r., jiménez, r., & isiordia, l. 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(2013). the role of acculturation in the civic engagement of latino immigrants. advances in social work, 14(1), 178-205. https://doi.org/10.18060/3750 uslaner, e. m., & brown, m. (2005). inequality, trust, and civic engagement. american politics research, 33(6), 868-894. https://doi.org/10.1177/1532673x04271903 van londen, m., phalet, k., & hagendoorn, l. (2007). civic engagement and voter participation among turkish and moroccan minorities in rotterdam. journal of ethnic and migration studies, 33(8), 1201-1226. https://doi.org/10.1080/13691830701613991 vergani, m., johns, a., lobo, m., & mansouri, f. (2017). examining islamic religiosity and civic engagement in melbourne. journal of sociology, 53(1), 6378. https://doi.org/10.1177/1440783315621167 voicu, m., & rusu, i. a. (2012). immigrants’ membership in civic associations: why are some immigrants more active than others? international sociology, 27(6), 788-806. https://doi.org/10.1177/0268580912452172 weng, s. s., & lee, j. s. (2016). why do immigrants and refugees give back to their communities and what can we learn from their civic engagement? voluntas: international journal of voluntary and nonprofit organizations, 27(2), 509-524. https://doi.org/10.1007/s11266-015-9636-5 world bank. (2019). middle east & north africa. https://data.worldbank.org/region/middle-east-and-north-africa zaff, j., boyd, m., li, y., lerner, j. v., & lerner, r. m. (2010). active and engaged citizenship: multi-group and longitudinal factorial analysis of an integrated construct of civic engagement. journal of youth and adolescence, 39(7), 736-750. https://doi.org/10.1007/s10964-010-9541-6 zarpour, m. t. (2013). discourse and dissent in the diaspora: civic and political lives of iranian americans [doctoral dissertation, university of maryland]. http://hdl.handle.net/1903/14216 author note: address correspondence to dr. sara makki alamdari, west texas a&m university department of psychology, sociology, and social work: salamdari@wtamu.edu acknowledgements: the researcher is immensely grateful to dr. hea-won kim, associate professor in the indiana university school of social work for her constructive and valuable comments during the planning and development of this research. the researcher would also like to thank wafa alhajri for her assistance with data collection. https://doi.org/10.1177/0899764008322779 https://doi.org/10.18060/3750 https://doi.org/10.1177/1532673x04271903 https://doi.org/10.1080/13691830701613991 https://doi.org/10.1177/1440783315621167 https://doi.org/10.1177/0268580912452172 https://doi.org/10.1007/s11266-015-9636-5 https://data.worldbank.org/region/middle-east-and-north-africa https://doi.org/10.1007/s10964-010-9541-6 http://hdl.handle.net/1903/14216 mailto:salamdari@wtamu.edu microsoft word garner fbo_1952_copyedit final ______________ michelle d. garner, phd, acsw, licsw, is an assistant professor of social work at the university of washington, tacoma. dr. garner would like to thank the substance abuse policy research program (saprp) of the robert wood johnson foundation for grant #63414 which has provided support for work on this article. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 484-509 advancing discussion of federal faith-based social service policies through overview and application of established health services research models michelle d. garner abstract: since the 1990s, federal policies have allowed public funds to support social services provided through pervasively faith-based organizations (fbos). public and academic discourse on these policies tends to be marked by limited data, narrow scope, and the lack of an appropriate analytic framework to adequately consider and critique the merits of the policies, as social workers are compelled to do. the goals of this study are to identify, and preliminarily apply, an established policy analysis model appropriate for use with fbo policy in order to progress discussion. health service researchers aday, begley, lairson, and balkrishnan (2004) provide a theoretically based policy analysis framework, which is appropriate for this task and for use by social workers. their effectiveness, efficiency, and equity policy analysis model is presented along with data and analysis intended to help frame and progress productive discussions on fbo policies within and beyond the profession. keywords: faith-based, andersen behavioral model of health services use, social service policy, religious intervention introduction faith communities have a long-standing, distinguished history of helping those in need. due to a policy shift in the mid-1990s, federal law currently allows faith-based organizations (fbos) to provide social services without requiring that they subjugate or alter their organizations' faith identities. discussion and evaluation of fbo policies and programs have garnered public and academic attention, but are generally limited in scope and predicated on segmented research (johnson, tompkins, & webb, 2008; kramer, 2010) and political or religious ideology (saperstein, 2003; wineburg, 2007). these analyses are unreliable and problematic because they rely on and perpetuate isolated data and thinking; formal attempts to organize and analyze disparate streams of data relevant to fbo policies are rare and require resources, including the identification of an appropriate framework for such analysis. yet, according to the council on social work education (cswe, 2010), all social workers are obliged, as part of competent professional practice, to critically assess interventions (2.1.3) and use “research-informed practice and practice-informed research” (2.1.6, p. 5) to advocate for improvement of programs and policies (2.1.5; 2.1.8) that affect their clients and practices. the goals of this study are to identify, and preliminarily apply, an established policy analysis model appropriate for use with fbo policy in order to progress discussion within the profession and perhaps beyond. specifically, this study begins by recounting the history of fbos and fbo policies and the limitations of the current literature. as explained below, current fbo policies are endemic to devolution of social and safety-net services. social work, as a field, is advances in social work, fall 2012, 13(3) 485 centrally concerned with social justice (cswe, 2010; nasw, 2008). therefore, the field is responsible for assessing fbo policies through a lens both sensitive to social justice and compatible with the profession’s dominant person-and-environment construction of human behavior (cswe, 2010)a construction that posits that human behavior is both influenced and constrained by contexts of the physical and social environment, while also reciprocally impacting the same (hutchison, 2011). because a model for such analysis of fbo policies is generally lacking in topical academic and public discussion, the study then contributes to the literature by introducing an established health service research model as an appropriate means for social workers to analyze fbo programs and policies. the model (aday, begley, lairson, & balkrishnan, 2004) includes three criteria— effectiveness, efficiency, and equity—each of which are discussed in turn. the discussion of each criterion includes preliminary, issue spotting application to the states of the science and administrative implementation of fbos. the history of faith-based organization policies communities of faith have long functioned as refuges for those in need, maintaining informal and formal systems of aid. when formalized, such services are traditionally offered one of two ways. faith communities may maintain auxiliary programs dependent upon membership-derived resources (financial or volunteerism; e.g., a friday night supper service donated, prepared, and served by members). faith communities may also give rise to chartered 501(c)(3) non-profit organizations focused upon providing social services, such as catholic community services, the salvation army, lutheran community services, and jewish family services; such organizations are maintained at arm’s-length distance from their religious roots, may receive government funding, and function subject to standard, prevailing laws. traditionally, national policy has sought to protect religious liberty by preventing public funds from flowing directly to religious organizations (such as churches). these “pervasively sectarian” entities, as they are referred to by the supreme court, receive tax benefits and engage in worship, proselytization, and religious education. pervasively sectarian organizations may discriminate in hiring, but historically are barred from direct receipt of public funding based on the rationale that the government should not favor or endorse particular religious views or interests (saperstein, 2003). however, policymakers have increasingly been swayed toward the competing view that religious organizations providing social services should not be excluded from public funding sources on the basis of faith. thus, fbo policy began shifting in the 1990s, tracking two trends in national politics: 1) the devolution of social and safety net services downward toward local levels and outward toward private contractors (hutchison, 2011) and 2) the politicalization of religion (gelman, park, shor, & cortina, 2010; mcmillin, 2011). beginning with the federal personal responsibility and work opportunity reconciliation act of 1996 (p.l. 104-193) and its extension through the faith-based and charitable choice initiatives, federal policy has formally fostered the role of faith communities in the provision of government funded social services, including substance abuse treatment and temporary assistance for needy families. the significance of these policies is their marked turn in legal and philosophical stance: pervasively religious garner/health services research models for faith-based organizations 486 organizations are now able and encouraged to pursue and administer government-funded social services without a requirement that they alter or subjugate their religious identity (de vita & wilson, 2001; saperstein, 2003). consistent with national political trends, the policies reflect a desire to enhance the role of fbos in the provision of public services, a concern for the organizations’ religious autonomy, and financial commitments in the form of technical trainings to entice fbos into the role of service providers. the new fbo policies prohibit proselytizing and seek to ensure the right to religious liberty of service recipients. however, adherence to these protections is neither systematically measured nor enforced (gao, 2006; kramer, finegold, de vita, & wherry, 2005b) and is recognized as problematic (gao; kramer et al., 2005b; president’s council, 2010). in 2001, president george w. bush pressed this fbo agenda through executive order, after congress declined to legislate (kramer, finegold, de vita, & wherry, 2005a). for example, president bush created the white house office of faith-based and community initiatives within the executive office, with the goal of expanding the opportunities for religious groups to contribute to public purposes “such as curbing crime, conquering addiction, strengthening families and neighborhoods, and overcoming poverty” (exec. order no. 13199, 2001, sec.1). eliminating obstacles to fbos fulfilling his envisioned role was a cornerstone in president bush’s domestic agenda (kramer, et al., 2005a). the fbo policy shift has been controversial. critics have suggested that the bush administration’s policy changes were aimed principally at supporting an evangelical religious agenda (wineburg, 2007). most fbo funding goes to christian-based groups (green & sherman, 2002; kramer, 2010), which has led to concerns about religious diversity in policy implementation. the constitutionality of president bush’s approach to supporting fbo services has also been questioned (mink, 2001; saperstein, 2003), on the basis that these policies establish a government religion and infringe upon an individual’s rights to free exercise of religion. minimally, the collective shifts in fbo policies have been criticized as part of a troubling devolution of public and safety-net services to the private sector (kennedy, 2003; mink, 2001; saperstein, 2003; wineburg, coleman, boddie, & cnaan, 2008). the swing in political power in 2008 suggested some course correction (pew, 2009). early in his presidency, president barack obama amended executive order 13199, abolishing president bush’s office of faith-based and community initiatives and replacing it with the president’s advisory council on faith-based and neighborhood partnerships (“president’s council”), which advises the president on best practices and needed improvements in the provision of services to vulnerable populations, specifically those who are low-income or underserved (exec. order no. 13498, 2009). president obama also recast the role of government from aggressively eliminating obstacles to fbo funding toward one of measured accountability. president obama described a need to balance the ability of fbos to deliver services with the preservation of constitutional commitments, including “guaranteeing the equal protection of the laws and free exercise of religion and forbidding the establishment of religion” (exec. order no. 13498, 2009, sec.1). advances in social work, fall 2012, 13(3) 487 in 2010 president obama amended fbo policy implementation by enhancing protections to beneficiaries while mandating that “[f]ederal financial assistance for social service programs should be distributed in the most effective and efficient manner possible” (“principles and policymaking criteria,” exec. order no. 13559, 2010, sec.2.a). these policies impact the purveyance of social services and the formal role of religious institutions in addressing governmental safety-net services. the pew research center (2009) reports that americans indicate having related concerns about: church and state separation (52%), fbos failing to meet program standards (48%), and discriminatory hiring practices (74% believe fbos receiving government funding should not be allowed to hire based on religious belief). however, only 25% of those polled oppose government support of social service programs through pervasively sectarian fbos. sixty-nine percent of the american public favors government funding for social services to religious organizations. they believe this enhances service options (78%) and that non-secular providers “would be more caring and compassionate” than other providers (68%; pew, 2009, 7th paragraph). in 2009, the majority (52%) of americans thought religious organizations are best suited to feed the homeless. thirty-seven percent of respondents generally believed religious organizations are best at helping the needy [compared to non-secular (28%) or government organizations (25%)]. this belief is both most prominent and rising among republicans (56%, up 16%) and white evangelicals (60%, up 13%; pew, 2008-2009 comparison). general support for fbo policies is strongest among african-americans (85%) and hispanics (80%). whether one personally views changes that allow pervasively religious organizations to directly receive public funding as a needed correction or a deviation from core principles, it remains imperative that policies regarding the provision of social services be focused on the resulting welfare of the individuals and communities served. it is incumbent upon professional social workers touched by the issue to critically evaluate federal fbo policies systematically, through an appropriate theoretical framework as a requisite of competent practice (cswe, 2010). faith-based organizations and limitations of the literature available fbo service research tends to be segmented. program evaluations of specific field-based services are prominent in the literature, rather than the controlled experimental studies required for clearer results and causal inferences. it is impossible to determine, in most fbo services research, what part (if any) religious aspects of programs have played when positive participant outcomes are found; or for whom religious aspects detracted from or impeded positive outcomes (e.g., kissane, 2008). research illuminating the relationship of religion and health is conducted and discussed separately from fbo research. in sorting through the fbo research literature, it often is difficult to discern program and outcomes research provided through private funding from those provided through government funding. existing fbo research can seem contradictory. for example, data from the national substance abuse and mental health services administration (samhsa, 2010) suggest garner/health services research models for faith-based organizations 488 fbo programs appear very similar based on reports of what is offered when compared to non-fbo programs (e.g., 87.6% of fbos and 92.2% of non-fbos offer discharge planning; and 76.3% and 82.6% offer aftercare/continuing care respectively). yet more nuanced research such as sung, chu, richter, & shlosberg (2010) and hodge and pittman (2003) reveal potentially important differences between services provided by fbo and non-fbo addiction treatment programs. sung, chu, richter, and shlosberg (2010) undertook a national, randomized study of program characteristics among faith-based teen challenge usa (tc; n=80) programs compared to secular programs (n=68) randomly drawn from the national directory of drug and alcohol abuse treatment. tc programs are associated with the pentecostal protestant assemblies of god faith tradition and do not use public funding, but annually offer an estimated 5,000 treatment beds and services worth $54 million to $66 million (sung et al., 2010). these researchers found several notable, meaningful differences between program types, in their conceptual etiology of substance abuse, matrix of on-site interventions offered, and assumptions about human nature. specifically, respondents in tc settings believed substance abuse is “a consequence of separation from god” and “caused by a lack of meaning and purpose in life,” whereas those in secular programs believed it “is a brain disease” and “people are genetically predisposed to drug use” (p. 393). tc and secular programs offered a different constellation of services: “bible classes (100.0% vs. 35.3%), prayer meetings (100.0% vs. 29.4%),” (p. 349), “individual psychotherapy (0.0% vs. 41.2%), group psychotherapy (0.0% vs. 35.5%), psychiatric assessment (0.0% vs. 23.5%), [and] primary medical care (0.0% vs. 23.5%)” (p. 394). eighty-three percent of tc respondents agreed that “human nature is fundamentally perverse and corrupt” (p. 392). only 16% of the secular providers similarly agreed. hodge and pittman (2003) researched state-registered fbo programs in texas (n=30 respondents of 55 possible) and also probed more deeply in their questions and analysis. program participants in the fbos received a prominently “salvation transformation” and scripture-based drug and alcohol treatment with no apparent reference to evidence-based intervention or best practices, which would include concerns such as appropriate steppedup levels of care and relapse prevention counseling. though more than half the providers of these treatments were trained chemical dependency professionals, the majority of fbos studied had no eligibility requirements for treatment providers. twenty-five of the fbos reported having a “follow-up program” for those discharged; the follow-up programs were described as: knowledge of the client’s work and church upon discharge (n=15), scheduled phone calls or letters to clients (n=5), and continued participation with the program or church (n=3). these data suggest definitions of important constructs such as discharge planning may differ among fbo and non-fbo substance abuse program respondents in samhsa’s (2010) research. samhsa’s data are from the national survey of substance abuse treatment services. the survey items are count or binary derived from check-mark lists to indicate “yes,” (e.g., “which of the following services are provided by this facility at this location . . . 14) discharge planning, 15) aftercare/continuing care;” samhsa, 2008, p. 3). there appears to be no knowledge base criteria for completing the form on behalf of the facility. if respondents desire clarification on terms used in the survey, the survey directions send advances in social work, fall 2012, 13(3) 489 them to consult a series of webpages. thus, definitional differences among survey respondents in “discharge planning and after care” would appear possible and quite likely in light of others’ research (hodge & pittman, 2003, samhsa, 2010, sung et al., 2010). this possibility calls into question true similarities across fbo and non-fbo addictions programs. such theoretical and substantive differences in services offered are not limited to addictions treatment services. comparative research among services of a houston-based community sample of fbo versus secular programs for the homeless also show stark differences (ebaugh, pipes, chafetz, & daniels, 2003). researchers analyzed data from 89 organizations, a 52% response rate of non-governmental or community development corporations in the 2001 homeless services directory pool. ebaugh and colleagues determined three notable, germane characteristics of religious organizations. first, religious organizations use more volunteer workers, use religious affiliation in hiring, and view religiosity of staff and leadership as central to their mission. second, they use religious sources along with secular resources in decision making. and, third, the religious organizations support religious activities with clients such as “praying with a client, promoting a particular religious viewpoint to a client, speaking about spiritual matters to clients, and discussing behavioral issues using religious principles” (p. 422). fbo service programs are different from secular ones. the core religious nature is obviously different, but understanding and quantifying how this character manifests as content, background, assumptions, or focus of interventions and organizational procedures is complex and not at all obvious (e.g., cnaan, sinha, & mcgrew, 2004; ebaugh, et al., 2003; jeavons, 2004; netting, 2004; sider & unruh, 2004; smith & sosin, 2001; unruh, 2004). nuanced explanation of how faith is included in fbo programs is complicated and often inadequately addressed in available research literature. what is certain is that currently the obama administration intends to continue to promote use of taxpayer money to provide public services through fbos (obama, n.d.). in sum, understanding the role of religion in fbos and assessing the merits of individual programs and the federal policies promoting their use is challenging. the social work profession views human behavior in the social environment as a dynamic interaction of the person with his or her environment (cswe, 2010). however, the person-and-environment construction alone is inadequate either to predict service utilization and outcomes or to assess policies affecting them (see wakefield, 1996). what is needed is a comprehensive, empirically-based framework, congruent with social work values and person-and-environment assumptions. health services research health services research is a promising field from which to adopt a comprehensive empirically-based model. much like social work, health services research is a multidisciplinary informed field aiming to facilitate the health and well-being of people through study and enhancement of health supporting policies and services (see ahrq, 2009; uw department of health services, 2011). rather than focus on specific issues or populations, health services research looks at the processes of services; e.g., access and garner/health services research models for faith-based organizations 490 entry, provision dynamics, provision mechanisms, content (interventions), site and environmental context, departure or continuance, and costs. the behavioral model of health service use (bmhsu; aday & andersen, 1974; andersen 1968, 1995, 2008; phillips, morrison, andersen, & aday, 1998) is highly compatible with the social work person-and-environment construct (cswe, 2010). the bmhsu captures and operationalizes those interrelated personal and exogenous features, such as site and provider characteristics, that impact an individual’s entry, continuance, consumer satisfaction, and future use choices regarding services (see andersen, 1995, 2008). the bmhsu has provided the conceptual framework for extensive national and international predictions and assessments of health care costs and utilization, including use with and without adaptation in evaluation of specific populations such as homeless people, minorities, women, and the elderly (ashton, 2008). as a contributor to the bmhsu (e.g., aday & andersen, 1974; phillips et al., 1998), aday and colleagues have built upon and extended the bmhsu to include policy evaluation criteria. the model may be applied for individual-level or population-level policy analyses. thus, they offer a robust, theoretically-based conceptual framework by which to evaluate health-related policies, including those that are principally social, institutional, or environmental (aday et al., 2004; aday et al., 1999). the world health organization (boerma, chopra, & evans, 2009) asserts that a multi-factored frameworksuch as aday and colleagues’ (2004) effectiveness, efficiency, and equity policy analysis frameworkis an important contribution amid efforts to solidify a means of defining and comparing the effectiveness and equity of health care systems. aday and colleagues’ effectiveness, efficiency, and equity policy analysis framework is an established, appropriate, and systematic way to consider fbo policies. it is also compatible with the social work profession’s person-and-environment construct and values of social justice and enhancement of community well-being (cswe, 2010). the effectiveness, efficiency, and equity policy analysis framework all social work practice shares the objective of understanding social problems and their potential solutions, but policy considerations introduce a second task: that of translating these understandings into government action (aday et al., 2004, p. 6). social workers must thus consider fbo policies on two levels: their scientific support and the pragmatics of implementing them. the sections below first describe each of aday and colleagues’ three policy analyses criteria: effectiveness (quality), efficiency (costeffectiveness), and equity (access). directly following each criterion description are preliminary literature review data and analyses that highlight issues within the states of science and implementation within that criterion. this initial issue spotting application is intended to demonstrate the utility of the model and to frame and spur, rather than exhaust, further discussion and research. advances in social work, fall 2012, 13(3) 491 effectiveness effectiveness is a measure of quality. whereas efficacy reflects the best outcomes found to be possible in a controlled study, effectiveness is the degree to which these possible outcomes are actually attained in the context of practice. measurements of effectiveness can be drawn from the structural levels of the community, system of care, institution, or patient. on the individual, clinical level, effectiveness is an evaluation of “interactions of patients and providers in the medical care system and institutions and the resulting clinical improvements or health benefits achieved by patients” (aday et al., 2004, p. 60). such improvements may be resulting changes in physical, behavioral, attitudinal (beliefs and satisfaction), or patient education measures. effectiveness is dependent upon the content and dose of an intervention and the context and process of delivering it. process aspects of care services include actions, dynamics, and individual characteristics of the site, provider, and the recipient(s) at play in the process of service delivery. on a population level, effectiveness is an epidemiology of health. it must therefore take into account both individuals seeking services and individuals eligible for or needing services who do not seek them. it must also evaluate the impact of services and the environment (physical, social, and economic) upon the population’s health. utilization rates (realized access) are an effectiveness outcome from the population perspective that fits conceptually within service processes (aday et al. 2004, p. 66). policy considerations of effectiveness in the clinical-level perspective (focused upon structures, processes, and outcomes) revolve around best practice guidelines and mechanisms for quality assurance or improvement of processes and outcomes, according to aday and colleagues (2004). whereas policy considerations from a population-level perspective (focused upon environment, biology, behavior, and medical care) revolve around research to understand and impact targeted issues, prevention efforts, and enhanced access through quantity and dispersion of care services. in practice, populationlevel policy analysis of effectiveness frequently focuses upon community needs assessments and comprehensiveness of an integrated continuum of available care (prevention through follow-up). fbo service related research. effectiveness is equivalent to traditional outcomes research (e.g., whether people better off for having the service). the goals of this criterion are to understand: “what services work for whom, under what conditions, when should they be offered, and by which providers?” (lyons, howard, o’mahoney, & lish, 1997, p. 1). as previously noted, existing fbo research is scant and problematic (dehaven, hunter, wilder, walton, & berry, 2004; dodson, cabage, & klenowski, 2011; johnson, et al., 2008; kramer, 2010). for instance, a social work abstracts (ovid) database key word advanced search of (faith, church, congregation, parish, or synagogue) with (program, social service, or social services) and (study or evaluation) conducted march 5, 2012 yielded 69 peer-reviewed articles. similar, non-mutually exclusive, searches within social services abstracts (proquest) and psychinfo (ebsco host) produced 647 and 622 respectively. there are multiple studies suggestive of the merits of fbo programs (e.g., bartkowski, call, heaton, & forste, 2007; see johnson, et al., 2008). however, when actually examining outcomes of a fbo intervention, such studies, as a group, suffer multiple methodological issues such as: poor variable measurement, garner/health services research models for faith-based organizations 492 failure to account for intent to treat, lack of randomized control groups (lack of randomized non-faith-based comparison treatment group), failure to account for attrition, and lack of appropriate statistical analysis (e.g., a segmented and limited in scope research base). at present, both the efficacy and effectiveness of fbo programs are still unproven (amirkhanyan, kim, & lambright, 2009; cnaan & boddie, 2002; dodson et al., 2011; gao, 2002, 2006; kramer, 2010; wineburg, 2007). there is a lot of work to be done in this area. empirically supported theory suggests that contextual, individual characteristics, processes of service delivery, satisfaction of actual or intended consumers, and measureable outcomes are all areas that impact service utilization, and, therefore, program effectiveness (andersen, 1995, 2008; aday et al., 2004). they merit research in the context of fbo service provision. specifically, how elements of religion in service processes, provider contexts, and provider character impact and interact with recipients to affect outcomes and realized access of services remains understudied. how does static religiosity of setting or provider compare in outcomes to services in which religious and spiritual assessment of the client are used to tailor the intervention provided to the clientas is best practice for social services based on professional counseling or case management standards (cohen, 2009; dhhs-omh, 2005; ehman, 2009; hodge, 2006; mattison, jayaratne, & croxton, 2000)? current fbo policy-related research is inconsistent or absent on multiple counts. most problematic are service process issues: 1) defining and operationalizing content and dose of religious inclusion among the continuum of fbos and their subprograms (as programs within organizations may vary in religious content and dose between each other and the organization as a whole); and 2) identifying and understanding the active “faith” mechanism that ostensibly makes these programs different from secular organizations and programs (see kramer, 2010). looking outside the fbo literature to the body of research exploring religiosity or spirituality and health outcomes quickly indicates that further research on the religion-health relationship is imperative and relevant to fbo policy considerations. most of the early and encouraging research that linked religion to positive health outcomes lacked specificity (hill & pargament, 2003). nuanced research of the last decade works to understand dimensions of religiosity, which is generally now conceptualized as a separate construct that can overlap with spirituality, and how religious and spiritual dimensions relate to outcomes of interest. contemporary work in this area suggests that religion can be helpful to people, but is far from a global panacea and may actually be deleterious in some cases. negative religious coping (crises of faith, struggles about meanings or negative self-appraisals in light of theology) as well as interpersonal religious conflicts are linked with poorer, not better outcomes (see hackney & sanders, 2003; hill & pargament, 2003; sternthal, williams, musick, & buck, 2010; or pargament et al., 1998). religion/spirituality (r/s) research is also now suggesting that meaning or forgiveness, both of which may be derived through religion but neither of which are unique only to religion, may moderate positive effects of r/s upon outcomes (lyons, deane, & kelly, 2010; park, 2007; sternthal et al., 2010). mental health status may (webb, robinson, & brower, 2011) or may not (edlund et al., 2011) play a advances in social work, fall 2012, 13(3) 493 mediating role in the forgiveness pathway relationship. others’ work suggests that positive benefits of r/s may stem from triggering of beneficial relaxation or meditation mechanisms (seeman, dubin, & seeman, 2003; seybold, 2007), which can be subsumed in r/s practice but are also not unique to r/s. many think social support derived from shared religious practice is at least part of the active agent linking religiosity to outcomes (powell, shahabi, & thoresen, 2003). religion is also not universally linked to pro-social behavior, but, in fact, can foster in-group/out-group dynamics detrimental to the greater community, such as greater prejudice and harsher treatment to out-group members (hall, matz, & wood, 2010; mckay, efferson, whitehouse, & fehr, 2010; preston, ritter, & hernandez, 2010). religion can also be detrimental to in-group members when their identity is in conflict with their communities’ religious teaching, most obviously with lesbian, gay, bisexual, and transgendered community members (blackwell & dziegielewski, 2005; levy & reeves, 2011; rowatt, labouff, johnson, froese, & tsang, 2009; sherry, adelman, whilde, & quick, 2010; whitley, 2009). it should be noted that all major allied health professional organizations oppose “reparative therapy” or “sexual orientation conversion therapy,” even with youth (just the facts coalition, 2008). again, there is a pressing need for research to discern the mechanisms by which r/s affects health outcomes, and for whom, in what context, and in what dose their use is helpful or harmful. there are additional processes of fbo service features that also specifically need research attention. the policy amendments enacted by the obama administration, principles and policymaking criteria (exec. order no. 13559, 2010), seek, in part, to correct some of the processes-of-service related concerns discussed in the president’s council’s report (2010); e.g., contention about religious icons in rooms used for government-supported programs, insufficiency of notice of non-religious alternatives to services, need for adequate separation in time and location between government-funded programs and the overtly religious programs of the organization, lack of proper training for providers around all identified issues, and lack of checks for policy adherence. research will be required to discern the progress made on these fronts. work to explore fbo service provider contexts and individual consumer characteristics is further along. conceptual work toward defining the widely varying sources and gradations of religiosity inherent in fbo services is progressing (ebaugh, et al., 2003; jeavons, 2004; smith & sosin, 2001). there are initial literatures about characteristics of service-providing fbo organizations (e.g., chaves & tsitsos, 2001; cnaan, sinha, & mcgrew, 2004; ebaugh et al., 2003; hodge & pittman, 2003; sung et al., 2009; tangenberg, 2005) and service recipients (heslin, andersen, & gelberg, 2003; sager & stephens, 2005; wuthnow, hackett, & hsu, 2004). it appears from empirical evaluation that those using fbo services have different characteristics or needs than those seeking services elsewhere (heslin et al., 2003; reingold, pirog, & brady, 2007; wuthnow et al., 2004). in part, this may be due to fbo providers formally or functionally barring service access to some people based on their characteristics, such as criminal histories or lifestyle choices (e.g., cnaan et al., 2004; reingold et al., 2007). even some of those who do use fbo services do not like the religious aspects (kissane, 2008; sager & stephens, 2005). limited access to, dissatisfaction with, or avoidance of garner/health services research models for faith-based organizations 494 fbo services are all differences in realized access (utilization and customer satisfaction) across groups that also have equity implications. it is also very likely that fbo program effectiveness may vary with the goals of services being provided. dehaven and colleagues (2004) conclude from limited data that it appears fbo programs can be successful community partners in a patient education role (e.g., helping to increase knowledge of diseases, increase screening behavior, and decrease risk behaviors). future research should consider if fbo providers may have different results delivering content that is less likely to be stigmatizing or have moralistic framing (e.g., the importance of breast cancer screening compared to addictions treatment). again, there are multiple research agendas related to clarifying and establishing the evidentiary effectiveness of fbo social services. research by o’connor and netting (2008) among diverse “exemplar” fbo programs underscores challenges to effectiveness research with fbos, whose providers prioritize “the faith factor” (p. 354), flexibility, stewardship, and commitment to multiple stakeholders over protocols or evidence-based outcome measures. fbo policy implementation considerations. from the above discussion, it would follow that policymakers and social workers should be contributing support and efforts for quality research on topics related to fbo service provision that will be required to determine effectiveness of fbo programs. lack of current research about the difference between secular and religiously-based social services, and the effectiveness of fbo programs in particular, puts administrators in a difficult position. administrators have presidential mandates to distribute funds for social service programs in the most effective and efficient way possible, while also being non-discriminating on the basis of religiousness of applicant organizations (see exec. order no. 13559, 2010). yet, they are without benefit of the knowledge needed to discern if and how these mandates can be simultaneously met. also on a population level, administrators and policymakers should be considering local needs assessments and the strength and integration of needed services. president obama’s recent amendment to executive order 13279 has called for better accountability in assuring that federally supported social service programs adhere to his revised fundamental principles for partnerships with fbos and other neighborhood organizations (exec. order no. 13559, 2010), and for related guidance documents for use by supported programs. thus, municipalities should look for best practices and quality assurance guidelines for administration of funds and services for publicly funded fbo programs. such guidelines are aspects of individual-level effectiveness policy criteria (aday et al., 2004), and indicate that policy implementation is effectively progressing, ahead of, and despite troubling gaps in, the evidentiary science. efficiency efficiency is achieved through proper production and allocation of health care services and goods within the constraints of limited resources (aday et al., 2004). thus, efficiency deals with the marginal cost for incremental health improvements and has a goal of maximum benefit of the population’s health, relative to the costs to accomplish it. advances in social work, fall 2012, 13(3) 495 allocative inefficiency can occur when resources are put into the wrong, or wrong mix, of goods or services, such as ineffective programs or programs targeted at the wrong level (prevention, primary, tertiary). discussions of need (when someone is both better off with the service and values it) and consumer demand (consumption of services at given costs to the recipient) enter these debates with the former usually driving regulatory allocations and the latter driving for-profit provider and market-based actions. production inefficiency occurs when the cheapest means of acquiring goods or services are not used. according to aday and colleagues (2004), factors that impact production efficiency include using the least sufficiently qualified persons to perform health care system roles, and optimizing economies of scale, service sites, and payment methods. determination of production efficiency is predicated upon determination of allocative efficiency, which is predicated upon determination of effectiveness. in other words, while a given actor may successfully buy goods and services as cheaply as possible, inefficiency occurs if the purchased goods and services are ineffective. evaluative tools used in determining efficiency draw heavily from economic theory and methods and include analyses of cost-benefit, cost-utility, cost-effectiveness, and comparative systems. policy considerations within the area of efficiency include: 1) the overall health care target budget as proportion of state or nation’s gross domestic product (allocative); 2) creating a “mix of services that maximizes a combination of positive health outcomes and consumer satisfaction for the available share of resources expended on health services” (aday et al., p. 175; allocative); 3) “considerat[ion of] the health of individuals receiving care, their satisfaction with the method of service delivery, and any health consequences to others who may be indirectly affected by health programs” (aday et al., p. 175; production); and 4) efforts to advance technology or organizational productivity (dynamic efficiency). fbo service-related research. without establishment of effectiveness, allocative efficiency, and therefore production efficiency, cannot truly be assessed or guaranteed. however, a literature related to production efficiencies (such as capacity, cost-savings of volunteer workers, etc.) is developing (e.g., chaves, konieczny, beyerlein, & barman, 1999; chaves & tsitsos, 2001; cnaan, sinha, & mcgrew, 2004). provided fbo service process issues such as intervention content, dose, and mechanism can be established and found to be effective, the emerging fbo production efficiency literature will be useful. it is worth noting, however, that empirically-based findings are showing less fbo capacity (production efficiency) than anticipated at the outset of the fbo initiatives (kramer et al., 2005b). as a whole, fbo organizations have shown little desire to enter public-private service contracts and have struggled for the technical skills (e.g., grant writing, financial management, legal analysis, evaluation) required to do so (kramer, 2010). national efforts are being made to address these technical gaps among fbos (exec. order no. 13498, 2009; kramer et al., 2005b). it will be important to evaluate how these efforts prospectively impact government contracting with fbos. if and as empirical research addressing the effectiveness of fbo programs is available, efforts to entice fbos to provide publicly funded social services, and the costs to develop their capacity to do so, can and should be assessed for allocative efficiency. garner/health services research models for faith-based organizations 496 fbo policy implementation considerations. there are a number of potential challenges to the efficient use of publicly funded fbo service providers, aside from the lack of prerequisite effectiveness evaluations. per policy, people seeking services must be notified of their rights and any potential service patron who “objects to the religious character of an organization that provides services under the program, that organization shall, within a reasonable time after the date of the objection, refer the beneficiary to an alternative provider” (exec. order no. 13559, 2010, sec.2.h.i). further, the referring organization must assure the service seeker’s actual connection with the alternative provider. even the president’s council acknowledges “that implementing this recommendation could result in significant costs for the government. nonetheless, council members believe the government must take these steps in order to provide adequate protection for the fundamental religious liberty rights of social service beneficiaries” (president’s council, 2010, p. 141). aside from cost issues, the principles and policymaking criteria policy (exec. order no. 13559, 2010) would seem implicitly to rely on the assumption that all communities are large enough to have: 1) duplication of equivalent services and 2) either at least one secular agency or such volume of fbo service programs that at least one organization’s religious character will not be objectionable to a given client. what happens in the many communities that do not meet these assumptions? in those that do, by what standard are alternative service providers deemed acceptably equivalent (program outcomes; accessibility of location, operation hours, out-of-pocket costs; comprehensiveness of services offered; monetary value of services; etc)? research indicating that some potential patrons find religious aspects of religiously-based programs distasteful (poor consumer satisfaction, e.g., kissane, 2008; sager & stephens, 2005) suggest that at least some people will request an alternative provider. policymakers, administrators, and social workers should be assessing their local municipalities to assess the best mix of services and providers in which they will invest to address local needs. all federal money allocated through the partnerships with faithbased and other neighborhood organizations office, be they direct (e.g., grants) or indirect (e.g., vouchers) payments, have administrative criteria regarding limitations on spending, expectations for fiscal accountability, and service process-related consumer rights and protections. municipalities should stay attuned to current model guidance and regulations to help shape their own implementation processes and related staffing needs. adherence to the administration and oversight guidelines of partnerships with faithbased and other neighborhood organizations office monies will require additional personnel time that must be accommodated. lastly, organizations and municipalities accepting partnerships with faith-based and other neighborhood organizations office funds might consider legal review of their obligations and duties. equity equity relates to fairness. ultimately, equity is contingent upon assessing health disparities and assuaging them through effective and fair means. effectiveness is an empirical criterion, but fair is a contested standard. aday and colleagues (2004) distinguish between procedural equity and substantive equity. procedural equity is advances in social work, fall 2012, 13(3) 497 concerned with the fairness of distribution of services and is tied to distributive justice and liberal political traditions. considerations within this criteria include health-related policies, the delivery system (organization, availability, and financing), population characteristics (need, enabling, and predisposing factors), and realized access (utilization and satisfaction of actual and potential consumers). distributive justice proponents will focus on the individual as the unit of equity analysis and prioritize values of costeffectiveness and freedom of choice. as such, it is associated with a more individualfocused, libertarian perspective. distributive justice has guided much of our policy, and most of the health services research to date, but is criticized as failing to account for its inability to reduce health disparities in practice, the collective good of population health, and non-medical factors of health (aday et al., 2004). substantive equity is concerned with the fairness of outcomes and relies upon social justice and communitarian principles. whereas procedural equity is concerned with individual access and equal opportunity, substantive equity is concerned with community well-being and population-level outcomes. accordingly, like social justice, substantive equity is concerned with fairness across population-level outcomes, with a focus on environmental factors (including social, physical, and economic) that foster or help reverse health disparities (aday et al., 2004). social justice proponents will prioritize the values of consideration of need across populations, the common good, and similar treatment outcomes. aday and colleagues (2004) conceptualize equity as derived through blending both of these traditions through deliberate discourse (reflecting deliberative democracy and justice principles wherein affected constituents use discourse to achieve mutual understanding and respect). thus, the proposed concept of equity harmonizes procedural and substantive equity, yielding a model that provides both empirical and normative guidance for assessing fbos. as aday and colleagues summarize, “health policy making must take into account norms of distributive and social justice and that conflicts between affected stakeholders grounded in these contrasting norms must be resolved through deliberate discourse if the resultant policies are ultimately to contribute to improved health and minimizing health disparities. both the effectiveness and equity criteria demand it” (p. 198). aday and colleagues’ (2004) blended concept of procedural equity (focused on individual access) and substantive equity (focused on population-level outcomes) provides a rigorous, comprehensive model for evaluating fbo policies, and, in particular, ensures that community-focused values are integral to the assessment. equity research may be descriptive (exploring dimensions), analytical, or evaluative. according to aday and colleagues (2004), data for analyses may come from a number of sources. service recipients may provide data through surveys, interviews, focus groups, or aggregated outcomes of official records. an institution’s discrete service records such as walk-in clients, counts of particular services rendered, and financial accounting can provide data, as can personnel through surveys, interviews, focus groups, or employment records. health care system records, such as funding or performance records, can provide data. representative or purposeful survey sampling of community populations about health and health care utilization factors can produce data. lastly, the community environment itself can provide invaluable data through physical measurements, garner/health services research models for faith-based organizations 498 observations, or reports about sociodemographic and physical environment health and health care use-related factors in a geographic region. aday and colleagues (1999) state: “the ultimate test of the equity of a health policy is the extent to which disparities or inequities in health persist among subgroups of the population” (p. sp41). this reveals a clear and consistent assumption that procedural equity (focused on equal access rather than equal outcomes) alone is an inadequate test for equity. they offer an in-depth discussion of justice theories and principles, along with corollary equity criteria and policy foci, that underpin the promoted distributive, social, and deliberative justices blended approach to equity that is beyond the scope of this article (aday et al., 2004). however, their six equity criteria and related empirical indicators across these constructions of justice that underpin the recommended approach can be summarized and discussed. health risks and health relate to the criterion of need. development and implementation of health policies will have inherent indicators about the criterion of participation of stakeholders (intended recipients, providers, general public). health care delivery systems relate to the freedom of choice criterion. realized access to health care relates to the criterion of cost-effectiveness. treatment across populations at risk relates to the similar treatment criterion. and assessing the social, built, and natural environment for indicators of wellness relates to the common good criterion. fbo service related research. from a research and scholarship perspective, aday and colleagues’ (2004) concept of equity advances the field in part by broadening the lens beyond traditional empirical social science methods. the framework draws upon philosophical theory and should include corollary methods, suggesting the need for crossdisciplinary training or multidisciplinary teams to address questions of equity. however, many of the empirical areas that aday and colleagues suggest should inform equity discussions, track procedural equity concerns, and parallel or complement the kinds of data needed to answer questions of effectiveness and procedural efficiency (e.g., accounts of organizational characteristics or capacity, networks and systems of care, recipient characteristics, and satisfaction with services). highlights of current fbo program research have been noted above. observational population data analysis of the incidence of indicators of health, particularly those specifically targeted by the fbo initiatives (such as addiction, housing, and employment), can be used as indicators of social justice criteria when used to assess shifts in disparities among subgroups of the greater population. on the scientific front, both the effectiveness and fairness components of fbo policies require attention. field research and advancing research design or analytic methods will help progress the empirical outcomes component of the equity criterion. a second important agenda lays in efforts to use humanities methods to illuminate, explore, or advance the philosophical underpinnings of assumptions, methods, and conclusions of scientific evaluation of fbo programs and policies. this requires widening the lens for many, but is an important agenda if transparency and integrity of knowledge are the goals. lastly, earnest and informed discussions among stakeholders are required for deliberative justice. thus, dissemination of results of both these veins of research agendas will be important. advances in social work, fall 2012, 13(3) 499 fbo policy implementation considerations. policymakers, administrators, social workers, and advocates will benefit from better breadth and depth of research, when available. the aday and colleagues (2004) framework suggests equity should be determined through an earnest discussion among stakeholders as balance is sought between individual-level equity and populations-level concerns. this requires taking account of, and reconciling to constituent satisfaction, policies that foster fair dispersion and access of services, customer satisfaction, and cost-effectiveness (individual-level outcomes) on the one hand, with policies that foster enhanced community welfare, equality among populations, and collective good on the other hand. it is worth noting that president obama’s creation of the president’s council and response to its recommendations suggests commitment to accountability and quality improvement of the policies and applications of federal funding of social services through fbos. applying aday and colleagues’ (2004) criteria for equity indicators of policy leads to mixed and inconclusive results. need, one of aday and colleagues’ suggested policy equity criteria, is a driving force in the faith-based initiatives. there are multiple ecopsychosocial needs among the nation’s vulnerable populations that go unmet, some of which are now targets of the fbo policies initiatives (exec. order no. 13498, 2009). this criterion is clearly met. while intended or actual program recipients may have participated in various points of the process, the inaugural president’s council is comprised of twenty-five nongovernment organization, religious, and academic leaders. deliberative democracy principles would suggest direct participation, with equal standing, by those intended to benefit from the programs. it is not readily clear that the participation equity criterion is currently met in fbo policy implementation. the principle of freedom of choice is well represented in current policy statements. efforts to correct implementation failures and assure religious freedom of program participants are underway (exec. order no. 13559, 2010). however this libertarian value is also aggressively being applied to rights of providers. a provider “may use [its] facilities to provide social services supported with federal financial assistance, without removing or altering religious art, icons, scriptures, or other symbols from these facilities. . .[and] may maintain religious terms in its name, select its board members on a religious basis, and include religious references in its organization’s mission statements and other chartering or governing documents,” (exec. order 13559, 2010, sec.2.g). thus, there are policies and measures being created to meet the equity criterion of freedom of choiceamong both intended recipients and providers. aday and colleagues’ (2004) equity consideration of cost-effectiveness is implicitly part of the current fbo policy and related regulatory effort. however, as noted above, this goal is currently problematic. cost-efficiency falls within aday and colleagues’ (2004) conceptualization of efficiency and requires knowledge of effectiveness, which is not yet established. further, policymakers will have to reconcile cost effectiveness goals against costs of policy services and implementation. implementation costs might include those associated with: 1) technical training and recruitment of fbo partners; 2) assuring alternative providers are available for those service seekers who object to the religious garner/health services research models for faith-based organizations 500 character of an fbo program; 3) potential inefficiencies of directly supporting a service program that fails at realized access for a sub-group populationthough using secondary (e.g., voucher) rather than primary (grant) funding mechanisms will help assuage this issue as payments follow use; and 4) administering and oversight of adherence to regulated service standards. the similar treatment equity criterion suggests that people should receive comparable treatment for comparable needs, regardless of personal characteristics (e.g., age, race, income, or insurance). a key concern within this criterion is how fbo policies do or do not effectively increase access to and use of needed services (realized access). are those accessing fbo services individuals who would not otherwise be served (e.g., would they go to a secular service provider?)? alternatively, are fbo programs simply shifting the site of services among those already being served, thus failing to extend the reach of services and giving rise to the need to research how these consumers’ outcomes compare between types of programs (an effectiveness issue)? the current policy effort seeks to meet the similar treatment equity criterion by dispersing services into organizations already embedded in communities, prohibiting providers from refusing clients based on a potential client’s religious (or nonreligious) beliefs, and assuring an alternative provider will be made available to a potential client within a reasonable timeframe. these approaches are solid but may prove hard to effectively and efficiently implement and enforce. a common good criterion perspective will be concerned with whether fbo policy improves social issue outcomes among the targeted vulnerable populations as compared to the general population. common good is found in policies that increase “the social resources, or social capital, that may be available to individuals associated with the family structure, voluntary organizations, and social networks that both bind and support them” (aday et al., 2004, p. 211). within the frame of this equity criterion, perhaps fbo policy simply serves to enhance localized human capital and resources. if collective good is the policy equity criterion, then vitalizing communities of faith, irrespective of effectiveness or comparative effectiveness of their services upon individuals receiving them (so long as they are not doing harm), could satisfy this criterion. mcmillin (2011) argues this is not what is happening, however. he raises concerns about contemporary churches abandoning communitarian values in favor of individualistic values and rhetoric. he argues churches are using these to advance their specific political and moral views through the leverage and platform of fbo social service program administration. such behavior actually increasesrather than decreasesjeopardy of minority interests (mcmillin, 2011). irrespective, implementation challenges are likely as different segments of a given population compete for limited funds, effectively vying to be among those in the community most benefited by investments in the common good (de vita & wilson, 2001; mcmillin, 2011; saperstein, 2003). discussion and conclusions good policy is of concern to us as citizens and professional social workers, charged with critically analyzing and advocating about issues and policies impacting our clients advances in social work, fall 2012, 13(3) 501 and communities (cswe, 2010). federal policy changes have been shifting roles and responsibilities for social and safety net services downward and outward (hutchison, 2011), including to fbos, which may now maintain their religious identity as pervasively religious organizations while providing government-funded services. responsible assessment of the impact of the fbo policy is challenging. most of the current literature consists of segmented research with limited scope, varied aims and standards for success (johnson et al., 2008; kramer, 2010; kramer et al., 2005a), and conflation among types and funding sources of fbos and their programs. much of the public and professional discourse on the topic of fbo policies is narrow in focus, ideologically charged (saperstein, 2003; wineburg, 2007), familiar only to certain vested groups, and absent an appropriate conceptual framework. moreover, the fbo policies are part of the devolution of public social and safety-net services (kennedy, 2003; mink, 2001; wineburg et al., 2008) and reflect the new role religion has taken in politics (gelman et al., 2010; mcmillin, 2011). setting aside the politics of this shift, it is clear that, consistent with its values and mission as a field, social work is responsible for evaluating fbo programs and policies through an analytic framework that includes the perspective of social justice and community well-being. aday and colleagues’ (2004) empirically supported, theoretically-based model, of the concepts of effectiveness, efficiency, and equity, provides such an analysis model. a preliminary application of the model raises questions and concerns with current fbo policy. from the perspective of effectiveness, alongside administrators and policymakers, social workers should consider, for example, the need for nuanced population and dosing research among populations in order to determine how the added element of provider or setting’s religiosity impacts social service outcomes. from the perspective of efficiency, alongside administrators and policymakers, social workers should consider, for example, whether the investment in services that requires additional expenditures (redundancy of alternative programs, and oversight management) is the best use of resources. from the perspective of equity, alongside administrators and policymakers, social workers should consider whether programs that emphasize and privilege a particular spiritual point of view provide better service, at the population level, than traditional secular programs that are responsive to the recipient’s religious preferences. aday and colleagues’ (2004) equity concept demonstrates that there is a need for nuanced, community-specific research to identify where and for whom fbo programs may serve a population that cannot otherwise be successfully served, in order to assess where these programs may fit within a region’s continuum of care. aday and colleagues’ (2004) model is particularly helpful to, and compatible with, the field of social work, given its balanced concept of equity that incorporates both empirical and normative standards. equity of outcome is empirical, but philosophies of equitable processes and values are contentious normative standards of central concern to social workers. aday and colleagues (2004) offer an eloquent solution for issues of equity in health-related policies. they suggest that by balancing, through a deliberative discourse process (deliberative justice), the individual focus contained within the dominant distributive justice approach with the collective focus of the social justice approach (advanced in public health and social work), stakeholders can build effective garner/health services research models for faith-based organizations 502 policies along with trust and understanding. the present study contributes to this effort by introducing and 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(2004). the effectiveness and trustworthiness of faith-based and other service organizations: a study of recipients’ perceptions. journal for the scientific study of religion, 43(1), 1-17. doi:10.1111/j.14685906.2004.00214.x author note address correspondence to: michelle d. garner, phd, acsw, licsw, university of washington tacoma, 1900 commerce street, tacoma, wa, 98402. email: mdgarner@u.washington.edu microsoft word 8. mooney et al_15089-researchdatamanagement_copyedit final ______________  hailey mooney, mlis, is the data services coordinator and social sciences librarian, w. aaron collie, mslis, is the digital curation librarian, and shawn w. nicholson, ms and mslis, is the associate director for digital information, all with the michigan state university libraries. marya r. sosulski, ph.d., is an associate professor in the school of social work at michigan state university in east lansing, mi. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 368-389   collaborative approaches to undergraduate research training: information literacy and data management hailey mooney w. aaron collie shawn w. nicholson marya r. sosulski abstract: the undergraduate research experience (ure) provides an opportunity for students to engage in meaningful work with faculty mentors on research projects. an increasingly important component of scholarly research is the application of research data management best practices, yet this often falls out of the scope of ure programs. this article presents a case study of faculty and librarian collaboration in the integration of a library and research data management curriculum into a social work ure research team. discussion includes reflections on the content and learning outcomes, benefits of a holistic approach to introducing undergraduate students to research practice, and challenges of scale. keywords: undergraduate research, research data management, faculty librarian collaboration, social work education undergraduate education provides students with foundational skills and abilities permitting entry into the workforce or advanced study at the graduate level. introduction to research methodologies is an important aspect of the social work curriculum preparing students to base real world practice on the critical appraisal of various techniques and interventions. research opportunities for social work students, such as those provided by undergraduate research experience programs, allow students to build relationships with faculty mentors and experience first-hand the research process, thereby amplifying critical thinking skills and preparing students to be producers (rather than just consumers) of professional knowledge (moore & avant, 2008). in today’s data-rich research environment, a key component of these foundational skills is the ability to successfully navigate the organizational and technological aspects of research data production. the library and information science profession is contributing to the training of this new arena of research skills known collectively as research data management. in many cases, the integration of data and information skills is not explicitly part of the undergraduate research experience. by collaborating with librarians, faculty mentors for undergraduate research can significantly enhance the experience and build foundational skills for students giving them a leg up from their peers in the competition they will face for jobs or graduate school entry after graduation. mooney, collie, nicholson, sosulski/undergraduate research training 369   this paper will introduce readers to the importance of research data management skills to social work education and the role of librarians in providing instruction and support in this area through the lens of enriching the undergraduate research experience. a case study of faculty/librarian collaboration with an undergraduate research team will provide an example of a data management curriculum. this article fills a needed gap in addressing a life-cycle approach to research data management in the growing literature on undergraduate research experiences (ure) while demonstrating the relevance to social work education. our experience of designing and implementing research data management modules and the reported authentic experiences of the students signals the potential benefit of integrated and detailed research data management instruction as routine for ure. literature review major context: research data management due to the widespread adoption of technology in higher education, a new baseline requirement for many research projects is digitally managing the data and digital ephemera that support scholarly dissemination. digital research data vary widely due to the irregular makeup of research itself, including within disciplines like social work where both qualitative and quantitative methods may be employed. variations in project size, research methods, disciplinary norms, available resources, and expected outcomes combined with the many possible ways to represent information digitally result in a variegated landscape of research data. because of this heterogeneity, research data requires equally nuanced responses for management, storage, preservation, and access. this problem in itself is not new and researchers have been pioneering methods of organizing, managing, analyzing, and collaborating around digital research data for over three decades. recent policy developments, such as the 2011 requirement from the national science foundation (nsf) to include data management plans in applications for funding, have pushed research data management into the spotlight of the scholarly communication crisis. many funding agencies have followed suit to the original nsf impetus and seek to expand the reach of research dollars by recommending that research data be made available as an additional output of publically funded research. this, combined with the more general call for open and increased access to the results of research, has created an environment where the sharing of research data itself (in addition to publications based on that data) will increasingly be expected (goben & salo, 2013). largely in response to these changes, an effort to create scalable and standardized research data training, best practices, and services has resulted in the confluence of a number of extant disciplines (information science, research administration, higher education administration, information technology) into an emergent community of digital data curators. broadly defined digital data curation is a term that reflects a holistic approach for managing digital assets for their entire "lifecycle" of utility for research and scholarship. this includes selection, collection, analysis, interpretation, description, preservation, transformation, maintenance, access, long term archiving, and reuse. while digital advances in social work, fall 2014, 15(2) 370 curation is a term that is prevalent in the information science literature, in practice the strategies and actions which support the holistic model of data stewardship are often simplified and colloquial. research data management and digital data curation are somewhat synonymous, with the former implying a streamlined research-centric lifecycle and the latter implying a more inclusive content agnostic lifecycle. this paper discusses data within the context of academic research in social work and therefore relies on the terminology of research data management. it is suggested in a number of recent studies that the general knowledge and skills necessary to manage research data are not currently a major part of undergraduate, graduate, and doctoral curriculums (carlson, fosmire, miller, & sapp nelson, 2011; scaramozzino, ramirez, & mcgaughey, 2012). carlson et al. identified in their assessment of faculty interviews that “[data management] skills, knowledge, and training needed by graduate students” was a “common theme” and that “typically, faculty determined graduate students were unprepared to manage or curate the data effectively…” (p. 636). those same faculty implied that there was a causality dilemma as “…they often could not provide adequate guidance or instruction because it was not an area that they knew well or fully understood” (p. 636). scaramozzino et al. found a similar dilemma in surveying the college of science and mathematics at california polytechnic state university; fully half (50%) of respondents reported they were “not sure or not confident in their data management skills” and were “open to increased educational activities on the topic” (p. 360). because researchers themselves widely vary in their command and comfort of information technology, it is unclear if research data management education can be consistently implemented by merely enforcing a new curriculum. despite these deficiencies, research data management is an expected job skill for graduate assistants, doctoral researchers, and faculty researchers (carlson et al., 2011). if our next generations of researchers do not possess the baseline knowledge, skills, and experience that are in demand for contemporaneous research data management, we risk exacerbating the deficiency by producing an underprepared workforce. the prerequisite knowledge for this baseline requirement has been positioned as a literacy that carlson et al. (2011) term “data information literacy.” they argue that data information literacy is a synthesis of related literacies that aim to foster understanding of key research concepts including methods of data collection or acquisition, data representation, data interpretation, statistical analysis, data manipulation, data management and preservation, and data summarization and presentation among other related skill sets. why is research data management important to undergraduate research experience participants? undergraduate research assistants are involved in meaningful research engagements with their faculty mentors. these beginning researchers through formal and at times funded undergraduate research experiences (ure) participate in various activities such as literature reviews, qualitative and quantitative data acquisition, coding, interpretation, and mooney, collie, nicholson, sosulski/undergraduate research training 371   the presentation of analyzed results. faculty ask undergraduate research assistants to work directly with their data in one way or another; therefore students should be aware of best practices for data management. many commentators point to the boyer report on reinventing undergraduate education (boyer commission on educating undergraduates in the research university, 1998), as spurring the birth of cross-cutting undergraduate research experiences at american research universities (fechheimer, webber, & kleiber, 2011). later, kuh and schneider’s (2008) highly influential high-impact educational practices singled out undergraduate research as important for formulating questions, honing observational skills and working with advanced technologies as a means to enhance student engagement and increase student success. the intervening decade has witnessed a spate of descriptive studies outlining design and implementation of ure programs (buckley, korkmaz, & kuh, 2008; cuthbert, arunachalam, & licina, 2012; howitt, wilson, wilson, & roberts, 2010; wilson, martinez-uribe, fraser, & jeffreys, 2011). social work education programs are included in the incorporation of undergraduate research into student learning opportunities, both within the context of regular coursework and field placements (rubin, valutis, & robinson, 2010), as well as supplemental ure mentored programs (hughes, ortiz, & horner, 2012). the need to engage undergraduate students in positive research opportunities is especially salient in the field of social work. as an applied helping profession, overcoming research anxiety is seen as an important goal (adam, zosky, & unrau, 2004; maschi, probst, & bradley, 2009). naturally, the numerous descriptive studies bred a desire to understand the impact of ure programs on the students as well as the domains. a wealth of empirically-based theoretical explorations of perceived benefits for students and institutions has emerged (bauer & bennett, 2003; kardash, 2000; russell, hancock, & mccullough, 2007). generally, these studies reveal that ure students feel positive about their experience, yet some concern has been raised whether research skills have been advanced. responding to these concerns is a growing body of qualitative and quantitative assessment literature (fechheimer et al., 2011; gum et al., 2007; lopatto, 2007) focusing on the learning outcomes (problem formulation, methodology application, lab techniques) of the undergraduate research experience. yet absent from these studies is an explicit account of research data management instruction, however loosely articulated. it is our assessment that data management and the broader scope of data information literacy, indeed even basic library research skills, are not widely perceived as explicit goals of participation in undergraduate research despite an overarching goal for the advancement of real world research experience. ideally, the ure engages students in knowledge creation by participation in the processes of discovery through the conduct of academic research. the advancement of knowledge is an exciting prospect, but any good researcher knows that there are less glamorous aspects to the research process, such as data entry. in fact, these less glamorous aspects are often what the undergraduate is assigned to do. but the glue that ties these mundane tasks to the glory of a well-received publication is the planning and execution of best practices in handling the information and data that bolster the process of discovery. we must ensure that students learn that data management is more than just a set of skills, it is about engagement in the creation advances in social work, fall 2014, 15(2) 372 and preservation of knowledge. as librarians, we often see students who are embarrassed to admit that they do not understand how to conduct a literature review, let alone decipher a call number location. faculty often assume that students come to them with these socalled basic skills, yet the reality is that these skills often fall through the cracks and are not a formal part of the curriculum. faculty and librarian collaboration how then, do we accomplish the integration of the undergraduate research experience and the development of library and research data management competencies? it will require the infusion of multiple expertise. faculty mentors are experts in their own research topics and methodologies and can guide students through the process of assisting with specific aspects of projects. however, since most faculty are not experts in the areas of information science and the accompanying data and information literacies, collaboration with librarian partners as additional mentors in the research process rounds out the undergraduate research experience. while bringing a librarian into the classroom to instruct students on the skills needed to write research papers, or referring students needing extra assistance with compiling bibliographies to consult with a librarian are both common examples of faculty reliance on librarian expertise, faculty collaboration with librarians as partners in research teams is not as widely done. traditional models of faculty/librarian collaboration focus on the classroom instruction environment (shumaker, 2011). as experts in the literature and practice of their own research areas, it can be easy for faculty to overlook the value of librarian mentorship for initiation of the student researcher. likewise, librarians are often focused on working with undergraduates within the context of course assignments. this results in a lack of attention paid to direct instruction from librarians within the undergraduate research experience. since undergraduate researchers are engaged in knowledge creation along with their faculty mentors, the experience presents a collaborative opportunity for librarians and faculty to advance student learning in a holistic, hands-on approach (stamatoplos, 2009). increasingly, librarians are actively expanding their roles beyond the traditional confines of the library building and the reference desk and in many cases are partnering as members of research teams (allard, 2012; brandt, 2010; carlson & kneale, 2011; dewey, 2004). both research faculty and librarians have much to share and learn from each other on the path towards synthesis of domain knowledge with data management skills for more efficient and impactful research. opening the undergraduate research experience to a combined faculty/librarian mentorship exposes students to the complete research process; not only will students work on a particular aspect of the faculty’s research project, they will also benefit from foundational skill-building in the areas of data and information literacy. this requires an ongoing collaborative partnership between faculty, librarian, and student as members of a research team. accomplishing this requires an embedded model wherein faculty and librarian experience a give and take of expertise sharing and learning from one another. mooney, collie, nicholson, sosulski/undergraduate research training 373   by integrating librarians into undergraduate research, faculty can provide opportunities for students to be coached on best practices for data management. project context case study: social work research team at michigan state university (msu), a large midwestern research university, the ure is situated within the office of the associate provost for undergraduate education. the msu ure has entered into its second half-decade of existence and its design, implementation and assessment tracks closely to the development of the body of literature. in spring 2012, approximately 575 students participated in the msu ure, with 92% of surveyed undergraduate researchers reporting involvement as a contributing member of their mentor’s research team (“msu undergraduate research survey,” 2012). students were involved in undergraduate research across 14 colleges within msu, with varying work experiences in different areas and with different mentors. the ure culminates at the end of each academic year in the university undergraduate research and arts forum, an event showcasing undergraduate research efforts where students share their work by presenting short talks or poster presentations. within the msu school of social work, mentored undergraduate research has been shown to positively support student learning and provide an overall beneficial experience (hughes et al., 2012). in the 2011-2012 academic year a unique social work ure was developed for a group of undergraduate researchers by their faculty mentor in collaboration with a small team of librarians. in normal cases, social work faculty would usually work with just one librarian, the subject specialist librarian for social work. however, given the experimental nature of the pilot project and the need for a depth of overlapping areas of expertise across the library faculty, a “library team” was formed to ensure the highest level of partnership and service to the ure research team. the library team consisted of the subject specialist librarian for social work (conveniently also working in a dual role as the data services librarian), the data curation librarian (digital technical expert), and the associate director for digital information (project visionary). the undergraduate research students were given distinct independent responsibilities within a given project in order to “own” the work and gain more specialized expertise in a particular area of research. students also worked collaboratively with the team, including attending biweekly research team meetings so that the group benefited from each other’s experiences. it was at these meetings where librarians joined the research team as embedded participant observers and contributed the library and research data management curriculum. this collective group of students, faculty mentor, and librarians (the library team) made up the complete ure research team. the functioning of the ure research team would allow for students to participate in the faculty mentor’s own research as had been done in previous years, while at the same time serving as a pilot project for the infusion of a research data management curriculum led by the library team. advances in social work, fall 2014, 15(2) 374 the purpose of this collaboratively led undergraduate research team was multifold: 1. to prove librarian support to students and faculty in their routine work, thereby fulfilling the traditional librarian liaison role. 2. to reveal knowledge about and interest in research data management, by having the library team act as quasi participant observers. 3. to test the efficacy of the seminar approach to library and research data management instruction. the ure research team for academic year 2011-2012 included students working on two projects: data analysis of minority women’s experience with spirituality and mental health care, and conception and planning for a study of recovery within the context of community mental health services. the second project is a rare example of a project in which the student team joined at the very beginning of the process of designing a new study. the faculty mentor felt as though it was a risk to involve students with very little experience at the outset, where they would be actively participating in the development of the research questions, methods, implementation, and analysis. while the mentor had ultimate decision-making power, she entrusted the process to the team as a whole. the results were overwhelmingly positive. the mentor provided formal instruction in theory and methods, and the students applied the knowledge and skills to the problem. the students’ questions about the instruments (survey and focus group and interview protocols) were particularly useful, as well as the range of their suggestions from which solutions were chosen. the coordination of tasks was delegated, but all of the students took part in each assignment. this way, the students also learned about management of tasks, as well as discrete skills in reviewing literature, designing and modifying instruments, scheduling and conducting data collection, entering survey data, and transcribing focus groups and interviews. in the mentor’s assessment, the process was more dynamic, creative, and progressed more quickly than she had expected. the project progressed from initial discussions of what the study should look like to implementation (i.e., data collection and management) in approximately one semester (16 weeks). the team approach provided students with the chance to experience a range of research tasks, including work on data gathered using both qualitative and quantitative methods. curriculum the library and research data management curriculum covered topics spanning from across the entire scope of a research project, from literature review to post-project storage. while a unique curriculum was developed, it was built from a review of existing data management training programs, and integration of social work education competencies (council on social work education, 2012). both of these curricular components are discussed below. there are numerous resources available aimed at training researchers in data management competencies. these include web resources such as online tutorials aimed directly at researchers (e.g., edina and data library, university of edinburgh, n.d.; mooney, collie, nicholson, sosulski/undergraduate research training 375   strasser, cook, michener, & budden, 2012; university of essex, n.d.) and teaching examples and resources for instructors (e.g., federation of earth science information partners, 2012; qin, small, & d’ignazio, n.d.; strangeland et al., 2010). piorun et al. (2012) have published a curriculum framework aimed directly at undergraduate and graduate students with seven modules covering data types and formats; contextual details and metadata; storage, backup, and security; legal and ethical considerations; data sharing and re-use; and data archiving and preservation planning. these modules map to a set of core competencies based on an inventory of related curricula and interviews with students about their data management practices. carlson et al.’s (2011) exploration of data information literacy also yielded a similar list of core competencies with additions in the areas of data discovery and acquisition, data conversion, quality assurance, disciplinary cultures, analysis, and visualization. many of these additional competencies reflect carlson et al.’s broader conception of data literacy including active research skills as well as management considerations. relevant social work education core competencies include critical thinking, research informed practice, ethical practice, and social justice. our approach to the ure and the data management curriculum emphasizes the placement of data management within the larger holistic research process. this is necessary in order for students to see how their particular assignments on the research team contribute to the development of scientific knowledge building. ethical concerns regarding the collection and treatment of human subjects data necessarily infuse the curriculum. social justice is raised not only as an outcome of research and practice, but as an issue integral to the scholarly communication system where public access to research findings are often limited by publication venues and the lack of open data. students well trained in good research practice will in turn do good social work practice. the modules developed for the ure students divide the elements of the research process logically in order to provide a fundamental structure that is helpful for beginning students without a background in research. although initially developed as training tailored to the needs of a specific research team, the modules are based on a broader set of universal research skills that can be widely applied. some research assistants may be reluctant to admit that they are unsure or do not understand the research process. integration of this curriculum into the ure saves time by helping the faculty mentor identify where students are starting with their knowledge and skills without having to engage in unnecessary backtracking to discern problems. by providing a grounding in the research process, students are able to begin to develop intuition about the intricacies and nuances of conducting research. the modules outlined below were delivered as short lectures interspersed with opportunities for discussion and reflection. topics were presented in tandem with the needs of the research team activities so that as often as possible they could be directly related to the actual real-time workflow of the students’ engagement with the faculty mentor’s research. therefore, the modules represent a series of thematic content areas rather than content covered during a single session. in practice, the library team contributed module content in a manner responsive to the ebb and flow of the entire research team’s work, so that covering a single module might be split over multiple advances in social work, fall 2014, 15(2) 376 meetings. in this way, our hope was to engage the students in a web of content delivery and practice activities; each reinforcing each to maximize learning. brown and adler (2008) refer to this as “reversing the flow.” their claim is that formal curriculum works from the presumption that you first fill students with content before sending them out to engage in practice. he argues that best learning derives from practicing the content. it is within this spirit that the modules were developed, winding about and allowing for contemporaneous practice to drive content delivery. we offer the module themes and attendant core elements in detail in hope that they can be readily put into practice in other contexts. curriculum modules outline module 1: introduction to literature management topics covered: literature management, citations conducting literature reviews and becoming familiar with the relevant literature is an important component of research. this module familiarized students with basic concepts for literature management by introducing zotero (george mason university), a free and open source citation management tool. starting with this module was a deliberate choice to introduce students to productivity and organizational tools before even beginning their literature reviews. integrating a citation management tool into the process of the literature review initiates students into approaching research in a systematic way and provides a relatable medium for the introduction of concepts such as organization, management, and collaboration. the research team created a shared group library in zotero where students could post articles and share annotations. this creates a space for students that demands the intellectual work of thematically categorizing articles using folders and keyword tags to begin the work of critically assessing the literature, building skills in critical thinking and laying the foundation for research-informed practice. additionally, discussion of what it means for a software program to be open source provides an opportunity for students to consider the social justice issues inherent behind the movement for free, open, and community-supported digital products, as well as the advantages and disadvantages of using an open source tool in research. module 2: literature and data topics covered: literature review, source evaluation, finding data the students in the research group had already been exposed to a guest lecture on literature searching from the social work librarian in their regular course schedule. since a basic familiarity with using library resources was already established, it was only necessary to refresh and reinforce best practices for conducting literature reviews. this was accomplished by viewing a video tutorial (smith et al., 2009) and going over steps and techniques in the literature review process. students were given the opportunity to reflect on previous experience and ask questions. in order to emphasize the role of critical thinking in the process of choosing appropriate articles to review, the evaluation of sources was also discussed, using de montfort university’s information source mooney, collie, nicholson, sosulski/undergraduate research training 377   evaluation matrix (towlson, leigh, & mathers, 2009) as a tool to define criteria for the inclusion of articles in student literature reviews. next, a transition towards focusing on data began by drawing out the integration of data in the scholarly literature. students were asked to identify the source of data analyzed in their literature review articles. after introducing the concept of secondary analysis as a research methodology, students were asked to determine if researchers collected original data or used data collected by someone else, such as data from a major government survey. by identifying instances of data re-use, the value of documenting and sharing data is uncovered as an important component of research practice. this sets the stage for the remaining modules. module 3: planning for project and data management topics covered: project parameters (tools & environment), file plans, naming conventions, formats, short term storage the overarching message of this module was that the research process is a complex project which can benefit from detailed planning and resource provisioning. highlighted in this module were the parallel lifecycles of research, scholarship, and data. data was identified as a central resource and fuel of research which requires not only expert interpretation and analysis but also competent stewardship. this concept was enforced by examining the benefits of fundamental data management tactics such as developing file naming conventions, creating flexible and interpretable file plans and understanding the risks and advantages of file formats. naming and organizing data to increase accessibility is a component of this module. the primary value of creating file plans and file naming protocols was demonstrated as a way to enhance the collaborative research process and provide ease of use. creation of a system that is easy not just for the current team but also for others who may join in the future is important. the significance of backing up data is generally accepted as good practice (three copies in three different places: original, external/local, and external/remote), but the majority of the team admitted to being inconsistent in this area. lost data is a chief concern, but issues of confidentiality including storing data securely, managing access, and handling of data in use (e.g., processing, transcribing, using quantitative or mixed methods analysis programs such as spss and dedoose) were also discussed. these issues are especially crucial in light of ethical concerns around private client data. options specific to the faculty research project were explained, such as using a secure server with limited access to the research team, as well as being protected from public access. discussion ranged from password protection to vigilance about the need to safeguard personal laptops used for research in public spaces and in living spaces (e.g., away from roommates or family members who might accidentally or personally view the data; locking the doors of rooms or cabinets where they keep their computers). the entire research team then weighed the benefits and potential drawbacks of the various security options and came up with a plan that worked for all of them, and first and foremost maximized the safety of the data. finally, a distinction was made between project-term data storage and post-project term data archiving. advances in social work, fall 2014, 15(2) 378 module 4: data collaboration and sharing topics covered: project collaboration, project documentation, metadata, data sharing collaboration and sharing around research data was introduced as a scalable practice that starts with strong project documentation. the recently covered topics of file plans and file naming conventions were highlighted as the type of documentation that can help establish an authoritative structure for data management. guidelines for selecting course or content management systems, wikis, and other tools for collaboration around documentation were discussed with special attention given to version control and access control. discussion centered on how good practices for capturing documentation for small team of researchers can be used as a building blocks to develop and capture more detailed description required for validation and reproducibility such as lab notebooks, research protocols, methodology, and metadata standards. collaboration and documentation were revisited at the end of the semester in order to create a final project documentation and data management plan that could be passed on to the next ure student group. this reinforced good research practice and an integrated view of individual student responsibilities into the whole of the research process. importantly, providing the building blocks throughout the ure program for grounding in the research process, with a particular focus on data management for collaborative purposes, helped to provide students with ownership of the study and data. this built motivation for students to claim parts of the project and share their knowledge and expertise with the team and with the broader university community as part of their final project poster presentations. module 5: archiving and reporting on research data topics covered: long term storage, data publishing, data citations, data presentation a session on data presentation was delivered as students were preparing posters for presentation at the undergraduate research and arts forum, giving this topic a heightened sense of relevancy. a slide set was prepared with a series of examples of differing methods of data presentation from simple text-based descriptions such as lists and tables to more advanced visual-representations of data including charts, figures, illustrations, and visualizations. these examples were examined for their benefits or drawbacks by applying tufte’s (2001) guiding principles for design of quantitative data, slone’s (2009) guiding principles for presenting qualitative data, and klass’ (2008) principles for presenting social science data. data stewardship and curation was presented as the ongoing preservation of access and enhancement of data during its lifetime of utility. long term or archival data storage was discussed as a baseline requirement for preservation of access to data and therefore differentiated from short or project-term data storage. the discussion circled back to confidentiality and ethical treatment of client data as students considered what types of data might be appropriate to archive and publish for other researchers to use, and what types of data would need to remain restricted or be eventually destroyed. common methods of data archiving were examined including self-archiving, journal deposit and publication, and institutional and disciplinary repositories. examples of each of these mooney, collie, nicholson, sosulski/undergraduate research training 379   methods were discussed, with particular attention given to data citations, available metadata, and sustainability. publishing data via the process of archiving was considered as a positive research practice in that it provides the ability for others to reproduce results or re-use data for new purposes. although data archives such as the inter-university consortium for political and social research have been around for more than 50 years, recent changes in the digital scholarly communication system have made data sharing within reach of many more research projects than before. the open access movement raises important social justice issues around the availability of research outside of the academic environment, especially in social work where many practice outside of the ivory tower. results and discussion student reflections our goal was for students to develop foundational skills and conceptual frameworks necessary to be conscientious researchers concerned about data management and positive contributors to the evolving system of scholarly communication and data-intensive research. we can share representative reflections of authentic experiences so as to frame future design, pedagogy, and assessment developments. these reflections are based on observation and discussion, as well as short written “minute papers” gathered throughout the duration of the program. throughout the curriculum, we asked students to draw from their existing knowledge and experience to create personal relevance to the material. there is nothing like the reality of putting data management best practices into action. this is especially salient when asked to reflect on current data backup strategies for course assignments. student responses ranged from dedicated dropbox accounts to haphazard use of flash drives, campus networks, and email accounts. one student intended to back up to an external hard drive, but was waiting on delivery of the appropriate connector cable from a family member. asking students to consider their own personal data management practices drives home the point that planning and executing research data management best practices is an important component of a well-designed research project. another good example is file naming and organization practices. students gravitated towards the practical advice that they could put directly into personal practice. using descriptive file names with dates and versions was an epiphany that students saw as useful, making research data files accessible to a team and easily transferable to their own course work. students noted the importance of organization as a key takeaway: the most valuable thing i have learned from working with the library team this year would be with my organization skills. the library team has helped me to anticipate future research problems and how preparing for these hiccups will allow for a much smoother research process. a lot of the skills that i have learned have helped me in the classroom, especially with writing papers. advances in social work, fall 2014, 15(2) 380 another student shared that one of the most valuable lessons she learned was “the importance of organization of data. this not only eases your own experience of analyzing the data but makes it accessible to others long after your own study is done.” at the end of the experience, students appeared to have gained a definite grasp of the research process and how it plays out in real life; the various components involved in planning and moving forward a project. one student’s reflection demonstrates this outcome: working as an undergraduate research fellow gave me an inside understanding of the complex and iterative process that is foundational to academic research. from the initial stages of irb approval to grant funding, facilitation, and the inevitable roadblocks, each stage in the research process is intricate. just as most academic research is a conversation between past and present literature, the research process is less linear than it is circular; every phase of the research has the potential to affect a later step. students recognized that the skills they learned as undergraduate researchers are readily applicable to their future professional activities. in one case, a student felt that she was awarded a spot on a different research team “because of my experience with the library staff and experience on this project.” she goes on to explain that the “skills we learned this year are easily transferable to any kind of research in all academic fields. i am going to be more prepared in all academic and professional senses because i am sensitive to things such as: what files to save things as, how to have multiple back-ups of my data, and how to stay organized on my own as i go rather than trying to catch up.” another student reflected that she is already putting her newfound knowledge to work at her new job where the need to [think] critically about seemingly small tasks to maximize efficiency and ease of use has already crept in...i think the research process teaches students to analyze assumptions and seek out better modalities rather than accepting the status quo. i’ve learned to see inefficiencies and time-wasters that i had never noticed before, in addition to learning how to spot possible problems in order to preventatively troubleshoot, which will definitely be a valuable skill set as i continue with research. a widening of perspective about research, both the process and its outcomes, was another notable reflection: i have enjoyed the team aspect of our meetings. i see how effective it is to go beyond your department when needed and ask for support so that ultimately your research can become something that is useful to not only your team but to others interested in the same questions/findings. the collaborative aspect of the project made an impression with this student, showing the understanding that research does not happen in a vacuum. this is an especially edifying reflection for the library team since it represents the successful integration of library resources and services into research and the awareness that research data (in addition to published articles) can be a valuable scholarly output. mooney, collie, nicholson, sosulski/undergraduate research training 381   these reflections show that, through exposure to research combined with thoughtful discussions of research and data management best practices, students learned valuable practical skills and were able to see the larger context within which the scholarly research enterprise takes place. faculty mentor working with many students at different levels, while rewarding, is time-consuming and can be resource-intensive. for this reason, some faculty members shy away from working with undergraduates. a research team needs to be able to work together, draw on each member’s strengths, and produce results for a cogent analysis. the question of how one prepares students with little or no experience to move into tasks that require skills along the continuum of basic to advanced has not been resolved. to an extent, the process is idiosyncratic. however, this training curriculum crystallizes the essential parts of each step in the design and implementation of a research study. having students work through the modules with the library team, along with individual consultations with them as needed, reduced the mentor’s training load from weeks to days and the amount of work for the mentor shifted from a deficit to a net positive balance of training input and work output. according to the mentor: the undergraduate research initiative funded by the university has increased my research capacity a great deal. because i don’t normally have funding to hire undergraduate research assistants, i rely on the ure program for extra hands. i hire, on average, three undergrad research assistants each year, and training can be onerous. some students can start immediately doing literature reviews, joining in data collection events, data processing and management, and even analysis. many, however, start at the beginning with little knowledge and few skills, and it may take a lot to get them up to speed. but all of them are expected to conform to my expectations and do the work thoroughly and well. achieving economies of scale is essential to getting the work done effectively and efficiently, while giving the students the best experience possible. time spent in training helped the mentor understand where the students were starting with their knowledge and skills, assist them, and prevent errors. the mentor reflected: research supervisors often assume that research assistants—at this point, mostly younger people—understand how to work with data, because they have always been around technology. also, it’s second nature to us. we sometimes forget that we had to learn it, and how we learned it. in general, i think that because i don’t always work on research in a linear way, it can be confusing for the students if i move from one piece of the study to another as quickly as i’m used to. but i realize that if i teach the research process in a systematic way, it’s good modeling for the students. the synergy of the curriculum with the actual work of the research projects enhanced student and faculty workflows. according to the mentor: advances in social work, fall 2014, 15(2) 382 having [the library team] in on the whole process was essential to our success. as the pi, i could have made an executive decision. that might have been more expedient, but i would have had to consult with the library team anyway, since i didn’t know all of the options and i value their input. so, hearing about the alternatives happened in the group with the students present. as always, the questions that the students asked added to the conversation, because i wouldn’t have thought of things that would be most helpful for them as they worked together. the mentor also appreciated that, as a practice, the team also held each other accountable for backing up data. this was achieved primarily through sharing tasks and making sure that updates and work completed were posted in the appropriate, secured places. the secure site where the raw and processed data were kept was monitored informally, and team members reminded each other to post their work regularly. the mentor began to think differently about questions of organization and documentation, as well: changing the way i thought about naming and organizing data files was difficult. everybody has their preferred way of labeling that makes sense to them, but then expecting five to ten other people to be able to understand and use it the same way is somewhat unrealistic. it was good for me to be on “the other side” again, like i was as a graduate student in my first experiences as a research assistant. this [curriculum] gave me the chance to sit back and reflect on the logic of organizing schemes. now, i have to learn about the rest of the team’s way of thinking. i think what they came up with was better organized than what i had, and will be easier to explain to future cohorts. what the mentor found is that when she asked the senior students to manage and delegate tasks to the junior team members, they were able to pick up the responsibility quickly because of their deeper understanding of the process. what normally would take a week or two to teach students was presented in one day, and the students then had each other and the library team for support. for this particular undergraduate research experience, the university encouraged research assistants to develop their own research questions from the faculty mentor’s study. the students identified unanswered questions in which they were interested, identified themes and/or variables in the data, analyzed them, and reported results and interpretation. the students presented their research findings as posters at a universitywide forum, where students represented every college and discipline. by the end of the year, the students were able to describe their projects in detail from beginning to end, including the roles they played in the research design. the guidance from the library team prepared them for answering questions about their work, especially those from the perspectives of people outside of the discipline. perhaps the most important aspect of the project is the collaboration because the students have learned when, where, and how to ask for help and where, when, and how to provide their opinions and understanding. affirming this impression, the mentor reflected: mooney, collie, nicholson, sosulski/undergraduate research training 383   i am confident that this group can join another project somewhere after they graduate, or design their own if they needed to, to evaluate their practice. i know they can do it, because i’ve seen them think through the process. they know what it takes to work together in a diverse group to problem-solve, to take a load of data and shape it into something meaningful, and to look at it from all sides. in the end, the mentor found the close collaboration very effective for teaching the students the skills and knowledge they needed. the model of individual assistance is not practical, however, if the curriculum were to be applied to all of the undergraduate research assistants in the department. the important lessons that the mentor took from the experience centered on two points: 1) the connections made between the technical skills and conceptual frameworks are essential, and the expertise of the library team was invaluable for teaching the fundamentals; 2) the relationships among the research team members are critical to success. in practice, it is unrealistic to expect that each research team include a dedicated librarian/data specialist. but a close affiliation, through which the faculty and students have regular formal and informal contacts, offers substantial benefits. the challenge to will be to find the balance of instruction and guidance, on a scale that will be as inclusive as necessary. future formats may include a program that could be open to any interested faculty mentors and undergraduate research assistants, consisting of prescribed workshops presented by a library team combined with periodic attendance by the librarians at team research meetings and individual consultations. librarians as librarians do not typically play an involved role in research team meetings, a primary benefit of this collaboration is the opportunity for the library team to see behind the curtain and observe the structure and discourse of student and faculty collaboration during the undergraduate research experience. faculty in turn were benefited by personal attention to their research support needs. librarians and faculty have a symbiotic relationship: librarians simultaneously observe and participate in research and scholarship, aiming both to understand and support the scholarly enterprise. one of the librarians reflected on the value of this relationship: the field of librarianship is changing along with evolution in the scholarly communication system and the focus on data-intensive research. the opportunity to have an inside look at the research process for a team at our university is invaluable as we are re-shaping our roles to meet changing needs. studying how researchers do their work enables me to discern what current needs are and learn how to best meet those needs. understanding research and informationseeking behavior is a really important aspect of my work so that i can purchase the right collections, learn how to provide the right guidance to new scholars, and advocate for investment in additional central university research infrastructure. the modularized curriculum provided flexibility to enhance the faculty member’s agenda. material and delivery is prepared in advance of meetings, and could be presented or delayed depending on the progress of the project as well as the topics and issues raised advances in social work, fall 2014, 15(2) 384 during the meetings. a typical meeting balances between education, training, reporting and discussion of research and task progress. however, this degree of focus and attention is not easily scalable. despite the modularized curriculum allowing for flexibility of delivery, the overhead of preparation and frequent meeting required by the embedded method is not particularly time efficient. after acclimating to the dynamics of the group, it was possible to respond to teachable moments by providing immediate and tailored instruction. this instruction was provided in an ad hoc nature, and out-of-band with the regular presentation of the modularized curriculum. the corollary effect is the ability to prepare for upcoming content or revisit recently covered topics. this means that not only is it possible to assess student comprehension, but the library team is able to address gaps or correct misunderstanding as issues arise. one librarian reflects on the curriculum delivery: at first it was difficult to realize that all of the material i had prepared could not realistically be delivered according to the calendar we had planned. although our curriculum stressed that research is not always a linear process, i still like to plot out a plan, especially for instruction. but we were melding the two. it was very different from my usual instruction work, where i am in and out of the classroom in one session and have to carefully plan a detailed lesson that covers everything in one fell swoop. in the end, i actually grew to enjoy the development of an ongoing relationship that allowed for curriculum to be delivered over a period of time in concert with real world needs. this dynamic was also mutually beneficial for the library team. the iterative nature of instruction provided an accelerated feedback loop for the library team to improve and expand upon earlier topics. many of the improvements discovered during this method have since been applied to subsequent revisions of the modules. because very few curricula exist that were designed for undergraduate comprehension, this situation provided a valuable test of content appropriateness. another unanticipated but noted benefit of embedded delivery of content is the close tandem of the lifecycle model for data management and the research process as a whole. information gathering, planning, management, analysis, reporting, and publication are paralleled in these curricula providing a serendipitous synergy of research agenda and traditional library instruction. because those with knowledge of best practices for research data management often are neither the same as those with knowledge of reference and instruction nor the same as those with detailed knowledge of the research process, team instruction diffuses teaching and learning. the social work librarian reflects on this aspect of the project: the experience of integrating recently conceived content on data information literacy along with our well-established information literacy competencies has proven to be valuable. a current struggle for many librarians is how to add data management work on top of their existing responsibilities. i see now that this is a continuum of service, which helps make data management work more accessible. working with my colleagues as a team has helped me develop a better understanding of the digital curation concepts that are used to inform the work of data management. mooney, collie, nicholson, sosulski/undergraduate research training 385   resulting is a forum for shared learning: librarians grow more adept at advocating support for tools (e.g., workflow software) and services (e.g., digital storage) for university researchers; researchers are better equipped to pursue data-centric improvements to research efficiency and impact; data managers are initiated into the research process and empowered with new teaching methods; and students are elevated into new roles on the research team for which they were previously underprepared. conclusion as a case study of a pilot project, this experience has laid the groundwork to explore the integration of a library and research data management curriculum into the undergraduate research experience. there is room for further assessment of student skills and knowledge within the context of mentored undergraduate research specific to this integrated skill set. in addition, the reflective assessments point up challenges of scale, time commitment, and the need for multiple areas of domain knowledge. the question of how to move forward in a way that provides the greatest impact for more students still remains unanswered. given that the undergraduate research experience involves many small distinct teams of faculty mentors and students working on different projects, there may not be a way to replicate the embedded model beyond one or two research teams. reaching the majority of research teams led by social work faculty may mean the forfeiting of a deeply personalized experience and teaching model for a more generic set of workshops that will apply across the board as a baseline of library and research data management competencies. although this would lose the high level of synergy and reciprocity between faculty, librarian, and student along with the direct relevance that is gained from mapping the curriculum directly to the agenda of a particular research project, it would still serve as an opportunity to build foundational skills for students and open their eyes to the holistic research process beyond the individual tasks to which they may be assigned. this launching pad effect could still have considerable utility and benefits as part of the overall mentored research experience. however, without the knowledge gained from the experience of working together over the course of a year as a collaborative faculty/librarian/student team, the potential for greater impact and the efficacy of the curriculum would never have been realized. this experience developed awareness, enhanced understanding, and built capacity for the research team in regards to workflow and data management, and for librarians in regards to researcher needs and behavior. it is clear that simple modules relating good practice resonate with an undergraduate population. librarians, in particular, bring a unique insider/outsider perspective that allows for the imparting of expertise across the lifecycle of a research project which is beneficial to both students and faculty. our project revealed that students possess a need and are excited to learn and situate their contributions to faculty research within a holistic context encompassing processes and best practices for the conduct of scholarly research in general. drawing out and directly addressing the skills, knowledge, and best practices surrounding library and research data management serve to make explicit what is often an implicit area of scholarly practice. mentored undergraduate research is an opportunity to expose students to the research process from advances in social work, fall 2014, 15(2) 386 soup to nuts and a forum for faculty and librarians to contribute their expertise for their 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(2011). an institutional approach to developing research data management infrastructure. international journal of digital curation, 6(2), 274-287. doi:10.2218/ijdc.v6i2.203 author note address correspondence to: hailey mooney, data services coordinator and social sciences librarian, michigan state university libraries, 366 w. circle drive, east lansing, mi 48824. email: mooneyh@msu.edu ______________ soonok an (corresponding author), phd, school of social work, university of georgia, 279 williams street, athens, ga 30602-7016, phone: (706) 424-1470 / fax: (706) 542-3364 /email: aso@uga.edu. jisung yoo, ma, department of lifelong education, administration, and policy, university of georgia, 850 college station road, athens, ga 30602, phone: (706) 469-0887 /email: jisyoo@uga.edu. larry g. nackerud, phd, school of social work, university of georgia, 279 williams street, athens, ga 30602-7016, phone: (706) 542-5470 / fax: (706) 542-3364 /email: nackerud@uga.edu. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 338-357, doi: 10.18060/16671 using game theory to understand screening for domestic violence under the tanf family violence option soonok an jisung yoo larry g. nackerud abstract: universal screening for domestic violence in the temporary assistance for needy families (tanf) program is required by most states, but its implementation is questionable. this paper employs game theory to conceptualize interactions between tanf applicants and frontline eligibility caseworkers. the intended outcomes of universal screening for intimate partner violence (ipv) – granting of a good cause waiver to ipv victims – are valid only by the assumption that caseworkers perform their roles. to grant a good cause waiver, tanf applicants and caseworkers should exchange two types of information: 1) disclosure of abuse by ipv victims and 2) notification of the availability of good cause waivers by caseworkers. this paper illuminates that intended outcomes of universal screening for ipv are difficult to achieve and discusses the applicability and limitations of game theory for policy evaluation. keywords: universal screening for intimate partner violence, strategic game theory, family violence option, policy analysis the family violence option (fvo) enacted during the 1996 welfare reform aims to assure safety for the person who experiences intimate partner violence (ipv) by mitigating any barriers to receiving and maintaining the cash benefits inherent in temporary assistance for needy families (tanf)(casey, davies, gifford, & menard, 2010). studies have found a higher prevalence of ipv in welfare populations compared to the general population (lawrence, 2002; meisel, chandler, & rienzi, 2003). among tanf enrollees, the prevalence of ipv ranged from 14% to 32% for the previous 12 months (gallagher, 2011; tolman & rosen, 2001). tanf recipients who had experienced ipv had multiple barriers to meeting tanf requirements, such as mental and physical problems, housing instability, human capital deficits, and child-related problems, with 2.3 barriers on average (brush, 2004). such individual barriers elevate the risk of program sanctions (casey, 2010). the service goals derived from the fvo are clear. the fvo may provide such support services as (1) waivers to tanf requirements, for example, work responsibility, lifetime limits, and/or child support enforcement; and (2) referrals to support services to address the needs of identified tanf applicants experiencing ipv (government accountability office [gao], 2005). to promote an informed use of waivers and other relevant services, the implementing agencies in at least 43 states have adopted a universal screening protocol (gao, 2005). ipv screening during the tanf application and assessment process is designed to resemble ipv screening in health care settings that routinely assesses “current harm or risk for harm from family and ipv in asymptomatic persons” (nelson, nygren, mailto:aso@uga.edu mailto:jisyoo@uga.edu mailto:nackerud@uga.edu an et al./using game theory 339 mclnerney, & klein, 2013, p. 388). however, the ipv screening in a tanf program differs in that it also assesses barriers to compliance with program requirements due to ipv and ultimately may benefit tanf clients with such barriers. universal screening for ipv as a protocol embraces diverse behavioral strategies for tanf eligibility caseworkers and applicants. by routinely asking tanf applicants about their ipv experience, routine screening creates an opportunity for all applicants to disclose abuse (davies, 2010). on the other hand, universal screening mandates that tanf eligibility caseworkers notify applicants that tanf requirements may be waived. temporary waivers to tanf requirements for victims of ipv are referred to as “good cause” waivers (cooke & burke, 2003). notification of good cause allows applicants to make an informed decision to apply for a waiver (pataki & doar, 2006). thus, universal screening exchanges key information about ipv from an applicant to a caseworker, as well as information about good cause waivers from a caseworker to an applicant, through their choice of behaviors that incrementally support the outcome of waiver use. an assessment that opts out of either of the two conditions cannot be referred to as universal screening (decarli, 2001; lindhorst & padgett, 2005). indeed, waivers for tanf requirements were so seldom an option for tanf applicants that a mere 2.4% of california cash assistance enrollees were waiver-holders in april 2013 (california department of social services, 2013). the prevalence of ipv among tanf applicants in california and their need for good cause waivers are unclear, but lifetime prevalence of ipv among welfare recipients is as high as 80% (meisel et al., 2003). barriers to comply with work requirements were reported in 8.1% to 8.4% of randomly selected welfare recipients in two counties (norris, speiglman, & dasinger, 2002; speiglman, fujiwara, norris, & green, 1999). other studies reported even lower waiver rates (hetling, 2011; lindhorst, casey, & meyers, 2010). low rates of waivers are inevitably linked to identification and notification rates. an interview study revealed that screening rates ranged from 2.9% to 7.5% in three states, with georgia as an outlier at 28.8% (lindhorst, meyers, & casey, 2008). nevertheless, the identification rate in all four states that had adopted the fvo was around 2%. tanf applicants were also not informed of good cause waivers. in 2000, 56 to 72% of tanf applicants in the state of new york did not receive an ipv screening form that described good cause (hearn, 2000). in california, one-third of the disclosed applicants were not informed of their eligibility for ipv services (spatz, katz, & rees, 2005). routine screening and notification were rarely implemented together, and only 1.2% of the eligibility caseworkers used both methods in georgia, michigan, new york, and texas (lindhorst et al., 2008). tanf caseworkers tended to identify applicants with ipv experience through profiling criteria, such as immediate danger, separation from an abuser, or subjective judgments (hetling & born, 2006). while ipv screening in tanf involves an interaction between caseworkers and applicants, only a few studies have attempted to describe how caseworkers and applicants interact with one another (lindhorst & padgett, 2005), and none of the reviewed studies provided a theoretical or conceptual framework to identify factors that determine the success of ipv screening. if such a framework were available, it could be used to improve screening outcomes. advances in social work, fall 2015, 16(2) 340 this paper conceptualizes interactions between tanf applicants and frontline eligibility caseworkers for their ipv screening processes based on game theory. by choosing the most relevant game model to formalize ipv screening in tanf, this paper hypothesizes two game models with different scenarios of tanf applicants’ informed and uninformed decisions for disclosing abuse. the scenarios represent tanf applicantcaseworker interactions under universal screening for ipv, as well as ipv screening that is not universally applied. the authors claim that the intended outcomes of universal screening for ipv are valid only through several assumptions. in addition, this paper compares the two game models on the basis of how a caseworker and an applicant interact. this paper is not intended to provide empirical findings based on this game theoretical conceptualization. game theory application in the context of ipv screening in tanf this section provides the definition of game theory, major components of game theory, and potential contributions of game theory application in policy evaluation and in understanding ipv screening in tanf. game theory is a useful and relevant policy evaluation tool that can be used to understand interactions between tanf applicants and frontline eligibility caseworkers during ipv screening. an application of game theory in this paper examines how good cause waivers can be granted to victims of ipv in tanf programs as intended by the family violence option. game theory describes strategic interactions and explains the outcome of such interactions (greif, 2006; osborne, 2004). a human interaction is strategic when one chooses a behavior by anticipating another person’s behavior. thus, the behaviors of two actors are interrelated. game theory establishes an analytic model that illuminates a problem or a social dilemma in the process of a particular interaction in a particular setting (grief, 2006). game theory has been applied to understand interactions in social science between an insurance company and the insured (agee & gates, 2013; dowd, 1982), a principal and an agent (miller & whitford, 2002; saam, 2007), parties to international relations (field, 2014; polachek & xiang, 2010), and a ruling party and the opposition party in congress (groseclose & milyo, 2013). the explanatory function is the key feature of game theory and is based on a rationality assumption. the assumption notes that a person will behave in certain ways to maximize gain and minimize loss. a game is defined by particular components such as players, outcomes, strategies, rationality, and information (von neumman & morgenstern, 1953). first, players are subjects of particular interactions and play a part to induce an outcome (hermans, cunningham, & slinger, 2014). games within the context of game theory are played by two people, and/or between groups, and they are simultaneously or repeatedly played (osborne, 2004). second, an outcome is what players obtain at the end of the interactions and indicates the purpose of a game (milton, 2006). third, strategies refer to a possible set of behaviors or actions that each player can choose at one time. in a strategic situation, a player acts upon the other player’s strategy; that is, players consider each other's strategies when making decisions. an et al./using game theory 341 fourth, a key assumption of game theory is that players are considered to be rational actors. this assumption consists of two properties: expected utility and a minimax criterion (von neumann & morgenstern, 1953). on the one hand, rational behavior chooses an alternative among an exhaustive action set that maximizes a particular function called an expected utility. giocoli (2006) defined expected utility as the rationality of a preference system. the rationality of a preference system endorses the subjective expected utility of a decision (savage, 1954). on the other hand, a rational actor should follow the minimax criterion that refers to a strategy that minimizes loss due to the other player’s choice (giocoli, 2006). fifth, information indicates the players’ knowledge of types of other players, their and the other players’ possible strategies, strategies the other players choose, and/or preferences of the other players (garratt, troger, & zheng, 2009). in case of a perfect or complete game in which each player is aware of the actions chosen by the other player and also knows possible actions available to them, strategies are common knowledge to both players (witzel, 2009). conversely, incomplete information defines an incomplete game in which at least one player is somewhat uncertain about the other player’s type (i.e., ipv victim or non-victim), strategies, and/or preferences (harsanyi, 1987). game theory is relevant to policy evaluation for specific occasions. game theory is particularly useful when information on how policy is implemented by the actors is unavailable or not easily accessible (hermans et al., 2014). many human interactions at the policy implementation level are hard to observe, thus limiting valid data with relevant variables. in fact, collection of primary data or access to secondary, administrative data of ipv screening from state and local tanf offices is often not available due to multi-level processes for permission, disinterest of the implementation of ipv screening in tanf, and/or distrust of outside researchers. such data, including direct observation, were obtained in two research initiatives (hetling & born, 2006; hetling, 2011; meyers & laurie, 2005). a very motivated tanf program (i.e., maryland department of human services) allowed outside researchers to analyze administrative data (hetling, 2011; hetling & born, 2006), and with collective research initiatives based on a federal level of funding and support (i.e., the u.s. department of health and human services) they could observe the applicant-caseworker interactions and interview the tanf workers (meyers & laurie, 2005). existing data also do not contain relevant variables to predict good cause waivers in relation to routine screening for ipv and routine notification of good cause waivers. thus, we do not know whether universal screening for ipv is effective at identifying ipv victims and granting of waivers. for evaluation of policy implementation, a well-developed theoretical framework to analyze available data is difficult to secure. game theory helps simplify and clarify complex processes of interaction with certain game components. although a game model cannot explain actual outcomes of the interaction, it can provide a logical structure to interpret observed human interactions and the variations of instances of interactions (hermans et al., 2014), and/or it can also develop hypotheses for empirical testing with statistical methods. advances in social work, fall 2015, 16(2) 342 game theory may be relevant to evaluation of intake interviews for welfare services. like ipv screening in tanf, such intake interviews are involved in identifying eligibility and/or assessing need for services. service providers may need to manage resources parsimoniously and identify eligible applicants for specific services – in this case, good cause waivers in ipv screening. this paper presents the potential applicability of game theoretical models as an evaluation method for social welfare policy--in this case, eligibility screening in tanf. the objective of this paper is to understand how intended outcomes to grant good cause waivers to ipv victims can be achieved. bayesian strategic game modeling this section addresses the relevance and applicability of bayesian strategic game modeling to ipv screening in tanf and describes major components of (bayesian) game theory to conceptualize ipv screening. the bayesian strategic game is particularly relevant to modeling a strategic game under uncertainty (osborne, 2004). this type of game is also called an incomplete game. ipv screening in tanf is an incomplete game in that the tanf applicant’s experience with ipv is unknown to a tanf frontline eligibility caseworker. in a common two-person zero-sum game in which a player benefits only at the equal expense of others, a player attaches subjective probability weight to the other player’s actions and beliefs. this type of decision process is called a bayesian theorem (keeney & nau, 2011; savage, 1954). a bayesian game model combines formal game theory and probability theory with set beliefs about a player’s hidden or unknown type. ipv screening in tanf should identify applicants’ hidden type regarding ipv experience through the interactions between an applicant and a caseworker. the bayesian strategic game is potentially applicable to conceptualize interactions that need to identify a hidden characteristic of a player. service eligibility interviews seem suitable for model development with a bayesian strategic game. ipv screening in tanf resembles a market of “lemons,” where the good being exchanged possesses high quality variations that are unknown to the buyers (akerlof, 1970). the market of tanf identifies variations of applicants’ characteristics related to their eligibility for good cause waivers, but such identification processes may be unattractive to the buyers, who are tanf service providers. high variations in eligibility for good cause waivers embrace costs based on identifying applicants’ experience with ipv. one major cost is from the sellers’ potential dishonesty regarding their true characteristics, for example, applicants’ false disclosure of ipv. such risk is called adverse selection (moe, 1984). bayesian strategic game modeling is also relevant to ipv screening in tanf because identification of one’s eligibility is linked to specific rewards. the purpose of a game is to deliver a good cause waiver in ipv screening in tanf. good cause for ipv victims waives one or a combination of the following tanf requirements: work responsibility, child support enforcement, and lifetime limits. without the consideration of a good cause waiver, tanf recipients can receive tanf for only 48 months in their lifetime, and every adult tanf recipient should be involved in work or work activities on a weekly basis and identify the biological father of a child to apply for child support (gao, 2005). receiving a good cause waiver also avoids program sanction by the failure to comply with any of the program requirements and/or extending tanf for up to 60 months (casey, 2010; fontana, an et al./using game theory 343 2000). in that case, good cause waivers may generate direct monetary rewards for ipv victims. a good cause waiver also avoids the risk of further abuse by complying with tanf requirements or recovery from the impact of abuse. these rewards may be attained within a more long-term timeline, yet it may be difficult to account for monetary rewards while a person is in the tanf program. a good cause waiver potentially prevents health costs from putting an ipv victim in danger through tanf requirements and/or perpetrating ipv. the waiver ultimately could strengthen its recipients’ capacity as a workforce. the potential rewards of receiving a good cause waiver are critically linked to the service need (levin & zeisel, 2009; tolman & rosen, 2001). the rationale for the family violence option is that ipv victims on welfare tend to have more barriers to complying with tanf requirements (tolman & rosen, 2001). theoretically, ipv victims who enter the tanf program and have barriers to complying with tanf requirements would perceive good cause waivers as rewards. the same type of tanf applicants would not perceive rewards if they do not receive the waivers. the following seven game components may define ipv screening in tanf programs. 1. players: the ipv screening in a tanf program is a two-person interaction between a tanf applicant and an eligibility caseworker. 2. incomplete information: a tanf applicant and an eligibility caseworker make a decision with incomplete information. incomplete information refers to the situation in which players may not know some information about the other players, such as their characteristics, strategies, etc. (harsanyi, 1987). at the beginning of the ipv screening, a tanf eligibility caseworker does not know about a tanf applicant’s characteristic as an ipv victim. in game theory, such a characteristic is called a type or a state (osborne, 2004). such a state is denoted as “ω”. because not all applicants experience ipv, two states of ω1 (applicants with ipv experience) and ω2 (applicants without ipv experience) exist. on the other hand, a tanf applicant may not know about good cause waivers. as a caseworker does not know the status of ipv among tanf applicants, the caseworker may subsequently face the following situations: a tanf applicant should signal the state of ipv to a caseworker, and the caseworker formulates a belief which is the probability 0 ≤ p ≤ 1 to each state of ipv of a tanf applicant consistent with the signal (zamir, 2010). 3. outcomes: the intended outcome of universal screening for ipv is to grant good cause waivers to applicants with ipv experience who have difficulty complying with a tanf requirement and to not grant good cause waivers to applicants without ipv experience. 4. rationality: a tanf applicant and a tanf eligibility caseworker are rational actors who maximize the expected utility of the outcome, receiving or granting a good cause waiver (milton, 2006; nurmi, 2005). an expected utility function represents a player’s preferences (keeny & nau, 2011), and it is defined by both a single action profile such as disclose ipv and a state of a player’s characteristic such as a true ipv victim. the term expected utility is interchangeably used with preferences or payoffs (osborne, 2004). a rational advances in social work, fall 2015, 16(2) 344 tanf applicant who has difficulty complying with tanf requirements due to ipv will prefer receiving a good cause waiver to not receiving such a waiver. a rational tanf eligibility caseworker will provide a waiver to ipv victims who have difficulty complying with tanf requirements. 5. preferences: preferences can be ordered, and such order of preferences is called ordinal preferences (barnett ii, 2003). ordinal preferences mean that if a player prefers action a to action b, and action b to action c, then that player prefers action a over action c. if a caseworker prefers granting a good cause waiver to not granting a good cause waiver to an applicant, a higher number is assigned to the strategy of granting a good cause waiver compared to the other strategy—for example, 2 for granting a good cause waiver and 1 for not granting a good cause waiver, simply because 2 is greater than 1. players choose their optimal strategy (action), the one most preferred in the strategy profiles, so that the outcomes furthest from that choice are the least preferred (shepsle, 2010). 6. strategies: a choice of a specific strategy is determined based on the expected utility of the final outcome. if tanf applicants expect a high utility to obtaining a waiver, they would strategically disclose ipv rather than not disclose ipv. a player chooses one of the strategies at the time of their decision node. ipv victims could disclose their experience with abuse at a tanf appointment or be silent. 7. rules: ipv screening in tanf follows specific game rules. game rules indicate all of the game components and they represent who moves, when they move, what options players have, what they know about the information, and why they move (associated with expected utility)(matos, ferreira, & andrade, 2010). in relation to the order of moves of decisions, a tanf applicant should disclose the experience with abuse prior to the caseworker’s granting of a good cause waiver. particular assumptions for hypothesizing universal screening this section begins with modeling universal screening for ipv according to the fvo using the bayesian strategic game model. to explore how intended outcomes of ipv screening may come about, four additional assumptions may be required to conceptualize the tanf applicant-caseworker interactions within universal screening for ipv. first, this paper assumes that the fvo defines rationality respectively for a tanf applicant and a caseworker. a rational tanf applicant would maximize expected utility regarding a good cause waiver. however, a rationality assumption for a caseworker needs clarification. in the real world, caseworkers may not perceive great utility by granting a waiver. caseworkers’ attitudes and beliefs about a victim’s worthiness to receive tanf benefits influence their screening of ipv (carrington, 2005; lindhorst & padgett, 2005). however, in the hypothetical scenario of universal screening for ipv, a tanf caseworker is assumed to strategically perform universal ipv screening to grant a good cause waiver. a caseworker should perceive lower utility for granting a good cause waiver to a false ipv victim than granting it to a true ipv victim. an et al./using game theory 345 secondly, this paper assumes one exception from the rationality assumption of a tanf applicant: self-determination. a tanf applicant who is informed of good cause waivers may not disclose ipv if the applicant does not perceive the waiver as a reward. tanf applicants may still prefer to pursue work and receive child support instead of receiving temporary good cause waivers or exemptions from tanf requirements (gao, 2005; raphael & haennicke, 1999). researchers found that victims of domestic violence did not use the waivers because they had no current danger, did not want to complete paperwork, had no evidence to prove harm, feared the abusive father, were motivated to work, and received child support from the father of their child (fontana, 2000; levin, 2001). this paper considers these conditions as self-determination. social work values appreciate clients’ self-determination to use or refuse services (national association of social workers [nasw], 2008, 2013). although a service provider may inform clients of opportunities and potential resources that could be used in a voluntary situation, the client is always the decision-maker. the assumption of self-determination as an exception was added because ipv experience is a core eligibility criterion to receive a good cause waiver, but ipv experience does not always determine the need for good cause waivers among ipv victims (fontana, 2000). therefore, this paper assumes the following ordinal preferences of good cause waivers in universal screening—that a tanf applicant with ipv experience who is indifferent about receiving a good cause waiver does not disclose ipv. a full assumption of ordinal preferences for both a tanf applicant and a caseworker is presented in the next section. third, this paper assumes that universal screening for ipv involves two types of information: information of a tanf applicant’s ipv characteristics and information about good cause waivers. on the one hand, universal screening for ipv determines the applicant’s hidden ipv characteristics as a starting point. it is assumed that caseworkers should know the true state of applicants’ ipv experience in order to achieve intended outcomes of granting a good cause waiver. when a game model is drawn as a figure, this characteristic is set as a starting point of the game (matos et al., 2010); see figure 1. on the other hand, in universal screening for ipv, information about good cause waivers needs to be common knowledge between players. tanf applicants need to know that good cause waivers are available to them. although it is not the case for all states and local agencies, universal screening for ipv entails universal notification of good cause waivers to tanf applicants (decarli, 2001; lindhorst & padgett, 2005). the assumption of a rational caseworker based on quality of service may eliminate information asymmetry of available strategies for ipv victims. in this case, caseworkers routinely inform tanf applicants of good cause waivers. fourth, this paper simplifies players’ behavioral strategies for the informed decision of a tanf applicant to disclose ipv. this paper defines a critical tenet of universal screening for ipv as a tanf applicant’s informed decision to disclose ipv. if the universal screening process for ipv that promotes such informed decision is deconstructed, it may entail very complex decisional points in order that: 1) a tanf applicant applies for tanf; 2) a caseworker screens for ipv; 3) a tanf applicant discloses abuse; 4) a caseworker informs advances in social work, fall 2015, 16(2) 346 a tanf applicant of good cause waivers; 5) a tanf applicant who did not disclose ipv may disclose ipv after being informed of good cause waivers and continue to other decisional points. contingent upon the informed decision to disclose ipv, this paper focuses only on two key decision points: tanf applicant’s disclosure of ipv, disclose or not disclose, and tanf caseworkers granting of good cause waivers, grant a waiver or not grant a waiver. additionally, this paper also limits this conceptualization of universal screening for ipv with a couple of supplementary assumptions to rationalize the relevance between the theory and the phenomenon of universal screening for ipv. this paper excludes the possibility of a third person such as a domestic violence specialist. also, this paper does not account for the possibility of repeated games or prior experience with the game by the players. informed ipv disclosure and applicants’ utility of good cause waivers the model of universal screening that supports the informed decision to disclose ipv is depicted in figure 1. figure 1 shows a bayesian strategic game model with incomplete information. the strategy profiles are all valid: disclose or not disclose for the applicants and grant a waiver or not grant a waiver for eligibility caseworkers. “n” determines the applicant’s state of ipv: applicants with ipv experience (ω1) with probability p or applicants without ipv experience (ω2) with probability 1-p. when applicants disclose ipv, caseworkers will either grant or not grant a waiver with a probability of q if they believe applicants to be victims of ipv (ω1), and with a probability of 1-q if caseworkers believe applicants have not experienced ipv (ω2). reversely, caseworkers will take no action when the applicant chooses not to disclose, so they unnecessarily set a conditional belief about the ipv state (ω1 or ω2). figure 1 also presents the expected utilities for tanf applicants that the model assigns. if a caseworker grants a waiver, then the applicant’s expected utility is 1, being granted a waiver. receiving a waiver may benefit applicants without ipv experience (ω2) if they intentionally misinform. applicants’ disclosure, therefore, could be based on need or fraud. both types of applicants who do not disclose ipv may be indifferent to receiving a waiver, so they do not disclose abuse (0 represents those who do not disclose abuse). the model assumes that informed disclosure, compared with informed non-disclosure, is more likely to increase applicants’ expected utility of receiving a waiver and to decrease their expected utility by the failure to receive a waiver (-1 represents those who disclose abuse but are not granted a waiver). caseworkers have three types of expected utilities according to the assumption of rationality: 1 when caseworkers make the right decision regarding the state of ipv, 0 when caseworkers do not grant a waiver to an applicant either with ipv experience (ω1) or without ipv experience (ω2) who does not disclose, and -1 when caseworkers grant a waiver to an applicant without ipv experience (ω2) or do not grant a waiver to an applicant with ipv experience (ω1). an expected utility of 0 for an applicant with ipv experience (ω1) is considered a client’s self-determination to not accept a waiver. thus, (1, -1) in the an et al./using game theory 347 right, bottom node indicates an applicant’s utility of receiving a waiver (1), and a caseworker’s utility of granting a waiver (-1). figure 1. informed ipv disclosure and applicants’ utility of good cause waivers uninformed ipv non-disclosure and the termination of a game a second model hypothesizes the situation of an uninformed decision to disclose ipv by a tanf applicant. the aim of developing such a model is to illuminate the disjuncture from universal screening for ipv. thus, a comparison of two different scenarios of informed and uninformed decisions to disclose ipv are available. in this new scenario, a tanf applicant makes a decision to disclose ipv, given no information about good cause waivers. figure 2 represents the game rules of an uninformed decision to disclose ipv by tanf applicants. under such rules, routine screening and notification of good cause do not guide tanf applicants’ disclosure of ipv. informed disclosure of ipv is strictly unavailable, making it impossible to grant a waiver because the information of a good cause waiver is asymmetrically available to caseworkers and applicants. the left side of figure 2 from the nature (n) shows that applicants are given a single strategy profile, not disclose, due to unavailable knowledge of good cause waivers. and, the only available strategy for the caseworker is not grant a waiver in response to the applicant’s non-disclosure. the probabilities r and 1-r represent a caseworker’s belief about the states of ipv, given an applicant’s action, not disclose. such uninformed non-disclosure is a distinctive feature of the uninformed decision to disclose ipv, which is inconsistent with universal screening for n ipv not ipv not disclose a not disclose disclose disclose p 1-p (1, 1) (-1, -1) (1, -1) (-1, 1) grant a waiver not grant a waiver grant a waiver not grant a waiver c q 1-q (0, 0) (0, 0) advances in social work, fall 2015, 16(2) 348 ipv. this uninformed non-disclosure is different from informed non-disclosure, which is based on applicants’ self-determination in the left nodes in figure 1. uninformed nondisclosure is caused by the ipv screening process eliminating applicants’ strategies because the ipv screening process does not entail notification of good cause waivers. figure 2. uninformed ipv non-disclosure and the termination of a game notification of good cause waivers influences the players’ expected utilities, but that effect cannot be displayed with numerical expected utilities in the model. when the players have the single strategy profile not disclose and not grant a waiver, the interaction does not satisfy game assumptions. this type of game rule does not transfer expected rewards to the applicants who experience ipv. outcomes of the game models this section finds nash equilibrium, which is a decisional outcome (osborne & rubinstein, 1994) from the model of the informed ipv disclosure and applicants’ utility of good cause waivers depicted in figure 1. nash equilibrium is a steady state where both players have no reason to change their strategy (osborne, 2004). any found equilibriums indicate predicted outcomes specifically regarding the granting of a waiver as the final outcome in this specific model. to find the equilibriums, the model of informed ipv disclosure and applicants’ utility of good cause waivers was reviewed with four different sub-games. the subgames consist of two separate games and two pooling games. these sub-games are characterized by two types of assumptions regarding (1) the caseworkers’ beliefs of an applicant’s types in ipv experience (ω1 or ω2) and (2) the applicants’ potential behaviors, n ipv not ipv not disclose a c not disclose disclose disclose p 1-p grant a waiver grant a waiver not grant a waiver not grant a waiver grant a waiver not grant a waiver grant a waiver not grant a waiver c q 1-q 1-r r an et al./using game theory 349 disclose or not disclose. regarding the applicants’ potential behaviors, a separating game is where the first player behaves differently prior to the second player’s strategy (munozgarcia, 2012), meaning that a caseworker thinks that an applicant behaves inconsistently but has behaved consistently with the states of ipv. in the model, two separate games are played by a tanf applicant: 1) when there is a possibility an applicant with ipv experience (ω1) discloses while an applicant without ipv experience (ω2) does not disclose (see the right, upper node and the right, bottom node in figure 1) and 2) when there is a possibility an applicant with ipv experience (ω1) does not disclose while an applicant without ipv experience (ω2) discloses (see the right, upper node and the left, bottom nodes in figure 1) a pooling game is played when the first player consistently chooses a strategy (munozgarcia, 2012). two pooling games are played in the model in figure 1: 1) when there is a possibility that an applicant with ipv experience (ω1) and also an applicant without ipv experience (ω2) discloses (see the upper right and bottom right nodes) and 2) when there is a possibility that both types of applicants do not disclose (see the upper left and bottom left nodes). regarding the beliefs of eligibility caseworkers, the first separating subgame assumes a caseworker believes only an applicant with ipv experience will disclose (q=1). the second separating subgame assumes a caseworker believes only an applicant without ipv will disclose (q=0). the first pooling game assumes that a tanf caseworker believes both applicants with and without ipv experience will disclose (q=p). thus, a caseworker believes an applicant with ipv experience is more likely to disclose than applicants without ipv experience (q≥1-q). in the second pooling game, a caseworker believes that all types of applicants will not disclose ipv. screening outcomes of the game model called informed decision to disclose ipv in universal screening were analyzed based on the utilities in numbers (i.e., 1, 0, -1) in figure 1. the game that is described in figure 1 helps understand the logical process to find the equilibriums. there was no predicted outcome (equilibriums) in either separating games in figure 1. in the first separating game, granting a waiver is an optimal strategy for caseworkers because they think an applicant with ipv experience (ω1) would disclose. an applicant with ipv experience (ω1) would be better off by disclosing (expected utility, 1) than by not disclosing (expected utility, 0). because a caseworker would grant a waiver if an applicant disclosed regardless of the state of ipv (q=1), an applicant without ipv experience (ω2) would also be better off by disclosing than by not disclosing. an applicant without ipv experience (ω2) would also prefer to alter her strategy from not disclose to disclose. therefore, no equilibrium can exist for this separating game. in the second separating game, caseworkers’ optimal strategy is not granting a waiver if they think that an applicant without ipv experience (ω2) discloses. in that case, an applicant with the state of ω2 would not disclose ipv because she is not granted a waiver. hence, an applicant without ipv experience (ω2) would prefer not to disclose because the applicant’s strategy of not disclose has a higher expected utility than that of disclose (expected utility, 0 > expected utility, -1). therefore, there is no equilibrium. advances in social work, fall 2015, 16(2) 350 the first pooling game embraces two different conditional beliefs of applicants’ types and the behaviors. when a caseworker believes an applicant with ipv experience is less likely to disclose than is an applicant without ipv experience, caseworkers must select not granting a waiver because they think that the applicant is more likely to be an applicant without ipv experience (ω2) than an applicant with ipv experience (ω1). if a caseworker prefers not granting a waiver, the expected utility of an applicant without ipv experience (ω2) would be -1. consequently, this applicant would prefer to not disclose ipv (expected utility, 0), which entails a higher expected utility, rather than disclose (expected utility, 1). therefore, with this specific belief, there is no equilibrium. conversely, if a caseworker believes an applicant with ipv experience is more likely to disclose than an applicant without ipv experience is, a caseworker optimally selects granting a waiver. given a caseworker’s strategy, granting a waiver, applicants may also perceive the higher expected utility 1 compared to -1 if they are not granted a waiver. thus, applicants, regardless of experience with ipv, will disclose if they believe that they are more likely to be granted a waiver rather than being denied. thus, an equilibrium occurs if a caseworker believes a disclosed applicant is a real victim and the applicant believes a waiver will be granted by disclosure. in the second pooling game, notice that both types of applicants prefer to not disclose (payoff 0) only if caseworkers select to not grant a waiver. the strategy, not disclose, contains a higher payoff compared to the situation where an applicant discloses but is not granted a waiver (expected utility -1; see the right nodes in figure 1). in order for not granting a waiver to be chosen, a caseworker must have a sufficiently pessimistic belief about the types of applicants despite their strategy for ipv disclosure. regardless of the states of ipv, a caseworker believes an applicant without ipv experience (ω2) is more likely to disclose than an applicant with ipv experience (ω1). within such belief systems, an applicant would prefer to not disclose as this sub-game predisposes. thus, a caseworker’s strategy, not granting a waiver, is optimal. in the second pooling game, an equilibrium exists when a caseworker believes that a disclosed applicant is not the real victim and an applicant regardless of ipv experience believes that they would not be granted a waiver. two equilibriums were found in the model of informed decision to disclose ipv in universal screening. that is, two outcomes are predicted if universal screening for ipv is implemented as assumed. the first outcome is applicants disclose ipv experience and caseworkers grant a waiver when caseworkers believe disclosed applicants are real victims and applicants believe they will be granted a waiver by disclosure. the second outcome is applicants do not disclose ipv and caseworkers do not grant a waiver when caseworkers believe that disclosed applicants are not the real victims and applicants regardless of ipv experience believe that they would not be granted a waiver. figure 2 describes the scenario of uninformed decision to disclose. the model of the no knowledge situation of good cause waivers cannot assign expected utilities to the players’ strategy profiles. allowing both an applicant and a caseworker to play a single strategy results in the play of not disclose by an applicant and not grant a waiver by a an et al./using game theory 351 caseworker. such strategy set clarifies that screening outcomes possess disjuncture from universal screening for ipv. discussion and limitations this paper claims that the intended outcomes of universal screening for ipv–granting of a good cause waiver to victims of ipv–are difficult to achieve without accurate ipv screening. two game models, particularly using a bayesian strategic game model of universal screening for ipv in tanf, helped explore the underlying assumptions of universal screening for ipv to achieve the intended outcomes of granting good cause waivers to ipv victims. the models also helped explore different strategies and outcomes based on whether or not a tanf applicant makes an informed decision to disclose abuse. development of such models is useful in 1) generating potential hypotheses for empirical tests, and 2) exploring assumptions of universal screening for ipv by refining the original components and assumptions of game theory, especially the rationality assumption for tanf frontline eligibility caseworkers. this paper suggests a need of empirical testing of several hypotheses as well as measurement development. equilibriums from the informed decision model for ipv disclosure in figure 1 suggest two hypotheses: 1) a good cause waiver is given to a tanf applicant only when the tanf applicant discloses ipv experience to a tanf caseworker who tends not to worry about potential fraud from tanf applicants, and 2) a good cause waiver is not given to a tanf applicant who does not disclose ipv if a caseworker believes that only a small number of tanf applicants are victims of ipv. in addition, from the uninformed decision model for ipv, 3) non-disclosure is a hypothetical outcome when a tanf applicant is not informed of a good cause waiver by a caseworker. the two models also illuminate crucial concepts that could be included as variables in quantitative research questions and/or could be measured for future policy evaluation. valid and reliable measurement of such concepts is essential. future studies could define and operationalize constructs of such variables in more valid and reliable ways. such variables include the tanf applicant’s need for a good cause waiver, the caseworker’s belief of tanf applicants’ need for a good cause waiver and their state of ipv, and universal screening for ipv. for example, the informed decision to disclose ipv may be facilitated with a combination of routine screening and routine notification of a good cause waiver. however, without measuring and including variables of both behaviors in a statistical model for testing, we cannot know the real preferences of behaviors or strategies of tanf applicants regarding a good cause waiver. several assumptions to conceptualize universal screening for ipv in the bayesian strategic game model imply that equilibriums may exist only based on the accuracy of ipv screening. both the rationality assumption and information about a good cause waiver available to tanf applicants may be relevant constructs of the quality of ipv screening. according to the rationality assumption, caseworkers’ preferences for granting a waiver are determined by accountable implementation of ipv screening. caseworkers prefer to respond accurately to an applicant’s state of ipv in granting a good cause waiver. the model of universal screening for ipv also identified information of a good cause waiver that may remove uncertainty for a tanf applicant to strategically disclose ipv to a advances in social work, fall 2015, 16(2) 352 caseworker. in order to employ universal screening for ipv, caseworkers should also routinely provide information of good cause waivers to tanf applicants. the rationality assumption for tanf caseworkers also invites potential applicability of anti-rationality assumptions to understand tanf caseworkers’ behaviors for future research. in the model of universal screening for ipv, the caseworker’s motive for choosing a strategy was supposed to be driven by their role, not their personal instincts, preconceptions, attitudes, etc. such an assumption is not aligned with the original rationality assumption of game theory. this approach is not uncommon in the study of human behaviors. outside formal game theory, human behaviors are considered irrational with alternative assumptions, such as bounded rationality, framing effects, and/or risk adversity (simon, 2001; tversky & kahneman, 1982, 1986). human beings sometimes act upon altruism, fairness, and/or trust rather than self-interest (thaler, 1991). this paper attempted to apply game theoretical concepts in model development of universal screening for ipv, but the rationality assumption of the model actually emphasized the role of tanf caseworkers who may be fair and altruistic. two conditions of universal screening for ipv--routine screening of ipv and routine notification of a good cause waiver--seem to require high work ethics of tanf caseworkers, relevant knowledge and skills, and person-oriented work. such requirements together underscore the role of caseworkers in facilitating informed decision-making opportunities for tanf applicants. such assumptions may not be realistic though, like ipv screening that is not universally implemented in the real world. we simply notice the similarity from evidence of ipv screening in tanf and agree with the claim that it is difficult to expect street-level bureaucrats to do people-oriented work to enhance clients’ self-determination (lipsky, 1969; watkins-hayes, 2009). this paper cannot conclude whether ipv screening in tanf is an implementation failure or policy design failure, but it is noteworthy that the policy design appears to embrace unrealistic expectations for the frontline worker to implement the expected rules. a bayesian strategic game model in formalizing models of a tanf applicantcaseworker interaction in tanf, however, cannot help in understanding “why actors are not contributing” to achieve intended outcomes or how unintended outcomes may result from interactions (hermans et al., 2014, p. 12). as discussed, game theory may offer insights on predictors of observed outcomes. however, it does not offer a tool to identify reasons for not granting a waiver or specific barriers to granting a good cause waiver. the authors strongly believe that research on the barriers to employing universal screening for ipv would be quite valuable for presenting evidence of how to improve ipv screening in tanf. however, game theory and the models discussed in this paper are not the proper tools to determine how to solve the problem of universal screening for ipv not working in the real world (schelling, 2010). in addition, overcoming the following shortcomings may strengthen the models presented in this paper as an evaluation method. first, the applicant’s experience with ipv is not identical to the need to utilize a waiver. this paper considers them equal. future study can make this distinction and investigate who among applicants with ipv experience actually needs a waiver. second, the model of universal screening does not undergo all the an et al./using game theory 353 possible steps related to game rules that could actually establish the applicants’ expected utilities differentially. the rationales for determining expected utilities need to be set clearly. third, this paper does not test the models and their hypotheses, so future studies need to analyze empirical data to investigate whether good cause notification determines the use of a waiver. despite such limitations, this paper’s application of the bayesian strategic game model was beneficial to exemplify game theory as an alternative tool in evaluating the fvo at the level of actor-interactions. this paper also revealed the potential use of soft application of game theory in policy evaluations rather than mathematical application of the theory. references agee, m. d., & gates, z. 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(2010, june). bayesian games: games with incomplete information. retrieved from http://www.ma.huji.ac.il/~zamir/documents/bayesiangames_shmuelzamir.pdf acknowledgement this article is adapted from a dissertation funded by the fahs-beck fund for research and experimentation, doctoral dissertation grants, new york community trust. author note http://dx.doi.org/10.1017/s0266267110000040 http://dx.doi.org/10.1016/s0039-3681(01)00013-9 http://www.geds-to-phds.org/approved%20to%20post%20on%20website/fvno%20final%2010.05.pdf http://www.geds-to-phds.org/approved%20to%20post%20on%20website/fvno%20final%2010.05.pdf http://dx.doi.org/10.1177/1077801201007002003 http://dx.doi.org/10.1086/296365 http://www.ma.huji.ac.il/%7ezamir/documents/bayesiangames_shmuelzamir.pdf advances in social work, fall 2015, 16(2) 358 address correspondence to: soonok an, phd, school of social work, university of georgia, 279 williams street, athens, ga 30602-7016, phone: (706) 424-1470 / fax: (706) 542-3364 /email: aso@uga.edu mailto:aso@uga.edu microsoft word 15. mccave et al_8767_prevention copyedit_final ______________ emily l. mccave, msw, ph.d., is an assistant professor in the department of social work at quinnipiac university in hamden, ct; carrie rishel, msw, ph.d., is an associate professor in the school of social work at west virginia university in morgantown, wv; meagann morris, msw, is a graduate of the school of social work at west virginia university and is a social worker at family advantage, llc. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 544-555 prevention as an explicit part of the social work profession: part two of a systematic investigation emily l. mccave carrie rishel meagann morris abstract: in 2011, advances in social work published results from an investigation into the explicit use of “prevention” language within the social work profession. findings from this study highlighted a gap in the knowledge and integration of prevention-focused social work education and practice. a recommendation was made to examine additional indicators that illustrate the extent to which “prevention” is an accepted and growing subfield within the social work academy. this second paper continues the inquiry by examining three additional indicators for integration of prevention content, including: 1) cswe accredited msw programs; 2) social work textbooks; and 3) abstracts accepted at two national social work conferences. although findings demonstrate that about a quarter of msw programs integrate prevention content into their curriculum there is a lack of prevention content available within social work textbooks and professional conferences for social work scholars and practitioners. barriers and supports to addressing these issues are discussed. keywords: prevention, social work education, social work profession the united states is facing a period of rapid change in health care delivery and services. most service delivery models have traditionally been designed to address the treatment of disease, with comparably little resources allocated toward the prevention of health problems (miles, espiritu, horen, sebiam, & waetzig, 2010; schroeder, 2007). despite spending more money on health care than any other country (borger et al., 2006), the united states ranks low on most measures of health outcomes (schroeder, 2007). longstanding health disparities among vulnerable and disadvantaged populations persist, with little indication of improvement (miles et al., 2010). large-scale population shifts, including increasing aging and veteran populations that may require multiple types of services, will likely make a critical impact on future health service delivery (oliver & decoster, 2006; wheeler & bragin, 2007). the current national attention on health care reform foreshadows upcoming changes in delivery practices. the affordable care act (aca) will dramatically influence the delivery of health services through the creation of accountable care organizations, health homes, and preventive integrated care (wotring & stroul, 2011). social workers, as key providers of health education and services, must capitalize on the opportunity for change in the era of health care reform. the need for a prevention-focused approach is clear. nearly half of all deaths are associated with preventable health conditions. over 90% of us health care dollars, advances in social work, fall 2013, 14(2) 545 however, are spent on treatment, with about 2% allocated for universal (or populationbased) prevention (mokdad, marks, stroup, & gerberding, 2004). a rapidly expanding empirical research base supports the efficacy and effectiveness of prevention efforts (rishel, 2007). the vast majority of this research has been conducted by scholars in psychology, many of whom have long been advocating for expanding the multidisciplinary focus on prevention (weisz, sandler, durlak, & anton, 2005). several other professions, including psychiatry, nursing, and counseling psychology, are currently addressing their professional role in prevention (marshall et al., 2011). social workers, however, appear to be largely absent from either national or professional dialogue regarding prevention approaches to health care services. as noted in part 1 of this two-part investigation (mccave & rishel, 2011), prevention efforts have been relegated to the margins, rather than acknowledged as a central aspect of social work throughout most of the profession’s history (mccave & rishel, 2011; woody, 2006). this assertion is based on the finding that there are few publications addressing prevention within the professional literature (mashall et al., 2011; mccave & rishel, 2011) and limited attention to prevention within the official policy statements compiled in social work speaks (mccave & rishel, 2011). although the initial indicators examined document sporadic episodes of particular interest in prevention, it appears that the profession as a whole has yet to embrace prevention as a core element of social work practice (mccave & rishel, 2011). current project as social work scholars interested in strengthening prevention content in our social work courses, we began to examine the current state of prevention in social work. our initial project, published last year in advances in social work (mccave & rishel, 2011), focused on examining the explicit prevention content in the social work literature, the current council on social work education (cswe) standards for social work educational programs (epas), and the national association of social work’s (nasw’s) most recent publication of social work speaks. at the conclusion of that investigation, we recommended that additional indicators be examined for explicit prevention content. consequently, the current project focuses on three more “indicators” of the status of prevention in the social work profession. these indicators include: 1) accredited msw programs in the united states, 2) social work texts, and 3) social work annual conference proceedings. similar to our first project, this current research focuses solely on “explicit” rather than “implicit” evidence of prevention content within the social work profession. methodology as mentioned above, three “indicators” of explicit prevention content were examined for this current project. the first indicator was the explicit prevention content within accredited msw programs. this was done through an in-depth online review of all accredited msw programs in the united states, which included numerous steps. the initial step was to identify all accredited msw programs in the u.s. through the cswe directory of msw programs in each state. from there we engaged in an online search that mccave, rishel, morris/prevention in social work: part 2 546 would allow us to document the extent to which prevention was explicitly mentioned in each program. a tiered online search occurred, such that initially, all the programs with a specified joint or dual degree with a master in public health (mph) program at that university were identified from the entire sampling frame. the joint or dual degree with an mph program was determined to be an indicator of an explicit focus on prevention content; according to the american public health association (n.d.), the discipline of public health is focused on prevention of disease and the promotion of health in all individuals, from local to global communities. from there, a review of all the remaining msw programs was completed, with a focus on those programs that offered a concentration with the term “prevention” mentioned in the title or description. the remaining msw programs with neither a joint/dual degree msw/mph program or a prevention-focused concentration were examined in terms of their course offerings. those programs that offered one or more courses with prevention in the title or description were identified. once all three levels of this search were completed, additional information was gathered about the universities identified to highlight broader similarities. this information included: 1) the geographic region of the university; 2) the university’s status as public or private; 3) the presence of a social work phd program; and 4) the designation of the msw program as being housed in a school of social work or a division/department. the second indicator was an in-depth review of the explicit prevention content in social work textbooks over the past several decades. this occurred through conducting several online searches of textbook holdings, namely our university’s library catalog, well-known social work text publishers, along with a targeted search in google scholar and google books. the search parameters included any textbook that had “prevention” and “social work” in the title with no limit on the date published. all of the books that were identified were obtained through the university’s library. these books were then examined to determine whether they were a text or monograph that was a substantive book on social work and prevention, in terms of theoretical contribution, or if the book was focused on a more narrow aspect of prevention and social work (e.g., juvenile justice). the final indicator used in this analysis was the presence of explicit prevention content in the abstracts selected for presentation at the recent annual conferences of both cswe (2012) and the society for social work research (sswr; 2013). this was done through searching the online conference schedules for the number of abstracts that used the word “prevention” in the title and determining the topics covered by these abstracts. results accredited msw programs when researching the accredited master of social work programs we looked at the online descriptions of the courses and concentrations offered by each school as well as identified programs that have an established joint or dual degree with a mph program. table 1 provides a breakdown of the characteristics of the msw programs that were advances in social work, fall 2013, 14(2) 547 identified. just under 15% (32) of accredited msw programs also had a joint or dual degree with a mph program. a majority of these programs were found within a school of social work at a public university that also offered a phd in social work. of the 216 programs that did not have an msw/mph program, 57 programs (26.64%) offered msw courses that had some focus on prevention, as indicated by having the term “prevention” in either the title or description of the course. a much smaller proportion of the programs (2.78%) had a concentration that focused explicitly on prevention, as indicated by having the word “prevention” in the description; there were no programs with the term “prevention” in the title of a concentration. table 1. breakdown of accredited msw programs with an identified prevention focus category total # schools with a dual msw/mph program 32 schools with msw/mph by region (regions established by census) northeast new england (ct, me, ma, nh, ri, vt) 2 mid atlantic (nj, ny, pa) 6 midwest east north central (in, il, mi, oh, wi) 3 west north central (ia, ks, mn, mo, ne, nd, sd) 4 south south atlantic (de, dc, fl, ga, md, nc, sc, va, wv) 5 east south central (al, ky, ms, tn) 1 west south central (ar, la, ok, tx) 4 west mountain (az, co, id, nm, mt, ut, nv, wy) 2 pacific (ak, ca, hi, or, wa) 5 schools with msw/mph: private vs. public private 7 public 25 schools with msw/mph: schools of social work vs. divisions/departments schools of social work 28 divisions/departments 4 schools with msw/mph: have a phd in social work program 25 schools with a concentration with a focus on prevention (but no msw/mph) 6 schools with course that focus on prevention (but no msw/mph or concentration) 57 total number of accredited msw programs in the united states 216 mccave, rishel, morris/prevention in social work: part 2 548 prevention and sw texts after following the search steps described above to examine textbooks, we were unable to identify any currently available textbooks that substantively address social work and prevention. specifically, upon examination of the search results, there was not a single contemporary book found that included both “social work” and “prevention” in the title. further, after reviewing nine books (including textbooks, monographs, and curriculum compendiums) that were secured through the library, it was determined that there is not a substantive text using a prevention framework for social work practice. multiple books and monographs were found that were published in the early 1980s such as: prevention in mental health and social work: a sourcebook of curriculum and teaching materials (nobel, 1981); primary prevention approaches to the development of mental health services for ethnic minorities: a challenge to social work education and practice (miller, styles o’neal, & scott, 1982); and education for primary prevention in social work (bowker, 1983). none of these, however, could be considered a textbook utilizing a prevention framework for social work practice. in several of these books and monographs, we found reference to a national institute of mental health (nimh) grant awarded to cswe in 1978 to promote the development of curriculum and teaching materials on primary prevention in mental health and social work. products from this project included a source book including curriculum and teaching materials on primary prevention and a manual of course outlines on prevention. after the series of publications that appeared in the 1980s, no other books were identified that contained both “social work” and “prevention” in the title. prevention and cswe/sswr meetings currently there is not a track at either cswe’s or sswr’s annual conference focused specifically on prevention in social work practice and/or education, nor is there a special interest group focused on prevention at either conference. a review of abstracts selected for presentation at the cswe annual program meeting (2012) and the sswr annual meeting (2013) revealed that a very small number of accepted abstracts contained the word “prevention” in the title. there were over 600 educational sessions offered at the 2012 cswe conference and over 500 educational sessions offered at the sswr conference. table 2 provides information on the number of accepted abstracts for cswe (13) and sswr (20) with the word “prevention” in the title and the topic areas of these abstracts. almost all accepted abstracts with “prevention” in the title fit into a specific topic area within social work (e.g. violence prevention), with only one (mccave & rishel, 2012)) that focused on the broader role of prevention in social work education and practice. additionally, when a keyword search for “prevention” anywhere in the abstracts was conducted, an additional 26 cswe abstracts and 122 sswr abstracts were identified; however, when looking further at the topic areas of these abstracts the authors found many of these abstracts did not readily fit into the topic areas presented in table 2 and some did not actually appear to have a prevention focus. advances in social work, fall 2013, 14(2) 549 table 2. cswe and sswr abstracts topic cswe 2012 sswr 2013 “prevention “ or variation in abstract title 13 20 violence prevention 5 6 hiv prevention-related 4 6 sexual health/family planning prevention 1 3 school-based delinquency prevention 1 0 public sector prevention 1 0 prevention in sw education 1 0 child abuse prevention 0 2 evidence-based prevention for youth 0 2 school-based prevention of academic problems 0 1 discussion over the past two decades there has been a lack of conceptual articles discussing how to integrate prevention-focused content into social work research, practice, and education. in addition to this, there are limited avenues for those wishing to cultivate and disseminate innovative prevention-focused research, curriculum, and practice; yet this is exactly what is needed to meet the current needs of the clients being served by social workers in our communities. there are several ways in which innovation and dissemination can be stimulated, such as through creating special topic issues in social work journals, creating prevention tracks at national social work conferences, and establishing a formalized social network (e.g., listserv) for social work scholars who are interested in prevention, to name a few. social work education within social work education, it is necessary for cswe to examine the current epas standards and determine what changes may be considered for the next revised standards to improve the integration of prevention-focused content into social work education. until then, social work programs across the country can utilize the current affirmation/reaffirmation process to assess the degree to which this integration is occurring and where improvements can be made to the explicit curriculum. programs also have the option of infusing prevention content into all of their courses or key required courses, creating electives, certificates, or concentration(s) with a prevention focus, or establishing a joint/dual degree with a mph program. further, one way in which social work education will be enhanced is to train both faculty and students in an established model of prevention practice. yet the limited dialogue regarding the role of prevention in social work has hindered the development of mccave, rishel, morris/prevention in social work: part 2 550 an operational definition of prevention practice. the social work profession has recently shifted toward a competency based education model as defined in the 2008 epas. therefore, efforts to integrate prevention content into the curriculum must reflect competency based educational goals. to effectively develop and implement prevention content in the social work curriculum, it is first necessary to define prevention practice. in other words, what is a social work practitioner who is competent in prevention practice able to do? to initiate this dialogue, rishel (in press) has proposed a working definition of competent prevention practice. practitioners competent in prevention practice are able to:  explain the definition of “prevention” and the different levels (e.g. universal, selective, indicated) of prevention interventions;  articulate the benefits, advantages, and challenges of prevention, and advocate for prevention practices and policy;  apply a risk and protective factor framework to identify those at higher risk;  identify multiple levels for prevention intervention drawing on their base in ecological systems theory;  access, implement, and evaluate evidence-based prevention interventions; and  facilitate multidisciplinary collaborative prevention efforts. the bulleted items above could be used as practice behaviors to define a preventionfocused competency within an advanced concentration. as x notes, this definition is a “work in progress.” further dialogue within the profession will build upon and strengthen this definition as social workers recognize prevention as a core component of social work practice. application examples an example of the elective development strategy is one of the author’s development and implementation of a specialized msw elective, child mental health: promotion, prevention, and treatment. the course was designed to prepare students to practice in various settings in a way that promotes and optimizes children’s mental health. the course is differentiated from typical course offerings in mental health by inclusion and emphasis of prevention content. prevention content is incorporated throughout all aspects of the course with the expectation that students will feel equally comfortable identifying and implementing prevention and treatment interventions upon course completion. please see x for a complete discussion of the content and evaluation of this course. another strategy involves integrating prevention as a key component in specialized msw training programs. responding to training grant opportunities is one mechanism of developing specialized training programs. for example, the u.s. department of health and human services, health resources and services administration (hrsa) awarded 24 mental and behavioral health education and training (mbhet) grants to graduate social work and psychology programs in 2012. funded under the affordable care act, advances in social work, fall 2013, 14(2) 551 additional mbhet grants are anticipated to be awarded in 2013 and beyond. the authors’ institution was one of 11 msw programs awarded a mbhet grant in 2012. this award funds the implementation of the integrated mental and behavioral health training program (imbtp). the purpose of the imbtp is to train msw students in mental and behavioral health practice, with a focus on integrated and culturally appropriate models of rural service delivery. one of the core components of the program is a focus on integrated models of service delivery, with integrated prevention and treatment models heavily emphasized. as the focus of the training is clinical practice, students trained under this program will be prepared to integrate prevention interventions into standard mental and behavioral health practice settings. challenges while the need for innovation, dissemination, as well as utilization of prevention practice in social work is clear, there are distinct challenges that exist for many social work practitioners, scholars, students, and educators. the primary challenge is connected to limited resources including time, money, expertise/knowledge, and mentorship. such resources are critical in order to build a strong and competent workforce of preventionfocused practitioners and scholars. for those scholars who do have the expertise, providing mentorship to junior faculty as well as taking a leadership role in revising the curriculum are resource-heavy endeavors. increasingly, faculty workloads reflect not only the scholarly interests of faculty but also the demands of the program and service needs of the institution. additionally, in order for changes to be made at the curricular level, consistent support needs to be obtained from faculty as well as administrators; asking faculty to change their syllabi requires time and energy. further, choosing to offer a new elective potentially takes the place of an existing elective, a potential source of faculty conflict. establishing a joint/dual degree with a mph program may not be part of the shared vision for the program and will likely take months of effort from faculty and administration from both programs. an additional challenge to the implementation of prevention practice relates to the heavy workloads practitioners are often negotiating in their agencies and communities, typically with limited access to social work scholarship and mentorship outside their existing practice background and expertise. supports despite the challenges that are present, several supports are available to improve the likelihood of the social work profession becoming more prevention-oriented. universities often offer internal grants or funding to stimulate innovative research or curriculum development as well as provide assistance to junior faculty who may wish to seek external funding from federal funders or foundations. further, it has been our experience that colleagues in public health, community medicine, psychology, and nursing, have been very interested in cultivating and sustaining informal and formal relationships. such resources can be capitalized on for those teaching in institutions where these degrees are offered. additional networking with stakeholders both within and outside the institution, such as students, deans, practitioners, and state nasw chapters can be incredibly useful for garnering support for curricular changes. making the connection to social work mccave, rishel, morris/prevention in social work: part 2 552 practice and the potential impact for the practice community and the clients they serve is key. limitations the research for this project represents a snapshot in time. in regards to the online search of accredited msw programs, it is likely that some programs were not identified that do in fact offer courses or concentrations focused on prevention because of limited access to online information. it is certainly expected that programs are in a constant state of development, such that at any given time there are courses, concentrations, and dual degree relationships being developed or changed, as well as new msw programs beginning candidacy. additionally, based on information available online, it was not possible to determine the number or topic areas of the abstracts submitted, but not accepted, to either cswe or sswr. as such, a vital piece of information is missing, which is whether the number of accepted abstracts is proportional to the number of abstracts submitted or whether the small number of accepted abstracts is indicative of a lag in broader acceptance of the focus on prevention in social work education and practice. further, it may be possible that the low number of accepted abstracts with a prevention focus may reflect a growing number of social work scholars who choose not to submit to either cswe or sswr due to a perception that prevention is not a valued topic at cswe or sswr and coinciding low acceptance rates. instead these scholars may submit their work to interdisciplinary, topic/population-specific, or prevention-focused conferences, such as the society for prevention research (spr) and the american public health association (apha), both of which welcome social work research. this may have an unfortunate cyclical effect with fewer submissions leading to a justification for fewer acceptances and overall lack of prevention focus at cswe and sswr. next steps there are several steps that can be taken by social work educators and scholars to assist in the promotion of prevention-focused practice and scholarship. one step is to gather data from social work scholars and practitioners via interviews, surveys, and/or focus groups about their existing knowledge and use of prevention theory and practice. as part of this data collection or as a separate endeavor, it is important that the practice community have an opportunity to discuss ways in which they could better integrate innovative scholarship and theory into their practice. social work scholars need to understand the needs of social work practitioners as they relate to prevention practice. as a way to build a community for those social work scholars interested in prevention, the formation of a special interest group at cswe and sswr on prevention in social work as well as an organized effort to advocate for a track on abstracts to be submitted within this topic area is recommended. additionally, social work students and faculty could benefit from expanding their professional network through a new social work listserv focused on prevention practice, education, and research. another step would be to establish a working group or taskforce to provide recommendations regarding the integration of prevention content into existing social work curricula. this could occur within the context of a single institution as part of advances in social work, fall 2013, 14(2) 553 ongoing curriculum improvement efforts. it could also be an initiative within cswe to create such a group to review current epas standards and consider prevention language for the upcoming 2015 standards. in connection to this, it would be worthwhile to explore the benefit of offering prevention-focused content within social work education, ranging from one elective to a joint/dual degree program with public health. determining the types of employment secured after graduation as well as the level of preparedness for the skills necessary in these positions would be beneficial. given the small proportion of social work msw programs that offer a focus on prevention, it is important that data be collected to determine whether or not there is an impact or added benefit to creating prevention-focused courses or developing joint msw/mph programs. lastly, a prevention social work text is clearly needed and is an endeavor that we hope to pursue in the future. conclusion prevention is a critical aspect of social work practice, yet, over the past two decades, there has been little formal support provided for students, faculty, and practitioners who recognize the importance of prevention in social work. this investigation was the second part of a continued effort to determine the extent of explicit prevention within the social work profession. as we found in the first inquiry, there is certainly a gap in the knowledge base as well as opportunities for dissemination for scholars and practitioners who view prevention as an essential aspect of the profession. a major paradigm shift in the social work profession toward prevention-focused practice can only come from within; this article is not only a vehicle for dissemination of information but also serves as a call to those who recognize the validity of the statement that prevention practice is social work practice. without such a cultural shift within the profession, it is likely that the status quo (i.e., treatment first, prevention last mentality) will persist. adding a patchwork of social work educators and practitioners who understand and value prevention theories and interventions leads to a fragmented system of care. a professionwide shift would instead result in a new generation of social workers who possess the requisite knowledge and skill set to target a myriad of social issues, at all levels of practice, that can be effectively addressed through a prevention framework. it is the hope that this investigation initiates a profession-wide dialogue, as well as promotes new course development, scholarship, and interventions. references american public health association. 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(2010). a public health approach to children’s mental health: a conceptual framework. washington, dc: georgetown university center for child and human development, national technical assistance center for children’s mental health. miller, s. o., styles o'neal, g. m., & scott, c.a. (1982). primary prevention approaches to the development of mental health services for ethnic minorities: a challenge to social work education and practice. new york, ny: council on social work education. mokdad, a. h., marks, j. s., stroup, d. e., & gerberding, j. l. (2004). actual causes of death in the united states, 2000. jama, 291, 1238-1245. nobel, m. (1981). primary prevention in mental health and social work: a sourcebook of curriculum and teaching materials. new york, ny: council on social work education. oliver, d. p., & decoster, v. a. (2006). health care needs of aging adults: unprecedented opportunities for social work. health & social work, 31, 243-245. rishel, c. w. (2007). evidence-based prevention practice in mental health: what is it and how do we get there? american journal of orthopsychiatry, 77, 153-164. rishel, c. w. (in press). integrating prevention content into clinical social work practice courses. journal of social work education. rishel, c. w., & mccave, e. l. (2012, november). formalizing prevention as an explicit part of the social work curriculum. curriculum workshop presented at the annual program meeting of the council on social work education, washington, dc. schroeder, s. a. (2007). we can do better – improving the health of the american people. new england journal of medicine, 357, 1221-1228. weisz, j. r., sandler, i. n., durlak, j. a., & anton, b. a. (2005). promoting and protecting youth mental health through evidence-based prevention and treatment. american psychologist, 60, 628-648. wheeler, d. p., & bragin, m. (2007). bringing it all back home: social work and the challenge of returning veterans [national health line]. health & social work, 32, 297-300. woody, j. d. (2006). prevention: making a shadow component a real goal in social work. advances in social work, 7, 44-61. advances in social work, fall 2013, 14(2) 555 wotring, j., & stroul, b. (2011). issue brief: the intersect of health reform and systems of care for children’s behavioral health care. washington, dc: georgetown university center for child and human development, national center for children’s mental health. author note: address correspondence to: carrie rishel, ph.d., associate professor, school of social work, west virginia university, po box 6830, morgantown, wv 26506. email: carrie.rishel@mail.wvu.edu _____________ kori r. bloomquist, phd, is an assistant professor at winthrop university. leila wood, phd, is the senior project director at the institute on domestic violence and sexual assault at university of texas at austin school of social work. kristin friedmeyer-trainor, msw, lsw, is a medical social worker at st. vincent hospital in indianapolis, in. hea-won kim is an associate professor at indiana university. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 292-311, doi: 10.18060/18760 self-care and professional quality of life: predictive factors among msw practitioners kori r. bloomquist leila wood kristin friedmeyer-trainor hea-won kim abstract: this study explored the effects of self-care practices and perceptions on positive and negative indicators of professional quality of life, including burnout, secondary traumatic stress, and compassion satisfaction among msw practitioners. results reveal that while social workers value and believe self-care is effective in alleviating job-related stress, they engage in self-care on a limited basis. findings indicate that msw programs and employers do not teach social workers how to effectively engage in self-care practice. various domains of self-care practice contribute differently to indicators of professional quality of life. this study sheds light on the under-studied relationship between social worker self-care and professional quality of life, provides insight into the type of activities practiced and not practiced by msw practitioners, and identifies gaps between perceived value and effective teaching of self-care. implications exist for social work educators and employers and the potential to support a healthier, sustainable workforce. keywords: self-care practice, self-care perceptions, professional quality of life social workers represent a significant segment of human service professionals in the public and private sectors. there are nearly 600,000 social workers in the united states, and this number is expected to grow by 19 percent by the year 2022, which is faster than the average growth rate of 11 percent for all occupations (u. s. bureau of labor statistics, 2013). social workers practice in a variety of settings including child welfare and family practice, schools, mental health and addictions, and health care (u. s. bureau of labor statistics, 2013). social workers often juggle high volumes of paperwork, complex caseloads, and challenging client situations (kim & stoner, 2008). additionally, social workers routinely engage with individuals, families, and groups who have experienced significant trauma and recent crises; exposure to such clients and the suffering they experience may become emotionally demanding on social workers (newell & macneil, 2010). compassion fatigue, secondary traumatic stress, and burnout are potential consequences of these emotional demands and can lead to feelings of exhaustion and incompetence, turnover intention, and actual turnover from one’s organization (bride, 2007; figley, 1995; killian, 2008; mccann & pearlman, 1990; mcgarrigle & walsh, 2011; newell & macneil, 2010). bloomquist et al./self-care and professional quality 293 self-care and professional quality of life the practice of self-care refers to the purposeful actions people and organizations take that contribute to wellness and stress reduction (alkema, linton, & davies, 2008; barker, 2010; killian, 2008; kraus, 2005). self-care has been heralded in the field of social work as a means to protect against the many stressors of the profession. according to the national association of social workers (nasw, 2008), social workers have an ethical responsibility to address impairment or personal challenges that could interfere with professional decision-making and services to clients, but is self-care predictive of professional quality of life? greater understanding is needed about self-care practices and perceptions of self-care as well as the relationship of self-care to the consequences of working with vulnerable and traumatized populations. the current study explored social worker self-care as a means to support a healthy and effective workforce. this study intends to enhance the social work knowledge base in the areas of self-care and professional quality of life. literature review professional quality of life the effect of trauma on professionals who work in direct contact with clients has been investigated over the past several decades across multiple disciplines including nursing, social work, psychology, mental health, and case management (ray, wong, white, & heaslip, 2013; stamm, 2010; thielman, & cacciatore, 2014; thompson, amatea, & thompson, 2014). understanding the factors that influence professional quality of life is important to helping professionals, including clinical social workers, and to their clients (thomas, 2013). the current body of literature indicates that the experiences of compassion satisfaction and compassion fatigue influence one’s overall professional quality of life (ray et al., 2013; stamm, 2010). professional quality of life refers to “the quality one feels in relation to their work as a helper” and is influenced by both positive and negative aspects of the work (stamm, 2010, p. 8). compassion satisfaction is a positive indicator of professional quality of life and refers to the pleasure derived from being able to do one’s work effectively (stamm, 2010). compassion fatigue involves negative responses to caring for those who have experienced trauma, including feelings of fear associated with trauma work (stamm, 2010). compassion fatigue is comprised of two parts–secondary traumatic stress (sts) and burnout (stamm, 2010). together, compassion satisfaction and the two components of compassion fatigue—secondary traumatic stress and burnout—generate a professional quality of life for helping professionals. secondary traumatic stress (sts) is a clinical extension of compassion fatigue (alkema et al., 2008; bride, 2007; figley, 1995; killian, 2008; stamm, 2010). figley (1995) argues that sts is experienced not only by people working with those who have experienced trauma, but also the families and extended support systems of victims. consequences of sts include sleep disturbance, intrusive thoughts (killian, 2008; stamm, 2010), forgetfulness, an inability to separate work and private lives, and an avoidance of trauma reminders (stamm, 2010). experiencing sts has the potential to compromise a practitioner’s well-being and service delivery. a significant number of social workers have advances in social work, fall 2015, 16(2) 294 been found to have symptoms of sts—most often intrusive thoughts, psychological stress, and avoidance of reminders of particular clients (bride, 2007). burnout is an additional component of compassion fatigue. maslach and jackson (1986) recognize burnout as a syndrome of “emotional exhaustion, depersonalization, and reduced personal accomplishment” common among human service workers (p. 1). burnout is typically the result of highly stressful work environments (grosch & olsen, 1994; maslach & jackson, 1986) and can also result from lack of esteem (mccann & pearlman, 1990). burnout has been found to be positively correlated with amount of time on the job (galek, flannelly, greene, & kudler, 2011); it can impact job performance (maslach & jackson, 1986) and interrupt cognitive schema including frame of reference and rationalization (mccann & pearlman, 1990). self-care. self-care practice requires individuals and organizations to purposefully engage in behaviors that contribute to wellness and reduced stress. five primary domains of self-care practice are recognized in the literature. these domains include physical, psychological, emotional, spiritual, and professional self-care (saakvitne & pearlman, 1996). physical self-care can be thought of as actions taken to promote one’s physical wellbeing. common physical self-care activities include exercise, adequate sleep, and a healthy diet. psychological self-care refers to actions taken to endorse self-awareness and healthy decision-making. engaging in therapy, journaling, and reading are examples of psychological self-care activities. emotional self-care refers to actions taken to encourage emotional well-being. emotional self-care activities include spending time with loved ones, laughing, and self-praise. spiritual self-care involves nurturing connections and finding meaning in life. attending religious or spiritual events, praying, and meditation are common spiritual self-care activities. professional self-care can be thought of as actions to promote professional health and competence. common professional self-care activities include participating in relevant trainings, setting appropriate boundaries with clients, seeking adequate supervision or support, and advocating for one’s own needs within the workplace. research suggests that specialized trauma training can improve compassion satisfaction and decrease compassion fatigue and burnout among mental health professionals (sprang, james, & whitt-woosley, 2007). knowledge and training may provide some protection against the harmful effects of trauma exposure (sprang et al., 2007). self-care perceptions. perceptions of self-care involve the attitudes and beliefs one holds about self-care and can be influenced by a variety of environmental and personal factors. a paucity of research exists with regard to social workers’ perceptions of self-care and the perceptions of self-care among helping professionals in general. however, in a study to determine the relationship between perceptions of self-care and quality of life among clinical psychology doctoral students, goncher, sherman, barnett, and haskins (2013) found that perceived self-care emphasis was a significant predictor of both quality of life and self-care practice. self-care perceptions are influential among students in a related helping field, clinical psychology. therefore, it is possible, if not likely, that the attitudes and beliefs social workers hold about self-care may influence quality of life and self-care practice. bloomquist et al./self-care and professional quality 295 environmental considerations of helping others. research has found that higher rates of burnout occur for social workers who have lengthy engagement with clients because the social worker can begin to feel helpless while assisting the client (mccann & pearlman, 1990). bober and regehr (2006) and brady, guy, poelstra, and brokaw (1999) found that therapists who spend more time working with victimized clients have higher levels of post-traumatic symptoms and distress. thus, it appears that more time in direct contact with clients is related to higher levels of job-related stress. studies using the traumatic stress institute belief scale have shown a statistically significant association between years of experience in the field and dysfunctional views of intimacy with others (bober & regehr, 2006). in essence, the longer someone is in the field, the more intimacy issues are encountered. conversely, a longer length of time in the field has been associated with less vicarious trauma (pearlman & mac ian, 1995). age (being younger), having children, and socioeconomic status have been found to be predictive of helping professionals’ intent to turnover from their current position (barak, nissly, & levinal, 2001). despite recognition of the stress and demands faced by human service professionals, including social workers, a historical lack of systematic research regarding the self-care of these workers exists (newell & macneil, 2010; norcross, 2000). some scholars posit that increased use of self-care strategies may decrease strain outcomes, or the negative consequences of engaging in human service work (alkema et al., 2008; bober & regehr, 2006; deery-schmitt & todd, 1995; kraus, 2005; kulkarni, bell, hartman, & hermansmith, 2013; newell & macneil, 2010; richards, campenni, & muse-burke, 2010; skovholt, grier, & hanson, 2001). additionally, researchers theorize that increased engagement in self-care practice leads to greater compassion satisfaction and professional resiliency (fink-samnick, 2009; killian, 2008). however, emotional and psychological risks associated with providing direct social work services to vulnerable populations and the use of professional self-care in response to these risks have been largely overlooked in social work practice, training, and education (newell & macneil, 2010). the purpose of this research study was to expand knowledge regarding the association among social workers’ self-care practices and perceptions and professional quality of life. exploring ways in which social workers perceive and practice self-care has the potential to improve employment retention, augment training, and enhance job satisfaction and overall professional quality of life among social work professionals. the researchers hypothesized that more frequent engagement in self-care practice and more positive perceptions of selfcare would be predictive of lower levels of sts and burnout and greater compassion satisfaction among msw practitioners. methods study participants this study focused on practitioners with an msw, as msw-level practitioners are likely to deliver clinical interventions and are thus at risk for experiencing trauma and strain outcomes. inclusion criteria for the study included holding an msw degree from a program accredited by the council on social work education (cswe) and being employed either advances in social work, fall 2015, 16(2) 296 part-time or full-time as a social worker at the time of data collection. the study used a convenience sample of alumni from cswe-accredited msw programs (n=786). the cswe website provided a list of 217 colleges and universities with an accredited msw program (cswe, 2011). the researchers identified and contacted program directors and/or other msw administrative staff with a personalized email about the study. programs that did not respond to the initial email were contacted with a second email. three programs were not able to be contacted. of the 214 programs contacted, 32 programs expressed interest in the study and agreed to forward the study information (e.g., recruitment email with a link to the online survey) to a list of their program alums (15% response rate). two follow-up emails were sent to the 32 participating schools in an effort to ensure the survey had been forwarded to alumni. this study was approved by the indiana university institutional review board. measures professional quality of life. professional quality of life was measured using the professional quality of life scale, version 5 (proqual-5), developed by stamm (2005). this instrument is the most commonly used measure of both positive and negative consequences of working with people who have experienced exceptionally stressful events (stamm, 2005). since its development in 1995, it has been revised multiple times. version 5 is the most current version of the instrument (stamm, 2015). the proqol-5 is a 30-item scale with three subscales to measure compassion satisfaction, burnout, and sts. each subscale includes 10 items. respondents were asked to rate how frequently they have experienced each item on 5-point likert scale (1=never to 5=very often). the compassion satisfaction scale measured the pleasure one derives from doing one’s work well (α=0.90, stamm, 2005). example items from the compassion satisfaction subscale include: “i get satisfaction from being able to help people” and “i feel invigorated after working with those i help.” the burnout scale measured feelings associated with hopelessness and difficulty in dealing with work or doing one’s work effectively (α=0.92, stamm, 2005). example items from the burnout subscale include: “i am happy” and “i feel connected to others.” lastly, the sts scale measured work-related secondary exposure to people who have experienced trauma (α=0.93, stamm, 2005). example items from the sts subscale include: “i am preoccupied with more than one person i help” and “i jump or am startled by unexpected sounds.” a summary score for each subscale was used for analysis with higher scores indicating greater compassion satisfaction, burnout, and sts, respectively. self-care practice. self-care practice was measured using a scale developed by the researchers based upon the work of multiple contributors to the field of self-care. the selfcare practice items included in this study were largely influenced by the works of bell, kulkarni, and dalton (2003), bober, regehr, and zhou (2005), and saakvitne and pearlman (1996). the measure included five domains of self-care practice—physical, professional, emotional, psychological, and spiritual. domains included between eight and 12 self-care activities associated with well-being in that particular area of life (see table 2 for items in each domain). in an effort to measure which activities social workers practice and how often they engage in each activity, respondents were asked to indicate frequency of engagement in 45 different self-care activities during the past 30 days. responses were bloomquist et al./self-care and professional quality 297 rated on a 6-point likert scale (0=never to 6=very frequently). a summary score was used to indicate each self-care practice domain as well as overall self-care practice. higher scores indicated a greater frequency of engagement. internal consistency reliability of the self-care practice scale was tested overall (α=0.90) and for each sub-scale (physical subscale α=0.73; professional subscale α=0.79; emotional subscale α=0.69; psychological subscale α=0.76; spiritual subscale α=0.76). self-care perceptions. self-care perceptions refer to one’s appreciation, value, and/or awareness of self-care. an 11-item scale to measure self-care perceptions was developed based upon existing literature (bell et al., 2003; bober et al., 2005; saakvitne & pearlman, 1996). respondents were asked to indicate their agreement with each item on a 5-point likert scale (1=strongly disagree to 5=strongly agree). four items were reverse-coded. a summary score was created with higher scores indicating more positive self-care perceptions (α=0.76). background variables. the study instrument also included questions to ascertain respondents’ demographic and additional background information. a total of 16 items inquired about current practice status, education level, licensure status, area of social work practice, salary, position status (full or part-time, clinical or administrative), amount of time spent in direct practice with clients, race, ethnicity, age, years of post-msw experience, years in current position, practice location (urban or rural setting and state where practicing), and gender. data analysis descriptive statistics were used to examine the current level of self-care practice and perceptions and capture respondents’ characteristics. in an effort to predict compassion satisfaction, burnout, and sts, multiple linear regression analyses were used. summary scores of each of the five self-care practice subscales as well as the summary score for selfcare perceptions and background variables were used as independent variables to predict each indicator of professional quality of life. years of post-msw experience, percentage of time in direct contact with clients, and annual salary were selected as independent variables in the analyses based upon their relationship to professional quality of life as identified in previous research. before the hypotheses were tested, several assumptions for regression were examined. multicollinearity did not prove to be a challenge in any of the regressions. findings participant characteristics the sample of msw practitioners (n=786) hailed from 42 states and the district of columbia. the majority of respondents were female (88%) and caucasian (85%). on average, respondents were about 42 years of age (m=41.52, sd =12.59), had practiced over nine years after earning their msw (m=9.54, sd=9.44), and had been in their current position for about five years (m=4.95, sd=5.79). the majority of respondents were licensed (68.9%), clinical (58.9%) practitioners. most respondents spent more than half of advances in social work, fall 2015, 16(2) 298 their work week in direct contact with clients (63.5%). nearly half of respondents earned between $30,000 and $50,000 annually. further sample characteristics can be found in table 1. self-care practice domains as seen in table 2, on average, respondents reported engaging in physical self-care most frequently (m=3.6), followed by professional (m=3.5), emotional (m=3.4), and psychological self-care (m=3.3). respondents reported engaging in spiritual self-care activities less frequently than all other domains (m=2.9). overall, respondents were not routinely or frequently engaging in selfcare practice (m=3.3, sd=0.61). none of the 45 listed self-care practices were rated at less than 1 (never), indicating that each activity was used by at least some respondents. each respondent indicated engagement in at least one of the 45 listed self-care practice activities. only 12 of the 45 activities were rated at a 4 or above (often–frequently). the self-care activities rated at a 4 or above included practicing healthy eating, sleeping regularly (physical), taking breaks throughout the work day, discussing cases with colleagues, chatting with co-workers, making quiet time to complete tasks, and setting limits with clients (professional), laughing, spending time with those one enjoys (emotional), and practicing being mindful, reading non-work related literature, and taking time for reflection (psychological). five of these 12 items are professional self-care activities. the least frequently practiced selfcare activities, with a rating at a 2 or lower (rarely–never), included writing in a journal (psychological), practicing yoga (spiritual), participating in stress table 1. study sample background characteristics (n=786) frequency (%) gender female 693 (88.2%) male 86 (10.9%) other 2 (0.3%) race caucasian 665 (85.0%) black or african american 58 (7.4%) other 39 (4.0%) multi-racial 20 (2.6%) ethnicity not hispanic or latino 709 (93.0%) position clinical 461 (58.9%) administrative 147 (18.7%) other 175 (22.3%) licensed yes 541 (68.9%) income less than $30,000 73 (10.6%) $30,001-$40,000 181 (23.4%) $40,001-$50,000 198 (25.4%) $50,001-$60,000 139 (17.8%) $60,001-$70,000 85 (10.9%) $70,001-$80,000 48 (6.1%) direct contact with clients 0-25% 142 (18.1%) 26-50% 144 (18.4%) 51-75% 270 (34.4%) 75-100% 228 (29.1%) practice setting urban 554 (71.3%) area of practice health 136 (18.7%) public welfare 79 (10.1%) mental health 277 (35.3%) child welfare 114 (21.5%) other* 104 (14.5%) bloomquist et al./self-care and professional quality 299 management training, and negotiating one’s own needs (professional). there were no items from the physical or emotional domains rated at a 2 or lower. table 2. self-care activities by domain physical self-care activity n m sd healthy eating habits 781 4.55 1.26 sleep regularly 777 4.54 1.38 engage in activity/hobbies 777 3.80 1.44 exercise 779 3.78 1.44 medical care when needed 777 3.77 1.62 preventative medical care 776 3.57 1.61 take time to be sexual with self or partner 765 3.33 1.41 take time off from work 778 2.87 1.46 take a vacation 772 2.56 1.45 physical self-care dimension-overall 782 3.64 0.74 professional self-care activity n m sd take time to chat with co-workers 781 4.71 1.37 set limits with clients 771 4.58 1.31 take breaks during the work day 781 4.31 1.56 discuss cases with colleagues 781 4.21 1.40 make quiet time to complete tasks 781 4.03 1.43 arrange your work space so it is comforting 780 3.69 1.65 get regular supervision 780 3.07 1.39 diversify your caseload 769 3.03 1.68 participate in professional education/training 778 2.88 1.56 participate in a peer support group 780 2.09 1.37 negotiate your needs 773 1.99 1.19 participate in stress management training 777 1.54 0.92 professional self-care-overall 782 3.46 0.76 emotional self-care activity n m sd laugh 778 5.24 1.04 spend time with those you enjoy 780 4.89 1.20 play with children 777 3.73 1.72 give yourself praise 767 3.25 1.41 allow yourself to cry 777 2.82 1.15 take social action 773 2.79 1.32 re-watch favorite movie(s) 775 2.68 1.34 re-read favorite book(s) 778 2.09 1.38 emotional self-care dimension-overall 781 3.44 0.75 psychological self-care activity n m sd practice being mindful 778 4.21 1.47 read non-work related literature 779 4.11 1.61 take time for reflection 778 4.05 1.42 set goals for yourself 777 3.86 1.37 say “no” to extra activities 777 3.16 1.12 develop a plan for caring for yourself 773 2.83 1.47 participate in your own therapy 777 2.10 1.38 write in a journal 778 1.81 1.25 psychological self-care dimension-overall 781 3.28 0.86 advances in social work, fall 2015, 16(2) 300 table 2. self-care activities by domain spiritual self-care activity n m sd pray 781 3.82 1.96 visualize yourself having a positive day 778 3.48 1.71 sing 778 3.36 1.74 spend time with nature 780 3.2 1.36 read inspirational literature 778 3.03 1.72 spend time in a spiritual community 782 2.52 1.54 meditate 781 2.37 1.57 practice yoga 778 1.72 1.15 spiritual self-care dimension-overall 782 2.94 0.98 note: respondents selected responses from 1 (n: never), 2 (r: rarely— once a month), 3 (s: sometimes—a few times a month), 4 (o: often— weekly), 5 (v: very often—a few times a week), and 6 (f: frequently— almost daily to daily) self-care perceptions using the general definition of self-care provided in the instrument, on average, respondents reported moderately positive perceptions of self-care. of the 11 perception items, respondents most strongly agreed with the statement “i value self-care” (m=4.5) followed by “self-care is effective in alleviating job-related stress” (m=4.38) (see table 3). these findings indicate that social workers value self-care and believe it is effective in combating strain outcomes. when asked about their msw program (m=3.8) and employer (m=3.3) valuing self-care, responses were more moderate as were responses related to respondents’ msw program (m=3.2) and employer (m=2.4) effectively teaching them how to engage in self-care practice. respondents indicated a moderate level of disagreement with the four items related to self-care practice barriers. overall, respondents indicated their msw program and employer value self-care much less than the individual worker, that msw programs and employers do not effectively teach workers how to engage in self-care practice, and when compared to msw programs, employers were less likely to value and effectively teach self-care. table 3. self-care perceptions perceptions n m sd i value self-care. 779 4.47 0.64 self-care is effective in alleviating job-related stress. 781 4.38 0.69 the msw program from which i graduated values self-care. 780 3.79 1.01 my current employer values self-care. 773 3.34 1.28 my msw program taught me how to effectively engage in self-care. 780 3.22 1.08 it is easy to engage in self-care practice. 780 3.06 1.15 my workload prevents me from engaging in self-care. 779 2.83 1.23 my family obligations prevent me from engaging in self-care. 780 2.45 1.18 my current employer effectively teaches me how to engage in self-care. 774 2.44 1.25 my community obligations prevent me from engaging in self-care. 780 2.03 .95 my social life prevents me from engaging in self-care. 778 1.95 .87 bloomquist et al./self-care and professional quality 301 variable correlations the researchers were interested in the relationships among study variables. self-care perception was found to have a significant positive correlation with multiple self-care practice domains including psychological (r=0.14, p<.01), spiritual (r=0.15, p<.01), emotional (r=0.18, p<.01), and professional (r=0.28, p<.01). multiple dimensions of selfcare practice were found to be significantly correlated, ranging from r=-.08, p<.05 to r=0.55, p<.01. among the background variables used in the analyses, there were significant positive correlations between years of post-msw experience and multiple domains of selfcare practice including physical (r=0.16, p<.01), psychological (r=0.18, p<.01), spiritual (r=0.14, p<.01), and emotional (r=0.07, p<.05). predicting professional quality of life the primary goal of this study was to explore the effect of self-care practice and perceptions on indicators of professional quality of life among msw practitioners. multiple regression analyses was conducted to identify predictors of each indicator of professional quality of life. secondary traumatic stress. the results of the sts regression revealed that the predictor variables explained 19.3% of the variance (r2 =0.19, f(9, 746)=19.83, p<.001). respondents reported less sts when they held more positive perceptions of self-care and had more years of post-msw experience (see table 4). psychological self-care was the only significant self-care practice domain; however, respondents who practiced more psychological self-care reported higher levels of sts (b=.11, p<.05). burnout. the results of the burnout regression indicated the six predictor variables explained 38.6% of the variance (r2=0.39, f(9, 746)=52.06, p<.01). as seen in table 5, respondents reported less burnout when they held more positive perceptions of self-care, engaged in more professional, emotional, and spiritual self-care practice, and had more years of post-msw experience. however, respondents who practiced more psychological self-care (b=.09, p<.05) reported higher levels of burnout. compassion satisfaction. in the compassion satisfaction regression, self-care practice, perceptions, and the background variables explained 24.5% of the variance (r2=0.25, f(9, 746=26.92, p<.001). as seen in table 6, respondents reported more compassion satisfaction when they held more positive perceptions of self-care, practiced more professional and emotional self-care, and had more years of post-msw experience. advances in social work, fall 2015, 16(2) 302 table 4. predictors of professional quality of life secondary traumatic stress b se β t p constant 33.78 1.51 22.31 <.001 self-care perceptions -.32 .03 -.37 -9.49 <.001*** physical self-care .01 .02 .01 .30 .761 professional self-care -.05 .03 -.09 -1.93 .054 emotional self-care -.07 .04 -.07 -1.73 .085 spiritual self-care .03 .03 .05 1.17 .244 psychological self-care .08 .03 .11 2.37 .018* annual income .00 .12 .00 -.00 .998 direct time with clients .06 .18 .01 .33 .745 years post-msw -.11 .02 -.19 -5.08 <.001*** burnout b se β t p constant 44.50 1.29 34.57 <.001 self-care perceptions -.37 .03 -.44 -12.90 <.001*** physical self-care .02 .02 .03 1.03 .302 professional self-care -.60 .02 -.11 -2.82 .005** emotional self-care -.16 .03 -.19 -5.11 <.001*** spiritual self-care -.07 .02 -.10 -2.85 .004** psychological self-care .06 .03 .09 2.19 .029* annual income -.10 .10 -.03 -.99 .321 direct time with clients -.03 .15 -.01 -.18 .860 years post-msw -.08 .02 -.15 -4.50 <.001*** compassion satisfaction b se β t p constant 23.21 1.57 12.47 <.001 self-care perceptions .23 .04 .24 6.54 <.001*** physical self-care -.02 .02 -.03 -.78 .438 professional self-care .08 .03 .12 2.74 .006** emotional self-care .17 .04 .18 4.45 <.001*** spiritual self-care .01 .03 .02 .49 .623 psychological self-care .03 .04 .04 .85 .399 annual income .32 .12 .05 1.52 .130 direct time with clients .28 .18 .05 1.52 .130 years post-msw .06 .02 .09 2.51 .012* *p < .05; **p<.01; ***p<.001 discussion this study provided interesting insights into the self-care practices and perceptions of social work practitioners. physical self-care was the most frequently practiced domain with average scores indicating between monthly and weekly use. this was closely followed by use of professional and emotional self-care. the most practiced activities overall included laughing, spending time with friends and family, and taking time to chat with co-workers. these activities were practiced often to very often by respondents. in their study of residential youth workers, eastwood and ecklund (2008) found healthy eating and spending time with friends and family to be among the most endorsed self-care practices (eastwood & ecklund, 2008). similarly, turner et al. (2005) found that psychology interns most often used relationships, humor, eating well, and self-awareness as self-care activities. bloomquist et al./self-care and professional quality 303 van hook and rothenberg (2009) also found that exercise, social time, and hobbies to be the most used self-care activities among child welfare workers. the use of multiple selfcare strategies among social workers in this sample follows norcross’ (2000) recommendation for workers to use a variety of self-care approaches to increase professional quality of life rated at a 2 or lower (rarely–never), journaling, practicing yoga, participating in stress management training, and negotiating one’s own needs were found to be the least practiced self-care activities among the respondents in this study. as noted, there were no items from the physical or emotional domains rated at a 2 or lower. perhaps activities in these two domains of self-care practice are more easily accomplished or available to social workers. participating in yoga and stress management training could potentially pose a cost to participants or agencies and perhaps deter social workers from engaging in these activities. it is somewhat concerning that negotiating one’s own needs within the workplace was practiced with such low frequency (m=1.92). while social workers are trained to advocate for their clients in practice, it does not appear that they are doing so for themselves in professional settings. of the five self-care domains explored in this study, three proved to be significant predictors of professional quality of life: professional, emotional, and spiritual. more professional, emotional, and spiritual self-care practice are predictive of less burnout. more professional and emotional self-care are predictive of greater compassion satisfaction. as discussed by nissly, barak, and levin (2005), burnout has been found to be predictive of turnover. findings from this study suggest that professional self-care, such as chatting with co-workers, setting limits with clients, and taking breaks throughout the work day, may buffer against burnout. this finding has implications for employers; endorsing and teaching professional self-care could support worker sustainability. with regard to professional social worker self-care, dombo and gray (2013) advocate a comprehensive model that incorporates interventions at the macro, mezzo, and micro-levels of an organization. content regarding professional self-care practice could also be built into social work education curricula, especially in the areas of practice skills and field, as a means to promote career longevity for new practitioners. newell and nelson-gardell (2014) strongly advocate for the incorporation of professional self-care into social work curricula and encourage the use of professional self-care techniques as a means for supporting a healthy workforce. van hook and rothenberg (2009) feel it is important top incorporate ways to identify work-related stress within the social work educational curriculum and also build supports into the organization context. emotional self-care activities can play a valuable role in professional quality of life. figley (2002) advocates the use of socially supportive relationships, a form of emotional self-care, as a way to manage or treat compassion-related stress that results from working with vulnerable and traumatized populations. killian (2008) found that clinicians cited spending time with friends and family as a self-care strategy and that social support was an important factor in predicting levels of burnout and compassion satisfaction. in the current study, emotional self-care proved to be significant in predicting less burnout and greater compassion satisfaction. these findings suggest that employers and educators may have the opportunity to support healthier, more satisfied social workers by attending to the advances in social work, fall 2015, 16(2) 304 emotional self-care needs of employees and students, including assessing and enhancing the social support networks of human service professionals (figley, 2002). although respondents reported engaging in spiritual self-care less frequently than the other domains, spiritual self-care was predictive of less burnout. hong (2012) found that workplace spirituality was associated with less intent to turnover among community mental health workers. collins (2005) also advocated the use of spiritual self-care practice as a means for social workers to address professional fatigue, over-commitment, and the trauma associated with human service work. dombo and gray (2013) assert that a model of selfcare that engages spiritual practices can prevent burnout, support social workers in developing adaptive coping strategies, and actually “offer the support needed to be present in clinical practice” (p. 94). in general, very little is known about the realm of spiritual selfcare among human service professionals, especially social workers. further exploration of this domain of self-care practice is needed. self-care perceptions and psychological self-care proved to be particularly interesting predictors of professional quality of life in this study. in existing literature, self-care perceptions have been found to be a predictor of improving quality of life (goncher et al., 2013) and reducing burnout among workers in a residential youth center (eastwood & ecklund, 2008). respondents in the current study largely agreed that they value self-care and believe it is effective in alleviating stress. however, overall findings suggest that social workers are not frequently practicing self-care. perhaps this is related to respondents’ perceptions of the ease of engagement in self-care practice or perceived barriers to selfcare practice. though respondents took a neutral position regarding ease of engaging in self-care, they largely disagreed that family, workload, community obligations, and social life prevented them from engaging in self-care practice. therefore, something else must be contributing to social workers’ lack of frequent engagement in self-care activities. in future research, it will be necessary to explore additional potential barriers to practicing self-care as well as other contextual and environmental factors that could affect the way social workers perceive self-care. the use of qualitative methods could be helpful in shedding light on these topics of interest. additionally, while respondents perceived their msw programs to value self-care, they were less likely to agree that their program effectively taught them how to engage in self-care practice. this finding demonstrates a potential gap between the value of self-care by msw programs and actual teaching of self-care practice to social work students. while there is no existing literature to directly address this gap, newell and nelson-gardell (2014) acknowledge that students routinely go into the field unaware of the potential for strain outcomes. newell and nelson-gardell highlight an ethical responsibility of social work educators to equip students with information and skills to acknowledge and address consequences of human service work. while responses to employers’ value of self-care were neutral, respondents disagreed that their employers effectively taught them how to engage in self-care practice. provided this study’s findings related to the role of professional self-care in predicting less burnout and greater compassion satisfaction, it appears employers have a real opportunity to address self-care in the workplace as a means to promote a healthier workforce. in an effort to learn more about how to best support social worker self-care, further investigation into bloomquist et al./self-care and professional quality 305 social work educational programs’ and employing agencies’ value and teaching of selfcare practice is needed. as noted, more psychological self-care was found to have a negative impact on professional quality of life, as indicated by higher levels of burnout and sts. the researchers theorized about possible explanations for these findings. commonly reported psychological self-care activities included taking time for reflection, journaling, saying “no” to extra activities, developing a plan for caring for yourself, and practicing being mindful (listening to your thoughts, belief, acknowledging your behaviors, suspending judgments, etc.). brown and ryan (2003) suggest that self-awareness is simply “knowledge about the self” (p. 823). psychological self-care techniques, such as participating in one’s own therapy, support the development of awareness of one’s boundaries and limitations (richards, campenni, & muse-burke, 2010). it is suspected that social workers who engage in these types of activities may be highly self-aware and particularly in-tune with negative indicators of professional quality of life—perhaps more so than those who do not practice psychological self-care or practice it limitedly. further research is needed to explore the relationships between psychological self-care practice and negative indicators of professional quality of life. additional interesting findings from this study include the role of post-msw experience in predicting indicators of professional quality of life. while some may have predicted that more years of practice experience would result in greater instances of negative indicators of professional quality of life, this was not the case in this study. years of post-msw experience actually seemed to buffer against negative indicators of professional quality of life. this finding may suggest that as practitioners gain more experience, they also learn how to cope with and/or address strain outcomes from their work. in their study of professional quality of life in child welfare workers (14% held an msw degree), van hook and rothenberg (2009) found younger workers (age 18-29 years) reported higher burnout scores than older workers (age 30 years and older). it is possible that these older workers also had more years of post-msw experience. alkema et al. (2008) found increased time of service to be connected to increased self-care: the longer hospice professionals worked, the more compassion satisfaction and self-care strategies they developed. these authors also found that chronological age was not a significant factor in self-care. additional research is needed to determine where and how experienced practitioners learn to address work-related stress and build capacity for compassion satisfaction. coupled with the findings from this study, research seems to indicate that experience, not biological age, is related to self-care practice and overall professional quality of life. this makes the emerging self-care practice of students, who are at an increased risk for burnout, even more critical to professional longevity (harr & moore, 2011). interestingly, direct service time with clients was not a significant predictor of any indicators of professional quality of life. this finding suggests that contextual factors outside of direct practice with clients, may influence practitioners’ experiences of strain outcomes. findings from this study suggest that overall, social workers are not frequently or routinely engaging in self-care practice. while the self-care perception measure used in this study included some items regarding potential barriers to practice, future research is advances in social work, fall 2015, 16(2) 306 needed to understand how and why social workers do not engage in self-care practice. conversely, further research is also needed to better understand how and why social workers do engage in some self-care activities, including those that may seem routine or easily accessible, such as chatting with co-workers and spending time with loved ones. in general, there exists a need for future research into social worker self-care practice and perceptions. this study focused on the direct impact of perception on professional quality of life. self-care perception is significantly correlated with multiple domains of self-care practice. future studies are necessary to shed light on how perception relates to practice, which in turn may affect professional quality of life. investigating the relationship between psychological self-care practice and negative indicators of professional quality of life may lead to new learning related to how best to support and maintain the social work workforce. limitations this study has notable limitations. respondents were from a self-selected sample of msw-level social workers in the united states. the sample of 786 msw social workers was not nationally representative; however, participants of this study came from 42 states and d. c., and their backgrounds mirrored previous random samples in terms of gender (nasw, 2003) and average annual income (u. s. bureau of labor statistics, 2013). respondents in this study had an average of approximately nine years of post-msw experience. in the nasw (2003) sample, respondents had, on average, 16 years of experience as a social worker. the use of alumni lists as a means of identifying study participants might have influenced the sample to include more recent graduates. in this study a vast majority of the participants (85%) was caucasian as compared to 58% of msw students in the cswe (2011) survey. overall, the sample is not representative of the general population of social work practitioners. thus, the results are not generalizable. an additional limitation relates to the use of a new survey instrument. although the internal consistency reliability for all subscales of professional quality of life measures were .90 or greater and the instrument has been used in numerous studies, some of the selfcare scales developed by the researchers for this study demonstrated only an acceptable degree of internal consistency reliability, which has implications for measurement. further testing of these scales in future studies as well as scale adaptations based upon new learning may improve the scales’ psychometric properties. the study was cross-sectional in nature. while a cross-sectional design allows for a snap-shot measure of the phenomena under study, this type of design is not able to capture participants’ changes in their perceptions and practice of self-care or professional quality of life over time (rubin & babbie, 2011). also, this study may not have accounted for the full scope of other variables that affect professional quality of life. stamm (2010) notes that professional quality of life is dynamic because it is associated with both environmental and personal characteristics. in future studies it will be valuable to explore additional contextual factors that may affect professional quality of life as well as self-care practice and perceptions. despite these limitations, this study does offer valuable insights regarding social worker self-care practice, perceptions, and indicators of professional quality of life. bloomquist et al./self-care and professional quality 307 conclusion professional quality of life is a complex concept that is comprised of both positive and negative experiences of human service work. study respondents valued self-care but engaged in self-care practice activities on a limited basis. this study explored the predictive ability of self-care practice domains, perceptions of self-care, and background characteristics on multiple indicators of professional quality of life and found that the perceptions practitioners have of self-care are significant in predicting levels of burnout, sts, and compassion satisfaction. also, domains of self-care practice contribute differently to indicators of professional quality of life. professional, emotional, and spiritual self-care predicted lower levels of burnout, and professional and emotional selfcare practices were both predictive of greater compassion satisfaction. findings from this study have important implications across levels of practice. social work practitioners, agencies, and educators should no longer just pay lip service to the value of self-care, but instead embrace self-care as a legitimate tool to support professional quality of life. references alkema, k., linton, j. m., & davies, r. 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(2009). quality of life and compassion satisfaction/fatigue and burnout in child welfare workers: a study of child welfare workers in community based care organizations in central florida. social work and christianity, 36(1), 36-54. author note address correspondence to: kori r. bloomquist, phd, winthrop university department of social work, bancroft hall 128, rock hill, sc 29733. email: bloomquistk@winthrop.edu http://dx.doi.org/10.17744/mehc.36.1.p61m73373m4617r3 http://dx.doi.org/10.1037/0735-7028.36.6.674 http://www.bls.gov/ooh/community-and-social-service/social-workers.htm http://www.bls.gov/ooh/community-and-social-service/social-workers.htm mailto:bloomquistk@winthrop.edu ______________ rebecca rouland polmanteer is a doctoral candidate, school of social work, university at buffalo, suny, buffalo, ny 14260; robert h. keefe is associate professor, school of social work, university at buffalo, suny, buffalo, ny 14260; and carol brownstein-evans is professor, department of social work, nazareth college, rochester, ny 14618. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 273-284, doi:10.18060/21008 social workers’ screening practices for postpartum depression rebecca rouland polmanteer robert h. keefe carol brownstein-evans abstract: the affordable care act specifies mothers living with postpartum depression (ppd) are a group in need of services. although mothers with ppd prefer to receive services from social workers than from professionals from other disciplines, limited research has addressed where social workers learn how to screen for ppd, the instruments they use, in what contexts they screen, and at what point during the perinatal period they screen mothers. the authors used an online survey to study a national sample of perinatal social workers (n=261) on their screening practices of mothers with ppd. more than half (n=149, 57.1%) of the respondents indicated they neither learned how to screen nor how to diagnose ppd during their undergraduate or graduate school education. despite the availability of easy-to-use ppd screening instruments, only 25% (n=66) of the respondents indicated they have used any screening instruments. of added concern is that many of the respondents indicated they do not consult the professional literature on ppd from social work and other disciplines to guide them in their practice. we recommend social workers integrate relevant findings from evidence-based research about ppd into their practice as appropriate, and that bsw and msw curricula incorporate relevant information on ppd into their programs. keywords: social work practice; postpartum depression; maternal and child health; assessment and evaluation postpartum depression (ppd) affects up to 25.0% of all new mothers (gaynes et al., 2005) and an even greater proportion of new mothers from racial and ethnic minority backgrounds (centers for disease control and prevention [cdc], 2008). because mothers living with ppd are more likely to seek services from social workers than from professionals from other disciplines (zittel-palamara, rockmaker, schwabel, weinstein, & thompson, 2008), social workers are in an excellent position to screen new mothers for ppd (abrams & curran, 2007). to date, however, there has been limited research that has investigated whether or not social workers screen new mothers at risk for ppd. despite the fact that social workers have a long-standing history of providing services to mothers and children, there has been little research published in social work journals to guide them in their work with mothers with ppd (keefe, brownstein-evans, lane, carter, & rouland polmanteer, 2015). although relevant to the population of mothers living with ppd, research from other professional fields such as nursing and psychiatry is more likely to address individual/biomedical factors such as hormonal fluctuations than to consider issues known to affect maternal and child well-being such as neighborhood safety and domestic violence (lane et al., 2008). the authors of this study conducted a nationwide polmanteer et al./social work screening practices 274 online survey to learn what screening instruments social workers use, in what contexts they screen, and at what point during the perinatal period they screen new mothers for ppd. literature review understanding postpartum depression (ppd) ppd has come into the public’s consciousness over the past 30 years, when highly publicized accounts of new mothers harming their newborn infants catalyzed legislators to begin addressing the problem (rhodes & segre, 2013). one result is section 2952 of the patient protection and affordable care act: support, education, and research for postpartum depression (2010), which mandates research on the course of ppd, consideration of the differences in treatment needs among mothers from various racial and ethnic groups, and the development of culturally competent, evidence-based treatment approaches (rhodes & segre, 2013). the american psychiatric association (apa, 2013) classifies ppd as a major depressive disorder. the primary symptoms include sadness, hopelessness, worthlessness, thoughts of self-harm or of harming the infant, and behavioral changes such as slowed body movements (apa, 2013). although other forms of major depression manifest within one month of the causative stressor, ppd often does not emerge until one year after childbirth (o’hara & mccabe, 2013; o’hara & wisner, 2014). ppd can be a debilitating disorder (apa, 2013) that has severe consequences for new mothers and their infants (letourneau et al., 2012). mothers with ppd report experiencing disrupted sleep (glavin, 2012; lucero, beckstrand, callister, & sanchez birkhead, 2012), poor concentration and appetite (glavin, 2012), decreased self-esteem, feelings of failure, (glavin, 2012), anxiety (glavin, 2012; lucero et al., 2012), social withdrawal, guilt (lucero et al., 2012), sexual dissatisfaction (morof, barrett, peacock, victor, & manyonda, 2003), obsessive thoughts (lucero et al., 2012), hopelessness (sealy, fraser, simpson, evans, & hartford, 2009), and ongoing fears of harming their baby (sealy et al., 2009) and of committing suicide (lucero et al., 2012). despite these negative feelings, an estimated 50% of mothers with ppd do not seek treatment (cdc, 2008) or do not consider their symptoms problematic (keefe & brownstein-evans, 2013). many other mothers who experience their symptoms as negative choose either to go without treatment (sampson, zayas, & seifert, 2012) or not to disclose their symptoms to service providers (lucero et al., 2012) whom they fear will judge them negatively or consider them unfit. relevance of ppd to social work among the mothers most at risk for ppd are mothers from racial and ethnic minority groups (liu & tronick, 2013), lower socioeconomic status (liu & tronick, 2013; o’hara & mccabe, 2013), and rural communities (villegas, mckay, dennis, & ross, 2011). these same mothers are often less able to afford ongoing health care, and therefore are often forced to access lower-cost or non-fee-for-service agencies, which often bring them to the advances in social work, fall 2016, 17(2) 275 attention of a practicing social worker. social workers working in maternal and child health settings are thus well placed to address this problem. screening new mothers for ppd the american college of obstetricians and gynecologists (acog) and the u.s. preventive services task force (uspstf) strongly encourage prenatal screening for depression in pregnant women (acog, 2015; uspstf, 2016). although various easy-touse screening instruments normed on mothers from differing backgrounds exist, social workers who are qualified to administer the instruments, have been reluctant to regularly screen mothers for ppd (gaynes et al., 2005; keefe, brownstein-evans, & rouland polmanteer, 2016). interestingly, the majority of mothers in one study indicated they were willing to be screened (gemmill, leigh, ericksen, & milgrom, 2006). of the healthcare providers who screen, many do not use the results to advise mothers on providing followup care (gjerdingen & yawn, 2007). consequently, the majority of mothers with ppd do not receive adequate screening, depression diagnoses, or appropriate follow-up care (uspstf, 2016). given the mandates from section 2952 of the aca, social workers working with new mothers must become competent in screening for ppd and providing evidence-based services. to learn about current screening practices, the authors surveyed perinatal social workers nationwide with the goal of being able to offer guidance to social workers working with new mothers. methods the purpose of this study was to learn more about how social workers working with new mothers and young children screen new mothers for ppd, where they learned how to screen new mothers, when they screen, and what screening instruments they use. methodology and measurement the authors obtained institutional review board approval to conduct a survey of perinatal social workers nationwide. the authors then obtained approval to adapt the scale developed by seehusen, baldwin, runkle, and clark (2005) on family practitioners’ screening behaviors for ppd. the seehusen et al. scale consists of 24 close-ended questions and one open-ended question: five questions on the frequency that family practitioners screen mothers for ppd, the scales they use, and the contexts in which the practitioners screen; 12 questions on the practitioners’ ideas about the importance of screening and the impact of screening on various family members; one question on where the practitioner learned to screen for ppd; five questions on practitioner demographics; and one openended question for the respondent to add additional information. the survey was adapted by adding seven questions specific to social work practice, including one question on where practitioners refer new mothers with ppd, four questions on the respondent’s practice setting, and two additional demographic questions (race and year of birth). the 32-item instrument was then pilot-tested with five social workers from the national association of perinatal social workers at their annual meeting in baltimore polmanteer et al./social work screening practices 276 and on 10 social workers from perinatal networks around new york state whose feedback was incorporated into the survey. the adapted survey was administered in the winter of 2014 using surveymonkey (2013). sampling frame study criteria included being age 18 or older and currently working with new mothers. an e-mail describing the purpose of the survey, the informed consent form, and the link to the survey was sent to contact persons at the national association of perinatal social workers and state perinatal associations who were asked to submit the email with the accompanying documentation and survey link to their listserv members. additionally, the program directors of all bachelors (bsw) and masters of social work (msw) programs accredited by the council on social work education were asked to submit the email with the accompanying documentation and survey link to their alumni listserv members. results respondent characteristics the final sample resulted in 261 respondents. because we do not know the total population of social workers practicing in maternal and child health settings or which contact people at the perinatal organizations and bsw and msw programs sent the email with accompanying survey to their listserv members, we are unable to assess if our respondents are representative of the total population of maternal and child health social workers nationwide. of the 261 respondents, 158 (60.5%) provided complete demographic information (see table 1). most of the respondents identified their role as a social work practitioner (n = 120, 76.0%) working full-time (n = 123, 77.9%) and having a master’s degree in social work (n = 130, 82.3%). the respondents are employed in a variety of settings including hospitals (n = 95, 60.1%), health centers (n = 32, 20.3%), child and family programs (n = 16, 10.1%), and private practice (n = 9, 5.7%). the responding social workers were overwhelmingly female (n = 153, 96.8%), and worked in urban areas (n = 102, 64.6%), were between 20 to 70 years of age (�̅� = 44.100, 𝜎 = 11.874) and self-identified predominantly as white, non-hispanic/caucasian (n = 125, 79.1%). source of learning about ppd of the 261 respondents, 112 (43%) reported learning about ppd while enrolled as undergraduate or graduate students (see table 2). while eight (3.1%) respondents reported having learned about ppd in their ba or bs programs, 27 (10.3%) reported learning about ppd in their bsw programs, and 77 (29.5%) reported having learned about ppd in their msw programs. advances in social work, fall 2016, 17(2) 277 table 1. characteristics of the respondents who screen new mothers for ppd variable n (%) social work role practitioner 120 (76%) supervisor 18 (11.4%) degree master’s degree in social work 130 (82.3%) bachelor’s degree 21 (13.3%) doctoral degree 7 (4.4%) employment status full-time 123 (77.9%) part-time 35 (22.2%) geographic location urban 102 (64.6%) suburban 43 (27.2%) rural 10 (6.3%) employment setting hospital 95 (60.1%) health center 32 (20.3%) child or family program 16 (10.1%) private practice 9 (5.7%) gender female 153 (96.8%) male 4 (2.5%) prefer not to disclose 1 (0.6%) race/ethnicity white, non-hispanic/caucasian 125 (79.1%) black/african american 14 (8.7%) hispanic 10 (6.3%) multiracial 3 (1.9%) asian 2 (1.3%) american indian 2 (1.3%) white, hispanic 2 (1.3%) note. percentage totals for each variable may not add to 100% due to missing data or rounding error. learning how to screen new mothers for ppd the respondents reported receiving information about ppd screening (see table 2) through on-the-job training (n = 119, 45.6%) followed by continuing education programs (n = 96, 36.8%), professional conferences (n = 69, 26.4%), and field/internship experiences (n = 53, 20.3%). the respondents also reported obtaining information from medical (n = 82, 31.4%) and social work journals (n = 98, 37.5%). polmanteer et al./social work screening practices 278 table 2. characteristics of screening practices variable n (%) where do social workers learn about ppd? master of social work 77 (29.5%) bachelor of social work 27 (10.3%) bachelor of science/arts 8 (3.1%) where do social workers learn about screening for ppd? on the job education 119 (45.6%) social work literature 98 (37.5%) continuing education credits 96 (36.8%) medical literature 82 (31.4%) conferences 69 (26.4%) field education 53 (20.3%) when do social workers screen for ppd? delivery to one year postpartum 92 (35.2%) when symptoms are present 72 (27.6%) prenatally 46 (17.6%) at well child visits 15 (5.7%) delivery to two years postpartum 7 (2.7%) what screening instruments do social workers use? edinburgh postnatal depression scale (epds) 66 (25.3%) patient health questionnaire (phq-9) 17 (6.5%) postpartum depression checklist (pdc) 10 (3.8%) postpartum depression screening scale (pdss) 9 (3.4%) beck depression inventory (bdi) 9 (3.4%) general health questionnaire (ghq) 7 (2.7%) structured clinical interview for the dsm (scid) 5 (1.9%) centers for epidemiologic studies depression scale (ces-d) 3 (1.1%) note. due to the potential for multiple responses to the corresponding survey item, percentages provided in parentheses are calculated using the total sample size (n=261). timing of ppd screening the respondents identified screening for ppd most frequently between delivery and one year postpartum (see table 2). of the 261 participants, 46 screened prenatally (17.6%), 92 screened from delivery to one year postpartum (35.2%), seven screened from delivery to two years postpartum (2.7%), and 15 screened during well-child visits (5.7%). additionally, 72 social workers (27.6%) reported screening only when symptoms were present. screening instruments used of the respondents who reported screening for ppd (see table 2; n = 135), 83 (61.5%) indicated they used a validated tool with the most common being the edinburgh postnatal depression scale (cox, holden, & sagovsky, 1987) (epds; n = 66, 48.8%). additional instruments included the patient health questionnaire (spitzer, kroenke, williams et al., 1999) (phq-9; n = 17, 12.6%), postpartum depression checklist (beck, 1998) (pdc; n = 10, 7.4%), postpartum depression screening scale (beck & gable, 2002) (pdss; n = 9, 6.6%), the beck depression inventory (beck, steer, & garbin, 1988) (bdi; n = 9, 6.6%), advances in social work, fall 2016, 17(2) 279 the general health questionnaire (goldberg & williams, 1988) (ghq; n = 7, 5.2%), the structured clinical interview for the dsm (gormanet al., 2004) (scid; n = 5, 3.7%), and the centers for epidemiologic studies depression scale (radloff, 1991) (ces-d; n = 3, 2.2%). implications and discussion the results from this study highlight that 43% of the responding social workers learned about ppd and how to screen for it during their educational training. this finding is similar to the findings from gaynes et al. (2005) who found more than half of practitioners did not learn about ppd while in their professional training. most of the respondents in this study learned how to screen for ppd while on the job, through continuing education programs, or at professional conferences. some of the respondents also reported learning about ppd through empirical literature, including social work journals. we were somewhat stymied by this outcome given the dearth of research reported in social work journals on ppd (keefe et al., 2015). although we were pleased to find that some of the responding social workers screen mothers from birth to one year, results from other studies conclude that ppd may not manifest until after one-year post-childbirth (o’hara & mccabe, 2013; o’hara & wisner, 2014). likewise, the recommendations set forth by acog (2015) and uspstf (2016) encourage maternal health service providers to screen all pregnant women and new mothers for ppd throughout pregnancy and the first postpartum year. as in the gaynes et al. (2005) report, many of our respondents reported learning about ppd while employed and not while enrolled in their academic programs. this finding is particularly troublesome given the sample in this study was comprised only of social workers working with pregnant and new mothers and children. research has begun to address the problem of too few knowledgeable social workers screening new mothers for ppd. for example, recently published research concludes that bsw and msw programs can incorporate content on ppd seamlessly into their curricula (keefe, et al., 2015), and specific recommendations have been made for developing social work continuing education workshops to train social workers on how to work with mothers who have ppd (keefe, rouland polmanteer, & brownstein-evans, in press). social work education instructors of social work research courses can help students develop and test interventions with individuals, families, groups, and communities at various service sites used by postpartum mothers. in human behavior and the social environment courses, instructors can include course content on ppd risk and protective factors. social work practice courses can include various case scenarios that emphasize engagement, contracting for services, and intervention practices, as well as forming coalitions with service providers working with new mothers. in social policy courses, instructors can require students to trace the development of the aca while also considering other landmark maternal and child health legislation including the sheppard-towner (moehling, & thomasson, 2012) and melanie blocker-stokes acts (rhodes & segre, 2013). finally, field educators can assign students in maternal and child health placements to work with new mothers at risk for ppd and the mothers’ families. students should be instructed on polmanteer et al./social work screening practices 280 the use of standardized screening instruments, which would help prepare them to work with new mothers who may develop ppd after childbirth (o’hara & mccabe, 2013; o’hara & wisner, 2014). social work practice only about one-third of the responding practitioners reported consulting evidencebased practice literature, including the social work (37.5%) and medical literature (31.4%). using existing evidence-based practices is crucial to effective social work practice (nasw, 2008). however, given the limited best practices research on ppd published in social work journals, we were not surprised by this finding. we recommend that social workers integrate relevant findings from evidence-based practice research about ppd into their own practice as appropriate. social work research in accordance with the aca, it is recommended that social work researchers systematically investigate the risk factors, screening and assessment approaches, and interventions for all new mothers with a particular focus on mothers from diverse or vulnerable groups. finally, researchers should publish their findings in social work journals not only as a way to reach other social work professionals but also to ensure that a social work perspective is infused in the developing research. summary and conclusion the interpretation of these findings should be made in light of the study’s limitations. to begin, data were collected electronically. although electronic data collection provided the opportunity to reach social workers nationwide, social workers who are uncomfortable with technology or who are without access to the internet were likely excluded. additionally, the data collection was limited by missing data. although there were 261 respondents, only 158 provided full demographic information. in addition, the sample was not randomly selected, so the results cannot be considered generalizable. despite these limitations, this study is the first to examine how social workers screen mothers for ppd, which thus adds to the very limited body of knowledge on ppd in social work journals. most of the responding social workers did not learn about ppd during their formal education or field placements. these findings, along with federal mandates put forward through the aca, should encourage maternal and child health social workers to focus more thoroughly on the needs of new mothers at risk for and who may have ppd. references abrams, l. s., & curran, l. 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(2011). postpartum depression among rural women from developed and developing countries: a systematic review. the journal of rural health, 27(3), 278-288. doi:https://doi. org/10. 1111/j. 1748-0361. 2010. 00339. x zittel-palamara, k., rockmaker, j. r., schwabel, k. m., weinstein, w. l., & thompson, s. j. (2008). desired assistance versus care received for postpartum depression: access to care differences by race. archives of women’s mental health, 11, 81-92. doi:https://doi. org/10. 1007/s00737-008-0001-1 author note: address correspondence to: robert h. keefe, school of social work, university at buffalo, suny buffalo, ny 14260, 716-645-1230, rhkeefe@buffalo.edu https://doi.org/10.1111/j.1748-0361.2010.00339.x https://doi.org/10.1111/j.1748-0361.2010.00339.x https://doi.org/10.1007/s00737-008-0001-1 mailto:rhkeefe@buffalo.edu microsoft word 00 goldkind_and_mcnutt_editorial.docx _________________ lauri a. goldkind, phd, lmsw, associate professor graduate school of social service at fordham university. new york, ny . email: goldkind@fordham.edu website: www.laurigoldkind.net john g. mcnutt, phd, msw, professor, university of delaware school of public policy & administration. email: mcnuttjg@udel.edu web site: http://www.policymagic.org copyright © 2015 advances in social work vol. 16 no.1 (spring 2015), i-iii editorial the future is always beginning now. mark strand (19342014) lauri goldkind and john mcnutt welcome to the special issue on technology and social work practice. this issue represents a broad array of thinking and scholarship on information and communication technologies (ict) for social work education and practice. this thematic issue of advances in social work examines how social work and social work education is meeting the challenges of the digital revolution. our contributors represent an international array of thinkers and scholars on a broad range of issues critical to social work education and practice. the authors we highlight here have focused on areas of traditional interest to social work practitioners including ethics and social justice as well as areas that may be new to social workers and social work educators such as geographic information systems (mapping) and gaming for service delivery. it is undeniable that technology is changing the ways in which we function at all levels of society both professionally and personally. similarly, it is undeniable that social work has been slower to infuse technology in practice than might be given our sensitivity to environmental forces and contextualized changes. our initial concerns regarding the possible lack of adequate material to complete an entire special issue on technology and social work practice proved to be unfounded. in total we received over 35 high quality studies, concept papers, and research notes covering topics ranging from massive open online courses for social work education to a comprehensive model of ict paradigms for integration into social work practice. one problem editors wish for are too many submissions to choose from. here we present a range of work that echoes the diversity of social work practice itself. beginning broadly with the larger themes of technology integration in practice, we move to ethical issues in using social media with vulnerable populations and in classroom settings. we survey some of the evolving technology-enhanced practices in the field being used with familiar populations such as juvenile delinquents and adolescent fathers and move on to papers focusing on the macro and administrative dimensions of social work practice. we close with a look at massive open online courses and whether they are a direction that social work should pursue. the first articles in the issue focus on the broad issues in play around technology in social work practice – we start with bullock and colvin’s article “communication technology integration into social work practice.” they explore the infusion of ict from the technology acceptance model, a theoretical framework commonly used to explore questions of innovation diffusion. next follows fitch’s article “a conceptual framework for information technology in social work practice.” he argues that information systems research in the human services can be facilitated with a conceptual framework that addresses the fundamental and interlocking roles of data, information, and knowledge to understanding organizational information systems. finally, a complementary article, goldkind/mcnutt/editorial ii “electronic information systems and social work: principles of participatory design for social workers,” by gillingham reflects on how to support front line social workers to be active participants in the robust design of information management systems at the agency level and how the well-designed data management systems can be key to the efficacy of front line social work. another broad thematic dimension attendant to ict implementation is ethical implications. brady, mcleod, and young use two theoretical approaches, social constructivist theory and the competing values framework, to guide the development of an ethical decision-making framework for social work educators to use in order to create dynamic classroom policies related to social media technology. while brady, mcleod, and young focus inward on our work with students, dolinksy and helbig urge us to consider applying ethical standards to the use of social media with vulnerable populations. the next five papers in our issue look at internet-based and mobile applications (apps), which are used to support and enhance traditional social work practices with a range of populations. mackrill, ebsen, and antczak document the development of a youth support mobile app from the client and worker perspective. anderson and cook describe the implementation of a web-based intervention for traumatized young people. evans-chase uses a mixed methods approach to investigate the effectiveness of mindfulness training for delinquent youth delivered via the internet. lee and walsh present early findings from a smartphone app developed to augment existing social work practices by providing a fatherfriendly tool to help new fathers learn about and engage with their infants and toddlers. lastly, sorbring, bolin, and ryding describe a game-based intervention to prevent adolescent dating violence. these are the traditional populations and interventions focused on by social workers, yet here technology is being used to enhance traditional practices and possibly create more accessible practices for a greater number of clients and community members than ever before. the third section of this issue focuses on macro and administrative social work practice. felke’s case study on the use of geographic information systems (gis) to assess community needs is an overview of both the tools of gis and the process for using this innovation for a traditional social work practice. saxton, niyirora, guo, and waters explore the use of hashtags for policy advocacy and remind us of this important community organizing tool. bosco-ruggiero, kollar, strand, and leake focus on technology for training and staff development in the child welfare setting. we close this issue with a look by gates and walters at the future of social work education, the efficacy of massive open online courses (moocs) for social work, and the opportunities and challenges such courses might present. we hope you find this collection of scholarship as compelling as we do and extend you good wishes for a great and productive summer. we would also like to take this opportunity to thank the new editor margaret adamek for her incredible patience and support in the assistance and production of this issue. she inherited our idea and production schedule and has served as a graceful leader on the project. valerie decker, the tremendous copy editor and behind-the-scenes glue of advances in social work, has also been a great supporter of this enterprise along with advances in social work, spring 2015, 16(1) iii assistance from christina schneider. however, a mountain of gratitude must be extended to william barton, the editor emeritus of advances in social work. in the winter of 2013, dr. barton approved the spring issue, but how little we understood the herculean role of editor. since that time we have come to appreciate his and dr. adamek’s work and input on shaping an issue of advances in social work. we will not soon forget the editorial impression left by dr. barton. microsoft word 08_coe_regan_21091_innovators_and_early_adopters   _________________ jo ann r. coe regan, phd, msw is vice president of education, council on social work education (cswe), alexandria, va 22314. copyright © 2016 advances in social work vol. 17 no. 1 (spring 2016), 113-115, doi: 10.18060/21091  invited innovators and early adopters of distance education in social work jo ann r. coe regan, vice president of education council on social work education (cswe) abstract: this article highlights the innovators and early adopters of distance education in social work. the past, present and future is discussed as it relates to the evolution of technology innovation in social work education. keywords: social work education; technology and social work; early adopters; technology innovation in 1998, a small group of social work educators gathered in charleston, south carolina to participate in the first distance education conference for social work educators. this conference was sponsored by the university of south carolina (usc) college of social work under the leadership of dean frank b. raymond. in 1980, usc became one of the first schools of social work in the nation to offer a graduate degree using distance education. dean raymond’s vision was to bring together the innovators and early adopters who were using technology to share best practices and support one another in this new way to deliver social work education. the theory of diffusion of innovations, developed by everett rogers in 1962, explains how, over time, an idea or product gains momentum and diffuses to the point that people adopt a new idea, behavior, or product (2003). rogers' theory found that people who adopt an innovation early have different characteristics than people who adopt an innovation later. he described innovators as people who want to be the first to try the innovation. they are venturesome and interested in new ideas. innovators are very willing to take risks and are often the first to develop new ideas. early adopters are those people who represent opinion leaders. they enjoy leadership roles and embrace change opportunities. they are already aware of the need to change and so are very comfortable adopting new ideas (rogers, 2003). these characteristics certainly described this early group of social work educators that converged that year and subsequent years at the social work technology conference. this group and the technology conference grew as social work programs began to develop more distance education models. the original group of innovators and early adopters represent many of the leaders in distance education today. i was privileged to collaborate with this group as the conference sponsor and chair. as with any academic passion or pursuit, one is always excited to find colleagues with similar interests in teaching and research. as a newly minted phd who focused her dissertation work on distance education, i was excited to discover rogers’ theory and real-life colleagues who embodied the characteristics described in his theory. i was especially grateful for the opportunity to be hired and mentored by dean frank raymond at usc. dean raymond always embraced change opportunities with enthusiasm, support, and commitment. he did this both from a macro and micro practice framework by providing administrative and financial support as well as coe regan/innovators and early adopters 114     empowering me and many others to design, deliver, and evaluate social work distance education courses. dean raymond supported quality education, teaching, and research interests in the area of distance education by creating opportunities to network with other social work educators who participated in the technology conference. this network of social work educators still remains today and continues to impact new ways of thinking about the delivery of social work education due to the leadership of dean raymond in promoting this conference. many of us, including myself, benefitted from his vision to support us as innovators and early adopters using technology in social work education. as the use of technology in social work education grew and became more mainstream, there seemed less of a need for a technology conference, so the conference was discontinued in the early 2000s. however, in 2015, the indiana university school of social work, under the leadership of dean michael patchner and dr. bob vernon, along with the council on social work education (cswe), decided to revive the technology conference. despite distance education having majority adopters, those that adopt new ideas just before the average member of a social system, in 2015 a large group of people maintained interest in meeting together to discuss teaching, learning, program development, administration, field, and practice in distance education. the use of technology, particularly the internet, continues to impact social work education as faculty struggle to meet the demands of their institutions to develop online courses, distance education programs, and distributed learning environments. the 2015 conference brought together over 400 social work educators to share models and best practices in web-based education. many of the same quality issues discussed about distance education 25 years ago are still being discussed regarding online education. as the conference proceedings indicate, schools of social work need continued leadership development to transform models of curriculum delivery with research findings on best practices and develop protocols and criteria for excellence in webbased education for social work (indiana university, 2015). as the conference proceedings indicate, schools of social work need continued leadership development to transform models of curriculum delivery with research findings on best practices and develop protocols and criteria for excellence in web-based education for social work (indiana university, 2015). future trends in teaching with technology still indicate tremendous possibilities, challenges, and changes for social work education. social work programs in the us are now delivering their entire social work program and field experiences in a web-based environment. new program delivery options and formats will likely change the landscape of social work education programs just as they did 25 years ago when distance education programs were starting to evolve. for example, as new technologies evolve, what future trends can we expect in areas such as pedagogy and course formats? will collaborative models of community learning as represented in moocs and focused on competencybased education models further enhance the development of web-based education? will these programs be more university-centric or provided by other outside groups? the continuum of delivery systems for social work education will continue to grow. improved pedagogical strategies will be informed by research and likely focused on learning outcomes (competencies) and skills performance. creating effective online teaching and advances in social work, spring 2016, 17(1) 115     learning strategies will require new partnerships, collaborations, and ideas to meet 21st century workforce needs. there is no doubt that new developments in technology will make social work education more effective and widespread. social work educators should be on the forefront of taking advantage of these technological developments to discover new and better ways of providing education to social work students. we should acknowledge the work of all those that have led us to this point and particularly those innovators and early adopters in social work education like dean frank raymond and the many others who gathered together each year to foster the diffusion of innovation in social work education. technology conferences and special issues to support the next generation of innovators and early adopters will ensure that these developments continue and enhance the quality of social work education. references indiana university school of social work. (2015). social work distance education conference [online]. accessed march 16, 2016, at http://swde.iu.edu/index.php rogers, e. m. (2003). diffusion of innovations (5th ed.). ny: free press. author note: author note: address correspondence to: jo ann r. coe regan, phd, msw, cswe, 1701 duke street, suite 200, alexandria, va, 22314 phone: (703) 519-2048/email: jregan@cswe.org microsoft word 1268-belliveau_manuscript_final _________________ michele belliveau, ph.d., is an assistant professor of social work at west chester university. the author would like to acknowledge the contributions of dr. andrea varricchio, professor of languages, to the development of the crossdisciplinary collaboration. in addition, the contributions of the social worker for the middle school, the students, the families, and the wcu office of service-learning were vital to the success of the project. copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), 79-93 interdisciplinary service-learning: building student competencies through the cross-cultural parent groups project michele belliveau abstract: changing demographics and an emphasis on competency-based social work education call for innovative approaches to the delivery of curricular content. in an effort to introduce bsw students to the socio-political issues facing the local latino immigrant community, a service-learning project was developed in collaboration with the spanish language department and a local middle school. an analysis of outcomes from social work student evaluations showed that students engaged with the community and issues in new and unexpected ways. through their engagement in a cross-cultural group project, students developed greater cultural sensitivity, honed their group practice skills in an unfamiliar context, provided a needed service to the community, and raised their awareness about the working conditions of new immigrants as part of a developing framework for social action. details and implications of the project as a means to build student competencies are described. keywords: cross-cultural, interdisciplinary, service-learning, core competencies introduction demographic shifts: implications for social work education given recent shifts in macroeconomic and social processes that have feminized migration flows and drawn immigrants to non-traditional receiving states, communities that were once homogeneous find themselves more linguistically, ethnically, racially, and culturally diverse than ever before (greenlees & saenz, 1999; massey, durand, & malone, 2002; singer 2002, 2004). as a result of growth in immigration from latin america, the latino population has become the largest ethnic and racial minority in the u.s. (u.s. bureau of the census 2003). in 2008, the largest percentage of immigrants in the u.s was from latin america; 49.9% of all immigrants were female; and the children of immigrants accounted for 29.9% of all children in low-income families (migration policy institute, 2008). with these trends, graduates of social work programs will most likely work with latino families, prompting programs to review whether their curriculum is keeping pace with shifting demographics and contexts of need. the region where the author’s social work program sits is comprised of multiple latino communities. the latino demographics of the region reflect its geographic diversity, with a well-established puerto rican, urban community; a longstanding, rural migrant farmworker community; and a newcomer undocumented mexican and central american community that works in both the rural farming and urban and suburban service sectors. according to population estimates, the county where the university sits experienced substantial growth in its latino population between 1990 and 2009. between belliveau/interdisciplinary service-learning 80 1990 and 2000, the latino population increased from 2.3% to 3.7% (chester county planning commission, 2001) and to an average of 5% between 2005 and 2009 (u.s. bureau of the census, 2010). given that these are official estimates and may not account for the presence of undocumented immigrants (bean, corona, tuiran, woodrow-lafield, & van hook, 2001), it is likely the population growth is even more significant. as a result, community-based social service and health care providers have struggled to serve monolingual spanish-speaking newcomers with their largely monolingual englishspeaking staff. as one response to this changing context and in an effort to increase student awareness of the social, economic, political, and psychological issues facing the local latino community, a service-learning project that matched social work students with spanish language students was conceived; together students facilitated groups on the topic of adolescent depression for the parents of latino middle schoolers in the community, a need identified by the community itself. completed in the spring of 2009, the project crossed disciplines, cultures, fields of practice (university and local school district) and the roles of expert-recipient. such crossings were consistent with the building of student competencies specified in the 2008 council on social work education (cswe) educational policy and accreditation standards and described below. pedagogical shifts: competency-based education at the same time that u.s. communities are diversifying, the council on social work education has issued new, competency-based standards for social work education that allow programs to respond to such diversity with greater agility. the 2008 educational policy and accreditation standards (epas), in specifying ten core student competencies, encourage the infusion of content across the curriculum (council on social work education, 2008). this is different from the 2001 epas that used the lexicon of “sequences,” tacitly underwriting, for example, the marginalization of policy within practice or cultural competency within social work competency. under the new epas, course content is conceptualized as building the core competencies that are demonstrated through a program’s practice behaviors and assessed through multiple measures. in addition, programs must specify how their mission and goals not only connect with core competencies but reflect the context of the program (for example, the geographic region in which the university resides). this standard fosters greater flexibility and creativity in the development of a curriculum that responds to the changing and diverse context of a social work program. in addition to the epas, the mission of the social work program in which the servicelearning project to be described took place reflects that of the broader university, which as a public institution is to serve the residents of the region and state. therefore, a service-learning project that could fulfill the mission of the university and social work program, while simultaneously meeting the unmet needs of the community, was wellsuited to the mandates of the 2008 epas. advances in social work, spring 2011, 12(1) 81 theoretical framework service-learning as a pedagogical tool service-learning in higher education has proven effective in helping students to develop their skills of civic engagement, critical thinking, and creative problem-solving (lemieux & allen, 2007). university students that have engaged in service-learning credit their experience with better success in the job market and believe it should be practiced in more courses at their colleges (prentice & robinson, 2010). in professional programs like social work that include a field practicum, service-learning has been found to complement the practicum by providing students with a field experience where the primary focus is on service and not professional development (eby, 2001). moreover, by engaging in a project that meets a need identified by the community and its providers, the service-learning project becomes an authentic service activity (eby) and socializes students to both the ethic of service and the practice of viewing clients as experts in their own experience, the latter of which is consonant with the epas standard for cultural competency. given this seemingly good fit between service-learning and social work education, educators have integrated service-learning into their courses, though literature on the subject remains limited (bye, 2005; lemieux & allen, 2007). given the 2008 epas emphasis on field as the signature pedagogy, service-learning projects offer opportunities to connect classroom and field learning either concurrent with or earlier than the third and fourth year when the undergraduate practicum typically occurs, and to infuse the pedagogy of field throughout the curriculum. however, what distinguishes servicelearning from the field practicum may ultimately be found in the role of the student as learner. service-learning provides a field learning experience unmitigated by the traditional structure of the professional social work internship. whereas in the field practicum students are socialized to take guidance from field instructors and other professionals, in service-learning students may have greater opportunities to learn directly from community members and stakeholders. cross-cultural service-learning has proven effective in facilitating social work students’ cultural and racial understanding, preparing students for cross-cultural practice, and helping them to recognize racism and inequality (sanders, mcfarland, & bartolli, 2003). importantly, cross-cultural service-learning has helped students make the connection between cultural competency educational goals stated in the curriculum and the real world (sanders, mcfarland, & bartolli), and moved them to social action. of equal importance in the context of competency-based education for work with client systems of all sizes, service-learning has been effective in the teaching of group practice skills to social work students (bye, 2005). given that field placements do not always afford students the opportunity for groupwork, a service-learning project completed as a group and within a group can potentially bridge theory and practice outside of the traditional realm of the field practicum. belliveau/interdisciplinary service-learning 82 building a framework for social action given that the cross-cultural service-learning project was designed for the second of two generalist practice courses (in this case, practice with groups, organizations, and communities), students came with the foundation of social work practice with individuals and families. larger systems were difficult to comprehend and intimidating, particularly when viewed as potential realms of social work practice. while students often take a social policy course prior to the second practice course, their framework for social change is based in a client-centered mode of practice. using pearlmutter’s (2002) conceptualization of helping social workers (and in this case, social work students) progress towards social change, the project was designed to introduce students to the meaning and impact of oppressions so that they could eventually achieve the integration of individual client work and social change agent, an integration spelled out in the 2008 epas core competencies. according to pearlmutter (2002), movement from clientcenteredness to radical practice occurs along a continuum and is fostered through personal growth and skill-building. the service-learning project, in meeting a need that would highlight the marginality faced by latino immigrant families in the region, was designed to move students along this continuum. critical to the learning process was the building of an affective connection between students and the latino parents in the community. pitner and sakamoto (2005) argued that the building of critical consciousness in multicultural practice must be both cognitive and affective; if it is one to the exclusion of the other, practitioners risk engaging in oppressive practices. in order for students to become aware of the potential oppressive structure of the helping profession, they must understand on both a cognitive (thinking) and affective (feeling) level how clients construct their own realities. one method for doing this is for students to take the role of “ethnographer” instead of “expert” (pitner & sakamoto). the cross-cultural parent groups project facilitated this method in that social work students were placed simultaneously and purposefully in the dual role of learner and educator. this enabled students to recognize and value not only the challenges facing latino parents in the community, but also their strengths. the service-learning project: interdisciplinary, crosscultural parent groups the impetus for the project came from a bilingual, bicultural social worker in one of the local middle schools that serves the children of latino farmworkers. the social worker served as a field instructor for the social work program and, on several occasions, had expressed her concern that she and her staff were not able to meet the growing needs of the latino community. to illustrate, she described a meeting that drew approximately 70 latino parents frustrated by the quality and level of their communication with their children. among other things, families struggled with differential levels of acculturation between parents and children, as well as parenting in a foreign context. of primary concern to the social work staff were the symptoms of depression, suicidal ideation, and other mental health issues that were at times dismissed or misunderstood by wellintentioned parents. the social worker wanted to hold informational and discussion advances in social work, spring 2011, 12(1) 83 groups for parents at the middle school but had one problem: a shortage of bilingual social workers to facilitate groups. at the same time these conversations occurred with the school social worker, the author discussed the possibility of collaborating with a colleague in the spanish department who had a record of engaging her students in community service-learning projects in order to improve their fluency and fulfill a need. therefore, a meeting was held at the local middle school between the author, spanish professor, and social worker, and the project outline emerged. small groups of students in the social work class would be paired with an advanced spanish student who would serve as their language “consultant.” the designation of consultant was made in order to fulfill the expectations of the spanish course which was billed as “spanish for business.” spanish consultants would serve as translators in order to help prepare and facilitate parent groups. project design, preparation, and goals design. coordination of the project presented several logistical challenges, not the least of which was the matching of student schedules in order to facilitate their collaboration. this is a challenge of both group projects and service-learning within the context of one classroom; in the context of matching across disciplines, it became more daunting. it was decided that the author would create a timeline for the project based on the social work students’ schedules, which took into consideration the meeting time of the advanced spanish course. this would allow for some meetings to occur during class time, while others would have to occur outside of class time. spanish language students would be recruited for the project by the social work professor in order to maximize the duration of student interest needed in order for the project to be successful. once the semester began, nine spanish students were assigned to nine groups of approximately 3-4 social work students. social work students were charged with creating a 5-minute role play and discussion questions in english; role-plays and questions were translated into spanish by the spanish student “consultants” and presented to small groups of latino parents around the issue of youth depression and suicidal behavior during one night in april. students planned and prepared for a group that could last up to one hour, including the time spent acting out the scenario in english and translating it into spanish. role plays were chosen as a medium to convey critical information based on the school social worker’s sense that they would put parents at ease and engage them in a discussion of the issues. table 1 provides the assignment description as it appeared in the course syllabus, as well as the timeline created for students to collaborate with their spanish language consultants. in addition to the schedule of assignments, both professors agreed to request funds through the university’s office of service-learning and volunteer programs that had small stipends to support service-learning initiatives. funds from the office covered the chartering of a school bus to transport college students to the middle school on the night of the cross-cultural parent groups. belliveau/interdisciplinary service-learning 84 table 1. project description and timeline from course syllabus cross-cultural parent group project (20% of grade) this group project presents a unique opportunity to (1) work in a group (2) plan for a group (3) work with a translator/consultant and (4) facilitate a group with a diverse population. this project has three partners: you the students, advanced spanish-language students, and the middle school. for this project students will be assigned to small groups and asked to design a single-session group for spanish-speaking parents of middle-schoolers. students will be assigned one spanish language consultant in order to create a 5-minute role play and questions in english and spanish for the parent groups, around the issue of youth depression and suicidal behavior. student groups, with the help of their consultant, will facilitate their one-session parent group on the night of thursday, april 2nd at the middle school. the following will help to prepare students for this project: an immersion trip to [rural areas of the county]; a visit from the social services liaison at the middle school to discuss the issue of mental health and the latino community; in-class time devoted to group meetings and preparation; out-of-class time to meet with the spanish language consultant; and coordination with course content in swo 395: junior seminar. student groups will produce their plans in two stages: the first will be a rough draft of the roleplay and a list of literature you read to prepare for the role-play and group (e.g. mental health access and the latino community, running parent groups, adolescent-parent communication, signs and symptoms of depression and suicidal thoughts in adolescents). the second stage will be the final draft of the role play (in english and spanish) and questions (in english and spanish) that you have developed for the group. draft of role-play and references due: march 9th role-play and questions due: march 23rd 6. reflection on group process (and ratings) (5%) this should be a brief summary of your experience in creating and participating in the crosscultural parent group project. what did you learn about yourself in this process? what did you learn about preparing for a group? working with the parents? what challenges did you face? what strengths did you discover or use in the process? suggested length: 2-3 pages. due april 10th. project timeline date task wed. feb. 11 meet with spanish language consultant to discuss role-play and timelines, room reserved and specified. mon. feb. 23 submit draft of role-play and questions to professor—not graded—will return by 2/25 wed. feb. 25 meet with spanish language consultant, review (and submit to consultant) roleplay and questions in preparation for translation—room reserved and specified. mon. mar. 9 submit role-play, questions, and references (english) to professor wed. mar. 25 submit english and spanish versions of role-play and questions to professor week of march 23 and march 30 find time to meet with consultant to practice role plays! thurs. april 2 parent groups night at middle school meet in parking lot at 5pm advances in social work, spring 2011, 12(1) 85 preparation for the groups. in order to prepare students for their work with latino parents, two specific activities were planned as exercises in “preparatory empathy” (cournoyer, 2008). the first was a visit to the social work class from the school social worker and another bilingual, bicultural mental health provider in the community to whom the school often referred families. the purpose of this visit was to give students an understanding of the unique issues confronting the latino immigrant community such as low wages, long working hours, language barriers, and the generational differences between parents and children that were often exacerbated by adjustment to a new culture and language. in addition, the visitors described some of the signs and symptoms they observed in the students they helped, and how some of these were unique to first and second generation latino middle schoolers. finally, students learned about the impact of social stigma in the local immigrant latino community on those that seek professional mental health services. the second preparatory experience was a brief “immersion” into the county where most latino families reside. with funding from the university’s educational services budget that covered transportation and lunch, social work students spent the day visiting with four different providers in the community: a traditional multi-service agency with an emphasis on culturally and linguistically competent services, a faith-based mission organization that operated out of the ground floor of a small strip mall, a youth drop-in center, and a farmworkers’ committee that emphasized capacity-building in the latino community over the provision of services. this gave students the opportunity to immerse themselves in the strengths and challenges facing both the community and the providers that served them. it also connected students affectively to some of the struggles faced by local latino families, a connection made more real when (coincidentally) one of the organizers for the farmworkers’ committee attended the parent groups night at the middle school. one final preparation for the groups was made by a social work student in the class that was engaged in an independent study. as part of the student’s independent study, she surveyed the student groups and the resources in the area in order to create a resource list in spanish and english to give to parents on the night of the parent groups. it was decided the best way to provide this information was in the form of a “wallet-size” card. goals of the project. learning goals (and corresponding competencies) for social work students were to: (1) demonstrate an understanding of the strengths and challenges facing the local latino community of parents and children; (ep 2.1.3; 2.1.4) (2) demonstrate an understanding of the social, economic, and political context of families’ lives such as language access, work arrangements, and parenting, in order to lay the groundwork for social action; (ep 2.1.5) (3) demonstrate an increased interest in bilingual/bicultural social work with the latino community (ep 2.1.9); and (4) demonstrate the ability to plan and facilitate a group, particularly in a cross-cultural context (ep 2.1.9; 2.1.10) (for linkage of competencies, practice behaviors, and project goals, see table 2.) while not the focus of the author, there were also learning goals for the spanish students such as improved comprehension and communication skills with native speakers and application of knowledge of the spanish language and latino culture. belliveau/interdisciplinary service-learning 86 table 2: linkage of competencies, practice behaviors, and project goals epas competency relevant practice behavior project goal 2.1.3: apply critical thinking to inform and communicate professional judgments. distinguish, appraise, and integrate multiple sources of knowledge, including research-based knowledge and practice wisdom. (1) demonstrate an understanding of the strengths and challenges facing the latino community of parents and children 2.1.4: engage diversity and difference in practice. --recognize the extent to which a culture’s structures and values may oppress, marginalize, alienate, or create or enhance privilege and power. --gain sufficient self-awareness to eliminate the influence of personal biases and values in working with diverse groups. --recognize and communicate their understanding of the importance of difference in shaping life experiences. --view themselves as learners and engage with those with whom they work as informants. (1) demonstrate an understanding of the strengths and challenges facing the latino community of parents and children. 2.1.5: advance human rights and social and economic justice. --understand the forms and mechanisms of oppression and discrimination. --engage in practices that advance social and economic justice. (2) demonstrate an understanding of the social, economic, and political context of latino immigrant families’ lives. 2.1.9: respond to contexts that shape practice. continuously discover, appraise, and attend to changing locales, populations, scientific and technological developments, and emerging societal trends to provide relevant services. (3) demonstrate an increased interest in bilingual/bicultural social work with the latino population. (4) demonstrate the ability to plan and facilitate a group, particularly in a crosscultural context. 2.1.10: engage, assess, intervene, and evaluate with individuals, families, groups, organizations, and communities. --substantively and affectively prepare for action with individuals, families, groups, organizations, and communities. --use empathy and other interpersonal skills. --assess client strengths and limitations. --help clients resolve problems. --critically analyze, monitor and evaluate interventions. (4) demonstrate the ability to plan and facilitate a group, particularly in a crosscultural context. advances in social work, spring 2011, 12(1) 87 analysis of outcomes: laying the groundwork for social action in order to evaluate the project and assess student learning outcomes, students were asked to submit (1) a copy of their role play with empirical references; (2) a self and group evaluation form; and (3) a reflection paper on the experience. in addition, feedback offered in the classroom was recorded in notes and analyzed. for the paper, students answered the following questions: what did you learn about yourself in this process? what did you learn about preparing for a group? what did you learn about working with the parents? what challenges did you face? what strengths did you discover or use in the process? student role plays, qualitative comments from self and group evaluation forms, reflection papers, and classroom feedback were coded and categorized; analysis of data was inductive, with themes emerging directly from the multiple sources of data (glaser & strauss, 1967). “comparative analysis” of the different sources of data for each category allowed for the latent pattern in students’ words to emerge (glaser, 2002). a small number of codes were “theory-driven” (boyatzis, 1998) and consistently checked against and revised according to codes created from the data. for example, consistent with cswe accreditation standard e.p. 2.1.4, one facet of cultural awareness is the ability to recognize and communicate the importance of difference in shaping life experiences. this practice behavior served as the basis for coding data for instances of recognition. for the most part, student role plays focused on the theme of miscommunication between parents and children that resulted from generational splits, differential acculturation, and parents’ work schedules; symptoms of depression and suicidal ideation in children; and the challenges of peer and school relationships faced by latino middleschoolers on account of their “outsider” status. based on an analysis of student role plays, evaluation forms, papers, and notes from class discussion, four key learning outcome themes emerged that corresponded to the goals for the project and laid the foundation for social action: language, challenging stereotypes, understanding the social and political context of latino immigrant families’ lives, and personal and professional growth. while some student learning was anticipated, some was not and could only occur as a result of “live” learning in the context of a field-based project. each of the four themes is described below. language the majority of social work students described their experience on the night of the parent groups as the first time they had ever experienced the powerlessness of being in the linguistic minority. one student commented that she had lived in an international context in the past but had never needed to deliver vital information in that context. another student expressed the empathy she developed for the spanish-speaking parents: “this project showed me how frustrating it is to be on the receiving end of not knowing the language…while the parents were speaking with the translator in spanish, us englishspeaking students did not know what they were saying.” for some students, the experience validated the spanish-speaking skills they had developed through their university studies; for others, the experience spurred them to further their language study belliveau/interdisciplinary service-learning 88 either through the college curriculum or supplemental language study. two students spoke of revaluing their own bilingual/bicultural identities. prior to the parent groups night, one latina social work student had not believed that she could engage professionally by using her spanish, the language of “home.” after the project, this student had not only used her spanish to communicate with parents when her consultant struggled to translate more complex ideas, but she secured a senior-year field placement at the school based on her bilingual competence. challenging stereotypes on the night of the groups, approximately 35 parents showed up to the middle school, all of them expressing concern for their children. while this was nearly half of what was expected, it was still considered a strong turn-out for an evening program held at the school. based on the content of their questions and their willingness to come to the school at 7pm on a weekday evening, the parents conveyed a commitment to their families that students did not necessarily expect to see based on some of the stereotypes they held of first generation latino immigrants, many of which they formed through their readings and the media. students expected parents to be either skeptical of outside professional help or disinterested, both of which were dispelled. instead, parents conveyed a willingness to work with professional systems of care, but a lack of information about how to do so. fortunately, students were able to explain and demonstrate the role and purpose of professional help and link families to potential services by reviewing (in person) the resources on the wallet-size card. as the students presented their scenarios and the parents responded, students were impressed by the thought and knowledge about parenting that mothers and father brought to the groups. while students had been encouraged to describe the evening as a “partnership” with parents, they still viewed themselves in an instructive role. while parents did refer to students as “teacher,” they also engaged in mutual aid, in part due to the lag time in translating from spanish to english and back. in one group, students could see that parents were responding to each other and encouraged this mutual aid process to unfold, asking the spanish consultant to translate the words being exchanged between parents. as “problem-swapping” occurred (shulman, 2009), students gained an appreciation for the mutual aid process, but also viewed the parents as experts in their own experiences. this forced the students to respond to the needs of the parents as defined by the parents themselves. this latter learning outcome had particular salience in a socio-political context where parents’ voices were marginalized on account of culture, language, and economic status. understanding the social and political context of families’ lives one of the learning outcomes of the project occurred as a result of unanticipated circumstances. the parent groups night, as advertised through the school social worker, was to be held from 6-8pm. parents were to gather in the school cafeteria to be welcomed, and would then divide into smaller break-out sessions where the role-plays and discussions would occur. at first, only a few parents arrived, something that puzzled the school that had received several responses indicating parents would attend. however, advances in social work, spring 2011, 12(1) 89 word soon spread that one of the local factories had let its workers out late and that several parents were still on their way. as a result, the groups started later than expected. importantly, the situation highlighted the tenuous working conditions that latino parents in the county faced. students commented on the work arrangements of parents as a possible impediment to securing services for their children. in recognizing some parents did not control when their workday ended, students understood the nuances of access for parents, not only to services that required set daytime (or evening) “appointments,” but to the afterschool and evening lives of their children. as a result of this experience, several students dedicated their time to the farmworkers’ efforts to improve their working conditions. during the academic year that followed the parent groups project, the social work student honor society sponsored a panel to raise awareness of the migrant workers’ plight for the campus community and held a fundraiser on behalf of the farmworkers committee. other students worked directly with the committee in the development of a survey to document the working conditions at farms and factories in the county. such community-based research and capacity-building occurred as a result of the affective and cognitive connection forged between parents and students through the service-learning project. personal and professional growth as stated previously, some of the learning that occurred though the project was both unanticipated and only possible through the field-based project. this was the case in terms of both the structure and content of the evening. for example, due to an ultimately smaller group of parent participants than expected, student groups doubled-up in order to perform their role-plays (under the supervision of a bilingual social worker or one of the professors), circumstances that forced students to collaborate and recreate on-the-spot. students developed a newfound appreciation for the importance of “flexibility” in social work practice, a skill not easily taught in the context of the classroom. students wrote about their initial negative reactions to the loss of their anticipated “scripts,” but that they learned how to think critically and engage with clients in situations where even the bestlaid plans must be altered in order to meet client needs. in addition, students described their struggles in working with a translator, a cross-disciplinary experience that they might not otherwise have had in the field practicum. in reflecting upon this experience, and the experience of working with students that were not trained translators, social work students demonstrated recognition of the need for truly bilingual workers or translation services. in addition to learning the value of flexibility, students applied the social work concept of “use of self” in the creative act of performing their role plays. this creativity not only stimulated strategies for students to communicate across cultures, but made parents comfortable enough to engage with “outsiders.” similarly, students viewed themselves in a professional role that night, whether they intended to or not. one student was able to connect a family with the afterschool program where she was placed in her practicum; another student, after the groups had ended, walked the school’s hallways with a family in order to find and connect them with the bilingual mental health specialist who was there that night. a third student commented that she recognized how belliveau/interdisciplinary service-learning 90 empowerment was as much about providing direct answers as it was supporting an individual through the decision-making process. finally, learning outcomes for the project were presented by the author and two undergraduate social work students that participated at the annual baccalaureate program directors’ (bpd) conference in the spring of 2010. in presenting on their own learning outcomes from the project, students were able to demonstrate competency and hone their professional communication skills in a national, professional venue. among the social work practice skills the students discussed having honed were their skills in planning for and facilitating a group, integrating theory and practice through the application of concepts, and talking to clients about taboo subjects (such as depression and suicide), significant in that, up to this point, social work students had primarily talked about these subjects “amongst ourselves.” lessons learned and implications for social work education several lessons emerged from the cross-cultural parent groups project. for one, the logistics of such a project are challenging and must be accounted for in the development and delivery of the project. given the value of the project, advocacy may be needed in departments to demonstrate the time and resources needed for faculty to prepare and execute such learning experiences. while the project was well-supported by the author’s department, it still required more preparatory and teaching time than the standard group assignment. similarly, students must be prepared for the amount of time such a project requires outside of class in preparation for one evening in the semester. while some collaborative time was built into the class schedule, the parent groups project required that social work students spend approximately 10 hours of time outside of class in order to meet with consultants, meet with one another to prepare role plays and questions, and travel to the middle school on the night of the parent groups. this amount of time does not include the hours spent on the day-long immersion trip into the county, nor the time expected from students to complete assignments without a service-learning component (for example, time spent doing the literature review for the role plays). however, it was this investment of time and preparation that facilitated the delivery of content to build the core competencies. one key lesson learned highlights the limitations of any assessment of the project’s effectiveness. while the social worker for the school deemed the night a success where “a lot of intervention happened” based on the reactions she heard from parents, the parents themselves were not surveyed. in future, such a project would need to be evaluated from both the perspective of the students and the individuals or community served. similarly, students recommended that any future parent group nights allow more time and opportunity for parents to network with one another. advances in social work, spring 2011, 12(1) 91 implications: linkage to competencies and teaching of generalist practice the goals and outcomes of the cross-cultural learning project supported the building of several core competencies under the 2008 epas: to apply critical thinking (e.p. 2.1.3), to engage diversity and difference in practice (e.p. 2.1.4), to advance human rights and social and economic justice (e.p. 2.1.5), to respond to [changing] contexts that shape practice (e.p. 2.1.9), and to engage, assess, and intervene with individuals, families, groups, organizations and communities (e.p. 2.1.10). (see table 2.) moreover, the project enabled students to build the professional skills of cross-disciplinary collaboration and working with a translator. the project was also beneficial in terms of program development. partnering across disciplines to better serve the surrounding community fulfilled the mission of the social work department as well as that of the university. under standards one and two of the 2008 epas, a program must demonstrate how its mission and goals respond to the unique context of the program, how the goals are derived from the program’s mission, and how the mission and goals are consistent with the core competencies that define generalist practice (council on social work education, 2008). changing demographics and needs call for unconventional approaches to the delivery of social work practice and policy content in the curriculum. with its emphasis on field as the signature pedagogy and the infusion of content throughout the curriculum, the 2008 epas implicitly supports the development of additional field-based opportunities to build the core competencies. whether offered to students that are already in the field practicum or those that have yet to enter, crosscultural service learning projects hone practice skills, meet a community need as identified by the community, and raise student awareness of the socio-political conditions faced by different groups such as racial and ethnic minorities, new immigrants, and migrant workers. moreover, service-learning in a cross-cultural context creates opportunities for students to take risks, develop their critical thinking skills, and build the foundation for social action. references bean, f. d., corona, r., tuiran, r., woodrow-lafield, k. a., & van hook, j. (2001). circular, invisible, and ambiguous migrants: components of difference in estimates of the number of unauthorized mexican migrants in the united states. demography, 38, 411-422. boyatzis, r. e. (1998). transforming qualitative information: thematic analysis and code development. thousand oaks, ca: sage. bye, l. (2005). teaching group work through service-learning. arete, 29(2), 44-49. chester county planning commission. (2001). census information #c4-01. retrieved from http://dsf.chesco.org/planning/lib/planning/pdf/census4.pdf belliveau/interdisciplinary service-learning 92 council on social work education. (2008). educational policy and accreditation standards. retrieved from http://www.cswe.org/file.aspx?id=13780. cournoyer, b. (2008). the social work skills workbook (5th ed.). belmont, ca: brooks/cole. eby, j. w. (2001). the promise of service-learning for family science: an overview. journal of teaching in marriage and family, 1(3), 1-13. glaser, b. g. (2002). constructivist grounded theory? forum: qualitative social research, 3(3), 1-10. retrieved from www.qualitative-research.net/fqs/ glaser, b., & strauss, a. (1967). the discovery of grounded theory: strategies for qualitative research. chicago: aldine. greenlees, c. s., & saenz, r. (1999). determinants of employment of recently arrived mexican immigrant wives. international migration review, 33, 354-377. lemieux c. m., & allen, p. d. (2007). service learning in social work education: the state of knowledge, pedagogical practicalities, and practice conundrums. journal of social work education, 43(2), 309-325. massey, d. s., durand, j., & malone, n. j. (2002). beyond smoke and mirrors: mexican immigration in an era of economic integration. new york: russell sage foundation. migration policy institute. (2008). american community survey and census data on the foreign-born by state. retrieved from http://www.migrationinformation.org/datahub/acscensus.cfm# pearlmutter, s. (2002). achieving political practice: integrating individual need and social action. journal of progressive human services, 13(1), 31-51. pitner, r. o., & sakamoto, i. (2005). the role of critical consciousness in multicultural practice: examining how its strength becomes its limitation. american journal of orthopsychiatry, 75(4), 684-694. prentice, m., & robinson, g. (2010). improving student learning outcomes with servicelearning. american association of community colleges. retrieved from http://www.aacc.nche.edu/resources/aaccprograms/horizons/documents/slorb_jan20 10.pdf. sanders, s., mcfarland, p., & bartolli, j. s. (2003). the impact of cross-cultural servicelearning on undergraduate social work students’ perceptions of culture, race, and economic justice. the journal of baccalaureate social work, 9(1), 19-40. shulman, l. (2009). the skills of helping individuals, families, groups, and communities (6th ed.). belmont, ca: brooks/cole. singer, a. (2002). america’s diversity at the beginning of the 21st century: reflections from census 2000. washington, dc: brookings institution. retrieved from http://www.brookings.edu/dybdocroot/views/papers/singer/20020402.pdf advances in social work, spring 2011, 12(1) 93 singer, a. (2004). the rise of new immigrant gateways. washington, dc: brookings institution. retrieved from www.brookings.edu u.s. bureau of the census. (2003, january). census bureau releases population estimates by age, sex, race, and hispanic origin. retrieved from http://www.census.gov/pressrelease/www/2003/cbo3-k.html u.s. bureau of the census. (2010). 2005-2009 american community survey (chester county). retrieved from http://factfinder.census.gov/servlet/adptable?_bm=y&geo_id=05000us42029&-qr_name=acs_2009_5yr_g00_dp5yr5&context=adp&-ds_name=&-tree_id=5309&-_lang=en&-redolog=false&-format author’s note: address correspondence to: michele belliveau, m.s.w., ph.d., west chester university undergraduate social work department, 114 w. rosedale ave., west chester, pa 19383. email: mbelliveau@wcupa.edu microsoft word 10. mccave et al_16672_human sexuality copyedit final ______________ emily mccave, ph.d., msw, is an assistant professor in the department of social work at quinnipiac university in hamden, ct. benjamin shepard, ph.d., lmsw, is an associate professor in the human services department at cuny/nyc college of technology in brooklyn, ny. virginia ramseyer winter, msw, is a doctoral candidate at the university of kansas in lawrence, ks. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 409-427 human sexuality as a critical subfield in social work emily mccave benjamin shepard virginia ramseyer winter abstract: human sexuality is of vital importance to social work practitioners, educators, and scholars. yet historically, the profession’s leadership around it has waxed and waned, impacting practice. this article discusses the importance of human sexuality as a critical subfield within social work. it suggests that the mechanisms, namely textbooks, journals, and national conferences, for stimulating human sexuality social work scholarship are limited. the authors assert that the taboo of human sexuality limits the advancement of a cohesive professional discourse and contributes to the continued oppression of marginalized populations. recommendations for providing better support for those who study, teach, and practice in the arena of human sexuality are offered. keywords: human sexuality, social work scholarship, social work education throughout the 20th and 21st centuries, a group of passionate leaders within our profession asserted that social workers should recognize human sexuality as an integral, rather than a peripheral or even “deviant,” aspect of human functioning. one such leader, social worker and sexuality educator, diane brashear, suggested, “to ignore our sexuality is to deny our humanity” (1976, p. 18). yet unfortunately, ignoring and pathologizing sexuality has happened all too often within social work education, scholarship, and practice (myers & milner, 2007). social workers gochros and shultz (1972) attributed this phenomenon, particularly the lack of competency and willingness of social workers to discuss sexuality issues with clients, to the fact that social workers are “people first, and then professionals” (p. 246). this problem is not unique to just the area of human sexuality; social workers recognize that a lack of understanding in any major aspect of one’s culture or identity can interfere with effective practice, establishing culturally competent practice as an ethical standard within the profession (national association of social workers [nasw], 2008). negotiating differences in practice requires self-awareness of personal and cultural values and also a commitment to dismantling oppression through empowerment and advocacy. issues related to human sexuality fall squarely within the arena of cultural competency given the diverse lived experiences, attitudes, and behaviors of clients, many of whom experience marginalization because of their sexuality. indeed, nasw (2008) specifically states in the ethical standard 1.05, “cultural competence and social diversity,” that social workers are ethically bound to “…understand the nature of social diversity and oppression with respect to …sex, sexual orientation, gender identity or expression ...marital status…” (para. 30). advances in social work, fall 2014, 15(2) 410 further, nasw (2008) asserts in the preamble of the code of ethics that the mission of the social work profession is to enhance the well-being of individuals and the larger society. particular attention is paid to vulnerable and marginalized populations and to considering the impact of the environmental context on individual, family, organization and community behavior on well-being. the world association for sexual health (wash, 2013) states that “full development of sexuality is essential for individual, interpersonal, and societal well-being” (para. 1). social work supports the importance of human sexuality as a critical topic for social workers while calling attention to the influence of the economic, social, political, and familial contexts on achieving optimal sexual well-being. further, nasw (2008) suggests special focus should be on the marginalization of individuals and groups by understanding the societal mechanisms that regulate aspects of human sexuality. given this, social workers have a responsibility to gain knowledge and skills for generalist and advanced practice and to support expanding existing knowledge through teaching and scholarship on human sexuality issues. the first step to building competency in a particular domain is defining its scope. the ever-evolving concept of human sexuality makes it challenging to capture within a single definition. too often the word “sexuality” is considered synonymous with sexual orientation (trotter, crawley, duggan, foster, & levie, 2009). yet human sexuality is an expansive term. for example, the world health organization (2006) suggests human sexuality is: … a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. while sexuality can include all of these dimensions, not all of them are always experienced or expressed. sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors. (para. 6) while this definition highlights that human sexuality is central to daily life and is experienced and expressed in complex ways, it does not explicitly address the relationship between sexuality, oppression, and privilege – a connection that is paramount to social workers. sexual privilege, the ability to experience your sexual attitudes, identities, or behaviors, as “normal” or “healthy,” is maintained at the expense of “others” who will be taught that their sexuality and sexual decisions are “abnormal” or “unhealthy” (crimp, 1988; crimp, pelligrini, pendleton, & warner, 1997). the importance of reframing such negative labels when working with marginalized populations is a key component of strengths-based social work practice (saleebey, 1997). to better prepare social workers to understand and negotiate the myriad of human sexuality issues, it is critical that human sexuality becomes a more visible and cohesive subfield. competency development needs to occur within professional practice, which can be facilitated through advances in social work education and scholarship. one possible avenue for pursuing such advances is through the cultivation of an environment that fosters the creation and dissemination of human sexuality scholarship. to this end, mccave, shepard, winter/human sexuality in social work 411 we examine the history and context of human sexuality and social work scholarship, as well as our experiences as sexuality scholars in social work. second, we propose potential pathways for change within the arenas of social work scholarship. lastly, we discuss the importance and timeliness of engaging in such change efforts. we begin with a review of the current state of social work knowledge around this topic. human sexuality: scope, surveillance, and social control while the scope of human sexuality literature is incredibly broad, much has been written about the symbolic nature of human sexuality (gecas & libby, 1976; jackson & scott, 2010; longmore, 1998). for example, hawkes and scott (2005) argue: human sexuality is distinct from non-human sexuality in that it is neither immutable nor static but is highly responsive to social forces. human sexuality is imbued with symbolic meaning and social significance…given that humans are social beings, human sexuality is inevitably influenced by a person’s social location...forms of social stratification, relating to class, status, gender, ethnicity, age and so on, will influence modes of individual self-expression. (p. 7) this focus on the symbolic meaning of human sexuality highlights the connection between human sexuality, social power, and social control. here, those in power (e.g., government officials, administrators, religious organizations, mass media, etc.) reinforce a hierarchy of social stratification and privilege, routinely advocating for and implementing social policy that regulates aspects of sexuality, including reproductive autonomy and sexuality education (bywater & jones, 2007). for example, the u.s. supreme court recently ruled that family-owned christian businesses do not need to provide health insurance coverage to women for certain types of contraceptives, such as intrauterine devices (iud) or emergency birth control pills (plan b), because it violates their religious belief that these contraceptives equate to abortion (liptak, 2014). this is contrary to the federal mandate that employers must provide health insurance that covers all fda approved contraceptives with no cost-sharing (through deductible or co-pay) to their employees under the patient protection and affordable care act of 2010 (national women’s law center, 2014). the impact of this judicial ruling is likely to disproportionately affect lower-income women who have fewer resources to access contraceptives not covered by insurance. repeatedly, human sexuality has been regulated through discourses involving social control, panic, power, and surveillance (chambon, irving, & epstein, 1999; shepard, 2007a). for example, social welfare policies have been aimed at the moral regulation of the personal and sexual lives of those on public assistance (abramovitz, 1996, 2000; flavin, 2009; gans, 1995; piven & cloward, 1993). in an era of a dwindling welfare state, the actions of the poor, those who subsist on survival services, are increasingly scrutinized and subject to surveillance (spade, 2011). for feminist philosopher nancy fraser (1989), a distinct series of social discourses produced the stereotype of the “welfare mother.” these discourses functioned to create a “gendered” form of “welfare provisions” used to undermine supports for social welfare programs. within this feminized system, women are labeled as deviant so that the services they receive serve as advances in social work, fall 2014, 15(2) 412 a mechanism of normalization (fraser, 1989). repeatedly, opponents of social services have responded to the new social mobility among women by calling for welfare policies based on social control, mandatory production, and demonization of female sexual selfdetermination (abramovitz, 1996, 2000; flavin, 2009). a racialized, dehumanizing view of women on welfare, combined with anxiety about shifts in the constellation of the nuclear family, fuel these anxieties (abramovitz, 1996, 2000; sidell, 1998). beyond the welfare arena, issues such as variant sexual behaviors, sexual assault, adolescent sexuality, and sexual orientation have been framed as “problems” to be solved by helping professionals (myers & milner, 2007). social workers have often responded with the best intentions, while unknowingly perpetuating the cycle of sexual oppression by delivering services that are based on erroneous assumptions and personal judgments, or avoiding such topics all together (myers & milner, 2007). given the profession’s emphasis on cultural competency, there is ample opportunity to move away from this pattern and to reframe the subfield of human sexuality as one where social workers can gain new knowledge, disseminate scholarship, and engage in anti-oppressive practice that fosters empowerment and challenges the status quo of what is considered “normal” human sexuality. while social workers have the capacity to be leaders in this effort, thus far momentum has been limited. social work’s response to human sexuality mirrors the larger cultural norms and values on sexuality, which favor social control rather than the field’s stated emphasis on self-determination (ehrenreich, 1985; margolin, 1997; myers & milner, 2007). there are multiple reasons for this response. similar to tatum’s (1997) astute declaration that none of us are able to avoid breathing in the “smog” of cultural racism (p. 6), social workers likely have an internalized belief system in which certain sexual attitudes and behaviors are perceived as more normative than others. this internalization is influenced by the frequent use of public shaming and stigma to regulate and control individual sexual behavior (bay-cheng, 2003; mcalinden, 2005). the consequences of this are manifested in social work practice (e.g., homophobia and discrimination of sexual minorities within residential treatment) (mccave, 2008), research (e.g., negating and ridiculing the worth of sexuality research) (hammond & kingston, 2014; israel, 2002), and teaching (e.g., avoiding the integration of human sexuality content into social work courses) (dunk, 2007). yet, it is the profession’s obligation to train future social workers to provide high quality, culturally competent care (nasw, 2008). rather than focus on the pathology of certain sexual issues (e.g., teenage sexual behaviors) and characteristics of certain populations (e.g., sexual abuse victims) (dunk, 2007; morrow & messinger, 2006), we emphasize a strengths-based approach that favors self-determination more in line with the field’s code of ethics (saleebey, 1996). the regulation of human sexuality can be seen within the social work academic arena as well. this is evidenced by the career challenges the authors of this paper have faced as result of their choices to study sexuality within the social work academy. according to one of the authors, while pursuing a graduate degree in social work, students and faculty seemed uncomfortable with discussions of sexuality-related material, such as teen pregnancy and hiv prevention, while advancing punitive policy solutions. while mccave, shepard, winter/human sexuality in social work 413 women’s sexuality was often blamed for problems extending from teen pregnancy to reproductive autonomy (abramovitz, 1996, 2000), few students or faculty seemed interested in critically engaging in questions about why this was the case. another author of this paper was told in no uncertain terms by a faculty mentor in 2007, in one of the initial explorations of dissertation topics, all of which centered on human sexuality in some way, that pursuing a “gay dissertation” (i.e., research focused on gay and lesbian sexual health) would be a barrier to a successful academic career because it would result in being “tracked” into “that kind of research.” while the intention might have been well meaning, the comment was both personally and professionally degrading. moreover, it ultimately affected the final choice of dissertation topic. perhaps ironically, the second experience that the same author had on several occasions was in fact related to the dissertation topic, which examined health providers’ hpv vaccination attitudes and behaviors. throughout the dissertation phase and especially while on the job market in 2009, one message came back consistently from other social work academics – that while the topic was interesting, it was not really a social work subject; rather it was a topic for public health researchers. this author was frustrated with having to justify her intellectual pursuits to strangers. repeatedly being told her research did not “fit” within her own profession made her question the worth of her research, and her worth as a social work scholar. the pattern of social control continued when the authors went on the job market for social work teaching jobs in the mid-2000s. when interviewing for a position at a large research institution in the northeast, one of the authors of this paper was told that the interview committee had laughed at one of the publications listed on the author’s curriculum vitae the day before the job talk at the school. the article in question was a book review of a book published by mit press published in a top tier journal. during this informal pre-interview conversation, the author asked what the faculty thought about questions about sexuality and self-determination as a part of social work education. “we are not there yet,” one of the members of the appointments committee noted during the informal discussion. unfortunately, experiences such as these can perpetuate feelings of academic and professional marginalization for engaging in topics outside widely accepted categories of mainstream social work research (e.g., child welfare, mental health, gerontology). these experiences are not unique to those who pursue sexuality issues (canda, 2003). while related fields have built a rich literature critically engaging questions about sexuality and difference (bernstein, 2007; crimp, 1988; foucault, 1978; freud, 1975; warner, 1999), the social work knowledge base is limited when it comes to questions about human sexuality and practice (timm, 2009). rather than expand our often limited knowledge base around this topic, social work tends to look the other way (dunk-west & haffordletchfield, 2011; goldstein, 1990; martin, et al., n.d.; morrow & messinger, 2006). our experiences suggest that social work sexuality scholars are forced to contend with a lack of understanding contributing to a bias that mirrors patterns seen in the larger culture (spade, 2011). to be fair, one of the authors’ experiences in the related field of psychoanalysis suggests providers in this area have equally difficult times engaging with advances in social work, fall 2014, 15(2) 414 questions about human sexuality and difference, especially around topics related to “deviant” sexual behavior. these experiences are well documented (timm, 2009). to be competent educators and practitioners, we are compelled to advance the social work knowledge base so as to support client self-determination in negotiating their sexual selves. this can be challenging given the social, legal and ethical issues related to human sexuality. wash (2013) identifies eleven sexual human rights, which include the right to sexual freedom, sexual autonomy in individual decision-making, and to be free from sexual violence, as well as the right to sexual privacy. it also includes the right to be free from sexual discrimination, the right to experience sexual pleasure and sexual expression. it asserts that individuals have the right to choose with whom they associate sexually and to make their own reproductive choices. yet, people can only make these choices freely when they have access to current, evidenced-based sexuality education and responsive health care (wash, 2013). a caveat is stated within this declaration that it is never the sexual right of an individual, organization, or society to engage in acts of sexual coercion, sexual discrimination, sexual violence, or sexual exploitation. these sexual rights and limitations serve as a guide for assisting practitioners who want to promote client sexual self-determination. integrating these sexual rights into one’s practice acknowledges that, “the expression of sexuality is a window into who each person is and how they relate to each other,” notes timm (2009, p. 15). however, when social workers avoid the topic of human sexuality, it limits a client’s ability to fully engage in self-determination. furthermore, “not talking about it sends a message that it is taboo and ignores valuable clinical information… one of the biggest barriers to productive, therapeutic conversations about sexuality is a lack of training; many … professionals simply are not adequately trained,” (timm, 2009, p. 15). yet, there are ways around this limitation. by recognizing sexuality as an integral part of social work education and practice, we can replace patterns of paternalism with strengths-based models of care more consistent with our code of ethics and evidence-based practice (saleebey, 1997). a critical component of building this knowledge base involves cultivating and disseminating scholarship and linking it with practice. yet, when it comes to human sexuality, cultural competence has waxed and waned. human sexuality and social work scholarship while social welfare scholars have long recognized that sexuality has a rightful place in the social work curriculum, the scholarship has rarely matched the need for this material (abramowitz, 1971; dunk-west & hafford-letchfield, 2011; martin, et al., n.d.; morrow & messinger, 2006). the ebb and flow of sexuality-focused scholarship reflects the field’s historic ambivalence about such scholarship. while scholarship can take many forms, three primary types of social work scholarship – books, journals, and conferences – are examined. scholarship on human sexuality and social work in the form of books and journals was limited for much of the 20th century. social work pioneers sophonisba preston breckinridge and edith abbott published a book in 1912 entitled, the delinquent child mccave, shepard, winter/human sexuality in social work 415 and the home: a study of the delinquent wards of the juvenile court of chicago. in it, the authors suggest that girls were more vulnerable to sexual encounters with adults when in families and communities that had severely limited resources and this, in turn, led to juvenile delinquency among these girls. in the early years of the profession, human sexuality knowledge was disseminated via the proceedings of the national conference of social work (formerly called the national conference on charities and correction) (national conference of social work, 1921). the topics presented were indicative of society’s unease with human sexuality; the index referenced the topics of childhood ideation about sex; the “steamy side” of sex; problems related to sex; moral education as the solution to sex; and the interpretation of sex by adolescents (p. 525). two decades passed before a social work book on human sexuality was published, entitled, a case work approach to sex delinquents (wessel, 1947), again supporting a pathology framework. it was not until 1972, that editors harvey gochros and leroy schultz published the first progressive, comprehensive book on human sexuality and social work, human sexuality and social work. the purpose of the book was to “…cut through the relative silence surrounding explicit sexual problems as they relate to social work practice” (gochros & schultz, p. 15). in the preface, the editors outlined nine professional values and beliefs that served as the foundation for the writings that were included. to paraphrase, these values and beliefs included: 1) the legitimacy of sexuality as an area of importance for social workers; 2) the recognition of sexuality as a complex aspect of humanity influenced by a variety of factors both internal and external to the individual; 3) the belief that sexual behavior is learned; 4) the right of every individual to be sexually fulfilled (within the context of society’s laws); 5) the assertion that sexual variation is normal; 6) the belief that social workers should be at the forefront of new theory and technological development as it relates to dealing with sexual problems; 7) the belief that social workers should be at the table in promoting progressive social policy related to sexuality; 8) the assertion that promoting sex education policy and programs is paramount to promoting responsible and fulfilling sexual practices; and 9) the declaration that social work practitioners will be most effective in assisting those with sexual problems when they become formally educated, and when they employ self-awareness and sensitivity. it is not surprising that this first major monograph about human sexuality and social work was written in the early 1970s, given the women’s and gay liberation movements and sexual revolution taking place (allyn, 2000; heidenry, 1997; kaufman, 2005). during this time period, dramatic changes in sexual attitudes and behaviors concerning intimacy, homosexuality, interracial relationships, reproductive decision-making, and gender norms (among others) were seen (d’emilio & freedman, 1997). subsequently, social work scholars began asserting the importance of human sexuality as a subfield within social work education and practice. between 1965 and 1980 social work scholars published 40 journal articles regarding sexuality-related issues focusing on: 1) teaching human sexuality to social work students; 2) addressing gender issues, particularly sexism, within the profession; and 3) preparing social workers to assist clients with sexual issues. advances in social work, fall 2014, 15(2) 416 the discourse on human sexuality and social work increased dramatically during the 1980s and early 1990s. the journal of social work and human sexuality, published by taylor and francis, was in circulation from 1982 to 1993 (taylor & francis group, n.d.). it was then discontinued and later became the journal of family social work. looking at the contents of each issue of journal of social work and human sexuality, several topics were covered each year, with some special issues included as well. figure 1 highlights that a range of topics were covered in the journal, both focused on specific populations (e.g., adolescents) and issues (e.g., hiv/aids). figure 1. description of populations and issues covered in journal of social work and human sexuality the journal’s rise and decline raises subsequent questions, such as: what precipitated the demise of the journal? did human sexuality cease to be a broad topic of concern and relevance for social work researchers, teachers, and practitioners? who stepped in to fill the space this journal left? a review of existing journals found that special topic social work journals certainly include content about human sexuality related to the same journal of social work and human sexuality (circulation: 1982-1993) population based issue based adolescents gay and lesbians sex offenders racial and ethnic minorities those with disabilities women social work students older adults childhood sexual abuse sexual variance hiv/aids & stds infertility health care love and intimacy sex therapy sexual communication contraceptives mccave, shepard, winter/human sexuality in social work 417 populations and issues covered in the journal of social work and human sexuality. table 1 provides a list of social work journals that include content in these areas of human sexuality. there are also several non-social work specific journals that promote sexuality-focused scholarship (see table 2). table 1. social work journals that include articles on sexuality issues or populations sexuality category journal title issue hiv/aids and stds journal of hiv/aids and social services childhood sexual abuse child and adolescent social work journal child and family social work health care social work in health care health and social work contraceptives health and social work social work in health care sex therapy psychoanalytic social work clinical social work journal journal of analytic social work infertility health and social work sex offenders journal of social welfare and family law population those with disabilities journal of social work in disability and rehabilitation women affilia: the journal of women and social work social work students journal of teaching in social work social work education (uk) adolescents child and adolescent social work journal child and family social work children and schools racial and ethnic minorities journal of ethnic and cultural diversity in social work journal of multicultural social work gay and lesbians journal of gay and lesbian social services journal of homosexuality older adults journal of gerontological social work journal of social work in end-of-life & palliative care the gerontologist advances in social work, fall 2014, 15(2) 418 table 2. sexuality-focused journals from other related disciplines journal name years of circulation american journal of sexuality education 2005-present annual review of sex research 1996-2007 archives of sexual behavior 1997-present canadian journal of human sexuality 1998-present contemporary sexuality 2000-present culture, health & sexuality 1999-2011 current sexual health reports 2004-2008 electronic journal of human sexuality 1998-present exchange on hiv/aids, sexuality and gender 2005-present gender and sexuality: journal of center for gender studies, icu 2005-present international journal of sexually transmitted diseases and aids 2000-2002 international perspectives on sexual and reproductive health 2009-present journal of child sexual abuse 2000-2011 journal of sex & marital therapy 1997-present journal of sex research 1965-present journal of sexual aggression 2003-2011 journal of the history of sexuality 1990-present law & sexuality 1991-present perspectives on sexual and reproductive health 2002-present sex education 2001-2011 sex roles 1997-present sexologies: european journal of sexology 2006-present sexual abuse 1988-present sexual addiction & compulsivity 1998-2011 sexual and relationship therapy 2000-2011 sexual & reproductive healthcare sexualities 2010-present 2008-present sexuality & culture 2000-present sexuality and disability 1997-present sexuality research & social policy 2004-present studies in gender and sexuality 2001-2011 while there are certainly a number of sexuality-focused journals, there is no longer a human sexuality journal written by and for social workers. this gap limits social work scholars by leaving them with the option of either publishing in social work journals with a broad scope, focusing their research into one of the few sexuality-focused topic or population journals in social work (e.g., journal of gay and lesbian social services), or publishing in non-social work journals, which most likely are interdisciplinary in terms of theoretical and practice orientations. the outcome of this choice may be that social work scholars, teachers, and practitioners struggle to easily find current scholarship on a wide array of sexuality-focused topics within the profession. additionally, this creates a fragmented discourse for social work scholars, who may be unaware of the latest theoretical, pedagogical, or empirical scholarship disseminated by fellow social work academicians who are researching human sexuality topics that overlap with their own mccave, shepard, winter/human sexuality in social work 419 areas of scholarship. a social work human sexuality journal would allow scholars to pursue a more nuanced analysis of the intersectionality of sexuality with issues of race, class, gender, and mechanisms of oppression. at the current time, there are no social work textbooks on human sexuality published for social work educators in the united states. this does not include those texts that are part of the required social work curriculum, which often include some content on human sexuality (e.g., human behavior in the social environment texts). currently, there is one british textbook by bywater and jones, titled human sexuality and social work (2007). while this textbook is well written and full of important content, including an antioppressive framework, its primary limitation is that it provides historical, policy, and practice information specifically for british social work students. without accessible and relevant textbooks, social work educators may be discouraged from teaching a human sexuality and social work course. moreover, given the many social work textbooks representing other subfields (e.g., child welfare, mental health, juvenile delinquency, etc.), it is not unreasonable to question whether this is reflective of a marginalized status of human sexuality within the social work academy. certainly, there are monographs and texts on practice with special populations or specific issues, such as gay and lesbian families, child sexual abuse, and working with families affected by hiv/aids (hilarski, wodarski, & feit, 2008; morrow & messinger, 2006; poindexter, 2010). these writings are profoundly beneficial to students and scholars. yet, the lack of both a sexuality social work journal and textbook reflects a significant gap in the social work knowledge base (goldstein, 1990). human sexuality and social work scholarship: national social work conferences in addition to books and journals, national social work conferences provide an important opportunity for scholars to disseminate cutting edge scholarship for use by practitioners, social work students, and faculty. both the council on social work education (cswe) and the society for social work and research (sswr) utilize conference “tracks” and “clusters and topics” to designate subfields that are of importance to the profession, such as mental health and addictions/substance abuse (cswe, 2014a; sswr 2014b). yet, a notable lack of sexuality-focused research and teaching scholarship is found in a review of the abstracts accepted at two of the major social work conferences hosted by cswe and sswr. at the 2012 cswe annual program meeting (apm), 33 abstracts included the words “sexuality,” “sex,” or “sexual” in either the title or abstract description. this is out of more than 600 sessions offered throughout the conference (cswe, 2012). these abstracts highlighted a range of sexuality-focused issues, including childhood sexual abuse; sex offenders; sex education; lgbt issues in practice and social work education; prostitution; hiv/aids; gender identity; and sexual assault. for the 2013 sswr conference (sswr, 2013) the numbers were notably higher than for cswe – 176 abstracts out of the 500 sessions offered were found when the word “sexual” was used as the search term, followed by 76 abstracts for the term “sex,” and six abstracts for the search term “sexuality.” this latter point is certainly promising as is the fact that a special interest group (sig) focused on “sexuality advances in social work, fall 2014, 15(2) 420 development and well-being” was formed in 2013. while there may be a growing recognition and support for research focused on sexuality at sswr, there currently is not an oral/poster presentation track for human sexuality at either conference. the cswe conference is focused on utilizing social work education to advance practice and scholarship, while sswr is geared towards promoting and disseminating cutting edge social work research (cswe, 2014b; sswr, 2014a). yet both are vital opportunities for disseminating social work scholarship, particularly as there is professional recognition that all three areas of social work (practice, education, research) are inextricably connected (cswe, 2014b). similar to what has occurred with journal publications, within the national conference arena, human sexuality conference proposal tracks are limited to those which more narrowly focus on marginalized populations where sexuality is explicitly linked (e.g., practice with lgbt individuals) and topics where federal funding is available (e.g., hiv/aids). this is certainly indicative of progress within our profession. however, human sexuality is a broader umbrella under which many interrelated and complex issues come into play, such as sexual orientation, gender identity and expression, sexual behaviors and fantasies, intimacy, sexual negotiation, sexual violence, as well as privilege and oppression of certain populations, including children, women, older adults, those with disabilities, and those with mental illnesses (bywater & jones, 2007). while there are benefits to creating narrowly defined tracks, such as “women” and “hiv/aids,” there are unintended consequences. instead of integrating questions of sexuality into larger debates within the field, the discourse on human sexuality remains fragmented and scholars miss out on the dissemination of research that likely intersects with their own research. further, it creates a challenge for social work scholars to decide on a proposal track that represents the complexity of their work. just as social work scholars are likely to look to interdisciplinary journals to publish their work, scholars may also seek out interdisciplinary conferences where their work is well-received and validated. the society for the scientific study of sexuality (2010) annual conference is an excellent example. this conference is committed to the dissemination and support of scholarship related to human sexuality issues. for social workers, the central limitation of this conference is that most of the individuals who attend and present are not social workers. cswe and sswr can capitalize on this distinction and attract social workers to their conferences if they are more inclusive of human sexuality content. it is reasonable to assume that cswe and sswr want to be among the top choices when it comes time to choosing between multiple conferences of interest. this is particularly relevant given that social work doctoral students, faculty, and practitioners typically have limited funding available for annual conference travel. pathways to advance human sexuality social work scholarship the subfield of human sexuality can become more cohesive and visible by stimulating human sexuality social work scholarship through a number of concrete mechanisms. this includes developing a community and infrastructure for supporting those social work scholars and students, who want to build expertise, disseminate knowledge, provide and receive mentorship, and explore their passions. three arenas of mccave, shepard, winter/human sexuality in social work 421 scholarship were presented in this article. concrete and feasible opportunities for change within each of these arenas exist. first, in regards to social work textbooks, social work scholars who regularly teach human sexuality courses within social work may be uniquely positioned to offer their expertise as either editors or as contributors to such a textbook. publishers can be contacted to determine if there would be an interest to accept such a manuscript. second, in considering scholarship disseminated through journals, it is suggested that a new peerreviewed human sexuality and social work journal be developed and circulated. this could be done through a traditional academic publisher that offers printed journals or an online journal established and maintained through a school of social work or other national social work organization. third, in regards to social work national conferences, members can submit requests to those in leadership positions within these organizations that a “human sexuality” proposal track be offered, either through some reorganization of existing tracks or by adding the track. including a new established track for scholars and students interested in human sexuality would greatly increase the options for disseminating scholarship as well as social networking while at the conference. finally, networking opportunities through new facebook™ groups, such as the social work sexuality scholars group, point to increased support efforts among those in the field. combined, these change efforts highlight opportunities to foster cohesiveness within this subfield. discussion it can easily be argued that sexuality is multifaceted. dailey (1981) proposed that sexuality includes our attitudes, values, and feelings as practitioners as well as the belief systems of our clients, coworkers, community leaders, and legislators. these belief systems can impact social work practice in countless ways. the intersections between systems, such as families, organizations, communities and society, and sexuality issues, including health and reproduction, sexual identity, intimacy, and sensuality, are vast. dynamic social forces, including race, class, cultural norms, ideologies, religious beliefs, and family organization, influence the way in which these issues are understood and negotiated. dailey’s framework highlights the possibilities of our professional impact as change agents if we are proactive in building expertise as practitioners, educators, and scholars. after all, issues of sexuality are connected to and shaped by the social and political milieu in which we operate. the presence of oppression, marginalization, and privilege are at the core of many of the sexuality domains included in dailey’s framework. the landscape social workers need to be able to traverse is dynamic and complex (dailey, 1981). however, the involvement by the social work profession in cultivating and producing human sexuality expertise and then disseminating that expertise is currently less than ideal. while the profession promotes models of practice that foster client dignity and respect (saleebey, 1996), without an adequate knowledge base (goldstein, 1990), the field tends to rely on paternalistic patterns of care (epstein, 1975; margolin, 1997; morrow & messinger, 2006). despite the passage of more than forty decades since gochros and schultz wrote their book, social work and human sexuality, many of the advances in social work, fall 2014, 15(2) 422 issues and challenges discussed within it are present today. the labeling, pathologizing, and oppression of sexual minorities and other marginalized groups continues to impact society’s most vulnerable populations (shepard, 2013; spade, 2011). for example, adolescents are bombarded with conflicting messages about sexuality and what is “right” and “normal.” gender policing, particularly of compulsory masculinity and heterosexuality, is ever present in our families and our schools (martino & pallotta-chiarolli, 2005). this continues despite the evidence of its tragic consequences, namely the recent wave of teen suicides in response to unrelenting bullying as a result of a teen’s perceived or actual sexual orientation (abc news, 2010). today, populations of runaway teens are still forced to live away from home because of sexuality-related issues. on the streets of new york, where there are only 250 shelter beds for lgbt homeless youth, the rate of hiv infection is three times higher among the homeless than the rest of the population (aviv, 2012). the reality is that in order to survive, these young people turn to squatting and survival sex, putting them at risk. while the stakes are high, the social work knowledge base with regard to sexual minorities is limited (morrow & messinger, 2006). in many ways, social workers have failed sexual minorities, who are still judged, neglected, and taken for granted (aviv, 2012; shepard, 2007a, 2007b, 2013). rather than turn away from this complicated area of practice, more social work scholars are needed to tackle both policy and practice issues related to all the issues of sexuality addressed in dailey’s (1981) framework on holistic human sexuality. the recent policy changes around lgbt equality, hpv vaccination, hiv services, sexuality education, youth services, sexual violence, health care, and reproductive autonomy are forcing the profession to grapple with issues of human sexuality and selfdetermination in increasingly nuanced ways (flavin, 2009). today, social workers are engaging discussions of sexuality in more proactive ways, recognizing sexuality as a vital component for social workers to be able to assess and engage in thoughtful, effective ways (dunk-west & hafford-letchfield, 2011; timm, 2009). this discourse is needed across the profession. after all, social workers are change agents, capable of challenging mechanisms of oppression that continue to control and stigmatize those we serve. conclusion throughout this paper, we presented evidence that suggests that, although human sexuality continues to be a topic of vital importance to social work practice, the subfield of human sexuality within social work is relatively invisible and fragmented. the prevalence of human sexuality social work scholarship and mechanisms for dissemination were discussed. having insight into the struggles of social work scholars can create much needed momentum to propel those within the social work academy to challenge “regimes of the normal” while creating a new more dynamic social work knowledge base (chambon, irving, & epstein, 1999; foucault, 1978; warner, 1999). after all, education is about power, education for change ideally connecting social theory with a practice of social change (gramsci, 1971). such a praxis is desperately needed for social work. fortunately, the foundation for this work exists within current social work education and scholarship. mccave, shepard, winter/human sexuality in social work 423 mechanisms of oppression, such as sexism, heterosexism, ageism, racism, able-bodiedism, and ethnocentrism, are already at the forefront of our conversations. an important next step is to recognize that within each of these “isms” there is prejudice and marginalization specifically tied to a group’s sexual attitudes, identities, or behaviors. yet, further work is needed to raise critical consciousness among those within the social work academy to make visible the insidious dynamics of sexual privilege and oppression. if we do not engage students in a dialog that expands the breadth and depth of knowledge on human sexuality, either as an area for discussion within existing courses or within an elective course, how do we prepare future practitioners and scholars to value and wrestle with issues related to human sexuality? how do we motivate social work educators and practitioners to connect with advocates involved in social movements that are committed to dismantling the mechanisms that marginalize and oppress those who are “different” sexually if they are limited in their understanding of the issues (crimp et al., 1997; d’emilio & freedman, 1997; shepard, 2007b; spade, 2011; warner, 1999)? how do we inspire future scholars to “dare to innovate” (canda, 2003, p. 81) if they feel marginalized for pursuing their academic passions? how do we package or frame each of the separate human sexuality issues (e.g., gay and lesbian families, sexual violence, gender oppression, etc.) as part of a larger whole? social workers greatly need a broad theoretical framework to examine and understand issues of sexuality, as well as a historical context to understand such issues from a generalist perspective crossing the span of the field. given the importance and timeliness of human sexuality issues, we hope this small paper is part of a larger dialogue about sexuality and social work education in theory, practice, and praxis. we call on social work students, teachers, scholars, and practitioners to join the conversation and engage in strategic individual and collective acts that will lead to significant change at all levels of practice and within the academy. if anyone can make this critical change happen, it is 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(2006). defining sexual health. retrieved from http://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/ author note address correspondence to: emily mccave, msw, phd, assistant professor, department of social work quinnipiac university, 275 mount carmel ave., hamden, ct 06518. email: emily.mccave@quinnipiac.edu microsoft word montero copyedit2 _________________ darrel montero, ph.d., is an associate professor in the school of social work at arizona state university in phoenix. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 164-180 end-of-life issues in the united states after terri schiavo: implications for social work practice darrel m. montero abstract: the very public death of terri schiavo in 2005 alerted americans to the growing ethical, medical, and social crises surrounding the status of end-of-life issues and decisions in the united states. currently, only a few states grant terminally ill patients the right to end their lives, with physicians’ help, if they so choose. public opinion data from 1947 to 2011 report that americans support greater rights for individuals facing end-of-life decisions—up to and including physician-assisted suicide and euthanasia. this paper considers the status of end-of-life issues in the united states after terri schiavo’s death and examines the opportunities for advocacy by social workers who serve clients and families encountering this complex and controversial issue. keywords: attitudes, death and dying, end-of-life decisions, euthanasia, physicianassisted suicide, right to die introduction on february 25, 1990, terri schiavo collapsed in her home and never regained consciousness; 15 years later, on march 31, 2005, she died in a florida hospice. terri schiavo’s death and the preceding legal battle to remove her feeding tube ignited a firestorm of debate about the status of end-of-life decisions in the united states. passionate reactions to the case came from all sides: an outraged public, government officials, and the professionals who specifically deal with end-of-life care, notably social workers, nurses, and physicians. this debate revealed how deeply divided the american public is when it comes to euthanasia and end-of-life care. moreover, these debates serve to highlight just how critical end-of-life issues will become as population demographics increasingly reflect a greater proportion of older americans. as freudenheim (2010) aptly notes, over 40% of elderly hospital patients are 65 or older. in addition, the u.s. census bureau (2010) reports that as of 2009, 12.5% of the u.s. population is 65 years of age or older, 5.8% are 75 years of age or older, and 1.5% are 85 years of age or older. freudenheim further observes that by 2030, more than 70 million americans will turn 65, with the fastest-growing segment being over 85 years of age. this specific population tends to be costly to treat, has numerous illnesses, and often requires multiple hospital stays. gardner and kramer (2010) found that end-of-life care sought by this age group focused on dying with dignity and ignoring additional medical treatment to keep them alive. similar findings were reported by leichtentritt (2011), luptak (2010), schroepfer and noh (2010), and thompson and chochinov (2010). in an independent study, the national hospice and palliative care organization suggests that medicare reimbursement cuts will potentially harm the financial stability of 66% of hospice programs in the u.s. (patients rights council, 2011). these cuts will advances in social work, fall 2011, 12(2) 165 only further undermine the growing number of elderly who seek to obtain quality end-oflife care from social workers. public attention to end-of life issues occurred throughout the 1990s with the controversy surrounding jack kevorkian, the michigan doctor who assisted terminally ill patients in taking their lives (kirk & sullivan, 1996), and earlier still with the karen ann quinlan and nancy cruzan cases, which both involved women in vegetative states like schiavo (pence, 2004). while the names attached to the euthanasia debate have changed over time, the core issues and questions continue today (boisvert, 2009; chong & fok, 2009; de bal, gastmans, & dierckx de casterlé, 2008; givens & mitchell, 2009; seale, 2009). euthanasia is an emotionally, politically, and sociologically charged word that evokes a strong reaction in almost every person. from the ancient greek word for “good death,” euthanasia can be defined more specifically by the following characteristics: active versus passive, voluntary versus nonvoluntary, and the role the physician plays in the act (leichtentritt & rettig, 2002, p. 568). the most commonly discussed types of euthanasia are physician-assisted suicide and active voluntary euthanasia. physicianassisted suicide (pas) is a practice whereby physicians prescribe medications or some other form of intervention to hasten death for terminally ill individuals (blevins, preston, & werth, 2005). active voluntary euthanasia (ave) occurs when a patient requests medical assistance in order to bring an end to life, while passive voluntary euthanasia (pve) is when life-sustaining treatment is withdrawn from a patient with the patient’s permission (pakes, 2005; mahmood, 2008). involuntary or nonvoluntary euthanasia involves the euthanasia of unwilling or incapacitated patients and is less frequently addressed in the euthanasia debate (allen et al., 2006). although the practice of involuntary or nonvoluntary euthanasia is rare, it is relevant to the discussion of the terri schiavo case, as schiavo’s wishes regarding end-of-life care were contested in the absence of a written document such as a living will. literature review physician-assisted suicide, patient self-determination, and oregon’s death with dignity act controversy over euthanasia and end-of-life decisions has been prevalent since the beginning of the 20th century, but became particularly heated in the early 1990s (altilio & otis-green, 2011). the patient self-determination act (1990) went into effect nationwide, requiring hospitals, nursing homes, and hospice facilities to provide their patients with legal documents (or advance directives) to convey their decisions about end-of-life care. in 1991, journalist and hemlock society founder derek humphry published final exit, a book that gives terminally ill patients detailed instructions for committing suicide (cited in blendon, szalay, & knox, 1992). during the same year, the michigan board of medicine revoked jack kevorkian’s license to practice medicine after he assisted three people in ending their lives (kirk & sullivan, 1996). montero/end-of-life issues in the united states after terry schiavo 166 while the patient self-determination act provided a national mandate on living wills, individual states also attempted to resolve questions regarding euthanasia. in 1994, oregon voters passed the death with dignity act, which allowed residents to request a lethal dose of medication from a physician under a certain set of circumstances (oregon death with dignity act, 1994). this law was enacted in 1997, legalizing pas under specific circumstances (miller et al., 2004; stevens, 2006), and was upheld by the u.s. supreme court in 2006 (gonzales v. oregon, 2006). other states followed; in november 1998, washington approved physician-assisted suicide, and in january 2010, montana became the third state to legalize the act (knickerbocker, 2010). as of this writing, only three states allow for physician-assisted suicide. the topic became so controversial and salient that the national association of social workers (2003; 2004; 2009) developed several reports to guide social workers on palliative and end-of-life care. demographic influences on end-of-life decisions differences between individuals’ religious and moral perspectives have led to heated debate over the merit of euthanasia (gielen, van den branden, & broeckaert, 2009). those who identify as very religious are less likely to support pas or to consider it for themselves (domino, 2003). caddell and newton (1995) observed a diversity of opinions regarding euthanasia across religions. catholic and conservative protestants viewed active euthanasia as more acceptable than suicide and preferred the physician, rather than the patient or family member, to facilitate the dying process. this finding is consistent with the results of a study from ohio where individuals expressed support for euthanasia when physicians were actively involved and exerted authoritative control over the voluntary procedure (macdonald, 1998). one such highly publicized example of how strongly polarized americans are regarding end-of-life decisions involved terri schiavo. the terry schiavo case in 1990, terri schiavo collapsed in her home and never regained consciousness. despite rehabilitation attempts, schiavo remained in a persistent vegetative state and was dependent on a feeding tube for nutrition and hydration (hampson & emanuel, 2005; kollas & boyer-kollas, 2006). in 1998, michael schiavo, terri schiavo’s husband and guardian, filed his first petition to have terri’s feeding tube removed—which was met with strong objection by schiavo’s family and many right-to-life activists. terri schiavo’s presumed wishes became the subject of intense national controversy; while schiavo made comments to friends and family about her desire not to be kept alive artificially, she had not formalized these wishes in an advance directive or living will (ditto, 2006). in the absence of such a directive, the courts were forced to resolve the question of schiavo’s death or continued life in a persistent vegetative state (preston & kelly, 2006). in 2003, a florida court issued a second order to remove schiavo’s feeding tube. the florida legislature passed hb-35e or “terri’s law” in response. “terri’s law” granted florida governor jeb bush the ability to name a new guardian for schiavo and prevent the removal of schiavo’s feeding tube (kollas & boyer-kollas, 2006). by 2005, the u.s. president, george w. bush, and several members of congress had become involved in advances in social work, fall 2011, 12(2) 167 the schiavo case. congressional involvement began the day after the removal of schiavo’s feeding tube on march 18, 2005, when two republican senators announced that they would call schiavo to testify before a congressional committee. republican leaders in the house of representatives followed suit by subpoenaing schiavo, effectively placing her under federal protection and barring any attempts to remove her feeding tube. congress additionally passed s.686, or the palm sunday compromise, to place the schiavo case under federal jurisdiction. president george w. bush signed the palm sunday compromise after the bill passed, and he also created the protection of incapacitated persons act of 2005 (hampson & emanuel, 2005). on march 31, 2005, terri schiavo died 13 days after her feeding tube was removed. since the schiavo case, euthanasia and end-of-life care have continued to stir strong emotions among the american people (bern-klug, 2010; gorsuch, 2009) and have generated a great deal of research (smith, goy, harvath, & ganzini, 2011). methods the findings of this study are based on published opinion polls from the gallup organization (1996; 2006a; 2006b; 2007a; 2007b; 2011) and the national opinion research center/general social survey (benson, 1999). the design of the sample for personal (face-to-face) surveys is that of a replicated area probability sample down to the block level in the case of urban areas and down to segments of townships in the case of rural areas. after stratifying the nation geographically and by size of community according to information derived from the most recent census, over 350 different sampling locations are selected on a mathematically random basis from within cities, towns, and counties that have, in turn, been selected on a mathematically random basis. the procedures just described are designed to produce samples that approximate the adult civilian population (aged 18 and older) living in private households (that is, excluding those in prisons, hospitals, hotels, and religious and educational institutions, and those living on reservations or military bases) and, in the case of telephone surveys, households with access to a telephone. survey percentages may be applied to census estimates of the size of these populations to project percentages onto the numbers of people. the manner in which the sample is drawn also produces a sample that approximates the distribution of private households in the united states; therefore, survey results can also be projected onto the number of households. results attitudes toward euthanasia for patients who have an incurable disease, 19472007 between 1947 and 2007, a cross section of the american public was asked the following question (see table 1): “when a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his family request it?” the results reveal consistent majority support for voluntary active euthanasia (vae) since the question was first posed in 1947. montero/end-of-life issues in the united states after terry schiavo 168 table 1: attitudes toward euthanasia for patients who have an incurable disease, 1947-2007a year yes % no % don’t know/na % 1947 1950 1973 1977 1978 1982 1983 1985 1986 1988 1989 1990 1991 1993 1994 1996 1998 2001 2002 2003 2004 2005 2006 2007 54 54 53 60 58 61 63 64 66 66 66 69 70 65 68 68 68 65 72 72 69 75 69 71 37 36 40 36 38 34 33 33 31 29 30 26 25 30 27 28 27 31 26 25 29 24 27 27 9 10 7 4 4 5 4 3 4 5 4 5 5 5 5 4 6 4 2 3 2 1 4 2 question: “when a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his family request it?” a figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by gallup organization and other major polling organizations. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled benson (1999) and gallup organization (2006b; 2007b). in 1947, 5 in 10 americans supported a patient’s right to end his or her life when that person was suffering from a terminal illness. beginning in 1977, american attitudes toward euthanasia began to change and support for vae steadily increased, with 6 in 10 advances in social work, fall 2011, 12(2) 169 americans agreeing that a patient with a terminal illness had the right to end his or her life. by 1991, 7 in 10 americans supported euthanasia. by 2005, fully 3 in 4 americans (75%) supported euthanasia, and this figure leveled off to 7 in 10 by 2007. support for doctor-assisted suicide by major social demographic factors, 20032006 from 2003 to 2006, a cross section of the american public was asked two significantly different questions: (1) “when a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his family request it?” (see column 1, table 2) and (2) “when a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it? (see column 2, table 2).” this variation in wording—“end[ing] the patient’s life by some painless means” versus “assist[ing] the patient to commit suicide”—yielded strikingly different results. as shown in table 2, while over 7 in 10 americans support euthanasia according to this set of questions, in contrast, fewer than 6 in 10 indicate support of euthanasia when the word “suicide” was used. without exception, the responses to the questions referencing “suicide” resulted in lower levels of support in every demographic category. table 2 details how responses to these questions broke down by gender, age, race, education, religion, church attendance, political affiliation, and political ideology. support for euthanasia ranges from a low of 54% of americans who attended church almost weekly to a high of 84% of those americans who report no religious preferences whatsoever. frequency of church attendance yields the greatest difference in the survey: from a low of 54% of those reporting weekly or almost weekly church attendance compared with fully 80% of those who seldom or never attended church—a significant 26% difference. when we address the issue of physician-assisted suicide in the second column of table 2, church attendance again yields the sharpest difference. for those americans who report weekly or almost weekly attendance, fewer than 4 in 10 (39%) compared to over 7 in 10 (72%) of those who report seldom or never attending church support a patient’s right to physician-assisted suicide. the second sharpest division in attitudes on the issue of physician-assisted suicide is reported between white and black americans. fully 6 in 10 white americans compared to fewer than 4 in 10 black americans support physician-assisted suicide. attitudes toward the moral acceptability of physician-assisted suicide, 2001-2011 from 2001 to 2011, a cross section of the american public was asked the following question (see table 3): “regardless of whether or not you think it should be legal… please tell me whether you personally believe that in general it [doctor-assisted suicide] is morally acceptable or morally wrong?” montero/end-of-life issues in the united states after terry schiavo 170 table 2 support for doctor-assisted suicide by major social demographic factors, 2003-2006 a support doctor ending patient’s life by painless means % support doctor assisting patient to commit suicide % total sample gender men women age 18to 29-year-olds 30to 49-year olds 50to 64-year olds 65 years and older race whites blacks education high school or less some college college graduates post-graduate education religion protestants catholics no preference church attendance weekly/almost weekly monthly seldom/never party affiliation republicans independents democrats political ideology conservatives moderates liberals 69 73 65 69 72 69 62 70 56 65 69 76 73 61 71 84 54 68 80 63 71 72 57 74 82 58 57 58 56 63 60 47 60 38 48 60 70 69 50 62 81 39 59 72 50 61 61 44 65 70 advances in social work, fall 2011, 12(2) 171 question: “when a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient's life by some painless means if the patient and his family request it? question: “when a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it?” a figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by gallup organization and other major polling organizations. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled by gallup organization (2006b). table 3 attitudes toward the moral acceptability of physician-assisted suicide, 2001-2011a year morally acceptable % morally wrong % depends on situation (vol.) % no opinion not a moral issue (vol.) % 2001 2002 2003 2004 2005 2006 2007 2008 2010 2011 49 50 45 53 49 50 49 51 46 45 40 44 49 41 46 41 44 44 46 48 8 4 5 3 4 6 5 3 6 5 3 2 1 3 1 2 2 1 2 2 question: “regardless of whether or not you think it should be legal… please tell me whether you personally believe that in general it [doctor-assisted suicide] is morally acceptable or morally wrong?” a figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by gallup organization and other major polling organizations. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled by gallup organization (2011). montero/end-of-life issues in the united states after terry schiavo 172 the results of this decade-long survey reveal remarkably stable american public opinion varying only 8 percentage points over 10 survey periods. that is, those reporting moral acceptability of physician-assisted suicide ranged from a low of 45% in 2003 and 2011 to a high of 53% in 2004. thus, over the last decade, we note that a majority or near majority of americans report that physician-assisted suicide is morally acceptable. american attitudes toward the terri schiavo case, 2006-2007 in 2006 and 2007, a cross section of the american public was asked the following three questions (see table 4): 1) “should the feeding tube have been removed from terri schiavo?”, (2) “how do you view congress’s involvement in the terri schiavo case?”, and (3) “do you approve or disapprove of the way george w. bush is handling… the terri schiavo case?” table 4: american attitudes toward the terri schiavo case, 2006-2007a should have % should not have % removal of feeding tube 52 42 approve % disapprove % congressional handling of case 20 76 presidential handling of case 34 53 question: “should the feeding tube have been removed from terri schiavo?” question: “how do you view congress’s involvement in the terri schiavo case?” question: “do you approve or disapprove of the way george w. bush is handling… the terri schiavo case?” a figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by gallup organization and other major polling organizations. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled by gallup organization (2006a; 2007a). when asked about the removal of schiavo’s feeding tube, a bare majority (52%) of americans believed that schiavo’s feeding tube should have been removed. when polled about congressional and presidential handling of the schiavo case, americans were decidedly opposed to congressional involvement in the schiavo case: only 1 in 5 americans approved. similarly, barely 1 in 3 americans approved of president george w. bush’s handling of the schiavo case. advances in social work, fall 2011, 12(2) 173 discussion since 1947, american support of vae has steadily increased. this trend suggests that americans are increasingly sensitive to the plight of terminally ill patients and are more willing to support euthanasia under certain circumstances. the terri schiavo case made national news, as did the cases of nancy cruzan and karen ann quinlan, and thereby raised critical questions regarding quality of life for individuals in a persistent vegetative state. this undoubtedly played a role in changing public sentiment regarding euthanasia and pas (kollas & boyer-kollas, 2006). it is interesting to note that increased support for both pas and vae corresponded with media attention generated by jack kevorkian, who began assisting patients in ending their lives in the early 1990s (kirk & sullivan, 1996). in 1997, oregon became the first state to legalize physician-assisted suicide or pas. the oregon death with dignity act allows physicians to write prescriptions for lethal doses of medication for terminally ill patients who request such medication in writing (okie, 2005). patients must be physically and mentally capable of making the request, and two witnesses must affirm the patient’s wishes. further, one witness must be unrelated to the patient and not be entitled to any financial benefit from the patient’s death. once the patient has made such a request, a mandatory 15-day waiting period applies, during which time the patient may cancel the request (miller et al., 2004). it is important to note that doctors are not required to help a patient end his or her life and that any physician who assists a patient does so voluntarily. while clear support for pas existed in oregon, which created the law, and among american citizens in other states, the federal government still took strong measures to render the law ineffective and override oregon voters’ decision. as with the terri schiavo case, both congress and the executive branch became involved. in 2000, the u.s. senate and house of representatives attempted to nullify the oregon death with dignity act through the creation of the pain relief promotion act (klinck, 2001). in 2002, u.s. attorney general john ashcroft attempted to invoke the controlled substances act to prevent doctors from prescribing oregon residents with lethal doses of medication—an attempt a federal judge later overruled (johnson, 2002). these strong parallels to federal involvement with the schiavo case are noteworthy in that they speak to the disconnect that exists between public opinion toward death-and-dying issues and the attitudes and actions of the government. concerns related to end-of-life issues involve many professions in the arena of health care, social services, and law. care-giving professions such as physicians, nurses, and social workers have the responsibility to adhere to current law, carry out patients’ wishes to the extent possible, and continue to advocate for patients and family members encountering the challenges of end-of-life decisions. the social work and larger medical community have a responsibility to adhere to current law, even when some physicians desire to honor their patients’ wishes. a patient’s mental competency is a heavily weighted determinant as to whether he or she might request physician-assisted suicide. montero/end-of-life issues in the united states after terry schiavo 174 implications for social work practice end-of-life care will undoubtedly continue to have significant implications for social workers. euthanasia, advance directives, and death-and-dying issues are often accompanied by grief, loss, chronic illness, and questions about morality, religion, family relationships, and responsibility. social workers are uniquely equipped to support patients and families encountering the challenges of end-of-life decisions. the national association of social workers [nasw] (2003) has developed a pertinent policy statement to assist social workers in working with end-of-life decisions and terminal patients. nasw mandates that social workers have a critical role assisting individuals with their end-of-life options without the use of coercion. self-determination is a core value for social workers. towards this end, these individuals should make their own decisions after all options are made known to them. nasw (2004) does not take any specific position on issues dealing with end of life; they are much more concerned with the care of the individual during this time, especially with children and those with developmental disabilities and/or mental illnesses. nasw’s (2009) updated statements on end-of-life care (pp. 114-120) and hospice care (pp. 186-191) were adopted by their delegate assembly in 2008. these two policy statements are the result of the assembly’s systematic approach to policy development and guide nasw’s advocacy efforts in social policy. each statement provides approximately 25 policy recommendations that guide social workers’ practice in this field. in addition to the nasw policy statements on end-of-life care, there are a variety of other resources that social workers can draw from. for example, university of washington school of medicine (2009) guidelines require physicians to abide by a set of duties and responsibilities. as well, the national hospice and palliative care organization also provides a variety of resources useful for social workers (patients rights council, 2011). it is an important responsibility for social workers to become knowledgeable concerning end-of-life issues. the responsibility to take action to withdraw actual life support appliances falls within the responsibility of the medical profession, a heavy responsibility that calls for legal sanction and personal and professional management on the part of the particular health provider. ethically, the social worker can only refer their clients and families to professionals that specialize in these types of issues (nasw, 2003, 2004). this study suggests that the american public supports terminally ill patients’ right to choose physician-assisted suicide under specific circumstances, even though this right is currently unavailable in most states. social workers serve families and individuals facing end-of-life decisions and have the potential to act as advocates for the rights of terminally ill patients. advocacy at mezzoand macro-levels can help impact policy. figueiramcdonough (1993) describes policy practice as the “neglected side of social work interventions” (p. 179). she articulates four approaches to policy practice—legislative advocacy, reform through litigation, social action, and social policy analysis—which we apply here in hopes of inspiring such work. advances in social work, fall 2011, 12(2) 175 legislative advocacy although a majority of the american public clearly supports legalizing pas and euthanasia, this option is only currently available in a few states. social workers may interpret this disparity to mean that a majority of americans’ voices are not being heard and that an extremely vulnerable portion of the population—the terminally ill—is not being served or having its interests represented. it is imperative that social workers organize to lobby for the opportunity of people to preserve the right to determine the course of their own lives. social work practitioners can work within the ethical framework of the nasw to organize the american public to influence legislation and end-of-life laws so that personal choices will be honored for the terminally ill and their families (allen et al., 2006; csikai & bass, 2000). it is interesting to note the various legislative efforts across the u.s. attempting to legalize physician-assisted suicide. from january 2011 through june 2011, at least seven bills had been introduced (patients rights council, 2011). montana, oregon, and washington have produced annual reports documenting the implementation of physicianassisted suicide and end-of-life care (montana legislative services, 2011; oregon department of human services, 2011; washington state department of health, 2011). these reports may serve as exemplars for other states seeking to pass similar legislation. reform through litigation individuals who investigate euthanasia as an option to end their lives are typically affected by chronic pain and/or terminal illness. americans would greatly benefit from reform through litigation because elected officials have been unwilling to represent the wishes of a majority of the american public with regard to end-of-life issues. social workers are qualified to represent the community’s wishes and should work toward reform through litigation to correct often unresponsive and non-representative state and federal laws regarding pas and euthanasia. several recent litigation cases have explored the rights of patients to physicianassisted suicide (see baxter v. state, 2009; smith v. state, 2009). these cases can serve as informational models for social workers as they use litigation advocacy to facilitate their patients’ rights to quality end-of-life care. overall, current laws are not favorable for patients and their families seeking end-of-life care (frank & anselmi, 2011). thus, if social workers implement these and similar models, it may serve to expedite and facilitate the litigation process. meisel and cerminara (2010) provide a comprehensive (nearly 1400-page) book on statutory and case law addressing the issue of end-of-life care. social workers may find this detailed manual to be an effective resource which they may dawn from to implement reform through litigation. social action although each approach has the potential to improve the rights of terminally ill patients in the united states, community-based social action may be more accessible to montero/end-of-life issues in the united states after terry schiavo 176 social workers than reform through litigation because social workers receive formal training in social action techniques as opposed to technical legal training. social workers could employ this approach on a local level by establishing ongoing dialogue within their community about end-of-life issues and by mobilizing community players and elected officials for change. knowledge of public opinion data, like those presented here, could aid social workers in their work toward expanding the rights of terminally ill patients. specific findings in this article—such as how support for euthanasia and pas has grown over time and has consistent majority approval—may be important “leverage points” that social workers can use to advocate for the rights of the terminally ill. social workers should also become aware of george soros’s project on death in america, which has provided funding to raise awareness in the field of palliative medicine and thereby improve end-of-life care (mcglinchey, 2004). social policy analysis social workers would benefit by becoming familiar with the provisions and status of the oregon death with dignity act, as this may be pertinent to any end-of-life discussion in their community. becoming knowledgeable about the provisions of the act, such as who has been impacted by it and how families have been affected, has the potential of being highly persuasive in any public debate. if state legislation proposed the expansion of the rights of terminally ill patients, social workers could take the lead in testifying regarding meeting the needs of this vulnerable segment of the population. the status of social work practice after the terri schiavo case could be likened to the calm after a storm or, perhaps, the calm before an even larger storm to come. although terri schiavo’s story no longer dominates the national news, the record number of baby boomers nearing retirement 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(2011, march 10). 2010 death with dignity act report. retrieved from http://doh.wa.gov/dwda author note: address correspondence to: dr. darrel montero, arizona state university school of social work, mc 3920, 411 north central avenue, ste. 800, phoenix, az 85004-0689. email: darrel.montero@asu.edu microsoft word dybicz_pyles copyedit2 _________________ phillip dybicz, ph.d., is an assistant professor in the department of social welfare at keimyung university in daegu, south korea. loretta pyles, ph.d., is an associate professor of social welfare and director, community and public service program, state university of new york at albany. the present research has been supported by the bisa research grant of keimyung university in 2011. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 301-317 the dialectic method: a critical and postmodern alternative to the scientific method phillip dybicz loretta pyles abstract: this paper introduces hans-georg gadamer's dialectic method and elaborates upon its application to social work inquiry. its strengths lie in its ability to uncover socially constructed truths, to explain human behavior in a non-deterministic manner that emphasizes personal agency and empowerment, and to foster a consciousnessraising process that leads to praxis. this makes it ideally suited for knowledge gathering by practitioners in the field who seek to apply postmodern practice approaches such as the strengths perspective, solution-building therapy, and narrative therapy. examples are given of its application to both micro and macro practice concerns. keywords: empowerment; hermeneutics; research methods; critical theory introduction when assisting individuals with their life issues or working with communities to promote development, social workers engage in a process of inquiry that informs interventions and actions. in order to have confidence in the knowledge acquired from an inquiry, one must follow a systematic method for gathering the knowledge relevant to one’s concerns. in its drive towards professionalization in the early 1900s, social work embraced the scientific method as its model for inquiry (leighninger, 2000; trattner, 1999). consequently, traditional social work practice has become an exercise in hypothesis testing as reflected in its early embrace of the medical model (leighninger, 1987; specht & courtney, 1995) and its current evolution into a problem-solving model for practice (blundo, 2006; de jong & berg, 2008; turner & jaco, 1996). knowledge is gathered, an assessment is made, and then an intervention delivered based upon the assessment (gambrill, 2006; hepworth, rooney, & larsen, 2009; johnson & yanca, 2009). since abraham's flexner's infamous speech (1915) critiquing social work for lacking a unique body of knowledge, over the past 100 years social work academics have amassed an impressive quantity of scientific knowledge. thus, one aspect of social work education involves fostering the ability of a student to consume this knowledge and apply it to practice. the role that scientific knowledge can and should play in social work practice is not the topic of this paper.1 social work education also seeks to educate students (through research methods courses) about a method of inquiry through which to gather knowledge and seek truth. drawing from the field of psychology, our profession embraced the scientific method and, in the 1960s, began to elaborate a dream of the social worker as being a scientist-practitioner (wakefield & kirk, 1996; witkin, 1996). in the 1970s, fischer (1973; 1981) attempted to fuel this dream by offering single-system advances in social work, fall 2011, 12(2) 302 design as a means for practitioners to apply the scientific method as a form of inquiry. popular current approaches are to teach program evaluation and evidence-based practice (grinnell & unrau, 2011; royse, thyer, & padgett, 2009). yet while the ideal of the scientist-practitioner remains strong in social work research textbooks, this dream has never reached fruition in the field. in a survey of 7,000 bsw and msw social work practitioners (teare & sheafor 1995), respondents listed competencies in research inquiry as having minimal importance to their work. yet to look within mainstream textbooks, alternatives to the scientific method appear quite limited. for example, rubin and babbie (2005) list the following as ways of knowing that are alternatives to the scientific method: tradition, authority, common sense, and popular media. most social work research textbooks (drake & jonson-reid, 2007; engel & schutt, 2010; grinnell & unrau, 2011) advance the notion that when gathering knowledge and seeking truth, the scientific method is the only legitimate game in town. to do otherwise, one falls prey to ignorance. however, there in fact exist alternative systems of rigorous inquiry to the scientific method—one need only to look to the humanist traditions of history, philosophy, and literary studies as proof that systematic investigation can be accomplished without following the scientific method. when the term "research" is interpreted to mean "a systematic method of knowledge gathering for determining truth" as opposed to simply being interpreted as "the scientific method", other possible forms of inquiry arise. for example, when we reflect upon the type of knowledge gathering done by practitioners as they delve into clients' lives, it seems clear that practitioners might benefit from a thorough knowledge of the comparative method— the methodological inquiry that drives historical research and investigative journalism. in this paper, the authors introduce another alternative: the dialectic method. in western thought, the dialectic method itself originated during the time of socrates around 400 bce. it is the methodology that currently fuels critical theory, feminist epistemology, and various forms of postmodernist thought. its ability to bring to light contradictions and drive a consciousness-raising process among its inquirers makes it ideally suited for postmodern and critical social work practice approaches. besides the importance of embracing contradictions, social work scholars of dialectics have noted the importance of dialectical thought in contributing towards the social construction of identities and the interconnectedness relevant to social work practice (leonard, 1997; tsang, 2000). the authors begin with a discussion of the history of the evolution of the dialectic method as a way to elaborate its basic principles and how they guide inquiry. next, gadamer’s (1960/1999) model for dialectic inquiry will be elaborated with attention given to its use as a model for social work inquiry. lastly, examples will be given of these principles at work in guiding postmodern and critical micro and macro practice approaches. history of dialectic method2 socrates “i only know that i know nothing.” this simple phrase uttered by socrates encapsulates the core of his wisdom, and forms the roots from which the dialectic method has grown. plato’s writings on socrates illustrating the dialectic method in this pure form dybicz, pyles/the dialectic method 303 (known as the early dialogues) always ended with a non-answer. in one such dialogue, socrates enters into a dialogue with euthyphro concerning the meaning of piety. at the beginning of the conversation, euthyphro is quite certain he knows what piety is; socrates adopts the position that he does not know. by the end of the dialogue, socrates is still not certain of one true definition for piety, yet also, he has moved euthyphro to this same conclusion. this is an example of a successful use of the dialectic method because the purpose of socrates’ inquiry is to break through one’s hubris that one “knows” and thus free the mind to critically examine alternate possibilities. as mcavoy (1999) notes, “it is the bite or sting that wakes us from our complacency, arouses us to excellence, to learn and discover and inquire” (p. 19). in social work literature, anderson and goolishian (1992) are noted for first elaborating the merits of such a not-knowing approach when entering a dialogue with clients. the social worker takes on the role of socrates as the not-knowing inquirer, while the client is in the role of euthyphro. the “bite or sting” serves to awaken clients to question oppressive devaluations of their identity and thus consider more empowering identity conclusions. more will be elaborated upon this later in the application to social work section. hegel and marx (the beginnings of critical theory) hegel's writings represent a modern reformulation of the socratic dialectic method and the roots of the critical tradition. the centerpiece of hegel’s philosophy was human freedom, or agency, and specifically the unique ability of human consciousness to be aware of itself and reflect on its future (blackburn, 1994). in contrast to the newtonian project, dialectics arises from phenomenology's stance that “all ‘things’ are actually processes, that these processes are in constant motion, or development, and that this development is driven by the tension created by two interrelated opposites acting in contradiction with each other” (au, 2007, p. 2). these processes are known as phenomena, and are conceived as comprising an existence plus an essence. hegel (1830/1991) postulated that logic and history follow a dialectical pattern, what fichte (kaufman, 1988) later called the “thesis-antithesis-synthesis.”3 hegel posited that this dialectic was fundamentally constituted in the realm of ideas or spirit. marx’s innovation was to “turn hegel on his head” by arguing that the dialectic operated in the material realm, namely through production, i.e. economics. philosophical materialism, as opposed to hegel’s philosophical idealism, means that our understanding of a phenomenon's essence stems from our interactions with the material world and not vice versa.4 for marx, dialectics is not just an epistemological or ontological theory, but it necessarily involves praxis. thus, for social work practice, dialectical inquiry is a not just a way to generate knowledge; it is also a key component of social work practice itself. the marxian dialectic—with its focus upon praxis and the analysis of power relations—provided the framework of inquiry from which critical theory was born. beginning in the first half of the 20th century, critical theory represented the application of the marxian dialectic by various german philosophers and social theorists, loosely known as the frankfurt school, to critique existing social practices by shedding light on advances in social work, fall 2011, 12(2) 304 the oppression arising from contradictions within the capitalist economy (jay, 1973/1996). as elaborated by horkheimer (1982), critical theory aims toward a specific purpose, “to liberate human beings from the circumstances that enslave them” (p. 244).5 husserl and heidegger (the beginnings of a postmodern dialectic) husserl (1913/1982) labeled both hegel's and marx's stance on phenomenology as the “natural standpoint”: the essence of the phenomenon lies within the phenomenon itself, and accurate perception is needed in order to reveal it. by contrast, husserl (1913/1982) advanced the notion that the essence of the phenomenon lies within human consciousness. heidegger (1927/1962) advanced husserl's standpoint even further by arguing that the essence of a phenomenon lies within language, and hence, culture. thus under heidegger's definition, the phenomenological understanding of reality becomes an endeavor aimed at accurate interpretation rather than accurate perception. consequently, his approach gained the label of hermeneutic phenomenology. with its stance that reality arises from accurate interpretation, a heideggerian phenomenological investigation opens the door for the recognition of the existence of multiple realities, thus putting it in alignment with social constructionism—a theory that holds much affinity with postmodern social work practices. this latest evolution of phenomenological thought, represented by heidegger, laid the foundation once again for a re-formulation of dialectical inquiry (elaborated by gadamer below). this reformulation enabled postmodern theorists to embrace critical theory as an approach of its own, moving it off its narrow economic base of examining oppression arising from class relations to more broadly examining the oppression visited upon individuals from cultural societal narratives defining gendered relations, racial relations, and relations of various sexual orientations, to name but a few (kaufman, 2003; lindlof & taylor, 2002). within critical theory based in postmodern thought, the area where this enslavement occurs is in the construction of identity that de-values the individual or community. so for example, social work scholars have spoken to the dynamic of how a diagnostic label comes to dominate the client's identity within the helping relationship (de jong & berg, 2008; saleebey, 2006b). the consciousness-raising process that arises from a dialectical inquiry serves to liberate individuals through insights that empower them to reassert their own power in defining who they are and who they wish to be (via the recognition that many possible realities exist). praxis (understanding that necessarily translates into action) occurs as individuals find that they can no longer act in ways that support the oppressive societal narratives. furthermore, this same praxis causes them to confront material structures of oppression in society spawned by these dominant societal narratives. gadamer building upon the hermeneutic insights of heidegger, gadamer (1960/1999), in his seminal work truth and method, offers up a new formulation of the dialectic method: dybicz, pyles/the dialectic method 305 thesis-antithesis-fusion of horizons. his dialectic approach has been labeled philosophical hermeneutics.6 gadamer's project involves elaborating a dialectic method to be used for encountering historical and literary texts, but more broadly it speaks to a dialogue that leads to the understanding of reality. gadamer's dialectic method has its application to social work inquiry via the stance of viewing humans' lived experiences as a behavioral text (white & epston, 1990). crucial to gadamer's (1960/1999) elaboration are the following concepts: bias, world, horizon, and fusion of horizons. bias: when the process of capturing the reality of an object (as in science) or a phenomenon (as in phenomenology) is seen as requiring accurate perception, bias is seen as an obstacle to this process. however, with heidegger's (1927/1962) move of viewing the essence of a phenomenon as something granted to it by language, bias represents this granting of essence, and thus contributes to the construction of reality. this is because when one encounters the existence of a phenomenon, one must use language when seeking to understand it. within this formulation, bias has a neutral connotation as it is an integral component of reality; gadamer (1960/1999) re-labels “bias” as “foreunderstanding”. this fore-understanding is a product of one's historical-social consciousness—one's unique encounter with the culture (societal, familial, work, etc.) of one's time. world: only human beings have a world (gadamer, 1960/1999). all other living things have a habitat. since human beings possess a consciousness, and thus by necessity seek to understand their habitat (via language) rather than simply interact with it, humans rise above their habitat and live within a world (a phenomenon comprised of existence plus essence). one's historical-cultural consciousness constructs one's world. thus, bias plays an active part in this construction as it is necessary for navigating one's world. take for example an encounter with a stop sign. when one encounters a stop sign, one brings a fore-understanding of how to interpret the stop sign. if one had to interpret the stop sign anew each time one encountered it, along with everything else in one's world, one would not be able to function effectively. horizon: gadamer (1960/1999) uses the term “horizon” to describe the outer boundaries of one's historical-cultural consciousness, the outer limits of one's understanding: we started by saying that a hermeneutical situation is determined by prejudices that we bring with us. they constitute, then, the horizon of a particular present, for they represent that beyond which it is impossible to see (p. 272). while fore-understanding allows one to easily function in one's world, it is also limiting in that it creates a horizon of understanding beyond which one is not able to conceive of alternative possibilities of being. fusion of horizons: gadamer is quick to point out that one's present horizon of understanding is not a static condition. it is open to change, as is one's historical-cultural consciousness. in fact, a change in one's historical-cultural consciousness is the goal of a dialectical inquiry. this is why it can be described as a consciousness-raising experience. gadamer (1960/1999) notes the following: advances in social work, fall 2011, 12(2) 306 in fact the horizon of the present is being continually formed, in that we have continually to test all our prejudices. an important part of this testing is the encounter with the past and the understanding of the tradition from which we come.... understanding, rather, is always the fusion of these horizons which we imagine to exist by themselves (p. 273). in this passage, gadamer is speaking about one's encounter with a past historical or literary text. one brings one's own world, one's own horizon of understanding, to the interpretation of the text. but also, one opens up a dialogue with a past world, the horizon of understanding that existed when the text was created. the resulting dialogue results in a fusion of horizons, a constructed reality born from both worlds; a new foreunderstanding is created. as the final step in the dialectical process, this dynamic will be explored in more detail in the following section. in terms of social work inquiry, people's lived experiences are looked upon as a behavioral text. one's present horizon of understanding constructs a reality for these experiences—a reality that speaks to one's identity. social work inquiry turns its focus upon those constructed realities that exert an oppressive influence on individuals by undercutting their self worth. a second horizon of understanding is sought that is in opposition to the oppressive constructed reality of concern, and thus serves as a means to question its legitimacy. this opens up a dialogue from which arises the fusion of the two, a constructed reality that no longer operates in an oppressive manner, and thus no longer undercuts the client’s self worth. gadamer's dialectic method an important feature that distinguishes gadamer's (1960/1999) dialectic method from that established by hegel (1830/1991) is that gadamer returns dialectic inquiry to its socratic roots by embracing dialogue as its driving force. hegel places the dialectic inquiry within a monologue, the singular voice of reason drives the inquiry in its attempts to accurately perceive a single reality. hegel's monologue of reason leads to the inquiry's formulation being that of thesis-antithesis-synthesis. synthesis represents a single understanding, a single reality that arises from the opposites. by contrast, gadamer's (1960/1999) formulation is that of thesis-antithesis-fusion of horizons. this can be further elaborated as thesis (present familiar horizon of understanding)-antithesis (alien horizon of understanding)-fusion of horizons. the antithesis represents an alternative constructed reality, one which serves to question the legitimacy of the constructed reality of the thesis. such a movement is what begins the consciousness-raising process. the fusion of horizons represents the dialogue that opens up between the thesis and the antithesis, wherein the biases of the thesis are tested and other possible constructed realities explored (for social work, this concerns other articulations of identity). the elaboration that follows will emphasize the affinity gadamer's (1960/1999) formulation holds for understanding a behavioral text—the lived experiences of persons. dybicz, pyles/the dialectic method 307 thesis (present familiar horizon of understanding) within a social work dialectic inquiry, the social worker plays the role of socrates. he or she adopts the stance of “not knowing” and invites the client (individual/family/community) into a dialogue about a topic of vital interest to the client. thus the beginning of this dialogue will involve the client elaborating his or her understanding of the topic. this understanding is the thesis of the dialectical inquiry. within various postmodern social work literature (brubaker & wright, 2006; white & epston, 1990), this thesis is often described as a dominant or master narrative. when applied to micro practice, this thesis will arise from the presenting problem and focus upon how it acts in an oppressive manner concerning the client’s identity conclusions. when applied to macro practice, the thesis will also arise from the presenting problem with the focus this time being upon oppression operating at the structural level in society upon a marginalized group (and the resulting identity conclusion that arises). the role of socrates is important here as the client is placed in the position of having to explain this understanding to someone who is “ignorant” and thus does not know. normally, one's biases, one's fore-understanding, operate at the intuitive level. the process of having to explain one's fore-understanding to someone who is ignorant necessarily moves this fore-understanding from one's intuitive level to one's conscious level of understanding. once these biases are exposed in one's conscious level of understanding, they can be examined and tested. gadamer (1960/1999) views dialectic inquiry as a conversation that relies upon the art of questioning, “dialectic, as the art of asking questions, proves itself only because the person who knows how to ask questions is able to persist in his [sic] questioning, which involves being able to preserve his orientation towards openness” (p. 330). this is where the expertise of the social worker comes into play. the social worker's expertise is that of a critical consciousness; this allows her or him to step into the role of socrates and artfully ask questions that preserve the openness of the conversation to other possibilities. in this first phase of the dialectic inquiry—elaborating the thesis—the social worker's critical consciousness directs him or her to explore the various identity conclusions that arise from the client's understanding of the thesis. mindful of the theory of mimesis (dybicz, 2010a; ricoeur 1984-88), he or she knows that a change in client's actions will arise from a change in identity conclusions. antithesis (alien horizon of understanding) the expertise of the social worker is relied upon even more heavily in this phase of the inquiry. in this phase of the dialectical conversation, the client is called upon to elaborate an understanding that is alien, and contrary to the client's understanding presented in the thesis. the knowledge of these other possibilities arises from the artful questioning by the social worker. gadamer (1960/1999) notes the following: ... as soon as we accept the priority of the question over the answer, which is the basis of the concept of knowledge. knowledge always means, precisely, looking at opposites. its superiority over preconceived opinion consists in the fact that it is able to conceive of possibilities as possibilities (p. 328). advances in social work, fall 2011, 12(2) 308 gadamer (1960/1999) also notes that a dynamic important for this knowledge to arise is that both parties of the conversation genuinely seek the truth, and thus work together towards this goal: to conduct a conversation requires first of all that partners to it do not talk at cross purposes.... it requires that one does not try to out-argue the other person, but that one really considers the weight of the other's opinion. hence, it is an art of testing. but the art of testing is the art of questioning.... a person who possesses the 'art' of questioning is a person who is able to prevent the suppression of questions by the dominant opinion (p. 330). the dominant opinion referred to above is the thesis, or master narrative. the social worker's expertise brings to the table a critical consciousness that frees him or her from the constraint that a dominant opinion would normally exert. thus the social worker is free to consider other possibilities of interpreting the behavioral text, hence other possible constructed realities (and the resulting identity conclusions that arise from them). the antithesis that arises does not come from fore-knowledge on the part of the social worker, as the social worker truly does not know what this will be for the client. the client must elaborate this antithesis, but the client is guided by the artful questioning of the social worker. as the thesis currently represents the client’s reality, the artful questioning seeks to invoke the imagination of the client as the vehicle for elaborating the antithesis. for example, one illustration of this process can be seen in solution building therapy (dejong & berg, 2008) with the asking of the miracle question. the miracle question asks the client to imagine life absent the problem. artful questioning on the part of the social worker encourages the client to slowly but surely elaborate such a picture (and the resulting identity conclusions that arise from it). the assets-based community development (abcd) approach advocated for by kretzmann and mcknight (1997) provides another example. the social worker uses an assets assessment as a tool to inspire artful questioning that leads the residents to elaborate a view of their community as an oasis of resources, thus taking ownership of their community's identity in a way that contradicts the previous problem-saturated narrative. fusion of horizons once the thesis and antithesis are clearly elaborated, the dialogue continues between these opposite poles and from within which a new understanding (i.e., a new constructed reality) will arise from the fusion of the two. each has something to contribute to this fusion. the thesis contributes the phenomenal objects (i.e., lived experiences comprising the behavioral text) that are of vital interest to the client. this vital interest is what initiated the inquiry process and thus serves to frame it. some of these lived experiences are what abbott (2002) describes as a constituent event (of a narrative or text). a constituent event is an event that is necessary to the narrative for it to maintain the integrity of its topic. for example, a pregnant teenager who is struggling over this issue cannot simple ignore the fact that she is pregnant: her pregnancy is a constituent event. in addition, abbott (2002) states that narratives are also comprised of supplementary events. while not necessary to maintain the integrity of the topic, supplementary events dybicz, pyles/the dialectic method 309 contribute towards the theme that arises from the narrative (i.e. identity conclusions from a behavioral text). as many of the identity conclusions from the thesis undercut the client's self worth, many of the thesis’ supplementary events are discarded as inappropriate. a well elaborated antithesis contributes the identity conclusions that are lifeenhancing, and thus of vital interest to the client. while these identity conclusions arise from a horizon of understanding based within the client’s imagination, they can be made applicable to the client’s present behavioral text. this is done in two ways. first, they can act as a lens in which to discover heretofore ignored supplementary events in the client’s behavioral text which support these life-enhancing identity conclusions. second, in being clearly elaborated as a firm ideal to which to aspire, they serve to motivate future actions on the part of the client. it is human imagination which allows us to create hopes and dreams. these future actions will be new supplementary and constituent events added to the client’s behavioral text. again, these will be events that support these life-enhancing identity conclusions. as the conversation unfolds, eventually a truth arises from the fusion of these horizons of understanding. as we are speaking to constructed realities, this will be a poetic truth, or what bruner (1986) refers to as verisimilitude. yet it will be a truth that demands recognition all the same. gadamer (1960/1999) describes this in the following manner: the unique and continuing relevance of the platonic dialogues is due to this art of strengthening, for in the process what is said is continually transformed into the uttermost possibilities of its rightness and truth and overcomes all opposing argument which seeks to limit its validity…. whoever wants to know something cannot just leave it a matter of mere opinion…. it is always the speaker who is challenged until the truth of what is under discussion finally emerges…. what emerges in its truth is the logos, which is neither mine nor yours and hence so far transcends the subjective opinions of the partners to the dialogue that even the person leading the conversation remains ignorant (p. 331). the relativism inherent in postmodern thought allows for the acceptance of multiple realities (multiple valid interpretations of the behavioral text). yet, once a dialectic inquiry is begun, a particular truth will arise from the context driving the inquiry that best serves the vital interests of the engaged parties. application to social work micro practice through the therapeutic conversation, social work is able to take gadamer’s (1960/1999) notion of dialogue and give it life in its pure form: following the model of socrates, two parties (social worker and client, where the client can be an individual or a family) engage in a dialogue as equals,7 collaborating together to find truth. in the postmodern context, this truth is one of “multiple realities”, or in other words, the verisimilitude of a social construction. the strengths perspective (saleebey, 2006a), advances in social work, fall 2011, 12(2) 310 solution building therapy (dejong & berg, 2008), and narrative therapy (white, 2007) are three prominent postmodern approaches that embrace the notion that the client is the expert, that dialogue should arise from a collaboration of equals, and that social constructions speak to the client's identity. this makes each highly amenable to a knowledge gathering process driven by the dialectic method. it should be noted that with the focus of this article being the elaboration of the dialectic method—a heady project in and of itself—for ease of understanding, a deliberate choice is made to keep the reference to narrative therapy, solution-building therapy, and the strengths perspective at this very broad and general level: they all spring from postmodern thought (e.g., all embrace social constructionism, collaboration, and a focus upon articulating identity). and hence, the argument is made that the dialectic method can be used effectively with each approach. we do not seek to favor one approach over another. upon first engagement with a client, each of these approaches privileges the client's understanding of the presenting life issue. by adopting a not-knowing stance, the social worker seeks to artfully ask questions that encourage the client to clearly and consciously "map the influence of the problem" (white & epston, 1990, p. 42) and thus obtain "the client's frame of reference" (de jong & berg, 2008, p. 55). this description represents the thesis—the master narrative (i.e., bias) under which the client is currently operating. furthermore, questions are posed that speak to the articulation of the client's identity arising from this thesis. next, the social worker poses questions that lead to the formulation of the antithesis: the client's image of life absent any hindrances from the problem. an appeal is made to the client's imagination to create such an image. the miracle question (de jong & berg, 2008), externalization of the problem (white & epston, 1990), and a client's ultimate dream or goal (rapp & goscha, 2006) are all examples of how this appeal is made. these techniques are used to artfully guide questions that speak to a new, life-enhancing articulation of the client's identity. this alternative articulation of the client's identity marks the beginning of the consciousness-raising process. lastly, the social worker poses questions that seek some type of fusion between these two horizons of understanding (thesis and antithesis). constituent events from the thesis are retained (i.e., events stemming from the presenting problem), while the antithesis' articulation of identity spawns questions that seek previously ignored strengths (rapp & goscha, 2006), exceptions (de jong & berg, 2008), and unique outcomes (white & epston, 1990) to serve as supplementary events in the client's narrative—all of which emphasize the client's personal agency in creating the event. the understanding arising from this fusion (and the resulting articulation of the client's identity) leads to praxis: the client's actions begin to change so that they reflect this new articulation of identity and in the process create a pathway towards successful amelioration of the problem, oftentimes in dramatic fashion. consciousness-raising allows clients to realize that there are many possible articulations of their identity, and that they have a strong voice in that articulation. dybicz, pyles/the dialectic method 311 macro practice for macro practice, the dialectic method offers a way to understand and confront the workings of power in society, power that leads to oppression. for this reason, employing a marxian dialectic is still a vital and valid approach, as its materialism directly confronts material forms of oppression. indeed, saul alinsky (1971), a classical icon of community organizing, advocated the use of dialogue to motivate other potential organizers as well as opponents. in rules for radicals, alinsky (1971) offers an example of the marxian dialectic at work through a conversation with an individual living in slum housing, the goal of which is to create what he terms “friction”. just as important as the recognition of the contradiction—the material injustice—is the awareness of personal agency, group empowerment, and strategies for change. this is exemplified through the idea that if everyone in the building engaged in resistance, a successful outcome might be achieved. a gadamerian dialectic inquiry based within hermeneutics confronts the power exerted by societal narratives interpreting reality. thus it recognizes that societal narratives are not created via a dialogue among equals, as in the socratic model, but rather arise from unequal social, political, cultural, and gendered relations. paulo freire’s use of dialectical methods in his popular education and organizing efforts serves as an illustration of gademerian dialectics operating in macro practice settings (au, 2007; freire, 1970; gadotti, 1994). freire uses dialogical relationships facilitated through problematizing education by critiquing traditional banking education (where the teacher merely makes deposits in the minds of students). banking education explains how those with little power in society internalize the master narratives of the oppressor (thesis). freire worked with illiterate peasants in brazil teaching them not only to read but using his popular education techniques as a strategy for “conscientization” (antithesis). eventually, the students/peasants come to imagine how they might go about advocating for changes in their situation given their current constraints and new visions (fusion of horizons). both saleebey's (2006b) application of the strengths perspective to community development and kretzmann and mcknight’s (1997) abcd approach follow a gadamerian dialectic mode of inquiry, similar to that illustrated by friere (1970). when the social worker first enters a troubled community, the first step involves confronting residents' beliefs that their community does not contain any assets or resources (thesis). like an individual dominated by a diagnostic label, the identity of the community has been dominated by societal narratives that advance a pathologizing “needs-driven dead end” method of community development, diagnosing communities as a host of social problems (e.g., poverty, homelessness, criminal behavior, drug abuse). a strengths or assets assessment is conducted which seeks to identify the resources, assets, and capacities of the community, which, in turn, crafts a life-enhancing picture of the community's identity (antithesis). this sparks the imagination of residents on how to confront community problems (fusion of horizons), by: helping unleash the power, vision, capacities, and talents within a (self-defined) [my emphasis] community so that the community can strengthen its internal relationships ... strengthen its relationship to outside institutions, associations, advances in social work, fall 2011, 12(2) 312 and organizations ... that allows the community to find its heart, solve its problems, and reach its goals (saleebey, 2006b, p. 246). a few other social work scholars have articulated postmodern and critical theories and applied them to issues in macro practice. pyles’ (2009) social work textbook on community organizing provides a framework that draws heavily from critical and postmodern traditions, including social constructionism, critical theory, feminist theory, and freirian pedagogy. for example, in a section of the book focused on overcoming barriers to coalition building, pyles notes that practitioners must de-construct societal narratives that tend to pit groups against each other, arguing that a critical-social constructionist framework can help practitioners overcome “the divide and conquer” narrative. houston (2008) has advocated the use of critical and postmodern social theory for social workers to understand identity formation in a new way, specifically using the example of working with communities to transcend ethnoreligious identities in northern ireland. conclusion a systematic method of investigation is necessary to provide rigor to one’s inquiry. however, at the same time, the method circumscribes the type of questions that can be asked, and thus the truths that can be uncovered. while valuable scientific knowledge continues to be produced by social work academics and consumed by social work practitioners, when it comes to knowledge gathering methods (i.e. research), is it truly in the best interest of our profession to limit ourselves to only teaching the scientific method (whether qualitative or quantitative) in research courses? do we wish to continue to propagate the myth of a false choice between science and ignorance (drake & jonsonreid, 2007; rubin & babbie, 2005). one does not need to abandon science in order to embrace other legitimate methods of inquiry.8 it is time to expand our conception of "research" when teaching research courses and embrace the humanist base of our profession and the rich traditions in methods of inquiry that it has to offer. this article has described the basic principles of the dialectic method, and has briefly outlined its relevance as a method of inquiry to drive postmodern and critical practice approaches that embrace empowerment, personal agency, and the human spirit—uncovering truths in these areas that lie outside the grasp of scientific inquiry. the scientific method's form of inquiry is bounded by the proposition of a subjectobject dichotomy: subjects (i.e., observers) seek to accurately perceive objects (entities). within this proposition, truth exists "out there" in the object of study and must be discovered by the subject. this is why such truth is labeled as objective truth. it lies within the object, independent of the subject. the goal of the subject (observer) is to remain as neutral as possible; any broach of this neutrality interferes with the observer's ability to accurately perceive the truth. as mentioned earlier, the comparative method is also capable of operating within this proposition, guiding historical research and investigative journalism. the rise of postmodern thought and critical theory has given credence to the long disabused notion of subjective truth. subjective truth arises when the subject contributes dybicz, pyles/the dialectic method 313 to the creation of truth. when operating within the dichotomous subject-object proposition wherein the scientific paradigm lies, subjective truth is not the goal. subjective truth is seen as objective truth that has been corrupted by bias, and hence, is more personal opinion than truth. but as was elaborated earlier, heidegger (1927/1962) advanced a new notion of phenomenology, an hermeneutic phenomenology. the phenomenon (existence plus essence) of investigation (e.g., in social work, the client and his/her life problem) operates hermeneutically. there is a fusion between subject-object rather than a dichotomy. the object (entity) contains the qualities of existence of the phenomenon. the inquiring subjects, via the process of dialogue, socially construct the essence of the phenomenon. gadamer's (1960/1999) 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(1996). if empirical practice is the answer, then what is the question? social work research, 20(2), 69-76. author note: address correspondence to: phillip dybicz, keimyung university, department of social welfare, college of social science building, 2800 dalgubeoldaero, dalseo-gu, daegu 704-701, south korea. email: pdybicz@gmail.com dybicz, pyles/the dialectic method 317 endnotes 1 for an extended treatment on the role that science plays in postmodern practice see dybicz (2010b). 2 this represents a history of the dialectic method in western philosophical traditions. yet the dialectic method has also arisen in both hindu and buddhist philosophical traditions as well. 3 hegel himself did not use the terms thesis-antithesis-synthesis to describe his approach, yet it is this formulation that is popularly used to describe his method (kaufman, 1988). hegel's dialectical pattern brings to fore contradictions and self-consciousness that are eventually resolved, though leading to and revealing new contradictions. importantly, each progressive stage of the dialectic “sublates” the previous stage, which means for hegel not only a moving on or overcoming of the previous stage, but a retaining of what was in the previous stage (hegel, 1830/1991). 4 the point of marx’s materialist dialectics is to understand the interrelated processes transpiring in the material world and provide a space for intervention in those processes to improve the material world (au, 2007). marx believed that the dialectic played itself out historically through class conflict such as through the working class and ownership class, eventually resolving itself in a revolution of the working class through socialism and communism. 5 this definition distinguishes critical theory from modernist, normative theory which seeks to simply explain and predict human behavior. critical theorists from the frankfurt school argued that critical theory involves practical application in a moral or value-laden sense, as opposed to normative theory which seeks practical application in an instrumental sense (horkheimer 1993). 6 so to summarize, hegel's work represents dialectical inquiry as philosophical idealism. marx's work represents dialectical inquiry as philosophical materialism. and gadamer's work represents dialectical inquiry as philosophical hermeneutics. 7 while it is always important within the social worker-client relationship to maintain awareness of the power differential arising from the social worker's authority, postmodern practitioners emphasize that the dialogue driving the dialectical inquiry should be entered into in the spirit of equals (de jong & berg, 2008; saleebey 2006b; white, 2007). they seek to capture this equality through emphasizing collaboration and adopting the stance that the client is the expert. 8 in recent years, naturalistic inquiry (lincoln & guba, 1985), constructivist research (rodwell, 1998) and participatory action research (mctaggart, 1997) all represent attempts to incorporate postmodern insights into the development of new types of investigations. while certainly representing worthy endeavors, they generally consider themselves as types of scientific research. they seek to broaden the scope of the scientific method, not leave the scientific paradigm completely. microsoft word osborne article final bb __________ victoria a. osborne, ph.d., msw, is an assistant professor, while l. ashley gage, msw, and abigail j. rolbiecki, b.s., are doctoral students, all in the school of social work at the university of missouri in columbia. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 166-184 psychosocial effects of trauma on military women serving in the national guard and reserves victoria a. osborne l. ashley gage abigail j. rolbiecki abstract: women involved in all aspects of the united states armed forces face mental health needs that are unique from women in the general population. because the most recent wars in iraq and afghanistan are involving more women in combat situations, social workers encounter female clients who are increasingly experiencing posttraumatic stress disorder, substance misuse, and sexual violence. special attention must be paid particularly to women who serve in the national guard or reserves, as they have different concerns than enlisted active duty women. these concerns include less social support and fewer resources upon return from deployment. thus, it is imperative for social workers in the community to be aware of these military women’s experiences and unique mental health challenges in order to effectively treat their needs. keywords: military women, military sexual assault, female service members, women in the military, national guard, united states reserve component introduction who are “military women”? the term “military women” has numerous meanings. until recently, most descriptions of women involved in military life referred to wives of enlisted men, women in civilian posts within the military, or women in other non-combat related military service. this changed with operation desert shield and desert storm in the early 1990s, when women began serving closer to the combat theatre. for example, women flew operational combat missions for the first time in 1998 (martin, 2010). regardless of what “military women” has meant throughout the years, one thing has remained the same: these women have been affected in some way by military involvement. “military women” have an extensive history of service in the armed forces. women have been involved in u.s. military service since the revolutionary war, but they did not enter all branches of the armed forces until world war ii. in 1948, congress allowed women to be permanent members of the military in non-war times (alliance for national defense, 2005). however, they stipulated that women could make up no more than 2% of the force and this was not repealed until 1967 (alliance for national defense, 2005). while there were women serving in the vietnam war, most were registered nurses (taft, monson, hebenstreit, king, & king, 2009). women were not deployed to the combat theatre until the conflicts of the 1990s (operation desert shield and operation desert osborne, gage, rolbiecki/mental health needs of military women 167 storm) and more recently, operation enduring freedom (oef) and operation iraqi freedom (oif) (cave, 2009). women currently represent approximately 10% of all u.s. armed forces in iraq and afghanistan (martin, 2010). recent surveys report women comprise approximately 15% of the u.s. military (military family resource center, 2009) and about 55% of women serving in the military are minorities (haskell, gordon, mattocks, duggal, erdos, justice, & brandt, 2010). women represent 17% of national guard and reserve component members (military family resource center, 2009), 20% of new military recruits to active duty (goldzweig, balekian, rolón, yano, & shekelle, 2006), and about 7% of the veteran population. approximately 40% of women returning from service in iraq and afghanistan utilize va health services (haskell et al., 2010). enlisted women are now witnessing injuries and deaths whereas previous exposure was limited to their roles as medics or nurses, helping to heal the wounded men. thus, in the past ten to fifteen years, researchers have been able to examine the toll of military life, especially combat, on the lives of women. however, there remains a gap in the research on military women, particularly active duty enlisted women and officers, including women in the national guard and reserve components. because there has been limited research investigating the impact of military service among servicewomen, particularly deployment during wartime, and because social workers in the community will more often work with women in the national guard and reserve component rather than active duty members, this paper focuses on women serving in the national guard and reserves of the united states armed forces. branches of the u.s. military women’s service in the branches of the u.s. military varies. there are differences between branches in the military with regard to types of service and mental health issues women may be likely to encounter. women experience unique challenges depending upon the branch; some branches are known more for having a higher percentage of occupations and positions available to women (e.g., coast guard) and others the lowest (e.g., marine corps) (alliance for national defense, 2005). though the size of both active and reserve components of the military have significantly decreased since 1990, the number of women has increased for both components (military family resource center, 2009). women comprise 17.8% of reserve component members (reservists), 10% of national guard, and 14.3% of active duty members (military family resource center, 2009; haskell et al., 2010). reservists, women who serve in the reserves component of all branches of the armed forces, experience perhaps the greatest amount of challenges. men and women serving in the national guard and reserve units are typically older than full-time enlisted soldiers and more likely to have civilian jobs or careers (kehle & polusny, 2010). they do not usually live around their military instillation after they return home and thus typically have little postdeployment support (kehle & polusny, 2010), yet they comprise about half of the forces in oif (stetz, castro, & bliese, 2007). studies have shown national guard women and men tend to have a greater risk for post-traumatic stress advances in social work, spring 2012, 13(1) 168 disorder (ptsd) and mental health issues than active duty personnel; in fact, approximately 42% of oif national guard troops and reservists have mental health problems (milliken, auchterlonie, & hoge, 2007). there has been little, if any, research on gender differences, other than sexual harassment and assault rates among reservist women (e.g., street, stafford, mahan, & hendricks, 2008). service-related trauma post-traumatic stress disorder (ptsd) is a common outcome of war-zone exposure. according to shea et al. (2010) the current war efforts in iraq and afghanistan have led to the interest in studying post-deployment mental health issues. shea et al. (2010) examined members of the national guard and reserve deploying in support of oef and oif, and found a strong association between ptsd and poorer psychosocial functioning. further, they note that study participants who were unable to interact functionally in social situations had more symptoms of avoidance, distress, and hyperarousal. ptsd can negatively impact the overall health status of female veterans. ouimette and colleagues (2004), state that members who have ptsd typically possess poorer overall health functioning and an increased likelihood of a greater number of medical conditions, including mental health disorders like anxiety, depression, and substance abuse. ptsd can be devastating for any military service member, but women returning from deployment with the national guard or reserves may have an even more difficult time recovering from their condition for a variety of reasons including lack of resources and social support. the following sections highlight two main traumas associated with service-related ptsd and how women in the national guard and reserves can have more difficulty in recovery: combat trauma and military sexual trauma. combat trauma there is a very small body of research measuring female veterans’ exposure to combat, however, as more women continue to deploy, interest in this topic has steadily increased (zinzow, grubaugh, monnier, suffoletta-maierle, & frueh, 2007). many military women will have direct exposure to combat operations, and as a result some will become injured, or even lose their life. the cost of war is insurmountable, and in addition to injury and death, members are at risk for developing serious mental health conditions such as posttraumatic stress disorder (shea, vujanovic, mansfield, sevin, & fengjuan, 2010). one of the strengths with the female veteran population is that they are more inclined than men to report combat exposure, and as a result, they are likely going to receive treatment they need; whereas male veterans may not report these issues, thus remain untreated (zinzow et al., 2007). even though women are more inclined to report exposure to trauma, there are still barriers to receiving this treatment, especially in a va setting. for example, women are often reluctant to disclose military-related trauma experiences with clinicians from the va because of the shame and stigma associated with these feelings (zinzow et al., 2007). additionally, service women have expressed a lack of continuity of care for military-related trauma (e.g. consistency). osborne, gage, rolbiecki/mental health needs of military women 169 military sexual trauma sexual trauma is a traumatic experience for all women, however, women in the military experience more challenges with reporting the incident and obtaining legal and medical attention than their civilian counterparts. oftentimes, they have to report back to their duty station and face the perpetrator every day; this situation is not as common in the general population (suris, lind, kashner, borman, & petty, 2004). for military women, experiences of military sexual trauma (mst) often result in several co-morbid disorders such as substance abuse, depression, anxiety, and ptsd. natelson (2009) reported that mst is a stronger predictor of ptsd among female service members than exposure to combat operations (natelson, 2009). in fact, studies have shown that exposure to sexual trauma and harassment causes equal amounts of ptsd in women as combat exposure does to men (natelson, 2009). in the military, women are more often victims of sexual harassment and assault than are men (murdoch, pryor, polusny, & gackstetter, 2007). recent reports show ranges of sexual assault from 4.2% to 7.3% for active duty women and 11% to 48% for female veterans; sexual harassment rates ranged from 55% to 79%, based on reported events (goldzweig et al., 2006). more recent research on women veterans from oif/oef show 14% screened positive for mst (haskell et al., 2010). perpetrators can be residents of the overseas country where women are stationed, or more commonly colleagues or superiors of the enlisted women. actual rates of assault and harassment are unclear, as many women are afraid to charge their fellow soldiers—or worse, their superiors—with crimes. although the armed forces have recently put a great deal of effort into sexual assault reporting practices, women are still hesitant to bring charges. women are encouraged to report assault through the sexual assault prevention and response (sapr) program, established by the department of defense in 2004; however, many military regulations serve as barriers to reporting the incident. for example, the department of defense’s two-tiered system of reporting may discourage a woman from reporting an incident. under this two-tiered system, the report is either filed as restricted or unrestricted; both differ drastically when it comes to confidentiality and anonymity. restricted reporting occurs when the victim’s primary goal is to seek medical assistance and counseling (williams & kunsook, 2010). this type of reporting is said to be confidential and the victim’s report remains anonymous. however, if the victim wishes to prosecute their assailant, they are required to file an unrestricted report, which is not anonymous. unrestricted reporting impacts the victim’s decision to proceed with prosecution, making it difficult for the perpetrator to be punished (williams & kunsook, 2010). female service members serving in the national guard and reserve components of the military have unique challenges to reporting and seeking help for mst. they often lack many of the resources that their active duty counterparts receive. survivors of mst in the national guard and reserve are asked to report incidents to the chaplain’s office, however limitations include issues with confidentiality and quality of care. chaplains are often not licensed clinicians, therefore many are not qualified rape counselors. moreover, unlike civilian women, victims of mst can rarely change their careers (service women’s advances in social work, spring 2012, 13(1) 170 action network [swan], 2010). if the unit’s chain of command fails to enforce an equal opportunity policy, victims are forced to live in hostile environments and fear future incidences of harassment or assault. reports show that approximately three-fourths of servicewomen who were raped did not report the assault (swan, 2010). several factors influence the victim’s ability to report the incident, including pressure from the victim’s chain of command, the victim’s efficacy in their ability to report the information, fear of the consequence from disclosing the information, and the unit’s operation tempo (op tempo). in military environments many times the perpetrators outrank their victims, as they may be supervisors or superiors. this allows higher-ranking perpetrators considerable control over the victims in the work environment (swan, 2010), which can create barriers to disclosing the information to medical and legal professionals. by seeking legal and medical help, the victim not only fears retaliation by her command, but she may also worry about harassment from colleagues (swan, 2010). oftentimes, mst is underreported because the victim fears that reports will jeopardize her military career. an estimated 33% of the 75% of women who did not report sexual assault did not know how to report the incident (swan, 2010). additionally, many times anonymity is compromised in reporting cases of assault, as women must give their rank, gender, age, race and branch of service when submitting an assault report (swan, 2010). this makes reporting the case anonymously very difficult, which further outweighs the benefit of seeking medical or legal attention. mental health disorders related to trauma experience mood disorders military women are at risk for developing anxiety and mood disorders, particularly those women deployed to combat areas (e.g., fiedler, ozakinci, hallman, wartenberg, brewer, barrett, & kipen, 2006). gulf war veterans who were exposed to combat reported higher rates of depression and anxiety than those not exposed to combat (black, carney, peloso et al., 2004). a recent study of iraq and afghanistan soldiers revealed women were more likely to be diagnosed with depression than men (haskell et al., 2010). part of the gender differences are marked by female military members having more predisposing psychosocial risk factors for combat-related depression than military men, including greater prevalence of childhood abuse and adult sexual assault (cox, ghahramanlou-holloway, szeto, greene, engel, wynn, bradley, & grammer, 2011). additionally, gender differences can be attributed to military women having less social support than men (e.g., vogt, pless, king, & king, 2005). women in the reserves or national guard may be at even greater risk as they have even less social networks and resources available than active duty service members (cogan, 2011). indeed, smith and colleagues (smith, ryan, wingard, slymen, sallis, & kritz-silverstein, 2008) found higher levels for ptsd for reserve and national guard members than active duty members, perhaps attributable to less social support. thus, women in the reserves or osborne, gage, rolbiecki/mental health needs of military women 171 national guard may be at greater risk for developing mood disorders than women in other active duty branches. suicide rates and suicide attempts are also increasing (yamane & butler, 2009), particularly for younger active duty women (wojcik, akhtar, & hassell, 2009). weiner, richmond, conigliaro, and wiebe (2011) found higher rates of suicide as cause of death for women in the military compared to women civilians; 25% of all female military deaths were attributed to suicide, which was the leading cause of death among military women. this is in contrast to a general female population prevalence of 1.6%. suicide among men and women in the national guard and reserves has also increased between 2009 and 2010, again attributed to less access to military health care than their active duty peers, as well as reintegration issues that differ from active duty members (goldstein, 2010). however, there is little research on suicide and related factors among branches of the military, and even less with regard to gender differences between branches. substance abuse substance abuse, particularly of alcohol and prescription drugs, is a concern for women trying to cope with stressors and mental health disorders. distinctive military conditions such as relocation overseas, separation from family, or a greater perceived acceptance of substance use, may foster higher rates among military personnel (ames & cunradi, 2004/2005). although alcohol misuse is common during military enlistment, it seems to be more prevalent during times of pre-deployment (e.g., hoge, castro, messer, mcgurk, cotting, & koffman, 2004), perhaps because substances are used as a coping mechanism. deployment stress, and drinking to cope, may be a greater problem among members of the national guard or reservists, as they have less resources available for dealing with pre-deployment stress and have jobs and lives outside of the military (ferrier-auerbach, kehle, erbes, arbisi, thuras, & polusny, 2009; jacobson, ryan, hooper, smith, amoroso, boyko, gackstetter, wells, & bell, 2008). burnett-zeigler, ilgen, valenstein, zivin, gorman, blow, duffy, and chermack (2011) found greater alcohol misuse among oie/oif national guard men and women. likewise, rates of postdeployment heavy alcohol use are higher for deployed men and women than for those who did not deploy (federman, bray, & kroutil, 2000). gender differences exist with regard to alcohol and tobacco use. military men drink more than their female counterparts (ames & cunradi, 2004/2005); however, among military women alcohol consumption is approximately 15% greater than alcohol consumption among civilian women. the difference between military men versus civilian men’s consumption is approximately 7%. bray and marsden (2000) found that 5% of women in the military were heavy drinkers. a study of national guard oie/oif men and women examining alcohol misuse found 23% of national guard women reported harmful drinking (burnett-ziegler et al., 2011). though gender differences were not reported, jacobson et al. (2008) found reserve and national guard members who reported combat exposure to have significantly higher odds of new-onset heavy weekly drinking and binge drinking. additionally, whereas only heavy drinking men were likely to use illegal drugs, even moderately heavy drinking women in the military are likely to advances in social work, spring 2012, 13(1) 172 use them (kao, schneider, & hoffman 2000). thus, the difference between military and civilian women’s drinking is higher than the difference between military and civilian men. military women serve in a male-dominated work environment, which itself is a risk factor for heavy drinking (wallace, sheehan, & young-xu, 2009). while working in a male-dominated environment is a risk factor for civilian women as well, women in the military experience additional stressors that civilian women may not (e.g., combat and related traumatic events) (wallace et al., 2009). military women are also less likely to use traditional coping mechanisms that civilian women are more apt to utilize to cope with stressors (norwood, ursano, & gabbay, 1997). additionally, after returning from being deployed, women who deployed were almost three times as likely to report alcohol misuse than women who were not deployed (federman et al., 2000). military women also have a higher prevalence of using tobacco (45%) than men or than civilian women, and the same rate as military men of heavy smoking (30%) (bray, fairbank & marsden, 1999). substance abuse programs such as tricare’s smoking cessation program (ucanquit2.org) and a changing culture in the military that discourages heavy drinking and alcohol abuse as well as underage drinking (wallace et al., 2009) are helping to lower rates of misuse and increase treatment options. still, rates remain high. eating disorders eating disorders are highly comorbid with substance use disorders, ptsd, and mood disorders (streigel-moore, garvin, dohm, & rosenheck, 1999). studies of service members suggest males and females participate in bulimic behaviors more than civilians (peterson, talcott, kelleher, & smith, 1995). additionally, mcnulty (1997) found a higher prevalence of anorexia, bulimia and eating disorder nos among active duty navy nurses than among civilians. a more recent study reported higher disordered eating patterns in enlisted women than enlisted men, and more so for soldiers who had had previous psychiatric treatment for other disorders (warner, warner, matuszak, rachal, flynn, & grieger, 2007). a high percentage of enlisted women develop abnormal eating patterns or eating disorders, at a rate higher than the general population (lauder, williams, campbell, davis, & sherman, 1999). a survey of active duty military women found 33.6% of women met criteria for being “at risk” of an eating disorder, and 27% of those at risk had a diagnosable eating disorder. overall, there was an 8% prevalence rate of eating disorders (anorexia nervosa, bulimia nervosa and binge eating disorder) in the military, higher than the general population at about 6% (hudson, hiripi, pope, & kessler, 2007; lauder et al., 1999). more recent research on disordered eating among deployed military women reported no significant correlation between deployment and disordered eating (jacobson, smith, smith, keel, amoroso, & wells, 2009). however, women who were exposed to combat were almost twice as likely to develop disordered eating patterns and more than two times as likely to lose an extreme amount of weight, compared to men and women who were not exposed to combat (jacobson et al., 2009). one explanation may be that women osborne, gage, rolbiecki/mental health needs of military women 173 serving in the military feel similar pressures as women athletes, to maintain certain body size and be physically active; likewise, women serving in active duty may feel similar societal pressures to be “thin” as women not serving in the military (lauder et al., 1999). furthermore, enlisted soldiers have fitness testing and weigh-ins periodically, and studies have shown disordered eating patterns increase around these times, including binging and purging, laxative use, and fasting (garber, boyer, pollack, chang, & shafer, 2008). carlton, manos, and van slyke (2005) reported high rates of disordered eating among enlisted navy women and men, with behaviors increasing before weigh-ins (“making weight”) and fitness tests. another reason for higher prevalence among women serving in the military is using disordered eating patterns and exercise as a way to gain control over their lives and cope with stressors (jacobson et al., 2009). there is limited research related to eating disorders among military men and women in active duty. moreover, few studies have been conducted specifically examining differences among branches of the military, including national guard and reserve components. lauder and campbell (2001) found that 20% of women in the reserve officer training corps (rotc) cadet examined had reported abnormal eating behaviors, putting them at risk for developing an eating disorder. thus, eating disorders among women in different branches of the military remains an important area to investigate. social issues for national guard and reserve component military women reintegration into civilian life is a difficult challenge for most veterans and ptsd may increase the likelihood of readjustment problems (sayer, noorbaloochi, frazier, carlson, gravely, & murdoch, 2010). the department of defense has recognized the need for reintegration plans for active duty service members by having an established system to assist members in their transition to civilian life. however, national guard and reserve components had minimal plans in place for reintegration (u.s. government accounting office [gao], 2005). in 2008, congress recognized that reintegration and access to services can be particularly challenging for reserve components and so they funded the yellow ribbon reintegration program (yrrp) through the national defense authorization act. despite the growing numbers of female service members in both active duty and reserve components, many of these reintegration plans fail to incorporate services that meet distinct needs of female service members (business professional women foundation [bpw], 2007). furthermore, the differences between components result in different reintegration needs for each. work popular media has reported on the condition of female veterans’ unemployment and career reintegration challenges (e.g., thiruvengadam, 2011). according to the u.s. department of labor (2011) gulf war ii veterans, those who have served since september 2001, have an unemployment rate of 11.5%; however female gulf war ii veterans have a slightly higher unemployment rate of 12%. the u.s. department of defense provides the transition assistance program (tap) for reintegration back into civilian life, including some services for reserve component service members (u.s. gao, advances in social work, spring 2012, 13(1) 174 2005). however, these services are limited for reserve component members due to the shorter demobilization period they have and the distance from tap services, which tend to be near major military instillations (bpw, 2007). active duty female veterans report that the tap services are helpful acquiring a job, but long-term support is lacking where it is needed (bpw, 2007). yrrps do provide some employment and career assistance, however neither tap or yrrps are mandated to provide specific programs for female service members. other federal programs have also been implemented to address employment issues for veterans. for example, the department of labor established america’s heroes at work, a website dedicated to educating and preparing employers for hiring veterans with traumatic brain injuries or ptsd (u.s. department of labor, 2011). a ptsd diagnosis can greatly impact one’s employability and ability to work. ptsd symptom severity tends to impact female veterans’ ability to work and satisfaction with work; that is, as symptom severity increases, so do impairment and dissatisfaction (schnurr & lunney, 2011). unemployment and ptsd symptoms are risk factors for homelessness in female veterans (washington, kleimann, michelini, kleimann, & canning, 2010), which is a serious issue considering that one in four female veterans are homeless (gamache, rosenheck, & tessler, 2003). social network social support is an important aspect affecting the risk of developing ptsd among veterans. vogt et al. (2011) report that social support is a greater mediator of ptsd symptoms for female veterans than for male. related to post-deployment social support, veterans who reported more concern for relationships during deployment were also strongly related to ptsd symptoms and this is, again, stronger for female veterans (vogt, smith, elwy, martin, schultz, drainoni, & eisen, 2011). relationship concerns may be valid for some female service members; the rate of divorce is higher for female service members than it is for male service members (karney & crown, 2007). this increased rate is stable across service component and rank (karney & crown, 2007). overall, the divorce rate is higher among military service members (karney & crown, 2007), but marriage in the armed forces differs compared to civilian marriage patterns (hogan & furst-seifert, 2009). military personnel with active-duty experience are three times more likely to marry between the ages of 23 and 25 compared to civilians, and military personnel who have served more than two years in active duty are significantly more likely to be divorced (hogan & furst-seifert, 2009). members of the national guard and reserve often volunteer for deployments, as opposed to being called for duty, which further increases partners’ stress. they typically do not associate themselves as being a “military family” which alienates them from the military culture and also their access to support (huebner et al., 2010). faber, willerton, clymer, macdermid, and weiss (2008) suggested reserve component families experienced role confusion during the member’s deployment and military family support groups provided assistance to families while adjusting to deployment and reunification. resources that help families adjust and cope with deployment are often not available because guardsmen and reservists are “geographically dispersed” throughout their states osborne, gage, rolbiecki/mental health needs of military women 175 and are typically not close to their duty stations (huebner, mancini, wade, mcelhaney, wiles, butler, & ford, 2010). this could potentially reduce the amount of resources available to the family because they are less likely to have access to services and programs and may not be able to associate with a network of people who are experiencing the same deployment frustrations (huebner et al., 2010). access to care women have repeatedly reported that the va system lacks appropriate services for women’s health (kelly, vogt, scheiderer, ouimette, daley, wolfe, et al., 2008). throughout the last four decades, reforms have been introduced in order to meet the rising demand for female-centered care. the number of female service members is at an all-time high, which has resulted in an even greater demand for appropriate care. despite reforms, gender disparities still exist at the expense of women’s health. as noted, the impact of mst has resounding effects on female veterans’ access to health care and general health. repeated violence against female veterans was linked to an increased use in health care (booth, falk, segal, & segal, 2004). women who experience mst also report a greater difficulty in readjustment, compared to female members without a history of military sexual trauma (katz, bloor, cojucar, & draper, 2007). despite the detrimental impact of sexual trauma, female veterans reported a greater perceived difficulty in accessing va health care and they cited impediments to receiving quality care, such as problems with va staff and a lack of services fit for addressing the needs of female veterans (kelly et al., 2008). military members of both genders reported a perceived lack of competence of military health care services, though female members specifically emphasized a lack of female centered knowledge (jennings, loan, heiner, hemman, & swanson, 2005). washington, et al. (2007) reported that female veterans lack an awareness of va health care entitlements and access and they also reported they felt the va health care system lacked gender specific sensitivity and competence. female veterans’ perceptions of gender-specific care has been reported in va mental health care as well; that is, female veterans with ptsd have reported that women-centered treatment was the most important factor contributing to their comfort with va services (fontana & rosenheck, 2006). gender differences exist in issues related to va mental health care services in addition to those reported for the health care system at large. proportionately, women have slightly more mental health concerns than men (hoge et al., 2006) and women veterans’ mental health diagnoses differ in type (fontana, rosenheck, & desai, 2010). congruent with reports that women experience more mst during service, women attributed their ptsd most often to mst, whereas men reported combat related exposure as the most prevalent cause for ptsd (fontana et al., 2010). service access differs between genders, in that women tend to seek services on an outpatient basis especially women who have comorbid physical and mental health problems (frayne, yu, yano, et al., 2007). though a body of literature is beginning to accumulate regarding female veterans’ experiences with the va health care system, fewer studies have specifically advances in social work, spring 2012, 13(1) 176 focused on women in reserve components or reserve members’ families. reserve component members reported more health concerns, referrals to mental health care, interpersonal conflicts, ptsd, depression, and other mental health risks than active duty members (milliken et al., 2007). among existing resources and programs provided to reserve members and their families is the yrrp. the program was created to support service members and their families through each phase of deployment: pre-deployment, during deployment and post-deployment. additionally, programs for communities and service members’ employers upon re-deployment or release from active duty are offered to help with successful reintegration (national guard bureau joint support services, 2010). services include education and assistance with tricare, the military’s insurance plan, and veterans affairs benefits such as health services, classes in anger management and substance abuse prevention, personal safety education including domestic violence awareness and services, along with more specialized issues which are unique to married and single service members (national guard bureau joint support services, 2010). additionally, the national guard bureau offers a psychological health program, developed to focus on the challenges unique to national guard service members. because national guard armories and wings are typically more community-based and not located near military treatment facilities (e.g., veterans administration hospitals and services), programs such as the psychological health program provide these necessary services. the uniqueness of the national guard members’ lives as civilians prior to and after deployment necessitates reliance on community resources to help them reintegrate and adjust from military life to civilian life (national guard bureau joint support services, 2010). where do we go from here? a research and service agenda this paper has highlighted issues that women serving in the reserve component and national guard experience that are unique to other women in the military. though these women encounter some similar issues as their male counterparts, they are at risk for additional problems including sexual assault, interpersonal violence, higher rates of eating disorders and substance use disorders. similarly, women in these two military branches experience more difficulties than active duty women with regard to social supports, access to healthcare, and higher rates of suicide and other mental health issues. military women, particularly those in the national guard and reserves, also have fewer services available to them than men. the need exists for more specialized services to women, more research on women’s substance misuse, mental health and sexual assault issues. there needs to be a more gendered approach to services, as the number of women who will use va services is projected to double within five years (maze, 2010). additionally, there needs to be an increase in the awareness focused on the unique needs of military women, particularly those serving in branches like the national guard and reserves where many military health and support services are not available or easily accessible. osborne, gage, rolbiecki/mental health needs of military women 177 social workers are important to improving service availability and utilization. social workers who work within the va system, as well as those in the general population who are not specifically oriented to veterans or military members’ issues, need to be educated on the unique mental health concerns of all military women, while serving in the military and after deployment. social workers need to provide services or referral mechanisms for women to reintegrate to their lives after deployment. these services can include helping women cope with ptsd and combat-related anxiety, mst-related ptsd and depression, family issues, financial concerns, substance misuse, eating disorders, traumatic brain injuries, and other physical injuries. social workers are particularly well suited to conduct community-based group therapy sessions, family therapy sessions, psychoeducation programs, and workshops that can help military women heal. federal funding agencies are beginning to understand the need for more research into military health and mental health, but more focus needs to be placed on gender differences and women-specific issues. women’s issues have not been researched well or extensively; while there is quite a substantial body of literature on military men’s mental and physical health issues and the effects of combat and deployment on men, there is a paucity of research with regard to women. as more data exists from women’s more extensive military service in the past two decades, we need to examine the effects of military life on women. similarly, as the oei/oif wars marked the first time national guard and reservists were deployed for active service during combat, much research is needed that will focus on the unique challenges these women face predeployment and upon returning home. references alliance for national defense. 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(2007). trauma among female veterans: a critical review. trauma, violence, & abuse, 8, 384-400. doi: 10.1177/1524838007307295 author’s note: address correspondence to: victoria a. osborne, ph.d., school of social work, university of missouri, 704 clark hall, columbia, mo 65211. email: osbornev@missouri.edu. after june 1, 2012, correspondence should be sent to victoria a osborne, ph.d., msw, assistant research professor, st. louis university school of medicine, department of family and community medicine, 1402 s. grand blvd, st. louis, mo 63104. e-mail: vosborne@slu.edu. microsoft word elllett_cw iv-e copyedit final ______________  alberta j. ellett, ph.d., is an associate professor in the university of georgia school of social work in athens, ga. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 63-79 a first-hand account of title iv-e child welfare initiatives in social work education and practice alberta j. ellett abstract: this article describes the personal experiences and insights of a child welfare practitioner and professor derived from 20 years of involvement in iv-e agency/university partnerships. the author describes perspectives from her work in iv-e programs in multiple contexts (federal, state, and local). included are descriptions of important historical events and changes in iv-e programs that have served to facilitate or impede successful child welfare practices and the education of iv-e students. emphasis is given to the importance of: (a) communicating the complexity of work in child welfare particularly by iv-e students; (b) the challenge of sustaining effective iv-e partnership programs; (c) designing and implementing sound iv-e program evaluation procedures; and (d) understanding the political and policy-driven contexts framing current cw practices. keywords: child welfare, iv-e partnerships, workforce professionalization after 25 years of public child welfare practice as a caseworker (ga & la), supervisor (ga & la), state office foster care program manager, and iv-e agency/university partnership administrator (la), i decided it was time to recruit, educate and prepare the next generation of child welfare employees. of course becoming a higher education faculty member required a doctorate. i entered the louisiana state university (lsu) social work ph.d. program in 1996 which meant that i had to be focused to graduate before i began collecting social security. i made this career change in 2000 as an assistant professor where i continue as a professor at the university of georgia (uga), school of social work. my experiences in a variety of positions in public child welfare and experiences as a social work faculty member have provided me with multiple personal perspectives on current concepts, issues, and practices in cw. this article traces the evolution of the title iv-e funded social work education initiatives following the de-professionalization of child welfare (cw) through my firsthand experiences in child welfare practice, policy, education, and research over the past four decades. social work educators have the responsibility to prepare iv-e graduates to be competent practitioners in their work with families which have multiple problems and needs, and to work with other child welfare employees in stressful and difficult environments. the national iv-e historical context for social work educators is described followed by personal experiences in louisiana as the state office administrator of the ive university/agency partnerships, as the uga director of the iv-e child welfare education program, and several of my national level activities. it concludes with needs and some optimism for the future of a long and grand-intermingling of sw education and cw practice. advances in social work, spring 2014, 15(1) 64 national policy, legal, and practice context the u.s. children’s bureau (cb) was established in 1912 at the same time that social work (sw) education was emerging in universities. because there were few child welfare programs available to address child maltreatment, foster care and adoption issues, the cb and sw education began to collaboratively address these needs (thomas, 2012). the ive social work education initiative evolved from long standing support from the cb that a social work education provided the knowledge and skills necessary to intervene in family matters as sensitive and serious as child welfare. the social security act of 1935 provided the first federal child welfare program at the state level. the cb provided funding for states to send their cw employees for a sw degree with over 55% of all public cw employees acquiring at least one year of graduate sw education in 1955; however this figure dropped to 30% by 1961 (coll, 1995). by the late 1970s, only 28% of public child welfare employees had social work degrees (coll, 1995; lieberman, hornby, & russell, 1988). perhaps as a result of the iv-e social work educational programs, this number has improved to 39.5% (barth, lloyd, christ, chapman, & dickinson, 2008). historically, the cb provided a number of funding streams for child welfare employee professional development in bsw and msw education through titles iv-a (the ‘60s), xx (the ‘70s), and iv-e (1980-present) (zlotnik, 2003). all of these were considered inadequate due to limitations within the legislation and related appropriation levels to professionalize cw practitioners with social work credentials. many factors contributed to the de-professionalization of the child welfare workforce (ellett & leighninger, 2007). for example, the 1962 service amendments to the ssa combined the aid to families with dependent children (afdc) and child welfare employees resulting in the cb losing several major functions and most of its professional identity (leiby, 1978). while the number of afdc families grew, the caseloads for child welfare services were simultaneously increasing more rapidly from public awareness of child abuse and neglect (costin, karger, & stoesz, 1996). following the passage of the child abuse and neglect prevention and treatment act (capta) in 1974, the number of children reported as maltreated increased exponentially. during the 1970s, the numbers of children in foster care swelled to over 500,000, many of whom were growing up in state custody (costin et al., 1996). states responded to public criticism, high caseloads, underfunding, and inadequate numbers of social workers for child welfare positions by dropping the social work degree requirement, with some states dropping a college degree altogether, to fill positions paying lower wages (karger, 1982). recognizing that they lacked the time and resources to adequately train new cw employees, states responded administratively by compartmentalizing cw work to individual programs, i.e., intake, child protective services, foster care, and adoption narrowly training employees to do tasks in their respective programs (steib & blome, 2003, 2004). the social work profession was also developing competing areas of practice such as mental health, school social work, and community organization which siphoned sw students from cw practice (kadushin, 1987). during the 1970s, some schools of social work dramatically expanded their programs by funding faculty through title xx. when ellett/child welfare title iv-e partnerships 65 title xx was block granted and funding evaporated for sw education, some schools nearly collapsed and many simply dropped child welfare content from their curricula. with title xx funding eliminated for sw education, what historically had been a close and collaborative working relationship between schools of sw and state cw agencies with the shared goal to professionalize cw grew distant (costin et al., 1996). iv-e legislation in an effort to remedy the problem of too many children in foster care growing up in state custody, the adoption assistance and child welfare act of 1980 (title iv-e of the ssa) was enacted. this legislation aimed to lower the number of children and shorten their time in foster care through (a) reasonable efforts to prevent removal and to reunify families, (b) case plans, and (c) permanency via time frames to qualify for federal funds. title iv-e (iv-e) of the social security act provides federal authorization and funding for u.s. public foster care and adoption programs. foster children’s iv-e eligibility applied only to children at the time of their removal whose parents would have been eligible for afdc. the iv-e legislation was passed under the carter administration, but it came up for appropriation under the reagan administration which prohibited issuance of regulations. the title iv-e law as written was long, technical, and included a brief, obscure clause funding training. states and universities were slow to discover and widely implement iv-e funded training until the 1990s. the legislative intent was to provide 75% federal funding for short and long term (bsw/msw) training for cw employees and potential employees with states contributing the remaining 25%. however, the reagan administration imposed restrictions significantly reducing the intended amount of federal funding for training to the percent of iv-e eligible children multiplied by .75. california and pennsylvania (county administered programs) and kentucky were among the earliest states to implement iv-e initiatives with multiple universities participating in statewide consortia. child welfare practice context when i began working in public child welfare as a caseworker in 1970 it was still a prestigious and respected area of social work practice and was viewed positively by the general public. this seems remarkable given my bs degree in microbiology; i knew immediately that i needed a msw degree to successfully assess and engage families to acquire healthier means to parent along with addressing issues of substance abuse, mental illness, domestic violence, and poverty. i worked with clients from intake to closure, i.e. child protective services (cps), foster care, reunification, relative guardianship, and adoption and learned from my mistakes to improve outcomes for children and their families. i graduated with my msw in 1974 to become the first child welfare supervisor in a ne georgia county. little did i understand that i entered a cw practice context that was in a rapid era of change due to growing caseloads, woeful underfunding, and public resentment towards welfare (afdc, food stamps, medicaid). at the same time, the first federal abuse and neglect reporting legislation had been enacted (capta). there was no advances in social work, spring 2014, 15(1) 66 child protective services protocol to follow, leaving me to read and interpret the law with no additional resources. experiences as an agency iv-e university partnership administrator program development and implementation the louisiana state university (lsu) dean of the school of social work, dr. james midgley, and the louisiana assistant secretary for the department of social services, brenda kelley, discussed starting a iv-e child welfare/social work education partnership in 1993. i was selected as the cw state agency iv-e administrator for this partnership. my involvement began with a meeting with dean midgley and professor marian fatout, assigned to direct lsu’s iv-e child welfare education program. at the same time, dr. carol williams, who headed the u.s. children’s bureau under the clinton administration, held a national iv-e conference in 1993 to encourage public agencies and universities to develop partnerships to provide social work education for cw employees and potential employees through stipends. dr. fatout and i attended this conference and began our seven year working relationship during which we developed and implemented a pilot model at lsu before expanding to other louisiana universities. as i recall, dr. kathy briar-lawson (now dean of the ssw at suny-albany) was one of the keynote speakers who inspired many attendees with her energetic enthusiasm for ive funded sw education to improve client outcomes. not only was the iv-e conference informative, it was exciting to become part of a national movement to inject sw back into cw practice. as i knew all too well, someone could work a lifetime in cw and never receive permission to attend a national conference. it was particularly gratifying that lsu would insist that i also attend the council on social work education (cswe) and the intensive home-based family preservation conferences to learn how other states had developed and implemented their models of partnership programs with iv-e funding. additionally, we traveled to arkansas to meet with the state office iv-e administrator and trainer as well as with kenneth millar, social work dean, university of arkansas at little rock, who had maximized iv-e dollars providing all pre-service and in-service cw agency training. soon thereafter, a regional meeting in dallas with the u.s. region vi administration for children and families (acf) was held for state iv-e partnership administrators to explain allowed and disallowed iv-e expenses universities could include in their iv-e contract proposals and invoices for which state administrators would be responsible. the acf program manager, joe woodard, championed iv-e partnerships, provided fascinating overheads of what appeared to be integrally entangled wires that turned out to represent the very complicated iv-e and child welfare funding mechanism. considerable iv-e organizational complexity (federal, regional, state, university) was evident from the beginning of this new thrust to enhance professionalization and the quality of cw services. the iv-e rate varied annually and differing university federal cost share rates compounded the complexity of participating university partnership budgets. ellett/child welfare title iv-e partnerships 67 during the 1990s in louisiana, the msw was the preferred degree for workers and a requirement for department of social service (dss) cw supervisors and most administrators. dss set aside iv-e funds for employees to obtain the msw degree to further increase the numbers of dss child welfare employees holding social work degrees. thus, louisiana dss reserved the iv-e university partnership stipends for potential dss employees in msw and bsw programs. dr. fatout announced the iv-e stipend program and we developed objective stipend student selection criteria for the first cohort of iv-e msw lsu students using a point system that included grades. the university partnership iv-e program included curriculum with cw content, a public cw agency internship, and a dss work obligation. at the end of the first semester, two of the six students withdrew from or were counseled out the program because they were afraid of the clients, didn’t want to make home visits, were found by agency personnel to be illsuited for cw, etc. fortunately the louisiana partnership was initially pilot tested at lsu to identify and correct unexpected consequences rather than implement problems statewide with all universities. the following year the iv-e education program was expanded to three additional universities with bsw programs. a written iv-e application asked open-ended questions eliciting motivation to work in cw, cw knowledge, relevant sw experiences, cw values, and a writing sample. in addition to the application, faculty recommendations were used to invite students to an interview with faculty and local agency administrators who made joint student selections. these requirements represented an improved selection process that also included a iv-e program orientation for selected students and faculty prior to the fall semester. two morebsw/msw programs joined the third year, and the last university was added the following year for a total of seven louisiana iv-e participating universities. some personal perspectives over the seven years that i administered the program for the louisiana child welfare agency, i experienced a few surprises: (a) a few students who experienced extreme child maltreatment could not separate their personal biases to work with parents; (b) criminal records checks and driving records yielded important information; (c) two universities had substantial central campus dysfunction related to students receiving their stipends in a timely manner; (d) cw content was not adequately addressed unless these were standalone courses; (f) agency employees were initially reluctant to take on the added responsibility to provide student supervision, but became enthusiastic supporters once graduates were hired; (g) the state merit system didn’t permit the hiring of bsw iv-e graduates because they lacked paid experience; (h) funds provided for field supervisors to attend a national cw conference encouraged others to become student supervisors; (i) iv-e bsw graduates who were allowed to delay employment to enter as iv-e msw students were less likely to complete their cw work obligations; (j) iv-e graduates who left dss employment were often hired by agencies that worked with cw clients; (k) noniv-e students learned about cw from iv-e students; and (l) few faculty could assist in developing evaluation tools. when i was informed that bsw graduates could not be hired, i worked with our human resources director and met with merit system administrators to substitute iv-e student internships for the required one year of paid experience. advances in social work, spring 2014, 15(1) 68 program evaluation with assistance from lsu educational research professor, chad ellett, i developed a solomon four group evaluation plan which became impossible to implement because it included comparison of the annual personnel evaluation of non-iv-e new hires with iv-e new hires. however, i developed a multiple choice cw knowledge exam because there was none that had demonstrated initial validity or reliability characteristics. lsu hired kristin gansle, ph.d. as the evaluator for the seven participating schools. the louisiana examination of child welfare information (lecwi) was administered to iv-e and noniv-e bsw and msw students at the beginning of the academic year and again at the end of the year (gansle & ellett, 2002). in successive years, faculty at all participating universities were requested to submit10 questions for inclusion in the lecwi to expand the exam item bank and delete unreliable questions after item analyses were completed annually. cronbach alpha reliabilities were computed yearly which saw increases from 1994/95 (alpha=.53) through 1998/99 (alpha=.84). iv-e bsw and msw students’ scores on the lecwi were significantly higher on both pre and post-test than non-iv-e students. some 83% of iv-e msw and 33% of bsw graduates were employed by dss in child welfare positions. of the iv-e graduates employed, 55% of msws and 84% of bsw remained employed at the time i resigned as the iv-e administrator in 2000 to join uga school of social work faculty. the employee turnover rate of all new agency hires within the first three years of employment was 39% (c. ellett, 1995), so it appears that the iv-e grads had longer retention rates and were promoted within dss. after i left as the iv-e partnership administrator, the program was terminated within a couple of years. it appears that state leadership and professional commitment to iv-e sw education were important to iv-e program sustainability. faculty experiences as pi and director of a university iv-e program upon completing my doctorate in 2000 at lsu in social work with a minor in industrial and organizational psychology, i had the good fortune to be hired as an assistant professor at the uga, school of social work for my cw and iv-e expertise. the first iv-e program in georgia was initiated by dr. jim gaudin (uga) in 1995 who shared his knowledge with four other universities. thus, five social work schools had a loose affiliation with the georgia division of family and children services (dfcs). they met periodically together with the agency administrator regarding their annual iv-e contract renewal. in georgia, though the msw and bsw were preferred degrees, only 20% of dfcs child welfare employees had social work degrees (ellett, ellett, & rugutt, 2003). the uga school of social work initially reserved iv-e stipends for dfcs employees, which was not the case at all participating universities. gaudin developed a course on social work with abusing and neglecting families, held four half-day seminars each semester, and students completed practicum internships in an alternate dfcs child welfare program to meet cswe accreditation standards. in 2000 there were 10 msw stipends and the total uga contract was $158,300. gaudin retired in december, 2000 and i became the director and pi of successive iv-e contracts from 2001-2011. gaudin ellett/child welfare title iv-e partnerships 69 also had a 426 children’s bureau demonstration stipend grant for bsw students that i was also asked to direct. iv-e expansion as pi and director of the iv-e program in 2001, i raised funding to $723,695 and increased the number of student stipends to include students as well as dfcs employees in the msw program. two uga doctoral students with extensive cw experience were funded by the iv-e contract to (a) teach bsw child welfare and msw practice courses and (b) serve as iv-e faculty liaisons. because it is imperative for iv-e students to also graduate with foster care and adoption knowledge and skills, i developed a second required cw course on social work with foster and adoptive families. to increase cw professional commitment, students could attend a state cw conference and dfcs field supervisors of iv-e students were funded to attend a state or national conference. a stipend selection committee was developed that included dfcs administrators, the two doctoral students, and me to select students with a genuine interest in cw as a career. the iv-e contract included summer salary and travel money for the pi to present, attend and network at cswe, sswr, and the bi-annual national child abuse and neglect conference sponsored by the u.s. children’s bureau. there were several fortuitous situations that developed soon after i joined the uga faculty. because the 2000 employee turnover rate of georgia dfcs child welfare employees was 44%, the annie e. casey foundation and dfcs agreed to fund an employee turnover study. i recommended that it would be far more important to do an employee retention study rather than one that studied those who left dfcs. in the end, i was pi for this sole-source contract to uga and completed the 2003 georgia dfcs child welfare employee retention and turnover study which identified personal and organizational factors related to both staying and leaving. from this study, we collected empirical evidence that iv-e graduates had stronger intentions to remain employed in child welfare than other graduates (ellett et al., 2003). this study also examined relationships between employees’ intentions to remain employed in cw and a variety of organizational and personal characteristics such as work morale, job satisfaction, organizational culture, self-efficacy beliefs, and human caring (ellett et al., 2003). of the many significant findings from this large statewide study (n=1423), one in particular stands out. the variable showing the strongest positive relationship to intentions to remain employed in cw was professional commitment (r=.67; p <.0001), a subscale of a larger measure of human caring. at about the same time, a faculty colleague, dr. geraldine jackson-white, who had previously worked in dfcs, chose to return to the dfcs state office as the director of professional development. she provided much needed leadership to expand iv-e partnerships by adding three new university social work programs and two private universities for a total of 10 participating universities. all-day university/agency consortium meetings were held monthly to develop fairly uniform iv-e funded competency-based cw education programs including: (a) two specific cw courses in the bsw and msw programs; (b) dfcs internships including specific delineated cw tasks; (c) dfcs work obligation; (d) an orientation each fall; (e) stipend selection committees advances in social work, spring 2014, 15(1) 70 that included both dfcs administrators and faculty; and (f) a uga administered, multisite, standardized evaluation with all ten universities. in 2000, in the dfcs 12-county region v, there were only a handful of cw employees with a sw degree. to meet cswe requirements to provide the minimum onehour per week of field supervision, one of the doctoral students provided this supervision until there was an adequate number of iv-e msw graduates employed for two years in dfcs. the regional and county directors not only hired all iv-e graduates wishing to work in the region, they also secured state funding for two years to hire selected iv-e msw students as part-time employees to carry five cases in their last semester of their msw program. region v had the largest proportion of bsw and msw employees in the state with 40% by 2009. the uga school of social work has benefitted by having adequate numbers of dfcs employees with two years post graduate experience willing to supervise internship students. nearly all dfcs child welfare employees participating in the iv-e program were promoted while in the msw program. many received additional promotions following graduation and have risen to county and regional directors and state office positions. the dfcs asked me to develop a multi-method, research-based employee selection protocol (esp). this protocol was designed for use as a new set of assessment procedures comprising minimally essential, work-related knowledge, skills, abilities and values (ellett, ellett, ellis, & lerner, 2009; ellett, ellett, westbrook, & learner, 2006). while originally designed for use with dfcs job applicants, the esp was used by the 10 university iv-e partnerships to improve student selection procedures. one goal of the esp as used in these iv-e partnerships was to increase retention rates of iv-e graduates. this new approach to select iv-e students was implemented with considerable success until iv-e funding was suspended in 2011. in 2005, a class-action settlement involving ga dfcs’s two largest counties included a provision that supervisors needed to have two years cw experience and a sw degree (kenny a. vs. sonny perdue consent decree). in response to this situation, dfcs included funding for uga to double the number of msw students admitted into the msw part-time program located in greater atlanta and enabled more of its employees to become eligible to supervise. we made several presentations in dfcs country offices to recruit employees to fill this added msw cohort. uga had the largest iv-e budget (over two million dollars) including match and 64 stipend students, half of whom were dfcs employees. at uga, i have had a continuous flow of iv-e graduates entering our doctoral program following their agency work commitment. these iv-e msw alumni who obtain their doctorate degrees help retain cw content and practice in sw curriculum in addition to expanding cw research. iv-e suspension following the great recession beginning in 2007, georgia dfcs experienced substantial budget cuts over 5 years and four years of employee furloughs, was no longer able to help universities with iv-e match funding. it became incumbent upon universities ellett/child welfare title iv-e partnerships 71 to generate all iv-e matching funds. concomitantly tuition was rising and universities experienced about 20% in state funding cuts that shrank the number of stipend students in iv-e social work programs. to maximize iv-e funds to sustain child welfare programs, dfcs altered its method to draw down iv-e funds which universities were instructed to use. in the summer of 2011, region iv administration for children and families (acf) disallowed some methods dfcs used to claim federal funds including the iv-e universities education programs. the acf wanted dfcs to contribute some state match dollars to enable continuation of the 10 iv-e partnerships; however after enduring extreme budget cuts, dfcs didn’t have the needed matching funds to continue the partnership. the dhs commissioner and dfcs director called an urgent meeting of the ten partnership universities july 13, 2011 and announced the suspension of the iv-e program effective august, 2011. this was devastating news for universities as iv-e proposals had been submitted months earlier, and iv-e personnel and students had been selected with fall classes to begin in less than a month. there were a few uga iv-e students who had received stipend support in the prior years who had dfcs work obligations upon their graduation in 2012. these remaining iv-e bsw and msw graduates helped dfcs fill vacancies. dfcs regional and county directors reported that the quality of new hires had declined following the iv-e suspension. at the request of georgia dfcs, schools of social work submitted contract proposals in march, 2014 to resume the iv-e program fall 2014; however, in april, 2014, universities were notified that resumption will be delayed until january, 2015 due to concerns about acf financing approval. the unexpected in complex, policy-based initiatives like iv-e there are many unexpected events that serve to impede or facilitate program implementation. this has certainly been the case with iv-e in georgia. unexpected impediments to the georgia’s 16 year iv-e partnership experience included (a) a revolving door of politically appointed dhhs commissioners and dfcs directors lacking child welfare experience and social work education; (b) difficulty getting iv-e grads to complete evaluation surveys and tracking the length of their employment; (c) six-month contract approval process resulting in universities running their programs sometimes as long as three months before final contracts were officially signed; (d) after the great recession dfcs experienced a substantial loss of its state funding which was magnified with the loss of federal dollars resulting in universities putting up all the match money most years; (e) change in iv-e funding claims led to the sudden and unexpected suspension of all iv-e partnerships july 13, 2011; (f) most faculty and staff with cw experience on iv-e contracts were in temporary status and many social work programs dropped cw courses; and (g) many non-iv-e sw faculty dissuaded students from entering dfcs cw employment. the section that follows provides a description of personal experiences and perspectives of national iv-e efforts. advances in social work, spring 2014, 15(1) 72 some national experiences and perspectives on iv-e iv-e programs wax and wane a primary influence on my iv-e perspectives has been shaped by attending and participating in national professional organizations and meetings. among these was the conference entitled the child welfare training partnerships for the 21st century workforce conference, a special meeting of the u.s. children’s bureau. this national conference, held in 2000, had wide professional endorsement of groups such as the council for social work education (cswe); the national association of social workers; the national association of public child welfare administrators; and the child welfare league of america. in this national cb meeting there was obvious excitement for expanding iv-e partnerships. this meeting helped further spread the development of iv-e university/state agency partnerships from 68 in 1996 (zlotnik & cornelius, 2000) to 144 in 2004 (barbee, antle, sullivan, dryden, & henry, 2012). at the same time, there was growing recognition from the social work national association of deans and directors (nadd) of the importance of iv-e participation for sw programs to prepare graduates for careers in cw. the nadd formed an active cw task force and began a small, annual invitational conference around iv-e and workforce research from 20022005. jean quam, dean, university of minnesota, hosted the first invitational conference in 2002 and i followed with the second 2003 nadd workforce conference at uga. kristi nelson, dean, portland state university, held the third conference in 2004. the university of north carolina postponed hosting the fourth conference in 2005 as the cb was holding a national workforce conference the same summer. sustaining increases in the number of university/state agency partnerships has been difficult. joan zlotnik found in the latest iv-e partnership study that 70% of respondents indicated that their funding had stayed the same or declined, and five schools reported termination of their iv-e program (zlotnik, 2012). the number reported in this study likely did not include all 10 university partnerships suspended in georgia. cswe pre-conference iv-e partnership attending the council on social work education (cswe) annual program meeting (apm) for the first time in 1996, i was pleased to attend many child welfare sessions including iv-e. however, i was shocked there was no special interest child welfare track given the long history between sw education and cw, so i initiated one. the cswe criteria to establish a proposed track included a written request, ten abstracts submitted to the proposed cw track with five accepted through the blind review process. in 1997 at a plenary session on iv-e partnerships, i circulated a petition supporting the need for a cw track. forty nine attendees signed the petition that i submitted along with a letter proposing a cw track in cswe. from these 49 supporters plus 30 people who had attended joan zlotnik’s roundtable, we encouraged individuals to submit abstracts to the proposed cw track for the 1998 conference. ten abstracts were submitted and five were accepted through a blind review process, thus meeting cswe’s track criteria. following the first cw tract business meeting in 1998, the new track grew quickly in 2000 to four pre-conference meetings including three specifically addressing iv-e partnership issues ellett/child welfare title iv-e partnerships 73 plus a business meeting prior to opening of the annual program meeting. it was from these meetings that a iv-e email distribution list was established by sherrill clark from the iv-e california social work consortium. crystal collins-camargo set up a iv-e partnership website while at the university of kentucky, and monit cheung (university of houston) organized and still maintains a matrix reporting specifics of each iv-e university program. the cw track was the largest cswe track measured by the number of abstracts submitted for 2-3 years (n=75-80) and the second largest for several years. i was elected and chaired the cw track from 1998-2013. to foster sustainability of tracks, cswe instituted a system of three-year co-chairs followed by three years as chair in 2011; crystal collins-camargo was the first elected co-chair and helen calhane was elected co-chair in 2013. there have been many participants who volunteered in the development, evolution, sustainability, and success of the cswe cw track which has been held out as a model for other cswe tracks. clearly the national iv-e effort has increased bsw and msw programs’ interest and participation in the professionalization of the cw workforce. an unobtrusive indicator of waning federal financial support for iv-e university and state agency partnership programs was a dramatic drop in cswe cw track abstract submissions in 2013. submissions dropped from a high of 82 to 50 and attendance at preconference all day sessions dropped over the years from 175 to 81. my experiences in attending and participating in iv-e topical meetings sponsored by professional sw organizations including cswe and the society for social work and research (sswr) through the years have been mostly positive. my observations suggest that: (a) sessions with child welfare and workforce focus have increased and been well attended; (b) participants have provided valuable insights, research, and expressed valid concerns about iv-e; (c) there is general consensus that iv-e partnerships prepare graduates for cw practice; (d) iv-e graduates have longer cw agency retention rates than other new hires; (e) partnership programs enhance communications between agency personnel and university faculty targeting the improvement of professional preparation and practice; and (f) a few iv-e programs (kentucky and texas) have been able to link better client outcomes of iv-e graduates than non-iv-e employees. iv-e education/agency hurdles from the cswe cw track partnership pre-conference meetings and discussion on the iv-e partnership listserv (i agreed to host at the uga ssw after clark at caswec could no longer do so), evidence grew that each of the ten regional offices of the administration on children and families (acf) interpreted the iv-e legislation and allowable expenses differently. this created angst for states and universities that continues to this day. also, as individuals in acf regional offices left, their replacements arrived at alternate decisions on allowable spending not only for their respective regions, but between states within the same region. over the past 20 years, states that had long standing iv-e agency/education partnerships were terminated or suspended (e.g., florida, georgia, hawaii, illinois, kansas, maine, michigan, new jersey, south carolina, tennessee, vermont, and virginia). some acf decisions were compounded after the cb developed regulations limiting topics for which iv-e funds could be utilized in short and advances in social work, spring 2014, 15(1) 74 long term training. these decisions have served to sanitize or purify sw curricula qualifying for this critical source of funding. oddly, the cb does not have oversight of the acf regional offices that approve or disallow iv-e budgets and expenditures. this structure has contributed to confusion and disruption for university and state agency partnerships. following the great recession, state child welfare agencies including georgia have experienced budget cuts further limiting their available state matching funds for title ive federal aid. many state legislatures have significantly cut funding to higher education resulting in colleges and universities steadily increasing student tuition and fees which in turn limits the number of students that social work programs can fund through iv-e stipends. the loss of temporary faculty and professional staff working in iv-e university partnerships has resulted in the loss of expertise and diminished cw in georgia schools and departments of sw. other university partnerships also report the declining rate of ive eligible children (tied to 1996 afdc eligibility) and rising tuition and fees have lowered the number of iv-e stipends. states’ percentages of children eligible for iv-e funds have drastically decreased, for example, from approximately 75% in 1980 to half or less than that in 2014. limiting federal funds to support state foster care and adoption programs has also impacted the rate of funding for short and long-term training. social work educators have experienced many successes with their iv-e programs, but they have been stymied in efforts to systematically evaluate results. for example, in louisiana, completing evaluation tasks was a requirement for all universities. completing the same knowledge exam was essential to implementation of a quality program evaluation design that included a non-iv-e new hires comparison with iv-e graduates. the state agency disallowed these comparisons. georgia’s evaluation plan was approved to use the comparison groups of new iv-e and non-iv-e workers. however, the response rate of both new hire groups was too low to draw meaningful statistical conclusions. in both states, access to employment data was not permitted. clearly, efforts to accurately assess and evaluate retention and promotion of iv-e graduates have been problematic. a national group of iv-e researchers has for many years tried to link client outcomes with iv-e graduates. however, high turnover (multiple workers per case) has confounded these efforts. evaluation data are important in assessing program quality, outcomes, and sustainability. policy makers remain interested in these evaluation concerns. patrick leung, university of houston, has provided considerable leadership in iv-e evaluation efforts. optimism for child welfare agency and social work education iv-e partnerships the children’s bureau has renewed its recognition of the importance of a stable and competent cw workforce in recent years. in 2003, the children’s bureau recognized the importance of sw educated employees in retention and quality of service delivery through eight retention grants and doctoral child welfare research grants. in 2003, i was principal investigator on a cb research grant that supported four cw doctoral students’ dissertation studies on cw and workforce factors related to employee retention. in 2008 ellett/child welfare title iv-e partnerships 75 the cb funded the national child welfare workforce institute (ncwwi) supporting: (a) 12 university/agency partnerships; (b) training through a leadership academy of supervision (las); and (c) a leadership academy of middle managers (lamm). the ncwwi funding was renewed for another five years in 2013: (a) supporting 11 new university/agency partnerships; (b) developing a leadership academy for ss deans/directors and state cw directors; and (c) continuing the las and lamm. randi walters, a cb program specialist and iv-e graduate, has presented in the cswe pre-conference cw track iv-e partnership meetings beginning in 2011. such meetings have presented opportunities for iv-e faculty to share successes and needs of the iv-e program. for example, iv-e graduates have longer retention rates than other new hires and promotion of iv-e graduates builds leadership capacity within state cw organizations. it was my hope in originating the cw track that it would institutionalize cw within the cswe, sswr, and schools of social work curricula, especially if congress were to defund iv-e for training in higher education. on another positive note, alvin sallee, university of houston, began the annual title iv-e national roundtable conference in 2011 to maintain the momentum for schools of sw and state agency collaborations. this roundtable conference is an important opportunity for iv-e partners to identify and discus issues and concerns about elements of developing, implementing and sustaining programs. during the 2003 nadd-sponsored small invitational conference, it became clear that more cw journals were needed to disseminate and accommodate the growth in cw research. following this conference, dean katharine briar-lawson, suny-albany approached dean marvin feit, norfolk state, about initiating a new cw journal through haworth press. in 2004, i accepted an appointment as co-editor of the new journal of public child welfare (jpcw). following my work to establish an editorial board of national cw experts, call for papers, editorial work etc. the first volume was published and disseminated in 2007. since 2008 the jpcw has been published by routledge taylor and francis groups and since 2011, i have been editor-in-chief. to honor and celebrate the cb centennial, norma harris (university of utah) and i were co-editors of the jpcw double special issue one-hundred years of the u.s. children’s bureau professionalizing and improving child welfare. the cb, through its contract with information gateway covered the cost of doubling the issue pages and printing 600 additional copies. the cb wrote the first article on the cb history and the last article on the cb’s vision for the future of cw. this special issue addressed both the vital role of iv-e partnership programs play in the workforce and included four other articles specific to iv-e partnerships. the jpcw has also published a number of other articles on title iv-e programs. while the nadd small annual invitational iv-e and workforce conference has not resumed, there is interest among nadd members to resume a cw iv-e task group. as previously mentioned, i had the good fortune to work with the georgia dfcs in 2006-2007 to develop an employee selection protocol (esp) which was, and will again, be utilized in the selection of iv-e stipend students interested in a cw career in all ten participating universities (ellett et al., 2009; ellett et al., 2006). the esp has been advances in social work, spring 2014, 15(1) 76 presented at the child welfare recruitment and retention summit in denver, co, 2008, the children’s bureau child welfare evaluation summit, washington, dc 2009, the national conference on child abuse and neglect (2012 & 2014), and the cswe and the sswr annual conferences. building on iv-e experiences to professionalize child welfare the vast majority of my experiences with the title iv-e as a state administrator (1993), director of the uga program from 2000, and at the national level since 1998 were positive until the suspension of georgia’s program in 2011. of course, there have been many minor impediments to the success of my work in iv-e. probably the greatest impediment i and others have encountered for the continued success cw and sw education has been confusing policy, inconsistent funding decisions for iv-e university/agency partnership programs, and the organizational structure in which iv-e is situated. navigating this field of impediments is not easily done. for example, the cb recognizes the importance of iv-e in developing a professional cw workforce. however, the position of the cb within the acf organization structure administratively cuts off the cb from supervising regional acf personnel whom approve or disapprove state iv-e fiscal claims. my iv-e experiences over the years show that university cw partnership programs have been in need of cb leadership and revised regulations since the 1990s. such leadership could invigorate these programs across states. federal and state cw funding has always been inadequate and iv-e funding is further diminished with eligibility tied to parents’ income pegged to 1996 afdc rates under welfare reform legislation. given the political climate, it seems clear that there has been little appetite to advocate for introducing revised legislation for fear of further reductions in funding. some final thoughts i have been involved in one role or another in iv-e for over two decades. my experiences in iv-e related activities have varied considerably over time. these experiences have provided me with a set of broad perspectives about core elements of this national effort to enhance the professionalization of the cw workforce and ultimately client outcomes. the text that follows provides a brief and closing summary of my perspectives about the importance of student selection, quality evaluation, university/agency commitments, and clearer legislation and policy funding for the iv-e initiative. because most cw employees leave within the first two years of employment (u.s. gao, 2003) student applicants need extensive information about the iv-e education program and cw work to make more informed decisions about a career in cw. many students are attracted to iv-e programs because of the availability of stipend support provided rather than a broad understanding of the complexities of work in cw. as well, those preparing and hiring cw employees (educators and agency personnel) need better information about applicants’ cw knowledge, skills, abilities and values to select individuals committed to a career in child welfare. university and agency collaborative working relationships are important to the success of programs, increasing advocacy for cw, and improved practice interventions. providing quality supervision is an important ellett/child welfare title iv-e partnerships 77 element of work in cw, particularly for new employees. graduates of iv-e programs often promote to supervisors, managers, administrators and even directors. thus, iv-e programs become an important conduit to enhance leadership quality and professional organizational capacity. this situation, in light of the larger workforce issue of high cw turnover (ellett et al., 2003) suggests a continuing need to improve the process of selecting students for iv-e programs and prospective employees as well. currently, we do not place enough emphasis on the importance of selection of iv-e students and cw employees. as has been noted above, designing and implementing quality program evaluation procedures, has been a major iv-e challenge. too frequently, iv-e evaluations have been fraught with design flaws and/or implementation issues that interfere with quality evaluation, including the difficulties of data collection procedures. participation in many iv-e evaluation efforts is voluntary, and much lower than desired. sampling considerations aside, low participation rates in iv-e evaluations tax the fidelity and generalizability of evaluation findings. as well, the need to establish linkages between iv-e education efforts and client outcomes remains an elusive butterfly. this situation suggests greater acknowledgement and support from agency and university partners for cw agencies to track iv-e graduates’ employment and iv-e and non-iv-e employees’ participation in evaluations. increased resource allocations, both human and technical, are essential for completing stronger iv-e evaluations. as well, there is a future need to design more comprehensive program evaluations. the iv-e evaluation literature is replete with single method (qualitative or quantitative) studies and small sample sizes. larger and more comprehensive evaluation studies are needed given the complexities of preparing cw professionals. because the quality of cw services and presumably client outcomes can only be as good as the knowledge and skill level of cw employees, revised legislation and policy is needed to clarify and adequately fund short and long term training for all cw programs. it is clear to me from my experiences that large-scale efforts such as iv-e in cw will stand or fall depending upon political support and accompanying policy. for example, needed supports for iv-e short and long-term training include: (a) clear legislative language to standardize iv-e programmatic efforts; (b) sufficient state and federal funding; (c) standardized and interpretable policies and regulations; (d) enhanced understanding between cw agencies and sw faculty; (e) clarifying the relationship between the cb and acf regarding oversight of funding for iv-e partnerships; (f) clarifying and providing resources to improve the role of partnership evaluation; and (g) identifying a set of experienced and well-respected strategic champions to advocate for iv-e partnerships with policy makers and professional meetings of organizations such as nadd, npcwa, cswe, sswr, nasw, cwla. given the availability of these supports, monitoring the sustainability of key iv-e program components and outcomes are key concerns. policy makers are likely to be more supportive of iv-e partnerships that identify and document sustainability of outcomes as an important programmatic thrust, than those that do not. the suggestions provided above are those that this writer considers priorities. those with different experiences and perspectives might well expand this list. advances in social work, spring 2014, 15(1) 78 references adoption assistance and child welfare act of 1980 (p.l 96-272). barbee, a. p., antle, b. f., sullivan, d. j., 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(2003). fatal error: the missing ingredient in child welfare reform: part 1. child welfare, 86(6), 747-750. steib, s. d., & blome, w. w. (2004). fatal error: the missing ingredient in child welfare reform: part 2. child welfare, 87(1), 101-104. thomas, m. l. (2012). one hundred years of children’s bureau support to the child welfare workforce. journal of public child welfare, 6, 357-375. u. s. general accounting office. (2003). hhs could play a great role in helping child welfare agencies recruit and retain staff (gao-03-357). washington, dc: author. retrieved from http://www.gao.gov/assets/240/237373.pdf zlotnik, j. l., & cornelius, l., (2000). preparing social work students for child welfare careers. the use of title iv-e training funds in social work education. journal of baccalaureate social work, 5(2) 1-14. zlotnik, j. l. (2003). the use of title iv-e training funds for social work education: an historical perspective. journal of human behavior in the social environment, 7(1), 5-20. zlotnik, j. l. (2012). laying the foundation for a stronger partnership under title iv-e. in a. lieberman & k. nelson (eds.), women and children first: the contributions of the children’s bureau to social work education (pp. 89-111). alexandria, va: the council on social work education press. author note address correspondence to: alberta j. ellett, ph.d., associate professor, tucker hall 423, university of georgia, athens, ga 30602. email: aellett@uga.edu alberta j. “bert” ellett, ph.d., is an associate professor at the university of georgia, school of social work joining the faculty in 2000. she received the 2010 council of social work education distinguished recent contributions in social work education award. she is nationally known as a leader in several professional organizations through her contributions in promoting the continued professionalization of child welfare. ellett was elected secretary of the society for social work and research 2008-2011 and re-elected for 2011-2014. her research interests and specializations center on developing child welfare organizations and strengthening their holding power in ways that retain and promote the development of competent child welfare staff. microsoft word gjesfjeld copyedit final _________________ christopher gjesfjeld, ph.d., lcsw, is an assistant professor in the department of social work at the university of north dakota in grand forks. michaela kennedy, ma, lpc, is a research specialist at family services of western pennsylvania. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 152-163 outpatient commitment on the ground: listening to consumers and providers christopher gjesfjeld michaela kennedy abstract: current debate and research on outpatient commitment (opc) has examined whether opc is (1) clinically effective or (2) ethically acceptable, yet little research has sought the voices of consumers and mental health providers who are most intimately impacted by outpatient commitment. our research was specifically interested in the perspective that consumers and providers had about opc. qualitative interviews were conducted with nine consumers on opc orders and eight treatment providers associated with these consumers. three major themes emerged. first, consumers voiced an ambiguous sense of personal control in the context of opc orders. second, consumers and mental health providers maintained inconsistent understandings of outpatient commitment. finally, all consumers reported an improvement in their life after being on opc. based on these findings, we suggest methods by which mental health providers could facilitate a collaborative relationship with consumers despite working within a context of opc orders. keywords: involuntary commitment, coercion, community mental health services, mandated treatment, opc introduction outpatient commitment (opc) has been defined as “a form of civil commitment in which the court orders an individual to comply with a specific outpatient treatment program” (torrey & kaplan, 1995). with outpatient commitment laws in over 40 states in the united states of america, the intention of opc is to mandate outpatient mental health services to individuals with a serious mental illness who maintain a capacity for violence, suicide, or re-hospitalization if left untreated. advocates of opc emphasize the importance of appropriate mental health treatment for the individual and the protection of the community from violence (torrey & zdanowicz, 2001). they note legal pressure requiring treatment is necessary for some individuals with mental illness because of their inability to make appropriate decisions about their own mental health care (munetz, galon, & frese, 2003). geller (1986; 2006), for example, has argued that some intrusion into personal liberties may actually increase personal freedom; those who are provided treatment early in their illness may avoid involuntary inpatient hospitalization. opponents, however, see the utilization of opc as problematic for a number of reasons. some opponents contend that opc undermines the aims of collaboration between the worker and client because of the “monitoring” and heightened stigma associated with opc orders (allen & smith, 2001; bazelon center for mental health law, 2001). other opponents have argued that mandated treatment, by its very existence, advances in social work, fall 2011, 12(2) 153 represents the failure of a public mental health system that is underfunded and offers ineffective treatments (united states psychiatric rehabilitation association, 2007). opponents to opc have also pointed out that longitudinal data refutes the assertion that mental illness is an independent contributor to violence, consequently making the necessity of opc less relevant (elbogen & johnson, 2009). besides ethical concerns surrounding mandating mental health treatment, another strand of opc research has examined the specific clinical outcomes associated with outpatient commitment. commonly known as the duke study, swartz et al. (2001) followed 331 involuntary patients randomly assigned to either voluntary or involuntary services after leaving the hospital. when individuals in this study were on opc for over six months and received frequent services (over 7 professional contacts a month), various researchers within this duke group found the individuals were less likely to be homeless, less likely to be a strain on caregivers, and had a greater quality of life (compton et al., 2003; groff et al., 2004; swanson, swartz, elbogen, wagner, & burns, 2003). these gains were only made, however, if mandated treatment was provided over an extended period of time and consisted of frequent visits with mental health providers. on the other hand, a cochrane review that included this duke study as well as an evaluation of opc conducted in new york city found little evidence for the effectiveness of opc (kisely, campbell, & preston, 2011; steadman et al., 2001). the authors found few differences on health service use, social functioning, mental state, quality of life, or satisfaction with care between consumers on or off outpatient commitment orders. in the most recent analysis of the new york city study, researchers found a few potential benefits in certain clinical outcomes yet note “caution against using our results to justify an expansion of coercion in psychiatric treatment” (phelan, sinkewicz, castille, huz, & link, 2010). in sum, the ethical and clinical effectiveness debates will most likely not be resolved (o’reilly, 2004). due to this mixed picture, we (an academic-agency research collaboration) found it difficult to advise a community-based agency providing mental health services in western pennsylvania about “best practices” in terms of opc. however, we found common agreement that the current discourse on opc lacked the voices of those most intimately connected to opc orders: consumers and those who provide treatment. with this in mind, we sought to hear how consumers and providers experienced outpatient commitment. by hearing from individuals and treatment providers about their experience with outpatient commitment orders, we hoped to achieve a better understanding of how opc “looked on the ground”. we hoped our efforts could facilitate two aims. first, the voices of consumers and providers could stimulate an inter-agency dialogue about the role of opc in the agency. second, our analysis could add a different dimension to the current discussions concerning the ethical dilemmas and clinical effectiveness of opc orders. gjesfjeld, kennedy/outpatient commitment on the ground 154 methodology conceptual framework a qualitative research method was selected as the most effective way to more deeply explore the different perspectives of both consumers1 and providers involved in opc. a semi-structured interview format was chosen because consumer and provider perspectives were to be used to directly inform decision-making by agency administration. given this evaluative purpose, sensitizing concepts, or “categories that the analyst brings to the data” (patton, 2002a, p. 456), were identified and used to structure the interview data and as an aid for data analysis. these concepts included: the stakeholders’ understandings of the opc process, attitudes and corresponding feelings about being placed on outpatient commitment, and any feedback that could improve the current implementation of opc. due to the utilization of this inductive approach and the partnering with an agency employee to do this research, our work was consistent with patton’s (2002b) stance of pragmatic utilitarianism. he notes that this stance is vital when specific evaluative questions do not require a comprehensive philosophical, ontological, or epistemological frame. while this methodological approach is flawed in terms of providing specific knowledge that could be generalized to other agencies providing treatment under opc orders, our inquiry was consistent with an approach providing specific yet descriptive answers to outpatient commitment stakeholders to inform them of the experiences of consumers and their mental health care providers. we also attended a number of outpatient commitment hearings. these specific hearings were not specific to a particular consumer in our study but did help us understand the legal context of mandated treatment. these experiences aided us in asking appropriate questions to both providers and consumers as to their understanding of these hearings and their significance. study participants nine interviews were conducted with consumers either currently or recently on opc orders. individuals were eligible for the study if they received services at family services, were involved in opc either currently or during the previous 2 years, and were 18 years and older. consumers were approached by clinical staff of family services either in-person or via mail. individuals were given a brochure to sign if interested and informed of their eligibility for the study. researchers contacted individuals who expressed an interest in the study and arranged a time and date to meet. all consumers who showed initial interest in the study completed the interview. interviews were taperecorded and conducted either in an agency office or in the consumer’s home. interview sessions averaged about an hour in length and all participants received a $25 gift card to a local grocery store for participating in the interview. of the nine consumers who participated in the interviews, five were on an opc order at the time of the interview, and 1 the term “consumers” will be used to describe individuals with a serious mental illness who have been placed on outpatient commitment orders. this specific term, in the context of mandated treatment, is problematic given that this term implies a consumption of mental health services that is voluntary. and yet, this was the language used within this agency to describe clients receiving mental health services, voluntary or involuntary. advances in social work, fall 2011, 12(2) 155 four had been on an opc order in the past two years. the age range of the nine individuals receiving services was age 28 to 71. a total of five females and four males were interviewed and all were caucasian. eight of the nine consumers had been diagnosed with schizophrenia or schizoaffective disorder, whereas one consumer had a diagnosis that included both depressive and anxiety symptomatology. after these nine consumers agreed to participate in the study, they were asked to voluntarily nominate a provider within family services that was intimately connected to their mental health care. eight providers were nominated with one consumer who chose not to nominate a provider. the strategy of nomination was used for two reasons. first, we wanted to find providers that had some experience working with an individual on opc orders. second, we thought that this process of consumers nominating a provider would enable us get multiple perspectives on a particular consumer’s experience with opc. providers nominated by consumers were approached with the study, provided informed consent, and contacted to arrange a time for meeting. all nominated providers participated in the research. these interviews were also recorded using digital recorders and conducted in a semi-structured format with identical concepts as used with the consumers. the professional titles of these providers included psychiatric nurses, case managers, and psychosocial rehabilitation counselors. data analysis after completion of the 17 interviews, all digital audio files were transcribed into written transcripts. initial categories were defined by the three predetermined concepts about (1) understandings of the opc process, (2) attitudes and corresponding feelings about the consumer being placed on outpatient commitment, and (3) feedback that could improve the current implementation of opc. with these a priori categories, both researchers separately coded the written text, making notes in the margins and finding commonalities among them. after we developed our codes separately, we met weekly for a month to clarify what themes we saw as present within the transcripts keeping in mind our specific aim of informing agency decision-making pertaining to opc. these themes were developed with the specific purpose of informing opc stakeholders about how opc intersects with the experiences of both providers and consumers. results in many ways, the opinions and feelings about opc orders differed between consumers and agency treatment providers. consumers often felt like they were being pushed into something they did not see a need for, whereas providers thought that outpatient commitment was helpful for consumers who lacked insight into their mental illness. yet, common themes were present in both interviews: (1) the ambiguous location of personal control for consumers in mandated treatment, (2) divergent definitions of outpatient commitment provided by consumers and providers, and (3) a perceived personal benefit of outpatient commitment voiced by both consumers and providers. gjesfjeld, kennedy/outpatient commitment on the ground 156 “what ever happens, happens” one of the predominant themes that emerged was the ambiguous location of personal control in mandated treatment. while it must be acknowledged that the very nature of mandated treatment suggests an individual has a compromised ability to assert selfcontrol, consumers’ responses suggested a fatalistic stance to opc orders whereby any personal self-control or initiative was of little use. consumer #1: i never say nothing. i am afraid of the judge. i just agree with him. what ever happens, happens. consumer #4: i kept saying to my caseworker when am i going to get off of this court order? i can be on my own to take my medications and make my appointments. i was pretty persistent. it felt like i wanted to hurry up and be responsible for myself. i felt that i was being treated a little childishly. consumer #8: i have been on it five or six years and nothing has changed. they have not changed anything yet. i have the idea that they are not going to change it. maybe six or seven years from now i will still be on it. i got the idea that i would like to get off of it, i would be better if i could get off of it. i think things would be better for me. consumer #9: they want to treat me like a baby. ‘how do you keep your house clean? do you know how to wash your hair? do you know how to bathe? do you know how to do this?’ why don’t they just let me live my life? they tell me i am not well and i am not doing good. one treatment provider spoke at length about the reason consumers were not more involved in decisions about their own care. provider #9: anytime they hear ‘hearing’ and ‘court order’ or ‘302’ or ‘diversion’ they are automatically thinking this is not a good thing. often times they will sit there silently and not say anything, unless they are more intelligent and have been in the system. but often times the people who don’t understand just sit there quietly and do as they are told. often times we are their voice. but the question is: ‘what if we are not there?’ then they are just kind of rolling along with whereever the doctor is putting them and giving them and pushing them. often times individuals in mental health won’t ask. they just assume that the doctors know what is right. providers know what is right and they go with that. the majority [of consumers] . . . have problems communicating and they have problems with authority so they won’t speak up. this excerpt illustrates how mental health providers can unintentionally influence the personal control of consumers on opc orders. while providers perceive themselves as advocates for their client, the quote also suggests that this advocacy is necessary given the consumer’s illness or intellectual capacity. while this is certainly a possibility, after observing several opc hearings, it also appears reasonable that the passive stance of individuals may have some origin in the substantial legal jargon and formality of the process rather than being merely a consequence of psychiatric symptoms. advances in social work, fall 2011, 12(2) 157 inconsistent understandings of opc an inconsistent understanding of outpatient commitment was also a common theme among both providers and consumers. consumers and providers alike could not accurately define opc, the specific mandate of opc orders, or the consequences of consumer non-compliance. both consumers and providers were unsure or confused about how consumers get removed from opc. providers’ descriptions of opc varied as the following comments demonstrate: provider #2: it’s voluntary. attending services that we can provide. provider #3: to the best of my knowledge the outpatient commitment is only committing a person on a written agreement that they will take their medications and that they will keep their psychiatric appointments. anything else is a bonus. provider #7: my understanding is opc at this agency is just in regards to the doctor’s visit. sometimes for therapy like a therapist. individuals subject to opc also had a wide range of understandings about the definition of opc: consumer #1: outpatient commitment means you are a patient out in the public. you can see a doctor anytime, stuff like that. to keep my nose clean and stay out of trouble. take the medicine. consumer #5: that is just where the doctor goes in and makes sure that i am obeying what she prescribes in medicine and makes sure that i come back to see her again. i don’t understand the whole procedure but i understand that it is the court that i go to. consumer #9: i am being treated by the court. the court pays for the treatment or something? i am treated but i am an outpatient. i don’t have to be committed all the time. in addition to being unclear about what opc actually entailed, it was unclear to most consumers as to why they were continued on opc despite taking their medication and living independently in the community. they noted that decisions about opc did not appear to examine their current ability to keep appointments, take medication, and maintain daily activities. they also seemed uninformed about what factors influenced the decision-making process for the professionals to get them dropped from an opc. consumer #4: i can’t remember who decided or what it was based on to let me finally go home. it was all of a sudden. the judge decided . . . oh i know she said that they had a separate meeting between the nurse, where i worked, the case worker and maybe the judge and they said i was doing well enough that i did not need this court order. consumer #5: i don’t understand it [opc process] but eventually the doctor wanted me to be off if it. they were going to decide what happens to me. they just looked at me and made the decision. it might even be made before i get there [to court hearing]. before the doctor even met me she had all the previous notes gjesfjeld, kennedy/outpatient commitment on the ground 158 from the previous doctor or from somebody. they already had their minds made up. she told me on the very first meeting that she is sure that i should keep coming to see her. consumer #6: sometimes they just take you off of it, [that’s how] you know if you are doing good. if they think everything is alright they will take you back off of it. for the consumer on opc, there was little understanding about what behaviors or actions could assist them in being removed from outpatient commitment. they were confused about how the decisions were made to terminate opc. termination from opc was something that just happened and was suddenly determined by professionals. similarly, the providers interviewed had divergent understandings about the definition of opc, the services that it mandated, and the consequences for individuals who did not follow the court order. a personal benefit another consistent theme was that all individuals subject to outpatient commitment interviewed reported some improvement in their quality of life while receiving treatment under outpatient commitment orders. however, it was not consistently understood from individuals what aspect of outpatient commitment actually helped them improve. while some individuals noted that the treatment received was beneficial, others noted that available support and the access to mental health services was what ultimately helped them succeed. consumer #1: keeps me out of trouble. keeps me on my medicine. keeps me on an even keel. consumer #6: i have been on court commitment many times and they always seem to work when i am on them. when i am taken off i end up back in the hospital soon after. it helped, it kept me going to my doctor appointments and it kept me medicated long enough to realize that i did have a problem. consumer #7: i should be on court commitment. now i have a car, i have an apartment, i have furniture, i have a job and i am stable and i agree with the court commitment’s decisions. so my life is good right now compared to what it has been. consumer #8: it helped me. i kind of got on my feet a little bit. if i did not have the program or treatment i would be back in the hospital or gutter or up at torrance [state hospital]. i have not been in the hospital for 6 years now. some individuals pointed out the understanding and availability of staff as the most helpful to them. consumer #3: she [therapist] was really like god sent to me. i don’t know if i would have made it without her. she just talked to me about everything. she understood everything i would tell her about what my problems were. and she would find a resolution for me. advances in social work, fall 2011, 12(2) 159 consumer #4: i think the best part of the outpatient commitment was that i saw a caseworker once a month. i could call her if i needed to. i was taking medication and that helped and i felt more responsible for my mother and i was fully in charge of taking care of my mother. despite treatment being mandated, individuals subject to opc reported that they were doing better now. while it was not clear how the court order helped, the consumers reporting maintaining positive relationships with their treatment providers had a particularly important positive impact on their lives. limitations despite being able to interview nine individuals who had been on outpatient commitment, a number of individuals were uninterested or unwilling to participate in this study. it is possible that these individuals may not have had positive experiences on outpatient commitment or feared that this study would impact their court order status in a negative way. due to symptoms common to psychotic disorders, it is also possible that individuals were reluctant to participate for fear of being placed on outpatient commitment, being hospitalized, or being reconnected with the mental health system. the specific characteristics of those willing to share their experiences certainly may not be representative of those typically on opc orders. consumers who were uninterested in sharing their experiences may have had more intense psychiatric symptoms or very different experiences with outpatient commitment than the consumers participating in our research. likewise, as a group, consumers who shared their experiences about opc may have been either exceedingly positive or negative about the provider they selected for us to talk with. despite the agency having personnel with a specific full-time role dedicated to evaluation and research independent of the specific clinical care these consumers received, consumers and providers may have shielded us from specific negative comments about their treatment under a court order. our study was also limited in terms of the racial and geographic diversity of the participants; all consumers and their providers were caucasian and resided in western pennsylvania. further research on how consumers and providers, particularly from underrepresented racial and ethnic minorities, interact with mandated treatment would improve the current body of research relevant to opc orders. concluding remarks and recommendations despite research that has considered the clinical effectiveness of opc (kisely et al., 2011), a much smaller amount of research has explored the consumer and provider perspectives associated with these court orders. with initial interest from a social service agency to understand how their specific consumers and treatment providers were influenced by outpatient commitment orders, we saw promise in listening to their perspectives and experiences. three general areas of questions were the initial topics of inquiry: (1) understandings of opc, (2) attitudes and feelings associated with being on gjesfjeld, kennedy/outpatient commitment on the ground 160 opc, and (3) feedback that could encourage agency improvement when commitment orders are used. the first theme prevalent in the consumer responses was the lack of active engagement consumers had in the opc process. consumers voiced little control of the process and general confusion about what specifically was being asked of them while on these orders. while passivity may be a very natural response to a court order, we see this theme as particularly troubling because of the potential for this passive pattern to continue into their post-opc care. simply put, how will consumers be active collaborators in their treatment when they are familiar with treatment experiences in which they are typically passive and obedient? to address consumer passivity, we see promise in practicing collaboration early in the commitment process. one specific opportunity can be in the formal opc legal hearing. first, one-on-one time with legal representation could be arranged before the actual court hearing. if the individual is uncomfortable or intimidated by the hearing, a written statement could also be created prior to the hearing that could assist the individual in presenting his or her viewpoint without having to speak spontaneously. agency providers can help consumers understand the court proceedings in simple language and encourage them to express their own perspective. one provider described soliciting consumers’ voices: provider #9 i am always in contact with them and trying to explain to them and i am asking questions for them because there are a lot of things we don’t understand . . . i am speaking to the staff. i am asking if there are alternatives. my goal is not to see them in a state hospital or to even court order them. i will speak to my client and say what would your ideal situation be? lets come up with our plan and then we mediate between what our thoughts are and the social worker’s at the hospital and what the team is. my goal is to explain what is going to happen to my client. offer them a chance, plenty ahead of time saying if you have anything to say, you might want to jot down some thoughts. we will review it because you do have a right to speak. if they want to speak to the attorney, we will pull the attorney aside and say they would like to speak to you ahead of time and get them as much time as possible. we were encouraged by this particular provider’s engagement with consumers to understand and have a voice in the opc hearing. even so, our research concludes that consumers require more information about the details of their commitment orders as they receive pharmacological and psychological treatment. we see ongoing education about opc as an opportunity to strengthen the therapeutic relationship prior to the termination of opc. in addition to the finding that consumers had little voice in the process, we also found that consumers generally did not understand what was being asked from them while on commitment orders. both providers and consumers offered different requirements for being on opc orders. did these orders require them to meet with the psychiatrist, go to specific groups, or give them special access to providers? consumers, in particular, were also confused about what was expected prior to termination of the opc orders. advances in social work, fall 2011, 12(2) 161 individuals were unsure of what behaviors would encourage the termination of their treatment orders. the orders seem to be terminated without a specific rationale. we see these varied understandings as problematic because they can undermine the consumers from become partners in their care. as behavioral theorists have widely noted, a behavior is extinguished if it receives no reinforcement. if the removal of the commitment orders is not specifically associated with specific behaviors of the consumer, how are such orders helpful? while it could be argued that the vague goals of opc could encourage greater clinical discretion about a specific consumer, a truly collaborative relationship, under commitment orders, would seem to require that therapeutic goals be specifically named and regularly evaluated. as noted by the divergent understandings of opc by providers, the rationale for the use of opc must also be communicated among treatment providers so there is consistency in its use within the agency and clarity for why it is being utilized. finally, whether individuals liked or disliked being coerced into treatment, all individuals reported an improvement of their life or a personal benefit from treatment. this positive reaction may have been the result of the accessibility and availability of support services, which are key components to the effectiveness of opc (appelbaum, 2005; swartz & monahan, 2001). when opc is utilized without appropriate funding for mental health services, it is likely an ineffective tool (petrila & christy, 2008). our consumers’ positive reaction is an important finding because many individuals subject to opc will continue to have a mental health illness that 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(2001). outpatient commitment: what, why, for whom? psychiatric services 52(3), 337-341. united states psychiatric rehabilitation association (2007, march). position paper on involuntary outpatient commitment. linthicum, md. retrieved from http://knol.google.com/k/uspra-staff/position-paper-on-involuntary/9hcd4qaqyqq0/5# author note: address correspondence to: christopher gjesfjeld, ph.d., gillette hall room 301c, 225 centennial drive stop 7135, grand forks, nd 58202-7135. email: christopher.gjesfjeld@email.und.edu microsoft word 5-3743 hodge et al_older latinos spiritual needs final ______________ david r. hodge, ph.d., is an associate professor in the school of social work at arizona state university in phoenix and senior nonresident fellow at the university of pennsylvania’s program for research on religion and urban civil society; robert j. wolosin, ph.d, is affiliated with press ganey associates, inc., south bend, in; and robin p. bonifas, ph.d., is an assistant professor in the school of social work at arizona state university. this research was supported by a grant from the john a. hartford foundation. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 65-81 addressing older latinos’ spiritual needs in hospital settings: identifying predictors of satisfaction david r. hodge robert j. wolosin robin p. bonifas abstract: many older latinos use spirituality to navigate the challenges associated with hospitalization. although spiritual assessments are typically recommended in such settings, little, if any, research has sought to identify the factors that predict satisfaction with addressing clients’ spiritual needs. using a national sample of recently hospitalized older latinos (n = 227), this secondary analysis identified predictors of older latinos’ satisfaction with how well their spiritual needs were addressed during their hospitalization. among the eight predictors examined, room quality, nursing staff, and physicians were positively associated with satisfaction, while the discharge process was negatively associated with satisfaction. by understanding the factors that predict satisfaction, practitioners are better positioned to provide culturally relevant and effective services to older latinos. keywords: latinos, hispanics, older adults, spirituality, health care settings the population of older adults in the united states is diversifying and increasing rapidly. by 2050, the number of seniors is expected to double, and latinos are projected to comprise approximately 20% of all people over age 60 (administration on aging, 2008a). in less than a decade, by 2019, latinos are anticipated to be the largest cultural group represented among older adults (administration on aging, 2008b). these demographic changes have important implications for social workers in health care settings. many latino elders will experience hospitalization and the attendant stress associated with admission to the healthcare system (berkman, silverstone, simmons, volland & howe, 2000). spirituality, which is commonly understood as an individual’s relationship with god (wuthnow, 2007), is frequently used to navigate such situations (soenke, landau, & greenberg, 2013). furthermore, spirituality is often considered a basic latino value (koss-chioino, 2013). to be clear, latinos affirm a wide variety of spiritual beliefs and practices, which can vary by gender, culture of origin, and geographic location (canda & furman, 2010). thus, while the vast majority of latinos are catholic or evangelical protestants (e.g., pentecostal christians), how these traditions are expressed can vary. this variation occurs at the micro level, between individual latinos, as well as at the macro level, between latinos collectively and european americans. indeed, based upon a nationally representative study, pew hispanic center researchers concluded that latinos practice a distinctive form of christianity (suro et al., 2007). latin culture shapes how christian hodge, wolosin, bonifas/addressing older latinos’ spiritual needs 66 beliefs are interpreted and practiced (koss-chioino, 2013). the compartmentalization of spirituality, commonly found in european american culture, is largely absent. rather, latino spirituality is characterized by a spiritually-animated worldview that affirms the existence of a vibrant, present, non-material reality. this spiritually-informed worldview serves as a “moral compass” for navigating life (suro et al., 2007). latino elders may rely upon this compass to guide them through the hospitalization experience, and social workers will need to be well prepared to effectively support them in this process. this paper presents the results of a study identifying factors associated with older latinos’ satisfaction with the attention given to their spiritual needs during hospitalization and provides social workers with foundational knowledge for delivering culturally relevant care. before detailing study procedures and findings, an overview of spirituality in the context of healthcare, social work, and client or patient satisfaction is provided to orient the reader. background hospitalization frequently evokes spiritual needs, especially among devout populations such as older latinos (nelson-becker, nakashima, & canda, 2007). spiritual needs are manifested in many different forms (bussing, balzar, & heusser, 2010; cavendish et al., 2006; hodge, horvath, larkin, & curl, 2012), but can be categorized under two basic rubrics: 1) assets that can be used to cope with or ameliorate challenges, and 2) barriers that can impede service provision (hodge, 2005). the characteristics of each of these categories are summarized below, and examples are provided of specific needs in each category. as an asset for coping, spirituality often plays an instrumental role in helping people deal with challenges (pargament, 2007; saleebey, 2009). a substantial and growing body of research indicates that spirituality is a significant source of strength that facilitates health, wellness, and resiliency in the face of adversity (hook et al., 2010; koenig, king, & carson, 2012; koenig, mccullough, & larson, 2001; pargament, 2007). for example, older mexican americans frequently turn to god to find the positive aspects of suffering, such as a sense of meaning or purpose in the experience (krause & bastida, 2011). to fully operationalize these spiritual assets in hospital settings, clients may have needs that must be addressed by healthcare personnel, and social workers are likely to be effectively positioned to begin a discussion of such needs. for example, previous qualitative research with non-latino samples suggests that spiritual needs that facilitate coping are often manifested in two dimensions, vertical (i.e., needs related to connection with god), and horizontal (i.e., needs related to connecting with other human beings) (conner & eller, 2004; hermann, 2001). regarding the former dimension, patients often report a need for prayer, meditation, bible reading, listening to devotional music, and other activities perceived to facilitate a connection with god. regarding the latter dimension, patients frequently report a need for interpersonal interactions, including interactions with hospital staff that are characterized by warmth, courteousness, caring, and reassurance. (nixon & narayanasamy, 2010; tanyi, recine, werner, & sperstad, 2006). this literature also suggests that hospital staff’s efforts to provide patients a quiet advances in social work, spring 2013, 14(1) 67 room (conducive for prayer, connecting with god, etc.), attend to special requests (e.g., procure access to a bible), facilitate visits by significant others, and demonstrate courtesy may help address patients’ spiritual needs. in terms of barriers to service provision, as implied above, spirituality often provides people with a worldview that informs them of who they are and how they should live (koenig, 1998; richards & bergin, 2000; van hook, hugen, & aguilar, 2001). from a social work strengths perspective, diverse beliefs should not be viewed as a hindrance to care. alternatively, it is important to recognize that service provision can conflict with clients’ spiritual value systems. for example, some latinos may believe that aspects of curanderismo1 are at odds with certain western medical proscriptions such as precautions to avoid valued herbal remedies when taking western medications (tafur, crowe, & torres, 2009). such conflicts can accentuate the stress associated with hospitalization and impede the healing process, requiring social workers to broker win-win solutions that respect latino clients’ spiritual values, while simultaneously maximizing adherence to essential aspects of care. prior qualitative research with non-latino samples has illustrated a related set of spiritual needs (davidson, boyer, casey, matzel, & walden, 2008). patients report a need to be active participants in treatment (hodge & horvath, 2011; meert, thurston, & briller, 2005), and to have some degree of involvement and control during hospitalization (hermann, 2001), which helps ensure that service provision is congruent with their spiritual beliefs and values. this literature also implies that hospital staff’s efforts to keep patients informed and engaged, in tandem with staff’s competency and responsiveness to requests may help address patients’ spiritual needs. the critical role that spiritual needs can play in service provision is implicitly recognized by the joint commission, the largest and most influential health care accrediting body in the united states. the joint commission revised its accreditation requirements at the turn of the century to necessitate spiritual assessments in hospitals and other settings (hodge, 2006; koenig, 2007). while each health care organization develops its own specific set of assessment procedures, the same overarching purpose exists across organizations: to identify patients’ spiritual needs and determine the steps necessary to address the issues that emerge (joint commission, 2005). put simply, the reason for conducting a spiritual assessment is to address clients’ spiritual needs. as might be expected, addressing patients’ spiritual needs has been linked with patient satisfaction in studies using a cross-sectional research design. patient satisfaction is an important construct because it is typically used to evaluate the quality of services provided in health care settings (gribble & haupt, 2005; press, 2002). addressing patients’ spiritual needs is associated with perceptions of global satisfaction with service provision. for instance, among a sample of patients receiving treatment from an outpatient cancer center in new york city (n = 369; mean age = 58 yrs, 65% female; 67% white), those who reported their spiritual needs were not being adequately addressed 1 traditional healing methods common among many latino cultural groups to address physical and spiritual maladies. hodge, wolosin, bonifas/addressing older latinos’ spiritual needs 68 also reported significantly lower levels of satisfaction with the medical care they received (astrow, wexler, texeira, he, & sulmasy, 2007). similarly, among hospital inpatients in chicago (n = 3,141; mean age = 56 yrs, 61% female; 73% black), those who reported discussing their spiritual concerns with a care provider reported higher levels of satisfaction with the care they received (williams, meltzer, arora, chung, & curlin, 2011). as such, addressing clients’ spiritual needs appears to be an important component of overall satisfaction. despite the often crucial role that spiritual needs play in service provision, little empirical work has sought to examine predictors of clients’ satisfaction with attention to their spirituality during hospitalization. as referred to above, some research has mapped the parameters of older adults’ spiritual needs in healthcare settings (cavendish et al., 2006; hermann, 2001; hodge et al., 2012; murray, kendall, boyd, worth, & benton, 2004; tanyi et al., 2006). while research suggests that a range of spiritual needs may present, the factors associated with clients’ satisfaction with spiritual care have yet to be identified. this lack of knowledge represents an important gap in the literature, especially for older latinos for whom spiritual needs may be particularly salient. articulating factors that predict satisfaction can enable social workers and other healthcare professionals to effectively address clients’ spiritual needs. indeed, highlighting such variables can help practitioners tailor services toward this end. accordingly, this study seeks to identify factors that predict older latinos’ satisfaction with how well their spiritual needs are addressed in hospital settings. the methods used to identify these predictors are delineated below. method to identify predictors of satisfaction regarding older latinos’ spiritual needs, a secondary data analysis of hospital inpatient satisfaction data was conducted. the data was obtained from press ganey associates, inc., a healthcare consulting firm that specializes in patient satisfaction measurement and management. as referred to above, hospitals routinely assess patient satisfaction as a means to evaluate the quality of their services (chandra et al., 2011). this task is frequently contracted out to other organizations, of which press ganey is the largest (press ganey associates, 2011). deidentified data was provided for the present study, which was conducted with the approval of a university institutional review board. participants the sample consisted of 227 latinos ages 65 and older who were consecutively discharged over a 12-month period from hospitals across the nation. some 56.8% (n = 129) of the sample was female. just over three quarters (76.7%, n = 174) of respondents were between 65 and 79 years old, while the remaining individuals were 80 and older. regarding ethnicity, 36.1% (n = 82) were mexican american, 23.3% (n = 53) were puerto rican, and the rest were “other hispanic/latino.” almost one third (32.2%; n = advances in social work, spring 2013, 14(1) 69 73) of respondents were from new england, 25.6% (n = 58) were from the midwest, and the remaining were from the south and western regions of the nation. survey instrument to assess patients’ perceptions, press ganey administers surveys to former inpatients soon after completion of the discharge process. surveys are typically mailed out within five business days of receipt of the discharge data from client hospitals. spanish language surveys are sent to patients whose language preference is noted in the demographic information provided by hospitals. the self-administered survey methodology tends to produce relatively accurate information about sensitive issues such as spirituality and the provision of medical care (press, 2002). the survey instrument included the demographic items reported above, several indicators of satisfaction, and the outcome variable: clients’ assessment of how well their spiritual needs were addressed. the study included eight predictors that cover major areas of service provision during hospitalization. these eight areas also capture key dimensions of satisfaction delineated by the national library of health care indicators (kaldenberg, 2001). more specifically, respondents were asked to rate the quality of services they received in terms of the admission process, room quality, food service, nursing staff, the administration of tests and treatments, accommodation of visitors and family, physicians, and the discharge process. prior qualitative research suggests that all of these areas could potentially be related to clients’ spiritual needs (cavendish et al., 2006; hermann, 2001; hodge et al., 2012; koenig, 2012). examples might include a quiet room in which to pray or meditate, food that conforms to religious proscriptions, and courteous interactions with hospital staff. each area was assessed with a multi-item scale; the shortest scale contained two items and the longest contained six items. for each item, respondents were presented with a 5-point, likert-type response key that ranged from “very poor” (1) to “very good” (5). table 1 lists the number of items in each scale, sample items, and each scale’s cronbach alpha. the reliability coefficients are consistent with alphas obtained in prior research (kaldenberg, 2001), with values from .88 to .96, and suggest the scales performed well with this population (spicer, 2005). the outcome variable was assessed by asking respondents to indicate the “degree to which hospital staff addressed your spiritual needs” on the same 5-point, likert-type response key described above. this item is similar to one used in prior quantitative work on spiritual needs in healthcare settings (astrow et al., 2007). hodge, wolosin, bonifas/addressing older latinos’ spiritual needs 70 table 1 predictors, sample items, and reliability coefficients measure (sample item) # α admission process (courtesy of the person who admitted you) 2 .90 quality of room (noise level in and around your room) 5 .89 food service (courtesy of the person who served your food) 3 .88 nursing staff (nurses’ attitude toward your requests) 6 .96 administration of tests and treatment (explanation about what would happen during tests or treatments) 4 .92 visitors and family (accommodation and comfort for visitors) 2 .88 physicians (how well physician kept you informed) 5 .96 discharge process (speed of the discharge process after you were told you could go home) 3 .88 data analysis data were first screened for missing responses. across the sample, 4.55% of values were missing. no data were missing from the outcome variable or the demographic variables. one of the items in the three-item admissions process scale was missing data from 17.2% (n = 39) of cases. an additional eight items across four scales were missing data from 5.3% (n = 12) to 9.7% (n = 22) of cases. missing data were imputed using the expectation-maximization algorithm procedure to enable statistical analysis of all cases (schafer & graham, 2002). initially, bivariate relationships were examined between the satisfaction variables and the spiritual needs variable to determine general associations among the data. statistical procedures included independent samples t-tests, one-way analysis of variance, and pearson’s correlation. subsequently, hierarchical ordinary least squares (ols) regression analyses were conducted to identify predictors of satisfaction associated with the degree to which staff addressed older latino’s spiritual needs. in block 1, demographic variables were included to examine the relationship between these variables and the outcome variable at the multivariate level. in block 2, the eight satisfaction variables were added to advances in social work, spring 2013, 14(1) 71 identify significant predictors after controlling for the effects of the demographic variables. variance inflation factors were well below 10, indicating little evidence of multicollinearity (field, 2009). results bivariate analyses t-tests and one-way analysis of variance procedures were used to examine the relationships between the demographic variables and the spiritual needs variable. gender, age, and latino sub-group were not associated with clients’ perceptions of how well their spiritual needs were met during their hospital stay. conversely, geographic region was associated with satisfaction (p = .005), with tukey’s post hoc test indicating that older latinos in the south and western regions reported significant lower levels of satisfaction compared to respondents in the midwest. pearson’s correlation coefficients were computed to examine the relationships between the satisfaction variables and the spiritual needs variable. all eight predictors were associated with the outcome variable as expected. in other words, higher values on each of the predictors was associated with higher perceptions of satisfaction with the degree to which hospital staff addressed respondents’ spiritual needs. across the eight measures, the coefficients ranged from .52 (admissions process) to .70 (room quality); these values are commonly understood to indicate relatively strong associations (cohen & cohen, 1983). multivariate analyses to identify predictors of satisfaction after controlling for the effects of the demographic variables, a series of ols regression analyses was conducted. as can be seen in table 2, the first block consisted of the demographic variables. these variables accounted for approximately 4% of the variance in client satisfaction with how their spiritual needs were addressed. consistent with the bivariate results, only one of the demographic variables was significant. older latinos in the midwest reported higher levels of satisfaction with how staff addressed their spiritual needs when compared to the reference group, older latinos in the south and west regions of the nation. in block 2, the eight satisfaction variables were entered into the model as potential predictors. results regarding the pattern of relationships among the demographic variables remained the same. as was the case with block 1, older latinos in the midwest region reported higher levels of satisfaction regarding their spiritual needs relative to the reference group. the inclusion of the predictors significantly increased the variance explained by the model, which accounted for approximately 57% of the variance in clients’ satisfaction with how their spiritual needs were addressed. hodge, wolosin, bonifas/addressing older latinos’ spiritual needs 72 table 2 hierarchical regression analyses predicting satisfaction addressing spiritual needs block 1 block 2 demographics female1 -.200 (.119) -.120 (.080) age 80+ yrs2 -.153 (.139) -.030 (.095) puerto rican3 .008 (.160) .141 (.109) mexican american3 .022 (.157) .028 (.109) new england4 .303 (.161) .126 (.110) midwest4 .487 (.155)** .358 (.107)** predicator of satisfaction addressing spiritual needs admission process .010 (.075) quality of room .462 (.106)*** food service .134 (.077) nursing staff 1.831 (.429)*** administration of tests .066 (.121) visitors and family -.168 (.089) physicians .238 (.102)* discharge process -.197 (.087)* adjusted r square .037* .566*** unstandardized regression coefficients with standard errors in parentheses. reference groups: 1 male, 2 age 65-79 years, 3 other latinos, 4 south and west regions. *p < .05, ** p < .01, *** p < .001. in terms of individual predictors, satisfaction with room quality, nursing staff, physicians, and the discharge process were significantly related to satisfaction with addressing spiritual needs after controlling for the effects of the demographic variables. the positive coefficients for room quality, nursing staff, and physicians indicate that higher levels of satisfaction with services in these areas predict higher levels of satisfaction with staff’s efforts to address older latinos’ spiritual needs. conversely, the negative coefficient for the discharge process indicates that higher levels of satisfaction with the discharge process predict lower levels of satisfaction with staff’s efforts to address respondents’ spiritual needs, holding all other values constant. advances in social work, spring 2013, 14(1) 73 discussion hospital admission often engenders spiritual needs among older adults (nelsonbecker et al., 2007). in recognition of this reality, the joint commission requires an assessment of clients’ spiritual needs to support the delivery of culturally-grounded care and services (hodge, 2006; koenig, 2007). although addressing clients’ spirituality is an important component of service provision (astrow et al., 2007; williams et al., 2011), surprisingly little is known about the implementation of this process (koenig, 2007). for instance, to the best of our knowledge, little, if any, research has investigated factors that predict clients’ satisfaction with the attention granted to their spiritual needs during hospitalization. given the growth of the older latino population, the current study sought to address this gap in the literature by identifying factors that predict satisfaction with spiritual care in hospital settings. before summarizing the results, it should be noted that the study employed a cross-sectional design. thus, due to the correlational nature of the study, caution is warranted in interpreting the findings and their application. with this caveat in mind, the study identified a number of variables that were associated with satisfaction regarding efforts to address older latinos’ spiritual needs. more specifically, key predictors identified include room quality and the quality of interactions with the nursing staff and physicians. in addition, the discharge process was negatively associated with satisfaction. the final model, which included the impact of all predictors, accounted for approximately 57% of the variance in older latinos’ satisfaction regarding the attention given their spiritual needs. these results are consistent with prior qualitative research on spiritual needs (cavendish et al., 2006; hermann, 2001; hodge et al., 2012). for example, past research with african americans has highlighted the important role that god and nurses are perceived to play in spiritual care (conner & eller, 2004; tanyi et al., 2006). a room’s noise level, its cleanliness, and temperature can have a direct bearing on clients’ spiritual needs by, for example, inhibiting prayer and meditation and other practices that foster connection with god. key members of the healthcare team such as nurses and doctors are also perceived to play a central role in addressing spiritual needs. they help respond to and fulfill requests, provide hope and interpersonal connection, and display warmth and empathy. some older adults express a spiritual need to be kept informed about the state of their illness/progress, which was also a dimension tapped by the nurse and physician scales used in this study. in addition to confirming prior research, the present study breaks new ground in at least three ways. first, it uses quantitative methods to document the relationship between the predictors and clients’ spiritual needs previously suggested by qualitative work. second, it extends the findings to older latinos, whose spirituality tends to differ from the spirituality often expressed by european americans (suro et al., 2007). in turn, the specific knowledge obtained about this growing population can be used to promote greater cultural competency in service provision. third, while much prior research on spiritual needs is based upon respondents at a single healthcare organization, the present study incorporated respondents from hospitals across the nation. this geographic hodge, wolosin, bonifas/addressing older latinos’ spiritual needs 74 diversity helps mitigate any extant regional biases and implies that the results are not an artifact of local dynamics. implications these results have key implications for social work practice, education, and research. in the area of practice, the findings highlight the importance of personal interactions between healthcare providers and older latinos. hospital staff—nurses, physicians, social workers, and others—represent the vehicle through which spiritual needs can be addressed. to promote quality of care and patient satisfaction, staff must spend time actively engaging clients about issues related to their spirituality. at the same time, it is important to acknowledge that not all healthcare providers will feel comfortable discussing spiritual issues. an essential role for social workers in healthcare settings is to support multidisciplinary colleagues in gaining proficiency for conversing with clients about their spiritual needs. such training needs are especially salient given that, in spite of the joint commission’s spiritual assessment requirements, research suggests that clients’ spiritual needs are often overlooked in health care settings (astrow et al., 2007; balboni et al., 2007; williams et al., 2011). for some older latinos, this may not be problematic if they are uninterested in discussing their spiritual needs or if spiritual needs are not a salient personal issue. for others, however, the failure to identify and address spiritual needs can impede wellness (cavendish et al., 2006; davidson et al., 2008). consequently, it is critical that older latinos be afforded the opportunity to relate any extant spiritual needs or concerns. in turn, these concerns should be treated with dignity and respect by tailoring services appropriately; social workers can guide their multidisciplinary colleagues in the delivery of services that reflect and respect clients’ spiritual values. this same open posture towards clients’ spiritual needs also applies to the discharge process. interestingly, higher reported satisfaction with the discharge process was negatively associated with satisfaction addressing spiritual needs. although more research is needed to confirm and further illuminate this relationship, the discharge process itself may elicit spiritual needs, especially in an era of financial constraints and attendant short hospitalizations. for example, older latinos may not have worked through all the spiritual issues sparked by their admission to the healthcare system (koenig, 2012). thus, while satisfied with the speed of the discharge process, older latinos may feel that the swiftness of their exit inhibits consideration of their spiritual needs. in these situations, social workers can enhance patient satisfaction and service quality by discussing strategies for post-discharge spiritual care by, for example, encouraging clients to connect with a cultural healer or religious leader if doing so is important to them. social workers can also play an important role facilitating connections and referrals. as implied earlier, older latinos can express their spirituality in a variety of ways (canda & furman, 2010). expressions of spiritual need are likely to be similarly diverse (kosschioino, 2013). maintaining a network of diverse contacts within the practitioner’s advances in social work, spring 2013, 14(1) 75 hospital, healthcare community, and the broader local community can help address diverse spiritual needs. the findings also underscore the need for further education and training on spiritual assessment. most social workers, including most gerontological social workers, report receiving little training in the process of identifying and addressing clients’ spiritual needs (murdock, 2005; sheridan, 2009). the paucity of training is problematic. practitioners who have not been trained in the assessment process may feel ill-equipped to administer spiritual assessments in a professional and ethical manner that respects clients’ spiritual autonomy (canda & furman, 2010). in order to support multidisciplinary colleagues in addressing clients’ spiritual needs, social workers will need to be firmly grounded in understanding and discussing such needs themselves. educational programs might acquaint future practitioners with various spiritual assessment tools (canda & furman, 2010; hodge, 2003; koenig, 2007; pargament & krumrei, 2009), along with their respective strengths and limitations (hodge, 2005). practitioners might also benefit from reading assessment approaches that operationalize the joint commission’s assessment requirements (hodge, 2006). similarly, evidencedbased guidelines for the use of spiritual interventions may also be helpful to some practitioners (hodge, 2011a; hodge, 2011b). curricula might also include strengths-based content on the spiritual traditions commonly affirmed by latinos such as catholicism, evangelical protestantism, and pentecostalism (suro et al., 2007). while it is important not to assume clients hold all tenets of a particular spiritual tradition, it is helpful to have some knowledge of beliefs and practices that are commonly held among latinos. such knowledge legitimates the topic of spirituality in healthcare settings, implicitly communicates respect for clients’ traditions, and provides areas that can be tentatively explored with clients. similarly, programs will want to include content that enables social work students to differentiate between incorporating clients’ spiritual values into practice, which is within their scope of practice, and incorporating spiritual guidance into practice, which falls under the rubric of clergy (hodge & bonifas, 2010). educators may benefit from visiting the council on social work education’s (cswe) religion and spirituality clearinghouse website. the cswe clearinghouse features a number of peer-reviewed teaching modules and syllabi designed to promote ethical and effective practice with diverse expressions of spirituality. for example, among the resources included in the religion and spirituality educational resources section of the website is a syllabus on “evidenced-based assessment and intervention.” the results also highlight the need for additional research. to better understand the discrete spiritual needs of older latinos, in-depth interviews with patients might be conducted to delineate the nature and types of spiritual needs commonly manifested by latinos from various spiritual traditions and cultures of origin. research is also needed on the prevalence of spiritual assessments, the protocols used to operationalize assessments, the types of spiritually-oriented services available to patients, the training provided to staff, and other factors associated with ensuring patients’ spiritual needs are adequately addressed. hodge, wolosin, bonifas/addressing older latinos’ spiritual needs 76 given the paucity of research on predictors of satisfaction with attention to spiritual needs during hospitalization, the present study should be replicated with different samples of older latinos, as well as general samples of latinos. research should also be conducted in other healthcare settings. spiritual needs emerge in nursing homes and longterm care facilities and other settings served by social workers. predictors of satisfaction regarding clients’ spiritual needs may be different in diverse settings, indicating the need for additional research to identify areas of similarity and difference. research should also be conducted with african americans, american indians, and other racial/ethnic groups. much like latinos, these populations typically affirm distinct spiritual narratives (richards & bergin, 2000; van hook et al., 2001). accordingly, it is important that research be conducted that utilizes samples comprised solely or primarily of members of these groups. by identifying predictors of satisfaction, services can be tailored to enhance their cultural relevance and effectiveness. limitations as noted at the start of the discussion section, the cross-sectional design precludes any assessment of causality. in keeping with the correlated nature of the data, other models may also be plausible. satisfaction with efforts to address patients’ spiritual needs may be more accurately predicted by respondents’ physical health status, religious affiliation, self-ascribed importance attributed to spirituality, or some other variable or combination of variables not included in the present study. although the study incorporated respondents from diverse regions of the nation, the findings should not be generalized to all hospitalized older latinos in the united states; hence, the need for replication with other samples of older latinos. it should also be noted that social desirability bias can affect survey responses (williams et al., 2011). finally, single-item measures such as the outcome variable employed in this study are characterized by limited reliability and validity. concurrently, it should also be mentioned that such measures have been shown to function reasonably well in previous research despite their psychometric limitations (bond, dickinson, matthews, jagger & brayne, 2006; menec, shooshtari & lambert, 2007; zimmerman et al., 2006), suggesting some degree of confidence in the findings is warranted. conclusion to the best of our knowledge, this is the first study to identify predictors of older latinos’ satisfaction with how well their spiritual needs were addressed during hospitalization. in light of the rapidly growing population of older latinos (administration on aging, 2008b) and the critical role that spirituality plays among this population (suro et al., 2007), this study makes an important contribution to the literature. the findings suggest that room quality, nursing staff, physicians, and the discharge process play an important role—either positively or negatively—in satisfactorily addressing older latinos’ spiritual needs. by understanding the role such predictors play in clients’ experiences, social work practitioners and their advances in social work, spring 2013, 14(1) 77 multidisciplinary colleagues are better equipped to provide culturally relevant and effective services to older latinos. references administration on aging. 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(2006). developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life. journal of clinical psychiatry, 67(10), 1536-1541. author note: address correspondence to: david r. hodge, ph.d., school of social work, mail code 3920, 411 n. central, suite 800, phoenix, arizona, 85004-0689. ______________ katie richards-schuster, am, phd is an assistant professor in the school of social work at the university of michigan. mary c. ruffolo, lmsw, phd is a professor in the school of social work at the university of michigan. kerri leyda nicoll, mdiv, msw, phd, is an assistant professor of social work in the department of sociology, anthropology & social work at the massachusetts college of liberal arts in north adams, ma. catherine distelrath, msw, is a research assistant in the school of social work at the university of michigan. joseph galura, lmsw is a lecturer and advisor in the school of social work at the university of michigan, alice mishin, llmsw, is a lecturer and program manager in the school of social work at the university of michigan. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 372-389, doi: 10.18060/18526 exploring challenges faced by students as they transition to social justice work in the “real world”: implications for social work katie richards-schuster mary c. ruffolo kerri leyda nicoll catherine distelrath joseph galura alice mishkin abstract: for students who are actively engaged in social justice efforts on their college/university campuses, the transition from a relatively easy platform for engagement to the “real world” can pose significant challenges and create new realities for negotiation. little is known, however, about the nature of these transitions into post-graduate social justice experiences. drawing on an open-ended survey of recent graduates (92 respondents, 50% response rate) from a social justice minor in a school of social work, we explore the ways in which respondents described their transitions into social justice work, focusing on a set of key challenges that emerged from our analysis and reflecting on the implications of these challenges for social work practice and future research. understanding some of the challenges in making this transition will help social work and non-profit administrators to better support this population’s future volunteer, service, and employment needs. keywords: social justice, higher education administration, social work, community organization, social action while social work has a particular and unique commitment to educating students with a social justice orientation, the field is not alone in producing such students, as more and more colleges and universities establish active social-justiceand community-oriented majors and minors apart from bsw and msw programs (glass, 2013; harkavy, 2006; hoy, johnson, & hackett, 2012). in keeping with this trend, many social work schools have engaged in curricular innovations that promote engaged learning and active involvement in communities (burke, 2011; glass, 2012; rome & hoechstetter, 2010). some schools of social work are developing social work minors or related social justice minors as an alternative to the bsw program. although only a few social work schools offer undergraduate non-bsw programs, these innovations offer the potential for a social work footprint on undergraduate campuses and create the possibility of pipelines from undergraduate to master’s or doctoral level education in social work (richards-schuster, ruffolo, & nicoll, 2015). for highly motivated students who are actively engaged in these minors, majors, and other social justice efforts, the transition from a relatively easy platform for engagement to the “real world” can challenge individuals’ understanding of social justice and their own identities as social change agents and can create new realities for negotiation. the reality richards-schuster et al./exploring challenges 373 of these transitions and the challenges that emerge have implications for the social work and non-profit settings that become the first employers for many of these students. yet little is known about these transitions and the immediate issues both positive and negative that students face as they enter this new realm of engagement. in this article, we offer a first step toward such understanding by examining the immediate issues and challenges that new graduates have faced in staying involved in social justice work and service in the first three years after graduating from a social justiceoriented minor. drawing on an open-ended survey of new graduates who had recently completed a social justice-focused minor within a school of social work, we explore the ways in which respondents described their transitions into the “real world.” we examine trends in their descriptions, focusing on a set of key challenges that emerged from our analysis and reflecting on the implications of these challenges for non-profit settings, social work education and practice, and future research. background literature over the last several years, higher education in the united states has experienced an increased sense of responsibility for educating young adults not just academically, but civically as well (bringle, clayton, steinberg, & studer, 2011). as students have expressed a desire to perform more community work and become more engaged in social justice activities both on and off campus, institutes of higher education have begun working to fulfill that desire, offering an increasing number of service learning courses, civic engagement minors and majors, and co-curricular service and civic engagement activities (bringle et al., 2011; colby, ehrlich, beaumont, & stephens, 2003; steinberg, hatcher, & bringle, 2011). as these programs grow and expand, there is a strong desire by social work and other allied fields to support students as they transition out of the college/university environment and adapt to the various ways that social justice activism takes shape in their lives (flanagan & levine, 2010; wendlandt & rochlen, 2008). little is known, however, about how these undergraduate initiatives impact students as they transition from higher education to work in the “real world.” this is especially true for the millennial generation, which is the primary cohort of students in many of today’s undergraduate colleges and universities, including our own. recent research demonstrates an overall optimism among young adults about their lives and the world in general that is somewhat unique to the millennial generation (murphy, blustein, bohlig, & platt, 2010). researchers have described this as a tendency to possess “world-conquering ambition” and a much greater emphasis than previous generations on personal identity and civic engagement in the workplace (alsop, 2008; arnett, 2004; murphy et al., 2010). this ambitious, civic-minded outlook often leads to disappointment, however, when these young adults transition to their first jobs, finding themselves in mundane positions and wondering whether they are actually contributing anything to their organizations or, more importantly for them, to society (alsop, 2008; arnett, 2004; murphy et al., 2010). many students entering college today have a richer background in civic engagement and social justice than ever before, primarily in the area of volunteering. among other things, they bring to campus a variety of experiences with community-based work, along advances in social work, fall 2015, 16(2) 374 with a disposition of unfailing confidence in their abilities. it then becomes the role of colleges and universities to foster the identities that have been formed through adolescence and continue to challenge the depth of civic engagement within each student. this is being done, more and more, through an intersection of educationand community-based programs (bringle et al., 2011; colby et al., 2003; steinberg et al., 2011). murphy et al. (2010) found that, regardless of their feelings about the ease of their transition during the gap years, many young adults share a common sense of the value of community and social support in their lives. after leaving the comfort of the college community, many students elicit support and encouragement from their family and friends that keeps them motivated through their transition. this sense of value placed on community support likely develops most for students during their college years, particularly if they have spent time learning through community-based programs and instruction. there is limited research, however, that focuses specifically on the postgraduate outcomes of those who participate in serviceand community-based programs, and very little attention is given to how these programs impact this growing population of alums in different and presumably heightened ways compared to other graduates (keen & hall, 2008). while attention to alumni transitions and the particular challenges faced by this generation of social justice-minded young adults is growing (polach, 2004; roksa & arum, 2012), little research has focused on the nature of immediate (first, second, or third year post-graduation) transitions from undergraduate to alumni status for social work and other social justice-oriented students. mitchell, battistoni, keene, and reiff (2013), for example, discuss the importance of building an “enhanced civic identity” that sustains the transition from undergraduate to alumni, outlining fundamental skills such as collaboration, voice, reflective practice, and engaged scholarship. these skills are developed during college and become necessary for civic leadership over time, but the majority of studies have focused on alumni five or more years after graduation. other studies finding significant correlations between collegiate engagement and post-college civic involvement have also used longer time frames (besser, 2012; bringle et al., 2011; goldsberry, 2007). knowledge about the specific challenges facing students in the initial post-graduation years could prove to be particularly important given the fact that these years are often indicative of long-term trajectories (roksa & arum, 2012). while it is true that many college graduates face a transition shock, we are particularly interested in those students embarking on social justice careers because of the potential impact on their long-term engagement in social work-related fields. if schools of social work – whether they offer bsw programs or social justice minors are to continue to build a robust cohort of lifelong social justice practitioners, we must advance discussions about how best to support our graduates in making successful post-graduate transitions. this paper contributes to such discussions by examining the immediate issues and challenges that students encounter as they leave social work and social justice-oriented programs and the implications of those challenges for education, research, and practice in social work and allied fields. richards-schuster et al./exploring challenges 375 methods in fall 2013, our team of researchers conducted a pilot survey of alumni from an interdisciplinary social justice-focused minor program offered by a school of social work. until 2010, this school of social work, housed in a large public university, provided graduate education for more than 600 msw and phd students each year but had no undergraduate programs. the minor discussed in this paper, which began in 2010, is the first and only undergraduate program that the school of social work offers and was created as a multidisciplinary program aimed to support students interested in social justice, community action, and social change (see richards-schuster et al., 2015; richardsschuster et al., 2014, for more details about the minor’s development and curriculum). there is no bsw or social work major program offered at this university. the goals of the minor, which is explicitly not intended to be a bsw program, are to enable students to: (a) examine community action and social change concepts using a multidisciplinary framework, (b) address community action and social change efforts in multilingual and multicultural communities, (c) integrate social justice values into the community action and social change processes, and (d) engage in service learning opportunities to promote community change initiatives. the courses included in the 16-credit minor are intended to provide students with theoretical frameworks for understanding social change, skills for self-identity development and facilitation in diverse settings, experiences in service-learning or community-engagement courses, practical skills for community change work, and opportunities for integrative reflection. in addition, the minor offers co-curricular activities to complement course-based learning. these include social justice fairs, speakers and panels, community-based experiences, community-building activities, and opportunities to hear about and learn from the experiences of program alumni. drawing on systems and community action frameworks, the many components of the minor were designed to prepare students to engage in social justice/change work throughout their lives, whether they pursue traditional social work careers or enter fields as diverse as sports management, biomechanics, or music. research design our pilot survey of the alumni of the minor was initially designed to gather information about the experiences of alums post-graduation, both in order to help in developing better supports for future cohorts as they transitioned to the “real world” and to assess the implications of these experiences for social work and social justice education more broadly. our specific questions were: (1) what are the challenges that highly motivated, socialjustice-focused students face as they graduate from college and enter the “real world”? (2) what are the perceptions of these new graduates as they move into social work and related non-profit settings? to gather this information we created an online, open-ended survey. in the survey, we asked alumni to share about their post-undergraduate work (paid, unpaid, continuing education), discuss accomplishments they had achieved since graduating from the minor, identify challenges they had faced, and reflect on what they had learned (and not learned) advances in social work, fall 2015, 16(2) 376 from the minor (e.g., what has been useful, what has mattered most to them in their postgraduation work, what they wish they had learned, and what advice they would give to current students). because this was a pilot survey and we were looking to generate themes rather than test particular hypotheses, we intentionally kept the survey open-ended (creswell, 2014). using qualtrics, an online survey tool, we administered the survey to alumni from the first three cohorts of the minor from 2011 to 2013 (n=187). we reached out to alumni using email addresses that they had provided at graduation or updated contact information they had sent of their own accord. after sending three follow-up emails as reminders to encourage alumni to complete the survey, our final response rate was approximately 50% (n=92). alumni from each of the three classes provided answers. the sample of survey respondents consisted of 71 women and 21 men. of the 92 respondents, 75% identified as white, 6.5% identified as black, 6.5% identified as hispanic, 5.5% identified as asian or pacific islander, and 6.5% chose not to respond. although over half (56.5%) of the respondents had been social science majors, respondents also reported a variety of undergraduate majors, including art and design, science, business, and cultural studies. the overwhelming majority of the students in this sample completed college within four years and were in their early 20s at the time of graduation. at the time of response, participants were in a range of post-college opportunities, most of which were in the nonprofit or public sectors, social work, or social justice fields (see table 1). table 1. post-graduate involvement of study participants (n= 92) post-graduation involvement # of alums extended service program (americorps, teach for america, peace corps, etc.) 23 (25%) msw or joint master's program 22 (24%) non-profit or government employment 23 (25%) other post-bacc. degree at u of m or other school 14 (15%) for-profit or freelance work 3 (3%) unemployed/ no response 7 (8%) analysis as our survey questions were largely open-ended and we were interested in exploring responses without particular predefined hypotheses, we approached our data using thematic analysis (boyatzis, 1998; creswell, 2014; denzin & lincoln, 2011). multiple research team members reviewed the survey responses, resulting in the identification of several potential thematic codes. once these codes had been identified, the data was reviewed again in an effort to locate all instances of the identified themes/codes in each individual’s survey responses. the reviewers then compared their codes and sorted them into three major categories: (a) current experiences, (b) challenges, and (c) the translation of learning from the university to the “real world.” using these categories, the data was reviewed yet again to uncover related sub-themes and ensure conceptual saturation (corbin & strauss, 2008; glaser & strauss, 1967). the team also used qsr international’s nvivo 10 software, a qualitative data analysis program that assists with pattern-based coding and theme tracking, to explore richards-schuster et al./exploring challenges 377 word frequencies and response trends (qsr international, 2012). in this article, we focus specifically on the themes that emerged related to challenges graduates faced as they transitioned from undergraduate education to post-graduate experiences. emergent themes: critical challenges in transitions while there were many successes that graduates faced during their transitions from undergraduate education to post-graduate life and work, these successes were most often accompanied by challenges. approximately two-thirds of our respondents noted specific challenges they had faced during their post-graduation transition. the remaining third did not explicitly acknowledge challenges, which could mean that they transitioned without challenges or that they failed to mention them in their survey responses. we acknowledge that transitions are complex and involve both ups and downs, but we chose to pay particular attention to challenges in this paper in order to highlight the ways in which schools of social work might more fully support social justice-focused graduates. challenges with adjustment to new communities more than a third of the students who responded to this survey described challenges related to their adjustment to new community environments. this is not terribly surprising, as one would expect that students who have spent years in one location might have difficulty relocating and starting anew outside of their familiar surroundings. building relationships, learning new jobs, and negotiating the requirements of living in new cities are challenges likely faced by many recent college graduates. for many, this was their first experience in moving to a new community without the structures and supports of a university environment, and for those beginning social-justice-focused positions, it often entails adjustments not only to new locations but also to the economic and social realities facing the communities they are entering and with whom they hope to work. as one respondent in his first year post-graduation reported: my biggest challenge by far has been adjusting to my community outside of work. it is a low-income black community centered around the church in a town ravaged by the collapse of industry. i can relate in some ways, but i’m not religious at all and it’s not a great place for 20-somethings. that being said, i feel it’s important to be involved in the community as much as you can, so it has been tricky to navigate being present with practicing self-care and not compromising myself. for this respondent, moving to a new community was challenging, not only because he did not know people and did not feel like he fit in with the culture around him but also because he wanted to become a part of this community, sharing in its struggles and accomplishments, while still maintaining his own identity. he was deeply committed to living in this community, not just physically but also socially, wanting to build relationships with his neighbors and other community members, but adjusting to life there was still a challenge. “i’m not sure (the minor) really prepares you for the full experience,” he said, “since it's gonna be different no matter who you are, but it does emphasize the importance of knowing your community and i realize now how important that is to take that to heart.” advances in social work, fall 2015, 16(2) 378 other respondents made similar comments about the challenges to adjusting to new communities and new environments: there have been a lot of challenges, from moving away from everything i’ve known, to adjusting to a new culture, language, and career…i am constantly reflecting on my role and what i hope to accomplish here. it has been overall a challenge to move to a new city and a new community to work in the social work field…it is a challenge to network and start ‘fresh’ when you are young and continuing to move to new environments. frustration with “social justice” ideology another theme that emerged was the challenge of ideological frustration around what social justice looked like in reality. despite feeling that their experiences in college and in the minor had given them the skills to engage with others and to work collaboratively, many of our respondents still expressed a stark realization that, as one student put it, “no one wants to talk about social identities and social justice as much as college students do.” in some ways the respondents described the difference between the theoretical frameworks around social justice and the practical implications of working for change on the ground, especially as it related to awareness around social identity. despite having taken service learning courses or participated in internships, students expressed feeling unprepared for moving into organizational environments that differed from their experiences surrounded by other social-justice-minded students in college. it has been very difficult working with (an) organization as a whole who, at times, do not carry the same sort of communal and cultural values as (the minor)…i am feeling a bit frustrated by all of this, to be honest. some of my biggest challenges are working with people who have been in the criminal justice/juvenile justice field for years. they seem to be more skeptical and pessimistic. they also doubt me because of my identity as a young white woman who is passionate about challenging our prison system. working with people who do not share my interest/passion/knowledge around social justice and community work has been a challenge. even among others who seemed to care about similar issues and share a commitment to social justice, it was sometimes difficult to not speak a common language. some respondents noted that they often used jargon that identified them as educational elites, which created additional challenges: “[school] helped me by giving me knowledge, but educational privilege has been a tough thing for me to manage.” another respondent added, “leaving [college], i sort of assumed that everyone would have this knowledge [of how experiences and identities play into people’s lives].” interestingly, we found that this was particularly acute for students who transitioned from college into graduate programs. our sense is that graduates who entered the workforce, although frustrated in many cases, were more positive about their experiences and their ability to apply the values they learned through the minor to their work, whereas richards-schuster et al./exploring challenges 379 those in msw programs expressed more frustration about their fellow students not possessing the same level of insight into social issues. i find that my colleagues [in the msw program] don’t have the in-depth understanding of social inequalities/issues that i… have, and this can be quite frustrating. i’ve been struggling with being frustrated with my peers because of their lack of inclusivity or multicultural awareness….my classmates often come to me with questions in these areas because of my experiences in [the minor]. stress of working in non-profit organizations a third emergent theme in the findings was the level of stress and frustration faced by respondents as they transitioned from the university to work in non-profit and communitybased environments. like many millennial students, the transition from college to the workforce was the first time that these young adults had held full-time positions in the nonprofit sector, although some had worked in part-time or volunteer positions while in school. their exposure to non-profit and community-based organizations, through service learning courses, internships, field experiences, and other volunteer activities, tended to be bounded, time-limited, and in some cases engineered specifically for student learning and thus did not accurately expose students to the realities of working full-time in the field. non-profits, particularly smaller, service-oriented organizations, face unique challenges and limitations that are not often discussed in the college classroom, leading some students to have unrealistic expectations of what work in this environment would entail. though they were committed to and excited about working in organizations devoted to social change, our respondents did not always have a sense of what this work would be like on a day-to-day basis. as one respondent noted, “working for a non-profit can be extremely frustrating due to lack of funding and organization.” this was echoed by another who said, “understanding agency limitations has been the most challenging.” several also expressed feelings of disillusionment with their job duties, which were not always as explicitly related to community change as they would have hoped. one respondent commented: the biggest challenge for me is just the days when i go into work and i’m doing the most seemingly unrelated, random task. and i should say it’s not the type of task like getting coffee, but more like writing a random report for something that doesn’t really change the way programs are going to run. [social justice work] is easier to be passionate about when you’re talking about [it] in class, but much harder when it’s your 40+ hours a week job. it’s filled with mundane tasks that seem totally unrelated to the mission…you have to have something that ignites that spark. while these respondents were not about to give up on community change work, they did wish that they had been more prepared for the day-to-day work of non-profit employees, advances in social work, fall 2015, 16(2) 380 particularly in the first few years after graduation when their jobs are likely to be entrylevel positions that lack major decision-making responsibility. these basic challenges of operating in a non-profit organizational culture were compounded for some by the stress of trying to balance their passion for social-justiceoriented work with a reasonable level of self-care. one recent graduate noted, “i think the biggest challenge so far is money...i am making barely enough to live on.” others focused less on financial concerns than on fears of losing their passion for change work as a result of financial, physical, or emotional stress. one respondent described her biggest challenge as “being treated like just because i have a heart and care about the issues, i will do anything and everything to get it done, including getting pushed to the point of physical and mental exhaustion.” “one of my main challenges,” another respondent said, “is separating my career from my personal life. i want so much for my clients to succeed in their goals but i have to realize that at the end of the day, i can only do what i can do.” overwhelming sense of “real world” injustices a fourth emergent theme from the survey involved efforts to grapple with the overwhelming nature of social injustices and oppression in the “real world.” while some students come to college with a strong understanding of the realities of injustice, other students-especially those from more privileged backgrounds–lack a realistic picture of the challenges faced by many individuals and communities. while short-term projects, service learning courses, and internship experiences in and with communities can open students’ eyes to issues they did not know existed, they cannot fully prepare them for what it is like to live these experiences on a regular basis. this is especially true for students in nonsocial-work degree-granting programs who do not have the same expectations for sustained field placements as most bsw and msw programs. one respondent noted, for example, that her biggest challenge is “just dealing with the personal stories from clients,” while another said that she has been surprised by how challenging “working with clients from different backgrounds can be.” for both of these respondents, as well as many others, learning about the very different – and often unjust – life experiences of clients has been enlightening but also disheartening. while some described finding ways to cope with issues of injustice, others mentioned the “immensity” of social problems and of the work they saw before them: i have faced burn-out and a type of exhaustion from the utter “brokenness” of the world…but i also get to see the other side of it. i have been able to rally with a team doing extraordinary work and focus on that rather than the things that we aren’t/can’t be doing. [i have been] overwhelmed by the immensity of social issues that still exist in the world, let alone our society. it is difficult to grasp the fact that i cannot positively impact every issue i come across. recognizing “real world” injustices has also challenged alumni to draw on the relationship-building skills they developed in courses and service experiences while in school. as they described it in response to our survey questions, this has involved not only richards-schuster et al./exploring challenges 381 becoming aware of the very real problems and injustices communities face but also of the uniqueness of each community’s experiences and therefore of the steps it will take to bring about change. acknowledging diversity and building relationships across difference were things the students learned about in the classroom but still struggled with as they entered work in the field. as one respondent said, “i learned in [classes] that you must always come into a community understanding that it is different but what i was not ready for was how different.” overall, while our respondents repeatedly described the ways that their social justice courses and other activities had helped them to deal with the challenges they faced as they moved into social-justice-oriented jobs post-graduation, they still encountered some challenges for which they felt unprepared. implications for social work practice and research the findings from our research suggest that there are many challenges that students face as they transition into post-college civic engagement and social justice work experiences. given that many students first work in non-profit settings and that these first post-college jobs often set the course for students’ desire to remain in social work or other social justice-oriented careers, it is critical that social work as a field pays particular attention to understanding transitions. similarly, it is important that social work agencies and community-based organizations be able to understand the mindset and transitional issues facing the graduates that become their newest employees or serve as long-term interns through programs like americorps or city year. understanding these challenges could potentially lead to easier transitions and higher job satisfaction by recent graduates and less turnover and workplace frustration by non-profit and social work agencies. while it is no surprise that students face challenges when they leave the university setting and enter the “real world,” there have been very few studies that attempt to capture the perspectives of recent graduates and to name and understand the nuances of these challenges. one of our respondents described this transition as moving beyond the “social justice bubble” that exists in many campus-based settings. while we may recognize that this bubble exists, as educators and researchers we often have not put much effort into understanding or preparing students for what leaving it will entail. in this next section we explore potential strategies for supporting transitions and discuss suggestions for future research. strategies for social work schools to support transitions because of the investment of social work schools in supporting social justice and social work agencies, social work educators play a special role in helping to develop strategies for successful transitions. while some social work schools already offer social justice minors as a form of connection to undergraduates, others schools, especially those without bsw programs, may look to opportunities to offer course work for undergraduates in order to provide more realistic understanding of work in social justice organizations. for example, social work schools might strengthen opportunities to connect undergraduate students to the daily realities of work in the social justice realm while they are still in school. while msw and bsw programs are required to provide field advances in social work, fall 2015, 16(2) 382 experiences that enable longer exposure to community organizations, social justice minors or programs are not; therefore, exposure to the actual day-to-day realities of work may not occur. such exposure might be accomplished, however, by developing a capstone or seminar to explicitly discuss the transition from student to graduate and/or by providing opportunities for students to learn about the day-to-day workload of non-profit employees, graduate students, and social justice advocates, particularly those in their first one to three years out of college. another strategy would be to include more opportunities for students to engage in conversations with recent graduates about their daily work life. courses could be developed that focus on the reality of social change work to expose students to an understanding of what is expected of them (i.e., to provide a realistic picture of what such work is like), what the tensions and issues are in the daily tasks of social justice work, the logistics of working in a non-profit, such as sample schedules, work pacing, and need for flexibility-and the impact of the work on the employees, including accomplishments and growth. in addition to providing more concrete examples of what social justice work is like in the “real world,” courses and co-curricular programs in social work and other related fields also need to help students to develop the specific skills they are likely to need for their post-graduation lives and work. based on the challenges described by our survey respondents, we argue that the following types of skills should be prioritized: relationship building, critical reflection and perspective-taking, cultural and educational humility, and self-care. the types of relationship building we have in mind include not only establishing relationships with people in one’s new community in order to learn from their perspective but also intentionally seeking out relationships with those who can inspire and support one in the face of challenges. both require similar skills in networking and communication with diverse community members, but the former involves using these skills to meet and interact with like-minded and non-like-minded people with an eye toward building coalitions across difference, while the latter entails maintaining contacts with people outside of one’s new community as well as developing relationships within that community with people who share one’s commitment to social justice. our respondents’ comments about “educational privilege” and the isolation they experienced as a result of this tie directly to the recent call in social work education for the development of “cultural humility” (ortega & faller, 2011). this is a practice that deemphasizes the role of the practitioner as an expert in cultural and diversity frameworks and focuses on being open to learning about people through their own perspectives and lived experiences as a core component of practice (ortega & faller, 2011), as well as on the need for frank discussions about the role of privilege and social identity within social change work. critically important to student transitions is the ability for students to be aware of and cognizant about their own privilege. in this minor, for example, with a population that is largely white, possesses an upper socioeconomic status (ses), and comes from an elite public university, privilege emerges from student’s educational perspectives, racial and ethnic identity, and ses, among other social identities. open and honest discussions about how to recognize one’s own privilege and the implications for practice richards-schuster et al./exploring challenges 383 are very important. these discussions occur in the classroom on a regular basis, covering topics such as “privilege,” “entering communities,” “fighting white savior complexes,” and “critiquing the concept of ‘help’” among others. they also happen outside of the classroom in minor-sponsored workshops, retreats, and network discussion activities. most recently, the minor developed a social justice retreat aimed at grappling with critical questions around privilege and social change. as students are able to be more open and humble in their engagement, they may be able to engage more deeply with others, even those of differing perspectives and persuasions and find a common humanity to listen and learn, even if they disagree. strategies for administrators of social justice and civic engagement organizations while social work schools have the potential for the biggest influence on students before they graduate and take entry-level social justice positions, the non-profits and social work agencies that hire the students as employees or volunteers can also incorporate strategies to support this transition. based on our respondents’ descriptions of the struggles they experienced during their transition out of college, non-profits especially those that recruit new employees from a wide geographic region may need to do more to equip new employees to build relationships in new and different settings. non-profit agencies like those that participate in multi-year service programs such as americorps and city year should consider orientations as opportunities for relationship and network building among students and for connecting students to the broader community. while orientations often occur, organizations should reflect on the ways their orientations can be more intentional in helping new graduates enter the community and build the connections that may ease some of the initial tensions. additionally, administrators of social justice organizations may want to seek opportunities to help new social-justice-focused graduates get involved in their work. while many of our respondents were involved in a social-justice-focused experience after graduation, we know that some are seeking additional opportunities to get involved or are seeking meaningful volunteer experiences to enhance their day-to-day work. one suggestion is for non-profit organizations to create more partnerships with local companies and agencies to encourage service days. in this way, organizations can make connections to those graduates who are social-justice-focused but engaged in other occupations or are seeking additional opportunities to be involved in social justice work. given the challenges our respondents expressed of finding others who are social-justice-oriented in their new communities, administrators may also seek alternative forms of service days or voluntary service groups that promote engagement and help build networks of social-justice-minded young professionals. although critical reflection is often a regular part of student experiences during college, it is less often practiced in busy non-profits. our alumni survey reminded us that students need to not only participate in facilitated reflection during their time in school but also to develop their own tools for continuing this type of reflection as they move into the world of social justice work. some of this may be individual work, such as encouraging new graduates to create interactive blogs to support self-reflection and shared learning or to participate in online forums to enable graduates to reflect on and share their experiences advances in social work, fall 2015, 16(2) 384 related to common issues. some might also be organizational work, such as encouraging new employees to create portfolios to capture their experiences, providing weekly learning and reflection opportunities, and creating settings in which to share reflections and learning in broader organizational contexts like newsletters, websites, and conferences. one place for critical reflection to occur is within supervision sessions. rethinking what supervision looks like and how supervision is provided may be necessary. depending on an organization’s structure, supervision may need to happen more often or may need to focus on reflection of skills and experiences gained in the process. supervision may occur one-on-one, in small groups, or even through ongoing communication using social media. regardless of process, it is important to remember that supervision and points of connection between new employees and senior leadership help shape expectations, process experiences, and also help new employees see the long-term horizon of working in social justice organizations. in other words, supervision can be not only a space to deal with immediate issues but also an opportunity for learning context and history and for putting the immediate issues into perspective. self-care also emerged as an important theme in our survey. understanding what selfcare is and why it is valuable on an intellectual level, however, does not mean that one knows how to practice it, particularly during a time of transition as one adjusts to the demands of a new job or living situation. social justice non-profits and agencies are perfectly positioned for helping students learn about and begin to practice such strategies. for example, non-profits might partner with social work schools to offer mini-courses, workshops, and co-curricular activities focused on realistic stressors and self-care strategies practiced in the field. the college years represent a significant time for students to prepare themselves for the stresses they may face after graduation; if they have begun these habits in a more secure and comfortable setting, it will be easier to carry them over to a new setting rather than attempting to develop new strategies in the midst of the transition. strategies for supporting alumni while all of the strategies mentioned here have the potential to significantly impact students’ transitions, it is also critically important, based on our respondents’ comments, that social work and other social-justice-oriented programs consider strategies for longerterm, continuous support of their alums, and, in particular, a focus on keeping alumni connected after graduation. while many schools of social work and academic programs try to maintain connections with alumni, we would push efforts to move beyond calling on alumni as donors and rather re-think alumni efforts to provide ongoing support for graduates in their work worlds and in furthering their commitments to social justice. this concept of moving from alumni as donors to a more active recognition of alumni engagement is being modeled nationally through programs like citizen alum, a national initiative of multiple colleges and universities aimed at moving from “donors to do-ers” and to “building multigenerational communities of active citizenship and active learning” (citizen alum as cited in ellison, 2013, p. 3). richards-schuster et al./exploring challenges 385 other practical ideas for alumni engagement include creating alumni networks focused on social justice, linking alumni by geographic location or issue of interest to support collaborations and reduce isolation, providing resources and training to support ongoing reflection and strategies for self-care, and linking recent alumni to others with longer-term positions and engagement in social justice work through a post-graduate mentorship program. in our own program, we are experimenting with a variety of ways to engage alumni in additional training through on-site sessions and web-based seminars on topics and strategies related to social justice work in the “real world.” we are also working to develop hubs of graduates across geographic areas (e.g., major metropolitan hubs and regional areas) as well as linking students across shared experiences (e.g., graduate students, teach for america, americorps, city year, community organizers, program developers, etc.) for reflection, connection, and support. lastly, we are actively working on opportunities to link alumni to graduating seniors to share and reflect on their experiences as an additional way of preparing those seniors for their transition into the world of social justice work. an additional recommendation would be to explore the potential for addressing the economic realities of social justice work and the barriers that these create for recent graduates. schools of social work should work with alumni and agencies to develop innovative solutions such as loan forgiveness, education scholarships, professional development/continuing education credits, high quality benefits, and work-life balance programs to explore additional venues for supporting and sustaining new employees in their efforts to engage in social justice work over the long haul. limitations and future research as with any research, our study faced limitations that need to be acknowledged and accounted for in future efforts. while only a pilot, we recognize that our sample does not include the experiences of students that have returned to school as non-traditional students and therefore have had work or family experiences that will shape their transitions to postcollege life. similarly, this research did not look at the link between prior work experience and transitions, which also would potentially impact how students experience challenges. last, using emails as a tool for outreach was a limitation because of the number of former students who did not respond in a timely manner. we learned that our outreach emails were sometimes sent to old university emails that frequently went unchecked. although we had a decent response rate, many other alums emailed us after the survey closed realizing that they had wanted to participate but had missed the deadline. in the future we will plan to use additional measures to ensure we have the most accurate email lists for outreach while also using other platforms such as social media to contact potential respondents. despite these limitations, we see this pilot as a base from which to develop future research on pathways and trajectories of students in social justice programs. in particular, longer-term follow-up of graduates is needed to learn about ways to facilitate civic engagement and social justice activities post-graduation. for example, what is the trajectory for most of these graduates at various intervals (e.g., one, three, or five years) post-graduation related to civic engagement and social justice work? what are challenges advances in social work, fall 2015, 16(2) 386 that continue to emerge at various intervals? how do experiences, both during school and post-graduation, shape perspectives over time? in our research it was difficult to tease apart the experiences between those in graduate school and those in employment, but future research should look specifically at differences between transitions to graduate programs (social work or otherwise), short-term volunteer employment experiences, and longer-term employment opportunities. more research is also needed to explore the “valued added” impact of participation in social-justiceintensive programs as compared to more traditional academic programs. is there a difference, for example, between the civic engagement and social justice trajectories of graduates from these programs and those of other graduates from their university? additionally, it will be important for future research to explore the impact of work settings and context on alumni experiences. what are the various experiences of graduates in different types of workplace settings? in what ways do those settings differentially impact civic engagement and social justice values and trajectories, and what remains common across all settings? finally, further research and discussion needs to focus more closely on the infrastructure needed to truly connect schools of social work and employers around issues in the field. too often there is a disconnect between a school’s curricular preparation and the needs of employers (polach, 2004). with rare exceptions (such as the iv-e child welfare programs), there is almost no infrastructure or research to support ongoing engagement between schools of social work, administrators of agencies and non-profits, and supporting alumni. lacking these discussions, and research to document their findings, the social work field risks creating a mismatch for the field moving forward. conclusion as a field committed to preparing future generations of social justice advocates and change agents, social work – together with allied fields – must continue to seek out practices that support the transition from undergraduate education to next steps in social justice engagement, helping graduates to cope, develop, and thrive rather than to burn out in the face of initial challenges. it is therefore critical that leaders in social work and other social-justice-oriented academic programs understand the challenges and issues students face as they graduate and move into the “real world.” only by hearing from recent graduates themselves can we gain a sense of not only the knowledge and skills our students need to develop while in school but also the support they need from their academic institutions and programs once they graduate. this study offers a first look at what very recent graduates of a social-justice-oriented program in a school of social work have encountered upon leaving undergraduate education and moving into the world of work, service, and graduate school and, by doing so, points educators, practitioners, and researchers in social work and social-justiceoriented fields toward new strategies that will enable us to produce graduates who become life-long change agents. richards-schuster et al./exploring challenges 387 references alsop, r. 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(2008). addressing the college-to-work transition: implications for university career counselors. journal of career development, 35(2), 151-165. doi: http://dx.doi.org/10.1177/0894845308325646 author note address correspondence: katie richards-schuster, phd, assistant professor, school of social work, university of michigan, 3850 sswb, 1080 s. university, ann arbor, mi 48109. email: kers@umich.edu http://dx.doi.org/10.1177/0894845308325646 mailto:kers@umich.edu abstract: for students who are actively engaged in social justice efforts on their college/university campuses, the transition from a relatively easy platform for engagement to the “real world” can pose significant challenges and create new realities ... background literature methods research design analysis emergent themes: critical challenges in transitions challenges with adjustment to new communities frustration with “social justice” ideology stress of working in non-profit organizations overwhelming sense of “real world” injustices implications for social work practice and research strategies for social work schools to support transitions strategies for administrators of social justice and civic engagement organizations self-care also emerged as an important theme in our survey. understanding what self-care is and why it is valuable on an intellectual level, however, does not mean that one knows how to practice it, particularly during a time of transition as one adju... strategies for supporting alumni limitations and future research references microsoft word 21. george et al_2440_reimagining field education copyedit_final ______________ purnima george, ph.d., is an associate professor, susan silver, ph.d., is an associate professor; and susan preston, ph.d., is an associate professor, all in the school of social work at ryerson university in toronto. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 642-657 reimagining field education in social work: the promise unveiled purnima george susan silver susan preston abstract: the current wave of neo-liberalism in canada has driven our universities to retreat from their responsibilities as public institutions, accountable to their communities. in this paper we present a case study of field education in canada and discuss the implications of the neoliberal academy on social work field education. on the basis of our experience as faculty consultants of bsw and msw students, and coming from a school of social work that embraces an anti-oppression perspective as its guiding philosophy, we undertake a reconceptualization exercise in which we re-imagine field education. we politicize field education as a site with transformative possibilities. we describe the principles and processes that inform our reconceptualization and offer an example of how this might be realized in practice. this paper contributes towards developing new knowledge that unveils the promise of transformative change through a re-imagination of field education. keywords: neo-liberalism, academy, social work, field education the current wave of neo-liberalism has driven canadian universities to reconsider their responsibilities as public institutions to their communities. while the mission statements of universities proclaim their social responsibility to communities through providing relevant and responsive education, in reality, this mission is being replaced with an entrepreneurial agenda. neo-liberalism within academia is aptly described by shore (2008) as the “transformation of the traditional liberal and enlightenment idea of the university as a place of higher learning into the modern idea of the university as corporate enterprise ... maximizing economic return and investment, and gaining competitive advantage in the global knowledge economy” (p. 282). this shift in universities’ mission has profoundly affected social work education. as neo-liberalism becomes more entrenched within universities, the mission of social work begins to shift away from engaging communities outside the academy towards meeting the new demands of neoliberalism. this trend is contrary to the stated mission of social work offered by the canadian association of social work education (caswe) and the canadian association of social workers (casw). according to caswe, the mission of social work is “to promote change and achieve equity and social justice” (caswe, 2011). this mission obligates a commitment by schools of social work to marginalized communities, centering these communities in all aspects of social work education, including classroom teaching, field education, and research. within this perspective, the role of social work education would be aligning with communities and working towards transformative change. this mission is critical in the current neo-liberal context where we are witnessing deepening inequalities and injustices within george, silver, preston/reimagining field education in social work 643 marginalized communities. however, schools of social work have interpreted this mission in a manner that tends to fit, rather than challenge, the individualistic and corporate shifts we are experiencing in the academy (larner, 2000). this is particularly evident in the design and delivery of field education. for the most part, field education continues to be delivered in a very traditional manner, with critical thinking limited to the classroom at best. instead of challenging the status quo, this traditional model actually reinforces the neo-liberal agenda (preston, george & silver, in press). in preparing students for social work practice, the current model of field education primarily situates students within the context of an agency. students in our school spend approximately 900 hours in the bsw and 450 hours in the msw. their practice training includes acquiring an understanding the practices and processes of their placement agency and assisting in the delivery of services to individuals and groups. consequently in this model, the scope of practice is limited to an agency context. this model does not center the community nor does it recognize its critical role in preparing students to promote equity and social justice within the broader societal context. with its focus on agency-based practice, this model of field education reinforces the very neo-liberalism that our mission proposes to challenge (aronson & sammon, 2000; preston, george & silver, in press). as wiebe (2010) points out, “the field education experience ought to provide students with the opportunity to go beyond analysis to active engagement in social justice work” (p. 70). the current model of field education was not explicitly designed to forge alliances between schools of social work and communities, though some placement contexts might provide these experiences. given the deepening marginalization of our communities (fanelli & paulson, 2010; mowbray, 2010; purcell, 2009; rose, 1996), it is timely and urgent for social workers to engage with the agenda of social justice, equity, and transformative change. coming from a canadian school of social work that embraces an anti-oppression perspective as its guiding philosophy, we consider this lack of alignment of field education with the original mission of social work as a missed transformative opportunity. on the basis of our experience as faculty consultants of bsw and msw students, we have come to visualize field education as a site with multiple possibilities, such as: the possibility for alliance building with communities; the possibility of being a critical partner in the process of social change; and last but not the least, the possibility for preparing future social workers for activism and transformative change. we recognize that this process of reimagining field education is fraught with many tensions, particularly as academics are increasingly becoming neo-liberal subjects (burchell, 1998; davies & petersen, 2005; olssen & peters, 2005). while we acknowledge the limits of reconceptualizing field education within the current neo-liberal context, we also recognize that it is imperative that we resist the neo-liberal project and not surrender ourselves to its dictates. much of the research on neo-liberalism focuses on academia and explores ways of disrupting managerialism in academy, not on how the academy could engage with communities (anderson, 2008; barnett & griffin, 1997; clark, 1998; fisher & rubenson, advances in social work, fall 2013, 14(2) 644 1998; giroux, 2003; kelsey, 1998; meemeduma, 2001; rhoades & slaughter, 1997; slaughter, 1998; slaughter & leslie, 1998). similarly, the literature on field education in social work has focused on exploring ways of strengthening the conventional model of field (andharia, 2011; lager & robbins, 2004; todd & schwartz, 2009, wehbi & turcotte, 2007). this paper contributes towards developing new perspectives on field education that unveil the promise of transformative change. we do not wish to provide a recipe but instead, stimulate further critical thinking and dialogue. the neo-liberal academy neo-liberalism has turned the academy away from being a public institution and towards functioning as a capitalist enterprise (barnett & griffin, 1997; carroll & beaton, 2000; clark, 1998; fisher & rubenson, 1998; giroux, 2003, 2010; kelsey, 1998; meemeduma, 2001; rhoades & slaughter, 1997; slaughter, 1998; slaughter & leslie, 1998). this shift has transformed knowledge into a commodity just like other goods and services (sit, 2008). as a public institution the academy’s responsibility towards achieving the social good is redefined in economic terms with an assumption that such economic development will be beneficial to everyone. thorpe (2008) understands this shift as a “crisis in the very idea of the university as an institution ... [with] the complete subordination of intellectual life to instrumental values and most brutally, to the measure of money” (p.1). deem and brehony (2005) see this as an ideological shift that maintains relations of power and domination by administrative hierarchies. this shift in the academy’s vision is reflected in the curriculum, roles of academics, and governance of the academy. with the shift to neo-liberalism there is an increasing expectation that the university will adapt its curriculum to meet the demands of the market, privileging research that will attract external research grants and striving towards developing demand for markets (deem & brehony, 2005; polster, 2005). based on this focus, neo-liberalism has privileged research over teaching and service (fairweather, 1996; gaffikin & perry, 2009; hughes, 2007). there is an increasing pressure on academics to pursue research funds by securing external grants (deem & brehony, 2005; gaffikin & perry, 2009; jacobs, 2004; newson, 1998; polster, 2005). these trends are accompanied by management practices that emphasize “efficiency, accountability and competition” (aronson & smith, 2010, p. 531). they encourage a culture of individualism and competition between academics (larner, 2000; shore, 2008; sit, 2008; whitley, aguiar, & marten, 2008) at the expense of collective well-being. anderson, johnson, and miligan (1996) perceive these practices as fitting with foucault’s (1991) assertion of ‘governmentality’ by coupling ‘individualization’ and ‘totalization’ through a single message that there is only one ‘right way’ to succeed. anderson and colleagues (1996) find that managerialist approaches to performance appraisals and reward systems in academia encourage individualism while reaffirming the totalizing message that there is only one “right way” to succeed. zipin (2006) examines how this “governmentality” highlights institutionalized bullying and weakens the autonomy and agency of academics (p. 26). marginson and terry (1995) describe performance reviews as “the key parts of the education panopticon, a way to steer from a distance” (p. 9). george, silver, preston/reimagining field education in social work 645 these changes have constrained the creativity and leadership within faculty members in areas that are not deemed as productive or income generating (clegg, 2008; kezar, lester, carducci, gallant, & mcgavin, 2007). at the departmental levels, research is becoming more significant, measured annually through indicators such as research income, research activity, grant applications and success rates (green, 2008; larner & heron, 2005). to be competitive, faculty are discouraged from undertaking research that is founded on social justice perspectives, as such perspectives are likely to receive less funding (wehbi & turcotte, 2007). this system rewards the entrepreneurial professors who generate research income and peerreviewed journal publications (anderson, 2002; anderson, 2008; baldwin & krotseng, 1985). although universities still include teaching and service as valued attributes, tenure and promotion committees are increasingly devaluing service and teaching and focusing on research outcomes (boyer, 1996). the consequence of this trend is the retreat of the academy from its engagement with communities. in withdrawing its attention away from the issues facing communities, the academy is continuing to relinquish its responsibility as a public institution (mollis, 2006; pusser, 2002; thorpe, 2008). boyer (1996) proposes a "scholarship of engagement" which implicates institutions of higher learning as partners in pursuing "our most pressing social, civic and ethical problems" (p. 19). boyer maintains that engaged "campuses would be viewed by both students and professors not only as isolated islands, but staging grounds for actions ...” (p. 20). slocum and rhoads (2009) also challenge the withdrawal of the academy from its communities and instead, provide a democratic emancipatory vision of the university as a “socially transformative agent concerned with active engagement in social problems (as opposed to claiming a position of neutrality) and addresses democratically negotiated social good ...” (p.88 ). we concur with boyer (1996) and slocum and rhoads (2009), in that, schools of social work can play a significant role in re-establishing the social mission of our universities. based on their unique advantage of being connected to communities through field education, schools of social work could act as a bridge that reconstructs reciprocal relations between the academy and the community. schools of social work have been particularly affected by the neo-liberal transformation of the academy. the essence of social work education is based on partnerships between the academy and communities. as faculty are compelled to focus inward on scholarship productivity (kilpatrick, turner, & holland, 1994), they become less focussed outside the academy and with communities. given this inward focus, faculty manage these neoliberal tensions by restaging critical perspectives in the classroom and less in the field. we find ourselves becoming complacent with classroom activism, and as such, our activist intentions remain rhetorical rather than enacted. problematizing our current model of field education in this section, we problematize certain aspects of our current model of field education. consistent with many other schools of social work in canada, our current model is primarily agency-based and focussed on service delivery. this model has advances in social work, fall 2013, 14(2) 646 remained strikingly constant over time, with only incremental changes since its inception. while designed during the expansion of the welfare state, the model prepares students for service delivery within a social rights and institutional approach to social welfare (hick, 2004; rice & prince, 2003; westhues, 2006). in the current neo-liberal context, there is a steady withdrawal of the state, a move to a residual model of social welfare and a retrenchment of funding for social services (burke & silver, 2012). the current model of field education lacks the capacity to respond to this erosion of services. while some schools may have tinkered with the practicum in terms of its goals and objectives, these changes have not interrogated the philosophical and theoretical foundations of the current model and their contributions to neoliberalism. the current model depoliticizes field education, providing symptomatic relief within a neoliberal construction of social welfare. rarely does the current model engage in activities that challenge the causes and processes of marginalization and oppression. hence, this perspective continues to shape the delivery of field education. as an agency-based model, field education primarily occurs in agencies that provide individualized and group-based services. within a context of neoliberalism, scholars have critiqued this model as it privileges service delivery at the expense of broader understanding of social issues and their impact (aronson & sammon, 2000). the inherent limitation of this model is that the training students receive is limited to addressing solely the symptomatic manifestations and not the root causes of marginalization. students have limited engagement with communities and with the day to day experiences of oppression and exclusion. within an agency-based model, it is assumed that problems can be effectively addressed through programs and services (baines, 2004). hence, programs and services within this model become an end in themselves, and not as a means towards social transformation (fisher & shragge, 2000; leighninger, 1999; mullaly, 2001; razack, 2002). this approach to field education tends to decontextualize and depoliticize practice, ignoring historical relations of power and processes of marginalization. this is in sharp contrast to the critical social work perspective students get exposed to in the classroom. within this context, field education prepares students for depoliticized practice. a further problematic with the current field education model is the individualized approach to supervision. in many ways this dyadic relationship mirrors the practitionerservice user relationship. too often, supervision in this context becomes ‘expert’ centered, privileging the knowledge and experience of the ‘trained’ practitioner / supervisor over that of others. this is in contrast with our classroom curriculum in which we challenge the assumptions of truth that are represented by notions of expertise. the divide between theory and practice becomes even more concerning when we see distinct differences between theory in classrooms and practice in field. in particular, we note an activist focus in the classroom, drawing on new ways of thinking about structures, power, and people, without shifts in the field that support such approaches to practice. practice, as illustrated through field education, too often remains individualfocussed, providing service to ameliorate personal needs rather than exposing and challenging the social forces that create and sustain such disparity and need. while this george, silver, preston/reimagining field education in social work 647 model prepares students to engage in agency-based social work, the experience it offers is limited especially when the context of practice is under siege (aronson & sammon, 2000). rossiter (2001) as well as wehbi and turcotte (2007) highlight the tension between educating employable practitioners and educating activist social workers. therefore, while the classroom curriculum remains critical of the changing context of practice, field education does not reflect the same responsiveness. at best this approach to field education is a missed opportunity for schools of social work to engage with communities and enact our transformative vision. at worst, this model unleashes vast numbers of students into agencies, ultimately practicing in ways that reinforce the status quo. given these concerns, it is imperative that schools of social work address the question of how to politicize field education. how do we structure field education to contribute towards a transformative agenda? we need to work differently with agencies and communities, so that we can respond to the issues that are the most concerning for these communities. the issues of significance to marginalized communities do not necessarily conform to agency mandates and services – rendering these invisible. field provides schools with the opportunity to be responsive to communities by realigning ourselves with agencies and communities. in this section, we propose a model of field education that centers social transformation and repositions the field as a site of resistance. re-imagining field education we begin our attempt at re-imagining field education by repositioning it as the center of social work education. we recognize that for social work practice to be transformative within the current neo-liberal context there is a need to reimagine field education with the rest of the curriculum. our re-imagination exercise re-examines the core principles of social work. these principles, described below, have informed our reconceptualization of field education, and we suggest they would continue as the foundation of this reimagined approach to field education. (1) historical and current relations of power and processes of marginalization challenges of marginalized groups and communities must be understood through the lens of historical and current relations of power (fook, 2002; smith, 1999). in the process of service delivery, issues must be seen in the larger context, and this must inform all aspects of the student’s interaction with the community (fook, 2002). (2) contextual understanding the re-imagined field education will be based on an understanding that learning always occurs within a context. drawing on the concept of contextual practice (fook, 2002) we believe that to prepare students for contextual practice even field education has to be geared towards exposing students to the nature of context and its consequent effects on communities. the current insular form of agency-based practice does not provide enough exposure to the neo-liberal context and its impact on communities. such an exposure will prepare students to consider the complexity of social work practice in advances in social work, fall 2013, 14(2) 648 current times and develop their abilities to “work with whole contexts, rather than simply a number of disparate players within a context” (fook, 2002, p. 143). this understanding of context would also enhance the possibility for applying the knowledge learned in the classroom. within this principle of contextual understanding is the importance of relevance – field education needs to be relevant to the emerging challenges of our communities in the current times. as such, field education will go beyond the model of delivering existing services to understanding the context specific challenges and engaging with communities in developing relevant responses towards those challenges (healy, 2000). it is only by being rooted in the context of the community, through a strong bonding with the community, that you can know what the issues are (finn & jacobson, 2008; kahn, 1991) and therefore guide the field placement experience to respond to those issues. (3) reciprocality the re-imagined field education will be based on the principle of reciprocality, in that our vision reflects a shift away from the transactional nature of reciprocity and towards a community-university process of building synergies for social transformation. more specifically, we believe in the primacy of engagement, relationality, and accountability to our communities, as these are critical foundational components required for building synergy (potts & brown, 2005; shragge, 2003). this principle implies the co-creation and exchange of critical knowledge, as students and faculty stand in solidarity with communities as a partner in the process of transformation. this would allow schools of social work and their universities to fulfill their mandate as public institutions committed to the issues and needs facing communities. (4) reflexivity we list reflexivity as the final principle as this principle critically draws on the other principles as its tools or dimensions for uncovering new ways of knowing. we consider reflexivity as a process of deep reflection, one through which we locate and implicate ourselves in relation to our perspectives, actions, relations, and structures that are produced and reproduced. we deepen our reflexivity by incorporating and implicating ourselves through a historical and contextual understanding of the operations of power and oppression. such a reflexive process contributes to uncovering power relations and structures of domination. new ways of understanding that emerge from this process will build the capacity for reciprocity that is authentic and transformative (d’cruz, gillingham & melendez, 2007; fook, 2002; heron, 2005; kondrat, 1999). our vision our vision represents a significant shift from current approaches to field education. we suggest a new approach to the field placement experience, one that centers communities through the delivery of field education. this shift would change the process george, silver, preston/reimagining field education in social work 649 and roles of all partners in field education: students, faculty, field instructors, and community members. (1) community-based field education the foundational change we envisage is a deliberate shift away from an agencybased model to a community-based approach. in doing so, we are not abandoning agencies, but are instead seeking ways to broaden activist intentionality beyond a single agency. in this way, we recognize the vulnerabilities that agencies face as entities dependent on the state – which delineates their focus to service-delivery alone. in working from a community model of field education, we bring a strategic focus to the issues that communities are confronting. by not solely focusing on the agency and its service provision, this approach can open up the space for a number of agencies to come together to align with communities (rubin & rubin, 2001; shragge, 2003). given the funding restrictions on advocacy (aronson & sammon, 2000; cox, 2001), in this model, it is the community that is engaged in advocacy, with support from agencies and the academy. thus, with a community model, we are broadening the scope of field education, from service delivery in a single setting to also include social action in a community with a community of agencies (gamble & weil, 2010; rothman, 2007). the purpose and intentions of the field placement become driven by, for, and within the community, rather than through an agency-specific mandate. the change in focus for field education, from the localized mandate of an agency to the broader goals and intentions of a community, will require changes in the delivery of field education itself – its processes and roles – and that change begins with the school’s field education office. (2) field education office – from placement model to hub model in our re-imagining exercise, we consider a corresponding revisioning of the role and processes of field education. the current processes of field education, driven by managerialism, require performance indicators that are often limited to numbers, particularly the number of students placed. consequently, the primary function of the field education office is recruiting placements and matching students. neo-liberal management systems, supporting this primary function, are reflected by the importance given to legal contracts and placement agreements with agencies, an emphasis on learning contracts, systems of assessments and reporting assessments and other documentation pertaining to the placement agency (ife, 1997). as an example of our concerns, we object to the current system of legal contracts with placement agencies as these legal contracts are increasingly replacing the strong university-community relations of the past. these contracts, in fact, challenge the image of a university as a public institution, further distancing the university from its communities and agencies. while some of these tools, such as learning plans and student evaluations, would inevitably continue within the new approach, they will be seen as a part of an overall community model. based on these considerations we envision the field education office to play a significantly different role (see figure 1). we imagine that the field education office advances in social work, fall 2013, 14(2) 650 might become a “hub” – a space similar to the notion of a “public sphere” (giroux, 2010; habermas, 1989) for community members and academics to meet and deliberate on contemporary social issues and explore ways of taking action on these issues. in this space, historical and current relations of power can be interrogated, as the contexts in which issues are discussed reflect broader and critical dimensions. further, opportunities for reciprocality are made possible, as these inform the intentions of the deliberations. we further envisage that field opportunities for students would emerge from these deliberations. figure 1. field education hub and community action connectedness the field education office would facilitate dialogues with communities, agencies and social movements. these dialogues could result in the identification of priority issues and the development of alliances based on these issues. this process could lead to a shift from agency-based matching to issue-based matching with schools of social work cocreating students’ learning opportunities in dialogue with communities. as described earlier, such a collective effort opens up the possibility of going beyond individual and program-based approaches to broader and more critical ways of identifying and addressing priority issues. to support this shift in field education, the role of the faculty consultant and the field instructor would need to incorporate a stronger liaison function. faculty consultants and field instructors have always been strategically positioned to connect the academy with communities. in our vision, we intentionally politicize this liaison role, moving beyond bridging to mobilization and social transformation. we see their roles as critical to field education  hub community  action george, silver, preston/reimagining field education in social work 651 facilitating the dialogues, identification of priority issues, formation of issue-based alliances and in the development of mobilization strategies. faculty consultants and field instructors would be able to plan student practicums that emerge from these collective processes and mobilization strategies. performance indicators of field education and student supervision would thus be tied to these collective processes and outcomes. faculty consultants, field instructors, and students would have the opportunities to participate in transformative processes along with agencies and communities. this dynamic process would expand the capacity for critical reflexivity, as participants are able to interrogate and implicate themselves in relation to processes of oppression and transformation. through this process, the academy can play an integral role as a “socially transformative agent concerned with active engagement in social problems” (slocum & rhoades, 2009). in the section that follows, we provide a brief example of how our vision might be enacted in relation to the issue of food security. field education and food security – an example our example begins with the field education office organizing various dialogues with communities and agencies in relation to identifying issues of concern for communities. through these dialogues, many issues could emerge and be prioritized for further action. for the purpose of this paper, a priority issue that could emerge would be food security among new and racialized immigrants. an alliance would then be forged with stakeholders committed to tackling this issue. stakeholders could include members of the community, grass roots agencies, mandated agencies, and faculty. through on-going discussions, this alliance would develop a transformative strategy and specific actions in relation to the strategy. emanating from this strategy, faculty consultants and field instructors could then identify various sites, responsibilities, and tasks that constitute student practicums. students from different years of the bsw and msw programs would be matched to these practicums emanating from the issue of food security and placed in various sites implicated by the issue, such as: grass roots agencies located within a geographic community/neighbourhood; social service agencies working in that community/neighbourhood; responsible government departments; and any citizen coalitions and social movements that community members are a part of. responsibilities generated within these sites could include: working with the geographic community and families affected by the issue; developing local initiatives at the community level to address the issue; working with food banks, schools, community health agency, local businesses in relation to the issue; developing policies or programs with government departments and political representatives; conducting research on food security; and connecting this issue with other campaigns against poverty and unemployment. while students may be working in various sites, their efforts are coordinated by the faculty consultants and field instructors, with members of the food security alliance paying particular attention to tracking the overall progress towards transformative change. this model further provides opportunities for students to work in a team or individually and to coordinate their efforts across agencies and communities. while a student may be placed in a specific site, they will have to work with students placed in other sites, with all students contributing to the overall transformative strategy. in this advances in social work, fall 2013, 14(2) 652 approach, student learning is enriched, and their contributions are mobilized towards realizing the broader goal of social change. it is the confluence of student learning and an agenda of social transformation that sets this model apart from current practices. in the process, the academy and its communities are united in resisting the pervasive neoliberalism. consequently, field education becomes a site through which collective efforts can be marshalled in the fight towards social justice and against neoliberalism. conclusion while our visioning exercise has been exhilarating, the prospect of implementing this vision is daunting. our goal is to develop a different conceptualization of field education, one which provides a new vision and a hope within the current neo-liberal context. we offer broad possibilities and processes that restructure field education from the current model to a “staging ground for actions” (boyer, 1996, p. 20). field education becomes a collective space for deliberating and acting on the issues most relevant to communities. practicums thus emerge through these deliberations and, in turn, students participate and contribute to this activist agenda. our focus on a community model is not intended as a binary that devalues the current agency model. instead, our vision encompasses agencies and recognizes their potential contributions towards a transformative agenda through field education. we realize the many challenges and tensions in shifting field education as suggested by our vision. we also recognize that our vision may offend as many readers as it may inspire. however, we hope that our colleagues, committed to social change, will explore ways in which they can contextualize this activist agenda within their delivery of field education. references anderson, d., johnson, r., & miligan, b. 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(2009). thinking through quality in field education: integrating alternative and traditional learning opportunities. social work education, 28(4), 380395. wehbi, s., & turcotte, p. (2007). social work education: neoliberalism’s willing victim? critical social work, 8(1). retrieved from http://www1.uwindsor.ca/criticalsocialwork/2007-volume-8-no-1 whitley, r., aguiar, l. m., & marten, t. (2008). the neoliberal transnational university: the case of ubc okanagan. capital and class, 96, 115-185. wiebe, m. (2010). pushing the boundaries of the social work practicum: rethinking sites and supervision toward radical practice. journal of progressive human services, 21, 66-82. westhues, a. (ed.). (2006). canadian social policy: issues and perspectives (4th ed.). waterloo, on: wilfred laurier university press. zipin, l. (2006). governing australia’s universities: the managerial strong-arming of academic agency. social alternatives, 25(2), 26-31. author note: address correspondence to: dr. purnima george, associate professor, school of social work, ryerson university, toronto on m5b 2k3. email: p3george@ryerson.ca microsoft word mcguire_service learning preface copyedit3 _________________  lisa e. mcguire, ph.d., is an associate professor and interim director of the bsw program and virginia majewski is a  professor and associate dean, both in the indiana university school of social work at the indianapolis campus. they  would like to thank shawn hensley for her editing help and mary lindop for her help in organizing the think tank  workshop.    copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), i‐vii    editorial: social work and service-learning in the age of competency-based education lisa e. mcguire virginia majewski special issue co-editors we are pleased and proud to have served as guest editors for this special issue of advances in social work focusing on “social work and service-learning in the age of competency-based education.” this compilation of peer-reviewed articles provides a timely update to the growing literature on service-learning in social work education. each article provides a snapshot of how individual faculty and their respective programs have embraced service-learning to enable students to achieve mastery of the competencies as articulated in the council of social work education’s (cswe, 2008) educational policy and accreditation standards (epas). as a whole, this issue demonstrates how the 2008 epas challenges faculty to be innovative in preparing students for professional practice. with each article as a snapshot, the issue itself provides a panorama of how servicelearning pedagogy provides multiple opportunities for social work education to operationalize and assess the competencies necessary for professional practice in the current dynamic practice environment. the special issue grew from a workshop held in indianapolis in may of 2010 entitled assessing professional competencies through service-learning: a dialogue and think tank, or the think tank from here forward. the think tank brought together over 50 faculty members from around the nation who were using or interested in implementing service-learning pedagogy in their courses. the think tank began with the opening plenary delivered by internationally-recognized service-learning scholar, dr. robert g. bringle, who presented service-learning, social justice and assessing competencies: an overview. the group then engaged in a passionate dialogue exploring the social justice mandate of the profession and basic issues of competency-based education. participants voiced concerns that competency-based education in social work, as articulated by the epas (cswe, 2008), might limit faculty members’ ability to be creative with experiential pedagogies such as service-learning. there was also concern that the emphasis on assessment might dilute the professional purpose of promoting social and economic justice. these concerns were not surprising given that service-learning pedagogy is part of a larger movement to facilitate the civic engagement of higher education (boyer, 1990; colby, ehrlich, beaumont, & stephens, 2003) and that faculty members who are interested in service-learning are likely to highly value civic involvement for themselves and their students. feeling that a competency-based approach was leading to the “rubric-ization” of social work education, and away from the mission mcguire, majewski/editorial ii   of social justice, the first morning of the dialogue ended on a somewhat somber, if thoughtful, note. in the afternoon, faculty members grouped themselves around selected epas (cswe, 2008) competencies including diversity, policy and human behavior and the social environment (hbse). social work faculty proved their resilience as they began to share how they had integrated service-learning activities to provide learning experiences for students in these areas. the synergy created in these discussions refocused faculty members on the competencies that they had watched their students develop through their service-learning experiences. discussions continued through dinner and participants regained their resolve to find the fit between the requisite competencies, service-learning pedagogy, and assessment. with the second plenary from dr. patti clayton entitled cultivating competencies through integrating critical reflection and assessment, issues began to come together. service-learning has always emphasized reflection as a requirement for high-quality pedagogy (eyler, 2000; eyler & giles, 1999) and dr. clayton’s presentation provided a roadmap for utilizing reflection as a tool to not just document and deepen, but also assess, learning (ash & clayton, 2004). providing examples from her consulting work, she demonstrated how using rubrics in a positive manner could “bloom-ify” (bloom, 1956) the epas (cswe, 2008) practice behaviors, facilitating students in moving from the lower levels of “identify and explain” to the high levels of “apply, analyze and evaluate.” the critical thinking required in reflection was demonstrated to provide the means to both assist students in deepening their learning while also demonstrating competence. participants went away from this session energized by the possibilities of utilizing structured, critical reflection to not only evidence the impact of service-learning pedagogy, but to also demonstrate a wide range of competencies. the think tank certainly challenged and inspired participants to continue their exploration of service-learning pedagogy and encapsulate their experiences in many of the articles in this special issue. burke’s (2011) conceptual exploration of civic education and social work is an excellent reflection of issues raised in the first session of the think tank, while twill, elpers, and lay (2011) provide a demonstration of using a structured reflection assignment to move students forward in bloom’s (1956) taxonomy with hbse content. lucas-darby (2011) offers an innovative example of how social work education may focus students on aspects in the physical environment, moving the profession forward to consider important issues of energy conservation and recycling as emerging social issues. combined with the contributions of other scholars who have also explored servicelearning pedagogy, this issue includes a broad array of thinking around service-learning in the age of competency-based education in social work. the issue begins with a review of social work and service-learning provided by phillips (2011). building on her previous article (phillips, 2007), she provides a summary of the “state of the art” regarding service-learning, both in higher education and social work education. focusing on the dearth of conceptual clarity around service-learning in social work education, she proposes critical questions and some tentative ways to ameliorate the risks of losing the advances in social work, spring 2011, 12(1)    iii  civic engagement focus of service-learning in a context of behavioral assessment of competencies. burke (2011) continues the exploration of the civic engagement aspect of service-learning with a thought-provoking review of concepts such as democracy and professionalism as they relate to the civic education of social work students. next, nino, cuevas, and loya (2011) present an example of how one social work program has created a community-based agency which provides an array of services, utilizing the service-learning volunteers along with practicum students to address the unmet needs of the community. this innovative endeavor models civic involvement by social work faculty and provides opportunities for transformative learning for students. the remaining articles provide exemplars of the utilization of service-learning pedagogy in ways that are particularly important to current social work practice. in fact, if one were to make of list of emerging challenges for social work education, it would certainly include issues such as the need to become globally and culturally competent, the importance of linking theory to evidence-based practices, the benefits of interdisciplinary collaborations, the challenge to prepare students to meet the growing need for competencies in gerontology, and the mandate to move to a greener way of community life to protect the environment for current and future generations. an example of utilizing service-learning pedagogy is presented on each of these important topics. as mentioned earlier, twill, elpers, and lay (2011) present an example of how a service-learning experience may provide evidence of mastery of competency/practice behaviors designated for hbse (cswe, 2008). social work education programs have traditionally been organized around content areas and the shift to competencies may be challenging for faculty who teach theory. service-learning pedagogy, including reflections structured around the identified practice behaviors, provides a framework for the shift, as well as a way to provide evidence of student mastery. the next two articles provide examples of international service-learning (ericson, 2011) and interdisciplinary collaboration to develop cross-cultural knowledge (belliveau, 2011). ericson (2011) highlights the opportunities and challenges of an international service-learning course to develop competencies/practice behaviors in human rights as well as diversity and difference. utilizing quantitative survey and qualitative journal data, students demonstrated increases in their self-reported competency and the gains seemed to continue beyond the trip itself. belliveau (2011) addresses similar competencies around human rights and social justice as well as diversity and difference in a crosscultural project much closer to home. this example is powerful in illustrating an interdisciplinary collaboration with the university spanish language department to provide an immersive experience with latino parents in a school setting. the planned activity presented serendipitous opportunities for students to experience how the sociopolitical context of immigrant families, as well as language differences, creates barriers, as well as opportunities, for parents and children alike. the final two articles focus on emerging issues that face our country, as well as the planet, and are those which future social workers will need to address, long after social work educators of today have completed their careers. as older adults are becoming increasingly represented in the american population, as well as in the client populations mcguire, majewski/editorial iv   served by social workers, jones (2011) provides an example of service-learning to expose students to this underserved population and explore attitudes toward aging. encouraging students to reflect upon their own aging process while building competencies measured by the geriatric social work competency scale ii (damron-rodriquez, 2006), students demonstrated gains on all 4 subscales of the tool, which supports previous research of the utilization of service-learning in geriatric settings. and finally, lucas-darby (2011) focuses attention on the protection of the environment, supporting sustainability of the environment as a basic human right. a service-learning assignment in a community practice class resulted in three diverse projects which allowed opportunities for students to build competency in multiple areas of the advancement of human rights, community context and community practice. as the articles discussed above were reviewed, edited and made ready for final publication, the editors identified overarching themes that transcend the individual contributions to the literature on social work and service-learning as related to the current context of competency-based assessment in higher education. the movement to assess learning outcomes in higher education has come from both regional accrediting bodies as well as professional accrediting organizations such as cswe (holloway, 2008), which provide the broader context for this analysis. the first theme relates to the importance of civic engagement and the mission of social work education. although much of the emphasis in preparing for cswe accreditation/reaffirmation seems focused on curriculum and competencies/practice behaviors, the new standards also highlight a school/program’s mission and the need to provide evidence that the mission is being met. given that the professional purpose focuses on issues of social and economic justice, respect for diversity, and elimination of poverty and oppression (nasw, 2008; ifsw, n.d.), one would be hard-pressed to find a social work program whose mission did not focus on these issues. service-learning pedagogy, with the emphasis on civic engagement and services to vulnerable populations, may provide powerful evidence that schools/programs are indeed meeting their missions. these efforts of individual faculty members in implementing this pedagogy may be thus viewed as part of a school/program’s strategy to demonstrate educational policy 1.0 – program mission and goals (cswe, 2008). in addition, the efforts of a social work program to implement service-learning and foster civic engagement become part of the overall college/university strategy for civic engagement, which is now required for regional accreditation as well. as part of the clear emphasis on program mission and goals, epas (cswe, 2008) also has added a standard to specifically address program context. holloway (2008) identifies that “(a)ttention to context is found throughout the new standards” (p. 3). the educational policy 1.2 program context states that “(p)rograms are further influenced by their historical, political, economic, social, cultural, demographic, and global contexts and by the ways they elect to engage these factors” (cswe, 2008, p. 2). each of the specific examples of service-learning courses in this volume provides opportunities to identify factors particular to the college/university context (e.g., traditional age undergraduate students working with older adults, students from homogeneous communities participating in an international experience, students developing services for advances in social work, spring 2011, 12(1)    v  a changing demographic, etc.). these unique opportunities grow directly from the local needs of the area and provide evidence that schools/programs are indeed responding to their university mission and setting in providing social work education to students. and finally, and perhaps most importantly, service-learning provides the opportunity for an emphasis on the process of learning over time. as discussed by phillips (2011) and nino, cuevas, and loya (2011), as well as by other scholars, service-learning pedagogy is often utilized by faculty in the beginning of a student’s academic career. this has multiple benefits for students in professions such as education, nursing and social work. these include allowing for career exploration, ensuring that a career is a good fit and introducing some of the major challenges and themes that will be explored throughout the student’s academic program. given that epas (cswe, 2008) focuses attention on the outcome assessment for student competencies and practice behaviors at the end of their academic career, service-learning creates an opportunity to focus on the journey toward competency, through its emphasis on early experience and reflection. it is clear that many service-learning courses have the potential to generate direct evidence of the achievement of specific competencies and practice behaviors. in addition to summative assessment, the opportunity to apply complex content on topics as farranging as hbse theory, community practice, and cultural competency to specific situations in a service-learning course may only serve to better prepare students for demonstrating competency in the field, where it is appropriately required to be assessed. the requisite emphasis on the development of structured, critical reflection becomes instrumental in describing, deepening, and documenting learning (ash & clayton, 2004). highly developed skills of structured, critical reflection will be necessary for students to identify and provide evidence for the wide array of competencies and practice behaviors from their practicum experiences. although field is certainly the “signature pedagogy” (shulman, 2005) of social work, skills in reflection are arguably necessary for students to be able to maximize their learning and integrate classroom content and the field activities for competent practice. well-designed service-learning courses have the potential to be a powerful tool for social work educators to meet the expectations of professional education as well as the civic mission of the profession itself. references ash, s., & clayton, p. (2004). the articulated learning: an approach to reflection and assessment. innovative higher education, 29(2), 137-154. belliveau, m. (2011). interdisciplinary service learning: building student competencies through the cross-cultural parent groups project. advances in social work, 12(1), 7993. bloom, b. s. (1956). taxonomy of educational objectives: the classification of educational goals. handbook i: cognitive domain. new york: david mckay company. boyer, e. l. (1990). scholarship reconsidered: priorities for the professorate. menlo park, ca: the carnegie foundation for the advancement of teaching. mcguire, majewski/editorial vi   burke, t. k. (2011). civic professionalism: using service learning to educate social work students as citizens. advances in social work, 12(1), 21-32. colby, a., ehrlich, t., beaumont, e., & stephens, j. (2003). educating citizens: preparing america’s undergraduates for lives of moral and civic responsibility. san francisco, ca: jossey-bass. council on social work education. (2008). educational policy and accreditation standards. retrieved from http://www.cswe.org/file.aspx?id=13780 damron-rodriguez, j. a. (2006). moving forward: developing geriatric social work competencies. in b. berkman (ed.), handbook of social work in health and aging (pp. 1051-1068). new york: oxford press. ericson, c. b. (2011). pura vida with a purpose: energizing engagement with human rights through service learning. advances in social work, 12(1), 63-78. eyler, j. (2000). what do we most need to know about the impact of service-learning on student learning? michigan journal of community service learning, special issue, fall, 11-17. eyler, j., & giles, d. e. (1999). where’s the learning in service-learning? san francisco, ca: jossey-bass. holloway, s. (2008). some suggestions on educational program assessment and continuous program improvement: revised for the 2008 epas. silver spring, md: council on social work education. international federation of social workers (ifsw). (n.d.) retrieved from http://www.ifsw.org/ jones, s. h. (2011). life is experienced until we die: effects of service learning on gerontology competencies and attitudes toward aging. advances in social work, 12(1), 94-112. lucas-darby, e. t. (2011). the new color is green: social work practice and service learning. advances in social work, 12(1), 113-125. national association of social workers (nasw). (2008). code of ethics of the national association of social workers. retrieved from http://www.socialworkers.org/pubs/code/code.asp nino, m., cuevas, m., & loya. m. (2011). transformational effects of service learning in a university developed community based agency. advances in social work, 12(1), 33-48. phillips, a. (2007). service learning and social work education: a natural but tenuous connection. in m. nadel, v. majewski, & m. sullivan-cosetti (eds.), social work and service learning: partnerships for social justice (pp. 3-19). lanham, md: rowman & littlefield. advances in social work, spring 2011, 12(1)    vii  phillips, a. (2011). service learning and social work competency based education: a ‘goodness of fit’? advances in social work, 12(1), 1-20. shulman, l. (2005). signature pedagogies in the professions. daedalus, 134(3), 52-60. twill, s., elpers, k., & lay, k. (2011). achieving hbse competencies through service learning. advances in social work, 12(1), 49-62. author note: direct correspondence to lisa mcguire, ph.d., indiana university school of social work, 902 w. new york street, indianapolis, in 46202. email: lmcguir@iupui.edu ______________ florian sichling, phd, assistant professor, and diane beckerle o’brien, msw, lcsw, assistant teaching professor and msw program director, university of missouri – st. louis school of social work, st. louis, mo 63121. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 383-396, doi: 10.18060/22918 this work is licensed under a creative commons attribution 4.0 international license. knowledge that changes social work practice: an exploration of its sources and content florian sichling diane beckerle o’brien abstract: there is continuing interest in the relationship between knowledge and practice in social work. overly narrow conceptualizations of the ebp model deepened the gap between practice knowledge and formal research evidence in the profession. while much has been written about the dissemination and adaptation of research findings to practice, much less is known about the actual sources of knowledge social workers draw on in their practice. this paper reports findings from an exploratory survey about the sources and content of knowledge that changed professional practice among social work field instructors (n=250) in st. louis. an analysis of open-ended responses revealed that coworkers and continuing education programs are the most important sources for knowledge and information that influence practice. while academic journals are perceived by practitioners to be relatively unimportant sources for such knowledge, research findings on the background and effectiveness of interventions, make up the primary content that appears to affect social work practice. the findings suggest that formal research knowledge is important but that it is primarily accessed through professional networks and training programs instead of directly from peer-reviewed journals. social media platforms seemed to be insignificant sources for professional knowledge. these insights raise important questions about how social workers use social media and the role of occupational networks and associations for the dissemination of research findings. finally, our findings suggest that agencies and researchers think more purposefully about the infusion of knowledge into practice through opportunities for professional socialization, the use of research briefs, and open-access, peer-reviewed journals. keywords: evidence-based practice; social work practice; professional knowledge “the only source of knowledge is experience.” albert einstein there is a long-standing interest in the relationship between knowledge and practice in the social work profession. throughout much of the profession’s history, discussions about the nature and character of an appropriate knowledge base for social work have been caught between the technocratic allure of science, or formal knowledge, and the more reflexive nature of acquired practice wisdom, or informal knowledge (ehrenreich, 1985; goldstein, 1990; lubove, 1969). these tensions continue to linger in the context of the most recent shift from an authoritarian practice paradigm to an evidence-based practice paradigm (gambrill, 1999; okpych & yu, 2014). an exhaustive discussion of evidence-based practice (ebp) and its adaptation by the social work profession has been provided elsewhere (see drake, hovmand, jonson-reid & zayas, 2007; fook, 2004; gambrill, 2003; gitterman & knight, 2013; rosen, 2003; walker, briggs, koroloff, & friesen, 2007; zayas, drake, & jonson-reid, 2011), but for the purpose of the argument in this paper it is https://creativecommons.org/licenses/by/4.0/ sichling & o’brien/swk practice & research 384 important to reiterate the inconsistencies between formal definitions of the concept of ebp and its actual implementation in the field. the original definitions conceptualize ebp as a process that includes asking empirically answerable questions, finding and evaluating the best available evidence, and applying that evidence in conjunction with client characteristics and practitioner judgment (evidence-based medicine working group, 1992). the actual implementation in the field, by contrast, seems to draw on a much narrower definition that emphasizes research evidence based on randomized clinical trials that control for idiosyncrasies of the very contexts in which everyday practice situations are embedded (chonody & teater, 2018; drake et al., 2007; zayas et al., 2011). particularly the omission of practitioner expertise in the adaptation of the ebp model led to intense debates about what constitutes appropriate knowledge and research evidence for social work practice (see allen-meares & lane, 1990; botha, 2012; fook, 2001; gilgun & abrams, 2002; hartmann, 1990; imre, 1991; osmond & o’connor, 2004; parton, 2000; rosen, proctor, & staudt, 1999; sheppard, 1995; trevithick, 2008; webb, 2001). regardless of where one may stand on these arguments, the failure to adequately recognize the central importance of practice knowledge and the particularities of client circumstances as a critical component of the ebp process created a seeming disconnect between formal empirical knowledge and informal practice knowledge in social work (herie & martin, 2002). carelse and dykes (2014), for instance, found that social work students experience this tension between different kinds of knowing as a gap between their theoretical and formal coursework that tends to promote formal knowledge and their real practice experiences in the field. the introduction of translational science can be viewed as the most recent effort to provide a bridge between social work research and practice (brekke, ell, & palinkas, 2007; brownson, colditz, & proctor, 2017; hudgins & allen-meares, 2000; palinkas & soydan, 2012) particularly in light of the rapid expansion of social work research evidence and the concurrent reduction of barriers to access this information through free article repositories (howard, mcmillen, & pollio, 2003). a recent study by pendell (2018), however, found only marginal use of such repositories for sharing research published in the top 25 social work journals. it is important to note that while translational science tends to examine variables and contextual influences on knowledge use in professional practice, ebp refers to the actual application of evidence in practice (hudgins & allen-meares, 2000; titler, 2018). despite this distinction, translational science raises important questions about the effectiveness of dissemination of research findings through academic journals or the accessibility of scientific language that can pose serious obstacles to the conversion of this knowledge into practice. the need for research-practitioner partnerships to generate evidence that is useful for professional decision-making (proctor, 2003) indicates, however, that notions of “bench-to-trench” knowledge production can reinforce tensions between formal and informal knowledge in social work. while the “bench” signifies academic or laboratory settings as the source of scientific or formal knowledge, the “trench” indicates practice fields as the origin of informal knowledge or practice wisdom (fook, 2004; proctor, 2003). there certainly exists a need to develop a deeper understanding of how to better implement the growing body of social work research evidence (brownson et al., 2017). in addition, advances in social work, fall 2019, 19(2) 385 there is also a dearth of research on the actual sources and content of knowledge that practitioners draw on when making practice decisions. research in kindred occupational fields such as education or nursing, however, has begun to examine the role of “non-bench” sites such as online communities and social media as sources of professional knowledge and development (duncan-howell, 2010; moorley & chinn, 2015). a recent study of teachers’ sources of practice knowledge, for example, found an increasing use of pinterest as a source for the development of pedagogical content knowledge (grote-garcia & vasinda, 2014). while social media is becoming a critical tool of communication for political actors, social movements, professional associations and non-profits (guo & saxton, 2014; margetts, john, hale, & yasseri, 2015; segerberg & bennett, 2011), there is currently a lack of research on the role of online platforms such as pinterest, facebook, or twitter for the dissemination of knowledge and information that influences social work practice. aside from the sources of this knowledge, research indicates that academic or formal knowledge may not be the primary content to guide social work practice, but that instead practitioners tend to privilege information that helps them solve everyday practice problems. a survey among nasw members, for instance, showed that the types of knowledge considered most useful for practice was on particular social problems or clinical diagnoses, followed by assessments of the effectiveness of interventions, and information on specific client populations (cha, kuo, & marsh, 2006; marsh, cha, & kuo, 2004). a more recent study of german social workers’ attitudes towards ebp by james, lampe, behnken and schulz (2018) revealed a general openness toward research-based knowledge. the study findings, however, also indicate that these kinds of formal knowledge were not the primary sources to guide practice decisions but that social workers mostly relied on less formal types of knowledge such as practice experience and collegial advice (james et al., 2018). beyond the recognition that utility for practice determines whether knowledge is used by social workers, we know very little about the specific content and sources of this type of knowledge. this paper seeks to explore the following questions: (a) what are the most important sources and content of knowledge used by social work practitioners? and (b) how did this knowledge change professional practice? a better understanding of the sources and types of knowledge that practitioners emulate is an important contribution to efforts to close the practice-research gap in our field. we present findings from a survey of social work field instructors in st. louis, missouri. the analysis is based on their responses to mostly openended questions exploring access and use, as well as types, of knowledge that practitioners draw on in their professional practice. the findings highlight patterns and themes identified by practitioners that provide important implications for future research as well as different modes of disseminating its findings in social work. methods and data the analysis for this paper draws on data from a qualtrics survey of social work field instructors in the st. louis metropolitan area. the survey comprised a mix of mostly openended and some closed-ended questions that covered three main topics: (1) respondent professional background, including field and length of practice, current position, and type sichling & o’brien/swk practice & research 386 of agency (public – private), (2) types of knowledge that recently influenced professional practice, as well as sources and content of that knowledge, and (3) needed program content for continuing education. the survey instrument consisted of 17 items: 7 closed-ended questions and 10 openended questions. closed-ended items included questions about educational background, years of professional practice, and type of agency employer. open-ended items were primarily aimed at exploring sources, content, and impact of influential knowledge for practice. the instrument was developed by the authors (an lcsw, and the director of the msw program at a local university), and was tested internally among msw students and faculty members to adjust for wording and content of questions, as well as the flow of the overall instrument. the survey was sent via email to all 516 msw field instructors in a joint database used by the field instruction offices of all three local social work graduate programs. the survey was live for about 4 weeks from mid may 2018 to early june 2018 and generated 349 responses yielding a response rate of 67.6 percent. open-ended responses were coded into categories of knowledge sources (e.g., professional website or continuing education). the analysis presented in this paper is based on 250 completed surveys. field instructors were chosen as the sampling frame because of their potentially multiplying influence on future social work practitioners in terms of their use of various sources of knowledge that shapes professional practice in social work. results sample characteristics about 57% of our respondents were employed in a public agency and 43% in a private agency. over 90% listed an msw as their highest degree, while 2.4% had a bsw and 1.2% had a doctorate. about 6% of our respondents had a different degree (mph, mba or joint degree with msw) and more than 73% had a professional license. almost all of our respondents had at least 2 years of professional social work experience. the majority of respondents had between 5 and 20 years of experience and almost 32% reported more than 20 years of experience in the field. this is not surprising given that our sample consisted of social work field instructors. it is important to note that the questions about respondents’ characteristics were limited to information deemed directly relevant to an exploration of sources and content of knowledge that influences social work practice, such as professional background and access to sources of knowledge. information on gender, race, and age (although years of professional practice may serve as an index for age) by contrast, did not seem directly relevant for shaping sources and types of influential knowledge. figure 1 displays the results for the sources of professional practice knowledge respondents have access to through their agency. respondents were asked to list all relevant sources. all respondents identified at least one source for professional knowledge and the most prevalent were continuing education (19.7%), and events and co-workers (18.5%). professional conferences (13.8%) and professional websites (12.3%) were also regularly mentioned. future research will need to explore the relative importance of advances in social work, fall 2019, 19(2) 387 professional conferences as an opportunity to connect with other colleagues as opposed to the more content-based workshops, panels, and presentations. figure 1. access to sources of knowledge in light of the growing importance of online platforms such as pinterest as a professional resource for teaching professionals (grote-garcia & vasinda, 2014), it was somewhat surprising that social media (9.9%) did not feature more prominently as a source of professional knowledge among the social workers in our study. finally, academic journals (5.2%) are only slightly more accessed than newspapers (4.9%) as sources for professional knowledge provided through their workplace. considering the cost of access to academic journals and the slow uptake of free article repositories among social work journals (pendell, 2018), this is not surprising. the insignificance of social media raised questions about whether these responses differed depending on years of professional experience (as indicative of age) and field of practice. table 1 shows the summary results of our cross-tab analysis that breaks down access to sources of knowledge by respondents’ years of professional experience. respondents were asked about the sources of knowledge provided by their agency and could select all that applied from a list of responses. the results in table 1 are not to be read as rank-ordering of knowledge sources but rather as a quick orientation to what sources were most often provided by the agency depending on the respondents’ years of professional practice. furthermore, years of practice are non-exclusive categories. we acknowledge that this is a measurement error but since this table represents a magnitude of themes rather than an accurate count we argue that a more precise scale would not alter the findings. since there were only two respondents in our study who had two years or less of professional experience, we omitted the data for these two respondents. there are three main impressions that emerge from this analysis: (a) the overall pattern of access to sources 0% 5% 10% 15% 20% 25% continuing education co-workers professional conference professional website social media professional newsletter professional journal academic journal newspaper sichling & o’brien/swk practice & research 388 of professional information is similar across the different experience levels, (b) regardless of length in the field, respondents highlight the critical importance of continuing education and co-workers as their primary sources for professional knowledge, closely followed by professional conferences, and (c) newspapers, professional journals, and academic journals, by contrast, were consistently ranked as the least important sources for professional information. furthermore, and contrary to our expectation, social media’s importance as a source for professional knowledge and information was considered slightly more important for social work field instructors with 5 or more years of professional experience. this finding raises interesting questions for future research about the use of social media in the context of professional social work practice. one plausible explanation would be that social workers with fewer years of professional experience view social media less as a professional tool compared to those with more years of experience. table 1. sources of knowledge by years of professional experience rank years of practice 2-5 5-10 10-15 15-20 20+ 1 cont. ed. co-workers cont. ed. cont. ed. cont. ed. 2 co-workers cont. ed. co-workers co-workers co-workers 3 prof. conference prof. conference prof. conference prof. conference prof. conference 4 prof. newsletter prof. website prof. website prof. website prof. website 5 prof. website social media social media social media social media 6 social media prof. newsletter prof. newsletter prof. newsletter prof. journal 7 academic journals academic journal prof. journal/ academic journal /newspapers newspapers prof. newsletter 8 prof. journal prof. journal prof. journal/ academic journal newspapers 9 newspapers newspapers academic journal we then filtered all respondents who were in macro practice positions, such as managers, administrators, directors, and team leaders (n = 114) in order to examine potential differences in their access to sources of knowledge. figure 2 shows that social work administrators in our sample did not differ in the types of sources of knowledge their agencies provided. next, we wanted to learn more about the types of knowledge that most recently changed our respondents’ professional practice, the sources and content of that knowledge, and how it changed their practice. these questions were open-ended and we coded the responses into categories of types, sources, and content of knowledge. advances in social work, fall 2019, 19(2) 389 figure 2. administrator access to sources of knowledge (n= 114) sources of knowledge that change practice the most common source of knowledge that recently had an effect on practice among our respondents was some form of professional training or continuing education. these programs included university-based programs, coaching schools, agency programs, or field instructor trainings. the importance of formal continuing education programs as sources of professional knowledge may in large part be due to the requirements of ceu for license renewal. the next category of sources for professional knowledge were professional journals, academic publications, conferences or associations, co-workers, and professional networks. these results are also consistent with the types of sources our respondents have access to through their agencies and they emphasize the importance of professional networks and conferences. while academic journals were ranked close to the bottom in terms of their accessibility, it is interesting to note that among administrators, along with expert presentations (e.g., researchers and consultants), academic journals and research reports fared noticeably better as sources for knowledge that influences practice. this could indicate one pathway through which research articles and peer-reviewed research may still find their way into professional networks and continuing training programs, despite the limitations to direct access of academic journals. the importance of academic and expert sources was closely followed by government websites, including the centers for medicare and medicaid services, u.s. department of housing and urban development (hud), centers for disease control and prevention (cdc) and the department of education, as well as online sources such as webinars, podcasts, and videos. and finally, newspapers and social media, including facebook and twitter, were least often noted as sources for information or knowledge that had recently had an effect on professional practice. 0% 5% 10% 15% 20% 25% continuing education co-workers professional conferences professional websites social media professional newsletter professional journal academic journal newspapers sichling & o’brien/swk practice & research 390 we then compared the sources of influential knowledge between administrators and practitioners in our study. table 2 shows that continuing education and professional training courses are the most common sources of influential knowledge for both groups, but that professional journals, conferences, or associations as well as online resources such as webinars, podcasts and ted talks are much more prevalent among practitioners, while expert presentations and co-workers are more often named as knowledge sources among administrators. academic journals are much less prevalent sources for influential knowledge among practitioners compared to administrators. table 2. sources of knowledge by staff rank practitioners (n=136) administrators (n=114) ce and training ce and training professional journal, conference or association expert presentation online (webinar, podcasts, ted talks) co-workers co-workers academic publications government websites professional journal, conference or association + government websites expert presentation online (webinar, ted, podcasts) social media (facebook) + foundation websites newspapers academic publications + newspapers social media (facebook) + foundation websites these findings of sources for influential professional knowledge raise interesting questions about the relative importance of different means, such as continuing education programs, professional networks or online platforms for the diffusion of information and knowledge in our field. but aside from the sources of such knowledge we also wanted to know what the content of this knowledge was and how our respondents thought it had changed their practice. knowledge content the most prominent types of knowledge that turned out to have influenced the professional practice of our respondents could be summarized under the general category of “what works.” this is consistent with previous research on knowledge use in social work (see cha et al., 2006; james et al., 2018; marsh et al., 2004). this category included training for, and background research on, new interventions and treatment models such as training on signs of safety in child welfare, trauma and different modes of trauma treatment, moral reconation therapy or eye movement desensitization and reprocessing (emdr). knowledge and information about the effectiveness of treatment models and interventions was the second most-often named type of knowledge that had influenced practice among our respondents. aside from training and information on treatments, information on policy and program changes, mostly derived from government and agency websites were also frequently considered influential forms of knowledge that changed our respondents’ practice. this type of knowledge includes information on changes in medicare and medicaid coverage advances in social work, fall 2019, 19(2) 391 policies, mckinney vento act updates, or changes in the missouri criminal code. information on policy changes was closely followed by knowledge content on supervision and administrative techniques such as leadership training, different processes for agency data collection, information on caseload sizes in child welfare, or development of staff capacity. a few respondents also mentioned information on occupational licensure and professional conduct as helpful. effects on practice how did this knowledge change or influence our respondents’ practice? nearly half of respondents (49.6%) noted the acquisition of additional professional interventions or tools and the expansion of services provided as the most frequent effects on their practice. these changes included the restructuring of the care management department at an agency, adjustments in how an agency helps foster families respond to behavioral problems of children in their care, additional therapy treatments to better support clients, and different approaches to structuring supervision sessions. in addition to the development of professional skills and services, changes in perspective on their practice (34.8%) was the second most prominent way in which new knowledge facilitated shifts in professional practice. these perspectives ranged from using a trauma-informed lens to examining interventions and services, acknowledging a client’s right to be wrong, rethinking abstinence as an appropriate objective for substance use treatments, and increasing awareness of racial dynamics in agency interactions. for others (8.2%) the new knowledge provided evidence supporting current agency practice or offered a refinement and extension of earlier practice. and finally, some respondents also mentioned that the new information helped them reflect on personal issues (7.4%) such as difficulties with listening and empathy, avoiding discomfort as a barrier to personal and professional growth, and realizing a better work-life balance. discussion this study explored the sources and content of knowledge that influences social work practice from the vantage point of field instructors. the analysis showed that colleagues and professional development programs were considered the most accessible sources for influential knowledge and information. this is not surprising given the expense for online access to research publications. it was interesting to note that social media was ranked in the middle range as a source for professional knowledge and this assessment did not vary much across respondents with different years of professional experience. access to various types of sources of information certainly influenced responses about the origins of the most recent knowledge that had an impact on our respondents’ professional practice. professional conferences, peers, and continuing education programs were among the most often noted sources of such knowledge. this makes sense in light of the requirements for professional license renewal. but in contrast to the relative difficulty in accessing academic journals, expert presentations – including researchers – along with research reports and academic publications, ranked in the middle range of sources for influential knowledge. in addition to professional networks and events or experts, a set of government or foundation websites were most commonly noted sources for information, primarily with regard to sichling & o’brien/swk practice & research 392 changes in policies and regulations. very few respondents reported receiving influential information through social media platforms such as facebook or from newspapers. the most frequently named types of knowledge content were training in new interventions but also research on background and effectiveness of treatments. this confirms findings from previous studies that indicate that social workers are most interested in information on what works (see cha et al., 2006; james et al, 2018; marsh et al., 2004). but these findings also highlight that, while research knowledge has a critical influence on practice, it is not necessarily accessed through peer-reviewed journals despite growing proliferation of open access sources for academic publications. instead, the results of this study point to the critical importance of occupational peer networks, professional conferences, and continuing education programs as a critical means for the dissemination of research evidence among social work practitioners. while theories of social networks or social capital note the central importance of relationships and connections with others for accessing critical information and support (burt, 2009; coleman, 1988; portes, 1998), their role for the dissemination of professional knowledge in social work is currently not very well understood. for instance, it would be helpful to learn whether the importance of professional conferences for knowledge dissemination is primarily due to their formal and expert presentations or whether they are primarily an opportunity to socialize with professional peers. in addition, our study did not elaborate on whether professional training and conference participation was facilitated by the respondents’ employer or whether they were sought out by the respondent, which may be a potentially relevant aspect of accessibility of professional knowledge. although some respondents noted online resources such as webinars, videos, podcasts and ted talks as sources for new knowledge, the relative insignificance of social media was somewhat unexpected. particularly the latter finding raises questions about the role of social media platforms such as facebook or twitter for the distribution of influential knowledge in our profession. aside from sources and content, our analysis also revealed that the influence of new knowledge on professional practice operated primarily on a technological and a reflexive dimension, either by expanding intervention tools and services provided, or by changing the perspective of social workers on their practice. it is important to reiterate that these findings are based on a localized sample of field instructors and do not capture sources and content of knowledge used by all social workers in st. louis or elsewhere. furthermore, in a conscious effort to keep the number of items on our survey at a minimum in order to be considerate of the busy schedule of social workers and to increase the response rate, we were not able to probe for the role of agencies in selecting training content or whether conferences are an opportunity for professional networking. and finally, while the analysis shows differences in sources of influential knowledge between administrators and practitioners, it did not explore these differences for licensed and non-licensed workers. this could be an interesting question for future research. given these limitations, however, the findings on the patterns of knowledge use among seasoned social work field instructors raise important questions about the sources and content of knowledge that changes practice in the field, the role of professional peer socialization, as well as social media and other online sources for the dissemination of knowledge in the social work profession. advances in social work, fall 2019, 19(2) 393 more importantly however, these questions urge social work researchers and agencies to think more purposefully about effective mechanisms to infuse knowledge into the practice of social workers in the field. for example, in addition to agency administrators deciding on appropriate topics for professional training sessions, it may be beneficial to think about providing opportunities for formal as well as informal professional socialization with colleagues through inter-agency workshops or at professional conferences. although social media did not feature prominently as a source for professional knowledge, online platforms or formats, ranging from periodic research briefs compiled by social work researchers to more open-access academic journals would greatly increase access to research knowledge. this study also raises a question about the potential to enhance professional practice through trainings on how to leverage new technologies and social media. after all, while we agree with einstein’s statement that experience is important, it is not 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(2011). overrating or dismissing the value of evidence-based practice: consequences for clinical practice. clinical social work journal, 39(4), 400-405. doi: https://doi.org/10.1007/s10615-010-0306-1 author note: address correspondence to dr. florian sichling, school of social work, university of missouri – st. louis, bellerive hall 215, 1 university boulevard, st. louis, mo 63121. e-mail: sichlingf@umsl.edu https://doi.org/10.18060/22180 https://doi.org/10.1146/annurev.soc.24.1.1 https://doi.org/10.1093/swr/27.2.67 https://doi.org/10.1093/swr/27.4.197 https://doi.org/10.1093/swr/23.1.4 https://doi.org/10.1080/10714421.2011.597250 https://doi.org/10.1093/bjsw/bcm026 https://doi.org/10.5175/jswe.2007.334832007 https://doi.org/10.1093/bjsw/31.1.57 https://doi.org/10.1007/s10615-010-0306-1 mailto:sichlingf@umsl.edu this work is licensed under a creative commons attribution 4.0 international license. trauma-informed social work practice with women with disabilities: working with survivors of intimate partner violence michelle s. ballan molly freyer abstract: women with disabilities experience intimate partner violence (ipv) at higher rates than both nondisabled women and men, and men with disabilities. their significant exposure to ipv suggests notable levels of trauma-related symptomology. however, there is a dearth of research on trauma and ipv among women with disabilities, and services tailored to their diverse strengths and needs are scarce. guided by critical disability theory and feminist disability theory, this article describes culturally sensitive, traumainformed approaches to practice with female survivors of ipv with disabilities. keywords: intimate partner violence; women with disabilities; trauma-informed practice women with disabilities are among the most vulnerable groups impacted by intimate partner violence (ipv), which includes physical, sexual, psychological, and economic abuse. they experience ipv at higher rates than nondisabled women and men, and men with disabilities (breiding & armour, 2015) and are more often subject to severe forms of physical abuse, including being kicked, punched, or bitten (brownridge, 2006). women with disabilities also experience subtle forms of abuse exploiting aspects of disability, such as withholding medication or denying needed supports (lund, 2011). the most common perpetrators of violence against women with disabilities are former or current intimate partners (hahn, mccormick, silverman, robinson, & koenen, 2014), but family members, caregivers, personal assistants, and medical providers may also be perpetrators (curry et al., 2009). the experience of abuse is compounded as women with disabilities remain in abusive relationships for longer periods of time than nondisabled women (nosek, howland, rintala, young, & chanpong, 2001). the impact of trauma on women with disabilities is under-researched, and its origins misunderstood. one study comparing trauma symptomatology among men and women both with and without disabilities found that women with disabilities reported significantly higher levels of trauma symptoms compared to men with disabilities and nondisabled men and women (strauser, lustig, & uruk, 2007). traumatic experiences can compound health problems among women with disabilities, as trauma has been linked with physical health problems, as well as poor health behaviors such as substance abuse (weissbecker & clark, 2007). despite the problem’s gravity, there is a dearth of research on trauma and ipv among women with disabilities, and services tailored to their diverse needs are scarce. research on trauma-informed practice with this population is particularly limited (anderson & najavits, 2014). trauma-informed practice is emerging as an effective approach to addressing the needs of female survivors experiencing ipv and related traumatic life experiences (taft, murphy, & creech, 2016). however, a systematic review of the ______________________ michelle s. ballan, phd, is professor of social welfare and professor of family, population and preventive medicine, stony brook university, health sciences center, 101 nicolls road, stony brook, ny, 11794. molly freyer, lcsw, is a doctoral student at nyu silver school of social work, 1 washington square n, new york, ny 10003 copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 131-144, doi: 10.18060/21308 https://creativecommons.org/licenses/by/4.0/ ballan & freyer/trauma-informed social work 132 empirical research found not a single effective ipv intervention for women with disabilities (mikton, maguire, & shakespeare, 2014), and the utility of trauma-informed practice has yet to be explored with this population. in this article, we consider culturally sensitive, trauma-informed approaches to practice for female survivors of ipv with disabilities. background: ipv, disability, and trauma-informed practice empirical research confirms that women with disabilities are disproportionately affected by ipv. according to the 2013 national crime victimization survey, individuals with disabilities experienced serious violent victimization at three times the rate of those without disabilities, and were more likely to experience serious violent victimization by an intimate partner (harrell, 2015). the 2010 national intimate partner violence and sexual violence survey revealed that women with a disability were significantly more likely to experience sexual and physical violence, stalking, psychological aggression, and control of reproductive or sexual health than women without a disability (breiding & armour, 2015). compounding the risks faced by victims with disabilities, ipv is associated with longterm physical and mental health problems. the health-related risks of ipv are of particular concern. the world health organization (2011) cites violence against women with disabilities as a major factor in their diminished health status, linking violence to “immediate and long-term” health outcomes including “injuries, physical and mental health problems, substance abuse, and death” (p. 59). ipv is associated with a wide range of mental health issues, including depression, post-traumatic stress disorder (ptsd), anxiety, self-harm, and sleep disorders (dillon, hussain, loxton, & rahman, 2013). furthermore, ipv is more common among women with serious or chronic mental illness, and studies have shown that women with chronic mental illness are more likely to attempt suicide as a result of ipv, and less likely to seek help from informal networks of support (khalifeh, oram, trevillion, johnson, & howard, 2015). women with disabilities also face unique risk factors for abuse, including physical and social isolation; difficulty identifying abuse; dependence on abusive partners for assistance with daily needs; and general vulnerability related to disability, such as physical difficulty escaping abusive environments (plummer & findley, 2012). social messages regarding the asexuality and undesirability of women with disabilities as intimate partners denigrates self-esteem, which is associated with ipv (hassouneh-philips & mcneff, 2005). poverty and unemployment further reduce alternatives to abusive relationships for women with disabilities (nosek et al., 2001), who are also impacted by structural inequalities related to race, gender, socioeconomic status, sexual orientation, and age (ortoleva & lewis, 2012). the need for evidence-based interventions is frequently noted in the literature, with a particular need to develop approaches tailored to women with physical, sensory, and/or psychiatric disabilities (lund, 2011; mikton et al., 2014). typical ipv violence intervention efforts for women with disabilities have been to modify approaches used with nondisabled women informed by traditional domestic violence theory (barranti & yuen, 2008). applying the same intervention tactics assumes that the causes and consequences advances in social work, spring 2017, 18(1) 133 of ipv are similar for nondisabled women and women with disabilities, when research has shown they often are not (plummer & findlay, 2012). women with disabilities may face great difficulty accessing support services, such as ipv agencies or the police, due to isolation, physical and attitudinal barriers among service agencies and providers, and fear of retribution by the abuser (chang et al., 2003). if women with disabilities do seek assistance from ipv agencies, they may find that these agencies, and those working within them, are inadequately prepared to meet the needs of survivors with disabilities. the physical and attitudinal inaccessibility of these agencies has been cited as a barrier to escaping an abusive relationship (chang et al., 2003; frantz, carey, & nelson-bryen, 2006). furthermore, the barriers preventing women with disabilities from accessing support, such as isolation, inaccessibility, and a lack of empowerment, may be exacerbated by trauma-related conditions such as ptsd (anderson & najavits, 2014). abuse among women with disabilities has largely been addressed within either domestic violence organizations lacking experience with this population, or disabilityfocused organizations unfamiliar with ipv. in a national census of domestic violence services, the national network to end domestic violence (2016) found that seventy-two percent of agencies surveyed reported providing advocacy related to disability issues throughout the year. it is critical that these agencies have the necessary tools to provide culturally relevant services to assist women with disabilities in their efforts to cope, heal, and achieve safety from abuse. accessibility moves beyond physical infrastructure and considers the needs of women with disabilities in their policies and practices, establishing relationships with disability organizations and interpreter services, and accommodating women with varying levels of medication use, service animals, and personal care attendants. these accessibility considerations extend to trauma-informed practice with survivors of ipv with disabilities. trauma-informed practice trauma-informed ipv practice is driven by an understanding of the impact of violence and trauma, past and present, on all aspects of an individual’s life and development (elliott, bjelajac, fallot, markoff, & reed, 2005). in a trauma-informed system, trauma is viewed not as a single discrete event but rather as a defining and organizing experience that forms the core of an individual’s identity (harris & fallot, 2001). systems of care operating from a trauma-informed approach design, organize, and implement all aspects of the clinical encounter to reflect an understanding of how trauma affects the life of the individual seeking services (ghandour, campbell, & lloyd, 2015). the core values of safety, trustworthiness, choice, collaboration, and empowerment are defining features of service settings utilizing a trauma-informed approach (fallot & harris, 2009). this includes ensuring that all staff working within the setting are trained on trauma-relevant information and skills, and have the competencies to work with a range of individuals and experiences (ghandour et al., 2015). trauma-informed ipv practice with women with disabilities requires an understanding of the complex interplay of medical, social, political, and personal factors influencing the experience of trauma within this population. quiros and berger (2015) note that an agency ballan & freyer/trauma-informed social work 134 that is truly trauma-informed must align itself with the social work mission of social justice, considering structural and environmental conditions when assessing trauma; that is, trauma is experienced on both interpersonal and sociopolitical levels. a comprehensive, traumainformed response to ipv for women with disabilities must begin by addressing the full constellation of disability-related risk factors and consequences of abuse, at both personal and structural levels. lessons from past research in addition to the tenets of trauma-informed practice discussed above, our past research suggests areas of focus for survivors of ipv with disabilities. our preliminary research (ballan et al., 2014; ballan, burke freyer, & powledge, 2015; ballan, burke freyer, powledge, & marti, 2016) examined familial, social, and contextual correlates of ipv among individuals with disabilities and barriers to self-protection. this research yielded insight into the factors motivating women with disabilities to seek assistance and the need to increase women’s independence and self-efficacy to enable them to find alternatives to violent relationships. health-related factors such as dependence on abusers for assistance with activities of daily living, social factors such as reduced community inclusion and lack of employment options, and personal factors such as the desire to retain custody of one’s children all present significant barriers to addressing ipv. findings indicated that female ipv victims with disabilities were often married and/or had children, challenging previous research and stereotypical portrayals of women with disabilities as single and childless. the possibility of losing custody of one’s children is a great deterrent to reporting abuse among women with disabilities, as perpetrators may erroneously claim that disability negatively impacts parenting ability (ortoleva & lewis, 2012). elliott et al. (2005) suggest including traumainformed parenting services for survivors of trauma with children, helping parents explore how to take care of their own feelings, as well as those of their children. the exclusion of women with disabilities from education and employment is a structural issue which has serious individual consequences. high rates of unemployment within our study sample indicated the need for vocational and financial assistance as standard components of ipv interventions. moreover, it guides practitioners to consider additional needs such as permanent housing and accessible affordable healthcare accompanying unemployment and low socioeconomic status. women with disabilities are disproportionately poor when compared to the general population (hassouneh-philips, mcneff, powers, & curry, 2005), which is by large a result of their secondary social status, and creates further difficulty in attempting to gain independence from an abuser. economic independence has a great impact on a woman’s ability to escape an abusive relationship, and stable employment is one crucial means of attaining financial stability. social workers need to be apprised of services such as vocational training and benefits such as supplemental security income (ssi) and social security disability insurance (ssdi), and understand the distinction between the various entitlements available to women with disabilities. an important role will be to serve as a link between the survivor and these federal and state resources. advances in social work, spring 2017, 18(1) 135 our previous research likewise indicated that practitioners must consider how needs may vary based on disability type. literature on violence and women with disabilities has included a range of disabilities in the study sample, yet generally fails to examine abuse among specific disability groups (hughes et al., 2011). it is essential for intervention methods to account for the interplay of disability, abuse, and related psychosocial dimensions, and acknowledge how these factors impact the health, well-being, and options of women with disabilities (copel, 2006). a critical consideration entails assessing disability status and how this interacts with the effectiveness of interventions for ipv survivors. below, we discuss theoretical approaches related to ipv and disability, and provide recommendations for integrating these into trauma-informed practice with survivors with disabilities. recommendations for trauma-informed practice with survivors of ipv with disabilities the unique range of factors influencing the experience of ipv among women with disabilities requires a consideration of disability-informed theoretical approaches to the problem. concepts drawn from critical disability theory and feminist disability theory provide a thorough foundation for culturally sensitive, trauma-informed practice with survivors with disabilities. traditional trauma theory neglects to consider the diversity of experiences shaped by race, ethnicity, and disability status, among other identities (quiros & berger, 2015). the tenets of critical disability theory and feminist disability theory remind practitioners of the salience of intersecting identity statuses to each individual’s experience of trauma. critical disability theory (shakespeare, 2014) views disability as an interaction between individual, or intrinsic factors, and structural/contextual factors. the intrinsic factors include issues such as the type and severity of one’s impairment, one’s own feelings about the impairment, and additional personality and psychological characteristics. contextual factors include the attitudes and reactions of others to one’s impairment, the extent to which one’s immediate environment is accommodating of disability, and wider cultural, social, and economic issues relevant to disability. critical disability theory reminds practitioners that women with disabilities cannot be treated as a homogeneous group, as personal experience will vary based on disability type. the severity of one’s impairment influences her ability to respond to ipv on a personal level. the system of social networks, agencies, and institutions surrounding survivors of abuse with disabilities, and their ability and willingness to support them, profoundly impacts a woman’s options. finally, the broader influence of general social and cultural attitudes toward disability shapes the experience of perceived vulnerability to abuse, discrimination and lack of responsiveness to women with disabilities experiencing ipv. feminist disability theory (asch & fine, 1988; garland-thompson, 2002) draws attention to the intersecting statuses of gender and disability, viewing violence against women with disabilities through the lens of disabilityand gender-based oppression. these attitudes manifest at the social and political level, but filter down to the personal level. ballan & freyer/trauma-informed social work 136 intersectional concepts further shed light on this phenomenon, but stress a consideration of intersecting statuses beyond gender and disability, such as race, ethnicity, immigration status, sexual orientation, age, and socioeconomic status. focusing solely on individual factors when constructing interventions for survivors of ipv with disabilities ignores broader structural factors contributing to the problem, and contributes to victim-blaming and marginalization (mays, 2006). barranti and yuen (2008) likewise argue that traditional models of ipv prevention and intervention do not consider the reality of social oppression. they suggest that feminist disability theory can correct for the current inadequacies inherent in ipv services for women with disabilities by “emphasizing issues of gender, disablism, poverty, and the inherent social oppression that intersect in the experience of ipv and abuse of women with disabilities” (p. 128). traumainformed practice with survivors with disabilities should begin with a consideration of these issues and how they impact the healing process. the tenets of the theoretical frameworks described above, along with the core traumainformed values (fallot & harris, 2009) can inform practice with survivors with disabilities. more specifically, the substance abuse and mental health services administration (samhsa; 2015) direct trauma-informed intervention programs recognize the following: the survivor's need to be respected, informed, connected, and hopeful regarding their own recovery; the interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety; the need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers (para. 3). using these specific guidelines, we consider how to integrate trauma-informed practice’s core values, along with the issues raised by critical disability theory and feminist disability theory, to guide social workers in providing culturally sensitive, trauma-informed practice with ipv survivors with disabilities. see table 1 for a summary of our recommendations. the survivor’s need to be respected, informed, connected, and hopeful respect begins with seeking to understand what the survivor wants when accessing assistance. when a woman with a disability seeks ipv related assistance, the goal may not always be to leave the abusive relationship, understanding that some women will be reluctant if the perpetrator is someone on whom she depends for assistance with daily needs (martin et al., 2006). women with disabilities also face the loss of accessible housing, barriers in the criminal justice system, and threats to their independence if they report abuse, among a host of concerns (ortoleva & lewis, 2012). social workers serving survivors of ipv with disabilities must guard against making assumptions based on disability, and not allow the disability to overshadow other relevant aspects of the woman’s experience. disability may present personal challenges on an individual level, but the social oppression stemming from disability-based discrimination, both visible and invisible, is equally damaging. focusing narrowly on the individual advances in social work, spring 2017, 18(1) 137 experience of disability neglects the diverse psychosocial context of one’s life; it also neglects the social context of disability. yet social workers may fail to see beyond a woman’s disability, and assume that the disability itself is the presenting problem. for instance, women with disabilities who seek help from ipv agencies are often diverted to disability service agencies because providers perceive their disability, rather than the abuse, as the primary treatment need (cramer, gilson, & depoy, 2003). this invalidates the woman’s experience of ipv and dilutes the effectiveness of the response. as a social worker, one can raise all relevant issues and safety concerns, but ultimately the goals of intervention must be defined on the survivor’s own terms, in her own words. survivors with disabilities will feel respected, informed, connected, and hopeful if social workers express an understanding of disability-related needs and considerations when responding to ipv. for instance, safety planning, a common aspect of ipv interventions, can be modified to address disability-related needs in collaboration with the survivor. creating a safety plan in collaboration with women with disabilities puts the survivor in control and teaches skills which can be individually executed, as opposed to a social worker assuming full responsibility and control. hoog (2004) provides the following guidelines in constructing an empowering safety plan: the advocate should ask the survivor about the physical and attitudinal barriers that are affecting her safety. the survivor with a disability is the expert on what safety techniques will work best for them…when developing safety planning strategies, the advocate should ask about and incorporate the practical ways a person with a disability navigates barriers. advocates should consider using support services that the survivor wants to use in the safety planning process. (p. 8-9) recognizing the survivor’s strengths employed in coping with the abuse up until the point of intervention is paramount. the interrelation between trauma and symptoms of trauma substance abuse, eating disorders, depression, and anxiety are noted mental health concerns related to trauma (samhsa, 2015). psychiatric disabilities have been found to precede ipv, serving as a potential risk factor, as well as occurring as a result of ipv (devries et al., 2013). social workers working with survivors of trauma must be vigilant to the possibility that unresolved mental health issues could increase one’s vulnerability to ipv, while also screening for mental health issues resulting from trauma. a previous study of female ipv survivors with disabilities determined that almost 72% of the study sample was diagnosed with a psychiatric disability of some type, and the majority of women with physical disabilities also had a psychiatric disability (ballan et al., 2014). however, less than half of all safe homes, shelters, and transitional housing services in the u.s. provide mental health services to survivors of ipv (douglas & hines, 2011). agencies addressing ipv, particularly those serving women with disabilities, must offer comprehensive mental health services. this unmet need warrants immediate attention. untreated mental illness further compromises a woman’s ability to respond effectively to abuse and other unsafe situations (hoog, 2004). ballan & freyer/trauma-informed social work 138 the need to work collaboratively collaboration in treatment, which includes providing choices and empowering survivors to make their own choices regarding their personal safety, is essential to traumainformed practice with survivors with disabilities. this point is especially salient, as issues of power and control are paramount in practice with survivors of ipv. social workers should strive to restore a sense of power to the survivor, and this may begin simply by asking her how she would like to proceed. ensure that the survivor is defining her own goals, related to both disability and ipv. reaching consensus regarding the goals of intervention requires an equal collaboration between social workers and survivors. women with disabilities should be in control of the forms of assistance they choose to utilize, and be assured appropriate resources in order to access what is needed. women with disabilities have reported feeling invalidated, discounted, and objectified in healthcare settings, noting a sense that providers take over their care (hassouneh-phillips et al., 2005). the services provided to survivors should be chosen by the woman with the disability herself, to the extent possible. for example, knowledge about one’s options in hiring, securing, and firing personal care assistants is an abuse prevention tool which acknowledges the medical need for care while allowing the woman with a disability to take control of this assistance. in addition to collaborating with the survivor, it is essential to work collaboratively with other agencies within the community to address the survivor’s needs. arranging meetings between ipvand disability-focused agencies, as well as healthcare providers and representatives from the criminal justice system, aids in the sharing of information and building of rapport. the social worker can serve as an advocate in this process, assisting the ipv survivor to access the trauma-related assistance she desires. table 1. recommendations for trauma-informed practice with survivors of ipv with disabilities trauma-informed principle recommendations considerations from critical disability theory and feminist disability theory -avoid treating women with disabilities as a homogeneous group -consider personal factors such as type and severity of impairment, and one’s adaptations to it; contextual factors such as the extent to which one’s immediate environment is accommodating of disability; as well as wider cultural, social, and economic issues related to disability -attend to the personal, social, and political contexts of gender and disability, as well as race, ethnicity, immigration status, sexual orientation, age, and socioeconomic status the survivor’s need to be respected, informed, connected, and hopeful -define goals of intervention in the survivor’s own terms, in her own words -express an understanding of disability-related needs and considerations when responding to ipv -recognize the survivor’s strengths advances in social work, spring 2017, 18(1) 139 interrelation between trauma and symptoms of trauma -screen for mental health issues associated with trauma -recognize that unresolved mental health issues can increase vulnerability to ipv -provide mental health services/address mental health in ipv agencies the need to work collaboratively -provide choices and empower survivors to make their own choices regarding personal safety -ensure that the survivor is defining her own goals related to both disability and ipv -give control to the survivor in the forms of disability assistance one chooses to utilize -work collaboratively with agencies in the community to address the survivor’s needs conclusion women with disabilities are disproportionately affected by ipv, yet disabilitysensitive, trauma-informed practice is in its infancy. in order to make trauma-informed practice truly accessible to survivors of ipv with disabilities, the effectiveness of evidencebased trauma-specific interventions must be researched with this population. promising research on trauma-informed interventions such as seeking safety has revealed its effectiveness with women with physical disabilities; however, the study’s authors acknowledge the need for more research with a larger, more diverse sample of women with disabilities (anderson & najavits, 2014). diversity is notably lacking in previous studies of ipv among women with disabilities (hughes et al., 2011), which tend to represent mainly white, college-educated women. prior research by this team (ballan et al., 2014) indicates that women with disabilities who seek ipv services are substantially more diverse than those sampled in abuse and disability research, and underscores the need to examine distinct groups of women with disabilities. women with disabilities form a diverse population with varying experiences, needs, strengths, and expertise. trauma-informed practice with survivors must respect this diversity, while understanding the unique ways in which disability impacts the experience of abuse. social workers will need to be vigilant to ensure equality of access, not simply in disability terms, but also in respect to aspects of identity such as race, ethnicity, sexual orientation, and immigration status. approaching trauma-informed practice from the theoretical foundation of critical disability theory and feminist disability theory ensures that these considerations are kept central to culturally sensitive ipv interventions with women with disabilities. references americans with disabilities act (ada) p.l. 101-336 (1990). anderson, m. l., & najavits, l. m. 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(2015). trauma-informed approach and trauma-specific interventions. retrieved from http://www.samhsa.gov/nctic/trauma-interventions taft, c. t., murphy, c. m., & creech, s. k. (2016). introduction. in c. t. taft, c. m. murphy & s. k. creech (eds.), trauma-informed treatment and prevention of intimate partner violence (pp. 3-12). washington, d.c.: american psychological association. doi: https://doi.org/10.1037/14918-001 weissbecker, i., & clark, c. (2007). the impact of violence and abuse on women's physical health: can trauma‐informed treatment make a difference? journal of community psychology, 35(7), 909-923. doi: https://doi.org/10.1002/jcop.20189 world health organization. (2011). world report on disability. malta: author. retrieved from http://www.who.int/disabilities/world_report/2011/report/en/ author notes: address correspondence to: michelle s. ballan, stony brook school of social welfare, health sciences center, 101 nicolls road, stony brook, ny 11794, 631304-5953, michelle.ballan@stonybrook.edu http://womenenabled.org/pdfs/ortoleva%20stephanie%20%20lewis%20hope%20et%20al%20forgotten%20sisters%20-%20a%20report%20on%20violenceagainst%20women%20%20girls%20with%20disabilities%20august%2020%202012.pdf http://womenenabled.org/pdfs/ortoleva%20stephanie%20%20lewis%20hope%20et%20al%20forgotten%20sisters%20-%20a%20report%20on%20violenceagainst%20women%20%20girls%20with%20disabilities%20august%2020%202012.pdf http://womenenabled.org/pdfs/ortoleva%20stephanie%20%20lewis%20hope%20et%20al%20forgotten%20sisters%20-%20a%20report%20on%20violenceagainst%20women%20%20girls%20with%20disabilities%20august%2020%202012.pdf https://doi.org/10.1177/1524838011426014 https://doi.org/10.1080/15325024.2013.836353 https://doi.org/10.1177/00343552070500040301 http://www.samhsa.gov/nctic/trauma-interventions https://doi.org/10.1037/14918-001 https://doi.org/10.1002/jcop.20189 http://www.who.int/disabilities/world_report/2011/report/en/ mailto:michelle.ballan@stonybrook.edu microsoft word schneider iussw history editorial copyedit2 _________________ rob schneider is coordinator of external relations for the indiana university school of social work on the indianapolis campus. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), iv-x special recognition the indiana university school of social work: the first 100 years! rob schneider on oct. 24, 2011, the indiana university school of social work formally celebrated its 100th anniversary at a dinner that drew nearly 400 people, including the president of indiana university, michael mcrobbie, as well as state, city and civic leaders. president barack obama also sent a letter congratulating the school on its accomplishments. the school’s story starts with the opening of the department of social service in indianapolis in 1911. the opening of the social service department makes the school of social work the oldest professional social work education program in the united states begun and continuously functioning as part of a university. the social service department was part of the department of economics and sociology in bloomington, but it was housed with the school of medicine in indianapolis. the department listed its objectives as: education, prevention and research. indiana university president william bryan turned to edna henry, ph.d., an indiana university graduate, to lead the new department. in a note to henry, dr. bryan explained the university intended to establish a sub-department of sociology to study “charity problems in connection with the city dispensary and later in connection with the city hospital and also in order to render service to the deserving poor that come to the medical school for assistance” (bryan, letter to edna henry, june 3, 1911). the new department struck a bold note in its first annual report. “the department must look through the individual patient to the society in which he lives and find there the causes which make individuals sick or which keep them so. such work cannot be limited to the confines of one city. it must be state-wide. indiana university can be satisfied with nothing less than better health, increased knowledge, and diminished poverty for the coming generations of all indiana” (indiana university, social service department, 1913, p. 5). “much of the learning was experiential in nature. students were assigned cases and learned by providing actual social services to people in need. the faculty of the new department developed a coherent curriculum and taught courses such as medical social work and social medicine. they also managed a laboratory for sociology students interested in social work. in addition, they administered hospital social services and supervised community volunteers who provided aid to patients and their families” (busch et al., 2001, p. 85). in 1918, dr. henry was elected the first president of the american association of hospital social workers. with america’s entry into world war i, she was asked to work in the federal government’s surgeon general’s office to develop a program for social service in reconstruction hospitals to assist soldiers returning home from the war. in schneider/iussw: the first 100 years v september of 1920, illness forced dr. henry to submit her resignation. in april of 1921, robert neff, the registrar of the indiana university school of medicine and administrator of the robert w. long hospital succeeded henry as director. the department of economics and sociology of the college of arts and sciences assumed administrative control of the social service program in 1921. the program took on a new name, the indiana university combined course for the training of social work. the program augmented students’ liberal arts studies with professional social work training and service experience. under this arrangement, students could complete the social work training program and earn a baccalaureate degree. neff served as director for three years, then left to become administrator of the new james whitcomb riley hospital, which opened in october of 1924, as well as administrator for the robert w. long hospital. professor ulysses grant weatherly stepped in to serve as director of the program in addition to teaching courses in indianapolis and bloomington, according to announcements for the 1926-27 school year (rogers, 1983, p. 33). to comply with the educational standards of the american association of training schools, the indiana university training course required undergraduate coursework in sociology, economics and psychology. students were expected to complete foundation studies followed by one of five specializations: medical social work, family social work, child welfare, visiting teaching, and public social work. students also completed field practicum experiences in agencies that supported one or more of these specializations. in the early 1930s, the combined training course for social work was reorganized as a two-year graduate program in indianapolis as part of an effort to promote social work as a profession. the program provided coursework for three specializations, including social casework, public welfare administration, and social statistics. students completed a research thesis and oral examination in addition to classroom and field practicum experiences. in 1935 the combined training course became a division within the department of sociology. the program shifted its curriculum to enable graduates to work at newly created public welfare agencies created to address problems brought on by the great depression. for the period from 1937 to 1942 the training course provided professional education for social work to those men and women who chose social service as their careers. it offered a two-year graduate program of professional courses, field work, and research leading to the master of arts degree in social service. its work was fully accredited by the american association of schools of social work. “strong programs in family welfare, child welfare, public welfare, and treatment of delinquents have been maintained and further developed” (evans, 1943, p. 2). this 1937-42 report further points out that special attention was given to the professional education needs of untrained and partly trained workers employed in social agencies throughout the state. world war ii drastically affected the social service program. in the program’s report for 1942-44, louis evans, who was in charge of the training program, wrote they had to make several “drastic adaptations to the war situation. a marked decline in enrollment occurred in the face of an increased demand for qualified social workers in indiana and advances in social work, fall 2011, 12(2) vi throughout the country” (evans, 1944, p. 1). the program adopted an accelerated yearround war schedule that shortened the time for completion of the standard four semester program from 21 to 16 months in 1944, the board of trustees established the division of social work as a unit within the college of arts and sciences, separate from the department of sociology. physically, the division remained in indianapolis and provided professional education leading to the degree of master of arts in social service and continued to collaborate with the college in offering an undergraduate major in social service on the bloomington campus (busch et al., 2001, p. 87) in november of 1944, dr. grace browning, a nationally regarded social work educator from the university of chicago school of social service administration, was named director of the division of social work. the division opened in the fall of 1945 with six full-time faculty members. in its report for 1945-46, the division reported having 39 full-time and 50 part-time students for the 1945-46 year. indiana university’s labor studies program, which would become part of the school of social work in 2007, got its start in 1946 at the direction of indiana university president herman b wells. under his administration, the university assumed the responsibility and commitment to provide workers and unions the education they would need to contribute to a modern, efficient economy. dr. browning was the first american social worker to be chosen for an assignment on the technical assistance program of the united nations as a consultant to the italian schools of social work in 1951. however, on the day she was to leave for italy, browning died in robert w. long hospital following a short illness. she was 46. the university selected mary hammond houk, who had joined the division in 1945 as the director of field work, to lead the division. a native of missouri, houk received her ba degree from the university of missouri in 1922 and a master’s degree from the university of chicago’s school of social service administration in 1939. “primarily because of houk’s success in enhancing the program’s reputation, the board of trustees upgraded the status of the division in 1966 by creating the graduate school of social service. director houk was appointed dean of the school and students earned the master of social work degree” (busch et al., 2001, p. 88). “professor walter johnson became acting dean of the school during the interim period following houk’s retirement. during his short tenure, johnson was able to obtain a commitment from university officials to move the school from its long-time location at 122 e. michigan street, to a building to be built on the new campus of indiana university in indianapolis” (busch et al., 2001, p. 88). dr. richard g. lawrence, who was a faculty member and associate dean of the george warren brown school of social work at washington university in st. louis, was named dean in 1967. in its 1967-68 annual report, the school of social services reported having 135 full and part-time students and a full-time faculty of 19 professors as well as 7 lecturers, of which 6 were part-time. during dr. lawrence’s tenure as dean, the msw curriculum was reorganized. “as partners in a national curriculum project, the schneider/iussw: the first 100 years vii school attempted to cross-integrate its course-work content by organizing plenary sessions and discussion groups instead of traditional classes. by 1969-70 block field placements were introduced for the first time and a community organization concentration complemented those in social casework and social group work” (busch et al., 2001, p. 88). the school moved from its offices in downtown indianapolis into cavanaugh hall on the iupui campus in 1971. the following year the school proposed new curricular designs for the new bachelor of social work and associate of science in human services programs. dr. cyrus behroozi was appointed coordinator for undergraduate development. in 1973 the proposal was accepted by the indiana commission on higher education and the same year the graduate school of social work was renamed the indiana university school of social service. the bsw program graduated its first class in 1975. “the school’s new bsw curriculum was designed to prepare students for beginning professional social work practice with a focus on the problem-solving process. over several years this curriculum was implemented on the indianapolis, richmond and bloomington campuses, replacing the undergraduate social service program that had been offered for so many decades in cooperation with the college of arts and sciences in bloomington” (busch et al., 2001, p. 89). the bsw program was accredited by the council on social work education in 1975 and has been accredited ever since. in 1976-1977, the associate degree was started at indiana university east under the leadership of professor valerie chang. between 1980 and 1994, the school offered the first three years of the baccalaureate program on the indiana university east campus, with students transferring to indianapolis for the fourth year. in 1994, the council on social work education approved the fourth year of the program on the iu east campus. dr. leonard schneiderman was named dean of the school in 1977 and dr. cyrus behroozi was appointed the first associate dean of the school. that same year, the school’s name was changed to the indiana university school of social work and it offered the associate of science in human services, the bsw and msw degrees. the origins of doctoral education at indiana university date back to dean lawrence, but the development of such a program took on an added urgency under dr. schneiderman who made it one of the school’s top priorities. dr. schneiderman was convinced that the realization of the school’s aspirations for national prominence would inevitably require the development of a research infrastructure that could lead to the creation of new knowledge. a faculty planning group was formed in 1979 and set about preparing a formal proposal to be submitted to the indiana commission on higher education. the committee opted for the dsw degree because of the lack of phd’s on the school’s faculty. the commission tabled the dsw proposal in 1980 pending a report on the progress of the expansion of the msw program to three additional indiana university campuses and the university of southern indiana. one year later, the commission voted seven to six against approval, citing the failure on the part of the school to mount programs on any of the regional campuses. the school had requested $1.6 million to implement the advances in social work, fall 2011, 12(2) viii approved msw programs, but in the absence of any additional funding to support the expansion, it created the option of a weekend work study program at the graduate level. in 1981, the school moved from cavanaugh hall to the fourth floor of the new education-social work building. a year later, dean schneiderman resigned his position as dean. dr. beulah compton served for a year as acting dean and was then followed by dr. powers, who served two years as acting dean. dr. sheldon siegel was appointed dean of the school in 1984. dr. siegel previously had been director of the university of cincinnati school of social work for six years and before that an associate professor at the university of michigan school of social work. dr. siegel continued the school’s efforts to increase the diversity of both its faculty and student body. dr. schneiderman was responsible for developing the school’s affiliation with the council on international programs (cip), an international initiative that was instrumental in bringing hundreds of human service professionals from more than 80 countries around the world to the iupui campus. the international and interdisciplinary initiative was sustained by dr. siegel under the leadership of professor david metzger. to enhance statewide access to graduate social work education, the school initiated a part-time weekend work study program on the indianapolis campus. in the late 1980s, dr. siegel reconvened a group of faculty to consider the feasibility of submitting a new proposal for a doctoral degree program. in the years that intervened since the submission of the original proposal, the makeup of the faculty had changed dramatically, both in terms of its academic credentials and racial diversity and the school applied for a phd program in 1991. the school’s proposal for a phd program was approved by the commission on higher education. the first cohort of phd students began coursework in 1994. in 1994, dr. roberta greene became the school’s fifth dean. dr. greene built upon her predecessors’ efforts to develop a variety of community-based field units headed by teacher/practitioners. dr. greene also secured major funding that dramatically enhanced the computer and technological resources of the school and contributed to a growing interest and capacity for research and scholarly writing among social work faculty and students. dr. michael patchner became the sixth dean of the school in 2000. the son of an appalachian coal-miner, he served as the associate dean and professor at the university of pittsburgh school of social work for eight years before coming to indiana university. previously, he served as dean and professor of the west virginia school of social work. in the school’s december 2000 newsletter, dean patchner outlined his goals for the school. among his top priorities were research and scholarship. “as we need to produce new knowledge to inform practice and the social work profession, i desire for the school to be recognized, both nationally and within indiana, for having a reputation for quality and service, and i look for the school to be well-connected to state government and social service organizations throughout the state” (patchner, 2000). the school’s new journal, advances in social work, started in 2000 to provide an additional outlet for the dissemination of social work scholarship and to bring additional recognition to the school. schneider/iussw: the first 100 years ix in 2004, the school celebrated another milestone with the graduation of the first class of bsw students on the bloomington campus. previously, students on the bloomington campus needed to transfer to the indianapolis campus to complete their senior year in the bsw program. state leaders turned to the school in 2004 to provide leadership for the indiana commission on abused and neglected children and their families. dean patchner served as chair of the commission, whose recommendations formed the basis for changes the state made to better protect children in indiana. during the 2005-06 academic year, the school marked a milestone as its enrollment topped 1,000 students on all of its campuses for the first time. one of the factors contributing to the school’s growth was the addition of the msw program at indiana university-purdue university, fort wayne. the school assumed administrative duties for indiana university labor studies program in 2007. labor studies courses are offered on all of indiana university’s campuses, and the program offers degrees ranging from an associate of science to a bachelor of science in labor studies. dr. irene queiro-tajalli, the executive director of undergraduate education, took on the role of interim executive director of the labor studies program as well. after gov. mitch daniels was elected governor and created the department of child services, the school enhanced its partnership with the agency to better train employees of the agency as well as students who wanted to become case managers with dcs. the school initiated a program where employees in public child welfare were able to earn their msw degrees. the addition of the labor studies program and the growth of the child welfare training program were among the reasons the school saw the number of its faculty jump from about 25 faculty members in 1998 to about 70 in 2011. the school’s growing and enhanced programs were reflected in national rankings – for 2008 the u.s. news and world report ranked the school’s msw program 26th out of more than 200 programs. after extensive discussions, the school began a new initiative in 2009 that linked the social work program to its earliest days of medical-related social work. with philanthropic support from jason baker, a punter with the carolina panthers, the school of social work collaborated with riley children’s hospital to establish an academic certificate program focused on training individuals to specialize in a career that provides support to children with special health needs and their families. the state of indiana again turned to the school of social work in 2010 asking for its help to resolve the growing problem of children living in poverty. dean patchner was asked to serve as chair of the commission on childhood poverty in indiana. the commission is charged with recommending how the state can reduce childhood poverty by 50 percent by 2020. advances in social work, fall 2011, 12(2) x the school and its faculty have expanded their focus to include a global perspective. it has developed partnerships that with universities in kenya, china and croatia that resulted in special opportunities for students and faculty members alike. while online courses have been part of the bsw program since 2001, the school moved to increase its online distance education efforts at the msw level. the school is planning an online master of social work program, msw direct, to serve students who cannot come to our campus. the size and scope of the school of social work has changed drastically since edna henry sat in her director’s chair determined to see the new social service department succeed. one aspect though remains very much the same 100 years later. the same passion that dr. henry and those that followed her brought to bear on their work is still very much in evidence today as we celebrate a century of giving hope and changing lives. references busch, m., powers, g. t., metzger, d., behroozi, c. s., siegel, s., & cournoyer, b. r. (2001). indiana university school of social work: 90 years of professional education. advances in social work, 2, 83-100. evans, l. (1943). report of the training course for social work 1937-42, indianapolis: indiana university. evans, l. (1944). report of the training course for social work september 1, 1942august 31, 1944, indianapolis: indiana university. indiana university, social service department. (1913). report of the social service department 1911-12 and 1912-1913. bloomington, in: author. patchner, m. (2000, december). “dean’s message,” network, p.1. rogers, h. c. (1983). seventy years of social work education at indiana university. indianapolis: indiana university. author note: address correspondence to: rob schneider, indiana university school of social work, 902 west new york street, indianapolis, in 46202. email: robschn@iupui.edu microsoft word dalton_1994_copyedit final ______________ bruce dalton, msw, ph.d., is an associate professor in the department of social work at east tennessee state university in johnson city, tn. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 618-632 “you make them do what?”: a national survey on field seminar assignments bruce dalton abstract: this national study of msw field directors provides data on field seminars and assignments. field directors at cswe accredited or in-candidacy msw programs were surveyed regarding program data, presence and nature of a field seminar, required assignments, and opinion questions about cswe requirements. findings from the 141 completed surveys (66.2% response rate) show assignments are similar between foundation and concentration years, and also similar to assignments required in the bsw curriculum. this raises questions of curriculum redundancy and how to properly sequence field assignments. other findings about field education and field seminar are also presented. keywords: field seminar, field education field education has varied from the stepchild of the curriculum to the signature pedagogy. field education programs vary from no field seminar to seminars of a variety of lengths and formats. regarding traditional classroom courses, shavelson states “instructors can introduce tremendous variation into seemingly standardized course formats” (1986, p. 52). the often unstructured nature of field seminars may allow for even greater variance in both quality and content. field instructors also have varying degrees of training, experience, skill, and loyalty to the social work education program. field seminars may be one place social work educators ensure that students in field placement are exposed to learning experiences seen as crucial by the program. however recent surveys show a significant minority of msw programs (19%) do not have field seminars and among those that do have seminars, 28% report using all or mostly all adjuncts to lead them (dalton, stevens, & maas brady, 2011). this creates opportunities for ‘slippage’ between the intentions of the program and the actuality of the seminar. there is currently little known about how field seminars are implemented in msw programs in the u.s. the purpose of this research is to fill that gap by exploring how the field seminar is implemented. this study will investigate the type of field seminar assignments reported by msw field directors and other aspects of field seminar delivery, such as length, frequency, texts, and format. literature review social work field instruction has evolved from an apprenticeship model early in its history to an educationally-focused model in which experienced professionals are selected as field instructors to help students achieve the educational objectives of the field program (bogo, 2005; frumkin & lloyd, 1995). field instruction is now seen as the signature pedagogy of social work by the council on social work education (cswe, 2008). shulman (2005) says that a signature pedagogy should be consistently applied and advances in social work, fall 2012, 13(3) 619 if a profession has a signature pedagogy “we should be able to find it replicated in nearly all the institutions that educate in those domains” (p. 54). signature pedagogy is defined as “the central form of instruction and learning in which a profession socializes its students to perform the role of practitioner” and its purpose is to “connect the theoretical and conceptual contribution of the classroom with the practical world of the practice setting” (epas, 2.3, cswe, 2008). the connection between theory and practice is widely reported in the literature (e.g. boisen & syers, 2004; dalton, stevens, & maas brady, 2009; henry, 2004; homonoff, 2008; noble, 2001). boisen and syers state “social work education rests on the assumption that competent social work practice is grounded in the intentional use of theory” (2004, p. 205). the field experience is where and when students connect the theoretical concepts learned in the classroom with the practical aspects of service provision while also gaining an appreciation for the breadth and depth of the many roles that a social worker performs. this approach is compatible with john dewey’s philosophy of progressive education in which students learn by doing (scannell & simpson, 1996). dewey believed having relevant experience in the wider world brought value and purpose to what happens in the classroom. although this perspective has long been accepted in social work education, it has also long been seen as difficult to implement; “however highly valued this integration of theory with practice may be, it is nevertheless hard to define” (basch, 1942, p. 32). bogo and power (1992) found that 31% of the 49 new field instructors surveyed believed teaching theory was unimportant. reviewing five studies of student perception of field instruction, bogo (2005) found that students do value reflective and conceptual learning activities that help to integrate theory and practice, yet only one of the five studies reviewed (fortune, mccarthy, & abramson, 2001, as cited in bogo) investigated whether the reported use of learning activities by field instructors that help integrate theory and practice were correlated to performance. fortune found that neither making connections to theory nor making connections to classroom work were significantly related to performance as rated by the field instructor in an end of placement evaluation. munson (1987) suggested that the direction of integration needs to be considered. the common assumption is that curriculum theory emanates from the classroom and spreads to field, but munson suggests a better model may be to teach in the classroom what the students are exposed to in the field. munson gives as an example an advanced practice track based on emotions encountered in the practice arena, such as anger, depression, anxiety, grief, etc. the field seminar is seen as the setting in which the connection between theory and practice is made clear for the students (mary & herse, 1992; poe & hunter, 2009). it is in the seminar that students have the opportunity, and often the mandate, to make a conscious connection between classroom knowledge and theory, and the experience they are gaining in placement. the seminar may do this through informal or guided discussion as well as through more formal oral and written assignments. for example, this author has asked seminar students to come the next week with a specific behavioral example of a theory being used to direct a client intervention. the ensuing class discussion makes clear the different abilities of students to understand how theory is used in practice. a dalton/“you make them do what?” 620 formal seminar assignment asking students to link theory and practice is congruent with the findings of mary and herse (1992), who found that student reports of theory/practice integration more often occurred in structured sessions than in unstructured ones. the literature on assignments used in field seminars is shallow. searching social work abstracts on the terms “field seminar” (n=9), “field assignment(s)” (n=12), and “field placement” (n=190) revealed few articles describing assignments specifically given in field seminar. the author found it common for articles to discuss assignments for field with no specification of whether it was for the field instructor to use alone or in conjunction with a field seminar leader, such as the process recording assignment that may be used by a field instructor with or without coordination with a field seminar (e.g., black & feld, 2006; canning & mullin, 2008; hendricks, finch, & franks, 2005; knight, 2000). fisher, reed, stough, and matt (2007) describe a bsw senior field seminar that requires several two page mini-papers designed to integrate coursework with field experience. potential topics include generalist opportunities in the agency and how the nasw code of ethics applies to field experiences. noble (2001) reports on the use of a reflective workbook that students complete in a narrative form and then process in seminar or with field instructors with the purpose of linking theory and practice. haslett (1997) reports on a two semester field assignment in which grant writing was taught in seminar and grants were then written by student groups to benefit a selected field placement. poe and hunter (2009) asked bsw field directors to identify which of 13 assignments were required as part of the field experience. the assignment most often required was a student-developed learning contract (94.7%), followed by reflective writing, oral case presentation, written micro case analysis, process recording, social history, written macro activity analysis, environmental study, policy study, literature review on field population/experience, portfolio, eco-mapping, and lastly a written group case analysis (29.7%). the top nine field assignments were required 50% or more of the time, and seven of those were written assignments. poe and hunter’s data do not distinguish whether those assignments are a field seminar requirement or for another course. if many of these assignments are required in the field seminar, then the format may become more like a traditional classroom and less like a process group where field issues and student concerns are discussed. shulman believes this process focus is important, stating “there are elements added through the group process that can have powerful and important impacts on a staff member that may not be present in individual supervision” (2010, p. 272). poe and hunter found that 57.7% of seminar leaders report using content delivery often or very frequently, which may distract from the process focus of field seminar. this present study will investigate the type of assignments from field seminars reported by msw field directors and other aspects of field seminar delivery, such as length, frequency, textbooks, and format. this research is best characterized as exploratory and descriptive with the research question “what are the national patterns of msw field seminar delivery?” the results will provide information about field seminar delivery that have not been previously reported. one hypothesis is suggested by the literature: in comparison to the bsw data collected by poe and hunter (2009), there will be a similar number and type of msw field assignments. the new response categories in advances in social work, fall 2012, 13(3) 621 this research will show if those assignments are required in seminar or other classes. the implications of these results for the field seminar will be discussed. methodology sample the sample population was the 219 cswe accredited or in-candidacy msw programs in the fall of 2009. the sample frame consisted of the 213 field directors (or msw program director when a field director could not be identified) at cswe accredited or in candidacy msw programs for whom email addresses could be acquired. the sample frame was constructed by visiting the webpage of each accredited or in-candidacy program. in february 2010, 213 emails were sent out announcing the survey and providing a link to the survey site. two reminder emails were sent out over the next several weeks. one hundred and forty-one surveys were completed for a response rate of 66.2%. survey the survey included program data, presence and nature of a field seminar, required field assignments, and opinion questions for the field director about cswe requirements. the list of assignments was an amended list that poe and hunter (2009) used with bsw field directors. three new items were added based on the literature and the author’s experience and another item was added when one of poe and hunter’s items was divided into two items (environmental study of the field agency and/or community became two separate items). the response categories were also changed to reflect whether the assignment was required in the seminar or elsewhere in the curriculum. poe and hunter had the response categories required, not required, and optional. this change was made because classes besides the field seminar may require assignments that are to be completed in the field. this is so common that benjamin and ward (2005) suggest students take all their course syllabi to their field instructor on the first day of field to begin coordination of course assignments required to be completed in field. this survey was piloted by sending it to ten field directors, six of whom completed it and provided feedback. results of the 141 respondents, 130 were the field director, four were the msw program director, two were field coordinators, 22 were seminar leaders, and 19 were liaisons. several wrote in unique titles in addition to field related titles, such as clinical professor. only two respondents provided no role. most respondents were from public universities (n=101, 72.7%). field is graded pass/fail 63.1% of the time, a-f 29.8% of the time, and other 3.5% of the time. respondents were asked to mark on a continuum, from 1=rural to 7=urban, the setting of their program. the results are shown in table 1. the mean was 5.1 showing most respondents considered their institution to be on the urban side of the continuum. dalton/“you make them do what?” 622 table 1: rural/urban program setting rural/urban frequency percent 1 rural 9 6.4 2 8 5.7 3 15 10.7 4 25 17.9 5 16 11.4 6 16 11.4 7 urban 51 36.4 total 140 100 respondents were asked how many msw degrees were awarded by their program last year; the results are shown in table 2. the median was in the 60-69 category (categories were collapsed for presentation in table 2). the mean number of graduates each year was 106 (computed after the response categories were recoded to their midpoints and the 500+ category set to 500). table 2: number of msw degrees awarded by program last year number of msw degrees frequency percent 0-49 52 37.7 50-99 33 23.9 100-149 20 14.5 150-299 25 18.1 300-499 7 5.1 500+ 1 .7 total 138 100 chi-square was conducted to determine if programs were statistically more likely to require a field seminar in the foundation or concentration year. though most programs report a field seminar at both levels, statistical significance was found, with more programs requiring field seminar in the foundation year (see table 3). advances in social work, fall 2012, 13(3) 623 table 3: required foundation and concentration seminars concentration seminar required? yes no total (%) foundation seminar required? yes 79 26 105 (76) no 7 26 33 (24) total (%) 86 (62) 52 (38) 138 (100) x2(1, n = 138) = 31.21, p = .000 statistical analysis revealed no significant relationship between either the rural/urban measure or whether the university was public or private and whether programs had either a foundation or concentration field seminar. there was a statistically significant relationship between the number of msw degrees awarded each year and whether the program had a field seminar in either the foundation (t=-3.23, df=136, sig.=.001) or concentration year (t=-5.5, df=82, sig.=.000). programs with a foundation seminar reported 90 msw graduates per year and programs without a foundation seminar reported 152 msw graduates per year. programs with a concentration seminar reported 71 msw graduates per year, and programs without a concentration seminar reported 162 msw graduates per year. those with a field seminar report the seminar meets as shown in table 4. at both the foundation and concentration levels, this variable was recoded to reflect the number of times the seminar meets in a 15 week semester and the ‘other’ category was replaced with a number when the respondent had entered a comment that provided that information. the length of the foundation seminars averaged 113 minutes and ranged from 45 minutes to three hours (n=101). the length of each foundation semester was multiplied by the number of times it met per semester to compute the length of time spent in seminar each semester. this revealed the total amount of time in foundation seminar per semester ranged from 240 minutes to 2700 minutes with a mean of 1081.7 minutes (sd=543) and a median of 840. the length of the concentration seminars averaged 117 minutes and ranged from 45 minutes to eight hours (n=81). the length of each concentration seminar was multiplied by the number of times it met per semester to compute the length of time spent in seminar each semester. this revealed the total amount of time spent in concentration seminar each semester ranged from 220 minutes to 2700 minutes with a mean of 988.2 minutes (sd=560) and a median of 840. the total amount of time spent in concentration seminar was statistically different from the total amount of time spent in foundation seminar (t=2.08, df=70, sig=.031). so not only do fewer programs have a concentration seminar, when they do they do not spend as much time in seminar over the course of a semester. dalton/“you make them do what?” 624 table 4: frequency of foundation/concentration field seminars foundation n (%) concentration n (%) weekly 43 (41.3) 31 (37.3%) biweekly 32 (30.8) 26 (31.3) monthly 15 (14.4) 15 (18.1) other 14 (13.5) 11 (13.3) total 104 83 seminar textbooks were reported as required at 41 (39.8%) of the 107 programs with a foundation field seminar. thirty-one provided identifying information for their textbook(s). the most commonly used were the social work practicum: a guide and workbook for students (garthwait, 2006) used by seven respondents, the practicum companion for social work: integrating class and field work (birkenmaier & bergweger, 2007) used by 5 respondents, and the successful internship: personal, professional, and civic development (sweitzer & king, 2008) used by three respondents. seminar textbooks were reported as required at 23 of the 86 programs (27.4%) with a concentration field seminar. fourteen provided identifying information for their textbook(s). only one was used by two respondents, the evidence-based internship: a field manual (thomlison & corcoran, 2008). respondents identified whether all, some, or none of their field seminar was conducted online and what those components were (see table 5). significantly more of the concentration field seminars were in whole or part conducted online (kendall’s tau = .701, sig.<.001). table 5. use of online medium for field seminar foundation concentration is any of your field seminar conducted online? all 0 2 (2.4%) some 25 (23.8%) 28 (33.3%) none 80 (76.2%) 54 (64.3%) total 105 84 which components are at least in part completed online? discussion 21 25 submitting assignments 20 23 accessing readings 11 14 viewing videos 5 4 other 7 5 advances in social work, fall 2012, 13(3) 625 field directors were asked which assignments were required in the field or elsewhere in the curriculum; the results are presented in tables 6 and 7. for the foundation year the response pattern was overall very similar to the bsw responses reported in poe and hunter (2009). the three most common items were the same in both. the next two items in the foundation data were new, but the next two (process recording and written micro case analysis/study) were fifth and fourth in poe and hunter’s data. a visual examination of the data also reveals similarity between the foundation and concentration years with only a few in different rank order (in table 7 the items are listed in the same order as in table 6 for ease of comparison). table 6: assignments required in foundation year foundation year assignment in foundation seminar n (%) elsewhere in foundation curriculum n (%) student developed learning contract 88 (82.2)* 16 (15.0) reflective writing on the field experience 85 (79.4) 12 (11.2) oral case presentation 67 (62.6) 27 (25.2) oral presentation of the placement agency 67 (62.6) 17 (15.9) required readings 53 (49.5) -- process recording 47 (43.9) 20 (18.7) written micro case analysis/study 45 (42.1) 39 (36.4) environmental study of the field agency 42 (39.3) 24 (22.4) written macro activity analysis/study 33 (30.8) 44 (41.1) social history 22 (20.6) 42 (39.3) eco-mapping 19 (17.8) 40 (37.4) written group case analysis/study 19 (17.8) 34 (31.8) policy study from field experience 18 (16.8) 44 (41.1) portfolio 16 (15.0) 15 (14.0) environmental study of the community 14 (13.1) 39 (36.4) literature review on the field placement setting 11 (10.3) 20 (18.7) literature review on the field placement population 10 (09.3) 24 (22.4) * percentages are of the 107 with a foundation field seminar. what can also be seen from both tables is that some assignments are seen as more appropriate for field seminar and some are seen as more appropriate for elsewhere in the curriculum. when comparing the percentage of assignments required in seminar in the foundation and concentration years, the greatest difference was 10.5% (literature review on the field placement population). when comparing the percentage of these assignments required elsewhere in the foundation and concentration years, the greatest difference was dalton/“you make them do what?” 626 8.3% (eco-mapping). most differences were much lower. this visual inspection of the data reveals the pattern of assignments given to both foundation and concentration years in the field seminar and elsewhere in the curriculum was remarkably similar. table 7: assignments required in concentration year concentration year assignment in concentration seminar n (%) elsewhere in concentration curriculum n (%) student developed learning contract 76 (88.4)* 8 (09.3) reflective writing on the field experience 64 (74.4) 10 (11.6) oral case presentation 58 (67.4) 17 (19.8) oral presentation of the placement agency 49 (57.0) 15 (17.4) required readings 41 (47.7) -- process recording 37 (43.0) 14 (16.3) written micro case analysis/study 41 (47.7) 25 (29.1) environmental study of the field agency 25 (29.1) 19 (22.1) written macro activity analysis/study 27 (31.4) 34 (39.5) social history 18 (20.9) 30 (34.9) eco-mapping 13 (15.1) 25 (29.1) written group case analysis/study 18 (20.9) 29 (33.7) policy study from field experience 22 (25.6) 30 (34.9) portfolio 21 (24.4) 13 (15.1) environmental study of the community 13 (15.1) 27 (31.4) literature review on the field placement setting 11 (12.8) 18 (20.9) literature review on the field placement population 17 (19.8) 21 (24.4) * percentages are of the 86 with a concentration field seminar. respondents were asked what other assignments are required for their foundation or concentration seminars that were not on the list to choose from. twenty six respondents added 27 foundation assignments and 17 respondents added 18 concentration assignments. of these only one assignment was mentioned as many as three times, a capstone assignment. this indicates there were no significant omissions in the list of assignments on the survey. as discussed above nearly all responding programs require written assignments in both field seminars, and most require multiple written seminar assignments. this may cause the seminar to take on a didactic nature as students require information to complete written assignments. even if the information necessary to complete the assignment is largely presented in another course, the seminar leader may be called upon to explain the assignment. respondents were asked to rate their seminar on a continuum from 1 to 7, advances in social work, fall 2012, 13(3) 627 with one being a process format and seven being a lecture format. the results in table 8 show that most fall on the process end of the continuum with no significant difference between foundation and concentration year. table 8. foundation/concentration seminars rated on process/lecture continuum. foundation seminar concentration seminar 1 process 28 (26.9%) 17 (21%) 2 35 (33.7) 35 (43.2) 3 23 (22.1) 13 (16) 4 16 (15.4) 16 (19.8) 5 1 (1) 0 6 1 (1) 0 7 lecture 0 0 total 104 81 (t=-.117, df=183, sig=.907) respondents were asked if seminar should be required by cswe. for the foundation year 78.4% replied yes and for the concentration year 62.5% replied yes, a significant difference (x2 = 38.363, df=1, p<.001). in the foundation year 12 respondents who did not have a field seminar believed it should be required, while 9 respondents who did have a field seminar believed it should not be required. in the concentration year the numbers were 14 and 13, respectively. respondents were asked if there were certain field seminar assignments that should be required of all cswe accredited programs. for the foundation year 64 (48.1%) replied yes and for the concentration year 52 (39.4%) replied yes, a significant difference (x2 = 62.303, df=1, p<.001). respondents were asked what field seminar assignments they believed should be required. fifty-five respondents mentioned 32 foundation field seminar assignments, and 47 respondents mentioned 39 concentration field seminar assignments. the most commonly noted were also those that were ranked high on tables one and two as being currently assigned. for the foundation year those were process recordings (n=20), reflection assignments (16), case presentations (15), and learning contracts (15). for the concentration year those were case presentations (16), process recordings (16), reflection assignments (11), and learning contracts (10). respondents were asked if there was anything else that they could tell us to help us understand the field seminar at their program; comments were provided by 65 respondents. using the method described by kerlinger (1986) a content analysis was conducted to identify themes in the comments. the most mentioned theme was the importance of the seminar function of integrating theory and practice (n=10). six respondents without seminars reported that discussion of field issues was expected in one or more practice classes, though two expressed dissatisfaction with this arrangement. one dalton/“you make them do what?” 628 respondent said their program was adding field seminar and another said they were dropping it. respondents were also asked if there was anything else they could tell us to better understand field issues in general and comments were provided by 37 respondents. no common themes emerged from these comments. some comments were suggestions, some were about their own programs, some were emotive, and some were questions. one respondent wrote “we are attempting to become less of a step child to course curriculum. any suggestions?” sorry, no. limitations this study was limited by several factors. respondents were mostly field directors who may not know all the details of the overall curriculum and whether assignments from other courses are linked to field, though over time they would likely become familiar with most or all of them. to more accurately measure field assignments required by other courses would require reviewing all course syllabi or surveying all faculty, a much bigger task than surveying field directors. another limitation of the study is its use of assignment titles and not the full assignment description. completing many of the assignments listed in tables 6 and 7 may allow or require discussion of the connection of theory and practice, but it is also possible the assignment instructions for a particular course or seminar could be written in such a way that it could be completed without explicitly connecting theory and practice. discussion the purpose of this research was to explore currently unknown aspects of field seminar with an emphasis on required assignments. that purpose has been met as a picture was drawn of field seminar characteristics that is informative to field directors as they implement their field component, as well as faculty who teach classroom courses that support field. fewer respondents reported a field seminar in the concentration year than the foundation year. further, when programs have concentration year seminar they meet 93 minutes less over the course of a semester than foundation seminar. the author is aware of no literature claiming seminar is more helpful in one or the other year. when the percentage of msw programs with a field seminar was previously reported, no distinction was made between foundation and concentration years, so this is a new finding. one variable that was found to impact whether a program had a seminar either year was the number of msw graduates, with larger programs less likely to have a seminar. it may be that larger programs have fewer financial resources per student and can’t afford a seminar, that larger programs are more research-oriented and take less time for student contact through a field seminar, find it hard to coordinate a large number of seminars, or some other reason. future research could examine the cause of this difference. the textbooks and assignments required may indicate a difference in purpose between foundation and concentration seminars. more foundation seminars than concentration seminars require textbooks. requiring a textbook suggests foundation advances in social work, fall 2012, 13(3) 629 seminar is seen as more basic and informational and implies a more traditional educational process. however the data in table 8 shows respondents more likely to claim a process than a lecture method for both seminar levels. shulman (2010) states the dynamic and process focused group is a valuable educational opportunity that may contribute to skill as a future group worker and social worker. if textbooks and assignments do create a traditional classroom environment in seminar then this educational opportunity will be missed. a visual examination of the assignments required of foundation and concentration students reveal them to be very similar. further, a visual examination shows that the assignments required of foundation and concentration students are similar to those required of bsw students in the poe and hunter study (2009). it is possible that some different use is being made of the assignments in the different levels, but these data cannot determine that. foundation students should be focused on skill development and the generalist model, while concentration year students should be making use of theorybased interventions and making conceptual connections between theory and practice (boisen & syers, 2004). however the patterns found in this data suggest that there is little deliberate use of assignments for different curriculum levels such as those proposed by fisher and colleagues (2007) or noble (2001). unfortunately concentration seminar assignments may often be a case of more of the same. curriculum redundancy has previously been identified as a problem elsewhere in the social work curriculum (dalton & wright, 2003, 2004), so it would not be surprising if it were also the case in field. most respondents believe seminar should be required by cswe, especially for foundation year. this position is in accord with shulman (2005) that a signature pedagogy should be consistently applied. it is difficult to imagine that field is consistently applied when programs can choose whether to have a seminar. this author has taught in programs with and without a seminar, and has seen learning take place in seminar that was not possible in any other setting because of the seminar’s process focus and focus on field. some assignments required by courses other than the field seminar are expected to be completed in field or draw upon field experience. this requires coordination between field and other courses. if assignments from seminar or any class are expected to be completed in field, then the field instructor needs to know this as early as possible so that planning for those activities can take place. in the author’s seminar students are required to have their field instructor sign the assignment page of all their syllabi and put copies in their field portfolio by the third week of class. this ensures students and their field instructors have discussed required assignments early in the semester as suggested by benjamin and ward (2005). conclusion this study has indicated that the field placement and seminar is unevenly implemented by cswe accredited msw programs. however epas (cswe, 2008) indicates there are different ways to get to the same end point, so if a field program achieves the goal of teaching students theory guided practice, then the specifics of their dalton/“you make them do what?” 630 field program can be left up to them. cswe does have certain requirements for field (e.g., minimum number of field hours, field instructor training), suggesting that some things are seen as necessary to meet professional educational competencies. it is unclear why some requirements exist while other aspects of field education, such as a seminar, do not. requiring a field seminar would address the recommendations of wayne, bogo, and raskin (2010) that field education have more student-to-student accountability and greater student visibility of their field education performance, thus continuing our movement away from the one-to-one supervisory model associated with psychodynamic theory. a required field seminar would also replicate our signature pedagogy across the field as recommended by shulman (2005). in the absence of a field seminar it becomes incumbent on the program to demonstrate it is otherwise meeting the primary goal of field seminar, that of integrating theory and practice. a future study could investigate how msw programs with and without seminar integrate theory and practice in their field component. most of the assignments required in field seminar (tables 6 and 7) seem to lend themselves to the measurement of many epas competencies and practice behaviors. it would be tempting for any program to measure student attainment of competencies with these assignments in a field seminar, and the author’s program and surely many others do so. there is however little guidance in the literature for choosing field assignments and less that empirically tests their effectiveness in meeting or measuring specific competencies. there is no research on why specific field assignments are chosen, though it is likely they are chosen based on each program or educator’s teaching experience and tradition. a next step would be to empirically link specific field assignments to specific competencies at the foundation and concentration levels. this would raise social work education to the level of evidence-based practice and model this process for our students. references basch, g. (1942). class room and field work: their joint contribution to skill. in v. p. robinson (ed.), training for skill in social case work (pp. 32-54). philadelphia: university of pennsylvania press. benjamin, s., & ward, j. (2005). ten tips for integrating the classroom and fieldwork. the new social worker, 12(1), 6-7. birkenmaier, j., & berg-weger, m. (2007). the practicum companion for social work: integrating class and field work (2nd ed.). boston: allyn and bacon. black, p., & feld, a. (2006). process recording revisited: a learning-oriented thematic approach integrating field education and classroom curriculum. journal of teaching in social work, 26(3/4), 137-153. boisen, l., & syers, m. (2004). the integrative case analysis model for linking theory and practice. journal of social work education, 40(2), 205-217. bogo, m. (2005). field instruction in social work: a review of the research literature. the clinical supervisor, 24(1/2), 163-193. advances in social work, fall 2012, 13(3) 631 bogo, m., & power, r. (1992). new field instructors’ perceptions of institutional supports for their roles. journal of social work education, 28(2), 178-189. canning, j., & mullin, w. (2008). student process recording in practice with children. the clinical supervisor, 27(1), 61-75. council on social work education. (2008). educational policy and accreditation standards. alexandria, va: author. available online at http://www.cswe.org/cswe/ dalton, b., stevens, l., & maas-brady, j. (2009). surveying the bsw field director. journal of baccalaureate social work, 14(2), 17-29. dalton, b., stevens, l., & maas-brady, j. (2011). “how do you do it?”: msw field director survey. advances in social work, 12(2), 276-288. dalton, b., & wright, l. (2003). exploring redundancy in social work education. advances in social work, 4(1), 48-63. dalton, b., & wright, l. (2004). eliciting student perceptions regarding curriculum redundancy. journal of teaching in social work, 24(1), 55-72. fisher, l., reed, n., stough, l., & matt, t. (2007). making the most of field seminar. the new social worker, 14(4), 8-10. frumkin, m., & lloyd, g. a. (1995). social work education. in r. l. edwards (ed.-inchief), encyclopedia of social work (19th ed., vol. 3, pp. 2238-2247). washington, dc: nasw press. garthwait, c. (2009). the social work practicum: a guide and workbook for students (4th ed.). boston: allyn and bacon. haslett, d. (1997). the education task group: teaching proposal writing to social work students. social work with groups, 20(4), 55-67. hendricks, c., finch, j., & franks, c. (2005). learning to teach, teaching to learn: a guide for social work field education. alexandria, va: cswe press. henry, p. (2004). the role of field instruction in social work education. the new social worker, 11(4), 7-9. homonoff, e. (2008). the heart of social work: best practitioners rise to challenges in field instruction. the clinical supervisor, 27(2), 135-168. kerlinger, f. (1986). foundations of behavioral research (3rd ed.). new york: holt, rinehart, and winston. knight, c. (2000). engaging the student in the field instruction relationship: bsw and msw students’ views. journal of teaching in social work, 20(3/4), 173-201. mary, n., & herse, m. (1992). what do field seminars accomplish? student and instructor perspectives. journal of teaching in social work, 6(2), 59-73. munson, c. (1987). field instruction in social work. journal of teaching in social work, 1(1), 91-109. dalton/“you make them do what?” 632 noble, c. (2001). researching field practice in social work education. journal of social work, 1(3), 347-360. poe, n., & hunter, c. (2009). a curious curriculum component: the nonmandated “given” of field seminar. journal of baccalaureate social work, 14(2), 31-47. scannell, j. j., & simpson, k. (1996). shaping the college experience outside the classroom. rochester, ny: university of rochester. shavelson, r. j. (1986). evaluating student outcomes from telecourse instruction: a feasibility study (report no. isbn-0-8330-0746-7; rand/r-3422-dpb). santa monica, ca: rand corporation. (eric document reproduction service no. ed 311 867) shulman, l. s. (2005). signature pedagogies in the professions. daedalus, 134(3), 52-59. shulman, l. (2010). interactional supervision (3rd ed.). washington, dc: nasw press. sweitzer, h., & king, m. (2008). the successful internship: personal, professional, and civic development (3rd ed.). belmont, ca: brooks/cole. thomlison, b., & corcoran, k. (2008). the evidence-based internship: a field manual. new york: oxford university press. wayne, j., bogo, m., & raskin, m. (2010). field education as the signature pedagogy of social work education. journal of social work education, 46(3), 327-339. author note: address correspondence to: bruce dalton, department of social work, box 70645, east tennessee state university, johnson city, tn 37614-1702. email: dalton@etsu.edu microsoft word byers_policy practice copyedit final ______________ katharine v. byers, ph.d., is associate professor and director of the indiana university school of social work’s bsw program on the bloomington, in campus. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 34-50 reemergence of policy practice: a journey back to our roots katharine v. byers abstract: many people and events have contributed to a renewed focus on policy practice in social work and social work education, culminating in the inclusion of policy practice as one of the ten core social work competencies in the 2008 council on social work education epas. robert schneider, founder of influencing state policy, was a key player in elevating policy practice, particularly at the state level, in light of the increasing devolution of social policy decision-making to the states. other social workers and educators created opportunities for policy scholars and practitioners to collaborate, including leon ginsberg and the policy conference that he and others initiated. now a new generation of policy practitioners will continue to educate social workers in policy practice skills in the pursuit of social justice. keywords: policy practice, influencing state policy, teaching advocacy skills this narrative reflects my own recollection and sense-making of our collective journey to bring policy practice back into the forefront of social work education. i have highlighted, in particular, the work of robert l. schneider, professor emeritus from virginia commonwealth university, who created influencing state policy, an organization providing resources and opportunities for the exchange of ideas about influencing policy at the state level. bob has been a collaborative reviewer of this document, as one of the major actors in this history. i remember it as if it were yesterday. the date is march 8, 1997, and the place is chicago illinois, site of the 45th annual program meeting of the council on social work education. to the casual observer, there was nothing especially unusual about this particular gathering of the profession’s educators. there was the typical array of interesting sessions to be attended, old friends huddled over lunch to renew acquaintances, and colleagues engaged in conversations that promised new opportunities for collaborative scholarly activities, while others ventured out into the windy environs of chicago to explore its many wonders. at 7:30 that evening, unlike most of my friends who were headed out for “a night on the town,” i found myself sitting in a small hotel meeting room attending the first ever meeting of the then named national committee for educating (social work) students to influence state policy and legislation. mary katherine o’connor, a friend and colleague from virginia commonwealth university, had told me her vcu colleague, robert (bob) schneider, had called this meeting of social work policy folks to foster more state level advocacy in light of the devolution of policy making from the federal government to the states with the passage of the personal responsibility and work opportunity act of 1996 (commonly referred to as welfare reform). i was not sure about going, but mary katherine had never led me astray so there i was. the 27 people who attended that first meeting, including the president and executive director of the national association of social workers (nasw), byers/reemergence of policy practice 35 enthusiastically embraced the idea of forming what is now called influencing state policy. fast forward to 2008 and the inclusion of policy practice as one of the ten core social work competencies identified in our cswe educational policy and accreditation standards: educational policy 2.1.8—engage in policy practice to advance social and economic well-being and to deliver effective social work services. social work practitioners understand that policy affects service delivery, and they actively engage in policy practice. social workers know the history and current structures of social policies and services; the role of policy in service delivery; and the role of practice in policy development. social workers � analyze, formulate, and advocate for policies that advance social wellbeing; and � collaborate with colleagues and clients for effective policy action (cswe, 2008, p. 6). this elevation of policy practice as one of the ten core competencies was celebrated as a huge accomplishment by social workers, both inside and outside academia, who had long sought return to the policy practice roots of the profession. how did we get from 1997 when few social work educators were talking about policy practice to 2008 and the inclusion of policy practice as one of the core competencies? in this article, i will discuss my perceptions and understanding of how the persistent efforts of bob schneider and others who shared his passion for the policy practice initiative ultimately led to its inclusion as one of the core social work competencies. during this reflective journey, i will attempt to capture some of the historical, ideological and political issues that surrounded this initiative. i will conclude with reflections from a recent discussion with bob about the next steps needed to advance the field of policy practice as we “elders” pass the baton to the next generation of social workers and social work educators. before we start, as in all narratives of this sort, it is helpful to set the context and look back at some of the historical underpinnings of policy practice in the social work profession. historical overview with the roots of our profession deeply embedded in the social reforms of the progressive era, it is no surprise that workers in both settlement houses and charity organization societies were engaged in what we currently refer to as policy practice activities. jane addams engaged in policy practice when she and other settlement house workers endeavored to improve the living conditions in the tenement neighborhoods where they lived and worked. julia lathrop, another settlement house worker, engaged in policy practice when she helped establish the first juvenile courts in cook county, illinois. social workers such as harry hopkins, frances perkins, grace and edith abbott, who also came out of the settlement house movement and worked at the community advances in social work, spring 2014, 15(1) 36 level, were engaged in policy practice when they shaped the new deal policies of president franklin d. roosevelt to respond to the challenges of the great depression. frances perkins, as secretary of labor, was one of the primary architects of the social security act and was particularly adamant that unemployment insurance be included as part of the law (cummins, byers, & pedrick, 2011). despite this rich early history in policy practice and advocacy, as social work sought greater professional recognition in the 1940’s and 1950’s, social workers placed less emphasis on policy practice and instead focused on the provision of mental health services. later, in the 1960’s, turning back to policy practice, social workers like wilbur cohen were involved in the development of the war on poverty programs designed to bring resources and opportunities to low-income communities. whitney young, director of the national urban league, was one of many social workers involved in the civil rights struggles of the 1960’s and a major architect of the federally funded project enable initiative. though social work leaders were engaged in important civil rights efforts, some worried about the depth of the engagement and commitment of the rank and file social workers in local agencies. howard gustafson, president of nasw at the time, after participating in the 1965 selma to montgomery march, reflected, “on the way back home, i tried to analyze what the civil rights struggle means to our association…i was wondering whether social workers, and nasw in particular, are really prepared to act on social issues in their own communities and in their own agencies” (nasw foundation, n.d.). social workers were involved in many local community efforts to improve civil rights even if their names were not in the headlines or in the national news. they were the people in the crowd scenes. in addition, for those of us who “grew up” during the 1960’s, the sit-ins, protests, marches, and door-to-door campaigns, both in the big cities of the north and the rural communities of the south, were pivotal in our own political and social justice development. raised in a family in which social activism was a way of life, advocacy on social justice issues has been a driving imperative throughout my life. as a high school student, i volunteered with the kennedy presidential campaign. working the phone banks helped compensate for being too young to vote. as a college student, i marched regularly in civil rights protests in the boston area. between college and graduate school, concerned that skyrocketing rents were driving working families out of cambridge, ma, where i lived, i knocked on tenement apartment doors to gather petition signatures as part of the (marxist) peace and freedom party’s rent control campaign. later, as an msw student, it seemed only natural to participate in the protests of both students and welfare rights organizations at the 1969 national conference on social welfare, well-documented in the social welfare forum (national conference on social welfare, 1969). although the exact details of the pressing social justice issues of the time have faded from my memory, i recall vividly the disruptive impact our collective efforts had on that important annual meeting, with some specific memories returning when i read the official commentary on the events. all of these experiences made it eminently apparent to me, as a beginning social worker, that collective social action can indeed make a meaningful difference. these and more recent policy efforts are the examples i use to convince our byers/reemergence of policy practice 37 contemporary students of the efficacy of their own policy efforts, as i am sure is the case for other social work policy faculty. many current faculty and older social workers witnessed this renewed commitment to the profession’s core social justice mission during the tumultuous 60’s. despite some significant incremental changes in the law, progress on the ground was much slower to materialize. it was a long and arduous uphill battle that ultimately saw some of the original combatants opt for safer and more predictable career paths. for some of us, that passion for social justice continues to burn to this day with the same intensity that inspired us during those formative years. in the 1970’s and 1980’s, much of social work advocacy energy was redirected toward establishing licensing laws in the states and developing clinical, rather than community, practice. the focus of the profession was on enhancing the status of clinical practice at the expense of furthering the community-based initiatives of the ‘60s. james wolk (1981) found that social workers were no more politically active than average citizens in the country. harry specht and mark courtney (1994) even charged that social work had “abandoned its mission.” in social work education, community organizing tracks in msw programs started to decline as more social workers wanted to be “therapists.” so how did we get from this “abandonment” to the inclusion of policy practice as one of the ten core competencies in social work? it seems like a huge leap in a little over ten years. the shifting political winds and their impact on policy practice the 1996 passage of the personal responsibility and work opportunity act (welfare reform) served as a wake-up call to social workers and social work educators, both for its policies/guidelines and for the implications of shifting more involvement in social policy formulation and implementation to the state level. this devolution of policy making to the states provided both cautions and opportunities for social work advocates. the new federal law established temporary assistance to needy families (tanf) to replace the long established entitlement program, aid to families with dependent children (afdc), with substantive changes designed to help single mothers become employed in the workforce within a two-year time limit, with very few exceptions. states were given greater latitude in setting eligibility guidelines and work requirements than had been the case under the former afdc legislation. ending the entitlement program, the policy goal was clearly to reduce the welfare rolls and government expenditures, not to reduce poverty. and, indeed, average earnings of those leaving the tanf rolls were below existing federal poverty levels (stoesz, 1999). social workers and social work educators became concerned about the impact of tanf on the lives of low-come women and their families (swigonski, 1996). some academics turned their concern into a traditional outlet: conducting research on welfare reform implementation (byers & pirog, 2003; larrison, nackerud, lane-crea, & robinson-dooley, 2005). others wrote policy pieces and critiques of the profession (long, 2000; mills, 1996). abramovitz (1998) made recommendations for social workers to recommit to their tradition of activism, noting, “historically, a small group of social advances in social work, spring 2014, 15(1) 38 workers consistently kept the voice of change alive” (p. 524). schneider and netting (1999) framed devolution as a crossroads for social work, presenting a new opportunity to develop skills and commitment to influence policy. “socializing practitioners, faculty, and students to a commitment to change state policy and engage in legislative processes is a continuing challenge,” noted schneider and netting (1999, p. 354). lens and gibelman (2000) were particularly critical of social work’s lack of involvement in welfare reform efforts, calling it a “failed opportunity to influence the course of public debate” (p. 611). karger and hernández (2004) made a case for a “renewed vision around the social justice mission of social work” (p. 51). a crescendo of voices advocating for an increased activist role for the social work profession seemed to be building. a few social work educators started to take action in new and different directions. i will highlight five specific developments that contributed significantly to the restoration of policy practice as a core social work responsibility: the development of influencing state policy and its initiatives; the development of the annual policy conference; an increase in the number of policy courses in accredited social work program with the accompanying policy practice-focused textbooks to support those courses; revisions of the code of ethics with a renewed emphasis on advocacy; and. the feedback to cswe about the importance of highlighting policy practice in the 2008 epas. we will look at each development separately, though many of the same actors were involved in each one so the developments influenced and intertwined with each other, creating an important synergistic effect. influencing state policy bob schneider was not new to political activism when he distributed flyers titled “the states take over welfare policy: project to prepare students & faculty” inviting policy faculty, deans, directors, and interested social workers to meet that saturday night in chicago in 1997. as a 10-year member (including serving as chair for 2 years) of the governor’s advisory board to the virginia department of aging, he had become concerned about the 1994 effort by governor george allen to consolidate this agency with another state agency in the name of efficiency. spearheaded by a spirited phone campaign, he was able to build a coalition that ultimately defeated the governor’s proposal (jansson, 2011). when welfare reform was passed in 1996, bob lamented that he was both troubled and disgusted with himself and the profession for not having much of a role in opposing clinton’s initiatives. “when i was on vacation and visiting the state capital of olympia, washington, it hit me. we needed a structure to increase our role in the states. we ‘blew it’ at the federal level and now we had a chance to shift to the states. why not promote policy practice at the schools of social work that are in state capitals?” (personal communication, december 30, 2013). when he got home, he realized that all social work programs have access to legislators, not just those in the state capitals, and so all programs should be involved. but involved in what? from his own teaching, bob knew that an experiential approach, getting students to actually talk with legislators about pending legislation, helped overcome the traditional reluctance and resistance that students bring to policy courses. prior to this time, most social policies discussed in the social policy classes were byers/reemergence of policy practice 39 federal in nature: social security, veterans’ benefits, medicare, etc. welfare reform changed the traditional federal-state partnership for many of the needs-based programs such as tanf, food stamps, and medicaid, tilting the policy making power more toward the states. that change not only required new strategies, but also provided new opportunities for advocacy efforts. bob wanted students to be able to make a difference in the states where they lived, worked, and went to school. he gained support from his dean and ran his emerging ideas by colleagues at the national offices of cswe and nasw. he took the fall to prepare for the spring meeting at cswe’s annual program meeting and sent information about the meeting to all the social work deans to distribute to their policy faculty. bob came to the meeting on march 8, 1997, brimming with ideas and handouts on different colored papers. there was excitement in the air. here were 27 faculty and professional leaders, most of whom shared his vision of an organization that could assist faculty with resources and incentives to get students involved in policy advocacy work. he had drafted a rationale, mission statement, goals, outcomes, objectives, potential products, bibliography, and ideas for student projects. i remember coming away from the meeting inspired and rejuvenated by the energy generated by both bob’s presentation and our brainstorming exchange as we generated even more ideas. and i had signed on to help, along with a number of others. we became friends and collaborators in that room that night because we shared this common passion for policy, a passion not always shared among our peers in social work education or our students. some of the people like david dempsey, john mcnutt, and paul stuart in the room that night were already known in social work policy circles for their writing, scholarly activity, and practice initiatives. others, like janet dickinson, david katz, jim kunz, mary katherine, and me, were younger faculty members, many of us just launching our careers in social work education. the rationale for isp that bob presented was one we could all embrace: if social workers do not exert policy leadership, they allow other people with less commitment to the well-being of vulnerable and oppressed people to shape the human services delivery systems. social workers need to enhance their credibility by making informed contributions to policy discourse in state capitals (“purpose,” 1997). and so the mandate for isp was set: to help faculty prepare social workers to assume these policy practice roles in advocacy work at the state level. we passed the hat (literally) in that first meeting to collect funds so bob could continue his work in building the organization. with bob’s guidance, indefatigable energy, and effective organizing strategies, influencing state policy grew from that “gang of 27” in chicago to over 300 paid members at the 10th anniversary celebration. starting fall1997, each semester bob distributed a newsletter, influence, with reports and articles of interest to faculty, including state-by-state counts of how many students visited their state capitals to influence policy. a website was created (www.statepolicy.org) that included resources for teaching policy. with some grant support, bob guided the development of six 30advances in social work, spring 2014, 15(1) 40 minute videos highlighting different aspects of state policy making, including legislative advocacy, state budget making, and coalition building. the videos, initially on separate vhs tapes and then later combined on a dvd, came to faculty with the modest isp membership fee. live auctions were held at several conferences to raise funds for various isp activities. in addition, during this time, bob authored or was featured in a number of articles describing the importance of state policy work and the role of isp (schneider, 2002; schneider, 2003; schneider, 2004; schneider & netting, 1999; “students seek state clout,” 1997). bob developed three contests to provide an opportunity for faculty to engage students in an experiential process of influencing state policy. under faculty mentorship, he envisioned groups of students creating strategies to influence policy makers in their states on a particular policy. two-page entries to the contests described the strategies the students used. the advocacy effort did not need to result in success: what was pivotal to the reviewers was that students learned from engaging in the process. the empowerment and sense of self-efficacy expressed in the essays were powerful: “we are inspired to continue being active in the legislative process because we received positive responses at our outreach events, and we discovered that we have the ability to influence change, that our voices will be heard, and even busy individuals will take a few minutes of their time to promote change” (personal communication, 2009). annual contests at the bsw and msw levels awarded cash prizes to both the students and the faculty member involved. some schools used the funds to help support their own state lobby day events. a ph.d. contest for doctoral students (later named in honor of bob) granted awards to those researching a state policy related issue, thereby attempting to increase state policy research among young faculty. contest winners were honored at a national social work education meeting, such as the policy conference and cswe’s apm. on february 18, 2006, again in chicago, we celebrated the tenth anniversary of isp with a gala dinner. that year, there were over 800 people on the email list with 300 duespaying members. seven organizations were helping to sponsor the annual contests. five different videos about state policy making processes had been produced and distributed to members. reported student visits to state capitals were 6000 to 7000 annually. nine annual bsw and msw student contests had been held with awards going to outstanding projects advocating on issues such as mental health budget increases, child welfare issues, immigration, and others. five annual ph.d. awards had been granted to doctoral students (r. schneider, personal communication, 2006). since bob’s retirement and my assuming the chair role, isp has undergone some retrenchment. funding has been tighter for programs and sponsors resulting in the reduction in the amounts of the cash prizes for the contests, but the quality of the student efforts in advocacy remains impressive. the email list has remained high, with over 1000, but the number of dues paying members has dropped. once faculty members receive the dvd, there seems to be less incentive to pay annual dues. at the most recent annual meeting in the fall of 2013, a slate of new officers, to replace the original board of advisors that bob created, was elected to broaden the leadership and incorporate new ideas and energy. most recently, resource lists for several state policy issues have been developed for distribution to faculty. we are exploring how we might maximize our byers/reemergence of policy practice 41 facebook page and other social media to engage more students and faculty. the webpage will be revamped soon and other media will be explored, including a wiki, to broaden participation and involvement of members. new energy and engagement of younger faculty will insure the future value of isp. development of the policy conference summer in charleston, south carolina may not sound like an opportune time and place for social work educators to gather for what became affectionately known as “the policy conference.” that first year, 1998, it was titled the faculty development institute on social welfare policy and services, and sponsored by the university of south carolina, nasw, and other groups. the policy conference was envisioned by organizers, including leon ginsberg in collaboration with dave dempsey from nasw’s national office and others, as a small gathering of both the policy scholars/sages of the profession as well as younger faculty teaching policy. the description from the 2002 program registration materials captures the intent well: this conference is designed to help prepare the social work profession to assume a greater role in influencing public social welfare policy by: 1) enhancing educators’ skills in policy analysis and instructional methodologies; 2) becoming familiar with current advocacy and social action efforts and developing advocacy skills; 3) cultivating linkages among the education and practice communities; 4) expanding social workers’ knowledge of the political system and how to work within it to further the objectives of the profession; and 5) enhancing skill and knowledge in the teaching and practice of social administration (the policy conference for social work education and practice, 2002). i remember well my excitement when i saw the call for papers and my determination to attend. can you imagine – a whole conference for people who were passionate about social welfare policy? i could not imagine a better way to spend a few days of my summer. my accepted presentation focused on ways to build more activist social workers through advocacy assignments in policy courses. a number of sessions highlighted welfare reform research. those of us who attended that first policy conference and subsequent ones, whether in charleston, atlanta, or in washington, d.c., found this conference, more than any other, to be formative in our development as policy faculty. what made the conference so special, particularly the ones held in charleston? first, the conference was on a smaller scale than other social work education conferences. in smaller venues, most of us had breakfast and “happy hour” together, both good “bonding” experiences. the mixture of leaders in social work policy and relative novices created opportunities for good interchange, discussion, and even debate within a very collegial environment. it was an ideal venue to present ideas, get feedback, and gain new insights. as one of the “novices,” i appreciated the opportunity to get to know some policy leaders, such as bruce jansson and diana dinitto, and form long lasting relationships. advances in social work, spring 2014, 15(1) 42 policy practice definitions and textbooks multiple authors have put forth definitions of policy practice and/or advocacy in social work practice. jansson (1984) was one of the first social work policy scholars to differentiate policy practice from social work practice. more recently, he defined policy practice as “efforts to change policies in legislative, agency, and community settings, whether by establishing new policies, improving existing ones, or defeating policy initiatives of other people” (jansson, 2005, p. 485). he places policy advocacy as part of policy practice. in their advocacy book, schneider and lester (2001) define advocacy, with roots in policy practice, as “the exclusive and mutual representation of a client(s) or a cause in a form, attempting to systematically influence decision making in an unjust or unresponsive system(s)” (p. 65). cummins, byers, and pedrick (2011) define policy practice as “using social work skills to propose and change policy in order to achieve the goal of social and economic justice” (p. 2). for them, policy practice includes policy analysis, engagement with policy makers, and advocacy. they use the whole range of generalist social work practice skills to make policy more responsive to the demands of social justice. all of these definitions of policy practice embrace the core value of social work: working in the larger political context toward a more just society. although political activism of this type has been a hallmark of the social work profession since its inception, historical accounts of such activities are rarely referenced under the more recent term policy practice, as noted above. when i first started teaching in 1974, i was employed full-time as a social worker in a community agency working with families whose children who had developmental disabilities. i started teaching the history of social welfare policy course in a bsw program as a part-time faculty member. the texts we used back then included romanyshyn (1971) and gilbert and specht (1974). both paid little attention to issues of advocacy or social reform and focused primarily on federal policies. if advocacy was mentioned, it was usually in the context of case-based advocacy that the caseworker would use to secure services for a client. in 1996 as the welfare reform act was being passed, i taught the second policy class, “social service delivery systems,” in our bsw curriculum as a full-time faculty member. most of the course objectives reflected knowledge acquisition and analysis skills. the last one stated: “an ability to employ a broad array of beginning policy practice skills, to initiate and attempt to influence the development of social policy within agencies and the broader community” (personal, s352 syllabus, 1996). not precisely the policy practice we envision today but it seems to capture the essence of the transition from case-based advocacy to advocacy for policy change. we used gilbert, specht, and terrell (1992) and haynes and mickelson (1991) as required texts. in the syllabus, i included a range of advocacy-related topics such as, how to write a letter to a legislator and how to monitor the legislation process. reviewing that syllabus, i found that i devoted a full four weeks exclusively to the subject of policy practice, a new benchmark – at least for me. the curriculum in our bsw program later evolved so that presently the first policy course covers history, current policy, and policy analysis and the second course reviews byers/reemergence of policy practice 43 policy analysis but focuses primarily on all aspects of policy practice. we now assign a policy practice text written exclusively for policy practice courses. my sense, from talking with faculty associated with other social work programs, is that they too are experiencing similar developments within their respective policy sequences. policy textbooks have also undergone some dramatic transformations, changes that closely parallel and reflect the trends taking place within the policy curriculum as they respond to marketplace demand. traditionally, most policy texts used a policy analysis framework to analyze important federal social welfare policies designed to meet basic human needs, including gilbert and specht (1974), dinitto & dye (1983), karger and stoesz (1987), and chambers (1993), and did not delve into policy practice. some early pioneers started to hone in on policy practice skills such as pierce (1984), mcinnisdittrich (1994), richan (1996), and haynes and mickelson (1997). bruce jansson (1990) merits special recognition in this discussion as authoring probably the first widely adopted textbook with a primary focus on policy practice. in the preface, he notes that since first writing about policy practice in his 1984 text: i have become even more convinced that policy and funding realities of contemporary american society require social workers to become proactive participants in the shaping of policies – for ethical reasons (to try to redress inequalities and inequities), for professional reasons (to shape the policies that serve the needs of clients and oppressed populations), and for pragmatic reasons (to protect the prerogatives and interest of the social work profession) (jansson, 1990, p. iv). both as a textbook writer and a social work educator with some prestige, his conviction and commitment to helping students learn specific policy practice skills, no doubt, was taken seriously by others. policy practice started to be included in policy texts such as segal & brzuzy (1998), chapin (2007), and ritter (2013). other social work policy educators started to write texts that focused more completely on policy and advocacy skills such as schneider and lester (2001) and rocha (2007). now, with policy practice as a core competency, we see more textbooks with a primary focus on policy practice and advocacy skills, including cummins, byers, and pedrick (2011), hoefer (2013), and jansson (2011). many social work educators today are demanding ‘competency-based’ textbooks that will help equip students with the important practice skills needed to carry out effective policy practice. in addition, the social policy journal, edited by rick hoefer, appeared on the scene in 2002, raising the research profile for social policy in general and providing a publication opportunity for social policy researchers, including those conducting research in policy practice. i remember that rick was an early supporter of isp and attended many of the policy conferences. ethical basis for policy practice interestingly enough, it so happens that in the 2008 revised version of the nasw code of ethics, policy practice was clearly mandated as one of social work’s core principles: “social workers challenge social injustice” (nasw, 2008). it would be advances in social work, spring 2014, 15(1) 44 virtually impossible to uphold that principle of social justice without following the ethical standard of social and political action identified below. the two certainly go hand in hand. 6.04 social and political action (a) social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully. social workers should be aware of the impact of the political arena on practice and should advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice (nasw, 2008). social work, with its person and environment perspective, challenges us not only to help people and their families achieve the changes they want in their lives but also to work toward changing the environments within which they live to more readily achieve that goal of social and economic justice. as c. wright mills has so aptly noted, behind every private problem resides a broader public issue (mills, 1963, 1967). as social workers, we commit to working at both the micro and macro levels in practice. inclusion in epas though a policy advocacy role for social workers was acknowledged in the 2001 epas, the explicit mention of policy practice is brief: “analyze, formulate, and influence social policies” (cswe, 2001, p. 7). and within the discussion of the social welfare policy and services component of the foundation curriculum, the development of policy practice skills is imbedded only in a much broader discussion of policy. programs provide content about the history of social work, the history and current structures of social welfare services, and the role of policy in service delivery, social work practice, and attainment of individual and social well-being. course content provides students with knowledge and skills to understand major policies…; analyze organizational, local, state, national, and international issues…; analyze and apply the results of policy research…; understand and demonstrate policy practice skills in regard to economic, political, and organizational systems, and use them to influence, formulate, and advocate for policy consistent with social work values (italics added for emphasis); and identify… processes required to deliver social services (cswe, 2001, pp. 9-10). some of us feared that policy practice skill development could be easily overlooked or minimized when it seemed to play such a minor role in the standards. as the 2008 epas was under development, we started to advocate for greater prominence for policy practice within social work education. after chairing a roundtable discussion and brainstorming session at the 2006 policy conference on ways to evaluate the policy practice curriculum for cswe accreditation site visitors, i wrote a note to myself about a possible research project, “is policy practice dependent on individual faculty or institutionalized in different programs and how would you know?” many of us, who were both involved with isp and the policy conferences, saw scant attention to policy practice within the policy course syllabi that we saw. we were concerned that inclusion of policy byers/reemergence of policy practice 45 practice skills was too dependent on the individual faculty teaching the policy courses. we noted that some faculty teaching policy courses had little or no direct experience with advocacy efforts themselves. without that experience, how could we expect them to engage students in policy practice in a passionate, empowering manner? it was a topic of discussion at meetings, lunches, and other informal encounters that we had together. both isp and the policy conferences, in bringing policy faculty together for multiple interactive opportunities, provided the synergistic effect of giving policy faculty a greater voice as a critical mass. as policy advocates, we knew how to “speak up.” i remember small, intense meetings at several conferences during the debate and discussion in the years of the development of the 2008 epas. members of isp wrote letters to the cswe epas committee advocating for a specific and detailed statement on policy practice in the new epas. bob schneider remembers that about 150 comments/letters were submitted to the committee about all areas of the curriculum statement and, of that number, over 50 of them were from isp members. as policy practitioners ourselves, we know the importance of letter writing campaigns. i remember my absolute joy when i first read the strong statement that the 2008 epas made about policy practice by identifying it as one of the core competencies. from late 2007 into the spring of 2008, cswe posted online and circulated drafts of the new epas, with multiple (though some, at the time, suggested there were not enough) opportunities for cswe members to provide feedback, both at national social work education meetings and in written submitted comments. in multiple forums, there was lively discussion and debate on both the content of the epas and the process. despite the controversy, the ultimate shift to competencies in epas brought social work education into a position of leadership within the national movement in higher education toward competency-based education and assessment (williams, 2007). those ten core competencies included one focused on policy practice: “educational policy 2.1.8— engage in policy practice to advance social and economic well-being and to deliver effective social work services” (cswe, 2008, p. 6). next steps – moving the agenda forward with policy practice now institutionalized as a core competency, the question becomes how to move the policy practice agenda forward. many of us who were involved in the effort to achieve this goal over recent years have retired or are nearing retirement. though some of us may remain engaged in social work education issues, we will not have the same clout that comes with occupying leadership positions in social work organizations and programs. new leadership is emerging with new authors of textbooks, new faculty teaching policy practice, and new leaders in partner organizations such as nasw. in our recent phone conversation, bob schneider and i discussed some possible next steps so that policy practice remains central and essential to social work practice. 1. for isp, we need to maintain a focus on state level policy as devolution has continued since 1996. current hot legislative and administrative issues at the state level include medicaid expansion under the affordable care act, marriage advances in social work, spring 2014, 15(1) 46 equality, immigration, voting rights, mental health, and gun control. while many of these issues will undoubtedly change or evolve over time, the need for the skills required to influence the direction of such changes will remain constant. social work faculty can provide advocacy leadership in the states and help get students involved to develop policy practice skills. helping students and practitioners use social media, both to provide information and to do grassroots organizing, will help isp move beyond its web presence. while isp has a facebook page, it is in the early stages of development and needs more “friends” and further development. isp must find more institutional support for the contests as they provide powerful experiential learning opportunities for students as well as a tangible recognition for substantive advancements in the field of policy practice. developing new videos and other more current resources will be important for faculty who are always looking for ways to support their classroom teaching. 2. providing opportunities for policy practitioners and policy educators to come together continues to be important for our future development. at the time of this writing, sunny harris rome, jessica ritter, stacey borasky, and i are planning policy conference 2.0, in austin, tx from may 29-31, 2014, with the theme, energizing for activism: recommitting to policy change. the conference will both revive the policy conference, a pivotal experience in the development of many current policy practice educators, and help us set the agenda for the future in policy practice as we engage new policy faculty as well. the call for papers is out and we anticipate a strong response with the growing interest in policy practice. 3. a new generation of student activists with front-line experience in advocacy through the occupy movement and other social actions will come into social work programs. as they pursue their social work careers, we hope they will continue to maintain that activist orientation within the profession and within social work education, if that is the direction they follow. preparing them with a wide range of policy practice skills will be important as we and they move forward. 4. both social work practitioners and faculty need to identify those to whom we will pass the advocacy baton. who will organize the future lobby days, whatever form they take? who will testify at hearings and mount the letter writing campaigns on important social justice issues? who will do the door-to-door knocking (both virtual and situated in communities) to engage the grassroots in voting and other acts of civic participation? the role of current faculty is to inspire their students to engage in policy practice and develop the necessary skills for successful social change. we will always need social workers with advocacy skills since, to quote frederick douglass (1857), “power concedes nothing without a demand. it never did and it never will.” byers/reemergence of policy practice 47 conclusion reflecting on this evolutionary journey toward a renewed emphasis on policy practice and the roles that so many played in that process reinforces for me the power of both passion and hard work in policy practice itself. at the time of this writing, i am working with other advocates in indiana to defeat a proposal that would amend our state constitution to include a ban on marriage that is not between a man and a woman, or any other legal status that would grant rights and privileges “substantially similar” to those granted by marriage. passion and hard work will ultimately result in the defeat of this discriminatory amendment, even if it is passed and has to be challenged in the courts. passion and hard work will pay off in achieving social justice in the end; that i know from my own experience. through the passion and hard work of many social workers and social work educators, we now have a mandate to educate students in policy practice so that they can continue this fight for social justice long after you and i are gone. i have a sense that we are on the right path as we move forward. references abramovitz, m. (1998). social work and social reform: an arena of struggle. social work, 43, 512-526. byers, k., & pirog, m. (2003). local government responses to welfare reform. public budgeting and finance, 23, 86-107 chambers, d. (1993). social policy and social programs: a method for the practical public policy analyst. boston, ma: allyn & bacon. chapin, r. (2007). social policy for effective practice: a strengths approach. boston, ma: mcgraw hill. council on social work education (cswe). (2001. revised june 2003 and october 2004.). educational policy and accreditation standards. retrieved from http://www.cswe.org/file.aspx?id=14115 council on social work education (cswe). (2008, revised march 27, 2010 / updated august 2012). educational policy and accreditation standards. retrieved from http://www.cswe.org/file.aspx?id=41861 cummins, l., byers, k., & pedrick, l. 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(1984). theory and practice of social welfare policy: analysis, processes, and current issues. belmont, ca: wadsworth. jansson, b. s. (1990). social policy: from theory to policy practice. pacific grove, ca: brooks/cole. jansson, b. s. (2005). the reluctant welfare state: american social welfare policies – past, present, and future (5th ed.). belmont, ca: brooks/cole. jansson, b. s. (2011). becoming an effective policy advocate: from policy practice to social justice (6th ed.). belmont, ca: brooks/cole. karger, h., & hernández, m. (2004). the decline of the public intellectual in social work. journal of sociology and social welfare, 31, 51-68. karger, h., & stoesz, d. (1987). american social welfare policy: a pluralist approach. boston, ma: allyn & bacon. larrison, c., nackerud, l., lane-crea, l., & robinson-dooley, v. 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(2007). essentials of social work policy practice. hoboken, nj: john wiley & sons. romanyshyn, j. (1971). social welfare: charity to justice. with the assistance of annie l. romanyshyn. new york, ny: random house. schneider, r. (2002). influencing “state” policy: social work arena for the 21st century. the social policy journal, 1, 113-116. schneider, r. (2003). policy advocacy challenge 3.3: a social work professor organizes a national committee to advocate for welfare recipients. in b. jansson, becoming an effective policy advocate: from policy practice to social justice (4th ed., pp. 95-98). pacific grove, ca: brooks cole. schneider, r. (2004). educating for policy practice: isp mobilizes resources to put students and faculty in the action of change (2004). social work education reporter, winter, 25-27. schneider, r., & lester, l. (2001). social work advocacy: a new framework for action. belmont, ca: wadsworth/thomson learning. schneider, r., & netting, e. (1999). influencing social policy in a time of devolution: upholding social work’s great tradition. social work, 44, 349-357. segal, e., & brzuzy, s. (1998). social welfare policy, programs, and practice. itasca, il: peacock. specht, h., & courtney, m. (1994). unfaithful angels: how social work has abandoned its mission. new york, ny: the free press. stoesz, d. (1999). ideological nostalgia, intellectual narcosis. in g. r. lowe & p. n. reid (eds.), the professionalization of poverty: social work and the poor in the twentieth century (pp.141-160). new york, ny: aldine de gruyter. “students seek state clout.” (1997). nasw news, 42. advances in social work, spring 2014, 15(1) 50 swigonski, m. (1996). women, poverty, and welfare reform: a challenge to social workers. afflia, 11, 95-110. the policy conference for social work education and practice. (2002). columbia, sc: university of south carolina. williams, c. (2007). editor’s prerogative. bpd update online. retrieved october 22, 2007, from http://bpdupdateonline.org/fall2007/id13.html. wolk, j. (1981). are social workers politically active? social work, 26, 4, 283-288. author note address correspondence to: katherine v. byers, ph.d., indiana university school of social work, 1127 atwater, bloomington, in 47405. email: kvbyers@indiana.edu katharine v. byers, ph.d., associate professor, directs the bloomington bsw program, indiana university school of social work and chairs influencing state policy. with a ba from wellesley college and msw from the heller school at brandeis university, she had 10 years of practice experience, primarily with children with disabilities, before earning her ph.d. from indiana university. she teaches bsw policy and macro practice courses. she has researched the impact of welfare reform in indiana and student activism. in 2004, she received the nasw indiana distinguished chapter service award for creating the first legislative education and advocacy day (lead) in indiana. dr. robert (bob) l. schneider is professor emeritus at the school of social work at virginia commonwealth university. he earned his msw and phd degrees in social work from tulane university. bob was a delegate to the 1981 white house conference on aging, became a fellow in the gerontological society of america, and was co-founder and first president of the association for gerontology education in social work. he served for more than a decade on the governor’s advisory board to the virginia department for the aging. in 1997, bob founded influencing state policy (isp), a group that promotes inclusion of policy advocacy at the state level into the curricula of all programs of social work education nationally, and served as its chair for 11 years. microsoft word kang_2057_copyedit final _____________ hye-kyung kang, msw, ph.d., is an assistant professor in the smith college school of social work in northampton, ma. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 510-526 re-imagining citizenship, re-imagining social work: u.s. immigration policies and social work practice in the era of az sb1070 hye-kyung kang abstract: the literature on immigrant cultural citizenship (ong, 1996; rosaldo, 1997) has argued that traditional and normative definitions of citizenship ignore various forms of civic participation and belonging and fails to capture the experiences of immigrants in an increasingly globalized world (getrich, 2008), calling for more nuanced and multiple meanings of citizenship. as agents of civil society, social workers have much power in constructing and maintaining (or resisting) normative discourses of citizenship, and how we participate in this process has material consequences for those we serve. applying poststructural and postcolonial theories, this paper excavates discourses of exclusion and inequity that produce the idea of u.s. citizenship through a critical historical analysis of key u.s. immigration and naturalization-related policies and proposes immigrant cultural citizenship as a conceptual frame for re-imagining social work practice with immigrants. keywords: cultural citizenship, immigration policies, postcolonial theories, social work practice with immigrants. introduction: discourses of citizenship citizenship, as the western legal and social framework for promoting individual autonomy and political democracy (shafir, 1998), also plays a major part in distributing and restricting access to rights and resources in the u.s. for example, currently voting rights, visa restrictions, and access to work and public assistance are all tied to u.s. citizenship. however, while formal state definitions of citizenship rely on legal and policy discourses, the literature on social citizenship (e.g., del castillo, 2002; marshall, 1964, 1998; park, 2005) and cultural citizenship (e.g., ong, 1996; rosaldo, 1997) has argued that such definitions of citizenship ignore various forms of civic participation and belonging and fail to capture the experiences of immigrants and transnational people in an increasingly globalized world (getrich, 2008). ong (1996) contends that the control of a populace of a modern society is accomplished not by a single dominant force (such as the state power) but by a complex web of relations that regulate how one is constituted as a citizen-subject and that immigrant cultural citizenship is produced through “a dual process of self-making and being-made within webs of power linked to the nation-state and civil society” (p. 738). in contrast, rosaldo’s idea of latino cultural citizenship involves both individual and group/community level processes and is concerned with the role of human agency in establishing and claiming human, social, and cultural space by marginalized groups (flores & benmayor, 1997; rosaldo, 1997). this paper does not reconcile differences in these two models but considers the tenets of both, and immigrant cultural citizenship is understood here as encompassing “the process of negotiation and contestation through advances in social work, fall 2012, 13(3) 511 which the immigrant subject is produced within the constraints of the nation-state and civil society, and the practices through which immigrants create and claim their social, political, and cultural space in the society” (kang, 2010, p. 26). through a critical historical analysis of key u.s. immigration and naturalizationrelated policies, this paper examines five interacting clusters of binaries (white/nonwhite; desirable/undesirable; native-born/foreigners; safe/dangerous; deserving/ undeserving) that shaped u.s. immigration discourses to demonstrate how they ultimately construct u.s. citizenship as a discourse of exclusion and offers cultural citizenship as a more complex and inclusive conceptualization for understanding citizenship. poststructural and postcolonial theories poststructural and postcolonial theories provide the theoretical framework and inform the method of this paper. poststructural theories maintain that social realities and subject positions (such as "citizens" and "race") are produced through discourses (fairclough, 1992; foucault, 1972, 1975, 1982) but that discourses are partial, privileging one version of social reality over others and promoting a version of social subjects (e.g., "undesirable immigrants")—one that both defines and establishes what is supposedly "true" at particular moments (carabine, 2001). furthermore, discourses are mutable and dynamic— as are the subject positions produced by them—and contingent upon their social, political and historical contexts (fairclough, 1992; 1995). in extending this discursive construction of subjects (foucault, 1972, 1975, 1982), postcolonial theorists such as hall (1996) and bhabha (1994) propose that while subjects may not be able to escape the effects of the discourses that construct them (e.g., essentializing discourses), they still can resist and even alter them (ashcroft, griffiths, & tiffin, 2000). one effective way in which postcolonial theories open up such opportunities is by calling into question the binary system (e.g., legal/illegal) in dominant social discourses (ashcroft et al., 2000). they argue that the binary oppositions are not merely two opposing signs but entail “a violent hierarchy, in which one term of the opposition is always dominant,” and that “the binary opposition itself exists to confirm that dominance” (ashcroft et al., 2000, p. 24). one unavoidable problem of the binary system is that the social reality must fit neatly into dual oppositions; the ambiguity inherent in an interstitial state threatens it by exposing its contradictions (bhabha, 1994). by illuminating these contradictions (e.g., biracial in the white/non-white binary system of race), postcolonial theories expose how this system perpetuates relations of cultural, social, economic and political dominance and open up possibilities for hybridity (bhabha, 1994) and change. guided by poststructural and postcolonial theories, this paper uses a critical discourse analysis method (fairclough, 1992, 1995) to illustrate how subject positions, such as "immigrants" and "citizens," were produced and transformed through legal and policy discourses over time and illuminates binary oppositions that resulted in promoting citizenship as a system of exclusion. kang/re-imagining citizenship, re-imagining social work 512 discursive construction of citizenship in the u.s., citizenship is a legal status that may be achieved in three ways. the first path qualifies those who are born on the u.s. soil. the second path is open to those who are born to parents who are u.s. citizens (e.g., children who were born overseas to a u.s. citizen parent). the third path is through naturalization. currently, immigrants who have a legal resident status may apply to become naturalized citizens after 5 years (or 3 years for the spouses of u.s. citizens) of continuous residency. however, these paths to u.s. citizenship – and their attendant rights and access to resources – have been paved with racialization and inequities. in fact, a review1 of key u.s. immigration and naturalizationrelated policies2 illustrates how these constructed who was “american” and who would be worthy of becoming a citizen of this country, based on a set of interrelated binaries such as white/non-white; desirable/undesirable; native-born/foreigners; deserving/ undeserving; safe/dangerous. together and repeatedly, these discourses construct immigrants as the binary opposite "other" to the u.s. citizens "norm." making of a racialized (non)citizen: white/non-white; desirable/undesirable one example of “violent hierarchy” in colonial ideology (and its attendant contradictions) is the idea of race, which is based on the white/non-white binary opposition in the united states (lowe, 1996; mills, 1997). historically, the construction of race as a white/non-white binary has never presented these two terms as equals nor resulted in equitable treatment (hing, 2004; lopez, 1996; ngai, 2005). this construction of race consolidates great variances within ethnicities (both white and non-white) and cultural traditions while prohibiting racial mixing between whites and non-whites (e.g., anti-miscegenation laws). as detailed in a later section, the race prerequisite cases demonstrate that any experience or state that did not fit the white/non-white binary opposition was rendered suspicious and was repressed and silenced through legal and policy discourses. because the white/non-white binary is not only significant in its role in shaping the nation’s racial landscape but also is implicated in— and complicates—all other binaries, this binary will be analyzed in more detail than others to illustrate the mechanism of discursive construction of citizenship through policies. before the 1790 naturalization act, the u.s. naturalization process was largely based on the asylum principle, which is famously echoed in emma lazarus’s 1883 poem, the new colossus: “[…] give me your tired, your poor./ your huddled masses yearning to breathe free […].” while magnanimous, this principle was not applied to everyone, nor did it bring those who were already in this land (native americans) through the “golden door” of u.s. citizenship. in fact, european migration to america resulted in near decimation of the indigenous population (stannard, 1992; takaki, 1993). until 1790, it was assumed that immigrants to the u.s. would be granted u.s. citizenship, as there were no specific federal regulations regarding it. it is notable that before that, most immigrants had come from western europe; however, after that the naturalization act restricted u.s. citizenship to “free white persons.” this act, the nation’s first policy regarding naturalization, was also the first national act to limit naturalization rights based on the idea of race (white) and status (free). the designation “white” is especially important because the incipient idea of race, and specifically who was considered “white,” was advances in social work, fall 2012, 13(3) 513 beginning to be constructed through both scientific and social discourses of that era (lopez, 1996; mills, 1997; omi & winant, 2007). by privileging one category (“white”) over others, and granting them the right to naturalize, this naturalization policy became part of a discourse that constructed binary and unequal meanings of race in the u.s. furthermore, this act began codifying the link between the idea of race and the idea of citizenship. racializing naturalization in this section, immigration and naturalization-related policies targeting asian immigrants are used to illustrate the racialized discourse of citizenship based on the white/non-white binary. (the history of latino immigrants also represents the similar point. however, for the sake of brevity, this paper uses the history of asian immigrants as an illustrative focus.) asian immigrants represent both the undesirable "other" and the exposed ambivalence in the white/non-white binary discourse of race. after the discovery of gold in california in 1849, chinese laborers were actively recruited and brought to the u.s. in large numbers to work in the gold mines and on the transcontinental railroad construction. once considered an essential labor force, chinese workers laid an estimated 90% of the railroad tracks (takaki, 1993). however, chinese laborers quickly became a target of malicious exclusionary laws once white laborers started moving to the west and saw them as economic competitors (takaki, 1993). national, state, and local laws during the gold rush era established asian immigrants as undesirable foreigners, as the economic and labor needs of the nation shifted (chin, 2001; hing, 2004; takaki, 1993). also, chinese immigration presented a threat to the white/non-white binary system as their racial position was somewhat ambiguous in the still-incipient system of the u.s. racial taxonomy. this threat would be silenced through a series of court cases. one of the landmark cases that determined chinese immigrants’ place within the white/non-white binary construction of race was the people v. hall case. in 1854, the california supreme court ruled that chinese could not give testimony against white people in court. the ruling was an extension of california criminal procedure's existing (1850) exclusion, "no black or mulatto person, or indian, shall be allowed to give evidence in favor of, or against a white man" (lopez, 1996, p. 51). the california supreme court declared: we are of the opinion that the words "white," "negro," "mulatto," "indian," and "black person," wherever they occur in our constitution and laws, must be taken in their generic sense, and that, even admitting the indian of this continent is not of the mongolian type, that the words "black person," in the 14th section must be taken as contradistinguished from white, and necessarily excludes all races other than the caucasian. (california supreme court, 1854, italics added) this case not only contributes to constructing chinese (or the “mongolian type”) as non-white but also defines the existing categories through an exclusionary binary logic. furthermore, it is the idea of the “impassable difference” [of] “a distinct people, […] a race of people whom nature has marked as inferior” (california supreme court, 1854) on kang/re-imagining citizenship, re-imagining social work 514 which the court based its opinion to declare them undesirable to participate in society as citizens. during the civil war, the emancipation proclamation (1863) effected changes that resulted in the naturalization act of july 14, 1870, extending the right to naturalize to "aliens" of african nativity and to persons of african descent. this act, however, did not dismantle the race-based exclusions of the 1790 act or change the discourse of citizenship as based on the white/non-white binary. instead, it upheld such exclusion by simply adding african americans to the list of those who were eligible for naturalization. asians and other people of color were still excluded from such rights. in fact, the proceedings from the circuit court case in 1878 regarding ah yup, a chinese immigrant, reveals that the makers of this act expressly sought to block from citizenship the chinese (and by extension, all asians, as the chinese were being denied the naturalization rights on the grounds that they belonged to the “asiatic” or “mongolian” race, which, the court argued, was distinct from the “caucasian” race): at that time of the amendment, in 1870, extending the naturalization laws to the african race, mr. sumner made repeated and strenuous efforts to strike the word “white” from the naturalization laws, or to accomplish the same object by other language. it was opposed on the sole ground that the effect would be to authorize the admission of chinese to citizenship. every senator, who spoke upon the subject, assumed that they were then excluded by the term “white person,” and that the amendment would admit them, and the amendment was advocated on the one hand, and opposed on the other, upon that single idea. (sawyer, 1878, in lopez, 1996, p. 211) in this case, the circuit court ruled that chinese were not white, and thus were ineligible for citizenship, using two major discourses: congressional intent (explained above) and scientific. the scientific discourse was used to argue that the chinese were considered to be of the “mongolian race,” and therefore could not be considered “white,” according to the contemporary anthropological classifications (lopez, 1996). this argument used these anthropological classification systems not necessarily to determine who was white but to disprove that chinese, specifically, were white. the case of ah yup was the first of many racial prerequisite cases to continue this intertextual trend, thereby determining the meaning of race by disproving who may or may not be considered “white” and eligible or ineligible for naturalization. lopez (1996) lists 52 such racial prerequisite cases from 1878 to 1944, revealing the complex and intimate connection between the construction of race and the construction of citizenship in the u.s. two of the most influential of those cases, ozawa v. united states and united state v. thind, will be discussed later in this section. since asians were considered to be non-white through the legal cases and in the eyes of the civil society, their immigration posed a potential threat to maintaining the racial composition of the country. although african americans were given the rights to naturalize, there was no sizable migration from africa during the post-civil war era. thus, asian immigration was one of the most important potential sources of non-white migration. the immigration laws following the ah yup case illustrate how asians were advances in social work, fall 2012, 13(3) 515 targeted as undesirable immigrants, in opposition to and reinforcing the construction of white europeans as desirable immigrants. for example:  the chinese exclusion act (1882): the first immigration act to ban immigration and naturalization of a population based solely on nationality. suspended immigration by all chinese laborers for ten years and specifically barred the chinese from naturalization.  the u.s. circuit court in massachusetts (1894): declared that the japanese were also ineligible for naturalization.  the act of march 3, 1887: restricted real estate ownership to american citizens and barred asians from owning land.  the scott act (1888): prohibited the re-entry of chinese laborers who left the u.s. to visit families and homeland, effectively stranding them, and reducing the number of chinese in the u.s.  the act of april 29, 1902: extended chinese exclusion act indefinitely.3  the act of february 5, 1917: prohibited immigration from the “barred zone,” which designated most of eastern asia and pacific islands. the first national act to exclude whole populations based on their geographic locations and, presumably, race. the 1920s brought highly specific race-based (white/non-white) and ethnicity-based (desirable/undesirable) restrictions on immigration, which solidified the linkage between race, ethnicity and citizenship. in 1921, the quota law was enacted, limiting admissions from each european country to 3% of each foreign-born nationality in the 1910 census and upholding asia as a “barred zone.” since the u.s. population in 1910 was predominantly western and northern european, the quota for southern and eastern europeans was only about 45,000 out of 350,000 total immigrants per year (hing, 2004), and there would be no growth through immigration in the number of asians and pacific islanders. three years later, the johnson-reed act (the immigration act of may 26, 1924) extended this law and established the official national origins quota system, which based the immigration numbers on the ethnic makeup of the u.s. population as a whole in 1920, determining the future ethnic pattern of the nation.4 the quota system was lauded as a major accomplishment that halted “the tendency toward a change in the fundamental composition of the american stock" (hing, 2004, p. 69). judging from the 1920 census, what was meant by “the fundamental composition” seems plain: predominantly western european (hing, 2004). the quota law and the johnson-reed act, as they assigned the number of allowable immigrants based on their nationality, betrays the stability of the white/non-white; desirable/undesirable paring of the binaries. they assigned different degrees of desirability to different nationalities, implying that not all europeans were equally desirable even if they were considered white. in fact, scholars such as brodkin (1998) and ignatiev (1995) argued that only through the exclusion of people of color did more marginalized (i.e., the “less desirable,” such as irish, jewish, italian) europeans come to be constructed as “white.” thus, this kang/re-imagining citizenship, re-imagining social work 516 law reveals not only the specific coupling of ethnicity and race with the citizenship but also the hierarchy (desirable/undesirable) therein. two of the most influential racial prerequisite cases in this era are ozawa v. united states and united state v. thind. in 1922, the u.s. supreme court ruled that mr. takao ozawa, a japanese immigrant, could not be naturalized because he was not white. in this case, the court rejected mr. ozawa’s argument of “white” skin pigmentation and of his cultural assimilation and allegiance to the u.s. instead, the court determined that persons of japanese ancestry, regardless of their skin tone or their cultural practices, were not white because “only persons of what is popularly known as the caucasians race" (lopez, 1996, p. 79) were white. therefore, in this case, the word "white’" was equated with the modern anthropological category "caucasian." just three months later, in 1923, the supreme court rejected this equation in u.s. v. bhagat singh thind. in this case, mr. thind, an immigrant from india, argued that he was white because anthropologists classified asian indians not as "mongolians" but as "caucasians" (lopez, 1996). however, the supreme court determined that mr. thind could not be considered white (and therefore could not be naturalized), even though the anthropological classification system—the very basis on which mr. ozawa’s case was rejected—would place him within the category, "caucasian." the u.s. supreme court ruled that: what we now hold is that the words ‘free white persons’ are words of common speech, to be interpreted in accordance with the understanding of the common man, synonymous with the word ‘caucasian’ only as that word is popularly understood,” [and that the words of the statute were] written in the words of common speech, for common understanding, by unscientific men. (lopez, 1996, p. 90) thus, the court abandoned the “scientific” argument for a “popular understanding” and “common speech” argument in this case. however, whether the court used the scientific argument, the “popular understanding” argument, or the congressional intent argument (as in the ah yup case), what remains consistent throughout these cases is suppression of the ambivalence within the white/non-white hierarchical binary system of race. also apparent is the insistent use of a binary discourse of white/non-white: desirable/undesirable as the rubric for exclusion. raceand ethnicity-based immigration restrictions started to ease after u.s. involvement in world war ii. needing to strengthen the u.s.-china relationship during the war, the act of december 17, 1943 (the magnuson act) repealed the chinese exclusion act, allowing chinese to be eligible for naturalization. however, due to the quota law, the number of allowable immigrants from china was still miniscule. in addition, the luce-cellar act of 1946 extended the right to become naturalized citizens to filipinos and asian indians, but with a quota of just 100 persons per year. finally, the immigration and naturalization act of june 27, 1952 (the mccarran-walter act) made all races eligible for naturalization; however, it affirmed the national-quota system of 1924, limiting total annual immigration to 1/6 of 1% of the population of the continental u.s. in the 1920s. in the end, these post-war provisions did little to change the racial and advances in social work, fall 2012, 13(3) 517 ethnic landscape of the u.s. citizenship or the discourse of exclusion, but rather were used as a token to assuage the u.s. relationship with its wartime allies. it was not until the enactment of the immigration and nationality act of 1965, reflecting the changing national discourse about race, rights, and democracy (e.g., the vietnam war controversy, the civil rights movement, and the ensuing civil rights legislations), that the national origins quotas were finally eliminated. this act gave immigration priority to family reunification instead of the numerical restrictions based on national origins. it had a profound impact on immigration since it finally allowed immigration from the countries that had been barred or underrepresented under the johnson-reed act. in fact, data from the u.s. immigration and naturalization services indicate that the majority of immigrants who entered the u.s. since the 1965 act have been people of color (united states department of homeland security, 2009), thus effecting changes in the overall population patterns of the nation. these shifts illustrate how changing discourses of race, equity, and politics (domestic and international) interact with changing discourses of citizenship. citizenship as restriction: native-born/foreign; safe/unsafe; deserving/ undeserving while u.s. citizenship is celebrated as granting various rights (u.s. citizen and immigration services), it has also been used to restrict those rights. this section illustrates how binary constructions such as native-born/foreign; deserving/undeserving; safe/dangerous in immigration and naturalization laws excluded immigrants from their rights as citizens of a society. when these binaries intersect with the white/non-white binary these laws produce a highly inequitable version of citizenship. restricting immigrants’ access: native-born/foreign; deserving/undeserving the laws in this section illustrate how immigration policies constructed unequal citizenship through deserving/undeserving discourses. often coupled with the nativeborn/foreign binary, these laws barred undesirable immigrants from entering the country, restricted their access to resources and resulted in a severely bifurcated system of citizenship. the immigration act of august 3, 1882, which established a system of central control of immigration through state boards under the secretary of treasury (thus implying immigration as an economic issue), also broadened the definition of “inadmissible aliens” by barring “persons likely to become a public charge.” this law not only constructs immigrants as a potential drain to public resources (such as government or private-funded charities) but also establishes the line between the deserving (nativeborn) and the undeserving (foreign). the 1891 immigration act, the first comprehensive law for national control of immigration, added to the list of undesirables ineligible for immigration: “persons suffering from a loathsome or a dangerous contagious disease,” and those convicted of “a misdemeanor involving moral turpitude.” targeting newer immigrants from southern and eastern europe, who had started migrating in larger numbers, as well as immigrants from kang/re-imagining citizenship, re-imagining social work 518 asia (takaki, 1993), this law contributed to a long and enduring construction of ethnicized and racialized immigrants as morally inferior and as public health problems (park & kemp, 2006). furthermore, this policy again stabilized the unequal discourse of citizenship based on the coupling of the native-born/foreign and deserving/undeserving binaries where immigrants faced exclusion from benefits even if they had the same conditions as did their citizen counterparts. this discourse reverberates in contemporary policies as well. in 1994, california passed proposition 187, which stipulated that public agencies should deny services to undocumented immigrants (“illegal immigrants”) and report them to the immigration and naturalization services (ins). it also cut government benefits to noncitizens (regardless of their legal status). in 1996, the personal responsibility and work opportunity reconciliation act (prwora) established severe restrictions on the eligibility of legal immigrants for means-tested public assistance. under this law, legal immigrants were barred from receiving public assistance that their taxes helped pay for. given the fact that the majority of immigrants in the recent years have been people of color, this law also meant that the public benefits were barred from these immigrants of color where similar benefits were allowed for the immigrants of earlier eras, who were predominantly from europe. thus, this law illustrates the ways in which white/non-white, native-born/foreign, and deserving/undeserving binaries interact to produce harsh inequality. together, these acts construct immigrants (especially immigrants of color) as undeserving subjects. restricting immigrants’ rights: native-born/foreign; safe/dangerous the laws in this section illustrate the ways in which the native-born/foreign binary interacts with the safe/dangerous binary to curb immigrants’ rights in the name of national security. the alien and sedition act of 1798 provides the first example of coupling immigration with national security, constructing immigrants as a potential threat to the safety of the nation. this law authorized the president to deport any foreigner deemed to be dangerous and made it a crime to speak, write, or publish anything “of a false, scandalous and malicious nature” about the president or congress. as a result, it reduced immigrants’ rights to free speech (which had been created by the bill of rights just nine years before), while their citizen counterparts were able to fully enjoy such rights, creating a bifurcated (native-born/foreign) construction of citizenship. the immigration act of march 3, 1903, reiterated this construction. following the assassination of president mckinley, it became the first measure to exclude aliens on the grounds of proscribed opinions (e.g., “anarchists”). the alien registration act of june 28, 1940, further solidified the construction of immigrants as a potential danger to the national security as it required the registration of all aliens and fingerprinting of those over age 14 for the first time. the national security argument to take away the rights of immigrants reached its peak in 1942 when executive order no. 9066 was enacted, forcing an internment of 120,000 japanese immigrants and japanese americans (takaki, 1993). the fact that the internment targeted americans of japanese ancestry but not italian or german immigrants reveals the underlying discrimination based on race (white/non-white). this advances in social work, fall 2012, 13(3) 519 policy illustrates how the national security discourse interacted with the race discourse to construct japanese americans (regardless of their place of birth or legal citizenship status) as perpetually foreign and therefore dangerous. the immigration reform and control act of 1986, which was passed in order to control and deter illegal immigration to the u.s., echoed this construction. while this law was to increase enforcement at u.s. borders, most of the increase was geared toward the mexican (signifying non-white) border, rather than the canadian (signifying white) border (ngai, 2005). by singling out the mexican border as a risk to national security, this law again solidifies the non-white-foreign-dangerous link. the national security discourse became intensified in the 2000s. after the 9/11 attacks, the homeland security act (2002) made the ins part of the homeland security department, formally subsuming immigration under national security. thus, this law positions immigrants as potential national security problems (instead of as a source of labor or possible solution for the declining national population, for example). detaining and/or expelling foreign-born individuals became easier under the patriot act (2001), and many suffered unjust deportation and/or detention. while it was not written in a racespecific language, this act nevertheless became infamous for its racial-profiling consequences, as many immigrants of color were harassed and detained because they were presumed to be middle eastern (aclu, 2004). these laws illustrate the ways in which binary discourses such as white/non-white, native-born/foreign, and safe/dangerous converge to construct immigrants as a risk to national security and also to restrict civil rights. current implications: the mutable and enduring legacy of the inclusion/ exclusion binary in the 2000s, immigration increased, particularly from asia and south of the u.s. border, triggering waves of nativism and derailing federal efforts to enact immigration reform. between 2005 and 2007, fifty-five localities passed anti-housing, antiemployment, or english-only initiatives (j. garcia, personal communication, 07/01/2008), particularly aimed at latino immigrants. this wave of contemporary local anti-immigrant initiatives culminated in arizona’s senate bill (sb) 1070, which was signed into law (the support our law enforcement and safe neighborhoods act) by arizona governor jan brewer, on april 23, 2010. this law, commonly referred to as az sb 1070, has many broad and controversial implications too numerous to fully summarize here (aclu, 2010) and is currently being debated publically and contested legally in various courts. two of the most divisive issues revolve around the following sections: sec. 2. b. for any lawful contact made by a law enforcement official or agency of this state or a county, city, town or other political subdivision of this state where reasonable suspicion exists that the person is an alien who is unlawfully present in the united states, a reasonable attempt shall be made, when practicable, to determine the immigration status of the person. kang/re-imagining citizenship, re-imagining social work 520 sec. 3. a. in addition to any violation of federal law, a person is guilty of trespassing if the person is both: 1. present on any public or private land in this state. 2. in violation of 8 united states code section 1304(e) or 1306(a).5 section 2b not only gives local law enforcement officers and agencies the authority to enforce federal immigration laws but also uses such broad language as “reasonable suspicion,” raising concerns about potential racial/ethnic profiling. section 3a essentially makes it a misdemeanor for immigrants to be in the state of arizona without carrying their alien registration documents at all times, sparking a critique that it will result in civil rights violations and harassment of immigrants as well as citizens. fueled by anxiety over demographic changes, economic uncertainties and reports of increased drug trafficking and violence in mexico (archibold & steinhaur, 2010), this law not only reprises the white/non-white, desirable/undesirable, native-born/foreign, deserving/undeserving, and safe/dangerous binaries that constructed many exclusionary policies of the past but also highlights the ambivalence within these narratives. for example, the hispanic population in arizona reached 30% in 2010 (up from 25% in 2000), and proponents of this law raised concerns about threats to the maintenance of an idealized anglo-american culture (huntington, 2004), echoing earlier sentiments behind the nationalization act of 1790, the ah yup case in 1878, the johnson-reed act of 1924, and many other acts based on white/non-white and desirable/undesirable binaries. while this law does not explicitly mention race, an arizona police officer, martin escobar, argued in his lawsuit against the state that there were no race-neutral criteria to suspect someone was an “illegal immigrant” and that the only way to enforce this law was to interrogate people who visibly looked hispanic (i.e., non-white) (smith, 2010). proponents also argued that undocumented immigrants weakened the economy and took away scarce resources, echoing deserving/undeserving narratives, such as the immigration act of august 3, 1882, and more recently the california proposition 187 in 1994 and the personal responsibility and the work opportunity reconciliation act of 1996. finally, fear of an increase in crime and violence was often cited as the main reason for this policy, reflecting the native-born/foreign and safe/dangerous binaries of the alien and sedition act of 1798, and more recently the immigration reform and control act of 1986, the homeland security act of 2002 and the patriot act of 2001. however, there has been no evidence that the crime rate has risen with an increased presence of immigrants (archibold & steinhaur, 2010); in fact, sampson’s (2008) study indicates that immigration seems to reduce violent crime rates. by repackaging these binaries (white/non-white; desirable/undesirable; native-born/foreign; deserving/ undeserving; safe/dangerous) into a legal/illegal binary framework, az sb 1070 consolidates contradictions within them. this review of the major immigration and naturalization policies from 1790s to early 2000s illustrates how these policies constructed who was “american” and who was worthy of becoming a citizen. it also reveals that the binary frameworks are ultimately about exclusion/inclusion, which demands suppression of contradictions, tension and ambivalence within the very idea of citizenship. they obscure underlying racism, political exigencies, and competing economic interests that are deeply implicated in immigration and naturalization policy discourses. advances in social work, fall 2012, 13(3) 521 discussion: implications for social work practice social workers contribute, wittingly and unwittingly, to the production, maintenance, and change of the discourse of citizenship through their work in all levels (micro, mezzo, macro) of practice. as such, they should use their power as agents of civil society mindfully and critically. immigrant cultural citizenship as a conceptual frame may help social workers to critically evaluate the normative narratives of citizenship and help immigrants resist such discourses and claim their social and cultural space. as illustrated in the previous section, u.s. immigration and naturalization policy discourses have constructed and maintained a binary version of citizenship that produced egregious and persistent inequities. the binary construction of realities is of a particular relevance for social workers. on the one hand, social workers are operating in a world of binary realities made up of agency policies, state eligibility guidelines, and diagnostic criteria with which they assess their clients. on the other hand, social workers function within the most complex and irreducible contexts that constitute people’s lives. these coexisting realities demand that social workers become critical in their appraisal of normative realities and their consequences. when social workers unquestioningly embrace a binary construction of reality, they risk perpetuating the “violent hierarchy” of the binary system that may result in colonizing and dominating people’s experiences. as many postcolonial writers stress, while the military and the imperial governments conquered nations and enforced oppressive imperialist rules, the “benevolent missionaries, teachers, administrators, and social workers – educated persons united in their desire to help in various ways those defined as in need of assistance, guidance, and protection" (rober & seltzer, 2010, p. 124) colonized peoples’ minds and subjugated their lifeworlds (summerfield, 2004) by upholding hegemonic discourses around health, rights and citizenship that resulted in pathologizing differences and normalizing social injustice. similarly, simply by accepting dominant policies and procedures, social workers can easily become agents of social surveillance and discipline. certainly, more severe examples such as the involvement of u.s. social workers in the cultural displacement of the native children through the indian adoption project of the 1950s (hair & o’donohue, 2009) demonstrate the iatrogenic effects of accepting the truncated realities prescribed by government policies. thus, unless social workers actively engage in a critical analysis of such inequitable discourses as citizenship and immigration, they continue to act as a disciplining force to uphold inequitable normative narratives and to reinforce injustice on immigrant subjects. in interrogating such narratives, social workers may uncover binary positioning of subjects that subjugate the experiences and lives of immigrants and restrict their access to equitable resources. for example, contesting the dominant discourse of the legal/illegal binary construction and changing the language from "illegal aliens" to "undocumented immigrants" radically shifts the positionality, discourses, and options for immigrants. the historical analysis in the previous section also demonstrates that the idea of citizenship is far from monolithic or stable, and that immigration and naturalization policies reflect many changes experienced by the nation, both internally and internationally. these changes tell us that the idea of citizenship can be contested, kang/re-imagining citizenship, re-imagining social work 522 negotiated, and is, ultimately, changeable. in fact, immigrant individuals, groups, and communities are actively engaged in practices that contest, resist, and negotiate the very discourses that construct them as the "other" and place them in inequitable positions. for example, the racial prerequisite cases discussed in the previous section represent the ways in which immigrants of various ethnic backgrounds attempted to contest the unequal access to naturalization rights by calling into question the binary construction of race (white/non-white) on which such rights were based. the cases such as korematsu v. united states [1944] and yick wo v. hopkins [1886] demonstrate immigrants’ demands for equal protection and legal rights, as national and local laws violated their civil and economic rights (nakanish & lai, 2003). immigrant labor movements such as the farmworkers movement in california in the 1960s (delloro, 2009), the filipino cannery workers movement in alaska in the 1970s (chin, 2001), the garment industry workers’ labor organizing in los angeles in the 1990s (lowe, 1996), and domestic workers’ organizing in new york in the 2000s (sen, 2010) further exemplify the ways in which immigrant groups organized themselves to contest the unequal narratives of labor rights and to negotiate space for themselves in the nation’s economic landscape. most recently, the dream act inspired a powerful movement by undocumented young people where they deconstructed the very discourse (immigration and naturalization laws) that had produced them as noncitizens by engaging in civil disobedience, political advocacy, organizing, and other rights of citizenship (hing, 2010). learning from these examples, social workers who work with immigrants must actively generate interventions that embrace multiple narratives, resistance, and negotiations. by contemplating the process of discursive production, maintenance, and change, they may reach beyond the usual adjustment (i.e., adjustment of the immigrant "person" to the "environment" of the host society and its civic and governmental disciplinary forces) narrative of intervention and actively assist in and foster opportunities for all immigrants to claim their social, political, and cultural places in the society. conceptualizing the process of immigrant cultural citizenship not only as an individual process but also as a collective process enables social workers to consider interventions that go beyond the usual individual acculturation-centered paradigm and offer opportunities for collective interventions that change the discourses.6 in today’s turbulent and divisive immigration debates, social workers have an opportunity to make an important impact. the recent passage of az sb 1070 produces immigrant subjects as less than human by prohibiting humane treatment for undocumented immigrants. thus, this policy attempts to force social workers to either submit to the disciplinary powers of the law (and deny services to those in need) or to stand with the disadvantaged, risking discipline under the law. however, such moral dilemmas ensue only if social workers accept these normative discourses as a stable authority. the concept of immigrant cultural citizenship reminds social workers that they can resist and contest such constructions that attempt to colonize not only the lives of immigrants but also their practice as social workers.7 only when they begin to question the very discourses that produce them will they start the process of decolonizing and creating change. advances in social work, fall 2012, 13(3) 523 ______________________________________________________________ 1 since they are influenced by slightly different political reasons, refugee-related policies are not included in this review. 2 unless otherwise noted, all immigration and naturalization policies discussed here are based on lemay & barkin (1999). 3 however, an exception was made so that chinese laborers would be able to enter hawaii, which was forcibly annexed by the u.s. in 1898 and needed workers to work on its plantations that were owned by americans. this exception exemplifies the ambivalence of the legal discourse as the nation deals with different political and economic exigencies. although hawaii was a territory of the u.s., it was not part of the mainland and did not have the full status and rights of a u.s. state. in addition, since there were few white laborers competing for jobs in hawaii, the chinese presence in this newly acquired territory did not pose a problem in terms of balancing the political and economic exigencies of the nation. 4 the quota system, however, did not apply to asian immigration since this law denied entry to virtually all asians, which meant that the asian population could fall even below the rate of what it was in 1920. the same law also prevented chinese women from rejoining their husbands in the u.s., thereby further curbing chinese population growth. 5 this clause refers to the federal laws that require certain immigrants to register with the u.s. government and to have the documents in possession at all time. 6 for example, the kang (2011) case study examines how applying postcolonial conceptual frames such as immigrant cultural citizenship helped immigrant clients to produce their own counter-narratives, which contested inequitable immigration and welfare policies and created alternative meanings of citizenship. 7 in fact, the national association of social workers (nasw) demonstrated this resistance when it released a public statement to express its strong opposition to az sb1070 (nasw, 2010). references american civil liberties union. 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(2005). consuming citizenship: children of asian immigrant entrepreneurs. palo alto, ca: stanford university press. park, y., & kemp, s. p. (2006). “little alien colonies”: representations of immigrants and their neighborhoods in social work discourse, 1875-1924. social service review, 80(4), 705-734. kang/re-imagining citizenship, re-imagining social work 526 rober, p., & seltzer, m. (2010). avoiding colonizer positions in the therapy room: some ideas about the challenges of dealing with the dialectic of misery and resources in families. family process, 49(1), 123-137. rosaldo, r. (1997). cultural citizenship, inequality, and multiculturalism. in w. v. flores & r. benmayor (eds.), latino cultural citizenship (pp. 27-38). boston, ma: beacon press. sampson, r. j. (2008, winter). rethinking crime and immigration. contexts. retrieved from http://contexts.org/articles/winter-2008/sampson/ sen, r. (2010, sept. 2). domestic workers lead the way to 21st century labor rights. retrieved from http://colorlines.com/archives/2010/09/domestic_workers_lead_the_way_toward_21s t_century_labor_rights.html shafir, g. (ed.). (1998). the citizenship debates. minneapolis, mn: university of minnesota press. smith, d. (2010, april 29). tucson cop files federal suit against az immigration law. tucsonsentinel.com. retrieved from http://www.tucsonsentinel.com/local/report/042910_ecobar_1070/tucson-cop-filesfederal-suit-against-az-immigration-law/ stannard, d. (1992). american holocaust: the conquest of the new world. new york: oxford university press, inc. state of arizona. (2010). arizona session laws, chapter 113, forty-ninth legislature, second regular session: senate bill 1070. retrieved from http://www.azleg.gov/formatdocument.asp?indoc=/legtext/49leg/2r/laws/0113.htm summerfield, d. (2004). cross-cultural perspectives on the medicalization of human suffering. in g. m. rosen, (ed.), posttraumatic stress disorder: issues and controversies (pp. 233-245). chichester, west sussex, uk: john wiley & sons, ltd. takaki, r. (1993). a different mirror: a history of multicultural america. new york: back bay books. united states department of homeland security. (2009). immigration statistics. retrieved from http://www.dhs.gov/files/statistics/immigration.shtm author note: address correspondence to: hye-kyung kang, assistant professor, smith college school for social work, northampton, ma 01063. email: hkang@smith.edu _________________________ lisa v. blitz, phd, lcsw-r, is an associate professor, department of social work, college of community and public affairs, binghamton university, binghamton, ny 13902. denise yull, edd, is an assistant professor, department of human development, college of community and public affairs, binghamton university, binghamton, ny 13902. martha g. solá, lcsw-r, is a former project supervisor and john e. jones, lmsw, is a former social work intern with the project discussed in this manuscript. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 254-272, doi:10.18060/18978 teaching macro social work through experiential learning: student reflections on lessons learned in building school-community partnerships lisa v. blitz denise yull martha g. solá john e. jones abstract: a faculty-led experiential learning project was implemented with master of social work students at their field placement sites to teach macro practice skills and research methods. as part of a grant-funded school-university partnership, msw students were placed in school social work field placements, where their practice focused on individual and small group interventions with youth. ten msw students participated in asset-based collective family engagement in diverse, low-income communities, using community organizing skills and community-based participatory research methods. to examine student learning, a pilot study gathered narrative data from seven of the students and three supervisors. msw students’ learning from the project is discussed in the context of cswe’s 2015 epas competencies. participation in the experiential/service-learning project supported the ability of the msw students to build a sense of themselves as professionals bringing value to the community, enhanced their understanding of cultural diversity and family engagement, and provided context for vulnerable students’ struggles in school and the families’ difficulties with school engagement. this project illustrates the potential of school-university partnerships involving msw field students to help bridge the gaps in school-family partnerships, particularly in diverse and low-income communities, and highlights areas where different teaching methods can be used to reinforce competencies learned. keywords: experiential learning; service learning; field education; school-community partnership; macro social work; community organizing; participatory research; family engagement considered the primary pedagogy of social work, field education provides students opportunities to develop a full range of practice skills, and all social work competencies are expected to be taught and evaluated in field (council on social work education [cswe], 2015). the emphasis on field education validates the importance of experiential learning to help social work students apply theory to practice and develop skills necessary for their professional development (carey, 2007). each field placement, however, is necessarily focused on helping students develop skills related to the primary service focus of the organization. experiential learning that takes place at the internship site, but includes activities distinct from the typical fieldwork responsibilities of that organization, can enhance students’ education and add depth to their experience with a wider range of social justice issues (cramer, ryosho, & nguyen, 2012). advances in social work, fall 2016, 17(2) 255 social work students may struggle to understand how individual and family practice relates to macro work (miller, tice, & harnek hall, 2008), and social work educators may struggle with teaching research, community work, and policy in ways that help students value these as relevant in social work practice (sather, weitz, & carlson, 2007). experiential and service-learning is increasingly used to teach macro-level knowledge and skills (bringle & steinberg, 2010; lemieux & allen, 2007) and can be particularly beneficial in teaching practice competencies that may not be emphasized in traditional field placements. when engaged in experiential learning, social work students increase competency in areas such as research (jacobson & goheen, 2006), data-driven practice (shaw, lee, & wulczyn, 2012), and policy practice (rocha, 2000). additionally, evaluation of social work student learning is increasingly focused on observation of students’ competency in practice skills (cswe, 2015), however, observing macro social work skills can be challenging in classroom-based instruction. different models of experiential learning include activities that emphasize selfdiscovery, which often involve class or group projects, and those which take students outside of the classroom to gain knowledge and develop awareness of people and communities (cramer et al., 2012). teaching research methods, community organizing skills, and policy issues through experiential learning in tandem with traditional field placements is a method of teaching that engages students in learning macro skills. this paper describes one such project, conducted with master of social work (msw) students at their social work field placements in public middle schools. the focus of this paper is on the msw students’ learning in the context of the related 2015 educational policy and accreditation standards (epas) competencies (cswe, 2015). the project is described to give context to the students’ educational experiences. students’ reflections on their learning illustrate how participation in the project taught and reinforced macro social work competencies. highlights are shared regarding different teaching strategies that may help msw students develop macro practice skills. benefits of experiential and service-learning universities can create a lasting impact in the community through deep engagement and a commitment to using university resources for community transformation through community-based experiential learning projects (kronick & cunningham, 2013). for social work students, experiential learning can be transformative. some students come to their msw program with limited exposure to critical reflection about social justice issues and scant knowledge of how equity ideals can be put into action (jones, 2009). experiential learning that contributes to social change and centers around reflection on the process provides in-vivo teaching opportunities to facilitate students’ learning. students engaged in experiential learning show increased self-awareness and improved cultural competency (pugh, 2014), have a more nuanced understanding of the population (cheek, rector, & davis, 2007), and also show a more complex understanding of, and commitment to, social justice (cramer et al., 2012). experiential education can take the form of service-learning. student reflection on the learning activities and their role in the community is critical to service-learning, a process that promotes students’ civic responsibility (bringle & steinberg, 2010). the combination blitz et al./teaching macro social work 256 of engagement and reflection central to service-learning can also add to students’ learning in other areas, as it helps develop their abilities in critical thinking and challenges them to understand and respond to complex social problems (eyler, 2009). service-learning can be used to teach and reinforce social work values, such as strengths-based perspectives, empowerment, anti-oppressive principles, and asset-based citizen–driven approaches (donaldson & daughtery, 2011). service-learning can also help reinforce students’ mastery of practice competencies by providing opportunities to use skills differently than what may be used in their field placement (phillips, 2011). a distinguishing feature of service-learning, however, is the emphasis on the reciprocal nature of the project. students are engaged in learning for themselves, but their role is defined by the needs of the community. integrating service-learning into fieldwork practice thus requires flexibility in defining the nature and goals of the project (lemieux & allen, 2007). experiential learning and university partnership for k-12 education universities are increasingly prioritizing engagement with public schools to address problems in primary and secondary education (harkavy, hartley, axelroth hodges, & weeks, 2013). family engagement is one area in which a university partnership can be valuable. family engagement is a central component of student achievement (karbach, gottschling, spengler, hegewald, & spinath, 2013), but these initiatives are often difficult for schools to take on alone. traditional models of parent involvement in schools often do not respond effectively to financially poor families, families of color, or those from diverse cultural backgrounds (baquedano-lópez, alexander, & hernandez, 2013). families who live with poverty are particularly vulnerable as they are likely to have higher exposure to multiple stressors contributing to physical and mental health concerns that make engagement with their children’s schools difficult (blitz, kida, gresham, & bronstein, 2013). university partners who develop relationships with marginalized families can act as liaisons to help bridge gaps between home and school (sanders, 2008) and create opportunities for new ways to understand complex problems. in the project described here, msw students conducted family engagement outreach led by their field instructor and university faculty as part of a school-university partnership. description of the communities and project in 2009, a federal safe schools/healthy students grant was awarded to a cooperative of educational services to initiate a school-university partnership to address a range of school concerns, including family engagement, for the region. the university was a subcontractor on the grant and hired licensed master's-level social workers to act as project supervisors and field instructors for msw students placed in local schools, working alongside the school social workers. three project supervisors each led a team of four to seven msw students who were placed in a middle school, serving grades 6 through 8, for two days per week. these teams added social work capacity to the school and enhanced the visibility of social workers as change agents in school improvement. engaging families of vulnerable students was a priority identified by the school advances in social work, fall 2016, 17(2) 257 districts that participated in this project, which included three geographically contiguous school districts in the northeast united states. to protect the identity of the school districts, specific citations are not provided for community or school data. the school districts radiated outward from an urban school district, a small city where more than 75% of students in the district were economically disadvantaged and about 50% were people of color. in suburban district 1 (sd1), over 70% of students were economically disadvantaged and just over 35% were people of color. in suburban district 2 (sd2), 50% of students were economically disadvantaged and 20% were people of color. each district struggled with disproportionately negative outcomes, including lower graduation rates and higher discipline referrals, for students of color and financially poor students when compared to white students and those who were not financially disadvantaged in the same district. msw students’ field placement responsibilities were primarily traditional school social work tasks: individual and small group counseling with students, collaboration with schooland community-based mental health professionals, and consultation with the parents of the students on their caseloads. working closely with school social workers, building administrators, guidance counselors, and teachers, the project’s social work supervisors and university faculty established relationships to form foundations for innovation directed at improving student achievement and eliminating disproportionally negative outcomes for vulnerable students. a faculty member from the department of social work led the project, and a team of seven other faculty from the university’s department of social work, department of human development, the school of education, and the school of nursing collaborated on other interconnected projects aimed at similar goals. project supervisors led efforts in family engagement that were directed toward families identified by the schools as hard-to-reach and whose children were struggling academically and/or socially. to better understand the experiences, strengths, and needs of these families and to enhance partnerships, three of the project teams worked with university faculty to conduct outreach with families. the outreach was informed by community-based participatory research methods ([cbpr] bermúdez parsai, gonzalez castro, marsiglia, harthun, & valdez, 2011) and asset-based community organizing principles (bauer, kniffin, & priest, 2015). for the msw students, these responsibilities were framed as experiential/servicelearning designed to give them the experience of macro social work practice through activities that were outside of typical fieldwork tasks. in the initial phases of the project described here, the full criteria for service-learning as described in this paper were not met, which led to the characterization of the project as experiential/service-learning. school community was defined as the school and the neighborhoods surrounding it. it includes both the physical buildings and the people--staff, students and their families, as well as neighbors, who used them. there was reciprocal benefit between msw students and the school building communities, but the reciprocity with the neighborhood communities was not yet developed. further, the experiential/service-learning project did not add additional pacademic instruction beyond the students’ msw coursework, a central component of service-learning. the project did, however, provide numerous opportunities for reflection and civic engagement for msw students. the project also laid the groundwork for family engagement that incorporates reciprocal benefit among schools, families, and later groups blitz et al./teaching macro social work 258 of msw students who take on the next stages of the work. experiential learning and epas competencies. consistent with service-learning, the project was developed around the schools’ goal of engaging families rather than being driven by a faculty research agenda. since the project worked in tandem with the msw students’ field placements, it was expected that all epas competencies would be addressed. as the project developed, however, there were some competencies that were emphasized more than others in the experiential/service-learning. since the project involved outreach to families in diverse communities, msw students developed skills for both competencies 2, “engage diversity and difference in practice” (cswe, 2015, p. 7), and 6, “engage with individuals, families, groups, organizations, and communities” (cswe, 2015, p. 8). the families lived with financial hardship, and during the outreach families would often discuss their experiences of individual bias and systemic inequities, supporting the msw students' learning for competency 3, “advance human rights and social, economic, and environmental justice”. since the students were assisting in a cbpr project, competency 4, “engage in practice-informed research and researchinformed practice”, was supported through training in the research protocol and gathering, organizing, and analyzing data. finally, in the larger context of the family engagement project, the msw students had experience with competency 5, “engage in policy practice”, as they were part of discussions about changes needed in existing social service and school policies to effectively meet families’ needs and helped develop recommendations to the school districts. methods of inquiry taught to msw students: cbpr and community organizing the faculty member who acted as principal investigator (pi) on the family engagement research trained three project supervisors and 10 msw students (the project teams) in the research protocol and guided them in the research process, including integrating social work theory and practice. the students were both foundation (first year) and concentration (second year) students in an advanced generalist social work program. each year of their social work education included courses in research and macro practice, and the experiential/service-learning focused on practice competencies commensurate with their course work and epas standards. the project extended over both the fall and spring semesters. in the fall semester, prior to being included as research assistants on the human subjects review board protocol, the project supervisors and msw students took the online collaborative institutional training initiative (citi) research course. the pi trained the project team members in the research protocol in the fall semester and provided support throughout the academic year. msw students and the project supervisors understood and agreed that as part of the cbpr process, their experiences and learning were also important data. none of the project supervisors had participated in this type of research project before. therefore, the pi worked closely with the project supervisors to build their confidence in their research skills and to ensure that the concepts and skills were reinforced with the msw students. an important part of this process was for the pi to teach research interview skills to the project supervisors so they could, in turn, teach these skills to the msw advances in social work, fall 2016, 17(2) 259 students. in contrast to social work practice skills, which may reach for feelings or encourage clients to focus on their own behaviors, research questioning focused on experiences, observations, and elaboration of opinion—a subtle but important difference for the supervisors and msw students to understand. the pi met with the supervisors weekly and had periodic meetings with the teams, but the project supervisors took the lead in the school district in which they worked. all team members were responsible for gathering, organizing, and analyzing data, as well as thinking about next steps in family engagement. the teams were more closely connected to the school they served and their local community than the pi. therefore, the teams made decisions about the direction of the family engagement efforts informed by their experiences in the school and what they learned through the research process. consistent with cbpr and supporting deeper learning through experience, msw students tracked the evolution of the project in each district through field notes and observations, adding to their understanding of families’ strengths and needs. the msw students worked closely with the school social workers, and their evolving understanding of families’ concerns informed the schools’ family engagement efforts. it was important that the research allow flexibility to meet the needs of the school community and the requirements of grant-funded services, which also contributed to reflections on the experiential/service-learning as it evolved. in meetings with all three teams together, msw students had the opportunity to learn about the different trajectories of the project and discussed possible contributing factors. these discussions deepened the students’ understanding of research-informed practice, community organizing, and the impact of school policies on family engagement. parent cafés: asset-based collective family engagement family engagement was a service goal of the grant-funded program and supported the service-learning ethic of reciprocity by promoting student learning and benefiting the school community. consistent with the msw students’ course work, the project involved philosophy of asset-based community development (abcd; kretzman & mcknight, 1993). abcd was developed as an alternative to needs-based approaches in which universities and/or community-based organizations intervene on behalf of a community to address problems defined by the outsiders. according to kretzman and mcknight (1993), needs-based approaches tend to over-emphasize deficits and problems and can have the undesired effects of reducing motivation and self-agency and creating dependence on outside institutions. in contrast, the abcd approach positions outside institutions as facilitators to uncover internal strengths and assets that community members can use to address the problems they define as needing attention. although abcd has been criticized for not attending to the macro-level causes of disempowerment, the focus on relationship and community-building can mobilize groups for collective action to address root causes of concerns (ennis & west, 2010). the project adapted a parent café model, loosely based on the community café (national alliance of children’s trust and prevention funds, n.d.) and world café models (sheridan, adams-eaton, trimble, renton, & bertotti, 2010) to start conversations and blitz et al./teaching macro social work 260 build relationships among families. the café models use a set of questions to guide structured conversations among community members. along these lines and using a cbpr framework, msw students were taught a grounded theory approach for initial inquiry, building conversations around grand tour questions (faulkner & faulkner, 2014) aimed at understanding the parents’ experiences in the community and with the school. cbpr fit well with the café model as the dual goals of data collection were to learn more about the families and bring them together to explore their interest in collective action (berg & lune, 2012). equally important, the café model supported an orientation toward identifying common concerns and collective action centered on families’ goals, not institutional priorities (weiner, 2009). the conversations also promoted the asset-based philosophy that supports msw students’ ability to see families as equal partners in familyschool engagement (bauer et al., 2015). project supervisors and msw students began by conducting outreach to families of students referred by the school administration. the school administrators identified students who were in danger of not passing their grade or not graduating, often because of chronically low attendance, and students with multiple discipline referrals. initial contacts were often made by phone, but direct outreach to the home was made when a family was difficult to reach. visits to the families’ homes were conducted in pairs, beginning with a project supervisor–msw student pair. as the students gained skills and confidence, two students conducted outreach independent of the supervisor. team members introduced themselves by stating they were working with a university project, noting that they worked with, but not for, the school, and their interest was in the parents’ experiences and concerns with regard to their children. they obtained informed consent for the research prior to asking questions. msw students took turns talking with the parent while the other team member took notes. notes were reviewed with the parent at the end of the interview to ensure that the answers were recorded accurately, as a form of member checking (ely, anzul, friedman, garner, & steinmetz, 1996), and to affirm the respect for the family member’s opinion and experience. the project teams contacted a total of 138 parents and custodial grandparents. of these, 70 parents were contacted from the urban school district, 31 from sd1, and 37 from sd2. just under half of the total group of parents were people of color and about one-third lived in two-parent families. there was no intent to focus on students from financially poor families, but in each school district all of the families contacted were economically disadvantaged. the project team used the interviews with parents to stimulate interest in collective action, requiring the msw students to use community organizing and research skills simultaneously. the team asked parents if they were interested in hosting a parent café, which involved the parent inviting five to seven friends or neighbors who also had children in the district to meet and discuss school concerns. this snowball technique provided access to parents who might otherwise not have been interested in working with social workers. if the parent was interested in hosting a parent café, a member of the team, usually the msw student, followed up and helped organize the meeting. since the msw students only worked with the project two days per week for the academic year, the project advances in social work, fall 2016, 17(2) 261 supervisors and school social workers assumed responsibility for maintaining contact with families and building relationships that extended beyond msw students’ time in their field placement. the initial parent café meetings were organized as focus groups facilitated by the project team. the teams organized five parent café focus groups in the urban district, three in sd1, and one in sd2, totaling nine parent café focus groups. meetings were held at various locations convenient to the families, including a community library, a church meeting room, and families’ homes. each group explored the parents’ perspectives regarding their child’s education and their experiences with the school. one of the team members took notes and checked with café members to ensure accuracy of the responses. parents received a $50 gift card to a local store for hosting a parent café, and group members received a $10 gift card for attending the first café meeting. at the end of the café, the group discussed the possibility of future meetings to identify a goal or project the group wanted to complete or to discuss inviting school personnel to join them to talk about a concern. if the group was interested, the team worked with them to plan and organize future meetings. future meetings focused on understanding issues from multiple perspectives, identifying community assets, and developing strength-based solutions to problems, more fully actualizing the abcd model. as relationships and trust developed, the project team members functioned as liaisons among parents, school personnel, and community resources. some parents invited school personnel to join their conversations, and school personnel understood the parent café as a method of accessing and communicating with parents (see yull, blitz, thompson, & murray, 2014). learning from data and taking action in debriefings with the project supervisor following the outreach into the community, the msw students reflected on their experience, discussing their impressions and reactions to what they heard and saw. the teams reviewed the notes taken during individual meetings with parents and the parent café focus groups and began developing open codes that formed a foundation for later analysis (sherman & reid, 1994). data were combined from the individual interviews and the parent café focus groups but kept separate for each school district. each team worked to understand the themes that evolved from the outreach in their school district and used this to inform next steps in the family engagement process. through this process, the project supervisors taught and modeled research-informed practice and practice-informed research. toward the end of the spring semester, when the bulk of the data had been collected and initial analysis had been conducted, the pi met with each team to begin the next phase of analysis. in this process, the pi reviewed the notes from the debriefing sessions with each project team, discussed the initial codes from the data they collected, and together they categorized the information into themes. the triangulation process, with data examined by multiple people from different perspectives to arrive at a collective understanding about the meaning, helped to ensure the trustworthiness of the findings (ely et al., 1996). furthermore, it taught msw students qualitative analysis techniques and led to discussions about dependability and transferability of findings (guba, 1981). at the end of the academic year, the pi, project supervisors, and msw students presented districtblitz et al./teaching macro social work 262 specific data to the administrative team in each school district, providing opportunities for the msw students to think through the policy implications of the findings and develop recommendations for school district administration. in debriefings with their supervisor, msw students were encouraged to think about their experiences in the community in relationship to their work at the school and their academic lessons in classes. discussion often focused on policies related to education and social services, school expectations and norms, and various degrees of fit and disconnection between the policies and the parents with whom they engaged. msw students were also encouraged to critique the research methods and processes to identify strengths and limitations of the techniques for gathering meaningful data. these conversations helped msw students link their experiential knowledge to macro issues, such as school policies, mental health policy and service availability, housing and tenant concerns, public assistance, and child protective services. macro social work in action: lessons learned by msw students the reflections on msw student learning presented here come from conversations and email exchanges with the pi approximately six months after the msw students had completed the project and the fieldwork placement. separate human subjects review board approval was obtained to include the msw students’ reflections on their learning. ten msw students participated in the project, and the experiences of seven of them are reflected here. the other three had graduated and were not available. all the students who participated in the follow-up interviews were people of color, and several grew up in financially poor communities of color in urban areas. four of the students, two male and two female, were in their early 20s and had very limited adult experiences in their home communities. the other three, one male and two female, were older and had returned to school after a variety of professional and other life experiences. of the project supervisors all were female; one was black, one latina, and one white. the interviews were conducted by the pi in a semi-structured format where the former msw student participants were asked to reflect on their experiences and talk about what they learned. they were informed that the pi, another researcher, a project supervisor, and a former msw student who worked on the project (the research group) wanted to understand what the students had learned and would be developing a manuscript for publication. following the interviews, several of the former msw students followed up by email to share additional thoughts and experiences. notes from the conversations and the text of emails were compiled by the pi and checked with the former msw students to ensure accuracy. de-identified notes were then studied by the research group, which used epas competencies as a priori codes. by reviewing the comments, the research group identified that the former msw students’ learning in competencies 2, “engage diversity and difference in practice” (cswe, 2015, p. 7), and 6, “engage with individuals, families, groups, organizations, and communities” (cswe, 2015, p. 8) were clearly enhanced by their participation in the project. three additional epas competencies were noted as showing indications of some growth, but practice skills were not clearly developed. advances in social work, fall 2016, 17(2) 263 epas competency 2: engage diversity and difference in practice regardless of their personal identity and experience, all the students noted that the community outreach expanded the range of families and community stakeholders with whom they had contact. the exposure to ethnically diverse families in their homes and community helped the students understand and practice culturally responsive approaches and enhanced their social work skills. as noted by one student, “family engagement gave me direct exposure to at least three different ethnic families: white, black, and hispanic. to me, this was remarkable because i was able to differentiate between my ability to communicate with each of the ethnic families.” the one thing all the msw students had in common was that they were people of color for whom education had been a vehicle for self-improvement and advancement. their own success informed their worldviews and often mediated their personal experience of oppression. they were often surprised by how racism impacted the lives of the families they met and how families were frequently reluctant to talk about the issues even when the outreach worker was also a person of color. one msw student recounted: [parents] had the hardest time talking about race and culture, i think because they didn’t trust outsiders. when they did open up they had so many stories about things that had happened to them, things i was not aware of. i didn’t realize these things were happening. for some msw students, hearing the families’ experiences of racial bias and the impact of oppression brought up complicated feelings about their own situation or life issues with which friends or family members struggled. students’ awareness of how race and cultural issues played out in the schools was also heightened. they developed a greater understanding of the need for in-depth education regarding race, oppression, and privilege for school personnel to better understand the students and their families. as one msw student stated, “the training on cultural competency that the teachers get just doesn’t go far enough for them to really understand what kids live with every day.” another student noted, “i didn’t know how serious [racism] is, i didn’t realize how much people just don’t know.” the students often reflected on the difference between the race-aware education they received in their social work curricula and the colorblind perspective maintained by many school personnel. one student noted that: lack of education around race really affects education; it limits how effective education is. race is a part of everything, a part of the education experience. if the school administrators and teachers don’t understand that then too much gets lost or misunderstood. one student reflected on how different understandings of race and culture directly impacted communication among parents and school personnel. as he noted, the education around race is so limited it skews our understanding about what is going on. if a parent has one perspective on race relations, and the kid has a different perspective, and the school personnel have a different idea, it skews how they blitz et al./teaching macro social work 264 understand how race impacts what is happening. another student considered how both school personnel and parents may bring preconceived notions of one another into their encounters. he noted that some parents may be skeptical of school personnel because of past negative experiences. for the msw student, analyzing how race and culture-bound experiences strained the relationships was imperative. he recalled an example where school personnel mistook one black male student for another in a discipline issue and were not sensitive to how this mirrored the kind of generalizations and stereotyping that black people struggle against in our society. in talking about this incident, the msw student noted: in the end it turned out that the student had been mistaken for someone else. the school personnel not only didn’t call and apologize to the parent, but weren’t polite when the parent called. they didn’t realize how hurt the dad was. these are the kinds of experiences parents bring with them when they engage with school staff. epas competency 6: engage with individuals, families, groups, organizations, and communities while the msw students were interested in community outreach, in the beginning many were tentative and afraid. as noted by one, “initially, it was overwhelming and scary because i’d never done anything like it before.” but by the time the project was underway, they expressed enthusiasm for the work. as they spent time out in the community talking to families, many msw students also began spontaneously reaching out to local agencies in the area in an effort to understand the community service networks. as they did so, they began to see the power of partnerships among parents, schools, and community organizations. as noted by one student, “what was outstanding for me was the effort to get the community involved in the affairs of the school for the welfare of school children.” others noted the benefit of engaging with multiple organizations as a result of the outreach with parents. as one student stated, “i got to know the program directors of the different agencies around here and in the community as a whole. that helped me make professional connections even beyond my field placement.” the msw students frequently talked about the need to bridge gaps between home and school. for some, the primary lesson learned was about understanding multiple perspectives of complex issues. for example, one student stated, “what struck me was that it’s not that teachers don’t care; the teachers care and the parents care too, but it’s frustrating trying to bridge that gap.” this concern was mirrored in another student’s comment, “bridging gaps has to be the most pivotal lesson learned. there are always two sides to a story and bridging those two stories is difficult.” others demonstrated an appreciation of their role in helping to be the bridge between families and schools. for example, one msw student discussed the sense that some families experienced school personnel as punitive which inhibited engagement. the project team’s asset-based focus was better received. as one student observed, “when the school official goes out they are the authority, talking about what is going wrong. when we went out we could focus on building relationships…the families were so much more receptive after that, more advances in social work, fall 2016, 17(2) 265 welcoming.” msw students also came to appreciate the importance of developing relationships with community leaders and stakeholders and learned the power of community work. engagement with families provided a chance to get to know the community from a different perspective and created opportunities for learning about community resources. one student stated, “it was a great opportunity to get to know the community better. i learned a lot about the different agencies in the area, different organizations for afterschool care. that helped me help make those connections for the parents.” other students developed a passion for community work, discovering an important avenue for their careers. as one stated enthusiastically: community work is highly effective and important. i absolutely love community work. a social worker cannot, the government cannot, those in power cannot identify the needs of a community of which they are not a part, nor will the community be receptive to your insight. lessons learned—but were competencies developed? in addition to clearly learning and using skills related to competencies 2 and 6, the former students indicated advancement in their understanding in other areas. however, their ability to translate learning into practice was less clear. epas competency 3, “advance human rights and social, economic, and environmental justice” (cswe, 2015, p. 7), was one such area. effective advocacy or other action to advance human rights and work for justice requires a genuine understanding of the issues from the points of view of the people who are affected. while it is not clear whether the msw students’ were able to take action, their deepened awareness of social justice concerns was evident. hearing about family and community problems is often difficult, especially for students, and the outreach put students in the middle of neighborhoods where these problems were the most concentrated. the immersion created struggles with maintaining a strengths-based perspective, as noted by one student: i began to hear all of these horror stories and concerns, so much that strengths about the community and schools became unimportant. i would minimize those strengths but then stress and harp on the negatives. it is easy to get caught in the negatives of situations versus highlighting the positives. another msw student noted how seeing the living conditions changed the way she looked at students’ struggles in school, “there were so many needs. it helped put everything in perspective. how can they come to school and perform like everybody else when they have so much to deal with at home?” seeing the lived experience of oppression was profound for the msw students, and understanding the ripple effects of marginalization on a family’s life was a key lesson. as one student stated, “i was surprised about how many times [the families] did not use a service in the community because they did not think it was for them or they didn’t think they would fit in.” students also talked about how impressed they were that families who felt ostracized by their community actually wanted to be engaged. as noted by one student, blitz et al./teaching macro social work 266 “the people in the community have so much to say about the issues. they not only have concerns but they also have insight and ideas on what can be done to change these issues.” another student noted, “the families want some control; they want to be part of the solution. they don’t want someone to come in and tell them what the solution is.” learning in epas competency 4, “engage in practice-informed research and researchinformed practice” (cswe, 2015, p. 8), was also enhanced, but the extent to which the msw students developed competency in this area was less clear. each of the msw students expressed that the project provided them with fundamentally different experiences than what they would have had if they had only participated in a school social work field placement, and they were glad to have had the experience. all expressed surprise that research could be so relevant to the immediate needs of families and schools. two observations were made by the pi. first, although the project supervisors maintained a clear sense that they were participating in a research project and that information gathered was research data—and this clearly felt different to them—the msw students approached the work as simply a social work project. for the students, collecting and using data to develop programming and inform school policies and initiatives seemed natural and fit well with what they were being taught in class as best practices. second, during team meetings to discuss the data, identify themes, and critique the cbpr process, the msw students clearly showed that they understood research concepts and could use research skills. yet when asked about the project, none of them talked about specific learning related to research methods. although the extent to which research methods were learned or retained is not clear, it is clear that research was experienced as a natural and important part of practice. finally, students’ learning in epas competency 5, “engage in policy practice” (cswe, 2015, p. 8), was another area where progress in understanding was seen but practice skills were not clearly developed. the impact of the students’ learning around issues of diversity was profound, multifaceted, and included issues related to policy. hearing stories about how systems were not working for families prompted students to learn more about the social service and mental health systems locally and nationally. students began considering the policies behind the practice and questioned why some families did not or could not access services. seeing how many parents had good ideas to solve community problems also prompted students to learn and understand obstacles to getting those ideas heard and acted upon within the schools and the community at large. the project gave the msw students exposure to other facets of the lives of the middle school students they worked with in the school. this exposure helped them understand some of the school policy issues that created barriers for families, and they were able to talk about these with the school social worker and other school personnel. as one student stated, it made me better able to talk to the school about the student’s problems, especially with attendance. i could advocate better for the student and help the school understand why it was so hard for the kid to come to school every day. other students reflected on their learning about systems functioning and the importance of advances in social work, fall 2016, 17(2) 267 communication among the different people involved. as noted by one student: i learned that you can’t, as social workers, just go into the school and do individual treatment with the kids and think that’s going to work to solve all the problems…but if all parties come together, administrators, teachers, social workers, afterschool programs, and work together, then the needs of the whole child and the whole family can be met. discussion participation in the experiential/service-learning project supported the ability of the msw students to build a sense of themselves as professionals bringing value to the community. the experience added to their knowledge about the diverse families and communities they served in their fieldwork and provided opportunities to learn community outreach and organizing skills as well as participatory research methods. the project also provided numerous opportunities for field instructors and faculty to observe epas competencies in action and enriched the field instruction experience. in generalist social work education and practice, social workers need to think critically and dynamically, using micro-, mezzo-, and macro-level social work skills interactively, which can be challenging during the learning process (miller et al., 2008). in this project, the msw students saw the impact of social and economic oppression firsthand by spending time in the community with students and their families, witnessing situations and events that their young clients rarely talked about when in school. through this process, the intersection of individual troubles and environmental factors that made daily survival difficult became obvious, and sometimes even painful, for the msw students to face. identifying community assets can be difficult for students confronted with enormous troubles and needs (green, 2015), and some of the msw students in this project discussed that struggle. the project’s asset-based approach, however, helped them learn to identify community and individual strengths, making this an important method for communitybased experiential and service-learning projects (bauer et al., 2015). as seen in similar projects, the experience enhanced the msw students’ understanding of cultural diversity and family engagement (belliveau, 2011) and provided context for vulnerable students’ struggles in school and the families’ difficulties with school engagement. further, the msw students developed enthusiasm for macro social work, supporting their commitment to act as agents of social change (kronick & cunningham, 2013). the msw students’ reflections also confirm previous findings that the experiential/service-learning project reinforced social work values of strengthsand assetbased perspectives and citizen-driven approaches to understanding and responding to community concerns (donaldson & daughtery, 2011). the students’ reflections showed they understood the concepts and used the skills for epas competencies 2, “engage diversity and difference in practice” (cswe, 2015, p. 7), and 6, “engage with individuals, families, groups, organizations, and communities” (cswe, 2015, p. 8). although the students had been instructed and supported in learning skills related to other macro competencies, the extent to which they developed competency was less clear when they talked about their experiences. much of their reflections focused blitz et al./teaching macro social work 268 on the aspects that had been the most emotionally compelling, emphasizing that their learning was profound, and that connections made with families were poignant. it may be that the emotional development that took place during the learning process overshadowed developing practice skills, or that there was simply not enough time for them to turn their thinking and feeling into action. it is also possible that the competencies were developed but not part of what students chose to share when reflecting on the experience. all the msw students came away from the experience clear about the need for social work advocacy to enhance social and economic justice. the project exposed them to what social justice advocacy can look like in practice, providing a foundation for further skill development. it is important to note that, in contrast to other projects (see rocha, 2000), the msw students’ engagement in policy work and actions to advance human rights and social justice were not as clear as their increased understanding and interest in doing this work. action for social justice sometimes requires confrontation and willingness to disagree with those in authority. the skills required to do this effectively can feel as though they are in contrast to the engagement and collaborative strategies used in community development and may need differentiated field instruction for optimal skill development (hardina & obel-jorgensen, 2009). the msw students’ complex connections with the diverse families and community members encouraged them to advocate for families in the schools and helped them understand policy and develop commitments to advance social justice. one aspect that was not mentioned by msw students, but which made an impact on a project supervisor (and co-author), was the importance of discussions around language in debriefing sessions with msw students. schools require the use of standard american english (sae), which was often not used by the families contacted through the outreach. msw students and their supervisors explored the possibility that the demand to use sae could be experienced as a tool of hegemony by some families and the choice to use ethnic-identified english could be a form of healthy resistance (see cunningham, 2014). considering that msw students were all very successful in scholarly pursuits and valued ways of knowing and communicating that were rewarded in academia, these insights were valuable in preparing them to move beyond the academy and into social work practice. by collecting, analyzing, and interpreting data at each step of the family engagement process, consistent with similar projects (shannon, kim, & robinson, 2012), the msw students were able to experience research-in-action making the empirical process accessible and relevant. although others have found that engagement in experiential learning increased social work students’ competency in practice-informed research and research-informed practice (jacobson & goheen, 2006; shaw et al., 2012), the evidence here was not clear. the pi observed the students using the related skills during the project, but they did not reflect on this in the follow-up. again, the emotional impact of the experience may have outshone reflections on research. it is also possible, however, that following their participation in the project, research concepts were not retained or seemed less relevant than other aspects of practice. there are limitations to assessing epas competencies though the process of semistructured interviews asking msw students to reflect on their learning. the emotional advances in social work, fall 2016, 17(2) 269 impact of the experience may have ultimately been more memorable, and overall professional development more meaningful, than the specific skills acquired. all the msw students in this project received strong positive feedback from their field instructors, and field evaluations showed that they did ultimately develop all the epas social work competencies. it may be that it was difficult to discern where and how specific skills were learned since they were used across multiple practice areas. it is also possible, however, that some competencies developed in field were not retained if they were not currently being used. preand post-test measures, with follow-up once the former students were in professional practice, is needed to better clarify the learning and retention of the full range of social work competencies. beyond the benefits to the msw students, the project had other benefits as well. linking the project with faculty service and research provided seamless connections that enhanced community service, faculty research, and student learning simultaneously (flinders, nicholson, carlascio, & gilb, 2013). school-university partnerships seeking innovative solutions to complex problems may take years to develop as 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(2014). can we talk? using community-based participatory action research to build family and school partnerships with families of color. school community journal, 24(2), 9-31. author note: address correspondence to: lisa v blitz, phd, lcsw-r, department of social work, college of community and public affairs, binghamton university, po box 6000, binghamton, ny 13902, 607-777-9169, lblitz@binghamton.edu http://dx.doi.org/10.1080/08841233.2013.863264 http://dx.doi.org/10.3200/joer.101.5.287-298 http://dx.doi.org/10.1300/j067v27n03_05 http://dx.doi.org/10.1080/08841233.2012.680867 http://dx.doi.org/10.1080/08841233.2012.640599 http://dx.doi.org/10.1921/095182410x576840 http://dx.doi.org/10.1111/j.1533-8525.2008.01134.x mailto:lblitz@binghamton.edu microsoft word 672-jones_manuscript_copyedit3b _________________  sally hill jones, ph.d., is an associate professor in the school of social work at texas state university, san marcos, texas. this research was funded by the texas state university service-learning initiative faculty fellows program. copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), 94-112 life is experienced until we die: effects of service-learning on gerontology competencies and attitudes toward aging sally hill jones abstract: this mixed methods study examined the effects of service learning in an undergraduate gerontology course on student learning outcomes. eleven of thirteen students chose to provide companionship and practical help to community-dwelling older adults and link course assignments to this experience. participating students were mostly female and social work majors or minors, of various races and ethnicities, and of traditional and nontraditional ages. self-ratings using the geriatric social work competency scale showed significant skill improvements for students from pretest to posttest. analysis of student journals indicated improvement in interaction skills, knowledge of aging processes, dismantling of stereotypes, awareness of issues affecting healthy aging, valuing older adults, and cultural competence. career plans were positively affected for most students. letters offering advice to their 70-year old selves appeared to impact students’ plans for self-care. service-learning is recommended to increase students’ gerontology competencies and attitudes toward aging in others and themselves. keywords: service-learning, gerontology, competencies introduction with the burgeoning growth of the older adult population comes the well-established need for social workers trained in gerontology (bureau of labor statistics, 2010). social workers encounter older adults in a variety of settings, and therefore need skill development to work effectively in this area. engaging students in the field of gerontology can be difficult due to stereotypical beliefs or lack of experience with older adults, although progress is being made in this endeavor (cummings & galambos, 2002; mason & sanders, 2004). service-learning exposes students to direct encounters with older adults, which when connected to assignments, has the potential to challenge learners’ beliefs about aging and the value of gerontology work, as well as increase their gerontology competency levels. this mixed methods study examined the effects of service learning in an undergraduate gerontology course on student learning outcomes. background service-learning is an educational approach that ties experiential learning specifically to course objectives through assignments and equally benefits the students and community. it differs from experiential education, which does not include the intentional connection to assignments, and also from internships, which are designed to primarily benefit students (king, 2003; lemieux & allen, 2007). bringle and hatcher (1997) defined service-learning as a: advances in social work, spring 2011, 12(1) 95 type of experiential education in which students participate in service in the community and reflect on their involvement in such a way as to gain a further understanding of course content and of the discipline and of its relationship to social needs and an enhanced sense of civic responsibility (p. 153). benefits of service-learning have been demonstrated in many studies. these include increases in students’ civic attitudes, ability to solve social problems, and positive individual development; however, evidence of its effectiveness is limited by the use of varying definitions and standards of service-learning (boyle, 2007). service-learning has been described as particularly suited to the field of social work, but underutilized. king (2003) outlined the compatibility between service-learning and social work core values, while also pointing out the paucity of examples in social work literature. lemieux and allen (2007) acknowledged the natural fit between servicelearning and social work’s emphasis on social justice. however, their examination of published research supporting this fit revealed the need for substantial development to catch up with the general service-learning field and with the promise described in social work literature. they also found that most of the literature described projects that did not include direct involvement with clients. king and lemieux and allen called for further research in these areas. recent examples of service-learning in social work include use in an undergraduate research course (knee, 2002), a graduate policy course (rocha, 2000), a maymester experience at a children’s burn camp (williams, king, & koob, 2002), an innovative field model (poulin, kauffman, & silver, 2006), and cross-cultural learning in introductory social work courses (sanders, mcfarland, & bartolli, 2003). these authors described positive results in students’ self-efficacy, policy skill competencies, political activity, attitudes toward research, scores on field evaluation practice skills, and qualitative differences in cross-cultural learning. service-learning has also been used in gerontology to enhance learning, overcome students’ negative beliefs and perceptions of work with older adults, and increase the likelihood of students choosing careers in the field. cohen, hatchett, and eastridge (2006) presented an overview of intergenerational service learning, describing vital components, outlining advantages and challenges, and providing several examples for use in graduate foundation social work courses. among the benefits listed were students’ exploration of and changes in attitudes toward older adults and their own aging, as well as improved university-community relationships. anstee, harris, pruitt, and sugar (2008) presented a model for including service-learning in undergraduate gerontology courses. the foundation for long term care’s decade-long development and study of gerontology service-learning in 28 colleges included social work and several health-care professions (hegeman, horowitz, tepper, pillemer, & schultz, 2002). results included positive ratings by students, agencies, and older adults, as well as statistically significant positive changes in student attitudes toward older adults. however, no significant changes occurred in student attitudes toward community service or careers in gerontology. vandsberger and wakefield (2005) studied students’ experiences of a 10hour intergenerational service-learning component in an undergraduate practice class. jones/life is experienced until we die 96 although no change in majors were found, students exhibited stronger desires to explore gerontology career options. others who have introduced service-learning in undergraduate gerontology courses described improved student attitudes toward and desire to work with older adults, reduced myths about aging, better understanding of course concepts and the realities of long-term care, and an increase in positive feelings of self-worth, efficacy, and skills (blieszner & artale, 2001; brown & roodin, 2001; gutheil, chernesky, & sherratt, 2006; singleton, 2007). laganà (2003) offers several creative ideas for students to become involved in service-learning research aimed at improving older adults’ quality of life. bringle and kremer (1993) specifically studied the effect of intergenerational service-learning on students’ attitudes toward their own aging and reported increased positive attitudes. a recent study measured geriatric competencies in a small sample of mostly graduate social work students before and after a service-learning gerontology course (dauenhauer, steitz, aponte, & faria, 2010). the authors found significant positive differences pre and posttest, as well as between service-learning and non-service learning students. this study builds upon existing research in intergenerational service-learning in social work in several ways. it studies service-learning involving direct client contact, called for by lemieux and allen (2007). geriatric competencies are measured in undergraduate social work students, which has not been a focus of the literature. analysis of students’ journal themes offers insight into the learning processes of intergenerational service-learning. a reflection tool is also described that guides students to link their awareness of others’ aging realities with their own. method procedure in an elective undergraduate for-credit course introducing students to social work with older adults, enrollees chose a 10-hour intergenerational service-learning project or a research paper. offering this option was based on discussion in the literature of possible negative effects when service is mandated (parker-gwin & mabry, 1998; rama, ravencroft, wolcott, & zlotkowski, 2000). although the course was elective, it was one of the few choices for students with required minors in social work or gerontology. the service-learning option also required students to provide their own transportation to older adults’ residences in a rural community. mutual adoption pact (map) is an established university program providing gerontology service-learning opportunities for courses across this large university campus. map employees screened and assessed community-dwelling older adults in need of assistance, and paired each older adult with a service-learning student who offered companionship and practical help. for the social work course, service-learning students were required to spend at least ten hours with their assigned older adults, who were referred to as map clients. initial class sessions included content on stereotyped beliefs about aging and basics of interviewing older adults, as well as role plays to advances in social work, spring 2011, 12(1) 97 practice interviewing skills. handouts were provided summarizing class content on how to get started, including making introductions, clarifying expectations, possible conversation topics, and maintaining boundaries. a multidimensional assessment, intervention plan, and policy analysis were based on students’ experiences with their older adult clients. service-learning students also completed seven journal entries that tied their service experiences to course material. the initial entry was completed before meeting the older adult, followed by five entries, each covering two meetings. the seventh and final journal entry was a summary of what students learned from their experiences with their map clients. the instructor provided specific instructions for each entry and a sample. journal entries were to include meeting descriptions, feelings and thoughts about the relationship process, and how specific course content covered during that time period pertained to map clients and their situations. based on the idea that students learn more easily when they relate personally to concepts being taught, students were required to include letters to themselves at age 70. in these letters, they offered advice based on course content and experiences with their map clients. students who chose the research paper option also completed the assessment, intervention plan, and policy analysis, based on an older adult they located themselves. they were not required to spend 10 hours with the older adults or to complete journals or letters to their future older selves, instead submitting a research paper on a topic related to course content. all students gave final presentations on the most important course learning and completed pre and posttests measuring self-rated geriatric competencies in the first and last class meetings. the university internal review board approved the research. the study was designed to determine the effect of the course on students’ ratings of their gerontology skills. in addition, the research explored students’ experiences interacting with older adults, in particular changes in their attitudes toward older adults and their own aging. participants thirteen students completed the course, with 11 choosing the service-learning project. twelve were female. seven were caucasian, three african american, two hispanic, and one asian american. eight were traditional students, while five were nontraditional. three majored in social work and one was a social work pre-major. other majors were psychology, urban and regional planning, exercise and sports science, recreation administration, health and wellness promotion, art, and health administration. nine students had minors, five in social work and four in gerontology. although 10 hours were required, the mean time students spent with their older adult partners was 19.2 hours (sd = 8.41), with a median of 16 hours and range of 10 to 36.5 hours. ten of the 11 service-learning students exceeded the required number of hours. non-service-learning students were female and of traditional age, one caucasian and one hispanic. they held majors in exercise/sports science and recreation administration, with one minor in social work and one in gerontology. jones/life is experienced until we die 98 measurement quantitative and qualitative measures were used to measure learning outcomes. students completed the geriatric social work competency scale ii (gswcs) (damronrodriguez, 2006) in the first and last class periods to measure students’ ratings of their gerontology skills. ratings were on the following likert scale: 0 (not skilled at all – i have no experience with this skill); 1 (beginning skill – i have to consciously work at this skill); 2 (moderate skill – this skill is becoming more integrated in my practice); 3 (advanced skill – this skill is done with confidence and is an integral part of my practice); and 4 (expert skill – i complete this skill with sufficient mastery to teach others). the scale’s 40 items describe skills important to social work with older adults in four domains of 10 items each: ethics and theoretical perspectives; assessment; intervention; and aging services, programs and policies. the maximum total score is 160 and 40 for each domain. the instrument has reported convergent validity and strong internal reliability (nakao, damron-rodriguez, lawrance, volland & bachrach, 2008). it has been used by the john a. hartford partnership program for aging education (social work leadership institute, 2010) to measure competencies of foundation graduate social work students. it was chosen as the appropriate measure because undergraduate social work majors are considered in the field to be learning material comparable to foundation level master’s students. the researcher also analyzed the content of student journals and final presentations on course learning using qualitative content analysis. after an initial reading to get a general sense of the content, journals and final presentation summaries were read several times to determine and confirm emerging themes and categories. the number of nonservice-learning students (n = 2) was too small for meaningful comparisons with servicelearning students. results quantitative means for domain and total scores on pretests and posttests were compared, using paired samples t-tests. as shown in table 1, posttest scores were significantly higher than pretest scores on total competency mean scores and the four domains. students progressed from initial ratings of having no or beginning skills to being moderately skilled at the course’s end. the largest increases in skill ratings were in the domains of assessment and aging services, programs and policies, which were initially the lowest rated domains. the smallest increase was in the values, ethics, and theories domain, which also had the highest ratings at the start and end of the course. because students’ number of contact hours varied, pearson’s correlations were computed for contact hours and mean competency scores. no significant correlations were found. advances in social work, spring 2011, 12(1) 99 table 1. pretest/posttest mean scores for all students (n = 13) mean scores significance geriatric social work competency scale pretest posttest values, ethics & theories 1.84 (0.71) 2.91 (0.53) t (12) = -4.18* assessment 1.07 (0.88) 2.70 (0.71) t (12) = -6.22** intervention 1.36 (0.85) 2.57 (0.93) t (12) = -4.92** services, programs & policies 1.05 (1.05) 2.56 (1.00) t (12) = -5.23** total scores 1.33 (0.77) 2.69 (0.73) t (12) = -5.84** note: standard deviations are in parentheses. *p <.01; **p <.001. qualitative qualitative data provided depth and indicated rich learning had occurred. the researcher examined students’ journals and final presentation summaries several times, extracting common themes. categories emerged from service-learning students’ journal entries, letters advising their 70-year old selves, and final journal entries summarizing what they had learned in the course. students’ final presentations on applications of course learning also generated common themes. journal: developmental process of relationship-building. an overarching theme in students’ journals was the developmental process of building relationships with older adults. subthemes emerged within each relationship phase. prior to the initial meeting, students described nervousness and anticipation, with fears of being boring, not knowing what to say, or having misunderstandings. they also described hopes and desires to be helpful and learn from older adults. one student noted, “he is 82 years old and would be the oldest person i have ever met – i am nervous about our interactions.” another student stated, “i hope to learn from her and prevent making the same mistakes she made.” they described class discussions and materials as helping them feel more prepared in areas of maintaining confidentiality, active listening, and showing respect. in describing the beginning phase of the relationship, three subthemes emerged. students were becoming more comfortable, as indicated by one student’s comment that “. . . the second meeting was much more vibrant … i feel that already she is getting more jones/life is experienced until we die 100 comfortable with me being around.” they also appeared to struggle with maintaining appropriate boundaries. one student stated, “i notice she has little control of her hands – should i ask? i’m glad we talked about this in class.” other examples of comments included a student who wrote, “i need to know when to keep my views to myself,” and “she asked me lots of questions and wanted to take me with her to church.” a third subtheme was the challenge to students’ beliefs about aging, indicated by comments in their journal entries that aging is not a disease, and that older adults can still learn, are not necessarily hard of hearing, and still have romantic lives. in the middle phase of the relationships, it was clear that many students were feeling closer to their map clients. one student reported, “we are getting to know one another more and more each day; our relationship has grown into a very open one.” another stated, “i look forward to our games during each visit – i have to say one of the highlights of visiting with my client is seeing her face light up when i get there because for that time she gets to do her favorite thing.” a third example was a student’s comment that, “i actually felt very close to mrs. x today – she and i really ‘let our hair down’ so to speak today. she is an endearing person and i am so glad i was matched with her.” students described helping clients with tasks of cleaning, organizing, setting up online account systems, shopping, and enrolling in home-delivered meals programs. they also observed psychological or physiological aspects of aging discussed in class. some students encountered barriers and frustrations as their involvement increased. one student wrote, “she was not there three times . . . asked her and she was embarrassed . . . maybe she needs a calendar.” another student described her struggle, “i’ve noticed that she is comfortable living in a cluttered and unclean environment … the amount of stuff she has accumulated would take days and weeks to remove or organize – i don’t understand this.” however, deeper understanding often followed, such as when the student later stated, “i realized that these things i thought was just stuff are her keepsakes and it reminds her of her past.” as they struggled with barriers, some students hit upon new ways to relate to their map clients. a student assigned to an older adult in a long-term care facility became frustrated with her partner’s reluctance to engage in conversation or participate in arts and crafts projects she planned. applying her skills as an urban and regional planning major, the student discovered a way to connect with the older adult. using a laptop computer and program that displayed current images of geographical locations, the student gave her map client a virtual tour of places that were meaningful to her. these included the home and church in which the older adult grew up, the campus of the university she attended, the nursing home where her sibling resided, and her child’s new business, all located in other states. the student reported that this activity thrilled her map client and brought new life to their interaction. as the semester concluded, students described feelings about ending with their map clients that revealed the attachments they had formed. for example, one student stated, “i wonder what will happen to him; there are just a few more weeks remaining for the semester,” and “our last visit was more difficult for me then i had originally anticipated.” many students decided to continue the relationships. they also wrote comments advances in social work, spring 2011, 12(1) 101 evaluating their experiences, such as, “we have built an open relationship – one i have not had sense the passing of my own grandmother,” and “working with ms. x will be an experience that will remain with me through my life – so much of what she has taught me and shared with me has been inspiring.” journal: racial, ethnic, and religious differences. experiencing and grappling with racial, ethnic, and religious differences were commonly discussed in student journals. students appeared to be at various levels of cultural competence and to increase cultural awareness, knowledge, and skills from their experiences. some students described increased awareness of cultural differences and reflected on biases in themselves and others. for example, an african american student went shopping with a caucasian client and was taken aback that the salesperson assumed they were not together. an asian american student confronted her stereotyped beliefs when she was surprised that a mexican american senior cooked healthy foods. in another situation, a caucasian student struggled to identify whose biases were involved when her caucasian map client complained that nursing facility staff members where she lived spoke only spanish around her. some students reported increased awareness of generational differences within the same ethnic group. for example, an african american student described discovering a difference with her african american map client: “she told me ‘race and culture only plays a significant role in your life if you are weak and let it’ – african american elderly i have grown up around set boundaries on their own freedom.” a caucasian student described being challenged in a different way when learning about generational differences from her african american map client: in my studies of racism i have found a lot of people that feel we aren’t doing enough to end racism, whereas mrs. x thinks the black youth don’t appreciate that they have a place in society and it’s nothing like when she was growing up – it was eye-opening to me and reminds me not to start thinking things are a particular way. journals also indicated students gained knowledge of other cultures from interacting with their map clients. a caucasian student paired with an american indian older adult described valuable learning from attending cultural events with her and discussing her beliefs. an asian american student applied knowledge of societal oppression in understanding her african american map client. she connected his deep distrust of medical professionals to discrimination he had encountered and historical uses of deceptive medical practices with persons of color. students also demonstrated culturally-informed interaction skills with their map clients. one example occurred in the introductory phone call, described by a caucasian student: jones/life is experienced until we die 102 the client said, ‘you need to know that i am black.’ i said okay, and that it won’t bother me if it doesn’t bother her and she laughed and thought that was good. . . i hope she has not had someone from the school discriminate when visiting. one african american student negotiated cultural differences with her caucasian map client at several points in the relationship. she initially reported comments indicating the older adult had little experience with people of other races. description of improvement followed: i believe my client has become more comfortable being around someone of a different culture and ethnicity. i believe that she is starting to see beyond the color of my skin and seeing me as an individual. she grew up during a different time than i have and she may still carry some prejudices and stereotypes but i can tell that she is making a conscious effort. the student then encountered a situation in which she felt treated like a servant or “white lady’s companion.” she questioned the validity of her perception, but set reasonable limits on the older adult’s expectations. the student worked hard to “keep the relationship in perspective,” since she believed the older adult saw herself as a mentor. at the semester’s end, the student recognized multiple realities in the situation, feeling “more like a protégé than a hired companion,” while also acknowledging structural inequities. a productive partnership was forged, while the student also made plans to advocate for the oppressed in the community. students also appeared to increase their awareness, knowledge, and skills in the area of religious differences. initially, many students noted that their map clients were active in their religions. one student explained, “the spiritual aspects of aging are going to be a new thing to me also since i was not raised under any strict religious guidelines.” they learned about different faiths and also demonstrated skills in this arena. for example, one student stated, “i am a religious person, but it is really important that i keep my beliefs and opinions about religion to myself.” another student noted, “we have different religious beliefs but i try to find common ground.” as relationships progressed, many students appreciated the important role religious communities played in clients’ lives, providing social and spiritual support, as well as meaning. journal: independence. students’ journal entries indicated an increased awareness of the importance of independence as one ages. they observed challenges to remaining independent and talked with their map clients about planning for the time when more care is needed. students noticed that older adults’ independence was affected by their home situations and that they preferred to live at home, even in a dysfunctional situation, rather than in a long-term facility. students also noticed financial concerns influencing independence, such as the comment, “she needed four additional prescriptions which has really set her back financially.” health status was a third factor of independence noted, as students observed the impact of health challenges. advances in social work, spring 2011, 12(1) 103 journal: family and social support. another pervasive theme in students’ journals was the importance of family and social support in later life. students observed the value of quality relationships with family and friends and their effect on the aging process. for example, one student wrote, “i believe that what she needs from me is for someone to pay her some attention, listen to her or be the daughter or grandchildren she does not get to see.” another student described, “she expresses her strong desire to let all of her family know she loves them and has appreciated them – it is so beautiful.” students saw pets as crucial in older adults’ support systems, such as the student who explained: the family has adopted a small dog for the house and i can see how it has had a positive effect on her. she remembers his name and picks him up and lets him lick her – she loves that dog. the dog has her reaching down and petting him and getting her to move around. advice to 70-year old self. in letters students wrote giving advice to themselves at age 70, several themes emerged that paralleled descriptions of their map clients’ aging. themes included physical self-care, staying active, managing independence/dependence, maintaining social and family relationships, financial planning, staying organized, benefits of pets, and having a positive attitude about aging. taking good care of their physical health was a strong subtheme in the advice, exemplified by the following statements: “take care of your body – you only have one;” “your body is not a prison, it is your vehicle in life as mrs. x advised you;” and “keep up with your doctor’s visits and follow your doctor’s instructions – this is extremely important – get plenty of exercise, go for a walk every day.” at times, the advice was for their younger selves: i am of course hoping that in the next 44 years there will be many scientific breakthroughs … however if science stays at a standstill then you will have to start now to live a healthy lifestyle and age gracefully. staying active was another subtheme in the advice letters. examples included: “although i may have some degenerative diseases does not mean that i cannot stay active;” “if you keep moving, motion is lotion to your bones, joints, and muscles;” and “i would advise you to always keep in touch with technology, it is your friend, it can make life easier and more enjoyable.” again, some advice was preventive: “i should develop and build more healthy activities today. i will start building the audio book library.” just as students observed independence as key for their map clients, students gave advice to their 70-year old selves about independence and accepting help, such as “i hope i continue to stay open minded so that i do not close out the help that is available to me.” another student advised, “remember that you can retain your independence while accepting assistance.” more specific advice came from an older student: “please allow others to help you when you truly need it; you know that if you need assistance getting jones/life is experienced until we die 104 organized, you cannot ask your children because they will not have the patience, so ask grandchildren.” practical advice included, “live in an area where you have access to groceries and doctors,” “give up driving when you are scared to drive, have had others mention that your driving is lousy, or by instinct know that it is time,” and “make sure you have a house you can get around in.” some students referred to psychological help for depression or grief, such as “… take the time and fully devote immediate attention to grief … seek out the counsel of a close friend, therapist, or pastor who is willing to listen … or just date the young ones so you go first.” students recognized the crucial role social relationships will play in their healthy aging, as they had observed in their map clients. several examples included, “i hope you are still pleasant to be around so that way you don’t get lonely,” and “don’t be the cliché grumpy old man like your grandpa was because kids will be afraid of that.” one student paired with a woman in a long-term care facility wrote, “make friends wherever you go especially in the lunchroom because that may be the only way to get a refill on tea.” staying involved in the community was also seen as important, exemplified by the comment, “make sure you are well connected to your environment like neighbors, friends or staff so you can be involved in plenty of activities and remain in people’s consideration.” one student wrote, “try to live in a town with a college so you can have student helpers like this.” maintaining ties with family was strong advice and sometimes preventive. one student stated, “i need to improve my relationships with others, such as with family and friends – as i get older i want to have a good support system and be a support to others.” another student’s comments summarized this advice: keep your family close – i hope in all these years you haven’t cut any ties with anyone in your family… it seems to me that family surrounds us when we enter this world and i hope that it is family that is surrounding us when we leave it. maintaining healthy boundaries was part of students’ advice about family relationships, sometimes humorously stated. for example, one student advised, “don’t let your children live with you when they can grow a beard.” another wrote: learn to say no to your children when they get older. know where your boundaries should be and stick to them. know that there is a time to help and a time to not. know and understand what an enabler is. student comments indicated an awareness that it was necessary to expand their circles of support since family may not be available. one student wrote “don’t let your age dictate the age of your friends – just as people come in all shapes and sizes so do friendships and that is what my client has shown me.” another comment expanded on this idea: i know you sometimes worried about having a relationship with your children but your client has showed you that it isn’t necessarily your blood family who are the ones who you have a close relationship with but those who you have mentored over the years and adopted who have now become your family. advances in social work, spring 2011, 12(1) 105 finances and future planning were also seen as essential. warnings to save money and stay out of debt were common, such as, “if i save up money now, i will be more secure when social security runs out,” “begin investing more money immediately after college … wean your friends and relatives off now,” and “plan ahead no matter how morbid you think it is.” organization and clutter was a minor theme. advice included, “buy a scanner and shred” and “i beg of you to not keep so many things around.” one student offered practical advice after helping her map client decorate for the holidays, “keep christmas lights on the cardboard.” based on observations of pets helping older adults, students recommended pets for their old age. one student wrote, “find time to involve myself with animals … the joy they bring her is more than can be explained and i hope that i can have that same companionship.” other students made decisions about specific pets they would get, exemplified by this statement, “70-year old self, first things first you’re going to get a dog whether you want one or not – it will improve your mood and give you companionship when there is no one around to visit with you.” students offered recommendations on keeping positive attitudes about aging. examples included, “life does not end when you get ‘old’, only that the challenges in life change” and “i must keep a ‘can-do’ attitude and try new opportunities.” one student decided, “i want to make a promise to myself that i never quit on life.” another advised, “keep painting your toe nails funky colors and be the cool grandma.” finally, a student recommended the following: enjoy the sunshine and the fact that you have two functioning legs on which to walk on. love and live life to the fullest and don’t let a day go by that you do not mention something that you are thankful for… keep on laughing never lose your sense of humor because you are definitely going to need it. final journal entry: what i learned. in their final journal entries, students summarized what they learned from interacting with their map clients. several themes emerged. patience was a consistent theme in what students stated they learned from the experience. for example, “it has shown me the value in taking my time so things are done correctly.” once again, the importance of personal and professional relationships came through as a theme in student learning. one student described, “my client has taught me that the relationships you build with other people can last a life time whether they are good or bad.” another stated, “i have learned that building healthy relationships are important when being a social worker – if you do not build healthy relationships with your clients they will not open up to you.” a third student remarked, “it only takes a little bit of time to improve someone’s quality of life.” jones/life is experienced until we die 106 many students described acquiring skills in relating to older adults. they described becoming good listeners and taking into consideration physical limitations. some were more specific, such as, “i have learned how to interact with someone in early stages of dementia.” another student described learning to be more attentive and present: i was a task master with this map client and one day he said to me, hush and just slow down. you worry too much and you do too much. i did not realize this because i thought that’s what he needed me for, which is to get things done. wrong! students also reported expanding their knowledge of aging processes, individual differences, and faulty stereotypes. examples were: “it is good to know that depression is not a normal aging process;” “i also believe that we learn until we die. i have also seen that life didn’t take my client down the road that she had visualized;” and “physical ailments as well as mental do not stop one from living – age is not a disease or a disaster, only an extension of our life.” final presentations: application of course learning all students gave brief presentations at the end of the course reporting how they will apply their learning to two areas, the first being their own aging. they described decisions to change current physical health habits (eating, exercise), to focus on relationships so they are not alone in old age, and to plan practically for their later years. they also described changes in attitudes about aging, feeling more optimistic about the aging process, as well as fearing death less than before. some described learning the necessity of preparing financially for old age. the second area addressed application of what they learned to interactions with older adults. most students described building healthy and meaningful relationships with older adults, particularly listening well, being sensitive and patient, respecting and valuing them, and focusing on the person when dementia takes over. one student wrote: learning how to build this relationship was huge step for me because i have always been afraid of conversation with the elderly. i feared that i would not be able to relate to them, but now i am certain i can do it. some students described increasing their knowledge of elder abuse and learning the importance of including older adults in decisions concerning them. one student stated, “the one most important thing i am taking away from this course that i will use when interacting with older adults is that they were just like me at one point and i will be just like them at some point.” changes in future plans in journal entries or final presentations, students indicated changes in future plans as a result of the course. one student described an overall impact: “i have gained more knowledge in talking with her about her life and the obstacles that she has overcome and in doing so have reexamined my own life and the direction i would like to go.” others described plans to become advocates for older adults, particularly for elder-friendly advances in social work, spring 2011, 12(1) 107 communities. one student decided to involve her community service organization in a volunteer arts and crafts project at the nursing home. she also became involved in forming a student gerontology club the following semester. ten of thirteen students indicated some movement toward gerontology careers. one student indicated a definite new decision to work in the field of dementia care, announcing she had obtained a job in a dementia care facility and found her career path. the student least certain about change indicated she began the course only wanting to work with children but now would not limit herself. five students described confirmation or increased clarity about their decisions to work in gerontology. of these, two narrowed their interests to long-term care, exemplified by this statement, “now i know what my next set of goals will be after i receive my lcsw – i am going to look into opening my own long term care facility.” three students described increased interest in gerontology work. for example, one student decided to explore “where i can take my career to change the way america sees the elderly, nursing homes, and their involvement and place in the physical community and society.” another student stated, “this semester the experience with our map client … has moved me closer to working with the older adult by way of seeing that life is experienced until we die.” discussion several findings from this study have potential importance for gerontology education, given the limitations of the small non-representative sample and use of self-report instruments. results suggest that intergenerational service-learning in social work can be a valuable pedagogy. through relationships with older adults, guided reflections, and assignments tying experiences to course objectives, rich learning occurred. significant improvement was reported in gerontology competency skill ratings and many areas found by others (brown & roodin, 2001; cohen, hatchett & eastridge, 2006; vandsberger & wakefield, 2005). career plans were reconsidered, confirmed, or refined, with most students describing plans to use the skills learned in their chosen fields, similar to findings of vandsberger and wakefield. students appeared to progress on the continuum of interest in aging outlined by gorelik, damron-rodriguez, funderbunk, and solomon (2000), and these findings support their suggestion for gerontology courses that include interactions with older adults to be offered to undergraduates. further research needs to include essential components of intergenerational service-learning outlined in the literature that tie experiences to course objectives, distinguishing it from experiential learning and internships. in this way, a body of work can be built based on a common definition. a scale measuring career plan movement could also capture such changes quantitatively. findings suggest that a tool such as the geriatric social work competency scale is promising as an effective measure of student ratings of gerontology skill development. the scale could be used to compare effectiveness of teaching methods and measure levels of increasingly advanced skills in gerontology programs. the posttest ratings in this study were in the moderate range, compared to the advanced ratings of the graduate students in the study by dauenhauer, steitz, aponte, and faria (2010), suggesting a progression through educational levels may be measured. although more research is needed using the jones/life is experienced until we die 108 scale, this study suggests its use should be studied at the undergraduate level. including independent ratings of student competencies and feedback from older adult participants may produce a fuller picture of student outcomes. as social work education becomes increasingly competency-based, the gswcs is also a potentially useful tool to demonstrate social work programs’ compliance with accreditation standards. competencies measured in the gswcs are compatible with the 2008 educational policies and accreditation standards (epas) of the council on social work education (cswe), used to guide social work educational curricula (cswe, 2008). many skills listed in the gswcs overlap with cswe standards, as applied specifically to work with older adults. measuring gerontology competencies could therefore demonstrate student learning outcomes. intergenerational service-learning may enable students to demonstrate many competencies in actual relationships rather than in case studies. for example, educational policy (ep) 2.1.1 (p.3), which focuses on identifying and behaving as a professional social worker, outlines the importance of personal reflection, professional boundary management, and career-long learning, all of which students had the opportunity to practice in this course. another key area in which students demonstrated competencies is ep 2.1.4, which involves diversity in practice (p.4, 5). students in this course demonstrated positive learning outcomes described in many components of this standard, as they engaged diversity on multiple levels in interactions with map clients. students also demonstrated skills of engagement, assessment, and intervention described in ep 2.1.10 (p.6, 7), applied knowledge of human behavior in social environment (ep 2.1.7, p. 6) and analyzed policies affecting older adults’ well-being (ep 2.1.8, p.6). the relationship-building process was a significant theme in the qualitative findings, supporting the notion that a one-on-one relationship with an older adult is a significant aspect of gerontological service-learning (dauenhauer, steitz, aponte, & faria, 2010; vandsberger & wakefield, 2005). assisting students through the phases of relationshipbuilding is therefore warranted to ensure positive experiences for all. practical guidance for the initial interview and maintaining boundaries, as well as role plays may help students allay early anxieties and gain confidence in their abilities, as suggested by others (blieszner & artale, 2001; brown & roodin, 2001; laganà, 2003). attending to frustrations and barriers as relationships progress may deepen students’ understanding of older adults and prevent misunderstandings. students also may need assistance negotiating the ending process. research of effective methods of fostering relationships in intergenerational service-learning could contribute to its success. an important finding was that student letters to themselves at age 70 fostered intentional connections of course learning to planning for their own aging, with positive results. this assignment set the stage for students to expect reciprocal learning and to gain personally from the experience. tying course material to students’ personal lives also appeared to enliven classroom discussions. this student group entered with fairly high interest in gerontology, given the number with gerontology minors and interest in the field. however, guided reflections that focus on students’ aging processes, within the context of intergenerational relationships, may contribute to overcoming reluctance of advances in social work, spring 2011, 12(1) 109 younger, less interested students by making the material personally relevant. research in this area is sparse and may be productive to investigate further. another key finding was students’ learning about cultural differences. the servicelearning project offered rich opportunities to increase cultural awareness, knowledge, and skills. the potential for this type of learning is invaluable for students at all points along the cultural competency continuum. in a review of culturally competent social work practice, kohli, huber, and faul (2010) recommended that students be “immersed in cultural experiences where they observe the uniqueness of every individual” (p. 268). intentionally matching students and older adults to enhance cross-cultural learning is one way to provide such opportunities and prepare students for work with diverse older adult populations. more focused investigation is needed into cultural aspects of intergenerational service-learning, specifically in social work. sanders, mcfarland, and bartolli (2003) advocated for specific measures of changes in students’ perceptions of cultural differences. measurement of cultural knowledge and skills would also be valuable, as would research that includes experiences of students from oppressed populations who encounter prejudicial attitudes in older adults during service-learning projects. the substantial time requirement for faculty and students in implementing servicelearning projects has been described as a barrier (hegeman, horowitz, tepper, pillemer, & schultz, 2002; rocha, 2000). the university program that located and assessed the needs of community-dwelling older adults and matched them with students was invaluable. as suggested by king (2003), advocating for such institutional support is highly recommended. for student time investment, ten to thirty hours seemed adequate for these students to significantly increase competency ratings and experience qualitative changes. within this range, number of hours did not seem to affect competency ratings. interestingly, the student who spent 10 hours made the most decisive career change. ten hours appeared feasible to students initially, perhaps contributing to their willingness to participate, and many chose to invest more time. of the many variables that potentially impact outcomes in service-learning projects, number of contact hours may be worth further investigation to inform future project planning. service-learning in gerontology education has the potential to open students’ minds to the complex realities of aging, for others and themselves, and to increase their competence in building productive relationships with older adults across a broad spectrum of diversity. as one student put it, “i have learned a lot about older adults through my meetings with my map client that you would not have gotten out of reading a textbook.” as such, the needs of the growing older adult population, social work profession, and society compel further development and study of the effective components of gerontology service-learning. jones/life is experienced until we die 110 references anstee, j. l. k., harris, s. g., pruitt, k. d., & sugar, j. a. 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(2000). evaluating experiential teaching methods in a policy practice course: the case for service-learning to increase political participation. journal of social work education, 36(1), 53-61. sanders, s., mcfarland, p., & bartolli, j. s. (2003). the impact of cross-cultural servicelearning on undergraduate social work students’ perceptions of culture, race, and economic justice. the journal of baccalaureate social work, 9(1), 19-40. singleton, j. l. (2007). taking the class to the community with service-learning: gerontological macro social work practice. journal of gerontological social work, 50(1/2), 105-118. social work leadership institute. (2010). the hartford partnership program for aging education. retrieved from http://www.socialworkleadership.org. jones/life is experienced until we die 112 vandsberger, e., & wakefield, m. (2005). service learning with rural older adults: effects on students’ career perspectives in gerontology. journal of intergenerational relationships, 3(4), 83-97. williams, n. r., king, m., & koob, j. j. (2002). social work students go to camp: the effects of service-learning on perceived self-efficacy. journal of teaching in social work, 22(3/4), 55 – 70. author’s note: address correspondence to: sally hill jones, ph.d., associate professor, school of social work, texas state university, 601 university drive, san marcos, tx 78666. email: sh29@txstate.edu microsoft word nedegaard article final bb ___________ randall c. nedegaard, ph.d., (retired lieutenant colonel usaf) is an assistant professor, department of social work, university of north dakota. major rachel e. foster, ph.d., is a united states air force officer, clinical social work, stationed at joint base anacostia-bolling, washington, dc. lieutenant commander mercy yeboah-ampadu, msc.ss, rsw, is a senior social work officer in the canadian forces stationed at canadian forces base edmonton. captain andrew j. stubbs, rmn, dip mh, bsc (hons), is a british army mental health officer based at queen elizabeth barracks, strensall, york, england. the opinions expressed in this article are the authors’ and should not be interpreted as the policy or opinions of the united states air force, canadian forces, or the british army. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 98-111 lessons learned in afghanistan: a multi-national military mental health perspective randall c. nedegaard rachel e. foster mercy yeboah-ampadu andrew j. stubbs abstract: america has been at war for almost 10 years. because of this, continuing missions in the middle east require the support and cooperation of our allied north atlantic treaty organization (nato) forces from around the world. in this paper we provide an overview of the mission at kandahar air field (kaf) and the multi-national role 3 hospital located at kaf. next, we explain the mental health capabilities and unique perspectives among our teammates from canada, great britain, and the united states to include a discussion of the relevant cross-cultural differences between us. within this framework we also provide an overview of the mental health clientele seen at kaf during the period of april 2009 through september 2009. finally, we discuss the successes, limitations, and lessons learned during our deployment to kandahar, afghanistan. keywords: multi-national, military, mental health, deployment introduction america has been at war for almost 10 years. shortly after the attacks on the united states on september 11th, 2001, operation enduring freedom (oef) began on october 7, of that same year. this started with aerial bombings in afghanistan by american and british forces in an attempt to end worldwide terrorism. in december 2001 the united states (us) and her allies (specifically the united kingdom, germany, and the northern alliance) had received intelligence reports that the leader of terrorist operations, osama bin laden, was directing operations from the rugged mountains of tora bora in the nangarhar province of afghanistan. efforts to capture osama were lost despite the battle waged there. on march 2, 2002, the us military and other countries that comprise the north atlantic treaty organization (nato), to include the afghan national army, canada, united kingdom, germany, france, australia, new zealand, norway, and denmark launched operation anaconda in an attempt to destroy al-qaeda and taliban forces in the shahi-kot valley of the paktia province of afghanistan. operation anaconda ended on nedegaard, foster, yeboah-ampadu, stubbs/lessons learned in afghanistan 99   march 16, 2002 with reports of over 500 taliban forces killed. despite this, osama bin laden continued to evade capture. soon after these initial conflicts with afghanistan, the us presidential administration under george w. bush, along with the united kingdom (uk), launched operation iraqi freedom (oif) on march 20, 2003. these countries shifted their focus to iraq based on their suspicions of that country’s involvement of employing weapons of mass destruction. after capturing the president of iraq, saddam hussein, and charging him with war crimes, nato turned its attention to securing iraq as a free democracy. eight years later, us president barrack obama renamed this initiative operation new dawn to reflect the ongoing withdrawal of nato’s military presence in iraq. despite the drawdown of oif, oef continues. as part of oef, kandahar airfield (kaf), which was once controlled by taliban forces, is now a nato base. the primary mission of the nato forces is called international security assistance force (isaf). true to the original intent of 9/11, isafs goal is to help build a democratic and free afghanistan that is devoid of oppression and terrorism. multiple oef operations are based out of kaf and over 45 countries are represented there. it is at kandahar, and the surrounding forward operating bases (fobs) and combat outposts (cops) near kandahar, that represent the focus of our work for this paper. kandahar air field nato has divided afghanistan into four regional commands. regional commands north, south, east, and west. kandahar airfield (kaf) is the headquarters for regional command – south (rc-s). our team was deployed together at kandahar in the summer and fall of 2009 and was responsible for nearly all mental health support in rc-s. in the summer of 2009, there were only 1-2 more military mental health providers mobilized in rc-s with their respective military units in order to provide services to those specific units. this was during the time of a massive us troop build-up in afghanistan that started in the spring of 2009. according to isaf statistics, the approximate rc-s troop strength in april 2009 was 22,830 (isaf, 2011). this nato troop strength was more than doubled in less than one year. isaf reported a rc-s troop strength of 45,100 in february 2010. deployment of the medical and mental health assets needed to support this burgeoning troop population originally lagged behind, leading to significant increases in workload. productivity in terms of medical and mental health encounters was at an alltime high for oef, leaving the medical services in place to shoulder the additional burden until reinforcements could arrive. kandahar role 3 hospital there are four levels of medical care that wounded soldiers may receive from their time in the battlefield, all the way home to their respective countries. nato has a developed common system of identification that assigns medical treatment facilities, or ‘roles,’ that correspond with the levels of medical care each provides (department of national defence canada, 2010). role 1 medical facilities provide primary health care to include services in specialized first aid, triage of casualties, resuscitation, and advances in social work, spring 2012, 13(1) 100    stabilization. role 2 medical facilities have the capacity to provide a higher level of treatment and care than the role 1. role 3 medical facilities are trauma level hospitals located in the deployed setting. they offer primary care services, surgical facilities, intensive care units, medical-surgical wards, diagnostic support and other in/outpatient services such as pharmacy, dental clinics, mental health services, and physical therapy. this was the case of the role 3 multinational medical unit at kaf (role 3 mmu) during the time of our deployment in 2009. role 4 medical facilities provide a broad spectrum of medical care and cannot be deployed in a combat theatre such as a local hospital found in most western nations. if required, soldiers are evacuated to role 4 medical facilities to their home nations. the role 3 mmu is organized into four components: (a) in-patient care; (b) clinical support; (c) primary care; and (d) administration. in-patient care is composed of the operating room, an intensive care unit, trauma bays, and the acute care ward. mental health services, pharmacy, x-ray, and laboratory services falls under clinical support. primary care was responsible for physical therapy, dental services, preventive medicine, and the unit medical services. from 2006 to october 2009 canada was the lead nation commanding the role 3 mmu at the kaf. during this time period the role 3 mmu treated over 42,000 patients, performing an estimated 4,500 surgeries and admitting more than 3,600 patients (department of national defence canada, 2010). the role 3 mmu provided care to nato forces, afghan security forces as well as to civilian contract employees and local nationals who had been injured as result of the conflict. the most unique aspect of the role 3 mmu was its multinational workforce. medical personnel, allied health professionals, and support staff from canada, us, uk, new zealand, australia, germany, denmark, and the netherlands ensured the highest levels of care to patients (department of national defence canada, 2009). mental health capabilities at kandahar kandahar is the transportation hub of rc-s. most fixed wing aircraft and rotary (helicopter) flying was done between kandahar and the outlying fobs or cops. when a soldier needed the care of a mental health professional, they had the option of being flown into kaf if space was available. otherwise, their unit leadership could call the mental health providers at the role 3 to request that someone come to their location and provide services for their troops. this could be problematic, because it might take a soldier upwards of one week to fly from their location to kandahar, get the short-term mental health support they needed, and return to their unit. our team experienced similar travel challenges when we went to the fobs as these trips averaged a minimum of 3 days or more, leaving the role 3 mental health team back at kaf to cover the workload short staffed. mental health care has been an integral part of medical care provided at the role 3 mmu kaf. the mental health department was designated as an outpatient service under primary care. despite this, it offered 24-hour services as mandated by the role 3 mmu kaf mission. the permanent team consisted of four canadian mental health clinicians; nedegaard, foster, yeboah-ampadu, stubbs/lessons learned in afghanistan 101   one civilian psychiatrist, one senior social work officer, one junior social work officer and one mental health nurse officer. additionally, one mental health nurse officer from the uk was assigned to the role 3 mmu. finally, a combat stress control (csc) team from the us air force was attached (lended) to the role 3 mmu and included either a social work officer or a psychologist officer and a mental health technician. this small team was responsible for the provision of mental health care for an expanding population of over 25,000 people at kaf and to canadian forces located at fobs. together, the mental health providers were able to form a cohesive team and pool resources to provide a high quality of mental health care to service users of all nationalities who spoke english or french. the us is unique in that it employs mental health technicians. these are enlisted members of the armed forces who are not required to have any formal training in mental health before they enlist in the military. they are sent to a mental health technical school training program after they complete basic training and receive a great deal of on-the-job training at their respective bases of assignment once they complete technical school. in essence, they are provider extenders and supporters. the us teams typically deploy mental health technicians with their mental health providers so that there are one or two technicians supporting each provider. because this model is somewhat unique within nato, canadian and british providers needed to be trained as to how best to utilize the support of us mental health technicians. challenges unique to the international environment each country also has a unique approach to deployed mental health care and this created challenges for the team when treating members from another country. for example, there were vastly different standards for repatriation of military members depending on the country. this was a particular challenge for the team when, for example, a significant number of canadian soldiers whom the team treated did not meet the canadian standard for deployment fitness according to our psychiatrist but were denied repatriation home because they were commanded by us officers who applied a us treatment philosophy to these situations. in the canadian forces, a recommendation by a psychiatrist or a physician was normally accepted and substantiated by the senior medical advisor who advises command. this routinely leads to final approval by the joint task force commander and the soldier was medically repatriated. this difference in policy among the various countries meant that the mental health team had to manage more clients with poor functioning and/or chronic, severe mental health issues than the team was designed and trained for. this forced a focus on symptom management rather than problem resolution when dealing with long-term clientele, further compelling the team to provide on-going care as needed rather than engage the brief therapy models that are more widely embraced by the canadian and british military forces. this approach was selected largely because most us military members were going to remain in theatre for extended periods of time and many adjustment problems, family challenges and even some mood disorders such as depression would not completely resolve themselves unless they returned home. advances in social work, spring 2012, 13(1) 102    confidentiality was also a challenge in this international environment. for example, patient information is deemed confidential and is protected under federal legislation for the canadian forces. the only information that can be communicated to commanding officers are the soldier’s employment limitations (e.g., cannot lift more than 15 1bs x 10 days). any other medical or social work information requires the expressed voluntary written consent of the member and the member can refuse to sign consent. the non-us members of our mental health team were challenged by being required to comply with a us uniformed code of military justice (ucmj) they were unfamiliar with. the disclosure of drug use, homosexual orientation, and other violations of the ucmj had to be disclosed to their command and the member could be reprimanded as was indicated on the us consent to treatment forms that were used for all us forces. in canada, the disclosure of such information during the therapeutic process is protected and only discussed with the medical team that places members on employment restrictions as needed. obliging mental health clinicians to violate patient trust by disclosing information communicated in therapeutic setting with the potential of punishment is viewed as contrary to the goals of the therapeutic process and professional standards of mental health practice. this is in no way a criticism of us military policies, rather a demonstration of the different needs of each military organization and their requirements and the challenges of working with other nations in a multinational context. deployment screening criteria is also different among nato countries. this is true among the us forces (army, air force, navy, and marines) as well, adding to the complexity of how many mental health needs a particular military member can have and still remain deployed. these differences create diverse and layered complexities in terms of expectations and diagnosis for military members in which the multinational team had to navigate. for example, us soldiers with attention deficit hyperactivity disorder taking prescribed medication for their condition is something that would likely disqualify canadian or british forces from military service. the stigma associated with mental health services is a problem for members of all military services, despite the country of origin. interestingly, stigma did not appear to be as problematic for the american soldiers seen at the role 3 and they seemed to be more willing to engage in mental health work than the canadian or british. the british are working hard to eliminate stigma and the trauma risk management program supports lowering stigma, but we speculate that, as a nation, the british have not embraced 'therapy' in the same way the americans have and an element of 'stiff upper lip' still remains. a further difficulty was that the british forces were only seen by their own mental health team, which caused a splitting of time between the nato work in the role 3 and the duties to see the british forces mainly at the british role 1 facility for the british provider. the british deploy three mental health nurses to cover the needs of a british deployed population of between 8,000 and 10,000. british mental health nurses are expected to pay ‘house calls’ to the royal air force regiment who guarded kaf, and the black watch regiment who were stationed at kaf. a further duty was to attend to the troops in kabul, which was some 300 miles away, as well as briefings for all troops coming into theatre and going home. the primary mental health philosophy of the british nedegaard, foster, yeboah-ampadu, stubbs/lessons learned in afghanistan 103   forces is known as trauma risk management (trim). trim is a system first used by the royal marines and is now well embedded into the british fighting operations (frappell-cooke, gulina, green, hacker-hughes, & greenberg, 2010). trim is a system of peer-support that operates through trained personnel within operational units who are trained to recognize psychological issues and facilitate social support (greenberg, langston, everitt, iversen, fear, jones, & wessley, 2010). this allows for mental health care to be assessed and in part delivered without the need for professional mental health practitioners to be present. if a need arises then the trim personnel can contact the british field mental health team for support. further to this system, the treatment options for the british are different from the us and canadian models. within the nato mental health team there was a facility for the us and canadian troops to have access to a psychiatrist and the possibility of a number of different medications to be prescribed. this was not the case for the british forces as they cannot be in theatre with prescribed medication for mental health issues. this left the uk with limited treatment options and the use of short-term therapy, some very limited sleeping medication or just rest and ‘watchful waiting’ could be used before the patient would be repatriated for treatment back in the uk. the us employs a philosophy of providing services as far forward as possible, enabling combat assets to remain in theater as long as possible and hopefully to complete their deployment and redeploy back home with their respective units. this philosophy is markedly different than other nato countries. when we combine this with the fact that the us had roughly 50% (isaf, 2011) of the combat troops in isaf in 2009, this leads to an inordinate number of us troops being served in theatre as is evidenced by the figures above. this began to overwhelm nato mental health care resources as these countries had only deployed the assets they needed for their military populations given their treatment philosophies. this had the possibility of building resentment as these nato providers ended up having very limited time to service troops from their own countries. similar to the us and uk approaches, canada uses the general principles of proximity, immediacy, and expectancy (pie) to treat other mental health and psychosocial presentations. the pie approach was designed to reduce the soldier’s sense of having to escape fighting and return home. thus the proximity of care was close to the battle lines. staying close to the battle lines allowed the soldier to stay in contact with their unit and maintain a sense of belonging and cohesiveness with their unit; a vital element in mission effectiveness. symptoms are normalized and treatment is immediate to reduce the development of, or the long-term effects of symptoms. during the time of treatment, the soldier received constant reassurance and communication from the medical providers, the chain of command, and their fellow soldiers that there was an expectancy of recovery and return to work. consistent with the principles of pie, the canadian forces (cf) approach to mental health is the preservation of personnel and support to families through early intervention, use of chaplain and social work services, and use of family support services on bases and in the community. however, in a combat zone such as afghanistan, the resources available to mental health clinicians and medical staff are limited. as a result, there is much less flexibility in the intensity and duration of care compared to what can be advances in social work, spring 2012, 13(1) 104    provided at home bases. therefore, the canadian approach to mental health care is brief intervention. service personnel who require more psychiatric care or psychosocial services and could not be returned to duty within a specific number of days were normally repatriated home through the medical chain of command. this was because a replacement had to be notified and deployed in a way that caused least disruption to the mission. each deployed unit has a reserve of personnel who can replace most occupations. there were only a handful of jobs for which no replacements were available. due to the small size of the canadian forces (cf) and the integrated nature of its elements under one umbrella or force, most clinicians are able to forge relationships with the multiple command levels and their respective leaders of the deployed battle group. this close working relationship facilitated open communication and problem solving as an early intervention in dealing with challenging canadian soldiers seeking mental health care. this type of intervention is highly encouraged within the cf model of patient care as it reduces the numbers of mental health and psychosocial repatriation. it also reduces an adversarial stance between medical professionals and unit commanders and instead promotes a partnership that seeks to balance the needs of the member with the operational requirements. communication with the medical chain and unit commanders is designed to be regular and consistent. in the cf it is extremely rare that a supervisor or commander will go against a medical recommendation or a well-substantiated social work recommendation that offers a clear a supportable plan as these decisions are often made after exhausting other alternatives. medical and psychosocial fitness for deployment are constantly evaluated at each interview with the core principle of pie underlying each intervention. overview of patients – who did we see interestingly, combat stress reactions were not the predominant complaint among patients interviewed by the mental health team during the 2009 deployment. the majority of cases seen at the mental health clinic were related to depression and anxiety and adjustment issues related to military induced separations (table 1) and the majority of cases were us soldiers as they constituted at least half of the fighting force and are deployed for the longest time (table 2). nedegaard, foster, yeboah-ampadu, stubbs/lessons learned in afghanistan 105   table 1. mental health visits by category (april 2009 – september 2009) in the combined role 3 multinational medical unit combat/operational stress 135 (06%) ptsd/asd 245 (11%) depression or anxiety 623 (28%) mental health issue not previously specified 111 (05%) stress or adjustment issues 401 (18%) partner or family issue 133 (06%) behavioral or occupational problem 156 (07%) military acute concussion evaluation 131 (06%) brief contact 201 (09%) other 89 (04%) table 2. mental health visits by nation (april 2009 – september 2009) in the combined role 3 multinational medical unit april 09 may 09 june 09 july 09 aug 09 sept 09 us 154 241 242 277 382 292 canadian 115 98 173 140 110 142 other 7 12 1 16 8 17 0 50 100 150 200 250 300 350 400 450 apr 09 may 09 june 09 july 09 aug 09 sep 09 us canadian other advances in social work, spring 2012, 13(1) 106    limitations of the treatment environment as with any deployed setting, there were natural limitations of the treatment environment. the immense heat of the summer in southern afghanistan makes for an oppressive setting. it also makes any kind of intervention very challenging to conduct outdoors if inside space is not available. as previously mentioned, space and a relative lack of privacy were often problematic and this was the case at the vast majority of military bases throughout afghanistan. we also endured multiple rocket attacks. when rocket attacks occurred, the airfield was mostly shut down so that residents could shelter in bunkers to increase safety. this occurred during multiple sessions and was highly disruptive of not only that session, but of the appointment schedule overall. understandably, the role 3 hospital at kaf was located directly next to the very busy flight line so that wounded troops could be transported as quickly as possible. unfortunately, this meant that the noise level was frequently very loud and conducting interviews was challenging at those times. this location was also difficult to access for many of our patients who were stationed at kandahar as the flight line is located near one edge of the airfield. unlike the smaller fobs and cops, kandahar is a vast base where transportation on the base is very limited. this meant that some of our patients would have to walk for more than an hour in intense heat just to be seen and served as a significant disincentive to seek care. the final challenge/limitation of seeing patients in a combat environment has to do with carrying a weapon. us and canadian forces are required to be armed at all times while deployed in order to support the defense of the base. many times we would see troops who expressed significant suicidal and homicidal ideation and they would have their weapon on their person or right beside them. this occasionally led to some uncomfortable situations, especially considering the fact that a us army soldier had been recently charged (may 2009) with killing five service people, two of which were mental health providers, after opening fire at a mental health facility in iraq where he was being treated for combat stress. later, concerns from patients were voiced about providers carrying weapons after the tragic fort hood shooting done by an army psychiatrist who was scheduled to deploy with a combat stress detachment to rc-s. the rotating nature of deployment always is a challenge for continuity of care and team stability. canadian military members have 6 month deployments with the exception of the contract psychiatrist who could work for as little as 3 months before returning home. british providers had 3-month deployments and the usaf deployments were 6 months. this created challenges in developing and maintaining a cohesive team, especially when you consider these deployments were staggered so the teams were normally consistent for the duration of a month or two. strengths and successes our team was able to overcome many of the obstacles listed above and experienced several strengths and successes. we met every morning to coordinate the schedule and to discuss challenging cases. this helped to instill a common purpose of goals and mission for the team. we tried to help each other accomplish the mission, strengthening the team. nedegaard, foster, yeboah-ampadu, stubbs/lessons learned in afghanistan 107   if needed, we covered for each other, shared space, and tried to put the team in front of our personal needs. this increased morale and built cohesion. we also spent some time as a team while we were off duty, celebrating or relaxing together. the team had a broad range of experience and we shared this with one another. this occurred because we expressed interest and were willing to share the different points of view we had as a result of our differences in professional training, culture, and military experiences. goodnatured teasing and competition based on these differences was evident throughout our time together. we were also fortunate enough to have a contract psychiatrist who was a retired officer in the canadian forces so we had some common bonds in place as opposed to previous contract psychiatrists who had very limited experience with military members. perhaps one of the greatest successes was the productivity of the team. productivity was arguably the highest it had ever been. in fact, it was 35% larger (2225 contacts for apr 09 sep 09) than the average of the previous two 6-month rotations (apr 08 sep 08 = 1426 and oct 08 mar 09 = 1849). data was not available for rotations prior to april 2008. this sharp spike in the demand for services came as a result of rc-s absorbing a significant percentage of the large us troop surge that was ordered by the obama administration earlier that same year. because the deployment of mental health support services lagged behind this surge, we had to pull together as a team in order to manage this increased demand. good communication and coordination of services was no longer a luxury, but a rather was a necessity. this resulted in better quality of care for our patients, more useful discussion about treatment options and, most importantly, a reduced wariness of our coalition forces patients to be treated by a provider not from one’s own country. this was especially helpful for us troops, since the number of nato mental health providers at kandahar far outnumbered the available us mental health providers. this team focus also led to the admission of the first multi-national troop to the freedom restoration center located in rc-east. this was the only restoration center in afghanistan at the time and had served only us military personnel prior to this point. this program, run by the us combat stress control detachment at bagram airfield, is a 3-5 day program that gives service members a break from their stressful situations and return to their units more rested and better able to cope. one of the main tests to the joint working environment came when there was a helicopter crash on the flight line killing 16 people and traumatizing many involved in the rescue effort. the base commander requested a response from the mental health team. the team facilitated visits to the fire service, ambulance service, and various personnel (both military and civilian) who witnessed this tragedy. despite the fact that no precedent was in place for the team to follow for such an incident, our cohesion allowed us to quickly and decisively implement an effective plan, each member providing important contributions to our approach. for example, the uk provider noted that under the uk national institute for health and clinical excellence (nice) guidelines, single incident debriefing was not indicated for this type of disaster and had the potential to make the situation worse (nice, 2005). this recommendation was quickly adopted by the team and was incorporated into our response. advances in social work, spring 2012, 13(1) 108    all of these factors led to a more balanced effort on the part of the entire team and superseded insignificant issues such as who might be working harder, had better work space, or was a team player. the bonds developed in a period of two to three short months together led to lasting camaraderie post-deployment, as is evidenced by the combined authorship of this manuscript. lessons learned several lessons were learned from this experience, perhaps the most important being the value of putting aside differences in order to accomplish a larger goal of better service to our clientele. in order for coalition forces of any kind to be successful, the focus had to be on the larger team. among the differences to be put aside are things like rank. within the larger mental health team, rank has very little value. this is not to say that rank does not have a vital place within the context of the military, but in a setting like this one, it can create barriers. large differences in rank can produce uneasiness and excessive formality within a military team and these barriers can take a great deal of time to overcome. in our situation, time was of the essence. even the team leader worked to build consensus rather than be directive when this was possible. openness about differences proved to be vital as well. as a team, we needed to have a solid understanding of the differences in situation and philosophy for each of our members. by asking questions and honestly sharing our answers, there was an increased appreciation for the multiple roles we all had to play as well as a better understanding of the unique pressures we each faced within those roles. in social work education, we push our students to learn how to practice cultural competence and embrace the differences within the clients we serve. this situation required us to do that not just with our clients, but with our co-workers as well. working together, we used each other’s knowledge base as a pathway to cultural competence when treating service members from each other’s country. as an example of the unique pressures faced by team members, the british nurse at kaf had to juggle not only their time between duties to their own forces and the nato command, but also toward the different treatment options of the nato forces and two sets of paper work from the canadian command and the british patients. tensions could have easily existed with this ‘splitting’ of roles and countries philosophies towards the care of the troops. however, this was not the case for this deployment team. the unified goal for the team was focused on getting the best treatment we could to the patients rather than pursuing individual issues of power and control. the main strength of the team was found in accepting our differences and building on our strengths. an example of this was the canadian team was highly trained in solution-focused therapy (sft). this was a skill that was shared by the british nurse but not practiced in some time. the team shared ideas and gave peer supervision regarding using this therapy and developed a more effective joint working environment. the higher workload appeared to help increase team cohesion. being in a hospital environment and also being required to travel out to smaller fobs and cops, there was a constant workload as the number of isaf troops increased. quite simply put, we were nedegaard, foster, yeboah-ampadu, stubbs/lessons learned in afghanistan 109   inundated with one challenging, desperate situation after another. in order to adequately manage in this kind of environment, we needed to pull together for support. this created a shared vision and an ability to provide more care to those who needed it. as previously mentioned, there was a tension between the need to travel farther forward to meet the needs of those on the smaller fobs and cops and the need to maintain enough personnel at kandahar to manage the increasing stream of patients. we sometimes received requests from forward deployed commanders that we had difficulty meeting. one tactic that worked well was to channel up requests our chains of command to have them engage directly with the forward deployed commanders and determine what the best use of the provider’s time would be. they were more aware of the larger situation and helped with prioritizing and negotiating our seemingly conflicting requirements or needs. this took the conflict out of the hands of the providers at kaf, freed them up to continue seeing patients, and helped them manage potential overextension and burn out. we need to maintain an adequate awareness of multiple theoretical frameworks. social work students often wonder why they need to be familiar with as many different theoretical frameworks as they are exposed to throughout their undergraduate and graduate educations. this situation serves as a very good model for why we need to have at least a baseline familiarity with these theories. working in a multi-national, multidisciplinary team illustrates several differences in training. the canadian and british providers tended to be more versed in solution-focused therapy whereas the us providers were primarily trained in a cognitive-behavioral model. although these models can be quite compatible with one another, it is important to have a baseline understanding of these perspectives so that the providers could better appreciate and support one another while we discussed challenging cases. clinical feedback may not be as useful if we do not understand the treatment direction and rationale being used by our colleagues. along these same lines, baseline knowledge of the mental health disciplines outside of social work is a very useful. in this case, our small team predominantly represented social work but also represented psychiatry, psychiatric nursing, psychology, and a nonlicensed mental health technician. we were not all familiar with what unique expertise each field brought to our team so we spent a good amount of time learning from each other. this knowledge helped us more effectively strategize as a team to meet the everincreasing demand we were facing. urgency dictated that we focused less on appearing “competent” to one another and instead were open to differing ideas and skill sets. by remaining inquisitive and supportive, we allowed each other to assume more of a learning role without the pressure of having to appear more learned or competent than other members of the team. because our team was so diverse, we all had questions and knowledge gaps about how to provide the best services we could in this challenging environment. it is important to note that this was the first deployment for the majority of our team and this likely contributed to a greater willingness to ask questions without the fear of appearing incompetent. given the high turnover rates among military mental health professionals in the us military, the modal number of deployments for any mental health team is likely to be one. although there are many who have experienced multiple advances in social work, spring 2012, 13(1) 110    deployments, many professionals are on their first deployment while in a combat zone, so openness and a willingness to learn and cooperate are key to success. as stated above, another lesson we learned was also that we need to understand more about the “in theatre” treatment philosophy of each nation so we could more effectively treat troops from other countries. for example, it is clear that the us highly values mental health treatment in theatre and as a general rule, us forces strive to have a soldier to mental health provider/technician ratio of 1000 to 1 or less. while our team was deployed, canadians had a similar ratio, although it did not include mental health technicians. the british, on the other hand, had a provider to troop ratio of close to 3000 to 1. as mentioned earlier, treatment by a mental health provider in theatre is not as highly valued by the british military and the unit is charged with providing the support that is needed to troops who are struggling with mental health symptoms. clearly, there are differing pressures, expectations, and stigmas within each countries military forces and the providers from each of those military services feel those same pressures. this also requires more flexibility as a mental health provider. should a us mental health provider approach a british unit in the same manner that would be used with us forces, they risk offending the unit leadership by implying they are not supporting their troops in a satisfactory manner. the ability to properly assess the situation, improvise, and be flexible with our responses proved to be an invaluable skill. other differences between countries are that neither canadians nor the british employ mental health technicians like the us does. the closest equivalent position in canada is a social service worker. they have completed a two-year college diploma, but are not authorized under health legislation to work in clinical mental health centers. because of this, the canadian military does not employ uniformed or civilian social service workers. not only do the british not have mental health technicians, they do not employ social workers or psychologists as uniformed members of their military. the uk has mental health nurses and psychiatrists. psychiatrists are generally not deployed, leaving nursing to provide all of the mental health services within theatre. perhaps the most important factors contributing to the success of our multi-national relationship towards mental health care work was respect of our differences and a good dose of humor. the team managed to maintain a good sense of humor within this difficult environment while also doing our job under strenuous conditions. the british provider made fun of the fact the americans and canadians were required to carry handguns to work while theirs were in the uk armory. the us providers enjoyed poking fun at the way the british tailored their hats to look ‘cool’. it was this kind of relationship that enabled the team to gel and work so effectively. in this situation, humor served as a great way to diffuse tensions caused by our challenging mission and helped us develop greater shared bonds. though a multiplicity of nations continue to serve at kandahar, all display the same admirable resilience, dedication, and loyalty to the mission despite their country of origin, extreme conditions, an array of difficulties, and daily challenges. we came to see our clientele not as us, british, or canadian. instead, we were all soldiers, engaged as nedegaard, foster, yeboah-ampadu, stubbs/lessons learned in afghanistan 111   one team with one mission. as a cohesive group of mental health providers we were, and continue to be, protective and proud of all who serve. references department of national defence canada. (2009, october 28). the maple leaf. giving the best care anywhere. health services made cf history as the lead nation of a multinational medical unit. retrieved from http://www.forces.gc.ca/site/commun/mlfe/article-eng.asp?id=5705 department of national defence canada. (2010). surgeon general’s report 2010. retrieved from http://www.forces.gc.ca/health-sante/pub/sgr-rmc-2010/page-15eng.asp frappell-cooke, w., gulina, m., green, k., hacker-hughes, j., & greenberg, n. (2010). does trauma risk management reduce psychological distress in deployed troops? occupational medicine, 60(8), 645-650. greenberg, n., langston, v., everitt, b., iversen, a., fear, n., jones, n., & wessley, s. (2010). a cluster randomised controlled trial to determine the efficacy of trauma risk management (trim) in a military population. journal of traumatic stress, 23(4), 430-436. international security assistance force. (n.d.). retrieved from http://isaf.nato.int national institute for health and clinical excellence. (2005, march). clinical guidelines cg26. post-traumatic stress disorder (ptsd): the management of ptsd in adults and children in primary and secondary care. retrieved from http://www.nice.org.uk/cg26 author’s note: address correspondence to professor randall nedegaard, department of social work, university of north dakota, gillette hall room 306b, 225 centennial drive stop 7135, grand forks, nd 58202-7135. e-mail: randy.nedegaard@email.und.edu microsoft word whitworth article final bb ________  james whitworth, ph.d., and joseph herzog, ph.d., are assistant professors and diane scott, ph.d., is an associate professor at the school of justice studies and social work, university of west florida, pensacola, florida. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 112-131 problem-based learning strategies for teaching military social work practice behaviors: review and evaluation james d. whitworth joseph r. herzog diane l. scott abstract: this article outlines and evaluates a military social work course as it has been taught by three social work faculty members at two universities in the southeastern us. the authors highlight why these courses are needed within social work undergraduate and graduate programs. they report how cswe-identified military practice behaviors are addressed within the course. they also describe how practice-based learning approaches appear to be ideally suited for teaching military social work curricula. data on student perceptions of military social work courses and the application of problembased learning are presented along with an assessment of knowledge gains and ability to practice military social work. findings reflect that social worker students find these courses helpful and that they believe that problem-based courses in this subject help prepare them for initial work with this population. they also highlight the need for an extensively updated military social work textbook addressing major changes within the military and social work over the last decade. keywords: military social work, problem-based learning, practice behaviors, social work education, council on social work education (cswe) introduction military and civilian social workers play a vital role in sustaining and supporting military members, veterans, and their families. their role has grown and adapted during the last decade with the recent wars in afghanistan and iraq. social workers have historically taken the lead in programs to prevent and respond to substance abuse, and family maltreatment along with providing mental health services and medical social work. they are now key players in developing and providing individual, family, and community responses to help those impacted by combat-related trauma, military deployments, and mild traumatic brain injuries. the developing role of social workers within the military has been largely fueled by a significant increase in deployments and the expanded use of reserve and national guard members (adams, durand, burrell, teitelbaum, pehrson, & hawkins, 2005; knox & price, 1999). the number and frequency of deployments have led to unparalleled strains on the military, their families, communities, and caregivers. many military members have been deployed for six to 18 months with the period of time between deployments getting shorter (hosek, kavanagh, & miller, 2006). many service members have been regularly exposed to nontraditional hostile combat conditions where they observed fellow military whitworth, herzog, scott/ problem-based learning strategies for teaching 113   members being injured or killed (hoge, castro, messer, mcgurk, cotting, & koffman, 2004). military social workers have been described by some as mental health “first responders” to military members since they often deploy to combat zones (savitsky, illingworth, & dulaney, 2009). given the growing need for social workers, and the demands on active duty providers, social work services are increasingly being provided by civilians (savitsky, et al., 2009). there is also an increased recognition of the military as a separate culture with unique and specific norms, challenges, strengths, and needs. these factors, among others, highlight the need to provide social work students with specialized training to prepare them for working with this population. leadership is now emerging within social work education to assure that social work students are appropriately trained to respond to the needs of today’s military, veterans, and their family members. the council on social work education (cswe) stated “specialized education to prepare social workers to aid this population (military) is clearly indicated” (cswe, 2010, p. 1). cswe recently delineated practice behaviors for advanced practice in military social work for each of their 10 core competencies specified by the 2008 educational policy and accreditation standards (cswe, 2010). although some educators have been disseminating and teaching military-focused social work publications and courses for many years, specific training programs and curriculum focused on preparing social worker students to work within the military has more broadly developed within the last five years. courses to teach undergraduate and graduate students about military social work are now being taught in a minimum of 30 cswe-accredited social work programs within the u.s. (cswe, 2010). students in these courses are learning essential information about working with military members, veterans, and their families along with being exposed to new interventions to help these groups. social work students appear to be generally quite receptive to taking military social work courses especially at those universities in close proximity to military installations. many of these courses intentionally address some of the inherent ethical issues and conflicts that arise for helping professionals working within a military context. only minimal research into the content and outcomes of military social work courses exists. the authors found one qualitative investigation that interviewed 24 graduatetrained social workers who had deployed to combat areas (simmons & decoster, 2007). the social workers participating in that study had all completed cswe-accredited graduate social work programs, and had not completed a military social work class prior to their deployments. they primarily described their social work education as helpful in preparing them to work in combat areas. the present review and investigation outlines a military social work course using problem-based learning (pbl) approaches. the course was developed and taught by three social work faculty members involving nearly 100 graduate and undergraduate students at two universities in the southeastern u.s. the authors describe how csweidentified military practice behaviors were taught within the course. specific examples of pbl curricula are provided. findings from an evaluative survey of the course are also detailed. advances in social work, spring 2012, 13(1) 114    military social work military social work is a broad term encompassing social services provided to active duty, national guard, or reserve military members, veterans, their family members, and the communities in which they live (cswe, 2010). it includes all social workers who provide these services such as uniformed and civilian social workers working within any of the branches of the department of defense (dod), the veterans administration (va), private and public social service agencies, and practitioners who treat or work for any of the above individuals, groups, or organizations. military social work “involves direct practice; policy and administrative activities; and advocacy including providing prevention, treatment, and rehabilitative services to service members, veterans, their families, and their communities” (cswe, 2010, p. 2). daley (2003) listed six functions (see table 1) as “international core requirements for military social work” (pp. 438-439). these six functions succinctly capture the primary focus and purpose of military and civilian social workers serving within the military services. table 1. international core requirements for military social work (daley, 2003, pp. 438-439) function 1. enhance military members’ capability to conduct and recover from warfare 2. develop or consult on military policies and procedures which minimize psychosocial damage while maximizing military member and family wellness within military structural boundaries 3. build and/or implement programs which reduce the likelihood of damage from psychosocial problems such as family violence, substance abuse, mental illness, or maladjustment to serious medical illness 4. offer intra-military perspectives and interventions to improve service functioning 5. ensure the highest quality of professionalism in delivery of military social work services 6. disseminate cumulative historically effective technologies practice behaviors for advanced practice in military social work the council on social work education (cswe) recently delineated practice behaviors for advanced practice in military social work for each of their 10 core competencies specified by the 2008 educational policy and accreditation standards (cswe, 2010). although the course described in the present study was taught both before and after these practice behaviors were created, the class expressly addressed them throughout the time that it was offered. in particular, the courses address practice whitworth, herzog, scott/ problem-based learning strategies for teaching 115   behaviors related to ethical principles, application of critical thinking, research-informed practice, human behavior in the social environment, contexts that shape practice, and engagement, assessment, intervention, and evaluation at multiple levels. table 3 identifies where these practice behaviors were taught within the course. problem-based learning approaches pbl, also called inquiry-based learning, is a teaching method that has been used across multiple disciplines for nearly four decades within the us and many other countries (savery, 2006). originally and continuously used within medical education, pbl employs “real-world” problems and scenarios as a context for students to practice problem-solving skills while increasing their subject matter knowledge (lam, 2009). instructors who use this approach seek to provide an active-learning environment where students are challenged to use course material to assess and respond to realistic problems. pbl approaches were created out of a belief that more “traditional”, primarily didactic, lecture or instructional methods rarely give students a working content application context (savery, 2006). barrows (1996) described pbl as having the following core elements: ‐ learning is student centered ‐ learning occurs in small groups ‐ teachers are facilitators or guides ‐ problems are the organizing focus and stimulus for learning ‐ problems are the vehicle for the development of clinical problem-solving skills ‐ new information is acquired through self-directed learning (p.5) research comparing the effectiveness of pbl to more conventional approaches for teaching multiple disciplines, is somewhat mixed and inconclusive (kam pun wong & lam, 2007). most studies to date, especially those conducted in non-medical fields, had limited or no controls. however, a meta-analysis of 20 years of investigations into courses taught with a pbl approach concluded that students who were taught with these methods demonstrated equal knowledge acquisition when compared to those who learned with more traditional methods and they showed evidence of superior clinical problemsolving skills (albanese & mitchell, 1993). a second meta-analysis of 43 studies concluded that pbl consistently helped students on skills-related outcomes (dochy, segers, van den bossche, & gijbels, 2003). students almost universally reported high levels of satisfaction with pbl courses, and they repeatedly stated that they generally prefer this method over traditional approaches (savery, 2006). the use of pbl instructional approaches within social work education at the bachelor of social work (bsw) and master of social work (msw) levels has consistently increased over the last twenty years. pbl has been used in schools of social work within the us, the united kingdom, australia, and hong kong (lam, 2009). some of these schools have employed pbl approaches across their entire curriculum (kam pun wong & lam, 2007). schools of social work adopted pbl instructional methods to help students start to “think like social work professionals” and as a means of increasing the advances in social work, spring 2012, 13(1) 116    transfer of classroom learning to the field (williamson, chang, fellows, & decker, 2007). rigorous evaluation into the impacts of pbl approaches on social work student outcomes is limited. most investigations to date had difficulty employing student control groups. two separate mixed-methods (quantitative and qualitative) single-cohort pre-and post-test studies of social work students taught with pbl methods were conducted at the university of hong kong (kam pun wong & lam, 2007; lam, 2009). this university broadly adopted pbl instructional concepts across their social work program. these researchers found evidence that pbl courses taught at the bsw level stimulated student “growth in employing multiple sources of learning, directed their own learning goals and activities, and teamwork collaboration” (lam, 2009, p. 1499). they also found that pblinstructed students reported statistically significant increases in their social work knowledge, skills, and values compared to when they began the academic year. the generalizability of these findings is clearly limited by the lack of controls. such student gains would arguably be anticipated with active participation in most cswe accredited programs irrespective of teaching approach. beveridge and archer (2006) compared social work student’s perceptions of a social work course taught using pbl approaches to their perceptions of a required psychology course that employed traditional didactic teaching methods. all 70 study participants took both classes. students reported a stronger mastery of the achievement goals of the class, utilizing effective study strategies, and had a more positive perception of studying in the pbl-based social work course. a smaller sub-sample of students in the beveridge and archer (2006) study reported in interviews that they liked the social work course’s “high degree of challenge, authentic tasks, self-directed learning, autonomy and choice, collaboration with peers, developing of cognitive strategies, cognitive engagement, high level of relevance of material, and developing a personal knowledge base” (p. 13). other studies found similar social work student perceptions of pbl-focused courses to include a belief that these courses make them feel more confident to practice social work skills and better prepared for practice (williamson, et al., 2007). field supervisors and employers of social workers also reported that students who take multiple courses using pbl techniques appear more confident than their social work peers (lam, 2009). although the majority of students noted that they enjoy learning with pbl methods, some in at least two studies also stated that they struggled with a perceived the lack of structure in group activities, negative group dynamics, having to trust other students to complete tasks, and inadequate collaboration skills in social work courses taught using a pbl approach (beveridge & archer, 2006; hartsell & parker, 2008). method course description, objectives, curriculum six introductory military social work courses were taught by three instructors over two years at two universities in southeastern us. all six courses were taught from a basis whitworth, herzog, scott/ problem-based learning strategies for teaching 117   core syllabus, using the same textbook (daley, 1999) with each faculty adding supplemental material as they saw fit. table 2 details the course schedule along with required readings. four of the courses were provided online and the other two were taught using a blended (on-line and in-person) format. five of these courses were provided at the msw level and one was for bsw students. one of the universities where five of the courses were taught was in a community with multiple military installations and the other university has an extended history of providing courses for military members, veterans, and their families. the course was offered at both schools as an advanced clinical practice elective for msw students or as a general elective for bsw students. table 2. course schedule and required readings week topic required reading 1 course introductions – overview 2 history of military social work daley(1999) – chapters 1,2,3 military facts for non-military social workers (kadis & walls, 2005) 3 legal and ethical dilemmas in military social work daley (1999) – chapter 11 4 family advocacy in the military services daley (1999) – chapter 4 5 medical social work and the impact of tricare in the u. s. armed forces daley (1999) – chapters 5,7 6 military social work practice in substance abuse programs daley (1999) – chapter 6 7/8 military social work practice in mental health programs daley (1999) – chapter 8 9 combat-related post traumatic stress disorder (ptsd) and mild traumatic brain injury (mtbi) cigrang et al. (2005) hoge et al. (2004) litz (2007) 10 the impact of combat-related ptsd and mtbi on families chapin (2009), adams et al. (2005) mcfarlane (2009), herzog & everson (2010) 11/12 suicide assessment and response within the military air force guide to managing suicidal behavior (2002), knox et al. (2010) 13/14 building community capacity in military communities: the integrated delivery service approach huebner et al. (2009) 15 service member and family wellness across the lifespan daley (1999) – chapters 16,17,18 advances in social work, spring 2012, 13(1) 118    all three instructors had a strong interest and involvement in military social work prior to teaching the course. one instructor was an active-duty air force social worker; another had worked as a civilian social worker within the military and is married to a retired soldier, while the third instructor had been a private practitioner near military installations for over 15 years with a heavy military case load. the course description is provided below: this course provides a comprehensive and in-depth examination of the practice of military social work. swk ### outlines the historical context of specific practice of social work within the branches of the u.s. military. the course will enable students to understand some of the unique challenges and needs of military members and their families. they will learn specific community and clinical practices to help military members and their families. the course also examines the unique culture of the military community along with specific ethical dilemmas faced by active duty and civilian social workers practicing in a military setting. the course objectives are provided in table 3 along with the cswe-identified military practice behaviors that they addressed. each cswe education policy (ep) or competency is also specified within the table. the first half of the course largely focused on topics that can be described as fundamental military social work curricula, which generally mirrored many of the chapters within the daley (1999) textbook. they included: history of military social work, legal and ethical dilemmas in military social work, family advocacy programs, substance abuse programs, medical social work, tricare, mental health programs, and military member and family wellness across the lifespan. the second half of the class addressed topics that have arisen as essential for military social workers over the last decade such as combat-related post traumatic stress disorder (ptsd), mild traumatic brain injury (mtbi), impact of ptsd and mtbi on families, suicide assessment and response, and building community capacity within military communities. incorporation of military practice behaviors the course centers on many of the key elements highlighted within the csweidentified practice behaviors. table 3 reviews each of the course objectives and links them to the specific practice behavior that was addressed. each cswe education policy (ep) or competency is also noted within the table. specific emphasis was placed in the course on students learning the following topics within the military population: cultural competency, historical context, systems perspective concepts, bio/psycho/social variables, ethical dilemmas, and evidence-based practice. the social work profession has consistently stressed the importance of cultural competency. although there are numerous and somewhat varying ways to define cultural competency, cross, bazron, dennis, and isaacs (1989) appropriately described it “as a set of congruent behaviors, attitudes, and policies that come together in a system or agency, or among professionals, that enable the system, agency, or those professionals to work effectively in cross-cultural situations” (p. 1). given that the us military has many whitworth, herzog, scott/ problem-based learning strategies for teaching 119   table 3. course objectives, cswe-identified military practice behaviors, and education policies (eps) addressed within the course course objective cswe military practice behavior & ep apply knowledge of the variables within the military structure and environment that affect social work practice demonstrate a professional demeanor that reflects awareness of and respect for military and veteran cultures (ep 2.1.1) recognize boundary and integration issues between military and veteran cultures and social work values and ethics (ep 2.1.1) describe the historical context of social work practice within the armed services assess service systems’ history, trends, and innovations in social work practice with service members, veterans, their families, and/or their communities (ep 2.1.9) apply knowledge of practice within the military context to the development of evaluations, prevention plans, and treatment strategies (ep 2.1.9) use systems perspective concepts and framework to assess military client problems and develop interventions assess service systems’ history, trends, and innovations in social work practice with service members, veterans, their families, and/or their communities (ep 2.1.9) identify, understand, and describe bio/psycho/social variables that impact human behavior in the military recognize and assess social support systems and socioeconomic resources specific to service members, veterans, their families, and their communities (ep 2.1.6)recognize the impact of military transitions and stressful life events throughout the family’s life course (ep 2.1.6) identify issues related to losses, stressors, changes, and transitions over their life cycle in designing interventions (ep 2.1.6) demonstrate the ability to critically appraise the impact of the social environment on the overall well-being of service members, veterans, their families, and their communities (ep 2.1.6) describe the impact of changing societal structures on human relationships in the military identify and analyze conflictual responses and potential consequences to conflicts between basic human rights and military life and duty experience (ep 2.1.5) identify and respond to ethical dilemmas involved in practicing social work with active duty military members employ strategies of ethical reasoning in an environment that may have policy and value conflicts with social work service delivery, personal values, and professional ethics (ep 2.1.2) identify the military culture’s emphasis on mission readiness, support of service, honor, and cohesion and how these influence social work service delivery at the micro, mezzo, and macro levels (ep 2.1.2) know and assess evidence-based practices for treating mental conditions common among military members and their families locate, evaluate, and analyze current research literature related to military social work (ep 2.1.6) evaluate research to practice with service members, veterans, families, and their communities (ep 2.1.6) analyze models of assessment, prevention, intervention, and evaluation within the context of military social work (ep 2.1.6) apply different literature and evidence-informed and evidence-based practices in the provision of services across the dod/va continuum of care and services (ep 2.1.6) advances in social work, spring 2012, 13(1) 120    aspects of a separate culture or subculture, it is vital that social workers who work within this population understand as much as they can about how the military functions. students within the military social work course described here learned information about each of the military services, their unique behaviors, attitudes, and policies. students in the course also learned about how social workers have been working within the us military for nearly a century, and that they have helping veterans and their families for longer than that. the course provides information to understand the rich history of military social workers to include the early role of the red cross, accomplishments and challenges faced by pioneering military social workers, and how social work roles adapted over time with many changes within the us military and the va systems. students are also taught about how social workers led in the development and provision of substance abuse and family maltreatment programs across the military services. a significant portion of the course is dedicated to understanding the unique bio/psycho/social needs of military members, veterans, and their families. students learn about the impacts of frequent transitions, losses, and deployments among this population along with programs and interventions to lessen the impacts of these challenges. they also learn about innovative ways to foster community capacity to respond to needs and problems within military communities. ethical conflicts appear to be inherent for social workers who practice in or with a military population. these conflicts often result from the high priority placed on accomplishing the military mission while concurrently assuring that members, veterans and their families are acknowledged as independent humans with ongoing bio/psycho/social needs. students in the course learn about these conflicts along ways to avoid them when possible, and they are instructed on available means to attempt to resolve them. they similarly learn about conflicts arising from the differences between civilian legal systems and those involving the military uniformed code of military justice (ucmj). extensive emphasis in the course is placed on learning and “practicing” evidencebased treatments for conditions common among military members, veterans, and their families. these conditions include ptsd, substance-related problems, mtbi, and secondary trauma response. students are required to review and critically analyze the research which supports emerging military-specific treatments for these conditions. use of problem-based learning approaches the course instructors employed pbl approaches by challenging students to apply each week’s lessons and material to a realistic military social work clinical or community scenario. after reviewing each scenario, students would individually formulate their analysis of the case or situation. this analysis included the student’s assessment and delineation of the military client, family, or community needs and challenges, and specific strengths. students were also required to explicitly detail how they would intervene as a social worker within the scenario. in the online courses, students would whitworth, herzog, scott/ problem-based learning strategies for teaching 121   then post their analysis of the scenario to their small (usually 5-7 students) discussion groups. they would then provide detailed feedback assessing at least two other group members scenario reviews although they often commented on more than two reviews. the instructors provided guiding feedback and comments for each of the group discussions. they however, left the leadership of each discussion up to the students. students were graded individually on their ability to appropriately assess the scenario and develop a viable intervention plan utilizing primarily material addressed during the course. for the blended courses, the scenario application exercises were done as formal class presentations with discussions following each. case scenarios represented a wide-range of clinical and community challenges and situations common within military and veteran populations. each scenario highlighted key aspects of the course material. some of the scenarios included a young military couple dealing with post-deployment issues, family members caring for a severely injured soldier, substance abuse by a junior military member, ethical conflicts for a civilian social worker providing services on a military installation, a community responding to several military member suicides, and a member who wants to leave the service early, along with several other relevant military scenarios. case scenarios included veterans, family members, and members from all military branches and from locations throughout the world. students were advised that all scenarios were not actual cases or situations, but that they were representative of clinical and community scenarios that military social workers regularly address. the following sample scenario used by one of the instructors challenged students to respond to a family maltreatment situation: petty officer second class (po2) michael johnson is a 28 year old sailor currently stationed at eglin air force base in florida where he is attending explosive ordinance disposal (eod) school. he just arrived at the school last week to begin a 7-9 month program to train him as an eod technician. he has been in the navy for seven years. he has worked as an electronic technician for his entire career up until now which required him to be at sea for long periods (5-8 months at a time). he liked the work that he did as an electronic technician. however, he is very motivated to succeed as an eod technician because of the complex type of work he will be doing and the increased status and pay that will come from this job. p02 is married to amanda and they have two children ages four and six. amanda and the children are still living at his previous base (san diego naval base) in california. po2 johnson was brought to your office at the eglin afb family advocacy program (fap) office by his training supervisor, senior chief petty officer (scpo) barker. you are employed as a family advocacy treatment manager (fatm), which is a civilian social work position within fap. you conduct assessments of child and spouse abuse allegations and provide treatment interventions for military members and their families who have been involved in substantiated maltreatment. scpo barker requests to meet with you while po2 johnson is completing some initial paper work. he states that he brought po2 advances in social work, spring 2012, 13(1) 122    johnson to your office at the request of the commander of the eod school. the commander had been called by po2 johnson’s previous supervisor in san diego who states that amanda is alleging that michael physically abused her three days before leaving to come to his eod program. she is also alleging that he left her with only $100 cash and no access to any other funds to pay their bills. before meeting with michael you call the fap staff at the san diego naval base. they tell you that amanda has called them also to report the abuse. they state that they evaluated and substantiated a mutual spouse abuse case with michael and amanda about 14 months ago. michael attended 5 individual counseling sessions with a fap counselor and that he completed a six-month men’s domestic violence treatment course. amanda met once with a victim advocate, but she declined to participate in fap treatment or other services. the san diego base fap staff hasn’t met with amanda to assess the current situation/allegations, but they have an appointment scheduled with her tomorrow morning. you meet with po2 johnson for 75 minutes to assess the allegations and to evaluate his emotional status. he is initially very quiet in the interview and is clearly quite angry about the allegations. he is concerned that he will be kicked out of the eod program. michael denies that he harmed amanda, but does admit that they had a significant argument three days before her left for school. he admits to pushing amanda aside to get out of their apartment because “she was blocking the door and yelling at me in front of the kids.” he tells you he thinks amanda is “psycho” and that she needs mental health care. when you ask him for details about this statement, he states he is not able to describe any specific severe mental illness behaviors of amanda, but that he thinks that amanda wants to ruin his navy career. he believes that she may be having an “internet relationship” with a guy she knew back in high school. michael has not been sleeping well the last two nights. he states that this is because he is worried about the impact that this situation will have on his training and his career. he admits to feeling depressed, anxious, and angry. michael denies any suicidal or homicidal thoughts, plan or intent. he also denies that he abuses alcohol or that others have been concerned about his alcohol usage. survey all students who had taken the course within the two prior years were asked to complete a survey regarding the class (see attachment). administration of the survey was approved by both universities’ institutional review boards. the brief survey was conducted through survey monkey. participating students responded to survey items assessing their knowledge of information reflecting military social work practice behaviors, student attitudes regarding doing social work with military members and their families, student’s anticipated social work practice with military members/families, or veterans and student perceptions of use of pbl concepts within the course. there were also several “open-ended” questions requesting students to provide feedback on their overall perceptions of the course. whitworth, herzog, scott/ problem-based learning strategies for teaching 123   results sample the final sample included 19 students. of the 110 surveys sent to students, 30 surveys were undeliverable due to incorrect email addresses. the final response rate was 23%. a small number (26%) of the respondents were either current military members or veterans while the majority (63%) reported being married to either a current military member or veteran. thirteen respondents (68%) reported previous work experience with military members, veterans, or their family members. almost a third (32%) of the students reported very little to no knowledge of military populations prior to taking the military social work course while a greater number (52%) reported a good to moderate knowledge and a smaller number (16%) reported extensive knowledge. the majority of students (79%) are either working or plan to work with military populations. military population beliefs all of the students (100%) believed that concerns about confidentiality and the impact of receiving care on the career of the service member to be potential barriers for seeking social service assistance. over half (53%) of the students believe limited coping skills to put young military families at risk while a smaller number believed the cause to be either strained finances (21%) or young age (16%) and one student (5%) none of the above were risk factors. separation from natural resources was selected by a majority of students (84%) as a unique demand and risk for military members and their families. the majority of students (72%) correctly indentified family advocacy program, substance abuse programs, medical programs, or mental health programs as agencies whose primary focus is “mission readiness.” problem-based learning the majority of students (79%) remembered the case scenarios that were presented in class. likewise a vast majority of students (93%) of the students who answered this question believed the case scenarios to be helpful to very helpful in helping them to understand military populations (26% of respondents left this item blank). military population task abilities students rated their abilities to perform specific tasks with military populations on a scale from 0 (cannot do at all) to 100 (certain can do) with a midpoint of 50 (moderately certain can do) (see table 4). of the 19 students who responded to the survey, 17 completed this section. the mean for specific task performances ranged from a low of 82.3 for “review all aspects of the client’s case and history to determine benefit eligibility” to a high of 92.3 for “provide information about substance abuse to military members or veterans.” one student rated them self less than moderately certain they could perform specific tasks with that student rating a 20 on “review all aspects of the client’s case and history to determine benefit eligibility” and a 30 on “establish rapport with clients from different cultural backgrounds and experiences” while another student advances in social work, spring 2012, 13(1) 124    rated a 30 on “network with agencies to coordinate services for military members or veterans” and a 40 on “define military member or veterans’ problems in specific terms.” the remaining 15 students were at least moderately certain (50) that they could perform all of the specific tasks inquired about with military populations. responses to open-ended items students responded to open-ended questions regarding their experience and the settings of their work with military populations, their goals in taking the course, information they recalled from the case scenario application exercises in the course, and their overall perceptions of the course. not surprisingly, given the close proximity of one of the universities to military installations and the close association of the other with the military, seven of the thirteen students (53.8%; n=19) who indicated they had prior experience with military populations were veterans, active-duty or family members of veterans who cited that experience. the same number of students (7; 53.8%) indicated they had experience with military populations during their social work internships, previous employment or volunteer experiences. table 4. descriptive statistics for task abilities items item n mean sd review all aspects of the client’s case and history to determine benefit eligibility. 17 82.35 20.77 identify barriers to obtaining services and develop plans for overcoming barriers. 17 84.70 16.24 establish rapport with clients from different cultural backgrounds and experiences. 17 87.64 20.77 understand the impact of substance abuse on military members or veterans 17 90.58 10.28 critically evaluate substance abuse issues with a military member or veteran. 17 91.17 9.27 provide information about substance abuse to military members or veterans. 17 92.35 12.51 work with various systems to obtain services for military members or veterans. 17 90.58 8.99 advocate on behalf of military member or veteran 17 90.58 13.44 network with agencies to coordinate services for military members or veterans. 17 86.47 16.93 define military member or veterans’ problems in specific terms. 17 83.53 15.78 students had varied goals and desired outcomes from the military social work course. nine students (50%; n=19; 1 blank) reported that they had taken the course to prepare for their internship or future employment within agencies serving military populations. students said, “my goals for taking the social work class were directly linked to my whitworth, herzog, scott/ problem-based learning strategies for teaching 125   desire to practice sw here in pensacola, a military town. i was also hoping to use the information learned during possible internship with the va.” others reported wanting to be “able to work with military families as a family advocate” and “moving from base to base supporting my husband’s career and i would like to be able to continue my career as a social worker on military bases.” the majority of students (14; 73.7%) most commonly indicated an overall desire to become more familiar with the military community. they expressed goals to learn about the “history, roles, and impact social work has for the military,” “the structure and background of the military,” “the dynamics of military service,” and “the issues military families face during their life as a member of the armed services,” and to “gain more knowledge about the military community and how social work is integrated into that community.” consistent with research on student learning using pbl (lam, 2009), students were able to identify the scenario exercise and specific details about the interventions in 13 responses (68.4%; 6 blank; n=19). this is noteworthy because the six courses were taught from 2008 to 2011. the overall feedback question yielded more support for using the case scenarios. for example, “the course was good because it left room for people to do more research on the military” and “the exceptional design [which] focused on a detailed inside view of the military soldier and families. if you thought you knew what a military service member or families of service members experience during their tours of duty, before taking this course, you would be surprised to find out how much more there really is to know.” and, a student who was in the blended version of the course said “it was great to discuss real life scenarios and i enjoyed the reading material and presentations”. finally, as found by barrows (1996) several students made comments similar to the following made by one student “the information learned was broad spectrumed, but specific to caseloads. it was helpful in that the scenarios brought a certain realness to the subject at hand. having to assess each case and interpret what was needed helped to define what the social work job was and how it should be done.” one student suggested adding to the curriculum “an advanced sw in the military class … to get even more indepth information and experience.” discussion and implications this article describes one method for teaching military social work classes to bsw and msw students. the evaluation components of the present study were intended to explore and identify the primary benefits that students perceive from taking a pblcentered introductory military social work course along with gauging some of their knowledge gains. generalizability of the findings is significantly limited by a small and convenient sample size, lack of any control group, and moderately low response rate. this rate was largely impacted by the fact that many of the students had already graduated from their social work programs thereby making it difficult for the researchers to contact these individuals. the post-test only design also significantly limits drawing any conclusions based on the results. use of a pre-test, post-test design would strengthen any assessment regarding the impact of the course content. despite the limitations noted above, this study provides some exploratory and qualitative evidence to suggest that pbl approaches are helpful for teaching military advances in social work, spring 2012, 13(1) 126    social work courses. students who responded to the survey almost universally reported that they believed the course was highly helpful in preparing them for working with military members, veterans, and their families. many students entered this course with little or no knowledge of military populations, while many others had no work experience with military populations. some of the students had limited life experiences with military populations and few students had any direct military experience. after taking this course, the vast majority of students reported being at least moderately certain of their ability to perform specific tasks with military populations. most of these students could recall the pbl approaches and the scenarios. a great majority of students perceived this technique to have been helpful in understanding military populations. future investigations of initial military social work courses would benefit from prospective and longitudinal research methods to improve response rates, gather meaningful current and more long-term effects of the course, and pbl approached to teach social work material. the use of control groups or classes would allow for better comparison of this course to traditional or other methods. the high level of military experience among the faculty who taught the course described in this study may be an invaluable pre-requisite for creating such a course and addressing the detailed military, veteran or family case scenarios. the present findings also suggest that this course may be better suited to in-person or interactive teaching methods. there is a clear need for further evaluation and development of these initial military social work courses along with creating more advanced military social work courses to address military-related topics. future courses might address such issues as helping military members and their families with deployments, assessment and treatment of ptsd and mtbi, interventions with veterans, and bereavement/loss among the military and veteran populations. they could make up the central curriculum components of a military social work concentration or certificate program. given that the primary textbook employed in many military social work courses (daley, 1999) is over 12 years old, there is an evident need to either substantially update that textbook to incorporate social method in response to emerging military needs and current research findings or create a comprehensive new text book to address this new material. conclusion the military social work course described in this article appears to be meeting a need to train practitioners who are informed and sensitive to the specialized and growing needs among military members, veterans, and their family members. this course, along with the increasing number of similar courses at universities throughout the us, responds to a critical need to appropriately train social workers before they start to work with this population. participating social work students report that these courses helped prepare them for initial military-related social work and improved their perceived ability for working with this population even though many had limited direct prior experience with the military. many students who thought they knew military populations quite well whitworth, herzog, scott/ problem-based learning strategies for teaching 127   because of their personal experiences before taking the course commented about the knowledge that they gained after participating in the class. the course detailed in this review was able to specifically address the essential military practice behaviors outlined by cswe. it is also evident that problem-based learning approaches appear to be well-suited for teaching initial military social work courses given their focus on use of realistic problems which challenges students to integrate and apply curricula to a military or veteran client, family, or community problem. 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(2006). how deployments affect service members. rand corporation. retrieved from http://www.rand.org/pubs/monographs/2005/rand_mg432.pdf hoge, c. w., castro, c. a., messer, s. c., mcgurk, d., cotting, d. i., & koffman, r. l. (2004). combat duty in iraq and afghanistan, mental health problems, barriers to care. new england journal of medicine, 351(1), 13–22. huebner, a. j., mancini, j. a., bowen, g., & othner, d. (2009). shadowed by war: building community capacity to support military families. family relations, 58(2), 216-228. kadis, j., & walls, d. (2005). military facts for non-military social workers. vha social work service staffing and clinical practice committee. retrieved from: http://www.mhawisconsin.org/uploads/veterans/military-facts-for-nonmilitarysocial-workers.pdf kam pun wong, d., & lam, d. (2007). problem-based learning in social work: a study of student learning outcomes. research on social work practice, 17(1), 55-65. knox j., pflanz, s, talcott, g. w., campise, r. c., lavigne, j. e., bajorska, a., xin t., & caine, e. d. (2010). the us air force suicide prevention program: implications for public health policy. american journal of public health, 102(1), 613-621. knox, j., & price, d. h. (1999). total force and the new american military family: implications for social work practice. families in society, 80(2), 128-136. lam, d. (2009). impact of problem-based learning on social work students: growth and limits. british journal of social work, 39(8), 1499-1517. litz, b. t. (2007). research on the impact of military trauma: current status and future directions. military psychology, 19(3), 218-238. mcfarlane, a. c. (2009). military deployment: the impact on children and family adjustment and the need for care. current opinion in psychiatry, 22(4), 369-373. whitworth, herzog, scott/ problem-based learning strategies for teaching 129   savery, j. r. (2006). overview of problem-based learning: definitions and distinctions. interdisciplinary journal of problem-based learning, 1(1), 3. retrieved from: http://docs.lib.purdue.edu/ijpbl/vol1/iss1/3 savitsky, l., illingworth, m., & dulaney, m. (2009). serving the military and veteran populations. social work, 54(4), 329-339. simmons, c. a., & decoster, v. (2007). military social workers at war: their experiences and the educational content that helped them. journal of social work education, 43(3), 497-512. williamson, s., chang, v., fellows, m., & decker, c. (2007). using modified problembased learning to teach social work practice skills. presentation at the iussw facet retreat. retrieved from http://www.facet.iupui.edu/pdf/retreat/07_modified_pbl_social_work_williamson _chang.pdf author’s note: address correspondence to: james d. whitworth, ph.d., university of west florida school of justice studies and social work, 11000 university parkway, pensacola, fl 32514. email: jwhitworth@uwf.edu advances in social work, spring 2012, 13(1) 130    appendix survey (for all questions below, the terms military member and veteran consist of any person who has served or is serving in the us armed forces, which includes active duty, retired, separated, national guard, and reserve military members) 1. have you ever been or are you currently a military member or a veteran? yes____ no ____ 2. have you ever been married to or had a partner relationship with a military member or veteran? yes____no____ 3. have you had any work experience with a military member, veteran, or their family members? yes___ no____ (if no skip to question 4) briefly describe the setting/location/role of your working with military members, veterans, or their families: 4. please rate your level of knowledge of military populations prior to completing your military social work course (circle one)? none very little moderate good extensive 5. briefly describe your desired goals or outcomes for taking the military social work course: 6. do you remember any of the military member, military family, or veteran case scenarios that were discussed in your military social work course? yes___ no____ (if no skip to question 9) 7. briefly describe one of the military member, military family, or veteran case scenarios that were discussed in your military social work course: please rate how helpful you believe these case scenarios were in helping you understand how to help military member, military family, or veterans? not helpful somewhat helpful helpful very helpful 8. are you currently working with or do you plan on working with military members, military families, or veterans? yes____ no ____ 9. for military and family members, the following are potential barriers for seeking social service assistance: o concerns about confidentiality o concerns about the impact of receiving care on the career of the service member o all of the above o none of the above 10. "mission readiness" is the focus of which of the following military program(s)? o family advocacy program o substance abuse programs o medical programs o mental health programs o none of the above 11. young military families are an at risk population because of: o no transportation o strained finances o limited coping skills o young age o none of the above 12. military members and their families face a number of unique demands and risks. these include: o increased stress due to drawdowns o mission change o a high number of young families with young children o separation from natural support networks whitworth, herzog, scott/ problem-based learning strategies for teaching 131   instructions for questions 14 23: we want to know how confident you are, in your ability to perform specific tasks with military members, their family members or veterans. after you consider each task below, please rate your confidence in your ability to perform that task successfully, by circling the number from 0 to 100 that best describes your level of confidence. what we mean here by successfully, is that you would be able to perform the specific task in a manner that a supervisor would consider excellent. the phrases above the numbers [0 = cannot do at all; 50 = moderately certain can do; and 100 = certain can do] are only guides. you can use these numbers or any of the numbers in between to describe your level of confidence. we want to know how confident you are that you could successfully perform these tasks today. how confident are you that you can… cannot moderately certain certain do at all can do can do 13. review all aspects of the client’s case and history to determine benefit eligibility. 0 10 20 30 40 50 60 70 80 90 100 14. identify barriers to obtaining services and develop plans for overcoming barriers. 0 10 20 30 40 50 60 70 80 90 100 15. establish rapport with clients from different cultural backgrounds and experiences. 0 10 20 30 40 50 60 70 80 90 100 16. understand the impact of substance abuse on military members or veterans. 0 10 20 30 40 50 60 70 80 90 100 17. critically evaluate substance abuse issues with a military member or veteran. 0 10 20 30 40 50 60 70 80 90 100 18. provide information about substance abuse to military members or veterans. 0 10 20 30 40 50 60 70 80 90 100 19. work with various systems to obtain services for military members or veterans. 0 10 20 30 40 50 60 70 80 90 100 20. advocate on behalf of military member or veteran. 0 10 20 30 40 50 60 70 80 90 100 21. network with agencies to coordinate services for military members or veterans. 0 10 20 30 40 50 60 70 80 90 100 22. define military member or veterans’ problems in specific terms. 0 10 20 30 40 50 60 70 80 90 100 23. please write below your feedback on your overall perceptions of the military social work course: some items adapted from the social work self-efficacy scale, holden, g., meenaghan, t., anastas, j., & metrey, g. (2002). _______________ tonika duren green, ph.d., is an associate professor, department of counseling and school psychology at san diego state university, san diego, ca, 92182-1179 and project director of cares. sally mathiesen, ph.d., is a full professor, school of social work, san diego state university, san diego, ca, 92182-4119 and project cares evaluator. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 166-186, doi: 10.18060/18337 who cares? interprofessional competencies for meeting the complex needs of culturally and linguistically diverse foster youth with disabilities tonika duren green sally g. mathiesen abstract: this paper highlights effective interprofessional competencies for school professionals who are interested in improving the educational path of culturally diverse foster youth who are at risk of a disability or who have a disability. the interprofessional competencies were developed based on the lessons learned in the first three years of a federally funded grant. we propose cost-effective ways to address shortages of highly qualified school personnel to work with diverse foster youth with disabilities. recommendations to improve practice with diverse foster youth with disabilities include increasing the number of culturally affirming and responsive education specialists (cares; school social workers, school counselors, and school psychologists) who are trained to respond to the educational and mental health needs of diverse foster youth with disabilities, who are culturally competent, who are advocates in schools, and who are skilled at interdisciplinary service delivery. keywords: foster youth; foster care; child welfare; culture; disability the foster care system represents the most vulnerable youth. over 400,000 children in the united states are in foster care, with 75% entering through reports of neglect and 25% entering through reports of child abuse (physical and/or sexual; u.s. department of health and human services administration for children and families on children, youth and families children’s bureau (usdhhs 2014). one of the primary goals of the foster care system is to ensure children’s safety, permanence, and well-being (adoption and safe families act, 1997; child and family services improvement and innovation act, 2011; fostering connections to success and increasing adoptions act, 2008; preventing sex trafficking and strengthening families act, 2014). education is a critical component in assuring well-being, especially when instability and out-of-home placements lead students to experience frequent school transfers, disruptions to learning, and emotional insecurity (clemens, lalonde, & sheesley, 2016; pecora, 2012). while some youth in foster care blossom, the majority struggle and fail to thrive because of the lack of resources needed to develop in educational environments (day, riebschleger, dworsky, damashek, & fogarty, 2012; ferguson & wolkow, 2012). this statement is especially true of school-aged children in foster care. of the 400,000 youth in foster care in the united states, 62% are school-aged (usdhss, 2014; foster care and education national work group, 2014). these youth experience withering educational outcomes. over 78% of students in foster care attend low-performing schools (foster care and education national work group, 2014). youth in the foster care system face adverse advances in social work, fall 2016, 17(2) 167 conditions, including instability and school mobility, and for foster youth with disabilities, lack of access to least restrictive educational settings (hill, 2013; stone, & zibulsky, 2015). students in foster care score 16-20% lower on statewide standardized achievement measures compared to students who are not in foster care (foster care and education national work group, 2014; stuart foundation, 2011; wiegmann, putnam-horstein, barrat, magruder, & needell, 2014). fifty percent of students in foster care complete high school, and only 44% who graduate read at a high school level or higher (day, dworsky, & feng, 2013; stuart foundation, 2011). thirty-five percent experience five or more school changes, and each school move results in a six-month loss of educational progress (child trends databank, 2015; foster care and education national work group, 2014). these weak educational outcomes lead to poor post-secondary education, higher percentages of unemployment, incarceration, homelessness, and lower percentages of attaining a college degree (foster care and education national work group, 2014; legislative analyst’s office of california, 2009; snyder et al., 2016). poor results may intensify for children in foster care from culturally and linguistically diverse (cld) backgrounds who also have disabilities. the term culturally and linguistically diverse foster youth with disabilities (cldfyd) refers to children and youth in the foster care system “who may be distinguished (from mainstream culture) by ethnicity, social class, and/or language” and disability (perez, 1998, p. 6). this triple whammy (being a foster child, from a diverse background, with a disability), can lead to severe challenges to school success. cldfyd need educational advocates who are culturally affirming, accountable, collaborative, and skilled in prevention and intervention services to reduce achievement gaps, improve school stability, and improve the quality of special education services (zetlin, 2006; zetlin, weinberg, & kimm, 2004). educational advocates help to access or create resources to promote a healthy environment for growth. unfortunately, no data sources that provide estimates of the number of cldfyd and their educational and mental health outcomes currently exist. this paper reviews what is known about the current outcomes and complex needs of cldfyd. to highlight the unique characteristics of this population, the paper begins with a description of cld foster youth and the disparities they face, then expands this discussion to include cld foster youth with disabilities. the critical shortages of highly qualified professionals in school social work, school psychology, and school counseling needed to meet the needs of foster youth are presented, along with ways to respond to these shortages. the paper ends with a discussion of interdisciplinary strategies and competencies that encourage disciplines to work together to improve educational outcomes for children in foster care. the implications are relevant for all stakeholders who are responsible for academic and professional training relevant to the mental health and well-being of foster youth. culturally and linguistically diverse youth in foster care cld youth are often overrepresented in foster care and in special education (child welfare information gateway, 2013; hill, 2006). hill (2006) examined several studies to determine the role of race in the child-protective services decision-making process and found that race was the “primary determinant” within reporting, investigation, green & mathiesen/who cares? 168 substantiation, placement, and exit from care (hill, 2006, p1). reentry into the child welfare system was the only decision-making stage that did not reveal disparities across race and ethnicity. african american youth make up over a third of the foster care population (child welfare information gateway, 2016; usdhhs, 2015). their presence in foster care represents about twice their proportion in the general child population, resulting in a disproportionate representation of african american children in foster care (child welfare information gateway, 2016; courtney, barth, berrick, & brooks, 1996; usdhhs, 2015). however, new reports show a decline in foster care among african americans and an increase in foster care for other diverse groups (child welfare information gateway, 2016; usdhhs, 2015). according to a 2015 report from the u.s. department of health and human services administration for children and families, youth and families, children's bureau (usdhhs), the total number of foster youth declined between 2005 and 2014; however, there was an increase in these numbers from 2013 to 2014. table 1 displays the comparison of children from cld backgrounds in the united states with those in foster care. percentages with an asterisk represent an overrepresentation of that ethnic group in the foster care system compared to their representation in the u.s. population. table 1. percentages of cld children in foster care 2015 (usdhhs, 2016) ethnicity us children (73.6 million) children in foster care (427,910)1 african american 14% (10.2 million) 24%* (103,376) asian 5% (3.7 million) 1% (2,232) hispanic/latino 24% (18 million) 21% (91,105) native american 1% (632,000) 2% (10,5130) *represents higher percentage in foster care compared to percentage in general population (disproportionality) 1data from the afcars june 8, 2016 file submissions. missing data are excluded from each table. therefore, the totals within each distribution may not equal the total provided for that subpopulation. (usdhhs, 2016) the number of cld children in foster care continues to rise (usdhhs, 2015). additionally, the outcomes of these youth remain stagnant (child welfare information gateway, 2016). children in foster care from diverse backgrounds experience longer lengths of stay, remaining in foster care eight months longer on average than their noncld peers (center for the study of social policy, 2010; child welfare league of america, 2005; summers, wood, & donovan, 2013). cld foster youth also experience lower rates of reunification (center for study of social policy, 2010; child welfare information gateway, 2013; usdhhs, 2015) and are more likely to become legal orphans because of high rates of re-entry into the system (kimberlin, anthony, & austin, 2009; usdhhs, 2006). legal orphans are children who have not yet been adopted and have no legal permanent connection to their biological parents because the parents’ rights have been terminated (adams, 2010). cld foster youth also experience less placement stability and achieve permanency less often or not as quickly (usdhhs administration for children and families, 2013). advances in social work, fall 2016, 17(2) 169 addressing disparities in foster care the need to address the overrepresentation of cld children in child welfare has been discussed in the literature for four decades, but more prominently within the last ten years (boyd, 2014; child welfare information gateway, 2013; courtney et al., 1996; courtney & skyles, 2003; grossman, 1967; hill, 2006). this problem has led stakeholders to consider whether inequality in child welfare practices and policies exists for cld children and for what reasons (child welfare information gateway, 2013). boyd (2014) describes a conceptual framework for understanding and explaining the pathways of african american disproportionality and disparity in child welfare. boyd’s framework acknowledges that many factors contribute to inequalities within child welfare. boyd (2014) describes these factors as pathways including: (a) the disproportionate needs of african american children and their high exposure to overlapping risks (e.g., poverty, parent-child characteristics, community dynamics); (b) human decision-making, which includes the bias of culturally incompetent professionals who make important decisions about care; (c) agency-system issues that are saturated with institutionalized racism, policies, and infrastructures that exclude or limit services for african american children and youth; (d) placement dynamics, including the lack of support in kinship care, the length of stay in foster care, the quality of experience in foster care, lower rates of adoption, barriers to adoption, and the lack of stable placements; and (e) the lack of policies that specifically address the needs of african american children in foster care. additionally, researchers are challenged to consider effective practices to reduce disproportionality and disparities in foster care across ethnic groups. recent literature on ways to address disparities and disproportionality in child welfare have considered culturally competent frameworks and evidence-based strategies in public agencies that serve foster youth (center for advanced studies in child welfare, 2015). in the early literature on cultural competence, mcphatter (1997) introduced a cultural competence attainment model that encouraged professionals to pursue education about respecting cultures that are different from their own. this education model highlights the importance of accepting others’ cultures and beliefs (enlightened consciousness), places an emphasis on strengths-based and resiliency approaches and de-emphasizes eurocentric views and biases that exclude the voices and information from diverse communities (grounded knowledge base), and shows the importance of self-reflection and evaluation to build and develop skills through a social justice framework (cumulative skill proficiency). in the late 1990s and early 2000s, agencies developed cultural competence training initiatives based on mcphatter’s model and other models of its kind to increase the number of culturally competent professionals (boyle & springer, 2001; weaver, 1999; yan & wong, 2005). despite these efforts, there continues to be a shortage of culturally competent professionals to meet the complex needs of cld foster youth with disabilities. merkel-holguin (2015) provides support for considering family group decisionmaking (fgdm) as a culturally responsive strategy in child welfare practice. fgdm has indigenous roots and recognizes the limits of western approaches to serving families and children. a key feature of the model is to consider families as experts to ensure that the culture and values of specific groups are held in high honor and regard, which leads to effective practices (merkel-holguin, 2015). these practices include the inclusion of green & mathiesen/who cares? 170 cultural brokers or coordinators who understand the values and cultural context of the families, giving families an active role in decision-making, and creating flexible environments and procedures that allow communities and families of color greater access to services (al-krenawi & graham, 2001). several other culturally competent strategies have emerged in the literature, including the life skills parenting programs and the indian positive parenting curriculum at the denver indian family resource center (difrc) (leake, 2007). difrc provides comprehensive services, including trauma-informed services, to native populations. their approach includes training service providers on the unique aspects of trauma and the multifaceted and multilayered impact of trauma on this population. this level of cultural awareness and responsive practices results in highly effective service delivery outcomes, including increased percentages of children placed with relative caregivers, increased reunification rates (higher than the national average), and positive changes in child wellbeing (leake, 2007). several programs are designed to respond to the diverse needs of children in foster care and the disparities that exist in foster care. however, when the unique needs of children in foster care become more complex due to disabilities, there are limited resources and culturally competent practices to address these needs. in the next section, we discuss this triple whammy of being a cldfyd, the outcomes these children face, and the challenges schools face to ensure educational success for these students. disabilities are used broadly to include the 13 disability categories under the individuals with disabilities education act (idea, 2004). these disabilities are autism, deaf-blindness, deafness, emotional disturbance, hearing impairment, intellectual disability, multiple disabilities, orthopedic impairment, other health impairment, specific learning disability, speech and language impairment, traumatic brain injury, and visual impairment (idea, 2004). the triple whammy: foster youth from culturally and linguistically diverse backgrounds with disabilities approximately 30 to 40% of foster youth receive special education services, a percentage well above average for the general population (hill, 2013; larson & anderson, 2005). foster children in special education are often unserved, underserved, overlooked, and ignored (sullivan & knutsen, 2000; zetlin, 2006). foster youth with disabilities often experience multiple school placements, lost school records, and minimal interagency communication (stuart foundation, 2011; zetlin, 2006). they are more likely to be in segregated special education classes and restrictive settings. they experience delayed or unimplemented individualized education programs (ieps) and have little access to quality mental health services (stuart foundation, 2011). as a result, these youth experience gaps in the delivery of needed special education services. these outcomes are partly the result of the lack of effectively trained school professionals who are prepared to respond to the diverse needs of cldfyd (boyd, 2014; center for advanced studies in child welfare, 2015). kweisi mfume argues that for cldfyd, “education is a bridge over troubled water… not a guarantee of success but a precondition to survival” (folman & anderson, 2003, p. advances in social work, fall 2016, 17(2) 171 2). research that specifically addresses how to improve the educational conditions for cld children in foster care with disabilities is scarce. the literature addresses parts of the triple risk, for example, cld children with disabilities or foster youth with disabilities (hill, 2013; larson & anderson, 2005; zetlin, 2006). when these characteristics exist in unison, the search for recent evidence-based research and strategies produces limited results. leake, black, and roberts (2004) share essential tools to address challenges faced by cld youth with disabilities who are in transition. leake et al. (2004) highlight effective evidence-based programs that increase social skills, self-determination, expectations, financial resources, and access to education. more recently, the national health foundation (2013) published a report on the healthy development of minority youth with disabilities, with specific attention on youth in california. this report provides recommendations for meeting the needs of cld youth with disabilities; however, foster youth issues are missing from the discussion. schools are perplexed by the ways to best serve and educate cld foster youth with disabilities (center for great leaders for teachers, 2014; clemens et al., 2016; folman & anderson, 2003; hill, 2013; staub & meighan, 2007). there is an immediate need for related services personnel (school counselors, school psychologists, school social workers) who can respond to the complex social, emotional, and learning needs of diverse foster youth with disabilities or who are at risk of disabilities. in addition, professionals who accurately reflect the students they serve are critical in special education evaluation and assessment processes. these professionals stand in the gap and help to eradicate the “fast and furious track to special education” (webb-johnson, green, & beard, 2008, p. 69). this accelerated track to special education happens when students are placed in special education at disproportionate rates and without implementing effective interventions (webb-johnson, green, & beard, 2008). cares: a response as the remedy project cares (culturally affirming responsive education specialist) is a five-year graduate program training grant initiated in 2012 by the u.s. department of education office of special education program (green, 2012). this initiative was designed to respond to the need for quality services for cld students with disabilities in foster care through four major goals: 1. to respond to the shortages of school psychologists, school counselors, and school social workers. 2. to increase the number of school psychologists, school counselors, and school social workers who are trained to provide high quality academic and mental health services known to be effective for cld students in foster care with, or at risk of, disabilities. 3. to enhance the capacity of the programs to prepare professionals to work collaboratively to serve and advocate for these youth. 4. to disseminate best practices at conferences and workshops, in classrooms (e.g., case studies), and in our professional disciplines (e.g., professional papers). green & mathiesen/who cares? 172 project cares’ unique design includes: (a) an interdisciplinary approach, (b) a focus on children in foster care with or at risk of disabilities, and (c) a focus on training professionals who are highly qualified to impact students from ethnically and linguistically diverse backgrounds. the goal of the grant was to train 30 high-quality fully credentialed related services personnel (school counselors, school psychologists, and school social workers) prepared to serve high-need cldfyd. based on the lessons learned from the grant, the current paper highlights effective competencies for school professionals who are interested in improving the educational path of foster youth from diverse backgrounds who have or are at risk for a disability. gaps in care: shortages of highly-qualified professionals to meet the needs of cldfyd across the nation, there is a deepening shortage of school psychologists, school counselors, and school social workers prepared to serve cld foster youth with disabilities (boyle & springer, 2001; center on great leaders for teachers, 2014; center on personnel studies in special education, 2004). according to folman and anderson (2003), there are a limited number of education professionals who have specialized training in working with students in foster care. additionally, teachers, foster parents, and child welfare workers rarely interact to determine the best needs of the students (folman & anderson, 2003). schools have experienced significant shortages of these personnel for the past 10 years. since 1996, school professionals, especially those who provide services for children with disabilities, represent personnel in the “considerable shortage” category among all fields in education (müller, 2011, p. 3). they rank among the country’s top labor shortage areas (national coalition on personnel shortages in special education and related services [ncpssers], 2014). in some western states, the shortages run deeper (ncpssers, 2014). california, with a population of over 37 million, has approximately 9,000 school counselors, 4,000 school psychologists, and 200 school social workers certified to serve children under the individuals with disabilities education act (idea, 2004), a law originally enacted by congress in 1975 to ensure that children with disabilities have the right to a free appropriate public education (lucile packard foundation for children’s health, 2016). personnel-to-student ratios exceed the maximum number suggested in all three disciplines, with the highest ratios for social workers. table 2 displays the recommended ratios of school counselors, school psychologists, and school social workers to students and the actual ratios in the u.s. table 2. recommended versus actual ratios of students to personnel related services personnel maximum ratio u.s. ratio actual ratio-u.s. largest state school counselor 1:250 1:471 1:1016 school psychologists 1:1000/ 1:5001 1:1383 1:1579 school social worker 1:250 1:2500 1:15256 1full service recommended ratio (sources: lucile packard foundation for children’s health, 2016; national association of school psychologists, 2010; national association of social workers, 2016; u.s. department of education, national center for education statistics, 2014) advances in social work, fall 2016, 17(2) 173 the most prominent shortages exist in high-needs schools with higher percentages of cld students and students receiving free and reduced lunch (ncpssers, 2014). these schools experience the highest rates of turnover, unfilled positions, and educational achievement gaps. they also have the lowest rates of quality special education services and qualified personnel (center on personnel studies in special education, 2004). ncpssers (2014) attributes these shortages to the increasing demand for services, a lack of highly qualified personnel to meet the demand, insufficient funding, and limited capacity of existing training programs to meet the demand. the impact of these shortages may be summarized as follows: (a) fewer than one in five children in need of mental health services get the services they need; (b) students experience missing or incomplete services when qualified professionals are not available; (c) low-quality services are provided by unqualified personnel; (d) there are increased caseloads and workloads; (e) there is less opportunity for individual services; and (f) there are decreased opportunities to work collaboratively with school staff, students, and parents (ncpssers, 2014). shortages of highly qualified professionals impede the ability of foster youth with disabilities to maximize their academic potential (ncpssers, 2014). the literature reveals a demand for more professionals of color (grapin, bocanegra, green, lee, & jaafar, 2016; green, cook-morales, robinson-zañartu, & ingraham, 2009; green & ingraham, 2005; green, tran, & young, 2005; mckellar & cowan, 2011; webbjohnson et al., 2008). these professionals may help to stem the tide of discrimination, overrepresentation, and misidentification that students in foster care experience. in addition, professionals who accurately reflect the students they serve are critical in special education evaluation and assessment processes. the changing population of schools challenges the field of education to close the gaps and increase the number of school personnel to accurately reflect the level of need. cldfyd advocates school counselors as advocates. school counselors are on the front lines of working with children in schools. as advocates for students who are also in the foster care system, they can support youth and their families in obtaining effective resources that help to promote positive social and emotional well-being. school counselors can also help foster youth define long-term educational goals and develop effective decision-making for the future (american school counselor association, 2012). as foster youth advocates, school counselors can serve as liaisons between parents, guardians, teachers, courts, administrators, and the child. school counselors can also keep stakeholders informed about the academic progress of each child and arrange conferences when necessary. additionally, school counselors hold a basic understanding of the social service system and are tasked to keep up with current educational laws related to foster youth. school social workers as advocates. school social workers have specialized training in mental health, behavior, academic support, consultation, and counseling techniques (school social work association of america, 2014). as advocates for foster youth, school social workers can help to build strong and lasting partnerships between teachers and parents by advocating for ongoing school-family partnerships. they have the resources and training to connect students and families with community support services. they can help green & mathiesen/who cares? 174 schools, parents/guardians, and teachers understand the unique behavioral and emotional needs of cldfyd. school social workers can implement mental health and behavioral interventions to reduce absences and dropout rates and increase academic success (national association of social workers, 2016). however, there are not enough school social workers in the field to meet the needs of the increasingly diverse population they serve (ncpssers, 2014). the need for school personnel to work collaboratively to meet these challenges is evident in this field. school psychologists as advocates. school psychologists are uniquely qualified members of school teams who support students’ ability to learn and teachers’ ability to teach. they apply expertise in mental health, learning, and behavior to help children and youth succeed academically, socially, behaviorally, and emotionally (national association of school psychologists, 2015). school psychologists work together with students, families, teachers, and other school professionals to build and create safe and supportive learning environments that strengthen the home-school-community connection (national association of school psychologists, 2015). school psychologists serve as advocates who identify foster youth who need support, help evaluate eligibility for special education services, and design and implement academic and behavior plans. as advocates for cld children in foster care, school psychologists can help to ensure school stability. their role is crucial in the development of services and supports addressing the negative impact that maltreatment and neglect can have on school performance (staub & meighan, 2007). school psychologists can work with teachers to ensure that cldfyd have a supportive and stable environment where they can feel safe and welcomed. interdisciplinary practice: meeting the complex needs of cld foster youth with disabilities the complex nature of the issues that children in foster care face can be overwhelming for personnel who are not adequately trained to provide services for these youth. children in the welfare system are at a higher risk of having or acquiring disabilities (larson & anderson, 2005) and are often abused or neglected at higher rates than children in foster care without disabilities (3.4 times more likely). in a study conducted by sullivan and knutson (2000), 31% of children with disabilities were found to have experienced maltreatment. of these maltreatment cases, caseworkers reported that the presence of a disability was directly correlated with maltreatment for 47% of the children. maltreatment coupled with the need for special services makes it challenging for personnel to respond, especially if they have not been trained adequately in working with this population. when diverse cultures are added to the equation, many personnel find themselves unprepared to address the issues. professionals who work closely with foster youth (e.g., school counselors, school psychologists, and school social workers) should be knowledgeable regarding successful ways to work as a team to impact change for all foster youth. while each profession has its own set of professional competencies, little has been done in the area of interdisciplinary competency development, specifically for work with children in foster care (ivanitskaya, clark, montgomery, & primeau, 2002). advances in social work, fall 2016, 17(2) 175 caring for cldfyd: competencies for culturally affirming and responsive education specialist (cares) table 3 presents professional competencies designed to improve educational and mental health outcomes effectively for youth in foster care. these competencies build on the areas identified by child welfare and developmental disability professionals at the institute for human services (ihs). the competencies delineate knowledge, skills, and practices that are essential in providing effective child welfare services to children in foster care from diverse backgrounds who have special needs. the competencies provide a blueprint for training highly qualified child welfare caseworkers and supervisors (rycus, freundlich, hughes, keefer, & oakes, 2006). competencies adopted from merrell, ervin, and peacock (2012) are also included within this framework of competencies: (a) awareness of the nature, scope, complexity, and developmental trajectories of students in foster care with disabilities including behavioral, social, and mental health issues, (b) knowledgeable of effective interventions; (c) preparedness to interact with a multisystem of professionals (e.g., medical, clinical, and community care) that impact foster youth with disabilities; and (d) serve as experts in the application of data-oriented problem-solving approaches to the management of primary, secondary, and tertiary prevention and intervention efforts. table 3 presents the combined interdisciplinary competencies from merrell et al. (2012) and the research literature for school professionals in four major areas: (1) effective academic and mental health services, (2) educational and parent advocacy, (3) cultural competency, and (4) interdisciplinary service delivery (bridges, davidson, odegard, maki, & tomkowiak, 2011; merrell et al., 2012; michael, bernstein, owens, albright, & anderson-butcher, 2014). the cares competencies encourage innovative ways for professionals to work together to improve outcomes for foster youth. they promote a collaborative effort that makes obsolete the old practices of doing work separately behind closed doors. educational specialists with training in interdisciplinary prevention and intervention services help to enhance outcomes for foster youth and increase chances of school success (bridges et al., 2011; merrell et al., 2012; michael et al., 2014). the cost of cares funding the cares interdisciplinary model might pose a challenge for some school districts, especially those with limited budgets. these budget shortfalls and the lack of capacity to implement this work can serve as a barrier to providing essential training and professional development. however, some districts have made great strides in addressing the needs of foster youth in schools. for example, in california, current personnel, many who are school counselors or school psychologists, are designated as foster care/educational liaisons for their school. foster care liaisons are responsible for ensuring that children in care have their basic needs met, are safe, experience school stability, and gain access to education. foster care liaisons receive ongoing professional development on issues impacting youth in foster care to improve their educational performance (ab 490, 2003; essa, 2015). green & mathiesen/who cares? 176 table 3. interdisciplinary competencies for culturally affirming and responsive education specialists (cares) competency interdisciplinary competencies for culturally affirming and responsive education specialists (cares) competency 1: effective academic and mental health services  cares should understand the nature, scope, complexity, and developmental trajectories of cld students in foster care with or at risk of disabilities (e.g., disproportionate placement in foster care and special education).  cares implement and evaluate effective academic and mental health services with cld children in foster care with disabilities and their families.  cares actively collaborate with key stakeholders (e.g., teachers, principals, special education teachers, general education teachers, and other team members) at assigned school-based fieldwork sites. competency 2: educational and parent advocacy  cares demonstrate knowledge of the child welfare system and child advocacy, including culturally specific mandates.  cares actively collaborate with key stakeholders (e.g., teachers, principals, special education teachers, general education teachers, and other team members) at assigned school-based fieldwork sites.  cares develop an awareness of the need for self-care for practitioners who work with underserved populations. competency 3: cultural competency  cares demonstrate knowledge and skills in working effectively with foster children and their families from a variety of ethnic, cultural, linguistic, economic, and religious backgrounds.  cares demonstrate an awareness of how school professionals’ own cultural frameworks/perspectives influence their work with children and families from culturally and linguistically diverse backgrounds.  cares are knowledgeable of the issues and impact of disproportionate representation and overrepresentation in special education of cld students in foster care.  cares understand and use culturally relevant/affirming practices to improve academic and mental health services for cld children with disabilities who are in foster care. competency 4: interdisciplinary service delivery  develop shared knowledge and skills in improving outcomes for cld foster youth with disabilities.  disseminate knowledge gained/learned to child welfare professionals, parents, school staff, and other key stakeholders in models supporting foster youth.  use interdisciplinary models for effective collaboration, teaming, and group problem-solving to improve outcomes for cld children with disabilities in foster care. (sources: laliberte & lightfoot, 2013; lewallen, hunt, potts-datema, zaza, & giles, 2015; merrell et al., 2012; rycus et al., 2006; rycus & hughes, 2000) with the recent reauthorization of the elementary and secondary education act of 1965 (esea), now called the every student succeeds act (essa, 2015), all state advances in social work, fall 2016, 17(2) 177 education agencies are required by law to have a foster youth liaison. in addition, states are mandated to track the achievement and graduation rates for children in foster care. this is the first time that essa has included protections and services for foster youth and collaboration with child welfare services to promote educational success and school stability (hults & burdick, 2016). under essa, local education agencies receiving title i funds must work with child welfare agencies to implement clear plans to ensure school stability, including transportation. this title i funding can also be used to hire qualified personnel to provide comprehensive learning supports and other interventions (i.e., mental health, academic interventions, and behavioral interventions). essa references these highly qualified personnel as specialized instructional support personnel (sisp). sisps are school counselors, school social workers, school psychologists, and other qualified related personnel with specialized training to meet the unique needs of school-aged foster youth. many of these personnel work in schools across several states (e.g., california, florida, massachusetts, nevada, pennsylvania, and rhode island; center on great leaders for teachers, 2014). schools can also partner with local universities to enlist the support of graduate programs that train degree-seeking students to become specialized instructional support personnel. students can serve as interns within the district to provide support to schools in need. this could be a cost-effective way of obtaining comprehensive support. it would also provide the intern with specialized practical and hands-on training. additionally, parents and other stakeholders may be willing to serve as volunteers to help schools meet the unique needs of children in foster care with disabilities. funding streams such as training grants and other federally funded and non-federally funded state and national grant initiatives can provide support to ensure the educational success of foster youth. school professionals can work together to develop sound proposals. however, to date, there is no consistent funding source that has the goal of training school professionals to meet the needs of cldfyd. project cares is one funding success story that garnered the support needed to build a successful interdisciplinary training program, but the funding ends in 2017. there is some promise in california with the recent passage of the local control funding formula (lcff) (california department of education, 2013), a new school funding law that gives districts funding to provide greater resources to serve low-income students, english learners, and students in foster care. however, school districts have had difficulty demonstrating progress toward annual goals and implementing actions to achieve these goals. this funding source could potentially be the stepping stone to train highly qualified cares personnel across the nation. future directions and implications schools districts are facing enormous challenges in knowing how best to serve and educate cldfyd in their schools. a critical issue in educating cldfyd is the lack of highly qualified personnel who can work collaboratively with teachers, parents, and other stakeholders to ensure educational success of these youth. cares addresses the national need to recognize who cldfyd are in schools, how they learn best, and ways to implement culturally affirming practices to support academic success. cares responds to green & mathiesen/who cares? 178 essa’s call for specialized instructional support personnel who are highly qualified to provide comprehensive services (e.g., school-wide support, academic interventions, behavioral interventions, and mental health support) (essa, 2015). cares seeks to address the triple whammy through culturally competent interdisciplinary practices that encourage school professionals to work together, instead of in silos, to provide school stability and achievement for cldfyd. youth in the foster care system have a complex set of needs that can best be addressed by culturally affirming interdisciplinary teams. the work begins with university training programs and other professional development programs that have a vested interest in producing culturally competent professionals across disciplines. interdisciplinary teams address the myriad needs that arise, differentiating interventions based on their specializations. thus, early training for work in an interdisciplinary setting helps professionals understand how to address the needs of foster youth and improve educational outcomes (strand, 2006). training and professional development programs that infuse the aforementioned competencies (academics, mental health, and parent educational advocacy) in their clinical practices help prepare professionals for interdisciplinary work. interdisciplinary practice creates effective learning that is more holistic than individualized knowledge-based practice (ivanitskaya et al., 2002). this practice provides school professionals with cross-disciplinary knowledge and evidence-based practices for cldfyd. ivanitskaya et al. (2002) completed a comprehensive review of the literature and found that interdisciplinary learning and practice models yielded the following predicted outcomes: (a) flexible thinking; (b) understanding of strengths and limitations of thinking; (c) ability to assess; (d) value of the knowledge; (e) improved content retention, enhanced thinking and learning skills and enlarged perspectives; and (f) the ability to synthesize or integrate. the model empowers professionals to develop new competencies that are shared between the professions and that reflect contributions of one discipline to another. the work ahead encourages professionals to work together, embrace what they learn from one another, and acknowledge the value that each profession brings to the table. school social workers can play a leadership role in creating and coordinating interprofessional teams. interdisciplinary practice and competency development ensure that children and youth in foster care get the educational, mental, and physical support they need to grow and blossom. references ab 490. 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(2004). improving education outcomes for children in foster care: intervention by an education liaison. journal of education for students placed at risk, 9(4), 421-429. doi:https://doi.org/10.1207/s15327671espr0904_5 author note: address correspondence to: tonika duren green, san diego state university, department of counseling and school psychology, north education room 193, 5500 campanile drive, san diego, ca 92182-1179, 619-594-4467, tduren@mail.sdsu.edu https://doi.org/10.1207/s15327671espr0904_5 mailto:tduren@mail.sdsu.edu microsoft word ponder and aguirre_trauma_copyedit bb _________ warren n. ponder, lmsw, acsw is a social worker for the readjustment counseling service, department of veterans affairs, fort worth, tx. regina t. p. aguirre, ph.d., lmsw-ap is an assistant professor at the university of texas at arlington school of social work. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 203-215 war-related trauma: increasing the american gi’s resilience through marriage warren n. ponder regina t. p. aguirre abstract: studies have shown ptsd has a negative impact on close relationships among vietnam war veterans. recently, studies have replicated these findings in the operation iraqi freedom (oif) and operation enduring freedom (oef) cohort. currently, over half of the military is married and veterans are returning from combat with elevated rates of ptsd. thus, investigating which symptom clusters influence marital satisfaction of the veteran the most is important for assisting social workers and other mental health professionals in identifying and prioritizing treatment goals. the current study identifies which of the four ptsd symptom clusters impacts marital satisfaction the most in returning combat veterans using regression analysis. the emotional numbing cluster negatively impacted marital satisfaction whereas the hyper-arousal cluster positively impacted it. using all 17 post-traumatic disorder checklist-military (pcl-m) questions as possible predictors of veterans’ marital satisfaction, regression analysis revealed five of the questions account for 26 percent of the variance in marital satisfaction. clinical implications and recommendations are explored. keywords: veterans, marital satisfaction, ptsd, pcl-m, marriage introduction when veterans return from operation iraqi freedom (oif) or operation enduring freedom (oef), they may come back with experiences of war that often lead to the development of post-traumatic stress disorder (ptsd) (seal, et al., 2008). for purposes of this article, veteran(s) is an all inclusive term that refers to active duty personnel and those who have separated from their respective military component who have been deployed in support of operation iraqi freedom (oif) and/or operation enduring freedom (oef). to be diagnosed with ptsd, according to the diagnostic and statistical manual for mental disorders (dsm-iv tr) (american psychiatric association [apa], 2000), a person must meet several requirements. the first criterion is that: the person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person’s response involved intense fear, helplessness or horror (p. 467). the person must also have symptoms from three clusters present for longer than one month: (b) re-experiencing, (c) avoidance/emotional numbing, and (d) hyper-arousal. re-experiencing symptoms are intrusive memories about the trauma; nightmares; feeling as though the trauma is reoccurring; intense psychological distress; and physiological reactivity. avoidance/emotional numbing symptoms are efforts to avoid thoughts, advances in social work, spring 2012, 13(1) 204 activities, and memories of the trauma; decreased interest in activities; emotional detachment; restricted affect; and a sense of a foreshortened future. hyper-arousal symptoms are characterized as difficulty falling asleep; irritability; difficulty concentrating; hyper-vigilance; and an exaggerated startle response. the last criterion for ptsd is “the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning” (p. 468). seal et al. (2008) report that about 21.8% of returning oif and oef veterans have ptsd. when a veteran is married—over half of the us military active duty population is (defense manpower data center [dmdc], 2008)—ptsd not only affects the veteran but also the marital dyad and the entire family system (monson, taft, & fredman, 2009). research shows secondary/vicarious traumatization, caregiver burden, ambiguous loss, and intergenerational transmission can develop in close relationships when an individual exhibits ptsd symptoms (monson, fredman, & dekel, 2010). maintaining and strengthening military marriages is integral in protecting veterans and their families from negative outcomes additional to ptsd including intimate partner violence, divorce, and suicide. the primary purpose of this study was to identify which post-traumatic stress symptom clusters impact marital satisfaction the most among returning oif/oef veterans to assist social workers and other mental health professionals in prioritizing treatment goals. literature review researchers have been studying adaptation in close relationships after trauma for some time (e.g., hill, 1949; lavee, mccubbin, & patterson, 1985; mccubbin, & mccubbin, 1991; mccubbin & patterson, 1982; segal, 1986). whisman and beach (2010) assert “studies have suggested that marital satisfaction is lower among people with psychiatric disorders, including anxiety disorders” (p.17). the majority of what is known about ptsd and close relationships is derived from research conducted on vietnam veterans and their partners (monson, et al., 2010). for example, jordan et al. (1992) examined data from the national vietnam veterans readjustment survey (nvvrs) and concluded approximately 60% who met ptsd criteria reported medium-high to high levels of marital issues and poor family adjustment. additionally, significant others of vietnam veterans reported less satisfaction in their life (jordan, et al., 1992). finally, researchers (jordan, et al., 1992; kulka, et al., 1990) report male vietnam veterans diagnosed with ptsd were more likely to experience divorce than those not diagnosed with ptsd. however, mcleland, sutton, and schumm (2008) caution divorce rates may not be the best way to determine if deployments cause marital dissolution and suggest “using marital or relationship-satisfaction scores may be a more sensitive way to assess the immediate effect of predeployment or deployment stress on close relationships” (p. 842). literature has shown the more severe the ptsd experienced by the male veteran, the lower the marital satisfaction (allen, rhoades, stanley, & markman, 2010; renshaw, rodrigues, & jones, 2008). ptsd can have a deleterious impact on a close relationship with an ultimate culmination being physical aggression as stith, green, smith, and ward (2008) concluded in a meta-analysis investigating marital satisfaction and marital discord ponder, aguirre/war related trauma and marriage 205    as precursors to intimate partner violence. their results indicate “that decreased marital satisfaction and increased marital conflict are positively associated with physical aggression in intimate relationships” (p. 158). theoretical framework explaining the role of ptsd in marital satisfaction there are two main theories of ptsd in an interpersonal context: the couple’s adaptation to traumatic stress model (cats model) (nelson goff & smith, 2005) and cognitive behavioral interpersonal theory (monson, et al., 2010). the cats model shows how individuals and/or couples function and cope after a traumatic event; for this study, the traumatic event is combat exposure of the veteran and the long-term effects that exposure has on the veteran and the veteran’s marriage. the cats model posits that how the couple copes with the trauma is contingent on three variables: predisposing factors/resources, level of functioning in each partner, and the couple’s functioning (monson, et al., 2010; nelson goff & smith, 2005). monson and colleagues (2010) have also illustrated that cognitive behavioral theory explains relationship issues where ptsd is present. monson et al. (2010) assert domains like safety, trust, power, esteem, and intimacy can be impacted by a trauma, thereby affecting close interpersonal relationships. essentially, as the veteran manifests ptsd symptoms at the individual level in the cognitive, behavioral, or affective realm, the same symptoms can be seen at the dyadic level. both theories highlight the interpersonal exchange of ptsd in close relationships, yet leave the question: are certain symptoms more deleterious to the couple than others? the role of individual ptsd clusters in close relationships prior to 1998, there were few studies examining the role individual ptsd clusters play in close relationships (riggs, byrne, weathers, & litz, 1998). riggs et al. (1998) were able to conclude each ptsd cluster can uniquely impact the interpersonal dyad. for example, if a veteran is re-experiencing trauma via nightmares, the spouse might not be inclined to sleep in the same room, possibly resulting in further isolation and emotional separation which could lead to the marriage deteriorating. similarly, if a veteran is avoiding situations or becoming emotionally numb, this could lead the veteran to become less intimate with the spouse as has been confirmed in current research (nunnink, goldwaserf, afari, nievergeltf, & baker, 2010; solomon, dekel, & zerach, 2008). riggs et al. (1998) concluded that the emotional numbing was the only significant predictor of relationship distress among vietnam veterans diagnosed with ptsd. however, in their limitations, they caution their results may not be generalizable to other traumatized populations, which can include different war cohorts such as oif/oef. purpose of the study from an interpersonal therapeutic context, identifying which clusters are creating the most impairment for oif and oef veterans in relation to their marriages—a key source of support for them—is of paramount concern to assist mental health professionals in prioritizing treatment goals such as strengthening military marriages. the primary purpose of this study was to fill the gap in previous research by identifying which ptsd advances in social work, spring 2012, 13(1) 206 clusters impact marital satisfaction among returning oif/oef veterans. the hypotheses that guided this study included:  h1) veterans who score above 50 on the post traumatic stress disorder checklist-military (pcl-m) will have lower marital satisfaction than veterans who score 49 or below on the pcl-m.  h2) emotional numbing as measured by the pcl-m will be the strongest predictor of oif/oef veterans’ marital satisfaction among the four different clusters.  h3) a model exists to predict ras scores based on individual pcl-m questions. method procedure for data collection and analysis this exploratory study used an anonymous survey to investigate variables that influence marital satisfaction among oif and oef veterans. all procedures were approved by the university of texas at arlington institutional review board. these authors contacted veteran service organizations to inquire if they would allow us to collect data from their members. after written permission was obtained from the organizations, these authors posted the survey to their private discussion boards, chat rooms, and via email. only organizations that verified oif or oef service via department of defense form 214 were allowed to participate in this study. data were collected for approximately forty days and included demographic questions, the relationship assessment scale, the combat exposure scale and the post-traumatic stress disorder checklist-military version. all data were analyzed using the statistical package for social sciences (spss) version 18.0; statistical significance was assessed at the .05 level. measures relationship assessment scale (ras) the relationship assessment scale (ras) is a seven-item measure that assesses satisfaction in close relationships (hendrick, 1988). the cumulative scores range from one to five. hendrick, dicke, and hendrick (1998) report “scores over 4.0 would likely indicate non-distressed partners, whereas scores closer to 3.5 for men and between 3.5 and 3.0 for women would indicate greater relationship distress and possibly substantial relationship dissatisfaction” (p. 141). the ras has good discriminant validity and has been found to have good convergent validity with both the dyadic adjustment scale (das) (.80 and .88) and the kansas marital satisfaction scale (kmss) (.64 for men and .74 for women) (hendrick, et al., 1998). ponder, aguirre/war related trauma and marriage 207    combat exposure scale (ces) the combat exposure scale (ces) was developed by keane et al. (1989) and is a seven-item self-report instrument designed to measure level of combat exposure. the items are rated from one to five and measure extent and severity of active combat experiences using a score weighted for the severity of each item. scores can range from 0 to 41 with a higher score indicating heavier exposure. the test-retest reliability of the ces is .97 (keane, et al., 1989) showing excellent stability. for internal consistency, cronbach’s alpha was calculated for the ces to be .85 (keane, et al., 1989). additionally, keane et al. (1989) concluded that the ces has good discriminant validity. post-traumatic stress disorder checklist military (pcl-m) there are several versions of the ptsd checklist (pcl) that can be modified to different populations including civilians, spouses, and military personnel. the ptsd checklistmilitary (pcl-m) is a likert scale standardized assessment instrument with 17 items assessing ptsd symptomology derived from the diagnostic and statistical manual of mental disorders-fourth edition (apa, 1994). each item relates to criteria for the ptsd diagnosis. pratt, brief, and keane (2006) examined the pcl-m and concluded that it has good convergent and discriminant validity along with high internal consistency and test-retest reliability. the pcl-m is used to identify persons within the military population who might have a diagnosis of ptsd, requiring further clinical assessment for confirmation of the diagnosis (weathers, litz, herman, huska, & keane, 1993). the dsm first recognized ptsd as a mental disorder in 1980 (apa, 1980) and currently has three symptom clusters (re-experiencing, avoidance/emotional numbing, and hyper-arousal) (apa, 2000). for some time researchers have recognized the avoidance and emotional numbing features of ptsd as separate and distinct (asmundson, stapleton, & taylor, 2004; foa, riggs, & gershuny, 1995; riggs, et al. 1998). for the purposes of this study, the avoidance/ emotional numbing traits are separated into two groups by generating means for each pcl-m question and coding them into the following clusters: questions 1-5 (re-experiencing), 6-7 (avoidance), 9-11 (emotional numbing), and 13-17 (hyper-arousal), thereby creating cluster means. the decision to code pcl-m questions into these clusters is in replication of riggs et al.’s (1998) coding strategy and is recommended by staff from the national center for ptsd (b. litz, personal communication, february 16, 2011). participants the sample consisted of 119 participants. all were married and had been deployed to oif or oef at least once. one hundred and one were males (84.9%) and eighteen were females (15.1%). the majority of respondents were white (n = 107, 89.9%). four other categories accounted for the remaining 10.1% (hispanic, n = 4; other, n = 4; more than one race, n = 3; and african american, n = 1). because the majority of the participants were white males, separate analyses based on race and sex would have lacked statistical power so no sub-group analyses were conducted. length of marriage ranged from 1 to 37 years with a mean of 9.18 years (sd = 7.96). of the respondents, 56 (47.1%) had been advances in social work, spring 2012, 13(1) 208 deployed once; 38 (31.9%) twice; 14 (11.8%) three times; and 11 (9.2%) four or more times to oif/oef. length of deployment was collapsed into total months deployed. the minimum was two months and the maximum was 39 months. the mean was 16.58 months (sd=8.52). five respondents did not complete this question. ninety-five (79.8%) of the respondents had been stateside more than one year, the rest had been home one year or less and two did not complete this question. results assessment instruments all 119 participants completed the ras, ces and pcl-m. the distributions of these scales all approached normality. for the ras, the minimum score was one and the maximum was five; the mean ras score was 3.65 (sd = 1.02). the data suggest that eighty-one participants (68.1%) are likely not martially distressed (3.5 or higher) and thirty-eight participants (31.9%) are likely distressed in their marital relationships (3.49 or lower). the mean ces score was 16.46 (sd= 9.9) indicating light to moderate combat exposure (keane et al., 1989) with scores ranging from 0 to 41; 48% of the respondents reported moderate or high combat exposure. the minimum score for the pcl-m was 17 and the maximum was 85, the mean pcl-m score was 43 (sd= 17.61). forty-five participants (37.8%) had a pcl-m score of 50 or greater suggesting a ptsd diagnosis, requiring further clinical assessment for confirmation of a ptsd diagnosis. hypothesis 1 the first hypothesis was veterans who score above 50 on the pcl-m will have lower marital satisfaction than veterans who score 49 or below; this was tested using t-tests. the mean pcl-m score for those 50 and above was 61.46 (sd = 10.13) and the 49 and below group’s mean pcl-m score was 31.81 (sd = 9.56). the mean marital satisfaction score for the 50 and above cohort was 3.45 (sd= 1.14), suggesting greater marital distress than the 49 and lower group whose mean ras score was 3.78 (sd= .92). homogeneity of variance was assessed using levene’s test. equal variances were not assumed (f(78.6)= 4.41, p< .05). the t-test indicated a rejection of hypothesis 1 since there was no statistically significant difference in marital satisfaction between veterans who had a clinical cutoff on the pcl-m of a score above 50 versus those who scored 49 or below (t(78.6)= -1.64, p=.11). hypothesis 2 the second hypothesis was that the emotional numbing cluster as measured by the pcl-m will be the strongest predictor of oif/oef veterans’ marital satisfaction among the four different clusters. a regression model using the enter method with ras scores as the dependent variable and each ptsd symptom cluster mean as the four independent variables was conducted. the regression model was statistically significant (f(4)=5.75, p<.001) and had an adjusted r squared value of .14, which accounts for 14% of the ras variability. the emotional numbing and hyper-arousal clusters were both statistically significant predictors of marital satisfaction. the beta weight of the emotional numbing ponder, aguirre/war related trauma and marriage 209    cluster was larger (ß = -.73) than the hyper-arousal cluster (ß = .49), thus supporting hypothesis two. the emotional numbing beta weight suggests that as emotional numbing increases, marital satisfaction decreases. the hyper-arousal beta weight can be interpreted that as hyper-arousal increases, so too does marital satisfaction. please refer to table 1. table 1. prediction of marital satisfaction by ptsd symptoms clusters ptsd clusters ß t p re-experiencing .09 .50 .62 avoidance -.06 -.37 .71 emotionally numb -.73 -4.61 <.01 hyper-arousal .49 2.73 <.01 hypothesis 3 the third hypothesis is a model exists to predict ras scores based on individual pcl-m questions. due to the results of hypothesis 1, all participants were included in the testing of this hypothesis as opposed to the original plan of only including participants who scored 50 or higher on the pcl-m. a backward stepwise regression model with all 17 pcl-m questions as predictors of marital satisfaction was conducted. the statistically significant model (f(5)=9.07, p<.001) had an adjusted r squared value of .26, which accounts for 26% of the ras variability. five pcl-m questions (10, 11, 14, 15, and 16) were statistically significant: two relating to emotional numbing and three to hyper-arousal. the beta weights for feeling distant from others (ß = -.29), emotionally numb (ß = -.44), and irritable or angry (ß = -.27), suggest inverse relationships with marital satisfaction—as each increases, marital satisfaction decreases. the beta weights for difficulty concentrating (ß = .35) and being alert or watchful (ß = .44) can be interpreted that as these increase, so too does marital satisfaction. please refer to table 2 for a complete listing. limitations data were not gathered from the spouse’s point of view; this was done to ensure anonymity to the veteran. if data had been gathered from the spouse, anonymity could not have been ensured. future studies should aim to collect data from the spouse and service member. another limitation is that data for this article were gathered at one point in time (post deployment). data should optimally be gathered pre, during, and post deployment in an attempt to establish a baseline level of marital satisfaction and assess change over time, especially given the cats model of ptsd in an interpersonal context where the couples’ predisposing factors/resources, level of functioning in each partner, and the couple’s functioning impact the dyad (monson, et al., 2010; nelson goff & smith, 2005). advances in social work, spring 2012, 13(1) 210 table 2. prediction of marital satisfaction by post traumatic stress disorder military (pcl-m) items pcl-m question ß t p 10. feeling distant or cutoff from other people?a -.29 -2.12 .04 11. feeling emotionally numb or being unable to have loving feeling for those close to you?a -.44 -3.25 <.01 14. feeling irritable or having angry outbursts?b -.27 -2.05 .04 15. having difficulty concentrating?b .35 2.42 .02 16. being “super-alert” or watchful or on guard?b .44 3.91 <.01 arelates to the emotional numbing cluster. brelates to the hyper-arousal cluster. conclusions and implications for social work practice this study is a significant contribution to the growing body of literature on how ptsd among returning oif/oef combat veterans affects interpersonal functioning. almost thirty-eight percent of veterans in the current study had a score of 50 or higher on the pcl-m suggesting a ptsd diagnosis requiring further clinical assessment for confirmation of the diagnosis; this is considerably higher than previous research (e.g. hoge, et al., 2004; seal et al., 2008). research investigating ptsd has generally analyzed ptsd symptoms using the three clusters set forth by the dsm-iv (tr). however, recent research has concluded that the avoidance/emotional numbing cluster is in fact two distinct clusters (asmundson, et al., 2004; foa, et al., 1995; riggs, et al. 1998). this study assesses the impact of ptsd, conceptualized using the four cluster organization of symptoms, on veterans’ marital satisfaction. the goal of this study is to assist social workers and other mental health professionals in prioritizing treatment goals related to the four clusters so as to increase veterans’ marital satisfaction quickly, equipping the veteran with an important resource—the marital relationship—for support and healing while decreasing the likelihood of intimate partner violence, divorce, and suicide. conclusions our first conclusion is that, though it has been supported in the literature, veterans with ptsd have more problems in their marriages than their fellow, trauma-exposed veterans without ptsd (monson, et al., 2009), the results of this study do not support this finding. in our sample 37.8% scored a 50 or above on the pcl-m, suggesting that a ptsd diagnosis and marital satisfaction scores among those with ptsd were not ponder, aguirre/war related trauma and marriage 211    statistically different than those for the veterans who scored 49 or below on the pcl-m. one possible reason for this is the moderate combat exposure reported by this sample. those participants with a score of 50 or greater on the pcl-m on average endorse moderate combat exposure. their mean score on the ces was 20.51 (sd= 9.86) whereas those with a score of 49 or below on the pcl-m reported light to moderate combat exposure (m=14; sd= 9.15). renshaw et al. (2009) showed combat exposure was directly related to ptsd, which was related to lower marital satisfaction. thus, since the combat exposure on average was moderate, it could account for the results not being significant. our second conclusion is that emotional numbing and hyper-arousal are the two clusters with the most impact on veterans’ marital satisfaction. this differs from previous research (riggs, et al., 1998) where the avoidance/emotional numbing cluster was the only significant predictor of relationship distress among vietnam veterans. the data of the present study shows that as the veterans’ emotional numbing increases, the veterans’ marital satisfaction decreases; for the hyper-arousal cluster, as hyper-arousal increases, so too does the veterans’ marital satisfaction. finally, our third conclusion is that certain aspects of the emotional numbing and hyper-arousal clusters are more influential on marital satisfaction than others as indicated in the regression analysis of individual questions on the pcl-m. specifically, the emotional numbing cluster components of feeling “distant or cut off” from others and emotionally numb or “being unable to have loving feeling for those close to you,” and feeling “irritable” or having “angry outbursts” all had inverse relationships with marital satisfaction meaning the less severe these components, the higher the marital satisfaction. for the “difficulty concentrating,” and being “watchful” components of the hyper-arousal cluster, the more severe these are, the higher the marital satisfaction. together, these five components explained a little more than a quarter of the variance in marital satisfaction with the remaining items in emotional numbing and two questions regarding hyperarousal not being significant to marital satisfaction. implications for practice and future research the findings of this article are important to social workers and other front line mental health providers who treat oif/oef combat veterans and their family members. even if a veteran does not meet full diagnostic criteria for ptsd, it is important for a clinician to assess for sub-clinical symptoms. the pcl-m is widely used and could easily be adapted for clinical practice with couples. it is recommended that the clinician administer the pcl-m to the veteran and a modified version to the spouse upon intake. the pcl-m can easily be modified to obtain the spouse’s perceptions of the veteran’s post-traumatic stress symptoms; this has been done previously in a research setting (renshaw, et al., 2008) and could easily be adapted for a clinical setting. this would allow for a more holistic picture of ptsd in the couple’s interpersonal relationship. using the results of our pcl-m regression model, the clinician could look at the individual pcl-m questions, especially the 5 that were significant in this study, and be provided with a quick overview of the couple’s presenting issues. advances in social work, spring 2012, 13(1) 212 a clinician can use these findings to quickly hone in on and prioritize areas for intervention; this is especially important for veterans seeking couple’s therapy because of the extensive impact that the emotional numbing and hyper-arousal clusters have on marital satisfaction. in work with veterans prior to oif/oef, behavioral/cognitivebehavioral therapy has been the most effective approach to working through couplerelated issues (monson, et al., 2009). however, current research shows that effectiveness can be achieved using a generic approach or by using a more ptsd-focused approach (monson, et al., 2009) leaving the clinician in a quandary as to which modality to embrace. thus, one example of how the findings of this study assist in prioritizing treatment goals relates to using behavioral/cognitive-behavioral therapy while enhancing communication when the veteran is exhibiting emotional numbing. when emotional numbing is present, communication or quality of communication between spouses decreases leading to stress, in turn resulting in lower marital satisfaction. thus, a primary social work implication is that when emotional numbing is present, a couple’s counseling treatment goal should be increasing quality of communication to maintain or increase marital satisfaction. this has been found to be an effective strategy with vietnam veterans (cahoon, 1984; sweany, 1987). two additional social work implications from our research relate to the effects of hyper-arousal. hyper-arousal includes irritability and angry outbursts, difficulty concentrating, and increased watchfulness; this study supports that two of these aspects— irritability and angry outbursts—have an inverse relationship with marital satisfaction. the authors posit that the irritability and angry outbursts may be perceived as a threat by the spouse who shuts down and withdraws. thus, social work interventions with couples should focus on anger management. contrastingly, our findings support that the other aspects of hyper-arousal—decreased concentration and increased watchfulness (items 15 and 16 on the pcl-m)—increase marital satisfaction, perhaps eliciting more empathy from the spouse. specifically decreased concentration by the veteran might not be viewed as a threat thereby allowing the spouse to assist without threat of harm. being watchful or on guard has the same possibilities for eliciting empathy from the spouse without the spouse feeling threatened. clinically, social workers may be wise to prioritize emotional numbing, anger and irritability over increasing concentration and decreasing watchfulness given the results of this study. references allen, e. s., rhoades, g. k., stanley, s. m., & markman, h. j. 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(unpublished doctoral dissertation). university of washington, seattle. weathers, f., litz, b., herman, d., huska, j., & keane, t. (1993). the ptsd checklist (pcl): reliability, validity, and diagnostic utility. paper presented at the annual convention of the international society for traumatic stress studies, san antonio, tx. whisman m. a., & beach s. h. (2010). models of understanding interpersonal processes. in j. g. beck (ed.), interpersonal processes in the anxiety disorders: implications for understanding psychopathology and treatment (pp. 9-35). washington, dc: american psychological association. author’s note: address correspondence to: warren ponder, lmsw, acsw, fort worth vet center, 1305 w. magnolia ave., ste b, fort worth, tx 76104. e-mail: warren.ponder@va.gov microsoft word 17. goldkind_pardasani_2691 senior executives leadership styles copyedit_final ______________ lauri goldkind, lmsw, ph.d., is an assistant professor and manoj pardasani, lcsw, acsw, ph.d., is an associate professor, both in the graduate school of social service at fordham university in new york. the authors wish to thank the office of research at fordham university for providing funding which supported this research. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 573-593 social workers as senior executives: does academic training dictate leadership style? lauri goldkind manoj pardasani abstract: the range and patterns of leadership styles in human service organizations are important for social work educators and their students to understand if social work administrators are to compete successfully in the marketplace for executive director and other top management roles. using a sample of executive directors of human service organizations located in a state in the northeast section of the u.s., the multifactor leadership questionnaire (mlq) was used to explore their leadership style. the authors compare various elements of leadership style (charisma, inter-personal transactions, reactions to work issues, etc.) as well as perceptions of effectiveness and satisfaction with leadership style across academic backgrounds of executive directors. these results highlight the competencies required of successful leaders and can assist educators in identifying curricular gaps developing courses preparing social workers for leadership positions in the field. this study provides critical information on the core leadership skills and knowledge relevant for effective social work administration. implications for social work training and education are discussed as well as possible avenues for curriculum revision. keywords: leadership style, executive director, multifactor leadership questionnaire, social work administrator the nonprofit sector is a critical component of the u.s. economy. in 2010, the bureau of economic analysis reported over 1.5 million tax exempt organizations including nearly 1 million public charities. these organizations represent 9 percent of all wages and salaries paid in the u.s. as well as over 5 percent of the overall gdp of the united states economy (sherlock & gravelle, 2009). this figure includes a diverse group of organizations, both in size and mission, which range from hospitals and human service organizations to advocacy groups and economic development corporations. according to roeger, blackwood and pettijohn (2011), human service organizations accounted for approximately one-third of all organizations in the public charities category, making it the largest segment in the nonprofit sector. similar to the growth of the non-profit sector, social work has been recognized as one of the fastest growing careers in the united states, with over 600,000 people holding social work degrees (national association of social workers [nasw], 2009). despite the significant expansion of the nonprofit sector and the social work profession, the field of social work administration has not followed suit. very few students in graduate social work programs express an interest in preparing for careers in goldkind, pardasani/social workers as senior executives 574 administration; a large majority of students select clinical or interpersonal work as their practice focus (wilson & lau, 2011; wuenschel, 2006). this has created a serious scenario: on one hand many nonprofit social service administration jobs are filled by individuals with no social work background, while in parallel fewer social workers are being prepared for leadership positions in organizations. a 2003 study by the united way of new york city suggested a looming crisis in nonprofit management, with many nonprofit leaders on the verge of retirement and few potential leaders poised to take their place (birdsell & muzzio, 2003). despite the overwhelming need, few organizations reported that they were investing in the leadership training of their management staff (birdsell & muzzio, 2003). similarly, austin, regan, samples, schwartz, and carnochan (2011) suggest that leadership training for non-profit administrators is limited in the practice arena, and scholarship evaluating and documenting such efforts is equally scarce. as a growing number of social service agencies are being run by administrators from fields other than social work, educational programs and professional groups like the national association of social workers (nasw) and the national network of social work managers are concerned about the ability of social work to remain at the forefront of agency decision-making and the development of policy at the highest levels (ezell, chernesky, & healy, 2004). for more than three decades, some social work educators have recognized the unique challenges of training social work administrators and the limitations of schools of social work in preparing students as administrators (ezell, chernesky, & healy 2004; neugeboren, 1986; patti, 1987; wuenschel, 2006). one of the reasons for this is the absence of a conceptualization and the documentation of specific competencies that are essential for administrative practice (edwards, cooke, & reid, 1996; mcnutt, 1995; menefee, 2009; wimpfheimer, 2004). another is uncertainty around the unique knowledge base and skills required to be effective managers and organizational leaders. it is imperative, therefore, to assess the specific competencies and knowledge-base required by service administrators and managers in the field, highlight the essential differences between administrators/managers trained in social work and those trained in other disciplines (such as law, business, public health, etc.), and evaluate the impact of specific leadership training on competencies needed in the field. literature review in the last two decades administrators with a social work background have faced significant challenges. while human services leadership jobs at the most senior levels have increasingly been filled with lawyers, economists, and mbas, enrollments in social work administration and organizational leadership programs has been falling (ezell et al., 2004; hoefer, 2003). social workers appear to be missing from leadership roles even in agencies that have unique social work traditions such as settlement houses. a review of the 37 member agencies of the united neighborhood houses of new york city reveals that only 30% of settlement house leaders hold an msw degree (united neighborhood houses, 2012). if schools of social work are to remain viable vehicles for the training and professional development of social work leaders and managers they must focus on competency development that these social workers will need to be successful in advances in social work, fall 2013, 14(2) 575 leadership and senior management roles. in order to begin to understand the present leadership landscape in non-profit human services organizations the following sections explore recent scholarship on leader’s demographic characteristics, social work education’s specific focus on leadership training, and the main themes of the “full range leadership model” (frlm) posited by avolio and bass (antonakis, avolio, & sivasubramaniam, 2003). race, gender, and academic credentials in the executive office despite rapidly changing racial and ethnic characteristics in the united states, human services executive leadership remains dominated by whites. this is true both in agencies’ governance structures, where boards of directors are comprised of predominately white males, and among executive directors. a national survey of nonprofit executives found that 82 percent of executive directors were white, 7 percent were african american, 4 percent were asian-pacific islander, 4 percent were latino/a, 0.7 percent were native american, 0.4 percent were middle eastern, and 2 percent were “other”(cornelius, moyers, & bell, 2011). in all geographic areas studied, the percentage of executive directors who were white exceeded the share of whites in the population. for example, in the san francisco bay area, 78% of executive directors were white compared with 58% of the population; in sacramento, 91% of executive directors were white compared with 48% of the population (bell, moyers, & wolfred, 2006). it is also more likely for people of color to be an organization’s primary clientele than it is for them to be the organization’s executive director or deputy directors; even in organizations that serve primarily people of color, the executive leadership tends not to be of color (teegarden, 2004). human service agencies appear prepared to embrace women leaders. a national survey of nonprofit executives found that the normative nonprofit executive director is a white woman in her 50s with about six years of experience as an administrator (teegarden, 2004). while it is promising that women in the nonprofit arena have made inroads into executive management, teegarden (2004) also found that female-led organizations were smaller than those led by men. similar trends were identified in the budgets of such organizations; the median budget for female-led organizations was $500,000 to $1 million, while for men the median budget was $1 million to $2 million (gose, 2004; hrywna, 2006; o’leary, 2009; teegarden, 2004). moreover, income disparity still exists between men and women agency leaders. on average, women earn less than men, with average salaries between $60,000 to $69,999 compared to men’s $70,000 to $79,999 (joslyn, 2003; lipman, 2006; teegarden, 2004). while race and sex characteristics of nonprofit leaders are well-documented in the literature, academic credentials of senior leaders and their impact on agency operations, structures, and services remains a less examined area (hoefer, 2003; nesoff, 2007). given the discourse in the field about social workers losing ground as human service agency executives, it is surprising that more empirical work has not been completed in this area. as suarez (2010) notes, “nonprofit leaders must be credible with clients, donors, and staff” (p. 6), but there is nothing to say that the skills that lead to credibility goldkind, pardasani/social workers as senior executives 576 must be procured in any single academic discipline. in his study of 200 nonprofit leaders, suarez (2010) found that approximately 51% held advanced academic credentials. thirteen percent held degrees directly related to management, and 43% held advanced degrees in other applied disciplines, including five (2.5 percent) with msws (suarez, 2010). leadership training for social workers recent social work management literature has discussed the need for an “integration” of social work values with management skill and expertise (richardson, 2010). in 2010, the social work congress convened over 400 social work leaders for the purpose of defining social work “imperatives” to promote the advancement of the profession in the next decade. among the ten imperatives was a call for leadership development to “integrate leadership training in social work curricula at all levels” (social work congress, 2010). achieving the integration of social work values and effective management skills may call for a restructuring of how social work educators prepare the next generation of leaders in the field. at the same time scholars have acknowledged the possible inadequacies of leadership and management training at the msw level, since 1987 the number of social work students specializing in administration has been declining steadily (ezell et al., 2004). approximately 80% of msw graduates report a primary interest in direct or clinical practice (austin & ezell, 2004). only 3% of graduate social work students specialize in administration in their academic programs (wuenschel, 2006), suggesting that many social work students have extremely limited exposure to administrative and leadership activities during their professional education. the landscape of professional social work education also reflects these circumstances. the council on social work education’s website lists a total of 68 accredited masters of social work programs offering an administration or management concentration, and over 130 programs offering a clinical or direct practice oriented program. thus, while many students may not come to advanced social work education with administration in mind, the limited number of programs that even offer such a concentration ensures that many students cannot even be exposed to this content even if they are interested in it. when thinking about possible gaps in leadership and management training at the msw level, it is worth noting that “many current human service managers began their careers as direct service workers and bring a more micro perspective into what, by definition, is a macro-oriented job” (hopkins & hyde, 2002, p. 12). the presence of unplanned transitions from direct service worker to manager bolsters the argument for social work educators to seek opportunities to nurture and enhance the administrative inclinations and abilities of social work students and their exposure to the theories, skills, and techniques of leadership (ezell et al., 2004; long & shobe, 2010; nesoff, 2007). msws transitioning into leadership roles should have had at least some exposure to administrative thinking and management strategies. knee and folsom (2012) identify five skills commonly focused on in foundation year curricula and provide examples of how more explicit connections could be made to a management practice. building on the advances in social work, fall 2013, 14(2) 577 work of earlier social work scholars, they argue that the foundational skills of communication, supervision, facilitation, teaming, and interpersonal skills, which are all hallmarks of social workers ability to relate and connect to people and communities, can be capitalized on in the management arena (knee & folsom, 2012). those who design social work curricula need to understand the reasons human service agencies are hiring leaders from non-social work backgrounds. do these disciplines provide knowledge or skills that are critical to leadership? if so, what specifically is this content? can it be provided in the social work curriculum? the full range of leadership model the full range of leadership model (frlm) posited by bass and avolio (1994) describes leadership behaviors and characteristics on a continuum from transformational to transactional, a third type of leadership described by the model is laissez-faire leadership. building on the work of james macgregor burns who first introduced the concept of transformational leadership in 1978, bass and avolio (1994) not only refined the concept of transformational leadership but also suggested ways to measure it. the central argument of the frlm is that a transformational leader assists individuals in uniting for a collective purpose and a vision for the future (bass & avolio, 1994). they further define four distinct qualities of the transformational leader: charisma, intellectual stimulation, individual consideration, and inspirational motivation. according to the authors, better leaders are transformational more frequently; lesser leaders are passive or focus on corrective action (bass & avolio, 1994). in contrast to the intellectually engaging affective and charismatic qualities of transformational leadership, transactional leadership has been characterized as a contractual or exchange process between leaders and followers (jung & avolio, 2000). transactional leaders focus on the role of supervision, performance, and building organizational structures. the transactional leader identifies staff’s expectations and provides rewards in exchange for high performance (bass, 1985; daft, 1999) – there is no concerted effort to change followers' personal values, nor necessarily a need to develop a deep sense of trust and commitment to the leader. instead, the transactional leader works with followers' current needs and tries to satisfy those needs with desired outcomes once agreed upon performance levels are achieved. where transformational leadership is viewed as influential and inspirational and transactional leadership is goal oriented, laissez-faire leadership leaves decisions unmade, authority un-consulted, and responsibilities un-noticed (khan, aslam, & riaz, 2012). laissez-faire leadership may be thought of as an absence of or avoidance of leadership (bass & avolio, 1990, 1993, bass, avolio, & atwater, 1996). transformational leadership has emerged as a focus of study in social work leadership literature. research has found that social service agency employees respond more favorably to transformational leaders than to transactional leaders (gellis, 2001; mizrahi & berger, 2005). additionally, recent studies have noted transformational leadership’s natural fit with the values of the social work profession (mary, 2005; mizrahi & berger, 2005; richardson, 2010). goldkind, pardasani/social workers as senior executives 578 study questions this article reports on the results of an empirical study investigating the possible relationship between leadership style and academic background among administrators in the human services field. the authors surveyed over 1,600 human service agency administrators, managers, and leaders in a large northeastern state. this exploratory study sought to address two primary questions: 1. what, if any, patterns exist between demographic characteristics and leadership styles of human service agency administrators? 2. are there essential leadership style differences between administrators from social work backgrounds and those from other academic disciplines? methods the authors utilized a survey design to reach human services administrators in a large northeastern state. the national taxonomy of exempt entities (ntee) system is used by the irs and the national center for charitable statistics (nccs) to classify nonprofit organizations (nccs, 2011). this study identified human service organizations by their ntee codes. all organizations with an ntee code of p (human services) were included in the sample. cover letters and paper survey instruments were mailed to over 1,600 executive directors of category p – human services providers as identified by the national taxonomy of exempt entities. due to budgetary constraints for this project, follow-up mailings, which might have increased the response rate, were not possible. surveys were returned anonymously; agency leaders did not submit their names or the names of their organizations. the letter to agency executives invited them to participate in a study exploring the possible relationships between leadership styles and demographic characteristics of social service agency administrators in the tri-state region. the letter also introduced the principal investigators as current faculty members and former agency administrators with a personal interest in the subject matter of the study. the invitation letter also laid out the objectives of the study for the prospective participants. this research was conducted with institutional review board approval from the authors’ university. sample a total of 393 completed surveys were returned for a response rate of 23 percent. table 1 describes the sample’s characteristics. the majority (61.6%) of the respondents were female while the rest were male (38.4%). more than three-fourths of the respondents were caucasian (85.8%), while only 8.7% were african american and less than 4% were either latino (3.6%) or asian (2.0%). nearly half of the administrators (48.7%) reported more than 20 years of experience as a supervisor, while an additional one-third (33.7%) reported between 11 and 20 years of experience. about one-third of the administrators had an msw (35.9%), while more than a quarter (29.8%) had a master’s degree in arts or social sciences. about the same advances in social work, fall 2013, 14(2) 579 number of respondents had only an undergraduate degree (13.8%) or a doctoral degree (13.0%). table 1. demographic characteristics of the respondents demographic characteristics percent gender male female 38.4 61.6 age 26-35 36-45 46-55 56 and older 6.0 14.5 33.2 46.4 race/ethnicity african american latino/latina asian american caucasian american 8.7 3.6 2.0 85.8 educational background ba/bs ma/ms msw mba jd phd 13.8 29.8 35.9 3.9 3.6 13.0 years as supervisor 10 years or less 11-20 years more than 20 years 17.6 33.7 48.7 instrument this study included the multifactor leadership questionnaire (mlq) to assess leadership styles of administrators of social service agencies. the mlq measures leadership behavior as articulated by the frlm (full range leadership model) posited by bass and avolio (2000). the frlm is a leadership typology system with three distinct types of behavior: transformational, transactional, and non-transactional laissezfaire leadership. these types of leadership are represented by nine factors: idealized influence (attributed), idealized influence (behavior), inspirational motivation, intellectual stimulation, individual consideration, contingent reward, management by exception (active), management by exception (passive) and laissez-fairre leadership (hunt, 1999; goldkind, pardasani/social workers as senior executives 580 lowe, kroeck, & sivasubramaniam,1996; yukl, 1999). the nine factors are grouped into six domains of leadership, including: charisma/inspirational – provides followers with a clear sense of purpose that is energizing; a role model for ethical conduct which builds identification with the leader and his/her articulated vision. this factor (style) comprises idealized influence (both attributed and behavior) and inspirational motivation. intellectual stimulation – gets followers to question the tried and true ways of solving problems; encourages them to question the methods they use to improve upon them. individualized consideration – focuses on understanding the needs of each follower and works continuously to get them to develop to their full potential. contingent reward – clarifies what is expected from followers and what they will receive if they meet expected levels of performance. active management-by-exception – focuses on monitoring task execution for any problems that might arise and correcting those problems to maintain current performance levels. passive avoidant – tends to react only after problems have become serious to take corrective action and may avoid making any decisions at all. this factor comprises management by exception (passive) and laissez-faire leadership styles. reliability and validity of the mlq 5x instrument were established by bass and avolio (2000), who report reliabilities ranging from .74 to .91. they also documented the construct validation process associated with the mlq 5x. an early version of the scale was evaluated by an expert panel, and their recommendations were included in the final instrument development, which helped to ensure content validity. since its initial development, 14 samples have been used to validate and cross-validate the mlq form 5x (bass & avolio, 2000). the 45-item instrument (mlq) utilized in this study comprised six characteristic leadership categories (measured through nine sub-scales) and three self-perception of outcome scales (extra effort by administrators, perception of effectiveness as administrators, and satisfaction with leadership). the six characteristic leadership categories are further collapsed into three components – transformational leadership (comprising charisma, intellectual stimulation and individual consideration), active transactional leadership, and passive transactional leadership. additionally, the mlq also contains items that evaluate the administrators’ self-perception of engaging in extra efforts as a leader, perception of effectiveness as a leader, and personal satisfaction with one’s leadership. each item on the mlq was assessed on a likert scale ranging from 0 (not at all) to 4 (frequently, if not always). figure 1 associates sample questions with the leadership style they are measuring. reliability testing of the scales in this study yielded cronbach alphas of 0.866 (transformational leadership), 0.753 (active transactional leadership), 0.811 advances in social work, fall 2013, 14(2) 581 (passive transactional leadership), 0.905 (extra effort as leader), 0.838 (effectiveness as a leader) and 0.898 (personal satisfaction with one’s leadership) respectively. figure 1. leadership domains and corresponding questionnaire items leadership style sample questions transformational  i talk optimistically about the future  i talk enthusiastically about what needs to be accomplished  i go beyond self-interest for the good of the group active transactional  i express satisfaction when others meet expectations  i discuss in specific terms who is responsible for achieving performance targets  i provide others with assistance in exchange for their efforts passive transactional  i delay responding to urgent questions  i avoid getting involved when important issues arise  is absent when needed extra effort as leader  i get others to do more than they expected to do  i heighten others’ desire to succeed self-perception of one’s effectiveness as a leader  i am effective in meeting others’ job-related needs  i am effective in representing others to higher authority satisfaction with one’s own leadership style  i use methods of leadership that are satisfying  i work with others in a satisfactory way transformational leadership style scores were derived by averaging all of the scores from the items contained in the idealized influence (attributed), idealized influence (behavior), inspirational motivation, intellectual stimulation, and individualized consideration sub-scales, a total of 20 items. transactional leadership (active) style scores were derived by averaging all of the scores from the 8 items in the contingent reward and management-by-exception (active) sub-scales. transactional leadership (passive) style scores were derived by averaging all of the scores from the 8 items in the management-by-exception (passive) and laissez-faire leadership sub-scales. extra effort was derived by averaging the scores of 3 items, self perception of effectiveness was derived by averaging the scores of 4 items, and self satisfaction with leadership was derived by averaging the scores of 2 items. the higher the score on each component scale, the greater was the utilization/incorporation of that style by a leader. thus, a higher score indicated a preferable (positive) outcome for all domains, except the avoidant transactional leadership style, where the lower score indicated lesser avoidant and passive behavior. additionally, demographic characteristics of the administrators (age, gender, race/ethnicity, years as supervisor, current title, years in current position, educational background and agency budget) were also ascertained by the survey. goldkind, pardasani/social workers as senior executives 582 findings frequency distributions were used to explore the demographic characteristics of the respondent pool. to evaluate the impact of sex (a binomial variable) on the leadership domains, an independent sample t-test was conducted. to evaluate the impact of age, years as supervisor and educational background on the six leadership domains being measured, analysis of variance (anova) tests were conducted as each of the independent variables (age, years as supervisor and educational background) had multiple categories, and the dependent variables (leadership domains) were measured as continuous variables. influence of administrators’ demographic characteristics the demographic characteristics of sex, race/ethnicity, age, and years as supervisor were tested to evaluate their impact on the three leadership styles (transformational, transactional {active} and transactional {passive}), as well as the self perceptions of extra effort, one’s assessment of effectiveness as a leader, and satisfaction with one’s leadership. with respect to sex, the only leadership style that was found to be statistically significantly different for male and female administrators was charismatic leadership (see table 2). an independent samples t-test demonstrated that women (m=3.38, sd=0.36) were likely to perceive themselves more charismatic than their male counterparts (m=3.26, sd=0.39), t(381) = -3.15, p = 0.002). race/ethnicity, age and years as supervisor were found to have no statistically significant relationship to the leadership styles or self perceptions of effectiveness, extra effort and professional satisfaction of administrators. influence of administrators’ educational backgrounds educational background was measured by asking respondents to highlight the highest degree obtained as well as specifying their major area of study. the educational backgrounds were then collapsed into six major categories – undergraduate (ba/bs), graduate degree in liberal arts or social sciences (ma/ms), graduate social work degree (msw), graduate business degree (mba), law degree (jd), and a doctoral degree (phd). an analysis of variance showed that educational background was significantly related to transformational leadership f(5, 356) = 3.62, p = 0.003, passive transactional leadership f(5, 356) = 2.76, p = 0.02, self perception of applying extra effort f(5, 352) = 2.98, p = 0.01, perception of one’s effectiveness as a leader f(5, 352) = 2.25, p = 0.05, and satisfaction with one’s leadership f(5, 350) = 2.24, p = 0.05. these findings are presented in table 3. the authors would like to caution readers that the differences in scores between administrators from diverse educational backgrounds were relatively small. however, keeping in mind the small differences between most of the educational backgrounds, administrators with a jd seemed to score the lowest on most of the domains of leadership, while administrators with a phd scored the highest. table 3 compares the advances in social work, fall 2013, 14(2) 583 mean scores across leadership domains. with regard to transformational leadership, administrators with a phd (m=3.42, sd=0.37) were most likely to assess themselves as transformational (charismatic), while administrators with a jd (m=2.93, sd=0.47) were least likely to identify themselves as charismatic or inspirational (sub components of transformational leadership). with regard to passive transactional leadership styles, administrators with only an undergraduate degree (m=0.84, sd=0.57) were most likely to identify themselves as passive and avoidant while administrators with an msw ((m=0.61, sd=0.47) were least likely to so identify themselves in this way. administrators with a phd (m=3.32, sd=0.56) were most likely to highlight engaging in extra efforts as a leader to enhance employees’ functioning, while administrators with a jd (m=2.84, sd=0.69) were least likely. administrators with a phd (m=3.51, sd=0.37) were most likely to perceive themselves as effective leaders, while administrators with a jd were the least likely (m=3.04, sd=0.69). finally, administrators with an msw (m=3.42, sd=0.54) were the most satisfied with their own leadership while administrators with a phd seemed to be the least satisfied (m=2.49, sd=0.52), followed by administrators with a jd (m=2.91, sd=0.62) tukey hsd post hoc tests were conducted to assess the pair-wise differences between the various educational backgrounds. for transformational leadership (charismatic and inspirational), statistically significant differences were observed between administrators with a jd and those with an undergraduate (p = 0.015), graduate ma/ms (p = 0.003), msw (p = 0.002) and phd (p=0.001) degrees respectively. for passive transactional (avoidant) leadership, statistically significant differences were observed between administrators with an ma/ms and an msw degree (p=0.05) only. with reference to applying extra effort as leaders, there were no statistically significant differences between any two groups. for self-perception of effectiveness, statistically significant differences were observed between administrators with a jd and those with an msw (p=0.04), and between administrators with a jd and those with a phd (p=0.015) respectively. statistically significant differences were observed with respect to satisfaction with one’s leadership between administrators with a jd and those with an msw (p=0.04) and between administrators with a jd and those with a phd (p=0.023) respectively. when gender, race/ethnicity, age and years as supervisor (all coded as categorical variables) were added to the model comparing educational backgrounds and leadership styles (using manovas), they did not have a statistically significant impact on the relationship between educational background and leadership styles. advances in social work, fall 2013, 14(2) 584 table 2. independent samples t-test, means, and standard deviations for leadership styles and gender leadership domains sex n x  sd t df p transformational leadership male 147 3.26 .39 -3.15 381 .002** female 236 3.38 .36 active transactional leadership male 147 2.42 .51 female 236 2.45 .59 -.56 381 .571 passive transactional leadership male 147 0.74 .43 0.72 381 .472 female 236 0.70 .52 extra effort as leader male 147 3.16 .55 -1.54 377 .124 female 236 3.25 .57 perception of one’s effectiveness as leader male 147 3.38 .46 -1.49 377 .135 female 236 3.45 .45 satisfaction with own leadership style male --- female *p<0.05, **p<0.01 advances in social work, fall 2013, 14(2) 585 table 3. analysis of variance (anova) and mean scores for leadership styles and educational background leadership domains educational background n  x sd sum of squares f df p transformational leadership between groups ba/ba 50 3.32 .37 2.50 3.62 5 .003** within groups ma/ms 108 3.35 .37 29.24 356 total msw 130 3.35 .36 51.74 361 mba 14 3.29 .36 jd 13 2.93 .48 phd 47 3.24 .37 active transactional leadership between groups ba/ba 50 2.35 .62 2.46 1.56 5 .171 within groups ma/ms 108 2.45 .51 112.49 356 total msw 130 2.44 .53 114.95 361 mba 14 2.55 .52 jd 13 2.20 .66 phd 47 2.60 .67 passive transactional leadership between groups ba/ba 50 .84 .57 3.18 2.77 5 .018* within groups ma/ms 108 .79 .47 81.94 356 total msw 130 .61 .47 85.12 361 mba 14 .64 .34 jd 13 .79 .42 phd 47 .66 .47 extra effort as leader between groups ba/ba 50 3.06 .59 4.62 2.98 5 .012* within groups ma/ms 108 3.31 .56 109.27 352 total msw 130 3.18 .55 113.89 357 mba 14 3.14 .28 jd 13 2.84 .69 phd 47 3.32 .56 (continued) goldkind, pardasani/social workers as senior executives 586 table 3 (continued) leadership domains educational background n  x sd sum of squares f df p perception of one’s effectiveness as leader between groups ba/ba 50 3.41 .44 2.31 2.25 5 .049* within groups ma/ms 108 3.41 .51 72.23 352 total msw 130 3.43 .42 74.54 357 mba 14 3.42 .23 jd 13 3.04 .69 phd 47 3.51 .37 satisfaction with own leadership style between groups ba/ba 50 3.35 .52 3.28 2.24 5 .050* within groups ma/ms 108 3.38 .56 102.59 350 total msw 130 3.42 .54 105.87 355 mba 14 3.32 .42 jd 13 2.91 .62 phd 47 2.49 .52 *p<0.05, **p<0.01 advances in social work, fall 2013, 14(2) 587 discussion the authors had expected to find a significant difference in leadership styles between those administrators with social work backgrounds and those from other educational backgrounds. although some statistically significant differences based on educational background were found, those between msws and others did not emerge in these data. nonetheless, four major themes did emerge in this study. 1. administrators with a jd were most likely to assess themselves as less effective leaders than their counterparts from other educational disciplines. administrators with a jd comprised barely 7% of our total sample. this may reflect their low representation in the upper management of social service agencies in our study region. nevertheless, administrators with a law degree consistently scored low on several components of leadership – transformational, perception of effectiveness as a leader and satisfaction with one’s leadership. since this was a self-assessment, the low scores could be interpreted in a number of ways. one might conclude that administrators with a jd do not perceive themselves as strong in traditional areas of leadership – inspirational, motivational, and transactional. this may be the consequence of a lack of formal training or course opportunities in administration and management while pursuing a law degree. or it may be a consequence of lawyers simply using a different metric in rating themselves than others in the study. it is also possible that attorneys who currently manage social service agencies may delegate the responsibility of day-to-day management to other professionals, while they focus on the legal and fiscal components of their job. 2. administrators with phd’s were most likely to assess themselves as more effective leaders than their counterparts. this was a surprising finding. though the doctoral degrees represented diverse fields of study, the majority were in the fields of social work or public administration. we hypothesized that unlike an msw degree, which may offer limited opportunities for the study of management, doctoral programs in social work or public administration offer more comprehensive opportunities for education in leadership. one would expect that doctoral programs in public administration would attract students who are specifically interested in pursuing careers in nonprofit management or social service administration. similarly, doctoral students in social work may perceive the value of a phd for career advancement as administrators. this may explain the higher level of self-assessment as leaders among those with the most education in the study. however, it cannot be assumed with a high degree of certainty that the enhanced scores of leadership in this group represent a comprehensive understanding and application of optimal leadership skills/knowledge. it may simply be that these respondents are more attuned to the leadership requirements of the field and provided the answers they believed to be the most appropriate, whether or not they actually applied them in practice. goldkind, pardasani/social workers as senior executives 588 3. administrators with an msw or ma/ms were most likely to assess themselves higher on transformational leadership skills while being the least likely to be passive avoidant. although administrators with an msw did not score the highest on most of the components of leadership, they were the second highest scorer in the component of transformational leadership, just below administrators with a phd (some of which were in social work). it is heartening to know that administrators with a social work background place a premium on transformational leadership – inspirational, motivational and charismatic components. given the relatively low salaries in the nonprofit world and the significant service and budgetary barriers that are present, administrators need to utilize their transformational skills to attract and retain their workforce, prevent burnout, and enhance service delivery. research has shown that motivational and charismatic leaders have a positive impact on staff retention and morale (mary, 2005). it was also heartening to note, that despite the stereotype of social workers being “soft”, the msw administrators in our sample scored quite low on passive-avoidant leadership styles. this underscores the fact that social work administrators can be just as effective and “tough” as their counterparts from other fields. but it should be noted that the social service administration field may attract a specific personality type among social workers – those who want to and like to lead. while administrators from other fields may also be attracted to administration in social service for similar reasons, we believe that given the propensity of social workers for clinical practice, the few that are attracted to administration and management positions may see their purpose as transformational. 4. the overall differences in scores on most of the components of leadership between the various cohorts of educational backgrounds were small (although some were statistically significant). we believe that the reason we did not see major differences between the various cohorts of administrators is that the human services administration field attracts a specific kind of person – an individual who wants to make a difference, is interested in change and social transformation, and would like to help those who are vulnerable or in need. thus, personal attributes such as charisma, inspiration, and motivation are inherent traits that are shared by the majority of administrators, irrespective of their educational background or training. this may be the reason for the lack of statistically significant differences between all the academic disciplines in our study. limitations there are some limitations of this study that may impact the generalizability of the findings. first, since this was a mail survey, self-selection bias reflected in the low response rate may have influenced the findings. a relatively high number of msw respondents may be due to the authors identifying themselves with social work in the introduction to the survey, thus perhaps eliciting a higher response rate from social workers. advances in social work, fall 2013, 14(2) 589 second, there were relatively few administrators with an mba or jd in our study, as compared to administrators with other degrees. thus power was compromised and there is the possibility of issues of statistical conclusion validity. third, the selection of the mlq instrument to assess leadership styles may have limited our ability to understand and interpret leadership in social service organizations. because this instrument was not specifically designed to assess leadership characteristics of social service administrators, a few important elements critical to leadership in this field may not have been included. for instance, prior social work practice experience that some administrators may possess, the skills and knowledge needed to work with at-risk populations and complex social problems, knowledge of social policy analysis and advocacy, dual roles played by administrators in smaller agencies (direct practice and management), etc., might be additional factors that need to be evaluated. finally, the mlq relied on self report and assessment by administrators, thereby introducing the element of social desirability bias or exaggerated self-rating of positive attributes of leadership. due to financial constraints, we could not include multiple perspectives of leadership style and competence in the study. areas of future inquiry this study only assessed the leadership styles of human service administrators from diverse disciplines and the sample represented a small portion of all leaders in a single geographic region. while the findings confirm that people from various academic disciplines lead social service agencies, it is possible that this type of work attracts people with specific leadership orientations. further investigation is required to more deeply understand how social work administration students can be trained and supported to take on senior leadership roles. such questions might include:  what are the specific challenges faced by administrators in the social service field?  do social work administrators believe their academic training prepares them for the challenges of leadership?  what can social work education at the msw and phd levels do to enhance the effectiveness of future administrators? the question of how social workers can impact leadership at the most senior levels, as well as the appropriateness of social workers for such roles, has been debated for the last twenty years. it is clear given the sample that despite small numbers of social work students entering administration and management tracks, social workers are finding their way to leadership roles. it is our responsibility as educators to help prepare 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(1999). an evaluation of conceptual weaknesses in transformational and charismatic leadership theories. the leadership quarterly, 10, 285-305. author note: address correspondence to: dr. lauri goldkind, lmsw, phd, assistant professor, graduate school of social service, fordham university, 113 west 60th street, rm. 721a, new york, ny 10023. email: goldkind@fordham.edu microsoft word 1318-phillips_manuscript_copyedit3 _________________ amy phillips, ph.d., is an assistant professor in the department of social work at the university of north dakota. copyright © 2011 advances in social work vol. 12 no. 1 (spring 2011), 1-20   service-learning and social work competency-based education: a ‘goodness of fit’? amy phillips abstract: as social work education moves to a competency-based approach, faculty are increasing their use of pedagogical tools designed to provide students with opportunities, in addition to traditional field placements, to develop practice skills. faculty are no doubt turning to service-learning, and other forms of experiential education, to provide these opportunities and to offer an additional means for departments to demonstrate and measure student practice behaviors. to help focus the use of service-learning in social work education, this article uses sources from the larger service-learning field and from social work scholarship to examine the nature of service-learning, to review current service-learning trends, to summarize its use in social work education, and to raise questions about its goodness of fit with competency-based education. keywords: service-learning, social work, competency-based education introduction as social work education moves to a competency-based approach, faculty are increasing their use of pedagogical tools designed to provide students with opportunities, in addition to traditional field placements, to develop practice skills. faculty are no doubt turning to service-learning, and other forms of experiential education, to provide these opportunities and to offer an additional means for departments to demonstrate and measure student practice behaviors. the purpose of this article is to help provide a focus for the use of service-learning in social work education and to encourage a common disciplinary understanding and language about service-learning. a broad lens is first employed to examine the definition of service-learning and its role in the higher education civic engagement movement. current service-learning trends are reviewed, and then the focus is narrowed to a discussion of its use in social work education. the article concludes with a section that raises questions about the goodness of fit between servicelearning and social work competency-based education. what is service-learning? service-learning and the higher education civic engagement movement in the context of higher education, service-learning is cited as one example of the various activities reflective of the higher education civic engagement (hece) movement (colby, ehrlich, beaumont, & stephens, 2003; jacoby, 2009a). other hece activities include participatory action research, public scholarship, and college-sponsored service abroad. in the past decade, numerous initiatives, both inside and outside higher education, have emerged to encourage and support the civic engagement of college students and phillips/service learning and social work competency-based education 2 their institutions. in addition, over 15 years’ worth of research demonstrates positive impacts of civic engagement generally and service-learning specifically on student academic learning, critical thinking abilities, heightened sense of civic responsibility, and sense of personal efficacy (astin, vogelgesang, ikeda, & yee, 2000; eyler & giles, 1999; eyler, giles, stenson, & gray, 2001; seifer, 2005). researchers studying effective educational practices view engaged learning activities, such as service-learning, as “high impact” educational practices that improve the quality of undergraduate education (indiana university center, 2009). the term “service-learning” emerged in the late 1960s at a time when national service initiatives such as the peace corps, job corps, vista, and university-community partnerships were drawing thousands of college students and other young adults into community service activities (learn and serve, n.d.a). by the mid-1980s, grass roots and campus-based organizations such as the campus outreach opportunity league and campus compact were in place to encourage civic engagement among college students and to support service-learning initiatives in higher education. the federal government offered its support to the burgeoning higher education civic engagement movement through passage of the national and community service act of 1990 and the creation of the corporation for national and community service in 1993. through its learn and serve america program, the corporation provides grants, training, and technical assistance to community-service and service-learning programs in community, k-12, and postsecondary institutions. the higher education civic engagement movement can claim success in encouraging student service involvement. by 2006, college students had logged 377 million service hours (nylc, 2008), and at present there are over 1100 member colleges and universities in the campus compact national coalition (campus compact, n.d.). service-learning described service-learning projects and programs may be curricular or co-curricular. curricular service-learning, sometimes called academic service-learning, is classroom-based and is used to meet course learning objectives. curricular service-learning may also take the form of fourth-credit option courses, stand-alone service-learning modules, introductory service-learning courses, course clusters with service-learning, capstone service-learning projects, and service-learning majors and minors (enos & troppe, 1996). co-curricular service-learning takes place outside the classroom and may take the form of school-wide service learning programs, campus leadership-development initiatives, residence hall or greek organization projects, and athletic service-learning programs (scheuermann, 1996). both curricular and co-curricular service-learning “make intentional efforts to engage students in planned and purposeful learning related to service experiences” (howard, 2001, p. 10). service-learning is sometimes viewed interchangeably with volunteerism and internships. however, there is widespread agreement among service-learning scholars and practitioners that there are three necessary conditions for service activities to be considered service-learning: civic engagement, reflection, and reciprocity (jacoby, 1996; advances in social work, spring 2011, 12(1) 3 howard, 2001; welch, 2009). regarding the first condition, student participants must engage in a service experience designed to address real community problems and to develop student civic engagement skills. the second condition requires that the service experience be grounded in curricular learning objectives that are facilitated not only through instruction and the service experience itself but also through intentional, deep, and structured reflection on that experience. without routine reflection on the root causes of community problems, on the relationship between the service, community problems, and curriculum, and on the student’s role in the service activity, the experience is solely volunteerism. thirdly, service-learning requires a reciprocal relationship between all participants in the experience. in other words, students and their instructors take leadership from community members in defining and addressing issues, and community members are receptive to the contributions of their educational partners. there is mutual responsibility and accountability in the relationship. as jacoby (1996) notes, service-learning thus stands in contrast to the traditional, paternalistic, one-way approach to service, where one person or group has resources that they share with a person or group that they assume lacks resources….service-learning encourages students to do things with others rather than for them. (p. 8. italics in original.) service-learning, then, is distinctly different from volunteerism due to servicelearning’s focus on intentional learning (both curricular and civic), and because of its emphasis on the reciprocal relationship between students, their instructors, and community members. in addition to confusion with volunteerism, service-learning is often viewed synonymously with internships and field practica. field training, however, places primary focus on student disciplinary skill development and little to no focus on development of civic engagement skills. in addition, the condition of reciprocity is generally absent from internships, with the student playing a traditional one-way service provider role in relationship to some service recipient. in summary, the three essential components of service-learning outlined above set it apart from volunteerism and internships and ensure the equal weight of learning and service, as the term’s hyphen represents. in a well-known conceptual tool, furco (2003) highlights this required balance via demonstrating service-learning’s distinction among other service programs on a beneficiary and focus continuum. as seen in figure 1, service-learning is distinguished from recipient-oriented activity where the focus is primarily service, and from provider-oriented programs, in which the focus is on student learning. phillips/service learning and social work competency-based education 4 figure 1: distinction among service programs furco, a. (2003). service-learning: a balanced approach to experiential education. in campus compact, introduction to service-learning toolkit: readings and resources for faculty (2nd ed.). providence, ri: campus compact. in addition to promotion of service and learning through civic engagement, reciprocity, and reflection, there is often an expectation that service-learning will promote the larger goals of democratic participation, improved community well-being, civic responsibility, and social justice (calderon, 2007; colby, beaumont, ehrlich, & corngold, 2007; colby et al., 2003; jacoby, 2003; kelshaw, lazarus, minier, & associates, 2009). service-learning has been viewed as a “model for community development” (nylc, 2008, p. 9), a pedagogy for shaping “student civic and moral values and dispositions” (o’meara & niehaus, 2009, p. 25), and a type of “justicelearning” (butin, 2010; conley & hamlin, 2009). these expectations are reflected in numerous definitions of service-learning, including the following used by learn and serve america to describe service-learning at the k-12 and college levels: “servicelearning is a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility, and strengthen communities” (learn and serve, n.d.b.). while servicelearning research may not yet be able to demonstrate the direct correlation between service-learning, social justice, and strengthened communities, it is clear that numerous scholars, practitioners, and organizations view service-learning as a tool for social, as well as academic and personal, transformation. current higher education service-learning trends and deliberations from the late-1980s through the1990s, discussion about service-learning moved from debate about what constitutes service-learning to delineation of best practices and assessment of its impact on student learning outcomes (furco, 2009). over that time, numerous professional associations, publications, conferences, and university servicelearning centers emerged to provide a broad array of texts, workbooks, discussion opportunities, and research all designed to support the novice or seasoned servicelearning practitioner. advances in social work, spring 2011, 12(1) 5 in the first decade of the 21st century, research, such as that conducted by the national survey of student engagement, has demonstrated the importance of servicelearning as a valuable pedagogical tool for promoting civic engagement (indiana university, 2009). service-learning scholars have also published models and processes for ensuring service-learning institutionalization and sustainability (billig, holland, & bowden, 2008; ccncce, 2006; chadwick & polowski, 2007; hartley, harkavy, & benson, 2005). grounded in what appears to be a solid foundation, new trends in servicelearning practice and research, as well as deliberations about service-learning, are emerging. the following section reviews some of these areas. service-elearning as various forms of distance learning have exploded onto the educational scene (e.g., videoconferencing, computer-based courses, and web-based courses), faculty are developing pedagogical models which blend e-learning activities and service. “serviceelearning” is the name given to this blend and it is defined as “an integrative pedagogy that engages learners through technology in civic inquiry, service, reflection, and action” (dailey-hebert, donnelli-sallee, & dipadova-stocks, 2008, p. 1). service-elearning may involve the simple addition of a discussion board into a traditional face-to-face (f2f) service-learning course, or in the case of a completely online class, it may involve blogs, wikis, web-conferencing, skype, or other e-communication methods for all academic activities. in addition, the service portion of service-elearning may be conducted either f2f in the student’s location, or take place purely online, with students providing an online service to a local or distant community (dailey-hebert et al., 2008; guthrie & mccracken, 2010; pearce, 2009). as strait (2009b) outlines, serviceelearning may look different depending on the course delivery method, but the core components of service-learning such as civic engagement with community partners, course content, and reflection, are expected to remain constant. a variety of online resources are emerging to provide support for and dissemination of information about service-elearning and other forms of civic engagement via the use of communication technologies. these resources include the journal of interactive online learning, the journal of online learning and teaching, the journal of community informatics, and university-related resources such as minnesota campus compact’s center for digital civic engagement, massachusetts campus compact’s digital engagement initiative, and the university of south dakota’s service-learning handbook for distance learning. international service-learning although students have involved themselves in civic engagement through service abroad for many years (chisholm & berry, 1999; yates & youniss, 1998), the most rapidly growing service-learning programs today are those promoting international learning and global citizenship (jacoby, 2010). parker and dautoff (2007) make a clear distinction, however, between study abroad and service-learning, noting that students are the primary beneficiaries of study abroad while international service-learning also benefits faculty and community members. in addition, international service-learning refers not only to students from the u.s. providing service abroad, but now “embodies phillips/service learning and social work competency-based education 6 the many different models and methods used by international students and practitioners outside the united states in international settings” (strait, 2009a, p. 5). there is a growing body of academic literature related to international service-learning that provides case examples, guidelines, and resources (e.g., grusky, 2000; metcalf, 2010; sternberger, ford, & hale, 2005). in addition, international networks and associations exist to support global service-learning initiatives in a variety of countries, to link initiatives to each other, and to provide resources for examination and dissemination of research on international programs. examples of these associations include the talloires network, the international partnership for service-learning and leadership, and the global service institute. while international service-learning is a growing area, jacoby (2009b) notes that challenges to global service efforts include affordability and accessibility, concerns about exploitation of community partners, and questions about whether service abroad inhibits responsiveness to domestic social issues. service-learning research in addition to the national survey of student engagement mentioned earlier, servicelearning practitioners are fortunate to have a body of research to support assertions that service-learning positively impacts student academic learning and personal development. research by eyler and giles (1999; 2002), astin et al., (2000) and other scholars whose studies are found in publications such as the michigan journal of community service learning and advances in service-learning research, have contributed to the evidence base of service-learning practice and pedagogy. publications also exist to provide guidance to faculty for assessing service-learning outcomes in their own classes (bringle, phillips, & hudson, 2004; gelmon, holland, driscoll, spring, & kerrigan, 2001). current service-learning research includes what shumer (2009) describes as constructivist approaches. these approaches view knowledge as socially constructed and work toward inclusion of all participants in the development and implementation of research studies. constructivist researchers view service-learning itself as “a constructivist process in which those being served create new understandings so that they can control their own destiny” (shumer, 2009, p. 193). examples of this kind of research include community-based research, empowerment evaluation, youth participatory research, and utilization focused evaluation and research (shumer, 2009). constructivists researchers are also attempting to extend the conceptualization of service-learning through a community inquiry framework that, instead of the classroom, identifies the “community as a locus and source of learning” (bishop, bruce, & jeong, 2009). in addition to the research on service-learning’s impact on students, the servicelearning literature provides case studies and models of university-community collaborations and some research on service-learning’s impact on community partners (d’arlach, sanchez, & feuer, 2009; ferrari & worrall, 2000; jacoby & associates, 2003; kelshaw, lazarus, minier, & associates, 2009). additional research is still needed, however, to determine the effect of service-learning on partner organizations, community members, and on whether service-learning is having the larger transformative effects many intend it to have (jacoby, 2009b). advances in social work, spring 2011, 12(1) 7 deliberations about service-learning’s function and purpose service-learning is variously discussed as pedagogy, practice, theory, philosophy, or some combination of these. authors trace its philosophical and theoretical roots to john dewey’s early twentieth-century experimentalist theory of knowledge (rocheleau, 2004) and his advocacy of active learning tied to democratic participation. as a pedagogy and practice of civic engagement, service-learning is linked to ernest boyer (1990) and his influential work, scholarship reconsidered: priorities for the professoriate which promotes civically-engaged teaching, learning, and scholarship (colby et al., 2003). stevens (2003) connects service-learning roots to african american social thought and action. various authors also ground service-learning in the context of theoretical models such as the philanthropic model (abel, 2004), the civic engagement model (watson, 2004), or the communitarian model (codispoti, 2004). building on, and responding to, the perspectives mentioned above, some authors have offered critical examinations of service-learning’s functions and purpose in higher education. mitchell and donahue (2009) posit that service-learning is a pedagogy “that has traditionally targeted privileged students” (p. 173). their work highlights the “service” in which students of color engage in the classroom, “helping white classmates learn about the communities where they serve and challenging their peers to understand that white and middle class are not normative perspectives” (p. 188). the authors’ examination of the classroom experience and what constitutes “service” raises questions about the potential disconnect between service-learning’s transformational aspirations and its functional reality. consistent with long-standing concerns raised about the purpose of service-learning and its potential to reinforce stereotypes and systems of privilege, (chesler & vasques scalera, 2000; morton, 1995), jones, gilbride-brown, and gasiorski (2005) found that service-learning activities can, in fact, uncover student stereotypes, assumptions, and privilege, resulting in student resistance. these authors promote a critical whiteness and developmental approach to address resistance and to promote critical awareness. jacoby (2009b) also takes a critical perspective by asking if service-learning perpetuates the status quo and calling on practitioners to ensure that service-learning confronts “the structural inequities that create unjust and oppressive conditions” (p. 98). butin (2006; 2010), probably more than any other author, has challenged the servicelearning field to take a hard look at the definitions, conceptualizations, and underlying premises of service-learning. for butin, the most commonly accepted understandings of the purpose and nature of service-learning (described in this article’s first section above) are grounded in a generally unacknowledged “modernist, liberal, and radical individualistic notions of self, progress, knowledge, and power” (2010, p. 7). he elaborates as follows: specifically, such a worldview is grounded in the notion that individuals are autonomous change agents who can effect positive and sustained transformations. it is the belief that we can consciously and deliberately bring about betterment (by the more powerful for the less powerful) through a downward benevolence whereby all benefit. (2010, p. 7) phillips/service learning and social work competency-based education 8 despite this benevolent urge, butin (2010) points out that there is significant lack of evidence about the beneficial impact of service-learning on service recipients or communities in general. in addition, butin interestingly uses the work of stanley fish to assert that any foundational declarations about the ultimate purposes of servicelearning—to encourage democracy, support social justice, or whatever—actually work against achieving those purposes by shutting off critical examination of service-learning conceptualizations, practices, and underlying assumptions. as butin notes, for servicelearning to be “justice-oriented education,” it must be “antifoundational,” operating “from the presumption of service-learning-as-question rather than service-learning as answer” (2010, p. 63). butin also asserts that service-learning has reached the limits of its ability to be institutionalized and would be more effective as a transformative tool if it were an actual academic discipline rather than a pedagogy used in various forms primarily by faculty in the “soft” disciplines. the various deliberations about service-learning found in the literature and discussed at conferences may strike some service-learning practitioners as somewhat extraneous to their on-the-ground efforts. however, critical thought about service-learning is consistent with one of its core components, reflection, and is also indicative of the growth, influence, and discipline, of the service-learning field. service-learning in social work education in the context of its disciplinary focus on service and empowerment, and with its traditional use of field practica, social work education has been viewed as an historic contributor to the development of service-learning (zieren & stoddard, 2004) and even indistinguishable from service-learning (jarman-rohde & tropman, 1993). in truth, however, social work education has suffered from a lack of clarity about the nature of service-learning and, in comparison to other disciplines, has been late to incorporate service-learning into its curriculum (phillips, 2007). in their review of service-learning in the social work education literature, lemieux and allen (2007) demonstrated that social work education has often confused service-learning, field practica, and volunteerism, ignoring service-learning’s focus on community-led activities and development of student civic engagement skills. the authors noted that this lack of “conceptual clarity and consistency” has posed problems for service-learning development and research in social work education (p. 312). they provided examples from the social work literature, however, which described service-learning experiences they considered to be based in established theory and practice from the larger service-learning field. such established practice meant that the experiences were a part of academic coursework undertaken by “a group or class of social work students that integrated a community-based service component distinct from both voluntary service and field instruction (lemieux & allen, 2007, p. 313). examples included a cross-cultural service-learning project which assessed students’ perceptions of race and culture (sanders, mcfarland, & bartolli, 2003), a summer course at a camp for children with burn injuries which assessed student selfefficacy and value orientations (williams, king & koob, 2002; williams & reeves, 2004), and a housing needs assessment project conducted by a research class (knee, 2002). advances in social work, spring 2011, 12(1) 9 as phillips (2007) outlined, the lack of conceptual clarity, along with the perception of field practica as service-learning, has resulted in social work’s arrival as a late-comer to service-learning scholarship. in addition, such scholarship has occurred without a common language for service-learning and without broader disciplinary recognition of service-learning’s role in supporting social work as a civically engaged discipline. as a result, articles have appeared in the social work literature related to “experiential education,” “community-based learning,” “participatory action research,” “hands-on learning,” “social change interventions,” and “service-learning” (phillips, 2007). despite the range of civic engagement pedagogical examples and the general lack of conceptual clarity in the literature about what constitutes service-learning (lemieux & allen, 2007), a body of work related to service-learning across the social work curriculum is emerging in the literature. service-learning has been used to foster beginning-level knowledge and skills in introduction to social work and social welfare courses (allen, rainford, rodenhiser, & brascia, 2007; watkins, charlesworth, & house, 2007) and in the context of micro, mezzo, and macro practice courses (bye, 2005; norris & schwartz, 2009; sather, weitz, & carlson, 2007; singleton, 2009; williams, king, & koob, 2002). service-learning has been applied in policy classes (droppa, 2007; pierpont, pozzuto, & powell, 2001; rocha, 2000) and social work research courses (hyde, 2004; kapp, 2006; knee, 2002). it has been used to influence student attitudes, values, and self-awareness while working collaboratively with diverse community groups (arches, 2001; forte, 1997; lowe & medina, 2010; sanders et al., 2003; williams & reeves, 2004). service-learning has also been used to support the application of theory to a community project in the context of a human behavior and the social environment class (ames & diepstra, 2007). it has even been incorporated into social work internships (poulin, silver, & kauffman, 2006). all of the pedagogical projects listed above, and others in the social work literature, may or may not reflect the necessary components for designation as service-learning (as discussed in the first section of this article), yet all may represent a movement toward a more civically-engaged curriculum, with service-learning as a core component of the movement. in an effort to support both conceptual clarity and civic engagement, social work educators and authors are offering theoretical tools, pedagogical models, and discussion forums to promote a common language, purpose, and research agenda for service-learning in social work education. for example, lemieux and allen (2007) provide a review of service-learning practice and assessment issues for social work education, and the nadel, majewski, and sullivan-cosetti text, social work and service learning (2007) offers models for service-learning across the social work curriculum. discussions about service-learning and social work education have taken place via the university of nebraska’s service-learning and social work education conferences in 2003 and 2004, indiana university’s service-learning conference in 2010, and this special issue of advances in social work. as in the larger service-learning arena, social work education will best utilize service-learning if it understands its distinction from internships and volunteerism, builds on its current best practices as pedagogy, and undertakes research to determine its effectiveness and encourage its development. these activities are particularly important phillips/service learning and social work competency-based education 10 in the context of social work’s current focus on competency-based education (cswe, 2008). it is natural that social work educators would seek to use service-learning as a tool for enhancing and assessing student competencies. but social work programs may want to move this agenda forward with some caution, taking the questions and accompanying discussions in the following section into consideration while determining the “goodness of fit” between service-learning and competency-based education. service-learning and social work competency-based education question 1: what is at risk in the application of service-learning to social work competency-based education? educational policy 2.1 of the council on social work education’s educational policy and accreditation standards states the following about competency-based education: competency-based education is an outcome performance approach to curriculum design. competencies are measurable practice behaviors that are comprised of knowledge, values, and skills. the goal of the outcome approach is to demonstrate the integration and application of the competencies in practice with individuals, families, groups, organizations, and communities. (cswe, 2008, p. 3) the current cswe epas lists 41 practice behaviors and skills and states that “practice behaviors may be used to operationalize the curriculum and assessment methods” (p. 3). developing curricula and assessment around the teaching and learning of practice behaviors to ensure the competency of graduates makes undeniable sense and, in fact, a competency-based approach is not new in social work education (see, for example, arkava & brennen, 1976). with such an approach, educational programs must then provide students with the opportunities to practice the behaviors. since it may be difficult for all practice behaviors to be measured in internships or field practica, and since programs are required to undertake multiple measures of the behaviors, additional active and experiential learning activities such as simulations, role plays, and servicelearning offer opportunities for behavior development and assessment. competency-based education focusing on the development of student practice behaviors is just that, though – a focus on student practice behaviors -and any active or experiential learning experience which has student skill development as its singular goal is ultimately reflective of the learning-side focus of furco’s (2003) diagram shown earlier. in other words, using service-learning for practice behavior development runs the risk of losing the service/learning balance, and particularly runs the risk of losing servicelearning’s focus on service to the community informed by reciprocal relationships with community members. in addition, if the focus is on learning a prescribed set of practice behaviors, service projects may be developed for the purpose of practicing some subset of those behaviors but none of the behaviors may be related to civic engagement—and developing civic engagement skills is another intended by-product of service-learning. advances in social work, spring 2011, 12(1) 11 lastly, unpacking the relationship between service activities, community issues, and learning objectives through structured, critical reflection is a sine qua non of servicelearning. however, the breadth and depth involved in critical reflection (ash & clayton, 2009) may be more than what some instructors feel is manageable, or necessary, for practice behavior development. in summary, using service-learning for competency-based education risks the watering down, if not complete loss, of service-learning’s critical, civically-engaged, and transformative potential. this is not a problem if social work educators choose to define service-learning in ways other than that outlined in the first section of this article. nevertheless, it is possible for educators to use service-learning as outlined above to develop practice behaviors which would require intentional application of the elements that characterize service-learning. this should not be difficult given the close alignment of these elements to the mission of the social work profession. if there is a risk to service-learning in the context of competency-based education, could the opposite also be true? as referenced earlier, service-learning has been viewed alternately as a pedagogy potentially promoting the status quo (jacoby, 2009b) or “a progressive and liberal agenda under the guise of a universalistic practice” (butin, 2006, p. 483). these perspectives highlight the fact that service-learning, or any pedagogy, is not a value-free, objectivistic endeavor, and that the act of using service-learning is also a philosophical, if not political, statement. social work education was attacked just a few years ago for “having ideological proclivities and a strong penchant for advocacy” (national association of scholars, 2007). while the profession might be inclined to dismiss such statements as coming from a fringe sector, social work educators might want to be aware that adoption of service-learning for competency development could raise further questions about the ideology, and resultant competencies, into which social work students are being indoctrinated. question 2: what are some practical considerations for the use of service-learning in competency-based education? as mentioned earlier, if social work programs begin using service-learning more frequently in their curricula, they may want to hold faculty discussions to clarify their definition of service-learning and for what purpose it will be used. it would also be useful to review best practices from the service-learning and social work literature for replication purposes, and to make assessment plans to measure not only practice behaviors but also other service-learning outcomes. in addition, programs may want to think strategically about the placement of service-learning in their curricula. servicelearning has been used variably in a number of disciplines in introductory classes to introduce new majors to the field, in methods or practice classes to enhance disciplinary skills or to prepare students for practica, and in capstone courses to demonstrate cumulative knowledge and skills. since service-learning courses generally require substantial work in and out of the classroom on the part of both instructor and students, programs may want to determine the best strategic location for service-learning. in other words, consideration should be given not only to service-learning’s best fit in a course, phillips/service learning and social work competency-based education 12 but also its best fit in the curriculum as a whole, taking multiple issues such as faculty time, community needs, and practice behavior development, into account. another practical consideration already alluded to is the effort and time needed to develop and implement quality service-learning courses. a service-learning center may exist on campus to assist with course mechanics and community placements, but most faculty who use service-learning probably have a very hands-on approach to their courses to ensure course/service compatibility, reciprocity with community partners, student support, and meaningful assessment. many such faculty also choose to use servicelearning courses for their scholarship, undertaking action research, community-based studies, and collaborative inquiry projects. while a scholarship of engagement has been recognized as a viable endeavor for at least two decades, an individual college or university may not always value it. as driscoll notes (2008, as cited in sandmann, 2009), “most institutions continue to place community engagement and its scholarship in the traditional category of service and require other forms of scholarship for promotion and tenure” (p. 41). social work programs that decide to incorporate service-learning for competency development will need to ensure that faculty are not penalized in the professional evaluation process by their use of service-learning for scholarship or teaching. the questions above and the challenges they raise are intended to stimulate dialogue about service-learning and competency-based education. however, individuals new to service-learning may be reading this special issue in search of tools for competencybased education. also, as of the writing of this paragraph, the u.s. house of representatives has passed a federal funding bill which would eliminate the corporation for national and community service and all its programs (including learn and serve america). for both these reasons, a summary of the benefits of service-learning in competency-based education is certainly appropriate and timely. the benefits are many and the list below comes primarily from those already mentioned throughout the article and from this author’s own experience. additional service-learning adherents can easily add to the list. 1. as mentioned earlier, the cswe educational and policy accreditation standards define competency-based education as “an outcome performance approach to curriculum design,” the goal of which is to “demonstrate the integration and application of the competencies in practice” (cswe, 2008, p. 3). key words here are “performance,” “application,” and “competencies.” it is not enough for students to demonstrate knowledge about competencies; they must also demonstrate ability in the performance of them. the more opportunity students have to use skills and behaviors, particularly in practice courses, the more able they will be to demonstrate competence by graduation. service-learning is an experiential methodology which can be adapted to any social work course and which aptly serves the purpose of providing opportunities for skill integration and application in practice. 2. since social work programs are required by the epas to undertake multiple measures of student competencies, service-learning offers programs an initial advances in social work, spring 2011, 12(1) 13 point-in-time course-based measurement of practice behaviors before a second measurement which could occur during internship. service-learning is also an educational method with a substantial body of literature providing implementation and assessment tools (see the “service-learning research” section above). some of these tools could be useful in the development of assignments and assessments related to social work practice behaviors. 3. service-learning has been used effectively as preparation for field practica and for development of skills in areas which practica may not offer (such as macro practice). service-learning projects give programs the opportunity to measure practice behaviors not used in internships, and if sequenced appropriately, service-learning activities may give students a beginning-level exercise in certain skills, which they can then deepen and develop once they are in capstone field experiences. 4. finally, service-learning offers social work education an additional mechanism to reinforce to students the core values of the profession. service-learning’s primary conditions of civic engagement, reflection, and reciprocity (see “servicelearning described” section above), support all social work values, but particularly the values of “service,” “social justice,” and “the importance of human relationships.” these values are reflected in the core competencies outlined in cswe’s educational policies (e.g., ep 2.1.5 and ep 2.1.8). to the extent that social work educators who use service-learning meet its core conditions, they will be enabling students to act out of the profession’s core values while developing core competencies of social work practice. service-learning and social work competency-based education would seem to be a good fit given their shared values, social work’s history as an engaged profession, and the opportunities service-learning affords students to apply knowledge, values, and skills. yet, as i hope this article has reinforced, a head-long rush to use service-learning in social work competency-based education without consideration of their 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(2002). social work students go to camp: the effects of service learning on perceived self-efficacy. journal of teaching in social work, 22(3/4), 55-70. williams, n. r., & reeves, p. m. (2004). msw students go to burn camp: exploring social work values through service-learning. social work education, 23(4), 383-398. yates, m., & youniss, j. (1998). roots of civic identity: international perspectives on community service and activism in youth. new york: cambridge university press. zieren, g. r., & stoddard, p. h. (2004). the historical origins of service-learning in the nineteenth and twentieth centuries: the transplanted and indigenous traditions. in b. w. speck & s. l. hoppe (eds.), service-learning: history, theory, and issues (pp. 23-42). westport, ct: praeger. author note: direct correspondence to: amy phillips, m.s.s.w., ph.d., department of social work, university of north dakota, gillette hall 309, 225 centennial drive, grand forks, nd 58202. email: amy.phillips@email.und.edu microsoft word 01 bullock_and_colvin_18259_communication_technology_integration_au_ce.docx ______________ angela n. bullock, phd, lmsw, assistant professor, social work program university of the district of columbia. washington, dc. email: angela.bullock@udc.edu. alex d. colvin, phd, msw, assistant professor of social work, division of social work, behavioral and political sciences, prairie view a&m university, college station, tx. email: adcolvin@pvamu.edu copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 1-14 communication technology integration into social work practice angela n. bullock alex d. colvin abstract: the uses for communication technology continue to grow in the united states. communication technology is being incorporated into traditional social work practice for administrative and therapeutic purposes. this article provides an overview on how the use of technology has evolved in social work practice. the technology acceptance model is used to addresses the challenges that communication technology poses for social work practice. this article also examines a theory-based direction for the future creation of technologically driven interventions in social work practice. keywords: communication technology, technology acceptance model, social work overview of communication technology integration into social work practice there has been a rapid increase in the adoption of communication technology in everyday life over the last five years. both youth and adults rely on communication technologies for entertainment, information, and social connections (mishna, bogo, root, sawyer, & khoury-kassabri, 2012). communication technologies are tools that support the production of knowledge and the development of skills; thus, there are significant value implications for social work practice (cwikel & cnaan, 1991; kreuger & stretch, 2000). social media sites, including facebook, instagram, pinterest, twitter, and linkedin, are common networking platforms used by approximately 73% of online adults (duggan & smith, 2013). furthermore, 91% of american adults own a cell phone and use it for services other than phone calls, such as text messaging, accessing the internet, downloading online applications, and participating in video chats (duggan, 2013). technology is not only transforming how people collect and share information but also altering how people interact with one another. the speed of technology has created the lure of immediate gratification and the pressure to communicate more quickly and often with larger numbers of individuals (csiernik, furze, dromgole, & rishchynski, 2006). technology has also evolved in social work practice over the past decades, playing a part in giving practitioners easy access to colleagues and to their clients through fax, email, cell phones, chat rooms, and online messaging (csiernik et al., 2006). in the 1980s, clinical practice involved one-way mirrors with clients to allow for interdisciplinary and team participations in assessment and training (csiernik et al., 2006). as early as 1982, social work services emerged on the internet in the form of online self-help support groups (kanani & regehr, 2003). by the late 1990s, groups of clinicians offered online counseling services to the public using secure web sites (grant & grobman, 1998; martinez & clark, 2000; reamer, 2012; 2013; schoech, 1999). today, social work services include a much wider range of digital and electronic options. these options allow social workers to engage bullock & colvin/comunication technology integration 2 clients through email exchange and text messaging using their smartphones or through video teleconferencing using tools such as web cameras, skype, facetime, and second life (chester & glass, 2006; kanani & regehr, 2003; lamendola, 2010; menon & millercribbs, 2002). through these forums, social workers can offer services such as online and video counseling (csiernik et al., 2006; reamer, 2014). access and equity, greater flexibility, and economic or geographic restraint have driven the deployment of these technological tools in social work (jones, 2010). the move toward a technologically driven practice has been so important that in 2005 the national association of social workers (nasw) and the association of social work boards (aswb) collaborated to develop standards for ethically integrating technology into social worker practice (nasw & aswb, 2005). these standards addressed ethical issues such as technical competence, client privacy and confidentiality, documentation, and research evidence concerning the effectiveness and impact of distance services (reamer, 2014). presently, there is increasing pressure on social service agencies to produce “results,” and often agency computer information systems are associated with efforts to do so as practitioners try to provide effective services to clients (carrilio, 2007). despite the everincreasing user-friendliness of the systems’ availability to capture program and service data, some social workers have been reluctant to embrace them (barrett, 1999; carrilio, 2005; carrilio, packard, & clapp, 2003). social workers who refuse to acknowledge this technology trend risk falling out of step with the profession (reardon, 2010). the role of the social worker is evolving, and social workers need to adjust to the changes in social work practice in the technology age (social work and technology, 2013). the integration of technology into practice presents challenges and opportunities for the field of social work. although much research effort has been directed to understanding user acceptance of new technologies, it is important to understand some of the factors that go into acceptance and utilization of information systems (carrilio, 2007). for this reason, this paper will explore a theoretically based direction for the future creation of a technologically supported social work practice through an examination of the technology acceptance model (tam). additionally, this article will address both the challenges and opportunities communication technology poses for social work practice, placing emphasis on the social workers’ response to the adoption of communication technology. description of the technology acceptance model (tam) the tam, developed by davis (1985), is derived from fishbein and ajzen’s (1975) theory of reasoned action (tra). tra was designed to apply to any specific domain of human-computer interactions (davis, bagozzi, & warshaw, 1989), and the tam expounds on this theory by providing a theoretical linkage among users’ internal beliefs, attitudes, intentions, and usage behavior to determine an individual’s acceptance or rejection of a new technology (davis, 1989). the tam postulates that technology adoption behavior is an outcome of an individual’s emotional response toward a technological innovation. the tam examines user acceptance of technology and shows the relationship between perceived usefulness (u), perceived ease of use (eou), behavioral intentions to use (bi), and the actual system use. the tam predicts further that user acceptance behaviors of advances in social work, spring 2015, 16(1) 3 technology are based on the influences of two key determinants: u and perceived eou. the first belief, u, is the degree to which an individual believes that a particular system will enhance their job performance within an organizational context (davis et al., 1989). eou is the degree to which an individual believes that the use of a particular system will be free of mental effort (davis et al., 1989). u and eou are distinct but related concepts: u focuses on the impact of technology use on overall organizational processes and outcomes, whereas eou is concerned primarily with the level of complexity required in the use of the technology (teo, 2012). the tam posits that eou has a direct impact on u: the easier the system is to use, the more likely the user will accept it (venkatesh & davis, 2000). additionally, u and eou are key antecedents that determine one’s behavioral intentions (bi) to use technological systems (kowitlawakul, 2008). bi are the degree to which a person formulates a plan to perform or not perform some specified future behavior (davis et al., 1989). the tam proposes further that a user’s bi are determined by their perception of the level of difficulty and practicality of the technological system (venkatesh, 2000). accordingly, bi are the strongest predictor of actual use (davis et al., 1989; taylor & todd, 1995). thus, the tam can predict the intent to use technology, which is derived from the user’s attitude, and actual use of technology, which is derived from the user’s actions (willis, 2008). accordingly, the tam provides the framework for exploring the key determinants associated with the communication technology adoption behaviors of social workers (davis et al., 1989). the origins and basis of technology acceptance and resistance in an organization become complex when examined in the light of how technology has been used in the past, how it may be seen as a tool of oppression, and how these experiences affect employees’ emotions and attitudes about the proposed new technology in the workplace (stam, stanton, & guzman, 2004). the following sections will examine both the challenges and benefits of integrating technology into social work practice. challenges with communication technology acceptance and integration into social work practice although the concept of adapting communication technologies into social work practice can present some advantages, such as increased productivity and reduced paperwork, it can also present unique complexities and ethical challenges for social work practitioners, as the incorporation of technology into practice can be met with some resistance from social workers. this resistance may manifest through bi, perceived u, and eou. behavioral intentions (bi) oftentimes, social workers consider technology to be complex systems that contribute to diminishing the client-worker relationship (reardon, 2010). some practitioners argue that the type of rapport developed through face-to-face interactions cannot be duplicated though online interactions (hill & ferguson, 2014). for seasoned practitioners, the practice bullock & colvin/comunication technology integration 4 of social work is about the interface of people, their families, and their communities. the nasw code of ethics places human relationships at the center of ethical social work practice (nasw, 2008). social workers in the profession are viewed as agents of social control who also promote social welfare and social change to empower the individual, the group, and the community (csiernik et al., 2006). for these reasons, some social work practitioners question whether real, long-term relationships can be created when people do not meet face-to-face (costello, brecher, & smith, 2009; csiernik et al., 2006). because of this, many seasoned social workers may perceive the adoptions of new technologies as cumbersome, making them feel more like bureaucrats than helpers (reardon, 2010). ease of use (eou) a challenge exists in the profession’s generation gap between new practitioners, who are most likely to have experience with technology and feel comfortable using it, and more experienced social workers who used typewriters, not computers, during their education (csiernik et al., 2006). early research noted that the lack of technological literacy on behalf of the social worker was exacerbated by characteristics such as worker sex, age, and prior experience with information systems (monnickendam & eaglestein, 1993). for example, recent statistics report that between 2008 and 2010, approximately 66% of social workers in the united states workforce were 35 and older (u.s. department of health and human services, 2013). csiernik et al. (2006) explained that beginning practitioners are considered digital natives because they grew up immersed in digital technology. according to palfrey and gasser (2008), digital natives are individuals who were born after 1980 and possess the skills to use digital technology. established practitioners are considered digital immigrants because they were born before the introduction of digital technology. in some regard, digital natives may have an advantage over digital immigrants because they use technology from an early age (gillingham, 2014). saleem et al. (2009) discovered that many seasoned workers (digital immigrants) still chose to rely on paper to complete certain tasks rather than embracing new technological tools; these seasoned workers turned to paper for various reasons, including the perception that it was efficient in certain cases, easier to use, and more useful in helping them remember important information. in a study of 245 community social workers, carrilio (2007) reported that social workers’ skill and experience with computers and perceptions about the user-friendliness of the systems and usefulness of data affected utilization of technology and software applications. however, research has reported very compelling reasons for social workers to document relevant client information electronically as, in principle, properly encrypted electronic records are more secure than traditional paper records (reamer, 2013). poor implementation and lack of training of technological tools has also been cited as an explanation for social workers’ resistance to technology (baker, warburton, hodgkin & pascal, 2014). drumm, mccoy, and lemon (2003) point out that although the use of technology in social service is increasing, social workers still lack technological skills. social workers have a duty to meet minimum standards of competence when providing services to clients, particularly with the use of novel and emerging interventions (reamer, 2013). according to the nasw code of ethics (2008): advances in social work, spring 2015, 16(1) 5 social workers should provide services in substantive areas or use intervention techniques or approaches that are new to them only after engaging in appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques. (p. 8, standard, 1.04[b]) social workers should therefore exercise careful judgment and take responsible steps (including appropriate education, research, training, consultation, and supervision) to ensure that competence of their work. (p. 9, standard 1.04[c]) the nasw and aswb (2005) standards for practitioners’ use of technology state, “[s]ocial workers shall be responsible for becoming proficient in the technological skills and tools required for competent and ethical practice and for seeking appropriate training and consultation to stay current with emerging technologies” (p. 7). perceived usefulness (u) reardon (2010) stated that although many industries embrace communication technology, a switch to advanced technology may not be easy in social work. previous research has indicated that social workers resist using technology that is primarily focused on collecting data because they perceive this technology as neither enhancing quality of life for clients nor producing more effective and efficient services (watling & rogers, 2012). the challenges with embracing new communication technology may involve the traditional tensions between management and frontline workers (reardon, 2010). in their research, stillman and mcgrath (2008) highlighted some challenges in integrating technological advances, including client management and reporting systems, into contemporary practice. for example, managers are often in charge of technology initiatives and therefore gravitate toward systems that reflect their needs. this is evidenced in a study by stam et al. (2004), who reported that agency management mandated that employees take portable laptop computers into the field for collecting data during client visits. in this study, the agency decided that laptops were the direction in which to move to reduce duplication and increase efficiency. stam et al. (2004) further reported that the agency’s management had not discussed the planned changes with the caseworkers. because of this lack of control and input, it is perhaps understandable that many social workers view information and communications technology (ict) as dehumanizing and taking them away from their core practice tasks (hill & shaw, 2011; rafferty, 1997). schoech stated, “it should be no surprise that frontline workers often find these systems to be of limited value” (as cited in reardon, 2010, p. 1). this helps to explain why social workers tend to view icts as a management tool rather than a practice one (hill & shaw, 2011; parrott & madoc-jones, 2008). moreover, social workers, in a study by burton and van den broek (2009), perceived that the administration did not appreciate the amount of time it took to produce reports using the new communication technology. communication technology also gives rise to potential ethical issues related to professional boundaries. mishna et al. (2012) examined how online communication, such as email, text messages, and social networking sites, are being integrated into face-to-face bullock & colvin/comunication technology integration 6 social work practice and found that when communication technologies were used for administrative purposes, such as scheduling appointments or sharing supplemental resources, professional boundaries were not challenged. however, when communication technologies were used for non-administrative purposes, social workers believed that professional boundaries could potentially become blurred because no clear standards related to communication technology had been established (mishna et al., 2012). with the growth in the use of social networks such as facebook, social workers have an ethical obligation to address boundary issues in relation to their clients’ online lives (baker et al., 2014). for example, because of the perceived usefulness of new technologies, many social workers may receive requests from current or former clients asking to be social networking “friends” or contacts. clients who have access to social workers’ networking sites may learn a great deal of personal information about their social worker that may introduce complex transference and countertransference issues in the professional-client relationship (reamer, 2014). moreover, one of the greatest challenges toward integrating communication technology into social work practice is the emergence of e-counseling and e-therapy (csiernik et al., 2006). extensive concerns about both ethical and legal components have been raised regarding conducting counseling via the internet, e-mail, or through chat rooms. examples of areas of concern include practitioner competence as well as privacy and confidentiality issues. the nasw (2008) states that, “social workers should take precautions to ensure and maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology” (p. 12, standard 1.07[m]). additional noted concerns included: the level of expertise and skill in the medium as compared to traditional social work skills; the ability to establish an electronic therapeutic relationship; increasing time spent documenting contact with clients; using streamlined interviews with clients rather than spending time with them face-to-face; and the privacy and confidentiality, anonymity, and security of the electronic relationship and conflicts of interest (ames, 1999; gelman, pollack, & weiner, 1999; kamani & regehr, 2003; rock & congress, 1999). for instance, social workers who deliver services using email, avatars, live chat, and video counseling must be sure to use sophisticated encryption technology to prevent confidentiality breaches (hacking) by unauthorized parties and must comply with relevant privacy laws and regulations (morgan & polowy, 2011). this may be a major challenge for seasoned (digital immigrant) social workers. opportunities created by information technology acceptance and integration into social work practice integrating communication technology can revolutionize social work practice (csiernik et al., 2006; hill & ferguson, 2014; mishna, bogo, root, & fantus, 2014). the integration of technology into practice creates the capacity for social workers to become more efficient through reduction of paperwork and expansion of time with clients (reardon, 2010). moore, a chief information officer at araohohoe douglas mental health network in colorado, stated: advances in social work, spring 2015, 16(1) 7 electronic systems allow workers to be more mobile in the services they provide because they can access client records using an internet connection rather than carrying around paper files. this means workers can spend less time searching for records and more time working with clients. (as cited in reardon, 2010, p. 1) work in the field has examined the potential uses of communication technologies to enhance the implementation of evidence-based practice in social service programs (schoech, basham, & fluke, 2006). because rural areas frequently experience a scarcity of specialized professionals, resources, and clinical services, researchers have acknowledged that e-mail, instant messaging, and video conferencing can create opportunities for people in remote areas and for populations with limited mobility due to a disability to receive assessment and counseling services (csiernik et al., 2006; ginsberg, 2011; kowalenko, bartik, whitefield, & wignall, 2003). brownlee, graham, doucette, hotson, and halverson (2009) reported that access to communication technology has a positive impact on social work practice in rural areas. for example, through teleconferencing, rural social work practitioners are able to address problems such as professional isolation, lack of ongoing training, limited availability of supervision, and reduced access to professional development. furthermore, social workers identified the internet as a useful tool for researching additional client resources, communicating with service providers, generating online recording, and assessing online client databases. researchers have suggested that the extended access to services for people with disabilities and individuals living in rural areas can be effective in establishing strong client-worker relationships and successful client outcomes that are similar to face-to-face practice (mishna et al., 2014). communication technology also offers benefits to social workers in macro practice as these new and innovative technological tools can make it easier for practitioners to establish connections with stakeholders and seek support for their organizations (hill & ferguson, 2014). this includes creating a pathway to engage in collaborative endeavors such as coordinating on service delivery, soliciting external funding opportunities, and developing strategic plans. all these efforts can be accomplished as stakeholders connect, communicate, and coordinate from remote locations, thus making planning more efficient and timely. social workers are beginning to engage in electronic advocacy, which is the use of technology to influence policy decision making (dunlop & fawcett, 2008). hill and ferguson (2014) outlined the key functions of electronic advocacy: conducting policy research and information gathering, creating public awareness and education, building cyber communities and activism, organizing communities online and offline, raising funds, and placing pressure and influence on policy makers. electronic advocacy is conducted through avenues such as blog sites, e-mail, electronic mailing lists, online news groups, photojournalism, and social networking sites. through the utilization of such electronic advocacy, social work practitioners can assist nonprofit agencies in promoting social justice and equality for marginalized populations (dunlop & fawcett, 2008). advocacy can also be conducted at the micro level in which practitioners advocate for improved ict access for their clients (baker et al., 2014). agencies could facilitate free wireless access bullock & colvin/comunication technology integration 8 for clients in waiting areas. in circumstances where social workers visit clients in their homes, they could be provided with smartphones that allow those nearby to share the phones’ data. these strategies have the potential to help empower clients and build independence via access to online support (baker et al., 2014). additionally, this usage of technology is both effective and efficient because communication technology requires minimal resources and has the capability of reaching a global audience (hill & ferguson, 2014). implications for social work practice the digital divide is becoming ever increasing in social work populations, as increased advocacy for digital literacy, technology inclusion, and access is an immediate need (belluomini, 2013). for these reasons, technology communication acceptance in the workplace may involve a complex mix of how easy the system is to use, the organization’s readiness for infusion, and enhancing staff skills, attitudes, and experience with data (carrilio, 2007). to accomplish this, user characteristics (skill and experience), system attributes (eou), and the importance of the data (u) are important elements that must be present in system utilization (carrilio, 2007). further, reardon (2010) reported that the tensions between social work and technology might ease as younger and more computer-savvy practitioners enter the profession. as stated by fitch, assistant professor at the university of missouri’s school of social work, “we need a cadre of talented students and young researchers interested in designing information systems that reflect the values of social work” (as cited in reardon, 2010, p. 3). until social work education is updated with current technological training, social workers with technological literacy should educate others on the integrations of technology into practice (belluomini, 2013). there is limited research addressing technology and social work practice. therefore, further research is needed to fully understand the impact of technology as a tool in social work practice (hill & ferguson, 2014). although studies have identified that newer social workers who are classified as digital natives may have the ability to incorporate technology into practice with greater ease than digital immigrants, few research studies identify the specific population of social workers that shows the greatest resistance to technology (gillingham, 2014). additional studies that not only analyze the effectiveness of technology-related interventions but also examine the key characteristics of social workers who are less likely to use technology could help to reduce practitioners’ resistance to technology. as more outcome-based data that present cost-effective models of technology in social work practice are made available, technology-enhanced service delivery will be expanded, and practitioners will be more apt to use evidence-based technological tools (smith, 2009). in planning for the future integration of icts into practice, there must be considerations for infusing practice-led approaches to ict usage as well. this begins with organizational leaders assessing current skills and arranging for social workers to attend training with the new communication technology. harrison and rainer (1992) reported that user training advances in social work, spring 2015, 16(1) 9 had an important effect on communication technology usage. it also involves “starting with social work practice, not with icts themselves” (hill & shaw, 2011, p. 11). firstly, the practice-led approach involves social workers playing a key role, along with ict specialists and other stakeholders, in developing icts' infrastructure (hill & shaw, 2011). this involves the active involvement of frontline workers in the design of data management systems. this is paramount if human services organizations want systems that workers will actually use and benefit from (reardon, 2010). additionally, in a practice-led environment, ict hardware and software should be easy to use and “not get in the way of face-to-face work” (hill & shaw, 2011, p. 17). further, ict software should allow social workers to effectively tell the story of their work with clients (hill & shaw, 2011). finally, practiceled approaches to ict use should enable social workers to play an active role in advocating for improved access to the global information network for their clients (baker et al., 2014). while the perceived benefits to integrating tam into practice have been highlighted, integration also comes with noted limitations. one limitation of tam is the assumption that the usage of a given technology is voluntary; however, many employees are required to use a technology system to perform their jobs (adomavicius & gupta, 2009). a second known limitation of tam is that even if a user is not compelled to use a technology by their employers, they may be forced to use a technology they find difficult because there is no other viable choice. moreover, a third limitation of tam is that an individual’s performance may not necessarily be positively impacted even if the user finds technological tools useful and incorporates technology into their work with ease. additionally, a system that does not work well but is still highly used by an organization may actually harm the organization that uses it (adomavicius & gupta, 2009). conclusion the origins of technology acceptance and resistance by social workers have been viewed as complex, particularly in light of how technology has been used in the past, how it may have been seen as a tool of oppression, and how these experiences have affected employees’ emotions and attitudes about proposed technology in the workplace (stam et al., 2004). in social work practice, embracing new and innovative communication technologies can create opportunities for enhancing human service delivery. with that said, social workers must capitalize on technological change and overcome their resistance to learning new information technology skills, change from traditional to electronic advocacy practice, and integrate these new changes into practice (dunlop & fawcett, 2008). references adomavicius, g., & gupta, a. 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(2008). an evaluation of the technology acceptance model as a means of understanding online social networking behavior. dissertation abstracts international, 69. author note address correspondence to: angela bullock, lmsw, phd, university of the district of columbia, 4200 connecticut avenue nw, washington, dc 20008. email: angela.bullock@udc.edu microsoft word leukefeld copyedit final _________________ sarabeth leukefeld, msw, is a doctoral student in the college of social work at the university of kentucky in lexington. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 318-328 using internet-based videos as pedagogical tools in the social work policy classroom sarabeth leukefeld abstract: students often feel disconnected from their introductory social welfare policy courses. therefore, it is important that instructors employ engaging pedagogical methods in the classroom. a review of the literature reveals that a host of methods have been utilized to attempt to interest students in policy courses, but there is no mention of using internet-based videos in the social welfare policy classroom. this article describes how to select and use appropriate internet-based videos from websites such as youtube and snagfilms, to effectively engage students in social welfare policy courses. four rules are offered for choosing videos based on emotional impact, brevity, and relevance to course topics. the selected videos should elicit students’ passions and stimulate critical thinking when used in concert with instructor-generated discussion questions, writing assignments, and small group dialogue. examples of the process of choosing videos, discussion questions, and student reactions to the use of videos are provided. keywords: internet-based videos, pedagogical methods, social welfare policy social work policy introduction courses are replete with facts about the founders of the profession, historical policy initiatives, and historical truths students have likely never heard before. more importantly, social work policy introduction courses may be the first time young students are asked to think critically about their own values and beliefs. however, policy courses are, at best, unpopular and are generally viewed by students as mandated torture (anderson & harris, 2005; morris, 2000; wolk, pray, weismiller, & dempsey, 1996). some students even view policy courses as irrelevant and outside the sphere of their practice interests (gordon, 1994). it is because students perceive policy courses as unimportant and because the courses introduce so much new information to students that instructors must strive to ensure that the courses are palatable, and even interesting. this article briefly explores the literature pertaining to theories and methodologies that have been put forth for teaching social work policy courses. additionally, literature that identifies the use of internet videos in the classroom is explored. finally, a discussion of the use of easily-obtained internet videos is presented as an innovative pedagogical method that can help students become more involved in the social work policy classroom. why is social work policy education important? introductory social work policy courses are, in essence, history courses that require students to learn significant dates, biographies of important people, influential policies, major historical events, competing political ideologies, and new terminology. it is the instructor’s job to tie those seemingly outdated pieces of information together and to advances in social work, fall 2011, 12(2) 319 make them relevant to today’s social work students. it is those students who will soon be relied upon by the profession to utilize their critical thinking skills to advocate for social justice via socio-political change and new, more wide-reaching social welfare policies. for these reasons and others, social welfare policy courses are fundamentally important to professional social work education (sundet & kelly, 2002). if tomorrow’s advocates for change are uninformed or are simply uninterested in historical and current policy, social work may again be relegated to an ineffective, under-informed, generic helping profession (reamer, 1993). further, by ensuring that social work students have an effective and thorough education in the history of social welfare policy, the social work profession has the potential to become as influential as it was during the late 1800s, the early 1900s, and the 1960s, due to its numerous radical members who were tireless in their advocacy efforts (reamer, 1993). thus, the effort to help students find current and relevant applications for their policy education continues (sundet & kelly, 2002). further underscoring the importance of student engagement in social welfare policy courses is the relatively recent educational policy and accreditation standards (epas) mandate put forth by the council on social work education (cswe) (2008). with epas, the cswe “introduces the notion of requisite student competencies comprised of interrelated practice behaviors” upon which subsequent course curricula must be based (holloway, black, hoffman, & pierce, 2009, p. 1). with ten core competencies, cswe has standardized the areas in which students must demonstrate proficiency in their courses. additionally, students can be evaluated based upon their mastery of the core competency areas relevant to each course including social welfare policy courses. under the epas mandates, there is freedom to develop new teaching approaches that can help students demonstrate competence in the mandated areas. literature review: social work policy teaching methods and internet-based video teaching methods numerous methodologies and theories for effectively teaching social work policy courses have been described in the literature, whether the courses are introductory social welfare policy courses or more advanced policy analysis courses. a brief discussion of various teaching methodologies is offered here. one theory is that social welfare policy should not be relegated to separate courses but should, instead, be infused in each course across the curriculum. in this “experiencebased” method, students complete specifically outlined value-, theory-, skills-, policy-, and research-based assignments and synthesize those assignments with a series of practice tasks across the curriculum (gibbons & gray, 2005). a different method, explained by o’connor and netting (2008), involves teaching policy courses as though they are research courses. the authors point out that researchers utilize specific statistical analyses that are apropos to their projects, not one type of analysis for each project. they suggest that when students are seeking to complete a policy analysis, they should choose frameworks based on the specific policies they are analyzing, rather than relying upon a generic framework. leukefeld/using internet-based videos 320 wolfer and gray (2007) offer another method for teaching social work policy courses called the “decision case method.” students are asked to thoroughly review and analyze actual cases, which build on their analytic, political, interactional, and value-clarifying skills. social work policy has also been taught utilizing legislative policy briefs (sundet & kelly, 2002). in this method, course instructors meet with members of the state legislature before the semester begins to generate a list of impending policy initiatives that will be discussed by the legislature. the instructors then present the list of upcoming policy issues to their students who author thoroughly-researched policy briefs that are utilized by members of the legislature to make decisions on policy initiatives. another method, the task force approach, takes into consideration that, just as social workers often form groups to solve problems, task forces are formed to “investigate problems, recommend solutions, and sometimes carry out immediate action” (johnson, 1994, p. 336). johnson (1994) notes that students who experience the task force policy teaching method may be able to more effectively and adeptly utilize those sorts of task force group experiences in different areas of their professional lives. service learning and policy-integrated practica are two policy teaching methods that have been utilized and compared by anderson and harris (2005). a service learning policy course immerses students in actual community issues and problems while policyintegrated practica help students understand "the ways in which policy informs practice and practice informs policy” (anderson & harris, 2005, p. 516). when these two teaching methods were compared, anderson and harris (2005) found that if students have experiential involvement with policy, whether through service learning or policyinfused practica, they are equally as likely to understand and correctly apply policy theories. classroom assessment techniques (cats) are short, evaluative, non-graded, anonymous formative evaluations that students complete throughout the semester to help their instructors assess whether or not they understand and can apply the concepts that are being taught. adams (2004) describes several cats that can be utilized in the social work policy classroom to ensure that key concepts have been absorbed by students. for example, the knowledge probe cat can be utilized to ask students whether or not they have ever heard of a particular person, legislative act, or program, as well as the extent to which the concepts are known to students. additionally, according to keller, whittaker, and burke (2001), debate is an effective teaching method that can be utilized in the social work policy classroom. for debate assignments, students are assigned controversial policy issues and are asked to use critical thinking skills in their research and reporting of both sides of the issue. most innovative approaches to teaching social welfare policy involve widely utilized pedagogical tools such as debate and small group work. one approach, however, stands out. shdaimah (2009) utilizes multimedia, in the form of documentary films, to help students understand the viewpoints of real people who are coping with the effects of social policies. shdaimah (2009) suggests that students become emotionally involved with the subjects of documentary films and states that that involvement promotes a deeper level of engagement in class discussions. shdaimah (2009) contends that students may be able to enter the social work profession with a clearer understanding of social advances in social work, fall 2011, 12(2) 321 policies if they have the benefit of being able to process the multifaceted complications of real peoples’ lives presented in documentary films within the relative safety of the social work classroom. each of these original teaching methods seeks to engage students in social work policy courses. many of the methods attempt to pique students’ interest by engaging them in active learning exercises like policy brief preparation and community-based assignments. however, while videos and films are often used to teach students in other disciplines (for example, see everhart, 2009 and mullen & wedwick, 2008), only one method could be found in the literature (shdaimah, 2009) that described the use of films to teach a social policy course. through films, students can experience powerful visual and audio stimuli in concert. these stimuli connect students to their emotions in a way that a single photograph or a lone sound byte cannot. instead of merely viewing a photograph and reading the accompanying text or listening to a podcast, through films students are given the opportunity to connect with people who are living with and struggling through the policies they are studying. thus, when instructors are seeking a way to involve students emotionally in social welfare policy, multimedia in the form of films, documentaries, and other videos can be effective and engaging. today’s students have, by and large, become technologically savvy. google has become a verb overheard frequently in student conversations, and everyone on campus knows what a wiki is. youtube is a perennial favorite of students where video clips, movies, short films, documentaries, and almost any other form of video can be accessed. there is some discussion in the literature of youtube and other web-based video sites (e.g., google video) being used to teach primary and secondary students (e.g., everhart, 2009; pace & jones, 2009) however, web-based video sites have not been widely discussed as pedagogical tools in the college classroom. there are multiple widely-used web sites such as youtube, google video, hulu, and snagfilms, to name only a few, that allow users to easily search for video clips, short films, full-length films, documentaries, and other types of videos by subject, length, and age (among other criteria). these types of video sites have enabled teachers to engage twenty-first century students in a new way. mullen and wedwick (2008) discuss using youtube in a middle-school classroom, reminding us that students have “grown up digital” (p. 66) and that, by utilizing technology in the classroom, instructors can “close the digital divide between teachers, educational systems, and students” (p. 66). they suggest that students benefit immensely from the content available on youtube because it provides unlimited information in a distinctly different and engaging format. pace and jones (2009) point out that using youtube in primary and secondary science classrooms has great benefits for students. they identify that using web-based videos in the classroom helps students become critical thinkers and also helps them integrate newly learned information by catering to their different learning styles. everhart (2009) also discusses the use of youtube in the primary science classroom. in his classes, he assesses what students know about upcoming lesson topics and then fills in the knowledge blanks with videos from youtube. he uses both professional and amateur videos to keep students interested and engaged. everhart reminds us that it is the leukefeld/using internet-based videos 322 instructor’s discussion and questioning that connects the selected videos to the lesson’s content, and that without the instructor’s insight, the video clips cease to have meaning. additionally, trier (2007) points out that youtube can be used to find video clips to help with literary interpretations in the graduate school classroom. youtube has also been proposed as an effective teaching method for colleges of nursing and other healthcare professions (skiba, 2007). teaching an introductory social work policy course with internet-based videos in order to make social work policy relevant to undergraduates in an introductory course, youtube and other internet-based videos can be integrated into the course, especially because many of today’s college students are, as suggested by skiba (2007) “digital natives who grew up in a multimedia world and are most comfortable with technology” (p. 100). the history of social work policy is exciting and has, in large part, shaped the way the profession operates today. it is, therefore, imperative that social work students learn about our social welfare policy past and how policy is created along with their other, perhaps more appealing, social work practice courses. in order to expose these students, many of whom are “digital natives,” to historical and contemporary aspects of the development of social welfare policies, relevant web-based videos can be incorporated effectively into an introductory social welfare policy course. the following rules and suggestions for integrating web-based videos into the social welfare policy classroom were developed through the author’s experience teaching an introductory social welfare policy course. choosing effective internet-based videos to successfully discover appropriate web-based videos to integrate into social welfare policy courses, instructors should use their course syllabi, textbooks, and assigned readings to identify important areas of instruction and, accordingly, identify key terms to search for useful video websites. sometimes, appropriate videos are easily located, but other times the correct videos may be elusive. it may take several hours of searching different websites and often dozens of videos have to be previewed in order to find the best one. there are, however, useful tools provided by websites such as google (e.g., the advanced search option) and youtube that provide succinct lists of videos in a much shorter amount of time. choosing the most effective internet-based video for each lesson is not as difficult as it may seem at first. though it can be daunting when several thousand “hits” for a given search term appear, most video websites list search results in order of relevance to the search term. often, refining the search term to be more precise can help when videos being previewed seem unrelated to the lesson. the first rule is that it is important for the instructor to keep in mind that appropriate key words that relate to the topic being taught must be used as search terms. instructors should use fewer words as key search terms to begin a video search. for example, if the lesson calls for a video that will help students discover and understand the origins of the orphan trains of the 1800s, instead of using charles loring brace, orphan train program founder, as the search term start simply advances in social work, fall 2011, 12(2) 323 with orphan trains. search terms can always be expanded by adding more words in order to narrow the search. the second rule is that videos should be short. as a rule of thumb, anything over twenty minutes is too long. most students are used to short, highly-edited multimedia products, and showing clips over twenty minutes long may lead to students becoming distracted or bored. instructors should keep in mind that the video is a means to helping students think critically and should not take up too much of the class time. if too much time is taken up viewing videos, students will have less time to demonstrate their mastery of the course’s core competencies. the third rule is that each video must be emotionally-charged. the more visceral the reaction the instructor has while previewing the video, the more emotionally engaged the students are likely to be when they view the video. videos do not have to be cutting-edge or sleekly edited to qualify, but they must be poignant or controversial, or they must introduce topics new to the students and about which they have little information. the fourth rule is that students should know why they are watching the videos. instructors should provide a brief introduction to each video and identify key ideas for students to keep in mind and/or questions that they must answer as they view the videos. additionally, it is important for instructors to generate several discussion questions that require students to confront and question their values and to think critically about the topic presented in the video. for these reasons, the instructor should always keep in mind that the videos are a means to an end. to illustrate how provocative, informative, and interesting internet-based videos have been found and utilized to promote critical thinking, discussion, and learning in the social work policy classroom, three examples of videos used in an introductory policy course taught by this author in the fall 2010 semester at the university of kentucky are described below. utilizing internet-based videos effectively in the social work policy classroom the death penalty. one of the topics typically discussed in the introductory social work policy course is the death penalty. to produce a listing of apropos videos, the term death penalty was entered in the youtube site search engine, and a list of over 5,000 videos was generated. over a dozen videos were previewed before the most relevant and emotion-producing one was located. in the video documentary, the warden of central state prison in raleigh, north carolina provides a tour of the prison’s execution chamber and delivers an eerily emotionless explanation of a death row prisoner’s last hours and of the execution procedure. this ten-minute documentary (langley, 2007) introduced the death penalty to the class and generated an initial discussion about students’ views. the video struck such an emotional chord with the students that it initiated the longest and most intense discussion the class had during the semester. to continue the discussion, a series of questions were developed by the instructor and were addressed in small groups on the heels of the class discussion. the questions asked students to clarify their thoughts and feelings, and each student was assigned one question as a homework writing assignment to help bolster critical thinking skills. examples of questions students addressed are: 1) what if the death penalty didn’t exist? 2) is it acceptable for social workers to be in favor of the death penalty? why or why not? 3) what do you think about leukefeld/using internet-based videos 324 the cause of death on executed prisoners’ death certificates being marked as “homicide”? should they be? because of the video, students were drawn to the topic emotionally and were forced to confront ideas and feelings they had not considered before. after all, since their inception, documentary films have been designed to stimulate not only the intellect, but emotion as well (rose, 1961). in fact, one student remarked that she had never thought about the death penalty before, much less about the inmates awaiting execution on death row. she came to the next class meeting armed with information about wrongful executions which she shared with the class. immigration. immigration policy is another provocative subject that might be addressed in an introductory social welfare policy class. when asked, students in the class seemed generally uninformed and ambivalent about both the history of immigration in the u.s. and current policy debates about immigration. it seemed fitting, therefore, to prod the students into considering issues surrounding immigration and immigration policies during the late 19th and early 20th centuries and to compare them to contemporary immigration issues. in order to facilitate this process with videos, the term immigration was entered into the youtube search engine. after multiple videos were previewed over approximately one hour, a determination was made that none of the videos on the first several pages of the youtube search results met the learning objectives for the course. next, the same search term (immigration) was entered into the google video search engine. a brief perusal of the first page of videos yielded a short (eight minute) and contentious abc news this week roundtable discussion on the arizona immigration law (amanpour, 2010) featuring rev. al sharpton, george will, matthew dowd, katrina vanden heuvel, and bill maher. both conservative and liberal viewpoints are expressed by members of the roundtable in the video clip which allows students to be exposed to both schools of thought. next, to meet the other learning objective of the lesson, (i.e., to compare historical and contemporary points of view on immigration), the search term ellis island was entered in the google video search engine. multiple documentary-type videos and video clips were discovered, and about ninety minutes was spent previewing videos. finally the decision was made to show students the first half of a show (13 minutes) called great museums: face of america: the ellis island immigration museum (doyle & smith, 2002), retrieved from snagfilms.com. many times it is not necessary to show entire videos, clips, films, or shows. in the case of the ellis island museum video only the first half of the video, which discusses how immigrants came to the u.s., their passage through immigration at ellis island, and common immigration concerns of the late 19th and early 20th centuries, was apropos to the course. during class, the immigration video clips were shown back-to-back, and a class discussion ensued. several students volunteered stories about their visits to ellis island and about searching the database there for relatives who had passed through as well as other personal stories. next, instructor-generated discussion questions were distributed to students in small groups, and they were asked to think about and discuss their answers. examples of questions used to stimulate discussion are 1) what are the liberal and advances in social work, fall 2011, 12(2) 325 conservative views presented in the roundtable discussion? 2) are the issues presented in the roundtable discussion the same as the issues presented in the ellis island video that existed in the 1900s? 3) what are the similarities between the situations of ellis island immigrants and immigrants today? in small groups, students felt comfortable relating their own stories, viewpoints, and prejudices about immigrants and, with continued guidance from the instructor; they were able to use their developing critical thinking skills to imagine the immigration experience from others’ points of view. the universal declaration of human rights. an important internationally agreedupon policy that is introduced in many introductory social work policy courses is the universal declaration of human rights (udhr). students in the class reported that they had heard of the udhr, but they also said they could not remember what it contained. thus, it became important to expose them to the udhr in a new and exciting format. with social justice as one of the core components of the social work profession, it is imperative that students understand the basic human rights they and their future clients have. therefore, instead of simply distributing copies of the udhr to the class and having a discussion, a search of youtube for attention-grabbing videos was undertaken with the search term universal declaration of human rights history. the second video yielded by the search, the story of human rights (youth for human rights, 2009) met the criteria perfectly. it is a sweeping yet succinct (10 minutes) video that is made for young adults and explains the history and substance of the udhr. during the class discussion after watching the video, students connected the udhr to other policies and topics that had been studied during the course of the semester. a debate ensued about whether the low-quality education provided to poor children (e.g., with outdated textbooks in sub-par facilities) still constitutes an education, and students also debated whether or not torture during war can ever be justifiable. several weeks later, some of the students in the class cited the udhr during a group assignment on healthcare and stated that they remembered the udhr because of the video they watched in class. discussion a brief review of the literature revealed that a wide range of methods are used to teach social welfare policy courses. however, the pedagogical use of internet-based videos in the social work policy classroom has not been widely described. while the use of internet-based videos is not formally evaluated in this article, according to students’ anecdotal reports, the method appears to have been beneficial. for example, students had been introduced to the udhr prior to the course, but reported they could not remember the information until they had viewed the udhr video retrieved from youtube. additionally, students displayed increased critical thinking skills as they engaged in discussion and debate subsequent to viewing internet-based videos on immigration and the death penalty. the use of internet-based videos in the social work policy classroom could benefit from formal evaluation of its pedagogical utility. students would be required to demonstrate their understanding of an assigned policy by finding an appropriate internetbased video highlighting that policy. they would also be expected to explicitly identify how their videos demonstrate an understanding of epas core competencies identified as leukefeld/using internet-based videos 326 course objectives in their syllabi. students would utilize internet-based video websites to search for and find an appropriate video that, in some way, whether straightforwardly or creatively, illustrated the importance of their assigned policies. videos would have to follow the four rules described above. they would need to be engaging, emotionallycharged or controversial, short, and appropriate for classroom viewing. students would also be required to generate several discussion questions to further highlight salient points about the video and the policy it represented. students would then be evaluated based on how well the video they chose demonstrated the identified epas core competencies. social work policy courses seem to have acquired the reputation of being akin to a gulag. it is, therefore, incumbent upon instructors to engage students by utilizing innovative pedagogical tools to excite and inspire them. by bringing reality to the attention of students via films and videos, emotion is injected into the classroom. film has been described as “one of [the] most intimate and effective tools for learning” in the college classroom (sargent, 2006, p. 72). argentinean filmmaker fernando solanas (solanas & volpi, 1969) has famously asserted that the key to a successful film is the passion it evokes in those who view it. the use of internet-based films and videos in the social policy classroom emotionally bonds “digital natives” to course content and helps them make significant connections to important information 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(2007). using the decision case method to teach legislative policy advocacy. journal of teaching in social work, 27(1/2), 37-59. wolk, j. l., pray, j. e., weismiller, t., & dempsey, d. (1996). political practica: educating social work students for policymaking. journal of social work education, 32(1), 91-100. youth for human rights. (2009). the story of human rights [motion picture]. united states: youth for human rights. available from: http://www.youtube.com/watch?v=oh3bblk5uiq author note: sarabeth leukefeld, msw, doctoral student, college of social work, 527 patterson office tower, lexington, ky. e-mail: s.leukefeld@uky.edu this work is licensed under a creative commons attribution 4.0 international license. the impact of a title iv-e program on perceived practice skills for child welfare students: a review of five msw cohorts elizabeth jane greeno lisa fedina berenice rushovich caroline burry debra linsenmeyer christopher wirt abstract: title iv-e education for public child welfare training programs are designed to build knowledge and practice skills among students and current child welfare workers in efforts to build a competent and highly trained workforce. a mixed methods study was conducted to: 1) measure changes in msw title iv-e students' perceived confidence to perform skills across 13 practice content areas for public child welfare practice, and 2) to explore students’ perceptions of their competency for child welfare practice. this study also focused on the impact of prior child welfare experiences on perceived child welfare knowledge and skills among title iv-e students. a total of 224 title iv-e msw students over the course of five academic cohorts participated in this study. surveys were conducted at three time points: pretest, posttest, and retrospective pretest. twenty focus groups were conducted during the study time period. findings indicate gains across all practice content areas with the largest gains in areas of working with the courts and conducting assessments. qualitative findings assessing student's perception of competency to practice in child welfare include themes of students’ preparation to practice post-graduation and differences between the students’ experiences in the iv-e program and what they witness in the field. specific practice area recommendations include addressing workers’ age and prior experience in title iv-e seminars and trainings as well the importance of title iv-e field instructors in helping to prepare students for child welfare practice. keywords: title iv-e; child welfare knowledge; child welfare practice; child welfare training over the last 20 years, federal funding through title iv-e and title iv-b, section 426, (adoption assistance and child welfare act, p.l. 96-272) has provided states with resources to design, implement, and facilitate child welfare training programs for future and current public child welfare employees in the united states. workforce retention and specialized child welfare knowledge, skills, and competencies are the key outcome objectives of these training programs. a considerable amount of research has been dedicated to evaluating the impact of title iv-e training on workforce retention, suggesting that iv-e programs are a significant predictor of stronger workforce retention outcomes and therefore are a valuable tool in reducing staff turnover in public child welfare (zlotnik, _________________ elizabeth j. greeno, msw, phd is a research associate professor at the university of maryland school of social work (um ssw) in baltimore, md. lisa fedina is a phd candidate at um ssw. berenice rushovich, msw is a research scientist with child trends in bethesda, md. caroline burry, phd is an associate professor at um ssw. debra linsenmeyer, msw is the educational director of the title iv-e program at um ssw. christopher wirt, msw is a clinical instructor at um ssw. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 474-489, doi: 10.18060/21058 https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2017, 18(2) 475 depanfilis, daining, & mcdermott lane, 2005). additionally, title iv-e programs place a strong emphasis on building and strengthening knowledge and practice skills among program participants and subsequently, within the child welfare workforce. in 2008, the council on social work education (cswe) adopted a competency-based education framework and described social work competence as “the ability to integrate and apply social work knowledge, values, and skills to practice situations in a purposeful, intentional, and professional manner to promote human and community well-being” (cswe, 2015, p. 6). cswe (2015) defines values as recognizing social, economic, cultural, and political climates and the impact of these areas on the clients they may serve. indeed, the inclusion of values in definitions of competence sets the social work profession apart from other professions that do not consider values to be an integral part of competence in addition to knowledge and skills. this is especially salient for assessing competencies in child welfare, as not all child welfare workers have professional degrees in social work and thus agencies often provide training on social work values (barth, lloyd, christ, chapman, & dickinson, 2008). child welfare knowledge and skill acquisition overall, research indicates that title iv-e participants score higher on public child welfare measures of knowledge and practice skills compared to non-program participants, suggesting that iv-e education provides students with fundamental child welfare knowledge and practice skills (bagdasaryan, 2012; fox, miller, & barbee, 2003; franke, bagdasaryan, & furman, 2009; jones & okamura, 2000; yankeelov, barbee, sullivan, & antle, 2009). hartinger-saunders and lyons (2013) identified 10 peer-reviewed studies that used empirical data to evaluate title iv-e programs. only 4 of the 10 studies measured competency through knowledge and skill assessment among iv-e participants, while the remaining studies focused on areas of job satisfaction and retention. based on knowledge tests, 3 of the 4 studies indicated improved knowledge gains among title iv-e participants (see franke et al., 2009; gansle & ellet, 2002; jones & okamura, 2000). one study assessed findings from an evaluation of a new employee pre-service training program and revealed that newly-hired title iv-e employees scored higher on both pre and posttest measures of child welfare content knowledge (i.e., areas such as permanency planning, maltreatment definition) and knowledge associated with application of practice skills (i.e., vignettes for decision-making related to child welfare cases) compared to newly hired nontitle iv-e employees (franke et al., 2009). previous child welfare experience a variety of external factors may influence student practice skills in child welfare. specifically, one overlooked area is the influence of prior child welfare experience. child welfare experience prior to a formal social work education often includes volunteer experience or paraprofessional roles that may introduce students to professional child welfare practice and build skills specific to child welfare settings. this experience may also include generalist practice courses or exposure as well as a values orientation to the field. previous child welfare experience exposes and socializes students to the [social work] field, which subsequently increases self-perceived competency in child welfare practice (cheung greeno et al./perceptions of recidivism 476 & tang, 2010). very few studies, however, have explored the impact of prior child welfare experience on practice skills and knowledge among iv-e participants. overall, the impact of socialization to the field on child welfare competency, social work values attainment, and practice skills, requires further study. university of maryland, baltimore title iv-e program the title iv-e public child welfare education program in the state of maryland is a collaborative effort between the university of maryland, baltimore school of social work (umb ssw) and the maryland department of human resources. the mission of the title iv-e program in this state is to prepare master of social work (msw) students for social work practice to provide family-focused and strengths-based public child welfare services to families and children. the program is funded through federal title iv-e funds for state and local child welfare training. the primary objectives of the program are to increase the number of professionally trained social workers in maryland’s public child welfare system and to further the development of core values, knowledge, and skills necessary for competent provision of services to children and families served in public child welfare. at the msw level, umb ssw’s title iv-e program recruits students who are interested in the families and children specialization. the families and children specialization prepares graduates for clinical, community development, and human services management practice with families and children. it also provides focused studies in family and child programming and policies, with particular emphasis on public child welfare issues. students in the iv-e program are required to complete specialized coursework that includes a child welfare practice class and training in child welfare. trainings include monthly seminars on child welfare topics and specialized trainings, such as court and testimony preparation. title iv-e students also fulfill field placement requirements at local public child welfare agencies. the student units at umb ssw are composed of a combination of msw foundation and msw advanced clinical students under the supervision of a university field instructor who is assigned to the agency in which the unit is located. the field instructors provide individual instruction to each student in the unit and conduct case presentations and seminars relevant to practice issues. students are assigned child welfare cases being served in the local child welfare agency and work as a team with child welfare workers to provide services to children and families. purpose of study the current study has two primary aims: first, to measure changes in msw students’ perceived confidence to perform skills across 13 public child welfare practice content areas before and after participation in the university's title iv-e education for public child welfare program and second, to explore students’ perceptions of their competency to practice in child welfare. the following research questions were addressed in the current study: 1) is participation in the title iv-e program associated with changes in student selfreported confidence across 13 public child welfare practice content areas? 2) is there a difference in student self-reported confidence at pretest and retrospective pretest? 3) are confidence gains influenced by student demographic characteristics? 4) is prior child advances in social work, fall 2017, 18(2) 477 welfare experience associated with higher levels of perceived confidence prior to and following participation in the title iv-e program and retrospectively? and 5) how do students perceive their competency and readiness for their post-graduation, full-time employment with a public child welfare agency? questions 1 through 4 are addressed quantitatively and question five is addressed through focus groups. the current study strengthens the empirical body of research on title iv-e programs by examining perceived practice skill confidence across five msw cohorts. additionally, two critical, yet understudied, areas within title iv-e research are addressed. first, the impact of prior child welfare work experience on perceived practice skills among iv-e participants is evaluated. examining the effect of prior child welfare experience on iv-e participants’ perceptions of their skills may highlight specific training needs for iv-e students with prior experience. second, few studies have assessed students’ perceptions of their competency and readiness to begin a full-time position with a public child welfare agency post-graduation. assessing students’ perceptions of their competencies and ability to practice after completing the title iv-e program can provide insight into possible training needs. in addition, specific strategies that helped students gain a sense of competence to practice are presented. methods both qualitative and quantitative methods were used to evaluate the university’s title iv-e program. pretest, posttest, and retrospective pretest surveys were administered and focus group interviews with iv-e participants were conducted to analyze students’ perceived practice competency. qualitative and quantitative methods held equal status in the research design and both types of data were collected simultaneously throughout the study (see johnson & onwuegbuzie, 2004). additionally, the use of the retrospective pretest evaluation approach has been shown to be an effective way of accounting for response shift bias that would otherwise not be accounted for in traditional pre-posttest designs (pelfrey & pelfrey, 2009). using retrospective pretest-posttest design mitigates the underestimation of program effects (pratt, mcguigan, & katzev, 2000) that can occur in curricula such as title iv-e training; that is, as an understanding of social work and child welfare concepts grows, respondents’ original understanding of their prior knowledge may change. sampling and recruitment recruitment for study participants occurred through a two-stage process. first, program staff provided all title iv-e participants with information on the study during ive program orientation, which is held annually in the beginning of each academic year. all iv-e students were invited to participate in the evaluation. participants were also provided with title iv-e evaluation goals, objectives, and consenting procedures. second, evaluation consent forms and stamped, self-addressed envelopes were mailed to all students who agreed to participate in the evaluation. this study is comprised of students from five cohorts who participated in the title iv-e program during the academic years of 2009 to 2013. over this time period, 256 students were eligible to participate in the evaluation. among the 256 eligible students, a total of 224 students participated, yielding greeno et al./perceptions of recidivism 478 a response rate of 88%. university institutional review board (irb) approval was obtained for the current study. data collection procedures participants completed a self-assessment child welfare competency practice skills survey at the beginning (pretest) and end of the academic year (posttest) in which they participated in the title iv-e program. at the end of each academic year, students were asked to rate themselves on how confident they believed they were now (standard posttest) and how confident they thought they were at the beginning of the year (retrospective pretest measure). this measure asked participants to rate, on a 10-point scale, their level of confidence to perform 13 practice skills related to public child welfare practice (see table 3 below for a list of all 13 practice skills). the self-assessment child welfare competency practice skill survey was created using the knowledge and skill competencies derived from the key competencies identified for this iv-e program (for more information on key competencies, see zlotnik, 1997) across 13-different child welfare content skill areas. skills such as engaging families, developing a service plan, and working with the courts are assessed. scores of 0-4 are considered to be perceived low confidence in ability to practice the skill; scores of 5-7 are considered to be perceived levels of moderate confidence in ability; and scores of 8-10 are considered to be perceived levels of excellent confidence in ability. all surveys were administered through an online survey software program. at the pretest measure (beginning of the academic year), students were also asked to answer a demographic survey that captured age, race and ethnicity, gender, and prior child welfare experience. for prior child welfare experience, students were asked to indicate their years of experience and to describe by a text write-in option their prior experience. prior child welfare experience was counted as prior experience if it included working in any child welfare setting (i.e., public child welfare agency, private foster care settings, group homes or residential treatment centers), for non-profit agencies involved in child welfare work or working in hospital or mental health settings. following recommendations from dillman, smyth, and christian (2008), a web-based survey and emailing strategy were used. specifically, students were emailed an initial survey invitation, which included a link to the online survey. over the course of three weeks, students were sent three reminder emails to complete the survey. completed survey data were available for all 224 participating students. however, demographic data were not available for the full sample (data available for n=146). all quantitative data were analyzed using spss version 22.0. paired samples t-tests, one-way anovas, and multiple regression analyses were conducted to assess survey outcomes. a total of 20 focus group interviews (approximately 1 hour each) were conducted by the lead iv-e evaluator (first author). the groups were conducted at the end of each academic year at field instruction sites. a semi-structured focus group questionnaire was developed to assess students’ perceived competency in child welfare, as well as their perceived readiness and ability to apply newly learned skills to their practice in child welfare. students were specifically asked, "how competent do you feel about your ability advances in social work, fall 2017, 18(2) 479 to practice as a public child welfare worker post graduation” (prompt: “how do you feel about your ability to competently practice as a new child welfare worker?”) among the 224 students participating in the evaluation, a total of 155 students participated in focus groups, yielding a participation rate of 69% for the qualitative portion of the evaluation. narrative data were analyzed using the qualitative data analysis software program nvivo (qsr international pty ltd, 2010). qualitative analyses were conducted through a fourstep process. first, all focus group interviews were audio-recorded and transcribed verbatim. second, interviews were analyzed using open coding techniques and recurrent themes were identified. third, a constant comparative method, following padgett’s (2004) qualitative analysis framework, was employed to compare themes that emerged from the data. finally, categories and themes were organized and interpreted (krueger, 1988; krueger & casey, 2009). results demographics demographic data for age and ethnicity were available for 3 out of 5 academic years (n=146). table 1 presents ethnicity data for participants. study participants were primarily female (92%), white/caucasian (39%) or black/african american (20%) (see table 1). the average age of participants was 27.6 years (range 21-55). there was approximately a two-year age difference between those who indicated they had prior child welfare experience (m=29) compared to those without prior child welfare experience (m=27). however, this was not a statistically significant difference, f=(1, 111)=2.972, p=.087. see table 2 for details. the length of prior child welfare experience was available for only 64 participants; the average number of years of prior experience was 3.3 (sd=4, range 6 months – 22 years). table 1. ethnicity of msw student participants (n=146) ethnicity n (%) white/caucasian 87 (39%) black/african american 45 (20%) more than one race 8 (4%) hispanic 6 (3%) table 2. age data for iv-e students with and without child welfare experience (n=146) mean mode median sd range age-all 27.6 24 25 6.6 21-55 students with prior child welfare experience (n=64) 29 26 25 7 21-55 students without prior child welfare experience (n=82) 27 23 24 5 22-46 changes in perceived practice skills after program participation findings for pre and post-practice skill assessments are provided in table 3. overall, students demonstrated increased self-reported confidence across all 13 skills. students greeno et al./perceptions of recidivism 480 indicated perceived levels of moderate gains across all 13 practice skills at pretest. scores ranged from 1 to 2 points higher between pre and posttest, suggesting that students had increased self-perceived child welfare practice skills after completing title iv-e education. by posttest students were classified as either having perceived levels of moderate to excellent practice skills. students demonstrated the largest gains between pre-post test scores within the areas of working with court systems and conducting assessments for child sexual abuse. students had modest gains in areas such as diversity, use of self in practice, working in settings other than their current field placements (e.g., investigations, foster care), and working with a variety of child developmental stages (e.g., infancy, adolescence). table 3. pre and post-program participation scores on self-assessed competencies (n=224) child welfare practice content area m pretest m posttest m difference 95% ci t p ll ul 1. engaging families in assessment 6.8 8.2 1.4 0.81 1.68 5.68 <.001 2. developing a service plan 6.7 8.1 1.3 0.89 1.77 6.00 <.001 3. collaborating as a team member 6.9 8.4 1.5 0.88 1.76 5.96 <.001 4. diversity & use of self 7.4 8.4 1.0 0.56 1.25 5.18 <.001 5. assessing for abuse & neglect 6.7 8.2 1.5 0.97 1.87 6.21 <.001 6. using clinical skills 5.9 7.6 1.7 1.21 2.12 6.95 <.001 7. working in other settings 7.4 8.4 1.0 0.49 1.56 3.82 <.001 8. assessing & intervening for substance abuse 6.0 7.4 1.4 0.83 1.80 5.36 <.001 9. assessing & intervening for sexual abuse 4.9 6.9 2.0 1.32 2.48 6.52 <.001 10. arranging out-of-home placement 5.2 6.9 1.7 0.57 1.71 4.03 <.001 11. permanency planning 6.1 7.2 1.1 0.42 1.57 3.43 0.01 12. working with the courts 5.2 7.1 1.9 1.14 2.44 5.47 <.001 13. working with developmental stages 7.3 8.3 1.0 0.69 1.42 5.74 <.001 notes. ci=confidence interval; ll=lower limit; ul=upper limit retrospective pretest findings table 4 details findings for the differences between the pretest and the retrospective pretest. ten of the thirteen skill areas were statistically significant, indicating differences in student perception from pretest to retrospective pretest. students did not report gains in the areas of using clinical skills, assessing for sexual abuse, and working with court systems. overall, at the beginning of the academic year, students reported perceptions of a higher level of confidence for practice skills than they did when retrospectively assessing their skill level. demographic differences the demographic variables of age and ethnicity were used to assess differences at the three survey time points. results from the multiple regression analysis suggest significant differences at pretest. specifically, the demographic variables had an impact on the participant's overall score (r²=.094, f(2,110)=.5.707, p=.004). ethnicity was not a significant variable in differences at pretest. however, age was significant. for each advances in social work, fall 2017, 18(2) 481 additional year in age, participants scored 1 point higher on the practice skill assessment (p=.002) at pretest. multiple regression analysis was also used to assess demographic differences at retrospective pretest (r²=.094, f(2,106)=1.602, p=.206) and posttest (r²=.030, f(2,109)=1.671, p=.193). both models were non-significant; demographic variables did not have a significant difference on the retrospective pretest or the posttest scores. table 4. pretest and retrospective pretest scores on self-assessed competencies (n=224) child welfare practice content area m pretest m posttest m difference 95% ci t p ll ul 1. engaging families in assessment 5.9 6.8 0.9 .35 1.36 3.36 <.001 2. developing a service plan 5.9 6.7 0.8 .26 1.31 2.98 .004 3. collaborating as a team member 6.3 6.9 0.6 .26 1.21 3.07 .003 4. diversity & use of self 6.5 7.4 0.9 .46 1.33 4.09 <.001 5. assessing for abuse & neglect 6.1 6.7 0.6 .18 1.23 2.67 .009 6. using clinical skills 5.4 5.9 0.5 -.05 1.07 1.79 .076 7. working in other settings 6.2 7.4 0.2 .65 1.75 4.30 <.001 8. assessing & intervening for substance abuse 5.4 6.0 0.6 .05 1.20 2.16 .033 9. assessing & intervening for sexual abuse 4.9 4.9 --.57 0.66 0.16 .876 10. arranging out-of-home placement 4.8 5.2 0.4 .30 1.50 2.98 .004 11. permanency planning 5.0 6.1 0.1 .59 1.79 3.90 <.001 12. working with the courts 4.8 5.2 0.4 -.22 1.05 1.28 .202 13. working with developmental stages 6.6 7.3 0.7 .28 1.15 3.24 .002 notes. ci=confidence interval; ll=lower limit; ul=upper limit prior child welfare experience data were available for 164 students regarding their prior (to the start of the academic year) public child welfare experience. table 5 presents results from three one-way anova analyses that explored: 1) the difference between students with and without prior public child welfare experience before and after program participation, 2) differences on the retrospective pretest, and 3) overall change in total practice skill score. students with prior public child welfare experience had significantly higher scores on the self-assessment measure prior to program participation (i.e., pretest). however, there were no significant differences at posttest and retrospective pretest time points (see table 5). table 5. differences between total competency scores for students with and without prior public child welfare experience time point experience n m score f p pre-iv-e none 68 5.6 3.75 <.001 prior 62 7.0 post iv-e none 49 7.8 0.59 0.59 prior 51 7.8 retrospective none 49 5.5 1.16 0.284 prior 52 5.9 greeno et al./perceptions of recidivism 482 qualitative findings students were asked to assess their perceived child welfare competency gains throughout their graduate education in conjunction with their title iv-e program experience and to gauge their perceived or anticipated competency post-graduation as a projected full-time employee in a public child welfare agency. three main themes emerged from the qualitative data: 1) preparation to practice post-graduation; 2) difference between iv-e field experience and what they witness in practice during field; 3) work and life balance. qualitative themes are presented below, along with supporting documentation from participants. preparation to practice post-graduation overall, student responses indicated two distinct perceptions of competency readiness to practice post-graduation from the iv-e program: those who felt competent to practice post-graduation and those who felt less prepared to practice. students who felt competent or ready for the "challenge" reported that they felt as prepared as they could be to practice in child welfare and appeared to anticipate the unexpected challenges they would likely face as an employee. these students understood that they would eventually be exposed to situations and experiences they had not previously encountered in their field placements while in the iv-e program. still, this group of students felt confident that they possessed the foundation skills necessary to practice competent social work and manage unexpected challenges. these students also described strategies that increased their self-confidence in practicing social work and managing unexpected challenges. two main strategies were repeatedly mentioned: field instructors and seminars. students reported that they learned the most from their field instructors. field instructors provided the opportunity to “hone skills,” process cases, and discuss child welfare policy and practice. they provided students with practical and hands-on experience and were able to model child welfare practice skills for students. other descriptions of field instructors included “sounding boards” or people who eased the students’ anxiety. seminars provided a means of structured and concrete teaching of child welfare practice and policy. the resources and discussions held during these seminars were seen as useful and applicable. ...you’re just never going to, you can’t prepare us for everything but i think you’ve got all the bases down.-student, 2011 i've learned to gain confidence to be able to speak to people and confront them about the things that they’re resistant about,...and having the courage to do that. it definitely is a learning process to build that level of confidence.-student, 2012 an additional strategy students indicated as valuable to achieving competency was shadowing other workers in the field. shadowing experiences had two main benefits: 1) exposing students to numerous and varied situations/experiences in their units and 2) allowing students to see how other social workers conduct themselves and implement practice skills in the field. other students thought that despite the resources, preparation, and training received from their public child welfare field placements and the iv-e program, they still did not advances in social work, fall 2017, 18(2) 483 feel prepared to graduate and practice at a public child welfare agency. students who felt less prepared also mentioned the role of shadowing in their field placement experiences. unlike students who felt competent and confident, the shadowing experiences, which were often identical (i.e., multiple students shadowed the same child welfare workers), appeared to make this particular group of students feel more anxious about practicing in a public child welfare agency post-graduation. these students reported satisfaction with the iv-e program, but appeared to have the feeling they could never "get enough practice" before becoming full-time employees. these students wanted to feel prepared in all areas of child welfare so they could be "prepared for anything." the following quotes from two students illustrate this theme: everything scares me....just scares me. i’m scared. i’m really not prepared. not that this iv-e experience hasn’t been really awesome. and it has helped me out a lot. i think i’m, i mean i don’t know if i’ll ever feel prepared.-student, 2014 .the way i see it, it’s really, this job is so much, seems so much on the job versus, ya know, reading this or class training...there’s things that you’re not going to know until you come across it…there’s tons i haven’t come across yet.-student, 2013 difference from iv-e field experience and what they witness in practice all students reported concern about their ability to transfer what they learned from the iv-e program to their practice. students believed they were being trained to provide quality practice with their child welfare clients, though they reported witnessing current workers doing mainly case management activities and not having opportunities to practice clinical skills. students viewed their role as a child welfare worker as combining both clinical skills and case management activities. students reported that there is a strong emphasis on developing and mastering clinical skills and competence within the title iv-e program. however, students’ view of workers in their field placement was that there was no emphasis on, or no time to use, clinical skills. instead, the focus was to “get the work completed.” i mean, here [in field] we spend a lot of time being with the client, what the client wants, and following their lead...but the time constraints in a dss work relationship, you don't have time to really explore and get them to elaborate and talk. you've got this checklist that's mandated.-student, 2011 some things are beyond your control because the caseloads are cumbersome, so, and like, documentation becomes a priority so you want to spend this extra hour there engaging but you want to get back because you know you've got this stuff to do. so it's a struggle.-student, 2013 students also reported on various aspects of professional behavior, including attitudes among child welfare workers at their field placements, which brought about additional concerns for students. based on what they had witnessed from workers, students were concerned that once they began working they would become overwhelmed with job greeno et al./perceptions of recidivism 484 demands and "lose" their ability to both implement comprehensive clinical child welfare practice skills and perform the necessary case management activities. well what i've noticed is there's just like this tension where we learn the right way to do things a lot of times in the iv-e seminars and [in] the school and a lot of good practices and then you go out to field and it's a little discouraging sometimes when you are around a bunch of social workers that have become a little bit cynical and you have people telling you just do the bare minimum, like that's all they want you to do. and it's just like, like for me, i think that you're kind of like if i want to do this, i care about it, so you're not really supported in that. they kind of look [at you] like you're going to burn yourself out.-student, 2013 work and life balance additionally, many students reported future concerns related to their ability to balance having a family and being able to practice the iv-e skills they had learned. several students (the majority of participants in the evaluation were female) reported plans or hopes of having their own family within five years after graduation and reported concerns that they would not have the time and energy to have both a family and a job in public child welfare. students appeared to be influenced by what they had witnessed from child welfare workers in the field placement and perceived there would be future conflict over the demands of the job, being overwhelmed, and obligations to their family. ...you could do this job with, if you really wanted, it would be hard. i think it’s good when you're young and you’re vibrant but i could see it getting, it being really hard to juggle this specific job in family welfare and also having a family. -student, 2014 discussion the multifaceted nature of social work practice in the field of public child welfare is undeniably challenging, especially for new social work practitioners. rigorous and comprehensive training in child welfare practice, such as the preparation provided in title iv-e programs, is needed to build an efficacious public child welfare workforce. additionally, jones and okumura (2000) suggest that the more competent child welfare workers feel in their practice, the more likely they are to remain in public child welfare over time. overall, findings from the current study provide support for umb ssw's title iv-e educational program. results from participants’ pre-posttest scores indicate increased perceived confidence to practice in child welfare settings. this finding is consistent with previous studies on iv-e programs (bagdasaryan, 2012; franke et al., 2009; gansle & ellet, 2002; jones & okamura, 2000). measuring perceived confidence in practice skill ability among iv-e participants is a step towards measuring actual competency in child welfare practice. this study provides empirical evidence through a mixed methods approach to support umb ssw's title iv-e program goals, which are focused on graduating social workers who are competent to practice in public child welfare. still, there were differences in participants’ perceived skills for specific areas of child welfare practice. pre-posttest results suggest only modest gains in areas of diversity and advances in social work, fall 2017, 18(2) 485 use of self, working in other settings, and working with children of different developmental stages. however, for all three practice domains students entered scoring in the moderate range of perceived skills and there was approximately a one-point difference from pretest to posttest. this suggests students entered the msw program with a fair amount of confidence in these areas, but were still able to make gains through their title iv-e experience. greater gains were made in areas of assessing and using clinical skills, arranging out-of-home placements, intervening for sexual abuse, and working with the courts. these gains would tend to support the use of some specific strategies employed by this iv-e program. for instance, as iv-e students have historically stated that they were very anxious about preparing for and testifying in court, this iv-e program includes a fullday mock court experience. similarly, feedback from past students about their need for additional preparation for addressing child sexual abuse resulted in additional emphasis on this topic in their required child welfare practice course. other iv-e programs, therefore, may want to consider adding or emphasizing training and educational support in these areas. students reported differences between pretest and retrospective pretests in all but three areas; clinical skills, assessing for sexual abuse, and working with court systems. this finding is not unexpected as these areas require specific training and exposure for students to feel comfortable with the skill and it is highly likely that students did not have these skills at the start of the academic year (pretest) and thus the retrospective pretest would not have picked up any differences. for the other practice areas, students rated themselves higher at pretest but at retrospective pretest students likely had more perspective after having two semesters of field and classes, and thus retrospectively rated themselves lower in 10 of the 13 practice areas. other findings from this study suggest several interesting and important patterns. for example, age and prior child welfare experience were associated with increased selfperceived confidence in practice skill ability at the beginning of the iv-e program. there may be an interaction between age and having prior child welfare workforce experience, as those who had prior child welfare workforce experience were on average two years older than those who did not have prior child welfare workforce experience; however, this was not a statistically significant difference. additionally, at the conclusion of the academic year, no difference was found on the posttest or the retrospective pretest for those with or without prior child welfare experience. in addition, age was not a predictor of scores at posttest or retrospective pretest. this suggests that upon completion of the iv-e program, all students had fairly equal levels of competency. all students gained confidence after participation in iv-e, but those with prior experience in child welfare or who were older did not have additional or greater gains than those without prior experience. this finding is somewhat surprising, since other research suggests that prior work experience contributes to higher levels of perceived competency after training (cheung & tang, 2010). explanations for this finding may be that students with prior experience truly thought they had more confidence in the practice area than those without experience and through their academic and field experience, they realized there were new skills they could learn or skills on which they could improve. however, it is likely that the rigor of the title iv-e participation that included specialized field experiences and coursework provided younger students and students without prior experience the opportunity to learn or catch up to their counterparts. regardless, title iv-e programs may need to be tailored to provide greeno et al./perceptions of recidivism 486 maximum benefit for students with prior child welfare experience and/or older students. future research is needed to assess the differences in needs for students with and without prior child welfare experience as well the impact, if any, of the age of the student. previous research suggests the possibility that older child welfare workers may benefit from a holistic approach to teaching and learning (franke et al., 2009) and this may address different learning styles. training for older child welfare workers and/or those returning to school after work experience may need to address how the older student assimilates new information and material with what they have already learned or have already been practicing. tailoring trainings, supervision, and for this university, seminars to these specific subpopulations of title iv-e students likely will impact perceived practice abilities. findings from the qualitative portion of this mixed methods study also yield interesting themes related to preparedness and perceived competency. although all students in the ive program receive the same program elements (e.g., field placement, field supervision, training seminars, and academic coursework), there were differences in reported preparedness to practice post-graduation. several focus group participants reported that the iv-e program prepared them for practice. this “more prepared” group also reported being aware of and feeling prepared to address the unknown elements of public child welfare they would likely encounter post-graduation. field instructors seemed to be invaluable to these students, providing them with learning opportunities, support, and guidance for child welfare practice. for the remaining focus group participants, they appeared to feel "less prepared" and it seems that their iv-e experience appeared to make them feel more anxious and even less prepared for child welfare practice post-graduation. this may reflect different student learning styles. in addition, focus groups were conducted at the end of the academic year and it is likely that these students either expressed or would have expressed anxiety (if asked) at other times during the academic year. these types of students may require additional supervision and support by their assigned field instructors. preparation for the inevitability of “unexpected challenges” and uncertainty faced in child welfare may reduce anxiety among students. perception of preparation to practice in child welfare is likely highly influenced by personal characteristics and future research should identify these specific characteristics. overall, students’ reports of either feeling more prepared or less prepared suggest the need for iv-e programs and iv-e field instructors to prepare students for unexpected challenges in the field and to remain attuned to students’ individual education and training needs. additional findings from the focus groups included students’ perceptions of practice competency post-graduation as full-time employees. students noted discrepancies between what they were being taught in iv-e curricula and what was actually happening in the field. while students believed they were being taught means to be competent and current clinical skills to practice in their field units (in local departments of social services), they witnessed child welfare workers’ not having opportunities to perform these clinical skills. students identified that issues of time management and agency-mandated task requirements likely explain workers’ inability to conduct clinical practice with children and families. indeed, the transition from being a social work student to a public child welfare employee is difficult to navigate. this finding also suggests the need to prepare students for the advances in social work, fall 2017, 18(2) 487 organizational climate of child welfare agencies. students may likely benefit from postgraduation support from title iv-e programs (e.g., access to seminars and trainings, iv-e alumni networking). other possible avenues may include title iv-e programs working with child welfare supervisors and administrators in efforts to provide clear communication regarding the skills the students and future employees are being taught and will be using in the field as a child welfare worker. limitations there are several limitations to the current study. first, this study was conducted at one university using a convenience sample of title iv-e students and findings may not be generalizable. additionally, the use of self-report measures, including a retrospective measure, is susceptible to recall bias, which impacts the reliability of study findings. while quantitative measures distinguished between those students with and without prior child welfare experience, the questions in the focus groups and therefore subsequent analyses did not account for this difference. this is a significant limitation as those students with prior experience may have had different perspectives on preparation for practice and the types of practice they witnessed in the field. the quantitative measure in this study assessed perceived confidence of child welfare practice skills and did not assess other areas of social work competence, such as values. in addition, focus groups participants were asked about their perceived competency to practice. questions used in the focus groups did not address student definitions of competency. assessing student definitions of competency may have clarified whether or how students view competency in relation to cswe definitions that include knowledge, skills, and values. in addition, given the number of t-tests completed for the analyses there is an inflated type i error rate. finally, iv-e students are placed in a variety of departments and units within the public child welfare system which may impact their perceived practice skills and was not accounted for in this study. additionally, the amount of experience and expertise among field instructors supervising iv-e students may also impact student competencies. differences in students’ assigned units, including the structure of the departments, the types of cases to which students were exposed, and the level of experience among field instructors, were not evaluated. therefore, the extent to which these factors impacted perceived competency among students is unknown. future studies might explore the various aspects of practice settings and their moderating or meditating effects on perceived competency among iv-e students. conclusion and recommendations funding for title iv-e programs has provided universities and public child welfare agencies with substantial support to develop training programs that build and retain a competent child welfare workforce. research suggests that graduates of iv-e programs have more on-the-job competence when compared to non-iv-e participants (government accountability office, 2003). however, the particular components of iv-e education that contribute to competency gains remain unknown (bagdasaryan, 2012). additionally, no research has examined the impact of competency gained through iv-e programs on child and family outcomes (hartinger-saunders & lyons, 2013). findings from the current study suggest that title iv-e programs be tailored to students with different learning styles and/or greeno et al./perceptions of recidivism 488 for older students or those students with prior child welfare experience. additionally, students need to be prepared for the unpredictability of child welfare and how to respond to the many unexpected challenges that may arise. finally, the relationship between competency and burnout or turnover is not clearly understood. future research should focus on the application of skills, knowledge, and values attained through the title iv-e program in iv-e graduates’ practice as full-time child welfare employees, and on the outcomes for the children and families they serve. references adoption assistance and child welfare act of 1980. p.l. 96-272. §§ 422(1980). bagdasaryan, s. (2012). social work education and title iv-e program participation as predictors of entry-level knowledge among public child welfare workers. children and youth services review, 34(9), 1590-1597. doi: https://doi.org/10.1016/j.childyouth.2012.04.013 barth, r. p., lloyd, e. c., christ, s. l., chapman, m. v., & dickinson, n. s. (2008). child welfare worker characteristics and job satisfaction: a national study. social work, 53(3), 199-209. doi: https://doi.org/10.1093/sw/53.3.199 cheung, c., & tang, k. (2010). socialization factors conducive to social work students’ gain in competence: experience in the hong kong sar, china. journal of social work, 10(1), 42-58. doi: https://doi.org/10.1177/1468017309349990 council on social work education [cswe]. (2015). educational policy and accreditation standards for baccalaureate and master’s social work programs. cswe on accreditation. retrieved from http://www.cswe.org/file.aspx?id=81660 dillman, d. a., smyth, j. d., & christian, l. m. (2008). internet, mail, and mixed-mode surveys: the tailored design method (3rd ed.). new york, ny: wiley. fox, s. r., miller, v. p., & barbee, a. p. (2003). finding and keeping child welfare workers: effective use of training and professional development. journal of human behavior in the social environment, 1(2), 67-81. doi: https://doi.org/10.1300/j137v07n01_06 franke, t., bagdasaryan, s., & furman, w. (2009). a multivariate analysis of training, education, and readiness for public child welfare practice. children and youth services review, 31(12), 1330-1336. doi: https://doi.org/10.1016/j.childyouth.2009.06.004 gansle, k. a., & ellett, a. j. (2002). child welfare knowledge transmission, practitioner retention, and university community impact: a study of title iv-e child welfare training. journal of health & social policy, 15(3/4), 69-88. doi: https://doi.org/10.1300/j045v15n03_06 government accountability office. (2003). child welfare: hhs could play a greater role in helping child welfare agencies recruit and retain staff [gao-03-357]. washington, dc: author. retrieved from http://www.gao.gov/products/gao-03-357 https://doi.org/10.1016/j.childyouth.2012.04.013 https://doi.org/10.1093/sw/53.3.199 https://doi.org/10.1177/1468017309349990 http://www.cswe.org/file.aspx?id=81660 https://doi.org/10.1300/j137v07n01_06 https://doi.org/10.1016/j.childyouth.2009.06.004 https://doi.org/10.1300/j045v15n03_06 http://www.gao.gov/products/gao-03-357 advances in social work, fall 2017, 18(2) 489 hartinger-saunders, r. m., & lyons, p. (2013). social work education and public child welfare: a review of the peer-reviewed literature on title iv-e funded programs. journal of public child welfare, 7(3), 275-297. doi: https://doi.org/10.1080/15548732.2013.798246 johnson, r. b., & onwuegbuzie, a. j. (2004). mixed methods research: a research paradigm whose time has come. educational researcher, 33(7), 14-26. doi: https://doi.org/10.3102/0013189x033007014 jones, l. p., & okamura, a. (2000). reprofessionalizing child welfare services: an evaluation of a title iv-e training program. research on social work practice, 10(5), 607-621. krueger r a. (1988). focus groups: a practical guide for applied research. new dehli, india: sage. krueger, r. a., & casey, m. a. (2009). focus groups: a practical guide for applied research. london, united kingdom: sage. qsr international pty ltd. (2010). nvivo qualitative data analysis software [version 9, windows]. victoria, australia. padgett, d. k. (ed.). (2004). the qualitative research experience. pacific grove, ca: wadsworth/thomson learning. pelfrey, w. v., sr., & pelfrey, w. v., jr. (2009). curriculum evaluation and revision in a nascent field: the utility of the retrospective pretest-posttest model in a homeland security program of study. evaluation review, 1, 54-82. doi: https://doi.org/10.1177/0193841x08327578 pratt, c. c., mcguigan, w. m., & katzev, a. r. (2000). measuring program outcomes: using retrospective pretest methodology. american journal of evaluation, 21, 341349. doi: https://doi.org/10.1177/109821400002100305 yankeelov, p. a., barbee, a. p., sullivan, d., & antle, b. f. (2009). individual and organizational factors in job retention in kentucky's child welfare agency. children and youth services review, 31, 547-554. doi: https://doi.org/10.1016/j.childyouth.2008.10.014 zlotnik, j. l. (1997). social work education programs, state child welfare agencies comment on title iv-e regulations. social work education reporter, 4(6), 8-11. zlotnik, j., depanfilis, d., daining, c., & mcdermott lane, m. (2005). professional education for child welfare practice: improving retention in public child welfare agencies. institute for the advancement of social work research, iaswr research brief 2. retrieved from https://archive.hshsl.umaryland.edu/handle/10713/289 author note: address correspondence to: elizabeth j. greeno, phd university of maryland school of social work, 525 w. redwood street, baltimore, md 21201. egreeno@ssw.umaryland.edu. https://doi.org/10.1080/15548732.2013.798246 https://doi.org/10.3102/0013189x033007014 https://doi.org/10.1177/0193841x08327578 https://doi.org/10.1177/109821400002100305 https://doi.org/10.1016/j.childyouth.2008.10.014 https://archive.hshsl.umaryland.edu/handle/10713/289 elizabeth jane greeno lisa fedina berenice rushovich caroline burry debra linsenmeyer christopher wirt child welfare knowledge and skill acquisition previous child welfare experience university of maryland, baltimore title iv-e program purpose of study methods sampling and recruitment data collection procedures results demographics retrospective pretest findings demographic differences prior child welfare experience preparation to practice post-graduation work and life balance discussion limitations conclusion and recommendations references ______________ deneca winfrey avant, ph.d., is an assistant professor in the school of social work at illinois state university in normal, il. brenda coble lindsey, ed.d., is a clinical associate professor in the school of social work at the university of illinois at urbana-champaign, il. copyright © 2015 advances in social work vol. 16 no.2 (2015), 276-291, doi: 10.18060/16428 school social workers as response to intervention change champions deneca winfrey avant brenda coble lindsey abstract: school social workers (ssws) are known for serving students with social, emotional, and academic needs. implementing response to intervention (rti)/multitiered system of supports (mtss) is one avenue in which ssws play an integral role by guiding the development and implementation of student interventions. rti/mtss requires substantive and multifaceted system changes that involve more than simply adopting new approaches. this paradigm shift brings change which may not be desired or easily accepted by school systems. however, developing collaborative relationships and using effective leadership strategies throughout the rti/mtss transformation can be a pathway to success. a survey of 192 ssws in illinois revealed the challenges that ssws experienced as the process of implementing rti/mtss transformed them into change leaders. this revelation was viewed as an opportunity to closely align social and emotional practices with students’ academic achievement. keywords: change agents, leaders, multi-tiered system of supports, response to intervention, school social workers life in schools is about changes, challenges, and the ability to preserve order. as change agents, school social workers (ssws) are largely responsible for nurturing young minds both socially and academically (alfred, slovak, & broussard, 2010). students’ social habits, lifestyles, school performance, and psychological and emotional needs have changed substantially from the past (bridgeland, bruce, & hariharan, 2013). because the current generation of students is being faced with more social media influences, mental health concerns, bullying, and issues at home, there has been an increase in identified learning and behavioral problems (zosky, avant, & thompson, 2014). as a result of these changes and mandated federal policies, schools have been pushed to incorporate new evidence-based interventions to properly serve student needs (sabatino, kelly, moriarity, & lean, 2013). response to intervention (rti)/multi-tiered system of supports (mtss) is one example of adhering to this new obligation. rti/mtss is leading the nation in altering our approach to resolving barriers and supporting student success (clark & tilly, 2010; sugai & horner, 2010). rti/mtss is a multi-level system-wide approach that focuses on students at risk for poor learning outcomes by monitoring progress and providing evidence-based interventions (batsche et al., 2006). the purpose of rti/mtss is to identify learning and behavioral problems and then integrate assessments and interventions that provide students with the best school opportunities. problem-solving teams are key factors in effective rti/mtss implementation (nellis, 2012). best practice is to have team members represent a wide variety of disciplines including teachers, principals, ssws, and other school specialists (burns, wiley, & viglietta, 2008). avant & lindsey/school social workers as rti change champions 277 ssws play a unique role in expediting rti/mtss and intervening in the educational process at multiple levels (clark, alvarez, marckmann, & timm, 2010; kelly et al., 2010). as active participants on school leadership teams, ssws may solely design or be integral contributors to rti/mtss processes. rti/mtss implementation has pushed the expansion of social work services from traditional roles of providing individual and group counseling, school and community consultations, and crisis interventions to becoming change champions (clark & alvarez, 2010). a change champion is someone who plays a pivotal role in advancing adoption of new ideas in organizations (rogers, 2003). they have considerable influence over others and hold key linking positions within their organizations. because ssws have excellent leadership skills in facilitation and coordination of change efforts, they are well-positioned to guide rti/mtss implementation. although rti/mtss is strongly encouraged by the federal government and mandated in numerous states, many teachers and staff are reluctant to embrace the approach as educational change (greenfield, rinaldi, proctor, & cardarelli, 2010; landon, 2010). change is often difficult to implement because of barriers that people place between themselves and change efforts (fullan, 2007). school personnel have traditions and become comfortable with the way issues are handled (winfrey, 2011). stability is seen as desirable; therefore, being content and maintaining status quo may be preferred over change. some individuals may resist adopting rti/mtss because they do not understand the rationale for change. effective change is the result of increasing the capacity of individuals and organizations to know when and how to pursue and implement change. moreover, the psychological process of accepting and learning new ways of operating is typically a slow process. regardless of whether the decision to adopt rti/mtss is enthusiastically or reluctantly perceived, it may involve loss, anxiety, and struggle for those involved in its implementation. such emotional reactions are a natural response to change. ssws are uniquely qualified to play key roles in the rti/mtss change process because they have a holistic understanding of how schools work. this attention to detail includes developing collaborative relationships with teachers and using effective strategies to engage them throughout the transformation (harris, franklin, & lagana-riordan, 2010). by using a systems perspective, understanding the whole child, and managing school-wide behavior interventions, ssws are able to facilitate rti/mtss implementation. ssws can take the lead by identifying and ameliorating challenges experienced during major changes required at schools (clark & tilly, 2010; peckover, vasquez, van housen, saunders, & allen, 2013). literature review rti/mtss refers to school-wide application of academic and behavioral interventions that promote assistance to children having difficulty learning (batsche et al., 2006; ridgeway, price, simpson, & rose, 2012). sugai and horner (2002) suggested that schools interested in implementing rti/mtss are best served by adopting a systems perspective and developing a common set of desired academic and behavioral expectations for students. schools accomplish this through administrative support coupled with team-based problem-solving approaches, research-validated practices, and data-based decision-making processes. these strategies ensure a congruent school-wide approach to prevent academic http://cs.oxfordjournals.org/search?author1=michael+s.+kelly&sortspec=date&submit=submit advances in social work, fall 2015, 16(2) 278 failure and encourage students to display socially appropriate behaviors while reducing the likelihood that challenging behaviors will occur (lindsey, 2008). rti/mtss uses a three tier model to apply this integrated approach (batsche et al., 2006; brown-chidsey & steege, 2005; sugai & horner, 2002) (see figure 1). tier one interventions are universal to all students and aim to prevent academic and behavioral problems. examples of tier one interventions include research-based, social-emotional learning curricula taught in general education classrooms. these interventions provide students with methods to display expected behaviors, proactively pre-correct students, and acknowledge them for exhibiting expected behaviors. the rti/mtss model anticipates that 80-90% of students will respond to tier one interventions (lindsey, 2008). tier two interventions are short-term and individualized, such as check & connect, which targets students at risk of displaying problems including reading below grade level or poor social skills (alvarez & anderson-ketchmark, 2010; eber, lindsey & white, 2010). these interventions are designed to bring about rapid improvement and be quickly accessed, highly efficient, and flexible (hawken & horner, 2003; mcintosh, campbell, carter, & dickey, 2009). rti/mtss estimates that 10-15% of students will need tier two interventions to be successful in school (center for mental health in schools at ucla, 2011). tier two interventions include specially designed small group counseling provided by ssws, school psychologists, school counselors, and other behavioral specialists (crone, hawken, & horner, 2010; lindsey, 2008). tier three interventions are provided to students with highly intensive academic and behavioral needs. these interventions are developed based on unique student needs and are likely to be long-term (eber et al., 2010; malloy, sundar, hagner, pierias & viet, 2010; scott & eber, 2003). interventions include rehabilitation, empowerment, natural supports, education, and work (renew, malloy et al., 2010). renew is an application of the wraparound planning process based on student strengths and needs across home, school, and community contexts. the rti/mtss framework anticipates that 1-5% of students will require tier three interventions. all three tiers work together to provide a continuum of school-wide instructional and behavioral supports that most likely come under the lead of ssws. this three-tiered intervention for effective school environments is demonstrated by sugai, horner, and gresham (2002) as shown in figure 1. avant & lindsey/school social workers as rti change champions 279 figure 1. designing school-wide support systems for student success a critical ingredient for accurate and sustained rti/mtss implementation is to provide coaching to teachers and staff in becoming proficient in the application of all three tiers (university of south florida, 2011). coaches are responsible for supporting schools and rti/mtss implementation teams. they do this by creating positive and productive team environments, facilitating consensus for decisions, guiding meaningful problemsolving processes, and providing access to training and resources. schools are more likely to successfully implement rti/mtss when they adopt organized and systematic coaching models (university of south florida, 2011). school social work leadership the rti/mtss framework is dramatically changing expectations for related-service providers (clark & alvarez, 2010; frey, lingo, & nelson, 2008), especially the profession of ssws. historically, ssws have had a great deal of flexibility in the strategies, interventions, and methods they use to remove learning barriers (kelly et al., 2010). rti/mtss brings consistency to school-wide curriculum, programs, and practices; it also affords ssws key leadership opportunities to demonstrate specialized skills working with students experiencing behavioral challenges (lawson, 2010). in practice, this means ssws incorporate evidence-based approaches that are identified and evaluated based on data and are focused on the whole child (lawson, 2010; raines, 2004, 2008). 1-5% 1-5% 5-10% 5-10% behavioral systems 80-90%80-90% intensive, individual interventions •individual students •assessment-based •high intensity intensive, individual interventions •individual students •assessment-based •intense, durable procedures targeted group interventions •at-risk student •high efficiency •rapid response targeted group interventions •at-risk student •high efficiency •rapid response universal interventions •all students •preventive, proactive universal interventions •all settings, all students •preventive, proactive academic systems (adapted from sugai, horner, & gresham, 2002) http://cs.oxfordjournals.org/search?author1=michael+s.+kelly&sortspec=date&submit=submit advances in social work, fall 2015, 16(2) 280 rti/mtss requires concurrent changes in school organizational structures and learning environments that need to be achieved without discord. such changes need to be viewed from within a person-in-environment framework (lawson, 2010). ssws are uniquely prepared for this challenge because of their knowledge and skills in problem assessment and interventions, their understanding of the relationship between academics and behaviors, and their familiarity with the person-in-environment framework that is an intrinsic part of rti/mtss. moreover, as change leaders, ssws are familiar with factors that influence successful implementation of new school programs and approaches. for these reasons, ssws may be in the best position to champion student achievement and promote school reform. diffusion of innovations diffusion of innovations is the process by which new initiatives are adopted by organizations, customers, or clients (rogers, 2003). it can be applied to decisions made by individual consumers about whether to buy the latest technology or to decisions made by school districts on adopting rti/mtss (lindsey, 2008). diffusion of innovations encompasses a number of factors including: the innovation itself, how information is relayed to others, the point in time that the innovation emerges, and the characteristics of potential users (rogers, 2003). in reality, the true quality of the innovation is not as important as the user’s perception of its worth (lindsey, 2008). once a school district decides to introduce rti/mtss, implementation does not typically follow a linear path (landon, 2010). because the organizational change process requires a number of individuals to work together, it is highly complex (rogers, 2003). implementation of innovations within schools requires both the innovation and the organization to change in order to facilitate goodness-of-fit. a “change champion” plays a critical role in bringing about successful implementation (rogers, 2003). such a person must have an established interpersonal network that provides ongoing opportunities for collaboration and consultation with key staff. they should be politically astute and understand informal patterns of relationships and alliances between members of the organization. champions must also possess excellent communication and negotiation skills that enable them to work effectively with a wide range of interests and people. many times an innovation must be reworked to better fit the needs of a particular organization. a champion can facilitate this process by employing his or her people skills to organize a coalition of individuals that will ensure the implementation process goes smoothly. ssws exhibit these characteristics and thus are a logical choice to assume the pivotal role of rti/mtss leader or change champion. as an innovation, rti/mtss requires organizational structures in schools to change in order to accommodate the approach. frequently, the degree of change required is underestimated. substantive change does not occur overnight. it is a delicate process that involves time and careful navigation. change means transition which requires people to adjust their thoughts, attitudes, and behavior, (winfrey, 2011). the change process for major school restructuring consists of initiation followed by implementation to continuation and evaluation of outcomes (fullan, 2007). for rti/mtss to become embedded within the school culture, staff must acquire a deeper understanding of the type avant & lindsey/school social workers as rti change champions 281 of changes that are truly required. kotter (1996) indicates, “new approaches usually sink into a culture only after it’s very clear that they work and are superior to old methods” (p. 157). only after school staff are convinced that rti/mtss is superior to previous policies and practices will it become ingrained. innovations cannot exist without trust, confidence, consistency, and integrity (evans, 2000). these values, characterized by personal ethics, vision, and belief in others, are fundamental components of both leadership and the social work profession (evans, 2000). ssws are often skillful in generating trust, which is critical to be effective change leaders. by understanding the issues, concerns, barriers, and challenges associated with widespread organizational transformation, ssws can facilitate the systemic changes required for rti/mtss. teachers tend to resist changing for a future they cannot clearly see (lunenburg & ornstein, 2007). according to knight (2009), teachers usually need to experience success and believe that change is powerful with easily implemented programs or practices. because of the massive changes required to implement rti/mtss, ssws are well-equipped to shepherd the change process and generate buy-in from teachers and staff. as rti/mtss is now mandated within the state of illinois, schools are transitioning to evidence-based assessments and interventions for students with learning and behavioral problems. due to the major systemic changes that are necessary for the success of rti/mtss, all staff roles and responsibilities may be altered, especially those of ssws. this transformation has forced ssws into leadership roles. because ssws play a unique role in expediting rti/mtss, their perspective is critical in understanding the challenges and accomplishments of rti/mtss. while many studies discuss staff roles and rti/mtss implementation (avant, 2014; kelly et al., 2010), there appears to be a significant gap in the literature regarding how ssws' roles and responsibilities are influenced. this research study examined how ssws perceive the advantages, disadvantages, and challenges of implementing rti/mtss. methods this study used survey research with a 32-item questionnaire composed of open and forced-choice responses. sample items include: (a) describe the potential gains and disadvantages of implementing rti, (b) how has rti limited and/or increased your ssws' roles?, (c) did you receive formal training on implementing rti?, and (d) what form of rti supports are provided by your school? question construction was based on a review of rti/mtss and school social work practice literature, as well as an illinois association of school social workers (iassw) university relations committee discussion. this committee, which served as an advisory group to iassw regarding school social worker education in illinois, is composed of faculty representatives from various universities with accredited schools of social work. appropriate institutional review board approval was obtained, and ssws were invited to participate through the iassw listserv. because ssws in illinois are not required to hold iassw membership, only current members (n=772) were invited to participate in this research opportunity. ssws received an email explaining the study with an attached link providing access to the online survey via survey monkey for approximately 4 weeks. to encourage participation, a follow-up reminder was sent by email at the end of the third week. although the survey yielded a total of 313 responses http://www.google.com/search?tbo=p&tbm=bks&q=inauthor:%22prof+fred+c+lunenburg%22 http://www.google.com/search?tbo=p&tbm=bks&q=inauthor:%22allan+c.+ornstein,+fred+c.+lunenburg%22 http://cs.oxfordjournals.org/search?author1=michael+s.+kelly&sortspec=date&submit=submit advances in social work, fall 2015, 16(2) 282 (for an initial response rate of 41%), a significant portion of the surveys were incomplete. only 192 individuals replied to all of the questions; only these cases were included in the data analysis, producing a final response rate of 25%. analyzing and coding of responses consisted of identifying key issues focused on by the ssws. a thematic analysis procedure involving coding and recoding the data was used (braun & clarke, 2006; miles & huberman, 1994; patton, 2001). content analysis focused on identifying themes and patterns in participants’ responses. themes that emerged most frequently were considered to reflect factors that contributed to ssws’ perceptions and formed a comprehensive picture of their collective experience. topics that were mentioned infrequently were revisited to see if they could be incorporated as a sub-theme or should be discarded. this data-driven analysis process required constant comparison as referred to by strauss and corbin (1998). co-analyst triangulation was used to validate themes and strengthen the trustworthiness of the findings (lauri, 2011; patton, 2001). co-analyst triangulation provided an opportunity for both authors to understand multiple ways of seeing the data and hence avoid selective perception and illuminate blind spots. when disagreements arrived, both authors provided additional perspectives to review the themes and thus achieve a final coding. this method of organizing and triangulating data was used to ensure a well-developed and comprehensive analysis of ssws’ roles, responsibilities, and perceptions regarding rti/mtss. results demographic characteristics of the survey respondents varied greatly. thirty-three percent of the ssws (the largest group) had between one and five years of total work experience while only 9 percent had 21 or more years in their current position. the largest group of respondents (42.7%) were employed in rural/small towns, with 40% in suburban locations, and 13% in urban areas. most respondents (73%) worked with elementary students, whereas 44% worked with middle school students. about one-third worked with early childhood (33%) and high school (35%) students, respectively. the majority (95.3%) of the 192 respondents reported working in schools currently implementing rti/mtss. interestingly, although rti/mtss is mandated in the state of illinois, 4.7% of the schools were not implementing interventions. respondents varied in the extent to which they were involved in the rti/mtss process: 42% reported a great extent of involvement, 40.6% were somewhat involved, 12.5% had very little involvement, and 4.6% had no involvement. respondents reported that the nature and type of rti/mtss implementation varied based on school and district levels. fifty-seven percent of the ssws revealed differences in how rti/mtss is implemented in the elementary, middle, and high school grades. the results demonstrated a divide between ssws--some eagerly embraced rti/mtss and others reluctantly tackled the systems changes. the implementation of rti/mtss was described by respondents as both enhancing and altering the role of ssws. avant & lindsey/school social workers as rti change champions 283 school social worker roles ssws who were already a part of rti/mtss in their schools felt that their responsibilities had changed dramatically by allotting more opportunities to share their input and multi-faceted knowledge about students. ssws were viewed by school staff as functioning as coaches, consultants, or leaders. ssws shared experiences of being an integral part of the rti/mtss team to implement interventions to address significant behavior concerns. according to one individual, “a lot of the work on the secondary and tertiary levels is left to the social worker.” for example, respondents noted their social work roles had expanded to include behavioral observations, teacher consultations, and increased prevention work with general education students. additionally, ssws were frequently in charge of managing and coordinating collection and dissemination of schoolwide data. previously they were responsible only for their own data, counseling, and evaluation. the survey revealed that 72.4% of respondents felt rti/mtss did not limit ssws roles and responsibilities but required explicit organization and balance. some respondents who worked in a cooperative district commented that rti/mtss made it more difficult to meet special education mandates in a timely fashion while managing daily rti/mtss responsibilities. “i am responsible for implementing tier two social and academic instruction groups while also serving as the tier two building coach. this includes implementing positive behavioral interventions and supports (pbis) check-in and checkout, which minimize time to facilitate therapeutic groups.” in addition to limiting the amount of time available for counseling, the majority of respondents felt that rti/mtss would replace the necessity of completing social developmental studies (sds). these respondents feared that eliminating sds would ultimately lead to fewer special education referrals in the future by limiting the opportunity for social workers to share their input about students. other respondents, however, felt that the heavy reliance on data-driven assessments represented an improvement over previous practice because it facilitated earlier completion of sds. advantages of rti/mtss respondents noted several advantages of rti/mtss by selecting from predetermined options on the survey, with opportunities to provide examples. the most frequently noted potential advantages in implementing rti/mtss were in providing school-wide behavior supports (90.1%) and problem-solving interventions (89.6%). interestingly, heavy emphasis on data to guide implementation of rti/mtss was viewed as an advantage by 77% of ssws. this response indicated positive reactions to using data to help schools determine student interventions. some of the responses for “other” advantages included feeling that rti/mtss has led to improved dialogue systems, more consultation opportunities and input regarding students, and enhanced parental involvement and community awareness. some respondents indicated that rti/mtss encouraged open discussions and consultation between disciplines. “rti is increasing my role and responsibilities. i work more closely with teachers and parents.” some ssws noted experiences of collaborating with school psychologists to implement behavioral and reading interventions. this open dialogue also encouraged other staff to approach ssws with questions about students or to inquire about resources and additional intervention advances in social work, fall 2015, 16(2) 284 strategies. these conversations resulted in explicit goals for all involved (i.e., students, staff, and parents), a structured timeline, and greater clarity throughout implementation stages. respondents also shared that ssws were a great asset to parents by encouraging parental involvement and participation in the rti/mtss process. additionally, ssws also provided community awareness and education about rti/mtss implementation and its advantages. challenges of rti/mtss survey respondents noted many concerns involving rti/mtss implementation that seemed to outweigh its potential advantages. concerns included the lack of social work involvement in rti/mtss planning, the implementation process, confusion over intervention tier selection, imbalance between academics and behaviors, data collection, and inadequate training and guidance. these issues are typical of the complexities associated with school-wide changes. rti/mtss planning. respondents declared that ssws are not usually involved in the initial planning and development phases of rti/mtss. however, they are called on later to lead the implementation of interventions at tiers two and three. “staff come to me now with concerns about general education students; i educate the teachers and staff about rti/mtss.” one ssw noted, “i am responsible for arranging interventions, planning schedules and behavioral referrals, and problem-solving for both behavior and academic sides of rti/mtss.” other respondents noted that ssws and psychologists were also responsible for training, consulting, and modeling rti/mtss implementation within their districts. implementation process. ssws perceived that rti/mtss implementation is an overwhelming process. “it is time-consuming, labor-intensive, especially at the beginning, and quite inconsistent.” another respondent shared, “having to attend additional meetings and being placed in a leadership role as rti/mtss building coordinator took valuable time away from direct social work services.” ssws identified challenges associated with providing services to students with and without an individualized education program. “i am involved in all aspects of rti and with all students, not just with special education.” these time constraints were even more intensified for ssws employed in cooperative school districts (i.e., multiple schools that share pupil personnel resources). some respondents remarked that many challenges are faced at different levels during the implementation phase. “it seems to be implemented differently everywhere depending upon who is in charge, who is dispersing the information, and who is implementing it.” other implementation concerns included the need for precise methods to monitor progress and ensure fidelity, inadequate time for implementation, lack of sufficient funding, and the absence of a collaborative effort from the entire rti/mtss school team to move the process forward. interventions. respondents indicated that funding for interventions, especially those designed for special education services, was a pivotal issue. they provided various examples of how rti/mtss interventions were limited in some districts due to inadequate data-gathering practices or lack of staff. other critical concerns regarding interventions included difficulties for students transferring between schools. for example, schools in avant & lindsey/school social workers as rti change champions 285 various districts may be at different stages of rti/mtss implementation which could lead to barriers in overall systems flow. further, difficulties with rti/mtss interventions were associated with a lack of administrative support. other respondents noted a lack of consistency in how schools applied social and emotional interventions. for example, some respondents noted a dearth of tier three interventions to meet the needs and demands of students with significant mental health concerns. other challenges of the process included difficulty in gauging improvements or quantifying effectiveness and difficulties in finding evidence-based interventions. for example, some respondents reported that ssws were given a narrow list of options that could be used to assess the effectiveness of interventions. “sometimes it is difficult to implement interventions that would support pre and post-tests for progress monitoring, thus limiting the use of such tools for social workers.” according to one respondent, “not all issues that social workers deal with in a school setting could be quantified or assessed for improvement, which in some ways seems to limit the role of rti/mtss.” another respondent stated, “providing tier one support with a social emotional learning curriculum is emphasized.” however, many respondents revealed that demands to provide tier two and tier three interventions services were also increasing. other respondents commented that making distinctions within a tier system, especially between tiers two and three, was difficult in the absence of well-developed behavioral guidelines. for example, schools with clear guidelines denote the number of behavioral referrals required to move to the next tier. additionally, if progress monitoring data do not indicate improvement within a specified period, consideration is given towards movement to the next tier. behavioral side of rti/mtss. respondents commented that the behavioral side of rti/mtss interventions was not as well developed as those on the academic side. they noted few specific behavioral interventions beyond pbis and check & connect. the survey revealed that some districts emphasized the academic side of rti/mtss more than the behavioral side. “since we don’t have a behavioral system in place, it makes rti very confusing as to what the expectations are.” respondents also thought that the behavioral side of rti/mtss was critical but time-consuming and difficult to address for some students with multiple and intense academic and behavioral issues. for example, some respondents revealed that there was a greater need for more precise decision-making rules to differentiate when students should move from one tier to the next. this lack of clarity made implementation of behavioral interventions more challenging. some respondents also reported that their schools did not have a solid tier one behavioral management system in place. this limited the focus of rti/mtss to the academic side, thus heightening the need for additional manpower to collect and maintain behavioral data during implementation. one respondent stated that “teachers are more academic-focused, but ssws focus more on behavior functioning, which sometimes creates confusion.” another respondent noted, “i am constantly creating individual behavior plans and classroom plans. i also do a lot more classroom groups.” data collection. the survey revealed that not all schools could invest in costly data management systems despite the need to maintain and store information. some respondents felt that too much time and effort was being wasted in collecting unimportant data. the respondents commented that insufficient data collection processes ignored important areas advances in social work, fall 2015, 16(2) 286 that needed attention and focus, which led to a lack of understanding of “big picture” issues concerning home, school, and community connections. “way too much time is wasted on measures which do not tell a whole story and is not always a student’s primary need.” over-reliance on certain types of data was also viewed as a barrier as “it detracts from other measures of progress, such as psychological assessments or behavior rating scales.” despite their reservation about the methods used, respondents also recognized the positive value of data collection processes. they acknowledged that data provided necessary evidence to make the right decisions and also assisted in identifying early interventions and prevention strategies. nevertheless, collecting the amount of data needed at each point of the process and framing social work goals were perceived to be timeconsuming. as one respondent stated, “it is exhausting to gather data that really shows improvement in social and emotional interventions.” training and guidance. ninety percent of the survey respondents indicated a strong desire for obtaining further information and training about rti/mtss. three-quarters (74%) noted that they had attended rti/mtss training, but most wanted further education on its key elements. respondents participated in trainings provided by school districts, iassw conferences, free-standing workshops, and various other entities such as pbis network, illinois alliance for school-based problem-solving and intervention resources in education, graduate schools, and the illinois state board of education. despite a high percentage of respondents partaking in rti/mtss trainings, many felt the instruction was limited and lacked ongoing guidance and support throughout implementation. for example, one respondent commented that “there is little follow-up to formal training which makes it difficult.” overall, many ssws expressed a need for more guidance on their new roles concerning rti/mtss. limitations there are several limitations of this study suggesting that the findings should be interpreted with caution. limitations include potential sampling biases related to the pool of respondents and online survey methodology used in this study. because respondents were drawn from iassw membership lists, this pool cannot be generalized to the entire population of illinois ssws. the sample was based on those members who self-selected to participate; therefore, it introduces the possibility of information bias. while 82.7% of the 192 respondents worked in rural and suburban communities in illinois, their perceptions are most likely influenced by location and employment demographics. likewise, the response rate of 25% posed a limitation as findings cannot be generalized to the entire population of illinois ssws. the use of an online survey may have also served as a limitation by discouraging those less comfortable with technology from participating. conclusion ssws are integral trailblazers at their schools with essential responsibilities in creating a true educational community. this study offers a unique perspective of role transformation and underscores what ssws in illinois experienced while implementing rti/mtss. the results demonstrate recurring themes in rti/mtss implementation as many school personnel are unsure about the potential gains. while some advantages of implementing avant & lindsey/school social workers as rti change champions 287 rti/mtss were identified, ssws discussed many obstacles and challenges, such as intervention imbalance between academics and behaviors, difficulties regarding data collection, insufficient involvement in planning, and inadequate training. ssws have training in managing systems change and are particularly suited for implementing rti/mtss; unfortunately, they are frequently not called upon to contribute this expertise. the findings suggest that schools are in need of rti/mtss data management support to properly address the challenges of addressing students’ social and emotional needs. clear goals for staff and parents are needed as well as a structured timeline for interventions. such guidelines are necessary to provide clarity to stakeholders throughout rti/mtss implementation stages, potentially resulting in more appropriate and available student services and better academic outcomes. although some ssws were resistant to implementing rti/mtss, many eventually came to see its potential for improving students’ academic outcomes and that it offered them an opportunity to become leaders of this systems change. consistent with the literature, rti/mtss has strengthened the role of ssws in many ways by enhancing their responsibilities as consultants, coaches, and leaders (clark & tilly, 2010). in these roles, ssws are seen as knowledge providers who act as a primary source of information on rti/mtss for teachers and parents (clark et al., 2010; massat, constable, & thomas, 2009; raines, 2010). for example, ssws are viewed as providing strong support to teachers for case documentation and planning. ssws are also entrusted to solve problems or address issues that no one else in the organization can or wants to address. essentially, changes in the organization are triggering changes in the roles of ssws. a surprising finding of this study indicated ssws' perceptions of leading their school as an rti/mtss change champion. despite the many implementation barriers, this new revelation led to an “ah-ha” moment for ssws as they recognized the rti/mtss the potential leadership advantages outweighed the challenges previously noted. many essential aspects of managing change require ssws to use their specialized knowledge and skills to reframe their role as change leaders. because ssws understand the need for a collaborative change process, they are well-equipped to advocate and contribute to the performance of the whole school as rti/mtss change champions. implications the findings from this study could have important implications for ssws. however, it is important to keep in mind that this study used a small sample of 192 survey respondents mostly from small towns and suburban communities in illinois; therefore, the results should only be generalized to populations that closely resemble this sample. although there are potentially important extrapolations that could be made from this study, the topic requires more rigorous research to thoroughly understand how ssws participate in implementing rti/mtss. it is critical that ssws understand and maximize their new opportunities to effectively manage systems change (clark & tilly, 2010). consistent with the literature, ssws have begun lending their expertise in facilitating organizational change as well as designing, implementing, and evaluating the impact of services (dupper, 2003). ssws must continue to develop collaborative relationships with other professionals to benefit students and employ effective leadership strategies that are deeply embedded within the profession. embracing additional leadership responsibilities creates ample opportunities advances in social work, fall 2015, 16(2) 288 for ssws to closely align social and emotional practices with academic achievement (clark & alvarez, 2010; kelly et al., 2010). moreover, accepting the challenge to be change champions allows ssws to exert influence by creatively guiding schools through the rti/mtss process. based on the number of foundational changes to roles identified by respondents, rti/mtss presents ssws with an opportunity to embrace their new responsibilities and role of a change champion (avant, 2014). consistent with the literature, taking action beyond simply complaining is paramount (winfrey, 2011). rti/mtss is here to stay, thus requiring ssws to either step up as leaders and adapt to the changing landscape of schools or be relegated to the sidelines. as champions of change, ssws must anticipate rti/mtss challenges and meet them with determination and perseverance. references alfred, l., slovak, k., & broussard, c. 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(2002). behaviorally-effective school environments. in m. r. shinn, h. m. walker & g. stoner (eds.), interventions for academic and behavior problems ii: preventive and remedial approaches (pp. 315350). bethesda, md: national association of school psychologists. university of south florida. (2011). implementing a multi-tiered system of support for behavior: recommended practices for school and district leaders. retrieved from http://flpbs.fmhi.usf.edu/pdfs/rtib%20guide%20101811_final.pdf winfrey, d. (2011). unwrapping tradition: shifting from traditional leadership to transformative action. in c. m. shields (ed.), transformative leadership: a reader (pp. 114-130). ny: peter lang. zosky, d., avant, d.w. & thompson, j. (2014). social work and special education students’ attributions of poverty: a leadership opportunity for school social workers. school social work journal, 38(2), 77-97. author note address correspondence to: deneca winfrey avant, phd, illinois state university, school of social work, campus box 4650, 326 rachel cooper hall, normal, il 61790. e-mail: dwinfre@ilstu.edu http://dx.doi.org/10.1093/cs/cdt017 http://dx.doi.org/10.1177/10983007030050030201 http://dx.doi.org/10.1300/j019v24n01_03 http://dx.doi.org/10.1300/j019v24n01_03 http://flpbs.fmhi.usf.edu/pdfs/rtib%20guide%20101811_final.pdf mailto:dwinfre@ilstu.edu _________________________ adrienne baldwin-white, msw is a doctoral candidate, school of social work, arizona state university, phoenix, az 85004. nada elias-lambert, phd, lmsw is an assistant professor and msw program coordinator, department of social work, texas christian university, fort worth, tx 76129. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 235-253, doi:10.18060/20882 influence of victim and perpetrators’ alcohol use on social work student’s levels of rape myth acceptance adrienne baldwin-white nada elias-lambert abstract: rape myths are stereotyped, false cultural values that serve to justify sexual assault against women. this study examined the perceptions of alcohol use on levels of rape myth acceptance among social work students. one hundred and ninety-five bachelor's and master's students were randomly assigned to read a vignette developed by researchers depicting a date rape with the victim, perpetrator, both, or neither consuming alcohol. results of a descriptive analysis showed that students are willing to accept certain rapesupportive beliefs, but not others. participant responses to rape myths differed based on the particular vignette the respondent was assigned to read. further research is needed to examine the particular myths social work students endorse and the situational factors that influence those endorsements. social work students must be educated about how endorsements of rape myths can affect their interaction with survivors and perpetrators. keywords: rape myth acceptance; rape supportive beliefs; social work students; sexual assault; alcohol consumption sexual assault is legally defined as any sexual contact or behavior that occurs without the explicit consent of the recipient. behaviors considered sexual assault include activities such as forced sexual intercourse, fondling, and attempted rape (u.s. department of justice [doj], 2014c). sexual assault is a public safety concern, with the u.s. department of justice (2014a) reporting an estimated 300,170 sexual assaults of persons age 12 and older in 2013. approximately 91% of all sexual assault victims are women (u.s. doj, 2013). sexual assault has implications for public and individual health, with long-term physical and mental health consequences (national institute of justice, 2007). four out of five sexual assault victims suffer from a chronic physical or psychological condition, and are 13 times more likely to commit suicide than those who have never been victimized (national institute of justice, 2007). rape, a form of sexual assault, is defined as the penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim (doj, 2014c). women who survive rape report high rates of depression, anxiety, post-traumatic stress disorder (yuan, koss & stone, 2006), sexual dysfunction (postma, bicanic, vaart, & laan, 2013), issues with social adjustment (hayes, lorenz, & bell, 2013), and negative effects on self-esteem (perilloux, duntley & buss, 2012) and health (zinzow et al., 2011). recent research has revealed that college students are at a high risk for sexual assault (crawford, wright, & birchmeier, 2008; vanderwoerd, 2009) with the rate of sexual assault for college-age women 20% higher than for 18 to 24 year olds not enrolled in an institute of higher education (u.s. doj, 2014b). twenty to twenty-five percent of collegeage women report a sexual assault while attending college (white house council on baldwin-white & elias-lambert/influence of alcohol 236 women and girls, 2014) and are more likely to be sexually assaulted than any other age group (national institute of justice, 2000). college-age men have the greatest likelihood to commit sexual assault compared to any other age group. thirty-five percent of collegeage men reported some proclivity towards sexual assault if they could be assured they would not get caught, and 23% reported committing acts that meet the definition of rape (burgess, 2007). the prevalence of sexual assault among female college students is influenced by the acceptance of rape myths (chiroro, bohner, viki & jarvis, 2004). rape myths are prejudicial or false beliefs about rape, rape victims, and rapists (burt, 1980). over half of college students endorse some combination of rape myths (edwards, turchik, dardis, reynolds, & gidycz, 2011). college students still possess scripts that are more conducive to what has been termed and described as “real rape” (estrich, 1987; ryan, 2011). a real rape is a false conceptualization of sexual assault that perpetuates the myth that a sexual assault involves a stranger and occurs late at night in a dark alley (estrich, 1987). this real rape archetype is typically violent: the assailant uses a weapon and the victim has scars and bruises from attempting to fight off the perpetrator. in this real rape scenario, the victim also reports the incident immediately (estrich, 1987). rape is a social problem and does not occur in social or cultural isolation (campbell, dworkin & cabral, 2009). for decades research has demonstrated that rape culture supports and condones objectifying, assaulting, and abusing women (burt, 1980; lonsway & fitzgerald, 1994; shin, 2005; walsh, 2015). ward (1995) asserts that sexual assault and rape are a means to oppress women. the current patriarchal society perpetuates certain behavioral scripts, placing the responsibility on women to prevent an assault by conforming to expectations (cahill, 2001). a woman’s behaviors, therefore, are restrained out of the fear of sexual violence (ward, 1995). rape myths are an extension of this rape culture and are a complex set of cultural beliefs that perpetuate and support male violence against women (aronowitz, lambert, & davidoff, 2012). rape myths are based on patriarchal social norms that potentially serve to dominate women through the threat of sexual assault. they serve to deny and justify the patriarchal violence of male sexual aggression and rape (anderson, beattie, & spencer, 2001). one concept to emerge from the acceptance of the real rape scenario is the acceptance and prevalence of rape myths. previous studies have demonstrated that college students are discriminant in their endorsement of rape myths; they accept certain rape myths and not others (mcmahon, 2010). in order to reduce the prevalence of these myths, it is important to not only examine college students’ overall levels of rape myth acceptance; research must also work to distinguish those myths that college students accept versus those they reject. it is also important to understand the factors that influence rape myth acceptance among social work students, particularly due to their potential to be an integral part in the implementation of sexual violence prevention programming and direct intervention with sexual assault survivors and perpetrators. previous studies have explored the relationship between rape myth acceptance and circumstances such as a date rape or the consumption of alcohol among college students (lonsway & fitzgerald, 1994). the current study sought to understand rape myth acceptance specifically among social work students by exploring advances in social work, fall 2016, 17(2) 237 how situational factors (date rape and alcohol consumption) affect which rape myths they are more likely to accept. literature review rape myth acceptance rape myths support cultural values and ideas that justify the sexual victimization of women (king & roberts, 2011) and contribute to the public consciousness in unproductive and damaging ways (kahlor & morrison, 2007). rape myths also advocate that women should accept responsibility for their sexual victimization (deming, covan, swan, & billings, 2013) by suggesting that women provoke their own sexual assault by the clothing they wear, their demeanor, being alone, being out at night or drinking. rape myths have been called, “the most self-serving justification of sexual coercion ever invented by callous men” (zillmann & weaver, 1989, p. 124). common myths tend to blame the victim, exonerate the perpetrator, and deny or belittle the violence inherent in rape (bohner, siebler, & schmelcher, 2006). rape myth acceptance has the potential to facilitate sexual aggression by allowing men to turn off social prohibitions against committing sexual violence against women. higher levels of rape myth acceptance have been linked to increased likelihood of sexual aggression (basow & minieri, 2011). higher levels of rape myth acceptance also have the potential to lead to the underreporting of sexual assaults (heath, lynch, fritch, & wong, 2013). women who accept these rape-supportive beliefs and whose experience corresponds with these myths are less likely to identify their experience as rape (peterson & muehlenhard, 2004). women who internalize these rape myths and blame themselves for the incident are more likely to have poor psychological well-being, including higher levels of depression and lower levels of self-esteem (branscombe, wohl, owen, allison, & n’gbala, 2003). situational factors date rape. studies have shown that rape-supportive beliefs are applied to date rape, a rape by someone the victim knows (estrich, 1987), more than to stranger rape (bridges, 1991; grubb & harrower, 2008). the majority of sexual assaults committed by college men occur on formal or casual dates or during interactions at parties (abbey, mcauslan, zawacki, clinton, & buck, 2001). eighty-five to ninety percent of sexual assault victims know their offender (national institute of justice, 2008). date rape is considered less distressing (heath et al., 2013), and observers are less likely to label forced sex with an acquaintance or date as rape (bridges, 1991). victims tend to be blamed more in incidents of date rape (bridges, 1991; hinck & thomas, 1999) with women being held responsible for not maintaining control of the situation and the man’s behavior being mislabeled as a simple miscommunication or misunderstanding of sexual cues (bridges, 1991). date rape incidents are also more likely to involve the consumption of alcohol (finch & munro, 2007). baldwin-white & elias-lambert/influence of alcohol 238 alcohol consumption. alcohol is a significant factor in the commission of sexual assault (bernat, calhoun, & stolp, 1998) and can be viewed as both a precipitant of and excuse for sexually aggressive behavior (finch & munro, 2007). sexual assault with voluntary alcohol consumption is the most common type of rape on college campuses with previous studies finding that sexual assault is more likely to occur among college students when one or both parties have been consuming alcohol (lawyer, resnick, bakanic, burkett, & kilpatrick, 2010). forty percent of victims report they believed the offender was drinking prior to the victimization (u.s. department of justice, 2011). alcohol consumption is a situational factor that has the potential to affect levels of rape myth acceptance (bernat et al., 1998). a double standard exists among college students wherein perpetrators are held less responsible when consuming alcohol and victims are held more responsible when drinking (finch & munro, 2007). victims are more likely to blame themselves when they have been drinking alcohol and subsequently, may not report the assault (hayes-smith & levett, 2010). sexual assault and social work sexual assault is an under-studied area in social work (mcmahon & schwartz, 2011). however, research around intimate partner violence supports that in the past, the social work profession earned a reputation as uncaring, uninformed, and unhelpful to battered women. social workers were faulted for blaming the victim, failing to recognize abuse as a problem, and failing to make appropriate interventions and referrals (danis, 2003). currently, social workers play a part in both prevention and intervention in sexual violence situations. social workers develop and implement prevention programming to reduce sexual violence. they also provide treatment for clients who have experienced trauma due to sexual violence, as well as work with perpetrators who commit sexual assault. social work knowledge is essential to understanding the complexity of sexual assault and the multiple variables, including rape myth acceptance, that need to be addressed in effective prevention and intervention programming. in order to more fully understand the nuances of sexual assault, it is imperative that social work students understand how rape myth acceptance affects a woman’s psychological and emotional state prior to and after experiencing a sexual assault. it is also important for social workers to understand a man’s proclivity towards sexually aggressive behavior, how these myths may affect a woman’s willingness to report the assault, and how the internalization of these myths may influence mental health outcomes during treatment. previous research has established that certain factors such as date or acquaintance rape (heath et al., 2013) and alcohol consumption by the victim and/or perpetrator (bernat et al., 1998) independently affect rape myth acceptance among observers. however, the current study sought to further understand the nuances of rape myth acceptance among social work students. the study examined the potential relationship between alcohol consumption, date rape, and a willingness to accept rape myths by presenting students with a hypothetical scenario depicting a date rape involving alcohol consumption by the victim, perpetrator, both victim and perpetrator, or neither victim nor perpetrator. no studies known to the authors have been conducted to examine whether these perceptions affect the rape-supportive beliefs an individual attributes to a particular incident of rape. advances in social work, fall 2016, 17(2) 239 methods this descriptive study used a cross-sectional survey design to assess the differences in responses across four date rape vignettes involving alcohol consumption. a descriptive methodology was used because previous research has demonstrated that college students have low overall levels of rape myth acceptance; however, more discriminant analysis has demonstrated that college students are more willing to accept some myths (gerger, kley, bohner, & siebler, 2007). therefore, a descriptive analysis has the potential to identify which myths college students are more willing to accept and how situational factors influence those tendencies. a descriptive analysis provides the necessary foundation for understanding what rape-supportive beliefs social work students endorse. this study also implements a vignette methodology that the researchers have not found in other research concerning rape myth acceptance and provides an important foundation for future analyses. the use of varied vignettes may reveal social work students’ rape-supportive beliefs and whether those beliefs vary with different alcohol consumption scenarios. participants a convenience sample of 197 bachelor's and master's social work students completed the survey. as shown in table 1, a majority of respondents self-identified as female (84%) and white/caucasian (61%). the majority of respondents (69%) were graduate students with a mean age of 29. table 1. respondents demographics (n=197) procedure participants were recruited by contacting all social work instructors in the same department as the primary author at a southwestern university via email. they were asked label label n % gender female 166 84.3 male 31 15.7 race/ethnicity white/caucasian 121 61.4 black/african american 10 5.1 hispanic/latino 39 19.8 asian 3 1.5 native american 8 4.1 pacific islander 0 0 mixed race 11 5.6 other 4 2.0 age 18-22 34 17.3 23-25 58 29.4 26-30 37 18.8 31-62 68 34.5 education level undergraduate 61 31 graduate 136 69 baldwin-white & elias-lambert/influence of alcohol 240 if they would be willing to distribute a link to an anonymous survey or allow facilitation of the survey in their classroom. the instructors were informed that the purpose of the research was to examine perceptions of rape among social work students. twenty-six professors or instructors were contacted. after receiving responses from 23 instructors, each class was randomly assigned to one of the four different conditions with the following number of social work students in each condition: victim drinking (n=52), perpetrator drinking (n=54), both drinking (n=35), and neither drinking (n=54). the survey was not administered in-person to any students in the authors’ classes; however, it is possible that students in the authors’ classes completed the online survey. students did not receive incentives for completing the survey. students were advised that by completing the anonymous survey, they were providing consent. for those students completing the survey online, a study description, along with the link, was forwarded to instructors who then sent the link to their students. after two weeks, a reminder was sent to instructors encouraging students to complete the survey. the survey remained available online for one month. the study received university institutional review board approval. the survey included a vignette describing a sexual assault. the vignette for this study was developed using a template from a previous vignette study that had been created for sexual assault research; the researchers created the template by defining and identifying significant elements that should be included in a study that uses a vignette describing a sexual assault (crawford et al., 2008). the authors then used that example as a foundation while incorporating elements relevant to this particular study, such as the inclusion of alcohol and the description of a date rape. the participants were asked to read the vignette and respond to the survey questions based on the situation described in the vignette. prior research suggests that in order to ensure vignette equivalency, all descriptions of the scenarios should be the same except for the factor being measured (rice, robone, & smith, 2011). therefore, each aspect of the four vignettes was the same except for the drinking component: the first vignette described a sexual assault with only the victim, audrey, drinking (vignette 1); the second vignette described a sexual assault with only the perpetrator, joshua, drinking (vignette 2); the third vignette described a sexual assault with both the victim and perpetrator drinking (vignette 3); the fourth vignette described a sexual assault with neither the victim nor perpetrator drinking (vignette 4). the following is vignette 1 which describes a sexual assault with only the victim, audrey, drinking. audrey was invited by her friends to attend a fraternity party on her college campus. audrey was excited to go and spent the entire afternoon picking an outfit, deciding on her favorite strapless little black dress and 4 inch heels. she had spent the entire week studying non-stop for midterms and was ready to have a little fun. she was even more excited to find out that joshua was going. joshua had taken her out on a few dates; taking her to a concert, dinner, a picnic in the park and the movies; and they had been intimate. they really liked each other. when they arrive at the party, audrey and her friends grab a beer. they dance, talk and have a good time. audrey immediately goes to joshua when she sees him walk through the door. they kiss and hug each other. they spend the rest of the party talking, kissing and flirting. audrey continues to drink throughout the party. at the end of the night advances in social work, fall 2016, 17(2) 241 audrey invites joshua back to her room. she is feeling slightly intoxicated and since joshua has only had soft drinks the entire night, he drives her to her dorm so she doesn’t have to walk. when they arrive at audrey’s room, they begin to kiss. joshua is assertive and pushes her down on the bed. audrey says she doesn’t want to because she is feeling sick but joshua persists. he tells her it’s not a big deal because they had sex before but audrey insists and tells him she doesn’t want to. joshua gets on top of her and she tries to push him off. she continues to tell him “no” but he doesn’t stop. after a couple of minutes of trying to push him off and telling him no, she puts her head to the side and closes her eyes. after joshua finishes, he kisses her on the lips gently and puts on his clothes. he tells her he will call her tomorrow and leaves. audrey sits up and checks her body to see if she has any bruises. after not seeing any physical injuries, she turns off her cell phone, lays down and tries to go to sleep. as previously mentioned, the only differences between the vignettes was who was drinking alcohol the victim (audrey), the perpetrator (joshua), both victim and perpetrator, or neither. vignette 2 portrayed audrey drinking only soda throughout the night in order to be the designated driver and indicated that she drove herself, her friends, and joshua back to the dorm. vignette 3 indicated that both audrey and joshua were drinking alcohol and both walked back to the dorm instead of driving. lastly, vignette 4 described both audrey and joshua abstaining from alcohol consumption. the last vignette also indicated that audrey drove herself, her friends, and joshua back to the dorm. measures in order to gather basic background information, students were asked demographic questions, including age, gender, race/ethnicity, and education level (see table 1). vignette scale after reading the vignette, respondents were asked to respond to 10 survey items pertaining directly to each of the vignettes. each item addressed a specific rape myth (see table 2) and addressed typical rape myths related to the vignettes. for example, “because they previously had sex, it is okay that joshua expected to have sex with audrey.” answer options for each item were: agree, disagree, or uncertain. ten of the items were common across all surveys. for three of the four vignettes, there were unique items that pertained specifically to the scenario presented in the vignette. for example, in vignette one with audrey drinking, participants were asked if audrey, the victim, could consent to having sex with joshua. this item would not have been relevant in the vignettes describing joshua drinking or neither person drinking. for those who read the vignette with audrey drinking, items were included such as, “audrey should not have taken joshua to her room considering her intoxicated state.” for those who read the vignette with joshua drinking, items such as “joshua didn’t fully understand what he was doing because he had been drinking,” were included. for those who read the vignette with both audrey and joshua drinking, items such as “because of their intoxicated states, audrey should have expected joshua would want to have sex” were included. these items were used to evaluate students’ responses to the specific scenario. baldwin-white & elias-lambert/influence of alcohol 242 table 2. vignette statements and the rape myths they represent vignette item rape myth audrey’s outfit gave joshua the wrong impression and led him to be sexually aggressive. women who dress provocatively are responsible for a sexual assault. audrey’s flirtatious behavior led joshua on, giving him the impression that sexual advances would be expected. if a woman is flirtatious, she should expect a partner would want sex and be held accountable if a sexual assault occurs. because they had previously had sex, it is okay that joshua expected to have sex with audrey. if a woman consents to having sex with a partner one time, then it is assumed that she will consent to having sex with that partner all the time. because audrey invited joshua back to her room, she should have expected that he would want to have sex with her. if a woman invites a partner back to her room, she is accountable if a sexual assault occurs. even though audrey said no, because she stopped fighting him, she consented to having sex. a woman is required to fight vigorously to protect herself against a perpetrator attempting to sexually assault her. because joshua kissed audrey and told her he would call, he is a good boyfriend. rape is just bad sex; or men who commit sexual assaults just made a mistake and are not bad men. even though audrey may be upset right now, everything will be better tomorrow. rape does not have substantial negative effects on victims. because audrey did not have any physical injuries, joshua was not too sexually aggressive. a woman who is sexually assaulted will always have physical injuries. this is an example of a sexual assault. rape is more serious than sexual assault; rape has more devastating effects than sexual assault. this is an example of rape. rape is an inflammatory term that shouldn’t be used unless force was used to have sex with a woman. data analysis descriptive analyses were performed to assess the differences in responses across the four date rape vignettes and examine the impact of the particular vignette respondents read on social work students’ rape-supportive beliefs. results four items on the vignette scale had a similar percentage of respondents across all four groups: “because they had previously had sex, it is okay that joshua expected to have sex with audrey,” “even though audrey said no, because she stopped fighting him, she consented to having sex,” “even though audrey may be upset right now, everything will be better tomorrow,” and “because audrey did not have any physical injuries, joshua was not too sexually aggressive.” for the other six items, the vignette each respondent read had a significant impact on results, with a variation in responses between groups (see table 3). for example, 21% of respondents who read the vignette with audrey drinking agreed that she should have expected joshua would want to have sex considering she invited him back to her room; only 8% of those who read the vignette with joshua drinking agreed. twentyone percent of respondents who read the vignette with neither drinking agreed that audrey led joshua on with her flirtatious behavior, leading to the sexual assault; however, only 5% of those who read the vignette with joshua drinking agreed that audrey held some responsibility for leading joshua on by flirting with him. ninety-seven percent of participants who read the vignette with joshua drinking thought the incident was an example of sexual assault; only 52% believed the incident was an example of rape. advances in social work, fall 2016, 17(2) 243 table 3. descriptive statistics: vignette scale (n=197) notea-agree, d-disagree, u-uncertain question vignette 1 audrey drinking (n=52) vignette 2 joshua drinking (n=54) vignette 3 both drinking (n=35) vignette 4 neither drinking (n=54) a d u a d u a d u a d u audrey’s outfit gave joshua the wrong impression and led him to be sexually aggressive. 0(0%) 53(98.1%) 0(0%) 27(45%) 30(50%) 2(3.3%) 2(4.3%) 31(85.1%) 2(6.4%) 1(1.5%) 52(93.9%) 2(3%) because they have previously had sex, it is okay joshua expected to have sex with audrey. 3(6.1%) 42(83.3%) 3(6.1%) 5(8.3%) 51(86.7%) 2(3.3%) 2(6.4%) 32(89.4%) 0(0%) 4(7.6%) 49(89.4%) 1(1.5%) audrey’s flirtatious behavior led joshua on, giving him the impression that sexual advances would be expected. 10(19.7%) 32(63.6%) 6(12.1%) 3(5%) 47(80%) 8(13.3%) 6(17%) 21(59.6%) 7(19.1%) 12(21.3%) 39(71.2%) 3(6.1%) even though audrey said no, because she stopped fighting him, she consented to having sex. 0(0%) 46(92.4%) 1(1.5%) 2(5%) 54(91.7%) 1(1.7%) 1(2.1%) 34(93.6%) 0(0%) 0(0%) 53(95.5%) 2(3%) because audrey invited joshua back to her room, she should have expected that he would want to have sex with her. 11(21.2%) 32(63.6%) 5(10.6%) 5(8.3%) 49(83.3%) 4(6.7%) 13(36.2%) 21(58.9%) 4(10.6%) 17(30.3%) 33(60.6%) 4(7.6%) even though audrey may be upset right now, everything will be better tomorrow. 0 (0%) 48(93.9%) 2(3%) 0(0%) 53(90%) 5(8.3%) 0(0%) 30(83%) 5(12.8%) 0(0%) 48(86.4%) 7(12.1%) because audrey did not have any physical injuries, joshua was not too sexually aggressive. 1(1.5%) 48(93.9%) 1(1.5%) 0(0%) 58(98.3%) 0(0%) 1(2.1%) 31(87.2%) 2(6.4%) 1(1.5%) 53(95.5%) 1(1.5%) because joshua kissed audrey and told her he would call, he is a good boyfriend. 0(0%) 48 (92.4%) 2(3%) 8(13.3%) 40(68.3%) 10(16.7%) 0(0%) 34(95.7%) 0(0%) 0(0%) 53(95.5%) 2(3%) this is an example of sexual assault. 53(98.5%) 0(0%) 0(0%) 57(96.7%) 0(0%) 1(1.7%) 32(89.4%) 1(2.1%) 2(4.3%) 53(97%) 0(0%) 1(1.5%) this is an example of rape. 48(92.4%) 0(0%) 1(3%) 31(51.7%) 22(38.3%) 5(8.3%) 30(83%) 1(2.1%) 4(10.6%) 49(89.4%) 1(1.5%) 4(7.6%) advances in social work, fall 2016, 17(2) 244 unique vignette questions vignette 1 audrey drinking the respondents who read the vignette with audrey drinking were asked unique questions pertaining specifically to the circumstances of that particular vignette (see table 4). forty-five percent of respondents believed that audrey should not have taken joshua back to her room considering her intoxicated state. twenty-nine percent agreed that audrey was able to consent to having sex even though she was intoxicated. ninety-six percent of respondents believed joshua took advantage of audrey in her intoxicated state, and 88% thought it was unreasonable to think that joshua did not believe audrey when she said no due to her intoxicated state. table 4. unique questions: vignette 1 audrey drinking agree disagree uncertain even though audrey was intoxicated, she was able to consent to having sex with joshua. 18(28.8%) 36(57.6%) 6(9.2%) audrey should not have taken joshua back to her room considering her intoxicated state. 29(45.5%) 22(35.4%) 9(13.8%) it is reasonable to think that joshua did not believe audrey when she said no because she had been drinking. 2(3.0%) 55(87.9%) 3(4.6%) joshua took advantage of audrey in her intoxicated state. 61(95.5%) 0(0%) 1(1.5%) vignette 2 joshua drinking participants who read vignette 2 were asked to respond to items relevant to the circumstances of only joshua drinking (see table 5). for those who read vignette 2, 97% did not excuse joshua’s sexually aggressive behavior because he was intoxicated and, ultimately, held joshua responsible. however, 47% agreed that, “joshua didn’t fully understand what he was doing because he had been drinking.” the majority of respondents (72%) did not hold audrey responsible for the incident because she took him to her room. this contradicts results showing that 69% agreed he should have expected sex since she invited him to her room. table 5. unique questions: vignette 2 joshua drinking agree disagree uncertain because joshua was intoxicated, his sexually aggressive behavior is excused. 0(0%) 54(96.7%) 1(1.7%) audrey should not have taken joshua to her room considering his intoxicated state. 7(11.7%) 40(71.7%) 8(15.0%) joshua didn’t fully understand what he was doing because he had been drinking. 26(46.7%) 21(36.7%) 8(15.0%) vignette 3 both audrey and joshua drinking respondents who read the vignette with both victim and perpetrator drinking were asked to respond to unique questions relevant to that vignette (see table 6). although 75% of those who read vignette 3 did not believe audrey should have expected joshua would advances in social work, fall 2016, 17(2) 245 want to have sex considering their intoxicated states, 17% agreed, potentially excusing his behavior. in response to, “audrey should not have taken joshua to her room considering their intoxicated states,” 68% agreed. thirty-eight percent of respondents believed audrey was able to consent while 40% disagreed and 16% were uncertain. eighty-three percent of respondents believed joshua understood what he was doing despite his intoxicated state, and 85% believed joshua took advantage of audrey in her intoxicated state. table 6. unique questions: vignette 3 audrey and joshua drinking agree disagree uncertain because of their intoxicated states, audrey should have expected joshua would want to have sex. 6(17.0%) 27(74.5%) 2(4.3%) audrey should not have taken joshua to her room considering their intoxicated states. 25(68.1%) 6(17.0%) 4(10.6%) even though audrey was intoxicated, she was able to consent to having sex with joshua. 13(38.3%) 14(40.4%) 5(15.6%) joshua didn’t fully understand what he was doing because he had been drinking. 2(4.3%) 30(83.0%) 3(8.9%) joshua took advantage of audrey in her intoxicated state. 31(85.1%) 2(4.3%) 2.4(6.7%) discussion rape myth acceptance is an essential concept in the understanding of sexual assault and the ultimate reduction in the prevalence of rape among college students (lonsway & fitzgerald, 1994). therefore, it is important to understand levels of rape myth acceptance among social work students not only due to their own potential to perpetrate or be victims of sexual assault, but also because social work students are likely to interact with sexual assault survivors and perpetrators in practice settings. previous research has shown that although college students have low levels of rape myth acceptance overall, they do accept certain rape myths while rejecting others (mcmahon, 2010). the current study shows that certain factors, such as the consumption of alcohol or the relationship between the perpetrator and victim, may affect college students’ willingness to support certain beliefs about rape. research suggests that males are more accepting of rape myths (buddie & miller, 2001). in this study, because the majority of the sample was female, gender comparisons were not feasible. however, the results showed that female social work students endorse certain rape myths, such as if a woman has been drinking, she did something careless to put herself in that situation and bears some responsibility. these results are significant because they suggest that at least a portion of respondents have internalized these rape myths. women who endorse rape myths are less likely to acknowledge an incident that meets the definition of sexual assault as rape, to report it, or to seek treatment due to their own shame and guilt (duran, moya, megias, & viki, 2010). even among social work students, there may be a portion of students who do not identify an incident as rape and therefore may not report the incident or seek help. the authors proposed that the respondents’ levels of rape myth acceptance would be influenced not only by alcohol consumption, in general, by those in the scenario, but also baldwin-white & elias-lambert/influence of alcohol 246 by which individual was drinking in the vignette. overall, respondents endorsed certain rape myths while rejecting others, demonstrating low to moderate levels of rape myth acceptance. results are consistent with previous research (bridges, 1991) and reveal the double standard that exists in the relationship between gender and alcohol consumption. when the victim was drinking, she was held more responsible for the incident. however, when the perpetrator was consuming alcohol, he was held less responsible, and respondents were more likely to excuse his behavior. when the victim is sober, perhaps respondents believe she should have taken more precautions. alcohol is also an important factor to consider when examining beliefs about rape because at least 50% of sexual assaults among college students involve alcohol consumption (krebs, lindquist, warner, fisher, & martin, 2007). therefore, alcohol is a likely component that will influence how observers perceive a sexual assault. this study demonstrated that not only did alcohol consumption by the victim and/or perpetrator involved in a sexual assault affect a social work student’s willingness to accept certain rape myths, but who was consuming alcohol also affected a participant’s willingness to accept certain rape-supportive beliefs. additionally, respondents were discriminatory in their rape myth acceptance, simultaneously holding the victim accountable for her drinking or flirtatious behaviors and holding the perpetrator responsible for his sexually aggressive behavior. results of the study also show that social work students may conceptualize sexual assault and rape differently. respondents were first asked if the incident was a sexual assault; and then later, in a separate question, asked if the same incident was a rape. in all groups, a smaller percentage of respondents identified the incident as a rape compared to the percentage that identified the incident as a sexual assault, with the largest percentile difference in respondents who read the vignette with joshua drinking. there could be multiple potential explanations for this difference. first, it is possible that the sample possesses real rape scripts. because the described incident does not coincide with their ideas about what rape looks like, they do not believe the incident was rape. secondly, because joshua was drinking, perhaps respondents exhibited a double standard wherein because he was drinking, they did not believe he had committed rape. alcohol, in this case, was an excuse for his behavior and absolved him of wrongdoing. fourth, joshua did not fit the real rape scenario of a rapist who is violent, aggressive, and uses a weapon; therefore, joshua did something wrong, but was not necessarily a rapist. social work students also appear to lack a clear understanding of consent. when reading the vignette with audrey drinking, nearly half of the sample agreed the victim was able to consent to sex despite her intoxicated state. implications for social work education and practice the results of this study are important because in order for sexual assault survivors to have the best potential outcomes while in treatment, social work students must be aware of and work to correct the biases they have towards survivors, perpetrators, and the act of rape. social workers are typically more empathetic towards those in need (acker, 1999); however, this study shows that even those learning to be helping professionals can have misunderstandings concerning the act of rape and the behaviors of perpetrators and survivors. these views could lead social workers to dismiss a victim’s claim of sexual advances in social work, fall 2016, 17(2) 247 assault due to a lack of understanding of what constitutes a rape or sexual assault or due to subconscious biases that influence their interaction with victims. this could have tremendous negative effects on clients. research suggests that survivors of sexual assault who are not believed by helping professionals, including social workers, tend to have poorer psychological or emotional outcomes (ullman & peter-hagene, 2014). in addition, social work students displayed the double standard that places more responsibility on the victim if she has been drinking and less responsibility on the perpetrator if he has been drinking. the study demonstrates it is important to understand this double standard because a social worker has the potential to behave differently if a survivor or perpetrator has been drinking alcohol due to changes in his/her perceptions of sexual assault. this perception may create a bias in interventions and may leave perpetrators without proper treatment because their behavior has been excused due to alcohol consumption or victims without the necessary support to help them move past the trauma of sexual assault. students demonstrated a less overt endorsement of rape myths by participating in both victim-blaming and exonerating the perpetrator but also holding the perpetrator accountable for his actions. this inconsistency is a potential reflection of the current limitations of social work education, which may benefit from being more inclusive of issues pertaining to the prevention of violence against women. social work students need to be further educated concerning the nuances of sexual assault in order to be better advocates for survivors. social work students must be educated about how endorsements of rape myths can affect their interaction with survivors and perpetrators. this research demonstrates that these beliefs about rape cannot be understood in isolation and are influenced by social and environmental factors, such as the consumption of alcohol or the relationship between the survivor and perpetrator. because these beliefs serve to oppress women (ward, 1995), social work education should address these social constructs and work to change them among social work students to ensure the best possible treatment outcomes for women suffering from mental, emotional, and physical health issues due to the trauma of a sexual assault. also, because social workers understand the importance of and examine the influence of socio-environmental factors, social work education can provide students with foundational knowledge about how the social construct of rape myths are created and maintained by certain belief systems. in order for social workers to conduct effective prevention programming around the issue of sexual violence, social work students must understand the relationship between alcohol consumption and consent in date rape situations. social workers who conduct prevention programming and also endorse rape myths may inadvertently exhibit rapesupportive values and beliefs when conducting prevention programming. this could be detrimental when attempting to change the beliefs that currently support sexually abusive behaviors. when conducting prevention programming, social workers will more than likely interact with both survivors and perpetrators. so, if those prevention programmers exhibit rape-supportive beliefs, survivors in attendance may feel blamed for the sexual assault they experienced, and perpetrators may feel justified in their actions to commit sexual violence. it is important for social workers who present prevention programs to understand the link between rape myth acceptance and alcohol consumption in order to effectively explain the baldwin-white & elias-lambert/influence of alcohol 248 relationship between situational circumstances and the acceptance of rape-supportive beliefs. limitations and future research selection bias may have an effect on results. students who self-selected to participate in the study may be students who have low levels of rape myth acceptance. social desirability is also a concern. social work students may be more likely to answer in a way that is more socially acceptable; therefore, the results may not be a true reflection of what social work students believe. in addition, the study did not account for the influence of respondents’ own experience with sexual assault. future research needs to include a larger sample of men to understand both gender differences and men’s rape myth acceptance levels. future research also needs to explore the potential differences in rape myth acceptance based on the gender of the participant, whether male or female; and explore whether male victims evoke more or less rape supportive beliefs. also, studies need to examine rape supportive beliefs in the context of same-sex relationships. in-depth qualitative analyses should also be completed in order to provide more insight into what social work students, and college students in general, believe about rape and the factors that influence those beliefs. in order to have the largest impact on college students, future studies should also go beyond social work to include college students in other disciplines. conclusion understanding the different facets of rape myth acceptance is significant in order to not only reduce the negative effects of these myths on individuals and society as a whole, but also potentially reduce the prevalence of sexual assault. there is optimal opportunity within the social work curriculum to facilitate learning and discussion around sexual violence and rape myths in order to ensure that social work students are prepared to be effective practitioners when working with survivors and perpetrators of violence against women. references abbey, a., mcauslan, p., zawacki, t., clinton, a.m., & buck, p. 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(2011). self-rated health in relation to rape and mental health disorders in a national sample of college women. journal of american college health, 59(7), 588-594. doi:http://dx.doi.org/10.1080/07448481.2010.520175 author note: address correspondence to: adrienne baldwin-white, school of social work, arizona state university, university center, 411 n. central avenue, suite 800, phoenix, az 85004, adrienne.baldwin@asu.edu http://dx.doi.org/10.1080/07448481.2010.520175 mailto:adrienne.baldwin@asu.edu microsoft word 9-3874 schwan negroni santiago final ______________ nelly rojas schwan, ph.d., lcsw, acsw, is an assistant professor of social work in the school of graduate and professional studies at the university of st. joseph in west hartford, ct. lirio k. negroni, ph.d., lcsw is associate professor and faculty in the puerto rican and latino social work studies project of the university of connecticut school of social work. annette santiago-kozmon, msw, lcsw, is an adjunct social work faculty member in the school of graduate and professional studies at the university of st. joseph and the director of healing house of connecticut. this work was supported by nasw, the university of st. joseph, and the university of connecticut. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 146-162   culturally-attuned mentoring for graduating latina/o social workers to foster career advancement nelly rojas schwan lirio k. negroni annette santiago-kozmon abstract: the underrepresentation of latinas/os in the social work profession, especially in higher levels of administration, has been amply documented. successful latina/o professionals can address the need for latina/o leadership in the field by mentoring new graduates and supporting their development and career planning as they enter the professional world. this article presents an innovative mentoring program for latina/o social work professionals conceptualized and led by the latina/o network of the latina/o network of the connecticut chapter of the national association of social workers (nasw). the program matches a latina/o master’s in social work graduating student with a senior latina/o social work professional. the model of the mentoring program incorporates a coordinator,  a liaison to each mentor-mentee dyad, a mentor-mentee developmental relationship, and group gatherings. a key aspect of the model is the attention to and inclusion of latino cultural values of familismo, personalismo, confianza, and colectivismo, to foster the development of a sense of community. empirical and anecdotal data illustrate the outcomes of the program. the implementation of the program, the lessons learned, and its applicability to other professionals and cultural groups are discussed. keywords: mentoring, latina/o professionals, latino culture, career advancement, developmental relationships the 2010 census counted 50.5 million latinas/os in the united states, making up 16.3% of the total population (enis, rios-vargas, & albert, 2010). the nation’s latina/o population, which was 35.3 million in 2000, grew 43% over the decade, and accounted for most of the nation’s growth, (56%) from 2000 to 2010 (passel, cohn, & lopez, 2011). it is projected that latinas/os will total 29% of the u.s. population in 2050 due to immigration, migration, and high birth rates (passel & cohn, 2008). according to the pew hispanic center (passel & cohn, 2008) latinas/os will account for 60% of the population growth between 2005 and 2050. the pew hispanic research center reports that 37% of latinos currently living in the united states are foreign born (patten, 2012). like other immigrant groups, latinas/os come to the united states seeking economic advancement and social mobility, and education is a recognized avenue to accomplish these aspirations. like other immigrants, many latinas/os want their children to have the opportunities they did not have such as advances in social work, spring 2013, 14(1) 147     pursuing higher education. also many latina/o immigrants started their college education in latin america and dream of completing their degrees in the states. historically, latina/o students have been underrepresented and underserved in higher education (fry, 2002; schmidt, 2003). as of 2010, the pew hispanic center reported significant growth in educational achievement among young latinas/os, with 73% of 1824 year olds completing high school and 44% attending college (fry, 2011). however, most of the increase in college attendance has been at community colleges. of those completing high school and attending college, only 54% of latinas/os were enrolled in four-year colleges, compared with 73% of whites, 78% of asians, and 63% of blacks (fry, 2011). the low enrollment of latinas/os in four-year compared to two-year  colleges indicates difficulties progressing to higher education. the 2010 american community survey of the u.s. census bureau documented the significant decrease in the percentage of higher levels of educational attainment with 62.2 % latinas/os earning a high school degree, 35.7% with an associate’s degree or higher, 13% obtaining a college degree, and only 4.1% completing a graduate or professional degree (u. s. census bureau, 2010). the latina/o college population includes a large number of first generation and immigrant adults most of whom are the first in their families to obtain a degree. while families in general are supportive of a family member pursuing education, they are not prepared to offer the support and guidance students need. in addition, families frequently do not anticipate the time demands of academic pursuits and may experience stress as a result (cevallos, 2004). it has been recognized that mentoring can be a source of support and guidance for students. according to zalaquett , gallardo, and castellanos (2004), latina/o students need role models to help them understand their educational opportunities and show them how to navigate the college system. many schools offer programs focused on supporting students while in college. when graduates join the professional world they may find mentoring in the workplace, but there seems to be a scarcity of mentoring resources for new professionals as they prepare to enter the work force and transition from students to professionals, an important developmental process that requires career planning. they face challenges negotiating the higher education system, and continue to face challenges when they move into the professional world (sólorzano, villalpando, & oseguera, 2005). as a minority group, latinas/os encounter institutional and cultural racism (hernandez, carranza, & almeida, 2010), therefore it is very important to have role models and supporters who reflect the population, across political, economic, and social institutions. social service organizations providing services to and employing people of color need people of color in supervisory, managerial, and leadership roles, including boards of directors, to achieve cultural competence. latinas/os, the population with one of the highest percentages of poverty (lopez & cohn, 2011), are high consumers of social work services, and social work institutions are pressed to increase their latina/o bilingual staff at all levels of organization. however, the number of latinas/os in supervisory positions or at higher levels of administration is very low (the federal hispanic workgroup, 2008); an indication that the pace of professional advancement for rojas schwan, negroni, santiago-kozmon/culturally-attuned mentoring 148 this minority group is slow. as newcomers to the professional world, new latina/o social workers need to develop networks of professional connections, be clear about their career goals, be realistic about the options available, and develop strategies for their own development. more privileged groups benefit from generations of networking, which constitutes social capital not available to latinos. the lack of professional networks and limited focus on professional development can lead to poor choices, poor negotiation of employment conditions, dissatisfaction in employment, and changes in position arising from dissatisfaction with the job. young professionals of color, latina/os specifically, benefit from developing a strategy for advancement in order for their choices to become rungs in their career ladder. this article presents an innovative mentoring program for latina/o social work professionals. conceptualized and led by the latino network of the connecticut chapter of the national association of social workers (nasw), this program matches a graduating latina/o master level social work student with a senior latina/o social work professional. the mentoring program emerged as an avenue to support graduating latinas/os entering the professional workforce or transitioning to more advanced positions. literature review mentoring mentoring is defined as the relationship between an experienced professional and a novice, one that includes advising, guidance, and coaching focused on the personal and professional growth of the individual (adams, 1998; bogat, liang, & rigol-dahn, 2008; zalaquett & lopez, 2006). it is based on the premise that a mentor and mentee engage in a series of interpersonal exchanges that are beneficial for both. mentorship relationships may be formal or informal in nature. formal mentoring is usually planned and established by a third party and has set goals, timelines, training, and structured activities. it is not surprising that at times a formal mentoring relationship evolves and becomes informal as mentors and mentees decide to cultivate and continue their relationship after the formal commitment ends and without the guidelines of the formal program (zalaquett & lopez, 2006). career mentoring is specific to a mentor working with a mentee for the purposes of professional development and career growth. the qualities expected in a mentor include commitment to the role, acceptance of the mentee, ability to provide support, effective interpersonal skills, ability to communicate hope and optimism, and commitment to continuous learning (zalaquett & lopez, 2006). the mentor has to be committed and must possess awareness of the responsibilities and skills embedded in the mentoring role. two types of mentoring, instrumental and psychological, occur simultaneously in an integrated manner (laden, 2000; luna & prieto, 2012). instrumental mentoring refers to processes such as teaching, advising, coaching, advocating, and connecting with resources; while psychological mentoring includes emotional support and validation (laden, 2000). both types of mentoring help mentees enhance their self-esteem and sense advances in social work, spring 2013, 14(1) 149     of competence and efficacy (laden, 2000). studies document that integrated mentoring expands a mentees’ network, sense of self-empowerment, and overall academic and career preparation (luna & prieto, 2012). crisp and cruz (2012) distinguish four types of support: emotional, educational and career related, knowledge of academics, and role modeling. mentoring as a developmental relationship the literature examines mentoring as a developmental relationship (brown, daly, & leong, 2009; allen & finkelstein, 2003). developmental relationships can contribute to individual growth and career advancement (allen & finkelstein, 2003) and have been shown to have an association with career success (gonzalez-figueroa & young, 2005). a developmental focus, tailored to the developmental needs of the mentee, is essential to maximize the benefits of mentoring for both mentors and mentees (brown et al., 2009). mentoring of a new professional, thus, includes assisting in defining the professional self, exploring career options and opportunities, focusing on career development, setting realistic goals, and planning a path to achieve them. developmental relationships are mutual and reciprocal (gutierrez, 2012; pomeroy & steiker, 2011). while the relationship provides a professional developmental pathway for the mentee, it is also an opportunity for the mentor to grow and develop into more advanced roles and to make leadership contributions. mentoring provides opportunities for professional enrichment which returns to the community as social capital. the mentors’ work is sociopolitical in its nature as they assure, through the mentoring, that more latinas/os and other underrepresented groups will gain visibility and access to power. through networking and collaboration, latina/os can get organized to become visible and influential, so they might represent their communities and advocate for their interests. social work and mentoring social work knowledge and skills are important for mentoring (pomeroy & steiker, 2011). international experts have addressed the existing connections between social work and mentoring. pehkonen, arola, zviyagina, and grouev (2010) described mentoring as a process that can help senior social workers transfer their knowledge to new social workers, and in this way contribute to their professional growth and the strengthening of their professional identity. the authors stated that mentoring in the workplace allows new social workers to explore expectations, potentials, and qualifications, and decide whether those are aligned or in conflict with the agency’s environment. according to the authors, “mentoring provides a forum for discussing the occupational welfare experienced in social work and the challenges emerging in it” (p. 24), and helps social workers cope effectively with occupational issues. they also stated that mentoring, at its optimal, can provide strength to an individual’s professional identity, which includes the ability to be pliable in the workplace. gutierrez (2012) asserted that mentoring is a significant, but often overlooked, component of social work students’ education, and frequently takes place “outside of rojas schwan, negroni, santiago-kozmon/culturally-attuned mentoring 150 formal courses and programs” (p. 1). the author stated that when students have positive mentors, they are more likely to do well in school, be more productive, have stronger professional skills, be more confident, and develop a larger professional network. she claimed that “mentoring students on any level can be a way to expand our knowledge of and to learn about different life experiences” (p. 2), and that faculty who mentor students benefit personally and professionally. in the case of field instructors, mentoring is one of the activities through which they provide expertise and facilitate students’ learning of needed practice skills (ortiz-hendricks, finch, & franks, 2005). however, this studentfield instructor mentoring relationship often ends as the student prepares to join the workforce. culturally-attuned mentoring it has been documented that demographic similarities between mentor and mentee contribute to the success of the relationship (brown et al., 2009). same-race relationships provide significantly more psychosocial support than cross-race relationships (davis, 2006). for instance, having a latino/a mentor can provide role modeling, cultural validation and pride (rivera-goba & nieto, 2007), and the meta-message that advancement as a latina/o is possible. cultural differences can be a barrier to effective mentoring of racial and ethnic minority professionals. when a mentor and a mentee are from different cultural backgrounds, differences in attitudes and values may arise that can cause cultural miscommunications and conflict (brown et al., 2009). experienced professionals who have successfully navigated the challenges involved in career advancement are especially suited to offer culturally-attuned mentorship and support mentees’ professional development. in the workplace, professionals of color may experience prejudice and racism ranging from overt racism to micro-aggressions, the often subtle comments reflective of prejudice, which are perceived as undermining by the receiver (sue, 2010; sue et al., 2007). the mentoring relationship becomes a safe environment when issues of racism, oppression, and micro-aggressions can be explored to validate the experience and identify strategies to respond in constructive ways. offering cultural affirmation is one of the most important goals of an ethnicallymatched mentoring relationship. specifically, for latina/o social workers new to the professional world, there are two distinct levels of bi-cultural exchanges: the socialization into the professional world and the ability to function in the predominantly white culture. senior social workers of the same background who have successfully accomplished these developmental tasks can serve as role models and resources to new professionals (thomas, 2006). it is important for latino professionals new to the organizational culture to be mentored by other latinos. once they are confident negotiating the institutional culture, they can benefit from cross-cultural mentoring from higher level administrators. kay and wallace (2009) indicated that women and minority racial and ethnic groups may find themselves on the periphery of organizations and would benefit from cross-gender and cross-racial mentoring. this perspective is definitely applicable to latina/o social workers, who often practice in organizations where high level administrators and board members are predominantly from the majority culture. however, it is important that they advances in social work, spring 2013, 14(1) 151     first gain comfort with the institutional culture to maximize the benefit of cross-cultural mentoring. mentoring programs for latina/os increasingly incorporate a culturally-attuned focus. in order to be culturally-attuned, the program must pay special attention to the latino cultural values of familismo, personalismo, confianza and colectivismo. familismo is a “cultural value that stresses attachments, reciprocity, and loyalty…” (andres-hyman, añez, paris, & davidson, 2006, p. 696). the same authors referred to personalismo as a preference for relating on a personal rather than formal or institutional level. because of familismo and personalismo values, latinas/os in mentoring programs may value relationships based on genuine caring; may expect others in relationships to be open to sharing about themselves; and may prefer or expect close relationships. development of confianza, an earned feeling of trust and familiarity and a feeling that the other person is worthy of their confidence is essential as mentors and mentees regard the other as a quasi-extended family member (falicov, 2001). colectivismo emphasizes activity for the benefit of the community rather than individual interests and needs (zuñiga, 2001). the state nasw latina/o network mentoring program nasw latina/o network the latina/o network of the connecticut chapter of the nasw started in 1997 with the mission to provide a professional network; to connect, support and recognize latina/o social workers; to highlight the importance of culture in professional practice; and to advocate for the latina/o population and social workers. among the different efforts developed by the network to address these goals has been the inclusion of mentoring opportunities for latina/o social workers entering the career world. given the demographic data on latinas/os, population projections, and the data on educational attainment, the network realized the importance of developing interventions to reverse the trend of losing latina/o individuals along the pathway of education. throughout the years, members of the latina/o network, a completely volunteer group, with the support of the chapter’s executive director, have been committed to this cause. the mentoring program the network’s interest in developing a mentoring program came from a desire to aid latina/o students in the pursuit of higher education. in 2007 the network reached out to local high schools, colleges, and universities to inquire about existing and needed support for latina/o students. this effort identified a gap in support at the graduate level. once a student graduated from their master’s program, no support services were in place to aid in career advancement. this was reaffirmed in 2008 at a connecticut nasw statewide conference when attendees to a workshop completed a survey regarding types of support social workers needed. mentoring after graduation came up as a stated need. the mentoring program functioned with senior social work volunteers who committed one year at a time to serve as mentors of graduating latina/o msw students. in 2009 the latina/o network launched the mentoring program with two mentor-mentee rojas schwan, negroni, santiago-kozmon/culturally-attuned mentoring 152 dyads. the program began with limited structure and no group activities, and the followup with mentors and mentees was done by the network’s chair utilizing formal letters and telephone contacts. in 2010 the program became more structured, with a designated coordinator, formal guidelines for matching, clearer expectations, and an evaluation component. the number of participating mentor-mentee dyads increased to four in 2010, seven in 2011, eight in 2012, and seven in 2013. the purpose of the mentoring program was to provide support and guidance to recent latina/o social work graduates to aid their transition to the professional world. the mentor was expected to: (1) help the mentee plan his/her future career goals and professional steps; (2) provide the mentee with knowledge of the professional world; (3) help the mentee explore ways he or she could be more successful; (4) facilitate the development of new professional networks for the mentee; (5) help the mentee transition into more advanced career levels as an msw graduate; and (6) support the mentee in the exploration and negotiation of cross-cultural exchanges. the mentee was expected to: (1) use the mentoring relationship to focus on her/his professional development; (2) be receptive to what the mentor can offer; (3) be straightforward and honest and in consistent communication with the mentor; and (4) be open to change as part of her/his developmental process. in addition to the expectations listed above, both mentors and mentees committed to (1) attend an orientation meeting; (2) determine ways in which they will keep in touch; (3) keep monthly contacts with each other; (4) coordinate at least two face-to-face activities; (5) participate in mentor-mentee gatherings coordinated by the latina/o network; (6) engage in a respectful, caring, and responsible relationship; (7) ask for assistance if they need help in their interactions; (8) inform the coordinator if for any reason they need to withdraw from the program; and (9) participate in the evaluation of the mentoring program. the recruitment of mentors and mentees was done by the network’s members. the mentoring program was publicized in the state chapter’s newsletter and through other events of the organization. members of the network reached out to the state’s schools of social work and collaborated with the directors of student services to identify graduating latina/o students. those students were invited to an informational meeting and if interested, were given an application to become a mentee. mentors were recruited through outreach at conferences, professional meetings and one-to-one contacts with successful professionals. the requirements for mentors included being a latina/o with a minimum of five years of post-msw experience and having the commitment to mentor. those interested completed an application form that was used to match mentors and mentees according to interests, expectations, geographic location, strengths of mentors and expressed needs of the mentees. the mentor-mentee-liaison model the mentoring model developed by the latina/o network included a coordinator, a liaison to each mentor-mentee dyad, a mentor-mentee developmental relationship, and group gatherings. a key aspect of the model was the attention to and inclusion of latino advances in social work, spring 2013, 14(1) 153     cultural values. the mentoring program was coordinated by a member of the latina/o network. members of the network served as liaisons to the mentor-mentee dyads. the responsibilities of the liaison were to: (1) act as a “bridge” between mentor and mentee; (2) be accessible when needed; and (3) have bi-monthly contact with the dyad to review progress and answer questions. liaisons were an important component of the mentoring process because they helped facilitate the development of the mentoring relationship. developmental mentoring. there is a professional development process once social work students complete their master’s degrees. the process involves preparing for licensing and then becoming a licensed practitioner. some new professionals will move into supervisory positions and field instruction positions while others will use their practice experience to prepare to pursue doctoral education and teaching in community colleges and universities as adjunct instructors. mentoring allows the mentee to prepare for that developmental process, as mentors have already passed through the developmental process or are in more advanced roles. mentors help mentees become aware of professional options, discover their strengths and areas of further development, and strengthen their self-confidence in their ability to advance. the developmental pathway creates leaders within the profession. group gatherings. in addition to the one-to-one mentor-mentee communications and interactions, there were four all mentor-mentee-liaison group activities during the year and a special latina/o social workers’ recognition event, to which the mentoring program participants were invited as guests of honor. these activities were intended to prepare mentors and mentees for the mentoring experience and to facilitate relationshipbuilding and enhancement. they were planned to reflect the latino cultural values of the group. for instance, in all events latino food was included and group activities incorporated latino music, decorations, etc. the group icebreakers encouraged personal sharing and were often connected to cultural identity and experiences of acculturation. in the first gathering (orientation meeting), mentoring expectations were discussed and mentors and mentees were informed of who they were matched with. there was a training that included group activities to build relationships and to share prior experiences with mentors and mentoring, and an orientation about mentoring. the network invited latina/o social workers and allies to a special latina/o social workers’ recognition event, which is usually celebrated in march, social work month. the purpose of the event was to recognize the contributions of latina/o social workers from different fields of practice. the event was also an opportunity for the mentor-mentee dyads to socialize together and strengthen their relationships. this celebration enhanced professional and cultural identity pride and provided opportunities for networking. the second gathering took place during the summer. this meeting served to celebrate mentees’ graduation and transitioning to different jobs or career positions. participants brought their parents, children and other relatives. the overall experience of connecting within the context of their families was a meaningful aspect of the latino culture and strengthened the mentor-mentee-liaison connection. the third gathering took place at the beginning of the fall. mentors and mentees were invited to reflect on their developmental relationship. the group activities during this rojas schwan, negroni, santiago-kozmon/culturally-attuned mentoring 154 meeting were geared toward celebrating both mentors’ and mentees’ professional and personal accomplishments. the final meeting, held in december, gave participants the opportunity to share their experiences and accomplishments and for the staff to highlight participants’ contributions to the program. three years of programming the mentees who have participated in this mentoring program have been immigrants/migrants or second generation latinas/os and the first person in their family to complete a college education. most of the mentors have had similar backgrounds. they may also have shared a common language. their identification with traditional cultural values and beliefs, their experiences with immigration/migration, and their cultural identity and level of acculturation served as the context for their mentoring relationship to develop and grow. when latina/o mentees who are first generation college students start their higher education, they make two cultural transitions: to the majority culture and to the academic culture. likewise, when they enter a new job as an msw they encounter an organizational culture that may not operate based on their cultural values. they need to become bicultural, both to be able to maintain their latino culture and function within the institutional environment. talking with the mentor who has gone through these challenges helps the mentee realize “i am not the only one” and to respond to differences without thinking there is something wrong with him or herself. specific outcomes both empirical and anecdotal data have been compiled in order to evaluate the mentoring program. every year during the last meeting of the program, participants completed a confidential questionnaire that combined open-ended, likert-scale questions. the questionnaire explored respondents’ thoughts regarding a mentee’s career development and transition, the quality of the personal experience, and the success of the mentoring program. more specifically, mentors and mentees were asked to indicate how much the mentoring program helped mentees (1) with career goals and professional steps; (2) to explore ways they could be more successful; (3) to transition from their role as student to that of a working professional; and (4) to develop networks. they indicated how much of the following were provided to the mentee: (1) knowledge of how the professional world operates; (2) knowledge of jobs, agencies, and populations that were good for them; and (3) guidance and support as they entered or re-entered the workforce. additional likertscale questions inquired about (1) how clear was the purpose of the mentoring program; (2) how much of an issue was time in establishing a mentor/mentee relationship; and (3) how much did time interfere with mentees ability to participate fully in the mentoring program. mentees also indicated how much they agreed or disagreed with the following: (1) it was important for me to meet a successful professional i could learn from; (2) mentoring advances in social work, spring 2013, 14(1) 155     has helped me feel more confident as a latina/o social worker; and (3) mentoring has helped me value more my qualifications as a latina/o social worker. mentors were asked how much they agreed or disagreed with these statements: (1) it was important for me to mentor a young latina/o professional; (2) mentoring has given me satisfaction and a sense of giving back; (3) mentoring has helped me value much more my qualifications as a latina/o social worker. the open-ended questions required mentors and mentees to describe their experience; identify activities they did together; describe their level of comfort with the mentor/mentee relationship and what was lacking in the relationship; describe what the mentoring accomplished; and identify the gains and benefits along with areas for improvement. questionnaire findings a total of 20 respondents (9 mentees and 11 mentors) completed the questionnaire in the last three years (2009-2011). although the number of respondents is small, the findings provided a preliminary impression of the usefulness of the program and the areas to be improved. the findings suggested progress toward achieving the goals of the program. the overall experience was described as positive, enjoyable, encouraging and educational. the mentoring occurred through e-mails, phone calls and face-to-face contacts. in most instances mentors and mentees felt comfortable with their match and the relationship. mentees reported increased self-confidence, self-awareness and appreciation of the networking opportunities. areas identified for strengthening were same gender matching, frequency of face-to-face contact, and scheduling of time together. table 1 presents the frequencies and percentages in the very much and somewhat categories for each of the following likert-scale questions. table 1 mentors’ and mentees’ responses to the outcome questions questions how much does the mentoring… mentees n = 9 mentors* n = 11 f % f % help mentee with career goals 9 100% 7 (n = 9) 78% provide mentee knowledge prof. world 9 100% 9 (n = 10) 90% help mentee explore ways to success 6 67% 7 (n = 10) 70% provide knowledge of jobs, agencies 6 67% 8 (n = 11) 73% help transition from student to professional 7 78% 8 (n = 10) 80% help mentee develop networks 5 56% 6 (n = 10) 60% provide mentee guidance 8 89% 8 (n = 11) 73% *the total number of respondents varied per question in the mentors’ column and percentages were calculated based on that number. rojas schwan, negroni, santiago-kozmon/culturally-attuned mentoring 156 all mentees felt that the program helped them with career goals and knowledge of the professional world. slightly more than half of the mentees indicated the program helped them to develop networks. this item had the lowest score for mentors and mentees and may reflect that for many of the dyads, communication was via e-mail and phone, which provided less opportunity for the social interaction involved in networking. table 2 displays the frequencies and percentages in the very much and somewhat categories for each of the likert-scale questions about participation in the mentoring program. table 2 mentors’ and mentees’ responses regarding participation in the program questions indicate whether … mentees n = 9 mentors* n = 11 f % f % the purpose of the program was clear 9 100% 11 (n = 11) 100% time was an issue for relationship to develop 6 67% 9 (n = 11) 82% time interfered with participation in the program 7 78% 5 (n = 10) 50% *the total number of respondents varied per question in the mentors’ column and percentages were calculated based on that number. the purpose of the program was clear to all participants. however, time was an issue that affected the development of the relationship and participation in the program. for the majority of the mentors, time was an issue for developing the relationship; and for the mentees, time was an issue for participating in the program. table 3 presents the results of the combined strongly agree and agree responses about mentees’ professional gains. table 3 mentees’ responses on professional gains questions how much do you agree or disagree with … mentees n = 9 f % it was important to meet a successful professional i could learn from 9 100% mentoring helped me feel more confident as a latina/o social worker 6 67% mentoring helped me value my qualifications as a latina/o social worker 6 67% mentees were in full agreement that it was important for them to meet a successful professional from whom they could learn. even though the majority (67%) felt that it had helped them feel more confident and valued, the impact of these aspects on professional self-esteem was not as strong as the authors had anticipated. table 4 presents the results of the combined strongly agree and agree responses about mentors’ professional gains. advances in social work, spring 2013, 14(1) 157     table 4 mentors’ responses on professional gains questions how much do you agree or disagree with… mentors n = 11 f % it was important for me to mentor a latina/o professional 10 91% mentoring gave me satisfaction and a sense of giving back 9 82% helped me value my qualifications as a latina/o social worker 9 82% the mentors’ response indicated a high level of satisfaction with the experience, with the satisfaction of giving back, and an increased professional self-esteem. the sharing of mentoring experiences that occurred in the first meeting triggered recognition and memories of their own mentors, and having the opportunity to mentor another latina/o to give back to the next generation, met the mentors’ developmental need of contributing and nurturing others. the findings of this evaluation have provided valuable feedback that has been used to modify and enhance the quality of the program. given the small size of the sample, the variation in the data collection process and the early developmental stage of the program, these findings must be taken cautiously and cannot be used to make generalizations. discussion groups’ comments at the fall and december meetings mentors and mentees were encouraged to share their experiences of the program. their comments are presented next and have been organized around the following themes: ethnic/cultural connections. while there was great diversity in their country of origin, the dyads felt connected as latina/os and shared a sense of responsibility for their ethnic community. mentors felt they were helping launch the new generation of latina/o professionals who will continue their work, “passing on the baton.” one mentor expressed that he felt that mentoring had a ripple effect and made the analogy to a pebble thrown in the water. the mentees felt they had somebody who understood their experience and represented a resource they did not have in their families. a mentor expressed: “i was a single mother going to school so i know what ...my mentee experiences. i have sons, and mentoring a female has made the connection very strong…it is like mothering a professional.” the mentees repeatedly commented that they were the first in their families to go to college and graduate school. a mentee shared how deflated she felt after a negative job interview and how the mentor was there to “hold” her, help her reflect on what went wrong, learn from the experience, and prepare for the next interview. in line with cultural values of familismo and personalismo the mentoring relationship often went beyond the strictly professional focus and took an interest in the mentee and in the mentee’s family. a mentee commented that early in the mentoring year she had been rojas schwan, negroni, santiago-kozmon/culturally-attuned mentoring 158 hospitalized for a heart problem and her mentor called her everyday “just to tell you that i am thinking of you and hoping for your recovery.” the mentee added, “…that meant the world to me and i think it contributed to my recovery.” a mentor of two consecutive years indicated that she had developed very close relationships with her mentees and she knew they would always have a special relationship. there was agreement when a mentee indicated that her experience with her mentor was “like having a second parent.” the value given by mentors and mentees to the group gatherings highlighted the importance of colectivismo which supported the creation of a community among all program participants. including family members in social activities reflected the consideration of familismo and strengthened the mentor-mentee connection. having everyone share their experiences with mentoring, their professional histories, how they have arrived to their present positions, and something personal in the orientation meeting reflected personalismo and served to build confianza. the sharing of food in the activities contributed to informal exchanges and community building. having a liaison. the liaison functioned as a back-up and monitored the relationship. participants’ comments indicated that once the relationship developed, the liaison was no longer needed. however, for some mentees, having the liaison meant that “there was another person who cared… and it made me feel more valued.” having one person specifically assigned to one dyad, as opposed to having a coordinator assigned to all dyads, had some benefits. it ensured more personal, frequent and intimate connections within the mentor-mentee dyad and thus more possibilities for the mentoring to succeed. professional growth. the mentoring offered a range of support, from addressing immediate needs and skill development to engaging in long-range planning. mentees felt understood, supported and encouraged to advance. they reported growth in their job application, interviewing, and negotiation skills. a mentee expressed that when she felt she had reached her goal, the mentor challenged her and said, “no… there is a ladder you can climb.” the mentee realized that she needed to change jobs to pursue employment that could provide opportunities to reach this new goal and was encouraged to take the next step of licensing. another mentee credited her mentor with helping her find strength to develop her skills: “i had never spoken in public and with the encouragement of my mentor, i spoke in a panel, and discovered such strength in myself; i received terrific feedback and now i know that i can do this and more.” for the latina/o network members developing the program there has also been satisfaction and growth. every mentoring activity led to the development of human capital among the latina/o professionals through training, education, knowledge and skills; (turner de tornes et al., 2013) and to the appreciation of the mentors and mentees. the mentors have been generous to give of themselves to nurture new professionals; and the mentees have been willing to trust and explore their fears and insecurities. it is reassuring to know that there are more social workers prepared and committed to serve the community, and that the two groups combined are contributing “nuestro granito de arena” (our grain of sand) to make it happen. the spirit of the mentoring program is reflected in the following quote by a mentee: “i would like to express my appreciation of the program and my mentor…[who] has been advances in social work, spring 2013, 14(1) 159     amazing and continues to mentor me. i am truly thankful and blessed that i have had the opportunity to meet such an amazing individual and am certain she will continue to touch the lives of those whom she meets and mentors.” applicability of the mentoring program this mentoring program represents a contribution to the field of mentoring because of its focus on latinas/os and the career of social work. the program validates the importance of mentoring programs attuned to the cultural experiences and values of latina/os. while there is scarcity in the literature about mentoring programs for graduate level students transitioning to the professional world, the authors propose that this program can be used with graduate students in other disciplines and other cultural backgrounds. experiences in other disciplines confirm the value of mentoring to support graduate professionals for successful career development (rivera-goba & nieto, 2007; williams-nickelson, 2009). specific recommendations for mentoring programs for professionals include consideration of demographics, i.e. gender, racial, and ethnic background in matching dyads; and inclusion of activities reflective of the culture when developing programs for specific cultural groups. programs should also consider the importance of a liaison to sustain the mentors and mentees’ energy and commitment to the relationship. this mentoring program can be replicated with the sponsorship of an agency or a professional organization. it requires committed staff or volunteers who have allocated time to coordinate the program. there is need to develop a connection with the schools of social work and the professionals of the ethnic community identified for the mentoring program. planning and implementation of the program needs to incorporate the cultural values of the particular ethnic group. the costs are minimal but essential to develop materials for recruitment and supplies for group gatherings. possible challenges include time demands and a need for continuous recruitment of mentors and liaisons. however, hearing about the gains for mentors and mentees and experiencing the success of the program is rewarding and generates the energy for all involved. so far, the program has offered mentoring to 20 graduating msw students and has involved 11 mentors. it is becoming known in the community, thus increasing awareness of the benefits of mentoring and networking among young latina/o professionals.   references adams, h. g. 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(2001). latinos: cultural competence and ethics. in r. fong & s. furuto (eds.), culturally competent practice: skills, interventions, and evaluations (pp. 4760). boston, ma: allyn and bacon. author note: address correspondence to: nelly rojas schwan, ph.d., school of graduate and professional studies, the university of st. joseph, 1678 asylum avenue, west hartford, ct 06117-2791. email: nschwan@usj.edu. ________ carrie w. rishel, msw, phd, professor, school of social work; sara guthrie, ma, phd student, department of sociology & anthropology; helen p. hartnett, ma, msw, phd, professor, school of social work, west virginia university. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 440-453, 10.18060/23640 this work is licensed under a creative commons attribution 4.0 international license. who am i and what do i do? developing a social work identity through interprofessional education and practice carrie w. rishel sara k. guthrie helen p. hartnett abstract: the purpose of this study is to examine social work professional identity development through interprofessional education and practice. the integrated mental and behavioral health training program (imbtp) was developed to prepare students for collaborative practice in integrated behavioral health settings. interprofessional education and training was a core component of the imbtp. at the conclusion of five cohorts (graduating 2014-2018), 61 msw students had completed the training program. content analysis of qualitative evaluation data revealed professional identity development as a recurring theme across multiple domains. results demonstrate that providing opportunities for social work students to participate in interprofessional education and training allows for a greater understanding of other professional roles and perspectives, while at the same time helping to solidify the role and identity of a social worker. social work education programs should consider including interprofessional education experiences for all students. keywords: interprofessional education; msw education; professional identity; integrated care fostering student development of a social work professional identity has long been a core component of social work education (miehls & moffatt, 2000; oliver, 2013; wiles, 2013). while always a complicated endeavor, the recent growth of interprofessional practice adds new challenges for social work students as they work toward forming their own professional identity (ambrose-miller & ashcroft, 2016; oliver, 2013). this article focuses on how the development of a social work identity can occur through interprofessional education and practice. the study stems from evaluation of student learning outcomes in a specialized training program intended to prepare students for collaborative practice in integrated behavioral health settings. the original goal of the data analysis was to identify key elements of the training model that enhanced student knowledge of integrated practice and ability to implement integrated and interprofessional practice skills. unexpectedly, professional identity development emerged as an important outcome of the training experience when students reflected on their learning in the program. students identified interprofessional experiences as integral in helping them to understand and solidify their role and identity as a social worker. social work identity social work educators know that becoming a social worker is not solely grounded in knowledge and skill development. professional identity development is complex and https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 441 involves internalizing a profession’s norms and values as part of one’s own behavior and self-perception (adams et al., 2006; levy et al., 2014). social work, as defined by the international federation of social workers, is grounded in a commitment to social justice, human rights, and empowerment of people, along with a respect for diversity (international federation of social workers, 2014). these are all value-based concepts that social work educators hope students develop and embrace as they grow into their roles as professional social workers. wiles (2013) notes that students must “develop a personal sense of being a social worker” in order to develop professional identity, and “that this can only emerge through opportunities to articulate this identity in both the workplace and academic setting (p. 864).” the social work field placement or practicum provides many students with their first opportunity to represent and articulate the profession of social work in a workplace setting (scholar et al., 2014). many educators consider the field placement experience as the cornerstone in student development as a professional social worker (loseke & cahill, 1986). as required by the council on social work education (cswe), social work students in placement are supervised by a professional social worker who holds a degree in social work (baccalaureate or master’s when supervising baccalaureate students and master’s when supervising master’s level students) and at least two years post degree experience. this ensures that a social work practice perspective is reinforced throughout the placement experience (cswe, 2015). with the recent growth of interprofessional practice, students may be placed in settings where their supervisor or field instructor is the only social worker among other professionals. in some cases, the social work field instructor may be off-site or external to the host organization and only meet with the student periodically to provide social work supervision. this raises a potential challenge for students in developing and maintaining a social work professional identity with limited social work role models while working among others who may not be familiar with the values and goals of social work (scholar et al., 2014). social work identity within the context of interprofessional practice a growing emphasis on prevention and related efforts to contain health care costs have resulted in the emergence and growth of integrated care approaches (zerden et al., 2017). integrated care includes a range of practice approaches that aim to coordinate physical and behavioral health services among behavioral and primary health care professionals. this coordination of services relies on effective interprofessional collaboration and communication (vogel et al., 2017). in response to this need, academic programs across the country have developed training models to prepare students to work effectively in interprofessional settings (e.g., abu-rish et al., 2012; bridges et al., 2011; davis et al., 2015; rishel & hartnett, 2017; zerden et al., 2017). for social work students, this means an increased likelihood of completing field placement experiences in settings where they work closely with colleagues from many professions, in comparison to working solely or mostly with other social workers. helping students develop a professional social work identity is especially important in a practice environment where students may be learning what it means to be a social worker without other social workers around to assist, and rishel et al./who am i and what do i do? 442 performing work within an interprofessional team that may utilize different approaches from the social work professional norm (oliver, 2013). development of a strong professional identity is an important factor in effective interprofessional practice (bronstein, 2003). effective team practice depends on knowledge contributions from each team member. uncertainty about professional identify and role conflict can impede knowledge sharing and cause problems within an interprofessional team (karpetis, 2014; mitchell et al., 2011). in a recent study of social workers and interprofessional collaboration, social work identity was recognized as an important factor that facilitated effective collaboration in team practice. specifically, participants emphasized the need for social workers to be confident in their identity as a social worker. closely related to professional identity, role clarification was another factor identified as important for interprofessional practice. participants noted particular challenges in team functioning when social workers were not clear of their role or the roles of their interprofessional colleagues’ (ambrose-miller & ashcroft, 2016). considering the changing practice context and growth of integrated care, the challenge for social work educators is to prepare students for interprofessional team practice (which often includes placement in settings that provide opportunities for interprofessional exposure, learning, and practice) while at the same time assisting them to develop a solid social work professional identity that supports their functioning as an effective team member. interprofessional education models, such as the interprofessional socialization (ips) framework, may help educators in guiding students through the process of social work profession socialization, professional role learning, understanding of other professions, and ability to integrate these into effective interprofessional practice (khalili et al., 2013). preparing students for interprofessional, collaborative practice has been identified as critically important in order to successfully implement new integrated health models that provide better health services and achieve improved health outcomes (gilbert et al., 2010). opportunities to work beside and learn with other professionals as part of a social work field placement can help prepare students to enter the workforce ready for collaborative team-based care (rishel & hartnett, 2018). learning the practice of social work within an interprofessional team, however, may also create tension between a student’s developing social work values and identity formation and the expectations within that interprofessional team and its organizational norms. some studies note that social work students and professionals report feeling a threat to their values and professional culture, an integral part of their professional identity, when practicing as part of an interprofessional team (barnes et al., 2000; wiles, 2013). the potential tension between social work professional identity and interprofessional practice is recognized in standard 2.03, interdisciplinary collaboration, of the national association of social workers (nasw) code of ethics. the standard states that “social workers who are members of an interdisciplinary team should participate in and contribute to decisions that affect the well-being of clients by drawing on the perspectives, values, and experiences of the social work profession” (p. 16). the standard goes on to state that “professional and ethical obligations of the interdisciplinary team as a whole and of its individual members should be clearly established” (nasw, 2017, p. 16). the nasw standards for social workers in health care settings provide further guidance for social advances in social work, summer 2020, 20(2) 443 workers practicing in interprofessional health settings. standard 8, interdisciplinary and interorganizational collaboration, notes that social workers should promote collaboration among team members and engage in interdisciplinary education to learn about each profession’s contributions to improving client outcomes (nasw, 2016). the balance of promoting interprofessional collaboration, while at the same time maintaining a social work professional identity can be challenging to navigate as a student in an interprofessional setting. this study specifically examines student development of a professional social work identity within the context of interprofessional education and practice. program overview responding to a national need to prepare social workers for interprofessional practice in integrated health settings, the west virginia university msw program developed the integrated mental and behavioral health training program (imbtp) in 2012. supported via 2012 and 2014 behavioral health grants from the health resources and services administration (hrsa), the imbtp aimed at preparing students for collaborative practice in integrated behavioral health settings. training emphasized prevention and intervention with particular focus on interprofessional approaches. the program was delivered via a cohort model with selected students from the larger msw program grouped together for specialized coursework, field instruction, advanced skills workshops, and mentoring. at the conclusion of five cohorts (graduating 2014-2018), 61 students had completed the imbtp. the training program included four key components: a) specialized advanced field placements in integrated behavioral health settings that included opportunities for interprofessional practice; b) required program-specific coursework, including two 3-credit courses entitled, “advanced clinical social work practice in integrated healthcare” and “child mental health: promotion, prevention, and treatment”; c) required training workshops with interprofessional colleagues (two per year) targeting behavioral health practice knowledge and skill development; and d) ongoing mentorship, leadership development, professional networking opportunities, and employment placement support. grant funding provided students with a $10,000 stipend to support training in advanced field placement. the stipend is intended to help students offset living expenses and allow them to focus more fully on their program of study than might be possible without the support. interprofessional education and training was a core component of the imbpt. students in the program had access to specialized advanced field placements that emphasized opportunities for interprofessional training and practice. participating field sites allowed students to practice with, and learn from, a variety of professionals working within a range of settings. field sites included health care settings (e.g., federally qualified health centers, hospitals, va medical centers), educational settings (e.g., public schools, early head start/head start), and other behavioral health settings (e.g., psychiatric treatment centers, university counseling center, adolescent residential placement centers). in all collaborating field sites, students had opportunities to practice on interprofessional teams with other health care professionals, educational professionals, and/or behavioral health rishel et al./who am i and what do i do? 444 professionals. students reflected on their field placement experiences in the classroom with other trainees where faculty facilitated discussion on the opportunities and challenges of integrated and interprofessional practice. students also participated in interprofessional education opportunities through full day workshops held each semester that included participants from a wide variety of professions to learn about and discuss specific topic areas relevant to integrated health care. a full description of the training model can be found in rishel and hartnett (2017). method participants as part of acceptance into the training program, students consent to participate in program evaluation activities. sixty of the 61 trainees completing the training program from 2014-2018 were included in this study. none of the students left the program before program completion. the one trainee who was not included was not able to participate the day that the qualitative free write was conducted for that cohort. of these 60 students, four graduated and completed the program in may of 2014, seven in 2015, 19 in 2016, 15 in 2017, and 15 in 2018. age of the students at program matriculation ranged from 21 to 51 with an average of 28.6 (sd=6.90). the majority of students identified as female (83%, n=50) and as white (87%, n=52). six students (10%) identified as black or africanamerican, one student as asian, and one as other. four students indicated that they were veterans of the united states military. procedures data collection. this study is part of larger study aimed at assessing student learning outcomes in the training program. a mixed-method approach was used for the larger study. first, students and field instructors rated student attainment of program competencies on a 5-point scale. second, students participated in a free-write and guided discussion to assess knowledge and skill gained and contribution of training program components to learning and preparation for practice. results of student learning outcomes related to competency attainment as assessed by the 5-point scale and discussion of associated knowledge and skill development are reported in rishel and hartnett (2017). the current study addresses the following research question: how does interprofessional education contribute to professional identity development in graduates of a behavioral health-training program? the free-write component of the larger program evaluation is used for this study. the freewrite consisted of two 10-minute sessions in which students were asked to respond to the following prompts: “how has the imbpt training influenced your knowledge of integrated practice in social work?”, “how will this knowledge be applied to practice?” the freewrite data were collected anonymously. data analysis. content analysis was used to examine the responses of students completing the training program from 2014-2018. all data were thematically coded using a directed content analysis approach (hsieh & shannon 2005). initial data analysis revealed professional identity development as a recurring theme across multiple domains. therefore, interpretation of the data was conducted systematically, and in relation to advances in social work, summer 2020, 20(2) 445 professional identity development. this approach first requires the creation of key concepts derived from this focus. using these concepts, a preliminary codebook was created outlining the operational definitions of the key concepts. after the creation of the initial codebook, the data was read through and all instances that matched the outlined operational definitions were noted. after the initial analysis, the data were revisited for further thematic coding. all the data that were not coded into the original domains, were again analyzed for the creation of additional categories. when appropriate, the data were subcategorized into the original coding schema. this resulted in the final codebook as found in table 1. all coding was conducted by the author who was not involved in the free-write data collection and following guided discussion in order to reduce potential bias in interpretation of student written comments. this research is considered curricular evaluation by the west virginia university irb and is therefore exempt from review. table 1. operationalization and frequency of identity domains code operationalization frequency interprofessional awareness/networking discussion of building professional relationships, beyond social work (integration with other disciplines) 43 growth/development as a social worker claim that the program has helped the individual become a better social worker or that they gained additional social work knowledge from the program 35 development of integration skills/ knowledge discussion of an increased understanding of integrated practice or increase in integrated practice skills 27 client care discussion of improved client care/ways to better serve the client (including holistic approaches) 23 advocacy discussion of wanting to advocate for change 17 confidence claim of increased confidence in social work ability/knowledge 15 prevention knowledge/skills discussion of increased knowledge of skills relating to prevention 13 peer collaboration discussion of importance of peer collaboration/support 8 results eight different domains related to social work identity development emerged based on the content analysis of the 60 end-of-program free-writes. students were most likely to discuss their “interprofessional awareness/networking” and “growth/development as a social worker.” both domains were salient, with over 40 instances of students mentioning “interprofessional awareness/networking” and over 30 instances of students discussing their “growth/development as a social worker.” “development of integration skills/knowledge” and “client care” were also both mentioned over 20 times. lastly, comments relating to “confidence” and “advocacy” and “prevention knowledge/skills” all occurred over 10 times. “peer collaboration” was the only domain that did not appear more rishel et al./who am i and what do i do? 446 than 10 times. table 1 depicts the operationalization used for each code and the occurrence frequency of each domain. while each of the following sections highlights a specific domain, a commonality across these domains is students’ ability to better understand the roles and identity of a social worker. interprofessional awareness/networking student responses were most likely to include some discussion regarding their growth of interprofessional awareness and networking ability because of the imbtp. students’ responses were coded into this domain if they discussed building professional relationships beyond the social work profession. students often discussed the importance of fostering relationships outside of the social work profession and how these relationships will strengthen their social work practice. for example, one student wrote, the appreciation i have developed for the various disciplines involved in healthcare teams (doctors, nurses, psychiatrists, first responders, etc.) will allow me to convey genuineness in all interactions and build professional rapport. (cohort 5) further, students often discussed their role as a social worker through the lens of integration. students expressed how the effectiveness of their work as a social worker was dependent upon building relationships with other professionals. for instance, the unique role of social workers in integrated models is to elicit some form of change, and to do this, it is necessary to build good working relationships. understanding the nature and value of collaboration with treatments teams and with clients will allow me to do my job adequately and effectively. building those relationships is really the most important aspect of my future practice. (cohort 3) lastly, students often mentioned the importance of interprofessional collaboration in achieving the best possible outcome for clients, as exemplified by members of cohorts 4 and 5, i realize now integrated is more than just [placing a] social worker in [a] hospital, it is a way of thinking. pulling from the strengths of doctors and social workers to produce better outcomes for the client. (cohort 4) the imbtp increased my knowledge of how to better communicate with other professionals to provide the best services. (cohort 5) growth/development as a social worker students also frequently identified professional growth as a benefit of the imbtp. this domain illustrates the individual’s growth as a social worker because of the unique opportunities provided through the program. many students pointed to the ability to grow their understanding of working with different populations. understanding the variety of people with whom a social worker will work is vital to effective practice. example comments include: advances in social work, summer 2020, 20(2) 447 it has helped to develop my skills with a variety of populations in a comprehensive way through our training seminars, coursework, and approved field placement sites. (cohort 3) there are many different ways that i can be involved in social work, and it doesn’t have to be the traditional child protective services or clinical counseling. (cohort 2) students also noted the ability to learn new models and techniques. acknowledging the need to have skills in multiple therapeutic models as a social work practitioner demonstrates an important step in professional development. for example, the imbtp increased my knowledge about therapy modalities cbt [cognitive behavioral therapy], mi [motivational interviewing], sft [solution focused therapy]. (cohort 5) lastly, students pointed to the benefit of learning their role as a social worker. students again expressed learning about their role as a social worker in relation to others, such as, …i have been able to see how i, as a social worker, can contribute in a multidisciplinary team of professionals. (cohort 3) development of integration skills/knowledge in addition to an increase in general social work practice knowledge, students also pointed to an increase in understanding integration and the skills needed to successfully engage in integrated practice. one student wrote, i have developed a working knowledge of the various forms of integration as well as the benefits and challenges involved. i have witnessed the many benefits of integration in the school system (school + community resources + mental/ behavioral health providers). (cohort 5) further, multiple students recognized the importance of the program in helping to shed light on the role of social workers within integrated settings. for example, the course specifically designed for this program provided a mental framework of what integration looks like in its many partial and at times fully integrated forms. it taught me my place within that framework, where i am a valuable part of the healthcare team. it also taught me the vocabulary i will need to explain the benefits of integrated care wherever i end up in the future. (cohort 5) another student pointed to the success of the program in teaching the importance of integration, and the role social workers can play in integrated practice. understanding the variety of roles a social worker can play is an important component of professional identity. the student elaborated that: this training has exposed me to a sector of social work that i didn’t have much knowledge of. the specific course requirements (integrated healthcare, child mental health) were beneficial in teaching me about how integrated services work, how they can be adapted and implemented, and their benefits on clients, rishel et al./who am i and what do i do? 448 professionals, and systems. i gained knowledge of the roles of a social worker/behavioral health provider in integrated care settings as well as how i could promote my own knowledge and skills to convince other professionals of the importance of these roles. (cohort 3) client care students often focused on the practical knowledge they could use to directly benefit their current and future clients. many discussed the importance of a collaborative approach to understanding the concerns and needs of their clients. for instance, all the professionals collaborate with one another in discussing every aspect of the client and decide with the client the best direction of treatment. this allows the client to be treated based on their needs. the implementation of integrated services can decrease onset as an adult, save taxpayers money and produce a more secure setting for the client in need. (cohort 3) further, students also noted the importance of meeting clients where they are. one student expressed, simply meeting someone where they are and offering them information and options based on their own wants/desires has the ability to open up further dialogue and/or treatment in the future. imbtp has taught me how to utilize resources and organizations to form a safety net around the most vulnerable individuals to help prevent negative outcomes. (cohort 5) another student noted, meeting the client where they are at means gaining an understanding of all the different systems that the client is a part of. (cohort 2) confidence students also reported feeling that they gained increased confidence in their role as a social worker because of their experience in the imbtp. this confidence may stem from developing a strong sense of professional role and identity. one student explained, i can feel confident working with adolescent populations. i feel confident working in a multidisciplinary team approach. (cohort 3) more specifically, many students noted their increase in confidence among other professions such as, i feel confident leading and/or participating in treatment team meetings with other professionals. (cohort 3) another specified, i now feel prepared to work as an effective team player in integrated, team, or bilocational professional and therapeutic settings. (cohort 3) advances in social work, summer 2020, 20(2) 449 in addition to feeling more confident in their abilities to work and collaborate with other professions, students also reported they were more confident in their ability to explain and advocate for integrated practice. for example, i feel more competent explaining the value of integrated practice to others. (cohort 3) another wrote, i feel that the knowledge that i have gained in this training program will allow me to be a leader in integrated care within our state. (cohort 3) these sentiments point to an important programmatic outcome as it critical for the profession to develop leaders in integrated care models. advocacy students highlighted an increase in motivation for advocacy as one of the outcomes of completing the imbtp. advocacy is a critical role in the profession of social work, but often undervalued by students planning to practice in traditional clinical roles. exposing students early to the need to participate in system level change as an integral component of social work may add to a greater understanding of the role of advocacy within the profession. generally, students expressed wanting to advocate for further implementation of integrated care in other settings. one student said, i will advocate for the use of integrated practice by educating co-workers, striving for continued knowledge regarding integrated practice, and promoting the research aspect. if my place of employment has already embraced an integrated practice approach, i will assist with its continued development, while advocating the practice with the resource partners which we interact with. (cohort 1) another student noted, my knowledge about integrated services will be implemented through practice by advocating for more integrated services, continuing to collaborate with other health care professionals, advocating for policy changes that allows for more integrated services, continuing to learn about the approaches of other professionals, working on treatment teams to ensure patients are receiving quality and effective care, continuing to stay knowledgeable on best evidence-based practices, and linking my patients to various services and resources that they may need. (cohort 3) further, students also articulated the importance of advocating for their patients from rural settings such as, as a rural social worker, i find it more necessary to advocate for ic (integrated care) settings in our state. (cohort 5) rishel et al./who am i and what do i do? 450 prevention knowledge/skills students were asked how the program helped to advance their understanding and knowledge of prevention interventions. as with other domains, the discussion of prevention was often related to an understanding of one’s role and identity as a social worker. one student wrote, the imbtp has also influenced my understanding of the role social workers play in prevention, and how it can be implemented in integrated settings. (cohort 4) other students noted, because of the training, i will think more about prevention efforts on a wide-scale, reaching kids before they need intensive care. (cohort 3) prevention is the logical way to spend resources. so many disorders/challenges can be prevented or minimized by prevention efforts. i believe this is the most important facet of integrated care. (cohort 4) peer collaboration while less salient than the other domains, students also noted the importance of peer collaboration within the program. in the instances when peer collaboration was mentioned, students often expressed the importance of these connections, and the unique opportunity to meet like-minded colleges. one student explained that the program:, gave me additional resources to depend on for knowledge through colleagues and other professionals met only in imbtp. (cohort 3) another student noted, the support of my fellow imbtp peers has dramatically increased my support system in learning. practicing collaboration with peers in the educational process has also enhanced my confidence in reaching out to others for advice and fresh ideas. (cohort 3) discussion results demonstrate that providing opportunities for social work students to participate in interprofessional education and practice allows for a greater understanding of other professional roles and perspectives, while at the same time helping to solidify the role and identity of a social worker. specifically, graduates report that interprofessional education and practice: 1) helped to expand their understanding of what is possible as a social worker; 2) created a social work practice perspective that goes beyond their original understanding (e.g., prevention, holistic and rural practice); and 3) helped them gain confidence to shape the service delivery system to more effectively utilize social workers in integrated settings. perhaps an unexpected benefit of interprofessional education is how it helped the students solidify a social work identity, not just learn how to work well with other professions. this project shows how professional identity is solidified by understanding social work roles as advances in social work, summer 2020, 20(2) 451 same and different from others in the helping professions. as students gained more clarity about others’ roles, they, in turn, better understood their own roles. several limitations of this study should be noted. results are based on the qualitative reported experience of students in one specific training program. their experiences may not be representative of others in similar training programs. additionally, data collection only occurred at the conclusion of training participation. collection of baseline data focused on student professional identity would allow for assessment of change in understanding of professional identity over time. future work in this area would benefit from intentional study design to specifically examine student professional identify development in interprofessional education and practice settings. the findings from this study have important implications for social work education. traditionally, the focus of social work education has often been training social workers (in classroom and field settings) surrounded by only other social workers. results from this study suggest that the development of a professional social work identity is not only possible in interprofessional settings, but that it is fostered or encouraged in ways that may not be possible in settings where students work only with other social workers. based on these results, it may behoove programs of social work to expose students to a variety of techniques and modalities used in other helping professions during their education. this could provide a more robust understanding and foundation for social work practice. additionally, social work programs should encourage field placement opportunities in interprofessional practice settings. allowing students the opportunity to work in such settings as they are formulating their professional identity could lead to a stronger sense of the profession and their place in it. references abu-rish, e., kim, s., choe, l., varpio, l., malik, e., white, a. a., craddick, k., blondon, k., robins, l., nagasawa, p., thingpen, a., chen, l., rich, j., & zierler, b. 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(2017). infusing integrated behavioral health in an msw program: curricula, field, and interprofessional educational activities. journal of social work education, 53, 59-71. https://doi.org/10.1080/10437797.2017.1288595 author note: address correspondence to carrie w. rishel, school of social work, west virginia university, po box 6830, morgantown, wv 26505. email: carrie.rishel@mail.wvu.edu acknowledgments: this project was supported by the health resources and services administration (hrsa) of the u.s. department of health and human services (hhs) under m01-25201, g02-28009, & m01-31391. this information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by hrsa, hhs or the u.s. government. https://www.socialworkers.org/linkclick.aspx?fileticket=ffnsrhx-4he%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=ffnsrhx-4he%3d&portalid=0 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://doi.org/10.1080/02615479.2013.765401 https://doi.org/10.1080/10437797.2017.1288593 https://doi.org/10.1080/02615479.2014.926320 https://doi.org/10.1007/s10865-016-9798-7 https://doi.org/10.1080/02615479.2012.705273 https://doi.org/10.1080/10437797.2017.1288595 mailto:carrie.rishel@mail.wvu.edu ____________________________________ jill s. levenson, phd, lcsw is a professor of social work, barry university, miami shores, fl. michael baglivio, ph.d. is the chief research officer at truecore behavioral solutions, llc, tampa, fl. kevin t. wolff, ph.d. is an assistant professor, john jay college of criminal justice. nathan epps, m.s., is with bureau of research & data integrity, fl dept. of juvenile justice, tallahassee, fl. william "chip" royall, lcsw is the director of outpatient services at truecore behavioral solutions, llc, tampa, fl. katherine c. gomez, ma is with the department of juvenile justice office of research and data integrity, tallahassee, fl. dahlia kaplan, lmhc, is the chief clinical officer at truecore behavioral solutions, llc, tampa, fl copyright © 2017 authors vol. 18 no. 1 (spring 2017), 313-334, doi: 10.18060/21204 this work is licensed under a creative commons attribution 4.0 international license. you learn what you live: prevalence of childhood adversity in the lives of juveniles arrested for sexual offenses jill s. levenson michael baglivio kevin t. wolff nathan epps william "chip" royall katherine c. gomez dahlia kaplan abstract: social workers often find themselves working with children or adolescents who have been victims of adverse childhood experiences (aces), including youths who have ended up in the juvenile justice system. childhood trauma has been linked to negative health, mental health, and behavioral outcomes across the lifespan. the aim of this study was to examine the prevalence rates of child maltreatment and household dysfunction in the lives of juveniles who have been arrested for sexual offenses (jso; n = 6,549). ace prevalence rates for jsos were compared by gender to juveniles arrested for other crimes, to adults arrested for sexual offenses, and to the general population. youths in the delinquency system in florida had much higher rates of high-ace scores than the general population, indicating that they came from households where the accumulation and variety of early adversity is a salient feature in their lives. for those who have engaged in sexually abusive behavior, the existence of early maltreatment and family problems was prominent. through a better understanding of the traumatic experiences of these youths, we can inform and enhance interventions designed to improve the functioning of sexually abusive juvenile clients and their families, and reduce risk of future recidivism. keywords: juvenile; sexual offense; ace; adverse childhood experience; early adversity; trauma-informed care social workers often find themselves working with children or adolescents who have been victims of maltreatment, including youths who have ended up in the juvenile justice system. early adversity has been clearly linked to negative health, mental health, and behavioral outcomes across the lifespan (centers for disease control and prevention, 2013; felitti et al., 1998). social workers and social service organizations have begun to embrace trauma-informed practices as a crucial part of the psychosocial assessments and interventions provided to clients in general, and to adult sexual offenders more specifically (levenson, 2017; levenson & willis, 2014; samhsa, 2014a; strand, sarmiento, & pasquale, 2005). the aim of this study was to examine the prevalence rates of child maltreatment and family problems in the lives of juveniles who have been arrested for https://creativecommons.org/licenses/by/4.0/ levenson et al./you learn what you live 314 sexual crimes. through a better understanding of the experiences of these youths, we can inform and enhance clinical and case management practices to improve the functioning of sexually abusive juvenile clients and their families, and reduce risk of future recidivism. adverse childhood experiences in the early 1990s the centers for disease control (cdc) partnered with kaiser permanente, a health maintenance organization, to study the prevalence of adverse childhood experiences (aces) in the lives of american adults (felitti et al., 1998). inspired initially by the observation of a curious phenomenon – that obese patients often had a history of childhood abuse – physicians hypothesized that adult health was sometimes compromised by traumatic experiences earlier in life. they postulated that painful childhood experiences, especially those that are chronic, can lead to high-risk coping behaviors (e.g., substance abuse, over-eating) which impact health and well-being across the lifespan (felitti, 2002). using a dichotomous 10-item scale, the ace researchers investigated the rates of five child maltreatments (sexual, physical, and verbal abuse, and physical and emotional neglect) as well as five common areas of household dysfunction (domestic violence, unmarried parents, and the presence of a substance-abusing, mentally ill, or incarcerated household member) in a sample of over 17,000 adults. one's total ace score is the sum of the items endorsed (range = 0-10), with higher scores indicating a greater degree of childhood adversity. perhaps most revealing about the study was the staggering frequency of aces; nearly two-thirds of these middle-class adults endorsed at least one item, and 12.5% endorsed four or more (cdc, 2013). subsequently, many studies have shown significant correlations and a dose-response relationship between early adversity and a range of medical and behavioral disorders including chemical dependency, physical disease, and psychopathology (e.g., anda et al., 2006; douglas et al., 2010; edwards, holden, felitti, & anda, 2003; weiss & wagner, 1998). adverse childhood experiences create toxic stress, leading to an over-production of hormones associated with survival responses (fight or flight), and producing neurobiological changes in the brain that can impede cognitive processing and selfregulation capacities (alink, cicchetti, kim, & rogosch, 2012; creeden, 2009; finkelhor & kendall-tackett, 1997; samhsa, 2014a; streeck-fischer & van der kolk, 2000; van der kolk, 2006). research has indicated that the multiplicity, frequency, and chronicity of early adversity creates what has become known as complex post-traumatic stress, manifesting in a constellation of maladaptive coping strategies, mental health symptoms, and behavioral problems (cloitre et al., 2009; herman, 1992; van der kolk, 2014). the frequency and correlates of aces in criminal populations aces were surprisingly common in the original cdc sample, but are even more pervasive in poor, minority, marginalized, and oppressed populations commonly served by social workers (eckenrode, smith, mccarthy, & dineen, 2014; larkin, felitti, & anda, 2014). pathogenic parenting and deprivational environments hinder family functioning and reinforce maladaptive coping styles, and household dysfunction is often exacerbated by the stress of impoverished socioeconomic conditions (patterson, debaryshe, & ramsey, 1990). criminal samples have higher rates of childhood maltreatment and household advances in social work, spring 2017, 18(1) 315 dysfunction than the general population, and exposure to early trauma was significantly associated with mental health disorders, drug abuse, and violence in adult offenders (harlow, 1999; messina, grella, burdon, & prendergast, 2007). prospective analyses from the chicago longitudinal study identified child maltreatment as a predictor of adult criminal behavior in a sample of over 1,500 low-income minority youths (mersky, topitzes, & reynolds, 2012). prisoners often witnessed violence in their childhood homes and communities, and reported many other types of traumatic experiences such as the death of a family member, parental abandonment, or out-of-home foster care placement (harlow, 1999; maschi, gibson, zgoba, & morgen, 2011). both male and female adult sexual offenders report childhood trauma at rates greater than the general population (levenson, willis, & prescott, 2015, 2016), with male sexual offenders (n = 679) three times more likely to report child sexual abuse (csa), twice as likely to report physical abuse, thirteen times more likely to have been verbally abused, and four times more likely to experience emotional neglect or having unmarried parents. among adult sexual offenders, ace scores were associated with persistence and versatility in arrest patterns, increased sexual violence and sexual deviance, and substance abuse disorders (levenson, 2015; levenson & grady, 2016; levenson & socia, 2015). physical and sexual abuse prospectively predicted increased risk of being arrested for a sexual crime (widom & massey, 2015). juveniles involved in the justice system are especially likely to have lived in chaotic homes where caretakers were poorly equipped to parent effectively or to protect their children from harm. research on justice–involved youths has consistently found higher rates of adversity compared to youths in the general population, and they are more likely to have suffered multiple and chronic forms of trauma (abram et al., 2004; baglivio et al., 2014; dierkhising et al., 2013). furthermore, these youths have a greater likelihood of child protection involvement and foster care placements, exacerbating traumagenic factors that contribute to the development of delinquent behavior (barrett, katsiyannis, zhang, & zhang, 2013). ace factors are inter-related, and high-risk youths are especially vulnerable to increased odds of multiple adversities (baglivio & epps, 2016). the emotional and behavioral self-regulation deficits commonly seen in maltreated youths can pave the way for disciplinary problems in school which can shift a child’s trajectory toward the “pipeline to prison” (wald & losen, 2003). the link between early adversity and development of sexual behavior problems notably, childhood trauma is associated with risky sexual behavior, such as early onset of sexual activity, higher rates of sexually transmitted diseases, unwanted pregnancies, and higher numbers of sexual partners (dietz et al., 1999; hillis, anda, felitti, nordenberg, & marchbanks, 2000). youths who were lured into sex trafficking and later arrested were found to have extraordinarily high rates of every single ace (the highest being parental neglect and sexual abuse), and higher cumulative ace scores than non-trafficked youths (naramore, bright, epps, & hardt, 2015). thus, maltreated children are especially vulnerable to re-victimization by sexual predators and human traffickers, but they may also be at increased risk for engaging in behaviors that violate the sexual boundaries of others. levenson et al./you learn what you live 316 the pathways to juvenile sexual offending are certainly varied and complex (burton, duty, & leibowitz, 2011). the etiology of sexually abusive behaviors seems to be fostered by early attachment disruptions, whereby attempts are made to satisfy unmet emotional and intimacy needs through sexual or aggressive means (bushman, baumeister, & phillips, 2001; grady, levenson, & bolder, 2016; marshall, 2010; smallbone & dadds, 1998). attachment theory proposes that if a child’s caretakers are not trustworthy, nurturing, consistent, and responsive to needs, youngsters will have difficulties establishing secure bonds with others across the lifespan (bowlby, 1977, 1988). chaotic home environments can preclude the development of healthy interpersonal skills, and inconsistent or abusive parenting styles may not model empathy (carlson & sroufe, 1995; cicchetti & banny, 2014; rutter, kim-cohen, & maughan, 2006). abused and neglected children are therefore exposed to relationships characterized by betrayal and invalidation, which contributes to distorted cognitive schema, boundary violations, disorganized attachment patterns, personality pathology, and emotional dysregulation (chakhssi, ruiter, & bernstein, 2013; loper, mahmoodzadegan, & warren, 2008; young, klosko, & weishaar, 2003). sexual offending may be one manifestation of these maladaptive responses. purpose of the current study the current exploratory and comparative study examines the prevalence of ace items and the distribution of ace scores of juvenile offenders at the time of their first arrest. juveniles who were charged with a sexual offense prior to turning 18 years of age are compared to those with only non-sexual arrests on each ace type and overall ace score. additionally, the juvenile sample ace measures are compared to prevalence rates in a sample of adult male and female sexual offenders reported in prior published research. finally, the rates of early adversity in this specialized population of juveniles arrested for sexual offenses (jso) are compared to general population statistics reported by the centers for disease control and prevention (cdc) based on data from over 17,000 adults in the original ace study. because differences have been found in prevalence rates of different adversities for males and females (felitti, 1998), all comparisons are gender-specific, meaning females and males are compared across samples separately. we hypothesized that jsos will have higher ace scores and higher prevalence rates on every ace item than the original cdc study participants. method sample the current study employs official florida department of juvenile justice (fdjj) charge data on all youths who aged out of the juvenile justice system (turned 18 years of age) between january 1, 2007 and december 31, 2015. of note, a youth may be continued on juvenile justice probation supervision past his/her 18th birthday. however, any new law offense committed after the age of 18 will be processed at the local adult jail and the charges will be handled in the criminal justice system. the purpose of the current study is to examine juveniles who were arrested for sexually-based offending prior to 18 years of age. additionally, arrest in the current study is not meant to imply all youths are “booked” and processed at a juvenile assessment center (i.e., there may not be a custody event). many advances in social work, spring 2017, 18(1) 317 instances, especially for sexual offending, there may be a gap between the event (the offense) and discovery. in these instances, charges may be incurred without a custody event. upon arrest, all juvenile offenders are assessed using the fdjj risk/needs assessment, the community positive achievement change tool (c-pact). the c-pact has been found predictive of recidivism for multiple samples of florida juvenile offenders for both males and females, and across age and dispositions (such as diversion, probation, and day treatment; baglivio, 2009; baglivio & jackowski, 2013; baird, healy, johnson, bogie, dankert, & scharenbroch, 2013; winokur-early, hand, & blankenship, 2012). additionally, the reliability of the c-pact was assessed using videotaped interviews and an offense history file, finding an intra-class coefficient (icc) of .83, with 4% of items (5 items) with less than 75% agreement with an expert rater (baird et al., 2013). the c-pact has two versions, a pre-screen and a full assessment, which both produce identical overall risk to re-offend classifications (low, moderate, moderate-high, and high risk). the versions differ in that the full assessment contains 80 additional items (not used in the overall risk to re-offend classification) that provide more detailed information about each youth. fdjj policy dictates that all rated as moderate-high or high-risk receive the full assessment, as must all youths being considered for residential placement, day reporting/day treatment, or the fdjj intensive family therapy services termed redirections (predominately multisystemic therapy and functional family therapy). these policies result in thousands of lowand moderate-risk youth also being assessed using the full assessment version annually. additionally, the vast majority of youth with sexual offending charges are assessed with the full assessment, regardless of overall risk to reoffend. the current study includes juveniles assessed with the c-pact full assessment during the study period (n=89,045; 19,910 females, 69,135 males). youths who were only assessed with the c-pact pre-screen were excluded, which intentionally oversamples higher risk youths. the c-pact pre-screen does not contain items to compute complete ace scores and therefore youths who were only assessed with the pre-screen were excluded from the current study. this process oversamples higher risk youths. specifically, an additional 423,413 youths that also aged out of the juvenile justice system during the study period were assessed with the c-pact pre-screen. the 89,045 youths included in the current study represent 17.4% of all youths that aged out, and were significantly (at p<.05) more male, black, younger at first arrest, had more history of detention placements, and were assessed as higher risk to re-offend. this demonstrates the current study may not be as generalizable to all juvenile offenders, but is generalizable to the most policy-relevant group, i.e., higher risk juvenile offenders. of note, only 0.3% of the excluded youths (prescreen only) has a history of sexual misdemeanor offense, and 1.6% had a history of a felony sexual offense. thus, the current sample of 89,045 youths included 46.3% low-risk, 18.7% moderaterisk, 21.9% mod-high-risk, and 13% high-risk youths, as classified by the full assessment. just under 7.4% of the juveniles evidenced an official charge for sexual offending prior to the age of 18. specifically, 312 females and 6,237 males were arrested for a sexual offense, levenson et al./you learn what you live 318 making the prevalence of female juvenile sexual offending 1.6% and male juvenile sexual offending 9% of all delinquent youths in the current sample. table 1 provides the race/ethnicity and age of the juvenile subgroup samples. table 1. male and female juvenile offenders with and without sexual offensesdescriptive statistics female jso* female non-jso male jso male nonjso ethnicity white 41.7% 48.7% 36.5% 40.1% black 45.0% 42.9% 46.0% 46.1% hispanic 12.8% 8.0% 17.0% 16.6% “other” 0.5% 0.3% 0.5% 0.5% age** 15.5 16.2 15.9 16.3 notes: *jso= juvenile sexual offense **average age at assessment upon first arrest. measures juvenile with sexual offense history (jso). study participants who had an official sexual offense charge prior to the age of 18 were classified as juveniles with a sexual offense history (=1, else= 0). sexual offenses could be either misdemeanor or felony offenses. juveniles classified as jso must have been arrested one or more times for a sexual offense prior to age 18, and could have been arrested for non-sexual offenses as well (meaning we are simply comparing juvenile offenders with at least 1 sexual offense to those without any sexual offenses, not necessarily general juvenile offenders to sexual offense-only juvenile offenders). of the 6,549 juveniles with sexual offense histories, the most sexual offense charges included felony sexual battery (58%), felony kidnapping with sexual offending (0.6%), other felony sexual offenses (34.7%), and misdemeanor sexual offenses (6.7%). thus, most juveniles with a sexual offense history (93.3%) were arrested for felony sexual offenses. the most frequent specific charge was felony sexual assault by sexual battery to a victim under 12 years of age (n=2,012, 30.7%). to clarify, “sexual battery” in florida refers to oral, anal, or vaginal penetration by, or union with, the sexual organ of another or the anal or vaginal penetration of another by any other object. ace exposures & ace score. while created to assess juveniles’ overall risk to commit delinquent/criminal offenses, the c-pact assessment contains items which encompass the ten specific ace items identified by the cdc (see felitti et al., 1998). the ace scale includes five child maltreatments and five types of household dysfunction. the exact items, responses, and coding used to create ace indicators and the ace score from c-pact data have been reported elsewhere (baglivio et al., 2014), and have been replicated in several prior studies (e.g.,baglivio & epps, 2016; baglivio et al., 2016; wolff & baglivio, 2016; wolff, baglivio, & piquero, 2015). the following ten ace indicators were included and coded dichotomously (yes = 1, no = 0):  emotional abuse: parents/caretakers were hostile, berating, and/or belittling to youth; advances in social work, spring 2017, 18(1) 319  physical abuse: the youth reported being a victim of physical abuse by a family member;  sexual abuse: the youth reported being the victim of sexual abuse/rape;  emotional neglect: the youth reported no support network, little or no willingness to support the youth by the family, youth does not feel close to any family member;  physical neglect: the youth has a history of being a victim of neglect (includes a negligent or dangerous act or omission that constitutes a clear and present danger to the child’s health, welfare, or safety, such as: failure to provide food, shelter, clothing, nurturing, or health care);  family violence: the level of conflict between parents included verbal intimidation, yelling, heated arguments, threats of physical abuse, domestic violence, or the youth has witnessed violence at home or in a foster/group home;  household substance abuse: history of parents and/or siblings in the household abusing alcohol or drugs;  household mental illness: history of parents and/or siblings in the household includes mental health problems;  parental separation/divorce: youth does not live with both mother and father;  incarceration of household member: there is a jail/prison history of family members. ace exposures were summed for a cumulative ace score, ranging from 0 (no exposures) to 10 (exposed to all indicators). again, aces were assessed at the time of first arrest of the juvenile. each ace indicator is self-reported by the youth (consistent with the original ace study; felitti et al., 1998), as well as corroborated with child welfare records (to which the assessors have access). the youth’s self-reported affirmative response, as well as instances in which child welfare records indicate abuse/exposure are counted as an endorsement of each ace item. instances in which child welfare investigations led to decisive findings that the maltreatment did not occur are counted as a “no” for a given ace indicator, and inconclusive child welfare investigations are captured according to the youth’s self-reported response. analytic strategy first, we conducted descriptive statistics for the ace items and ace score distributions of the jso group. group comparisons were then used to explore the prevalence rates of each ace item as well as the distributions of ace scores for jsos by gender, compared to non-jsos, adult sex offenders, and the general population. chi-square statistics were used to assess prevalence differences. due to the large sample sizes of juvenile offenders without sexual offense histories, we additionally supply measures of effect size to assess substantive significance (phi and cohen’s d). the adult sex offender data used in the comparison has been reported elsewhere (levenson et al., 2015, 2016) and was collected in a nonrandom sample of male and female participants surveyed in outpatient, prison, and civil commitment sex offender treatment programs across the united states (n=679 males, 47 females). finally, we provide a visual representation levenson et al./you learn what you live 320 comparing the overall ace scores of jsos, juveniles without a sexual offense history, adult sex offenders, and the general population (with gender-specific figures). results table 2 provides the results of analyses comparing female jsos with female juvenile offenders without a sex crime history. the original cdc study of female prevalence rates are also provided to provide reference for how juvenile offenders differ from a populationbased sample of adults. as shown, female jsos have higher prevalence rates than non-jso females in every ace category except emotional abuse and household incarceration histories. significant differences were found in the rates of physical abuse, sexual abuse, and physical neglect, as well as higher overall ace scores. the magnitudes of the effects are statistically significant, but would be considered small (cohen, 1988). importantly, results suggest that while two exposures are slightly higher for non-jso females, there is no exposure for which female non-jsos have statistically significantly higher rates than female jsos. additionally, female jsos evidenced higher prevalence on eight of the ten ace indicators than the female cdc sample. table 2. female juveniles with and without juvenile sexual offensesace prevalence and comparisons measure jso (n=312) non-jso (n=19,598) χ2 phi cdc study (n=9,367 ♀) emotional abuse 30% 34% 1.97 13% physical abuse 39% 28% 15.72*** .028 27% sexual abuse 42% 23% 64.78*** .057 25% emotional neglect 31% 27% 1.98 17% physical neglect 23% 11% 49.29*** .050 9% family violence 58% 55% 1.05 14% household substance abuse 22% 18% 3.25 30% household mental illness 10% 7% 3.30 23% separation/divorce 89% 87% 0.69 25% household incarceration 52% 53% .052 5% t-statistic cohen’s d average ace score 4.0 3.4 -4.06*** .23 note: jso= juvenile sexual offense history; *p<.05, **p<.01, ***p<.001. table 3 compares male jsos to non-jso males, and provides the original cdc study male prevalence rates for reference. jso males have significantly higher prevalence rates of physical abuse, sexual abuse, physical neglect, household mental illness, and separation/divorce than male juvenile offenders without a sexual offending history. additionally, the overall ace score is significantly higher for jso males, though not substantively meaningful, as both jso and non-jso males averaged just shy of 3 ace exposures. non-jso males evidenced higher emotional neglect and household incarceration than male jsos. it should be noted that only the sexual abuse difference (13% for male jso, 5% for non-jso males) is substantively meaningful, per effect sizes, but both groups show lower rates of csa than the cdc male population (16%). additionally, the overall ace score of 2.7 for male jso is more than 1 ace exposure lower than the 4.0 average for female jsos presented in table 2 (t=11.066, p<.001). male jsos evidence advances in social work, spring 2017, 18(1) 321 higher rates than the male cdc sample on five of the ten ace indicators, with a greater than ten times prevalence in household incarceration (46% compared to 4%; of note, nonjso males evidence even greater emotional neglect and household incarceration than the cdc males). table 3. male juveniles with and without juvenile sexual offensesace prevalence and comparisons measure jso (n=6,237) non-jso (n=62,898) χ2 phi cdc study (n=7,970 ♂) emotional abuse 21% 26% 81.78*** -.034 8% physical abuse 20% 15% 133.93*** .044 30% sexual abuse 13% 5% 725.25*** .102 16% emotional neglect 20% 22% 14.33*** -.014 12% physical neglect 11% 6% 201.93*** .054 11% family violence 38% 38% .242 12% household substance abuse 13% 14% 2.58 24% household mental illness 5% 4% 10.28** .012 15% separation/divorce 85% 83% 29.45*** .021 22% household incarceration 46% 48% 4.42* -.008 4% t-statistic cohen’s d average ace score 2.7 2.6 -4.81*** .06 note: jso= juvenile sexual offense history; *p<.05, **p<.01, ***p<.001. table 4 compares the 312 female jso youths (those reported in table 2) with 47 adult female sex offenders examined in prior work (levenson et al., 2015). the female jsos have significantly higher rates of physical neglect, family violence, separation/divorce, and household incarceration than those reported by adult female sex offenders, while the adult females reported higher rates of household substance abuse. the average ace score was also higher for female jso than adult female sex offenders, by almost one ace exposure (jso= 4.0, adult female so= 3.2). of note, the effect sizes are more substantial for this comparison than the prior comparisons within juvenile groups (tables 2 and 3). table 4. ace prevalence of females jsos compared to adult female sex offenders measure female jso (n=312) female so (n=47)a χ2 phi emotional abuse 30% 38% 1.17 physical abuse 38% 34% 0.34 sexual abuse 42% 50% 0.97 emotional neglect 31% 40% 1.75 physical neglect 23% 11% 3.91* -.104 family violence 58% 23% 19.67*** -.234 household substance abuse 22% 40% 7.40** .144 household mental illness 10% 21% 5.19* .120 separation/divorce 89% 47% 51.70*** -.379 household incarceration 52% 17% 20.32*** -.238 t-statistic cohen’s d average ace score 4.0 3.2 2.11* .33 notes: jso= juvenile sexual offense; so= sex offender; a= sample size for each ace indicator for adult females ranged from 46 to 47 due to missing data; *=p<.05, **p<.01, ***p<.001. levenson et al./you learn what you live 322 table 5 compares the 6,237 male jsos to 679 adult male sex offenders (so) examined in prior work (levenson et al., 2016). the prevalence rates of every ace indicator differed significantly between the groups; all but one had meaningful effect sizes. specifically, male jsos evidenced more family violence, absent parents, and household incarceration than adult male sos. adult male sos, in contrast, reported higher rates of emotional abuse, physical abuse, sexual abuse, physical neglect, household substance abuse, household mental illness, and a higher overall ace score. the largest substantive difference is in reports of household mental illness (26% for adult male so, only 5% for male jso). additionally, the reported rate of sexual abuse is nearly three times higher for adult male sos compared to male jsos (38% compared to 13% for male jso). table 5. ace prevalence of male jsos compared to adult male sex offenders measure male jso (n=6,237) male so (n=679)a χ2 phi emotional abuse 21% 53% 345.01*** .223 physical abuse 20% 42% 169.19*** .156 sexual abuse 13% 38% 288.49*** .204 emotional neglect 20% 38% 113.28*** .128 physical neglect 11% 16% 15.42*** .047 family violence 38% 24% 51.63*** -.086 household substance abuse 13% 47% 513.17*** .272 household mental illness 5% 26% 381.01*** .235 separation/divorce 85% 54% 398.31*** .64 household incarceration 46% 23% 136.30*** -.140 t-statistic cohen’s d average ace score 2.7 3.5 -7.27*** .30 notes: jso= juvenile sexual offense history; so= sex offender; a= sample sizes for each ace indicator for adult male sex offenders ranged from 635 to 676 due to missing data; *p<.05, **p<.01, ***p<.001. finally, figures 1 and 2 compare jso, adult so, and the original ace study sample of adults on each ace indicator for females and males, respectively. of particular importance are the comparisons at the tails of each distribution, namely the proportion with zero ace exposures, and the proportion with four or more exposures. as shown in figure 1, only 3.2% of the female jsos reported zero exposures, compared to 19.2% of adult female sos, and 34.5% of the females in the original cdc study. in contrast, while 15.2% of the cdc females self-endorsed four or more ace items (proven to have staggering health and psychosocial consequences later in life), 41.4% of adult female sos and 55.1% of female jsos reported four or more ace exposures. advances in social work, spring 2017, 18(1) 323 figure 1. distribution of ace scores by female sample figure 2 illustrates similar findings. thirty-eight percent of the ace study males evidenced zero exposures, compared to only 15.6% of male sos and 7.3% of male jsos. additionally, while 12.5% of ace study males reported four or more exposures, 45.7% of male sos, and 32.1% of male jsos endorsed four or more ace items. in contrast to the females discussed above (figure 1), for males, the adult sos evidenced higher overall ace prevalence than male jsos. figure 2. distribution of ace scores by male sample levenson et al./you learn what you live 324 discussion this study represents a large-scale investigation of the prevalence of early adversities in the lives of youths who encounter the criminal justice system, and in particular, those who are arrested for sexual crimes as minors. the findings lend support for our hypothesis: youths in the delinquency system in florida have much higher rates of high-ace scores than the general population, indicating that they come from households where the accumulation and variety of early adversity is a salient feature in their lives. for those who have engaged in criminal sexual behavior, the existence of early maltreatment and dysfunctional family dynamics is prominent. the differences in some of the prevalence rates between jso and adult sos are noteworthy. we speculate that some of the differences are due to the data collection methodologies. the jso data included official record reviews, while the adult so data were all self-reported retrospectively. most of the differences are seen on the household dysfunction items (e.g., domestic violence, substance abuse, mental illness, household member incarcerated, parental absence), which may be more likely to be documented in official records. on the other hand, it may be that official records of youths are less likely to detect certain events if the child is not disclosing it (such as sexual abuse). many children do not report abuse by close relatives or acquaintances, due to shame, fear, or loyalty to the perpetrator. it is also possible that some individuals do not recognize their own victimization, and this may be especially true for youths for whom abusive households or violent communities have seemed normalized. conversely, some offenders may embellish their maltreatment history as a way to gain sympathy or to obfuscate their criminal culpability. there may also be some generational differences. perhaps the adult sos grew up in an era where parents were less likely to be unmarried, and when policing was less aggressive, resulting in lower endorsements of unmarried parents and justice-involved household members. on the other hand, the adults tended to have higher rates of reported mental illness and substance abuse in their families, suggesting perhaps a greater awareness of these conditions in retrospect than during childhood, as well as a societal consciousness and responsiveness to these issues in recent years. interestingly, the female jsos had substantially higher rates of childhood sexual abuse (csa) than the general female population (42% compared to 25% in the cdc sample), but the male jsos reported lower rates than the general population (13% vs. 16% of males in the cdc sample). while adult male sos have reported much higher csa rates (38%) than males in the general population, perhaps male adolescents are less apt to report csa due to the stigma that remains for male victims. it is also possible that the male youths do not fully understand the parameters of sexual abuse and/or that they minimize the effects of their own victimization in attempts to alleviate guilt and shame for their own sexually aggressive behaviors. both male and female jso youths in the current sample had markedly greater rates of family violence, absent parents, and household members involved with the criminal justice system than the cdc sample, suggesting that an understanding of the role played by these interpersonal dynamics in the homes of justice-involved youths can provide insight into the psychosocial etiology of delinquent behavior. advances in social work, spring 2017, 18(1) 325 implications for trauma-informed social work practice and policy predictors of sexual deviance in adult male sex offenders have been found to include csa, emotional neglect, mental illness in the home, and unmarried parents, while physical abuse, substance-abusing parents, and having incarcerated family members have been found to predict sexual violence (levenson & grady, 2016). though there is no definitive victim-to-victimizer trajectory for maltreated children who go on to perpetrate sexual assault, sexually abusive behaviors sometimes compensate for feelings of disempowerment or invalidation. they may be learned from modeling an abuser's behavior and distorted thinking, or they become associated with sexual arousal due to early abusive conditioning experiences (seto, 2008). sexualized coping can become a way of soothing distress, and can also become a maladaptive strategy used to satisfy emotional needs such as intimacy, affection, attention, and control (bushman et al., 2001; levenson et al., 2016). the abused or neglected youth may seek out victims whom he perceives as weaker and who will not hurt him; younger children seem “safe” and therefore the jso feels less vulnerable. witnessing domestic violence models aggression and poor self-regulation, and distorts perceptions of intimate relationships. growing up with family members who are justiceinvolved may reinforce criminal modeling, and may also exacerbate feelings of hopelessness and helplessness for children observing such conditions in their own homes or experiencing the absence of a parent due to incarceration. disempowerment can create a distorted sense of entitlement, and violence can become instrumental in grasping a sense of power and control. finally, the chaotic household dynamics characterized by family violence may offer few opportunities to observe and experience healthy emotional attachments, paving the way for affective and behavioral dysregulation (ford, chapman, connor, & cruise, 2012). thus, youths with sexual behavior problems would likely benefit from traumainformed practices aimed at corrective experiences that help troubled youngsters identify unmet emotional needs and to meet those needs in healthy and non-victimizing ways. clinical staff and others working throughout the juvenile justice system are encouraged to avoid disempowering dynamics such as unnecessarily authoritarian interactions, and to model appropriate boundaries and respectful communication. the use of restraints and seclusion can be re-traumatizing for physically or sexually abused children. although they are occasionally necessary to ensure safety to self and others, they should be used cautiously and as a last resort. engaging youths in activities that foster self-efficacy is profoundly important, as they can promote cognitive transformation by which maltreated youths begin to view themselves as competent and worthy of love and respect. treatment for juveniles who have committed sexual offenses has historically relied heavily on psycho-educational models focused on distorted thinking about sexual abuse and relapse prevention, but should emphasize process-oriented relational interventions that can help youths improve interpersonal skills and alter general maladaptive cognitive schema (burton et al., 2011; cicchetti & banny, 2014). by understanding how childhood trauma contributes to deficits in self-regulation and relational skills, we can inform and refine correctional interventions that reduce future risk of recidivism (abbiati et al., 2014; levenson, 2014). the assessment and understanding of levenson et al./you learn what you live 326 the impact of early trauma is crucial in social work educational curricula and in practice across all problems and populations. trauma-informed treatments are those which incorporate common elements of client-centered engagement, therapeutic alliance, and emotional safety that transcend specific models of intervention (strand, hansen, & courtney, 2013; strand et al., 2005). childhood victimization can result in anxious and insecure attachment styles, and thus it is crucial for social workers to attend to the environmental context of delinquent youths and expose them to healthy emotional experiences that model empathy and effective interpersonal styles (grady et al., 2016; grady, swett, & shields, 2014; marshall, 2010; strand et al., 2013). the substance abuse and mental health services administration (samhsa, 2014b) emphasizes the need to engage behavioral health consumers in treatment settings that provide psychological safety and collaborative treatment planning, and to avoid harsh responses that can re-enact disempowering family dynamics and re-traumatize clients. finally, due to its long-reaching effects, childhood adversity is now commonly viewed as a public health crisis (anda, butchart, felitti, & brown, 2010; felitti, 2002; larkin et al., 2014). it is essential that public policies be reflective of our knowledge about the lasting impacts of toxic stress in childhood and their role in the development of criminal behaviors. childhood trauma, which is more prevalent in disadvantaged communities and oppressed populations (eckenrode et al., 2014), increases risk for poly-victimization and subsequent psychopathology (cloitre et al., 2009; finkelhor, turner, hamby, & ormrod, 2011). unfortunately, american social policies designed to address child maltreatment have focused more heavily on offender punishment and child placement rather than primary prevention strategies (larkin et al., 2014). in order to interrupt the intergenerational transmission of crime and victimization in our communities, it is critical that the child protection and juvenile justice systems invest in comprehensive prevention programs for high-risk families and intervene early with trauma-informed services for child victims (anda, et al., 2010; baglivio, et al., 2014; miller & najavits, 2012). as a final note, there were some important racial and ethnic disparities present in the data analyzed. jsos were more likely to be black than white, which differs from adult so samples (where about 67% are white and about 22% black; levenson, willis, & prescott, 2016). both suggest a significant over-representation of blacks compared to the u.s. census (13%) (u.s. census bureau, 2010). in this study, black girls and boys were extremely over-represented in the jso population. blacks and minorities are commonly seen in disproportionate numbers in criminal justice samples, suggesting that the legacy of historical trauma and the persistence of racial inequities are important factors to consider when serving delinquent youths with sexual behavior problems. limitations like any research, the current study is not free from limitations. the ace scale as a measure of early adversity is imperfect. clearly, there is an immeasurable array of traumatic experiences beyond child maltreatment and family dysfunction; the ace scale does not include extrafamilial or environmental factors such as community violence, poverty, discrimination, death, illness, natural disasters, or bullying. the ace scale is not intended to be an exhaustive measure of trauma, nor does it fully capture the scope of advances in social work, spring 2017, 18(1) 327 variables that contribute to sexually abusive behavior. furthermore, the dichotomous nature of the ace items does not allow for estimations of the frequency, duration, or severity of childhood traumas. given the retrospective and cross-sectional research design, statements of causality cannot definitively be made about the link between early maltreatment and juvenile delinquency, but the large sample size provides a generalizable estimate of the prevalence of early adversity in the lives of jsos. the current study relies on official records of sexual crimes by juveniles and, as such, may underrepresent the prevalence of offenses that do not come to the attention of authorities. furthermore, as the current study included only juveniles assessed with the pact full assessment (necessary to calculate ace scores), results may not be generalizable to lower-risk juvenile offenders. however, we note that higher-risk youths are the most policy-relevant group due to the fiscal and human costs of their offending on society, as well as prior work indicating higher-risk youths have greater childhood traumatic exposure (baglivio et al., 2014). the current analyses performed approximately 44 separate comparison of means tests for aces across samples. a very conservative bonferoni correction would suggest a p-value of .0011 (.05/44). we note, that all but five of the comparisons reached that very conservative level of significance. as such, we note the limitation of our experimental design in choosing to analyze ace by gender, as opposed to an aggregate analysis using composite scores with gender as a covariate. however, in defense of our approach, differences among specific aces are arguably more relevant to the practitioners and the field than simple comparisons of aggregate ace scores. conclusions the research is clear and compelling that childhood adversity, especially when it is chronic, contributes to a complex web of neuro-biological, social, psychological, cognitive, and relational impacts across the lifespan, and increases risk for criminal behavior (larkin et al., 2014; young, 2014). trauma-informed workers in the juvenile justice system should recognize the prevalence and impact of childhood adversity, expect the majority of clients to have experienced early trauma, and be well-versed in knowledge related to complex trauma responses and how they contribute to delinquent behaviors. social work practice with delinquent youths can be informed and enhanced by the literature on attachment, developmental psychopathology, and trauma-informed care. evidence-based 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(2003). schema therapy: a practitioner's guide. ny: guilford press. author note: address correspondence to: jill s. levenson, phd, lcs, professor of social work, barry university, 11300 ne 2nd ave, miami shores, fl 33161 or jlevenson@barry.edu mailto:jlevenson@barry.edu microsoft word luca sugawara_parental involvement in an emerging democracy copyedit2 _________________  carmen luca sugawara, msw, ph.d., is an assistant professor at the indiana university school of social work in indianapolis. jocelyn clare r. hermoso, msw, ph.d., is an assistant professor in the school of social work at san francisco state university. eva anđela delale, ph.d., is a faculty member in the department of social work, faculty of law, university of zagreb. key hoffman, ph.d., is a professor in the college of social work at the university of kentucky. diana lupšić, ll.m., is a ph.d. student at the indiana university school of social work in indianapolis. the authors wish to thank colleagues from proni centre for social education, osijek, croatia, for their support, interest, and flawless implementation of the research project in vukovar. special thanks to kristin farthing who, through frank discussions and editorial comments, provided valuable insight that improved the quality of the manuscript. finally, gratitude is extended to the vukovar community members who are exceptional in their efforts to reconstruct their community. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 451-470 parental involvement in an emerging democracy: the case of croatia carmen luca sugawara jocelyn clare r. hermoso eva anđela delale kay hoffman diana lupšić abstract: parental involvement in schools in an emerging democracy has gained significant attention among school administrators, educators, parents, local governments, and the international development community; yet, empirical data on this subject remains sparse. this study aims to examine the patterns of parental involvement in schools in croatian communities. using mixed-methods, the sample size consists of 294 elementary school parents, two focus groups (parents and teachers), and nine interviews with national and international stakeholders. the study found that, apart from the educational outcomes for children, parental involvement also may be an important platform through which parents can practice democratic behaviors and engage in community-building initiatives. through school-related activities, parents learn to interact with a government institution, voice their interests, participate in decisionmaking, leverage and use power, and cooperate with each other and the community. findings from this study can have implications for social work practice and social development assistance by recognizing how engaging parents in school-based activities can become a platform for community participation and democratic behavior. keywords: parental involvement, democracy, community participation, croatia introduction the last two decades have been turbulent for croatia, including both a war for independence and major democratic transformations in political and socio-economic systems. with the growing democratization as well as preparation to enter the european union (eu), important social transformations inevitably followed. social institutions, including schools, had to adjust their practices to meet new requirements and expectations for civic participation. in the schools, parents and community members alike were called, through the new educational reform from 2005, to engage and participate in decision-making processes in local governments and schools. parental involvement in schools in croatia became a topic of discussion among social scientists, educators, policy makers, and international development agents. international development stakeholders targeted parents and teachers with peace advances in social work, summer 2012, 13(2) 452  programming, reconstruction, and reconciliation programs immediately afterwards, and the interest continues. parental involvement in croatia is gaining even more attention from the international community in those communities that continue to be affected by the croat independence war. however, although implementers have paid significant attention to parental involvement in schools, very little empirical research has examined parental involvement as a social phenomenon in communities undergoing democracy and post-war community building. thus, the purpose of this research is to explore the patterns of parental involvement in croatian communities markedly affected by the war and its aftermath, to understand the why and how parents participate in school related activities, and to link that participation to emerging democratic behaviors. using data from a self-administered parent survey, we first discuss the dimensions of parental involvement in the vukovar region. further, through focus groups with parents and teachers, and interviews with community stakeholders, we identify and discuss the benefits of parental involvement in post war communities along with the factors that may contribute to increasing parental involvement in the elementary schools. we locate our research in the context of social transitions in schools in which educational reform demands a shift in parental involvement, thus inviting these changes to influence community members’ democratic behavior and participation in community building efforts. parental involvement in the emerging croatian democracy from traditionally centralized social institutions, functioning as a locus for acquiring knowledge, schools increasingly are becoming public spheres for practicing democracy, in which parents and the community come together to negotiate new roles in their children’s education and in their own communities (bauch & goldring, 1998; chan and chui, 1997; lewis & naidoo, 2006; mintrom, 2009). parents are no longer perceived as passive listeners in their children‘s education. quite the opposite, they became central stakeholders and active participants in the educational system. in the past, the parent teacher meeting was hardly more than a platform for practicing authority of the school (state) over parents (the citizens) thus causing most parents to avoid engagement (males, 1995). the new paradigm of parental involvement promotes a strong parents’ participation and parents-school-community relationships in which parents, teachers, and the community are no longer insular entities, but allies in educating children in a new socio-political context (bauch & goldring, 1998; dewey, 1921). parental involvement in schools is receiving increasing consideration in croatia because of educational reforms put in place as part of croatia’s preparation to enter the eu. in order to come closer to the contemporary european education practices and prepare for its accession to the eu, croatia was required to undertake serious actions related to its educational traditions and views on the role of schools, especially toward parental involvement. as such, several elements of the educational reform are worth mentioning. first is the creation of the croatian national education standard for primary schools, in which special attention was paid to broadening the definition of education to include both luca sugawara, hermoso, delale, hoffman, lupšić/parental involvement in croatia 453 transfer of knowledge and socialization; these standards also include the introduction of modern teaching methods requirements for ongoing professional training for teachers and cooperation among teachers, schools, parents, and local communities. for these reasons the education and teacher training agency was created (http://www.azoo.hr/). one of its responsibilities is to provide preconditions for the external evaluation of education. this change allows different stakeholders, including parents, to have a voice in improving the educational system. the assumption is that establishing a role for parents would lead to greater parental involvement. the second document on strategy of professional training for teachers 2009-2013 (http://www.azoo.hr/images/razno/strategija_su.pdf) suggests, among other propositions, higher involvement of local communities and parents in schools. in addition, the croatian education sector development plan for 2005-2010 (http://public.mzos.hr/fgs.axd?id=14194) calls on teachers and school administrators to establish networks of contacts and partner relationships with parents and the local community. finally, the law on upbringing and education in primary and secondary schools (national gazette, 87/2008) establishes specific school governance regulations, including mandating parents’ participation on school boards—an institutional change that represents a step forward through increasing participation of parents in the educational system. however, without much teacher/parent training on parental involvement or guidance on how to implement this school reform, the challenge of working and promoting parental involvement within this new paradigm is shared by both the parents and the schools. adding to this, the academic community in croatia did not historically include parental involvement as a priority topic. therefore, the literature on parental involvement in croatia is sparse and only subsequent to 2009 has attention been paid to it. as democracy was unfolding in the newly independent croatia, males (1996) notes that schools must develop democratic practices and open their doors toward parents’ engagement in educational processes. her work calls for a shift in the parental role from passive to active—from engaging parents not only in school activities and their children’s academic performance, but also in the school’s decision-making process and in building partnerships between the school and the community. when the family, school, and the community work together, the rewards may go beyond improving students’ academic success to improving schools’ atmosphere, providing needed family services and support, and increasing parents’ human capital through the connection of families with others in the school and in the community (epstein, 1995). echoing males’s work, a 2010 study on parental involvement (pahic, miljevic-ridicki, & vizek vidovic, 2010) also finds schoolparent communication in croatia to be traditional, in which schools would determine the educational goals and subsequently, and sporadically, inform parents about those goals. investigating the differences in the perception of school-parent cooperation between parents who are not included in school advisory bodies and parents-representatives in school bodies, the study discovered that parents showed interest in engaging in school because they believe such participation would benefit their children advances in social work, summer 2012, 13(2) 454  with this shift, parental involvement in schools becomes especially challenging, particularly in those communities affected by war and divided along ethnic lines. one such area, the vukovar region in eastern croatia, continues to be heavily affected by the croat independence war. more than 15 years after the end of the war, the city of vukovar remains ethnically segregated. the ethnic division is especially marked in the educational system (freedman et al., 2004); croatian and serbian children attend different classrooms, on different floors, and often at different times. both the academic and international development communities have focused on the school segregation, but much of the research done in schools examines residents’ views on the war and prospects for reconciliation (corkalo et al., 2004), with little focus on parental involvement per se. in addition, research on parents’, teachers’, and students’ attitudes toward the present and future of education (corkalo biruski & ajdukovic, 2008)—specifically, the role that public education plays in the process of reconstruction (corkalo biruski & ajdukovic, 2007; freedman et al., 2004)—occupies the research agenda. these foci add great value to the body of literature on schools, but parental involvement continues to receive short shrift in the literature. this article serves to fill the gap and provide an understanding of parental involvement in the vukovar region, typical of communities struggling toward democratization and post-war community building. parental involvement and community participation for decades of work and research, parental involvement in schools has been mainly focused on outcomes derived from involving parents in their children’s education, and both literature and schools’ experience have established a clear relationship between parental involvement and students’ academic achievements and motivation to succeed in school (clark, 1983; comer & haynes, 1991; epstein & dauber, 1991; henderson & mapp, 2002; steinberg, lamborn, dornbush, & darling, 1992). this focus of research also established that schools clearly are interconnected with the community in which they exist, to the people they serve, and to the values they uphold. schools and parental participation may be used as a platform to become civically engaged in the community. when parents practice parental involvement, this behavior engenders participation in education and in the overall community concerns (castells, flecha, freire, giroux, macedo, & willis, 1999). more precisely, researchers have examined parent participation as a civic capacity (stone, doherty, jones, & ross, 1999) or as community leadership development (shatkin & gershberg, 2007). the underlining thesis is recognizing that investments in parents will encourage citizens to engage in a more vigorous civic life. by working with parents to hone their skills and increase their participation in decisionmaking groups at the school level, and most importantly, by participating and working with other parents in traditional events such as a spring carnival, parents begin to become acquainted with each other, learn to respect one another, and eventually begin to see themselves as participants in school/community programs as opposed to viewing the other as a competitor (schraft & comer, 1979). their research supports the assertion that principles of participation, empowerment, civic engagement, and asset-based community development bolster the parent involvement initiatives and create greater community capacity. luca sugawara, hermoso, delale, hoffman, lupšić/parental involvement in croatia 455 contrary to the parental involvement/ community building approach, there are scholars who examined the role of schools in post-war social reconstruction and identified that, while schools have the potential to be central social institutions for socialization and community reconstruction, they may also play a divisive role in a community. a case in point is the city of vukovar in croatia in which researchers (corkalo biruski & ajdukovic, 2007) identified that parental attitude and behavior may be connected to children’s discrimination toward those who are seen as different from themselves. the view is supported in weinstein, freedman and hughson’s (2007) work in croatian schools, by recognizing that schools are considered positive social agents in communities, but they can also contribute to identity-based conflicts. nonetheless, this study suggests that schools are not only education institutions; they are also institutions that can take on responsibility for community building efforts. although it is worth spending time on discussing this possible relationship between parental involvement and community building, until parental involvement is empirically studied in a war-torn community and clearly defined, it is premature to discuss the parental involvement-community building equation. thus, the main purpose of the study aims to examine the patterns of parental involvement in elementary schools in the vukovar region, to understand how and why parents participate in school related activities, and to link that participation to emerging democratic behaviors. lastly, it aims to identify specific factors that contribute to increased positive parental involvement in elementary schools in the region of vukovar, croatia. research context: the city of vukovar and its region the city of vukovar is located on the river danube, on the border with serbia, in a region of the country well known for its fertile land and wine production. before the 1991-1995 war, the area was an example of a functional and integrated multiethnic community, in which more than 20 ethnic groups made their home and peacefully coexisted for decades. these communities had been characterized by dense social networks and ethnic integration, in which community members socialized with one another without regarding or even necessarily knowing the other’s ethnic background (corkalo biruski et al., 2004; corkalo biruski & ajdukovic, 2009). nevertheless, the pre-war instability and war overtook this community and erased the calmness and the spirit of togetherness. pre-war instability was marked by the continuous economic, social and political crisis in yugoslavia during 1980s and by the breakdown of both communist rule and of federal state itself by 1989, as well as of ideological and value system. political instability created the atmosphere of fear and production of national animosity and hate that, coupled with and the first free democratic elections held in former yugoslav republics suddenly brought upon the rise of national issues and closed ethnic groups within themselves. silence and deterioration of inter-personal trust and inter-group relations soon became a common place in many heterogeneous communities, such as vukovar. trust was lost even before first shots in the war were fired, and thereafter the vukovar community developed as separate, ethnic communities (corkalo biruski & ajdukovic, 2009). advances in social work, summer 2012, 13(2) 456  during the massive and overwhelming war that followed, vukovar community was severely traumatized as thousands of lives were lost – many in one of the first massmurders of the following wars, families have fallen apart, with intense massive destruction of housing, infrastructure, and symbolic eradication of symbolic objects. the war attempted to erase all culture and history belonging to other groups. many vukovar citizens of croatian origin have disappeared, with tens of thousands expelled from their homes throughout the rest of croatia. extreme traumatizing experiences, suffering and losses have burdened this community, especially its croatian majority, and contribute to poor prospects for community recovery and healing. thus, reconciliation among citizens appears difficult (corkalo biruski & ajdukovic, 2009). the post war atmosphere does not appear to foster social interaction and it is possible that the divisions within schools have deepened disconnections among the community members. the erdut agreement signed in 1995 aimed to facilitate the integration of the minority groups in vukovar, including croat students and teachers (who were displaced in 1991), whereas the schools for serbs in vukovar had operated and served the existing serbian community from 1991 to 1998. several provisions of erdut agreement such as separate schooling for croat and serb children, remained in place for years after its expiration in 1998. according to erdut agreement, the serbian community has chosen 'a model of schooling' 1 with all teaching held in serbian language and script, in practically separated schools, while it was also possible to choose more integrated 'b model' or 'c' model. all this said, division remains today1 . today, the city of vukovar remains divided, symbolizing the reality that a deeper sense of reconciliation has failed. the ethnic communities are separated by mistrust, divided institutions and disappointment. lately, some people report positive improvements, as some participants have mentioned in our pilot study. however, vukovar and its region still remains a stark contrast when compared to multi-ethnic and integrated city of vukovar prior to war. methodology study design and procedures this study applied a mixed research methodology using principles of participatory research (israel, schulz, parker & becker, 1998; wallerstein & duran, 2006) within a cross-sectional research design. for the quantitative aspect of the study, data were collected using a self-report questionnaire for parents during their parent-teacher meetings. focus groups with parents and teachers, and interviews with community stakeholders were the main source of data for the qualitative segment of the study. parental involvement is conceptually defined as any form of interaction between parents and schools, such as: parenting, which encompasses any form of interaction between parent-child school activities; communicating, reflecting on any type of parent-school communication and in turn monitoring the students’ academic progress and development; meeting/volunteering, reflecting on the parents’ participation in school governance and meetings in the school; and collaborating, through which parents identify and connect luca sugawara, hermoso, delale, hoffman, lupšić/parental involvement in croatia 457 resources form the community with the school to help students develop and achieve their academic full potential (epstein, 1991, 1994, 1995). planning and setting up the field research was an important first step. the principal investigator (pi) was from the school of social work from a university based in the united states. two other co-pis included a faculty member from another u.s.-based university and a faculty member from a university in croatia. the research team also included a community research partner based in vukovar. although the community research partners were well respected in their community, the school principals demonstrated a high level of mistrust toward any postsecondary education was experienced. it is assumed that the mistrust stemmed from many years of partnerships with research projects, national and international, that did nothing but collect data to satisfy academics’ publication interest or project requirements, without much responsibility towards enhancing the well-being of the community. thus, as part of the participatory process that the researchers intended to promote was to step back, and let the community members decide whether they would collaborate on this research initiative, laying down the clearly identified steps of the research and post-research plan. from the six elementary schools approached, two confirmed their interest in the study and two new elementary schools (outside the city of vukovar) heard about the project and asked to be included in the sample. the levels of participation (cornwall & jewkes, 1995) used in this study was consultative and collaborative among the schools, the community and the research partners. description of sample due to perceived low levels of trust at the community level, we employed an availability sample, based on schools’ interests in further studying parental involvement. the sample consisted of 294 elementary school parents from two urban and two rural schools in the region of vukovar. both urban schools participating in this study are considered segregated schools in which children from different ethnic backgrounds, majority croats and serbs, attend school at different times, or in different classrooms. one of the rural participant schools has five branches in small villages around the town of vukovar–most of them being predominantly serbian ethnicity. the sample characteristics of our study participants are presented in table 1. for the qualitative segment for the study, an availability sampling approach was used to recruit participants for the focus groups with parents and teachers and for the interviews with stakeholders. the parents and teachers were from the schools where the quantitative questionnaire was previously administered. the participants come from different ethnic backgrounds and were from both rural and urban areas. the teachers’ focus group was made up exclusively of female participants while the parents’ focus group consisted of both males and females. there were five participants for the teachers’ focus groups and six participants for the parents’ focus groups. nine stakeholders participated in the interviews. they were parents, school principals, and local governance representatives involved in education and governance of elementary schools, along with representatives of non-governmental organizations and research institutes that work on education and social change in elementary schools in vukovar. advances in social work, summer 2012, 13(2) 458  table 1: demographic characteristics of sample frequency percentage gender female 229 79.5 % male 59 20.5 % age 22 to 29 29 11.4 % 30 to 35 105 41.2 % 36 to 40 74 29.0 % 41 to 49 44 17.3 % 50 and above 3 1.2 % ethnicity croat 90 33.0 % serb 181 66.3 % others 2 .7 % education elementary school 34 12.5 % three years of secondary school 16 5.9 % secondary school 194 71.6 % college or university 25 9.2 % graduate school 2 .7 % employment status employed full-time 131 47.0 % employed part-time 7 2.5 % unemployed 132 47.3 % retired 8 2.9 % war-veteran 1 .4 % marital status single/never married 3 1.1 % married 260 91.5% separated/divorced 10 3.5 % widowed 4 1.4 % not married but living in a marriage-like relationship 7 2.5 % instrumentation and measurements for the quantitative aspect of the study, we used the parent and school survey (pass) adopted from ringenberg, funk, mullen, wilford, and kramer (2005). prior to its application, an instrument testing for cultural sensitivity took place based on which several questions where removed or adjusted. both the survey and the focus groups and semi-structured questions received irb approval. the survey had 46 main questions and 85 contingency questions to gather more data on specific themes under examination. to measure the main research variable – parental involvement – a factor analysis was performed using principal component analysis with a promax rotation. out of 18 luca sugawara, hermoso, delale, hoffman, lupšić/parental involvement in croatia 459 questions that measured parental involvement following epstein’s conceptualization (1995), only 16 loaded into three major factors: parent-child-school activities, parentschool relations (communication and monitoring), and parent-school-community collaboration. moreover, to test the internal consistency reliability of each scales, cronbach’s alpha were calculated (see table 2). while the alpha is low (.666) for the parent-school-communication scale, we believe it is due to this new paradigm of linking and understanding schools and parental involvement in a changing community and political climate. table 2: the reliability of parental involvement scales: parent-child-school activities, parent-school communication, and parent-schoolcommunity collaboration parental involvement scales items mean sd coefficient alpha parent-child-school activities 6 17.55 3.14 .711 parent-school relations 5 16.11 2.54 .739 parent-school community collaboration 5 13.20 2.52 .643 for the qualitative component of the study, semi-structured interviews were run for both the focus groups and interviews. quantitative data analysis. demographic and survey data was entered in statistical package for the social sciences program (spss); frequencies and descriptive statistics were calculated. factor analysis was performed to create parental involvement subscales, which helped explain the dimensions of parental involvement in croatian communities. qualitative data analysis. the analytic approach used was a basic hermeneutic inquiry while content analysis was the method used to sort through the documentation. the digital recordings of the focus groups and interviews transcribed on to a word processing document. the transcriptions were then exported on to atlas.ti which was the qualitative data analysis software used to code the data. in analyzing the focus group and interview transcripts, three researchers conducted line-by-line coding by identifying relevant text (auerbach & silverstein, 2003) or meaning units (engel & schutt, 2009). we then categorized these relevant text or meaning units into repeating ideas or themes. with each of the three coders, a peerdebriefing session was conducted to discuss the list of themes and their supporting meaning units or relevant text. as a peer-debriefing group, we developed theoretical constructs that demonstrate how the themes relate to one another. we then wrote our theoretical narrative, which discusses the theoretical constructs we came up with concerning parental involvement. the theoretical narrative weaves together our theoretical constructs, the voices of the research participants, and the literature on parental involvement. advances in social work, summer 2012, 13(2) 460  results and discussion dimensions of parental involvement several findings emerged regarding parental involvement in the vukovar region. we begin with a discussion of the dimensions of parental involvement. although we operationalized parental involvement through epstein and dauber’s (1989) and epstein’s (1991, 1994, 1995) six constructs (parenting, communicating, volunteering, learning at home, decision-making, and collaborating with community), our factor analysis results revealed only three main factors that explain the existing dimensions of parental involvement in that region: parent-child-school activities, parent-school relations (communication and monitoring), and parent-school-community collaboration. it is not surprising that volunteering and decision-making constructs did not retain in the factor analysis. these are constructs anchored in democratic practices, new to the schools and the parents. until schools recognize that the responsibility of education must be shared, and that parents need social and political skills to make the school work to their own and children’s educational advantage, the struggle to promote volunteerism and parents’ participation in schools and decision-making process will continue. among the skills that might help parents successfully participate in various school-democratic structures are: knowledge about persuasive speeches, strategies of community practice, decision-making practices, budgeting, voting, power, and parliamentary procedures (schraft & comer, 1979). however, this does not imply that it is the school’s role to teach parents such skills. since the schools struggle to embrace democratic practice in the new educational reform, the civil society organizations (csos) may be a starting point in the engagement of parents to become community leaders, insuring that citizens take a more active role in matters that affect their own lives. a closer examination of the each of the three dimensions of parental involvement echoes the reminiscence of an authoritative, centralized school system, in which schools are still perceived as solely responsible for children’s education. first, when examining the parent-child-school dimension, data reveal a medium to low involvement of parents in their children’s school related activities (mean=1.91, sd=.776). seventy-four percent (74%) of parents reported a medium to low involvement in their children’s education (see table 3). specifically, the itemized parent-school activities’ subscale highlights that parents engage in a low level of reading to their children (52% of parents surveyed reported that they do not read to their children) (see appendix 1). this finding was also supported by our qualitative interviews, in which a teacher clearly stated that “i encourage parents not to read to their children, as this is our job; they should nurture them, feed them, clean them, and our job is to educate them”. luca sugawara, hermoso, delale, hoffman, lupšić/parental involvement in croatia 461 table 3: the parental involvement subscales second, our data show that parental involvement measured through the parent-school relations is medium to high (mean=2.13; sd =.706). eighty-one percent (81%) of parents reported that they felt comfortable visiting the school, talking with the school administration, and getting informed if any problem were to occur with their child while in school (see appendix 1). parent-school relations are basic to building strong parental involvement programs. while croatian scholars (males, 1995; pahic, miljevic-ridjicki & vizek vidovic, 2010) have identified that parents-school relationships remain authoritative, the fact that schools and parents continue to communicate with one another is an asset for a democratic parental participation. the focus should now be on helping both parties recognize that they are equal stakeholders in their children’s education with different roles. when parents feel respected and engaged in their children’s education, they become more willing to attend school functions and stay connected which consequently influences students’ academic success. lastly, our data reveal a medium to low parent-school-community collaboration (mean=1.77; sd =.725). low involvement in parent-school-community collaboration was reported by 41% of parents; 42% reported medium involvement, and only 17% reported high involvement (see appendix 1). this is an important finding, especially in the context of educational reform. with the major societal changes during this reconstruction period, schools can no longer remain in traditional roles. this is a time in which both, the school and the parents must unite their efforts to build bridges with community services and resources that would strengthen school programs, family practices, and students’ learning and development (epstein, 1995). further information on parents-school-community participation will be discussed when presenting the qualitative findings. subscales mean sd n % 1. parent-child-school activities low medium high 1.91 .776 73 83 55 35% 39% 26% 2. parent-school relations low medium high 2.13 .706 46 116 76 19% 49% 32% 3. parent-school-community collaboration low medium high 1.77 .725 66 69 28 41% 42% 17% the subscale is rated on a 3-point scale, ranging from 1=low, 2=medium, 3=high advances in social work, summer 2012, 13(2) 462  defining and explaining (the why) of parents participation the qualitative component of this study focuses on depicting parents’, teachers’, and stakeholders’ narratives reflecting on parental involvement in the region of vukovar. the focus groups and the interviews sought to discover how each of these groups defined parental involvement, the rational ‘being involved’, and the factors that might enhance parental involvement. the research participants’ understanding of parental involvement can be categorized in two ways. the first refers to the conventional understanding of parents participating in parent-school meetings, parent teachers associations, school councils, and similar venues to address concerns about their children’s academic outcomes. the second understanding of parental involvement provides a broader perspective of parents’ participation in schools by viewing it as a way of building communities parental involvement as community building. parents inevitably become part of a community without consciously thinking of it. they begin to spend time with one another and develop relationships. the following quote illustrates that: “when your child starts going to school, you will have to meet the other parents regardless of whether you want it or not. you become a member of the community that consists of the parents of all the children that go to the same class. you get to know people… start talking to them and develop relationships” (parents focus group). especially in communities affected by ethnic division, this is an important finding that calls for a closer examination of the role that parental involvement may play in building social capital in the community. apart from relationships with other parents, parental involvement also serves as venues for parents, teachers, and other stakeholders to dialogue on issues beyond school matters. “i like it when the parents feel free, and actively participate, when they want to exchange their opinions with me” (teachers focus group). for example, “on the open doors day ...the environment is informal so while talking to the teacher, issues might be mentioned that otherwise would not. it is a chance to improve things. on parental meetings usually particular topics are discussed, you cannot bring up anything besides that, but if the occasion is informal it is easier to talk about other things, such as concerns about the community, neighborhood, or other topics alike” (parents focus groups). the fact that parents use parental meetings as an opportunity to address other community concerns seems to indicate that parental involvement, aside for being a central factor for students’ academic success, it may also provide a space for building democratic skills (community engagement and public speech). what these findings suggest is that parental involvement might be an important platform to practice democracy and achieve community. it is with no doubt that when parents begin to share their ideas and dialogue with their community members, regardless of their professional community roles, they build a sense of community and begin practicing democracy. in other words, our findings support mintrom’s (2009) work on the relationship between local democracy and education. when communities invest in parental involvement, and create that platform for parents to become involved, parents begin to exercise their voices opening opportunities for stronger democratic engagement. luca sugawara, hermoso, delale, hoffman, lupšić/parental involvement in croatia 463 our findings also recognize that parental involvement enhances parents’ sense of personal power and their sense of community contribution. the opportunity to be involved, whether by being a guest speaker, or giving a workshop, affirms parents of their own capacities and contribution to that school and that their voices count. the occasion offered by participating in decision-making on their children’s education trains parents on democratic practice. parents not only learn to articulate their views but also listen to different points of view. these venues for interaction between parents and schools are akin to the citizenship schools organized by septima clark and other civil rights organizers in the south that taught african-americans basic literacy as well as democratic literacy (levine, 2004). parental involvement in schools can thus serve as citizenship schools for communities rebuilding from conflict. at the same time, the increased sense of personal power and community contribution that parents experience creates new power struggles between them and the teachers and school administrators. the more parents get involved, some teachers become uncomfortable with parents over-stepping their boundaries, even while they encourage greater involvement of parents in the schools. “there is always the risk that the parents will try to meddle into the school’s business, which is not always desirable. parents think they do not know less than the teachers, but still they do not have the methodological and pedagogical knowledge as a person who mastered that as faculty does. parents are not always welcome to interfere into the expert’s field, but they play the greatest role when it comes to their child’s upbringing.” with more parents becoming involved in decisionmaking around their children’s education, such conflicts will be inevitable. the idea is not to avoid these conflicts but to handle them thoughtfully. unless managed wisely, such conflicts can actually hinder rather than strengthen social relations of parents with other teachers. encouragements of dialog related to these topics would also facilitate parental role construction and enhance their motivation for involvement as well as make teachers more prepared for parental involvement into schools and educational reform. factors enhancing parental involvement the following conceptual constructs delve into the factors that enhance parental involvement in schools. first, parents and teachers shared ideas of how to engage parents, to take part in decision-making concerning their children’s education as well as in school policies. although the typical structures of parent councils were suggested, there were also ideas shared about simplifying ways for parents to be more involved. “having fun is what matters, not educating; education is for teachers to worry.” “others also talk about allowing the process of parental involvement take its natural course rather than strictly enforcing it.” this gets back to comer and haynes’s work (1991) on the pyramid of parental involvement which suggests three levels of parental involvement. the first level is that in which parents get involvement in general activities around school, such as christmas celebration events, gardening programs, flower festivals excursions, and bread days. by attending these events, parents not only share their resources and capacities with the school community, but activities help them build a sense of pride and satisfaction by seeing their children performs. when parents are encouraged to attend school events and are reminded of the good ‘news’ of their children’s performance (as opposed to the more advances in social work, summer 2012, 13(2) 464  ‘bad’ news), they tend to become more interested in coming back or participating in parental involvement initiatives (comer & haynes, 1991). along the same lines, other constructs shed light on how often parents might participate in school activities and how teachers and school officials may make a conscious effort to include parents in decision-making and in the conduct of activities (involving parents as often as possible). one way of building parents’ capacities, apart from providing opportunities for on-going training, is to create opportunities for their participation. hands-on experience is believed to be one other way of enhancing parents’ knowledge and skills in school involvement. the other two levels promoted through this pyramid of parental involvement are parents involvement in the day-to-day classroom activity and school activities (level two), and parents elected by the parents group to participate in the school planning and management structures (level one) (comer & haynes, 1991). this pyramid of parental participation could be a good starting point for enhancing parental involvement programming in the vukovar region. with the school division along ethnic lines, starting with parents’ encouragements to participate in general school events and then moving to more specific involvement of parents in academic activities and leadership may help build a sense of trust and belongingness among community members. conclusion by examining croatian parental involvement in postwar communities, this mixedmethods study contributes to the empirical literature on parental involvement and community participation. our data demonstrate that when parents become involved in a school related event, they form new relationships, learn that their voices count, get involved in decision-making processes, and create a space in which to dialogue about mutual concerns. in doing so, parental involvement may become a platform to practice and learn democratic behavior. however, for this to happen, we also learn that parents and schools have to be educated and empowered to embrace new roles and responsibilities in an emerging democracy. especially in areas affected by war and an ethnically divided community, our findings remind us that by supporting parental participation in school, we are investing in the community as a whole. while the literature on parental involvement and community building is at a formative stage, primarily consisting of case studies of school reform (shatkin & gershberg, 2007; stone et al., 1999; wohlstetter & briggs, 2001), this study goes further through the provision of empirical evidence that supports the relationship between community participation and parental involvement. furthermore, this study calls for further research that will provide additional empirical evidence on the relationship between parental involvement and the social fabric renewal in post war communities. notes: 1. three different models of education are available to national minorities in croatia (doolan, 2010): model a schooling is implemented entirely in the language and script 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(2001). key elements of a successful school-based management strategy. in j. simmons (ed.), school reform in chicago: lessons and opportunities (pp. 351-372). chicago: chicago community trust. author note: address correspondence to: carmen luca sugawara, msw, ph.d., indiana university school of social work, 902 west new york st., indianapolis, in 46202-5156. email: clucasug@iupui.edu luca sugawara, hermoso, delale, hoffman, lupšić/parental involvement in croatia 469 appendix i i. parent-child-school activities subscale subscale items mean sd strongly disagree % disagree % agree % strongly agree % q3: i frequently talk with my child about school 3.60 .546 1 1 37 61 q6: i read to my child every day 2.42 .881 16 36 37 11 q9: i have visited my child classroom several time in the last four month 3.05 .804 6 12 53 29 q10: there are many children’s books in our home 2.97 .899 10 12 49 29 q11: i have attended activities at my child school several times, the past four month (school presentations, kids acting, singing, recitals, participated in parents-teachers meetings, parents’ workshops, etc.) 2.83 .785 6 23 53 18 q13: reading books is a regular activity in our home. 2.69 .921 14 22 47 17 ii. parent-school relations subscale subscale items mean sd strongly disagree % disagree % agree % strongly agree % q1: i feel very comfortable visiting my child’s school 3.13 .779 8 1 61 30 q2: if my child misbehaved at school, i would know about it soon afterward 3.24 .664 3 5 58 34 q14: if my child will have problems (academic or behavioral) in school, i would know how to get extra help for her/him. 3.16 .751 6 5 58 31 q17: i feel comfortable to come to my child’s school. 3.22 .712 7 8 57 28 q18: the leaders (school directors, teachers) of our children’s school facilitate honest conversation among students, and families from different ethnic backgrounds 3.23 .752 5 5 52 38 advances in social work, summer 2012, 13(2) 470  iii. parent-school-community collaboration subscale subscale items mean sd strongly disagree % disagree % agree % strongly agree % q5: i always know how well my child is doing in school. 3.18 .773 6 5 54 35 q7: i talk with other parents (regardless of their ethnicity) frequently about educational issues. 3.05 .747 6 9 61 24 q8: my child attends community programs regularly (library readings, ngo extra-curricular activities, and other community fun events). 2.82 .840 8 20 52 19 q15: in the past 4 months, i volunteered (help clean the classroom, assist the school with various activities, etc.) at my child’s school. 1.93 .665 23 65 9 3 q16: i know of many programs for children in my community that are free and accessible to everyone, such as artfairs events, eco-projects, library programs, ngo programs, etc. 2.40 .879 18 33 41 8 microsoft word smith osborne article_final bb2 _________ alexa smith-osborne, ph.d. is assistant professor of social work, university of texas at arlington. support for the preparation of this article was given by a university of texas arlington research enhancement grant and a grant from the hogg foundation for mental health. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 34-50 supporting resilience in the academic setting for student soldiers and veterans as an aspect of community reintegration: the design of the student veteran project study alexa m. smith-osborne abstract: the post 9/11 gi bill is leading an increasing proportion of wounded warriors to enter universities. this paper describes the design and development of an adapted supported education intervention for veterans. the intervention trial was one of two projects which grew out of a participatory action research process aimed at supporting reintegration of returning veterans into the civilian community. this intervention is being tested in a foundation-funded randomized controlled trial in a large southwestern university, with participation now extended to student-veterans at colleges around the country. some protective mechanisms which were found in theory and in prior research were also supported in early results. sed intervention was associated with the protective mechanisms of support network density, higher mood, and resilience. practitioners may benefit from the lessons learned in the development of this supported education intervention trial when considering implementation of this complementary intervention for veterans reintegrating into civilian life. keywords: veterans, resilience, supported education, psychiatric rehabilitation, gi bill introduction the department of defense (dod) has initiated innovative efforts to support mission readiness and prevent mental health problems among troops in current conflicts. these efforts use two theoretical frameworks, resilience and positive psychology, which show goodness of fit with military emphasis on proactive preparedness and adaptive fitness and training (e.g., britt, adler, & bartone, 2001; castro, 2008; cornum, matthews, & seligman, 2011; mojica, 2010; office of the u.s. army surgeon general, 2003, 2008, 2009; orsingher, lopez, & rinehart, 2008). community institutions which serve military members and families, taking over educational, health, and social service delivery from dod institutions when military service is done, may enhance continuity of care and community reintegration by adopting service models consistent with these theoretical frameworks. choice of theory has important implications for measurement (luthar, 1993, luthar & cushing, 1999), goodness of fit of intervention with target group (greene, 2007; holter, mowbray, bellamy, macfarlane, & dukarski, 2004; luthar, sawyer, & brown, 2006), and fidelity of intervention implementation (bond, evans, salyers, williams, & kim, 2000; borrelli et al., 2005). academic settings are one important community institution for returning service members, as pursuing higher education has been identified as a key goal for smith-osborne/ supporting resilience for veterans 35 today’s all volunteer force (avf) soldiers (asch, fair, & kilburn, 2000; fernandez, 1980; national priorities project, 2006), including those with this combat era’s signature conditions (hall, 2009; tanelian & jaycox, 2008). this paper describes the design and development of an innovative intervention utilizing a resilience theoretical framework to support community reintegration via the academic setting, and reports first wave results. theoretical considerations: who may benefit from supported education for veterans and through what mechanisms this author’s prior resiliency-based research has suggested several potential protective mechanisms which may operate to support educational attainment for avf veterans with mental health risks and service-connected disabilities (smith-osborne, 2009a; 2009b). further, evidence-based practices in supported education (sed) have already been established for the civilian college population with psychiatric disabilities (anthony & unger, 1991; holter, mowbray, bellamy, macfarlane, & dukarski, 2004; national public radio, 2002); approaches to their wider dissemination have also been investigated (mowbray, bellamy, megivern, & szilvagyi, 2001; mowbray, moxley, & brown, 1993). how might supported education, adapted to a resilience theory framework consistent with military prevention programs, operate to promote recovery, community reintegration, and advancement for military/veterans in the academic setting? the resilience theoretical paradigm would indicate that supported education can operate by four protective processes against mental health risk (rutter, 1990). initial findings from this intervention trial (reported below) suggest that supported education intervention for this population may operate by several of these processes. the first type of protective process reduces the risk impact, which could be suggested in this intervention trial by reduced or stable levels of symptoms (e.g., post-test ptsd symptoms) for the intervention group compared to unchanged or increased symptoms for the control group while functioning in the academic setting. operation of the second type of process, to reduce negative chain reactions stemming from the risk factor, would be suggested by unchanged or decreased post-test resilience scores in the control group compared to increased or sustained scores in the intervention group. the third type of process promotes resiliency traits, which could be suggested by higher posttest scores on resilience and associated evidence-based protective factors (such as informational support network measures) for the intervention group. the fourth type of process operates by setting up new opportunities for success. the recent passage of expanded financial aid benefits under the new post 9/11 gi bill represents one such opportunity (mcchesney, 2008; merrow, 2008). however, prior research suggests that the gi bill alone may not be sufficient to support veterans’ access to higher education without effective collateral social, health, academic, and income support systems (smith-osborne, 2009a; 2009b). brokering of concrete and informational resources necessary to educational success (e.g., internships, scholarships, faculty mentoring, family income support, and child care) is a component of supported education models (anthony & ungar, 1991; mowbray, 2002). intervention effects on educational attainment variables such as college entry, use of nonadvances in social work, spring 2012, 13(1) 36 va as well as va financial aid, grade point average, and retention could provide evidence that supported education operates by this process. a parallel theoretical paradigm which may be useful is the job control model for high demand and ambiguous work contexts (dubow, schmidt, mcbride, edwards, & merk, 1993; karasek, 1979). ambiguity may characterize academic settings as contrasted with the more highly structured and directive military occupational setting (although both are high demand). this model suggests that increased latitude (relative flexibility and autonomy) in making decisions about work methods and scheduling mediates ambiguity and conflicting demands so as to prevent burnout. from this perspective, a preventive mechanism by which supported education could support resilience is through providing targeted consultation and mentoring to student veterans in exercising decision latitude in their educational decisions, thus preventing emotional exhaustion which may be related to school drop-out (hobfall, 1989; hobfall, johnson, ennis, & jackson, 2003; meilman, manley, gaylor, & turco, 1992). thus, a supported education model such as the chooseget-keep program (collins, mowbray, & bybee, 1999), which utilizes an explicit goalsetting and decision-making protocol, may operate via increasing decision latitude to prevent emotional exhaustion and (potentially) college drop out. a higher proportion of avf troops are married with families, compared to earlier combat era cohorts (defense manpower data center, 2008; karney & crown, 2007), suggesting that family resilience may also need to be addressed in order to support student veteran resilience. lavee, mccubbin, and patterson’s double abcx model of family adjustment and adaptation (1985) has been used to investigate military families under stress and to suggest ways to enhance family resilience in earlier conflicts (mccubbin & dahl, 1976; mccubbin, dahl, lester, benson, & robertson, 1976; mccubbin, hunter, & dahl, 1975). the double abcx model highlights the importance of family appraisals of the associated hardships, and of the perceived resources and vulnerabilities for dealing with them, rather than solely the stressors themselves. the later revised version, the resiliency model of family adjustment and adaptation, includes post-crisis variables descriptive of the long-term adaptation phase (mccubbin & mccubbin, 1991), suggesting goodness of fit for supported education intervention. student veteran project intervention design current service delivery systems and models are reported to have limitations in reaching and serving avf personnel with service-connected co-morbid conditions (batten & pollack, 2008; hoge, auchterlonie, & milliken, 2006; seal et al., 2010). design and development of innovative interventions for this population must address these limitations, as well as be based on applicable substantive theory and empirical efficacy and effectiveness evidence. therefore, the design of the target intervention began with a participatory action research (par) approach (viswanathan et al., 2004) to engaging a range of stakeholders in the community, the va, and higher education settings in the identification of these limitations and how they could be addressed in connection with veterans’ educational goals (smith-osborne, 2009c). from this process emerged two trajectories: the development of efforts to enhance a veteran-friendly campus at the host institution under the auspices of a newly created interdepartmental smith-osborne/ supporting resilience for veterans 37 steering committee (being studied as implementation research [fixsen, naoom, blase, friedman, & wallace, 2005] using mixed methods) and the development of a randomized clinical trial of an adapted manualized supported education program with a comparison “usual care” group and a wait-listed control group. this paper reports on the second effort. the clinical trial, entitled the student veteran project, selected the choose-get-keep supported education model (sullivan, nicolellis, stanley, & macdonald-wilson, 1993) as the experimental intervention due to its established efficacy and effectiveness with civilian populations, the consistency of its goal-setting emphasis with the job control theoretical model, and its consistency as a psychosocial rehabilitation program with resilience and family resilience theory (carpenter, 2002), as described above. this choose-get-keep model has a manualized protocol developed by the boston university center for psychiatric rehabilitation (knighton, mcnamara, & nemec, 2002) which is being slightly adapted for veterans with the participation of a student-veteran advisory group. the manual identifies more than 70 practitioner skills that facilitate client success in the educational environment; examples are requesting assistance, taking notes, developing a study plan, budgeting, recognizing conflict signs, disclosing disability information, requesting feedback, and responding to feedback. in the interest of fidelity and generalizability, the adaptations are limited to the skills practice components (e.g., role play scenarios) of the lesson plan modules. they are modified to reflect typical student veteran environment: for example, a house share with other veterans, some of whom are non-students, rather than a residential rehabilitation program, and budgeting which includes a va disability pension instead of a supplemental security income benefit. a protocol for the comparison group was developed based on information and referral case management strategies commonly used in academic advising and retention of non-traditional students (astone & schoen, 2000; calloway & jorgensen, 1990; ofiesh, rice, long, merchant, & gajar, 2002; paul, 2000; rummel, costello, acton, & pielow, 1990; swail, redd, & perna, 2003; weiner & wiener, 1997). such strategies typically use student-accessed online information platforms, and case management through email and telephone follow-up, so this “usual care” group protocol emphasizes these technology-mediated contacts. prior research (smith-osborne, 2005; 2009a; 2009b) provided the foundation for intervention design, identifying resilience protective mechanisms moderating or mediating the impact of mental health risk factors on educational attainment at the personal, interpersonal, and systems (see figure 1); they are incorporated in both the target intervention model and in usual care, and are communicated in study recruitment as well as during the setting of intervention goals. advances in social work, spring 2012, 13(1) 38 method design as introduced above, one result of the par process was the development of a three group randomized controlled clinical trial of sed for veterans returning to college. procedures for random assignment and allocation concealment are described in smithosborne (2008; 2009c). figure 1. empirically identified protective factors applied within the selected theoretical frameworks incorporated within the target and comparison interventions. personal domain *family income *psychosocial functioning interpersonal domain: direct *living with spouse *few children systems domain: direct *sed program *va and nonva aid *urban *↑health insurance positive educational outcomes interpersonal domain: indirect *information social support→ mh tx systems domain: indirect *ptsd tx→va educational benefits resilience and family resilience theory job control theory mh = mental health; tx = treatment; ptsd = posttraumatic stress disorder; va = veterans administration; sed = supported education program. sample recruitment approval was obtained from the author’s institutional review board (protocol 07.225s). participants are recruited at community events, employment offices, veteran services, and colleges (see figure 2). measures and procedures measures participants complete questionnaires at pre-random assignment, post-intervention period, 6 months follow-up, and 12 months follow-up. data on contact frequency and type (“dosage”), health status, and mental health treatment engagement are collected from case records maintained during the intervention period and from qualitative interviews. baseline analyses examine demographics and measures of resilience (resilience scale for adults), social support (perceived neighborhood scale), social smith-osborne/ supporting resilience for veterans 39 network density (density of support), ptsd (ptsd checklist-military), mood (short mood and feeling questionnaire), and substance abuse (cage-aid). a complete description of measures may be found in smith-osborne (2008) and of the conceptual and logic and measurement model in smith-osborne (2009c). figure 2. participant flow chart following consolidated standards of reporting trials guidelines. itt = intent to treat. enrollment assessed for eligibility (n= 125) excluded (n= 35)  not meeting inclusion criteria (n=4)  declined to participate (n= 31) randomized (n=90) allocation (control n = 28) allocated to intervention 1 (n=31)  received allocated intervention (n= 31)  did not receive allocated intervention (n =0) allocated to intervention 2 (n= 31)  received allocated intervention (n= 31)  did not receive allocated intervention (n =0) follow-up (control lost to follow-up n = 3) lost to follow-up (deployed/moved) (n= 2) discontinued intervention (n= 0) lost to follow-up (moved) (n= 2) discontinued intervention (n=0) analysis (control n = 25) (control for itt n= 20)  analyzed for correlations (n= 26) analyzed for itt (n= 23) excluded from analysis (missing data or data not yet entered) (n= 4) analyzed for correlations (n= 24) analyzed for itt (n= 21) excluded from analysis (missing data or data not yet entered) (n= 4) smith-osborne/ supporting resilience for veterans 40 intervention fidelity strategies fidelity procedures were developed and progressively refined during this design phase of the project (smith-osborne, 2011). fidelity ratings enhance validity in clinical trials, and provide an important base for translation of results to implementation as evidence-based practices by community providers (borrelli et al., 2005; greenhalgh, robert, macfarlane, bate, & kyriakidou, 2004; mowbray, holter, teague, & bybee, 2003). fidelity strategies recommended by borelli et al. (2005) were utilized. intervention adherence was assessed for the following standards. intervention dose consists of a standardized 1 hour intake interview, followed by contact sessions over 26-30 weeks. the minimum 4 sessions for the manualized intervention (group 1) are 1.5-2 hour sessions. the minimum 4 sessions for group 2 are delivered through an online platform, email, telephone, and face to face contact. contact ≥ 30 minutes addressing an intervention goal are counted and online platform use is tracked. videotapes of the experimental intervention and progress notes of the usual care comparison were also rated by a trained practitioner panel using a standardized checklist. staff training during the par phase of intervention development, prior to intervention delivery, online training modules were developed and pilot-tested for this study to provide training in military culture and benefit structures, to support implementation of the choose-getkeep manualized protocol with a military population, to support uniform implementation of the usual care services, and to provide grounding in the theoretical framework and targeted protective mechanisms. all providers used a standardized intake format (cournoyer, 2008) and study-specific multi-component (herschell, kolko, baumann, & davis, 2010) training and supervision. data analysis baseline data see table 1 for sample characteristics. this population resembles the average demographics of avf veterans, except for higher educational level at time of study enrollment (avf average is 14 years, the same as draft-era vietnam veterans; smithosborne, 2009a). descriptive, bivariate (n = 75), and multiple regression analyses (n = 26) using spss 17.0 of the developmental phase sample examine demographic and key risk and protective factors for baseline and short term (pre/post) completers (little, 1995; pocock, 1992; schulz & grimes, 2005a, 2005b). exploratory analyses of the key factor of resilience were repeated using intent to treat procedures (n = 64). intent to treat analyses use the entire sample that was randomized regardless of intervention dosage/participation. these linear mixed model repeated measure analyses for the two time points with multiple imputations for missing values were conducted using sas 9.0 (abraha & montedori, 2010; cook & demets, 2008; singer, 1998). this type of intent to treat analysis is more robust in handling groups of smith-osborne/ supporting resilience for veterans 41 unequal sizes, non-normal data, and categorical and continuous variables in longitudinal data in clinical trials, thus reducing error and increasing statistical power (beunckens, molenberghs, verbeke, & mallinckrodt, 2008; frison & pocock, 1992; keselman, algina, & kowalchuk, 2001). effect sizes cohens d statistic were calculated for t1 versus t2 for each condition for t test and mixed model analyses. table 1. baseline characteristics by group (n=75) variables group 1 (n=26) % or m (sd) group 2 (n=24) % or m (sd) group 3 (n=25) % or m (sd) gender: male 84% 56% 88% female 16% 40% 8% age 32.68 (10.92) 31.83 (8.45) 32.67 (11.44) ethnicity: non-minority 52% 64% 56% minority 48% 32% 36% marital status married, living with spouse 32% 32% 36% other 68% 64% 56% education in yrs. (range 12-18) 14.12 (1.54) 14.15 (1.39) 14.11 (1.29) used nonva aid 40% 64% 36% used va aid 84% 72% 76% learning disability 24% 24% 32% health status (range 1-4) 1.76 (.83) 1.92 (.88) 1.91 (.95) # health conditions 2.04 (1.34) 1.42 (.83) 2.00 (1.27) resilience (range 74-210) 161.18 (31.49) 157.41 (34.56) 137.50 (40.26) mood (range 19-39) 34.95 (3.41) 33.94 (16.45) 34.00 (5.05) social support (range 4-46) 28.44 (12.85) 24.61 (10.35) 28.22 (13.19) network density (range 0-16) 8.33 (4.79) 6.91 (4.79) 5.95 (5.08) alcoholism (range 0-2) 1.00 (.00) .58 (.33) .88 (.6) ptsd (range 17-26) 36.09 (19.82) 34.61 (19.13) 35.10 (18.76) note. percentages may not total 100% due to missing data. completion rate and fidelity of implementation eighty percent of group 1 participants and 83% of group 2 participants completed the minimum four contact sessions. one control group member and no intervention group members who were enrolled in college in the pilot phase at time 1 dropped out by time 2. fidelity for the group 1 manualized model was rated as moderate overall (mrange 1-5 = advances in social work, spring 2012, 13(1) 42 3.67, sd = 1.34), although interrater agreement on the dichotomous items (e.g., worker referred to lesson plan during session: yes/no) was low (fleiss’s kappa = 0.22; fleiss, 1971). eighty-three percent of participants in the pilot phase met both fidelity criteria of completion rate and contact content analysis findings. protective and risk factors initially, after analyses for descriptive statistics and assumption tests were done, pearson’s r correlations were analyzed to focus on one risk and one protective predictor variable identified in prior cross-sectional research and resilience theory and on experimental condition (group) that had significant relationships at the .05 level with the risk and potential protective factors. the predictors found to be significant in the bivariate analyses were intervention group assignment, which was correlated with the potential protective factors of denser support networks (r = -.41, p < .05), and control group assignment, which was correlated with higher levels of the risk factor ptsd symptoms (r = .47, p < .05). in multiple regression completer analyses (n = 26), intervention was significantly related to higher post social network density scores (b = 3.66, p =.04, r2 = 18.5%, adj. r2 = 14.8%) and control group with higher post ptsd symptom scores (b = -15. 54, p = .03, r2 = 17.4%, adj. r2 = 14%). consistent with prior cross-sectional research, these findings suggest that supported education interventions may increase social support as a protective factor and reduce ptsd as a risk factor for educational attainment. the effect size is weak to moderate (cohen, 1988). resilience is a key protective factor postulated by the theoretical framework of the trial. therefore, exploratory completer and intent to treat analyses were performed. paired sample completer t tests (n = 26) suggested that neither intervention group had significantly changed in resilience scores (t 25 = .057, p = .96), whereas the control group decreased significantly from pre to post (t 25 = -3.30; p = .01). findings suggest that supported education intervention may support resilience in the experience of stressors associated with reentry into the civilian life trajectory of college attendance. intent to treat analyses were conducted using the sas multiple imputation procedure for missing data. mixed models with six fixed effects, plus intercept, were fit to these data. the six effects were group assignment, gender, race, marital status, time (1 and 2), and gpa, with experimental groups 1 and 2 contrasted to control group 3. mixed repeated measure group effects for resilience in the intent to treat group and in the paired sample t test for the completer group were statistically significant. these data suggest that intervention (both groups combined) compared to wait list is significantly associated with higher resilience scores at posttest. the effect size is moderate for both conditions, consistent with the literature. lessons learned and applications to practice completion rates of the minimum intervention “dosage” were acceptable. early nonutilization rates led to an additional search of the clinical trial literature (e.g., cooper et al., 2009) and early adoption of an evidence-based procedure of conducting presmith-osborne/ supporting resilience for veterans 43 randomization and then final randomization assignment after eligibility confirmation, informed consent completion, and completion of the intake interview for all participants. fidelity findings were mixed for the manualized protocol, leading to plans for the addition of a fidelity checklist to each group 1 case record, as well as protocol readiness checklist at each training session. fidelity levels for usual care met expectations, both for common treatment elements (hart, 2009) and elements specific to technology-enhanced services (parasuraman, ziethaml, & malhotra, 2005). fidelity and attrition prevention will be further supported by addition of an automated voicemail and cell text service, currently in field testing, to issue reminders for referrals, appointments, and posttests and collect data on responses to monitor follow-through. this interactive web phone technology will be used in applications to prevent or determine the cause of missed classes/appointments and to inform participants' case managers. this report on project development examined a limited number of protective factors targeted in intervention from time 1 to time 2. some protective mechanisms which were found in theory and in prior cross-sectional and meta-analytic research were also supported in these findings: intact nuclear family, resilience, and va and non-va financial aid were correlated with educational attainment, while sed intervention was associated with support network density, higher mood, and resilience. this may suggest that practitioners, be proactive in providing or brokering couples and family counseling and support services for families of student veterans, despite eligibility limitations on university mental health services, some private health insurance, and some va services which exclude couples counseling or a non-student spouse for services. practitioners with this population need to attend to concrete resources, including all forms of financial aid, concomitantly with clinical services, consistent with a generalist social work model. of course, these preliminary findings are cautiously reported due to their consistency with the prior literature, since instability of results can characterize early phases of a longitudinal clinical trial. results become more reliable and stable as sample size increases (schulz & grimes, 2005b). next steps in this research will implement examination of possible differences in effectiveness of the two experimental conditions in an enlarged sample over additional time points. since the study will include multiple measures of several key variables, it will be possible to consider differences among outcome variables depending on measure, which were beyond the scope of this initial report. future reports will also address theoretical implications of the results for resilience theory development and suggest future research to examine the alternative decision-making model using, for example, emotional exhaustion measures. references abraha, i., & montedori, a. 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(1997). university students with psychiatric illness: factors involved in the decision to withdraw from their studies. psychiatric rehabilitation journal, 20, 88-91. author’s note: address correspondence to: dr. alexa m. smith-osborne, school of social work, university of texas at arlington, 211 s. cooper street, box 19129, arlington, texas, 76019-0129. e-mail: alexaso@uta.edu. microsoft word ponder and aguirre spousal communication copyedit bb _________ warren n. ponder, lmsw, acsw is a social worker for the readjustment counseling service, department of veterans affairs, fort worth, tx. regina t. p. aguirre, ph.d., lmsw-ap is an assistant professor at the university of texas at arlington school of social work. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 216-228 internet-based spousal communication during deployment: does it increase post-deployment marital satisfaction? warren n. ponder regina t. p. aguirre abstract: the purpose of this study was to explore the question: is a service member’s post-deployment marital satisfaction correlated with frequency and mode of communication during deployment? this study used an anonymous exploratory design with a sample of 119 operation iraqi freedom (oif) or operation enduring freedom (oef) married veterans. service members who communicated daily during deployment with their spouses had higher marital satisfaction scores than those who communicated less than once per week. additionally, participants who used us mail had the highest marital satisfaction scores compared to telephone and internet-based communication. this study expands the overwhelmingly qualitative current literature to include quantitative analysis of this topic. this study also depicts the veterans’ experiences since many of the previous studies of this topic used samples of spouses. keywords: communication, marital satisfaction, veteran, operation iraqi freedom (oif), operation enduring freedom (oef) introduction being able to stay connected to loved ones has been a top priority for military personnel for generations with both military and non-profit organizations allocating resources to aid soldiers in using all modes of communication available. during world war i (wwi) and world war ii (wwii), soldiers’ primary mode of communication was the us mail (schumm, bell, ender, & rice, 2004). during wwii soldiers were frustrated with the long wait times associated with receiving mail (applewhite, & segal, 1990; bell, schumm, knott, & ender, 1999; stouffer, suchman, devinney, star, & williams, 1949). the military auxiliary radio system (mars) was used during the korean and vietnam wars allowing service members faster communication time with their loved ones (schumm, et al., 2004). during operation desert storm (ods) fax, e-mail, videotapes, us mail, audiotapes, and teleconferences where available to some of the deployed personnel (ender & segal, 1990; schumm, et al., 2004). during operation joint endeavor (bosnia), operation restore hope (somalia), and operation uphold democracy (haiti), email, telephone and sometimes teleconferencing were available (schumm et al., 2004). in the present wars, operation iraqi freedom (oif) and operation enduring freedom (oef), military personnel have the most modern forms of communication at their fingertips. whereas in previous wars us mail was the only mode of communication, service members now can communicate with their loved ones over such media as telephone, email, instant messenger/message board, video, and webcam (merolla, 2010), increasing frequency and immediacy of communication. access to much of the modes of ponder, aguirre/internet-based spousal communication during deployment 217  communication is provided by the military with non-profits assisting with items such as telephone calling cards and cell phones. little is known about the impact that these additional communication modes have on the marital relationship after deployment. the purpose of the current study is to determine if a service member’s post-deployment marital satisfaction is correlated with the frequency and mode of communication during deployment. theoretical framework many theories exist about marital satisfaction covering a broad spectrum of aspects that impact satisfaction including employment, communication, adoption, and stress. for the purposes of this study, the two theories discussed are related to stressful events and are focused on the uniqueness of the military couples’ experiences. a long-standing theory of marital satisfaction in the face of life-stressors is hill’s (1958) abc-x model in which he attempted to address how (a) an event or stressor and (b) the family’s resources or strengths led to (c) how the family attached meaning to the event and whether they enter or avert (x) crisis. this theory has been thoroughly tested and revised (e.g., boss, 2002; lavee, mccubbin, & patterson, 1985; mccubbin & mccubbin, 1991) with more recent work focusing on the theory’s application to the military marriage. most recently, boss (2002) expanded on the abc-x model by proposing internal and external contexts. the internal context includes things the family has control over and can change such as the structural, psychological, and philosophical domains. the external context includes things the family has no control over: culture, history, economy, development, and heredity. this contextual focus adds a much needed arena for focus on marital communication as integral in the process of surviving and thriving in the face of crisis. boss and others have continued to apply the abc-x model with its varied revisions and expansions to the military marriage. in boss’ proposed expansion of the theory to include internal and external contexts, the examples are focused in the military domain related to post-traumatic stress disorder (ptsd). rosen and durand (2000) have also further tested the abc-x model with persian gulf war veterans. a two-phased study was commissioned, the first data collection was done while the service member was deployed and the second after the personnel had been stateside for one year. they conducted factor analysis and identified five factors that explained marital adjustment post-deployment: feeling distanced from each other; feeling closer to each other; increased role-sharing; increased independence of spouse; and increased dependence. they concluded that a large portion of the marriages that dissolved upon returning home had pre-deployment issues and that deployment actually strengthened the marriage for those who did not dissolve their marriages. despite the vast body of literature on marital satisfaction, available theories such as the abc-x model continue to be weak in certain aspects. one area lacking, especially in relation to military marriages and deployment stress, is the impact of communication (karney& crown, 2007) with the few studies on communication during deployment focusing heavily on the spouses, (i.e. lapp, taff, tollefson, hoepner, moore, & divyak, 2010; merolla, 2010; sahlstein, maguire, & timmerman, 2009) and only one from the veterans perspective (durham, 2010). advances in social work, spring 2012, 13(1) 218 partially in response to this, another theory of marital satisfaction was developed by karney and crown (2007) in their significant work families under stress: an assessment of data, theory and research on marriage and divorce in the military. karney and crown (2007) drew upon literature studying civilian marriages to expand the stress hypothesis to fit within the context of a military marriage. their theory has four components: (1) the conceptualization acknowledges the military spouses’ enduring (i.e., items that are stable and each spouse brings to the marriage such as demographic, psychological, and personal history variables) and emergent traits (i.e., things that can change over the course of a marriage such as maturity or financial stability); (2) the consideration of the environmental factors within and outside the military community (e.g., family, employment, and housing); (3) the impact spousal communication has on the marriage; and (4) “that spouses’ satisfaction with their marriage is but one predictor of whether or not a marriage will remain intact; barriers and a lack of alternatives can keep spouses in a marriage whether or not they find the marriage satisfying” (karney & crown, 2007, p. xxvi-xxvii). how spouses communicate during deployment will impact the postdeployment marital outcome. the karney and crown (2007) theory has been used to assist and guide other empirical investigations of military marital satisfaction (e.g., allen, rhoades, stanley, & markman, 2010; merolla, 2010). allen et al. (2010) used the karney and crown (2007) framework to explain how adaptive processes such as communication contribute to the link between ptsd and marital satisfaction. they concluded that the adaptive processes such as communication outlined in karney and crown’s model do partially account for the association between ptsd and marital satisfaction for both husbands and wives and note that focusing on communication is an important approach to intervention with couples struggling during post-deployment. similarly, merolla (2010) used karney and crown’s model (2007) to guide their qualitative research on marital maintenance during deployment. their study focused on spouses rather than service members and communication emerged as one of three main marriage maintenance mechanisms being not only important in terms of frequency but also in terms of mode of communication and the need for communication to be routinized. literature review applewhite and segal (1990) were among the first researchers to study modern modes of communication of military personnel during deployment. they surveyed 133 military personnel who were deployed on a peacekeeping mission to sinai in the 1980s. the study concluded the majority of personnel thought optimistically about the use of the telephone as a medium to stay connected to family, but also found it to be extremely expensive. interestingly, in their study of communication during operation restore hope, bell et al. (1999, p. 515) noted, “in general, communication had a positive effect on several outcome variables, with the notable exception of marital satisfaction, possibly operating through an intervening variable of perceived stressfulness of peacekeeping operations that was predicted by having had communication problems.” sahlstein and colleagues (2009) conducted a qualitative investigation with a sample of 50 female spouses through the lens of relational dialectics. they found that through the ponder, aguirre/internet-based spousal communication during deployment 219  different stages of deployment, several themes emerged: pre deployment (uncertainty vs. certainty), deployment (autonomy vs. connection), and post deployment (openness vs. closedness). they found military culture influences how spouses communicate in two ways. first, the soldier could not disclose information because of the operational security of the mission and secondly the variability in mode of communication. one participant specifically noted high-ranking officer’s limited phone privileges as a consequence for unfavorable behavior in theatre. merolla (2010) conducted a qualitative investigation about marriage maintenance with 33 wives of currently deployed service members. his findings acknowledge geographic separation can help and hurt a relationship. the following modes of communication were the most frequently referenced in regards to communication with their spouse: phone (61%), letters/care packages (55%), email (including digital photos) (52%), instant messenger/message board (15%), video messages (9%), and webcam (6%). participants had concerns about the military’s operational security, meaning it limited the conversation on the phone and over the internet. fifty-five percent of participants reported creating and maintaining a communication routine with family was important (merolla, 2010). lapp et al. (2010) used a phenomenological perspective to guide their study. they interviewed 18 spouses (two were male) of national guard and reserve service members who lived in a rural or semi-rural setting of less than 70,000 people. the study found that some spouses felt captive to the instant forms of communication available—always waiting by the phone for their partner to call. spouses intended to stay connected via telephone, instant messenger, email, and webcam. lapp et al. (2010, p. 60) note “all of the participants were reassured by frequent contact with their spouse.” most qualitative research has focused on the spouses of veterans who were deployed. recently, durham (2010) studied the service member’s point of view by conducting a qualitative investigation of six oif male combat veterans discharged from the military. she concluded that all respondents chose to limit their communication with family back home. respondents report limiting their communication was done because of regulations, control, and the distraction it could cause from the mission. if a service member is distracted from the mission, it could led to less concentration resulting in death of self or a fellow service member. currently, little quantitative empirical investigation has been conducted on the impact of frequency and mode of communication during a combat deployment on marital satisfaction. these new modes of communication may act as potential confounding variables affecting marital satisfaction. with the ever-evolving modes of instant communication, these authors were interested in which mode would have the highest martial satisfaction. we suspect that internet-based communication will have the highest because it is immediate and allows for a more frequent routine whereas mail can take weeks to arrive at its destination and/or get misplaced. additionally, these authors suspect that face-to-face communication via webcam will have higher marital satisfaction because it might provide a sense of comfort for the stateside spouse because they can visually see the service member. advances in social work, spring 2012, 13(1) 220 to date almost all the studies investigating communication within the marital dyad among oif and oef service members have been qualitative in nature. previous researchers have laid a solid foundation for this quantitative investigation. a great deal of the current research pertaining to deployment and separation within a marital dyad is outcome driven (i.e., divorce or the marriage continues). researchers (drummet, coleman, & cable, 2003; merolla, 2010) assert relationship maintenance during deployment within the military community is an area that still needs further exploration. karney and crown (2007) posit current research is lacking in depth analysis about ''all the ways that spouses interact, communicate, resolve problems, provide support, and understand each other" (p. 24). with only one empirical investigation primarily focusing on the service member (durham, 2010), more studies are needed to understand things from their perspective. the purpose of the current study was to explore the question: is a service member’s post-deployment marital satisfaction correlated with frequency and mode of communication during deployment? three hypotheses guided the study, largely grounded in merolla’s study of marital maintenance from the spouses’ perspective. considering merolla’s (2010) work indicating that routine communication was an important factor in marital maintenance, the first hypothesis was that the higher the frequency of communication during deployment, the higher the marital satisfaction post-deployment. since internet-based communication is more immediate than us mail and can be more frequent than the telephone, the second hypothesis was that participants who used internet-based communication during deployment will have higher post-deployment marital satisfaction scores than participants who used telephone and us mail. finally, because communication and partner interaction emerged for the spouses in merolla’s study as major factors in marital maintenance, the third hypothesis was that participants who used face-to-face communication via webcam would have higher post-deployment marital satisfaction than participants who used other forms of internet-based communication. method data collection this exploratory study used an anonymous survey to investigate the relationship between spousal communication during deployment and marital satisfaction postdeployment. all procedures were approved by the university of texas at arlington institutional review board. we contacted national veteran service and advocacy organizations through email to see if they would allow us to post a link to their private discussion boards, chat rooms, and send to their members. national service and advocacy organizations were selected based on how rigorously they vetted prospective members. only organizations that verified eligibility through dd214s were allowed to participate in the survey. this was done to make sure the respondents were truly oif/oef veterans. after permission was obtained from the group leaders, they sent an email to their constituents or allowed us to post links on their websites, chat rooms, and discussion boards. data was collected for approximately six weeks. ponder, aguirre/internet-based spousal communication during deployment 221  instrumentation a researcher-developed survey was administered along with the relationship assessment scale (ras). the researcher-developed survey was designed to gather demographic information and inquire about frequency and mode of communication during deployment. the first question was “how often per week did you communicate with your spouse?” the possible answers were: less than once a week, 1-2 times a week, 3-4 times a week, 5-6 times a week, or every day. the second question was “what was the main mode of communication with your spouse while you were deployed?” the possible answers were: computer (email, instant messenger, and webcam), us mail, or telephone. if the respondent selected computer, a follow up question was administered, “what was the primary method of communication on the computer?” the possible answers were email, instant messenger/chat room, or webcam. for the questions about mode of communication, the respondents were allowed to only select one answer so as to ensure that we knew the main mode and primary method respectively. the relationship assessment scale (ras) is a seven-item measure that assesses satisfaction in close relationships (hendrick, 1988). the cumulative scores range from one to five. hendrick, dicke, and hendrick (1998) report “scores over 4.0 would likely indicate non-distressed partners, whereas scores closer to 3.5 for men and between 3.5 and 3.0 for women would indicate greater relationship distress and possibly substantial relationship dissatisfaction” (p. 141). the ras has good discriminant validity (hendrick, et al., 1998) and has been found to have good convergent validity with both the dyadic adjustment scale (das) (.80 and .88) and the kansas marital satisfaction scale (kmss) (.64 for men and .74 for women) (hendrick, et al., 1998). test-retest reliability of the ras was .85 and it was found to be consistent across several samples (hendrick, et al., 1998). participants the sample consisted of 119 married participants. one hundred and one were males (84.9%) and eighteen were females (15.1%). because there were only 18 females who responded, analyses were not conducted on the role of sex in terms of the research question. the majority were white (89.9%). four other categories accounted for the remaining 10.1% (hispanic, n = 4; other, n = 4; more than one race, n = 3; and african american, n = 1). because there were only 12 non-whites who responded, analyses were not conducted on the role of race and ethnicity in terms of the research question. data analysis the survey data were collected in categorical and continuous forms. the ordinal data were analyzed using nonparametric statistics—spearman’s rank correlation coefficient, and the ratio data were analyzed using analysis of variance (anova) using the statistical package for social sciences (spss) version 18.0. statistical significance was assessed at both the .05 and .10 levels; the liberal .10 level is deemed acceptable for exploratory studies (black, 1999). advances in social work, spring 2012, 13(1) 222 results all 119 participants completed the relationship assessment scale (ras). the range of scores was from 1 to 5 with a mean of 3.65 (sd = 1.02); the distribution approached normality. higher scores indicate a non-distressed relationship. the primary mode of spousal communication was computer (email, instant messenger, webcam) (55.5%) with telephone (24.4%) and us mail (20.2%) following. please see table 1 for a complete listing. table 1. frequency of communication with spouse while deployed mode of communication frequency of communication frequency percent cumulative percent computer (email, instant messenger, webcam) less than once per week 10 15.2 1-2 times per week 16 24.2 3-4 times per week 12 18.2 5-6 times per week 7 10.6 everyday 21 31.8 total 66 100.0 55.5 us mail less than once per week 9 37.5 1-2 times per week 3 12.5 everyday 12 50.0 total 24 100.0 20.2 telephone less than once per week 5 17.2 1-2 times per week 8 27.6 3-4 times per week 2 6.9 5-6 times per week 3 10.3 everyday 11 37.9 total 29 100.0 24.4 grand total 119 100.0 hypothesis 1 hypothesis one is the higher the frequency of communication during deployment, the higher the marital satisfaction post-deployment. since the frequency of communication was measured ordinally, spearman’s rank correlation coefficient was calculated (ρ = .238, p < .01) and indicates a weak but statistically significant direct relationship. the average ras score increased with frequency of communication. those service members who communicated less than once per week while deployed had an average ras score of ponder, aguirre/internet-based spousal communication during deployment 223  3.34 whereas those who communicated everyday averaged 3.97. to assess whether the differences among means for the ordinal levels of frequency of communication were statistically significant, an analysis of variance (anova) was conducted. it was statistically significant (f(118) = 2.18, p = . 08) at the .10 level of significance. please see table 2 for frequency of communication and mean ras scores. table 2. mean frequency of communication with spouse when service member was deployed and average ras score frequency of communication n mean std. dev. less than once per week 24 3.34 1.19 1-2 times per week 27 3.46 1.14 3-4 times per week 14 3.45 1.09 5-6 times per week 10 3.84 .59 everyday 44 3.97 .82 total 119 3.65 1.02 hypothesis 2 hypothesis two is that participants who used internet-based communication during deployment will have higher post-deployment marital satisfaction scores than participants who used telephone and us mail. the average ras score differed with mode of communication. those service members who preferred internet-based communication (email, instant messenger, webcam) had an average ras score of 3.50 (sd = 1.08), us mail 4.10 (sd = .63), and telephone 3.64 (sd = 1.06). the analysis of variance (anova) was statistically significant (f(116) = 3.20, p< .05) at the .05 level of significance. hypothesis 3 participants who used face-to-face communication via webcam would have higher post-deployment marital satisfaction than other forms of internet-based communication. the analysis of variance (anova) was not statistically significant (f(63) = 1.73, p = .19). please see table 3 for means and standard deviations. table 3. type of computer communication and average ras score method of computer communication n mean std. dev. email 55 3.59 1.03 instant messenger or chat room 7 2.80 1.03 webcam 4 3.43 1.67 total 66 3.50 1.08 advances in social work, spring 2012, 13(1) 224 discussion the purpose of this study was to explore the question: is a service member’s postdeployment marital satisfaction correlated with frequency and mode of communication during deployment? this study expands the current literature to include quantitative analysis of the topic since the previous research on communication during a combat deployment has been overwhelmingly qualitative (e.g. durham, 2010; lapp, et al., 2010; merolla, 2010; sahlstein, et al., 2009). this study also depicts the veterans’ experiences since three of the previous studies used samples of spouses (i.e. lapp, et al., 2010; merolla, 2010; sahlstein, et al., 2009), and only durham’s (2010) used a small sample of veterans. findings include that the higher the frequency of communication during deployment, the higher the marital satisfaction post-deployment for the veteran. this supports the theory of military marriage presented by karney and crown (2007) where communication is one of four aspects contributing to whether a marriage survives stressors such as combat deployment. this is in contrast to a previous empirical investigation that found communication during operation restore hope did not impact marital satisfaction (bell et al., 1999). however, it should be noted that operation restore hope did not have the years of infrastructure that a deployed service member now enjoys in oif or oef. it is reasonable to consider that since the infrastructure is more comprehensive in oif and oef soldiers have access to more reliable communication, which bell et al. (1999) listed as a possible reason communication did not have a positive impact on marital satisfaction. additionally, researchers found that despite the wider availability of new technologies (e.g. webcam, email, synchronous chat) for communicating during deployment, us mail was still the most highly correlated with level of marital satisfaction post-deployment. of the internet-based forms of communication, email produced the highest ras scores (m = 3.59) over synchronous forms of communication (i.e. chat and webcam). there are a plethora of possible reasons why us mail was related to higher ras scores than internet-based communication and the telephone, all likely connected to another component of karney and crown’s (2007) theory of stress as it relates to military marriage: the consideration of the environmental factors within and outside the military community (i.e., family, employment, and housing). in general the instant nature of these types of communication has its drawbacks. lapp et al. (2010) noted that some spouses stateside felt bound to their mode of communication always waiting by the phone for their partner to call. spouses may also be more apt to vent frustrations in an unfettered way whereas letter writing allows time for the spouse to reflect on the most important things to focus on in communication. instant communication also presents issues for the service member. deployed service members try to limit their communication with loved ones stateside because they believe it could take away from the mission (durham, 2010), interfering with concentration and focus which could end up in them not doing their job to their best ability resulting in a person’s death, possibly their own. ponder, aguirre/internet-based spousal communication during deployment 225  another reason for us mail’s continuing preferential status among service members may be related to cost, time and location constraints when using telephones and the internet. though there are many veteran friendly organizations that provide free calling cards to deployed service members, the cost of sending a letter via us mail or email or chatting online is far less than using the telephone while deployed. time constraints are another issue for the telephone as well as the internet. while letters can be written anywhere and anytime, the internet and telephones require equipment often shared with many fellow-service members requiring scheduling. with shared equipment, scheduling usage is not the only issue. location is perhaps the most important since telephones and internet are usually accessed in community settings. there is likely an element of closeness that can be delivered in a hand written letter that cannot be in an email or a phone conversation. spouses may feel at liberty to write more personal information in a letter that they think no one else could look at since letters can be written in fairly private settings. related to privacy are deployed service members’ concerns about operational security (merolla, 2010) which can be easily compromised if the enemy is monitoring internet-based correspondence. service members might feel at greater liberty to say things in a letter than through internet-based communication or over the telephone because of operational security. a letter that is sealed in an envelope will not face the security scrutiny internet-based or telephone communication would. limitations this study did have limitations with regard to sampling, questions asked, and choice of method. in terms of sampling, limitations were: 1) we only collected data from the service member and not the spouse; 2) we limited the study to service members who were still married at the time of the survey possibly creating a bias toward higher marital satisfaction; 3) the sample was mostly white. we recommend that future researchers include the spouses as participants and aim for a more diverse sample on relationship status (i.e., include divorced and separated), race, and ethnicity. though the sample seems heavily biased toward whites, our sample is very closely representative of the military dispersion of race as indicated in table 4 which notes how our sample compares to the target population. for the questions asked, our two main limitations were: 1) we did not focus on the content of the correspondence, only the frequency; and 2) we did not ask the participants about availability of modes of communication during deployment nor command restrictions on frequency of communication. future studies should attempt to incorporate a mixed methods approach. the quantitative element should be structured to capture the method and frequency of communication and the limitations to these in terms of availability and command limitations to frequency. the qualitative piece should be designed to incorporate the content of the communication especially to determine if there is closeness that is delivered in a letter that is not in internet or telephone communication due to operational security concerns. advances in social work, spring 2012, 13(1) 226 table 4. study sample demographics compared to us military active duty 2008 demographics study sample target population (active duty us military as of 2008) sex a male = 85% female = 15% male (officers) = 85% male (enlisted) = 86% female (officers) = 15% female (enlisted) = 14% age a 36.35 years old 28 years old race a, b white = 90% all others = 10% white = 75% all others = 25% married a 100% 55% a defense manpower data center (dmdc) (2008). active duty demographic profile. retrieved from www.deomi.org/home/savecountfiles.cfm?fileid=280. b the total number of participants selecting a race other than white was 12 (10% of the sample). these were grouped together as “all others” and include african american, asian, hispanic, and other. implications for social work practice concerns for the safety of the service member and his or her fellow-service members, privacy, and security of the mission must be considered in tandem with the study results that frequent communication correlates with happier marriages post-deployment. specific implications for social work practice relate to actions to be taken both with the soldier and the spouse. prior to deployment, it is recommended that soldiers and their spouses be encouraged to use hand-written letters as their primary form of communication with each other, limiting internet and phone usage to quick messages of love and greeting, explaining the body of literature supporting that hand-written letters strengthen the marriage. perhaps the couple could agree to write a few sentences to each other every day and mail the result every few days. both soldiers and spouses should be encouraged to consider the impact of words on the others’ well-being, knowing that news of the others sadness or other difficulties could compromise the soldier’s safety or the spouse’s coping with the soldier’s absence, respectively. if both soldier and spouse are able to focus on the positive—especially positive emotions—in their communication (regardless of mode), outcomes will include increased positive emotions, resilience and improved quality of life (frederickson, 2001). during deployment, it is recommended for nonprofits that typically have assisted with telephone access through calling cards and cell phones focus their efforts more on care packages, stationary, postage, and the like. not only will this encourage use of us mail but will also allow their limited funds to stretch further, helping more soldiers and spouses than previous phone-focused endeavors. ponder, aguirre/internet-based spousal communication during deployment 227  references allen, e. s., rhoades, g. k., stanley, s. m., & markman, h. j. 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(2009). contradictions and praxis contextualized by wartime deployment: wives’ perspectives revealed through relational dialectics. communication monographs, 76(4), 421-442.doi: 10.1080/03637750903300239 schumm, w. r., bell, d. b., ender, m. g., & rice, r. e. (2004) expectations, use, and evaluation of communication media among deployed peacekeepers. armed forces & society, 30(4), 649-662. stouffer, s. a., suchman, e. a., devinney, l. c., star, s. a., & williams, jr., r. m. (1949). studies in social psychology in world war ii: the american soldier. vol. 1, adjustment during army life. princeton: princeton university press. author’s note: address correspondence to: regina t. p. aguirre, phd, assistant professor, the university of texas at arlington school of social work, 211 s. cooper, box 19129, arlington, tx 76019, rtpaguirre@uta.edu. microsoft word 12 sutphin et al_7942_role of formal theory family systems theory copyedit_final ______________ suzanne taylor sutphin, ph.d., is a research assistant professor at the center for child and family studies in the college of social work at the university of south carolina in columbia, sc; shannon mcdonough, ma, is an instructor of social sciences at allen university in columbia, sc; and amber schrenkel is a 2013 msw graduate of the college of social work at the university of south carolina in columbia, sc. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 501-517 the role of formal theory in social work research: formalizing family systems theory suzanne taylor sutphin shannon mcdonough amber schrenkel abstract: formal theories are critical to accumulating knowledge through scientific research to advance the discipline and practice. the use of formal theory in social work research is currently absent. family systems theory (fst) is commonly used in social work; however, it currently lacks the criteria to be considered a formal theory. we use fst to demonstrate the formalization process and its potential effect on social work research and practice. currently, fst is being used as a perspective, to develop theories and models used in marriage and family therapy, and to develop assessment tools. we identify the components of a formal theory while presenting a formal version of fst. directions for future research are suggested including the benefits of using formal theory to direct scientific research and guide the development of evidence-based practice. keywords: family systems theory, formal theory, social work research “the fact that human beings create theories testifies to their genius and uniqueness as the only known organisms who are able to conceptualize their own experience” (becvar & becvar, 1982, p. 55). social science theories, especially theories of the family, are frequently used by social work researchers and practitioners. however, like many theories applied in social work, the critical components that make the theory scientifically testable are not forthcoming. therefore, much of the practice in social work related to family theories does not have a solid scientific base. formalizing theory involves developing the critical components to increase its scientific testability with a focus on adding to cumulative knowledge in the field. this is accomplished by ensuring the deductive logical consistency of the theory, the clear definition of terms, and the explicit designation of the scope conditions under which the theory applies. we focus on a commonly used perspective in social work research, family systems theory (fst), as an example of formalizing a theory. this article briefly reviews the current state of theory in social work, defines fst and how it is currently used in social work practice, and presents the essential components of formal theories along with a formalized version of fst. finally, we suggest directions for future research relevant to formalized theories. theories in social work the role of theory in social work research has long been critiqued. kirk and reid (2002) argue that the current social work knowledge base is “not the product of rigorous scientific testing” (p. 20). the authors also propose that “the ‘soft’ nature of social work sutphin, mcdonough, schrenkel/role of formal theory in social work research 502 knowledge impedes cumulative knowledge-building efforts” (kirk & reid, 2002, p. 25). sibeon (1991) echoes that sentiment and points out that “different types of social work cognitions are drawn upon by practitioners in different historical periods, but their common denominator is that, with very few exceptions, none of them are drawn from academic disciplinary discourses” (p. 143). the professional concern is that while social work scholars identify many theories in their research and practice, most are not formal theories, and many are merely perspectives. this was evident in the work of gentle-genitty and colleagues (2007). the authors rated articles in social work journals based on their inclusion of theory. of their sample of over 1,000 articles, only 6% met their more rigorous standard of including theory with an empirical base. in fact, the authors found that most of the journals had only a small focus on theory altogether. gentle-genitty and colleagues (2007) proposed that “theory discussion may be defined as a superficial description of the theory that does not include exploration of the components or empirical base of the theory” (p. 65). longstanding formal theories must have empirical support (kirk & reid, 2002). the development, testing, and application of formal theories allows researchers to systematically revise and expand theories and leads to cumulative knowledge, which, ultimately, advances understanding of the phenomenon in question (cohen, 1989; freese, 1980; payne, 1997; white, 2005). turner (1998) proposes that theories used to solve problems evident in real-world settings will ultimately strengthen the theory. therefore, formal theories can enhance both theoretical research as well as empirical research used in real world applications. as an example in the following sections, we will focus on one theory commonly used in social work research and practice, family systems theory (fst). we present an overview of fst to provide a basis of formalizing the theory; it is not intended to be a comprehensive review of the theory. family systems theory family systems theory describes the processes that affect the ideal functioning of a family thereby causing disorder (dore, 2008). the main purpose of fst is to inform the “understanding and interpretation of the cognitive, social, and emotional functioning of individuals in society” (dore, 2008, p. 435). in therapeutic settings, fst emphasizes treating the whole family when treating a deviant family member(s).i the causes of a family’s problems are viewed as circular and the therapist attempts to modify family communication patterns to alter the interactions so that the family returns to a healthier state of functioning (howe, 1991). families are seen as systems that may become dysfunctional and that can return to a healthier state of functioning, referred to as homeostasis, by altering communication patterns and interactions, internal and external boundaries, and/or redefining or restructuring family roles and subsystems. payne (1997) describes that some scholars propose that individuals are dependent on systems such that informal systems (e.g., families), are nested in formal systems, (e.g., communities, neighborhoods), which are nested in societal systems, (e.g., schools, government). in other words, families are not advances in social work, fall 2013, 14(2) 503 only affected by their internal boundaries and interactions, but are also influenced by the larger systems in which they reside. family systems theory in social work practice one of the motivators to use fst as the example in this process was because of its utilization and applicability in social work research and practice. a review of literature on fst in social work reveals that fst is applied in three main ways: (1) as a perspective to approach a certain topic or research question, (2) as a model to treat families in therapeutic settings, and (3) for the development of assessment tools. family systems theory as a perspective in exploring how fst is applied in social work research, a majority of articles reviewed use the theory as a perspective by adopting the view that individuals in crisis should be evaluated within the family system and that interventions should involve the whole family in order to have any effect on the individual in question (bartle-haring, 1997; bilgin, cenkseven, & satar, 2007; bradbury & marsh, 1988; bray & harvey, 1991, 1992; brooks, 1999; brooks & ronen, 2006; delsing, oud, de bruyn, & van aken, 2003; franck & buehler, 2007; hammer, neal, newsom, brockwood, & colton, 2005; hughes & gullone, 2008; johnson, 2003; katz, 1977; richmond & stocker, 2006, 2008; skowron, 2000). fst as a perspective is also used to support the application of family preservation services (cimmarusti, 1992; walton & smith, 1999) and family group conferencing (brooks & ronen, 2006). these articles still fail to test a formal theory. rather, they briefly discuss fst by laying out a few concepts and assumptions from which they form hypotheses or research questions. without testing hypotheses that are logically derived from a formalized theory, fst cannot be properly tested and revised to produce cumulative knowledge. while informal theories and perspectives can play a crucial role in the early development of a formal theory, using theories without the intent of building a formal theory does not accumulate knowledge due to the lack of technical and formal language and the inconsistent definition of terms, which leave perspectives too open to interpretation (klein & jurich, 1993). family systems theory as part of models used in therapeutic settings another factor in the need to formalize fst is its use in developing techniques and models used in marriage and family therapy. becvar and becvar (1982) describe in detail how systems theory can be used in family therapy. the authors propose that the theory allows for the family to be treated as a network of systems including the individuals, the family system, and the social system in which they live (becvar & becvar, 1982). several therapeutic techniques and models have been developed that use tenets of systems theory and fst when helping families in stressful or crisis situations. therapeutic techniques using aspects of systems theory. many well-regarded therapeutic techniques have been developed using aspects of systems theory. based on the works of haley and madanes, strategic family therapy uses aspects of systems theory sutphin, mcdonough, schrenkel/role of formal theory in social work research 504 by shifting the focus in therapy from the individual to the family and the role of the therapist in developing strategies to address the problem. the goals of the techniques used in the therapy focus on changing the family structure to modify behavior (madanes, 1981). importantly, haley’s therapy strategies call for therapists to examine the individual needing treatment within the context of the family and the larger society (haley, 1972, 1978). developed by minuchin, structural family therapy also views the individual in the context of his family unit and social environment (minuchin, 1974). in this form of therapy, the family and the therapist are treated as a system to monitor behavior. the family system receives the intervention to modify behavior and promote family functioning. as proposed by gottman, the sound marital house focuses on marital therapy as a means to predict various outcomes and satisfaction in relationships and to identify qualities that make for a lasting relationship such as establishing a friendship in the marital couple. the theory focuses on a systematic approach in that the behavior of one partner affects the other (gottman, 1999; gottman, driver, & tabares, 2002). emotionally focused couple therapy (eft) is a synthesis of approaches that are designed to help couples in crisis navigate their emotions and emotional responses. the therapy draws on perspectives and premises of experimental therapies, family systems theory, and attachment theory. the authors point out that different family therapists use different techniques of breaking negative family cycles when incorporating fst into their therapies (johnson & denton, 2002). models using aspects of fst. several models have been developed using fst. the double abcx family crisis model incorporates aspects of systems theory by examining how stressors, such as becoming a parent, impact the family as a whole (mccubbin & patterson, 1983). the circumplex model of marital and family systems, based largely on systems theory, is designed to treat family systems by integrating cohesion, flexibility, and communication to promote family functioning (olson & gorall, 2003). the beavers systems model is based on five central concepts related to family functioning, family competence, behavioral style, family assessment, and task competence to assess functionality. the beavers systems model also incorporates elements of systems theory by examining the family system when determining how a therapist should engage the family (beavers & hampton, 2003). franck and buehler (2007) developed a model from fst, which lays out general knowledge claims and hypotheses to test concepts pertaining to marital hostility and parental depressive affect as stressors for youth. using family systems theory to inform assessment tools fst has been used to support an argument for the use of social work assessment tools (asarnow, berk, & baraff, 2009; bilgin et al., 2007; bray & harvey, 1992; brooks, 1999; brooks & ronen, 2006; cimmarusti, 1992; martin, miller-johnson, kitzman, & emery, 1998; walton & smith, 1999). many studies reveal a number of assessment tools advances in social work, fall 2013, 14(2) 505 that may be used to identify and measure instantiations of important concepts in fst such as the parent-adolescent relationship questionnaire/inventory (parq) (bilgin et al., 2007), the family system test (fast) (gehring, debry, & smith, 2001), the family adaptability and cohesion scales (faces) (olson & gorall, 2003) and the self-report inventory (beavers & hampton, 2003). since fst has many important real world applications, it is therefore beneficial to formalize fst. thus, a formalized version of fst could easily be tested using these available measurement tools, which would strengthen its explanatory and predictive power as a scientific theory. this would also be helpful in the development of evidencebased practices as discussed in future research. the following theory constitutes what we identify as the core of fst. we describe the critical components of formal theory and demonstrate the formalization process of fst. we then discuss the applicability of the theory for social work research and practice. formalizing family systems theory “theory” as a concept has previously been used in many different ways and defined to include other concepts such as ideas or hypotheses. this can make any generalization impossible, and promotes “mindless eclecticism” and a “lack of rigorous analysis” due to an “anything goes” approach to theory (doherty, boss, larossa, schumm, & steinmetz, 1993, pp. 18-19), which is found to be common in social work research and practice. according to papero (2006) “the term theory contains within it the assumption that such propositions represent the best current thinking about the phenomenon, an established framework within which known facts can be explained. from such theoretical thinking comes all therapeutic methodology” (p. 45). thus, social work research could extensively benefit from formalizing theories. since the accumulation of knowledge and findings is a key function of theories (white, 2005), we argue that using formal theories, from which hypotheses can be logically derived, is the ideal approach to conducting research. in fact, the process of building and revising formal theories is a primary way to advance theory and knowledge, while also lending widespread credibility to the field in question (white, 2005). components of formal theory the scientific method distinguishes theories from perspectives. whereas perspectives offer a way of thinking about the world, theories provide a way to test logically derived hypotheses about why things happen (payne, 1997). based on the scientific method, “’theory’ must explain in a provable way why something happens, not simply describe it in an organized way or provide a way of thinking about the world” (payne 1997, p. 35). cohen (1989) defines a scientific theory as “a set of interrelated statements, some of which are definitions and some of which are relationships assumed to be true, together with a set of rules for the manipulation of these statements to arrive at new statements” (p. 71). thus, formal theory requires a number of properties that distinguishes it from informal theories, quasi-theories, or perspectives. specifically, formal theories must sutphin, mcdonough, schrenkel/role of formal theory in social work research 506 consist of: meta-theory, primitive and explicitly defined terms, scope conditions, logically structured propositions that are interrelated and testable, and derived propositions (cohen, 1989; freese, 1980). all of these components of a formal theory allow for theory to be intersubjectively testable (cohen 1989; freese 1980). that is, formal theory reduces the latitude for multiple subjective interpretations of the theory, which fosters empirical evaluations of the theory that are more consistently valid among different researchers. this also allows for research programs to operate efficiently and productively (cohen, 1989; wagner & berger, 1985). therefore, when a formal theory is properly tested, knowledge gained from testing the theory becomes cumulative. ultimately, “if you know theory you can use it. if you don’t you can’t” (as cited in gilbert, 2006, p. 3). meta-theory meta-theory is essentially a theory about a theory. specifically, meta-theory is often used as a “source of perspectives that overarch sociological theory” (ritzer, 1990, p. 4). in other words, meta-theory is developed through a systematic study of a theory. the role of this type of meta-theory is to provide an overarching perspective that explains the foundational concepts, ideas, and statements behind a theory, including general statements about how society operates. the following meta-theory developed for the formalized version of fst includes general systems theory as a foundational view of society within which family systems exist. also, the following meta-theory presents some of the foundational concepts and ideas of fst to provide a general foundation upon which the formalized theory is based. family systems theory. family systems theory was developed in the 1960s from general systems theory (dore, 2008). as it relates to the social sciences, general systems theory provides a link between the macro and micro levels of analysis and shows the interconnected relationship between the two levels. an important feature of general systems theory is to regard the system as a whole and not solely focus on the individual parts to understand how the system works. fst describes the processes by which families that have moved out of homeostasis (the ideal state of family functioning) return to homeostasis. homeostasis can be thought of as a balance between a family’s level of enmeshment (dependence) and disengagement (interdependence). applying systems theories to families views individual family members in the context of the whole family and focuses on relationships between family members (becvar & becvar, 1982; howe, 1991). the theory focuses on the effects of a cycle of interactions and behaviors that cause problems within families (becvar & becvar, 1982). information is the energy that maintains the system. family systems with a higher rate of energy flow are less likely to be stabilized. systems that do not properly process energy flow are pushed toward a state of maximum disorder or entropy. that is, they are pushed out of homeostasis. what causes a family to move out of homeostasis? as described below, since fst explains the process by which families move back into homeostasis, it is important to review the types of stressors that can initially cause a family to move out of homeostasis. advances in social work, fall 2013, 14(2) 507 the book, stress and the family, reviews a number of stressors, both normative and catastrophic, that can cause a family crisis (figley & mccubbin, 1983; mccubbin & figley, 1983). specific instances of family distress discussed, which can also be identified as having the potential to move a family out of homeostasis, consist of both normative stressors that families commonly face and catastrophic stressors, which are much less common and often more debilitating (figley & mccubbin, 1983; mccubbin & figley, 1983). normative stressors include ambiguous boundaries in the marital relationship, sexual development over the life course, various stresses of parenthood (e.g., financial, physical, and psychological stressors), adolescent development, stressors of dual-career families (e.g., role strain, impact on children, balancing work and family), divorce, single parenting, step parenting or blending families, environmental stress, societal stress, and economic stress (mccubbin & figley, 1983). catastrophic stressors discussed include chronic illness, drug abuse, physical abuse, abandonment, death, unemployment, rape/sexual abuse, natural disasters, war, and captivity (figley & mccubbin, 1983). terms and definitions without clearly defined terms, a theory cannot be validly tested. the precise definition of terms provides a consensus among researchers regarding what exactly constitutes a concept, which has implications for how it will be operationalized in any derived hypotheses. when formalizing a theory, all terms which are included in other definitions, in the scope conditions, and in the propositions must be defined. the definitions are not written to be empirically testable themselves, but are written to be operationalized in a number of ways in a variety of empirical settings. all terms in a theory cannot be defined. the terms used in the theory are either primitive or defined. primitive terms have a widely agreed upon meaning and require no written definition while defined terms consist of both primitive terms and other previously defined terms used for specification of meaning. terms should also be presented in terminological order. presenting terms in terminological order allows the definitions to build upon each other, meaning new terms consist only of primitive terms and previously defined terms. table 1 presents the defined terms of fst, as identified in the literature, used to develop the formal theory. we have included a column that provides the citation for other models that examine families as a system that use the same terms. for models that use similar terms for the same concept, the term is also provided. scope conditions scope conditions define under what circumstances a theory applies. thus, a test of a theory must fall under specified scope conditions for the test to be valid. this helps to reduce a common problem found in social science research, where a theory is falsified under one empirical examination while being supported by another. the goal is to relax the scope conditions as the theory continues to be tested and applied in various conditions to increase confidence in the applicability of the theory. sutphin, mcdonough, schrenkel/role of formal theory in social work research 508 table 1. defined terms in terminological order* term definition terms from other models system a group of interacting and interdependent actors that function individually to form a complex whole beavers & hampton (2003); franck & buehler (2007); johnson & denton (2002); haley (1978); madanes (1981); mccubbin & patterson (1983); minuchin (1974); olson & gorall (2003) boundaries delineates what is inside or outside of a system beavers & hampton (2003); franck & buehler (2007); mccubbin & patterson (1983); minuchin (1974) family a system that has: (1) two or more interacting individuals, (2) related by marriage, birth, or adoption or voluntarily committed to each other as a unit to promote well-being, (3) identify themselves as a family beavers & hampton (2003); franck & buehler (2007); haley (1978); madanes (1981); mccubbin & patterson (1983); minuchin (1974); olson & gorall (2003) pattern the recognition of a repeated event by an observer beavers & hampton (2003); johnson & denton (2002); mccubbin & patterson (1983); minuchin (1974) norm implicit or explicit guidelines for behavior olson & gorall (2003) relationship a norm-based pattern of interaction beavers & hampton (2003); olson & gorall (2003) subsystem system in a larger system that has its own boundaries and norms minuchin (1974) internal boundary delineates subsystems within a system minuchin (1974) external boundary delineates a system from the larger social system beavers & hampton (2003) emotional boundary delineates what are appropriate levels of attachment and characteristics of behavior between two or more family members family cohesion olson & gorall (2003) enmeshment absence of emotional boundaries between family members beavers & hampton (2003); minuchin (1974); olson & gorall (2003)     advances in social work, fall 2013, 14(2) 509 table 1. (cont.) disengagement rigid emotional boundaries between family members franck & buehler (2007); haley (1978); mccubbin & patterson (1983); minuchin (1974); gottman (1999); olson & gorall (2003) hierarchical any system that ranks some persons or groups above others haley (1978); madanes (1981); minuchin (1974) homeostasis exists when there is equilibrium between levels of disengagement and enmeshment johnson and denton (2002); minuchin (1974) balance beavers & hampton (2003); madanes (1981); mccubbin & patterson (1983); olson & gorall (2003) morphogenesis change in a system flexibility olson & gorall (2003) transformation minuchin (1974) family adjustment and adaptation response (faar) mccubbin & patterson (1983) morphostasis no change in a system rigid flexibility olson & gorall (2003) inflexible style – beavers & hampton (2003) feedback loop a communication and information processing path that regulates behavior among family members circular cycles johnson & denton (2002) feedback; transactional patterns minuchin (1974) feedback process haley (1978) positive feedback loop a path of communication and behavior that increases deviation from homeostasis bonadaptation mccubbin & patterson (1983) negative sentiment override gottman (1999); gottman, driver, & tabares (2002) negative feedback loop a path of communication and behavior that restores homeostasis positive sentiment override gottman (1999); maladaptation mccubbin & patterson (1983) suprasystem environment of relationships within which a system is embedded     sutphin, mcdonough, schrenkel/role of formal theory in social work research 510 table 1. (cont.) goal desired state that motivates behavior gottman (1999); haley (1978); madanes (1981); mccubbin & patterson (1983); minuchin (1974); olson & gorall (2003) self-reflexive the ability to observe and evaluate oneself entropy maximum disorder in a system unbalanced olson & gorall (2003) first-order change an individual family member has changed first level balance mccubbin & patterson (1983) second-order change the family structure has changed olson & gorall (2003) self-regulating the internal ability to sustain the family system minuchin (1974); gottman (1999) * note: any undefined terms are considered primitive terms. the scope of the theory carries important implications. for example, in a critique of fst, pam (1993) uses an example of a family therapist who used a systems approach to resolve a disagreement between an administrator and an employee. the author argued that the systems viewpoint of the therapist in examining the system effects instead of the individuals was “convoluted” (pam, 1993, p. 86). in formalizing fst, we limit the theory to family systems, which we defined as part of our scope conditions. restricting the scope of the theory to family systems, as defined in the previous section, would prevent this example from being used as a critique of fst because a relationship between colleagues falls outside the scope of the theory. therefore, we have identified the following scope conditions. this theory applies to families that: 1. are hierarchical 2. have boundaries 3. interact in patterns 4. have individuals who are interdependent 5. have rules 6. have subsystems this theory applies to family systems that: 1. are self-reflexive 2. are goal-seeking 3. are self-regulating advances in social work, fall 2013, 14(2) 511 propositions propositions are logically interrelated knowledge claims that make up the core of the theory. requiring the propositions to be logically interrelated reveals any contradictory claims and allows for logical generations of new relationships or derivations. these claims can be true or false. that is, theories that are truly scientific have propositions that are able to be falsified (kirk & reid, 2002). based on our review of the literature, as described in the previous sections, we developed the following core set of propositions where d = the level of disengagement and e = the level of enmeshment: 1. if d > e, then d must be decreased or e must be increased (to make d=e) to move toward homeostasis. 1a. if disengagement increases or enmeshment decreases, then the family’s internal boundaries become more rigid. 1b. if internal boundaries become more rigid, then the communication within and across subsystems in the family system becomes more inhibited and infrequent. 2. if d < e, then e must be decreased or d must be increased (to make d=e) to move toward homeostasis. 2a. if disengagement increases or enmeshment decreases, then the family’s external boundaries become more permeable. 2b. if external boundaries become more permeable, then the family becomes more open to influence from the suprasystem. 2c. if the family is open to influence from the suprasystem that is unsupportive, then they are less likely to be in homeostasis. 3. if a family is not in homeostasis, then the family is moving towards a state of entropy. 4. if a family is moving towards a state of entropy, then they enter a (negative or positive) feedback loop. 4a. if the family enters a negative feedback loop, then they return to a morphostatic state of homeostasis. 4b. if the family enters a positive feedback loop, then the system moves to a morphogenetic state of homeostasis as the result of either a first order change or second order change. discussion dore (2008) proposes fst is the family theory that has the most relevance and salience for social work practice. formalizing fst allows for more scientific research to be conducted in this area to further advance the discipline. using a formal theory will allow for better implementation of the current uses of theory in social work models and assessment tools. the theory formalization process, as demonstrated in this article, significantly contributes to the literature by providing a solid basis to test the theory and sutphin, mcdonough, schrenkel/role of formal theory in social work research 512 expand and develop certain aspects of the theory such as adding propositions and further defining the scope conditions under which the theory applies as discussed below. herz and johansson (2012) point to the shift in using the scientific method when exploring social problems. we propose that this is done successfully by formalizing theories. through our formalization of fst, we hope to impress the need for the development and use of more formal theories in social work research. formalizing theories allows for more accurate tests of the theory and leads to the accumulation of knowledge. an increase in the number of formal theories will continue to lend credibility to social work as a social science discipline capable of conducting cumulative scientific research. connecting theory to methods and practice advances cumulative knowledge (turner, 1998). future research should continue to formalize commonly used theories and work on establishing a cumulative body of knowledge through the development of research programs in social work. family theories could be an example of such research programs. for example, future research could formalize bowen theory, which would therefore provide a more useful connection between bowen theory and fst. research based on the collaboration of these two theories could be used in therapeutic settings. we have presented a core set of propositions based on current literature. researchers can then begin to add more propositions, through rigorous testing, to develop a more comprehensive theory and contribute to the scientific knowledge in the profession. in addition to adding propositions, the scope of the theory could potentially be expanded to take into account cultural variations of family interactions. for example, the formalized version of fst presented would be less applicable within cultures that value enmeshment or high levels of cohesion in families. dore (2008) pointed out that “[i]t is important to highlight that any assessment of enmeshment and disengagement in families must take into account the cultural context of the family system. some cultures value a high level of emotional involvement among family members; other cultures reward emotional distance and self-containment” (p. 449). additionally, walsh (2003) described that normal family processes are socially constructed and therefore function in terms of the cultural context in which the family resides. specifically, a functional family in one cultural setting may be dysfunctional in another setting depending on the specific cultural values and norms within the setting. therefore, future tests of formal theory may reveal that it is necessary to add scope conditions to the theory that define the cultural setting. the applicability of theory, such as fst, extends beyond social work research and practice to family therapy. our review of therapies that include aspects of systems theory and specifically fst provides an overview of the usefulness of the theory in therapeutic settings. the therapies reviewed are grounded in theory to develop their techniques for treating individuals in the context of their family system. continuing to develop and refine formal theories can serve as a means to strengthen these techniques. finally, the development and use of formal theories in social work research would strengthen the current movement towards evidence-based practice. this movement envisions social work practice based on “the best available evidence to guide practice decisions” (witkin & harrison, 2001, p. 295). as evidence-based practice programs and advances in social work, fall 2013, 14(2) 513 models 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(1998). must sociological theory and sociological practice be so far apart?: a polemical answer. sociological perspectives, 41, 243-258. wagner, d. g., & berger, j. (1985). do sociological theories grow? american journal of sociology, 90(4), 697-729. walsh, f. (2003). changing families in a changing world: reconstructing family normality. in f. walsh (ed.), normal family processes: growing diversity and complexity (3rd ed., pp. 3-26). new york, ny: the guilford press. walton, e., & smith, c. (1999). the genogram: a tool for assessment and intervention in child welfare. journal of family social work, 3(3), 3-20. white, j. m. (2005). advancing family theories. thousand oaks, ca: sage publications. witkin, s. l., & harrison, w. d. (2001). whose evidence and for what purpose? social work, 46(4), 293-296. advances in social work, fall 2013, 14(2) 517 author note: address correspondence to: suzanne taylor sutphin, ph.d., the center for child and family studies, college of social work, university of south carolina, 226 bull street, columbia, sc 29208. email: sutphist@mailbox.sc.edu                                                         i  in a discussion of fst, it is important to point out bowen family systems theory, or bowen theory, which was developed by a psychiatrist, dr. murray bowen (bowen, 2002; papero, 2006). dr. bowen pioneered the application of family systems theory in a clinical setting (dore, 2008). initially constructed using six concepts, the theory is now expanded to include eight interlocking concepts: the nuclear family emotional system, the differentiation of the self, triangulation, cutoff, family projection process, multigenerational transmission process, sibling position, and the societal emotional process (bowen, 2002; also see freidman, 1991; gilbert, 2006; hall, 1981; papero, 2006; payne, 1997). this paper focuses specifically on fst, but future research discussed at the end of the paper suggests ways to link the two theories to further expand the usage. microsoft word 06_fitch_et_al_20874_use_of_online _________________ dale fitch, phd, is associate professor, kelli canada, phd, lcsw is assistant professor, suzanne cary, msw, lcsw is clinical instructor, and rebekah freese, msw, lcsw is clinical instructor, school of social work, university of missouri school of social work, columbia, mo 65211. copyright © 2016 advances in social work vol. 17 no. 1 (spring 2016), 78-92, doi: 10.18060/20874   facilitating social work role plays in online courses: the use of video conferencing dale fitch kelli canada suzanne cary rebekah freese abstract: role plays have served an instrumental role in social work education by providing opportunities for students to acquire interaction skills. this project tested various online video conferencing tools to facilitate role plays for students who live in different locations and who are unable to be at the same place at the same time. key features of the technology included the ability to facilitate real-time interaction, compatibility with laptops and wi-fi connections, and the ability to record sessions for later viewing and feedback. method: case study design. results: students were able to use the videoconferencing software with minimal support. video quality was not always ideal with contributing factors being the time of day students used the software. there were no distinguishable time and effort demands associated with the online video conferencing compared to classroom role plays. some students found use of the technology caused them to feel disconnected from their peers compared to face-to-face encounters, while other students found the encounter more intimate in that the pressure to perform in front of others was not felt. implications: video conferencing is a promising tool to facilitate social work role plays. future research needs to assess the acquisition of specific skills compared to traditional classroom students. keywords: role plays; online education; online videoconferencing; social work education acquiring and practicing interaction skills is a perceived challenge as the social work profession embraces online education. social work online education will continue to grow and develop, in large part, to the extent social work educators are successful in helping students acquire interaction skills. whether the interaction skill is as basic as engaging a client, or as advanced as supporting a client in dealing with the ramifications of a traumatic event, all such capabilities hinge on our abilities as social work educators to provide a learning environment that is accessible and effective at teaching interaction skills to online students. our program rose to this challenge by testing various online video conferencing tools to facilitate role plays for students who live in different locations and are unable to be at the same place at the same time on simulation game theory (hargreaves & hadlow, 1997), social work education has a long history in using role plays, which are a means for new students to achieve a sense of self-awareness (gardner, 2001) and self-efficacy (petrovich, 2004), and to instruct students on interaction skills (reid & hanrahan, 1982). role plays are valuable tools to assess whether students are ready for practice (duffy, das, & davidson, 2013), to develop advances in social work, spring 2016, 17(1) 79 group work skills (macgowan & vakharia, 2012), and to promote reflective learning, particularly when coupled with videotaped analysis (bolger, 2014; dempsey, halton, & murphy, 2001). various methods have been used to achieve pedagogical goals when employing role plays in the classroom. for example, petracchi (1999) and petracchi and collins (2006) used actors to simulate client situations, and the results were largely positive. while role plays are typically viewed as a dyad exercise, moss (2000) has used them in a large group format as well. the pedagogical goal was for students to experience multiple actors similar to what would be encountered when doing family therapy or engaged in a multi-agency collaborative project. some empirical studies have compared the efficacy of online role plays to face-to-face role plays with little difference found in student learning outcomes for acquiring problemsolving skills related to alcohol use (vapalahti, marttunen, & laurinen, 2013). on the other hand, regarding the learning setting, students in other studies prefered face-to-face experiences (holmes & kozlowski, 2015). related fields, such as counseling psychology, have also evaluated the efficacy of online training for clinicians needing to acquire cognitive behavioral therapy (cbt) skills with promising results, especially when accessibility is a key issue (rakovshik et al., 2013). finally, in social work, peterson (2014) reported significant improvement in clinical skills for students who used handheld digital recorders. students uploaded role play files to a private youtube channel for instructor feedback, eliminating the need to either email large media files or mail physical storage devices to the instructor in order to submit the assignment. cost can be a key consideration when online programs adopt new technology solutions. online programs in general can be quite costly to design and implement with overhead costs ranging up to the millions of dollars (miller, 2014). for example, some technology solutions involve the use of artificial intelligence to emulate unscripted conversational encounters (zhang et al., 2009). while a promising approach, the costs associated with developing the programming language can be substantial. other social work programs hire professional actors to perform role plays with online students (see http://www.backstage.com/casting/msw-online-education-role-plays-69125/). lastly, unlike peterson (2014), in which handheld devices and youtube were used, other programs developed their own web servers for feedback and discussion of videos that were shot with two cameras and stored on a separate media server (shibusawa, vanesselstyn, & oppenheim, 2006). in addition to the costs associated with the equipment, the resulting high definition video files could only be accessed by students on campus or by those with access to broadband internet connections. studies examining the implementation and effectiveness of online delivery of content must consider whether the delivery is synchronous or asynchronous. synchronous delivery means that students and instructors meet at the same time via videoconferencing software (e.g., adobe connect, blackboard collaborate, etc.) asynchronous delivery means that students and instructors interact solely via discussion boards, recorded video lectures, or other multi-media content, with no real-time interaction. online asynchronous programs could ask students to find a local friend with whom to perform a role play, videotape the encounter, and then email the video file to the instructor for feedback. some online professional counseling programs, however, have no practice component until students are fitch et al./use of online video conferencing 80   in their internships (reicherzer et al., 2012) (i.e., students do not have any role play experiences). the distinction between synchronous and asynchronous delivery is a central consideration when identifying and evaluating the types of technology needed for online courses. in sum, the literature provides numerous examples of the ways in which role plays can be incorporated into online education. however, most studies tend to skip over the thinking and design work that went into the actual technical solutions and focus only on group process issues like cohesion, presence, and therapeutic alliance (e.g., holmes & kozlowski, 2015) when evaluating their efforts. failing to document the design process is especially problematic when there are known technical issues that can be challenging in online verbal interactions, e.g., latency (when audio and video become out of sync). it is important to identify and describe the thinking and design work in order to assist other programs in adopting and implementing technology solutions that best address their desired delivery style. within social work and similar programs teaching clinical skills, the technical solution has to address a difficult problem – examining the best way for online students to acquire interaction skills. therefore, the purpose of this paper is to systematically examine the design features that need to be considered, that is, design choice, when developing a technical solution that facilitates online role plays. proof of concept project the course delivery method for our school of social work is largely asynchronous except for the role play component. when doing role plays, our students interact with each other in real time; therefore, our program is a hybrid asynchronous/synchronous approach. to achieve this synchronous component within an overall asynchronous program, we proceeded as a proof of concept project since the goal was the development of a technology solution that we needed to test in terms of feasibility, cost, and scalability. that is, the technical aspects needed to work across various hardware components, (e.g., personal computers, laptops, smartphones); it needed to be accomplished at little to no cost; and it needed to be implementable in classes across the curriculum whether online or on campus. key in our formulation of the technology solution is that the technology needed to align with our profession’s commitment to training students with face-to-face interactions whenever possible. specifically, one misconception with online education is that students are not able to interact with people in real time. prior research likely contributes to this misconception, for example, studies in which role plays were evaluated by listening to taped phone conversations (e.g., rakovshik et al., 2013) or occurred through text-only discussion forums (e.g., levine, 2013). in order to preserve real-time interactions, in 2013 project members began testing various online video conferencing tools. key features needed to include: a) the ability to facilitate the real-time interaction of two students from different locations. students learn in role plays by playing both the therapist and the client role. indeed, it might be argued that playing the client role is instrumental in helping students develop empathic skills, b) the ability to work well with laptops and wi-fi/3g connections in rural settings. c) the ability to record the session for later viewing and feedback. we examined various online platforms that could have met these needs, but all of them came with price tags above our advances in social work, spring 2016, 17(1) 81 program means. we also examined the videoconferencing capabilities available through our learning management system, blackboard. while financially feasible, it lacked the technical capabilities of being easily accessible across platforms (windows and macintosh), it required additional software downloads (java, in particular), and the resulting recorded sessions displayed degraded video quality. after considerable testing and use, we decided to examine google hangouts (https://plus.google.com/hangouts) and zoom (http://zoom.us/). peer and instructor feedback was accomplished using videoant (http://ant.umn.edu/) through the university of minnesota. methods institutional review board approval was obtained since a portion of our evaluative data involved the display and review of recorded online interactions between students. our sampling frame included students and instructors from three classes: an on-campus undergraduate course, an on-campus graduate class, and an online graduate class. in total, there were 3 instructors and 32 students who participated and provided feedback data. 35 instructor and student participants. as a proof-of-concept, formative evaluation of a technology tool, we used the design science methodology outlined by peffers, tuunanen, rothenberger, and chatterjee (2008) for three main reasons: 1) the focus of this project is on how the software application for role plays was chosen and implemented. as such, the software as a technology artifact was designed to fit a specific function within organizational constraints. 2) this focus on the design features, in turn, produces design principles that can be implemented in other settings like other schools of social work. 3) these design principles, in turn, can serve as the basis for future theoretical and empirical research projects. a sampling of what those research questions may entail is discussed under implications for future research. as outlined in peffers and colleagues (2008), we discuss four central components of this project: process, resources, management, and effectiveness. process too often so-called technology solutions are presented as a one-and-done solution offered by vendors to schools of social work. sometimes these solutions work, but oftentimes they do not. in either case, the faculty are left largely unaware as to how the solution actually works. in order to involve all key stakeholders in our technology adoption, participant recruitment, including instructors and students, unfolded in an iterative process. it began with the testing of various platforms among faculty, then soliciting feedback from a small number of students, and finally moving forward to classroom-level involvement. each step of the process resulted in feedback that informed the next step. we took this approach for several reasons. first, budgetary constraints prohibited the use of outside vendors to provide a technical solution. second, we needed to be able to explain why a certain approach was chosen pedagogically and how it could fit into online classes but also be capable of use in the traditional classroom. third, multiple instructors were involved to explore and test the technology. this is a strength as individual faculty members may identify a technology solution for a specific class, only to find out that it will fitch et al./use of online video conferencing 82   not work for other classes or lacks broader buy-in from other instructors. this may result in the non-adoption of the technology solution on a broader scale. resources this aspect of the analysis primarily examined the time and effort required to conduct and assess online role plays compared to the traditional classroom approach. secondarily, we considered the resources that would be required in terms of classroom time utilization, technology demands, connection speeds, etc. finally, costs were an integral aspect of the decision-making process to adopt a technology solution. resource-deep universities appear to have the option of expending funds in trying out various technology solutions that are simply cost-prohibitive for many institutions. we needed to explore technology solutions that did not require upfront expenditures yet still met our pedagogical goals. management the instructors were asked questions related to the feasibility of employing this technology on a wider scale if pilot results look promising. for example, the traditional classroom constrains the number of role plays that can be conducted and observed by the instructor within a given block of time. online video conferencing does not have this constraint thereby potentially increasing the workload of instructors. conversely, alternative methods of providing feedback may lessen this workload. the technology solution also needed to be one that did not have a steep learning curve and/or require the use of proprietary software that would require additional instructor obligations to learn and master. effectiveness as a formative evaluation, any assessment of effectiveness is provisional, but useful information was gathered from the student and instructor participants regarding the utility of the technology artifact, the video quality of the role-play compared to classroom settings, and a preliminary understanding of the efficacy of this technology artifact to nurture interaction skills. to elicit information related to these four dimensions, we asked the students and instructors via email or through face-to-face discussions the following questions: 1. how easy was it to use google hangouts/zoom and provide feedback? a. did you experience any technical difficulties? b. were the directions easy to follow? c. was the video quality sufficient to perform a role play? 2. how would you compare the time and effort compared to a classroom role play? 3. do you believe you were able to acquire social worker-client interaction skills comparable to a classroom role play? if so, how? if not, why not? findings the methodological framework and research questions resulted in findings that fell within eight domains: the user interface, technical issues, costs, support needs, time and advances in social work, spring 2016, 17(1) 83 effort, skill acquisition, privacy issues, and evidence for transfer of learning. while google hangouts was proficient in meeting many of the pedagogical and technical requirements necessary for conducting role plays, zoom was used because of the ease of use and video quality. as such, most of the findings refer to zoom. interface perhaps the most significant factor in deciding upon any technology solution is the user interface experience. to aid in better understanding the user interface, two screen captures have been provided from actual student participants. the first image, used with permission, captures exactly what the users see when talking to each other via zoom. figure 1. screen capture of zoom user interface. it is immediately apparent that the user interface is not cluttered with extraneous technical tools thereby preserving the one-on-one experience. as an observer to the role play, one is able to see each participant head-on and not in profile view as occurs in classroom role plays. after the role play is concluded, one of the participants uploads the video (automatically stored on the user’s device) to youtube choosing the unlisted privacy setting which means it can only be viewed if you have the specific link to the video. once uploaded, the url for the video is linked from videoant resulting in the following user interface: fitch et al./use of online video conferencing 84   figure 2. screen capture of videoant user interface. this interface, viewable by the instructor and peers, provides an opportunity to view the video and provide feedback. most important in this technical solution is the ability to provide annotated feedback that is time-stamped. closer examination of the image will show that feedback provided at the 12 second mark, 45 second mark, etc., results in a hash mark on the timeline above the video. as such, a student reviewing the feedback provided by an instructor can go to those specific spots in the video to see what is referenced. having this time-stamped annotated capability precludes the need to segment video sections into different files (shibusawa et al., 2006) or fast-forward or reverse through the entire video. most importantly, the annotation feature can have other uses. for example, an instructor may ask students to perform a self-assessment of their role play performance using an established rubric at the time of assignment submission. in this manner the instructor would then evaluate how well the participants were able to assess their skills. the instructor can then provide feedback using the “comments” feature. alternatively, peers may be asked to provide the initial feedback with the instructor evaluating how well peers are able to note specific interaction skills. in sum, there are multiple ways to provide feedback. the role play video is accessible via the internet, and the participants, instructor, and peers do not have to be at the same place at the same time to provide this feedback. taken together, the most salient features program planners will want to consider when designing or selecting an interface to facilitate role plays would include an uncluttered user experience, viewing the participants head-on, and the ability to provide time-stamped feedback. technical issues the importance of the user interface experience cannot be understated. instructor and student feedback revealed general consensus that the web-based technologies were easy to advances in social work, spring 2016, 17(1) 85 use. specifically, individuals with older laptops (6+ years) reported the technologies worked well. users with smartphones were also able to use zoom with ease. there were two types of occasional audio problems: a) some users reported no sound, but that was remedied by having the users check their default microphone configurations, and b) there was some degree of latency (the audio and video images were not in sync), occurring more frequently with google hangouts than zoom, but also easily remedied by having the users wear headsets. other contributing factors for the latency appeared to be the time of day the role plays occurred with 7:00 p.m. to 9:00 p.m. being the most problematic. in addition, the level of lighting in the participants' locations contributed to latency. insufficient lighting will cause a computer’s processor to work harder in order to capture the video image thus hampering overall performance. most important to our project, even students living in rural areas with no or limited broadband access were able to use their smartphones and reported a high quality user experience with the technology. stated otherwise, the design choice for technology selection must be a hardware/software/access choice that is accessible for students with limited bandwidth options and can accommodate older computers and multiple operating systems and devices. costs cost was one of the more important administrative aspects of the technology solution. zoom and videoant are free. zoom is free for up to 25 participants. since only two people were involved in the role plays, no costs were incurred. zoom is also a browser add-on, so there is no software to manually install and no administrative privileges are needed to use it on university-owned equipment. the videoant software also has no cost since it is offered freely by the university of minnesota. in addition, even though we used the free version of zoom, if a social work program needed to conduct role plays that might contain client identifiable information, paid versions of zoom are available that can provide additional privacy controls. the videoant software, likewise, while still freely available, can be installed on a university's secure server for enhanced privacy protections. in sum, the design choices we made for our program involved no costs. although free software may raise quality concerns, our experiences show that low-cost video sharing software can meet the needs for online social work education programs. support most helpful in our iterative approach was learning the needs of students in using the new technology. in line with existing best practices, an extensive step-by-step guide was written to direct the instructors and students through each part of the process of setting up a role play through video feedback. while most students found these guides very helpful, others did not. because of student feedback, online video tutorials were created to demonstrate how to do each step. once these online tutorials were introduced, no technical issues arose. it may be important to become familiar with the technology before the actual role play assignment. one student reported, “i thought [it] was relatively easy once i got my account set up and did a run through to verify that everything worked.” this design choice is the one that typically gets overlooked even though “help” buttons are found in fitch et al./use of online video conferencing 86   most software applications. by the very fact that most people rarely use “help” buttons beyond the first attempt (grayling, 2002), program implementers must devote the time necessary to learn exactly what types of support are needed and in which ways they need to be delivered. time and effort almost all of the students had prior experience doing role plays in the classroom setting. as such, they were asked to compare the two experiences in terms of the time and effort required to perform a role play. several students reported they would not have been able to do the role play if not for online videoconferencing due to travel barriers and employment obligations. for example, one student commented, there might be a little less time involved as it was completed without having to travel to a mutual location. it was very convenient for a single mother, someone out of town, and one traveling out of town for other appointments to coordinate a time to complete the assignment. similarly, a second student commented, after i get off work and drive an hour plus to [school location] i don’t feel like i can give the proper amount of attention to an assignment after class. this is a great tool to overcome that problem and still have an effective educational experience. for these students the use of technology allowed them to participate in key learning experiences while simultaneously managing competing life events. many of our students, particularly those enrolled in the part-time program, have a multitude of competing roles including fulland part-time work and caregiver responsibilities. time and effort is an important consideration and frequent barrier that technology may help address. the design choice for this task actually involves an analysis of the existing classroom as opposed to any technology. students experience location and time constraints in the traditional, oncampus classroom, and professors often must plan course time around the availability of rooms or recording equipment. these decision constraints are all taken for granted in most curriculum planning activities. online technologies now allow us to avoid those constraints. skill acquisition students and professors provided a range of feedback regarding the skills acquired through the online role plays. some students found the technology “distancing” compared to a face-to-face encounter. alternatively, other students found the encounter more “intimate” in that the pressure to “perform in front of others” was not felt. for example, one student commented, it is definitely not as natural as in-classroom role plays, but that’s to be expected. i think our actual verbal interaction was pretty comparable and i feel it is good technology to practice for the future of clinical social work. advances in social work, spring 2016, 17(1) 87 another student reported, it was an adjustment with the eye contact being difficult, though with the camera being straight on each person, it was easy to see body language, non-verbal idiosyncrasies, as well as facial expressions. this last comment is particularly important for those concerned about technology interfering with human interactions. online role play is different from in-person classroom experiences, but it does not appear to be so different as to prevent all nonverbal communications. however, more research is necessary. the instructor feedback related to skills acquisition indicated that students acquired comparable skills relative to classroom students. similar to the student feedback, the instructors reported that students were able to demonstrate engagement skills and other techniques much like their classroom counterparts. future studies will need to more rigorously assess if any differences occur with skill acquisition. privacy even though the privacy constraints in doing a role play are no different than those of the traditional classroom, additional steps were taken in light of the online environment in which this learning activity would take place. those steps included privacy settings within the software and the use of disclaimers. students were instructed how to change the default privacy settings for google hangouts and zoom and, for youtube, to change the video settings from public to unlisted. in addition, the role play began with the person playing the role of the social worker saying: “the following is a fictional role play – all names, places, and events are fabricated.” during the role play the social worker and client referred to each other with fictional names. at the conclusion of the role play, the person playing the role of the social worker said: “the preceding was a fictional role playall names, places, and events were fabricated.” no students reported any concerns due to privacy issues. the design choices for this issue will change as often as hardware and software change, and that point must not be forgotten. however, these choices should not be limited to the conduct of online role plays. indeed, with all types of classroom activities now having at least some online component (e.g., email, course management systems), students and faculty must continually upgrade their knowledge and skills regarding safe computing practices. new learning connections the connections some students made from this online exercise to the future of social work practice were unexpected. one student noted, “what a great way to provide counseling to those in remote locations (servicemen and women overseas?)!” another student stated, i like the idea of video interviews because of the convenience and learning opportunities. if a social worker could do appointments over video and they are able to record it confidentially, it would allow them to be able to watch the video afterwards to see if they might have missed something in the client’s expression, fitch et al./use of online video conferencing 88   tone, or body language. the client also might have said something important that the social worker missed during the initial interview, but noticed when watching the video. it is understandable that social work educators have serious concerns about the use of technology in online education and social work practice. however, it appears that students not only feel comfortable with this medium but are also able to see implications for practice that may not have been imagined without their exposure to it in the online role play exercises. finally, the design choice for programs looking to add an online component is simply to be aware these new learning connections will extend far beyond any one role play exercise or class. not only do students see the opportunity to use technology in new ways, but faculty will also find new ways to think about teaching and learning. when that happens, some faculty and students will be reluctant to return to the traditional way of learning if a technology-facilitated approach is viewed as preferable. discussion the purpose of our project was to systematically examine the design features that needed to be considered when developing a technical solution that facilitates online role plays. incorporating peffers and colleagues’ (2008) design science methodology allowed us to examine these features within pedagogical and organizational constraints. doing so allowed us to be more explicit in what the technology can and cannot do and how it can serve pedagogical goals instead of limiting them. in addition, the transparency of the technology design allowed our project to be more explicit in describing how the technology mediates the acquisition of interaction skills, a very important factor in future efficacy studies for online education. a lack of clarity regarding the mediating capacity can have unintended consequences. for example, the google hangout latency issue might have contributed to the findings reported by holmes and kozlowski (2015), yet we do not know since they did not address those issues into their article. this omission may lead some to believe that interaction skills cannot be obtained online due to technical rather than pedagogical reasons. extending this reasoning further can be especially problematic if we then infer that potential clients should not receive services online. not only did the students in our pilot project point out the possible contribution online therapy might make for clients who cannot access services otherwise, but randomized control trials from other fields also show that online therapy has demonstrated efficacy for depression (andersson et al., 2005; andersson et al., 2013; griffiths et al., 2012; preschl, maercker, & wagner, 2011), social phobias (berger, hohl, & caspar, 2009), anxiety (ellis, campbell, sethi, & o’dea, 2011; hedman et al., 2014), and eating disorders (heinicke, paxton, mclean, & wertheim, 2007). a surprising mediating role that technology played also occurred with performance anxiety issues around role plays. our finding that students found role plays intimidating in front of a room of peers was also encountered by shibusawa et al. (2006). ideally, one would hope we could provide settings for students to acquire skills without the complicating factor of performing in front of others since counseling is not done in that advances in social work, spring 2016, 17(1) 89 manner either. using technology as a mediator that focuses on skill acquisition may make it preferable for students to acquire skills regardless of online or on-campus settings. most intriguing is how the use of online technologies mediates the time constraints imposed by traditional classrooms. as noted by the instructors in our project and other researchers (peterson, 2014; shibusawa et al., 2006), the storage of recorded role plays on the web allows for their access at any later time in the semester for additional learning and understanding. all too often role plays are seen as one-time events, diminishing the educational capacity of the exercise. students may not fully appreciate certain aspects of a counseling technique until it is presented in a different context. by having the role play available online, new learning may occur that would not have happened otherwise. finally, while studies like peterson’s (2014) are to be lauded because they report pre/post measures of competency achievement, it may be just as important to document how the use of technology is to occur. that is, how should instructors identify potential technical solutions to address the issue of online role plays amid the various software and hardware options? this article attempts to answer that question. however, in doing so it also results in other intriguing possibilities. implications for future research the most important implication for future research is the need for more rigorous research designs in assessing student interaction skills. our preliminary results are promising, but no generalizable claims can be made due to the lack of comparison/control groups, and lack of a random sample. however, it is important that any future efficacy study involving technology be transparent in describing the role that technology plays and how that technology fits into pedagogical goals and organizational constraints. additionally, researchers should describe the process of using the technology including implementation procedures, ease of use, and any technical difficulties experienced. future students, online or not, need to be able to engage in more role play activities. one of the most paradigm-shifting outcomes from our project is getting instructors to think outside the 3-hour block of time that has historically constrained our educational activities. asynchronous online learning completely removes that constraint and re-shifts the focus away from online teaching and toward online learning. without the 3-hour time constraint, all students could conceivably engage in as many role plays as pedagogically desired. granted, this would increase workload issues for both students and instructors, but it would certainly address the need expressed by students to have more practice acquiring interaction skills prior to field placement experiences. finally, if our profession is to take the next step of offering social work services online, we must find the best ways to prepare students to provide those services. we must explore methods for training students to compensate for non-verbal cues that may be obscured by video technology. becoming familiar with technology interfaces via role plays may be the first step. fitch et al./use of online video conferencing 90   references andersson, g., bergström, j., holländare, f., carlbring, p., kaldo, v., & ekselius, l. 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(2009). edrama: facilitating online role-play using an ai actor and emotionally expressive characters. international journal of artificial intelligence in education, 19(1), 5-38. author note address correspondence to: dale fitch, school of social work, university of missouri at columbia, 703 clark hall, columbia, mo 65211, fitchd@missouri.edu, 573-884-7405.     microsoft word 10-3239-de jesus_reducing barriers to career entry final ______________ anthony de jesús, ed.d., msw, is an assistant professor and director of msw field education in the department of social work & latino community practice at the university of saint joseph in west hartford, ct. this research was supported by the centro de estudios puertorriqueños (hunter college) pathways to economic opportunity project sponsored by the ford foundation. the author would like to acknowledge dr. edwin melendez, director of centro for his support of this research. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 163-177 reducing barriers to career entry for latinos: an examination of pathways into social work anthony de jesús abstract: demand for bilingual/bicultural social work practitioners presents a mutually beneficial opportunity for the social work profession and latinos who are increasingly in positions to be employed as social workers (acevedo, gonzález, santiago, & vargasramos, 2007; ortíz-hendricks, 2007). uneven academic preparation, limited access to information about college, high tuition/opportunity costs and family obligations are among the barriers to higher education for latinos (arbona & nora, 2007; hurtado & ponjuan, 2005; ortíz et al., 2007). using comparative methods, this article describes career pathway program models that address obstacles to successful entry into social work careers. these models also demonstrate the potential to reduce barriers to degree completion and career entry for latinos. salient program components include reduced tuition and tuition assistance, transportation assistance, child care, support in strengthening oral and written english skills, and access to networks of employers (takahashi & melendez, 2004). implications for social work and social work education are also discussed. keywords: latinos, college completion, social work education the expected employment growth in the social work sector suggests opportunities for latino adults who are interested in completing degree programs in social work and are already employed in support roles in the field. the demand for bilingual/bicultural social work practitioners presents a mutually beneficial opportunity for the profession and latino communities, whose members are both in need of social work services and, increasingly, in positions to be employed as social workers (acevedo, gonzález, santiago, & vargas-ramos, 2007; ortíz-hendricks, 2007). anticipated growth in the social work/mental health sector underscores the demand for bilingual latinos to enter the field as practitioners and, in turn, address the needs of their communities (acevedo et al., 2007; bureau of labor statistics 2010; ortíz-hendricks, 2007). further, because migration histories, language, and culture are prominent variables in the academic success of latinos, models advanced by social work educators who are experienced with this population provide useful examples, which may be adapted and/or replicated to increase the number of latino social work practitioners (gardella et al., 2005; negronirodriguez, dicks, & morales, 2006). based on document review and interviews with directors of career pathway models for latino adults, this analysis describes program components of three models designed to address barriers to the completion of postsecondary credentials and to facilitate entry into the field. these barriers include costs (both monetary and opportunity costs), insufficient academic preparation, limited access de jesús/reducing barriers to career entry for latinos 164 to information about higher education, and discriminatory context (arbona & nora, 2007; hurtado & ponjuan, 2005; negroni-rodríguez et al., 2006). according to jenkins (2006), the concept of a career pathway reflects “a series of connected education and training programs and support services that enable individuals to secure employment within a specific industry or occupational sector, and to advance over time to successively higher levels of education and employment in that sector” (p. 6). latinos are more likely to experience interruptions in the pursuit of higher education, especially those who begin at two-year colleges and experience difficulty transferring to four-year institutions (hurtado & ponjuan, 2005; swail, cabrera, & lee, 2004; swail, cabrera, lee, & williams, 2005). many latino adults with some college credits but no degree stand to benefit from career pathways designed to address barriers to college completion. indeed, u. s. census data presented in tables 1 and 2 reveal that a national pool of latino adults employed in social work and related fields would ostensibly benefit from programs designed to upgrade their skills and credentials. the broadening of pathways that tap into this pool will both facilitate the human capital development of latino communities, and enable the social work profession to increase its capacity to serve latino communities. this study analyzes the program components of three career pathway initiatives targeted at supporting latinos in enrolling and completing twoand four-year undergraduate and graduate degrees in social work. the study is guided by the following question: “which program components assist latinos in reducing barriers to completion of social work credentials?” social work employment and latinos the expected growth of social work employment in the coming years confirms the need to reduce the barriers for latinos entering and advancing along career ladders in the field. employment within the social work/human services sector is expected to increase by 25% during the 2010–2020 decade. growing elderly populations will need social services, which will lead to new positions in medical and public health social work, case management, long-term care, and gerontological social work services. in addition, positions focused on mental health and substance abuse are also projected to grow by 31%; and medical and public health social work and social work assistant positions are expected to grow by about 22%, a growth rate much greater than the average (bureau of labor statistics, 2011). the growth of the latino population throughout the country also presents further opportunities for latinos trained in social work to be employed in areas where large populations of latinos comprise the client base (chapa & acosta, 2010; hernandez & fitch, 2004; ortíz et al., 2007). a review of the occupational distribution of latinos reporting employment in the social work sector is useful for obtaining a better understanding of the need for programs such as those described in this analysis. according to u. s. census data reviewed below, latinos are underrepresented, relative to the average for non-latinos, in professional and paraprofessional social work occupations (social work and social work assistant categories). advances in social work, spring 2013, 14(1) 165 according to 2006-2008 data from the american community survey (u.s. census bureau, 2012), only 7.14% of all latinos reported employment as professional social workers possessing a master’s degrees and 9.24% with a bachelor’s degrees (see table 1). while a bachelor’s degree is a minimum requirement for most social work positions, a number of individuals reporting employment in social work positions on the census also report educational attainment of less than a bachelor’s degree. of all latinos reporting employment in a professional social work role, 43.6% have yet to complete bachelor’s degrees; with 13.55% possessing only high school diplomas, 16.46% having attended some college, but with no degree, and 13.65% hold an associate’s degree. of the 811,553 adults (25 years and older) employed in social work positions in the united states, only 10%, or 81,817 were latino. this data is the best available estimate of the number of latino social workers working at the baccalaureate and master’s level. individuals who report working as professional social workers who possess less than a bachelor’s degree are included in this analysis. this highlights the demand for upgrading credentials for latinos already employed in field. table 1 u.s. social workers educational attainment hs diploma some college associates bachelors masters total non-latino 45,335 (86.45%) 72,869 (83.54%) 41,436 (86.35%) 308,235 (90.76%) 240,422 (92.86%) 729,736 latino 7,105 (13.55%) 14,356 (16.46%) 6,550 (13.65%) 31,378 (9.24%) 18,484 (7.14%) 81,817 total 52,440 87,225 47,986 339,613 258,906 811,553 source: u. s. census bureau, american community survey (2006-2008 three-year sample) further underscoring these disparities is the distribution of latinos who reported employment in social work assistant roles which include, human service worker, case management aide, social work assistant, community outreach worker, community support worker, mental health aide, clinical social work aide, addictions counselor assistant, life skills counselor, family service assistant, social services aide, youth worker, psychological aide, client advocate, or gerontology aide. as table 2 indicates 380,940 adults were employed in social work assistant positions in the united states: with latinos representing 12% (42,123) of this category. the over representation of latinos in the “some college, but no degree” category is a particularly relevant data point for this analysis, one that shows that 44% of latinos employed in social work assistant positions do not possess a bachelor degree. the educational attainment of social work assistants closely mirrors that of the social work professional category. fourteen percent of all latinos employed as social and human services assistants possessed some college, but no degree, while 15.39% possessed associate’s degrees and 14.31% had high school diplomas. the similarities in lack of educational attainment suggest formidable barriers to career advancement for latinos within the field of social work, but they also suggest that a robust market exists for pathway models that address barriers to enrollment and completion of social work degrees. de jesús/reducing barriers to career entry for latinos 166 table 2 u.s. social and human service assistants’ educational attainment hs diploma some college associates bachelors masters total non-latino 46,490 (85.69%) 63,184 (85.65%) 27,234 (84.61%) 108,235 (89.35%) 41,472 (92.95%) 299,123 latino 7,763 (14.31%) 10,588 (14.35%) 4,952 (15.39%) 12,902 (10.65%) 3,144 (7.05%) 81,817 total 54,253 73,772 32,186 121,177 44,616 308,940 source: u. s. census bureau, american community survey (2006-2008 three-year sample) barriers to attainment the occupational status of latino adults in social work is not surprising when understood in the context of the literature on latino higher educational attainment in the united states. uneven academic preparation, limited access to information about college and graduate education, the rising cost of tuition, the opportunity costs of pursuing a degree, financial challenges, and family obligations are among the most formidable barriers to higher education experienced by latino students. in addition, many latinos confront discriminatory and generally adverse educational environments, which discourage their degree completion (arbona & nora, 2007; hurtado & ponjuan, 2005). gardella and colleagues (2005) point out that latino students “struggle to meet the expectations of families, employers, and academic programs that were designed for students with few external responsibilities” (p. 41). at the master’s of social work (msw) level negroni-rodríguez and colleagues (2006) observed that latino students were frequently adult learners with many life stressors and limited financial resources. they were more likely to extend their graduate study beyond the two-year norm and need support in finding course and field education arrangements that accommodated their employment and family responsibilities (p. 204). the challenges described above are reflected in social work education nationally as indicated in a report by the council on social work education (cswe) task force on latino/a social work education (ortíz et al., 2007). one hundred twenty-five accredited undergraduate and graduate social work programs (n = 506) were surveyed in order to assess the “state” of latinos in social work education. the study analyzed latino student recruitment, retention, and graduation data from 25 % of the nationally-accredited social work programs at the baccalaureate, master’s, and doctoral levels and found latinos to be consistently underrepresented relative to the national population (ortíz et al., 2007). the most frequently ranked obstacles to latino student recruitment and retention included: insufficient financial aid and the high cost of tuition; insufficient representation of latino faculty and staff, either in the social work program or within the institution; lack of a large pool of latino applicants; and no focused recruitment efforts toward latino students. the most frequent reasons for not having a greater percentage of latinos accepted into msw programs included poor writing skills and low gpas among latino applicants (ortíz et al., 2007). advances in social work, spring 2013, 14(1) 167 the cswe latino task force report findings are consistent with predominant latino attitudes toward higher education which are characterized by the belief that higher education is academically and financially inaccessible. for example, a recent pew hispanic center (lópez, 2009) analysis “latinos in education: explaining the attainment gap,” found that although nearly 90% of latino young adults (16-25 year olds) believe a college education is important for success in life, only 48% say that they plan to get a college degree. of the respondents who cut their pursuit of higher education short, 74% stated their departures were due to the need to economically support their families, while half cited poor english skills (p. 6). higher education researchers found that latino student attainment gaps were also related to students’ experiences within adverse environments and stereotyping within institutions of higher education (arbona & nora, 2007; hurtado & ponjuan, 2005). they also found that a positive campus culture was a large determining factor in latino degree attainment (lópez-mulnix & mulnix, 2006). in a longitudinal study of latino students’ perceptions of their undergraduate experiences hurtado and ponjuan (2005) found that students from spanish-language dominant households were more likely to perceive hostile campus climates than those from english language-dominant households. hurtado and ponjuan (2005) also found that latino students’ backgrounds were less important to retention than their sense of belonging on campus, which was facilitated by a “positive quality of interaction with diverse peers,” resulting in a higher sense of belonging in college, and an “increase in confidence and skills that reflect a pluralistic orientation” (p. 248). facilitating this sense of belonging and the development of the “capacity to manage differences and function in a diverse workplace” (hurtado & ponjuan, 2005, p. 248) are among the goals of the programs described in this study. while tuition and opportunity costs heavily influence latinos’ decisions to pursue and complete a professional degree, hurtuado and ponjuan (2005) argue that many latino students also assess campus climate as a barrier—assuming that institutions of higher education are unwelcoming environments for latino adult learners. yosso, smith, ceja, and solórzano (2009) broadly define campus racial climate as “the overall racial environment of the university that could potentially foster outstanding academic outcomes and graduation rates for all students but too often contributes to poor academic performance and high dropout rates for students of color” (p. 664). the perception among many latinos that institutions of higher education are unwelcoming can only be overcome with programming that deliberately addresses these traditional barriers to latino student engagement. given the underrepresentation of latinos in social work positions nationally, and our knowledge of the challenges confronting latinos as they endeavor to complete degrees in social work, this research seeks to describe and analyze best practices among three different pathway models designed to address these barriers (costs, academic preparation, information and adverse environments). pathway models seek to address and reduce these barriers for latinos who have not completed a bachelor or master degree and who may benefit from programs that lead to entrance into social work careers. de jesús/reducing barriers to career entry for latinos 168 method in seeking to understand more fully the characteristics of pathway models that address the needs of latinos seeking social work credentials, this inquiry is guided by the question: “which program components assist latinos in reducing barriers to completion of social work degrees?” in order to answer this question, data used for this study was collected as part of the pathways to economic opportunity project for low wage puerto ricans sponsored by the centro de estudios puertorriqueños (centro) at hunter college. a purposive sample (maxwell, 2013; patton, 1990) consists of three pathway programs identified from an internet search of social work/human services programs serving latino participants and/or with programmatic missions that explicitly seek to address the barriers confronted by latino adults in completing social work degrees. the research was supported by a larger research initiative that examined industry and community-based workforce development strategies to assist low-wage puerto ricans (de jesús, 2011; visser & meléndez, 2011). as a result, program selection was limited to those located in communities in the northeast united states where puerto ricans are the largest latino subgroup. while these programs primarily serve puerto ricans, they also serve other latinos residing in these communities and may be appropriate to adapt for use with other latino communities. although the findings of this study are not generalizable because of the small sample and descriptive method, this analysis provides useful insight for social work educators interested in reducing barriers for latinos regarding which program components and organizational structures may represent promising practices. moreover, as there are very few programs specifically targeting and/or serving latinos, these programs illustrate the need for social work educators to develop innovative strategies for recruitment of latino students through partnerships with community-based organizations and two-year/community college(s) in order to strengthen pathways for latinos into the field. the three programs analyzed differ by type of institutional host/sponsor and by the level of credentials offered. one program, the health careers core curriculum (hc4) is a union-based partnership with several campuses of the city university of new york; another, harcum at congreso, is a partnership between a private two-year college and a community-based non-profit organization offering an associate’s degree in human services; and the third, the ¡adelante! bilingual career development certificate at the university of saint joseph, offers a career development certificate leading to undergraduate degree completion and is based at a small catholic women’s university. these varying program and organizational structures provide a range of approaches targeted at addressing barriers to degree completion for latinos. table 3 provides basic information on each model. this study employed a comparative case study (miles & huberman, 1994; yin, 2003) of the three pathway models and utilized multiple sources of data including interviews with program directors, published articles, annual reports, recruitment materials, brochures, and program websites. upon obtaining the human subjects’ approval, three semi-structured individual interviews were conducted with program directors, in person or via telephone, during march and april of 2010. interviews ranged in duration from 60 to 90 minutes. using an interview protocol adapted from takahashi advances in social work, spring 2013, 14(1) 169 and melendez (2004), the interviews focused on program characteristics, history, institutional motivation and context, recruitment and retention, support services, and program impact. table 3 social work pathway models program health careers core curriculum, hc4 ¡adelante! bilingual career development certificate harcum at congreso institution 1199 seiu training and employment fund university of saint joseph, west hartford, ct congreso de latinos unidos, philadelphia, pa program type pre-college, associates, bachelors, graduate undergraduate certificate, bachelor’s degree (bsw) associates’ degree number of participants 800+ 10-12 100 using academic databases and an internet search, a number of peer-reviewed journal articles, documents (brochures, etc.), and websites related to each program were collected and/or accessed and utilized for data analysis. in addition, program directors provided additional written reports and program description/data. once collected, data were analyzed using the constant comparative method, with which the researcher simultaneously codes and analyzes data in order to explore relationships, refine concepts, identify properties and integrate them into a coherent narrative (miles & huberman, 1994; taylor & bogdan 1984). this approach provides for a richer description of the program components that were identified to assist latinos in overcoming barriers to entering social work pathways (miles & huberman, 1994, p. 173). results 1199 seiu league training and upgrading fund health careers core curriculum (hc4) program 1199 seiu (service employees international union) is the new york city and long island chapter of this national union of health care workers, which has approximately 200,000 members. approximately 14,000 union members enroll in the union’s training and upgrading fund programs annually. of these, approximately 92% are people of color, and 12% of these are latinos. the part-time hc4 program allows union members who are first-time or returning college students to take up to 34 credits of required college courses through the city university of new york (cuny) and then apply those credits to healthcare-related associate’s or bachelor’s degree programs. through a tuition voucher program, participants can take up to six credits per semester before incurring out-of-pocket costs. participants attend a required program orientation and the training and employment funds’ college bound workshop, and must pass the reading and writing portions of the cuny-act skills assessment. courses are offered on cuny campuses, at local union sites, and online. participants are enrolled in a cohort and are supported by case managers de jesús/reducing barriers to career entry for latinos 170 and counselors who assist with course selection, provide counseling on campus and at the fund’s sites, and refer students to support services as needed. support services include tutoring and workshops that enhance study skills, time management, and computer and internet research to assist with college-level work. participants have seven-day access to program advisors. within the cuny system, hc4 works primarily with the college of staten island (csi), new york city technical college in brooklyn, and lehman college in the bronx. each of these campuses provides academic programs in human services and/or social work, with new york city technical college offering both an associate’s degree in applied sciences in human services and a bachelor’s of science in human services. the college of staten island offers a bachelor’s of arts in social work (basw) and lehman college offers a cswe accredited bsw and msw program. at the undergraduate level, each of these programs focuses on generalist practices. prospective participants in hc4 are recruited from the union membership via flyers, brochures, and advertisements in the union magazine, which is sent to members’ homes. members fill out response cards to request more information. each year, according to the program manager, the response cards yield several hundred applicants to the program. a considerable challenge for some applicants is difficulty in passing their cuny entrance exams, which will gain them admission into the partner cuny campuses (college of staten island, lehman college, and new york city college of technology). these members are referred to college preparatory programs, also sponsored by the union, and may reapply to hc4 upon obtaining a passing score on the entrance exam. harcum at congreso, philadelphia, pa in partnership with the institute for leadership, education, advancement and development (i-lead) and congreso de latinos unidos of philadelphia, harcum college, the oldest two-year degree granting institution in pennsylvania, offers north philadelphia residents associate’s degree programs in human services, law and justice, leadership, and early childhood education. the program draws on the strengths of each partner and, in its first year, enrolled approximately 100 community residents (over 90% of the students were latino). congreso’s 2009 annual report observed that the program was established to “address[es] many variables that weigh into creating self-sufficiency, provides entrance into higher wage employment, and increases college access by bringing college to the community” (congreso de latinos unidos, 2009). according to atlas and mireya leon (2010), the partners identified finances, transportation, and a discomfort with being outside of their community as the three main barriers to higher education for latinos. as a result, key features of the program included locating the associate’s degree program in the community at congreso’s facilities, which effectively addressed transportation concerns; provided subsidized tuition: and provided support services to participants. each partner was well suited to contribute specific components of the program, as atlas and mireya leon (2010) observed: congreso provides the long-standing history and community trust needed to attract (recruit) students, social support, facilities, and financial aid assistance; ilead provides leadership curricula, professional training, and academic advances in social work, spring 2013, 14(1) 171 assistance; and harcum provides the accreditation, professors, curriculum, and financial aid leverage (pg. 3). in addition, harcum at congreso instructors are hired based on their experience working effectively with this population and receive additional professional development from i-lead on how to specifically address the needs of latino and african american students from urban communities. while harcum at congreso is only in its second year, it has a documented 80% retention rate (atlas & mireya leon, 2010) and plans to expand from its current enrollment of 100 students to over 300 (congreso de latinos unidos, 2009). the human service curriculum is a modified version of the curriculum offered at harcum college’s main campus, which is being designed relevant to the needs of harcum at congreso’s students. classes are held in the heart of the kensington community of north philadelphia at congreso’s education and training center, a newly renovated facility with state-of-the-art classrooms, computer laboratories, and smart boards. dinner is also provided for students each evening. students are able to access a range of social services to address challenges that may interfere with their educational goals. these include case management, job readiness training, rental assistance, financial literacy programs, and tutoring. harcum at congreso was established in 2009 and was conceived by congreso’s former president and the executive director of i-lead, which achieved success in the development of smaller partnerships between non-profit organizations and harcum college to serve the educational needs of employees. harcum at congreso began with a small cohort of congreso employees who sought to provide themselves with opportunities to upgrade their skills and credentials at the work site. these original four employees graduated with associate degrees and have received salary increases or promotions since graduation. according to the program director, some of these program graduates had “attended larger educational institutions and felt intimidated by the competition of the other students, lost faith in themselves, and dropped out. students here find this a more empowering model because we’ve brought college to them and provided them with the supports to succeed” (l. heredia, personal communication, september 15, 2010). although initially targeting employees, harcum at congreso is now using its formal partnerships and informal networks to recruit prospective students. program staff are strengthening and developing partnerships with local high schools and other community-based organizations to recruit participants. harcum at congreso also emphasizes this small cohort model, as well as hiring adjunct faculty experienced in working successfully with latino and low-income populations. in addition to these faculty resources, harcum at congreso students can access a range of support services provided by the agency itself, including rental assistance, financial literacy programs, case management, and job readiness training. as the program director observed, the program was specifically designed to provide students with a range of support services and to address “any and all social barriers that our students would face that would hinder their academic success” (l. heredia, personal communication, september 15, 2010). while not a program accredited by the cswe, the human service program at harcum at congreso represents an important model for social work educators to consider because of its innovative partnership model and comprehensive support services. de jesús/reducing barriers to career entry for latinos 172 university of saint joseph, west hartford, ct: ¡adelante! bilingual career development certificate the ¡adelante! bilingual career development certificate program at the university of saint joseph (usj), in west hartford, ct, was designed to allow bilingual working adults with some college credits to obtain an undergraduate career development certificate with the goal of completing their bsw degree. participants are admitted into the university’s undergraduate weekend program for adult learners and complete four specialized courses for the certificate: prior learning and adult education, business and professional communication, latino/a storytelling, and community interpreting and cultures. ¡adelante! (english translation is forward.) is housed within the college’s department of social work and latino community practice and serves 12 students through: 1) affordable tuition for part-time returning students; 2) flexible schedules that accommodate working adults; 3) bilingual faculty advisors and faculty mentors; 4) individualized tutoring and academic support; 5) classes conducted in spanish and english; 6) culturally relevant curricula; and 7) inclusion of families and communities in the college experience. in addition, the program offers students a one-credit course, the latino community writing circle, which provides ongoing support to students in developing writing skills with an emphasis on social work writing (case notes, biopsychosocial assessments, etc.). ¡adelante!, in its third year, serves 12 latino students, the majority of whom are from the greater hartford area. according to the program director, of the 11 students in the first cohort, 100% successfully completed the certificate and matriculated into bachelor’s degree programs. after receiving a $50,000 grant from ¡excelencia! in education and recruiting two latina professors, ¡adelante! has developed a promising and innovative infrastructure to strengthen the human capital of latino adults in social work. students earn the certificate upon completion of the four-course sequence. each credit satisfies general education distribution requirements and is transferable to a fouryear bachelor’s degree program. in addition to continuing within usj’s weekend program for adult learners, ¡adelante! has also negotiated matriculation agreements with other local community colleges and institutions like tunxis community college and capitol community college. ¡adelante! utilized focus groups with prospective students and employers to develop its recruitment strategies. these included formal and informal approaches aimed both at recruiting “one student at a time,” and strategically strengthening relationships with larger institutional employers with access to resources for tuition reimbursement. emphasizing the importance of relationship building and trust in recruitment, the ¡adelante! program director observed: we have been going to state workforce development programs that, at least at one time, had some money, and might in the future. in connecticut, a priority area for incumbent worker funding is health, so this is a perfect opportunity for us. so, for example, a year ago would have been the case, that hartford hospital had a group of employees interested in ¡adelante! they might have received advances in social work, spring 2013, 14(1) 173 $25,000 from the state that they could use toward tuition support for those employees (l. g. gardella, personal communication 4/22/10). recognizing the prohibitive cost of private higher education, ¡adelante! has sought to strengthen relationships with institutional partners who can provide resources for upgrading their workers’ skills and credentials. these included large private agencies, state agencies, and health care institutions with which usj has long-term ties. ¡adelante! continues to develop and strengthen relationships with large employers in health and human services and work with agencies who can apply for incumbent worker funding. the university of saint joseph offers students the most support in this area by making career development an explicit part of the program’s name. the program director described how the program is specifically designed to advance student workers on a career trajectory in social work: it’s the ¡adelante! certificate in career development for bilingual professionals, so it’s very explicitly about career development, and that is how you attract adults to college. not by saying, “you’ll love it,” and “it’ll improve the opportunities for your children.” all that’s true, but what really attracts people tends to be career opportunities and advancement, and we mean it. so this program is very specifically looking at bilingual career development. students begin by making an educational and professional plan, and then we help them to realize that plan. they improve their english and spanish communication skills, which will help them advance in college, as well as in the workplace (l. g. gardella, personal communication 4/22/10). ¡adelante! provides latino adult workers with a pathway to enter or re-enter college through admission in usj’s weekend program for adult learners where they may elect to major in social work or other professional fields. the unique nature of the social work and latino community practice department, which also houses a post baccalaureate certificate in latino community practice (lcp), provides an extended pathway through the bachelor’s degree for ¡adelante! students who are interested in social work careers. discussion the pathway programs analyzed identify several key areas of need for latino adults including tuition support, academic support, and support services to students. affordable tuition and prepaid tuition vouchers; culturally relevant curricula, flexible schedules, credit transfers, supervised internships; and counseling, tutoring, and mentoring from bilingual faculty are among the services identified by negroni-rodriguez and colleagues (2006) as critical for latino student success in social work education. key program components offered by these models include academic advising, mentoring, and tutoring geared toward addressing academic and other needs of latino students. for example, hc4 provides its participants with academic counselors at each of the campus sites to whom they have access seven days a week. these participants also have access to tutors who assist them in preparing for the cuny proficiency exam (cpe) that they must pass in order to transition to a four-year program of study. de jesús/reducing barriers to career entry for latinos 174 participants in usj’s ¡adelante! program are each assigned a latina faculty mentor who provides additional academic support and an opportunity to develop a close relationship with a faculty member. in addition, three of the four courses students take in the program are taught by bilingual faculty. the small size of the cohort also fosters mutual support and community building among students facilitated by faculty. harcum at congreso students may receive a range of support services provided by congreso’s social service department including rental assistance, financial literacy programs, case management, and job readiness training. as the programs within the private institutions are smaller, they may have additional capacity to personalize advising and mentoring, as well as incorporate families in supporting and celebrating student accomplishments. this is most evident within adelante’s year-end recognition where family members are invited to a special graduation ceremony and are acknowledged for the support they have provided their relative. the pathway programs described herein represent novel and innovative institutional responses to supporting the career development of latino adults. furthermore, the programs provide the field with the human capital necessary to meet the demand for bilingual, bicultural social workers. while more comprehensive evaluation is needed to ascertain the full impact of these programs, many opportunities and challenges are evident from the data available. as a descriptive case study of three programs, these findings are not generalizable. in addition, these programs are geographically located in the northeast united states in latino communities with large concentrations of puerto ricans and dominicans. as such, the programs may not address needs specific to other latino subgroups such as cubans and central, and south americans. despite these limitations, the programs described represent innovative approaches to addressing barriers to career entry for latino adults, which may be adapted for use with other populations and have considerable implications for social work education. in addition, these programs may provide a blueprint for a redesign of social work education that reduces barriers for latinos to access undergraduate and graduate social work programs, persist, and complete the msw. alternatively, social work educators who are eager to address the needs of latinos may generate unrealistic expectations of what can be accomplished by addressing the most obvious barriers to completion of degrees. in their enthusiasm to remove barriers to degree completion, administrators must be aware that not all latino workers eligible for programs will succeed due to insufficient academic preparation and competing demands. admission criteria should carefully evaluate the student’s ability to persist to graduation with available resources in order not to set them up for failure. an important issue for further analysis is the lack of clarity regarding how participants may upgrade and transfer credits and credentials from one institution to another. while matriculation agreements exist within the cuny system and ¡adelante!, at the university of saint joseph, these agreements have yet to be solidified at harcum at congreso. in addition, there is a need for resolving issues of transferability of credits from associate’s degree programs accredited by the council on standards for human service education and bachelor’s degree programs in social work accredited by the cswe (topuzova, 2006). resolution of these issues would assist in establishing a more advances in social work, spring 2013, 14(1) 175 streamlined educational pathway for all, which would clearly benefit latinos enrolled in these programs. many challenges remain in creating seamless pathways into social work for latinos, however demand for bilingual and culturally competent practitioners calls for innovation. conclusion nationally, latino adults suffer from inadequate opportunities, as a result of lower educational attainment, and they confront multiple barriers in their pursuit of skills and credentials (hurtado & ponjuan, 2005; takahashi & meléndez, 2004). at the same time, census data described here reveals a pool of latinos who are already employed in the social work sector, but who have not completed undergraduate and graduate degrees in social work. the programs examined in this analysis demonstrate that career pathways for latinos into social work demonstrate great potential to reduce barriers to degree completion and career entry. social work credentials provide latinos a dual opportunity to enter a profession where they may earn a livable, middle-class wage with access to benefits that will enable them to strengthen their communities as they provide essential social and mental health services to latino populations. this dual opportunity is also highly attractive to the reciprocal desires of many latino adults to “give back” to one’s community. social work pathways for latinos benefit the profession, the individual practitioner, and the communities to which they will eventually provide services (chapa & acosta, 2010; hernández & fitch, 2004; negroni-rodriguez et al., 2006; ortíz et al., 2007; ortíz-hendricks, 2007). social work educators are well positioned to develop partnerships that integrate these components as a strategy to increase the number of latinos obtaining professional social work credentials. references acevedo, g., gonzalez, m. j., santiago, v., & vargas-ramos, c. (fall 2007). the state of latino health and mental health. new york, ny: hunter college, center for puerto rican studies, policy report, 1(4), 1-23. retrieved from http://centropr.hunter.cuny.edu/sites/default/files/working_papers/latinohealthr.pdf arbona, c., & nora a. (2007). the influence of academic and environmental factors on hispanic college degree attainment. the review of higher education, 30(3), 247269. atlas, j., & mireya leon, i. (2010, winter). congreso: building nonprofit partnerships and determining their financial costs. philadelphia social innovations journal, issue 2. retrieved from www.philasocialinnovations.org bureau of labor statistics, u.s. department of labor, occupational outlook handbook, 2012-13 edition, social and human service assistants, on the internet at http://www.bls.gov/ooh/community-and-social-service/social-and-human-serviceassistants.htm de jesús/reducing barriers to career entry for latinos 176 chapa, t., & acosta, h. (2010, february). movilizandonos por nuestro futuro: strategic development of a mental health workforce for latinos. washington, dc: office of minority health and the national resource center for hispanic mental health, united states department of health and human services. congreso de latinos unidos. (2009). annual report. retrieved from http://www.congreso.net/annualreportfy09.htm de jesús, a. (2011). abriendo caminos: an analysis of three social work pathways for low wage puerto ricans. centro: the journal of puerto rican studies, 23(2), 136155. gardella, l. g., candales, b. a., & ricardo-rivera, j., (2005). doors are not locked, just closed: latino perspectives on college. in m. a. wolf (ed.), adulthood: new terrain (pp. 39-52). san francisco: josey-bass. hernández, s. h., & fitch, d. (2004). ideological dislocation: implications for mentoring latino social work faculty (unpublished manuscript). hurtado, s., & ponjuan, l. 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(1990). qualitative evaluation and research methods (2nd ed.). newbury park, ca: sage. swail, w., cabrera, a., & lee, c. (2004). latino youth and the pathway to college. washington, dc: educational policy institute. swail, w., cabrera, a., lee, c., & williams, a. (2005). latino students and the educational pipeline. part iii: pathways to the bachelor’s degree for latino students. washington, dc: educational policy institute and lumina foundation for education. takahashi, b., & melendez, e. (2004). union-sponsored workforce development initiatives. in e. melendez (ed.), communities and workforce development (pp. 131162). kalamazoo, mi: w. e. upjohn institute for employment research. taylor, s. j., & bogdan, r. (1984). introduction to qualitative research methods: the search for meanings. new york: john wiley & sons. topuzova, l. (2006). community colleges and the preparation of the u.s. human services workforce. alexandria, va: council on social work education. retrieved from http://www.cswe.org/file.aspx?id=16354 u. s. census bureau. (2012). american community survey; 3yr 2006-08 sample. retrieved from http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml vidal de haymes, m., & kiltey, k. (2007). latino population growth, characteristics and settlement trends: implications for social work education in a dynamic political climate. social work education, 43(1), 101-116. visser, a., & meléndez, e. (2011). puerto ricans in the u.s. low-wage labor market: introduction to the issues, trends and policies. centro: the journal of puerto rican studies, 23(2), 4-19. whitaker, t. (2008). who wants to be a social worker? career influences and timing. nasw membership workforce study. washington, dc: national association of social workers. yin, r. k. (2003). applications of case study research (2nd ed.). thousand oaks, ca: sage. yosso, t., smith, w. a., ceja, m., & solórzano, d. g. (2009). critical race theory, racial microaggressions, and campus racial climate for latina/o undergraduates. harvard educational review, 79(4), 659–691. author note: address correspondence to: anthony de jesús, ed. d., msw, assistant professor and director, msw field education, department of social work & latino community practice, university of saint joseph, 1678 asylum avenue, mercy 246, west hartford, ct 06117. phone: 860-231-5563 email: adejesus@usj.edu microsoft word 0. editorial vol 15_2 _________________ william h. barton, ph.d., is professor emeritus in the indiana university school of social work on the indiana university-purdue university indianapolis campus. contact information: email: wbarton@iupui.edu copyright © 2014 advances in social work vol. 15 no.2 (fall 2014), i-iv editorial thank you and good night! william h. barton welcome to the fall 2014 issue of advances in social work. this issue represents the last one on my watch, as i retired from the indiana university school of social work (iussw) last may. since the journal moved to its current online, open-access format in the fall of 2008, i have had the privilege of serving as its editor, managing peer review, making final decisions, relaying both positive and negative news to authors, producing the issues, and trying to raise the profile of the journal. during that time we have seen an increase in manuscript submissions and the production of a number of excellent special, thematic issues under the guidance of exceptional guest editors. we now have nearly 1,000 registered users from all over the globe, more than 350 of whom also serve as peer reviewers. all of our archives, dating back to the very first issue in 2000, are now readily available from the advances website. i would like to take this opportunity to express my appreciation to michael patchner, dean of the iussw, for his commitment to and investment of school resources in producing and sustaining advances in social work. thanks are also due to the editorial board (its membership may be viewed on the website), those colleagues who have edited special issues, and, especially, to the many authors and peer reviewers whose work constitutes the intellectual core of the journal. finally, i would also like to thank kristi palmer, associate dean of digital scholarship, iupui university library, for supervising the open journals platform and providing technical assistance. while it would be impossible to top our spring 2014 special issue (vol. 15, no. 1), “eyewitnesses to history: first-hand accounts of sages of the profession,” containing 17 invited articles penned by some of the profession’s leading voices, the current regular issue presents an additional 17 articles on a variety of topics. what follows are brief descriptions of these articles, arranged in several loose groupings. the first three articles should be of broad interest. the first, by o’brien, emphasizes the importance of congruence between social work values and our relationships and interactions, not just with clients, but with one another. the author’s view is that these ethical issues are relevant across many professional disciplines including psychiatry, family medicine, psychology, nursing, pastoral services, education, and rehabilitation therapy. the second, by twill and lowe, examines civic-mindedness among a sample of social work educators, community practitioners, and new graduates. results of their webbased survey showed that traditional and field faculty were more civic-minded than new graduates and other practitioners; social work educators who focused on raising civic awareness in courses were more civic-minded than other colleagues; new graduates who had participated in service events were more civic-minded; and social workers, whether faculty or not, who had participated in collaborative research were more civic-minded. the third, by nilsson, presents a philosophical discussion of the relationship between empathy advances in social work, fall 2014, 15(2) ii and compassion fatigue. specifically, he attempts to refute suggestions that compassion fatigue may be caused by too much empathy or compassion. next is a set of articles related to child welfare. utilizing a social exchange framework, rice and girvin conducted a qualitative study exploring interactions among parents and professionals in dependency court hearings. findings revealed that a lack of reciprocity hinders the development of collaborative relationships that could support families. cherry, dalton, and dugan note that worker self-efficacy is predictive of child welfare worker retention, job performance, and persistence. from a sample of 395 child welfare workers, cherry and colleagues report the development of a new measure of self-efficacy with two domains, direct practice and indirect practice, which can be modestly predicted by worker characteristics upon hire and the training program the workers attend. noting that children with special needs disproportionately receive child welfare services in out-of-home placements, linton and colleagues introduce the special needs adoption and foster exigencies (safe) model which captures the issues facing adoptive and foster parents of children with special needs during the engagement, assessment, and intervention phases of case management. this theoretical model was developed from a content analysis of online discussion forums of adoptive and foster parents of children with special needs using a phenomenological framework. the next two articles focus on interdisciplinary collaboration and social work education. from a survey of 112 health sciences and social work students, lee and shipe explore interdisciplinary collaboration experiences amongst social work and allied health sciences graduate students and examine factors that contributed to their interdisciplinary collaboration. results showed that students with positive attitudes toward interdisciplinary health care teams and those with prior positive experiences of interdisciplinary collaboration demonstrated higher levels of interdependence. students in medicine were less likely than those in social work to show interdependence. mooney, collie, nicholson, and sosulski report on a faculty-librarian collaborative approach to undergraduate social work research training. a key component of foundational research skills is the ability to successfully navigate the organizational and technological aspects of research data production. the library and information science profession can contribute to the training of this new arena of research skills known collectively as research data management. mooney and colleagues present a case study of faculty/librarian collaboration with an undergraduate research team and provide an example of a data management curriculum. luna, horton, and galin next present findings from a student survey to assess perceptions of the effectiveness of writing across the curriculum (wac) strategies on writing skills and social work knowledge acquisition in an introductory social work class. wac is a process that requires cross curricular collaboration, intra-departmental support, and faculty commitment to course development and implementation. students reported that wac strategies substantially improved their abilities to write in the discipline and learn course content. also important to social work education, mccave, shepard, and winter discuss the importance of human sexuality as a critical subfield within social work. they examine the history and context of human sexuality and social work scholarship, as well as their experiences as sexuality scholars in social work, and suggests that the mechanisms for stimulating human sexuality social work scholarship are limited. the authors offer barton/editorial iii suggestions for enhancing attention to this critical subfield via targeted changes in textbooks, journal articles, and national conference opportunities. several articles related to special populations appear next. maccio, derosa, wilks, and wright present the results from a survey of lgbt persons, looking at age differences in attitudes towards marriage equality. they found that older lgbt adults were less likely to find same-sex marriage important, but that age cohorts did not differ significantly on legalizing same-sex marriage. on a related issue, montero used international poll data to look at differences in attitudes towards same-gender adoption and parenting across the world. alas, it is my sad duty to report that darrel montero passed away in september before the publication of this issue. he had contributed several articles to advances in social work and will be greatly missed. in this article, he noted that only 15 countries have legalized same-gender adoption with no restrictions, and two-thirds of these nations are located in western europe. attitudinal surveys conducted in 16 nations indicate that a majority of respondents in these countries report support for same-gender adoption and recognize same-gender couples’ ability to successfully raise children. wood, hostetter, and sullenberger used qualitative interviews to explore how college students construct attitudes about class differences among women. the results revealed that social class differences are constructed based on factors related to family of origin, personality, structural inequities, personal choices and relationships, as well as other intersecting experiences. using an international sample, wang, smith, and locke examined what variables were associated with social distancing of those with depressive and panic disorders among social work students. the results showed that levels of social distancing were related to age, knowing someone with a mental illness, type of disorder, level of conservatism, race, country, professional interest in mental health, level of student, and sex. next is an article by bai in which she analyzes the role of social work in the context of the special political, economic, cultural, and historical background in china. she notes that the chinese government has started to diminish its role as a direct service provider while, at the same time, the traditional family and community have less capacity to take care of people. yet, the social work profession does not appear ready to fill the gaps. the issue closes with two research reports. gallagher and colleagues present results from an evaluation of an indiana drug court, focusing specifically on identifying variables that predicted recidivism among drug court participants and comparing criminal recidivism patterns among drug court and probation participants. they found that drug court participants were less likely to recidivate than probationers who had similar offense and demographic characteristics. pope, loeffler, and ferrell explored the experience of aging in rural appalachia using qualitative interviews with geriatric service providers. they identified three prevalent themes associated with aging in rural north central appalachia: scarcity of resources, valuing neighbors and family, and the prevalence of drug use. looking to the future, as of january, my colleague dr. margaret adamek, a professor in the indiana university school of social work, will assume the position of editor. she is an accomplished social work scholar and educator, known by many of you as an expert in gerontology and as the long-standing director of iussw’s ph.d. program. in addition, advances in social work, fall 2014, 15(2) iv valerie decker, currently a doctoral student and a project evaluator for the indiana child welfare education and training partnership, will serve as the assistant editor. our upcoming spring 2015 special issue on “technology, the internet, and social work practice” should be timely and engaging. dr. lauri goldkind, of the graduate school of social service at fordham university, and dr. john mcnutt, from the school of public policy & administration at the university of delaware, will serve as guest editors for this special issue. articles will address several themes, including the impact of mobile technologies on social work practice; confidentiality in an age of open communication tools; challenges and opportunities for using technology and communication tools to help clients; accountability practices, data use, and management in human services agencies; social networking’s impact on social work practice; electronic advocacy; digital community organizing; and ethical dilemmas that arise from use of technology in practice. as of this date, there have been 35 manuscripts submitted for review. then, as usual, advances in social work will produce a “regular” issue with a range of topics in the fall of 2015. look for a call for papers this spring or summer for a 2016 special issue on a topic yet to be determined. stay tuned also for modifications/ improvements that the new editor will surely bring. in the meantime, we hope that you find that the current issue contributes new knowledge to the realms of social work practice, research, and education. keep working on those manuscripts to submit, tell your colleagues about advances in social work, and urge them to register to submit articles and to join our growing corps of reviewers. the journal will be in good hands! happy holidays! microsoft word 13-3810 romero-williams 3810 immigration legislations final _____________ sylvia romero, ph.d., msw, c-ssws, is a school social worker at community consolidated school district #46, grayslake, il. melissa romero williams, ma, lpc, is a counselor at deerfield high school, deerfield, il. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 229-246 the impact of immigration legislation on latino families: implications for social work sylvia romero melissa romero williams abstract: under the obama administration, approximately 1.2 million undocumented immigrants have been deported, (around 400,000 in 2011), placing children (who are often american citizens) at risk of unnecessary mental anguish as well as financial hardship. with republican and democratic leadership tied up in ideological debates addressing the issue of comprehensive immigration reform, many states are left in a dire position and we as a nation end up with draconian anti-immigrant legislation that places more latino immigrant families at risk. enforcement-only initiatives leave children and families of immigrants in our country vulnerable. comprehensive immigration reform is necessary. this article discusses the prevalence of such policy initiatives and their implications for social work education, practice, research, and policy. keywords: immigration legislation, latino children and families, immigrants throughout the history of the united states, there have been at various points in time, different immigrant, ethnic, and racial groups who have suffered the negative impact of political, legal, economic, and social ramifications resulting from increases and changes in the demographic patterns of the immigrant population (atkinson as cited in casas & cabrera, 2011). following the september 11, 2001 attacks, john ashcroft (united states attorney general) declared that immigration rules would be the primary weapon against terrorism, and targeted arab, muslim, and south asian men who were living in the united states (critelli, 2008). “the economic and psychological effects of september 11 have been compounded by the additional toll the response to the attacks has taken on civil liberties and human rights” (critelli, 2008, p. 146). hate crimes and anti-immigrant legislation have festered nationally. although, undocumented immigrants come from many countries and include diverse racial and ethnic populations, latinos have primarily been targeted nationally in the enforcement of anti-immigrant legislation (casas & cabrera, 2011). this has had an adverse effect on latino families. comprehensive immigration reform is needed. this article will address the impact of immigration legislation on latino families and the role that social work practice, education, policy, and research have in affecting social justice and reform. from 1990 to 2007, the largest growth of children (between the ages of 0 to 17) born in the united states were children of immigrants, and nationally 56% were latinos (fortuny, 2010). fortuny (2010) reported that beyond that, the breakdown of children of immigrants continues where 22% were from asia; 11% from canada, europe, and australia; 10% were from the pacific and east asia; 8% were from south asia and the middle east; 8% from the west indies and africa, and 4% were from southeast asia. fix and passel (2003) reported that 1 in 5 school-aged children (k-12) are children of romero, romero williams/impact of immigration legislation 230 immigrants (10.5 million); three quarters of whom are born in the united states, while one quarter were foreign-born. dolan (2009) concurred that one fifth of school-aged children were latinos, 91% of which were u.s. citizens. knight (2012) reported that according to the office of refugee resettlement 8,244 unaccompanied children (undocumented) entered the united states last year. according to capps, castañeda, chaudry, and santos (2007) “in 2005 there were 9.3 million unauthorized working-age adults (18-64) and 4.9 million children (ages 0-17) living with these unauthorized adults” (p. 91). wessler (2011) reported that there were 11 million undocumented immigrants; 5.5 million children of undocumented immigrants of which 4.5 million were u.s. citizens. bess (2011) concurred that approximately 5.5 million children lived with at least one undocumented parent. for every two deportations, one child was left behind, placing the children emotionally, economically, and socially at risk (capps et al., 2007). since the april 2010 passage of sb 1070, arizona has been at the forefront of the anti-immigrant movement. with the growing number of anti-immigrant laws, the writers of legislation are placing the mental and emotional health and well-being of latino children (whose parents are undocumented) and their families at risk. the jim crow type legislation legalizes racial profiling, discrimination, and the unnecessary harassment of latinos (immigrants and united states citizens), as well as the exploits of undocumented workers. according to cleary (2000) “racial profiling occurs when a law enforcement officer uses race or ethnicity as one of several factors to stop, question, arrest, and/or search someone” (p. 6). six states, arizona, utah, indiana, alabama, georgia, and south carolina, have enacted such laws. six states are considering copycat bills or have locally enacted anti-immigrant enforcement policies in various counties (illinois, wisconsin, mississippi, michigan, ohio, and pennsylvania) and 18 states attempted but failed to pass copycat bills in 2011 (southern poverty law center [splc], 2011b). the national council of la raza (nclr: 2011a; 2011b) has been following the national copycat landscape. alabama’s hb 56 is one of the harshest immigration laws and it has been in effect since june 2012. alabama’s hb 56 has terrorized (latino) families and children who are now afraid to go to school, since schools are required to check on the immigration status of the students (splc, 2011a). parents are denied the right to attend their children’s school functions without a state of alabama id. among other things, if a person does not have a state of alabama id card, that person is denied a water service connection, regardless of their ability to pay the fee. in addition, immigration documents must always be carried by all immigrants. according to the southern poverty law center, a victim of domestic violence was threatened with deportation if she pursued seeking a court order of protection by a judge elected to serve the community. it is important to note that victims of abuse qualify for u-visas, and victims of trafficking qualify for t-visas according to the department of homeland security (dhs). immigration and human and civil rights advocates consider hb 56 the most draconian anti-immigrant law (lewis, 2011). advances in social work, spring 2013, 14(1) 231 secure communities congress intended for the united states immigration and customs enforcement (ice) “secure communities” program to be used as a tool to assist local police to “identify aliens convicted of a crime, sentenced to imprisonment, and who may be deportable” (illinois coalition for immigrant and refugee rights [icirr], 2011, p. 4). the overall goal of this program was to deport criminals who were undocumented. yet, the program has swept up immigrants (fathers, mothers, and students) with no criminal convictions, and who have not posed harm to the community, resulting in separated families. congress has referred to this as “collateral damage.” “more than three-quarters (77%) of all immigrants arrested by ice in illinois under ‘secure communities’ through july 2010 have no criminal convictions” (icirr, 2011, p. 1). as of november 2011, 969 counties in 37 states signed onto ‘secure communities’ (illinois signed on november 2009) and further participation is expected nationwide by 2013. local law enforcements agencies in many states and cities can enforce immigration laws for any minor state law infraction. this has had a negative impact on the families, and in particular the children who have increased stress levels due to the fear of deportation and separation from their undocumented parents. according to the icirr (2011), “secure communities” encourages racial profiling. for example, many local police set up checkpoints and other operations to target latinos and other immigrants for minor traffic infractions like windshield obstructions. federal law requires that detainees be held for only 48 hours, yet often they are held in jails for two weeks until ice arrives, which costs taxpayers money. “secure communities” also undermines the normal trust between immigrant communities and the police. there is a lack of transparency as ice has not published any figures on the numbers of identified immigrants, arrests, and deportations (after litigation) since september 2010, and since july 2010 for county-level. counties are not allowed to opt out. “secure communities” was enacted to keep communities safe by primarily deporting undocumented “criminals,” yet it has increased racial profiling and has targeted parents, and students for minor vehicle infractions. once the local police departments have initiated participation with “secure communities” they are not allowed to opt out even though some sheriffs have spoken out against this program. there is also a lack of transparency (since the year 2010) even when data has been requested under the freedom of information act. the following will address how “secure communities” along with workplace raids has impacted detentions and deportations, detention centers, and foster care placement. detentions and deportations between 2002 and 2006 the number of workplace raids that led to the arrest of undocumented immigrants increased sevenfold from 500 to 3600 (capps et al., 2007). deportations hit a record high (nearly 400,000) in 2011 under the obama administration (splc, 2011b). jorge ramos (al punto con jorge ramos, 9/2/2012) reported that approximately 1.2 million undocumented immigrants have been deported in the four years of the obama administration. the detentions and deportations of mothers and romero, romero williams/impact of immigration legislation 232 fathers have emotionally and economically placed their children at risk by dividing the family (critelli, 2008). many children who are american citizens have returned (with their undocumented parents) to countries that are foreign to them. detention centers bernstein (2011) reported that companies are making a massive profit with detention centers, jails, and prisons used for immigration detention globally, particularly in the united states, britain, and australia. bernstein (2011) and frontline (2011) also noted that widespread abuse, neglect, and death have occurred in the detention settings, and human rights groups have advocated that detention has not worked as a deterrent, nor has it accelerated the deportation process. currently, corrections corporation of america (cca) targeted crete, illinois to build a new immigrant detention facility after the state senate voted (53-1) to ban the building of private prisons in illinois (icirr, 2012). according to the icirr (2012), in order to circumvent state law, ice and the federal government are negotiating with the city of crete rather than the state of illinois. foster care placement chaudry and colleagues (2010) reported that ice issued guidelines that “fots should not take into custody children under age 18 who are citizens or permanent residents but instead should refer them, in order, to child welfare authorities, local law enforcement agencies, or a third party designated by the parent” (p. 20). according to wessler (2011), in some cases ice contacts the child protection services (cps) following the arrest of an undocumented immigrant, and in other cases the parents are just detained. wessler (2011) identified at least 22 states where victims of domestic violence are arrested, detained, and separated from their children, and consequently have no idea where their children are. the undocumented victims of domestic violence will be at risk of further abuse and possible death, out of fear of deportation and separation from their children. these are human rights and social justice issues. wessler (2011) reported that 46,000 of those deported between january and june of 2011 were parents of children who are american citizens. typically, when a child has been in foster care for 15 of any 22 months, “federal law requires cps to petition the court to terminate parental rights (wessler, 2011, p. 7). there are 5,100 children of deported or detained parents currently in foster care (democracy now organization, 2011; wessler, 2011). according to wessler (2011), if nothing changes, and no action is taken, this number will increase to 15,000 in 5 years. most child welfare departments do not have systemic policies aimed at uniting the deported or detained families. thus, the children are separated for extended periods and sometimes permanently. the implications for the emotional well-being of both the children and the parents are devastating, since the immigration detention severs communication between the families (wessler, 2011). the american humane advances in social work, spring 2013, 14(1) 233 association (aha: 2010) noted that children (including the children of immigrant families) who are placed in the child welfare system often lack a strong relationship with their caregiver, which is their most critical protective factor. bowlby’s attachment theory is highly relevant when addressing the impact that separating children from their undocumented parents has on the emotional well-being of the latino children. attachment theory children are one of our most vulnerable populations and they need our protection and guidance. children are developmentally dependent on their parents and rely on their parents for all of their basic needs (care and nurturing, protection, emotional, and financial well-being) (romero, 2006, 2009). according to bowlby (1980), a child’s loss or separation from a mother figure/caregiver can evoke psychopathology. there also appears to be a link between childhood separation and loss and adult psychopathology. thus given bowlby’s research on attachment theory, the anti-immigrant legislation and laws are placing latino children (and the children of other immigrants) at risk of increased psychological duress due to the separation from their parents caused by detentions, deportations (removals), and the children’s placement into foster care. psychologists are concerned that depression and other mental health issues can affect children who are separated from their undocumented parents (capps et al., 2007). according to studies, immigrants may not experience more psychological distress or mental illness than nonimmigrants (alegria, canino, stinson, & grant as cited in the american psychological association [apa], 2012). “when immigrants do experience mental health difficulties, for many it is related to the immigration experience” (apa, 2012, p. 8). leaving their country of origin and their extended families behind to live in another country where language, customs, and life as they knew it, are new, is a huge culture shock for many. for the undocumented immigrants it is compounded given the current immigration legislations because the children and parents face the fear of separation from one another due to the undocumented status of the parents and/or children, and this can cause toxic stress. the toxic stress affects both the undocumented immigrants and their children, many of whom are american citizens by birth and are due the same protections and rights as any child born in this country based on the united states constitution. the children are integrated in the community, schools, and every facet of life in the united states, and this is the only place they know as home. “exposure to violence and other sources of toxic stress is considered a serious public health issue around the world because of its impact on individuals, families, communities, and societies” (aha, 2010, p. 9). a strong relationship with the caregiver is a critical factor that is necessary for children to fare well. the following section will address education, the dream act, the use of prosecutorial discretion, the contributions of immigrants as job creators and tax contributors, and conclude with considering the implications for social work practice, education, policy, and research. romero, romero williams/impact of immigration legislation 234 education education is one of the basic human rights. dolan (2009) reported that 20.5% of all school-aged children are latino, and 91% are citizens of the united states. latino children account for 24% of the population under the age of five, yet they are grossly underrepresented in early childhood programs (dolan, 2009; perez, 2000). latino and black children are more likely to attend schools with a higher concentration of poverty. furthermore, dolan reported that latinos are most likely to attend community colleges; less likely than all racial groups to obtain financial assistance to obtain a bachelor’s degree; and less likely to have expectations of receiving a bachelor’s degree. according to faulkner and berger cardoso (2010) immigrant children had poorer outcomes in adulthood when compared to non-immigrant peers. furthermore, children who immigrated to the united states prior to the age of 12 (generation 1.5), fared lower in economic advantage and job prestige when compared to 2nd generation individuals (faulkner & berger cardoso, 2010). there is a positive correlation between higher gpas and higher job prestige. educational attainment is lower for immigrant children than nonimmigrant peers. latino children have the lowest educational attainment rates in the country and the highest drop-out rates, exceeding both white and black students (lopez, 2005; olivos & mendoza, 2010). chaudry and fortuny (2010) reported that immigrant families had lower wages and income. despite the supreme court’s plyler v. doe decision that held the entitlement of undocumented children to receive a primary and secondary state-funded education and educational equality, the undocumented children are caught in the midst of the “immigration crisis” (lopez, 2005; olivos & mendoza, 2010). alabama’s anti-immigrant legislation is reported to deter the enrollment of children of immigrants by verifying the immigration status of the children and their parents (splc, 2011a). the state superintendent of education in alabama issued a memo regarding a revision to the attendance manual following the alabama immigration law, pertaining to all initial enrollments as of september 1, 2011 (morton, 2011). all students who are registering in alabama elementary and secondary school for the first time as of september 1, 2011 are required to submit an original or certified birth certificate, or supplemental documents, otherwise they will be reported to the state department of education (morton, 2011). this will deter enrollment of children of undocumented migrant workers who also have the arduous task of maintaining regular school enrollment since they typically travel seasonally from state to state to harvest crops. olivos and mendoza (2010) also noted the importance that school educators/personnel play in allowing latino parents access to educational meetings. access to higher education is very challenging for undocumented students due to: denial of admission, lack of access to student loan, and being charged out of state fees (when they have resided in the state) (lopez, 2005). according to professor victor romero (as cited by lopez): [w]ithout a guarantee that an undocumented person can achieve lawful immigration status following graduation from college, such a person will always live under the double threat of being ineligible to lawfully hold a job and possible advances in social work, spring 2013, 14(1) 235 removal from the united states. and since immigration regulation is a federal power, state legislatures could not tie academic achievement or state residency to immigration status. the power to change one’s immigration status rests solely on congresses shoulders. (p. 1404) the dream act the dream act (development, relief, and education for alien minors act) (h.r. 6497) was first introduced in 2001; it passed the house by a vote of 216 to 198 on december 8, 2010, but was defeated in the senate. the dream act would have benefited not only the young people in “immigration limbo” who grew up in this country and graduated from high school, but it could have reduced the “federal deficit by $2.2 billion over 10 years” (national immigration law center, 2010, p. 1). in addition, according to the congressional budget office (cbo), the dream act would have decreased the federal budget by $1.4 billion in 10 years due to increased tax revenues (the white house, 2011). qualifications for the dream act included the following: undocumented students of good moral character who arrived to the u.s. prior to age 15 (at least five years prior to the enactment of the bill) and who are under the age of 30, would be eligible for conditional nonimmigrant status, after they were accepted to college, graduated from high school, or obtained a ged in the united states. students who posed a security risk, committed crimes, or were ineligible, inadmissible, or removable based on certain other grounds, would not be eligible. conditional nonimmigrant status gives individuals the eligibility to drive, work, go to school, obtain student loans, and be eligible for the federal work study program. the process involves 10 years of conditional nonimmigrant status demonstrating good moral character, not committing crimes, avoiding violation of travel restrictions, and paying back-taxes, followed by three years with a permanent resident status, and lastly becoming eligible to apply for u.s. citizenship. the illinois dream act, sb 2185 (illinois general assembly, 2012; immigrant youth justice league, 2011) gives hope to illinois undocumented students who meet the criteria for inclusion to attend college and benefit from a privately-funded scholarship program. they can invest and save money for their education by using the illinois prepaid tuition plan. prosecutorial discretion on june 15, 2012 president obama announced an immigration policy regarding the use of prosecutorial discretion by the department of homeland security (dhs) in regards to the handling of cases of undocumented individuals who were brought to this country as children. under this policy, undocumented individuals who meet the criteria will be allowed to remain in the unites states for two years. in a memorandum issued by janet napolitano (2012), secretary of homeland security, the following criteria must be met prior to considering prosecutorial discretion for the individual:  came to the united states under the age of sixteen; romero, romero williams/impact of immigration legislation 236  has continuously resided in the united states for at least five years preceding the date of this memorandum and is present in the united states on the date of this memorandum;  is currently in school, has graduated from high school, has obtained a general education development certificate, or is an honorably discharged veteran of the coast guard or armed forces of the united states;  has not been convicted of a felony offense, a significant misdemeanor or offense, multiple misdemeanor offenses, or otherwise poses a threat to national security or public safety; and  is not above the age of thirty (reno, 2012, p. 1). this policy has been in effect since august 15, 2012 and has attracted a large number of qualified individuals. immigrants are job creators and tax contributors according to the white house (2011) nearly 30% of immigrants are more likely than non-immigrants to start a business, and they compose 16.7% of (all) new business owners in this country generating $67 billion of the united state’s $577 billion business income. immigrants started 25 percent of the highest-growth companies between 1990 and 2005, and these companies directly employ an estimated 220,000 people inside the united states. these immigrant-founded companies include intel, google, yahoo, and ebay, which have all helped drive american leadership in the computer and internet revolutions and have stimulated business and job creation throughout our economy. these immigrants give the u.s. workforce an important economic advantage. research shows that immigrants are more likely than u.s. born workers to start new businesses and are among the most prolific inventors in the american economy, generating ideas that lead to new products and more jobs in many sectors including pharmaceuticals and information technology. (white house, 2011, p. 11) paral (2006) reported that in illinois, 38% of college graduates are foreign born. immigrants in the united states currently represent 47% of the engineers (with doctorate or bachelor’s degrees), and 24% of the scientists (white house, 2011). the new immigrant populations tend to be younger than native-born citizens, which helps counter the fiscal effects of the aging population in this country (paral, 2006; white house, 2011). in illinois, “the addition of immigrants permits the state to maintain workforce growth” (paral, 2006, p. 2). the irs estimates that “undocumented immigrants paid almost $50 billion in federal taxes between 1996-2003. these taxes include payroll and social security (about $8.5 billion per year), property (directly or as part of rental payments), and sales taxes” (white house, 2011, p. 13). additionally, more than 114,000 immigrants are active-duty service members and represent nearly 8% of the u.s. military (white house). as of january 2009, the white house reported that 20,000 immigrants who serve in the military have been naturalized. advances in social work, spring 2013, 14(1) 237 implications for social work practice social workers must confront conditions (social, political, and economic) that challenge the human rights of immigrants from a social justice perspective (critelli, 2008; ortiz, garcia, & hernandez, 2012). social workers and counselors serve in crucial roles such as: providing therapy and information and referral services, community activists, and change agents that drive social policy. without comprehensive immigration reform, many children of undocumented immigrants live in fear that their parents and possibly they themselves may be deported. the children may benefit from social work and counseling services to help them process their fear of separation and loss of their parent(s) due to immigration status. counseling services can also be offered to children who have been placed in foster care. wessler (2011) conservatively estimates that 5,100 children of undocumented immigrants are placed in foster homes and make up 1.25% of children placed in foster care. cultural sensitivity with this vulnerable population is a growing area of need. referral services to appropriate agencies on an as-needed basis is crucial. the children may also benefit from free/reduced lunch and kid care since many live below the levels of poverty. berk, schur, chavez, and frankel (2000) reported that few undocumented immigrants access health care, with the exception of childbirth services. increasing school counseling programs is of utmost importance for the socialemotional well-being of children. given the compulsory attendance law, school social workers and counselors are in a crucial position to offer support to all school-aged children, including the undocumented. school social workers can serve as a resource for the students and their families, given the recent memorandum on the revisions of the alabama school attendance manual in relation to documentation needed for the enrollment of incoming students issued by the state superintendent of alabama. some school social workers may presume that they do not have the skills or language to assist in this “immigration” situation; when in fact, school social workers are more than qualified to address this loss issue. on november 26, 2011 (according to a san antonio news station) a young undocumented immigrant in mcallen, texas committed suicide and left a note to his devastated family noting that he had no will to live because he was undocumented and not able to attend college. many young students are devastated by the plight of their undocumented immigrant status because it causes not only emotional but financial turmoil, since they are not able to get a driver’s license, get a job, attend college and pursue the “american dream.” many children were brought into this country when they were young and have only known this country to be their home. for the majority, their dominant language is english and they have lived and attended schools in this country. social workers should advocate for comprehensive immigration reform. using a social justice theoretical framework, social workers have the skills to work with organizations and the media to bring to light the plight of immigrant families. social workers are trained in community organization and should use this skill to advocate for immigrants. child welfare agencies and caseworkers are challenged to provide services to diverse populations using cultural sensitivity. social work practice should be child romero, romero williams/impact of immigration legislation 238 focused, strengths based, culturally competent, community based, individualized to meet the unique needs of the family, and offer family centered services (aha, 2010). implications for social work education given the growing number of deportations faced by immigrants in this country the impact this has on latino school-aged children and their families is enormous (splc, 2011a). social work education needs to continue to address global issues (transnational issues and immigration) in the social work curriculum. social work macro practice (netting, kettner, mcmurtry, & thomas, 2012) also needs to address the issues of the impact of immigration. ortiz, garcia, and hernandez (2012) recommend that a “working with latinos and immigrants” curriculum be developed by cswe, bpd, nadd, and gade (p. 201). community organization courses need to address how to work with and empower the immigrant population (nclr, 2011b). advocacy groups have been on the forefront of emphasizing social events that impact vulnerable groups. social workers can play a crucial role in community activism and organization and develop culturally sensitive curricula to work with immigrants. given the growing number of latinos in this country, schools of social work must recruit and retain latino students and faculty (ortiz et al., 2012). cultural and linguistic competence is necessary when working with racial and ethnic populations, is essential for their emotional well-being, and helps to reduce health disparities among these groups (sanchez, chapa, ybarra, & martinez, 2012). social work students need to be able to address and work with populations who are undocumented, given the growing number of undocumented persons and the increase in anti-immigrant legislation. many state legislatures implement language that warns against those who provide services to the undocumented. therefore, it is imperative that our national and state associations take a public stand against xenophobic anti-immigrant legislation, because it violates human and civil rights, and social and economic justice. implications for policy human well-being can be achieved by creating policies and services that impact quality of life. social workers are change agents who can provide leadership for such policies (council of social work education, 2008). state and national social work organizations can take the lead to support comprehensive immigration reform. globalization also plays a role in transnational migration that cannot be overlooked. comprehensive immigration reform must be addressed by the federal government, because without bipartisan leadership, many states can end up like arizona, alabama, georgia, utah, indiana, and south carolina, which have mirrored legislation that violates the civil and human rights of immigrant families and their children who are often citizens of the united states. immigration policy must minimize the pronounced waiting list for those who have applied for residency (flynn & dalmia, 2008). furthermore, immigration policy and reform should ensure immigrants the right to due process similar to that used for the criminal justice system. currently, undocumented immigrants do not have the right to due advances in social work, spring 2013, 14(1) 239 process, which includes: miranda warnings, lawyer access, right to a bail hearing, speedy trial, trial by jury, as well as restrictions against illegally-obtained evidence. many immigrants are held in detention camps for what appears to be an unlimited amount of time and are treated as criminals. in illinois, approximately 77% of the immigrants being held are facing charges related to immigration and documentation issues rather than crimes that are violent in nature. this detention and deportation of undocumented immigrants is aimed at deterring their employment, yet it takes a terrible toll on the children and their families; many of which live below the poverty line. “sb 1070-style laws impose unfounded mandates on police, jails, and courts; drive away workers, taxpayers, and consumers upon whom the state economy depends; and invite costly lawsuits and tourist boycotts” (immigration policy center, 2011, p. 1). few states can afford these economic consequences. fitz and kelley (2010) reported that four months after arizona passed s. b. 1070, arizona’s hotel and lodging association reported a loss of 15 million dollars in lodging revenues, but fitz and kelley estimated that 45 million dollars would have been a more accurate figure. many farmers throughout the united states reported a loss of crops, as well as income due to the anti-immigrant legislation that drove their workers, many of which were undocumented, away. many farmers reported that americans would not take these hard labor jobs in the fields. churches and other faith-based organizations have been safe havens for the immigrant community and play a critical role in the distribution of services to support communities; social workers collaboration with these groups is beneficial. some schools have played a positive role to support students who have faced deportation. schools can make the enrollment process more user-friendly and not a deterrent for parents who may need an interpreter to register their children, or may not understand the educational system. school office staff may benefit from cultural sensitivity training, and social workers have the expertise to provide this training. in addition, schools should provide the necessary academic and emotional support to all enrolled students. an increase in early childhood education programs will provide children of immigrants who may speak another language at home the opportunity to learn english as they build their basic skills. school social workers and counselors play a crucial role in these settings, and, in addition, can offer counseling services for the children who have experienced a separation from their parents. immigrant community organizations and leaders have provided a network to address concerns that impact the community and should have plans that are ready to implement in cases of need (capps et al., 2007). implications for social work research the importance and need for further research and action on the impact of immigration on children, families, communities, and our nation is urgent and of utmost relevance to the body of research in the social work profession. state by state, the growing number of anti-immigrant legislation continues to fester and sever family ties, an important foundational element of our society. the well-being of vulnerable populations is at stake. romero, romero williams/impact of immigration legislation 240 social workers have the expertise and the experience to contribute to research on the need for comprehensive immigration reform and the impact of immigration legislation on latino families. research is crucial to understand the implications that toxic and constant stress and trauma have on children of immigrants and latino families. the growing number of children who are placed in foster care because their parents are detained or deported demands further study. research is also needed on the undocumented victims of domestic violence. further research is necessary on the impact that legal channels of immigration would have on the economy of the united states. immigration reform is necessary and merits research. paral (2006) reported that “…immigration policy is economic development policy” (p. 12). discussion many believe that immigration is primarily a latino issue, when in reality immigrants come from diverse countries. the latino population is one of the largest minority groups in this country and latino families have been targeted by draconian antiimmigration legislations. enforcement-only policies are devastating for immigrant families, their children, and our nation as a whole. while the issue of undocumented immigration applies to a larger group, recent antiimmigrant legislation (state and local) has primarily targeted the latino immigrants. in arizona, sb 1070 led the way to racial profiling targeting the latino population, many of whom are u.s. citizens. latino families have endured the impact of massive detentions. many latinos in detention centers suffer abuse, neglect, and death. five thousand one hundred children who are currently in foster care are there because their parents were placed in detention centers or deported and their parental rights were terminated (democracy now organization; wessler, 2011). the highest numbers of deportations in this country have been under the obama administration and they carry a heavy toll on the latino children and their families. enforcement-only initiatives do not work. according to the immigration policy center (2011) the estimated cost for enforcing sb 1070-style immigration enforcement is astronomical. ogden (2006) an arizona sheriff, reported on the projected high costs of law enforcement (officers, time, costs); jail operations (per diem rates, additional jail beds); the building of additional jails (plan, staff, finance); and criminal agencies (county attorneys and support staff, court rooms, support offices) as they relate to arizona sb 1070-style legislation. in addition to the issues brought up by ogden (2006) and the immigration policy center (2001) there is a loss to the economy (decrease in economic output, consumer purchasing power with the loss of workers, tax payers, and consumers, and tax revenue) as well as legal costs related to sb 1070-style legislation and “secure communities.” due to sb 1070, arizona endured astounding economic impacts related to drops in tourism and boycotts. it is imperative that lawmakers understand the economic contributions of latinos in this country. latino students will be the backbone of the u.s. economy (dolan, 2009). all latino students should be afforded their basic human right to an education. many latino families live in impoverished neighborhoods and their children attend schools with higher poverty levels. education should be equitable for all children regardless of advances in social work, spring 2013, 14(1) 241 where they live. education is crucial for reaching the american dream and the dream act will provide students the opportunity to succeed. the dream act could positively impact the economy by reducing the federal deficit (national immigration law center, 2010) and decreasing the federal budget (white house, 2011). prosecutorial discretion should be adhered to when the criteria is met by the undocumented individuals (napolitano, 2012). with the aging of the baby boomer generation, immigrants who are typically young and can contribute to the labor pool will help offset the impact that the loss of employees has on society. “immigrants are entrepreneurial and create jobs in the united states” (white house, 2011, p. 11). from a social justice perspective, social workers must be at the forefront of advocacy for oppressed groups (including undocumented immigrants). there are many theoretical frameworks that can be used to address these issues. the social-emotional well-being of children who are separated from their parents can be understood using bowlby’s attachment theory. the social justice theoretical framework is of utmost relevance when dealing with this population. social workers have the skills and expertise to provide leadership to those who enact policies. social justice and systemic oppression can be addressed through social work practice, education, research, and policy. conclusion various racial, ethnic, and immigrant groups have endured systemic oppression throughout the history of this country. latino families compose the largest immigrant group (wessler, 2011) and they suffer the negative impact of these political, legal, economic, and social ramifications due to the anti-immigrant legislations. comprehensive immigration reform is necessary at the federal level otherwise states will continue to enact legislation that violates the undocumented immigrants civil and human rights. the social, political, legal, and economic impact on these oppressed groups is enormous. in the latino community racial profiling affects not only the undocumented, but also the u.s. citizens alike. the anti-immigrant legislations have an adverse effect on the socialemotional well-being of latino children and their families (citizens and undocumented) who are separated due to detentions and massive deportations. when registration and school policies become exclusionary, they adversely affect the education of latino children and young adults who are striving for a better future through academic excellence. the economic impacts of anti-immigrant legislation are complex: 1) they will increase economic hardships for many undocumented latino families who are already living below the level of poverty due to their undocumented status, 2) there is an economic impact on our nation’s economy, since undocumented immigrants pay federal, property, and sales taxes, as well as payroll, and social security, and 3) they place more financial burdens on states to enforce these legislation (the rising costs of detention centers, jails, and manpower, not to mention losses due to boycotts and their effect on tourism). social work is a profession that has fought against tenacious systems of oppression and must continue to advocate for social and economic justice, equality, and fairness for all (including the undocumented immigrants and their families). jane addams stated, “the good we secure for ourselves is precarious and uncertain until it is secured for all of romero, romero williams/impact of immigration legislation 242 us and incorporated into our common life.” the impact of immigration legislation on latino families can be addressed through social work education, practice, research, and policy. references american humane association. 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(2011b, winter). state anti-immigrant laws. splc report, 41(4), 2, 3. wessler, s. f. (2011). shattered families: the perilous intersection of immigration enforcement and the child welfare system. new york, ny: applied research center. retrieved from http://arc.org/shatteredfamilies white house. (2011). building a 21st century immigration system. retrieved from http://www.whitehouse.gov/immigrationaction romero, romero williams/impact of immigration legislation 246 author note: address correspondence to sylvia romero, community consolidated school district 46, frederick school, 595 frederick road, grayslake, il. 60030. e-mail: romero.sylvia@d46.org _________________ heidi adams rueda, msw, phd is assistant professor, department of social work, the university of texas at san antonio, san antonio, tx, 78207. alicia hawley, mssw, is a phd candidate, school of social work, the university of texas at arlington, arlington tx, 76019. beverly black, ph.d., mssw, is jillian michelle smith professor in family violence research, school of social work, the university of texas at arlington, 76019. bernadette k. ombayo, msw, is a phd student, school of social work, the university of texas at arlington, 76019. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 203-220, doi:10.18060/21202 graduating msw students’ recommended interventions for teen dating violence: a descriptive analysis heidi adams rueda alicia hawley beverly m. black bernadette ombayo abstract: teen dating violence (tdv) is a widespread issue that social workers are likely to encounter in their practice with youth, yet little research exists concerning their preparedness to do so. this study assessed the proposed interventions of graduating msw students (n=73) from two accredited universities in response to two scenarios of tdv. each scenario reflected various forms of violence. nearly one-third of students’ proposed interventions focused on the need to deliver some form of education, healthy relationships being the most prevalent theme. other interventions included teaching about appropriate boundaries, issues of control and anger, self-esteem-building, and communication skills. the second most common set of responses pertained to individual assessment, and the third to individual and couple’s counseling. few comments identified specific tdv interventions, such as safety planning or evidence-based prevention programs. students’ recommendations for education and counseling rather than safety planning or multi-level interventions indicate that social work programs need to provide specific content in msw curricula related to tdv and evidence-based interventions. keywords: social work education, adolescent dating abuse, dating violence intervention, direct practice, school social work, qualitative methods data from the 2013 national youth risk behavior surveillance survey indicate that, of the nearly three-quarters (73.9%) of high-school adolescents who had dated in the past year, one in five females and one in ten males had been physically and/or sexually assaulted (vagi, olsen, basile, & vivolo-kantor, 2015). rates jump to approximately one-third of adolescents having experienced violence when psychological victimization is included in the measurement (halpern, oslak, young, martin, & kupper, 2001). experiencing relationship violence during the adolescent years tends to correlate with a number of other risks, including higher rates of sexual intercourse, marijuana use, binge drinking, eating disorders, physical fighting, electronic bullying, and suicidality (eaton, davis, barrios, brener, & noonan, 2007; silverman, raj, mucci, & hathaway, 2001; vagi et al., 2015). poor performance in school, decreased sense of self-worth, and depression are also associated with teen dating violence (tdv; banyard & cross, 2008; silverman et al., 2001). social workers serve youth in a variety of settings, underscoring the importance of being well-equipped with the necessary knowledge and skills to address tdv. however, very little is known about the extent to which graduating social work students in the u.s. rudea et al./graduating msw students 204 are prepared to work with teens experiencing tdv, and in particular, how they would respond to youth approaching them about the issue. this article presents research on proposed interventions to scenarios of teen dating violence identified by advanced master of social work (msw) students in the southern united states. literature review due to the lack of research concerning the preparedness of social workers to intervene specifically in situations of tdv, we draw on literature related to social workers and social work students’ knowledge of and responses to intimate partner violence. we also draw upon the broader literature on helping professionals’ knowledge of and responses to tdv. social work education and intimate partner violence for years, scholars have called for social work to provide more education on intimate partner violence (ipv) and to better prepare prospective social workers to effectively intervene (connor, nouer, mackey, banet, & tipton, 2012; danis, 2004; mcmahon, postmus, warrener, plummer, & schwartz, 2013). however, we know that few students in the u.s. receive specific ipv education and training in their social work education. for example, cohn, salmon, and stobo (2002) found that only 17 out of 74 reviewed msw programs had a course on family violence. further, danis (2004) found that licensed social workers encountered abused women in their professional duties, yet over half reported little to no academic preparation on ipv. postmus, mcmahon, warrener, and macri (2011) found that only half of student respondents from a large msw program had coursework that addressed domestic violence or sexual assault. in a somewhat more positive outcome, connor et al. (2012) found that most (70%) social work students had some form of ipv training during graduate school, with most reporting between one and five hours. these studies used different research methods making comparisons difficult; however, it appears as if there may be progress over time in exposure of msw students to ipv education. research has also sought to understand whether social work education on ipv has had an impact on students, yielding mixed findings. mcmahon and colleagues (2013) found that students in a specialized course on violence against women experienced a decrease in negative attitudes and beliefs concerning myths about survivors of sexual assault and domestic violence compared to students in human behavior in the social environment (hbse) courses. pomeroy et al. (2011) similarly found that specific attention to ipv in an introductory social work class helped students develop greater knowledge of ipv. in contrast, other studies have found that previous training and coursework have little impact on attitudes and beliefs about violence against women (postmus et al., 2011; tower, 2003) and raise concerns about students’ readiness to intervene effectively with clients experiencing ipv. black, weisz, and bennett’s (2010) examination of social work students’ probable interventions in response to a case scenario found that even though almost 20% of the students had taken an elective class on family violence, few mentioned ipv-specific interventions and one-third included statements that blamed the victim for the occurrence of violence. this study also found that a majority of students believed ipv to be a mental health issue and recommended counseling, an idea consistent with danis and advances in social work, fall 2016, 17(2) 205 lockhart’s (2003) assertion that social work students view ipv as a mental health problem of the victim. we do not know of any social work programs in the u.s. that offer a separate course on tdv. if social work students learn about tdv, the content is most likely incorporated in a course on domestic violence, family violence, or intimate partner violence. some of the textbooks on domestic violence or family violence include a chapter on tdv (e.g., barnett, miller-perrin, & perrin, 2010; lockhart & danis, 2010), and a few of the commonly used hbse textbooks include a short section on tdv (see for example, hutchinson, 2008; zastrow & kirst-ashman, 2010). students may also learn about tdv through field education. however, we know little about how social workers address tdv in their practice with youth. helping professionals’ roles and knowledge concerning tdv helping professions are increasingly recognizing their roles in addressing tdv. in 2009, the american academy of pediatrics described pediatricians’ roles as inclusive of preventing tdv through clinical services, advocacy, education, and in research practices. each of these areas include screening, counseling, and maintaining an accurate communitybased referral list, as outlined in application of a specific protocol (smith et al., 2009). state policies have also identified school professionals as serving an important role in the provision of services to victims and perpetrators of tdv. as of november 2015, 22 states had passed tdv-specific laws regarding the development of school-based educational, counseling, safety, and other recommendations or requirements (national conference of state legislatures, 2016). in texas, the state under study, districts are required to provide students with safety planning and counseling services, in addition to delineating a tdv policy and providing awareness education to students and teachers (texas h.b. 121, 2007). a recent policy analysis revealed that, although most districts had offered a definition of tdv and associated consequences, services were often lacking, leading the authors to conclude that “as districts move forward in implementing the dating violence policy, emphasis must be placed on providing services to victims and increasing awareness” (jackson, bouffard, & fox, 2013, p. 524). by definition, school social workers often serve in the capacities described. despite the identified roles of helping professionals in addressing and preventing tdv, research on knowledge and preparedness concerning this issue is limited to two studies in nursing and counseling. in these national studies examining school counselors’ (n=305) and school nurses’ (n=348) knowledge and training about tdv, and their ability to effectively intervene with youth experiencing it, khubchandani et al. (2012) and khubchandani, telljohann, price, dake, and hendershot (2013) found that although 61% of the counselors had assisted survivors of tdv in the past two years, 43% of the counselors had not received any training on tdv or how to intervene. similarly, over half of school nurses had assisted a student with tdv, but 70% had no training on tdv. counselors’ and nurses’ perceptions of tdv as a problem were correlated with the number of victims they had assisted. of interest to the present study, school social workers were ranked as playing a significant role (second only to school counselors among a list of seven rudea et al./graduating msw students 206 school-based professionals) in assisting adolescent survivors of tdv. as schools’ and communities’ awareness of tdv as an important and preventable health issue increases, social workers may be called upon with increasing frequency to deliver effective services to youth. in determining effectiveness, we direct the reader to other studies (see for example, de koker, mathews, zuch, bastien, & mason-jones, 2014 for a review of tdv interventions), including those with emphasis on social work and perspectives from the field (e.g., weisz & black, 2009). given that we know little about the extent to which msw students in the u.s. are prepared to work with adolescents experiencing tdv, the purpose for this exploratory study was to assess the specific interventions graduating social work students recommend for adolescents experiencing dating violence. understanding how recently graduated social workers approach situations of tdv can offer insights into curricular strengths and gaps for consideration among social work programs, as well as highlight how youth-serving agencies can provide relevant tdv training to social workers through comparison of students’ recommended interventions to best practices. methods a survey was administered across four semesters during the 2014-2015 school year to graduating msw students in two universities, both located in the southern united states. one university has approximately 800 msw students and offers specializations in either direct clinical practice with families and children, mental health and substance abuse, aging, health, or in community and administrative practice. the other has approximately 240 students and has one advanced concentration in cultural competence. students completed the survey online through surveymonkey. the survey was anonymous and took approximately 20 minutes to complete. in order to participate, students were required to be within one semester of graduating with the msw degree. these students were invited to participate via a listserv invitation sent out from the administration offices of both schools, as well as via flyer invitations hung in the social work offices of both departments. at the conclusion of each semester’s data collection, one student was chosen from each school at random to receive a $25 gift card. a separate link within surveymonkey was provided at the conclusion of the survey where students could confidentially provide their email address for participation in this drawing. all research activities were approved by a centralized institutional review board. the survey included questions on the general demographic information of the participants, experiences serving youth, msw coursework on tdv, and two vignettes reflecting commonly occurring tdv scenarios (see appendix). this analysis focused on student responses to the two vignettes. the first and third authors developed the vignettes based on their previous experience with tdv research and prevention programs. the first vignette (tiffany and ana) pertained to a same-sex, female, high school couple in which one of the partners became possessive and controlling of the other. she began to demand increasing amounts of time and insisted on being together at the expense of her partner’s extra-curricular activities. the student whose partner was behaving in a controlling manner approached the school social worker for help. the second vignette (edgar and angela) pertained to a heterosexual high school couple. the girlfriend became very jealous and advances in social work, fall 2016, 17(2) 207 violent in the relationship. after a heated argument in which she embarrassed her boyfriend in public and slapped his arm, the boyfriend pressured her to have unwanted sex with him. the girlfriend then approached the school social worker unsure of what to do. each vignette was followed by an open-ended question: “how would you respond to this situation? please be specific in describing the intervention(s) or series of interventions you feel would be most helpful.” table 1. demographics and study-related experience of msw students characteristics (n=73) n (%) gender  female 63 (86.3%) male 10 (13.7%) race  caucasian, non-hispanic 34 (47.2%) caucasian, hispanic 23 (31.9%) african american 8 (11.1%) asian 3 (4.2%) mixed 2 (2.8%) other 2 (2.8%) sexual orientation  heterosexual/straight 66 (90.4%) gay 4 (5.5%) bisexual 2 (2.7%) lesbian 1 (1.4%) age  20-29 42 (57.5%) 30-39 21 (28.8%) 40-49 9 (12.3%) 50-59 1 (1.4%) experience (n=48) ever worked with middle school or high school aged youth yes 33 (68.8%) no 15 (31.2%) msw coursework included training on how to intervene with teens experiencing dating violence yes 11 (22.9%) no 37 (77.1%) participants a total of 186 students completed the survey, 79% of who were from the larger of the two universities where the study took place. the survey was distributed over the course of four semesters (n=69, spring of 2014; n=13, summer 2014; n=49, fall of 2014; n=55, spring of 2015). a total of approximately 1016 students graduated over the course of survey administration, yielding a response rate of 18%. of these respondents, 73 students answered the open-ended questions pertaining to tdv vignettes. approximately 86% of the respondents were female; 90% identified as heterosexual. just under 50% were caucasian, 32% were hispanic, and 11% were african american. over 50% of the rudea et al./graduating msw students 208 students surveyed were between the ages of 20-29. nearly 70% indicated that they had experience working with middle or high-school aged youth, and approximately 30% reported formal coursework in their msw program on how to intervene in situations of tdv (see table 1). analyses utilizing nvivo (version 10), we conducted an inductive content analysis to delineate themes within participants’ written responses to vignette questions. following several thorough readings, the second author used open coding to assign independent conceptual ideas (e.g., safety planning, counseling) to all of the data for both scenarios (creswell, 2007). these preliminary categories were then further refined and organized into meaningful themes and subthemes (e.g., “education” as a primary theme, “teaching coping techniques” as a subtheme). a codebook was devised to communicate the second author’s operationalization of each theme and subtheme. this allowed the research team to evaluate the extent to which the themes and subthemes were clearly conceptualized and fit the data; several reiterations were made to the resultant codebook until agreement was reached. all of the data were then coded using the final codebook; comments that contained multiple classifications were coded into multiple themes or subthemes. this move from the raw data to more abstract levels of themes and subthemes is what allows for meaningful interpretation (creswell, 2007). finally, we calculated total frequencies by subtheme, theme, and vignette to allow for comparison. results students proposed a variety of intervention modalities in working with the dating couples. in order of prevalence, students recommended: 1) providing education, 2) counseling services, 3) conducting an assessment, 4) other (e.g., instituting a safety plan, notifying parents). see table 2 for a full display of results and table 3 for sample quotations. advances in social work, fall 2016, 17(2) 209 table 2. interventions for tdv recommended by 73 msw students (n=280)* total n(%) vignette 1: tiffany & ana n(%) vignette 2: edgar & angela n(%) education (n=86, 30.7%)    healthy/unhealthy relationships 25 (29.1%) 18 (20.9%) 7 (8.1%) boundaries 11 (12.8%) 6 (7.0%) 5 (5.8%) control and anger 11 (12.8%) 1 (1.2%) 10 (11.6%) self-worth/self-esteem 10 (11.6%) 7 (8.1%) 3 (3.5%) communication 9 (10.5%) 3 (3.5%) 6 (7.0%) sexual abuse 8 (9.3%) 8 (9.3%) birth control 6 (7.0%) 6 (7.0%) sexuality 4 (4.7%) 2 (2.3%) 2 (2.3%) coping 2 (2.3%) 2 (2.3%) education total 86 (100%) 37 (43.1%) 49 (56.9%) counseling (n=77, 27.5%)    individual counseling 34 (44.2%) 20 (26%) 14 (18.2%) couple's counseling 13 (16.9%) 7 (9.1%) 6 (7.8%) group counseling 8 (10.4%) 4 (5.2%) 4 (5.2%) specific counseling interventions    solution-focused 13 (16.9%) 9 (11.7%) 4 (5.2%) cognitive-behavioral 6 (7.8%) 4 (5.2%) 2 (2.6%) role play 2 (2.6%) 1 (1.3%) 1 (1.3%) client-centered 1 (1.3%) 1 (1.3%) counseling total 77 (100%) 45 (58.5%) 32 (41.5%) assessment (n=69, 24.6%)    assess the goals for the relationship 20 (29%) 13 (18.8%) 7 (10.1%) assess the overall situation 17 (24.6%) 11 (15.9%) 6 (8.7%) explore feelings 15 (21.7%) 1 (1.4%) 14 (20.3%) assess the home environment and past 9 (13.0%) 6 (8.7%) 3 (4.3%) assess support systems 5 (7.2%) 5 (7.2%) assess impact on school performance 3 (4.3%) 1 (1.4%) 2 (2.9%) assessment total 69 (100%) 37 (53.4%) 32 (46.3%) other (n=48, 17.1%)    safety plan 22 (7.9%) 16 (72.7%) 6 (27.3%) notify parents 11 (3.9%) 9 (81.8%) 2 (18.2%) referral 9 (3.2%) 3 (33.3%) 6 (66.7%) school interventions 4 (1.4%) 4 (100%) unsure 2 (0.7%) 2 (100%) other total 48 (100%) 32 (66.7%) 16 (33.3%) *note: frequencies refer to the number of responses in each category, not the number of respondents. rudea et al./graduating msw students 210 table 3. example quotations intervention total n example quotations education healthy/unhealthy relationships 25 "discuss what real love looks like" boundaries 11 "intervention regarding healthy boundaries would be implemented" control and anger 11 "brainstorm responses for ana to the possessive behavior" self-worth/self-esteem 10 "provide ana with education on self-esteem and self-confidence" communication 9 "it appears that edgar and angela can learn to recognize their emotions and better communicate them" sexual abuse 8 "explain that there should never be pressure with sex" birth control 6 "discuss birth control options" sexuality 4 "teen sexuality should be addressed once the parents are involved" coping 2 "i would coach her in calming techniques…" counseling individual counseling 34 "engaging with both clients first then some kind of individual counseling" couple's counseling 13 "i would attempt to talk to both girls together in order to discuss what is going on and how they are bothered by it" group counseling 8 "group counseling or support groups to help both girls with similar issues they face" specific counseling interventions solution-focused 13 "i think empowering the girls through individual solution-focused therapy would work well…" cbt 6 "then i would work to correct the distorted thinking ana has about her relationship with tiffany by using cbt methods" role play 2 "role-play ways in which angela might verbalize her boundaries to edgar" client-centered 1 "i believe in this situation client centered could be a preferred theoretical technique" assessment assess the goals for the relationship 20 "discuss the idea of goals in the relationship" assess the overall situation 17 "i would conduct a psychosocial evaluation on both girls individually" explore feelings 15 "i would ask both of them to be completely honest and talk about their feelings and what has just happened" assess the home environment and past 9 "i would assess her home life/history of abuse" assess support systems 5 "ask about parental or family support" assess impact on school performance 3 "how is this relationship affecting grades?" other safety plan 22 "i would first make sure she feels safe and then talk to her about how safe she feels staying in the relationship" notify parents 11 "i believe parents need to be notified about situation" referral 9 "offer ana resources that are available in the community and inform her that i am available should she need to talk" school interventions 4 "on a macro levelteach school personnel to recognize the warning signs of teen dating violence…" unsure 2 "i would research interventions for teen dating violence since i do not have a working base knowledge of tdv" total 280 advances in social work, fall 2016, 17(2) 211 education the largest number of responses (n=86; 30.7%) focused on some form of education that they would provide to the student(s). recommendations addressing education focused on several specific areas including healthy/unhealthy relationships (n=25; 29.1% of education responses), boundaries (n=11; 12.8%), control and anger (n=11; 12.8%), selfworth/self-esteem (n=10; 11.6%), communication (n=9; 10.5%), sexual abuse (n=8; 9.3%), birth control (n=6; 7.0%), sexuality (n=4; 4.7%), and coping (n=2; 2.3%). of these subthemes, the majority consisted of responses related to education on healthy/unhealthy relationships. examples included: i would provide psychoeducational information about healthy relationships. i would let her know that she has the right to be in a relationship free from domestic violence and educate her on what healthy/unhealthy relationships looks like. examples of education on boundaries included: role play ways in which ana might verbalize her boundaries to tiffany. help her to outline her own personal emotional and physical boundaries so that she can feel less relationship pressure in the future. examples of statements made relating to control and anger included: address anger management issues. focus on techniques of addressing anger that encourage positive physical and emotional boundaries. additionally, msw students recommended education regarding self-worth/self-esteem: i would work with ana to increase her self-esteem and work with tiffany on her self-esteem, and relationship views. i would help angela in self-acceptance unconditionally for herself. finally, students offered recommendations with regard to teaching youth to improve their communication skills: i would offer tools on how to effectively communicate with each other. discuss how angela and edgar are communicating; what is working and what is not. counseling the second most common recommended intervention proposed was counseling (n=77; 27.5% of total intervention responses). almost half (n=34; 44.2%) of the recommendations about counseling specifically identified individual counseling. additional counseling interventions proposed included couple’s counseling (n=13; 16.9%), group counseling (n=8; 10.4%), and other specific counseling interventions. the specific counseling interventions that some of the msw students proposed included: solution-focused (n=13; rudea et al./graduating msw students 212 16.9%), cognitive-behavioral (n=6; 7.8%), role-playing (n=2; 2.6%), and client-centered (n=1; 1.3%). the following were some examples of individual counseling recommendations: individual counseling for both tiffany and ana. engaging with both clients first then some kind of individual counseling. examples of couple’s counseling interventions included: i would see if she would be okay if i can call edgar in so that they can discuss their feelings with each other; being that they are both dealing with some issues. i would ask them to come in for couple’s therapy. group counseling recommendations included: psychoeducation group that focuses on healthy relationships, self-esteem, anger management, decision-making, etc. i think tiffany would benefit from participating in a group setting in which the topic of teen dating is focused on and specific beliefs about relationships are discussed in a peer environment with trained adult facilitation… finally, specific counseling interventions were recommended, the most common of which was solution-focused: since anna has decided to seek help shows her strengths and willingness to accept there is an issue. solution focus is goal-directed and focuses on the solution than the problem that brought anna to this point. i would possibly utilize solution focused combined with strengths model. assessment some msw students indicated that they needed additional information to better understand and assess the situation with the dating couples. approximately 25% (n=69) of the total coded responses included a recommendation about assessment in addition to or as a stand-alone method of intervention (i.e., double-coded alongside one of the additional themes). assessment subthemes included the following: assess the goals for the current relationship (n=20; 29%), assess the overall situation (n=17; 24.6%), explore feelings (n=15; 21.7%), assess the home environment and past (n=9; 13%), assess support systems (n=5; 7.3%), and assess impact on school performance (n=3; 4.4%). examples relating to assessment of goals for the current relationship included: list pros and cons to their relationship as well as a list of things that ana wants to change in her relationship for the relationship to continue. explore motivation for maintaining the relationship. examples relating to the need to assess the overall situation included: advances in social work, fall 2016, 17(2) 213 i would ask open-ended questions to understand what ana needs to feel safe with tiffany. assess her feelings and home situation and go from there. examples relating to the need to assess the home environment and past included: i would ask about prior relationships and also family and friend relationships that she has witnessed. i would ask angela how her childhood was and how problems got resolved. other safety planning (7.9%; n=22), notifying parents (3.9%, n=11), referral (3.2%; n=9), school interventions (1.4%; n=4), and stating that they were unsure (0.7%; n=2) were coded as “other.” although we did not consider these responses prevalent enough to meaningfully convey themes, we include them given their importance as interventions (e.g., safety planning) and given the research question (e.g., referral, unsure). discussion this study responds to a lack of research concerning graduating msw students’ preparedness to respond to adolescent dating violence. we were specifically interested in how students would respond to scenarios of tdv, including the types of interventions they would propose. we found that nearly one-third of recommendations focused on education. within this theme, over one-quarter of students’ recommendations pertained to healthy versus unhealthy relationships. students also noted the importance of teaching about appropriate boundaries, issues of control and anger, self-esteem, and communication skills. further, over one-quarter of recommendations focused on providing the dating couple with counseling, nearly half of which specified individual counseling. finally, almost onequarter of recommendations pertained to assessment of a range of factors including the high school student’s goals for the relationship, their feelings, and to gain information about their past or current home situation as a stand-alone intervention or in addition to another modality. few comments identified specific tdv or intimate partner violence interventions, such as safety planning, or discussed engaging with the school to enhance educational opportunities or services focused on tdv provided to students at large. a majority of recommendations identified individualized education interventions, most of which centered on teaching youth about healthy relationship dynamics. correspondingly, education is an important role of social workers and an intervention that they are often comfortable in recommending and performing (asquith, clark, & waterhouse, 2005; black et al., 2010; hepworth, rooney, rooney & strom-gottfried, 2013). it is a strength that graduating social workers would instruct clients on healthy relationships. however, an overemphasis on the individual as needing instruction neglects critical reflection on ecological contexts contributing to relationship dynamics, including modeling and acceptance of violent conflict resolution strategies by important role models in the lives of youth (ball et al., 2012). the msw students’ emphasis on individualized rudea et al./graduating msw students 214 education also aligns with the finding that over one-third of comments focused on counseling, a majority of which identified individual counseling as a preferred intervention. this was not surprising, as black and colleagues (2010) similarly found that almost onethird of social work students’ recommendations in a domestic violence scenario related to counseling. social work students may view tdv, similar to ipv (danis & lockhart, 2003), as a mental health problem. these results may be contextualized in part by our sample, as one university offered a macro track alongside four clinically focused tracks and the other did not offer a macro-focused track (rather, students could pursue micro/macro interests through integrated content and assignments). although many graduating social workers in the u.s. are interested in direct clinical practice (council on social work education, 2010), social workers should be taught and should similarly teach youth to understand how violent relationship dynamics are inseparable from peer, family, and societal influences. the finding that many of the students’ recommendations focused on the need to conduct an assessment, and specifically assess the goals of the relationship, suggests that students want to understand more about a relationship, even a volatile and violent relationship, prior to or as a key component of their intervention work. this is aligned with best social work practice and confirms the need for health professionals, including social workers, to be trained in how to implement appropriate screening tools and assessment protocols for tdv specifically (cutter-wilson & richmond, 2011). it is concerning that few comments mentioned assessing the client’s support systems given their importance in violent relationships (goodman & smyth, 2011). informal supports are often the most likely to offer guidance, instrumental, and emotional resources to survivors of partner violence. social workers should tap into these resources, where available, to mitigate the harmful effects of abuse and to bolster the efficacy of formal help-seeking (see goodman & smyth, 2011 for a review). social workers’ one-on-one work with youth offers a critical opportunity to discuss the adolescent’s safety. thus, it is concerning that very few recommendations from msw students pertained to safety planning. safety planning with teens can increase their understanding of the risk of violence as well as provide youth with resources and supportive options to consider (campbell, 2001). further, some of the recommended interventions did not consider safety; for example, many recommendations focused on couple’s counseling without contextualizing such responses in light of risk assessment. partners in abusive relationships are likely not free to engage in the open exchange of feelings, highlighting this as an important content area for training of social workers. further, some comments suggested notifying parents about the incident of tdv. mandatory reporting requirements are not always clear (broner, embry, gremminger, batts, & ashley, 2013) but much of teens’ reluctance to seek help for tdv is related to fear of their parents’ responses (ashley & foshee, 2005; black, weisz, preble, & sharma, 2015). establishing and maintaining trust is critical in working with teens experiencing dating violence. beyond working directly with the adolescent, social workers are called upon to work within and across ecological systems to serve in various roles including as macro-level change agents (kirst-ashman & hull, 2015). it is interesting that no student recommendations focused on advocating with school administration for student safety, advances in social work, fall 2016, 17(2) 215 including for protective orders, and the possible need for one student to transfer to another classroom or school (see jackson et al., 2013). a lack of responses reflecting macro-level interventions may reflect the wording of the question asked (i.e., focusing on the intervention one would conduct). still, social workers should be aware of their own state’s policies concerning protective orders for adolescents, advocating on behalf of such policies as supported by research (hoefer, black, & ricard, 2015). similarly, rather than advocate for school-level interventions, graduating msw students in this study focused primarily on the provision of individual education and counseling aimed at improving the relationship health of youth. it is interesting to note that their emphases (e.g., healthy relationships, communication skills) parallel the tendency for tdv programs to deliver similar content (see malhotra, gonzalez-guarda, & mitchell, 2015 and whitaker et al., 2006 for reviews). a strength of this finding is that it suggests social workers may be using their advanced clinical knowledge to build relationship capacities with youth and may be well-suited for further training in the delivery of tdv interventions in the classroom. limitations findings need to be considered within the context of the limitations of the research study. the researchers developed the instrument for the purpose of the study and its validity and reliability were not assessed. the survey had a low response rate and only 73 of the 186 students completed the open-ended questions on the survey. it is not atypical to obtain high nonresponse rates in online surveys (typical rates ranging from 20 to 33%; nulty, 2008), and higher nonresponse rates in open-ended questions compared to other question formats (millar & dillman, 2012). students completing the survey could have been limited to those who had a special interest in the topic. we have no way of knowing if students did not know how to respond to the tdv vignettes or simply did not want to take the time to respond. it may have been that some did not see any problems presented by the vignettes, in which case asking them what intervention(s) they would recommend might have prompted non-response. not asking whether there is a need for intervention may be considered a methodological limitation, although adolescents in each scenario addressed social workers directly for help. further, we asked students to speculate about how they would intervene in the tdv scenarios portrayed in the vignettes. however, how msw students speculate they would intervene may differ from what they might actually do if faced with the situation. many students in this study did report experience with middle school and high school youth, and some had received msw coursework specific to tdv. how msw students differed from one another with regard to their experience, training, and response to tdv is an area for future research, as is how social workers actually respond to tdv scenarios. future research can also assess how students respond differently to incidences of tdv involving same-sex and heterosexual couples. we surveyed msw students in two public universities located in the same state in the southern part of the u.s. although both student bodies were diverse, they were similar to each other. additional research is needed in other parts of the u.s. and in other countries. rudea et al./graduating msw students 216 conclusions only two other publications that we are aware of have assessed helping professionals’ (i.e., counselors’ and nurses’) knowledge and readiness to practice in contexts of tdv (khubchandani et al., 2012, 2013). the present study has extended this research in two distinct ways: one, by surveying graduating msw social work students, and two, by using open-ended qualitative methods to understand specifically how students would provide services to youth experiencing violence in their relationships. our findings parallel the studies conducted by khubchandani and colleagues (2012, 2013) in highlighting a need for further training specific to tdv, particularly in the areas of safety planning and mesoand macrolevel practice. students’ recommendations for education and counseling rather than safety planning or multi-level interventions indicate that social work programs need to provide specific content related to tdv and evidence-based interventions (see for example, weisz & black, 2009), particularly in order to prepare those interested in serving youth. one concern is that many 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(2008). the adequacy of response rates to online and paper surveys: what can be done? assessment & evaluation in higher education, 33(3), 301-314. doi:https://doi.org/10.1080/02602930701293231 https://doi.org/10.2105/ajph.91.10.1679 http://www.amazon.com/s/ref=dp_byline_sr_book_1?ie=utf8&field-author=dean+h.+hepworth&search-alias=books&text=dean+h.+hepworth&sort=relevancerank http://www.amazon.com/s/ref=dp_byline_sr_book_2?ie=utf8&field-author=ronald+h.+rooney&search-alias=books&text=ronald+h.+rooney&sort=relevancerank http://www.amazon.com/s/ref=dp_byline_sr_book_3?ie=utf8&field-author=glenda+dewberry+rooney&search-alias=books&text=glenda+dewberry+rooney&sort=relevancerank http://www.amazon.com/s/ref=dp_byline_sr_book_4?ie=utf8&field-author=kim+strom-gottfried&search-alias=books&text=kim+strom-gottfried&sort=relevancerank https://doi.org/10.1016/j.adolescence.2015.07.006 https://doi.org/10.1177/0887403412475136 https://doi.org/10.1542/peds.2011-3130 https://doi.org/10.1111/josh.12008 https://doi.org/10.1177/1524838014537903 http://www.surveypractice.org/index.php/surveypractice/article/view/48/html http://www.ncsl.org/research/health/teen-dating-violence.aspx https://doi.org/10.1080/02602930701293231 advances in social work, fall 2016, 17(2) 219 pomeroy, e., parrish, d. e., host, j., cowlagi, g., cook, p., & stepura, k. 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(2006). a critical review of interventions for the primary prevention of perpetration of partner violence. aggression and violent behavior, 11(2), 151-166. doi:https://doi.org/10.1016/j.avb.2005.07.007 zastrow, c., & kirst-ashman, k. k. (2010). understanding human behavior and the social environment. belmont, ca: brooks/cole, thomson learning. author note: address correspondence to: heidi adams rueda, msw, phd, department of social work, the university of texas at san antonio, 501 w. césar e. chávez blvd., san antonio, tx, 78207, 210-458-2309, heidi.rueda@utsa.edu https://doi.org/10.5175/jswe.2011.200900077 https://doi.org/10.5175/jswe.2011.200900122 https://doi.org/10.1001/jama.286.5.572 https://doi.org/10.1542/peds.2009-0943 http://www.legis.state.tx.us/tlodocs/80r/billtext/html/hb00121f.htm https://doi.org/10.1001/jamapediatrics.2014.3577 https://doi.org/10.1016/j.avb.2005.07.007 mailto:heidi.rueda@utsa.edu rudea et al./graduating msw students 220 appendix scenario 1 background information: tiffany and ana have been dating for 3 months. ana is in the 9th grade, is in cross-country track, and likes to run every day after school. tiffany is in the 10th grade, and does not participate in any school activities. this is both tiffany and ana’s first relationship, although tiffany has experimented a little bit sexually with both girls and guys. ana is also unsure about whether her sexual preference is just for females, and had told tiffany that when they first hung out. both ana and tiffany are caucasian. the situation: over the last month, tiffany has become more and more possessive of ana and insists that she be with her at all times when not in class. one day tiffany threatens to end the relationship if ana does not hang out with her after school. ana is upset that tiffany has asked her to do this, but decides that missing one cross-country practice won’t matter too much. while “chilling” at the donut shop, tiffany and ana have fun laughing with each other and hanging out with the other teens. although ana had a good time, the next day when tiffany approaches her in the halls asking her to go again, ana gets upset that missing two practices would mean she couldn’t participate in the next cross-country meet. tiffany insists that she come, and tells her that as her girlfriend she needed to be with her over her other friends. tiffany states that she loves ana, and that she couldn’t bear to live without her since her home life is so bad. ana ends up having to drop out of the cross-country team to accommodate tiffany’s demands. she notices that tiffany becomes jealous easily when she talks with any guys or girls. tiffany has also asked for her facebook and twitter passwords and, because she wanted tiffany to trust her, anna gave them to her. anna is upset, however, to see that tiffany is constantly on her pages to see what she is posting and has even deleted some of her pictures with other friends. tiffany begins to yell at ana in front of their friends at the donut shop over small things, and calls her names like “slut” and “whore” when she talks to guys. ana is afraid of tiffany’s growing possessiveness and anger towards her. ana misses her old friends, and misses running in cross-country, but she is afraid that she is all tiffany has. she remembers tiffany’s threat of “i don’t know what i would do if you left me.” could it mean that tiffany might hurt herself, or ana, if she tried to leave? ana decides to seek help from you, the school social worker. she tells you that she doesn’t want tiffany to be upset with her anymore and that she doesn’t know what to do. she wants to be free to do other things besides hang out with her, but still wants to work out their relationship; after all, she does like being together when tiffany is not mad at her. scenario 2 background information: edgar and angela are in 10th grade and have been dating for 5 months. this is the longest relationship either of them has been in, and they consider it “serious”. they are not sexually active, but they have been considering it for the last month. angela gets jealous easily, and has been known to pinch edgar and throw objects at him when they fight; edgar does not consider it violence since she is a girl. both edgar and angela are 2nd generation mexican americans. the situation: edgar and angela decide to go to the school dance together held that friday at 6pm. they agree that since angela has to work that night that she will meet edgar in the school lobby around 7pm after she gets off and has a chance to go home and change. on the night of the dance, edgar arrives at 6:30pm and waits for angela for about 15 minutes in the school lobby while chatting with a few of his friends who are already there. hungry, he decides to grab a quick bite to eat with his friends that are heading into the gymnasium where the dance is taking place. at 6:45pm angela arrives (15 minutes early) to find that edgar is not waiting for her in the lobby as he had promised. she becomes angry after waiting for 5 minutes alone and decides to go look for edgar inside the gym. angela finds edgar and a friend, erica, laughing by the snacks table. angela goes to edgar and yells at him. edgar tries to explain that he was just about to go back out to the lobby to be there by 7pm, like they had agreed, but angela cuts him off “i see how it is, you would rather eat with this tramp than wait for your girlfriend like you said you would!” she then slaps edgar’s arm and storms away, walking quickly to the school parking lot where she starts to cry. edgar is embarrassed that angela hit him, and extremely angry that she did it in front of so many people at the dance. he doesn’t know what to do, but decides to go after angela to make sure she is okay. he sees her crying in the parking lot; she tells that him that she is sorry and that she was just jealous of erica. edgar tells her that he forgives her, but that he is starting to doubt if she is serious about their relationship since she keeps embarrassing him in public. he then pressures her to have sex that night, telling her that she needs to prove how sorry she is, and how much she really loves him. the next day, she is deeply upset about what happened and feels she wasted her virginity on edgar. the next day of school she approaches her school social worker, explaining all that has happened. she does not want to leave the relationship, but does not want to feel pressured to keep sleeping with him. microsoft word 11-3750_tucker_santiago_role of acculturation final ______________  cristina michele tucker, ph.d., is a bilingual research analyst at ducker worldwide. anna maria santiago, ph.d., is the leona bevis & marguerite haynam professor of community development in the mandel school of applied social sciences at case western reserve university in cleveland. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 178-205   the role of acculturation in the civic engagement of latino immigrants cristina michele tucker anna maria santiago abstract: despite continued growth and dispersion of the latino immigrant population in the united states, the lingering effects of a sluggish national economy and growing antiimmigrant sentiments have contributed to ongoing marginalization and exclusion, further hindering their participation in american civic life. despite these challenges, latino immigrants have remained engaged, yet the factors and processes that facilitate participation in american society remain poorly understood. data from the latino national survey and focus groups with latino immigrants were used to examine how variations in levels of acculturation, demographic characteristics, socioeconomic status (ses), and characteristics of the immigrant experience influence the civic engagement of latino immigrants in american society. we found that citizenship, length of residence in the united states, and higher ses enhanced civic engagement, while brown skin color, migration for economic reasons, and mexican ancestry decreased participation. the level of acculturation significantly moderated the effects of these contextual factors. key words: civic engagement, acculturation, latinos, incorporation, immigration over the past four decades, the latino immigrant population in the united states has increased rapidly and has dispersed to a broader range of geographic locations throughout the country (desipio, 2011; fischer & tienda, 2006; fraga et al., 2010; passel, 2005, 2009; pew, 2007; smith, 2008; u.s. census bureau, 2010a). latinos, both immigrants and those born in the united states, are estimated to total 25% of the u.s. population by the year 2050, and have already become the statistical majority population in several states (fraga et al., 2010; passel, 2005, 2009; pew, 2007; u.s. census bureau, 2009a, 2009b, 2010a; wampler, chávez, & pedraza, 2009). at the same time, however, latino immigrants continue to be marginalized within american society and underserved by u.s. social service delivery systems (deaux, 2011; delano, 2011; moore & pinderhughes, 1993; telles & ortiz, 2008). of equal concern, latino immigrants historically have been excluded from multiple segments of american society, including middle class suburbs, skilled and white-collar employment sectors, predominantly white schools, and numerous social and community groups (berry, 2002; desipio, 2011; fischer & mattson, 2009; fischer & tienda, 2006; golash-boza; 2006; muñoz, 2008; o'brien, 2008; piedra & engstrom, 2009; piore, 1979; sander & putnam, 2010; telles & ortiz, 2008). moreover, latino immigrants have been the targets of harmful stereotypes, discrimination, unwarranted police intervention, and racial profiling (correia, 2010; fraga et al., 2010; massey, durand, & malone, 2002; muñoz, 2008; o'brien, 2008; portés, & rumbaut, 2006). advances in social work, spring 2013, 14(1) 179   furthermore, there has been a palpable anti-immigrant sentiment surrounding the current wave of latino immigrants in the united states that heavily overshadows the difficulties experienced by earlier waves of twentieth century european immigrants (desipio, 2011; fraga et al., 2010; hondagneu-sotelo, 1999). recent latino immigrants have been blamed for an array of contemporary social and economic problems in american society (correia, 2010; fraga et al., 2010; hondagneu-sotelo, 1999; wilson, 1999). this anger, emanating from the prolonged economic recession, loss of employment, diminishing state and national coffers, and the reduction of many public services, has grown among the american public (bacon, 2008; correia, 2010). however, it may be misplaced, as areas with growing immigrant populations have experienced economic booms, resurgence, and in many cases, increased employment and improved public schools (fraga et al., 2010). nonetheless, the popular media has fueled this public outcry, heightening the atmosphere of hostility and the targeting of undocumented immigrants (bacon, 2008; correia, 2010; espenshade & hempstead, 1996; espinosa, 2007; hondagneu-sotelo, 1999). this contemporary environment of dislike and poor treatment, within which many latino immigrants reside, makes their incorporation into american society difficult and their reticence to become involved in civic affairs understandable (correia, 2010; santa ana, 1999; verba, schlozman, & brady, 1995). in line with renewed nativism, a growing segment of the american public has focused their efforts on vilifying undocumented immigrants, their family members, and those who help them (anonymous, 2009; bacon, 2008; carlsen, 2009; perea, 1997). this new nativist movement has spawned anti-immigrant legislation that aims to prosecute undocumented immigrants and sanction mass deportation. one such example was california’s proposition 187, which denied public schooling, health care, and social services to undocumented immigrants and required public employees to report them to immigration authorities. proposition 187 passed in 1994 by a 3 to 2 margin, but was subsequently overturned by the supreme court (espenshade & hempstead, 1996; fraga et al., 2010). more recently, the state of arizona passed legislation (sb 1070) requiring police officers to detain anyone suspected to be undocumented, and making it illegal to not carry immigration papers. many, but not all of the contested provisions in this law were halted by a federal judge and overturned by the supreme court. in 2011, the states of alabama, indiana, and georgia passed (anti-immigration) legislation modeled after arizona’s sb 1070. additionally, in 2006, the u.s. congress considered hr4437, which would have mandated prosecution of all undocumented immigrants, as well as schools, health centers, community organizations, and churches that assisted in their ‘illegal’ stay in the united states. the passage of such anti-immigration legislation has led, in some cases, to an increase in the collective civic engagement of latinos, inciting them to march and protest (anonymous, 2009; fraga et al., 2010). on the individual level, however, these events have caused them to retreat for fear of punitive actions by authorities (anonymous, 2009; bacon, 2008; carlsen, 2009; desipio, 2011). in the midst of these challenges, latino immigrants have continued to participate in the civic affairs of receiving communities in the united states. yet, the factors and processes that contribute to this participation by latino immigrants remain poorly understood. we seek to address this gap in the current study. tucker, santiago/acculturation in civic engagement of latino immigrants 180 as a representative democracy, the united states selects the polity to represent them and their interests at all levels of government. the polity is elected by democratic vote, presumably based on the issues that are to become policy, and with the expectation that it represents all segments of the american public (diamond, 1990, 1994; van horn, baumer, & gormley, 2001). democracy is a deliberation, a negotiation of what is best for all stakeholders (de souza briggs, 2008; diamond, 1990, 1994). underlying this process is the assumption that all stakeholders should be represented in the deliberation. one critical means by which members of society participate in this deliberation is via civic engagement. civic engagement can be understood as individual and community-level involvement in social and political activities that attach people to society and influence multiple levels of policy (putnam, 2000). according to putnam (1995), civic engagement is the “people’s connection to the life of their community” (p. 2), and is considered the active voice of participation in a representative government, in addition to being a route to understanding american democracy (borden & serido, 2009; mcbride, sherraden, & pritzker, 2006; putnam, 2000). civic engagement is fundamental to the development of public goods, as well as to matching tangible outcomes to the will of the people (son & lin, 2007; tuennerman-kaplan, 2001; verba et al., 1995). civic engagement integrates multiple components of communities in which individuals and groups become involved in order to adequately connect with decision makers (diamond, 1994; garcía, 2003). some of these components might be community groups, schools, trade and labor unions, sports teams, religious organizations, workplace organizations, philanthropic organizations, civic groups, government agencies, businesses, recreational organizations, and social service organizations (putnam, 1995; son & lin, 2007; verba et al., 1995). the outcome of greater civic engagement is increased connection to public officials and thus more representative public policy and public goods (diamond, 1994; putnam, 2000; son & lin, 2007). however, some individuals and groups in american society are excluded from the democratic process. when particular groups are excluded from the decision-making process and have limited representation, decisions may be biased toward the majority and lead to unjust policy for the unrepresented minority (bacon, 2008; diamond, 1990; putnam, 1995; verba et al., 1995). in the case of latino immigrants, exclusion from the decision-making process is linked to issues of acculturation, discrimination, citizenship, anti-immigrant sentiment, and public policy (correia, 2011; fraga et al., 2010; garcía, 2003; hero, garcía, garcía, & pachon, 2000; levin, 2013; michelson, 2003; perea, 1997; sander & putnam, 2010). given that 44% of the latinos residing in the united states are foreign born (u.s. census, 2010a), it is necessary to understand the political and cultural contexts that shape patterns of incorporation into american society and civic life (deaux, 2011; desipio, 2011; fraga et al., 2010; stoll & wong, 2007). for example, latinos emigrating from countries with repressive regimes would have limited knowledge of and exposure to representative democracies (desipio, 2011; massey et al., 2002; uslaner, 2008; uslaner & conley, 2003; vedder, berry, sabatier, & sam, 2009). further, they may not realize that they have a voice in policy making nor have experience with electing representatives advances in social work, spring 2013, 14(1) 181   to advocate for their needs (correia, 2010; desipio, 2011). to facilitate greater representation, it is paramount that latino immigrants be encouraged, both directly and indirectly, to become engaged in their local, state, and national communities (desipio, 2006, 2011; garcía, 2003; massey et al., 2002; muñoz, 2008; putnam, 2005; saito, 2009; son & lin, 2007). however, immigrant feelings toward the u. s. government can be mixed, arising from difficulties with immigration, adversarial relationships between the united states and their countries of origin, and experiences of unfair treatment in american society (bacon, 2008; correia, 2010; desipio, 2011; fraga et al., 2010; muñoz, 2008). thus, incorporation into american society is an important factor in immigrant involvement in civic life and the representation of their interests in american policy (deaux, 2011; massey et al., 2002; papademetriou & terrazas, 2009; sánchez molina, 2008). in this study, we seek to identify possible causal pathways associated with patterns of incorporation and civic engagement of latino immigrants within american society. specifically, we employ acculturation and civic engagement theories to examine how variations in immigrant demographic characteristics, socioeconomic status, and characteristics of the immigrant experience influence civic engagement. further, we examine the role of acculturation as a potential moderator of such engagement. to address these questions, we utilize data about latino participation in civic affairs derived from the latino national survey augmented with qualitative data obtained from focus groups conducted in a major mid-western metropolitan area. civic engagement of latino immigrants in the united states a crucial feature of the civic engagement of latino immigrants is the long history of latino activism in the united states (orosco, 2008). throughout the twentieth century, latino activists such as césar chávez have been credited for inspiring latinos to fight for equal representation and just policy (espinosa, 2007; national park service, 2009; orosco, 2008). by uniting diverse constituencies on common interests, chávez and other latino activists successfully organized large and powerful protests that impacted policy on a large scale (anonymous, 2009; espinosa, 2007; orosco, 2008). in the spring of 2006, in unified opposition to the repressive anti-immigration house bill hr4437, 102 marches were organized across the country using chávez's model of organizing, fasting, marching, and non-violence to exert pressure on the polity to enact immigration reform (espinosa, 2007; silber mohamed, 2013). diverse groups, ranging from first-generation immigrants from latin america and asia to native-born american citizens, came together to fight for a just and humane immigration policy (espinosa, 2007; fraga et al., 2010; pantoja, menjívar, & magaña, 2008; silber mohamed, 2013). the marches had the intended effect of informing the public and the legislators about the harmful consequences of hr4437 (espinosa, 2007; fraga et al., 2010; silber mohamed, 2013). all undocumented immigrants would have been prosecuted, as well as the schools, health centers, community organizations, and churches that did not turn them in to immigration and customs enforcement (espinosa, 2007; padilla, shapiro, fernándezcastro, & faulkner, 2008). not only did the 2006 marches positively affect policy change by influencing legislators to reject the bill, they also awakened a passionate group of tucker, santiago/acculturation in civic engagement of latino immigrants 182 people with deep activist roots. the new slogan derived from the marches, "today we act, tomorrow we vote," seemed to be a foreshadowing of the civic power of the latino immigrant population. (espinosa, 2007). since the 2006 marches, the latino immigrant community has experienced unprecedented increases in the number of registered voters and interest in political campaigns (desipio, 2011; fraga et al., 2010). in the four years from 2004 to 2008, the immigrant vote increased by more than 1.3 million (desipio, 2011). moreover, since the marches, latinos have increasingly chosen to self-identify as american, and in so doing, have gained momentum in the fight for equal rights as americans (silber mohamed, 2013). nonetheless, continued racial and ethnic segregation of the latino community hampers the civic engagement of latino immigrants (keidan, 2008; massey, 2007; massey & denton, 1993; moore & pinderhughes, 1993; pratt & hanson, 1994; putnam, frederick, & snellman, 2012; sánchez-jankowski, 2008; sánchez molina, 2008; santiago & galster, 1995; wilson, 1978, 1993). there is substantial evidence that race matters, and that racial discrimination impedes integration into american society (félix, 2008; fraga et al., 2010; hernández-león, 2008; okigbo, reierson, & stowman, 2009; portés, 1997; rivas-drake & mooney, 2009; toussaint-comeau, 2006; waldinger, lim, & cort, 2007). even when newcomers with visible physical differences from those of the dominant population of white americans adopt behaviors of mainstream society, they may still experience social rejection in stores, restaurants, schools, housing, and employment, thereby increasing their chances of joining a racialized ‘underclass’ (e.g. brown, 2007; golash-boza, 2006; michelson, 2003; o'brien, 2008; parrado & morgan, 2008; piedra & engstrom, 2009; portés & rumbaut, 2001, 2006; portés & zhou, 1993; rumbaut & portés, 2001; wilson, 1993). this segmented ‘underclass’ group consists of other racial minorities who have not fully integrated into mainstream society and often struggle with social and economic injustice (wilson, 1993). when social interactions only transpire within these racialized minority groups, decision makers in the larger society do not hear their voices (félix, 2008; hernández-león, 2008; okigbo et al., 2009; portés, 1997; rivas-drake & mooney, 2009; toussaint-comeau, 2006; waldinger et al., 2007). therefore, their interests are not adequately reflected in the decisions made and in the public goods created. several recent studies have found that the newest waves of immigrants to the united states have had remarkably different experiences with acculturation than did previous waves of immigrants of european ancestry (barvosa, 2006; fraga et al., 2010; monzó & rueda, 2006; smith, 2008). golash-boza (2006) found that discrimination based on race and skin color was associated with diminished assimilation of the latino community in the united states. more contemporary models of acculturation, such as berry's (2002), describe a multidimensional process whereby immigrants maintain varying degrees of their original culture, adopt various aspects of the new culture, and influence the larger american society with aspects of their cultural heritage such as traditions, celebrations, foods, dress, music, and the arts (barvosa, 2006; ben-shalom & horenczyk, 2003; berry, 2002; fraga et al., 2010; monzó & rueda, 2006; smith, 2008). this model offers a strengths-based approach to acculturation by emphasizing the contributions each culture makes to american society, as well as how individual adoption of certain aspects of advances in social work, spring 2013, 14(1) 183   american culture facilitates access to goods and services within american society. as stressed by fraga and colleagues (2010), latino immigrants do adapt to mainstream american culture, adopting certain behaviors and practices expected in the workplace, in school environments, and the political landscape, in order to get ahead. implicit in this adaptation/acculturation process is the knowledge that in order to get ahead in american society, one must often interact with, work with, and be represented by the majority (fraga et al., 2010). a weakness of previous studies of civic engagement has been the minor role afforded ethnicity and race (correia, 2010; fraga et al., 2010). there have been many more civic engagement studies about the white majority than racial minorities (fraga et al., 2010; portney & berry, 1997). in part, this may be because civic engagement, as defined by putnam (1995, 2000, 2005), is encapsulated in a language of the majority, and as such, is most easily understood and measured by the white majority citizenry. however, as fraga and colleagues (2006) have argued, it is especially important to consider all aspects of american identity in the study of civic engagement, including the understanding of race and ethnicity. immigrant involvement in politics and in their communities is at times hindered, and at times propelled by their experiences with racial discrimination, their immigrant status, and their international politics (bacon, 2008; garcía, 2003; fraga et al., 2006; levin, 2013; prigoff, 2000; telles & ortiz, 2008). therefore, future conceptualization and research on civic engagement needs to be altered in order to be applicable to a racialized and increasingly immigrant society (fraga et al., 2010). in sum, the civic engagement of the residents of the united states is what connects the populous to those who represent them in this representative democracy. involvement at the local, state, and national levels brings the needs, concerns, and ideas of those represented to the decision makers. if decision makers do not hear or listen to all constituencies, they cannot appropriately represent them. policy, at any level, that does not take into account the needs of all the stakeholders is intrinsically unjust (diamond, 1990, 1994; son & lin, 2007; tuennerman-kaplan, 2001; verba et al., 1995). when those impacted by unjust policy are excluded from decisions on new policy, then a vicious cycle of unjust policy ensues (aguirre & turner, 1995; bacon, 2008; massey et al., 2002; telles & ortiz, 2008). data and methods the primary data used in this study were obtained from the latino national survey (lns) 2006, which examined the political views, experiences with discrimination, and levels of civic engagement of latinos in the united states (see fraga et al., 2008, 2010 for a detailed discussion of the research and sampling designs utilized in the lns). a spatially-stratified random sampling technique was used to capture a representative sample of latinos residing in one of 15 states or the district of columbia. the sample was further selected based on the size of the latino population as well as the rate of latino population growth. according to fraga and colleagues (2008), approximately 88% of the u.s. hispanic population lived within the selected areas. the lns samples were weighted by nation, state, and metropolitan area, and thus, can be used as stand-alone representations of their respective latino populations (fraga et al., 2008). tucker, santiago/acculturation in civic engagement of latino immigrants 184 in order to identify potential themes and questions, as well as to ensure that misconceptions and stereotypes about latinos and their experiences in american society were not perpetuated in the national study, the first 15 focus groups were conducted in diverse communities throughout the united states (fraga et al., 2010). following the focus groups, fraga and colleagues (2008) surveyed 8,634 latino residents using computer assisted telephone interviewing (cati). fraga and colleagues (2010) acknowledge the potential limitations of telephone interviews for hard to reach participants and migrant workers who may not have had landlines at the time of the survey. further, dutwin, keeter, and kennedy (2010) note that latinos without landlines tended to be younger, unmarried, and had higher levels of acculturation, suggesting that results from the lns may not fully represent these subgroups of latino immigrants. in this study, we restrict our secondary analyses of the 2006 lns data to include only those who had immigrated to the united states and resided in one of the sampling areas. we excluded those latino respondents who were of second or subsequent generations. our definition of immigrant also incorporates those who were born in puerto rico, but were residing in the united states. this resulted in a final analysis sample of 6,239 individuals. latino immigrants in the lns were primarily young, female, and married. nearly three quarters were catholic. slightly over half of the respondents indicated that they were brown skinned (51%), while the remainder identified themselves as white or light skinned. approximately half had earned less than a high school level of education. although 7 out of 10 were employed, annual household incomes were very low, with 40% earning less than $25,000 and 77% earning less than $35,000. only 40% of the respondents owned homes in the united states. nearly two thirds of the respondents were immigrants from mexico; the remaining individuals were from puerto rico, the dominican republic, cuba, and other central and south american countries. six out of 10 immigrants came to the united states for economic reasons. the majority of respondents (60%) had lived in the united states for more than 10 years; that same fraction expressed plans to stay permanently in the united states. although a third were actually u.s. citizens, more than half (53%) considered themselves to be at least somewhat american. although over a third of the sample felt they were good english speakers (38%), 45% had limited english proficiency, and 17% spoke no english at all (see tucker, 2010 for a detailed description of sample characteristics). in addition, we conducted a series of four 90-minute focus group interviews in spanish with a small purposive sample of latino immigrants (n=42) residing in a major midwestern metropolitan area. according to the 2010 u.s. census, the majority (64%) lived in a larger neighborhood inhabited primarily by immigrants of mexican descent (u.s. census bureau, 2010b). as a result, focus group participants were only those who self-identified as immigrants of mexican descent. approximately 80% were under the age of 40. the majority were women (93%). two thirds had less than a high school level of education. eight out of 10 participants had children enrolled in community schools. although only 17% of the focus group participants worked outside the home, their spouses were employed at a much higher rate. nearly half of the participants had lived in the united states for more than 10 years. four out of 10 (43%) were homeowners. over half (52%) of the participants were active in their communities (see tucker, 2010 for further discussion of the qualitative research design). advances in social work, spring 2013, 14(1) 185   findings figure 1 depicts the empirical model utilized in this study, and a detailed summary of our measures is provided in table 1. our outcome measure, civic engagement, reflects the respondent’s active engagement in community affairs, political and electoral participation, and school involvement. three sets of contextual factors, respondent demographic characteristics, socioeconomic status, and characteristics of the immigration experience, are hypothesized to directly impact civic engagement. moreover, we assess both the direct effects of acculturation on civic engagement, as well as a moderator of our contextual factors. we hypothesize that the level of acculturation could attenuate the negative effects that some of the contextual variables such as low levels of schooling have on civic engagement. additionally, we hypothesize that the level of acculturation could increase the effects of independent variables that have positive associations with civic engagement, such as full-time employment. figure 1 empirical model for immigrant civic engagement contextual factors demographic characteristics age gender marital status skin color religious affiliation socioeconomic factors employment status educational attainment household income homeownership characteristics of the immigrant experience country of origin reason for immigrating length of us residence permanency plans civic engagement community involvement electoral participation school involvement acculturation english language proficiency integrated friends integrated coworkers consider self american access to services in spanish unfair treatment citizenship tucker, santiago/acculturation in civic engagement of latino immigrants 186 table 1conceptual and operational definitions of variables variables conceptual and operational definitions outcome civic engagement individual and community level of involvement in social and political activities that attach people to society. measured using respondent self-reports of participation or membership at time of survey in community groups or organizations; extent of electoral participation (registering to vote, voting in the last election, interest in politics); connection to u.s. government by way of military service; involvement in work communities by way of union membership; and involvement in local parent networks through school involvement. an index of civic engagement was created based on a sum of the responses to the above questions. index scores ranged from 0, reflecting no engagement, to 5, indicating a high level of engagement. moderating factor acculturation level of individual integration into the dominant american society and access to its social institutions. measured using respondent self-reports of english language proficiency, integrated friendship networks, integrated coworker networks, consideration of oneself as american, becoming a naturalized citizen, and experiences of unfair treatment in the united states. for each of these dimensions the variable was coded as 1=yes, 0=otherwise. in addition, access to bilingual services was measured using an index based on self-reported access to social/health care services, public school services, and law enforcement/legal services in spanish. index scores ranged from 0, reflecting no access, to 3, indicating access to the full range of services. unfair treatment was a dichotomous variable (1=yes; 0=otherwise) indicating if the respondent had ever been unfairly treated in encounters with the police, in employment, in finding a place to live, in being paid or not paid for a job completed, or in restaurants or stores. contextual factors demographic characteristics skin color identification of one of the physical differences between immigrants and the dominant members of society. measured using respondent self-report to describe respondent’s skin tone or complexion shade on a five-point scale ranging from very light to dark. recoded as a dummy variable for brown skinned from the original values of 3, 4, and 5, and white skinned with original values of 1 and 2. socioeconomic factors household income refers to total income of all employed in household at time of survey. income was recoded into five dummy variables: very low income (below $15,000, used as the reference category); low income ($15,000 to $24,999); low-moderate income ($25,000 to $34,999); moderate income ($35,000 to $44,999); and higher advances in social work, spring 2013, 14(1) 187   income (above $45,000). missing income data were imputed using mean substitution. employment status proxy for labor market involvement that included all levels of work, from not currently employed, to working occasionally, to part-time and full-time employment. this variable was recoded into a series of dummy variables representing full time employment, including working more than one job; part time employment, including occasional labor; and not part of labor force, including all those who were not employed outside of the home. educational attainment refers to respondent's highest level of formal education completed at the time of the lns survey. the original response set included no formal education, eighth grade or below, some high school, ged, high school graduate, some college, 4-year college degree, and graduate or professional degree. the response set was recoded into four dummy variables: less than eighth grade (set as the reference category), some high school, high school diploma or ged, and greater than a high school diploma. homeownership status homeownership status in the united states. measured by asking if the respondents 1=owned; or 0=rented their place of residence at the time of the lns survey. characteristics of immigrant experience country of origin used to proxy form of government in the country of origin. because of sample size restrictions, recoded to mexico=1; 0=otherwise. length of residence in the u.s. length of residence in the united states. measured by asking respondents how long they had resided in united states at time of survey. reason for immigrating distinguishes between willing migration (e.g., immigrating for economic reasons), passive migration (e.g., being brought as a child), or trauma-induced migration (e.g., escaping political turmoil). measured using respondent self-report of reason for immigrating to the united states recoded as a dummy variable indicating 1=migration for better life/work/economic improvement; 0=otherwise. permanency plan extent to which an immigrant plans on remaining in the host country. measured using respondent self-report of intent to remain in the united states with 1=planning on staying permanently; 0=otherwise. demographic control variables respondent self-reported gender, age, marital status (1=married/partnered; 0=other), and religious affiliation (1=catholic; 0=other) at time of survey.   tucker, santiago/acculturation in civic engagement of latino immigrants 188 civic engagement of latino immigrants to measure the level of civic engagement of latino immigrants, we created an index composed of indicators for community involvement, electoral participation, and school involvement. subsequently, these index scores were categorized into low, moderate, and high levels of engagement for ease of interpretation (see table 2.). data analyses revealed overall low levels of civic engagement among latino immigrants. approximately 43% of the sample reported no civic engagement at all, 22% reported very low engagement, 29% were moderately engaged, and only 6% were highly engaged. nonetheless, latino immigrants showed considerably higher levels of participation in schools and politics. specifically, respondents were most actively involved by registering to vote (77%), if they were eligible to vote, followed by attending pta meetings at their children's schools (76%), if they had school-aged children. additionally, 61% of eligible voters voted in the 2004 presidential election, and 42% of parents with school-aged children volunteered at their children's schools. approximately one in six respondents had an immediate family member join the u.s. military and one in eight participated in community groups. however, fewer than 10% were members of a labor union in the united states. table 2 civic engagement in a national sample of latino immigrants (n=6,239)* characteristic n % of total level of civic engagement none 2,705 43.3 low 1,387 22.2 moderate 1,794 28.8 high 354 5.7 forms of civic engagement participate in community groups 791 12.7 union membership 431 6.9 family member in the u.s. military 978 15.7 attend pta meetings (full sample) 1,362 21.9 attend pta meetings (sample with children in school) a 1,362 75.7 volunteer at school (full sample) 764 12.2 volunteer at school (sample with children in school)a 764 42.5 registered to vote (full sample) 1,541 24.7 registered to vote (sample of eligible voters)b 1,541 77.3 voted in 2004 presidential election 1,221 19.6 voted in 2004 (sample of eligible voters)b 1,221 61.2 notes * sample was weighted to derive national estimates using lns sampling weights a the denominator is the 1,799 respondents with children in school. b the denominator is the 1,994 respondents who are naturalized citizens or u.s. citizens born in puerto rico. advances in social work, spring 2013, 14(1) 189   level of acculturation we estimated the acculturation of latino immigrants using indicators of english language proficiency, integrated friends, integrated coworkers, consideration of oneself as american, access to services in spanish, experience with unfair treatment, and citizenship (see table 3). approximately one third of latino immigrants identified themselves as proficient in english. over half of the sample reported having integrated friendship and coworker networks. although one half of the immigrants in the lns study considered themselves to be american, only a third were actually u.s. citizens. more than three quarters reported moderate to high access to bilingual social services, legal, and school services. one in three had experienced unfair treatment while residing in the united states. thus, this sample of latino immigrants would be portrayed as experiencing limited acculturation as measured by english language proficiency and citizenship, but relatively high levels of acculturation in terms of social and workplace integration, access to services in spanish, as well as relatively low levels of unfair treatment. table 3 levels of acculturation in a national sample of latino immigrants* acculturation indicators n % of total english language proficiency speaks no english 1,075 17.2 speaks a little english 2,809 45.0 speaks english well 709 11.4 speaks english very well 1,646 26.4 integrated friends 3,479 55.8 integrated coworkers 3,410 54.6 considers self american 3,323 53.3 access to services in spanish none 396 6.3 low 839 13.4 moderate 1334 21.4 high 3487 55.9 not applicable/no need for spanish services 184 2.9 experienced unfair treatment in united states 2,121 34.0 citizen (naturalized or born in puerto rico) 1,994 32.0 n = 6,239 * sample was weighted to derive national estimates using lns sampling weights in analyses not shown here, differences in means tests (t-tests and analyses of variance) were conducted to examine variations in the level of civic engagement by levels of acculturation and these contextual factors. these tests revealed significant differences (p=.000) in civic engagement for all of the variables in the empirical model. consistent with other studies on white populations (e.g., lewis, macgregor, & putnam, tucker, santiago/acculturation in civic engagement of latino immigrants 190 2013), we found that latino respondents who were female, married, older, or involved in religious groups reported higher levels of civic engagement. likewise, civic engagement increased among latino immigrants with increasing socioeconomic status. further, latino immigrants who were brought to the united states as children, those who intended to stay in the united states permanently, or those who had resided in the united states for longer periods of time had higher levels of civic engagement. in contrast, skin color, country of origin, and reason for immigration were associated with lower levels of civic engagement of latino immigrants. consistent with the literature on the racialized underclass, brown-skinned immigrants reported lower civic engagement than lighter-skinned immigrants. compared to latinos from other countries, immigrants from mexico had the lowest civic engagement scores, lending support to the argument that proximity to the country of origin reduces incorporation. finally, acculturation was positively associated with civic engagement. higher levels of civic engagement were associated with english language proficiency, integrated friendship, coworker networks, u.s. citizenship, and self-identification as american. moreover, greater access to health, social, educational, and legal services in spanish increased civic engagement as well. ironically, latino immigrants who experienced unfair treatment in the united states were more civically engaged than those who had no such experience. we suspect that experiences of unfair treatment may spur involvement in the fight for social and economic justice. we estimated hierarchical linear regression models in order to analyze the extent to which acculturation moderated the observed effects of immigrant demographic characteristics, socioeconomic status, and characteristics of the immigrant experience on civic engagement. thus, we were able to compare differences in the levels of civic engagement that were explained by contextual factors alone (model 1), as well as after controlling for level of acculturation (model 2). results from these analyses are summarized in table 4. model 1 accounted for 42% of the variance in the civic engagement scores of latino immigrants. with the exception of religious affiliation and employment status, all of the contextual factors were significant predictors of civic engagement. after controlling for the effects of the other contextual factors, the strongest predictors of increased civic engagement of latino immigrants were length of residence in the united states, socioeconomic status, and plan to remain permanently in the united states. compared to recent immigrants, those who had resided in the united states for longer periods of time were between 3.9 and 25.6 times more likely to be involved in civic affairs. relative to latino immigrants in the lowest income category, those with higher incomes were between 2 and 11 times more likely to be involved in civic affairs. relative to those who believed that their immigration to the united states was temporary, the odds of being involved in civic affairs were 4.7 times higher for those who planned to remain permanently. in contrast to the bivariate results, the most significant predictors of lower levels of civic engagement were being an immigrant from a country other than mexico (9.6 times lower odds), immigrating to the united states for non-economic reasons (5.6 times lower odds), or being brown skinned (2.7 times lower odds). advances in social work, spring 2013, 14(1) 191   table 4 predictors of civic engagement of latino immigrants variables model 1 model 2 b seb t b seb t demographic characteristics age at time of survey (omitted=under 30) 30-39 .197 .035 5.63*** .315 .030 10.41*** 40-49 .154 .038 4.02*** .322 .033 9.68*** 50 and over .172 .045 3.79*** .241 .039 6.10*** gender (omitted=male) .154 .026 5.87*** .185 .023 8.21*** skin color (omitted=white) -.066 .025 -2.67 ** -.050 .021 -2.39* marital status (omitted=not married) .111 .027 4.16*** .170 .023 7.49*** religious affiliation (omitted=not catholic) -.010 .028 -.37 .015 .024 .63 socioeconomic factors employment status (omitted=not employed) -.003 .029 -.09 .016 .025 .65 educational attainment (omitted=< high school) some high school .077 .036 2.14 * .002 .031 .05 high school diploma or ged .274 .034 8.11*** .118 .029 4.03*** above high school .544 .036 14.97*** .228 .033 6.97*** household income (omitted=< $15,000) $15,000 $24,999 -.026 .034 2.14 * -.052 .029 -1.81 $25,000 $34,999 .138 .044 3.14 ** .081 .037 2.17* $35,000 $44,999 .229 .052 4.41*** .093 .044 2.10* $45,000 or more .510 .048 10.58*** .272 .042 6.53*** homeownership (omitted=renter) .222 .028 7.81*** .126 .024 5.17*** characteristics of the immigrant experience country of origin (omitted=other than mexico) -.275 .029 -9.60*** -.096 .025 -3.90*** reason for immigrating (omitted=non-economic) -.154 .027 -5.62*** -.036 .024 -1.51 length of residence in the us (in years) (omitted=5 or fewer) 6 – 10 years in united states .151 .039 3.85*** .039 .034 1.17 11-20 years in united states .507 .041 12.49*** .151 .036 4.20*** more than 20 years in united states 1.197 .047 25.63*** .442 .043 10.23*** plans to stay in united states (omitted=return home) .124 .027 4.69*** .044 .023 1.92 acculturation english proficiency (omitted=not proficient) .096 .013 7.19*** integrated friends (omitted=not integrated) .068 .023 2.94** integrated coworkers (omitted=not integrated) .063 .023 2.74** consideration of oneself as american (omitted=not american) .108 .022 4.83*** us citizen (omitted=not citizen) 1.241 .028 44.13*** unfair treatment (omitted=no unfair treatment) .118 .022 5.29*** access to spanish services (omitted=no access) low access .004 .044 .09 moderate access .096 .041 2.36* high access .133 .037 3.62*** notes: n = 6,238 ***p < .001, **p < .01, *p < .05 model 1: adjusted r² = .420, f = 206.35***. model 1 constant: b = .163, seb = .063, t = 2.59* model 2: adjusted r² = .583, f = 257.53***. model 3 constant: b = -.399, seb = .067, t = -5.99*** tucker, santiago/acculturation in civic engagement of latino immigrants 192 in model 2, we introduced our acculturation measures as moderators for the aforementioned contextual factors. as shown in table 4, the inclusion of acculturation in the empirical model increased the amount of explained variance in the civic engagement scores of latino immigrants to 58%. all of the acculturation indicators were statistically significant predictors of increased civic engagement. holding u.s. citizenship increased the odds of participating in civic affairs by 44%. being english proficient, selfidentification as american, and having integrated friendship and work networks increased the odds of participating in civic affairs by factors of 7.2, 4.8, and 2.9, respectively. further, acculturation was found to moderate the effects of immigrant demographic characteristics, socioeconomic status, and characteristics of the immigrant experience on the levels of civic engagement of latino immigrants. we found that the positive effects associated with respondent age, gender, and marital status were further accentuated after controlling for level of acculturation. conversely, we found that although skin color and socioeconomic status variables remained statistically significant predictors of civic engagement, the effect of these variables was attenuated once we controlled for differences in levels of acculturation. finally, the significant effects on civic engagement of planning to remain permanently in the united states and reasons for immigrating disappeared once we accounted for variations in levels of latino immigrant acculturation. the contexts associated with the civic engagement of latino immigrants qualitative data were collected to provide a deeper understanding of the contexts in which latino immigrants are engaged in american society and the processes underlying said engagement. our focus group discussion guide was developed based on four themes that emerged directly from our analyses of the lns data: (1) the contexts within which the participants originally immigrated and in which they resided at the time of the study; (2) their patterns and level of civic engagement; (3) their experiences with local, state, and federal governments in the united states; and (4) their acculturation into american society. qualitative thematic analyses were completed to better understand the factors that the focus group participants reported as influencing their levels of acculturation and civic engagement (bazeley, 2007; braun & clark, 2006; fereday & muir-cochrane, 2006; gibbs, 2002; klassen et al., 2012). within each topical area, several subthemes emerged, thereby providing greater focus to the thematic coding and greater understanding of the particular situations in which the individual participants found themselves. through the key subthemes, the focus group participants were able to illuminate the local context of anti-immigrant sentiment in which they operated daily. situational contexts shaping patterns of civic engagement. data derived from our focus groups with latino immigrants were able to provide critical information about the situational contexts shaping patterns of engagement in the metropolitan area. further, they illuminated the role of acculturation on shaping these patterns. table 5 provides a summary of the major themes and subthemes discussed in these focus groups. advances in social work, spring 2013, 14(1) 193   table 5 key themes and subthemes discussed in focus groups* key themes and subthemes frequencies barriers to engagement lack of citizenship need for immigration reform 24 lack of driver's licenses need for legislative reform 17 experienced harassment by immigration and/or police 11 fear of officials/deportation worries 16 importance of civic engagement 18 civic engagement through neighborhood pride 12 school involvement 14 acculturation not north american/not part of american society 25 concerns about english language skills 10 importance of level of education 4 * a total of 42 immigrants participated in the four focus groups the metropolitan area where the focus groups were conducted has a history of latino immigration dating back to the early 1900s. nonetheless, latinos represented less than 5% of the area's population throughout most of the twentieth century (us census, 2000). in the past decade, the area has witnessed considerable growth in the number and diversification of the latino immigrant population (durand, telles, & flashman, 2006). between 2000 and 2006, the latino population increased by 20%. most latino immigrants have settled in a working class neighborhood located on the southwest side of town. by 2010, the latino population had grown to 69.6%, while the percentage of mexican descendants increased even more so to 82.9% of all latino residents (american fact finder, 2010). these population changes increased the potential for interethnic conflict. economic growth within this latino community has not been well documented. notwithstanding, our field observations, as well as those made by our focus group participants, suggest significant growth in the number of latino-owned small businesses during the past decade. these include numerous retail establishments, restaurants, and grocery stores. however, as public sentiments toward undocumented immigrants have become increasingly harsh across the nation, the metropolitan area has witnessed a similar rise in anti-immigrant attitudes and behaviors. since 2010, the local spanish language newspaper has reported increased raids by immigration authorities within the latino community. furthermore, conversations with our focus group participants touched on these experiences as well. it is within this context of economic and population growth in the midst of growing anti-immigrant rhetoric and atmosphere that our focus groups were held. the findings from these groups suggest the need for further research on the manner tucker, santiago/acculturation in civic engagement of latino immigrants 194 in which latino immigrants become engaged within the community, regardless of their legal status. slightly more than half of the focus group participants (52%) reported being involved in community affairs. one tangible way in which participants became engaged in their communities has been through community building efforts in their neighborhoods. nearly one half of our focus group participants owned their homes and reported making major improvements both to their homes and the surrounding neighborhoods by cleaning up areas previously abandoned or riddled with graffiti. further, they helped develop commercial activities in an area that once was desolate and offered few retail options. now there are many restaurants, stores, gardens, and well-maintained houses. nearly one third of the participants were engaged in their community through involvement in local schools. one woman ran for office at her children's school and became the pta president. this level of civic engagement connected her to local issues and gave the latino community a voice in district policy. the focus group interviews shed light on the barriers to civic engagement faced by immigrants residing in the united states. focus group participants identified the lack of u.s. citizenship as the largest barrier to civic engagement within the latino community. as one participant who had been in the united states for 10 years eloquently stated, “without papers, [we have] neither voice nor vote.” further, the desire for immigration reform and equalization of status in the united states was raised 24 times by group participants. one woman who attained her ged has become outspoken about the need to participate in politics to give the latino community a voice. she observed, “right now we don't have a voice because we don't have a vote. right now we are nobody. we need to change that, we don't have an identity in this country.” in addition to voting rights, study participants underscored the deleterious effect of a current immigration policy that fosters an environment of harassment, fear of deportation, a mistrust of government officials, and their subsequent avoidance of public forums, government offices, representatives, and in many cases any activities outside of work and school. as one participant described, “i don't go out. i would love to participate, but i am afraid of the police and of immigration [ice] because of the license. now, i don't go out.” this issue of obtaining a valid driver’s license, one of the key legal documents that conveys identity as well as enables mobility in the united states, came up 17 times in the four groups. three of the four groups noted the increased presence of immigration officers in their neighborhoods and at their workplaces. eleven participants spoke of harassment by the police and immigration officers. a woman who came from a small town in southern mexico, and who has been here for 16 years, recounted a story of a police officer pulling her over just to have the immigration officer quickly drive in and demand her papers. participants expressed fear of immigration officials and of being deported 16 times. similarly, a young woman who has been here for 6 years revealed that her husband had been deported and she was left behind with her children trying to figure out what to do. in addition, focus group participants identified an array of indirect barriers to civic engagement associated with the lack of legal resident status or citizenship in the united advances in social work, spring 2013, 14(1) 195   states. although these two issues are not mutually exclusive, they seem to be discussed as if they represented the same phenomenon. a 27-year-old woman who has lived in the area for 5 years and who owns her own home told the group that she had not been involved in community issues because of fear. however, she noted, “we must all participate in the community and in the marches [for immigration reform] with or without papers [legal immigration papers] to make change.” eight participants associated their limited involvement in community issues with a lack of confidence in their english language skills. these participants reported often remaining silent, even when they were being mistreated. one woman with less than a high school level of education and limited english language proficiency said, “they treat us like less [of a person] in the stores because of our accent and because we don't speak english.” several group members described being yelled at, humiliated, scorned, or simply ignored due to their poor english language skills. a 37-year-old woman, who owned her own home and had become involved in several community groups, said that she decided on her own that she would overcome this obstacle and began to take english language classes. while not conscious of its influence, and minimally addressed directly in the groups, level of education appeared to be a facilitator of civic engagement. participants with higher levels of schooling (high school and beyond) tried to teach other participants how to get involved. as one woman with a high school diploma asserted, “we do have a voice. we can move many. we just have to participate.” additionally, four other participants encouraged their fellow group members to get to know their rights as immigrants and told them not to be afraid to get involved. in sum, many of the latino immigrants who participated in the focus group discussions had engaged in the local community. they took classes to learn english. they also purchased homes and improved their neighborhoods. their children were enrolled in local schools. these participants held jobs and paid taxes. however, they expressed difficulty engaging in american society because of the discrimination they encountered across many contexts. they expressed heightened concern about what they consider to be failed immigration policy, increased police harassment, local immigration raids, and the deportation of family members. they expressed interest in participating more in civic affairs, but found it very difficult to become involved within a society in which they feared officials and often lived without proper identification. discussion findings based on the lns data indicate that acculturation exerts both a direct effect, as well as a moderating effect on civic engagement. data from both the national sample and the smaller purposive sample of immigrants suggest areas for improvement to enhance latino immigrant involvement in local, state, and national civic and societal affairs. given the strong positive effect of acculturation on civic engagement, some of this improvement could be made in the area of incorporating newcomers into american society in a culturally sensitive manner. using berry’s (2002) multidimensional acculturation model, latino immigrants could be encouraged to celebrate their cultural tucker, santiago/acculturation in civic engagement of latino immigrants 196 heritage, to strengthen their cultural identity, share their culture with american society, as well as adopt positive characteristics and practices of the american culture. this incorporation has the potential to not only increase current levels of engagement, but also to ameliorate some of the barriers to engagement that cannot be changed intrinsically (e.g., country of origin, skin color) (fraga et al., 2010). although focus group participants did not identify these factors as implicitly keeping them from becoming engaged in civic life, they did relate how feeling unwelcome led them to avoid involvement in a society that did not elicit their participation, and in some cases shunned them. the study identified barriers to engagement that could be tackled directly with proactive social policy. these include programs to improve english language skills, education levels, income levels, employment levels, and citizenship. these socioeconomic factors proved to be very important in whether latino immigrants engaged civically. such diversityoriented social policy has the added potential of influencing the broader american antiimmigrant sentiment as well. as individuals and groups with the propensity to blame immigrants and attempt exclusionary practice see immigrant-inclusive policy at all levels, they will have less powerful fuel for their fire. in order to facilitate the maximum participation of latino immigrants in american society, the right to vote and the right to legislative representation must be expanded. without these rights, immigrants face undeniable barriers to their engagement, while still being affected by policy decisions made at all levels of society. citizenship was found to be the strongest predictor of engagement; therefore, future efforts to increase access to naturalization and broaden eligibility requirements would influence all levels of civic engagement. while naturalization is part of the ongoing debate over immigration reform, an avenue towards legal residency for the estimated 11 million undocumented immigrants in the united states at this time has been fiercely contested (johnson, 2013). however, the contention arises most fervently when discussing citizenship/naturalization, and thus the right to vote for these millions. president obama, in a speech on january 29, 2013, said, “we need congress to act on a comprehensive approach that finally deals with the 11 million undocumented immigrants who are in the country right now. that's what we need” (johnson, 2013). president obama, in the same speech, alluded to proposals for updating the guest worker programs, legal residence, and expanded educational opportunities for these 11 million immigrants (johnson, 2013). the national immigrant law center, and services immigrant rights and education network support such naturalization efforts. specifically, they argue that latino immigrants would benefit from state and federal prioritization of naturalization services (cipc, 2007). this is a policy consideration that could be coordinated with broader immigration reform or addressed separately. this prioritization could take the shape of creating programs to disseminate information regarding naturalization eligibility and application processes throughout immigrant communities. additionally, efforts should target decreasing the cost of applying, reducing the obstacles in seeking naturalization, and increasing the opportunities for english language learning and american civics lessons (cipc, 2007). advances in social work, spring 2013, 14(1) 197   naturalization services could also take the form of multidimensional acculturation programming in immigrant communities. this study suggests that policies aimed at acculturating latino immigrants, by not only strengthening their own cultural identity, but also by integrating their neighborhoods, schools, community groups and work places, has the potential to increase their civic engagement. there is a precedent in the profession of social work for naturalization services and immigration programming with the twentieth century settlement houses that held many community groups and forums for immigrants (chung yan & lauer, 2008; karger & stoesz, 2005). these efforts also provided english language classes and venues for ethnic celebrations. such programs could provide the link between the need to acculturate and the desire to become civically engaged, as expressed by the latino immigrants we interviewed (chung yan & lauer, 2008). in keeping with the model presented by césar chávez, community marches could be the most powerful venue for community activists to elicit participation within the latino immigrant community (espinosa, 2007; orosco, 2008). civil demonstration is a forum understood and accepted in the latino immigrant community. the movement has grown since the resurgence of the marches in may 2006, following the passage of california's proposition 187, which denied access to social, health, and educational services for undocumented immigrants (espinosa, 2007). the focus group participants who were afraid to interact with the government had negative experiences that they associated with discrimination based on their physical appearance and their spanish accent. however, some of the most vocal individuals in the groups had experienced discrimination and racial profiling, but had been educated about their rights in the united states. they began to teach the others to stand up for their rights and seek appropriate representation through their state representative and the local office in their neighborhood. these few individuals with the power to inspire the group towards activism corroborated the statistical findings that showed some increased engagement of those who had experienced racial discrimination. community leaders could use similar marches and rallies to organize latino immigrants to participate in local, state, and national issues. they could use the energy and eager participation that emerge from such marches to organize the community to identify, understand, and advocate for new legislation to address their needs, inclusive of, but not limited to immigration reform. consistent with the literature, english language proficiency was associated with higher levels of civic engagement in this study. moreover, because the study showed english speakers to be more civically engaged than non-english speakers, teaching english language skills to immigrants could facilitate their involvement within their communities. english language ability, or lack thereof, has dominated the rhetoric surrounding immigration, citizenship, and assimilation for decades (abraído-lanza, armbrister, flórez, & aguirre, 2006; ben-shalom & horenczyk, 2003; lieberson, 1980; massey et al., 2002; michelson, 2003). however, the learning of english has been used as a divisive tool and suggested as a mandate in order to attain certain rights and benefits in american society, such as citizenship (golash-boza, 2006; massey et al., 2002; rumbaut & portes, 2001). in several cases, focus group participants who knew their state representative had greater english language skills and higher levels of education attained tucker, santiago/acculturation in civic engagement of latino immigrants 198 in the united states. this study suggests that if english language proficiency was facilitated and encouraged, it could facilitate civic engagement as well. conclusion the results of this study contribute to our knowledge of civic engagement by examining a minority group seldom studied – latino immigrants -as well as by investigating how their acculturation into mainstream american society influences their engagement. when considering the many barriers to engagement facing the latino immigrant population in the united states, it is easy to understand the low levels of civic engagement present in the study findings. latino immigrants who are the most civically engaged share the following characteristics: u.s. citizenship, female gender, married or cohabitating, older than 30, at least a high school level of education, income over $35,000 per year, homeownership, white skin color, proficiency in the english language, selfidentified as american, came to the united states for noneconomic reasons, not from mexico, and integrated friendships and coworkers. however, these characteristics are less important for engagement when the participants are integrated into american society. furthermore, this study uncovered a complex relationship between latino immigrants' demographic characteristics, their experiences with discriminatory practices and policies, and civic engagement. according to the focus group participants, this complex relationship takes roots in the anti-immigrant sentiment in which they reside and work, as well as in discriminatory policies that make them fearful of participation in their community. finally, local, state, and federal policies have the potential to incorporate latino immigrants more successfully into american society and thus increase their civic engagement by facilitating their naturalization, 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(1993). the ghetto underclass. newbury park, ca: sage. author note: address correspondence to: cristina m. tucker, ph.d., email address: cristina_tucker@yahoo.com microsoft word 11_pitzer_17470_mapping_community_capitals_final_ce.docx _____________ kyle a. pitzer, mssw, is a doctoral student at washington university in st. louis, george warren brown school of social work. calvin l. streeter, phd, is the meadows foundation centennial professor in the quality of life in the rural environment at the university of texas at austin school of social work. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 358-371, doi: 10.18060/17470 mapping community capitals: a potential tool for social work kyle a. pitzer calvin l. streeter abstract: concept mapping can be a useful tool in social work practice at all levels. mapping can help clarify and increase comprehension of abstract concepts, such as community capitals or assets. this paper describes community capitals, presents a simple method for mapping community assets conceptually, and demonstrates this method through two case examples. the cases detail activities of two organizations involved in work with communities. the development and leveraging of capitals is illustrated in both instances. following the case examples, the significance and value of mapping in social work and suggestions for future research are discussed based on the mapping exercise. keywords: community development, community capitals framework, community practice, concept mapping, social work practice social workers play a vital role in the assessment of social issues, the implementation of interventions, and the evaluation of interventions. these activities take place at multiple levels of practice including micro, mezzo, and macro levels. the community capitals framework (ccf) can be a useful conceptual tool for social workers in various practice settings and at multiple practice levels, especially the community level, where engaging community members in the process of identifying, leveraging, and building community resources is critical. the ccf fits logically with many models for community assessment and can be useful in planning and implementing community interventions. traditionally, mapping changes in community capitals has been visualized as an upward spiral. here we present a different style of mapping that can be easily interpreted and used by social workers and the communities with which they work to gain insights into the assets that exist in the community and how those assets might be used to enhance community capacity. this paper illustrates the mapping of community capitals in social work practice by including the interventions and community activities that are directly involved in building capital. by carrying out this exercise, the intention is to provide some examples that social workers can adapt to their own practice areas to benefit the individuals, groups, and communities they serve. in this paper, the ccf is briefly defined, the mapping method is outlined, and examples are presented to illustrate how community capitals are built and leveraged in different settings and through different approaches. lastly, the utility and importance of mapping community capitals is discussed as well as the role of intangible capitals in community development using capital maps as a reference. community capitals framework and community interventions the term capital is most frequently found in economics and refers to “money or assets” that are invested to yield economic outcomes (bishop, press, & tauber, 2010, p. 54). capital, in the context of the ccf, represents a range of resources found within a pitzer & streeter/ mapping community capitals 359 community that can be invested to grow other capitals and benefit the community (flora & flora, 2013). the community capitals framework outlines seven major types of assets that may be present in communities. these types of assets, detailed in table 1, are natural, cultural, human, social, political, financial, and built (flora & flora, 2013). according to flora and flora (2013), every community has some degree of resources, and these resources can be leveraged to develop additional resources, or capital. the authors also assert that the ultimate goal of every community is to become sustainable, which can be achieved by developing and leveraging community capitals. a sustainable community is defined as one that is economically secure, socially inclusive, and ecologically healthy (flora & flora, 2013). table 1. seven capitals in the community capitals framework natural capital elements of nature present in a community including land and water resources, weather, and biodiversity cultural capital values and perspectives of community members that play a major role in self-efficacy in affecting community change human capital education, skills, health, and self-esteem of community members social capital trust, collaboration, and shared vision among community members political capital ability of groups or communities to influence policy and ensure that policies are implemented accordingly financial capital monetary resources built capital facilities that contribute to infrastructural capacity of communities (flora & flora, 2013) the ccf can easily be used alongside other models or theories that are commonly employed in social work practice. previous mapping of community change using the ccf focuses on a systems perspective (emery & flora, 2009). mapping community capitals using the systems perspective is critical to social workers in assessing community capitals and guiding community intervention. alternatively, mapping that provides more detail in the illustration of interventions and activities of interest to social workers in the field could be useful as well. interventions that can be guided by the ccf take various forms. for example, several studies have shown that investments in leadership development can generate a great amount of community benefit (allen & lachapelle, 2012; apaliyah, martin, gasteyer, keating, & pigg, 2012; emery, fernandez, gutierrez-montes, & flora, 2009). apaliyah et al. (2012) found that participants in leadership training across six different states implemented over 200 community projects that enhanced each of the seven capitals. furthermore, most of the activities impacted more than one of the capitals resulting in multiple gains from a single project. this demonstrates that developing human capital can also generate gains in other capitals through community-based projects implemented by community members. social capital within communities is also crucial to developing other community capitals. bourdieu (1986, p. 248) defined social capital as the aggregate of resources, “actual or potential,” to which one has access by possessing “membership in a group.” advances in social work, fall 2015, 16(2) 360 coleman (1988) further implied that social capital plays a unique role in the development of other common forms of capital. more recently, bonding social capital has been defined as the connection between individuals in similar circumstances, and bridging social capital has been defined as the connection between groups within and external to communities-exclusive and inclusive, respectively (flora & flora, 2013; putnam, 2000; putnam & feldstein, 2003; woolcock & narayan, 2000). both of these types of social capital have been cited as important to sustainable communities and are useful for producing different kinds of community outcomes (flora & flora, 2013; putnam, 2000). an additional type of social capital that has also been cited is linking social capital, which is the connection between communities and other formal institutions that hold some position of power (woolcock, 2001). social capital has also been discussed to an extent in the field of social work (see dominguez, 2008; hawkins & maurer, 2012; healy & hampshire, 2002; overcamp-martini, 2008). given the importance and interconnectedness of both bonding and bridging social capital, as well as the impact of social capital on other capitals, understanding the assessment of social capital as well as interventions that can further enhance it is essential for communities hoping to build community capitals. social capital can be both a result and driver of community intervention. for instance, in a study of community capitals in one community development project described by emery and flora (2009), a critical component of development was increasing social capital. social capital was also recognized as one of the primary facilitators. the initiative focused on developing leadership, entrepreneurship, and philanthropy. existing leaders leveraged bonding social capital to initiate development, and social capital was then increased through the engagement of community members and external partners in the process. one example of this engagement is the provision of opportunities for youth and adults to work together on each facet of the development strategy. connecting these two age groups contributed to the regeneration of the community by retaining and developing the human capital found in the youth and using it within the community. the implementation of these types of activities resulted in enhanced community capitals. in this case, the community achieved gains in human, social, political, cultural, and financial capital, unfolding from the beginning of the intervention. although this is only one case, it offers an idea of the types of interventions that influence community capitals and how the ccf can be used in design and planning processes. the main objective of this paper is to present a method for mapping community capitals conceptually in a way that can be harnessed by social workers involved in practice with communities to bring about community change. the authors’ primary goals in writing this paper are to illustrate the viability of the ccf for social workers and provide an easily replicable and adaptable concept mapping approach that can be used by social workers and the communities with which they work. given that social workers are concerned with assessment, intervention, and evaluation, this method can be used in multiple phases: assessing which community capitals are present or needed, determining how to enhance them, and examining the impact of these strategies on community capitals. two case examples are presented to illustrate how community capital can be increased, as well as the actions that contribute to those enhancements. the cases are then mapped using the ccf pitzer & streeter/ mapping community capitals 361 as a guide to illustrate the outcomes as well as the interventions and community activities to serve as a reference for social workers. concept mapping different types of mapping have been successfully used in community practice to a variety of ends. typically, mapping is thought of as depictions of locations of attributes in geographic space. in this case, the authors are mapping abstract concepts rather than physical space, in order to track changes in community capitals. concept mapping tools can be used to identify assets, plan and guide implementation of community projects, or evaluate and reflect on community change efforts that have taken place within a specific community (see davis & cooper, 2014; kane & trochim, 2007; trochim, milstead, wood, jackson, & pressler, 2004). for each of these purposes, a map can provide a simple and neat illustration of the major components of the task at hand. concepts related to community development, such as community capitals, can be somewhat abstract and difficult to understand. mapping community capitals as they are developed through the programs and activities of community members can potentially enhance both social workers’ and community members’ understanding of these concepts as well as their selfefficacy in using this type of framework to improve communities. the mapping exercise presented in this paper was developed in order to clarify the concept of community capitals within communities and how these capitals are affected by social work practice. the maps are simple hybrids of the traditional spiraling up approach and concept mapping, which is used in various disciplines and professions. the maps are shown as flowing upward in order to emphasize the gain in capital, and consequently, the development of the target community. the capitals are contained within ovals, similar to several types of concept maps. arrows accompanied by the intervention or community activity are used to illustrate the activities associated with each capital gain. the maps are intended to be straightforward and easy to read to demonstrate that this technique can be adapted to and replicated with a variety of communities. the authors also speculate that this type of concept mapping exercise could enhance community engagement in development activities. community participation has been recommended as a key component of successful community development (kretzmann & mcknight, 1993). a major part of community participation is collaborative and open communication and sharing of information (botes & van rensburg, 2000; gaunt, 1998; mannarini & talò, 2013). at times, the implementation and impact of community development activities is not readily apparent to the greater community and can seem nonexistent or minimal based upon the experiences of community members. mapping the development of community capitals along with the activities by which they were developed can serve to clarify the impacts and narrow the gap of knowledge between the community at large and those directly involved in community development projects. these types of concept maps may also be straightforward enough to be used with diverse audiences. this can be critical to generating support from the community and sustaining community development by ensuring there is an understanding among community members regarding development projects and the activities and impacts these projects entail, although more research is needed to explore this idea. advances in social work, fall 2015, 16(2) 362 case examples the following case examples illustrate and integrate the concepts of the ccf and include community capital maps for each case. both of the examples are based on internships performed by a social work student placed at the organizations for educational purposes. the maps were generated after the experience for the purpose of this conceptual exercise, and some extrapolation has been used and hypothetical information added to supplement areas where direct evidence was not available. the first example is set domestically with a non-profit organization that manages programs and services for refugees, and the second takes place with a nongovernmental organization (ngo) that focuses on community development in rural india. it is important to note that this is not necessarily a step-by-step guide to mapping community capitals. these examples provide some idea of what mapping community capitals might look like. case #1: refugee resettlement in the united states the first example focuses on a specific project conducted by an organization specializing in refugee resettlement in the united states. the role of the organization was to provide technical assistance to a local ethnic community-based organization (ecbo) in order to build the capacity of the organization and expand the services available to benefit the greater refugee community. throughout the project, specific capitals were leveraged and increased, as shown in figure 1, to benefit the target community through a variety of tasks carried out by the resettlement organization and the ecbo. the first step in building capital within the refugee community as a whole was to gain support from the various ethnic groups that made up the greater refugee community. the refugee community targeted by the project was somewhat fragmented, though each ethnic group was rich in bonding social capital. to ensure the success of the project, developing bridging social capital was critical. the central task in building this type of social capital was connecting different refugee groups and encouraging conversation about the needs of group members and the goals they hoped to attain. the ecbo was used as a hub for these activities to connect the groups and served as a common meeting ground for hosting productive conversation. activities related to this task included meetings between ecbo leaders to encourage the development of common goals and objectives and focus groups with community members that were planned and facilitated by technical assistants in order to establish their needs. by helping community leaders recognize commonalities and bringing some of the larger groups together in conversation regarding their needs, cohesion was increased, partnerships were formed, and a shared vision was developed. pitzer & streeter/ mapping community capitals 363 figure 1. concept map showing community capital development within the refugee community financial capital human capital cultural capital bridging social capital built capital political capital bonding social capital ecbo staff is trained in grant‐writing skills discussions with group leaders and members are planned and facilitated ecbo staff applies for grants to support work ecbo expands to new space to offer more services to more people greater part of community contributes to support work the community establishes shared vision and can more easily mobilize to influence policy the community members feel more confident in their ability to shape their future refugee community advances in social work, fall 2015, 16(2) 364 as a twofold approach, human capital within the targeted community was increased as well. human capital was enhanced within the ecbo and its newly established partners. the skills that fall under human capital most pertinent to this case were those related to the operation of a non-profit organization that provides direct services. specific focus was given to writing grant proposals. at the beginning of the project, the ecbo was a subgrantee of the resettlement organization, and one of the major goals of the ecbo was achieving self-sufficiency, specifically in terms of funding. the staff received individual technical assistance in completing grant proposals for numerous funding sources. with this technical assistance, the staff members, some of whom were already well-versed in financial matters, were able to apply their knowledge in combination with their newly developed skills to writing grants, resulting in more successful grant proposals. with the increase in human and social capital, gains in financial capital could be realized. financial capital was made available through two pathways. the first resulted from the increased social capital. prior to the work done by the resettlement agency, the ecbo received a small portion of monetary assistance in the form of contributions from the primary ethnic group. it could be extrapolated that as the other ethnic groups became more committed to the advancement of the greater refugee community, the ecbo had access to additional contributions from these groups, supplementing the pool of donated funds. the ecbo could also begin receiving funding through grants. the increase in human capital gave the staff the skills they needed to secure grants through successful grant proposals. the additional financial capital available to the ecbo could be put toward various organization-related purposes such as program development, office expansion, and hiring new staff from other ethnic groups. although the ecbo planned to use funding to this end, it would also benefit the community in that the ecbo would be able to reach more members of the refugee community with more comprehensive services and increase community cohesion through the hiring of multiethnic staff. the ecbo also planned to use some of the financial capital to enhance built capital. this would be a small gain relative to the other capitals, but it would be important to the advancement of the community. the built capital would come in the form of new space acquired by the ecbo through which they could provide more services. the new space would be at another location and would be easily accessible to community members who may not have been able to reach the primary office. again, although the space would belong to the ecbo, the greater community would also benefit in that more people would be able to access services. lastly, based on the strides made by the ecbo, and subsequently the community, it can be inferred that both cultural and political capital was positively impacted. a major component of cultural capital is the confidence of community members in their ability to affect the future of the community (flora & flora, 2013). with the accomplishments detailed in this case-the newly developed skills, organizational partnerships, and social cohesion-community members likely felt much more confident in their ability to identify challenges and take the appropriate action to address them. in regards to political capital, as the ethnic groups began to recognize their common needs and shared goals, the cohesion of and commitment to the community likely improved. with the increased social cohesion pitzer & streeter/ mapping community capitals 365 and community commitment, it is possible that the greater refugee community could stand united and shape policy in their favor if the need were to arise. case #2: rural development in india the second example focuses on the community development efforts of a large ngo in south india. the community development program is focused on capacity building and community empowerment around a number of issues. the ngo at hand primarily focuses on rural communities in india, particularly those that are impoverished and marginalized. some of the major activities of this program are improving governance, assisting in the acquisition of resources both financial and built, raising awareness about community issues, and training community members in policy analysis, evaluation, and development. figure 2 illustrates these and other activities associated with community capital development. the ngo focuses on issues that are identified by community members as common between rural communities in the same block, district, region, and state. many of the rural communities in india with which the ngo works are rich in both bonding and bridging social capital. community participation in development efforts carried out by this ngo is close to 100% in many of the communities. in the communities this ngo serves, the problems of individual community members are seen as community issues and are addressed as such. for instance, small community funds exist to assist families and individuals who are in need due to various circumstances, such as loss of income due to injury, disability, or death. there has also been a hierarchy created through the ngo and community leaders that illustrates the bridging social capital of rural communities. the hierarchy begins at the village level and continues to the block, district, region, state, and national level. as villages experience common problems, such as lack of access to fresh drinking water or pollution by multi-national corporations, these problems move up the hierarchy to be addressed at higher levels. advances in social work, fall 2015, 16(2) 366 figure 2. concept map showing community capital development within rural communities in southern india cultural capital after training, community members analyze policy and approach government community members are trained in leadership and political action community members demand roads from government the community experiences victories with new skills and feels equipped to address community needs as they arise rural communities in southern india financial capital natural capital built capital community members secure government entitlements community members demand regulation of industries human capital political capital bonding & bridging social capital advances in social work, fall 2015, 16(2) 367 building human and political capital is at the core of the development program. a major part of the ngo’s work is training community members in policy analysis and evaluation. the community members identify policies that adversely impact them, and the ngo works with the community to analyze those policies and develop recommendations, which are then submitted to the appropriate policy-making bodies. this gives community members a voice in policy at multiple levels of government while improving their individual skills. the community members, aside from being informed about policy, also learn how to approach government representatives and access resources through the government, which is again building both the skills of the individuals and the political capacity of the community. as a result of the increases in human and political capital, financial capital is gained, natural capital is protected and developed, and built capital is acquired when necessary. instead of duplicating services provided by other entities, the ngo devotes their efforts to developing the capacity of communities to secure resources through existing avenues such as the government. for instance, the ngo works alongside many community members to inform them about and attain entitlements available through the government, strengthening the financial capital in the community. these entitlements include old age benefits, disability, and survivor benefits. also, by developing the capacity of community members to approach government officials and access necessary resources, the communities are able to protect their natural capital. in some of the policy workshops, both the speakers and community members discussed how the lack of regulation of some industries results in the pollution of rural villages, destroying crops and other natural resources. as the community members become familiar with approaching government officials and making demands, they are able to leverage their political capital to call for the regulation of industries by government and control the detrimental effects of pollution. in the same vein, community members are able to demand infrastructural improvements for their communities when necessary. an example would be the construction of roads by the government at the request of rural communities to help them become more connected to major cities. similar to the previous case, it can be inferred that the capital gains outlined in the previous section have had a dramatic impact on the cultural capital of rural communities in india. this increase in cultural capital was discussed in many community meetings attended by the authors. the ngo in this example has been working in rural communities for decades building community capacity. the many victories experienced by rural communities in india alongside the ngo have likely increased cultural capital. the community members have transformed their communities in many ways and likely feel much more in control of their future and confident in their ability to affect change. discussion the major points discussed here are the utility and importance of mapping community development concepts, such as community capitals, in community practice and the role of intangible capitals in the development process. the idea of community capitals is abstract and the development of community capitals can be difficult to understand. the two case examples presented here vary in many ways, but these maps illustrate that the development of capitals can be relatively easy to understand. this is important to note because both of advances in social work, fall 2015, 16(2) 368 the communities, as well as the interventions and community activities, are quite different, yet each map gives a clear visualization of what was accomplished in each case. the mapping technique can be used to help communities evaluate their activities and outcomes, identify ways to sustain the capital gains, or plan and guide future interventions for multiple community-wide issues. despite the fact that these communities are very different, using this relatively simple mapping technique can heighten the comprehension of complex social problems and concepts such as community capitals and the types of activities relevant to community development. this could also be integrated into the macro practice curriculum as along with organizational development, program development, and community organizing. this mapping exercise can be taken as a limited form of preliminary evidence of the viability of this tool in other communities around the world, although research is needed to understand exactly how social workers and community members perceive, understand, and use it. given the limitations of this exercise – it is retrospective, based on two specific experiences, uses some extrapolation and hypothetical information, and is more similar to evaluation -the process may look different when implemented with other communities or in other phases of practice, such as assessment and planning. the traditional idea of community development devotes attention primarily to supplementing funds and facilities that improve physical infrastructure in communities (emery & flora, 2009). these examples and mapping exercises suggest that intangible capitals, such as social, human, and political capital, are also significant to effective, efficient, and sustainable community development. in examining the community capital maps, intangible capitals typically precede tangible capitals. based on these experiences, enhancing intangible capital can lead to more sustainable and continuous community development outcomes. developing intangible capital gives communities transferrable skills and assets that can be applied to multiple community needs. research examining this type of capacity building through social work practice can be beneficial. this is clear in the example regarding rural communities in india and the increases in political capital. the rural communities leveraged this capital for more than one purpose: demanding the construction of roads, calling for the regulation of industries that were polluting their land, and securing government entitlements. the political capital that is leveraged in these instances can also be leveraged in other circumstances as issues arise rather than just acquiring an isolated financial or built capital gain. the growth of intangible capitals can also give communities a greater sense of ownership and control of their own development. lachapelle (2009) provides three facets of the concept of “sense of ownership.” these are (a) “ownership in process,” having a voice in development, (b) “ownership in outcome,” having control over the outcome through decision-making, and (c) “ownership distribution,” how the outcomes of interventions are distributed among members of the community (lachapelle, 2009, p. 53). developing intangible capitals could be equated with capacity-building in relation to the three types of ownership, and ownership in general, as outlined by lachapelle (2009). this is illustrated by the examples outlined in the mapping exercise. based on the presumed gains in cultural capital described in the case examples, it can be reasoned that both of the communities felt a stronger sense of control and ownership in pitzer & streeter/ mapping community capitals 369 their own development by the end of the mapped development processes. in both cases, the initial building of intangible capitals allowed for greater opportunity for involvement and control in the capital building that followed, demonstrating ownership in the process. secondly, both communities exhibited ownership in the outcomes by choosing to apply their newly found skills for the good of the community. although the agencies worked alongside the communities, the community members were responsible for identifying the issues as well as carrying out the actions to address them. finally, the ultimate goal for both communities involved strengthening the community as a whole. through the various activities performed by participants, the needs of the greater community were addressed, thus distributing the positive effects and benefits to all community members. conclusion the two examples and maps that have been developed through the lens of the ccf are diverse in a variety of ways. this speaks to the ccf’s applicability to many types of social work practice, such as organizational development, program management, and community organizing as well as practice in both domestic and international settings. the types of activities and programs as well as the starting points also vary between the examples. the first focuses on capacity building of a specific organization, and the other concentrates on individual and community capacity development. furthermore, the fact that both of the examples presented in the mapping exercises came from experiences in social work practice provides greater support for the notion that the ccf can be of great use to social workers. social workers should be encouraged to modify and adapt this exercise for use in their own practice areas. additionally, through further research regarding assessment and intervention in terms of community capitals, this type of mapping on a greater scale can be useful in working with communities in various capacities as well as determining a relationship between intangible capitals and successful community development in social work practice. references allen, r., & lachapelle, p. 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(2008). theory for the public good? social capital theory in social work education. advances in social work, 8(1), 196-207. putnam, r. d. (2000). bowling alone: the collapse and revival or american community. new york, ny: simon & schuster. putnam, r. d., & feldstein, l. m. (2003). better together: restoring the american community. new york, ny: simon & schuster. doi: http://dx.doi.org/10.1145/358916.361990 trochim, w. m. k., milstein, b., wood, b. j., jackson, s., & pressler, v. (2004). setting objectives for community and systems changes: an application of concept mapping for planning a statewide health improvement initiative. health promotion practice, 5 (1), 8-19. doi: http://dx.doi.org/10.1177/1524839903258020 woolcock, m. (2001). the place of social capital in understanding social and economic outcomes. isuma canadian journal of policy research, 2(1), 11-17. woolcock, m., & narayan, d. (2000). social capital: implications for development theory, research, and policy. the world bank research observer, 15(2), 225-249. doi: http://dx.doi.org/10.1093/wbro/15.2.225 author note address correspondence: kyle a. pitzer, mssw, washington university in st. louis, george warren brown school of social work, campus box 1196, 1 brookings dr., st. louis, mo 63130. email: kyleapitzer@wustl.edu microsoft word 14-3040 negi_social networks that promote well-being final ______________ nalini junko negi, msw, ph.d., is an assistant professor in the school of social work at the university of maryland in baltimore; lynn michalopoulos is an assistant professor in the school of social work at columbia university in new york; javier boyas is an assistant professor in the department of family studies and social work at miami university in oxford, ohio; and adrianna overdorff works for the evergreen health co-op in baltimore, maryland. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 247-259 social networks that promote well-being among latino migrant day laborers nalini junko negi lynn michalopoulos javier boyas adrianna overdorff abstract: latino migrant day laborers are a transnational population that often travels back and forth between borders in search of economic opportunities. these latino day laborers (ldls) are often at risk for exploitation and workers’ rights abuses. despite ldls' heightened social vulnerability and risks, this population often does not access formal social or public health services due to their undocumented legal status, lack of health insurance and distrust of governmental social services. in light of ldls' lack of access to formal services, social networks may enhance and protect their well-being and health through the exchange of emotional and social support, as well as the provision of concrete and practical services. utilizing berkman, glass, brissette, and seeman's (2000) conceptual framework on social networks and health, this ethnographic study investigates the role of social networks in facilitating the well-being of ldls (n=150). implications for social services for this transnational population are also discussed. keywords: day laborers, latino migrants, social services, transnational migrants globalization has led to a paradigmatic shift whereby many migrants live and work on both sides of the border in a transnational space that heightens their political and economic vulnerability (sassen, 2002). in the united states, meeting the social service and public health needs of the approximately 11.2 million undocumented immigrants, with the largest group coming from mexico (pew hispanic center, 2011), has been challenging. while some data suggests that most immigrants are healthier when compared to u.s. born populations (warner et al., 2006), emergent studies indicate a high risk sub-population comprised of mainly single, young, latino transmigrant men. these men often work in the informal economy as day laborers and travel back and forth between borders in search of economic opportunities. these latino day laborers (ldls) are employed in construction or demolition work and are at risk for exploitation and workers’ rights abuses, such as wage theft and dangerous working conditions (quesada, 2008; negi, 2011). their vulnerability is heightened due to their undocumented immigration status. as a result, this population is considered to be easily deportable and sometimes beyond the protection of the law (taran, 2001). preliminary studies suggest that this population experiences a myriad of psychosocial vulnerabilities such as social isolation, family disruption, poverty, undocumented immigration status, and criminal victimization (cepeda et al., 2012; organista, 2007). the transient nature of this negi, michalopoulos, boyas, overdorff/latino migrant day laborers 248 population and an unstable residential base to provide comfort and social support can further exacerbate the risk factors that this population experiences (valdez, cepeda, negi, & kaplan, 2010). despite such heightened social vulnerability and risks, ldls experience many barriers to care and often do not access formal social or public health services (hargrove, 2006). specifically, their undocumented legal status, lack of health insurance, and distrust of governmental social services are significant barriers to obtaining those services (berk & schur, 2001). this is especially compelling as difficult life circumstances, which include discrimination and stress, can place this group at risk for mental health problems, which may be compounded by a lack of access to formal treatment (moradi & risco, 2006). in light of the lack of access to formal services to address psychosocial needs, social networks may enhance and protect ldls’ well-being and health through the exchange of emotional and social support, as well as through the provision of concrete and practical services. previous literature on african-americans and caribbean blacks has indicated that social networks can play a protective role by reducing some of the negative consequences associated with a lack of professional social services (woodward et al., 2008). similarly, research on latino immigrants indicates that social networks are positively associated with individual health and community growth (garcia, 2005). however, little is known whether such a positive relationship exists among transnational migrant populations such as ldls. this qualitative study utilizes berkman, glass, brissette, and seeman’s (2000) conceptual framework on social networks and health to investigate the role of social networks in facilitating the well-being of ldls. in particular, this study elucidates participant-identified networks of support as well as provides rich contextual detail regarding how these networks may be leveraged to promote the welfare of this marginalized population. literature review day labor work typically involves open-ended verbal contracts that are often negotiated on public street corners where day laborers congregate to look for work (valenzuela, 2003). ldls’ public visibility, coupled with a lack of knowledge about this population often cause misconceptions from community members and law enforcement. ldls are often seen as troublemakers, criminals, and loiterers (quesada, 2008; turnovsky, 2006), and as a result, their life struggles, including their mental health and social service needs, remain largely unknown to local officials or service providers in the united states (turnovsky, 2004). a growing body of research indicates that rural latino farmworkers, a demographically similar population to ldls, experience social isolation and poverty, impacting well-being and creating increased risks for depression, anxiety, and substance abuse (hovey & magana, 2000; denner, organista, dupree, & thrush, 2005). studies further indicate that various protective factors, including social support may facilitate the well-being of latino farmworkers (hovey & magana, 2000, 2002). the sparse literature on ldls indicates that this population of urban-based immigrant workers experiences psychosocial problems similar to rural latino farmworkers (organista, 2007). however, the problems of day laborers may be compounded by the dangerous and unique conditions associated with their work as well as the broader urban advances in social work, spring 2013, 14(1) 249 environment in which they work and live. in light of such sociopolitical and psychosocial vulnerability, as well as lack of access to medical coverage, ldls’ social networks may act as a buffer to protect their well-being. this study uses a strengths focus to illuminate participant-identified social networks that enable well-being among ldls. social networks and health: conceptual framework berkman et al.’s (2000) conceptual model of social networks asserts that broad social structural conditions (such as discrimination, poverty and undocumented immigration status) influence the development and nature of social networks, which in turn leads to individual pathways that combine to impact health. this framework suggests that social networks influence behavior through four health related pathways: social support, social influence, social engagement, and access to resources and material goods (berkman et al., 2000). these networks are embedded within larger social and cultural contexts, which, in turn, have both a direct and indirect effect on the formation of a network (berkman & glass, 2000). these social networks are comprised of both strong and weak ties (granovetter, 1973; 1981). strong ties consist of small, tight, and mostly homogenous networks that, while instrumental in providing social support, often do not connect ldls to a wider range of people and resources outside the main network (mcpherson, smithlovin, & cook, 2001). weak ties, in contrast, are heterogeneous and provide wider access to diverse resources, and thereby act as bridges to new sources of opportunities (granovetter, 1981; smith, 2000). thus, the development of weak ties can be more critical in connecting marginalized populations, such as ldls, with higher status contacts (lin, ensel, & vaughn, 1981). within the context of ldls’ lives, an understanding of these pathways may be particularly salient due to the under-utilization of formal social and public health services of this group. such information can lead to the elucidation of potential modifiable protective factors with implications for the development of strategies to close the gap in service access and delivery among this population. to this end, this study utilizes berkman et al.’s (2000) social networks and health conceptual framework to qualitatively examine the role and impact of social networks on the well-being of ldls. in particular, this study explores the unique work and life context of ldls in shaping the types of social networks they develop and how these networks impact the well-being of this population. methods sample and procedure this ethnographic study used participant observation, informal interviews, and two focus groups to explore the social networks of ldls in a large city in the southwest of the united states. data used in this study is part of a larger mixed-methods study on factors associated with the psychological distress of day laborers with methods reported in detail elsewhere (negi, 2011, 2013). based upon extensive field work, the three largest and busiest day labor sites in a large city in the southwest were selected. over a two-year period, and on a weekly basis, multiple researchers observed and recorded verbatim negi, michalopoulos, boyas, overdorff/latino migrant day laborers 250 accounts, interactions, and informal interviews at the selected day labor corners to study the lived experiences of ldls. extensive field notes were recorded following each field visit to document the daily activities of the day labor corner including negotiation of work and payment, pick-ups by employers, and ldl interactions with each other and others. the informal interviews consisted of discussions regarding the participants’ work, family and country of origin, and life stressors. informal interviews included over 150 participants. two focus groups were also conducted at a nearby mexican restaurant, often frequented by ldls. the taquería was relatively private and allowed participants to exit quickly if a potential employer was approaching. a moderator guide, developed by the principal investigator (pi), employed open-ended questions to explore how participants manage and define well-being within their work and life contexts. the focus group was facilitated by the pi and a research assistant who took extensive notes on the process. eleven respondents, between the ages of 30 and 60, were asked to discuss the meaning of well-being (bienestar) within the context of day labor work and the challenges experienced that may impact the mental health of this group. the participants were also asked to provide general strategies that they or others they know have used to deal with any work or life challenges. data analysis thematic analysis was utilized to examine ethnographic and focus group data. this technique allows researchers to find common themes across participants without losing individual meanings and experiences (creswell, 2007). the pi and a research assistant conducted a line-by-line analysis, read the transcripts of the data separately, and recorded any thoughts. next, the pi and research assistant worked separately to group phrases that addressed the same topic area and created categories from these groups. themes were taken from each of these categories and those that were not initially identified by both researchers were discussed thoroughly until agreement was reached on whether to include or omit a theme in the analysis. initially, four themes reflecting the social networks of participants emerged during the coding process. specifically, the initial emergent themes were: networks on day labor corners, peer networks, family networks, and networks with employers (patrones). the themes peer networks and family networks were collapsed into one, based upon extensive discussion that concluded that these networks were conceptually too similar to stand on their own. furthermore, two themes (heightened vulnerability and barriers to accessing existing public services) were elucidated to establish the context whereupon the above mentioned social networks developed. upon reaching consensus, each researcher independently coded the data. the researchers then met to discuss their thematic coding and to reach further consensus on coding. a third party auditor who was familiar with the data was invited to contribute in the four instances that consensus was not reached, and a consensual decision was made based upon this input. the use of multiple researchers minimized researcher subjectivity and maximized the internal validity of the data (mcmillan & schumacher, 1997). the results are presented by first contextualizing the vulnerability of ldls and their perceived barriers to formal social services and authorities. next, the informal networks advances in social work, spring 2013, 14(1) 251 used by ldls to facilitate well-being are identified as those within the day labor corner, peer and family, employers, and church members. the following results are presented through the triangulation of the ethnographic field notes recorded at the day labor corners. they include observations and informal interviews as well as quotes from the focus groups. results contextualizing vulnerability and service utilization among ldls heightened vulnerability. findings indicate that ldls experienced a variety of psychosocial stressors such as criminal victimization, workers’ rights abuses, and poverty due to their undocumented immigrant status and employment in the informal economy. specifically, the informal verbal employment contracts with patrones (employers), their cash earnings, and distrust and fear of police or other authorities heightened their vulnerability to workers’ rights abuses and other types of crime. field notes from an informal interview with a 19-year-old mexican migrant day laborer document the perilous conditions that ldls must navigate due to their cash earnings: he has been assaulted six or seven times while he has been living here... he says that he has been assaulted by chicano (mexican american, born in the us) gangs because they know that they (the workers) carry cash on them. i noticed that one of his eyes looked red – so i asked him what happened there – and he told me that he had just had been mugged the day before yesterday. he told me that he has never reported these muggings to the police. in addition to violent victimization, a majority of the ldls also reported experiencing wage theft or unpaid wages for work rendered by employers. this wage theft had a significant impact on the economic well-being of ldls, as indicated in the following field note: the worker told us that he had “lost” about $300 last month and at that point had decided to not do anything about it. but now he is having a hard time paying his rent and wants that money to be recovered. without a formal work contract combined with their fear of deportation by police, many ldls expressed feeling helpless and without much recourse. consequently, wage theft had a negative psychological impact. one ldl, whose former employer owed him $600 in wages, stated: i feel fearful when i look for work now since they did not pay me the last time. what is the point of working if i am not going to get paid for all my efforts? barriers to accessing existing public services. as indicated above, the ldls in this study indicated that they did not report crime as they were afraid of the police and feared that the police would not take their concerns seriously because they (ldls) were sin papeles, or undocumented. in addition, many workers expressed that their sole purpose for being in the united states was to earn money to support their family in their country of origin. to this end, they did not want to risk exposure and deportation and jeopardize negi, michalopoulos, boyas, overdorff/latino migrant day laborers 252 the flow of financial support. participants also indicated that they knew that the city (where this study was conducted) was a “sanctuary city” (a city where the police do not enforce immigration laws or ask people about their immigration status); however, they still felt distrustful of police. this was especially true as the ldls in this study reported adversarial experiences with the police. for example, many participants reported feeling harassed by police officers that asked them to leave the public street corners where they congregated to look for work. one worker stated, “they say that we are loiterers but we are here only (to support)… our family.” robbery and wage theft also served to exacerbate the poverty that most ldls experienced. while most participants reported living in houses or apartments with multiple roommates, a minority of participants reported being homeless. these homeless ldls indicated they had accessed shelter services provided by the city. however, they reported that the homeless shelters lacked bilingual services, and, as a result many did not feel comfortable continuing to use shelter services. one homeless immigrant participant stated that he chose to live on the streets with other latino workers, rather than at a homeless shelter, as he felt more camaraderie and comfort on the streets with fellow workers than at the city-run shelter. furthermore, while a majority of participants reported experiencing wage theft, many did not access advocacy organizations that were available to assist with wage recovery. the ldls in this study that did not access advocacy organizations indicated that they had accepted the fact that they needed to afrentar la realidad, or “face the reality” of their difficult life and work conditions. a majority of the participants indicated that they preferred soliciting work on public street corners despite the several city-run worker centers opened to discourage public solicitation of work. these worker centers aimed to reduce the tension between the city’s need for labor and community opposition to street corners where day laborers congregated to look for work. when asked why they did not attend the worker centers, ldls stated several reasons, including: location, lack of transportation (the centers were often located in areas that were either too far or not on the bus route where many of the workers lived), and the perceived unfair nature of the current “lottery” system of allocating employment opportunities to workers (which means that workers arriving at different times of the day had the same chance of procuring a job as those who arrived early). finally, the ldls in this study felt that not many employers knew about or used the worker centers to look for potential employees and that they were better off on street corners. workers also stated that they had some hesitation attending worker centers because they did not want to be confused with panhandlers or perceived ex-convicts who they perceived were also looking for employment at the worker centers. they further indicated a preference for the flexibility and informality of the day labor corner versus the worker center and its associated rules. one participant voiced the workers’ dislike of the institutional feel of the centers: “everyone is sitting in a line. they look like sardines!” the role of social networks the ldls in this study indicated that they used their social networks to facilitate their well-being in light of their distrust of the police and lack of service use. in advances in social work, spring 2013, 14(1) 253 particular, networks developed at the day labor corner, with peers and family, with employers, and at church were considered to be the most salient to their well-being. building camaraderie at the day labor corner. many social networks were developed at the corner while ldls waited for work. in fact, some participants indicated that they would even come to the day labor corner on their day off to escape feeling lonely and to be with their peers. field notes describe the day labor corner as a dynamic space where workers shared experiences and camaraderie: the corner all of a sudden felt electrified by energy, as they haggled and negotiated for both work and the number of workers. the camioneta (pickup truck) took off with the two men, and the remaining men walked back to us— with chagrined smiles on their faces. men who had not been interacting with each other were now sharing their feelings of frustration with others. participants indicated that the day labor corner was a space where workers would organize themselves against employers who were known to exploit workers. specifically, participant observation indicated that ldls would often warn other workers about exploitative employers or those who were known not to pay workers by yelling“¡no paga, no paga!” (doesn’t pay, doesn’t pay!) when the employer stopped his car at the day labor corner to look for employees. in this way, the day laborers organized themselves to prevent newer immigrant workers, as well as others, from being victimized by wage theft from known unscrupulous employers. peer and family networks. peers and family were reported to provide practical and financial support through shared links to employment and local resources, including help paying rent and utilities. most ldls reported that they immigrated to the united states alone to support family members in their country of origin and spoke of the importance of tapping into peer networks to find roommates to ease the financial burden of rent and utilities. when new in a city, peer networks were also identified as essential in locating day labor corners to look for work, finding neighborhoods to live in and identifying resources such as restaurants and shops that cater to latinos. furthermore, peers also assisted in easing communication with family members. one ldl reported that he knew a truck driver who, when driving to mexico, would transport his video letters to his wife and daughters, and return their video reply to him. similarly, other workers reported that peers who traveled back to their country of origin helped by transporting letters, remittances, and general information. overall, many participants indicated that relationships with peers were significant. as one worker stated, “those that know more people…do better.” however, there was also recognition that some peer networks could lead them to negative life choices or vicios (vices) such as, heavy drinking, substance use, fights, and solicitation of sex work, especially for younger day laborers. one focus group participant stated, “younger people have fewer responsibilities for their families.” while another added, “there is no one or nothing that controls them, but as they get older they realize the reality of things (increased responsibility towards family members).” negi, michalopoulos, boyas, overdorff/latino migrant day laborers 254 for participants that had family in the united states, many indicated that they specifically immigrated to a particular place because they had a family member there. in a way, similar to peer networks, family members provided practical informal support such as help in becoming familiar with the area, and finding housing and work. building mutuality of trust with patrones. a mutual relationship of trust with employers (patrones) was viewed as paramount to ensure consistent work. participants’ indicated that their decision to migrate regionally was often influenced not only by the availability of work, but also trust in their employer. field notes indicate one worker’s description of the importance of mutual trust in his decision to migrate for employment, and how other social networks were deployed when work conditions were no longer optimal: his brother met a patrón [in los angeles] who was very nice and he started working for him pretty regularly. after the job was over the brother’s patrón said that he had other jobs available, not in los angeles, but in fort worth, tx. his brother was hesitant because it is a big risk to trust someone so much and move this way. but the patrón said that he could stay with him and that he would send him an airline ticket and all. so he told his brother to take the risk. his brother went to fort worth and he liked it a lot. he then asked him to come over as well as another brother from mexico. they all worked there [in fort worth] fine but then the patrón died. once the partner took over – things were not the same. the new patrón was not as nice and made their lives difficult. his brother then decided to leave since he heard that a city in the south west had some jobs…they all moved there and have been there for 2 years now. several participants discussed the importance of building relationships with the patrones as a way of ensuring consistent work. specifically, participants discussed how being perceived as a good worker by a patrón was important as it would guarantee longer contracts of employment and lead to being sought out for future employment opportunities. in these instances, the patrón would call the ldl directly on his mobile phone to negotiate the terms of work; thereby, bypassing the competition present at the day labor corner. this was seen as very important as day labor work is highly inconsistent and often solicited on a daily basis. support through church. participants who attended church often reported having more social ties and social support than those who did not. in particular, participants stated that church members tend to be united in their support for one another by offering help in times of emotional or financial need. participants also identified the positive impact of increased church attendance on social networks, which improved one’s chances of obtaining employment opportunities through personal referrals. during a focus group, one participant stated, “the most religious have the most amount of work” while another participant concurred, “…they (church members) help each other out.” religion was important because it offered spiritual comfort and provided the opportunity to develop increased social networks that could provide social and emotional support, hence serving as a source of social capital. advances in social work, spring 2013, 14(1) 255 discussion this study advances the literature on latino migrant day laborers by exploring the potentially protective role of social networks in maintaining the well-being of this marginalized and transmigrant population in the united states. this study also extends the use of berkman et al.’s (2000) conceptual model on social networks and health by applying this theoretical framework to ldls. this is especially relevant as ldls have low levels of service utilization and this study’s identification of salient social networks and their influence on the health of ldls has implications for the development of strengths-focused programming with this under-served population. to this end, we first discuss how ldls’ structural conditions influenced the development of their social networks and how these networks impacted the health related behavior of this population. next, we discuss how ldls’ social networks can be leveraged as sources of existing strengths to promote the well-being of this population, which has implications for practice and policy development. we conclude with an acknowledgement of study limitations as well as recommendations for future research. findings indicate that the structural conditions that ldls face, including their undocumented immigration status, poverty, and employment in the informal market as day laborers had a distinct impact on the types of social networks they developed in the united states. these social conditions placed ldls at a heightened vulnerability as many distrusted the police and other authorities and organizations to maintain their well-being. like other migrant groups, ldls reported that they were not likely to seek services due to persistent fears of being reported to immigration officials (hagan, rodriguez, capps, & kabiri, 2003). this fear of exposure existed despite the fact that the city where this study was conducted is a “sanctuary city.” this indicates that punitive anti-immigrant policy initiatives, as well as rhetoric, have had a direct negative impact on the service utilization of ldls. in cases where workers sought services, lack of cultural responsiveness created an additional barrier to continued use of services. in alignment with berkman et al.’s (2000) conceptual model on social networks and health, ldls’ social networks influenced their health related behavior through four pathways: social support, social influence, social engagement, and access to resources and material goods. in accordance with granovetter’s (1981) conceptualization of social networks, ldls mainly discussed the “strong ties” that they established with each other that provided them social support, influence and engagement. the development of such homogenous and tight networks was largely due to ldls’ experiences of discrimination which led them to feel fearful or distrustful of establishing links outside of their group. in addition, ldls’ relayed the establishment of “weak ties” with employers or patrones and indicated that these networks were vital in connecting day laborers to work opportunities. (granovetter, 1973; 1981). specifically, ldls’ persistent feelings of insecurity, based on their undocumented immigration status and their increased risk for crime victimization, influenced this population’s sense of camaraderie and social support at the day labor corners. the day labor corners became a space of social engagement where ldls could escape loneliness, develop social bonds with other men experiencing similar work and life conditions, and unite to protect themselves from workers’ rights abuses. the day labor corner became a site where ldls organized themselves to exert social influence negi, michalopoulos, boyas, overdorff/latino migrant day laborers 256 and thereby protect themselves from unscrupulous potential employers. this building of solidarity-based social action is especially compelling in light of ldls distrust of the police and other formal authorities. fostering and forging social relationships with other workers at the day labor corner or at church allowed ldls increased opportunities and access to various types of resources not possessed by them individually. similarly, building lasting relationships with patrones was viewed as critical as it provided ldls with potential work stability– highly prized due to the inconsistent nature of day labor work. without access to formal safety nets, ldls’ social networks became critical in facilitating their economic, social and psychological well-being. social service implications while findings indicate that ldls often develop extensive social networks to ameliorate the difficult conditions of their lives, the service utilization gap experienced by this population must be closed to ensure their well-being and health. in particular, the current study’s findings indicate that scarcity of spanish speaking and culturally responsive programs are significant barriers to service use. educational training programs as well as policies need to continue to respond to this increasing need for services in spanish. in addition, to maximize service-utilization, it is highly recommended that ldls be consulted in the development of any services or programming aimed to meet their needs. such consultation with ldls and respect for their life expertise may allow for rich data that may lead to the development of highly effective social service programming. the use of the existing strengths of this population in the development of social service programming is also highly recommended. findings indicate that day labor corners served as a psychosocial space where social networks were developed for the ldls. similarly, turnovsky’s (2004) ethnographic study of day laborers in the east coast revealed that despite significant hardships, day labor sites provided a space for ldls to develop a sense of camaraderie and community. social service providers can utilize this information to conduct outreach and provide on-site services at day labor corners. for example, the health care industry has begun to provide mobile medical and dental healthcare. providing mobile services in a context where many feel safe (the day labor corner) could potentially increase access to services for this population that they would not otherwise receive. limitations although our study is one of few investigations that seek to understand social networks and well-being among ldls, a number of limitations should be acknowledged. the limited sample size and use of a purposive theoretical sampling technique limits the representativeness and generalizability of the findings. however, this sampling method was considered appropriate since the aim of the current study was to offer a preliminary understanding of social networks that impact well-being. additionally, the use of purposive theoretical sampling facilitated the selection of day labor corners and allowed for participant recruitment, as ldls are a hard population to reach. furthermore, the study represents a distinctive and understudied population—urban latino day laborers advances in social work, spring 2013, 14(1) 257 and the sample size is considered to be appropriate for qualitative analysis (creswell, 2007). additionally, this study could have been impacted by several threats to its internal validity. ldls are a vulnerable population and participants may have been reluctant to discuss their psychological well-being with a researcher. this study employed several precautions to minimize the effects of social desirability. for example, significant time was spent building trust and rapport with this population so that they would feel more comfortable discussing difficult or taboo issues with interviewers. valdez and kaplan’s (1999) methodological procedures to establish entry into “hidden” communities proved to be especially useful in building trust with this community. to further minimize social desirability, all interviews were conducted in spots distant from the earshot of other workers to ensure the confidentiality of participants’ responses. additionally, all interviews were conducted in spanish, the ldls’ native language. conclusion and recommendations for future research despite such limitations, we believe that our study sheds light on the experience of a rising sub-population of migrants in the united states which is part of a larger global phenomenon. this research can inform variable selection for future quantitative research on the social networks of ldls. furthermore, longitudinal studies with social network analysis are recommended to examine the substance use and other health behaviors of this under-served population. the significant marginalization of day laborers and their exposure to various psychosocial and political risk factors for well-being underscore the importance of increasing knowledge of this population to inform social service interventions and policies. however, it also reveals a highly resilient population that has developed complex social networks to buffer their well-being in the 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(2006). hispanic drug abuse in an evolving cultural context: an agenda for research. drug alcohol dependence, 84(suppl), s8-s16. woodward, a. t., taylor, r. j., bullard, k. m., neighbors, h. w., chatters, l. m., & jackson, j. s. (2008). the use of professional services and informal support among black americans with a mental disorder. psychiatric services, 59(11), 1292-1298. author note: address correspondence to nalini junko negi, msw, ph.d., university of maryland, baltimore, school of social work, 525 w. redwood street, baltimore, md 21201. email: nnegi@ssw.umaryland.edu microsoft word 3. dybicz_1990-copyedit_final    ______________  phillip dybicz, ph.d., is an assistant professor in the department of social welfare at valdosta state university, valdosta, ga. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 355-366  client goals and dreams: replacing the norm of functioning philip dybicz abstract: this article examines how knowledge gathering is organized when interviewing a client and designing a treatment plan. when the focus of social work practice is upon adaptation (e.g., achieving a goodness-of-fit), knowledge gathering is organized by the presenting problem or need and the social worker’s expertise on human functioning. when the focus of social work practice is upon identity formation (as advocated by postmodern approaches), knowledge gathering is organized by the client’s dreams/goals and the client’s preferred identity (of who she or he would like to be). within these postmodern approaches, practice falls into three much different broad phases, encapsulated by the terms “confront, generate, solidify.” keywords: postmodern, problem-solving model, mimesis, narrative, strengths perspective client goals and dreams play a prominent role in the application of the strengths perspective (saleebey, 2006) and solution-focused therapy (de jong & berg, 2008). they also play a role in narrative therapy (white, 2007), although this role is less articulated than in the above two practices. yet client goals also play a role—much different in character—in traditional social work interventions that employ the problem-solving model. in addition, problem-solving is used in the postmodern practices—but in a much different way than when employing the problem-solving model. what is the nature of these differences, and are they significant? postmodern social work practitioners assert a paradigm shift in understanding is necessary in order to understand these differences and successfully apply the above approaches (de jong & berg, 2008; weick, kreider, & chamberlain, 2006; white & epston, 1990). it is this paradigmatic shift that accounts for the radically different foci between traditional, modernist social work practice and postmodern social work practices like those listed above. this paper seeks to elaborate one small ripple of this paradigmatic shift: the roles each that client goals and problemsolving play. first, these roles will be briefly elaborated for traditional practices. next, the roles that goals and problem-solving play in postmodern practices will be articulated, thus illustrating the paradigm shift in understanding that is needed. the problem-solving model and generalist practice “social workers are problem solvers” is a phrase that is often heard to describe the work we do. while this conception of social workers may be found throughout our history, it took a more definitive shape with perlman’s (1957) celebrated elucidation in her work: social casework: a problem solving process. today, the problem-solving model is deeply embedded in social work’s understanding of the helping situation. as turner and jaco (1996) note, “it [the problem-solving model] seems to have been so completely absorbed into much of social work thought and process that it has essentially dybicz/client goals and dreams 356 become the basic method that underlies much of practice in addition to the generalist approach” (p. 519). the problem-solving method is an outgrowth of the profession’s embrace of scientific knowledge to guide practice. this is because the problem-solving method seeks to employ the basic principles comprising the scientific method: the impartial gathering of data and hypothesis testing. as the hypotheses to be tested take the form of potential remedies to a client’s problem, it is easy to see why the presenting problem or need becomes a major mechanism for organizing information into relevant and irrelevant categories. there are two underlying concepts of the modernist paradigm of note here— adaptation and causality—which shape the roles that problem-solving and client goals play. interweaving seamlessly with generalist process steps, the problem-solving approach views the client as possessing a presenting problem or need—the issue that has triggered services. this presenting problem and the efforts to solve it consequently hold much influence over the process steps that are followed. when gathering information, the presenting problem or need serves to define what information is relevant (in some way causally connected to the presenting problem or its remedy—seen as successful adaption, or goodness-of-fit) or irrelevant (not connected to the presenting problem or remedy); it defines the nature of the assessment (seeking the causal factors contributing to the presenting problem and the resulting areas of adaptive need); and it defines the intervention (that addresses these causal factors in some manner to remedy the areas of adaptive need). the danger here is not in the correctness or incorrectness of the problemsolving model, but rather that its dominance goes unexamined by students and practitioners. typical practice textbooks (e.g., gambrill, 2006; hepworth, rooney, & larsen, 2009; johnson & yanca, 2009) make no special mention that they are adopting the problem-solving model; its ubiquitousness has come to present itself as a fundamental feature of social work itself. consequently, this makes the consideration of much different models of practice—most notably postmodern approaches—more problematic; hence, the need for a paradigmatic shift in one’s thinking if one wishes to successfully employ these much different models of practice. client goals as a process step in modernist practice, there is no “problem-solving” phase in the generalist process steps. rather as noted above, problem-solving (within the framework of causality and adaptation) serves as the theme, or overarching concept, guiding the entire generalist process steps of study/interview, assessment, goal setting, contracting, intervention, and evaluation. as turner and jaco (1996) aptly note: “problem solving draws a conceptual map to guide both worker and client through the stages and steps involved in a change process…” (p. 504). client goal setting, by contrast, can be seen as a specific phase in the generalist process steps. and as is the case with all the specific process steps, creating client goals with the client is necessarily guided by the concept of problem-solving, which furthermore, is built upon the concepts of adaptation and cause-effect. thus for example, goals gain advances in social work, fall 2013, 14(2) 357 recognition and relevance in direct proportion to how they are able to address or circumvent causal variables of the presenting problem and consequently advance the client towards a solution. the solution is framed as a restoration of or further promotion of functioning (i.e., enhancing adaptive fit). consequently, goals are viewed as the client’s attempts at adaptation (either through making personal changes or changes in the environment). the generalist process steps encourage these goals to arise during the assessment phase (birkenmaier, berg-weger, & dewees 2011; kirst-ashman & hull, 2009). the interview phase is devoted to gathering the necessary information to start developing hypotheses concerning the presenting problem. during the assessment phase is when plans are collaboratively developed to address the presenting problem. hence, client goals perform the function of seeking to advance the problem-solving process through moving the client toward the sought after ideal of normal/healthy functioning. they provide a plan of action and then an evaluative component via concrete measurable steps to mark the client’s progress towards this ideal. typical hospital social work provides a good example of this process. the goal is to return the client to a level of functioning appropriate for discharge. the social worker gathers information concerning possible impediments to this level of functioning once the client is to return home (e.g., stairs, lives alone, etc.) and seeks remedies to address these impediments. this hospital social work case example may also serve to illustrate the notion of “starting where the client is” within a modernist context when developing goals with the client. the presenting problem is the current medical condition from which the client is rehabilitating; typical client concerns and goals will naturally relate to this problem (i.e., getting well and leaving the hospital). the key themes of adaptation and understanding cause and effect are drawn upon to shape the intervention (i.e., the human action necessary to achieve the client goals). and this approach may achieve satisfactory results in a number of cases. yet drawing upon the work of foucault (1991/1975, 1994a/1963, 1994b/1966) and his notion of a discourse that shapes knowledge generation, the postmodern critique argues that the dominant discourse circulating within a societal setting (in this case, themes of adaptation and cause-effect) will shape the knowledge generation of all the parties involved: clients and the social worker are equally affected. hence according to this critique, when “starting where the client is,” the client is starting within the dominant discourse and his/her goals will reflect this. modernist practice does not pay any attention to the discourse shaping knowledge generation; it remains science-based regarding its interventions. as will be elaborated shortly, postmodern practice consists of examining this discourse, and confronting it when it acts to disempower the client. postmodern practice operating from a different paradigm, postmodern insights cannot be simply folded into the problem-solving approach, despite efforts by some to do so (e.g. hepworth et al., 2009; johnson & yanca, 2009). this is because they are built upon new philosophical assumptions at the most fundamental level of knowledge: embracing phenomenology as an alternative way to conceive of reality, and embracing social constructionism as an alternative way to verify true knowledge. these fundamental postmodern philosophical dybicz/client goals and dreams 358 assumptions privilege language and culture in how we understand the human condition, and thus, postmodern approaches turn to the humanities for guidance in the intervention process. this in turn has profound implications for how social welfare and practice is conceived, which then dramatically sets these practices apart from traditional, scientific (i.e. modernist) approaches to practice. for example, take the following quote by saari (1991) which sharply illustrates the paradigm shift in understanding taking place concerning the broad focus of intervention efforts: the perspective taken in this book asserts that the adaptive point of view has provided an inadequate foundation for clinical social work theory. a theory of meaning in which psychological health is indicated by a constructed personal meaning system (or identity) that is highly differentiated, articulated, and integrated is proposed to take the place of conceptualizations about adaptation (p. 4). the scientific concept of adaptation serves as the broad theme for the problem-solving model, a theme that serves to organize information into relevant and irrelevant categories. this is not the case for postmodern practice. instead concerns over identity—more specifically the client’s preferred identity of who he/she would like to be—serve as the broad theme for organizing information into relevant and irrelevant categories. mimesis one reason concerns over identity gain such prominence in postmodern practice is because the humanities offer us a much different theory to explain the fundamental causes of human action than newtonian notions of cause-effect (which is a theory to describe the motions of objects). this much different theory is mimesis, first offered long ago by aristotle (1996/c. 335 bce), and more recently as part of the postmodern movement, updated by paul ricoeur (1984-88). while an extended treatment of this theory’s application to social work has been given elsewhere (dybicz, 2010), simply put, mimesis states that we each have an image of who we are and who we would like to be. the literal interpretation of mimesis is “imitation”; one’s actions imitate the identity of a preferred future image of oneself. as davis (1992) notes, “all human action is always an imitation of action—achilles is living up to his own image of himself…like all brave men, he wants ‘to die like achilles” (p. xviii). ricoeur (1984-88) further refines aristotle’s notion of mimesis via describing its dynamics when operating within a foucaultian discourse. thus mimesis is a theory advancing the concept that an image of who we would like to be (based in the future) is what motivates one’s present actions. so for example, think back to the time when you were enrolled in a social work program studying to become a social worker. were your actions of attending class and doing homework motivated by causal factors in your past that shaped your personality? or were your actions motivated by the goal or dream you had of being a social worker in the future? mimesis argues the latter. while mimesis does not discount the possible truth of the former, if one is seeking to promote change in human action as we do in social work, mimesis shifts the focus (to advances in social work, fall 2013, 14(2) 359 the future) as the means to promote this change. thus the notion that we look to the future to explain present human actions rather than to the past—and do the same to promote change in present actions—illustrates one aspect of this paradigmatic shift in thinking that needs to occur. this shift in thinking lends great importance to a client’s main goal when initiating services, as this goal speaks to the notion of who the client would like to be. the process steps of postmodern practice being based upon different philosophical positions than modernism, postmodern practice approaches consequently are fundamentally different in a number of ways. most prominently, the two organizing structures for sifting relevant from irrelevant knowledge are the client’s goal (rather than concerns over adaptive fit), and the client’s preferred identity (instead of social scientific causal knowledge of human functioning). consequently, the primary steps of intervention from the generalist model—“interview, assessment, intervention”—are no longer valid within a postmodern approach as they represent a problem-solving process guided by the overall theme of adaptation. rather, as will be explained below, the process steps of a postmodern intervention can be described as “confront, generate, solidify.” these steps reflect a process of consciousness-raising that guides the overall endeavor. the master narrative (i.e., social construction) that acts to disempower the client is confronted, then an effort is made to generate and explore new possibilities of being “who i can/want to be” (i.e., new possible identities). once a new possible identity arises and is embraced, the endeavor turns toward solidifying this social construction so that it achieves the necessary level of verisimilitude. thus the articulation of identity replaces the theme of adaptation, as was noted by saari (1991). within a postmodern approach, the client is viewed as struggling under a master narrative that is oppressive. let’s use the example of bob, who suffers from schizophrenia and is receiving supplemental security income (ssi). in bob’s case the oppressive narrative is the following: a “normal” adult male should be symptom free and a self-sufficient, productive member of society. while this particular narrative serves a purpose for broader society (as a norm of human functioning), for bob as a unique individual, the narrative becomes oppressive because it paints him as a failure. thus the challenge becomes how to socially construct a new narrative that paints bob as a “normal,” hence valued, member of society (his preferred identity) while at the same time recognizing the existence of the presenting problem (his schizophrenia). this often will occur by creating a theme that depicts the client as someone who is valiantly struggling against an oppressive force. hence, the fact that the client sits before the social worker is not an indication of a lack of fit with one’s environment (as is the case when the focus is on adaptation). rather (when the focus is on articulating identity), it is a testament of the client’s strength; that despite facing all the various travails of the problem, the client has survived, and in some areas of his/her life, maybe even thrived—and that these strengths and successes can speak to empowering identities for the client. an example of this dynamic is captured in the following quote by saleebey (1994): these individuals, almost without exception, began to construct a life— collaboratively—that no one could have predicted. the interesting thing is that dybicz/client goals and dreams 360 they did this “in spite of their illness.” in fact, their symptoms may have occurred at the same level, but the other parts of them became part of their unfolding story: “me as employee,” “me as piano player,” “me as driver,” “me as spouse and parent.” the symptoms move into the background of a much richer symbolic ecology (p. 357). confront when the focus of the intervention revolves around the articulation of identity as the means to change behavior (via mimesis), then the first step in this consciousness-raising effort is to help the client move away from being overly defined by the presenting problem. this social construction must be confronted and dethroned from its “truth” status and revealed for what it is: simply one possible social construction. this is often difficult to accomplish, as this social construction is based within strong societal and scientific norms of proper functioning. by the very fact that the client is experiencing a problem and thus is unable to adapt on his/her own, the client’s image of him/herself is undercut. this begins to limit the horizons of possibilities of the client imagining “who i can be.” the preferred self image—of being “normal”—is not reached until the problem is resolved. until that time, the client’s self image suffers. so for example, bob can never truly be “normal” until his symptoms stop (e.g., hearing voices). thus, if the client suffers from a chronic condition (such as schizophrenia), the restoration of the client’s self image will never be achieved because he/she will never be able to view her/himself as normal. the technique used to confront such a strong narrative is known as making the familiar strange; this technique arises from postmodern theorist such as bakhtin (1984/1929) and his notion of the carnival and wittgenstein’s (1968) notion of attending to backgrounds (o’conner, 2002). such a move illuminates the realization that qualities of existence that previously held great importance no longer do so in this new context. thus, qualities such as schizophrenia are still recognized, but lose their central role in defining the client. there are many ways such a move can be undertaken. for example, white and epston (1990) accomplish this move in narrative therapy with their technique of externalizing the problem. externalizing the problem metaphorically depicts the problem as a force the client must struggle against, thus effectively excising it from the client’s identity. de jong and berg (2008) do the same with the miracle question in solution-focused therapy. the miracle question asks the client to imagine a future in which the problem no longer exists; hence, it is used to spark the client’s imagination to facets of identity unburdened by the problem. and the strengths perspective accomplishes this through conscientious use of the strengths assessment (rapp & goscha, 2006). the strengths assessment acts a canvas upon which alternative, empowering identity features can be considered. these three techniques are used to engage the client’s imagination, and by so doing, serves to dethrone the truth status of the problem-saturated narrative shaping the client’s identity. advances in social work, fall 2013, 14(2) 361 generate once the client gains an awareness that there are multiple possibilities in how to organize his/her lived experiences (that is, multiple ways in which to construct the narrative of his/her life in relation to the presenting problem), the client is able to take a more active, conscious role in generating a social construction. again, this involves an appeal to the client’s imagination and represents the consciousness-raising process that must occur in the client. at first, the client’s lived experiences are organized for him/her by a social construction of society based within a norm of functioning; this is because understanding is occurring at an intuitive level. when the client understands that this norm-of-functioning social construction is not the only (or most correct) way to organize his/her lived experiences, he/she begins to consciously contribute to this process. the generation of a new social construction occurs through organizing the client’s lived experiences around the client’s preferred identity (“who i want to be”) and the client’s ultimate goal (the “end” of the story). as the client is in the best position to elaborate both of the above criteria, this is what prompts the tag line “the client is the expert” (anderson & goolishian, 1992; goldstein, 1990). the social worker’s role is to provide advice and support in this generative process; hence, the metaphor of author/editor (goldstein, 1990; saleebey, 2006; white, 2007) used to describe the client/social work relationship and collaborative process. now a client will often state that his/her ultimate goal is the end of the problem. but in attempting to help the client articulate his/her identity, a good editor asks the client to reflect more deeply, to find the theme supporting this goal. why is the termination of the problem desirable? what is accomplished? what does the client receive? for bob, the amelioration of his problem may speak to images of independence and feelings of worth to society—sentiments that have been diminished since his schizophrenia began. this theme is then something which informs the client’s preferred identity (wanting to be a “strong” and “capable” man). by consciously choosing to change the plot of bob’s social construction—to that of a man named bob, valiantly struggling against the negative force of schizophrenia (an externalized conception of his condition), bob does not have to wait till the end of the story to capture his preferred identity of being a “strong and capable” man or to realize the theme of independence and worth to society. this begins to happen immediately because his strengths and the successes he has achieved—in spite of his illness—are highlighted. furthermore, this new narrative construction continues to strengthen each day, as bob makes progress towards his goal of achieving greater and greater levels of independence. these approaches emphasize a future orientation and rely upon the client to imagine an end of his/her story with a new theme (to replace theme of the dominant social construction of adaptation accomplishing a return to normal functioning). so the client’s ultimate goal serves the role of defining the end of his/her story and thus bringing into focus the theme of the social construction as it relates to the client’s identity. it is in this way that the client’s goal is crucial to articulation of the client’s empowering social construction. dybicz/client goals and dreams 362 solidify it is not enough to simply generate a new narrative. this new narrative must gain a strong enough level of verisimilitude for the client to begin basing his/her actions upon it. for the client to begin basing his/her actions upon the identity arising from the empowering social construction, being a social construction, it must gain recognition in the social arena. the client does not need the whole of society to agree with his/her newly constructed counter narrative, but he/she does need important people in his/her life to agree to it. thus the strengths perspective (rapp & goscha, 2006; saleebey, 2006), solutionfocused therapy (de jong & berg, 2008; de shazer et al., 2007), and narrative therapy (white & epston, 1990; white, 2005) each make use of family members, friends, teachers, etc., to strengthen the counter narrative by sending a message to the client, “yes, i see you this way too.” the social worker sends this message as well. in narrative therapy, white and epston (1990) also make use of “outsider witnesses” to contribute to this process. once the client’s narrative becomes solidified, the client will achieve a moment of intellectual insight wherein his/her actions will no longer need to be consciously directed. rather, the empowering social construction’s replacement of the dominant societal social construction becomes so complete that the client understands this new way of being-in-the-world on an intuitive level, and thus his/her actions become directed by this new intuitive understanding. client goals as an organizing structure with the articulation of identity being the defining concern for postmodern interventions, consciousness-raising concerning articulating the client’s identity replaces problem-solving as the process guiding investigations. consequently, this consciousnessraising endeavor prominently features client goals as a vehicle in which to advance the articulation of the client’s identity. client goals—in representing the “end” of the client’s alternative construction—play a key part in defining “who i want to be.” they also help the client redefine “who i am” by encouraging the client to look for strengths and successes related to these goals. in this manner, client goals replace expert knowledge on normal functioning as the desired endpoint organizing relevant and irrelevant information. in addition, the very process of forming goals is part of the consciousness-raising process (i.e., “treatment”). working with a client to formulate goals is what contributes to the construction of a new identity. so as opposed to the modernist paradigm, where the formation of goals arises from the assessment and is a specific phase in the intervention process (compton, galloway, & cournoyer, 2004), in the postmodern paradigm the formation of goals guides the entire intervention process, beginning immediately when interviewing the client. problem-solving is still relied upon, as there will be many obstacles along the client’s path toward his/her goal. in both the problem-solving approach and postmodern approaches, clients describe their problems and the social workers assist them in finding solutions. the key difference in the postmodern approaches is that the problem-solving activity does not involve a search for (newtonian) cause-effect mechanisms that have advances in social work, fall 2013, 14(2) 363 contributed to the problem. as de jong and berg (2008) note, “we ask for fewer details about the nature and severity of client problems, and we do not ask for possible causes of the problem” (p. 17). with its emphasis on the articulation of identity, postmodern approaches embrace mimesis as the theory of causality to promote change in human behavior, and thus, they focus upon the future. as noted above, client goals serve as the overarching concept in assisting the client to articulate his/her identity. in this context, problem-solving acts in the supporting role, serving as a tool to help move the client toward his/her desired goal. this dynamic is illustrated by the following case anecdote from the strengths perspective: once a trusting relationship had been established, mrs. j. divulged that she hated the idea of living in a home and going to day centers, and that she really wanted to be the queen [of england]. she challenged the practitioner to work toward that aim. without promising too much, the practitioner began to work out with mrs. j. what she felt the queen did that was worth aiming for. it emerged that mrs. j. believed that the queen did not have financial or administrative worries, she always knew where she was going to live, people respected her because she helped them, and most importantly, she had “companions” and “ladies in waiting” who helped her and kept her company. the subsequent assessment stated that mrs. j. needed a strong sense of financial security and the guarantee of help with day-to-day organization, she needed to move to one location and be promised that she need never move again, she needed to feel that she was helping people and feel respected for it, and she needed some “old-fashioned” companionship. mrs. j eventually began considering sharing a house with another person being discharged who was already a firm friend and an effective organizer both of good works and administration (bleach & ryan, 1995, p. 175 as quoted in rapp & goscha, 2006, p. 133). for the social worker, it did not matter that mrs. j’s goal was delusional, and thus unreachable as stated by her. rather, by focusing upon the articulation of identity the case manager used her goal of wanting to be the queen of england as an organizing tool to search for ways that would speak to this identity of feeling “queenly.” no attempt was made to seek the cause of this delusion or of any other symptoms she may have been expressing. rather, problem-solving was used—in the form of finding a friend being discharged and possible housing—as the means to help move her along the process of articulating this identity. hence, the roles of client goals and problem-solving are reversed in postmodern practice. in modernist practice, problem solving acts as the overall theme guiding the change process and client goals act in a support role as a tool to help move the client toward the desired solution (normal functioning). in postmodern practice, client goals act as the overall theme guiding the change process, whereas problem-solving serves in the support role of aiding the client to advance towards her/his goals and the subsequent articulation of the client’s preferred identity. dybicz/client goals and dreams 364 conclusion it is important to note that the postmodern critique of modernist practice is not a critique of scientific knowledge itself, as some misunderstand (thyer & myers, 1999), but rather, of how scientific knowledge is used. when one’s understanding of human action (i.e., causality) is based upon defining identity (i.e., mimesis) rather than explaining behavior in terms of newtonian cause and effect, the parameters defining the change process radically shift. advocates of the strengths perspective (weick et al., 2006), narrative therapy (white & epston, 1990), and solution-focused therapy (de jong & berg, 2008) each claim that practitioners must undergo a paradigm shift in understanding in order to correctly practice their approach. undergoing this shift is often a very difficult journey for practitioners and students to embark upon for the very reason that many elements of practice are present in both. if we view the concept of “social work” itself as a social construction, this shift represents a shift in meaning and understanding that occurs when social work is conceived as taking place in a different (i.e., postmodern) context. the existent qualities of social work do not change. social work (at the micro level) remains an endeavor where social workers are involved with linking clients to services and providing counseling. in addition, social workers make use of scientific knowledge of human functioning as well as assist clients in problem-solving efforts. however, these two qualities occupy center stage in a modernist context—playing the central role of organizing knowledge gathering and directing intervention efforts. when operating from a postmodern context these qualities do not disappear. rather, they move to the background and play the part of a supporting role. this is the shift that practitioners must understand. references anderson, h., & goolishian, h. 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(1968). philosophical investigations (3rd ed., g. e. m. anscombe, trans.). new york, ny: macmillian. author note: address correspondence to: phillip dybicz, valdosta state university, department of social welfare, 1500 n. patterson st, valdosta, ga 31698. email: pdybicz@valdosta.edu microsoft word 14 gates_and_walters_17112_moocs_and_social_work_au_ce.docx ______________ trevor g. gates is an assistant professor in the greater rochester collaborative msw program, at the college at brockport, state university of new york. alice walters provides academic and instructor support in the college of social and behavioral sciences, school of social work and human services at walden university. copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 184-201 massive open online courses (moocs) in social work education: implications for online education trevor g. gates alice walters abstract: rapid technological developments continue to create new opportunities for innovation in higher education. social work education (swe) has often lagged behind other disciplines in applying emergent trends. the historical influence of social work professionalization may contribute to this cautious approach. massive open online courses (moocs) are an important trend gathering recent attention in higher education. the contribution of moocs to swe remains undetermined. this essay explores the relevance of moocs for swe through the lens of historical context considering economic factors, benefits, and challenges to mooc implementation. we conclude with recommendations for integrating moocs in swe. keywords: social work education, online education, massive open online courses, open enrollment, educational technology, access to education higher education (he) continues to adapt to a changing economy, expanding technology, and fluctuating student bodies. social work education (swe) has become increasingly complex as such factors converge with pressures for educational change. massive open online courses (moocs) are a recent development sweeping through online he in expanding application to diverse disciplines of study (head, 2014; pence, 2012). determining the relevance of moocs for swe requires weighing the specialized professional requirements of social work with the benefits and challenges of the mooc educational format. in this essay, we provide an overview of moocs, review historical influences on swe, and consider factors surrounding mooc utilization for swe. lastly, we provide recommendations for a deliberative strategy to include moocs in swe. overview of moocs moocs have rapidly advanced from their first inception. moocs began in 2008 with a course opened to online enrollment by siemens and downes at the university of manitoba (brown, 2013). the massachusetts institute of technology and stanford university followed with free online courses in technical fields (sandeen, 2013). educators proposed moocs as free college-level courses that would provide instruction to any student with an internet connection, perhaps reaching thousands of students per course (bowen, 2013). in 2011, 160,000 students enrolled in stanford’s artificial intelligence mooc, grounding the vision (rodriguez, 2012). moocs are a specialized form of online education (oe). they are massive for enrollment numbers that dwarf comparison to traditional courses (tschofen & mackness, 2012). they are open both for access to courses and for a learning environment emphasizing flexible interaction between participants and content resources (rodriguez, gates & walters/moocs & social work 185 2012; tschofen & mackness, 2012). moocs are free to the enrolled, but do incur costs requiring subsidy decisions by sponsors (cusumano, 2013; vardi, 2012). the paradox of moocs is that there are many variations and practical interpretations for massive, open, and free implementation (baggaley, 2013; clark, 2013; miller, 2014; tschofen & mackness, 2012). moocs range from models of informal participation to formal recognition of completion through certificates and college credit (cooper & sahmi, 2013; cusumano, 2013). the attraction to moocs may be tied to a pedagogy that embraces elements of learner self-organization, connectedness, openness, complexity, and a chaotic learning environment reliant on individualized participant applications (brown, 2013; dewaard et al., 2011; saadatmand & kumpulainen, 2014). the phenomenal growth of moocs has astounded many in he. currently, mooc giant coursera (2013) offers 550 courses from 107 institutions throughout the world, in diverse subjects including education, science, sociology, law, and public health. a growing number of coursera's courses are available for college credit. to date, however, social work courses on mooc platforms are limited and only in beginning stages of development. historical tensions in swe in the u.s. historical influences in swe may be partly responsible for the discipline’s notable absence in moocs. professionalization was one of the first controversies surrounding swe and stemmed from two distinct approaches to practice. addams organized settlement houses at hull house in chicago, advocating for participatory engagement from middleclass volunteers to serve the poor (lundblad, 1995). richmond of the charity organization society conceptualized social work differently. she saw the potential for casework as a systematic method for managing individual and family problems (kemp, whittaker, & tracy, 1997; morris, 2000; wenocur & reisch, 2001). settlement houses focused on broad societal-level goals while casework targeted individualized interventions. time would eventually integrate these aims. social work grew to incorporate individual, family, group, and community work (margolin, 1997). practice competency has also driven the nature of swe. early swe occurred within community agencies using the casework-focused approach of richmond’s model (wenocur & reisch, 2001). though a consensus on whether swe should remain in agencies or move to the university was hardly reached, in 1898 the first social work class was offered at the new york school of philanthropy (later columbia university) (national association of social workers [nasw], 2013). this event began the convention, continued through the 1960s, of swe as an msw-level university degree (nasw, 1995). swe expanded further in the 1970s with bachelor of social work (bsw) education. bsw programs developed from a need to professionalize entry-level workers. in 1974, the first bsw programs emerged (reid & edwards, 2006). controversy ensued regarding elements of undergraduate swe and its distinction from msw programs; today, boundaries of bsw and msw programs continue to generate discussion (aguilar, brown, & cowan, 1997; raymond & atherton, 1991; vinton, 1999; weinbach, 1999; wolk & wertheimer, 1999;). advances in social work, spring 2015, 16(1) 186 oe and practice oe is one aspect of he affecting swe (menon & coe, 2000). online enrollments are growing at rates faster than traditional he enrollment. for the first time in years, he enrollments dropped in number while online enrollment sustained a 9.3% growth rate (allen & seaman, 2013). approximately 6.7 million students nationwide, or one third of he students, are enrolled online (allen & seaman, 2013). he institutions increasingly value oe. in the last decade, the percentage of educational administrators considering oe as a long-term strategy and acknowledging the institutional importance of online education has grown from a minority to nearly 70% (allen & seaman, 2013). oe owes its success to economic advantages, a growing numbers of tech-savvy students, measurable outcomes, emerging technology, and educational innovation (miller, 2014). perceived advantages to oe extend to swe. early discussions about oe in he concerned the efficacy of online instruction compared with traditional face-to-face formats. the bulk of research over several decades has found no significant differences in learning outcomes between online and traditional educational methodologies (bowen, 2013; neuhauser, 2002). in fact, some research points to small or moderate advantage to oe using objective measures of student outcomes (miller, 2014). oe research confirms similar equivalency between distance and traditional course outcomes (banks & faul, 2007; beaulaurier, 2005; cummings, foels, & chaffin, 2013; haga & heitkamp, 2000; pardasani, goldkind, heyman, & cross-denny, 2012). evidence supporting oe has moved debate from questioning oe to exploring its accepted role (gillingham, 2009). the incorporation of oe into swe has evolved unevenly through cautious experimentation. oe in swe has taken different forms as technology improves and comfort zones expand. beginning efforts used oe as peripheral supplements to face-toface instruction in blended learning models. swe has used online methodologies including wikis (allwardt, 2011), webct (aguirre & mitschke, 2011), videoconferencing (berger, stein, & mullin, 2009), discussion forums (bye, smith, & rallis, 2009), and social media (kilpeläinen, päykkönen, & sankala, 2011). these instructional strategies led to increasing engagement of social work in oe. researchers have consistently verified the success of oe in swe. social workers demonstrate technological skills and comfort with technology (dedman & palmer, 2011; hash & tower, 2010; levine & chapparro, 2007; webber, currin, groves, hay, & fernando, 2010). social workers use technology to communicate with clients, engage in consultation, identify community resources for the purpose of referrals, research best practices, engage in community building, and a host of other purposes (nasw, 2005). these findings indicate outcomes for oe spanning technological proficiency, communication demonstrations, research applications, and resource coordination. additionally, clients use the internet to research social work services, participate in selfhelp groups, develop social networks, and learn more about presenting needs (finn, 1999; perron, taylor, glass, & margerum-leys, 2010; waldman & rafferty, 2008). such developments in online activity have led to greater incorporation of oe in swe. gates & walters/moocs & social work 187 accreditation accreditation has been a natural outgrowth of oe in swe. the council on social work education (cswe) is the swe accreditation body in the u.s. cswe (2015) has accredited at least seven bsw programs using distance education in various forms. additions to the list of accredited online msw programs continue to rise; 35 are currently identified by cswe (2015). cswe uses the same criteria for accrediting traditional, blended, and oe. clearly, oe is gaining increasing acceptance. broadening oe in swe brings associated benefits. blackmon (2013) noted greater online accessibility for nontraditional students and advocated that swe stay technologically current to remain viable. the accessibility of oe has opened doors in he for nontraditional students. oe shows higher rates of minority, non-traditional, and graduate students (u.s. department of education, 2011). some describe this phenomenon as empowering (horwath & shardlow, 2000) but others critique oe as diluted and massproduced (collins, 2008). field education even those lauding oe’s potential acknowledge challenges. field education presents one dilemma for the development of oe, including moocs. field education provides socialization into the profession as well as the development of knowledge, skills, and appropriate professional judgment (earls larrison & korr, 2013). field education is the “signature pedagogy” of swe that integrates classroom theory and community practice (cswe, 2013). swe’s slow adaptation to technology may stem from the importance of human connection (dalton, 2001; siebert & spaulding-givens, 2006; simpson, williams, & segall, 2007). critics fear that interpersonal communication is lost in oe (haga & heitkamp, 2000). other perspectives support the ability for positive online interaction, admittedly through strategies that differ from face-to-face methods (brown, 2013; dewaard et al., 2011). the growth of oe in swe has produced research on the intersection of fieldwork and technology. researchers found field instructors favorable to internet tools (berg‐weger, rochman, rosenthal, sporleder, & birkenmaier, 2007; dedman & palmer, 2011). likewise, hash and tower (2010) confirmed that most social work students do not encounter technological barriers to oe. research investigating oe and development of practice skills has revealed significant findings. the benefits of oe include collaborative learning, peer support, and technological skill development (jones, 2010; kilpeläinen et al., 2011). tuite and mcllean (2013) found online support critical for alleviating isolation with students in field. online practice courses have provided feedback and practicum supervision to students accompanied by improved student skills (coe & elliot, 1999; coe & youn, 2008; rautenbach & black-hughes, 2012; siebert & spaulding-givens, 2006; zeman & swanke, 2008). online instruction may diversify teaching through global interaction, increasing cultural awareness (carter-anand & clarke, 2009; rautenbach & black-hughes, 2012). findings of negative student reactions to oe are sparse. allwardt (2011) is an exception that described bsw student complaints on wiki use including advances in social work, spring 2015, 16(1) 188 reluctance for the method, time-management concerns, and group collaboration difficulties. the bulk of research demonstrates the successful integration of fieldwork with oe. evidence shows that oe presents several advantages compared to face-to-face methodologies, including increased collaboration, globalized exposure, and accessibility. the mooc format shares similarity to many features in established oe. connectivist moocs (c-moocs) are a type of mooc using participant input to drive course direction. the hallmarks of c-moocs are autonomy, diversity, openness, and interactivity (rodriguez, 2012; tschofen & mackness, 2012). these characteristics relate directly to aspects of online instruction that support field work and practice skill development. economic concerns in he complementing curricular advantages in oe are financial benefits. he is in a financial crisis. the costs of maintaining a campus have skyrocketed while funding has decreased (mcguinness, 2011). the state university of new york, for instance, lost $700 million in state support over a 4-year period (smith, 2013). students bear the brunt of skyrocketing costs. tuition increases continue with tuition charges exceeding actual costs for institutions (bowen, 2013). many students graduate with educational debt. the institute for college access and success (2012) estimated that 66% of 2011 graduates have about $26,600 of debt. debt can negatively affect social workers, who are often paid low starting salaries (nasw, 2006). educators and policymakers seek alternative methods of course delivery to enable institutions to remain operable and contain student costs. understanding cost factors in educational delivery is complex, and there is no definitive answer for oe implementation costs. some critics point to increased costs associated with oe (miller, 2014). in contrast, some universities consider oe a way to offset budget cuts (mildenberg, 2013). stakeholders in he, including social welfare educators, are looking to oe models to address financial strains. moocs are a recent development in consideration for meeting such he goals. the role of moocs in he remains unclear, but the potential for moocs to teach large numbers of participants and increase social work conceptual mastery warrants attention. moocs are an emergent he development. the interest in moocs has engendered excitement and speculation in he. reactions have ranged from indifference to projections that moocs will forever change the market. baggaley (2013) captured this uncertainty: in the years to come, the mooc may be hailed as an educational redeemer, or as an ugly symptom of the general educational slide. if [the mooc] is ultimately disgraced, will the universities and colleges of the world pass the buck... [or if] it is a triumph, will fingers be pointed at the early mooc enthusiasts for another reason—for pulling the rug from under the feet of the original [oe] institutions, and destroying their market? (p. 374) institutional participation in moocs is limited. currently, less than 3% of he institutions offer a mooc, less than 10% are planning a mooc, and 33% do not plan to participate in moocs (allen & seaman, 2013). over 50% of institutions remain undecided gates & walters/moocs & social work 189 regarding mooc participation (allen & seaman, 2013). institutional caution toward developing trends is not unique to moocs. despite the success of oe over two decades of instruction, some faculty continue to question it (miller, 2014). reliance on any one measure of mooc evaluation is flawed. honest evaluation of potential mooc contribution requires comprehensive assessment of the benefits, challenges, and relevance to swe. mooc benefits moocs present many advantages which draw attention to their future promise. moocs provide a range of synchronous and asynchronous interaction for adult learners seeking scheduling flexibility from educational institutions. adult learners expect that educational programs fit the demands of their busy lives and desire increased options in education. individualized learning is another related advantage. within a single course, moocs typically offer a variety of resources and learning methods that students may select for strength-based application (skiba, 2012). social engagement, self-direction, and collaborative learning are mooc traits that attract learners though greater self-selection than traditional courses (dewaard et al., 2011; skiba, 2012). mooc participation may also generate student interest for traditional courses (cerf, 2013), as 75% of students taking a free online course later enrolled in an additional course (foster, 2013). curiously, students have not pursued offers of low-cost transfer credit for mooc courses (kolowich, 2013). many current mooc students are professionals who already hold degrees,83 and course credit may not be as valuable to these students (kolowich, 2013). he institutions have found benefits from mooc participation. the massive enrollments in mooc courses provide advantages over traditional oe. moocs generate enormous amounts of data on student participation and interaction. this characteristic allows unique research application to the mooc classroom and makes moocs a natural testing ground for online pedagogy (allen & seaman, 2013). educators may assess experimental or pedagogical interventions with large numbers of students in the timeefficient run of a single course (cooper & sahami, 2013). institutions have also used new instructional models incorporating moocs. “flipped classrooms” require students to access mooc content prior to class lectures, increasing subject familiarity (cooper & sahami, 2013, p. 30). this practice saves time and allows in-class instruction to focus on priority needs. moocs also offer the possibility of cost reduction for both institutions and students. the ability to generate courses shared across institutions through collaborative delivery aids educational institutions while free access directly benefits students. the role of moocs in social justice is relevant to the mission of social workers. each mooc has the potential for reaching hundreds of thousands of students globally. any person with an internet connection could access swe via a mooc. moocs are a suggested solution to disparities preventing access to high quality education in many areas of the world (hyman, 2012). expanding access to swe via moocs could help ensure that those involved in social welfare and social justice throughout the world have a baseline swe. this could have significant impact for social justice workers in developing or underdeveloped economies. planned funding structures could ensure economically advantaged constituencies offset the costs of moocs to ensure free content for the advances in social work, spring 2015, 16(1) 190 financially disadvantaged. this is an opportunity for swe in developed nations to fulfill a social justice mission. social justice and other mooc benefits offset challenges acknowledged in the emerging instructional format. mooc challenges mooc development is not without its skeptics. the harshest mooc critics describe the mooc learning process as mass communication that has abandoned educational principles in a simplistic, impersonal, and potentially disorganized manner (baggaley, 2013). low retention rates may confirm difficulties in the mooc learning environment. tens of thousands of students often enroll in a single mooc, but less than 10% of students actually complete courses (calderwood, 2013; daniel, 2012). universities weighing course completion, graduation rates, and federal student loan requirements must seriously consider such consequences. additionally, moocs may cater to more advanced or informal learners with abilities to navigate the self-directed learning inherent in mooc design (calderwood, 2013; fini, 2009; rodriguez, 2012). mooc critics also challenge the assumptions of accessibility and the promises of democratic idealism achieved through global participation in moocs. hopes for broad international participation may be tempered by findings that demonstrate an overwhelming rate of participation by developed nations (rodriguez, 2012). likewise, rhoads, berdan, and toven-lindsey (2013) provided provocative discussion highlighting the role of power through information management of mooc content. these authors cautioned that moocs could easily become a tool fostering increasing reliance of undeveloped nations on developed nations’ cultural imperatives (rhoads, et al., 2013). others have agreed that moocs have detrimental potential to advance elitist forms of knowledge control (portmess, 2013). as the wealthiest nations enter the mooc market, subversion of undeveloped national perspectives could be an unintentional consequence. moocs face a number of inherent difficulties. technical problems, such as the ones that forced georgia tech to abort a mooc course, intensify with massive enrollments (kolowich, 2013). evaluation of student work in moocs also poses difficulties. universities may struggle to verify student identity (hyman, 2012) or eliminate plagiarism (cooper & sahami, 2013). some disciplines, like social work, use subjective assessments that make mooc grading difficult. for example, it is difficult to quantify practice skills or subjective judgment. the financial viability of moocs is a primary concern, even for enthusiasts of the technology. a single course may require 100 hours to develop, cost upwards of $50,000, and need 10 hours of management per week while running (foster, 2013; kolowich, 2013). massive enrollments are a perceived value of moocs, but free participation presents a quandary. educators have not agreed on ways to capitalize such interest into monetary gains (cusumano, 2013; dellarocas & van alstyne, 2013; hyman, 2012). in addition, educators have found a range of philosophical problems with moocs. despite the financial uncertainties of moocs, the potential for economic gain from mass enrollments has prompted some analysts to suggest that monetary gain has trumped educational quality (aguaded-gómez, 2013; vardi, 2012). educators cite additional gates & walters/moocs & social work 191 philosophical objections to moocs, such as a perception that moocs discourage critical thinking and stifle engaged learning (kolowich, 2013) despite online potential to improve these educational goals (miller, 2014). even more, there are concerns that free he devalues education (cusumano, 2013). finally, moocs might become so popular that smaller colleges, unable to compete, would be shouldered out of the educational market, leading to large-scale educational monopolies (cusumano, 2013; kolowich, 2013). these concerns temper enthusiasm for mooc participation. moocs in social work the long-term success of moocs remains unknown. the potential of moocs and their current influence on he necessitates objective evaluation by the social work profession regarding potential mooc participation. collaboration and a variety of instructional methods provide options to tailor student learning, while the low cost of moocs offers low-risk opportunities for students to explore interests. institutional advantages occur in pedagogical assessment, supplemental resources, and cost savings. standardized courses and global access support social justice goals pertinent to swe. these benefits have earned moocs significant attention in he. still, challenges remain. objections to mooc participation include philosophical and concrete arguments. mooc instruction may circumvent critical thinking with a reliance on simplistic student evaluation. elitism may be an inadvertent result of top-down instruction that marginalizes underdeveloped nations’ cultural perspectives. low retention rates and specialized learning modalities may limit full participation to a less ambitious enrollment pool than initially projected. lastly, mooc financial sustainability remains a valid concern along with apprehension toward market saturation. assessment of moocs for swe requires understanding the complexity of moocs. it is clear that moocs are evolving in methodology and application. the potential of moocs to advance swe remains untested and without significant discipline contribution in this emergent format. recognition of mooc challenges is generating proposed solutions, and some educators regard moocs in swe as a positive trend (kurzman, 2013). further, swe is beginning to venture into mooc development. for example, “the social context of mental health and illness” is a mooc course offered through coursera (“mooc list,” 2014). it connects conceptions of mental illness to cswe core competencies addressing diversity, human rights, and policy (cswe, 2008). other possibilities exist for moocs in swe. using moocs, students enrolled in an introductory course at multiple institutions might participate in a single mooc offered by one institution. educators could offer a required foundation course (e.g., hbse) to students in all accredited social work programs. theoretical courses, like hbse, lend themselves to mooc adaptation and, ultimately, the standardization of a knowledge base among many social work students. moocs will force stakeholders in swe to re-think volume. why are 20, 30, or 100 students in a course section superior to 10,000 students (or 100,000 for that matter)? can an online-mediated course with such large enrollments deliver content as effectively as other online options or face-to-face encounters? advances in social work, spring 2015, 16(1) 192 discussion and recommendations certainly, questions on mooc use in swe will continue, but this dialogue is an important contribution to development. he is in flux, and swe must adapt. university budgets are being drastically slashed, and academic departments are required to serve more students with fewer resources. this reality is likely to continue. swe must adapt its educational offerings in order to survive, as well as to ensure that students are learning the skills needed for practice. swe have been slow to warm to oe. historical tensions have contributed to polarities in swe that cast influence on current trends. early controversies included conflicts between macro and micro practice, disputes over professionalization, and the disagreement over community or university settings for swe. today, swe is cautiously approaching greater acceptance of oe methods as research supports oe efficacy. methods to support fieldwork and skill development have proven possible for oe. technological development has introduced new methods for educating social workers, enhancing practice, and continuing practice development that swe needs to evaluate. the reluctance of swe to embrace oe has meant that social work has not participated in the development of new oe technology like moocs. swe is at disadvantage without participation in emerging oe. moocs have potential to contribute positively to he, and it is likely that moocs will have significant impact in he in the next decade. swe has not adequately assessed how moocs can help alleviate diminished institutional resources. failing to adapt moocs and other oe technologies would be a loss for swe. one of these losses will be in the arena of attracting students. students come to the classroom expecting to use emerging technology, including oe technologies. some students have this expectation because they use technology in every area of their lives, while others may want to be engaged with technology because they lead complex lives. moocs help these students fit their education around their lives. if swe does not adapt, student enrollments may suffer. there are also losses within the area of state and other institutional funding. public institutions of higher learning are being forced to do more with less. serving more students to meet the bottom line is a reality. moocs, while free to varying degrees, do have development and maintenance costs. most successful moocs have a course instructor, a team of teaching assistants, and technical support professionals, but these costs could be spread across multiple institutions. one solution would be for institutions to share a portion of the instructor cost per each enrolled student. for example, an institution enrolling 100 students would pay a greater portion of the instructor costs than an institution enrolling 50 students. however, there may be a potential long-term cost savings. while such an arrangement would mean that individual faculty members give up a degree of control over content delivery, such an arrangement could help ensure students receive a consistent knowledge base. the disadvantages of standardization may be offset by better public protection when states have greater certainty of consistent learning within shared moocs. gates & walters/moocs & social work 193 recommendations there are sound reasons for swe to use the mooc platform. some educators are already engaging in the discussion on mooc emergence, but the implementation of moocs in swe has not yet transpired. swe has much to lose by failing to embrace moocs. swe is already behind the curve. below are recommendations for how faculty and other stakeholders can more actively get involved in mooc development: (1) identify funding initiatives that would support the development of social work moocs. like other oe, moocs require significant resources. faculty cannot develop moocs without significant investment from their universities and other funding organizations. like other oe, developing moocs requires substantive expertise as well as technology support (schoech, 2000). faculty should be supported in the development of moocs through financial incentives (e.g., course releases or other grant support) and technical support. mooc development is not likely if faculty are expected to maintain typical teaching loads and to rely upon the university helpdesk for support. (2) further assess mooc course development needs in collaboration with other colleges/universities. the scope of moocs requires additional resources and planning beyond a traditional online format to accommodate extremely large enrollments. as moocs require significant substantive and technical expertise, administrators should pursue collaborations among colleges and universities. collaborations allow institutions to gain the benefits of moocs while sharing costs to provide them. institutional mooc benefits extend beyond advantages for tuition-paying students to preparing large numbers of at-risk students to succeed and providing free course content to promote interest in a field to the general population. departments and schools of social work should first begin conversations about what practice, policy, and/or research courses could potentially be developed together as a mooc. for example, educators could share a human behavior or policy course among 10 or more institutions. under the current model, classes of 20 or 30 are often taught within the same geographic region (and often by the same contingent instructor). this is significant duplication of effort. the cswe or another stakeholder could spearhead an effort to share development and delivery costs among institutions. (3) inform other social work educators about the benefits of moocs. much of the resistance to moocs may be stemming from fear about what faculty members have to lose by adopting moocs. the faculty may worry that moocs will make their jobs obsolete or that moocs will result in “farming out” swe positions to contingent faculty. these are real concerns. yet, to some degree, this is already happening. faculty members can best maintain their place in swe by adapting to new roles. there will always be need for faculty members to supervise students in field, as this can never be fully replicated online. (4) consider the diversity that moocs bring to swe. a mooc that is shared across universities, across rural and urban contexts, and across global advances in social work, spring 2015, 16(1) 194 boundaries has considerable advantage for students. imagine a diversity course shared between a university in rural alabama, chicago, san francisco, and bangkok. students and faculty alike would benefit from the diverse perspectives that such arrangements would afford. this would yield an experiential education component that would be difficult to replicate even in field placement. sharing moocs across borders would expose students to meaningful and lasting relationships that might spur a growth of interest in international social work. it might be a way of providing globalized content to students who would not otherwise seek out global opportunities. (5) determine the role of moocs’ social work educational provision through practical strategies. there are multiple possibilities for practical application of the mooc course format to swe. current students and participants from across the globe are sources for potential large mooc enrollments. certainly, challenges in financial sustainability, student self-directed learning capabilities, and practice skill considerations affect mooc implementation in social work. tailoring moocs to specific course content addresses several of these issues. policy, hbse, and elective courses may prove more appropriate than teaching practice skills, although future developments do not preclude mooc fieldwork contributions. moocs may be most appropriate for either advanced learners or novice learners with additional supports to facilitate navigating the mooc environment. cswe guidelines for recognizing a social work student, implicit curriculum, and credit for mooc coursework remain future determinations. swe is likely to benefit most from an integrated approach to moocs alongside online and face-to-face educational options. (6) conduct empirical research on the effectiveness of moocs and other emerging learning technologies. the contribution of swe to mooc content requires simultaneous evaluation efforts. some of the reluctance to moocs may be questions about effectiveness. swe should be at the forefront of empirically testing whether moocs have similar (or better) learning outcomes, including course grades and practice skills. swe should also examine student and faculty satisfaction with this new technology. moocs can offer better scheduling options for adult learners and will likely result in increased student satisfaction. faculty members may also experience increased satisfaction through the larger impact of reaching thousands, instead of hundreds, of students. summary moocs represent an important emerging trend in he. long-standing tensions in swe have complicated social work’s participation in the emergent mooc process. the training and education of social workers involves specialized knowledge and practice affecting educational methodologies. assessment of mooc capabilities provides evidence that social work participation in moocs is likely to have positive impact. moocs appear to be an important solution to address economic and adult learning expectations in the coming decade. the time is right for swe to begin engaging in mooc development and to gates & walters/moocs & social work 195 continue actively pursuing oe. references aguaded-gómez, j. i. 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(2008). integrating social work practice and technology competencies: a case example. social work education, 27(6), 601-612. gates & walters/moocs & social work 201 author note correspondence can be addressed to dr. trevor g. gates, 55 saint paul street, rochester ny 14604. email: tgates@brockport.edu microsoft word 5. cherry_dalton_dugan_12140-self efficacy of cw workers copyedit final ______________ donna cherry, ph.d., is an assistant professor and bruce dalton, ph.d., is a professor, both in the department of social work, and angela dugan is a doctoral fellow in early childhood education, all at east tennessee state university in johnson city, tn. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 318-333 self-efficacy in newly-hired child welfare workers donna cherry bruce dalton angela dugan abstract: child abuse and neglect in the united states resulted in 676,569 reports in 2011 (u.s. dept. of health and human services, 2012). workers in this field struggle with low pay, high caseloads, inadequate training and supervision, and risk of violence, all of which contribute to worker burnout and poor worker retention rates. worker selfefficacy is predictive of worker retention, job performance, and persistence in this difficult field. this paper reports the development of a new measure of self-efficacy from a sample of 395 child welfare workers. factor analysis revealed two domains of selfefficacy, direct practice and indirect practice, which can be modestly predicted by worker characteristics upon hire and the training program the workers attend. worker selfefficacy can be used to identify vulnerable workers who may be especially in need of strong supervisory support as well as understand who to target for recruitment. a review of the literature of self-efficacy in child welfare workers is included. keywords: child welfare, self-efficacy, title iv-e child welfare workers embrace one of the most challenging and stressful careers in social services. they serve a population of children who have suffered neglect, physical abuse, and sexual abuse, numbering 676,569 in 2011 (u.s. dept. of health and human services, 2012). negative job characteristics such as low pay, high caseloads, inadequate training and supervision, conflicting roles, and risk of violence all contribute to worker burnout (depanfilis & zlotnik, 2008; faller, grabarek, & ortega, 2010; mcgowan, auerbach, & strolin-goltzman, 2009; morazes, benton, clark, & jacquet, 2010). it is no surprise, then, that retention rates are poor, with national turnover rates reported at 3040% (u.s. general accounting office, 2003). these high turnover rates are generally higher in the first few years of employment (balfour & neff, 1993; curry, mccarragher, & dellman-jenkins, 2005; smith, 2005). in the interest of child well-being it is imperative to develop and retain competent child welfare workers in spite of contextual challenges, and self-efficacy is one important way to do so. self-efficacy is related to job satisfaction, job retention, and job performance and can be influenced by supervisor support (chen & scannapieco, 2010; dickinson & painter, 2009; ellett, 2009; judge & bono, 2001, stajkovic & luthans, 1998). given that turnover of child welfare workers is a substantial issue and that selfefficacy is an important worker characteristic, it would be useful to investigate the level of self-efficacy of child welfare workers at the time they begin their jobs as well as explore the predictors of self-efficacy levels. understanding worker self-efficacy can be used to recognize which workers are more vulnerable and may be especially in need of cherry, dalton, dugan/self-efficacy in newly-hired child welfare workers 319 strong supervisory support as well as to understand whom to target for recruitment. a review of the literature regarding self-efficacy in child welfare workers is presented in the next section. self-efficacy self-efficacy refers to “people’s belief in their capacities to mobilize the motivation, cognitive resources, and courses of action needed to exercise control over given events” (ozer & bandura, 1990, p. 472). in other words, although self-efficacy does not directly change individuals’ capabilities, they may show more perseverance and effort when faced with difficult situations due to the control and sense of mastery they feel (bandura, 1997; lazarus & folkman, 1984; liu, siu, & shi, 2010). more specifically, studies indicate that people with high self-efficacy use more problem-focused coping as compared to the emotion-focused coping employed by those with low self-efficacy; further, problemfocused coping is related to less stress, both physical and psychological (see semmer, 2003 for review). by extension, those with higher self-efficacy are more likely to be successful and therefore satisfied with their work (judge, locke, durham, & kluger, 1998). numerous studies in other fields also have found that high self-efficacy is related to greater job satisfaction, better job performance, lower job burnout, and better wellbeing, as compared to low self-efficacy (e.g. bandura, 1997; grau, salanova, & peiro, 2001; judge & bono, 2001; pinquart, juang, & silbereisen, 2003; schyns & von collani, 2002; siu, lu, & spector, 2007; stajkovic & luthans, 1998). self-efficacy as a focus of child welfare research is quite limited to date. descriptively, fox, miller, and barbee (2003) evaluated newly trained child welfare employees across 26 job duties reflecting basic competency training. barbee and colleagues (2009) subsequently used the same indicators to evaluate new iv-e-trained child welfare workers at 6 months and 2 years. in both studies and at all data collection points, workers rated themselves above the midpoint for self-efficacy. murphy (2007) compared three groups of new child welfare workers: graduates of a iv-e program were compared to two non-iv-e comparison groups, one containing employees who had no training in social work and one containing employees with degrees in social work. each group included both bachelor’s and master’s level workers and used a self-assessment measure comprised of 30 child welfare-related tasks. the average scores for each group were above the midpoint in this study as well. there were no statistically significant differences among the three groups nor were there any differences when comparing all social workers (both iv-e and non-iv-e) with non-social workers. finally, wehrmann, shin, and poertner (2002) also found high scores on self-report learning outcomes at the end of child welfare training; however and notably, scores had dropped six months later. in child welfare worker retention studies, self-efficacy has been positively associated with intention to remain on the job as well as actual retention (chen & scannapieco, 2010; dickinson & painter, 2009; ellett, 2009; fryer, miyoshi, & thomas, 1989). in a longitudinal study, jones and okamura (2000) assessed newly hired workers on selfperceived competency and retention, finding that high self-efficacy scores were associated with longer retention periods. dickinson and painter (2009) found that those advances in social work, fall 2014, 15(2) 320 who remained in child welfare felt more efficacious about their ability to have a positive influence in the lives of their clients. self-efficacy is related to job performance in a variety of fields. a meta-analysis (n = 114 studies) of studies from a variety of fields found a significant correlation of .38 between self-efficacy and job performance. a significant moderator of the relationship was task complexity; as task complexity rose the strength of the relationship fell (stajkovic & luthans, 1998). collins-camargo (2007) found child welfare worker selfefficacy to be related to job performance and also two child outcome indicators, timeliness of investigations and cases open over 12 months. while only one of these outcome indicators was desirable, it is the only study to date directly linking child welfare worker self-efficacy to case outcome. a few studies have specifically considered environmental variables and self-efficacy. this is important since the working environment of child welfare agencies is often characterized by staff shortages, high caseloads, and other factors (u.s. general accounting office, 2003) that may reduce workers’ beliefs that they can exercise control over their work lives. ellett (2009) writes that child welfare is arguably the most difficult field in social work. to work in such a context it is important that individual workers have the personal characteristics that help them persevere in the interest of the children they serve, and sometimes workers may have to advocate for children within an unsupportive system. workers need a strong belief in their ability to effect change in the client’s situation in the face of opposition and long odds. in a study of public child welfare workers in california, mcelroy (2002) related self-efficacy to a number of personal and agency-related characteristics. she found self-efficacy to be positively and significantly correlated with job satisfaction but not with supervisory support. chen and scannapieco (2010) also examined these variables but looked for interaction effects. they found that supervisory support was important but, specifically, it was more important for the retention of child welfare workers with low self-efficacy as compared to those with high self-efficacy. also, whereas job satisfaction was positively correlated with self-efficacy, it was not a linear relationship: it had a stronger relationship for those with high self-efficacy. this study indicated that job satisfaction was not enough to compensate for low self-efficacy where there was also a perceived lack of supervisor support. these findings about the importance of environmental factors for child welfare workers with low self-efficacy are consistent with findings on employees in the broader literature (appelbaum & hare, 1996). in summary, self-efficacy in child welfare workers is related to retention, job satisfaction, job performance, and supervisory support. further, it appears that selfefficacy may drop over time (jones & okamura, 2000), suggesting that the experience of work or environmental factors influences self-efficacy in the workplace. this is consistent with the idea that self-efficacy is not a static personality trait: rather, it is malleable (bandura, 1997). as such, and because turnover is higher within the first few years of employment, it would be useful to assess self-reported level of job preparedness (i.e., self-efficacy) of workers at the time they begin employment to know who may be more vulnerable to workplace culture. since self-efficacy is domain-specific (bandura, 1986b) and child welfare competencies cover a wide range of skills, it would also be cherry, dalton, dugan/self-efficacy in newly-hired child welfare workers 321 useful to develop a scale of worker competencies and conduct a factor analysis to look for the presence of subfactors. because recruiting and hiring workers with high levels of high self-efficacy is preferable, it would be useful to know what factors predict higher levels of self-efficacy. the study in this paper uses a retrospective pretest. in collins, kim, and amodeo’s (2010) review of empirical studies of child welfare training, those with retrospective pretest designs were deselected for inclusion due to perceived weakness in design. campbell and stanley (1963) consider the retrospective pretest design to be inferior, though acceptable, when a longitudinal study is not possible. pratt, mcguigan, and katzev (2000) compared pretest-posttest methodology to retrospective pretest methods in a sample of 307 mothers in a prevention program. they found that in situations where response-shift bias is present (where, before training, participants do not understand the concept being measured and thus overestimate their abilities), retrospective pretests are more accurate measures of the change produced by training. this is also supported by berger, gunto, rice, and haley (1996) in a large study of 2,100 trainees in the field of hazardous waste handling. those trainees who completed retrospective pre-test/posttest measures showed a larger change than those who completed concurrent pretest/posttest measures. in essence, those completing efficacy pretests may overestimate their skills because before training they don’t know what they don’t know. retrospective pretests may be more accurate because after training the participants now know what they didn’t know. the goals of this study are to (1) develop a measure of job preparedness to assess worker confidence (aka self-efficacy) for child welfare job duties; (2) explore these levels of self-efficacy at the time workers begin their jobs; and (3) examine factors that predict self-efficacy. it is hypothesized that self-efficacy will be significantly predicted by worker characteristics. methods design, sample, and data collection the study reported here is from an evaluation of training preparedness of caseworkers employed by the department of children’s services (dcs) in a southeastern state. bachelors-level workers are prepared in one of two methods: (1) through the title iv-e child welfare stipend program or certification program, a university-agency collaboration in which social work students complete two child welfare classes and a one-semester full-time internship with dcs immediately prior to graduation; or (2) a 9week pre-service training program in which training is delivered within dcs immediately prior to assuming job responsibilities. the researchers used a cross-sectional design and surveyed the entire population of child welfare workers in a southeastern state hired in a particular time period. workers were invited to participate via an email invitation and web link to an internet-based survey using surveymonkey. data collection took place in two phases. in phase 1, data were collected in 2009 from employees hired from 2004 to mid-2008; phase 2 data collection took place in 2011 for employees hired from mid-2008 to early 2011. two advances in social work, fall 2014, 15(2) 322 follow-up emails and an incentive in the form a drawing for a gift card were used to encourage participation. the research study methods were approved by the institutional review board for human subjects prior to any data collection. measures participants completed the level of preparedness scale (lops) in addition to education and employment variables. (1) education, experience and employment. workers completed the following demographic items: education (undergraduate degree, graduate degree or working toward a graduate degree); length of employment (years and months); prior child welfare experience (yes/no); current position in dcs (team coordinator, case manager/family services worker 1, 2, 3, or 4, or other; and current work area (19 work areas, detailed in results). (note: in order to protect the identity of workers, especially given the low prevalence of male workers and workers who are non-white, no other demographic variables were collected as it would have been easy to identify individual workers with this information along with current position and title). (2) level of preparedness scale (lops). the lops is a new scale designed to measure self-reported perception of the degree to which the worker felt prepared for a range of child welfare job duties at the time s/he began employment with dcs. content for the lops came from a review of relevant training literature and input from child welfare trainers for the state. the lops went through an extensive review process. state foster care professionals reviewed a draft set of items for clarity, comprehensiveness, sensitivity, and practice relevance. a pool of 29 items was given with the following instructions: the following set of questions address job duties at dcs. as you read each question, think about what your level of personal preparedness was at the time you began employment with dcs. please respond thoughtfully to each item. each item is rated on a sixpoint scale from (5) excellent to (1) poor, and (0) not covered in training. results results are presented in three sections: (1) worker characteristics; (2) factorial structure and scores of the lops; and (3) results of linear regression analyses. statistical analyses were completed utilizing ibm spss 21. new worker demographic characteristics a total of n = 395 workers participated for a response rate of 45.13%. although the intent was to survey only workers who had been on the job for 36 months or less, a few subjects reported much longer periods of employment. in order to better ensure the integrity of recall, these cases were deleted. for the remaining sample (n = 342), education was as follows: 37.5% (n = 127) reported having an undergraduate degree in social work, 19.5% (n = 66) were working toward an advanced degree and 24.0% (n = 82) had an advanced degree. length of employment ranged from 0 to 35 months, (m = cherry, dalton, dugan/self-efficacy in newly-hired child welfare workers 323 16.9, sd = 9.58) and almost half of the sample (48.2%) reported having prior child welfare experience. most respondents went through the 9-week pre-service training after hire (n = 319, 80.8%) while the rest went through the title iv-e program (n = 76, 19.2%). other employment characteristics are summarized in table 1. table 1. current employment characteristics current position (n = 342) n % team coordinator 0 0 team leader/case manager 4/family services worker 4 7 2.0 case manager 3/family services worker 3 9 2.6 case manager 2/family services worker 2 201 58.8 case manager 1/family services worker 1 78 22.8 other 42 12.3 missing 5 1.5 total 342 100.0 current work area n % child protective services/multiple response services 159 46.5 social services-foster care 115 33.6 juvenile justice 56 16.4 social services adoption 18 5.3 non-custodial case 13 3.8 investigation 10 2.9 court 8 2.3 other 7 2.1 placement 6 1.8 continuous quality improvement 4 1.2 intake 3 0.9 administration human resources 1 0.3 supervision cps 1 0.3 supervision social services 1 0.3 supervision-juvenile justice 1 0.3 eligibility and benefits; financial management; legal; security; well-being/staff health 0 (each) 0 total 403 n/a note: total responses are greater than number of subjects: subjects could check more than one work area. percentages are calculated as a percent of total subjects (n = 342), not total responses. advances in social work, fall 2014, 15(2) 324 the samples collected at phase 1 and phase 2 were compared. no significant differences were found between the groups on the percent working toward an advanced degree, having prior child welfare experience, or the total months of dcs employment. significantly more respondents at phase 2 were graduates of the title iv-e program (9.5% at phase 1 and 36.4% at phase 2, x² = 42.2, df = 1, p < .001). this is likely because the title iv-e program continued to grow during this time. lops factorial structure and scores there were 10 cases with more than 20% missing data that were deleted. of the remaining cases, there were five cases (1.27%) with one missing item and two cases (0.51%) with two missing items. missing item values were replaced with the mean item score and rounded to the nearest whole number. of the original 29 items, five had a large response frequency of not covered in training. these items were deleted after confirming with trainers that these items are not reliably part of the training curriculum. with remaining 24 variables, not covered in training responses were recoded as “missing” before the exploratory factor analysis (efa) was conducted. (note: to assess the impact of this coding strategy, we also coded these responses as “poor” and conducted an efa subsequent and identical to the procedure described below. both coding approaches resulted in the same factor structure.) an efa was conducted to explore whether one or more dimensions underlie the item scores. efa was used because the lops is a new measure and it was necessary to investigate the underlying factor structure (fabrigar, wegener, maccallum, & strahan, 1999; osborne, costello, & kellow, 2008). unweighted least squares with promax rotation was used for the factor analysis, the scree test was used to guide the number of factors, and the pattern matrix was used to guide interpretation of the factors. bartlett’s test of sphericity [x2 (276, n = 347) = 6365.22, p < .001] and the kaiser-meyer-olkin measure of sampling adequacy (kmo = .94) strongly supported the suitability of the items for factor analysis. the scree test clearly indicated a two-factor solution. although 22 of the items cleanly loaded on one of the two factors, two items were problematic. the item “working directly with persons who supervise you” had a loading of .39 and the item “maintaining your personal safety” had low and cross-loaded results (.39 and .30). efa was recalculated deleting one item at a time and with no marked improvement to the remaining items. therefore, both items were deleted. efa was conducted with the remaining 22 items (n = 333). factor 1 contained 16 items, all loading at .48 or greater (see table 2). all corrected-item total correlations were .62 or greater and cronbach’s alpha was  = .96. the item content for this factor was comprised of direct practice knowledge and skills. factor 2 contained six items, all loading at .57 or greater. all corrected-item total correlations were .60 or greater and cronbach’s alpha was  = .89. the item content for this factor was comprised of indirect practice knowledge and skills. the total amount of variance accounted for by both factors was 60.3% (direct practice 51.3%; indirect practice 9.0%) and the correlation between cherry, dalton, dugan/self-efficacy in newly-hired child welfare workers 325 factors was r = .61. for each factor the potential score was 1.00 to 5.00. for lops/direct practice, the overall mean score was m = 3.73 (sd = .68, n = 374). for lops/indirect practice, the overall mean score was m = 3.05 (sd = .84, n = 347). table 2. level of preparedness scale (lops) items and factor loadings factor 1 factor 2 items direct practice indirect practice building positive working relationships with families of diverse backgrounds 0.96 -0.28 partnering with families 0.96 -0.16 building positive working relationships with families 0.94 -0.24 developing a working agreement with a family 0.86 -0.05 planning with family teams for the child’s safety 0.74 0.15 planning with family teams for the child’s well-being 0.73 0.17 asking appropriate questions during all contacts with a family 0.73 0.10 planning with family teams for long-term permanency 0.69 0.16 building positive working relationships with community agencies 0.66 0.10 remaining respectful during all contacts with a family 0.65 0.01 applying the best practice guidelines (the practice wheel)* 0.64 0.11 working effectively with children and youth of different ages 0.64 0.15 being aware of different parenting strategies 0.60 0.18 developing an appropriate case plan with the family based on identified strengths and needs 0.54 0.34 assessing signs of safety and risk, and making accurate determinations 0.53 0.35 identifying indicators of abuse and neglect 0.48 0.30 understanding the steps involved in closing a case -0.23 0.99 understanding the steps involved in transferring a case -0.17 0.96 understanding the law as related to child welfare practice 0.05 0.74 knowing appropriate time frames pertaining to your specific duties 0.10 0.63 writing/updating a functional assessment 0.09 0.63 being able to document all case activities in a professional manner 0.15 0.57 *this item reflects the agency’s internally designated best practices, including a best practice referred to as the practice wheel. advances in social work, fall 2014, 15(2) 326 linear regression analyses two linear regression models were used to explore relationships between a number of predictor variables and the two lops subfactors. the independent variables included length of employment, computed in months; training program, coded as 9-week preservice (2), title iv-e (1); undergraduate degree, recoded as social work (2), all other (1); having an advanced degree, coded yes (2), no (1); working toward an advanced degree, coded yes (2), no (1); and prior child welfare experience, coded yes (2), no (1). no other demographic variables were available for inclusion in these analyses. all of these variables were regressed simultaneously in separate models with lops/direct practice and lops/indirect practice as the dependent variables. for lops/direct practice, the overall model was significant f (6, 307) = 5.31, p < .001. the significant predictors for preparedness included length of employment (longer employment was associated with a lower level of preparedness), working toward an advanced degree, and having prior work experience (see table 3). the model accounted for 9.4% of the variance in level of preparedness. for lops/indirect practice, the overall model was significant f(6, 283) = 3.58, p = .002 and the significant variables were social work as an undergraduate degree (associated with a lower level of preparedness), receiving training through the 9-week pre-service program (associated with a lower level of preparedness), working toward an advanced degree, and having prior child welfare experience. this model accounted for 7.0% of the variance in level of preparedness. table 3. linear regression results variables model 1 – lops/direct practice model 2 – lops/indirect practice b se b β b se b β length of employment -0.014 0.004 -0.201** -0.004 0.005 -0.042 training program -0.115 0.124 -0.071 -0.516 0.161 -0.255** undergraduate degree -0.146 0.105 -0.104 -0.366 0.137 -0.209** having an advanced degree 0.065 0.091 0.04 0.02 0.119 0.010 working toward adv degree 0.343 0.095 0.200** 0.37 0.125 0.173** prior child welfare experience 0.189 0.078 0.139** 0.225 0.101 0.133* note. r² = .094; *p ≤ .05; **p ≤.01 note. r² = .070; *p ≤ .05; **p ≤.01 discussion the first objective of this study was to develop a new measure, the lops, designed to assess the degree to which new workers feel prepared for a number of job task items at the time they begin employment with dcs. the efa conducted on these items resulted in two factors, direct practice and indirect practice, with high factor loadings, strong reliability, and strong content validity for the items associated with each subscale. the subscales provide the opportunity to approach and understand the data analysis with more specificity. cherry, dalton, dugan/self-efficacy in newly-hired child welfare workers 327 the second objective was to explore these levels of self-efficacy at the time workers begin their jobs. for lops/direct practice employees reported self-efficacy above the scale median (m = 3.73, sd = .68) while for lops/indirect practice employees reported self-efficacy at the scale median (m = 3.03, sd = .84). previous studies have found selfefficacy reported above the scale median (barbee et al., 2009; fox et al., 2003) across an entire set of worker competencies. this is the first time self-efficacy was measured in two domains and suggests that a clearer understanding of self-efficacy can be gained with this approach. the third objective was to determine which factors are associated with a sense of task competency, or self-efficacy, among public child welfare workers. for lops/direct practice, three of these variables were significantly related to self-efficacy. first, the longer workers had been on the job, the less prepared they felt at the beginning of their employment. this finding may reflect that training effectiveness had gotten better over time, so that employees who had been through training closer to the time of the survey had a better quality of training for worker competencies as compared to those who had been through an older version of the training. however, the trainers reported that training had not changed. further, because the data was collected in two phases, this interpretation would not be supported. another explanation could be that, despite being instructed to think back to how prepared they felt at the time they began employment, subjects’ recall was influenced by time on the job and their evolving perspectives of the difficulty of their jobs. in this case, the findings would be similar to barbee et al. (2009) who found a decrease in the mean self-efficacy scores from six months to two years. this supports the literature indicating how difficult child welfare work is (ellett, 2009) and that workers need to be supported on the job in order to maintain their confidence in their work. chen and scannapieco (2010) found that supervisory support is especially important for workers with low self-efficacy. improving supervisor support overall and/or matching vulnerable workers with more supportive supervisors would be indicated as possible interventions to improvement retention. employees who had prior work experience or were working toward an advanced degree also were more likely to report higher levels of job preparedness. prior child welfare experience has also been identified as a correlate of retention in other studies (balfour & neff, 1993; also, see review by zlotnick, depanfilis, daining, & lane, 2005), although it was not directly tied to self-efficacy in these studies. nonetheless, the findings in the current study are consistent with the view that self-efficacy is malleable and can be increased in four ways: through mastery experiences (the most effective way), modeling coping strategies and practice, social persuasion with positive appraisals, and increasing physiological states that are read as signs of strength and invulnerability (bandura, 1986a). in terms of working toward an advanced degree, this would suggest that workers with the academic ability and ambition to pursue graduate education are more confident, possibly because they are better learners or are more persistent. each of these qualities is consistent with aspects of self-efficacy (bandura, 1997). oddly, already having a graduate degree was not associated with higher levels of self-efficacy. it may be that workers who were currently pursuing a degree were doing so in fields more relevant to advances in social work, fall 2014, 15(2) 328 their child welfare work as compared to those who had already attained advanced degrees. also, workers with graduate degrees may have brought more experience or a higher degree of critical thinking to their training and may therefore have been more conservative when evaluating their levels of preparedness. for lops/indirect practice, four worker characteristics were significantly related to self-efficacy scores. as with lops/direct practice, working toward an advanced degree and having prior child welfare experience were both positively associated with higher levels of self-efficacy. in contrast to lops/direct practice scores, length of employment was not a significant predictor for indirect practice. this difference may be accounted for by the types of competencies that comprise lops/indirect practice. these are indirect practice skills that are arguably more knowledge-based (e.g., “understanding the steps involved in transferring a case”) whereas the lops/direct practice skills are more practice-based (e.g., “partnering with families”) and are skills that workers may feel they understand at the beginning of a job but feel less confident about their competency with time and the wide variety of clients they encounter. also significant were training program and undergraduate degree. specifically, workers who were trained through the 9-week pre-service program felt less confident about indirect practice skills as compared to those who were title iv-e graduates. yet, workers with an undergraduate degree in social work also reported less confidence as compared to those with any other undergraduate degree. these findings seem contradictory in that all title iv-e workers have a bsw degree. however, 20% of the 9week trained workers reported social work as their undergraduate degree. as a follow-up analysis, we compared the lops/indirect practice scores of title iv-e workers to the subset of 9-week pre-service workers with social work undergraduate degrees. the average scores of the title iv-e workers (m = 3.19, sd = .80) were slightly above the midpoint and higher than those of the 9-week pre-service training (m = 2.89, sd = .87) and the difference was significant t(117) = 1.96, p = .05. this finding suggests that a title iv-e education (child welfare classes and a field placement in child welfare) better prepares social work students for indirect practice competencies. further, the importance of type of training program for indirect practice but not direct practice, as shown in this study, adds to the literature that has compared worker self-efficacy between these programs. to date, the results are mixed: for example, whereas jones and okamura (2000) found that title iv-e workers are more confident than non-title iv-e workers, murphy (2007) found no differences between groups. the current study suggests there may be subtleties that can be understood by evaluating subdomains of worker selfefficacy. the results of this study suggest that prior child welfare experience and working toward an advanced degree are common predictors for higher levels of self-efficacy. recruiting workers of this caliber would be an obvious effective strategy towards improving worker retention. however, this does not suggest that those who do not fit this profile should be avoided. since environmental variables are influential, closer attention should be paid to these factors, especially supervisory support, for those workers who are more vulnerable. by extension, assessing self-efficacy of workers at the time they began cherry, dalton, dugan/self-efficacy in newly-hired child welfare workers 329 employment in child welfare can help agencies better predict which workers need support. the primary strengths of this research included a large sample and the development and use of a scale that, upon factor analysis, resulted in two highly reliable subscales supporting two separate domains of child welfare practice. further, statistical analyses using linear regression identified worker characteristics that are associated with workrelated self-efficacy. weaknesses included the use of a non-probability sample and a non-validated measure. also, because these data were gathered after workers were already working, the time lapse between training and data collection might have weakened the integrity of the data due to subject recall and confounding with practice experience. also problematic was the lack of additional demographic variables. although excluding other variables was justifiable to assure confidentiality and increase subject participation in the study, the lack of additional demographic information limits generalizability. as well, it may somewhat account for the low r-squared values in both subfactor analyses. future research should address the limitations noted above. specifically, it would be informative to capture worker self-efficacy immediately after the training and then again after 1-2 years in practice to better understand how work experience and environmental variables influence self-efficacy for subgroups (i.e., those with prior work experience and graduate degree aspirations). also, given the relatively low amount of variance accounted for by each model, it is important to consider which variables may have been missing. identification of these variables is important to increase the r-squared value in each model as this is an indicator of the goodness-of-fit of the models (kutner, nachtsheim, & neter, 2004). these may include demographic variables, as noted above, as well as environmental variables such as staff shortages, high caseloads, inadequate supervision, and others. conclusion overall, these findings suggest workers feel confident about their level of preparedness across a variety of child welfare competencies. however, self-efficacy varies across workers. it is influenced by prior work experience and is associated with the pursuit of graduate education for both direct and indirect practice skill domains, and by length of time on the job, 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(2003). hhs could play a greater role in helping child welfare agencies recruit and retain staff. washington, dc: author. wehrmann, k. c., shin, h., & poertner, j. (2002). transfer of training: an evaluation study. journal of health & social policy, 15, 23-37. zlotnick, j. l., depanfilis, d., daining, c., & lane, m. m. (2005). factors influencing retention of child welfare staff: a systematic review of research. washington, dc: institute for the advancement of social work research. available from: http://www.socialworkpolicy.org/wp-content/uploads/2007/06/4-cwsrrfinalfullreport.pdf author note address correspondence to: donna j. cherry, phd, 203 lyle house, etsu, johnson city, tn 37614. email: cherryd@etsu.edu ______________ kate hendricks thomas, ph.d., is an assistant professor of health promotion, charleston southern university. sarah plummer taylor is a graduate student, school of social work, university of denver. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 312-322, doi: 10.18060/18537 bulletproofing the psyche: mindfulness interventions in the training environment to improve resilience in the military and veteran communities kate hendricks thomas sarah plummer taylor abstract: while clinical health services exist for service members with existing mental health conditions like posttraumatic stress, they are not stemming the rising tide of service suicides. a new approach to mental health intervention and suicide prevention in militaryconnected personnel is required, one that speaks to the participatory, hard-working ethos of military culture. social work and health promotion professionals working to prevent and treat mental health problems like depression and stress injuries must understand the confluence of warrior culture and mental health issues in the veteran community. while the research literature does not yet address this confluence issue directly, programs exist that provide guidance, and a mindfulness-based training protocol may provide the answer. the purpose of this review is to provide programming recommendations based on a review of successful exemplars in treatment settings, the limited evaluation of best practices currently available when working with this priority population in prevention settings, and a cultural analysis of the military veteran community. keywords: veterans, depression, mental health, resilience, mindfulness, warrior culture in 2011, the number of suicide deaths among active duty military personnel eclipsed the number of combat deaths. in contrast, before the wars in iraq and afghanistan, the incidence of suicide in active duty us service members was consistently 25% lower than in the civilian population (us department of veterans affairs, 2014). understanding the mental health problems facing american military veterans requires reviewing both the issue of depression and stress injury as well as the culture of the military population. depression in veterans can be categorized as both diagnosed and undiagnosed. stress and anxiety are symptoms of depression, and depressive conditions are closely related to trauma and stress-related disorders like posttraumatic stress (pts); the two often co-occur (american psychiatric association, 2013). diagnosed depression is subject to semantic debate in the military community, and symptom overlap between depressive conditions and stress injuries often leads to misdiagnosis or confusion about co-occurring conditions (us department of veterans affairs, 2014). professionals discussing the same stress injury symptoms may refer to pts or the less-popular posttraumatic stress disorder (ptsd), stress reaction, battle fatigue, operational stress, or shell shock (hoge & castro, 2012). these trauma and stress disorder diagnoses are often accompanied by symptoms of depression in varying degrees of severity, and this co-occurrence may or may not be understood, recognized, and diagnosed (american psychiatric association, 2013; hoge & castro, 2012). advances in social work, fall 2015, 16(2) 313 over 19 million people in the united states are reportedly diagnosed with depression, while others suffer without diagnosis (hendricks thomas, 2015). the department of defense and the veterans health administration have made combatting depression a major priority, specifically because it is a known predictor of suicide (bossarte, 2013). careful study of suicide risk in the military population compared to the general population shows that suicide risk is almost four times higher among young veterans than their non-serving peers, a difference made more statistically significant when analysis controls for age and time in service (bossarte, 2013). internationally, numbers indicate the same. a british study of recent combat veterans found the risk of suicide to be 2-3 times higher for military members than the general population, with the year immediately following discharge being a particularly risky time (ilgen et al., 2012). social workers, health promoters, and psychologists need to advocate for new treatment protocols and a paradigm shift to sharpen focus on prevention in order to change these numbers (spelman, hunt, seal, & burgo-black, 2012). while clinical health services exist for service members with existing mental health conditions like pts, they are not stemming the rising tide of service suicides. a new approach is required, one that shifts the focus towards training and prevention and speaks to the participatory, hard-working ethos of military culture (libby, corey, & desai, 2012). a research basis exists for mindfulness-based training protocols grounded in resiliency theory. studying resilience involves identifying the protective personality traits and behaviors that promote growth and looking for practical ways that programming can strengthen and encourage such traits (richardson, 2002). original research on resiliency theory came out of the fields of social work and social psychology, but unlike more problem-oriented theories, it came about after inquiry into characteristics demonstrated by survivors of trauma. researchers first began by asking the question of why some survivors fared better after difficulty than others who experienced the same events. based on three decades of research on children labeled “at-risk,” werner and smith (1982) found that 36% of those children were thriving and achieving success in school, professions, and relationships. they self-reported high levels of happiness and quality of life among other similar qualities and personality indicators, and werner codified these as resilient traits. children who tested as socially responsible, adaptable, tolerant, and achievement-oriented seemed to thrive, especially if they also had excellent communication skills and high selfesteem (werner & smith, 1982). researchers reported findings that were both practically and statistically significant regarding individuals’ ability to self-correct, demonstrate confidence, and exude sociability. these resilient characteristics helped them to thrive despite dire circumstances and trauma histories (heavy runner & marshall, 2003). key identifiable traits make a person resilient (hendricks thomas, 2015; richardson, neiger, jensen, & kumpfer, 1990). researchers interested in psychological and social determinants of health picked up the concept of resilience and have gradually extended its use from the domain of mental health to health in general. early work on resilience was concerned with the individual, but more recently researchers have become interested in resilience as a feature of whole communities. resilient traits can be taught, but this does not happen in a vacuum. cultural analysis to ensure applicability is vital. third wave resiliency theory works to apply hendricks thomas & plummer taylor/bulletproofing the psyche 314 questions of environment and culture to any study of individual resilient traits, with the goal being more effective cultivation of those traits by focusing on building them within supportive communities invested in doing the same (fletcher & sarkar, 2013; richardson, 2002). the dialogue surrounding resilience is well-suited to training of the military population. training protocols differ from treatment prescriptions and address the problem preventively, without the same stigma barriers. these protocols would be best implemented in participatory fashion in the training environment, rather than in treatment settings. veterans often reject patient identities, which creates a major barrier to mental health care with this population (hendricks thomas, 2015). to combat suicide rates and promote military and veteran mental health, a new approach is required, one that embraces peer education and speaks to a competitive and individualistic military culture (kobau et al., 2011; seaward, 2004). within the military community, much of the issue lies neither in lack of screening for depressive disorders, nor in the medical care available to service members suffering from depression. rather, the challenge is getting veterans to avail themselves of treatment services (currier, holland, & allen, 2012; elnitsky et al., 2013; koo & maguen, 2014). in one post-deployment study, 42% of screened reserve and national guard soldiers answered questions in such a way that they were flagged as being in need of evaluations and possible treatment (greden, et al., 2010). however, only half of those soldiers referred sought treatment. only 30% of those that sought treatment followed the basic program through the full eight sessions (greden, et al., 2010). part of the issue is the stated disconnect combat veterans feel from civilians, even civilian mental health professionals who treat the military population (malmin, 2013). service members and veterans often feel they are wasting their time dealing with people who cannot relate to their perspective and may actually feel more comfortable in the war zone (hoge, 2010). warrior subculture tends to promote the belief that acknowledging emotional pain is synonymous with weakness and specifically, that asking for help for emotional distress or problems is unacceptable (malmin, 2013). depressed veterans face inexorable stigma when it comes to care-seeking for a possible or confirmed condition because of the normative values held within the warrior subculture. culture is an important factor that shapes individual behavior through customized sets of attitudes, beliefs, and values shared by a large population (shiraev & levy, 2010). one’s surrounding social norms play a vital role in shaping the attitudes and beliefs commonly used to delineate and define culture. in insular and intense communities, normative values can become highly prescriptive and are enforced in a myriad of intangible ways. emotional norms become disciplinary tools, rendered more effective in communities with high levels of adherence to hierarchy (ahmed, 2010). especially in military communities that promote competitive individualism, this allows the expectations of others to weigh heavily on warriors’ shoulders. the result of such a firmly entrenched value system is shame associated with patient identity and mental health conditions. according to social worker and grounded theory researcher dr. brené brown (2012), warrior culture is opposed to vulnerability and sees outreach as weakness. yet, vulnerability is in fact critical to healing and selfknowledge (brown, 2012). advances in social work, fall 2015, 16(2) 315 program recommendations resilient trait cultivation through mindfulness mindfulness interventions teach participants unique methods for improving their own ability to regulate their nervous system and calm the body’s fear receptors (nassif, norris, gomez, karch, & chapman, 2013). the term has become in vogue, and many branded phrases are used to describe the sorts of mindfulness interventions used to treat patients (meredith et al., 2011). typically, such interventions involve still, seated meditation, physical movements of varying difficulty levels, and instructional seminars on individual peace, spirituality, and stress management (hendricks, turner, & hunt, 2014; seaward, 2004). interventions using mindfulness have met with tremendous success and have been used to improve mental health outcomes in a variety of populations (van der kolk, 2014). timing and framing rather than operating from a paradigm of post-incident therapeutic intervention, social workers and health programmers who wish to maximize efficacy within the confines of warrior culture must alter the conversation to one of preparation and training pre-incident. training in mindfulness focuses on building agency and resilience and can ameliorate the problem of stresses due to deployment both before and after the tour (ryan, 2012). creating a climate of peer-led training at both the unit and individual levels will reduce overall stigma against self-care practices because everyone participates, the program is led by trusted informants, and no one has to take on a patient role to participate. to train is to actively participate, and this is a wellness concept with which service members are already familiar. framing mindfulness training as a way to bulletproof your brain renders palatable a training opportunity designed to create more effective warriors with mental endurance; framing this as promotion of combat fitness, resilience, and mental endurance makes it accessible to the military population (ryan, 2012). creating training protocols that emphasize connection and compassion over disassociation is important to maximize success (us department of veterans affairs, 2014). by establishing mental fitness as another component of optimal combat readiness, we establish mindfulness training as a crucial component of mission preparedness and remove the stigma of mindfulness treatments for post-deployment troops who may be struggling with stress illnesses of varying degrees. the message can become directive. just as service members learn mission essential skills and train their bodies for arduous combat, we must adopt practices designed to train and promote a healthy mind. turning to notions of empowered self-care, health promoters can modify stress management therapies to help them resonate with the military community. protocols stress injury can certainly be a result of a one-time traumatic experience, but it can also be a result of chronically elevated hormone levels that cause the nervous system to remain constantly on alert. anyone subjected to recurring threats of death over time is at risk of developing issues because their stress response will be continually active. this hendricks thomas & plummer taylor/bulletproofing the psyche 316 abnormal stress reactivity and chronic stress response elevation becomes a stress injury, or pts in clinical circles. a fight or flight impulse that never goes away can wreak havoc on the human body. the research basis for specific somatic treatment protocols exists (van der kolk, 2014). mindfulness interventions have been highlighted in community setting studies as effective in reducing stress and anxiety (stevens, 2012) and in individual case studies looking at mindfulness and mood recovery (jouper & johansson, 2012). the department of defense has demonstrated the validity of yoga in wounded warrior recovery programs and is slowly expanding research partnerships with universities like the uniformed services university of health sciences and johns hopkins. studies on one particular yoga nidra protocol (called irest) at walter reed yielded positive qualitative feedback and resulted in a 3-week version being included in the treatment program at the deployment clinic (hoge et al., 2008). in san francisco, a qualitative study of 16 veterans with diagnosed ptsd completing an irest course yielded positive findings (stankovic, 2011). research from a team at the mind fitness training institute led to the development of mindfulness protocols in response to stress case studies conducted at the university of pennsylvania. the research team found demonstrable changes to deployed service members’ stress reactivity even when removed from the combat environment (jha & kiyanoga, 2010). using a case study approach, the team studied long-term cognitive changes in marines post-deployment, looking at how stress reactions either enabled or impaired mission effectiveness. they found that in iraq, the intensity made sense because the fast-moving landscape of the contemporary combat environment trains service members to respond quickly and to spend most of their time in elevated states of alertness. those states persisted up to two months after soldiers returned home. the team found the marines struggling with focus, anxiety, and emotional outbursts (jha & kiyanoga, 2010). emotional reactivity is a hallmark symptom of a stress injury and can cause a vicious cycle of problems for sufferers as they create rifts in their support relationships (hoge & castro, 2012). jha discovered that the reason for such reactivity is that long-term stress injury decreases working memory capacity (jha & kiyanoga, 2010). this higher-level brain function emotionally regulates humans, allowing for bonding and social interaction. working memory capacity also makes advanced, intellectual activities possible. losing working memory capacity can cause a host of emotional and behavioral problems and result in major issues with attention, focus, and regulation of responses. in studies, deployment adversely impacted the working memory capacity of study participants (jha & kiyanoga, 2010; vasterling et al., 2006). interestingly, high stress reactivity, naturally-occurring adaptation though it may be, hinders the ability of service members to perform complex missions and interact with foreign nationals. the modern battlefield involves interaction with civilians and allies as a matter of course (hoge, 2010). becoming overly reactive as a response to environment hinders that mission. for example, soldiers who screened positive for mental health problems were three times more likely to report having engaged in unethical behavior while deployed (jha, stanley, kiyanoga, wong, & gelfand, 2010). behaviors ranged from unnecessary property damage to noncombatant injury or harm, all diametrically opposed advances in social work, fall 2015, 16(2) 317 to the united states’ mission of winning hearts and minds. improving stress regulation allowed study participants to bond and interact with one another socially and made advanced, intellectual activities and focus possible (jha et al., 2010). the mind-fitness training institute team conducted a specific study on a company of marines during pre-deployment work-ups, seeking to answer the question of whether a mindfulness-based behavioral health intervention could improve the resilience of marine corps reservists preparing for a tour in iraq. employing a mixed-methods approach to the instrumental case study, the researchers studied one unit of 34 reservists. in addition to the normal training required before heading overseas, these reservists underwent a carefully tailored yoga and mindfulness program designed to improve their ability to manage both chronic and acute traumatic stress (teng et al., 2013). study results were statistically significant, as participants demonstrated that adherence to intervention protocol for 15 minutes each day exponentially improved their working memory capacity (teng et al., 2013). other researchers have followed the path of the mind-fitness team and attempted to validate specific interventions for the military community incorporating mindfulness practices. a 2011 rand analysis commissioned by the office of the secretary of defense conducted a systematic evaluation of existing programs in different branches of service. a noted finding of the study was that few programs currently being delivered in piecemeal fashion have any formal evaluation plan in place, though almost all those interviewed saw the need for longitudinal studies to determine the effectiveness of their programs (foran, adler, mcgurk, & bliese, 2012; teng, et al., 2013). peer leadership because of military culture insularity and lack of communication between bureaucratic treatment agencies, programs that seek to collaborate, bridge gaps, and use peer leadership meet with real success (greden et al., 2010). understanding culture and delivering a product specifically targeted to the military is important; allowing for participatory implementation of a given program is vital. in the military community, the best program implementation cases are found within participatory research frameworks. warrior subculture creates a powerful mandate for peer-to-peer outreach. any message aimed at decreasing stigma must come from members of the community in order to be deemed credible. recall that a major symptom of separating service members, especially after a combat deployment, is a feeling of disconnect from civilians (hoge, 2010). because warrior cultures have their own temperaments, they are typically exclusive and mistrustful of outsiders with different life experiences (malmin, 2013). a 2010 case study highlights one michigan pilot program’s experience with buddy-tobuddy peer support programs. a team from the university of michigan and michigan state worked with the army national guard (ang) to address the constellation of issues facing soldiers returning from a deployment to iraq. national guard soldiers, like all reservists, often face stresses additional to those faced by active duty troops. reservists do not come from as insular of a military community and may lack support services in civilian community settings. particularly because pts symptoms are very likely to be misread as hendricks thomas & plummer taylor/bulletproofing the psyche 318 behavioral deviance, stigma may be even more difficult to overcome in community settings removed from the active duty military component (greden et al., 2010). the university of michigan researchers also understood the need for audiencecentered communication and partnered with unit leadership to institute a program that was completely peer-led. this decision came out of the qualitative research they conducted in the unit prior to developing a program. interviewees said things like, “if you haven’t been there, you don’t get it” and “other veterans can be trusted” (greden, et al., 2010, p. 93). the research team considered concepts of warrior culture and sought to design a program that spoke the correct language, using an understanding of social norms to change the culture of treatment avoidance (greden et al., 2010). the researchers trained 350 peer leaders called “buddy ones” by the program. one returning unit participated in the program. preliminary results were encouraging. ninety percent of participants understood program intent, received regular calls and contact from their buddies, and felt comfortable with their trained peer. more than 20% were referred to formal treatment by their buddy, and that percentage all affirmed using the recommended services. as a pilot study, the michigan buddy program is light on long-range evaluation results but advances greatly the notion that attention to warrior culture, unit-specific language, peer leadership, and insider message delivery can aid in suicide prevention (greden et al., 2010). a focus on stigmareduction can lead to improved rates of treatment-seeking. when working within the boundaries of warrior culture and so improving treatment-seeking by reducing existing barriers is of paramount importance (hendricks thomas, turner et al., 2015; tanielan & jaycox, 2008). research and program efforts in the training environment must be participatory and peer-led whenever possible (hendricks thomas, plummer taylor, hamner, glazer, & kaufman, 2015). as has been demonstrated successfully in recovery communities, peer mentoring and leadership provides the interaction, camaraderie, and instructor credibility required to encourage participation in an intervention with potentially recalcitrant participants in very specific, insular, or marginalized communities (gosan & dustman, 2003). mindfulness programs, with their focus on individual agency and training to control the nervous system, have unique appeal to military-connected personnel who embrace notions of agency and actively avoid patient identity (hendricks thomas, 2015). by promoting mental fitness training, mindfulness programs work around the boundaries erected by warrior culture. in truth, warrior culture can distort critical thinking and good judgment in cases where warriors suppress emotional pain, fail to apply sound cognitive thinking, do not acknowledge real health or wellness issues, and intentionally choose not to seek help that might remedy a mental health problem. if strength is a virtue, becoming a patient is antithetical to being virtuous (malmin, 2013). conclusion case studies of existing programs provide the foundation upon which savvy programmers must build. health promotion professionals working to prevent and treat mental health problems like depression and stress illness must understand the confluence of warrior culture and mental health issues in the veteran community. while the research literature does not yet address this confluence issue directly, it contains ample evidence to advances in social work, fall 2015, 16(2) 319 support the development of a culturally-informed mindfulness training protocol. this protocol would be best implemented in participatory fashion in the training environment, rather than solely in treatment settings. current initiatives such as the air force resiliency training program, the army’s total force fitness, and the marine corps’ operational stress control and readiness program endeavor to train in the short-term and rely primarily on the classroom setting. importantly, the training programs involve information dissemination without the inclusion of performance metrics that commanders can rely upon to track unit progress. service members often reject patient identities, which creates a major barrier to mental healthcare in this population. to combat suicide rates and promote military and veteran mental health, a new approach is required, one that embraces peer education and speaks to the participatory, hard-working ethos of military culture. mindfulness-based programming has the potential to meet these needs, and may provide a blueprint for success in working with the military population. references ahmed, s. 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(1982). vulnerable but invincible: a longitudinal study of children and youth. ithaca, ny: mcgraw hill. author note address correspondence to: dr. kate hendricks thomas, charleston southern university college of health sciences, 9200 university ave, north charleston, sc 29406. email: kthomas@csuniv.edu, website www.katehendricksthomas.com http://dx.doi.org/10.1111/cpsp.12039 http://www.mentalhealth.va.gov/msthome.asp http://dx.doi.org/10.1001/jama.296.5.519 http://www.katehendricksthomas.com/ microsoft word 17. pope et al_17059_aging in rural appalachia copyedit final   ______________  natalie d. pope, ph.d., lcsw, is an assistant professor; diane n. loeffler, ph.d., msw, is a senior lecturer; and d. lee ferrell, msw, is a phd student; all in the college of social work at the university of kentucky in lexington, ky. the authors would like to express their appreciation for support from the ohio university college of health sciences and professions. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 522-537   aging in rural appalachia: perspectives from geriatric social service professionals natalie d. pope diane n. loeffler d. lee ferrell abstract: this paper uses qualitative methodology to explore the experience of growing old in rural appalachia. given the growing population of older adults seeking and utilizing services, it is important to understand the challenges and specific needs related to aging. within the context of rural appalachia, these challenges and needs may be different than those in urban areas or areas outside of the region itself. from interviews with 14 geriatric service providers in rural southeast ohio, the authors were able to identity three prevalent themes associated with aging in rural north central appalachia: scarcity of resources, valuing neighbors and family, and the prevalence of drug use. these findings suggest that preparation and ongoing training of rural geriatric social workers should include attention to topics such as substance abuse and strengthening social support networks that often exist in these regions. keywords: rural aging, older adults, appalachia, qualitative the 65 and over population is growing exponentially, in large part because of aging baby boomers. from 2007 to 2030, the number of older adults will have increased by 89%, with the population as a whole increasing 21% (houser, fox-grage, & gibson, 2009). between 1950 and 2000, life expectancy increased by eight years for men and women alike (kinsella & velkoff, 2001). in appalachia, 15.2% of the population is 65 or older, compared with 13.2% of the overall u.s. population. moreover, two-thirds of elders in the appalachian region reside outside metropolitan areas. in appalachian ohio, where the present study takes place, 15.7% of the population is 65 or older (pollard & jacobson, 2014). thus, while the aging population is growing at the same rate in appalachia and the rest of the country, appalachia has a higher concentration of older adults (haaga, 2004; pollard & jacobson, 2014). in a systematic literature review on attention to rural topics in social work journals, slovak, sparks, and hall (2011) found a low proportion of research-focused articles on rural populations. out of more than 3,000 peer-reviewed articles published between 2004 and 2008 in 14 top social work journals, only 71 articles had a distinctly rural focus. we support these authors’ conclusions that, “empirical studies about the issues and needs of rural populations and evaluations of interventions are needed to address gaps in services, improve programs, and assist in policy matters” (p. 435). in light of the scarcity of social work research on rural topics, this study focuses on a particular subgroup of rural america—older adults. this paper aims to provide an in-depth description of rural aging, pope, loeffler, ferrell/aging in rural appalachia 523   as viewed through the experiences of rural social service providers in a rural region of north central appalachia. the appalachian region of the u.s. is, for the purpose of research and inquiry, divided into sub-regions. in 2009, the appalachian regional commission (arc) refined the subregion classification, moving from a three sub-region classification (north, central, southern) to a five sub-region classification that includes north central and south central regions. these revised classifications reflect “contiguous regions of relatively homogenous characteristics (topography, demographics, and economics)” (arc, 2009, para. 2). thus, for this paper, statistics and discussion of the north central appalachian region are provided when available. the housing assistance council (housing assistance council [hac], 2012), however, prefers to look at central appalachia as a whole. thus, reference to central and north central appalachia are overlapping at times and both used in this paper. review of the literature there is much evidence documenting the poor physical health of appalachians (halverson, barnett, & casper, 2002; halverson, ma, & harner, 2004; smith & holloman, 2011), and of older appalachians in particular (behringer & friedell, 2006; haaga, 2004). the region has a greater percentage of older adults with disability and chronic conditions (halverson et al., 2004). compared to a disability rate of 36.8% among those 65 and older across the u.s., four out of ten elders living in appalachia are disabled. in appalachian ohio, rates of disability among older adults are higher than the state average (38.2% compared to 35.8%) (pollard & jacobson, 2014). cancer rates are also high in appalachia and the availability of treatment options (both preventive and therapeutic) are limited (baldwin et al., 2008; deskins et al., 2006; lengerich et al., 2005). chronic diseases such as diabetes are also prevalent in the region. diabetes rates are high for both older adults and the general population (barker, gerzoff, crespo, & shrewsberry, 2011; della, 2011). in general, rural communities are notoriously underserved with respect to health care providers and services (kropf, 2004) and alternative long-term care services are also scarce in these communities (buckwalter & davis, 2011). as a result, many often rely upon themselves, friends, and family members for a more informal level of care (blieszner, roberto, & singh, 2002; hayes, 2006). in addition to poor physical health, the region faces other challenges that likely affect those growing old in the region. high poverty rates plague the area. taken as a whole, the region’s poverty rate is 16.6%; in the north central sub-region, the poverty rate is 17.3% (pollard & jacobson, 2014). in north central appalachia, 9.7% of older adults are living in poverty, as compared to a 9.4% poverty rate for older adults across the u.s. (pollard & jacobson). in appalachian ohio, older adults are slightly less likely to be poor than older adults throughout the region (9.0% live in poverty) yet are more likely to be poor than older adults in the state of ohio as a whole (7.8% live in poverty) (pollard & jacobson). given high poverty rates, it is not surprisingly that many young people are moving out of the small towns and communities in search of work and opportunity (haaga, 2004). this contributes to a lack of available and qualified adults to work in long-term care and other health-related jobs within the region. advances in social work, fall 2014, 15(2) 524 the social and cultural milieu of the region may also affect health perceptions, experience of illness, and preventative and curative behaviors (furnham, 1994). older appalachians have a unique culture that likely affects their experiences with aging and long-term care. the “deep sense of place” relationship that appalachians often have to their communities (coyne, demian-popescu, & friend, 2006), coupled with a more widespread desire to age in place might be detrimental to older adults accessing adequate medical care (aarp, 2000; alley, liebig, pynoos, banerjee, & choi, 2007). the appalachian characteristic of living in the “here and now” may prove harmful if it prevents forethought and keeps adults from making concrete plans for later life (hayes, 2006). rather than preparing for potential care needs, some middle age and older adults rely on reciprocity from family and friends. relying on close relationships for informal care enforces a tendency not to ask for help (particularly in the means of formal care) and the expectation of others to offer help; this can be particularly detrimental in receiving timely and appropriate care (hayes, 2006; pope, 2013). growing old in rural areas may provide different challenges to elders and their families than aging in large metropolitan communities. thus, this study sought to better understand the challenges and specific needs related to aging in rural appalachia. by asking service providers to share their experiences and stories, we are better able to think about how to develop interventions and services that will support effective service delivery systems in our small towns and communities. given that appalachia is distinct in terms of its geography, history, culture, and current social problems, it is important to consider the experiences of rural appalachian professionals apart from that of rural professionals in other regions. the region has distinct cultural traditions (lengerich et al., 2006) and although some may put appalachians at risk for health and social consequences in late life (e.g., independence and fatalism), other values and beliefs may be protective (e.g., strong family ties and religiosity) (coyne et al., 2006; hartley, 2004). methodology this study utilized qualitative methodology to allow for the voices of the study participants to be heard and for themes to emerge from their experiences. because little is known about rural aging—and specifically from rural social service providers who engage with and serve rural elders—this grounded approach was preferable. a distinguishing feature of qualitative inquiry is that it “elevates context as critical to understanding [a phenomenon]” (patton, 2002, p. 63). north central appalachia, specifically rural southeast ohio, serves as the study setting and its context is vital to this research. sample selection and recruitment nonrandom, purposive sampling was used to locate participants who: 1) self-identified as a direct service provider; 2) provided services to older adults currently or within the past year; 3) provided services to elders living in rural appalachia; 4) possessed at least one year’s experience with older adults in order to be able to reflect on their experiences; and 5) lived and worked in southeast ohio (as defined by the ohio environmental protection agency, n.d.). the first author utilized professional and personal contacts to reach out to pope, loeffler, ferrell/aging in rural appalachia 525   potential participants who met the inclusion criteria. initial contact was made through either an email or phone inquiry about the professional’s potential interest in the project. fourteen geriatric social service providers, ranging in age from 24 to 69, comprised the final sample (see table 1). one social service professional who met the criteria for inclusion chose not to participate due to time constraints. participants averaged 13 years of practice experience and 11 had more than 5 years of experience working with older adults. three self-identified as supervisors of other social workers. all participants were white, all were female, and all but two worked full time. all of the professionals had attended some college; six had master’s degrees and six had completed undergraduate programs. the educational backgrounds of participants included six studying social work, two in nursing, and two with a background in counseling/ family studies. six participants worked at an area agency on aging, two were in a hospital, two worked in adult protective services, and two were in a community crisis center. other work settings were an agingfocused nonprofit and private practice with one participant at each. data collection this research was conducted following approval from the ohio university institutional review board. between august, 2012 and may, 2013 the first author collected data through semi-structured interviews that were digitally recorded and transcribed. some of the questions included, “what’s it like to age in this community?” and “what are some of the values common to this area about care for older people?” prior to each interview, participants signed a consent form; this included the purpose of the study, researcher contact information, audience for which the study is intended, and explanations of the voluntary nature of participation. all participants were assigned a pseudonym and names of towns mentioned by participants were changed. participants were offered a $35 gift card to a vendor of their choosing. interviews averaged one hour in length. data analysis grounded theory methods were used to analyze the data, specifically the techniques of coding and constant comparison. the first author read each of the 14 transcripts several times to get a sense of the data in its entirety. during initial reading of the transcripts, open coding procedures were employed, where codes were created from what was present in the data. after identifying initial codes in the transcripts, the first author moved to focused coding, which involved making decisions about what codes were most relevant to the research questions, discarding codes that were not relevant, and combining earlier codes that were similar. constant comparison was used to look for similarities and differences in categories across the transcripts (charmaz, 2014). to facilitate this, segments of data pertaining to participants’ perceptions of rural aging (e.g. attitudes, beliefs, relevant experiences, statements) were copied and pasted into a separate document using microsoft word. sorting the data into categories that emerged (i.e. informal support, limited health care resources, drug use) and assigning codes to segments of data occurred simultaneously and were iterative processes. pope, loeffler, ferrell/aging in rural appalachia 526    table 1. participant characteristics participant age race educational background program of study length of time employed at current job part-time/ full time job title lydia 46 white bachelor’s degree social work 21 years full-time supervisor hospital social worker tatum 35 white bachelor’s degree social work 10 years full-time hospital social worker jacquelyn 52 white master’s degrees social work, economics 4 years part-time director of operations amy 36 white master’s degree family studies 14 years full-time supervisor supervisor courtney 38 white bachelor’s degree nursing 2 months part-time service coordinator taylor 24 white bachelor’s degree social work 2 years full-time case manager marge 69 white associate’s degree nursing 6 ½ years part-time service broker joanne 65 white master’s degree counseling 25 years part-time therapist, grief counselor karen 62 white master’s degree social work 24 years full-time supervisor terri 48 white bachelor’s degree philosophy 17 ½ years full-time case manager/ assessor linda 51 white some college marketing 12 years full-time program coordinator donna 43 white bachelor’s degree social work 5 years full-time case manager maggie 38 white master’s degree counseling 5 ½ years full-time case manager carolyn 62 white master’s degree applied behavioral science 20 years full-time supervisor advances in social work, fall 2014, 15(2) 527   member checks were used to help ensure rigor (bogdan & biklen, 2007; merriam, 2009). after preliminary interpretations of the data were developed, the first author sent a summary of the findings to seven participants via email. three participants provided feedback on the common themes and adjustments were made based on their feedback, such as clarifying the label of a theme or category. findings three themes were identified concerning rural aging, as viewed from the perspective of social service providers in a rural region of north central appalachia: a scarcity of resources, a valuing of neighbors and family, and a high prevalence of drug abuse in the area. these themes are discussed below. scarcity of resources aging in rural appalachia is influenced by limited access to healthcare and social services, limited technology, poverty, and the distance one must travel to access care. maggie, who provided case management and mental health counseling at an area agency on aging, discussed the trouble that many clients have in accessing healthcare services due to geographic isolation, poverty, and a shortage of medical care in the region: the transportation to medical appointments is a big issue. it’s gotten better recently in the rural area, but because a lot of the specialists are so far away, they have to drive. [clients] have to somehow get themselves there. and they get max $700 a month and they’ve got to figure out how they’re going to get to the doctor and how they’re going to buy their groceries. you know, the nearest grocery store for some people is twenty miles away. participants described their rural communities as having few medical doctors, resulting in clients having to commute to nearby large cities to receive specialized healthcare services. a second example of scarce resources that was mentioned was insufficient social services for rural elders. lydia, a hospital social worker, asserted that many older adults in her community are “geographically isolated” and many aging-related programs serve elders living in the city limits and not those living in more remote areas of the county: “[with] the senior programs we have—who are the folks that belong to them but the town folk?....as hard as we’ve tried over the years…to reach out to these outlying areas— those people don’t come in to town.” social isolation is often a consequence of scarce resources. a lack of transportation or access to social services can lead to limited interaction with other people. linda, a program coordinator at an area agency on aging, has observed this over her 12-year tenure in the agency. she stated that “loneliness [which] then leads to depression [which] leads to all sorts of ailments” was common for her clients. terri, a case manager with more than 17 years of experience at an area agency on aging, discussed the limited technology where she lived and worked. advances in social work, fall 2014, 15(2) 528 where i live, [there is] very little cell phone reception – actually no internet unless you want slow dial up through the phone or an expensive satellite. we don’t have cable, we don’t have broadband, you know, we don’t have the pieces that a lot of these things are dictating now what you have to have access to. we still have a lot of technology deficits in this zone. accessing the internet was especially important for terri’s clients, who participated in a consumer-directed medicaid waiver program where they, or their authorized representative, assumed responsibility for managing their own in-home services. these older clients act as the “employer of record” for their care providers and manage hiring, scheduling, and payroll duties for their service providers. an unreliable internet connection was a real hindrance for older adults or authorized representatives who need to access the web to input time sheets and enter data into an online system. lastly, intergenerational poverty was mentioned by several of the participants and is closely linked to the access issues facing many rural elders. for example, donna, an adult protective services case worker, observed: “you get out in rural areas where they don’t live with running water, they don’t have electricity…i’ve seen [clients who] use buckets to go to the bathroom. they’ve just lived this way their whole life.” despite many participants describing a lack of resources in their rural area, two participants expressed different sentiments about this issue. interestingly, both of these women worked at community crisis centers where the bulk of their job entailed connecting clients with community agencies and services; these two women also worked in the same town. when asked what it was like for older adults in her small town, courtney, a service coordinator, said simply: “i think aging around here, i mean …i think it’s pretty good, actually.” she described close immediate and extended families and local church and civic organizations that were concerned about their older community members. similarly, marge, a service broker, said, “i think resources are excellent around here. i think it’s just that people just need to know the right questions to ask or the right person…but they’re out there.” the divergent perspectives of courtney and marge indicate between-site variation that emerged from interviewing aging services providers at different communities in southeast ohio. their comments also relate to the next theme to be discussed—the valuing of neighbors and families. valuing of neighbors and family an aspect of aging in appalachia that might counterbalance the poverty and scarcity in resources is the importance placed on neighbors and family. taylor, the youngest participant in this study at age 24, spoke about informal support from fictive kin that is often present in rural communities: i think that in small towns…a lot of people know people and have known their families for a long time. so [elders have] that informal support of maybe somebody who was—maybe it was somebody who was best friends with your mother—and so now they’re going to a step up and take care of them. i think in small towns and in rural areas that happens a lot. i think that people are more aware of what’s going on with everybody because everybody knows everybody. pope, loeffler, ferrell/aging in rural appalachia 529   jacquelyn, a social worker and director of an aging-focused nonprofit, shared similar observations from her own experiences. in this region, we’re going to take care of each other. i think it’s really significant and i see that happen at all socioeconomic levels…. my mom and grandma are good examples of that. they’ve been adopted by i don’t know how many people helping to take care of them. i think that goes on a lot. in addition to neighbors providing informal support to older people, participants also observed strong attitudes toward filial responsibility and close family ties. amy, a supervisor with adult protective services, said simply, “families stick together in appalachia as far as taking care of each other.” she went on: [they] may not be taking care of each other to the extent that i would think that it needed to be done, but you do see families saying “i’ll take him”, “i’ll take him”, “i’ll take him.” more so than just, “well, just place them [in a nursing home].” courtney, a service coordinator and registered nurse, observed older adults in her area receiving much support from extended families: “there seems to be lots of, ‘you know, my daughter comes in and does that for me’ or ‘yeah, my niece does that for me.’” likewise, tatum, a hospital social worker, shared, “a lot of times it’s…like mom has two acres and everybody’s got a trailer or a camper or something on the property and so they kind of stick together that way and they’re very protective of each other.” terri related what she has heard from adult children regarding parents’ expectations for caregiving: several [clients] have indicated, “you know, mom and/or dad, they want me to take care of them forever, they want me to promise them that they’ll never be put in a nursing home and i’ve made them that promise. but you know, i just can’t do it anymore.” i hear a lot of that. there’s a lot of respect still in this area through our culture and the way that families are pretty tight still. carolyn, a supervisor with more than 20 years of experience working at an area agency on aging, also spoke to this: “i think that a lot of family feel that they have to be responsible for the parent.” despite cultural values that support expectations for family caregiving, several participants commented on the incongruity between filial responsibility and the reality of young people leaving the small towns. karen, a supervisor at an area agency on aging, shared: i think the biggest thing that i’ve seen as far as the planning [for aging] is the tendency for the older generation to make assumptions based [on the idea] that you take care of the seniors in your family. that’s their value and the younger generation doesn’t have the ability to do that all the time because they’ve left the area because there are no jobs. [young people] have had to go wherever to get them and they’re not available to provide support and assistance that they would love to give [but] they just physically aren’t there. so, it’s not even a matter of a different value system—it’s a matter of a different reality. advances in social work, fall 2014, 15(2) 530 linda provided a similar outlook. in her town, increasing numbers of elders were being cared for by long-distance caregivers; she attributed this to the fact that many young adults had to relocate to larger towns and cities to access financial and educational opportunities. linda observed, “there’s no work here. everybody’s leaving to go find work and now everybody’s running off to the big city to find jobs and pursue their dreams or what have you.” prevalence of drug abuse a third, somewhat surprising theme related to aging in a rural environment that emerged was the perception of rampant drug abuse problem in the region. abuse of both illicit and prescription drugs is a public health concern in many rural communities that affects older adults and their family members. maggie, who provided case management and counseling services through an area agency on aging, shared about clients being addicted to both illicit and prescription drugs: [drug abuse] is starting to become pretty widespread in this area. we have lots of conversations about it. one of the workers actually had a consumer overdose on heroin…. we’ve had some arrested multiple times for drug usage and selling their [prescription] drugs. they are no longer in the program. participants also shared about older adults who profited from selling their prescription drugs. linda described what she had heard from other case managers in her regional office: “i’ve heard of seniors selling their meds so they can buy groceries.” similarly, karen had recently learned of older adults renting out their kitchen tables for people to use for selling drugs. drug use affects not only rural older adults who misuse, abuse, and sell them, but family members who have a significant role in these elders’ lives. carolyn, a supervisor, shared about the shift she had seen in her community and her work with older adults: some of the issues we’re having are family members who are taking advantage of the parent. some of them are the individual who has had a history of alcoholism or has become drug dependent. you know…lots of things are coming up that we’ve never had to deal with before. it’s a whole new phase of case management! joanne, a social worker who specialized in caregiver support services and hospice, described what she had seen in her work: “drugs are…a huge problem with family members or neighbors stealing them. people protect their family member and go without the needed drugs at times. they are not going to turn them in.” likewise, donna, an adult protective services case manager, mentioned family loyalty characteristic of appalachians and how this affected elders and their interactions with relatives abusing drugs: “with the drug abuse in the appalachian population—it’s amazing. you have the elder population who doesn’t want to say anything. they’re never going to do anything against their grandkids. they’re never gonna’ do anything like that.” for participants in this study, drug abuse was not an issue typically thought to affect older adults. however, appalachian elders are not immune from the drug abuse epidemic in the region, and health and social service providers have to adjust their approach to pope, loeffler, ferrell/aging in rural appalachia 531   working with older clients and their families in light of this issue. carolyn said, “there’s a lot of drug and alcohol problems that never existed twenty years ago…. we’re having to branch out and look at things differently… [and] look at issues and situations that we had never had to deal with before.” similarly, this comment from karen gives additional insight into how drug abuse among the older population affects geriatric professionals: [we have] service providers refusing to go in [to homes] and provide care because of the family members. it’s seniors who are doing without the medications they need because family members borrow them. it’s physicians being reluctant to prescribe the medications that individuals need because of certain assumptions. although not affecting the majority of clients, abuse and misuse of prescription and illicit drugs was an issue that these social service providers were facing. discussion the purpose of this study was to learn more about rural aging, as viewed through the experiences of social service providers in a rural region of north central appalachia. given that aging in appalachia might look different than growing old in other regions of the united states, this study adds to the literature by having participants describe the experience of aging in rural appalachia based on their work experience in geriatric social services. themes surrounding growing old in this region were scarcity of resources, a valuing of neighbors and family, and a high prevalence of drug abuse. it is not surprising that high rates of poverty and scarce health and social services were mentioned often by participants interviewed in this study. high rates of chronic illness and disability that are present among older rural elders are exacerbated by shortages in health and social services in these regions (smith & holloman, 2011). poor health outcomes are highly correlated with factors such as lower incomes and educational attainment which are more widespread in rural areas of the united states (behringer & friedell, 2006). additional burdens for rural older adults living with chronic conditions include less access to physicians, hospitals, and routine medical care. although 25% of the u.s. population lives in rural areas, only 10% of physicians practice in these regions (barley, reeves, o’brien-gonzales, & westfall, 2001). those living in rural communities are often geographically isolated, lack public transportation options, and have to travel long distances to access health and social services (hartley, 2004; krout, 1998). in the rural healthy people 2010 survey, access to quality health services (including primary care) was ranked as the top rural health priority with about 75% of respondents naming access as a priority (gamm, hutchison, bellamy, & dabney, 2002). in this study the importance of informal support from family and friends was a second prominent theme regarding aging in small communities. historically, children of older adults would assume the responsibility of informal caregiving of their parents. this is often done in conjunction with raising their own children. an issue that complicates the ability for aging parents to receive care from their adult children is the rural population loss through outmigration of young people. one effect this may have on elders is that it limits the availability of unpaid family caregivers to provide assistance when chronic illness or disability necessitates the need for care (carter & wang, 2006). this was reflected in advances in social work, fall 2014, 15(2) 532 participant comments about the conflict between attitudes towards filial responsibility for aging relatives and the reality of potential family caregivers relocating to larger cities. however, participants described support provided to elders not only by family, but also by fictive kin. this supports other evidence of a social structure in appalachia based on fictive kin (e.g., close neighbors, fellow church members) as well as blood relatives, possibly because in isolated communities these are the individuals with whom one usually interacts (russ, 2010). these extended family networks may be a resource for older adults in the region whose blood relatives are no longer living nearby. another effect of outmigration is the loss of the “professional and leadership skills” that “young and educated people leaving for more prosperous areas and opportunities” take with them (hac, 2012, p. 67). thus, within rural central and north central appalachia there may be a loss of both familial informal and skilled formal caregivers for the aging population. finally, an unanticipated theme that emerged about aging in rural appalachia was how prevalent drug abuse in the region influenced older adults and their well-being. like stories from participants in this study, basta, della, and ashlock (2013) found that the selling of prescription drugs in appalachia is closely linked to the depressed economy; individuals often resort to selling their prescriptions to pay for basic needs like food and utility costs. older adults, they found, were also not excluded from drug abuse. one participant in their recent study commented: “…the sad part of it is people my age, which is in the 60’s, there has been drug overdoses from that age because they got hurt in the coal mines, they got hooked on drugs” (basta et al., slide 13). certainly a factor in substance abuse among rural elders is the fact that older people use prescription drugs about three times more often than the general population. representing only 13% of the u.s. population, individuals 65 and older consume 25 to 33% of all prescription drugs (richardson & barusch, 2006) and 25% of elders are taking psychoactive medications with abuse potential (simoni-wastila & yang, 2006). research has also identified a strong relationship between therapeutic exposure to opioid analgesics and abuse of these drugs (cicero, surratt, inciardi, & muñoz, 2007). data suggests that rates of prescription drug abuse in appalachia are congruent with the rest of the country—5.6% and 5.9% respectively (arc, 2008). however, high unemployment rates may influence prescription drug use in rural north central appalachia (thornton & deitz-allen, 2010). the ease with which drugs are made available by physicians (leukefeld, walker, havens, leedham, & tolbert, 2007; schoenberg, hatcher, & dignan, 2008), influence from peers and families (leukefeld et al., 2007), and cultural acceptance of drug misuse (leukefeld et al., 2007) may also contribute to prescription drug abuse in the region. in addition, the region has witnessed a recent crackdown on the prescription drug abuse trade by state and local officials. for example, in scioto county, ohio (within the geographic boundary of the current study), heroin use is on the rise and has been since the community came together to eliminate “pill mills” and ameliorate the prescription drug epidemic (roberts, 2012). limitations a central aim of qualitative research inquiry is to provide in-depth descriptions of a phenomenon, using a small sample of information-rich cases. therefore, the findings of pope, loeffler, ferrell/aging in rural appalachia 533   this study should be cautiously applied to other groups. these participant descriptions of rural aging will not necessarily hold true for all rural and/ or appalachian regions of the us. in addition, study participants were limited to direct service providers for older adults. potential participants might have not responded to the recruitment flier because they did not identify with the selection criteria or the language used in eligibility requirements. despite these limitations, this study highlights the voices of 14 seasoned geriatric social service providers, because the focus was to understand rural aging from their perspectives. implications for social work research, education, and practice this study adds to the developing knowledge about aging and aging services in rural areas of the u.s. given the small regional focus and sample size, this research can serve as a jumping off point for future work aimed at understanding the realities of growing old in the 21st century. based upon results of this study, it seems that future research in this area must address the following: 1) the complexities of familial relationships and aging, including the role that fictive kin may play in the lives of older adults, 2) access to services and service discrepancies between rural and urban communities, 3) how older adults engage in/utilize technology and what barriers exist related to the burgeoning tech-driven models (e.g., tele-medicine, web-based services) in rural communities, and 4) substance abuse—particularly prescription drug abuse—and aging. this study revealed that older adults are very much impacted by substance abuse and misuse. while social work students often study substance use and misuse, they may not be prepared for the realities of how substance abuse affects older people and their family caregivers. resources for instructors interested in infusing gerontology content into substance abuse courses are available online at the council on social work education gero-ed center (http://www.cswe.org/teachinginfusion.aspx). by challenging common beliefs about substance abuse in the classroom, students can be better prepared to engage with the complexities in their caseloads. findings from this study also highlight the need for awareness and attention to be brought to the drug issue in appalachia – particularly its effects on the older rural population. future research needs to explore the ways in which older adults engage in illicit activity with prescription drugs, the vulnerability of older adults in prescription drug fraud/sales, and the protections available to older adults who may be victimized, such as those who have their prescriptions sold or stolen. the grassroots efforts of those in scioto county, ohio (roberts, 2012) serve as an example for communities looking to fight the prescription drug epidemic. campaigns to oppose “pill mills” should certainly consider the needs of older citizens, as well as the susceptibility of this group to prescription drug abuse. moreover, social workers should be at the center of these efforts. the knowledge gained from this study can also help social work educators prepare students to be effective in working with older adults in rural agencies and communities. for example, participants in this study identified family and fictive kin as important resources for elders in their small towns. students need to be made aware of the complexities of family dynamics and the role that family (fictive and relational) plays in the aging process. while many rural regions in the u.s. have been characterized by their strong social support networks, it is crucial to have culturally competent and sensitive advances in social work, fall 2014, 15(2) 534 social workers in such regions who can build upon the strengths of such social support networks. in order to get a strong cohort of skilled social workers in the rural areas who are also interested in older adults (especially at the masters level), it would advantageous to extend the benefits of loan repayment programs to geriatric social workers practicing in rural regions, like the loan repayment options available 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(2010). substance abuse, unemployment problems, and the disparities in mental health services in the appalachian southwest region. journal of human behavior in the social environment, 20(7), 939-951. doi:10.1080/10911359.2010.516690 author note address correspondence to: natalie pope, ph.d., university of kentucky, college of social work, 610 patterson office tower, lexington, ky 40506. email: ndpo224@uky.edu microsoft word raymond_international programs_copyedit final ______________ frank b. raymond, ph.d., licsw, acsw, is dean emeritus and distinguished professor emeritus at the college of social work, university of south carolina, in columbia, sc. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 143-162 the development of international programs in a school of social work frank b. raymond abstract: during the last decade increasing numbers of schools of social work have adopted an international mission and have developed a variety of activities to reflect their global perspective. in earlier years, however, relatively few schools expressed a global mission, offered coursework on international social work, provided field placements or other opportunities to expose students to international learning, or extended components of their academic programs to other countries. an early leader in doing such things was the college of social work at the university of south carolina (cosw), where the author was privileged to serve as dean for 22 years (1980-2002) when many of these developments occurred. this paper will discuss how this school acquired an international mission and developed various programs to manifest this commitment. the paper will describe, in particular, the college’s signature achievement in international social work education – the development and implementation of a koreabased msw program. the cosw was the first school of social work in the us to offer a master’s degree in its entirety in a foreign country. it is hoped that the recounting of this school’s experiences will offer guidance to other social work education programs that are exploring ways of expanding their international initiatives. keywords: international social work, international education, globalization, social work education, academic partnerships, study-abroad the various international activities that have taken place at the cosw over the past 25 years have occurred in response to the changing world situation and the consequent need for students to be educated appropriately for service in this new world order. the first part of this paper will therefore discuss these global changes and their implications for social work practice and social work education. the need for a contemporary global perspective and mission during the past several decades the world has experienced several social changes that have been radical, drastic and far-reaching. these major social changes have impacted every nation, altering their culture, economy, and socio-political institutions. they have required paradigm shifts, or a re-ordering of the constellation of concepts, values, perceptions and practices that form society’s vision of reality. these changes are best understood as transformational changes in the sense of metamorphosis, whereby an organism (like a butterfly) becomes something new, remarkable and dramatic; in such changes the organism has not been replaced, but has evolved from one state to another. throughout earlier periods of history radical social changes occurred less often, took longer to unfold, and were sometimes confined to nations or continents. however, during the past 20-30 years several social changes have taken place that have affected the entire world and they have transpired rapidly. these transformational events have included advances in social work, spring 2014, 15(1) 144 climate change, globalization, innovations in technology, and developments in biomedical sciences and health care. raymond (2011, 2013) has described how these four changes have had major impacts on challenges, roles and practices of professional social work in the united states and in other countries. in order for social workers to practice successfully in light of these major social changes they must have a global perspective. all social workers – from those who practice in small us rural communities to those who work in ngos in other countries – are personally and professionally affected by these radical global changes. the clients they serve are also impacted by these changes. social workers must therefore embrace a relevant world-view paradigm in order to engage in appropriate and effective practice at either the micro or macro level. this global perspective requires that social workers move beyond a parochial local, regional, or even national perspective and to understand that their clients are directly affected by what happens in other parts of the world. it is essential that social workers understand that “the world is flat” (friedman, 2005) and that the lives of all people throughout the world are interconnected in a multiplicity of ways. events in other nations such as war, economic crises, trade agreements, population movements, and climate changes influence the lives of people in all countries and have implications for their social service needs. beyond understanding social work practice from such a global perspective, the radical social changes that have occurred require social workers to adopt a more global mission. the world is now our “service area,” and increasing numbers of social workers will practice abroad in coming years. it is important for the field of social work to have such a world vision of practice. global developments have resulted in the growing need for micro-level and macro-level social workers to serve in more countries, to work with new client populations, to provide new types of services, and to respond to the emergence of new problem areas. there are many types of assistance social workers can provide to help improve the overall health and well being of people in other nations. now, more than ever, the social work profession has a critical role to perform in helping those who are in need around the world, and this should be a commitment of our field. the millennium development goals, which were unanimously adopted by all of the 191 member states of the united nations in 2000, help frame the global needs that social work should be concerned with during the coming years (united nations, 2010). these goals, which the un committed to achieving by 2015, are as follows: 1. to eradicate extreme poverty and hunger; 2. to achieve universal primary education; 3. to promote gender equality and empower women; 4. to reduce child mortality; 5. to improve maternal health; 6. to combat hiv/aids, malaria, and other diseases; 7. to ensure environmental sustainability; and 8. to develop a global partnership for development. there are numerous jobs that professional social workers can perform in their efforts to achieve objectives such as those set forth in the millennium development goals. raymond/development of international programs 145 these include, among other roles, serving as advocates, community organizers, policy developers, organization administrators, lobbyists, social development experts, relief agents, crisis intervention experts, therapists and counselors. as the need for social work services continues to grow globally, the various types of professional roles for social workers also continue to increase. obviously many of these new roles will require that social workers possess special sets of knowledge, values and skills. the social work profession has never before offered so many possibilities for service, both in the us and abroad. indeed, the bureau of labor statistics (2010-11) has projected that in the us, alone, the field of social work will be one of the growing areas of employment in coming years. the need to prepare students for practice in a changing global environment the provision of appropriate and effective social work services to respond to problems and needs that have resulted from radical world changes obviously demands social workers who are adequately prepared for these new roles (see link & ramanathan, 2010; pawar & cox, 2010). all schools of social work must rise to the challenge of educating students to respond to the new client needs of the 21st century. this means that social work educators must have a clear understanding of major changes that are occurring in the world and their impact on social work. it also means that schools should prepare all students to provide services in a global, interconnected society – to engage in what is often referred to today as “international social work.” in earlier years, international social work was seen by some writers as a discrete area of social work practice, and by others as programs of social work with an international focus (including those carried out by intergovernmental agencies or by non-governmental agencies). today, however, the term “international social work” is used increasingly to describe social work practice within the context of globalization. healy and link (2011), in their comprehensive handbook of international social work, also reflect this broader viewpoint. their position is that today’s social workers necessarily work with service users and colleagues from diverse cultures and countries, and that they therefore need to operate within an expanded worldview. they also contend that globally relevant concepts such as human rights, development, and inclusion offer new perspectives to enhance one's understanding of policy and practice. their book, which contains an extensive collection of content by authors from throughout the world, demonstrates the integral and necessary nature of international social work knowledge to all areas of practice, policy, and research. this conception of international social work from a broader perspective suggests that all schools of social work must prepare students for practice in a changing global environment. the council on social work education (cswe), the accrediting body for social work education programs in the us, now mandates the inclusion of international content in the curriculum. cswe has signaled its intent to do more to promote a global perspective in social work education. it is noteworthy that the theme of the organization’s annual program meeting in dallas, texas in fall 2013, was “global social work–the advances in social work, spring 2014, 15(1) 146 world is here.” clearly cswe is advocating for schools to see the “big picture” of global social work and prepare students for practice within this new paradigm. cswe has also provided guidance to schools to assist them in developing such programs. cswe's commission on global social work education developed a white paper on this topic that was adopted by cswe as its official policy statement on international social work education (council on social work education, 2008). this document describes, among other things, the history of international social work education; the goals, knowledge base, values and beliefs of this approach; the primary educational models used; and important curricular issues. the paper also provides an extensive listing of resources for schools of social work to utilize in developing international education programs. it is now incumbent upon schools of social work in the us to follow the recommendations and guidance of cswe and develop programs that will equip their students with a global vision and with the knowledge, values and skills needed to practice effectively in an interconnected and rapidly changing world. more and more schools are meeting this challenge, although to varying degrees. it is encouraging that increasing numbers of schools of social work are incorporating a global component into their mission statements. these include urban and rural schools, small and large programs, public and private institutions, secular and church-related schools, and programs at all levels of social work education. many schools also reflect their global missions in their statements of their program rationale, goals and objectives. in addition, more schools are designing or redesigning their curricula so that their educational programs will better accomplish their global purposes. these curricula usually integrate content on social work in a global environment into various courses. furthermore, the curricula of a great many schools include specifically designed course offerings that focus on different aspects of global social work. regardless of how a school implements its international curriculum, the focus should be on imparting to students the knowledge, values and skills for practice in a world that is becoming increasingly global. as schools endeavor to develop globally-related programs, they must do so within the context of major changes that are occurring in the world environment. examining the impact of current social changes can provide a frame of reference that will lead schools to focus on a variety of other topics that are critical to developing an international perspective – teaching students an understanding of immigration issues; developing in students appropriate attitudes towards diversity; preparing students for services to newlyemerging population groups; equipping students to meet the changing needs of traditional population groups that are expanding; developing in students the knowledge and skills to engage in social advocacy on behalf of specific populations; preparing students to engage in social development; etc. no doubt there are a number of frameworks schools can use to build a curriculum around the context of current social changes. raymond (2011, 2013) has described one model whereby schools can develop curriculum content around four themes: the impact of technology, globalization, climate change, and advances in bio-science and health care on the practice of social work. raymond/development of international programs 147 many schools have not only included international content in the classroom curriculum, but have also done other things to help students develop a global perspective and acquire knowledge and skills to engage in practice within an interconnected world. these activities include, for example, offering international field placements, providing study-abroad opportunities for students, arranging international student exchanges, providing international faculty exchanges, developing partnerships with foreign academic institutions, and offering online courses collaboratively with faculty and students in other countries. such activities are effective means of extending a school’s global mission. cross-cultural programs, in particular, can be valuable because of the mutual benefits they provide to parties in the participating countries. one school’s experience in developing international programs the college of social work at the university of south carolina was an early leader in developing international activities to address new and developing needs resulting from global development, to equip students for practice in an increasingly interdependent world, and to provide current practitioners with learning experiences that will enable them to provide better services in a global environment. given the other competing demands of social work education, the cosw did not make sweeping programmatic changes overnight. rather, in response to developing educational needs and opportunities, the college gradually created a number of activities aimed at meeting its larger global objective. (it should be noted that the college did these things within the context of the broader university's mission statement, which included an international component.) these activities are described below. curriculum content since the early 1980s the college of social work has offered curriculum content on international social work. the cosw began by making a concerted effort to incorporate international content into a number of its normally-required courses, both as substantive content and as illustrative material. in addition to including such content within existing courses, for over thirty years the college has offered specific courses that have a significant focus on international subjects. for example, the cosw developed an undergraduate course, titled social work in other nations. this course examines social welfare systems in selected nations of the world and focuses, in particular, on variations in services. at the graduate level, the cosw created a course titled seminar on social work education and human services in another nation. during this course students examine the differences and similarities between the human service system of another country and that of the united states. each student selects a specific area of study consistent with his or her field of practice interests and analyzes this area in depth. both of these courses are sometimes taught in conjunction with a study-abroad experience offered to students during maymester or summer school (see below). in these instances, the coursework also entails travel to and within another nation, and includes visits to social agencies in other nations, visits to human service agencies, and occasionally attendance at an international conference in the other nation that is visited. the cosw also provides independent study options to those graduate students who wish to pursue advances in social work, spring 2014, 15(1) 148 in-depth study of particular international topics. the college’s doctoral students can also focus their dissertation study on international subjects. there is a growing body of literature to help schools develop international curriculum content. in addition to the writings of earlier scholars in this area, there have been a number of significant recent contributions to the literature by distinguished academicians such as lynne healy, brij mohan, james midgley, richard estes, michael sherraden, manohar pawar, david cox, rosemary link, chathapuram ramanathan and others. furthermore, there are several important journals devoted to international social work such as social development issues, journal of comparative social welfare, international social work, and international journal of social welfare. in addition, through its katherine a. kendall institute, the council on social work education (2013) maintains an extensive database of curriculum resources. all these materials can provide important resources to schools of social work as they expand their international course content. study-abroad program in 1985 the college of social work created a program aimed at providing studyabroad opportunities for students and current social work practitioners. this college was one of the first schools of social work to offer study-abroad learning experiences. the cosw's study-abroad program has included visits to numerous countries, including mexico, israel, greece, england, scotland, france, russia, sweden, india, ghana, ireland, and brazil. students who engage in these learning experiences do so under the direction of one of the cosw professors, and they earn course credit for their work. they are required to do advance study about the country to be visited, to attend lectures and presentations by educators and agency officials in the host country, to gather data while on the trip (often focused on a selected topic of study), and to meet usual course requirements such as the preparation of papers. from the beginning of this program the cosw’s study-abroad trips have been offered not only to students from the university of south carolina, but also to students from throughout the us. these students can receive course credit either from the university of south carolina or from the students' respective home institutions (depending on the regulations of their universities). in addition to students, social work practitioners are also invited to participate in the study-abroad trips. these participants are awarded continuing education credits after meeting appropriate cosw and university requirements. these trips have made it possible for participants to become familiar with social problems and needs in other countries and to learn about social work and human services in other nations. it is believed that these study-abroad experiences make the practitioners more culturally sensitive and equip them with new knowledge that enables them to provide more effective services to their clients in the us. although relatively few schools of social work offered study-abroad courses in earlier years, such programs are now widespread in social work education. given this raymond/development of international programs 149 plethora of study-abroad opportunities provided by schools of social work, the council on social work education (2013) maintains a listing of study-abroad programs currently offered. given the growth of study-abroad programs in recent years, the cswe has also established guidelines for all types of academic programs that involve study in other countries including academic courses abroad, field practicums abroad, international service learning projects, internships abroad, independent learning abroad, and group study abroad (council on social work education, 2012). cswe’s council on global learning, research, and practice, one of the councils under the cswe commission on global social work education, created these guidelines for establishing international programs for social work students that meet not only the cswe educational policy and accreditation standards but also the global standards for the education and training of the social work profession established by the international association of schools of social work and the international federation of social workers. therefore, these general study abroad guidelines are offered for social work programs to use in planning international study opportunities for their students. any school that wishes to establish a study-abroad program would be well advised to follow these guidelines from the beginning of the planning process. international partnerships in 1988 the cosw began developing partnership arrangements with academic programs and human service organizations in other countries. eventually the college established as many as twenty international partnerships in countries including, for example, mexico, germany, south korea, india, and china. these partnerships have had significant positive impact on cosw and the other institutions involved. healy (1986) has described how international partnerships enable educators to work collaboratively to build knowledge and relationships which contribute to global solutions to common concerns, and to prepare students to live and work in a world in which cross-cultural understanding and cooperation are considered essential. despite of the potential benefits of international partnerships, however, the process of developing such collaborative arrangements can be challenging. in another article this author has described many of the issues involved in creating international partnerships (raymond, 1998). in that article raymond discusses the importance of developing and demonstrating cultural awareness throughout the collaborative process, especially in the early stages of a new relationship. in fostering the personal relationship with a potential partner, one should move slowly in exploring the possibilities for collaboration in order to develop understanding and trust. the success in achieving formal institutional agreements will be built upon the foundation of the personal relationship between the primary collaborators. raymond (1998) also discussed the process of developing the formal written contract between the collaborating institutions, emphasizing the importance of establishing expectations that are realistic, insuring that all key actors are in agreement, and obtaining approvals at all appropriate levels within each institution. most universities that engage in advances in social work, spring 2014, 15(1) 150 international partnerships have well-developed procedures for developing formal agreements, such as those of princeton university (princeton, 2013). there are a number of potential barriers to developing successful international partnerships. these barriers include costs involved, language and cultural differences, bureaucratic differences regarding things such as methods of instruction or transfer of academic credits, and problems that may arise in arranging for visas, transportation or living facilities (raymond, 1998). in addition to these barriers, perhaps a more serious area of concern in developing international academic partnerships is the historical tendency of schools to export ideas, methods and goals from one country to another without sufficient regard for their relevance to societies whose needs, problems, laws and values are significantly different (cetingok & hirayama, 1990; hartman, 1990). avoiding, or at least mitigating, such problems and barriers can best be achieved when those persons who are trying to establish an international partnership have an understanding and genuine respect for each other's cultures, traditions, and academic systems. it is therefore helpful when each partner already has a familiarity with the other person’s culture. otherwise, it is wise to devote preparatory time towards learning about the other culture in order to develop the knowledge and attitudes required for a successful partnership. the cosw has developed formal agreements, or memorandums of understanding, with all of its international partners, clearly describing the expectations for each of the participants. these partnerships have resulted in a numerous activities, including faculty exchanges, student exchanges, curriculum sharing, cross-cultural research, and joint service projects. many faculty members from these partner institutions have come to the university of south carolina as visiting scholars, and a number of faculty from the cosw have spent sabbaticals or shorter periods of time for research or study at the partner institutions. the cosw has also hosted numerous student groups from its partner institutions. these groups are normally led by professors from their respective universities. the cosw assists in arranging lodging and local transportation for the visiting groups. during the visits the cosw provides lectures to the visitors and arranges for them to visit human service agencies in south carolina in order to learn about the delivery of social work services in this country. as a result of cosw’s partnerships, many students from other countries have enrolled in the college’s msw program. these partnerships have also led to the enrollment of several students from other countries in the college’s ph.d. program. reciprocally, a number of cosw students have had field placements in countries of the partners, and some have taken courses at the host institutions. international conferences as part of its commitment to fostering international collaboration and exchange in the field of social work education and practice, the cosw has hosted or sponsored a variety of international conferences and symposia. for example, in 2001, the cosw hosted the annual meeting of human services information technology applications raymond/development of international programs 151 (husita). husita is an international professional association that promotes the ethical and effective use of information technology to serve humanity. the organization, which was created in 1983, focuses on the development of knowledge and the transfer of technology within human services. husita meets at locations throughout the world to bring together social work educators and practitioners as well as professionals from other areas of human services. (for more information on husita, visit www.husita.org.) in 2004, the cosw and one of its partner schools in korea, kangnam university, co-sponsored a conference in south korea. this meeting, with the theme of “social welfare issues and social worker’s new roles in the era of globalization,” brought together social work educators and practitioners from countries throughout the world. the cosw also served as a sponsor of two international meetings of the international consortium for social development—icsd (formerly known as the inter-university consortium for international social development). icsd is an international organization that is concerned with empowering people to bring about economic and social improvement in their lives. it is comprised of scholars, practitioners and students from social work and other disciplines from throughout the world. in 2003 the cosw, under the leadership of one of its faculty members, dr. goutham menon, sponsored and planned the organization’s 13th biennial meeting which was held in india. in 2005, the cosw sponsored and planned icsd’s 14th biennial meeting that was held in brazil, and a faculty member, dr. julie miller-cribbs, chaired this effort. in both instances, local schools of social work served as hosts and co-sponsors of the meetings. in addition, the author of this paper served as president of icsd and, in that role was involved in the planning of the 2007 biennial conference, held in hangzhou, china (and co-sponsored by the cosw), and the 2009 conference, held in monterrey, mexico. the cosw’s leadership in international conferences has served to support its other international initiatives. for example, many people have learned about the cosw’s global mission through participation in its conferences. this international attention has led to enrollment of students from other countries in the cosw’s academic programs, expanded participation in the cosw’s study-abroad programs, fostered the creation of partnerships with academic institutions in other countries, and led to the development of a variety of exchanges and collaborative ventures among cosw faculty and conference participants from other countries. msw program in korea one of the most notable achievements of the cosw in advancing international social work was the establishment of a branch program in south korea to offer the school’s msw program in that country. responding to a need in 1992 the korean association of social workers (kasw), representing the south korean social work community, contacted the dean of the cosw through a mutual friend, dr. paul kim. dr. kim is a korean-american social work educator who, at that time, was on the faculty at another university in the us. knowing of the cosw’s advances in social work, spring 2014, 15(1) 152 demonstrated commitment to international social work, kasw inquired about the possibility of the cosw’s establishing a master’s degree program in south korea. (social work education in korea is not comparable to that in the us. it is structured differently than in this country, and is primarily an academic discipline with less focus on practice training.) the kasw representatives said that although many koreans desired a master’s degree in social work from the united states, most of them could not come to this country to study. they were precluded from doing so because of the cost involved, their life circumstances, and their inability to speak english. kasw asserted that the cosw would make an important contribution to the field of social work in korea if it would offer its msw program there, with courses taught in the korean language (raymond, 1997). obtaining approval korean representatives came to south carolina to meet with the dean and faculty. they described social work and social work education in korea, explained the educational needs and life circumstances of potential students, and discussed various options for offering a degree program in korea. after learning about these needs and opportunities, the faculty gave the dean approval to move forward in developing a plan to offer the msw degree program in korea. planning began in spring 1992. the dean, along with dr. paul kim, visited korea to assess needs, opportunities, and resources that might be available to mount such a program. these visits entailed meeting with potential students, going to various academic institutions with whom the cosw might partner in the venture, locating possible housing for faculty, assessing available resources such as libraries and technology, meeting with officials of agencies that might be supportive of the program and its students, etc. in response to the needs and circumstances of the korea social work community, and based on resources of the cosw, the dean developed a formal proposal for an off-site msw program in seoul, korea. he presented this proposal to the faculty and they granted their approval of the plan. the faculty also authorized the dean to submit the proposal to the appropriate authorities. (different written versions of the plan were required to meet the guidelines of these various authorities. the fundamental elements of the plan were identical in each version.) because the program was to be conducted at an off-site location, with all classes being offered in korea, prior approval by the cswe commission on accreditation was required. a proposal was developed under the commission’s evaluative standard 7: alternative programs. this standard stated the following. 7.0 alternative programs introduce change into one or more components of a program already accredited by the commission. if such alterations do not constitute substantive changes the program must, as part of the self-study process at the time of submitting materials for accreditation, include information about the alternative program and its evaluation results. 7.1 an alternative program that offers the equivalent of one or more academic years of the social work degree program, whether the class or field curriculum or raymond/development of international programs 153 both, in an off-campus location must submit a proposal to the commission on accreditation for approval before implementing the program. the cosw had been offering a part-time program in south carolina for many years. this program included options for both block and concurrent field placements. the cosw proposed to offer this same program on site in seoul, korea. the intent was that the korea-based msw program would be in all ways comparable to the south carolinabased program, with the only differences being the location, the timing of the courses, the waiver of toefl scores for applicants to the program, and the inclusion of interpreters to translate the faculty lectures from english to korean. the plan for the alternative korea-based msw program was submitted to the cswe commission on accreditation in december 1992, and it was approved by the commission in january 1993. during this same time period the plan for extending the college’s msw program to korea was submitted to, and approved by, various levels of authority within the university of south carolina. following ultimate approval by the university’s board of trustees, the proposal was submitted to the south carolina commission on higher education, and that state agency also gave its approval to the plan. while approval of the plan was being sought in the us, it was also necessary to obtain approval in korea. after the dean’s visits to a number of universities in korea that offered social work education programs, the cosw extended an offer to kangnam university to serve as a partner in this venture. (kangnam university was well-known for its reputation of having the oldest, largest and most prestigious undergraduate program in korea). the president and other officials at kangnam university accepted the cosw offer, and the proposal was then submitted to the south korea ministry of education. because of korea’s previous experiences with a number of bogus foreign academic programs, the ministry of education was initially somewhat wary of the cosw proposal. consequently, in addition to submitting the proposal to the ministry, it was necessary for the dean to meet personally with officials from that government agency to provide reassurance of the legitimacy of the proposed program. the cosw’s partnership with kangnam university, given its reputation as a highly respected university in korea, also provided credibility to the proposal. the ministry of education gave its approval to the plan and steps were then taken to implement it. following approval at the various levels in the us and korea, the cosw began to implement the plan. this included hiring dr. paul kim to be the director of the program (additional korean-american faculty were later hired by the cosw). courses were scheduled and faculty were assigned to teach them. classroom space was set up in korea and resources such as library materials and technology equipment were sent to seoul. the cosw began to accept applications and to process them through its admissions office and the university graduate school. an initial class of 28 students was admitted to the korea-based msw program. the cosw began offering courses to this first cohort of students in summer of 1993. with the initiation of this program, the college of social work at the university of south advances in social work, spring 2014, 15(1) 154 carolina became the first school of social work in the us to offer its master’s degree program in its entirety in a foreign country. at first the program was offered only in collaboration with kangnam university, but after the program began several additional korean universities joined the partnership. these have included dan kook university, hallym university, induk institute of technology, korea christian university, chang shin college, sookmyung women’s university, seowon university, and suwon university. the participation of these other schools not only provided further enhancement to the credibility and reputation of the msw program, but also brought to bear additional resources such as classrooms, libraries and technology. kangnam university has remained the primary partner, however. structure of the program the korean program is structured on the framework of the part-time msw program that the cosw has offered in south carolina for many years. faculty from the university of south carolina travel to korea to teach courses on-site during the summer and in specially arranged schedules during the fall and spring semesters. as in the parttime program in south carolina, courses are taught during evenings and weekends in order to accommodate the needs of working students. all faculty members who teach in korea participate in an orientation program prior to going abroad in order to heighten their cultural sensitivity and make them more effective educators in korea. in addition to the regular classroom teachers, korean-american professors from the cosw’s faculty serve as interpreters in each class. these interpreters, who hold master's and doctoral degrees in social work from united states schools and are familiar with social work and human services in both the us and korea, help ensure the correct meaning, cultural relevance, and appropriate application of the course content. (their roles might best be described as “co-teaching.”) these korean faculty members not only serve as interpreters, but they also teach some courses themselves. when they teach, of course, they do not require additional translators. applicants to the korea-based program must meet the same admission requirements as persons who apply for enrolment in the south carolina-based msw program, with the exception of submitting passing toefl scores as normally required of foreign students. their applications must be submitted in english in order to be reviewed by the cosw’s admissions office and the university’s graduate school. in addition to the korean students, each cohort includes 3-4 american students that are affiliated with the us military stationed in korea (either soldiers, military employees, or spouses). this arrangement not only meets the needs of these english-speaking students, but it contributes significantly academic value. this enables all students to experience greater diversity, and the students learn much from each other’s personal and professional backgrounds. the block field placement plan is used in the korean program. this follows the same model used with cosw’s part-time program in south carolina. students must complete all of their foundation courses before they can begin their first year field placements. the first year field placements are offered during fall semester of the students’ second year raymond/development of international programs 155 of matriculation. the advanced year field placements occur after all other advanced year courses have been completed, except for the final integrative seminar, or capstone course. this course is offered simultaneous with the second year field placements during the fall semester of the students’ last year of enrollment. the field instruction program is carried out in the same manner as in south carolina. the field director selects agencies and field instructors who meet the cosw’s usual criteria. most of the korean field instructors are graduates of the korea-based msw program, with the exception of a few social workers who are affiliated with the us military in korea. the field director not only sets up the placements in korea, but also returns to korea to participate in the evaluation of the students’ learning at the end of the field placement experience. the field director is assisted in these efforts by a korea-based social worker who received her msw degree in an earlier class that matriculated in the korea-based msw program. having lived in the united states previously, she speaks fluent english. she serves as the field director’s translator during visits, stays in touch with the students and the field instructors while field placements are taking place, and keeps the field director informed as to what is happening. the total korea-based msw program requires 2.5 years to complete. students come to the columbia campus for graduation (this is not required, but most of them strongly want to do so – often bringing family members with them). because it would strain the cosw’s resources to attempt to offer courses to both foundation and advanced students simultaneously in korea, the college does not begin to offer classes to a new cohort of students until the preceding one has graduated. after a group graduates from the program in december, another class begins its studies the following summer. the korea-based program is completely self-supporting from student tuition. the university does not charge its normal tuition and fees and no state funding is contributed towards the costs of the program. instead, based on projected costs, a budget is established before each cohort of student begins study and the students pay for these costs on a pro-rated basis over their 2.5 years of study. evaluation of the program because the korea-based msw program was developed as an alternative program under the cswe accreditation guidelines, it was necessary to evaluate the effectiveness of the undertaking. evaluation of the program was also required by the south carolina commission on higher education. in order to provide assurance of the program’s adherence to accreditation standards, the cosw invited cswe’s director of the division of standards and accreditation to visit the program in korea on two occasions for review and feedback purposes. the reviews of the director were extremely positive and her advice was very helpful to the college in insuring the quality of the program and its compliance with accreditation standards. in order to provide further assurance that the program was of high quality and was meeting accreditation requirements, in the early years of the program the cosw advances in social work, spring 2014, 15(1) 156 contracted with two separate outside evaluators with expertise in social work education, including accreditation standards, to provide independent reviews of the program. these evaluators visited the program in korea, met with officials from kangnam university, attended classes, interviewed students, interviewed field instructors, examined course materials and students’ performance records, and met with the faculty in columbia. the findings of these external evaluation activities provided additional independent assurance that the alternative program was, in all relevant aspects, equal in quality to the columbia-based program. specifically, the findings revealed that:  the program was carefully planned and was administered/managed well.  students were well qualified and highly motivated, and many opportunities were available and used to foster connections among students and between students and faculty.  students performed better overall on comparable classroom assignments than did similar students in the columbia program, and most received a’s or b’s in all their coursework.  student field performance was equivalent to performance of similar students in the columbia program.  faculty were very positive about the program and students unanimously rated faculty highly.  the learning and educational support services (e.g., buildings, technology, library holdings) available to students were at least adequate.  most limitations of the program were related to environmental conditions (e.g., heat, travel time, resources, isolation of faculty).  initially learning resources were seen as a problem, but the cosw addressed this by developing a supplemental library and utilizing the libraries of more partner institutions.  in summary, the korea program was found to be highly commensurate with the part-time msw program in columbia in all areas, including curriculum content, texts and other materials, instruction methods, evaluation methods, and student outcomes. in the year 2000 the cosw went through its regular review for reaffirmation of accreditation and the korea-based program was part of that review. the above data from outside evaluations were included in the college’s self-study document. the koreanbased program evaluation plan for the reaffirmation review also included many of the same measures that were used to evaluate the columbia-based program. specifically, these included:  student grades  field instructor’s evaluation of students raymond/development of international programs 157  teaching evaluations  field work rating form  field liaison assessment the 2000 reaffirmation review resulted in unconditional approval of the cosw’s master’s degree program, including the korea-based component. the regular review of the cosw’s accreditation occurred again in 2008 and, once again, the review resulted in unconditional reaffirmation of accreditation. this reaffirmation of the college’s accreditation during its last two reviews by the commission on accreditation has thus provided solid evidence that students in the korea-based program have parallel course content, similar resources and learning opportunities (libraries, equipment, field placements), and a program of equivalent quality to the columbia-based msw. the korea-based program has also been evaluated by the southern association of colleges (sacs) as part of its accreditation of the university of south carolina. this organization has also given its approval to the korea-based initiative as an integral part of the cosw’s master of social work degree program. since the cosw began offering courses to the first cohort on students in 1993, six groups of students have graduated. with the graduation of the current cohort in december 2013, over 175 students will have received their msw degrees through the korean program. most graduates of the korea-based msw program have moved into positions of increased responsibility as a result of their graduate degrees. over 50 are now teaching social work education courses as full-time faculty (20) or adjunct faculty (30) in korean universities. a large number of graduates have been promoted to high ranks within their organizations and some have assumed leadership positions in other institutions, including the korean government (one is now korea’s senior secretary to the president for employment and welfare). over a dozen of the alumni have gone on to pursue doctoral study in social work education programs in korea and in the united states. (two of the alumni have completed ph.d. degrees at the university of south carolina.) faculty from the university of south carolina have enjoyed the experience of teaching abroad, and have found that they are better social work educators as a result of insights they acquired from living, studying, and teaching in another country. similarly, faculty from korean universities who participate in the program have emphasized that they profit from this cross-cultural activity. several faculty from both countries have engaged in joint research projects which have resulted in scholarly publications and papers presented at national and international conferences. conclusion the college of social work at the university of south carolina was not the first school of social work to engage in international activities, nor does it claim to be preeminent in this arena. other schools have a long history of offering study-abroad courses, providing international field placements, conducting research or developing advances in social work, spring 2014, 15(1) 158 special projects in other countries, offering educational content to academic institutions abroad, and so on. however, there were relatively few schools involved in such activities thirty years ago. starting with its international coursework and its study-abroad courses, the cosw was an early entrant in this field. the cosw gradually expanded its activities to include a variety of internationally-focused projects. with the implementation of its korea-based msw program, which represented a unique venture among schools of social work, the cosw established what might be considered a leadership position among schools. in this age of globalization more and more schools of social work are endeavoring to develop international initiatives of various types. it is hoped that the above recounting of the experiences of the cosw can be of benefit to schools seeking to expand their efforts in the global field. there are several lessons to be learned from the cosw’s experiences in developing international activities. one of the most striking conclusions is that the establishment of an international program of any type has widespread effects that extend beyond the immediate objective of that initiative. often there are benefits of international activities far greater than those imagined by the planners. for example, a study-abroad course provides much more than an exposure of students to another culture and a different system of social services. as johnson, johnson, and good (1995) pointed out, students who have participated in international studies return with noticeable growth in selfconfidence, general maturity, adaptability and responsibility, as well as international awareness and an understanding and appreciation for another culture. these authors also noted that faculty members who engage in international projects seem to attain greater vision and credibility, and to emerge as leaders as a result of the challenges they have faced in international settings. there is no doubt that faculty members from the cosw have become better teachers as a result of their engaging in study-abroad courses, teaching international content, becoming involved in the college's partnerships with schools in other countries, participating in international conferences, and teaching in the korea-based msw program. faculty report that these international experiences have served to broaden their world views, increase their sensitivity to other cultures, and expand their repertoire of options for enriching the curriculum. the overall professional development of the cosw faculty as a result of their international experiences support what other writers have found. for example, sanders (1980) explained that engagement in multicultural experiences enhances one’s flexibility, psychological adaptability, and capacity to make shifts in one’s frame of reference. similarly, harris (1990) pointed out that developing understanding of differences between oneself and others, as well as points of unity, can help one look again at what was previously believed and to see new possibilities. another lesson from the cosw’s experiences is that engagement with partners from other countries is inevitably a two-way experience  –  and it should be. a number of writers (hartman, 1990; healy, 1986; healy & link, 2011) have emphasized that recognition of mutuality and sharing, in contrast to an attitude of noblesse oblige, is essential for international collaboration. faculty and students who have participated in the cosw’s study-abroad courses, international conferences, or the korea-based program have soon learned that we have much to learn from other countries. indeed, some of the raymond/development of international programs 159 human service systems of other countries are far superior to those of the us and offer models for replication. as a school of social work embarks of an international endeavor it is essential that the leader(s) of the effort be passionate about it. it is not unusual for a school to include an international component in its mission statement, but in order to effectuate that mission there must be a strong commitment to the importance of some specific goals and objectives. this kind of enthusiasm for a proposed international enterprise will lead one to look for opportunities for action. the next lesson from the cosw’s experiences builds on the preceding discussion. that is, one must be aware of opportunities when they arise and quick to embrace them. for example, the cosw’s first study-abroad trip grew out of the availability of a university-owned property in mexico that the university’s president encouraged deans to use for academic purposes. the husita international conference took place because that organization, which meets biennially in different countries, was looking for an institution in the us that could host the event. the korea-based msw program resulted from an invitation from the korean social work community to offer a degree in that country. another lesson for schools that are interested in developing international programs is the importance of networking with others who are engaged in the global arena. indeed, many of the initiatives developed over the years at the cosw were generated by the examples of work done at other schools. it is helpful for faculty who want to develop international activities to go to sessions having that focus when attending national conferences such as the cswe annual program meeting. it is also useful for them to participate in international social work organizations including the international association of schools of social work (iassw), the international federation of social workers (ifsw), the international consortium for social development (icsd), and the international council on social welfare (icsw). these organizations provide forums for educators, researchers, students, and practitioners to come together to hear expert speakers, present papers on their own work, share ideas, and learn from each other in regard to international social work education and practice. these types of organizations also offer a variety of other resources to facilitate international collaboration and development such as publications, web-based information, and opportunities for online communication and data exchange among members. another lesson from the experience of the cosw is that it is essential to obtain support for the proposed venture from leaders at every possible level. it was necessary for the cosw to obtain the endorsement and approval of many authorities in developing the korea-based program, so efforts were made to assure these parties of the legitimacy and value of the initiative. for example, it was helpful to have the cswe director of the division of standards and accreditation visit the program, not just to have her provide guidance regarding accreditation standards, but also to give her the opportunity to see the worth of the program. similarly, the provost of the university of south carolina visited the korean program and he became one of the strongest advocates of the endeavor within the university and with the south carolina commission on higher education. in korea, advances in social work, spring 2014, 15(1) 160 also, the dean cultivated the friendship of officials within kangnam university and at the ministry of education. their support helped facilitate the approval processes in that country and has helped maintain the ongoing success of the program. it is also important to insure the availability of sufficient resources in order for an international project to succeed. this requires being knowledgeable of potential funding sources, such as private and governmental grants. also, it is sometimes necessary to risk capital expenditures at the front end of a venture in order to develop the potential project. the cosw had to commit resources in order to create study-abroad courses, mount international conferences, and make the necessary foreign trips to develop the korean program. sufficient human resources are also necessary for any foreign endeavor. offering successful study-abroad trips requires faculty with the requisite knowledge and skills. hosting international conferences calls for faculty with the necessary subject area knowledge as well as planning and management abilities. offering academic programs in other countries requires faculty that have not only the needed knowledge base, but also the desire and willingness to work abroad. (sometimes it is necessary to hire faculty with international backgrounds and fluency in another language, as was the case with cosw’s korea-based program.) finally, engagement in international endeavors requires full commitment on the part of the school. this means a willingness to commit the necessary money, human resources, and time to insure the success of the project. it is therefore absolutely essential to obtain the support of the school official(s) who have the authority to make such commitments, as well as pledges of full participation from all persons who will be involved. sometimes long-term financial commitments are not possible, particularly when there is no guarantee of the success of the project. in any case, there should be a clear, written plan for the project that includes goals and objectives, a time frame, a description of the roles of each actor, an evaluation scheme with intermediate measures of progress, and a projection of future efforts that includes contingency plans. as discussed above under the section on “international partnerships,” when organizations from other countries are involved there should be formal agreements between the institutions in the respective countries that spell out the roles, responsibilities, and expectations of all parties. it should be evident from this paper that the involvement of a school of social work in any type of international activity should not be entered into lightly – but thoughtfully, earnestly and resolutely. no doubt this level of engagement will seem frightening and overwhelming to some faculty and administrators. however, we are living in times of transformational social change and it is incumbent upon schools of social work to maintain relevancy in light of these events. schools must expand their institutional worldviews. schools must equip their students with the appropriate knowledge, skills and values to practice effectively in our fast-changing environment. and, to be pertinent in a shrinking world, schools of social work would do well to consider developing concrete programs that will involve students and faculty in international activities. as the college of social work at the university of south carolina has learned through its experiences with international programs, the benefits of engaging in such projects are profound and rewarding. raymond/development of international programs 161 references bureau of labor statistics. 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(1997). preparing social workers to assume human service needs in the korean peninsula: an example of cross-cultural exchange. journal of global awareness, 300-305. raymond, f. b. (1998). developing international education partnerships. journal of global awareness, 334-341. raymond, f. b. (2011). current revolutionary changes and their implications for christians in social work. social work and christianity, 38(1), 1-28. raymond, f. b. (2013). the future outlook of social work in the united states. paper presented at the international social work forum, korea association of social workers, seoul, korea. sanders, d. s. (1980). multiculturalism: implications for social work. international social work, 23, 9-16. united nations. (2010). millennium development goals report 2010. brussels, be: author. author note address correspondence to: frank b. raymond, ph.d., 133 dibble lane, columbia, sc 29223. email: frankr@mailbox.sc.edu  frank b. raymond is dean emeritus and distinguished professor emeritus at the college of social work at the university of south carolina. he joined the faculty of the college of social work at the university of south carolina in 1972, and served as dean of this college from 1980 until his retirement in 2002. he has published five books related to administration, technology and social work education, as well as over 200 book chapters and journal articles in areas such as organizational management, program evaluation, social work education, technology in higher education, and international social work.   microsoft word 2-3735 garcia case study on chile final ______________ moctezuma garcia, ph.d., lsw, is a postdoctoral teaching associate, central michigan university, department of sociology, anthropology, and social work. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 13-25 globalization, inequality, and transnational activism: a case study on chile moctezuma garcia abstract: globalization has transformed how states are governed through a neoliberal economic approach that reinforces an unregulated capitalist market. an emphasis on chile is important because it was the first state in latin america to apply neoliberalism and has been hailed as a prime example for other developing states to integrate similar strategies to strengthen the local economy. however, inequality continues to persist despite economic gains. a combination of historical struggles affecting victims of the pinochet era and present struggles with poverty, have resulted in a constant conflict between the power elite and the rest of society. social movements in chile have played a pivotal role in raising international awareness and pressuring the local government to protect the rights of highly vulnerable populations. a focus on transnational activism provides an effective medium for local and international advocates to work together toward holding chile accountable for addressing social disparities. keywords: globalization, inequality, human rights, transnational activism, latin america, social movements [g]lobalisation is a multi-dimensional process characterized by:  the acceptance of a set of economic rules for the entire world designed to maximise profits and productivity by universalizing markets and production, and to obtain the support of the state with a view to making the national economy more productive and competitive;  technological innovation and organisational change centred on flexibilisation and adaptability;  the expansion of a specific form of social organisation based on information as the main source of productivity and power;  the reduction of the welfare state, privatisation of social services, flexibilisation of labour relations and weaker trade unions;  de facto transfer to trans-national organisations of the control of national economic policy instruments, such as monetary policy, interest rates and fiscal policy;  the dissemination of common cultural values, but also the re-emergence of nationalism, cultural conflict and social movements. (urzúa, 2000, pp. 421-422) globalization in the 1990s reinforced a neoliberal economic model that fostered an unregulated capitalist system (kotz, 2002) that transformed how states are governed. garcia/chile: globalization, inequality, and transnational activism 14   states are no longer able to function in isolation, which requires one to take into consideration the influence that internal and external factors have on implementing economic strategies at the state level. “states find themselves trying to respond to pressures from local societies and global markets simultaneously without the breathing room previously offered by controls on national trade, finance, and production” (ó rian, 2000, p. 188). held and mcgrew (2007) indicate that “...national governments across the globe have been forced to adopt increasingly similar (neoliberal) economic strategies which promote financial discipline, deregulation and prudent economic management” (p.55). the national state still has the capacity to influence local markets’ involvement with the global economy, but this depends on how government resources are disseminated (e.g., tax incentives, policies) among local entrepreneurs (ó rian, 2000). globalization further determines how high-income states financially support initiatives to address social disparities in lowand middle-income states, a process that allows the donor states to reinforce their ideology on the recipient states. “global institutions such as the world bank and the international monetary fund are blatantly pursuing the interests of western governments and impose structural adjustments on poor nations with devastating consequences” (ife, 2007). the u. s. government, for example, has invested billions of dollars of foreign aid through the president’s emergency plan for aids relief (pepfar) and significant strides have been accomplished in addressing hiv/aids globally. but the program has been scrutinized due to contractual agreements for partner states to reinforce abstinence-based interventions for young people and the eradication of prostitution. the brazilian national aids commission rejected $40 million from the united states agency for international development (usaid) due to the pepfar stipulation that excluded sex workers from accessing hiv prevention services (middleberg, 2006). brazil, however, is an exception and has taken drastic measures to ensure access to hiv prevention and treatment services for its citizens, which has revolutionized global initiatives addressing hiv/aids in lowand middleincome states. an emphasis on foreign aid demonstrates how a hierarchy of power is reinforced and limits the power of recipient states, which may also increase the vulnerability of historically oppressed and highly marginalized populations that are dependent on the local power elite to accept the terms of foreign aid or demand revisions to address issues affecting highly vulnerable populations. globalization contextualizes the role of the social worker and determines how ideology influences the development of local and international policies that may narrow a professional’s ability to address social disparities. this manuscript focuses on the influence globalization has on reinforcing inequality and how transnational activism can be used as a model for activists to demand accountability from a local government. chile is used as a focal point, but inequality in latin america is also discussed to conceptualize how power and status are reinforced between, as well as within, states. the historical perspective on chile highlights how economic, political, and social events have influenced the development of a nation. a section on transnational activism provides a useful model for social workers to mobilize efforts locally, as well as abroad, to advocate for highly vulnerable populations. implications for social welfare will also be discussed. advances in social work, spring 2013, 14(1) 15   inequality in latin america the power elite is composed of men whose positions enable them to transcend the ordinary environments of ordinary men and women; they are in positions to make decisions having major consequences (mills, 1956, pp. 3-4). mills (1956) believed that power is not solitary, but it is composed of an intricate hierarchy put in place to dominate society. power results in a limited number of power elite members imposing their beliefs and values (ideology) onto the larger society. the power elite are composed of a small percentage of society that controls and determines how, and within what limits, resources (e.g., money, property, education, healthcare) will be disseminated in society. inequality is based on the uneven distribution of resources throughout society (hoffman & centeno, 2003). several measures have been used to determine levels of human development and inequality. the human development index (hdi) measures the national level of human development based on health, education, and income (united nations development programme [undp], 2011). however, in 2010 the inequality-adjusted hdi (ihdi) was introduced to take into account differences in human development within a state due to inequality (undp, 2011). the hdi and ihdi range from 0 (lowest) to 1 (highest) for determining the level of human development. the gini index is a measure used to determine levels of inequality based on the distribution of income or consumption within a state, 0 indicates perfect equality and 100 indicates perfect inequality (the world bank group, 2012a). measures to collect data on these indices are limited and restrict greater analyses of inequality, which further impedes our understanding of the phenomenon in latin america and the caribbean (mahoney, 2003). despite limitations, researchers have been able to utilize measures to determine the influence of the global economic market and levels of inequality between, as well as within, states. latin america has a high level of inequality with the top 10% controlling between 40 to 47% of the total income (de ferranti, perry, & ferreira, 2004). brazil was the only state in latin america that ranked in the top 10 states with the most billionaires, of which 1% of that population is worth $300 billion (cnbc, 2012). the richest man in the world is carlos slim helu, a citizen of mexico with a net worth of $69 billion (forbes, 2012). sebastián piñera is an established billionaire who was elected president of chile in 2010 (meyer, 2012). the united states had 3 of the top 10 richest men in the world (forbes, 2012). the top 1% of total income controls 43% of the wealth in the nation; and the next 4% control an additional 29% of the wealth in the united states (dunn, 2012). held and mcgrew (2007) indicate that “...globalization enhances the development prospects of states in the south and contributes to making the world a less unequal place” (p. 80). overall, inequality between states has declined from 1978 through 1998 (firebaugh & goesling, 2004). however, the undp (2011) demonstrates that greater access to wealth does not lead to a reduction of inequality within a state as demonstrated in the united states (.91 hdi, .85 ihdi, 40.8 gini), mexico (.77 hdi, .59 ihdi, 51.7 gini), and brazil (.72, hdi, .52 ihdi, 53.9 gini). multiple factors (e.g., employment, education, housing) affect inequality, but it is important to acknowledge the historical context that has influenced the development of a garcia/chile: globalization, inequality, and transnational activism 16   nation. political, economic, and social structures reinforce inequality in latin america (de ferranti et al., 2004). states have played a regressive role in providing public goods (e.g., education, health, water, sanitation) for poverty stricken populations (de ferranti et al., 2004). the power elite in latin america have the essential resources to protect themselves and influence the state to establish policies that protect their interests (de ferranti et al., 2004). historically, social structures were created and maintained to reinforce the interests of the dominant group (e.g., colonizers, power elite), which has resulted in “truncated systems” that exclude the most vulnerable (de ferranti et al., 2004). “wealthy groups again have greater options for either exerting influence on public service provisioning for themselves or opting out for private provision” (de ferranti et al., 2004, p. 123). scholars (de ferranti et al., 2004) emphasize that in order for change to occur in latin america, it must be made from within as well as outside of social structures. chile provides a unique perspective because it was the first state in latin america to apply the neoliberal model in the 1980s to improve its local economic market, which continues to be sustained. chile is regarded as an upper-middle-income developing state and it has been a strong ally of the united states in advancing democracy, human rights, and trade (meyer, 2012). chile’s poverty rate has drastically declined since 1990, and no other state in latin america has been able to approach chile’s progress. despite chile’s decline in poverty, it still has to overcome obstacles associated with inequality. chile has become the leader of human development (.81 hdi and .65 ihdi) in latin america, but ranks number six for the greatest inequality (52.1 gini) in latin america (undp, 2011). chile’s share of the top 20% in total income is 57.7%, and its share of the bottom 20% of total income is 4.3% (the world bank group, 2012b). the distribution of wealth within a state provides critical insight on how power is established and reinforced throughout the years among a select privileged group of an elite upper class. a brief historical perspective on chile chile initially established a stable democratic political regime from 1932 to 1970 (meyer, 2012). economic development after world war ii set the stage for the foundation of the global market. the united states had gained control of power in the world and the soviet union threatened american capitalism with communism (hite & roberts, 2007). the united states wanted to secure their status and modernization theory provided an explanation as to why some countries are poor and underdeveloped. “…[a]ccording to this group of ‘modernization theorists,’ poorer nations are poor because they lack big capital, technology, and modern social organization and values” (hite & roberts, 2007, p. 8). the soviet union also had a strong interest in reinforcing socialism in latin america, and chile was no exception. chile encountered significant economic struggles that caused a considerable political shift from a democratic to a socialist state in 1970. by the early 1970s, latin american economies were in trouble. chile elected the marxist president salvador allende. allende’s solution was not less government intervention, but more. businesses were nationalized or expropriated. price advances in social work, spring 2013, 14(1) 17   controls were imposed. civil unrest grew as the economy spun out of control. (yergin & cran, 2003) allende’s efforts during his presidential term (1970-1973) to nationalize the state’s control of resources backfired and instead united capitalists, landowners, and the middle class to strengthen a political alliance against laborers, peasants, and leftist organizations (silva, 1993). disparities increased in chile and social protests demanded change. this resulted in a military coup and dictatorship by general augusto pinochet in 1973 (garretón, 2005; yergin & cran, 2003). pinochet secured his newfound role of the state by conducting a massacre of allende supporters and prohibiting political protests (yergin & cran, 2003). the military regime seized acquired wealth (e.g., money, property) from middle to upper class families so they would not threaten pinochet’s newly established role, which caused them to transition into poverty (paley, 2001). prominent chilean activists fled the country, and grassroots organizations went underground to avoid tyranny from the military (paley, 2001). “indeed, pinochet’s autocratic system of one-man rule had concentrated power at the top to such a degree that it seemed as if the state had developed virtually complete autonomy from all social groups” (silva, 1993, p. 526). inflation continued to escalate, as harberger states in an interview (yergin & cran, 2003): “after a year, year and a half of military government, you still had 20 percent permonth built-in inflation that wouldn’t go away until something structurally changed.” significant changes needed to be made and reduction of the state led chile toward a “[d]ecentralization and privatization with a geopolitical view of power” (garretón, 2005, p. 364). a small group of elite chilean scholars, referred to as the “chicago boys” who studied free market economic theories abroad at the university of chicago, influenced pinochet to take drastic measures through “shock treatment” and apply neoliberalism to stabilize the economy (yergin & cran, 2003). usaid had established financial support for students from the catholic university of chile to study at the university of chicago and for professors from the university of chicago to teach economics at the catholic university of chile (borzutzky, 2005). professor milton friedman from the university of chicago mentored the chicago boys and he played an influential role in the development and implementation of the neoliberal economic plan for chile (silva, 1991). the chicago boys emphasized that “…government decisions were to be inspired by ‘technical and scientific’ principles and not by political ideological postulates as in the past” (p. silva, 1991, p. 393). chile’s economic crisis allowed the chicago boys to implement a radical alternative, but pinochet also perceived it as an opportunity to save the country from marxism (borzutzky, 2005). the local economic market was completely revamped, which resulted in significant reductions in government budgets and privatization of state-owned businesses (yergin & cran, 2003). the transition toward an authoritarian regime, implementation of neoliberalism, and globalization of the economy created a new environment for the power elite to maneuver and protect their capital. the neoliberal economic market placed an emphasis on the free market, which gave rise to a new power elite referred to as “technocrats” who were garcia/chile: globalization, inequality, and transnational activism 18   highly educated and occupied influential roles in the public and private sectors (silva, 1991). pinochet relied on technocrats to secure chile’s economy, but his dependence on others weakened his control of the state. the newly established power elite prospered and became an influential source toward developing state policy under authoritarian rule (e. silva, 1993). as the power elite became established, the weaker upper-middle class either fled the country or the military sequestered their resources. chile encountered an economic boom between 1976 and 1981, but it caused poor people to endure greater inequality (yergin & cran, 2003). pinochet imposed a new constitution in 1980 to extend his dictatorship for an additional eight years (yergin & cran, 2003). however, a bank crisis from 1981 to 1984 caused widespread protests, which resulted in the organization of civilians to become more critical of the existing regime (meyer, 2012). the newly established technocrats seized the opportunity and withdrew their support of pinochet. the pinochet regime encountered pressures internally (social movements) as well as externally (united states and united kingdom) to legalize a re-election in 1989, which resulted in pinochet’s defeat and chile’s return to a democratic state (yergin & cran, 2003). patricio aylwin was elected president in 1990 and played an instrumental role in transitioning chile’s return to a democratic state. the significant transition in the economy for chile during this period was that the state did not allow a completely free market. garretón (2005) indicates that chile applied a “[m]arket-oriented model with corrections to the role of the state and policies against poverty” (p.363). the free market allowed chile’s economy to prosper, but inequality rose as well. a combination of liberal trade (import and export) policies and state interventions allowed chile to overcome international economic struggles and stay ahead of the competition. “although chilean exports surged in the 1980s as the peso devalued, they also surged in the early to mid1990s as international prices for nontraditional crops declined markedly and the peso appreciated” (kurtz, 2001, p. 7). chile implemented the necessary infrastructures to address local market failures and support local businesses to capitalize on the global market, but a greater emphasis was placed on dynamic sectors such as forestry and fishing (kurtz, 2001). at the same time, the state provided limited support to the fruit industry, which was distinguished by severe class biases and oligopolies (kurtz, 2001). the post 1989 period focused on establishing a democratic state and reducing inequality. the neoliberal economic model increased wealth for chile, but without state intervention, the rich got richer and the poor got poorer. president eduardo frei ruiztagle’s (1994-2000) political campaign emphasized rule by the people and not the military, but in 1980 pinochet enforced a law that ensured life long positions (10 out of 48 seats) in the senate for military officials (freedom house, 2007). president frei ruiztagle’s attempts to take power away from the military limited his capacity to implement drastic measures to address social disparities. president ricardo lagos escobar (20002006) focused his initiatives on eliminating poverty, but political corruption charges (peddling, insider trading, and kickbacks) were made public (freedom house, 2007). increased rates of unemployment and inflation during lagos escobar’s presidential term also added to the growing disparities among poverty stricken populations. chileans grew restless due to limited access to resources and growing levels of inequality. while advances in social work, spring 2013, 14(1) 19   successors of pinochet encountered the difficult task of maintaining an economic model that would work to stabilize the local economy, it widened economic disparities between the rich and poor in the absence of state intervention. unfortunately, the top military commanders also proved to influence political initiatives despite pinochet’s defeat in 1989. in 2006, chile made history and elected its first female president, michelle bachelet (freedom house, 2007). inequality persisted and became the force for chileans to demand government support despite chile’s drastic poverty reduction by 2006. bachelet was committed to addressing inequality and issues affecting women such as access to healthcare and discrimination against women (freedom house, 2007). however, chile’s capital surplus in copper increased by 83% from 2005 to 2006. economic gains remained among the wealthy, which spurred social movements demanding distribution of the copper surplus for social programs by students, copper miners, health care workers, and teachers (freedom house, 2007). in spite of bachelet’s work on inequality, students mobilized in 2006 and pressured the state to increase funding for education (freedom house, 2007). chileans also advocated for an increase in salaries and access to their share of the copper boom (freedom house, 2007). bachelet demonstrated her commitment to addressing inequality and invested billions towards health, housing, and education for low-income families (freedom house, 2007). despite bachelet’s initiatives to address social disparities, persistent inequality and dissatisfaction with the existing government resulted in a shift of political parties in the 2010 elections from the center-left to the current center-right (meyer, 2012). however, chileans continued to protest over gas prices, environmental issues, education, and labor rights (meyer, 2012). “some analysts believe chileans have resorted to street protests as a result of their increasing dissatisfaction with the country’s political class, which they view as unresponsive to citizen demands and unwilling to address the country’s high level of inequality” (meyer, 2012, p. 7). the pinochet era overall exposed chilean society to a tumultuous environment that provided a limited sense of safety and security, unless one was directly associated with the military regime. reestablishment of a democratic government increased vigilance among the public to become more critical of the political system, especially among political leaders responsible for governing the state. society played a pivotal role in holding the power elite accountable for their actions as well as designating limitations on harnessing wealth and/or resources. inequality became more prevalent and the public raised awareness through social protests as a vehicle to advocate for the needs of highly disenfranchised populations. social protests also allowed the local public to raise international awareness on social issues impacting a state locally and provide a global forum to scrutinize initiatives taken by the power elite. global consumers were able to support causes abroad through financial support of local grassroots organizations or by pressuring their local government to respond to social disparities in another state (e.g., chile), which is the premise of transnational activism. garcia/chile: globalization, inequality, and transnational activism 20   transnational activism globalization has not only affected the economy, it has also influenced how people interact. technology (e.g., internet, faxes, international flights) has made the world highly accessible, which has revolutionized social activism. the pinochet era, for example, caused exiled chileans to mobilize abroad and they played a significant role in raising international awareness of human rights violations due to the pinochet regime. foreign human rights organizations gained a greater understanding of the atrocities committed by the pinochet regime, which garnered international support (e.g., foreign aid, publicity) for local organizations that advocated for social justice and pressured their local government to address claims of human rights violations. social activism has transcended borders and it is no longer isolated to a state. keck and sikkink (1998) refer to this intricate network between domestic and international actors as “transnational advocacy networks.” tarrow (2005) emphasizes the importance of distinguishing globalization from internationalism. globalization is grounded in “…a source of interest, ideology, and grievances” (tarrow, 2005, p. 19). “internationalism is the institutional and informal framework within which transnational activism – some of it aimed at globalization but much of it independent of that process – takes shape” (tarrow, 2005, p. 19). therefore, transnational activists utilize internationalism as a framework to strategize and mobilize toward a designated mission. transnational activism has a greater influence on getting the state to address issues due to its endogenous (rooted cosmopolitans) and exogenous (transnational activists) influences. rooted cosmopolitans are deeply entrenched in a state and play a critical role domestically in activism at the community level (tarrow, 2005). transnational activists are a subgroup of rooted cosmopolitans with a deep understanding of issues at the state level who become key actors in raising awareness and support at the international level (tarrow, 2005). the link between transnational activists (e.g., chilean exiles) and rooted cosmopolitans (e.g., chilean activists during the pinochet era) determines how influential the transnational network will be on pressuring the government to address social disparities. transnational networks usually arise due to a lack of response by the state on issues being raised by local activists. keck and sikkink (1998) identified the following tactics to pressure a state to respond: 1) information politics – generates information quickly to impact the political climate and persuade people to act, 2) symbolic politics – relates the lived experience of the people encountering human rights violations for people abroad to join the alliance, 3) leverage politics – encourages powerful actors in influential positions to withhold resources for the state to respond to the claims of human rights violations, and 4) accountability politics – powerful actors are held accountable for prior commitments and/or policies addressing human rights. successful transnational networks have committed actors who are influential as grassroots activists and transnational activists. they raise global awareness of the plight of vulnerable populations at the local level and utilize foreign resources (e.g., foreign aid, policy, international trade, media) to pressure a state or local government to address human rights violations. advances in social work, spring 2013, 14(1) 21   chile, as a case study, highlights how transnational networks are able to persuade, socialize, and pressure the local government to address human rights violations. amnesty international (2008b) conducted a research mission in 1973 to investigate human rights allegations (i.e., information politics) and collect testimonials of victims (i.e., symbolic politics). families of victims sought legal support from spain and the united kingdom due to failed attempts within chile to prosecute perpetrators of human rights violations (pion-berlin, 2004), which is an example of leverage politics. “in 1978 the military had decreed for itself a sweeping amnesty which let all state security officials off the hook for human rights crimes committed between september 1973 and march 1978” (pion-berlin, 2004, p. 483). amnesty international (2008a) was the first international ngo to pressure the british government to extradite pinochet during his stay in the united kingdom in september 2008. extraditing pinochet was a paramount moment because international experts (e.g., legal advocates, human rights activists, scholars) were able to successfully raise global awareness and prosecute offenders of crimes against humanity (pion-berlin, 2004). external pressures from spain and the united kingdom resulted in accountability politics, which influenced judge guzman to introduce a “new doctrine” in chile’s judicial proceeding that overturned amnesty of military officials (pion-berlin, 2004). chile’s supreme court honored the “new doctrine” and was successful in prosecuting multiple military officials guilty of human rights crimes (pion-berlin, 2004). overall, human rights violations committed by the pinochet regime have caused chile to create an institute of human rights and designate an under-secretariat for human rights to address complaints from the public as well as organizations (meyer, 2012). amnesty international continues to monitor human rights violations in chile, and attention has currently been focused on prisoners and indigenous people. conclusion the international field of social welfare requires professionals to take an interdisciplinary approach toward advocating for the protection of highly vulnerable populations. inequality between states has decreased through globalization, but it is imperative that professionals deepen their understanding of how inequality is reinforced within a state and the affect it has on addressing the needs of highly vulnerable populations. the literature has emphasized the implications of neoliberal ideology being reinforced through globalization, which sustains a hegemonic structure that hinders the distribution of wealth and access to resources. however, every state varies on how a nation is governed and what type of ideology reinforces cultural beliefs and values. acknowledgement of historical events provides critical insight into how social structures reinforce power and status within a state, as well as political influence between the host and foreign state. the field of social work takes a multi-perspective approach toward addressing social problems at the micro-meso-macro levels (the office of the high commissioner for human rights [ohchr], 1994). social workers are well poised to address global disparities because the profession reinforces a holistic approach in ensuring social justice, human rights, and sustainable development for highly vulnerable populations. as stated by the national association of social workers (2012): “the primary mission of the garcia/chile: globalization, inequality, and transnational activism 22   social work profession is to enhance human wellbeing and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.” the greatest obstacle to overcome in establishing a transnational network is for there to be a consensus of a shared vision and values among activists. developing a shared vision with an overarching goal and designated objectives is pivotal for the transnational network to be successful in addressing issues and optimizing resources toward accomplishing outcomes. the universal declaration of human rights (udhr) provides a common understanding of shared values for key players at every level. the code of ethics for social work also reinforces the udhr. the office of the high commissioner for human rights (2012) provides 388 translations of the udhr and identifies voluntary commitments and pledges made by a state to address human rights. the millennium development goals (mdgs) is an agreement made by states throughout the world to address: 1. poverty and hunger; 2. education; 3. gender equality; 4. child health; 5. maternal health; 6. hiv/aids; 7. environmental sustainability; and 8. global partnerships (united nations, 2010). the udhr, along with the mdgs, provide critical tools for activists to collaborate with intergovernmental organizations, international organizations, and local organizations to hold a state accountable for human rights violations and measure progress toward addressing social disparities. once a transnational network agrees on a shared mission of designated goals and objectives, it is also important to take into consideration the influence that power, status, and entitlement have within the network as well as external factors between the host and visiting state. ife (2007) has raised awareness on the implications of globalization and how power has influenced the social work profession in reinforcing a western ideological approach in addressing social disparities abroad. an emphasis is placed on a dominant colonial discourse and the implications it has in shaping the social work profession toward addressing the needs of historically oppressed and highly marginalized populations (ife, 2007). professionals addressing social disparities in foreign states must take into account how personal factors (e.g., citizenship, employment status, educational status, biological sex, ethnicity, economic status) influence interactions with the local community as well as the power elite. foreign professionals should empower rooted cosmopolitans (local activists) to take the lead in addressing local social issues as well as to recognize experiential knowledge as a valuable source for addressing the needs of highly vulnerable populations. a focus on sustainable development strengthens a collaborative approach among activists and prevents the rooted cosmopolitans (local activists) from depending on transnational activists (foreigners) to address the needs of the local community. an emphasis has been placed on addressing social disparities abroad, but professionals are able to apply the same principles locally to hold a government accountable for reinforcing inequality and social disparities among historically oppressed populations such as latinos. the udhr applies to issues within the united states and american ideology continues to influence the development of lowand middle-income states through international aid and policy. transnational activism utilizes power and status between states to pressure a local government in addressing human rights advances in social work, spring 2013, 14(1) 23   violations among highly vulnerable populations. therefore, professionals addressing social disparities play a critical role in monitoring existing systems to ensure that the needs of highly vulnerable populations are addressed appropriately. inequality will remain rampant, unless professionals advocate for change from within as well as from outside existing social structures, domestically and internationally. references amnesty international. 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(2003). the commanding heights: the battle for the world economy. retrieved from http://www.pbs.org/wgbh/commandingheights/lo/index.html author note: address correspondence to: moctezuma garcia, ph.d., lsw, postdoctoral teaching associate, central michigan university, department of sociology, anthropology, and social work, 142 anspach, mount pleasant, mi 48859 email: moctezuma.phd@gmail.com microsoft word 08 evans-chase_17973_if_they_can_take_it_au_ce.docx ______________ michelle evans-chase, ph.d., is an assistant professor of psychology at rowan university in glassboro, nj. 116 robinson hall, rowan university 201 mullica hill road • glassboro, new jersey 08028. email: evanschase@rowan.edu copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 90-106 if they like it they can take it with them: a mixed methods examination of internet-based mindfulness meditation with incarcerated youth michelle evans-chase abstract: the most successful programming offered in juvenile justice facilities does not easily transfer back to communities to give youth the opportunity to practice intervention skills once they return home. this transferability is particularly important to youth leaving state custody given that they disproportionately return to poor communities and disrupted families that both exacerbate behaviors associated with juvenile justice involvement and act as barriers to much needed services and support. with this in mind, a randomized controlled trial was conducted with a sample of 60 youth, ages 16 to 22, sentenced to state custody in a juvenile detention facility in new jersey to quantitatively assess the ability of freely available internet-based mindfulness meditation instruction to increase mindfulness. weekly journals and open-ended post-test questions were used to qualitatively explore treatment experiences. differences among age and treatment groups on quantitative measures of mindfulness, along with content analysis of journal entries, suggest that the internet delivery of mindfulness meditation instruction increased mindfulness in older youth. forty percent of treatment youth, compared to 5% of control youth, provided at least one detailed entry describing their use of “class skills” to help them deal with conflict in the facility. these findings suggest that an internet delivery of mindfulness meditation is engaging to incarcerated youth, helpful to them in coping with life in a juvenile justice facility, and able to increase mindfulness in older youth who practice it. keywords: internet, mindfulness meditation, juvenile justice, transition, incarceration, youth approximately 60,000 youth were detained in juvenile justice facilities in 2012 (hockenberry, sickmund, & sladky, 2015). previous cohorts of youth leaving state custody have reported difficulties with anger management (80%), anxiety (61%), depression (59%), substance abuse (68%), and suicidal ideation (27%) at the time of their release (sedlak & mcpherson, 2010; snyder & sickmund, 2006). these findings are important given that incarcerated youth are disproportionately exposed to family and community environments out of custody known to exacerbate these and other poor mental health and behavioral outcomes. additionally, such experiences, which include exposure to family and community violence (baglivio et al., 2014; hawkins et al., 2000), family disruption (baglivio et al., 2014; travis, cincotta, & solomon, 2003), and poverty (snyder & sickmund, 2006), often act as barriers to obtaining the services and support youth need to deal with these issues once they return home. until those structural factors that give rise to these circumstances (e.g., poverty, institutional racism) are addressed, identifying ways to provide youth with support both in and outside of custody is one operative way to address the impact that these experiences have on youth. evans-chase/if they like it 91 the purpose of this study is to identify an effective intervention for incarcerated youth that 1) increases their ability to cope with the stressors that exacerbate the emotional and behavioral problems associated with juvenile justice involvement and 2) is delivered in such a way that they have continued, free access after release, regardless of family or community resources. the intervention chosen for the study, mindfulness meditation, is a practice associated with positive mental, behavioral, and emotional changes in samples of adults and youth with and without mental health diagnoses, and it is amenable to an internet delivery method that would allow for continued practice once youth leave custody. background and significance it is well documented that incarcerated youth face disproportionately high rates of community and family stressors outside of custody known to increase the likelihood of delinquent and aggressive behavior (baglivio et al., 2014; bjerk, 2007; carlson, 2006; smith & ecob, 2007). these experiences, which are enduring factors in the lives of incarcerated youth, include parental incarceration (schnittker & john, 2007; travis et al., 2003), violent victimization, exposure to violence (baglivio et al., 2014; bjerk, 2007; carlson, 2006), and poverty (bjerk, 2007; carlson, 2006). programming and out of custody context programming in juvenile justice facilities is an opportunity to intervene in the lives of youth and help them develop into healthy young adults. currently, most of the successful interventions used with incarcerated youth, such as cognitive behavioral therapies and interpersonal skill development (lipsey, wilson, & cothern, 2000), are not designed to provide continued structure in the practice of newly acquired skills once youth are out of custody. additionally, a systematic review of 198 juvenile justice intervention studies found that only five studies assessed transition or post-release programming, suggesting that transition programming is either a rare practice with youth leaving custody or that such programming is implemented with no evidence (evans-chase & zhou, 2014). what appears to be the current practice in juvenile justice facilities is to provide treatment and programming for youth only until they are released, after which ill-equipped families and communities are left responsible for finding, connecting, or providing youth with the support they need. high rates of recidivism (snyder & sickmund, 2006) and longitudinal data suggest that this is not a successful strategy. one study of youth leaving custody found that, while 45% had at least one dsm-iv diagnosis, only 20% were receiving mental health services at 6 months post release and only 15% at 12 months (bullis, yovanoff, & havel, 2004). additionally, only 48% of the cohort was connected to any community-based agencies at 6 months post release, with 33% at 12 months. identifying mechanisms that provide access to continued support once youth leave custody could help to ensure their success while at the same time serving the goals of the juvenile justice system. internet-based interventions previous research on technology use by adolescents has indicated that 93% of youth, regardless of income, are daily users of technology, including personal computers, ipods, cell phones, and the internet (palermo, wilson, peters, lewandowski, & somhegyi, 2009). advances in social work, spring 2015, 16(1) 92 despite empirical support for the use of technology in the delivery of interventions supporting adolescent physical health (maher, williams, olds, & lane, 2010), mental health (palermo et al., 2009), and risk reduction (heinicke, paxton, mclean, & wertheim, 2007), it is rarely used in juvenile justice interventions (evans-chase & zhou, 2014). using computers or ipods to deliver in-custody programming could give youth leaving custody the opportunity to continue to practice intervention skills after release with the same structure, breaching the transition gap and increasing their ability to incorporate intervention skills into their everyday lives. mindfulness meditation mindfulness meditation (mm) is a skill that has been successfully taught both with a teacher present as well as via guided meditation tapes (ditto, eclache, & goldman, 2006). successful integration of mm into individual practice has been found with programs ranging from 45-minute sessions once per week for 4 weeks (jain et al., 2007) to 2-hour sessions once per week for 8 weeks (ramel, goldin, carmona, & mcquaid, 2004). the three components common to most definitions of mm practice include present awareness, or having one’s awareness in the present moment; nonjudgmental awareness, or being aware of but not judging the emotions, thoughts, or events of the present moment as good or bad; and acceptance, or accepting the emotions, thoughts, or events of the present moment as they are (biegel, brown, shapiro, & schubert, 2009; burke, 2010). positive mental health outcomes and behavior change. previous research on mm has found significant effects on positive states of mind and stress reduction in comparison to relaxation and control groups (broderick, 2005; jain et al., 2007). studies have also found a positive relationship between mm and reduced substance abuse in incarcerated adults (bowen et al., 2006) and increased self-control and self-awareness and decreased stress and anger in adolescent sex offenders (derezotes, 2000). mm has been successfully combined with cognitive and dialectical behavior therapies as a treatment for children with anxiety (semple, reid, & miller, 2005) and for the prevention of suicidal behaviors in patients with past suicidal ideation (williams, duggan, crane, & fennell, 2006). a recent review of research conducted between 2003-2008 found the associated effect of mm to include lowered anxiety, depression, anger and worry; a greater sense of well-being; increased emotional control; lowered levels of cortisol; and an increased ability to reduce harmful behaviors such as binge eating, smoking, and substance use (greeson, 2009). mm with incarcerated youth. these findings suggest that mm may be uniquely suited for use in the juvenile justice system given its successful use with adolescents and as an effective treatment for youth with behavioral and emotional problems similar to those reported by youth leaving custody. furthermore, given the effectiveness of mm in addressing mental health issues such as suicidal ideation, depression, and anxiety in a variety of populations, mm should be no less effective and may even be more helpful for those youth incarcerated in the juvenile justice system with undiagnosed and/or untreated mental health issues. finally, the increased emotional and behavioral control associated with mm may be protective against the emotional responses associated with the life stressors incarcerated youth face outside of custody (greeson, 2009). evans-chase/if they like it 93 methods as part of a randomized, controlled trial of the effects of mm on self-regulation, the current study explores participants’ experiences with the internet-based instruction qualitatively through content analysis of journals and open-ended questions and quantitatively using the five-factor mindfulness questionnaire (ffmq). for a full description of study methods, see evans-chase (2013). recruitment and randomization all male juvenile offenders incarcerated in the new jersey state correctional facility in monroe township, nj who were scheduled for release no less than 3 months from entrance into the study, who voluntarily agreed to be in the study, who voluntarily signed an assent or consent form, and who had at least one parent sign a consent form (for youth under 18) were eligible to participate in the study. residents who were in protective custody or were otherwise not safe in a group setting, either because they were a threat to others or a high victim risk as defined by the facility, were excluded from the participant pool prior to recruitment activities. consent interviews were conducted with youth 18 and over, and assent interviews were conducted with youth 17 and under. parental consent forms were sent to the parents/guardians of all youth under the age of 18 who assented to participate. the packets contained a letter of introduction, two copies of the consent form, one for the parent/guardian to keep and one for them to mail to the principal investigator (pi), and a stamped envelope addressed to the pi. randomization was done at the individual level within housing unit groups such that youth from housing units 1, 2, and 3 were randomly assigned to either treatment or control groups meeting on thursday nights and youth from housing units 4, 5, and 6 were randomly assigned to either treatment or control groups meeting on friday nights. housing units were combined by the facility administrators based on those units that normally mixed in other facility activities. all study activities were held in the same community building, including recruitment, randomization, treatment and control sessions, and data collection. the randomization process itself used a list of numbers, with even numbers representing mindfulness meditation assignment and odd numbers representing guided relaxation (gr) assignment. each number was written on an individual piece of paper, folded, and placed in a small paper bag. at the end of the pretest session, as each participant turned in his completed questionnaire he was asked to pick one of the pieces of paper out of the bag. the number chosen indicated group assignment. randomization was conducted in this fashion for three reasons: 1) to give the participants a clearer understanding of what was meant by random assignment to groups, 2) to give the participants an opportunity to feel that they were a part of the study process, and 3) because conducting the randomization process after administration of the pretest has been identified as a method that can prevent the impact that knowledge of group assignment can have (boruch, 1997). advances in social work, spring 2015, 16(1) 94 treatment and control sessions classes were conducted for 1 hour once per week for 8 weeks. a male research assistant used pre-recorded instructions to facilitate treatment and control group sessions. participants sat in chairs at the table of their choosing. all of the chairs faced the front of the room where the ipod and speaker were placed on a centrally located table. snacks provided by the facility were also made available during the sessions. the research assistant handed out the journals, took roll, and turned on the audio for that session. the journals were handed out at the beginning of the session to give participants something to do (doodle, draw, write) if they found it difficult to sit still during the entire audio session. this procedure was planned in recognition of the high rates of attention deficit disorder in this population (adams, 2010) to allow them to continue to listen while also engaging in a physical activity that would not be disruptive to the other participants. mm classes used mp3 downloads of classes led by noah levine, who has extensive experience teaching meditation to incarcerated youth and adults as well as non-incarcerated youth recovering from drug and alcohol addiction. the downloads used for the study, all of which are available for free on levine’s website (levine, 2015), involved specific instructions in mm that encouraged relaxed, nonjudgmental awareness of thoughts and feelings while focusing on breathing. the instruction also included commentary on how these mm practices (nonjudgmental awareness of thoughts and feelings during meditation) relate to compassion, patience, and mindfulness in everyday life. gr classes utilized a progressive muscle relaxation (pmr) mp3 download that included very simple instructions in contracting and relaxing different muscle groups in a conscious attempt to relax the body and reduce cognitive and physiological stress (pawlow & jones, 2005). progressive relaxation has been found to significantly lower levels of salivary cortisol after a single 1-hour session (pawlow & jones, 2005) and, in metaanalysis, to have a medium-high effect on anxiety, particularly for young people (manzoni, pagnini, castelnuovo, & molinari, 2008). while pmr and meditation both significantly reduce anxiety (manzoni et al., 2008), the practice of mm is additionally associated with “important shifts in cognition, emotion, biology, and behavior” (greeson, 2009, p. 15). it is this change in behavior, cognition, emotion, and biology that was hypothesized for the treatment group but not for the control group. that both the treatment and control groups might experience decreases in anxiety was an additional benefit of the choice of pmr (termed guided relaxation for the study) for the control group such that it provided the possibility that the comparison group might benefit from participation in the study, although no stress or anxiety scales were included in data collection materials. incentives to thank participants for their participation, snacks were provided during data collection and class sessions. additionally, gift cards were provided based on level of participation: $5 for the pre-test, $5 for attending 5 or more classes or $10 for attending all 8 classes, and $5 for the post-test. participants were asked at post-test to identify a store or restaurant for which they would like a gift card purchased in the amount corresponding to their level of participation in the study. evans-chase/if they like it 95 measures to test the novel delivery of mm instruction, a quantitative measure assessing changes in mindfulness between pre and post-test and qualitative measures exploring the experience of the delivery method were used. the 5-facet mindfulness questionnaire (ffmq). the ffmq includes 5 subscales that measure different facets of mindfulness, including observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience. the ffmq was designed for use with a range of ages and has been used successfully with both children (e. sabinga, personal communication, march 5, 2010) and young adults (baer et al., 2008). construct validity of the five facets has been demonstrated in a sample of older adolescent and adult students, where the describing, acting with awareness, nonjudging of inner experience, and nonreactivity facets were significantly and negatively correlated with psychological symptoms and significantly and positively correlated with psychological well-being (baer et al., 2008). the observe facet was positively and significantly correlated with psychological symptoms in those with more meditation experience but not amongst those with little or no meditation experience. it appears that the observing facet has different meanings in experienced versus inexperienced meditators such that observing for non-meditators represents a more negative self-focus that can be maladaptive, while in experienced meditators, observing involves an internal and external focus that is non-judgmental (baer et al., 2008). journals. journals were handed out at the beginning and collected at the end of each class session and included a closed-ended section in which participants were asked to circle the number of times they had practiced between classes and an open-ended section in which they were asked to write down any thoughts, experiences, or suggestions about the class. any practice done between classes would, by necessity, be from memory, as participants had no access to computers or the internet, nor were they given the name of the mm or gr instructor until the classes were completed. to assure that identical instructions were given to treatment and control groups, the following was read during the initial class sessions: we will meet each week to do this but in between classes you can practice (mm or gr) as much or as little as you want to. the only thing we ask is that you keep track of how many times you practice. each week before i start the mp3 instructions i will hand out these journals for you to keep track of whether you practiced between classes or not and if you did, how many times. you can also use the journals to write down anything about the classes that you think would be important for the researcher to know. treatment experience six open-ended questions were presented at post-test to the mm participants; these questions asked for general opinions about their experiences with the intervention. the questions asked what they liked most and least about the classes, if and how learning mm helped them deal with everyday life, if they would be interested in participating in more advances in social work, spring 2015, 16(1) 96 classes, and if/how they thought being at a juvenile facility affected the ability to practice mm. data analysis multiple regression analysis was used to test the effect of the mm instruction on mindfulness using four dummy variables: three for age: age1 (age 16-17), age2 (age 18), and age3 (age 19-23) and one for group assignment. two models tested differences between groups in mindfulness post-test scores: a main effects model that included pretest scores, a treatment dummy variable, and two of three age group dummy variables; and an interaction model that added an interaction term (agextreat) created by multiplying the age group dummy variables by the treatment dummy variable. the author used an iterative, open coding process to identify topics and themes arising from the mm journals and post-test open-ended questions. the content analysis process included multiple readings of the narrative data (i.e., journal entries and post-test answers), with the first reading done without expectation of what topics or themes might arise. during the second reading, topics were noted for each entry or answer and then transferred to a database in microsoft excel. topics were then explored for key concepts or words, and themes were created out of related topics. entries were then re-read for the existence of the main themes or key concepts across participants. content analysis was done first for the mm group and followed by analysis of gr narrative data for the frequency with which youth in the gr group addressed the most common themes identified in the mm data as well as for common topics and themes within gr journal entries. human subjects the risk to the participants was minimal. participation in mindfulness meditation or guided relaxation does not include any risk greater than that faced in everyday life in the facility. however, because of the vulnerability of incarcerated youth, several procedures were implemented to ensure that participation was truly voluntary. first, although the state is the legal guardian of the youth and able to give consent for their participation, assent forms were used to make sure that each youth was completely informed about the study and participated voluntarily. parents of all assenting youth were contacted and asked to provide consent for their son’s participation in the study. second, to assure that any youth who declined to participate did not face any consequences for declining, both the pi and research assistant referred to youth who declined as “not qualifying” when communicating with the facility rather than saying that the youth declined to participate. this terminology is consistent with and reflective of the study entrance criteria, which includes voluntary participation and a voluntarily signed assent form. all procedures were approved by the university of pennsylvania institutional review board and the new jersey juvenile justice commission research review board. evans-chase/if they like it 97 results a total of 60 young men participated in the study. the mean age of the overall sample was age 18 (sd =1.30), with 17 (28%) in the age 16-17 group, 24 (40%) in the age 18 group, and 19 (32%) in the age 19-23 group. of the 60 participants who started the study, 45% (n=27) completed the study through the post-test and are used in quantitative analysis. attrition from the study and thus exclusion from the quantitative analysis was most commonly due to being out of custody at the time of the post-test (n=17, 29%), not attending the post-test session (n=9, 15%), or being on lockdown on the day of the posttest (n=3, 5%). all journals with at least one entry were included in the analysis. treatment vs. control: mindfulness a paired samples t-test was used to establish equivalence between the mean scores for the two groups (mm vs. gr) on baseline mindfulness. no significant differences were found between the mm (m=122.71, sd=19.80) and gr (m=124.58, sd=11.16) groups, t (24) = 0.289, p=0.77. multiple regression analysis was used to test models of differences between groups at post-test using four dummy variables: 3 for age: age1 (age 16-17=1, age 18-23=0), age2 (age 18=1, age 16-17=0, age 19-23=0), and age3 (age19-23=1, age 1618=0); and one for group assignment: treatgrp (1=treatment, 0=control). the age groupings were made 1) based on common separations in brain imaging studies of developmental differences in those areas most affected by mm practice (allen et al., 2012; holzel et al., 2007; luna, padmanabhan, & o’hearn, 2010; tang, lu, fan, yang, & posner, 2012), 2) to allow for contrast with multiple referent groups (gordon, 2010), and 3) to create more equal groupings for analysis (gordon, 2010). because the developer of the ffmq has recommended that the observing sub-scale be used only in comparisons within treatment groups when evaluating mindfulness programs due to possible differences in meaning for those with more mm experience (baer, samuel, & lykins, 2011), two datasets were used to test four models. two models used the original mindfulness scores, including the observing sub-scale, and three models used a dataset of scores with the observe sub-scale removed from both pre and post-test totals. the main effect only model for each dataset tested the effect of being in the treatment versus the control group, controlling for pre-test scores and age group; the interaction model included these variables plus an interaction term for age group x treatment group. as demonstrated in table 1 using all of the sub-scales, the gr group significantly outperformed the mm group in the oldest age group by an average of 15 points (p<0.05), a difference that did not hold once the observe sub-scale was removed (b= -11.57, p>.05). the age2 mm youth (comprised of youth aged 18) also outperformed the age3 mm youth (comprised of youth age 19-23) by almost 21 points (p<0.05) using the full mindfulness scale, but the difference was both smaller and non-significant with the reduced scale (b= 13.86, p>0.05). advances in social work, spring 2015, 16(1) 98 table 1. regression analysis of mindfulness scores using the full scale and reduced scale with the observe sub-scale removed from post-test totals. original adjusted main effects only interaction main effects only interaction b (se) b (se) b (se) b (se) pretest 0.66 (0.15)* 0.70 (0.15)* 0.58 (0.15)* 0.60 (0.16)* treat v control -4.91 (4.29) -3.81 (3.73) treat v control age1 -4.56 (8.13)º -2.25 (7.93)² treat v control age2 5.09 (6.51)ª 2.29 (6.06)³ treat v control age3 -15.68 (6.55)* -11.57 (6.12) age1 -8.41 (5.7) -12.62 (7.5) -4.89 (4.85) -8.63 (7.14) age2 -3.55 (4.95) -12.31 (5.95) -3.52 (4.41) -9.28 (5.59) age1xtreat 11.12 (10.59) 9.31 (10.09) age2xtreat 20.77 (9.03)* 13.86 (8.54) age1xtreat¹ -9.65 (10.75)ª -4.54 (10.45)³ intercept 45.05 (18.95)* 43.81 (18.78)* 45.39 (15.64)* 45.42 (17.02)* n 24 24 24 24 adj r2 0.53 0.60 0.42 0.45 f-value f(4, 19)=7.42* f(6, 17)=6.69* f(4, 19)=5.22* f(6, 17)=4.07* δadjr2 0.07 0.03 f-value f(2,17)=1.46 f (2,17)=0.31 *p<0.05 ¹ with age 2 as the reference group ª intercept: b=31.50, se=18.45, p>0.05 ² intercept: b=36.79, se=16.66, p<0.05 º intercept: b=31.19, se=19.53, p>0.05 ³ intercept: b=36.14, se=16.73, p<0.05 content analysis: journal entries table 2 lists the most common themes found in the mm journals. comparisons with gr journals indicated that a higher percentage of youth in the mm classes wrote about the application of class skills to help them control their behavior or deal with their emotions outside of class (54% v. 30%), with an even bigger gap between the two groups in the percentage of youth who described specific examples in which they used class skills to regulate their emotions or behavior outside of class (42% v. 5%). a higher percentage of youth in the gr classes reported that practicing class skills both inside and outside of class reduced their stress levels and/or made them feel calm or relaxed (65% v. 58%). evans-chase/if they like it 99 table 2. primary themes compared across treatment conditions number of participants* mm gr n=24 n=20 described using class skills to self-regulate behavior or emotions 13 (54%) 6 (30%) described specific examples of self-regulating emotions or behavior 10 (42%) 1 (5%) reduced stress, were calmed by class or practice outside of class 14 (58%) 13 (65%) neither 4 (17%) 2 (10%) * some participant journals contained multiple themes, therefore column totals > number of participants as demonstrated in figure 1, about half of the mm participants (n=12) had journal entries that communicated only positive experiences and thoughts about the class or the use of meditation or mindfulness skills outside of class. about 38% (n=9) had primarily positive journal entries mixed with entries that communicated factors about the class that they did not like. one primary complaint about the class was that it was boring (n=3), although two of these three participants also commented in their journals that, while they found the class boring, they still practiced the mm instructions outside of class and found that it helped them relax and control their anger. a second complaint was that it was difficult to hear the instructions because of the volume of the ipod (n=3) or that the speaker’s voice on the ipod was sometimes hard to understand (n=2). of the 10 participants who wrote negative comments, nine also included positive experiences of class participation. all of the participants who described practicing mm outside of class, regardless of their feelings towards the class itself, reported only positive experiences in applying class skills to difficult situations encountered in their day-to-day lives in the facility. figure 1. journal commentary about participation in mindfulness meditation classes across all entries 12 9 1 2 0 4 8 12 16 only positive positive + negative only negative neutral number of participants advances in social work, spring 2015, 16(1) 100 treatment engagement youth in the mm group were asked open-ended questions at post-test about their experiences in the class. in response to the question what part of the meditation classes did you enjoy most?, 60% (n=9) indicated that it was the intervention activity itself that they liked the most, 27% (n=4) indicated that it was the class time spent interacting with other participants or eating the snacks provided by the research assistant that they liked most, and 13% (n=2) provided a response too ambiguous to interpret (see figure 2). figure 2. percentage of respondents reporting what they liked most about the mindfulness meditation classes. in response to the question what part of the meditation classes did you not like?, 47% (n=7) indicated that there was nothing about the classes that they did not like, 33% (n=5) indicated that they had some difficulty with the sound of the intervention delivery, and 7% (n=1) indicated that he found the classes boring. in response to the question did learning mindfulness meditation help you deal with everyday life?, 67% (n=10) indicated that learning mm helped them deal with the stressors that they faced living in a juvenile justice facility by helping them control or be aware of their own behavior in emotional situations, and/or by helping them stay out of trouble. in response to the question would you be interested in participating in more classes if they were offered at the [facility]?, 93% (n=14) indicated that they would be interested. in response to the question do you think being in a juvenile justice facility makes it hard to practice mm?, 60% (n=9) reported that practicing mm was hard because of the difficulty in finding a quiet place where they would not be bothered, and 40% (n=6) reported that it was not difficult, that it is something particularly well suited to juvenile justice facilities. 60% 27% 13% 0% 25% 50% 75% 100% intervention activity interacting + snacks unclear what did you like most? percentage of respondents evans-chase/if they like it 101 discussion findings from this study provide support for a new method of mm instruction for incarcerated youth. using the internet in this fashion could increase the ability of juvenile justice facilities to not only provide mm instruction in custody but also provide a longer period of transitional support for youth leaving custody such that the instruction is freely accessible on the internet, giving youth the opportunity to continue to practice intervention skills using the same instructions and teacher after release that they became familiar and comfortable with in custody. mindfulness because previous research suggests that the observing factor has different meanings for experienced meditators, all comparisons were made using two datasets: one with mindfulness scores including the observe sub-scale and one with the observe sub-scale removed. the results suggest that the observing questions may have been understood differently at post-test by older youth in the mm group given that the oldest gr age group significantly outperformed the oldest mm group at post-test using the full scores but that the difference did not hold once the observing sub-scale was removed. these findings may be an indication that older youth in the mm group had the qualitative change referenced by baer and colleagues (2011) in which their experience with mm changed their understanding at post-test of what it means to observe one’s emotions and reactions, that is, from one with to one without judgment. once the observe scores were removed, neither model found significant differences between the mm and gr groups in any of the age groups. this is surprising given the differences found between groups in the content analysis of journal entries and the evidence of changes in the oldest mm group associated in previous research with mm experience. it may be that ffmq questions, at least those other than the observe sub-scale, hold different meanings in the institutional setting. there are many unique factors in custody that may impact the ability of youth to identify, without examples specific to their unique situation, how often they accept the moment as it is or have present time awareness as asked in the ffmq. future research is needed to test the validity of the ffmq in measuring mindfulness with youth living in correctional settings. journals comparisons of journal entries between the mm and gr youth provide qualitative support for the ability of internet-based mm instruction to increase mindfulness in incarcerated youth. first, over half of the youth in the mm classes wrote at least one entry mentioning the use of class skills to self-regulate emotions and behavior outside of class while less than a third of gr youth did. more compelling is the difference between the groups in providing specific, detailed examples of situations in which class skills were used and how they used them, with over 40% of mm youth providing at least one detailed example that recounted a situation in which they became angry during an interaction with a staff member or resident but took a moment to breath and think about how they wanted to respond and as a result did not react in an angry or aggressive manner. by contrast, only advances in social work, spring 2015, 16(1) 102 one gr youth provided such specific examples. instead, entries describing the use of gr in the self-regulation of emotions or behavior were more likely to be general reactions unassociated with any particular situation. the specificity and detail of the journal entries of the mm youth compared to the gr youth suggest that the mm youth may have been more aware of their behavior and able to apply what they were learning more consciously so that when the time came to write in their journals during class time, they could bring to mind and provide considerable detail of specific situations in which they found class skills helpful. furthermore, descriptions of interpersonal situations where they became angry contained evidence of responses characteristically associated with mindfulness: awareness of thoughts and emotions (awareness), conscious decisions not to respond with anger (acceptance of situation or emotion, non-reaction), and the ability to later describe situations with detail (being present, describe). treatment engagement programming that is found in intervention studies to be effective with youth does not always translate into effective practice unless youth themselves find the program engaging enough to be worth the effort of participation. based on questions asked of the mm participants at post-test, it appears that the vast majority of youth found the intervention as delivered engaging. most reported that the mm activity itself was their favorite part of the class (compared to the opportunity to socialize and eat snacks) and that the skills they learned were immediately applicable to their lives in dealing with the stress associated with living in a juvenile justice facility, in being aware of and controlling their emotional reactions, and/or in helping them stay out of trouble. conclusion the level of engagement and real-life application of intervention skills demonstrated here suggests that mm instruction using mp3 downloads with youth in custody could increase their ability to cope with the stressors of life within juvenile justice facilities and possibly translate to continued practice after release when such coping mechanisms are even more imperative if youth are to thrive within their troubled families and communities. future research should include longitudinal studies to assess the extent to which youth continue to practice mindfulness meditation once they return home and if such continued practice is associated with positive effects on mental health and behavioral outcomes. future research should also include samples of young women and special populations of youth not represented here (i.e., those in juvenile justice substance use and mental health treatment units) and 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(2006). mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior. journal of clinical psychology: in session, 62, 201-210. microsoft word 13. wood et al_16627-waiting to be cinderella'd-copyedit final ______________  leila wood, lmsw, ph.d., is an assistant professor in the texas state university school of social work in san marcos, tx; carol hostetter, ph.d., is a professor in the indiana university school of social work in bloomington, in; and sabrina w. sullenberger, ph.d., is an associate professor and chair of the social work department at belmont university in nashville, tn. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 460-479     waiting to be cinderella’d?: attitudes on class differences among women leila wood carol hostetter sabrina w. sullenberger abstract: this article explores the way in which college students construct attitudes about class differences among women. social work student researchers interviewed 30 college students at a midwestern public university and asked them to tell stories about women in two different social class positions. the results revealed that social class differences are constructed based on factors related to family of origin, personality, structural inequities, personal choices and relationships, as well as other intersecting experiences. in addition, participant stories highlighted gendered attitudes towards women in poverty. implications for social science teaching, practice, and research are discussed. keywords: feminization of poverty, gender, attitudes, college students, social class, social work the economic status of women in the united states has been the frequent subject of social science research. while academics and helping professionals may be well aware of the intersecting forms of oppression faced by women, less is known about people’s beliefs about females in different class positions. attitudes inform action (cozzarelli, wilkinson, & tagler, 2001) so a lack of knowledge about perceptions of gender and social class creates a deficit in the ability to work for social justice, especially regarding women experiencing poverty. an exploration of how people view differences between a woman in an uppermiddle class position and one living in poverty can reveal the factors that help to shape such attitudes. information about perceptions of women and economic status can be used to inform social work research and practice in order to reduce disparities and stigma for women in different social class positions. of particular importance is how college students form beliefs about social justice issues as they are getting ready to enter the workforce, where they will have influence on the experiences of women in various social class positions. this study focuses on the findings of a research project aimed at exploring how college seniors create indicators of social class. the research team asked participants to construct stories about women in two different social class positions: one a janitor or factory worker and the other a successful business person. the narrative from the participant interviews illuminates some of the ways that gendered beliefs about social class are determined and constructed. these findings have important implications for social science research, teaching, and practice. wood, hostetter, sullenberger/waiting to be cinderella’d 461  literature review the role of gender in social class since the 1970s, researchers have noted a decidedly feminine trend in poverty (richards, garland, bumphus, & thompson, 2010; tiamiyu & mitchell, 2001), with women experiencing more poverty than men. this “feminization” of poverty is cemented by experiences of single parenthood, domestic violence, lack of affordable housing, poor job opportunities, and inadequate public welfare (richards et al., 2010; tiamiyu & mitchell, 2001). at the same time, wealth in america has increasingly become concentrated, making class mobility more difficult (froehlich, 2005). in addition, job polarization with economic growth only at the top and bottom of the labor market has led to a decrease in middle-class incomes. the increase of women entering the workforce has created more opportunities in the upper and middle class among females with a college education, but has put greater strain on those in poverty (dwyer, 2013). in 2012, 16% of american women were living in poverty, and 28% of female-headed families had incomes below federal poverty lines (u. s. census bureau, 2012; u. s. bureau of labor statistics, 2012). an additional 7.6% of women qualify as working poor (u. s. bureau of labor statistics, 2012). women of color experience a more hostile labor climate, influenced not only by pervasive sexism, but racism as well. poverty rates for women of color are double those of white women (ahmad & iverson, 2013). these data suggest that women are vulnerable to poverty and to other social class issues, such as racism. disparities in pay in the labor force play a large role in the feminization of poverty. analysis of the gender wage gap in the united states revealed that in 2011, women earned only 77% of male counterparts, despite strong family reliance on their earnings (american association of university women [aauw], 2014b). the pew research center recently gave the name breadwinner moms to women, married or single, who have children under the age of 18 and provide the sole or primary income for their family (wang, parker, & taylor, 2013). breadwinner moms share responsibility for their families’ livelihood, but differ dramatically in income levels with poor women making considerably less than male counterparts (wang et al., 2013). inequities in the labor force stemming from gendered discrimination and changes in national policy are seen as a source of the feminization of poverty. an increased expectation, propelled by the personal responsibility and work opportunity reconciliation act and subsequent welfare restructuring in 1996, that lowerincome mothers enter the workforce has shifted policy closer to devaluing the work traditionally done in the home (froehlich, 2005). women entering the workforce in lowpaying jobs may face occupational injustice and “occupational imbalance,” meaning that they have more labor commitments than others in higher class positions (froehlich, 2005, p. 406). this occupational injustice can be compounded when women are part of other historically marginalized groups and encountering multiple forms of oppression. part of this imbalance stems from mothers entering the workforce while continuing multiple forms of labor at home as well as from the influx of women into low-wage care taking professions that were historically done in the home, such as childcare (dwyer, 2013; froehlich, 2005; gittell, 2009). women have higher educational attainment now than at any point before, but face struggles exiting and re-entering the work force when they have families (gittell, advances in social work, fall 2014, 15(2) 462   2009). overall, white and asian women make more money with comparable educational backgrounds than black or hispanic women (aauw, 2014a). men of color out earn their female peers within their ethnic group, and white men out earn all groups of women (aauw, 2014a). the feminization of poverty and its impact on the lives of women is not new news in social science research. while some women have been able to make enormous economic strides, those living in poverty and especially mothers have been unable to achieve meaningful class mobility. impacting their experiences are societal attitudes and expectations, which is an area of study that merits more attention attitudes about gender and poverty research on beliefs about poverty is important because beliefs shape attitudes and behavior, including civic participation (cozzarelli et al., 2001; davidson, 2009). opinions about social issues reflects public discourse, which often reflects generational beliefs and political action (foster, 2008). analyses of many social surveys and census data have indicated that race and class standing influence beliefs about poverty attributions (adeola, 2005; foster, 2008). caucasians and people from middle class backgrounds are more likely to have individualist views of social class, while african americans and those in lower income brackets are more likely to have structural beliefs about the causes of poverty (adeola, 2005; foster, 2008). in a survey of 154 undergraduates, abowitz (2005) found that college students believe in individualist causes of class mobility, including the idea of the american dream, or that anyone can achieve a high class status with enough work. views on gender may impact poverty perceptions. in a sample of 575 college students, participant adherence to traditional gender roles and promotion of victim-blaming attitudes were connected to low support for social welfare spending, whereas promotion of feminist values was connected to stronger support of social welfare (swank, 2005). cozzarelli et al. (2001) surveyed over 200 undergraduates about their attitudes towards poor women and men. the sample had more positive beliefs about poor women than men in poverty. poor women were seen as having more positive characteristics, but also as having too many children. participants’ attributions for men in poverty were internal in nature, while attributions for women were individual and culturally based. attributions for social class among men matched the research team’s previous survey when no gendered pronoun was given suggesting that attitudes about male poverty are closer to general attitudes as a “default” mode (cozzarelli et al., 2001). these findings necessitate a closer look at constructions of social class among women, especially if attitudes towards men in poverty differ from those towards females. in particular, it is important to learn more about college students and their attitude constructions in light of emerging knowledge about human development. as social, emotional, and neurological development extends into emerging adulthood (ashford & lecroy, 2013), inquiry focused on this age range may offer insights to assist in enhancing understanding about social class issues among this group. the following research project offers new insights into how college students construct femalespecific attitudes about class. wood, hostetter, sullenberger/waiting to be cinderella’d 463  methods research question the research question guiding the inquiry was: how are social class differences among women constructed? the research question guided analysis by seeking to uncover the process by which people in the sample shape attitudes about class difference among females and construct meaning about how women achieve and maintain economic status. procedure this study is unique in that, in addition to offering insight into constructions of social class, it served as a teaching tool to illustrate the research process to undergraduate social workers. social work juniors at a large, midwestern university, who were enrolled in a required introductory research course, located, recruited and interviewed study participants. the students were engaged in a semester-long, institutional review board approved research project that also taught them skills for conducting social work research. this is a multi-year study aimed at gathering data towards a grounded theory about poverty attributions. for more information about the student learning process and an evaluation of this teaching method as a learning tool, please see hostetter, sullenberger, and wood (2013). the inclusion criteria for participation were graduating seniors, between the traditional graduating age of 20 and 25. study participants were found using a peer-swap style of snowball sampling in which one student found a participant for another student to minimize student use of close friends or relatives. these interviews took place at the location preferred by a participant and lasted anywhere from 15 to 30 minutes. the interview consisted of questions based on two scenarios, one involving a woman who was described as working as a janitor or in a factory and struggling to get by, and the other of a woman who is the vice president of a successful business. these two sets of descriptive terms were meant to distinguish different social class experiences. a total of 30 participants were asked questions with a female pronoun and 25 participants were asked the questions with a male pronoun used in the scenario. for the current analysis related to constructions of women in poverty, a subsample of all 30 interviews using the female pronoun was used. of the 30 college students interviewed with the protocol using “woman,” 21 were female respondents and 9 were males. ages ranged from 21 to 23. the interviews were conducted by the undergraduate researchers, a doctoral student, and the two principle investigators. the interviewees represented an array of majors, from history to business and education. no further demographic information was taken. social work majors were intentionally not sampled due to the heavy emphasis on social class differences in the social work curriculum. analysis the data were analyzed using the grounded theory method. grounded theory is a good fit for studies examining social processes (annells, 1997). in grounded theory, data are analyzed using the constant comparison method, where items are compared to the instances that come before it and those that will come after it (birks & mills, 2011; charmez, 2006). advances in social work, fall 2014, 15(2) 464   this process leads to coding of the data. in this study, coding happened in three stages: open, or line-by-line coding, axial coding to build relationships, and advanced coding to construct theory (charmez, 2006; corbin & strauss, 2008). open coding involves a careful line-by-line analysis of the data. the axial coding phase helps to build relationships and refine categories. in the advanced coding phase, the theory is constructed (charmez, 2006; corbin & strauss, 2008). two researchers analyzed the data separately during the stage of open coding using the verbatim transcripts. coding occurred using the constant comparison method. the codes emerged from the data, consistent with constructivist grounded theory (charmez, 2006). the codes were merged by the same two researchers during the axial coding phase. the codes were analyzed for similarities and differences, and a third member of the research team was consulted about intersecting and divergent codes and interpretations. as this is an ongoing project, the third stage of analysis helped to develop themes that relate to ongoing theory construction about attitudes on poverty. the themes related to the gendered nature of poverty attributions among women were finalized in the advanced coding stage. saturation was reached when subsequent data collection and analysis failed to reveal new insights. like many qualitative methods, grounded theory has procedures for rigor. charmez (2006) details the four rigor criteria of a grounded theory study as creditability, originality, resonance, and usefulness. use of memos from data collection and analysis formed an audit trail to monitor theory and thematic development. creditability was established through use of thick descriptions coming from participant voices. all findings are rooted in saturated mention and comparison within and across the data and presented in the findings section below in order to verify their place in the conceptual framework. the previous year’s findings and theoretically sensitizing literature indicated the originality of the line of inquiry and the need for the study focusing on gender. the participant’s ability to use storytelling in order to shape the interview helped to establish resonance. the usefulness of the study will be illustrated for the benefit it provides for the social work students involved in the research project, as well as for the information gleaned from the findings. after analysis, use of existing literature helped to triangulate and contextualize the data. findings college students in the sample expressed beliefs that the differences between women in lower socio-economic statuses, defined as struggling to get by as a janitor or factory worker, and those in the upper class position of being a successful vice president, were a combination of several related factors. a careful analysis of the data set and construction of related themes resulted in six related factors. these factors included cycling, or the generational transmission of social class status; choosing, or the implications of personal decision-making in class status; accessing, or the level to which women were able to have social and educational structure and support; identifying, or the importance of personality traits in achieving and maintaining financial success; relating, including the role of the relationships of the women described by the participants in shaping gender norms and social class status; and finally intersecting, or the impact of other identity positions in the construction of social class distinctions. cycling, choosing, accessing, identifying, relating wood, hostetter, sullenberger/waiting to be cinderella’d 465  and intersecting made up the process by which participants constructed social class differences. cycling participants overwhelmingly asserted a generational aspect to social class, which is passed down from the family of origin, in particular, from the mother. for the woman described as financially struggling, storylines were frequently constructed around someone who came from a single-parent home. chloe described succinctly the dominant story line for the low-income woman throughout the sample: she kind of had a hard upbringing, she did not have both parents in the home so she’s kind of repeating something that her mother went through with kind of struggling to make ends meet. she had children at a younger age, so now not only is she struggling to make ends meet, she’s struggling to also feed her children. so, that’s hard and there’s no father figure around to kind of help her or guide her through what she’s going through right now. generational poverty not only acts as a barrier to achieving economic goals, it also permeates to extended family, placing constraints on economic and social choices, and limiting the ability to access social support. for example, the needs of the family of origin can be a powerful draw to join the work force. several times, participants referred to the need of the low-income woman in their story to begin work to help with siblings. ariel explained why the lower-income woman in her story may not have gone to college: …she had other siblings, so she couldn’t focus on kind of that achievement, that academic achievement as much as like the feeling of trying to help with the household. so she could have possibly been the oldest child to an extent to where she kind of felt like, okay, i need to help my mom out, it’s my responsibility. so she could have been forced to get a job at a young age, or, something like that. this generational cycle of social class was seen by some participants as nearly impossible to escape, rachel said, which makes class differences unfair. okay, they’re not fair because you can’t help the situation you’re born into, you can’t help, poverty, i see it as a vicious cycle. if you’re stuck into it, it’s really hard to get out of it, and i think that it’s unfortunate because there are so many people that have so much potential, and they just don’t get the opportunity to that potential because they’re stuck in a situation they have no way out of. for the woman working as a vice president, class positions were also generationally transmitted. families not only pass down economic values, but also can provide support to maintain and gain class status. women who grew up in middle or upper class families have the advantage of the ability to access networks from their family of origin. in addition to being able to access networks, the woman who grew up in a middle or upper class family was taught the value of education. dionne told a story about the family of origin of a successful vice president. advances in social work, fall 2014, 15(2) 466   they were probably middle-class and more than likely she wasn't a first generation college student. she was able to fund college or her parents were able to fund college. she may have been smart enough to find the money that is out there for college students. in school i think she was a hard-working student that led to her success in college as well as in high school. she did whatever it took to be successful and that's why she is in the position she is in now. overall, while participants acknowledged the power of other factors, family of origin was identified as a major influence along with choices made by the individual in determining social class. choosing participants related that the women in the stories they constructed often made critical choices that solidified their financial positions and impacted the possibility for social mobility. further, while circumstance can provide the initial class position, the path of decisions taken affects what happens later. amber described the potential lost opportunity of class mobility: she might be attending the local college or at some point in time have had attended the local college but if you’re currently working as a janitor, i doubt that you struck it rich and just sorta decided to live a poor life by choice…and that’s how it is, i think sometimes. it’s not even money, it might be opportunity, it might be circumstances, i mean sometime you just can’t make it there. but then other times, you’re on teen mom 2 and you get knocked up and you just cannot be bothered to take your ged because you would rather lay up in bed with your good for nothing, ugly boyfriend named adam, all day long. even when structural factors, such as lack of access to good education are a factor, participants told stories of women who made choices that ultimately limited their ability to have more economic security. participant attitudes were influenced by the woman’s attempts to gain status, as jessica articulated: it’s not necessarily fair but it depends on the situation. did the mom with less money try to go to college? did she try to make her life better? did she take the steps that you have to take to get to where you need to be or where you want to be to live a comfortable lifestyle? participants created a successful vice president who may have structural factors in her favor, but also makes the best possible choices to be poised for good class standing. tonni talked about a woman in this position: still had a social life because in order to be a vice president you have to be social, but so she was probably popular i would say, but not too popular. that didn’t overtake her whole life and she focused on school and went to college and tried to make her parents proud. got a job right away and maybe worked her way up, met the right people, kept working her way up, switching jobs, getting promotions and here she is. wood, hostetter, sullenberger/waiting to be cinderella’d 467  the higher-income woman is viewed as more deserving of the quality of life she enjoys because she made the right choices, as expressed by becky: like if the women that owns her own company worked very hard, went through school, tried very hard to get good grades. like built her company from the ground up and she worked very hard for that then she deserves it. the stories told by participants reflected choice as a critical element of class status. decisions may be impacted by structural barriers, but participants viewed being poor as ultimately a lifestyle choice of someone who did not try hard enough to escape poverty. in addition to personal choices, access to resources and support were seen as critical in class status. accessing class differences between the two women were seen in part as a matter of accessing resources, such as social support and education. the lower-income woman was conceived of as lacking support to pursue education and other goals. women growing up in lowincome homes were seen as having little or no access to higher education, as well as coming from families who placed limited value on college. this limits their ability to achieve mobility, as cora elaborated: i think that she completed her ged; she has a high school degree. a diploma. and i think probably she didn’t have all the same opportunities as other people did. i think maybe she came from a working class background; with her parents anyway. they were working class as well. and so, she has kind of limited mobility. the low-income woman is also one who lacks social support from her family of origin, as becky explained: as for the one that works in the factory i think the difference for her would be maybe not having that much of a support system. because either they are too far away or she is not that close with them. she gets less time with her family i think. in juxtaposition, the higher-income woman has supportive social networks and educational help. this often stems from the support of active family and peer networks, which offer models for success, as ariel noted: she probably had a better support system, especially at home because i feel like when you don’t have it at home and your parents aren’t there then it kind of makes it hard for you to be driven or to feel more comforted and supported. but i imagine her having that and also i imagine her having a better group of friends maybe at a younger age or in high school. support from family and friends and the ability to gain resources helps women stay in middle and upper class positions, in addition to individual personality traits. advances in social work, fall 2014, 15(2) 468   identifying personality emerged as an important aspect of social class construction for women. participants carved out a definite personality type for a higher-income woman. the female vice president was narrated as powerful, focused, and confident. she is perceived, as olivia put it, as having a strong personality. she’s probably has a very strong personality for becoming a vice president of her company. it takes a strong woman to become a leader within a company. the higher income woman was often described as coming from a more affluent family of origin, which also shaped personality. in order to achieve her goals, she had the support of her family and social personality. these leadership skills are honed through extensive training and academic work, but as ariel noted, personality counts in how well a woman could perform the role of being vice president of a business. it takes a lot to be a vp. it takes a certain personality and qualities to be a leader, you have to be confident, you have to be motivating, very on top of things and organized, so i see her being president of union board at (her university) or something like that. just a very high up position. amber noted that a successful woman is not necessarily a “soft” woman. um, you’re looking at 2 to 3 degrees and you’re looking at a very extensive resume and experience. you’re also looking at someone who has the ability to kind of like, be that softer woman but, um, also take no bullshit in the, in the in the board room so to speak. she’s not coming in there, she’s not coming in there ready to play with the kids or to go get her nails done she’s coming in there ready for business because she has to earn that respect. physical appearance and presentation was an indication of personality, especially for higher income women. the vice president was defined by her use of feminine indicators of social class. harper described what the woman in her story would wear. a lot of business woman gear, a lot of jewelry to show that she’s feminine. i mean i would have some high heels personally. less mention was made about the personality of the woman in the story working in a lower class position. a handful of participants indicated that she probably would be a woman of color. a couple of interviewees also indicated that she might not be physically attractive or fit. when it was alluded to, the personality of the woman in the lower-class position was constructed as milder, more traditionally feminine. the vice president was described by participants as tough, demanding, and calculating in addition to personality, participants indicated that women’s relationships affected how they gain class status, but more importantly, how they maintain their social position. relating relationships were the most unifying indicator of class status among women in the sample. they were conceived of in many forms, including the parenting role, relationship wood, hostetter, sullenberger/waiting to be cinderella’d 469  with family of origin, friends and peers, and marriage. the quantity and quality of relationships were major factors affecting social class from an early age. several participants indicated that the lower-income woman had experienced violence in her past, as eddie stated when describing her relationships: she is closest to her mom’s family because she was never really close with her dad because he abused her. the vast majority of the sample also indicated the lower-income woman’s family structure was that of a single mother raising children without financial or emotional support from the father of her children. herbert’s comment on family structure matched much of the sample. i’d probably characterize her as like single mother, either divorced or widowed in sort of a, a type of manual labor or service job, working in either, maybe having more than one job but not really a kind of well paying, stable career. most low-income women were viewed as having children who lived with them. thus, in the case of the lower-income woman, the quality of parenting became a major issue explored in participant interviews. many participants, such as krista, imagined the work life of the woman to negatively impact her children. yeah, for the woman who is a janitor. she probably is not as involved in the children’s schooling. maybe she doesn’t really expect great grades or make sure they’re in extra-curricular activities. maybe, the kids even help support the mom or family. the contrast of the two class positions of the women described by participants was clearest when it came to parenting roles, as summed up by eddie: they are always thinking for providing for the kids as they grow up. the rich woman is thinking about college, while the poor woman is thinking about where dinner is going to come from. the successful vice present was described as having strong relationships. these relationships often stemmed from a supportive family of origin. the sample however, was split on the issue of marriage for the vice president. some participants, like grace, imagined her as married with children. okay well i envision this person since she’s vice president, you know, in a big luxury house, a lot of land, probably a nuclear family i would think. with the husband but she would be the bread winner too. so he might work also. i’d say they both work and then the children, they’re in a, you know, high pre-school or you know a really prestigious school, any of the children they might have. others, like jacob, imagined a woman with no children. she lives in an apartment in the city. um, she doesn’t have any kids or anything like that, she’s basically just kind of a career woman, and that’s how she likes it. advances in social work, fall 2014, 15(2) 470   one critical element of social class construction in the sample was that a successful middleor upper-class woman is more able to control the relationships in her life, including the decision to raise children or get married. freedom over reproduction was a major factor influencing how participants constructed class differences among women. having children was seen as a major expense, and one that influenced social class position. the ability to evaluate the cost of raising children and wait until a person could afford to have children was seen as a critical element of class status among woman. jessica described a successful woman who made the right moves: she is probably doing smart things with her money. saving and planning. she probably has a nice car and can afford the gas to get to and from work. she probably graduated from college to get that position. maybe she is married and maybe she has kids. if she does then she can afford to have kids. she can afford for them to have a pretty good life. being able to afford quality care and possessions for children, and to watch them grow, was considered a luxury of the middle and upper class. however, participants acknowledged the struggles of women in all class brackets of managing many competing roles. intersecting participants in this study imagined social class differences in part based on the intersection of different roles and identity positions held by women. some participants saw the intersection of roles as a work and life balance issue. amber described the plethora of roles that a woman must play and the challenge of the pressure to be everything: what’s interesting is when i think of both the first and the second scenario, i think that woman is a go-getter and i feel like we already talked about music so much shania twain has a song where, um, she’s describing different women and she says, um, you know, she’s your, she’s your bagger at the local grocery store, she’s your mom, she’s your, she’s your doctor and women these days just like, as a gender are expected to be so many different things and you can’t be just a stay at home mom. you have to be the stay at home mom and the p.t.o. president and, you know, such the faithful wife who’s got dinner on the table by seven o’ clock and kids in bed by 9 pm and homework in backpacks and you also have to go to all the soccer games and you also have to go to all the softball games. and you have to be so many different people at so many different times and be willing to wear so many different hats and to do it well. for the vice president, participants imagined success as having a comfortable work-life balance and financial security. the lower-income woman’s life is out of balance from the pressure of the many roles she must take. the participants in this study imagined many possible successes for middle or upper class women, and several challenges for one working as a janitor or in a factory. however, many participants saw how in both class positions, women face obstacles. the pressure of gender roles and norms adds stress to women in all class positions. amber related the intersection of class and gender roles, and the expectations of physical appearance. wood, hostetter, sullenberger/waiting to be cinderella’d 471  it’s really hard to have your cake and eat it too as a woman. men can go out and be doctors and in their free time go over to happy hour and they’re done for the night. whereas a woman, you’re getting off of work... like, you can’t be walking up in the club competing with other people looking a hot mess…so it’s just like really hard to be that woman that like has it all and maintain it all, and do it well. ariel mused that no matter how hard the vice president might work, she will still be compared to her male counterparts. i think just that she has the qualities and she can do her job just as well as if a male were in her position. because i know now a lot of corporation, now i don’t know if it’s a large business or small business but i think it’s hard for a women to prove themselves when they already have people prejudging the situation before they have even had a chance to prove themselves, people already have these judgments. so i think she is probably already really stressed out about proving herself already and she’s probably almost doing everything times a million to do everything better. despite the resiliency and independence of women in either class position in this sample, participants endorsed the idea that many women are looking for partnerships with men to improve or change their economic circumstances. eve declared what she saw as the two options for class mobility for women: because as women, unfortunately it goes back to like luxury and opportunity and privilege and either you’re studying to get a diploma or you’re studying to get a man with a diploma. for a struggling woman, this was often described to be a failed attempted at a marriage relationship to escape from poverty, as jacob indicated. she saw a way out with, you know, getting married to her guy, and was like, ok, were going to be alright, but it didn’t turn out to be that way. when the marriage does not work out, as mallory conveyed, the results are poverty, and single-parenthood. so we’re going to say she’s a mother, supporting two children, the first one out of wedlock. that didn’t turn out so well. the father is “m.i.a.,” or at least not paying child support, and she has to support two kids participant views on marriage and coupling suggest that women look for partners that will improve or at least help them to maintain their class status. the ability to provide financial support was seen as a deciding factor about a romantic relationship. amber attributed this desire to partner for financial gain as part of an innate desire to be cared for, or have a cinderella story. …girls are designed to be caretakers and so part of being a woman is just that innate desire to be taken care of. and that’s not necessarily living up in a mansion and getting, you know, big ole bitty breast implants, but it is that, you know, you’re going to one day have kids and you’re going to one day wanna be taken advances in social work, fall 2014, 15(2) 472   care of and you’re not going to want to have to worry about bills and school and car insurance and tuition. and so if she’s working in a position like she’s in, it seems like the situation is pretty desperate and that she’s basically begging for someone to not necessarily sweep her off her feet and like have that cinderella ending, but for her to not have to worry. discussion cycling, choosing, accessing, identifying, relating, and intersecting made up the process by which participants constructed social class differences among women. no marked major differences were noted by participant major or gender. the research team was able to construct, from participant interviews, dominant plots that indicated what factors make a woman have a lower or higher class status. in the typical participant story line, the woman described as struggling to get by and working as a janitor or in a factory was portrayed as a single mother. this is a fitting description. over 40% of american households have women as the primary earner, and 63% of those homes are single-parent ones (wang et al., 2013). the average income for a single mother household is between $17,400 and $29,000, and 28% of female-headed families have incomes below federal poverty lines (u. s. census bureau, 2012; wang et al., 2013). in participant stories, most often the low-income woman came from poverty in her family of origin and lacked access to education and social support, but also made choices that negatively impact her ability to be upwardly mobile. this also matches the findings of survey data. those born to lower income families are more likely to fall lower in income than their parents or stay at a similar level (acs, 2011). the lower-income woman led a stressful life, without support for her and her children, and must balance many roles and expectations. her personality, though not often described, is thought to be gentle and nice, traits classically associated with the female gender (brannon, 2004). interestingly, the participants in this sample seldom referenced race as part of the lower-income woman’s identity. it could be in part because the interviewers were students and were emerging in their qualitative interview skills. this reflects a need for the research team to more explicitly probe about the issue of race in further studies. this is in opposition to survey data that reveals considerations of race and racism are a major aspect of american’s attitudes about poverty (foster, 2008; swank, 2005) and indication that women of color are more than twice as likely to be in poverty or working poor than white females (ahmad & iverson, 2013). in short, the study revealed that many college students constructed a relatively realistic story about being poor and female in america, including the stress of gendered stereotypes. missing from participant analysis was the intersection of race, sexual orientation, and citizenship status. the middle or upper income woman who works as the vice president of a successful business differed greatly from her low-income counterpart. a great majority of participants indicated that she comes from a family who also has a middle or upper class income, and that she had supportive parents and family. the woman who becomes the vice president has access to education and strong peer support. access to college education is indeed a major factor in the ability of women to gain or maintain class status (acs, 2011; tiamiyu & mitchell, 2001). in addition, a woman in a higher class position has more control over her reproductive life and relationships. she may or may not have a husband, but most often wood, hostetter, sullenberger/waiting to be cinderella’d 473  does not have children. her personality is strong, focused, and motivated, which matches societal constructions of masculine traits (brannon, 2004). like the woman in the lower economic position, she faces work and life balance issues and stress, but she possesses more internal and external resources to meet these challenges. implications one major standout of the findings is about how participants attribute social class differences among women. the interviews in this study revealed that both structural and individual elements are critical to constructions of class differences among women. this is similar to the cozzarelli et al. (2001) findings that college students tend to hold cultural and generational beliefs about poverty transmission for women, but also to believe that structural barriers impact a woman’s ability to achieve economic mobility. college students in this sample by and large got the “right” story about social class, gender, and oppression. participants implicitly recognized the realities of the feminization of poverty, and even identified a handful of the core structural reasons women may be poorer. however, many participants believe that women are still to blame in some part for their socioeconomic position through the choices they have made and their family of origin. in general the interview participants saw class mobility in the form of the american dream as a possible but distant goal. some participants felt that the american dream can be shattered or achieved through relationships, such as marriage or having children. while students may understand that there are structural issues, their adherence to traditional gender roles and belief in the american dream indicate that there is work to be done in offering a more nuanced perspective of class and gender in america. men and marriage are still viewed as major devices for women to get ahead. this notion is not without merit. single women with children are more likely to be downwardly mobile than their married peers (acs, 2011). in short, children are an expensive liability for a woman struggling to get by. while participants understand some of the realities of class and gender in america, strong belief in exceptionalism and the american dream is still evident. participants told stories that noted important similarities among women in all economic situations, including the difficulties of dual participation in workforce and parenting roles. high and low wage work has a plethora of stressful implications for women when intersected with societal role expectations (froehlich, 2005). in both stories of high and low income, these breadwinner moms (wang et al., 2013) supported their families while balancing gendered and relational expectations. the resounding consensus from this sample of college students is that it is hard to be a working woman in this country. the turn of phrase “waiting to be cinderella’d” offers pause to the now-standard storyline about the struggles of work-life balance for many women. participants suggest a more modern cinderella story of a woman who does not necessarily want to be taken care of like a princess in a castle, but perhaps wants a supportive partner to offer some relief from the burdens of managing family, work, and life stressors. the suggestion from participants is not that women categorically wish to return to mid-century gender roles and expectations, but that they may want support to improve quality of life. the data reveal that participants told half the story about the feminization of poverty. as foster (2008) suggested, two or more dominant discourses on social issues can exist at advances in social work, fall 2014, 15(2) 474   the same time. this was evident in the stories told by participants, celebrating the freedom of middle and upper class women while also expressing concern about deviations from classic gender roles among single moms and personality shifts in women. this split is evident in the rest of america, too. pew research indicates that 79% of americans do not think women need to return to traditional roles, but 64% think that the trend of single motherhood is a big problem and 51% think children are better off staying at home with a mother (wang et al., 2013). the findings from this study confirm that college students believe that women hold primary responsibility for care of the family unit, an attitude that may contribute to the perpetuation of a gender wage gap (gittell, 2009). the findings also imply that women are expected to be participants in the work place. interestingly, very few participants explored the structural deficits, such as a wage gap, lack of supportive mentoring, or discrimination, that impede a woman’s ability to gain and maintain high wage work. while participants may understand the struggles faced by women due to social class, few interviewees actively challenged structural factors. the implications of these findings are two-fold. first, the dominant narrative about the feminization of poverty in this sample may be “right” in some ways, but begs intervention. the realm of social science inquiry is influenced by rhetorical discourse about the intersections of poverty, gender, and race. participants in this sample ascribed to beliefs that low-income women are vulnerable and in need of aid, but also that they make choices that impact their class status. this implies that it is not enough to teach about the existence of the feminization of poverty, but social work educators and other college professors must explore the causes and consequences. academics and helping professionals should be cognizant of the impact of these attitudes on people, and challenge the assumptions on both micro and macro levels. this may mean exploring the impact of internalized oppression with clients, or working with community collaborators and organizations on social justice projects aimed at low-income women (froehlich, 2005). importantly, it also means continuing to highlight and expose the impact of structural factors in personal lives with the aim of increasing access and skills for women related to their economic positions. intervention is important, especially in the practice-based field of social work. the concept of economic empowerment, stemming from work to eliminate gender violence, may offer pathways to increasing knowledge among women about social class and mobility (kristoff & wudunn, 2009; postmus, 2010). economic empowerment is a process by which an increase in financial literacy, improvement in economic self-efficacy, and more economic self-sufficiency occurs (postmus, 2010). preliminary evaluations indicate that empowerment-based programs have had some success in increasing economic resources (kristoff & wudunn, 2010; postmus, 2010). the data reveal ongoing shifts in feminist perspective among millennial students. while this research project was not designed specifically to evaluate the impact of feminist thought on college students, some of the current issues in feminism are evident in the sample. participants did not indicate concern with some of the classic issues of second wave feminism, such as reproductive and legal rights (baxandall & gordon, 2000). instead, interviewees focused more on what might be called a third wave perspective focused on identity positions, freedom of expression, and broader constructions of family and gender roles (chamallas, 2010; snyder, 2008). much like critiques of the second and third wave wood, hostetter, sullenberger/waiting to be cinderella’d 475  of feminism, this sample failed, for the most part, to acknowledge the role of intersecting oppression beyond class and gender to include age, ability status, geographic location, and race (bograd, 1999; crenshaw, 1993; danis & bhandari, 2010). this suggests that while participants, and perhaps other college students, know that women struggle with issues of social class and work-life balance, more education and awareness are needed to bring to light the influence of structural discrimination and intersectional oppression. an intersectional lens helps to provide/promote awareness of how identity, power, privilege, and oppression come together to shape a person’s unique experience and positionality in the world (bograd, 1999; crenshaw, 1993; danis & bhandari, 2010). the need for more of an intersectional approach is evident in the lack of discussion about race, sexual orientation, or citizenship status in the participants’ responses. a truer picture of what it is to be poor and female in the united states would require attention to intersecting oppressions and privilege. bringing light to the intersections of oppression, through education, but also in the media, will help to foster more diversity in the dominant discourse about women and social class and perhaps influence attitudes, culture, and policy priorities. this is especially critical in social work, a value-based profession charged with increasing social justice (national association of social workers [nasw], 2008). social science research and teaching can benefit from the knowledge gained from this inquiry. as foster (2008) suggested, class must be looked at as the intersection of not only gender, but race, age, ability and any multitude of identity positions. for researchers and educators, this means approaching gender and social class as related to each other and many other factors. dominant class attitudes represented in college teaching and research may indicate a seemingly neutral position that in fact matches constructions of male poverty, as found by cozzarelli, tagler, and wlikinson (2002). this study reaffirms that constructions of female social class positions are not the same as male positions, which makes it important for researchers to differentiate the two in projects, and also reveals the need for more data about attitudes on gender-based poverty attitudes that include other forms of intersecting oppression, such as race. this research was conducted with college seniors, and while not applicable to all populations, indicates that the multiple discourses about attributions to poverty may mean there is a role for educators in helping to shape attitudes on poverty. the important developmental transitions in emerging adulthood include transitioning from beliefs of the family of origin to a more independent lens. this is coupled with new experiences in relationships, careers, and life experiences as well as exposure to diverse viewpoints (ashford & lecroy, 2013). college students, then, are at an age primed for intervention to introduce more dialogue about the structural and gendered nature of social class. beyond the feminization of poverty is the awareness of action needed to address some of the intersecting challenges faced by women in a variety of social class positions. college education may be one way to introduce change. in short, it is not enough to know there is a feminization of poverty and that it creates problems for women. social work and other social science researchers, educators and practitioners must illuminate pathways to explore the causes of these oppressions and develop, implement, and evaluate solutions. more exploration in scientific inquiry is needed about the constructions of class and gender among different populations, chiefly those who are experiencing poverty, in order to advances in social work, fall 2014, 15(2) 476   increase the knowledge about how attitudes are formed, and possibly internalized, among people in a state of economic hardship. through more inquiry, social science researchers can gain insight that will aid in the efforts to eliminate and alleviate poverty. limitations this study represents a small sample of college seniors at one university who cannot be considered representative of the larger population of students. in addition, data were collected by multiple students and faculty, which may have led to inconsistencies with interviewing skills and methods. lack of demographic information, in particular race and income of family of origin, makes it difficult to assess potentially important defining characteristics. in addition, participants were not asked to describe the racial or ethnic background of the women in the constructed stories, which could have yielded a more comprehensive response about the impact of intersecting oppressions. more research needs to be done to support these findings, and to explore the meaning behind participant attitudes. in addition, this analysis does not directly ask participants to contrast attitudes on male versus female experiences of poverty, which might have yielded more direct comparisons. conclusions a sample of 30 midwestern college seniors were asked to tell stories about two women in different social class positions. the results of this analysis indicate that participants construct social class differences among women as a multi-layered process involving generational cycles, choices, access to resources, personality, relationships, and the impact of other roles. the findings match much of the survey data about attitudes on women and social class positions, but offer a more nuanced understanding of how participants come to these attitudes. while the findings illustrate a basic understanding of structural aspects of the feminization of poverty, more needs to be done to address the impact of these attitudes on women, and increase knowledge of structural barriers among helping professionals. social science researchers should continue to explore these constructions and how they 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(2013, may). breadwinner moms. pew social & demographic trends. washington, dc: pew research center. retrieved from http://www.pewsocialtrends.org/files/2013/05/breadwinner_moms_final.pdf author note address correspondence to: leila wood, lmsw, phd, assistant professor, texas state university school of social work, 601 university drive, hpb 150a, san marcos, tx 78666. email: leila_wood@txstate.edu   _______________ jill m. chonody, associate professor, department of social work, indiana university northwest, gary, in. mike killian, assistant professor, school of social work, the university of texas at arlington. jacqui gabb, professor, faculty of social sciences, the open university, milton keyes, uk. priscilla dunk-west, senior lecturer, faculty of social and behavioural studies, flinders university, adelaide, south australia. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 355-368, doi:10.18060/21155 understanding everyday relationship work: the development of a relationship maintenance scale jill m. chonody mike killian jacqui gabb priscilla dunk-west abstract: relationship maintenance behaviors contribute to the longevity of intimate relationships, yet existing scales are limited. available measurement tools are primarily constrained to the relationship maintenance strategy measure (rmsm) and its further revisions. covering a number of domains, conceptual overlap with other aspects of an intimate relationship (e.g., household division of labor) may exist. our cross-sectional exploratory study included participants from 60 countries (n=8,162) who completed an online survey. participants were diverse in their relationship status, age, sexual orientation, and race/ethnicity. from their responses, we developed a parsimonious and brief measure of relationship maintenance (8 items) through exploratory and then confirmatory factor analyses. results indicated that the relationship maintenance scale (rms) shows initial evidence of reliability and validity. the rms may have utility in working with couples and families. future research should seek to re-test its use with varied samples, such as couples seeking relationship support. keywords: relationship maintenance; scale development; psychometrics; couple relationship despite the way that intimate relationships have been shaped and redefined over time and the loosening of social pressure to legally marry, most adults spend some or nearly all of their lives in a romantic couple relationship. according to a recent report by the pew research center, 53% of adults living in the united states were living with a romantic partner, with 47% being married to that individual (lenhart & duggan, 2014). in europe, marriage rates are somewhat lower as young adults opt to live together without marriage. an exception is the uk, where married couples head up seven in ten households with recent figures showing an increase in legal unions that equates to one marriage every two minutes (ons, 2014). in the first five years of civil partnerships in the uk (december 2005–2010), over 46,000 same-sex partnerships had been registered (ons, 2011). understanding these relationships is important as an enduring relationship can support personal well-being and overall health (kiecoltglaser & newton, 2001) and reduce the risk of depression (walker, isherwood, burton, kitwe-magambo, & luszcz, 2013). whether the couple is married or in a committed relationship without marriage, dissolution of the coupledom is a chief social concern and may be viewed as a public health issue given its impact on individuals and children. dissolution can have an adverse effect on adults’ mental and physical health (coleman & glenn, 2009), and children of divorce have lower scores on well-being than children living in intact families (amato & keith, 1991; garriga & kiernan, 2013). a major cause of family breakdown is poor relationship quality (relationships alliance, 2014), which is, therefore, an important chonody et al./understanding everyday relationship work 356 consideration when evaluating the positive effects of being in a long-term relationship. good relationship quality has been shown to have positive impacts on the health, life satisfaction, and happiness of adults (proulx, helms, & buehler, 2007; robles, slatcher, tombello, & mcginn, 2014; whisman, 2008) and their children (barrett, chang, & walker, 2011; cummings & davies, 2010). relationships that are marked by high levels of satisfaction can help buffer stress (walker & luszcz, 2009). research indicates that good communication (mackey, diemer, & o’brien, 2004), low levels of conflict (levenson, carstensen, & gottman, 1993), and relationship maintenance behaviors (dainton, 2000) are associated with high relationship quality. myriad research exists regarding relationship quality and satisfaction, whilst far less is known about what comprises everyday relationship maintenance. for example, how do factors such as family obligation, children, and related responsibilities impact on the couple relationship over time? how do couples sustain their relationships in these different and intersecting contexts? understanding how relationships are maintained over the life course and in different contexts is important for both research and social work practice. in terms of research, accurate measurement of those elements that sustain a couple allows further study of the other factors that help maintain intimate relationships. in regards to practice, social workers provide 60% of mental health services in the u.s. and work with couples is a significant part of that role (nasw, 2016). there is, therefore, a pressing need for research that can inform practice—to facilitate effective couple support and work with couples to overcome relationship problems. targeted intervention can help the couple to re-establish themselves as a team: a unit that endures over time dealing with issues through mutual support and combined strength and resources. given that research has found that routine relationship maintenance behaviors are integral to relationship satisfaction (dainton, 2000), assessing the degree to which these behaviors occur and how they influence relationship quality is fundamental. however, there is a dearth of scales available for measuring relationship maintenance. the relationship maintenance strategy measure (rmsm; stafford, 2010) is the primary scale employed for the measurement of relationship maintenance within an intimate relationship. despite being the most used scale, the rmsm is not without weaknesses. this scale covers a number of different relationship constructs beyond relationship maintenance (such as giving advice). while these other aspects of a relationship would be expected to have an association with relationship maintenance behaviors, we contend that they represent relationship factors beyond relationship maintenance. our exploratory study sought to pilot a scale of relationship maintenance focused primarily on the measurement of routine behaviors that reinforce the relationship. the rmsm the rmsm is grounded in social exchange theory, which suggests that relationship maintenance supports longevity because the relationship will be perceived as rewarding (stafford & canary, 1991). investments made in the relationship create the expectation of reciprocation, and when this system is equitable and rewarding, the relationship is supported. further, it is presumed that every relationship needs maintenance to be sustained (stafford & canary, 1991). from this framework the rmsm was developed. the original 5-factor rmsm (stafford & canary, 1991) and advances in social work, fall 2016, 17(2) 357 the revised 7-factor version (stafford & canary, 2006) represent the most widely used measures of relationship maintenance (stafford, 2010). the 5-factor rmsm was found to explain as much as 56% of the variance in relationship satisfaction (stafford & canary, 1991). aside from these two versions, canary and stafford (1992) and stafford, dainton, and haas (2000) made two other revisions, but these modified scales do not appear to be frequently used. later, stafford (2010) made further changes to the rmsm to address weaknesses in its measurement strategy and renamed the scale the relationship maintenance behavior measure (rmbm). while stafford (2010) seems to have addressed many of the flaws present in the rmsm, the rmbm items are still drawn from the original rmsm. one of the chief issues found in both the 5and 7-factor rmsm is that many of the items are double-barreled (e.g., “…is very nice, courteous, and polite when we talk”). multiple adjectives, along with the qualifier “very,” makes this item along with others ripe for measurement error. stafford (2010) identified this problem and noted that “of the original 29 items, 11 are double or triple barreled” (p. 281). in addition, stafford (2010) indicated that some items are not explicitly behavioral, which was how relationship maintenance was operationalized for the original development of the rmsm. it is these issues that led stafford (2010) to subsequently develop the rmbm whereby qualifiers were removed, items that contained multiple ideas (e.g., “try to be romantic, fun, and interesting; p. 281) were broken into more than one item, and conceptual issues (i.e., non-behavioral items) were addressed. these changes undoubtedly strengthened this scale, but other conceptual concerns may persist. for example, both the rmsm and the rmbm contain many different constructs associated with intimate relationships, including positivity, assurances, openness (in the rmbm this is covered in two factors: relationship talks and selfdisclosure), tasks, and networks. each of these constructs is seen as one individual factor of relationship maintenance. positivity refers to the degree to which a positive attitude is used with one’s partner. assurances contain behaviors that support commitment and love. openness items cover the ability to discuss the relationship, including feelings about the relationship. tasks are primarily focused on the division of labor within the household, while networks are focused on the extent to which time is spent together with friends and family members (stafford & canary, 1991). the 7factor rmsm also contains management and advice while the rmbm includes understanding. while these dimensions may, in fact, impact relationship satisfaction or perhaps relationship maintenance strategies, we question if these concepts are a part of routine relationship maintenance. in other words, are all five (or seven) of these different types of behaviors necessary to maintain a relationship? moreover, do they adequately include the minutiae of behaviors that may routinely take place? we argue that these various elements of an intimate relationship go beyond relationship maintenance inand-of-itself. for example, in the management scale, equality in the division of labor is indicative of relationship maintenance. that is, to achieve a high score on this factor, which would be an indicator of greater relationship maintenance, a participant must have a household that is based on equal sharing of tasks and responsibilities. even though egalitarianism within the household structure is a widely accepted notion, it is not something that is embraced by all couples. indeed, for those who chose to create a coupledom based on traditional gender roles, because the couple is in, for example, cultural or religious contexts where the demarcation of gender roles is viewed chonody et al./understanding everyday relationship work 358 positively or because they do not co-habit, such egalitarian ideas may have little purchase and/or meaning. researchers cannot know the degree to which equability in the relationship may be supporting the maintenance of that relationship; as such, this needs to be measured as a separate construct related to intimate relationships. furthermore, sampling methods and the make-up of the final sample raises concern over the applicability of both the rmsm and the rmbm. the 5-factor rmsm was based on a sample made up predominantly of students (69%) at a midwestern and a western university who, in turn, also recruited the remainder of the sample for extra credit in a course (stafford & canary, 1991). the racial/ethnic background, sexual orientation, and other sociodemographic descriptions of the sample are not provided, but the sample did include both married and non-married (e.g., engaged or dating) participants. the rmbm sample was also recruited by students from a midwestern university for extra credit, and it was further limited to heterosexual married persons (stafford, 2010). additional background information about the sample is not given. item retention and scale development are dependent on the response patterns of participants. when those responses are limited to a narrow demographic, its use with diverse samples, including individuals in same-sex relationships and non-cohabitators, may not be appropriate without further research to demonstrate factor stability. current study relationship maintenance has been conceptualized in the literature as behaviors that are both strategic and routine in nature and help to sustain the relationship over time (dainton & stafford, 1993). these behaviors may be strategic when they are intentionally enacted with the goal of supporting the relationship. on the other hand, these behaviors may be unintentional or routine in nature, but still help to sustain the relationship. given that research has substantiated the importance of a mutually rewarding relationship, where the quality of the relationship includes reciprocal assertions and positive interactions (ogolsky & bowers, 2012), measurement is a key issue. utilizing dainton and stafford’s (1993) framework along with findings from the literature, we conceptualized relationship maintenance as the degree to which routine relationship behaviors are intentionally or unintentionally used to sustain an intimate relationship. this definition guided our scale development and the subsequent study, which sought to develop a conceptually parsimonious scale of routine relationship maintenance behaviors with low respondent burden. based on our review of the literature and a previous pilot study, we tested our items both with experts and advanced statistical analysis. our goal was to create a strengths-based scale that assesses routine behaviors in relationship maintenance and to develop this new scale by recruiting a diverse sample of participants (including same-sex attracted) who were in different types of relationships (married, cohabiting, and living apart). we aimed to develop a scale more reflective of contemporary society. method item development our larger study was designed around the structuring interests of the enduring love? research project, which investigated how couples sustain their long-term partnerships. “long-term” was not straightforwardly associated with relationship duration but instead framed through personal experience – such as family stability, advances in social work, fall 2016, 17(2) 359 household permanency, and security of friendship networks. it is also experienced in dynamic terms, including the past (time spent together), the present (relationship satisfaction), and a desire to be with a partner into the future (relationship horizon; gabb & fink, 2015). the study focused attention on the ways in which couple relationships are materialized and experienced through everyday relationship practices in the context of different personal, socio-cultural, and economic circumstances. that is to say, relationships are about money, employment, children, and housework as much as the dyadic couple relationship itself. based on the literature and our theoretical conceptualization of relationship maintenance, we developed items to create the relationship maintenance scale (rms), which could then be subjected to further testing. these items were designed to include everyday contexts and mundanities as well as the more intimate dynamics of couple relationships (gabb & fink, 2015). each item was couple-focused (i.e., began with the stem “we”) and included making time to be together, saying “i love you,” and pursuing shared interests. this framing of statements was designed to elicit responses on lived experience rather than perceptions of what “typical” couples do and/or should ideally do. items were given to experts in family or relationship research to provide feedback on content coverage, including relevance for different groups (e.g., lgbtq). in this way, we were attentive to the specificity of experience amongst these different groups to ensure that it did not marginalize minority experience and thus elide relationship diversity. items were also discussed with frontline staff from different relationship support organizations to determine if our new scale would provide useful information regarding intimate relationships that could subsequently inform and be applied in clinical contexts. in response to this feedback, items were revised for clarity. one item originally intended for another scale that we were developing (relationship quality; see chonody, gabb, killian m, & dunk-west, 2016) was conceptually re-evaluated and found to be more consistent with the relationship maintenance items. through this consultative process, a total of 14 items were included in our measure of relationship maintenance and subjected to further testing. data collection the dataset was based on a large-scale mixed methods study, enduring love? couple relationships in the 21st century that was funded by the economic and social research council (res-062-23-3056) and administered in the united kingdom. this first wave of data collection was completed in two stages. firstly, an online survey was implemented over a 12-month period (2011-2012). qualitative data collection overlapped this period and continued for 20 months. information on the study was posted on various online forums and newsletters, with targeted recruitment on parenting and relationship support community noticeboards. to increase participation of under-represented groups the survey questionnaire was also implemented in hard copy format and disseminated among hard-to-reach community groups and networks through face-to-face contact. the survey directed participants to the study’s website where project information was available alongside frequently asked questions (faqs) and detailed guidance on research methods and ethics. in the second wave, researchers in the u.s. and australia extended this study, and data were collected anonymously through survey monkey from august through december 2014. recruitment in these two countries relied primarily on social media (facebook and twitter) and sharing of the link amongst social networks and media. chonody et al./understanding everyday relationship work 360 contents of our survey and our hypotheses are described below. additional questions and scales were included in the survey and are described elsewhere. prior to data collection, the relevant ethics and institutional review board (irb) granted approval of this study. convergent construct validity variable. a single-item indicator related to happiness with one’s partner was used as a test of convergent construct validity. participants were asked to rate this question: “how happy are you with your partner overall?” employing a 5-point likert-type scale (1=very unhappy and 5=very happy). given that in a recent meta-analysis, relationship maintenance behaviors were associated with liking one’s partner (ogolosky & bowers, 2012), a positive correlation was hypothesized between this item and the rms. known-groups validity variable. parenthood was assessed by a dichotomous question and was used as a test of known-groups. research findings indicated that relationship maintenance is lower amongst parents, likely due to the demands of childcare (dainton, 2008). therefore, we hypothesized that parents would have lower relationship maintenance scores than non-parents. socioedemographic variables. age, gender, sexual orientation, religious affiliation, education, employment, length of relationship, and relationship status were included in our survey and are used descriptively in the current analysis. data analysis our data analysis plan for testing the rms started with a review of item performance, including skew and kurtosis and a correlational analysis. with the large sample, a split-sample exploratory factor analysis (efa) and confirmatory factor analysis (cfa) were conducted. using spss version 23.0, the sample was randomly divided into two equal subsamples. next, an exploratory factor analysis using principle components analysis was performed on one subsample to determine the factor structure of the scale and identify any poorly performing items (fabrigar, wegener, maccallum, & strahan, 1999). eigen values greater than one were used to identify the factors, and orthogonal rotation was used (varimax) to improve factor loading interpretation. after arriving at a factor structure from the efa, a confirmatory factor analysis (cfa) was conducted using the other half of the split-sample and the obtained factor structure from the efa (fabrigar et al., 1999). we hypothesized that a factor structure found in one half of the sample (efa) would then be found and supported in the second half (cfa). the model chi-square value and chi-square per degrees of freedom (2/df; bollen, 1989; kline, 2011), comparative fit index and tucker-lewis index (cfi and tli; hu & bentler, 1999; kline, 2011), standardized root mean square residual (srmr; brown, 2006), and the root mean square error of approximation (rmsea; kline, 2011) were each used to assess the degree of fit between the obtained scores and the model. generally, acceptable fit for a cfa would be lower 2 values, lower 2/df scores, a rmsea and srmr values less than .08, and cfi and tli scores each greater than .95. the cfa was conducted using mplus version 7.3 (muthén & muthén, 2012). lastly, the final factor structure for the rms was then used for tests of convergent construct validity and known-groups validity. advances in social work, fall 2016, 17(2) 361 results demographics once missing data and respondents who reported no long-term relationship were removed, a final sample of 8,132 was achieved with participants from 60 different countries. a majority of the participants were from the uk (69%). demographically, our sample was diverse with 12% who reported as a member of a sexual minority group, 49% who indicated that they were atheist/agnostic, 37% who were in a relationship other than marital, and 27% who identified as a person of color. table 1 provides additional sociodemographic information. table 1. sociodemographic description of sample (n= 8,132) variable n (%) variable n (%) gender education level male 1516 (19.2%) no high school diploma 102 (1.5%) female 6364 (80.8%) high school diploma/equivalency 309 (4.6%) age vocational training/some college 1227 (18.2%) 16-24 631 (8.0%) professional / bachelor’s degree 2855 (42.3%) 25-34 2177 (27.5%) master’s/phd 2257 (33.4%) 35-44 2023 (25.5%) parent (yes) 2966 (44.4%) 45-54 1565 (19.8%) relationship status 55-64 1116 (14.1%) married 4981 (62.7%) 65+ 409 (5.2%) couplenot living together 832 (10.5%) sexual orientation living together 1744 (22.0%) heterosexual 6839 (88.0%) civil partnership 250 (3.1%) gay/lesbian 499 (6.4%) dating 133 (1.7%) bisexual 936 (12.0%) number of years in relationship country under 1 year 336 (4.2%) united kingdom 5683 (69.9%) 1-5 1813 (22.6%) united states 1652 (20.3%) 6-10 1506 (18.8%) australia 491 (6.0%) 11-15 1133 (14.1%) other country 306 (3.8%) 16-20 779 (9.7%) ethnicity and race 20+ 2451 (30.6%) white british, american, australian 5004 (74.3%) happy with partnerb 4.36 (0.84) other white 1286 (19.1%) relationship maintenancec 30.94 (5.04) caribbean 29 (0.4%) african/african american 69 (1.0%) other african decent 11 (0.2%) indian, asian subcontinent 63 (0.9%) asian 64 (1.0%) hispanic/latino 18 (0.3%) native/aboriginal 5 (0.1%) mixed ethnicity, other 186 (2.8%) note: asample sizes are different on each variable due to missing data. btheoretical range=1-5. ctheoretical range=840 (based on final scale). evaluating item performance measures of central tendency, skew, and kurtosis were checked, and items were found to have an acceptable degree of variance. skew and kurtosis were not greater than 2.5 for any of the items. a correlational analysis of the items indicated adequate association between items, and each item had at least one correlation greater than .30. no items were correlated with another item above .80, which would indicate item redundancy. all 14 items were used for the next step of analysis. chonody et al./understanding everyday relationship work 362 exploratory factor analysis next, the sample was randomly split into two equal subsamples. responses from one subsample (n=4,066) were used for the exploratory factor analysis (efa). measures of sampling adequacy and sphericity were excellent (kaiser-meyerolkin=.853, bartlett’s test of sphericity=9077.80, df=91, p<.001). the initial model explained 53.0% of the variance in the items and included four factors. items were removed from the model due to double loadings (greater than .40) or weak loadings (less than .40). after several iterations, a final one factor model with 8 items was obtained and explained 40.9% of the variance. table 2 contains the final items for the scale along with factor loadings and communalities from the efa results. table 2. exploratory factor analysis: factor loadings (n=3,630) relationship quality item factor loading commonality score rm1 we make time to be together, on our own .660 .436 rm2 we say “i love you” to each other .677 .458 rm3 we lead separate lives* .485 .235 rm4 we give each other gifts and/or cards .627 .256 rm5 we are there for each other .747 .558 rm6 we talk to each other about everything .760 .578 rm7 we pursue shared interests .636 .404 rm8 we are both equally affectionate .627 .393 *reverse-scored. note: item labels correspond to figure 1. confirmatory factor analysis the initial cfa model for the rms demonstrated moderate fit (2=424.550, p<.001; 2/df=21.23; rmsea=.072, p<.001, (90% ci=.067, .078); cfi=.941; tli=.918; srmr=.034). as suggested through the modification indices (kline, 2011), two error terms were allowed to correlate, which reduced the 2 by 170.35 (p<.001). the correlation between the error terms of these items was conceptually supported in that both of these referenced emotional and communicative support for “each other.” the revised and final model demonstrated excellent fit (2=266.52, p<.001; 2/df=14.03; rmsea=.058, p=.014, (90% ci=.052, .064); cfi=.964; tli=.947; srmr=.029). figure 1 provides the factor model with loadings and error terms. internal consistency reliability the rms demonstrated good internal consistency reliability (cronbach’s alpha) in both subsamples and with the full sample. the cronbach’s alpha obtained in the efa subsample was good (=.775). similar internal consistency scores were found in the cfa subsample (=.787) and in the full sample (=.781). convergent construct and known-group criterion-related validities as hypothesized, happiness with one’s partner was highly correlated with the rms (r=.670, p<.001). this finding is indicative of evidence for convergent construct validity between maintenance and liking, which has been reported in the literature (ogolosky & bowers, 2012). also, as hypothesized, parents (m=29.94, sd=5.41) reported significantly lower relationship maintenance than respondents without children (m=31.78, sd=4.62), advances in social work, fall 2016, 17(2) 363 t=14.82 (df=5714), p<.001. this finding is consistent with the literature (dainton, 2008) and provides evidence of known-groups validity. figure 1. confirmatory factor analysis: item loadings (n=3,857) items correspond to item list in table 2 discussion results of our study indicated that the newly developed rms shows initial evidence of both reliability and validity. coefficient alpha was found to be good for a newly developed scale (nunnally, 1978), and given the large sample, these preliminary results are promising for future research with the rms. the single factor model obtained through the efa was supported by the cfa results providing evidence of factorial validity. while all psychometric studies are sample dependent, the degree of diversity of couple relationships found in our community sample and its international sampling frame support its structure for capturing this latent construct. evidence of convergent construct validity was indicated by the association between greater happiness with one’s partner and more relationship maintenance, as found in past chonody et al./understanding everyday relationship work 364 studies (e.g., ogolosky & bowers, 2012). relatedly, participants without children reported greater relationship maintenance than those with children, which is consistent with prior research (dainton, 2008) that shows the stressors that parenthood can bring to bear on the couple relationship (walker, barrett, wilson, & chang, 2010). this association establishes evidence for known-groups validity. available measures for the assessment of relationship maintenance are few and may suffer from conceptual issues. the rms offers an unobtrusive and strengths-based assessment of relationship maintenance in that it is focused on those elements of the relationship that may be working well. it is conceptually parsimonious with a sole focus on routine behaviors that support the maintenance of the relationship, unlike the rmsm, which has multiple factors that are not relationship maintenance behaviors per se. this allows researchers or practitioners to learn how individuals or couples are working to sustain their relationship. moreover, the rms is a rapid assessment instrument, which can easily be incorporated into larger studies on relationships that may contain a number of scales or can be quickly implemented in a practice setting. anecdotal evidence based on participant feedback about our study suggested that participants were compelled to think more about their relationships, including some who asked their partners to also complete the survey, while others initiated conversations with her/his partner about the content of the survey and thus their own partnerships. this is encouraging and suggests clinical utility for the rms as a tool for practice that provides a starting point for discussions on how the relationship can be strengthened and the couple unit supported. social work practice with couples and families might benefit from the use of the rms as a baseline clinical assessment tool, to encourage participation in therapeutic efforts, or to facilitate dialogue and remove barriers to communication during sessions. given the social, psychological, and economic impact that dissolution has for both the individual partners as well as any children that may be part of that family system (e.g., coleman & glenn, 2009; garriga & kiernan, 2013), support for enduring partnerships is an essential component of social work practice. the strengths-based nature of this scale can provide social work practitioners and their clients an unobtrusive and efficient assessment of progress during clinical work. gaining insight into both the strengths and weaknesses that are present in the relationship may facilitate the change process. future research should seek to garner feedback from couples on how this scale and other elements of our survey can promote partner communication around relationship maintenance. relationship maintenance is a burgeoning area of research, and its role in relationship quality is important for enduring coupledoms (dainton, 2000). these promising preliminary results warrant future tests of the psychometric properties of the rms. concurrent construct validity and predictive validity are needed using other measures of couples’ maintenance behaviors and long-term relationship outcomes especially with a sample of dyadic participants (i.e., couples), including those who may be seeking relationship support or who are having relationship difficulties. future research should also seek to parse out various aspects of intimate relationships and how they relate to relationship maintenance, such as communication, assurances, and division of household labor, which can inform theory development and intervention efforts. advances in social work, fall 2016, 17(2) 365 limitations findings from psychometric studies are sample-dependent in nature; thus, our results need to be considered within the limitations of our sample. first, the sample was primarily composed of individuals from the uk, and they were mostly married and identified as heterosexual. the sample was gained through social media and through convenience sampling methods, which limits the generalizability of the results. further replication is therefore needed. moreover, individuals who are happy in a relationship are more likely to complete a relationship survey (levenson et al., 1993), and our reach to couples who are in trouble was likely limited. similarly, women are more likely to complete a relationship survey, and our sample reflects that tendency. nonetheless, we did achieve a degree of diversity in terms of sexual orientation and relationship status, thus expanding the potential utility of the scale beyond the heterosexual, marital, cohabiting couple. second, the extent to which these individuals may have had or are currently experiencing relationship problems was not assessed. therefore, the scale needs further exploratory testing with individuals/couples who are seeking support to determine its usefulness given that responses from another sample may support changes to the obtained factor model. future studies should assess if the rms can differentiate between distressed and non-distressed couples, which would be beneficial in providing further validity evidence as well as support its use in practice. third, within the cfa analysis, error variances from two items were allowed to correlate which may indicate the presence of other unique relationship maintenance constructs or sample-specific variation (kline, 2011). however, the efa analyses did not support the presence of a second factor within this large sample of individuals, and the addition of the correlated error terms in the cfa was within the sample factor and theoretically supported. the current study did use a large, international sample and a randomly selected split-half efa and cfa; the analytical strategy combined with the diversity of the sample thus lends confidence to the obtained factor model of the rms. conclusion the operationalization of relationship maintenance was reconceptualized in order to avoid the overlap of constructs present in the two most widely used scales in this area of research. the rms is conceptually parsimonious with a low respondent burden and has shown initial evidence of both reliability and validity in a diverse sample of participants. additional psychometric studies are needed to support our findings and expand its use with other populations. longitudinal studies are essential to determine if the rms can identify couples in distress. moreover, future research should seek to determine how the scale could be used in clinical practice to provide insight into relationship maintenance behaviors for couples in treatment. qualitative tools used in our extended mixed methods study have proven to be highly effective in systemic family therapy (gabb & singh, 2014). we are thus hopeful that the rms may be similarly helpful in facilitating partner perceptions of relationship maintenance and identification of strengths alongside areas that require further work. chonody et al./understanding everyday relationship work 366 references amato, p. r., & keith, b. 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(2008). adapting cognitive therapy for depression: managing complexity and comorbidity. new york: guilford. author note: address correspondence to: jill m. chonody, department of social work, indiana university northwest, 3400 broadway ave, dunes/medical professional building, room 3172, gary, in 46408, 219-981-5631, jchonody@iupui.edu https://doi.org/10.1111/j.1741-3737.2007.00393.x https://doi.org/10.1037/a0031859 https://doi.org/10.1177/0265407591082004 https://doi.org/10.1207/s15327698jfc0604_1 https://doi.org/10.1080/03637750009376512 https://doi.org/10.1017/s0144686x08007903 https://doi.org/10.2190/ag.76.2.b mailto:jchonody@iupui.edu _______ gordon limb, phd, is a professor at school of social work, brigham young university, 2190 jfsb, provo, ut 84602. kevin shafer, phd, is an associate professor in sociology, brigham young university, 2019 jfsb, provo, ut 84602. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 201-216, doi: 10.18060/22605 this work is licensed under a creative commons attribution 4.0 international license. american indian fragile families and the marriage initiative: a replication study gordon earl limb kevin shafer abstract: beginning in the mid-1990s, the federal government, supported by both republican and democratic administrations, has allocated roughly $1.5 billion to promote “healthy marriage initiatives.” a major target of these initiatives have been unmarried parents, or what researchers call fragile families. over the past two decades, studies have examined this issue within the general population. this study applied three areas of the marriage initiative used by mclanahan (2006) to american indian people: potential participation in marriage promotion programs, potential impact of marriage programs, and likelihood of marriage. data for 3,152 women were examined from the fragile families and child wellbeing study, including 154 who self-identified as american indian. this study showed that american indians exhibited a high willingness to participate in marriage promotion programs. american indians were less likely than other racial/ethnic groups to see marriage as better for children. this study underscores the need to understand american indian families and their unique approaches to developing healthy marriage and family structures. for marriage promotion programs to work, they should reflect the cultural practices of the individual american indian communities. keywords: american indians; native americans; fragile families; marriage american indian fragile families and the marriage initiative in the mid-1990s, the clinton administration and the federal government began to examine the association between marital status and poverty (johnson, 2012). in 1996, congress made two very important statements about marriage. first, “[m]arriage is the foundation of a successful society” (u.s. department of health and human services, administration for children and families, 2012, para. 1). second, “[m]arriage is an essential institution of a successful society which promotes the interests of children” (u.s. department of health and human services, administration for children and families, 2012, para. 1). the bush administration continued this effort by having the administration for children and families (afc) develop policy and funding initiatives to promote healthy marriage (johnson, 2012). congress then passed the deficit reduction act (2005) and provided $150 million each year for healthy traditional marriage promotion (i.e., defined as marriage between a man and a woman) and fatherhood. as a result, many states began participating in healthy marriage initiatives (hmi). a major focus of hmi targets were unwed parents who mclanahan (2006) has referred to as fragile families. hmi funding included the following activities: (a) public advertising campaigns on the value of marriage; (b) educational programs targeting high schools on the value of https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2019, 19(1) 202 marriage, relationship skills, and budgeting; (c) marriage education, focusing on skills for non-married, pregnant women, and non-married fathers; (d) pre-marital education and marriage skills training for engaged couples; (e) marriage mentoring and marriage skills training programs for married couples; (f) divorce reduction programs; and (g) programs to reduce the disincentives to marriage. the policy also provided funding for research, technical assistance, and demonstration projects (acf, 2004). mclanahan (2006) examined three perspectives of the initiative using data gathered from the fragile families and child wellbeing study (reichman, teitler, garfinkel, & mclanahan, 2001). the potential for participation in marriage promotion programs, the potential impact of marriage programs, and the likelihood of marriage were examined. further, mclanahan examined evidence to indicate whether the hmi was founded on reliable data and if it was likely to be successful. using data gathered from the fragile families and child wellbeing study, mclanahan concluded that the three initial assumptions of the hmi were empirically supported, and the programs funded by the initiative would generally have a positive influence on relationship stability and marriage. in addition, mclanahan (2006) suggested that the hmi should “guardedly move forward” (p. 5). as part of the hmi, american indian families provide unique insight into issues relating to fragile families. in this study, it should be noted that participants self-identified as american indian with no restrictions placed on residential status or need to officially belong to a federally recognized american indian tribe. american indians encounter many challenges as they try to form and sustain healthy marriages. the proportion of american indians who live below the poverty line is almost twice the national average (u.s. census bureau, 2016). american indian children are twice as likely to live in poverty as are their non-indigenous counterparts (national healthy marriage resource center, 2012; u.s census bureau, 2010; white, godfrey, & moccasin, 2006). further, one of the greatest challenges of american indian communities under this policy is the high percentage of unmarried families (administration for children and families healthy marriage initiative [acfhmi], n.d.). although previous studies using the fragile families data have examined african americans and mexican americans, little research has been done in areas that address the strengths, needs, and issues of american indians (reichman et al., 2001). in this study, the term american indian matches the language used in mclanahan’s study (2006) and the original fragile families and child wellbeing research (see also reichman et al., 2001). therefore, the current study applied mclanahan’s research on the hmi to american indian people. as such, the same three areas were examined to better understand american indian families that are defined by mclanahan (2006) as fragile: (1) potential participation in marriage promotion programs and activities, (2) potential impact of marriage programs, and (3) likelihood of marriage. examination of these areas increases the knowledge-base of a western perspective on american indians and marriage and provides valuable information for funding future programs. limb & shafer/american indian fragile families 203 potential participation in marriage promotion programs the first area that mclanahan (2006) examined was whether unmarried parents were willing to participate in marriage promotion programs. supporters of marriage promotion programs point to research that shows that many unmarried parents desire to marry, suggesting that they are open to participating in marriage promotion programs (brown, 2000; bumpass, sweet, & cherlin, 1991; hawkins, blanchard, baldwin, & fawcett, 2008). however, another group of researchers claim that most parents will not participate because their relationships are casual, they have been involved in traumatic or violent relationships, they prefer cohabitation to marriage, or, they simply do not have time to participate (e.g., edin & reed, 2005; roberts & morris, 1998). there is little research about american indian families and marriage promotion programs. there are, however, federal programs set up and designed specifically for marriage promotion among american indians. for example, as part of the acf implementation of the hmi in 2002, the native american healthy marriage initiative (nahmi) was launched. nahmi was designed to strengthen relationships and families in american indian communities by promoting healthy marriages, responsible fatherhood, and child well-being (acfhmi, n.d.). then in 2008, president obama signed into law the healthy marriage and responsible fatherhood initiative the provided demonstration grants in this area (acf-hhs, 2014). nahmi was established to utilize culturally competent strategies to strengthen american indian families and communities. similarly, the administration for native americans (ana) supports projects to improve child well-being by forming and sustaining healthy marriages and strengthening families in indigenous communities. unfortunately, data about these programs is difficult to obtain from tribal communities due to limited access and measure variability, making it hard to determine if nahmi has been successful or not. further, funding opportunities around nahmi have been sparse since 2012, while funding for healthy marriage and responsible fatherhood initiatives continues (acf-hhs, 2018). potential impact of marriage programs and likelihood of marriage mclanahan (2006) also examined whether relationship enhancement programs increased marriage rates. supporters and critics appeared on both sides. research on a number of relationship enhancement approaches (including marriage education and relationship skills building activities) used with the general population found that relationship enhancement programs increased marital satisfaction and stability (carroll & doherty, 2003; cowan, powell, & cowan, 1998; stanley, blumberg, & markman, 1999). however, critics pointed out that the data used were predominately conducted on married, middle-class couples and that these results may not be generalized to other couples (dion, 2005; jarchow, 2003). further, critics questioned whether the emphasis on relationship skills was warranted. they argued that low wages, high unemployment, trauma, domestic abuse, and other socio-demographic elements could pose much stronger barriers to actual marriage (e.g., legal momentum, 2006; lerner, 2004; onwuachi-willig, 2005). mclanahan (2006) also examined whether marriage promotion policies actually increased marriage and whether marriage was thought to be best for children. mclanahan reported that there is widespread disagreement among researchers about whether marriage advances in social work, spring 2019, 19(1) 204 would make children better off financially and physically. a number of studies (e.g., mclanahan & sandefur, 1994; waite, 1995; waite & gallagher, 2000) found that marriage is beneficial and that children who grew up with both biological parents were more successful across a broad range of outcomes than children who grew up with a single parent. however, several researchers believe the benefits of marriage have been overstated and it is not so much because the parents were married as the characteristics of parents who marry and stay married versus characteristics of parents who divorce or never marry (axinn & thornton, 1992; booth & johnson, 1988; cherlin, 2010). there are few studies about american indian people that specifically examine relationship enhancement programs. for example, american indian children who live with their own married parents have better physical health than children in other family forms (radel, bramlett, chow, & waters, 2016). american indian children whose parents divorce have higher rates of psychological distress and mental illness (kenney & singh, 2016). marriage is associated with better health and lower rates of injury, illness, and disability for both american indian men and women (administration for children and families healthy marriage initiative, health and human services, n.d.; goins et al., 2018). additionally, marriage increases the likelihood that american indian fathers have good relationships with their children and married women appear to have a lower risk of experiencing domestic violence than do cohabiting or dating women (sapra, jubinski, tanaka, & gershon, 2014). several factors may differentiate american indian families from other american families. according to the annie e. casey foundation (2012), 39% of american indian adults are married (compared to 60% of whites) and american indians have higher divorce rates than african americans, whites, and hispanics. single-parent families account for 52% of american indian households, compared to 24% for whites, 66% for african americans, and 41% for hispanics or latinos. american indian families include extended family members. selected community members are often included in their definition of family, reducing the expectations on nuclear family members (day, 2014a; red horse, martinez, & day, 2001). due to multi-generational trauma and lost parenting skills from residential schools and poverty (day, 2014b), american indians also have the highest rate of reported child abuse or neglect at 21.7 per 1000 children compared to 10.7 per 1000 for white children (child trends, 2015). additional research is needed due to the lack empirical studies on this critical topic with this understudied population. mclanahan’s (2006) research has set the stage for some crucial discussions about the marriage agenda and the impact of marriage on couples and families from a western legal, policy, and practice perspective. as a result, the purpose of this study was to examine these three areas with the american indian sample of the fragile families and child wellbeing study (see reichman et al., 2001) and to compare findings with those of mclanahan. limb & shafer/american indian fragile families 205 method data data from the fragile families and child wellbeing study were used (reichman et al., 2001). the data set sampled mothers with children born between 1998 and 2000 in 20 cities with populations greater than 200,000. stratified sampling was used to identify 4,898 children and mothers (with an oversample of unmarried parents) who were interviewed within 48 hours of their child’s hospital birth. additional waves of data were collected at ages 1, 3, 5, 9, and 15. because of the study’s explicit interest in programs that promote marriage among the unmarried and the explicit focus of these programs on women (manning, trella, lyons, & du toit, 2010), the sample was limited to women who were not married at baseline. the response rate at birth was 87% for unmarried mothers. an additional 11% of the sample was lost at age 1 and 3% more were lost at age 3. thus, 73% of the sample remained by age 3. the outcomes for the current study were assessed at birth, age 1, and age 3. multiple imputation techniques were used to impute values on six of the dependent variables. although imputation on dependent variables is not without controversy, it has become an increasingly accepted practice in recent years (van ginkel, linting, rippe, & van der voort, 2019; von hippel, 2007). the variable with the highest number of imputed values had approximately 25% missing. some respondents did not answer any of the dependent variables. as a result, the values were not imputed for these individuals because their data may not have been missing at random. a final analytic sample included 3,152 women, including 154 women who self-identified as american indian but not hispanic or of multiple racial identities (bendheim-thoman center for research on child wellbeing, 2018). dependent measures potential for participation measures. following mclanahan’s (2006) lead, various measures were used to tap the potential participation in marriage promotion programs of the 154 women who self-identified as american indian. specifically, eight dichotomous measures were indicated if program participation is likely. willingness to participate in a marriage promotion program was dichotomized to indicate if a respondent was very likely to do so. participants who responded that the chance of marrying the baby’s father was greater than 50% were coded as having a high chance of marriage. distrust of men was originally dichotomized in the data and respondents indicated whether they did or did not trust individuals of the opposite sex. individuals who agreed or strongly agreed that marriage was the best relationship type for children were coded as believing marriage was the best relationship type. potential impact of marriage promotion programs. based on the work of mclanahan (2006), the possible effects of marriage promotion programs by racial/ethnic group was addressed. the two explicit goals of these policies are to improve child wellbeing and reduce poverty. as such, four outcomes were examined to determine improvement after marriage (married by the time their child reached age 3, or wave 3 of the data). marriage was examined through the lens of race/ethnicity to assess whether advances in social work, spring 2019, 19(1) 206 american indians might fare better or worse on these outcomes after marriage. three outcomes were about parenting from the mother’s perspective: whether the mother engaged in cognitive stimulation (play games, read stories, and tell stories) during the week, whether the mother engaged in warm parenting (sang songs, hugged the child, and played with child) during the week, and whether the mother used corporal punishment (spanking). all three were dichotomous measures. a fourth dichotomous measure indicated if the family was below the poverty line when the child was age 3. likelihood of marriage. perhaps the simplest way to assess the potential impact of marriage promotion programs is to see if marriage is more likely due to being a parent. thus, a dichotomous dependent variable indicating whether the respondent married the child’s father by the time the child was age 3 was added. again, differences were assessed by race/ethnicity on this variable. key independent variables. one focus was on racial and ethnic differences in the potential participation and impact of marriage promotion programs. more specifically, differences between american indians and other racial/ethnic groups in the data were examined by the race/ethnicity the mother identified via a set of dichotomous variables. at the time of the birth of their children, mothers were asked to identify what “best describes” their race and/or ethnicity. the racial and ethnic groups included on the questionnaire were american indian, non-hispanic black, non-hispanic white, latina, and other race/ethnicity (including multiracial). potential program participation characteristics are likely to correlate with one another and are important to consider as well. as a result, this study included willingness to participate in a program, high marriage chance, high gender distrust, marriage is best for kids, and father involvement in our models. each variable was measured in the same manner as the dependent variables described above. control variables. various socio-demographic variables which may be associated with marital attitudes, the likelihood of marriage, gender distrust, father involvement, and parenting behaviors were controlled for. this study also controlled for father’s involvement with a continuous measure formed from a series of dichotomous variables indicating whether the baby will have the father’s last name, whether the father’s name is on the birth certificate, whether the father helped to buy things for the baby, provided transportation, whether the father visited the baby in the hospital, and whether the mother wants the father involved in raising the child. these items were added together to form a scale (α= .80) which ranged from 0 to 6, with higher values indicating greater father involvement. mclanahan (2006) noted that how involved a father was with a child can affect one’s willingness to marry as well as parenting styles. socioeconomic characteristics such as living below the poverty line, using public assistance, and employment in the prior year were measured with dichotomous variables. relationship status at baseline was measured with dichotomous variables for cohabitation, visiting relationship, and other relationship types. finally, educational attainment data were also gathered; response options included: less than a high school diploma, high school graduate, some college, and at least a college graduate. limb & shafer/american indian fragile families 207 analytic strategy in order to compare our data with mclanahan’s (2006) findings, we used the same analytic strategy as they employed, with the american indian sample. logistic regression models were used for the outcomes except in the case of father support, which was analyzed with ordinary least squares (ols) regression. several variables were imputed, and the results were averaged over five imputations. the first set of models focused on potential participation in marriage promotion programs and on racial/ethnic differences. the second set of models addressed the potential impact of marriage promotion programs by considering differences by marital status at age three and racial and ethnic differences in this effect. as a result, marriage of the mother by the time the child reached age three and race/ethnicity were incorporated in these models. finally, the likelihood of marriage by potential participation in marriage promotion programs and race/ethnicity was examined. the data assessed whether the respondent was married by the time her child was age 3, by willingness to participate in marriage promotion programs, high marriage chance, and high gender distrust. thus, this examination focused on the possibility that a desire to participate will affect marriage entry and if this varies by race/ethnicity. results descriptive results when examining mother’s demographic data, approximately 5% of the sample was american indian, 55% non-hispanic black, 14% white, 27% latina, and 14% of another race. while racial and ethnic minorities are disproportionately represented in the sample, because the focus of research and the data set are on fragile families, this discrepancy makes sense. approximately 43% of respondents were in poverty and used public assistance, though the correlation between these two variables was not very high (r= 0.31). nearly 68% of respondents had worked in the prior year. fifty-two percent of women had cohabited with their child’s father, 35% were in a visiting relationship, and the remaining 13% were in other arrangements. the sample was disproportionately less educated than the general population with 39% not completing high school and an additional 34% having graduated high school. only 3% had graduated from college. table 1 provides proportional differences between american indians and nonamerican indians on a number of dependent measures. american indians had a significantly higher proportion than non-american indian counterparts who were willing to participate in marriage promotion programs, high distrust in men, lived below the poverty line, and married by age 3 of their child. a significantly lower proportion of american indians were less likely to use corporal punishment (spanking) on children. advances in social work, spring 2019, 19(1) 208 table 1. proportional difference on dependent measures for full sample, non-american indians and american indians full sample (n=3,152) not american indian (n=2,998) american indian (n=154) willingness to participate 0.276 0.274 0.331* high marriage chances 0.592 0.591 0.579 high distrust of men 0.235 0.230 0.364* marriage is best for children 0.781 0.779 0.804 cognitively stimulating parenting 0.187 0.188 0.171 warm parenting 0.453 0.451 0.483 uses corporal punishment 0.291 0.298 0.173* below poverty line at wave 3 0.343 0.337 0.471* ever marry (baseline to wave 3) 0.147 0.139 0.266* source: fragile families and child wellbeing study (reichman et al., 2001); note: *chi square test indicates difference between american indians and non-american indians at p<.05 logistic regression models the first set of models examined racial/ethnic differences on potential participation in marriage promotion programs. regarding willingness to participate, the study found that only participants who self-reported white were significantly less likely to report a willingness to participate in marriage promotion programs than were american indians (see table 2). interestingly, all racial/ethnic groups appeared to have a relatively high willingness to participate in marriage promotion programs. however, when examining high marriage chances, whites reported they were more likely to marry the child’s father as compared to american indians. no other differences were observed in this area. when we looked at women’s distrust of men, whites were significantly less likely to distrust men than were american indians. however, women from other racial/ethnic groups were significantly higher on distrust than were american indian women. finally, we examined potential participation in marriage promotion programs and its impact on children. white people, latinas, and other race/ethnicities were all significantly more likely to see marriage as better for children than did american indians (see table 2). the second set of models examined the potential impact of marriage programs and whether american indians might fare better or worse on these outcomes after marriage. there were no differences in the effect of marriage across stimulation, warmth, or corporal punishment. however, blacks and latinas were less likely than were american indians to engage in cognitive stimulation and blacks were more likely to use corporal punishment. results also showed that american indians were much more likely to be in poverty after marriage than were any of the other groups (main effect vs. interactive effects). thus, it appears that marriage does little to alleviate this challenge for american indians. limb & shafer/american indian fragile families 209 table 2. logistic regression models for potential participation in marriage promotion programs (n= 3,152 averaged over five imputations) willingness to participate high marriage chances high distrust of men marriage best for children racial/ethnic identification american indian --- -- ---- non-hispanic black 0.816 0.863 0.759 1.715 non-hispanic white 0.573* 1.694 0.363** 2.452** latina 1.054 1.155 1.042 1.829* other racial/ethnic identification 0.898 0.936 1.347* 1.340 marriage orientation willingness to participate --1.193 1.338* 1.149 high marriage chances 1.193 --0.364*** 1.407* high distrust of men 1.329* 0.380*** -- 1.160 marriage is best for children 1.147 1.404* 1.153 -- socioeconomic characteristics below poverty line 0.930 0.864 1.431*** 1.147 uses public assistance 1.126 0.830 0.808* 1.063 any employment in prior year 1.016 0.952 0.729** 0.848 relationship status at baseline cohabiting relationship -- -- -- -- no relationship 0.880 0.024*** 0.894 0.799 visiting relationship 0.865 0.405*** 0.964 1.031 father's involvement 1.048 1.874*** 0.881** 0.877* mother's educational attainment not high school graduate 1.369 0.734 1.993* 0.865 high school graduate 1.332 0.890 1.469 0.819 some college 1.798 0.820 0.928 0.853 r-squared/psuedo r-square 0.180 0.246 0.106 0.120 source: fragile families and child wellbeing study (reichman et al., 2001); * p<.05, ** p<.01, ***p <.001 (two-tailed tests) the third set of models addressed the likelihood of marriage by potential participation in marriage promotion programs and race/ethnicity. respondents were assessed based on whether they were married by the time their child was age three, by willingness to participate, high marriage chance, and high gender distrust. interestingly, results showed that american indian women were more likely to marry than most other groups. similarly, willingness to participate in marriage promotion programs was strongest for american indians and somewhat weaker for other racial/ethnic groups. when looking at high marriage chances, this was the only significant difference for american indian women. despite higher odds for latinas than american indian women, distrust had little effect in this model. advances in social work, spring 2019, 19(1) 210 table 3. logistic regression models of marriage by potential participation and race/ethnicity (n=3,152 over five imputations) 1 model 1 model 2 model 3 model 4 race/ethnicity non-hispanic black 0.246*** 0.500 0.712 0.492* non-hispanic white 0.540 1.204 1.392 0.991 latina 0.654* 1.627 2.347 1.090 other race/ethnicity 0.791 0.817 0.543 0.892 willing to participate in program 5.293* non-hispanic blackparticipate 0.336 non-hispanic whiteparticipate 0.274 latinaparticipate 0.267* other race/ethnicity participate 0.601 high marriage chance 4.025 non-hispanic black chance 0.612 non-hispanic white chance 0.594 latinachance 0.444 other race/ethnicity chance 1.467 high gender distrust 0.711 non-hispanic black distrust 0.725 non-hispanic whitedistrust 0.314 latinadistrust 1.843 other race/ethnicitydistrust 0.532 source: fragile families and child wellbeing study (reichman et al., 2001); 1 indicates american indian as reference group; * p<.05, ** p<.01, ***p <.001 (two-tailed tests) discussion given that very little research has been done about american indian fragile families and the impact of hmi, the purpose of this study was to add critical information to the profession’s knowledge-base. this study examined three areas of marriage promotion among american indians. the analysis of this data identified several components from each area in understanding the impact of marriage on american indian families. in examining data pertaining to the potential participation in marriage promotion programs, american indians exhibited a high willingness to participate. american indians were lower than other racial/ethnic groups in whether they saw marriage as beneficial for children. this goes against what others have found in the general population (mclanahan & sandefur, 1994; waite, 1995; waite & gallagher, 2000) and may suggest cultural differences in the definition of family and child-rearing practices. prior research by white et al. (2006) suggests that american indians have a more communal philosophy when it comes to raising children. this might suggest that, in addition to the mother and father, some american indian people feel it is important for the well-being of children to involve their extended family, friends, and community. for example, according to purzycki (2004), in the lakota culture a child’s mother’s sister would be considered their second mother figure and his/her father’s brother would be a second father figure. therefore, american indian women may not feel compelled to marry for the sake of the children. in this study american indian mothers considered their chances for marriage to be good, yet this enthusiasm for marriage did not come to fruition as often as hoped for, as indicated by a smaller percentage of couples actually getting married within 3 years of the limb & shafer/american indian fragile families 211 baseline survey. this could indicate that while american indian women see marriage as important, there are other factors that need to be considered if a marriage promotion program is to be successful in american indian communities. foremost among those factors is likely the impact poverty has on potential marriage relationships in some cases. perhaps another way to measure this is child well-being, rather than just marriage, as an outcome measure. this study found that american indians were much more likely to be in poverty before and after marriage than any other group. while some researchers found that marriage has a positive impact on poverty in the general population (lerman, 2002; sawhill, 2014; young, 1990), it appears from this study that marriage does little to alleviate these circumstances for american indian families. finally, american indians were less likely to achieve higher levels of educational attainment, which could explain some of these results. during the analysis, several limitations were encountered. the relatively small sample of american indian participants limited the generalizability of findings. american indians make up roughly 1.5% of the u. s. population and were almost 5% of this study. because of this small sample size, it was difficult to detect significant differences with other racial/ethnic groups. second, this study used data from large urban areas. these findings may have been different if respondents included rural and/or reservation areas. taking the location and sample size factors into account, findings regarding american indian fragile families and the marriage initiative variables may not be generalizable for all american indian people. in addition, cultural backgrounds, individual tribal differences, and historical issues were not considered. although marriage promotion programs may have attempted to provide culturally appropriate services, participants came from many different indigenous cultures. it should also be noted that in the descriptive results, nine chi square tests were conducted using a .05 alpha, thus increasing the chance of a type i error. finally, while the fragile families project is ongoing, data for this study occurred almost 18 years ago. thus that age of the data needs to be taken into account when looking at current policy and practice implications. despite these limitations, this study offers several useful implications for practice with american indian families. first, in this study, american indian fragile families do not greatly differ from the general population in their willingness and desire for marriage and commitment to those relationships. also, marriage promotion programs in american indian communities appear to be needed and wanted. here, cultural experts suggest that for marriage promotion programs to work, they must reflect the cultural practices of the individual american indian communities, which is difficult in large urban areas (nicotera, walls, & lucero, 2010). therefore, they believe that successful programs are those in which tribal communities have input and are engaged in every aspect of the program (national healthy marriage resource center, 2012). while fragile families of all races and ethnic groups are at risk, this study found that american indian fragile families are particularly at risk because of the high incidence of poverty and its deleterious effects among american indian children. additionally, while poverty can impact mental health, culturally competent practitioners can have greater influence in helping american indian fragile families by addressing poverty and the advances in social work, spring 2019, 19(1) 212 economic issues these families experience and by including extended family in assessment and interventions. because the fragile families (reichman et al., 2001) study only included american indians living in cities with a population over 200,000, future studies in this field should address the rural american indian fragile families and the direct impact of poverty in these areas as well (saasa & limb, 2017). perhaps more meaningful data could be gathered when examining the relationship between marriage and child well-being. further, additional, continued, and focused funding in these areas is needed. as noted earlier, while specific funding for nahmi seems to have not taken place recently, acf continues to fund initiatives and grants for healthy marriage and fatherhood initiatives. it is recommended that this funding source, similar to temporary assistance to needy families (tanf), include line items and funding streams that target american indians. conclusion this study aimed to understand american indian families and their unique needs for developing healthy marriage and family structures. by learning about the need for culturally competent, evidence-based marriage promotion programs and poverty programs addressing these needs, fragile families can be strengthened. with increased understanding, this study intended to promote additional research on american indians that might help in providing specific steps for improving and strengthening these families. as the definition of marriage and families has been redefined by the us supreme court ruling of same-sex marriage, marriage promotion programs must also be redefined. american indians broad definition of marriage among two-spirit, lesbian, bi-sexual, transgender, and gay partners need to be incorporated in these programs to strengthen families and support children. additional research is needed to explore how federal funding avenues have changed for these programs and the impact that the expanded definition of marriage has on american indian families and children. references administration for children and families, health and human services [acf-hhs]. 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(1990). poverty, suicide, and homicide among american indians, psychological reports, 67, 1153-1154. doi: https://doi.org/10.2466/pr0.1990.67.3f.1153 author note: address correspondence to: gordon limb, school of social work, brigham young university, 2190 jfsb, provo, ut 84602. email: gordon_limb@byu.edu http://www.census.gov/prod/cen2010/briefs/c2010br-14.pdf https://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t https://www.acf.hhs.gov/ofa/programs/healthy-marriage https://doi.org/10.1111/j.1467-9531.2007.00180.x https://doi.org/10.3149/fth.0401.49 https://doi.org/10.2466/pr0.1990.67.3f.1153 mailto:gordon_limb@byu.edu abstract: beginning in the mid-1990s, the federal government, supported by both republican and democratic administrations, has allocated roughly $1.5 billion to promote “healthy marriage initiatives.” a major target of these initiatives have been unma... conclusion carroll, j. s., & doherty, w. j. (2003). evaluating the effectiveness of premarital prevention programs: a meta-analytic review of outcome research, family relations, 52, 105-118. doi: https://doi.org/10.1111/j.1741-3729.2003.00105.x microsoft word 7. montero_8805_same-gender marriage copyedit_final _________________ jennifer fasbinder, emily monson, jaime sanders, and annie c. williams are msw students in the school of social work at arizona state university. darrel montero, ph.d., is an associate professor in the school of social work at arizona state university in phoenix. the authors wish to thank the following organizations for their generosity in allowing the use of their survey data: gallup organization (2013), cbs news/new york times poll (2012), and cnn/orc poll (2013) copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 416-432 same-gender marriage: implications for social work practitioners jennifer fasbinder emily monson darrel montero jaime sanders annie c. williams abstract: notably, in 2013, maryland, rhode island, delaware, and minnesota became the 10th, 11th, 12th, and 13th states, respectively, to legalize same-gender marriage. without legal recognition or social support from the larger society, the majority of samegender partnerships in the u.s. are denied privileges and rights that are considered basic for heterosexual marriages. this manuscript draws from a national cross section of published survey data from 1996 to 2013 reporting americans’ attitudes regarding samegender marriage and civil unions. social work practitioners have broad opportunity to apply their skills to the critical needs facing same-gender partners. after an overview of the legal status of same-gender marriages and their accompanying social and policy issues, recommendations are provided that include identification of specific needs for premarital counseling of same-gender partners and ensuring sensitivity to the myriad challenges they face. keywords: same-gender marriage, same-sex marriage, civil union, marriage equality same-gender partnerships in the u.s. have had a very tumultuous history. notably, the 2010 census reported the existence of same-gender couples in 99% of the counties in this country (williams institute, 2011); however, currently only 13 states recognize samegender marriage. existing without legal and social recognition and support for their family unit is a constant, harsh, and exhausting strain on many same-gender partnerships in this country. these couples are often denied certain privileges and rights that are considered basic for heterosexual marriages. indeed, some 1,100 legal privileges have been identified as stemming from the institution of legal marriage (duncan & kemmelmeier, 2012). there are also often negative consequences for the mental and emotional well-being of the individuals within these family units, which, many times, include children. this is sometimes referred to as minority stress theory (alessi, 2013; ponterotto, casas, suzuki, & alexander, 2010). the 2010 census bureau reported that 115,000 same-gender couples out of 594,000 have at least one child (lofquist, 2011). some studies have revealed that partners in same-gender relationships desire the recognition of marriage for their relationship regardless of whether or not such recognition is accompanied by additional benefits (shulman, gotta, & green, 2012). social work practitioners have broad opportunity to apply their practice to the many areas of need facing same-gender partners, using their training as practitioners, advocates, and researchers to intervene effectively at multiple levels (rostosky & riggle, 2011). fasbinder, monson, montero, sanders, williams/same-gender marriage 417 this article highlights potential avenues for these professionals to assist with the issues faced by same-gender marriages, after an overview of the relatively recent evolution of the legal status of same-gender marriages, and their accompanying social and policy issues. in addition, we report national poll data from 1996 to 2013 which address america’s attitudes regarding same-gender marriage and civil unions. our rationale for presenting these national survey data is that there is ample evidence that public opinion impacts policy formation, such as the legalization of same-gender marriage in this case (agnone, 2007; blekesaune & quadagno, 2003; zernike, 2013). legal background in the u.s., the legal status of same-gender partnerships began to emerge sporadically as a social issue throughout the 1960s and 1970s, predominantly through the voices of journalists, playwrights, and other writers and artists. a seminal legal challenge to minnesota’s denial of a marriage license to a gay activist in the early 1970s was unsuccessful (baker v. nelson, 1972), followed by similar decisions in kentucky and washington state (geidner, 2011). later in that decade, the u.s. episcopal church considered banning the ordination of openly gay priests (sheppard, 1979). it was not until 1989 that the issue began to take shape and gain momentum, and was swept up in the rising wave of the gay and lesbian rights movement of the 1980s. in that year, in two reversals of traditional u.s. thinking on marriage and family, new york’s judiciary ruled that for the purposes of rent-control laws, two gay men qualified as a family, and the state bar of california publicly advocated recognition of same-gender marriages (gutis, 1989). doma. though the stage was readying for a pendulum swing, the aforementioned steps were not widely accepted or integrated into america’s social or political fabric just yet. in 1996, both houses of the u.s. congress passed the defense of marriage act (doma) by large majorities, restricting to opposite-sex marriages all federal marriage benefits, including insurance benefits (for government employees), social security survivors’ benefits, immigration, and tax filing status (epstein, 2012; franck, 2011; willetts, 2011). doma’s provisions restricting same-gender couples from rights and benefits with regard to bankruptcy, public employee benefits, estate taxes, and immigration were subsequently held to be unconstitutional in eight federal courts. doma also required recognition of inter-state marriage status only for opposite-sex marriages; the states were left with the ability to determine whether to allow same-gender marriages or unions within their borders, and whether they would recognize marriages performed legally in other states (zupcofska, 2010). in 2000, vermont became the first state to legally recognize same-sex unions, referred to as civil unions, granting same-gender couples certain rights and benefits of marriage (“vermont lawyer,” 2013). it took years for additional states to begin to react, some expanding on their definitions of legally recognized same-gender partnerships, and some solidly rejecting any such expansion. domestic partnership policies were implemented in seven states, namely, california, maine, new jersey, washington, oregon, nevada, and wisconsin (willetts, 2011). in 2008, new hampshire passed legislation allowing for civil unions. however, that same year, arizona, florida, and advances in social work, fall 2013, 14(2) 418 california amended their state constitutions to legally define marriage in a way that outlawed same-gender unions (whitehead, 2010). california’s mechanism for outlawing same-gender marriage was ballot proposition 8 (sherkat, powell-williams, maddox, & mattias de vries, 2011), which actually reversed an earlier state supreme court decision holding that same-gender couples have a constitutional right to marry. existing same-gender marriages were “grandfathered” in and allowed to stand, under a subsequent california supreme court decision upholding proposition 8. in perry v. schwarzenegger (2010), proposition 8 was overturned as a violation of the due process and equal protection clauses of the u.s. constitution (nicolas, 2011). overall, 41 states have passed state-level versions of doma, expressly prohibiting rights for same-gender couples (ellison, acevedo, & ramos-wada, 2011; woodford, chonody, scherrer, silverschanz, & kulick, 2012). historically, in june 2013, the u.s. supreme court struck down doma, allowing for federal recognition of same-sex marriage in the states where it was legal. this action provided access for same-gender couples to over 1,100 federal benefits which were formerly denied to them. the court also declined to consider a case challenging proposition 8. as such, on june 28, 2013, gay and lesbian couples resumed marriage ceremonies in california (leitsinger, 2013). religion and spirituality walls (2010) observes that failure to recognize and address the importance of religious motivations about same-gender marriage could result in a substantial portion of the u.s. population remaining opposed to equal rights for same-gender couples. as pointed out by judge walker (in perry v. schwarzenegger), moral views are the primary basis of objection that individuals have against same-gender couples (franck, 2011). there are clearly vast differences of opinion among churches on this topic. many liberal religious groups and movements have promoted rights and recognition for samegender couples (sherkat et al., 2011). however, opposition to same-gender marriage remains high among conservative protestant and sectarian faith communities (ellison et al., 2011), and sherkat and colleagues found that both denominational ties and religious participation traditionally have negative influences on support for same-gender marriage. incidentally, it has been suggested that canada’s great strides toward equal rights for lesbian and gay citizens are due to the fact that canada does not have a strong religious right advocating against their equal rights (green, murphy, & blumer, 2010). the vatican publicly opposes same-gender marriage and same-gender relationships in general. however, in 2013, pope francis declared that homosexuals should not be marginalized stating, “who am i to judge?” in addition, when he was asked if he approved of homosexuality, the pope replied, “tell me: when god looks at a gay person, does he endorse the existence of this person with love, or reject and condemn this person? we must always consider the person” (goodstein, 2013, p. a1). in concert with this position, catholic charities in massachusetts has declined to place any adoptive children with same-gender couples (franck, 2011). similarly, research suggests that u.s. latinos, fasbinder, monson, montero, sanders, williams/same-gender marriage 419 who are largely catholic, tend to oppose progressive policy regarding same-gender marriage (ellison et al., 2011). other non-christian religious groups’ attitudes toward same-gender marriage range from outright condemnation by a substantial number of orthodox jews and muslims (marcus, 2013; pew research religion & public life project, 2012) to tacit support for those who embrace reform and reconstructionist judaism (kipnes, 2013). the conservative jewish movement approved a ceremony in 2012 to allow same-gender couples to marry. there is no official buddhist or hindu position on same-gender marriage (pew research religion & public life project, 2012). family and adoption issues gay and lesbian persons often face tensions and dilemmas in the context of family relationships (green, murphy, blumer, & palmanteer, 2009). this discord is easily compounded when it progresses from a matter of their own sexuality to the context of a relationship with a member of the same sex. same-gender couple relationships are often ignored or rejected by parents and relatives, rather than validated, supported, and celebrated (rostosky & riggle, 2011). when they announce to family and friends a decision to get married, they tend to receive mixed reactions (baker & elizabeth, 2012). same-gender couples that have had wedding ceremonies have reported being told by family members that they will not live “happily ever after,” and that their choice of a same-gender partner is “wrong” (rostosky & riggle, 2011, p. 959). with regard to parenting rights of same-gender couples, many u.s. states protect gay and lesbian parenting without officially recognizing gay and lesbian couples. for instance, almost half of u.s. states recognize second-parent adoption, whereby a child may be adopted by a second parent in the home who is not married to the legal parent of the child (epstein, 2012). healthcare while some studies have found that legal and social recognition of same-gender marriage has had positive health outcomes for the lgbt (lesbian, gay, bisexual, and transgender) community (buffie, 2011), generally, compromised healthcare delivery to this community compared to that provided to the general population is well documented (bonvicini & perlin, 2003; penniman et al., 2007). one aspect to consider is that a partnered lgbt person is less likely to receive employee-sponsored dependent health insurance coverage (buffie, 2011). partnered gay men are much less likely than are married heterosexual men to have access to employer-sponsored dependent coverage, while partnered lesbians have even less opportunity for coverage than married heterosexual women. moreover, enrolling a same-gender partner or spouse as a dependent frequently requires that an employee “come out” as lesbian or gay if the employee has not done so already (ponce, cochran, pizer, & mays, 2010). advances in social work, fall 2013, 14(2) 420 methods the findings of this study are based on previously published opinion polls from the gallup organization (2013), cbs news/new york times poll (2012), and cnn/orc poll (2013). for the gallup organization, the design of the sample for personal (face-toface) surveys is that of a replicated area probability sample down to the block level, in the case of urban areas, and down to segments of townships, in the case of rural areas. after stratifying the nation geographically and by size of community according to information derived from the most recent census, over 350 different sampling locations are selected on a mathematically random basis from within cities, towns, and counties that have, in turn, been selected on a mathematically random basis. the procedures just described are designed to produce samples that approximate the adult civilian population (aged 18 and older) living in private households (that is, excluding those in prisons, hospitals, hotels, and religious and educational institutions, and those living on reservations or military bases) and, in the case of telephone surveys, households with access to either a landline or cell phone. the manner in which the sample is drawn also produces a sample that approximates the distribution of private households in the united states; therefore, survey results can also be projected onto the number of households. for further detailed methodology, see gallup organization (2013), cbs news/new york times poll (2012), and cnn/orc poll (2013). results given that same-gender marriage is one of the most controversial and divisive social issues faced by americans, national polls have been conducted on this topic for nearly two decades. for example, from 1996 to 2012, the gallup organization (2013) asked a cross section of americans the following question: “do you think marriages between same-sex couples should or should not be recognized by the law as valid, with the same rights as traditional marriages?” (see table 1). results showed a notable increase for support for same-gender marriage: in 1996, only 1 in 4 americans were in support, whereas by november 2012, a majority (53%) of americans expressed their support. in order to tap into americans’ attitudes toward same-gender marriage in a slightly different format, from 2004-2012, the cbs news/new york times poll (2012) asked a cross section of americans: “which comes closest to your view? gay couples should be allowed to legally marry. or, gay couples should be allowed to form civil unions but not legally marry. or, there should be no legal recognition of a gay couple's relationship?” (see table 2). the most striking difference compared to the results reported in table 1 is that when respondents were provided with three response alternatives, support for legal marriage declines from a majority (53%) to only 40% of americans in support of legal marriage. approximately one quarter of americans support civil unions as opposed to legal marriage, while nearly one third of americans desire no legal recognition of a gay couple’s relationship. fasbinder, monson, montero, sanders, williams/same-gender marriage 421 table 1. attitudes toward the legal recognition of same-gender marriage, 1996-2012 should be valid (%) should not be valid (%) no opinion (%) 2012 53 46 2 2012 50 48 2 2011 48 48 4 2011 53 45 3 2010 44 53 3 2009 40 57 3 2008^ 40 56 4 2007 46 53 1 2006^ 42 56 2 2006*^ 39 58 4 2005* 37 59 4 2004* 42 55 3 1999* 35 62 3 1996* 27 68 5 question: do you think marriages between same-sex couples should or should not be recognized by the law as valid, with the same rights as traditional marriages? note*: [question was slightly different]: do you think marriages between homosexuals should or should not be recognized by the law as valid, with the same rights as traditional marriages? note^: asked of a half sample. notea: data reported two or more times in one year indicate that the same question was asked multiple times. noteb: figures may not total 100% because of rounding. notec: random sample of 2,027 adults, aged 18+, living in all 50 u.s. states and the district of columbia. for results based on these samples of national adults, one can say with 95% confidence that the margin of error is ±3 percentage points (t. sugar [gallup organization], personal communication, september 5, 2013). noted: for each table, the authors have reported all data that were collected by the gallup organization. however, it is important to note that the gallup organization did not conduct the same survey every year, which explains the occasional gaps in data reported from year to year. source: poll data compiled by the gallup organization (2013). advances in social work, fall 2013, 14(2) 422 table 2. attitudes toward same-gender marriage and civil unions, 2004-2012 legal marriage (%) civil unions (%) no legal recognition (%) unsure (%) 2012 40 23 31 6 2011 38 27 28 7 2010 40 30 25 5 2010 39 24 30 7 2009 33 30 32 5 2009 42 25 28 5 2009 33 27 35 5 2008 30 28 36 6 2007 28 32 35 5 2006 28 29 38 5 2006 27 30 40 3 2005 23 34 41 2 2004 21 32 44 3 2004 28 31 38 3 2004 28 29 40 3 2004 22 33 40 5 question: “which comes closest to your view? gay couples should be allowed to legally marry. or, gay couples should be allowed to form civil unions but not legally marry. or, there should be no legal recognition of a gay couple's relationship.” notea: data reported two or more times in one year indicate that the same question was asked multiple times. noteb: n = 1,197 adults nationwide with a margin of error of ±3 percentage points. notec: for each table, the authors have reported all data that were collected by the cbs news/new york times poll. however, it is important to note that the cbs news/new york times poll did not conduct the same survey every year, which explains the occasional gaps in data reported from year to year. source: poll data compiled by the cbs news/new york times poll (2012). to gain yet another perspective, table 3 presents cnn/orc poll (2013) data from 2008 to 2013 derived from a slightly different question: “do you think marriages between gay and lesbian couples should or should not be recognized by the law as valid, with the same rights as traditional marriages?” it is interesting to examine these data by important demographic subgroups: gender, age, and political party affiliation. for example, women were slightly more likely than men to support same-gender marriage during the two years reported, 2012 and 2013. when we examine the impact of age, the younger respondents (under 50) supported the proposition by nearly two thirds, whereas of those 50 and older, only 4 in 10 expressed similar support. finally, the sharpest differences were reported between those who identified their political affiliation as either fasbinder, monson, montero, sanders, williams/same-gender marriage 423 republican or democrat: nearly 3 times as many democrats (70%) as republicans (25%) supported same-gender marriage. table 3. attitudes toward same-gender marriage by gender, age, and political party affiliation, 2008-2013 should % should not % unsure % 2013 53 44 3 men 49 48 3 women 56 40 4 under age 50 61 36 3 50 and older 42 53 4 democrats 70 28 2 independents 55 41 4 republicans 25 71 4 2012 54 42 3 men 52 43 5 women 56 42 2 democrats 70 28 2 independents 60 37 4 republicans 2011 2011 2009 2008 2008 23 53 51 44 44 44 72 46 47 54 55 53 5 1 2 2 1 3 question: “do you think marriages between gay and lesbian couples should or should not be recognized by the law as valid, with the same rights as traditional marriages?” notea: figures may not total 100% because of rounding. noteb: data reported two or more times in one year indicate that the same question was asked multiple times. notec: n = 1,014 adults nationwide with a margin of error of ± 3 percentage points. noted: for each table, the authors have reported all data that were collected by the cnn/orc poll. however, it is important to note that the cnn/orc poll did not conduct the same survey every year, which explains the occasional gaps in data reported from year to year. source: poll data compiled by the cnn/orc poll (2013). advances in social work, fall 2013, 14(2) 424 discussion what is most striking when we review the findings reported in tables 1 and 2 are the substantial differences in support for same-gender marriage, ranging from a majority (53%) expressing support for marriage equality to only 4 in 10 supporting same-gender marriage when americans are offered three response alternatives: support for legalization of marriage, civil unions only, or no legal recognition of same-gender couples. an alternative interpretation emerges when we combine responses supporting civil unions and no legal recognition. more than 5 in 10 americans support these two approaches, whereas only 4 in 10 support the right to legally marry. for social workers committed to social action and legislative change, it is useful to be aware of the various demographic subgroups which support marriage equality, as reported by national polls. as such, this knowledge would provide a beginning point to focus on populations within states that have not approved same-gender marriage. towards this end, when we examine the data in table 3, two important demographic subgroups emerge: age and political party affiliation. when age is considered, those under 50 years of age are much more likely to support same-gender marriage than americans 50 and over. another national survey (cbs news poll, 2013) reported a very strong relationship between age and support for same-gender marriage. for example, nearly 3 in 4 (73%) of respondents aged 18-29 were in support of marriage equality. this level of support declines systematically through each older cohort without exception. for example, only 35% of the oldest cohort (65+) supports same-gender marriage. political party affiliation yields the greatest response differences: nearly three quarters of democrats support same-gender marriage versus one quarter of americans who consider themselves republicans (see table 3). it is useful to note that several national surveys have reported similar results (nbc news/wall street journal, 2013; pew research center, 2013, princeton survey research associates international, 2008; quinnipiac university poll, 2012). finally, regarding religious affiliation, the strongest support for same-gender marriage comes from the following demographic groups: jewish americans (81%), the religiously unaffiliated americans (76%), catholics (58%), and mainline protestants (55%) (jones, cox, navarro-rivera, dionne, & galston, 2013). social workers may wish to look to these groups as their support base as they advocate for marriage equality. the results from these national public opinion surveys may be useful for social workers who seek to advance social justice and marriage equality for the gay and lesbian population (national association of social workers, 2012). there is a great deal of evidence that public opinion can directly influence public policy (burstein, 2003; kenworthy, 2009; silver, 2013). for example, doma was approved under the clinton administration, when public opinion did not strongly support same-gender marriage. however, recently, the supreme court, some would argue, was influenced by public opinion, when it struck down doma and took no action on california’s prop 8 with a near majority supporting same-gender marriage. some would also suggest that the 13 states that have approved same-gender marriage were influenced by national and statewide public opinion supporting same-gender marriage. fasbinder, monson, montero, sanders, williams/same-gender marriage 425 study limitations and directions for future research study limitations numerous scholars have reported the limitations of survey research methodology (creswell, 2013; dillman, smyth, & christian, 2009; groves & couper, 2012; groves et al., 2013). the findings can be impacted by numerous factors: the size, quality, and representativeness of the sample; survey type (face-to-face, online, mail, or telephone); question wording; question ordering; potential for social desirability response bias; number of response alternatives; and potential impact of various media announcements at the time of data collection (e.g., supreme court rulings, newspaper headlines, social media, etc.). limitations specifically related to data reported in table 1 include a change in question wording from “homosexuals” to “same-sex couples” by the gallup organization. for example, in 2006, gallup collected data twice that year, once using the question: “do you think marriages between homosexuals should or should not be recognized by the law as valid, with the same rights as traditional marriages.” in the same year, they changed the wording: “do you think marriages between same-sex couples should or should not be recognized by the law as valid, with the same rights as traditional marriages?” we note that there was a negligible change in response rate from 39% agreeing that marriage should be valid to 42% when the second version of the question was asked. this difference is considered to be within the margin of error of ±3 percentage points, as reported by the gallup organization (see notec in table 1). in examining the data in table 2, we note the following limitations: the cbs news/new york times poll (2012) decided to frame their question differently than did gallup in table 1. table 2 used the phrase “gay couples” as opposed to “same-sex couples” in table 1. in addition to wording differences, table 2 offered respondents three response alternatives: legal marriage, civil unions, and no legal recognition. it is interesting to note in table 1 that when respondents are limited to one of two response categories—should be valid and should not be valid—53% felt that same-gender marriage should be legally valid in 2012. however, when data were collected in 2012 by the cbs news/new york times poll, which provided three response alternatives, only 40% of americans expressed support for legal marriage. it appears that the impact of question wording and the availability of several response alternatives yield substantially different results. the data reported in table 3 have the following limitations. it is interesting to note that the cnn/orc poll (2013) uses yet a third variation in question wording: “gay and lesbian couples”; however, the results for their 2012 survey are almost identical to gallup’s results (54% and 53%, respectively, supporting same-gender marriage). in addition, the age categories of “under 50” and “50 and over” are extremely broad. however, other polling organizations report that for each cohort as age increases from youngest to oldest, there is a steady decline in support for same-gender marriage (jones, 2013). similarly, regarding political party affiliation, if respondents were given a fourth advances in social work, fall 2013, 14(2) 426 choice of no political affiliation, in addition to democrat, republican, or independent, these results may yield a measurable difference. future research future social work research might focus on the demographic subgroups in american society that do not support marriage equality. findings from such research may shed light on how we can address the serious concerns of those americans opposed to the legalization of same-gender marriage. to effectively conduct this research may require detailed, qualitative, face-to-face interviews, which generally provide much richer insights than can be gathered by using standard survey research methods. collecting data from a sub-sample of americans that do not support same-gender marriage is, of course, time consuming, costly, and may lack generalizability. drawing from the results of these in-depth interviews may enable researchers to design meaningful questions that may have eluded earlier researchers who had used standard survey methodology. groups to be identified include the politically and religiously conservative as well as respondents over 50 years of age who typically report the lowest level of support for marriage equality. with this arsenal of detailed qualitative information, social workers could draw from these data as they pursue their various social policy advocacy efforts. in the past, social workers have only been armed with a thumbnail sketch of the demographic subgroups that are opposed to same-gender marriage, whereas the data gathered through this new research direction could provide a detailed breakdown of the reasons why certain demographic subgroups are opposed to the legalization of samegender marriage. addressing such concerns may accelerate the progress towards full marriage equality for all americans. implications for social work practice direct practice the number of lesbian women and gay men who turn to therapy for help for any number of reasons is rapidly increasing. for example, 72% of american association of marriage and family therapy clinical members indicate that approximately one tenth of their practice is with lesbian and gay clientele (green et al., 2009). many practitioners are challenged to think outside of their comfortable and familiar heterosexist constructions of family life, thereby promoting a more gayand lesbian-affirmative therapeutic stance (green et al., 2009). also, same-gender marriage partners often need counseling or therapy to assist with their constant struggle amidst layers of unsupportive laws, policies, and social attitudes. the impact of these struggles can negatively affect not only their finances and certain privileges and rights, but also, commonly, the mental and emotional well-being of the members of their family unit including partners and children. pre-marital education services, readily available to opposite-sex couples, are limited for same-gender couples. premarital counseling could provide a wealth of support and guidance to lesbians, gays, and bisexuals to nurture their relationships in the midst of societal discrimination, legal prohibitions, and other forms of social injustice that are fasbinder, monson, montero, sanders, williams/same-gender marriage 427 enacted against same-gender marriages. the development of programs to address these and related issues could be strengthened by linking same-gender and bisexual couples with successful couples who have experienced and resolved various challenges related to their sexual identities (casquarelli & fallon, 2011). social workers also have an important role in addressing the “minority stress” that same-gender couples experience as a result of the lack of marriage equality. minority stress is associated with increased risk for depression, anxiety, and other physical and psychological health outcomes. the denial of civil marriage rights is a specific example of minority stress that can negatively affect the psychosocial well-being of lesbians, gays, bisexuals, and the transgendered (rostosky & riggle, 2011). some therapists have failed to explicitly attend to the social context of their gay and lesbian clients, which has sometimes led to ineffective practices (green et al., 2009). with regard to same-gender partners involved in health care issues, in states where samegender marriage is not recognized, it could be important to guide them towards initiating a form of health care proxy to help approximate the kinds of rights that a heterosexual spouse would have in a medical emergency (zupcofska, 2010). macro practice the lack of legalized marriage for same-gender couples directly affects their rights and psychological well-being. furthermore, the massachusetts department of public health indicates that 93% of children with same-gender parents report feeling happier and better off as a result of the legal recognition of same-gender marriage (buffie, 2011). further, social workers can take steps to become advocates for marriage equality by educating themselves about local and state laws that affect their clients (rostosky & riggle, 2011). they can also facilitate marriage equality by conducting and disseminating research and by engaging in political advocacy efforts in conjunction with national organizations, such as the national gay and lesbian task force (ngltf) and the human rights campaign (hrc), which are nationally organized political voices for the u.s. lgbt community (callahan, 2009). with regard to the need for premarital counseling for same-gender couples, social workers can play an important research role to increase their understanding (casquarelli & fallon, 2011). to help change the knowledge base in the courtroom, social workers can serve as informational consultants to politicians, attorneys, and judges. as an example of the critical role that social workers and other professionals can play, research psychologists testified on behalf of the plaintiffs during the 2010 federal district trial challenging the constitutionality of california’s proposition 8. one social scientist presented expert testimony and cited research on “minority stress”; another testified on the vast research literature demonstrating that child outcomes do not differ based on parent sexual orientation. the impact of such research is clear in the judge’s decision in favor of marriage equality (rostosky & riggle, 2011). researchers have reported in recent years that homophobic attitudes are decreasing; however, it is unclear whether attitudes are actually changing, or whether instead it is less advances in social work, fall 2013, 14(2) 428 socially desirable to admit having these attitudes (green et al., 2010). although intentional anti-gay behaviors are common, more common are unintentional anti-gay behaviors that some people engage in without conscious awareness. the impact of homophobia on gays and lesbians can be devastating, resulting in feelings of inadequacy, self-hatred, guilt, and a general lack of optimism (blumer & murphy, 2011). this is an important observation since it can impact social work practice, particularly if social workers or their homophobic clients hold such attitudes and unintentionally harm lgbt individuals. therefore, it is critical that social workers engage in serious self-reflection regarding their personal attitudes toward lgbt clients and how those attitudes may negatively impact the clients they are seeking to assist. conclusion when we trace america’s historical, cultural, and political roots surrounding samegender marriage equality, we observe a significant journey marked by the violence of the stonewall riots in 1969 to the policy decision of the american psychiatric association to remove homosexuality as a mental health disorder from the dsm-iv manual in 1973. nearly half a century later, today’s national opinion surveys report a slight majority of americans in support of same-gender marriage. it is interesting to note that american public opinion has often led the opinion of state and federal legislators on controversial issues, and this appears to be true today. social workers who choose to advocate in this arena have a full agenda which involves a great deal of effort, but also requires a fundamental shift in how society views traditional marriage—a shift that americans do not easily make. this is a challenging but not impossible undertaking. today’s social 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(2010). when couples are same sex, drafting considerations differ. family advocate, 32, 18-22. author note: address correspondence to: dr. darrel montero, arizona state university school of social work, mc 3920, 411 north central avenue, ste. 800, phoenix, az 85004-0689. email: darrel.montero@asu.edu microsoft word garcia_reflections of a latino copyedit final ______________  alejandro garcia, ph.d., is professor, school of social work and the immediate past director of the school, as well as faculty associate of the aging studies institute at syracuse university in syracuse, ny. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 80-90 reflections of a latino in the social work profession alejandro garcia abstract: this is a first-person account of seminal events that have helped shape the rich history and cultural heritage of the social work profession. in examining these events, the author has provided some personal history as a mexican american growing up in south texas that provides a historical and value context for his participation in these events. he also discusses his leadership experiences in serving on the national staff of nasw and volunteer leadership experiences in a number of professional organizations during critical times for the profession. key words: autobiography, latino, mexican american, diversity, guiding words, ethical perspective, professional associations, professional development, poverty, higher education, role models i was asked by the editors of advances in social work to contribute to a special issue that would focus on first-person accounts of seminal events that have helped shape the rich history and cultural heritage of our profession. i am humbled by being asked to participate in this effort, as i am not sure that i have been instrumental in any seminal events that helped shape our profession, but i will let the readership be the judge of that. personal history is a fleeting element unless it is recorded. one concern is that one’s personal experiences are of no value to anyone else and, therefore, do not need to be recorded in any way. the problem with this kind of thinking is that the individual determines the value of such information, rather than allowing other interested parties to participate in that assessment. personal history we never know which events will have the strongest influence on our life. i believe that my family was strongly responsible for influencing the shape of my character. i was raised in a poor mexican-american family with six siblings. my first language was spanish, and i did not speak a word of english until i entered public schools in south texas. i spent a year in first grade and a year in “high” first grade to address my limited english fluency (i later skipped a grade because i was too advanced for the rest of the kids in my class and i was being disruptive). the elementary schools that i attended in my neighborhood were composed exclusively of mexican american children, and the only non-hispanic whites were some of my schoolteachers. both of my parents, who were immigrants from mexico, had 3rd grade educations. apparently, they were taken out of schools by relatives and they served as servants for family members or worked in the fields. before bearing children, my mother worked at housecleaning jobs at the homes of non-hispanic whites, whom we called “anglos.” after children started arriving, she kept the home while dad worked a garcia/reflections of a latino in the social work profession 81 number of odd jobs, including shrimp fishing in the gulf of mexico and working at gas stations. development of personal perspectives i began my studies at the university of texas in 1958, at a time when it had just started to integrate in line with the brown v. board of education mandate. while mexican americans were considered to be white for the purpose of integration, as was also the case in the city of houston, they were still victims of discrimination in a variety of ways (see mexican american legal defense and educational fund [maldef], 2009; ross v. eckels (1970), cited in rangel & alcala, 1972). coming from the lower rio grande valley (brownsville, texas), which had very few black americans, to austin, i was unaware of widespread discrimination against them. my only previous experience related to discrimination against black americans was going to a department store in san antonio and finding two water fountains: one marked white and the other marked “colored.” (out of innocence, i should note that i drank out of both of them because i did not know whether i was white or colored. needless to say, both tasted the same, although the one for whites was more aesthetically pleasing.) my experience with discrimination against mexican americans was compounded by poverty. we lived in one of the poorest neighborhoods in brownsville, texas, and our street was unpaved. when it rained, we were lucky to live next to the railroad tracks that led to the cotton compress that created bales of the cotton that we helped to pick. the train tracks helped us to keep our shoes dry as we walked to the nearest paved road several blocks away. we were so poor that my school band uniform was the best outfit i had. while my brothers and i picked cotton during the summer months, i sold newspapers after school and was obsessed with the korean conflict and the trial of ethel and julius rosenberg, and remember crying when i read that they had been executed. i also remember reading the want ads and noting that a number of them contained notices that “only anglos need apply.” i wondered why that was the case, but was told that that was simply the ways things were. one of my earliest recollections was having been taught by some anglo teachers that mexicans had no culture and implied that american culture was superior. this perspective was reaffirmed in the texas history books that we were required to read. i learned that mexicans were vicious killers who had massacred the heroes of the alamo during the texas war of independence. the alamo still stands today in support of that perspective. it was not until much later that i learned a different perspective of what happened at the alamo from revisionist historian rodolfo acuna (1981). i learned that the heroes of the alamo were interested in freeing texas from mexico and allowing it to become a slave-holding state. mexico had freed slaves in 1829, and this left slaveholders in texas in a precarious situation. had i learned this as a child, i would have been proud of my mexican heritage. instead, i was embarrassed that i was a mexican child who had internalized the anglo-centric teachings and had become the recipient of a number of pejorative terms. in retrospect, i recall feeling disempowered during these formative advances in social work, spring 2014, 15(1) 82 years. i had bought into a perspective that i was worthless and that i could not effect change. i was led to believe that there was nothing i could do that could possibly make a difference. it was only gradually that i became empowered with the help of people who believed in me more than i believed in myself. some of these persons were a few of my teachers who selected me for the national honor society, the vice principal who had me attend a meeting of the rotary club, and my family, particularly my mother who would not let me quit school to help support the family. my affirmation of self was not independent of others, but a collective effort that helped me to celebrate who i was rather than who i thought others wanted me to be. that empowering belief was then transferred to others whom i believed had also been denied their rights. i discovered that the more i actively engaged in advocacy for the rights of others who had been similarly disenfranchised, the stronger i became. i had learned that i was not alone. it was not until i was in the military that i had a chance to travel to the interior of mexico. i was taken aback by the metropolitan area of mexico city with its skyscrapers, colonial buildings, aztec temples, and teotihuacan pyramids. i felt a surge of pride in what i saw. i was angry that what i had learned in school was erroneous, ethnocentric, and misleading. i began to collect as much mexican folk art as i could afford, and have continued to do so until this day. i consider it part of my cultural heritage, an essential part of my identity. i have also pursued photography as a hobby and have tried to capture mexican spirit and culture in the photographs i take of people, culture, architecture and archeological wonders. decision to pursue social work toward the end of my three-year enlistment in the army, i was in an auto accident that left me hospitalized for 20 months. during that long period of time, 9 ½ months of which i spent bedridden, i had much time to consider my career path. i was concerned about the disconcerting limitations of my disability and the prospect that i may never be able to stand and ambulate for extended periods of time. my mood was one of despondence as i ruminated about my lack of movement and having to depend of others for my basic needs. i was in skeletal traction for several months and in a body cast for an additional period of time. this left me feeling depressed, and there were no social workers or other mental health professionals to whom i might have turned for help at the army hospital. during my non-ambulatory period, i had much time to read, think, and reflect on my personal life experiences and those of my fellow mexican americans. i began to think about mexican americans and their socioeconomic status in the united states. while i had not considered social work as a profession before, this extended period of introspection led me to enroll at cal state sacramento when i left the military, a decision influenced in part by the extent of my disability and its implications for my professional path. i thought that i would have difficulty standing or walking for extended periods of time. the initial courses that i took in the summer of 1967 convinced me that this profession would help me develop skills and knowledge in my chosen path. the formal garcia/reflections of a latino in the social work profession 83 admission date for the fall semester had already passed, but the director of the program, dr. alan wade granted me an exception and encouraged me to follow through with my application and i was admitted to the program that fall. when i began my msw studies, i discovered that there was much more literature on african americans than there was on latinos. to address my need for greater knowledge in this area, i attended a number of workshops that purported to provide information on minorities, but the discussion focused primarily on african americans. i would raise questions about latinos, but the experts leading the workshops were not able to answer them. while i was not able to find books about latinos and social work, i did find literature about latino history in the united states and efforts to address civil rights concerns in organizing in the workplace, voting rights, and problems with immigration authorities and the administration of justice. the more i learned, the angrier i became about latinos’ conditions in texas and elsewhere. while a student at sacramento state university during my msw studies, i worked with a fellow social worker, alejandra ebersole, in founding a chapter of trabajadores de la raza (social workers of our race – it literally translates to “workers of the people,” but the group was composed exclusively of social workers.). our efforts were modest. we tried to influence the social work program in hiring latino faculty and expanding the recruitment of latino students, and we also tried to encourage social welfare agencies to become more sensitive and responsive to the needs of the growing number of latinos in the sacramento area. post-msw employment after graduating with an msw degree, i began working for a state agency that served mentally ill persons, many of whom had recently been released from state institutions in the california deinstitutionalization efforts under governor reagan. while the explicit intent of such actions was to return the mentally ill to the community, the implicit intent was economic. the result of such action was the release of thousands of chronically mentally ill persons into an environment that lacked any critical support systems, including adequate housing. many of these individuals had been in state institutions for years and had developed what goffman called “institutional syndrome” (goffman, 1961). in other words, they had difficulty surviving independently without extensive supports. we worked with the community services division of the state of california in sacramento during that period of deinstitutionalization to help stabilize these vulnerable clients. joining the nasw national staff while i was working with the community services division, i participated in an nasw leadership conference, where i met some national nasw staff members. shortly thereafter, i was invited to interview for the newly created position of national student coordinator in the national office. i was interviewed for the position in 1970 both by chauncey alexander, and then president, whitney young. after much consideration, i accepted the position and decided to make the move from sacramento to new york city. advances in social work, spring 2014, 15(1) 84 my primary goal was to work with the national federation of student social workers (nfssw). some social work programs had nfssw chapters, but most did not. at this time of high student activism and opposition to the war in vietnam, students were also disenchanted with nasw, and saw it as an agent of the status quo rather than as an agent for change in support of the poor. in my work, i attended a number of nfssw conferences, and also met with student groups in a number of institutions. i tried to encourage students to join nasw and to provide valuable input from their perspective. my intent was to increase the credibility of nasw with students. a major concern at that time was a division between clinicians and community organizers, with each side claiming the higher moral ground. students were drawn to the more politically oriented community organizers, many of whom suggested that nasw only represented clinicians and was not interested in the broader macro issues, such as racism and poverty. chauncey alexander believed this to be a false dichotomy and suggested that both clinical practice and community organization were essential interdependent parts of the profession. in visiting campuses around the nation, i found many students alienated from nasw without fully understanding the historical evolution and nature of our profession. i worked with nasw as it moved to include student members on the national board of directors in order to give them a legitimizing voice and greater visibility. another major issue that arose during my four years on the national staff occurred when the american psychiatric association took action to remove homosexuality from its list of psychopathologies in 1973. the nasw board met and discussed this issue at length. regrettably, nasw decided not to include any similar statement in its policy manual at that time due to some ambivalence about whether homosexuality belonged in the list of psychopathologies, although it would change its mind at a later date (national association of social workers, 2014). diversity within nasw itself was yet another important issue facing the profession during that period. although a number of us fought hard for greater diversity among the organization’s leadership, there did not appear to be widespread recognition of the need for change. it should be noted that while nasw was composed primarily of women members, the majority (both men and women) tended to vote for male leaders. the first woman to become president of the association did so by ascending to the position when the former president died. the creation at that time of a presidential slate with two women candidates was intended to insure the election of a woman to that post. the election of a minority president posed similar difficulties. i ran for president of nasw in the late 1970s against a white male, and was defeated. my recollection is that, at that time, no minority had ever been elected to the presidency when competing with a nonhispanic white male. at the same time, nasw was concerned about the low number of persons of color in both its general membership as well as its leadership, and it formed a national committee on minority affairs (ncoma) composed of latinos, african americans, asian americans, and native americans. all of the individuals initially chosen were recognized leaders within their respective ethnic/racial social worker organizations. i was garcia/reflections of a latino in the social work profession 85 asked to staff that body. it was a challenging experience in that nasw had never had this kind of a unit. the group initiated efforts to make persons of color more visible within the professional association and also worked in developing practice components in working effectively with these groups. at that time, the emphasis on minority groups was very limited, and there was a sense of alienation by a number of groups. their perception was that nasw believed that social work interventions that had been developed were applicable to all groups. as a result, a number of persons of color preferred to work with their respective social work organizations rather than nasw. minority membership in nasw was very limited for that reason, and nasw made efforts to increase its credibility with these groups through the creation of ncoma and by hiring additional minority staff. in addition, great efforts were made to insure that persons of color and women were represented in leadership positions. at nasw, the influence of chauncey alexander, mitch ginsburg, alan wade and whitney young was tremendous. without direct lectures, they taught me through example. chauncey, the executive director of nasw, was a strong civil libertarian and had friends from across the political spectrum. whitney young was executive director of the urban league and, at the same time, president of nasw, when he lost his life in a drowning accident in africa. whitney’s commitment to civil rights was strong and eloquent. his loss in the middle of his presidential term at nasw was a shock to all of us. alan wade, then director of the social work program at california state university at sacramento and vice-president of nasw, assumed the nasw presidency with a strong conscience and high standards for the profession and a commitment to equality. following alan wade’s tenure, mitchell ginsburg became the president of nasw. mitch ginsburg had been dean of the columbia university school of social work and came to nasw with prior leadership experience in the new york city welfare department. his commitment to recipients of public assistance was well recognized to the extent that one recipient of public assistance even named a daughter after him: “mitchellina.” i had the opportunity to interact with mitch regularly when i became president of the staff union at the time the national office was moving from new york city to washington, dc. despite occasional disagreements, he served as a valued mentor in relation to the importance of mutual respect and the complexities associated with the negotiation of difficult issues. decision to pursue doctoral studies in 1974, after four years with the nasw national office, i knew that i wanted to pursue doctoral studies and ultimately teach, but i was not sure about my area of study. one of my major mentors was dr. juan ramos, who, when i met him, was conducting much organizing and training of latino social workers on behalf of the national institute of mental health. dr. ramos was an excellent role model for many latinos and encouraged my pursuit of doctoral studies. my initial foray into doctoral education at the florence heller graduate school for advanced studies in social welfare, at brandeis university, provided me with an opportunity to explore the demographics of an aging society that was ill prepared to deal advances in social work, spring 2014, 15(1) 86 with the challenges associated with the aging process. more specifically, i was concerned about the compounding effect that such phenomena were having on an aging latino population. three of my role models at the heller school were my dissertation chair, james schulz, a welfare economist who made high academic demands of me; robert binstock, a political scientist; and david gil, a sociologist with a strong activist orientation. an additional role model was charles schottland, who had been the founding dean of the heller school and later the president of brandeis university. i hope that some of their expertise, wisdom, and commitment to high academic standards, as well as commitment to the powerless, have left a powerful imprint on my conscience and actions. there were also subtle changes occurring within the latino society relative to the dominant culture. one such concern, especially among younger latinos, involved the socialization process that seemed to be fostering a more individualistic orientation to life, one that honored filial piety less and less as our members became increasingly acculturated into the american way of life. even if adult children wanted to help their elderly relatives, they had limited resources to do so. i was also concerned that latinos were less financially prepared for retirement than other ethnic/racial groups in american society. the convergence of these various social concerns helped focus my scholarly interests around issues involving the economic resources available to latinos and their ultimate impact on retirement. when i was a doctoral student, i gained a greater appreciation for social action, and i found myself participating in demonstrations in support of unionization of farm workers in the agricultural fields in salinas, california. i also participated in picketing liquor stores who sold scab wine and grocery stores that sold scab lettuce in waltham, ma, and the surrounding area. after gaining my doctoral degree in 1980 and becoming a faculty member at syracuse university, i learned that racism does not recognize doctoral degrees or professorial status. some years back, when i was on an intercity bus in south texas, a non-hispanic stranger approached me and told me to show him my citizenship papers. he was not wearing a uniform and he had not shown me a badge or other identity. he assumed that because i looked mexican, i could be ordered to prove my citizenry. he reacted angrily when i asked him who he was. he responded that he was an officer of the immigration and naturalization service. without thinking, i asked him for his identification, and he demanded my proof of citizenship. i took the first identification i could out of my wallet, and it was my military retirement identification card. he looked at it and tossed it back to me, telling me that the card did not prove my citizenship, as he walked away. everyone in the bus looked at me as if i had committed an egregious error. at that time, i was unaware that there were many stories of border patrol beatings of mexican americans who “did not stay in their place.” post-doctorate involvement with professional associations over the years since obtaining my doctoral degree, i have had an opportunity to be active as a volunteer with a number of professional and advocacy organizations. below i have focused primarily on these organizations’ involvement in human diversity issues and my role and perspective in those difficult discussions. primary among those have garcia/reflections of a latino in the social work profession 87 been the council on social work education and the national association of social workers. cswe and diversity the council on social work education has been committed to addressing diversity for some time. each new iteration of the educational policy standards has incrementally called attention to issues involving ethnic and racial diversity, women, lgbt, and disability issues. the efforts have not been without their detractors. highlighting this trend has been cswe’s commitment to addressing lgbt issues. some years back, when i was serving on either the cswe board or the commission on accreditation, some religiously-based programs took exception to cswe mandating non-discrimination on the basis of sexual orientation and threatened lawsuits over the issue. upon advice of legal counsel that it would be difficult for cswe to hold its ground on this particular issue, since religiously-based programs had prevailed on other matters that they indicated violated their commitment to their religious dictates, the council yielded on this issue, but still mandated that programs address lgbt issues in their curricula. this battle was agonizing in that we were dealing with an issue of discrimination to which we were deeply committed. the compromise satisfied no one, but it was an incremental step in the right direction. focus of publications my publications include journal articles, op-ed pieces, and three co-edited books. two of the books focus on latino elderly on which i worked when i was a member and then chairman of the board of directors of the national hispanic council on aging. the co-editor was the late marta sotomayor (sotomayor & garcia, 1993, 1999), who was the executive director of that organization. our concern in developing these two books was to address an area of study that was underdeveloped. our sense was that older latinos had been ignored in the gerontology literature and that we needed to address that need through encouraging experts on latino aging to contribute to these books. the third book was a co-edited book with a former colleague, susan taylor-brown (garcia & taylor-brown, 1999). she had created an annual camp for families with hiv/aids to provide them with a weekend in which they would be able to enjoy themselves and be free from discrimination, harassment, and fear. this led to the two of us discussing the needs of young, vulnerable individuals, many of them in families already affected or infected by hiv/aids. we were able to recruit a number of colleagues who were interested in the topic to contribute to our volume in hopes of a better understanding of young, vulnerable persons growing up in the age of hiv/aids. conclusion as i reflect on my life in the social work profession, i have realized that our imperfect society is a work in progress and that we need to continue to address the issues that continue to affect our society negatively. my ongoing question is whether i did as much as i could to help others, to change opinions, to change policy outcomes. our advances in social work, spring 2014, 15(1) 88 ethical responsibility to society is clearly enunciated in our code of ethics. this code mandates us to promote the general welfare of society. it mandates us to prevent and eliminate discrimination on the basis of race, gender, sexual orientation, age, handicap, and other criteria. it mandates us to advocate for changes in policy and legislation to improve social conditions and to promote social justice. we have heard pope francis talk more about the poor in the brief time that he has been in office than we heard either of the presidential candidates discuss the issue during their prolonged campaigning. perhaps we are retreating to a time of michael harrington’s invisible poor – out of sight, out of mind. but we must make our society aware that one out of six of us is poor and not able to afford the basic necessities of life. we need to stop blaming the poor for their dilemma and examine ourselves as a society that continues to permit this serious inequality among us. while the overall poverty rate approximates 16 percent, the poverty rate for african americans and latinos is over 25 percent. we cannot tolerate this disparity! the great farm worker leader, cesar chavez, noted that we were involved in a battle in which “the poorest of the poor and weakest of the weak are pitted against the strongest of the strong.” in spite of all the social issues i have enumerated, these concerns have met resounding silence as each of us goes about his or her own way rather than confronting these social injustices. many years ago, dr. martin luther king, jr., reiterated this sentiment when he said, “history will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.” unfortunately, this indictment of our society still applies today. the social in social work must remain. our work with the poor, the oppressed, and the disadvantaged must be directed at multiple levels. the late harry specht, the former dean of the school of social welfare at the university of california at berkeley characterized social workers as unfaithful angels. his perception was that the social work profession has abandoned its traditional mission. have we abandoned our traditional mission? are we now more interested in working with middle class, walking wounded than in addressing the larger problems of the poor? are jane addams, whitney young, and mother jones historical artifacts now considered irrelevant? our late colleague reuben bitensky suggested that the social work profession has tended to vacillate in how it has related to american society. he said that at times the social work profession has been society's conscience. at other times, the social work profession has been society's apologist. i suggest that there has never been a greater need for the social work profession to be the conscience of society. now is the time to be heard: to reiterate our commitment to those who cannot care for themselves, to condemn an era of narcissism and ethnocentricity, and to re-establish the spirit of humanitarianism that has been an essential ingredient of american society. we must be heard. we must speak and be guided by the spirit that emanates from the depths of our hearts and the wisdom of our minds. we have guiding principles that speak garcia/reflections of a latino in the social work profession 89 to the dignity of the individual and advocacy for the downtrodden. with our voices in unison, we can be heard and we can work toward effective change. we can regain our place as the conscience of american society.  we must keep our priorities clear: we have a responsibility to those who cannot provide for themselves.  we have responsibilities to continue aggressive efforts toward the eradication of poverty, racism, sexism and homophobia.  we cannot allow our society to capitulate to narcissistic, self-serving interests.  we cannot allow what carl rowan calls "a spirit of meanness" to pervade this country.  we have to make certain that terms like compassion, commitment, social justice, and equality continue to be an integral part of our essential vocabulary and focus. only then can we reaffirm the meaning of our profession. references acuna, r. (1981). occupied america: a history of chicanos (2nd ed.). new york, ny: harper & row. garcia, a., & taylor-brown, s. (eds.). (1999). hiv affected and vulnerable youth: prevention issues and approaches. new york, ny: routledge. goffman, e. (1961). asylums. new york, ny: anchor books. hoffman, a. (1974). unwanted mexican americans in the great depression: repatriation pressures, 1929-39. tucson, az: university of arizona press. mcwilliams, c. (1933, march). getting rid of the mexicans. the american mercury. mexican american legal defense and educational fund (maldef). (2009). maldef presents closing argument in case defending rights of texas school children. retrieved from: http://www.maldef.org/news/releases/closing_arguments_tx_school_children/ national association of social workers. (2014). affirmative practice. retrieved from http://www.naswpress.org/publications/diversity/inside/affirmative-chap.html rangel, s. c., & alcala, c. m. (1972). project report: de jure segregation of chicanos in texas schools. harvard civil rights – civil liberties law review, 7(2), 307-391. ross v. eckels, 317 f. supp. at 513-514 (s.d. tex. 1970) 182 id. at 514.183. sotomayor, m., & garcia, a. (eds.). (1993). elderly latinos: issues and solutions for the 21st century. washington, dc: national hispanic council on aging. sotomayor, m., & garcia, a. (eds.). (1999). la familia: traditions and realities. washington, dc: national hispanic council on aging. advances in social work, spring 2014, 15(1) 90 author note address correspondence to: alejandro garcia, ph.d., aging studies institute, lyman hall 314, syracuse university, syracuse, ny 13244. email: agarcia@syr.edu alejandro garcia is currently professor, school of social work and the immediate past director of the school, as well as faculty associate of the aging studies institute at syracuse university. he is an nasw social work pioneer, a past chair of the national hispanic council on aging, a fellow of the gerontological society of america, and an elected member of the national academy of social insurance. he is also the past chair of the aarp national policy council and a member of the executive council of aarp new york. he serves as vice-president/secretary of cswe and on the editorial board of the journal of sociology and social welfare. the author of publications on aging and diversity, he is also the co-editor of elderly latinos: issues and solutions for the 21st century (1993), hiv affected and vulnerable youth (1999), and la familia: traditions and realities (1999). dr. garcia received his ph.d. in social welfare policy from brandeis university. microsoft word ausbrooks copyedit2 _________________  angela r. ausbrooks, ph.d., is an assistant professor and sally hill jones, ph.d., and mary s. tijerina, ph.d., are associate professors, all in the school of social work at texas state university-san marcos. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 255-275   now you see it, now you don’t: faculty and student perceptions of classroom incivility in a social work program angela r. ausbrooks sally hill jones mary s. tijerina abstract: classroom incivility is identified as a concern in the higher education literature; however, the extent to which these concerns apply to social work education has not been empirically addressed. this initial, exploratory study examined the perceptions of classroom behaviors in a small convenience sample of faculty and students in one social work program. quantitative results indicated that faculty tended to perceive incivility as generally less serious and frequent than did student participants. qualitative findings suggested that while faculty believed they were addressing incivility, students did not. students expressed the desires for instructors to be more aware of behaviors, especially distracting use of electronic devices, and to take stronger actions to enforce guidelines. social work programs may need to consider developing uniform policies for addressing incivility as well as helping faculty to find more effective ways to address the problem. future research is needed with larger, more representative samples. keywords: incivility, classroom management, social work, higher education, social work ethics introduction once dismissed as a problem of elementary and secondary education, classroom incivility has been the subject of increasing concern in higher education over the past several years. uncivil behaviors are those generally viewed as disrespectful and disruptive; they may include carrying on conversations with others during class, talking on cell phones, texting, surfing the internet, sleeping, arriving late, leaving early, and challenging the instructor about grades (nordstrom, bartels, & bucy, 2009). asking students to assume a larger role in the learning process leads to classroom incivility in that students may become resistant if not openly hostile (boice, 1996). although accounts of discourteous, disrespectful, and disruptive student behaviors are growing among faculty, relatively little research has focused on classroom incivilities in higher education. according to boice, this lack of attention on incivility in higher education may stem from instructors’ embarrassment over acknowledging their inability to control classroom behavior. additionally, structural factors may include lack of training for instructors on dealing with the problem and administrators' reluctance to publicly discuss such problems for fear of tarnishing the institution’s image (boice, 1996). in social work education, the literature is essentially silent with regard to issues of classroom incivility. social work education programs and curricula are rooted in the profession’s core values, among which are dignity and worth of the person, integrity, and importance of human advances in social work, fall 2011, 12(2) 256  relationships (nasw, 2008). acknowledging problems of classroom incivility in social work education poses the risk of considering how well social work educators are socializing students to the profession as well as raising questions about the appropriateness of students relative to professional identity and fit. literature review a number of factors have been identified as contributing to uncivil classroom behavior in higher education. some authors believe classroom incivility is related to an overall decline in civil behavior in american society (bjorklund & rehling, 2010; connelly, 2009; bray & del favero, 2004). one obvious contributing factor is an individual’s attitude regarding the appropriateness of uncivil classroom behavior. hersch (1998) pointed out that current college students are more socially isolated than students from twenty years ago. raised by parents who work longer hours and live very hectic lives, today’s students are often forced to develop their world views and behavioral expectations in conjunction with their peers rather than adults. as a result of those generational differences, it should not be surprising that students and instructors often have markedly different views regarding what constitutes appropriate behavior. the widespread use of electronic mail, texting, and tweeting may serve to further compound the sense of social isolation. the impersonality associated with the use of contemporary communication tools may provide students with few cues about how to effectively navigate in the “real” social world (hernandez & fister, 2001). consequently, some students may see nothing wrong in behavior that others perceive as uncivil. another contributing factor to uncivil classroom behavior is a consumer orientation to the educational process. students who hold a consumer orientation toward their education tend to feel that the main purpose for college is economic, a means to increase their earning potential (delucchi & korgen, 2002). indeed, students’ motivations for attending college have shifted significantly in recent years. according to the 2006 higher education research institute’s report, 69% of students surveyed indicated that they attended college to earn more money (as opposed to acquiring knowledge)—a marked increase from 21% in 1976 (higher education research institute, 2006). consistent with this notion, baker, comer, and martinak (2008) note that automatic and inherent respect for college professors, which was once based on the perception of them as experts in their respective fields, has been replaced by students’ perceptions of their professors as merely employees of the university to which the students pay money. hence, the perception among some students has become “i’m paying your salary, and i expect an a” (baker et al., p. 66). according to delucchi and smith (1997), an emphasis on obtaining good grades in order to make more money has led to “grade grubbing” where students dispute deservedly low grades. some students thus perceive themselves as consumers or customers rather than learners. embracing the concept that “the customer is always right,” consumer-oriented students may feel that they are entitled to act in whatever manner they choose (including incivility) since they have paid for the privilege. this relationship was confirmed by nordstrom et al. (2009) who found that students with a consumer orientation toward the educational process also reported engaging in uncivil classroom behaviors. among their findings, males were more likely to hold a consumer ausbrooks, jones, tijerina/perceptions of classroom incivility 257      orientation compared to females. additionally, students who were less involved with their classes and colleagues (e.g., part-time students, those working many hours off campus and spending less time on their classes) were also more likely to hold consumerism beliefs as well as engage in uncivil classroom behaviors. a concept closely related to consumerism is student entitlement. instructors often complain that students resent instructors who are challenging and demand a lot of work, and instead prefer those who are entertaining (edmundson, 1997), approachable, and flexible (trout, 1998). entitlement behaviors may include students expecting good grades, even when the work they submit does not meet standards; expecting instructors to be available to them at all times and prepared to make accommodations for them; and blaming their instructors if they do not succeed in their academic work (bartlett, 2004). students with an entitlement disposition often believe that knowledge should be acquired with a minimum of effort on their part (boice, 1996) and that they should be rewarded with high grades for simply attending class (gose, 1997). entitled students therefore take on a passive learner role, expecting faculty to bear more responsibility for student learning. student entitlement has been attributed to the structure of the u.s. education system which is seen as offering many students little academic challenge prior to entrance to higher education, resulting in unrealistic expectations of work at the university level (bettinger & long, 2005; greene & forster, 2003). nordstrom et al. (2009) suggest that another possible predictor of classroom incivility is narcissism, defined by akhtar and thompson (1982) as “a concentration of psychological interest in the self” (p. 12). self-preoccupation of narcissistic individuals is manifested in a lack of empathy for others. further, according to the dsm-iv-tr criteria, narcissists often have a sense of entitlement, holding unrealistic expectations for favorable treatment or automatic compliance with their expectations. “they expect to be catered to and are puzzled or furious when this does not happen” (apa, 2000, p. 659). nordstrom et al. did in fact find that students with narcissistic tendencies were likely to report engaging in uncivil behavior in the classroom. differing perceptions between students and faculty regarding what constitutes problem behaviors have been primarily attributed to generational differences between the two groups (baker et al., 2008; connelly, 2009). while most faculty are members of the baby boomer and generation x generations, the majority of today’s students are members of the millennial generation. in contrast to the characteristically strong work ethic of the baby boomers, a characteristic of millennials is the expectation of rewards for any performance, regardless of quality (baker et al., 2008). parents of millennials who have praised and rewarded their children for mediocre and substandard performance have created the expectation that others will do the same (twenge, 2006; zaslow, 2007). in addition to generational differences, gender and ethnicity differences may also result in problematic student behaviors in the classroom. alexander-snow (2004) reported that the degree of classroom incivility may be determined by the professor's gender and ethnicity. problem behaviors may include caucasian students “folding arms across the chest, slumped posture in the chair prior to…initial introduction of their teacher” when that teacher is a person of color (p. 26). students may also begin advances in social work, fall 2011, 12(2) 258  questioning the instructor’s authority and developing expectations of the instructor’s behavior based on pre-determined values and belief systems regarding how people of the identified ethnicity are supposed to conduct themselves. alexander-snow adds that “the extent of the students’ undermining behavior will lessen or intensify depending on whether the teacher’s behaviors are in accordance with students’ own cultural expectations” (p. 27). it is not only students who can create problems with classroom incivilities, however. several authors report that faculty too can contribute to the problem (alberts, hazen, & theobald, 2010; alexander-snow, 2004; bayer, 2004). according to braxton and bayer (1999), faculty behaviors such as “condescending negativism, inattentive planning, moral turpitude, particularistic grading, personal disregard, uncommunicated course details, and uncooperative cynicism” (p. 21) can provoke student incivilities. bayer (2004) believes that “the dynamic of classroom incivility is perhaps frequently a synergistic one involving inappropriate behavior on the part of students often combined with, or prompted by, misfeasance or malfeasance of the college teacher…” (p. 78). bayer also found that faculty who mistreat students experience higher incidences of disrespectful student behavior. regardless of the initiator, classroom incivility is harmful to the classroom climate and prohibitive to quality instruction and learning. how faculty respond to instances of classroom incivility is also important. schneider (1998) argues that students rarely get punished for committing incivilities, providing little disincentive for antisocial behavior. tenure expectations may discourage or restrict faculty members from confronting incivilities. hogan (2007) suggests that instructors’ attempts to avoid negative evaluations by students lead to failure to confront uncivil behavior and ultimately to a weakening of discipline. alternately, faculty simply may not know how to handle problematic situations (sorcinelli, 1994), or they may feel uncertain that they will be supported by higher authorities if they punish misbehaviors, particularly as universities compete for students and seek to avoid lawsuits. generally, students expect professors to step in and control disruptive behaviors and have little respect for instructors who do not (kuhlenschmidt, 1999; young, 2003). thus, investigating classroom incivilities and ways to respond to them is important. purpose and aims the present exploratory study seeks to address some of the gaps identified in the literature regarding classroom incivility, particularly in the context of social work education. specifically, we examine perceptions of faculty and students concerning the type, frequency, and severity of classroom behaviors that may be perceived as uncivil. our aims are to identify differences, if any, in perceptions between faculty and students, examine gender and ethnicity based patterns, and identify and/or develop strategies for addressing the problem of classroom incivility. a beginning exploration of such patterns may guide efforts towards further research aimed at understanding the nature of classroom incivility, assisting faculty in dealing with classroom problems, and identifying ways to help students understand behavioral expectations and their roles in preparing to enter this value-driven profession. ausbrooks, jones, tijerina/perceptions of classroom incivility 259      context of the study the study was conducted in a school of social work located in a large southwestern state. the program is fully accredited by the council on social work education and offers both the bachelor and the master of social work degrees. although the school offers online msw classes, only the on-campus student population was included in the study. in the academic year during which the study was conducted, the on-campus undergraduate and graduate enrollment totaled 213 students. the faculty included 27 individuals, including 10 tenured faculty, seven tenure-track faculty, three clinical faculty, and seven adjunct faculty. faculty in the program traditionally teach across both undergraduate and graduate levels. however, for purposes of the study, faculty responded from the perspective of the courses they typically teach. method sampling procedure a convenience sample was obtained from all faculty and on-campus students in the department of social work. fliers were posted on faculty and student bulletin boards announcing the study, and emails were sent to all faculty and students inviting participation. surveys with return envelopes were placed in all faculty and student mailboxes. students were instructed to deposit completed surveys in a locked, slotted box labeled “student civility survey” which was placed in the main office on top of the student mail folder file cabinet. faculty returned surveys to the authors’ mailboxes in the department office. faculty sample. fifteen faculty members returned completed surveys for a 56% faculty response rate. the faculty sample included 10 females (66.7%) and five males (33.3%). participants were asked to indicate their ages by selecting one of several age categories. the median age was 41.4 years, with 80 % falling in the 41 to 60 year range. ten respondents reported their race/ethnicity as caucasian (66.7%), two as african american (13.3%), two as hispanic (13.3%), and one as asian (6.7%). seven participants were tenured (46.6%), while four were tenure-track (26.7%), and five were clinical or adjunct faculty (27.7%). participants were asked to report their years of teaching experience, with categories ranging from zero to three years to 20 or more years. the median number of years of teaching experience was 9.3, with 33.3% reporting eight to eleven years of teaching experience and another peak of 26.7% reporting 20 or more years of teaching experience. the demographics of the faculty sample composition were representative of the faculty as a whole. faculty members were also asked how much training they had received in classroom management. almost half reported having received no training (46.7%, n = 7), and another quarter (26.7%, n = 4) stated they had received between one and three hours of training. the remainder (26.6%, n = 4) reported having received from seven to more than 10 hours of training. all faculty members reported that they taught required courses, while 26.7% also taught elective courses. approximately three-quarters (73.3%) reported teaching both undergraduate and graduate courses, while 20% reported teaching only graduate and 6.7% only undergraduate. advances in social work, fall 2011, 12(2) 260  student sample. of 213 student surveys distributed, only 28 were returned for a response rate of 13%. because of the low response rate, and in order to assess comparability to the student population, comparisons were made to the population of social work students enrolled in the same semester. the sample differed in demographic characteristics from the social work student population enrolled at that time. considerably more males, older students, and students of color chose to participate in the study than were enrolled. although a sample this nonrepresentative of the larger population may be considered biased, for purposes of this exploratory study, the authors believe there is value in examining perceptions of this group of nontraditional and ethnic minority students who evidently felt strongly enough about the civility issues to participate. table 1: student sample comparison to larger student population demographic characteristic study sample % (n = 28) on campus social work students % (n = 213 ) gender female 78.6 90.1 male 21.4 9.9 age 20 – 30 years 28.6 69.0 31 – 40 years 32.1 19.2 41 – 50 years 39.3 11.8 race/ethnicity black/african american 17.8 9.4 hispanic/latino/a 25.0 28.1 american indian/alaska native 3.6 0.9 asian/pacific islander 3.6 0.9 caucasian 50.0 59.7 academic status undergraduate 32.1 43.7 graduate 67.9 56.3 full-time/part-time (msw) full-time 67.9 51.7 part-time 32.1 48.3 measures with approval from the university institutional review board and the author of the instrument, a self-report survey, classroom civility and teaching practices survey ausbrooks, jones, tijerina/perceptions of classroom incivility 261      (black, wygonik, & frey, in press) was adapted for use in the present study. revisions to the original survey consisted of removal of one item (wearing hats) and addition of one item (joking inappropriately). in both quantitative and qualitative formats, the survey asks participants about the seriousness and frequency of disruptive behaviors, the most frequent and troublesome behaviors, and preferred strategies for addressing these behaviors. for quantitative measures, the survey provides a list of 25 student behaviors and asks participants to rate the behaviors for seriousness and then for frequency using a likert scale of one to four, with four representing the most serious and most frequent. from the list of 25 disruptive behaviors and a separate list of 23 strategies for promoting civility, participants were asked to identify the three most troublesome behaviors and the three most effective strategies for dealing with the three behaviors identified. the survey also included demographic items, items regarding the types of courses taught and number of years teaching experience for faculty, questions about the perceived seriousness and perceived frequency of classroom incivility in general (not specified by type), and perceived effect of class size and gender of students on frequency of classroom incivility. faculty were asked whether graduate or undergraduate students exhibited more incivility, and students were asked whether more incivility occurred in required or elective courses. cronbach’s alpha on the survey items addressing seriousness and frequency of behavior ratings was .88. because this is an initial exploratory study with a small sample, data analysis was focused on response frequencies, some statistical comparison of faculty and student responses, and qualitative analysis. quantitative results general behavior seriousness, frequency, and characteristics participants were asked to rate the seriousness and frequency of disruptive or uncivil behaviors in their classes in general (non-specific as to type of behavior). as seen in table 2, faculty appeared to view the problem of incivility as less serious and less frequent than did student respondents. each rating category was assigned a code of one to five, with one being least serious and frequent and five being most serious and frequent. significant differences were found between faculty and student mean responses as determined by independent samples t-tests. the faculty mean rating of seriousness (1.9, sd = 0.9, n = 15) was significantly lower than the student mean rating (2.8, sd = 1.2, n = 28; t (41) = -2.4, p = .02). similarly, the faculty mean rating of behavior frequency (2.7, sd = 1.3, n = 15) was significantly lower than the student mean (3.8, sd = 1.4, n = 27; t (40) = -2.6, p = .01). several survey items asked about characteristics of students more likely to behave disruptively and situations in which these behaviors would more likely occur. more faculty (46.7%) than students (25%) reported that gender made no difference, while more students (64.3%) than faculty (40%) reported females were more likely to disrupt class. faculty were asked to compare the frequency of uncivil behaviors among graduate and undergraduate students. almost half (46.7%) reported that undergraduate students behaved disruptively more than did graduate students, while 40% said there was no advances in social work, fall 2011, 12(2) 262  difference, and 13.3% did not respond. students (46.4%) reported that incivility occurred more frequently in large classes, while the same proportion, 46.4%, said there was no difference. half (50%) of the students said there was no difference in frequency of incivility between required or elective courses, while 35.7% reported that these behaviors occurred more frequently in required courses. table 2: general behavior seriousness and frequency comparisons behavior measure faculty % (n = 15) students % (n = 28) seriousness not at all 33.3 14.3 slightly 46.7 28.6 moderately 13.3 32.1 very 6.7 14.3 extremely 0.0 10.7 frequency does not occur 20.0 10.7 once per semester 26.7 7.1 several times per semester 33.3 14.3 one to two times a month 6.7 21.4 once a week or more 13.3 42.9 missing 0.0 3.6 behavior seriousness and frequency: comparisons of faculty and students participants were provided with a list of 25 disruptive behaviors and asked to rate their seriousness, if they were to occur in their classrooms, on a scale of one to four, where a rating of four indicated “very serious” and a rating of one was “not serious” (table 3). although faculty rated the seriousness of disruptive behaviors actually occurring in their classes in general as significantly less serious than did students, when it came to rating the seriousness of specific behaviors, should they occur, the two groups’ ratings were comparable, with some exceptions. faculty mean ratings of the seriousness for 19 of the 25 behavior items were the same as or slightly higher than student ratings. however, faculty rated text-messaging, allowing the cell phone to ring, and dressing inappropriately as slightly less serious than did students. larger differences between faculty and student ratings were found in higher faculty mean ratings of the seriousness of reading the newspaper, sleeping, using vulgarity, making threats to faculty or students, verbally attacking, and physically attacking other students. faculty mean ratings for 16 of the 25 behaviors were rated three or higher, indicating they perceived these behaviors as more serious, compared to 11 behaviors rated that seriously by students. ausbrooks, jones, tijerina/perceptions of classroom incivility 263      table 3. behavior seriousness and frequency: comparison of faculty and student mean ratings behavior seriousness mean (sd) behavior frequency mean (sd) behavior faculty (n = 15) student (n = 28) faculty (n = 15) student (n = 26) verbal attacking other students 4.0 (0.0) 3.4 (1.1) 1.2 (0.4) 1.6 (0.9) physically attacking other students 4.0 (0.0) 3.3 (1.3) 1.0 (0.0) 1.0 (0.0) making threats to faculty/students 4.0 (0.0) 3.3 (1.3) 1.1 (0.3) 1.1 (0.4) computer use unrelated to class 3.5 (0.9) 3.3 (1.1) 2.2 (1.1) 2.8 (1.1) taking phone calls in class 3.6 (0.5) 3.2 (1.0) 1.7 (1.0) 2.0 (0.9) text-messaging 3.2 (0.8) 3.3 (0.8) 2.5 (0.9) 3.5 (0.7) allowing cell phone to ring 2.9 (0.9) 3.1 (0.9) 1.8 (0.9) 2.4 (1.0) groans/sighs 2.3 (0.8) 2.3 (1.0) 1.5 (1.0) 2.3 (0.8) sleeping 3.4 (1.0) 2.5 (1.3) 1.6 (1.0)a 1.3 (0.5) acting bored or apathetic 2.9 (0.8) 2.7 (1.0)c 1.9 (1.2)a 2.6 (0.9) reading the newspaper 3.3 (1.0) 2.1 (1.0) 1.2 (0.4) 1.2 (0.4) using vulgarity 3.5 (0.9) 2.8 (1.3) 1.2 (0.6)a 1.5 (0.6) challenging teacher’s credibility/ knowledge 3.0 (0.8) 2.7 (1.1) 1.3 (0.6) 2.0 (1.0) sending inappropriate emails to faculty 3.5 (0.7) 3.1 (1.3) 1.3 (0.5) 1.0 (0.0) making sarcastic remarks 3.3 (0.7) 3.1 (1.0) 1.7 (1.0) 2.2 (1.0) making offensive remarks 3.8 (0.4) 3.3 (1.3) 1.3 (0.6) 1.5 (0.8) joking inappropriately 3.0 (0.7)a 2.8 (1.2) 1.3 (0.6) 1.5 (0.8)b talking to other students at inappropriate times 3.1 (0.4) 3.1 (0.9) 2.7 (1.0) 3.0 (1.0) talking out of turn or interrupting others 2.9 (0.6) 2.9 (0.8) 2.3 (1.0) 2.6 (1.0)b arriving late or leaving early 3.0 (0.7) 2.9 (1.0) 2.5 (1.1) 2.9 (0.9) unpacking or packing backpacks 1.9 (0.7) 1.5 (0.7) 2.0 (1.0) 2.2 (1.1) eating 1.5 (0.8) 1.3 (0.5) 2.8 (1.1)a 3.6 (0.8) wearing distracting clothing 2.2 (0.9) 2.0 (1.1) 1.6 (0.9) 1.4 (0.8) dressing inappropriately 2.1 (0.9) 2.3 (1.3) 1.3 (0.8) 1.3 (0.7) poor hygiene or offensive odor 2.5 (0.7) 2.4 (1.2) 1.1 (0.3) 1.3 (0.6) an = 14; b n = 25; c n = 27 advances in social work, fall 2011, 12(2) 264  participants also rated the frequency of the 25 behavior items they observed or experienced most often, on a scale of one to four, where a rating of one represented “infrequent (one time or less per semester)” and four represented “quite frequent (one or more times per week)” (table 3). while the faculty mean rating of incivility frequency in their classes in general was significantly lower than that of students, when it came to rating the frequency of specific behaviors they have observed, the mean ratings of the two groups were comparable, again with some exceptions. faculty mean ratings of 20 of the 25 behaviors were the same as or only slightly lower than students’ ratings. however, faculty rated sleeping, sending inappropriate emails, and wearing distracting clothing as slightly more frequent than did students. the largest differences between faculty and student ratings of frequency were the higher student mean ratings of text-messaging, groans/sighs, eating, acting bored or apathetic, and challenging the teacher’s credibility or knowledge. while student mean ratings of 11 of the behaviors were higher than two, the mid-range rating, six behaviors were rated that frequently by faculty. most troublesome behaviors and instructor strategies participants were asked to identify from the provided list of 25 behavior items those that were both most troublesome and occurred most frequently in their classrooms. they were also provided a list of strategies instructors could use to address disruptive behaviors and asked to choose three strategies that would be most effective for each troublesome and frequent behavior selected. frequencies were computed and compared for faculty and students. there were considerable commonalities in the responses of both groups, as seen in table 4. three behaviors reported by faculty and students as among those most troublesome were talking to other students at inappropriate times, texting, and computer use for tasks unrelated to class. among the most frequently listed troublesome behaviors identified by faculty but not students were arriving late or leaving early and talking out of turn or interrupting others. among the strategies most commonly selected as those most effective for instructors to use in addressing troublesome behaviors, the top choice for both groups was speaking privately with the offending student. both also listed speaking publicly to the offender and addressing the entire class. faculty included stating expectations clearly, while students listed sending an email to the offender. in summary, quantitative results indicated a general trend of faculty viewing disruptive behaviors as less serious and frequent than did students. within this trend, there were many points of agreement on ratings of specific behaviors, which were the most troublesome behaviors, and preferred strategies to address behaviors. however, there were also potentially important differences. faculty and students appeared to agree that several behaviors warranted little attention. these included behaviors viewed as serious but rare (aggressive behaviors, sleeping or reading the newspaper in class, vulgar or offensive remarks), frequent but not serious (eating in class), and both infrequent and not serious (dress or hygiene issues). ausbrooks, jones, tijerina/perceptions of classroom incivility 265      table 4. most troublesome behaviors and preferred strategies: faculty/ student comparison most troublesome behaviors ranking faculty students 1 arriving late/leaving early (n = 8) texting (n = 16) talking to other students at inappropriate times (n = 8) 2 texting (n = 5) computer use unrelated to class (n = 11) 3 talking out of turn or interrupting others (n = 4) computer use unrelated to class (n = 4) talking to other students at inappropriate times (n = 9) strategies to address behaviors ranking faculty students 1 speak privately with student (n = 23) speak privately with student (n = 50) 2 state expectations clearly (n = 17) address entire class (n = 31) 3 speak publicly to offender (n = 15) send email to offender (n = 12) 4 address entire class (n = 12) speak publicly to offender (n = 11) faculty and students seemed to agree that other behaviors were both fairly serious and frequent, indicating they need effective intervention. distracting behaviors such as talking to students at inappropriate times, talking out of turn, and arriving late or leaving early were rated as mid-range to high in seriousness and frequency by both groups. these behaviors were also among those listed as most troublesome behaviors that occur frequently. there were several behaviors, however, that faculty and students agreed were serious but students viewed as occurring more frequently than did faculty. these included behaviors indicating boredom such as acting apathetic or groaning, challenging the teacher’s credibility, and technology-related behaviors. computer use unrelated to class and text-messaging, while rated high in seriousness and listed in the most troublesome behaviors by both groups, were seen as occurring much more frequently by students than faculty. therefore, these differences in perceptions point to potential areas needing attention. qualitative results in addition to the forced-response, quantitative items, the survey included several open-ended questions. the qualitative questions elicited participants’ perceptions of the most serious and most common disruptive behaviors observed, instructors’ responses to these behaviors, strategies instructors can/should utilize to address disruptive behaviors, advances in social work, fall 2011, 12(2) 266  whether personal characteristics (age, gender, race/ethnicity) of the instructor affect behavior, whether observed behaviors affected teaching and learning, and reasons students engage in disruptive behaviors. participants were also given the opportunity to provide additional comments. a content analysis was conducted on participants' qualitative responses. faculty and student responses to each of the open-ended questions are reported below. each response was considered a unit of analysis, however, participants may have provided several responses to each question. therefore, response totals may exceed the number of participants who responded to qualitative questions. most serious behaviors when asked to describe the most serious cases of classroom incivility/disruption observed and/or experienced, four (27%) faculty identified “disrespect toward the teacher and the students,” two (13%) identified “texting,” and two considered an “angry outburst” and “emotional breakdown in class” as the most serious behavior. two faculty reported observing no incidents in field placement courses. of those faculty who observed/experienced classroom incivility, 10 (67%) reported most incidents of incivility occurring in undergraduate classes, two (13%) in graduate courses, and one faculty reported that incivility/disruption is an uncommon occurrence in field seminars. examples of faculty responses included the following: (a) "a student that felt persecuted by peers and faculty and was regularly vocal about these feelings of persecution;” (b) “angry argument/outburst to the extent that immediate intervention and follow-up counseling were required;” (c) “student giving herself manicure and pedicure during guest lecture.” based on responses to open-ended items, students reported observing serious incidents of classroom incivility as occurring more frequently than did faculty. behaviors students reported as among the most serious included “surfing the internet” (n = 6, 21%); “checking facebook” (n = 6, 21%); “disrespect of teachers and students” (n = 6, 21%); “talking on cell phones during class” (n = 4, 14%); “texting” (n = 3, 11%); and “talking during class” (n = 2, 7%). two individual students identified additional behaviors which were “students coming into class late,” and “noise,” specifically related to large classes. examples of student comments were: (a) students using their computers to check their facebook status or using their phones to [check] facebook;” (b) “someone talking on the phone during class;” (c) “in a fairly large policy class this semester, i’m sitting in the back and the last three or four rows are all frenzy of texting, internet surfing, passing notes, and gossiping. all while the instructor is lecturing.” most commonly observed/experienced disruptive behaviors the most common type of incivility/disruption observed by faculty was “side conversations” (n = 6, 40%). other behaviors reported as most commonly observed were “texting” (n = 3, 20%); “arriving late/leaving early” (n = 3, 20%); and “rude behavior toward peers” (n = 3, 20%). two (13%) faculty reported the most common behavior they have experienced was students openly challenging them in class. in addition, “eye rolling,” “surfing the internet,” “talking on cell phones,” and “apathy” were each identified by four different faculty members. sample faculty comments included: (a) ausbrooks, jones, tijerina/perceptions of classroom incivility 267      "the most common are students whispering to each other during class;” (b) “students being rude to others;” (c) “surfing net on laptop unrelated to course; taking phone calls and leaving class; coming late to class.” behaviors cited as most commonly observed by students included “texting” (n = 8, 29%); “talking during class” (n = 5, 18%); and “disrespect toward the instructor” (n = 3, 11%). several students cited behaviors related to use of the computer as the most common. these included “surfing the internet” (n = 3, 11%), and “checking facebook during class” (n = 3, 11%). several behaviors were reported as most common by six different students. they included: “arriving late/leaving early,” “disrespecting another student,” “not being prepared for class and asking questions,” “expressing bias during class discussions,” “talking on the cell phone during class,” and “electronics” in general. sample student comments included the following: (a) “texting is common, but not necessarily disruptive. there are a few people though who do it constantly and openly – that is when it’s disruptive;” (b) “one of those students (described elsewhere) made a very judgmental, hateful comment about people who shop at wal-mart...how the people who shop there cannot afford babysitters so they bring their ‘wild’ children and let them run around. it was incredibly out of line and shocking coming from an msw student.” six (40%) faculty reported not having experienced incivility/disruptive behavior in their classes. they attributed this to “providing clear expectations” (n = 4, 27%); “modeling desired/appropriate behavior for students” (n = 1, 7%); the fact “students are engaged and understand the rules” (n = 1, 7%), “the instructor places a greater focus on professionalism and expectations” (n = 1, 7%), and “the maturity level of students during their field practicum” (n = 1, 7%). however, one faculty member believed that if anyone had not experienced incivility/disruptive behavior in their classes, they were “not being honest.” measures taken by faculty to address disruptive behavior faculty and student perceptions differed regarding the measures instructors took to address disruptive behaviors previously identified. of the faculty responses regarding measures they take to address disruptive behaviors (n = 14, 93%), they reported that they “address observed behaviors with specific students” (n = 5, 33%); “with the entire class” (n = 4, 27%); “by reviewing pre-determined rules and expectations” (n = 3, 20%); “physically inserting themselves in close proximity to the students engaging in incivility/disruptive behaviors” (n = 2, 13%); “taking control of the class” (n = 1, .07%); “changing the syllabus and highlighting expectations” (n = 1, 7%); and “providing personal examples (of disruptive behavior)” (n = 1, 7%). examples of faculty comments follow: (a) “take control of discussion. speak with student privately;” (b) "changed syllabus to reflect expectations and consequences; verbal redirection in class;” (c) “move over to the areas of the room where they are located, and that usually results in their stopping their ‘visiting’ without causing further disruption by ‘scolding’ them in front of whole class.” comments by students regarding measures taken by faculty to address disruptive behaviors included reports that the majority of their instructors “did nothing” to address advances in social work, fall 2011, 12(2) 268  incivility/disruptive behaviors (n = 9, 32 %); and most instructors “ignored the behavior” (n = 4, 14%). of these 13 students reporting inaction on the part of faculty, three reported having only one instructor who addressed incivility/disruptive behaviors. additional faculty responses to disruptive behavior as reported by students included “instructors addressed the behaviors with the entire class” (n = 5, 14%); “the instructor regained the focus of the class” (n = 2, 7%); “instructor held down the noise while others spoke” (n = 1, 4%); “not sure the instructor was aware the behavior occurred” (n = 1, 4%); and “the teacher was involved in the incident” (n = 1, 4%). sample comments by students included: (a) "texting is ignored by all instructors with the exception of dr. x. she asks the student to please turn off the phone;” (b) “they didn’t do anything. dr. x has a bell she uses to get the classes’ attention. sometimes this works. i’d suggest a stun gun!” (c) “the professor was involved in the incident. the professor was trying to make/persuade the students about the topic. the students would not back down and eventually the professor suggested they speak after class.” suggested strategies for proactive measures by faculty asked to identify proactive measures that instructors can use to promote a positive environment, eight (53%) faculty members suggested “establishing rules,” “putting expectations on the syllabus,” and “setting high expectations at the beginning of the class” as the most effective strategies. four (27%) faculty believed “role modeling behavior” and “treating students with respect” are the best strategies. another three (20%) faculty members suggested “encouraging dialogue” and “beginning class with questions and concerns of students” as a method to promote a positive environment. other strategies identified by three individual different faculty included: “using humor,” “being assertive,” and “having students sign a contract.” students suggested several strategies instructors can utilize to promote a positive environment. twelve (43%) students suggested instructors should “take charge/be in control” which would include “stating and enforcing the rules,” "providing expectations for phone and computer usage,” and “applying penalties.” five (18%) students believed the instructor should talk to the student or class, and one (4%) suggested instructors should “address behavioral issues early.” additional suggestions included “unprepared students should ask questions during office hours” (n = 1, 4%); “instructors should treat students with respect and as adults” (n = 1, 4%); “instructors should teach the textbook material” (n = 1, 4%); and “instructors should walk around the room and rearrange tables” (n = 1, 4%). only one (4%) student believed “the instructor should ignore disruptive behaviors.” sample student comments included: (a) “reminding all students that they have a responsibility to fellow students and to their professor to act in accordance with school code of conduct or face further consequences. if that doesn’t work put them on suspension or kick them out. in a master’s program we are, or should all be, professionals;” (b) “walk around room, rearrange tables so they can view what is on computer. insist phones are put away. send person out of class and try again next week.” ausbrooks, jones, tijerina/perceptions of classroom incivility 269      age, gender and race/ethnicity patterns faculty were divided as to whether age, gender, race/ethnicity of the instructor affected the incidence of incivility/disruptive behaviors. of the faculty who responded to this open-ended item, four (27%) believed these factors could increase disruptive behaviors, especially if the faculty member was african american (n = 2, 13.5%), female and/or ethnic minority female (n = 2, 13.5%), and older (n = 1, 6.8%). four (27%) faculty indicated they weren’t sure whether these factors would affect the occurrence of incivility/disruptive behaviors. sample comments included the following: (a) "i think so, and it is also affected by the demographics of the disruptive student. the only time i have been questioned on my knowledge and credibility was by an older white male student. i don’t think that would have happened if i was white and male;” (b) “i have heard from faculty of color that there is more challenging of their credibility coming from students.” students (n = 12, 43%) also offered opinions about the impact of instructor characteristics on the incidence of classroom incivility. eight of these students believed personal characteristics of faculty did not contribute to the presence of disruptive behaviors. however, two students believed these factors did affect the presence of disruptive behaviors, specifically if the instructor was older, african american, and female. comments included: (a) "i believe age, gender, race/ethnicity play a part for everyone involved,” (b) “i have noticed a lack of respect toward an older female, african american professor by younger students." in addition, three (17%) students stated that instructor and student characteristics can be factors in uncivil behavior: (a) it’s the overachieving high strung females;” (b) “unfortunately, these students are ‘nontraditional’, meaning over 30-ish. i know these girls well, and they definitely have attitudes of superiority and feel as if they have ’earned their place here’”; (c) “i hate to think so. however, in dr. x’s class – she’s african american, older, and less inclined to confront. seems out-of-control in her class.” effect of incivility on teaching and learning in response to the open-ended question about whether incivility/disruption affected their teaching, six (40%) faculty reported that incivility made them more vigilant (n = 2), pay more attention to the atmosphere (n = 1), be more determined to keep the class focused (n = 2), and learn from their mistakes (n = 1). three (20%) faculty reported losing their focus and becoming distracted when they experience disruptive behavior, and two (13%) faculty indicated they become more defensive, angry, and offended. one (4%) faculty member stated his/her teaching is not affected by classroom incivility. examples of faculty comments included: (a) “yes – in the past and in the classroom. it has made me more vigilant, less impulsive and less excited about the classroom experience...;” (b) “i find myself coming more defensive when there is an atmosphere of hostility or disinterest from several students. i may respond with sarcasm and that, of course, leads to a further downward spiral in class morale. thank goodness this is not a frequent pattern;” (c) “yes – it’s distracting. i wonder about students’ interest. i wrestle with how to handle. i get angry and feel offended at times. so, it takes energy and focus away from course objectives.” advances in social work, fall 2011, 12(2) 270  nine students (32%) reported that the occurrence of disruptive behaviors caused them to lose or have difficulty maintaining their focus, and/or become distracted. five (18%) students reported these behaviors were disruptive, two (18%) considered them annoying, two (18%) identified them as a waste of time, and one student (4%) described the behaviors as stifling to his/her learning. one (4%) student reported getting angry when observing disruptive behaviors, and another (4%) admitted to engaging in uncivil behavior when disruption occurs. five (18%) students indicated they are not affected at all by classroom incivility. sample comments from students included: (a) “i’ve selected seats away from repeat offenders. one semester, i sat behind a student who social networked in facebook the whole three hours. her computer was constantly flashing new images that was disruptive to my concentration of the lecture;” (b) “it has made many hours this semester a waste of my time. it is frustrating to work hard to meet expected goals as given to us well in advance only to arrive to the packed-to-capacity classroom and hear the extension granted because one person found the schedule too challenging;” (c) “yes. i act bored and in turn, [i] text during class because i feel unchallenged.” reasons students engage in disruptive behaviors faculty and students offered a myriad of reasons students engage in incivility/disruptive behaviors. faculty responses included: student entitlement (n = 3, 20%); not being held accountable (n = 3, 20%); boredom (n = 2, 13%); students having their own agenda (n = 2, 13%); professors being uncomfortable with authority (n = 2, 13%); and professors wanting to be friends with students (n = 2, 13%). individual respondents (n = 1, 7%) identified each of the following reasons for students' disruptive behaviors: generational differences, students not being taught appropriate behavior, students not being provided clear expectations, students not being invested, student narcissism, power issues, students seeking attention, identity issues, students being comfortable with each other, and student conflict spilling over into the classroom. examples of faculty comments included: (a) “sense of entitlement. ‘i paid for this class. it’s my business how i act…;” (b) “the natural narcissism of youth, enhanced by overlydoting parents, and a general breakdown in civility and respect for authority (and authority figures);” (c) “sometimes generational differences – checking phone, e-mail, texting is like breathing or drinking water. lack of clear expectations or enforcement from instructor. material not engaging student interest.” students’ responses were similar, and they identified additional reasons. students’ perceptions of reasons their peers engage in disruptive behaviors included: lack of interest and boredom (n = 4, 14%); weren’t taught better (n = 2, 7%); unaware of their behavior (n = 2, 7%), and lack of respect and rude (n = 4, 14%). individual students (n = 1, 4%) stated each of the following reasons for disruptive behaviors: think they know more than the instructor and their peers; lack discipline, push limits and haven’t dealt with demons, generational differences, self-centeredness, technology trends, immaturity, too many people in a small space, no consequences, and no attention span. only one student described being unsure why students engage in disruptive behaviors. sample comments included: (a) “lack of respect and consideration, not being aware that it’s disruptive;” (b) “immaturity of students; general lack of respect for those in authority; ausbrooks, jones, tijerina/perceptions of classroom incivility 271      generational;” (c) “boredom/burned out – we hear a lot of the same subjects/issues/topics in every class...,” (d) “because they lack discipline and are not held accountable. they also avoid instructors that do hold them accountable.” in summary, the major finding from the qualitative data is the difference in perceptions between faculty and students regarding faculty's responses to incidents of incivility. faculty reported that they address the behaviors with individual students and/or with the entire class. however, students overwhelmingly report that faculty do not address disruptive behaviors. one possible explanation for this could be that faculty report addressing disruptive behaviors much more than they do because they don't want to be perceived as unable to manage their classrooms, as suggested by boice (1996). another possibility is that faculty are not observing all the behaviors students observe because they are in the front of the classroom engaged in pedagogical activities— lecturing, conducting powerpoint presentations, and writing information on the classroom board. therefore, computer and telephone screens are not visible, and uncivil behaviors are not evident. although it is possible that students are correct regarding their reports of faculty inaction, it should be noted that students have no way of knowing if faculty addressed behavioral problems with students privately. the qualitative and quantitative findings are similar in terms of the students identifying behaviors as occurring more frequently than did faculty and more of a focus on technology-related behaviors by students. disrespect was mentioned quite frequently by both faculty and students, including peer-to-peer disrespect, which may need more focus. an additional significant finding is the difference in faculty and student perceptions of how disruptive behaviors should be addressed. this supports the quantitative findings regarding student and faculty desires for behaviors to be addressed verbally with individual students. however, qualitative data appear to indicate that students want faculty to engage in much more direct and punitive methods to address and resolve disruptive behaviors exhibited by their peers. students want faculty to address these behaviors openly and remove perpetrators from the classroom. discussion limitations the ability to generalize the findings of this study to other populations is limited by the small and non-representative sample from one social work program. nevertheless, this study represents an initial attempt to empirically explore the issue of classroom civility. as such, the aim of the study was not to generate generalizable results but rather to obtain a beginning understanding of the issue of classroom incivility in social work education. the fact that the student sample was not representative of the student body of the social work department from which it was drawn, however, is informative. the demographics of the students who chose to respond suggest the possibility that some students feel strongly about incivility in the classroom, in particular older, male, africanamerican, and graduate students. this profile suggests generational and power differences in that older students and those from ethnic minority groups may be less likely to hold attitudes of entitlement than do traditional age, non-minority students. advances in social work, fall 2011, 12(2) 272  implications and recommendations the findings, although preliminary and based on a small sample, indicate that incivility may be an issue social work students and faculty observe and struggle with in ways similar to that described in the literature. faculty and students in this study identified reasons for these behaviors similar to those reported in the higher education literature. several findings warrant the attention of social work faculty in terms of classroom management and research. it is possible that at least some students observe disruptive behaviors that faculty do not and are bothered by them, desiring faculty to take stronger stands in managing behaviors, as found by others (hogan, 2007; kuhlenschmidt, 1999; schneider, 1998; young 2003). based on participants' responses, faculty could utilize these findings to gain insight into students' perceptions related to faculty’s classroom management or lack thereof. the findings also suggest that some students want to be aware of consequences implemented for disruptive behaviors. although it may not always be feasible to provide students with this information, it appears there is a need to ensure students understand that there are consequences for disruptive behavior and that these will be enforced. faculty and students agreed that this can be accomplished by clearly articulating in the syllabus the course expectations and associated consequences and reviewing these with students at the beginning of the course and several times throughout the semester. there are many variables possibly at play in disruptive behaviors, as the literature indicates. generational differences between instructors and students may mean a gap in definitions of civility. drawing from the seminal work of mannheim (1952, as cited in joshi, dencker, franz, & martocchio, 2010), joshi et al. define age-based generational identity as “membership in an age group that shares collective memories developed during the formative years of life” (p. 398). the underlying assumption is that the process of growing up during a particular era impacts an individual’s attitudes and that these attitudes are shared by all those born in the same time period. while the majority of social work faculty in the present study represent the baby boomer generation, characterized by its strong work ethic and work-centrality, students are more likely to represent the cohort known as genme, gen y, or millenials, i.e., those born after 1982 (twenge, 2010). literature on generational differences in the workplace suggests these more recent generations express a weaker work ethic, view work as less central to their lives, and seek more freedom and work-life balance than older workers (twenge, 2010). research specific to generational differences in personality traits relevant to the workplace consistently show increases in individualistic traits, with younger generations scoring higher on both positive individualist traits such as self-esteem and assertiveness and more negative individualistic traits such as narcissism (twenge, 2010). it is this negative level of individualism (narcissism, defined as an inflated sense of self) that can lead to the possibility of entitlement, or expecting something for nothing. differences in faculty members’ classroom management styles or comfort levels in dealing with conflict may suggest the need for policies that promote more uniform responses to incivility. additionally, methods of effective engagement of students in course material may be lacking. social work faculty may need more training in classroom management, finding effective ways to manage disruptive behaviors, setting clear ausbrooks, jones, tijerina/perceptions of classroom incivility 273      expectations and consequences, obtaining student buy-in to behavioral guidelines, and following through with enforcement. the ubiquitous use of electronic devices, not easily detected, has brought new challenges to classroom management that also need to be addressed. students who participated in this study reflected underrepresented demographics of the student population in age, gender, ethnicity, and degree program (msw). these students may have responded at a higher rate than those students who reflect more traditional/represented demographics because it was an opportunity for them to be heard. ethnic minority students may not always speak out in class because they don't perceive they have a "voice." participating in this study may have provided an opportunity to express their opinions anonymously without any threat or perception of risk. therefore, another area to pursue in a larger study is whether there are significant differences in behavioral expectations of students based on gender, ethnicity, and age. the effect of faculty gender, race/ethnicity, and age also needs further investigation, as some participants in this study noticed effects catalogued by alexander-snow (2004). future research using larger, representative samples and comparisons among various social work programs will assist in determining whether these preliminary findings reflect the perceptions of a broader student base or are specific to the initial respondents who reflect underrepresented demographics in the student population. larger samples will allow statistical analysis of relationships between demographic characteristics and perceptions of incivility. in addition, research that focuses more specifically on what incidents occur in social work classrooms, perhaps by surveying faculty and students about behaviors in individual courses immediately upon completion of those courses would determine more specifically what behaviors occur. while the findings of this small, exploratory study are similar to those reported in the higher education literature, the implications of these results for the profession of social work also speak to socializing social work students into the profession and its values and ethics. framing classroom incivility in terms of breaches of such core social work values as integrity, dignity and worth of persons, and the importance of human relationships may be an opportunity to instruct and shape behavior consistent with the principles and conduct of the profession in the classroom environment and beyond. references alberts, h. c., hazen, h. d., & theobald, r. b. 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(1999). promoting internal civility: understanding our beliefs about teaching and students. new directions for teaching & learning, 77, 13. national association of social workers. (2008). nasw code of ethics: guide to the everyday professional conduct of social workers. washington, dc: author. nordstrom, c. r., bartels, l. k., & bucy, j. (2009). predicting and curbing classroom incivility in higher education. college student journal, 43(1), 64-85. schneider, a. (1998). insubordination and intimidation signal the end of decorum in many classrooms. chronicle of higher education, 44(29), pp. a12-a14. sorcinelli, m. d. (1994). dealing with troublesome behaviors in the classroom. in k. w. prichard & r. m. sawyer (eds.), handbook of college teaching: theory and application (pp. 365-373). eastport, ct: greenwood press trout, p. (1998). point of view: incivility in the classroom breeds ‘education lite’. chronicle of higher education, july 24, p. a40. twenge, j. m. (2006). generation me: why today’s young americans are more confident, assertive, entitled-and more miserable than ever before. new york: free press. twenge, j. m. (2010). a review of the empirical evidence on generational differences in work attitudes. journal of business psychology, 25, 201-210. doi:10.1007/s10869010-9156-6 young, j. (2003). sssshhh. we’re taking notes here. chronicle of higher education, august 8, p. a29-30. zaslow, j. (2007, july). blame it on mr. rogers: why young adults feel so entitled. wall street journal (online). retrieved from http://online.wsj.com/article/sb118358476840657463.html  author note: address correspondence to: angela ausbrooks, school of social work, health professions building, 150a, texas state university-san marcos, san marcos, tx 786664616. email: aa16@txstate.edu microsoft word krill_existential sw_copyedit 3_bb ______________ donald f. krill, ph.d., is a professor emeritus of social work at the university of denver in denver, co. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 117-128 existential social work donald f. krill abstract: the existential impact upon social work began in the 1960’s with the emphasis upon freedom, responsibility and a sense of the absurd. it affirmed human potential while faulting the deterministic thinking that was popular with psychological theorists at that time. it was open to the prospects of spirituality, but was less than optimistic concerning great progress among social institutions. it was a forerunner to the strengths-based social work programs of our present day. keywords: existential social work, theories of social work practice, social treatment, clinical social work existential social work had its modest entry into social work in the 60s and 70s. sixteen articles were published by seven different social workers in the late 70s. three of these authors also published books on the same topic. in his book social treatment, james k. whittaker (1974) declared existential social work as one of the three major theories for social work practice. by 1975 francis turner included it as one of fourteen practice approaches in his book social work treatment (1974). even earlier, in the 50s, existential ideas had surfaced in the pennsylvania school of social work wherein the functional approach stemming from the work of otto rank. in his award-winning book, the denial of death, ernest becker (1973) contrasted freud with rank and linked the latter with existential thought. contrasting social work with the fields of psychiatry and psychology, it would seem that philosophical ideas tend to elude the interest of many social workers who appear more practice minded, politically motivated, or both. while social workers embraced social systems thinking early on, they seemed hesitant to expand the systems construct to its cosmological or quantum theory dimensions. perhaps social work’s socialistic leaning from the 30s and 40s raised a cautionary ambivalence to spirituality and philosophy. in psychiatry there were well known existential advocates such as viktor frankl, rollo may, ludwig binswanger, medard boss and thomas hora. two outstanding psychologist existentialists were william offinan and irvin yalom. the journal of existential psychiatry and the review of existential psychology and psychiatry both appeared in the mid-60s. nevertheless, social work did eventually adopt the major existential themes in the form of varied strength-based therapies. a social work article, “existential psychotherapy and the problem of anomie,” identified these five existential principles: aiding the process of disillusionment; finding meaning in suffering; freedom of choice; affirming the necessity of dialogue; and, the way of commitment (krill, 1969). in 1989, psychiatrist irvin yalom emphasized the existential themes of advances in social work, spring 2014, 15(1) 118 death, freedom, isolation, and meaninglessness in his book existential psychotherapy (yalom, 1989). the existential model was a part of the humanistic psychology movement, in contrast to the psychodynamic and behavioral schools. the emphasis in the psychodynamic school was upon diagnostics and theory. with the behaviorists, the emphasis was upon research and techniques. the humanistic group, sometimes called “the third force,” prized the therapeutic relationship above all, emphasizing transparency, authenticity and spontaneity. important shifts in social work identity occurred during the 60s and 70s. government sponsored mental health clinics were springing up throughout the country and there was a dearth of psychiatrists to provide services. they became administrators and consultants but therapy work was largely done by social workers, psychologists and counselors of varied backgrounds. prior to this time articles appeared in social work journals differentiating social casework from psychotherapy, the latter being done by psychiatrists and psychologists. but the expanding roles of social workers in mental health changed this. insurance companies also valued social workers as psychotherapists. in the late 70s psychiatric training programs moved away from teaching psychoanalytic psychotherapy and instead embraced the use of medication for the spectrum of emotional problems. this shift may well have been related to psychiatrists having competition with social workers and other counselors, who were entering the field of private practice and charging considerably less money. the new emphasis on the use of pharmaceuticals gave psychiatrists a significant advantage. most social work clinicians held on to the psychodynamic approach. mounting research studies were indicating t h a t no one theory or therapy model proved itself any more effective than any other one (krill, 1980). while a nod was given to the behaviorists by social work clinicians using cognitive-behavioral methods, the theoretical loyalties of many avoided the relationship vagaries of the humanist approach, preferring the diagnostic specifications of the traditional psychodynamic model. along with the increased demand for therapy, often promoted by local mental health associations, there occurred a knowledge explosion of new therapy methods and their related theories. turner’s (1974) aforementioned book was an indication of how this array of new ideas was being adopted by many social workers. jurjevich (1973) also described 28 american original therapy models among psychologists. in addition to the mental health movement of the 60s there were also social movements for addressing the oppressive conditions of the poor, blacks, chicanos, students, women and the handicapped. this became a time when social and family system therapies of social work became popular in schools of social work. these represented a major departure from the individual emphasis of the psychodynamic approach. soon social work theories of practice appeared that sought to incorporate the many new ideas of the knowledge explosion and social action movements. social krill/existential social work 119 work was coming into its own regarding theories of practice. it can be noted here that existentialism was born in europe during the depression years of the 30s and with the horrific destruction of the world war ii and the holocaust. in the united states it became popular among the beat generation in the 50s in their reaction to what they perceived as mounting conformity of the post war years. social critics and theologians were echoing similar concerns. now, with the changing times for social work in the 70s, existentialism made its appearance in the practice arena. existential linkages i came upon existentialism in college in 1951. later i had been taught and supervised from a psychodynamic model, about which i had doubts, but it was the only game in town. denver had the university of colorado medical center, which trained psychiatrists in the psychoanalytic tradition. books by rollo may (1958) and viktor frankl (1962) as well as existential journals provided me an alternative for study. yet it was family therapy that best enabled my departure from the psychodynamic school. in the mid-60s i adopted a family systems orientation following jay haley, salvador minuchin and virginia satir. i finally found integration with existential thinking through family therapist, carl whittaker. then, becoming a social work professor in 1967 enabled me to pursue study of new therapies appearing and making my own linkage with existential thinking. william glaser’s reality therapy and albert ellis’ rational emotive therapy both ignored the deterministic emphasis of the psychodynamic school. they both affirmed the idea of freedom of choice and the capacity of the individual will to make rational choices. fritz perls’ gestalt therapy, along with psychodrama, gendlin’s focusing model, and the encounter group movement all emphasized the healing power of hereand-now awareness and the expression thereof. here was the existential notion of problem solving in a present rather than past orientation. another allied existential-related belief was that the unconscious had a creative core that could be accessed through present awareness experiencing. this was the spiritual dimension found among religious existentialists and was quite compatible with jungian and transpersonal psychologies as well. carl rogers (1961), frank farrelly (farrelly & brandsma, 1974) and sydney jourard (1964) focused upon the healing function of honest, spontaneous, genuine communication between therapist and client. here also was the dialogical emphasis of the jewish existentialist, martin buber. theoretical dilemmas in teaching these exciting new approaches, and being able to link my own existential views with them, i still found students struggling with their ability to conceptualize a workable theory. this issue was minimized for me by ideas from two women therapists – lynn hoffman, a social worker and family therapist, and ann schaef, a psychologist. both were quite disillusioned by the use of psychological theories to explain human beings, and both posed post-modern thinking as an answer advances in social work, spring 2014, 15(1) 120 to this dilemma (hoffman, 2007; schaef, 1992). i was delighted to find them both alluding to the very conclusions i had come to over years of practice. modernist theories had sought to theoretically explain human problems and their treatment. for researchers and many professional helpers these ideas were found wanting. postmodern thinking opened us to the unknown, to the mysteries about human functioning and how to change it. the very vagaries of humanistic psychology people on the subject of healing via the relationship itself were closer to this shifted postmodern awareness. this idea of no theory would not likely sit well with academia, nor with students paying enormous tuitions in order to learn about human beings and how to help them. i did find an answer to this matter, however, and it lay in the use of that muchdiscredited notion of an eclectic use of therapy methods. if the relationship between client and therapist was the key ingredient for fostering change, then the challenge was simply this: how was the therapist to discover a relationship-heightening method with each client? clients varied in their intelligence, motivation, cultural views of the world and their problems. in order for a worker to be effective with the wide variety of clients coming to social workers for help, one needed a good armamentarium of therapeutic methods. techniques stemmed from various theories of helping, so in order to learn a variety of methods it would be useful to study the theories from which they came. the eclectic approach was not for the big-hearted helper but rather for one well educated in the varied theories and their methods. one need not be wedded to any particular theory in order to utilize its methods. quest for self-understanding then there are the existential ideas of the absurd, disillusionment, suffering as meaningful, and the importance of personal commitment. during the 50s and 60s many social workers, including myself, believed that a personal psychoanalysis was important for their professional development. this emphasis on self-discovery seemed to subside by the late 60s and 70s, perhaps because of the rising awareness of social liberation of one sort or another. by the 80s and 90s there were signs of a renewed interest in self-examination – that of spirituality and even religion for many. even joint degree programs that combined theology and social work were occurring. this was a major departure from the decided split between social work and religion from the 30s to the late 70s. some students would complain that if the subject of religion was brought up in class there was inevitable scoffing and critical responses, even from faculty. in recent years, by way of contrast, meditation is taught in some social work schools not even affiliated with religious institutions. my own understanding of practice wisdom is that in addition to knowledge that seeks to explain human beings there are two other important dimensions that professionals need to learn, both of which are valid ways to understand people. first is that of spirituality-religion-philosophy, all of which attempt to see why we are krill/existential social work 121 here and what is the point of it all. second is heightened awareness of oneself, the self-encounter with one's own hopes and failures, fears and potentials, self-deceptions and new insights. this would be the most direct way of experiencing what it is to be human. practice wisdom then is the integration of theory (or the lack thereof) with one's spiritual-philosophical view as well as with one's ongoing pursuit of selfawareness. when any of these three areas change significantly, a new level of integration will be called for. such is the notion of professional development and maturity (krill, 1990). existential perspective what is special about existentialism, and how does it differ from other humanistic psychologies? freedom, the absurd and responsibility are its major themes. professor robert c. solomon of the university of texas states that existentialism is a movement, a sensibility and not a set of doctrines. contrary to some who imagine its ideas to be pessimistic, he finds the philosophy to be invigorating and positive. it presents a refreshing view of empowerment (solomon, 2000). existentialism, solomon points out, emphasizes the individual and a life filled with passion, self-understanding and commitment. let’s see what some famed existentialists have to say and how they differ. jean-paul sartre coined the term “existentialism” and defined it simply as “existence precedes essence.” this simple phrase is the basis for personal freedom. we are not a determined nature or personality. consciousness is our observing self, requiring something of which to be conscious. consciousness is nothing in itself and exists by giving meaning to situations encountered. the good news to this view is that we are quite free to create our own meanings, limited only by the boundaries of any situation. we create our own destiny from arising possibilities. the discomforting aspect of this position is that we alone are responsible for our lives. we have no excuses. as sartre says, we are free whether we like it or not. to realize this generates a troubling anguish, and this painful realization, is what sartre terms “bad faith.” this bad faith imagines oneself to be set in place, usually with deterministic or divine explanations denying awareness of one's freedom. one will use roles – social, work, familial, etc. – to proclaim its solidity. bad faith is based “in memory” (solomon, 1972). existential psychologist, rollo may, relates existential guilt and anxiety to this very view of authentic awareness of freedom versus its denial in bad faith. existential guilt occurs when one denies one's actual potentials for growth and expansion. existential anxiety occurs at those moments when one is aware of one's possibilities for choice, yet senses the risk to one’s established security (may, 1958). sartre agreed with nietzsche’s conclusion that god is dead, meaning that god no longer seems relevant to modern, self-sufficient man. nevertheless sartre valued the writings of kierkegaard, a christian, and considered him the father of existentialism. kierkegaard viewed reason as useful for pragmatic matters of living; however, he declared rational conceptualization of little value in relation to ultimate truths, i.e., advances in social work, spring 2014, 15(1) 122 personal meaning, destiny, love, god. these activities present paradoxes, which elude reason. such experiences had to be engaged by freedom of choice, and this freedom was to be had in one's subjective experience – not by objective reasoning. without a reliable authority on such matters to direct one’s choices one experienced fear, trembling and dread, similar to sartre’s anguish. a passionate commitment was called for and this was grounded in a depth and richness of feeling, a “leap of faith.” for kierkegaard bad faith often took the form of lives devoted to pleasure or to duty. he contrasted these with the religious life. while sartre calls for lucidity and authenticity for responsible living, kierkegaard speaks of infinite resignation before god, a humility that looks to the mercy of god again and again (solomon, 1972). neither sartre nor kierkegaard provides a satisfying description of interpersonal relationships. sartre’s play, no exit, concludes, “hell is other people” (sartre, 1955). kierkegaard himself was a social isolate, lonely and unhappy much of his life. in contrast, martin buber and gabriel marcel, jewish and catholic existentialists respectively, both emphasize the importance of interpersonal connections. spiritual awareness is especially valued between people, with the world of nature, and with god. this view is compatible with science’s quantum theory, which describes the universe as a composite of energy forms, a web of vibrating exchanges with endless possibilities (taylor, 2000). while there is still the individual's freedom and mysterious unknowns in this perspective, it resembles the universal connections of the mystics in contrast to the apparent lonely anguish of sartre and kierkegaard. in fairness to them both, however, it should be noted that they did have valued social relationships: sartre in the paris underground during the war, and kierkegaard with his lutheran church community. the religious existentialist who perhaps embraced freedom the most extensively was nicolas berdaev (vallon 1960). he was russian orthodox by tradition, and drew from the mystical writings of jacob boehme. like sartre, berdaev believed that freedom is nothingness, but he added that freedom is a nothingness seeking to become something. we humans experience this process as the fire of creative passion. what sartre described as bad faith berdaev said was the objectification of freedom. the cooling of freedom’s passion into objectified forms was characterized by reason. one’s thinking activity was therefore suspect. too often this objectified process took the forms of dominance of authority, slavery of conformity, and dullness of routines. freedom, for berdaev, is a transcendent spirit, divine in origin. it becomes a repeated upsurge aimed at destroying objectification in its many forms. this may be expressed in love, sympathy, ecstasy, beauty, the need to know, valuing justice, attendance to nature, beauty and wonder. god, he believed, is present in disruptive and creative acts. he described this passion as messianic will with transformative power in the world (vallon, 1960). historically speaking, prior to the enlightenment of the 18th and 19th centuries, in the western world there was the judeo-christian god as an aid and direction for a troubled world, struggling with matters of good and evil, condemnation and grace. with the advent of science and technology and related materialism, humans had krill/existential social work 123 imagined having power to create their own security, pleasure, power roles and destiny. god was eventually removed from the equation and seemed “dead” to human need. humans could control not only their own behavior but also the economic and political systems of society. then came the two world wars, interspersed with the great depression, the atomic bombings and holocaust. there was an aftermath of fear, confusion, distrust and alienation. enter the existentialists and later the post-modernists, saying we had fooled ourselves with exaggerated expectations of our own knowledge and hopes. not only had we found ourselves alienated from nature and each other, but also we had even lost sight of our own centered selves. we felt lost as cogs in a mechanistic wheel of economic and psychological determinism. we were defined by our roles – social, familial, work, gender, racial all fostering a false sense of our self. is it possible to determine a “true self” behind our self-deceptions? the existentialists claim we are free to create our own destinies. sartre would call this a “nothingness,” meaning that we are not a defined thing, hence “no-nothingness.” the religious existentialists would equate this freedom with spirit, divine grace and potential as co-creators with god. some, like kazantzakis (1970), would even say we are “saviors of god” – that god needs us as we need god. much like zen buddhism, or what abraham maslow (1962) called “peak experiences,” we have moments when we see reality directly and speak of this as intuitive knowing, wonder, beauty, love and we know we are beyond our predictable social roles and habit patterns of thinking. so what? now here we are in the early years of the 21st century, worried by insecurities of economic depression, loss of jobs, terrorist attacks, street violence, addictions of many forms, ecological damage to our very planet, broken marriages and divided families, and even uneasy about unknown potential consequences of our computerized society. so how do we address our troubled clients? a professional know-it-all stance with pat answers simply doesn’t ring true these days. the existential social worker will affirm the values of disillusionment and of finding meaning in suffering. “false self” attitudes and conclusions (bad faith conceptions) are identified and seen to be not only causing but even maintaining personal problems of complaint. troubling feelings of anxiety, guilt, dread, despair and fear not only· reflect deceptions of the false self but also indicate possibilities of choice and new directions. here you have the existential highlight on choices and commitment. most clients enter counseling with a sense of despair about solving their own problems. they doubt their ability to choose and remain doubtful of any clear-cut life direction. the challenge to the worker is how to reveal the reality of personal freedom. since this is the worker’s own core belief he or she is privy to such matters as meditation, dreams, opening to transcendent experiences such as beauty, wonder, nature and intimacy. the worker identifies false versus true self (authentic) advances in social work, spring 2014, 15(1) 124 experiencing, emerging choice possibilities and how responsibility accompanies choices. he or she also sees the inevitable function of interpersonal relationships as undergirding matters of true or false self activation, believing that self-esteem is directly related to the quality of one’s existing relationships, or the lack thereof. even addictions are viewed as maneuvers to substitute for what is lacking in current relationships. while it is true that body chemistry can be affected by emotions and physical depravations, there is a place for the use of medications. but body harmony can be affected by these same factors just as well, and self-knowledge is thereby valuable. but what of diagnosis, prognosis, and prescriptive techniques? hogwash! says the existential worker. what is important is the understanding and clarification of the client’s worldview. this consists of the personal conclusions they maintain about themselves, other people, the world at large, and their own limitations and possibilities. the advent of narrative therapy provided one effective way of accessing this information (kelley, 2011). along with such knowledge, it is the worker’s job to aid the client in accepting responsibility for one’s condition, situation and one's responses to it all. in clarifying the client’s worldview and its tie to problems, the worker affirms the client’s right to not change it (perhaps even calling it a characteristic rather than problem) or change it. there is one other thought in relation to a relatively theory-less therapy – probably not available to everyone, but most women would have the advantage of this factor. it is called intuitive knowing and is really a zen idea. one korean zen master regularly advised his students to avail themselves to “don't know mind” (sahn, 1976). (not easy for helping professionals who are expected “to know.”) this is similar to the idea in meditation practice of not getting caught up in one’s own conceptualizing. a therapist would be invited to simply be with a client without analyzing or thinking diagnostically or even pragmatically about the client. nor should the worker be reflecting about oneself – judging, evaluating, and planning. such a stance was described in persig’s (1974) zen and the art of motorcycle maintenance as simply sitting with a problematic engine without trying to figure out the nature of the malfunction. this need not be viewed as being as mystical as it may sound. there is an integrative-creative activity that can operate when the mind is free of trying and conceptualizing (krill, 1978). a natural connection occurs between one’s consciousness and the presenting client situation. not only will one likely perceive a deeper understanding of the client, but also one will often be spontaneously moved to a responsive action, an appropriate helpful activity. a mistaken criticism of the existential approach is that it may only be used for clients motivated to discover personal meaning in their lives. few of our suffering clients show such a philosophical interest. the existential response to this is “healing is revealing,” an idea shared by martin buber and carl rogers (friedman, 1955). revealing is most likely to occur when the worker is able to discover the most effective road for connecting with any client. the very importance of the eclectic model of many and varied techniques addresses this challenge. the worker knows krill/existential social work 125 that goals in treatment must reflect the particular attitudes a client has about treatment expectations. one variety of goal possibilities is the following: no change desired; sustaining relationship only; specific symptom (behavior) change; environmental change; relationship change; directional change. each of these goals can be related to a variety of technique possibilities. this scheme is based upon the appreciation of the unique worldview of any client (krill, 1968). when the worker meets the client at his or her level of motivation and expectation healing becomes a likely possibility. concluding thoughts the central ideal permeating existential philosophy is that of existential freedom. sartre describes this as consciousness. kierkegaard calls it the passion of faith, subjectivity and infinite resignation. berdaev speaks of it as spirit and passionate creativity. all three contrast freedom with habitual and learned patterns of selfidentity used for personal security, idolization and denial of responsible choice. when experiencing personal freedom we are not necessarily beyond thoughts; we are beyond self-serving thoughts. as social workers we know firsthand how people have been limited by many factors – social, physical, emotional, racial, class, and gender. liberation efforts are called for when possible. where is the choice for them? the existential worker would agree that there is a significant difference between freedom of choice and freedom of opportunity. as viktor frankl (1962) pointed out in relation to his own experiences in a german death camp, given whatever limits, an important choice remains. he describes such choices as “attitudinal values,” meaning what attitude you choose to take toward your given situation. optimism has been a key motivation for most people entering social work. over time, many have become jaded and discouraged over limited success rates with clients and groups. while existentialists are generally doubtful about the long-range effectiveness of social, economic and political institutions, they do believe in the potential of the individual personality, and this is their very safeguard from cynicism. practice wisdom is called for if we are to use ourselves effectively with the wide array of troubled people we serve. the themes of freedom, authenticity and passionate commitment, which characterize existentialism, are not just aims for helping clients. they are guidelines for the worker himself/herself. many helping professionals are tempted to seek clients who are somewhat similar to themselves, e.g., neurotics, addicts, abused, having gender or sex identity struggles, etc. such knowledge from personal experience is meritorious – the commitment of the “wounded healer.” too often, however, these preferences limit the growth and range of knowledge of the worker. the pursuit of the spirit of freedom is really a creative venture. social work has been associated with the poor, misfits, marginal, homeless, lost and “crazies.” usually these people are unable to pay for private practice. welfare workers often lack advances in social work, spring 2014, 15(1) 126 graduate degrees, so their skills and knowledge are often wanting. seriously disturbed people are too often left to psychiatrists and other medical doctors, with medication and “follow-up” as their primary treatments. if one wishes to get beyond the limiting comfort of “workable clients” one needs to consider this basic observation: to expand your helping skills and even discover new insights about yourself, seek out people who are very different from you and your past experiences and find ways to connect with them in a compassionate, helping role. here is an opportunity to actualize berdaev’s free spirit by means of “disruptive and creative acts.” disrupt your own comfort zones and enter the unknowns of true strangers so as to engage your own creative juices. of course there is the economic factor. many of these marginal types cannot afford your service, or don't fit agency policy. so keep doing what you're good at and pays the bills and also volunteer some limited time with the downtrodden who are alien to you. agencies overloaded with caseloads will be happy for your service and mental health associations can readily provide you with such opportunities. the challenge of existential thinking is not finding meaningful philosophical discussions with your clients (like yourself), but rather how to engage others of all types, many being fearful and doubtful about the possibility of any caring relationship. remember what authors dostoevsky and solzhenitsyn learned in prison camps – not only about themselves but also of the human condition. existential social work and psychotherapy may well be the most appropriate helping approaches for our current cultural condition of anomie. clients, regardless of their psychological or social limitation, do experience confusion about the present state of our nation, culture and ourselves. there is a deep need for meaning and fulfillment despite our many material advantages. existentialism can respond to matters of spiritual transcendence regardless of the language used to describe such imperative experiences. references becker, e. (1973). the denial of death. new york, ny: free press. farrelly, f., & brandsma, j. (1974). provocative therapy. fort collins, co: shields publishing co. frankl, v. (1962). man’s search for meaning: an introduction to logotherapy. boston, ma: beacon press. friedman, m. (1955). martin buber: the life of dialogue. chicago, il: university of chicago press. hoffman, l. (2007). family therapy: an intimate history. new york, ny: w.w. norton. jourard, s. (1964). the transparent self. princeton, nj: van nostrand. krill/existential social work 127 jurjevich, r. (1973). direct psychotherapy: 28 american originals. coral gables, fl: university of miami press. kazantzakis, n. (1960). the saviors of god: spiritual exercises. new york, ny: simon & schuster. kelley, p. (2011). narrative theory and social work treatment. in f. j. turner (ed.), social work treatment: interlocking theoretical approaches (5th ed., pp. 315325). new york, ny: oxford university press. krill, d. (1969). existential psychotherapy and the problem of anomie. social work, 14(2), 33-49. krill, d. (1978). existential social work. new york, ny: free press. krill, d. (1980). the beat worker: humanizing social work and psychotherapy practice. new york, ny: university press of america. krill, d. (1990). practice wisdom: a guide for helping professionals. newbury park, ca: sage. maslow, a. (1962). toward a psychology of being. princeton, nj: van nostrand. may, r. (1958). existence. new york, ny: basic books. persig, r. (1974). zen and the art of motorcycle maintenance. new york, ny: bantam. rogers, c. (1961). on becoming a person. boston, ma: houghton mifflin. sahn, s. (compiled and edited by stephen mitchell). (1976). dropping ashes on the buddha: the teaching of zen master seung sahn. new york, ny: grove press. sartre, j. p. (1955). no exit and three other plays. new york, ny: vintage. schaef, a. w. (1992). beyond therapy, beyond science: a new model for healing the whole person. san francisco, ca: harper. solomon, r. c. (1972). from rationalism to existentialism: the existentialists and their nineteenth-century backgrounds. new york, ny: harper & row. solomon, r. c. (2000). no excuses: existentialism and the meaning of life. (course guidebook, part 1, audiotapes). chantilly, va: the teaching company. taylor, b. b. (2000). the luminous web. boston, ma: cowley publications. turner, f. j. (ed.). (1974). social work treatment: interlocking theoretical approaches. new york, ny: free press. vallon, m. a. (1960). an apostle of freedom: life and teaching of nicolas berdaev. new york, ny: philosophical library. whittaker, j. k. (1974). social treatment: an approach to interpersonal helping. chicago, il: aldine. advances in social work, spring 2014, 15(1) 128 yalom, i. (1989). existential psychotherapy. new york, ny: basic books. author note: address correspondence to: donald f. krill, 351 woodland lane, golden, co 80401-9578 professor donald krill taught social work courses at the university of denver graduate school of social work from 1968 through 1997. as professor emeritus, he has continued to teach existential social work there on a part-time basis. prior to his academic career, he worked at the university of colorado medical center’s child guidance center for nine years while also doing part-time work in both rural and urban mental health clinics. he established the family therapy training center in denver in 1982. in addition to his published scholarship, he has had a private practice since 1962. he also entertains as a magician and teaches classes in exploring paranormal phenomena. this work is licensed under a creative commons attribution 4.0 international license. dual master of social work / master of public health degrees: perceptions of graduates and field instructors trina c. salm ward patricia m. reeves abstract: despite growing interest in master of social work/master of public health (msw/mph) programs, limited research literature is available on msw/mph graduates and none has examined field instructors’ perceptions of msw/mph students. this study describes the perceptions and experiences of msw/mph alumni and field instructors from a recently implemented msw/mph program at the university of georgia. electronic surveys were administered to 32 alumni and 34 field instructors; response rates were 71.9% (n=23) and 70.6% (n=24), respectively. alumni reported satisfaction with the dual degree and utilization of both social work and public health skills in the workplace. field instructors underscored the complementary skill sets of dually-trained students and noted the added value of msw/mph professionals in their agencies. dually-trained msw/mph practitioners are uniquely prepared to address the need for transdisciplinary and interprofessional collaborations to address long-standing social and health issues. keywords: public health social work; msw/mph: dual degree; joint degree; dual degree programs public health social work (phsw) is a growing profession (ruth, marshall, velásquez, & bachman, 2015; ruth et al., 2008; ziperstein et al., 2015). while enjoying resurgence in popularity, phsw actually dates back to the early 20th century when social workers engaged in infectious disease control, maternal and child health promotion, and worked in settlement houses (popple & leighninger, 2004). phsw practice focuses on: a) promoting health, including disease prevention and protection from environmental dangers, and b) populations rather than individuals (sable, schild, & hipp, 2012; watkins, 1985). the knowledge and skills of social workers complement those of public health professionals. social workers understand the need for tailoring interventions to specific populations, adopt a person-in-environment/family-centered perspective, and provide insight into the social conditions that negatively affect health and health equity (moniz, 2010; sable et al., 2012). the knowledge, skills, and values of the two professions coalesce in phsw and support contributions to research, policy analysis, program development, direct service provision, and administration (sable et al., 2012). need for collaborative practice in social work there is an increased focus on health among social workers. about one-third of social workers practice in health-related settings, with a projected 19% increase in the need for health care social workers by the year 2024 (u.s. bureau of labor statistics, 2015). the international federation of social workers (2012) calls for an understanding of health, _________________ trina c. salm ward phd, msw is an assistant professor, helen bader school of social welfare, university of wisconsin-milwaukee, milwaukee, wi 53211 and formerly assistant professor jointly appointed at the school of social work and the college of public health, the university of georgia. patricia m. reeves is a professor, school of social work, the university of georgia, athens, ga 30602. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 507-521, doi: 10.18060/21531 https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2017, 18(2) 508 asserting “health is an issue of fundamental human rights and social justice and binds social work to apply these principles in policy, education, research, and practice” (p. 1). moreover, passage of the affordable care act in 2010 has changed the shape of social work practice in health-related settings in the u.s., strengthening focus on improved patient care, reducing costs, and emphasizing prevention as a critical component of health care (koh & sebelius, 2010; ruth, marshall et al., 2015). as a result, attention is shifting to interprofessional and transdisciplinary teams to provide health services to meet patient, family, and community health care needs (haire-joshu & mcbride, 2013; koh & sebelius, 2010), as evidenced by the creation of the interprofessional education collaborative (ipec, 2016). the council on social work education (cswe) became a member of ipec in 2014 (cswe, 2016). further, long-standing issues of terrorism, disasters, war, disease, viral outbreaks, climate change, oppression, and social justice reinforce the need for creative and multi-perspective problem-solving (jackson, 2015; sable et al., 2012). added value of public health education public health education adds tremendous value to an interprofessional partnership with social work. public health’s focus on prevention (primary, secondary, and tertiary) at the population level, coupled with social work’s emphasis on intervention at the individual level, ensures a more holistic approach in addressing persistent social problems (mccave, rishel, & morris, 2013; rine, 2016; ruth, velasquez, marshall, & ziperstein, 2015). underscoring the disciplines’ complementary relationship, public health training offers greater inclusion of the biological/physiological aspects of health and well-being which is critically needed to extend the scope of social work education beyond its traditional focus on the psychosocial realm (andrews, darnell, mcbride, & gehlert, 2013; reisch, 2012; spitzer & davidson, 2013; ziperstein et al., 2015). public health education provides skills (e.g., biostatistics, epidemiology, social marketing) that promote a wider range of healthrelated opportunities for students. public health and social work’s shared history, values (e.g., social justice), theory (e.g., ecological), research/evaluation (e.g., community-based participatory), and practice (e.g., interdisciplinary) are strongly aligned (ashcroft, 2014; bronstein, kovacs, & vega, 2007; ruth & sisco, 2008; sable et al., 2012). students with social work and public health training can apply both perspectives to solving trenchant social and public health issues, and thus address the increased need for transdisciplinary and interprofessional problem-solving (cswe commission on educational policy & the commission on accreditation, 2015; haire-joshu & mcbride, 2013; ipec, 2016; koh & sebelius, 2010). msw/mph students also expand perspectives and conversations in msw classrooms (reardon, 2009). unquestionably, interest in msw/mph degree programs is growing. over a 30-year period, msw/mph programs have maintained high marketability, increasing in number from 20 in 2008 to 42 in 2015 (mcclelland, 1985; ruth, marshall et al., 2015; ziperstein et al., 2015). these programs provide a formal integration of knowledge between social work and public health that prepares students to contribute to a dynamic and complex world (miller, hopkins, & greif, 2008). students pursue dual degrees for multiple reasons, e.g., a competitive edge in a tight job market, identification with the values of both disciplines, access to the resources (financial, research, course options) of two areas of study, blending salm ward & reeves/dual swk and mph 509 of the preventive aspect of public health and the problem-solving orientation of social work, and the desire to become a public health social worker (mcclelland, 1985; michael & balraj, 2003; moniz, 2010; rosenstock, helsing, & rimer, 2011; ziperstein et al., 2015). universities may implement dual degree programs in order to increase enrollment or to attract high-quality students, and dual degree programs (vs. serial degree programs) ensure incorporation of the philosophies and concepts of both disciplines (mcclelland, 1985). limited literature on msw/mph programs despite the growing interest in and proliferation of msw/mph programs, there is a dearth of research literature pertaining to msw/mph programs (miller et al., 2008; ruth et al., 2008; ruth, marshall et al., 2015; ziperstein et al., 2015). current literature underscores several challenges for msw/mph graduates as they transition to the workplace, including few phsw role models to demonstrate integration of social work and public health knowledge and skills, limited employer understanding of phsw, and the perception that dual degree students are over-qualified (michael & balraj, 2003; ruth et al., 2008). a survey of 153 msw/mph alumni from one long-standing program found that a majority of respondents identified as social workers and held social work licenses (ruth, marshall et al., 2015). a majority also reported engaging in core public health functions on a daily or weekly basis, focusing primarily on community mobilization, program evaluation, health promotion, and policy planning/analysis (ruth, marshall et al., 2015). while the majority expressed success in integrating public health and social work knowledge and skills, limited employer understanding of phsw remained a challenge (ruth, marshall et al., 2015). the purpose of this study was to describe and better understand the perceptions and experiences of msw/mph alumni and field instructors in a recently-implemented msw/mph program in the southeast. the following questions guided our investigation: 1. how do alumni perceive their preparation by the msw/mph program? 2. how are alumni using their msw/mph education in the workplace? 3. what are field instructors’ perceptions of the preparation and competencies of msw/mph students? the findings reported herein make two important contributions to the literature. first, this study is the first to report data from both graduates and field instructors, and second, it contributes to the limited body of literature on msw/mph program outcomes. program overview the university of georgia launched a msw/mph program in 2011 through a collaborative partnership between the school of social work and the college of public health. based on the challenges identified in the literature and discussions with existing msw/mph program coordinators across the u.s., the program was designed with three distinguishing features: a) concurrent social work and public health coursework throughout the program; b) an integrated field practicum that addresses both social work and public health internship requirements; and c) an intensive (seven consecutive semesters, two-anda-half years; many programs are three-year programs), 90-credit program of study. the advances in social work, fall 2017, 18(2) 510 msw/mph degree is an option for students in the clinical or community empowerment and program development concentrations in social work and the health promotion and behavior or gerontology concentrations in public health. students must apply separately to the school of social work (msw program) and the college of public health (mph program) and can enroll at two time points: in fall or spring semester of their first year of graduate study. the msw/mph program is intense, with students typically enrolling in 15 credit hours each semester. msw/mph students complete two placements: a one-semester msw foundation placement and a two-semester integrated social work and public health concentration placement. the integrated placement is completed as a block (40 hour/week) placement over the summer, continuing into a 24-hour/week placement in the fall semester of their third year. during the block placement, students integrate public health and social work activities. field coordinators from both programs work closely together to identify placement sites (e.g., clinics, hospitals, behavioral health clinics) that meet the internship requirements of their respective accrediting bodies and that will offer learning experiences to integrate the knowledge and skills of the two disciplines. students develop learning plans with objectives, activities, and interventions that will achieve both public health and social work competencies. assignments during the semester address the competencies of both disciplines. site visits take place at the beginning and end of the integrated summer semester, with the msw/mph program coordinator working in conjunction with field instructors to oversee the integration of the knowledge and skills of both disciplines during the placement. methods survey the authors developed surveys for each group (alumni and field instructors) based on existing literature (ruth, marshall et al., 2015). the surveys included closedand openended questions. closed-ended questions used a five-point, likert-type scale with ratings from 1 (strongly disagree) to 5 (strongly agree). the alumni survey included 51 questions addressing topics such as msw/mph program experiences, employment and career experiences, professional identity, and the practice of phsw. the field instructor survey included 21 questions addressing topics such as perceptions of msw/mph student competencies and integration of phsw in the field experience. sampling and analysis as of january 2017, 32 students had graduated from the msw/mph program and 34 field instructors had supervised msw/mph students during their integrated field placements. emails with the survey link were sent to all alumni and field instructors inviting them to participate in the survey. follow-up reminders were emailed at oneand two-week intervals after the initial email. no incentives were provided for participation in the survey and data collection occurred between january and april 2017. the evaluation protocol was reviewed and approved by the university’s institutional review board. descriptive statistics, means, and frequencies were calculated for each of the survey salm ward & reeves/dual swk and mph 511 questions using spss (version 24, ibm corporation). open-ended survey responses were reviewed for overarching themes. results twenty-three graduates (response rate of 71.9%) and 24 field instructors (response rate of 70.6%) completed surveys. about a third of alumni (39.1%) had graduated within the previous year and over half (56.5%) had graduated more than two years ago (see table 1). the majority of alumni (91.3%) identified as female, white (75%), and non-hispanic (81.3%). field instructor respondents were almost evenly divided among the four academic years since inception of the program. a little over half (54.2%) typically supervised both msw and mph students, and 45.8% typically supervised msw students. supervisory experience ranged from one to 25 years, with two-thirds (66.7%) having one to five years of supervisory experience. table 1. descriptive statistics of survey respondents characteristic n % graduates (n=23) academic year (n=23) 2013-2014 2014-2015 2015-2016 2016-2017 5 8 1 9 21.7 34.8 4.3 39.1 gender (n=23) female male 21 2 91.3 8.7 racei (n=16) white/caucasian black/african american other or mixed race 12 2 2 75.0 12.5 12.5 ethnicityi (n=16) not hispanic hispanic 13 3 81.3 18.8 field instructors (n=24) academic year 2013-2014 2014-2015 2015-2016 2016-2017 5 7 6 6 20.8 29.2 25.0 25.0 students typically supervised msw & mph students msw students 13 11 54.2 45.8 supervision experience 1-5 years 6-10 years 11-15 years 16+ years 16 3 2 3 66.7 12.5 8.3 12.5 note: i race and ethnicity were not collected from all participants advances in social work, fall 2017, 18(2) 512 perceptions of preparation by the msw/mph program when asked about their professional preparation, alumni agreed that they had a strong grasp of social work competencies (m=4.57, sd=.73) and public health competencies (m=4.52, sd=.51), and that they could easily see the connections between social work and public health (m=4.83, sd=.39; see table 2). respondents reported a good understanding of phsw that they could describe to others (m=4.65, sd=.57), easily drawing from public health and social work competencies (m=4.65, sd=.65), and seeing problems differently because they had a dual professional perspective (m=4.83, sd=.39). alumni were satisfied with the decision to pursue a dual degree (m=4.65, sd=.71), and they generally agreed that they felt a part of both public health and social work professions (m=3.91, sd=1.2). in terms of their current employment situation, alumni agreed that their dual degree had a positive impact on their ability to obtain the position (m=4.45, sd=.69). table 2. alumni perceptions of preparation (n=23) survey statement mean sd i… have a good grasp of social work competencies. 4.57 .73 have a good grasp of public health competencies. 4.52 .51 can easily see the connections between social work and public health. 4.83 .39 have a good understanding of public health social work and can describe it to others. 4.65 .57 can easily draw from both public health and social work skills and competencies. 4.65 .65 see problems/issues differently because i have a dual professional perspective. 4.83 .39 feel i am part of both public health and social work professions 3.91 1.2 program satisfaction satisfaction with decision to pursue the dual degree program 4.65 .71 employment (n=20) msw/mph had a positive impact on ability to obtain current position 4.45 .69 overall, the written comments by msw/mph alumni were also very positive, focusing mostly on their expanded professional perspective and the marketability of the msw/mph degree. for example, alumni described having broader perspectives when approaching social problems: the dual degree program has provided me with a more well-rounded understanding of human beings and the array of problems in our world today (that need attention from a social work and public health perspective). i believe that social work has provided me with great tools for intervening and working directly and competently with diverse people, while public health has given me a more factbased/science-based approach to improving health outcomes in american society and in other cultures. it [dual degree program] has allowed me to have more input in my organization's operations. it has given me higher social standing (in some cases) than other social workers. it has given me multiple frameworks to address client health issues and salm ward & reeves/dual swk and mph 513 organizational challenges. i have research and evaluation skills as well as direct practice competencies, and that has created a niche role for me at my organization. most alumni indicated that the msw/mph degree increased their marketability and helped them stand out from other candidates, as one noted: “i was told that the reason i got my first job after graduating was because i had two degrees. that put me ahead of other applicants.” however, one alumnus expressed doubt about having a competitive edge because of the dual degree, stating, “i think it helped me to meet the minimum requirements for master’s-level jobs in these fields, but most jobs only care if i have one degree or the other.” most alumni also commented on an overall positive learning experience in the msw/mph program, including meaningful learning and field placement experiences and positive relationships with advisors. a few, however, expressed frustration with the program having limited options for electives and disappointment with a lack of rigor in the curriculum. use of msw/mph education in the workplace the majority (87%) of alumni were employed at the time of the survey and two (8.7%) were pursuing doctoral studies (see tables 3a and 3b). slightly less than half of alumni (40%) worked in a health care setting, followed by government settings (25%). alumni reported a variety of position titles, with about half (55%) requiring a msw and only one (4.8%) requiring an mph. over half (63.2%) were earning salaries of $40,000 or more. most respondents (73.9%) pursued licensure or certifications, with 52.2% having or pursuing a licensed master social worker or licensed clinical social worker credential (association of social work boards, 2017), followed by the certified health education specialist (21.7%) credential (national commission for health education credentialing, inc., 2017), and the certified in public health (13%) credential (national board of public health examiners, 2017). about a third (34.8%) of alumni reported belonging to a professional organization, including the national association of social workers (21.7%), american public health association (4.3%), or other organizations (21.7%). alumni described themselves to others in a variety of ways, including as a social worker (43.5%), public health social worker (21.7%), public health professional (8.7%), health educator (4.3%), or by their position title (13.0%). alumni somewhat agreed that they were constrained in their phsw practice by the limits of their work setting (m=3.35, sd=1.35), that their position was the ideal integration of phsw (m=3.35, sd=1.63), and that their workplace acknowledged their unique phsw competencies (m=4.0, sd=1.26). advances in social work, fall 2017, 18(2) 514 table 3a. use of msw/mph in workplace (n=23) survey item n (%) employment status employed unemployed, looking for work phd student 20 1 2 87.0 4.3 8.7 type of employer (n=20) health care government or other public agency private, not-for-profit agency university/research private, for-profit agency self-employed 8 5 3 2 1 1 40.0 25.0 15.0 10.0 5.0 5.0 position titles (n=19) coordinator/specialist, health department medical social worker social worker/behavioral health provider clinical specialist executive director other 5 5 3 2 2 2 26.3 26.3 15.8 10.5 10.5 10.5 degree required mph (n=21) msw (n=20) 1 11 4.8 55.0 salary range (n=19) <$30,000 31,000-40,000 41,000-50,000 >$50,000 1 6 9 3 5.3 31.6 47.4 15.8 uses the following competencies (n=20): both social work and public health social work only public health only neither set of competencies 15 2 1 2 75.0 10.0 5.0 8.7 licensure/certificationi lmsw, lcsw or applying ches or applying cph none 12 5 3 6 52.2 21.7 13.0 26.1 self-description social worker public health social worker public health professional health educator by position title other 10 5 2 1 3 2 43.5 21.7 8.7 4.3 13.0 8.7 professional organizationsii national association of social workers american public health association other none 5 1 5 15 21.7 4.3 21.7 65.2 notes: itwo alumni maintain both cph & ches; one maintains both cph & lmsw; iithree alumni were members of more than one professional organization salm ward & reeves/dual swk and mph 515 table 3b. use of msw/mph in workplace (n=23) survey statements (n=20) mean sd i am constrained in my public health social work practice by the limits of my work setting. 3.35 1.35 my position is the ideal integration of public health social work. 3.35 1.63 my workplace acknowledges/understands my unique public health social work competencies. 4.00 1.26 the majority of alumni (75%) reported using both social work and public health skills and competencies in their position. alumni were asked to describe the public health and social work skills they used in their workplace settings; of those who responded (n=15), all listed both public health and social work skills, regardless of position title or profession. table 4 summarizes the five most commonly cited public health and social work skills, with program design and planning the top skill in public health and assessment and counseling the most often used skills in social work. it should be noted that more social work skills were mentioned, which may reflect the greater number of alumni employed in social work-related positions. table 4. top five public health and social work skills used (n=15) skill n % public health program design/planning 6 40.0 health education 5 33.3 program evaluation 5 33.3 health/healthcare policy 3 20.0 health promotion 3 20.0 social work assessment 8 53.3 counseling skills 8 53.3 case management 5 33.3 diagnostic criteria 5 33.3 therapeutic techniques 4 26.7 perceptions of field instructors field instructors agreed that msw/mph students evidenced a good grasp of social work competencies (m=4.67, sd=.48) and public health competencies (m=4.46, sd=.59), and demonstrated understanding of social work and public health values (m=4.79, sd=.42), theories (m=4.29, sd=.81), and practices (m=4.54, sd=.59; table 5). they agreed that msw/mph students were competent to apply for msw positions (m=4.71, sd=.69) and mph positions (m=4.58, sd=.58), and that they would hire an msw/mph graduate if given the opportunity (m=4.75, sd=.53). field instructors also agreed that their agency effectively integrated both the msw and mph field experience (m=4.63, sd=.50). supervising a msw/mph student also helped field instructors learn how social work and public health are integrated in practice (m=4.42, sd=.65), and field instructors expressed satisfaction with their decision to supervise msw/mph students (m=4.88, sd=.45). all but two field instructors (91.3%) expressed willingness to supervise another msw/mph advances in social work, fall 2017, 18(2) 516 student, with the two who were unwilling citing time constraints. all field instructors (100%) stated they would recommend this university’s msw/mph program to other students. table 5. field instructor perspectives (n=24) survey statement mean sd msw mph students demonstrated… social work and public health values 4.79 .42 competence to apply to msw position 4.71 .69 good grasp of social work competencies 4.67 .48 competence to apply to mph position 4.58 .58 social work and public health practices 4.54 .59 good grasp of public health competencies 4.46 .59 social work and public health theories 4.29 .81 field placement effectively integrated both msw and mph field experience 4.63 .50 would hire a msw/mph graduate 4.75 .53 field instructor learned how social work and public health are integrated 4.42 .65 how satisfied are you with decision to supervise a msw mph student 4.88 .45 written comments by field instructors were very positive overall, with most pertaining to the high caliber of the students. field instructors described them as “motivated,” “confident,” “outstanding,” “ingenious,” “self-directed,” and “team-oriented.” as one stated, “dual degree students appear to be extremely self-motivated, self-directed, and confident when they arrive at the field placement. they are eager to jump right in.” field instructors also commented on the added value to the agency in hiring dual degree students, especially in comparison to msw-only students. they noted, in particular, the stronger skill sets of dual degree students in conducting literature reviews, program development and evaluation, grant and accreditation management, and prevention and physical health. the following statement by one field instructor captured a common sentiment: “our dual degree intern provided a perspective that was not formerly represented in this organization, so the public health perspective was innovative and valuable. the intern was taken more seriously by administration (mbas and mds) at least partly due to the intern’s ability to speak a language they understand better than ‘msw talk.’” field instructors also noted that the benefits of having msw/mph students in comparison to mph-only students. one, for example, indicated that msw/mph students were “better equipped to manage social barriers to medical care.” several remarked that msw/mph students were a better fit for their agency’s mission. as one expressed, “they can see the larger needs of a population and where they fit in the community, to the more specific work of helping clients connect with those resources they need.” additionally, field instructors reported a very positive perception of msw/mph students and believed their dual degrees would enhance their marketability. they also offered suggestions for improving the msw/mph integrated field experience including providing greater clarity for students about expectations prior to entering the field placement, modifying the timing and length of the integrated field placement (for example, salm ward & reeves/dual swk and mph 517 three semesters instead of two), and coordinating msw and mph field evaluation paperwork. discussion despite growing interest in msw/mph programs, limited literature exists that describes how alumni from these programs practice phsw (ruth, marshall et al., 2015; ziperstein et al., 2015) and, to our knowledge, no literature exists on field instructors’ perceptions of msw/mph students’ competencies when completing their field placement experience. the purpose of this study was to describe the perceptions and experiences of msw/mph alumni and field instructors associated with a recently implemented msw/mph program at the university of georgia. we found that overall, msw/mph alumni were satisfied with their experiences in the program, were employed in phsw settings, and used both social work and public health skills in their workplace. field instructors were impressed with msw/mph students’ performance in the field placement, and saw the added value of dual degree professionals in their agency settings. our findings add weight to those found by others. for example, the majority of alumni used both social work and public health skills and competencies in their current employment as well as agreed or strongly agreed that their position is the ideal integration of public health and social work (ruth, marshall et al., 2015). as ruth and colleaguesnoted, our respondents tended to identify more strongly with the profession of social work, calling themselves social workers or public health social workers, and about half pursued social work licensure. alumni reported success in grasping public health and social work competencies, felt a part of both professions, believed their dual degree had a positive impact on their ability to obtain their current position, and reported satisfaction with their decision to pursue a dual degree. previous literature has suggested that the workplace may not fully appreciate the competencies of msw/mph practitioners (ruth, marshall et al., 2015). we found that our alumni were more likely to agree that practice as phsw professionals was constrained by the limits of their work setting, and less likely to agree that their position was the ideal integration of phsw and that their workplace acknowledged their unique phsw competencies. nevertheless, our msw/mph alumni still found opportunities to apply both social work and public health competencies in their work settings. field instructors were very positive in regard to msw/mph students’ preparation for entering the field and their demonstration of social work and public health competencies. the majority strongly agreed that their agency was able to effectively integrate both msw and mph field experiences, which supports the call in the research literature for transdisciplinary and interprofessional perspectives to address current societal problems (haire-joshu & mcbride, 2013; koh & sebelius, 2010). supervising msw/mph students also helped field instructors learn more about how social work and public health are integrated in practice. field instructors clearly appreciated the promise of msw/mph practitioners, which seems somewhat in contrast to the perception of msw/mph alumni of less understanding of the value of phsw in their workplace. prior to student placement in field and to help bolster their willingness to take a msw/mph student (with his/her advances in social work, fall 2017, 18(2) 518 unique field requirements), the program’s public health and social work field coordinators emphasized to field instructors the value of msw/mph students. thus, field instructors in our sample may have had a more thorough understanding of what msw/mph students could offer to an agency. further, msw/mph students work with their field instructors to create learning plans that explicitly describe public health and social work competencies. perhaps this added orientation helped foster positive field instructor expectations. msw/mph graduates would be well-advised to explicitly describe (both written and verbally) their phsw competencies to prospective employers as a way to increase awareness of the knowledge and skills they would bring to the workplace setting, and to have continued conversations about how those phsw competencies can benefit the agency moving forward. unfortunately, however, as indicated in extant literature and as our findings confirm, a large majority of positions specifically seek an mswor mphprepared practitioner; very few specify both. thus, it is incumbent for msw/mph graduates to advocate strongly for themselves, and to make a compelling case for how their broader, transdisciplinary, and interprofessional perspective on societal problems can benefit the workplace. most encouraging, as our study and others have shown, is that msw/mph graduates understand and can clearly describe the affordances of being dually educated and trained in public health and social work. limitations this study has some limitations. as the first systematic attempt to collect evaluation data from a newly-implemented program, the sample size is relatively small. however, the literature on msw/mph programs suggests that most programs are quite small, graduating an average of seven individuals per year (ziperstein et al., 2015). also, the findings are limited to alumni and field instructors associated with one msw/mph program, which, as noted earlier, has three distinguishing structural features; thus, the results may not be generalized to other msw/mph programs. a further limitation is that gender and racial/ethnic data were not collected from field instructors. additionally, there is a potential for bias as the authors evaluated their own program. we attempted to minimize this bias by assuring students survey data were anonymous, survey participation (or nonparticipation) would not affect program participation, and by presenting both positive and negative data and comments. despite these limitations, this study adds to the literature on the perceptions and experiences of msw/mph practitioners and adds those of field instructors who have supervised msw/mph students, thereby contributing to a broader understanding of msw/mph practitioners in real-world settings. implications health is a growing area of focus in the social work profession, as is the need for transdisciplinary and interprofessional collaborations to address long-standing social and health issues. dually-trained msw/mph practitioners are uniquely prepared to address such issues. additional research is needed to gain a more nuanced understanding of the experiences and unique contributions of msw/mph practitioners. a national, crossprogram evaluation could help identify common challenges across programs as well as the unique structural strengths of each program (michael & balraj, 2003; ruth et al., 2008). salm ward & reeves/dual swk and mph 519 such feedback would help programs best tailor the educational experience of msw/mph students for maximum benefit. further, there is a strong need for msw/mph practitioners to advocate for how their dual education and training uniquely positions them to address intractable social and health problems. at the individual level, for example, they must confidently and explicitly describe their unique set of phsw competencies to potential and current employers, and at the macro/policy level, they must engage in advocacy and education. others have called for cross-school leadership, enhanced resources, a greater investment of faculty time, more student funding, expanded career services, and postgraduate professional education to help maximize the ability of msw/mph professionals to apply transdisciplinary approaches to problem-solving, with the long-term result of improved community health (ruth, marshall et al., 2015). we enthusiastically support this call. two potential professional resources for msw/mph practitioners are the public health social work section of the american public health association, and the health 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(pp. 17-33). rockville, md: division of maternal and child health. u. s. bureau of labor statistics. (2015). social workers. retrieved from http://www.bls.gov/ooh/community-and-social-service/social-workers.htm ziperstein, d., ruth, b. j., clement, a., wyatt marshall, j., wachman, m., & velasquez, e. (2015). mapping dual degree programs in social work and public health: results from a national survey. advances in social work, 16(2), 406-421. https://doi.org/10.18060/18372 author note: address correspondence to: trina c. salm ward, phd, msw, helen bader school of social welfare, university of wisconsin-milwaukee, 2400 e hartford ave, milwaukee, wi 53211. salmward@uwm.edu acknowledgement: the authors gratefully acknowledge the willingness of the msw/mph graduates and field instructors who enthusiastically shared their viewpoints and opinions. the authors also deeply appreciate the efforts of kelly ryder, prashikshya karki, elaina schreckenberger, and taylor kennedy--msw/mph students who assisted in literature searches and data collection. https://doi.org/10.1177/00333549081230s210 https://doi.org/10.1093/sw/swu060 https://doi.org/10.1080/00981389.2013.834028 http://www.bls.gov/ooh/community-and-social-service/social-workers.htm https://doi.org/10.18060/18372 mailto:salmward@uwm.edu microsoft word 15. bai_16441_role of social work in china copyedit final ______________  jieru bai, ph.d., is an assistant professor in the grace abbot school of social work at the university of nebraska at omaha. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 495-506 what is the role of social work in china? a multi-dimensional analysis jieru bai abstract: this article analyzes the role of social work in the context of the special political, economic, cultural, and historical background in china. a historical perspective is used to understand the evolution of the chinese welfare system and explain the timing of reintroducing the social work profession. a pluralistic perspective is adopted to define social work relating to different stakeholders in social welfare and services. the government starts to diminish its role as a direct service provider. the traditional family and community have less capacity to take care of people. yet, the social work profession is not ready to take over. finally, a social development perspective is used to illustrate why economic growth is prioritized by the chinese government and social work as profession is supposed to work to promote social stability and prosperity. implications for social work research and practice are discussed. keywords: china, pluralistic, social development, policy through the past few decades, china has experienced fundamental economic, political, and social changes. on the one side, china has achieved significant improvements in poverty alleviation and social development (chi, 2005). on the other hand, china is facing numerous new challenges due to rapid social change, including poverty, income disparities, family breakdown, rural-urban migration, unemployment, underemployment, criminality, housing, an aging population, child labor, public health, and environmental pollution (leung, 2007; tsang & yan, 2001). in order to maintain the economic success and achieve wealth and prosperity, the chinese government has implemented corresponding welfare reform to remedy social problems, avoid social unrest (guan, 2003), and maintain social stability (chi, 2005). development and professionalization of social work was strongly advocated by top chinese leaders and perceived as the most important theme in the welfare reform (xiong & wang, 2007). in 1986, social work was officially recognized as a university discipline and four universities started to provide social work programs. within the following twenty years, the number of social work programs increased from 20 in 1994 to more than 300 in 2011 (personal communication, sibin wang, the current president of the china association of social work education, december, 2011). after the new millennium, the government has selected large, metropolitan cities as experiments, such as shanghai, shenzhen, and beijing, to develop local social service delivery systems and social work teams (hung, ng, & fung, 2010; leung, 2007). in 2003, the government of shanghai issued temporary measures of qualifications for social workers registration and tried some experimental projects of employing professional social workers in hospitals, community centers, and schools. by 2010, there were more than 1,500 people registered as social workers (shanghai civil affairs bureau, 2010). those social workers have played an important role in providing services for juvenile delinquents, the elderly, and people with advances in social work, fall 2014, 15(2) 496 substance abuse problems (xiong & wang, 2007). following the steps of shanghai, the government of shenzhen developed an integrated system in which the government purchased services from independent social service agencies (hung et al., 2010). the shenzhen bureau of civil affairs provides funding and helps to develop nongovernmental social work organizations which hire social workers and provide direct services. the experiences of experimental cities strengthened the government’s determination to promote social work as a profession for the whole country. in recent years, the government made great efforts in legislation and provided legal support in the professionalization of social work. in 2004, the ministry of labor and social security issued regulations on the occupationalization of social workers. in 2006, the ministry of civil affairs and the ministry of personnel issued temporary regulations on the social workers occupational standard system, by which the government officially recognized social work as a profession. right after that, the ministry of civil affairs and the ministry of personnel published regulations on the professional certification for assistant social workers and social workers, which defined different positions and corresponding requirements of the new profession. the experiences also demonstrated the importance of the government’s support in the successful, experimental cities. as a socialist country, the chinese government plays a strong and directive role in the development of social welfare as well as the social work profession (tsang & yan, 2001). many chinese scholars appreciate that it is a golden chance for the development of professional social work in china. however, others criticize that although the term “social work profession” has suddenly become popular and frequently appears in various government reports, “a widely agreed definition of what social work is and what social workers do is missing” (xiong & wang, 2007, p. 568). this article analyzes the role of social work in the context of the special political, economic, cultural, and historical background in china. a multi-dimensional model is used to analyze why the chinese government is determined to develop social work contemporarily, and how to define social work as a profession in the chinese welfare system. implications for social work research and practice are discussed. a multi-dimensional model in order to explain the timing of the professionalization of social work, a historical perspective is used to understand the evolution of the chinese welfare system and social work profession. in consideration of the vastness and complexity of the social problems in china, a pluralistic perspective is adopted to define social work relating to different stakeholders in social welfare and services, including the state sector, the voluntary sector, the informal sector, and the commercial sector. moreover, china is still a developing country and economic growth is its highest priority. there is a consensus that the current policy is directed to maintain social stability in order to achieve wealth and prosperity for the country. the major assignment for the social work profession is to remedy social problems caused by economic reform (xiong & wang, 2007), which reflects the political-economic perspective in social policy. this article combines these three bai/role of social work in china 497 perspectives and proposes a multi-dimensional model (see figure 1) to explain the role of social work in china. figure 1. multi-dimensional model of social work in china the historical perspective old china: before 1949 before the people’s republic of china (new china) was founded in 1949, china had been a feudal society for nearly three thousand years. confucianism was, and still is, the dominant belief system in china. it provided a foundation for social welfare ideology in chinese culture (hutchings & taylor, 2007). core values of confucianism include reciprocity, filial piety, loyalty to one’s family, and consensus and harmony (chung, 1992). confucianism encourages mutual help because of the individual’s responsibility for the collective good (chan & tsui, 1997). individuals and families were the primary caregivers. social provisions from the state were limited to famine relief on an ad hoc basis (chan & tsui, 1997). in addition, buddhist temples were the major charitable entities. this is similar to the role of churches in western societies before social work was developed. social work was absent from chinese history until the 1920s, when it was first introduced to china by western missionaries. however, at that time, china was invaded by western countries and japan and then trapped in civil war. although there were approximately 20 social work-related education programs before the people’s republic of china was established in 1949 (yan & tsang, 2005), social work was not able to develop in the society. communist china: 1949-1978 after the communist party took over in 1949, a centrally-planned economy was established. the central government took the responsibility of providing social welfare to advances in social work, fall 2014, 15(2) 498 the whole chinese society (tsang & yan, 2001). in urban areas, citizens enjoyed employment-based social welfare. “danwei”, or work units, provided comprehensive social services for their employees, including housing, food, education, child care, health care, income protection, and old age pensions (leung & nann, 1995). in rural areas, social welfare was delivered by production teams (mok, 1983). however, there was a huge gap between welfare in urban areas and rural areas. rural welfare services were relatively undeveloped due to limited resources. within this period, all social sciences, including sociology and social work courses, were eliminated from the universities during the “restructuring of institutions of higher learning” (yuen-tsang & wang, 2002, p. 376). the underlying rationale was that social welfare was a by-product of capitalism to remedy social ills, while the socialist state itself was a social welfare agency (mok, 1983). social work was removed before having any chance to develop. china in transition: 1978-present in 1978, the chinese government decided to shift the focus of national policy from political debate to economic development. the government initiated the transition from a planned economy towards a market economy and opened the door of china to the world. within those political and economic transformations, the welfare system of china also underwent profound changes. in 1983, the collective system was formally ended. during the 1990s, many stateowned enterprises were dissolved. individuals were no longer permanently protected by the collectives. the comprehensive employment-based welfare was terminated, but no substitute welfare system has been established yet. as a result, many people were left out in the welfare transition. they no longer receive free housing, education, and medical care from the government. instead, they have to pay for everything out of their own pockets. unfortunately, this is challenging for many people. in facing those new social problems, the chinese government tried to engage various resources and encouraged localized services (leung & nann, 1995). in the late 1980s, the chinese government brought up the concept of “large society and small government.” the government started to reduce its responsibility in providing social welfare and tried to promote the “socialization” of social services. private, quasi-government, and nongovernmental sectors were encouraged to share the responsibility for welfare service provision (leung, 2007). the government’s diminishing role in welfare provision combined with increasing social needs imposed great pressure on the social welfare system (xiong & wang, 2007). as a result, the chinese government decided to reintroduce social work. the government expected the new profession to provide comprehensive services and help remedy social ills. social work programs expanded rapidly with the support from the government. welfare pluralism perspective welfare pluralism, also referred as “mixed economy of welfare,” contends that there are four sectors involved in the production and delivery of welfare. they are the state bai/role of social work in china 499 sector, the commercial sector, the non-profit or voluntary sector, and the informal sector (gilbert, 2008). currently in china, although most social services are directly operated by the state, a multiple-intervention system is emerging. people are encouraged to seek help from informal and semi-formal system (smith, 2003). the state sector social welfare in china is provided by various organizations under the leadership of the central government. the most important agencies are the ministry of civil affairs and the ministry of labor and social security. civil affairs work has been well established within each level of government and is considered as social work with chinese characteristics (wang, 2011). at present, there are nearly 500,000 people working in the civil affairs system (li, huang, & han, 2012). instead of being direct service providers, the government is now focusing more on policy, legislation, management, and financial support. the welfare delivery system is decentralized, and community-based services are developed. however, most of the staff members hired in civil affairs organizations do not have a social work background. they usually perceive their work as administrative and executive duties. wang (2011) defined the “embedded model” of social work development in china. because the civil affairs system has been functioning since 1978, social work as a new profession has to strive for its place both within and outside the historical structure. social work educators like wang have advocated for embedding social work within the civil affairs system and gradually transferring the civil affairs work into professional social services. in recent years, many social work students have been sent to national and local bureaus of civil affairs for their practicum experiences. working in the civil affairs system is one of the few jobs related to social work that students can find in china (wong & pearson, 2007; yan, ge, cheng, & tsang, 2009). however, this model has triggered the argument about who should take the lead: staff members without professional training but who understand the services or social workers with professional training but having little experience in the system? the embedded model also echoes the strong political tradition in chinese social welfare system. the voluntary sector during the 1990s, many local and international ngos (non-governmental organizations) and npos (non-profit organizations) emerged in china. the number of ngos registered in the ministry of civil affairs increased from 5,901 in 1999 to 381,361 by the third quarter of 2008 (ministry of civil affairs, 2008). those newly emerged ngos played more and more important roles in producing and delivering social services. before this period, the chinese government held a very skeptical attitude toward the development of ngos. now, the government allows much more room for the development of ngos. especially during the sichuan earthquake in 2008, the government demonstrated unprecedented flexibility toward ngos because of their contributions in crisis intervention and post-disaster reconstruction. currently, the government is working actively on the legislation and standardization of ngos. ngos advances in social work, fall 2014, 15(2) 500 are expected to replace the welfare services which the government no longer provides. however, the government does not provide tangible support for the ngos beyond tax incentives (wong, 2008). as a result, numerous ngos are facing great difficulties in finding stable funding sources, establishing efficient management, and recruiting professional workers. though growing rapidly, the function of the ngos as service providers is limited (hutchings & taylor, 2007; tsang & yan, 2001). due to the political environment, it is hard for grassroots ngos to achieve true independence (wong, 2008). the quality of the services from grassroots ngos varies greatly depending on what resources they can get in the society. some well-functioning ngos are actually affiliated with governmental organizations, or transformed from previous government branches. thus, they have adequate funding sources and other support from the government. however, they do not function independently as the third sector. the informal sector informal care refers to the help received from family, friends, neighbors, and other non-statutory sources (gilbert, 2008). informal care and family obligations are valued in chinese tradition and are still important principles of the contemporary welfare system (chan & tsui, 1997). the government uses legislation to enforce the family’s responsibility to take care of individuals and an individual’s obligation to the family (leung, 2001). however, in modern society, the capacity of chinese families to provide care is seriously deteriorating (leung & wong, 2002). because of the one-child policy, most families are now nuclear families. the family size is decreasing while the divorce rate is increasing, which means there are fewer people in stable family relationships that share the responsibility of caregiving. what is more devastating, due to the urbanization, many rural residents have left their land and migrated to urban areas to make money, while their elder parents and young children are left behind to take care of themselves (shang, wu, & wu, 2005). this phenomenon seriously threatens the traditional chinese family values and undermines the family’s capacity as the primary care provider. the rapid change in family structure results in urgent needs for professional services, especially for elderly people. it is anticipated that the portion of elderly people (age 65 and above) in the population will increase from 8% in 2010, to 16% in 2030 and 24% in 2050 (jackson, 2011). the growing aging population will overwhelm the traditional care model for elderly people, where adult children take care of their elderly parents. using professional services will be inevitable for chinese families. the professional services will compensate the weakening roles of family as the primary care provider. however, this change will challenge chinese people’s values about family and filial piety, which is fundamental in confucianism. some people believe that sending elderly parents to nursing homes is abandoning them. social work as a new profession will have to cope with those negative attitudes and help people transform their values. bai/role of social work in china 501 the commercial sector the commercial sector of the welfare system in china is not well developed yet. from the middle of the 1990s, the chinese government has been trying to commercialize higher education and the medical care system, but has encountered great resistance. people have been very dissatisfied with the booming prices. many people from urban poor and rural families cannot afford higher education and medical care. after admitting the failure of the medical care system reform in 2006, the chinese government is now promoting a social insurance system to the whole society. in urban areas, employers are mandated to purchase medical insurance for employees. in rural areas, the government has established a new insurance system named “new cooperative medical scheme” (ncms). the system is co-financed by rural residents (a premium of rmb 60/usd 10 per year), the central government, and each level of local government. rural residents get reimbursement for inpatient services and outpatient services for severe medical problems. as of now, the majority of rural residents in china participate in the ncms. meanwhile, because of the economic reform and policy change, there are many more private hospitals, schools, and nursing homes in china. in 2013, the chinese government started to allow for-profit services for elderly people and people with disabilities. chan and tsui (1997) argued that the private sector will play a greater role in meeting social needs, particularly for those who have become rich thanks to economic reform. the welfare pluralism perspective provides a holistic overview of the welfare system in china. however, it is easy to isolate each part and neglect the interaction among different sectors. in a socialist country, the influence of the government is prevailing. none of the other sectors can totally be independent of the government. thus, it is important to consider welfare pluralism under the centralized political system in china. social development perspective the social development perspective broadens the traditional view of western social welfare by including economic development (lowe, 1995). it contends that economic development is a way of promoting the well-being of the whole population and achieving social goals (midgley & sherraden, 2008). the social development perspective is particularly popular in developing countries, where a comprehensive social welfare system is not available. economic development is vital for developing countries to build up a social welfare system and enhance the overall well-being of the society. as a developing country, china has prioritized economic development as the most significant national task since 1978. after nearly 30 years of economic reform and opening up to the outside world, china has achieved remarkable economic development. the living standard of its citizens has been greatly improved. however, the achievement is dramatically uneven between rural and urban areas, between eastern coastal and inland provinces, and among different populations (chi, 2005). china’s gini coefficient, which measures the disparity between rich and poor, increased from 28.2 in 1981 to 38.8 in 1995 and 47.4 in 2012 (atinc and world bank, 1997; national bureau of statistics of the people’s republic of china, 2013). social inequality and class divisions have become more and more severe. advances in social work, fall 2014, 15(2) 502 in the face of those critical social problems and potential social conflicts, the chinese government has shifted its policy from focusing only on economic growth to balancing economic development and social development. stability is considered the premise of economic development. building a socialist harmonious society is proposed by the former president hu jingtao as the national goal of contemporary china. the government has made great efforts to improve the social welfare system. rebuilding social work as a profession is one of the most important agendas. there is a consensus between the government and social work scholars that the mission of social work in china is to fix social problems, maintain social stability, and support economic development. for example, chi (2005) contends that the main objective of social welfare is to provide basic benefits to maintain social stability. guan (2003) maintains that the primary task of social welfare is to provide a basic safety net, avoid social unrest, and make china more competitive in the world economy. the chinese social workers are very clear about their roles as problem-solvers within the existing political system. the social development perspective was critiqued for overemphasizing economic participation while neglecting the real hardships of disadvantaged groups. many developing countries endorsing a social development perspective have experienced situations similar to that in china. the benefits of growth are experienced by privileged groups, while the major burden of growth is imposed on poor people (midgley & sherraden, 2008). tang (1996) argued that social work and social welfare are marginalized in developing countries, and the expenditure on social programs is limited to a minimum part in economic development. discussion and implications the multi-dimensional model of this article provides a comprehensive analysis of the welfare system and the role of social work in china. the historical analysis explains how chinese welfare systems evolved into the current situation and why social work has received more attention now. through a welfare pluralism lens, it is explicit that social work in china will have a greater potential for development. the government sector will be the main source of job positions for future social workers. meanwhile, the increasing grassroots ngos and private service agents will have an urgent need for professional social workers. the informal sector will also require professional intervention to compensate for the eroding capacity of families as care providers. the social development perspective helps define the role of social work as a problem-solver within an existing political system. the task of social work is to remedy social problems, maintain social stability, and sustain economic development. only with the clear understanding of the professional role and task can chinese social workers develop indigenized intervention strategies and function appropriately in a socialist system. currently, the development of social work in china is facing many challenges. the whole society has encountered many new social problems which they have never experienced before. also in a developing country, resources are particularly limited. chinese social workers have to develop the new profession and accomplish its mission in a cost-effective way. social work, as a new profession, is not yet well recognized in chinese society. not many chinese people know what social work is and most people bai/role of social work in china 503 cannot differentiate social workers from volunteers or social work from charity activities (tong, 2007). localizing social work and making the profession compatible with chinese cultural values are critical issues for social work pioneers. social work education in china is also confronted with numerous problems. many social work programs do not have an independent status in universities but often are affiliated with sociology, public administration, or political science (bai & daley, 2014). most social work programs lack professional social work educators and practicum supervisors. of even more concern, a social work job market is nearly non-existent in china (sha, wong, lou, pearson, & gu, 2012; yan et al., 2009). yan and her colleagues (2009) interviewed 31 social work students and only five of them reported that they would try to look for social work related jobs. sha and his colleagues (2012) surveyed 1,331 social work students in beijing and shanghai. they found that fewer than 40% of the students expect to perform any social work activities in the first five years after graduation. the jobless reality has led to a severe waste of social work education in china. although the government’s support is fundamental for the development of social work in china, wang (2011) believes that the subordinate status of social work in the administrative system has hindered the impact of the new profession. chinese social workers should advocate for their own status by creating new services that the government has not developed, such as medical social work, school social work, and mental health services. in this way, it will be easier for social workers to establish professional reputations. also, hospitals and schools are secondary settings for social workers. they do not have to start from a blank slate or create activities to fulfill a schedule. rather, they can work within a multi-disciplinary team with an independent role. in recent years, there have been urgent needs for interventions in doctor-patient and teacher-student relationships. it would be a good opportunity for social workers to contribute to the situation from their own perspectives. for chinese social work researchers, it is time to focus more on practical development. from the literature review, it was found that most authors wrote about social work on a macro level, such as policy analysis, academic programs, historical evolvement, and chinese culture. however, few studies have been done on how to relate those macro-level issues to micro-level practice. also, evidence-based practice is missing and there are barely any empirical studies. more needs assessments and program evaluations should be done to examine social problems and the effectiveness of existing services. with sufficient empirical studies, social workers can negotiate with the government to develop feasible plans for serving vulnerable populations. for chinese social work educators, it is essential to study how to incorporate western social work values and methods into china’s context. it is reasonable to suspect that some values will conflict with traditional chinese values. chinese social workers should not be judged if they do or do not adopt these western values. social work educators should never ignore the influences of the traditional chinese culture and current political system on the development of social work profession. after the earthquake in 2008, social workers have gained much more public recognition because of their involvement advances in social work, fall 2014, 15(2) 504 in crisis intervention and post-traumatic intervention. appropriate use of mass media is an effective way to gain public recognition. chinese social workers should cooperate with the media to publicize this new profession and attract more people to participate in the professional team. international cooperation is also imperative. chinese social workers should critically consider the theories and practices from developed countries before using them. shortterm condensed training programs could be provided to social work educators, and joint programs could be developed through collaboration at the university level. social work educators and practitioners in developed countries should not impose western values on chinese colleagues, nor prescribe conclusive solutions to chinese social problems (chi, 2005). references atinc, t. m., & world bank (1997). sharing rising incomes: disparities in china. washington, dc: world bank. bai, j., & daley, j. g. 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(2002). tensions confronting the development of social work education in china: challenges and opportunities. international social work, 45, 375-388. author note address correspondence to: jieru bai, phd, assistant professor, grace abbott school of social work, university of nebraska at omaha (uno), 6001 dodge street, cb 205k, omaha, ne 68182-0293. e-mail: jbai@unomaha.edu microsoft word 1. o'brien_16430_ethics_do_matter_copyedit final ______________ peter j. o’brien, msw, rsw, is a clinical consultant for alberta health services, shared mental health care, in calgary alberta. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 261-277 ethics do matter, but where? peter j. o’brien abstract: the implications of social work being an ethics-based profession are explored. conduct toward colleagues in the discharge of ethical practices is a focus of this article. the author’s view is that other disciplines involved in mental health, for example, psychiatry, family physicians, psychology, nursing, pastoral services, education, and rehabilitation therapy, share these values. as such, these themes are relevant across many professional disciplines. the article’s intent is to promote discussion as to how we cultivate a collective demeanor as social workers that is congruent with our most hallowed values and principles, namely, social justice, ethical practice, fairness and respect for all people. an examination of daily practices in the workplace and suggested remedies to enhance ethical conduct, including a series of questions we can ask ourselves, are offered. keywords: ethics, ethical conduct, workplace congruence the purposes of this article are threefold: 1) to identify a gap in the existing social work literature regarding congruence between some of our fundamental values and principles such as social justice, ethical probity and respect, and practices towards one another within the work environment; 2) to promote a dialogue about the importance of congruence between social work values and principles that we hold as sacred and our relationships and interactions, not just with clients, but with one another; and 3) to suggest ways to promote ethical practice. interactions that reflect lapses in moral judgment are part of the human condition. however, when ethically dubious conduct is relentless, systematic, and accompanied by an absence of accountability we risk entering the realm of moral turpitude. when such conduct is practiced, reflection will not suffice. action is imperative. ethical congruence applies to colleagues as well as clients the premise of this article is that colleagues, not just clients, should be considered when social workers make a commitment to ethical practice in the discharge of our duties. as such, when we “…demean, disrespect, harass or otherwise mistreat those in the workplace…” we are “…violating the code of ethics” (macdonald, 2007, p. 14). macdonald further states that “social work is an ethics-based profession and social workers are expected to support the philosophy behind the code of ethics, not view it simply as a list of rules to follow” (p. 14). social work’s foundation in ethics (freire & moch, 1987; hugman, 2005; reamer, 2001; weinberg & campbell, 2014) suggests that there is incongruence between values and actions if we tolerate mistreatment of colleagues – worse if we perpetrate the harm. this article is an invitation to discuss these ideas and to foster a clearer vision of what it means to be social worker. advances in social work, fall 2014, 15(2) 262 situating the author’s context the author is trained as a social worker and has worked as a mental health therapist for 25 years, both in hospital settings and in the community. the questions and ideas raised herein have been stimulated by observation and discussions with countless individuals of all ranks employed in the mental health and social service sectors throughout the larger community. social workers and therapists often talk informally about troubling interactions with colleagues. the bewilderment or distress articulated frequently stems from disregard for respect, healthy communication skills, fairness, or social justice in the workplace. constructive responses are called for. literature review there appears to be a gap in the existing social work literature related to incongruence between social work values and principles and practices in contemporary work environments. much is written about fundamental social work principles such as self-determination (hepworth, rooney, rooney, strom-gottfried, & larsen, 2010), respect (reamer, 2013), equality (austin, 2013), social justice (hong & hodge, 2009; rountree & pomeroy, 2010), empathy (gerdes, 2009), and being a value-based profession (ferguson & lavalette, 2007; reisch & jani, 2012). a focus in social work literature is on teaching our code of ethics (congress, 2000; johns & crockwell, 2009), learning a formal process for ethical decision-making (boland, 2006) or considering its application in work with clients (landau, 2000; manning, 1997; mattison, 2000). the importance of these principles in order to be effective in our work with clients is commonly amplified (mitchell et al., 2012). however, there is a lack of discussion in the literature concerning how values and ethics inform interactions with colleagues. of note, similar observations have been made about the paucity of articles examining ethical practices among professional ethicists in the health care system (charland, 2008). there is a growing body of literature in the nursing discipline (hartrick doane, 2002; johnson, haigh, & yates-bolton, 2006; rassin, 2008) concerning values, attitudes, moral identity, and ethical conduct. an entire issue of the journal of nursing management (spence laschinger, 2010) focused on the deleterious effect of incivility in the work environment. the issue highlighted how attitudes and interactions with colleagues and inter-disciplinary team members will impact one’s own mental health, risk of burnout, or resignation from the professional work group, in addition to the possibility of compromising client care. several articles concluded that positive working relationships matter for quality nursing and better patient outcomes. three factors that influence our ethical conduct the larger culture influences ethical conduct. examples of questionable ethical conduct and egregious ethical practices are rampant in 21st century north american culture. scandals involving prominent figures; steroid-fuelled cheating in olympic and professional sports; greed in the financial industry; school and work place violence leading to shootings and the idiom “going postal” that has entered our vocabulary; and an accent on aggression and competition do affect us (weingarten, 2003). o’brien/ethics do matter 263 a lack of civility in everyday social discourse is prevalent. articles abound in the mainstream media about bullying and at least one tragic consequence, suicide. the harvard business review printed an article in its ‘breakthrough ideas’ section dealing with eliminating psychological abuse, defined as “the sustained display of hostile verbal and nonverbal behaviors…” (sutton, 2004, p. 19) in the workplace. the author of the article subsequently described an outpouring of feedback precipitated by the opportunity to talk about abusive employees and toxic work environments. exploitation, deceit, entitlement, and a tendency to look the other way when impropriety is occurring are all too common. a lack of accountability often accompanies such acts of impropriety. this is not to suggest that there are only grim stories to be told. interest in examining ethical and moral conduct and a focus on acts of kindness (saunders, 2014) exist and can inspire. the humanist community at harvard university has developed a seminar format to address human interaction. one subject, nonviolent communication, focuses on “…learning how to speak to others – and to ourselves – more directly and compassionately” (epstein, 2009, p. 128). a second factor that will influence the evolution of our ethical practices is the culture of the program/agency in which we work. do the values and goals of the workplace reflect core social work principles? trends in the recent past of funding cuts, cost containment (cummings, cummings, & o’donahue, 2009; steinberg & luce, 2005), downsizing, and increased caseloads can be a recipe for burnout among staff (courtois & ford, 2013). attention to core values and principles can suffer accordingly. the leadership of the program/agency, indeed the organization itself (liefooghe & macdavey, 2001), have responsibility for the culture of the work environment and for promoting an ethical culture (kotter, 2007; nembhard & edmondson, 2006; toor & ofori, 2009). this includes “…establishing clear expectations of ethical conduct” (bell & breslin, 2008, p. 96). “…employers not only have a moral obligation to fairly treat employees regarding wages and benefits, but also to treat the employees with sufficient dignity as persons. emotionally abusive behaviors would violate these obligations” (keashly, 1998, p. 95). “…ethical leaders do more than show followers what is right or wrong – if they behave authentically, they are also able to have greater influence over subordinates because they are operating ethically” (hunter, 2012, p. 81). not all leaders accept this responsibility. worse, leaders may condone or model bullying, entitled, or abusive practices. a leader may embody sadistic impulses (peck, 1997). real harm is perpetrated when the organization or individual leaders do not facilitate ethical practices. the culture of the work environment may then be toxic. the betrayal of acceptable standards of conduct in a workplace relationship between a supervisor and employee can result in the development of complex trauma for the victim of such behavior (courtois & ford, 2013). over time, the repercussions for staff and clients escalate. silence emerges (wall & austin, 2008) out of fear or actual threat of reprimand. individuals may be forced to leave the employment position. a third factor which influences ethical conduct is the social work ethos. a goal of most professions is to “…instill the implicit assumptions, values and behaviors necessary to be a certified or licensed member” (hadjistavropoulos, 2003, p. 98). this underscores advances in social work, fall 2014, 15(2) 264 the importance of imparting practices that are sanctioned and valued in social work (leighninger, 2000). the canadian association of social workers’ ([casw], 2005) code of ethics sets out an ethical responsibility to relate to colleagues with “respect, integrity and courtesy…” (p. 13). the pursuit of social justice has also been a core value of social work in the united states since the early 20th century, and discussions about justice go back to the ancient greek philosophers, plato and aristotle (reisch, 2002). it does matter that we conduct ourselves, not just with our clients, but in all spheres of social work practice, in accord with these principles. just as “there’s no such thing as business ethics – there’s only ethics” (maxwell, 2003, preface), it is folly to think that we can maintain one standard with clients while having a different standard of conduct with colleagues. moral sensitivity to the complexity in our lives and the real differences that exist between people enhances our commitment to one another (jaeger, 2001). closely associated to the concept of justice is fairness (rawls, 1971) and “…fairness (equity) is a basic issue that runs through the course of human history in all cultures” (goldberg, 2000, p. 41). consideration of fairness in our relationships connects to the concept of reciprocity, which suggests that beyond personal gain in an interaction, there are corresponding “…principles of reciprocity that guide healthy human interactions” (young, klosko, & weishaar, 2003, p. 236). “…[i]deals of fairness and reciprocity underwrite all contract-based systems of morality…” (appiah, 2008, p. 135). unfortunately, as we delve more deeply into core themes such as ethics and social justice and how to promote congruence between the stated concept and reality, a number of dilemmas quickly emerge. a review of the literature on either ethics or social justice reveals that there is neither a uniform nor precise understanding of either social justice (hong & hodge, 2009; reisch, 2013) or ethics (weinberg & campbell, 2014). relationships with both clients and colleagues are inevitably complex and require an understanding and examination of context. the lack of clear consensus or objective truth regarding any of these core concepts amplifies the difficulty in entering into discussion and agreed upon action or rules of conduct. however, as we engage one another in the “struggle to translate the profession’s compelling ethical imperative into real world terms” (reisch, 2013, p. 718), there is a dynamic opportunity to bring real meaning to the experience of living values such as justice, ethical practice, and respect. among the common transgressions in the work place is how oblivious staff can be to stark unfairness. issues of rivalry, ambition, and resentment can arise in social work and may account for such unfairness and disregard for reciprocity. these are all problems stemming from individuals’ focus on how their actions affect only themselves, not their colleagues. however, considering consequential ethics suggests that the consequences of our actions are part of the process of forming an ethical judgment (singer, 1994). consequentialism suggests that we honor our values (mcnaughton & rawling, 1992) and promote them through our actions (pettit, 1989). hence, if we value ethical practices, respect for people, and social justice, right action in given situations requires that our actions are directed at ends consistent with the promotion of such principles. consideration of consequential ethics calls for a discussion of obligations (sinnottarmstrong, 2005), specifically, the moral obligation to act in ways that do not cause harm to others (sinnott-armstrong, 2009). for example, one individual’s ambition can result in o’brien/ethics do matter 265 a poor outcome when considering the consequences for the larger staff group. the thrust of the moral obligation as suggested in the latter article requires consideration of the harm that is caused. this can incorporate reflection and real dialogue about treating one another fairly in the workplace. this is not an easy discussion if it involves examining advantages vis-à-vis disadvantages among colleagues. such discussion can move us into the realm of virtue ethics, which focuses on the individual’s character rather than an action. virtue ethics helps us to examine how we learn to develop preferred character traits. social work educators have a role in supporting the development of moral character and virtue (holmstrom, 2014). as we learn to behave well routinely particular virtues will become ingrained (gardiner, 2003). two dilemmas that cue us to ethical considerations this article will now examine two of the dilemmas and transgressions we can encounter in the workplace. these are bullying and an environment that overlooks or condones discourteous deportment among staff. these examples illustrate the challenge in maintaining congruence between social work values and workplace practices. such deleterious conduct is by no means a fixture in all work environments. nor are these the only examples of dilemmas encountered in a work environment. what motivates or allows such conduct to flourish is beyond the scope of this article. however, these two dilemmas contextualize ideas raised for discussion. a search of the term “workplace bullying” in the academic literature will produce copious references (agervold & mikkelsen, 2004; aquino & thau, 2009; liefooghe & macdavey, 2001; samnani & singh, 2012; vega & comer, 2005). bullying is a form of interpersonal violence (crawford, 1997; lipman, 2003). acknowledging this idea should give all social workers pause to reflect on their behavior toward one another. one risk in attempting to address such unsavory interactions is that the perpetrators will engage in escalating acts to avoid accountability. colleagues may be recruited to engage in mobbing behavior (zapf, knorz, & kulla, 1996), “…ganging up on someone, bullying, or psychological terror” (leymann & gustafsson, 1996, p. 252). mobbing behavior involves hostile communication frequently (weekly) and over time (six months) which can cause “…considerable psychological, psychosomatic and social suffering” (leymann & gustafsson, 1996, p. 252). one aim of such action may be to deflect examination of the contentious conduct. finding ways to ensure “…secrecy and silence are the perpetrator’s first line of defense” (herman, 1992, p. 8). judith herman’s seminal analysis of common behaviors of perpetrators and victims of violence also offers sobering reflection in relation to confrontational interactions in the workplace. bullying is but one type of victimizing behavior in the workplace (aquino & thau, 2009), along with mobbing, incivility, emotional abuse, and harassment. there are several definitions of workplace bullying including that “…it must be perceived by the victim as oppressive, unfair, humiliating, undermining, threatening, difficult to defend against…” (djurkovic & mccormack, 2008, p. 405). such behaviors occurring over an extended period of time is considered an additional characteristic of bullying. workplace bullying is deemed to be a contemporary problem, characterized by hostile and prolonged advances in social work, fall 2014, 15(2) 266 mistreatment toward a person who does not welcome such interaction (appelbaum, semerjian, & mohan, 2012). the intent to do harm and the depth of pain that results from bullying can render victims demoralized and powerless as the behavior persists (vega & comer, 2005). suicide is one tragic result of workplace bullying (brotheridge & lee, 2006; samnani & singh, 2012). more recently, media attention to completed suicide as an outcome of bullying in schools and in cyberspace toward individuals with an alternate lifestyle is also prominent. perhaps the greatest irony of all is to walk through corridors in hospitals or entrances to medical centers and see signs announcing that “abuse of staff will not be tolerated.” it is not just ‘the public’ that needs to respect such commands. a second dilemma or transgression which can illustrate the difficulty in maintaining congruence between social work values and workplace practices involves discourteous deportment in the work environment. it is difficult to understand how well-educated individuals, presumably committed to working in the helping professions, can so often and so cavalierly engage in discourteous, disrespectful conduct toward colleagues. emotional shunning (the silent treatment), shouting at colleagues, or walking around with a baleful expression, effectively distancing colleagues, is not just discourtesy. incivility and even emotional abuse (keashly, 1998) are being practiced. the long-term psychological distress of emotional abuse can be even more deleterious than that caused by sexual or physical abuse (goldsmith & freyd, 2005; kaplan, pelcovitz, & labruna, 1999; rees, 2010). in a culture that oftentimes rewards posturing, aggression, and a macho deportment, it is troubling to see the success of social workers who will imitate a 12 year old schoolyard bully in their interactions with colleagues. responding effectively, without resorting to similar tactics, is a challenge. akin to the scourge of bullying in the workplace, incivility is a concept receiving increasing attention (cortina, 2008; cortina & magley, 2009; cortina, magley, williams, & langhout, 2001; gallus, bunk, matthews, barnes-farrell, & magley, 2014; pearson & porath, 2005). an array of behaviors are identified as constituting incivility, including that they are “…in violation of workplace norms for mutual respect” (cortina et al., 2001, p. 64), demonstrate “…disregard for others” (pearson, andersson, & wegner, 2001, p. 1387), have a negative impact on the work environment and result in harming the target (cortina et al., 2001; gallus et al., 2014). canadian health care providers engaged in project crew (civility, respect and engagement at work) focused on reducing incivility, burnout, and improving social relationships among staff groups (leiter, spence laschinger, day, & oore, 2011). the project arose out of the acknowledged prevalence of incivility in organizations and the desire to promote civility – “…identified as courteous and considerate behavior toward other people” (leiter et al., 2011, p. 1258). the authors contend that civility and respect are defining qualities of an organization, the absence of which connotes numerous negative outcomes. the focus on developing positive social behavior among members of the work group was seen as reducing burnout and creating more positive attitudes at work. in follow-up surveys one year later it was determined that the improvements (crew) can become self-sustaining if they are continued after the formal intervention o’brien/ethics do matter 267 has been concluded (leiter, day, oore, & spence laschinger, 2012). the authors suggested that improvements in civility likely enhance the self-esteem and energy of staff and that a sense of psychological safety evolves in a respectful work environment, further promoting civility. a final implication noted in the latter article is that enduring change is more likely when explicit behaviors that reflect civility are established. it is disconcerting to be in a social work group or a department where multiple staff, even supervisors or senior managers, will acknowledge discomfort in addressing a relentless pattern of surliness and disrespect being communicated by a few staff, often for years. our collective awkwardness in addressing a persistent, demeaning tone contributes to a toxic environment and the departure of staff who simply do not wish to engage in such incivility (cortina & magley, 2009; djurkovic & mccormack, 2008). a “hear no evil, see no evil” practice exacerbates the challenge of maintaining congruence, as staff not subject to transgressions, and even individuals in positions of significant seniority, will prefer to know nothing about impropriety, so long as they are not directly impacted. “do not ask what you do not want to know” is held out as an effective management strategy to side-step impropriety, or to remain apart from the complex interactions that occur in a staff group. such stances neither promote values nor demonstrate respect for persons (pettit, 1989), each important considerations when determining our conduct. communicating indifference to impropriety and abuse risks dehumanizing those subjected to such treatment. perhaps fear of reprisal, self-preservation, or confusion about the complex principle of neutrality, prompt individuals to say and do nothing while colleagues are treated with disrespect or driven from their jobs. this is not neutrality. the risk is that we are collectively diminished when incivility and impropriety goes unchecked. colleagues can help targets of impropriety make sense of their experience (olson-buchanan & boswell, 2008). the quality of social support from colleagues will impact the individual’s stress (chiaburu & harrison, 2008) and decisions to leave the workplace (djurkovic & mccormack, 2008). an opportunity to marry personal responsibility to collective responsibility presents itself when we witness incivility, abuse, and bullying behavior. the poem ‘for whom the bell tolls’ (donne, 1839, pp. 574-575) inspires the idea that we are all interconnected. our social conscience is strengthened when we stand beside, not turn away from our colleagues when they are harmed. ethical deportment is all our concern. suggested remedies this article will now consider steps to support ethical practices. from a systemic point of view, specific values and a code of conduct can be articulated as part of the program mandate. how these are implemented to demonstrate that they are not mere words, but guidelines for interaction, is an important consideration. the congruence between words and actions is a virtue (freire & moch, 1987). the leadership of the program/agency has a unique opportunity to set the tone for deportment in the workplace, not just toward clients, but among colleagues. the responsibility of agency leaders in conducting themselves in a consistently dignified manner can set a strong example for the tone expected among staff of the agency (hunter, 2012; nembhard & edmondson, 2006; toor & ofori, 2009). this important step will likely not suffice. it is also imperative that advances in social work, fall 2014, 15(2) 268 mechanisms to support the stated values and deportment be included in the agency charter. a commitment to accountability and a determination to enforce sanctions against those who choose to transgress the expectation of ethical conduct are essential. when the administrative leadership of a program/agency demonstrates the intention to “walk the talk” of a workplace environment informed by respect, fairness, and justice, the possibility of being part of a deeply meaningful work environment can be inspired. closely resembling the inquiry of our client, “what do you want your life to stand for?” (hayes, follette & linehan, 2004, p. 22), we can recognize that we have a deeper choice in our life being about something. a collective sense of purpose can transcend the everyday mundane, further galvanizing individuals in their calling. the code of ethics for social work and other disciplines in the helping professions can offer a similar example of commitment to our most hallowed values and a determination to enforce them where necessary. having confidence that the professional social work regulatory body has mechanisms to support individual staff in addressing ethical misconduct can help to address impropriety in those situations where the workplace administration is unwilling to do so. the model for such an approach is wellestablished in respective professional codes of conduct, for example, with a protocol for investigating and, where appropriate, sanctioning a social worker charged with ethical impropriety toward a client. holding staff accountable for breaches in ethical conduct could be a progressive step toward creating a professional discipline that exemplifies a commitment to respect, dignity, and fairness. such steps might initially serve as a deterrent, eventually becoming a standard to which all might aspire. the focus will now shift to the individual’s self-reflection and inviting dialogue with colleagues. considering individual contributions to the work environment guards against the individual worker feeling overwhelmed by systemic factors they feel powerless to change. an emphasis on individual actions congruent with social work values and principles also reflects the reality of more front-line staff than administrators in a program, hence the opportunity to make contributions to the creation of a work environment that matters in our collective lives. achieving congruence between values and principles and our everyday interactions is a complex process. making time to talk, being present in the moment, being authentic, practicing the skills and attitudes we value, and being attentive to the real effects that we have on one another all matter. regular meetings and attention to the nuances of communication can contribute to a healthy work environment. fostering respect and a commitment to practices of fairness, justice, and simple decency will further support a healthy workplace. policy can outline specific steps to demonstrate respect and healthy communication. practice occurs as social workers shift from talking about these terms to focusing on how we actually speak to and treat one another in daily interactions. exercises to support staff in developing new, explicit ways of interacting (leiter, day, et al., 2012; leiter, spence laschinger, et al., 2011) can sensitize all concerned to their impact on colleagues. facilitating dialogue has a rich tradition in teaching social work ethics, raising critical awareness in training (hugman, 2005; sakamoto & pitner, 2005), and promoting collaboration in discussion about complex issues for which there is “no o’brien/ethics do matter 269 clear right and wrong” (weinberg & campbell, 2014, p. 45). an ethical workplace is nurtured as such processes evolve. in the current health care and social services climate, it is a lot to ask of social workers that they also make time for reflection and discussion beyond the direct care of clients. however, an experiential supposition of the author is that the quality of care provided for clients can only be as good as the health of the multi-disciplinary staff offering that care. nurturing congruence between our sacred values and our actual daily practices toward one another can support a robust staff not compromised by demoralization or burnout. there are four questions i propose be asked when considering the ethics of our actions. first, are we employing ‘the golden rule’, some variation of which can be found in most major religions and throughout human history (armstrong, 2010; baumard & boyer, 2013; epstein, 2009; maxwell, 2003)? the golden rule is simply ‘to do unto others as you would have others do unto you’. caution is suggested in presuming the golden rule to be a panacea, as individuals may have varying ideas about how they wish to be treated (sandel, 2009). immanuel kant’s categorical imperative (neiman, 2008) may be a more agreeable approach for some. this latter idea suggests that our actions be universalized. in other words, can we answer the question, what would happen if everyone were to act in the manner i am now acting? alternately, the consequences of our action can be considered as a beacon to guide our behavior. by examining the consequences of an action and encouraging discussion of the implications of individual actions for the entire group, a dynamic and comprehensive exploration of ethical practices can evolve. in each instance, the idea is to raise our consciousness about how we wish to be treated and how we treat others. a second question is to consider a more personal examination of the proposed behavior: what would it be like for me if i was treated in the manner that i am treating others? as a reverse form of empathy, this may assist us in paying attention to the real effects of our actions. a third question is: how would i feel if everyone knew that i was acting in this manner? our comfort level when answering this question is a useful barometer of the ethics of our actions. a fourth question is: am i accountable for my actions and their consequences for colleagues? it is troubling to realize how frequently questionable conduct will occur, with no apparent thought or concern for the impact of one’s actions on others. an absence of accountability may be accompanied by denial, disdain, or impunity with respect to the impact of our actions on colleagues. these are alarming warning signs about our ethical conduct. an inordinate focus on self-interest can deflect sensitivity to the inevitable impact of our actions on our colleagues. in a culture where the notion of entitlement is so prevalent, being accountable for our actions and their consequences takes character. further complicating this discussion is the realization of how difficult it is to arrive at a shared agreement about what constitutes social justice or fairness. there is no guarantee of a shared ethos or even a clear mandate beyond lofty ideals that may not readily advances in social work, fall 2014, 15(2) 270 translate into applicable behavior toward one another. a work situation, created by accident or design, which privileges one individual at the expense of another demands a great deal of both parties to engage in discussion and negotiation about redressing what may be perceived by only one party as an injustice. this can be an extraordinarily difficult discussion to enter into, calling for trust, genuineness, and a commitment to agree upon values and practices in the workplace. how we speak to one another and how we negotiate our relational space can inform our ethics. openness to a discussion with colleagues about our conduct and its impact is a further check on the propriety of our actions. such practices require self-awareness and sensitivity. karen armstrong’s examination of necessary steps to a compassionate life identifies the eighth step as “how we should speak to one another” (armstrong, 2010, pp. 131-132). armstrong notes that this takes time, is hard work and must “…be conducted in a kindly and compassionate manner” (p. 132). social workers are generally wellinformed about the nuances of communication expressed through words, tone, body language, and eye contact. individuals can decline to resort to demeaning language or personal slurs. choosing language and tone that invites mutual respect, dialogue, and collaboration speaks volumes. it also takes considerable neural energy to interrupt old patterns and to establish new habits that are more consistent with communication that is respectful and compassionate (newberg & waldman, 2012). with every word and sentence we speak we are sending verbal and nonverbal messages about how we intend to be with other people. our relationships can thrive as we practice nuanced communication that invites mutual respect and compassion. it is not a matter of presuming to dictate how social workers will interact. rather, it is a matter of providing a forum where individuals are invited to have an authentic and open discussion about how we intend to be with one another. multiple factors such as personal inclination, ambition, experience, self-interest, and informal alliances deserve reflection. exploration of interactions among colleagues that identify uncertainty, disagreement, and challenges in creating a preferred environment can be encouraged. an emphasis on opening up a dialogue among staff of the work environment can guard against a limitation in self-reflection. the process of self-reflection, while a necessary precursor to change, does not ensure engagement with colleagues. when we commit to meaningfully talk to one another we enter into a spirit of community; “…it is in dialogical encounters that one’s ethical understanding takes shape and that these must be true encounters…” (austin, 2007, p. 85). bringing ethical practice to life involves a commitment to encounter one another with genuineness. in recent years interest in such concepts as mindfulness and being present in the moment (kabat-zinn, 1990) has increased. these practices can enhance our attention to interactions and communication with colleagues. we can commit ourselves to being aware of the real effects of our actions toward one another (white, 1996). this includes nurturing respect in our relationships with one another, respect for the differences that inevitably arise from negotiation, and increased attention to the relationships we wish to create and maintain with our colleagues (bergum & dossetor, 2005). o’brien/ethics do matter 271 conclusion ethics do matter, and on a daily basis in our workplace. the commitment to ethical practices, grounded in congruence between social work values and our everyday acts, can promote a healthy work environment. this can sustain the individual worker and enhance the care of clients. the willingness to engage in genuine dialogue with colleagues about 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(1996). on the relationship between mobbing factors, and job content, social work environment, and health outcomes. european journal of work and organizational psychology, 5(2), 215-237. author note address correspondence to: peter j. o’brien, msw, rsw, shared mental health care, alberta health services, sheldon m. chumir health centre, 1213 – 4th st. sw, calgary, alberta, t2r 0x7. email: peter.obrien@albertahealthservices.ca microsoft word editorial_sages_copyedit 2 ______________ gerald t. powers, ph.d., is a professor emeritus and virginia majewski, ph.d., is a professor, both in the indiana university school of social work, indianapolis. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), i-iii editorial sages of the profession: celebration of our heritage gerald t. powers virginia majewski special issue co-editors the indiana university school of social work recently celebrated its 100-year anniversary as the oldest school of social work continuously affiliated with a university. that seminal occasion served as a compelling reminder of the extraordinary history of our profession and its relentless efforts on behalf of the vulnerable, oppressed and disadvantaged members of society. for more than a decade, the school’s journal advances in social work has been devoted to the dissemination of theory and research that supports these efforts of social work educators and practitioners. thus it seemed only appropriate that we devote a special issue of advances to a retrospective exploration of some of the critical events in the history of the profession that have contributed to and help shape our present understanding of social work practice and education. the intent of this special issue is to chronicle the rich heritage of the social work profession and its educational initiatives as seen through the eyes of those who have actually lived and contributed to that heritage. accordingly, the editorial board felt that the best way to document some of these critical events would be to invite a group of nationally recognized scholars to provide first-person, eyewitness accounts of their observations and direct involvement with the events as they unfolded. the initial challenge in creating this special issue was to identify a representative group of social work “sages,” that is, those individuals with the professional and academic credentials that would qualify them to speak authoritatively about the landmark events and challenges in the history of the profession. the editorial board agreed that the best approach might be to send requests for nominees to all deans and directors of social work programs across the united states and canada. the request stated, “we are especially interested in capturing the first-hand accounts of our senior colleagues who have either been a part of seminal historical developments within the profession or have been eyewitnesses to those events. the authors will have considerable latitude with respect to the topics they wish to address. our goal is to provide a forum for the discussion of historical events that have helped shape the culture and direction of the profession and its educational and knowledge-building endeavors.” from an impressive pool of more than 40 highly credentialed nominees, we then contacted a wide range of prospective authors whom we felt would enable us to compile a diverse set of historical documents representative of some of the more significant historical events in the evolution of the profession. the identified prospective authors were then invited to submit manuscripts on topics directly related to their specific areas of expertise. advances in social work, spring 2014, 15(1) ii the response to our invitations was both immediate and enthusiastic. virtually all of the invited authors indicated a genuine interest in the project. some indicated that they had to regretfully decline our invitation due to earlier commitments and the tight turnaround time dictated by the publishing deadlines. however, many invited scholars indicated that they were both interested and willing to submit articles. the scholarly products of this initial group of sages appear in the present volume. readers may undoubtedly look for sages they know well or for areas of practice and education not covered in this volume. we recognize that our initial group represents a small sample of the many highly distinguished individuals who might submit authoritative documents for such an historical volume. we also recognize that we have not covered all areas of education and practice. nonetheless, despite the limitations of our selection process, we have been very encouraged by the enthusiastic response exhibited by our colleagues for an historical initiative designed to capture some of the rich heritage of our profession before it is lost to posterity. given our success in this limited initiative, and partially because of its limitations, we would like to perpetuate the organizing principle that has informed this volume by creating a more permanent repository for subsequent scholarly manuscripts directly related to the history of social work. by doing so, we hope to provide a forum for authors of the type represented in this special edition to share their unique first-person perspectives on important historical events in the development of the profession. this continuing initiative will be referred to as the heritage collection. as subsequent historical manuscripts that meet the editorial protocol established for both the journal and this present special eyewitness edition are submitted and approved, they will be published in the most current edition of advances in social work and, with the approval of the author, included as part of the compendium of articles comprising the heritage collection. because of the unique enduring nature of these historical documents, it is anticipated that they will provide an invaluable resource for researchers, faculty compiling course syllabi, or anyone interested in the origins and development of the profession. in addition, the collection will provide a forum for scholars to compare and contrast individual perceptions of the same historical events. our editorial decision was to present the seventeen manuscripts in alphabetical order by primary author name. each scholarly contribution stands alone in the author’s or coauthors’ presentation and interpretation of salient historical events and her/his/their unique involvement in these events. nonetheless readers will see some overlap in terms of such topics as the growth of professional education, research infrastructure for social work, evolution of theoretical approaches and frameworks for practice, ethics and philosophy, diversity and oppression, and pioneer efforts in fields of practice such as child welfare and mental health. due in part to the direct eyewitness nature of many of the historical accounts, the authors chose to write in the atypical first-person. this more colloquial approach contributed to the kind and level of authenticity that can only be achieved by someone who has “been there and done that.” in many instances, the content of the articles provides intriguing insights, not only into the nature of the subject matter under powers, majewski/editorial: sages of the profession iii consideration, but also into the character of the authors as they struggled to make meaningful changes with respect to the issues with which they grappled. the editing of this special issue has proven to be a most rewarding and informative learning experience. we have been privileged to be able to communicate and interact with so many noted scholars and pioneers of our profession. we have been struck by the care and sensitivity with which our cohort of authors approached their subject matter. several indicated that at times, their journey into the past precipitated a sense of nostalgia, and in some instances, painful memories. nevertheless, a common reaction to having participated in these historical sojourns has been one of satisfaction and fulfillment. in every instance, their manuscripts reveal how passionately the authors feel about the subjects on which they’ve written and devoted important segments of their lives. we extend sincere thanks and appreciation to all our contributing sages and to those who will consider contributing in the future to the heritage collection. author note address correspondence to gerald t. powers, ph.d., professor emeritus, indiana university school of social work, 902 w. new york st., indianapolis, in 46202-5156. e-mail: gpowers@iupui.edu gerald (jerry) powers earned his baccalaureate degree in sociology and philosophy from the university of scranton, an msw degree at fordham university, a phd at the university of pittsburgh, and did post graduate work at the university of chicago. during his 37-year affiliation with the iu school of social work, he was instrumental in the development and accreditation of the phd program and served as its founding director during its first nine years. he also served as acting dean of the school from 1983 thru 1985. his teaching, research and published scholarship, including a research text entitled practice-focused research, have emphasized practice evaluation research, the scholarship of teaching and learning, strengths-based social work and resilience theory. jerry has several university awards, including induction into the indiana university faculty colloquium on excellence in teaching (facet) in 1990 and was recently recognized by that organization with the prestigious honorary pa mack award for distinguished service to teaching. he was a captain in the us army having served as an army social work officer at brooke army hospital in san antonio, tx and the irwin army hospital at fort riley, ks. virginia (ginny) majewski serves as professor in the indiana university school of social work. she holds a master of arts in hispanic languages/latin american studies, master of social work, and doctorate in public and international affairs from the university of pittsburgh. in 2013, she received the distinguished alumni award from the university of pittsburgh school of social work. she recently served the iu school of social work as associate dean, and before as chairperson and msw director at west virginia university, and chairperson and bsw director at california university of pennsylvania. dr. majewski’s teaching, service, and scholarship revolve around her commitment to service and experiential learning to enhance professional competence. in 2007, she co-edited the book social work and service learning: partnerships for social justice and has presented extensively in this area in national and international venues. she is also active in the national rural social work caucus and focuses on food insecurity, indigenous issues, and community organizing. microsoft word ginsberg_rural sw_copyedit final ______________  leon ginsberg, ph.d., is dean emeritus of the college of social work at the university of south carolina in columbia, sc. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 105-116   the origins and future of rural social work leon ginsberg abstract: traced in the article are some of the author’s reflections and experiences related to the origins of rural social work practice as well as some of the issues currently crucial for rural social work educators and practitioners. new data on u.s. rural demographics are provided. one factor with a special impact on rural life is the development of technology, which in some ways is changing the nature of rural community life. integrated into this discussion of rural practice are observations about social work education in general and some of its current trends, reflective of the author’s 50 years as an educator. keywords: rural social work, social work education, west virginia university close to fifty years ago, the council on social work education decided to include a session on rural social work in the 1968 annual program meeting, to be held in cleveland, one of the classically metropolitan areas of the united states. in that same year i was to be the new director of the division of social work at west virginia university in morgantown, when there were only 50 accredited msw programs. wvu was one of a handful of schools that organized its curriculum around “functional social work,” based on the theories of otto rank, who although once a colleague of sigmund freud, had charted a different approach to psychiatry and psychology. in order to provide a bit of historical context for those who became social workers more recently than i did, i should note that schools were oriented to one or the other of two ways of understanding human behavior and human services. i will thus begin with a discussion of these two orientations. freudian vs. rankian social work orientations in the decades before the 1970s, almost all accredited schools of social work, meaning msw programs because bsw programs were not accredited until 1975, were nominally associated with freudian or “diagnostic” approaches to human services. i was educated in that approach at the tulane university school of social work in new orleans in the late 1950s. these distinctions are treated in nasw’s various editions of the encyclopedia of social work as well as books on the subject (rozean, 1975). in 1961, the cswe curriculum policy statement was changed significantly. it required schools to add to their curricula content from the social science disciplines. schools, for the most part, continued to focus on the teachings and writings of freud although often there were more current updates of the diagnostic theory. one of the most popular was the work of erik h. erikson and his concept of the eight stages of life laid out in his 1950 book, childhood and society, as well as in many subsequent works further developing his ideas. the impact of erickson’s epigenetic paradigm has advances in social work, spring 2014, 15(1) 106 demonstrated remarkable persistence over the years and continues to be an important conceptual lynchpin for a number of contemporary psychology programs. erickson’s continuing influence has also been evident in several recent doctoral dissertations on which i have served. selma fraiberg’s (1959) work on early childhood was also popular with freudian-oriented schools. the rankian school of thought also had an important impact in curriculum development of a number of schools of social work, especially at the university of pennsylvania where the so-called “functional school” originated with the help of rank himself (rozean, 1975). for a time, the university of north carolina and west virginia university were also oriented to the “functional” school. whether or not a school was “functional” or “diagnostic” often depended upon the point of view of its dean or director. at wvu, before i arrived, the director was bernhard scher, who had been associated with the university of pennsylvania. eventually the philosophical disputes among the advocates of the freudian vs. the rankian points of view were largely forgotten in the wake of the hotly debated issues that emerged during the tumultuous 1960s. there was a heightened awareness of the influence of systemic factors on human behavior. a whole host of new concerns precipitated a growing awareness of the importance of incorporating sociological, anthropological, and political perspectives into mainstream social work theory and practice. of all the societal issues that seemed to converge during this period, the explication of and action about ethnicity, color, and the civil rights movement were paramount. with increased pressures from both within and outside the profession to validate the efficacy of its interventions, this broader “systems” framework was complemented by approaches such as behavior modification based on learning principles espoused by b. f. skinner (2011), social change theory (ross & lappin, 1967), and the emergence of resilience theory and strengths-based social work (saleebey, 2006). the 1960s signaled the origin of the major civil rights battles including: the brown v. board of education supreme court decision in 1954, requiring the desegregation of public schools; the montgomery, alabama bus boycott; and, the emergence of such leaders as thurgood marshall, who argued the brown case before the supreme court and eventually became the first african american member of the supreme court, and, of course, martin luther king, whose birthday is now a national holiday. some of that history of the civil rights movement was recently revisited in connection with the 50th anniversary of the 1963 march on washington. richard cloward and herman stein’s edited book, social perspectives on behavior (1958), was the basis for much of the emphasis on the social science additions to the traditional social work curriculum. cloward and stein were social work professors at columbia university, site of the first school of social work and often known at the time as the flagship school of social work. when columbia did anything, most other schools fell into line. so what orientation should the west virginia university school adopt? the rankian functional orientation was no longer in the mainstream. however, the faculty was oriented to it. the freudian diagnostic orientation was perhaps becoming passé given the ginsberg/rural social work 107 new emphasis on social issues and social science ideas. i asked richard lodge, then dean of the virginia commonwealth university school of social work, who had nominated me for the west virginia position and who had a history of affiliation with penn, what he thought. (lodge later became executive director of cswe.) he suggested that the orientation ought to be rural social work – neither diagnostic nor functional. eventually, many schools adopted such orientations reflecting settings or fields of practice rather than an allegiance to any particular theoretical frame of reference such as the rankian or freudian schools. the wvu school of social work selected rural social work as its primary field of practice for its msw program. without belaboring the issues, making such a broad change as orienting the msw program around rural social work had significant consequences. over the scher years most of the wvu school’s field placements were all in agencies oriented to the theories of rank – most of them outside the state. but the changes were made: placements were all to be in the appalachian region, most in west virginia. parenthetically, although many schools evolved away from the freudian vs. rankian orientations, not all did. some schools continue to emphasize one or the other of the approaches. even the freudian adherents adopted some of the rankian concepts such as limited time, identifying with the agency function, as well as others. and there continue to be agencies that focus on some of those approaches, neither of which makes much sense in disadvantaged and rural settings. not long ago, i recommended one of my outstanding university of south carolina students to an eastern u.s. agency that was committed to freudian approaches. she was lost during the interviews – had no idea what she was being asked. the rural social work orientation of the west virginia university school of social work culminated in a special session at the 1968 cswe annual program meeting in cleveland, mentioned earlier, a session that was not only oversubscribed but which also attracted a wide range of participants from areas as disparate as new england, the south, and of course, appalachia. from that early beginning, cswe obtained grants and contracts to educate about rural social work. agencies such as the national institute of mental health, which provided grants at the time to all msw programs, the children’s bureau, and the veterans’ administration, all adopted some emphases on rural social work. one of the early grants provided for educational sessions at indiana university and the university of denver. today there is a rural social work educators’ caucus, an online journal, contemporary rural social work, and an annual institute on social work in rural areas that has operated continuously since 1976 at sites throughout the u.s. i discovered, somewhat later, after i began writing about rural social work, that this was not a new initiative. josephine brown wrote in 1933 about rural social casework but somehow her work and several other earlier efforts were lost in the new approach to the subject. emilia martinez-brawley’s (1981) seven decades of rural social work traces that history, which began with the theodore roosevelt administration in the early twentieth century to the inception of the rural caucus in the mid-seventies. many of brown’s ideas are similar to those i included in the earliest versions of my edited book (ginsberg, 1976) and in the lectures and workshops i presented. where did i advances in social work, spring 2014, 15(1) 108 get my ideas? for the most part, i made them up, based on a lifetime of small town connections and work with american indian groups, rural texas eastern european contacts, rural peace corps centers, serving on the board of the now-defunct rural america, incorporated, and other places and organizations in which i lived and worked. the ideas of the domination by primary groups such as churches, families, and neighborhoods, and the importance of relating to and working with and through such groups were primarily based on personal experiences and informal conversations with rural residents. the issues of social policy and the american neglect of its rural areas were obvious and were also emphasized in president johnson’s national advisory commission on rural poverty (1967) report, the people left behind. changes in rural america the huffington post reported that the metropolitan-rural population differential had changed to 85 percent urban or metropolitan to 15 percent rural by 2011, the smallest rural proportion in american history (yen & dreier, 2013). the rural or non-metropolitan population had consistently been 20 to 25 percent of the total since we began writing about rural social work, and stood at 72 percent in back in 1910 (nusca, 2011). yen and dreier (2013) suggest that much of the change can be attributed to older adults leaving their rural homes for cities – often because of necessary and more broadly available health care and the other resources of american cities. rural areas, which include manufacturing and farming as well as scenic retirement spots, have seen substantial movement of residents to urban areas before. but the changes are now coinciding with sharp declines in u.s. birth rates and an aging population, resulting in a first-ever annual loss. u.s. migration data show that older americans are most inclined to live in rural counties until about age 74, before moving closer to more populated locations. the oldest of the nation's 76 million boomers turn 74 in 2020, meaning the window is closing for that group to help small towns grow (yen & dreier, 2013, para. 12-13). i noticed that my relatives in rural texas towns such as weimar and halletsville moved to houston and its suburbs as they advanced in age, confirming, for me, at least, that the huffington post observations are correct. of course, many analysts point out that the rural population is also declining because many formerly rural towns have become suburbs of major metropolitan areas. technology and rural people the fifth and most recent edition of social work in rural communities (ginsberg, 2011) includes two chapters on technology and its impact on rural people authored by glenn e. stone and karen v. harper-dorton. these documents chronicle the major shifts in the lives of rural people. innovations such as the internet changed and are continuing to change the lives of people who live in smaller communities. such remarkable changes were not foreseen by most writers when they envisioned the future. now that the future ginsberg/rural social work 109 has arrived, it is clear that technology, especially technology tied to the internet, is the most important development in the lives of rural people. when we discuss rural limitations and disadvantages several issues tend to arise: the lack of recreational and entertainment options; the lack of the ability to shop at reasonable prices for goods and services; the availability of health care services; and, economic opportunities, principally jobs. many, but not all of these, are addressed by technological developments. for example, entertainment, which was once limited to movie theatres in metropolitan areas, is now available to anyone in the united states through sources such as redbox and blockbuster dvd kiosks, in both traditional dvd and blu-ray formats, almost everywhere for relatively low cost. netflix, which relies on the u.s. postal service and the internet, makes films available conveniently, rapidly, and at low cost. many current and recent films are available to anyone with a tv cable connection through video on demand and various other video streaming services – often at a greater cost than those mentioned above but still significantly less than a typical pair of theatre tickets. rural people who invest in securities such as stocks and bonds can track their purchases and holdings on several internet sites or on financial news networks such as cnbc. whereas in the past investors had to visit investment companies to follow the markets, that kind of information is now readily and consistently available on tv or on the internet. the theatre-style rooms in brokerage offices with stock information constantly displayed to a few interested investors are no longer necessary. perhaps the greatest entertainment developments are through social networking sites such as facebook, twitter, linkedin, and several smaller services, all readily accessible via computers, tablets, and smart phones. i first encountered the importance of these “social media” in the los angeles area when i stopped for dinner at an ihop near the lax airport. a young woman sitting across from me, whose male friend had departed for a while, was looking at her cell phone and smiling and laughing. i couldn’t figure out what she was doing. why would one stare at a telephone call? later i realized that californians were using social media sites. like most american trends, that one began on the west coast and spread across the nation. now, wherever we go, people are staring at their telephones and, on occasion, fingering them. at the movies or at plays, announcements forbid cell phones to be activated. nevertheless, when the entertainment becomes tedious or dull, audience members turn immediately to “texting” and their social network memberships. apparently, networks such as facebook and twitter provide unlimited entertainment, gossip, and news about people. texting while driving has been documented as a major contributing factor in many automobile accidents and is extensive enough that several states have outlawed it. notwithstanding the faa’s recent regulation change, most airlines have attempted, often unsuccessfully, to ban cell phone usage while their planes are airborne. classrooms, which often permit note-taking by computer, are plagued by constant, sometimes noisy, pecking on cell phones and ipads. even at home, i notice that my children and grandchildren and wife spend hours of their free time reading their cell advances in social work, spring 2014, 15(1) 110 phones and connecting with others on computers. the social networks are a major form of entertainment for many people. as for shopping for clothing, technology hardware and software, toys, sporting goods, or almost anything else, rural people have access through the internet to all kinds of sites and services that make it possible to purchase almost anything. the amazon.com site literally sells everything – cosmetics, books, sports equipment, auto parts – although it began as a place to buy books at discount prices. amazon owns zappos, one of the largest vendors of shoes as well as clothing. computer users can try on eyeglasses “virtually” and receive an assortment of frames to choose from before making a final selection. several years ago, when i frequently traveled to new york, i always visited forty second street photo, a local chain of stores that sold name brand electronics at discount prices. it advertised regularly in the new york times. but the stores are long gone. now anyone, anywhere, can purchase all the electronics and photography equipment they want at competitive prices, which can be checked and compared on the internet. a toll free telephone call or email will yield the purchase by mail, ups or fedex. so buying almost anything is available to rural residents through the internet. rural-urban inequalities despite the technological advances described above, there are still some advantages in urban areas that are not available in rural communities and they are not likely to come to small towns to the extent necessary. health care is one example. most of the tertiary care hospitals are located in large urban areas, which may be distant from most small towns. even office visits with physicians are limited. in boone, north carolina, a town with 15,000 permanent residents and a similar number of students at appalachian state university, almost all of our medical visits are with physician assistants or nurse practitioners – usually quite talented and knowledgeable – rather than mds. vision services are often with optometrists rather than ophthalmologists. those differences in care are not likely to change any time in the future. transportation in rural areas is still limited primarily to privately-owned automobiles. there is little public transportation except in special situations. in boone, appalachian state university and local government operate a free and efficient bus service available to anyone at no cost. the alternative would have been construction of extensive parking lots, which cause a variety of other problems. two major issues that remain unresolved despite the availability of technology are economic disadvantage and unemployment. jobs are still scarce in rural areas although some corporations are decentralizing their operations to areas outside large cities. bmw operates a plant in greer, south carolina. apple is constructing a facility in maiden, north carolina, and google is doing the same in lenoir, north carolina. honda, hyundai, and mercedes operate plants in several alabama small towns, as does toyota. so there is some relief to the endemic unemployment and underemployment in rural america. ginsberg/rural social work 111 technology and higher education, including social work education probably the single most revolutionary transformation in the preparation of social work practitioners has been the infusion of technology into higher education. schools of social work began offering courses online, by television, and on media such as dvds and videotapes in the latter decades of the twentieth century. according to executive vice dean r. paul maiden, the university of southern california school of social work offers the msw throughout the united states wherever there are sufficient numbers to justify a class (personal communication, 2011). much of the instruction is by means other than traditional classroom activities with students and professors in the same room. the cost differential for studying social work at southern california or at a state university is significant. according to websites for the institutions mentioned, each semester’s tuition at southern california is $21,000. at appalachian state university, where i most recently taught, semester tuition and fees for north carolina residents is $3,246 and for residents of other states $9,356. california state-supported universities such as ucla charge in-state students about $6,500 per semester and out of state students about $11,000 per semester. at indiana university, a full semester in the graduate school costs about $5,000 for residents and $15,000 for non-residents. of course, state universities in all states have some support from their state governments, although many of the most distinguished claim that state support amounts to less than half their budgets. duke university began offering its master of business administration in nonresident ways several years ago. harvard offers a number of non-degree programs throughout the year which allow participants to indicate they have studied at the nation’s most prestigious university. largely non-resident institutions such as webster university, nova university, and capella university, among others, offer extensive education away from traditional campuses. some were seeking social work education accreditation as this was written. the university of phoenix is another non-traditional institution that offers extensive higher education throughout the united states. argosy, whose current president is a former social work education dean, is another. many, but not all, of the newer and non-traditional universities are proprietary, profit making businesses. some are listed on stock exchanges as stockholder-owned corporations. these universities as well as many of those that are traditional, bricks and mortar institutions, advertise extensively. the competition for students has become increasingly intense. potential students are recruited in the same ways other products and services are marketed in the united states, by newspaper, tv, and magazine advertising. i’m always a bit surprised to see, read, and hear pitches for education, which was once a staid and limited product. higher education administrators, noting the high costs of construction, find that education can be delivered technologically with minimal costs. one of the less often mentioned elements of technology is that information can be conveyed at little or no cost, once the infrastructure is developed for such information transmission. signals delivered through the air or stored on “the cloud” are basically free as are most telephone advances in social work, spring 2014, 15(1) 112 communications. so a small investment in technology can save billions compared to constructing and maintaining traditional classrooms and laboratories. part of this trend is also a function of the pervasiveness of modern technology. college recruiters tell me that the first place students look for information on degrees are university websites. so keeping websites attractive and informative becomes one of the main strategies by which institutions promote themselves. education referral services, which must earn fees for recruiting students, often pop up when one tries to access information about a college or university. for a while, every time i entered the term “social work” in an email document, which is most of the time, i was offered an opportunity to apply to the university of southern california social work program. while doing research for this article, i entered the term social work and received an ad saying that if i had a bsw i could earn the msw at southern california in only one year. tv advertising, especially during off-prime time hours when rates are lower, is also common and growing. often the ads are for proprietary programs. where i live, the most frequent ads are for itt technical programs and virginia college – not the same, of course, as many of the long-standing universities and colleges in the state of virginia. new hampshire advertises an online college, which might be confused with the university of new hampshire, the site of one of the best rural institutes in recent years and home of a distinguished school of social work. they’re quite different institutions. one also notices highly specialized advertising in specialized magazines. the b’nai b’rith magazine, publishes several pages of ads each month for college and university programs, especially law schools, proclaiming their interest in jewish applicants. of course, disproportionate numbers of jewish people seek university degrees, especially professional degrees. from a 2007 survey, the pew forum on religion & public life (2008) reported that 59 percent of american jewish people have four or more years of college, exceeded only by american hindus, 74 percent of whom have similar academic achievement. the jewish community, which is traditionally located in metropolitan areas, has some outlets with a rural focus. the national association of jewish federations is a fund raising and social planning organization principally for rural and small town jewish residents. organizations such as the south carolina jewish historical society regularly reports on jewish backgrounds in rural communities, most of which disappeared long ago into metropolitan america. ben bernanke, former chair of the federal reserve, for example, grew up in dillon, south carolina, and played in the high school band there. the online colleges typically advertise that they are “accredited.” however, accreditation, as social work educators know well, comes in a variety of forms. regional accreditation by one of the six accrediting bodies can give sanction to an institution but not necessarily to every degree it offers. for our own example, an accredited school or department of social work has to be associated with a regionally accredited institution (middle states, southern association, western interstate commission, etc.) and also accredited by the council on social work education, which has its own standards and accreditation procedures. online colleges have their own accrediting bodies such as the accrediting commission of the distance education and training council (detc). accreditation by ginsberg/rural social work 113 that group does not imply regional accreditation or the specialized accreditation required for social work, nursing, and many other fields. many of the online and other non-traditional colleges and university students are eligible for government-guaranteed student loans and critics often suggest that some of those institutions survive financially because of those loans. critics also suggest that the failure to pay back these loans is higher in non-traditional institutions than in the more traditional colleges and universities: for-profit institutions continue to have the highest average twoand three-year cohort default rates at 13.6 percent and 21.8 percent, respectively. public institutions followed at 9.6 percent for the two-year rate and 13 percent for the three-year rate. private non-profit institutions had the lowest rates at 5.2 percent for the two-year rate and 8.2 percent for the three-year rate” (u.s. department of education, 2013, para. 6). of course, all colleges and universities depend, in part, on students receiving federally guaranteed loans. some critics suggest that many of the degrees provided by nontraditional schools are less than valuable for seeking employment and becoming eligible for promotions. the primacy of money and fund-raising money and the primacy of fund-raising needed to provide it have changed some older institutions that have not always seemed to need solicitations to keep themselves afloat. when an organization’s primary focus becomes that of fund-raising it would seem to distort the organizational purposes and priorities. for example, since my teenage years i have read consumer reports to help determine what to buy. in recent years, however, that publication has become more and more a fund-raising operation – seeking inclusion in their readers’ estates, running sweepstakes, selling automobiles, and marketing specialized publications on various subjects such as health and finances. recently, they ran an article in their main magazine on the best hospitals for surgery in various parts of the country. but to find detailed information on the subject, one had to subscribe to their health newsletter, in print or online. aarp, which used to stand for the american association for retired persons and now just stands for itself, sells medicare supplement plans, automobile insurance, life insurance, and a host of other products and services. of course, they, along with consumer reports, also advocate for policies affecting their spheres of interest such as older adults by aarp and product safety and quality by consumer reports. my own work, before i moved to the carolinas was as chief executive officer of higher education in west virginia. the more i reflect on that position, the more i have come to believe that i was ill-suited for the job. higher education is extensively about marketing and fund-raising. in state institutions, one of the major preoccupations is real estate – land, construction, and real estate regulation. many of the board members are in the real estate business at one level or another. they may have some discussions of advances in social work, spring 2014, 15(1) 114 academics but the majority of the agendas in meetings of boards of trustees are about buying and selling land and constructing or renovating buildings. my own knowledge of these issues is minimal. i watch the newest president of the university of south carolina, with whom i served as a dean colleague and in his purview when he became a vicepresident. he is masterful in discussing bond issues, interest rates, land acquisition, and construction, yet his professional background is public health. he is so good at his job that the university gave him a bonus if he would promise to stay in the presidency for the coming five years. i wrote about these issues in the 1980s and was quoted in the chronicle of higher education, suggesting that public officials and legislators were more interested in showing that they “got” a building for a local campus than they were in talking about their educational achievements. the reporter from the chronicle said my comments astonished the reporters. they knew the same things but had never found a higher education officer who would discuss them. conclusions rural social work has changed over the years since this author personally began writing about the subject at west virginia university. some of those changes are discussed in this article. technological changes have made large differences in the lives of rural americans, who are a dwindling proportion of the american population, according to some analysts of the 2010 census. many of the non-economic elements of rural inequalities are mitigated by the developments in technology, especially the internet, but economic and employment inequalities remain. technology is also changing social work education, especially the ways in which it is delivered. earlier concerns about psychological orientations are no longer extensively discussed – or in most cases even remembered – in a very different social work environment that existed before the 1960s. as this article has suggested, social work in rural areas is changing, partly because of technological developments. education for professional social work is also changing, providing aspiring social workers with many more options for pursuing degrees such as the bachelor of social work or the master of social work. with the development of many new delivery systems, social work education is no longer as place-bound as it has been, historically. students may pursue their studies in their own residential areas. the costs of education and service delivery are also potentially reduced because of new technological developments. it is much less costly for educational institutions to play their roles economically. perhaps the reduced costs will be reflected in future tuition and fee assessments. in essence, rural social work may be in the process of equalizing with metropolitan social work and education for social workers may be changing in ways that make it less costly and less different than it has been in the past. ginsberg/rural social work 115 references brown, j. c. (1993). the rural community and social case work. social service review, 7(4), 691-693. cloward, r. a., & stein, h.d. (1958). social perspectives on behavior: a reader in social science for social work and related professions. glencoe, il: free press. erikson, e. h. (1950). childhood and society. new york, ny: w.w. norton. federal highway administration. (2011, july 27). census issues: metropolitan planning and programming milestones. washington, dc: author. retrieved from http://www.fhwa.dot.gov/planning/census_issues/archives/metropolitan_planning/cps 2k.cfm fraiberg, s. (1959). the magic years. new york, ny: charles scribner and sons. ginsberg, l. h. (ed.). (1976). social work in rural communities. new york, ny: council on social work education. ginsberg, l. h. (ed.). (2011). social work in rural communities (5th ed.). alexandria, va: council on social work education press. martinez-brawley, e. (1981). seven decades of rural social work: from country life to rural caucus. new york, ny: praeger. nusca, a. (2011, july 28). rural u.s. population lowest in history, demographers say. retrieved from http://www.smartplanet.com/blog/smart-takes/rural-us-populationlowest-in-history-demographers-say/17982 pew forum on religion & public life (2008). u.s. religious landscape survey. report 1: religious affiliation: diverse and dynamic. washington, dc: author. retrieved from http://religions.pewforum.org/pdf/report-religious-landscape-study-full.pdf president’s national advisory commission on rural poverty. (1967). the people left behind. washington, dc: u.s. government printing office. ross, m. g., & lappin, b. n. (1967) community organization. new york, ny: harper and row. rozean, p. (1975). freud and his followers. new york, ny: knopf. saleebey, d. (ed.). (2006). the strengths perspective in social work practice (4th ed.). new york, ny: pearson/allyn and bacon. skinner, b. f. (2011). about behaviorism. new york, ny: harper and row. u.s. census bureau. (2012). 2010 census urban and rural classification and urban area criteria. retrieved from http://www.census.gov/geo/reference/ua/urban-rural2010.html u.s. department of education. (2013, september 30). default rates continue to rise for federal student loans. washington, dc: author. retrieved from advances in social work, spring 2014, 15(1) 116 http://www.ed.gov/news/press-releases/default-rates-continue-rise-federal-studentloans yen, h., & dreier, h. (2013, june 13). rural population shrinking for first time in u.s. history, census finds. huffington post. retrieved from http://www.huffingtonpost.com/2013/06/13/rural-us-population-goesdown_n_3433855.html author note address correspondence to: leon ginsberg, ph.d., 318 leaning tree road, columbia, sc 29223-3011. email: leonleonginsberg@gmail.com leon ginsberg teaches social work at the university of south carolina and appalachian state university. recipient of the 2011 council on social work education lifetime achievement award, ginsberg led the department of social work at appalachian state and assisted with the department's initial accreditation of its msw program. he also served as interim chair of the appalachian state department of physics and astronomy after his completing his work with the department of social work. from 1986 until his retirement in 2006, dr. ginsberg was carolina distinguished professor at the university of south carolina college of social work and served as its dean during the last three of those years. previously he served the state of west virginia as commissioner of the department of human services and chancellor of the board of regents for higher education and had been the dean of the school of social work at west virginia university. _________________ rebecca g. mirick phd, msw is an assistant professor, school of social work, salem state university, salem, ma 01970. ashley davis, phd, msw is an assistant professor, wheelock college, boston, ma 02215. stephanie p. wladkowski, phd, msw, is an assistant professor, eastern michigan university school of social work, 900 oakwood st., ypsilanti, mi, 48197. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 415-436, doi: 10.18060/21167 this work is licensed under a creative commons attribution 4.0 international license. understanding sampling and recruitment in social work dissertation research rebecca g. mirick ashley davis stephanie p. wladkowski abstract: the field of social work has increasingly focused on improving the quantity and rigor of its research. for many social work doctoral students, their first independent research experience begins with their dissertation, and yet, little is known about the factors that facilitate students’ success during this process. sample recruitment is one step where significant and unexpected challenges can occur. as social justice is the central value of the profession, social work doctoral students may focus on research with vulnerable or marginalized populations; however, little research has been done that focuses on social work dissertations, samples used, and the process of recruitment. in this study, 215 doctoral-level social work graduates who completed their degree within the past ten years were surveyed about their dissertation research, with a focus on the sampling strategy and recruitment processes. findings show that students have a wide diversity of experiences with the dissertation process. while 64.6% anticipant challenges around recruitment and sampling, only 54.9% encounter challenges. less than half (44.7%) of study participants received guidance during this process and most (80.5%) felt the dissertation experience impacted subsequent research, both positively (40.5%) and negatively (9.8%). based on these findings, doctoral programs are encouraged to increase supports available to dissertating students, particularly those recruiting study participants from vulnerable and marginalized populations. these supports include community connections, skills for obtaining gatekeeper buy-in, and both relational support and advice from dissertation committees and other colleagues. keywords: dissertation; social work education; recruitment; sampling; empirical research doctoral education prepares social work scholars to participate in the development and dissemination of professional knowledge. doctoral students are socialized to value and contribute to the knowledge base on topics of importance to the profession that advance social justice. these emerging scholars learn the methodological and analytical skills through coursework and research practicum (jenson, 2008), and then further develop and demonstrate this skill set through the completion of a dissertation. sampling and recruitment are preliminary and integral steps in designing a research study, which entail defining the population of interest and soliciting eligible, willing participants (pettus-davis, grady, cuddeback, & scheyett, 2011). in social work research, sampling approaches are among methodological decisions that reflect the profession’s values and concerns. challenges with recruitment and retention, especially of vulnerable and marginalized populations, are common. when unanticipated, such challenges can derail and delay research. https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2017, 18(2) 416 in a review of social work dissertation research (n=593), maynard, vaughn, and sarteschi (2012) found that the majority of doctoral students (61%) collected primary data, allowing them to further develop sampling and recruitment skills. while numerous textbooks offer “practical roadmaps on how to define, recruit, and retain a sample” (abrams, 2010, p. 537), the social work literature has paid far less attention to this methodological issue, especially in terms of potential pitfalls or successful approaches. the latter is especially important as even experienced researchers face barriers in recruitment, particularly when accessing hard-to-reach or vulnerable populations (jessiman, 2013). many social work doctoral students have an interest in conducting research on topics that address social inequities and support the needs of marginalized or vulnerable populations. they perceive an ethical responsibility to be inclusive and approach research from a social justice perspective (national association of social work, 2008). this includes having a representative sample, striving to include those who have the greatest needs, are exposed to the greatest risk, or have experienced disparities in outcomes (casado, negi, & hong, 2012). by doing this, social work researchers conduct rigorous, relevant studies with attention to ethics, social justice, and cultural competence, creating research which reflects the values and priorities of the profession. the present study explored recent social work doctoral graduates’ experiences with sampling and recruitment in their dissertation research. the study aimed to provide a firsthand understanding of the impact of these challenges and describes the guidance and resources needed to successfully complete primary data collection for a dissertation. literature review social work has made intentional efforts to increase its research capacity and build a unique body of knowledge as a means of establishing itself as a distinct profession (maynard, vaughn, sartaschi, & berglund, 2014). social work doctoral education awards two advanced degrees: doctor of philosophy (phd) and doctor in social work (dsw) (diaz, 2015). the phd, with an emphasis on research and scholarship (kurzman, 2015), remains the dominant doctoral degree in social work. there has been a resurgence in dsw programs for advanced practitioners (diaz, 2015), but these programs tend to value many forms of scholarship beyond empirical research and may not require a dissertation (anastas & videka, 2012). over the past 20 years, the group for the advancement of doctoral education in social work (gade) has focused on the education of researchers (berzoff & drisko, 2015). gade describes research expertise as among the specific knowledge and skills that graduates should possess. these skills “involve the systematic collection and analysis of data that shed light on research questions relevant to social work” (gade, 2013, p. 3). in this way, social work research has the potential to “address the problems confronting practitioners, administrators, policymakers, and the clients they serve” (rothwell, lach, blumenthal, & akesson, 2015, p. 59). doctoral-level social workers need to be trained in the methods that will generate and disseminate knowledge of importance to the field (maynard et al., 2014). mirick et al./understanding sampling 417 anastas (2012) describes the dissertation as the signature pedagogy of doctoral education in social work as doctoral students learn experientially about the research process, develop research skills, and gain expertise with a body of knowledge. the dissertation requires the doctoral student to learn how to manage an individual research project. the dissertation period may last longer than the coursework phase of doctoral studies, shape future research plans, and for some, result in unfinished research and unearned doctoral degrees (anastas & videka, 2012). an additional challenge for social work research is that dissertation research is often not disseminated within the field. for a random sample of social work doctoral dissertations (n=593), maynard and colleagues (2014) found that only 28.8% were published in peer-reviewed articles or books due to the inconsistent quality of the research, a lack of attention on writing for publication in doctoral training, and insufficient supports for navigating the process. when dissertations remain unpublished, the knowledge base of the profession does not benefit from the findings. the field has a vested interest in preparing the next generation of doctoral-level social workers to be skillful researchers who can successfully complete and disseminate their findings. research preparation in doctoral education doctoral programs vary in their approaches to preparing students to engage in rigorous research. in a content analysis of phd programs (n=69), drisko, hunnicutt, and berenson (2015) found that curriculum requirements varied widely but all programs required two to four research courses. only 58% of social work doctoral programs require a research internship (drisko et al., 2015) and therefore, some students gain research experience only through their dissertation work. this reality highlights the importance of the dissertation as a critical opportunity to learn research skills and generate findings for the social work community, and may make it more challenging to both plan a successful research study and disseminate the results effectively. some doctoral students do not gain experience in the recruitment of study participants if they choose to use secondary data analyses in their dissertations. the number of social work dissertations that use secondary data analyses has increased over time (maynard et al., 2012). secondary data analyses tend to be inexpensive and efficient, require minimal infrastructure, foster high productivity with publications (howard, 2009), and allow students to have access to large data sets with numerous variables and representative, random samples (maynard et al., 2014). however, they do not offer students the opportunity to engage in the steps of the research process prior to data analysis (lepp, remmik, karm, & leijen, 2013). the learning that arises from carrying out a primary research study is invaluable in acquiring a broad range of research skills, particularly when the reality of conducting research often is quite different than textbook descriptions (narui, truong, & mcmickens, 2015). sampling, recruitment, and retention conducting research involves many discrete skills, including conceptualizing a study, operationalizing concepts, identifying or creating instruments, collecting data, and advances in social work, fall 2017, 18(2) 418 analyzing the findings. creating a sampling strategy that is congruent with the purpose and design of the study, and recruiting and retaining participants are key skills. social work research textbooks, such as rubin and babbie (2013) and thyer (2014), describe sampling and recruitment techniques in detail as a straightforward and linear process. the reality is that this process may be fraught with challenges that could negatively impact the study or researchers themselves (narui et al., 2015). in designing a sampling strategy, addressing slow recruitment, or ensuring sufficient retention, social work researchers need to consider common, although not frankly or frequently discussed challenges, including accessing hard-to-reach populations and resolving logistical and ethical issues. accessing hard-to-reach populations. social work research often involves describing the experiences of diverse populations. these studies may include samples from groups that are stigmatized or vulnerable, where there may not be a ready-made sampling frame or easy way to access the population, which makes it difficult to locate individuals. for example, research may involve a non-associative population; these individuals share a trait, such as being hiv+, but do not know each other or receive services together (thompson & phillips, 2007). a clear sampling frame, however, does not ensure participants will be easy to reach or willing to participate. due to concerns about power imbalances and the potential for coercion, many institutional review boards (irbs) require indirect recruitment methods, having a third-party agency share study information, and requiring potential participants to contact the researchers themselves (abrams, 2010). indirect recruitment entails multiple levels of support needed to access a specific population, including administrative staff. at any stage of this process, gatekeepers may not support the project, derailing recruitment. gatekeepers may lack the time and motivation to devote to research projects or may appear supportive, but perceive research as harmful or even predatory towards clients (mirick, 2016). the specific traits or characteristics of a vulnerable population can impact research participation. community members themselves can be instrumental in helping researchers design and execute a study that is sensitive to the cultural norms and needs of a population. for example, gelman (2010) described social work research with latino caregivers of patients with alzheimer’s disease whose sense of caregiving burden was so large that participation in a supportive intervention was perceived to be onerous. the input of community members was necessary to anticipate this barrier to recruitment. community members can provide an invaluable perspective on a study that successfully recruits hardto-reach populations. in order for research findings to be generalized, the sample must be representative and thus diverse. one challenge to recruiting a diverse sample is that historically, some researchers have engaged in practices that deceive, violate, or otherwise harm members of oppressed groups, which has eroded the trust of some groups and increased their reticence to participate in studies (moore & collins, 2002). when researchers endeavor to recruit a diverse sample, they may default to convenience sampling. this can have the unintended consequence of privileging the experiences of people who are easy to reach and willing to participate (abrams, 2010). researchers often settle for non-representative samples when mirick et al./understanding sampling 419 achieving more diversity in the sample seems unfeasible (descartes, asencio, & blank, 2011). researchers have a responsibility to use culturally competent practices to recruit and retain potential participants. effective communication with the community of interest is imperative, and may involve partnering with bilingual or bicultural individuals who can facilitate and provide interpretation (casado et al., 2012). social work research is a relational endeavor, particularly when engaging cross-culturally or with marginalized populations, and thus, utmost attention must be given to nurturing and sustaining relationships with community partners and participants throughout the project (amador, travis, mcauley, bernard, & mccutcheon, 2006). such collaboration and regular contact is an investment of time and effort that cannot be shortchanged for effective recruitment and retention. ethical and logistical issues. depending on the population of interest, recruitment may involve ethical issues. for example, when descartes and colleagues (2011) aimed for a racially and socioeconomically diverse sample of gay men, they encountered challenges in preserving the integrity of their data while protecting participants. the researchers offered a monetary incentive, which led some potential low-income participants to misrepresent their demographic backgrounds to match eligibility criteria highlighting the need for clear and ethical recruitment guidelines. sometimes social work researchers carry out studies with populations whose social and health problems reflect great needs, and yet whose participation may expose them to physical, emotional, financial, or legal harm. kyriakakis, waller, kagotho, and edmond (2014) studied the experiences of intimate partner violence and help-seeking with mexican immigrant women, in order to inform culturally appropriate services and interventions. due to the inherent risks for participants, the researchers needed to make accommodations to protect their physical safety, provide emotional support, and ensure anonymity. these researchers demonstrated the ethical responsibility to be adequately trained to recognize and account for the risks faced by participants, particularly from marginalized and vulnerable populations. in addition to ethical challenges, logistical constraints may affect sampling and recruitment. some effective strategies for locating and retaining an unbiased sample of research participants are prohibitively expensive and time-consuming, such as paying for media advertising, offering gift vouchers as inducement, investing in an immersive participatory approach, or combining mail, telephone, and face-to-face methods (thompson & phillips, 2007). few studies offer insight into the journey towards the successful recruitment of research participants, particularly for dissertation research. the present study explored the experiences of social work doctoral graduates who carried out primary data collection for their dissertation research. successes, challenges, supports, and lessons learned from the experience were examined as well as how students were impacted by their experiences with recruiting and retaining study participants. advances in social work, fall 2017, 18(2) 420 methods procedure this study used a convenience sample. respondents needed to have earned a phd in social work in the previous 10 years and recruited study participants for their dissertation research. doctorates in social work (dsw) degrees were excluded, as few dsw programs require a traditional dissertation (diaz, 2015). participants were recruited in three ways. first, an online survey was shared through social media and social networks. second, doctoral program directors belonging to gade were contacted via email and asked to share the study information and survey link with alumni. third, a search of completed social work dissertations on the proquest dissertation and theses database identified 3392 potential participants, who completed dissertations in the prior ten years and recruited study participants. the survey information and link was emailed to those for whom contact information was found (45%, n=1,533). data collection following irb approval, data were collected over a three-month period from january to march 2015, using an online qualtrics survey. the survey consisted of 40 open-and closed-ended questions about the dissertation experience, and questions on participant demographics and dissertation and program characteristics. the survey was piloted with five social work doctoral students, and was revised based on their feedback. data analysis descriptive statistics were used to determine the mean, standard deviation, range, and/or frequencies for demographic (gender, race, age at graduation, current role), dissertation (research method, planned sample size), and program data (program type, length of time in program, and years since graduation). see table 1. the narrative data were uploaded to a separate excel spreadsheet for each survey question. the researchers conducted a thematic analysis to identify themes and exemplars across the data (braun & clarke, 2006; denzin & lincoln, 2011). the dissertation topics were coded using the 22 topical areas established by the society of social work and research (2016) (see table 2). for the other questions, all three researchers did a preliminary coding of 20% of the responses. this inductive process identified “units of meaning” from the data, which were combined or teased apart to refine and form a set of codes to use in coding the rest of the data. for each question, two of the researchers independently used these codes to analyze the remaining uncoded data, and the third researcher reviewed the coding decisions and reconciled any discrepancies. this step enhanced the trustworthiness and credibility of the findings by ensuring the inter-rater agreement and fidelity of coding decisions (denzin & lincoln, 2011). similar codes were reported in thematic categories, and each theme needed to represent at least 10% of the responses for the question. these themes are presented to give a clear picture of the experience of the overall sample. see table 3. in addition, exemplars are used to illustrate mirick et al./understanding sampling 421 the themes and provide more depth about respondents’ experiences with sampling and recruitment in dissertation research (braun & clarke, 2006). findings respondents the sample consisted of 215 doctoral graduates who completed social work doctoral programs from 2005-2015 (m=5.1 years since graduation) and recruited study participants for their dissertation research. the majority (73.0%, n=143) of respondents identified as female and white (81.2%, n=155). the mean duration of their doctoral degree program was 5.5 years. approximately one half (49.3%, n=106) used samples of marginalized or vulnerable populations (e.g., youth in foster care, prison inmates, refugees). see table 1. table 1. respondent demographics, dissertation, and program information n (%) m (sd) range gender (n=196) female 143 (73%) male 48 (24.5%) transgender 5 (2.6%) race (n=191) white 155 (81.2%) black 13 (6.8%) asian 12 (6.3%) biracial 5 (2.6%) latino 4 (2.1%) native american 2 (0.5%) type of program (n=196) full-time 149 (75.3%) part-time 49 (24.8%) years in program (n=195) 5.5 (2.4) age at graduation (n=193) 41.5 (8.9) 29-71 years since graduation (n=196) 5.1 (3) 1-10 research method (n=215) qualitative 96 (44.7%) quantitative 49 (22.8%) mixed methods 70 (32.6%) planned sample size (n=198) 171.7 (338.3) 5-3000 vulnerable sample 106 (49.3%) current role (n=191) a faculty 145 (67.4%) practitioner 40 (18.6%) no paid employment 16 (7.4%) other employment 26 (12%) anote: participants chose more than one answer advances in social work, fall 2017, 18(2) 422 dissertation topics were categorized as mental health (17.2%, n=37), health (9.3%, n=20), aging services and gerontology (8.8%, n=19), child welfare (8.8%, n=19), and violence against women and children (7.9%, n=17). see table 2 for the list of all 22 topics. table 2. dissertation topics based on sswr codes (n=215) topic n (%) mental health 37 (17.2%) health 20 (9.3%) aging services & gerontology 19 (8.8%) child welfare 19 (8.8%) violence against women & children 17 (7.9%) social work practice 14 (6.5%) race, ethnicity, & immigration 13 (6%) work, family, & family policy 13 (6%) inequality, poverty, & social welfare 12 (5.6%) crime & criminal justice 10 (4.7%) social work education 9 (4.2%) gender 8 (3.7%) substance misuse & addictive behaviors 8 (3.7%) adolescent & youth development 7 (3.3%) sexual orientation & gender identity 7 (3.3%) organizations & management 7 (3.3%) communities & neighborhoods 6 (2.8%) school social work 5 (2.3%) disability 4 (1.9%) international social work & global issues 4 (1.9%) military service members, veterans, & their families 4 (1.9%) research design & measurement 0 (0%) note: there are 243 responses because 28 dissertation topics fell equally into two categories. respondents provided detailed examples of their experiences with the recruitment of study participants for their dissertation. topics of inquiry included anticipated challenges, observed challenges, perceived strategies that led to success, supports, and the impact of the experience on their identity as a scholar and future research. see tables 3a-d. anticipated challenges prior to recruitment nearly two-thirds of respondents (64.7%, n=139) expected the recruitment process to present challenges, even before they engaged in the research. those reporting (63.7%, n= 137) described anticipated challenges in three primary categories: 1) access to eligible participants (49.6%, n=69), 2) research design to gather an adequate sample size (46.5%, n=66), and 3) commitment from gatekeepers and potential participants 395.4%, n=54). mirick et al./understanding sampling 423 table 3a. survey questions, number of respondents, and themes: anticipated challenges prior to recruitment (n=215) question n(%) prior to beginning recruitment, did you anticipate any challenges? (n=215) yes 139 (64.7%) if yes, what were they? (n=137)* access to sample 69 (49.6%) research design 66 (47.5%) logistics 30 (45.5%) sample size 36 (54.6%) buy-in 54 (39.4%) gatekeepers 25 (46.3%) participants 29 (53.7%) if not, why not? (n=76)* access to sample 38 (50.0%) research design 25 (32.9%) incorrect assumptions 17 (22.4%) anote: participants chose more than one answer access to eligible participants. nearly one-half (49.3%, n=106) of respondents recruited from vulnerable or marginalized populations. however, less than one-third (32.1%) expected challenges gaining access to participants from hard-to-reach (50.7%, n=35) or stigmatized groups (49.3%, n=34). one respondent described her awareness of the difficulty connecting with vulnerable individuals, saying, “i knew that trying to recruit…trafficking victims would be difficult due to the underground nature of this population in addition to [the] stigma that this group experiences.” another respondent said, “i anticipated challenges in recruiting immigrant women, due to the potential concerns regarding their safety and anonymity.” one respondent described, “hiv is a sensitive issue….” participants identified realistic challenges to accessing study participants. research design. for 47.5% (n=66) of respondents, recruitment concerns focused on issues related to the research design. for 54.6% (n=36), obtaining the ideal sample size felt unrealistic. one respondent described, “fifty [participants] was a large sample and i was concerned about how long it would take to achieve this sample size.” another listed anticipated barriers, “it would be hard to find participants, no one would volunteer, or volunteers would not be competent or able to provide thick description.” thirty respondents (45.5%) were concerned about the necessary logistics for participation within the study’s design. one said, “prospective participants were physically ill and some would potentially be unable to participate due to severity of illness or the intensity of the services received,” highlighting how the particular vulnerabilities of the sample can create logistical barriers to data collection. commitment from others. approximately three-quarters (74.9%, n=161) of the respondents did not anticipate challenges getting buy-in from gatekeepers or participants. the 25.1% (n=54) who did foresee these challenges thought they would focus specifically advances in social work, fall 2017, 18(2) 424 around obtaining buy-in from potential gatekeepers (46.3%, n=25) or participants (53.7%, n=29). concerns about gatekeeper buy-in were varied, including time, willingness, sensitive topics, and research design requirements. for example, one respondent said, “it was challenging to find agencies that would agree to allow me to recruit their service providers due to concerns about over-burdening staff with participation.” another said, “i recognized that there may be resistance to the research design and that there would be layers of administrative and caregiver support required before access to residents would be possible.” one respondent described the anticipated challenges of indirect recruitment strategies saying, “i expected that it might be difficult to get enough participants because irb procedures did not allow me to contact them directly but rather to go through [child protective services]”, while another said, “i was also relying on service providers to do the recruitment, which left the recruitment out of my control.” challenges to participant buy-in included time, the topic of the study, and the researcher’s lack of membership in the community. one respondent said, “i was concerned that potential respondents would simply not have the time or interest to participate.” another said “finding couples who would be willing to participate…and would agree to be video-taped,” or “…these busy professionals would not be willing/able to give me the time.” one participant described, “the subject matter is ‘heavy’. i anticipated that….people would not be ready to talk about their experiences with homicide,” while another said, “adolescents not wanting to speak to a stranger and open up about their experiences with parents with terminal cancer.” two respondents described the impact of not belonging to the community, saying, “being an outsider was also seen as a limitation to gaining a commitment” and, “this was cross-cultural work that was related to a very sensitive topic/population. i anticipated resistance or guardedness from interview participants in speaking to a foreigner.” almost one-quarter (22.4%, n=17) of the respondents who did not anticipate challenges (35.3%, n=76) attributed this to incorrect assumptions about the feasibility of the research plan. for example, “i figured snowball sampling would be relatively straightforward. it was not.” this represents only a small percentage (7.9%, n=17) of the total sample. observed challenges during recruitment over half of respondents (54.9%, n=118) experienced recruitment challenges during their dissertation. these challenges can be categorized as access to eligible participants (28.7%, n=35), response rate (18.1%, n=39), and logistics for participation (10.2%, n=22). accessibility. just over one-quarter (28.7%, n=35) of respondents reported issues with obtaining access to eligible participants. one respondent described, “i was not allowed to use the listserv myself, instead relying on an administrator at the university to do so.” another said, “my committee insisted that i canvas agencies in the [city name] and since those places were not known to me, i did not get any volunteers.” mirick et al./understanding sampling 425 table 3b. survey questions, number of respondents, and themes: observed challenges during recruitment (n=215) question n(%) did you encounter any challenges with recruitment? (n=215) yes 118 (54.9%) if yes, describe the challenges you encountered. (n=122) access to sample 35 (28.7%) gatekeeper buy-in 22 (18.0%) response rate 39 (32.0%) logistics 22 (18.0%) if not, what factors do you think contributed to this success? (n=89) data collection methods 51 (57.3%) gatekeeper support 26 (51.0%) logistics 15 (29.4%) participant contact 10 (19.6%) participant buy-in 30 (33.7%) did these challenges impact your recruitment strategy? (n=114) yes 62 (54.4%) if yes, how?* revised recruitment 25 (40.3%) decreased sample 17 (27.4%) changed criteria 16 (25.8%) more effort 26 (41.9%) did these challenges delay completion of your dissertation? (n=55) yes 25 (45.6%) anote: participants chose more than one answer gatekeeper buy-in. only 18.0% (n=22) identified challenges obtaining gatekeeper buy-in. one respondent described a lack of connections, saying, “it was just timeconsuming trying to find enough fathers to include…i had also become somewhat isolated during my phd work and had fewer people i could contact.” for those using indirect recruitment, challenges to obtaining gatekeeper buy-in could be multilayered, such as, “having the support of the administrators…did not always translate to nursing staff or social service provider engagement. as a result, it was possible for the study to be derailed at any step in the process.” one respondent described gatekeepers as “suspicious and protective of their clients.” another said, “not all directors were willing to send out my link for fear of overwhelming staff more.” response rate. less than one-fifth (32.0%, n=39) of respondents identified challenges obtaining participant buy-in, resulting in a low response rate. one described bluntly, “response rate sucked (only 136 completed surveys within two months). participants agreed to participate and then didn’t return surveys.” one respondent described a continual struggle, “lack of response to initial letters, lack of response to follow-up emails and phone calls.” various issues were blamed for low response rates. one attributed the challenges to advances in social work, fall 2017, 18(2) 426 “incorrect information to mail out the recruitment letters---addresses were wrong, people had moved, phone numbers were incorrect.” another described the intersection of gatekeeper and participate buy-in challenges, saying, “participants cancelled or did not show, difficult to obtain buy-in from some directors....” logistics. only 18.0% (n=22) of respondents reported logistical barriers, such as obtaining consent for participation and transportation to research sites. one respondent said, “it was very difficult to get participants to travel to the face-to-face interviews…most cited difficulty arranging child care and transportation, or scheduling difficulties that conflicted with work.” another respondent said, “transportation to the va was also triggering for some dealing with ptsd. they wanted to participate over the phone, but irb requirements wouldn’t allow it.” responses to challenges. respondents addressed these challenges by putting in more effort, including accessing community connections (22.0%, n=26), revising recruitment plans (214.2%, n=25), decreasing the sample size (14.4%, n=17), and changing the eligibility criteria for participation (13.6%, n=16). for 21.2% (n=25) of respondents, recruitment challenges delayed the completion of the dissertation. the mean delay time was 3.4 months (sd=0.50). perceived strategies of success the primary reasons for anticipated success were access to or prior experience with the sample (50.0%, n=38) and the perceived feasibility of the research design (32.9%, n=25). the 89 respondents (41.4%) who experienced successful recruitment attributed their success to factors which fell into two major categories: 1) data collection methods (57.3%, n=51) and 2) participant buy-in (33.7%, n= 30). data collection methods. the methods seen as contributing to success included working with professionals and gatekeepers who supported the project, sometimes due to the researcher’s connections or relationships with them (51.0%, n=26), simple enrollment logistics 29.4%, (n=15), and personal contact with participants (19.6%, n=10). examples included, “actually going to the groups and meeting the women made the difference-a flyer would not have worked,” using “one point person at each program,” or having the participating agency facilitate participation, “…time blocked out during their work day to participate.” these strategies were viewed as increasing both the opportunities for enrollment and the ease of participation. participant buy-in. one-third (33.7%) of respondents (n=30) found that having participant buy-in was key to success. one respondent described this being easier than expected, saying, “people wanted to talk to us. they [were] ‘honored’ in a way that we were there to learn from them and wanted to hear their story…this was unexpected.” connections to the community such as a “positive professional reputation” and the researcher’s membership in the community were also seen as facilitating participant buyin. one attributed her success to, “being of southeast asian descent…and my relationship and status within the southeast asian community.” mirick et al./understanding sampling 427 identified supports before and during recruitment respondents described the guidance they obtained prior to (90.7%, n= 195) and during the recruitment process (84.2%, n=181). almost one-third of respondents (29.3%, n=63) identified specific supports they wished were available to them during data collection. table 3c. survey questions, number of respondents, and themes: identified supports before and during recruitment (n=215) question n(%) what guidance or advice about recruitment did you receive before you carried out your study? (n=195) data collection 58 (29.7%) recruitment 17 (8.7%) if you received guidance, who gave it to you? (n=191) chair & committee 93 (48.7%) researcher, mentor, advisor 78 (40.8%) other 19 (10.0%) during the recruitment process, what guidance or advice did you receive about recruitment? (n=181) research design changes 29 (16.0%) none 67 (37.0%) if you received guidance, who gave it to you? (n=96) chair, committee, mentor, advisor 51 (53.1%) participant & gatekeeper 23 (24.0%) other researcher 22 (22.9%) are there supports you wish had been available to help you recruit participants? (n=63)* guidance 39 (61.9%) methods 18 (46.2%) committee 15 (38.5%) resources 35 (55.6%) connections 23 (65.7%) financial 12 (34.3%) anote: participants chose more than one answer guidance received before recruitment. the most common sources of support were dissertation chairs and committee members (n=93, 48.7%) and senior researchers, mentors, and supervisors (n=78, 40.8%). twenty respondents (10.3%) reported they had very little or no guidance. nineteen (10.0%) cited other mentors and non-relational sources, such as classes, the irb, and books. less than one-third of respondents (29.7%, n = 58) described receiving specific types of guidance related to data collection prior to the start of recruitment. some of this advice was a reminder of the realities of research, for example, being realistic about the time required for data collection, “i was told that recruitment always takes longer than you advances in social work, fall 2017, 18(2) 428 expect, but even with that, i expected data collection to take 3-4 months, not a full year.” surprisingly, only 8.7% (n=17) described getting support specific to recruitment efforts, for example “how to recruit participants from different cultural backgrounds with confidentiality concerns.” guidance received during recruitment. almost half (44.6%) described specific sources of guidance (n=96) during recruitment of participants. of these, 53.1% (n=51) identified dissertation chairs, committee members, mentors, and advisors. other sources of support included study participants and gatekeepers (24.0%, n=23) and other researchers, such as outside academics and doctoral peers (22.9%, n=22). for example, one said, “i consulted with chinese american faculty members in my university as well as asked chinese american people.” another shared, “i talked to a friend (who was getting her phd in a different university) about the problem i was having with not getting enough black people or males in my study, and she suggested marketing directly to websites that cater to those populations.” only 16.0% of respondents (n=29) described getting advice around changing the research design, such as by altering recruitment plans. one of these respondents described getting guidance from a member of the sampling frame, “she told me that mailing is not going to be effective with clergy because they get so many surveys. she suggested that i should rely more on calling them directly.” another described the advice she got from her chair as “the most helpful advice i had throughout the process.” the respondent added, “she made suggestions about contacting schools and about contacting the independent living center in my area.” sixty-seven respondents (37.0%) reported receiving no guidance during this period. twelve (17.9%) did not view this as a problem, saying, “the help was available; i simply didn't ask” or “i knew my site of data collection better than my advisors.” one participant noted that guidance was not always helpful, “i did not get any advice other than my committee telling me they did not think i would be able to find recruits. that was not helpful.” desired supports. almost one-third of respondents (29.3%, n=63) identified supports they wished had been available to them. these included more guidance (61.9%, n=39) and resources (55.6%, n=35). in terms of guidance, 46.2% of respondents (n=18) wanted methodological help, such as “more qualitative research recruiting guidance”, “advice on hard-to-reach populations,” and “suggest not sampling children in child welfare.” and 38.5% (n=15) wanted more support from committees such as “more direct involvement” and “direct, helpful feedback.” in terms of additional resources, 65.7% (n=23) wanted stronger university relationships with gatekeepers or community groups. for example, one respondent shared “i wish there had been a stronger connection between the school and long-term care facilities.” twelve respondents (34.3%) wished for financial support, primarily for participant incentives. one said, “i paid for incentives out of my own personal funds; small university grants would have been helpful.” it is unknown how many respondents already had access to financial support for their research. mirick et al./understanding sampling 429 impact of dissertation experience impact on students. the majority of respondents (71.6%, n=154) described ways in which the dissertation experience had impacted them. more than half (56.5%, n=87) identified positive feelings, including feeling “confident,” having “enthusiasm” for research, and describing a “very positive learning experience.” one described her dissertation process by saying, “i can’t begin to describe what a rich experience this was. if i had to say one thing about it, it gave me a much greater understanding of my current patients.” some (24.0%, n=37) described how the experience impacted their identity as a researcher. only 13.6% (n=21) reported negative feelings, such as, “the dissertation process was long and dreadful. i am literally burnt out from conducting my own research,” and, “it left me emotionally drained and somewhat defeated.” while many more felt inspired and gained confidence from the experience, the few with negative experiences described powerful feelings, which seem to have had a lasting impression. table 3d. survey questions, number of respondents, and themes: impact of dissertation experience (n=215) question n(%) do you think your dissertation experience had an impact on your subsequent research since graduating from your doctoral program? (n=196) yes 173 (88.3%) explain in more detail how it affected you? (n=154)* positive feelings 87 (56.5%) negative feelings 21 (13.6%) future research 56 (36.4%) researcher identity 37 (24.0%) did it impact your… (n=175)* …willingness to engage in research? yes 172 (98.3%) ...ability to engage in research? yes 171 (97.7%) …enthusiasm to engage in research? yes 170 (97.1%) have you carried out research since your dissertation? (n=193) yes 134 (69.4%) if no, why not? (n=61) other commitments 42 (68.9%) recent graduate 13 (21.3%) other 16 (26.2%) *note: participants could give more than one response. impact on research. the majority of the respondents (80.5%, n=173) reported that the dissertation experience impacted their subsequent research agendas. most (97.7%, n=171) reported it influenced, either positively or negatively, their ability to engage in research, 97.1% (n=170) that it affected their enthusiasm to engage in research, and 98.3% (n=172) that it impacted their willingness to engage in research. fifty-six (26.1%) said that their experience influenced future research projects. one respondent said, “child advances in social work, fall 2017, 18(2) 430 trafficking is very difficult to research and therefore i have moved my research focus to a more accessible population despite the need for research in trafficking.” another moved away from data collection altogether, saying, “secondary data analysis is much easier in terms of getting publications out and i have done a lot of that since graduating.” these examples illustrate ways in which respondents adapted future research plans based on their dissertation experience. more than half of the respondents (n=134, 69.4%) reported carrying out post-dissertation research. for those who did not, the most common reasons were other commitments (68.9%, n=42), such as teaching courses and other projects or they were recent graduates (21.3%, n=13) who had not yet had the opportunity to engage in research post-graduation. limitations limitations to this study include the use of a nonrandom sample. it was challenging to determine how many social work doctoral graduates fit the eligibility criteria— completed primary research, including recruitment—out of all possible graduates. therefore, a response rate was impossible to accurately calculate. some participants did not complete questionnaires, which led to lower response rates on later questions (see table 3). this may have introduced some bias on later questions if those respondents were different in some way. contact information for people with academic positions in the united states was the easiest to obtain, so those in faculty positions may be overrepresented. social work doctoral students who did not graduate were not included; those students, especially those who dropped out during the dissertation process, and their experiences are therefore excluded from these findings. future research could explore these students’ experiences or focus more in-depth on challenges and successes through longer, open-ended interviews. in addition, future research could investigate more specific questions which arose from these findings, such as the rate of funding for doctoral dissertations, specific challenges and successes experienced by those engaging in longitudinal research, or possible differences in experience for qualitative versus quantitative researchers. discussion this study explored the experience of planning and engaging in the recruitment process of social work dissertation research. this study solely explored the experiences of students who were eventually successful at completing their doctoral programs, although many (55.8%) did encounter some challenges during the process. this provides a strengths-based perspective as these students found ways to be resourceful and resilient in the face of challenges. while most participants (88.4%) were able to finish their dissertations without any delay, many participants described how they encountered recruitment challenges. almost half (49.3%) recruited from vulnerable populations. when working with diverse populations, recruitment challenges are an expected component of the research project. the skills involved in recruiting hard-to-reach populations, especially those who share a characteristic and yet are unrelated to one another are complicated (abrams, 2010; thompson & phillips, 2007). students for whom the dissertation is their only researchbased experiential learning experience may need more direct guidance and advice from the mirick et al./understanding sampling 431 committee; in particular, a lack of knowledge of the population or methodology may impact their overall learning. for students with research experience, this kind of support from committee members may be less necessary. most (81.9%) respondents were content with their committee’s support. this suggested that while only 29.7% of respondents reported having received guidance on data collection, and only 7.2% reported guidance specific to recruitment, many may not have felt the need for guidance during this process. only a few (18.1%) respondents reported that they wished for more guidance and support from their committee, such as practical assistance or encouragement during the sampling and recruitment stage. the committee seemed to play different roles for students; for some, they were hands-on mentors who would strategize and offer advice, but for others, committee members maintained more of an observer role. this may reflect the diversity in level of student preparation and need, as previous studies have highlighted that social work doctoral programs offer uneven (drisko et al., 2015) or inadequate preparation in research methods (rothwell et al., 2015). only 16.3% of respondents pinpointed other supports, beyond additional guidance, that would have helped them achieve success. while it is possible that for many no additional resources were needed, it could also be that respondents assumed that challenges did not stem from structural factors or from methodological issues, but from their own individual deficits, such as a lack of preparation, understanding of recruitment strategies, or skill in networking with gatekeepers. internalizing challenges are more likely to occur in environments in which research problems are addressed quietly and not commonly discussed publicly (curtis, roberts, copperman, downie, & liabo, 2004). new researchers may assume others do not have these experiences, remain silent in their own struggles, and internalize their challenges. dissertation experiences can evoke a range of feelings as dissertations likely fulfill different needs for each student. for some, the dissertation may be an experiential learning exercise. for others, the dissertation is an opportunity to develop and demonstrate mastery of knowledge and skills needed for success with research endeavors post-graduation, such as launching a scholarly agenda for an academic career (maynard et al., 2014). some respondents (40.5%) reported they left the dissertation process with positive feelings, such as confidence and pride, and an appreciation of the research process, whereas many fewer (9.8%) left with negative feelings, such as demoralization and inadequacy. while the majority do not identify strong negative feelings, even 10% is concerning, considering that 80.5% of respondents said their dissertation experience impacted their future research. as the majority of social work doctoral students pursue careers in academia (anastas, 2012), negative experiences may impede the initiation of a scholarly agenda or steer graduates into research projects that avoid recruitment, such as secondary data analyses, or which recruit from more easily accessible populations. in order to help all doctoral students have a positive, successful dissertation experience, it is critical to understand the sources of success in this process. the respondents who did not face recruitment challenges (45.1%) attributed their smooth recruitment processes to data collection strategies (57.3%), and participants’ engagement in the process (33.7%), buy-in from gatekeepers and other professionals (29.2%) and from participants (33.7%), advances in social work, fall 2017, 18(2) 432 straightforward logistics (16.9%), and personal contact with potential participants (11.2%). effective recruitment is a relational process and respondents who recognized this and engaged actively in this process seemed to meet with success. participant and gatekeeper buy-in were recognized as important components of the process and could either facilitate or hinder recruitment as both groups need to value the research topic and recognize the importance of the findings (axford, lehtonen, kaoukji, tobin, & berry, 2012). the researcher’s connections within the community were vital to successful recruitment, and for 10.7%, even functioned as additional sources of guidance before and during the process (casado et al., 2012; gelman, 2010). implications for social work doctoral education over and above other sources of support, the chair and committee members play a critical role in offering guidance and support during the dissertation process. the respondents in this study cited committee members as the most common source of guidance both during the planning process (48.7%) and while recruitment was ongoing (53.1%). the role of the committee may be particularly critical in programs without a strong emphasis on research preparation. social work doctoral programs pair students and their mentors in a myriad of ways that may or may not match students’ populations of interest or intended research methods with faculty members’ strengths, interests, and experience. committee members may struggle to guide students when they themselves are not experts in the content area. doctoral programs vary in how much they support faculty members during this process. at many universities, faculty members are given few incentives to prioritize mentoring or to develop their effectiveness as mentors (liechty, liao, & schull, 2009). such institutional expectations are imperative in ensuring that committee members are willing and able to devote significant time and energy to teaching students about research through the dissertation process, particularly in programs without strong methodological preparation of its students. social work programs can encourage and formalize other forms of mentoring, such as bringing in outside research experts and organizing peer consultation groups. in this study, over half of respondents (54.9%) acknowledged encountering sampling and recruitment problems although only a small percentage of these students (21.2%) experienced a longer than anticipated recruitment process or negative feelings about the process (8.5%). clearly, the majority of students who encounter challenges go on to experience successful, timely recruitment and positive feelings about the process. for some though, this may be a vulnerable time period in which they need guidance and support around recruitment challenges. these challenges, however, are often not openly discussed in the professional discourse; they tend to be “airbrushed” out of methods sections, “as a result of pressure on length of journal articles, professional pride, or a disinclination for well-trained, careful researchers to admit difficulties” (curtis et al., 2004, p. 168). such omissions do a disservice to social work researchers who turn to the literature for strategies, guidance, and reassurance as some of the participants in this study described. social workers have a long tradition of offering “practice wisdom” from one professional to another and doctoral-level social workers can offer “research wisdom” when they openly discuss their successes and challenges in the dissertation process, and share problemmirick et al./understanding sampling 433 solving strategies. this study is an example of this kind of sharing of “research wisdom” that can inform both current doctoral students and the programs that train them. finally, the challenges with sampling and recruitment have social justice implications. first, with the minimal availability of dissertation funding (jenson, 2008), 11.3% of respondents reported needing financial support for their project, after having to pay out-ofpocket for research expenses or forgo costly approaches or monetary incentives that would have facilitated recruitment. unfortunately, this reality may drive some research decisions toward the priorities of funding sources or may create an undue financial burden on some students. secondly, some respondents linked anticipated success (17.7%) or actual success (12.1%) with relationships, connections, and experience with community leaders, agency gatekeepers, professional experts, or participants themselves. not all social work doctoral students or committee members have such connections to rely upon. thus, those students with economic means or social capital may have an easier time with the dissertation process, which may in turn affect their scholarship and identity as a researcher (ortega & buscharmendariz, 2014). doctoral programs might address these inequities by matching students who need them with committee members or additional mentors with more community connections, or supporting more programmatic community connections and collaborations. finally, 49.3% of respondents carried out research with vulnerable populations whose day-to-day realities and potential risks in participation must be considered (kyriakakis et al., 2014). it is vital to the knowledge base of the profession to hear the voices of vulnerable populations, include their perspectives, and understand their needs. therefore, doctoral programs need to be able to devise strategies, locate guidance, and create supports to effectively address sampling and recruitment challenges with these populations. conclusion this research study describes the often invisible area of the recruitment process of dissertation research through the experiences of 215 social work phds. the majority identified the impact this process has on their future research. respondents highlighted the important role of the committee as well as students’ community connections. future committee members and doctoral programs can use these experiences to support doctoral candidates in designing studies that successfully anticipate and address recruitment challenges for social work researchers. references abrams, l. s. 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(2014). the handbook of social work research methods. thousand oaks, ca: sage. microsoft word mccave_rishel_prevention final _________________  emily l. mccave, ph.d., is an assistant professor and carrie w. rishel, ph.d. is an associate professor, both in the division of social work at the west virginia university. the authors would like to thank ashlea shiflet for her consistent enthusiasm and high quality work in assisting with the preparation and editing of this article. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 226-240 prevention as an explicit part of the social work profession: a systematic investigation emily l. mccave carrie w. rishel abstract: historically, social workers have espoused a philosophy of prevention. however, this philosophy has not consistently translated into prevention-focused social work practice. this gap in social work practice is of concern given the growing federal attention placed on prevention efforts in key social work arenas, such as health, mental health, and substance abuse. in an effort to illustrate this practice gap, this article presents a systematic investigation of the status of prevention and social work through the examination of three seminal indicators including: the social work literature, the 2009-2012 national association of social workers (nasw) social work speaks, and the 2008 educational policy accreditation standards (epas). results indicate that the social work profession lacks an emphasis on prevention, as well as cohesiveness regarding prevention across social work practice, education, and scholarship. opportunities for integrating prevention into the profession are highlighted for key stakeholders, namely social work scholars, educators, and practitioners. keywords: prevention, social work profession, social work literature, social work speaks, epas introduction the historical roots of the social work profession are grounded in a philosophy of prevention. throughout our tenure as a profession, however, social workers have not consistently embraced prevention as a core component of practice (bracht, 2000; woody, 2006). early commitment to prevention practice within the profession faded as social workers professionalized and established themselves as psychiatric case workers and mental health professionals (trattner, 1999). renewed interest in prevention-focused social work emerged in the 1960s, and again in the 1980s, but prevention has yet to become a firmly established focus of social work practice. while there have been areas within social work that have drawn from prevention principles, such as hiv/aids prevention, even within the arena of sexual health there has been a strong emphasis on the consequences of the sexual behavior (providing support to those with unplanned pregnancies or stds) as opposed to a focus on prevention (brashear, 1976; mccave, 2010). although previous work has addressed the connection between prevention and social work at various points throughout our professional history, up to this point there has been no systematic analysis of the status of prevention in social work. the purpose of this article is to present the results of a systematic investigation of the prevalence of prevention in social work and to discuss the implications of these results for the current and future status of the profession. advances in social work, fall 2011, 12(2)  227 what is prevention? as some social workers may not be familiar with prevention theory and concepts, it is important to briefly define and discuss prevention practice here. the goal of prevention practice is to prevent major problems of living. by definition, prevention occurs before a problem is fully visible or developed (national research council and institute of medicine, 2009). the prevention approach requires moving beyond the medical-based disease model, in which practitioners wait for an illness or problem to develop and then provide evidence-based treatment, to a practice philosophy that focuses on long-term healthy development. the salient question asked in this philosophy is, “what resources need to be put in place now to support this healthy development?” (national research council and institute of medicine, 2009). prevention science as a unique discipline was formally recognized in the 1980s (shore, 1998). since that time, the study of prevention has greatly increased. one notable example, the institute of medicine (iom) report, reducing the risks for mental disorders: frontiers for preventive intervention research (mrazek & haggerty, 1994), popularized a change in terminology regarding classification of prevention programs (farmer & farmer, 2001). while the traditional classification system categorized prevention efforts as primary, secondary, or tertiary, the new classification system uses the terms universal, selective, and indicated. universal prevention programs are targeted at the general public or an entire population group. selective prevention efforts are aimed at those who are at an elevated risk for a particular problem as compared to the general population. finally, indicated prevention efforts are aimed at high-risk individuals, usually those who already demonstrate signs or symptoms of the targeted problem, but in whom it has not yet fully developed (rishel, 2007). it is important to note that the 1994 iom report, and its recent 2009 update (national research council and institute of medicine, 2009) clearly specify that the term “prevention” should be used only to refer to intervention activities that occur prior to the full onset of a disorder or problem. therefore, efforts that were previously labeled as secondary or tertiary prevention are now more appropriately considered as “treatment” or “rehabilitation” (woody, 2006). prevention practice is the application of prevention principles and goals to interventions aimed at preventing individual and social problems. prevention scholars agree that prevention practice and programs should focus on targeted predictors of illness or health, called risk factors and protective factors (rishel, 2007). risk factors are defined as circumstances that increase the likelihood of negative outcomes while protective factors are considered to decrease the likelihood of negative outcomes (durlak, 1998; smith & carlson, 1997). risk and protective factors are typically categorized into three groups: individual factors, family factors, and environmental factors (garmezy, 1985), representing the three levels defined by ecological systems theory (bronfenbrenner, 1979). why should social workers focus on prevention? while a prevention approach has long been promoted in the field of public health, and has more recently become encouraged in many areas of health care, other areas of mccave, rishel/prevention as an explicit part of the social work profession  228 practice have lagged behind. for example, in the area of mental health services, most resources available have been used for treatment and rehabilitative services with very little funding allocated for the prevention of mental health problems (dulmus & wodarski, 1997). this may be changing, however, as the new report by the national research council and institute of medicine (2009) highlights the urgent need for a paradigm shift in the field of mental health. the report notes that, “interventions before the disorder occurs offer the greatest opportunity to avoid the substantial costs to individuals, families, and society that [mental health] disorders entail” (national research council and institute of medicine, 2009, p. 1). as key providers of mental health services, social work professionals have a vested interest in the future of mental health practice. while good evidence regarding the effectiveness of prevention did not exist in the early years of our profession, scholars in the field of prevention science have made important advances in recent years in developing an empirical research base and rigorously evaluating prevention efforts. we now know much more than in the past about “what works” in prevention (rishel, 2007). although prevention interventions have been shown to be effective at reducing problems (please see rishel, 2007 for a thorough discussion of the evidence supporting prevention practice), most practitioners do not use a prevention-oriented approach to practice. this makes sense considering that clinical training has historically focused on diagnostic assessment and treatment skills, and rarely includes prevention theory or discussion of successful prevention efforts (beardslee, 1998). it, therefore, seems likely that the majority of practitioners are not prepared to incorporate prevention principles and theory into their practice, and do not approach individual cases with a prevention focus. social workers are uniquely positioned to lead the movement toward preventionfocused practice. prevention scholars point toward the need for a bio-psycho-social approach to prevention practice that focuses on the interaction between person and environment (beardslee, 1998; coie et al., 1993; kellam, koretz, & moscicki, 1999). social workers have long embraced the ecological, person-in-environment perspective as our hallmark approach to practice—well equipping the profession to lead the way in cultivating prevention-focused service delivery. in his editorial on prevention, bracht (2000) reviews a number of factors that support a preventive approach to practice, but notes that the practice community has been slow to respond to “prevention pleas.” he suggests that the “will to change needs to be rekindled” (p. 3). social workers, who are trained to be change advocates, are well prepared to initiate and encourage a shift in policy and practice toward a preventive approach. what is the historical connection between social work and prevention? from its inception, social workers have espoused prevention-focused goals and practice approaches. jane addams’ community-based approach to practice was, at its heart, a prevention-oriented approach. while they may not have been labeled as such, early settlement house services (e.g. education, socialization opportunities, skills training) were delivered with the hopes of preventing individual and social problems within the community. the profession’s primary mission is to enhance human well-being, both in advances in social work, fall 2011, 12(2)  229 terms of individual well-being in a social context as well as the well-being of society (national association of social workers, 2010). prevention, by definition, enhances human well-being by preventing major problems of living. furthermore, the profession’s values and goals, such as reducing health disparities among oppressed and vulnerable populations, are consistent with a preventive approach to practice (bracht, 2000). despite the apparent “goodness-of-fit” between the mission and goals of the profession and prevention practice, throughout most of our professional history social workers as a whole have not promoted our services as prevention-focused (woody, 2006). review of the social work literature indicates sporadic episodes of particular interest in prevention in the 1960s (e.g. deschin, 1968; rapoport, 1961; rice, 1962) and most heavily in the 1980s (e.g. feldman, stiffman, evans, & orme, 1982; geismar & lagay, 1985; germain, 1982; gilbert, 1982; libassi & maluccio, 1986; roskin, 1980; siefert, 1983; walsh, 1982; whitman & hennelly, 1982). then, a decade ago, a pair of editorials in social work in health care again raised the issue of prevention and social work (bracht, 2000; rosendberg & holden, 1999). in summarizing their thoughts on prevention, rosendberg and holden (1999) urged “social work educators, practitioners and researchers to engage in a dialogue to find ways to focus the profession away from pathology and towards prevention” (emphasis added; p. 9). although results of specific prevention interventions have appeared in social work journals since this call (e.g. ager, parquet, & kreutzinger, 2008; skiba, monroe, & wodarski, 2004; yampolskaya, brown, & vargo, 2004), little “dialogue” or discussion of the role of prevention in the profession (or, conversely, the role of the social work profession in prevention efforts) has appeared in the social work literature (with the exception of hawkins, 2006, lurie & monahan, 2001, and woody, 2006). methodology in order to best assess the current status of prevention within the social work profession, a systematic strategy was employed to ascertain the explicit content of prevention within three seminal indicators within the social work profession. these included the social work scholarly literature, the most current national association of social workers (nasw) social work speaks, and the most current educational policy accreditation standards (epas) curriculum guidelines for social work undergraduate and graduate programs developed by the council on social work education (cswe). these three sources were selected because they represent the profession’s focus, and allow for an examination of the explicit content of prevention across social work scholarship, practice, and education. while implicit prevention content is important within these three sources and is likely connected to both the presence and absence of explicit prevention content, it is beyond the scope of this paper. rather only the explicit, that is, irrefutable, prevention content was considered in this investigation. assessing the social work literature a review of the social work literature allowed for an examination of the prevalence of “prevention” and “social work” in past and current social work scholarship. the databases examined included social services abstracts and social work abstracts. these mccave, rishel/prevention as an explicit part of the social work profession  230 two databases were used because they were considered the most likely to include social work prevention-focused literature. all years within each database were searched, which were 1970-2010 for social services abstracts, and 1960-2010 for social work abstracts. it was decided that books within the authors’ institutional library would not be considered, given the variance of collections between university libraries. assessing social work speaks since 1955, nasw has published social work speaks, which features nasw’s official position on both professional and societal policy issues (national association of social workers, 2009). the delegate assembly within nasw is responsible for the creation of the statements, with input from the nasw membership. social work speaks is used by nasw to make policy recommendations at the national and state level. nasw also recommends this book for use in the social work curriculum, as either a main text or supplemental reading. further, “social workers developed the statements to serve as broad parameters for advocacy work and to help professionals who are concerned with social issues focus their thinking” (p. x). social work speaks is updated every three years, with the most recent edition covering 2009-2012. within this most recent edition, nasw covers 64 policy issues. given that social work speaks is a reflection of our national association and thereby, our profession, we felt it pertinent to include social work speaks in our review of the prevalence of explicit prevention content within social work. in order to assess this prevalence, the word “prevention” or any direct variation, such as “preventive” or “prevent,” was counted within each policy issue. this highlights the extent to which “prevention” is explicitly a matter of importance to the social work profession at the state and federal policy level. while “prevention” may often be implied and indirectly discussed within social work speaks, it is likely that there is not consensus on whether a passage within the text is actually referring to “prevention,” such as in the case where “early intervention” is discussed. for this investigation, only the overt presence of “prevention” language was the focus. in completing the process, a total score (number of total times the word “prevention” or variation of the word was used) was recorded for each of the 64 policy issues. within each policy issue, a subscore was tallied from the number of times the word “prevention” or variation of the word was used specifically within the “policy statement” section of the policy issue. this subscore was equally important as the total score, given that the policy statement is the “call to action” section within each policy issue statement. assessing epas to fully examine the status of prevention in social work, we must also consider how the profession educates social work students. it is within their educational programs that social work students learn about the values and goals of the profession, our holistic approach to practice, and commitment to helping vulnerable populations. for social work practitioners to adopt prevention-focused practice, social work education content must include, or even emphasize, prevention knowledge, values, and skills. the council on advances in social work, fall 2011, 12(2)  231 social work education (cswe) regulates accredited bsw and msw programs through the educational policy and accreditation standards (epas). as the epas represents the profession’s regulatory mechanism regarding social work education programs, we believed it necessary to include it in our review of the current status of “prevention” in social work. as with our review of social work speaks, we examined the prevalence of the word “prevention” (or any direct variation) within the current 2008 epas (cswe, 2008). results prevention within the social work literature the authors used a tiered search process, working from most broad to most specific. the rationale was to gauge both the breadth and the depth of the explicit prevention content within the social work literature. the first two searches were meant to assess the breadth, with the first search finding those documents that included “prevention” and “social work” anywhere in the document. this yielded 4,635 records in social services abstracts, and 940 records in social work abstracts. from there, the search was narrowed down to only those documents with “social work” and “prevention” in the abstract. the results, as expected, were dramatically reduced to 294 records in social services abstracts and 253 records in social work abstracts. the third step, used to assess the depth of explicit prevention content within the literature, included only those documents that were either journal articles or dissertations and had “prevention” and “social work” in the title of the document. by narrowing to a title-level search, only those articles with a core focus on prevention and social work were identified. there was again a dramatic drop in results at this level, with 36 records retrieved in social services abstracts and 25 records in social work abstracts. within this third search step, there were some records that were found in both databases. these duplicates were identified and excluded in the results, which left 44 unique records between the two databases. in order to examine if any trends or patterns could be established from examining those 44 records, the publication sources were identified as well as the years of publication. first looking at the publication sources, there were a total of 32 different publications (e.g., journals). only five journals had more than one article that was found in this title-level search: social work in health care (6 articles); health and social work; journal of social work education; journal of teaching in social work; and child welfare (each of these with 2 articles). additionally, there were four dissertations found within dissertation abstracts international. the journals covered a wide range of audiences, including practitioners and academics, as well as a broad array of interest areas, including diversity, mental health, social policy, and school social work to name a few. second, for those 44 records found within the two databases, there was inconsistency in the trends for years of publication. within social services abstracts, there was an increase in prevention related articles over the last decade, while the opposite of this was found within social work abstracts. overall, social services abstracts yielded much higher results at all three search steps than social work abstracts. this can be attributed mccave, rishel/prevention as an explicit part of the social work profession  232 to the fact that the two databases have different holdings of journals and the number of journals indexed varies as well. social services abstracts indexes over 1300 journals, as well as dissertations and book reviews, compared to social work abstracts’ collection of 400 journals (personal communication with j. tapia, april 15, 2010). further, social services abstracts is a broader database that includes articles not only from social work and human services related journals, which is the primary focus within social work abstracts, but also from those publications focused on more macro-related topics, such as social policy and social welfare, along with community development (personal communication with j. tapia, april 15, 2010). as a final step in examining the social work literature, it was important to conduct a similar search that served as a measure of comparison. throughout the history of the social work profession, there has been a consistent waxing and waning dichotomy between “prevention” (e.g., public health efforts, social reform, mental health prevention) and “treatment” (e.g., clinical practice) (trattner, 1999). as such, a search using the terms “social work” and “treatment” using the same three steps described above was conducted. as shown in table 1, the results of this search revealed that explicit treatment content represented within the social work literature occurred 1.5 to 4 times as often as compared with explicit prevention content. table 1: comparison between “prevention” and “treatment” in the social work literature level of search key words swa ssa level 1: anywhere “social work” and “prevention” “social work” and “treatment” 940 3,648 4,635 9,184 level 2: abstract “social work” and “prevention” “social work” and “treatment” 253 1,037 294 943 level 3: title “social work” and “prevention” “social work” and “treatment” 25 58 36 58 “prevention” in social work speaks based on the total score for each policy issue (number of total times the word “prevention” or variation of the word was used), the issues were separated into four categories—from having “frequent” (10 or more) mention of “prevention” followed by “moderate” (3 to 9), “minimal” (1 or 2), and lastly “none”. while eight (12.5%) of the 64 policy issues made it into the category of “frequent” with having 10 or more appearances, 24 (37.5%) of the policy issues fell into the “minimal” category of having a total score of either 1 or 2. surprisingly, 17 (26.5%) of the policy issues had no explicit mention of “prevention” in the entire statement. several of the policy issues that fell into the advances in social work, fall 2011, 12(2)  233 “frequent” category also had a prevalence of “prevention” in the “policy statement” sections. the top three policy issues with both the highest total score and subscore were: school violence (23, 9, respectively), hiv and aids (21, 8, respectively), and youth suicide (20, 6, respectively). to see if this translated into high numbers within the social services abstracts and social work abstracts databases, three searches, using “prevention” and “social work” along with each policy issue were used in an abstract search. the purpose of this was to determine if there was a cohesive focus regarding specific areas of prevention between nasw and scholarship. two articles were identified with “social work,” “prevention,” and “school violence” in the abstract. three articles were identified with “social work,” “prevention,” and “youth suicide” in the abstract, and 42 articles were identified with “social work,” “prevention,” and “hiv/aids” (38 under social services abstracts and 4 under social work abstracts). this demonstrates some cohesion within the hiv/aids arena between the social work literature and social work speaks, but not within youth suicide or school violence. lastly, those 44 records found within the two databases that had both “prevention” and “social work” in the title were categorized according to how they related to the 64 policy issues within social work speaks. almost half of the articles were not readily identifiable as fitting into one of the policy issues. these articles did, however, fall into three identifiable topics that included: conceptualizing prevention in social work, school social work, and social work education. prevention reflected in our accreditation standards the 2008 epas contains the word “prevention” (or some variation) four times: once in the introductory section, twice in the core competencies and practice behaviors (the section that drives foundation curriculum content), and once in the standard defining generalist practice (cswe, 2008). these four references are as follows (emphases added): “the purpose of the social work profession is to promote human and community well-being. guided by a person and environment construct, a global perspective, respect for human diversity, and knowledge based on scientific inquiry, social work’s purpose is actualized through its quest for social and economic justice, the prevention of conditions that limit humans rights, the elimination of poverty, and the enhancement of the quality of life for all persons.” (p. 1). education policy 2.1.3 critical thinking (under core competencies) . . . “social workers . . . analyze models of assessment, prevention, intervention, and evaluation . . .” (p. 4). education policy 2.1.10(c) intervention (under core competencies) . . . “social workers implement prevention interventions that enhance client capacities . . .” (p. 7). educational policy b2.2 generalist practice . . . “to promote human and social well-being, generalist practitioners use a range of prevention and intervention mccave, rishel/prevention as an explicit part of the social work profession  234 methods in their practice with individuals, families, groups, organizations, and communities . . .” (p. 7). it is important to note here that by including prevention language under the core competencies and practice behaviors, the 2008 epas more or less require accredited programs to demonstrate that their students achieve competency in the prevention tasks/activities mentioned (i.e. “analyze models of prevention” and “implement prevention interventions”). for comparison, we also examined the most recent previous 2001 epas. the 2001 epas contain the word “prevention” or “preventing” twice, once in describing the purpose of the profession and once in describing the achievement of this purpose (cswe, 2001). it is again important to note that “prevention” (or any variation) does not appear anywhere in the 2001 foundation program objectives, which are equivalent to the new core competencies and practice behaviors of the 2008 epas. this omission of any mention of prevention in this section implies no requirement for the inclusion of prevention content in the social work curriculum under the previous 2001 epas. discussion policy makers at the federal and state level are demonstrating increased recognition of the need for health and mental health prevention programs and interventions (e.g., national research council and institute of medicine, 2009). although the social work profession is uniquely positioned to promote and advocate for a prevention-focused approach to service delivery, our review indicates that there is limited focus and attention to prevention practice in the social work profession. implications for social work scholarship from this investigation, it is clear that scholarship that is focused on prevention in social work is limited. of the two databases searched, social services abstracts revealed an increase in prevention related articles within the last decade and social work abstracts indicated a decrease. however, when the focus of these articles was more closely examined, we found that conceptual articles that advocate a prevention focus in social work have clearly decreased. these types of articles were published most frequently in the 1980s, with at least seven published during this decade (feldman et al., 1982; geismar & lagay, 1985; germain, 1982; libassi & maluccio, 1986; roskin, 1980; siefert, 1983; whitman & hennelly, 1982). our search revealed no other conceptual articles published until 2006 (hawkins, 2006; woody, 2006). other articles published between the 1980s and 2006 with “prevention” and “social work” in the title were all area-specific (e.g. delinquency prevention; school-based prevention; teen pregnancy prevention). the lack of conceptually focused articles in the last two decades suggests that there has been little debate or consideration among social work scholars regarding the connection between prevention and social work during this time period. increasing prevention-focused scholarship would facilitate further debate regarding the role of prevention in the social work profession. this could be done in a number of ways. editors of journals could increase their efforts to encourage prevention-related advances in social work, fall 2011, 12(2)  235 content by creating a special issue on the topic. editors could also use explicit prevention-focused language in the routine calls for papers, within the online “aims and scope” description of their journals, and within their instructions for authors. additionally, we encourage all editors to review their journal’s past table of contents and to assess whether prevention related articles are being published, and if not, to examine why. further, our national conferences hosted by the society for social work and research (sswr), cswe, and baccalaureate program directors (bpd) could add a “prevention in social work” track or add explicit prevention language into the call for abstracts. in addition, mentorship is critically important for junior scholars whose focus is prevention within social work, regardless of population of interest. in order for prevention to receive a greater emphasis, prevention-focused scholars and practitioners will need to define a distinct knowledge base and skill set for those interested in this area of social work. this may be difficult, given the lack in prevention-focused content in social work education and possible lack of recognition of “prevention” as a legitimate area of research within social work. this supports the need for mentorship, both informal and formal. while helpful email listservs, such as the early career preventionists network (ecpn), sponsored by the society for prevention research (spr) exist, it seems likely that social workers could benefit from a similarly formed social network that connects scholars interested in social work and prevention. we assert that prevention should be an equally important focus as treatment within the profession, with evidence reflected in the social work literature. currently, there were 74 unique records found in social service abstracts and social work abstracts when searching “social work” and “treatment” within the title. this compares to 44 unique records found when searching “social work” and “prevention.” this represents a clear benchmark that can be set for the near future. implications for social work practice if nasw’s social work speaks can be viewed as a window into where our profession is focused in current social policy and practice issues, then prevention is clearly not a core element of many areas of social work practice. review of the most recent social work speaks indicates a lack of explicit prevention language in policy issues addressed, particularly in the “policy statement” sections. it was surprising that more than 25% of the policy issues covered had no explicit mention of prevention, especially in issues such as: 1) poverty and economic justice, 2) rural social work, 3) people with disabilities, and 4) prostituted people, commercial sex workers and social work practice. these are areas in which it seems clear that prevention should play a role in practice, as well as policy formation and advocacy. for poverty and economic justice, practitioners who are engaged in policy practice can advocate for social welfare policies that will prevent increased percentages of those in poverty (e.g., raising the federal minimum wage). practitioners in rural areas can focus on the prevention of social problems that are particularly prevalent in rural locations because of isolation and lack of access to care, such as teen pregnancy (skatrud, bennett, & loda, 1998). prevention in the area of disabilities can include a focus on advocating for inpatient substance abuse mccave, rishel/prevention as an explicit part of the social work profession  236 treatment centers to admit pregnant women as a way to prevent fetal alcohol syndrome, which is the leading cause of mental retardation (hutchison, 2008). for the last issue mentioned, sex trafficking and prostitution, it is acknowledged that as long as there is a demand for sex-work there will always be a supply. however, prevention efforts can focus on increasing access to condoms, as well as hiv counseling and testing for sex workers (rekart, 2005). it seems reasonable that a benchmark of adding explicit prevention language into the 17 policy issues currently lacking any mention of prevention for the next edition of social work speaks could be reached. the review of social work speaks also suggests a gap between practitioners and scholars, particularly in the disconnect between research and practice in areas such as youth suicide and prevention as well as school violence and prevention. both of these policy statements emphasized prevention in social work speaks. there was little attention to these areas, however, in the social work literature. a special issue in a related journal could address these issues easily. implications for social work education review of the current (2008) and previous (2001) epas indicates a slight increase in prevention language, with explicit prevention language used twice in the 2001 epas and four times in the 2008 epas. more importantly, the fact that prevention language is included in the core competencies and practice behaviors of the current epas suggests that social work programs will need to demonstrate that graduating students are competent in analyzing and utilizing prevention models with clients. this may be a challenge as prevention is typically not a primary focus of social work education programs. for the profession to move forward in the area of prevention-focused practice, however, educational content in social work programs must include, or even emphasize, prevention knowledge, values, and skills. this can occur in two different ways. one identifiable mechanism is through accreditation/reaffirmation. the self-study requirement for reaffirmation provides an excellent opportunity for program directors and faculty to thoroughly examine the curriculum for prevention-focused content in each of the courses. as course objectives are written to fit the core competencies and practice behaviors that are associated with each course, faculty responsible for these objectives can consider incorporating one objective that emphasizes prevention-focused content. a second way in which prevention-focused content can be incorporated into social work curriculum is to first create an elective that has a prevention focus as the overarching theme for the class (e.g., children’s mental health or sexual health). this allows programs to gauge the interest level of students as well as provide time for faculty to determine how they would start integrating prevention-focused content into other required courses and electives. of course, faculty will need to embrace the idea that prevention-focused content is a priority before any program-wide change occurs. as faculty become committed to integrating prevention-focused content, siefert, jayaratne, & martin (1992) and more recently woody (2006) offer specific recommendations for developing and implementing prevention-focused content into generalist and advanced social work courses and programs. siefert and colleagues describe the development of three specialized prevention courses created within a public health conceptual framework aimed at advances in social work, fall 2011, 12(2)  237 strengthening social workers’ preparation in prevention practice. woody (2006) provides specific guidelines for integrating prevention principles and practices, as well as models of prevention services, into the social work curriculum. the ten specific principles discussed include ideas such as teaching skills related to the identification of both risk and protective factors, risk screening and risk reduction practices, and community capacity building. finally, lurie and monahan (2001) suggest eight specific prevention practice principles for social workers practicing in the area of mental health, which could be used as a starting point for developing prevention-focused curriculum content within courses focused on mental health and clinical practice. limitations of investigation several limitations of this study should be noted. most notably, the authors made a conscious decision to choose the literature, the epas standards, and the nasw social work speaks, to serve as the indicators in this investigation. these indicators are not exhaustive and there are certainly other indicators, such as academic and practice job posting descriptions, the number of social work programs with a joint msw/mph option, and so forth. the three indicators were chosen both because they were deemed appropriate for the research question at hand, and the information needed to assess them was easily accessible. another limitation that relates specifically to using the social work literature as one of three indicators is that the number of articles within the two databases, social work abstracts and social service abstracts, is constantly in flux. consequently, the numbers that are presented in this manuscript will inevitably vary as compared to what would be found if the search were conducted at another point in time. however, it is unlikely that the numbers will experience a dramatic shift within the near future. finally, the authors have made a conclusion that social workers ultimately can and should become more effective in integrating prevention into social work scholarship, practice, and education. that said, it is also worthwhile to note that it is likely that social workers are, in fact, engaging in prevention-focused research, teaching, and practice, but there is not a viable and systematic mechanism for identifying and tracking those activities. what is the future of prevention and social work? in conclusion, our scholarly literature, along with our educational and professional guidelines, seems to lack both focus as well as integration in explicit prevention content. what may be needed is a break from “business as usual” (i.e., a treatment-only philosophy). this can be done first and foremost through social work education by encouraging deans and chairs of social work programs across the country to initiate discussion among social work faculty regarding integrating prevention content throughout the curriculum. the new 2008 epas support this by 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(2004). assessment of teen pregnancy prevention interventions among middle school youth. child and adolescent social work journal, 21, 69-83. author note: address correspondence to: emily l. mccave, west virginia university. po box 6830 morgantown, wv 26506 email: elmccave@mail.wvu.edu _______________ nicole willis, phd, lmsw, assistant professor of social work, texas southern university, houston, tx 77004. nancy chavkin, phd, lmsw-ap, regents’ professor and director of the center for children and families, school of social work, texas state university, san marcos, tx 78666. patrick leung, phd, professor and director of the office for international social work education, graduate college of social work, university of houston, houston, tx, 77004. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 116-133, doi: 10.18060/20856 finding “health” and “meaning” in texas-sized turnover: application of seminal management principles for administration and research in u.s. public child welfare agencies nicole willis nancy chavkin patrick leung abstract: public child welfare agencies in the united states have struggled with high turnover rates, especially among caseworkers. research has explored turnover in terms of negative organizational outcomes, and efforts have been developed to reduce overall turnover rates. however, there has been little change in turnover rates in the last 30 years. the public child welfare system is inclined to higher turnover due to the unique nature of the work. efforts to reduce the overall turnover rate fail to recognize the heterogeneity and healthy aspects of turnover unique to public child welfare organizations, which present challenges for both practice and research. by critically questioning how turnover is socially constructed, measured, and addressed, and integrating seminal management principles, a more meaningful metric can be developed. these challenges are explored, and recommendations are proposed for administration and research that include reconstructing and applying a new perspective on turnover to inform and evaluate initiatives that can reduce the impact of dysfunctional turnover within public child welfare organizations. keywords: public child welfare; turnover; retention turnover has been identified as a major problem for public child welfare organizations (weaver, chang, clark, & rhee, 2007; williams, nichols, kirk, & wilson, 2011). over the last 30 years, child welfare organizations have consistently struggled to develop new initiatives to improve workforce quality and stability (ball & dexheimer, 2015). in this paper we assert that it is time to examine the “problem” of turnover from a new perspective. by critically questioning how turnover is socially constructed, measured, and addressed, a more meaningful metric can be developed. the concept of turnover can be redefined in a way that captures its heterogeneity. specific recommendations are made for initiatives designed not necessarily to reduce the rate of turnover, but rather to reduce the impact of unhealthy turnover. based on this new perspective, recommendations are provided for administration and research for public child welfare agencies across the united states. advances in social work, fall 2016, 17(2) 117 texas-sized turnover: the social construction the national turnover rate for child welfare workers has been described as a “chronic problem” (strolin-goltzman, 2008, p. 125) and varies between 20-40% annually (national child welfare workforce institute, 2011; national council on crime and delinquency, 2006). statistics that demonstrate high turnover can be found in a variety of sources, such as government documents, peer-reviewed journal articles, and even local newspapers spanning time periods and geographic locations. for example, some headlines read, “review: cps hobbled by bureaucracy, high turnover” (rosenthal, 2014, para. 1), “florida child-welfare agencies battling high staff turnover—80% in some parts of state” (menzel, 2014, para. 1), “workforce issues continue to plague child welfare” (riggs, 2007, para. 1), “we suck the passion out of employees: turnover among caseworkers a product of low salaries, high stress; agency hopes latest overhaul will change culture” (ball & dexheimer, 2015, para. 1). such language used in communicating turnover statistics impacts a variety of public child welfare stakeholders. the magnitude of turnover has fueled a sense of urgency on the part of researchers to understand variables that contribute to turnover, including individual and organizational variables (strolin-goltzman et al., 2009; williams & glisson, 2013), as well as the health of the economy (strolin-goltzman, 2008; texas department of family and protective services [tdfps], 2012). high turnover statistics have motivated public child welfare administrators to develop initiatives to reduce turnover (ball & dexheimer, 2015) and can be a deterrent in the recruitment of highly qualified employees (burstain, 2009; the stephen group, 2014). although most would agree that the rate of turnover appears high, it is possible that the common metrics used to measure turnover have led to a social construct that lacks meaningfulness. a texas template: department of family and protective services the public child welfare system in texas has struggled to understand and address turnover, and these challenges are similar to the experiences of public child welfare systems in other states. in texas, the turnover rate for public child welfare is approximately 26% (texas department of family and protective services [tdfps], 2015). this rate increased from 20% in 1980 (martinez, 2014) to 25.5-33% in 2015 (ball & dexheimer, 2015). these rates are particularly high for child protective services (cps) workers in the investigations unit, with a 30-41% turnover rate (martinez, 2014; mcclure, 2008; tdfps, 2015). tdfps workers report leaving their job due to workrelated stress (21.2%), lack of satisfaction with pay (14.3%), and collegial conflicts (12.6%; martinez, 2014). of 200 new cps hires each month, more than 30 terminated employment within six months of their start date (ball & dexheimer, 2015). these data have driven efforts designed to reduce turnover. a variety of interventions to address turnover have been implemented in various areas of the texas public child welfare system. in 2008 cps implemented a $5,000/year stipend for workers to go into the investigations unit. however, even after the initiative, the turnover rate among investigators remained around 33% (burstain, 2009). title iv-e programs have built relationships between bsw/msw programs and public child welfare willis et al./finding “health” and “meaning” 118 to recruit more highly qualified new hires (tdfps, 2015). a mentoring program for new caseworkers and strengths-based supervisor training were recently implemented to address turnover (ball & dexheimer, 2015; tdfps, 2015). a rewards program was also piloted, in which employees recognized by supervisors for excellence could earn administrative leave or wear blue jeans to work. in the 2005 texas senate bill 6 on child welfare reform, tdfps was required to hire ahead or recruit new employees prior to vacancies (burstain, 2009). in addition, the texas state auditor’s office developed a state of texas employee exit survey to collect data from workers terminating employment in order to better respond to retention needs (keel, 2014). despite such initiatives, turnover rates have not significantly declined. the challenges that the public child welfare system in texas has experienced are not isolated situations. public child welfare employees in neighboring states face the same challenges (martinez, 2014; tdfps, 2012), and these challenges are reflected in child welfare literature (strolin-goltzman, 2008). in a national survey of public child welfare workers in 17 states, workers reported experiencing low salaries, high caseloads, safety risks, staff shortages, as well as insufficient training and supervision (u.s. general accounting office [usgao], 2003). in a study of 260 public child welfare workers in georgia, the majority reported feeling burned out, having an unreasonable workload, being unsatisfied with salary, and taking steps to look for employment elsewhere (williams et al., 2011). these factors are commonly associated with either intent to leave or actual turnover in public child welfare organizations. a wealth of studies have demonstrated that various factors such as burn-out, change of career goals (dickinson & perry, 2002; graef & hill, 2000), dissatisfaction with work environment, lack of commitment to agency, lack of supervisor support (cahalane & sites, 2008; collinscamargo & royse, 2010; dickinson & perry, 2002; freund, 2005; morbarak, nissly, & levin, 2001; morrison, burke, & greene, 2007) and attractiveness/availability of jobs at other agencies (dickinson & perry, 2002; maertz & campion, 2004; usgao, 2003) impact both cognitive and behavioral components of turnover. turnover in public child welfare is complicated, and states across the country struggle to address this issue— especially since turnover can impact the quality of services provided to our most vulnerable children and families (faller, grabarek, & ortega, 2009; shim, 2010). conventional definition of turnover it is first important to understand how the construct of turnover has been defined and measured. there are various ways in which turnover has been computed, but in general, those computations include a homogeneous perspective. for example, the conventional calculations include dividing the number of workers who leave employment during a fiscal year by the average number of workers for that same fiscal year (glebbeek & bax, 2004). the average number of workers, for example, can be calculated by totaling the number of workers for each quarter, and dividing by four (keel, 2014). in texas, there are two types of measures used in public child welfare. the first includes a measure outlined by the legislative budget board (lbb), which includes all full-time workers who left during the period without returning divided by the average number of full-time workers on the last day of every quarter in that particular period (burstain, 2009). the advances in social work, fall 2016, 17(2) 119 second measure includes a metric used by the state auditor’s office, in which turnover rate is calculated by dividing the number of workers who leave during that fiscal year by the average number of workers for that fiscal year (keel, 2014). there is some variation, but the general interpretation is the same. for example, if a public child welfare agency had an average of 100 workers in 2015 and 30 of them left that year, the turnover rate would be calculated as 30%. subsequently, that agency might be described as “hobbling,” “plagued,” and “sucking passion out of employees.” a critique of the turnover construct the conventional construct of turnover in the united states has several weaknesses. calculation of turnover in public child welfare does not incorporate the heterogeneity of the construct (heavey, holwerda, & hausknecht, 2013). in business and management literature, many explain that measuring turnover as a rate is not the best way to measure a construct (muñoz & villalobos, 2002). developing a more meaningful metric of turnover can lead to improved understanding, research, and development of initiatives in public child welfare. lacks multi-dimensionality turnover rates typically reflect only the unidimensionality of job termination (i.e., leaving or staying). this lacks information about the circumstances under which a worker leaves employment, including their motivation and initiation. the dimension of motivation includes information about the reason for leaving employment. employment termination can be considered preventable or unpreventable (strolin-goltzman, 2008). unpreventable turnover includes workers who leave their organization for reasons such as job relocation of spouse, return to school, marriage, parenting, death, or retirement. preventable turnover includes workers who leave for other reasons (e.g., work-related stress, dissatisfaction with salary, work relationships, workload, or lack of goodness-offit). another dimension of turnover includes initiation, that is, who initiated the termination. for example, turnover can also be categorized as voluntary or involuntary (kammeyer-mueller, wanberg, glomb, & ahlburg, 2005; keel, 2014; u.s. department of labor [usdl], 2016). employees initiate voluntary types of termination, which include the employee making the decision to terminate, regardless of reason for leaving. on the other hand, involuntary terminations are those initiated by the employer, for reasons such as poor performance, agency downsizing, or expired agency contracts (mcelroy, morrow, & rude, 2001). workers who transfer within the agency or to another state agency are sometimes excluded from the turnover construct, as some do not consider it a loss to the state as a whole (keel, 2014). however, burstain (2009) explained that turnover measures should include not only those who leave the agency, but also those who transfer to other positions within the agency, since this also disrupts the worker-client relationship. keel (2014) found that turnover rate for the tdfps was 18.8% using the traditional metric. however, if involuntary turnover were excluded, the turnover rate would fall to 14.8%. keel (2014) asserts that excluding involuntary turnover would be a more accurate measure of turnover. willis et al./finding “health” and “meaning” 120 turnover rates also do not take into account an employee’s length of service or employee value to the agency (buchan, 2010; muñoz & villalobos, 2002). for example, an overall turnover rate could either reflect that all employees left the agency in one year, or that 25% of them left the agency each quarter. this limits insight regarding employment longevity among staff (buchan, 2010). in addition, some studies (e.g., kammeyer-mueller et al., 2005; the stephen group, 2014; strolin-goltzman et al., 2009) included both low and high performing employees in the same turnover variable. this creates a challenge with drawing accurate conclusions about the impact of turnover on an organization, since losing a high-performing employee can have a more negative consequence on agency performance than losing a low-performing employee. lacks distinction: functional versus dysfunctional according to staw (1980), the misperception that turnover is negative has been driven by assumptions, including the saliency of associated costs. a multidimensional perspective could help distinguish turnover that is functional (not harmful) from turnover that is dysfunctional (harmful). according to smith and rutigliano (2002), the organizational cost of a 15% turnover rate depends on the type of workers that figure represents. in other words, losing 15% of high-performing employees will have a very different cost to the organization than losing 15% of low-performing employees. although research has found that turnover is costly to public child welfare agencies (graef & hill, 2000), the failure to incorporate multidimensionality into the social construct of turnover inflates the perceived rates and costs to the agency. the impact of turnover has been examined in terms of hard costs (e.g., administrative time, advertising open positions, interviewing potential new hires, drug and background checks, new employee orientation, etc.) and soft costs (lost productivity of employees who left the agency, employee’s colleagues and supervisors) (graef & hill, 2000; mcclure, 2008). mcclure estimates the total cost to tdfps for each child welfare worker who quits to be more than $52,500. based on the turnover of more than 1,000 child welfare workers in 2006, mcclure (2008) estimated that tdfps experienced a loss of more than $56 million that year. however, the actual costs to public child welfare agencies may be inflated due to the way in which turnover is conceptualized. how assumptions have driven research the linear perspective research has consistently reported that turnover is dysfunctional (negative) and associated with poor organizational outcomes while assuming that this relationship is linear. the assumption that turnover damages client outcomes and organizational effectiveness through a loss of financial and social capital have driven the bulk of the literature, especially in public child welfare (heavey et al., 2013). national child welfare outcomes have been established by the u.s. department of health and human services (2016) and include reducing: recurrence and incidence of child abuse/neglect, time between foster care and reunification, time between foster care and adoption, and placements of youth in group homes/institutions, as well as increasing permanency for advances in social work, fall 2016, 17(2) 121 youth in foster care and placement stability. some research has found that high turnover is correlated with difficulty in meeting the standards for client outcomes, such as increases in foster care placements (strolin-goltzman, kollar, & trinkle, 2010), delays in plan approvals for both keeping children in the home and family reunification, increases in substantiated re-abuse or re-neglect (national council on crime and delinquency, 2006) and reduced permanency (leung, 2008; martinez, 2014). in addition, increased turnover has also been associated with poor agency fiscal health (cahalane & sites, 2008; folaron & hostetter, 2007; landsman, 2007; rosenthal & waters, 2006). however, some research, especially in the business and management disciplines, suggests that the assumptions that drive turnover research in public child welfare may not capture the whole picture. research has found that relationships between turnover and organizational effectiveness are weak and curvilinear, even if statistically significant. studies have also found that the impact of turnover on organizational performance is small (huselid, 1995; koys, 2001). for example, heavey et al. (2013) found that the relationships between voluntary and involuntary turnover, customer satisfaction, and organizational efficiency were weak (r=.20, r=–.35), even though statistically significant. other research challenges the assumption that the relationship between turnover and organizational outcomes is linear. glebbeek and bax (2004) found that turnover explained less than 19% of the variance in organizational performance and that this relationship was curvilinear. siebert and zubanov (2009) also found a curvilinear relationship between turnover and organizational productivity, but this was specific to the type of worker. furthermore, in a national study of 73 child welfare agencies, williams and glisson (2013) found that a decrease in caseworker turnover was not associated with improved child outcomes in all child welfare agencies. in fact, decreases in turnover only improved child outcomes in agencies that had high organizational proficiency (agencies characterized by having norms/expectations that focus on clients’ well-being) and workers with current knowledge/skills who respond effectively to client needs and contribute to positive client outcomes (williams & glisson, 2013). within agencies that had low organizational proficiency, decreases in turnover had no significant impact on child welfare outcomes. these findings provide some evidence that challenges the linear relationship between turnover and both client and organizational outcomes in public child welfare agencies. turnover and organizational health although turnover is generally associated with workforce stability (buchan, 2010; burstain, 2009), low turnover rates are not always an indicator of organizational health. our current perception of turnover limits its value to an agency because negative consequences of turnover receive more attention than positive ones (staw, 1980). in large organizations, turnover can be quite natural and healthy in several ways. retirement, death, relocation, or leaving due to illness are all natural forms of attrition, expected in any organizational system. transferring to other departments or to other state agencies is also common and can be expected. in addition, hiring and/or retaining employees who are not a good fit for providing services in public child welfare can have negative impacts on the health of the organization. willis et al./finding “health” and “meaning” 122 research has found that low turnover rates are highly correlated with the overall health of the job market (kenny, 2007). burstain (2009) and the tdfps (2012) found that turnover in public child welfare is lower during periods of stagnation in the economy. for example, it is plausible that workers who are unfit or unmotivated to work are more likely to remain employed in public child welfare when the job market is stagnant and the prospect of working elsewhere is limited. on the surface, higher retention might appear to be a success and be interpreted as less costly to the agency (staw, 1980). however, retention of workers whose turnover would be considered desirable could also have a negative impact on the agency’s fiscal health and client outcomes (mowday, 1984; park & shaw, 2013; smith & rutigliano, 2002). the public child welfare system is unique in nature, and some people are not a good fit as employees. in fact, tdfps (2012, 2015) found that 19-25% of applicants are not recommended for this type of work based on their pre-employment screening. the work-life fit is a strong predictor of intent to leave, regardless of working in a high or low turnover agency (strolin-goltzman, 2008). managing bureaucracy, constant organizational change, lower pay in exchange for responding to allegations of maltreatment, identifying needs, and providing services makes this professional environment suited to particular types of employees (wells, jolles, chuang, mcbeath, & collins-camargo, 2014). high turnover can also be a characteristic of specific types of organizational systems (mowday, 1984). therefore, higher turnover might be a reasonable and expected component of public child welfare organizations. due to the stressful nature of public child welfare, the average length of tenure could be considered expected, compared to other jobs, in general. graef and hill (2000) state that “long-term employment is not the norm for many child protection staff” (p. 519). some workers leave because they recognize they are not a good fit and cannot contribute to a healthier organization (strolin, mccarthy, & caringi, 2007). turnover is highest in the first three months of employment when training occurs (tdfps, 2015). the timing of worker departure can inflate overall rate of turnover and costs to the organization. the reasons those who quit before the three month training ends can have an influence on the health of the organization. for instance, employees might realize the job is not a good fit, might not perform well during exercises, may not have realized what the job entailed, etc.; thus, the bulk of turnover in the first three months could be considered healthy. in 2012, the average length of employment of child welfare workers was four years in texas (tdfps, 2012). this is similar to tenure in other states. in a national sample of over 9,000 public child welfare workers, the average length of employment was less than four years (madden, scannapieco, & painter, 2014). in a national study of almost 2,000 child welfare workers, barth, lloyd, christ, chapman, and dickinson (2008) found that the average tenure in employment was approximately seven years. furthermore, strolingoltzman (2008) found that employee tenure at low turnover agencies was only two years higher than at high turnover agencies. retaining workers for the sake of having low turnover rates can be more costly to organizations if workers are unmotivated, burned out, and/or lack goodness-of-fit (abelson & baysinger, 1984). furthermore, turnover makes room for new hires that bring fresh ideas and savings on salary expenditures (abelson & baysinger, 1984; park & shaw, 2013). advances in social work, fall 2016, 17(2) 123 recommendations for administration and research research shows that most public child welfare agencies have a goal to reduce overall levels of turnover (rosenthal & waters, 2006; strolin-goltzman, 2008; usgao, 2003). this is driven by the perception that turnover is unhealthy, leading to initiatives to reduce its overall magnitude. this is in and of itself somewhat problematic, due to lack of consensus regarding rates of turnover, recognition that some types of turnover are healthy, and the nature of public child welfare work. new dialogue about turnover in public child welfare needs to come from a perspective of health and meaning. there is evidence that: (a) the way we measure turnover is not as meaningful as it could be, and (b) there have been many preventive initiatives in the last 30 years with no major changes to turnover (ball & dexheimer, 2015; tdfps, 2015). our knowledge base will stagnate if research and practice have a one-dimensional view of turnover. for example, turnover rates in public child welfare will continue to be reported as “crippling” in public and professional circles, which is a deterrent in recruitment efforts of highly qualified employees. if research continues to examine turnover in terms of linearity and homogeneity, our understanding of this phenomenon will remain limited. administrators will continue to incorporate a onedimensional perspective of turnover and develop practice initiatives that have little impact on turnover. however, a new perspective could redefine the social construct of turnover and focus on reducing the impact (not overall rate) of turnover. therefore based on the research reviewed herein, we present the following three recommendations to reduce the impact of dysfunctional turnover, 1) set realistic goals for optimal years of service, based on the unique nature of public child welfare work, 2) monitor and report on meaningful turnover in public child welfare, and 3) develop initiatives to minimize the impact of turnover instead of minimizing overall rate of turnover. recommendation #1: set realistic goals for optimal years of service, based on the unique nature of public child welfare work although retention is a desirable outcome, the length of retention has not been standardized in turnover literature. for example, how many years are ideal for a caseworker to remain employed in public child welfare? providing services to vulnerable children and families in public child welfare requires workers to apply specialized skills, knowledge, and values with competence and compassion. working in an environment with increasing caseloads, low pay, and daily exposure to issues such as abuse and neglect is stressful (martinez, 2014). the burden of emotional stress may occur at a faster rate than other types of employment, impacting the length of employment in this field. in addition, the average american person will have more than seven jobs before 33 years of age (kenny, 2007). however, barth et al. (2008) argue that the average length of employment of seven years is a “cause for concern” (p. 208), and that longer tenure is key in a field like public child welfare. although research demonstrates that two to seven years of service in public child welfare is the norm, what is normal may or may not be optimal. optimal tenure length is not clearly defined and should be further explored in future research focused on caseworkers who are “in the trenches” and deliver services within departments that traditionally have the highest level of instability (burstain, 2009). willis et al./finding “health” and “meaning” 124 future research among u.s. public child welfare agencies should explore relationships between public child welfare roles and optimal years of service. in addition, cost-benefit analyses can examine the impact of dysfunctional turnover in terms of organizational hard and soft costs. this can be used to establish optimal turnover rates within individual organizations. recommendation #2: monitor and report on meaningful turnover in public child welfare research has demonstrated that there are various dimensions of turnover, persons who initiate the turnover (voluntary/involuntary), reasons for leaving (avoidable/unavoidable), and proximity (intra/inter-agency transfer/no transfer). however, it is the one-dimensional rate of turnover that is most often reported and associated with negative impact on agency outcomes. a new perspective on turnover should incorporate heterogeneity and allow differentiation of functional (healthy) turnover from dysfunctional (unhealthy) turnover. resources have been allocated to develop and implement preventive initiatives, such as mentoring; however, incentives have generally not been tailored to the multi-dimensionality of turnover. in fact, staw (1980) asserts that allocating resources equally among low and high performing workers is more likely to result in unhealthy turnover of high-performing employees than low performers. therefore, these resources are likely to prevent healthy turnover (i.e., increased retention of workers who are disengaged, not a good fit, etc.) and would be inefficiently spent on unavoidable turnover (i.e., turnover due to illness, retirement, etc.). research and practice initiatives should focus on the turnover that has the most negative impact on child welfare organizations. some studies have attempted to test the association between voluntary and involuntary turnover with organizational attributes (e.g., hausknecht, trevor, & howard, 2009; kammeyer-mueller et al., 2005; keel, 2014; mcelroy et al., 2001). however, current research that examines voluntary turnover has included those employees with both low and high performance (park & shaw, 2013). including both lowand high-performing employees in the same category makes it difficult to draw conclusions about the impact of turnover on an organization (hausknecht et al., 2009; mowday, 1984). partitioning turnover into voluntary and involuntary categories might limit our measures, as it leaves out the distinct interaction with other dimensions of turnover. the dynamic relationship between worker performance and turnover is an important direction for future studies (kammeyermueller et al., 2005). in order to determine what is considered healthy and unhealthy, research should include worker performance as an additional dimension of turnover rates. abelson and baysinger (1984) suggest coding functional turnover for those with low performance scores who leave and dysfunctional turnover for those with high performance scores who leave. the interaction between worker performance and turnover characteristics—for those workers who remain past the probationary/training period—will help to produce a more meaningful metric about the level of turnover considered unhealthy to the organization. in order to create a more meaningful metric, public child welfare organizations in the united states can integrate some of the instruments that already exist. for example, the advances in social work, fall 2016, 17(2) 125 tdfps (2012, 2015) administers the state of texas employee exit survey when employees leave the agency and has developed a new performance evaluation. the exit interviews were designed to gather more information about employee motivations and types of turnover. however, completion of both of these evaluations is optional. while the majority (79%) complete the performance evaluation, less than 15% of employees complete the exit interview (tdfps, 2012, 2015). exit interview data could indicate motivation and initiation of turnover and could be combined with the employee performance data to create a richer multidimensional view of turnover (see table 1). providing incentives for completing the exit interview (e.g., gift cards, etc.) could yield a higher response rate, and thus, increase the generalizability of the results. a change in how turnover data is defined and collected would require public child welfare administrators to invest significant resources into creating and administering annual performance reviews for each worker, deciding cut-off scores for those reviews, and developing a systematic way to collect and integrate data from each worker's performance score and turnover type. there may be a lack of administrative and/or financial resources at some agencies to implement this type of data collection and analysis. table 1. functional/dysfunctional metric of organizational turnover type of turnover characteristic low performance high performance preventable dissatisfied with pay, lack of collegial relationships functional (+) dysfunctional (–) unpreventable/ voluntary death, relocation of spouse, illness, retirement, intra-agency transfer functional (+) dysfunctional (–) involuntary laid off, fired, expired employment contracts functional (+) dysfunctional (–) turnover is a complicated construct that has distinct interaction effects. for example, although retirement is voluntary/unpreventable, the impact of this type of turnover depends on the level of worker performance. similarly, the impact of turnover due to pay dissatisfaction of a high performer is different on the organization than turnover of a low performing worker who leaves for preventable reasons. previous initiatives have been designed to reduce turnover; however, literature in business and management has demonstrated that organizational effectiveness is low in both very low rates of turnover and very high rates (abelson & baysinger, 1984). glebbeek and bax (2004) tested this model in a staffing firm with over 1,800 employees, controlling for absenteeism, age, and region; they found that both extremely low and high turnover have a negative impact on organizational performance. the turnover explained less than 19% of the variance in organizational performance. turnover can only be considered dysfunctional if it takes away from overall organizational effectiveness. once public child welfare agencies use integrated data to create a more meaningful metric that estimates dysfunctional turnover, an optimal turnover rate can be determined willis et al./finding “health” and “meaning” 126 to inform practice initiatives. an optimal turnover rate is “the rate that minimizes the sum of the costs of turnover plus the costs associated with reducing it” (abelson & baysinger, 1984, p.333). currently, there is a lack of consensus about what is considered low and high, or acceptable and unacceptable rates of turnover in public child welfare. some research utilized an arbitrary cut-off to distinguish agencies with low rates (17% or less turnover) from agencies with high rates (greater than 17% turnover; e.g. keel, 2014; strolin-gotzman, 2008). according to strolin-goltzman et al. (2010), an annual turnover rate greater than 25% is considered “high.” in the business industry, a turnover rate of up to 15% is considered optimal and healthy (schreiner, n.d.; siebert & zubanov, 2009). “high turnover” is a term used to describe the rates in most public child welfare agencies (auerbach, schudrich, lawrence, claiborne, & mcgowan, 2014), but it is not useful to describe all turnover as high and interpret such rates as entirely negative. in complex organizational systems, the optimal turnover rate will vary by agency because there is no standard of turnover (abelson & baysinger, 1984) and will even be higher in lower-level positions within the agency itself (mowday, 1984). public child welfare agencies across the united states can integrate their existing data collection instruments or develop instruments that provide a metric that distinguishes functional and healthy turnover from dysfunctional and unhealthy turnover. this will likely reduce the rate of turnover that is reported to the public, and thus, could result in a more positive organizational image. a more positive image of public child welfare can help attract highly qualified candidates for positions within the agencies, as well as improve worker morale (burstain, 2009). a better understanding of dysfunctional turnover can also help to inform practice initiatives targeting turnover deemed to have a negative impact on outcomes. recommendation #3: develop initiatives to minimize the impact of turnover instead of minimizing overall rate of turnover the reality of the public child welfare industry is that organizations are inclined to high turnover. therefore, organizations should develop initiatives that reduce the impact of high turnover. in business and management organizations, specific strategies are used to mitigate turnover impacts, such as buffering, smoothing, and forecasting (mowday, 1984). these same approaches might be adapted for the public child welfare organizations across the united states. in business, buffering includes reducing the disruption of turnover by implementing “strategies that increase the organizational resources beyond a level minimally required to complete a task” (mowday, 1984, p. 371), which introduces slack in the organizational system. agencies could create a new metric to assess dysfunctional turnover at the departmental level, and can then identify high priority systems with the most need for initiatives. for example, one initiative in texas was the practice to hire ahead of vacancies. however, this would be challenging when there are excessive vacancies to fill in departments with high turnover. instead, a strategy to reduce the impact of high turnover might be to overstaff that particular department. for example, if the investigations unit had the highest level of dysfunctional turnover, the organization could over-hire to create additional slack when a worker leaves. however, as public child advances in social work, fall 2016, 17(2) 127 welfare agency budgets are already strained—many by inadequate state funding—this approach might be met with resistance, as it would increase the operating costs for many agencies. another way to use buffering to reduce the impact of turnover is cross-training employees (mowday, 1984). although cross-training is not common in public child welfare agencies, the american public human services association (2010) recommends cross-training as one of its key strategies for improving child welfare outcomes. in public child welfare, cross-training for skills used in other departments will allow mobility in departments with the lowest dysfunctional turnover to fill in departments with the highest dysfunctional turnover. an examination of historical trends within each specific department in an agency can help inform this strategy (mowday, 1984). traditionally, workers in the same department absorb extra caseloads until an additional person is hired and trained. however, application of cross-training might help to reduce the impact of dysfunctional turnover. mowday (1984) suggests redefining job titles to allow for more flexibility to achieve cross-training movement. turnover research has contributed to the development of process models (i.e., describing how workers leave/remain employed) and content models (i.e., why workers leave/remain employed (maertz & campion, 2004). research suggests that variables from the individual to the organizational levels influence intent to leave, decisions to stay, and actual retention and turnover rates (gansle & ellett, 2002; jacquet, clark, morazes, & withers, 2007; zlotnik, depanfilis, daining, & lane, 2005). however, one limitation to this research is that the unit of analysis is on individual processes and behaviors. although substantial knowledge about how and why a worker leaves public child welfare has been developed, there is limited knowledge about these processes in terms of the fluidity of turnover between persons. a new perspective on turnover can drive different units of analysis for research. future research can examine the differences in the turnover process between those who leave and those who stay (i.e., the interpersonal component of turnover) to build on existing research about the intrapersonal cognitive and behavioral processes of turnover. in a study by willis (2010), qualitative comments by public child welfare workers suggested that a more fluid transition process with leavers/new hires will alleviate stress, absorption of extra caseloads, changing relationships, and overtime work hours. in another study, strolin-goltzman et al. (2010) found that foster youth corroborated the need to focus on the fluidity of transition between workers during turnover, in order to maintain trust in the worker-client relationship. once organizational initiatives are developed to reduce the impact of dysfunctional turnover, research studies can be conducted to measure interpersonal processes in public child welfare agencies across the united states. evaluating interpersonal processes (i.e., cross-training) can add to current knowledge about process and content models of turnover. the well-being of the children and families served in the public child welfare system is the top priority, yet a large knowledge gap currently exists in our understanding about the nature of the relationship between turnover and client outcomes in public child welfare (williams & glisson, 2013). researchers can collaborate with agency administrators to explore the relationship between approaches to reduce the impact of turnover on child welfare outcomes. willis et al./finding “health” and “meaning” 128 conclusion although a variety of initiatives have been implemented in the last 30 years, the headlines about high turnover in public child welfare have persisted. new headlines and new perspectives need to be created. future research initiatives that focus on the multidimensional approach to turnover can better inform efforts to redefine the public image of turnover in the public child welfare system. recognizing that public child welfare organizations are different than traditional businesses, it is imperative that constructs, measures, and initiatives that are evidence-based in business/management disciplines are carefully evaluated and adapted to be culturally appropriate for public child welfare organizations. applying interdisciplinary knowledge and approaches can help us find new ways to understand and address the turnover problem that has “plagued” the public child welfare system for the last 30 years. a new perspective that recognizes and responds to the heterogeneity of turnover can lead to a more meaningful turnover construct that contributes to a more positive public image, development of useful practice initiatives, new directions for research, and ultimately, better outcomes for the children and families that we serve. references abelson, m.a., & baysinger, b.d. 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(2003). child welfare: hhs could play a role in helping child welfare agencies recruit and retain staff. retrieved from http://www.gao.gov/assets/240/237373.pdf weaver, d., chang, j., clark, s., & rhee, s. (2007). keeping public child welfare workers on the job. administration in social work, 31(2), 5-25. doi:http://dx.doi.org/10.1300/j147v31n02_02 wells, r., jolles, m. p., chuang, e., mcbeath, b., & collins-camargo, c. (2014). trends in local public child welfare agencies 1999-2009. children and youth services review, 38, 93-100. doi:http://dx.doi.org/10.1016/j.childyouth.2014.01.015 williams, n. j., & glisson, c. (2013). reducing turnover is not enough: the need for proficient organizational cultures to support positive youth outcomes in child welfare. children and youth services review, 35(11), 1-17. doi:http://dx.doi.org/10.1016/j.childyouth.2013.09.002 williams, s. e., nichols, q. i., kirk, a., & wilson, t. (2011). a recent look at the factors influencing workforce retention in public child welfare. children and youth services review, 33, 157-160. doi:http://dx.doi.org/10.1016/j.childyouth.2010.08.028 willis, n. (2010). using systems theory & social exchange theory to understand factors that impact retention, turnover and motivation to work in a public child welfare agency (doctoral dissertation). university of houston, graduate college of social work, houston, tx. zlotnik, j. l., depanfilis, d., daining, c., & lane, m. m. (2005). factors influencing retention of child welfare staff: a systematic review of research. washington, dc: institute for the advancement of social work research. author note address correspondence to: nicole willis, assistant professor of social work, texas southern university, 3100 cleburne street, pab 302z, houston, tx 77004 or willisng@tsu.edu http://www.gao.gov/assets/240/237373.pdf http://dx.doi.org/10.1300/j147v31n02_02 http://dx.doi.org/10.1016/j.childyouth.2014.01.015 http://dx.doi.org/10.1016/j.childyouth.2013.09.002 http://dx.doi.org/10.1016/j.childyouth.2010.08.028 mailto:willisng@tsu.edu ______________ stacy m. deck, phd, mssw, is an associate professor of social work at spalding university, in louisville, kentucky. phyllis a. platt, phd, msw, is ceo of the shawnee christian healthcare center, inc.in louisville, kentucky. laneshia conner, phd, msw, is an assistant professor in the school of social work at the university of north carolina at charlotte in charlotte, north carolina. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 233-248, doi: 10.18060/18302 engaged teaching-learning: outcome evaluation for social work students in a graduate-level service learning research course stacy m. deck phyllis a. platt laneshia mccord abstract: the challenges of engaging social work students in the research curriculum are well-documented, and the literature supports the use of service learning to increase engagement. this study explores self-efficacy as one measure of learning outcomes. changes in students’ (n=88) assessment of their ability to perform research and program evaluation tasks skillfully were measured by administering the evaluation self-efficacy scale (ese) on the first and last days of a graduate-level advanced research class that included a service learning project. ese scores on the last day of class were significantly higher than on the first day of class. the effect size was larger than in prior similar studies, suggesting that service learning contributed to students’ sense of mastery of course content. these results support the use of an engaged-learning model such as a service learning project in advanced social work research courses to improve students’ evaluation self-efficacy. keywords: service learning, engaged teaching, social work, research self-efficacy, evaluation self-efficacy the challenges of engaging students in the research curriculum are well-documented in the social work education literature (harder, 2010; hebert, kulkin, & ahn, 2014; phillips, macgiollari, & callaghan, 2012; wells, 2006). because students commonly lack interest in research, and may fail to see connections between learning and applying research, it can be difficult to design courses that help students move beyond their reluctance (lundahl, 2008; macintyre & paul, 2013). on the other hand, students are more inclined to express interest in research when they find it to be relevant, useful in practice, congruent with their values and ethics, and collaborative (gibbs & stirling, 2013). as social work education has moved toward a competency-based approach to measuring program outcomes, the challenge of integrating research and practice has become even more pressing (phillips, 2011). focusing on student self-efficacy provides a theory-based outcome measure useful for monitoring students’ academic development. this study explores self-efficacy, not as a measure of knowledge, but as a measure of change in students’ perceptions of context-specific abilities as related to program evaluation and research. evaluation self-efficacy self-efficacy is a key component of bandura’s social cognitive theory. according to bandura, “self-efficacy is not a measure of the skills one has but a belief about what one can do… with whatever skills one possesses” (bandura, 1997, p. 37). lack of self-efficacy advances in social work, fall 2015, 16(2) 234 can diminish an individual’s propensity to take action or to persevere in the context of challenging or complicated circumstances (carpenter, 2011; hebert et al., 2014; quinney & parker, 2010). bandura maintains that self-efficacy is influenced by four types of experiences: (a) mastery, (b) vicarious experiences, (c) social persuasion, and (d) physiological states (bandura, 1986). successful experiences (mastery) contribute to increased self-efficacy as does observing others’ success. modeling (i.e., providing vicarious experiences) offers an opportunity to engage in activities that enhance selfefficacy, especially in situations where students have had few prior opportunities to engage in the task. according to bandura, modeling may be particularly useful with those who are mostly unsure of themselves, which is certainly the case for many social work students when it comes to research. students’ lack of experience with and reluctance to engage in research activities often result in low self-efficacy for this professional competency. the third factor that affects self-efficacy, social persuasion, is the encouragement or discouragement received from others. physiological factors (or more specifically, one’s interpretation of physiological responses in stressful situations) also impact self-efficacy (bandura, 1997). in this theoretical framework, a student’s anxiety and related feelings about math or statistics, and the ensuing butterflies, could be interpreted as a sign of lacking adequate ability and, therefore, decreased self-efficacy. this belief in one’s efficacy is unlike self-esteem and confidence. self-esteem is related to one’s sense of self-worth. confidence is a less well-defined concept, and refers to the strength of one’s belief or how certain one is. bandura explained that “perceived self-efficacy refers to belief in one's agentive capabilities that one can produce given levels of attainment. a self -efficacy assessment, therefore, includes both an affirmation of a capability level and the strength of that belief” (bandura, 1997, p. 382). in other words, confidence is necessary, but not sufficient. to have self-efficacy, a person must also possess personal agency (i.e., affirm his or her own skill or ability to perform at a particular level). social work educators have found self-efficacy to be a relevant measure of educational outcomes in social work research courses. holden, barker, meenaghan, and rosenberg (1999) described their research self-efficacy scale (rse) as offering a means for assessing the impact of social work instruction in this area. unrau and grinnell (2005) subsequently used the rse in a study of social work educational outcomes. they found that undergraduate and graduate students’ research self-efficacy increased during a semester in which they were enrolled in a required research course and that those who began with lower levels achieved larger gains. a review of the literature also supports the use of service learning as a teaching method to increase academic self-efficacy. service learning service learning is a pedagogical approach that offers a systematic structure for linking classroom instruction and service experiences (rhoades, 1998). in higher education, academic service learning takes on a variety of forms and is integrated into course work in multiple formats. in social work education, volunteering, and field practicum experiences often have been classified as service learning (harder, 2010). yet, for purposes of this study, service learning is more distinctly defined as “intentional learning (both curricular deck et al./engaged teaching-learning 235 and civic) because of its emphasis on the reciprocal relationship between students, their instructors, and community members” (phillips, 2011, p. 2). the use of service learning must provide opportunities that meet both academic and community needs (campbell, 2012; lucas, 2000; wells, 2006). in their meta-analysis, yorio and ye (2012) found that students who participate in service learning generally “demonstrate a more positive understanding of social issues, alter their personal insight, and experience gains in cognitive development” (p. 25). similarly, cronley, madden, davis, and preble (2014) found that social work educators’ use of service learning is predicated on a belief that it positively impacts students’ personal development and their ability to resolve moral and ethical dilemmas. yet, surprisingly, educators who used service learning also tended not to agree with the idea that it increases students’ ability to apply what they have learned (cronley et al., 2014). wells, maschi, and slater (2012) found that among three approaches to integrating research and practice, the problem-solving approach—which included service learning activities—was least frequently described by the social work research faculty they surveyed. similarly, an examination of research education in the united kingdom found that while faculty were aware that students value experiential learning and hands-on experience, this method was not commonly used (macintyre & paul, 2013). self-efficacy has been identified as a “motivational outcome,” which suggests that building confidence in one’s ability to complete a difficult task increases the likelihood that one will engage in that behavior in the future (carpenter, 2011, p. 128). self-efficacy takes the concept of confidence further, however, to include “an affirmation of a capability level” (bandura, 1997, p. 382). this requires knowing through assessment that one’s ability to do something is at a high enough level to be successful. harder (2010) found that reallife experiences gained through service learning increased students’ motivation to engage in research by heightening their perception of its relevance to practice. thus, it is plausible that as students’ self-efficacy increases, their likelihood to engage in research activities as part of their future practice also increases. the literature related to socializing students into the profession by helping them to attain and use professional knowledge and expertise in general (wilson & kelly, 2010), as well as to researchor evaluation-related self-efficacy specifically (holden, barker, rosenberg, & onghena, 2007), is limited. one literature review of published studies on social work education outcomes measured over time using quantitative or mixed methods identified only 31 english-language articles published between 2004 and 2010 and concluded that “rigorous evaluation of the outcomes of social work education is still at an early stage of development” (carpenter, 2011, p. 137). even as the body of evidence is growing for the use of service learning in social work, some argue that more research is needed to assess its “goodness of fit” as an effective teaching-learning approach (charles, alexander, & oliver, 2014; lemieux & allen, 2007; phillips, 2011). the purpose of this study was to explore the following research questions: what are the effects of a service learning approach to teaching social work research and program evaluation methods? specifically, does students’ post-course evaluation self-efficacy differ from their precourse evaluation self-efficacy? advances in social work, fall 2015, 16(2) 236 methods study design this study used a one group, pretest-posttest design. preand post-course data were collected by three faculty members from four consecutive cohorts of students who were enrolled in graduate-level advanced research courses between 2010 and 2013. the course is required for the master of social work (msw) degree and is offered in the concentration year. in the first three years, it was offered as a traditional face-to-face course that was enhanced with a service learning component of community-based practice (a program evaluation project for a local non-profit agency). in 2013, the course was offered in a hybrid-learning format that included 24 hours of face-to-face class time, approximately 16 hours of online learning, and the service learning component. sample during the four academic years in which data were collected, 106 students were enrolled in the advanced research course. of these, 88 submitted preand post-course data collection forms that could be linked using a matching identification number and were included in the study. to ensure anonymity, demographic information was not collected from study participants. however, program-level administrative data indicate that 26.1% of msw students enrolled during the most recent year of the study were under age 25, 39.1% were between the ages of 25 and 34, 52.2% were between the ages of 35 and 44, and 17.4% were over age 45. most were female (82.6%). half of the students (50.0%) were african american or another racial/ethnic minority. about two-thirds (64.8%) of the students in the study sample reported that they had entered the graduate program with an undergraduate degree in social work. of these 57 advanced standing students, 51 provided information about how long it had been since their last research course. the timeframe ranged from less than one year to 14 years. while the most frequent response was one year (15 participants), the median elapsed time was three years. the remaining students were in their second year of a two-year program and had completed their first graduate-level research course in the prior year. data collection data were initially collected as part of the curriculum evaluation plan for spalding university school of social work’s continuing accreditation through the council on social work education (cswe). the original purpose for collecting these data was to assess the degree to which course objectives were achieved and to evaluate the effectiveness of the engaged-learning strategy (service learning approach) used in the course. in the current study, the investigators conducted a secondary analysis of the existing data. the university’s research ethics committee approved the study methods. all students enrolled in the research course completed a print version of the data collection instrument during a face-to-face class meeting on the first and last days of the course. to protect students’ identity, promote greater willingness to disclose perceptions of their own ability, and decrease the potential for social desirability bias, students were deck et al./engaged teaching-learning 237 asked not to write their names or any identifying information on the data collection forms. to match preand post-course data, students created and recorded a unique identification number on their forms. these identification numbers were not linked to student names, making it impossible for instructors to connect students with their responses. variables/measures in the study reported here, evaluation self-efficacy was the dependent variable. changes in students’ confidence in their own ability to perform specific social work tasks related to research and program evaluation (evaluation self-efficacy) were measured by administering the evaluation self-efficacy scale (holden et al., 2007; holden, barker, rosenberg, & onghena, 2008) on the first and last days of class. the evaluation selfefficacy scale (ese) is an 11-item self-report scale that measures students’ confidence in their ability to perform tasks related to social work program and practice evaluation (holden et al., 2007; 2008). items include skills such as “search electronic databases and the world wide web to obtain the scholarly literature necessary to design your evaluation of practice,” “design a measurement approach for your evaluation of some aspect of practice,” and “carry out all the elements of your evaluation in a practice setting” (holden et al., 2007; 2008). respondents rated each item on a likert-type scale in 10-point increments reflecting level of confidence in their own ability from 0 (cannot do at all) to 100 (certain can do). approximately 10 minutes are required for participants to complete the assessment. to score the instrument, responses are summed and divided by 11 (the total number of items). in the current study, a summed score was only calculated for students who rated all 11 scale items. only those students with a matched pair of preand postcourse scale scores were included in the study sample. the psychometric properties of the ese have been evaluated. holden et al. (2007) presented evidence of its reliability (cronbach’s alphas of 0.94 at pretest and 0.96 at posttest), content validity, construct validity (demonstrated by establishing a correlation between the scale scores of the ese and the social worker empowerment scale), and sensitivity to differences in students’ evaluation-related self-efficacy and to changes in selfefficacy over time. the same authors replicated the original validation study, again demonstrating its content and construct validity, and reporting cronbach’s alphas of 0.95 at both pretest and posttest (holden et al., 2008). cronbach’s alpha for the current study was 0.95 at pretest and posttest. to contextualize their ese responses, students were asked to report whether they had entered the program with advanced standing, and if so, how long it had been since they had taken their last research course. as noted above, students in the second year of a two-year program had completed their last research course in the prior year. data collection forms were also coded with the academic year that the survey was completed (four categories) and an instructor identification variable (three categories). the teaching-learning intervention (i.e., research course using a service learning approach) represents the independent variable of interest. course content for this graduatelevel advanced research course focuses on evaluating service delivery in social work practice. the goal is for students to develop a critical appreciation of and the ability to advances in social work, fall 2015, 16(2) 238 conduct research and program evaluation. in all four years, course sessions (whether faceto-face or online) included the following topics: (a) ethical issues in program evaluation, (b) using logic models to describe programs and their theory of change, (c) needs/assets assessment and formative/process evaluation, (d) client satisfaction and cost effectiveness, (e) qualitative/mixed methods in evaluation, (f) measurement tools and strategies, (g) inferential statistics, (h) data analysis and interpretation, and (i) writing and presenting evaluation reports. across all class sessions, a portion of class time was used for a statistics lab, in which students were engaged in a faculty-guided, hands-on process of analyzing and interpreting increasingly complex sets of data. for this course, microsoft excel was selected as the software package for data management and analysis because this is a resource that students are likely to have in their subsequent professional careers. in partial fulfilment of course requirements, class members worked together to conduct a pro bono program evaluation for a local non-profit agency, a day shelter for homeless men (i.e., the service learning project). research faculty guided students through the phases of evaluation design, data collection, data entry, analysis, and reporting. the project began with a visit to the service learning partner agency for a presentation on the agency’s services and program evaluation needs and culminated with student presentations of results and recommendations to the agency’s executive director and board of directors on the last day of class. this service learning project was intended as an engaged-learning strategy to help students gain skills and knowledge for determining the effectiveness of practice and the critical use of research in social work decision-making. a desired outcome of the course was that students would view research as a core component of ethical practice and gain a set of tools to use in their social work careers. each student contributed to the service learning program evaluation project by completing a 30to 60-minute participant observation at the non-profit agency using ethnographic methods and completing five structured, one-to-one interviews with clients. students entered interview data into a password-protected, online data collection site, and faculty exported and compiled this data into a single excel file. small groups of four to six students were assigned a topic area that related to a subset of the interview questions (e.g., education and work history, health/mental health, substance use, trauma, and utilization of/satisfaction with services). these small learning groups were coached by the faculty as they completed a literature review, and analyzed, interpreted, and reported on data from their assigned interview questions. throughout the project, course assignments and class discussions supported students in gaining skills needed to complete the project as well as reflecting on what they were experiencing and learning. data analysis paired samples t-tests were used to compare mean ese scale scores at the preand post-course points in time. because an exploratory, pre-experimental design was used in this study, it was impossible to conclusively establish a causal relationship between the independent variable (the service learning course) and the dependent variable (the postcourse ese score) or to rule out alternative explanations. however, to explore potential relationships between post-course outcomes and other plausible influences, the pairwise relationships between post-course ese score and the contextual variables (years elapsed deck et al./engaged teaching-learning 239 since last research course, instructor, and course year) were tested using anova and regression analyses. last, to compare the mean post-course ese scale score in this study to post-course scores in prior, similar studies, one-sample t-tests were conducted using the mean posttest scores in other studies as the test values. when results of t-tests were statistically significant, effect size was also calculated using the formula for cohen’s d. data were analyzed using ibm spss 19 software. results results are presented in three sections: (a) differences in preand post-course evaluation self-efficacy, (b) exploration of potential alternative explanations, and (c) comparison of post-course evaluation self-efficacy in this and other study samples. changes in evaluation self-efficacy consistent with cronbach’s observation that instructional outcomes are multidimensional (as cited in holden et al., 2007 and holden et al., 2008) and therefore should be considered separately as well as in aggregate form, table 1 presents a summary of responses to the ese scale items at the beginning and end of the course. item ratings can range from 0 to 100. on the first day of class, there was substantial variation in students’ confidence ratings for the scale items. on average, students felt most confident that they could successfully search electronic databases for scholarly literature in a manner that a social work supervisor would consider excellent; the mean pre-course rating for this item was 80.11 (sd=20.71). they felt least confident in their ability to design an inferential data analysis for evaluation of some aspect of practice (m=33.2, sd=25.17). on the last day of class, these two items remained the areas with the highest and lowest average ratings (m=92.3, sd=9.31 and m=75.2, sd=18.51 respectively). however, by the end of the course, mean ratings had increased for each of the 11 items. these increases ranged from 12.2 points (search electronic databases) to 42.05 points (design an inferential data analysis). importantly, the mean rating for the item carry out all elements of evaluation in a practice setting increased by 38.9 points (from a mean of 45.3 at the beginning of the course to 84.3 at the end). the amount of variability in ratings was also lower at the end of the course for all ese items. there was also substantial variation in preand post-course ese scale scores. on the first day of class, individual ese scale scores ranged from 4.6 to 93.6. on the last day of class, scores ranged from 38.2 to 100.0. the paired differences in preand post-course ese scale scores were normally distributed. paired samples t-tests were used to compare mean ese scale scores at these two points in time. ese scale scores on the last day of class (m=82.3, sd=12.44) were higher than on the first day of class (m=48.1, sd=20.84), t(87)=17.2, p<.001, d=1.83. given the large effect size (cohen’s d=1.83), the increase in evaluation self-efficacy was both statistically significant and practically important. advances in social work, fall 2015, 16(2) 240 table 1. ese item ratings and scale scores on the first and last days of class (n=88) variable pre-course post-course pre-post change m sd m sd m search electronic databases and web for scholarly literature 80.1 20.71 92.3 9.31 12.2 review a particular area of social science theory/ research and write a balanced, comprehensive lit review 60.8 22.4 86.5 13.16 25.7 design a program implementation study 41.3 23.33 78.8 13.96 37.5 create a single system design 48.5 28.27 81.4 15.84 32.8 create a group research design 43.0 26.27 79.7 15.04 36.7 design a sampling strategy 46.0 26.5 80.6 16.36 34.6 design a measurement approach 43.5 25.28 80.9 15.13 37.4 design a descriptive data analysis 37.1 24.92 79.1 16.99 42.0 design an inferential data analysis 33.2 25.17 75.2 18.51 42.1 design an evaluation of practice that incorporates social work values and ethics 49.9 27.66 86.9 15.11 37.1 carry out all elements of evaluation in a practice setting 45.3 27.62 84.3 15.91 38.9 average of all items (scale score) 48.1 20.84 82.3 12.44 34.3 exploration of potential alternative explanations an analysis of variance showed that the effect of academic year on post-course ese scale scores was non-significant, suggesting that the traditional and hybrid course models were equally effective. similarly, analysis of variance showed that the effect of the instructor on post-course ese scores was non-significant. finally, for advanced standing students, regression analysis was used to test whether the number of years elapsed since last research course was independently associated with the post-course ese score after controlling for the pre-course ese score. the two predictors explained 29% of the variance in post-course ese score, r2=.29, f(2, 48)=9.85, p<.001. however, after accounting for an expected statistically significant effect of the pre-course ese score (b=.55, p<.001), time since last research course did not independently predict post-course ese scores. in summary, in this population, academic year, instructor, and time elapsed since last research class were not associated with the post-course ese score, suggesting that these potential alternative explanations were unlikely. comparison of study results with other study samples this study replicates two prior studies that used the ese to measure social work educational outcomes of advanced research courses focused on program and practice evaluation (holden et al., 2007; 2008). in the first study of 85 master's-level students, holden et al. (2007) reported that students’ mean ese score increased from 44.8 near the beginning of the 14-session course to 68.3 at the end of the course. in a follow-up study of 111 masters-level students enrolled in the same course in a subsequent year, holden et al. deck et al./engaged teaching-learning 241 (2008) reported a change in the mean ese score from 44.1 at pretest to 73.1 at posttest. in the current study, the mean scale score at the pre-course point in time was comparable to the mean pretest scale scores in the studies conducted by holden and colleagues; the differences were non-significant. however, the mean post-course scale score in the current study was over 14 points higher than the posttest mean in the first study conducted by holden and colleagues, and over nine points higher than the posttest mean in their replication study. one-sample t-tests using the mean posttest scores in the holden studies as the test values indicated that these differences were each statistically significant and practically important, (t(87)=10.58, p<.001, d=1.13 and t(87)=6.96, p<.001, d=0.74, respectively). discussion the importance of self-efficacy for graduate level social work students should not be underestimated. as previously mentioned, the belief students have about their capabilities to perform practice-specific tasks is affected by their behavior and motivation (bandura, 1986). as observed by these authors, using an agency-related research project provided the platform for a facilitative process of learning to occur. through this process of practice, students were conditioned to use a set of skills to engage in practice-informed research. as evidenced by the increase in evaluation self-efficacy scale (ese) scores, students’ selfefficacy was strengthened. the learning environment provided the opportunity for students to credit their successes (i.e., performing primary data collection, analyzing the data, reporting to constituents) to their own performance, exemplifying performance mastery. the results support the psychometric quality of the ese, as well as the theoretical basis for using this measure to assess the change in self-efficacy of student learners. as in prior studies, students’ self-efficacy related to research and program evaluation increased from the beginning to the end of the course. importantly, the effect was larger in the current study than in prior, similar studies, and it is plausible that the use of an engaged-learning strategy (the service learning project) contributed to this outcome. this exploratory study provides initial support for the use of service learning as a teaching method, suggesting that it is a good fit for increasing self-efficacy through mastery, modeling, and social persuasion. as an example of course activities designed to promote mastery through direct experience, students presented their findings to the service learning partner agency’s executive director and board of directors at the end of the course. their report provided a tangible community benefit, and it also allowed students to participate in a verbal exchange that offered feedback to them about their work, identified them as valuable human resources, and generated new energy regarding the benefits of applied social work research for all involved. a great challenge in social work education is transferring what is learned to practice. as a fervent attempt in “making learning purposeful” (wells, 2006, p. 401) and supporting students’ work to acquire practical skills, the level of involvement with such a project can be seen as supportive for modeling career commitment, providing students the opportunity advances in social work, fall 2015, 16(2) 242 to see the real and practical effects of their evaluation work on service delivery systems and clients. through modeling (using the cycle of action and reflection) students were encouraged to develop a deeper understanding of their skills and capacity, which can lead to positive impacts on learning and personal outcomes for adult learners (knowles, holton, & swanson, 2005). as a result of the collaborative nature of the project over time, students were able to interact with actual consumers of social services and to work in groups, which is reflective of real research-informed practice. given this experience and the aforementioned fact that students may have lacked prior opportunities to actively learn and practice these skills, the gains made by the end of the course are yet another way to conceptualize a positive development in their learning (chang et al., 2014). finally, the experience of social persuasion through working in small groups can foster leadership skills and academic learning, another benefit of engagement that positively affects self-efficacy (national youth leadership council, 2007). students in this project typically identified which members of their project group possessed particular skills related to the program evaluation project (e.g., data analysis, critical thinking/interpretation of results, professional writing, public speaking, group facilitation, etc.). teams had the freedom to assign group roles as they chose. this resulted in students being able to play to their strengths and to learn from one another in areas where skills were still developing. course assignments provided opportunities for students to actively reflect on and evaluate each group member’s contributions as well as the overall experience of working in a group. the role of faculty as coaches was also critical to the success of the project. in summary, using service learning as an engaged-learning strategy in this course created opportunities to intentionally use mastery, modelling and social persuasion in order to build students’ confidence in their own abilities to perform skills related to program evaluation in social work settings. this resulted in a measurable change in students’ selfefficacy. self-efficacy theory suggests that students who are confident as well as competent will be more motivated—and therefore more likely—to engage in research and program evaluation activities in their future professional practice (carpenter, 2011; harder, 2010; hebert et al., 2014). the effectiveness of service learning is supported by the results of this study. as a familiar challenge in developing social work curricula, the task of training students on research and evaluation methods calls into question ideological differences regarding research and instructional delivery methods (gibbs & stirling, 2013; macintyre & paul, 2013; wells et al., 2012). in short, there is not one best way to teach students about this process. it is a worthy goal, however, to streamline the task, provide insight on what is demonstrated to be effective, and increase awareness that research improves the quality of practice (chilvers, maidment, & crichton-hill, 2012). common to academicians and researchers is an understanding that most work is done in groups focused on integrating learning and generating knowledge. through service learning projects such as this one, students can be shepherded into that same realm of knowledge generation within a social service setting in their community. in keeping with bandura’s theory (1977) that learned behavior results from a social process of observation, deck et al./engaged teaching-learning 243 imitation, and modeling, service learning is a complement to other experiential learning activities. in a major shift to support students as they become consumers of evidence, experiential activities in social work training are increasingly important (chilvers et al., 2012). integrating real-world experiences with classroom training improves students’ ability to understand complex and ambiguous circumstances, increases their interpersonal development and social responsibility, helps them to connect with professionals for career opportunities, and importantly, enhances community relations (vanderbilt university center for teaching, n.d.). additionally, active reflection on the nature of service learning assignments adds a layer of meaning to the process of community engagement. limitations although promising, these results should be interpreted with caution. a convenience sample was used from a single school over four academic years. while the results of this study are not generalizable beyond the sample population, this replication of results from prior studies contributes to the body of literature related to research and evaluation selfefficacy in an important way. it is encouraging that across study populations and sites, these studies have yielded very similar results: an overall improvement in self-efficacy. a second limitation is the use of self-reported data in this study. it should be acknowledged that participants in this and other similar studies could have responded in socially desirable ways and may have had different levels of awareness as it relates to perceptions of their own ability (pedrazza, trifiletti, berlanda, & di bernardo, 2013). however, while there are noted issues with self-reports, social science research embraces the use of this type of data. students are one source of credible information about their own abilities. further, this study was intended to measure perceptions of confidence in their abilities, not the underlying abilities, and students arguably are in the best position to rate their own confidence. as such, this was a study of one element in the multidimensional construct of learning. to explore the relationship between confidence and competence, future studies could integrate other sources of data including independent faculty or field instructor assessments of students’ knowledge and ability in the areas of research and program evaluation. gibbs and stirling (2013) emphasize that learning new knowledge and skills does not necessarily translate into their regular use in professional practice, so ongoing training and support are necessary. a longitudinal study could explore outcomes over time to objectively assess whether a student’s level of self-efficacy while enrolled in a graduate-level social work program is predictive of actual use of relevant skills in subsequent practice. finally, this measure could be combined with other measures of social work education outcomes to provide a multifaceted appraisal of learning. a third limitation is the use of a one-group, pretest-posttest design. while the findings of this study are consistent with a conclusion that the course was associated with changes in student self-efficacy, causation cannot be definitively inferred. carpenter (2011) notes that observed changes also could be attributed to (a) maturation effects, (b) hawthorne effects, and (c) the effects of testing. while common in the literature on social work education outcomes, simple pre-post designs cannot rule out these threats to validity. in replication, future studies should consider comparing the reported results with a control group comprised of comparable students exposed to a more traditional teaching strategy advances in social work, fall 2015, 16(2) 244 and should control for other maturational factors that might account for the observed changes. yet, this design is sufficient to establish that change in the desired direction did occur from the beginning to end of the course. further, some have suggested the utility of self-efficacy measures as diagnostic instruments (for formative assessment, adjustment of course content, and identification of tailored supports) and for periodic student selfassessment in combination with identification of goals and activities to strengthen confidence (quinney & parker, 2010). finally, comparing results of this study to results of prior studies conducted at a different school suggests the possibility of using a betweenprogram comparison group design. while the groups were not tested for similarity on any characteristics other than mean pretest scores in this study, future studies could do so. a fourth limitation is that much of what was captured in this study and other related studies of self-efficacy focuses on personal agency. this course, however, also illustrated the interdependent nature of research through working in collaborative groups. what was not measured in this study is the aggregate ability of a group to achieve an outcome, or the notion of collective efficacy (bandura, 2000; 2006). it would be important in future studies to separate how individuals appraise their personal capabilities from perceptions of the group’s capability to operate as a whole (bandura, 2006). while group and individual outcomes may be similar for some members of the group (e.g., dominant or highest functioning members), it is nonetheless important to consider the possibility of withinand between-group differences because group functioning is based upon its membership. a final limitation is that self-efficacy was treated as a unidimensional construct in this study. future studies should explore self-efficacy as a multidimensional construct. previous research has shown that there are elements of self-efficacy that should be considered when operationalizing and measuring a belief in one’s ability to carry out tasks as well as the related beliefs needed to produce the desired outcome (i.e., bandura, 1997; choi, fuqua, & griffin, 2001; miller, coombs, & fuqua, 1999). this study also may not have captured other factors that relate to students’ future use of research and evaluation skills in practice. as an example, it is likely that students must be convinced that evidence-based practice is important and effective as well as having confidence in their own skills. incorporating an additional measure such as the gregory research beliefs scale (gregory, 2010), a validated instrument that measures social work students’ beliefs related to the value of research for practice, would complement the measurement of confidence in one's ability and broaden the assessment of outcomes related to research courses. conclusion it has long been recognized that students need to make connections between knowledge and its application in order to enhance their adult learning experience (knowles et al., 2005). today’s adult learners depend heavily upon course delivery formats that use innovative teaching-learning strategies such as service learning to simultaneously provide career experience and skills training. through community involvement, students gain an understanding of community issues and processes related to change. deck et al./engaged teaching-learning 245 because service learning is intended to help students develop both competence and confidence, it is equally important for social work programs to assess students’ level of skill as well as their belief that they are able to practice these skills. specifically, students’ confidence in their own ability to perform social work tasks related to research and program evaluation can be assessed by using the ese to measure change in self-efficacy. as other studies have investigated how to best assess the effects of self-efficacy on learning and performance in various domains (chang et al., 2014; luzzo, hasper, albert, bibby, & martinelli, 1999; shively, smith, bormann, & gifford, 2002), this study contributes to the social work literature in this regard. the results of this study provide initial evidence that using an engaged-learning model such as service learning improves students’ self-efficacy. our hope is that as students’ self-efficacy increases, the likelihood of them engaging in research activities as part of their future practice will also increase. references bandura, a. 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(1999). effects of selfefficacy-enhancing interventions on the math/science self-efficacy and career interests, goals, and actions of career undecided college students. journal of counseling psychology, 46(2), 233-243. doi: http://dx.doi.org/10.1037/00220167.46.2.233 macintyre, g., & paul, s. (2013). teaching research in social work: capacity and challenge. british journal of social work, 43, 685-702. doi: http://dx.doi.org/10.1093/bjsw/bcs010 miller, j., coombs, w., & fuqua, d. (1999). an examination of psychometric properties of bandura's multidimensional scales of perceived self-efficacy. measurement and evaluation in counseling and development, 31(4), 186-197. national youth leadership council. (2007). growing to greatness 2007: the state of service-learning. retrieved from http://www.nylc.org/sites/nylc.org/files/files/320g2g07.pdf pedrazza, m., trifiletti, e., berlanda, s., & di bernardo, g. (2013). self-efficacy in social work: development and initial validation of the self-efficacy scale for social workers. social sciences, 2(3), 191-207. doi: http://dx.doi.org/10.3390/socsci2030191 phillips, a. (2011). service-learning and social work competency-based education: a "goodness of fit"? advances in social work, 12(1), 1-20. phillips, j., macgiollari, d., & callaghan, s. (2012). encouraging research in social work: narrative as the thread integrating education and research in social work. social work education, 31(6), 785-793. doi: http://dx.doi.org/10.1080/02615479.2012.695200 quinney, a., & parker, j. (2010). developing self efficacy in research skills: becoming research-minded. in h. burgess, & j. carpenter (eds.), the outcomes of social work education: developing evaluation methods (pp. 16-25). southampton, england: http://dx.doi.org/10.5175/jswe.2007.200500548 http://dx.doi.org/10.1080/08841230802179373 http://dx.doi.org/10.1037/0022-0167.46.2.233 http://dx.doi.org/10.1037/0022-0167.46.2.233 http://dx.doi.org/10.1093/bjsw/bcs010 http://www.nylc.org/sites/nylc.org/files/files/320g2g07.pdf http://dx.doi.org/10.3390/socsci2030191 http://dx.doi.org/10.1080/02615479.2012.695200 advances in social work, fall 2015, 16(2) 248 higher education academy subject centre for social policy and social work (swap). rhoades, r. (1998). in the service of citizenship: a study of student involvement in community service. journal of higher education, 69(3), 277-297. doi: http://dx.doi.org/10.2307/2649189 shively, m., smith, t., bormann, j., & gifford, a. (2002). evaluating self-efficacy for hiv disease management skills. aids and behavior, 6(4), 371-379. doi: http://dx.doi.org/10.1023/a:1021156914683 unrau, y., & grinnell, r. (2005). the impact of social work research courses on research self-efficacy for social work students. social work education, 24(6), 639-651. doi: http://dx.doi.org/10.1080/02615470500185069 vanderbilt university center for teaching. (n.d.). what is service learning or community engagement? retrieved from http://cft.vanderbilt.edu/guides-sub-pages/teachingthrough-community-engagement/ wells, m. (2006). teaching notes: making statistics "real" for social work students. journal of social work education, 42(2), 397-404. doi: http://dx.doi.org/10.5175/jswe.2006.200400466 wells, m., maschi, t., & slater, g. (2012). integration of research and practice: innovations and challenges in social work programs. social work education, 31(3), 331-346. doi: http://dx.doi.org/10.1080/02615479.2011.551827 wilson, g., & kelly, b. (2010). evaluating the effectiveness of social work education: preparing students for practice learning. british journal of social work, 40, 24312449. doi: http://dx.doi.org/10.1093/bjsw/bcq019 yorio, p., & ye, f. (2012). a meta-analysis on the effects of service-learning on the social, personal, and cognitive outcomes of learning. academy of management learning & education, 11(1), 9-27. doi: http://dx.doi.org/10.5465/amle.2010.0072 author note address correspondence to: stacy m. deck, phd, mssw, spalding university school of social work, 545 south 3rd street, louisville, ky 40203. email: sdeck@spalding.edu http://dx.doi.org/10.2307/2649189 http://dx.doi.org/10.1023/a:1021156914683 http://dx.doi.org/10.1080/02615470500185069 http://cft.vanderbilt.edu/guides-sub-pages/teaching-through-community-engagement/ http://cft.vanderbilt.edu/guides-sub-pages/teaching-through-community-engagement/ http://dx.doi.org/10.5175/jswe.2006.200400466 http://dx.doi.org/10.1080/02615479.2011.551827 http://dx.doi.org/10.1093/bjsw/bcq019 http://dx.doi.org/10.5465/amle.2010.0072 mailto:sdeck@spalding.edu microsoft word reamer_ethics copyedit final ______________ frederic g. reamer, ph.d., is a professor in the school of social work at rhode island college in providence, ri. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 163-181 the evolution of social work ethics: bearing witness frederic g. reamer abstract: the evolution of ethical standards in social work, and conceptual frameworks for examining ethical issues, is among the most compelling developments in the history of the profession. since the formal inauguration of social work in the late nineteenth century, the profession has moved from relatively simplistic and moralistic perspectives to conceptually rich analyses of ethical issues and ethical guidelines. this article examines the evolution of social work ethics from the profession’s earliest days and speculates about future challenges and directions. keywords: ethical standards, ethics, professional ethics, values prologue october, 1976. i remember it well. at the time i was a doctoral student at the university of chicago, school of social service administration, where i had enrolled in 1975. i entered the doctoral program with a reasonably well-defined, relatively narrow focus on issues related to criminal justice and corrections and their relationship to the social work profession. my longstanding professional interest and experience in criminal justice and corrections led me to social work somewhat by happenstance. i started my graduate school career at the university of chicago in the social sciences, not in social work. within a matter of weeks i realized that i would not be happy wrestling with relatively abstruse theory, the hallmark of social science education at the university of chicago. my interests were more applied and practical. i quickly knew that i needed to spend time with colleagues and scholars who cared deeply about the human condition and were earnest about addressing vulnerable populations and promoting social justice. in my tenacious attempt to climb down from intellectual clouds that seemed very far removed from real-world social problems and challenges, i began working part-time as a group worker at a federal prison in illinois. i also scoured the university of chicago in an effort to find kindred spirits. knowing little about social work, i was intrigued by the range of courses offered by the university’s school of social service administration. my eyes widened as i read description after description of courses related to human behavior, poverty, crime, social policy, mental illness, addictions, aging, and so on. “this is where i need to be,” i thought. “if only i had known about this program when i applied for admission to the university.” i began knocking on faculty members’ doors at the school of social service administration asking for the names of professors who were involved in research on issues related to criminal justice and corrections. i found them and, in short order, was hired to work as a research associate on a project evaluating services provided to illinois prison inmates. advances in social work, spring 2014, 15(1) 164 for nearly a year i immersed myself in my social work entrée, with noteworthy side dishes related to my passionate interest in criminal justice and corrections. getting back to october, 1976, i clearly recall sitting in the lobby of the school of social service administration, looking north through the floor-to-ceiling picture window in the building designed by the renowned architect mies van der rohe. as i stared at the gothic buildings that dominate the university of chicago campus, i chatted earnestly with a fellow doctoral student. at the time we were working together on a research project evaluating the effectiveness of community-based services for juvenile offenders and discovered a shared interest in broad philosophical and moral issues, especially as they pertained to human and social services. during that conversation my doctoral student colleague and i mused about challenging ethical issues germane to the research in which we were engaged. i shared with my colleague my growing realization that embedded in the policy debate about the relative merits of community-based care of juvenile offenders and incarceration are a number of daunting philosophical and moral issues: is it appropriate to hold juvenile offenders – minors – morally accountable for their misconduct? under what circumstances, if any, are punishment and retribution warranted when human beings and, more specifically, minors misbehave? when is it appropriate to deprive people of their liberty? is coercion ever acceptable when we provide social services to people? are there times when it is morally permissible to interfere with clients’ self-determination rights or lie to clients to protect them from themselves (what moral philosophers call paternalism)? what criteria should we use to allocate scarce resources (for example, agency funds, client benefits and services) when we try to assist people in need (philosophical issues of distributive justice)? this was my “ah-hah” moment. with only a modicum of insight, i realized for the first time that social work entailed complex ethical dilemmas. certainly by then i had been exposed to discussions of social work’s and social workers’ core values, which at that point in the profession’s history constituted what was known as social work ethics (levy, 1976). but ethical dilemmas meant something quite different. ethical dilemmas entailed far more than exploration of the profession’s and practitioners’ values; they involved complex analysis of ethical puzzles where social work’s values, duties, and obligations conflict. and this, it seemed to me, required the application of ethical theory that was the province of moral philosophy, a discipline with which i was then vaguely familiar and which issued its siren song. i was not sure where my 1976 quest would take me, but i had a very strong sense that exploring and cultivating the connections between moral philosophy and social work would bear fruit. my developing instincts were reinforced by my awareness of a nascent field that was then in its infancy: bioethics. by poking around the professional literature i discovered that a relatively small coterie of physicians and moral philosophers were engaged in a parallel effort to connect ethical dilemmas in medicine with moral philosophy. for a variety of complex reasons, this specialty was taking off and provided a helpful precedent for what i envisioned for social work: identify compelling ethical dilemmas in professional practice and view them through the conceptual lenses that moral philosophers have developed since the time of socrates, plato, and aristotle. reamer/the evolution of social work ethics 165     so off i went and, with modest encouragement (and i suspect bewilderment) from my faculty advisors at the school of social service administration, i devoted a significant portion of my doctoral coursework to seminars in moral philosophy, including theories of metaethics and normative ethics, and epistemology (philosophy of science). to be sure, i was out of my intellectual comfort zone, surrounded as i was with extraordinarily bright philosophy doctoral students. but i held on for the ride, challenging myself at every step to extract practical meaning from the stunningly abstract philosophical theories i was studying. there were virtually no kindred spirits or role models in these seminars, and i worked hard to explain to my philosophy instructors what i had in mind. i think they were intrigued to have a social work student in their midst, which may have been unprecedented. by 1977 i had a much clearer vision of the ways in which moral theory and other philosophical questions connect to social work. by then i had immersed myself in classic and contemporary philosophy and my mind exploded with conceptual and practical applications to the day-to-day challenges faced by social workers. i found myself thinking outside the intellectual box that was so familiar to me: how might immanuel kant’s (1959) eighteenth century ideas about moral duty and obligation pertain to social workers who contemplate whether to violate agency regulations or the law to benefit vulnerable clients? what are the implications of john stuart mill’s (1973) nineteenth century reflections in his classic essay on liberty for social workers who consider coercing or lying to clients with major mental illness to prevent them from engaging in self-harming behavior (a classic illustration of paternalism)? can john rawls’ (1971) powerful analysis in his book a theory of justice guide social workers who are responsible for allocating scarce or otherwise limited resources, such as emergency shelter beds, agency funds, or subsidized housing units for people who are disabled?i the vexing questions seemed endless. fortuitously, at the very time i was exploring connections between moral philosophy and social work, the bioethics field – in which a number of scholars and practitioners were engaged in a similar pursuit with regard to the relationship between moral philosophy and medicine – was burgeoning. the lodestars during the 1970s were the kennedy institute at georgetown university and the hastings center in new york. without question, these two pioneering centers put professional and applied ethics on the map. they moved moral philosophy from the intellectual clouds to the practical challenges facing health care professionals, primarily concerning questions related to the end of life, genetic engineering, organ transplantation, reproductive rights, truth-telling in health care, allocation of limited health care resources, and a whole host of nagging and challenging bioethical issues. timing may not be everything, but it certainly can be vitally important. i completed my doctoral work in 1978 and by 1980 had taught two graduate student seminars on social work ethics at the university of chicago. as i developed these courses i struggled mightily to find engaging, relevant, and accessible literature that would help students appreciate the nature of ethical dilemmas, ethical theory, and their relevance to social work. at the time very few social work programs were teaching in-depth ethics courses and there was very little social work literature on which to draw; nearly all of the extant advances in social work, spring 2014, 15(1) 166 social work ethics literature focused on the nature of social work values and their implications for professional-client relationships. social work’s body of knowledge at that point in the profession’s history lacked a critical mass of scholarly examinations of ethical dilemmas, moral theory, and ethical decision-making. fortunately, in 1980 the hastings center, with support from the carnegie corporation of america, formed a working group of faculty from a range of professions – engineering, law, business, medicine, the military, public policy, journalism, nursing, social work, and criminal justice – to identify compelling ethical issues in the respective professions, identify pedagogical goals for teaching ethics to practitioners, and develop curricular guides. participants in this cutting-edge hastings center project published a series of monographs on teaching professional ethics, which included the teaching of social work ethics (reamer & abramson, 1982). in retrospect, these key developments provided the beginnings of a conceptual foundation that influenced the development of social work ethics for at least the next three decades. the evolution of social work ethics my own involvement with social work ethics has occurred within a much broader historical context, only some of which i have experienced firsthand. although the theme of values and ethics has endured in the profession, social workers’ conceptions of what these terms mean and of their influence on practice have changed over time. in my view, the evolution of social work values and ethics has occurred in five key stages: the morality period, values period, ethical theory and decision making period, ethical standards and risk management period, and, most recently, digital period (reamer, 2013a). the morality period the first stage began in the late nineteenth century, when social work was formally inaugurated as a profession. during this period social work was much more concerned about the morality of the client than about the morality or ethics of the profession or its practitioners. organizing relief and responding to the “curse of pauperism” (paine, 1880) were the profession’s principal missions. this preoccupation often took the form of paternalistic attempts to strengthen the morality or rectitude of the poor whose “wayward” lives had gotten the best of them. the rise of the settlement house movement and progressive era in the early twentieth century marked a time when the aims and value orientations of many social workers shifted from concern about the morality, or immorality, of the poor to the need for dramatic social reform designed to ameliorate a wide range of social problems, for example, those related to housing, health care, sanitation, employment, poverty, and education (reamer, 1992). during the great depression especially, social workers promoted social reforms to address structural problems. many social policies and programs created during the new deal years in the united states (1933–1941) were shaped or influenced by social workers (mcnutt, 2008). reamer/the evolution of social work ethics 167     the values period concern about the morality of the client continued to recede somewhat during the next several decades of the profession’s life, as practitioners engaged in earnest attempts to establish and polish their intervention strategies and techniques, training programs, and schools of thought. over time, concern about clients’ morality was overshadowed by debate about the profession’s future, that is, the extent to which social work would stress the cultivation of expertise in psychosocial and psychiatric casework, psychotherapy, social welfare policy and administration, community organization, or social reform. after a half century of development, the social work profession was moving into a phase characterized by several attempts to develop consensus about the profession’s core values. several prominent commentaries appeared during this period in which authors defined, explored, and critiqued the profession’s core values and mission (bartlett, 1970; emmet, 1962; gordon, 1965; keith-lucas, 1963; levy, 1972, 1973, 1976; lewis, 1972; perlman, 1976; pumphrey, 1959; teicher, 1967; towle, 1965; varley, 1968; vigilante, 1974; younghusband, 1967). in addition to exploring the profession’s core values, some of the literature during this period (the 1960s and 1970s) reflects social workers’ efforts to examine and clarify the relationship between their own personal values and professional practice (e.g., hardman, 1975; varley, 1968). in the context of this so-called values clarification movement, many social workers developed a keen understanding of the relationship between their personal views and their professional practice, especially when it came to controversial and divisive issues such as poverty, abortion, homosexuality, alcohol and drug use, and race relations. nearly half a century after its inauguration, the profession began to develop formal ethical guidelines, based on its core values, to enhance proper conduct among practitioners. in 1947, after several years of debate and discussion, the delegate conference of the american association of social workers adopted a code of ethics. the profession’s journals also began to publish articles on the subject with greater frequency (hall, 1952; pumphrey, 1959; roy, 1954). this is not to say, of course, that social workers neglected the subject until this period. social workers have always espoused concern about a core group of central values that have served as the profession’s ballast, such as the dignity, uniqueness, and worth of the person, self-determination, autonomy, respect, justice, equality, and individuation (biestek, 1957; cabot, 1973; hamilton, 1951; joseph, 1989; national association of social workers, 1974; richmond, 1917). in addition, there were several modest efforts earlier in the twentieth century to place ethics on social workers’ agenda. as early as 1919 there were attempts to draft professional codes of ethics (elliott, 1931). in 1922 the family welfare association of america appointed an ethics committee in response to questions about ethical challenges in the field (elliott, 1931; joseph, 1989). however, the late 1940s and early 1950s rather clearly constituted a watershed period in social work when the subject of professional ethics became a subject of study and scholarship in its own right (frankel, 1959; reamer, 1980, 1982, 1987; reamer & abramson, 1982). advances in social work, spring 2014, 15(1) 168 not surprisingly, in the 1960s social workers shifted considerable attention toward the ethical constructs of social justice, rights, and reform. the public and political mood of this turbulent period infused social work training and practice with a prominent set of values focused on social equality, welfare rights, human rights, discrimination, and oppression (emmet, 1962; lewis, 1972; plant, 1970; reamer, 1994; vigilante, 1974). the national association of social workers (nasw) adopted its first code of ethics in 1960. perhaps the most visible expression of emerging concern about social work values and ethics was the 1976 publication of levy’s social work ethics. although the profession’s journals had, by then, published a number of articles on social work values and ethics, levy’s book was the profession’s most ambitious conceptual discussion of the subject. this had great symbolic significance. since then, scholarship on social work ethics has blossomed. levy’s work, contained in social work ethics and other publications (1972, 1973), helped to turn social workers’ attention to the study of overarching values and ethical principles. the ethical theory and decision making period until the mid-to-late 1970s, the profession focused primarily on the nature of social workers’ values and social work’s core values and value base. at this point the profession underwent another significant transition in its concern about values and ethical issues. as i noted earlier, this is when i was privileged to join the discussion. the 1970s saw a dramatic surge of interest in the broad subject of applied and professional ethics (also known today as practical ethics). professions as diverse as medicine, law, business, journalism, engineering, nursing, social work, psychology, and criminal justice began to devote sustained attention to the subject. large numbers of undergraduate and graduate training programs added courses on applied and professional ethics to their curricula, professional conferences witnessed a substantial increase in presentations on the subject, and the number of publications on professional ethics increased dramatically (callahan & bok, 1980). the proliferation of bioethics and professional ethics think tanks during this period is a major indicator of the rapid growth of interest in this subject. today, in fact, the number of such ethics centers is so large that there is a national association, the association for practical and professional ethics. the field has also produced two prominent and influential encyclopedias: the encyclopedia of bioethics and encyclopedia of applied ethics. the growth of interest in professional ethics during this period was due to a variety of factors. controversial technological developments in health care and other fields certainly helped to spark ethical debate involving such issues as termination of life support, organ transplantation, genetic engineering, psychopharmacological intervention, and test-tube babies. key questions concerned, for example, the criteria that should be used to determine which medically needy patients should receive scarce organs, such as hearts and kidneys. scholars and practitioners also debated when it is acceptable to terminate the life support that is keeping a comatose family member alive; to what extent it is reamer/the evolution of social work ethics 169     appropriate to influence, through laboratory intervention, the sex of a fetus; and whether it is ethically justifiable to implant an animal’s heart into the body of an infant born with an impaired heart. widespread publicity about scandals in government also triggered considerable interest in professional ethics. beginning especially with the watergate scandal in the early 1970s, the public has become painfully aware of various professionals who have abused their clients and patients, emotionally, physically, or financially. the media have been filled with disturbing reports of physicians, psychologists, lawyers, clergy, social workers, nurses, teachers, pharmacists, and other professionals who have taken advantage of the people they are supposed to serve. consequently, most professions take more seriously their responsibility to educate practitioners about potential abuse and ways to prevent it. in addition, the introduction, beginning especially in the 1960s, of such terminology as patients’ rights, welfare rights, women’s rights, and prisoners’ rights helped shape professionals’ thinking about the need to attend to ethical concepts. since the 1960s, members of many professions have been much more cognizant of the concept of rights, and this has led many training programs to broach questions about the nature of professionals’ ethical duties to their clients and patients. contemporary professionals, including social workers, also have a much better appreciation of the limits of science and its ability to respond to the many complex questions professionals face. although for some time, particularly since the 1930s, science has been placed on a pedestal and widely regarded as the key to many of life’s mysteries, modern-day professionals acknowledge that science cannot answer a variety of questions that are, fundamentally, ethical in nature (sloan, 1980). finally, greater awareness of social work malpractice litigation and licensing board complaints, along with publicity about unethical professionals, has forced the professions to take a closer look at their ethics traditions and training. as a result of these troubling phenomena, the professions, including social work, have enhanced their focus on ethics education (congress, black, & strom-gottfried, 2009; houston-vega, nuehring, & daguio, 1997; reamer, 2001a, 2003, 2013a). the emergence of the broad applied and professional ethics field clearly influenced the development of social work ethics (banks, 2012; barsky, 2009; congress, 1999; dolgoff, loewenberg, & harrington, 2009; mattison, 2000; reamer, 2013a). beginning in the early 1980s, a small number of social work colleagues and i began writing about ethical issues and dilemmas, drawing in part on literature, concepts, and theories from moral philosophy in general and the newer field of applied and professional ethics. the net result of these developments was the emergence in the 1980s of a corpus of literature on social work ethics. for the first time in the profession’s history, several books (loewenberg & dolgoff, 1982; reamer, 1982, 1990; rhodes, 1986) and a number of journal articles explored the intricate and complex relationship between ethical dilemmas in social work and ethical decision making. interestingly, the 1987 edition of the nasw encyclopedia of social work included for the first time an article directly exploring the relevance of philosophical and ethical concepts to social work ethics (reamer, 1987). advances in social work, spring 2014, 15(1) 170 unlike the profession’s earlier literature, several publications on social work ethics in the 1980s explored the relevance of moral philosophy and ethical theory to ethical dilemmas faced by social workers; similar developments occurred in nearly all the professions (rachels & rachels, 2011). clearly, this was a key development, one that has dramatically changed social workers’ understanding of and approach to ethical issues. the ethical standards and risk management period and then the winds shifted yet again. in 1990 i received my first telephone call from an attorney who sought my opinion about ethical issues related to litigation. the attorney who called me was representing a social worker who provided services to a young man who committed suicide. only then did i begin to discover the complex connections between ethical standards in social work and risk management, including professional malpractice and liability. this added a new challenge to my ethics-related work and, as a result, i had to learn a great deal about pertinent legal concepts, including negligence, malpractice, standards of care, acts of commission and omission, misfeasance, malfeasance, nonfeasance, evidentiary rules and procedures, legal discovery, burdens of proof, regulatory law, statutory law, common law, and constitutional law, among others. i also began to understand that social workers needed much more guidance than was available in the existing nasw code of ethics. social work ethics had become much more complex, in part because of increasing litigation and licensing board complaints and, especially, because of the dramatic growth of the professional and applied ethics field generally and social workers’ expanding grasp of complex ethical issues unique to the profession. this stage in the evolution of social work ethics is characterized mainly by the significant expansion of ethical standards to guide practitioners’ conduct and by increased knowledge concerning professional negligence and liability. more specifically, this period included the development of a much more comprehensive code of ethics for the profession, the emergence of a significant body of literature focusing on ethics-related malpractice and liability risks, and risk-management strategies designed to protect clients and prevent ethics complaints and ethics-related lawsuits (barker and branson, 2000; barsky, 2009; houston-vega, nuehring, and daguio, 1997; jayaratne, croxton, & mattison, 1997; madden, 2003; nasw, 2008; reamer, 2001b, 2003, 2009, 2013a, in press). many ethics complaints and litigation against social workers allege some kind of ethics violation related to such issues as confidential and privileged information, informed consent, conflicts of interest, dual relationships and boundary issues, use of nontraditional and unorthodox interventions, termination of services, impairment, and documentation (reamer, 2003, 2013a). dramatic changes in the nasw code of ethics during this period are instructive. the first nasw code was published in 1960, five years after the organization was formed. the 1960 code of ethics was very brief and consisted of a series of fourteen proclamations concerning, for example, every social worker’s duty to give precedence to professional responsibility over personal interests; respect the privacy of clients; give appropriate professional service in public emergencies; and contribute knowledge, skills, and support to programs of human welfare. brief first-person statements (such as “i give reamer/the evolution of social work ethics 171     precedence to my professional responsibility over my personal interests” and “i respect the privacy of the people i serve”) were preceded by a preamble that set forth social workers’ responsibility to uphold humanitarian ideals, maintain and improve social work service, and develop the philosophy and skills of the profession. in 1967 a principle pledging nondiscrimination was added to the proclamations. however, over time some nasw members began to express concern about the code's vagueness, its scope and usefulness in resolving ethical dilemmas, and its provisions for handling ethics complaints about practitioners and agencies. in 1977 the nasw delegate assembly established a task force to revise the profession’s code of ethics and to enhance its relevance to practice. the revised code, ratified in 1979, was much more detailed; it included six sections of brief principles preceded by a preamble setting forth the general purpose of the code, the enduring social work values upon which it was based, and a declaration that the code’s principles provide standards for the enforcement of ethical practices among social workers. the 1979 code set forth principles related to social workers' conduct and comportment, and to ethical responsibility to clients, colleagues, employers and employing organizations, the social work profession, and society. in 1992 the president of nasw appointed a national task force, which i was asked to chair, to suggest several specific revisions of the code. in 1993, based on the task force recommendations, the nasw delegate assembly voted to amend the code to include several new principles related to the problem of social worker impairment and the problem of inappropriate boundaries between social workers and clients, colleagues, students, and so on. because of growing dissatisfaction with the 1979 nasw code, and because of dramatic developments in the field of applied and professional ethics since the ratification of the 1979 code, the 1993 nasw delegate assembly also passed a resolution to establish a task force to draft an entirely new code of ethics for submission to the 1996 delegate assembly. the task force, which i was privileged to chair, was established in an effort to develop an entirely new code of ethics that would be far more comprehensive in scope and relevant to contemporary practice. development of this new code represented a fundamental shift in social work’s approach to ethics. the code contains the most comprehensive contemporary statement of ethical standards in social work. the first section, “preamble,” summarizes the mission and core values of social work, the first ever sanctioned by nasw for its code of ethics. the second section, “purpose of the nasw code of ethics,” provides an overview of the code’s main functions and a brief guide for dealing with ethical issues or dilemmas in social work practice. the brief guide in this section of the code to dealing with ethical issues highlights various resources social workers should consider when faced with difficult ethical decisions. such resources include ethical theory and decision making, social work practice theory and research, laws, regulations, agency policies, and other relevant codes of ethics. the guide encourages social workers to obtain ethics consultation when appropriate, perhaps from an agency-based or social work advances in social work, spring 2014, 15(1) 172 organization’s ethics committee, regulatory bodies (for example, a state licensing board), knowledgeable colleagues, supervisors, or legal counsel. an important feature of this section of the code is its explicit acknowledgment that instances sometimes arise in social work in which the code’s values, principles, and standards conflict. moreover, at times the code's provisions can conflict with agency policies, relevant laws or regulations, and ethical standards in allied professions (such as psychology and counseling). the code does not provide a formula for resolving such conflicts and “does not specify which values, principles, and standards are most important and ought to outweigh others in instances when they conflict.” (national association of social workers, 2008:3) the code’s third section, “ethical principles,” presents six broad ethical principles that inform social work practice, one for each of the six core values cited in the preamble. the principles are presented at a fairly high level of abstraction to provide a conceptual base for the profession's more specific ethical standards. the code also includes a brief annotation for each of the principles. the code’s final section, “ethical standards,” includes 155 specific ethical standards to guide social workers’ conduct and provide a basis for adjudication of ethics complaints filed against nasw members – a radical departure from the one-page code, including only fourteen principles, adopted by nasw in 1960. the standards fall into six categories concerning social workers’ ethical responsibilities to clients, to colleagues, in practice settings, as professionals, to the profession, and to society at large. the introduction to this section of the code states explicitly that some standards are enforceable guidelines for professional conduct and some are standards to which social workers should aspire. furthermore, the code states, “the extent to which each standard is enforceable is a matter of professional judgment to be exercised by those responsible for reviewing alleged violations of ethical standards” (nasw, 2008:7). the digital period i think it is fair to say that the newest period in the evolution of social work ethics has taken nearly all of us by surprise. i know i certainly did not anticipate that in the current era, beginning in the mid 2000s, we would face enormously complex issues related to social workers’ use of digital and other “distance” or remote technology to serve clients. social work services emerged on the internet as early as 1982 in the form of online self-help support groups (kanani & regehr, 2003). the first known fee-based internet mental health services emerged in the mid 1990s; by the late 1990s, groups of clinicians were forming companies and e-clinics that offered online counseling services to the public using secure web sites (grant & grobman, 1998; martinez & clark, 2000; reamer, 2012a, 2013b; schoech, 1999). in contrast, today’s social work services include a much wider range of digital and electronic options, including a large number of tools for the delivery of services to clients (chester & glass, 2006; kanani & regehr, 2003; lamendola, 2010; menon & millercribbs, 2002). key examples include online counseling, video counseling, email therapy, reamer/the evolution of social work ethics 173     avatar therapy, telephone therapy, social networking, and text-message-based intervention. these new forms of social work intervention raise a wide range of novel and unprecedented ethical issues. significantly, for the first time in social work’s history, the current nasw code of ethics includes explicit references to social workers’ use of electronic media to deliver services to clients, particularly with respect to issues of informed consent, privacy, and confidentiality. however, these standards were ratified in 1996, long before the invention of many forms of digital technology social workers currently use. for example, facebook, the most popular electronic social network site, was created in 2004; linkedin, skype, and second life (software that enables clinical social workers to provide avatar therapy and other online services to individual and groups of clients) launched in 2003. in addition to pertinent ethical standards, nasw and the association of social work boards (aswb) have collaborated on standards for social workers’ use of technology, a number of which focus on ethical concerns (nasw & aswb, 2005).ii these standards address such issues as cultural competence, technical competence, privacy and confidentiality, confirmation of client identity, documentation, and risk management. a number of compelling ethical issues are emerging as social workers make increasing use of a wide range of digital and other electronic technology. key issues include practitioner competence, client privacy and confidentiality, informed consent, conflicts of interest, boundaries and dual relationships, consultation and client referral, termination and interruption of services, documentation, provision of social work services electronically across jurisdictional lines, and research evidence concerning the effectiveness and impact of distance services. social workers’ use of digital and other electronic technology raises particularly challenging issues related to client privacy and confidentiality. for decades, social workers have understood their obligation to protect client privacy and confidentiality and to be familiar with exceptions (for example, when mandatory reporting laws concerning abuse and neglect require disclosure of information without client consent or when laws or court orders require disclosure without client consent to protect a third party from harm). however, the rapid emergence of digital technology and other electronic media used by social workers to deliver services has added a new layer of challenging privacy and confidentiality issues. for example, social workers who deliver services using e-mail, avatars, live chat, and video counseling must be sure to use sophisticated encryption technology to prevent confidentiality breaches (hacking) by unauthorized parties and comply with relevant privacy laws and regulations (morgan & polowy, 2011). according to the nasw code of ethics, “social workers should take precautions to ensure and maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology. disclosure of identifying information should be avoided whenever possible” (p. 12, standard 1.07[m]). the nasw and aswb (2005) standards on practitioners’ use of technology state, “social workers shall protect client privacy when using technology in advances in social work, spring 2014, 15(1) 174 their practice and document all services, taking special safeguards to protect client information in the electronic record” (p. 10). social workers who use digital and online technology to deliver services must also pay close attention to complex and novel informed consent issues (berg, appelbaum, lidz, & parker, 2001). the recent advent of distance counseling and other social services delivered electronically has enhanced social workers’ ethical duty to ensure that clients fully understand the nature of these services and their potential benefits and risks (see nasw code of ethics, standards 1.03[a–f]). this can be difficult when social workers never meet their clients in person or have the opportunity to speak with clients about informed consent. special challenges arise when minors contact social workers and request electronic services, particularly when social workers offer free services and do not require credit card information; laws vary considerably regarding minors’ right to obtain mental health services without parental consent (madden, 2003; recupero & rainey, 2005). novel forms of distance counseling and other social work services may introduce conflicts of interest that were previously unknown in social work. for example, some video counseling sites offer free services to social workers and their clients; the web sites’ sponsors pay for their development and maintenance. in return, sponsors post electronic links on the consultation screen that take users to their web sites that include information about their products and services. clients may believe that their social workers endorse these products and services. digital technology also introduces unprecedented boundary issues (reamer, 2012b). for example, social workers face several challenges involving their use of social networking sites such as facebook. first, many social workers receive requests from current and former clients – either delivered electronically or in person – asking to be social networking “friends” or contacts. electronic contact with clients and former clients on social networking sites can lead to boundary confusion and compromise clients’ privacy and confidentiality. clients who have access to social workers’ social networking sites may learn a great deal of personal information about their social worker (such as information about the social worker's family and relationships, political views, social activities, and religion), which may introduce complex transference and countertransference issues in the professional-client relationship. moreover, clients’ postings on social networking sites may lead to inadvertent or harmful disclosure of private and confidential details. in addition, social workers who choose not to accept a client’s “friend” request on a social networking site may inadvertently cause the client to feel a deep sense of rejection. social workers who provide online and electronic services also face unique and unprecedented risks related to what lawyers refer to as abandonment. abandonment occurs when a social worker-client relationship is terminated or interrupted and the social worker fails to make reasonable arrangements for the continuation of services, when needed. online and electronic services could be terminated for a variety of reasons. clients may terminate services abruptly, “disappear,” or otherwise fail to respond to a social worker’s e-mail, text messages, or telephone messages. social workers may reamer/the evolution of social work ethics 175     terminate or interrupt services, perhaps inadvertently, because of computer or other electronic equipment failure or because a social worker fails to respond to a client’s email, text, or telephone message in a timely fashion. social workers’ use of online and other electronic services also poses new documentation challenges. social workers must develop strict protocols to ensure that clinically relevant e-mail, text, social networking (for example, facebook), and telephone exchanges are documented properly in case records (see nasw code of ethics, standards 3.04[a][b]). these are new expectations that are not reflected in social work’s long-standing literature on documentation guidelines (sidell, 2011). epilogue life is full of surprises. my initial career goals did not include immersing myself in matters related to professional and social work ethics. i bumped into these issues unexpectedly during my doctoral-student ruminations about criminal justice issues and their relationship to social work. i suspect this sort of nonlinear path is common in our profession. i suppose many, if not most of us develop new interests as we travel our career paths and discover challenging and compelling issues of which we were previously unaware. this sort of inquisitive meandering is one of the joyful byproducts of being a professional, especially as a member of a profession that is as diverse as social work. over the years i have come to understand two key phenomena pertaining to social work and professional ethics. first, this is an enormously complex subject that requires considerable study in order to grasp its broad range of conceptual challenges. rarely does a week pass when i have not learned, or have needed to learn, something that i did not know and that is essential to my understanding of ethical issues, especially concerning such matters as ethical theory and moral reasoning, ethical standards, and legal concepts that intersect with professional ethics. i relish the opportunity to continue learning this deep into my career. further, i am humbled by my chronic inability to forecast the sorts of ethical challenges that arise in social work. certainly, many ethical issues have endured over time and, at their core, are not likely to disappear. examples include fundamental ethical issues pertaining to informed consent, client confidentiality and privacy, professional boundaries, and conflicts of interest. particular details and challenges may change over time as cultural and social trends, ethical standards, and relevant laws and regulations emerge (for example, new laws pertaining to clients’ confidentiality rights and their exceptions). but many overarching issues are not new and are likely to endure. in contrast, i am stunned by the breadth and depth of ethical challenges in contemporary social work that i could not have anticipated earlier in my career. when i became a social worker, facebook, video counseling software, and text messaging did not exist. now i am consulted frequently about ethical and risk-management issues arising out of social workers’ use of this digital and related technology. when i became a social worker in the 1970s no one had ever heard of hiv or aids. by the early 1980s, advances in social work, spring 2014, 15(1) 176 however, i was starting to consult on cases involving the limits of social workers’ clients’ right to confidentiality, for example, when a client’s sexual partner did not know that the client was hiv positive. and there are other examples, too, including healthcare social workers’ involvement in daunting ethical decisions about the allocation of scarce organs for lifesaving transplants and end-of-life decisions involving clients who live in states that permit physician assisted suicide. i have been so humbled by my limited ability to predict new ethical challenges that i resist offering strong predictions. in my view, our best bet is for social workers to develop and refine the core knowledge and conceptual skills required to address whatever issues emerge in the future. the burgeoning of social workers’ interest in professional values and ethics, especially since the late 1970s, is remarkable. today’s practitioners have an unusually rich appreciation of the complex challenges associated with professional and personal values, ethical dilemmas, ethical decisions, and ethics risk management. ethical theories, concepts, decision-making protocols, and related legal guidelines have changed dramatically since social work’s nineteenth century origins. i dare say that these developments are among the most profound and compelling in social work’s history. we now know that mastery of these subjects requires in-depth and sustained education and training. superficial knowledge will not suffice. in fact, i would argue that social workers’ preoccupation with professional values and ethics must be the centerpiece of practitioners’ education and training. after all, social work is a profession rooted in action, and this action must be anchored in a deep sense of moral mission and ethics. as the social work pioneer jane addams (1902) said soon after the profession’s formal inauguration, “action indeed is the sole medium of expression for ethics” (p. 273). references addams, j. 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(1974). between values and science: education for the profession; or, is proof truth? journal of education for social work, 10, 107-115. younghusband, e. (1967). social work and social values. london, uk: allen and unwin. reamer/the evolution of social work ethics 181     author note: address correspondence to: frederic g. reamer, ph.d., school of social work, rhode island college, 600 mount pleasant avenue, providence, ri 02908. email: freamer@ric.edu  frederic reamer is professor in the graduate program of the school of social work, rhode island college, where he has been on the faculty since 1983. reamer has served as a social worker in correctional and mental health settings. since 1992 reamer has served on the state of rhode island parole board. he served as editor-in-chief of the journal of social work education and serves as associate editor of the national association of social workers encyclopedia of social work. reamer chaired the national task force that wrote the current national association of social workers code of ethics.                                                              i the potential links between philosophical inquiry and social work seemed limitless. in my book the philosophical foundations of social work (1993), i broadened the lens to explore the ways in which a range of core philosophical questions – including epistemology, political philosophy, aesthetics, and logic, in addition to moral philosophy – apply to social work.  ii i am currently chairing an international task force, sponsored by aswb, that is developing model practice standards and regulations pertaining to social workers’ use of digital, online, and other technology. microsoft word 05 dolinsky_and_helbig_18133_risky_business_au_ce.docx _____________ hillary r. dolinsky, lmsw is a program associate at the center for technology in government at the university at albany, state university of new york. albany, ny. email: hdolinsky@ctg.albany.edu. natalie helbig, phd is a senior research associate at the center for technology in government at the university at albany. albany, ny. email: nhelbig@albany.edu. copyright © 2015 advances in social work vol. 16 no. 1 (spring 2016), 55-66 risky business: applying ethical standards to social media use with vulnerable populations hillary rose dolinsky natalie helbig abstract: social media is changing how those in the helping professions offer clinical, medical, or educational services, provide referrals, administer therapeutic interventions, and conduct research. non-profits and government organizations working with vulnerable populations need to consider the possibility of ethical missteps when using social media. a comparison of facebook strategies used with the national youth in transition database (nytd) program to engage and locate current and former youth in the foster care system was conducted. facebook practices and strategies were examined based on the current national association of social workers (nasw) code of ethics and the association of social work boards (aswb) standards for technology and social work practice. the ethical standards examined included obtaining consent, preserving confidentiality, verifying youth identity online, and avoiding disclosure of foster care affiliation. findings provide valuable insight for further discussions around ethical standards in light of the rapidly changing uses of technology in social work. in addition, we illustrate guidelines and best practices used when adopting social media tools for interacting with vulnerable populations. keywords: social media policy, ethics, social work administration, vulnerable populations social media and social networking sites (sns) are playing a greater role in various aspects of child welfare practices. examples range from providing counseling, therapy, and self-guided interventions to finding prospective adoptive parents (reamer, 2013) or tracing research participants in long-term outcomes-based research (balfe, hackett, masson, & phillips, 2013). the accessibility of social media and sns enables non-profit and government agencies to easily use the power of these tools for information dissemination, resource referral, intervention provision, or tracking. however, one major reason government agencies, regardless of policy area, are hesitant to use social media and sns in the delivery of public services is the perceived and real risks of security, privacy, records management, and legal issues associated with terms of service (national association of state chief information officers [nascio], 2010; oxley, 2011). these issues become even more risky for agencies working with vulnerable populations. state agencies and non-profit organizations likely have some type of acceptable use policy for social media within the organization; however, many are not likely to have guidelines or policies that target use in professional practice. likewise, the current national association of social workers (nasw) code of ethics has limited guidance directly related to the use of these new technologies for practice and administration of programs (nasw, 2005, 2008). dolinsky & helbig/risky business 56 literature review an emerging body of research is starting to call attention to the type of sns used and the implications of their use with respect to ethical standards, particularly for those who identify as a member of a vulnerable population (american youth policy forum, 2014; reamer, 2013; sewpaul & jones, 2004). for example, if a victim of domestic violence participates in an online social media group for survivors, that interaction is at risk of being made public knowledge. the interaction may not only allow for her social media network to know that she is a victim, but her perpetrator may also be able to locate her as a result, possibly placing her at risk for further abuse. many kinds of unintentional mistakes can often be mitigated by designing informative guidelines or social media policies (hrdinova, helbig & stollar-peters, 2010; reamer, 2013). non-profits and government organizations that cater to a specific vulnerable population need to develop detailed social media policies that outline how the organization is going to engage with their consumers while still protecting identities and avoiding undue risk or harm as a result of participation in an online relationship. the nasw code of ethics the nasw code of ethics dates back to 1960 and includes 14 statements on best practices in social work (congress & mcauliffe, 2006). last revised in 2008, the nasw code of ethics has evolved to feature ethical principles valued by the profession and ethical standards of practice, each outlining behavioral expectations, reporting requirements, professional obligations, and responsibilities that social workers have to broader society (nasw, 2008). to update the nasw code of ethics, approval is required from its delegate assembly. consisting of elected nasw members, the delegate assembly meets every three years to approve policies and revisions proposed by the association (congress & mcauliffe, 2006). although the nasw code of ethics describe what social workers should value and what rules they should abide by, it has been critiqued for its inability to translate the principles and standards into practice, particularly with regards to utilizing technology within social work (perron, taylor, glass, & margerum-leys, 2010). there is limited guidance on how to apply the ethical standards within the context of social work practice. in an effort to evaluate the nasw code of ethics, researchers at the university of michigan, washington university, and eastern michigan university compared specific standards from the code to the importance of teaching information and computer technologies (icts) in social work education. for example, nasw ethical standard 3.07 states that “social work administrators should advocate within and outside their agencies for adequate resources to meet clients’ needs” (nasw, 2008, p. 20). based on their own interpretation, the research team used this standard to encompass the importance for social workers to obtain real-time data, adopt open source software, and consider cloud computing as a reasonable alternative to issues of remote data storage and security (perron et al., 2010). these researchers were able to loosely interpret the nasw code of ethics and compare them to their ict research and social work education agenda. as intended, the advances in social work, spring 2015, 16(1) 57 nasw code of ethics leaves enough room for open interpretation to accommodate a wide variety of practice settings and situational dilemmas. however, open interpretation may also leave room for disparity in how non-profits, government agencies, and social work clinicians perceive the nasw code of ethics. the aswb standards for technology and social work practice with the emergence of icts, the nasw teamed up with the association of social work boards (aswb) in 2005 to create the aswb standards for technology and social work practice. similar to the nasw code of ethics, the aswb standards for technology dictate specific principles and expected practitioner efforts in verifying client identity, preserving confidentiality, and obtaining consent when using technology. even though the aswb believes that “social workers should acquire skills that use technology appropriately and adapt traditional practice protocols to ensure competent and ethical practice,” (nasw, 2005, p. 4) no guidance is offered on how to apply the technology standards within a clinical, non-profit, or government environment, leaving implementation and enforcement of the ethical standards to the interpretation of decision makers. case study the national youth in transition database (nytd) the national youth in transition database (nytd) is a federal data collection effort on youth in the child welfare system who are transitioning to independent living. every three years, a new cohort of youth turning 17 while in foster care participates in the nytd survey, reporting independent living services received to the state and federal government. if youth participate in an nytd survey at age 17, they are eligible to participate again at age 19 and 21, illustrating which services are used while youth are in foster care and what services are used or needed once they leave the foster care system. youth aging out of the foster care system are not only a vulnerable population but also can be difficult to maintain communication with. their nomadic tendencies and changing addresses and phone numbers require non-profits and agencies seeking to engage with this population over time to consider additional outreach methods. states are responsible for creating systems for surveying and tracking youth until they are 21. once a young person leaves care, their information is not updated and the state has a limited relationship with them. in order to create an engagement strategy and tracking mechanism, several states turned to the use of social media. one interviewee, “i came into this knowing that the easiest way to be able to reach the youth at 19 and 21 years old was to reach out to them on their level,” adding that facebook was a preferred social media tool to help make finding these youth easier. another state started using social media because “a lot of [foster youth] didn’t have a phone number, but they had email addresses and they were always on facebook, so it was easier for [the youth].” using facebook with the nytd not only allows nytd administrators to use a method commonly used among youth in this age range but also offers an additional avenue for providing the survey and tracking youth throughout the data collection phase. dolinsky & helbig/risky business 58 methods sample we used our knowledge of the nytd program and verified state nytd facebook activities through an online search in order to construct a convenience sample of states using facebook for our study. after an initial scan, seven states were identified as using social media. we contacted each state representative for the nytd program to construct a convenience sample of ten child welfare government employees, non-profit agency contractors, and university researchers to be interviewed, with at least one from each of the seven states. initial contact was established through email invitations, and representatives were provided informed consent and further details about the goals of the study. data collection semi-structured phone interviews were conducted with questions regarding social media goals, strategies, applications, practices, and outcomes. each state representative was asked the same questions, although conversations frequently expanded beyond the interview questions to provide additional insight into each state’s rationale for facebook use within the nytd. all interviews were conducted in june and july of 2013, and each lasted approximately 45 minutes. data analysis a review of the existing nasw code of ethics (nasw, 2008) and the aswb standards for technology (nasw, 2005) was used to develop our analytic framework. we identified the following important ethical dimensions: (a) informed consent, obtaining consent from former or current foster youth to engage through facebook; (b) confidentiality, ensuring that information shared through facebook was kept private and confidential; (c) disclosure, avoiding the disclosure of foster care or child welfare involvement as a result of engaging through facebook and (d) verification of identify, confirming and verifying the identity of former or current foster youth prior to initiating a facebook relationship. all interviews were transcribed, and a coding instrument was developed. the team used various qualitative techniques for examining the transcripts. summary practices were described, and various characteristics of facebook strategies were outlined. results each of the seven cases varied in their approaches, resources, and overall processes for data collection, program structure, and social media use. table 1 identifies the three models of facebook use that were observed in the study. one model was an open page, which provides the public with unrestricted access to the nytd content created by the state. this model is essentially a supplement to a website, and content is not private or hidden from users. the second model is a private group, which hides the membership of the facebook group from other users and is considered closed to the public. in this advances in social work, spring 2015, 16(1) 59 model, only nytd administrators of the facebook group can send invitations to join the group. the third model is the use of a professional profile. the profile represents an actual person, not an organization. it is very similar to a personal profile, but the person is using their professional persona. a professional facebook profile allows the person to send personal messages and have friends in contrast to an open facebook page which cannot have friends, just followers. table 1: models of facebook strategies by states model description # of states* open page  public has unrestricted access to content no hidden content  supplement to a website  no attached individual identity  cannot have friends no direct link to other individual profiles  limited means of interaction 5 private group  membership is invitation only  group does not show up in search results  administrators oversee membership  members carry same shared identity 1 professional profile  represents an individual  interactive capabilities include sending messages and event invitations as well as posting photos  profile can friend another profile to build network 3 *two states utilize multiple models of facebook. those states are noted twice in the total number of states use. table 2 provides a summary of strategies and resources used by each of the seven states. the states varied in their processes for decision-making, approval, facebook format, and their development of a social media policy. states also varied in their assessment of how valuable facebook was to their overall outreach and youth engagement strategies. findings and discussion obtaining consent in standard practice, a social work clinician will obtain consent from their client prior to providing any form of treatment or intervention. this effort not only protects the clinician and the clinician’s non-profit or government agency but also clarifies expectations and boundaries for the client. the nasw code of ethics, 1.03 states that “social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent” (nasw, 2008, p. 7). the code further explains what consent entails by adding that “social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services, etc.” (nasw, 2008, p. 8). obtaining consent is a fundamental part of the clinician-client relationship and is an ethically essential part of the therapeutic relationship. dolinsky & helbig/risky business 60 table 2: description of facebook strategies, practices, and policies by state case description state a contracted with a university to implement nytd  model: open page  approval process: the state child welfare authority approves a biannual content plan  social media policy: yes, the state and the university have a social media policy in place  importance to overall outreach strategy: not important state b contracted with a non-profit to implement nytd  model: open page  approval process: the state child welfare authority does not review or approve content  social media policy: the state and the non-profit do not have a social media policy in place; process documentation does exists  importance to overall outreach strategy: important state c contracted with voluntary agency to implement nytd  model: open page; professional profiles  approval process: the state child welfare authority has a low level of approval of facebook content  social media policy: the state and the non-profit do not have a social media policy in place  importance to overall outreach strategy: most important state d contracted with non-profit to implement nytd  model: open page; professional profiles  approval process: the state child welfare authority has low level of approval of facebook content  social media policy: the state and the non-profit do not have a social media policy in place  importance to overall outreach strategy: most important state e contracted with university to implement nytd  model: private group  approval process: the state child welfare authority has no required approval of facebook content  social media policy: the state and the non-profit do not have a social media policy in place  importance to overall outreach strategy: most important state f contracted with university to implement nytd  model: open page  approval process: the state child welfare authority has a high level of approval of facebook content  social media policy: the state and the non-profit do not have a social media policy in place; process documentation does exist  importance to overall outreach strategy: not important state g state authority implements nytd  model: open page; professional profiles  approval process: n/a state implementation  social media policy: the state does have a social media policy  importance to overall outreach strategy: most important advances in social work, spring 2015, 16(1) 61 this component of social work practice is no less important when engaging with clients or consumers online. when referring to the use of technology, the nasw code of ethics, 1.03 states that “social workers who provide services via electronic media (such as computer, telephone, radio, and television) should inform recipients of the limitations and risks associated with such services” (nasw, 2008, p. 8). it can be implied that the reference to computers in this ethical standard is intended to include websites, social media, and email, even though these are not explicitly mentioned within the nasw code of ethics. the aswb standards for technology also mention obtaining consent in standard 95; however, this standard only refers to research. the standard states “social workers conducting, evaluating, disseminating, or implementing research using technological approaches shall do so in a manner that ensures ethical credibility and ensures the informed consent of the participant” (nasw, 2005, p. 15). when applying this standard in practice, aswb suggests that “a risk-management plan is highly recommended, and should include protocols and policies for all technologies used by the agency for all administrative, managerial, and social worker-related purposes” (nasw, 2005, p. 14). depending on the type of organization, some government agencies implementing facebook with youth in foster care were required to establish strict procedures and protocols for their social media strategy, whereas non-profit agencies participating in the data collection effort through a contract with a government agency were left to devise their own standards for approval and implementation. states used a variety of methods to obtain consent from youth prior to beginning facebook relationship. some states included specific social media consent language within the survey content used for data collection, indicating that if youth provided their social media information (i.e., facebook name or twitter handle), they were agreeing to allow the representative to contact them. other states obtained more formal documentation of social media consent by asking youth over the age of 18 to sign consent forms in person agreeing to be contacted by the representative through facebook. to avoid concerns of obtaining parental or guardian consent for youth under the age of18, one state determined that they were not going to use social media to engage with any youth who were not old enough to provide consent for themselves. on a very high level, some states considered a young person’s-initiated act of “liking” a facebook page or joining a private group as consent to participate. facebook requires that all users who create a personal profile or professional page agree to their terms of use, which state “by using or accessing facebook services, you agree that we can collect and use such content and information in accordance with the data policy as amended from time to time” (facebook, 2013, ¶21). some states use the facebook terms of use as sufficient consent, arguing that if youth are over the age of 18, they are legally able to consent for themselves and are accountable for their actions on facebook. preserving confidentiality online given that current and former foster care youth are members of a vulnerable population, all states interviewed heavily considered the implications that a facebook dolinsky & helbig/risky business 62 relationship has on the ability to maintain confidentiality. the nasw code of ethics 1.07 privacy and confidentiality states “social workers should take precautions to ensure and maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology” (nasw, 2008, p. 12). echoing the nasw code of ethics, standard 7 of the aswb standards of technology states “social workers shall protect client privacy when using technology in their practice and document all services, taking special safeguards to protect client information in the electronic record” (nasw, 2005, p. 9). in making confidentiality a top priority in the development of their social media strategy, some states decided to limit the ability for users to interact on their facebook page, ensuring that information could not be shared publicly unless approved by the facebook page administrator. interactions were kept to private messages, and in some instances states would only interact with youth who initiated private conversations. state representatives who created a private, opt-in facebook group felt that youth over the age of 18 who provided confidential information online were able to consent to online interactions about that information. all state representatives interviewed took precautions to ensure that, as social media account administrators, they would not share confidential information online. communication directed towards a specific young person through facebook would be conducted through private messages, not public wall posts or public comments. avoiding disclosure of foster care status or affiliation nasw code of ethics 1.07 privacy and confidentiality states that “social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences” (nasw, 2008, p. 10). when discussing disclosure concerns with states, all state representatives recognized the importance of allowing youth to engage with them through social media without the expense of disclosing their current foster care status or former foster care affiliation. to avoid disclosing identities, some states selected to use an open, public, and professional facebook page instead of a personal facebook profile tied to a specific employee. state representatives indicated that the open facebook page removed the assumption that anyone interacting with or “liking” the page was affiliated with the child welfare system since the page was public. a consequence of keeping a professional facebook page was the inability to interact directly with specific youth, and states indicated that in some instances this was preventive in their social media efforts. to address this issue, one state decided to remove all mention of foster care from the professional facebook page and instead switched to a personal facebook profile. by removing all mention of foster care from the profile content, assumptions could not be made about foster care status or affiliation. this state decided to revise the language to say “youth survey” instead of “foster care survey,” intending to remove any undue harm in associating with their profile. for some states using private facebook group to interact advances in social work, spring 2015, 16(1) 63 with foster youth, state representatives assumed that all members shared the same implied foster care affiliation, and as a result, disclosure concerns were not present. as a result of varying contracts, agency roles, and government policies, states had different procedures and protocols for addressing disclosure concerns. some states were required to have approval from the legal counsel within their state child welfare authority, whereas others were only accountable to their individual agency policies and liabilities. verifying youth identity all interviewees recognized the potential dangers of contacting the wrong individual when starting an online engagement with a former or current foster youth. while the nasw code of ethics fails to offer guidance on online identity verification, the nasw and aswb standards for technology describe the importance of verifying identity prior to engaging online. standard 6 of the nasw and aswb standards for technology states “social workers who use electronic means to provide services shall represent themselves to the public with accuracy and make efforts to verify client identity and contact information” (nasw, 2005, p. 9). although this standard mentions the verification of identity, the nasw and aswb interpretation of this standard only outlines the importance for clients to verify the identity and credentials of those claiming to be social workers online, not vice versa. their interpretation indicates that “social workers need to provide their full name, credentials, licensure information, office address and phone number, and e-mail address” (nasw, 2005, p. 9). no guidance on how social workers should verify the identity of their clients prior to engaging through social media is provided. however, states recognized the potential dangers of disclosing information and violating both consent and confidentiality when attempting to begin an online relationship with the wrong former or current foster youth. states adopted a variety of methods to confirm that the facebook profile they were viewing was that of the intended person. some states sent a private facebook message, void of all mention of the survey or foster care affiliation, to the young person, and simply asked for a date of birth verification. other states used email address and locations provided by the young person during initial data collection efforts to verify the email address and location listed on the profile. depending on the state’s child welfare records database, some records included photos of the young person that were then compared to photos on the facebook profile. once the correct profile had been found, one state took these methods even further and searched through each young person's list of facebook friends for identified family members and friends, cross-referencing the names found with the names affiliated with that individual's case records. a few smaller states confirmed identity in person, asking youth to pull up their facebook profile once they agreed to allow the state representative to contact them online. each state in our study was able to interpret the standards within their own context and consider the implications when developing their facebook strategy. however, the outcomes of their interpretation and application of the code of ethics and standards for dolinsky & helbig/risky business 64 technology were not always consistent, indicating that the states had varying perspectives on what the ethics and standards meant and how they should be applied in practice. table 3 summarizes useful practices used by nytd administrators to uphold these four ethical standards and to avoid ethical mistakes. table 3: summary of practices applying ethical standards to facebook use ethical standard practices for applying standards obtaining consent  including social media in survey language  including a comment and participation policy on social media site  asking permission in person before engaging with youth online preserving confidentiality  keeping social media private and invitation only  including policies on social media sites that explain liability both for page administrators and for participants avoiding disclosure  removing foster care language from all social media  keeping social media open and public to all  making caseworker profiles with no mention of child welfare  teaching youth about online dangers and risks of disclosure verifying youth identity  comparing social media pictures to those on file  checking name, date of birth, location, and/or email address  checking relatives and friends in the young person's social media network  confirming profile in person or over the phone discussion and future research when compared to the nasw code of ethics and the and aswb standards for technology, it appears that these states were able to interpret the standards within their own context and consider their implications when developing their social media strategy. however, the outcomes of their interpretation and application of the code of ethics and standards for technology were not always consistent, indicating that the states had varying perspectives on what the ethics and standards meant and how they should be applied in practice. the nasw code of ethics was last updated in 2008, and the nasw and aswb standards for technology has not been revised since its inception in 2005. since 2008, the number of active monthly facebook users has grown from 100 million users to over 1 billion. facebook continues to be the leading sns, closely followed by twitter, pinterest, and youtube. these tools have become a staple in human interaction and are being applied in a variety of personal and professional settings, including non-profits and government agencies. the nasw and aswb standards for technology define technology as “a set of prescribed events that are embedded in hardware, software, or telecommunications and that direct activities, decisions, or choices” (nasw, 2005, p. 20). however, neither the nasw code of ethics nor the nasw and aswb standards for technology define, mention, or address the ethical considerations for social media use. there are several advances in social work, spring 2015, 16(1) 65 examples of how non-profits and government agencies are currently applying sns and social media tools based on their individual interpretation of these ethical standards. reamer (2013) highlights three sets of ethical risks relevant to using social media tools, particularly in social work practice: ethical mistakes, ethical decisions, and ethical misconduct. an ethical mistake, such as not obtaining a client’s full informed consent, can occur by omission or by commission (reamer, 2013). ethical mistakes are different from ethical decisions and misconduct (reamer, 2013). future research and standard development could include reamer’s ethical framework when evaluating ethical social media use within social work practice. a 2009 nasw news issue included an article titled “new technology transforming profession,” where the aswb director of board services is quoted saying “there are some states that have taken a hard look at this issue and are making some changes. however, there is still confusion about how to regulate and what to regulate” (as cited in sfiligoj, 2009, p. 1). with little to no ethical guidance on social media use in the context of social work practice, social workers will continue to adopt sns and social media based on their own interpretation of the standards. 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(2009). nasw news: new technology transforming profession. retrieved july 16, 2013, from http://www.naswdc.org/pubs/news/2009/09/default.asp author note address correspondence to: hillary r. dolinsky, lmsw, center for technology in government, university at albany, state university of new york, 187 wolf road, suite 301, albany ny 12205. email: hdolinsky@ctg.albany.edu microsoft word 13. young_3739-org identity in social media envt copyedit_final ______________ jimmy young, ph.d., is an assistant professor in the department of social work at the university of nebraska-kearney. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 518-530 a conceptual understanding of organizational identity in the social media environment jimmy young abstract: nonprofit organizations have increasingly adopted the use of social media over the last several years. this presents a myriad of challenges and opportunities in regards to organizational identity. this paper provides a conceptual understanding of identity as an entry point for nonprofit organizations to deliberate their own use of social media and the relative impact on organizational identity. a theoretical understanding of the formation of social identity situates the development of organizational identity and contextualizes the process in a manner suitable for conversation and strategic decisionmaking at the administrative level. a conceptual model is presented to illustrate the development and maintenance of organizational identity in the social media environment. keywords: organizational identity, social media, strategy nonprofit and voluntary institutions all over the world find themselves at a crossroads during some point of their organizational lifecycle. for instance, new and rapidly changing technology creates unique challenges for administrators in which they must use creativity and innovation to adequately cope, move forward, and maintain sustainability. the rise of social media technology such as facebook, youtube, and twitter, has many administrators mystified with exhilaration and trepidation as they begin to navigate this new interactive digital environment. this has particular implications for identity when thinking about how organizations change to “deal with turbulent environments and the increasing role of media” (gioia, schultz, & corley, 2000, p. 63). the following discussion highlights theoretical concepts leading to the construct of identity, which offers particular insight on how to manage organizational identity within the environment of social media from an individual perspective. a brief review of the literature on organizational identity will also aid in constructing a conceptual understanding for nonprofit administrators to utilize when developing social media strategies. this is not meant to be a handbook on how to use social media; rather, it represents more of an interpretive process that administrators and organizational leaders can use to think critically about organizational identity in the social media environment, and how to advance with strategic decision-making at the administrative level. understanding identity in any environment is important. understanding organizational identity in the social media environment is critical for the success of any organizational strategy. the discussion begins with defining social media. social media provide a platform for networking and interacting in a way that allows individuals to become content creators rather than merely content consumers (hopkins, 2008). content refers (but is not limited) to the images, video, text, or information that is freely available on the internet. much of this information is found on blogs, facebook, advances in social work, fall 2013, 14(2) 519 twitter, and youtube, which also exemplify a myriad of social media technologies that are often referred to as web 2.0 or the social media environment. social media technology is an array of digital tools that are easy to use, inexpensive, and allow people to create and or manipulate their own photos, videos, and stories to share with others (kanter & fine, 2010). social media offer the opportunity for nonprofits to access and leverage multiple networks of individuals to increase volunteer pools, raise awareness about a specific issue, tap into a new funding stream, or develop innovative strategies to address diverse challenges. the nonprofit and voluntary sector represents a number of diverse organizations, institutions, and agencies that serve critical aspects of society (salamon, 1999). for example, in social welfare many agencies are classified as human service organizations because they seek to deliver human services and address human concerns (o’connor & netting, 2009). the social work literature is still emerging with respect to how human service organizations use social media. a majority of scholarly social work literature to date centers on education, ethics, or advocacy (edwards & hoefer, 2010; giffords, 2009; houghton & joinson, 2010; kilpelainen, paykkonen, & sankala, 2011; mcnutt, 2008; mcnutt & menon, 2008; perron, taylor, glass, & margerum-leys, 2010; rockinsonszapkiw & walker, 2009). while the nonprofit sector in general is at the forefront in social media adoption (barnes, 2011; barnes & matteson, 2009; lacasse, quinn, & bernard, 2010), human service organizations continue to lag behind. research indicates that nonprofit organizations recognize the opportunities and challenges to utilize social media to assist with fundraising, volunteer recruitment, and to foster engagement and interaction with their community (bortree & seltzer, 2009; hackler & saxton, 2007; mcnutt & menon, 2008; rybalko & seltzer, 2010; waters, 2007; waters & jamal, 2011). amid all the potential social media seem to offer, several questions remain. how does a nonprofit organization develop, share, manage, or maintain its identity in the social media environment? how does it manage identity when interacting with potentially limitless stakeholders? what are the implications for interacting with new communities in the social media environment? recognizing how individual identity is developed or maintained will assist in understanding how organizational identity can be developed or maintained in the social media environment suitable to organizational strategy. social identity identity is composed of many constructs, too many to unpack here, but nevertheless several theories illuminate how individuals develop their sense of identity. charles cooley (1902) hypothesized that one’s self, or identity, is formalized through interaction and communication with others, also known as the looking glass self. cooley’s ideas are very similar to those of george herbert mead and that of symbolic interactionism, which explains that social interaction shapes the capacity for thought and serves as a process for individuals to learn the meanings and symbols that allow for individual thought. these thoughts, meanings, and symbols guide individuals to construct their identity and subsequent actions through an ongoing and changing interpretive process (blumer, 1969). although symbolic interactionism provides a lens for understanding identity formation young/organizational identity in the social media environment 520 through social interaction, it lacks the integration of environmental forces and macro structures of society (ritzer, 2008). role theory offers some insight as to how identity is influenced by the social environment. the central view of role theory is that individuals play many parts in their lives and others provide the basic scripts; however, the enactment of those scripts is uniquely one’s own (davis, 1986). this view aligns with that of symbolic interactionism because it stems from mead’s concept of role taking and the development of identity through social interaction (berger & luckmann, 1967; davis, 1986). identifying the implication of the environment on role identity evolves from the work of robert k. merton, who observed that various roles of individuals depends upon the status they occupy within society (davis, 1986). in other words, individuals may perform certain roles and behaviors based on their status as designated by social systems and assumed normative behaviors. identity formation and/or management in this micro context may not seem to offer much for a macro-oriented issue of organizational identity. however, this formation is extremely important when discussing the interplay of identity and environment (hatch & schultz, 2002). traditionally, and in the context of the theories described previously, identity construction happens through face-to-face encounters and in real time where individuals can immediately reconstruct their identity based on the perceptions of others. in the social media environment, individuals connect with each other through text, images, and video over various platforms synchronously, as well as mostly asynchronously. this digital platform means that individuals connect with one another without many of the meanings and symbols that help to guide their thoughts and actions. the challenge is that social media allows individuals to connect without a real sense of the context of the social interaction and may cause identity confusion or perhaps an identity crisis. michael wesch (2009) describes this crisis as “context collapse” among individuals using the popular social media website youtube (p. 23). the central premise here is that as individuals initially upload videos and interact online, they began to imagine thousands of people in a multiplicity of situations, as well as the possible perceptions of their own identity. in the midst of such a situation many individuals reported spending several hours transfixed on deciding what to say or how to act (wesch, 2009). the issue here is not lack of interaction or context, but “the infinite number of contexts” (wesch, 2009, p. 23). the impossibility of reshaping one’s identity in that context creates a barrier for social media users that requires a sense of introspection as to how they will actually portray themselves and their identity in the social media environment. the challenge for organizational identities that continually evolve through the years, just as individual identities do, is that the invention of a new environment, specifically social media, has tremendous implications for the use and implementation of a social media strategy that seeks to encourage interaction without the context, symbols, and meanings that have come to shape and reshape the organization’s identity. individuals have the capacity to evolve their identity in the moment and with certain immediacy. nonprofit organizations are not always afforded the same opportunity advances in social work, fall 2013, 14(2) 521 because their identity may be so embedded in organizational culture, tradition, or in tangible artifacts such as a mission statement (hatch & schultz, 2002). this presents a sort of organizational identity crisis. this means that if an organization that is using social media is not cognizant of this new landscape and how to perform within it, the identity or image of the organization could possibly transform into something less than ideal, at least online. just as individuals face context collapse in the digital environment (wesch, 2009), nonprofit organizations may also face context collapse because of the potential to access multiple new networks in a variety of different contexts without the constraint of time. symbolic interactionists are generally critical of focusing on macro structures, although blumer (1969) argues that large-scale structures emerge from micro processes. this is important for nonprofit administrators to understand because the core of social media is about interaction. understanding how identity develops through micro-social interactions will ensure that nonprofit organizations are portraying the identity that is important to them in a new and dynamic environment (hatch & schultz, 2002). navigating the social media environment is challenging and several studies highlight how organizations are not using these new tools to their full potential of fostering interaction and engagement (bortree & seltzer, 2009; rybalko & seltzer, 2010; waters & jamal, 2011). this may be evidenced by the context collapse discussed previously. others, however, explain that social media users should choose their applications carefully, ensure that the applications align with the activities being selected, plan for integration, and to be social (kaplan & haenlein, 2010). kietzman, hermkens, mccarthy, and silvestre (2011) also explain that users should be cognizant of the available social media tools and how they align with organizational goals. the incorporation of a social media strategy parallels the social purpose of what many nonprofit organizations do—namely, generate social capital and build community (shafritz, ott, & lang, 2005). the adoption of social media necessitates a careful review of the organization’s identity prior to the implementation of the social media strategy. a brief review of the organizational identity literature further contextualizes the concept of identity development in the social media environment and provides a foundation for the necessary introspection, conversation, and development of a social media strategy. organizational identity the organizational literature defines identity as that which is central, enduring, and distinctive about an organization (brilliant & young, 2004; gioia et al., 2000; hatch & schultz, 2002; young, 2001). brilliant and young (2004) contend that identity is important when organizations face a diversity of challenges, such as mission completion, rapid expansion, or mergers and acquisitions that force an organization to undergo some sort of change. organizations often must adapt their identities to address new environments and challenges (brilliant & young, 2004; sosin, 2012; young, 2001), in addition to the flux of technology while confronting change. the literature makes a distinction between identity and image; whereas identity is internally constructed, image involves the concept of how individuals within the young/organizational identity in the social media environment 522 organization think people outside of the organization perceive it (young, 2001). this is generally important given the theoretical ideas of cooley, mead, and blumer discussed previously, and specifically because this impacts how organizational members use social media to portray the organizational identity or image. gioia and colleagues (2000) argue that this latter construct of image is defined by the “organizational elites” to project an image that communicates a specific purpose, which represents features of organizational identity (p. 66). maintaining a positive identity in the face of changing contexts or environments, organizations must recognize that identity and image are dynamic constructs that create a paradox of continuity and change through which “instability fosters adaptability” (gioia et al., 2000, p. 79). the key struggle within this paradox may stem from the fact that organizations have and maintain multiple identities. just as individuals shape their own identity based on the context of social interaction and ultimately the construction of many identities, organizations also have multiple identities because of the roles and demands from various constituencies or institutional arrangements (brilliant & young, 2004; gioia et al., 2000; sosin, 2012). multiple identities are beneficial for organizations in dealing with conflicting pressures of their environment as they can be analyzed and managed to the benefit of the organization (brilliant & young, 2004; sosin, 2012). however, others argue that maintaining multiple identities is paralyzing and unstable as organizations attempt the balancing act of changing their identity and keeping it the same (gioia et al., 2000; young, 2001). this paradox corresponds to the idea of context collapse in individuals described by wesch (2009), and the emergence of organizational identity in the social media environment. the concept of organizational identity has practical significance for how nonprofit organizations reinvent themselves in the face of changing environments (brilliant & young, 2004). the discussion of identity development from the personal to the organizational level is intended to illustrate how identity development is fluid, dynamic, and socially constructed. this knowledge can help organizational leaders in framing their strategic use of social media to assist with organizational identity, development, and maintenance in the social media environment. utilizing a conceptual model or enacting some general policies will also provide nonprofits with a framework for utilizing social media in a more strategic and meaningful way. a conceptual framework for the strategic use of social media the pew internet & american life project indicates that 75% of american adults are active in some kind of voluntary group or organization and that internet users are more likely than others to be active in those organizations (rainie, purcell, & smith, 2011). despite this unique opportunity, nonprofit organizations have been slow to capitalize on the potential of using the internet (sargeant, west, & jay, 2007). the explosion of social media use in the nonprofit sector presents clear opportunities and challenges as many administrators look to this technology as a figurative super hero coming to the rescue in an increasingly competitive and changing sector. the ability to access millions of people through facebook, twitter, or youtube to increase membership, raise awareness, or increase general exposure of the organization is extremely attractive and daunting. advances in social work, fall 2013, 14(2) 523 three main concepts should help nonprofit organizations that currently use or are thinking about using social media within their organization (see figure 1). the first two concepts for using social media in a nonprofit organization are very similar, and yet distinct. transparency and accountability have been part of the nonprofit sector for decades and ultimately work with the third concept, authenticity, to help nonprofit organizations develop and manage the organization’s online identity. although the model consists of three main concepts, the core element in the proper use of social media is interaction. social media is mainly about making connections and having a conversation, which helps to build community. a better understanding of these concepts can orient strategic decision-making and provide the foundation for the development of a social media strategy. the conceptual model builds upon the discussion of organizational identity to help organizational leaders understand how to demonstrate their organization’s distinctive elements, values, and goals in the social media environment. figure 1. conceptual model of organizational identity in the social media environment transparency transparency is an evolving term with many definitions that convey how organizations are expected to operate (ball, 2009). this discussion defines transparency as “the process of keeping actions and the decision-making processes open and available to the scrutiny of the public and the media” (netting, kettner, mcmurtry, & thomas, 2012, p. 358). nonprofit organizations are unique operations that generally lend themselves well to being transparent. additionally, their tax-exempt status usually impels them by a legal, ethical or moral mandate to be transparent about their finances and transparency authenticity accountability organizational identity young/organizational identity in the social media environment 524 operations (jeavons, 2005). the idea of transparency or openness is not a new concept in the nonprofit sector; however, with the tools of social media that allow for rapid communication and connectivity, there is a new charge for this type of ethical behavior (saxton & guo, 2011; waters, burnett, lamm, & lucas, 2009). utilizing social media often means working with a networked mindset, which is characterized by principles of openness, transparency, decentralized decision-making, and distributed action (scearce, kasper & grant, 2009). social media tools allow organizations to utilize these principles and portray to the public just how funds are used, decisions are made, and volunteer time is executed. examples of how organizations use social media to promote these principles include organizations like kiva (www.kiva.org) and donorschoose.org (www.donorschoose.org). these organizations employ the principles of social media through peer-to-peer philanthropy that allow individuals to choose and donate to specific projects. these organizations use video, images, and blogs to report on the progress of the projects, and individuals can continue to interact online by commenting and sharing with others in their own social networks by linking to the websites. nonprofit organizations using social media need to understand that transparency is good, but that there are also levels to transparency that should and should not be shared (kanter, 2009). generally, public information makes for content that is readily available for reporting on an organization’s website. however, there are instances where information must remain private so as to ensure a safe place for individuals to have discussions without disrespecting others (kanter, 2009). effective nonprofit organizations will assess and evaluate their work in an open and transparent process with the board and the public (brown, 2002). this has been operationalized through websites but can now be greatly enhanced with social media and the use of networks (saxton & guo, 2011; saxton, guo, & brown, 2007). transparency is the ideal for nonprofit organizations and lends itself well to social media. this process also impacts accountability. accountability accountability, like transparency, has multiple definitions in the literature. accountability suggests responsibility for actions and is often linked to financially related information and performance (benjamin, 2008; brinkerhoff, 2001; murry, 2005; saxton, kuo, & ho, 2012). some have argued that greater accountability interferes with the independence that gives the nonprofit sector its uniqueness (salamon, 1999). however, grantors, the federal government, and increasingly the public are requesting greater accountability among nonprofit organizations (binder, 2007; brinkerhoff, 2001; ebaugh, chafetz, & pipes, 2005; saxton & guo, 2011). using social media allows organizations to demonstrate transparency and accountability through social interaction. examples include the use of video, blogs, and most notably websites like facebook where organizations update their status or post news on a variety of topics and actions. specifically, nonprofit organizations are able to disclose financial records such as irs form-990 and other financially related performance documents (gandia, 2011). advances in social work, fall 2013, 14(2) 525 utilizing this new medium also allows a nonprofit organization to connect stakeholders to its mission and expand its targeting efforts, thereby increasing public trust and accountability (saxton & guo, 2011; saxton et al., 2007). one of the main recommendations for nonprofit organizations is to implement more content and opportunities for interaction (gandia, 2011; sargeant et al., 2007; saxton et al., 2007). accountability is more evident on the peer-to-peer philanthropy websites. as mentioned previously, these organizations employ social media to highlight the good work and causes that garner donations from people who care about the issues and the organizations. accountability is vital in this era of website fundraising and organizations that understand this element will do well (sargeant et al., 2007). social media allows nonprofit organizations to develop a relationship with individuals, or an e-relationship, and requires nonprofit organizations to view donors as partners in the process of mission achievement (sargeant et al., 2007). additional key components include designing websites with a focus on engagement rather than a static webpage with a simple “donate here” link, making the process of giving simple and providing a clear explanation of how the donation is being used (ingenhoff & koelling, 2009; sargeant et al., 2007). social media tools enhance these ideas by cultivating connections as demonstrated by organizations such as kiva, donorschoose.org, and many others. examples of cultivating connections include blogging about events, posting videos through youtube of projects that were funded by donors, and updating the organization’s status on facebook or twitter to advertise the work that is being done (waters et al., 2009; waters & jamal, 2011). transparency and accountability are important elements for nonprofit organizations to embrace in general. they are particularly important when using social media if the organization hopes to see engagement from various stakeholders and earn the trust of all supporters (ingenhoff & koelling, 2009; ingram, 2009; saxton & guo, 2011). transparency and accountability naturally flow into the final principle of this framework and help to establish authenticity. authenticity in the absence of symbols and meanings that help to form identity, and facing context collapse because of the endless possibilities, individuals are left to make a connection with a source deep within themselves as they are free to decide who they are (taylor, 1992). authenticity is to be true to one’s self and is a construct that develops along with identity; however, taylor (1992) argues that this construct has lost meaning in contemporary culture as it has come to focus more on modes of self-fulfillment and less on strengthening ties to community. authenticity in the social media environment is about staying true to the organizational identity as well as strengthening ties to its community. authenticity is about relationships; it is what keeps people engaged and willing to spread the word about a particular service, message, or cause through their own social networks. amid the many professional blogs and articles professing details or guidelines on how to make a nonprofit organization successful in the social media environment, young/organizational identity in the social media environment 526 portraying a caring image is truly what will make an organization successful. however, it is more than just portraying a specific identity, it is demonstrating transparency and accountability in an authentic and genuine manner that builds trust, respect, and cohesion among the social networks of individuals who come into contact with the organization via their friends or families through social media. saxton and guo (2011) believe that this new medium offers great potential for nonprofit organizations to be more responsive to their core constituents. responsiveness, interaction, and participation help to increase authenticity, transparency, and accountability. it is critical for nonprofit organizations to understand that their identity develops based on interactions, just as it does for individuals. despite the multiplicity of contexts, organizations must realize that being authentic will allow for their true identity to come forth, and they should not be afraid to demonstrate that. social media is merely a mechanism to create unique connections, and if nonprofit organizations do not take the time to critically think about their social media identities, they will face challenges and frustration. kanter and fine (2010) discuss this idea as the concept of developing a social culture, or a culture where the organization uses the power of social media to change relationships. the shift to a social culture requires organizations to become more open and transparent, and to devote critical attention to authentic conversations (kanter & fine, 2010). authenticity exists when organizations leverage the power of social media to develop relationships, build trust, listen, and respond to the community. using this framework as guide, nonprofit organizations can begin to think about various strategies and methods as they implement the use of social media. conclusion nonprofit organizations that recognize their organizational identity and the need to develop or maintain the identity in multiple contexts will be better off in their pursuits of social media because they can be flexible and make strategic decisions. recognizing that identity is socially constructed is the first step to understanding organizational identity. secondly, identity formation is fluid and dynamic based on the effects of social interactions and the environment (gioia et al., 2000; hatch & schultz, 2002). the most challenging factor in using social media may not merely be organizational identity maintenance, but the notion that organizations must give up some sense of control to the community of users (watson, 2009). nonprofit organizations that are transparent, accountable, and authentic should not have issues with this sense of letting their social media community actively participate in the conversation. after all, the core of social media is connecting and having a conversation that builds trust, engagement, and ultimately community. this opportunity to collaborate with the social media community, combined with an understanding of organizational identity development and the conceptual framework outlined above, provides the initial foundation for thinking strategically about using social media within the organization. advances in social work, fall 2013, 14(2) 527 references ball, c. 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(2009). causewired: plugging in, getting involved, changing the world. hoboken, nj: wiley & son’s. wesch, m. (2009). youtube and you: experiences of self-awareness in the context collapse of the recording webcam. explorations in media ecology, 8(2), 19-34. retrieved from http://hdl.handle.net/2097/6302 young, d. r. (2001). organizational identity and the structure of nonprofit umbrella associations. nonprofit management & leadership, 11(3), 289-304. author note: address correspondence to: jimmy young, ph.d., assistant professor, department of social work, founders hall, university of nebraska-kearney, 2504 9th avenue, kearney, ne 68849. email: youngja2@unk.edu microsoft word editorial vol 13_3 _________________ william h. barton, ph.d., is a professor in the indiana university school of social work on the indiana university-purdue university indianapolis campus. contact information: (317) 274-6711; email: wbarton@iupui.edu copyright © 2012 advances in social work vol. 13 no. 3 (fall 2011), i-iv editorial william h. barton with the fall 2012 issue, advances in social work is pleased to bring you its third issue of the year (volume 13, no. 3). when the editor (me) informed his staff (also me): “i would like you to prepare, copyedit, and release three issues in 2012,” his staff replied “are you serious, boss?” now this small and not very self-aware staff is relieved that the three issues have all been carefully produced, and more than grateful to the co-editors of the two previous special issues: drs. james daley and anthony hassan for the military social work issue (vol. 13, no. 1), and drs. khadija khaja and joseph varga for the global problems: local solutions issue (vol. 13, no. 2). if you have not yet already done so, i would urge you to visit those issues on our website. i will say, however, that in 2013 we only plan to produce the usual two issues, and intend to keep it that way for the foreseeable future! i would also like to take this opportunity to express appreciation to our expanding roster of reviewers. with the three issues this year, and a generally increasing number of manuscript submissions, many reviewers have been asked to do multiple reviews, and most have responded in a thorough and timely fashion, only occasionally needing a gentle reminder. the results are apparent in the quality of articles published. moreover, several authors, even including those whose manuscripts were rejected, have expressed appreciation for both the constructive nature of the reviewers’ feedback and the relatively quick timelines from submission to initial decision. this fall 2012 issue contains 9 articles on a range of topics. it begins with michelle d. garner’s “advancing discussion of federal faith-based social service policies through overview and application of established health services research models.” she perceives a lack in the literature of an appropriate analytic framework for critiquing the merits of federal policies regarding faith-based organizations’ (fbos) provision of human services, and suggests applying the theoretically-based policy analysis model introduced by aday and colleagues (2004) to that task. she concludes that their effectiveness, efficiency, and equity policy analysis framework is an appropriate lens through which to consider fbo policies. the second article, “re-imagining citizenship, re-imagining social work: u.s. immigration policies and social work practice in the era of az sb1070,” by hyekyung kang, is also policy-related. “guided by poststructural and postcolonial theories, this paper uses a critical discourse analysis method (fairclough, 1992, 1995) to illustrate how subject positions, such as ‘immigrants’ and ‘citizens,’ were produced and transformed through legal and policy discourses over time and illuminates binary oppositions that resulted in promoting citizenship as a system of exclusion” (kang, 2012, p. 511). kang’s historical analysis of u.s. immigration laws illuminates how the intersections of race/ethnicity-based restrictions and binary constructions such as nativeadvances in social work, fall 2012, 13(3) ii born/foreign, deserving/undeserving, and safe/dangerous have produced an exclusionary and inequitable version of citizenship. continuing with the thread of critical analysis, marcus herz and thomas johansson, from sweden, provide the next article: “‘doing’ social work: critical considerations on theory and practice in social work.” they argue that the current emphasis on evidencebased practice reflects a form of social engineering that reproduces and strengthens dominant discourses and perspectives. they offer instead the idea of a more deconstructive and reflexive form of practice which they call “doing social work.” as they note: “while race, gender, age, sexuality, and class, for example, are often treated as stable categories, almost as parts of a personality, we suggest that these ‘categories’ are constantly evaluated, deconstructed, and put into motion. doing social work would then be a demanding social practice, with critical and ongoing discussions about changes at the physical, social, and cultural levels as an important tool and practice” (herz & johansson, 2012, p. 535). the next three articles contain sophisticated quantitative analyses to address measurement, theoretical, and intervention goals. elizabeth a. segal, m. alex wagaman, and karen e. gerdes present the next installment in an impressive program of research attempting to develop measures that adequately capture what is meant by the concept of empathy. in “developing the social empathy index: an exploratory factor analysis,” their results help “to refine the conceptualization of social empathy as a construct with three components: 1) interpersonal empathy (as measured by the eai); 2) contextual understanding of systemic barriers; and 3) macro self-other awareness and perspectivetaking” (segal, wagaman, & gerdes, 2012, p. 554). next, jacky t. thomas also explores empathy, using regression analyses to address the question posed in the title of the article “does personal distress mediate the effect of mindfulness on professional quality of life?” she begins with the notion that upon observing another person who is suffering, some people exhibit an urge to help (presumably an indicator of empathy) while others experience an aversive reaction characterized by anxiety, withdrawal, or avoidance (personal distress). in addition, the literature suggests that mindfulness is associated with better professional quality of life indicators (lower levels of burnout and compassion fatigue, and higher levels of compassion satisfaction). using a sample of 171 lcsws, thomas found some support for a potential mediating effect of personal distress on the relationship between mindfulness and the professional quality of life measures. mediation effects were also observed by ann maceachron and nora gustavsson in the article “peer support, self-efficacy, and combat-related trauma symptoms among returning oif/oef veterans.” using a sample of 216 veterans returning from the recent wars in iraq and afghanistan who attended weekend retreats sponsored by vets4vets, their study analyzed preand postmeasures of perceived peer-support, self-efficacy, and ptsd symptoms. in addition to finding that increased peer support and self-efficacy were associated with reduced ptsd symptoms, they found support for both situation-specific and general theoretical models of self-efficacy serving to mediate the relationship between peer support and ptsd symptoms. barton/editorial iii in “perceptions of administrative and supervisory support in public child welfare,” tonya m. westbrook and josie crolley-simic present the results from a portion of a survey of 1033 employees of a public child welfare agency. they compared the perceptions of administrative and supervisory support reported by child welfare employees with and without social work degree backgrounds. the results indicated that child welfare employees with social work degrees perceived less support from administrators and supervisors than did employees without social work degrees. the final two articles focus on issues related to social work education. in “you make them do what?”: a national survey on field seminar assignments,” bruce dalton reports on the extent to which msw programs use field seminars, how often such seminars meet, whether or not online components are used, and the extent to which required foundation and concentration year field assignments are seen as appropriate for inclusion in field seminars. results show considerable variations in whether and how field seminars are used, leading to dalton recommending that field seminars be required components of field education. similarly, kristen faye bean and taylor e. krcek report results from a survey of the top-25 schools of social work regarding the extent to which disability content was included in their curricula in this issue’s concluding article, “the integration of disability content into social work education: an examination of infused and dedicated models.” bean and krcek conducted a content analysis of 1620 course titles and descriptions from these schools’ curricula. they found that 80% of the schools included disability content in course titles or descriptions. however, of the 1620 course titles and descriptions analyzed, only 7% included disability-related terms. other findings of note included: “twenty percent of the courses with disability content used the dedicated model, while the remaining courses infused disability content into courses with other main topics. only one course description mentioned covering the ada. developmental and childhood disabilities were reported the most often in the course titles and descriptions” (bean & krcek, 2012, p. 643). thus ends the issue, and another year. for next year, we are eagerly anticipating the spring 2013 special issue of advances in social work focusing on the impact of socioeconomic, cultural, political, and international factors on latinos/latinas in the united states, edited by dr. irene queiro-tajalli. the submission deadline for that issue has passed; we received nearly 30 manuscripts for review. stay tuned for an announcement and call for papers next summer for a 2014 special issue on a topic yet to be determined. of course, we will produce a “regular” issue with a range of topics in the fall of 2013. so, there is still ample time to write and submit manuscripts for that issue, and i encourage you to do so! meanwhile, enjoy the current issue, tell your colleagues about advances in social work, and urge them to register to submit articles and to join our cadre of reviewers. happy holidays! advances in social work, fall 2012, 13(3) iv references aday, l. a., begley, c. e., lairson, d. r., & balkrishnan, r. (2004). evaluating the healthcare system: effectiveness, efficiency, and equity (3rd ed.). chicago: health administration press. bean, k. f., & krcek, t. e. (2012). the integration of disability content into social work education: an examination of infused and dedicated models. advances in social work, 13(3), 633-647. fairclough, n. (1992). discourse and social change. cambridge, uk: polity press. fairclough, n. (1995). critical discourse analysis: the critical study of language. uk: longman group limited. herz, m., & johansson, t. (2012). ‘doing’ social work: critical considerations on theory and practice in social work. advances in social work, 13(3), 527-540. kang, h-k. (2012). re-imagining citizenship, re-imagining social work: u.s. immigration policies and social work practice in the era of az sb1070. advances in social work, 13(3), 510-526. segal, e. a., wagaman, m. a., & gerdes, k. e. (2012). developing the social empathy index: an exploratory factor analysis. advances in social work, 13(3), 541-560. ______________________ matthew l. vasquez, phd, lmsw is assistant professor, department of social work, university of northern iowa, cedar falls, ia 50614, shamra boel-studt, phd, is assistant professor, college of social work, florida state university, tallahassee, fl 32306. copyright © 2017 advances in social work vol. 18 no. 1 (spring 2017), 1-24, doi: 10.18060/21243 this work is licensed under a creative commons attribution 4.0 international license. integrating a trauma-informed care perspective in baccalaureate social work education: guiding principles matthew lorenzo vasquez shamra boel-studt abstract: over the past decade, there has been substantial growth in empirical evidence supporting that proper assessment and treatment of trauma using evidence-based practices can effectively reduce a wide range of symptoms in both children and adults. given the complex nature of trauma treatment, trauma-based educational programming in social work is most commonly found at the graduate level. yet, to date, there has been little discussion calling for the inclusion of trauma content in bsw education. in this paper, we examine the current state of trauma-content inclusion in social work education, and offer a guiding framework for integrating core trauma content into the bsw curriculum that is based on the core principles of trauma-informed care. keywords: trauma; trauma-informed care; baccalaureate social work over the past decade, there has been mounting evidence for assessment and treatment methods capable of effectively identifying and reducing a wide range of trauma symptoms in pediatric (de arellano et al., 2014; schneider, grilli, & schneider, 2013) and adult samples (ehlers et al., 2010; rubin & springer, 2009). subsequently, trauma-focused interventions have grown in popularity and are increasingly being recognized as a standard form of treatment for trauma-affected individuals. given the complex nature of trauma treatment and the numerous issues that can arise concerning client-safety, trauma-based educational programming is most commonly found at the graduate level (courtois & gold, 2009). indeed, a growing number of msw programs have begun integrating trauma content into their curriculum (abrams & shapiro, 2014; bussey, 2008; strand, abramovitz, layne, robinson, & way, 2014). yet, to date, there has been little discussion calling for the inclusion of trauma content in bsw education (mckenzie-mohr, 2004). with bsws often having “first contact” with various client populations, including those who have been chronically maltreated and traumatized, it is necessary for bsw programs to include content into their curriculum that provides students with an understanding of trauma, its treatment, and the ways in which service organizations can best serve traumatized individuals. in this paper, we examine the current state of trauma-content inclusion in social work education, and offer guiding principles for integrating core trauma content into the bsw curriculum that is based on the principles of trauma-informed care. definition and prevalence of trauma a variety of definitions of trauma have been presented in the literature. in an effort to develop a common conceptualization that is applicable to both practitioners and researchers, the substance abuse and mental health services administration (samhsa; https://creativecommons.org/licenses/by/4.0/ vasquez & boel-studt/integrating tic 2 2014) conducted an extensive review of existing definitions followed by a review from an expert panel to propose the following definition: individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. (p.7) prevalence of exposure to traumatic events is high among children and adults in the united states. studies have shown that approximately 70-80% of children and adolescents (ages 2-17) were exposed to at least one type of victimization in their lifetime and 66% had been exposed to multiple types of victimization including child maltreatment, attempted kidnapping, peer/sibling victimization, domestic violence and crime in their communities (copeland, keeler, angold, & costello, 2007; turner, finkelhor, & ormrod, 2010). in a nationally representative survey of adults, 89.7% reported having been exposed to at least one traumatic event with an average exposure to 3.30 different types of events (kilpatrick et al., 2013). similar rates of traumatization have been found in other studies using national and internationally representative samples (see breslau et al., 1998; frans, rimmö, åberg & fredrickson, 2005; stein, walker, hazen, & forde, 1997; vrana & lauterbach, 1994). trauma studies in social work education numerous studies highlight the impact of trauma on long-term health and mental health functioning (dong et al., 2004; felitti el al., 1998), including the high rates of social service use among these populations (elhai, north, & frueh, 2005; jennings, 2008; solomon & davidson, 1997). consequently, there is a growing sentiment that the inclusion of traumafocused content should be presented in helping professional degree programs (courtois & gold, 2009; marlowe & adamson, 2011; strand et al., 2014). yet, courtois (2002) notes that the specialized study of traumatic stress has yet to be fully included in social science educational programs. courtois (2002) cautions: this lack of inclusion has the effect of preventing traumatized individuals from getting needed services from professional and lay personnel who are knowledgeable about trauma, trauma response, and their particular role. in turn, it has also had the potential for creating more distress in traumatized individuals, in their loved ones, and in even those charged with providing help. thus, the need for this information and its inclusion in professional curricula, is not casual and is, in fact urgent. (p. 53) this sense of urgency has not gone unnoticed within the field of social work. in 2012, the task force on advanced social work practice in trauma published guidelines on how to integrate trauma-focused content into social work programming (cswe, 2012, advanced social work practice in trauma). these guidelines are based on the 10 education and policy accreditation standards (epas) core competencies that were set forth by cswe in 2008, and include individual, family, organizational, and community-based recommendations for advanced social work practice in trauma. the authors are clear that these guidelines are meant for integration in msw-level programming. as such, there is ample discussion of activities that concern assessment, diagnosis and clinical intervention, advances in social work, spring 2017, 18(1) 3 which are practice behaviors often associated with advanced social work practice. thus, it could be argued that the current state of social work education views the inclusion of trauma-related content as best-suited for the graduate level. graduate social work education in trauma currently, there are several graduate-level trauma certificate programs offered at schools of social work throughout the nation. many of these programs have a clinical emphasis, and include specific training in interventions like trauma-focused cognitive behavioral therapy (tf-cbt), crisis/disaster intervention models, and trauma-informed care (see bussey, 2008). these programs may be included as part of the graduate curriculum, or housed within continuing education programs, with graduate students and practicing social workers being able to participate. many of these programs are relatively new and, therefore, have yet to be evaluated. one recent approach to integrating trauma-related content into graduate social work education has come from the national child and traumatic stress network’s (nctsn) core curriculum on childhood trauma (ccct; layne et al., 2011). the ccct’s aim is to advance the knowledge of graduate students and current working professionals on the core concepts of psychological trauma, which can then prepare them for more advanced training in evidence-based trauma treatment (ebtt). the ccct consists of a five-tier conceptual framework, and uses problem-based learning (such as the use of real case vignettes) along with the use of facilitators who hold extensive clinical experience in trauma-related practice. in a large-scale evaluation of a modified version of the ccct, the core concepts in child and adolescent trauma, in graduate schools of social work researchers found that students experienced significant pre-posttest increases in selfreported confidence in applying the core concepts of trauma (layne et al., 2014). the researchers also found that other students who participated in the “gold standard plus” educational model, which included the ccct course, training in ebtt, and implementation of the ebtt in field placement, experienced significant pre-posttest increases in self-reported conceptual and field readiness. the ccct constitutes one of the first comprehensive initiatives to promote trauma training for msw students, and may reflect a growing trend for schools of social work to implement more structured approaches to offering trauma-based programming. there is also a growing discussion of how to safely and effectively present trauma content to graduate social work students. students with trauma histories who are exposed to trauma-related content, whether in the classroom or during field placement, have the potential to experience vicarious trauma, or to be re-traumatized by material that reflects past experiences (carello & butler 2014, 2015; didham, dromgole, csiernik, karley, & hurley, 2011; knight, 2010). this can be highly disruptive to student learning (miller, 2001), as those who lack awareness of the severity of their past trauma can draw upon intense, maladaptive patterns of coping when exposed to course content that triggers prior traumas (etherington, 2000). in response to this issue, recommendations have been offered on how to make the classroom environment a safe place for graduate students by presenting content that aids in the reduction of secondary traumatic stress (o’halloran & o’halloran, vasquez & boel-studt/integrating tic 4 2001; shannon, simmelink, im, becher, & crook-lyon, 2014) and vicarious trauma (dane, 2002). baccalaureate social work education in trauma although the inclusion of trauma-related content in graduate level curricula has grown in popularity, the literature on the inclusion of trauma content in bsw education is limited. mckenzie-mohr (2004) calls for the inclusion of trauma-focused content in the bsw curriculum due to the high likelihood that most graduates will obtain employment in organizations that provide services to traumatized and/or oppressed individuals. breckenridge and james (2010) discuss the rationale for their development of a bsw course that emphasized multifaceted approaches to addressing trauma that encourages students to view treatment as including individual, group, community, and policy-based interventions. finally, farchi, cohen, and mosek (2014) describe their development of an israeli stress and trauma studies (sts) program. the sts was a supplementary curriculum to an undergraduate social work program in which students were trained to act as psychological first responders to those who had just experienced traumatic events with the aim of preventing the development of trauma symptoms. currently, there is no recommended model for infusing trauma-related content across the bsw curriculum like the one provided by the task force on advanced social work practice in trauma (cswe, 2012) for msw programming. the reasons behind this lack of emphasis are not entirely clear. one reason could be, as previously discussed, the potential for students to experience duress when exposed to trauma content. msw students may be viewed as having more life and/or work experience than bsw students, and therefore, perceived as mature enough to manage the sensitive nature of the content (bell, kulkarni, & dalton, 2003; neumann & gamble, 1995). another reason may be the perception that the study of trauma is inherently complex and clinical in nature (see cswe, 2012), and therefore best suited for graduate-level social work programming. the cswe educational policy and accreditation standards (epas; 2015) state that msw programs help students to “identify the specialized knowledge, values, skills, cognitive and affective processes, and behaviors that extend and enhance the nine social work competencies and prepare students for practice in the area of specialization” (p.12). although there is no discussion of what constitutes specialized practice, the study of trauma and its treatment may be viewed as a primarily clinical endeavor, which is often synonymous with advanced or specialized practice. thus, the structure of graduate social work education, with its strong emphasis on field education, may be deemed as best-suited to help students learn the theoretical concepts related to trauma and then to apply them during field placements. due to bsw education being rooted in generalist practice, which does not typically include content on clinical or other specialized forms of practice, there may be a perceived difficulty in connecting traumarelated content with the bsw curriculum. with the high likelihood of bsw students finding employment with organizations that serve traumatized individuals, we advocate for the inclusion of trauma-related content in the bsw curriculum. such content should provide students with an understanding of the advances in social work, spring 2017, 18(1) 5 ways in which trauma affects individuals, families, and communities, along with an understanding of how social service organizations’ practices and policies can impact service delivery and their clients who have experienced trauma. one practice model that may offer an effective way to integrate a broad spectrum of trauma content into a generalist model of social work practice is trauma-informed care. trauma-informed care in recent years, there has been a growing movement for trauma-informed practices to be implemented across a broad spectrum of service settings and client populations, such as in child welfare (ko. et al., 2008), in-patient psychiatric settings (azeem, aujla, rammerth, binsfeld, & jones, 2011; huckshorn, 2004; regan, 2010), with inmates (levenson, willis, & prescott, 2014), and the homeless (hopper, bassuk, & olivet, 2009; mckenzie-mohr, coates, & mcleod, 2012). generally, in trauma-informed care settings, staff a) assess for and understand the impact of trauma on their clients, b) provide clients the knowledge and skills needed for recovery, and c) actively address treatment barriers and service delivery practices that may lead to potential re-traumatization (elliott, bjelajac, fallot, markoff, & reed, 2005; gatz et al., 2007). depending on the specific needs of the client population, staff may be trained in how to establish and maintain safety and therapeutic relationships, de-escalation techniques, and strengths and empowerment models of client-care and case management (azeem et al., 2011; borckardt et al., 2011; elliott et al., 2005). a trauma-informed care system also serves to support and maintain trauma-specific treatment approaches, which are “designed to treat the actual sequelae of sexual or physical abuse trauma” (jennings, 2008, p. 10). these approaches can include psychoeducation, therapies designed to address trauma and its accompanying symptoms (e.g., cognitive therapies, desensitization therapies, prolonged exposure), emotional regulation and social skill-building, enhancing resiliency, and psychotropic medication management (cohen, mannarino, berliner, & deblinger, 2000; jennings, 2008; nctsn, 2007). this dualapproach to service delivery provides all those involved in client cases (e.g., case managers, clinicians, and administrators) with a common understanding and language surrounding the impact of trauma and its treatment. such an environment allows clients to safely and confidently engage in trauma-based therapy without the fear of potential mismanagement of their care by those uninformed about their specific needs. at the crux of trauma-informed care is the understanding that service organizations need to be consistent in the ways that they engage clients who have experienced trauma, while being flexible in responding to their individual needs (prescott, soares, konnath, & bassuk, 2008). striking this balance requires staff to continuously reflect upon and evaluate both personal and organizational forms of practice, and to make changes accordingly. we propose that the skills and competencies needed to effectively engage in this type of practice closely align with those found in generalist social work practice. therefore, the bsw curriculum, which is based on a generalist model, serves as an ideal platform to present principles of trauma-informed care. in the following sections, we present a comprehensive trauma-informed care framework that educators can use to guide the infusion of trauma-related content into their bsw curriculum. vasquez & boel-studt/integrating tic 6 method to identify core content areas that could be integrated into the bsw curriculum, we conducted a literature search to identify common principles found in trauma-informed care practice frameworks across a variety of professional disciplines. focusing on frameworks that were published since 2000, we searched google scholar, academic search complete and elite, and psychinfo. additionally, we searched the internet using google to identify frameworks published on organizational and government websites and other reputable nonacademic literary sources (e.g., nctsn, samhsa, national center for biotechnology information). we used a combination of the search terms: trauma, trauma-informed care, approach, perspective, principles, and framework. to begin, each author conducted a separate literature search to identify traumainformed frameworks. in total 13 frameworks were found using our search criteria. each framework was then separately reviewed for common practice principles by both authors and compared for agreement. initially, 19 common principles were identified. in a second review, we collapsed seven of the principles into broader categories in which they were closely aligned (e.g., empowerment, choice, autonomy). we further applied a selection criterion in which a principle had to have been present in at least four frameworks to be considered ‘common’. this was based on our finding that a principle appeared at least four times and below that range, the identified principles or guidelines were sporadic, appearing only once or twice. at that point, we reached 100% agreement on the remaining principles. this level of agreement was facilitated by the high level of consistency in the stated principles and the language used across frameworks. the remaining nine principles are summarized in table 1, and represent the most commonly identified principles of traumainformed care practice across the fields of mental health, social work, nursing, child welfare, and criminal justice. in the following section, we present these nine principles, along with recommendations for integration within a generalist bsw curriculum. similar to the task force on advanced social work practice in trauma (cswe, 2012), our framework should serve as a guide for social work educators. advances in social work, spring 2017, 18(1) 7 table 1. common principles identified across trauma-informed care practice frameworks source 1 trauma knowledge 2 trauma screening & assessment 3 safety & minimize revictimizing 4 empowerment & selfdetermination 5 identifying strengths 6 cultural competency 7 healthy relationships 8 emotion regulation 9 self-care bath (2008) x x x bloom & sreedhar (2008) x x x x x covington et al. (2008) x x x x x x elliot et al. (2005) x x x x x x x guarino et al. (2009) x x x x x x x x huckshorn (2004) huckshorn et al. (2005) x x x harris & fallot (2001) fallot & harris (2001) x x x x kinniburgh et al. (2005) x x x mcmanus & thompson (2008) x x x x nctsn (2007) x x x x x x x prescott et al. (2008) x x x x x x x x saakvitne et al. (2000) x x x x x samsha (2014) x x x x note. nctsn = national child traumatic stress network; samsha = substance abuse and mental health service administration. vasquez & boel-studt/integrating tic 8 recommendations for integrating trauma-informed care principles in the bsw curriculum principle 1: trauma knowledge trauma knowledge is defined as having an understanding of how traumatic events impact individual’s development, health, well-being and coping abilities (guarino, soares, konnath, clervil, & bassuk, 2009; nctsn, 2007). having this foundational awareness is an essential first step for social workers to effectively work with traumatized populations and understand the various ways in which trauma can affect clients’ cognitive, emotional, behavioral and social functioning. one such example would be recognizing that many trauma symptoms stem from physiological responses within the body (e.g., hyperarousal and activation of the sympathetic nervous system), and that maladaptive coping behaviors (e.g., physical and verbal aggression, substance abuse, self-harm) are often used to manage these symptoms. understanding this can help social workers to more accurately assess clients and the symptoms they may be presenting with (covington, burke, keaton, & norcott, 2008; mcmanus & thompson, 2008; prescott et al., 2008). post-traumatic stress symptoms or maladaptive coping behaviors often interfere with healthy functioning in other domains of life and can make seeking assistance, whether voluntarily or mandated, from a service organization seem “fraught with danger” (elliot et al., 2005, p. 463). understanding the types of duress traumatized clients may be experiencing when seeking services can aid social workers in developing professional practices and service environments that promote physical and emotional safety and reduce the risk of retraumatization (mcmanus & thompson, 2008). education on trauma has largely focused on understanding individual trauma (audergon, 2004; bell et al., 2003), yet trauma can also be experienced collectively and impact functioning within larger community (nytagodien & neal, 2004) and organizational systems (bloom, 2010). social services organizations often operate under conditions of chronic stress (bloom, 2010) including working with traumatized and challenging clients, limited resources, workforce issues, and political and social scrutiny. the accumulation of chronic stress can lead to high rates of burn-out, employee turnover, mission drift and a loss of clarity in the values and goals that drive the organization (bloom & sreedhar, 2008). similarly, communities can also be deeply impacted by trauma and become entrapped in a traumatized culture. individuals experience and cope with trauma within the context of a community (kahn, 2003) and communities as a whole can experience collective trauma due to natural disasters, violence, poverty or other events (samsha, 2014). trauma-affected organizations and communities can manifest traumatic stress symptoms characterized by hypervigilance, fear, mistrust, and withdrawal. because the community and organizational contexts provide the backdrop in which micro and macro level interventions are delivered, they are an integral part of any intervention, whether it involves providing direct care services within an agency, community outreach work, or organizational practice. integrating trauma content in the bsw curriculum could enhance students’ understanding of the impact of trauma on individuals, families, groups, communities and advances in social work, spring 2017, 18(1) 9 organizations. courtois and gold (2009) recommend presenting trauma in undergraduate curricula as “a normal and frequent occurrence in human history and as an influential, but as yet not fully recognized, factor in human development” (p. 18). they further recommend highlighting how traumatic experiences can engender strength and resiliency (posttraumatic growth). as such, courses like human behavior in the social environment (or its equivalent) that focus on developmental theories and the specific needs of people across the lifespan could easily incorporate content that discusses how traumatic experiences can affect multiple domains of functioning and development. research courses could expand on this content by providing bsw students opportunities to review current empirical studies on trauma, and macro-oriented courses could highlight how organizational structures, community initiatives, and policy decisions can impact clients who use certain services. principle 2: trauma screenings and assessments in addition to understanding the ways in which trauma can impact clients, it is equally important to screen and assess clients for past and current trauma experiences so that more individualized, holistic treatment planning can occur (harris & fallot, 2001). fallot and harris (2001) define trauma screening as “brief, focused inquiry to determine whether an individual has experienced specific traumatic events” (p. 24). trauma screenings aid in identifying exposure to traumatic experiences or events, whether the client is currently in danger or exhibiting trauma symptoms, and are used to determine if a referral for a more in-depth trauma assessment is needed (conradi, wherry, & kisiel, 2011; fallot & harris, 2001). screening can also encourage service providers to see clients from a perspective of how they have been hurt, rather than seeing only their presenting problems resulting in greater compassion and understanding of the client’s presenting issues and the surrounding circumstances. the value that trauma-informed care places on screening and assessment practices that identify the ways in which trauma has affected a client’s current functioning is reflective of generalist social work practice’s use of the person-in-environment framework (cswe, 2015). as such, many undergraduate programs of social work likely already provide content that emphasizes the importance of screening and assessment, the use of ecological and systems models, and the identification of strengths along with needs. thus, the inclusion of how these frameworks and practice behaviors can better serve clients who have experienced trauma could be a relatively seamless integration. we do not necessarily advocate training bsw students on how to conduct specific types of standardized trauma screening tools and assessments, as this may be too specific of an activity for some generalist programs. however, universal trauma screening is often done during the period of initial contact with a client and often by bachelor’s level service providers. indeed, some of the most widely used trauma screening tools require bachelor’s level education and training (e.g., child abuse and neglect scale – trauma version; kisiel, fehrenbach, small, & lyons, 2009; trauma symptom checklist, briere, 2005). thus, the decision to incorporate training on specific screening and assessment tools can be left to the discretion of individual bsw programs. vasquez & boel-studt/integrating tic 10 principle 3: client safety and minimizing re-traumatization the principle of developing and sustaining organizational practices that promote client safety and limit the possibility of re-traumatization was found among all of the identified trauma-informed care frameworks. the importance of such a principle cannot be overstated; it represents the core of trauma-informed care, serving as a prerequisite to providing other elements of trauma-informed services. safety, in the context of individual and organizational service delivery, is multi-faceted, with many elements that need to be considered by helping professionals (bath, 2008). for example, professional qualities such as consistency, reliability, availability, honesty, and transparency in helping professionals can engender a safe and therapeutic environment for clients. furthermore, a demonstrated tolerance for the range of intensity of reactions by trauma survivors can aid in developing rapport and feelings of trust (guarino, rubin, & bassuk, 2007; prescott et al., 2008). client safety can be established through case management practices (nctsn, 2007) that include assessing the potential for re-traumatization (e.g., does an abusive partner or parent have access to the client?), providing contact information for shelters, food pantries, crisis hotlines, and establishing legal protections such as restraining and protection orders. implementing organizational practices that are sensitive to the individual needs of traumaaffected clients can also foster a sense of client safety. for example, a domestic violence shelter for women who have likely experienced abuse by male perpetrators, may have policies limiting the type and duration of contact male staff have with the clients as a way to protect clients from becoming triggered or experiencing symptoms of hyperarousal and fear (prescott et al., 2008). integrating or enhancing content in existing bsw curricula that exemplifies how building trust, establishing rapport, adhering to ethical and professional standards of practice, and case management, can increase bsw students’ preparedness to engage in practices that promote a sense of safety in trauma survivors. social work educators may choose to approach this in many ways, including through having students role play the intake and assessment/screening processes with trauma-affected clients, practicing communication styles, both verbal and non-verbal, that allow students to develop a skillbase and sense of self-efficacy in their future work with trauma survivors, and through the use of case-vignettes that require students to assess the current functioning of a client and then to provide their recommendations for building safety. finally, additional content outlining the importance of identifying how organizational practices and policies promote (or possibly restrict) the development of client safety may prepare future social workers to proactively assess and advocate for organizational practices that ensure clients’ safety and needs are being met. principle 4: client empowerment and self-determination organizations that serve clients who have experienced traumatic victimization (e.g., intimate partner violence, and physical, emotional, and/or sexual abuse) understand that the inherent nature of these experiences are often rooted in a sense of coercion, powerlessness, and a loss of control (dutton & goodman, 2005; gershuny & thayer, 1999; najavits, sonn, walsh, & weiss, 2004). as such, recognizing and addressing power imbalances between the organization/staff and client can help to lessen the likelihood of advances in social work, spring 2017, 18(1) 11 re-traumatization and foster a sense of safety and trust in the client. for example, shareddecision making surrounding client treatment options and goal setting is strongly encouraged in both policy and practice (sahmsa, 2014). allowing trauma survivors to have a voice in their own treatment and goal development will increase motivation to engage in services, which may result in better outcomes (prescott et al., 2008). in instances where the social worker believed the client to be making a poor choice, every effort is made to understand the perspective of the client in addition to providing clarifying information in the hopes of reaching a mutual goal (elliot et al., 2005). the principles of client self-determination and empowerment constitute some of the foundations by which contemporary generalist social work practice is formed (see kirstashman, & hull, 2014; miley, o'melia, & dubois, 2013). incorporating these principles within the context of working with traumatized populations into bsw programs of study should be relatively seamless, as many programs likely already include such content. bsw programs may consider adding content on how to engage in practices that promote client empowerment and self-determination during the initial contact with a client who has experienced trauma during screenings and assessments, and in more long-term service relationships to demonstrate how such an approach can be implemented across a variety of practice situations. principle 5: client and organizational strengths identification an integral part of client empowerment and self-determination (principle 4) is the identification of client strengths (samsha, 2014). in repeated or long-term cases of trauma, individuals may perceive their current reality as one where they have little control over what happens to them. therefore, daily stressors and problems may seem insurmountable. identifying client strengths can help lessen this sense of powerlessness, and promote a sense of empowerment, self-efficacy, and resiliency, all of which can aid in the attainment of therapeutic goals (mcmanus & thompson, 2008; nctsn, 2007). the identification of strengths can also be applied to service organizations. in discussing the steps of the sanctuary model, bloom and sreedhar (2008) point out the need for staff members to engage in discussions that identify the strengths, vulnerabilities, and conflicts within an organization. these open discussions can provide a shared analysis of the organizations’ structure, current functioning, and quality of service delivery. such an approach may prove useful in building cohesiveness among staff within an organization, and can highlight positive attributes of the organization, all of which could bolster employee satisfaction and productivity in the long-term. like client self-determination and empowerment, the strengths perspective can be seen as one of several core concepts of generalist social work practice (see mcmillen, morris, & sherraden, 2004; poulin, 2009). the epas (cswe, 2015) asserts that the generalist practitioner will “recognize, support, and build on the strengths and resiliency of all human beings” (p. 11). it is important to note that although the strengths perspective is recognized as an important aspect of client-centered practice, there is no universally accepted approach to application in practice settings (staudt, howard, & drake, 2001). therefore, for bsw programs that want to include content on how to integrate a strengths-based perspective vasquez & boel-studt/integrating tic 12 when working with clients who have experienced trauma, we propose the following: 1) help students to recognize that there is inherent resiliency that comes with having survived traumatic events, 2) emphasize that identifying strengths is most effective when there is a comprehensive and thorough assessment of the client’s trauma history, biopsychosocial functioning, and social and cultural background, and 3) the identification of strengths can and should be applied to organizational processes and policies. principle 6: cultural competency critical to the development of client safety (principle 3), client empowerment and selfdetermination (principle 4), and the identification of strengths (principle 5), is recognizing the important role culture plays in the lives of clients who have experienced trauma. the ways in which a client expresses emotion, copes with traumatic stress, and seeks (or avoids) the support of others could all be influenced by cultural norms (nctsn, 2007). therefore, the start of services should always entail exploration of the client’s cultural background and needs. refugees, for example, who have experienced the effects of war and migration, may need additional time to build trust with service providers, especially if language barriers exist and there is need for an interpreter. social workers can help clients identify the ways in which cultural norms aid or possibly restrict the expression of anger, sadness, and fear, along with how these emotions can serve to aid in the recovery from trauma. it is also important to recognize and respect a client’s adherence to culturally-specific medical traditions and healing practices, and possibly find ways to incorporate such practices into more standard forms of trauma treatment (sahmsa, 2014). equally important to recognizing and valuing a client’s cultural background is understanding how one’s own cultural background influences the helper-client relationship (elliot et al., 2005). by exploring one’s own history and culture, a deeper awareness and appreciation can develop for how life events, cultural influences, and privilege can shape one’s worldview (yan & wong, 2005). such insight can aid social workers in recognizing deeply held biases that could hinder the quality of services or, even worse, re-traumatize clients. cultural competency is widely regarded as a crucial element for effective social work practice (boyle & springer, 2001). the epas (cswe, 2015) asserts that the generalist practitioner will “engage diversity in their practice and advocate for human rights and social and economic justice” (p. 11). cultural competency can be seen as a more of a continuum of learning (cross, 1988), and embodies a willingness to be a lifelong learner of other cultural and diverse peoples and traditions (saunders, haskins, & vasquez, 2015). we suggest bsw programs incorporate content into their curriculum that a) explores the unique relationship between culture and trauma, b) emphasizes the importance of selfreflexivity and understanding the effect one’s own cultural background has on perception and attitude toward others, and c) frames cultural competency as a lifelong journey of inquiry and personal exploration. courses on diversity, human development, and/or social work practice could all serve as ideal settings for the presentation of such content. advances in social work, spring 2017, 18(1) 13 principle 7: healthy relationships creating an environment that is safe and accepting of clients who have experienced trauma (principle 3) can also enhance feelings of trust and building healthy relationships. traumatic experiences, especially in the cases of physical, emotional, and/or sexual abuse, can have damaging effects on one’s ability to trust others (bath, 2008) and can be especially detrimental to the development of healthy attachment in children (kinniburgh, blaustein, spinazzola, & van der kolk, 2005). developing an environment that promotes honest, transparent, and accepting interactions can act as a model by which clients can begin to practice learning to trust again, which may benefit them when it comes time to repair damaged relationships (elliot et al., 2005; saakvitne, gamble, pearlman, & lev, 2000). social workers also need to be aware of how the effects of trauma and maladaptive forms of coping can affect families and external relationships (conners-burrow et al., 2013). for example, clients who have experienced substantial trauma in their past may have engaged in alcohol and/or illicit substance use and anti-social behaviors as a way of managing their trauma symptoms. as a result, clients may have alienated spouses, children, extended family, and friends, along with potentially damaging professional relationships. to provide effective treatment, social workers in direct service roles may need to assist clients in identifying ways of repairing damaged relationships and helping clients gain more external social supports, a key factor often associated with lower rates of ptsd and better treatment outcomes (han et al., 2014; tarrier & humphreys, 2003; tsai, harpazrotem, pietrzak, & southwick, 2012; vranceanu, hobfoll, & johnson, 2007). bsw programs may want to include or emphasize content in their practice courses on the importance of relationships and social support for clients who have experienced trauma. communication and social skills, including how to model appropriate boundaries should also be included in bsw course content. prescott and colleagues (2008) underscore the importance of providing opportunities for clients to obtain peer support, especially from other clients who have experienced similar traumatic experiences. these interactions can engender opportunities for clients to “gather, educate and organize for action can decrease isolation, generate accountability among the group, increase self-esteem and awareness of how personal experiences of violence and loss fit within a larger socio-political context” (p. 34). the idea of peer support as essential to the recovery from trauma is echoed in numerous trauma-informed frameworks (see bloom & sreedhar, 2008; elliot et al., 2005; sahmsa, 2014). bsw programs may consider including content that emphasizes the importance of the worker-client relationship for both its therapeutic benefit to the client and its ability to serve as a model for future relationships. furthermore, practice courses could provide students methods for modeling specific social skills, which may enhance students’ feelings of selfefficacy when working with clients who have experienced trauma. finally, we recommend providing instruction on the importance of peer support and the need for identifying ways in which organizations can develop or modify existing processes or policies to allow clients to safely interact and provide support to one another. vasquez & boel-studt/integrating tic 14 principle 8: emotional regulation as discussed in principle 1, trauma-affected clients experience a myriad of symptoms, many of which can hinder emotional regulatory capacities. trauma can create a sense of disconnectedness from one’s own emotional experiences (kinniburgh et al., 2005), which can lead trauma survivors to not recognize when they are being triggered and/or experiencing high levels of stress. consequently, the feeling of being emotionally overwhelmed can be perceived as occurring suddenly, which may (and often does) result in individuals engaging in maladaptive responses and/or coping behaviors. furthermore, consistently feeling unsafe and being emotionally overwhelmed can be especially damaging to children’s development (nctsn, 2007). thus, an essential component of trauma recovery includes the development of emotion regulation. the ways in which clients learn to manage stress and cope with negative emotions varies widely across trauma-specific intervention approaches. yet, at the core of these methods are three fundamental goals for emotional self-regulation that includes the development of 1) affect awareness, which is the ability to identify one’s own emotional and physical feelings, 2) affect expression, which is the ability to express negative internal states in a safe and controlled manner, and 3) affect modulation, which is the ability to recognize negative emotional experiences and engage in coping activities that can aid in the return to a comfortable state of arousal (kinniburgh et al., 2005). working to build emotion regulation skills in clients who have experienced trauma, in many service environments, may be seen as an activity that is best suited for graduate-level clinical personnel. in such instances, bsws can act as supporting agents to clinicians by helping to remind and reinforce the use of these skills with their clients. this dual support may enhance the clients’ feelings of safety and support, and may serve to encourage them to engage in more difficult aspects of therapy. however, not every service organization will have clinical staff available, nor may it be the role of the agency to provide direct mental health services. further, bsws often serve in a direct service capacity in agencies providing services to adults and children in group treatment settings, providing remedial or behavioral health services, social skills training, parent education classes, support groups and afterschool or day treatment programs. in these environments, bsws play a direct role in helping clients build emotion regulation and problem-solving skills. therefore, it is recommended that bsw programs provide knowledge and skills on how to build emotion regulation capacities in clients who have experienced trauma. bsw programs may consider including content that reviews benefits of developing emotional regulations skills in clients who have experienced trauma, especially if those clients are actively working toward processing trauma with graduate-level clinicians. practice courses that provide opportunities for in-class demonstrations and role-play practice on skills that can help with emotional regulation may promote a sense of competency for students who plan to work with client populations that have frequent exposure to trauma in their field placements. advances in social work, spring 2017, 18(1) 15 principle 9: self-care trauma education also has relevance to understanding and addressing work-related stress, burnout, and organizational trauma (dane, 2000; trippany, kress, & wilcoxon, 2004). some research findings suggest that trauma education may be of even greater relevance to preparing bachelor’s level social workers for practice. dalton (2001) found that social workers with master’s degrees exhibited lower levels of secondary traumatic stress than bachelor’s level social workers. this difference that may be due to training in graduate programs that includes information on client empowerment, self-care, and recognizing maladaptive processes that may be less emphasized in bsw programs. younger and less experienced social workers may be less skilled in effectively managing work-related stress and more vulnerable to direct and indirect exposure to trauma (neumann & gamble, 1995). it is not uncommon for social workers to work with clients who engage in aggressive and violent behavior or to work in crime-ridden, high risk communities placing them at heightened risk for victimization. yet many organizations do not have formal policies or practices related to dealing with work-related victimization and violence (bureau of labor statistics, 2006). many incidents go unreported due to beliefs that reporting will not be of benefit or fears that an incident will be considered the result of negligence or poor job performance (bloom, 2010). in some organizations, victimization by clients is viewed as part of the job and is a normalized into the culture. students who are knowledgeable in the tenets of trauma-informed care can apply them to assess whether organizational practices and policies ensure physical and emotional safety and employee well-being. providing bsw students with introductory knowledge on the effects of secondary and vicarious trauma can strengthen their ability to recognize the sources, processes, and symptoms associated with trauma. furthermore, educators can help them to work more effectively in organizations by engaging in practice behaviors that contribute to healthy organizational environments, including knowing when and how to practice self-care and provide peer support to co-workers who may be dealing with traumatic stress (bell et al., 2003). in addition to classroom teaching, students can gain experience applying skills during their field placements, for instance, reviewing organizational procedures and policies and assessing them from a trauma-informed perspective. teaching students basic skills they can apply to respond to work-related stress may help reduce burn out, vicarious trauma and symptoms of traumatic stress which, in turn, promotes improved organizational functioning and more effective practice with clients. conclusion the prevalence of traumatization across the general population, the deleterious impact of traumatic exposure, and the high rate of service use among those who have been traumatized, has prompted many schools of social work to start incorporating trauma content into their programing. this can take the form of specialized programs (e.g., ccct), electives, or continuing education courses. these offerings frequently have a clinical emphasis, and are often considered “advanced” or “specialized” trainings. thus, trauma content is most often presented at the msw level. unfortunately, there has yet to be a push for trauma training to be included at the bsw level. the aim of this paper was to present vasquez & boel-studt/integrating tic 16 guiding principles that educators could use to infuse within the generalist perspective of the bsw curriculum. in doing so, we hope to have demonstrated that the scope of traumatic studies does not have be relegated to the presentation of only clinical material. rather, trauma training can include work with individuals, agencies/organizations, and communities. we echo the statement made by courtois and gold (2009): “the territory of trauma practice can only be adequately mastered if training in trauma is grounded in the fundamental and generalist curriculum of a profession” (p. 18). we call for the field of social work to start viewing the study of trauma as spanning both generalist and advanced domains of social work practice. only then will our field be able to provide 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(2010). poly-victimization in a national sample of children and youth. american journal of preventive medicine, 38, 323330. doi: https://doi.org/10.1016/j.amepre.2009.11.012 vrana, s., & lauterbach, d. (1994). prevalence of traumatic events and post‐traumatic psychological symptoms in a nonclinical sample of college students. journal of traumatic stress, 7(2), 289-302. doi: https://doi.org/10.1002/jts.2490070209 vranceanu, a. m., hobfoll, s. e., & johnson, r. j. (2007). child multi-type maltreatment and associated depression and ptsd symptoms: the role of social support and stress. child abuse & neglect, 31(1), 71-84. doi: https://doi.org/10.1016/j.chiabu.2006.04.010 yan, m. c., & wong, y. l. r. (2005). rethinking self-awareness in cultural competence: toward a dialogic self in cross-cultural social work. families in society: the journal of contemporary social services, 86(2), 181-188. doi: https://doi.org/10.1606/10443894.2453 author note: address correspondence to: matthew vasquez, department of social work, university of northern iowa, sabin 235, cedar falls, ia 50614 matthew.vasquez@uni.edu https://doi.org/10.1016/j.amepre.2009.11.012 https://doi.org/10.1002/jts.2490070209 https://doi.org/10.1016/j.chiabu.2006.04.010 https://doi.org/10.1606/1044-3894.2453 https://doi.org/10.1606/1044-3894.2453 mailto:matthew.vasquez@uni.edu ______________________ diane s. vancleave is an assistant professor in the social work department at indiana state university, terre haute, in 47809. copyright © 2016 author vol. 17 no. 2 (fall 2016), 369-389, doi:10.18060/21087 contributions of neuroscience to a new empathy epistemology: implications for developmental training diane s. vancleave abstract: the difficulty in comprehending the epistemology of empathy lies in shifting paradigms which have resulted in empathy being viewed as vague and elusive. such elusive understanding of empathy has confused research, practice, and advancement of therapeutic principles. empathy is the core of all social and intellectual transformation. humankind is biologically programmed to use empathy for survival, health, and wellbeing. pursuing and understanding empathy frees human capacity for wisdom. studying the epistemology of empathy is operationally and scientifically relevant in the synthesis of an empathic practice theory. clear epistemic definition and neuroscience provide the foundation for an expanding discovery of rational frameworks for a clinician’s empathic training and teaching. a clinician’s empathic ability requires competency in reflective, global, affective, cognitive, and interpersonal perspective-taking. once understood, renewed curriculum for teaching and training are recommended that would produce more finite outcomes. epistemic review culminates in empathy skills training over the course of curricula at the undergraduate (bsw) and graduate (msw) levels. keywords: empathy; neuroscience; teaching; perspective-taking some therapists see empathy in human relationships as elemental to survival, to relationship, to physiological well-being, and to therapeutic success (norcross, 2011). if empathy is so necessary to human survival, why the apparent lack of urgency in understanding, analyzing, and developing effective training models? this article provides an epistemic review of literature on empathy to argue for better training. an effective study of empathy should first include an examination of viable empathy definitions which are congruent with contemporary social work practice philosophies. current discoveries in neuroscience have lent clinical legitimacy, supporting empathy as a powerful tool within social work practice. neuroscience, rogerian philosophy, therapeutic practice, and humanism provide epistemic proofs of empathy (e.g., carkhuff, 1984; davis, 1980; decety, 2010; decruz, boudry, desmedt, & blancke, 2011; gerdes & segal, 2011; rogers, 1975, 2003). the plan for this analysis is to consider what is already known about empathy and its place in therapeutic skill development. contradictions early empathy studies have diverged into debates over nature versus nurture, cognition versus affect, and interpersonal versus intrapersonal dualities (chambers & davis, 2012; dvash & shamay-tsoory, 2014). advances in neuroscience, research findings, and reexamination of historical touchpoints lead to a more contemporary and broader understanding of empathy (bal & veltkamp, 2013; rogers, 1975). empathy has a primary advances in social work, fall 2016, 17(2) 370 role in brain function and thus survival, involving extensive interplay between affective and cognitive regions of the brain. historical touchpoints carl rogers has been the social work standard-bearer for empathy application. rogers (1951/2003) offered early philosophies on empathy as a part of humanism that supported growth and transformation through genuine, positive regard. at the end of his professional career rogers (1975) attempted to articulate a more finite definition of empathy that conveyed empathy’s precise process of substance and meaning. in 1975, rogers clarified empathy as an action of the therapist’s voluntarily surrendering into another’s perceptual world with the sensitivity to experience emotions of the other, moment by moment, without succumbing to the emotion or judgment of the other. during this action process, the therapist is able to move the client from a discovery of meaning to a fuller experience (gendlin, 1962; gerdes, segal, & lietz, 2010; rogers, 1975). interestingly, rogers saw the process of this empathy interaction as a growth experience, not only for the client, but for the social work clinician as well (gerdes & segal, 2011). nature versus nurture if nature and nurture work in concert, innate precipitators are likely to be present to activate the nurturing desire for an empathic response (gerdes & segal, 2011). motivation, drive, creativity, imagination, and reflective/reflexive processes act to prod the subject to move into empathy and would be activated in certain activity (erez & isen, 2002; gerdes & segal, 2011; kasapi & mihiotis, 2014; lachmann, 2008; yaniv, 2012). affirming the nature/nurture connection, studies have shown significance for increased perspective taking and empathic concern (altruistic compassion) when watching films (gerdes, segal, jackson, & mullins, 2011; martin et al., 2015). additionally, reading fiction has resulted in significant transformation in empathic fantasy development (bal & veltkamp, 2013). empathy, as more than simply promoting compassion, aids in increasing intelligence (dearing & steadman, 2009; gardner, 2006). gardner (2006) connected empathic intelligence/wisdom to interpersonal, intrapersonal, logic, kinetic, linguistic, spatial, and naturalistic experience. as an example, gardner (2006) identified musical intelligence as a valuable empathy outcome. operational empathy empathy has shown that it can be operationalized, making it research testable. davis (1980) divided empathy into component parts: perspective-taking, empathic concern, empathic distress, and fantasy (davis & hayes, 2011). the davis interpersonal reactivity index (iri) has become one standard measure that can evaluate these empathy components (chambers & davis, 2012; davis, 1980). empathic films and discussion have been instruments of measure for empathic concern and perspective-taking. vancleave./empathy epistemology 371 intrinsic empathy decety (2010) defined empathy intrinsically: internalizing observed feelings of others (mirroring), imagining another’s feelings, and recognizing separate feelings of the self and of another. rogers (1975) identified this as the ability to hold one’s own emotions while experiencing the emotions of the other. miehls and moffatt (2000), both practicing social workers, challenged clinicians not to withhold their affective sharing from the client. according to miehls and moffatt, unrestrained interactions could bring a new transparency to session work and elevate treatment outcomes. in open exchange, social work students must learn the nuanced balance between compassionate sympathy and immobilizing empathy (nilsson, 2014). clinicians need to be in touch with their own defenses, resistance, and flaws. the new paradigm of empathy over the years, numerous social workers have developed a definition of empathy to fit their own experience. these multi-layers of contribution show the difficulty in forwarding a workable definition. empathy is the central core of social work and cannot be ignored. the nature, belief, rationale, scope, and justification in an epistemic review of empathy affirm the power of empathy (juliusdottir, 2006). a working definition of empathy has emerged from this discussion. rogers’ (1975) definition of empathy affixes the process of substance and meaning, with the social worker voluntarily surrendering into another’s perceptual world. empathy types include cognition, affect, and interpersonal exchange. davis (1980) and decety (2010) identified empathy components as perspective-taking, empathic concern, distress, and fantasy—with decety’s inclusion of the intrinsic qualities. practice/skill behaviors of use to social work are compassion empathy, empathy-responding, intellectual empathy, and empathy discrimination (dearing & steadman, 2009; linker, 2011; vancleave, 2007). capacities associated with high levels of empathy are intuition, openness, insight, motivation, creativity, and interpersonal skills (buckman et al., 2011; smith, 2012). the neuroscience ledoux (2002) has contended that biology has now affirmed empathy. as the human species, we had to be able to use our neural circuitry (our intellect and our affect) in concert to create social and protective groups which would guarantee individual and group survival. if our thoughts and feelings did not work in tandem, then mother-child bonds would not have been formed. infants would have been exposed to certain death. we would not have been able to draw together in groups and communities to survive threats and dangers. nurturing, care, innovation, translations of joy, conveyed history, and resourcefulness would have been nonexistent, and the human species would have faded from the earth. a well-orchestrated blending of feeling and thought exists within cognitive systems that have evolutionary threads connecting to primal survival. to achieve a complex coexistence between the cognitive and the affective, the brain developed an affective system called the limbic system (decety & svetlova, 2012). the limbic system functions as a connection between the primitive portion of the brain and the advances in social work, fall 2016, 17(2) 372 higher-ordered neocortex. there is an interplay between brain systems dedicated to empathy. the limbic system (affect) projects to the anterior cingulate cortex (cognitive) to assist in regulation and decision-making from the emotional data (decety & svetlova, 2012). neuroscience has provided proof that the intellect/affect connection exists. specific brain structures are responsible for sensory perception of facial stimuli and language processing, directly impacting empathy (gu, hof, friston, & fan, 2013; marcum, 2013). brain imaging has identified self-correcting centers for empathy assessment and accuracy (shamay-tsoory, 2015). affective brain systems stimulate corresponding cognitive processes. the density of gray matter regulates levels of cognitive and affective empathy (eres, decety, louis, & molenberghs, 2015). greater density in one region enhances cognitive empathy; greater density in another region of the gyrus affects perspective-taking (chambers & davis, 2012). eres and colleagues (2015) surmised that density composition (in either the affective or cognitive regions) was altered (made more or less dense) with empathy practice. empathy’s neuroscience connection to intellect the social world has required a willingness and an ability to share cognitive experience within an affective state (gerdes & segal, 2011; ong, zaki, & goodman, 2015). the ability to understand the world rests in integrating and sharing in the other’s emotional states (decety, 2010). a full command of empathy intelligence is then elemental for interactive relationship with another (gardner, 2006). from an evolutionary perspective, success and survival in full participation with the world is necessary for social protection, effective social integration, and social bonding (decety & svetlova, 2012; mutschler, reinbold, wankerl, seifritz, & ball, 2013). without access to empathy, there are no intellectual resources to draw upon for basic decision-making, calculating others’ responses, and communication with another. visceral cues from emotions have affirmed decision-making (lehrer, 2010). the recent discovery of mirror neurons as visceral cues has explained the transfer of skills from generation to generation. in addition, while watching another feel pain, the mirror neurons fire, creating a sense of that feeling of pain (lehrer, 2010). mirror neurons have also explained a heightened identification with skill-building as one observes another completing tasks (martin et al., 2015). while equipped with mirror neurons from birth, modeling is required from parental figures to ingrain prosocial behaviors that occur in the infant at about 14 months of age (aksan & kochanska, 2005). it takes modeling or nurturance to bring prosocial behaviors forward. neurochemical link the role of well-placed neurotransmitters is elemental in the development of relationships. bonds and relationships are established and maintained with the help of enkeuphalin (encephalin) and dopamine (decety & svetlova, 2012). these reward pathways additionally influence affiliative and bonding behaviors. social contacts mediated by these opioids are the glue of social interaction (decety & svetlova, 2012). the vancleave./empathy epistemology 373 effect of initiating empathy-responding activates prosocial behavior, like the hormonally induced desire toward altruism. in therapeutic practice, this combination of hormones may drive clinicians to greater competency with their clients. for the clinical social worker, transmitting empathy in session releases endorphins— giving the social worker pleasure (grant, 2014; loyola, 2016; pavey, greitemeyer, & sparks, 2012). from the perspective of a helpful professional, both client and social worker are nurtured and transformed as the result of interpersonal processes (cialdini, schaller, houlihan, & beaman, 1991; welp & brown, 2013). therefore, interpersonal exchange, for both client and therapist, fosters resilience, trust, healing, personal growth, creativity, and learning from the nourishment of therapeutic exchange (morelli, leiberman, & zaki, 2015). the social worker is genuinely using self as a conduit in transforming conflict, in collaborative action, with the expectation of positive individual change. proof of the importance of these transmitters is exemplified by the biochemical link of oxytocin to compassion (decety & svetlova, 2012). oxytocin has many therapeutic purposes, such as increased bonding when identifying with someone in pain (abu-akel, palgi, klein, decety, & shamay-tsoory, 2014). oxytocin and dopamine can act together where bonding creates a preference for social interaction with another. oxytocin may be a trust hormone that is the foundation for empathy (barraza & zak, 2009). this trust also implies empathy-responding that builds into addictive patterns and a subsequent greater need for bonding and deeper interpersonal connection between therapist and client. developmental empathy the biologic legitimacy of empathy and morality have a presence in the developmental process of the human experience, even from birth. that interpersonal practice begins in infancy, with the discovery that crying induces holding, hugging, and an expression of bonding with the caregiver (spinrad & stifter, 2006). however, social functioning of empathy as a cognitive function presents beyond the age of 10 years, when the child is developmentally able to initiate interpersonal exchange (decety, 2010). empathy development typically grows with modeled empathy, inducing a greater desire to react in a manner that reinforces an empathy response from others. when developmental empathy modeling and bonding are not present in childhood, creative and empathic induction can occur in a psychodramatic session (yaniv, 2012). a psychodramatic concept, like role reversal, can be introduced as suspension of disbelief or a role-play experience (holland, 2003). in this state, what was not integrated into childhood experience may be integrated into the adult mind at the time of the psychodrama session. the creativity of more complete role-taking (such as in a psychodramatic experience) may enhance the ability to more fully receive empathic responses. empathy responding the use of the reflective and reflexive self in therapy has provided more meaningful opportunities for therapeutic advancement and growth (hieker & huffington, 2005). there has been an expectation in social work that these reflections would be more authentic and clearly understood. the applications of systemic reflexivity in practice have created greater advances in social work, fall 2016, 17(2) 374 intimacy and a fuller client response in the therapist and client relationship. at the same time, isolating factors like cell phone technology have encouraged separation in social relationships (przybylski & weinstein, 2013). common barriers to effective empathic exchange have included failure to clarify, inattention, false assumptions, or anticipating the other is using stereotypical screens (compton, galaway, & cournover, 2005). mastering the mechanics of the communication process has been a pivotal point in the conveyance of empathic responding. the ability to integrate and synthesize cues, sense the client, connect one's internal self without getting lost in the other, and then be able to make an advanced empathic response has typically required a special mastery. as with all in-themoment therapies, there needs to be a willing suspension of one’s own filters and disbelief (holland, 2003). the client, or student, has to be willing to let go and trust the therapist. integration of more contemporary understanding about introspective empathy has called for broadened perspectives while maintaining an internal locus of control (kohut, 1978; wagaman, geiger, shockley, & segal, 2015). the social worker must have the courage to go with the client in order for the client to fully process and fully receive that interchange (sinclair & monk, 2005). the key to empathy over sympathy is a compassionate connection rather than a feeling of pity or loss of self. the misunderstanding about how to use the reflexive self has led social workers to be affectively restrained and less able to align in full interaction with the client. such traditional practice philosophies are in dissonance with interactive relationships that should rightfully place the social worker as a collaborative equal with the client. sociologists hold a balanced systemic view of empathy and its function. when keltner, smith, and marsh (2010) examined the degree of caring and donation from rich versus poor study participants, an interesting outcome occurred. the keltner team found both groups possessed the same ability toward a caring temperament. the sociologists posited that being rich or poor was not the causal factor of increased empathy. in order to solicit an empathic response, an individual had to have been exposed to recent acts of altruism. without that practiced experience, the respondent tended to focus on self-serving and selfinterest stimuli. therefore, the more people practice or observe empathy, the more empathic they can become (wagaman et al., 2015). in the discipline of social work, theorists have wrestled with whether empathy is innate (buckman, tulskey, & rodin, 2011; chambers & davis, 2012). if empathy theorists have won the argument that empathy is solely genetic, then there would be no reason for social work clinicians to be actively practicing more enlightened empathic approaches. however, there are multiple examples of training modules for empathy and critical thinking development, which have demonstrated efficacy (e.g., carkuff, 2009; dearing & steadman, 2009; linker, 2011). with neuroscience discoveries, theorists do now view empathy to be both natural and nurtured. in order to discern if empathy is present, the easiest manner is through observation of an interpersonal exchange between a sender and a receiver (jemczura, 2004). paul (1993) reported that another’s empathy experience must be observed to be understood. the observer, therefore, must be fully present to observe and hear the sender. being fully aware and fully present, the receiver can begin the process of a fair-minded assessment about the vancleave./empathy epistemology 375 truths of the sender, through the process of critical thinking. how empathy is felt in the sender/receiver exchange depends on the orientation of the receiver (blandul, 2015). there is evidence that empathy can be received from a left-brained or right-brained orientation of the receiver. neuroscience indicates factors like gender may predict whether empathy is processed as an affect function or as a cognitive function, based upon left-brained or rightbrained orientation (field, 2014). cognitive empathy presents more prevalently in males; affective empathy presents more prevalently in females (christov-moore et al., 2014). in examination of interpersonal exchange, the analysis must look beyond the messages of the sender and receiver to consider awareness, presence, listening, and orientation. empathy’s influence on learning according to neuroscientist immordino-yang (2016), social emotions shape the way learning occurs. the conductivity across the brain network affects complexity, integration, and social functioning within the world. thus, a social worker’s therapeutic empathy is more complex than simple reflection, acts of altruism, displays of imagination, or the ability to reflect (sperry, carlson, & kjos, 2002). therapeutic empathy is respectful of the client’s strengths and vulnerabilities and qualitatively adds to the client’s verbal and nonverbal messages. our socio-cultural environment causes us to feel the implications across the same pathways that keep all human-kind alive—that we are more alike than different from one another. in brain-mapping, observations indicate that feeling alive causes the individual to strive and to share a sense of determination (parvizi, rangarajan, shirer, desai, & greicius 2013). the rational mind must continue to call upon subtle emotional data to assist in the everyday routine of basic decision-making (lehrer, 2010). there cannot be a splitting or separation over the importance of both thinking and feeling; it is indispensable to have emotion to produce sound reason (demasio, 1994; ledoux, 2002). emotional intelligence and its connection to the rational mind while the limbic system is the center of our emotional regulation, it continually processes commands from the neocortex, which instructs emotions to activate. however, the limbic emotional regulator is also responsible for our intellectual health. learning research has indicated the best problem-solvers are those who have the ability to laugh, thus showing a connection between the affective and rational brain (ruben, 2015. neuroscience may hold macro-solutions to global conflicts. an interesting study using a double-blind placebo-controlled within-subject crossover design asked jewish israeli participants to report empathy to pain responses for jewish israeli participants, europeans, and then palestinians (shamay-tsoory et al., 2013). the natural experiment revealed that increases in oxytocin resulted in reduction of bias over controls. as a result of the increased oxytocin, the respondents indicated higher levels of empathic connection and compassion for their palestinian adversaries. rosenberg (2015) developed a strategy for nonviolence in communication that has also shown success with large diverse populations. intellectual empathy considers social responsibility to others and has ties to social justice (dearing & steadman, 2009; linker, 2011). advances in social work, fall 2016, 17(2) 376 a call for greater therapeutic competency a therapist’s empathic ability has been considered a fundamental element for recipient change within the therapeutic setting (elliott, bohart, watson, & greenberg, 2011; larson & yao, 2005). core therapist characteristics for optimum empathic response include active listening, good reflective qualities, imagination, risk-taking, altruistic motivation, and the ability to be vulnerable (eres & isen, 2002; gerdes & segal, 2011). smith (2012) interpreted this as the fundamental ability to intuitively discern how another person would feel in a given situation. the social worker can then use empathy in interpersonal response to convey meaning, feeling, thinking, and content (compton et al., 2005). without the proliferation of empathy research, training, definition, and literature, a social worker’s empathic ability is still considered only as instinctively understood (elliott et al., 2011). in a self-assessment study, undergraduate students reported a need for empathy training in the classroom but also felt discussions from personal experience were a better strategy than only instructor prepared materials (ruben, 2015; zaleski et al., 2015). professors solicited in the same study felt the classroom was exactly the place for expanding personal experiences by adding cultural characteristics that enhanced empathy integration. the initial difficulty for instructors was having all students absorbing the same degree of interpersonal empathy with the same degree of true integrated learning. the professors continued to observe a lack of clear techniques for teaching empathy that achieve good learning outcomes. ruben (2015) concluded that mixed impressions remain about how to discern empathic properties. grant, kinman, and baker (2013) conducted a mixed design study to evaluate types of curriculum necessary for social work students experiencing empathic distress. resiliency training was initiated for undergraduate social work students to address affective sharing and empathic distress. curriculums included lectures and workshops over a 4-year period, covering mindfulness, stress, irrational beliefs, and reflective supervision to improve practice skills. savageau (2014) discovered that deliberate training specific to mindfulness by the social worker increased self-compassion and protective resiliency against anxiety, depression, and burnout. practicing within that empathic proficiency, selfawareness and perspective-taking can be engaged to understand the world of the other (stanley & bhuvaneswari, 2016). need for a consistent training protocol despite considerable evidence of empathy’s legitimacy, methods for enhancing a therapist’s empathic response have not been codified within the literature (ming lam, kolomitro, & alamprambil, 2011). studies offer differing conceptualizations of empathy, combine experimental and non-experimental data, may lack a standardized measurement tool, or are limited to narrative review. the absence of contemporary empirical proofs in training to increase empathic responses and strategies has contributed to decreased reliance upon that skill in favor of diagnosis and psychopathology. techniques for empathy training need to employ tested approaches (chambers & davis, 2012). codifying such training techniques would reinforce empathy’s potency in the therapeutic world. vancleave./empathy epistemology 377 a training model a selection of a training model might focus on perspective taking, which is amenable to an empathy training model developed by carkhuff (2009): human resource development training (hrd). carkhuff was a protégé of rogers’ and sought to take empathy farther into measurability and into response training (braizer, 1996). in the training process, students are exposed to practice strategies reported to improve empathy for perspective-taking and empathic concern (chambers & davis, 2012; freedburg & vittorio, 2007). the hrd teaching model dissects the interaction between giver and receiver. the outcome of hrd training is to assist the helper/giver to elevate the participant/receiver to respond competently with the highest level of empathic response. hrd training challenges the social worker to be aware of emotion and thought while integrating perspective-taking, empathic concern (compassion), accurate description of distress (another’s pain), and fantasy (chambers & davis, 2012; davis & hayes, 2011). empathic origins and acquisition. imagination, motivation, and vulnerability have been linked to internal drives, instincts, and aptitudes that inspire individual empathic development (decety & cowell, 2016; erez & isen, 2002; gerdes & segal, 2011). active listening has often been credited as the competency necessary for the discernment of empathy discrimination—a clinician’s discernment of the emotive depth of a client’s verbalization. the ability to verbally respond in an empathic manner has been a skill more difficult to achieve than simple discriminatory identification or active listening. these responses have been conveyed as encoded and decoded messages between the sender and the receiver. encoding and decoding phases have always been vulnerable to distortions and barriers that interfere with the communication process. trevithick et al. (2004) challenged that classrooms may not be the appropriate environment for teaching empathic responding. the assumption is that socratic styles are not compatible with empathy development. to support this, one study observed that physician empathy tended to decrease as the physician became more professionally educated (dehning et al., 2013). actual interpersonal exchange benefits were confirmed in a study of weight loss for diabetic patients, and empathy practiced in an actual setting brought better client outcomes (canale et al., 2012). social work practitioners similarly achieve more effective client outcomes when they are empathically competent (gerdes & segal, 2011). this competency has been proven achievable in simulated and role-played activities (chen, kiersma, yehle, & plake, 2015; goldstein & winner, 2012). carkhuff (1984) offered that those without academic training may be better equipped to teach others empathic responding and discrimination because socratic instructors lacked the necessary flexibility and imagination. however, carkhuff also proposed that a training instructor needed to be experienced to achieve a certain level of empathic accuracy in order to therapeutically match the client for thought and feeling. carkhuff’s 5-point communication discrimination scale has directed the clinician to be empathically qualified up to two levels beyond a therapeutic reciprocal response (carkhuff, 1984). the carkhuff training model has demonstrated significant outcomes in evaluating empathy responses from master’s level social work students (vancleave, 2007). to be qualified for academic and instruction, the trainer would have to be innovative, comprehensive, and theoretically advances in social work, fall 2016, 17(2) 378 grounded (yochly & britto, 2012). yochly and britto (2012) supported introduction of novel ways of teaching that went beyond lecture and textbook instruction. training that promotes insight and skill development is consistent with disciplines such as social work where the mission of the profession is to legitimize therapeutic strategies that promote the flexibility, creativity, and innovation necessary for client growth and development (national association of social workers, 1999). empathy and other disciplines. much of what has been written about empathy training and development has come from the fields of medicine, business, and education (larson & yao, 2005). physicians were found to develop empathy in the presence of role models and experiential opportunities, rather than through socratic exposure (marcum, 2013). further, the use of empathic measures in criminal justice and in court case observations has gained credibility (crawley & suarez, 2016). unfortunately, laboratory learning of communication skills has not translated well into field practice. as a prosocial skill, empathy promotes open-mindedness, encourages flexibility, promotes creativity and novelty, and discourages rigidity in thought. studies have affirmed that empathy and learning are intrinsically tied (leece, caputi, & capnin, 2014). therefore, introduced as a learning tool, empathy training should be compatible with field placement learning experiences. contemporary instruction on nursing ethics recognizes the fundamental necessity to teach empathy and charges that the lack of empathy training is a violation of the nursing ethic for best treatment (mcmillian, 2010). a recent study into empathy of the nursing profession revealed that, after a year of professional training, undergraduate nurses showed significant declines in empathy (ward, cody, schaal, & hojat, 2015). social work students have experienced a similar decline within master’s programming (routh, 2005; wallman, 1980). scant research has been available on specific social work training in empathic development (savageau, 2014). professional development research has shown that current education and training programs in social work have not provided the specialized training required in communication and interpersonal relationships. only anecdotal study has been conducted on the use of psychotherapy to facilitate empathy development (e.g., jemczura, 2005). few universities offer full courses on the advancement of clinician empathy. one study asked practicing social workers about learning experiences that forwarded their empathy development beyond the classroom (savageau, 2014). the top responses included “listening, understanding, natural ability, empathy training, practice, reading about empathy, and spirituality” (pp. 63-64). an expansive training model for clinical empathic response would have to offer a blend of behavioral, cognitive (didactic), and experiential exercises that were cognitively, affectively, and interpersonally blended. this training should be testable to enhance the validity and generalizability of the model (ming lam et al., 2011). vancleave./empathy epistemology 379 the importance of knowing what aspect of empathy is being introduced to assist in proper training activities. because of the range of therapeutic activities, it is necessary to know what aspects of empathy need to be introduced for what effect. is the technique to develop trust, fantasy, perspective-taking, distress, concern, or intrinsic identification or to prepare the student for empathic insight and learning (davis & hayes, 2011; decety, 2010)? the most current studies emphasize internalized empathy, allowing the client/student to feel empathy through systematic exposure and discussion of films. humor has been tagged with the ability of enhancing empathy and also mediating distress through perspective-change (hampes, 2016). research revealed humor through joke-telling had the potential to change perspective through tension reduction and elevation of mood (niculesu, van dijk, nijholt, li, & lan, 2013). lachmann (2008) has called the connection between humor, empathy, and creativity transformational. transformative learning allows the interaction from the client and therapist to move from the distant to the intimate (bal & veltkamp, 2013; lachmann, 2008). this is a similar technique to non-dominant hand-writing. the effect is to confuse the brain and open the person to new creativity. creativity, as displayed in acting and role-play, also enhances empathy (goldstein & winner, 2012). simulation has been shown to teach empathy (chen et al., 2015). additionally, mindfulness techniques have the capacity for elevating empathy awareness (grant, 2014; van lutterveld et al., 2016). narrative journaling has also been widely utilized for increased perspective-taking (smith, 2009). at the macro-level, social work has a natural tendency to align with belief, policies, and opinions that disenfranchise others (segal & wagaman, 2015). segal supported the benefits of teaching social work students the aspects of social empathy, which presents compassion for broader empathy perspectives and allows for more generalized acceptance of differing political perspectives. virtual reality has been shown to create compassionate empathy by placing the participant more fully in the scene (dave, 2015). the study of empathy could be improved by discovering the determinants that make classroom-based exercises progressive and useful. learning mediums could include role-play, social skill building, emotional connection with another allowing for interpersonal intelligence building, and a sense of community loyalty to foster responsibility, self-control, and cooperation (briggs, 2014). toward a more empathic way of being for the classroom engagement. rogers (2003) was so aware of the benefits of his client-centered therapy that he took a similar student-centered approach in the classroom. the supportive therapeutic framework from social work has applicability to the student learning environment (tenenbaum, 1959). in the classroom, the ability to use multiple teaching approaches provides variety and may include experiential opportunities (gardner, 2006). the experiential do-think-read application promotes creativity and openness to learning that increases attention and transformation. the scope of this curriculum considers the infusion of these activities within courses throughout the bsw and msw learning experience. empathy curriculum should develop in graduated complexity and align with advances in social work, fall 2016, 17(2) 380 other competencies, like the development of critical thinking, analysis of ethical dilemmas, cultural and diversity sensitivity, and professional practice behaviors (kessen & turner, 2012). the instructor needs to be empathically proficient to model and provide activities that teach prosocial behaviors. faculty will need to practice empathy within their own departments for modeling and continued proficiency. assessment of students’ level of empathy competency. assessing the student’s empathy skill readiness would be the first task and consistent with the planned change model and the critical thinking conceptualization (beaumont, 2010; dearing & steadman, 2009; kirst-ashman, 2012). training modules would need to build from knowledge, to values clarification, and to skill-building as determined by the level of assessed readiness. the knowledge component would consider operationalized empathy definitions and characteristics. the values component would explore characteristics and expanded vocabulary for feelings. recognition of facial expressions could complete the assessment portion of empathy identification. implementation of advanced skill-building would follow. options for empathy training include infusing it into another course, presenting it as a continuing education opportunity, or developing an entire course on empathy. implementation/application of the plan. empathy curriculum could be determined after identifying (a) the skill sets to be taught, (b) the number of training hours available, and (c) the applicability of what needs to be learned by a given student. adjustments can be made to take-home assignments to individualize training. perspective-taking exercises could include cognitive training, like hrd (carkhuff, 2009), empathic films, virtual reality videos, storytelling, role-play, labs, simulations, interdisciplinary simulation and advocacy, support/conversation groups, and community service (jemczura, 2005; marcum, 2013; yaniv, 2012). suspension of disbelief (fantasy) exercises could include laughter, humor, reenactment, imagination, play therapies, and psychodrama (lachmann, 2008). the five components of empathy to could be separated into five distinct modules. empathic distress could be taught using testimonials, documentaries, affirmation and reduction exercises, music, and singing (greenberg, renfrow, & baron-cohen, 2015). perspective-taking would focus upon interpersonal exchange activities (yaniv, 2012). empathy concern might include oxytocin activation through warm temperatures, touch, and massages. oxytocin medication is available but is not as effective as non-medical strategies. empathic concern can also be produced by encouragement to give monetary donations (abu-akel et al., 2014; barraza & zak, 2009; decety & cowell, 2015). fantasy development could occur in reading fiction, reenactments of fairy tales (lachmann, 2008 intrinsic empathy activities could include activities like yoga, meditation, mindfulness, and reflective journals (decety, 2010; grant, 2014). more structured training manuals are available on reliable websites (e.g., butters, 2010). evaluation. the outcomes of empathy competency could be evaluated with the grading system, within practice behavior rubrics, with a preand post-class survey, or with tools like those provided by davis (1980), carkhuff (2009), or evaluations from structured training manuals. if empathy activities are planned throughout the coursework, there is a greater likelihood that students will incorporate empathy practice into their professional settings. vancleave./empathy epistemology 381 closure. wrap-up and closure would always be beneficial in module training, as it gives time to reinforce training, complete post assessments, and offer opportunities for student closure, with follow-up recommendations to encourage the student(s) to continue empathy practice. trainers should consider post-graduation follow-up and refresher workshops to reinforce the training (ming lam et al., 2011). class discussion of post-class synthesis of empathy learning would be a productive use of closure (beaumont, 2010). recommendation empathy has transformational qualities, and there are systematic methods for empathy training. it is recommended that schools of social work infuse empathy training in master of social work courses that incorporate fantasy, empathic concern, perspective-taking, empathic distress, and intrinsic components into curricula. it is important to generate evidence-based outcomes that support empathy as a social work competency. references abu-akel, a., palgi, s., klein, e., decety, j., & shamay-tsoory, s. g. 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(2015). usc study feels out empathy in students, by s. shin, uscnews. retrieved from https://news.usc.edu/82898/usc-study-feels-out-empathy-in-students/ author note: address correspondence to: diane s. vancleave, department of social work, indiana state university, room 421, 749 chestnut street, terre haute, in 47809, 812-237-3388, diane.vancleave@indstate.edu https://doi.org/10.1016/j.neuroimage.2016.02.047 https://doi.org/10.1093/sw/swv014 http://dx.doi.org/10.1016/j.profnurs.2011.10.007 https://doi.org/10.1080/17439760.2013.831465 http://dx.doi.org/10.1037/a0026580 https://doi.org/10.1037/a0030721 https://news.usc.edu/82898/usc-study-feels-out-empathy-in-students/ mailto:diane.vancleave@indstate.edu this work is licensed under a creative commons attribution 4.0 international license. teaching trauma: a model for introducing traumatic materials in the classroom jessica d. cless briana s. nelson goff abstract: university courses in disciplines such as social work, family studies, humanities, and other areas often use classroom materials that contain traumatic material (barlow & becker-blease, 2012). while many recommendations based on trauma theory exist for instructors at the university level, these are often made in the context of clinical training programs, rather than at the undergraduate level across disciplines. furthermore, no organized model exists to aid instructors in developing a trauma-informed pedagogy for teaching courses on traumatic stress, violence, and other topics that may pose a risk for secondary traumatic stress in the classroom (kostouros, 2008). this paper seeks to bridge the gap between trauma theory and implementation of sensitive content in classrooms of higher education, and presents a model of trauma-informed teaching that was developed in the context of an undergraduate trauma studies program. implications and future directions for research in the area of trauma-informed university classrooms are discussed. keywords: trauma-informed; teaching; higher education since the events of september 11, 2001, interest in courses on trauma and traumatic stress has spiked at universities across the country (smith, 2002). while directly learning about trauma often occurs at the graduate level and in clinical programs of study, many disciplines outside of social work, human services, and clinical training programs also interact with materials and curriculum that involve trauma (barlow & becker-blease, 2012). for example, courses related to humanities, literature, art, and journalism often make use of films, readings, video clips, and guest speaker lectures which contain elements of traumatic experiences that may or may not trigger the students’ own personal experiences (dufresne, 2004; dworznik & grubb, 2007). college and university professors have shared a variety of reasons for incorporating this type of trauma-related material into their classrooms, such as to prepare students for real-life situations they may encounter in the workforce, increase understanding of sociopolitical issues, or give life to boring topics or stories (kostouros, 2008). using this material in a classroom to promote student learning and engagement may be positive; however, it is not without some risk. persons interacting with traumatic material may be at risk for secondary traumatic stress, also sometimes referred to as vicarious traumatization (kostouros, 2008). while trauma-informed (bath, 2008) may have become somewhat of a buzzword in recent culture, it represents a crucial piece of implementing prevention and intervention services for individuals and families. according to fallot and harris (2009), a culture of trauma-informed care is rooted in the values of safety, trustworthiness, choice, collaboration, and empowerment. while gaining an understanding of the effects of trauma _______________ jessica d. cless, m.s., lmft, is a graduate teaching assistant, school of family studies and human services, college of human ecology, kansas state university, manhattan, ks 66506-1403. briana s. nelson goff, phd, is professor, family studies and human services, college of human ecology, kansas state university, manhattan, ks 66506-1403. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 25-38, doi: 10.18060/21177 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 26 may be a first step to creating a culture of trauma-informed care, it is also crucial to shift patterns of thinking and behaviors that embrace this understanding (harris & fallot, 2001). the term “trauma-informed” has been most commonly applied to settings such as medical and mental health as well as prevention and intervention programs; less has been done to develop trauma-informed practices in classroom settings, especially in higher education. recent recommendations for creation of trauma-informed systems have included providing education regarding traumatic stress for all professionals who may work with children and families (ko et al., 2008), seeking to expand trauma-informed practice from its previous focus on mental health and medical practitioners. the current proposed model for trauma-informed teaching aims to begin to address the current gap for implementing trauma-informed teaching practices in higher education. literature review student exposure to trauma primary exposure to trauma and diagnoses of trauma and stressor related disorders (see american psychiatric association [apa], 2013) may increase the risk for students to experience adverse reactions to course materials in classrooms that introduce traumatic materials (cunningham, 2004). traumatic experiences have been shown to be prevalent in both the general population (chapman et al., 2012; finkelhor, turner, ormrod, & hamby, 2009; kilpatrick et al., 2013; lukaschek et al., 2013) as well as populations of undergraduate students (bernat, ronfeldt, calhoun, & arias, 1998; frazier et al., 2009). a recent study found approximately 85% of students reported having experienced at least one traumatic event in their lifetime and 21% of students reported having experienced a trauma while in college (frazier et al., 2009). furthermore, specific types of students may be especially at-risk for having been exposed to trauma, such as veteran populations (ackerman, diramio, & mitchell, 2009) and female students (read, ouimette, white, colder, & farrow, 2011). veteran students represent an important population of college students that may have a history of trauma exposure. one study found a diagnosis of ptsd in veteran college students of oif and oef was associated with more problem drinking and physical aggression with others (widome et al., 2011). active duty and veteran service member students are more likely to have symptoms of posttraumatic stress than civilian students (barry, whiteman, & macdermid wadsworth, 2012), furthering the need for traumainformed classroom practices. recommendations have been made to universities regarding veteran student care and support, such as building awareness of veteran issues and creating external partnerships with military organizations (rumann & hamrick, 2009) and creating a veteran-friendly climate through creating student veteran organizations and campus offices meant to address the needs of veterans (o’herrin, 2011). these recommendations are meant to address the veteran student population as a whole on college campuses, however specific university faculty should also recognize how course content may affect veterans in the classroom. cless & goff/teaching trauma 27 risk and protective factors while exposure to trauma should not be a barrier to students participating in education that includes trauma-related materials, in consideration of the high prevalence of trauma exposure, instructors should be mindful in introducing these materials in a classroom setting. it may also be helpful for instructors to be aware of risk and protective factors that may mitigate risk of reactivity after exposure to trauma has occurred. trauma-exposure does not equate to traumatization (bonanno, 2005) or a certain diagnosis of ptsd (yehuda & flory, 2007); however, those who qualify for a ptsd diagnosis can be seen as more “reactive” or affected by the trauma. according to a 2000 meta-analysis, risk factors for ptsd include female gender, minority race, younger age, lower levels of education, previous trauma history, and childhood adversity (brewin, andrews, & valentine, 2000). certain personality traits, such as neuroticism, have also been shown to increase risk for ptsd (lauterbach & vrana, 2001). factors such as social support, optimism, cognitive flexibility, and active coping such as problem-solving and learning to face fears have been identified as protective against traumatic stress (haglund, cooper, southwick, & charney, 2007; schumm, briggs-phillips, & hobfoll, 2006). severity of the trauma along with a combination of risk and protective factors contribute to individual reactivity and adjustment, which may lend a more contextual understanding of student risk after exposure to trauma. student risk for reactivity various levels of risk may exist in regards to student reactions to course content. students who have been exposed to some trauma but are not experiencing any distress are presumably at the lowest level of risk. the next level of risk may be comprised of those students experiencing some trauma-related symptoms that lead to discomfort or disrupt functioning. finally, students at the highest level of risk would be those with a current diagnosis of posttraumatic stress disorder. framing student levels of risk in this way can be helpful to instructors as they consider the need for thoughtful intervention of traumarelated materials in the classroom. while it is important to consider student risk for reactivity based upon the students’ own past experiences, it should be noted that reactions to course content may occur regardless of trauma history. secondary traumatic stress (sts), which can occur when a person is not primarily experiencing a trauma themselves, but is exposed to traumatic material by hearing an account of another’s trauma and as a result experiences a set of symptoms that mimic ptsd (apa, 2013) or acute stress disorder (bober & regehr, 2005). in recognition of sts, instructors of courses on trauma and traumatic stress should introduce course content that contains traumatic material through responsible and strategic methods in order to minimize student risk for traumatization or secondary traumatic stress. existing trauma-informed teaching recommendations in order to reduce occurrences of secondary traumatic stress in classroom settings, it has been recommended that university faculty be purposeful and cautious with the use of traumatic materials in the classroom (kostouros, 2008). specific biobehavioral, affective, advances in social work, spring 2017, 18(1) 28 cognitive, relational, and spiritual strategies may be utilized by students to protect against secondary traumatic stress, ranging from encouraging students to take time for recreation to being aware of their own maladaptive coping strategies (o’halloran & o’halloran, 2001). for educators, carello and butler (2014) proposed steps for educators to make their educational practices more trauma-informed to include the importance of acknowledging the prevalence of students’ trauma histories and making learning and safety central to the classroom experience. mccammon (1995) also provided suggestions to faculty for implementation of traumatic material to include establishing safety in the classroom, letting students know what materials are to be covered, carefully selecting examples, being knowledgeable of community and university referrals available to students, and handling student disclosures with care. the international society for traumatic stress studies (istss) provides best practice parameters for professionals in the areas of clinical work, research, and education. according to these parameters, educators should: communicate the potential impact of working in the field of trauma, such as vicarious traumatization; prepare students when materials may possibly be triggering; and avoid requiring assignments that encourage selfdisclosure without providing a genuine alternative (istss, 2016). these best practice parameters are not stated to pertain to any specific academic or training setting. while these recommendations do align with trauma theory, many of them are largely based in clinical training populations and do not specifically address undergraduate students or academic programs across multiple disciplines. furthermore, these recommendations are mainly individual suggestions for strategies on how to cope with course content, rather than representative of an organized model for implementation of content. the current paper attempts to bridge this gap between trauma theory and implementation of content in the classroom, through a model that was developed in the context of a trauma studies undergraduate program. trauma-informed classroom care model the pedagogical need for introducing traumatic materials thoughtfully in the classroom arose over years of instruction and coordination of an undergraduate trauma studies program. this program, in which students are required to take courses on trauma and conflict, and may also choose elective courses related to trauma in topic areas such as violence, grief and loss, and life crises, was the context for the development of the traumainformed classroom care model. this model is designed to aid instructors in recognizing and responding to student reactivity to traumatic materials in the classroom, with implications for instructional design. the following sections outline and describe each component of the model, with an emphasis on the research or evidence that was used to support the pieces of the model that have been combined to work together. trauma exposure students may begin participating in courses that contain elements of trauma already having been exposed to trauma via their own life experiences, while other students without significant trauma histories may learn about the nature of trauma and traumatic stress for the first time in the classroom environment. in either case, exposure to elements of trauma cless & goff/teaching trauma 29 is inevitable as course objectives may be to explore the nature of trauma, posttraumatic stress disorder, as well as common symptoms and reactions to stressful and/or traumatic events (nelson goff, 2016). as cited previously, university students may be exposed to traumatic experiences prior to and/or during their time in college (frazier et al., 2009), with veteran students who may experience pts symptoms or are diagnosed with ptsd (barry et al., 2012). while instructors may or may not be aware of students’ previous exposure to trauma, it can be assumed that many students will have had these experiences based upon general knowledge of trauma exposure. some instructors may wish to help students evaluate how their own experiences may affect their experience in the course. this can be accomplished using a variety of methods, including assigning a reflective writing assignment at the beginning of the course in which students are prompted to consider how their personal background may “show up” in the course, and identifying which personal strengths may aid their learning experience. reactions to trauma trauma exposure does not imply traumatization will occur, as many persons are resilient in the face of trauma and may not experience significant adverse reactions (bonanno, 2005; yehuda & flory, 2007). for this reason, trauma exposure and reactions are separate in the model. as possible previous trauma exposure may exist in students’ own histories and re-exposure to trauma through the course materials will inevitably happen in the courses that are of current discussion, student reactivity to course materials may occur at any given point and time during the class. student reactivity to traumatic materials is conceptualized using the triphasic model (herman, 1997). this model describes three phases of trauma recovery: safety, remembrance and mourning, and reconnection. the three phases of trauma recovery in this model can serve as a way to understand a student’s own level of reactivity to trauma, both personal and in the classroom. safety. during this stage of trauma recovery, survivors of trauma often feel unsafe in their own bodies, in their minds, in their relationships with others, or a combination of these. this phase may last weeks, months, or even years, depending on the severity of trauma (herman, 1997). in the classroom setting, those in the safety stage may feel intense physiological reactions to lectures, videos, or other activities. others may distance themselves from triggering materials by disengaging purposely or unintentionally. of course these reactions, if they are present, may be easily masked in the modern classroom in which total student engagement is often interrupted by other students or means of technology (e.g. students using electronic devices during class for activities not related to the course, use of mobile phones or tablets). the instructor, then, should be aware of these reactions and open his/her mind to the possible various meanings of student overt reactivity or disengagement. furthermore, the instructor should strive to make the classroom as safe and comfortable as possible. establishing safety has been noted as an important and often primary element of trauma-informed care (bath, 2008; fallot & harris, 2009). safety can be fostered in the classroom in a number of ways, both structurally and through the instructor’s use of self. first, making clear the course structure and content can help to establish a safe environment, which may be accomplished by making students aware of what content will advances in social work, spring 2017, 18(1) 30 be covered, communicating about when certain topics will be discussed, and clarifying the expectations of student participation in class. furthermore, instructors should communicate to students clearly and often the acknowledgment of the intensity of the course materials, as well as being available to students. this need not be a long or overstated message, but it is important that the students are able to see the professor as a resource and as a safe person in the environment of a course that teaches trauma-related materials. in addition to verbal communication, instructors may also wish to include written notices on the course syllabus regarding possible student reactivity as well as resources available to students. remembrance and mourning. during this stage, survivors of trauma recall and work through their own memories of personal trauma, often reconstructing the trauma story (herman, 1997). for survivors in this stage, the foundation of safety reached in the previous stage remains crucial to support healing during this time of recalling and examining personal trauma. while students in this stage may be less overtly or physically reactive to course materials, they may also be more emotionally or cognitively connected to the story of their own experience. students may recount their own memories to instructors either verbally during class or through writing for course assignments, which warrants validation and monitoring on the part of the instructor as well as possible referrals and documentation of student interactions according to relevant university policies. for some students, learning about trauma in the classroom setting may lend new ideas and perspectives to their own processes of reconstruction or meaning making. for example, students learning for the first time about normal physiological reactions to threatening situations may begin to reframe actions taken in their own lives as protective rather than unresponsive or weak. to support students who may be in this stage of recovery, instructors may wish to refrain from taking hard stances on what is “right” or “wrong” in relation to trauma reactions, treatment, or prevention, as it may disrupt a recovering student’s own personal process. mourning may increase reactivity and challenge students’ beliefs and worldview, as they attempt to develop a cohesive understanding of their previous trauma experiences and work through the reactions that are a part of this stage of healing. the classroom should be supportive of this process, and instructors can take advantage of an open learning environment that is conducive to sharing new perspectives, and stories, which may help healing students to psychologically make room for new perspectives of their own trauma. keeping with the values of choice and empowerment necessary in trauma-informed care (fallot & harris, 2009), instructors should strive to allow students to move at their own pace and determine their own meanings about personal experiences or examples which may be present course content. while instructors should be supportive of students in this stage, they should also be mindful to stay within the scope of their teaching role. this may be particularly important for those instructors who work as social workers or clinicians in other settings, as separating these two roles may be more difficult. reconnection. the third stage of the triphasic model is that in which the survivor of trauma must create and define a new future self, as the past self was mourned in the previous stage. often survivors in this stage are rediscovering a sense of “normalcy” in areas of their life that was altered by the trauma itself. according to herman (1997), “the traumatized person recognizes that [he/she] has been a victim and understands the effects of [his/her] victimization. now [he/she] is ready to incorporate the lessons of her traumatic cless & goff/teaching trauma 31 experience into [his/her] life” (p. 197). students in this stage may be comfortable disclosing their own experiences to the instructor or even to the whole class, and they may articulate integration of the trauma into their own lives. while students in this final stage of healing may present as less reactive to course content, use of this model may give instructors a clearer understanding as to how and why these students engage with the course materials, with peers, and with the instructor. the trauma-informed care value of empowerment (fallot & harris, 2009) may be present in this stage as students come face-to-face with reminders of their journey and are able to retain a sense of self, power, and meaning. even with students who have made significant progress in their healing journey, it is important to recognize these students in relationship to the course and how trauma-related materials may affect them. student disclosure of trauma students recovering from trauma in all three stages may disclose personal experiences of trauma as noted above. student disclosure may occur in a variety of settings: in an individual meeting with the instructor, during on-campus discussions, or in writing through online message boards or in projects, papers, or other course assignments. instructors should handle student disclosures with care, especially if shared in the larger classroom setting. if assignments that may prompt disclosure of personal history are required, such as reflective essays on personal stories, instructors should communicate with students about confidentiality and its possible limits, in compliance with the policies of their institution. instructors may choose to refer students to on-campus counseling services who disclose recent experiences of trauma, as well as those experiences that may still affect their functioning. if students disclose information that suggests they may harm themselves or others, instructors should be knowledgeable about his or her school’s process for reporting a student of concern to units such as student life or counseling services to promote student and community well-being. flexibility in using the trauma-informed classroom care model, flexibility should be parallel to student levels of reactivity. this is meant to demonstrate students’ varying needs in the classroom according to their own levels of reactivity to course content. the model posits that students with higher levels of reactivity to traumatic materials should be met with higher levels of flexibility within the course. while many students may be exposed to these topics for the first time by means of the course content, other students will have previously been exposed to trauma and may or may not be triggered by materials in the class. reactions to trauma are variant, and many individuals show signs of resilience even in the face of trauma (bonanno, 2005), making it difficult to predict which students may be triggered during the course, even if information about a student’s previous trauma exposure is known by the instructor. flexibility may vary in each course according to the needs of each class and instructor. some recommendations for implementing flexibility in a course setting include allowing various options of assignments with a mix of objective and subjective choices, allowing students to attend a specific lecture remotely, or offering alternative ways for students to advances in social work, spring 2017, 18(1) 32 comfortably demonstrate learning. this can be accomplished through offering alternative assignments, allowing students a certain number of absences, or having an incomplete policy in place for students who may need to stop the course and retake it in the future. it should be noted that flexibility in a course does not mean a lack of structure or allowing students to do whatever they would like to do or not meet academic requirements. instructors should be able to allow certain flexibilities in the course, while maintaining clear structure and boundaries. course progression especially in courses in which traumatic topics are the core focus of the class, it is expected that student reactions to the course may vary over time as topics are introduced. for example, a general course on identifying trauma and traumatic stress may heavily focus on sexual assault at one point in the course, but move to other topics as the course progresses. this is important to recognize as student personal histories with exposure to specific traumas are unknown to instructors, and reactions to more specific content within a course may occur at various points over the semester. for this reason, instructors should be cognizant of student reactions and be available to students throughout the course. communication with students directly regarding course progression can be a tool for instructors to utilize in order to promote student well-being in the course. in sending electronic notifications or emails to the class, instructors can acknowledge the intensity of the course material and offer to meet with students who may be experiencing distress. these statements can also be added the course syllabus, as a way to display this message throughout the duration of the course. instructors can also make an effort to check in with students who seem to have withdrawn from the course by not attending or completing assignments. these moments of communication may seem insignificant, but they can be strategically implemented in order to create a safe and supportive environment for students exposed to traumatic materials in the course content. assessment in courses with a heavy focus on trauma related topics, assessment should always be part of the course. whereas courses that do not use traumatic materials may assess student progress toward learning outcomes, this process is of even greater importance in courses with traumatic materials not only to assess student learning but also to monitor student reactivity. assessment of student learning outcomes often comes in the form of an assignment (e.g., test, quiz, essay) while assessing student reactivity may take place on various levels. while some students may feel comfortable approaching instructors to share any adverse reactions to course materials, other students may withdraw from the course in various ways. student withdrawal may include poor or no attendance, low or no participation in course assignments and discussions, or failing to respond to assignments in-depth. instructors should also be aware of more overt reactions to the course content (such as tearfulness or anger) and be ready to respond accordingly. as previously mentioned, students who disclose having personal histories that may increase risk for reactivity to course content should be offered referrals to university and/or community resources that he or she may choose to utilize as a source of support and method of coping. cless & goff/teaching trauma 33 if students reach a higher level of concern, exhibited by making statements that would be indicative of harm to self or others, instructors should be ready to make a report without the student’s consent in order to ensure the student’s well-being and safety. although this can be difficult for instructors, as they may fear it could jeopardize the rapport they have built with their student(s), student well-being is of primary concern and reporting to academic or student services administrators allows a broader network of care and support to be developed for the student. discussion and future directions this paper has proposed a trauma-informed teaching model for use in university courses that cover trauma and traumatic stress, violence, sexual assault, or other courses that may be completely or partially focused on topics that contain elements of trauma. building on the work of other scholars who have addressed this topic, this model was constructed using a well-known trauma treatment model as a foundation for understanding reactivity to trauma, and expanding it to be relevant for the classroom. this work contributes to existing trauma-informed recommendations for teaching by providing a framework through which the need for these recommendations can be understood. using a trauma-informed model for teaching should not be the only step to becoming “traumainformed.” instructors of university courses should take additional steps in order to respond to the varying needs of their students. educating students about and communicating the need for self-care in courses that incorporate trauma-related content may encourage prevention of burnout and secondary trauma in students (o’halloran & o’halloran, 2001). steps such as providing trainings to help instructors identify students at risk for mental health problems, which are prevalent among college students (hunt & eisenberg, 2010), implementing mentoring programs (santos & reigadas, 2005), and making clear to both instructors and students campus resources for mental health, advocacy, and advising are also recommended for holistic care of students in addition to mindful introduction of sensitive materials in the classroom. this model may help those in the social work profession to more clearly implement the competencies outlined by the council on social work education (cswe). specifically, competency #3, which calls for social workers to understand and promote the advancement of human rights and social, economic, and environmental justice, to include safety and education (cswe, 2015). the creation of this model was founded on the recognition of the widespread experience of trauma, and aligns with the cswe’s call for professionals to “engage in practices that advance social, economic, and environmental justice” (cswe, 2015, p. 8). instructors at the university level should be a part of this process, and can both model and practice social justice with students in the classroom. furthermore, the cswe regards dignity and worth of the person as a central professional value in the field of social work that should be fostered in the educational environment (cswe, 2015). since this proposed model centers on understanding the student’s own level of reactivity and strives to help instructors respond accordingly to foster student well-being, the values of dignity and worth are exemplified through its use. it should be acknowledged that this model was developed in the context of a nonclinical trauma studies program with courses that focus on topics such as trauma and advances in social work, spring 2017, 18(1) 34 violence directly. in this way, the model has been formulated through the experience of teaching about trauma and implementing traumatic materials into the classroom due to the general focus of the course itself. however, other instructors may find that their own students are having reactions to materials that are not overtly “triggering” or seemingly traumatic in content. the authors denote this as a difference between teaching trauma, in which traumatic materials are the focus of the course content (carello & butler, 2014), and trauma-informed teaching, in which students with prior histories of trauma exposure may react adversely to any number of cues that are presented in a classroom not related stereotypically to trauma but personally meaningful to the student (cunningham, 2004; dufresne, 2004). this model may be flexible for both contexts; however, as the elements of trauma exposure and trauma re-exposure in the classroom setting may also be true for students taking courses unrelated to psychological trauma or distress. more development of the current model and empirical investigation of teaching trauma and trauma-informed teaching may help to clarify any existing differences in the needs of students with trauma histories in both types of classes. it is important to remember that in conceptualizing student reactivity to traumatic course materials using herman’s (1997) triphasic model, instructors do not fill the role of helping professionals, such as social workers, psychologists, therapists, or doctors. all care toward students should be provided by licensed professionals. however, the triphasic model does provide a frame of reference that can inform instructors of signs and symptoms of student reactivity at various levels of the recovery process for students. again, as it is expected that students will be present in the course with a history of trauma that may have occurred in the distant or recent past, or is currently ongoing, leaving students vulnerable to adverse reactions to course materials that should be thoughtfully implemented. instructors may need to make referrals or work with student services offices offered at their university in order to ensure student care and safety. while this pedagogical model recognizes the possibility for student reactivity to trauma-related course materials, it does not address how the histories and reactions of instructors may also influence the higher education classroom. further study and conceptualization should be done to consider how this added element may affect the current model and trauma-informed teaching as a whole. perhaps the greatest focus of attention in advancing knowledge related to trauma-informed teaching at the university-level is to provide empirical support for models such as these authors propose, as well as for traumainformed interventions. while in the past many recommendations have been made for teaching trauma, no studies to date have tested these recommendations. an empirically supported model that can be used as a lens in how to teach traumatic materials in the classroom will give university faculty the opportunity to more carefully introduce students to trauma in an academic setting, while keeping in mind the students’ own levels of reactivity and steps to healing from previous trauma. references ackerman, r., 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(2006). cumulative interpersonal traumas and social support as risk and resiliency factors in predicting ptsd and depression among inner-city women. journal of traumatic stress, 19(6), 825-836. doi: https://doi.org/10.1002/jts.20159 smith, d. (2002). undergrads flock to classes on trauma. monitor on psychology, 33(4), 34. retrieved from http://www.apa.org/monitor/apr02/undergrads.aspx widome, r., kehle, s. m., carlson, k. f., laska, m. n., gulden, a., & lust, k. (2011). post traumatic stress disorder (ptsd) and health risk behaviors among afghanistan and iraq war veterans attending college. american journal of health behavior, 35(4), 387-392. doi: https://doi.org/10.5993/ajhb.35.4.1 yehuda, r., & flory, j. d. (2007). differentiating biological correlates of risk, ptsd, and resilience following trauma exposure. journal of traumatic stress, 20(4), 435447. doi: https://doi.org/10.1002/jts.20260 author note: address correspondence to: jessica cless, college of human ecology, kansas state university, manhattan, ks 66506-1403. email jhigh@ksu.edu https://doi.org/10.1002/jts.20159 http://www.apa.org/monitor/apr02/undergrads.aspx https://doi.org/10.5993/ajhb.35.4.1 https://doi.org/10.1002/jts.20260 mailto:jhigh@ksu.edu microsoft word blanchard article final bb _________ lieutenant colonel samantha blanchard, lcsw, bcd, abd is the director of behavior medicine, nellis family medicine residency, nellis air force base, nevada. the opinions expressed in this article are the author’s and should not be interpreted as the policy or opinions of the united states air force. the author would like to acknowledge the dedication and hard work of eileen brennan in making this article a reality. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 83-97 are the needs of single parents serving in the air force being met? samantha e. blanchard abstract: the military has taken extraordinary steps in establishing programs to support not only the member serving but their families as well. this article will examine military policy as it impacts single parents serving in the air force, highlighting existing programs, and calling for more research on this valuable population. keywords: single parents, policy, military introduction the air force has the predictable aspects of a bureaucracy (i.e. fixed jurisdictional areas, firmly ordered office hierarchy, belief that holding office is a vocation, and more or less stable rules; weber, 1978), and in particular those of a 'greedy' bureaucracy (coser, 1974), which have implications for recruitment and retention of qualified personnel to defend our country. according to coser (1974), “members of greedy institutions must be so fully and totally committed to them that they become unavailable for alternative lines of action” (p. 8). these organizational attributes present stress for all, but particularly for service members who are single parents. social support theory predicts that attention to family and other social support could mitigate some of these stressors (boss, 2002; karney & crown, 2007). the military has in place program and policy steps to help increase social support, so that personnel are available for the task of protecting our country. in light of recent demographic increases in the proportion of air force single parents, the military should continue to build targeted family support programs and policies as a strategy to help maintain a ready workforce. this article will argue that although the air force’s prime mission is not to provide social support for this group, it is in the organization’s best interest to understand and provide for single parents. the number of active duty members serving in the air force in 1990 was 525,000; by 2005 that number decreased to 325,000. although the actual number of single parents decreased from 21,000 to 16,000, the proportion of personnel who are single parents increased from 4% to 5.1% (air force personnel center, 2010). one difference that emerges when comparing the single parents in the armed forces with those in the civilian world is that the single parents in the military are mostly male while those in the civilian world are mostly female (bowen & orthner, 1986). single parents, those without a partner sharing day-to-day parenting responsibilities for minor children, will be the focus of this article. this review will first explore the military environment, and allow the reader to more fully understand the demands and issues facing single parents serving in the united states air force and how those demands and obligations affect their relationship with their families. air force basic blanchard/needs of air force single parents 84 family policy, social support policy, policy enforcement, military stressors, and supporting research addressing the situation of military single parents will be discussed as well as the supports that need to be added to improve the experiences of those personnel. finally, research recommendations will be made. this review will conclude with recommendations for possible policy changes for single parents currently serving in the air force. military social environment as an organization, the military functions similarly to civilian institutions by revealing and communicating social expectations and values to its personnel and their families. concomitant with social expectations and family values are military work expectations. as a work organization, the military requires a range of personal and family sacrifices that dominate the lifestyles of military personnel and their families in accommodating to its work mission. many unique and adaptive challenges are presented, because the military’s environmental context requires readiness and preparedness for missions crucial to national security (bowen, 1985; bowen, orthner, & zimmerman, 1993; chapin, 2009; jensen, lewis, & xenakis, 1986; walker, 1985; wheeler & kiorb, 2009). these demands of the armed forces dictate the selection of a lifestyle that pervades almost every facet of a person’s life. there are few civilian occupations that require such a high level of commitment and dedication from employees (bowen & orthner, 1986; hoshmand & hoshmand, 2007). albano (1994) and segal (1986) used lewis coser’s (1974) notion of the “greedy institution” to describe the great demands that the military as an organization places on the time, energy, and commitments of service members and their families, demands that are unrivaled in the civilian workplace. a key difference between the military as a work organization compared to a civilian company is how intensely the military family is dominated by the requirements of the “greedy” organization. the military requires many sacrifices by the personnel employed by the military and their family including frequent relocations, extended separations and the subservience of the needs of the family to the requirements and objectives of the military (bowen, et al., 1993; chapin, 2009; wheeler & kiorb, 2009). in exchange the military provides many economic and social supports to compensate the family for those sacrifices, combined with a community lifestyle which allows the family members and service members an interpersonal support network (bowen, et al., 1993; bowling & sherman, 2008). military policy: impact on joining and job choices for single parents the military has policy solutions that attempt to resolve the dynamic tension between maintaining a ready workforce that is available to meet the security of the nation and ensuring support is given to members to combat the multitude of stressors that come from serving in the armed forces. max weber (1978) declared a basic premise of organizational functioning as a bureaucracy: tasks are put before people. several researchers have documented stress advances in social work, spring 2012, 13(1) 85 arising from conflicts between the family and work lives of individuals (bianchi, casper, & king, 2005; boles, 2001; chow & berheide, 1988). since the foundational research of reubin hill (1949), there has been ongoing study of the interrelationships of family stress and military work life (boss, 1987; britt, 2006; britt, adler, & castro, 2005; burr, 1973; drummet, 2003; faber, 2008; finkel, 2003; mccubbin, joy, cauble, comeau, patterson, & needle, 1980; pincus, 2001; rothrauff, 2004). in research that was focused on the army, it was shown that families could contribute to readiness, and that support to families was a cost effective way to enhance readiness (kirkland & katz, 1989) the following policy review will show how the military, and in particular the air force, has screened applicants, and after their induction has created a social support system that attempts to serve all of its members and their families. policy on personnel selection due to the specialized needs of the nation’s armed forces strict guidelines and regulations must be met by applicants seeking to join any of the military branches. these specialized needs allow the military to accept or reject applicants based on their personal characteristics such as number of dependents, financial stability, and their age. while it might be difficult for the average citizen to understand the requirements of the selection process maintained by the armed forces, these requirements have been examined and approved by the supreme court in the case kennedy v. mendoza-martinez (1963): the military is, by necessity, a specialized society (separate) from the civilian societies…the military must insist upon a respect for duty and a discipline without counterpart in civilian life,’ in order to prepare for and perform its vital role … the essence of the military service ‘is the subordination of the desire and interests of the individual to the needs of the service.’ the history of the courts deferring to the judgment of military leaders on matters affecting the armed forces is one of the most consistently upheld principles of constitutional law. furthermore, serving in the military is a privilege and sometimes an obligation, conferring neither the right to serve nor the right to avoid service. policy dictates how the military controls parent status at entry. the united states department of defense (dod) generally prohibits the enlistment of any individual who has responsibility for two or more dependents under the age of 18 at the time of the enlistment. the various military services have the ability to waive this requirement and many of them have even stricter requirements than the standard dod policy. the air force in particular requires an examination of an applicant’s financial situation if the individual has any dependents including a spouse. this is done to ensure that the individual will be able to support his or her family with a military salary (u.s. code, title 10, armed forces 2007. united states) policy on job assignments the second policy area that could potentially affect single parents would be that governing job assignments. here the fundamental value of ‘equity’ of tasks for all in the same job group is the rule. policy does not limit or vary work assignments with regard to blanchard/needs of air force single parents 86 parental status. the demands that the military places equally on all employees make it a difficult environment in which to be a single parent. there are no exceptions made in the assignment of orders, duty stations, deployments or time off for individuals who have become a single parent due to divorce or death of their spouse (u.s. code, title 10, armed forces 2007. united states). social support theory would predict that individuals with strong social support would better cope with these demands (young, 1999). the military takes this into account at the point of assignment by putting safeguards in place to assure that the service member has taken care of family obligations and will be fully available to all assignments. in these cases the single parent is required to have a local individual who is not a member of the military agree in writing that he or she will accept the responsibility of those children with no notice in the event that the parent who is in the military is deployed or otherwise called to duty. an individual who fails to comply with these regulations could receive an immediate discharge from service (u.s. code, title 10, armed forces 2007. united states). another area where policy might apply differently for single parents is the case of emergencies. when an individual serves in the military there is a limited amount of flexibility with regard to family emergencies and the needs of the military come before the needs of the family. by being a single parent and a member of the military the difficulties become more complicated because there is not another parent available to assist with the rearing of the children. the accumulation of stressors could lead to an unplanned crisis that would put the single parent into an emergency situation such as losing childcare, unstable housing, or financial difficulties. although family emergencies sometimes occur without warning, the point is to not accumulate stressors to the point they result in emergencies. policy changes could help prevent the accumulation of stressors that could lead to emergency situations. military single parents are required to fulfill the terms of the contract that was signed during the enlistment process. there is no way to renegotiate the contract unless there is a medical reason, such as a service-related injury or condition. the individual who either enlisted or accepted a commission must fulfill the terms of the contract signed or be dismissed from military service (u.s. code, title 10, armed forces 2007. united states). military policy and social support for single parents as well as increasing demands, policy can also establish supports for family members. in recognizing and responding to the needs of the service members and their families, albano (1994) has stated that there have been landmark shifts in military family policy over the past two centuries. these shifts have been made from informal implicit obligations to help meet the needs of military families to formal supports that have been institutionalized through the dod in the form of directives, public laws, policy statements, a prime example of formal supports established by policy are the airman and family readiness centers in which parents can receive the support and services that they need in order to meet the demands created by the family. several of these services include the air force aid society (afas), the relocation assistance program (rap), family life advances in social work, spring 2012, 13(1) 87 education (fle), the family readiness program (frp), and the transition assistance program (tap). the afas helps with interest free loans in cases of emergencies such as traveling home for deaths, illness or accidents of immediate family members. afas also can help with emergency car repairs and other unexpected financial difficulties. the rap program is designed to ease the transition to another duty station by providing information about the new assignment, tips on moving, and expectations on making the move to another base. the fle program offers educational classes on parenting, spousal communication, and overall successful living in a military lifestyle. the frp program offers services to the family members of those that deploy to a combat area. services can include activities for the family members, phone calls for morale purposes, and monthly dinners with all the family members left behind. the tap program is utilized by members of the service either retiring or leaving the service after their commitment is over. this program offers resume services, interview skills, and job hunting techniques (air force instruction 36-3009, 2008). these policy supports clearly reflect the manner in which mutual benefits are shared between the military as an organization and its constituents: service members and their families. albano (1994) noted that “the more the military institution adapts to family needs, the more it will preserve itself as an institution. as family members become increasingly integrated into the military community, there is an increased commitment to the organization” (p.13). in essence, the military provides economic and social support to compensate families for their sacrifices in meeting the demands of the military lifestyle. likewise, the military prides itself on facilitating an informal work and community context from which service members and their families can derive organizational and interpersonal support, and develop a sense of mutuality (bowen, et al., 1993). policy enforcement with changing demographics there has been a growth in the need for family-related supports due to changes in demographics in the population from which the military recruits. based on defense manpower data center records from 2005, almost half of the air force population is comprised of parents, with 10% of those being single parents without partners (air force personnel center, 2010). events in the world precipitated a mass deployment of the various services to the middle east in the early 90s. during the staging of the troops for deployment it was discovered that the majority of the single parents had not made the proper arrangements for the care of their children while they were deployed. this caused the deployment to be delayed resulting in a slower reaction time for the armed forces (albano, 1994). this also resulted in some individuals being reassigned to different units leaving at different times, creating situations in which deployed military units were not fully staffed for the mission requirements. units going to a combat area being understaffed can result in higher casualties and increased risk (albano, 1994). consequently, the military had to reexamine the enforcement of policy surrounding single parents. in order to prevent a similar situation from occurring again the instructions governing single parents were more strictly enforced to comply with the military’s primary mission blanchard/needs of air force single parents 88 of protecting the united states. single parents were required to create family care plans detailing how their children would be cared for when the parent was deployed (department of defense instruction 1342.19). these plans required that the individual assuming responsibility for the children be available at a moment’s notice. the plan calls for short term care as well as long term care. short term caregivers have to be co-located in the local area. long term caregivers would step in if the parent would be gone for an extended period of time. short and long term caregivers are given powers of attorney in order to enroll children in school and to make medical decisions during the parent’s absence. access to funds to help offset the cost of taking care of these children also had to be established. instructions as to how these children would be transported from short term to long term caregivers are also required. parents who were unable or unwilling to create these plans were dismissed from the air force so that they could care for the children without placing the primary mission of the air force at risk (department of defense instruction 1342.19). the military’s shift to a more voluntary service has provided more opportunities for personnel to have family members accompany them to peace time bases all over the world. over time, family members at bases have outnumbered military personnel (drummet, 2003; goldman & segas, 1983). as the changing demographics of the military has evolved from predominantly single males to include various types of family units the military’s behavioral and social science research program was expanded. the air force’s original focus on achieving adaptation of the individual service member to military life shifted to understanding the adaptation patterns of the families of service members, specifically in adapting to the changes required by the military lifestyle (bowen, et al., 1986; drummet, 2003). military stressors and policy responses the extent to which families accept, internalize, and exhibit behaviors indicative of military expectations reflects the degree to which they are able to manage the stress and demands of the organization (mccubbin, 1979). the military requires a cadre of contextual changes which produce varying degrees of stress. some of these changes include: frequent relocations; extended family separations; spouse/parent separation; absence and reunion; hazardous duty assignments; possibility of injury, captivity, or death in combat or in other dangerous environments; social and cultural isolation of families on bases in remote areas overseas; uncertainty of future careers; and fast-paced deployment (albano, 1994; bowen, 1985; bowen, mancini, martin, ware, & nelson, 2003; bowen, et al., 1993; drummet, 2003; jensen, et al., 1986; rosen & moghadam, 1989; rosen & moghadam, 1988; wilson, 1994). there are important differences between single parenting in the civilian world compared to single parenting in the armed forces. in sharp contrast to american society at large where females comprise the majority of single parents, single parents in the military are more likely to be males who are faced with the dual challenge of raising a child or children largely on their own while balancing their responsibilities to their respective service (air force child programs, 2011). advances in social work, spring 2012, 13(1) 89 importantly, military duty takes on many different forms. some servicemen and women work for eight hours a day, five days a week, and enjoy a certain degree of stability in their schedules without the added concern of being deployed at a moment’s notice. other military occupational specialties involve long work days (in some cases 12 hours or more) and weekly schedules that frequently involve working or training on weekends and holidays. the latter category of military service may place inordinately high levels of stress on parents in general and single parents in particular as they struggle to balance their military responsibilities with their parenting. it is also important to take these issues into account when formulating support programs for single parents in the military because individual circumstances may differ greatly with military service being one of the only common denominators. a study of air force women serving in the u.s. air force during the first persian gulf war deployment conducted by pierce (1998) revealed a number of work-family conflicts that contributed to the resignation of these service personnel once their enlistments were completed. such conflicts were identified by 25% of those leaving military service and rated as critically important by 11%. many respondents commented that there was simply insufficient time to meet all the demands placed on them. although some parents had successfully managed their work lives, the anticipation of having children had caused a reappraisal of their commitment to the military. the air force was losing highly trained personnel because of parental status. according to hammelman (1995), although lengthy separations of family members are a natural and expected consequence of military service, there have been some significant changes in recent years. for instance, hammelman emphasized that, during the persian gulf conflict, families were separated. although this typical for previous wars, more single parents were called to serve than previous wars. in february 1991, there were approximately 16,300 single parents serving in the theater (hammelman, 1995). hammelman pointed out that the “literature on stress and the military has emphasized two-parent families in which the man was called to duty; timely and relevant studies concerning the stress experienced by single-parent military families, though, remain virtually nonexistent” (p. 143). the following describes how the military has responded to these unique stressors by providing programs and services to address the needs of the members serving, to include family members. all the programs described below were created to serve the population as a whole. although these programs are needed and utilized, policy changes to address the unique needs of single parents could improve the lives of single parents serving in the air force. in 1994, $2.7 billion was allocated to improve the quality of life in the armed forces (serrano, 1994). these funds were to be used to modernize and build new military housing, enhance family-support programs, and increase military paychecks for those living in high cost areas. the armed services have come to realize that helping families become stronger can also help service members do their job more safely and efficiently. if service members do not worry about their families, their minds are clear (heubner, mancini, bowen, & orthner, 2009). the armed services are also helping families to cope blanchard/needs of air force single parents 90 with military life through many other programs. these programs include health care, childcare, drug and alcohol abuse programs, spousal and child abuse prevention programs, child development centers, youth programs, parenting programs, family services, family support groups, legal assistance, spouse clubs, and the red cross (heubner, et al., 2009). stress from frequent moves, base closings, and force reductions were found to be related to spousal and child abuse (segal, 2006). in 1981, the dod mandated cooperation among the army, navy, air force, and marines to address prevention, evaluation, and treatment of child abuse and neglect, and spousal abuse (moss, 1994). during the late 1980s and early 1990s, the number of spousal abuse cases rose from 12 per 1,000 to 18 per 1,000. in that same period, confirmed child abuse cases increased from 6.0 per 1,000 to 6.6 per 1,000, and on average, every year, one child or spouse died at the hands of a relative in the army, navy, air force, or marines (moss, 1994). in 1995, military spousal abuse rose slightly, and the rate of child abuse slightly dropped (jowers, 1996). over time, support programs have been developed to counteract negative trends. in 1996, lawmakers added $30 million to the defense authorization bill for the family advocacy program (jowers, 1996). this program deals with aspects of spousal and child abuse— preventing, identifying, reporting, and treating. the new parent support program was initiated to address “at risk” parents and children in early 2000. this program was developed to identify and offer resources to parents and children that met certain standards, such as age of parents, single parents, high risk pregnancy, multiple child birth, and high levels of stress (salas & besetsny, 2000). programs and initiatives of this kind are considered crucial to the “readiness and retention of quality people” (jowers, 1996). in the last thirty years, the armed forces have risen to the challenges of spouse and child abuse, alcoholism, quality of life, and child care issues, and research has documented the need for support programs addressing these issues, and has established program effectiveness. now is the time to document the needs of single parents in the military, and conduct intervention and evaluation research. supporting research on military single parents the majority of the research on work and family issues done throughout the years has focused on two-parent family units rather than the single parent households. when single parent households were examined the researchers more typically chose single parents employed in the civilian job market. the literature reveals little in the way of research surrounding single parents in the military. since most of articles on military single parents are fifteen to twenty years old, i have included studies on single parents in general to help bridge this gap in the literature. military families struggle with the same basic issues as mainstream america. there is little doubt that stressors experienced on the job or in the family are often interrelated. the interactive nature of role overload in both the workplace and the family constitutes one of the more serious stressors for families, particularly for single women and parents of young children (allen & armstrong, 2006; hall, 2007). job-related stress and work-family conflict can be detrimental to a worker’s well-being and health, advances in social work, spring 2012, 13(1) 91 including the over-stressed single parent (hammer, cullen, neal, sinclair, & shafiro, 2005; quick, horn, & quick, 1987). major causes of stress can be the characteristics of a job, demands of the job, and employment-related life events. these factors can lead to behavioral changes that cause the individual to be less responsive to the feelings and needs of his or her family members, as well as to become less productive on the job (quick, et al., 1987). in a ten year old article describing stress among single parents serving in the air force heath and orthner (1999) concluded that when members received or perceived support from their environment their stress level decreased. according to bowen et al. (1993), single parents in the military face many challenges. often, they encounter institutional discrimination and are discouraged from reenlisting if they become single parents while on active duty. potentially, they face greater role strain and role conflict in fulfilling work and family obligations. unlike single parents in the civilian labor force, single military parents must deal with norms of the military, such as unaccompanied family tours, deployment to foreign battlefields or extended tours with limited or no advanced notice, and frequent disruption in informal community networks and extended families. there are frequent changes in duty stations and long absences from their families; therefore, single parents may not also have access to their extended family for support while raising their children. these demands and norms are enforced by both social and legal sanctions. in contrast to their counterparts in civilian life, single military parents are offered an important asset: reasonable job security with fringe benefits (medical, housing, and childcare subsidies; bowen, et al., 1993). although these benefits exist, the military should examine its policies to insure that they also meet the needs of this increasing proportion of the military population. in essence, bowen (1987) has stated that a working knowledge of this segment of the military culture, and sensitivity to the diversity of their needs within it, provides a value-added contribution both to effective leadership by military decision makers and delivery of services by military and civilian employees. what’s missing for single parents? the following is a discussion of programs available to military family members as a whole with a focus on what could be improved to entice single parents to participate. the military is aware of the stresses that being employed by the military places on the family structure. many of the family life classes offered assist married couples to deal with the stress caused by deployment rather than the stress caused by being a single parent in an emotionally demanding job (air force instruction 36-3009, 2008). by not designing the classes to assist single parents as well as married parents employed by the military the single parent does not have the access to the support groups that are essential for strengthening the family unit. the military is also aware of the stresses on the family unit caused by long term deployments. in order to minimize the amount of stress on the family unit and the member, programs and initiatives have been created to help provide the necessary blanchard/needs of air force single parents 92 support which results in minimizing the negative effects of long term deployments. while the military’s main focus is in responding to situations requiring military force they understand that by providing for the dependents left at home they can create an atmosphere where the service men and women can focus on the responsibilities of their jobs with the knowledge that their family left behind at home is supported by the branch of the military that they serve (segal, 2006). single parents who have completed the family care plan also know that their children are taken care of; however, the individual watching their children is most likely off base and not close to the services located on base. while the children have access to these services, by not being close to those services, it is less likely for them to be utilized. childcare is crucial due to an increase in the number of single parents and dual military career couples, along with their odd working hours, rotating shifts, deployment, and frequent moves. the defense department provides childcare in both child development centers and in homes. the dod currently oversees 800 child development centers (cdcs) located on military installations worldwide. these centers offer a safe child care environment and meet professional standards for early childhood education (military.com, 2011). child care is typically available through these centers for children ages six weeks to twelve years. military childcare facilities are certified to meet the standards of the national academy of early childhood programs (jowers, 1994). this accreditation is separate from the requirements set forth by the armed services and the defense department. other available family childcare providers and facilities are regulated by military officials. these facilities are specifically designed to accommodate military parents who work long and/or erratic hours (jowers, 1994). another program designed to help parents as well as children are military youth programs. they were developed to reach pre-teens and teens. these programs provide this population with structured activities. there is also a wide variety of programs that are designed for school-age children (jowers, 1994; air force child programs, 2011). mobilization deployment and relocation programs are designed to assist single and married service members cope with mobility requirements. the information and referral programs assist with answering questions regarding all aspects of military life, locating and facilitating personnel in fulfilling needs, and providing information about installations and communities, as well as about foreign customs, languages, and cultural differences. educational programs offer workshops and classes regarding parenting, stress management, self-esteem, and strengthening family ties (air force instruction, 363009, 2008; jowers, 1994). legal assistance is available for dealing with creditors, understanding rental contracts, solving personal financial problems, and other legal matters (air force instruction, 36-3009, 2008; jowers, 1994). conclusion and call for research in this dynamic environment, identifying opportunities to improve the support services provided to servicemen and women is a timely and worthwhile enterprise because of its capacity to contribute both to quality of life issues as well as the primary mission of the armed forces to remain combat ready. in this regard, wingo (2002) reported that: advances in social work, spring 2012, 13(1) 93 the military force must increasingly rely on women, thus, comprehensive family programs that recognize changes in military families… and improving policies regarding childcare are necessary to maintain combat readiness and to continue to recruit and retain highly skilled military personnel (p. 18). the studies done by researchers over the years have virtually ignored a substantial proportion of the population of the united states air force. although there has been some recent research on single parents serving in the armed forces, much is conducted on the army or the navy (taylor, wall, liebow, sabatino, timberlake, & farber, 2005). while the percentage of single parents in the armed forces should be decreasing through the recruitment policies and regulations of the armed forces, they are not. as long as the possibility of becoming a single parent still exists through a divorce or the death of a spouse, single parents will remain involved in the air force. as long as the proper instructions are followed and the family care plan created they will be allowed to remain on active duty. more research is needed with the population of military single parents in the areas of services addressing domestic violence, childcare needs, housing issues, and workplace challenges. however, what stands above all is the need to understand the issues facing this population because before any real policy changes can be made, one must understand the challenges and the strengths of this dynamic population. one of the themes that quickly emerges from the review of the relevant literature is just how few studies have been devoted to how best to provide timely support services for those on active duty, especially single parents. additionally, it has been indicated that there will likely be more single parents and more overseas deployment in the years to come rather than less (wingo, 2002). as wingo (2002) concluded when writing about military life: since it is not likely that there will be fewer global nomads among our population in the future, or around the world for that matter, there is room for even more research into the problems and advantages of this lifestyle (p. 31). references air force child programs. 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(1994). $2.7-billion plan drafted to enhance military life. los angeles times, sec. a, home edition. taylor, n. e., wall, s. m., liebow, h., sabatino, c. a., timberlake, e. m., & farber, m. (2005). mother and soldier: raising a child with a disability in a low income military family. council for exceptional children, 72, 83-99. u.s. code, title 10, armed forces, 2007. walker, a. j. (1985). reconceptualizing family stress. journal of marriage and the family, 47, 827-837. advances in social work, spring 2012, 13(1) 97 weber, m. (1978). economy and society (4th ed.). berkeley: university of california press. wheeler, w. t., & kiorb, l. j. (2009). military reform: an uneven history and an uncertain future. stanford, ca: stanford university press wilson, g. (1994). what’s going on here? navy times. wingo, j. d. (2002). growing up as a global nomad. minerva: quarterly report on women and the military, 20(3-4), 30-31. young, m. (1999). work-family backlash: begging the question, what’s fair? annals of the american academy of political and social science, 562(1), 38-40. author’s note address correspondence to lieutenant colonel samantha blanchard, director of behavior medicine, nellis family medicine residency, 4700 las vegas blvd n, nellis afb, nv 89191. e-mail: samantha.blanchard@us.af.mil microsoft word editorial vol 11_2 _________________ william h. barton, ph.d., is a professor in the indiana university school of social work on the indiana university-purdue university indianapolis campus. contact information: (317) 274-6711; email: wbarton@iupui.edu copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), i-iii editorial william h. barton welcome to the fall 2010 (volume 11, no. 2) issue of advances in social work. this issue ranks with one of the most extensive we’ve ever published. we have had the good fortune to receive many high-quality manuscripts, and reviewers and authors alike have responded quickly and capably to their respective reviewing and revising tasks. as a result, this issue contains 13 articles on a range of topics. there should certainly be something to satisfy the interests or curiosity of all advances readers. before previewing the current issue, let me remind you that the next issue of advances (vol. 12, no. 1: spring, 2011) will be a special issue on “social work and service learning in the age of competency-based education,” co-edited by virginia majewski and lisa mcguire. this special issue grew out of the conference “assessing professional competencies through service learning” held in indianapolis this past june. the deadline for manuscript submission for that issue has passed; the co-editors are hard at work shepherding the many manuscripts received through the peer review process. advances will also publish an additional special issue this spring or early summer focused on “military social work,” co-edited by james g. daley and anthony hassan (this one will be vol. 12, no. 1.5 so that issue #2 can remain consistently in the fall of each year). the call for papers for that issue remains open until march 15, 2011. those interested in submitting manuscripts will find more details in the announcement on the journal’s home page. one of the many advantages of the online, open-access format of the journal is that we have the capability of producing multiple issues, with the main cost being the dedicated time of the editors. but, as they shout in those late night television commercials, “wait! there’s more!” we will be publishing yet another special issue, this one scheduled for spring, 2012. its focus will be “global problems: local solutions,” highlighting the latest work on cross-border, cross-disciplinary, and cross-boundary practices that seek solutions at the local level to problems caused by global conditions. khadija khaja and joe varga will serve as co-editors. look for more details in an announcement on the advances home page soon. the current issue opens with an historical and epistemological treatise, “the role of science in postmodern practice,” by phillip dybicz. this article offers an original perspective that may intrigue and/or provoke those who have followed debates pitting science against practice wisdom. next up, stephanie k. boys (who holds the relatively rare degree combination of a ph.d. in social work and a j.d.) proposes that, to be effective in communicating with an audience of judges, social workers should consider using legal discourse to frame findings from social science regarding the issue of gay marriage. her article, “let’s talk about same sex: how social workers can make judges listen,” is especially timely, as the recent case in california (perry v. schwarzenegger) is unlikely to be the final forum for resolution of this issue. advances in social work, fall 2010, 11(2) ii the next two articles present findings from original research. from a survey of nasw members in new york, vicki ashton examines differences in the attitudes of professional social workers regarding corporal punishment and the perception and reporting of child maltreatment, according to the worker’s ethnic group membership. in “does ethnicity matter? social workers’ personal attitudes and professional behaviors in responding to child maltreatment,” ashton concludes that while approval of corporal punishment and perception of maltreatment differed according to ethnic group membership, ethnicity had no effect on the likelihood of reporting maltreatment. in “‘we have a lot of sleeping parents’: comparing inner-city and suburban high school teachers’ experiences with parent involvement,” david wilkerson and hea-won kim use a mixed methods approach to compare inner-city and suburban high school teachers’ reported experiences with parent involvement. wilkerson and kim suggest that parent involvement may be relatively devalued among inner-city teachers, who hold beliefs that parent competence is reduced by socioeconomic challenges. next are two articles examining the properties of measurement tools. in “evidencebased practice questionnaire: a confirmatory factor analysis in a social work sample,” karen rice, jeongha hwang, tina abrefa-gyan, and kathleen powell examine the psychometric properties of the ebpq (upton & upton, 2006), a tool developed to measure health professionals’ attitudes toward, knowledge of, and use of evidence-based practice (ebp). rice et al.’s results suggest that a slightly modified ebpq may be a useful tool to extend its reach to social workers. this is followed by sung hyun yun and robert d. weaver’s “development and validation of a short form of the attitude toward poverty scale.” they conclude that the short form is a feasible alternative to the original atp scale (atherton et al., 1993) for researchers and academics seeking to assess the poverty-related attitudes of university students. in the next article, “evaluating qualitative research for social work practitioners,” cynthia a. lietz and luis e. zayas argue that many social workers receive minimal training regarding qualitative methodology and how to evaluate qualitative research. building on the seminal work of lincoln and guba (1985; 1986), the lietz and zayas provide a concise framework practitioners and students may use to evaluate the trustworthiness and merits of qualitative research. the issue turns next to three articles concerning social work education. kala chakradhar and llena chavis describe the experiences of a group of faculty adapting to the context of distance education in “developing a pedagogy of itv teaching experience.” then, in “enhancing self-awareness: a practical strategy to train culturally responsive social work students,” nelini negi, kimberly a. bender, rich furman, dawnovise n. fowler, and julia clark prickett introduce the “ethnic roots assignment,” a teaching exercise to aid students in developing self-awareness. finally, sabrina williamson, carol hostetter, katherine byers, and pamela huggins present a qualitative analysis of practicum students’ reflections in “i found myself at this practicum: student reflections on field education.” they suggest that agency experiences help students see social work values and ethics in action, develop an awareness of themselves as social workers, and enhance their self-confidence. barton/editorial iii cynthia a. lietz returns, this time with kathleen l. andereck and richard c. knopf, to present a study of a strengths-based initiative in arizona intended to increase the quality and integration of human services. in “the breakthrough series collaborative on service integration: a mixed methods study of a strengths-based initiative,” the authors conclude that while the teams faced many challenges, they were able to be productive in initiating positive changes in their communities as a result of their commitment to the process, perseverance, effective communication, and creativity. in “strategies for engaging men as anti-violence allies: implications for ally movements,” erin casey presents the results of a qualitative analysis of interviews with 27 men who recently initiated involvement in an organization or event dedicated to ending sexual or domestic violence. she discusses themes that emerged regarding gaining access to such groups and delivering their message to potential allies. in the final article in this issue, “does police intervention in intimate partner violence work? estimating the impact of batterer arrest in reducing revictimization,” hyunkag cho and dina j. wilke present new evidence regarding this controversial strategy for responding to intimate partner violence. cho and wilke use data from the national crime survey (ncs) from 1987 to 1992 combined with the national crime victimization survey (ncvs) from 1993 to 2003 to examine the relationship between partner arrest and revictimization. results suggest that arrest of perpetrators is effective in reducing revictimization, controlling for victims’ characteristics and the nature of the violent incidents. so, something to do over the long holiday break! cheers! references atherton, c. r., gemmel, r. j., haagenstad, s., holt, d. j., jensen, l. a., o’hara, d. f., et al. (1993). measuring attitudes toward poverty: a new scale. social work research and abstracts, 29(4), 28-30. lincoln, y., & guba, e. (1985). naturalistic inquiry. beverly hills, ca: sage. lincoln, y., & guba, e. (1986). but is it rigorous? trustworthiness and authenticity in naturalistic evaluation. new directions for program evaluation, 20, 15-25. perry v. schwarzenegger, 591 f.3d 1147 (2010) upton, d., & upton, p. (2006). development of an evidence-based practice questionnaire for nurses. journal of advanced nursing, 54, 454-458. doi: 10.1111/j.13652648.2006.03739.x microsoft word 12-2692_ayon becerra_mexican immigrant families final ______________ cecilia ayón, msw, ph.d., and david becerra, msw, ph.d., are both assistant professors in the school of social work at arizona state university in phoenix. the research team would like to thank the participants for sharing their experiences and making this research possible. this research was funded by the silberman fund faculty grant program. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 206-228 mexican immigrant families under siege: the impact of anti-immigrant policies, discrimination, and the economic crisis cecilia ayón  david becerra  abstract: latino immigrants have historically faced many challenges living in the united states. the economic crisis combined with new anti-immigration policies and harsh enforcement strategies may exacerbate the stress and anxiety latino immigrant families already endure as a result of discrimination and financial hardships. the purpose of this study was to understand the current challenges latino immigrant families encounter within an anti-immigrant socio-political environment. fifty-two first generation immigrants participated in focus group sessions, which lasted between 90 and 120 minutes. the findings revealed that the economic crisis, anti-immigration policies, and enforcement strategies have had deleterious effects on latino immigrant families’ wellbeing. participants stated that their limited english proficiency and racial profiling were the basis for the discriminatory practices they endured. discrimination was experienced through instances of micro-aggression, as well as horizontal discrimination and institutional discrimination. implications for social policy, social work practice, and research are discussed. keywords: latino families, immigration policy, discrimination, economic crisis over the past several decades, numerous factors have influenced the rise of antiimmigrant sentiment and an increase in anti-immigrant policies in the united stated during the last century, wars have led to anti-immigrant policies and discrimination of japanese, korean, vietnamese, and most recently arabs and muslims in the united states. economic issues also contribute to anti-immigrant policies and discrimination. although immigrants have historically filled the demand for labor in the u.s., during times of economic hardship and high unemployment, immigrants are often used as scapegoats and blamed for taking jobs away from “real” americans. the economic recessions of 1990-1991, 2001, and 2007-2009 have contributed to the current antiimmigrant sentiment and the increase in anti-immigrant policies against latino immigrants in the united states (becerra, 2012). such policies directly impact latinos who represent 16% (or 50.5 million) of the u.s. population (humes, jones, & ramirez, 2011), of whom it is estimated 18 million are immigrants (grieco, 2010). this study sought to understand the challenges of latino immigrant families within an antiimmigrant sociopolitical environment. advances in social work, spring 2013, 14(1) 207   socio-political context in arizona impacting latino families a plethora of anti-immigrant legislations have passed at both the state and federal levels and have impacted the well-being of latino immigrants and their families. arizona has been at the forefront in anti-immigrant legislation. although the personal responsibility and work opportunity reconciliation act (prwora) of 1996 specifically prohibited undocumented immigrants access to public services (prwora; u.s. public law 104-193), the state of arizona passed proposition 200 in 2004 which requires proof of immigration status/id when applying for public benefits (i.e., medicaid/acccs, housing assistance, and tanf). state employees are also mandated to report anyone who is suspected to be undocumented to immigration officials, with failure to report leading to misdemeanor charges (furman, langer, sanchez, & negi, 2007). arizona has also passed several bills that impact the education of latino and immigrant students throughout the state. despite previous studies that indicated the benefits of bilingual education (combs, evans, fletcher, parra, & jiménez, 2005; mora, 2000), proposition 203 was passed in 2000. proposition 203 eliminated bi-lingual education and segregated children who were english language learners. proposition 300 passed in 2006, requires university students who are not u.s. citizens or permanent residents to pay out-of-state-tuition and eliminates their eligibility for financial aid. house bill 2281 passed in 2011, which banned mexican-american studies in arizona. the legal arizona workers act (aka employers sanctions policy) was passed in 2008. in accordance with this act, the state of arizona requires the use of e-verify to validate immigration statuses of all newly hired employees, and the state has the power to revoke or suspend business licenses if a company knowingly hires an undocumented worker. although this policy is meant to sanction businesses that hire undocumented immigrants, few have been sanctioned, and instead the immigrant workers have been subjected to worse treatment. evidence suggests that employers are using this policy to conduct exploitive practices, such as withholding payment or reducing pay rates significantly, while still requiring individuals to work the same number of hours, if not more (ayón, gurrola, moya-salas, androff, & krysik, 2012). since there are limited job prospects, such individuals have to endure these exploitive practices in order to support their families. arizona senate bill 1070 (sb1070) passed in 2010, requires individuals to carry documentation at all times and defines failure to do so as a crime. state and local police officers are also permitted to check the immigration status of individuals they suspect are undocumented (pew hispanic center, 2010). in 2012, three of the major provisions of sb1070 were struck down, but the u.s. supreme court upheld the “show me your papers requirement.” that is, police officers may question people’s immigration status if reasonable suspicion is present (liptak, 2012). meanwhile, since 2006 the maricopa county sheriff’s department has carried out “crime suppression activities” or community/workplace raids in order to identify and detain undocumented immigrants. ayón, becerra/mexican immigrant families and discrimination 208   latino family well-being and immigration family disintegration it is estimated that 6-in-10 latinos worry that they (themselves), a family member, or close friend will be deported (pew hispanic center, 2010). there are an estimated 5.5 million children with undocumented parents, approximately three quarters of whom are u.s. citizens (chaudry et al., 2010). deportations of parents presents a serious risk to children’s immediate safety, economic security, and well-being, as children are separated from their parents during critical stages of development (chaudry et al., 2010). as a result of parent-child separation, children experience changes in eating and sleeping patterns, excessive crying and clinging to parents, and aggressive and withdrawn behaviors (chaudry et al., 2010). barriers to health care immigrants experience many challenges in accessing health care and thus are less likely to utilize medical/social services than native-born individuals (kullgren, 2003; vega, kolody, aguilar-gaxiola, & catalano, 1999). access to care is severely limited by latinos lack of health insurance. latinos have the lowest level of health insurance coverage in the united states. more specifically, 57% of foreign-born mexicans lack health insurance (saenz, 2010). many latino immigrant families are unable to afford health insurance (cristancho, garces, peters, & mueller, 2008), are ineligible for employer-sponsored insurance (pitkin derose, bahney, & lurie, 2009), or do not understand different aspects of insurance policies (cristancho et al., 2008). individuals who have limited english proficiency (lep) encounter another set of challenges in accessing care (cristancho et al., 2008; pitkin derose et al., 2009). language access is part of organizational cultural competency (hilfinger messias, mcdowell, & estrada, 2009). access to bilingual providers, trained interpreters, translated written materials, and cultural and linguistic competency trainings for all staff are necessary to provide culturally competent services (hilfinger messias et al., 2009). evidence suggests interpreters are often unavailable or poorly trained (cristancho et al., 2008) and confronted with ethical dilemmas during practice (cristancho et al., 2008; hilfinger messias, et al., 2009). lep impacts the quality of care, increases the risk of misdiagnosis (hilfinger messias et al., 2009; ku & flores, 2005; ku & matani, 2001; pitkin derose et al., 2009; viladrich, 2006), and may exclude them from or delay receiving services (suleiman, 2003). discrimination the experience of discrimination among latinos has been exacerbated with the passage of anti-immigrant legislation. a 2009 study revealed that americans perceived latinos as the ethnic group that is most often subjected to discrimination (pew hispanic center, 2010). perceptions of discrimination vary among latinos with 70% of foreignborn latinos and 49% of native born latinos viewing discrimination against latinos as a major problem (lopez, taylor, & morin, 2010). concomitantly, latinos are subjected to racial profiling as assumptions and judgments are made about their documentation status advances in social work, spring 2013, 14(1) 209   based on their appearance and english proficiency. discrimination occurs at multiple levels. the implementation of policies or practices can marginalize or prevent whole communities from participating in society (mullaly, 2002). micro-aggressions are “brief and commonplace daily verbal, behavioral, and environmental indignities…that communicate hostile, derogatory, or negative racial slights and insults” (sue et al., 2008, p. 330). nier, gaertner, nier, and dovidio (2012) drew from antidiscrimination law and social psychological research in their analysis of sb1070 and the fair enforcement of its statues. they found that the ambiguity innate to what constitutes “reasonable suspicion” of unlawful presence in the united states, “paired with a lack of comprehensive training and ineffective testing procedures for detecting discrimination will likely result in many latinos being illegally targeted on the basis of their race” (p. 1). furthermore, in their investigation of the maricopa county sherriff’s office (mcso), the u.s. department of justice civil rights department found that latinos were subject to racial profiling and discriminatory practices (perez, 2011). the report states that the mcso’s deputies, supervisory staff, and command staff engaged in racial profiling of latinos including unlawful stops, detentions, and arrests of latinos; and unlawful retaliation against individuals who complain about or criticize mcso’s policies or practices. in addition, “crime suppression activities” or raids were often initiated in communities based on biasinfected indicators, such as individuals with “dark skin” or “individuals were speaking spanish” (perez, 2011). discrimination has deleterious effects on the well-being of latino immigrant families. perceived and actual discrimination prevents latino immigrants and lep individuals from accessing care and impacts their quality of care (keller, silberberg, hartmann, & michener, 2010). in addition, substantial evidence links discrimination to indicators of poor physical and mental health among immigrants and children of immigrants (ayón, marsiglia, & parsai, 2010; ding & hargraves, 2009; umaña-taylor & updegraff, 2007; williams, neighbors, & jackson, 2008). for example, chronic vigilance for discrimination may result in chronic stress and this can be detrimental to one’s health (brosschot, gerin, & thayer, 2006; williams & mohammed, 2009). sawyer, major, casad, townsend, and berry mendes (2012) found that latinas who anticipated prejudice experienced cardiovascular stress and increased psychological distress. among latino youth discrimination has been found to impact their educational process and has also been linked to anti-social behavior. foreign-born and native-born latino youth reported discrimination in their school context from teachers, white children, and horizontal discrimination or within group discrimination (córdova & cervantes, 2010). instances of discrimination included lower expectations by teachers, assuming gang membership or problematizing of latino/lep youth, and name calling. adolescence is a challenging time for any youth and when compounded by perceived/actual discrimination, youths’ health is placed at risk. after controlling for factors associated with antisocial behaviors, perceived discrimination remained a robust predictor of antisocial behavior among latino youths with the odds of antisocial behavior nine times higher when youths reported discrimination (rivera et al., 2011). ayón, becerra/mexican immigrant families and discrimination 210   this study examined the challenges latino immigrant families encounter within an anti-immigrant social-political environment. methods focus groups focus groups were used to obtain information on mexican parents’ perceptions on factors impacting families’ well-being. focus groups are often used with ethnic and low income communities because they are communitarian in style, stimulate dialogue among participants, and often feel safer than one-on-one interviews (genttlemen & winkleby, 2000; linhorst, 2002). seven focus groups were held at a community-based agency where participants received services. the focus groups were facilitated by the lead author, and trained research assistants attended the sessions as note takers and observers. the focus groups’ sessions ranged in duration from 1.5 to 2.0 hours. focus group data was collected between april and october 2010. sampling procedures and recruitment the participants were recruited from a family literacy program in arizona. following human subjects approval, the first author informed potential participants about the research project including the purpose of the study, confidentiality, potential risks and benefits, and eligibility criteria (i.e., first generation latino parents with young children). the participants received $25 remuneration to partially compensate for their time. participants fifty-two, first-generation immigrants/migrants participated in the focus group sessions. the sample consisted predominantly of mothers (n = 45, 86.5%) and one focus group that included only fathers (n = 7, 13.5%). the participants’ mean age was 36 years (sd=8.058) and each had an average of 3 children (sd=1.223). the majority of the participants were married (n = 36, 69.2%) or living together (n = 8, 15.4%) and the remaining were single (n = 5, 9.6%) or reported their status as ‘other’ (n = 2, 3.8%). over half of the participants had annual incomes below $19,999 (n=28 or 54%). most of the participants were mexican (n = 50, 96.2%), one participant was born in the united states. and raised in mexico, and another participant was from south america. participants had resided in the u.s. an average of 11 years (sd = 5.690). interview guide a semi-structured interview guide was used to facilitate the focus group dialogue. several topics were discussed including familial and community strengths, family needs and challenges, support networks, and services needed to promote family well-being. for the purpose of this study, we focused on participants’ stories on the needs and challenges experienced by families. participants were asked for examples and probing questions were used as needed. a short demographic survey was also completed. data was collected in spanish and translated for the purpose of this study. advances in social work, spring 2013, 14(1) 211   data analysis the procedures outlined by straus and corbin (1990) were used to analyze the focus group data. the transcripts were (re)read, labeled, and categorized using open and axial coding. open coding involved identifying and labeling each distinct incident or idea; categorizing the data by grouping concepts that represented similar phenomena; labeling or naming the categories; and developing properties and dimensions of the identified categories. in axial coding, connections between the categories and subcategories are made. axial coding contextualizes the properties of the phenomenon by identifying the causal conditions by which the phenomenon is manifested and examining the consequences of the phenomena. throughout the analysis, a constant comparative approach was used within and between focus group transcripts (charmaz, 2006; strauss & corbin, 1990). several steps were taken to enhance the trustworthiness of the study. the analysis was completed by the lead author and one trained research assistant, who discussed major themes and interpretations. the researchers referred back to transcripts whenever inconsistencies in the analysis emerged and discussed our understanding of participants’ comments. in addition, two additional focus groups were held to complete member checks with a randomly selected subgroup of participants (n =15). during the member checks, findings from the preliminary analysis were presented to the participants for their feedback on whether the findings were consistent with their experiences (armour, rivaux, & bell, 2009). participants’ feedback was incorporated into the final analysis. finally, in order to support the credibility of the findings, quotes were used extensively (charmaz, 2005). findings participants were asked to comment on the major challenges confronting latino immigrant families. the three overarching challenges shared by participants were discrimination, uncertainty, and a lack of jobs. at the root of the challenges faced by latino immigrant families were recent anti-immigrant legislation (i.e., sb1070) and the economic crisis that is confounded further by their status as immigrants. participants experiences of discrimination, uncertainty, and a lack of jobs impacted their lives in multiple ways. they described high levels of stress/depression and fear among all family members, family instability, and barriers to accessing care/assistance. economy – no jobs pues yo creo que ahorita con la crisis económica casi no hay trabajo. casi no hay trabajo y cuando hay no te lo dan por problemas de papeles o lo pagan muy barato. [well, i think that right now, with the economic crisis there is very little work. there is very little work, and if there is work, they won’t give it to you because you don’t have papers, or if they do, they pay you really low]. participants’ comments reflect statistics indicating that latinos experience a higher unemployment rate compared to the general population, 11% vs. 8.2% respectively ayón, becerra/mexican immigrant families and discrimination 212   (bureau of labor statistics, 2012). in addition, it is believed that foreign-born latinos may be the segment most adversely impacted by the recession (tan, 2010). la gente se estresa porque no hay trabajo. [people are stressed because there is no work].. también por falta de trabajo muchas familias se están desuniendo porque los señores se están yendo a otros estados o está quedando uno solo de mujer…o matrimonios se está deshaciendo. [and, also, because of the lack of work, there are a lot of families that are becoming less united because the men are going to other states or there are a lot of single moms left…or marriages are splitting up.] individuals who are employed are often enduring abusive working conditions where they are asked/forced to work more and are not compensated. this finding has been reflected in other studies following the implementation of the employers sanction policy (ayón et al., 2012). discrimination hacen falta leyes que pidan respeto para los latinos porque hay mucha gente grosera…pues sería la discriminación. [there is a need for laws that ask for more respect towards latinos because there are a lot of people who are rude…well, it is discrimination.] participants reported experiencing discrimination at an institutional and individual level. incidents of discrimination included discrimination based on limited english proficiency (lep), horizontal discrimination, micro-aggressions, and racial profiling. institutional level discrimination. immigration policies are becoming progressively harsher restricting the day-to-day functioning of latino families who are confronted by discriminatory practices through their interactions with various institutions. at an institutional level, participants reported being discriminated against by police, educators, and social services providers whose behaviors often reflect racial profiling. participante 1: los policías casi la mayoría también son racistas. si ven a una persona en cualquier carro no más que le vean cara de mexicano, de ilegal, lo paran por cualquier cosa y piden documentos que a veces yo creo que no tienen que pedir. eso, eso le da inseguridad a uno y ellos saben el temor que le está dando a uno por eso también digo el racismo de parte de los policías ellos saben con que atemorizar a uno y lo hacen. el sheriff te para hasta por un foco fundido, por un vidrio quebrado o por cualquier cosa. y eso ya es un delito grande para ellos y un problemón más grande para uno que se tiene que regresar. [most of the police are also racists. if they see someone in a car that kind of looks mexican, an illegal, they stop you for whatever reason and they ask for your documents. that sometimes, i think they don’t need to ask for, and that’s what causes insecurity. and they know the fear they are causing, so that’s why i say that exists racism from police, they know how to scare you, and they do what they do. the sheriff will stop you even for a broken light, for a broken advances in social work, spring 2013, 14(1) 213   window or anything else. and that is a big crime for them now, but an even bigger problem for those that have to go back [home country]. participant 2: ese es el pretexto de ellos para pararte y poderte pedir, que te identifiques y para empezar un, para poder reportar a la gente y pedirte documentos. si no lo tienes te piden el otro o bajo cualquier pretexto con tal de esposarte. [that is the excuse they use to stop you and ask you to identify yourself and so they can start, so they can report you and ask you for your documents. if you don’t have it they ask you for another one and under whatever pretext as long as they take you in.] participant 1: por eso te digo mientras para ellos es, es algo fácil mientras para uno es un problemón que se le viene encima. ¿y ahora que voy hacer, y ahora que voy hacer? [that’s what i’m saying, for them it’s easy meanwhile for us it’s a huge problem. and what am i going to do? what am i going to do?] these quotes illustrate racial profiling where participants feel assumptions are made based on their appearance. the use of racial profiling to implement sb1070 is one of the major arguments held against this policy. racial profiling is already evident as found by the u.s. department of justice investigation of the mcso (perez, 2011). furthermore, individuals who experience such treatment often do not know who to turn to for assistance. participants described the impact of discrimination by police officers and educators toward their children. before, children aspired to be police officers and teachers, because these individuals represented people who would assist them in a time of need. however, now, children fear these individuals. participante 1: si tu miras unos años atrás la policía eran los héroes de los niños todos los niños querían ser policía. ahora…miran a un policía y tienen aquel miedo porque dicen te va a llevar la policía…están perdiendo la confianza en la policía…[if you look a few years back the police were the heroes, all children wanted to be policemen. now… they look at a policeman and they have that fear that the police will take you away… they’re losing faith in the police.] participante 2: y los maestros tienen mucho que ver porque…por ejemplo mis sobrinitas en la escuela…la maestra le dijo, ‘a todos los mexicanos los van a sacar de este país,” entonces ellos son niños y empiezan agarran ideas…ellos no saben ni que ni nada y digo yo entonces que tipo de maestros son ellos de educar……[and the teachers have a lot to do with that… for example, my nieces in their school,…a teacher said, “they are going to kick all mexicans out of the country.” they are children and they start to get ideas…they don’t know what is right or wrong, and i think, what kind of teachers are they to educate…] participante 3: ya las personas que confiaban las criaturas que son los maestros…y los policías…ahora lo niños tienen miedo. [and now the people that children used to trust, like teachers… and the police… now they are scared of them.] ayón, becerra/mexican immigrant families and discrimination 214   in addition to fearing individuals who used to represent help (i.e. police officers and educators), children are exposed to hostile environments where they are bullied in school and tormented by teachers. es que los maestros como dijo ella también están exponiendo sus ideas que tienen. mi hija va a la high school y cuando firmaron la ley dijo que una maestra hispana dijo ‘pues yo estoy en acuerdo con esta ley porque ninguna persona indocumentada paga impuestos.’ le digo a mi hija, le digo pues si con el trabajo de tu papa que pagamos casa, víveres, comemos más o menos, a veces compramos ropa nueva. le digo y cuando va a ser sus impuestos él todavía tiene que pagar aparte de lo que le están quitando. como no vamos a pagar impuestos. tienen una idea muy errónea. mhm, muy mal le digo de la realidad que nosotros estamos viviendo. [teachers at school, like she said, are also voicing their ideas. my daughter goes to high school and when they passed the law, she said one of her hispanic teachers said, ‘well i’m in favor of the law because not one undocumented immigrant pays taxes.’ i told my daughter, i told her that, with her dad’s job, we pay taxes, rent, groceries we eat decently, sometimes we buy new clothes. i added, and when he goes and does his taxes he has to pay extra from what they are already taking away. how would we not pay taxes? they have the wrong idea. mhm, quite different, i tell her, from the reality we are living.] another participant shared, participante 1: …cada quien vive la discriminación […everybody lives in discrimination.] participante 2: de los mismos compañeros…escuchan lo que oyen en casa van y lo dicen en la escuela con los niños que no son de su misma raza, los que no hablan completamente bien el inglés, que no sea su color, por muchas razones. la discriminación vive y ahora que tienen la idea de separar hispanos con americanos. [from the same classmates… they hear what they say at home and they go and say it at school with the children that aren’t from their same race, the ones that don’t speak english fluently, that aren’t their same color, for a lot of reasons. there is a lot of discrimination and now that they have the idea to separate hispanics and americans.] participante 1. eso les va afectar muchísimo, muchísimo, muchísimo a ellos. [that is going to affect them so very, very, very much.] as described by participants, schools are becoming hostile sites where teachers make inappropriate comments and children are bullied. this is no longer an environment conducive to learning for latino children. language was reflected in most of the stories shared by participants. participants were aware that their inability to speak english prevented them from actively participating in u.s. society as shared by one parent who said that it impacts her ability to participate in her child’s education. advances in social work, spring 2013, 14(1) 215   sabe también a veces si uno no habla inglés se detiene mucho de participar en las cosas de las escuelas de los niños….va a reuniones [con los maestros] y muchas veces no hay traducciones…y uno muchas veces prefiere no ir a juntas ni nada de eso porque no entiende….entonces… no participa uno en las escuelas ni en los eventos de los niños en las escuelas. [you know, also sometimes, if one doesn’t speak english, you hesitate to participate in things involving the children’s school… you go to meetings [with the teachers] and a lot of the times there aren’t any translators… and a lot of the time, one prefers to not go to the meetings at all because one doesn’t understand… so… you don’t participate in school things or the children’s school events.] although most participants were enrolled in a literacy program and were in the process of learning english, their limited english skills were not enough. participants reported that they were confronted with service providers, such as the arizona health care cost containment system (ahcccs), who refused to speak in spanish even when they were able to speak spanish. language barriers impact their ability to access services, health care being one of them. participant a: em pues hay personas por ejemplo a mí me ha tocado…ver en ahcccs que [entre los trabajadores] la mayoría habla inglés, inglés y algunos trabajadores habla español. y a veces llega gente hablando español y dicen [los trabajadores] que no saben [hablar español]. entonces he visto mucha gente así que trata de no ayudar a la gente o hacerlas menos. [um, well, there are people that i have seen for example…in ahcccs that [among the employees] the majority of them speak english, and some employees speak spanish. sometimes people come in talking spanish and they say [the employees] that they don’t know [how to speak spanish]. so i have seen a lot of people that try to not help or make them feel less [because they can’t speak english]. participant c: y en cualquier lado, en todos los lados es así. [and everywhere, it’s like that everywhere.] participant b: y aunque hablen español no quieren hablar español [con uno] y uno se siente todo cohibido. [and even if they speak spanish, they don’t want to speak spanish [to you], and you feel inhibited.] [participant a: um well there are people that i have seen for example…in ahcccs that [among the employees] the majority of them speak english and some employees speak spanish. sometimes people come in talking spanish and they say [the employees] that they don’t know [how to speak spanish]. so i have seen a lot of people that try to not help or make them feel less [because they can’t speak english]. participant c: and everywhere, it’s like that everywhere. participant b: and even if they speak spanish they don’t want to speak spanish [to you] and you feel inhibited. ] ayón, becerra/mexican immigrant families and discrimination 216   in many examples shared by participants, it was front line workers who function as gate keepers to health care services who refused to speak in spanish or to get an interpreter to assist. the following participant stated that she continuously had to advocate for herself because although she is a u.s. citizen she was often refused services or treated poorly because she did not speak english well. a mí me pasa muchísimo simplemente por no hablar inglés siempre pido traductor, pero siempre me están discriminando. yo he reportado muchos doctores. cuando estaba embarazada me pasó…que no me querían atender y simplemente el doctor me decía es que traes plan de emergencia, ahcccs de emergencia….yo soy ciudadana americana…digo yo no debería de tener que hacer eso….yo siempre les alego. cuando yo fui a reportar ese doctor le dije a mi no me importa que yo sea indocumentada a mi me dan el servicio porque me lo tiene que dar. le dije aunque esta tarjeta sea de emergencia…ese no es problema de él. él tiene que dar su servicio porque a él le van a pagar aunque sea ahcccs de emergencia….osea muchísima discriminación. [it happens to me a lot simply for not speaking english. i always ask for a translator, but they always discriminate against me. i have reported many doctors. it happened to me when i was pregnant… they didn’t want to see me, and the doctor would simply say ‘you only have an emergency plan, ahcccs for emergencies…’ i’m an american citizen… i mean, i shouldn’t have to go through that… i always argue with them. when i went to report that doctor, i told them that i don’t care [even if] i was undocumented, you give me the services, because you have to give it to me. i told them that even if this card is just for emergencies…that is not his problem. he has to provide me with his service because they are going to pay him, even if it is ahcccs for emergencies… so, there is so much discrimination.] fortunately, this participant was able to advocate for herself and knew she had rights. this is not always the case. as stipulated by the emergency medical treatment act of 1986, hospitals that accept medicare payments are required to treat persons seeking emergency care and cover the costs if patients are unable to pay or have no insurance (dolgin & dieterich, 2010). hospitals have found caring for undocumented immigrants economically disadvantageous, and as a result, have turned to contracting with private agencies that will deport such patients (dolgin & dieterich, 2010; sullivan & zayas, in press). for example, it is estimated that st. joseph’s hospital in phoenix arizona repatriates 96 immigrants each year (sontag, 2008). individual level discrimination. participants also reported discrimination at an individual level; that is, in their interactions with community members, including latinos who were residents/citizens (horizontal discrimination) and other ethnic/racial groups. participants’ narratives revealed experiences of micro-aggressions in the use of verbal or behavioral racial slights and insults (sue et al., 2008). discrimination based on lep was carried into participants’ descriptions of discrimination at an individual level. instances of horizontal discrimination were often advances in social work, spring 2013, 14(1) 217   shared during the focus groups. the division among latinos, based on citizenship and immigration status, was often challenging for participants. discriminación hacia la misma gente y luego lo peor de todo es que la gente latina es la peor. los que tienen papeles son los peores, no digo que todos pero si mucha gente son bien racistas. si se ha fijado ahora en las marchas de todo eso los que apoyan la ley esa son más latinos, más chicanos, apoyando la ley más que gabachos, que afro-americanos. son más latinos que dicen ‘váyanse.”…incluso no son que hayan nacido aquí, que se hicieron después residentes o que después se hicieron ciudadanos son los que andan mas, haciendo discriminación. [discrimination against the same people, and what’s worse is that the latino people are the worst. the people that have their papers are the worst. i’m not saying all of them, but a lot of people are very racist. if you saw in the recent protests about all of this, the ones that support the law are more latinos, more chicanos, supporting the law than whites, or african-americans. there are more latinos saying, ‘leave.’…in fact, it’s not the ones that were born here, [its] the ones that later became residents, or later became citizens, are the ones doing more discrimination {discriminating}.] in the following quote, a participant shares another example of horizontal discrimination, and her quote illustrates that the passage of anti-immigrant policies have also reduced the tolerance for difference among communities in general. the standards that the participant is being held to (i.e., to speak english without an accent) also reflect instances of micro-aggressions. y yo he notado mucha diferencia porque he tenido mis propias experiencias porque trabajo de cajera ahí en la tienda 99. y antes de que entrara esta ley…la gente era más amable….y ahora que entro esa ley, yo he notado que la gente no quiere hablar español. la gente latina yo la saludo en español…y no me contestan en español. sé que me entienden porque me responden lo que les estoy preguntando pero me responded en inglés y ya no quieren hablar español. es rara la gente que llega y me habla español, todos mucho inglés inglés inglés inglés. y los gabachos o morenos también desde que entro esa ley si quieres platicar con ellos, decirles algo, saludarlos o si me preguntan algo y yo no sé responderles bien en inglés y a la primera palabra que me equivoqué me dicen ‘do you speak english?’ ya me discriminan y ya que ven que más o menos hablas te hacen mala cara…o dicen que quieren hablar con otro. y antes yo notaba que era diferente ellos también trataban a la vez de comunicarse con uno mismo y ahora ya a la primera le tuerce la cara a uno. [i have noticed a lot of difference because i have my own experiences, because i work as a cashier at the 99 cent store. before this law was passed… people were a lot nicer… and now that the law passed, i have noticed that people don’t want to speak spanish anymore. i greet latinos in spanish… and they don’t answer in spanish. i know they understand me, because they reply to what i’m asking, but they answer in english, and they don’t want to talk in spanish. it is rare that people who come will speak to me in spanish. everybody is english, english, english, english, and white or brown, ever since that law was passed. when you want to talk to ayón, becerra/mexican immigrant families and discrimination 218   them, or tell them something, or greet them, or if they ask me something, and i don’t know how to respond correctly in english, and the first time i make a mistake they ask, ‘do you speak english?’ and they discriminate against me, and if they see that you kind of speak english, they give you a dirty look…or they say they want to talk to someone else. and before, i would notice that it was different, they would also try to communicate with you, and now at the first mistake, they give you a smug face.] participants noted that such policies impacted how latinos were treated. participants often felt humiliated and reported a lack of respect for latinos. individuals were treated as second-class citizens or lesser beings, a form of micro-aggressions (sue et al, 2008). como ahora por lo de esta ley que si el mismo gobierno está haciendo que la gente nos falte el respeto, nos tratan peor que animales. yo digo que valoran más a un perro que a uno. porque si ven a uno perro ahí tirado lo levantan y lo llevan a curar y a uno no. [now because of this law, the government itself is making people disrespect us. they treat us worse than animals. i say, they value a dog more than one of us. because if they see a dog lying there, they pick it up and take it to be healed, and they don’t do that for us.] uncertainty participants live in a constant state of uncertainty. what will happen with the immigration legislation? what will happen with the economy? what will happen to our children if we cannot access health care for them? what will happen to our children if we do not return home one day? these are common questions participants raised throughout the focus groups. the degree of uncertainty in their lives seemed to be the most stressful aspect of their situations. participante 1: yo pienso que ahorita a nosotros todos los hispanos…tenemos un futuro incierto. porque nadie sabemos…yo tengo tiempo que tengo como dos semanas que estoy así, no sé, no sé qué va a pasar, no sé que voy hacer. pero sí me pongo a pensar y si me voy? y si no? y digo si me quedo y de verdad me pasa algo? te pones a pensar que tenemos un futuro incierto porque nadie, ni el que se va no tiene la culpa ni el que se queda tampoco. [i think that right now, all hispanics… we have an uncertain future. because none of us know. i have [for] some time, like two weeks [been] thinking like, that i don’t know what’s going to happen, i don’t know what i’m going to do. but i start thinking, if i leave? if i don’t? what if i stay, and something does happen? you start thinking, we have an uncertain future because it’s no ones, not the one that leaves or the ones that stay’s, fault.] participante 2: es un sentimiento, el sentimiento que lo que tú sientes te hace reaccionar. el miedo…[it’s a feeling, the feeling that you get that makes you react. the fear…] the uncertainty of their futures created much stress in their lives and participants often stated that they just needed some tranquility. – necesitamos tranquilidad. to advances in social work, spring 2013, 14(1) 219   illustrate the degree of uncertainty experienced by latino individuals who may be undocumented, or have undocumented family members, consider the chronology of sb1070. we ask the reader to imagine how one feels when one (or one’s family member) is waiting to hear back about the results regarding a potentially life-threatening disease. now consider experiencing those feelings for a time period exceeding two years. from january 2010 to june 2012, latino families have been awaiting the final ruling on sb1070. impact on families stress and depression. the economic crisis and anti-immigrant legislation impacts families’ health. participants stated that they were depressed, as a result of the recent antiimmigrant legislation. it manifested through their inability to sleep and eat, and carry on with daily activities. participant x: yo pienso que nos está dando hasta depresión, nos estamos enfermando. depresión por esta ley…[i think we are even falling into depression, that we are getting sick...depression because of this law…] participant ar: uh si. [oh yes.] participant a: yo me he sentido mal, hay veces que a mí no me dan ganas de nada. [i have been feeling bad. there are times when i don’t feel like doing anything at all.] participant an: ni de bañarse. [not even of showering.] particpant xx: no tiene uno fuerzas. [you don’t have the strength.] participant a: hay mucha gente que se ha deprimido yo me incluyo porque si, a veces que estoy bien y otros días que estoy con una tristeza y más que si a diario estas escuchando las noticias, en las noticias que cada día más gente se va…. [there are a lot of people who have fallen into depression, including me, because yes, sometimes, i’m okay, and other days, i have a sadness, and even more so if you are listening to the news daily. on the news every day, more and more people leave…] participants stated that the economic conditions they have endured also heightened the level of stress experienced in their households. parents have had to work hard to not lash out at their children or significant others. family instability. as stated earlier, many fathers left their families in search of work, and, as a result, families were disintegrating. at the same time, participants reported that parents who did have jobs, often had to work all day leaving their children alone. participants went on to say that even when children were left alone, the family was still barely making ends meet. participante 1: ¿sabe lo que ahorita está pasando mucho? que como muchas personas no tienen trabajo, están preocupadas y se descuidan de los niños porque uno como adulto dice, que voy hacer mañana? ¿que voy hacer o voy a ayón, becerra/mexican immigrant families and discrimination 220   salir, voy a buscar trabajo? los niños se quedan solos hay veces que en la casa y luego…[do you know what’s happening a lot now? well, a lot of people don’t have jobs. they are worried and they neglect their children, because one, as an adult, says, what am i going to do tomorrow? what am i going to do, or am i going to go out and look for a job? the children stay alone sometimes at home and then…] participante 2: la frustración, la frustración. [the frustration, the frustration.] participante 1 continua: empiezan ellos[los hijos] a sentir, dicen que caso tiene seguir en la escuela o que caso tiene esto o que caso tiene lo otro. y ahí es donde empiezan ya los jovencitos a salirse de la escuela, juntarse con malas compañías y esa es una de las cosas que ahorita. o la soledad de ellos, o que los adultos nos metemos en tantas cosas que…[they [the children] begin to feel, to say, what’s the point of staying in school, or what’s the point of this, or what’s the point of that. and it starts, that is, when the kids begin to drop out of school, hanging out with a bad crowd, and that is one of the things happening now. or their loneliness, or that we, adults, are so busy with things that…] participante 2: o por lo mismo, por el trabajo no estar en la casa uno. [or for the same reason, because of their jobs they aren’t home.] participante 3: por tener trabajo y por no tenerlo. [because of work and because of not having work.] participante 2: y por no tenerlo. [and for not having it.] participante 1: porque cuando tienen trabajo muchas veces tienen que trabajar todo el día y no tienen tiempo para los hijos. [because when you have a job, sometimes you are working all day and you don’t have time for your children.] fear. fear impacted the whole family. participants feared that if sb1070 was implemented as proposed, they would be at risk of multiple forms of abuse. one concern that has been prominent in the critique of sb1070 is that women in domestic violence situations who are undocumented will not seek help from police, placing them and their children at greater risk (spence, 2010). no deje que no vamos a llamar a la policía vamos hacer abusados totalmente, van a entrar a las casas, nos va a asaltar. van a ver…todas clases de abuso porque ya saben ellos tanto como morenos y blancos y de todas las razas ya saben que no vamos a poder hablarles a la policía. o sea vamos a ser víctimas …[we aren’t going to call the police… we are going to be completely abused. they are going to go into our homes. they are going to assault us. there are going to be…all kinds of abuse, because they know, no matter what, brown, white, or whatever race, we won’t be able to call the police. so we are going to be the victims…] children of all ages were aware that there were unsafe places for their families and they feared leaving their homes and what their futures would bring. consider the following quote: advances in social work, spring 2013, 14(1) 221   “…íbamos cada rato a wal-mart. y ya después, ‘mija vamos a wal-mart?’ ‘no mama ya no vamos a ir,’ dice ‘ahí está el sheriff.’ tres años y es no mas lo que escucha en las noticias y nosotros que platicamos…”[we used to go to wal-mart all the time. then afterwards, ‘want to go to wal-mart?’ ‘no mom, we aren’t going anymore’ she says ‘the sheriff is there.’ she is three years old and she knows just by hearing the news and us talk…] another participant stated, mi niña me pregunta también, tiene ocho años, me dijo un día, ‘¿mami cuando yo crezca y si ese señor sigue ahí también me puede hacer lo mismo?’ porque yo le dije tu estas chiquita a ti no te puede hacer, … ‘¿pero cuando yo crezca también me va a pasar?’ ósea ellos están atemorizados. [my daughter also asked me —she’s eight years old—one day she asked me, ‘mommy when i grow up and that man is still there, can he also do that to me?’ because i told her that since she’s little, nothing can happen to her ‘but when i grow up it will happen?’ so they are terrified.] barriers to care. as a result of discrimination and economic conditions, families experienced many barriers to health care. families experienced high levels of stress, fear, and depression. at the same time, they were unable to access care due to their documentation status or lep status. this was a major concern as often, children who are u.s. citizens are denied services. the following quote illustrates the inconsistency in the implementation of proposition 200. participante 2: porque me quitaron el ahcccs. yo no soy de aquí pero mi hija es de aquí y no puedo aplicar para ahcccs por no tener id. [because they took my ahcccs away, i’m not from here, but my daughter is, and i can’t apply for ahcccs, because i don’t have an id.] participante 5: ¿quién te dijo eso? [who told you that?] participante 2: si esa ley esta desde el año pasado o antepasado [yes, that law is from last year, or the year before…] participante 5: déjame te digo que estas en un error porque yo no aplicaba para ahcccs por los ingresos de mi esposo ahora [que se quedo mi esposo sin trabajo] tuvimos que aplicar. y fuimos aprobados y para nada me pidieron identificación y… [let me tell you that you are mistaken, because i didn’t qualify for ahcccs because of my husband’s income, and now, my husband was laid off, and we had to apply. we were approved, and they didn’t ask me for identification, and…] participante 2: a muchos según los mismos trabajadores si veían que no tenías id del estado de arizona, ellos mismos te mandan a migración. eso salía hasta en las noticias y puede ser que no sea cierto pero si crea miedo porque mucha gente ya no aplicó. [to a lot of people, if the employees saw that you didn’t have id from the state of arizona, they themselves would send you to immigration. that even came out on the news, and it might not be true, but it does create fear in a lot of people, because a lot of them haven’t applied.] ayón, becerra/mexican immigrant families and discrimination 222   discussion and implications the economic crisis has impacted most people living in the united states, but studies have shown that latinos have been more negatively impacted by the crisis than other groups (bureau of labor statistics, 2012; denavas-walt & smith, 2011). many politicians have portrayed undocumented immigrants as a drain on federal and state resources, and, as a result, an increased number of anti-immigration bills have been passed. sb1070 has cost arizona hundreds of millions of dollars in lost revenue (lacayo, 2011; national association of elected and appointed officials, n.d.) and exacerbated the problems many latino immigrants face such as discrimination, poverty, and access to quality health care, education, and employment. the findings of this study highlight the challenges that immigrant latino families in arizona face as a result of the current economic and political conditions. the participants expressed the confusion, sadness, frustration, and fear that they feel and how their children share these feelings as well. understanding how the current economic and political environment impacts latino immigrants has important implications for policy makers and social service providers. policy makers need to consider not just the economic consequences of a policy, but the social consequences as well. the participants indicated that they feared immigration enforcement as a result of new immigration policies. studies have found that fear of deportation for an individual or his/her loved ones can lead to mental health issues, particularly stress and anxiety (cavazos-rehg, zayas, & spitznagel, 2007; potochnick & perreira, 2010). the stress, anxiety, and depression that can result from constant fear of deportation only exacerbate the stress associated with adapting to a new country and culture (finch & vega, 2003). the recent anti-immigrant policies and increased enforcement of immigration policies, as well as negative depictions of latino immigrants in the u.s. media, have led to greater feelings of discrimination among latino immigrants (becerra et al., 2010). participants indicated they had encountered increased discrimination since the passage of new immigration policies, including horizontal discrimination from documented latinos, instances of micro-aggressions, and institutional discrimination. these findings are significant as discrimination is associated with negative health and social implications. for example, ayón and colleagues (2010) found that latino youths who had higher levels of perceived discrimination reported higher levels of internalized emotional issues, such as anxious and withdrawn depressive symptoms. in addition, perceived and actual discrimination can have a negative impact on latino immigrant families because their hope for a better life may be replaced by a sense of isolation and marginalization (finch, kolody, & vega, 2000; hancock, 2005). the marginalization of immigrant communities should also be a major concern for policy makers and social service workers. if a community is marginalized and people are excluded from meaningful participation in society, then not only will health and safety issues persist, but residents will never be able to achieve self-actualization. participants described how the anti-immigrant policies and enforcement of such policies have instilled fear and affected their daily lives. one participant described how her three-year-old daughter was afraid to go to wal-mart for fear of being apprehended by the sheriff. if advances in social work, spring 2013, 14(1) 223   families fear being apprehended and avoid conducting normal daily activities such as going to the store or interacting with others, then this will increase the social isolation of latino immigrant families (capps, castaneda, chaudry, & santos 2007). the strategies used to enforce immigration policies also played a role in increasing social isolation, as immigrant families feared being apprehended by police officers or being reported by social service providers – individuals who are meant to provide help and support. police officers and service providers were no longer trusted, yet serve as gate keepers to needed services. such efforts to enforce immigration policies have been found to deter political, social, and cultural integration of latino immigrant communities (romero, 2008). instead of fostering a sense of safety, the increased presence of police and immigration authorities and patrols in latino immigrant neighborhoods may have created a sense of fear and anxiety of constantly being pursued, as well as an increased mistrust of police (menjivar & bejarano, 2004). furthermore, participants in this current study expressed concern that anti-immigrant policies and enforcement were actually creating a dangerous situation for immigrants, especially immigrant women. if latino immigrants are fearful of apprehension and deportation, they may be hesitant to call police to report crimes, placing latino immigrants at greater risk of being victims of crimes. the findings of this study highlight the negative health and social implications that the economic crisis and immigration policies and enforcement have had on latino immigrant families. undocumented immigrant communities were already isolated from the majority population, and, despite the supreme court ruling striking down much of sb1070, anti-immigrant policies and enforcement strategies continue to affect immigrant families and entire communities. for example, although president obama initiated the deferred action for childhood arrivals, which allows undocumented immigrants who came to the united states as children to apply for a two-year temporary work permit, jan brewer, the governor of arizona, signed an executive order which prohibits individuals who received work permits through deferred action from receiving state benefits, instate tuition, or even drivers’ licenses. these inconsistent and often contradictory policies leave families in a state of fear and confusion, which may cause undocumented immigrant parents of u.s. citizen children to avoid applying for services their children are eligible to receive, for fear of being apprehended by immigration authorities. policy makers must understand that there are consequences that negatively impact people beyond the intended economic gains of targeting undocumented immigrants. in addition, social service agencies and practitioners must be informed and prepared to work with latino immigrant families under these current conditions. if people perceive that they are targets of discrimination and fear deportation, then even individuals in need of services may avoid seeking care from community and social service agencies. avoiding care, even in times of need, may create further health disparities between latinos and whites in the united states and lead to increased economic costs (berk & schur, 2001). social service agencies may not be prepared to work with latino immigrant communities because they lack bilingual/bicultural practitioners and staff. for example, martinez-brawley and zorita (2011) argue that, in addition to language barriers, social ayón, becerra/mexican immigrant families and discrimination 224   work curricula do not adequately prepare future social workers to work with immigrant populations. education for helping professions must do more to reflect the changing demographics of the united states and prepare practitioners to work with immigrant populations. community-based organizations must recruit, hire, and train bilingual/bicultural practitioners and staff to work with latino immigrant communities. it is also important that community-based organizations incorporate cultural and community strengths into social service delivery and community development efforts. community-based organizations should partner with public health officials, and state and county social service agencies to conduct outreach and education efforts regarding immigrant rights, as well as help address the fear and anxiety that latino immigrant families face in this current economic and political climate. future research is needed to further understand the impact of anti-immigrant policies and sentiment on latino and immigrant families, including the various forms of discrimination and oppressive circumstances experienced by immigrant families as a result of such policies. in particular, close attention is needed to examine the long term impact of discrimination on latino and immigrant children. in addition, research is needed to understand how helping professions are 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(2006). latino immigrant health in the us: a growing field amidst unraveling challenges. journal of latino-latin american studies, 2(2), 125-139. vega, w. a., kolody, b., aguilar-gaxiola, s., & catalano, r., (1999). gaps in service utilization by mexican americans with mental health problems. the american journal of psychiatry, 156(6), 928-934. williams, d. r., neighbors, h. w., & jackson, j. s. (2008). racial/ethnic discrimination and health: findings from community studies. american journal of public health, 98(supplement), s29-s37. williams, d. r., & mohammed, s. a. (2009). discrimination and racial disparities in health: evidence and needed research. journal of behavioral medicine, 32(1), 20-47. author note: address correspondence to cecilia ayón, msw, ph.d., school of social work, 411 n. central ave., suite 800, phoenix, arizona, 85004-0689. email: cecilia.ayon@asu.edu microsoft word costantino_rotabi_rodman_vaw asylum copyedit2 _________________ roselyn costantino, ph.d., is an associate professor of spanish and women´s studies at the pennsylvania state university altoona college. karen smith rotabi, ph.d., msw, mph, is an assistant professor at the virginia commonwealth university school of social work in richmond, va. debra h. rodman, ph.d., is an associate professor in the department of sociology and anthropology at randolph-macon college in ashland, va. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 431-450 violence against women and asylum seeking: global problems and local practices applied to guatemalan women immigrating for safety roselyn costantino karen smith rotabi debra h. rodman abstract: this paper, based on broader discussions surrounding gender violence and immigration in the u.s., provides critical information on the historical context of extreme violence against women and femicide plaguing central american societies today. drawing on experiences of precedent setting cases of guatemalan women, the authors offer suggestions for culturally specific treatment of and support for women who seek asylum in the u.s. out of justified fear for their and their family members’ lives should they return to their country of origin. the arguments presented are predicated on the belief that women worldwide share experiences of myriad forms of male domination and gender inequality which, however, play out differently on their bodies and lives in ways that must be accounted for in our attempt to offer them appropriate care and assist them in creating the tools they need to change their circumstances. key words: guatemala, femicide, violence against women, asylum, social work practice, immigration, battered women, ptsd, gender violence, trauma, interpersonal violence social workers in the united states have been committed to the welfare of immigrant populations and human rights dating back to 1889 with jane addams and the women of hull house (healy, 2008). these early service providers in the settlement house movement declared their belief in the fundamental dignity of all individuals regardless of their ethnic origins, gender, or age. they shared their commitment to provide aid so individuals could build responsible, self-sufficient lives for themselves and their families (addams, 1961). this tradition continues today, with the focus on providing a wide array of services for families as they adjust to life in the united states. those services, no longer carried out in settlement house communities but more broadly provided at the community level by nonprofit organizations and some government organizations, have constituted important resources for people emigrating to the united states. over the last decades, complex issues related broadly to globalization have placed increasing pressure on social work professionals to respond with a variety of interventions within many different human service arenas (lyons, 2006). notably, latin american immigrants, who comprise the largest immigrant group to arrive in the country in contemporary history (lopez & dockterman, 2011), have been the recipients of many of these services. as a result, it is imperative for social workers to learn about the sociopolitical and cultural dynamics of this diverse immigrant group. complicating the issues are intensifying political and social tensions in the united states over the legal status of both documented and undocumented immigrants (gomes & advances in social work, summer 2012, 13(2) 432 ross-sheriff, 2011). extremely divisive in nature, these issues place even more strain on a variety of health and human service resources. inherent problems include numerous linguistic, cultural, and legal challenges related to access to and delivery of care and, ultimately, the human rights of immigrant populations. numerous researchers have written about the phenomenon of violence as an immigration push factor (morrison & may, 1994; zolberg, 1989). the subject, however, has not been adequately explored in the social work literature. more study is needed to include considerations of how this global problem, extending across regional, social, cultural, and economic boundaries, requires local solutions (fischbach & herbert, 1997). our goal here is to identify social work assessment and advocacy practices specifically to assist asylum-seeking clients facing deportation, particularly women whose asylum case is based on violence against women. because of the brief nature of this article, we focus on guatemala as the country of origin based on our collective expertise, as we have acted as expert witnesses for survivors of violence from central american nations, most frequently guatemala. guatemala is the third most-violent country in central america (fox, 2012) and one of the most violent in the world for women (costantino, 2006; sanford, 2008). recent groundbreaking legal precedence in gender violence-based asylum cases related to this particular country are important for social workers to understand and consider when engaging with guatemalan women and others from neighboring nations with extreme levels of violence (e.g., júarez, mexico; honduras; el salvador). further, the authors have chosen to address guatemalan women, who, due to guatemala and u.s. geographic proximity and intertwined histories, constitute a large segment of the u.s. undocumented immigrant population. their cases present a broad view of the challenges service professionals face. with the goal of informing the practice of service professionals, the first section gives an overview of guatemalan immigration patterns and deportation dynamics. next is a historical overview of the origins of complex systems and attitudes underlying extreme gender violence in guatemala, with data to support assertions and discourse about the stereotypes and common misconceptions that interfere with providing appropriate care. then, through discussion of legal precedence and a brief profile of several cases representing significant successes and a painful loss, the article underscores critical approaches to the ethnic, cultural, linguistic, socioeconomic differences between the client and the social service provider and among the guatemalan women clients that effectively minimize the obstacles to a successful outcome. background guatemalan immigration patterns, deportation, and gendered dynamics approximately 4 million (3,998,200) central americans currently live in the united states (u.s. census, 2011); more than 2 of every 5 central american immigrants lack legal status, and 1 in 10 has some sort of temporary humanitarian protection (terrazas, 2011). while most are seeking economic opportunities, these numbers include a small but costantino, rotabi, rodman/violence against women and asylum seeking 433 significant group seeking to escape mental, physical, sexual, and economic violence. roughly 140,000 guatemalans arrive each year to join the more than one million who reside in the united states. guatemalans constitute the second largest national subgroup of central americans in the united states, after the salvadorans (cohn, 2010). of these guatemalans, the u.s. immigration and naturalization service deported 29,095 in 2010. over the last 5 years, deportations from the united states have increased by 200% (ghrc, 2011a). the nature of these deportations results in hundreds of unattended children being left behind, unaware and unprepared for the trauma that follows (gomes & ross-sheriff, 2011). often social workers intervene in cases of family disintegration as a result of deportation, including offering child protection and psychosocial support interventions. invisible in these and similar statistics are the complexity and intersectionality of the crises and the ways in which these affect women differently from men. the recognition of these differences and the intense labor of attorneys and advocates nationwide have resulted in numerous precedent-setting decisions. perhaps the most critical has been the precedent consisting of raising women to the status of a social group, a characterization that, considering women's history in all patriarchal societies, constitutes a given to women's rights advocates. precisely this designation created the possibility of abused women being granted eligibility for asylum, as it expands or creates nuances of legally stipulated asylum eligibility beyond persecution based on religion, political beliefs, race, and nationality. domestic and economic violence, genital mutilation, and sex slavery are among other gender-based crimes that may be considered for eligibility under this ruling. later we further explore the feminization of immigration in the context of guatemala’s extreme poverty and resulting social problems. guatemala: created and managed through violence similar to those of most central american countries, guatemala's political, social, economic, and cultural histories have been shaped, at least since the 16th century, by ideologies of domination enabled through violence (grandin, 2000, 2006, 2012). guatemala emerged from conquest and colonization: absolute rule by elites driven by wealth and power. roman catholic dogma structured institutions as rigid patriarchal hierarchies. small elites have designed economic policy to maintain control of the masses while exploiting their labor, most often with no regard for life. first spain and then the united states used military and nonmilitary intervention that continues to prejudice statecivil society relations. the diverse local populations—maya indigenous and ladino/mixed—consistently experience one of the largest income/wealth gaps in the world. guatemala’s 23 maya ethnic/linguistic groups, along with poor women and children from all ethnic groups, constitute the most vulnerable and excluded citizens; maya women, then, struggle the most. popular images and official policies have constructed the indigenous maya and women in general as naturally inferior members of society who, when they refuse to assimilate or follow social norms, require constant vigilance and supervision. women, particularly maya women, have been treated as disposable and their lives dispensable (costantino, 2012a; grandin, 2012), even as they advances in social work, summer 2012, 13(2) 434 have made and continue to make major contributions to the survival of their families and communities. a most significant and recent event to exacerbate the misery and “violence of everyday life” (chomsky, quoted in grandin, 2012, p. 32) is guatemala’s 36-year internal conflict (1960–1996). during this war, the longest and most brutal in 20thcentury americas (doyle, 2012), government, military, and paramilitary forces perpetrated genocide on the maya. with u.s. financing and training, they savagely tortured and murdered over 200,000 citizens—mostly indigenous maya—and disappeared tens of thousands more (doyle, 2012, p. 37). this war on civil populations created thousands of widows and orphans, and displaced over one million people (oficina de derechos humanos del arzobispado de guatemala, 1998). as has been done for centuries, soldiers used rape as an element of war, making women’s bodies the cultural symbol upon which the war played out. in the 1960s guatemalan military members trained for, practiced, encouraged, and were forced to rape, torture, and kill with an unspeakable brutality; they often displayed publically women's mutilated bodies to create even more terror (costantino, 2012a; oficina de derechos humanos del arzobispado de guatemala, 1998). very young girls to mature women were forced to serve as sex slaves. these crimes remain in almost complete impunity (myrna mack foundation, 2009; sanford, 2008). by the time of this writing, only one of the highestranking military generals responsible for the genocide has been arrested and awaits trial. another has been recently elected president (bbc 2011; doyle, 2012; national security archive, 2011; peacock & beltrán, 2003). against this enduring injustice, instead of peace and stability, the 1996 peace accords that ended the war ushered in an age marred by expanding militarization of civil society, intensifying nonmilitary violence, and a generalized sense of personal and collective insecurity as never before experienced—as it knows no ethnic, gender, socioeconomic boundaries. an explosion of ordinary crime, organized crime, drug trafficking by notorious mexican cartels, gang warfare, and, in the service of landed elite and multinational corporations, “death squads,…now legal security companies,” are ripping at the already tattered social fabric (grandin, 2012, p 33). guatemala is not truly “post-conflict,” but rather a nation with a majority population suffering from past trauma and injustice, and extreme present insecurity and need. the war on women: femicide this insecurity is magnified by the wave of femicide plaguing guatemala since 2001. femicide or feminicidio—the killing of females by males because they are female, and in ways that correspond to their sexual body—has reached epidemic proportions guatemala (costantino, 2006; sanford, 2008) with levels of brutality and frequency never before recorded in non-wartime. the femicide has spread to other central american societies, such as el salvador and honduras (central american women’s network, 2010). in guatemala and elsewhere, prosecution and conviction for gender and sexual crimes is almost nonexistent and almost absolute impunity for the perpetrator is the norm (ghrc 2009b). along with these more visible, “spectacular,” types of violence, guatemala's majority faces structural, systemic violence responsible for grinding poverty, high infant/maternal costantino, rotabi, rodman/violence against women and asylum seeking 435 mortality, food insecurity, chronic malnutrition, and illiteracy (lovell, 1995; morantaylor & taylor, 2010; morrison & may, 1994). these social problems are compounded by neoliberal economic policy and man-made environmental degradation; the last decade has witnessed persistent drought and devastating natural disasters. these stressors disproportionally affect women negatively, due to structural gender differentials in assets and earnings, all of which deepen related imbalances in access to education, health care, and physical mobility. due to the reality that guatemalan women are most often directly engaged in providing the basic needs of the family, the convergence of these stressors led to a "feminization" of migration patterns (diaz & kuhner, 2007; smith, 2006). religious factors increase the discrimination and violence women suffer as the result of unsympathetic religious leaders. roman catholic and evangelical christian constitute the two major religious preferences for guatemalan women. these churches, in tandem with nationalist discourses on family values (chant, 2006; costantino, 2006), insist on the woman's obligation to protect the integrity of the family unit regardless of her personal "discomforts." as a consequence of the traditional exclusion of women from economic and educational opportunities—even though her survival and that of her children are at stake—a power discrepancy remains entrenched in every aspect of her life, and by extension, her children’s lives (macculloch, 1998). women are shamed into staying with violent men. a woman without a male partner or husband—be she never married, separated or divorced, or widowed—is rendered dangerous in these discourses because her independence brings chaos into the order established by religious and other social institutions. thus, women, in these terms, require male vigilance and supervision. importance of social worker’s understanding of this complicated history and cultural transaction in practice why is this history important to service providers to guatemalan women seeking asylum in the united states? this knowledge provides insight into the socially formative discrimination, exclusion, abuse, and exploitation that drives women—poor indigenous maya and ladina—to emigrate, even as persistent fear, instability, and trauma follow them here (gomes & ross-sheriff, 2011). in addition, the profile provides a key to the savage viciousness with which men are attacking women. as part of the genocide and social reorganization, the military obliged thousands of civilian men and boys to serve in the civil patrol. there, they were forced to rape, murder, and mutilate members of other communities, their neighbors, and even their own family members. when the war ended, these males neither received nor had access to professional help to deal with the psychic trauma they experienced. nor did they have job opportunities or a way to support themselves or their families. thus, they had no chance to reintegrate into their communities, even if they survived the military’s scorched-earth policy. in addition, tens of thousands of regular military, paramilitary, and death squad forces who committed the genocide, still have the guns and skills to use in their private search for a life in a decimated economy. as a consequence, the cycle of violence bears down on the women, who suffer ever more severe devaluation, discrimination, and physical violence. advances in social work, summer 2012, 13(2) 436 while the historical background provides perspective to the violence individual men and larger social systems perpetrate on women, it does not foreground key insights into who guatemalan women are. guatemaltecas, as they are referred to in spanish, do not constitute a homogenous group, as cultural, socioeconomic, ethnic, linguistic, and religious differences are often substantial. geography also factors into their diversity. the history of women’s experiences, however, are not contained in national history, and as a result their resilience and the contributions they have made can be easily overlooked—a mistake for unaware social service providers whose concept of guatemaltecas is based on the image of a poor and illiterate peasant with minimal ability to help herself, let alone others who depend on her. however, on the sole evidence of making the typical liferisking mexico-u.s. border crossing in search of the security necessary to survive and provide for their children and other family members, guatemaltecas demonstrate physical and character strength, intelligence, and resilience. they reveal their resistance to myriad forms of violence that targets and inscribes itself on their bodies and psyches. this background information makes comprehensible indigenous maya and other women's willingness to risk their and their family's lives to escape to the united states. importantly, too, this brief profile suggests an additional fear they carry across two borders—guatemala-mexico and mexico-united states; that is, fear of the united states itself. while relatively few u.s. citizens know about the historical and present-day effects of u.s. economic, political, and military policy in guatemala, affected guatemalans recognize and still experience its power; its traces are engrained in their collective memory (grandin, 2000, 2012). how violence plays out on guatemalan women's bodies the above, necessarily brief, overview highlights the multiple sources of trauma guatemalan immigrants carry to the united states and allows us to trace the roots of the terror ingrained in women's corporal and psychological memory. data on the psychological effects of long-term exposure to violence, including interpersonal domestic abuse, reveal associations between that violence and mental health, observing psychological and physical consequences in the context of a woman's daily life, depression, stress-related syndromes, chemical dependency, substance use/abuse, and suicide among them (fischbach & herbert, 1997). guatemala remains statistically one of the most dangerous places in the world to be a woman and one of the worst in the americas to be a child (costantino, 2006; ghrc, 2009b). understandably, gender violence constitutes a principal reason guatemalan immigrants seek asylum, and injury and death are only the most visible consequences (fischbach & herbert, 1997, p. 1161). guatemalan women, mostly young single mothers or heads of family, feel forced to migrate northward to feed their children and maintain their families back home (smith, 2006). for other guatemalan women, however, risking their life to come to the united states illegally is the last chance to save their own and often their children's lives by escaping severe physical and psychological abuse and death. statistics confirm that their sense of terror is warranted. in 2010, police received 4,600 reports of domestic violence in that country of approximately 14 million inhabitants and the size of tennessee. experts believe these statistics to be low, as most costantino, rotabi, rodman/violence against women and asylum seeking 437 cases go unreported for fear of retribution by a male partner, husband, other family member or other man implicated in the crime, or the police to whom it is reported (guatemala human rights commission/usa [ghrc], 2009a). in 2010, men raped, tortured, and brutally murdered more than 800 women and girls in a surge of femicides. since 2001, men have brutally murdered more than 5,000 guatemalan females of all ages (3–81), social classes, and ethnicities. for the shock factor, they often leave the mutilated and dismembered bodies and body parts around town in public spaces. of those cases of femicide, 99% remain in impunity. (ghrc, 2011b). this gendered killing, covered regularly and explicitly by the media, reveals an institutionalized misogyny and a sense of superiority and impunity ingrained in the masculinist psyche of that nation (costantino, 2006). millions of women, especially those in indigenous rural and poor urban areas, live with ongoing trauma, as the escalation of violence profiled above impacts their security directly and with deadly consequences (amnesty international, 2006; costantino, 2006; myrna mack foundation, 2009). so unstable and insecure is life for guatemalan women that in 2010, secretarygeneral of the un ban ki-moon designated guatemala as the first un site for its new global initiative to fight violence against women. he explained that guatemala was selected because, although in 2008 women's organizations successfully pushed through passage of the "the femicide law," the incidence of femicide increases. this law is considered to be the first of its kind in the world, as well as the most comprehensive and progressive, as it codifies and sanctions a broad spectrum of types of violence against women. the state, however, has utterly failed to implement the new legal responses and protections made available through the law (guatemala human rights commission 2009c). guatemalan children, too, pay a high price for systemic and structural gender violence. unicef data from 2007 show guatemala to have the highest percentage of chronically malnourished girls and boys in the americas (over 50%, 80% in indigenous areas) and the fourth highest in the world (nybo, 2009). rates of infant mortality put guatemala second after bolivia (kühlen, 2008). the un international labour organization found guatemala to have the highest rates of child labor in central america. an estimated 1 million children work, 12,000 between the ages of 5 and 7; 56% of them are indigenous (avendaño, 2011). while these statistics shed light on why women risk everything to escape to the united states, concomitantly, they disembody the injustices and crimes committed. it is precisely the body and psyche of the violated woman that concerns us, as advocates for human and women's rights. we all struggle against corruption, indifference, hypocrisy, and pure self-interest that perpetrate and perpetuate violence against women. recently in the united states, social workers, legal advocates, women's rights defenders, and healthcare providers have had to confront these conditions of abuse as they come into contact with guatemalan women who seek asylum in the united states. advances in social work, summer 2012, 13(2) 438 survivors of violence, asylum seeking, and effective interventions the terrorizing lack of security in both public and private spheres for guatemalan women, indigenous maya, and, although not discussed in this paper, gay and lesbian citizens, render them appropriate for asylum (central american women’s network, 2010). since 2009, in response to the cases of a mexican and a guatemalan woman, the u.s. department of homeland security in a landmark decision ruled that abused women constitute a social group requiring special attention, and as such are eligible for asylum (preston, 2009). gender-based violence is a global issue, and advocates' arguments for asylum are predicated on the belief that women worldwide share experiences of myriad forms of male domination, gender inequities, and power imbalances. even in developed countries or high-resource countries, researchers are identifying “deeper associations between domestic violence and a broad range of serious health and social problems” (fischbach & herbert, 1997, p. 1161). fischbach and herbert (1997) note that in regions like central america, with scarce material resources and greater social and political disruption, oppressive government structures, systemic non-enforcement of law, and high rates of impunity, the impact on women is magnified. according to the context in which the women exist, however, these forms play out differently on their bodies, psyches, and lives in ways that must be accounted for in our attempt to offer them appropriate care and assist them in creating the tools needed to change their circumstances. the physical, emotional, and psychological consequences of this violence on women places increasing specialized demands on social service providers (jones & horan, 1997). they must respond not only with appropriate language skills and cultural sensitivities, but also with a range of social services that, to be most effective, require additional knowledge about the client, her home country, and her particular culture (gomes & rosssheriff, 2011). in addition to physical medical care, clinical services with an emphasis on trauma are critically important as individuals make significant cross-cultural adjustments while reconciling past human rights violations (burnett & peel, 2001). social workers are often asked to assist with identifying low-cost legal resources and to offer expert testimony on the individual’s trauma from violence, as this relates to legal grounds for asylum seeking, both previous persecution and ongoing fear of reprisal and violence. building a legal case while being sensitive to long-term treatment we authors have acted as expert witnesses for survivors of violence from central american nations, most frequently guatemala. paramount to successfully assisting abused asylum-seeking central american clients facing deportation, social service providers must design effective programs to make the legal case for asylum by first establishing a clear profile of the violence in context. such strategies require exposing the structural, systemic, and culturally embedded exclusionary practices that have a material impact on the woman. the diagnosis and treatment vocabulary for women escaping gender violence in guatemala and seeking asylum in the united states has both medical and legal consequences. some experts have cautioned against using the term "battered woman syndrome" and its vocabulary in preparing both a treatment plan and the legal case. they find using costantino, rotabi, rodman/violence against women and asylum seeking 439 “post-traumatic stress disorder,” the symptoms of which overlap with the battered woman syndrome, more efficient by avoiding the emphasis on pathology and not on a broader picture of the woman's and others' responses to the battering (dutton, n.d.; walker, 1991). by not recognizing women's strength and efforts, dutton posits, the term battered woman syndrome perpetuates stereotypic images of battered women that, in the courtroom, "may inadvertently communicate to the jury or judge the misguided notion of an ‘abuse excuse’" (dutton, n.d.; gordon & dutton, 1996; walker, 1991). from a feminist perspective, classifying the trauma suffered as ptsd rather than battered woman syndrome stresses the ubiquity of this power inequality and the apparent abnormal nature of the stressors. ptsd takes the blame away from the individual woman, which is a significant goal when dealing with women from guatemala. similar to the stereotypes of other “third world” women, they are seen as submissive and overly religious women who accept abuse by macho men because that’s just the way it is in cultures south of the rio grande. in other words, battering is a natural, accepted part of their culture, and they are as helpless as children (costantino, 2012b, in press). countering these misguided cultural visions can make the difference between life and death for the abused woman. recognizing and aiding the woman to (re)discover her strengths and resilience are key to her taking "responsibility" and therefore credit for her recovery and adjustment. even the language we use to classify or describe the elements of the case affects our and others' understanding, decision-making, and social service practice. the term macho is an easy catch-all dismissive classification—it is an overused, deceptive, and even dangerous noun or adjective, as it assumes in its construction (machismo originates from spanish) that the root of the problem lies in hispanic/latino/spanish cultures. yet, the data on domestic abuse in the united states prove otherwise: one in every four women in the united states will experience domestic violence in her lifetime, and the number of women physically assaulted by an intimate partner each year is estimated at 1.3 million (national coalition against domestic violence, 2007). macho creates a convenient or safe us versus them dichotomy that can interfere with the approaches to aid guatemalan (and other hispanic or latina) female clients. the victimology shifts; sympathy comes to replace empathy. the strategy of helping the less fortunate (i.e., inferior, less capable) substitutes the empowerment of strong, resourceful women subjected to an individual man's or patriarchal institutional abuse. this latter abuse, when naturalized and ingrained in all social relations and institutions, renders the abused woman increasingly vulnerable as world economic crises proliferate; as militarization and intervention, in service of economic interests, intensify insecurity; and as climate change and man-made environmental devastation (open pit mining, dams, deforestation) drastically influences food production and plunge the majority of guatemalan women into already extreme poverty and chronic food insecurity. caring for battered women in one's own social setting is challenging; to suddenly be confronting the layers of post-traumatic stress that guatemalan women come with is daunting. not only do cultural differences pose challenges on the social worker–client relationship, but language can be a significant obstacle. many guatemalans speak spanish, and because approximately 50% of guatemalans are indigenous maya, they speak one of 22 mayan languages that can be so distinct as to require another native advances in social work, summer 2012, 13(2) 440 speaker of that language to translate from the mayan language to spanish and then english—as has been one author's experience. in some rural areas of guatemala the majority of women are illiterate (macculloch, 1998). in addition, maya women and poor ladina women have a deep, justifiable, suspicion of the medical establishment and intense fear of police and members of the judicial system. in the immediate present, we need to engage in a self-reflexivity that would uncover our own preconceived notions about guatemala, guatemalan women, and/or abused women from any developing, “third world” country. we must continually work to create platforms for locating and then correcting the core causes of gendered violence nationally and internationally: the power inequality between women and men. our differences may be greater than our similarities, as across cultures and geographies, identities are constructed from varying worldviews. one enduring commonality that women across the globe do share in varying degrees, however, is the inferior status allotted us by powerful social institutions—the state, religion, education, economic policy, healthcare systems— that implicitly or explicitly condone abusive gendered behavior and resist change in the paradigm. knowing the facts about the context from which guatemalan women come, then, is essential to designing approaches and practices to intervene with and help resolve conflict within a woman (inferiority complex, ingrained trauma) as well as between her and her family. case examples for a deeper understanding including legal precedence two cases have significantly influenced the discourse surrounding and the precedence for granting asylum in the united states: guatemalans rody alvarado peña, who requested asylum and withholding of deportation in 1996, and mindy rodas, whose brutal murder upon her relocation to guatemala from mexico informs expert witnesses' supporting arguments for granting asylum in similar cases before u.s. immigration courts. knowledgeable and culturally sensitive social service providers and client advocates are more important than ever, as the immigration debates in the united states become increasingly vitriolic and less based on constitutional and international human rights law and treaties to which the united states is signatory. the surge in violence against women and femicide related directly to economic, political, and climatic crises are affecting women disproportionately. the case of rody alvarado provides an instructive example. alvarado's legal counsel for her appeal, karen musalo, forced the hand of the court to recognize women as a social group, and alvarado as a member of that social group (elias, 2010; university of california, 2009). in this way, the outcome of alvarado's petition for asylum goes beyond her right to remain in the country to include the expansion of this category of the eligibility for asylum under international and u.s. law. in alvarado's case, the court established a social group "defined by immutable characteristics and fulfilled the new social visibility": abused married women in guatemala unable to leave a relationship (u.s. department of homeland security, 2004). costantino, rotabi, rodman/violence against women and asylum seeking 441 for more than 10 years, rody alvarado's husband abused her in horrific ways. a former soldier with continued ties to the military, he repeatedly beat her unconscious, raped her, and kicked her until she hemorrhaged; he broke mirrors and windows with her head, pistol whipped her, and threatened her with a machete. each time she attempted to get away from him, he found her and the abuse intensified. when alvarado turned to the guatemalan police and courts for protection, they refused to intervene in what they considered "a private matter." she attempted suicide and finally fled to the united states seeking asylum, leaving her two children with her mother in guatemala (elias, 2010). alvarado spent 14 years in an immigration status limbo in the united states. after being granted asylum the first time in 1996 by an immigration judge in san francisco, the immigration and naturalization service had the ruling overturned and asylum denied. the majority ruled that her claim did not "lie in our asylum laws as they are currently formulated" (shelton, 1999, n. p.). this denial was then appealed and it took advocates and legal experts more than a decade to reverse it and establish new precedents in case law. the story of mindy rodas is emblematic of the crisis of violence against women and impunity in guatemala. mindy's husband attempted to kill her by drowning, after slicing her face with a machete. this happened after he came to their home with another woman and announced he was leaving mindy to live with this new partner. mindy said, “fine, i don't love you anymore,” which enraged him. he attacked mindy near a river and then left her for dead, but she survived. she received legal and economic support and medical care in mexico to reconstruct her face. during this time after the attack, mindy made a video in which a blue surgical mask hid her remaining facial disfiguration. she described what her husband had done to her and she encouraged abused women to come forward and reject the abuse (rodas, 2009). mindy still experienced post-traumatic stress, depression, homesickness, and the desire to commit suicide. consequently, in mid-2010, she returned to guatemala from mexico to see her family. it should be noted that mindy was in mexico to seek treatment including cosmetic surgery to rebuild her face, and also as a safety precaution—as the mexican first lady intervened by advocating for medical care and other services for mindy, and welcomed her to remain in mexico. mindy, however, felt compelled to go home, and on december 17, 2010, once back in guatemala, she disappeared. her body was found the next day far from her small town, tortured and strangled to death (ghrc, 2011b). because she was found in guatemala city and there is no national register of missing persons, another month passed before her mother learned that mindy's unidentified body had been found the day after she went missing and then buried in a cemetery with an xx or joan doe designation (portenier, 2006). mindy joined the thousands of other women who have disappeared with joan doe status. some women, nonetheless, who attempt to escape such violence have recently won their asylum cases in the united states. three such cases are now presented to further illuminate recent asylum rulings. advances in social work, summer 2012, 13(2) 442 the case of m.o. and rosa the facts of rody alvarado and mindy rodas cases are known because of media attention and documentation made by human rights defenders, and in mindy’s case, by making her own testimonial video (rodas, 2009). there are, however, many other cases which unfold in relative silence. this following case is a composite of one which a mother and daughter were recently granted asylum in the united states in the fall of 2011. it is offered as a composite to guarantee confidentiality. m. o. left guatemala as a 25-year old woman with her infant daughter rosa. she crossed the border by a dangerous journey through mexico and across the desert. m. o. chose that route as the lesser of evils—she was escaping the abuse of her husband who had repeatedly threatened to abduct her infant daughter and sell the child into human trafficking networks. because m. o. had lived in fear of her husband for many years, after extreme physical beatings and humiliation, m. o. had credible fears of violence and child abduction (estrada zapeda, 2009; rotabi, 2012, 2009, in press). when the authors presented expert testimony to the court, the context of violence against women formed the basis for m. o. and rosa’s case, just as alvaro’s case demonstrated. among the facts incorporated were both the rates of femicide and the general lawlessness related to impunity. testimony included the second author’s expertise in child abuse and abduction in guatemala, including nefarious networks of child trafficking. on examination, the most critical aspect of testimony was twofold. first, the history of abuse that m. o. experienced at the hands of her estranged husband was primary to establishing a familial context of fear nested in the larger community or societal level violence. then secondly, the history of child abduction in the nation and an absence of law enforcement response (estrada zepeda, 2009; rotabi, 2012, 2009, in press) constituted critical factors in the final determination of asylum—both mother and daughter were granted asylum. the case of l. l.: beyond a narrow definition of violence against women not all cases are so clear, however. another example of women seeking asylum illustrates the complexity of gendered violence and the impunity that reigns for those who seek to harm women. more importantly, it shows that the relationship between the asylum seeker and the perpetrator is not necessarily clear in domestic situations. social workers need to be sensitive to the fact that men in guatemala (for example, those in and with power, such as former military and landholders) can make a claim on women who are not their domestic partners. recently, the third author of this article served on two cases in boston federal court that resulted in successful asylum claims. the women’s asylum claim was based on complex stories in which the abuse was not clear cut; the perpetrators were not the women’s former or legal domestic partners, but had made some sort of “claim” on them. in one case, the woman had some interest in a military officer that she met through her brother. on several occasions, she had contact with the man while she was visiting her brother in the military. although her brother warned her about the violent nature of his commanding officer, there was some flirtation until the officer attempted to sexually costantino, rotabi, rodman/violence against women and asylum seeking 443 assault her. when the brother tried to intervene with the officer in his attempts to seduce the sister, the officer became violent. afterwards, the officer was transferred to another military installation and the applicant went on to marry and have children. over the years, however, the officer continued to pursue her and enter her life periodically. although they were never in a domestic relationship, as far as he was concerned, she belonged to him, and consequently, the applicant and her family lived in fear. this and other similar cases are successful because the lawyers and expert witness had a clear understanding of the larger systemic nature of impunity and gendered violence, and thus were able to argue such cases more effectively. the judge granted asylum based on his interpretation of a previous case in the matter of l. r., in which mexican women became an eligible social group based on their on their inability to leave a domestic relationship, or they are viewed as property by virtue of their positions within a domestic relationship. even though these two cases were not women who were in domestic relationships with their abusers, the lawyers and judges had a very nuanced understanding of gendered violence, of how women can be forced into a “relationship” without consent, and their resistance to the relationship is life threatening. social work practice implications: from global social problem to local practices women seeking asylum for reasons of violence, past persecution, and/or fears of future violence have multiple and diverse needs. two areas will be considered for this brief discussion: clinical needs related to trauma and other mental health issues, and expert testimony. it is important for social workers to understand that asylum seekers have been found to have a higher incidence of depression, anxiety, and other health conditions compared to the general population. also, they often experience social isolation in a new country of residence (burnett & peel, 2001). and while social workers may make an assessment that counseling is needed, they must recognize that women originating from traditional societies may not find such an intervention to be comfortable or appropriate, and may resist. social workers should begin by assuming that the conceptions of counseling—in a clinical setting—is quite foreign to many women and, when possible, the women would prefer to seek help privately in the family or community group (burnett & peel, 2001). language and a client’s perceptions of the power of the service providers can both pose major challenges. relevant to these cases, one practice with a great deal of promise for helping women seeking asylum is the development of mutual aid opportunities, such as connecting with other women in a similar situation or even peer counseling. such an intervention, based on informal social support, may be the best approximation of the care a woman would seek in her community of origin. in order to make an assessment of appropriateness of the asylum petition, a psychological evaluation is a common practice—specifically a trauma assessment that will be used in court proceedings. this particular aspect of the investigation is critically important but often intrusive and brings up difficult memories that the survivor may prefer to forget (burnett & peel, 2001). as a result, a clinical social worker engaged in advances in social work, summer 2012, 13(2) 444 such an assessment must understand the social dynamic and consider how to approach the survivor’s history in a way to both develop a strong assessment and avoid any further trauma. ultimately, this may be impossible, but the social worker should proceed with the greatest of caution in this clinical aspect of building a case. a second expert witness is frequently consulted on the state of domestic violence and societal violence in the particular nation of origin. this is a particularly important aspect of developing a strong case and we authors have all participated as experts on the societal and family dynamics in guatemala as well as other nations. it should be noted that this particular “expert witness” may be a social worker but not necessarily—experts come from a wide range of disciplines, including anthropology and women’s studies. ultimately, it is not the discipline of this individual that is central, but rather the role she or he can play in developing strong testimony on the state of violence in the country of origin and on the unique issues each case presents. this dimension of asylum-seeking strategy cannot be underestimated and it is our position that a highly articulate expert witness with years of research and practice experience in the country or region of origin can make the difference between winning and losing a legal case. testimony carried out by such experts must be targeted and based on current data and case examples contextualized in guatemala’s history of violence against women and impunity.1 this is notable because clinical assessment for trauma and intervention by master’s-level practitioners, such as licensed clinical social workers, is entirely appropriate and is likely the best strategy for ongoing practitioner care, given social work’s commitment to developing support networks, using culturally appropriate interventions, and upholding deeply held values related to social justice and gendered oppression. ultimately, all of these aforementioned practice activities fall under both clinical and advocacy domains. navigating such a terrain for a social worker who may come into contact with a violence survivor from guatemala or other central american nations requires knowledge of the problems that have been outlined in this article as well as other competencies, including language skills or access to interpretation services for spanish and often maya indigenous languages. making appropriate referrals for legal assistance and offering culturally sensitive care constitute a necessary and often a daunting process for social workers. conclusion the knowledge of the evolution of guatemala’s masculinist and racist ideologies and the practices we design to address them are intimately interrelated and essential to effectively intervening for women. while the focus here has been on guatemalan women, 1 it should be noted that most frequently this particular work is carried out by doctoral-trained witnesses (phd credential) as immigration judges prefer to hear from professionals with the highest of academic credentials in this particular aspect of case assessment. this assertion is made because master’s-level practitioners who have engaged in this sort of expert testimony have experienced questioning of qualifications to make an opinion while doctoral-level witnesses are rarely challenged. this is particularly true when they have a research/publication record in the country and region under consideration. costantino, rotabi, rodman/violence against women and asylum seeking 445 their reality is shared with women in other central american nations with similar past and present conditions; they are also experiencing elevated rates of violence against women (central american women’s network, 2010). also, women in some areas of mexico should not be excluded, including júarez with its notorious problems of violence against women (fregoso & bejarano, 2010). differences in identity between groups of women and among individual women in any one country require social workers and advocates (e.g., expert witnesses and others) to create flexible frameworks from which to evaluate each woman's crisis. without false cultural prejudice, we must empower her to self-assist, to imagine and use adequate actions. first, however, she must remove herself and/or be removed from immediate danger, and then begin the process of building a "self." this approach is time sensitive, since in the case of central american women, the danger may follow them to the united states, where they may still lack any meaningful support system. advocacy is a core social work function. advocating for changes in foreign policy or change in a sovereign nation is consistent with the national association of social workers (nasw) code of ethics, particularly section vi that focuses on global problems and our obligations to act (nasw, 1999). we have found such action to be fundamental in forcing the u.s. legal system to confront any and all gendered and racial/ethnic biases—whether rooted in misinformation, government policy pressure, or personal prejudice—that interfere in applying asylum laws equally and without prejudice. in addition, central american states remain “locked into the u.s. sphere of influence” (grandin, 2012, p. 34), and this unbalanced relationship still bears heavily upon the violence women experience in their home countries, their ability to address that violence, and the 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(1989). the next waves: migration theory for a changing world. international migration review, 23(3), 403-430. author note: address correspondence to: roselyn costantino, ph.d., associate professor, spanish and women´s studies, the pennsylvania state university altoona college, 3000 ivyside drive, altoona, pa 16801. email: rxc19@psu.edu ______________ kevin y. c. hui (kevinhui@sracp.org.hk), cressida w. c. leung (m_vp@sracp.org.hk), morgan c. k. ng, wing-ching yu, and edison k. l. lau (rdo@sracp.org.hk) are with the society of rehabilitation and crime prevention, hong kong, unit 11b, 9/f, tower b, hunghom commercial centre, 37 ma tau wai road, hunghom, kowloon, hong kong. siu-kau cheung (s.k.cheung@cityu.edu.hk), is with community college of city university of hong kong division of social sciences, 88 tat chee avenue, city university of hong kong, kowloon tong, hong kong. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 323-337, doi: 10.18060/18428 effectiveness of strengths-based case management for people with mental health problems in hong kong kevin y. c. hui cressida w. c. leung morgan c. k. ng wing ching yu edison k. l. lau siu-kau cheung abstract: this study examined the effectiveness of a 6-month strengths-based case management intervention with 45 chinese participants with mental health problems in hong kong. social workers provided service according to the strengths-based case management (scm) model developed at the university of kansas. changes in participants’ recovery components (stage of recovery scale), mental health symptoms (ghq), and satisfaction with life were assessed using a single group pretest and posttest design. results suggest that participants had some improvement in their autonomy, hope, and overall wellbeing as well as satisfaction with life after receiving services. no significant improvements in the other recovery components and ghq score were found. significantly, a number of participants progressed from stages of being overwhelmed or struggling with disability to stages of living with or beyond disability. strengths-based practice helped participants develop a transformed self which sees hope and possibility despite the vulnerabilities caused by their illness. though further refinement and testing are vital, adoption of scm in hong kong mental health services is promising. keywords: strengths-based practice, recovery, mental health, hong kong mental health problems have become a major concern in hong kong. as the population’s awareness of mental health issues heightens, the demand for mental health service has rapidly increased. in recent years more and more resources have been allocated to hong kong mental health settings. to cope with this high demand and the associated costs, a more effective and efficient model for mental health service is needed. traditionally, psychiatric services in hong kong have followed the medical model with psychiatric drugs being the major treatment option for people with psychosocial disabilities (lee & yiu, 2013; siu & sung, 2013). the emphasis has been on treating symptoms and/or pathologies based on psychiatric diagnoses, with the aim of restoring individuals to the level of functioning before their mental illness surfaced. in the last two decades, growing evidence suggests that the medical model is not as effective as practitioners had once thought in either lessening the incidence and prevalence of various mental health disorders or promoting psychosocial betterment in our world (hillman & ventura, 1992). some findings even indicated that the medical model could have negative impacts on service recipients (e.g., low self-esteem; see xie, 2013 for a brief review). these observations triggered the development of an alternative approach in the early 1980’s, namely, the strengths-based approach (rapp & sullivan, 2014). this approach provides practitioners with a new perspective of mental health service which allows them to direct the service recipients to a new recovery journey that is full of possibilities, options, and wellness (rapp & goscha, 2011). advances in social work, fall 2015, 16(2) 324 although strengths-based social work practice has gained popularity in the west, it is still in its infancy in mental health settings in hong kong. until the early 2010s, social workers mainly followed the mental rehabilitation model and focused on alleviation of psychiatric symptoms and restoration of adaptive functions of people with mental illness (liu, 2014). there were applications of the strengths perspective to individual cases with dementia and self-cutting behaviors (yip, 2005, 2006), but systematic applications to a wider population were scant. in 2010, the social welfare department of the hong kong government established integrated community centers for mental wellness (iccmw) in all districts across the territory. as their name suggests, the centers take a more positive focus aimed at enhancing the social support and re-integration of individuals with mental illness into the community (lee & yiu, 2013). these centers provide one-stop, districtbased, and accessible community support and social services ranging from early prevention to risk management for service users. only then did the concept of strengths-based practice begin to take root in the social work field in the city. the strengths-based case management (scm) intervention examined in this study was a project undertaken in two iccmws in hong kong for a sample of people with mental illness. using a single group pretest and posttest design, the study aimed to examine the applicability and effectiveness of the scm model in a chinese population. the concept of recovery an associated development in psychiatric rehabilitation in recent decades is the notion of recovery. recovery has become an ultimate goal of treatment for people with chronic mental illness in western societies (song & hsu, 2011). despite the absence of a universal definition of recovery, the definition proposed by deegan (1988) has been generally accepted. recovery is a process, a way of life, an attitude, and a way of approaching the days’ challenges. it is not a perfectly linear process. at times our course is erratic, we falter, slide back, regroup and start again… the need is to meet the challenge of disability and to re-establish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the aspiration is to live, work and love in a community in which one makes a significant contribution. (p. 15) according to this definition, recovery is a comprehensive concept encompassing both process and outcome. it is about an attitude as well as a way of life. in this sense, there is never an endpoint in recovery. a “recovering” person is not one who will no longer struggle and experience symptoms, never use mental health services and medications again, or is completely independent in his/her life (rapp, 1998). rather, the person has come to accept his/her symptoms and struggles, think forward with hope, and take proactive control in his/her life. various researchers have proposed components that may foster recovery in people with mental illness, including the emergence of hope, taking responsibility for one’s own wellness, effective management of one’s own disability, developing a self-identity with potential, developing new meaning and a sense of purpose in life, advocacy for one’s own rights, and peer support (lee & yiu, 2013; mead & copeland, 2005). based on the recovery components, song and hsu (2011) charted the recovery process in terms of four stages: (1) overwhelmed by the disability, (2) struggling with disability, (3) living with disability, and (4) living beyond disability. the stages represent progressive development towards recovery, with the higher stages characterized by an increase in the process components of regaining autonomy, disability management/taking responsibility and sense of hope, and the positive outcomes of improving social functioning/role performance, overall wellhui et al./effectiveess of stengths-based 325 being, and willingness to help. song and hsu (2011) developed the stages of recovery scale and argued that it could be used for assessing the status of service users in both recovery components and outcomes. strengths-based approach as recovery focuses on valuing and building one’s inherent worth, resilience, and capacities, treatment methods that merely alleviate symptoms of the disorder have become insufficient (hillman & ventura, 1992). in this regard, the strengths-based approach appears to be a promising alternative (xie, 2013). the strengths-based approach is a hope-inducing and energizing approach which emphasizes possibilities, options, and wellness rather than problems, constraints and sickness (rapp & goscha, 2011). its focus is not only on the intrapersonal and interpersonal qualities of a person but also on the resources in their environment (saleebey, 2006). different strengths-based practices have been developed, including the strengths-based approach (rapp, 1994), the asset-building model of community development (kretzman & mcknight, 1993), individual placement and support model of supported employment (becker & drake, 2003), and solution-focused brief therapy (miller, hubble, & duncan, 1996). the strengths model proposed by rapp embodies six vital principles: (1) a person has the capacity to recover, reclaim and transform; (2) the focus is on human strengths rather than weakness/deficits; (3) mental health services are directed by the service recipients; (4) the therapeutic relationship is primary and essential; and (5) community is indeed the preferred setting to work in because (6) it is the oasis of resources. following these six principles, rapp (1998) designed the scm model, an intervention that is both a philosophy of practice and a set of tools. the scm aims to enhance recovery through a client-directed and goal-oriented approach of service delivery. the model includes five main steps: engagement, assessment, case planning, resources acquisition, and tracking and evaluation (rapp & goscha, 2011). after the initial engagement, practitioners implement strengths assessment to guide the service recipients to identify their strengths, personal medicines (the things that people do to create wellness and betterment in their lives), environmental resources, and personal goals. based on these elements, a personal recovery plan is then collaboratively compiled. following the plan, service recipients are assisted to acquire the available resources and to achieve their set goals. throughout the process, tracking and evaluation are done periodically to ensure the applicability of the service recipients’ plans in different periods and to credit them in order to encourage and support them to move forward on their recovery journeys. even though problems, constraints and sickness are not the main concern of scm, they are addressed in the context of goal attainment in the service recipients’ recovery journey (fukui et al., 2012). effectiveness of strengths-based intervention empirical research has suggested that scm has a positive impact on one’s well-being as well as symptoms management. macias, kinney, farley, jackson and vos (1994) found that consumers with psychiatric symptoms who received scm in conjunction with psychosocial rehabilitation showed statistically significant better physical and mental health than those who received only psychosocial rehabilitation. they reported less mood disturbance, fewer maladaptive thoughts but clearer and more rational thoughts in comparison to a control group. in a later quasi-experimental study, macias, farley, jackson, and kinney (1997) found that scm was effective in helping adults with serious mental illness to achieve community support goals and reduced symptomatology. similar results were found in barry, zeber, blow, and valenstein’s (2003) study. smock et al. (2008) advances in social work, fall 2015, 16(2) 326 argued that it is the strengths identification and utilization as well as hope induction and maintenance that lead to improvement in one’s well-being and symptoms management capability. other studies have suggested that people receiving scm were more independent in their daily living. they were found to lead more purposive lives (kisthardt, 1993) and possess more effective community living skills (stanard, 1999). also, scm intervention appeared to enhance positive employment outcomes (siegal et al., 1996) and facilitate proactive use of leisure time (modrcin, rapp, & poertner, 1988). despite some evidence about the positive outcomes of strengths-based practice, relevant research to date is still far from adequate and conclusive. recent reports of its effectiveness are scant. rapp and sullivan (2014) maintained that there is a need for rigorous research to examine the effectiveness of the model with different client groups and that adopt pre-post designs as a precursor to experimental testing. in hong kong, as the broad concept of recovery has gained acceptance in mental health services, there were attempts to test the effectiveness of a number of recovery-oriented pilot programs, including wellness recovery action planning (wrap; mak, 2013) and the peer support worker project (yeung et al., 2013). these were mainly project-based interventions; none related to scm have been examined. the current project was the first to investigate the effectiveness of scm intervention on the recovery of people with mental illness in hong kong. present study design and hypothesis a single group pretest and posttest design was used in the current study. the mental health practitioners (23 social workers) had both the philosophy as well as the tools – the strengths assessment form and the personal recovery plan – of scm proposed by rapp (1994). these social workers received more than 30 hours in scm training and supervision by experienced scm practitioners from the university of kansas through skype. they were supervised by four senior local social workers (the supervisors) who had received onsite scm training at the university of kansas and johnson county mental health center. the social workers provided a six-month scm intervention for a group of adults with a diagnosis of mental illness. to maintain the fidelity of scm, the social workers wrote detailed case recordings after every meeting with the participants. throughout the intervention period, each social worker attended twelve group supervision sessions conducted by the senior social workers, once every two weeks. in each session, the case recordings as well as the strengths-based assessments were discussed. during the intervention, the worker used the strengths assessment form (rapp & goscha, 2011) to help participants visualize their personal and environmental resources and identify the strengths they currently possessed, accumulated, or made use of in the past. typical of chinese people, the participants tended to be overly humble and discount their strengths, achievements, and resources. the worker had to be patient and persistent to help the participants see the values and virtues of their assets, no matter how small and mundane they seemed. participants’ goals and aspirations were also recorded in the strengths assessment form. the goals were broken down into small, measurable, and attainable steps and put into the personal recovery plan. progress toward goal accomplishment was reviewed every four to six weeks, and the recovery plans were updated if necessary. to recognize members’ specific achievements, celebrations in the form of a lunch or a certificate were organized. in whatever form it might take, modesty was practiced because in chinese culture ostentation might create embarrassment for those who considered themselves unworthy of the kudos (bond, lun, chan, chan, & wong, 2012). hui et al./effectiveess of stengths-based 327 the effectiveness of the intervention was evaluated through examining the participants’ change in the components of recovery, mental health status, and life satisfaction after receiving the service. it was hypothesized that scm would facilitate the process and outcome of recovery of participants, which in turn would lead to better overall well-being as well as higher life satisfaction. methods participants participants were recruited from two iccmws operated by the same organization in hong kong. though situated in two different districts (both working to middle class), the nature of the services provided were largely the same. all service users seeking counseling service in the period from february 2014 to january 2015 were invited to participate in the study, and they joined on a voluntary basis with no incentive given. the participants were all chinese-speaking adults diagnosed with a mental illness without immediate suicide and/or risk of violence. people suffering from intellectual disability, dementia, substance abuse, personality disorder, and/or autism were excluded. a total of 67 participants were recruited at the baseline and 45 completed the scm intervention. twenty-two participants dropped out due to moving out of the service district or they found filling out the questionnaires too time-consuming. the analyses in this study were based on the 45 complete sets of data. independent samples t-tests and crosstabulations were conducted to examine whether the 22 participants who dropped out differed from the 45 participants who completed the study in terms of demographic characteristics and the dependent variables. no significant differences between the two groups were found. among the 45 participants, 19 were men and 26 were women. their ages ranged from 18 to 74 (m=36.4, sd=13.38). they were born either in hong kong or mainland china, and were all currently living in hong kong. most of the participants (64.4%) were living with family or friends, 26.7% were living alone, and 8.9% were living in private hostels providing mainly residential service. the majority (n=25, 55.6%) had secondary school education, 24.4% had primary school education or below, and 20% had a college education or above. the predominant diagnosis of the participants was mood disorder (n=25, 55.6%), followed by schizophrenia and other psychotic disorders (n=17, 37.8%), adjustment disorder (n=2, 4.4%), and sleeping disorder (n=1, 2.2%). the mean age of onset was 36.4 (sd=15.27). twenty-seven had been hospitalized with the mean number of hospitalizations since onset being 2.9 times (sd=2.39). the rest reported no hospitalization experience. measures three self-reported questionnaires were used in the current study: the stages of recovery scale (srs; song & hsu, 2011), the chinese version of the general health questionnaire (c-ghq-12; lee et al., 1985), and the chinese version of the satisfaction with life scale (swls; diener, emmons, larsen, & griffin, 1985). these three scales formed the pre and post-assessment batteries. stages of recovery scale (srs). srs is a self-reported, chinese scale to measure the personal recovery of people with mental illness (song & hsu, 2011). it comprises six subscales with a total of 45 items. three of the subscales measure the process of recovery (regaining autonomy, disability management/taking responsibility, and sense of hope) and the other three measure the outcome of recovery (social functioning/role performance, overall well-being, and willingness to help). participants were asked to indicate the advances in social work, fall 2015, 16(2) 328 frequency of occurrence of the situations described by the items using a 4-point likert scale, ranging from 0 (never) to 3 (often). the total score of these six subscales were used to define the stage of recovery following the cut-off points suggested by song and hsu (2011): stage 1-over-whelmed by the disability (srs score 0-57), stage 2-struggling with the disability (srs score 58-90), stage 3-living with the disability (srs score 91-119), and stage 4-living beyond the disability (srs score 120-135). the srs has been shown to demonstrate good psychometric properties, including test – retest reliability and internal consistency for the overall scale and the subscales. the current study yielded a cronbach’s alpha of .96 for the overall scale score and .66 to .94 for the subscale scores. the chinese version of the general health questionnaire-12 (c-ghq-12). the short form of the chinese version of the general health questionnaire is a self-reported scale commonly used to measure mental health status and distress in a hong kong population (goldberg & williams, 1988; lee, lam, ong, wang, & kleevens, 1985). it consists of 12 items (six positive and six negative) measuring the frequency of nonpsychotic mental health symptoms on a 4-point scale ranging from 1 (never) to 4 (usually). examples of the positive items include “able to concentrate” and “playing a useful part in things,” whereas negative items include “loss of sleep over worry” and “felt constantly under strain.” the positive items were corrected from 1 (usually) to 4 (never) and summed with the negative ones. high scores indicate worse health. the c-ghq-12 was found to correlate strongly with concurrently reported symptoms of physical symptoms of pain and anxiety-related somatic symptoms (lee et al., 1985). high reliability and internal consistency of the scale scores have been obtained. the current study yielded a cronbach’s alpha of .92. the chinese version of the satisfaction with life scale (c-swls). the satisfaction with life scale is a validated self-reported scale used to measure global life satisfaction (diener et al., 1985). participants indicated the extent to which they agreed or disagreed with five items using a 7-point likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). examples of the items include “in most ways my life is close to my ideal,” “the conditions of my life are excellent,” and “i am satisfied with my life.” confirmatory factor analysis of the scale showed support for a unidimensional factor structure of general overall life satisfaction (sachs, 2004). c-swls has been found to have good internal consistency across studies (pavot & diener, 1993). the current study yielded a cronbach’s alpha of .89. procedures the research monitoring committee of the organization operating the two iccmws conducted an ethical review of the study and granted approval to proceed with the data collection in the centers. prior to the beginning of the intervention, an intake interview was conducted in which the nature of the study was explained. informed consent was obtained from the participants before they were requested to fill in the pre-battery assessments. participants received a six-month intervention by a social worker who practiced according to the scm model, while they maintained their regular psychiatric follow-up. during the intervention, participants had an average of 5.4 face-to-face contacts (range from 4 to 7 times) with the social worker, each lasting a minimum of 60 minutes. at the completion of the intervention, participants filled out the post-intervention batteries and were debriefed. in order to examine the change in the process and outcome variables after the sixmonth intervention, seven paired sample t-tests were conducted to analyze the differences between the pre and post-intervention scores of the srs as well as its six subscales, the chui et al./effectiveess of stengths-based 329 ghq-12, and the c-swls. in order to understand whether there was an interaction between the intervention and the participants’ background factors on the dependent variables, repeated measures analyses of variance were conducted on srs, c-ghq-12, and the c-swls, using gender (male vs. female), diagnosis (affective disorder vs. psychotic related disorder; adjustment disorder and sleeping disorder were excluded from this analysis), living status (alone vs. in an institution vs. with family/friends) and hospitalization (none vs. more than one) as covariates. these variables were chosen as covariates because they were found to correlate with some of the srs scale scores (see table 1 and 2 for correlation matrices of all variables). a chi-square analysis was performed on the change of recovery stage. results stage of recovery scale (srs) overall score of srs. results of a paired sample t-test performed on the pre and postintervention scores of srs revealed a statistically significant difference, t(44)=-2.60, p<.05, d=.36, in which the average post-intervention score of srs (m=95. 9) was higher than the average pre-intervention score (m=87.1) (see table 3). this result suggested the participants had an improvement in the recovery processes and outcomes of small to medium practical significance after receiving the scm intervention. the results of the repeated measures anova revealed no statistically significant interaction effects between the pre and post-intervention scores of the srs and gender (male vs. female; f(1, 43)=0.41, p=.53), diagnosis (affective disorder vs. psychotic related disorder; f(1, 40)=0.02, p=.89), living status (alone vs. in an institution vs. with family/friends; f(1, 43)=1.96, p=.17) or hospitalization (none vs. once or more than; f(1, 41)=0.15, p=.70). these indicated that the inter-individual characteristics (i.e., gender, diagnosis, living status and hospitalization) had no statistically significant interaction effects on one’s recovery due to the scm intervention. advances in social work, fall 2015, 16(2) 330 table 1. correlations between the pre-intervention dependent variables and four covariates (n=45) 1 2 3 4 5 6 7 8 9 10 11 12 1. gender 2. diagnosis .04 3. hospitalization -.28 -.47** 4. living status .06 -.18 .01 5. pre-srs overall score .00 -.28 .21 .05 6. pre-srs regaining autonomy -.03 -.22 .20 -.02 .93** 7. pre-srs disability management/ taking responsibility -.02 -.16 -.06 -.07 .78** .69** 8. pre-srs overall well-being -.01 -.32 .32* .04 .83** .68** .46** 9. pre-srs social functioning/role performance .05 -.20 .25 .28 .85** .68** .58** .68** 10. pre-srs sense of hope .19 -.26 .01 .14 .46** .45** .17 .35* .40** 11. pre-srs helping others -.05 -.22 .20 .05 .82** .70** .62** .64** .81** .19 12. pre-ghq -.06 .22 -.41* -.08 -.30 -.21 -.01 -.55** -.19 -.19 -.28 13. pre-swls -.14 -.13 .33* .17 .51** .45** .12 .71** .46** .22 .37 -.47 note. srs=stage of recovery scale; ghq=general health questionnaire; swls=satisfaction with life scale. *p<.05; ** p<.01 hui et al./effectiveess of stengths-based 331 table 2. correlations between the post-intervention dependent variables and four covariates (n=45) 1 2 3 4 5 6 7 8 9 10 11 12 1. gender 2. diagnosis .04 3. hospitalization -.28 -.47 4. living status .06 -.18 .01 5. post-srs overall score .09 -.27 .16 .24 6. post-srs regaining autonomy .15 -.28 .13 .26 .97** 7. post-srs disability management / taking responsibility -.01 -.09 .05 .14 .90** .85** 8. post-srs overall well-being .06 -.34* .32* .15 .85** .75** .70** 9. post-srs social functioning/role performance .07 -.30 .16 .24 .92** .97** .79** .76** 10. post-srs sense of hope .12 -.18 .05 .24 .81** .81** .73** .59** .66** 11. post-srs helping others .09 -.21 .03 .29 .93** .84** .67** .59** .77** .74** 12. post-ghq -.27 .34 -.24 -.13 -.65** -.62** -.45** -.73** -.53** -.58** -.53** 13. post-swls .12 -.38 .40** .21 .59** .55** .46** .73** .50** .48** .30* -.58** note. srs=stage of recovery scale; ghq=general health questionnaire; swls=satisfaction with life scale. *p<.05; ** p<.01 advances in social work, fall 2015, 16(2) 332 table 3. paired sample t-test results for measures of srs, ghq and swls (n=45) pre-intervention post intervention scales m sd m sd t p stage of recovery scale overall score 87.1 23.45 95.9 25.29 -2.60 .01* process variables regaining autonomy 29.5 8.93 32.9 9.41 -2.44 .02* sense of hope 6.3 1.80 6.9 1.76 -2.37 .02* disability management/ taking responsibility 18.9 5.13 20.3 5.14 -1.79 .08 outcome variables overall well-being 13.4 6.07 15.4 5.50 -2.54 .02* social functioning/role performance 12.6 4.10 13.7 4.08 -1.77 .08 helping others 6.4 2.28 6.7 2.00 -0.95 .35 general health questionnaire 17.4 7.39 16.1 6.13 1.14 .26 satisfaction with life scale 19.6 7.37 22.0 6.85 -2.50 .02* note. *p<.05. recovery stage. participants’ recovery stages were defined following the cut-off points suggested by song and hsu (2011). a chi-square analysis was performed to analyze the change in the recovery stage of participants before and after receiving strength-based intervention. results revealed that there was a statistically significant difference between the pre and post recovery stages of participants, χ2 (1, n=45)=6.79, p<.01. nine of the 45 participants progressed to a higher stage as a result of the intervention, but five regressed to a lower stage (see table 4). most of the participants (68.9%) remained in the same stage. general health questionnaire (ghq) a paired sample t-test was conducted to analyze the difference between the pre and post-intervention scores of the ghq. the difference was not statistically significant, t(36)=1.14, p=.26 (see table 3). similarly, repeated measures anovas were conducted to analyze the differences between the pre and post-intervention scores of the ghq with gender (male vs. female), diagnosis (affective disorder vs. psychotic related disorder; adjustment disorder and sleeping disorder were excluded from this analysis), living status (alone vs. in an institution vs. with family/friends) and hospitalization (none vs. more than one) as covariates (see table 1 and 2 for correlation). no statistically significant interaction effects between the pre and post-intervention scores of ghq and gender, f(1, 35)=1.08, p=.31, diagnosis, f(1, 33)=.54, p=.47, living status, f(1, 35)=.12, p=.74, and hospitalization, table 4. chi-square test result for stage of recovery by period pre-stage of recovery overwhelmed/ struggling with disability living with or beyond disability χ2 p post-stage of recovery overwhelmed/ struggling with disability 16 (35.56%) 5 (11.11%) 6.79 .01** living with or beyond disability 9 (20%) 15 (33.33%) note. **p<.01 hui et al./effectiveess of stengths based 333 f(1, 33)=4.03, p=.053, were found. satisfaction with life scale a paired sample t-test was conducted to analyze the difference between the pre and post-intervention scores of the swls. results revealed that there was a statistically significant difference between the pre and post-intervention scores of the swls, t(44)=2.50, p<.05, d=.34. the average post-intervention score of swls (m=22.0) was higher than the average pre-intervention score (m=19.6) (see table 3). overall, participants were more satisfied with their life after receiving the scm intervention, with an effect size of small to medium practical significance. similarly, repeated measures anovas on the preand post-intervention swls scores using gender (male vs. female), diagnosis (affective disorder vs. psychotic related disorder; adjustment disorder and sleeping disorder were excluded from this analysis), living status (alone vs. an in institution vs. with family/friends) and hospitalization (none vs. more than one) as covariates (see table 1 and 2 for correlation matrix) showed no statistically significant interaction effects between the pre and post-intervention scores of the swls in terms of gender, f(1, 43)=3.49, p=.07, diagnosis, f(1, 40)=0.60, p=.44, living status f(1, 43)=0.03, p=.87, and hospitalization, f(1, 41)=0.10, p=.76. discussion the current study provides the first empirical evaluation of scm practice with people with mental illness in a mental health setting in hong kong. though the design lacks the rigor of randomized control group designs, it does provide data regarding the effectiveness of scm in improving and enhancing the recovery of individuals with mental illness. the findings of the current study produced mixed results. on the one hand, the scm intervention in the study brought about significant though small improvements in mental health recovery. more promising changes were observed in two process components (autonomy and hope) and one outcome component (overall well-being) after the scm intervention. given the emphasis on goal orientation, strengths assessment and hope inducement of scm, it is not surprising to note the positive outcomes regarding the two process components. since autonomy and hope are associated with general well-being (rapp & goscha, 2004), the enhancement of these elements likely contributed to the improvement in participants’ overall well-being in the current study. nevertheless, no statistically significant improvement was found in the process component of disability management/taking responsibility and the outcome components of social functioning/role performance and helping others. the ghq results also indicated that scm failed to bring about reduction of psychological distress among the participants. behind the apparently disappointing façade, the findings actually have important implications for the effectiveness of strengths-based practice. first, while the six-month intervention may facilitate the recovery process, these intermediate changes may not be translated immediately into enhanced personal and social functioning outcomes. second, despite the persistence of certain psychological distress and symptoms as indicated by the ghq, the individuals experienced an enhanced sense of overall well-being and satisfaction with life. these positive changes may have been downplayed if the focus remained on alleviation of symptoms, illness, and dysfunction. actually, the experience of the participants in this study exemplifies the notion of recovery which “involves a transformation of the self-wherein one both accepts one’s limitations and discovers a new world of possibility” (deegan, 1988, p. 13). the participants in this study are not “cured” advances in social work, fall 2015, 16(2) 334 or free from mental health problems, but they can lead more satisfying, hopeful, and contributing lives despite their illness. in terms of stage of recovery, some participants progressed into a higher stage but a few regressed. as song and hsu (2011) reminded, the stage a service user reaches might be transitory because recovery is a journey of spiral progress. a longer term intervention is needed before service users can stably progress into a higher stage. clearly, the current study provides only preliminary evidence of the applicability and effectiveness of scm among people in hong kong with mental health problems. the study had a number of limitations. first, with the small sample size, it is difficult for the statistical tests to acquire adequate power to detect statistically significant changes. second, the intervention was implemented for six months and the number of worker-user contacts was on average 5.4. the dosage might be too low to realize the full potential of scm. finally, the absence of a control group precludes any definitive conclusions. despite the limitations, the preliminary findings suggest that a more rigorous design with a control group is warranted. in future applications, it will be useful to extend the period of intervention beyond six months and examine whether hope and autonomy can have rippling effects on the other elements of recovery and mental health status in the long run. qualitative inquiries to explore service users’ responses to scm will also inform how the approach can be adapted for the local population. despite the limitations and modest findings, the current study adds to the existing literature on scm. in particular, the strengths-based model was originally developed to help people in western cultures which embrace individualism. chinese people including hong kong citizens are 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(2006). a strengths perspective in working with an adolescent with self-cutting behaviors. child and adolescent social work journal, 23(2), 134-146. doi: http://dx.doi.org/10.1007/s10560-005-0043-4 author note address correspondence to: siu-kau cheung, phd, rswhk, community college of city university, 88 tat chee avenue, kowloon tong, hong kong. email: scskc@cityu.edu.hk http://dx.doi.org/10.1177/1471301205055901 http://dx.doi.org/10.1007/s10560-005-0043-4 mailto:scskc@cityu.edu.hk table 4. chi-square test result for stage of recovery by period microsoft word bromfield_capous-desyllas copyedit2 _________________ nicole f. bromfield, ph.d., is an assistant professor in the social work department at the united arab emirates university in al ain. moshoula capous-desyllas, ph.d., is an assistant professor in the sociology department at california state university northridge. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 243-261 underlying motives, moral agendas and unlikely partnerships: the formulation of the u.s. trafficking in victims protection act through the data and voices of key policy players nicole footen bromfield moshoula capous-desyllas abstract: in response to the overwhelming amount of attention to human trafficking, the debates surrounding its definition, and its focus on the sex industry, the purpose of this study was to understand the motivations behind the formation of the trafficking in victims protection act (tvpa). using the advocacy coalition framework (acf) as a model, data was collected and analyzed in order to examine the coalition identities of key players and their positions. through the presentation of in-depth interview data with key policy players involved in the making of the tvpa, this article illustrates how and why the tvpa was formulated, the implications of its development, and the necessity for critical analysis of its effects. the use of alternative frameworks of labor and migration for understanding trafficking is proposed. further consideration is given to legislative changes to eliminate anti-prostitution ideology and to support anti-oppressive approaches to addressing forced or deceptive working conditions. keywords: tvpa, sex trafficking, legislation, prostitution, acf introduction attention to human trafficking while human trafficking is not a new phenomenon, the issue has received an enormous amount of attention over the last 15 years. an eruption of conferences, debates, protocols, media coverage, and the development of various forms of legislation have taken place on a worldwide scale, aimed at the eradication of human trafficking. reports of severe human trafficking offenses surfaced in the u.s. during the mid to late 1990s. beginning in 1995, policy makers and other stakeholders started paying attention to human trafficking as an issue of u.s. governmental concern. during this time, various factors brought attention to trafficking. these include: the rise of the women’s human rights movement; the increased international labor migration in response to globalization; shifting economies and political systems resulting in the feminization of poverty and subsequent migration; and the growing recognition of organized crime in the underground movement of people (chuang, 2010). economic explanations for the migration and trafficking of women are often conceptualized in terms of push factors (limited opportunities in countries of the global south) and pull factors (developed countries’ demand for cheap migrant labor) (sassen, 2002). others have associated the recent surge in attention to trafficking as being linked to the moral panic over women’s sexuality and autonomy (doezema, 1998), undocumented migration, (capous-desyllas, 2007; pattanaick, 2002), racism, and xenophobia (saunders & bromfield, capous-desyllas/the trafficking in victims protection act 244 soderlund, 2003). trafficking is a phenomenon that seems unable to escape its historical association with prostitution, morality and migration control. the first piece of legislation considered to address human trafficking issues comprehensively was the united states’ trafficking victims protection act of 2000 (tvpa), which was passed under the clinton administration. other governments were encouraged by the u.s. to adopt similar legislation. although a number of heated debates ensued during the making of the tvpa, it passed relatively quickly by national coalitions of unlikely partnerships debates in definitions of trafficking the term “trafficking” has been used interchangeably with diverse concepts such as illegal immigration, modern slavery, prostitution, and the sexual exploitation of women. trafficking definitions fail to distinguish clearly between trafficking and voluntary consensual migration, often combining women’s migratory movement with trafficking (kapur, 2005). definitions of trafficking are highly contested among scholars, ngos, feminists, and governments, thus posing challenges in conducting research studies, reporting statistics and making generalizations. debates over the definitions of (sex) trafficking are grounded in the “feminist sex wars” between abolitionist (radical) feminists and labor-rights (sex-radical and third wave, transnational) feminists. feminist debates shape understanding of trafficking the abolitionist approach to trafficking asserts that prostitution is a violation of human rights, analogous to (sexual) slavery (bindman & doezema, 1997) and “an extreme expression of sexual violence” (outshoorn, 2005, p. 145). the beliefs and assumptions are that no person can truly consent to prostitution, no woman would choose to prostitute herself by free will, and a woman who engages in prostitution is a victim who requires help to escape sexual slavery (outshoorn, 2005). this point of view applied to trafficking always involves a victim of force, coercion and/or deception. outshoorn (2005) asserts that from this lens “…trafficking of migrant women is always seen as against their will; they are by definition victims of trafficking. according to abolitionists, trafficking is caused by prostitution; making the best way to fight trafficking, the abolition of prostitution” (p. 146). the other major trafficking discourse is the sex worker’s rights approach, which views prostitution as a viable option and a choice that women make in order to survive. from this perspective, sex work should be respected, not stigmatized (outshoorn, 2005; chapkis, 1997). the pro-rights or sex radical perspective is supported by the beliefs that women have the “right to sexual determination,” the right to work in safe labor conditions, and the right to migrate for sex work wherever they choose (outshoorn, 2005, p. 145). for this group, “it is not the work, as such, that violates women’s human rights, but the conditions of deceit, violence, debt-bondage, blackmail, deprivation of freedom of movement, etc. be it in prostitution, in domestic labor, or in the commercial marriage market” (wijers & van doorninck, 2005, p. 2). some assert that women who are in these violating conditions “can be victims of trafficking, but not all women sex workers advances in social work, summer 2012 13(2) 245 crossing borders are victims of forced prostitution” (outshoorn, 2005, p. 147). however, most labor rights feminists reject the term ‘victim’ because it does not take into account those migrants who leave their homes for a better economic future. labor rights feminists aim to distinguish prostitution from trafficking, and point out that males are also being trafficked for sexual purposes (not only females) and women are being trafficked for other types of labor (such as domestic labor or caretaking), not just for the sex industry. some activists, such as obando (2003), highlight that numerous migrants who identify as transsexual or transgender are also entering the sex industry. sex workers’ rights groups advocate for the differentiation between voluntary migration and (sex) trafficking, in order to advocate for labor rights for those who are voluntarily working in the (sex) industry. while this position works for protecting sex workers and other marginalized individuals, agustin (2005) points out that migrants, when in countries illegally, do not even have rights that other citizens have. u.s. definition of trafficking the media, the general public, and policy makers distinguish human trafficking as being the illegal transportation, exploitation, and sexual enslavement of adults and children through the use of manipulation of force for the purposes of profit. the common association of trafficking is one of foreign-born females being sold into prostitution against their will. however, “this focus on sex and sexuality distorts the image of both trafficking and sex work” (ditmore, 2003, p. 2). there is a disproportionate amount of attention to sex trafficking and not enough attention to trafficking into other industries, such as sweatshops, construction, agriculture, and domestic labor. a more encompassing and less biased view of trafficking in persons should refer to men, women, transgender individuals and children, while addressing both cross-border trafficking for migration and labor in diverse industries. the controversies in defining trafficking illustrate the lack of a global consensus with regards to “the extent of trafficking, sexual or otherwise, its definition, its remedies and even its existence,” with prostitution remaining at the center of the debate (saunders, 2005, p. 346). development of current u.s. trafficking policy as disturbing stories of the trafficking of women and children emerged in the u.s., the problem of trafficking was addressed as a priority issue by the clinton administration and the 106th congress. the clinton administration set up the interagency international crime control strategy group, to address the international crime implications of trafficking. on march 11, 1998, president clinton issued a directive establishing a threepronged, u.s. government-wide anti-trafficking strategy consisting of prevention, protection and support for victims, and the prosecution of traffickers. this strategy had both domestic and international policy components (miko & park, 2002). in addition, a workers’ exploitation task force, which was chaired by the department of justice’s civil rights division and the solicitor’s office in the department of labor, was responsible for investigating and prosecuting cases of exploitation and trafficking. bromfield, capous-desyllas/the trafficking in victims protection act 246 the 106th congress undertook several legislative initiatives on human trafficking. the various bills that were introduced focused on prevention, protection, and prosecution, corresponding with the clinton framework. however, some of the congressional initiatives went beyond clinton’s recommendations, notably, in calling for sanctions against other countries’ governments that tolerated trafficking (miko & park, 2002). since its inception, the tvpa has generated controversy and critique. the development of this policy entailed more than just protecting victims; certain ideologies and agendas have been promoted and continue to permeate the way that the policy is being implemented and understood, as will be discussed below. purpose of this research through the presentation of quotes from in-depth interview data with key policy players involved in the making of the tvpa, this article provides an insider’s view of competing motivations from various coalitions involved in the formulation of u.s. trafficking policy. this article also illustrates the necessity for a critical analysis of the legislation’s effects. the purpose of this study is to identify specific coalitions and to examine coalition identities of key policy players involved in the making of the tvpa, in order to gain a better understanding of the competing motivations behind the making of the legislation. methodology framework and approach the advocacy coalition framework (acf) was the model used to guide this study. the acf allows one to think of agency officials, academic researchers, and journalists as potential members of advocacy coalitions that engage in “some nontrivial degree of coordinated activity in pursuit of their common policy objectives” (sabatier & jenkinssmith, 1999, p. 127). in the acf, policy change or policy development is analyzed within a policy subsystem, which includes groups of people or organizations who interact “regularly ... to influence policy formulation and implementation within a given policy area/domain” (sabatier & jenkins-smith, 1999, p. 135). the foundation for the acf is grounded in the perspective that those involved directly with the policy-making have well-integrated policy belief systems and that policy players within a particular policy subsystem will group into distinct advocacy coalitions based on these belief systems. determining the existence of advocacy coalitions and defining these advocacy coalitions gives insight into their motivations and their members. it is through an understanding of the motivations of advocacy coalitions and their members that we can critically assess the implementation and implications of the tvpa. identification of key policy players this study focused on the human trafficking policy subsystem in order to gain insight into the formation of u.s. human trafficking legislation. identifying subsystem participants can be accomplished in several ways. one way is to “rely on the records of participation in arenas in which subsystem members (or their representatives) regularly advances in social work, summer 2012 13(2) 247 participate” (sabatier & jenkins-smith, 1993, p. 241). the most useful source of records that sabatier and jenkins-smith (1993) have found consists of public hearings conducted over time on a specific policy issue. to gather the sample that was used for this study, public officials testifying in human trafficking related hearings during 1995-2000 were identified through a search of congressional hearings related to human trafficking. the 1995-2000 time period was chosen because human trafficking was first mentioned as an issue of concern by the u.s. government in 1995 at the beijing conference on women. the tvpa legislation was passed in 2000. a search of the lexisnexis ™ congressional database using the key words “human trafficking”, “trafficking victim*”, and “trafficking victim* protection act” and searching between the years 1995-2000 produced four hearings related to human trafficking. a total of thirty-five testimonies, speakers, and statements were included. twenty-seven prospective respondents were identified through the congressional hearings. these prospective respondents were then invited to participate in an interview. participants twenty-one in-depth interviews were conducted with key policy players. twelve interviews were conducted with individuals testifying in hearings related to human trafficking during the 1995-2000 time period, who were identified through records of congressional testimonies, as noted above. nine other individuals, who were key stakeholders but did not publicly testify, were also interviewed. these individuals were identified through a snowball technique, in which other informants mentioned them as being critical players within the human trafficking policy subsystem and essential to the tvpa’s development. nine of the 21 interviews were conducted in-person. the remaining 12 interviews were conducted via telephone. some of the interviews occurred over several telephone conversations, with one occurring over three separate telephone conversations. the average length of interviews was 1.5 hours. with the exception of two interviews, which lasted approximately 35-40 minutes, the interviews ranged from over one hour to 4.5 hours. the informants were representative of those involved in the human trafficking policy subsystem and included a range of governmental officials, key congressional staffers, human rights organization representatives, feminist organization representatives, other ngo representatives, christian organization members, members of research institutes, and academics. nine informants were government officials consisting of elected and appointed officials, congressional staffers, and others working within the federal government; nine informants were ngo officials; two informants were independent academic researchers; one informant was a journalist. data collection each informant was asked a set of interview questions related to their policy positions on human trafficking and on the events that occurred during the making of the tvpa. the interviews were recorded and later transcribed; notes were also taken during bromfield, capous-desyllas/the trafficking in victims protection act 248 the interviews. the interview questions were designed to find out more about the informants’ involvement in human trafficking as a legislative issue and also to explore the forces and factors which led to the making of the tvpa. in order to limit interviewer effects and biases, standardized open-ended interview questions were used. the protocol included three sets of questions. the first set of eight questions was related to human trafficking as an issue in general, the second set of six questions was related to beliefs regarding trafficking legislation, and the third set of seven questions was related to the making of the tvpa specifically. one additional question, “is there anything else on this issue i should be asking about?” was also included in the protocol. data analysis the data were categorized and organized by key topics and themes using atlas ti software. by categorizing and comparing topics and themes, larger themes emerged that advanced the understanding of the human trafficking policy subsystem and the impetus for the legislation. in order to aid in categorizing the key topics and themes, a coding sheet was developed and used to guide the coding of the data. this was also used to group each player into a specific coalition (the coalitions emerged during the data analysis). the coding sheet included ten illustrative components that make up one’s policy core beliefs, according to the acf (sabatier, 1998). also included on the coding sheet was a description of each illustrative component as it relates to the human trafficking policy subsystem. each informant’s policy core beliefs were coded in order to place each informant into a coalition. the acf assumes that policy core beliefs are the principle “glue” that holds coalitions together (sabatier, 1998). findings data from this study reveals that there were three distinct coalitions made up of several sub-groups who coordinated efforts during the making of the tvpa. the coalitions are briefly described below, and a detailed discussion regarding each of the coalitions follows: 1) liberal feminist coalition was made up of some governmental officials, academics, and some human rights organizations. this coalition was interested in passing trafficking legislation, but was primarily concerned about protecting the rights of women and the rights of sex workers to be able to choose sex work as an occupation. 2) pragmatic coalition was made up of government officials and representatives from non-profit organizations, whose primary concern was creating legislation that would provide usable services to victims of trafficking. these services included protection for victims of trafficking (to ensure that victims of sex trafficking, as well as victims of labor trafficking, received services), and effective prosecution of traffickers. advances in social work, summer 2012 13(2) 249 3) left/right coalition was made up of conservative christians, republicans, democrats, radical feminist organizations, human rights groups, academics, and others. this was the coalition that was responsible for the legislation’s passage, and whose primary mission was to equate human trafficking with prostitution. the core members of this coalition were most interested in restricting prostitution. they were (and still are) interested in abolishing legalized prostitution on a global scale. liberal feminist coalition this small coalition was visible in the trafficking scene during the mid to late 1990s. the liberal feminist coalition included several (transnational, third wave, liberal, and postmodern) feminist academics, organizations, human rights groups, and government players, including the president’s interagency council on women. this coalition made a clear delineation between prostitution and human trafficking. one of their main concerns was protecting the rights of women who choose sex work. the impetus for the development of this coalition included hillary clinton’s interest in trafficking as a social issue and the development of the president’s interagency council on women, which took on human trafficking as an issue of their concern. “a very ideological perspective . . .” several academics and feminist organizations became involved in this coalition and had great influence on the coalition’s ideologies. one informant (who was not involved in this coalition) felt that the president’s interagency council on women’s position on trafficking as an issue was shaped by liberal academic feminists and others who shared similar ideological perspectives on sex work. this perspective maintained that sex work was quite different from trafficking and that sex workers should not be viewed as victims of human trafficking. this informant, when asked about the formation of the trafficking definition during the making of the legislation, explained, i’ll be very honest because i don’t have any reason not to be. in my view [the president’s interagency council on women] got set up and early on, its thinking was shaped by [liberal academic feminists] and people like that who had a very ideological perspective and they put their stamp on the early workings of that and groups like ours which were too small and too far away to be dealing with that policy level on-going thing. we got pulled into this [other] coalition and we ended up playing a useful role. we weren’t in the washington scene. when trafficking first hit the washington scene these people really helped shape the policies that were coming out of the state department and i don’t think there was any serious understanding inside of the state department. i know that’s a horrible thing to say …they were government people who cared a lot, but they didn’t really understand the debate, and somebody like [a feminist academic] is just running circles around them. she knows where she wants to go, and she really put a stamp on it and you could feel their influence on all of the state department’s documents…by the time we got in…their idea of the definition of trafficking had already been solidified and we had to undo or try to undo some of bromfield, capous-desyllas/the trafficking in victims protection act 250 the thinking that we felt was problematic. the definition had been thrown at them, and there wasn’t a real debate, because we weren’t there…nobody was really there. that was a little unfortunate, i think. “[the abolitionists] are twisting where we are coming from on this bill . . .” according to respondents, the liberal feminist coalition members were almost dragged into the human trafficking legislation debate and forced to form a coalition in response to the left/right coalition’s sudden interest in human trafficking. the liberal feminist coalition was concerned that the left/right coalition was going to “steal” the human rights issue of human trafficking to use it as a means to abolish legalized prostitution. some informants saw human trafficking as a human rights issue, thus “belonging” to liberals and democrats, not to the conservative christians and republicans who made up part of the left/right coalition. a member of the liberal feminist coalition, when asked about disagreements during the making of the tvpa, mentioned, we sat down and we said we’ve got to get a response because they [the abolitionists] are twisting where we are coming from on this bill…it became forced prostitution very quickly and the kind of conservative, conservative, conservative, portion of the republican party was beginning to increasingly dominate mainstream human rights issues that the liberals, democrats, and moderates had generally stewarded…and it was like, “oh my god, they are going to take this issue,” and that’s what actually happened. i mean, they won. they won. the worst, in many ways, has been the trafficking bill in terms of ideological impact. “it was that or nothing . . .” the liberal feminist coalition did have some influence on the final outcome of the tvpa, although the left/right coalition had substantially greater influence over the legislation. within the tvpa, there is a two-tiered definition of trafficking. this includes sex trafficking and severe forms of trafficking in which force, fraud, or coercion must have been used. according to some respondents, the two-tiered definition of trafficking was suggested by a member of the left/right coalition to appease the liberal feminist coalition members. a member from the left/right coalition, when asked about her organization’s stance on the two-tiered definition of trafficking mentioned, “some of the groups in our coalition did not want the [two tiered definition of trafficking] compromise, but it was clear to me that it was that or nothing. it wasn’t like we could get what everybody else wanted.” members of the liberal feminist coalition noted that they had ultimately “lost”, especially after the tvpa legislation was passed and bush ii came into office and supported the abolitionist agenda. advances in social work, summer 2012 13(2) 251 pragmatic coalition based on our findings, a second coalition in existence during the making of the tvpa legislation was a pragmatic coalition, made up of several government players and ngos. this coalition was loose and focused on particular pieces of the legislation that they felt were important, such as protecting victims of labor trafficking and severe labor exploitation. these players weren’t so interested in participating in the ideological debate surrounding prostitution versus sex trafficking. their focus was to see a “good” piece of legislation passed in order to help victims of trafficking, which is why we label them as the pragmatic coalition. according to informants, those involved in this coalition were frustrated with both the liberal feminist coalition members and left/right coalition members for “hijacking” human trafficking in order to push their own ideological perspectives on prostitution. “no one ever cared about them when they were black or latin…” one informant, a former congressional staffer who helped to draft early human trafficking legislation in the u.s., described the context for u.s. human trafficking legislation development when asked about it: it was a perfect storm. you had the clintons; you had hillary clinton. you had people that despised them. you had this new york times article describing white women in slavery. no one ever cared about them when they were blacks and latin. and the evangelical movement was peaking. it was the perfect storm of sex, politics, the taking over of the international human rights agenda…it was all of these factors and it was unbelievable. unbelievable! i remember not sleeping well for a year. it was rough. it was really rough. “you have to try to do something good for real victims . . .” another informant, who was part of this coalition and had experience working with trafficking victims, illustrated the coalition’s basic stance when asked about debates during the making of the legislation: i don’t buy that thing that the ‘sex worker types’ push; that every woman has the capacity [to make her own choices] and doesn’t need to be protected. i also don’t buy the things that the abolitionists or ‘rad fems’ say about [prostitution] being all rape and all trafficking, because i know enough trafficking victims, so that pisses me off on their behalf…what [our part of] the law tries to do is steer this middle ground where you have to try to do something good for real victims. “i cannot, in good conscious, equate [prostitution] with slavery . . .” an informant, who was part of this coalition, demonstrated her frustration with both of the other coalitions when asked about the human trafficking definition debate. this individual noted, “i despise prostitution, i don’t support it as a right to work issue. i think it’s inherently harmful, but i cannot, in good conscious, equate it with slavery. i can’t. it doesn’t have the same coercive quality. not when somebody can ultimately walk away. and in slavery, by definition, you cannot.” bromfield, capous-desyllas/the trafficking in victims protection act 252 “i don’t see trafficking as a black and white issue; it’s all shades of gray” a third member of this coalition seemed to agree with the other informants from the pragmatic coalition when asked about the human trafficking definition debate, saying, i don’t see trafficking as being a black and white issue, it’s all shades of grey . . . i’ve met very few classic, sort of like, the lifetime [network] kinds of women, who are trafficked, who are obviously deceived, who are obviously sold, who are obviously raped, and kept locked up. most of the women i meet who have been trafficked or who are in prostitution may have been deceived to some degree or another, but they may know that they were going to be working in prostitution. but they feel so desperately in need of helping their families that they will do anything. so, i see it in many, many, many, many different shades, not just the ones that people would like to so clearly define; as being trafficked victims or victims, period. “they wanted to make all prostitution an anti-slavery movement . . .” one member of the pragmatic coalition revealed her frustration with the ideologies that dominated the left/right coalition noting, the neo-abolitionist movement—they wanted to make all prostitution an antislavery movement. this is an interesting thing because this is hardcore…if you look at the 70’s movement, bra-burning exercises, the most extreme ideologies were in the anti-prostitution camp. so what you got was a group that would write you off if you said forced prostitution. because all prostitution isn’t forced. [name withheld] is still carrying a torch on how all prostitution is forced…the movement was extremely oriented to all prostitution is illegal. it is really hard to sell [this idea] to the mainstream. there was a lot of squabbling during the legislative crafting phase. was it going to be prostitution or was it going to be labor and prostitution…squabbling over how much you were going to come against prostitution as slavery…this is where the crack in the wall started…some people just wanted it to be about sex trafficking and my view was that, listen you know, you’ve got to have a balanced reflection of what modern day slavery looks like. you are over simplifying things and misrepresenting sex slavery and severe forms of the definition. “punishing the victim all over again…” an informant, who worked for an international ngo which assisted trafficking victims in south east asia, strongly opposed the abolitionist movement. when asked about different perspectives that were represented during the making of the legislation she noted, i think that [the abolitionist movement] diverts us from being able to carry on a deeper conversation about sexuality, sexual attitudes, about the demand side of economic depravity, and economic injustice in this world. we would have a lot fewer prostitutes if we had economic justice in this world. it’s like were advances in social work, summer 2012 13(2) 253 punishing the victim all over again by being so terse in our abolitionist attitudes. it’s very elitist. “money that is being taken away from helping victims…” an informant who was an official for the department of defense discussed the academic research (supported by federal grants) that was used to bolster the abolitionist position in the early days of human trafficking legislation development. you know, the state department has steered millions of dollars of very questionable contracts to this group of people [neo-abolitionists]…everybody kept on saying, ‘well you don’t actually have research that shows that every prostitute is a slavery victim’ and so they then gave the very people, who were pushing that position, grants to write research papers that they could cite. so all of the research papers that they cite are by [the academics pushing the neoabolitionist agenda]. it is disingenuous science is what it is…every dollar that gets spent on a bullshit grant to put up a crony, is money that is being taken away from helping victims…they ain’t done shit as far as we can tell. the pragmatic coalition had some impact on the legislation’s final outcome, such as the inclusion of protecting labor trafficking victims in the legislation. however, the pragmatic coalition has since lost control of the trafficking issue to the left/right coalition. left/right coalition the left/right coalition was the most powerful and vital force in the passage of the tvpa, and is where the hidden motivations and unlikely partnerships in the tvpa legislation most prominently exist. according to informants, this coalition still exists today, but does not include the same members; many have drifted from the original coalition while the hard-line members of the coalition continue to push the abolitionist agenda. the abolitionist agenda, which appears to be such a vital concern for this coalition, was not quite clear to some of its former members during the making of the legislation. this is the reason that we consider the motivations of the left/right coalition to be somewhat hidden. the players inside of this coalition are considered to be unlikely partners because the coalition is made up of both republicans and democrats, as well as conservative christians and radical feminists, players that usually find themselves on the opposite sides of other social issues, such as abortion. the primary players in this strong left/right coalition during the making of the tvpa legislation were faith-based ngos, radical feminist activists, radical feminist academics, elected officials (and their congressional staffers) both democratic and republican, some human rights groups, some ngos working “on the ground” with trafficking victims, and some think tank representatives. this coalition’s origin is credited to michael horowitz of the hudson institute, who initially built a strong left/right coalition to pass the international religious freedom act of 1998 (h.r. 2431). based on the interview data, the larger goal of the left/right coalition was to get human trafficking legislation passed in order to: (1) protect victims of trafficking; (2) bromfield, capous-desyllas/the trafficking in victims protection act 254 prosecute victims of trafficking; and (3) prevent trafficking into the united states through various means (such as public information campaigns and educational programs for would-be victims before leaving their countries of origin). it must be noted that according to informants, the members of this coalition did not all necessarily have the same goals or agendas, other than getting some form of trafficking prevention legislation passed. the debates and in-fighting within this coalition seem to have been, for the most part, ideological and were based around the prostitution versus human trafficking debate. in other words, the strongest members of the coalition (radical feminists) did not see a clear difference between sex work and human trafficking. the radical feminists also wanted to focus primarily on victims of sex trafficking in the legislation, largely ignoring victims of trafficking into other forms of labor. “actively looking for a new issue to take on…” according to informants, the left/right coalition did not develop around the human trafficking issue in particular, but previously existed as the religious freedom coalition. the religious freedom coalition managed to get the international religious freedom act of 1998 (h.r. 2431) and its amendment of 1999 (public law 106-55) passed. the religious freedom act seeks to promote freedom of religion and conscience throughout the world as a fundamental right, assist religious and human rights ngos in promoting religious freedom, and to identify and denounce regimes that prosecute their citizens or others based on religious beliefs. the religious freedom coalition had so much success with the development of the religious freedom act that they actively searched for new issues to take on as a coalition. after the religious freedom legislation passed, according to an informant, “it established an appetite for building hard left/hard right coalitions and to get things done.” the coalition specifically targeted human rights issues, which they perceived as being neglected by the left. a left/right coalition consisting of conservative christians, liberal jews, and human rights groups was put together as an experiment. michael horowitz was the coalition builder and was the driving force behind it. one informant, when asked about her involvement in the making of the tvpa shared, what we saw was that once you put together the hard left and hard right, you can capture the soft middle. [then] we looked at the universe of the worst religious persecution scenarios; we were looking for another human rights issue to take on after the passage of the religious freedom act…something to transport the coalition over. we chose sudan. it was a good left/right issue. it was good for the left because of the genocide, and organizing against war, and peace building. it was good for the right because of the religious persecution in the south and the fact that [the southern sudanese] were being enslaved…here we had all the elements that would capture the left and the right…it was the perfect issue and that’s how we started out with the slavery issue…you could go across the country and hear pastors and rabbis talking about sudan and ending the war against slavery…we thought, ok now is the time, we could do the trafficking advances in social work, summer 2012 13(2) 255 legislation. we had successfully introduced the slavery in sudan issue. it was time to introduce the trafficking issue. it was 1998. we thought, we can do this, we can start this movement. another informant, when asked about how she became involved in the making of the tvpa, mentioned that she remembered having conversations with other coalition members discussing what issue they might take on after the religious freedom legislation. this informant remembered asking, “what are the human rights issues that the left are not picking up on? why are they not picking up on human trafficking?” some informants believed that the trafficking movement had not taken off because of the feminists. from the informant’s perspective, the liberal and radical feminists had been cannibalizing each other over the prostitution issue. they were completely stymied over it. when coalitions go bad, they eat their own. these are highly ideological people; they just rip each other to shreds and won’t stop at anything. as conservatives, we can shame them into working with each other. when conservatives started taking this issue, the feminists were shamed. “what are the human rights issues that the left are not picking up on?” according to informants, the reason that conservative christians initially became involved in human trafficking as an issue was because of their involvement in the religious freedom coalition and their involvement in the sudan issue. the coalition, which had gained momentum, was actively looking for another issue of concern for conservative christians to tackle. human trafficking seemed like the perfect issue: the liberal feminists and democrats were not paying attention to trafficking at that time, and they could put a conservative twist on the issue by equating prostitution with human trafficking. another informant who was part of the left/right coalition said, [human trafficking] was picked up by this fledgling coalition of mainly conservatives and faith based organizations that had had a success in the recent past in passing a law on religious liberty. they weren’t really looking for a new project, but this one hit them. [name withheld] brought that to his coalition, and they had decided that they wanted to do something… one respondent described the lens through which they were seeing this, when she was asked how her organization got involved in the making of the tvpa. what are the human rights issues that the progressives and the left are not picking up on? why isn’t the progressive movement picking up on human trafficking and speaking out on it? it’s the same reason the women’s movement wasn’t. they had decided that this issue was not in their best liberal interest to push on…and so this fledgling group picked it up…we were strategizing over the long term and we said, well, we don’t have to bring them together as one happy coalition, in fact that will never work because they were too uneasy with one bromfield, capous-desyllas/the trafficking in victims protection act 256 another over these other [social] issues. the faith-based organizations didn’t like the women’s organizations because of the pro-abortion stuff. the women’s organizations were absolutely adamant about all of this anti-abortion stuff. so we had to decide to set those two things aside and we decided the best way to do that was to have a loose coalition and one person would be the conduit for each one…the first draft [of the legislation] in 1998 changed over the next two years and there was a lot of compromising. “we weren’t ever having these discussions out loud…” the neo-abolitionist agenda was much more nuanced and subtle, so that the real issue of abolishing prostitution was just too volatile to be discussed openly. as mentioned previously, the abolitionist agenda was kept hidden by some members of the left/right coalition, even from other coalition members. in fact, one of our informants mentioned that the prostitution debate was under the surface. this informant also said, “we all knew what we were about [in favor of abolishing prostitution] but we weren’t ever having these discussions out loud.” the neo-abolitionists were not openly discussing the goal of eradicating all forms of prostitution as part of the larger human trafficking debate, but rather, this collective goal was kept under the surface until the tvpa legislation was passed. “we’ve created a monster…” according to some informants, the relationships among many members of the left/right coalition seemed tenuous at best. as mentioned, some initial members of this coalition did not agree with the hard-line coalition members on the definition of trafficking and other points of debate during the making of the legislation. another informant revealed the tensions in the left/right coalition when asked about debates during the making of the tvpa, mentioning that there was a lot of slanderous stuff going on—some of the most hardball politics i’ve ever seen. people, the big guys…they will tell you the human trafficking movement is the meanest, most difficult movement as far as hurting their own. we have created a monster. our humble little group has gotten a taste of getting something done and it has gotten mean. majority republican in both houses and bush came in. people became little kings after bush came in…then it gained momentum to the degree that it has. informants explained that some members had since left the coalition and some had completely left working on human trafficking legislation. others remained in the coalition, but with a very strained relationship with the hard-line coalition members. the following is what one informant said about this powerful coalition in action: i felt like it was a very impressive coalition and at the same time it was difficult. i think what made it work was there were buffer zones and we, in fact, were a buffer zone. i think that a lot of the groups that we worked with wanted to stay away from other wings of the coalition because they really do have such disagreements and we would share those [disagreements]. advances in social work, summer 2012 13(2) 257 “hijacked by this weird agenda…” ultimately, it seemed that the hardliners pushing the abolitionist agenda alienated some members of this coalition. one informant, who was angry over the ideologies that existed in the coalition said, i was always interested in the domestic violence connection to prostitution, all prostitution. it marginalized the anti-slavery movement. we just passed the largest slavery bill [the tvpa], and for god’s sake, now that you have a momentum going, you want to “deep six” this thing by turning it into a weird agenda against prostitution, right when you have traction on this thing. it gets people geared up on this ideological thing. we have 144 new countries that adopted protocols. america allowed it to get hijacked by this weird agenda. it hurt a lot of the coalition building and served to marginalize... the unlikely partnerships that formed the left/right coalition served to push the passage of the tvpa legislation. however, many informants were in disagreement with the ways in which certain underlying agendas surfaced and led to an anti-prostitution crusade. discussion the purpose of this research was to identify coalitions and examine coalition identities of policy players involved in the making of the tvpa, in order to gain a better understanding of the competing motivations behind the making of the legislation. what we found through our research was that there were more players who were interested in protecting ideologies and pushing an anti-prostitution agenda, than there were players who were interested in having strong legislation to protect actual victims of human trafficking. the underlying moral agenda to abolish prostitution and other conservative motives led to unlikely partnerships (between republicans, conservative christians and radical feminists), forming the left/right coalition whose voice had the greatest influence on the formation and passing of the tvpa. it’s imperative that we acknowledge the ways in which the tvpa legislation was constructed and formed by a moral agenda, in order to understand why current efforts to address trafficking are futile and unproductive. although the tvpa was the most comprehensive and far reaching legislation that was passed to combat human trafficking at the time, and despite the large amount of funding provided by the u.s. government that has been invested into the protection of trafficking victims, few trafficking victims have actually received protection under the tvpa, especially in consideration of the original (and unreliable) estimates of trafficking victims that were provided by the u.s. government. it has been more than ten years now since this legislation has been implemented and since its enactment, $500 million dollars have been spent or allocated for anti-trafficking programs (mcgaha & evans, 2009), with little success. the data presented by the federal government during the making of the tvpa estimated that there were as many as 50,000 persons trafficked in the united states every year and 700,000 people per year trafficked globally (footen, 2007; mcgaha and evans, 2008). however, later those numbers were revised to an estimate of between 18,000 to 20,000 people bromfield, capous-desyllas/the trafficking in victims protection act 258 trafficked in the u.s. annually, and then later revised once again to between 14,500 and 17,500 (footen, 2007). recently some scholars and those in the media have blamed the lack of protection of victims, not on ineffective legislation or poor implementation of the tvpa, but on the lack of actual victims. victims are not being helped because the victims don’t exist, despite the high estimates of trafficking victims provided by the u.s. government and the task forces that exist in every state to find trafficking victims and root out perpetrators of trafficking crimes (we do acknowledge that victims may be hidden). according to weitzer (2011), several myths surround human trafficking such as: trafficking is a “mammoth” problem, trafficking is a growing problem, and trafficking and prostitution are the same phenomenon. it has been suggested that the human trafficking problem in the u.s. has been over exaggerated by those on the far right (conservative christians) and those on the far left (radical feminists) in order to push their own anti-prostitution/antisex worker agendas. the discourse on human trafficking and the anti-trafficking moral crusade is a vehicle used to push this agenda. we believe that this assertion can be supported by our interview data. what seems most unfortunate about the tvpa is that it was passed in a fervor of outrage and hysteria by several strong coalitions with a highly ideological base and millions of dollars have been thrown into anti-trafficking efforts by the federal government with few results. as mcgaha and evans (2009, p. 3) note, “the problem lies within the context of how the need for the legislation was presented and the zealous response to the issue.” in addition, anti-prostitution and anti-trafficking groups have officially partnered and collaborated with government agencies, while those who do not share the same ideological perspective have been excluded and denied funding (weitzer & ditmore, 2010). under the bush administration, the morally-driven coalitions have infused their ideology, not only in formation of the policy, but in law enforcement, research agendas, scholarly articles, media reports, social service provisions, and agency practices. millions of dollars are being authorized by the government for the creation of task forces, the criminalization of customers, and the surveillance of internet-based businesses, while the anti-prostitution pledge of the tvpa cracks down on prostitution and ignores the need for larger structural changes within our society. conclusions trafficking, as a social issue, needs to be re-conceptualized and understood from a different framework so that we do not continue to oversimplify and sensationalize the same trafficking narrative that the left/right coalition utilizes to push their agenda. legislation needs to be amended to eliminate anti-prostitution ideology and to support anti-oppressive approaches to addressing forced or deceptive working conditions. a more socially just perspective would (1) seek to understand and address socio-economic conditions that promote sex work with consideration for gender, race, ethnicity, and other embodied identities; (2) focus on all forms of un-free labor, as opposed to just focusing on the sex industry; (3) acknowledge the diverse experiences of sex workers in various aspects of the sex industry, without privileging specific narratives to support a moral agenda; (4) be mindful of the multi-layered experiences of migrants in the sex industry; advances in social work, summer 2012 13(2) 259 and (5) identify and implement concrete ways in which to provide comprehensive and meaningful services that enhance worker’s health, safety, agency and control over their working conditions (weitzer & ditmore, 2010). there is a need to acknowledge and address structural issues of inequality and oppression which lie at the root cause of social problems (such as trafficking). alternative labor rights and migration frameworks need to be taken into account when understanding the trafficking phenomenon. diverse perspectives and global voices need to be honored and incorporated when formulating and implementing policy related to human trafficking so that the trafficking discourse isn’t dominated by governments and organizations of the global north. underlying motives, moral agendas & unlikely partnerships have worked in full force to silence individuals, communities, organizations and alternative ways of understanding and conceptualizing human trafficking. the u.s. trafficking discourse and the corresponding policy needs to be re-evaluated, de-constructed and re-focused to address global and local structural issues that lead to conditions of un-free labor. the trafficking phenomenon and its complexity much be situated in the broader context of labor migration in our globalized economy before we even begin to implement national and local ways to address the issue. references agustin, l. (2005). migrants in the mistress’s house: other voices in the “trafficking” debate. social politics, 12(1), 96-117. bindman, j., & doezema, j. (1997). redefining prostitution as sex work on the international agenda. retrieved on march 20, 2006:http://www.walnet.org/csis/papers/redefining.html capous-desyllas, m. (2007). a critique of the global trafficking discourse and u.s. policy. journal of sociology and social welfare, 34(4), 57-79. chapkis, w. (2003). trafficking, migration, and the law: protecting innocents, punishing immigrants. gender & society, 17(6), 923-937. chuang, j. (2010). rescuing trafficking from ideological capture: prostitution reform and anti-trafficking law and policy. university of pennsylvania law review, 158(6), 1655-1728. ditmore, m., (2003). morality in new policies addressing trafficking and sex work. “women working to make a difference” iwpr’s seventh international women’s policy research conference, june. doezema, j. (1998). forced to choose: beyond the voluntary v. forced prostitution dichotomy in k. kempadoo & j. doezema (eds.), global sex workers: rights, resistance and redefinition (pp. 34-50). new york: routledge. bromfield, capous-desyllas/the trafficking in victims protection act 260 footen, n. k. (2007). the making of the trafficking victims protection act of 2000: viewed through the lens of the advocacy coalition framework. (doctoral dissertation, virginia commonwealth university). kapur, r. (2005). ‘travel plans: human rights of transnational migrants’, harvard human rights journal, 18, 107-138. miko, f., & park, g. (2002). trafficking in women and children: the u.s. and international response. washington, dc: congressional research service. mcgaha, j., & evans, a. (2009). where are the victims? the credibility gap in human trafficking research. intercultural human rights law review, (4), 239. obando, a. e. (2003). migrant sex workers. retrieved from www.iiav.nl/ezines/web/whrnet/2003/august/whrnet/issue-migrantsexworkers.html outshoorn, j. (2005). the political debates on prostitution and trafficking of women, social politics: international studies in gender. state and society, 12(1), 141-155. pattanaik, b. (2002). where do we go from here? in s. thorbek & b. pattanaik (eds.), transnational prostitution: changing patterns in global context (pp. 114-137). london and new york: zed books. sabatier, p. (1998). the advocacy coalition framework: revisions and relevance for europe. journal of european public policy, 5(1), 98-130. sabatier, p., & jenkins-smith, h. (1993). policy change and learning: an advocacy coalition approach. boulder, co: westview press. sabatier, p., & jenkins-smith, h. (1999). the advocacy coalition framework: an assessment. in p. sabatier (ed.), theories of the policy process (pp. 117-166). boulder, co: westview press. sassen, s. (2002). global networks, linked cities. new york: routledge. saunders, p. (2005). traffic violations: determining the meaning of violence in sexual trafficking versus sex work. journal of interpersonal violence, 20(3), 343-360. saunders, p., & soderlund, g. (2003). traveling threats: sexuality, gender and the ebb and flow of trafficking as discourse. canadian woman studies, 22, 35-46. weitzer, r. (2011, august 24). myths about human trafficking. huffington post, retrieved on oct. 20, 2011 from: http://www.huffingtonpost.com/ronaldweitzer/human-trafficking-myths_b_935366.html weitzer, r., & ditmore, m. (2010). sex trafficking: facts & fictions. in b. weitzer (ed.), sex for sale: prostitution, pornography and the sex industry (2nd ed., pp. 325-351). new york: routledge. wijers, m., & van doorninck, m. (2005). what’s wrong with the anti-trafficking framework? background paper for the “european conference on sex work, human rights, labour and migration,” icrse (international committee on the rights of sex advances in social work, summer 2012 13(2) 261 workers in europe) retrieved on february 15, 2010 from: http://www.sexworkeurope.org/ author note: address correspondence to: nicole f. bromfield, ph.d., department of social work, united arab emirates university, p.o. box 15551, al ain, united arab emirates. email: nicole.f@uaeu.ac.ae microsoft word vourleklis et al_research infrastucture final ______________  betsy s. vourlekis, ph.d., ms, is a professor emerita of the university of maryland school of social work in baltimore, md; joan levy zlotnik, ph.d., acsw, is the director of the nasw social work policy institute in washington, dc; juan ramos, ph.d., msw, is a retired senior executive of the national institute of mental health in washington, dc; and kathleen ell, dsw, msw, is the ernest p. larson professor of health, ethnicity, and poverty in the school of social work at the university of southern california in los angeles, ca. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 230-245 building the profession’s research infrastructure betsy s. vourlekis joan levy zlotnik juan ramos kathleen ell abstract: beginning in 1988, the social work profession undertook a twenty-five year endeavor to enhance its research capacity and to assure greater representation of social work research needs, priorities and findings at the federal level, where major policy initiatives take place. described here are some of the key processes, highlighting the efforts to achieve professional solidarity, and the interventions, by social workers, federal “insiders” and outside advocacy agents that carried the work forward. details and accomplishments of this long-term, carefully sustained, and still incomplete professional self-strengthening change strategy provide insights for future collective professional endeavors. twenty-five years ago the social work profession began a sustained effort to strengthen its research infrastructure in support of demonstrating practice effectiveness, advancing knowledge for critical social problems, and informing national policy. the steps and processes undertaken and the outcomes achieved by this effort have been described elsewhere (austin, 1998; corvo, zlotnik, & chen, 2008; tfswr, 1991; zlotnik, biegel, & solt, 2002; zlotnik & solt, 2006, 2008). what we want to capture through this, our eye-witness account, are some of the nuanced and specific actions, obstacles, and decisions involved in this effort. recreating this case study of a profession’s selfstrengthening change strategy – targeted both to the external environment and its own internal one – can provide insights for future profession-wide, collective efforts. keywords: social work research, history, change process background the social work profession has been involved in research and research strengthening for much of its history. the first state policy for providing systematic aftercare to institutionalized persons with serious mental illness emerged in new york in 1907, a result of advocacy bolstered with data collected by students of the new york school of philanthropy (now columbia university school of social work) (vourlekis, edinburg, & knee, 1998). the historical record with respect to research prior to the period under consideration has been well synthesized in the 1991 report of the task force on social work research (tfswr, 1991) and by zlotnik (2008). the effort to be described here begins in the 1980s. there had been a number of significant changes at the federal level, heightening awareness of social work’s vourlekis, zlotnik, ramos, ell/ research infrastructure 231 vulnerability in key practice domains and marginalizing the profession's main social concerns and contributions. public health hospitals and treatment centers were closed, eliminating many direct service and administrative social work positions. congressional action in early 1981 converted funding and regional structures for community mental health center initiatives, previously overseen and funded by the national institute of mental health (nimh), and led and staffed to a significant degree by social workers, to block grants overseen by the states, resulting in a twenty-five percent cut in the nimh budget. nimh's division of manpower training, including for social work, long a source of graduate stipends for its students, was eliminated. also in the early 1980s nimh's research portfolio was stripped of significant “social” research programs, eliminating another ten percent of the agency’s budget and further diminishing connections with social workers. new medicare/medicaid regulations for hospitals, proposed and sent to the field for comment in the early 1980s, and approved as final june 17, 1986 (51 fr 22010), eliminated the requirement for a director of social work. state and local child welfare agencies were experiencing growing numbers of children that were reported for child abuse and neglect and placed in out of home care without a workforce of welltrained social workers with the necessary competencies and low enough caseloads to address the increasingly complex needs of children and families served by these systems. as states struggled to deal with these issues, technical assistance, leadership and guidance from the federal government, i.e., the children’s bureau, were lacking. in 1985 nasw identified a vacancy on the national mental health advisory council (the key federal level mental health policy oversight group) and worked to have a social work member appointed. the director of nimh, shervert frazier, md let it be known that he would support only a federally funded mental health researcher. lacking at the time a systematic data base to identify such social work researchers, nasw staff relied on their own knowledge, yielding very few names. that summer nasw's health and mental health commission undertook to contact every school of social work to generate names, again yielding very few. in an interesting twist of federal influencing, none of the suggested social work researchers got the appointment. it went to dennis jones, msw, then the indiana commissioner for mental health. indiana was the home state of the secretary (1981-89) of the department of health and human services, otis “doc” bowen, to whom nasw had made a case for gaining a voice at the council. social work got its spot on the council via our strong practice identification. this reflected reality: social workers were the largest provider group of mental health services in the united states and a number of state directors of mental health were social workers, yet the profession was represented in federal research in a limited way in 1987 lewis judd, md became director (1987-91) of nimh. responding to his wife’s (a clinical social worker) query about nimh’s relationship with social work, judd asked his deputy director for prevention and special populations, juan ramos, for an appraisal. ramos detailed the ramifications of policy and budgetary actions since 1980 in creating disconnects between nimh and the social work profession, both its practitioners and researchers. ramos argued that social work was involved with an array of critical issues for which a body of knowledge was needed. he recommended a mechanism to audit and reconnect with the field's research capacity. advocacy by staff within nimh advances in social work, spring 2014, 15(1) 232 and by nasw and cswe led to judd’s appointment of the nimh social work research task force in 1988. david austin, professor at the university of texas school of social work, was appointed chair (appendix a). the group was charged to have a broad focus “with regard to the role of research in social work and the role of research in the underpinning and development of the individual social worker...” and to specifically examine ‘”what is the current state of research in social work? what should be the role of research in social work? .... how can social work most broadly and quickly be influenced by the recommendations of the task force?” (vourlekis, personal letter, october 3, 1988). when judd met with the task force at its first meeting in november, 1988, he encouraged an unstinting and courageous effort at professional self-scrutiny, “like the flexner report.” task force: 1988-91 austin, employing his community organization and administrative skills, began a tireless process of connecting the task force’s assignment, inquiry process and eventually its findings to key constituent groups – social work education, specialty practice organizations, and social welfare associations and their leaders – as they held annual meetings. he maintained a clear vision of the true nature of the undertaking as a change process, not just a “report to sit on the shelf.” ramos, nimh project officer for the task force, facilitated resources for the comprehensive effort involving nine face-to-face multiple day meetings of the entire task force, austin’s travel throughout the country, exhaustive data-based assessments of the current state of the social work research enterprise, meetings with private and government funders, and finally, editing and publication of the task force final report. the task force’s comprehensive sweep of the environment revealed the profession was facing a supply problem (e.g. inadequate numbers and preparation of researchers) as much as a demand problem (e.g. limited funding and different priorities). capacity building in the profession was always the tf’s end goal; however, the perceptions for many in our field were of limited research dollars and federal research agendas seemingly incompatible with primary social work concerns. while there was some validity to these views, by the late 1980s the reality at nimh had shifted. judd, in a 1989 speech to social workers (nasw annual meeting of the profession, november 10, 1988, philadelphia, pennsylvania), outlined some of these changes. the institute had experienced its largest ever increase in funding in the two years 1986-88, with a budget jumping from 382 million to 515 million dollars. with the objective of diversifying its research portfolio and encouraging “all science,” nimh priorities now included the homeless mentally ill, aids, youth suicide, service system research including psychosocial rehabilitation and psychotherapy, environmental and clinical services research in the schizophrenia initiative, and a push for public system-academic research partnerships (judd, 1989). as the task force work proceeded, some stark facts about the profession’s capacity, not unknown to many, but hard to acknowledge publically, emerged and were documented in the report. for example, social work doctoral graduation numbers remained stagnant despite an increase in the number of programs available (tfswr, vourlekis, zlotnik, ramos, ell/ research infrastructure 233 1991, p. 21). the quality of preparation for research was uneven across programs and often deficient. alan leshner, ph.d., then associate director of nimh, met with the task force and was struck by the average age of late 30s of social work doctoral recipients and its implications for a grueling research career trajectory. often entering doctoral studies after a number of years in practice, these individuals were less likely to apply for postdoctoral fellowships (and their modest stipends) that were considered essential for building research expertise, and aimed for teaching positions instead. social work researchers and their investigations infrequently involved the interdisciplinary approach and partners that were viewed as essential for the complex problems facing policy makers and service providers. social work education had been largely unsuccessful in creating models of advanced research training that incorporated or were integral to social work practice activities, fostering a concern that future educators for the profession would lack a sufficient grounding in the practice they were teaching, and their research would be too far removed from the central needs of practice. austin made another round of communicating conclusions and recommendations from the task force as the report was being written. these included comprehensive and detailed recommendations for action to federal government agencies, private funders, and to the full range of social work organizations. paramount was the urgent need for the profession itself to establish dedicated research advocacy structures that would address issues of both supply (professional capacity) and demand (appropriate funding opportunities) on a long-term basis. nasw and cswe each were urged to have an office of research development. the task force also recommended that a national social work research institute be established by the profession to focus exclusively on “increasing recognition and support accorded to research career development and research productivity within the profession...” (tfswr, 1991, p. 47). nimh agreed to fund a twoyear implementation effort as the task force disbanded. implementation committee: 1991-1993 again with the change process paramount, membership on the implementation committee (ic) consisted of leaders from both the educational and practice domains. appointed to the task were the president and executive director of cswe, the presidents of the national association of deans and directors, group for the advancement of doctoral education (gade), and the baccalaureate program directors (bpd), all representing social work education; the president, executive director, and one board member of nasw, and representative practitioner/leaders from each of the health, mental health, child welfare, and aging fields, all representing social work practice. betsy vourlekis served as chair, and austin, ex officio, providing continuity with the original task force (appendix b). as the ic met, each organization quickly committed to specific implementation recommendations from the task force report that were viewed as feasible at the time. the majority of the ic’s time and activity were devoted to discussing and fleshing out the parameters, governance, structure, and possible initial financing of a national social work research entity, or what came to be known as the institute for the advancement of social work research (iaswr). advances in social work, spring 2014, 15(1) 234 there were formidable challenges to the establishment of an entity such as the one under consideration. the group argued initially to prioritize advocacy efforts for a federal social work research institute (as the national institute for nursing research), emphasizing their enthusiasm and collective will to address the demand problem. while that was (and remains) a goal for the profession, realistic assessment dictated: 1) this was a long-term goal; and, 2) there was a need for the profession to demonstrate its own commitment to capacity building. building solidarity to undertake action by the profession itself was more complicated. to begin, the group asked mark battle, don beless and betsy vourlekis to flesh out a draft proposal for an organizational structure, mission, and goals. delineating the purpose and scope of activities required careful weighing of the potential competing interests of schools and programs, who would be pursuing research dollars on their own. iaswr would actually do research only as part of capacity building and in response to initiatives for which schools were ineligible. some committee members challenged the need for such an institute. they wondered if some of its proposed functions were redundant or necessary. this was primarily because these advocacy functions and activities were, and still are, poorly understood – except by seasoned federal influencers and players – for the time-consuming, nuanced and relationship-based work they involve. concurrent with the ic’s work, meetings held in different parts of the country throughout 1991-93 reinforced the message and directives of the task force report. one such meeting, “building social work knowledge for effective mental health services and policies,” sponsored by the services research branch of nimh (april 6-7, 1992, bethesda, md), culminated with a brief address by janet williams entitled “organization of a society for social workers in research.” she presented an outline of her proposed goals and structure for an individual membership, dues-paying entity to an enthusiastic response from attending social work researchers. the potential benefits of such a group were clear. social work researchers had not had an organized interest group, as such, since the social work research council was disbanded in nasw's 1974 reorganization (zlotnik, 2008). however, with the ic’s discussions and negotiations about the proposed iaswr at a critical point, vourlekis and austin were concerned that starting the society just then could derail the more contentious profession-wide effort. the existing organizations, each with their freight of constituency demands, might see themselves as off the hook, fiscally and agenda-wise. williams agreed to hold off organizing the society until the implementation committee concluded its work. funding for the proposed iaswr was the major difficulty. all the represented organizations had limited budgets as well as fully allocated programmatic funds and priorities. committee members questioned the long-term fiscal viability of even the modest sized establishment already under consideration. ultimately, leaders of the profession’s organizations at the table were challenged to come up with dollar figures for an initial appropriation for each year for three years, based on each group's size and budget. bpd was the first to put an offer in play. baccalaureate directors accepted their recommended actions with prominent activities and initiatives. in his speech at the group’s 25th anniversary meeting, president grafton hull emphasized again how important strengthening research comprehension and utilization was to the mission of vourlekis, zlotnik, ramos, ell/ research infrastructure 235 baccalaureate programs, and said that working with the ic and its agenda had been a highlight of his term (bpd 25th anniversary conference, march 5-9, destin, florida). after the professional organizations’ funding parameters were established, the ic hammered out a mission statement and initial set of goals and objectives, and the structure and representation of the oversight board of directors was determined. nimh indicated willingness to consider an initial contract for capacity building activities, some of which had already begun under nimh auspices that would provide funds for projects plus overhead to the proposed institute. at the ic’s final meeting in the shadow of the alamo in san antonio the committee voted for the institute plan and agreed to take it to their respective boards. ultimately the boards of each organization represented on the ic voted to approve the plan, including the funds involved, and iaswr was born. institute for the advancement of social work research: 1993-2009 iaswr began with an initial budget of 94,000 dollars, based on contributions from cswe, nasw, nadd, gade, and bpd, donated office space at nasw, an interim director (vourlekis, on a semester leave from the university of maryland), and a parttime administrative assistant. the first task was to write the response to the rfp for an nimh contract for technical assistance activities. thanks to the “inside” advocacy – including interest, dogged determination, superb writing, and skillful bureaucratic infighting – of kenneth lutterman, staff social scientist at nimh, both this disciplinespecific contract as well as the far more consequential rfp for social work research development centers issued a few months later moved through the contentious process of approval at nimh. nimh senior staff questioned the need for any discipline-specific initiatives, arguing for interdisciplinary center rfps exclusively. in a key “outside” advocacy intervention, ronald feldman, dean at the columbia school of social work, met with alan leshner, by then acting director of nimh, and made a persuasive case for the potentially unique and consequential contributions of social work research. nimh ultimately funded eight social work research centers (washington university, fordham university, portland state, the universities of tennessee, pennsylvania, pittsburgh, and michigan). the expertise and stature of a permanent director at iaswr to oversee and implement its largely federally funded efforts was a dominant concern at nimh. opportunely, at tf and ic meetings nimh staff had offered an ipa (intergovernmental personnel act) position for a social worker to come to work at nimh. rino patti, then dean at usc and serving as president of the newly formed iaswr, urged kathy ell, who was beginning a sabbatical leave year, to come east and take the ipa position. after eight months at nimh, ell, with the blessings of her nimh colleagues, agreed to take the directorship of iaswr, thereby providing both permanence and serious research credentials to the position (ell, 1996, 1997; ell & martin, 1996; inouye, ell, & ewalt, 1995). under ell’s leadership (1994-1996), iaswr reached out to other federal agencies, successfully garnering contracts and grants from nimh, nida, department of defense, and the centers for disease control and prevention (cdc). in addition, iaswr began advances in social work, spring 2014, 15(1) 236 participating in multi-disciplinary groups calling for increased nih funding for psychosocial research. simultaneous to the expanded focus on social work research was increased advocacy for behavioral and social sciences research at nih, resulting in the creation of the office of behavioral and social sciences research (obssr). a key iaswr activity was its significant contribution in supporting and facilitating the creation in 1994 of the society for social work and research and playing a leadership role in the nimh funded, sswr inaugural meeting april 9-11, 1995 in arlington, virginia. as a part of that meeting and organized by iaswr, leaders from nih and members of congress attended the first ever capitol hill social work research poster session, bringing researchers and their work in important areas of social concern to the attention of national policy makers and research funders. after ell’s return to her university position, john lanigan, a former foundation program officer was hired to lead iaswr (1996-2000). during his tenure one of the recommendations from the initial task force report was realized when a bill was introduced by senator daniel inouye (d-hi) to create a federal national center for social work research, most likely to be placed at the national institutes of health. also during this time nida, now under the directorship of alan leshner, launched a social work research development center program as well. championed within nida by social workers peter delany and jerry flanzer, over the course of five years seven centers were funded (washington university, arizona state, suny-albany, case western reserve, columbia, and the university of texas austin). the national center for social work research act legislation garnered bi-partisan support in the house of representatives, when asa hutchison (r-ar) (with a social work educator as his chief of staff) and ciro rodriguez (d-tx) (himself a social worker educator) together introduced the bill in the house. there was also bi-partisan support in the senate for several congressional sessions, when republicans tim hutchison (r-ar) and susan collins (r-me) served as cosponsors. senator collins was approached by kim anne perkins, president of the maine nasw chapter and director of a bsw program in maine. senator hutchison was the brother of congressman hutchison, who had attended high school with social worker betty guhman, who made the contacts and the case. relationships matter. although the federal center has yet to be realized, the introduction of the legislation energized the action network for social work education and research (answer), a coalition of the same organizations that supported iaswr, along with iaswr to mount a large scale lobbying campaign. in addition, the focus on nih attracted interest from the cdc that thought social work research should also have a place at the cdc. this resulted in a contract to iaswr to focus on social work contributions to injury prevention and prevention of child maltreatment (iaswr, 2003). despite having key social workers in congress reintroduce the bill in both the house and the senate during several subsequent sessions of congress, it was hard to maintain the bi-partisan support as congress became more polarized, and as the profession’s advocacy focus moved on to other priorities, especially the dorothy i. height and whitney m. young social work reinvestment act. the effort was further depleted by vourlekis, zlotnik, ramos, ell/ research infrastructure 237 concerns that institutes and centers were proliferating at the nih, resulting in the 2006 reauthorization of nih (p.l. 109-482) limiting the number of institutes and centers (office of legislative policy and analysis, 2014). despite the on-going challenges of a small staff and severe budget constraints, iaswr made robust progress during joan levy zlotnik’s nine year tenure (2000-2009) as director. zlotnik came to iaswr after working both at nasw and cswe. her reputation for creating collaborations, knowledge about how to work with the executive branch of government and with congress, as well as her connections with social work academic and practice leadership positioned her well for taking on iaswr’s agenda. in assuming the directorship, zlotnik immediately sought to reach out further to multiple institutes of the nih, and to assess how iaswr could best support the strengthening of research culture and infrastructure within social work education and through the many social work practice organizations. the iaswr board engaged numerous stakeholders in developing a strategic plan (zlotnik, biegel, & solt, 2002). in its implementation, one of the first tasks was to invite sswr, the rapidly growing membership organization of social work researchers, to become one of iaswr’s supporting organizations. another was to increase social work’s visibility in the washington (inside the beltway) behavioral and social science research community. iaswr pursued active involvement with the advocacy efforts undertaken by the consortium of social science associations (cossa) and three of the coalitions cossa leads (coalition to advance health through behavioral and social science research [caht-bssr]; coalition to protect research [cpr]; and collaborative for enhancing diversity in science [ceds]) (zlotnik & solt, 2006). iaswr’s advocacy and continual presence at these meetings, along with attendance at nih’s various advisory groups, resulted in greater inclusion of social work researchers in hearings, briefings, review panels and workgroups. iaswr also arranged for social work leaders and researchers to meet with key institute and center directors, resulting in new research support, social work researcher training, and knowledge building strategies. in addition, through iaswr’s advocacy, the national advisory mental health council finally appointed a social work researcher, enola proctor of washington university in st. louis, who served for three years. iaswr worked closely with the answer coalition and nasw to bring attention to social work research through the strategy of recommending “report language” to be inserted into house and senate appropriations bills, language that directs the executive branch to take certain actions. iaswr’s outreach had by now moved beyond nimh, and included efforts to promote social work research at nida, niaaa, national institute on aging (nia) and the national cancer institute (nci). zlotnik had also cultivated iaswr's engagement with the new nih office of behavioral and social sciences research (obssr). consequentially, report language was included in the 2003 nih senate appropriations report (senate report 107-216) directing nih to create a social work research plan (national institutes of health, 2003). the plan was the first transnih effort to recognize the importance of social work research and identify steps to build social work research opportunities at nih. obssr convened a workgroup to develop the plan. members of the group were representatives from nimh, nida, niaaa, nci, the advances in social work, spring 2014, 15(1) 238 national institute on aging (nia), the national institute on nursing research (ninr), the national institute on child health & human development (nichd), and the office on aids. that workgroup, 10 years later, continues to meet and plan efforts to provide technical assistance, training and nurturance to the social work research community. continuing members since the beginning include stephane philogene of obssr, denise juliano-bult of nimh, peggy murray of niaaa, and suzanne heurtin-roberts of nci. the working group has included both social workers on the nih staff as well as nonsocial workers. they have been challenged to garner support from their own institutes as well as from obssr and to monitor the social work research enterprise. the need for a systematic, comprehensive, and continuously updated database covering all facets of the profession's research infrastructure has been evident since before the initiation of the tf. in 2004, iaswr undertook the seemingly simple, but actually complex task of trying to track social work researchers funded by nih between 1993 and 2004. many people thought such a database ideally should include research funding from other federal and state entities as well as foundations, but zlotnik knew how hard it was to gather such information and thought it was important to have a specific focus as a starting point. information for the directory was gathered from the institutes themselves (although their data was not readily retrievable by discipline, only by degree and university affiliation, resulting in considerable ambiguity), and by asking researchers to enter their information in a database. in addition requests were made to deans and directors, and iaswr staff became copious readers of a range of newsletters, e-alerts, press releases and conference programs, scouring as many sources as possible for information about social work researchers. the document highlighted the longstanding and growing investments that nimh had made in social work research as well as the other lead institutes that supported social work research. despite its accomplishments both within the profession and within the washington, dc scientific community, iaswr was always challenged. the routinely changing leadership of the supporting social work organizations required regular orienting of new board members and convincing once again the new leaders of the value and utility for the profession and their own organizations represented by their contribution to the collaborative undertaking. sometimes the message and the institute itself was well received; other times less so. funding support from the organizations would shrink and grow with some of the leadership changes and, at best, iaswr was always in need of outside, contracted support. this challenge was made more onerous with a new environment at the nih. changes in staff and changes in available funding made it difficult to garner large-scale contracts after 2003. while the nih budget doubled between 1998 and 2003, a time of important growth in the number of nih funded social work researchers, after that point budgets became flat or actually decreased in real dollars. iaswr successfully garnered smaller, short-term contracts and grants from several federal agencies including the children’s bureau, cdc, the agency for healthcare research and quality, and at nih – obssr, nida, niaaa, nci, and nimh as well as from the annie e. casey foundation, casey family programs, and the gill foundation. however, the 2008 and 2009 economic downturn had all funders and vourlekis, zlotnik, ramos, ell/ research infrastructure 239 supporting organizations considering how to prioritize the funds they had available, resulting in a stagnant funding environment. by 2009, the iaswr board of directors determined that the institute would have great difficulty continuing with its limited contributed funds and shrinking outside funding opportunities. when zlotnik was offered a new position at nasw, the board realized it would have difficulty attracting someone new to lead the organization. agreeing to planfully dissolve the organization, the iaswr executive committee, working with key deans and sswr leaders, held a retreat at the university of maryland school of social work in june 2009. certain iaswr goals and tasks were taken on by other organizations. sswr, fiscally strengthened through membership and a successful annual conference, planned a national research capacity building initiative, hoping to maintain social work research’s presence with federal agencies and within coalitions. the popular iaswr listserv, with more than 3000 subscribers migrated to the boston university school of social work, with the dean agreeing to take on this task because she valued the product (www.bu.edu/swrnet). zlotnik's new position as director of nasw’s social work policy institute assured some continuity in key federal relationships and a focus on garnering research and research-generated information for issues of practice. as the taskforce and implementation committee had envisioned, the research advocacy and facilitative organization that became iaswr, collaboratively undertaken, successfully gave visibility to social work research in washington, dc and supported social work research development within social work institutions. it was an essential entity in building the social work research enterprise and the profession's knowledge development over the past 25 years. its demise may have come too soon – as much work continues to be done. but organizations such as iaswr are always challenged to maintain collaboration among organizations with many competing demands, and need champions among all of the potential stakeholders. conclusion the many and diverse successes of the profession’s twenty-five year collective change effort with respect to its research capacity and infrastructure have been documented elsewhere (jensen, briar-lawson, & flanzer, 2008; mcroy, flanzer & zlotnik, 2012; zlotnik, biegel, & solt, 2002; zlotnik & solt, 2006, 2008). certainly there are enormous challenges remaining. among the most intractable is the need for social work intervention research that is of sufficient scale and rigor to influence key decision makers including provider organizations, service system funders and administrators, and state and federal policy. furthermore critically needed is research across our many fields to generate evidence-based and demonstrably effective social work practice that integrates social work practice settings (and their practice concerns) with social work researchers and research resources. equally needed is research that will bring evidencebased interventions into the complex service systems that provide services and support to our nation’s most vulnerable individuals and families. this remains as vitally true today as it did ten years after the task force report, when david austin concluded in a 1998 progress report “only as research contributes systematically to the knowledge base that advances in social work, spring 2014, 15(1) 240 will improve professional practice, in all of its forms, can there really be a justification for expanded financial support for such research” (austin, 1998, p. 43). an important lesson from the perspective of twenty-five years is the sustained and lengthy nature of the effort itself. change has been incremental, piecemeal and certainly incomplete. the practice of policy influence at the federal level is intricate, timeconsuming and on-going and must be learned and mastered. relationships matter and must be cultivated – researchers with federal agency staff and staff with social work researchers. at critical junctures in the endeavor recounted here, career federal civil service social work colleagues played leading roles. their expertise was indispensible in making a case for the profession’s actual and potential contributions to important initiatives within their agencies; in promoting opportunities and providing thoughtful guidance to social work researchers; and skill in bureaucratic maneuverings to create legitimate space and attention for social work priorities. in moving forward, the profession and its educational enterprise need to promote such career-long commitments to federal policy positions as a key component of “insider” knowledge and influence and as valued social work professional roles. from the beginning, the effort described here relied on our own profession’s organizational collaboration, inclusiveness, and recognition of common as well as disparate interests. for us an important insight suggests that professional unity and a collective “voice” are possible around specific, bounded goals. results and progress toward such delineated goals are more likely to be achieved in this manner than are larger scale structural and conceptual efforts at professional unification. the scope and diversity of social work's practice and educational enterprise generate more needs and demands than our financially limited organizations can hope to meet, so the struggle over what to “talk about,” let alone in one voice, and then to collectively “do about it” continues. the solidarity to address our research infrastructure remains a powerful and successful example. references austin, d. (1998). a report on progress in the development of research resources in social work. washington, dc: institute for the advancement of social work research. corvo, k., zlotnik, j., & chen, w. (2008). organizational and institutional factors associated with national institutes of health research grant awards to social work programs. research on social work practice, 18(5), 514-521. ell, k. (1996). social work and health care practice and policy: a psychosocial research agenda. social work, 41, 583-592. ell, k. (1997). the national institutes of health: a partner in advancing social work intervention research. social work research, 21, 181-185. ell, k., & martin, j. a. (1996). enhancing social work research on military women’s health report. washington, dc: institute for the advancement of social work research. vourlekis, zlotnik, ramos, ell/ research infrastructure 241 institute for the advancement of social work research (iaswr). (2003). social work contributions to public health: bridging research & practice in preventing violence lessons from child maltreatment & domestic violence. washington, dc: author. retrieved from http://www.socialworkpolicy.org/publications/iaswrpublications/social-work-contributions-to-public-health-bridging-research-practicein-preventing-violence-%e2%80%93-lessons-from-child-maltreatment-domesticviolence.html institute for the advancement of social work research (iaswr). (2009). directory of social work research grants awarded by the national institutes of health: 19932009. washington, dc: author. retrieved from http://www.sociaworkpolicy.org/publications/iaswr-publications/iaswr-directory-offunded-research.html inouye, d., ell, k., & ewalt, p. (1995). research for public policy. social work, 40, 1-3. (guest editorial with senator daniel inouye, hawaii). jenson, j., briar-lawson, k., & flanzer, j. (eds.). (2008). research capacity and infrastructure development in social work research. special issue. social work research, 32(4). judd, l. (1989, november). building the profession's knowledge base. address at the national association of social workers meeting of the profession, san francisco, ca. mcroy, r., flanzer, j., & zlotnik, j. l. (2011). building research culture and infrastructure. new york, ny: oxford university press. national institutes of health. (2003). the nih plan for social work research. retrieved from http://obssr.od.nih.gov/pdf/swr_report.pdf office of legislative policy and analysis. (2014). legislative updates: national institutes of health reform act of 2006. retrieved from http://olpa.od.nih.gov/legislation/109/publiclaws/reformact06.asp task force on social work research. (1991). building social work knowledge for effective services and policies: a plan for research development. retrieved from http://www.socialworkpolicy.org/publications/iaswr-publications/building-socialwork-knowledge-for-effective-services-and-policies-a-plan-for-researchdevelopment-a-report-of-the-task-force-on-social-work-research-november1991.html vourlekis, b. s., edinburg, g., & knee, r. i. (1998). the rise of social work in public mental health through aftercare of people with serious mental illness. social work (centennial issue), 43, 568-575. zlotnik, j. l. (2008). research: history of research. in t. mizrahi & l. davis (eds.), encyclopedia of social work (20th ed., pp. 521-526). washington, dc: nasw & oxford press. advances in social work, spring 2014, 15(1) 242 zlotnik, j. l., biegel, d. e., & solt, b. e. (2002). the institute for the advancement of social work research: strengthening social work research in practice and policy. research on social work practice, 12(2), 318-337. zlotnik, j. l., & solt, b. e. (2006). the institute for the advancement of social work research: working to increase our practice and policy evidence base. research on social work practice, 16(5), 534-539. zlotnik, j. l., & solt, b. e. (2008). developing research infrastructure: the institute for the advancement of social work research. social work research, 32(4), 201-207. author note address correspondence to: betsy s. vourlekis, ph.d., 5021 van ness, nw, washington, dc 20016. email: vourleki@umbc.edu  betsy schaefer vourlekis is professor emerita at the university of maryland school of social work. she received her b.a. from harvard, msw from columbia, and ph.d. from the university of maryland. she practiced psychiatric social work at st. elizabeths hospital, washington, dc, and was staff director for health and mental health at the national association of social workers prior to joining maryland’s faculty in 1988. she served on the nimh task force on social work research and chaired the follow-up national implementation committee. she was the project consultant and field researcher for nasw’s clinical indicator guideline project that developed quality improvement indicators for social work/ psychosocial services in medical and psychiatric settings. she worked extensively with social work groups designing program evaluation tools that improve visibility and accountability for their practice. joan levy zlotnik has a b.a. from the university of rochester, an mssw from the university of wisconsin-madison, and a ph.d. from the university of maryland, baltimore. she currently serves as the director of the social work policy institute (swpi), a think tank established in the nasw foundation to enhance social work’s voice in the public policy arena and to use research findings to inform policy and practice. dr. zlotnik served as executive director of the institute for the advancement of social work research (iaswr) from 2000 to 2009 and also previously served as director of special projects at the council on social work education (cswe) after working at nasw from 1987 to 1994. dr. zlotnik is an nasw social work pioneer®, a fellow of the gerontological society of america, and was identified as one of the six most influential social workers in the united states by the university of maryland school of social work. vourlekis, zlotnik, ramos, ell/ research infrastructure 243 juan ramos retired after 35 years at the national institute of mental health (nimh/nih/hhs) having served in various positions, including a 12-year period as a division director, and 20 years as associate director for prevention and senior advisor on international activities. he was the nimh project officer for the task force on social work research from 1988 to 1991. he is a member of the steering committee of the nasw social work pioneers; vice-chairman of the board of the center for behavioral health solutions; a board member of the catholic social workers national association; past board member of the national hispanic council on aging; assisted in the founding of the society for social work and research (sswr) and the society for prevention research (spr); and has been a longtime advocate for the full implementation of title vi of the civil rights act of 1964. he holds an msw from the school of social work at the university of southern california and a ph.d. from the heller school for social policy and management at brandeis university. dr. kathleen ell’s nationally and internationally recognized research has addressed two overarching scientific questions: 1) how is the mind and body linked in acute, chronic and life-threatening illness, quality of life and mortality; and 2) how can access to health care, patient selfcare and treatment activation and adherence, and health outcomes be improved. her work has focused on: a) improvement of communitybased services for patients with abnormal cancer screens, individuals diagnosed with clinically significant depression, often concurrent with acute and/or chronic medical illness; b) socio-cultural adaptations aimed at reducing barriers to optimal care receipt; c) patient-centered care preferences and uptake, psychological and medical outcomes, and medical provider needs to advance collaborative care models. her emerging health information technology application research is also significantly focused on social work clinician preferences, needs, and application in real world practice.   advances in social work, spring 2014, 15(1) 244 appendix a national institute of mental health social work research task force members david m. austin, phd, chair ronald a. feldman, phd, vice-chair glenn allison, ma scott briar, dsw elaine m. brody, msw claudia coulton, phd king e. davis, phd patricia l. ewalt, phd w. david harrison, phd steven p. segal, phd barbara solomon, dsw tony tripodi, phd betsy s. vourlekis, phd juan ramos, phd, nimh project officer vourlekis, zlotnik, ramos, ell/ research infrastructure 245 appendix b social work research task force implementation committee david austin (university of texas), ex officio mark g. battle (executive director, nasw), ex officio don beless (executive director, cswe), ex officio sandra butcher (georgetown university hospital, representing health practice, nasw) michael frumkin (cswe, alternate) grafton hull (president, bpd) dennis jones (texas commissioner of mental health, representing mental health practice) jack sellars (bpd, alternate) sheila kamerman (president, gade) c.w. king (board representative, nasw) ruth massinga (casey family foundation, representing child welfare practice, nasw) julia norlin (president, cswe) rino patti (president, nadd) nola proctor (gade, alternate) frank raymond (nadd, alternate) fernando torrez gil (ucla, representing aging practice, nasw) betsy s. vourlekis (university of maryland), chair barbara white (president, nasw) juan ramos (nimh project officer) microsoft word 7. lee_shipe_16686-interdisciplinary collaboration copyedit final   ______________  sang jung lee, msw, and stacey l. shipe, msw, msc, are both phd students in the university of maryland school of social work in baltimore, md. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 352-367 influences on interdisciplinary collaboration among social work and health sciences students sang jung lee stacey l. shipe abstract: interdisciplinary collaboration is an effective and satisfying way to provide health care services and learning across professions. this study aimed to explore interdisciplinary collaboration experiences amongst social work and allied health sciences graduate students and examined factors that contributed to their interdisciplinary collaboration. an interdisciplinary survey was conducted in a midatlantic public university. analysis was conducted using hierarchical regressions from 112 health sciences and social work students. students with positive attitudes toward interdisciplinary health care teams and part-time students compared to fulltime students presented higher flexibility of interdisciplinary collaboration. students with positive experiences of interdisciplinary collaboration demonstrated higher levels of interdependence, compared to those with no and negative experiences of interdisciplinary collaboration. students in medicine were less likely to show interdependence, compared to those in social work. professional disciplines and educators should put efforts in offering opportunities for interdisciplinary collaboration practice and building curricula to promote positive attitudes toward interdisciplinary teamwork. keywords: social work, allied health sciences, interdisciplinary collaboration interdisciplinary collaboration is an effective and satisfying way to provide health care services (drotar, 2002; hanson, spross, & carr, 2000; robinson & kish, 2001). but it is also important for solving complex and multidimensional issues in health and human services (mabry, olster, morgan, & abrams, 2008; syme, 2008). in social work practice and health care settings, serving clients effectively is impossible without collaboration with professionals from other disciplines (bronstein, 2003). therefore, health care and health education decision-makers have been more attuned to education and professional collaboration across disciplines (reeves et al., 2011). current research has shown that interdisciplinary education improved the skills and behaviors that are needed for effective interdisciplinary collaboration both academically and professionally (barr, 2002; curran, sharpe, forristall, & flynn, 2008; meads & ashcroft, 2005). ivey, brown, teske, and silverman (1988) found that undergraduate students exposed to an interdisciplinary course would be more likely to work collaboratively once they moved into the workforce. among professionals, gaboury, bujold, boon, and moher (2009) found that practitioners were more likely to collaborate with clinicians who had been exposed to interdisciplinary collaboration trainings. these positive findings have also been replicated in studies focusing specifically on social workers. for the better part of 100 years the pairing of social workers and allied health care professionals (e.g., nursing and medicine) has been common practice as the social worker can help to provide a broader perspective on patient health (baldwin, 2000). consequently, social workers in both academic and lee, shipe/interdisciplinary collaboration 353    professional settings are more likely to have positive attitudes about collaboration (carpenter, 2002; peterson et al., 1998). due to the research on the benefits of interdisciplinary collaboration experiences, particularly in professional settings, the opportunity for students to obtain interdisciplinary training should be a priority (kenaszchuk, rykhoff, collins, mcphail, & van soeren, 2012). many institutions of higher education have started offering interdisciplinary courses and programs that support the development of student interdisciplinary collaboration (browne et al., 1995). however, there is still little opportunity for students to understand the values, roles, and expertise of other health professionals (clark, 1997; irvine, kerridge, mcphee, & freeman, 2002). this has led to students entering interdisciplinary settings where traditional roles, responsibilities, and territory from their own disciplines are maintained (mu, chao, jensen, & royeen, 2004). thus, this study aimed to explore interdisciplinary collaboration amongst social work and allied health sciences graduate students and to examine factors that contribute to their interdisciplinary collaboration. findings will provide implications for educating and preparing students to work in social work and allied health sciences. literature review of the studies that focused on interdisciplinary collaboration, the populations typically came from either a professional or college setting. studies in a college setting had a focus on the implementation of a new class or curriculum. the studies also tended to target undergraduate students rather than those students focusing on specific career tracks (browne et al., 1995; chan, chi, ching, & lam, 2010; curran, sharpe, flynn, & button, 2010; misra et al., 2009). on the other hand, studies from professional settings tended to focus on policy changes or environmental moves (burd et al., 2002; liedtka & whitten, 1998). despite these differences in the population settings, there were a number of similar findings, including exposure to interdisciplinary collaborations as well as intrinsic and extrinsic characteristics, including chosen discipline. previous interdisciplinary collaboration experiences studies focused on interdisciplinary trainings or courses in college have reported improved outcomes relating to interdisciplinary collaboration. interdisciplinary trainings improved students’ understanding of professional role, responsibilities, and interdisciplinary behavior such as teamwork and communication skills (amundson, moulton, zimmerman, & johnson, 2008; misra et al., 2009). similarly, browne et al. (1995) found that in an integrated ethics course among allied health professions all the participants enjoyed the course and found the exposure to other professions to enhance their understanding of decision making and confidentiality. misra and colleagues (2009) further found that students who were exposed to an interdisciplinary training were more likely to engage in interdisciplinary behaviors and activities as compared to students who did not receive the training; these findings were consistent among the 101 training participants. very little research has been conducted on the association between past interdisciplinary work experience and future interdisciplinary collaboration. with this knowledge, bronstein (2002) predicted that social work professionals with previous advances in social work, fall 2014, 15(2) 354   interdisciplinary experiences (paid or unpaid) would be more likely to continue working in an interdisciplinary environment; however, she found that this hypothesis supported only for those in unpaid or internship work settings. in another study, bronstein (2002) found that a professional who had a positive collaboration experience continued to have positive attitudes about professional collaboration. individual characteristics among the studies that examined individual characteristics that supported interdisciplinary collaborations, liedtka and whitten (1998) found that a commitment to the process of collaborating was a critical determinant in developing trust and open communication among the different disciplines. burd et al. (2002) also concluded that strong communication skills among professionals were crucial for collaborative relationship development; however, gaboury et al. (2009) reported that not only was open communication necessary but also how the information was communicated, such as in a face to face manner versus in passing, affected collaboration outcomes. participants found that having dedicated time to discuss cases and pertinent health care topics increased collaboration. overall, when a person was able to communicate his or her needs, the boundaries, and mission of the profession, the group would become more cohesive and would demonstrate more positive attitudes about interdisciplinary collaborations (gaboury et al., 2009; misra et al., 2009). disciplinary culture although research has mainly reported on the usefulness of interdisciplinary collaborations, many disciplines promote a perspective that directly opposes this rationale and supports the tendency to maintain professional territories (d’amour, sicotte, & levy, 1999). this can also be found when interpreting a professional’s code of ethics. whereas social work, nursing, and public health all explicitly mention the need to collaborate with other professions in order to maximize knowledge and skills of other professions as it relates to patient outcomes, medicine and pharmacy do not state that there is a need to collaborate unless it benefits the patient (american medical association, 2001; american nurses association, 2001; american pharmaceutical association, 1994; national association of social workers, 2008; public health leadership society, 2002). of the studies that examined the effect of collaborating among different disciplines, many found that type of discipline affected how they perceived other professions (curran, health, kearney, & button, 2010; gaboury et al., 2009; rijnsoever & hessels, 2011; stone, ekman, english, & fujimori, 2008). leipzig et al. (2002) found that medical residents held significantly less positive attitudes toward interdisciplinary collaboration than did students in social work and nursing. similar findings were reported in the study by curran, sharpe, and colleagues (2010) where medical students showed more negative attitude toward interdisciplinary healthcare team and pharmacy students reported more positive attitudes during three-year interdisciplinary education curricula than three disciplines (medicine, nursing, and social work). conversely, rijnsoever and hessels (2011) found that students in fields with practical application of interdisciplinary techniques, such as medicine or other helping professions, were more likely to want to collaborate with other disciplines. what these studies suggest is that students from different disciplines demonstrate diverse attitudes toward interdisciplinary collaboration. lee, shipe/interdisciplinary collaboration 355    studies that focused on social workers found that most had a positive perception of interdisciplinary collaboration; however, some findings illuminated that beneath the positive perception were consistent concerns around having their voice heard and attempting to navigate non-social work paradigms (chan et al., 2010; jani, tice, & wiseman, 2012; mizrahi & abramson, 2000; parker-oliver & peck, 2006). for example, in the study conducted by parker-oliver and peck (2006), social work hospice workers found that having professionals from other disciplines with whom to discuss cases and obtain different perspectives was helpful when dealing with difficult issues. on the other hand, rigidity on the use of the medical model prevented social workers from being able to work with patients outside of physical complaints. similarly, mizrahi and abramson (2000) found that social workers viewed the professional collaboration with physicians as benefitting the patient but that the physicians did not view the social workers’ skills as contributing as much as their own to the case. various professional and educational contextual factors can influence participants’ interdisciplinary collaboration and the experience of collaboration can promote future interdisciplinary collaborations. however, many of the studies reviewed above used qualitative or experimental study designs; thus, multiple factors that are associated students’ interdisciplinary collaboration could not be examined simultaneously. therefore, using a cross-sectional design, this study examined factors associated with interdisciplinary collaboration through the following research question: “what factors are predictive of interdisciplinary collaboration among graduate students in social work and allied health science?” conceptual framework bronstein’s (2003) interdisciplinary collaboration model guided the current study. the model was built upon the multidisciplinary theory of collaboration, services integration, role theory, and ecological systems theory and was aimed at social work practitioners (bronstein, 2003). according to the model, interdisciplinary collaboration consists of interdependence, newly created professional activities, flexibility, collective ownership of goals, and a reflection process. however, this study sampled both students in social work as well as those in allied health fields. thus, only the flexibility and interdependence constructs were used because they are applicable to all the professions included in this study. flexibility is defined as deliberately blurring roles so compromises can be made; and interdependence means the occurrence of reliance on interactions amongst professionals from different disciplines (bronstein, 2003). bronstein (2003) identified four major influences on the interdisciplinary collaboration model including professional role, structural and personal characteristics, and history of collaboration. professional role refers to how a profession socializes its members according to role type, values, and practice (abramson, 1990). how interdisciplinary relationships are built is also contingent upon one’s professional role (i.e., type of discipline and role type). structural characteristics refer to an organization’s desire and ability to foster interdisciplinary collaboration. for example, many academic settings offer interdisciplinary courses and programs which are meant to enhance a student’s professional training (browne et al., 1995). personal characteristics center on how collaborators view each other above and beyond their professional role such as trust, respect, understanding, and advances in social work, fall 2014, 15(2) 356   informal communication (mattessich & monsey, 1992), while history of collaboration is about a person’s past experiences with interdisciplinary collaboration. applying the bronstein (2003) interdisciplinary collaboration model to this study, the four aforementioned influencers are operationalized in the following manner: for professional role, we focused on the differences between social work, medicine, nursing, and other allied health sciences including dentistry, pharmacy, and public health among students in a graduate setting. structural characteristics were defined as the number of interdisciplinary courses that students have taken. although this definition does not directly parallel bronstein’s, it was chosen based on the assumption that a school desiring to foster interdisciplinary collaboration among students would offer more courses with this mission thus allowing students to take them. for example, phd students in the school of social work, where this study was conducted, must take a course outside the school in order to graduate. personal characteristics were defined as a student’s attitudes toward interdisciplinary collaboration health care teams. finally, personal/professional history of collaboration was operationalized as past experience in interdisciplinary teams (e.g., as practicums, internships, or part-time/full-time jobs). the study model is presented in figure 1. figure 1. influences on interdisciplinary collaboration applying bronstein’s model (2003)   method research procedure this study used a cross-sectional design with a non-probability convenience sample of students enrolled in a mid-atlantic public university. institutional review board (irb) approval was obtained in august 2012. the university is made up of interdisciplinary collaboration flexibility/ interdependence professional role social work, medicine, nursing, and other allied health sciences structural characteristics -number of interdisciplinary courses taken history of collaboration -past experience in interdisciplinary settings personal characteristics -attitudes toward interdisciplinary health care teams lee, shipe/interdisciplinary collaboration 357    seven schools (medicine, nursing, pharmacy, social work, dental, law and graduate) with degrees predominantly at the graduate level. the survey, interprofessional students interdisciplinary survey (isis), was sent out in two waves, two weeks apart by the university’s student government association, which has access to the email addresses of all enrolled students,. the online survey used qualtrics software (qualtrics, provo, ut) to gather data from study participants. sample all students (n = 6,368) who were enrolled for the fall semester of 2012 automatically received the isis through their school email. a total of 288 surveys were completed yielding a response rate of 4.5%. due to this study’s interest in health sciences students currently working on an interdisciplinary practice, 176 students were excluded (students not currently working; n = 172, students in non-health sciences disciplines such as law; n = 14). this resulted in a total sample of 112. measures dependent variables. perceived flexibility and interdependence of interdisciplinary collaboration were measured using the two subscales from the index of interdisciplinary collaboration (iic; bronstein, 2002). all items were rated on a five-point likert scale and summed for total scores. higher scores indicate a higher level of flexibility and interdependence. interdependence scale consisted of 12 items and flexibility consisted of 6 items. parker-oliver, bronstein, and kurzejeski (2005) reported a chronbach’s alpha of .78 for reliability of the interdependence scale and .62 for the flexibility scale. the present study produced a cronbach’s alpha values of .74 for interdependence and .59 for flexibility. independent variables. a student’s school affiliation was used to indicate their professional role. students were categorized into four groups depending on their affiliation: social work, nursing, medicine, and other allied health sciences (pharmacy, dental, and public health). social work was used as a reference group. the number of interdisciplinary courses that a student had taken ranged from 0 to 5+ and was continuous. to assess students’ experience with interdisciplinary collaboration, two questions from the isis were used: (1) have you ever worked as part of a team with professionals from other disciplines? (yes/no); and (2) was your overall experience positive or negative? the responses ranged from very negative (1 point) to very positive (5 points). students were coded into two groups: those who answered with no to the first question, and those who negative, very negative, and neither negative nor positive to the second question were coded as 1, whereas students that had positive or very positive experiences were coded as 0. the last independent variable used a standardized instrument, students’ attitudes towards interdisciplinary health care teams, originally developed by heinemann, schmitt, farrell, and brallier (1999). it consists of 14 five-point likert scale items ranging from strongly disagree (1 point) to strongly agree (5 points). the total score ranges from 14 to 70, and higher scores indicate more positive attitudes. reliability of the attitudes towards interdisciplinary health care teams scale has been supported by previous studies; heinemann et al. (1999) and curran et al. (2008) each reported a cronbach’s alpha of .83, and this study also demonstrated a high reliability of the advances in social work, fall 2014, 15(2) 358   scale (a = .88). total scores were used to indicate students’ attitudes toward interdisciplinary health care teams for this study. demographic variables. age, race, and attendance status (part or full time) were included in the model as control variables. age was measured at a continuous level. race was dummy-coded to compare whites with non-whites. part-time students were compared to full-time students. female students were compared to male students. data analysis statistical software for the social sciences (spss v.18, 2010) was used for data analysis. following descriptive and bivariate analyses of variables of interest, a hierarchical multiple regression was used to determine which factors predict graduate students’ positive experience of interdisciplinary collaboration. listwise deletion was employed for missing data which removed 8 cases (7.7%) yielding a final sample size of 104. continuous variables were normally distributed based on their skewness and kurtosis. results descriptive and preliminary analyses the results of descriptive statistics are presented in table 1. among the study participants, allied health sciences students were evenly distributed (social work: n = 32; 28.6%, nursing: n = 32; 28.6%, medicine: n = 18; 16.1%, and other allied health sciences: n = 30; 26.8%). nearly two-thirds (n = 73; 67.6%) were white, and more than two-thirds were full-time students (n = 82; 73.2%). the majority of students had positive past experience of interdisciplinary collaboration (n = 95; 84.8%). students’ mean age was 32.54 (sd = 10.45, range: 22-59). students took 1.81 (sd = 1.94, range: 0-5) interdisciplinary courses on average. on average, students scored 21.96 (sd = 2.84, range: 13-30) in flexibility and 46 (sd = 5.18, range: 31-60) in interdependence. gender was associated with students’ disciplines (x2(1) = 5.78; p = .02); meaning male students were more likely to be affiliated with allied health science disciplines versus social work. there were no other significant differences between social work and allied health sciences students in bivariate analyses. hierarchical multiple regressions two separate hierarchical multiple regression analyses were conducted to examine factors that predict students’ flexibility and interdependence of interdisciplinary collaboration. hierarchical multiple regression analysis allows one to evaluate the unique contributions of the model variables after accounting for control variables. the assumptions for multiple regression analysis (normality of residuals, independence of residuals, linearity, homoscedasticity of residuals, and non-multicollinearity) were checked and met. in step 1, individual characteristics including age, gender, and student status were entered to be controlled. four model variables (disciplines, the number of interdisciplinary courses taken, attitudes toward interdisciplinary healthcare teams, and past experience in interdisciplinary settings) lee, shipe/interdisciplinary collaboration 359    were entered in step 2 to examine changes in variance and coefficients. the results of the hierarchical regressions are presented in table 2. table 1. descriptive statistics variable valid n range m sd flexibility 112 13-30 21.96 2.84 interdependence 112 31-60 46.00 5.18 number of courses 109 0-5 1.81 1.94 atihta 110 3.21-5 3.93 .35 age 112 22-59 32.54 10.45 variable n (%) gender (n = 110) female 97 88.2 male 13 11.8 race (n = 108) white 73 67.6 non-white 35 32.4 attendance status (n = 112) part-time 30 26.8 full-time 82 73.2 discipline (n = 112) social work 32 28.6 medicine 18 16.1 nursing 32 28.6 other allied health sciences 30 26.8 past experience (n = 112) positive experience 95 84.8 no & negative experience 17 15.2 notea: attitudes toward interdisciplinary health care teams scale advances in social work, fall 2014, 15(2) 360   table 2. results of hierarchical multiple regressions flexibility interdependence model r2 r2δ b s.e. β 95% ci r2 r2δ b s.e. β 95% ci step 1 .18** .20*** age .06* .03 .21* .01, .12 .15** .05 .29** .05, .25 gender (male) -.74 .80 -.09 -2.31, .84 -1.74 1.40 -.11 -4.51, 1.04 race (non-white) .65 .57 .10 -.49, 1.78 .69 1.01 .06 -1.30, 2.69 attendance status (part-time) -1.76** .65 -.27** -3.04, -.48 -2.67* 1.14 -.23* -4.92, -.42 constant 20.88*** 1.30 18.31, 23.45 42.65*** 2.28 38.13, 47.17 step 2 .32*** .14** .43*** .23*** age .03 .03 .11 -.02, .09 .08 .05 .16 -.01, .17 gender (male) .07 .81 .01 -1.53, 1.67 -.69 1.32 -.04 -3.31, 1.94 race (non-white) .39 .56 .06 -.72, 1.50 .47 .92 .04 -1.36, 2.30 attendance status (part-time) -1.49* .69 -.23* -2.86, -.12 -1.13 1.13 -.10 -3.38, 1.11 medicine (sw) -.11 .81 -.01 -1.71, 1.49 -3.42* 1.32 -.25* -6.05, -.80 nursing (sw) 1.14 .74 .18 -.33, 2.61 2.18 1.21 .19 -.23, 4.59 other health disciplines (sw) -.82 .72 -.13 -2.25, .61 -1.20 1.18 -.10 -3.55, 1.14 past experience (positive experience) -.78 .70 -.10 -2.17, .61 -4.35*** 1.15 -.31*** -6.63, -2.07 n. of courses .01 .02 .06 -.02, .04 .01 .03 .02 -.05, .06 atihta 1.79* .79 .22* .22, 3.34 -.38 1.30 -.03 -3.00, 3.21 constant 14.74*** 3.35 8.08, 21.40 46.34*** 5.50 35.41, 57.26 notea: attitudes toward interdisciplinary health care teams scale, ( ): reference, sw: social work, *p <.05, **p <.01, ***p <.001 lee, shipe/interdisciplinary collaboration 361    the first regression analysis examined predictors of flexibility. demographic variables were entered instep 1 of the model, explaining 18% of the variance (f(4,99) = 5.43, p = .001). for one unit increase in age, flexibility increased .06 points (b = .06, t = 2.19, p = .03) independent of the other variables. attendance status was also a significant predictor of flexibility at the first step (b = -1.76, t = -2.73, p = .008); fulltime students’ scores in flexibility were 1.76 points lower than those of part-time students, holding all other variables constant. interdisciplinary collaboration model variables were entered in step 2 of the model, increasing the model r2 significantly to .32 (r2δ =.14, f(10,93) = 4.45, p <.001). attendance status remained significant (b = -1.49, t = -2.17, p =.03). in addition, among the model variables, attitudes toward interdisciplinary health care teams (b = 1.79, t = 2.26, p = .03) significantly predicted students’ flexibility of interdisciplinary collaboration. for each one unit increase in attitudes toward interdisciplinary health care teams, flexibility of interdisciplinary collaboration increased 1.79 points, holding all other variables constant. the second regression analysis examined predictors of interdependence. demographic variables were entered in step 1 of the model; 20.1% of variance was explained (f(4,99) = 6.23, p <.001). attendance status (b = -2.67, t = -2.35, p = .02) and age (b = .15, t = 3.04, p = .003) were the significant predictors of interdependence. interdisciplinary collaboration model variables were entered in step 2 of the model, increasing the model r2 significantly to .43 (r2δ = .23, f(10,93) = 6.92, p <.001). attendance status and age did not remain significant. however, compared to students in social work, those in medicine were less likely to demonstrate interdependence, taking the other factors into account (b = -3.42, t = -2.59, p = .01). in addition, past experience significantly predicted interdependence of interdisciplinary collaboration (b = -4.35, t = -3.79, p <.001); compared to students with positive experience, those with no and negative experience scored 4.35 points lower in interdependence, controlling for all other variables. the other three interdisciplinary collaboration model variables were not statistically significant. discussion this study examined factors that influenced graduate students’ interdisciplinary collaboration based on bronstein’s (2003) interdisciplinary collaboration model. this model was developed to conceptualize collaboration between social workers and other professionals in practice. the results of this study suggested that bronstein’s (2003) model emphasizing the importance of individual and environmental factors predicting interdisciplinary collaboration holds not just for seasoned professionals but for students being socialized to their professions. bronstein (2002) originally tested her model with professionals; however, subsequent research with college students (bronstein, 2003; parker-oliver et al., 2005), including this study, has shown that the model applies to this population as well. positive attitudes towards collaboration are indicative of successful interdisciplinary collaboration (browne et al., 1995; gaboury et al., 2009). research has also shown that health sciences students and professionals generally reported positive attitudes toward interdisciplinary teamwork or education (curran et al., 2008; curran, sharpe, et al., 2010). this study found that when students had more positive attitudes toward interdisciplinary health care teams, they were more likely to show advances in social work, fall 2014, 15(2) 362   higher levels of flexibility of interdisciplinary collaboration. studies have shown that students and practitioners with exposure to interdisciplinary courses or trainings were more likely to collaborate with others from different disciplines (gaboury et al., 2009; ivey et al., 1988). therefore, in order to foster positive attitudes toward interdisciplinary collaboration, educators and professions should offer more interdisciplinary classes and training opportunities to students. students in social work and allied health sciences who had a positive experience of interdisciplinary collaboration in the past were more likely to rely on interactions with professionals from different disciplines than were those who had no or negative experience. this result is consistent with previous studies that demonstrated that positive experiences in interdisciplinary settings were associated with interdisciplinary collaboration (amundson et al., 2008; bronstein, 2002). this finding underscores the importance of disciplinary curricula that necessarily include interdisciplinary collaboration. headrick and khaleel (2008) suggested that involving trainees from one profession to work with other health professionals as their mentors or teachers enriched the student experience as did a well-developed interdisciplinary practicum course that involved students and/or faculty members from other disciplines. in addition, as amundson et al. (2008) suggested, interdisciplinary student internship programs are a way to expose health sciences students to interdisciplinary collaboration. among the control variables, attendance status significantly predicted both flexibility and interdependence of interdisciplinary collaboration. it even significantly predicted flexibility controlling for other factors; part-time students showed higher levels of flexibility than full-time students. because part-time students are more likely to be working than full-time students, they could have more exposure to interdisciplinary collaboration practice. this is in line with findings from rijnsoever and hessels (2011) who found that previous work experiences influenced current interdisciplinary collaborations. along with the positive past experience, this emphasized the importance of practice experience among students during their learning process to help influence future interdisciplinary collaboration. the significant positive relationship between age and interdependence also emphasized the importance of collaboration experience. older students were more likely to have come from settings where interdisciplinary collaboration was either part of their practice or their many years of experience has provided evidence for the usefulness of idc. the study finding that students in medicine were less likely to demonstrate interdependence compared to those in social work was consistent with the finding of previous studies where medical students reported significantly less positive attitudes toward interdisciplinary collaboration (curran, heath, et al., 2010; leipzig et al., 2002). however, there was no other significant difference found in flexibility and interdependence compared to social work. the approach of social work to clients (i.e., understanding a client in the context of his or her environment and helping the client function appropriately in the context) is distinct from that of other health care professions (gitterman & heller, 2011). the non-significant findings on flexibility and interdependence may be due to the academic environment where this study was conducted; the university emphasizes the importance of interdisciplinary collaboration and provides opportunities for interdisciplinary collaboration across all disciplines. another possible reason could be that students’ school affiliation may not lee, shipe/interdisciplinary collaboration 363    have captured their professional roles in the interdisciplinary settings. assessment of each profession’s expected or valued role in interdisciplinary collaboration settings, with a validated measure, may produce more reliable study results. the number of interdisciplinary courses taken was not a significant predictor of either flexibility or interdependence. the number of interdisciplinary courses taken may have been a limited measure to assess disciplines’ structural characteristics, although more interdisciplinary courses would be available for students when schools value and support interdisciplinary collaboration across professions. each discipline’s educational policy or level of administrative support toward interdisciplinary collaboration may be a more accurate construct to measure disciplines’ structural characteristics. limitations of this study should be acknowledged. online surveys usually result in a lower response rate than mail (paper) surveys (nulty, 2008; resnick, 2012) or inperson surveys (truell, barlett, & alexander, 2002); it is possible that the low response rate (4.5%) of this study also may have been due to use of the online survey. however, the low response rate may not represent the school population. in addition, small sample size may limit generalizability of the study findings, although post-hoc tests, using g*power 3.1, suggested that the sample size provided enough power for the statistical analyses for interdependence (99.9%) and flexibility (95.7%). therefore, the results of this study may not be generalizable to all graduate students within the university or students within and among the different schools. second, technical problems that were caused by the use of online survey (e.g. not receiving emails, not being able to open the survey) as well as the anonymous nature of the survey could have led to biased responses. third, for the purpose of the survey applying to students from all available disciplines, three constructs of the interdisciplinary collaboration model (bronstein, 2003; newly created professional activities, collective ownership of goals, and a reflection process) were not measured in this study. these constructs should be investigated in the future because they could offer a more comprehensive lens of student perceptions. in addition, the accepted norm of internal reliability of a scale is .70 (huey et al., 2004). however, the reliability of the flexibility subscale was below the norm, although previous studies also reported the lower internal reliability (bronstein, 2002; parker-oliver et al., 2005); therefore, results based upon the flexibility subscale should be interpreted with caution. implications for research despite the limitations, this study has important implications for future studies and for allied health sciences and social work students’ education. few studies have explored interdisciplinary collaboration among student groups. moreover, quantitative studies that used a cross-sectional design and examined factors of interdisciplinary collaboration among allied health sciences and social work students are rarely found. this study can be used as a foundation that leads to more quantitative research on this student group’s interdisciplinary collaboration. implications for interdisciplinary education this study suggests that the future direction of interdisciplinary education is to foster allied health sciences and social work students as competent collaborators. graduate school administrators and educators should offer opportunities for advances in social work, fall 2014, 15(2) 364   interdisciplinary collaboration practice experience. educators and students in these disciplines should put effort into promoting positive attitudes toward interdisciplinary teamwork through interdisciplinary trainings and courses as means of the professional development process. when students have positive experiences with interdisciplinary collaboration during their learning process, they will be more open to collaborating with other professionals and the collaboration will contribute to better client and patient outcomes. references abramson, j. s. 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(2002). response rate, speed, and completeness: a comparison of internet-based and mail surveys. behavior research methods, instruments, & computers, 34(1), 46-49. author note address correspondence to: sang jung lee, msw, university of maryland school of social work, 525 west redwood street suite 502 ssw/law building, baltimore, md 21201. email: slee@ssw.umaryland.edu ______________ pinar zubaroglu, mssw, is a doctoral student at fordham university, graduate school of social service. marciana l. popescu, phd, is an associate professor at fordham university graduate school of social service. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 214-232, doi: 10.18060/18504 preparing social work students for international interdisciplinary practice: a teaching model and its impact on self-efficacy pinar zubaroglu marciana popescu abstract: to promote international social work education and prepare msw graduates for international careers, several teaching models have been developed, including intensive teaching in international settings, hybrid teaching with study abroad components, and applied learning through service learning and international internships. benefits of international social work education range from increased knowledge and skills in addressing global issues through policy and advocacy, to significant improvements in multi-cultural competence and awareness upon participation in structured cultural immersion programs. current challenges for social workers in international development careers point to the need for an interdisciplinary approach to best address complex global social issues. this paper proposes an international interdisciplinary teaching model that aims to prepare social work students for international development practice. based on a pilot study of the proposed model, students showed significant increases in the self-efficacy of interdisciplinary international knowledge and skills. keywords: international social work, interdisciplinary education, self-efficacy, experiential learning, social work education using scientific inquiry and knowledge of the person-in-environment approach, respect for human diversity, and a global point of view, social work professionals strive to achieve social and economic justice, prevent constraints on human rights, eliminate poverty, and promote quality of life for every individual (council on social work education [cswe], 2008). for a profession with such a wide focus of practice, there is an increased challenge of promoting globally-minded social work practitioners. international social work provides the framework for educating global social workers and prepares students for international social development as a dimension of social work practice. over the past three decades, socioeconomic, political, and technological changes created a new range of social issues that require more diverse and innovative approaches, shifting intervention paradigms from a local to a global context of social work practice. new knowledge and skills are required, and existing professional realms have to go through a transformation process to remain relevant within the current context. with international social development issues requiring multidisciplinary approaches, an international interdisciplinary focus in social work education is one core element of this transformation process. the internationalization of social work education was accelerated by the political and economic changes at the end of the 1980s. after the fall of the communist regimes in zubaroglu & popescu/preparing social work students 215 eastern europe (1989-1991) there was a surge in the need for social work education and implicitly international social work curriculum development (török & korazim-kőrösy, 2012). immediate transfer of knowledge from countries with recent social work traditions (such as the united states) shaped the development of social work education not only in post-communist countries in eastern europe, but also in china and throughout latin america, following a neocolonialist pattern challenged by local social justice and human rights activists (cheung & liu, 2004; healy, 2008). however, it shortly became apparent that the imported american social work educational models did not necessarily fit within the local systems and practice paradigms (cheung & liu, 2004; healy, 2008). this lack of fit can be partially attributed to the micro-practice focus in american social work in recent years, which did not respond to the imminent need for macro-social work practice competencies necessary in countries undergoing major socio-political change. the lack of attention to macro-social work practice was a barrier to effective solutions to social problems in developing countries. focusing on a clinical social work model leaves out the social action traditions established by jane addams, bertha reynolds, and others (specht & courtney, 1994), undermining the opportunity of people in developing countries to receive appropriate social work services that address their life challenges and improve their well-being. globalization, increased migration, increased natural disasters, and changes in the nature of war also challenge the existing paradigms of social work practice in the united states. the third millennium was characterized by a renewed emphasis on human rights, indigenous knowledge, and the importance of systemic, structural changes. the cswe responded by revising its standards of competency to include global practice and human rights (cswe, 2008). as noted by estes and snell (2009), these changes required an added focus on multicultural competence in social work practice and a better understanding of global affairs. it became clear that international social workers have to redefine their profession and reclaim its place among other international development and human rights professions. a study conducted in 2009-2010 by pittman, luca-sugawara, rodgers, and bediako (2015) under the direct coordination of the cswe global commission identified very distinct skills sets that will require a transfer of knowledge from other disciplines (such as economics, public health, law, and anthropology) as well as from other communities and cultures. existing theoretical frameworks therefore need to be adapted to address different contexts (urban, rural, indigenous communities) as well as different practice settings (community/collective approaches, often within a context of chronic trauma). to ensure the competence of the social work profession in working with other professions in a global arena, different models of international social work education continued to emerge–ranging from curriculum changes (to include international topics), to study tours and experiential learning (to link theoretical concepts to practice), to internships and international fellowships (to provide students with international practice experiences), as well as international student and faculty exchange programs (aimed to increase the scope of social work as a global profession). also, more interdisciplinary collaborations were forged, to address the complex socio-economic and political challenges through a transfer of knowledge and skills, with over 200 joint degrees advances in social work, fall 2015, 16(2) 216 developed in the united states within the past 25 years (caragata & sanchez, 2002; cswe, 2013). in light of all these changes, as social work educators, we need to ensure that we promote best practices to prepare social work graduates to work within a global environment and collaborate across disciplines to provide best services to diverse population groups. this paper proposes an alternative model for interdisciplinary international social work education. focusing on the impact of the interdisciplinary course, the model was evaluated using students’ self-efficacy as an indicator of effective transfer of knowledge and skills. supporting international interdisciplinary social work education recognizing the challenge of preparing the social work cadre for 21st century social issues, in early 2014, the international association of schools of social work (iassw) changed the global definition of social work to recognize the value of indigenous knowledge for social workers. this change followed the cswe (2008) competencybased professional education standards, charging social work educators to prepare students to practice with various competencies, ranging from engaging diversity and difference in practice to responding to contexts that shape practice (education policy 2.1.9). the 2008 cswe standards stressed the importance of improving interdisciplinary knowledge and skills for social workers. correspondingly, social work educators developed multiple teaching models focusing on either international education or interdisciplinary collaboration. in 2015, the cswe issued new educational policy and accreditation standards (epas). relevant to international interdisciplinary social work, the 2015 epas requires social work educators to consider the following competencies in their curriculum design: ● engage diversity and difference in practice (competency 2); ● advance human rights and social, economic, and environmental justice (competency 3); ● engage in policy practice to advance social and economic well-being and to deliver effective social work services (competency 4); and ● acknowledge the implications of the larger practice context when assessing and intervening with individuals, families, groups, organizations and communities and consider benefits of inter-professional collaboration in this process (competency 7 & 8, cswe, 2015). previous research on international social work education models included intensive teaching in international settings, hybrid teaching including study abroad components, and applied learning through service learning and international internships. these studies revealed a number of positive outcomes on students’ learning, including increased student understanding of the effects of globalization and the interrelationships between discrimination, oppression, and privilege across classes and national boundaries (das & anand, 2014; gammonley, rotabi, & gamble, 2007); enhanced understanding of the zubaroglu & popescu/preparing social work students 217 connection between social work practice and international social policies; improved intercultural skills and increased cultural sensitivity (fairchild, pillai, & noble, 2006; gilin & young, 2009; tesoriero, 2006); positive changes in self-awareness regarding knowledge and skills in addition to values and beliefs (moorhead, boetto, & bell, 2014); increase in understanding of professional identity (gilin & young, 2009; moorhead et al., 2014); a new perception of theory and practice with local and global applications (cheung & liu, 2004; cornelius & greif, 2005); increased employment opportunities; and improved fluency in a foreign language (caragata & sanchez, 2002). in regards to contributors to an enhanced student learning process, studies described that pre-trip planning, peer learning and support, debriefing and critical reflection, open communication between students and faculty members, writing journals and poetry, and an integration of post-trip activities were most beneficial (das & anand, 2014; furman, coyne, & negi, 2008; gammonley et al., 2007). empirical studies exploring the effect of interdisciplinary education on students’ learning suggested that collaboration between disciplines expands non-social work professionals’ knowledge of the social work discipline (stone, ekman, english & fujimori, 2008; supiano & berry, 2013); promotes respect for and by non-social work professionals; grows personal and professional confidence and competence of social work students (supiano & berry, 2013); and strengthens social justice outcomes for collaborating professions (jones & jones, 2011; stone et al., 2008). while recently more attention was given to interdisciplinarity (or inter-professional collaboration, as stated in the 2015 epas) in social work education, particularly with disciplines such as health care, law, psychology, and media and communications, other disciplines, such as economics and environmental studies, remain at the margins. considering the potential synergy of combining social work, economics, business, and environmental studies, we propose an alternative interdisciplinary model of international social work education. we present the concepts on which this alternative education model is built, explain the theoretical underpinnings that support it, discuss the model’s potential effectiveness based on student assessments, and suggest further steps based on its impact on student self-efficacy. concept definitions this article addresses the body of knowledge and field of practice relevant for international social work and social development as a dimension of social work practice. accordingly, we focus on teaching methods used for building knowledge and practice readiness for social work students preparing to work in international social work. to this extent, we propose the following operational definitions: international social work the international federation of social workers (ifsw) defines international social work as: […] a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation advances in social work, fall 2015, 16(2) 218 of people. principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance well-being. (ifsw, 2014, para. 2) international social development international development, as a concept, a discipline, and a global aim, was born within the context of the post world war ii (wwii) era, mostly linked to the safety threats created by wwii and the economic destruction in the aftermath of the war. thus, it has its dominant emphasis on reconstruction (within a human rights framework emphasizing peace-building and cooperation) and economic development. keynesian economics became the blueprint for international development, and global institutions such as the world bank (wb) and the international monetary fund (imf), its main stakeholders. yet focusing on economic growth alone did not deliver the expected global development results (thomas & allen, 2000). the major international development agencies revised their strategies to integrate a focus on social development and introduced the people-centered approach to development (easterly, 2006; korten, 1984). the new millennium marked a greater step towards humanizing development by introducing the millennium development goals (mdg) as the new international social development strategy (united nations, 2000). to address the poor results of previous approaches to global issues, the mdgs challenged existing paradigms and required a change in mindset. building on the historical evolution of the international development concept, we define international social development as a field of practice and the related knowledge and skills necessary to achieve sustainable development through effective partnerships between communities, local and international organizations, international development agencies, and global bodies of governance, with the active participation of civil society. sustainable international social development focuses on community capacity-building as the ultimate outcome of any development strategy. within this framework, good governance becomes a tool for supporting effective community capacity-building. applied experiential learning this paper focuses on a model of international social work education that integrates an applied experiential learning component and teaching concepts in an international context of practice based on kolb’s experiential learning theory (kolb & kolb, 2012). learning experiences within international contexts, over short periods of time, are mostly referred to in the literature as “study tours.” the educational model presented in this paper combines an intensive course with applied practice experiences. the overall learning process involved cultural immersion as well as constant reflection on students’ daily experiences and integration of indigenous knowledge as part of the applied experiential learning process. zubaroglu & popescu/preparing social work students 219 interdisciplinary education studies in the literature describe three types of “multiple disciplinary” (choi & pak, 2006) education: (1) multidisciplinary education, which yields knowledge from various disciplines where each discipline remains within their own boundary; (2) interdisciplinary education, which produces knowledge through incorporation of disciplines where disciplines act as a whole to solve a problem exceeding the boundaries of their discipline; and (3) transdisciplinary education, which refers to knowledge produced through collaboration of different disciplines where disciplines transcend their boundaries by sharing information and skills, as well as responsibilities (choi & pak, 2006; dyer, 2003). for the purpose of this paper, interdisciplinarity combines these definitions and refers to the incorporation of knowledge from various disciplines to address complex global problems and the transdisciplinary sharing of information, skills, and responsibilities to improve problem-solving as it relates to global issues. theoretical underpinnings within current contexts of practice, there are several ongoing adjustments to social work education that provide the basis for the alternative educational model proposed by this paper, each of them supported by a specific theory: globalization theory: integrating global contexts to provide effective responses to local issues. globalization theory states that globalization and technological advancement reduce temporal and spatial distance between different elements to such a degree that local circumstances are affected by situations happening in another part of the world (webb, 2003). this diminishing distance increased connectivity, which in turn has been affecting individual, cultural, social, political, and economic relations (ahmadi, 2003; webb, 2003; wilson, 2012). while globalization contributed to creating a universal expectation for a standard of living based on western values, this expectation has not been matched by the ability/willingness of local governance to provide equal access to resources (as reflected by current policies and programs). as a result of the most recent globalization wave, social workers had fewer resources to allocate, more interdependent problems, and more culturally diverse clients. although this new reality poses challenges to preparing social workers with new knowledge and skills, it also creates new opportunities for shared learning once international social work is reconsidered. intersectionality theory: expanding the body of knowledge to include interdisciplinary approaches to international social work practice. intersectionality theory addresses the interrelations of multiple dimensions of social life and structures (mccall, 2005). based on this theoretical framework, in order to fully understand social issues, specifically inequality, a person should examine the entire form of diverse, intersecting, and conflicting dimensions of social issues rather than a single dimension. since no single dimension can sufficiently illustrate an issue, intersectionality theory suggests an interdisciplinary approach to comprehend social issues (mccall, 2005). to link this theoretical framework to the discussion on globalization in relation to the social work profession, we note that globalization affects social relations and creates different dimensions of analysis and points of intervention. therefore, in order to fully grasp the advances in social work, fall 2015, 16(2) 220 globally interdependent nature of social problems and develop more effective, innovative solutions, social workers require an interdisciplinary international education. the capabilities approach: enhancing social workers’ capacity to address injustice and promote human rights through international social work practice. the capabilities approach stresses that the level of justice in a society depends on the level of equality of freedom and opportunities to achieve and use individuals’ own abilities (nussbaum, 2011; sen, 2007). in other words, evaluation of justice in a society can be done through assessment of individuals’ capabilities to function–the more equal these capabilities are, the higher the potential for justice in that particular society (fraser, 1995). education is crucially important to implementing the capabilities approach because it is the key to development and supports the exercise of numerous other human capabilities (nussbaum, 2011). with this point of view, the capabilities approach indicates the need for reconsideration of social workers’ roles in achieving justice by ensuring their clients’ equal access to resources and the implicit development of their full capabilities. experiential learning theory: develop social workers’ self-efficacy by fully exposing them to an interdisciplinary international context. experiential learning theory (elt) suggests that learning is an ongoing dynamic process, which includes interactive dimensions of concrete experience, reflective observation, abstract conceptualization, and active experimentation (kolb & kolb, 2012). in other words, elt states that a learner acquires knowledge from his/her experiences in an environment, reflects on the receipt of information while testing out the knowledge in the environment, reflects on the outcomes of testing, and acts on the knowledge by adjusting it along continuous experiences (kolb, 2015). elt emphasizes that an effective learning process requires practicing each dimension. when applied to social work education, elt indicates that social work students need to be exposed to interdisciplinary international contexts to have concrete experiences and enhance their practical capacity in the globalized arena. additionally, students need to reflect on, conceptualize, and actively apply their emerging knowledge. the alternative education model introduced in this paper applies each dimension of elt in an effort to increase students’ self-efficacy and their subsequent readiness for the field of international social work and social development. an alternative model for interdisciplinary international social work education the proposed model includes an intensive interdisciplinary msw course, taught in an international context, as well as the pre-departure orientation/preparation for the international immersion, the applied/experiential learning central to the model, and the dissemination of knowledge upon return. figure 1 illustrates the structure of this course along the lines of elt and self-efficacy. using strategies that helped previous scholars and the elt framework, the educational model followed these stages: preparation 1. introduction to the benefits of interdisciplinary international education: two planning and orientation meetings were held within a month before departure. zubaroglu & popescu/preparing social work students 221 2. introduction to the course: the course syllabus was shared with students two weeks before the departure. knowledge building 3. knowledge development: during the first six days after arrival in peru, instructors from the u.s. and peru taught students about the history, social, economic, and political structure of the country; social problems; and the effects of globalization. experiential learning 4. applied knowledge: students spent six days learning from community organizations and banks in urban areas (in lima), rural areas (around cuzco), and indigenous communities (in the high lands). 5. contextualization and reflection: each day included debriefing sessions for knowledge application, skills-building, and reflection. 6. knowledge sharing and dissemination: for the last two days students worked in groups on different issues, discussed their topics with other groups, and gave presentations to other students as well as staff from the community organizations. a final poster presentation disseminated knowledge and experience to students and professors in the u.s. the aim of this course and of the proposed experiential learning model was to enhance msw students’ skills in the areas of community building, community organizing, community needs assessment, and capacity mapping, stakeholder analysis, and advocacy in an international practice context based in peru. the course was centered on the following themes: (1) theoretical perspectives of international social development and social work in a global context; (2) globalization, global issues, and the local consequences of these issues; (3) human rights and the implications of choosing to become an agent of change from a human rights’ perspective; and (4) current approaches, best practices, and future trends in international social development. in particular, the course emphasized three essential aspects of development: (1) microcredit as a poverty reduction strategy; (2) historic trauma and its impact on specific population groups such as women, rural communities, and indigenous communities; and (3) migration and impact of migration on development, specifically relating to indigenous communities. an evaluation of the 3-week intensive course titled, international social development and capacity building in a global context, was used to further examine the proposed model. zubaroglu & popescu/preparing social work students 222 self-efficacy concrete experience conceptualization active experimentation reflection debriefing • asking questions to staff and clients; • daily debriefing sessions immersion exposure to peruvian context by living there, communicating with people, and visiting organizations integration of knowledge • have more informed discussions in debriefings; • make presentations to staff; provide recommendations for practice dissemination asking questions based on the acquired knowledge and exchanging ideas with agencies staff pr e pa r at io n k n o w l e d g e b u il d in g figure 1: international interdisciplinary education in peru in experiential learning theory framework zubaroglu & popescu/preparing social work students 223 methods the study used preand a post-test surveys to analyze the impact of this education model on students’ self-efficacy. the pre-test survey was conducted at the beginning of the first class and the post-test survey was administered at the end of the final class. institutional review board approval for the course was obtained before participants departed from the u.s. students were informed about the study, and a written informed consent accompanied the surveys they were invited to complete. thirteen students enrolled in the course: ten women and three men. all of the students participated in the pre-test. eleven students completed the post-test survey (response rate=84.6%). the pre-test survey collected information on demographics, knowledge and skills, reasons for taking the course, and expectations. a knowledge scale and a skill scale were used to assess students’ self-efficacy in regards to the knowledge and skills introduced by this course. information on reasons for taking the course and students expectations were obtained through open-ended response items. the post-test survey collected information on students’ confidence with changes in knowledge and skills; contributions of the course to prepare the students for international work. data on gains, challenges, and recommendations about the course were obtained through open-ended response items. measures self-efficacy is an individual judgment or belief about an ability to accomplish the required tasks in a given situation (bandura, 2006; woody et al., 2014). in this pilot study, we define self-efficacy as change in confidence in students’ abilities to apply knowledge and skills that are necessary to work effectively in the international social development field. self-efficacy was used as the core indicator of the effectiveness of this model. to measure self-efficacy the pre/post course survey included a knowledge and a skills scale. knowledge scale: the knowledge scale consisted of 10 items and measured students’ confidence with discussing and applying core concepts introduced by the course. students were asked to rank their level of confidence from 1 (not confident at all) to 7 (most confident) on the course concepts, including international development, globalization, global markets, financial markets, microfinance/microcredit, international development policy, mdgs, poverty as a global issue, environmental issues/climate change, and indigenous communities-cultural awareness. skills scale: the skills scale consisted of five items and measured students’ confidence with understanding and utilizing capacity mapping, stakeholder analysis, market feasibility study, risk assessment, and strategic planning when working with communities and microfinance institutions. students ranked their confidence level from 1 (not confident at all) to 7 (most confident) for the five skills. advances in social work, fall 2015, 16(2) 224 findings participant characteristics most of the students (76.9%) in the course were women. participants’ age ranged from 22 to 51 with a mean age of 33.7 (sd=9.54). all of the students, except the research assistant, were advanced msw students. over onethird of the students spoke english only (38.5%), and the rest of the students were either bilingual (english/spanish) (30.8%), conversational in two languages or more (23.1%), or proficient in more than two languages (7.7%) (see table 1). table 1. participants characteristics (n=13) characteristic n mean age 13 33.7 n % gender female 10 76.9 male 3 23.1 language skills english only 5 38.5 bilingual (english and spanish) 4 30.8 conversational level in two languages 3 23.1 proficient in more than two languages 1 7.7 all students had some prior international experiences (table 2); for about half of the students (46.2%) this prior experience was from a combination of travel and work. participants’ prior experience with microcredit/microfinance ranged from none (31%) to very limited or limited (69%), and 61.5% had previous exposure to international course content. table 2. previous international experiences of students (n=13) n % prior international experience travel only 6 46.2 travel and work 3 23.1 international volunteering 2 15.4 other 2 15.3 prior experience with microcredit/ microfinance none 4 30.8 very limited 6 46.2 limited 3 23.1 prior courses with international content yes 8 61.5 no 5 38.5 zubaroglu & popescu/preparing social work students 225 reasons for taking the course and student expectations students were asked to identify their main reasons for taking the course. students’ responses were analyzed for common themes. in order to fully preserve student voices, quotes were not modified or corrected. a majority (75%) of the students mentioned the desire to gain knowledge in international social work. for example, one student reported: [the main reason that i decided to take this course is] to apply and expand concepts in an innovative and exciting way, i.e., outside the classroom and the country with fewer students, and a feeling of academic community. in addition, half of the students wanted to take this course to obtain knowledge in general, and to be able to apply and expand concepts in a different country (see table 3). i would like to immerse myself in other countries and cultures from a social work standpoint. it is important to get out of the "bubble" of america--see other needs and process--opening myself to new social work. cultural opportunities will make a better person and social worker. there is always something new to learn. the student who wanted to gain knowledge in a specific population group reported that: as a bilingual counselor and working with victims of sexual assault, i would like to increase my knowledge on what women experienced beyond the u.s., their trauma, their coping mechanisms, how culture influenced them dealing with the trauma. students were also asked to identify their top three expectations from the course. students’ answers were grouped under four main themes (see table 3). the “other” category included cultural immersion, improving spanish, and seeing the inner workings of nongovernmental organizations (ngos). table 3. reasons for taking and expectations of the course reasons for taking n % to gain knowledge in… international social work 9 75.0 general 6 50.0 microcredits 4 33.3 communities 3 25.0 a specific population group 1 7.7 expectations from the course to gain knowledge/skills in… international social work 7 58.3 microfinance/microcredits 6 50.0 other 6 50.0 indigenous communities 5 41.7 advances in social work, fall 2015, 16(2) 226 students’ self-efficacy: assessment of knowledge and skills to measure students’ self-efficacy, we used the knowledge and the skills scales described above. the knowledge scale had a cronbach’s alpha coefficient of 0.89, and the skills scale had a cronbach’s alpha coefficient of 0.73, both values indicating acceptable statistical reliability. to determine the changes in students’ confidence, we conducted paired sample t-tests on the pre and post scores for both scales. findings indicate statistically significant changes for both scales (see table 4). due to the small sample size, we also conducted a non-parametric statistic test, the wilcoxon signed-rank test, for each scale. results indicate significant differences in both knowledge (z=-2.67, p=0.008) and skills (z=-2.67, p=0.008). some items in the knowledge scale were particularly impacted by this course: knowledge of global markets (mpre=2.0; mpos t=5.0; es cohen’s d=4.24), financial markets (mpre=1.6; mpost=4.9; es cohen’s d=5.57), and microcredit (mpre=2.8; mpost=6.0; es cohen’s d=2.45). similarly, students’ confidence with strategic planning skills in micro-finance institutions (mfis) (mpre=1.1; mpost=5.1; es cohen’s d=4.31), market feasibility assessment skills (mpre=1.6; mpost=4.8; es cohen’s d=3.75), and stakeholder analysis skills (mpre=3.1; mpost=6.1; es cohen’s d=2.78) greatly increased. table 4. changes in student confidence of knowledge and skills pre-test (n= 9) post-test (n=9) comparison mean sd mean sd t df p* cohen’s d** knowledge 3.2 1.13 5.5 0.39 6.59 8 <.001 2.80 skills 2.3 0.89 5.4 0.74 8.70 8 <.001 3.79 *2-tailed **effect size assessment of the course experience upon completing the course, about half of the students reported that this was the one course that prepared them greatly for international work (45.5%), while another 36% stated that it was one of the courses that contributed to their preparation for international work (36.4%, n=11). one student stated that this course greatly prepared him/her for international social work, along with individual experiences in other countries and their own international contacts. in order to understand what contributed most to preparing students for international work, students were asked to rank six different components of this educational model on a scale from 1 to 7 (with 1 being the lowest and 7 being the highest): lecture/presentations, field applications, immersion in an international context, interdisciplinary content/group work, link between course and assignments, and other. table 5 shows the contribution of each component according students’ ratings. zubaroglu & popescu/preparing social work students 227 table 5. contributions of the course components to student learning (n=11) course components mean sd immersion in an international context 6.8 0.40 interdisciplinary content/group work 6.2 1.22 field applications 6.0 0.77 link between course and assignments 5.8 1.67 lecture/presentations 5.7 1.10 findings suggest that the largest contributions were the immersion in an international context (m=6.8) and the interdisciplinary content (m=6.1). in addition to these components, one student noted the contribution of self-reflection. another student reported that the interaction with the peruvian people contributed the most because it was helpful to gauge their needs. when asked about their utmost gains from the course, one student stated: it was a very positive experience! being in the field with the indigenous community helped me better apply concepts that i learned in class. most students (70%) stated that they gained knowledge from the interaction with community members (including women, indigenous communities, and poor people in urban and rural areas). several students (60%) stated that they gained knowledge from general observation (observations included bottom-up development and culture). one student described the overall experience and perceived gains from this course: i came with the expectation of evaluating the different aspects that contribute to social and economic development of communities. it was extremely important for me to visit the urban and rural sector in which i could see all the visible work that people are doing to survive and to contribute to their economy. the least useful aspects noted by students included logistics (40%), time constraints (50%), and limited opportunities for unmediated interaction with community members (20%). discussion two key elements of the educational model presented are used to contextualize findings: (1) the international element–addressing global issues in an international context and (2) the interdisciplinary element–building capacity across disciplines, through knowledge and skills. students’ self-efficacy was significantly changed as a result of their participation in this comprehensive educational model, with both their perception of readiness for international work and their ability to integrate interdisciplinary knowledge increasing by the end of the program. students’ self-efficacy changed significantly between the pretest and the posttest, and the effect sizes were moderately strong. students started the course with some prior exposure to international social work, and their confidence with related social work advances in social work, fall 2015, 16(2) 228 concepts was higher than their confidence with concepts from other disciplines in this case, microcredit and finance-related knowledge. the knowledge on financial markets scored the lowest levels of confidence both for the pre-test and the post-test values. yet it also recorded the steepest change in confidence (with 3.3 points increase between pretest and posttest average scores), followed by students’ confidence with their knowledge of microfinance/microcredits, which also increased significantly (3.2 points). when examining the skills introduced by the course and their impact on students’ self-efficacy, students started with the lowest level of confidence with strategic planning in mfis (mpre=1.1) followed by market feasibility study skills (mpre=1.6) which remained lowest at post-test (mpost=4.8). the confidence with skills related to strategic planning for mfis recorded the greatest increase of 4 points between preand post-test values. overall, changes in self-efficacy were greatly impacted by interdisciplinary knowledge and skills students acquired through this course. the findings indicate that the course was effective in transmitting the knowledge and skills students expected to receive and in integrating the interdisciplinary content/skills. students’ highest expectation was to learn about international social work, followed by the desire to learn more about microfinance/microcredits, which recorded the greatest positive change in students’ confidence. it is also interesting to note that, when asked what course components most contributed to their learning, students identified immersion in an international context, the interdisciplinary content of the course, and the (interdisciplinary) hands-on field applications. learning from economists, human rights activists, government officials, and agency and program directors greatly contributed to the students’ satisfaction with the course and overall experience of feeling more prepared for international social work. however, the most impactful transfer of knowledge came from the various communities students interacted with: women, indigenous communities and their leaders, and people in marginalized communities in urban and rural areas. the effect of the interdisciplinary nature of the course was compounded by the participatory learning approach that characterized all activities during this experiential learning/study tour. limitations there are a number of limitations that affect the results of this pilot study. first, the small number of students enrolled in the class prevents any generalization of the findings beyond this group. also, the self-efficacy measures introduce a level of subjectivity to students’ assessment of their confidence. this limitation could be addressed if other measures of efficacy were added (e.g., content evaluation of students’ projects or the use of the same scale items with agency and community representatives–asking them to evaluate the changes in students’ knowledge and skills based on their performance on different tasks during field applications). the educational model proposed was designed to include multi-disciplinary student teams–with economics and business students working together with social work students on different field applications. due to external factors beyond our control, only zubaroglu & popescu/preparing social work students 229 social work students participated. however, we addressed this limitation by working across disciplines with professors from the economics department in peru and at the home institution and with economists and finance experts providing students with multidisciplinary course content. conclusions/next steps while the findings of this pilot study are tentative, this learning experience stresses the importance and benefits of international interdisciplinary social work education. these findings point towards both curricular and methodological changes to improve students’ readiness for international social work practice. on one hand, curricular changes should facilitate adding economics and finances content; on the other, teaching models should incorporate more participatory, experiential learning. we need to further explore the benefits of interdisciplinary student groups working together and to measure the impact of their work on communities and agencies. future research should compare the effectiveness of this model with other models (e.g., shorter study tour/experiential learning, case-based international interdisciplinary education, etc.) to identify strengths of each model and challenges that need to be addressed to increase their effectiveness and impact. by preparing students to work in diverse, international contexts and participate in international development efforts, we are fulfilling social work’s mission to pursue justice, address global issues, and promote human dignity and human rights. references ahmadi, n. 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(2012). globalization. in l. m. healy & r. j. link (eds.), handbook of international social work: human rights, development, and the global profession (p. 16). new york, ny: oxford university press, inc. woody, j., zeleny, m., d’souza, h., harder, j., reiser, j., & szto, p. (2014). student progress in a social work writing course: self-efficacy, course objectives, and skills. journal of social work education, 50(3), 507-524. author note address correspondence to: pinar zubaroglu, mssw, fordham university, graduate school of social service, campus box 97, room 716a lincoln center, 33 w. 60th street, new york, ny 10023. e-mail:pzubaroglu@fordham.edu http://dx.doi.org/10.1177/0020872811427717 http://dx.doi.org/10.1080/1369145032000144449 microsoft word editorial vol 14_2 _________________ william h. barton, ph.d., is a professor in the indiana university school of social work on the indiana university-purdue university indianapolis campus. contact information: (317) 274-6711; email: wbarton@iupui.edu copyright © 2012 advances in social work vol. 14 no.2 (fall 2013), i-ii editorial a “seasonal stew” – food for thought; fuel for action william h. barton welcome to the fall 2013 issue of advances in social work. arriving on the heels of our previous, 17-article special issue on latinos/latinas, we now present the largest regular issue (21 articles) ever published by advances. for this, we must thank the many authors who submitted manuscripts during the last several months, as well as a tireless cadre of reviewers who typically view and evaluate each eventually successful manuscript at least two times prior to its acceptance. we appreciate the increase in submissions and the growth in our ranks of registered authors, readers, and reviewers. we now have more than 800 social work researchers, educators, and practitioners from around the world registered with the journal, about 300 of whom serve as reviewers. the sheer number of articles in this fall 2013 issue precludes the usual practice of individually introducing each one here in detail. instead, what follows are descriptions of several loose groupings of these articles. the first four articles should be of broad interest. the first, by chaumba, presents a classification and list of mixed methods studies in social work, organized by the reasons mixed methods were chosen. the second, by strand, hansen, and courtney, extracts common elements across several evidence-based trauma treatment protocols. the third, by dybicz, contrasts traditional, problem-oriented and postmodern, strength-based practice approaches in terms of their respective approaches to gathering information from clients. the fourth, by powell, garrow, woodford, and perron, suggests a variety of ways direct practice social workers can influence policy. next is a set of articles concerned with specific populations. hodge and limb discuss using spiritual histories in practice with mormons, or latter-day saints. shier and graham focus on how community-based organizations can identify and respond to social service needs of muslims in the post-9/11 era in the united states. fasbinder, monson, montero, sanders, and williams derive implications for social work with same-gender partners from an analysis of published survey data from 1996 to 2013 tracking public attitudes towards same-gender marriage and civil unions. the next article, by wall, takes a more direct approach to offer suggestions for social worker practitioners and agencies working with lesbian-headed families. the last article in this group, by s. young and mcleod, addresses strategies for hiv/aids prevention and intervention with black men who have sex with men. the following two articles contain the results of survey research studies. haffejee, yoder, and bender report on results from a mixed methods study of a sample of college students aged 18-25 examining factors differentiating those who abstained from illegal behaviors, desisted from illegal behaviors, and persisted in illegal behaviors. castillo, asante, dwumah, barnie, and becerra present results from their survey of ghanaian social work students’ perceptions of poverty and social welfare policies in ghana. advances in social work, fall 2013, 14(2) ii three diverse conceptual articles comprise the next group. sutphin, mcdonough, and schrenkel argue that formal theories are relatively rarely used to guide social work research. by using family systems theory as an example, they suggest that formalization of theories can usefully guide social work research and practice. next, j. young presents a conceptual model to describe how contemporary nonprofit organizations can use social media as part of their organizational identity construction. organizations are also the focus of majiros’ article that examines principles of social exchange theory associated with mentoring as a means of knowledge transfer in the federal workplace. the final group of seven articles is related to social work education. mccave, rishel, and morris present the second in a two-part series of articles (the first appeared in advances in the fall 2011 issue) decrying the relative absence of prevention-focused language and content in social work curricula, textbooks, and presentations at national social work conferences. park, hawkins, hawkins, and hamlin examine attitudes towards interprofessional collaboration among a sample of medical, nursing, and social work students, with implications for expanding interprofessional education efforts. the next two articles focus on styles of leadership. goldkind and pardasani surveyed a sample of human services executive directors to explore the relationship between academic background (i.e., social work vs. other disciplines) and leadership style. call, owens, and vincent present a qualitative analysis from a survey of social work faculty members about how they experienced the leadership style of their current academic unit heads. hunter and mileski offer a case study of academic civic engagement, the formation and impact of the emerging leaders project, a community-based participatory action research (cbpr) project focused on capacity building with new arriving communities in salt lake city. turning to the classroom, acquavita and tice discuss lessons learned from incorporating a process of reflection and peer review in a social policy course. closing out our fall issue is a critique of neo-liberal social work education from our colleagues to the north (canada) – george, silver, and preston – who argue for nothing less than a reconceptualization of social work field education that could result in a more transformative educational experience. there you have it, a seasonal stew – food for thought and, perhaps, fuel for action in the realms of social work practice, research, and education. you may have noticed from the announcement on the home page of advances in social work that our spring 2014 issue will be very special, indeed. “eyewitnesses to history: first-hand accounts of sages of the profession,” under the guidance of co-editors drs. virginia majewski and gerald t. powers, will consist of a series of invited articles concerning “sages of the profession,” individuals who are generally recognized as intellectual and professional pioneers in the field of social work. then, as usual, we will produce a “regular” issue with a range of topics in the fall of 2014. look for a call for papers this spring or summer for a 2015 special issue on “technology, the internet, and social work practice.” i hope you enjoy the current issue, work on those manuscripts to submit, tell your colleagues about advances in social work, and urge them to register to submit articles and to join our growing corps of reviewers. happy holidays! _______________ elizabeth a. wahler, phd, msw program director/assistant professor, school of social work, indiana university, indianapolis, in 46202. karen badger, phd, associate professor in the college of social work, associate dean and assistant provost in the division of undergraduate education, university of kentucky, lexington, ky 40506. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 340-354, doi: 10.18060/20886 exploring faculty perceptions of student incivility in social work: results from a national survey elizabeth a. wahler karen badger abstract: the literature suggests that incivility is a growing problem in college classrooms, but few studies have examined incivility within social work programs. using a national sample of social work instructors (n=327), this study examined faculty experiences with social work student incivility in both undergraduate and graduate education. results showed that some behaviors often deemed disrespectful or inattentive do occur in social work classrooms, and they occur more frequently in undergraduate classes than graduate classes. although rare, hostile behaviors were also reported by faculty. discussion of these findings includes recommendations for addressing incivility in the context of preparing social work students for professional practice. keywords: incivility; social work education; student uncivil behavior the occurrence of student incivility appears to be on the upswing (alberts, hazen, & theobald, 2010; knepp, 2012). various studies indicate that disrespectful and inappropriate classroom behavior has been increasing across college campuses (alexander-snow, 2004; baker, comer, & martinak, 2008; boice, 1996). uncivil student behavior such as arriving late or leaving early, talking inappropriately in class, texting, making confrontational or sarcastic comments to instructors, or using computers for tasks unrelated to class activities can all be distracting to instructors and other students (ausbrooks, jones, & tijerina, 2011; boice, 1996; bjorklund & rehling, 2009). indeed, student incivility, defined as “any speech or action that disrupts the harmony of the teaching-learning environment” (clark & springer, 2007, p. 93), has been documented as a serious problem nationwide in higher education (alexander-snow, 2004; baker et al., 2008; boice, 1996). the cultivation of responsible and engaged citizens is among the goals of higher education (clark & springer, 2007). in addition to the traditional emphasis of higher education on preparing students for their careers and fostering their intellectual growth, many educators and administrators also strive to increase students’ knowledge of themselves as well as prepare them to be active members in a community (pascarella & terenzini, 2005). this charge suggests that educators influence not only the building of knowledge, but also the development of students' self, particularly in relation to others and their community. civility has been described as a virtue (connelly, 2009) and as “…otherregarding in the sense of knowing how to live harmoniously with others and with self” (p. 54). however, the literature documents instances of students (alberts et al., 2010; ausbrooks et al., 2011; bjorklund & rehling, 2009; boice, 1996) as well as faculty (clark, 2008; clark & springer, 2007) not acting consistently with this virtue. acts of incivility present educators with the challenge to more intentionally address students’ behaviors advances in social work, fall 2016, 17(2) 341 towards others and, for social work faculty, the opportunity to better align actions with social work values and principles outlined in the national association of social workers code of ethics (nasw, 2008). the social work profession emphasizes core values of service, integrity, social justice, the belief and worth of all people, and the importance of human relationships (nasw, 2008). acts of incivility in the classroom could be considered as incongruent with these core values and could suggest a student’s poor fit with the professional expectations of the social work profession (ausbrooks et al., 2011). social work values are basic to social work education as are its competency standards which assert the need for social work graduates to have mastered the forming of a professional identity, practicing ethical behavior, and appreciating and respecting diversity, as well as aligning practice and advocacy efforts to further human rights and justice (council of social work education [cswe], 2015b). these central tenets of social work education and the expectation that students be prepared for professional practice mandate that educators influence the shaping of students’ professional identities and behaviors. it may be presumed that social work students ascribe to the core social work values and that their behaviors in the classroom and field settings reflect compassion towards others, suggesting that faculty need not be concerned about incivility. however, anecdotal reports of incivility among social work students lead to questions about the actual prevalence of these behaviors. the purpose of this crosssectional study was to explore the type and frequency of uncivil behaviors in undergraduate and graduate classrooms as reported by social work educators. overview of student incivility in the classroom boice (1996) conducted an early large-scale empirical study examining incivility in higher education classrooms. he observed instructors and students in large introductory classes (student enrollment of 100 or more) and interviewed samples of both faculty and students. boice found that incivility took place in most of the classrooms he studied, and faculty with senior rank and teaching experience were not immune. students and faculty agreed that the most objectionable demonstrations of student incivility were side-talking so loudly that the instructor or students speaking in class could not be heard, reacting to instructors with sarcasm or negative comments, and creating unease in the classroom environment by behaving in a highly emotional or erratic way. along with identifying problematic student behaviors, boice observed instructor behaviors/characteristics that were associated with uncivil student behaviors. boice reported that incivility seemed to be more common in classrooms of instructors whom students perceived as uncaring or unresponsive to their needs. incivility also perpetuated itself; that is, the more students behaved in an uncivil manner, the more student morale and instructor interest decreased, and the more incivility increased. following boice, others have explored the prevalence of uncivil student behavior in college classrooms and found similar results. caboni, hirschy, and best (2004) investigated student attitudes towards their peers’ uncivil behaviors in the classroom and the extent to which the students considered such behaviors to be acceptable. they found that “disrespectful disruptions,” behaviors the authors defined as “active behavior in which a student engages that impedes learning by other members of the class” (p. 62) were not wahler & badger/exploring faculty perceptions 342 considered appropriate classroom behaviors. in contrast, “insolent inattention,” or disengaged or passive actions that “demonstrate an inability or unwillingness to pay attention to classroom activities” (p. 62) were more likely to be tolerated. bjorklund and rehling (2009) explored the frequency with which students observed incivility in the classroom and asked students to assign severity ratings to each behavior. behaviors considered more severe included students continuing to talk after being asked not to, coming to class having used drugs or alcohol, letting cell phones ring, and having loud conversations with other students—behaviors that mostly fit the definition of disrespectful disruptions as defined by caboni and colleagues (2004). however, bjorklund and rehling found that the most severely rated behaviors were reported infrequently. text messaging during class and gathering books and belongings prior to the end of class were the most frequent offenses. alberts and colleagues (2010) investigated incidents of student incivility as reported by non-tenured faculty members. they found that the majority of faculty respondents reported incivility in their classrooms. their findings suggested that larger class size was associated with higher rates of incivility. smaller formats such as recitation sections, fieldbased experiences, and lab courses were associated with fewer behaviors. the most common type of uncivil student behaviors observed was student inattentiveness. hostile behavior or language directed towards a faculty member or others were observed to occur infrequently—findings also consistent with previous research. although there have been numerous studies examining incivility in general college student samples or specific college majors, we found few using a sample of social work students. ausbrooks and colleagues (2011) conducted a pilot study examining faculty and student perspectives of incivility in a single social work program. student study participants rated the acts of incivility as significantly more concerning and occurring more often than their faculty counterparts. however, both groups agreed on which behaviors they considered to be the more serious infractions: “verbal attacking of other students, physically attacking other students, making threats to faculty/students, and making offensive remarks” (p. 263). faculty and student respondents both reported “eating, talking to other students at inappropriate times, arriving late or leaving early, and text-messaging” (p. 263) as the most frequently observed behaviors. the only other study we found that examined incivility among social work students was a dissertation examining factors affecting perception of incivility among students in a single social work program (ballan, 2015). based on the finding that social work students sometimes exhibit uncivil behaviors similar to other college student samples, ballan suggested this issue be examined on a larger scale with a national sample. in summary, a review of the literature suggests that student incivility is a common problem on college campuses, suggesting the need to explore this issue within social work programs. building on two studies of student incivility in single social work programs (ausbrooks et al., 2011; ballan, 2015), this study used a national sample of social work faculty to examine the type and prevalence of student incivility in undergraduate and graduate classrooms, compare differences in frequency of incivility between the two levels advances in social work, fall 2016, 17(2) 343 of education, and explore whether experiences of student incivility differed based on faculty demographic characteristics. methods study procedure following approval from the institutional review board, an online survey was distributed via a national social work education organization’s listserv comprised of educators, administrators, researchers, and doctoral students (approximate n=1,400) and the listserv at one of the author’s home institution that contained all faculty and staff affiliated with the social work college (approximate n=100), yielding a general sampling frame of approximately 1,500. participants were eligible and invited to complete the survey if they had taught either an undergraduate or a graduate social work course within the previous three years. the exact number of eligible individuals receiving the invitation is unknown since the listserv reaches many people who may no longer teach graduate or undergraduate students. additionally, it is possible that a small number of faculty were on both lists and may have received the invitation twice. survey content and procedures followed the guidelines provided by dillman, smyth, and christian (2014). an email informed all listserv recipients of the upcoming survey and invited eligible faculty to consider participating. one week following the initial announcement and description of the study, a second email was sent to invite eligible subscribers to participate and included an embedded link to the on-line survey. the survey could be completed at the respondents’ convenience and did not request any identifying data. within the next three weeks, two reminder emails were sent via the listserv to potential respondents. a return of a completed survey was recognized as consent to participate in the study. measures the survey consisted of two parts: (a) six demographic items and (b) 29 items listing different behaviors demonstrating classroom incivility compiled from those documented in the extant literature. these items included a range of behaviors often considered inattentive (e.g., sleeping, texting, reading non-class material during class time, using the computer for non-class purposes, etc.), disrespectful (e.g., mocking or making fun of other students, challenging the instructor’s authority, arguing about a grade, talking back to the instructor, etc.), hostile (e.g., threatening the instructor, threatening other students, behaving violently in class, etc.), or otherwise inappropriate (e.g. talking over other students, dominating the discussion, not participating in class activities, etc.). additionally, questions about plagiarism and cheating were included since these have been considered uncivil in previous literature (bray & del favero, 2004). these issues were considered important in the current study because of their relevance to social work core values (specifically integrity). eating in class was also included in the survey as a potential uncivil behavior, consistent with other research (ausbrooks et al., 2011; bjorklund & rehling, 2009; paik & broedel-zaugg, 2006; swinney, elder, & seaton, 2010). see table 2 for a complete list of survey items. for all items, respondents recorded how frequently they had wahler & badger/exploring faculty perceptions 344 observed each type of uncivil student behavior in class using a likert-type scale of 1 (never experienced) to 5 (usually experienced). analytic plan the frequency with which respondents observed each behavior was determined by calculating the mean scores and standard deviation for each behavioral item according to each student group (undergraduates and graduates) using the likert-type responses. all 29 items were also summed to create an overall index of incivility experienced at the graduate and undergraduate level. independent samples t-tests were calculated to compare means of the individual behaviors and total index scores between those reported in undergraduate and graduate classrooms. ninety-five percent confidence intervals were computed for the mean difference between behaviors reported at the graduate versus undergraduate level. cohen’s d was computed as a measure of effect size. demographic variables for faculty members including gender, education level, age categories, and years of teaching experiences were examined for differences in relation to the overall incivility index for each student group using t-tests and one-way analysis of variance (anova). results sample demographics three hundred and twenty-seven (n=327) faculty responded to the survey. this yielded approximately a 22% response rate when calculating the rate using the total number of subscribers to both listservs. a response rate specific to the eligible faculty from both listservs could not be calculated. in addition, it is unknown what percentage of the total sample was from the social work education listserv versus the university listserv because responses were anonymous. the obtained sample was primarily female (n=248, 76%) and caucasian (n=276, 84%). comparison to national data on faculty demographics provided by cswe (2015a) indicated that the demographic characteristics of the current sample were similar to that of the national sample for gender but had a lower percentage of non-white respondents (36% of national sample were non-white compared to 15.6% of the current sample). seventeen percent (n=57) of the respondents were 40 years old or younger with the greatest number of respondents falling in the age category of 51 to 60 years (n=121, 37%). most respondents held doctoral degrees table 1. sample demographics (n=327) variable n(%)* gender male 77 (23.7%) female 248 (76.3%) race caucasian 276 (84.4%) african american 18 (5.5%) asian 11 (3.4%) latino 8 (2.4%) other 14 (4.3%) age 25-40 57 (17.4%) 41-50 77 (23.5%) 51-60 121 (37%) 61+ 72 (22%) education master’s degree 103 (31.7%) doctoral degree 222 (68.3%) position teaching assistant 7 (2.1%) adjunct faculty 24 (7.4%) full-time faculty 295 (90.5%) level undergraduate 151 (46.6%) graduate 35 (10.8%) both 138 (42.6%) *n may not total 327 due to missing data; % may not equal 100.0 due to rounding advances in social work, fall 2016, 17(2) 345 (n=222, 68%), and approximately 90% (n=295) were full-time faculty. about 46% (n=151) taught only in a social work undergraduate program, approximately 11% (n=35) only in the graduate social work program, while close to 39% (n=128) reported that they taught in both programs in the three years prior to completing the survey. respondents had an average of 14.7 (sd=9.9) years of teaching experience, with responses ranging from 1 to 46 years (see table 1). prevalence of incivility faculty respondents were asked to complete survey items related to the student groups they taught; 274 of the participants responded to survey items in relation to undergraduate students, and 157 participants responded to items relative to graduate students (responses total more than the sample of 327 due to some participants teaching at both the undergraduate and graduate levels). the mean scores of types of incivility experienced by faculty teaching bsw and msw students and t test results are reported in table 2. the uncivil behaviors faculty respondents reported as most frequent were generally the same for both student groups, although the order of their prevalence differed. the most frequently reported uncivil behavior at the undergraduate level was tardiness, and this behavior was observed to occur significantly more often with undergraduates (m=3.48, sd=0.74) compared to graduate students (t(430)=7.27, p≤.001, d=0.70), although it was also frequently reported by faculty teaching at the graduate level (m=2.92, sd=0.82). the most frequently reported uncivil behavior at the graduate level was eating in class (m=3.51, sd=1.02). however, there were no significant differences when compared to the frequency at the undergraduate level (m=3.41, sd=1.04, t(328)=-0.97, p=.34, d=0.09). other frequently occurring behaviors were talking in class, texting, packing books and papers noisily before the end of class, and dominating the discussion. all of these but dominating the discussion were reported to occur significantly more frequently in undergraduate than graduate classrooms. plagiarism was reported to be frequent in both groups, although to a significantly greater extent among undergraduate (m=2.68, sd=0.84) than graduate students (m=2.33, sd=0.86, t(424)=4.11, p≤.001, d=0.40). cheating on assignments or exams was also reported significantly more often for undergraduate (m=2.12, sd=0.72) than graduate students (m=1.80, sd=0.75, t(428)=4.37, p≤.001, d=0.42). hostile and more severe types of incivility were reported at both levels, albeit less frequently than inattentive or disrespectful behaviors. faculty reported observing general hostility toward other students significantly more often in undergraduate (m=1.62, sd=0.66) than graduate students (m=1.44, sd=0.73, t(423)=2.61, p=.010, d=0.25). general hostility toward the instructor was also experienced slightly less often for faculty teaching graduate students (undergraduate: m=1.72, sd=0.78, graduate: m=1.55, sd=0.77, t(427)=2.19, p=.030, d=0.21). there were no significant differences in level of racist comments (undergraduate: m=1.53, sd=0.65, graduate m=1.48, sd=0.63) or other prejudicial comments in the classroom (undergraduate: m=1.90, sd=0.68, graduate: m=1.83, sd=0.78). specific types of hostility, such as threatening others or behaving violently, were experienced rarely. threatening other students was reported at the same level by faculty who taught undergraduates (m=1.16, sd=0.39) and graduate students wahler & badger/exploring faculty perceptions 346 (m=1.14, sd=0.42). similar results were found for threatening the instructor (undergraduate: m=1.20, sd=0.45, graduate: m=1.13, sd=0.41). there were also very few faculty reports of students behaving violently in class for either undergraduate (m=1.06, sd=0.25) or graduate (m=1.04, sd=0.19) students. description of incivility experienced in addition to the quantitative data gathered in this study, an open-ended item in the survey allowed faculty to write in details of experiences with incivility or mention other types of incivility experienced. most respondents left this item blank, but some faculty participants described the hostile student behaviors they had experienced. one respondent commented about a student “physically preventing me from leaving my classroom,” while others reported “glaring” and “stalking/traumatizing” behaviors in relation to undergraduate students. respondents who taught graduate students reported students using “profanity towards [the] instructor,” as well as “challenging in the form of excessive questioning” and “demanding to meet and talk with [the] professor about personal problems while others are still around after class.” one faculty member reported receiving death threats from a student. additionally, several study participants indicated that they took issue with the inclusion of eating in class on the survey; they communicated that they did not consider it an act of incivility to eat in class and did not think it should be listed as such. incivility, student education level, and faculty demographics using the summed scores of the 29-item overall incivility index, an independent ttest showed that faculty reported statistically more uncivil behaviors among undergraduates (m=62.41, sd=12.63) than graduate students (m=57.22, sd=12.73, t(375)=3.81, p≤.001, d=0.39). faculty demographic variables were then examined relative to student incivility using the overall 29-item incivility index. independent samples t test analysis showed no statistically significant differences in incivility experienced by gender at either educational level (male m=63.29, sd=13.63, female m=62.05, sd=12.30, t(240)=0.64, p=.523 for undergraduate student incivility and male m=57.03, sd=13.13, female m=57.28, sd=12.70, t(131)=-0.10, p=.918 for graduate incivility) or by faculty education level at the graduate level (master's m=55.97, sd=10.82, doctoral m=57.33, sd=13.08, t(131)=-0.53, p=.598). however, there was a significant difference between student incivility reported by faculty education level for respondents teaching at the undergraduate level. faculty with a doctoral degree reported more incivility than faculty with a master's degree (master's m=59.67, sd=10.70, doctoral m=63.75, sd=13.35, t(240)=-2.40, p ≤ .05). a one-way anova showed no statistically significant differences in experiences of undergraduate or graduate student incivility by faculty age when four categories were used (f=0.685, p=.60 for undergraduate incivility experienced, and f=0.783, p=.54 for graduate incivility). correlations were computed to examine the association between years of teaching experience and incivility with each student group. the number of years of teaching experience was minimally associated with increased faculty experiences of incivility with undergraduate students (r=.15, p=.02) but not with graduate students (r=.01, p=.94). wahler & badger/exploring faculty perceptions 347 table 2. mean frequency of uncivil behaviors and comparisons between graduate and undergraduate levels (n=372) item undergraduates m (sd) graduates m (sd) t d mean difference 95% c.i. tardiness 3.48 (0.74) 2.92 (0.82) 7.27*** 0.70 0.56 .41 .71 eating in class 3.41 (1.04) 3.51 (1.02) 0.97 0.09 -0.10 -.30 .10 talking in class 3.38 (0.84) 2.96 (0.81) 5.06*** 0.49 0.42 .26 .58 texting 2.96 (1.01) 2.53 (0.91) 4.40*** 0.43 0.43 .24 .62 packing books, etc. noisily before end of class 2.96 (1.04) 2.51 (1.02) 4.34*** 0.42 0.45 .25 .65 dominating the discussion 2.76 (0.75) 2.69 (0.83) 0.89 0.09 0.07 -.08 .22 plagiarizing 2.68 (0.84) 2.33 (0.86) 4.11*** 0.40 0.35 .18 .52 using computer inappropriately 2.42 (0.93) 2.37 (0.90) 0.54 0.05 0.05 -.13 .23 talking over other students 2.41 (0.79) 2.30 (0.82) 1.37 0.13 0.11 -.05 .27 reading outside material in class 2.39 (0.83) 2.19 (0.87) 2.35* 0.23 0.20 .03 .37 using cell phone 2.37 (1.03) 2.19 (0.92) 1.81 0.17 0.18 -.02 .38 sleeping 2.29 (0.81) 1.70 (0.75) 7.47*** 0.72 0.59 .43 .75 non-verbally making fun of other students 2.28 (0.79) 2.07 (0.84) 2.58** 0.25 0.21 .05 .37 not participating in activities (no outright refusal) 2.13 (0.91) 1.79 (0.75) 3.94*** 0.38 0.34 .17 .51 cheating on assignments or exams 2.12 (0.72) 1.80 (0.75) 4.37*** 0.42 0.32 .18 .46 disrespectfully arguing about a grade 2.01 (0.85) 1.96 (0.84) 0.59 0.06 0.05 -.12 .22 challenging the instructor’s authority 1.96 (0.80) 2.01 (0.89) 0.60 0.06 -0.05 -.21 .11 talking back to the instructor 1.90 (0.81) 1.81 (0.83) 1.09 0.11 0.09 -.07 .25 inappropriately joking during class for laughs 1.78 (0.75) 1.70 (0.73) 1.07 0.10 0.08 -.07 .23 behaving with hostility toward the instructor 1.72 (0.78) 1.55 (0.77) 2.19* 0.21 0.17 .02 .32 verbally making fun of other students 1.68 (0.71) 1.56 (0.71) 1.69 0.16 0.12 -.02 .26 refusing to participate in group activity 1.66 (0.77) 1.50 (0.72) 2.12* 0.21 0.16 .01 .31 behaving with hostility toward other students 1.62 (0.66) 1.44 (0.73) 2.61** 0.25 0.18 .04 .32 making racist comments in class 1.53 (0.65) 1.48 (0.63) 0.77 0.07 0.05 -.08 .18 making other prejudiced comments in class 1.90 (0.68) 1.83 (0.78) 0.97 0.09 0.07 -.07 .21 threatening the instructor 1.20 (0.45) 1.13 (0.41) 1.59 0.16 0.07 -.02 .16 threatening other students 1.16 (0.39) 1.14 (0.42) 0.50 0.05 0.02 -.06 .10 throwing small items during class 1.12 (0.35) 1.11 (0.33) 0.29 0.03 0.01 -.06 .08 behaving violently in class 1.06 (0.25) 1.04 (0.19) 0.87 0.08 0.02 -.02 .06 total index score 62.41 (12.63) 57.22 (12.73) 3.81*** 0.39 5.19 2.51-7.87 *p≤.05, **p≤.01, ***p≤.001 wahler & badger/exploring faculty perceptions 348 discussion social work educators who participated in this study reported observing behaviors of incivility during interactions with both their undergraduate and graduate students. although found in both student groups, incivility was reported with significantly greater frequency in undergraduate courses. the student demographics in this study are not known, but traditional undergraduate students tend to be younger than social work graduate students. undergraduates might also have less socialization into the culture of higher education and less familiarity with expectations of the social work profession. in addition, we should note that all of the undergraduate students who exhibited uncivil behaviors may not be bsw majors. in some schools, bsw students may not declare a major until their junior year. likewise, non-social work majors may take some undergraduate social work courses. overall, findings regarding types of incivility observed and experienced were consistent with those reported in similar studies. the most frequently reported behaviors of incivility were those that could be categorized as disrespectful or inattentive, such as tardiness, texting, or talking in class. more severe behaviors, such as behaving threateningly or violently, were experienced by respondents to a far lesser extent. the results of the current study are consistent with previous research literature using both social work (ausbrooks et al., 2011; ballan, 2015) and non-social work (alberts et al., 2010) samples. faculty respondents in the study by alberts and colleagues reported eating, talking to other students inappropriately, being tardy or leaving early, and texting in class as the behaviors they most frequently experienced in undergraduate and graduate students combined. in addition to faculty reports, student respondents in other studies show that they also noticed these uncivil behaviors in class. the behaviors reported as most frequently observed by faculty in this current study were also among those most frequently observed by students reporting about incivility among their peers in a previous study (bjorklund & rehling, 2009). the lack of consensus in the literature about what behaviors constitute incivility (boice, 1996) is also evident in this study. while behaviors that are hostile (e.g., behaving violently in class, threatening other students or the instructor, making hostile comments, etc.) are more consistently accepted as incivility, other behaviors deemed uncivil by some are not considered as such by others. for example, in the current project, eating in class was included as an uncivil behavior as it has been in other studies (ausbrooks et al., 2011; bjorklund & rehling, 2009; paik & broedel-zaugg, 2006; swinney et al., 2010), and was the item most frequently experienced by respondents. however, several participants reported in the open-ended survey question that they took issue with eating being included in a survey on incivility and did not feel it was inappropriate to eat in class. their reactions to this item were consistent with findings in a previous study in which only a small percentage of the faculty respondents perceived this behavior as uncivil (swinney et al., 2010). with future research in mind, this study highlights the influence that individual characteristics (e.g., subjectivity, preferences, and perceptions) can have when studying classroom incivility. it also demonstrates the importance of measuring the degree to which advances in social work, fall 2016, 17(2) 349 a behavior is uncivil. for example, a student who is quietly eating a small snack during class yet still engaged could be considered as exhibiting acceptable behavior, while a student who brings in a full meal in noisy containers and is pre-occupied with their meal rather than attending to the class could be considered as behaving in an uncivil manner. where a specific behavior is placed on such a continuum can determine how intrusive it is to the learning environment. however, instructors may see some behaviors as less serious and more tolerable than the students who also observe the actions (ausbrooks et al., 2011). faculty ought to take student perspective and experience into account when making decisions regarding the acceptability of these behaviors. in addition, behaviors that are, at first glance, considered tolerable may become quite disruptive if their occurrence is high. for example, one student arriving a few minutes late to class may create no or minimal disruption, but many students arriving late and at different times during class could negatively impact the learning experience for both the instructor and the students. it is worth noting that some respondents sent emails to the authors in addition to their responses to the survey instrument to share that, in general, they struggled with labeling behavior as incivility. these respondents stated that social work students should be encouraged to question authority, argue about their grades, and talk back to the instructor since social work educators should also be teaching about the need to act uncivilly to fight against social injustice. these comments highlight a conflict regarding civility likely not present in literature regarding professions other than social work and one that should be the focus of future research on incivility in our field. social work educators are expected to assist students in developing advocacy skills and to embrace social work’s mission of addressing social injustice (cswe, 2015b; nasw, 2008), but also need to strike a balance of doing so by still encouraging students to exhibit proper classroom behavior without being oppressive. social work educators most likely vary regarding the level of authoritychallenging behavior they accept from students as being appropriate; thus, it is even more important that each institution or faculty group delineate specific definitions of inappropriate and intolerable behavior from students to aid in identifying and addressing uncivil behavior within the implicit curriculum. in this study, faculty members’ gender and level of education were not statistically significantly related to the frequency of overall uncivil behaviors reported for either undergraduate or graduate students. similar to this finding, alberts et al. (2010) did not find statistically significant differences in relation to gender and reports of disrespectful or inattentive uncivil behaviors in their sample. however, their results did show that female faculty reported experiencing more incidents of hostility from students than their male counterparts. additionally, a mild positive correlation was found in the current study between years of experience and incivility experienced with undergraduate students, but not with graduate students. these findings contrast with those of boice (1996), who found that years of teaching experience were not correlated with experiences of incivility, but found instead that faculty characteristics (such as standoffishness) or behaviors (such as racing through a lecture) were associated with students’ uncivil behaviors. these faculty characteristics and behaviors should be measured in future research on student incivility in social work. wahler & badger/exploring faculty perceptions 350 developing professional behaviors in the classroom student incivility runs counter to the high professional standards of social work. the social work core competency, demonstrate ethical and professional behavior (cswe, 2015b), requires students to master practice behaviors (or student learning outcomes) such as selfreflection and subsequent behavioral correction, as well as behaving, appearing, and communicating as a professional in accordance with social work roles and the profession’s standards and values. although such an emphasis may create the expectation that social work educators do not experience incivility, the findings of this study as well as those of ausbrooks et al. (2011) and ballan (2015) indicate otherwise. thus, through using the purpose, competencies, and values of social work as a guide, social work educators have the opportunity to model appropriate professional behavior in class and address incivility in a way that reinforces social work professionalism and the development of congruent attitudes and behaviors. the literature presents strategies educators can implement to manage these student improprieties (baker et al., 2008; bjorklund & rehling, 2009, mcnaughton-cassill, 2013; nordstrom, bartels, & bucy, 2009; royse, 2001; suplee, lachman, siebert & anselmi, 2008), some of which may resonate with social work educators. for example, it has been suggested that the presence of learning goals has been correlated with a decrease in inappropriate behavior (nordstrom et al., 2009), findings which support reviewing the cswe (2015b) core educational competencies with students at the start of a course and reinforcing them throughout the curriculum. students may be more likely to meet behavioral standards in class if they understand how the standards apply to their future professional practice. rather than only emphasizing rules and requiring civil behavior for the purposes of class, the instructor can map their importance for shaping of students’ future behaviors and appearance as social workers, explaining how civility fits with professional values and norms as well as with its role in establishing professional credibility. if students demonstrate inappropriate classroom behavior, instructors can define and reframe for students why it is inappropriate in the real world and how this is relevant for their future careers (fink, 2003). for instance, if a group of students is observed mocking another student in class, the instructor could discuss with them the social worker’s responsibility to serve those who are marginalized by society. these students could be asked to envision themselves working with a client who is similar to the student they are mocking and be reminded that the classroom is where they can begin practicing those behaviors they will apply in the field. another example concerns plagiarism, which corresponds with the social work value of integrity. investigations of an alleged act of plagiarism can also include exploring the context within which the student made the decision to use another’s material without proper credit. although specific reasons for plagiarism should be the focus of future research, some students might describe feeling overwhelmed, stressed, unsure of how to do an assignment, or being out of time as explanations for plagiarism. in circumstances such as these, the possible ramifications of being in a practice setting and choosing to resolve problems by taking short cuts or misrepresenting work, etcetera, can then be discussed. additional problem-solving routes can be explored to connect the classroom behavior with professional expectations. if instructors introduce the classroom atmosphere as one similar to that established in social work practice—where all students (and the instructor) are expected to be treated and treat advances in social work, fall 2016, 17(2) 351 others with fairness and compassion—the stage is then set for making a connection between in-class behaviors and those essential for success in future practice settings. incivility has also been described as consisting of an “interactional effect between students and faculty” (bray & del favero, 2004, p. 10) and as occurring within this relational context and/or that of the classroom milieu. bray and del favero (2004) discuss student incivility from the perspective of social control theory which describes “deviance as a lack of adequate socialization into the culture” (p. 11). in social work education, the culture into which students are socialized is the classroom, but it also extends beyond and includes the norms and behaviors expected within field settings and the wider social work profession. given this, incidents of student incivility present social work educators with the opportunity to reinforce social work values and to emphasize the development of professional attitudes and behaviors. in social work education, students are socialized into the profession through field work with community-based social workers, providing students with opportunities to integrate the knowledge, values, and skills they have learned in the classroom. consistent with the assumptions of social learning theory (abbey, willett, selby-penczak, & mcknight, 2010), students are also able to learn new behaviors through observation and application. classroom-based social work educators are also in the position to model professional behaviors and expectations for students. classroom observations and interactions (with peers and instructors alike) can impart professional norms and values and create learning opportunities for students (abbey et al., 2010). for example, if professional social workers are expected to be prepared, reliable, and respectful of others, this could be modeled by the classroom instructor (e.g., being on time for class, preparing the class session, providing an organizational structure, and actively listening to students) and, in turn, be expected of the students (e.g., being on time for class, having completed the required readings, using electronic devices appropriately during class, completing homework on time, and attending to class discussion). also of note, uncivil student behavior could signal underlying social or psychological problems (mcnaughton-cassill, 2013) that need to be addressed through referrals for services. although this could be challenging for all educators, perhaps it could be especially difficult for faculty who might also be social work practitioners in the field. social work educators should be careful to establish appropriate boundaries, work within their ascribed roles, and not provide social work services to students in their classes. besides dual relationships being prohibited by the nasw code of ethics (2008), counseling students can confuse classroom roles, reduce instructors’ objectivity in class, and increase chances students will feel personally rejected by instructors’ feedback or by receiving a lower grade than desired (royse, 2001). all of these factors have the potential to feed incivility rather than improve behavior. depending on the severity of the problem, the student’s willingness to address it, and the student’s ability to fulfill requirements of the educational competencies, it could also be appropriate at times to discuss the fit of the student with social work and coach them toward other career options. limitations and future directions although this study contributes to knowledge about incivility among social work students, there are several limitations that must be considered. self-reported data were used wahler & badger/exploring faculty perceptions 352 in this study which are vulnerable to selective recall and potential bias. the study sample was not highly diverse in regards to ethnicity, and the diversity of the sample in terms of geographic or academic location is unknown. this study did not include environmental context variables such as the type of school (e.g., small or large institutions, private or public institutions) or the size of the classes or status of students (freshmen, sophomore, senior) taught by faculty respondents. additionally, student variables such as age, declared major, and familiarity with the nasw/cswe core principles and competencies could also influence uncivil behavior and were not included in this or other studies of social work student incivility. these variables could potentially influence the degree to which faculty experience student incivility and should be considered in future research on this topic. the actual response rate of the sample could not be calculated as the number of listserv subscribers who fit the eligibility criteria was not known to the researchers. despite the limitations, this study extends the exploratory work completed by ausbrooks et al. (2011) and ballan (2015), and the results continue to suggest that additional investigation in this area is needed to further examine incivility in social work education. specifically, to better understand its occurrence, the contributions of instructor, student, and university attributes to incivility should be studied. studies might examine the prevalence with which faculty incivility, as well as student incivility, is present in social work education. exploring social work students’ perceptions of student and faculty incivility is needed to better understand the students’ experiences in the classroom and what circumstances detract from learning. with the growth of online education, future research should examine prevalence of incivility in online settings and interactions. future research should also examine the efficacy of preventive methods and interventions for addressing incivility in social work classrooms so that social work educators can intervene with evidence-supported methods. in closing, social work educators have an important role in socializing students into the social work profession, its values, and expectations. those who encounter acts of student incivility in their classrooms are presented with teachable moments. addressing uncivil behavior in the context of social work practice and linking civility with expectations that students will experience as future social workers can contribute to their development as social work professionals and foster the shaping of engaged citizens. references abbey, l., willett, r., selby-penczak, r., & mcknight, r. 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(2008). code of ethics. retrieved from http://www.socialworkers.org.pubs/code/code.asp nordstrom, c. r., bartels, l. k., & bucy, l. (2009). predicting and curbing classroom incivility in higher education. college student journal, 43(1), 74-85. paik, c., & broedel-zaugg, k. (2006). pharmacy students’ opinions on civility and preferences regarding professors. american journal of pharmaceutical education, 70(4), 1-9. doi:http://dx.doi.org/10.5688/aj700488 pascarella, e. t., & terenzini, p. t. (2005). how college affects students, volume 2: a third decade of research. san francisco, ca: jossey-bass. royse, d. (2001). teaching tips for college and university instructors. needham heights, ma: allyn & bacon. swinney, l. s., elder, b. r., & seaton, l. p. (2010). incivility in the accounting classroom. american journal of business education, 5, 1-16. doi:http://dx.doi.org/10.19030/ajbe.v3i5.422 suplee, p. d., lachman, v. d., siebert, b., & anselmi, k. k. (2008). managing nursing student incivility in the classroom, clinical setting, and on-line. journal of nursing law, 12(2), 68-77. doi:http://dx.doi.org/10.1891/1073-7472.12.2.68 author note address correspondence to: elizabeth a. wahler, assistant professor in the indiana university school of social work, 902 w. new york street, es 4158, indianapolis, in 46202 or bwahler@iupui.edu http://www.socialworkers.org.pubs/code/code.asp http://dx.doi.org/10.5688/aj700488 http://dx.doi.org/10.19030/ajbe.v3i5.422 http://dx.doi.org/10.1891/1073-7472.12.2.68 mailto:bwahler@iupui.edu microsoft word editorial vol 12_2 _________________ william h. barton, ph.d., is a professor in the indiana university school of social work on the indiana university-purdue university indianapolis campus. contact information: (317) 274-6711; email: wbarton@iupui.edu copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), i-iii editorial william h. barton welcome to the fall 2011 issue of advances in social work (volume 12, no. 2). once again, we have had the good fortune to receive many high-quality manuscripts, and reviewers and authors alike have responded quickly and capably to their respective reviewing and revising tasks. as a result, this issue contains 16 articles on a range of topics. in addition, this issue begins with a special recognition, written by rob schneider, of the centennial of the indiana university school of social work, the oldest social work education program affiliated with a university, and the sponsor of this journal! on the advances horizon for 2012 will be two special issues. some delays in processing manuscripts have moved the “military social work” special issue, co-edited by james g. daley and anthony hassan to sometime in early 2012. in the spring of 2012, we will be publishing yet another special issue, “global problems: local solutions,” highlighting the latest work on cross-border, cross-disciplinary, and crossboundary practices that seek solutions at the local level to problems caused by global conditions. khadija khaja and joe varga are co-editors, and we’ve had a good response to the call for papers for that issue. our next “regular” issue will be the fall 2012 issue. the first regular article in the current issue, “strengths-based practice and motivational interviewing,” should be of particular interest to practitioners. in it, trevor manthey and colleagues systematically examine the fit between motivational interviewing and strengths-based practice. the article includes a detailed case example that makes the abstract comparison come to life. next, in “outpatient commitment on the ground: listening to consumers and providers,” christopher gjesfjeld and michaela kennedy present a qualitative study of the perspectives of consumers and providers about outpatient commitment, that is, court-ordered mental health treatment. although they found that consumers perceived that outpatient commitment led to improvements in their lives, they also identified themes of ambiguity of personal control among consumers, and inconsistencies among both consumers and providers regarding what outpatient commitment specifically required. two articles by darrel montero in this issue use gallup poll and other national survey data to investigate changes in public attitudes about controversial social issues. the first, “end-of-life issues in the united states after terri schiavo: implications for social work practice,” looks at attitudes towards end-of-life issues in the years following the highly publicized case of terry schiavo. the second, “survivorship and inheritance rights for same-gender couples: relevance to social workers,” appearing as this issue’s next-to-last entry and co-authored by montero with several former msw students, analyzes changes over time in attitudes related to same-sex marriage and other civil rights of homosexuals. both articles provide evidence that increasingly larger percentages of the public favor the extension of greater rights. advances in social work, fall 2011, 12(2) ii two articles explore parent-child issues in the context of specific ethnic families. kimberly stauss and colleagues, in “parent-child communication related to sexual health: the contextual experiences of rural latino parents and youth,” explore perceptions of first-generation, immigrant rural latino parents and youth regarding parent-child communication related to sexual health. results suggest that parents provided gender-specific messages about sex to their children, mothers discussed birth control facts in greater frequency, and youth, especially boys, expressed the need to have more conversations about sex with their parents. next, in “understanding fathering among urban native american men,” jeffrey shears and colleagues use qualitative data from the national early head start research and evaluation project to examine the perceptions of native american fathers about their role as fathers. the fathers indicated that it is important to them to be “present” in addition to “being there” in the lives of their children, to pass on the language and cultural traditions to their children. they also perceived fathering as a protective factor for themselves, helping them reduce their participation in at-risk behaviors. in “paying project participants: dilemmas in research with poor, marginalized populations,” lara descartes and colleagues offer lessons learned about issues that can arise in research with marginalized populations. in a study of gay men’s perceptions of prostate health and prostate cancer, they attempted to recruit focus group participants using monetary incentives. they encountered unanticipated problems in specifically recruiting low-income participants, and reflect upon how such situations might be avoided or better handled in future research. the next five articles in this issue should be of particular interest to social work educators. emily l. mccave and carrie w. rishel, in “prevention as an explicit part of the social work profession: a systematic investigation,” argue that, despite social work’s endorsement of prevention-focused practice, little attention to prevention can be found in a systematic search of the social work literature, nasw policy positions, or the new epas curricular competencies and practice behaviors. in “lawyers are counselors, too: social workers can train lawyers to more effectively counsel clients,” stephanie boys and colleagues advocate and provide examples of transdisciplinary education in which social work educators teach classes in law schools. angela r. ausbrooks and colleagues next provide results from an exploratory study of faculty and student perceptions of classroom incivility in a social work program in an article entitled, “now you see it, now you don’t: faculty and student perceptions of classroom incivility in a social work program.” they report that faculty noticed classroom incivility less than did students, while students felt that faculty were not doing enough to address incivility. bruce dalton and colleagues, in “‘how do you do it?’: msw field director survey,” report great variation in respondents’ reports of field requirements, field credits, and field liaison faculty status. while recognizing the potential problems of having overly standardized requirements, the authors recommend pursuing some level of basic equity of student field experience between programs. in the final article in this group, “towards a research agenda for social work practice in virtual worlds,” scott anstadt and colleagues discuss the potential merits and challenges of using second life, an online 3d barton/editorial iii virtual world, in social work practice and education. their review of existing research reveals a number of questions that remain for researchers to answer. and now for something completely different. “the dialectic method: a critical and postmodern alternative to the scientific method,” by phillip dybicz and loretta pyles, ventures into the philosophical territory of hans-georg gadamer. the article discusses how gadamer’s dialectic method can be applied to social work inquiry and practice concerns, as an alternative to the traditional scientific method. the authors identify the dialectic method’s strengths in uncovering socially constructed truths and emphasizing empowerment. the next two articles return to social work education issues. in “using internet-based videos as pedagogical tools in the social work policy classroom,” sarabeth leukefeld describes how to select and use contemporary internet videos to engage students in policy courses. then, in “exploring empathy embedded in ethics curricula: a classroom inquiry,” susan gair presents exploratory, qualitative research regarding the use of case vignettes to teach empathy in social work. she concludes that an introduction to empathy in social work classes may be insufficient if students do not advance beyond a superficial understanding of empathy to deeper listening and empathic capacity. the final article in this issue, “social workers’ role in the disproportionality of african american students in special education,” kristen faye bean addresses a timely social justice issue. she employs patricia collins’ domains-of-power framework to identify ways school social workers can practice transformational resistance to reduce the overrepresentation of african american students in special education. so, something to do over the long holiday break, perhaps curled up by the fire (if you are in the northern hemisphere) or on the beach (if you are in the southern hemisphere)! of course, you may also use some of whatever time off you may have to work on those next manuscripts you intend to submit to advances – i look forward to receiving them. cheers! _____________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2015 advances in social work vol. 16 no.2 (fall 2015), i-iv, doi: 10.18060/21011 editorial margaret e. adamek as we launch this issue of advances in social work with a relatively new editorial staff, it is with growing appreciation and respect for the tremendous work that goes into producing a quality social work journal. as i became immersed in the process of assigning manuscripts to reviewers, sending reviews to authors, reviewing revised manuscripts, and making publication decisions, i gained insight into both the huge job it is to be an editor as well as to the special privilege it is to have a hand in nurturing the communication of scholarly knowledge and facilitating its dissemination. i would also like to offer a heartfelt thanks to dr. bill barton for his years of service as the editor of advances in social work. he did a tremendous job single-handedly and has continued to offer support behind the scenes. his steadfast commitment to excellence continues to guide and inspire us. the fifteen papers in this issue present innovations in the areas of teaching (5), practice (4), policy (2), programming (3), and publishing (1). our hope is that you find the articles in this issue to be transformative as well as informative, relevant, and important to the social work enterprise. teaching innovations: keefe, brownstein-evans, lane, carter, and polmanteer highlight the opportunity for social work educators to capitalize on provisions of the affordable care act regarding postpartum depression to prepare social work students to proactively and effectively address the needs of new mothers, one-fourth of whom struggle with postpartum depression, too often without the help they need. zubaroglu and popescu propose an alternative teaching model for international interdisciplinary education grounded in globalization theory, intersectionality, the capabilities approach, and experiential learning theory. they argue that an interdisciplinary approach to international development work is needed for social workers to address increasingly complex global social issues. drawing on bandura’s self-efficacy theory, they assessed the impact of an immersion course in peru on their students’ selfrated self-efficacy. also applying bandura’s theory, deck, platt, and mccord examined the selfefficacy of 88 students who took an msw research course that included a service learning component. their analysis indicated that incorporating service learning into a research course enhances students’ self-efficacy in relation to carrying out research tasks, which hopefully increases their likelihood of integrating evaluation into their future practice. mccleod describes an innovative approach to teaching msw students about clinical decision-making that interweaves verbal, visual, and spatial processing activities. the multimodal learning approach included journaling about client interactions and selecting advances in social work, fall 2015, 16(2) ii a work of art during a museum tour that represented the themes that students identified in their journals. mccleod asserts that a multimodal approach is a useful and creative way to engage students and to enhance their sensitivity to client perspectives. expanding the view of learning as a lifelong endeavor, jivanjee, pendell, nissen, and goodluck share the perspectives of bsw and msw students, social work practitioners, and field instructors about their motivations and benefits of pursuing lifelong learning as well as the factors that hinder such opportunities. social work faculty members and field instructors are called upon to model lifelong learning to social work students. practice innovations: based on a survey of 192 school social workers in illinois, avant and lindsey examine the emerging leadership roles of school social workers as they coordinate efforts to implement response to intervention (rti) multi-tiered systems of support (mtss). rti/mtss requires substantive and multifaceted system changes which may not be easily accepted by schools. their respondents revealed not only the challenges of implementing systems changes, but the opportunity for school social workers to become change leaders and to more closely align social and emotional interventions with students’ academic achievement. in an effort to support a healthier sustainable social work workforce, bloomquist, wood, freidmeyer-trainor, and kim conducted a national survey of msw practitioners to examine the impact of self-care practices and perceptions on their professional quality of life. various dimensions of self-care were analyzed in relation to different components of professional quality of life. despite valuing self-care in principle, few practitioners engaged in self-care practices on a regular basis. bloomquist and colleagues call for social workers to embrace self-care practices as a necessary tool to enhance professional quality of life. in light of the high rates of depression and suicide among military personnel, hendricks thomas and taylor propose a prevention approach involving mindfulness training that takes into account both the warrior culture among service personnel and the significance of peer interactions. hendricks thomas and taylor suggest that mental health problems can be minimized by offering mindfulness-based programming to military personnel in a pre-deployment training environment rather than waiting for mental distress to develop into serious mental health challenges post-deployment. such an approach may also overcome the resistance to traditional interventions that require service personnel to acknowledge their mental health problems and to initiate treatment. recognizing the success of the strengths-based approach to working with individuals with serious mental illness, hu, leung, ng, yu, lau, and cheung evaluated an intervention program that applied the strengths-based model with 45 individuals in hong kong. using skype, 23 social workers in hong kong received over 30 hours of training in strengths-based case management (scm) and supervision from experienced scm practitioners from the university of kansas. based on preand post-test ratings, some participants progressed from stages of being overwhelmed or struggling with disability to adamek/editorial iii stages of living with or beyond disability. strengths-based practice helped participants develop a transformed self which sees hope and possibility despite the vulnerabilities caused by their illness. policy innovations: an, yoo, and nackerud take a unique approach to policy analysis, applying the concepts and principles of game theory to analyze the use of good cause waivers by tanf workers. good cause waivers are meant to assist tanf recipients who are victims of domestic violence by waiving some of the mandates for continuing benefits. the analysis illuminates the challenges with implementing universal screening of tanf recipients for domestic violence, and provides a model for analysis of other social welfare policies. pitzer and streeter propose the use of a conceptual tool based on the community capitals framework. the tool involves identifying assets in a particular community, mapping them out in diagram form, and determining how those assets can be leveraged to resolve community problems or to bring about community change. pitzer and streeter illustrate the mapping community capitals approach using two case examples—one involving work with a non-profit organization providing services to refugee populations and an international example involving community development in rural india. programmatic innovations: as universities put more emphasis on civic engagement, more social justice-oriented majors and minors, often apart from social work, are being offered. richards-schuster, ruffolo, nicoll, distelrath, mishkin, and gulura investigated the experiences of 92 new graduates of a social justice minor offered by a school of social work to better understand their transitions into social justice work. they describe the graduates’ perspectives of the various challenges they face doing social justice work in the “real world,” with implications for schools of social work and other program developers as well as for non-profit organizations that employ such graduates. acknowledging that “fit to the profession” and academic preparation are often difficult to judge in the admissions process, vliek, fogarty, and wertkin examined the relationship between the criteria used in an admissions model of a medium-sized msw program and student success in the program. based on a sample of 522 accepted applicants over four academic years, vliek and her colleagues found that undergraduate gpa was a strong predictor of success in the msw program but the various fit to the profession criteria were not reliable predictors. the authors endorse the adoption of evidence-based admissions models that minimize arbitrary decision-making and uphold the principles of the profession. in recognition of the evolving changes in the health care system, ziperstein, ruth, clement, marshall, wachman, and valasquez surveyed 41 administrators of msw/mph programs with the goal of better understanding the nature of dual-degree programs and their graduates. interest in msw/mph programs is high and new programs advances in social work, fall 2015, 16(2) iv are under development. findings suggest that graduates seem to be wellprepared for leadership and interdisciplinary practice in the new healthcare environment. publishing innovations: woehle conducted an intricate social network analysis to examine social work author networks and their connection to citations of published social work articles. his study illuminates the outcomes of aligning with co-authors to produce scholarly work. drawing from complexity theory and similar analyses in other disciplines, woehle demonstrates the potential value of co-author networks in contributing to the social work knowledge base. with this issue, advances in social work, is taking a new step by adding dois to each article and to the references of each article for which dois are available. the addition of dois was made possible with the able assistance of ted polley of the indiana university library. thanks, ted! production of the spring 2016 issue is underway with the guidance of special issue editor, dr. andrew quinn of the university of north dakota and will present a cadre of papers originally presented at the first annual social work distance education conference held in indianapolis in april 2015. we expect the special issue to be launched before the second annual social work distance education conference to be held in april 2016. microsoft word editorial global problems copyedit2 _______ khadija khaja, ph.d., is an associate professor at the indiana university school of social work, indianapolis. joseph varga, ph.d., is an assistant professor in the indiana university labor studies program on the bloomington campus. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), i-iv editorial: global problems, local solutions: what works, what does not, what can we do? khadija khaja joseph varga special issue co-editors the inspiration for this special issue came at a faculty retreat held on a glorious late summer day on a bucolic campus. in such a setting, what else would social work and labor studies faculty think about but intractable problems and impossible solutions! we had been thinking of ways that our two disciplines, social work and labor studies, converge, and the obvious answer was that both were oriented towards problem-solving, as were other disciplines in the social sciences. but what were the problems we were trying to solve? where did they originate and where were the solutions come from? two things seemed obvious, intuitive, and in need of specific attention of the type provided by a journal issue. first, many of the problems faced by the populations both disciplines serve were, if not new, then at least historically located in the emergent global order. and second, most solutions were being worked out at the local level, through some combination or coalition of actors attempting to fashion problem-solving institutions and methods that empowered at-risk populations. thus was born the global problems and local solutions issue of advances in social work. what was out there that could be shared amongst practitioners to bring best practices to problems at different local levels? our hope was to bring in different approaches that could be applied across regions and disciplines in order to see what works, who was doing what, and if there were truly regional applications to problem solving that, with some adjustments, could be generally applicable at the local level given the ongoing processes of global emergence. we recognized that such a single journal issue could never be comprehensive, and that our target of potential contributors would necessarily be limited by disciplinary and professional boundaries. yet in looking at the state of the game in local problem solving and empowerment, our 15 essays provide a valuable window into both the successes and ongoing difficulties of providing paths of resistance, preparedness, and pro-active power to vulnerable, at-risk communities. of course, empowerment must be more than just a buzzword when it comes to fashioning local solutions, and our collection of articles highlights the difficulties of using top-down power to promote bottom-up action. as contributor bret weber reminds us, the nasw code of ethics charges us to “enhance human well-being…with particular attention to the needs and empowerment of people who are vulnerable.” so what our articles, and our experience shows, is that there are many paths to empowerment, and those paths are often blocked in various ways. in casting our net wide, we drew in reports from a wide-ranging field of experience, and in this, we consider our efforts a success. indeed, the problems for vulnerable populations are not confined to a single area, or a limited set of circumstances. global processes, while bringing the world’s people khaja, varga/editorial ii together in many ways, cause a myriad of seemingly unending and intractable problems. given those conditions, we were certainly pleased with the vast array of problems, solutions, methods, and approaches in the submitted articles. however, that very wide net and vast array of responses presents another challenge: organizing some sort of cohesive, readable summary. in an effort to bring some order from a diverse group of articles, we indentify three main paths to local solutions on offer in the case studies: government policy, legislation and state institutions; nongovernmental organizations (ngos); and grassroots and community-based organizations. of course, as experience and our articles show, efforts to solve problems at the local level are rarely attempted or achieved in homologous paths involving just one right way. solutions are crafted in a global system; they require cooperation across boundaries, across disciplines, and through different levels of authority, organization, institutions, and networks. when they work, it is through these interactions, just as when they fail, it is usually within these interactions that efforts break down. along those lines, our essays are organized into three sections, based on what level of problem solving they engage. the categories, of course, will not be perfect, and often overlap, but each essay provides insight into state-centered, ngo, or community-based solutions in some measure and in some combination. in looking at state-centered action, policy, legislation and institutions all received attention. bromfield and capous-desyllas’ work on the problems of human trafficking offers valuable information on how legislation is crafted through the formation of somewhat unlikely and often uncomfortable alliances. here we see how views of what constitutes human trafficking, and indeed, what counts as empowerment, are neither simple nor subject to general agreement. thus while the major players agree on the nature and scope of the problem, they vigorously clash over what defines the at-risk community. the result is legislation that, while helpful, stops short of being a real local solution. likewise, marquita walker’s work on displaced workers highlights the problems of crafting a policy solution that satisfies the vulnerable population while actually addressing the problem. few issues appear more intractable than the problem of displaced workers in the new, flexible global economy. walker shows that there are no easy answers, and points to ways that more local control might improve retraining programs. on a more hopeful note, jones, rotabi, levy, and gray, in their study of teaching innovations, point to ways that state-sponsored institutions can draw on local knowledge and experience to craft education programs that work to truly empower populations at risk from natural disaster. their work demonstrates the power and knowledge that state institutions with proper support can direct and bring to bear on the thorniest and most immediate of global problems, those caused by ecological catastrophe. on the problems in the developing and vital field of gendered immigration, agbényiga and huang suggest ways that both state-centered institutions of higher learning in social work and ngos can learn from a close study of women’s immigration experiences. they point to the need for social work curricula to include a sub-category on gendered immigration in order to understand the diverse issues facing immigrant women at the local level. advances in social work, summer 2012, 13(2) iii states will almost always have a role to play in crafting solutions, but often that role will be in concert with ngos, which often take on the most active roles when local problems arise. as well, ngos often are the go-between when coordination is necessary between state resources and community-based organizations. agbényiga, barrie, djelaj, and nawyn’s article shows how refugee agencies play a key role in the re-settlement of the recently displaced within state systems. this is best accomplished, they found, by forging deeper ties between refugees, agencies that serve them, and local ethnic organizations to fashion a truly local set of solutions to one of the most severe global issues. simmelink and shannon’s work on community-based aid for refugee communities highlights some major advantages and constraints in local problem solving. their work indicates that while ethnic based refugee organizations can be more helpful for certain issues, mainstream refugee aid groups often are better equipped to assess the mental health issues that affect this troubled population. des marais, bhadra, and dyer’s work on how japan responded to disaster is a vital intervention into the local/state/ngo debate. their work demonstrates how local and regional relief work can be enhanced by limited, targeted actions deeply based in local preparedness, infrastructure, and culture. their case study serves another function by making an unimaginable event such as the tsunami/nuclear disaster legible and knowable. similarly, saleh ahmed brings the popular concept of microfinance into focus by examining the actual workings of ngos. his article dispels the myth that microfinance is a cure-all, while pointing to the importance of ngo work and large-scale goals such as the un millennium development goals. on the topic of fair trade certification, charity fitzgerald’s article discusses the difficulties in establishing true fair trade systems through ngos that provide information to local retailers linked to community-based efforts at supporting local agriculture and industry. her conclusions on this important topic deal frankly with the contradictions and problems of free trade and encourage social work researchers to take a lead role in providing information to producers, retailers, and certifiers. many hail the grassroots and community-based organization as just such a cure-all, but of course, practitioners and academics know better, and several of our articles pointed to the difficulties of problem solving at any level, including the grassroots. bret weber’s exciting piece points to the urgency of ecological action, while also highlighting the perils of cooperative efforts as they make their way up the power ladder. what begins as a grassroots community-based effort at sustainable economics runs into the problem of the growth-based economy at the larger level. similarly, david k. androff’s insightful work on the problems of utilizing truth and reconciliation commissions within a north american setting also points to the problems a grassroots group encounters as it confronts power. hamilton and erickson’s article on urban heat islands urges social work professionals to become fully engaged in the issue of global climate change by pointing out the deleterious effects of the crisis on urban populations. they call on social workers to strengthen community efforts to form a sustainable ecological system and push state agencies into stronger action. constantino, rotabi, and rodman’s work on gendered violence also revolves around the struggle between community and grassroots-based action and power structures, as local solutions encounter the entrenched power of gender violence. luca sugawara, hermosa, delale, hoffman, and lupšić’s article looks at how khaja, varga/editorial iv very local solutions deriving from community-based support for family involvement in children’s education in post-war conditions, while no cure-all either, help to enhance the development of democracy and renewal in truly empowering ways. and finally, ankita deka makes a potentially important intervention in critical social work practice by showing how a human rights-based approach to systemic poverty can aid practitioners in engaging with community groups working to address the root causes of endemic economic and social inequity. what each study shows is that no solution, local, regional, state-centered, or grassroots, fits every aspect of our global problems, and not even the most empowering bottom up effort will satisfy everyone involved. the collection of articles for this special issue double as a field report on the both the state of at-risk populations under emerging global conditions and a best practices update on how local organizations and institutions are trying to meet the challenges. there is so much more out there, mainly because for each global connection, there emerges a local problem. our task as educators, researchers and citizens is empowering populations to craft their own solutions, utilizing every tool available. if these collected articles contribute to that effort, and we believe they do, the effort is worthwhile. author note: address correspondence to khadija khaja, ph.d., indiana university school of social work, 902 w. new york st., indianapolis, in 46202. e-mail: kkhaja@iupui.edu ______________________ patricia l. desrosiers, phd, lcsw is an associate professor, department of social work, college of health and human services, western kentucky university, bowling green, ky 42101-1039. gayle mallinger, phd, is an assistant professor, department of social work, college of health and human services, western kentucky university, bowling green, ky 42101-1039. tonya bragg-underwood, dnp, aprn-fnp, cne is an associate professor, school of nursing, college of health and human services, western kentucky university, bowling green, ky 42101-1039. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 187-202, doi: 10.18060/18609 promoting socially just healthcare systems: social work’s contribution to patient navigation patricia louise desrosiers gayle mallinger tonya bragg-underwood abstract: patient navigation is an emerging area of healthcare practice that uses an interdisciplinary and integrated care model designed to reduce health disparities and improve health outcomes. the authors define patient navigation, delineate the alignment of social work competencies with patient navigator requirements, and argue for a clear social work role and presence as patient navigators in interdisciplinary healthcare delivery. social workers are well-equipped to carry out a variety of patient navigator responsibilities due to their unique skill of social justice advocacy as a macro-level intervention. through involvement in patient navigation, social work leaders can promote the development of socially just healthcare systems that respect the dignity and worth of all patients. keywords: patient navigation; health disparities; social work roles; interdisciplinary teams patient navigation is an emerging area of healthcare practice designed to assist patients in negotiating complicated healthcare systems. this patient-centered approach promotes improved health outcomes and diminished health disparities. specifically, patient navigators (pns) assist medically needy individuals to overcome barriers to treatment. thus, navigators are charged with coordinating services, organizing transportation, and arranging for translation and financial support. in addition, the navigator provides emotional support and patient education. complex patients, including those with multiple diagnoses, diverse cultural backgrounds, or special needs, such as hearing or vision impairments, are often inundated with a variety of helpers. navigators aim to reduce confusion and frustration for patients. consider the fictitious case of sally, a 70-year-old african american female with high blood pressure who is not having success following her doctor’s orders. she first saw dr. a for a regular checkup which she had avoided for several years. due to sally’s high blood pressure reading, dr. a immediately placed her on a blood pressure medication with little discussion about eating right and exercising. when sally went to fill the prescription, her medicare did not cover it. sally is on a fixed income and could not afford the medication. she did not know who to ask for help. she thought dr. a would be upset if she did not get the medicine. within 45 days of her checkup, sally was rushed to the emergency room (er) after passing out at a family event. this time sally was assigned a patient navigator, carol, who had a first visit with sally while she was in the er. carol immediately identified the need for a less expensive, insurance-covered medication and encouraged sally to discuss this option with the doctor. sally left the hospital with handouts on coping with desrosiers et al./patient navigation 188 high blood pressure, an appropriate prescription, and carol’s phone number. they had a follow-up appointment two days later at sally’s house. carol checked on the medication regime, started identifying social supports, and began encouraging healthy eating and exercise goals in collaboration with sally. sally has had no additional high blood pressure concerns and has kept all healthcare appointments for the past 60 days. sally’s case study highlights the importance of patient navigation in improving health outcomes and reducing health disparities; however, there is more than just anecdotal evidence. since physician harold freeman developed the first navigation program in the early 1990s, patient navigation has undergone empirical validation (freeman, 2012). patient navigation intervention has been shown to improve health outcomes in patients with chronic health conditions ranging from cancer (ely et al., 2014; jean-pierre et al., 2012) to hiv/aids (sullivan et al., 2015) to diabetes (esparat et al., 2012). clients residing in both urban (nonzee et al., 2012) and rural settings (ely et al., 2014; hook, ware, siler & packer, 2012; inrig, tiro, melhado, argenbright, & craddock lee, 2014) have benefitted from patient navigation. although the genesis of patient navigation revolved around eliminating barriers to treatment for marginalized populations, recent research has demonstrated other benefits as well. elkin, shapiro, snow, zauber, and krauskopf (2012) found patient navigation reduces healthcare costs. increased patient satisfaction and improvements in quality of care have also been reported (gawande, 2011; percac-lima, ashburner, bond, oo, & atlas, 2013). in addition, sullivan and colleagues (2015) found patient navigation services led to diminished health disparities among vulnerable populations. these positive outcomes have increased the demand for patient navigation; however, there are not enough skilled workers to meet this demand (nix, huber, shapiro, & pfiefle, 2016). social workers already provide effective services in healthcare settings. in fact, there were 146,200 healthcare social workers in the u.s. in 2012 with a projected growth of 37% by 2022 (u.s. bureau of labor statistics, 2015), making this the third largest area of social work practice. offering additional training to professionals with overlapping competencies is one potential strategy to increase the number of patient navigators in healthcare settings. with the addition of approximately 12-18 credit hours (the amount in a typical certificate program), social workers can master medical information (including healthcare terminology), electronic medical records, and interdisciplinary team skills. this will prepare them for patient navigation positions in a rapidly changing healthcare industry. social workers are ethically mandated to realize the value of social justice (national association of social workers [nasw], 2008). providing leadership, research, and practical services in healthcare settings is one way to realize this value. the purpose of this conceptual paper is twofold: a) to provide information and guidance for healthcare social workers practicing in medical settings either as patient navigators or alongside them, and b) to encourage the profession to strive towards the social justice mandate through increased leadership, research, and practice in healthcare settings in relation to patient navigation with the goal of improving healthcare outcomes and reducing health disparities. advances in social work, fall 2016, 17(2) 189 convergence of social work and patient navigation best practices in a 2010 position statement on patient navigation, the oncology nursing society, the association of oncology social work, and the national association of social workers together outlined best practices for social work and nursing professionals involved with patient navigation. these groups asserted that both nursing and social work skills could be enhanced through additional training in patient navigation processes including “conduct[ing] community assessments and the identification and crafting of interventions to resolve systems barriers that interfere with timely access to needed care and services” (oncology nursing society (ons), association of oncology social work (aosw), & national association of social workers (nasw), 2010, p. 251). they concluded that social workers, nurses, and non-clinically licensed navigators function together in interdisciplinary teams to produce the best patient outcomes (ons et al., 2010). this position statement suggests that social work is a primary force impacting healthcare systems for the benefit of patients in the current environment, and as such, must continue to take leadership in improving patient care and outcomes. hospitals are struggling to deal with affordable care act provisions requiring accountability for patient outcomes, leading to the employment of more patient navigators (thoms & moore, 2012). with a projected growth of the healthcare social work workforce of 27% between 2012 and 2022, social workers in health settings (including pns) will be in high demand. as liechty (2011) points out, social workers have over 100 years of experience in healthcare delivery systems. with such expertise, the mission of the social work profession is congruent with that of patient navigation. considering social work’s values of cultural competency and respect for diversity, social workers are not only ethically obligated to uphold these values, they are also trained to do so during multiple activities throughout their educational process (cswe, 2015). patient navigation and council of social work education competencies prior to the passage and implementation of the patient protection and affordable care act of 2010 (aca, 2010), patient navigation was supported on the federal level. in an effort to improve health outcomes for patients with chronic diseases, including cancer, diabetes, and cardiovascular issues, president bush signed into law the patient navigator outreach and chronic disease prevention act of 2005 (pub. l. 109-18). this law requires patient navigators to facilitate involvement of community organizations to enhance access and decrease barriers to quality healthcare, as well as to provide outreach to vulnerable groups (pub. l. 109-118). the aca makes a single reference to patient navigation in title iii (improving the quality and efficiency of healthcare), section 3510. funding requirements state that core competencies of patient navigators must be defined by the requesting entity. criteria are more clearly explained in the training standards for navigators and non-navigator assistance personnel carrying out consumer assistance functions under §§ 155.205(d) and (e) and 155.210. among other mandated standards, patient navigation training programs must provide trainees with expertise in meeting the needs of marginalized populations. desrosiers et al./patient navigation 190 additionally, section 1945(h)(7) of the act defines the “health team” as an interdisciplinary, inter-professional team that requires a variety of healthcare providers, including social workers, to participate in team decision-making. having social workers with healthcare knowledge on community health teams is expected to enhance the health team functioning; therefore, the social work profession should prioritize healthcare education and training initiatives. pratt-chapman, willis and masselink (2014) outline eight domains that in the aggregate comprise competent patient navigation practice. these areas include patient care, knowledge for practice, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice, inter-professional collaboration, and personal and professional development. contained within each domain are specific skills that demonstrate the competency. for example, employing active listening, remaining solution-focused with client and action systems, and communicating effectively to build trusting relationships across various cultural and socioeconomic backgrounds are considered key elements of interpersonal and communication skills. similarly, the ability to sensitively respond to patients of all diversities, including race, religion, and sexual orientation, is part of professional patient navigation. the personal and professional development competence includes identification and effective management of personal and professional conflicts. through specialized education and training, social workers are well-equipped to carry out the specified patient navigator duties including public education, information and referral services, and coordination of care (andrews, darnell, mcbride, & gehlert, 2013). parker and colleagues (2010) categorized tasks of navigators and the social networks with whom they interact. the tasks include navigating patients through a confusing health care system, facilitating patient care, maintaining culturally and linguistically accessible systems of care that reach uninsured and underinsured populations, and carefully documenting these tasks. patient navigators coordinate services between and among the medical patient and clinical providers, non-clinical staff, supports, and medical records systems. the knowledge, values, and skills needed to be a competent patient navigator mirror those necessary for competent professional social work. social workers are adept at efficiently managing these tasks and successfully negotiating these systems. schools of social work are charged with preparing students to deliver competent services to diverse populations (cswe, 2015). the values of self-determination, empowerment, and collaboration with client systems are central to the profession of social work (scheyett & diehl, 2004). social work accreditation standards promote competency-based education (cswe, 2015). upon graduation, social work students are expected to effectively demonstrate a number of practice behaviors related to each competency. for example, accredited schools of social work ensure that students successfully demonstrate an understanding of how diversity and structural exclusions influence experiences of marginalized populations. students are also expected to recognize how their personal values may be in conflict with professional social work values and demonstrate use of self-reflection to manage personal values and uphold professional values and ethics. further, social work students are required advances in social work, fall 2016, 17(2) 191 to be skilled in collaboration and advocacy to best serve diverse client systems. all of these competencies are important to patient navigation positions as well. table 1 displays the social work competencies (cswe, 2015) side-by-side with professional or non-clinically licensed patient navigator competencies (patient centered education & research institute [pceri], 2015). it is notable that each of the five core competencies for patient navigators corresponds to at least one social work competency. this further demonstrates the close relationship between social work competencies and pn competencies. table 1. comparison of social work competencies and patient navigation competencies definition of patient navigation the definition of patient navigation is not firmly established. the needs of health and behavioral health organizations vary. the definitions of patient navigation at various institutions reflect the particular needs of the organization. some definitions are task focused, while others focus on goals such as reducing barriers to care (thoms & moore, 2012). thus, there is no universally accepted definition of patient navigation (gunn, clark, competencies social work (cswe, 2015) professional patient navigator (pceri, 2015) comp. 1: demonstrate ethical and professional behavior core i: professional knowledge comp. 2: engage diversity and difference in practice core ii: patient services comp. 3: advance human rights and social, economic, and environmental justice core v: system-based practice comp. 4: engage in practice-informed research and research-informed practice core iii: evidence-based delivery comp. 5: engage in policy practice core v: system-based practice comp. 6: engage with individuals, families, groups, organizations, and communities core ii: patient services core iv: interpersonal communication and collaboration skills core v: system-based practice comp. 7. assess individuals, families, groups, organizations, and communities core ii: patient services core iv: interpersonal communication and collaboration skills core v: system-based practice comp. 8: intervene with individuals, families, groups, organizations, and communities core ii: patient services core iv: interpersonal communication and collaboration skills core v: system-based practice comp. 9: evaluate practice with individuals, families, groups, organizations, and communities core ii: patient services core iv: interpersonal communication and collaboration skills core v: system-based practice desrosiers et al./patient navigation 192 battaglia, freund, & parker, 2014). consequently, there are multiple definitions of patient navigation in use across the united states. gunn and colleagues (2014) indicate how differences in program level principles occur as a result of interactions between patient navigators and varying professional groups within each specific patient navigation program. as changes in the role of patient navigation occur, the professional roles within each program change. the different levels of patient navigation in healthcare settings (i.e., non-clinically licensed (pn), clinically licensed (cpn), or volunteer [vn]) alter the navigators’ role further. for example, if a cpn is present in the setting, this navigator may focus on advocating for change in system-level barriers and supervising and training pns and vns. at the same time, pns focus on overcoming individual-level barriers and assisting patients in problem-solving the day-today difficulties of following recommended treatments, identifying resources, and understanding medical terms and treatments. at the same time, vns may alleviate barriers to care through transporting patients to appointments, encouraging patients to attend appointments through reminder phone calls, and identifying strengths and support systems. multiple patient navigator levels require a coordinated patient navigation system. it is important to establish unique definitions for each patient navigation position in order to reduce confusion for patients and multidisciplinary team members. a clear scope of practice and defined levels of skill were missing in many of the programs reviewed by gunn et al. (2014). these authors provide a firm definition thereby preventing the usurping of the patient navigation role by other professional groups. until there is agreement on the role and scope of practice, patient navigation programs will continue to struggle with implementation of these unique roles. while not offering a specific definition, freeman (2012) recently established nine principles and standards of patient navigation that can be used as a starting point. freeman’s principles are summarized as the following: a) “patient navigation is a patient-centered health care service delivery model” focused on assisting patients to move in a timely way through the “complex health care continuum ” (p. 1616). b) patient navigation integrates a fragmented health care system for the individual patient. c) one patient navigation “core function…is the elimination of barriers to timely care” through a “one-on-one relationship between the navigator and the patient ” (p. 1616). d) clear scope of practice should be defined for pns, and pns should be integrated into the health care team. e) patient navigation services should be cost-effective, and the pn must have appropriate training and skill for the patient treatment phase. f) “…a spectrum of navigation...” ranging from trained lay navigators “to services that require navigators who are professionals, such as nurses and advances in social work, fall 2016, 17(2) 193 social workers” should be effectively utilized so that appropriate providers are assigned at appropriate times in the patient treatment process (p. 1616). g) each system of care should define the start and end of patient navigation. h) the process of patient navigation should operate across disconnected systems of care for the benefit of patients. i) patient navigation systems require coordination, and one coordinator should oversee all phases of navigation activity within the system. table 2 includes freeman’s (2012) principles that are the basis for the proposed definition for non-clinically licensed patient navigation. the proposed definition emphasizes that multiple skill levels of navigation are required at different points in the treatment process. table 2. aspects of non-clinically licensed patient navigation freeman’s principles (2012) prattchapman et al. (2014) pceri (2015) individual level aspects patient-centered care integration of a fragmented system of care elimination of barriers to timely care resource identification inter-professional collaboration knowledge of healthcare terms and treatments strong communication skills ethical knowledge professional presentation of self self-care knowledge helping patients follow preferred treatment protocols navigate across disconnected systems knowledge of pn role cultural sensitivity program level aspects defined level of skill defined beginning and end of navigation clear scope of practice/roles for all pn levels system improvement cost-effective coordinated patient navigation system the george washington cancer institute developed eight core competencies to be used in developing non-clinically licensed patient navigation positions (pratt-chapman et al., 2014). there is some overlap between these eight core competencies and freeman’s nine principles (freeman, 2012) including patient-centered care and interprofessional collaboration; however, these competencies are more specific and skills-based than freeman’s principles. competencies not mentioned by freeman (2012) or gunn et al. (2014) include knowledge of healthcare terms and treatments, strong communication skills, ethical and professional presentation of self, and self-care (pratt-chapman et al., 2014). desrosiers et al./patient navigation 194 the patient centered education and resource institute (pceri, 2015) has emerged with the goal of certifying patient navigators to make sure that they are able to demonstrate a basic skill level that will facilitate patient success. the institute lists one additional competency of “helping patients follow preferred treatment protocols” (pceri, para. 3) which would enhance the definition. considering these various competencies leads to the following definition: patient navigation: patient-centric interventions (undertaken by ethical professionals with strong communication and self-care skills plus knowledge of medical terminology and treatments) spanning professions and organizations that assist patients in removing barriers to accessing and utilizing care and in identifying resources that exist in a fragmented and disconnected healthcare system with the goal of successfully navigating and improving the continuum of care (freeman, 2012; gunn et al., 2014; pceri, 2015; pratt-chapman et al., 2014). this working definition is inclusive of the skills, knowledge, values, and behaviors currently used by practicing lay patient navigators and the bodies that seek to certify them. this definition provides a starting point to examine the intersection of patient navigation and social work competencies. see table 2 for the range of individual and program level aspects included in this definition. in the current u.s. healthcare context, both social workers and nurses are functioning in the role of patient navigator. this is typical because both professions possess most of the required skills for patient navigation. for example, while licensed bachelor-prepared nurses are knowledgeable regarding medical terminology and disease processes, licensed bachelor-prepared social workers do not leave social work programs with detailed knowledge of medical terms and disease processes. while licensed bsw-level social workers are skilled in community assessment as well as advocating for systems change and social justice, licensed bachelor-prepared nurses typically do not possess that knowledge. optimally, both professions are working together on an interdisciplinary team to enhance patient outcomes (ons et al., 2010); however, when that is not the case, and one or the other of these professionals serves in the role of a non-clinically licensed patient navigator, adherence to this definition of the non-clinically based patient navigator serves to differentiate the non-clinical patient navigator role from that of a clinically licensed social worker or a licensed nurse practitioner. patient navigation: cpn versus pn from a social work perspective, a clinically licensed patient navigator (cpn) possesses a clinical social work skill set in addition to the case management skill set of a nonclinically licensed patient navigator (pn). for example, a clinically licensed social work patient navigator (with an msw and a clinical license) may function as a therapist in addition to functioning as a patient navigator. when that is the case, both roles must be clearly defined in order to provide the most cost-efficient, coordinated system of care. if the majority of a cpn’s work tasks could be completed by a pn, it would make financial sense to hire a pn instead. if half of a cpn’s work tasks are related to a clinical role and supervision, then it would be financially prudent to continue a dual position. a social http://patient-institute.org/education.html advances in social work, fall 2016, 17(2) 195 worker with a non-clinical license can function as a non-clinically licensed social worker/patient navigator (pn). models of patient navigation several models of patient navigation have been explored in the literature. based on strong alignment with the social work perspective, we describe two models—the freeman model and the transformation for health framework (esparat et al., 2012). these models serve to highlight the fit between social work and patient navigation. freeman’s model freeman pioneered the concept of patient navigation in 1990 to use the “critical window of opportunity… between an abnormal finding to the point of resolution of the finding by diagnosis and treatment” (freeman patient navigation institute, 2015, para 1). this concept has since been expanded to include patient navigation across the healthcare continuum from prevention to end-of-life palliative care. freeman’s model relies on nine principles that focus on removing barriers to medical care. these frequently include financial, communication, medical system, and psychological barriers in addition to barriers such as lack of transportation and child care. barriers are overcome through oneon-one guidance and assistance to individuals as they move through the continuum of healthcare. pns bridge the divides in a disconnected healthcare system where patients sometimes get lost (freeman, 2012). in freeman’s face-to-face model, lay navigators (those with training and experience but no professional degree) and professional navigators, pns and cpns (nurses and social workers), assist patients according to their level of experience and training. this may lead to role confusion as various levels of navigators are working together. clarifying roles and maintaining dialogue among team members is necessary to avoid duplication of services and to ensure workers are providing services at their appropriate level of expertise. transformation for health framework as previously discussed, it is possible to divide patient navigation roles into pn and cpn groupings dependent upon contextual needs. esparat et al.’s (2012) intervention adds another level called a community health worker (chw). chws are associate-level nurses who are trained and supervised by a cpn. employing chws indigineous to the patient’s home community is key. chws provide training and support to patients struggling with chronic health conditions, including hypertension, diabetes, and asthma (esparat et al., 2012). in esparat et al’s (2012) tranformation for health framework, patients move through four phases whereby they are able to overcome oppressive conditions that may prevent them from gaining the full benefit of the healthcare system. in the first phase, cognition, critical consciousness is developed as patients comprehend the nature of their conditions and the ways in which their lives may be impacted. ideally, patients ultimately realize that they can control their health conditions. the chw facilitates this through interactions which balance unequal power relationships between healthcare providers and the desrosiers et al./patient navigation 196 healthcare receiver. in the second phase, intention, the individual’s motivational system is activated by the critical consciousness awakened in the previous phase. the individual makes the decision to change behaviors and elements of their lifestyle that affect the progression of the chronic disease. the third phase, decision, is where the individual actually makes changes in behavior that promote self-management of negative conditions. during the final phase, transformation, the patient is assisted with development of chronic disease management skills. the patient receives support in transforming into a person in charge of their own health status. esparat and colleagues found the use of this face-to-face model led to statistically significant changes in clinical biomarkers such as reduced blood pressure and hgba1c, as well as reducing hospital admissions for asthma. it is notable that esparat et al. (2012) recommended a pn/cpn position to provide supervision to chws, advocate for systems change, and complete program evaluations. if changes to the position or system were needed, the pn/cpn manage those tasks. esparat et al. (2012) recommends that a nurse be hired in this position; however, a social worker would also fit. in this particular setting, due to the use of associate-level nurses being used as chw/pns, it may reduce role tension to use a nurse pn; however, the use of a social worker in the supervisory position would provide an opportunity for an inter-disciplinary team as mandated by the aca of 2010 (aca; pub. l. 111-148). this is also consistent with recommendations from a patient navigation position statement jointly produced by the ons et al. (2010) in which navigation practiced by trained non-clinical or volunteer staff may occur under the supervision of a nurse or a social worker. these models are good examples of patient navigation, and both are consistent with social work values and ethics. patient outcomes with patient navigation patient navigation began with freeman’s foray into its usefulness for cancer patients (freeman, 2012). over the past twenty years, multiple studies have demonstrated the usefulness of pns and cpns as a best practice for encouraging cancer screening and treatment (braschi, sly, singh, villagra, & jandorf, 2014; ely et al., 2014; inrig et al., 2014; nonzee et al., 2012). however, the success of patient navigation across the united states has moved beyond solely cancer-related ailments. research demonstrates that pn services have successfully increased adherence to preferred treatment protocols among diverse patient populations (dignan et al., 2005; esperat et al., 2012; gawande, 2011). all of the previous research studies explored face-to-face patient navigation services with the exception of two: dignan et al. (2005) and loiselle et al. (2013). a virtual environment was the chosen environment for navigation in loiselle et al.’s (2013) study. a website with cancer information was provided for newly diagnosed cancer patients, and the patients reported via telephone that they appreciated the resource because they could limit the amount of information they received at one time and they could search for answers at times when phone calls to a provider were infeasible (i.e., late at night). dignan and colleagues (2005) compared face-to-face and telephonic navigation to increase mammogram screenings for urban native american women and found no difference in outcomes. advances in social work, fall 2016, 17(2) 197 in their study of telephonic patient navigation, dignan et al. (2005) determined that transient populations such as native american women would frequently not complete the intervention due to not having a working phone when on the reservation where they periodically resided. the digital divide is real with approximately 48.5% of households with incomes less that $25,000 per year (as opposed to between 69 94.9% for those households earning more than $25,000 per year) and only 61.3% of black and 58.2% of native american households (as opposed to 77.4% of white and 86.6% of asian households) having internet access at home (rainie, 2015). over a third (35%) of adults aged 65 or older do not use the internet (rainie, 2015). providing online services that clients cannot access or do not access cannot improve outcomes. thus, context is important when determining the patient navigation model for a particular area or population. the use of pns and cpns to support patients dealing with a multitude of chronic health conditions has proliferated in the past five to ten years as successes have been realized. women of color coping with hiv/aids in north carolina (sullivan et al., 2015), refugees in boston struggling with obtaining regular breast cancer screening (percac-lima et al., 2013), and patients of mexican heritage in texas struggling with hypertension, diabetes, and asthma (esperat et al., 2012) have all realized successful outcomes with the support of patient navigation services. discussion it may seem puzzling that healthcare systems developed a job title of “patient navigator” when the competencies necessary for this position are so closely aligned with that of “social worker.” healthcare social workers in particular have been providing effective services to patients in clinics, hospitals, and other medical settings for many years. with a workforce approaching 150,000, there is strong evidence for the presence of healthcare social workers. with a projected demand for an additional 39,200 healthcare social workers by the year 2022, there is a great need for well-trained social workers to work in healthcare settings (u.s. bureau of labor statistics, 2015). some may argue that the current shortage of healthcare social workers is partially responsible for the recent development of patient navigation positions and programs. despite some overlap, there are differences between social work competencies and those of a patient navigator ranging from knowledge to professional skills to ethics. darnell (2007) specifically discussed the social work value of promoting patient self-determination as a critical dimension “…that is largely absent from the public discussion about patient navigation…” (p. 83). knowledge differences include knowledge of healthcare terminology, specific disease and illness processes, and medical treatments (pceri, 2015). as any oncology social worker can attest, learning those terms happens with time; however, if they were taught prior to the social worker entering the healthcare setting, this would reduce training time. with education and experience, other professions will become more aware of the valuable contributions that social workers make to healthcare teams. skill differences include the competencies of advancing social justice, engaging diversity and difference, engaging in policy practice, and a systems perspective that requires simultaneous attention to micro, mezzo, and macro practice (cswe, 2015). davis, desrosiers et al./patient navigation 198 darby, likes, and bell (2009) report that oncology social workers are natural leaders with regard to decreasing health disparities due to their professional values, training, and skills. one specific social work competency requires demonstrating ethical and professional behavior by adhering to the nasw (2008) code of ethics (cswe, 2015). should a social worker fail to uphold these standards, a client has recourse options. without licensure or any specific governance of competencies, vulnerable clients in healthcare settings have little protection when their patient navigation provider is ineffective, under-performing, or fails to practice ethically. as part of a college-wide team at western kentucky university, we developed an interdisciplinary patient navigator certificate program in order to prepare students from various disciplinary backgrounds for this career option. social work, nursing, public health, and health information management programs collaborated in developing the interdisciplinary training program. through the use of existing courses, undergraduate students from multiple majors participating in the certificate program are being crosstrained in other disciplines to ensure that all patient navigation competencies are met. initiatives such as this can help meet the increasing need for competent pns while ensuring that the particular domains of the various professions are understood and respected. schools of social work are already successfully preparing healthcare social workers. patient navigation provides an opportunity for social workers to facilitate positive changes on the micro, mezzo, and macro levels. governmental mandates require each cancer center to employ a pn (pub. l. 109-18). further, healthcare clients are assigned social workers as part of their healthcare team (aca, 2010). the increased needs for pns in addition to other healthcare social work positions necessitates that social workers are increasingly knowledgeable in these areas and involved as leaders in shaping these contexts. rishel (2015) recommends establishing a prevention-focused integrative approach to social work practice as a way to “effectively function and provide leadership in the new era of health care” (p. 125). according to rishel (2015), this approach “integrates micro, mezzo, and macro practice efforts across service systems and with allied health and social service professionals to effectively and efficiently address major problems of living within the environmental context” (p. 127) which in this case dovetails well with the position of pn. adopting an approach such as this in the creation of patient navigation systems and processes is increasingly considered best practice and is consistent with the mandates of the patient protection and affordable care act. specifically, social workers in micro practice can provide services to medically needy individuals who are at risk. those specifically in the role as patient navigators have the skills needed to coordinate services, provide support, and advocate for individual clients. on a mezzo level, social work navigators work with family members and can develop educational and support groups for clients. on a macro level, social workers have the advocacy skills to promote policy changes including securing funding for workforce development and regulation of patient navigators. schools of social work can work in tandem with other disciplines to develop interdisciplinary programs to meet this growing workforce need. advances in social work, fall 2016, 17(2) 199 implications for practice and research while there are many compelling reasons social workers should be involved in patient navigation, the most important is the benefit to clients. improving healthcare outcomes and reducing health disparities in healthcare access and utilization are consistent with the social work value of social justice. patient navigation has consistently facilitated improved patient outcomes. research questions remain, and development of research projects aimed at determining variance in patient outcomes is necessary. do healthcare outcomes vary by educational perspective of the patient navigation provider? which competencies impact health care outcomes, and how? what level of educational preparation is ultimately most effective for each health care challenge? additional projects to assess the potential role confusion that occurs in all professions doing patient navigation work as well as the unique benefits of social worker pns on healthcare teams are needed. these lines of inquiry will further inform the utility of social work involvement in patient navigation. providing leadership to patient navigation programs in healthcare settings should be urgently undertaken by social workers individually and as a profession. social work leaders can facilitate the development of socially just healthcare systems that respect the dignity and worth of all patients. the social justice mandate found in our professional code of ethics (nasw, 2008) can be used to improve pn practices. the standards for practice in healthcare settings (nasw, 2005) are guiding principles for the specialized knowledge, skills, values, and method requirements of healthcare social workers, and initiatives such as social work heals demonstrate that the social work profession is taking these specialized requirements seriously (cswe, 2015). continued responsiveness to the current healthcare context indicates social work 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(2015). occupational employment and wages, may 2014: 21-1022. healthcare social workers. retrieved from http://www.bls.gov/oes/current/oes211022.htm author note: address correspondence to: patricia desrosiers, department of social work, western kentucky university, academic complex room 113b, 1906 college heights blvd#11039, bowling green, ky 42101-1039, 270-745-4557 patricia.desrosiers@wku.edu http://doi.org/10.1007/s11606-013-2491-4 http://www.pewinternet.org/2015/09/22/digital-divides-2015/ http://doi.org/10.1089/apc.2014.0279 http://www.chanet.org/ http://www.bls.gov/oes/current/oes211022.htm mailto:patricia.desrosiers@wku.edu microsoft word 4-3758 marsiglia et al acculturation and life satisfaction final _____________ flavio f. marsiglia, ph. d., msw, is the distinguished foundation professor of cultural diversity and health and director of the southwest interdisciplinary research center [sirc]; jaime m. booth msw, is a graduate research associate at sirc; adrienne baldwin, msw, is a graduate research associate at sirc; stephanie ayers, ph. d., is the associate director of research at sirc. this research is supported by funding from the national institutes of health/national institute on minority health and health disparities (nimhd/nih), award p20 md002316-05 (f. marsiglia, p.i.). the project is housed in the school of social work, college of public programs, at arizona state university in phoenix. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 49-64 acculturation and life satisfaction among immigrant mexican adults flavio f. marsiglia jaime m. booth adrienne baldwin stephanie ayers abstract: the numbers of mexican americans living in the united states, many of whom are first generation immigrants, are increasing. the process of immigration and acculturation can be accompanied by stress, as an individual attempts to reconcile two potentially competing sets of norms and values and to navigate a new social terrain. however, the outcomes of studies investigating the relationship between levels of acculturation and well-being are mixed. to further investigate the dynamic of acculturation, this article will address the impact of acculturation and familismo, on reported life satisfaction and resilience among mexican american adults living in the southwest (n=307), the majority (89%) of which are immigrants. the findings indicate that bilingual individuals report significantly higher levels of life satisfaction and resilience than their spanish-speaking counterparts do. speaking primarily english only predicted higher levels of resilience but not life satisfaction. implications for social work practice with mexican american immigrants are discussed. keywords: acculturation, mexican-american, life satisfaction, resilience latinos now make up a large majority of the minority groups in the united states and their numbers are growing, with mexican americans representing 10% of the total population in the united states (u. s. census bureau, 2012). while the u. s. population increased by only 9% between 2000 and 2009, the latino population experienced a 37% increase (saenz, 2010). this growing number of latinos, specifically mexican americans, presents an opportunity for advancing our knowledge about the distinct challenges that migration and acculturation may have on the mental health of latinos, and accordingly, what policy and service delivery changes are needed to address those needs (castro, marsiglia, kulis, & kellison, 2010; lara, gamboa, kahramanian, morales, & hayes bautista, 2005). when cultures interact because of migration, individuals are forced to negotiate their identity and reconcile their culture of origin with the dominant culture in the receiving country (redfield, linton, & herskovits, 1936). the process of acculturation can cause conflict within individuals and families because they feel the competing pressures of adopting new cultural norms and maintaining the ways of life of their country of origin (nguyen & peterson, 1993). extensive research has been done examining the relationship between acculturation and poor mental health; however, findings are mixed and very few marsiglia, booth, baldwin, ayers/acculturation and life satisfaction 50 studies include measures of well-being or positive mental health (konerua, weisman de mamania, betancourt, & flynn, 2007). understanding the impact of a culture of origin and host culture on well-being enables social workers to promote positive mental health in both micro and macro practice settings. to that end, this article addresses the impact of acculturation and familismo, a traditional mexican cultural norm, on reported general life satisfaction and resilience among a sample of recent mexican immigrants living in the southwestern united states. life satisfaction healthy people 2020 identified life satisfaction, defined as a distinct construct representing a cognitive and global evaluation of the quality of one’s life, as an indicator of well-being (pavot & diener, 2008; u. s. department of health and human services, 2012). the construct of life satisfaction addresses an individual’s ability to 1) have a life that meets their needs (karan, lambour, & greenspan, 1990), and 2) be “happy” (andrews & mckennell, 1980). life satisfaction is associated with stable marriages, selfefficacy, goal orientation, work ethic, and positive intraand interpersonal outcomes (diener, napa‐scollon, oishi, dzokoto, & suh., 2000; gilman, huebner, & laughlin, 2000; myers & diener, 1995). although life satisfaction is a distinct dimension of mental health, it strongly and negatively correlates with depression (headey, kelley, & wearing, 1993). life satisfaction is a psychological strength that has a buffering effect against stressful life events (suldo & huebner, 2004). this buffering effect points to the potential of life satisfaction as a viable outcome in its own right, but also a protective factor against the development of more serious mental health challenges. resilience in addition to life satisfaction, resilience is a key component of the positive psychology movement, which claims that the best way to address mental health issues is to promote strengths that may act as buffers against pathology (suldo & hueber, 2004; greene, galambos, & lee, 2004). resilience is the ability to bounce back in the face of stressful life events (tugade & fredrickson, 2004). resilient children and adolescents develop abilities to respond with resourcefulness and tenacity when confronted with unwanted challenges (fraser, richman, & galinsky, 1999). a resilient individual has a strong commitment to self, is willing to take action to deal with problems, has a positive attitude toward his or her environment, has a strong sense of purpose, and has developed a strong internal locus of control that enables him or her to view obstacles as challenges that can be overcome (hérbert, 1996). both risk and resilience are discussed within the ecological systems framework. fraser et al. (1999) has advanced a model of resilience that includes interactions between all levels of the ecological system: micro, mezzo, and macro. in this framework, resilience is a dynamic response to a multiplex of biological, psychological, social, and other environmental risks (fraser et al., 1999; jenson & fraser, 2006). resilience is expressed through an individual’s ability to adapt to risks that occur on all levels of the system by leveraging resources that may be present in different arenas (jenson & fraser, advances in social work, spring 2013, 14(1) 51 2006). for all people and for latinos in particular, a cohesive and supportive family environment plays an important role in the development of resilience (hérbert, 1996). resilience acts as a buffer for negative mental health outcomes in three ways: 1) minimizing harm, 2) protection, and 3) promotion (davydov, stewart, ritchie, & chaudieu, 2010). resilience not only enables individuals to recover more quickly when they encounter stressful situations (e.g., minimizing harm), but can also have a protective effect, enabling individuals who have experienced adversity as children to have better relationships in adulthood (collishaw et al., 2007). resilience decreases the number of events experienced as stressful, therefore increasing overall well-being (ong, bergeman, bisconti, & wallace, 2006). based on the ecological model, researchers are now beginning to view resilience as the result of the interactive process between risk, protection, and promotion (jenson & fraser, 2006). the transition from a focus on deficits and defects to protective factors represents a move toward a strengths-based approach to problem solving (guo & tsui, 2010; masten, 2001). although resilience is an individual response, it is conditional on both individual and environmental factors (fraser et al., 1999). the ecological model provides the most thorough representation of resilience because it considers the influence of context, including neighborhood, school, peers, and family influences on resilience. acculturation and mental health acculturation is broadly defined as the process of adaptation that results when two cultural groups interact, and/or the extent to which an individual assumes the norms and values of the host culture (lueck, & wilson, 2011; miranda, estrada & firpo-jimenez, 2000). acculturation is a vitally important process to consider when discussing both life satisfaction and resilience among latinos in the united states. historically, it has been hypothesized that the process of acculturation is stressful and may negatively impact mental health because it forces an individual to negotiate two potentially conflicting identities (stonequist, 1935) and integrate into a society that can be hostile to minorities (u. s. department of health and human services, 2001). the more an individual’s beliefs about their cultural group are clearly and confidently defined, the more likely they are to have clear and confident definitions of the personal self and self-esteem markers of psychological well-being (usborne, 2010). living between cultures may be more stressful than total assimilation or no acculturation at all. however, an individual’s level of cognitive flexibility, which enables them to switch their cultural orientation depending on the context, is more protective against negative mental health outcomes than high levels of acculturation or assimilation (lechuga, 2008). the complexity of the relationship between acculturation or assimilation and mental health is seen in the disparate results of scientific studies, with some findings suggesting that high levels of acculturation are associated with a decrease in negative mental health outcomes, while others have shown the opposite (abrams, allen, & gray, 1993; miranda & umhoefer, 1998; shen & takeuchi, 2001). in a study comparing the mental health of recent mexican american immigrants and mexican americans who were born either in the united states or who had lived in the united states for more than 13 years, recent marsiglia, booth, baldwin, ayers/acculturation and life satisfaction 52 immigrants were found to have more positive outcomes (u. s. department of health and human services, 2001). however, this study did not include measures of acculturation. ortiz and arce (1984) interviewed 1,300 mexican families about their mental health and found that the less acculturated individuals reported higher levels of life satisfaction. similarly, in another study of both immigrant and native-born older mexican americans, a positive relationship was found between depression and acculturation; however, acculturation did not significantly predict life satisfaction (cuellar, bastida, & braccio, 2004). conversely, in two studies, low levels of acculturation among mexican american women were associated with higher levels of depressive symptomatology (salgado de snyder, 1987) and feelings of hopelessness (melville, 1978). recently, torres (2010) found that a variety of factors associated with being an immigrant in the united states increased the likelihood of reporting depression. these mixed findings suggest that both high levels of acculturation and low levels of acculturation do not necessarily mitigate distress among mexican americans and further leads us to question if multiculturalism, or retaining aspects of one’s culture of origin while adapting norms and values of the host culture, may positively influence resilience and life satisfaction. familism although studies have traditionally treated acculturation as a single item, underlying cultural norms may also be possible risk or protective factors (rodriguez, mira, paez, & myers, 2007). for instance, having a bicultural orientation is more protective when individuals are grounded in social networks within both cultures (laframboise, coleman, & gerton, 1993). familism, a traditional latino norm, may provide a more complex picture of acculturation and account for one aspect of latinos’ culture of origin that promotes “groundedness” and positive mental health. the idea of familism refers to cultural norms of loyalty, solidarity, and reciprocity with both the nuclear and extended family (martín & martín, 1991). among latinos, values and norms like familism are taught in the family and serve as a source of resilience, giving youth the context in which to practice adaptive behaviors (masten, 2001). the social support and sense of belonging that result from being part of a close family are protective factors against negative mental health outcomes (castillo, conoley, & brossart, 2004). in a study with second-generation mexican american youth, adherence to traditional norms and values seemed to influence the youth’s identity, supporting resilience in the face of stress (holleran & waller, 2003). similar findings were reported in a quantitative study that found that maintaining ties to the traditional latino culture was protective against distress (torres, 2010). multicultural model while classic studies characterized acculturation as a unidirectional linear process in which an individual adapts to norms of the dominant culture (gordon, 1964), recently, scholars have recognized the processes’ bidirectional nature, in which individuals are able to retain aspects of their culture of origin while adapting aspects of the host culture (berry, 2005). this model recognizes that individuals can simultaneously maintain the identity, norms, and values of their culture of origin while also learning successfully to advances in social work, spring 2013, 14(1) 53 interact with the host culture (lafromboise, coleman, & gerton, 1993). this model further demonstrates that these individuals can maintain separate identities in private and public spaces without causing psychological tension, which may serve as a protective factor (kelly, 1971). the multicultural model more accurately reflects the dynamic nature of culture and the potential protective effect of maintaining aspects of an individual’s culture of origin when compared to models of assimilation; therefore, the multicultural model was used to guide the hypotheses being tested in this research. berry (1997) elaborates on this multicultural conception of acculturation by outlining four different reactions to the interactions of culture; 1) integrative, in which individuals maintain norms, beliefs, or customs from their culture of origin, while also incorporating aspects of the host culture; 2) assimilation, in which individuals lose their culture of origin and are completely integrated into the host culture; 3) separation, in which an individual completely rejects the host culture maintaining their culture of origin’s attitude, norms, and beliefs; and 4) marginalization, in which an individual is rejected or is rejecting both their culture of origin and the host culture. in a study examining the impact of these four reactions on psychological well-being, integration was associated with positive outcomes while marginalization was associated with negative outcomes (berry, 2005). because the findings on the effects of high levels of acculturation or assimilation on mental health are mixed, and few studies have examined how the process impacts positive aspects of mental health, this study will examine the impact of linguistic acculturation and the endorsement of traditional latino values, specifically familismo, on life satisfaction and resilience. based on the multicultural model, it was hypothesized that: 1) among latinos, an integrative or multicultural orientation will be associated more with increased life satisfaction and resilience than both assimilated and separated individuals. 2) latinos with higher levels of familism will have increased levels of life satisfaction and resilience. methods sample the data in this study came from a four-year-long randomized control trial that tested families preparing the new generation (fpng), a parenting intervention developed to accompany keepin’ it real. taught in school classrooms by teachers, keepin’ it real is a culturally-based, evidence-based substance use prevention program for youth designed to: (a) increase drug resistance skills; (b) promote anti-substance use norms and attitudes; and (c) develop effective decision making and communication skills for resisting drugs and alcohol (marsiglia & hecht, 2005). keepin’ it real is now recognized as a national model program by the substance abuse and mental health services administration (samhsa) (schinke, brounstein, & gardner, 2002). marsiglia, booth, baldwin, ayers/acculturation and life satisfaction 54 all independent variables were measured in the pre-test needs assessment at wave one; while dependent variables, life satisfaction and resilience, were measured at wave three, one year after the treatment group completed the program. wave three data was utilized because the main variables of interest, life satisfaction and resilience, were not measured at wave two. pre-test questionnaires were administered in two cohorts: cohort 1, surveyed in the fall of 2009, and cohort 2 completed the survey in the fall of 2010. all surveys read at a 5th grade level, were available in english or spanish, and were translated following the procedures described by rogler (1989). in order to engage parents in the study, parental consents explaining the study and asking parents if they wished to participate were sent home with the students. all children in the 7th grade and parents that agreed to participate in fpng were included in the sample. parents could choose one of three options: 1) to consent both parent and youth; 2) to consent youth only; 3) to consent neither parent nor youth. parental consents were provided in both english and spanish. although data was collected from all youth, regardless of their parent’s decision to participate in the study, only parent data was used in this analysis due to our focus on the well-being of adults. parents who expressed an interest in participating in the study attended a meeting at the school to complete a packet of questionnaires. trained research staff followed detailed administration instructions that emphasized the confidentiality of responses. questionnaires were administered in small groups and took from 60-90 minutes to complete. surveys were completed in the language of preference of the participant with 93% of parents choosing to complete the questionnaires in spanish. in the study, 1,131 seventh-grade students in nine schools (regardless of their race or ethnicity) and their parents were invited to participate in the study; 681 parents completed and returned consents (consent rate of 79%), 468 parents completed surveys at wave one, and 369 of those returned to complete the survey at wave three. participants were included in the analysis if they identified as mexican, mexican american, chicano, or another hispanic or latino group and who completed a survey at wave three, resulting in a total sample size of 307. the majority (89%) reported being born in a country other than the united states. the sample had a mean age of 38.67, a mean education of more than six years of school, but no high school diploma, 60.91% of the sample was married, and 86% was female (see table 1). measurement general life satisfaction was measured at wave one and wave three using 10-items in which respondents answered questions about their level of satisfaction with a variety of aspects, ranging from spiritual life to trust in important persons. possible responses ranged from (1) not at all, to (5) extremely (for scale items see table 2). because these items appeared to be disparate, a factor analysis was conducted using a paf rotation. when the analysis was conducted, one factor emerged with an eigenvalue of 6.47. all items of the scale were retained with factor loadings well above the minimum cut point of .40 (see table 2). a scale was constructed by summing all items with a final range of possible scores from 10 to 50 and having an α = .93. advances in social work, spring 2013, 14(1) 55 resilience. although resilience has been operationalized traditionally as the characteristics of an individual that moderates the relationship between stressors and negative outcomes, resilience is ultimately an individual’s ability to “successfully cope with changes or misfortune” (ahern, kiehl, lou sole, & byers, 2006, p. 104). the ability to “bounce back” is a quality inherent in the definition of resilience. this conceptualization of resilience was drawn from tugade and fredrickson’s (2004) definition, which includes an individual’s perceived ability to overcome various challenges including anxiety and disappointments. based on this definition, the three items in the life satisfaction scale that asked the respondents about their ability to overcome challenging life circumstances or emotions were isolated and analyzed in order to examine an individual’s level of resilience. a factor analysis was conducted using a paf rotation and a new item was created. when the exploratory factor analysis was conducted, one factor was retained with an eiganvalue of 2.40 and factor loadings ranging from .87 to .91 (see table 1). given the results of the factor analysis, a new variable, resilience, was created by summing the three items, with responses ranging from 3 to 15 with an α = .87. acculturation. despite the conceptual limitations, linguistic-based measures have been useful in identifying english language proficiency as a predictive factor for low acculturative stress, especially for latino immigrants (lueck & wilson, 2011). language is a significant aspect of acculturation because language fluency is pertinent in crosscultural communication. previous research has indicated that language usage (measured by asking participants, “in your home, do you speak…?” and “with your friends, do you speak…?”), explains the variance in levels of acculturation and is therefore an acceptable brief measure (unger, ritt-olson, wagner, baezconde-garbanati, & soto, 2007). acculturation was measured using a 3-item scale (α = .90) and by asking participants, “today, 1) you speak, 2) you read, and 3) the language of the television and radio shows you watch or listen to are:” with the following possible responses (1) only in a language other than english, such as spanish, (2) another language more than english, (3) both languages equally, (4) english more than other languages, and (5) only english. to create the scale, these items were summed, resulting in a range of scores from 3 to 15. cut off points were then created, with less than six indicating a primarily spanish-speaking individual (e. g. low acculturation), between seven and nine was considered bilingual (e. g. bicultural), and 10 or greater indicating a primarily english speaking individual (e. g. high acculturation). familism, an 8-item scale, was measured by asking participants, how strongly they agreed with statements including 1) “you should know your family history so you can pass it along to your children” and 2) “traditional celebrations such as baptisms, weddings or graduations add meaning to life,” with possible responses ranging from (1) strongly disagree to (5) strongly agree. when a factor analysis was completed, one factor emerged with an eigenvalue of 3.82. all factors were retained with factor loadings higher than .40 (see table 1 for scale items and factor loadings). all eight items were summed, creating a new variable that ranged from 8 to 40, with an α = .87. marsiglia, booth, baldwin, ayers/acculturation and life satisfaction 56 analysis after factor analyses were conducted and scales were summed, an ols regression was performed predicting life satisfaction and resilience at wave three using acculturation and familism, controlling for wave one responses in education, marital status, gender, age and treatment condition. because the effect of treatment condition was not significant, it was not included in the models for the sake of parsimony. table 1 factor loadings of 10-item life satisfaction scale and 8-item familism scale (n = 295) life satisfaction resilience familism a good spiritual life . 69 a positive sense of self (self-esteem) . 84 leadership abilities and the ability to inspire others . 81 the ability to overcome life’s problems . 87 . 89 a sense of trust with persons important to you . 84 the ability to overcome disappointments . 86 . 92 social confidence with others . 81 the ability to overcome (conquer) anxiety . 81 . 88 clear life goals and a direction in life . 82 the ability to get enough sleep on a daily basis . 65 you should know your family history so you can pass it along to your children . 68 the good life is lived by staying home and taking care of the family . 61 children should be taught to be loyal to their family . 70 traditional celebrations such as baptisms, weddings or graduations add meaning to life . 68 we should preserve our customs and traditions as they contain the wisdom of generations of our forefathers . 75 adult children should visit their parents often as an expression of love and respect . 72 the good life is lived by spending time and bonding with family without worrying or being concerned about the passage of time (without watching the clock) . 67 it is very important to always to remain close to family even when there is a fight between members of the family . 70 advances in social work, spring 2013, 14(1) 57 results the mean life satisfaction score at wave three was 40 with a standard deviation of 6. 58, and total resilience score had a mean of 11. 89 with a standard deviation of 2.28. sixty-four percent of the sample reported being primarily spanish speaking, 25.08% reported being bilingual, and 11.07% reported speaking primarily english. the mean score on the familism scale was 33.87 with a standard deviation of 4.49. for descriptive statistics of all control variables, age, education, marital status and gender, see table 2. an ols regression analysis was then estimated, predicting life satisfaction at wave three, controlling for life satisfaction at wave one, age, gender, education and marital status (f(8,264) = 9.84, p>.000; r2 = .23)(see table 3). we observed a significant increase of β=2. 04 (p > .05) in general life satisfaction for individuals who were bilingual/ bicultural compared to those who were primarily spanish speaking/low acculturated. for individuals that primarily spoke english, no significant difference was found. a positive relationship was also found between familism and general life satisfaction (β= .19, p > .05). for every one additional point on the familism scale, we expected a .19 increase in general life satisfaction. while this effect size is rather small, it indicates that a connection to tradition may promote general life satisfaction. table 2 means and standard deviations for the analytic sample mean sd % life satisfaction w1 36. 65 7. 04 life satisfaction w3 40. 00 6. 58 resilience w1 10. 79 2. 61 resilience w3 11. 89 2. 28 familism 33. 87 4. 49 age 38. 67 6. 90 educationa 3. 29 1. 58 acculturation primarily spanish 63. 84 bilingual 25. 08 primarily english 11. 07 gender female 86. 81 male 13. 19 marital status married 60. 91 single 39. 09 a education: 3 indicates more than 6 years of education but no high school diploma marsiglia, booth, baldwin, ayers/acculturation and life satisfaction 58 when the same model was estimated predicting resilience, controlling for resilience at wave one, a very similar pattern was observed (f(8,264)= 7.44, p>. 000; r2 = .18) (see table 3). for bilingual speakers, a significant increase was predictive of high resilience, with this group scoring on average .84 (p > .001) points higher than their primarily spanish-speaking counterparts, controlling for wave one, age, gender, education, and marital status. unlike the previous model, those who primarily spoke english were also predicted to have significantly better scores on the resilience scale (β= .95, p > .05) than primarily spanish speakers. a positive relationship was also found between higher scores on the familism scale and resilience (β= .07, p > .001). while the effect size is again not large, a positive relationship beyond levels of acculturation indicates a protective effect of staying connected to a traditional orientation toward family. table 3 regression predicting life satisfaction and resilience among latinos living in the us (n=273) life satisfaction w3 resilience w3 β(se) sig β(se) sig life satisfaction w1 .34(.06) *** resilience w1 .25(.05) *** spanish speaking bilingual 2.04(. 91) * .84(.33) ** english speaking 2.01(1. 29) .95(.46) * familism .19(. 09) * .07(.03) ** female (1) 1.23(1. 08) .40(.39) education .03(. 25) .03(.09) married (1) 1.51(. 75) * .48(.27) + age .01(. 05) .01(.02) _con 18.18(3. 69) *** 5.32(1.31) *** r2 0.23 *** 0.18 *** *** p<.000, **p< .01, * p<.05, +p<.10 discussion among latino adults living in the southwest, the findings lend support to the hypothesis that individuals who have been able to integrate aspects of both the host culture and the culture of origin, or those that are bicultural, have better mental health outcomes than those who are still culturally separate (berry, 2005). immigrants who exhibited an integrative reaction had higher ratings of life satisfaction than those individuals that chose to remain culturally separate from the american culture (primarily spanish speaking). it is important to note that immigrants who had fully assimilated (primarily english speaking) did not show high ratings of life satisfaction. these findings may indicate that retaining aspects of one’s culture of origin and embracing elements of the host culture, may promote the best mental health outcomes among latino immigrants. advances in social work, spring 2013, 14(1) 59 having the skills to navigate the host culture while remaining grounded in the culture of origin promoted life satisfaction. this was not the case for resilience. both individuals that reported being culturally integrated (bilingual) and assimilated (primarily english speaking) reported higher rates of resilience than their separated or primarily spanishspeaking counterparts. the results also lend support to the hypothesis that identification with traditional norms about family would result in higher levels of life satisfaction and resilience, again illustrating the potentially protective effect of remaining connected to traditional norms and values while acquiring skills like language proficiency, which allows an individual to be more successful in navigating american culture. limitations these results have some geographical, sampling, and other limitations that should be noted. first, although acculturative stress was the assumed pathway between acculturation and life satisfaction, a measure of stress was not included in the survey; therefore, this relationship could not be tested directly. another limitation is that not all individuals surveyed at pre-test completed a post-test survey, which potentially biased the results. the vast majority of the parents were monolingual in spanish, or bilingual with a preference to communicate in spanish. because this program was developed in a southwestern metropolitan area, it is uncertain how the program would generalize to other mexican american communities outside the southwestern metropolitan area, particularly where mexican american parents may be in the minority. in addition, because this particular southwestern area has a distinctive socio-political environment, the program may also be uniquely characteristic of that specific environment. third, parents self-selected whether they wanted to participate and wanted their child to participate, possibly creating a selection bias. difference in self-selection by treatment condition could be due to level of interest of parents willing to participate in a youth-only intervention compared to participating in a parent-based intervention or receiving nothing. it should be noted that once baseline data were collected, an unconditional model in mplus was conducted to examine the interclass correlation (icc) between schools. the unconditional model indicated non-significant iccs between schools. implications for social work practice the findings have implications for both macro and micro social work practice with latinos, specifically first-generation mexican migrants. the large and growing number of mexican immigrants living in the united states, both legally and in the shadows, makes understanding the circumstances that promote optimal physical and mental health among this population, and working to eradicate social and economic barriers to mental health care, crucial concerns in the field of social work. although the process of immigration and acculturation presents a host of unique risk factors, this study has identified a bicultural orientation and an endorsement of traditional family norms as protective. these findings run counter to the typical american norm that encourages complete assimilation into the dominant american culture. instead, the findings suggest that policies that aim to separate individuals from their country of origin and fully integrate them into american society (i.e. english only policies) might have a negative impact on well-being. marsiglia, booth, baldwin, ayers/acculturation and life satisfaction 60 furthermore, the findings suggest that failing to adopt essential skills necessary for integration such as english language proficiency is also related to lower levels of life satisfaction. in fact, individuals who primarily spoke english were found to be more resilient than those who primarily spoke spanish. these findings might reflect discriminatory systems, but they indicate a need to acquire new skills to successfully navigate american culture (torres, 2010). however, these skills do not need to be obtained at the expense of an individual’s culture of origin. in addition to ending discriminatory policies that create barriers for immigrants, policies need to be created on the national, state, local, and agency level that allow individuals to co-exist in micro and mezzo systems that reflect their culture of origin and the larger systems of work and school, places typically dominated by american norms and values. when applying traditional psychotherapeutic models with latinos in direct practice, social workers need to consider the impact of acculturation to ensure that they arrive at an accurate diagnosis and provide effective treatment. this may require culturally adapting existing intervention strategies so they not only better fit the population being served, but also build and strengthen protective cultural norms and values. it is also essential for social workers to identify and address policies that perpetuate social and economic barriers to mental health care. ultimately, creating spaces that facilitate multicultural identities for mexican immigrants, in both social work practice as well as the larger society, may be crucial to promoting quality mental health systems for populations that face stressors in the process of acculturation. this study suggests several possible avenues for future research. both the acculturation and resilience measures used in this research only scratch the surface of this complex process; therefore, further studies need to focus on what promotes and hinders resilience among new immigrants as they move through the process of acculturation. additionally, future research should explore how the larger social context may be interacting with culture to hinder or promote well-being. specifically, more needs to be understood about the immigrants’ experiences with discrimination and structural barriers to upward mobility, which may impact the adaptation of a bicultural 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(2010). the role of cultural identity clarity for self-concept clarity, self-esteem, and subjective well-being. personality and social psychology bulletin, 36(7), 883-897. author note: address correspondence to: flavio f. marsiglia, ph. d., school of social work, arizona state university, 411 n. central avenue, suite 720, phoenix, az 85004. email: marsiglia@asu.edu microsoft word 2. strand et al_3052_common elements across trauma treatment copyedit_final ______________ virginia c. strand, ph.d., is a professor and co-director of the national center for social work trauma education and workforce development; susan hansen, ph.d., is an adjunct professor; and deborah courtney is a doctoral candidate, all in the graduate school of social service at fordham university in west harrison, ny. this research was supported in part by a grant from the substance abuse and mental health services administration, grant number 5u79sm059293-03. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 334-354 common elements across evidence-based trauma treatment: discovery and implications virginia c. strand susan hansen deborah courtney abstract: the social work profession is facing a critical gap in its provision of effective services to an increasingly large number of clients who are affected by trauma. to explore for the presence of common components in evidence-based trauma treatments, a qualitative content analysis of 8 trauma treatment manuals was undertaken. analysis resulted in the identification of 35 intervention objectives and 59 practice element codes. these were further organized into nine domains: trauma assessment, safety, engagement, attachment, core treatment interventions, attention to the social context, trauma processing, post trauma growth, and therapist self-care. future work for the profession may involve synthesizing and integrating what has already been learned, and translating that knowledge into the classroom. significantly, three domains which stress activities with the client in their social context were found to be common to trauma treatments, including safety promoting activities. implications for social work education, practice, policy, and research are discussed. keywords: trauma treatment, evidence-based practice, common elements the social work profession is facing a critical knowledge gap in its provision of effective services to an increasingly large number of clients who are affected by trauma. the prevalence of trauma exposure in many, if not most, clients served by social workers, coupled with the dual problems of both identifying appropriate treatments and accessing training for implementation of evidence-based trauma treatments, is presenting a major challenge for practitioners. a corresponding shortfall in social work education of both training in trauma and training in evidence-based practice may exacerbate the problem in the next generation of practitioners. in this article, dilemmas in the field in regard to dissemination of evidence-based trauma treatments and the parallel challenges in social work education are identified, findings regarding common elements in trauma treatments presented, and implications for social work education, practice, social policy and research discussed. by definition, children who have experienced child abuse and neglect, sexual abuse, and/or witnessed domestic violence have been exposed to trauma. many children, adults and their families have often also had exposure to community violence, war-related refugee experiences, combat violence for returning veterans, medical trauma, natural disasters, and traumatic loss. when these experiences are unaddressed, clients are at greater risk for a range of behavioral, emotional, educational and social problems in childhood and later in life. many studies document the widespread prevalence of trauma advances in social work, fall 2013, 14(2) 335 exposure and its lasting impact across the life cycle in all the populations served by social workers (dong et al., 2004; felitti et al., 1998; putnam, 2006). the adverse childhood experiences study (aces), using a sample from a non-clinical population of adults presenting for routine annual physical exams found a significant relationship between negative childhood experiences (including physical, emotional, and sexual abuse, interpersonal violence, divorce, mental illness, alcoholism and family member incarceration) and a range of lifelong serious physical and mental-health problems. these adulthood problems included, but were not limited to, higher rates of adult depression, drug use, juvenile arrest, obesity, diabetes, and overall occupational health and job performance impairment as they were reported by those with histories of adverse childhood experience (anda et al., 2006; felitti et al., 1998) literature review the past several decades have yielded more evidence-based or empirically-supported treatment interventions and yet it has been challenging to integrate those treatment approaches into everyday practice for the typical front line clinician (weisz & gray, 2008). there are methodological issues along with differing opinions about whether treatments tested in a laboratory setting can be replicated in the field, as well as issues of fidelity to the model once the treatment approaches are introduced into natural settings. weisz and gray (2008) also report that there are some inconsistencies in the research findings resulting in evidence-based treatment approaches not consistently outperforming usual care. this results in a questioning of evidence-based treatments and leaves both clinical staff and social work educators to wonder about their effectiveness as a whole. in the area of trauma treatment, while evidence-based interventions for children and adolescents have been disseminated through the federally funded national child traumatic stress network (nctsn), they are by no means universally available. adult trauma treatment, lacking a funding “engine” like the nctsn to drive dissemination, are not nearly as widely available as the child trauma treatments. the debate has affected the degree to which training in evidence-based practice has been incorporated into social work education. according to a recent article (bledsoe et al., 2007), fewer than 40 percent of msw programs meet the “gold standard” of integrated clinical training as proposed by weissman and colleagues (2006). “gold standard training” consists of didactic training in an empirically-supported treatment (est) paired with its implementation in a field setting with supervision by a clinician trained using the same est. this 40% stands in contrast to 60% of phd clinical psychology graduate schools and 90% of medical schools nationwide who provide training in at least one est. to increase the prevalence of “gold standard training” in social work education, the importance of strengthening the link between classroom-based and field practicum learning settings has received enhanced emphasis (boitel, farkas, fromm, & hokenstad, 2009; mullen, bledsoe, & bellamy, 2008; proctor, 2007). in a parallel process, social work education has struggled with the need to incorporate trauma content into its curriculum (bussey, 2008; cunningham, 2004; miller, 2003; mckenziemohr, 2004; strand, abramovitz, layne, robinson, & way, in press). strand, hansen, courtney/evidence-based trauma treatment 336 there is another interesting dialogue now occurring in the field. according to chorpita and colleagues (2011), there is a present “knowledge management problem” (p. 494). they assert that the mental health professional community must begin to address how to manage the current knowledge base that is already in existence. in other words, it is no longer about creating more evidence-based treatment protocols, but about synthesizing and integrating what has already been learned. in a prior publication, chorpita, daleiden, and weisz (2005) proposed a model to allow the treatment intervention literature to be “factored or distilled” in an effort to create a synopsis of evidence-based treatment elements that can then be matched to individual clients (p. 5). this distillation and matching model involves distilling the empirical data to develop profiles from the evidence-based models that allow for matching treatment interventions with clients’ problem behaviors and individual and environmental variables. chorpita and colleagues (2011) have raised the question of whether greater proliferation of treatment approaches is helpful to the field or whether identifying ways to design, apply, and organize the information from treatments already in existence has more utility. barth and colleagues (2012) concur and argue that the social work profession is at a crossroads, suggesting that the time has come for the field to turn its attention to the development of common factors as well as common elements. common factors are defined as those elements that are not specific to any particular treatment model but may contribute extensively to client outcomes (such as worker-client relationship). a common elements framework, incorporating a modular approach to treatment, is viewed as having potential advantage over individualized manualized treatment. a similar question regarding how to organize information from treatments already in existence has been posed by the national child traumatic stress network (nctsn), a federal initiative to both increase access and improve the quality of trauma treatment available to traumatized children and adolescents (pynoos et al., 2008). as part of its mandate, the nctsn has been active in the dissemination of evidence-based trauma treatments (ebtt). however, as early as 2007, the training arm of nctsn identified the problem of duplication in training content across many of the treatments it was disseminating. this led to a decision by the nctsn leadership to create a foundational curriculum in child trauma that would draw on common concepts, components and skills across ebtts. the core curriculum on childhood trauma (ccct) task force was formed to develop this curriculum. composed of national experts in trauma treatment, the ccct task force first developed the core concepts phase of the curriculum. twelve core concepts were identified using an expert consensus model and five developmentally and culturally contextualized cases created using a problem-based learning methodology. (see layne et al., 2011 for a fuller description of the ccct). the goal of the core concepts portion of the curriculum is to provide a foundation in trauma knowledge to assist with case conceptualization, formulation, and assessment. this curriculum has been adapted for social work education and disseminated nationally (strand et.al., in press) and the curriculum is in the process of being adapted by nctsn for agency in-service training. advances in social work, fall 2013, 14(2) 337 the second phase of curriculum development is designed to focus on core components of evidence-based trauma treatment, in which components are defined as both intervention objectives and practice elements. rather than use an expert consensus approach to develop the core components portion of the curriculum, a decision was made to code trauma treatment manuals in order to identify the common intervention objectives and practice elements across these manuals. others have undertaken the challenge of defining and codifying client treatment operations/techniques/strategies. bisson and colleagues (2010) used a delphi technique, which recognizes the experience and knowledge of experts when empirical knowledge is lacking, to develop evidence-informed guidelines for post disaster intervention. sburlati, schniering, lyneham, and rapee (2011) also used a dephi method, which they defined as a “procedure that draws together empirical evidence and iterative expert review to achieve consensus regarding effective and ineffective treatment approaches” (p. 91). chorpita and colleagues (2005), as described in their distilling and matching initiative noted above, have defined practice elements as “discrete clinical techniques or strategies used as part of a larger intervention plan” (p. 11). using an expert consensus method, those elements most often identified in the literature were combined into a coding manual (practice wise, 2005) and this coding manual was then used in analysis of evidencebased treatments focused primarily on child anxiety and depressive disorders. the nctsn developed a partnership with practice wise in 2010, with the intent to code 26 evidence-based trauma treatment manuals. however, when the practice wise (2005) coding manual was reviewed by the ccct task force, it was felt that the codes would not capture trauma-specific practice elements in the ebtt manuals. therefore, a special project was launched with the aim of identifying trauma-specific codes for use in coding the ebtt manuals. overview of the coding project in 2010, a research team at the national center for social work trauma education and workforce development, a center funded through the nctsn initiative, utilized a grounded theory approach (glaser & strauss, 1967) to embark on a qualitative research project with a mission of creating a coding manual that could be utilized to code promising practices and empirically-supported treatments specifically related to trauma interventions. evidence-based practice can be conceptualized as both a verb (an approach to practice) and a noun (a specific, usually manualized intervention with some level of empirical support). for purposes of this study, evidence-based practice is defined as a manualized, empirically-supported treatment that is considered to have a certain level of evidence supporting its efficacy (barth et al., 2012; pettus-davis, grady, cuddeback, & scheyett, 2011). the coding manual would be developed by the national center for social work trauma education and workforce development and then used to code the full sampling of treatment intervention manuals. this article reports on the process of developing the coding manual, and the implications for training, practice, policy, and research that arise strand, hansen, courtney/evidence-based trauma treatment 338 from the identification of common intervention objectives and practice elements codes in a sample of empirically-supported treatment manuals. method sample the sample included eight trauma treatment manuals, which were drawn as a purposive subsample from the larger group of 26 manuals. the eight were varied in regard to treatment modality (e.g., child, dyad, family), age of the child for whom the intervention was designed (preschool, school-age, adolescent), intensity of intervention (i.e., trauma treatment or post-disaster intervention), and level of empirical support, ranging from those with rcts to those with outcome studies only. the criteria used to assess the level of empirical support are based on the schema developed by saunders and berliner (2004), which defines treatments with the strongest empirical base (most efficacious) as those which have at least two randomized, controlled treatment trials (rcts) that have found the treatment protocol to be more effective than that of an appropriate comparison group. the criteria also include that the treatment has a book, manual, or other writings that specify the components of the treatment and explain how to implement it. five levels of empirical support are identified, with level 5 (an innovative or novel treatment) characterized by a theoretical basis, a small clinical literature but the treatment is not in wide use. all of the manuals in this sample fell between levels 1-4. (see table 1). table 1. trauma treatment manual by level of evidence*  trauma treatment manual number level of evidence 1 2 3 4 5 6 7 8 1. well-supported, efficacious treatment x x x 2. supported and probably efficacious treatment x 3. supported and acceptable treatment x x x 4. promising and acceptable treatment x 5. innovative or novel treatment * saunders, b. e., berliner, l., & hanson, r. f. (eds.). (2004). child physical and sexual abuse: guidelines for treatment (revised report: april 26, 2004). charleston, sc: national crime victims research and treatment center. advances in social work, fall 2013, 14(2) 339 design the project was undertaken over a four month period and utilized a qualitative content analysis research methodology. a basic qualitative approach utilizes procedures to generate theory grounded in data. as noted by babchuk (2011), “it involves an iterative process of simultaneous data collection and analysis, … constructing codes and categories from data rather than from a preconceived hypothesis … and the theoretical saturation of categories signaling a stopping point in data collection” (p. 386). while many “branches” of grounded theory have emerged since the seminal work of glaser and strauss (1967), this project adopted the overarching method, most consistent with glaser’s (1978, 1992) open coding, in which the codes emerged from the data and were not selected prior to the data analysis. consistent with this approach, codes are often labeled from words found in the data themselves. the codes are then clustered into categories and conceptual saturation is reached when no new categories are generated from the open codes. content analysis, a refinement of a qualitative approach for use with text documents, has been defined by some to include two approaches: an inductive method, in which codes or categories are derived from the data; and a deductive approach, which is based on previous knowledge and research (elo & kyngas, 2007). others have suggested three categories—conventional (similar to the inductive method), directed, and summative. the latter both involve a deductive approach (hsieh & shannon, 2005). the qualitative content analysis methodology utilized here, while consistent with glaser’s approach, has as its purpose not the construction of theory but the identification of categories or codes and is consistent with the inductive or conventional approaches. it uses open coding, the creation of categories, and abstraction. the purpose of creating categories using content analysis is to “describe the phenomenon, increase understanding and generate knowledge” (elo & kyngas, 2007, p. 111). abstraction is used to group categories, or in this study, to group codes. unit of analysis the coding team prepared for the analysis by defining the unit of analysis as a trauma treatment manual available in print form. while this contributed to the development of a large data set, the use of computerized software (described in more detail below) allowed for relative ease in the management of the quantity of data. since the purpose of the eventual analysis of a larger sample of manuals was to search for common intervention objectives and practice elements, an a priori decision was made to code for these using the following definitions: intervention objectives: a specific therapeutic outcome the therapist intends to achieve through implementing a given set of practice elements in a given setting. practice elements: observable, concrete therapeutic procedures the therapist implements with the client or on behalf of the client (when acting in an advocacy role) with the intention of achieving one or more intervention objectives. strand, hansen, courtney/evidence-based trauma treatment 340 multiple coders the use of multiple coders has generally been viewed as an aid to establishing methodological rigor in qualitative research (berends & johnston, 2005; ryan, 1999). it has also been argued that having multiple coders is beneficial when the data set is large (lu & shulman, 2008). in this project the research team consisted of four coders, the three authors plus an additional doctoral student. this is consistent with a recommendation for team-based coding (laditka et al., 2009). all four members were professional social workers, all four had worked as clinicians, and more specifically, all had provided trauma treatment, albeit with differing degrees of years of experience and intensity. there is some evidence that the history of working as a therapist, where the development and use of empathy is an important skill, supports the approach of open coding, where the researcher has to become immersed in the data and allow the authors’ meaning to emerge. type of content to be coded the team decided to code only for manifest, not latent content, since there is debate about whether “hidden” meaning can be accurately coded in text documents, as this usually involves considerable interpretation (elo & kyngas, 2007). therefore, for example, to determine if a statement or description was to be coded as an intervention objective, the coder searched to see if the author of the treatment manual used words like “the goal is”, “the desired outcome is”, or “the purpose is” in describing the activity. similarly, in deciding if a statement or description was to be considered a practice element, the procedure, operation, strategy, or technique needed to be observable. a separate issue relates to the presence of handouts in the manuals. some of the manuals contained dozens of handouts totaling over 100 pages. while some developers argued that these should each be analyzed for content in order to capture the full scope of intervention objectives and practice elements in the treatment approach, this would have significantly increased the data set to be coded. after an exploratory analysis of handouts from two manuals, it was determined that coding handouts would contribute little to the development of new codes. a typology of handouts was developed instead for coding. computer software the research team used the atlas.ti 7.1.4 software in the coding process. the advantages of using this kind of computer-assisted qualitative data analysis software include that it provides a straightforward data reduction method to handle large amounts of data. each of the 8 manuscripts were on average 200 pages of text, and using atlas.ti made it easy for every coder to have the same text and to be able to easily compare codes for sections of the text. the use of computer software also makes for flexibility in the coding process as new ideas or codes can be readily inserted. furthermore, exploratory coding schemes can be developed as soon as the first data are entered, yet because there is an ongoing record of codes and memos, these can be refined or revised upon reflection and more in-depth consideration of initial codes. fundamentally, it also makes the analytic process more transparent, as the process is explicit and easier to report. advances in social work, fall 2013, 14(2) 341 the potential downside is that the capability to deal with large samples can lead to a focus on quantity, rather than meaning. learning and using the software can in and of itself become a distraction, and the researcher needs to be careful not to let the structure of the software drive the research (lu & shulman, 2008). iterative process three levels of review were included in this iterative process: 1) the team of primary coders independent and combined coding; 2) integration of feedback from the authors of the manuals; and 3) integration of input from an external review team of non-developer trauma experts. 1) the primary author and two others read each manual independently, coding as they went. to be immersed in the content and assure that the material was understood, sections of the manual were often read more than once as the codes were developed. the three coders then met to review each chapter of the manual, compare codes, identify areas of agreement and disagreement, and discuss options for consolidation. this method is consistent with the recommendation for frequent and face-to-face communication among team members (laditka et al., 2009). the number of codes was not limited in the initial stages of the project, and after an analysis of three manuals, approximately 300 practice element codes had been developed. the process of dialogue, dissection of the codes, and reconceptualization based on mutual agreement resulted in consolidating the number of codes by the time of the analysis of the seventh manual to approximately 30 intervention objectives and 60 practice elements. with the analysis of the 7th manual, saturation was reached and no new intervention objective or practice element codes were found. these codes were then used successfully in the coding of the eighth manual. 2) outreach to ebtt authors. all of the authors were invited to comment and 5 of the 8 authors provided feedback to the research team. after codes were developed from a given manual, a report was generated for the authors. the authors were asked for both a reliability and validity check, that is, to see if the definition of the code adequately reflected the meaning they (the authors) would ascribe, based on a text sample from their manual provided for each code, and if the range of codes was sufficient to describe what they would estimate were the range of intervention objectives and practice elements contained in their approach. 3) a final step in the analysis was a review of the codes by the lead author and an external team of three additional trauma experts. the purpose of this review was to examine alternatives for further consolidation of the codes and to refine definitions of the codes. in writing definitions for the codes, the team retained the words of authors where relevant. this team met for two days and reviewed each of the codes. the final coding manual contained 35 intervention objectives and 59 practice element codes. strand, hansen, courtney/evidence-based trauma treatment 342 categorization there has been some attempt to define either the nature or levels of categorization as an aid to qualitative methods. rabinovich and kacen (2010) review the method developed by tutty, rothery, and grinnell (1996) in which three key relationship types were identified: contained, temporal, and causal. contained categories are those in which one category is contained in another, or several categories in one larger category. temporal relationships, however, reveal relationship in time, that is, which categories precede others. causal relationships identify the occasion when one category is the reason for another. in this study, “contained” categories were used. the large contained categories are termed “domains” for the purpose of this study. temporal categories are used to a lesser extent; however a temporal arrangement of domains is suggested. by combining practice elements in the same domain as intervention objectives, a link is made in a causal sense (intervention objectives in a domain are achieved through the implementation of certain practice elements). however, as described in more detail below, neither intervention objectives nor practice elements are viewed as mutually exclusive to a domain in practice. results as noted above, 35 intervention objectives and 59 practice elements were identified for the coding manual. findings suggest that there are, indeed, common intervention objectives and practice elements across trauma treatments. each code has a name and a 25 line description. an example of an intervention objective code is: address adversities in the social environment: includes activities aimed at addressing adversities which either pre-exist the trauma or are a secondary effect of the trauma experience with the goal of enhancing the ability of the social environment to support the child/family with needed resources and services. interventions may include advocacy, case management and/or collaborative intervention service planning. an example of a practice element code is: narrative story building: activities designed to provide a summary of important experiences which incorporate an integrated understanding of past experiences. may include the development of a “life story” book. includes activities designed to help the individual share their story and receive acknowledgement. consistent with the abstraction process identified above, categories were created with the purpose of bringing together codes that could be argued belong together conceptually. the codes were thus clustered into domains based on an estimation of shared properties. nine domains were identified, as follows: 1) trauma assessment: specific to activities undertaken to assess the presence and impact of trauma; advances in social work, fall 2013, 14(2) 343 2) safety: activities undertaken with or on behalf of the client to reduce the potential of harm to the child, self-harm, or harm to others, and to build stability within the social environment; 3) engagement: includes general assessment (non-trauma specific) as well as interventions to build a working alliance, increase motivation, identify obstacles and provide psychoeducation to the child and family; 4) attachment/strengthening relationships: activities undertaken to strengthen parent-child, caregiver-child and/or family relationships by enhancing attunement, communication and problem solving capacities; 5) core treatment interventions: interventions to reduce symptom distress and strengthen affective, cognitive and behavioral coping strategies within the context of the client’s culture. generally undertaken prior to trauma processing; 6) attention to the social context: activities undertaken with other service providers for collaborative treatment planning, advocacy or case management in an effort to address environmental adversities; 7) trauma processing: activities specific to processing and integrating traumatic experience. 8) consolidation/post trauma growth: future-oriented interventions subsequent to trauma processing focused on making meaning of the traumatic experience and promoting adaptive functioning. 9) therapist self care: interventions that the therapist engages in to anticipate and manage vicarious trauma or secondary traumatic stress; there is an inherent chronology in the listing of the domains in that to some extent the creation of the domains can be considered in temporal order. thus, assessment usually precedes treatment planning, safety planning precedes intervention, and intervention for trauma processing precedes post trauma growth or consolidation. however, the researchers caution against strict interpretation of these domains in temporal order, as assessment is on-going throughout treatment, regulation of affect may be achieved prior to trauma processing but need to be revisited during that phase of treatment, and issues in regard to safety can occur at any phase of treatment. table 2 lists these domains along with their respective intervention objectives and practice elements. it is acknowledged that these groupings are somewhat arbitrary and not mutually exclusive. the authors are of the opinion that a particular intervention objective could exist in more than one domain. for example, the intervention objective of “enhance affect/emotional regulation,” which is defined as “________to assure that emotional difficulties are less intense and manageable, to regulate affective emotional arousal to trauma reminders and foster the capacity to respond realistically to threats, and enhance existing strengths; includes the intention to identify feelings or emotional states, to interpret others' cues and expression, and to manage, organize, and coordinate emotional strand, hansen, courtney/evidence-based trauma treatment 344 responses; also includes the intention to help the client/client system share emotional experience,” could occur not only as part of the “core interventions” work done with clients (often undertaken before trauma processing), but also occur in the “trauma processing” phase of treatment. similarly, the practice element entitled “parent skills training/ development”, defined as “introduction of skills to support effective parenting (praise, positive attention, selective attention, etc.)”, could be used not only to achieve the objective of “improving parental/caregiver functioning or competence”, an objective in the “attachment/strengthening relationships” domain, but also to meet the objective of “building routines and rituals”, an objective in the “safety” domain. table 2. intervention objectives and practice elements by domain  domains intervention objectives practice elements trauma assessment 1. gather information 2. identify grief & loss 1. assess trauma/symptoms/reactions 2. assess presence of trauma reminders, triggers, stressors safety 1. promote safety 2. build routines & rituals 3. stabilization 1. safety planning 2. interventions to build routines & rituals 3. safety promoting interventions 4. safety actions engagement/general assessment 1. develop alliance/engagement 2. explain phases of treatment 3. treatment/intervention planning 4. promote understanding of dimensions important to treatment 5. evaluate treatment model or intervention 6. identify obstacles to intervention/treatment 7. increase motivation 1. psychoeducation about trauma and its impact 2. interventions to carry out treatment planning 3. interventions to promote therapeutic working alliance/engagement 4. assess individual 5. psychoeducation that is not trauma specific 6. assess family 7. generalized assessment instruments 8. assess eligibility for intervention/treatment 9. assess culture and religion attachment/ strengthening relationships 1. build problem-solving skills 2. improve parental/caregiver functioning or competence 3. improve family communication 4. improve family interactions/relationships 5. foster attachment 6. improve family structure 1. validating interventions 2. therapeutic interventions to improve parental functioning 3. interventions to improve family interactions & relationships 4. attunement promoting interventions 5. developmental guidance 6. parent skills training/development 7. interventions to strengthen family structure 8. interventions for circular causality continued advances in social work, fall 2013, 14(2) 345 table 2 (continued) domains intervention objectives practice elements core interventions 1. enhance affect/emotional regulation 2. enhance cognitive restructuring/regulation 3. enhance behavioral regulation 4. enhance capacity for physiological regulation 5. incorporate cultural sensitivity and spirituality 6. acknowledge the child’s reality 1. feelings identification 2. affect/emotion regulation 3. communicating emotions 4. intervening to improve family communication 5. behavior regulation interventions 6. cognitive regulation/restructuring interventions 7. problem solving interventions 8. social skills development 9. homework 10. mindfulness 11. relapse prevention 12. relaxation/stress reduction 13. attend to latent content 14. non-verbal interventions 15. interventions to incorporate cultural sensitivity and spirituality attention to social context 1. promote supportive networks 2. address adversities in the social environment 1. activities to promote supportive networks 2. case management’ 3. assess social environment 4. advocacy 5. crisis management 6. collaborative intervention service planning trauma processing 1. promote understanding of connection between trauma and current experience 2. process trauma memories/integrate trauma experiences 1. trauma-specific interventions/tools 2. narrative story building 3. interventions to process/integrate traumatic memories/experiences consolidation/post trauma growth 1. promote post trauma growth 2. build integrated sense of self 3. promote adaptive functioning 4. make meaning of experience 5. build family identity 6. promote therapeutic termination 1. termination rituals/interventions 2. interventions to promote adaptive functioning 3. build interpersonal competencies 4. interventions to build family identity 5. interventions to build an integrated sense of self 6. build cohesion 7. meaning making activities 8. strategies to promote post-trauma growth 9. intervention for grief/loss therapist self care 1. attend to self care 1. interventions to promote clinician self care while a determination of the frequency of the codes across the 26 manuals awaits further analysis, the commonality found in these manuals during the coding process warrant discussion. first, there is preliminary evidence that, indeed, evidence-based trauma treatments do contain common intervention objectives and practice elements. this finding was true across all domains but was particularly striking in some. for example, not surprisingly, almost all manuals articulated the objective of processing the trauma, defined in our codebook as: strand, hansen, courtney/evidence-based trauma treatment 346 “processing/integrating traumatic memories/experiences – the goal is to develop a coherent, integrated understanding of trauma and of the abusive parent, to unpair thoughts, reminders or discussions of the traumatic event from overwhelming negative emotions, mastering or re-integrating traumatic memories, to re-integrate painful memories, and to build individual and interpersonal resources to aid in this process.” the following reflect examples from 3 of the texts reflecting the intervention objective to “process trauma”: a) “work with children to actively explore, process, and integrate historical experiences into a coherent and comprehensive understanding of self in order to enhance their capacity to effectively engage in present life” (blaustein & kinneburgh, 2010, p. 209). b) “the main theme of the … phase is the establishment of therapeutic communication about the traumatic experience so that the child and family are no longer consumed by the traumatic experience” (saxe, ellis, & kaplow, 2008, p. 127). c) “ ___________ is designed to help both parent and child understand and modulate their responses to traumatic reminders, to help them find ways to calm and soothe themselves when faced with upsetting feelings, to restore their trust in one another, and to address these misattunements between the parent and the child” (lieberman & van horn, 2005, p. 12). another example of commonality is found in what we described as the “core treatment interventions” domain. the practice element “feelings identification” was defined as: “interventions or strategies to build a vocabulary for emotional experience in self and other, discriminate among emotional states, and to acknowledge the presence of mixed or ambivalent feelings.” the following are excerpts from three different manuals where this practice element entitled “feelings identification” was identified, illustrating the commonality of this practice element in many trauma treatment approaches. a) “there are several different ways to help children enhance their feeling identification and expression skills…. the therapist can initially ask the child to write down all the different feelings he/she can think of in 3 minutes (younger children may only be able to think of 5-10 feeling words, whereas adolescents will typically identify more feelings than they can write in 3 minutes). this exercise….” (cohen, mannarino, & deblinger, 2006, p. 88). b) “affect identification work often occurs in stages…. interventions may include: inviting the child to share daily emotional experiences (e.g. how are you feeling today?) ; naming emotions in the context of specific experiences (e.g. how did it feel when it happened?). inviting observation of the advances in social work, fall 2013, 14(2) 347 experience of others (e.g. how do you think jimmy was feeling when.…)” (blaustein & kinniburgh, 2010, p. 119). c) “use the "knots" and "personal power" thermometers at the beginning and end of each session to guide a child to step back, self-monitor, and share with therapists how they are feeling. it is important to check in with a child periodically throughout a session and the thermometers can be used at any time. this will help the child begin to connect external variables with differences in his or her internal states. use of the thermometers also provides a means for the therapist to validate a child's ability to 'stop' work that becomes too painful and to remind a child to utilize self-soothing skills.” (kagan, 2007, p. 106). these findings and many similar ones across the nine domains lead us to anticipate that continuing commonalities may emerge with a wider application of the codes to all 26 manuals. in the next phase of the coding project all 26 manuals will be coded by an independent coding team. discussion implications for social work education as noted above, the findings suggest that there are common intervention objectives and practice elements across trauma treatments. just as we have found it to be helpful in building foundational knowledge about trauma through the dissemination of the core concepts course, it is anticipated that it will be useful for msw students with only a beginning knowledge of trauma to be exposed to common intervention objectives and practice elements. learning common practice elements, in particular, may help prepare students for training post msw in specific trauma treatments. knowing why and how to do a trauma assessment, understanding key components in collaborative treatment planning and case advocacy, and learning some of the common practice elements like affect, behavioral, and physiological regulation, will develop a foundation upon which training in a specific evidence-based treatment can more easily be built. the development of curriculum materials to foster this learning will put msw students at an advantage in working with clients with histories of exposure to trauma. social work education reflects and attempts to imbue in the graduate the core value of the person-in-environment perspective. results of this project suggest that practice with the child’s family and social environment is essential to the delivery of evidencebased trauma interventions for children and adolescents. to prepare social work students for effective interventions will require elaboration of skills in working with traumatized children and their families in the social context. the second phase of curriculum development already underway by the nctsn ccct task force will assist social work educators with this task. however, new graduates will continue to be frustrated in their ability to deliver effective trauma services if the policy framework for reimbursement does not sufficiently support interventions in the social environment. social work strand, hansen, courtney/evidence-based trauma treatment 348 education will need to continue to educate students regarding effective policy advocacy as well as effective practice. implications for practice many of the implications discussed for social work education apply to current practitioners. however, the authors stress that the purpose of the coding project is to develop a familiarity among social work practitioners with trauma components common across interventions, and not the development of an intervention per se. it is critical to recognize that there is no empirical base for the effectiveness of individual components in trauma treatment; the research the field has compiled has studied these elements as they have been “packaged” by individual developers for specific target populations with specific modalities. it is the treatment as an entity that has an empirical base, not specific elements, “common” as they may be across trauma interventions. this is stressed in order to dissuade those who might think that because they have training in common elements they can practice trauma treatment. the evidence-based trauma treatments are still the class of interventions that have the best empirical support for working with traumatized children and adolescents. it is anticipated that familiarity with common elements will prepare practitioners for training in a specific evidence-based treatment. implications for social policy of particular interest was the emergence of three domains which are significantly consistent with the person-in-environment perspective of social work, and which have significant implications for policy. the domains are: 1) safety, 2) attachment/ strengthening relationships and 3) attention to the social context. the first—safety— often involves interventions in the social environment (family, school, and neighborhood) and with other service providers. the attachment/strengthening relationships domain includes a focus on improving attachment and relationships between the child and significant figures in the child’s environment: parents and siblings, extended family members, staff in residential settings, teachers, and peers. the third—attention to the social context—is specific to interventions undertaken in the social environment, and includes, among others, activities to promote supportive networks, crisis management, and collaborative intervention service planning. the relevance of these findings is that by and large these interventions involve activities outside of the 45(or in these times even 30-) minute “hour” of direct client contact for which mental health clinicians can typically claim reimbursement. intervention objectives (ios) and/or practice elements (pes) regarding the need to assure safety from future trauma or interpersonal abuse is a critical prerequisite for trauma treatment, and were found in 7 of the 8 manuals; those related to attachment/ strengthening relationships were found in all 8 manuals and io and/or pes regarding attention to the social context were found in 7 of the 8 manuals, suggesting how important, and common, these components are for trauma treatment. federal and state funding sources, as they become more actively involved in promoting the adoption of empirically-supported treatments, will need to take these advances in social work, fall 2013, 14(2) 349 factors into consideration. innovative examples for such funding streams exist. it is clear that the federal government, through samhsa, has taken an active role in forming trauma-based initiatives, researching and discussing trauma-informed care, identifying barriers to implementing trauma informed care and creating dialogue about possible solutions. trends related to mental health reimbursement are an obvious barrier to accessible trauma informed care for consumers. the states’ and insurance companies’ control over the “who, what, how, when, and where” of reimbursement makes implementation of trauma-informed services very challenging. a state example helps illustrate the dilemma. in 2006, the new york state office of mental health announced its achieving the promise initiative designed to authorize the single largest investment in children’s mental health services in new york’s history. as part of this initiative the child and family clinic-plus program was initiated in new york state. within this program, broad-based screening occurred as well as comprehensive assessment, expanded clinic capacities, inhome supports, and evidence-based practice supports. these features provided greater access and flexibility within the system to enhance positive outcomes. by 2009, however, a shift away from the expanded scope had already occurred in new york state with the initiation of a clinic restructuring implementation plan (nys office of mental health, 2009). despite attempts by the new york state office of mental health to soften the impact of this restructuring challenge, there is a dramatic shift occurring in the outpatient mental health service system in new york state. given that over 100,000 children and families receive services annually from clinics throughout new york state (nys office of mental health, 2006), the impact is extensive. the shifts will disproportionately affect families with fewer financial resources and the child welfare population who utilize mental health services from clinic settings with few other options available to them. as kazdin and nock (2003) point out, this issue is not limited to new york state. if 20% of the 70 million children and adolescents living in the united states suffer from developmental, emotional, or behavioral problems, then there are 14 million children who suffer from impairments in their functioning. social policy advocates will need to be vigilant to assure that further legislative changes do not disadvantage traumatized children and their families who are entitled to effective treatments, which will need to include community-based as well-as office-based intervention. implications for research assuming that the next phase of the coding project consolidates the identification of common intervention objectives and practice elements in trauma treatment, developing a second phase of the ccct curriculum will necessitate evaluation. does education at the graduate level in core concepts and components of trauma treatment prepare students for work with traumatized children and adolescents more effectively than education “as usual”? does this education in fact accelerate the acquisition of an ebtt? does inservice training for agency-based practitioners have similar results? at the direct practice level, intervention studies to investigate the critical or “traumaspecific ingredients” of the social, or person-in-environment practice elements for strand, hansen, courtney/evidence-based trauma treatment 350 effective trauma treatment will be helpful and absolutely essential before the field of trauma treatment considers a move to a common elements intervention approach as advocated by chorpita and colleagues (2011) and barth and colleagues (2012). comparative studies undertaken in environments that allow for provision of all elements of evidence-based trauma treatment in contrast to those environments that do not support the social context elements will also advance the fields’ understanding of the relevance of the array of practice elements. there continues to be a need for research that compares different interventions to each other and for research undertaken by investigators other than the developers of individual trauma treatments. limitations of the study limitations include the lack of a methodology to calculate statistical inter-rater reliability. there are now methods to do this; lack of time and resources meant that the research team relied on discussion, comparison and deconstruction in our deliberations to establish reliability. the coding manual may have been strengthened by more precise attention to this matter. the review at two additional levels was an attempt to assure the development of meaningful and representative codes. a second limitation is that not all 8 manuals used for this project were child and adolescent treatment manuals; one was an intervention designed for post-disaster work. this potentially skews the sample in unexplored ways. a third limitation is that implications are developed based on the coding of a sample of manuals, not all 26. the issues discussed must therefore be viewed as ideas for further consideration, not generalizations that are informed by the research. fuller confidence in the inferences drawn awaits further analysis of the 26 manuals. while the authors anticipate that these findings may not be so different—partly based on the high level of evidence supporting the 8 trauma manuals used to develop the codes— the findings need to be viewed as preliminary. conclusion as the search for common elements in evidence-based treatments has gathered steam, researchers and practitioners are increasingly turning to qualitative methods to synthesize what is known about empirically supported treatments for a given problem or class of disorders for particular client groups (bisson et al., 2010; hsieh & shannon, 2005; sburlati et al., 2011). this study adds to the growing literature, serving as an important place-holder for common components across evidence-based trauma treatments in the absence of more rigorous dismantling studies for many empirically-supported trauma interventions. it provides benchmarks for practitioners against which to evaluate a given trauma treatment as well as providing an important knowledge base for trauma education and training. evidence-based trauma treatments do appear to have common intervention objectives and practice elements. incorporating these into social work education and agency inservice training has promise for increasing the preparedness of both msw students and practitioners for trauma treatment. these evidence-based treatments typically have elements that require activity on the part of the clinician in the client’s social environment advances in social work, fall 2013, 14(2) 351 and beyond that of office-based direct client contact. this will remain true even with a move toward a “common elements” or modular intervention for trauma treatment. the emphasis placed on the importance of providing empirically-supported interventions is based on a shared value among mental health providers including social workers, psychiatrists, psychologists, and others of the imperative to provide the best available mental health treatment for children and families. this value resonates with the social work principles of human rights and social justice which assert that children and families have a right to the best available health care. if as these results suggest, trauma treatment needs to include person-in-environment interventions, then reimbursement support clearly needs to be expanded to move us in this direction. social work professionals have the ethical obligation to incorporate new knowledge into education and practice and to advocate for responsible and reliable choices in policies that affect the availability of effective services for traumatized children and their families. references anda, r. f., felitti, v. j., bremner, j. d., walker, j. d., whitfield, 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(2008). evidence-based psychotherapy for children and adolescents: data from the present and a model for the future. child and adolescent mental health, 13(2), 54-65. doi:10.1111/j.1475-3588.2007.00475.x author note: address correspondence to: virginia c. strand, professor, graduate school of social service, fordham university, 400 westchester ave., west harrison, ny 10606. email: strand@fordham.edu microsoft word 17-3811 crespo rivera_voces de los menores inmigrantes final ______________ evelyza crespo-rivera, ph.d. catedrática auxiliar, directora del departamento de trabajo social, escuela de ciencias sociales y humanas, universidad del este. agradecimiento especial a la dra. marilis cuevas torres por su colaboración en la edición de este artículo.  copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 289-306   voces de los menores inmigrantes en el sistema de cuidado sustituto de puerto rico evelyza crespo-rivera resumen. el objetivo central de esta investigación es comprender las experiencias de los menores inmigrantes bajo la custodia del estado. además, busca describir la política pública y las prácticas diseñadas por el estado para responder a las necesidades de los menores inmigrantes desde la realidad jurídica social de puerto rico. el estudio es cualitativo y el enfoque que se utilizó es la técnica de la triangulación de datos para poder construir las situaciones por las cuales los participantes atravesaron y al mismo tiempo, comparar sus percepciones con los escritos de las agencias sociales y las políticas estatales que abogan a favor de la protección, la seguridad, la calidad de vida y la no discriminación. la investigación permite concluir que son los menores de la población inmigrante quienes pueden relatar sus vivencias y construir un marco de referencia para mejorar la intervención y la aplicación de las políticas existentes. el estudio recomienda que se incluyan a aquellos que fueron inmigrantes bajo la custodia del estado en comitivas de distintos grupos de interes que abogan por el bienestar de tal población. palabras clave: menores inmigrantes, servicios de protección, cuidado sustituto, derechos humanos los menores inmigrantes y sus familias representan una de las poblaciones de mayor crecimiento en los estados unidos. durante los años 1990, más de 15 millones de inmigrantes entraron a los estados unidos en comparación con 10 millones en la década de los 1980 y 7 millones en los 1970 (capps & fortuny, 2006). actualmente, la cantidad de menores inmigrantes participantes en el sistema de cuidado sustituto es desconocida. la información estadística no se recoge de manera uniforme ni en los estados de la nación norteamericana ni en informes estadísticos a nivel nacional. la ley de puerto rico núm. 338 del 31 de diciembre de 1998, conocida como la carta de derechos de los niños, reconoce la responsabilidad del gobierno del estado libre asociado de puerto rico de propiciar el máximo desarrollo social y emocional de los niños puertorriqueños. el estado, a través de las leyes y políticas públicas de las agencias de bienestar infantil, establece como política pública que los menores en el sistema de cuidado sustituto reciban servicios de calidad, protegiendo su seguridad, permanencia y bienestar. en puerto rico, el sistema de cuidado sustituto está bajo la responsabilidad de la unidad de administración de familias y niños del departamento de la familia. la administración de familias y niños fue creada en virtud del plan de reorganización número 1, del 28 de julio de 1995, el cual reorganizó y denominó el departamento de servicios sociales como departamento de la familia. dentro de esta agencia, la crespo-rivera/voces de menores inmigrantes 290 administración de familias y niños, a través de la administración auxiliar de cuidado sustituto y adopción, es la agencia responsable de implantar la política pública establecida en la ley de puerto rico número 177 del 1ro de agosto de 2003, ley para el bienestar y la protección integral de la niñez, así como se encarga de desarrollar los programas, servicios y recursos para la atención de los/as menores removidos de sus hogares de origen. posteriormente, se aprobó en puerto rico la ley 246 del 16 de diciembre de 2011 ley para la seguridad, bienestar y protección de menores, para derogar la ley anterior. con esta ley, se presentó un cambio de política pública del estado referente a los esfuerzos razonables:   será política pública que en los casos donde surja un conflicto de intereses entre el custodio del menor y el mejor bienestar del menor, debe priorizarse el bienestar del menor. esto aplicará en todos los procesos administrativos y judiciales que se lleven a cabo como consecuencia de esta ley (ley 246 del 16 de diciembre de 2011, párrafo 7). se espera que el sistema de cuidado sustituto proporcione un hogar mejor al natural para el crecimiento integral del menor. de acuerdo a datos del national child abuse and neglect data system, del año fiscal 2011, los hispanos representan en 22.1% de los menores en el cuidado sustituto a nivel nacional. según el sistema de información y seguimiento del departamento de la familia (2012), en puerto rico, para el 2009, había 6,950 menores en el sistema de cuidado sustituto, de los cuales 1,943 residían con familiares. al considerar la información acerca de los menores inmigrantes y las políticas que regulan los protocolos de los casos en puerto rico, el propósito de esta investigación fue analizar desde un enfoque cualitativo, la condición de invisibilidad y vulnerabilidad de los menores inmigrantes en custodia del estado. como así también, describir las políticas públicas y las prácticas del estado para responder a las necesidades de la comunidad inmigrante desde la realidad jurídica social de puerto rico. este estudio pretende contribuir al entendimiento de las experiencias de la niñez inmigrante en el sistema de cuidado sustituto y cómo se relaciona con la política pública vigente y las prácticas del estado que responden a las necesidades de dicha comunidad en puerto rico. tal como se señaló anteriormente, la niñez inmigrante y sus familias representan una de las poblaciones de más rápido crecimiento en los estados unidos, por lo que no es de extrañar similitudes proporcionales en la isla, no solo por la relación que mantenemos con los estados unidos, sino por la posición geográfica de puerto rico en el caribe. el fondo de las naciones unidas para la infancia (unicef) trabaja con los gobiernos, las comunidades locales y otros organismos de más de 160 países, territorios y regiones para promover los derechos de la niñez y suministrar atención a la nutrición, educación y salubridad. este fondo es el único organismo de las naciones unidas dedicado exclusivamente a la niñez que defiende sus intereses y promueve la plena aplicación de la convención sobre los derechos del niño (unicef, 2006). advances in social work, spring 2013, 14(1) 291 la declaración de los derechos del niño (1959) dispone que "el niño, por su falta de madurez física y mental, necesita protección y cuidados especiales, incluso la debida protección legal, tanto antes como después del nacimiento" (preámbulo, párrafo 3). se trabaja con los principios sociales y jurídicos relativos a la protección y el bienestar de los niños, con particular referencia a la adopción y la ubicación en hogares de crianza en el plano nacional e internacional. la necesidad de proporcionar a los menores una protección especial fue enunciada inicialmente en la declaración de ginebra de 1924 sobre los derechos del niño y en la declaración de los derechos del niño, adoptada por la asamblea general el 20 de noviembre de 1959. además, se reafirmó en el pacto internacional de derechos civiles y políticos (en particular, en los artículos 23 y 24), en el pacto internacional de derechos económicos, sociales y culturales (con énfasis específicamente, en el artículo 10) y en los estatutos e instrumentos pertinentes de los organismos especializados y de las organizaciones internacionales que se interesan en el bienestar del niño. en puerto rico, la constitución del estado libre asociado de puerto rico en su carta de derechos (1952) expresa que la dignidad del ser humano es inviolable: “todos los hombres son iguales ante la ley. no podrá establecerse discrimen alguno por motivo de raza, color, sexo, nacimiento, origen o condición social, ni ideas políticas o religiosas” (artículo ii, párrafo 1). por lo tanto, dentro de este contexto los menores inmigrantes, sin importar su procedencia, tienen derecho de trato justo hacia la satisfacción de sus necesidades básicas. además, la ley 338 del 31 de diciembre de 1998 expresa que: el estado libre asociado de puerto rico, con plena conciencia de que es su responsabilidad lograr el máximo desarrollo y bienestar de todos los niños del país, declara que todo niño en puerto rico, desde su nacimiento hasta los veintiún (21) años de edad, y sin menoscabo de las leyes vigentes, tendrán derechos dirigidos a que se le garantice la vigencia efectiva de los derechos consignados en la constitución del estado libre asociado de puerto rico y en las leyes y reglamentos que le sean aplicables (artículo ii, párrafo 1). objetivos de investigación para la consecución del propósito de investigación planteado, se delinearon los siguientes objetivos:  describir las necesidades de la niñez inmigrante en puerto rico que se ubica en hogares sustitutos.  describir las percepciones de los menores inmigrantes en relación a los servicios de protección que les provee el estado.  sugerir diseños de política inclusiva apoyando el mejoramiento de los servicios a la niñez, la juventud y sus familias. en términos generales, esta investigación pretendió mediante sus hallazgos dar respuesta a las siguientes interrogantes: ¿cómo las personas participantes describen su experiencia migratoria como menores de edad en custodia del estado? ¿cómo las crespo-rivera/voces de menores inmigrantes 292 personas participantes describen su experiencia en el sistema de cuidado sustituto? ¿cómo definen los derechos humanos? finalmente, ¿cuál es la percepción de la población menor inmigrante en cuanto a los servicios provistos y coordinados por el sistema de cuidado sustituto para el logro de sus planes de permanencia? marco conceptual el marco conceptual bajo el cual se planteó esta investigación es la perspectiva construccionista. el tema de la inmigración representa una categoría de acuerdo al contexto y a quién se define. para entender el concepto de inmigración, es necesario considerar los elementos estado, nacionalidad y ciudadanía. el estado es central porque representa el ente llamado a garantizar que todas las personas en su jurisdicción o territorio tengan completo goce de sus derechos humanos. el concepto de ciudadanía se convierte en eje central de la discusión en las democracias modernas dadas las contradicciones en el principio de igualdad y la particularidad de la diferencia de las mujeres y otros grupos excluidos. la nacionalidad es fundamental en este contexto porque ahí es donde se dan las brechas de lo que pertenece y es relativo a un país (acevedo, agostini, & murúa, 2003). además, el contexto social juega un rol bien importante en torno al trabajo de las leyes protectoras de los más desventajados. la represión, tanto en países en vías de desarrollo como en los más ricos y poderosos, demuestra que, en lo cotidiano, se dan situaciones contrarias a lo legal y a lo moral. se destacan tres tipos de ciudadanía entre los inmigrantes: (a) los que obtienen la ciudadanía formalmente, (b) los que reciben algún beneficio, pero no tienen una ciudadanía formal y (c) los llamados ilegales o indocumentados. acevedo et al. (2003), enlazando el tema de ciudadanía e inmigración, señalan que la situación de los inmigrantes manifiesta las injusticias sociales presentes en nuestra democracia, porque tienen que soportar discriminación y la negación de sus derechos como ciudadanos. es por ello que resulta relevante examinar las percepciones de los inmigrantes respecto a lo que ellos representan para el estado. la necesidad de comprender el sentido de la acción social en el contexto del mundo de la vida desde la perspectiva de los actores, requiere el enfoque de paradigmas cualitativos. particularmente, desde este enfoque kisnerman (2005) y gergen (2009) convergen en referir la importancia al contexto y al protagonismo de la interpretación de los actores. específicamente, gergen (2009) señala que lo más importante, desde el construccionismo es la deconstrucción, la participación de los sujetos y las posibilidades de la reconstrucción de nuevas realidades con la intención de abogar hacia una transformación cultural. es ahí donde la ciencia logra su cometido, por lo tanto, es esencial en este estudio examinar la realidad desde la interpretación de los menores inmigrantes. por otro lado, berger y luckman (2005) argumentan que la sociología del conocimiento debe ocuparse de lo que la gente conoce como realidad en su vida cotidiana, una realidad que es a su vez opresiva y presenta retos de sobrevivencia ante un contexto no planificado. cuando las personas no son consideradas ni tratadas de manera equivalente da lugar a vivir bajo coerción y dominación. la desigualdad es el resultado advances in social work, spring 2013, 14(1) 293 de las prácticas y actitudes hacia las diferencias, sean de raza, orientación sexual, género, edad, necesidades especiales, condición económica, u origen étnico. considerando los teóricos antes esbozados, se establece como necesario darle voz a la población y considerarla en el diseño de los servicios. en puerto rico hay mucho desconocimiento sobre la existencia de la inmigración y no se han generado investigaciones relativas a la situación de los menores inmigrantes. es por ello que se debe hacer referencia a estudios previos en contextos similares. quiñonezmayo y dempsey (2005) enfatizaron el reto que enfrentan los manejadores de casos, cuando asisten a familias latinas, para mantener la integración familiar y fomentar la adaptación cultural de los menores. mientras que capps, rosenblum, rodríguez, y chisthi (2011) investigaron sobre las redadas del inmigration and custom enforcement en el lugar de trabajo de las personas inmigrantes y el impacto dramático que tienen en las comunidades, earner (2007) trabajó con dos grupos focales en new york investigando las experiencias de los padres y madres inmigrantes con el proceso de investigación en protección a menores. por otro lado, dettlaff y fong (2011) argumentaron sobre la necesidad de evaluar los programas en cuanto a la competencia cultural. de ello se desprendió que resulta fundamental la competencia cultural para los profesionales que ofrecen servicios y asistencia a inmigrantes. a partir de la literatura, queda evidenciado que los profesionales y las agencias del estado deben estar preparados para responder, de manera competente, respetuosa, y efectiva, a personas de todas las culturas, clases, razas, trasfondos, etnias, orientación sexual, creencias y religiones de manera que se reconozca la dignidad del ser humano. método la investigación cualitativa permite un acercamiento a los fenómenos de manera particular, dando énfasis prioritario a los detalles y a la individualidad. la investigación cualitativa es el cuerpo de conocimientos que conforman los distintos diseños y estrategias de investigación que producen datos o información de manera textual, visual o narrativa, los cuales se analizan a través de medios no matemáticos (lucca & berríos, 2009). kisnerman (2005) habla de la investigación como un modo de emancipación, construcción de sujetos vinculando sus representaciones y centrado en los procesos sociales. a partir de estos supuestos, la información relevante y hasta repetitiva de los menores, obtenida en esta investigación, nos ayuda a analizar este fenómeno desde distintos puntos de vista. en esta investigación, se utilizó el estudio de caso múltiple para entender las experiencias de los menores inmigrantes. se presentaron las experiencias de los participantes para examinar cómo sus vivencias contrastan con los datos descriptivos de los expedientes oficiales de la agencia principal proveedora de servicios. esta investigación es de carácter descriptivo y se caracteriza por las diversas maneras de acercarse al tema de estudio mediante el análisis de documentos y de políticas públicas existentes, entrevistas a los participantes de servicios impactados por tales políticas y notas de campo. se utilizó varias estrategias de recopilación de información con el fin de triangular la misma. crespo-rivera/voces de menores inmigrantes 294 instrumentos la investigación constó de tres instrumentos para la recopilación de datos. el primero de ellos fue la hoja para guiar la lectura de los expedientes de archivo. el instrumento de lectura de expedientes contiene una lista de indicadores observables en las distintas secciones de los expedientes sociales de la administración de familias y niños. las evidencias documentales tenían áreas relacionadas a: (a) cumplimento de términos de acción prestablecidos por los protocolos de la agencia, (b) interpretaciones hechas a la población de los distintos acontecimientos dentro de su caso, (c) la participación familiar, (d) servicios provistos, (e) evidencia de las notificaciones consulares, (f) planes de servicios y planes de permanencia, y (g) contacto con familiares tanto en su país de origen como en puerto rico. el segundo instrumento fue la guía para el análisis de los documentos relacionados a la ley estatal de protección a menores, las cartas normativas y el manual vigente de servicios a menores en el sistema de cuidado sustituto. la guía de análisis de política se basó en los argumentos planteados por bardach (2005), que propone evaluar la calidad de las políticas públicas de acuerdo a los siguientes criterios: análisis, recopilación de evidencia, construcción de alternativas, selección de criterios, proyección de resultados, compensación de pérdidas, y decisión y divulgación de resultados. el tercer instrumento para la recopilación de datos fue la guía de preguntas para las entrevistas, que incluyó: (a) la experiencia de emigrar a puerto rico de los entrevistados o de sus padres o madres, (b) la relación cultural y su experiencia en el país receptor, (c) el proceso de remoción o rescate, las relaciones familiares pasadas y vigentes, incluyendo la relación con sus hermanos y hermanas, (d) la provisión de servicios relacionados a su condición de menor inmigrante, (e) la relación con su(s) manejadora(s) de casos (se refiere al puesto oficial del trabajador social y técnico de servicios encargados de los menores en la agencia), (f) su experiencia general en el sistema de cuidado sustituto, (g) sus recomendaciones para mejorar el servicio a otros menores y (h) sus planes futuros. participantes en esta investigación la unidad de estudio estaba constituida por la juventud inmigrante de primera y segunda generación activa en el sistema de cuidado sustituto en puerto rico. se seleccionó un total de nueve jóvenes, de los cuales se analizaron sus expedientes, pero solo se entrevistaron a ocho de ellos. todos los menores cumplían con los criterios de inclusión: (a) tenían entre 14 a 18 años, (b) estaban bajo la custodia activa del estado a través del departamento de la familia, (c) hablaban español, (d) permitieron que se grabara la entrevista, (e) su participación fue voluntaria, y (f) estaban bajo la custodia del estado por más de seis meses. dos de los participantes se encontraban confinados al momento de la entrevista. la población inmigrante es una de difícil reclutamiento por los temores inherentes a su condición de legalidad migratoria. se hizo claro que la información recopilada no sería utilizada por las agencias relacionadas con inmigración. no obstante, tomó tiempo ganar la confianza de los posibles participantes para acceder a las entrevistas. advances in social work, spring 2013, 14(1) 295 procedimiento este estudio contó con la autorización del comité institucional para la protección de los seres humanos en la investigación de la universidad de puerto rico, recinto de río piedras y del departamento de la familia de puerto rico. los posibles participantes fueron identificados por la persona designada en la administración auxiliar de cuidado sustituto y adopción y éstos a su vez, se comunicaron con los manejadores de casos. se procedió a entregar al funcionario designado a nuestra investigación la promoción necesaria para el reclutamiento de los posibles participantes y los manejadores de casos. los participantes recibieron información escrita sobre el estudio. las entrevistas se realizaron de acuerdo a la situación del menor (residencia de los participantes, escuela, centro correccional o universidad) y tuvieron una duración aproximada de entre 30 a 45 minutos. todas las entrevistas fueron grabadas en cinta magnetofónica y luego transcritas. análisis de la información en esta investigación se trabajó con el modelo planteado por wolcott (2009) que consiste de tres componentes principales: descripción, análisis e interpretación. la descripción, sostiene el autor, se refiere al proceso mediante el cual ilustramos los relatos de lo ocurrido u observado. el análisis se refiere a las interrelaciones, que como investigadores, establecemos entre diferentes elementos de una situación bajo estudio. finalmente, la interpretación responde a las inferencias que derivamos acerca del significado de los datos en el contexto. la triangulación de datos fortalece el estudio utilizando las diferentes fuentes de recopilación de información. por lo tanto la información proveniente de las entrevistas, el análisis de expedientes sociales y la observación ofrecen la información necesaria para la interpretación. se desarrollaron categorías iniciales, basadas en la literatura, para codificar la información obtenida de los documentos y de las entrevistas. durante el proceso de análisis, también fue necesario incorporar nuevas categorías para la codificación. el análisis de los códigos mediante categorías se elaboró utilizando el programa nvivo8. resultados y discusión el marco del construccionismo social sirvió para explicar los resultados del estudio, y a partir de ello, construir conocimiento específico en torno a las políticas públicas que abarcan la situación de los menores inmigrantes en puerto rico. en esta sección se presentan y analizan los hallazgos desde la perspectiva del análisis cualitativo. la organización de los resultados presentados se enmarcó en tres de las categorías principales de análisis: (a) vivencias como menores inmigrantes, (b) servicios provistos y coordinados por el sistema de cuidado sustituto y (c) construcciones por parte de las personas participantes sobre sus derechos (véase tabla 1). la discusión de estas categorías surgió de las verbalizaciones de los participantes así como de la información contenida en los expedientes sociales correspondientes y del contenido de la política crespo-rivera/voces de menores inmigrantes 296 pública. para garantizar el anonimato de los participantes se utilizaron seudónimos y se eliminaron las conexiones con los lugares específicos de origen y otra información sensitiva de las verbalizaciones. primera categoría de análisis: vivencias de los menores inmigrantes. un hallazgo importante de la categoría vivencias de los menores inmigrantes fue que el historial de los participantes en la agencia correspondiente, no contenía evidencia de los documentos migratorios o no estaban actualizados para hacer gestiones (ej. visa o permiso de estudio y trabajo). en términos del análisis de las entrevistas a los menores, indicó que debido a razones económicas, políticas, religiosas y sociales, muchas personas abandonan sus países de origen para mejorar sus condiciones de vida y la de sus familiares. siete de los ocho menores hicieron el viaje con sus familias, cinco eran infantes o preescolares al momento de la travesía y no recordaban con claridad el momento ni las circunstancias del viaje. una de las participantes relató el viaje con cierta superficialidad. en el caso de linda, las circunstancias del viaje no estaban claras y se percibieron indicios de tráfico humano que no pudieron ser validados desde esta investigación. en cuanto al análisis de las políticas públicas, en la normativa del departamento de la familia (normativa:  orden administrativa para disponer el procedimiento a seguir cuando personal del departamento de la familia interviene con menores o familias extranjeras, df-05-001) se dispone que en el caso de menores inmigrantes las agencias correspondientes deben establecer normas y procesos, deben facilitar la coordinación entre las agencias, y el departamento de la familia debe ser responsable de que lo dispuesto se cumpla. a partir del análisis de las entrevistas y los expedientes, se pudo contrastar que la información obtenida no fue congruente con lo dispuesto en la política pública. los expedientes no contenían la evidencia suficiente para validar que los menores pasaron por los procesos adecuados para la documentación legal. segunda categoría de análisis: servicios provistos y coordinados por el sistema de cuidado sustituto. en esta categoría surgieron datos relacionados con la experiencia educativa de los menores en puerto rico, sus experiencias con la receptividad comunitaria, y la aceptación de sus costumbres como la alimentación, prácticas religiosas e idioma. es importante recordar que la cultura es una serie de creencias, actitudes, y estándares de comportamiento transmitidos de una generación a la otra (siegel, 2010). por otro lado, la cultura étnica es la que da sentido de pertenencia, es excluyente de un grupo a otro y no es estática (fontes, 2005), dadas las influencias contantes que tienen los grupos de enfrentar los nuevos retos tecnológicos, económicos y sociales que enfrenta una generación versus otra. advances in social work, spring 2013, 14(1) 297 tabla 1 resumen de hallazgos de las categórias principales categoría entrevista expedientes política vivencias de los menores inmigrantes al momento del viaje la mayoría eran infantes o pre-escolares y no tenían claro las circunstancias y eventos del viaje migratorio. no contienen documentos (ej. visa o permiso de estudio y trabajo) migratorios o no estaban actualizados para poder hacer gestiones para estudio y trabajo. df-05-001 carta normativa: “notificación consular cuando se interviene con menores o familias extranjeras” dispone la política pública sobre la protección de los menores basada en su desarrollo integral; adoptar las medidas y mecanismos protectores necesarios; establecer las normas que regirán los procesos administrativos y judiciales; facilitar la coordinación multisectorial y entre las agencias; facultar al departamento de la familia a implantar esta ley; tipificar delitos e imponer penalidades. (página 1) servicios provistos y coordinados por el sistema de cuidado sustituto los participantes son desertores escolares, otros están en el sistema público de enseñanza, aunque en varios casos, la edad no corresponde al grado (rezago académico). rescate del significado de la escuela y comunidad y actividad religiosa reportan los diferentes grados académicos alcanzados. no se desprende evidencia documental relacionada a la evaluación psicológica o dental requerida a la población. adfan-ps-csa-2006-009 carta normativa:” evaluación y prestación de servicios de salud física y mental” dispone que las necesidades de salud física de los menores en cuidado sustituto deben ser evaluadas anualmente, a menos que las condiciones de los menores requieran evaluaciones más frecuentes. los servicios médicos a ofrecerse deben ser adecuados y los necesarios de acuerdo a la situación y edad del menor. esto incluye, pero no se limita a, evaluación y cuidado preventivo, salud oral, laboratorios y tratamiento para condiciones médicas. en el caso de menores en cuidado sustituto el/la funcionario/a que tenga a su cargo la atención del caso se asegurará de evaluar al menor al momento de su colocación inicial y en las reubicaciones subsiguientes. los menores que reciben servicios de protección social en el hogar, serán evaluados cuando el área de salud física o mental se considere afectada por la situación de maltrato o negligencia, especialmente en menores víctimas de abuso físico y sexual. los menores que requieran servicios en el área de salud mental deben ser evaluados y recibir servicios de acuerdo a su necesidad y condición. siempre que existan indicadores de problemas de salud mental deben realizarse evaluaciones lo más pronto posible. menores bajo la custodia del estado, deben recibir una evaluación al momento de ingresar a cuidado sustituto.” (página 1) crespo-rivera/voces de menores inmigrantes 298 tabla 1 (cont.)   categoría entrevista expedientes política construcciones por parte de los participantes sobre sus derechos no tiene claro cuáles son sus derechos. dificultades de adaptaciones en términos del proceso en el cual son custodios bajo el departamento de la familia u hogares sustitutos. no perciben a los manejadores de caso como defensores de sus derechos, sino a otras personas significativas en su vida. derechos humanos etéreos. en uno de los casos hubo coordinación con las agencias de inmigración y aduana federal para el proceso de extradición a la republica dominicana. este trámite era desde la óptica legal y no desde la provisión de servicios para la reunificación familiar. en el resto de casos estudiados no se evidenciaron trámites para garantizar derechos de legalidad migratoria y otros derechos ciudadanos. ley para la seguridad, bienestar y protección de menores, art. 2 ley 246 del 2011 “los menores tienen derecho a la vida, a una buena calidad de vida y a un ambiente sano, en condiciones de dignidad y goce de todos sus derechos en forma prevalente. la calidad de vida es esencial para su desarrollo integral, acorde con la dignidad de ser humano. este derecho supone la generación de condiciones que les aseguren desde la concepción, el cuidado, la protección, la alimentación nutritiva y equilibrada, el acceso a los servicios de salud, la educación, el vestuario adecuado, la recreación y la vivienda segura dotada de servicios públicos esenciales en un ambiente sano.” ley para la seguridad, bienestar y protección de menores, artículo 3 de la ley 226 (inciso jj): “protección integral el reconocimiento como sujetos de derechos, la garantía y cumplimiento de los menores, la eliminación de la amenaza para la seguridad de su restablecimiento inmediato en desarrollo del principio del mejor bienestar del menor. la protección integral se materializa en el conjunto de políticas, planes, programas y acciones que se ejecuten con la correspondiente asignación de recursos financieros, físicos y humanos.” advances in social work, spring 2013, 14(1) 299 la información recopilada en relación a la experiencia educativa en puerto rico parte de las entrevistas con los menores y la información en los expedientes sociales. esta categoría indicó que dos de las personas participantes no estaban en la escuela, dos habían terminado estudios técnicos (enfermería y artes culinarias), cuatro estaban en la escuela secundaria y uno tomaba clases en el programa de educación especial. ninguno de ellos había terminado su escuela de manera regular, es decir que en todos los casos se encontró un desbalance entre la edad cronológica y el nivel escolar alcanzado. esta información se recogió esencialmente de los entrevistados ya que los expedientes solamente contenían los grados alcanzados y las anotaciones no estaban escritas de manera secuencial. dada la diversidad étnica, social y religosa presente en el sistema de la educación publica de puerto rico, es difícil para los académicos poder ajustar sus modalidades pedagógicas a los distintos estilos de aprendizaje y necesidades de los alumnos. todos los participantes habían utilizado el sistema de educación pública de puerto rico, excepto linda, quien estudiaba en un colegio privado al momento de la remoción. luego de ese cambio, ella ingresó en el sistema público de enseñanza del departamento de educación y se encuentra actualmente en undécimo grado. en el caso de caleb, la escuela es muy significativa, ya que él la identifica como su espacio donde tiene que defender a sus hermanos y a si mismo de las burlas de sus compañeros por razón de su origen étnico. su dialecto y el de sus hermanos es “papiamento”. caleb relata sus experiencias en la escuela de la siguiente manera: “eso sí. ahí se reían de mí. yo peleaba …yo iba pa’ la escuela a pelear na’ más”,… “no, en verdad, yo iba ahí… a la escuela to’ los días y yo estaba ansioso porque llegara las seis de la mañana y las tres de la tarde… pa’ pelear… con mis otros hermanos… [se ríe]. y si me-se metían con uno, los otros le brincaban encima. eran como que un tres pa’ uno…” la investigación sugiere que la niñez y la juventud en hogares de crianza no están teniendo éxito en la escuela. claramente es necesario un esfuerzo concertado para poder obtener mejores resultados. cónsono con este hallazgo, el departamento de salud y servicios humanos federal (2010) informó que en 52 estados y jurisdicciones que participaron en los procesos de evaluación y monitoria federal entre los años 2007 al 2010, se evidenció que las necesidades educativas no fueron satisfechas de manera adecuada. específicamente en las transferencias de expedientes, comunicación y retrasos en las matrículas escolares. nuestra investigación es una evidencia más de esta realidad en la cual los participantes tienen rezago académico, son desertores o están en una gran desventaja en sus escenarios escolares. ninguna agencia cuenta con los recursos, ni la experiencia para proporcionar los servicios necesarios para atender las necesidades de esta población de alto riesgo. la agencia de protección, las escuelas, las familias y la propia juventud deben trabajar juntos de manera estratégica en nuevas formas de abordaje y con gran energía para acelerar, ampliar y unificar esfuerzos para lograr mejores resultados (zeitlin, weinberg, & shea, 2006). por otra parte, al analizar la política pública, se encontró que, según establecido por las normas del departamento de la familia (adfan-ps-csa-2006-009), las crespo-rivera/voces de menores inmigrantes 300 estipulaciones se concentran en atender las necesidades de salud física, psicológica y mental de los menores. la política establece que los menores deben evaluarse anualmente, a menos que presenten una condición que requiera evaluaciones frecuentes. es alarmante que en los expedientes examinados no se encontrara evidencia si los menores habían recibido estas evaluaciones, aun cuando deben documentarse todas las gestiones realizadas por el manejador de casos. del análisis de las entrevistas, surgió información relacionada al desarrollo de identidad cultural en la categoría servicios provistos y coordinados por el sistema de cuidado sustituto. los menores enfrentaron dificultades de adaptación en la comunidad, relacionadas mayormente con la situación de estar bajo la custodia del gobierno. a pesar de la remoción, ellos estaban en comunidades donde su identidad cultural era reconocida. en el caso de linda, ella vivía en una comunidad donde la iglesia y los negocios eran frecuentados por personas de su mismo origen étnico (china). en el caso de los participantes provenientes de la república dominicana, ellos vivían en comunidades donde se sentían protegidos por sus compatriotas. en el tema de experiencias culturales se exploraron las vivencias en cuanto al tema de religión, alimentación e idioma. la cultura étnica incluye el lenguaje, la visión de mundo, vestimenta, alimentos, estilos de comunicación, nociones de bienestar, estilos de crianza y auto-concepto (abney, 2002). linda, la menor oriunda de china, hablando de su dieta actual en el hogar sustituto expresó lo siguiente: “pues, sí, me respeta […] nosotros comemos más saludable, sin mucho… poco sal, poco aceite; pues… ellos comen mucho.” en cuanto al tema de religión, dos de los menores señalaron participar de alguna actividad religiosa de manera constante y un menor que se encontraba confinado al momento de la entrevista participa de manera casual. aquellos que participan de algún tipo de actividad religiosa indican que ésta no tiene relación con la religión practicada por sus padres, madres o personas responsables de ellos antes de la remoción. ambos menores expresaron que la experiencia de participar de comunidades de fe les ayudaba en su proceso de vida. ellos hicieron referencias a algunos rituales específicos en sus familias de origen, pero no pueden explicarlas de manera concreta y no las relacionan con sus creencias actuales. caleb, hablando de las prácticas religiosas de su madre dice: “no, mi ma’i creía en san… san miguel. que ella lo ponía ahí, prendía un tabaco y se lo echaba ahí encima ahí… cosas ahí que… que ella entendía.” “no, ella iba pa’ la iglesia. ella iba pa’… una… católica yo creo, no sé; no me acuerdo bien. pero iba pa’ una iglesia.” linda relata las prácticas religiosas de sus padres: “budismo, algo así, siempre to’s los chinos son eso […] ajá, incienso, pa’l día y lo pones entonces ahí, y hacer un buen comida a… a… a agradarle gracias al cielo, y después celebramos y comemos. algo así” aja, pero yo pertenece advances in social work, spring 2013, 14(1) 301 muchos religiones. yo soy evangélica, pero yo, yo no rechazo a los demás, porque yo-yo estudiaba en-en colegio de católica.” otro elemento significativo es que aquellos que expresaron estar practicando alguna religión se identificaron como protestantes o evangélicos, siendo la fe católica dominante en puerto rico. en resumen, en cuanto a sus experiencias como menores inmigrantes se puede afirmar que los entrevistados no participaron de la decisión de emigrar, sus familias viajaron para mejorar sus condiciones de vida, y en la mayoría de los casos vinieron con sus madres y otros familiares. además, en su proceso de integración cultural todos se han rezagado en su proceso educativo. sin embargo, la escuela resultó ser un espacio importante para varios participantes y representa un área en la cual reciben apoyo emocional y educativo. en cuanto a la religión, tres participantes la mencionan como algo significativo en sus vidas, aun cuando no pueden describir con claridad las creencias o prácticas de sus familias de origen. es decir, sus prácticas religiosas actuales responden a su decisión y no a la crianza original. tercera categoría de análisis: construcciones por parte de los participantes sobre sus derechos. en términos generales, los resultados de esta categoría indican que los participantes emigraron, en su mayoría, con sus familias de origen que buscaban mejorar sus condiciones de vida, tanto sociales como económicas. bajo este rubro se procuró conocer las percepciones de los entrevistados de sus derechos, cómo los definían, y quienes representaban mejor sus intereses como menores de edad. todas las personas entrevistadas viajaron con sus familiares, excepto en uno de los casos, el cual no formó parte de la decisión de emigrar. los participantes manifestaron enfrentar dificultades de adaptación al país receptor, en este caso puerto rico, por varias razones. el factor más importante o consistente a través de los relatos fue que ellos provenían de familias en las cuales ellos o algunos de sus familiares cercanos habían atravesado por problemas de maltrato, uso de drogas, encarcelamiento, condiciones mentales, entre otras dificultades. pasar por tales circunstancias los llevó a estar sujetos a intervenciones del estado, ya fuera por el sistema de protección a menores o de justicia en el caso de los dos menores transgresores de la ley. hubo consistencia en las razones para el movimiento migratorio, sin embargo, las percepciones sobre la integración al país receptor fueron diversas; especialmente por las diferencias culturales entre los entrevistados. la noción de derechos por parte de lo participantes resultó ambigua y se alineó a conceptos como acceso a un lugar donde vivir, la escuela y los alimentos. es importante conocer y entender cómo las distintas culturas abordan un mismo tema, ya que las interpretaciones de los participantes varían según sus culturas de origen. en el caso de linda, donde expresa que su cultura no valora a las mujeres, se refiere a puerto rico con esperanza de progresar y considera su condición de custodia como una transición en su vida. distinto es el caso de harold, quien mostró una opinión muy negativa del proceso de remoción y habló despectivamente de la agencia, ya que él lleva muchos años en el crespo-rivera/voces de menores inmigrantes 302 sistema. maría fue la única participante que reconoció a su familia de crianza como un sistema de apoyo con el que podrá contar en el futuro. esta joven estudió un curso técnico en enfermería y es su familia de crianza que la ayudaron en el cuido de su bebé. el resto de los participantes identifican a sus maestras como personas claves que los han representado en distintos momentos de necesidad. ninguno de ellos identificó a sus manejadores de casos como sus defensores de derechos. en cuanto a la política pública en puerto rico, el artículo 3 de la ley 226 del 2012 (inciso jj) establece que la protección integral a menores como: (…) el reconocimiento como sujetos de derechos, la garantía y cumplimiento de los menores, la eliminación de la amenaza para la seguridad de su restablecimiento inmediato en desarrollo del principio del mejor bienestar del menor. la protección integral se materializa en el conjunto de políticas, planes, programas y acciones que se ejecuten con la correspondiente asignación de recursos financieros, físicos y humanos. los contextos económicos y sociopolíticos más amplios en los cuales la gente opera, también dan forma a los derechos humanos en la práctica. los participantes de esta investigación mostraron un vago concepto acerca de sus derechos. mencionaron, principalmente, que los derechos eran como algo etéreo, no los relacionaron con el sentido práctico de su realidad cotidiana. todos los seres humanos tienen derecho a una vida digna y a que se promuevan aquellas gestiones que sean necesarias para un mejor bienestar. aun cuando esta población tiene dificultades para acceder a servicios (tales como ayuda para alimentos y servicios de salud) limitados por su estatus migratorio, ellos tienen el derecho de ser tratados en igualdad de condiciones para alcanzar una calidad de vida digna. el estado tiene la obligación de protegerlos, identificar a familiares en sus países de origen para su regreso a sus ciudades natales o como última alternativa hacer todas las gestiones pertinentes para que cuando cumplan su mayoría de edad tengan toda su documentación vigente. conclusiones analizar las verbalizaciones de los menores posibilitó contestar las preguntas de investigación propuestas con el fin de entender las construcciones que ellos tienen acerca del proceso de inmigración, experiencias en: puerto rico como país receptor, experiencias con los servicios provistos y coordinados por el estado y sus experiencias relacionadas a esta circunstancia. la información presentada en las diversas categorías de análisis no es mutuamente excluyente, sino que se pueden observar interconexiones para acercarnos a la realidad de los participantes. los menores son frecuentemente separados de sus padres, madres y hermanos por periodos extensos de tiempo antes de una reunificación familiar en el país receptor (fontes, 2005). aunque las verbalizaciones de los participantes son la parte principal del estudio, la revisión de documentos reforzó la investigación en torno al impacto en la política pública existente. en ese sentido, cuando la política no surge teniendo en cuenta las personas advances in social work, spring 2013, 14(1) 303 afectadas y sus características, puede no cumplir con las necesidades y expectativas de esos grupos sociales. en términos de la población estudiada, son los propios menores de la población inmigrante que pueden relatar sus vivencias y construir un marco de referencia para mejorar la aplicación de las políticas existentes. vidich y lyman (1994) explican que la investigación cualitativa es de gran aportación para entender la cotidianidad de las personas y a partir de ello, generar nuevas contribuciones a las disciplinas. la migración de personas a través de la historia indica que se ha creado una diáspora global. la tecnología ha facilitado las conexiones entre los países y fortalecido lazos de solidaridad, sin embargo, aún se evidencia discriminación frente a las poblaciones étnicas minoritarias. los contextos internacionales tienen que tomar en cuenta la complejidad de las nuevas narrativas desde la perspectiva de los derechos humanos. la población estudiada tiene mucho que decirnos en cuanto a sus necesidades específicas, a la falta de apoyo del país receptor y de las instituciones de servicios humanos y además, nos presentan recomendaciones para que el sistema responda a su realidad. es importante que aquellos inmigrantes que en su niñez estuvieron bajo la custodia del estado participen en juntas asesoras, comités consultivos, grupos multidisciplinarios, grupos de autoevaluación de la agencia de servicios, entre otros. a partir de los hallazgos de esta investigación surgen como recomendaciones principales para la práctica: concentrarnos en la supervisión de los hogares de crianza, dialogar con los menores cuando visitemos dichos espacios para conocer sus necesidades y percepciones y sugerir ajustes necesarios a los hogares de crianza en términos de adiestramiento y sensibilidad cultural. de todas las observaciones y preocupaciones expresadas desde sus experiencias diversas, cada entrevistado repitió la necesidad de este seguimiento. los profesionales de trabajo social pueden recopilar los relatos de los participantes y entrelazarlos para hacer una historia que facilite el trabajo en conjunto (hall, 1997). las conclusiones y recomendaciones de esta investigación pueden servir de base y promoción para la continuidad del arduo esfuerzo en el trabajo con los menores en cuidado sustituto. es importante reconocer la tarea que tienen que hacer los manejadores de casos en una agencia de limitados recursos y la necesidad existente de identificar el capital humano y económico apropiado para delinear un plan estatal responsable en todos los ámbitos del servicio a menores en puerto rico. referencias abney, v. 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(2006). caregivers, school liaisons, and agency advocates speak out about the educational needs of children and youths in foster care. social work, 55(3), 245-255. crespo-rivera/voces de menores inmigrantes 306 nota del autor: address correspondence to: evelyza crespo-rivera, ph.d., departamento de trabajo social, escuela de ciencias sociales y humanas, universidad del este, puerto rico; 787257-7373 ext. 2165, crespoe2@suagm.edu this work is licensed under a creative commons attribution 4.0 international license. mitigating psychological distress among humanitarian staff working with migrants and refugees: a case example kristen l. guskovict miriam potocky abstract: ongoing acute stress in humanitarian work leads to psychological distress among humanitarian workers. stress management within humanitarian agencies requires responses at both the individual staff member and agency levels. stress management is often conceptualized in four categories: stress that can be accepted; stress that can be altered; stress to which individuals can adapt; and stress that can be avoided. humanitarian workers accept the stress created by the environment in which they choose to work. they can manage stress by altering their own behaviors through improved communication skills and the implementation of self-care plans. they can adapt, with the help of staff care plans such as counseling and peer support, to the stress created by their own histories of trauma or mental illness. the stress created by the workplace can be avoided. however, without a comprehensive support plan for mitigating psychological distress, both the individual humanitarian worker and the agency overall suffer. this article reviews current literature regarding the impact of avoidable stress and the impact of adaptation programs such as staff care and stress management plans on humanitarian work, and illustrates these impacts with a case example from the danish refugee council, an international non-governmental organization with approximately 300 employees working in greece. keywords: humanitarian workers; refugee; migrant; self-care; stress management; greece self-care is a core principle of social work (cox & steiner, 2013), and is critical for effective work with traumatized populations (lipsky & burk, 2009). refugees are people who are forced to flee their homes because of war or persecution. by definition, a person who is labeled a refugee has experienced trauma. yet, self-care is not universally practiced within humanitarian agencies serving these vulnerable populations (porter & emmens, 2009). people categorized as refugees have experienced the trauma of forced migration and as many as 37% may be suffering from ptsd and 75% may be suffering from depression (slewa-younan, uribe guajardo, heriseanu, & hasan, 2015). thus, working with traumatized individuals requires that those providing services understand the unique aspects of stress to which they are exposed. humanitarian workers, also referred to as aid workers, are those working with an agency that is responding to a humanitarian crisis. both humanitarian work and social work are helping professions that seek to protect and promote human dignity. the international association of social workers (ifsw) defines social work as a profession that “promotes social change and development, social cohesion, and the empowerment and liberation of people. principles of social justice, human rights, collective responsibility, and respect for diversities are central to social work” (ifsw, 2014, para. 1). social workers conduct _______________ kristen guskovict, lcsw is principal and founder of klg consulting services, llc and heart (humanitarian empathy and refugee trauma) of aid work. miriam potocky, phd, msw is professor, school of social work, florida international university, miami fl, 33199 copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 965-982, doi: 10.18060/21644 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 966 professional activities under the guidance of the code of ethics, which outlines the core values of the profession as: service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence (national association of social workers, 2017). humanitarian work is defined through the geneva conventions. the international committee of the red cross (icrc) delineated the role, specifically in the 4p th p geneva convention, which outlines the protection of civilians during war. the icrc (2014) further defines a humanitarian mission as the delivery of necessary assistance that protects the dignity of the person receiving aid. just as social work activities are guided by a code of ethics, humanitarian work is guided by four key principles: humanity, neutrality, impartiality and independence. together these principles oblige aid workers to provide assistance that protects the rights and vulnerabilities of every person in need (rysabacksmith, 2015). both social workers and humanitarian workers choose a profession of providing assistance to people in need. however, social workers are more homogenous in their roles, whereas the humanitarian field is made up of people with a variety of backgrounds. some aid agencies specialize in health care, such as doctors without borders or doctors of the world, and their staff is often made up primarily of health care providers. other aid agencies, such as the danish refugee council, focus on the needs of the entire refugee community. they set up and manage camps, create shelters, and provide sanitation services. they also provide protection monitoring, ensuring that people entering the camp are screened for special needs. in many ways, humanitarian workers create and administrate a city. their backgrounds may be in fields such as engineering, to ensure that housing needs are addressed, or international relations, to ensure that they have a macro understanding of the crisis. because not all roles require the same type of education, not all aid workers have the type of training that is considered standard among social workers, such as an understanding of human development, trauma, or the importance of clinical supervision. although these staff come from a variety of disciplines, many work directly with the affected population and very few, outside of those in specialized organizations, have a background in social work or mental health. similar to social workers, humanitarian workers are often responsible for conducting assessments to identify needs and assist beneficiaries in accessing basic necessities, such as food and shelter. for humanitarian workers, unique stressors are often present in locations that in and of themselves are stressful. stress management requires responses at both individual and agency levels. a review of stress management and staff care techniques among international aid agencies (curling & simmons, 2010) revealed that 74% of staff members felt moderately or extremely stressed. in the human service sector, it is well-known that burnout, vicarious trauma, and secondary traumatic stress are occupational hazards (mathieu, 2012). the criteria for burnout are met when a person working in human services experiences emotional exhaustion, depersonalization, and a reduced sense of accomplishment (maslach, schaufeli, & leiter, 2001). vicarious trauma is the change in worldview that takes place as the result of hearing an accumulation of traumatic stories over time. arising from the guskovict & potocky/mitigating psychological distress 967 helper’s engagement with the traumatized client, vicarious trauma involves distress, specifically a change in the worker’s cognitive schemata (nimmo & huggard, 2013). as with post-traumatic stress disorder, the change in worldview seen with people suffering from vicarious trauma may be a shift from altruism into pessimism. for example, an aid worker may generally see the world as a place with good people trying to help each other, but over time may begin to see it as a place where people torture and harm each other, instead of help each other. the worker may or may not be aware of these effects. secondary traumatic stress is experienced when the helper begins to display trauma responses similar to those of persons directly exposed to trauma (pearlman & saakvintne, 1995). secondary traumatic stress symptoms are very similar to those of ptsd, such as hypervigilance and intrusive thoughts, except that the exposure to trauma is secondary rather than primary (bride, robinson, yegidis, & figley, 2004). a worker’s secondary traumatic stress reactions may or may not reflect the client’s actual responses. all three of these types of staff stress manifestations impact the quality of care provided to people in need. but for humanitarian aid workers, much like social workers, a significant piece of their sense of purpose and identity is associated with their work, which means the consequences of burnout, vicarious trauma and secondary stress can be very high. this article will apply the lens of common stress management techniques to a review of the challenges facing humanitarian workers and their agencies as they work to meet the needs of refugees and migrants. the article will further apply this stress management lens to a case example based on the first author’s experience providing a psychosocial support program to staff of the danish refugee council delivering humanitarian services to refugees in greece. the case example will draw upon the author’s case notes, records of services provided, and anecdotal observations. conceptual framework stress management is often conceptualized in four categories, or four “a’s”: (1) accepting stress; (2) altering stress; (3) adapting to stress; and (4) avoiding stress (mayo clinic, 2016; robinson, smith, & segal, 2017). humanitarian workers accept the stress created by the environment in which they choose to work. aid workers can manage stress by altering their own behavior through improved communication skills and the implementation of self-care plans. they can adapt to the stress created by their own histories of trauma or mental illness and the stress created by the workplace with the help of staff care plans such as counseling and peer support (mayo clinic, 2016; robinson et al., 2017). however, when the majority of staff are experiencing psychological distress due to acute stress, without a support plan, the stress reactions can create a toxic environment (glasø & vie, 2010). this toxic environment is avoidable through the application of the other “a’s” in stress management. advances in social work, spring 2018, 18(3) 968 the four “a’s” in humanitarian work accepting stress as in the field of social work, there are some stressors that are an inherent and accepted part of humanitarian work. accepted stress in the humanitarian workplace can come from many different sources: a worker’s own history of trauma or mental illness; ongoing exposure to people who have been traumatized and are suffering; and high-risk work environments. social workers are taught, throughout their training, to know themselves and the environment that they are entering. by understanding the physical and emotional risks, social workers can recognize their strengths and limitations and learn how to manage challenging work environments. humanitarian work takes place in similarly stressful environments, both physically and mentally, but the training and support these workers receive while on mission often lacks this fundamental aspect. although aid workers are aware of the types of environments in which they will work, they are often unaware of the level of emotional distress this type of work can have on them. humanitarian aid is provided to people who have experienced manmade and natural disasters. the profession itself requires that aid workers accept stress, including witnessing the impacts that war, violence, and disasters have on people (curling & simmons, 2010). aid workers’ own safety may be at risk while deployed in unstable and dangerous situations (connorton, perry, hemenway, & miller, 2011; curling & simmons, 2010; ehrenreich & elliot, 2004). in addition, aid workers are continuously exposed to the traumatic experiences of the people they are supporting (blanchet & michinov, 2014). however, studies find that stress and burnout are not correlated with higher-risk or higherstress environments (cardozo et al., 2012; eriksson et al., 2009). while being exposed to these stressors, aid workers are often separated from the support of their families and other social networks (connorton et al., 2011; ehrenreich & elliot, 2004). aid workers who have experienced personal trauma or mental illness may be unaware that working with traumatized individuals may trigger their own memories of trauma (cardozo et al., 2005; ehrenreich & elliot, 2004). this type of stress can impede judgment and reduce coping skills (sommers-flanagan, 2007). it can also increase the risk of depression, anxiety, and burn-out (cardozo et al., 2012). aid workers with a history of anxiety and depression are at greater risk of experiencing anxiety, depression and overall emotional exhaustion in the field (cardozo et al., 2012). over the past few years, several surveys have found high rates of stress, along with symptoms of depression, ptsd and anxiety among staff working within the humanitarian sector. in a 2010 study, 74% of aid workers surveyed were found to be moderately or severely stressed (curling & simmons, 2010). severe stress places a person at increased risk of depression. a 2011 study reported that up to 43% of aid workers have experienced ptsd, 20% have experienced depression, and 29% have experienced anxiety (connorton et al., 2011). a longitudinal study found that rates of anxiety in expatriate aid workers increased from nearly 4% to nearly 12% from pre-deployment to post-deployment, while rates of depression nearly doubled from 10.4% to 19.5% (cardozo et al., 2012). guskovict & potocky/mitigating psychological distress 969 studies often find higher rates of emotional distress among national staff, or staff coming from the host country, in comparison to international staff, or expatriate staff coming from other countries. national staff often face a unique burden. in many crises, they share a similar culture, language, heritage and history as the refugees they are assisting. they themselves may also have experienced forced migration (cardozo et al., 2012). the burden of accepted stress is higher in these humanitarian staff members. a 2008 study found sudanese aid workers had higher levels of stress and burnout than their international counterparts (musa & hamid, 2008). a 2009 article found that 42% of national staff in guatemala experienced symptoms of ptsd (putman et al., 2009). a 2012 study found that 68% of national staff in uganda had symptoms of depression, while 53% had symptoms of anxiety, 26% had symptoms of ptsd, and 50% had symptoms of burnout (ager et al., 2012). notably, each of these studies found that the aid workers as a group had experienced both primary and secondary trauma, corroborating the unique burden of national staff in regard to their frequent exposure to the same traumas as their clients. the risks of emotional distress are well known and documented, but often aid workers themselves are unaware of the impact that this work could have on their overall wellbeing. a 2009 longitudinal survey of aid workers revealed that 40% of participants stated that the work environment was more stressful than expected (dahlgren, deroo, avril, bise, & loutan, 2009). and, perhaps more importantly, these workers are often unaware of some of the factors that could protect them from emotional distress. without knowing these risks, the emotional distress experienced by aid workers often goes untreated, which can have a significant impact on not only the individuals experiencing these symptoms but the quality of the work they provide. for example, in a sri lanka study, over half of humanitarian workers experienced traumatic stress symptoms and nearly one-third avoided working with certain clients (cardozo et al., 2013). altering stress the types of stress that can be altered are those that individuals have some control over. self-care strategies along with assertive and open communication skills are ways in which people can alter their experience to decrease stress (mayo clinic, 2016; robinson et al., 2017). aid workers employ numerous positive and negative coping skills. positive coping skills can include journal writing, open communication with friends, exercise, the use of mindfulness and meditation, and counseling. although aid workers are often separated from their families and support networks, a new support network is frequently formed with colleagues, who are often their friends and sometimes their roommates as well. a 2016 study of serbian medics in the democratic republic of the congo measured the impact that open communication had, in comparison to the use of avoidance, and found that it had a positive correlation with reduced stress levels (jokovic, krstic, strojanovic, & spiric, 2016). the same study highlighted how connection with work, regular communication with family, and regular exercise can help lower stress levels. in a 2012 study, strong social support was related to lower levels of depression and burnout (cardozo et al., 2012). the converse has also been found to be true; depression rates were higher among aid workers with lower family and social support (cardozo et al., 2005). mindfulness trainings for aid workers are now being successfully introduced into the field (pigni, 2014). advances in social work, spring 2018, 18(3) 970 the impact of psychological distress on the individual may elicit negative coping skills such as emotional dysregulation, cynicism, and self-destructive behaviors. aid workers often respond to emotional distress with anger, avoidance, or distancing (connorton et al., 2011; ehrenreich & elliot, 2004). one study found that 27% of aid workers engaged in risk-taking behaviors such as speeding, drinking and driving, unprotected sex, frequent change in sex partners, and excess use of alcohol and other drugs as ways of coping (dahlgren et al., 2009). a similar study found that 16% of aid workers met the criteria for alcohol abuse (connorton et al., 2011). the coping skills that people employ to respond to stress can have a significant impact on the quality of work they provide. negative coping skills can lead to accidents involving injury (dalhgren et al., 2009). aid workers rely on their communication skills to assess and respond to the needs of their refugee clients. emotional avoidance, cynicism and distancing can impact the relationships staff have with their clients, as these defense mechanisms may reduce the amount of information workers receive from their clients. avoiding stress some stress can be avoided altogether with advance planning. within the context of humanitarian work, avoidable stress is that which is caused by the dynamics within an office environment. stress management is not only the responsibility of the individual; it is also an agency responsibility. typical signs of agency burnout include high turnover, clique formation, frequent conflicts, scapegoating, lack of initiative, increased sick leave, and lower output (united nations high commissioner for refugees [unhcr], 2001). one study found that the top five sources of stress within humanitarian work were not associated with related trauma or safety factors; they were all agency-related. the stressors included workload, ability to achieve work goals and objectives, hours, status of contract, and feeling undervalued (curling & simmons, 2010). a similar study in sri lanka found that when staff members felt supported by their agency they experienced lower levels of depression and anxiety symptoms (cardozo et al., 2013). another similar study found that 56% of participants identified the office environment as the most frequent stressor experienced by humanitarian workers (dahlgren et al., 2009). likewise, among the various stressors listed in a 2004 study were lack of adequate resources (i.e. personal time or logistical support to meet expectations), excessive bureaucratic demands, lack of leadership and recognition from the employer, and interpersonal conflict among team members (ehrenreich & elliot, 2004). although aid work is provided in high-stress environments, the agencies themselves do not need to be high-stress. high-stress agency characteristics include unclear boundaries, over-identification with clients, uncoordinated services, lack of clinical supervision and coaching for leaders, workaholism, self-sacrifice and inadequate self-care. low-stress agencies include care-for-caregiver programs, coaching for leaders, and clear definitions of roles and boundaries (pross & schweitzer, 2010). unsupportive administration, lack of professional challenge, and difficulties in providing client services are predictive of high burnout rates (bell, kulkarni, & dalton, 2003). low-stress environments, on the other hand, have been identified as having strong boundaries, having good leaders that utilize internal resources and delegate responsibilities to staff according guskovict & potocky/mitigating psychological distress 971 to their skills and experience, providing opportunities to learn and improve skills, and providing space for reflection to build self-awareness. clinical supervision, in particular, has frequently been associated with lower agency stress (bell et al., 2003; jones, muller, & maercker, 2006). staff members feel valued when they have the opportunity to provide feedback on agency decisions (brooks et al., 2015; curling & simmons, 2010; halbesleben & buckley, 2004). because aid work is provided in an emergency context, not everything can be planned. emergency work, which is usually characterized by deadlines and short-term contracts for management staff, may lead to competing procedures and overall frustration in the field (francis, galappatti, & van der veer, 2012). decisions are made quickly, and roles and expectations are continuously evolving (blanchet & michinov, 2014). however, just as aid agencies are able to plan for the setup of a camp and the number of tents needed, they can anticipate and plan for the certain aspects of internal stress. protective planning can assist with team cohesion, inter-office communication, and sense of efficacy. an unstable work environment with unclear roles has a direct impact on transactive memory, that is, the memory that allows a team to function successfully (blanchet & michinov, 2014). the transactive memory is a shared cognitive process that helps a team know which person to rely on for what task. when staff members change teams or leave, it is difficult for the remaining team members to adjust unless the incoming staff member has the same skill set and strengths. as the transactive memory decreases, so does the degree to which individuals rely on their colleagues, and they become more likely to keep their work to themselves. humanitarians are often much more patient with their refugee clients than they are with each other and the way that this cohort of colleagues interact with each other acts as a catalyst to spread stress. ongoing exposure to trauma can have a cumulative effect; people may not feel the impact of the first or second exposure to trauma but after several experiences they may begin to show symptoms (curling & simmons, 2010). as it is cumulative, the overall impact can appear in subtle changes. according to studies, seasoned aid workers are less likely to experience high rates of stress or burnout than more inexperienced workers, but it has been noted that this conclusion may be inaccurate (eriksson et al., 2009). surveys assessing rates of burnout and secondary stress use time limits, with questions framed as, “in the last two weeks have you…?” people who have experienced an accumulation of stress may simply have adjusted to the cynicism and depersonalization used in reaction to their stress (eriksson et al., 2009). therefore, seasoned workers, now in leadership roles, may have adapted to the depersonalization and the cynicism common in burnout, but the impact of burnout can still be seen in the way they treat their work and their colleagues. emotional dysregulation and cynicism impact the office environment by leading to outbursts of anger and blame. in addition, work takes longer to complete when someone is dealing with the emotional exhaustion and depersonalization of burnout (halbesleben & buckley, 2004). as stress and burnout spread, team cohesion and work effectiveness decrease as much as 50% (mccormack & joseph, 2012; nilsson, sjöberg, kallenberg, & larsson, 2011). burnout is more likely to spread from management to staff than vice versa (maslach et al., 2001). eriksson et al. advances in social work, spring 2018, 18(3) 972 (2013), in their work on locally recruited staff in jordan, recognized that managers can be five times more likely than non-managers to experience burnout. inexperienced aid workers often develop burnout due to growing recognition of the limited scope of services that humanitarians provide (cardozo et al., 2012). aid workers start their careers imagining how they will help people, but the limitations of what can be done to help can create feelings of inadequacy, and if not managed correctly, burnout. many people who choose humanitarian work are perfectionistic and highly motivated. humanitarians are people who expect to make a difference in the world through their work (eriksson et al., 2013). the reality of the work and its limitations can cause cognitive discord when those who thought they would make a difference now feel that none of it matters. they may focus more strongly on the failures of the work than on its successes, and internalize the failures as their own. this often causes feelings of inferiority and shame in humanitarian workers (mccormack & joseph, 2012). this type of stress can cause serious challenges for the agency. according to studies, it can impede recruitment and retention of good staff (nilsson et al., 2011). when dysfunction sets in, no matter how hard people work, the quality of services delivered suffers. one challenge to ensuring that staff feel valued is the way in which programming is evaluated and funded. funding priorities lead agencies to value service delivery to high numbers of beneficiaries over capacity building within staff. however, staff feel valued when they are given the opportunity to improve their skills and grow within an agency (halberson & buckley, 2004). the decrease in sense of value or ability to contribute to the agency impacts the sense of self-efficacy and the overall feeling of burnout. increased stress causes people to leave rapidly. the dichotomy in agencies’ priorities creates a rise in the number of beneficiaries and a simultaneous drop in service quality (goncalves, 2011). adapting to stress adaptation in stress management refers to changing one’s expectations or standards. within this context, humanitarian aid agencies adjust their standards regarding the type of care and support they provide to their staff. people in aid, an organization founded by humanitarians to improve organizational effectiveness, identifies the objective of staff care to create wellbeing among staff and improve the quality of their work (goncalves, 2011). in addition, aid agencies have a duty to protect principle with regard to staff. the duty to protect often refers to the duty to keep someone safe from physical harm. but given that decreased emotional well-being increases risk of accidents and decreases quality of service, agencies also have a duty to protect staff against burnout, secondary stress, and vicarious trauma. measures that can be taken by agencies to decrease exposure to these occupational hazards include providing emotional support, physical safety, and a respectful environment (cripe & nyssens, 2017). study after study recommends that agencies offer access to counseling and/or peer support models. a 2005 study of kosovar aid workers (cardozo et al., 2005) found that existing support services provided to staff were characterized as poor by the participants, and recommended staff support to attenuate the emotional distress experienced. another guskovict & potocky/mitigating psychological distress 973 study noted that the key to protecting staff from secondary traumatic stress is recognizing it and treating it early through mental health services (bilal, rana, rahim, & ali, 2007). in a study of guatemalan aid workers, the authors noted a need for emotional support (putman et al., 2009). a study in sri lanka recommended ongoing training regarding stress along with increased support for staff (cardozo et al., 2013). emotional support programs provided to staff should include two primary aspects: training and ongoing support. other programmatic initiatives such as counseling and peer support models have also been shown to be helpful (curling & simmons, 2010). studies have identified having someone to talk to, and training regarding the emotional distress that is common in aid work, as essential to protecting staff against severe emotional distress and burnout (jokovic et al., 2016). trauma-specific training has been found to decrease the potential for vicarious trauma (harr, 2013). curling & simmons’s (2010) study on support programs for aid workers found that 77% of participants identified training on stress and trauma reactions as necessary and 64% of staff saw access to counselors as helpful. furthermore, a study of international red cross delegates found that participants who had someone to talk to, such as a counselor or a peer support person, were 28% less likely to feel emotionally exhausted (dahlgren et al., 2009). more and more agencies are recognizing the need to support their staff through onsite or outsourced counseling, emergency assistance programs, and peer support programs. the world health organization has developed a promising pilot program called problem management plus that utilizes paraprofessional counselors to deliver short-term crisis counseling (rahman et al., 2016). although this program is envisioned to provide direct support to beneficiaries, it could also be a promising model for peer support. through the use of peer support or counseling, agencies have the opportunity to help not only those who seek counseling, but the entire agency. however, it is important to note that programs that respond to the emotional needs of aid workers must take into account the types of individuals they seek to support. aid workers are often people who would be considered “non-traditional” clients. many come from cultures and backgrounds for whom counseling carries a heightened sense of stigma, and those coming from western backgrounds often deny a need for counseling and use emotional distancing as a coping mechanism (brooks et al., 2015). case example: the greek context greece is a major transit point for middle eastern migrants and refugees, particularly those from syria. syrian refugees constitute the largest community of displaced people in the world. over 5 million syrians have sought safety worldwide (unhcr, 2017a). over 1 million refugees crossed through greece between 2015 and 2016 (european civil protection and humanitarian aid operations, 2017). refugee camps in greece are now home to over 60,000 people (unhcr, 2017b). in response to the crisis, the united nations, the european union and humanitarian aid organizations, such as the danish refugee council, have established refugee camps and related services throughout greece. however, in greece, the normal stressors that are common in refugee crises are exacerbated by the country’s economic crisis and lack of government preparedness to respond to the crisis. advances in social work, spring 2018, 18(3) 974 the first author provided psychosocial support services to the danish refugee council in greece starting in 2016, shortly after the agency began operations in that country, through 2017. at the time, the agency had approximately 300 staff in greece. the psychosocial support program developed for the danish refugee council in greece included four components: training on burnout, secondary traumatic stress and vicarious trauma; clinical supervision/case consultation; group counseling; and individual counseling. the overall approach was influenced by a trauma-informed self-care framework (salloum, kondrat, johnco, & olson, 2015). this case example is based on the initial nine months of the psychosocial support program, from september 2016 through june 2017. the program was developed in response to a high rate of burnout seen among staff and was initially intended to focus on the needs of one area of humanitarian work, protection. protection staff are responsible for conducting vulnerability assessments with each refugee. their assessments assist in informing their colleagues about vulnerabilities that an individual refugee may have and that may need to be accounted for with each aspect of the work, from food distribution to medical support to housing accommodations. the psychosocial support program consisted of live programming, delivered during five visits to each of four program sites, and remote support delivered via skype. in september of 2016, protection staff from four sites across greece – athens, thessaloniki, larissa and lesvos – were invited to a multi-day intensive training. six hours of this training was dedicated to the concepts of trauma, vicarious trauma, and staff care. following the training, each protection team was provided monthly clinical supervision/case consultation. in addition to the ongoing clinical supervision, each team was provided with the opportunity to participate in an open group session. during the initial visit to each office, the scope of work expanded from protection staff to all staff in the agency, based on staff requests. although only protection staff were provided with clinical supervision/case consultation, all staff were invited to participate in trainings, group sessions, and individual sessions. staff participating in some portion of the psychosocial support program ranged in age from 22 to 60 years old and came from over a dozen countries in europe, north america, and the middle east. staff at each of the four sites mirrored the population make-up of the surrounding refugee camps, to ensure that communication between staff and refugees could be easily facilitated. during the initial nine-month period of the psychosocial support program, 21 training sessions were provided to approximately 120 aid workers (approximately 40% of the agency personnel) on signs and symptoms of mental health crises along with burnout. each training lasted approximately two hours and introduced the signs and symptoms of ptsd, depression, anxiety, burnout, vicarious trauma, and secondary traumatic stress. also during this period, 262 individual counseling sessions were provided to approximately 70 people (23% of the staff), and seven counseling groups were held. accepting stress in the greek context as noted earlier, national staff often have higher rates of emotional distress. national staff are often the people to hear the needs of the refugee first hand; they then interpret them to international aid workers. however, in greece, it is not national staff that play guskovict & potocky/mitigating psychological distress 975 these roles but international staff. these expatriate staff often come from refugeeproducing countries, and some have first-hand refugee experiences. in greece, the danish refugee council’s staff accepted the stress of working with traumatized individuals, although many were unaware of the impact that may have had on their own personal wellbeing. however, the environment itself is not a war zone. with the exception of working with a disturbed or violent client, these aid workers are physically safe while conducting their work. nonetheless, the physical safety did not seem to mitigate the level of emotional distress. as described previously, training was provided to the staff on the signs and symptoms of ptsd, depression, anxiety, burnout, vicarious trauma and secondary traumatic stress. this information was new for the vast majority of participants. even seasoned aid workers were surprised to learn that the emotional distress they were experiencing individually was common among aid workers. altering stress in the greek context among the staff members who received individual counseling over the nine-month period in greece, 34%, or 24 people, found themselves becoming avoidant. as noted previously, social support within the aid worker community most often comes from coworker relationships. this can create a certain level of support, but it can also isolate the workers from other aspects of their social networks. avoidant behaviors impacted their personal and professional lives. within the counseling sessions, one of the questions the therapist (first author) often asked was, “what generally makes you feel better when you’re upset?” staff members frequently responded that talking to their families and their friends outside of aid work was helpful. but as stress increased, the level of engagement with such friends and family decreased. most had gone weeks or months without talking to anyone outside of their coworkers. participants often expressed worry about “burdening” their loved ones with their stress, and exhaustion at even the thought of trying to explain how they were feeling. however, the reverse was also true; when participants reached out to their families and friends they often returned to counseling the following week citing a lower level of stress. in group counseling sessions, each group discussed the challenges of working and socializing together. when socializing together, the groups found that they often talked about work. but this only served to heighten their stress levels. each group discussed ways in which they could change this pattern of behavior. one group found a creative solution in the decision to create a list of conversation topics and cut them up into little strips of paper and put them in a plastic bag. that way when they were out, they could choose a non-work related topic, from those included in the plastic bag, to discuss. avoiding stress in the greek context low-stress and high-stress qualities were seen within the danish refugee council in greece. the agency responded to needs of staff for training regarding topics such as boundaries, active listening, and psychological first aid, providing opportunity for staff to increase their skills. in addition, some staff were invited to participate in case consultations/clinical supervision to allow staff to receive feedback and assess the advances in social work, spring 2018, 18(3) 976 successes and challenges of their work. however, the spread of burnout and overall stress had a significant impact on the personal experience of the work. common conversations during individual counseling sessions included interpersonal experiences with colleagues. frustration often stemmed from the feeling that colleagues didn’t know how hard a person was working, or the strengths that person had. individuals experiencing conflict within the workplace often felt alone in their work, or as if they could rely on only a few people. adapting to stress in the greek context the author used a flexible approach in designing and delivering a psychosocial support program for the danish refugee council in greece. particular attention was paid to the needs of these “non-traditional” clients through activities and trainings that normalized conversations about feelings and challenges. the programmatic approach utilized strategic timing of services offered. the initial introduction to the psychosocial support program was a training using psychosocial and stress-relief activities to highlight the commonality of the feelings of distress individuals often feel. participants were then invited to participate in psychosocial groups around stress management. finally, individual counseling was made available. sessions focused on past experiences of trauma, grief and loss, along with the everyday stressors of humanitarian work. through programming and training on burnout, the aid workers became more likely to seek services as needed, once familiar with the service provider. discussion the body of research reviewed earlier provides ample evidence that humanitarian work can cause burnout, vicarious trauma, and secondary traumatic stress among aid workers. the environment of the work, the nature of the work, and organizational stressors create barriers to the provision of quality humanitarian services to vulnerable populations. the experience of humanitarians working with the danish refugee council in greece mirrors the prior research regarding trauma and stress in this field. viewing the stressors faced by humanitarian workers through the lens of the four “a’s” of stress management provides a roadmap to assist agencies and aid workers both in decreasing the emotional distress and the impact it has on beneficiaries. implications for humanitarian workers and agencies although aid workers accept the inherent stressors of the job, they need training and education about how those stressors may impact them. with information regarding the emotional impact the work will have, aid workers can alter some of their behaviors to increase their overall wellbeing. aid agencies can avoid the internal stress that the office dynamic creates through planning and developing staff recognition and support programs. finally, aid agencies can further decrease the rates of burnout, vicarious trauma, and secondary traumatic stress through adaptation programs such as counseling or peer support. guskovict & potocky/mitigating psychological distress 977 limitations this article presented a case example of a psychosocial support program implemented by the danish refugee council in greece. the description provided was based on the first author’s case notes and anecdotal information, thus limiting scientific rigor. further, a case example based on one agency in one country prohibits generalization. finally, this program was provided both through in-person and remote support; the relative effectiveness of the two approaches cannot be determined. recommendations for future research to further support or refute the observations made in this case example, replications in other humanitarian settings should be conducted. more rigorous quantitative and qualitative evaluations are needed to examine the impact of psychosocial support programming on the stress experienced by humanitarian workers. the authors are presently conceptualizing means to include such evaluations in future research endeavors. moreover, further research regarding the accumulation of trauma exposure among seasoned aid workers is needed. often, seasoned aid workers ignore symptoms of psychological distress within themselves, sometimes for years. in these cases, assessment tools may not adequately identify the distress, as the adaptive functioning, including pessimism and acting out behaviors, has become normalized. finally, further research regarding the efficacy of remote-based psychosocial support for humanitarian workers would be valuable. conclusions this article has highlighted the unique role that social workers can play in supporting humanitarian work. social workers have the benefit of academic training that provides skills in the areas of interviewing traumatized individuals, boundary-building, and understanding personal triggers. in addition, social workers have the benefit of ongoing clinical supervision to help hone those skills. these social work skills are foundational elements of good self-care and provide support to both the worker and the program beneficiary; however, humanitarian workers often do not have the benefit of these types of training and supervision. aid workers often fear the stigma of mental illness, coming from communities where counseling is considered abnormal. they often feel that they took a job that is defined by emotional and physical intensity and that asking for help undermines their self-image of their ability to do the work. the employment cycle of an aid worker is often divided into three phases: pre-deployment, during mission, and post-deployment. each of these phases offers an opportunity for prevention of burnout, vicarious trauma and secondary traumatic stress (hearns & deeny 2007). however, many international non-governmental organizations find themselves responding to instead of preventing burnout, vicarious trauma and secondary traumatic stress. agency culture, the accumulation of stress that may be present in seasoned aid workers, and stigma all create barriers to creating programs that can prevent and respond to existing psychological distress. advances in social work, spring 2018, 18(3) 978 the refugee crisis in greece, for many aid workers, was envisioned as a light mission. instead of working in a war zone, they would be working in europe. however, as the volume of requests for psychological support in this program suggests, working with traumatized people is always strenuous, regardless of the setting.yet, as demonstrated by this program, when support is made available and seeking support is normalized as a common response to the types of occupational hazards experienced by aid 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(2017b, august 10). greece. retrieved from 34thttps://data2.unhcr.org/en/situations/mediterranean/location/517934t author note: address correspondence to: 34tkristen l. guskovict, heart of aid work, kguskovict@heartofaidwork.com https://doi.org/10.1016/j.childyouth.2014.12.023 https://doi.org/10.1007/s10903-014-0046-3 https://doi.org/10.1080/10508420701378123 https://drc.ngo/media/2113528/unhcr-booklet-on-stress-management.pdf https://drc.ngo/media/2113528/unhcr-booklet-on-stress-management.pdf http://data.unhcr.org/syrianrefugees/regional.php https://data2.unhcr.org/en/situations/mediterranean/location/5179 mailto:kguskovict@heartofaidwork.com mitigating psychological distress among humanitarian staff working with migrants and refugees: a case example kristen l. guskovict miriam potocky abstract: ongoing acute stress in humanitarian work leads to psychological distress among humanitarian workers. stress management within humanitarian agencies requires responses at both the individual staff member and agency levels. stress management ... keywords: humanitarian workers; refugee; migrant; self-care; stress management; greece self-care is a core principle of social work (cox & steiner, 2013), and is critical for effective work with traumatized populations (lipsky & burk, 2009). refugees are people who are forced to flee their homes because of war or persecution. by definit... humanitarian workers, also referred to as aid workers, are those working with an agency that is responding to a humanitarian crisis. both humanitarian work and social work are helping professions that seek to protect and promote human dignity. the int... humanitarian work is defined through the geneva conventions. the international committee of the red cross (icrc) delineated the role, specifically in the 4pthp geneva convention, which outlines the protection of civilians during war. the icrc (2014) f... both social workers and humanitarian workers choose a profession of providing assistance to people in need. however, social workers are more homogenous in their roles, whereas the humanitarian field is made up of people with a variety of backgrounds. ... because not all roles require the same type of education, not all aid workers have the type of training that is considered standard among social workers, such as an understanding of human development, trauma, or the importance of clinical supervision.... in the human service sector, it is well-known that burnout, vicarious trauma, and secondary traumatic stress are occupational hazards (mathieu, 2012). the criteria for burnout are met when a person working in human services experiences emotional exhau... the four “a’s” in humanitarian work accepting stress altering stress avoiding stress case example: the greek context during the initial visit to each office, the scope of work expanded from protection staff to all staff in the agency, based on staff requests. although only protection staff were provided with clinical supervision/case consultation, all staff were inv... accepting stress in the greek context altering stress in the greek context avoiding stress in the greek context adapting to stress in the greek context discussion limitations recommendations for future research references ager, a., pasha, e., gary, y., duke, g., eriksson, c., & cardozo, b. (2012). stress, mental health, and burnout in national humanitarian aid workers in gulu, northern uganda. journal of traumatic stress, 25, 713-720. doi: 34tuhttps://doi.org/10.1002/j... francis, f., galappatti, a., & van der veer, g. (2012). developing a responsive model to staff care beyond individual stress management: a case study. intervention, 10, 74-78. doi: 34thttps://doi.org/10.1097/wtf.0b013e328351bc4b34t this work is licensed under a creative commons attribution 4.0 international license. “we pride ourselves on being strong…and able to bear a lot”: examining the socio-cultural and historical context of black americans’ experiences with depression and help-seeking rosalyn denise campbell abstract: research consistently shows that black americans’ symptoms of depression are more severe and persistent than their white counterparts yet they seek out and/or use services at a far lower rate. while trying to understand this disparity, it is important that researchers explore the socio-cultural and historical context around black americans’ experiences with depression and help-seeking. this study involved semi-structured indepth interviews with 17 black american men and women, aged 21-57, who experienced depression. a thematic analysis revealed that black americans’ experiences are often rooted in a socio-cultural and historical context where black people are seen as a strong people, able to deal with anything, and do not get depressed. these findings suggest that black americans may go through a process of reconciling being depressed with certain aspects of their cultural identity as they strive to better understand themselves, their illness, and options to help alleviate their symptoms. researchers and practitioners alike should pay more attention to this complex process as they attempt to understand the illness experiences and help-seeking behaviors of black americans. keywords: depression; black americans; experiences; culture; help-seeking depression is a major mental health issue that impacts the lives of many in the u. s. regardless of racial/ethnic background (kessler, berglund et al., 2005, williams et al., 2007). while black americans have consistently been found to be less likely to meet the diagnostic criteria for major depressive disorder (mdd) than whites (kessler, berglund et al., 2005; kessler, chiu, demler, & walters, 2005; williams et al., 2007), the course of mdd among blacks tends to be more severe and persistent (williams et al., 2007). black americans have higher rates of unmet needs related to this disorder than do whites (redmond, galea, & delva, 2009; usdhhs, 1999, 2001). most of the diagnosable cases of mdd among black americans go untreated and tend to have more impairing effects (wang et al., 2005; williams et al., 2007). in terms of professional help-seeking for depression and other mental health problems, research has shown that black americans utilize mental health services at a rate below that of whites (alegría, chatterji et al., 2008; keyes et al., 2008; williams et al., 2007), even when they have insurance. despite efforts through the affordable health care act to increase access to care and establish mental health parity, the overall gap in service use between blacks and whites is expected to persist (alegria, lin et al., 2012). this means that the group who experiences greater burden due to this illness receives the least professional help. to better understand these disparities, it is important to take a closer look at the experiences of black americans with depression, including their experiences of the disorder itself as well as their help-seeking behaviors and service use patterns related to _________________ rosalyn denise campbell, phd, lmsw is an assistant professor, school of social work, university of georgia, athens, ga 30605-1746. copyright © 2017 author, vol. 18 no. 2 (fall 2017), 663-681, doi: 10.18060/21235 https://creativecommons.org/licenses/by/4.0/ campbell/we pride ourselves 664 this illness. part of this exploration must include an examination of the socio-cultural and historical context of those experiences. this study sought to do just that by interviewing black americans diagnosed with depression about their experiences, focusing specifically on how various aspects of culture and history influence those experiences. literature review culture and health to begin to understand the socio-cultural and historical context of black americans’ experiences with depression, it is important that the impact of culture on health is explored. culture, as it is used and understood in this study, is “broadly defined as a common heritage or set of beliefs, norms, and values” (usdhhs, 1999, 2001, p. 9). research has shown that “culture plays a [crucial] role in shaping beliefs, value and rule systems, problemsolving patterns, communication styles, and learned coping behaviors” (matthews & hughes, 2001, p. 77). health behavior, or how people think about and define illness as well as how they think about and approach health and healing, is heavily shaped by culture (angel & thoits, 1987; bagley, angel, dilworth-anderson, liu, & schinke, 1995; kleinman, 1980, 1992; murray, 2001; olafsdottir & pescosolido, 2009). moreover, what is considered normal behavior and what is considered symptomatic of an illness is determined based on any given number of factors and/or circumstances, meaning culturally-shaped conceptions of “health” and “illness” can vary according to time, place, and social context (angel & thoits, 1987; capers, 1991; kleinman, 1988; murray, 2001; scheff, 1966). culture also influences how people experience illness and how their distress is communicated (angel & thoits, 1987; bagley, et al., 1995; good, 1997; kleinman, 1988; murray, 2001). while scholars, researchers, and practitioners know that culture has a strong influence on health, it has become a “long abandoned topic” in scholarship (small, harding, & lamont, 2010, p. 6). with the popularization and subsequent vilification by many of the “culture of poverty” doctrine introduced by oscar lewis in the 1960s, many scholars sought to distance themselves from a theory viewed as racist, ethnocentric, or at best, incomplete (small et al., 2010, p. 6). however, rather than challenging the theory, many researchers abandoned culture as a crucial concept necessary for exploring differences between and within groups. the use of the concept of culture in health research has its supporters and critics. as previously mentioned, because of the lingering legacy of the “culture of poverty” era, some interpret the use of “culture” in any type of commentary or analysis as a form of victimblaming (small et al., 2010; valentine, 1968). critics of an (over)emphasis on culture, particularly in health research, believe that scarce resources should be used to research and craft interventions that can be applied more universally (fabrega, 1989). on the other hand, those who support using culture in research and practice believe that it is an important lens to better view and understand health behavior (angel & thoits, 1987; bagley et al., 1995; good, 1997; kleinman, 1980, 1992; murray, 2001; olafsdottir & pescosolido, 2009). advances in social work, fall 2017, 18(2) 665 arguably, most scholars believe that the problem with culture is not its inclusion in research but its misuse. a number of investigators have stated that the actual issue is the tendency of researchers to employ either outdated or narrow definitions of culture (angel & thoits, 1987; lopez & guarnaccia, 2000; valentine, 1968). too often particular beliefs, practices, and/or values are situated within a single ethnocultural group instead of viewed as expressions related to the beliefs and practices themselves, ones that the group just so happens to embody and employ (lopez & guarnaccia, 2000). therefore, some behaviors and norms are erroneously ascribed to a group that may not truly reflect its inner-workings. it is this practice that made the “culture of poverty” theory problematic (valentine, 1968). finally, some researchers over-emphasize differences between groups and underemphasize within group differences. while the use of culture has had its problems in research, it still remains a key means to understanding how individuals from various racial/ethnic groups might think about depression and help-seeking, and thus, how they approach service use (broman, 1987; schnittker, freese, & powell, 2000). an approach to research that acknowledges the influence of culture can offer a wealth of information to researchers and practitioners looking to better understand the health experiences, behaviors, and choices of people of color. culture and black americans black americans have seen themselves historically, culturally, and socially as a strong people, and they have been viewed by others through both research and relationship as being resilient (thompson, bazile, & akbar, 2004; usdhhs, 2001). surviving and overcoming historical injustices and experiences of discrimination have been the basis for feelings of cultural/racial pride, strength, and resolve. it is often this pride, along with the desire to handle problems themselves or with the help of loved ones that keeps a number of black americans from seeking professional help for mental health problems (rostain, ramsay, & waite, 2015). further, depression is often seen as a sign of weakness (alang, 2016), antithetical to the strength and resilience often associated with being black. so what does this mean for a person whose racial group is seen socio-culturally and historically as strong? how do the feelings of weakness often associated with suffering from a mental disorder interact with the perception of strength linked with being a black american? how, then, does this socio-cultural context influence and shape black americans’ experiences with depression, help-seeking, and service use? only a small body of research has examined the direct link between cultural/racial identity and help-seeking among adults, particularly mental health service utilization. while the body of literature is small, it illuminates the importance of focusing on the sociocultural context of experiences, including meanings and messages around what it means to be black and/or what help should look like when one is experiencing problems. for instance, redmond and colleagues (2009) found that individuals reporting stronger cultural identity are more likely to view their experiences in treatment with some providers as less helpful and less fulfilling. campbell/we pride ourselves 666 specific study aims the original study, from which the basis of this manuscript was drawn, was aimed at better understanding the experiences of black americans with depression, including helpseeking behaviors and patterns of service use. the author used qualitative interviews to explore those experiences and a number of themes emerged. this analysis seeks to highlight those themes that spoke to the socio-cultural and historical context of those experiences. this study does not seek to extend blame or hold black americans responsible for the behaviors that are noted and the patterns that are observed herein; it simply attempts to better understand how black americas think about depression and help-seeking in the hopes of informing interventions to increase service use participation for those who feel that they might benefit. methods a qualitative interviewing approach was used to explore the topic of depression, helpseeking, and service use with 17 black american adults who had experienced depression. following the protocol recommended by qualitative methodologist charmaz (2006), indepth interviews were selected because they allowed the researcher to: 1) focus on the details and nuances of the participants’ experiences, 2) explore various statements and/or topics in more depth, and 3) ask specifically about feelings, thoughts, perceptions, and behaviors. .also, face-to-face interviews have been found to be preferable among african american research participants over telephone or mail surveys, allowing for trust between researcher and participant to be established, fostered, and respected (burlew, 2003). additionally, qualitative methods have been essential to health research in that it allows the researcher to capture the complexity of health experiences and behaviors (stewart, makwarimba, barnfather, letourneau, & neufeld, 2008). recruitment and interview procedures this study was approved by the university of michigan’s medical institutional review board. subsequent recruitment took place during the summer months of 2007 and 2008. flyers containing information about the purpose of the study and the criteria for participation were posted at local colleges/universities, libraries, area churches, social service agencies, doctors’ offices, and outpatient mental health organizations. individuals meeting the following criteria were encouraged to contact the principal investigator: 1) aged 18 years or older, 2) identified as black or african american, and 3) responded “yes” to at least one of the following: a) has felt sad, empty or depressed for 2 weeks or more during their life; b) has been told by a doctor, pastor, co-worker, family member or friend that they were depressed; or c) has seen a doctor, counselor or mental health professional for depression. while no incentive was offered during the 2007 recruitment period, an incentive of a $10 gift card to a grocery or local discount store was offered during the 2008 recruitment period to encourage participation from a greater range of participants. the 2007 cohort included eight women, the majority of whom were pursuing graduate degrees. the 2008 cohort included five women and four men with various educational and occupational experiences. advances in social work, fall 2017, 18(2) 667 a total of 17 black american men and women were ultimately recruited and provided informed consent. the principal investigator then scheduled and conducted semi-structured interviews with the participants in locations they selected, including their homes and local coffee shops. the interviews followed a guide created to capture the various aspects of the participants’ experiences with depression, including help-seeking and service use experiences. the length of the interviews ranged from 30 minutes to 2.5 hours and were audio-recorded with the participants’ permission. the interviews were transcribed by the principal investigator, a trained undergraduate research assistant, and a paid transcriptionist. many of the “ums,” “likes,” and “you knows” were removed when appropriate to improve the clarity of the respondents’ thoughts. pseudonyms are used in the presentation of findings to ensure confidentiality. analysis a thematic analysis was performed on the interview transcripts to identify relevant themes. this approach, as outlined by braun and clarke (2006), was selected because it allows the researcher to identify, refine, and report themes that emerge from the data, similar to the grounded theory approach developed by glaser and strauss (1967). however, the thematic analysis does not insist that the findings contribute heavily, or even remotely, to theory development as does grounded theory, which was not a goal of this study. the study aim was to explore the richness of the narratives shared and note overarching themes in the participants’ experiences. several factors were considered when approaching the thematic analysis. as recommended by braun and clarke (2006), the author contemplated the following: 1) will the analysis be a “rich description of the data set or a detailed account of one particular aspect?” (braun & clarke, 2006, p. 11) 2) will an inductive or deductive approach be used? 3) is the level of analysis explicit or interpretive? 4) is the researcher using an essentialist or a constructionist epistemology? even though a number of topics were discussed during these semi-structured interviews, the thematic analysis focused particularly on excerpts that highlighted the socio-cultural and historical context of the participants’ experiences. the author approached the data inductively, allowing the themes to come from the data itself, not fitting the data into pre-set categories. in other words, the themes were not selected beforehand. the analysis was more interpretive in that the author sought “to identify or examine the underlying ideas, assumptions, and conceptualizations – and ideologies that are theorized as shaping or informing the semantic content of the data” (braun & clarke, 2006, p. 13). the author brought a constructivist orientation to this work, an epistemology that “does not seek to focus on motivation or individual psychologies, but instead seeks to theorize the socio-cultural context, and structural conditions, that enable the individual accounts that are provided” (braun & clarke, 2006, p. 14). in other words, the researcher paid attention to the factors that externally pushed and pulled participants and not those that were internally or self-driven. campbell/we pride ourselves 668 after establishing the approach to examining the data, i.e., recorded experiences, the researcher progressed through the analysis in six phases as outlined by braun and clarke (2006): 1) familiarize yourself with your data, 2) generate initial codes, 3) search for themes, 4) review themes, 5) define and name themes, and 6) produce the report. first, the author became familiar with the data by reading and rereading the transcripts. no coding was completed at this point, but the investigator did jot down notes, including general thoughts about the data and what patterns and meanings seemed to be reflected. braun and clarke (2006) recommend this approach as it can help inform the formal coding process. next, the author generated some initial codes. the codes were quite simple at first, noting when keywords were used that reflected illness (e.g., “depression”), help-seeking behaviors (e.g. “talked to family member about depression,” “talked to friend about depression”), or service use (“saw a therapist,” “prescribed medication”). after the initial coding, the author began to search for themes. this process included recoding the data by (re)contextualizing the initial codes (i.e., providing some additional context). for example, as the author focused on excerpts coded as “beliefs,” they were seen as providing context to respondents’ illness, help-seeking, and service use experiences. these codes were reexamined and recoded to note various details about said belief (e.g., was this a belief held by the respondent; was it a belief thought to be held by black americans in general; what was the impact of the belief on the participants’ experiences; what behaviors, practices, and subsequent beliefs were borne out of that belief, etc.). these recodes then became initial themes. braun and clarke’s (2006) fourth step calls for a review of the themes. since this analysis aimed to highlight the socio-cultural and historical aspects of the participants’ experiences with depression and help-seeking specifically, the investigator focused on those themes that seemed to speak to that particular context of the participants’ experiences (e.g. “culturally-influenced belief that respondent believes shapes experience,” “reference to the influence of slavery and civil rights on black americans beliefs about helpseeking”). after focusing on those specific themes, the author moved to what braun and clarke (2006) refer to as “define and refine” the selected themes, “identifying the ‘essence’ of what each theme is about (as well as the themes overall), and determining what aspect of the data each theme captures” (p. 22). it was at this point that the investigator noticed that the themes seemed to speak or convey a message to the participants related to their depression and help-seeking experiences. the investigator then selected themes that reflected the voice that participants heard as they navigated their episodes of depression and attempts at help-seeking (e.g. “black people don’t get depressed,” “black people can deal with anything that comes their way”). finally, the investigator wrote up the study’s results. noticing a clear pattern in how the themes broke down (i.e., the representation of the beliefs themselves and the impact of these beliefs on participants), the investigator decided to reflect this pattern in the presentation of the results, separating the findings into sections that reflected “the beliefs” and “their impact,” each with their own subthemes. advances in social work, fall 2017, 18(2) 669 findings the respondents the 17 participants ranged in age from 21 to 57, with a mean age of 36 years (sd = 2.8; see table 1). the majority of participants were female (n=13). over half of the participants (n=9) were diagnosed with major depression at one point in their lives by a mental health professional, three were diagnosed by a medical physician, and 5 diagnosed themselves as having problems with depression. overall, the study participants had achieved a high level of post-secondary education: five completed at least a master’s level education (three of whom were pursuing doctorates), four participants were college graduates, and four reported completing some college (three of whom were currently enrolled). three participants reported their highest level of education completed as high school or receiving a ged, and one participant, the eldest in the study, did not graduate high school, finishing the 11th grade. table 1. profile of study respondents (n=17) respondent gender age education source of diagnosis sought professional help carol f 24 some college* self yes; talk therapy via psychologist denise f 26 college** clinician yes; talk therapy via psychotherapist derrick m 40s*** college clinician yes; medication & talk therapy via various mental health professionals devon f 32 college self no donna f 37 high school self no, not for depression but did for other mental health problems doris f 57 some high school clinician yes; medication via unknown clinician drucilla f 49 high school clinician yes; talk therapy via counselor elisa f 28 master’s degree** clinician yes; medication & therapy through counselor; prescribing clinician unknown janelle f 27 master’s degree self no kamille f 26 master’s degree** clinician yes; medication via psychiatrist & talk therapy via psychologist keith m 54 college clinician yes; medication only through physician campbell/we pride ourselves 670 respondent gender age education source of diagnosis sought professional help laura f 21 some college* clinician yes; medication & talk therapy; professionals unknown margie f 49 doctorate clinician yes; medication, talk therapy, & hospitalization; professionals unknown miller m 43 ged clinician yes, medication only through psychiatrist richard m 39 some college clinician yes; medication & talk therapy; professionals unknown shalesa f 35 master’s degree** clinician yes; medication via psychiatrist & talk therapy via social worker sidney f 28 some college* self not for depression; physician prescribed medication for sleep problems brought on by “stress” *enrolled in college; **enrolled in doctorate program; ***not included in the mean socio-culturally and historically-shaped beliefs participants spent a fair amount of time speaking about how beliefs shaped by black americans’ socio-cultural and historical experiences in the united states influenced their experiences with depression and help-seeking. before speaking about how these beliefs influenced participants, it is important to first name those beliefs as the participants understood them. black people don’t get depressed many respondents talked about what kamille, a 26-year-old woman, described as the “perception that black folks don’t get depressed.” sidney, a 28-year-old woman, shared this sentiment stating that “some black people believe that black people can just dust their shoulders off and not get depressed and can deal with everything.” janelle, another woman in her late 20s, expanded on this idea, saying i think [black] people would joke around, “oh, black people don’t get depressed; they…” there was a saying. i can’t remember, but it was pretty much saying black people don’t get depressed; they get over it or something to that effect, like it was non-existent in the black community.” other participants noted how this idea that depression was not something blacks experienced was reflected in their families and communities, specifically. twenty-eightyear-old elisa stated that depression was a foreign topic within her family; rather, “white people talk about stuff like that.” in her experience, depression was not seen as a “black advances in social work, fall 2017, 18(2) 671 person’s disease.” kamille shared this experience, stating that for her, therapy was something “for white people.” for laura, the youngest respondent at 21 years old, it was not even that depression was something experienced by others; it just did not exist. “at home, [she] kind of felt like there wasn’t any such thing as depression. it wasn’t real.” janelle and kamille felt that black americans’ belief in the lack of depression among black americans was gender-specific and discussed depression in the context of being a black woman. when talking about the messages she received about depression, janelle said that for her, “the biggest thing was black women are strong; they can handle anything.” kamille talked about this perception in greater detail: i think that there is a perception that black women don’t get depression and that no matter what life throws at us, we just find a way to deal with it and overcome and pray and move on and then it’s over, which is a really oversimplified version of what happens. so, i think that there’s this perception that white women, they can cry and fall apart and they’re depressed and they take their medications and whatever, but black women aren’t like that. (laughs) you know? we’ve been dealing with all kinds of adversities for generations. this a historical legacy that we just deal with it and move on, so i think that makes it hard to acknowledge the fact that you’re depressed when you are. some participants viewed black americans’ perception of depression as more complex. they believed that black americans did in fact have an understanding of depression but not one that necessarily reflected a clinical understanding of the illness. elisa stated that distress in black communities is “not seen as depression” and that “feel[ing] bad all the time” is “just how life is.” she went on to say that there is an assumption that “people get depressed but you just suck it up. you deal with it.” sidney, keith and kamille made statements about the ability to deal with the difficulties of life by “dust[ing] your shoulders off” (sidney), “walk[ing] it off” (keith) or simply “just deal[ing] with it” (kamille). a number of respondents discussed a link between a shared historical past and the apparent rejection of the clinical conceptualization of depression. participants shared the belief that life was supposed to be hard but nevertheless “dealt with” as a pervasive thought among black americans. they felt that it was the traversing of events in this “past” that, for many black americans, deemed one’s seeming inability to cope as counter to the very definition of being black. respondents shared the belief that difficulties, including culturally-understood experiences of depression, could be successfully endured or surmounted. elisa stated that based on “the context that black americans have had in this country, [black americans believed] you just had to struggle and suck it up. depressed or not, [as a black person] you had to suck it up and cope the best way you could.” elisa shared more about this “context,” stating, well, i could always pull out slavery for one, but just… you know, discrimination, racism, poverty, economic strife, educational inequality, violence. i mean, these are all real reasons to be sad regardless if you’re not predisposed to be depressed or not. so we’ve had to learn to cope with sadness whereas i think with my white and asian friends, they didn’t have to cope with that in the same way. campbell/we pride ourselves 672 black people are strong and can deal with anything perhaps the most prominent idea to emerge from these interviews was that participants thought that most black americans believed that black americans were a “strong people” who could deal with anything that came their way. most of the respondents made some reference to the idea of “strength” being a definitive characteristic of being black, with most connecting the idea of strength with the ability to deal with many hardships. it was a belief that shalesa, a 35-year-old female, stated she had heard “so many times.” margie, a woman in her late 40s, described it more as a kind of “folk wisdom,” “the kinda thing that, you know, when people are sittin’ around the table bull shittin’, that we all say, probably even me, you know.” respondents felt that an air of pride often accompanied the belief that blacks can deal with anything. margie says that she had heard this belief and that “the black american community say that with a lot of regard.” a 24-year-old named carol stated that as black americans, “we pride ourselves in being strong, emotionally strong and able to bear a lot.” some respondents stated how the idea of strength was firmly rooted in the historical and social experience of black americans in the united states. denise, a woman in her mid20s, stated that “[blacks] feel like black people are stronger than everybody else because black people have been through so much.” keith, a 55-year-old male, stated it differently. when supporting his belief that black americans at large would agree with the idea that blacks can deal with anything, he said, “i agree that they do. they deal with it. you know some of the comedians say, you know, they walk it off. and we’ve had to do it, you know? collectively, we’ve had to do it.” kamille had more to say about the historical legacy when asked to explain why she believed black americans experienced depression differently than other groups. i think like we have such a historical cultural legacy of overcoming and dealing with things and being able to get through that i think that contributes to the perception that black folks don’t get depressed or even if you do, you just pray about it and god will take it away, and you just deal with it. whereas i think that, for example, white people don’t have that same type of legacy. i don’t know, we always hear about celebrities going to like the hospital for like exhaustion and stuff. there’s this perception that you’re black, you have to go out and work, you know? you don’t have time to be going to the hospital talkin’ ‘bout you exhausted (laughs). you know, you just deal, and i think that’s a huge difference. even those that did not explicitly link black americans' historical past to the theme of strength talked about the difficulties of the black historical experience. when discussing how blacks are different from other groups experiencing depression, doris, the eldest respondent at 57 years old, believed that while depression does not discriminate, this country does: “blacks are coming up from slavery, and we still have a lot of prejudiced people even today.” she also believed that “blacks have been exposed to a lot more hardships.” derrick, a male in his late 40s to early 50s, also cited blacks’ historical experience when explaining why he believed blacks’ experience of depression was different than other groups: advances in social work, fall 2017, 18(2) 673 well because we had to fight, our backgrounds, our ancestors and where we came from and what we all had to go through. when you think about what rosa parks did that day on the bus, why does she have to sit in the back of the bus because of the color of her skin? that’s depressing. and just thinking about what she stood for at that moment and we as a people had to fight for to be where we are today, to me that weighs more on a scale versus let’s say a caucasian race or indians, the native indians. you know what i’m saying? we had to fight more even though your particular situation or your particular family structure may be upper and you’re doing well and you might not have to fight for nothing and your dad might be governor, you know? it’s still there. martin luther king is still there. it’s real, you know? the impact after speaking about the socio-culturally and historically-shaped beliefs that they felt black americans held about concepts like depression and strength, the participants spent time discussing the impact these beliefs had on their personal experiences of depression and help-seeking. they spoke about how these types of beliefs initially shaped their thoughts about and experiences with depression, followed by a discussion around how they eventually began to challenge, for themselves, certain aspects of those culturally-held views. initial (mis)understandings of depression and help-seeking some respondents expressed how these beliefs made it difficult for them to identify depression or recognize their symptoms as problematic. kamille said that she “didn’t even recognize [her] symptoms as depression…simply because [she] thought that…black people just don’t get depressed.” kamille went on to say, i think i would be more willing to recognize a weepy white woman as being depressed versus a black woman who did the same thing. i think there’s almost a stereotype that that’s how white people are, that they haven’t had any hardships, so of course, they’re gonna fall apart at the slightest provocation. i think i just thought that black people just weren’t…we just weren’t built that way, so-tospeak.” elisa stated how she “didn’t think [depression] was an illness or anything until [she] got to be 19 and got out of [her] house and was around a bunch of white people” (laughs). she said that it was not until that time that she was “like ahh, wait! this isn’t normal.” other respondents cited the concept of strength in relation to black americans’ historical past in the united states that made it difficult for them to admit to being depressed. richard, a male aged 39, stated that the idea that “we are strong and when you are strong you can get over anything” made him reluctant to share his struggles with others for fear of appearing weak. he also stated that the historically and culturally-infused concept of strength kept him from seeking help: campbell/we pride ourselves 674 because we have been through so much physically, it’ll make you think that you don’t need help. you are going to get over it one day; you just need the strength, you know? laura shared this sentiment stating: i think because black americans have gone through so much as a race and have been through so many hard things that being depressed for what seems like no reason isn’t something you can really admit to. janelle agreed: blacks will have [depression] but not acknowledge it or they’ll deny it, especially black women cause it’s always “oh, you’re the matriarch, you have to be the strong one” and you know, it’s kinda like you’re not allowed to be depressed, almost. eventual rejection of the “ability to deal with anything” while there is understandably a great deal of pride surrounding the strength of a people who could endure being enslaved and the vestiges of the system of slavery including racism and discrimination, many respondents stated that as they begin to learn and understand more about depression, they began to take issue with some of the culturally-influenced beliefs. of particular focus was the belief around the apparent ability to deal with just about anything. as kamille shared: i think there is a perception that we can deal with anything without any trouble, and that if we keep working at it then things will get better. but i honestly think that there is some things that happen…or maybe it’s not even one single thing, it’s a series of things…any one person should not be expected to just be able to deal with it on their own. elisa stated that even though she felt it was “reasonable” for many black americans to think that feeling bad was a part of life when “considering the context in which we’ve had in this country,” she believes that it is “totally unreasonable to assume that [if] you feel bad, you’re sad…that you just deal with it.” keith, who was quoted earlier discussing the ability of blacks to “walk it off,” quickly followed this statement saying that he did not mean to say that this was “always positive.” like elisa and keith, other respondents doubted the ability of anyone, including blacks, to simply “deal with” struggles like depression. margie stated: it is frequently interpreted…that i don’t need help, i can deal with anything that comes my way, and i not only strongly disagree with that for black people, i strongly disagree with that for human beings in general. shalesa said it more plainly: “i don’t think anyone can deal with anything that comes their way.” she went on to say that “that whole image of the strong black woman or the strong black man can do more damage than good. it’s not like black people are invincible. no one is.” advances in social work, fall 2017, 18(2) 675 respondents also discussed the impact of simply accepting beliefs like “life sucks” and the ability to “suck it up and just deal with it” without reflecting on their impact on people and persons. elisa observed that black people come to accept that people feel bad and that life sucks without “realizing how it’s affected how they look at life.” kamille also considered the acceptance of these beliefs and the toll it takes on black americans’ mental health, many times unbeknownst to them: i think it’s really important that as black people, we really stop and assess the emotional toll that things have on our lives. i think a lot of times we just sort of just suck it up and just deal with it without recognizing the emotional, the spiritual, the psychological toll that things can have on us. i mean, i think there’s just been very bad situations that i’ve been in that i just thought that, i just have the strength to just deal with it and make it through without really assessing the emotional toll it was having on me. discussion this study sought to highlight the socio-cultural and historical context of black americans’ experiences with depression and help-seeking. the results helped illuminate the complexity of these experiences, especially when considering meanings and messages around what it means to be “black” and what it means to be “depressed.” the findings encourage us to think more critically and act with more intentionality when working with black americans around depression and help-seeking as well as other mental, behavioral, and public health issues. the findings were divided into two sections, “the beliefs” and “the impact,” each with specific sub-themes. in the first section, cultural beliefs that respondents believed black americans held related to black americans’ mental health experiences and racial identity were identified. through the themes labeled as “black people don’t get depressed” and “black people are strong and can deal with anything,” respondents identified and discussed culturally-informed beliefs that seemed to equate the racial identity of “black” with the concept of “strength.” respondents were particularly critical of the idea that black people do not get depressed. while all of the respondents did not hold this belief at the time of the interview, they did discuss how they noticed what could be described as an ambiguity among black americans around what constitutes depression. some indicated that many black americans simply did not “buy into” the idea of depression or thought it did not exist in black communities. still others felt that black americans understood the concept of depression but not in a way indicative of illness requiring medical intervention. these participants stated that depression, as black americans defined it, was simply a part of life that must be endured or pushed through, a finding that has been reflected in other research (anderson et al., 2006; beauboeuflafontant, 2007; hines-martin, malone, kim, & brown-piper, 2003; thompson, et al., 2004). infused in these beliefs were ideas related to strength and the ability to handle adversity due to blacks’ historical and socio-cultural past. consistent with previous research, this study finds that strength and the ability to deal with adversity of many kinds is tied to the historical and social experiences of blacks in the u.s. (beauboeuf-lafontant, 2007; usdhhs, 2001). many respondents felt that the message they derived from these concepts campbell/we pride ourselves 676 was clear: if black americans could endure slavery as well as racism and discrimination as experienced during the jim crow era, they could and should be able to deal with anything. according to a few respondents, many black americans believed that it was because people from other races lacked this past that they were not “as strong” and were unable to deal with things. thus, these non-black americans became depressed and needed help to cope. in conclusion, the message conveyed was that needing help to cope (with depression) was seen as something foreign to the black experience. the second section of findings, entitled “the impact,” had sub-themes capturing how the aforementioned socio-culturally and historically-shaped beliefs impacted participants’ depression experiences: “initial (mis)understandings of depression and help-seeking” and “eventual rejection of the ‘ability to deal with anything.’” these findings highlight the impact that the absence of conversations about mental health in black communities can have on depression sufferers. respondents felt that it was the relationship between black identities and being strong that made depression seem non-existent in black communities. this view of black strengths also contributed to the racialized views of depression and help-seeking. many respondents described the difficulty in trying to acknowledge and deal with their depression in communities that, for socio-cultural and historical reasons, viewed depression as undermining the image of black strength and the act of seeking professional help was exclusive to “white people.” for many of these participants, it was not until they left their familial homes or were exposed to people of other races that they begin to see depression as a “real” problem. the idea that life was expected to be difficult and black americans were built to handle difficulties was also expressed by respondents. this understanding of life and living is supported by previous research showing that many black americans believe that hard times and adversity are a part of life and that they are expected to show strength in order to get through them (anderson et al., 2006; beauboeuf-lafontant, 2007; hines-martin, et al., 2003; thompson, et al., 2004). some respondents echoed these sentiments stating that “feel[ing] bad all the time” was “not seen as depression” and instead, was “just how life is.” respondents perceived that black americans were to follow the lead of their ancestors and “dust your shoulders off,” “walk it off,” or simply “just deal with it.” respondents believed that it was beliefs like these that delayed their attempts to seek help for their depression and currently keeps many black americans who need help from seeking it. they felt that the belief in their ancestors’ ability to overcome adversity is understood too simply. while they believed that it was no doubt admirable and a source of great pride that black americans survived many historical and social atrocities, some respondents felt that the failure to recognize the “emotional, the spiritual, the psychological toll that things can have on us” makes the cry to “dust your shoulders off” an uninformed and potentially dangerous practice. for them, they felt that they had to go through a process of rejecting such beliefs in order to pursue the help that eventually and, for some, successfully addressed their depression. advances in social work, fall 2017, 18(2) 677 implications for research and practice while this study was not without its limitations, including the reliance on selfdiagnosis in some participants and drawing heavily from one particular demographic of the black american population, it showed how beliefs around being “black” and “depressed” impacted how respondents thought about themselves and help-seeking for their depression. the study uncovered the perception that black americans suffering from depression might have to go through a process of rejecting or, perhaps better articulated as, reconciling being depressed with certain aspects of their cultural/racial identity in order to seek help for depression. future research is needed to investigate this idea more explicitly, intentionally focusing on the role of identity in black americans’ illness experiences and the process of identity rejection and/or reconciliation. while culturally adapted interventions do exist that appreciate and target illness education, healthy coping, and stigma bred by culturallyshaped beliefs (ward & brown, 2015), studies need to focus more explicitly on how identities around race, ethnicity, and gender interact with those around illness, as well as the process of identity rejection and/or reconciliation and their role in facilitating treatment engagement. this study included the views of participants who had not sought a formal diagnosis of depression. the idea was to capture the thoughts from black americans who do not, for a variety of reasons, seek professional help for depression. while this study offers a glimpse into the perspectives of non-professionally-diagnosed individuals who are often missing from the research, the findings might have been strengthened by capturing how those participants identified themselves as depressed. in other words, a discussion around how these individuals determined they had experienced depression would help us better understand the similarities and differences in professionals’ and lay individuals’ understanding of depression. future research could also explore the experiences of a more diverse group of black americans. most of the participants in this study had completed a high level of education, and while the findings were fairly consistent across education levels, further study would continue to seek and note within group differences. social work practitioners can benefit from a more nuanced understanding of the sociocultural and historical context of the clients they serve. understanding that black americans may go through a process in which they must contemplate how depression impacts their racial, and possibly core, identity can help social workers be more culturallyresponsive to these clients. clients who struggle to come to terms with certain aspects of diagnosis and treatment would then be seen as engaging in a more complex process of “accepting” their illness rather than being labeled as resistant, non-adherent, or noncompliant. practitioners could then aid clients in this process, or at least provide the opportunity to attend to this process, as part of their therapeutic work and/or interventions. engaging in this process not only expands upon social work’s tenets of seeing the person in environment (i.e., context) but also operate from a strengths-based perspective in that they see the processing around identity in a less problematic 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(2005). twelve-month use of mental health services in the united states: results from the national comorbidity survey replication. archives of general psychiatry, 62(6), 629-640. doi: https://doi.org/10.1001/archpsyc.62.6.629 ward, e. c., & brown, r. l. (2015). a culturally adapted depression intervention for african american adults experiencing depression: oh happy day. american journal of orthopsychiatry, 85(1), 11-22. doi: https://doi.org/10.1037/ort0000027 williams, d. r., gonzalez, h. m., neighbors, h., neese, r., abelson, j. m., sweetman, j., & jackson, j. s. (2007). prevalence and distribution of major depressive disorder in black americans, caribbean blacks, and non-hispanic whites: results from the national survey of american life. archives of general psychiatry, 64(3), 305-315. doi: https://doi.org/10.1001/archpsyc.64.3.305 author note: address correspondence to: rosalyn denise campbell, phd, lmsw, school of social work, university of georgia, 279 williams st., athens, ga 306051746. rdcampb@uga.edu. https://doi.org/10.1001/archpsyc.62.6.629 https://doi.org/10.1037/ort0000027 https://doi.org/10.1001/archpsyc.64.3.305 microsoft word walker_jv_copyedit3 _________________  marquita r. walker, ph.d., is an assistant professor of labor studies in the indiana university school of social work at the indiana university-purdue university indianapolis campus. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 262-278  training for my life: lived experiences of dislocated workers in an advanced manufacturing training program marquita r. walker abstract: this qualitative paper explores the lived experiences of one group of workers dislocated because of globalized trade policies who completed a hybrid advanced manufacturing training program (amtp) by taking advantage of trade adjustment assistance (taa), a federally-funded program for retraining workers dislocated because of trade policies. the research questions focus on how satisfied these workers are with the services and programs provided by taa. focus groups and survey instrument results indicate these workers found taa services and processes cumbersome and time consuming and actually had the effect of discouraging their education, training, and self employment. the consequences of their dislocation as it relates to taa experiences are increased frustration and dissatisfaction with the taa program. serious consideration for taa policy changes should be deemed of utmost importance. keywords: advanced manufacturing training, dislocated workers, lived experiences introduction globalization has created an environment in which american firms seek to lower labor costs by moving production offshore, forcing american workers to compete for work with workers worldwide. us government free trade policies, which promote this competitiveness, offer to american workers dislocated by trade policies opportunities for retraining through federally-funded trade adjustment assistance (taa), a training program which provides 104 weeks of paid training for workers certified as dislocated because of import competition. this paper explores factors which impacted thirteen displaced workers from the navistar engine plant and foundry in indianapolis, indiana. the thirteen workers were certified to participate in taa. through a focus group, their satisfaction with the taa program and services from workforce dislocation to workforce reintegration is measured. their stories reflect one local solution to the global problem of import competition. brief history of worker dislocation periods of worker dislocation continue to increase especially during times of economic downturns. dislocated and displaced workers are defined as “persons 20 years of age and older who lost or left jobs because their plant or company closed or moved, there was insufficient work for them to do, or their position or shift was abolished” (bureau of labor statistics, 2010a). long tenured displaced workers are those who have worked at least three years with a firm. dislocated workers lost 51 percent of their jobs following the 1973-1975 recession, 64 percent of their jobs following the 1981-82 recession, and 85 percent of their jobs following the 1990-92 recession (koppel & hoffman, 1996, p. 114). continued production cutbacks due to increased off-shoring and advances in social work, summer 2012 13(2) 263  outsourcing estimated around “two million permanently displaced workers” (beneria & santiago, 2001, p. 78) by 1997. in 2010, the number of permanently displaced and dislocated workers in the united states was 6.9 million (bureau of labor statistics, 2010b). during the time of economic expansion from 1993 to 1994, sometimes called the “new economy,” many workers were still displaced through plant closings and layoffs (knapp & harms, 2002). (hipple, 1997) posited that during this period over “2.4 million displaced workers reported they had lost their jobs because their plant or company had closed down or moved” and another “one-fourth cited ‘slack work’ as the reason for their job loss” (hipple, 1997). three in ten workers reported their “individual position or entire shift had been abolished (hipple, 1997). a more current analysis of displaced workers suggested their plight had not improved. according to the bureau of labor statistics (2011), the number of long-term unemployed workers who have remained jobless for 27 weeks or more is 5.8 million while involuntary part time workers numbered 8.6 million. involuntary part-time workers experienced reduced hours and were unable to find full time work. there were 2.5 million marginally attached or discouraged workers available for work and not currently looking for work because they believed no work existed. the bureau of labor statistics divided the u.s. into geographic regions for purposes of reporting job loss. the east north central region in which indiana is located had the second highest job loss of any us region losing 1,268,000 jobs as of january, 2010 (bureau of labor statistics, 2010c). manufacturing workers in this region who produced durable goods lost 328,000 jobs during this period (bureau of labor statistics, 2010c). indiana manufacturing employment contracted by 25 percent from june 2006 to december 2009 (joint economic committee, 2010b, p. 8). indiana relied on manufacturing for “19% of all employment” (joint economic committee, 2010a, p. 5). most of these manufacturing jobs were in durable goods such as “transportation equipment, machinery, fabricated metal products, and primary metals” (joint economic committee, 2010a, p. 1). indiana’s reduction in jobs in durable manufacturing contributed to the national durable manufacturing job loss of “two millions jobs between june 2006 and december 2009” (joint economic committee, 2010a, p. 6). the increase or reduction in orders for durable goods is an economic indicator of whether the overall economy is growing or shrinking. in indiana since december 2009, there is some growth in durable goods manufacturing from restocking inventories but not new orders. a subsector of durable goods, transportation equipment, has seen 22,000 jobs added between december 2009 and december 2010 (joint economic committee, 2010a, p. 10). most firms’ inventories reached pre-recession levels around january 2010 so new growth came from export-related demand with “over one-third (35.9 percent) of all jobs supported by exports in the manufacturing sector” (joint economic committee, 2010a, p. 14). walker/lived experiences of dislocated workers 264 decision of dislocated workers to participate in training programs based on the theory of human capital in which individuals invest in skills and knowledge so the value of their labor produces economic gains, dislocated workers make choices to participate in training programs based on the program’s “impact on future earnings, time remaining in the trainees’ work lives, and direct and indirect costs of going to school” (jacobson, lalonde, & sullivan, 1993, p. 51). older displaced workers have fewer years remaining in the workforce, so they have less incentive to enroll in training programs than do younger workers (heckman, lalonde, & smith, 1999; jacobson, 1993; knapp & harms, 2002). participation in government subsidized programs depends on individual motive. if we study the reasons displaced workers take advantage of these programs, and then explore displaced workers’ perceptions of the ease or difficulty of accessing the programs, and their perceptions of the effectiveness of these programs, then stakeholders can better understand how to fashion polices which deliver better payoffs for their investments. why workers become displaced workers may lose their jobs for many reasons: changes in technology, plant or company closures, insufficient work, changes in demand for goods and services, inept management, economic downturns, or for some other reason (bureau of labor statistics, 2010c). there is little scholarship concerning exactly why workers are displaced, but there is growing evidence that workers do lose their jobs because of import competition (addison & fox, 1995; kletzer, 1998). such is the case with over 1650 workers at the navistar engine plant and foundry in indianapolis, indiana. over the last six years, all navistar workers, represented by the united auto workers (uaw) locals 98 and 226 have become dislocated through import competition thus making them eligible candidates for trade adjustment assistance, a federally funded program to retrain workers who have lost their jobs due to import competition. during 2009, locals 98 and 226 applied for certification through workforce development for the final group of employees who received layoff notice, and certification was granted. some of these dislocated employees then begin to complete and file the necessary paperwork to comply with taa requirements to receive educational monies. the training programs eligible for taa assistance have to be on an approved state wide occupational training provider list in order to receive monies from taa. educational providers must submit an application to indianapolis private industry council (ipic), indiana department of workforce development (dwd), and demonstrate successful training and placement in high-demand occupations. approval comes from dwd. economic rationale for subsidizing dislocated workers job loss is costly not only to the worker but to society. joblessness costs society because fewer workers are contributing to the tax pool from which the government advances in social work, summer 2012 13(2) 265  operates. when tax coffers are empty, fewer monies are available for operational expenses, and fewer social welfare programs can operate. therefore, governments have an incentive to discourage joblessness by initiating training programs to reintegrate workers back into the workforce. another reason to subsidize dislocated workers is to provide more skilled workers in order to alleviate shortages of workers in certain arenas and to minimize poverty by increasing the earning power of low income workers (ashenfelter, 1978). joblessness is also costly in terms of decreased output and productivity and increased incidence of physical and mental health problems, financial problems, and crime (lalonde, 2003). social rationale for subsidizing workers when workers are displaced, they suffer from lost income streams and lost economic rents as well as losses during the adjustment period (leigh, 1995). according to lalonde (2003) joblessness creates or increases the incidence of “substance abuse, crime, and broken homes, as well as costs associated with the loss of individuals’ self-esteem that is thought to come from work” (lalonde, 2003). a social cost of displacement also occurs when powerful interest groups block socially beneficial programs such as free trade policies and new labor saving technology. government response to dislocated workers to increase jobs in a still fragile economy, the states need targeted policies to bring manufacturing jobs to indiana and ensure there are skilled workers to fill those jobs. toward this end, congress and the obama administration passed the american recovery and reinvestment act of 2010 which channeled “$ 1,250,000,000 for grants to the states for dislocated workers employment and training activities” (american recovery and reinvestment act, 2009). this increased funding provided money for the creation and delivery of new educational programs which met the requirements of taa; all course content delivered by training providers must include theoretical and practical instruction which would prepare workers to secure future “green” or technical jobs as outlined by the employment and training administration, department of labor. a joint effort by navistar management and uaw locals 98 and 226 created such a program for dislocated workers from the navistar facility who were certified for taa benefits. the bulk of the training program, which would revolve around practical and hands-on application in manufacturing, was delivered by a local community college. higher level thinking skills, team development, and problem-solving courses were delivered by a research university, and lean manufacturing courses known as six sigma were delivered by a technological institution. this hybrid training program met the requirements of and was approved by ipic and dwd and paid for with taa monies. firms’ response to dislocated workers firms are often hesitant to tell workers about impending reductions in workforce for several reasons: (1) the firm doesn’t want the community to know it is downsizing for walker/lived experiences of dislocated workers 266 fear of consumers seeking other vendors; (2) the firm does not want its workers to look for work elsewhere while still employed with them (casey, miller, & johnson, 1997); (3) the firm fears equipment and property might be damaged (bray, 2002). who participates in the programs? most of the literature concerning taa training programs looks at the economic impact of training dislocated workers to reintegrate into the workforce. decker and corson (1995) examined “the pre-layoff characteristics and post-layoff labor market experiences of two nationally representative samples of taa program participants” (p. 758) with the objective of identifying the types of workers who utilize taa training and to determine the benefits participants receive. they reported findings that the taa program training did not have a significant positive impact on the earnings of the participants “at least in the first three years after the initial unemployment insurance claim” (p. 773). their comparison of two samples of dislocated workers, preand post1988, reflect dislocated workers experienced significant wage losses after being laid off, and those who were reemployed earned less than in their previous job. jacobson, lalonde, and sullivan (1993) studied 65,000 workers displaced from the aerospace and wood product industries in the state of washington between 1990 and 1994. of the fifteen percent of dislocated workers who attend retraining programs, the younger participants tended to be white, displaced from the aerospace industry, and better educated. older participants tended to be from the wood products industry. participants who attended training programs were found to have “lower than expected earnings relative to comparably educated non-trainees” (p. 53). thus, the participants who attended training programs are not representative of the broader sample of dislocated workers. another study conducted by jacobson, lalonde, and sullivan (2005) looked at the returns to retraining displaced workers over the age of 35 using the same data from washington state in the 1990s. younger workers’ and older workers’ earnings after community college training are compared. though fewer older workers participate in community college classes, both groups’ “quarterly earnings [are] similar” (p. 398) and “retraining seems likely to have been a sound investment” (p. 409). they conclude that older workers “acquire new skills about as effectively as do younger workers” (p. 406) but the social net benefits, though still positive, are less robust because “community college schooling is heavily subsidized by taxpayers” (p. 409). history of navistar navistar, a premier manufacturing facility on indianapolis’s east side, formerly known as international harvester, employed nearly 2, 000 workers in its facility, which consisted of an engine plant and a metal casting foundry, in the 1990s. the engine plant produced diesel engines for ford motor company, their primary customer, while the foundry, owned by navistar and known as the international casting corporation (icc), produced metal castings for diesel engines for ford and other customers as well. the nationwide decline in manufacturing affected the navistar plant’s workforce, and by advances in social work, summer 2012 13(2) 267  2005, the plant employed around 1,100 workers in the engine plant and 550 workers in the foundry. in 2007, the ford motor company sued the navistar plant for raising its products’ prices without explanation and not sharing in the warranty cost on its engines. the dispute was resolved when ford decided to make its own diesel engines in mexico. as the country slumped into an economic recession, the demand for pickup trucks nosedived, and in may, 2008, “navistar laid off 500 assembly workers because of low demand” (mclaughlin, 2009). in january, 2009, navistar international corporation, based in warrenville, illinois announced the closure of the navistar east side 1.1 million square foot engine plant and foundry by the end of 2009. previously contracted through 2012, navistar began winding down operations but continued to produce diesel engines for ford through 2009. navistar worked with the automaker on a number of projects including two existing joint ventures which expanded operations into china and india and an engine-supply agreement in south america in an effort to diversify its product offering (mclaughlin, 2009). ford and navistar agreed to end their contract on december 31, 2009. the engine plant closed in december, 2009, but the icc foundry found a way to maintain its existence without the 73 year relationship with ford because it produced engine blocks for other customers. this allowed a delay of the foundry’s closing. in april, 2010, navistar international set the anticipated closing date for its indianapolis iron foundry for july 16, 2010 at which time 220 employees lost their jobs. worker adjustment and retraining notification (warn) notices about the foundry’s closing were filed with indiana’s department of workforce development. scheduled layoffs included a total of 176 workers on july 2 and 24 workers on july 16 (ibj staff, 2010, april 28). this meant the remaining workers in the plant were notified of impending layoffs. worried about their jobs, these workers looked to their union for information. the business agent for uaw local 98 was instrumental in helping them maneuver through these difficult times. local 98 became command central for these dislocated workers who needed to know their contractual rights during lay-offs and plant closings as well as options available to them for assistance from navistar, the uaw, and the government. the business agent was active in securing andre carson, congressman for indiana’s 7th district, to intervene with workone, the state’s one-stop career center, on behalf of the dislocated navistar workers; the business agent and the congressman met with and informed these union members in january, 2010 of their eligibility for taa assistance. about 3-4 months before being laid-off, the business agent encouraged them to enroll in the newly developed hybrid advanced manufacturing program. at that time there were around 150-300 laid-off workers eligible for taa. about 40 of these workers took the hvac heating and air, welding, or electrical tracks while others opted for training in heavy equipment maintenance. forty workers opted for the amtp. other workers chose not to take advantage of taa assistance. walker/lived experiences of dislocated workers 268 in order to qualify for the amtp, workers had to test out of basic math and reading requirements at a ninth grade three-month level. those opting for the amtp who tested below that standard had to complete basic education classes that were held at local 98’s union hall. in an effort to assist both dislocated navistar management and union workers, navistar and the uaw worked together in providing assistance by installing a bank of computers at local 98’s union hall in order for all dislocated navistar workers to file taa paperwork and work on adult basic education classes. this in-house joint effort grew from the necessity of providing services to a growing crowd of dislocated workers in a field already crowded with thousands of dislocated workers. mornings at the union hall are devoted to adult basic education classes while afternoons are left open for filing paperwork. in order to qualify for taa, workers had to be dislocated from their jobs because of import competition and file a group certification petition with the taa and be certified (america), file an individual taa application through the workone career center, meet several deadlines, submit all required forms in a timely fashion, and enroll in an approved trainer program. because of the huge numbers of dislocated workers flocking to workone centers to file for unemployment benefits and file taa paperwork, navistar and the uaw were instrumental in bringing a satellite workone office to local 98’s union hall. staffed with unemployment personnel and one taa coordinator, this local office alleviated some strain on navistar workers who would otherwise have to travel to a workone center and wait in congested lines for services. because of the huge number of individual taa applications being processed through the workone centers, the [taa] coordinators and workone centers were overwhelmed by applications, so the process took longer than usual. according to the afl-cio working for america institute (2001), the vast majority of taa petitions had long processing times. the taa legislation required an investigative period of 40 days (employment and training administration services act, 2002), but from january 1, 2009 to march 1, 2011, the national average processing time was over 102 days. this elongated processing time had a deleterious impact on workers who are unable to utilize their full benefits under taa until approval, were delayed in beginning their training programs, and adversely suffered from decreased morale. the uaw, which represented the navistar workers, negotiated several packages for workers laid off in 2008 and those affected by the engine plant’s closing. in 2009, navistar offered to continue the foundry’s operation if uaw local 226 agrees to a reduced wage and benefit package. navistar reported it needed reductions to remain cost competitive in the market. a ratification vote for this contract was rejected by local 226 members on august 17, 2009. on july 15, 2010, navistar and uaw local 226 negotiated and accepted by a 58% majority a new five-year contract covering 250 workers that included wage and benefit reductions. the new contract that extended through july, 2015 reduced vacation time, holidays and wages, and included a buy-out for older workers. the new pay structure was $17 per hour for production jobs and $23 for skilled trades and technical positions (ibj advances in social work, summer 2012 13(2) 269  staff, 2010, april 28).though the foundry continued to be operational; there was a four to six month shutdown while navistar expended it backlog of parts. in april, 2011, purepower technologies (ppt), llc, based in columbia, south carolina and which produced diesel power systems, emissions control systems, and industrial metal castings announced it would take over the navistar foundry and produce diesel structure components. this move resulted in recalling 120 dislocated workers from the foundry with plans to recall 30 more by june, 2011. long term plans included a $19 million dollar investment in the firm and hiring 100 more workers by 2014 (todd, 2011). workers were recalled according to seniority beginning in june, 2011. the companies also continued to collaborate on a range of initiatives, including their existing blue diamond truck and parts joint ventures and their diesel engine supply agreement in south america. the future of the navistar/ppt has currently been somewhat stabilized by the forgiveness of a debt owed to the city in 2010. ppt applied for and received a five million dollar personal property tax abatement from the metropolitan development commission (mdc). recognizing the casting facility acted in good faith during a severe economic downturn as the reason for nonpayment, the city’s mdc restructured the debt in anticipation of future investment by the facility (olson, 2011). methodology institutional review board approval was granted for this study prior to data collection. data collection included returned survey responses and focus group participation. utilizing convenience sampling,1 14 students enrolled in the hybrid amtp offered in fall, 2010 were mailed requests for participation and consent forms during summer, 2010. thirteen students initially agreed to take part in the study that involved completing a survey instrument which asked for demographic information and requested their participation in a focus group. one student opted out of the program very early. eleven students returned the survey and 5 participated in the focus group. survey results denoted demographic data that consists of age, gender, length of service at navistar, years of education, and consent to participate in a focus group. table 1: demographic survey data for dislocated worker participants from navistar number of returned surveys average age of participants gender average tenure at navistar average years of education participate in focus group 11 45 years male: 7 female: 4 11 years 11 5                                                              1 the use of convenience sampling does not ensure the small number of participants is a representative sample of dislocated workers from the navistar plant.  walker/lived experiences of dislocated workers 270 the focus group met with the pi at a local restaurant to discuss their history with navistar and their involvement with taa. the focus group met for two hours during which responses from participants were recorded via notes taken by the pi. these notes became the basis for the data analysis. the following questions were asked during the focus group: 1. please tell me about your experience after you found out your job/position was going to be eliminated. 2. tell me about your experiences in filing for and receiving training assistance through the taa. 3. tell me about your experiences in taking the amtp. 4. tell me about your experiences in securing future employment as a result of receiving certification in advanced manufacturing training. a hand analysis of the qualitative responses utilizing lean coding (creswell, 2009) resulted in three themes reflecting the lived experiences of students’ satisfaction with the services and programs provided by the taa. these themes evolved from participants’ concern and apprehension, discouragement, disillusionment, disorganization, and uncertainty concerning the application process, the structure and organization of the program, and the outcomes of the program. discussion all thirteen dislocated workers participating in this study were members of uaw and had lifetime recall rights. prior to layoff, they each made around $21.50 per hour and had good benefits. they had an excellent 90/30 insurance plan, a cost of living allowance (cola), a night shift differential, and four weeks of vacation pay after ten years of service. they each participated in the company’s 401k with a 6% company contribution match. uniforms and corresponding laundry service were provided to them every two weeks at a cost of $6 per week. optional overtime was available to them from 19992006. after 2006, overtime became scarce, and they each worked only eight hours per day monday through friday. after they were laid off from navistar, they drew state unemployment benefits as well as supplemental unemployment pay, a contractual benefit. at the time the focus group was conducted, all had been certified for taa assistance, engaged with the taa process, and were nearing completion of their amtp. three themes relating to participants’ satisfaction with taa services and its programs emerged from interpretation of participants’ responses: 1) processes involving certification and application to the taa program; 2) the structure and organization of the amtp; and 3) outcomes from the amtp. the negativity associated with participants’ lived experiences as told through their narratives suggests an overall dissatisfaction and disillusionment with the taa process and the amtp. the first theme involved the processes in which participants engaged after learning of the plant closure, their advances in social work, summer 2012 13(2) 271  subsequent dislocation, application for taa certification and training and engagement with the training program. processes related to certification and application to the taa program the first finding suggested workers were concerned and apprehensive about the processes related to certification and application to the taa program. in response to focus group question one which asked workers to tell about their experiences after they found their jobs/positions was going to be eliminated and question two which asked workers about experiences in filing for and receiving training assistance through the taa, workers confirmed their concern and apprehension about upcoming layoffs, who to turn to for help, where to go to get information, and how to apply for taa assistance. participants recount: “about nine months prior to being laid off, we were notified we were going to be laid off” and “there were rumors going around the plant that the facility was closing, but we couldn’t get a straight answer from navistar management. navistar stalled about work going out of country.” the uncertainty associated with not knowing management’s future plans was complicated by the difficulty in applying for taa assistance. once certified for taa assistance, which was facilitated by navistar management and the uaw locals, the process of actually qualifying for training monies began. participants were discouraged and frustrated by the many taa requirements administered by workone in order to qualify for assistance. one participant reported, “we filled out lots of forms. one form asked questions like: how will you support yourself during the time you are in school? what contingency plans have you made to pay your bills?” another participant said: we had to take adult basic education classes before signing up for taa. we had to pass math and reading tests. there were probably about 40 people interested in taking the advanced manufacturing track. we would meet at local 98’s hall where there were computers and work on filling out the taa forms. the business agent was a great help to us. he encouraged us all the way. we would not have been able to complete the paperwork if it were not for him. the number of forms and upcoming deadlines seemed overwhelming to these participants and contributed to their sense of disillusionment about the necessity and value of completing a training program. each participant met with a taa coordinator in order to receive the necessary forms and apply for training. one participant reported he was discouraged from applying for training from an approved taa educational provider by the taa coordinator with whom he worked even though he was approved for taa assistance. he related the taa coordinator discouraged his application because “she didn’t think i was smart enough to complete the program and that i would fail.” he said the process of getting approved for taa was difficult enough without having to deal with coordinators who tried to discourage application for training in which you were interested. so this participant entered the amtp instead of a program he preferred. this account reflected some issues with taa coordinators in general. in talking with several taa coordinators, they walker/lived experiences of dislocated workers 272 reported no training or experience in dealing with taa legislation and processes. one taa coordinator said: one day i was working in the unemployment office, and the next day i was transferred to another department and became a taa coordinator. i was given no training. there isn’t even a handbook for the coordinators. i was lost. this type of employee transfer between various state departments suggested some of the confusion and disruption during the time the navistar dislocated workers were applying for taa assistance could have been reduced or eliminated had trained staff been available to handle the applications. the subjective nature of a determination of “how smart” a dislocated worker might be made by an untrained taa coordinator could have a negative impact on the worker who is already distraught about his/her future. the dislocated worker, already determined to be eligible for approved provider training, now had to adjust his/her plans to enter a program that was not his or her first choice. engaging with the taa coordinator on site at local 98, the study participants reported the taa coordinator explained the process, deadlines, and forms to them. one participant reported: she told us we had to talk to/contact at least three other people in a field we thought we might want to enter and interview them. we really didn’t know what questions to ask them though. it was hard to find these people. the confusion these workers felt during this process was obvious. full of frustration over the operation of the process, it was clear the workers felt adrift without a life raft. each participant felt helpless in finding employers to interview and knowing what questions to ask them. another participant described this as “phone booking.” he said he would just open the phone book and find some name associated with some manufacturing facility and call them and ask them if he could interview him or her. some of them talk to him; some of them do not. one very frustrated participant responded: the taa agents’ advice was terrible. i was so frustrated; i went home and threw the papers down. i said i wasn’t going to go through all that to go to school. the taa program discourages workers who want to get an education. i was discouraged because i had to write an essay, contact 3 colleges i might be interested in going to, find out the cost, and interview people in the field in which i was interested. i did a lot of phone booking; trying to find workers to interview was a problem. i was given a questionnaire and the interviewee had to respond. the requirement was to turn in 3 interviews. the essay was about you; why should you be allowed to get taa assistance. you had to report that you had looked and couldn’t find a job and how was i going to support myself until school was completed. the deadline for submission was only two weeks. the entire packet had to be completed and submitted which included a resume. the excessive numbers of forms and deadlines to complete, file, and comply with taa guidelines posed a challenge to dislocated workers. this cumbersome process did not advances in social work, summer 2012 13(2) 273  contribute to the overall wellbeing of dislocated workers and discouraged them from availing themselves of taa assistance. structure and organization of the amtp the second finding suggested participants were discouraged and frustrated with the structure and organization of the amtp. participants’ narratives about their experiences in taking the amtp reflect discouragement and frustration with the content, timing, delivery, and instruction of the bulk of the program. participants began taking classes in the amtp in may 2010. one participant said, “the curriculum presented to us by the community college, the technological university, and the research university looked good, and we were encouraged by the business agent and others to move forward with the classes.” initially the classes were held by the community college from 1-4 pm, monday through thursday at local 98’s union hall. limited hours at the hall were available because adult basic education classes for dislocated workers upgrading their basic skills in order to qualify for taa training were being held there during the morning hours. from the start, these limited training hours prolong the length of the training program. two month’s into the program, local 98’s union hall was sold, so the community college classes move about two blocks away to uaw local 226’s union hall. this move introduced uncertainty into the training program because the workers were never sure where they were going to meet. communication from the community college was sparse and untimely. workers might show up for a scheduled class only to find the class was cancelled or moved without notification. there were no textbooks provided to the students and little communication between the instructors and the workers. the workers regretted their enrollment in the program. one participant reported: the curriculum looked good, but there was no consistency in the program. students never know in advance where their classes are to be held, when they are to attend, who their instructors are, and we have received no/few books concerning their instruction. computers are limited, so we often have to share a computer. many of the instructors are not knowledgeable about the classes they are teaching, and there is no feedback concerning students’ tests or grades. the community college program coordinator told us that employers want workers with critical thinking skills, math, computer skills, etc., but we are not getting that kind of training in this. another participant said: the program fell apart because of inconsistency with classes. the community college could not provide instructors who were knowledge[able] about the specifics of the courses. for instance, an instructor who was a (retired) math teacher was pulled in to teach intro to manufacturing. yet, another participant explained, “i feel we were pushed to fast without the time to learn. we have all been pushed through and get out of our lives. i feel we were being walker/lived experiences of dislocated workers 274 rushed, pushed, to get us out of their lives.” the depth of frustration resounded in this participant’s statement: [the community college] rushed me through, so i feel i’m a bad product. i’m supposed to represent [the community college] and i’m a failure. what’s that all about? we would like to see the program be a success and not a failure. reiterating this frustration, another participant said: i wished i could have gone into heavy equipment operator, a four month class, instead of this. at least i would have been done by now. i think the program is a failure. all participants responded they were satisfied with the instruction provided by the technological and research universities’ curriculum. those pieces of the training program, which totaled five weeks of instruction, were provided by trained professionals who supplied books and material and delivered quality instruction in a timely fashion in adequate facilities. there were no negative comments about those pieces of the training program. the general sentiment reflected from participants’ narratives was their frustration with the community college’s content and delivery of the program complicated by their discontent with continually filling out forms and meeting deadlines to comply with taa requirements. noncompliance with taa requirements meant dismissal from the program and termination of all future taa benefits so participants always felt pressured to comply for fear of losing future training monies. this created an environment in which participants felt they were set up for failure because of the inappropriateness of the training content and delivery coupled with the taa requirements to complete and verify components of training by certain deadlines. outcomes from the taa program the third finding reflects participants’ satisfaction, actually their dissatisfaction, with the outcomes associated with the training program such as securing employment and maintaining their living standards. the participants in the amtp completed the program in july, 2011. what began as a 10-month program evolved into a 14-month program. the 13 students finishing the program received certification in 10 areas of advanced manufacturing which should have given them an advantage in the job market. disillusioned and frustrated with the length of time it took to finish the program and the disorganization of the community college’s training, these participants hoped they would be recalled to the navistar/ppt foundry because they saw little prospect for work in advanced manufacturing elsewhere. one participant explained: i go in once a month and talk to the taa counselor. i tell her i’m dissatisfied. i don’t know what she does with that information. i don’t think anyone in our class has the confidence to go out and get a job. advances in social work, summer 2012 13(2) 275  another participant said: if called back to the factory, the [advanced manufacturing] training ends. then on the job training begins when we go back to work. the company pays for that. participants’ narratives suggested a general dissatisfaction with their overall training and the likelihood they would find work at comparable or higher wages after the training was completed. there was also dissatisfaction about the certifications they received. their general criticism was that the cost of their program was comparable to the cost of a degree program from an accredited college; they felt their efforts and energies would have been better spent in applying for acceptance to an accredited institution of higher learning and completing a terminal degree. this was not an option for them at the time of their layoffs because the time frame to complete a degree would have been elongated thus delaying their reentry into the workforce, and they would have to be accepted to an institution of higher learning with a certain level of credentials they did not have. as of this writing, several of the workers in the amtp have been recalled to work at navistar/ppt, and several more are planning to return soon. they are thankful to be returning to work even though they will have a reduced wage and benefit package. one participant mentioned the uncertainty of the future: if they [navistar/ppt] call us back, and they lay us off again, our insurance runs out. we had one year of insurance [under the old contract], and we had life time recall rights. the new contract is for five years. the lived experiences of these dislocated workers from dislocation to reintegration into the workforce and the adjustment of their living standards to new wage and benefits packages suggested training programs currently available need revision to better meet the training needs of dislocated workers and potential employers. further research into restructuring taa policies is necessary. conclusions the lived experiences of workers dislocated because of globalized import competition from the navistar engine plant and foundry who completed an amtp through taa reflected a general dissatisfaction with the processes, services and programs, and outcomes associated with taa. survey and focus group results indicate these workers found taa services and processes cumbersome and time-consuming and actually had the effect of discouraging their education, training, and self-employment. the consequences of worker dislocation as it relates to taa experiences are increased frustration and dissatisfaction with the taa program. a general sense of failure surrounded these workers even though some workers will return to work with reduced wages and benefits. this exploration suggested a serious need for changes in the application, implementation, and administration of taa policies. recommendations for taa policy changes included an increase in training funding from the federal government, a streamlined and simplified in person or online application process with less paperwork and fewer deadlines, a dedicated training program with competent walker/lived experiences of dislocated workers 276 instructors, support staff, and up-to-date materials, and an assessment plan to evaluate the effectiveness of the training program. references addison, j. t., & fox, d. a. 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(2011). purepower technologies, llc officially opens today in former icc foundry. news release. indianapolis, in: develop indy. retrieved from www.developindy.com working for america institute. (2001). trade act programs. washington, dc: afl-cio. retrieved from http://www.workingforamerica.org/actionbriefs/pdf/tradeact.pdf author note: direct correspondence to: marquita r. walker, ph.d., labor studies program, indiana university school of social work, 902 west new york street, indianapolis, in 46202. email: marqwalk@iupui.edu _____________ david a. mcleod, phd, msw is an assistant professor at the university of oklahoma anne and henry zarrow school of social work. copyright © 2015 advances in social work vol. 16 no. 2 (fall 2015), 249-259, doi: 10.18060/18590 moving social work education forward through the application of neuroscientifically informed teaching practice: a case study in student engagement through art and multimodal processing david axlyn mcleod abstract: modern advances in neuroscience suggest learning occurs through three basic cognition patterns. higher-level multimodal learning occurs when learning activities contain multiple cognition patterns. this case study details an application of these concepts where fine art, journaling, practicum experiences, and in-class processing were fused to create an active and participatory method of engaging social work students in critical thinking as related to differential impacts of clinical decision-making. the learning activities are described and multimodal learning is explained, along with the findings of a focus group used to assess student feedback. student experiences and the potential adaptations of this approach are also addressed. the tentative findings of this case study indicate positive learning experiences and suggest a need for further research to explore the opportunities associated with the use of multimodal and art-infused learning techniques in social work courses. keywords: social work education, neuroscience, art, multimodal learning, critical thinking, multimodal processing critiques of higher education have, for decades, suggested problems with apathetic students, ill-prepared graduates, incompetent teaching, and impersonal campuses (chickering & gamson, 1987). in more recent history social work education has been likewise represented in this narrative as no different from the university at large when it comes to struggling to find ways to improve student engagement (dooley, sellers, & gordon-hempe, 2009; mendes, 2003). further investigation is warranted to assess if apathy is truly to blame for these student engagement woes, or if new, creative approaches could be used to engage students not only in course content but also in relevant, connected, and meaningful learning experiences. multimodal learning advances in cognitive neuroscience suggest learning to be a much more dynamic, visual, and spatial processing experience than traditionally thought (blazhenkova & kozhevnikov, 2008). through neuroimaging, blazhenkova and kozhevnikov (2010) found that the brain processes and stores information not only in verbal or text-based modes, but also through visual and interactive exchanges. this research builds on gardner’s (1998) previous theory, which suggested humans have “multiple intelligences” including spatial, linguistic, kinesthetic, and others, from which the conceptualizations of “auditory” and “visual” learning styles were formed. creating a practical application for this line of research, groff (2013) proposed a theoretical framework for “wholemindedness” (p.16) which details the three primary cognitive pathways and speaks advances in social work, fall 2015, 16(2) 250 to the importance of engaging them holistically in learning activities. this framework suggests that multimodal learning environments, in which visualized, experiential, spatial, and verbal exchanges overlap, have the potential to produce more significant and widespread learning than traditional approaches since humans are not purely visual, spatial, or verbal learners. instead, each individual learns through engagement in a unique combination of these cognitive pathways. multimodal approaches could be a key to opening up our capacity to engage social work students in more creative and meaningful ways. previous research has suggested traditional teaching strategies, such as lectures, have less of an impact on student learning than active educational experiences where students are encouraged to think critically in order to solve complex problems (lundahl, 2008). in this case study i introduce one example of the “wholeminded” learning approach and detail how it manifested in a semester-long educational activity. methods of interaction and description of the learning experience the primary aim of the msw course (integrative seminar) for which this activity was built was to teach critical thinking as it applied to clinical decision-making in social work practice settings. clinical decision-making is an area of particular importance for new social workers in that it can be both a subjective and complex process to engage in, holding significant implications for the individuals, families, and communities that social workers aim to serve (gambrill, 2005; lacasse & gambrill, 2015). in order to help students better work toward this goal of proficiency in critical thought throughout the clinical decisionmaking process, a multimodal learning activity was created. this activity fused the explicit processing of clinical observations and activities from student practicum placements to reflective journaling, discussion, and the use of art for conceptual storytelling. this approach aimed to help students contemplate, process, and describe the differential impact of clinical decision-making on clients, their families and loved ones, communities, organizations, and themselves. the incorporation and use of art-based learning experiences, while not widespread, is not new to social work education. previous literature has suggested that arts-based materials can be highly successful at helping students explore personal schema, beliefs, worldviews, and systems with complexity while evoking deep emotional and cognitive connections (keddell, 2011). for this learning activity the choice was made to avoid the synthetic creation of reality. rather than using role-plays or scenarios, students were tasked to recall and study real interactions from their practicum placement where they, or another social worker in their presence, had made a clinical decision. this approach was used to maintain an organic connection to the interactive observation. these recalled observations of clinical decisionmaking fulfilled the role of the spatial cognition for the activity. according to groff (2013), these spatial interactions were neurobiologically processed through a distinct cognitive pathway that humans use to conceptualize and store information related to interactive exchanges. to document these experiences, students were asked to journal about at least mcleod/moving social work education 251 one interactive observation each week and to process the differential implications of clinical decisions that were a part of those interactions. in the learning activity students accessed their verbal/linguistic cognitive pathways in two primary ways. the first of these was through journaling about their clinical observations. in their journals students reflected about how clinical decisions they were involved in could impact the lives of others differentially. students were asked to postulate how these decisions may have felt to the client, as well as others associated with that client (family, community, etc.) in the short and long term. additionally, they were asked to write about possible implications of these decisions for their organizations and how these decisions affected them personally. additional verbal/linguistic processing was incorporated into the learning activity by giving students in-class time weekly to recall and discuss these decisions as a group. google docs was used as a platform for the student journals, which allowed the instructor to assess, in real time, what students were journaling. this approach permitted the instructor to develop a plan for in-class discussions by synthesizing themes identified in student journals with pre-determined course content for that week. the instructor would begin class discussions by drawing parallels between the week’s course content and themes from the journals. students would be given the opportunity to engage with each other in relation to the experiences they had documented. the instructor did not identify individual students or what was written about in their journals. instead, a collective learning environment that allowed students to openly share what they had been processing in their journals was created. about three-quarters of the way through the semester, and after approximately eight entries, students conducted a content analysis of their journals to identify themes regarding the differential nature by which clinical decisions impacted stakeholders. prior to this exercise, students were given a brief tutorial on the basic concepts of grounded theory, as defined by strauss and corbin (1998). the intent was not for students to engage in a full grounded theory exploration of their journals; however, several principles of the approach were used to help students organize the evaluation of their journals and to develop themes associated with the content. students were taught how to open code the narrative data and how to organize and make meaning of these codes in order to develop personalized theories on the potentially differential impacts of clinical decision-making. themes such as fear of engagement in treatment, frustration with mandated clinical intervention, relief after stabilization in care, pride from successful resolution in treatment, powerlessness in child welfare and other social protection systems, and many others were identified and related to the contexts of individuals, groups, families, and communities who are impacted by clinical decision-making. then, through coordinating with the director of public engagement at a large university art museum, students were led by a museum docent on a tour through the museum and learned how artists use their artistic ability to visually communicate issues such as those found in the themes from their journals. after the tour, students were asked to explore the museum on their own and find artwork that they believed could help them communicate the themes from their journals. students were given a detailed handout to keep them on task and help them organize their thoughts on the themes they had developed from their journals and interpret the artwork they selected to communicate those themes (see appendix 1 for an example of the advances in social work, fall 2015, 16(2) 252 handout). students photographed (with permission) their selected artwork, and the following week used those photographs to present to the rest of the class. in these presentations students were expected to synthesize their interactions with clients and clinical decision-making with the themes they identified from their written journals and to use the art they identified to help tell the story of how they believed those themes were connected to the lives of their clients and the systems with which they intersect. this process was designed to intentionally use all three domains of cognitive processing (verbal, spatial, and visual) concurrently. an example of these connections can be seen through a deconstruction of one of the student presentations. one student who had been journaling and verbally processing about their placement in a public mental health center which offered services centered on mental health, divorce, and family preservation selected the painting waiting for a bus: anadarko princess by t. c. cannon (1979, see figure 1). through journaling, the student identified themes of powerlessness, endurance, and survival. in describing the painting, the student shared with the class how they saw a woman between two worlds, dressed traditionally but still holding an umbrella and waiting on public transit. the student spoke of trying to understand the look on the face of the native women depicted in the painting, and noted how it came across as expressing displeasure or discomfort but also strength and pride. the student used the painting to help describe the powerlessness that clients may feel when they are told to make certain changes in their lives for which they may not be ready. the student also used the painting to talk about how clients often seem to endure situations when dealing with court-mandated treatment or intervention, and that success in the eyes of clients can often be closely related to survival and being able to finish treatment even when the choices being made about their lives do not align with what they may want for themselves at the time. through this multimodal learning project, students were given opportunities to gain awareness of the lived experiences of clients and process those experiences in their journals, giving them the opportunity to think more broadly about client perspectives. in the final presentations students demonstrated deeper learning as they incorporated the visual, spatial, and linguistic learning pathways they had been engaging in all semester into figure 1. waiting on a bus: anadarko princess (cannon, 1979) mcleod/moving social work education 253 a singular experience. by using art to showcase the themes they had identified in their journals, students were able to connect, in meaningful ways both cognitively and emotionally, to the stories of the clients they served throughout the semester. table 1 presents an organized description of the learning activity timeline with specific student and instructor tasks and product expectations, as well as their connection to cognitive processing domains during each part of the learning activity. table 1. multimodal learning activity progression throughout the semester timeframe cognition type student products instructor tasks sessions 2-9 spatial and verbal cognition • one journal entry each week that details an observed or enacted clinical decision from practicum and that postulates how that decision could impact clients, their families, the organization, and the social worker differentially • monitor journal entries and provide individual feedback • assess journal entries for themes across students • use those themes to facilitate in-class group discussions and decisionmaking processing with students sessions 10-13 verbal cognition • students use content analysis to code their journals and identify themes of differential experience and perspective and add notes on the process and key themes • in week 10 provide an overview of qualitative coding • provide examples of expected themes from earlier interactions with journals session 14 visual cognition • students will engage in discussion on perspective during a guided tour at the art museum (taking notes). • (directly following the tour) students go out on their own to identify and document works of art that can help them communicate themes from their journals • plan well ahead of time with the museum staff to coordinate the tour and communicate the fundamentals of the assignment • create a worksheet to guide students through the museum experience • monitor to ensure student engagement at the museum session 15 spatial, verbal, & visual cognition • students will show a picture of the art they chose and present to the class how it connects to their themes from their journals and how those themes were coded and developed • make sure the class is engaged in reflective questioning during student presentations advances in social work, fall 2015, 16(2) 254 student feedback and lessons learned at the conclusion of the semester, a focus group was conducted to explore student perceptions of their multimodal learning experience. students were advised that data collected from the focus group, in addition to being used for learning activity refinement, would be used for dissemination. all fifteen students consented to participate and were given the option to withdraw at any time and for any reason, as well as the opportunity to come forward and choose how their comments would be used. at the end of the focus group, students worked together to member check major themes that had been identified and helped to refine the interpretation of their experiences as associated with the multimodal learning activity. students were eager to offer suggestions and worked collaboratively in this process. through an examination and analysis of their feedback, and in partnership with the students as they participated in the focus group, three primary themes were identified. alternative educational activities can be intimidating the first of these themes suggested that alternative learning activities, such as this one, were not the norm for the students. students suggested they were initially confused, scared, and worried about if they would be able to competently fulfill the requirements of the activity. however, throughout the semester and likely due to thorough descriptions of activity expectations along the way, the instructor observed that student self-efficacy rose. in fact, it appeared that at the later stages of the activity students more comprehensively recognized their ability to participate successfully. one student stated, “all the way up until we got to the museum i was going, ‘i’m not creative, i can’t do this.’ but then once the tour started i got into it. it just kind of clicked.” this feedback suggests that it is important to be as detailed and transparent about the expectations of this type of exercise as possible. these students were interested but initially hesitant to participate; however, descriptive instructions and consistent feedback were found helpful in relieving their anxiety about how their performance would be assessed and ultimately helped students feel comfortable fully engaging in the learning activity. the benefits started far before arrival at the museum one of the more unexpected themes centered on how earlier stages of the activity were far more beneficial to students than had been originally anticipated. students found the journaling and in-class discussions about their journals to be remarkably helpful to their learning. one student observed, “the journal was actually really therapeutic for me.” students also found positive learning opportunities in processing the narrative data from their journals. when talking about that experience, one student said, “it was actually the end of the semester when we were doing the analysis of our entries that i started to see some of the same themes, like frustration, in both what i was describing about the client experience and that of the social worker.” these higher level processing activities demonstrated the nuances of critical thought used in this activity by facilitating opportunities for students to reflectively assess their own experiences, as well as the experiences of their clients, and were excellent teaching and learning resources that aligned with course goals. mcleod/moving social work education 255 it is the final reflective experience that “brings it all together” while there were specific benefits throughout the semester’s activities, students expressed how the final processing experience at the art museum was pivotal to their learning. one student said, “you know it’s one thing when you’re journaling, talking, or processing about this stuff (in class), but when you are really having to think about it and then you stand there in front of that piece of art and the whole thing just slaps you in your face and it’s like, duh, now i really get it.” interpretation of student feedback suggested that this learning experience was complex and, though each of the individual parts was important, the combination of them was greater than the sum of its parts. from journaling, to analysis, to introspection and processing, through finding art to communicate themes and presenting their findings to classmates, each stage of the learning activity built on the stage(s) that came before it and made the overall learning experience more meaningful. student feedback suggested the experience as a whole to be transformative. one student said, “this assignment really challenged me and forced me to think abstractly” while another shared, “using the qualitative analysis with our journaling and pulling in artwork to think about alternative client perspectives was by far the best experience i have had in college.” discussion multimodal learning experiences present promising opportunities for social work educators to engage students in activities that complement a variety of learning styles. however, several potential limitations exist to this approach as well as the assessment of its impact on student learning. the first of these is that the activity has not been empirically tested. feedback, as described above, is from a single case study of 15 students in one semester. additional student evaluation is needed to further assess the impact of the activity on student learning. additionally, the assessment and evaluation techniques to quantify learning need to be further refined. supportive institutional resources will also vary. in this case, the learning activity took place at a large research university with substantial resources, such as an on-campus museum of fine art and staff at that museum who could assist in helping students learn how to process and interpret the art during the learning experience. however, while these resources certainly influence the experience, the learning activity could undoubtedly be adapted. students could easily identify art found through online resources to connect to the themes developed in their processing of a variety of topics. coordination with off-campus, local, regional, or other resources could also be used to give students the opportunities to experience their cognitive processing in formal museums or spaces that curate artistic works. considering that one of the major tenets of the activity is to teach students how to think creatively to process the nuances of social work interactions, instructors would be well-served to model for students the identification of creative methods to help them access and process art for the activity. in contrast to previous finidings, social work students do not appear to be apathetic recipients of knowledge. they are eager to learn, keen to move past powerpoint, and hungry for experiential learning opportunities. this case study details an attempt to fuse advances in social work, fall 2015, 16(2) 256 the concepts of evidence-based neuroscience on learning with a creative and engaging approach to social work education. while this learning activity is based on evidence from the neuroscience literature, it should not be considered an evidence-based teaching practice at this time. further assessment is needed to empirically validate the approach used in this study. preliminary student feedback suggests the learning activity is highly successful and engaging. this is, however, an activity where the core concepts could easily be adapted and incorporated into courses on diversity and oppression, children and families, or a variety of other complex topics to encourage multi-layered conceptualization. interweaving verbal, spatial, and visual processing activities to create multimodal learning environments holds great promise for social work education as a whole and needs to be further explored. if social work educators are teaching students to work on the cutting edge of social work with evidence-based practices, then we should be working to bring ideas from outside of the profession to advance our teaching practices, continually evaluating the efficacy of these approaches, and assessing their impact on student learning. surely if it is our goal to help students learn how to fully engage with the clients we seek to serve, then enhancing the ways by which we engage in their learning could be a pivotal first step in that process. references blazhenkova, o., & kozhevnikov, m. (2008). the new object-spatial-verbal cognitive style model: theory and measurement. applied cognitive psychology, 23(5), 638663. doi: htt://dx.doi.org/10.1002/acp.1473 blazhenkova, o., & kozhevnikov, m. (2010). visual-object ability: a new dimension of nonverbal intelligence. cognition, 117(3), 276-301. doi: htt://dx.doi.org/10.1016/j.cognition.2010.08.021 cannon, t. c. (1979). waiting on a bus: anadarko princess [painting]. chickering, a., & gamson, z. (1987). seven principles for good practice in undergraduate education. american association for higher education bulletin, 40(7), 3-7. dooley, j., sellers, s., & gordon-hempe, c. (2009). lemons to lemonade: how five challenges in teaching macro practice helped to strengthen our course. journal of teaching in social work, 29(4), 431448. doi: htt://dx.doi.org/10.1080/08841230903249760 gambrill, e. (2005). critical thinking in clinical practice. hoboken, nj: john wiley. gardner, h. (1998). are there additional intelligences? the case for naturalist, spiritual, and existential intelligences. in j. kane (ed.), education, information, and transformation (pp. 111–131). upper saddle river, nj: merrill-prentice hall. groff, j. s. (2013). expanding our “frames” of mind for education and the arts. harvard educational review, 83(1), 15-39. doi: htt://dx.doi.org/10.17763/haer.83.1.kk34802147665819 http://dx.doi.org/10.1002/acp.1473 http://dx.doi.org/10.1016/j.cognition.2010.08.021 http://dx.doi.org/10.1080/08841230903249760 http://dx.doi.org/10.17763/haer.83.1.kk34802147665819 mcleod/moving social work education 257 keddell, e. (2011). a constructionist approach to the use of arts-based materials in social work education: making connections between art and life. journal of teaching in social work, 31(4), 400-414. doi: htt://dx.doi.org/10.1080/08841233.2011.597678 lacasse, j. r., & gambrill, e. (2015). making assessment decisions: macro, mezzo, and micro perspectives. in b. probst (ed.), critical thinking in clinical diagnosis and assessment (pp. 69-84). new york: springer. lundahl, b. w. (2008). teaching research methodology through active learning. journal of teaching in social work, 28(1-2), 273-288. doi: htt://dx.doi.org/10.1080/08841230802179373 mendes, p. (2003). teaching social policy to social work students: a critical reflection. australian social work, 56(3), 220233. doi: htt://dx.doi.org/10.1046/j.0312-407x.2003.00079.x strauss, a. l., & corbin, j. m. (1998). basics of qualitative research: techniques and procedures for developing grounded theory. thousand oaks: sage. acknowledgements i would like to offer a sincere thanks to the students who engaged with me in this process. i have learned a great deal from you all and hope that in sharing our experience with others we can broaden the conversation around unique experiences of class interaction in social work education. i would also like to thank ms. sue schofield, museum docent, whose collaborative effort allowed us to construct a meaningful and engaging experience that has forever changed the way i see art. author note address correspondence to: david a. mcleod, phd, msw, the university of oklahoma anne and henry zarrow school of social work, 700 elm ave, norman, oklahoma, 73019. email: damcleod@ou.edu http://dx.doi.org/10.1080/08841233.2011.597678 http://dx.doi.org/10.1080/08841230802179373 http://dx.doi.org/10.1046/j.0312-407x.2003.00079.x mailto:damcleod@ou.edu advances in social work, fall 2015, 16(2) 258 appendix a theme(s) artwork (title and artist) case connection c lie nt p er sp ec tiv e fa m ily /o th er pe rs pe ct iv es yo ur p er so na l pe rs pe ct iv e o rg an iz at io na l pe rs pe ct iv e mcleod/moving social work education 259 purpose: • students are to take this opportunity to process seeing the world from the perspectives of others. o specifically, students will think through how they have observed the differential impact of clinical decision-making in professional social work practice, and will identify works of art that can help the share the stories of those differential experiences. o prior to this process students will engage in a tour and discussion centered on artist and subject perspective and how the use of light, color, staging, and other artistic mechanisms help artists communicate themes and situations and tell stories of human experience and interaction with the world. directions: • use this sheet to help organize your process through the museum o take notes! • find artwork to help tell the story o you are looking for pieces that connect to the themes you found in your journal o be creative o use your imagination  this is a skill that will perhaps help you more than any other in social work practice. remember that. o there are no right or wrong answers • activity o take advantage of this time to connect as many pieces of art to your themes as possible o it is mandatory that you make at a connection to at least two themes o use this form for notes  you will be turning it in next week.  write down your themes before you get started  remember to list the artist and title of the artwork  take notes on how it connects • don’t plan on doing this later. you will forget.  remember to take a picture of the artwork with your phone (or whatever else) • i have a camera if you need it, let me know • email the picture of the artwork you have chosen to present on, to me at professor@university.edu • i will make a photo album in our facebook group • next week o what to turn in  this paper with your notes on it  a one page bulleted write-up outlining the connection between your chosen artwork and the case(s) its themes came from o presentations are 5 minutes or less microsoft word montero et al survivorship copyedi3 _________________ jessica cordero, teisha portee, renee spears, vicki stevenson, and erica tatum are all former msw students; and darrel montero, ph.d., is an associate professor, all in the school of social work at arizona state university in phoenix. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 345-362 survivorship and inheritance rights for same-gender couples: relevance to social workers jessica cordero darrel montero teisha portee renee spears vicki stevenson erica tatum abstract: californians voted in november 2008 to ban the right to same-gender marriage in california. this paper summarizes data on changes in societal attitudes relative to homosexuals, same-gender couples, and their civil rights as reflected in gallup and princeton survey research associates international poll data over the years through 2011. these findings report deeply entrenched and enduring divisions in american attitudes toward the rights and status of same-gender couples. although historically a majority of americans has consistently opposed same-gender marriage, americans increasingly recognize the need to extend equality to same-gender couples in the form of employment rights, inheritance rights, social security, and health insurance benefits. this article explores existing and proposed policies regarding the rights of same-gender couples. in addition, it examines the implications and opportunities for advocacy by social workers who face the challenge of navigating the legal and personal obstacles that arise when their client’s same-gender relationships are not sanctioned by law. keywords: homosexuality, same-gender unions, same-gender marriages, domestic partnerships, marriage on november 4, 2008, californians went to the polls in record numbers to strike down the right to same-gender marriage. the passage of proposition 8 was a major setback not only for the gay and lesbian community, but indeed, some would argue for all americans. this emotionally charged decision indicates the volatile nature of the attitudes towards gay and lesbian rights in america. the rate at which same-gender couples are forming and publicly declaring their relationships, as evidenced by census data, is growing. in august 2011, the u.s. census bureau counted 646,464 same-gender households headed by same-gender couples—up from approximately 358,000 in 1990 (yen, 2011). more significant, however, is the increasing urgency in which gay men and lesbians are asserting their rights to the same partnership benefits that married heterosexual couples enjoy. there are over 1,100 federal benefits awarded to heterosexual couples when they marry that cannot be taken advantage of by same-gender couples, including social security survivor benefits, coverage under family and medical leave act, and the right to file joint tax returns (robinson, 2011). advances in social work, fall 2011, 12(2) 346 while states like vermont and new jersey have begun granting same-gender couples domestic partnerships, many conservative americans have fought back, even proposing a constitutional amendment that would specifically define marriage as a heterosexual institution and limit the ability of gay couples to receive benefits like social security, health insurance, employee benefits, and survivorship rights (hunter, 2010). this push for a constitutional amendment has occurred at both state and federal levels. however, even some notable conservatives have supported the rights of same-gender couples to the institution of marriage (barnes, 2010; becker, 2009; totenberg, 2010). although television shows such as will and grace, queer as folk, and modern family have brought gay issues and gay characters into more and more american homes, american attitudes toward homosexuality remain deeply divided. this is perhaps nowhere more clearly seen than in relationship to the question of whether gay partners should enjoy the same legal and economic protections of married heterosexual couples (olson, 2010). this article examines the evolving opinions of the american public from 1977 to 2011 by asking a cross-section of americans the following questions: (1) do you think marriages between homosexuals should or should not be recognized by the law as valid, with the same rights as traditional marriages?; (2) do you think homosexuals should or should not have equal rights in terms of job opportunities?; (3) do you think there should or should not be… inheritance rights for gay spouses?; (4) do you think there should or should not be… social security benefits for gay spouses?; and (5) do you think there should or should not be… health insurance benefits for gay spouses? this study will advance our understanding of the attitudes towards the rights of same-gender couples and thereby provide empirically based ammunition for social workers as advocates of social change. literature review gay rights, domestic partnerships, and equality the promise of “equal protection of the law” is addressed in the u.s. constitution, and echoed in numerous significant pieces of legislation including the americans with disabilities act and the civil rights act of 1991. these acts serve to prohibit discrimination based on disability status, race, and gender. however, laws that would prohibit discrimination based on sexual orientation remain largely unaddressed, specifically concerning social security, health insurance, employee benefits, and survivorship rights. in the absence of such federal and state guidelines, gay men and lesbians are often vulnerable to discrimination and differential treatment. in new york, with the passage of same-gender marriage, the ability to add a spouse to an employer’s plan may be one of the more significant financial benefits. same-gender employees are taxed on the health benefits of their partner because their status is not recognized by the federal government. however, same-gender married couples no longer will have to pay state tax (bernard, 2011c; 2011d). it is interesting to note that the issue of rights for same-gender couples is currently being determined at the state level, which further adds to divide in public opinion on this issue. cordero, montero et al./survivorship and inheritance rights 347 great strides have been made towards encouraging more tolerant public attitudes towards gay and lesbian issues; however, more concise federal guidelines are needed in order to ensure that the writings of the u.s. constitution shift from promises to guarantees. closely monitoring the past and present trends of americans’ attitudes towards gay and lesbian issues allows social workers a close appraisal of the complexity of public sentiment and the political and social climate for future policy changes and advocacy for the equal rights of same sex couples. these data provide empirically based ammunition for social workers as advocates of social change. questions about equality for gay men and lesbians are nowhere more contested than in regard to the issue of same-gender marriage, civil unions, or same-gender partnerships. in 1999, the vermont supreme court granted gay and lesbian couples benefits identical to those of heterosexual married couples, ushering in a wave of similar legislation in california, connecticut, massachusetts, iowa, and new jersey (cole, 2009). these states’ actions reignited a national debate on same-gender marriage and the rights of samegender couples. while many conservatives objected to gay men and lesbians receiving what they considered special legal protection, gay activists criticized the unequal status of civil unions, which they felt denied them access to a social institution that symbolizes full membership in american society. the literature suggests that americans’ attitudes toward homosexuality are distinct from their opinions about whether gay men and lesbians should be allowed civil rights like that of marriage or domestic partnership. while the majority of americans are reluctant to identify homosexuality as “moral,” most americans are unwilling to restrict the civil liberties of gay men and lesbians (badgett, 2009; pan, meng, & zhou, 2010). a period of more tolerant public attitudes towards homosexuality emerged in the 1970s, but encountered a setback with the upswing of conservatism beginning in the 1980s through the 1990s. since 2000, support for expanding gay men and lesbians’ civil liberties has rapidly increased (harms, 2011). the defense of marriage act and homosexuality as an acceptable lifestyle in 1996, then-president clinton signed the defense of marriage act into law. the defense of marriage act (or doma) grants states the right to refuse recognition of marriages or unions between people of the same gender—even if those marriages or unions were legally performed in another state (defense of marriage act, 1996). further, doma prohibits the federal government from recognizing any state-performed samegender marriage or union. drafted in anticipation of states like massachusetts, that eventually granted marriage rights to gay and lesbian couples, doma has been criticized as governing morality and overstepping constitutional rights like due process (feigen, 2004). some doma supporters, however, feel that doma does not go far enough and have proposed a constitutional amendment known as the federal marriage amendment that would specifically define marriage in the united states as a heterosexual institution. with the passage of laws such as the defense of marriage act of 1996 and the fight to legalize gay marriages, the legal status of same-gender couples has become more salient. the most significant barrier to the american public’s acceptance of same-gender advances in social work, fall 2011, 12(2) 348 marriage or civil unions is institutionalized heterosexism or the “set of ideas, intuitions, and relationships that make the heterosexual family the societal norm while rendering homosexual/queer families ‘abnormal’ and ‘deviant’” (lind, 2004, p. 23). despite the cultural and legal entrenchment of institutionalized heterosexism, there have been some gains in rights for gays and lesbians—most significantly, the acknowledgment by a few states that gay men and lesbians have the right to their partners’ health and insurance benefits and the right to adopt. in addition, many private companies have voluntarily incorporated nondiscrimination clauses into their own practices and codes of ethics. same-gender partnerships and marriage rights for gay and lesbian couples in 2000, vermont became the first state to legalize civil unions for same-gender couples. civil unions in vermont and other states grant same-gender couples benefits similar or even identical to those of marriage, but allow states to “reserve” the institution of marriage for heterosexual couples (hunter, 2010). although support for civil unions has increased throughout the years, public opinion (among both gay-rights activists and conservative religious groups) is still somewhat divided (hertz & doskow, 2011; newton, 2010). the institution of marriage is a social, legal, and religious construct that has evolved over centuries. religious or orthodox conservatives who oppose allowing gay men and lesbians the right to marry cite biblical justifications and believe that marriage is for the purpose of procreation. advocates of same-gender marriage believe that all citizens have the right to marry and should not be discriminated against on the basis of their sexual orientation. additionally, supporters of same-gender marriage point to how the institution of marriage in the united states has changed over time. for example, interracial marriage was only decriminalized in 1967, and many gay-rights activists liken discrimination against same-gender couples to that previously exercised against couples of different races (frank & mceneaney, 1999). those who support same-gender marriage rights for gay men and lesbians want all couples—gay and straight—to share the status and rights associated with marriage (greene, 2011). according to the u.s. general accounting office, marital status is a factor in more than 1,100 federal laws, and marriage imparts nearly 1,400 federal and state benefits including hospital visitation, adoption, and inheritance rights (robinson, 2011). a key consideration in this debate is whether civil unions or same-gender marriage would be better suited as a path for gay men and lesbians to achieve social and economic parity with their heterosexual counterparts. some critics believe that permitting civil unions and not marriage would be equivalent to classifying same-gender relationships as second class. thus, this manuscript shall examine americans’ attitudes toward the rights and benefits for same-gender couples over the past 3 decades. cordero, montero et al./survivorship and inheritance rights 349 methods design of the sample for personal surveys the findings of this study were based on published opinion polls from the gallup organization (2011a; 2011b; 2011c; 2011d) and princeton survey research associates (2004; 2008). the design of the sample for personal (face-to-face) surveys was that of a replicated area probability sample down to the block level in the case of urban areas and down to segments of townships in the case of rural areas. after stratifying the nation geographically and by size of community according to information derived from the most recent census, over 350 different sampling locations were selected on a mathematically random basis from within cities, towns, and counties that have, in turn, been selected on a mathematically random basis. the procedures just described were designed to produce samples that approximate the adult civilian population (aged 18 and older) living in private households (that is, excluding those in prisons, hospitals, hotels, and religious and educational institutions, as well as those individuals living on reservations or military bases) and, in the case of telephone surveys, households with access to a telephone. survey percentages may be applied to census estimates of the size of these populations to project percentages onto the numbers of people. furthermore, the manner in which the sample was drawn also produces a sample that approximates the distribution of private households in the united states; therefore, survey results can also be projected onto the number of households. limitations of the study as in all survey research, there are questions of social desirability response bias, reliability, validity, and margin of error issues. davis (1971) and others have indicated that reliability and validity issues are some of the most challenging concerns encountered in social research. the gallup organization has addressed these issues on a continuous basis since 1935. they are constantly improving their methodological techniques through testing question wording and sampling design to improve reliability and validity of their survey results. a complete methodological appendix outlining these efforts can be found in gallup and newport (2010). results attitudes toward the legal validity of same-gender marriage the issue of whether marriage between same-gender couples should be recognized by law has had a history of controversy and divided opinion in america. from 1996 to 2011, a national cross section of americans was asked the following question: “do you think marriages between homosexuals should or should not be recognized by the law as valid, with the same rights as traditional marriages?” (see table 1). the results reveal support increasing dramatically from 1996 to 2011 for recognizing homosexual marriages by law as valid. in 1996, approximately 1 in 4 americans supported same-gender marriages. whereas, by 2011, a full majority (53%) reported that advances in social work, fall 2011, 12(2) 350 these marriages should be recognized by law as being valid, with the same rights as traditional marriage. table 1: attitudes toward the legal validity of same-gender marriage, 1996-2011a year should be valid % should not be valid % no opinion % 1996 1999 2004 2005 2006 2006 2007 2008 2009 2010 2011 27 35 42 37 39 42 46 40 40 44 53 68 62 55 59 58 56 53 56 57 53 45 3 3 3 4 4 2 1 4 3 3 3 question: “do you think marriages between homosexuals should or should not be recognized by the law as valid, with the same rights as traditional marriages?” a data reported twice in one year indicate that the question was asked twice in that year. notes: figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by the gallup organization. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled by the gallup organization (2011a). attitudes toward equal employment rights for gay men and lesbians americans have appeared to be historically fair-minded on the issue of equal rights in terms of job opportunities for gay men and lesbians. between 1977 and 2008, a cross section of americans was asked the following question: “do you think homosexuals should or should not have equal rights in terms of job opportunities?” (see table 2). the number of americans who supported equal employment rights for gay men and lesbians ranged from a low of nearly 6 in 10 americans in 1977 to a high of nearly 9 in 10 americans when the question was last posed in 2008. cordero, montero et al./survivorship and inheritance rights 351 table 2: attitudes toward equal employment rights for gay men and lesbians, 1977–2008a year yes, should % no, should not % 1977 1982 1989 1992 1993 1996 1999 2001 2002 2003 2003 2004 2005 2006 2007 2008 56 59 71 74 80 84 83 85 86 88 88 89 87 89 89 89 33 28 18 18 14 12 13 11 11 9 10 8 11 9 8 8 question: “do you think homosexuals should or should not have equal rights in terms of job opportunities?” a data reported twice in one year indicate that the question was asked twice in that year. notes: figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by the gallup organization. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled by the gallup organization (2011b). advances in social work, fall 2011, 12(2) 352 attitudes toward inheritance rights, social security, and health insurance benefits for gay and lesbian spouses from the mid-1990s to the late-2000s, a cross section of the american public was asked the following three questions: (a) “do you think there should or should not be inheritance rights for gay spouses, 1994-2009?” (see table 3); (b) “do you think there should or should not be… social security benefits for gay spouses, 1994-2008?” (see table 4); and (c): “do you think there should or should not be… health insurance and other employee benefits for gay spouses, 1997-2009?” (see table 5). table 3: attitudes toward inheritance rights for gay and lesbian spouses, 1994-2009 year should % should not % don’t know % 1994 1996 1997 1998 2000 2004 2008 2009 61 61 62 59 62 60 74 73 30 29 30 33 28 30 20 24 9 10 8 8 10 10 6 4 question: “do you think there should or should not be… inheritance rights for gay spouses?” notes: figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by the gallup organization and princeton survey research associates international. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled by princeton survey research associates international (2008) [newsweek poll conducted by princeton] and the gallup organization (2011c). cordero, montero et al./survivorship and inheritance rights 353 table 4: attitudes toward social security rights for gay and lesbian spouses, 1994-2008 year should % should not % don’t know % 1994 1996 1997 1998 2000 2004 2008 55 48 57 52 54 55 67 39 43 37 41 38 36 27 6 9 6 7 8 9 6 question: “do you think there should or should not be… social security benefits for gay spouses?” notes: figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by princeton survey research associates international. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled by princeton survey research associates international (2004; 2008) [newsweek poll conducted by princeton]. the results reveal some striking trends and remarkable consistency. over the decade in which these questions were posed, approximately 6 in 10 americans, in the mid-1990s, consistently supported gay men and lesbians’ rights to inheritance, social security, and employee benefits from their partners. this support increased modestly to nearly 7 in 10 americans by the late 2000s. advances in social work, fall 2011, 12(2) 354 table 5: attitudes toward health insurance benefits for gay and lesbian spouses, 1997-2009 year should % should not % don’t know % 1997 1998 2000 2004 2008 2009 59 58 58 60 73 67 36 37 34 33 23 30 5 5 8 7 4 2 question: do you think there should or should not be… health insurance and other employee benefits for gay spouses? notes: figures may not total 100% because of rounding. for each table, authors have reported all data which were collected by the gallup organization and princeton survey research associates international. however, it is important to note that these organizations did not conduct the same survey every single year, which explains the occasional gaps in the data reported year to year. source: poll data compiled by princeton survey research associates international (2004; 2008) [newsweek poll conducted by princeton] and the gallup organization (2011d). discussion marriage is a private and public demonstration of commitment that affords couples a range of benefits and protections. when a state denies same-gender couples the right to a legal marriage, these couples are denied many of the same benefits (gallagher, 2010). american attitudes toward homosexuality are sharply divided and, at times, even contradictory. these data reveal that a majority of americans hold nondiscriminatory attitudes toward homosexuality. for example, half of americans in 2011 think marriage between homosexuals should be recognized by the law as valid (gallup organization, 2011a). it is important to note that for the first time since this question was first posed in 1996, a full majority of americans (53%) support same-gender marriage. historically, change has occurred due to a cultural watershed or ideological change. that is, as americans’ opinions about other marginalized groups, such as african americans and women, became more accepting, these favorable opinions generalized to other marginalized groups, including gay men and lesbians (schroeder, 2004). other possible explanations for increased tolerance of homosexuality could be a greater cordero, montero et al./survivorship and inheritance rights 355 awareness of gay and lesbian issues in the media and larger numbers of americans who say that they know at least one person who is gay (brewer, 2007). although an individual’s race, gender, and disability status are protected from discrimination by federal and state laws, gay men and lesbians remain vulnerable to differential treatment and discrimination. this legal reality does not appear to be in line with a majority of americans’ views on homosexuality. for example, as reported in table 2 as recently as 2008, nearly 9 in 10 americans supported equal employment rights for gay men and lesbians. when it comes to inheritance rights, americans appear willing to allow same-gender couples the same benefits married couples enjoy: the ability to leave property to a surviving spouse. for example, new york couples who choose to marry will be first in line to inherit their spouses’ assets. this is true, even if there is no will (bernard, 2011b). if there are children, the spouse receives $50,000 and half of the estate. the children then split the remaining monetary assets. the surviving spouse also chooses what to do with the remains of the deceased. however, not all rights are granted. couples still neither file federal joint income taxes nor inherit the retirement benefits of their partner (greene, 2011). with regard to social security and employee health benefits, americans are more reluctant to extend these benefits to same-gender couples. vives (2010) contends that the overall concern of benefits rights should be based more on economic equality than even marriage equality. indeed, it is possible to argue that americans are cautiously conservative with regard to same-gender rights, but are less willing to grant same-gender couples the right to legally marry (winenke & hill, 2009). however, it is interesting to note that nearly 6 in 10 (58%) fortune 500 companies offer coverage to employees with same-gender partners. similarly, mcgough (2010), bernard (2011a), lutgens and trast (2011), and national conference of state legislatures (2011) also report increasing benefits rights for same-gender partners. implications for social work practice as social workers, we often think of same-gender marriage and related issues as fairly contemporary. however, current social work practice and policy is guided by the definition of family adopted over 3 decades ago in 1981 by the national association of social workers (nasw): “a grouping that consists of two or more individuals who define themselves as a family and who over time assume those obligations to one another that are generally considered an essential component of family systems" (bern-klug, 2010, p. 188). most of the injustices that gay men and lesbians experience are not linked to high profile national events, and their stories do not usually make the evening news. however, every day, gay men and lesbians experience the impact of discrimination on the job due to the fact that they lack comparable employee health, welfare, and retirement benefits for their same-gender partners. gay and lesbian couples’ differential legal status in the united states means that social workers must understand both how discrimination affects advances in social work, fall 2011, 12(2) 356 same-gender couples and their children as well as the urgency with which these couples need greater protection under the law. social workers have developed a variety of resources which provide best practice techniques that can be employed while working with same-gender couples. for example, ambrosio, heffernan, and shuttlesworth (2011) developed a framework of general social work practice techniques dealing with same-gender marriage. gardner (2010) examines the council on social work education’s (cswe) challenges regarding employment benefits for gay and lesbian partners. he further observes that same-gender couples face these challenges as they grow old, requiring social workers to create programs to meet their specific needs, to persuade for systematic change, and to make social workers aware of their own assumptions. additionally, hardina, middleton, montana, and simpson (2007) have developed culturally sensitive practice models and theories that empower this specific population. social workers often draw from allied professions such as psychology. in this vein, the american psychological association (2011) has developed practice guidelines based on 21 principles for working with lesbian, gay, and bisexual clients. self-determination is a core value for social workers. towards this end, same-gender couples should make their own decisions after all options are made known to them. in healthcare settings, several authors have discussed the role of social workers specializing in palliative care and end-of-life planning for same-gender couples. altilio, otis-green, and farrell (2011) note that despite the legality of same-gender marriage in a number of states, social workers need to assess the environment of their clients’ healthcare setting. this is because even well-executed documents may not meet the requirements of specific state laws. thus, we have seen that a variety of best practices have been developed for numerous social work settings that deal with same-gender couples; for example, end-of-life palliative facilities. collins (2011), for example, reports on the mandatory recognition of gay couples by hospitals. significantly, the presidential memorandum enacted on january 18, 2011 outlaws discrimination based on gender identity and requires more than 6,200 hospitals to inform patients of their rights to visitors of their choosing, with more than 35 million admissions yearly. according to the national resource center for permanency and family connections (2011), there are a variety of best practices available for meeting the needs of samegender couples and the complexity of gay marriage issues. in addition, mallon (2008) provides a series of best practice principles working with same-gender couples. nasw mandates that social workers have a critical role in assisting individuals and their families regarding their options in the face of legal barriers to marriage, civil unions, same-gender partnerships, inheritance and survivorship, and employees’ benefits as they affect this population. on a regular basis, nasw offers a series of continuing education seminars on topics for social workers and family law for same-gender couples (nasw, 2011). drawing from the numerous best practice techniques presented above as well as those available from allied professions, schools of social work throughout the country are now in a better position to design a comprehensive curriculum that employs these direct practice techniques to work with same-gender couples. cordero, montero et al./survivorship and inheritance rights 357 figueira-mcdonough (1993) describes policy practice as the “neglected side of social work interventions” (p. 179). she articulates four approaches to policy practice— legislative advocacy, reform through litigation, social action, and social policy analysis— which we apply here in hopes of inspiring such work. legislative advocacy given how deeply divided american opinion about gay rights is, an advocacy approach is particularly pertinent. past inequities in american history—slavery, segregation, and women’s suffrage—all required some form of legislation to set right, even when corrective action was unpopular at the time. social workers, equipped with this knowledge, could serve their clients by working at local, state, and federal levels to secure some form of partnership rights for same-gender couples. indeed, social workers familiar with the findings reported here may be in a unique position to advocate for legislative change by actively promoting the extension of inheritance rights and employee benefits to same-gender couples. reform through litigation when weighing the potential applicability of the reform-through-litigation approach, social workers should become familiar with the laws and the patience to see test cases through to their conclusion. reform through litigation is nevertheless a viable option for social workers interested in advocating for their same-gender clients’ right to inheritance, social security, and employee health insurance benefits, as well as to receive many of the other benefits associated with legal marriage. in perry v. schwarzenegger (2010), which challenged the federal constitutionality of proposition 8, expert witnesses were utilized to provide critical perspectives on the similarity between heterosexual and same-gender relationships. cott (as cited in shih, 2010) argued that marriage has become more gender neutral, and that same-gender marriage is capable of fulfilling the purposes of marriage from an economic perspective. in her testimony, ucla social work professor peplau (as cited in national center for lesbian rights, 2010) agreed that the quality and stability of same-gender relationships are similar to those of heterosexual relationships, noting that most couples marry to gain physical, psychological, and social benefits. social workers are in a unique position to collect data on the nature of relationships between same-gender couples and determine their similarity or distinctiveness from heterosexual relationships. this is how social workers can bolster their credibility through systematic empirical research to address these specific issues surrounding samegender couples. social action social workers could employ this community-based approach on a local level by establishing ongoing dialogue within their community about same-gender couples’ need for legal recognition and by mobilizing central community players for change. advances in social work, fall 2011, 12(2) 358 knowledge of public opinion data like those presented here could aid social workers in their work toward legal protection of same-gender relationships using the social action approach. specific findings in this article—in particular, the data presented on equal employment rights and support for gay spouses’ inheritance, social security, and health insurance rights—may be important “leverage points” social workers can use to advocate for expanding same-gender couples’ rights. knowing that a majority of americans is sympathetic to the plight of same-gender spouses—who may be unable to inherit property when their partner dies or visit their ailing spouse in the hospital—could provide much needed common ground in a conversation or public forum on gay rights. social policy analysis the fourth approach is a valuable tool because it provides social workers with the skills necessary to closely read and understand social policy. by applying analytical lenses like self-determination and equity, social workers are better equipped to understand pending legislation that directly affects their clients. social workers experience many ethical dilemmas related to same-gender couples, including how public opinion greatly influences this population. state and national policies continue to evolve, and the consequences of these policies have the potential to affect same-gender couples. this point may be relevant when working not only with gay and lesbian clients, but with family members of these clients whose feelings about homosexuality ultimately affect the entire family system. the national association of social workers (nasw) (2008) has established clear guidelines for social work with gay and lesbian clients: “same-gender sexual orientation should be afforded the same respect and rights as other-gender orientation” (p. 5). in terms of advocacy, the nasw is “committed to working toward the elimination of prejudice and discrimination based on sexual orientation, both inside and outside the profession” and is “working to help enact antidiscrimination legislation at the national, state, and local levels as well” (p. 1). all social workers have a responsibility to understand the unique circumstances of their clients. knowledge, training, and awareness are crucial in order to serve each client effectively. 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(2009). does the ‘marriage benefit” extend to partners in gay and lesbian relationships? journal of family issues, 30(2), 259-289. yen, h. (2011, september 27). census: many gay couples say they’re married—even if they technically aren’t. msnbc [online] retrieved from http://www.msnbc.msn.com/id/44690992/ns/us_news-life/?gt1=43001 author’s note: address correspondence to: dr. darrel montero, arizona state university school of social work, mc 3920, 411 north central avenue, ste. 800, phoenix, az 85004-0689. email: darrel.montero@asu.edu microsoft word rice et al ebp questionnaire confirmatory factor analysis final   _________________ karen rice, msw, is an instructor in the department of social work at millersville university in millersville, pa, and a ph.d. student at the university of maryland, baltimore. jeongha hwang and tina abrefa-gyan are ph.d. students at the university of maryland, baltimore. kathleen powell, msw, is an associate professor in the department of social work at frostburg state university in frostburg, md as well as a ph.d. student at the university of maryland, baltimore. this research was supported by funds from the university of maryland, baltimore school of social work as part of a doctoral practicum project. the authors wish to thank drs. llewellyn j. cornelius and donna harrington for their technical assistance and professional mentoring. in addition, the authors wish to thank the following student colleagues for their assistance with the project: margaret beall, darnell morris-compton, saltanat dushalieva, andrea jones, marlene materese, deborah vangeison svoboda, kimberly searce vanvulpen, michelle tuten, and crystal williams. finally, special thanks are given to dominic and penelope upton for allowing the use of their measure. copyright © 2010 advances in social work vol. 11 no. 2 (fall 2010), 158-173   evidence-based practice questionnaire: a confirmatory factor analysis in a social work sample karen rice jeongha hwang tina abrefa-gyan kathleen powell abstract: this study examined the psychometric properties of the evidence-based practice questionnaire (ebpq). the 24-item ebpq was developed to measure health professionals’ attitudes toward, knowledge of, and use of evidence-based practice (ebp). a confirmatory factor analysis was performed on the ebpq given to a random sample of national association of social work members (n = 167). the coefficient alpha of the ebpq was .93. the study supported a 23-item 3-factor model with acceptable model fit indices (χ² = 469.04; rmsea = .081; srmr = .068; cfi = .900). this study suggests a slightly modified ebpq may be a useful tool to assess social workers’ attitudes toward, knowledge of, and use of ebp. keywords: evidence-based practice, confirmatory factor analysis, ebpq, social workers introduction evidence-based practice (ebp) is defined as a “process that blends current best evidence, community values and preferences, and agency, societal, and political considerations in order to establish programs and policies that are effective and contextualized” (regehr, stern, & shlonsky, 2007, p. 410). in most developed countries, use of ebp is the goal of public services (nutley, walter, & davies, 2009), and in the past two decades, there has been a more conscientious attempt to use ebp in various social work settings including child welfare, employment, health, juvenile justice, mental health, and substance abuse (fixsen, blase, naoom, & wallace, 2009). the degree to which ebp is used varies among practitioners and across practice settings (mcneece & thyer, 2004). bellamy, bledsoe, and traube (2006) note that many federal agencies including the national institute of mental health (nimh) and the substance abuse and mental health services administration (samhsa) have emphasized the use of evidence-based interventions and are now linking their grants to translational research. advances in social work, fall 2010, 11(2) 159 social workers, however, do not generally incorporate research evidence into daily practice despite being encouraged, or sometimes required to do so (bledsoe et al., 2007; mullen, bledsoe, & bellamy, 2008; national association of social workers, 1999; rosen, 2003). in fact, some practitioners have actively resisted the use of ebp (gibbs, 2003; nelson, steele, & mize, 2006). in an attempt to understand the resistance to the use of ebp, research has been done on barriers to implementing ebp (bellamy et al., 2006). the findings reveal that negative attitudes toward ebp (aarons, 2004; addis & krasnow, 2000; rosen, 2003) and lack of knowledge and skills for using ebp (addis & krasnow, 2000; rosen, 2003) are the two most frequently cited barriers impeding practitioners’ use of ebp. to ensure that attitudes toward and knowledge of ebp are measured consistently across the diverse population of social workers, it is essential to have reliable and valid measures (harrington, 2009). a review of the literature identified scales measuring attitudes toward, knowledge of, and/or use of ebp developed for use in the health or mental health professions, but not explicitly for social work. to determine whether the original structure of a measure works well in a new population such as social work, a confirmatory factor analysis (cfa) can be performed (harrington, 2009), which is the purpose of this research study. as upton and upton (2006) noted, the psychometric properties of the evidence-based practice questionnaire (ebpq), the instrument used in this study, need to be evaluated for further refinement. thus, the purpose of this study is to assess the reliability and validity of the ebpq with a sample of national association of social work members. literature review a review of the literature was conducted to identify potential standardized scales that measure social service providers’ knowledge of, attitudes towards, and use of ebp. a search using keywords: “evidence-based practice” or “evidence-based interventions” and “measures” or “instruments” was conducted using academic search premier, social science index, psycinfo, pubmed, and hapi databases. the search produced three potential ebp scales that have been used in the health professions, particularly in nursing. these scales included the 15-item evidence-based practice attitude scale (ebpas) developed by aarons (2004); the 24-item evidence-based practice questionnaire (ebpq) developed by upton and upton (2006); and the joint 16-item ebp beliefs scale and 18-item ebp implementation scale developed by melnyk, fineout-overholt, and mays (2008). evidence-based practice beliefs and implementation scales the 16-item ebp beliefs and 18-item ebp implementation scales (melnyk et al., 2008) were designed to be used jointly to measure nurses’ attitudes toward and use of evidence-based practice. both scales are unidimensional constructs. the ebp beliefs scale has response categories ranging from 1 = strongly disagree and 5 = strongly agree with higher scores indicating higher value of ebp and belief in implementing it in practice. the ebp implementation scale’s response categories range from 0 = 0 times to 4 = > 8 times with higher scores indicating increased frequency in implementing ebp rice, hwang, abrefa-gyan, powell/evidence-based practice questionnaire  160 within the past eight weeks. high internal consistency reliability was attained for each scale (alpha = .90 for ebp beliefs and alpha = .96 for ebp implementation), and criterion validity was also supported. these scales were recently developed and the developers continue to test their reliability and validity. evidence-based practice attitude scale the 15-item ebpas was designed to measure mental health service providers’ attitudes about adopting new or different therapies or interventions with a sample of 322 public sector clinical service workers from 51 programs (aarons, 2004). approximately one-third of the sample was comprised of social workers. response categories on the ebpas range from 0 = not at all to 4 = to a very great extent. using two separate factor analytic procedures, exploratory factor analysis and confirmatory factor analysis, a fourfactor solution was found in the study as follows: (a) intuitive appeal of ebp (alpha = .80), (b) likelihood of adopting ebp given requirements to do so (alpha = .90), (c) openness to new practices (alpha = .78), and (d) perceived divergence of usual practice with research-based/academically developed intervention (alpha = .59). subsequent studies have tested the validity of the ebpas (aarons, 2006; aarons, mcdonald, sheehan, & walrath-greene, 2007). aarons’ (2006) study of 303 public-sector mental health clinicians and case managers, including 99 social workers, from 49 programs yielded an overall alpha of .77 for the ebpas with subscale alphas ranging from .59 to .90. the aarons et al. (2007) study of 221 mental health service providers, including 99 social workers, resulted in an overall alpha of .79 for the ebpas with subscale alphas ranging from .66 to .93. evidence-based practice questionnaire finally, upton and lewis (1998) laid the groundwork for the ebpq in an effort to record healthcare professionals' attitudes toward and knowledge of the concepts of evidence-based practice. upton (1999) subsequently refined the measure with a sample of 370 nurses, midwives, and health visitors. upton and upton (2006) then examined the factor structure of the 24-item ebpq and found a three-factor structure in a pilot study of 500 randomly selected nurses in the united kingdom. following a principal components analysis, three distinct subscales, attitudes toward, knowledge of, and use of ebp emerged. cronbach’s alpha for each subscale exceeded .70. the ebpq is not based on theory, but rather on prior quantitative and qualitative research related to barriers to ebp. the scale was found to have good construct and discriminant validity in a random sample of 751 nurses. construct validity was supported by positive correlations ranging from 0.3 to 0.4 (p < .001) between the measure and an independent measure of awareness of ebp. discriminant validity was assessed by comparing those who were knowledgeable about a local ebp initiative with those who were not; those who were knowledgeable of the initiative had a better attitude [t (332) = 2.5, p < .001], more frequent use of ebp [t (360) = 3.2, p < .02], and better knowledge of ebp [t (360) = 5.2, p < .001] than individuals without knowledge of the local ebp initiative. additionally, the subscales were reported to have adequate internal consistency including an alpha of .79 for attitudes toward ebp, an alpha of .91 for knowledge of ebp, an alpha of .85 for use of ebp, and an overall alpha of .87. advances in social work, fall 2010, 11(2) 161 ultimately, the ebpq scale was selected as it incorporated all three of the constructs that the study sought to examine: attitudes toward, knowledge of, and use of ebp, unlike the ebpas, which measures attitudes only, and the ebp beliefs and ebp implementation scales, which measure attitudes and use of ebp, but not knowledge of ebp. the incorporation of all three major constructs in one scale contributed to the goal of reducing the level of burden placed on potential respondents. purpose of the study ebp has made its way into the social work profession with an increasing expectation that social work practitioners will utilize evidence to guide their practice. however, no scale measuring social workers’ attitudes toward, knowledge of, and use of ebp exists. the ebpq was developed to measure these constructs within the nursing profession, but had not been used with a sample of social workers. the purpose of this study is to determine whether the ebpq can be used as a reliable and valid tool with a sample of social workers, which helps validate this tool across professional disciplines. method participants a random sample of 1000 current members of the national association of social workers (nasw) was obtained. this sample was subsequently randomly divided into two groups of 500 each; individuals in one group received a mail survey and the other group received a url link to an internet survey. two modes of delivery were used to assess the viability of each mode in reaching social work practitioners. fourteen invitations were returned undeliverable (11 from mail group and 3 from internet group), and seven participants (1 from the mail group and 6 from the internet group) refused to participate. further, of the mail surveys returned, two cases were deleted due to failure to complete the survey. forty individuals completed the internet survey (8% response rate). this response rate is close to the average 10-11% typically yielded from an internetbased survey (dillman, smyth, & melani-christian, 2009). combined with the 140 mail survey respondents (28% response rate), the total sample yielded 180 participants. table 1 presents the demographics of this study’s participants. on average, participants were female (n = 135), white (n = 148), and held a masters degree in social work (n = 145), with a mean age of 49 years old (sd = 14.21) and 18.2 (sd = 13.7) years of practice experience. the current sample characteristics are consistent with the 2008 nasw membership workforce study compiled by whitaker and arrington (2008), which indicated that the majority of nasw members are female, white, msw educated, older (median age of 50), and experienced (with most having more than 16 years of practice experience). rice, hwang, abrefa-gyan, powell/evidence-based practice questionnaire  162 table 1: select sample demographics (n = 167) sample characteristics n % gender female 135 80.8 male 30 18.0 missing data 2 1.2 race white/caucasian 148 88.6 black/african american 9 5.4 hispanic/latino 5 3.0 asian 4 2.4 american indian/alaska native 1 0.6 highest degree bachelors degree 5 3.0 masters degree 145 86.8 doctoral degree 15 9.0 missing data 2 1.2 employment status unemployed 9 5.4 employed full-time 114 68.3 employed part-time 28 16.8 retired 17 10.2 geographical area rural 26 15.6 urban 86 51.5 suburban 55 32.9 area of practice addictions 10 6.0 adolescents 7 4.2 aging 14 8.4 child welfare/family 19 11.4 community development 2 1.2 criminal justice 1 0.6 developmental/rehabilitative disabilities 6 3.6 health 14 8.4 mental health 81 48.5 school social work 9 5.4 other 10 6.0 direct clinical social work direct 132 79.0 no direct 33 19.8 missing data 2 1.2 (cont.) advances in social work, fall 2010, 11(2) 163 (table 1. cont.)   m sd years of experience 18.2 13.7 age 49.2 14.2 procedure upon obtaining permission from the measure’s authors and exempt status from the university’s institutional review board, the ebpq (upton & upton, 2006) was administered to a group of members of nasw as part of a larger cross-sectional study. a modified approach of dillman and colleagues’ (2009) mailing recommendations was employed in order to prevent over-burdening respondents, as well as to reduce the extra costs and time associated with dillman and colleagues’ process. the mail group respondents were sent a cover letter and survey; whereas, the internet group was sent a letter with the url address to access the online survey through survey monkey (2009). both groups were sent a reminder postcard 3-weeks after the first mailing. the survey asked respondents to rate their attitudes toward, knowledge of, and use of evidence-based practice by completing the ebpq (upton & upton, 2006). participants were not compensated for responding to the survey. measure the survey included the 24-item ebpq (upton & upton, 2006), which consists of three subscales: attitudes toward, knowledge of, and use of ebp. each item is scored on a 7-point likert-type scale with responses ranging from 1 (poor/never) to 7 (best/frequently) and higher scores indicating a more positive attitudes toward, knowledge of, or use of ebp. the attitudes toward ebp subscale is comprised of 4 items, the knowledge of ebp subscale consists of 14 items, and the use of ebp subscale is made up of 6 items. however, there is some variation in the structure of the subscale responses. for example, the attitude toward ebp subscale requires participants to indicate their attitude somewhere between opposite pairs of statements (e.g., “evidence based practice is a waste of time” to “evidence based practice is fundamental to professional practice”); whereas, the other two subscales do not utilize this paired statement approach. data analysis spss 17.0 for windows (2009) was used to analyze demographics and compute cronbach’s alpha. internal consistency reliability of the full ebpq and three subscales was examined using cronbach’s alpha. to identify items that may not fit well within each subscale, alphas if item deleted were also examined. all statistical analyses were interpreted with an alpha level of .05. a confirmatory factor analysis was performed on the ebpq using mplus (muthén & muthén, 2005). multiple fit indices are available for evaluating the goodness-of-fit of the model; therefore, the following fit indices were used: chi-square, the comparative fit index (cfi), root mean square error of approximation (rmsea) with 90% confidence rice, hwang, abrefa-gyan, powell/evidence-based practice questionnaire  164 interval, and standardized root mean square residual (srmr). values > .90 were indicative of good model fit using the cfi; rmsea close to .06 or less, and srmr close to .08 or less also indicate good fit (hu & bentler, 1999). consistent with upton and upton (2006), factor loadings >.4 were used as the criterion for including items on a subscale. in the current study, the initial model (with 24-item, 3-factor) did not fit well. to analyze the missing pattern, a new variable was created by computing the percent of missingness using nmiss function in spss. as a result, 13 cases were removed due to having 25% or more missingness. modifications based on modification indices (mi) or examination of residuals were considered. to examine the mi, spss missing values analysis (mva) using the expectation maximizing (em) algorithm was used to impute missing data for this sample as recommended by schafer and graham (2002). as a result, the full 167 sample size was retained for further cfas. additionally, the normality assumption using skewness and kurtosis indices was checked for each item using the following criteria: skewness index absolute value > 3, kurtosis index absolute value > 10 (kline, 2005). the assumption was met for this sample (see table 2). results internal consistency reliability cronbach's alpha was .93 for the knowledge of ebp subscale and was .90 for the use of ebp subscale, both well above the recommended .70 cutoff for good internal consistency reliability (de vaus, 2002). the overall scale yielded an alpha of .93; however, the attitudes toward ebp subscale yielded a cronbach’s alpha of .64. because the attitudes toward ebp subscale fell below the recommended alpha of .70, alphas if item-deleted were examined. removal of item 1 (“my workload is too great for me to keep up-to-date with all the new evidence.”) would result in an alpha of .69, suggesting this item does not fit well with the other three items on this subscale. confirmatory factor analysis using the subscales identified by upton and upton (2006), a 3-factor cfa model was examined. because of the change in alpha for the attitudes toward ebp subscale that resulted from dropping item 1, the 3-factor model was run with and without item 1. the chi-square difference test (kline, 2005) was used to assess whether changes to the model (deletion of item 1) resulted in an improved model fit. the original 24-item model resulted in χ² (252, n = 167) = 844.361; whereas, the 23-item model yielded a χ² (230, n = 167) = 789.402. the change in χ² = 55.959 (22, n = 167) between the models indicates the model improved significantly (p < .001) without item 1. therefore, all subsequent cfas were run without this item. advances in social work, fall 2010, 11(2) 165 table 2: ebpq item statistics including assumption checking (n = 167) item m sd skewness kurtosis attitudes toward ebp my workload is too great for me to keep up to date with all the new evidence 4.44 1.63 -0.16 -0.89 i resent having my clinical practice questioned 5.53 1.53 -1.11 0.71 evidence-based practice is a waste of time 5.69 1.47 -1.34 1.71 i stick to tried and trusted methods rather than changing to anything new 5.54 1.26 -0.75 0.52 knowledge of ebp research skills 4.33 1.50 -0.25 -0.54 information technology skills 4.71 1.46 -0.32 -0.72 monitoring and reviewing of practice skills 4.73 1.06 -0.18 -0.50 converting your information needs into a research question 3.89 1.53 -0.04 -0.55 awareness of major information types and sources 4.73 1.24 -0.07 -0.58 ability to identify gaps in your professional practice 5.10 1.09 -0.25 -0.28 knowledge of how to retrieve evidence 4.68 1.32 -0.22 -0.45 ability to analyze critically evidence against set standards 4.51 1.31 -0.28 -0.42 ability to determine how valid (close to the truth) the material is 4.59 1.24 -0.39 -0.19 ability to determine how useful (clinically applicable) the material is 4.98 1.11 -0.50 0.21 ability to apply information to individual cases 5.37 1.06 -0.79 1.36 sharing of ideas and information with colleagues 5.46 1.20 -0.70 0.57 dissemination of new ideas about care to colleagues 5.14 1.27 -0.66 0.33 ability to review your own practice 5.28 1.04 -0.76 2.30 use of ebp how often have you formulated a clearly answerable question as the beginning of the process towards filling this gap? 4.19 1.68 -0.20 -0.75 how often have you tracked down the relevant evidence once you have formulated the question? 4.41 1.64 -0.28 -0.59 how often have you critically appraised, against set criteria, any literature you have discovered? 4.07 1.75 -0.22 -0.81 how often have you integrated the evidence you have found with your expertise? 4.57 1.67 -0.54 -0.51 how often have you evaluated the outcomes of your practice? 4.41 1.63 -0.19 -0.72 how often have you shared this information with colleagues? 4.29 1.76 -0.19 -0.89 rice, hwang, abrefa-gyan, powell/evidence-based practice questionnaire  166 given that the 23-item, 3-factor model did not fit adequately, an examination of the modification indices suggested that the model fit could be improved by allowing several of the item errors to correlate. these modifications were made one at a time until the fit indices marginally met the cutoff criteria for acceptable levels. error correlations occurred between items 17 and 16, 8 and 5, 13 and 12, 20 and 19, 14 and 13, 18 and 16, and 18 and 17. all 23 items had significant loadings >.4, using the criterion set by upton and upton (2006) in their original study. the final model yielded a model χ² (223, n = 167) = 469.041, p < .0005; rmsea = 0.081 (90% ci 0.071-0.092); srmr = 0.068; cfi = 0.900. the chi-square difference between the second and the final model is 320.361 (df = 7) indicating a significant improvement (p < .001) in model fit. a graphic illustration of this final model is displayed in figure 1, and table 3 provides a summary of cfa goodness-of-fit indices by analysis. discussion the evidence-based practice questionnaire (upton & upton, 2006) is a 24-item, self-report survey measuring attitudes toward, knowledge of, and use of evidence-based practice. this study supported a 23-item, three subscale structure of the ebpq with seven error covariances. different from the original ebpq work done by upton and upton (2006), this study did not support retaining item 1 on the attitudes toward ebp subscale, resulting in the final 23-item ebpq. item 1 asks respondents to examine the impact their workload has on their ability to use evidence within their practice; whereas, the remaining three items on the attitudes toward ebp assess perceptions of the usefulness of evidence on one’s practice. this item may not have fit well due to the sample differences between this study and upton and upton’s (2006) study that surveyed nurses. the original survey was developed using a group of nurses; whereas, this study’s sample consists of a range of social work practitioners (e.g., clinical practitioners, case managers, and administrators). many social workers, regardless of area of practice, are able to relate to workload demands and the impact these demands have on their daily activities. for example, many workload studies within child welfare have confirmed the impact high workloads have on a caseworker’s ability to effectively engage and spend quality time with children, families, and caregivers (child welfare league of america, 2007). not all social workers, however, are engaged in direct practice, and in examining the three remaining items on the attitudes toward ebp subscale, the emphasis is on clinical practice, which could explain the discrepancy in how this subscale fit within this sample of social workers. the format of the attitudes toward ebp subscale may also have impacted the findings. unlike the knowledge and use of ebp subscales, the attitudes toward ebp subscale uses paired statements to anchor the 7-point likert scale. for example, item 1 was anchored with the following statements: 1 = “my workload is too great for me to keep up to date with all the new evidence” and 7 = “new evidence is so important that i make the time in my work schedule.” in fact, these items may be distinct and able to stand on their own, rather than representing opposite pairs. additionally, dillman et al. (2009) caution against using such a format due to the possibility of confusing respondents, which may increase response error. advances in social work, fall 2010, 11(2) 167 .66  .76 .59  .66  .50  .68  .68  .77  .57 .83 .81  .78  .85 .78  .60  .57  .59  .41  .20  .11  .32  .22  .63  .82  .77  .80  .71  .72  .46  .25  .53  figure 1: 3-factor confirmatory factor analysis of 23-item ebpq with 7 error covariances and standardized estimates attitudes  toward ebp    knowledge  of ebp  use of ebp  item 2 .30  .27  item 3 item 4 item 5  item 6  item 7  item 8  item 9  item 10  item 11  item 12  item 13  item 14  item 15  item 16  item 17  item 18  item 24  item 23  item 22 item 21 item 20 item 19 rice, hwang, abrefa-gyan, powell/evidence-based practice questionnaire  168 table 3: goodness-of-fit indices (n = 167) model χ²(df) rmsea (90% ci) srmr cfi number of items 3-factor model (with item 1) 844. 361 (252) 0.119 (0.110-0.128) 0.091 0.765 24 3-factor model (without item 1) 789.402* (230) 0.121 (0.112-0.130) 0.088 0.773 23 3-factor model with 7 error covariances (without item 1) 469.041* (223) 0.081 (0.071-0.092) 0.068 0.900 23 * change in chi-square indicated significant improvement of model fit at p < .001. the final 23-item 3-factor ebpq required seven error covariances, as suggested from the modification indices, before obtaining an adequate goodness-of-fit model. bloom, fischer, and orme (2009) define ebp as a process that involves developing a question, finding the evidence, analyzing the evidence, combining the evidence with your understanding of the client situation, applying the evidence to practice, and monitoring and evaluating your results. in examining the error covariances, item 8 explores respondents’ knowledge in converting information into a research question, and item 5 explores respondents’ knowledge in finding the evidence. it is not surprising, therefore, that as one item varies, the other will too. further, items 13 and 12 examine respondents’ ability to analyze the evidence. finally, items 14 and 13 covary as item 13 explores the ability to determine how valid the evidence is and item 14 explores respondents’ ability to determine the clinical applicability of the evidence. as for the error covariances between items 17 and 16, 18 and 16, and 18 and 17, they can best be explained as addressing social workers’ ethical responsibility to evaluate their practice and disseminate that knowledge. the nasw code of ethics (1999) indicates that social workers have an obligation to monitor and evaluate their practice, as well as contribute to the development of knowledge. adding the covariances between these items’ errors, therefore, seems reasonable. the last error covariance was between items 20 and 19, both on the use of ebp subscale. item 19 asks respondents their frequency in developing answerable questions and item 20 explores their frequency in tracking down relevant evidence to answer the questions. these items support bloom and colleagues’ (2009) definition of evidencebased practice being a process that requires social workers to develop the research question and find the evidence to answer it. for that reason, adding the covariance between these items’ errors makes sense. advances in social work, fall 2010, 11(2) 169 strengths and limitations the study’s sample was demographically similar to the nasw membership and sufficient to detect a medium effect size (kline, 2005). it is possible, however, that those who did not respond to the survey may have differed in significant ways from those who did respond. furthermore, some of the model fit indices may have been influenced by the small sample size. for example, the noncentral chi-square distribution used in the rmsea fit index is not well approximated in samples under 200 because it may lead to skewed values of model fit (curran, bollen, poxton, kirby, & chen, 2002). in addition, the study’s small sample is below kline’s (2005) recommendation of a minimum sample of 200. marsh and hau (1999) suggest using indicators with good psychometric properties where factor loadings are greater than .60 to compensate for a limited sample size. in this study, factors loaded at .50 or greater, thus approaching marsh and haus’ suggested minimum, and exceeding kline’s .40 recommendation. the current study made several model modifications (e.g., error covariances and dropping item 1) to the original measure while ensuring that the specified model retained at least three indicators for each latent variable per kline’s (2005) recommendation. still, the small sample does mean that caution should be exercised in interpreting the study’s findings, although this study’s response rate was not wholly inconsistent with expected response rates for other “coldcontact” surveys that have used these mediums (aday & cornelius, 2006). although the final ebpq model was slightly modified (deletion of item 1 and seven error covariances) in order to fit this sample of social workers, this may be reflective of the inherent differences between the two professions, nursing and social work. the professional model of ebp has its origins in medicine and is described as the use of best evidence in guiding the decision-making process regarding the care of individual patients (sackett, rosenberg, gray, haynes, & richardson, 1996). adopting ebp has not been an easy task for professionals in any discipline (glasgow, lichtenstein, & marcus, 2003; mullen, shlonsky, bledsoe, & bellamy, 2005). in particular, social work as a profession has lagged behind in embracing the use of evidence to guide practice with clients (mullen et al., 2005) and continues to hold onto what may be considered humanistic motivations (thyer, 2008). the error covariances that emerged within this sample of social workers seem understandable as they are potentially more reflective of the social work profession’s process in utilizing evidence to inform practice. in summary, the greatest contribution of this study is that it helps validate the only known tool that measures attitudes toward, knowledge of, and use of ebp. implications for research and practice the final 23-item three-factor (see figure 1) model produced acceptable fit indices; therefore, this analysis contributes to the ongoing refinement of the ebpq as a measure to evaluate social workers’ attitudes toward, knowledge of, and use of ebp. due to the paucity of scales examining ebp use, many primarily exploring attitudes toward ebp (e.g., aaron, 2004; melnyk et al., 2008), the ebpq offers a good alternative. given the challenges and potential influences on the social work profession of ebp use, it is essential that the profession’s practice evidence base be identified or clearly articulated. in line with this, the ebpq may be a reliable measure that should continue to be used for rice, hwang, abrefa-gyan, powell/evidence-based practice questionnaire  170 improving credibility among social workers and closing the gap between research and practice in the field. further research using the 23-item three-factor model is warranted, however. in particular, the 23-item three-factor model is recommended because use of this revised tool will further the development and confirmation of the three-factor ebpq structure. specifically, larger sample sizes and samples that are diverse in terms of age, race, ethnicity, and practice settings are necessary to examine whether there are differences in attitudes toward, knowledge of, and use of ebp among various social work populations. there is a need for evaluative research on the equivalence of measurement models across distinct groups (e.g., culturally different groups and different practice disciplines such as social work and nursing). multiple-group cfa will be a useful analysis to evaluate the generalizability of a construct across population subgroups (brown, 2006). ultimately, there is the need for a qualitative study that examines how well this measure assesses all relevant facets of the construct of ebp in social work. the recently adopted council on social work education educational policy accreditation standards (2008) encourages social work scholars and educators to devote more attention to the teaching of ebp in the classroom and to helping social work students and practitioners learn how to utilize the process of evidence-based practice as well as the use of evidence-based interventions. specifically, the revised ebpq could be used as a tool to evaluate social work students’ performance in the field with regards to their attitudes toward and knowledge and use of ebp. conclusion evidence-based practice is an attempt to bridge the gap between research and practice (hagell & spencer, 2004); therefore, finding a survey that measures social workers’ attitudes toward, knowledge of, and use of ebp is essential in order to increase the use of evidence in social work practice. in this study, the ebpq demonstrated adequate 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(2008). social workers at work: nasw membership workforce study. washington, d. c.: national association of social workers. retrieved from http://workforce.socialworkers.org/clearinghouse/default.asp author’s note: address correspondence to: karen rice, department of social work, millersville university, p.o. box 1002, 1 south george st., millersville, pa 17551. email: karen.rice@millersville.edu  microsoft word shulman_interactional sw final ______________ lawrence shulman, ed.d., msw, is professor and dean emeritus of the school of social work at the university of buffalo in buffalo, ny. copyright © 2014 advances in social work vol. 15 no. 1 (spring 2014), 207-229 a shifting paradigm – medical to interactional model: a personal history lawrence shulman abstract: this article chronicles over 50 years of change in the profession with an emphasis on the author’s professional experiences and the shift in practice paradigms from the medical model to an interactional model. a number of key phases in this shift are identified and illustrated drawn from the author’s work over time. keywords: interactional model, medical model, paradigm shifts, william schwartz when i was asked to submit an “eyewitness to history” article, i was at a loss as to how to approach it. after some reflection, i realized i had a personal and professional history that was closely tied to the development of what i describe as a paradigm shift in thinking about social work practice. i also had the advantage of being influenced by a number of mentors who themselves had significant roles in developing social work practice as we know it today. i decided to simply tell chronologically the story of my professional history, and as i did so, to connect my experiences to developments in social work and social work education during the 52 years since my 1961 graduation from the columbia university school of social work (cussw). in particular, i will focus on the events and activities that had a substantial impact on the development of the interactional paradigm. the list below provides an overview of the sections that follow, each presenting a component of the paradigm shift:  my msw education at the columbia university school of social work – group work and the social goals model  first contacts with bill schwartz and my introduction to the mutual aid model and a new paradigm.  defining a paradigm shift and the distinction between the interactional and medical models  the introduction of system’s theory to social work education: the agency as the “second client”  operationalizing and researching the interactional model  the functionalist approach to social work practice at the university of pennsylvania – contributions of taft and robinson  doctoral studies in educational psychology and my introduction to category observation and other research methods focusing on the process of practice as well as the outcomes.  the parallel process in social work, supervision and teaching advances in social work, spring 2014, 15(1) 208  the use of video tapes as a tool for dissemination of the interactional model  where do things stand now? phase 1: the early days – msw education at cussw i was a “group worker” in those days which meant i went through columbia with a cohort of 30 group work students. most students at cussw were “caseworkers” and a few were “community organization students” (c.o.). in those days c.o. meant, in large part, fund raising for “community chests,” now called united ways. it wasn’t until later that grass roots organizing, using the saul alinsky confrontation model, described in his book rules for radicals: a pragmatic primer for realistic radicals (1971), became associated with social work’s version of c.o. the civil rights movement also had an impact on c.o. as did the emergence of organized welfare rights groups. however, the concept of generalist practice and a universal foundation practice course taken by all students was not yet part of our social work education model. i was placed for my first year field experience at the mt. vernon jewish community center in 1960. it was at this placement that i first met two influential thinkers in social work. george braeger was the agency director and harry specht my field supervisor.1 george and harry later left the agency to run the mobilization for youth project in new york city. this was a 13 million dollar innovative program funded by president kennedy based on cloward and ohlin’s (1960) delinquency and opportunity theory. mobilization for youth, focused on expanding the legitimate opportunities afforded to young people in an effort to decrease delinquent behavior. braeger wrote the proposal and directed the project and specht helped to manage it. this project was seen as an application of the cloward and ohlin theory that contributed to the social reform movement that led to the war on poverty. on reflection i realize i did not get strong supervision on my group work practice, but i did get a heavy and helpful dose of concern for social justice. i was exposed to george and harry, and their views on the role of social work in my field placement, and similar thoughts in my cussw class on social issues taught by cloward. while emphasizing a return to social work’s classic historical mission, epitomized by jane adams and the settlement house movement, the model still borrowed from the medical paradigm. only now, instead of diagnosing the client and developing an assessment and intervention plan, we would diagnose the social systems that impacted our client and intervene with them. the target was different however the three-step model was the same. this was brought home clearly to me a few years later when, attending a conference presentation by cloward, i challenged his endorsement of the use of manipulation and 1 george went on to eventually become dean of cussw and harry to serve as dean at the school of social work at berkley university. george co-authored with steve holloway in 1978 the classic book changing human services organizations: polities and practice. harry co-authored with mark courtney in 1993 their challenge to what they believed was social work’s loss of its historic mission titled unfaithful angels. shulman/medical to interactional model 209 indirect influence when working with a community action group. his response was that it might be necessary because the social worker knew what was best in a conflict situation and therefore was acting in the client’s interest. the core paradigm of practice in which we might act on instead of act with the client had not really changed. cloward did go on to make a major contribution in his advocacy of the “motor-voter” registration program allowing people to register to vote when they registered their cars. phase 2: my early practice and how i met bill schwartz in 1964 when i returned to my first year field placement and began working at the mt. vernon jewish community center, the social change oriented legacy shared by braeger, specht and cloward was still strong in the agency culture. this orientation fit with the “social goals” model of group work taught at columbia. in addition to recreation, a major purpose for leading groups in y’s, community centers and youth programs, where many msw group workers worked, was to impart social work’s historic values of democracy and social justice. returning now to the field instructor’s seminar, the real start of this story, in our first session schwartz asked each of us to share the assignments we had developed for our students. i proudly described a teen leadership group with which i was involved and a project where our teens joined with an african-american church youth group to raise funds for poor residents of color in mt. vernon. this was one of the groups in my social work student field assignment. i went on to point out that the real purpose of the group was to improve black and white relationships in mt. vernon, a town experiencing a rapid growth in the number of poor families of color and the beginning of “white flight.” i remember to this day bill schwartz looking directly at me and asking: “do your group members know the real purpose of the group?” i felt confused and embarrassed. wasn’t this what my social goals model taught me as the job of a group worker? i remember little of the remainder of the session. i arrived home that night and told my wife i was so mad i was not going back to the seminar. after cooling down, and with some reflection, i realized bill’s question had been reasonable. we believed in “informed consent” but how could the group members be fully informed and give consent if we had a “hidden agenda.” i experienced this as a “light going on,” raising questions about all of my group practice and supervision of our part-time group leaders. most of our discussion in supervision was about how to impact the group using program (activities such as games, trips and social events) as it had been in my own supervision as a field student. the teen project was a good one. when it was initiated, i could have suggested it to the group members, involved them in the planning, and acknowledged the goal of impacting race relations in mt. vernon. i was unable to answer the question of why i had not done just that. later i realized it was an issue related to the paradigm that guided my practice and the field of social work as well. in some ways, as you will see later in this chapter, i believe that this remains true in some respects for social work today. i returned to the seminar and over the years bill became an important mentor for my practice, teaching and research. thus began my sometimes painful paradigm shift from the medical model toward what i now call the interactional model. advances in social work, spring 2014, 15(1) 210 phase 3: paradigm shifts, social work, group work, and the medical model thomas kuhn, in his influential book the structure of scientific revolutions (1962), discussed changes in science that occurred not by increment but by revolution. the classic example is the change from ptolomy’s astronomy paradigm which placed the earth at the center of the universe to the heliocentric model advocated by copernicus in the 15th century, which placed the sun, rather than the earth at the center. kuhn pointed out that such dramatic shifts often meet strong opposition. he also pointed out that new paradigms continue to emerge often building on the old ones as they replaced them. for example if one thinks of astronomy, there was einstein and the theory of relativity. more recently we have seen astronomy theories based on black holes, quirks and quarks, etc. these build on previous paradigms and may be gradually accepted because they offer explanations for the old paradigm’s anomalies. anomalies are unexplained events or findings that do not fit the established paradigm. for example, the sun, moon and other celestial bodies might move across the sky in ways not explained by the predominant, at the time, earth-centric paradigm. (for the medical model i believe a significant anomaly was client non-compliance with perfectly sound treatment plans.) kuhn also believed that the social sciences were not “scientific” enough to have paradigms and shifts. on this point, i disagree. social work and the medical model the medical model is often used in social work literature to describe a pathologyoriented approach to assessing and diagnosing clients. alternatives are offered by many newer models such as the “strengths perspective” and a “systems approach” both of which largely reject the pathology model for assessment and diagnosis. this is not the medical model to which i refer. the medical model challenged by the interactional model is based on the three (now four) sequential steps of thinking about social work practice: study, diagnosis, treatment and evaluation, cycling back to “study” should the evaluation indicate the need. this is the model that social work and other helping professions borrowed from medicine. it had become crucial to the medical profession’s early efforts to distinguish itself from other healing professions and to establish itself as “scientific.” please understand that i am not raising questions about the elements of study (gathering information) or diagnosing (attempting to understand the nature of the client’s problem or issue) or treatment (developing and implementing plans for intervention in collaboration with the client). the challenge is not to the individual elements of the medical model but rather to the three-step sequential description contained in the paradigm.2 in contrast, one of the essential differences in the interactional paradigm is the understanding that the worker-client interaction is dynamic, with each actor impacting the 2 at one school i taught during these early days, case work students spent their first year in practice class working on “study” and moved to “diagnosis” and “treatment” only in the second year. shulman/medical to interactional model 211 other moment-by-moment in the individual interview, family session, group or community setting. treatment does not wait for the diagnosis since the conversation with a client in the first session is actually the start of an intervention and the helping process. also, no matter what the diagnosis, treatment or intervention planned with colleagues or with the supervisor in the case conference, the social worker will be strongly influenced, often emotionally, by the responses of the client. that in turn will affect the interaction and so forth. social work practice does not proceed in the neat and orderly manner described in the medical model. another example of the paradigm shift involves the separation of the worker’s feelings and his or her professional interaction with clients. this separation was advocated in most social work education then, and is still advocated by some today. i refer to this as the personal/professional dichotomy. the need to maintain a separation between the two was also borrowed from medicine. in my early research, practice and teaching i found that professional versus personal was a false dichotomy in that effective practice involved learning how to integrate the personal and professional. the interactional model suggests that the social worker needs to “use” his or her feelings not “lose” them. i should make clear this does not give permission for the social worker to act out. rejecting the false dichotomy does not allow the worker to express any and all feelings of the moment. affect must be integrated with the professional purpose and role. for example, a common issue raised in my workshops by child welfare workers who are not parents is the emotional challenge they feel when a client, a mother of three for example, inquires as to how many children the worker has. defensive responses such as: “we are here to talk about you, not me!” or “i have none but i have taken courses in child psychology at the school of social work” miss the meaning of the question which often is “can you understand what it is like for me?” or “can you really help me?” or “are you going to judge me?” a worker who is “tuned in,” develops preliminary empathy to the meaning of the question and responds directly, with genuine empathy, saying, for example: “i don’t have any children. why do you ask? are you concerned i may not understand what it’s like for you? i’m concerned about that as well. if i’m going to help i have to understand you will need to tell me.” this or some version of this is an example of integrating personal and professional. a simple expression of what the unprepared worker may be feeling, such as: “you’re right! i don’t have kids. how do they expect me to help you?” is not an integration of personal and professional. those feelings need to be shared with the supervisor. this dichotomizing of personal and professional, borrowed from medicine, does not work well for doctors either as the emergence of “behavioral medicine” has emphasized. in a study i carried out with 54 family physicians in vancouver, bc in 1982, i asked doctors, among other variables, to rate their attitudes toward specific patients – positive, advances in social work, spring 2014, 15(1) 212 neutral or negative – immediately after seeing the patients.3 the study explored the impact of the physician’s communication, relationship and technical skills on patient compliance, satisfaction, reassurance, comprehension and improvement (shulman & buchan, 1982). in interviews conducted by research assistants with 603 patients at the doctor’s office immediately following the visits, we asked among other things about the patients’ perception of their doctor’s attitude toward them. we found a correlation between the two ratings. in discussions of these findings, doctors were surprised and often indicated they were sure they had hidden their negative feelings, just as social workers may feel they do as well. however, many patients (and clients) have powerful emotional radar and are able to detect these feelings. in our study, using data we obtained immediately following the visit and by phoning the patient one week later, we found that the doctor’s attitude toward the patient – positive, neutral or negative – had an impact on outcomes such as patient relationship, compliance, satisfaction and comprehension. for some in the helping professions, just as in astronomy, the old paradigms have too strong an influence and do not allow them to see practice from a strikingly different perspective. the well-known gestalt drawing of an old woman who, when the viewer’s perception shifts, becomes a young woman illustrates the dynamic. you can’t see both the old and young women at the same time. it’s necessary to let go of one in order to see the other. when i used this drawing in a class, some students were not able to let go of their first perception of the old or the young lady just as social workers may practice using the medical model, as defined here, and don’t realize they are guided by that paradigm. agency intake procedures, with forms that must be completed for insurance purposes, can occupy a first session. this displaces a contracting process that seeks to clarify the purpose of the encounter, clarify the role of the social worker, reach for feedback on the client’s perception of need, and address issues of authority and confidentiality. these are interventions that are part of the “contracting” process in the beginning phase of practice that may be given less attention while the social worker obtains data.4 many social workers have described to me how the pressure of obtaining “billable hours” or finding themselves supervised by other disciplines (e.g., social workers supervised by nurses in medical settings), forces them to skip the step of engaging the client in the first session. implementing these contracting skills at the start of the engagement process actually begins to build the “working relationship,” now termed the “therapeutic alliance” in the literature. when the intake of information is required by the agency or other setting, i encouraged my students to find a way to do both, pointing out that much of the needed information will come out in the contracting conversation. in addition, the data gathering 3 foundation funding for this study allowed me to serve full-time for one semester as a scholar in residence in the university’s family practice center. i met weekly with a group of family practice residents and site faculty and reviewed video tapes of their contacts with patients. 4 these skills and others are elaborated and illustrated in my books and articles including the skills of helping individuals, families, groups and communities, 7th edition, 2012. shulman/medical to interactional model 213 can be completed in the second half of the session. the central argument is that “treatment” actually begins when the client enters the office, not after a detailed study, and assessment, diagnosis and a treatment plan has been completed. phase 4: the social worker in the group schwartz’s major publication on this subject was an article published in 1961 titled “the social worker in the group.” it was a compression of his educational doctoral thesis that laid the groundwork for what was later termed the “mediating model.” this term was inferred by social work authors catherine pappel and beulah rothman (1966) because of the role of the group worker, as described by schwartz, in mediating the engagement between the individual and the group. schwartz never accepted the term “mediating model”; however, the title has been widely used along with the social goals and the remedial model, based on behavior modification concepts. this came to be known as the trio of approaches to group work practice. another term used by some to describe schwartz’s approach was the “reciprocal” model based on the notion that between members of the group and the group leader there was an element of reciprocity in the relationship. a more accurate term for schwartz’s approach would have been the mutual aid model since at the core was the concept of the group leader helping members to help each other. the mutual aid concept was based upon the belief that the central relationship between people, the individual and the group (or family) or the individual and society, was symbiotic in nature. this relationship was often obscured by obstacles that prevented group members and people in general from seeing their common ground. the group for schwartz was an “enterprise in mutual aid” and the role of the leader was to help the group members to discover and act on their need for each other. for example, the “all-inthe-same-boat” phenomenon, in which group members discover they are not alone, came to be seen as a supportive and healing process.5 this was a departure from the medical model in which the group leader was someone with authority who would structure the group and influence the interaction to change the member’s values (social goals model) or behavior (remedial model). a major tool used by group workers at that time was the use of activity specifically selected and designed to have an influence on group members, again often without their knowledge. for example, a group worker might select an activity for a children’s group that would allow a scapegoated child to excel thus indirectly attempting to influence and diffuse the scapegoating process. this intervention could fit within the social goals or remedial model approach to practice. this contrasted with an article i published in social work in 1967 (“scapegoats, group workers, and the pre-emptive intervention”) which tried to understand the scapegoating process as a dynamic interaction in the group in which group members projected onto the scapegoated member some of their own doubts, concerns and feelings 5 i attempted to inventory and illustrate a number of mutual aid processes in “the dynamics of mutual aid” which was a chapter in a collection of articles by schwartz and many of his former students entitled the legacy of william schwartz: group practice as shared interaction (gitterman & shulman, eds., 1986). advances in social work, spring 2014, 15(1) 214 about themselves.6 this was consistent with the biblical interpretation in which the sins of the people were projected onto the “scape” (skin) of a goat that was then sent out into the wilderness to die taking the mortal sins with them, at least for that year. in the article, i urged group leaders who naturally experience protective feelings toward the scapegoat not to side with the group or the scapegoated individual, but rather to see the group as the “second client” calling for help through the process of scapegoating. the significant paradigm change was that the scapegoating was not a behavior to be changed but rather seen as a message to the group leader by the scapegoating group members. by addressing the “meaning” of the behavior, the group leader was helping members deal with their own sense of low self-esteem. the group would no longer need a scapegoat. in theory, the scapegoat would no longer need to “volunteer” for the role. the “pre-emptive intervention,” a term borrowed from the card game bridge, for example siding with the scapegoat, pre-empts the important work that needs to be done by the group members. central to the mutual aid process is the idea of getting help by giving help. in the diagnostic framework of the time, one that is still referred to in social work and counseling publications today, the role of the group leader was to select the right activity (treatment) to help the scapegoated child and stop the process, rather than explore its meaning helping the individual and the group. phase 5: operationalizing and researching practice intervention a position as a full-time faculty member at the rutgers university school of social work opened up the next phase of my work at understanding, researching and writing about the interactional model.7 my position at rutgers involved leading a field unit of 6 msw students placed in a large new jersey institution for what was then referred to as “mildly retarded” teen agers with behavioral problems. meeting regularly with the 6 group-work students, i required them to write process recordings of their work with groups and also of their significant interactions with staff. the institution had a semimilitary culture with house staff concerned mostly with keeping order and keeping the teenage boys away from the girls. the two years i worked in this position had a significant impact on my developing ideas about the importance of identifying and measuring practice interventions and also on the concept of viewing the agency as the “second client.” my efforts to help my students develop the skills and interventions needed to work with their groups forced me to operationalize what they were doing. i needed the words to describe these interventions and to teach them consistently. this was the next step in identifying 6 this article led to my over 40 years of friendship and collaboration with alex gitterman, the co-author with carel germain of the life model of social work practice (1980). attending a conference and meeting me for the first time, he invited me to be a fourth in a bridge game since i had used bridge in the article. he was surprised to hear that i had no idea how to play bridge. this was the beginning a wonderful friendship and professional collaboration. 7 i should point out that the term interactional model was one i used later in my work since i think it more accurately described the broader paradigm of which the mutual aid model of group work was one example. shulman/medical to interactional model 215 behaviors that put the “mediating” functional role of the social worker, in individual and group practice, into action. i came to more fully understand this task a few years later in 1973 when joel fisher, who later became a good friend and colleague, published a controversial article entitled, “is casework effective?” joel had reviewed social work research on the effectiveness of practice. the findings indicated that social work was not effective. this was an example of a paradigm “anomaly.” all of the reported research projects were outcome studies in that they looked at the results of intervention models (e.g., family practice, group work, particular intervention models) but did not operationalize the independent variable, that is, what the social worker actually did when working with the client. if we could not clearly distinguish the “predictor” variable of practice we could not know, for example, if some social workers interacting in certain ways were actually very effective. other social workers in the same study might, through their use of less effective interventions, offset the positive findings. i realized that the real question, and the subject of needed research, was an answer to the question: “what is casework?” not “is casework effective?” this became a required step when i later researched the impact of specific interventions. outcome measures were, and still are important; however, i believed that as a profession we needed to first operationalize the “independent” variable at the level of specific worker skills. i also came to understand that there would be mediating or intervening variables – such as the development of a working relationship – now referred to as the therapeutic alliance in the literature – that would then influence outcome measures. rosenberg’s work in sociology (1968) on third variable analysis was helpful to me at that time. phase 6: the emergence of social systems theory: the agency as the second client my other significant learning as a full-time field instructor was my growing understanding that one could not practice within a setting, such as the institution housing my field unit, without using a dynamic and interactional perspective in which the “environment” was affecting the group, and the group in turn was affecting the environment. for me, this was the beginning of the concept of the setting as the “second client,” and the use of an “organismic” model with the group and the setting seen as dynamic systems. early organizational theory had often used a “mechanistic” model with “input,” “through puts” and “outputs” central to the framework. a shift to the organismic model considered the organization as an organism with the ability to change, to grow, and to interact with its environment. this understanding was crystalized for me by an incident involving a conflict between our student run program and the residential staff of the agency. the staff members, most of whom were middle age or older adults, former police or correction officers or army veterans, were responsible for the behavior within the dormitories. monitoring and restricting behavior and discipline using rewards and punishment was their basic job. advances in social work, spring 2014, 15(1) 216 on a monday morning, at my usual student unit meeting, one of my field students reported that the housing department had cancelled all social activities planned by my students and their group members. there had been an incident on friday evening. after a structured and chaperoned party, as the teen boys walked their girlfriends back to the girls’ dormitory, they kissed them goodnight on the dormitory steps while the other girls in the residence hung out the windows shouting encouragement and advice. the dormitory staff experienced this as a minor uprising and the solution was to ban all future parties planned by my students. i didn’t realize at first that this was actually a deeper organizational response to our work which was challenging the existing culture of the agency. my first reaction was anger at the staff group dictating what my social work students could or could not do. the parties were an important part of the social developmental work of these teenagers who were otherwise kept completely separate from each other. as we discussed this in the student unit meeting my thinking shifted to trying to understand the meaning or the message of the staff reaction. we had learned to understand our clients’ “deviant” behavior as signals they were sending of underlying feelings and issues. was the housing staff of the institution sending one to us? was this a signal of issues for the entire staff and residents in an institution that had been run from the top down with little consultation or involvement with others? could we apply principles we were using to describe the group process to a larger entity, the institution with the residential staff as one sub-group? this was a breakthrough both for me and my students in our thinking about the social work role. using contacts i had developed with heads of all of the departments (social work, housing, psychology, job training)8 i suggested we meet to consider the impact of our program on their work and what, if any, problems we were causing other staff. i was amazed at the number of department heads and staff who showed up at the meeting, which also was attended by my msw students. word of the meeting had spread throughout the institution with some expecting it to be a confrontation. applying the skills we had identified in working with the residents to our interaction with staff, skills i now refer to as the skills of professional impact, the students and i acknowledged the problems we may have caused in the system in a non-defensive manner. this diffused the negative tone of the meeting and the discussion shifted from our program’s impact on other departments to the minimal influence of all staff on the running of the institution. in hindsight after the meeting, we understood that the reaction of the housing staff was a signal of their feelings about their lack of influence in the system. we have learned to understand that in dynamic systems (e.g., families, groups, organizations) the members that experience the stress and feelings most strongly take on the role of acting them out. housing staff did not have professional degrees, or college degrees, and were seen as 8 i also learned the importance of developing informal relationships in a system. all of the department heads liked to play ping pong in a staff lounge during lunch. in the first few months of our unit’s involvement, i had developed friendships through ping pong competition that were important to the success of my first efforts at organizing. shulman/medical to interactional model 217 “low status” in the staff system. no wonder they took on the role of acting out the feelings of impotence experienced by most of the other staff.9 after meeting with the institution’s superintendent in which i outlined the issues in a manner designed not to make him feel defensive, and then proposed steps we could take to improve morale and the staff’s sense of involvement, we obtained his approval to go ahead with a plan that involved setting up cross-department staff groups addressing identified issues. my social work students worked as the “staff” for the staff groups, keeping minutes, etc. we were not yet at the stage where we could invite residents; however, the establishment of resident councils was one of the end results of this work. what was clear to me was that staff did not feel empowered and thus were not able to empower residents.10 i decided to write about my experiences in a monograph entitled, a casebook of social work with groups, published in 1968 by the council on social work education. the publication included the operationalizing and illustrating of a number of practice skills, critically analyzed process recordings and a discussion of the concept of the “setting” as the second client. up to that point, the council had published individual process recordings that social work faculty could purchase and use with their classes. this was the council’s first publication of an integrated monograph containing theory and process recordings. it was well received in the field and for years was one of their best-selling publications. at about the same time, gordon hearn, a canadian social work educator, was exploring the implications for social work of social systems theory, which had first emerged in sociology. this theory drew upon the “general systems theory” of von bertalanffy and others. at the core were universal principles which could apply to systems at many different levels, such as a small group, a family and a large institution. my casebook came to hearn’s attention and i was invited to present as part of a panel assembled for a national social work conference. this led to the inclusion of a chapter i wrote entitled “social systems theory in field instruction” in hearn’s ground breaking book entitled social systems theory in social work education (1969). while the idea of using systems theory seems obvious today, it was not so obvious at that time. social work education had required courses on human behavior, most with a psychoanalytic orientation. not yet widely developed was the idea of teaching courses addressing human behavior within the social environment (hubse) as we now do. 9 this concept has been useful in my work as a consultant on supervision and management when i have worked with large organizations. for example, when a hospital is under stress generally because of reduced funding one often finds the problems are acted out in the emergency room or other high stress departments. in a sense, they are acting for the institution as-a-whole. 10 as a resolution of the issue that triggered this process, the residents demonstrated self-empowerment. it was agreed that they could kiss each other goodnight but not on the dormitory steps. a stop sign was designated as the boundary. the second rule was that they had to keep walking. on a monday after the first party my student reported that they had stopped at the stop sign but remained there, kissing each other, while walking in place. advances in social work, spring 2014, 15(1) 218 while social systems theory was not inherently connected to the interactional model, it provided a theoretical structure for understanding both our practice in a group, the interactive nature of practice with worker and client constantly and immediately affecting each other, and the role of the profession in dealing with the setting and community as the second client. one could conceptualize a “boundary” surrounding the group, which was an open systems boundary with influence in both directions. phase 7: the university at pennsylvania and the functional approach to practice the next stage of my professional development came when i left rutgers and accepted a position as a lecturer at the university at pennsylvania’s (u of p) school of social work. my new appointment was controversial since i was the first recently hired full-time practice teacher who had not been a graduate of the u of p program. a new dean, a social policy professor, had been appointed and the university insisted that the “in-breeding” of practice faculty had to stop.11 some insight into this issue and its impact on development of the interactional model may be helpful at this point. although not a u of p graduate, i felt comfortable with the basic principles of the functional approach. schwartz had borrowed major concepts from two former faculty members – virginia robinson and her partner jessie taft. taft and robinson had been psychoanalyzed by otto rank who developed the “rankian approach” to therapy which i won’t describe in detail here other than to mention that “birth trauma” and the concept of “will therapy” were considered important. will therapy emphasizes “conscious will” and its impact on behavior as opposed to the freudian emphasis on the unconscious. rank had been a freud disciple but had broken with freud and was afterward marginalized by the psychoanalytic profession. taft was analyzed by rank in new york in 1926. taft and robinson had rejected the medical model, without calling it that. instead they adopted a rankian functional approach. the u of p ssw became the center for this model and the school itself ultimately was marginalized by the profession, which was still very much committed to freud, psychoanalysis, and the medical model. my early exposure to the marginalization of the u of p and the functional school was as an undergraduate in a course taught by a social worker. he provided an inaccurate and ridiculing characterization of the difference between the “functional approach” and the “diagnostic approach”: “if a social worker was standing on a beach and a swimmer was clearly drowning, the diagnostic social worker would make the assessment and would swim out and save the swimmer. the functional social worker would wait until the swimmer asked for help.” more serious isolation of the functionalist model and scholars by the mostly diagnostic oriented field included excluding u of p faculty from presenting at conferences or publishing their articles in scholarly journals. this may partially explain 11 this dean died three weeks after i started my appointment which explains, in part, some of the difficulty i experienced at the school without my “protector.” shulman/medical to interactional model 219 why the school turned inward and hired only its own graduates to teach practice, at least until my appointment. elements of the work of taft and robinson incorporated by schwartz into his model included the importance of affect and the impact of time. the feelings of the client (not the worker in the functionalist model) were very much a part of the helping process and needed attention. the concept of the phases of work – beginning, middles and endings – with the preliminary phase added by schwartz, drew on the functional literature. many of the disciples of taft and robinson went on to teach and publish an approach to practice, while not the interactional model nevertheless focused on the interaction between the social worker and the client. the functional approach was in part an important predecessor of the interactional model. i had assumed i would feel at home in this school since my writing and teaching had a strong functionalist theme. i soon discovered that while the group work sequence in which i taught described its approach as functional, as elaborated by helen philips (1957) a major figure in the field whom i replaced at the school, the actual paradigm in u of p group work was still diagnostic. although the functional terminology was used, students were taught to assess the needs of the group members, diagnose the problems, and develop treatments (usually activities) without ever using these terms. the problem of disciples not evolving and building on the theory of the founders, taft and robinson, was also evident in the notion of the agency as a “given,” one not to be challenged. it was the client’s willful struggle against the agency’s function during the exchange with the social worker that would lead to change. it was the social worker and the agency on one side and the client on the other. fresh off of my systems theory thinking and the publication of my casebook, i taught a model in which the social worker considered the agency as the second client and, as such, would remain open to systematic and skillful intervention directed toward potential agency change. the social worker in the mediation function as described by schwartz would try to have professional impact on the agency to make sure it was effectively meeting the needs of the clients. the social worker was a “third force” between client and systems including the agency and was not overly identified with the agency versus the client. this was a significant rejection of a core functional concept, and was being taught by this new faculty member (myself), a non-u of p graduate, who was hired over the objection of many on the practice faculty. the response to my “heresy” was brought home when the students invited me to present at one of their lunch time discussion groups. my topic was to be “social work impact on the agency as a system.” these lunch time discussion groups were usually well attended by students and faculty; however, my heretical topic led to a planned boycott with not a single faculty member attending. this experience along with my not receiving a promotion to assistant professor after my two years at the school, despite positive teaching evaluations and more advances in social work, spring 2014, 15(1) 220 publications than most other faculty, was the signal that shifting paradigms would not be that easy.12 phase 8: doctoral studies, research methodology and the move to mcgill university at the end of my second year of teaching at u of p, i was offered a position at the school of social work at mcgill university in montreal. my disappointment over not receiving what i believed was a deserved promotion led me to accept this offer in 1969. the fact that my wife was a canadian who grew up in ontario also affected my decision. during my two years in philadelphia, i had attended an evening and summer parttime doctoral program in educational psychology offered at temple university. the temple program was attractive to me because of a specialization in group development and counseling. this provided an opportunity to study many of the foundational thinkers and revolutionaries cited in schwartz’s writing, including john dewey, george herbert mead, martin buber, talcot parsons, mary follett and others who were not part of my original social work education (schwartz, 1986). in addition, the strong research component in this program allowed me to begin to develop the tools that i later would use in my practice research. at that time many if not most practice teachers in schools of social work, at least those i knew, did not have doctorates. social work faculty who had phds tended to teach in policy, research, or human behavior and the social environment. practice teachers came from practice settings which was their strength but also limited the amount of practice research done by practitioners. this may partially explain the focus on outcomes (the dependent variables) versus the nature of practice itself (the independent variables) by practice researchers. another advantage of my educational psychology doctorate was that the education field was conducting extensive research using category observation systems. these systems involved the development of categories of teacher and student behavior and then the analysis of the teaching, through observation or from videotapes. the numeric entries categorizing the behavior every number of seconds (e.g., five in one system) could then be entered onto punch cards and delivered to the main frame computer for analysis, with a printout available hours or days later. (yes, a far cry from current technology; however, this all predated the use of the personal computer). education was clearly ahead of social work in its interactional analysis research with as many as 70 different systems outlined in simon’s book, mirrors for behavior (1967), which was an anthology of observational instruments. in my judgment at the time, many of these systems were based on overly simplistic underlying educational theory so that the researchers reported the obvious. one system, the one developed by amidon and flanders (1963), seemed different with a structure and categories that more closely paralleled those i would want to explore. 12 a number of years later, when the school had undergone significant changes in its leadership, curriculum and faculty, i was given an award by the school and invited to be the speaker at a well-attended meeting on the shifting paradigm and the functional approach. shulman/medical to interactional model 221 i used this framework to develop my own interactional analysis tool for classroom teaching. my doctoral dissertation research examined teaching at the university level. my plan was to implement a study at mcgill university in montreal where i now was teaching. once again, it’s interesting how seemingly chance factors can have an important impact. in my first semester at mcgill, i became a social friend with another american ex-patriot, the director of mcgill’s instructional communication center (icc). this center had sophisticated video equipment and studios for use by mcgill faculty. a second ex-patriot, also a social friend, was working in mcgill’s center for learning and development (cld). this center’s mission was improving teaching at the university. in my second year at mcgill, i served for one semester as a full-time visiting scholar at cld conducting workshops on teaching for faculty from many mcgill schools and departments. this system was adopted by the university and a funded project allowed faculty members to sign up for the videotaping of one class and to have a questionnaire on teaching effectiveness, also developed as part of my doctoral research, distributed to their students. they would then meet with a cld consultant to review the interaction analysis print out as well as the student questionnaire data. the video tapes were time coded, as were the printouts, so the consultant and faculty member could select sections of the video for deeper analysis and discussion. this was a popular tool used for a number of years by some of the best teachers in the university as well as those who were new to teaching and by some who received negative teaching evaluations. this work laid the groundwork for my later interactional analysis research into social work individual and group practice in two canadian child welfare agencies, one in montreal and one in ottawa. this project was funded by the canadian government and involved videotaping and analyzing 120 hours of social work practice, 60 hours of individual sessions and 60 hours of group sessions. the videos were coded by trained and validated research assistants entering a number every three seconds that described the interaction they observed. we had over 100,000 coded entries. for example, the number 10 represented three seconds of silence. a software program developed for the project would pair the first coder entry with their second, their second with their third, the third with their fourth, and so on. the print out provided a crude sense of interaction which allowed us to determine, for example, how long silences lasted and whether or not the client or the worker broke the silence. in another example, we could also determine whether or not the worker, in our judgment, was responding to the client’s concerns or missing them completely. one interesting finding was that in the face of 3 seconds or more of silence the worker often intervened and at times did so by changing the subject. we were also able to analyze the sessions according to rough estimates of time – the first (beginning), second (middle) and third (ending and transitions) segments. understanding the impact of the phases of work in a single session was an important subject for the interactional model. we found that many workers were not responding to the direct or indirect “offerings” of the clients in the first third of the sessions, something advances in social work, spring 2014, 15(1) 222 we termed the lack of “sessional contracting.” they were missing each other like ships in the night. this was often due to the worker having his or her own agenda determined by the treatment plan developed after completion of the study and diagnosis steps. in addition the research included questionnaires completed by the clients, workers and their supervisors. we were exploring twenty-seven distinct social work skills. research assistants also examined the client files to rate outcomes, such as stability of homes, days in foster care, etc. this analysis helped us to find answers to the earlier posed question: “what is practice?” as well as “is practice effective?” the first sharing of the results of this study in 1978 was an article in social work entitled, “a study of practice skills.” the findings were integrated into the first of seven editions of the skills of helping individuals and groups (1979).13 the results of this project were also jointly published in 1981 by the council on social work education and the canadian association of schools of social work in a book entitled, identifying, measuring and teaching the helping skills. for a number of years my publisher, peacock press, had been producing a successful book on generalist practice (pincus & minahan, 1973) that integrated a social system perspective but within the medical model. this widely used textbook described social work practice at a more theoretical and abstract level and referred to “change agent systems,” “client systems,” “target systems” and “action systems.” the authors drew upon family systems practice which was evolving to recognize the interactive nature of members of a family and the family’s relationship to the environment. examples were included, but most often they were observations about the problem in a particular system and did not include process recordings that would focus on the specific social worker interventions. i believe the positive response to the pincus and minahan book and to the espoused model related in part to the rapidly spreading shift to generalist social work practice in schools of social work. schools that formerly organized according to method, casework, group work and community work, were rapidly moving to teaching a generalist approach in the first year (msw and bsw) and then using a specialization approach in year two. for some schools year two was method organized (e.g., individual, family, group and community) while for others it was field of practice (e.g., child welfare, medical). a first year practice book at this higher level of abstraction could be used to describe a generalist practice model within the diagnostic medical model. the 1979 publication of the skills of helping individuals and groups was an important transition time in the wider dissemination of the interactional model. this book was adopted by many faculty members for first year generalist practice courses and according to my publisher, peacock, was replacing the sales of the previously widely used text by pincus and minahan. i would mark this period and the years that followed as the beginning, for some social work educators and practitioners, of the paradigm shift. 13 the editions expanded over the years with the 7th published in 2012 titled, the skills of helping individuals, families, groups and communities, thus applying the interactional model to a full range of practice modalities. shulman/medical to interactional model 223 phase 9: a study of the parallel process in 1974 i moved to the university of british columbia in vancouver. this marked the beginning of 10 years of research into child welfare practice, supervision, management, teaching and the doctor-patient study mentioned earlier. with significant private foundation funding i was able to expand and replicate over a three-year period the previous study of practice but this time across 10 regions of the provincial ministry of human resources. participants in this project included 5 ministry executive directors, 10 regional managers, 68 district office (front-line) supervisors, 175 social workers and 53 family support workers. practice with 305 families (449 children) was studied over a three-year period. the central focus of the study was the impact of the use of a number of specific practice skills on the development of the working relationship with clients, and in turn, the impact of this relationship on a number of outcome measures. working relationship was defined as rapport (“i get along with my social worker”), trust (“i can tell my social worker anything on my mind”; “i can share my mistakes and failures as well as my successes with my social worker”) and caring (“my social worker cares as much about me as he/she cares about my children”; “my social worker is here to help me not just to investigate me”). outcome measures included client satisfaction with the social worker and case outcomes (e.g., number of days in care, court determinations, etc.). this study also included examination of the impact of race on practice since a number of families in the study were from canadian aboriginal tribes while their workers were mostly caucasian canadians. findings suggested that inter-cultural barriers could be overcome in practice when social workers effectively used a number of the interactional skills. of particular importance was the client perception of the worker as sharing his or her own feelings. as one client commented, writing on her questionnaire: “i like my social worker. she isn’t like a social worker but was more like a real person.” as pointed out earlier, this was a key element in the interactional model as compared to the dichotomy between personal and professional widely taught in the medical model. in addition, a significant cut in the number of family support workers (600) providing preventive services to families was implemented by the provincial ministry during the course of this study. the cuts were implemented in different regions over time. we were able to track the impact of the cuts on such factors as the number of children taken into care in the region, how long they remained in care, and if they were returned home. data analysis suggested that cost savings through the cuts in staff may well have been offset by significant increases in the number of children going into and staying longer in foster or residential care. it was in this study that the interactional model concept of the importance of the parallel process was tested. a central tenant of the model is that the core skills of the helping process are important in all helping relationships including supervision and management. the use of these skills would be guided by the specific role of the helping professionals. for example, clarifying one’s role and clarifying the purpose of the advances in social work, spring 2014, 15(1) 224 engagement would be important in the beginning phase in all professional relationships; however, the purpose and role of supervision would be significantly different than in direct practice. thus, it was possible to construct and test questionnaires for each of the levels of the study – executives, managers, supervisors, line workers and parents and explore the same skills and the working relationship for each. the specific wording was adapted to reflect the study population: for example, “i can tell my social worker anything on my mind” would be modified to “i can tell my supervisor anything on my mind.” the finding of the study supported, among other findings, an association between the worker’s perception of support from the supervisor and the resulting client’s perception of support from the social worker. in other words, how a supervisor supervised had an impact on how social workers dealt with their clients. in turn, this could impact how parents responded to their children. i published a complete report of the study in 1990 in a book entitled interactional social work practice: toward an empirical theory. using causal path modeling techniques (lisrel) i viewed the model as describing “person, in interaction, in context over time.” this was an effort to construct and test a holistic model that included variables such as client background, stress, motivation and support as well as worker background, stress, motivation and attitudes. organizational context and supervision were examined as they impacted workers’ practice. the impact of socio-economic context on the client was also modeled. while the large sample was still too small to create one statically valid causal path model containing all of the variables, sub-models were created and examined. the effort was to determine how these complex variables affected the working relationship and the outcomes with a view toward determining the percent of the impact on the outcome variance. for example, how much did the social worker’s education and skill impact the working relationship with the client and through the relationship the outcome measures of the study. in another example, what was the contribution of the client’s socio-economic status, motivation, stress, etc. to the working relationship and, in turn, to the client outcomes? how much did these client variables directly impact the outcomes? phase 10: dissemination of the interactional model through the use of videotaping returning to my time at mcgill and the university of british columbia and to my friendship with the director of the mcgill instructional communication center, i was able to use videotaping as a potent tool for communication of the model to the field.14 in 1975 a series of videotapes titled: the helping process in social work: theory, practice and research were produced at mcgill as was a video of bill schwartz in conversation with students entitled, “private troubles and public issues – one social work job or two.” in this video bill made the case for the social worker’s responsibility, using a 14 many of these videos are now available as dvds through insight media, "justin baer" <justin@insightmedia.com>, 800-233-9910) shulman/medical to interactional model 225 phrase from c. wright mills, not only for the client’s “private troubles” but also for the “public issues” that impacted the client. during my first year at the university of british columbia i co-led a married couples group at the university’s health science center video camera-equipped meeting room. with the clients’ permission, all 21 sessions were videotaped. the first session and the eighteenth session were selected for editing and use as training tapes. with the clients’ additional permission, after viewing the two tapes following the last session, these programs were edited at mcgill. both the first and the eighteenth sessions were particularly illustrative of the mutual aid model and the role of the co-leaders in conducting a group within the framework of the interactional model. the use of social work produced videotapes for teaching in social work was innovative at that time. the program committee for the council on social work education’s annual meeting that year decided to play around the clock all of the produced tapes through the conference hotel’s internal video system so that they could be viewed in a meeting room as well as in each of the participants’ hotel rooms. i have no doubt that this event significantly increased interest in the interactional model. there was wide distribution of the programs at that time, and for some programs, a continued interest in their use today. additional programs were produced in 1980 (the skills of helping), 1983 (core skills for field instructors), 1988 (the dynamics and skills of the middle phase of practice, in collaboration with my colleague alex gitterman) and in 1990 (social work practice: an interactional approach). in 1994, while teaching at boston university, a series of programs titled, “teaching about practice and diversity: content and process in the classroom and field” were produced with my bu colleague cassandra clay and were (and still are) distributed by the council on social work education.15 these also were widely used as social work education searched for ways of addressing interand intra-cultural issues in practice and social work education further disseminating the interactional model framework. finally, recognizing that the dynamics of classroom teaching and that the concepts of the interactional model were just as relevant for education, where my research began in the 1970s, i have led or co-led workshops on classroom teaching for over 20 years at the annual meetings of the council on social work education attended by hundreds of practice faculty. recognizing that “more is caught than taught,” i presented a model for new and experienced faculty on how to conduct their classes in a manner that demonstrated good practice through the teaching role and mutual aid possibilities in a social work practice class. in my final year of full-time teaching at the university at buffalo, i led a year-long monthly workshop for faculty and doctoral students on the same topic. these sessions were videotaped and seven one-hour sessions edited and indexed (according to the topic). this collection of programs was produced and made available for free viewing or 15 available on the cswe website (www.cswe.org). advances in social work, spring 2014, 15(1) 226 downloading on the school’s web site (http://www.socialwork.buffalo.edu/facstaff/ skills_dynamics.asp). where does the paradigm shift stand now? i have tried to share my personal and professional life experiences over a period of 52 years as a practitioner, researcher and educator, and to tie these experiences to what i believe has been an evolving shift in paradigms from the medical model to the interactional model. i was not alone in attempting to influence this paradigm shift and many others have contributed to extending the work started by bill schwartz. what i take from my experience is that it is possible for elements of a paradigm to change even if the paradigm itself does not. for example, the interactional model led to an emphasis on operationalizing social work interventions and researching the process instead of just focusing on outcomes. similar work was done, for example, by truax (1966) with his emphasis on the rogerian models of empathy, warmth and genuineness in-group psychotherapy. however, the medical model paradigm involving the three stage process – study, diagnosis and treatment – still guides practice in this area. in another example, social systems theory has been widely integrated into helping models with an understanding that the client (or family, group or community) must be understood in a dynamic interaction within the system and with the environment; however, the interaction between the social worker and the client is not necessarily viewed in the same way. the psychotherapeutic concept of being genuine is a step toward integrating the personal and professional selves; however, i still meet hundreds of social workers (and other professionals) in workshops or presentations who tell me that the concept of the worker sharing his or her feelings is refreshingly different from their current or recent past education. the use of spontaneity and “trusting their feelings” are also cited as welcome ideas but contrary to the model shared in their professional training or in their supervision. others indicate that they were taught the interactional model in the msw or bsw program; however, it may not have been specifically named nor the paradigm switch identified. the recent emergence of evidenced-based practices (ebp), such as solution focused, cognitive-behavioral treatment and motivational interviewing, offer mixed evidence of a shift. on the one hand they are all very much concerned with process between the helping professional and the client. an example would be the key concept in motivational interviewing of recognizing that clients may be in a “pre-contemplation” stage, and describing interventions that respond to this reality. on the other hand, fairly rigid protocols associated with these ebps may have restricted the ability of helping professionals to respond spontaneously and with their own emotions, even their own words, when interacting with a client. this results in a science that restricts art rather than encourages its expression, reinforcing the false dichotomy between science and art. i suspect this contributes to the concern, raised in publications of the national institutes of shulman/medical to interactional model 227 health (nih) about the lack of “sustainability” when ebps are introduced into agency practices. so i conclude this description of my personal and professional journey with a mixed assessment of where we are in the paradigm shift. a recent positive event has been my receiving the council on social work education’s significant lifetime achievement award. i believe this represents recognition of the work i have done in the development of the interactional paradigm. when i accept this award at the cswe annual meeting, i will indicate that i believe i share it with william schwartz. certainly the process has moved further along, which is encouraging; however, i share my concern that we may not have gone far enough. a complete paradigm shift is difficult to accomplish and takes significant time and effort. we need also to recognize that for some professionals and educators the earth remains the center of the universe and the old lady never becomes the young lady. references alinsky, s. (1971). rules for radicals: a pragmatic primer for realistic radicals. new york, ny: random house. amidon, e. j., & flanders, n. (1963). the role of the teacher in the classroom. minneapolis, mn: paul s. amidon and associates. brager, g., & holloway, s. (1978). changing human service organizations: politics and practice. new york, ny: free press. cloward, r., & ohlin, l. (1960). delinquency and opportunity: a theory of delinquent gangs. glencoe, il: free press. fischer, j. (1973). is casework effective? a review. social work, 18, 5-20. germain, c. b., & gitterman, a. (1980). the life model of social work practice: advances in theory and practice. new york, ny: columbia university press. germain, c. b., & gitterman, a. (1996). the life model of social work practice: advances in theory and practice (2nd ed.). new york, ny: columbia university press. gitterman, a., & shulman, l. (eds.). (1986). the legacy of william schwartz: group practice as shared interaction. new york, ny: routledge. also published as social work with groups, 8(4). kuhn, t. s. (1962). the structure of scientific revolutions. chicago, il: the university of chicago press. papell, c., & rothman, b. (1966). social groupwork models: possession and heritage. journal of social work education, 2(2), 66-77. phillips, h. u. (1957). essentials of social group work skill. new york, ny: association press. advances in social work, spring 2014, 15(1) 228 pincus, a., & minahan, a. (1973). social work practice: model and method. itasca, il: f. e. peacock. rosenberg, m. (1968). the logic of survey analysis. new york, ny: basic books. schwartz, w. (1961). the social worker in the group. in new perspectives on services to groups: theory, organization, and practice (pp. 7-34). new york, ny: national association of social workers. schwartz, w. (1986). the group work tradition and social work practice. in a. gitterman & l. shulman (eds.), the legacy of william schwartz: group practice as shared interaction (pp. 7-28). new york, ny: routledge. also published in social work with groups, 8(4), 17-28. shulman, l. (1968). a casebook of social work with groups. new york, ny: council on social work education. (published in swedish by student litteratur, l97l; french edition published by association nationale des assistantes sociales, 1977). shulman, l. (1969). social system theory in field instruction. in g. hearn (ed.), social systems theory in social work education (pp. 339-349). new york, ny: the council on social work education. shulman, l. (1979). the skills of helping individuals and groups. itasca, il: f. e. peacock. shulman, l. (1986). the dynamics of mutual aid. social work with groups, 8(4), 51-60. shulman, l. (1990). interactional social work practice: toward an empirical theory. itasca, il: f. e. peacock. shulman, l. (2012). the skills of helping individuals, families, groups and communities (7th ed.). belmont, ca: brooks/cole. shulman, l., & buchan, w. (1982). the impact of the family physician’s communication, relationship and technical skills on patient compliance, satisfaction, reassurance, comprehension and improvement. vancouver, bc: the university of british columbia. simon, a. (ed.). (1967). mirrors for behavior: an anthology of classroom observation instruments. philadelphia, pa: temple university, center for the study of teaching, research for better schools. specht, h., & courtney, m. e. (1993). unfaithful angels. new york, ny: free press. truax, c. b. (1966). counseling and psychotherapy: process and outcome. fayetteville, ar: university of arkansas, arkansas rehabilitation research and training center. author note address correspondence to: lawrence shulman, po box 1651, grantham, nh 037531651. email: shulman@buffalo.edu shulman/medical to interactional model 229 lawrence shulman, m.s.w., ed.d., is a retired professor and former dean at the university of buffalo school of social work. he has been a social work practice educator for over forty years, maintaining a pro-bono practice with at least one social work group each year. he has done extensive research on the core helping skills in social work practice, supervision, and child welfare. in addition to his many awards, he is a 2014 recipient of the council on social work education’s significant lifetime achievement award and was recently honored by his selection to the columbia university school of social work’s alumni hall of fame. he has been a widely used consultant and trainer in many areas of social work practice and education nationally and internationally, including canada, norway, hong kong, bermuda, and australia. he has published numerous articles and monographs on direct practice and is the author or co-editor of eight books, many of which are referenced in this article. microsoft word 8. wall_8846_lesbian headed families copyedit_final ______________ misty l. wall, ph.d., mssw, lcsw, is an assistant professor in the school of social work at boise state university in boise, id. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 433-441 working with lesbian-headed families: what social workers need to know misty l. wall abstract: more gay men and lesbian women are choosing parenthood. one common challenge facing lesbian-headed families is how to navigate interactions with societies that are largely homophobic, heterocentric, or unaware of how to embrace nontraditional families. systems may struggle to adjust services to meet the needs of modern family structures, including families led by lesbian women. the following are three areas of intervention (knowledge, creating affirmative space, and ways to incorporate inclusive language), informed by current literature, that allow social workers to create successful working relationships with members of lesbian-headed families. keywords: lesbian, same-sex couples, lesbian-headed families the landscape for lesbian, gay, bisexual, and transgender individuals (lgbt) has changed vastly within the last decade. for the first time in u.s. history, our president is openly supportive of same-sex marriage and all other formal extensions of equal rights to lgbt individuals. despite considerable progress, the nuclear heterosexual family is still viewed by parts of western society as the “the norm” and the “preferred” family constellation for child rearing. despite decades of research that have produced countless empirical studies showing lesbian women to be capable, protective, nurturing, loving parents (see the american psychological association for a list of studies), same-sex headed families are viewed by some americans as deviant and potentially harmful to children (short, riggs, perlesz, brown, & kane, 2007). many lesbian women desire motherhood and are choosing to become parents in the context of same-sex relationships despite public and private challenges associated with that choice. the purpose of this article is to provide social work practitioners practical, evidence-based interventions so that they may provide effective and affirmative services to lesbian-headed families. the 2010 u.s. census report shows 594,000 same-sex couple households in the united states (lofquist, 2011). almost half (48%) of lesbian couples report having a child under 18 in their home (gates, 2013). while there may be a number of issues with the accuracy of estimates of this hidden population, existing data provide social scientists evidence documenting the prevalence of lesbian women who are parenting. the definition of family has been evolving for centuries to meet the changing needs of society. such evolution has included inclusion of adopted children in wills and probated estates, acceptance of mixed-race couples, and grandparents raising grandchildren, among other non-traditionally defined family structures. narrow definitions of family offer fertile ground for oppression of lesbian-headed families. nontraditional family structures require practitioners to seek to understand how lesbian women raising children define “family” and the roles within their families. definitions of wall/working with lesbian-headed families 434 family vary from household to household, but there are a few key themes that social workers must be aware of in order to best support their lesbian clients. within lesbian communities, especially lesbian feminist communities, the ideas of lesbian and mother have been mutually exclusive categories. some lesbian scholars believe that lesbian women do not always recognize the political implications of lesbian motherhood (corley & pollack, 1997), and this sentiment can be alienating for some lesbian mothers (lewin, 1994). lesbian women encounter oppression due to their sexual orientation from every aspect of their public and private lives. this oppression is intensified when lesbian women make the decision to have children, because they make this choice in a society that frequently and boisterously protests the lesbian-headed family (short et al., 2007). lewin (1994) followed 135 lesbian women who were raising children for five years and has offered much insight into the plight of mothering while gay. in addition to examining the experience of motherhood, she presents a dichotomous range of lesbian women’s perspectives on paternity and paternal involvement. she reported that lesbian women all seemed to consider the role of “father” in their children’s lives, but the responses in how to define “father” and to include, or exclude, that person varied widely. for instance, one woman described the void created by lack of male involvement as strictly financial and saw government assistance as sufficient to fulfill that role (lewin, 1994). some women felt that raising their children without an active father figure was an advantage. other women, however, saw filling the “father” role as necessary and felt they were responsible to find diverse male figures, such as grandparents, brothers, or male friends to provide a positive male remodel in their children’s lives. regardless of a lesbian woman’s opinion of the place of a traditionally defined father figure, western culture places value on paternal involvement and considers it to be essential for healthy child development. however, the construct and culture of fatherhood is fluid and dependent upon societal, historical, and economic contexts (goldberg & allen, 2007). the fluid definition of fatherhood provides lesbian women opportunities to redefine traditionally ascribed “father” roles into gender-neutral paradigms that fit within their families. lesbian mothers have the opportunity to redefine other family roles as well. social workers must keep in mind that lesbian-headed households may not be strongly connected to their families of origin, depending on whether or not their biological family is aware of their kin’s sexuality or their reaction to the coming out process. lesbians often rely less on family of origin and more on families of choice (erwin, 2007). these selected individuals represent a safe community that understands and supports them (erwin, 2007). social workers must remember to validate and include, if necessary, families of choice when working with lesbian mothers. when working with couples of color or mixed race couples this is doubly important since extended family and friends are often included in family trees as a cultural standard (erwin, 2007). lesbian mothers have self-reported a variety of strategies and resources to ensure the wellbeing of their families (short et al., 2007). women cited that developing rich social networks and intentionally seeking relationships with people from diverse family advances in social work, fall 2013, 14(2) 435 backgrounds were important methods of creating a strong and unique family identity (short et al., 2007). this research is valuable in that these coping strategies came from lesbian women themselves, rather than counselors or researchers attempting to claim expertise in lesbian women’s experiences. social service, legal, and political systems in the u.s. are struggling to find ways to meet the needs of increasingly varied models of “family” that are beginning to challenge traditional stereotypes and traditional methods of service provision. as the idea of family expands and shifts to meet the needs of modern families, social workers may be called on to provide direct services to lesbian-headed families. the following are several interventions, informed by current literature, which will allow social workers to create successful working relationships with lesbian-headed families. interventions know the facts common cultural lgbt myths. while american society has succeeded in dispelling many myths about gay men and lesbian women, several harmful and invalid stereotypes persist perpetuating homophobic and heterosexist attitudes, which can negatively impact delivery of effective and competent services. social workers are not unaffected by homophobia (black, oles, & moore, 1998; messinger & topal, 1997). further, the nasw code of ethics (1999) calls for social workers to continually strive to improve their knowledge and practice. some of the harmful myths that exist in our culture include assuming that all lgbt individuals want to be “out” to society, assuming that lesbians dislike or even hate men, assuming that a list of all lgbt people within a community exists or that all gay people know or want to know each other, assuming that identifying as lgbt is not compatible with religion or spirituality, assuming that lgbt individuals are liberal or democratic, assuming that lgbt individuals do not want to be married or have children, and assuming that gender norms are derived entirely from nature rather than society. a particularly harmful stereotype that has prevailed in our society is an association between sexual orientation and child sexual abuse. this list, though long, is by no means exhaustive. the resulting damage from these assumptions and societal myths to individuals and families can be devastating. thus, in an effort to dispel remaining misinformation, the following is a brief overview of empirically-based information about lesbian and gay-headed families that contradict some of these cultural myths that permeate our society. despite research to the contrary, debate continues about how being raised by gay or lesbian parents will affect a child’s development and whether or not children of gay or lesbian parents are more likely to be sexually abused (erwin, 2007). however, research suggests that children raised by gay or lesbian parents may have developmental advantages over children raised by heterosexual parents (goldberg, smith, & perryjenkins, 2012; mallon, 2011; patterson, 2000; stacey & biblarz, 2001). this comparison to heterosexual families is also a form of oppression and heterosexism, as it defines heterosexual families as the norm to which other families are compared (erwin, 2007; pollack, 1987). pollack (1987) discusses the real danger of assuming that lesbian mothers wall/working with lesbian-headed families 436 are just like other mothers, explaining that doing so “thickens the veil of invisibility” that surrounds lesbian women. furthermore, available research focusing on lesbian families alone consists of lesbian-headed families of well-educated, white, middle class background, with children from previous marriages. this limiting image further prevents a clear and accurate portrayal of lesbian women, their children and their experiences. this cycle of oppression can affect lesbian women’s identities, as sexual orientation is defined and perceived through diverse political, cultural, and ethnic lenses. internalizing homophobia and heterosexism can affect lesbian women’s psychological health and parenting ability (erwin, 2007). continuing to view the family through a heterosexual lens will serve to further the oppression experienced by lesbian women and anyone existing outside of a nuclear, heterosexual family context. many lesbian-headed families, which can be created through adoption, donor insemination, or mixed families with children from prior relationships, have been found to display higher levels of equality between partners in regards to economic contribution as well as performing work in the home such as childcare and home and property maintenance, and they display advanced parenting skills (goldberg et al., 2012). children of lesbian-headed families demonstrate higher levels of attachment when compared to children of heterosexual-headed families (goldberg et al., 2012; mallon, 2011; patterson, 2000; stacey & biblarz, 2001). despite the cultural myths associating lesbians with a lack of desire and adequacy for partnership or motherhood, the trends of increasing lesbian-headed families and the positive outcomes of their children suggest that these women are desiring and fully capable of creating legitimate and healthy families. one of the most crucial understandings to have when working with lgbt families is to ask about their personal experiences and not make assumptions regarding cultural myths on their individual lives. protections and discrimination. societal oppression exists through the abovementioned myths; however, laws throughout the united states support legal discrimination. many in our society believe that law protects freedom from oppression, but this is often not the case for individuals who identify as lgbt. while civil rights have expanded to many historically disenfranchised groups, lgbt individuals have often been left behind though things are constantly in flux in different states or cities within states. various laws regarding bullying, employment protections, fair and equal access to housing, health care for pregnancy planning and partner coverage, marriage equality, availability to petition for second-parent adoption, child custody, donor insemination, and other issues that influence the lives of lgbt individuals, as well as their families, are often not inclusive of lgbt individuals. this lack of legitimized recognition can cause an increase in traumatic experiences and anxiety that would not occur with individuals who do not identify as lgbt, and the large disparity from location to location creates additional inequality of experiences and quality of life (knauer, 2012). even the increased political dialogue surrounding elections can increase negative psychological experiences including anxiety, depression, and posttraumatic stress disorder in lgbt individuals (russel, bohan, mccarroll, & smith, 2011). currently there is a lack of federal oversight, which leaves civil rights decisions up to state and local governing bodies. thus it is crucial for practitioners to be educated regarding local and national advances in social work, fall 2013, 14(2) 437 laws as well as the personal experiences of their clients regarding geographical location and legal discrimination. create affirmative space rapport-building begins when the client enters the agency, or often prior to physical introduction to the agency when the client receives paperwork to complete. experience has shown that this introductory process is especially important when working with marginalized populations, such as lesbian households because it sets the stage for further development of strong rapport and a trusting therapeutic relationship. lesbian women who are raising children have unique ways in which they navigate their sexual identity, with varying levels of disclosure depending on the context. lindsay and colleagues (2011) characterize the degree to which sexual orientation is disclosed on a continuum of proud, selective, and private. they further explain that lesbian women who are considered proud are those women who articulate a commitment to active disclosure of their sexual orientation as a means of advocacy or protection for their children. selective disclosure refers to women who are just that, selective, regarding to whom and when they disclose their sexual orientation. women who attempt to disguise their relationships, especially relationships to the non-legal or non-biological parent, choose to do so because they feel out of place, unwelcomed, or excluded when working within heteronormative systems. finally, private denotes deliberate and active non-disclosure. levels of authenticity and disclosure are directly related to the perceived level of acceptance and support within the social context and lower levels of disclosure are related to the desire to keep their children safe in systems that are homophobic (lindsay et al., 2011). lesbian clients may find it difficult to ask for or accept help, if the physical environment is not affirmative (hunter & hickerson, 2003). creating affirmative space extends beyond an individual social worker’s office to include the entire agency area. one way to create affirmative space agency-wide is to include pictures, periodicals, or other media that include various family constellations, equality organizations such as parents and friends of lesbians and gays (pflag) or the human rights campaign (hrc), and written statements about the agency’s commitment to providing equal services (mallon, 2000). providing images of same-sex couples, lesbian-headed families, or the like sends the message that all families are valued and encouraged to attend and be fully open about their sexual orientation and family constellations. within each social worker’s office he/she could include resources that are specifically lesbian and gay friendly (eldridge & barnett, 1991). mercier and harold (2003) interviewed 21 lesbianheaded families about their interfaces with schools and found that many reported feeling that their school systems were attempting to be inclusive of their families, but were doing so with a limited array of resources. further, lesbian-headed families are often knowledgeable about resources regarding their families and eager to share books, resources, pictures, or similar resources to create systems that affirm their families (mercier & harold, 2003). members of lesbian-headed families consistently mention heteronormative systems’ inability to “see” them as they are (eldridge & barnett, 1991; mercier & harold, 2003). lesbian parents frequently report that even when they are intentionally out with child wall/working with lesbian-headed families 438 care providers, school personnel, or other helping professionals, the helping professional reorganizes their family structure into a more common, heteronormative structure, mistaking partners for sisters, grandparents, or the like (mercier & harold, 2003; skattebol & ferfolja, 2007), perpetuating invisibility and oppression. when lesbian women have parts of their family system minimized, or restructured to fit within the norm, the message of otherness, less than, is internalized, further marginalizing lesbian parents and their children. one solution is to be aware of personal assumptions about families, let the client lead introductions of themselves and their families, and ask clarifying questions when necessary. lack of these lgbt-affirming environments, images, and literature can lead clients to feel marginalized, unwelcome, and can increase likelihood of internalized homophobia from living in a heterocentric society (lindsay et al., 2011; szymanski & chung, 2008). having a safe, confidential space is crucial in contributing to a strong therapeutic relationship and experience for lesbian women (pixton, 2003). use inclusive language the first encounters with a practitioner or agency are generally intake or registration forms or informational surveys. often forms present heterosexist language including “married, single or divorced” or describe relationships to the client with words such as “spouse,” “mother,” and “father.” redesigning forms to include language that is inclusive of all family structures will send a signal to lesbian clients that their families are understood and valued by the practitioner as well as by the entire agency. in general, it is important to always provide an option for “other” and a blank space for the client to provide appropriate information. utilize the client’s language and always ask for definitions or clarification rather that making assumptions. for a comprehensive list of replacement options for current agency forms, please see table 1. table 1. commonly utilized language contrasted with more inclusive language options language currently utilized more inclusive options marital status: divorced, married, separated, single relationship status: civil union, divorced, domestic partnership, legally separated, married, partnered, single, separated, unknown, widowed, other name of spouse name of partner mother/father parent, co-mother, co-father sex: male, female sex: male, female, intersex, other gender: man, woman gender identity: male, female, transgender male to female (mtf), transgender female to male (ftm), gender queer, other not applicable child’s status: biological, adopted, foster advances in social work, fall 2013, 14(2) 439 in situations where adoption is not a preferred or viable option for lesbian women, an important issue to focus on is the role of the “co-mother,” or the non-biological parent in a lesbian family. motherhood is associated with biology and childbirth in society, making the role of co-mother a difficult and often isolating position. in her published diary, gray (1987) writes of the disconnection she experienced during the first month after the birth of her partner’s child. she explains she felt “very left out because i can’t feed him” as well as “hurt by kathleen’s seeming unwillingness to share that fundamental task” (gray, 1987). she later comments, “no one’s allowed to have two mommies,” as was evident when people approached her family and asked, “who’s the mom?” or “whose baby is it?” (gray, 1987). how lesbian co-mothers are perceived and treated in society is another indicator of heterosexism along with the denial of basic cultural celebrations and landmarks to lesbian and gay families that include marriage, anniversaries, baby showers, and so forth. social workers have the opportunity to encourage lesbian families to create their own rituals to celebrate their union, and be inclusive of two mothers, two fathers, and other nonnormative family structures as agencies celebrate. family rituals and being included in agencies’ events validate and empower lesbian couples, as well as create a sense of legitimacy and family identity (erwin, 2007). utilizing the correct language and exploring the individual narrative of clients’ families is crucial to establishing a trusting relationship that validates all family structures and is required for a working therapeutic alliance. conclusion the attitudes of americans toward lesbian women have changed dramatically within the last ten years. the majority of americans support same-sex marriage and even more support equal protections regardless of sexual orientation. while the political landscape continues to grow more tolerant of sexual minorities, lesbian women still face real risks when disclosing their sexual orientation. further, many lesbian women are hesitant to disclose their sexual orientation. the growing forms of non-traditional family structures pose considerable challenges to heteronormative systems. because of their direct contact with clients and their ethical commitment to oppose oppressive systems, social workers are likely to be the agency representatives who are in the best position to advocate for corrections within heteronormative systems that marginalize lesbian-headed families. suggestions for social workers presented in this paper include: 1) knowing the facts about the challenges faced by lesbian-headed families, with special attention paid to legal and social risks associated with “coming out” as a lesbian or a lesbian mother; 2) empowering social workers to create affirmative space within their agencies for lesbian-headed families by, for example, supporting changes to policy, paperwork, and physical surroundings that suggest lesbian-headed families are seen and valued; and 3) reworking language to be inclusive of lesbianheaded families. in summary, working with lesbian-headed families may be challenging for social workers who often report feeling unaware of the needs of this population. however, addressing these three key areas (knowledge, space, and language) can wall/working with lesbian-headed families 440 transform an agency into an affirmative and efficient resource for lesbian-headed families. references black, b., oles, t., & moore, l. 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(2011). trauma, recovery, and community: perspectives on the long-term impact of anti-lgbt politics. traumatology, 17(2), 14-23. short, e., riggs, d. w., perlesz, a., brown, r., & kane, g. (2007). lesbian, gay, bisexual and transgender (lgbt) parented families: a literature review prepared for the australian psychological society. melbourne, vic: australian psychological society. retrieved from http://www.psychology.org.au/publications/statements/lgbt_families/ skattebol, j., & ferfolja, t. (2007). voices from an enclave: lesbian mothers' experiences of child care. australian journal of early childhood, 32(1), 10-18. stacey, j., & biblarz, t. j. (2001). (how) does the sexual orientation of parents matter? american sociological review, 66(2), 159-183. szymanski, d. m., & chung, y. b. (2008). internalized homophobia in lesbians. journal of lesbian studies, 7(1), 115-125. author note: address correspondence to: misty l. wall, ph.d., mssw, lcsw, assistant professor, boise state university school of social work, 1910 university drive, boise, id 837251940. email: mistywall@boisestate.edu this work is licensed under a creative commons attribution 4.0 international license. equine-assisted psychotherapy: an emerging trauma-informed intervention page walker buck nadine bean kristen de marco abstract: equine-assisted psychotherapy (eap) has emerged as a promising intervention for the treatment of trauma and stressor-related disorders. this experiential therapy offers an option for clients whose traumatic experiences may render traditional talk therapies ineffective. initial research on the most robust model of eap, developed by the equine assisted growth and learning association (eagala), indicates positive effects for children, adolescents, and adults who have experienced trauma. the eagala model® was designed to allow for rigorous evaluation of efficacy, a clear theoretical base, standardized implementation, and ongoing training for practitioners. as the primary providers of mental and behavioral health services in the united states, social workers are keenly aware of the need for a portfolio of treatment methods to manage the increasing demand for services. this article provides an overview of eap, including a review of the literature, the history of human-horse relations, an eagala case example, and a call for more rigorous research. keywords: equine-assisted psychotherapy; trauma-informed; trauma and stressorrelated disorders; eagala a number of cross-sectional and longitudinal studies regarding traumatic experiences indicate a far higher prevalence of exposure to trauma than once believed (anda, felitti, & corwin, 2014; cronholm et al., 2015; felitti et al., 1998; murphy et al., 2016). findings from the cdc-kaiser permanente adverse child experiences (ace) study reveal a graded dose-response relationship between aces and negative health and well-being outcomes across the lifespan (anda et al., 2014). the more exposure an individual has to adverse events such as child maltreatment, intimate partner violence, violent crime, disaster, terrorism or war, the higher the likelihood of physical and mental health issues throughout the lifespan. individuals face a higher risk of suffering from substance use disorders, depression, and trauma and stressor-related disorders, including post-traumatic stress disorder (ptsd). unresolved trauma is linked to poor academic achievement, early sexual activity, financial stress, poor work performance, heart disease, and liver disease (anda et al., 2014; larkin, shields, & anda, 2012). the effects of trauma are significant, leaving indelible footprints on the brain. increasingly, sensitive brain imaging techniques such as functional mris have illustrated that traumatic experiences, particularly severe and chronic exposure, affect brain development and functioning. imaging results show changes in the amygdala, corpus callosum, cerebellum, hippocampus, and prefrontal cortex (baker et al., 2013; bourne, _____________________ page walker buck, phd, lsw and nadine bean, phd, lcsw are associate professors in the department of graduate social work at west chester university in west chester, pa. kristen de marco is an eagala®-certified equine specialist and executive director of gateway horseworks in malvern, pa. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 387-402, doi: 10.18060/21310 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 388 mackay, & holmes, 2013; dannlowski et al., 2012). for individuals with a significant trauma history, these changes can overwhelm cognitive processes, including the ability to use words to express feelings and psychomotor sensations, as the prefrontal cortex goes off line (sekiguchi et al., 2013; van der kolk & mcfarlane, 2012). in addition to the effects that trauma has on the brain, trauma also lives in the muscles, bones, and the neurons serving the musculoskeletal system (van der kolk, 2014). van der kolk (2014) explains that when the limbic system is repeatedly triggered during stress responses, there is an increased risk that it will remain on and leave the body in a hypervigilant state. not surprisingly, traditional psychotherapy sessions can feel unsafe to clients whose systems are already overwhelmed. when the effects of trauma on the body are combined with the effects of trauma on cognitive processes, talk therapy alone is often rendered ineffective (van der kolk, 2002; van der kolk & mcfarlane, 2012). this is especially true for people who experienced their first traumatic experiences as children (anda et al., 2006). the substance abuse and mental health services administration (samhsa, 2014), in collaboration with the national center for trauma-informed care & alternatives to seclusion and restraint (nctic), outlines the six key principles of a trauma-informed approach: 1) safety, 2) trustworthiness and transparency, 3) peer support, 4) collaboration and mutuality, 5) empowerment, voice and choice, and 6) cultural, historical and gender issues sensitivity. underlying these principles is the conviction that recovery is possible and that through an appropriate trauma-informed approach; resiliency can be nurtured. the notion of recovery is a shift in perspective from the medicalized use of the term disorder in describing post-traumatic stress response, particularly in the military and in disaster mental health services. as understanding about the nature of post-traumatic responses has evolved, there is a wider appreciation for the fact that trauma responses are normal reactions to abnormal situations (american red cross, 2012). the call to fill the treatment gap for complex trauma, however, is pressing. practitioners need access to an expanded set of treatment options that includes modalities designed to specifically address the embodiment of trauma, especially given that the vast majority of mental and behavioral therapies are talk-based. rapidly emerging in the effort to enhance recovery and build resilience for trauma survivors are mind/body, experiential approaches and expressive therapies, including: mindfulness programs (davis & hayes, 2011; omidi, 2013), trauma-focused cognitive behavioral therapy or tf-cbt (getz, 2012; kliethermes & wamser, 2012), traumasensitive yoga (rhodes, 2015; van der kolk et al., 2014; west, lian, & spinazzola, 2016), and expressive art therapies including psychodrama (zucker, spinazzola, pollack, pepe, & barry, 2010). by deemphasizing verbal communication, these approaches allow for the inclusion of non-verbal approaches that support the therapeutic relationship and the establishment of safety and trust, which in turn can improve affect regulation and cognitive processing (bray, stone, & gaskill, 2017). in this paper, we present a synthesis of literature on equine-assisted psychotherapy (eap) as unique addition to the portfolio of e trauma-informed interventions. combining the therapeutic use of metaphor in client-directed settings such as play therapy (boyd buck et al./equine assisted psychotherapy 389 webb, 2015; landreth, 2002) with the unique experience of interacting with horses (hayes, 2015; yorke, adams, & coady, 2008), eap offers a promising approach to the treatment of trauma and stressor-related disorders. unique to eap is the inclusion of large prey animals in the therapeutic setting, inviting trauma survivors to interact with other sentient beings experiencing hypervigilance. the transparency and trust required of connection with the horses create an opportunity for survivors to experience safety in the therapeutic process. animal-assisted therapy animals have long been used to address issues of human suffering. morrison’s (2007) review of this history indicates that the practice has been around since the late 18th century when rabbits and chickens were included in the care of people with mental illness in england. today animals are used to address an increasingly wide range of mental, behavioral and physical health conditions. animal-assisted therapy (aat) is the deliberate inclusion of a non-human animal in an intervention setting to enhance client outcomes (american veterinary medical foundation [avma], 2017). common interventions include the presence of dogs, rabbits (pitheckoff, mclaughlin, & de medeiros, 2016), and guinea pigs (o’haire, mckenzie, beck, & slaughter, 2015) for outcomes such as stress reduction, reading fluency and the development of prosocial skills. client populations include school-aged populations, older adults, incarcerated populations, individuals testifying in court cases, and college students. in these cases, the presence of the animal is theorized to provide a social buffer that maximizes the effect of the intervention (o’haire et al., 2015). children, for example, have been found to read more fluently when a dog is present (jalongo, 2005). horses are often included in animal-assisted activities and therapies, especially miniature breeds, for many of the same reasons (mccullough, risleycurtiss, & rorke, 2015). full-size horses are included in some psychotherapeutic settings because of their distinction as large prey animals, specifically creating an environment that is not socially buffered. in their hypervigilant state, horses provide immediate, yet nonjudgmental, feedback to clients about their behavior (hayes, 2015). the evidence for equine-assisted therapy the evidence for the impact that horses can have on therapeutic outcomes is limited due to small sample sizes and the lack of rigorous research designs. the results that have been published, however, are encouraging and worthy of consideration given the pressing need for alternative approaches to the treatment of trauma. a meta-analysis of equineassisted therapy for at-risk adolescents who had experienced trauma found a medium effect size for seven studies (g=0.714, p < 0.001) that all included preand post-intervention data (wilkie, germain, & theule, 2016). this effect reduced to a small/medium size (g=0.402, p=0.002) when only the five studies that had both treatment and comparison groups were included. it is impressive that this effect is robust across the variations in treatment programs. systematic reviews of using horses in psychotherapy also indicate that interventions are promising for a range of populations (kendall et al., 2015; selby & smith-osborne, 2013). kendall et al. (2015) identified 15 studies that qualified for inclusion in their review. advances in social work, spring 2017, 18(1) 390 only two of the studies (bass, duchowny, & llabre, 2009; davis et al., 2009) were randomized-controlled trials. kendall and colleagues (2015) report that although additional rigorously-designed studies were needed to conclude that equine-assisted interventions are efficacious, “equine-assisted interventions hold much promise, particularly in terms of child/adolescent social and behavioural issues” (p. 75). selby and smith-osborne (2013) found a similarly small group of studies for review of equine-assisted therapy for populations with chronic illness or health conditions, noting that their analyses “lend credibility to the employment of equine-assisted techniques as an adjunct to traditional interventions for populations with health challenges” (p. 428). studies not included in the meta or systematic reviews of eap include a qualitative study of adults in recovery from trauma, which identified the importance of the equinehuman bond given the horses’ non-judgmental approach (yorke et al., 2008). one participant in this qualitative study reflected on her experience, noting, “they [the horses] don’t try and analyze you” (p. 23). nurenberg and colleagues (2015) designed a randomlycontrolled trial using clinical incident reports and independent staff observations to compare both equine and canine-assisted therapy to standard treatment for 90 adults hospitalized for psychiatric conditions. results indicate that the use of the eagalamodel eap, delivered weekly for less than an hour and for no more than 10 sessions, was statistically more effective than canine therapy in reducing occurrence of violence in study participants. the authors posit that the differential effect of incorporating equines for psychiatric clients may be related to the fact that the horses are prey animals. “nonpredatory equines, tending to mirror rather than direct human responses, may have a therapeutic advantage for some patients over more predatory species, such as canines and humans” (nurenberg et al., p. 85). they further suggest that this status may have particular significance for clients who have experienced interpersonal trauma. horses and humans humans have relied on horses for thousands of years, using them as a primary means of transportation on fields of battle and agriculture. in more recent years, horses became known for their ability to help people with both physical and emotional challenges. today horses are used for a range of therapeutic activities including treatments for traumatic brain injury, autism spectrum disorders, sensory disorders, and stressor related disorders such as ptsd (hayes, 2015). what makes horses particularly suited to psychotherapeutic work is their distinction as prey animals (hayes, 2015; thomas & lytle, 2016). horses live in a heightened state of awareness. this allows them to perceive outside stimuli with precision, keeping them, and their herd, safe. horses pay close attention to even the most subtle shifts in congruency and mirror their behavior accordingly. when faced with an external threat, horses are often compelled to flee. they become closer and more cohesive as a group, protecting one another. horses remain connected to the herd in times of stress. this is distinct from the individualistic model that humans often engage in and from the social isolation that trauma survivors can adopt. observing equine behaviors provides humans the opportunity to think differently about the value of connectedness, especially in times of stress, anger, and fear as they process these emotions while interacting with the herd (thomas & lytle, 2016). buck et al./equine assisted psychotherapy 391 horses’ flight instinct is balanced with an innate curiosity and desire for connection. horses are social, herd animals. they have distinct personalities and moods, just like people, and they have a hierarchical structure similar to that of families or the workplace. like people, horses form special relationships with one another, give and accept affection, and set boundaries with one another (eagala, 2015). because the horses react and interact with humans consistent with their status as prey animals, clients receive feedback about their own behaviors in immediate, candid and nonjudgmental terms. the opportunity to observe how their behaviors including attitudes, emotions, body language, and boundaries affect the horses and to receive feedback in the moment is leveraged in equine-assisted interventions. the transparency of communication from prey animals living in a state of heightened awareness may paradoxically create a sense of safety in clients, especially those who have survived trauma, and allows space for nonjudgmental self-examination. with assistance from the treatment team, clients can become more open to examining their own post-traumatic stress responses. as hayes (2015) states, many humans with certain types of emotional damage experience positive feelings of familiarity as they unconsciously identify with the two primary equine survival traits of hypervigilance and herd-dynamic-based social skills. these shared traits and interspecies identification can create mutual feelings of safety, acceptance, and compassion for both human and horse. in turn, this identification can lead a person to the self-awareness necessary for healing their emotional wounds. (p. 62) eap works with this mutuality to nurture the safe space initiated by the connection between clients and horses. the eagala model of eap while there are several emerging models of equine assisted psychotherapy, the eagala model® offers a professional, standardized approach to engaging horses in treatment (equine assisted growth and learning association [eagala], 2015). founded in 1999 by l. thomas, lcsw, eagala is a leading, international organization that supports the incorporation of horses into mental health and personal development work (eagala, 2010). thomas recognized the efficacy of eap as well as the need to professionalize standards for practice. she developed manuals, trainings, and a code of ethics to serve as scaffolding for this innovative therapeutic approach. with over 4,500 members in 50 countries and 700 active programs, eagala is the most widely known and respected equine-assisted psychotherapeutic model. eagala offers a fullydeveloped and professionally-endorsed treatment model for mental health professionals practicing eap. the eagala model is based in four tenets: 1) a team approach, 2) all sessions to be focused on the ground, 3) a solution-oriented belief system, and 4) an adherence to the eagala code of ethics. in each session, a treatment team is present. a licensed mental health professional and a certified equine specialist, along with horses and client(s), combine to form the treatment team. the mental health professional is charged with providing emotional safety for clients, treatment planning for each session, and ensuring advances in social work, spring 2017, 18(1) 392 ethical practice. the equine specialist provides physical safety for clients and horses, collaborates with the mental health professional to structure sessions, and offers observations of horse behavior. working as a team, facilitators combine their individual expertise to provide an emotionally and physically safe experience for the client. while therapeutic riding uses the kinesthetic connection between humans and horses to foster wellness, unmounted therapies primarily focus on the emotional connections that are present. eagala-model eap is focused on the ground. none of the interactions between clients and horses include horsemanship or riding. horsemanship develops horse skills, while eap develops people skills. this greatly reduces the incidence of injury and enhances the accessibility of the treatment. further adding to the accessibility of eagala as a treatment option is the fact that clients are not required to have any previous horse experience. usually, horses have no equipment on them during an eagala session. they are roaming freely in the space, allowing clients to meet them on equal footing rather than controlling them from a saddle a powerful experience with a 1,200-pound animal. because of the unmounted nature of the eagala model, clients are able to experiment through trial and error a multitude of ways for creating connection, developing relationships, and solving challenges. while clients can choose how close to get and where to touch the horses, the horses also have choices to move away or move closer. in order to interact with the horses, clients must experiment with different ways in which to connect. the theoretical framework of the eagala-model is grounded in the use of selfdistancing through metaphor as the foundation for a solution-oriented approach. in the arena, the clients often find it easier to talk about what is happening with the horses in the moment than talking about their issues rather than reflectively and after the fact. the treatment team assumes that each client has solutions to their challenges and are capable of reaching their goals if given the opportunity to discover them. “we do not offer solutions, nor do we instruct the clients in how to interact with horses. we encourage them to develop their own methods, their own interpretations, and their own form of problem solving. this in turn enables them to take these new skills and apply them in the real world” (thomas & lytle, 2016, p. 66). to be able to identify these solutions, eagala-model eap allows clients the opportunity to shift from a self-immersed perspective to a selfdistanced perspective through the use of metaphor in interaction with the horses. “...people who self-distance focus less on recounting their experiences and more on reconstruing them in ways that provide insight and closure” (kross & ayduk, 2011, p. 188). this happens within the context of trusting relationships with horses and humans often allowing clients the opportunity to gain some distance from their traumatic experiences before they can make meaning of them (kross & ayduk, 2011). also setting this model apart from other equine models is its code of ethics. eagala’s code of ethics creates a culture of professionalism for both mental health practitioners and equine specialists. additionally, eagala has an ethics committee, providing rigorous and global enforcement of the code of ethics (eagala, 2015). facilitating eagala-model eap buck et al./equine assisted psychotherapy 393 through a learned facilitation framework of reflective listening and observation known as spud’s™ (eagala, 2015), the treatment team is able to create a therapeutic environment for a client’s own story, perceptions, attitudes, emotions, and feelings to emerge. the spud's framework includes four criteria: shifts, patterns, unique aspects, and discrepancies …(this) methodology (is) used by the team to track the activity and responses of both horse and client, although the primary focus is on the horses and symbols. as a client session progresses, the first four spud's criteria allow the team to focus, pinpoint, and define moments of significance. the treatment team then takes these observations and reflects them back to the client in the form of question-asking, observational statements, metaphors, and invitations for clients to share their story. the four spud's, combined with these two actions observing and reflecting form the backbone of session execution. (thomas & lytle, 2016, p. 71) when people first enter the arena with the horses, they typically rely on their usual life coping skills to try to interact with or cajole the horses. if clients are unsure how to build rapport with the horse, they are often observed doing the same thing over and over again. horses mirror that behavior back to the client through patterns of behavior. when the client shifts his or her awareness internally, such as an awareness that their prior actions were not working, the horses seamlessly shift their physical position, outward behaviors, and patterns. thomas and lytle (2016) explain that shifts in an eagala session pertain to any physical or behavioral change in the horses, other symbols, or the humans. example of shifts: the horses were together, but now they are apart. they were standing still, but now they are moving. the gate was open, and then it was closed. the client was outside along the wall but is now standing in the center of the arena. every shift in session, no matter how small, correlates to movement. tracking movement is essential because movement indicates change. and change, in one form or another, is the global objective for both client and team. shift by shift, bit by bit, the client moves further from whatever state has him or her mired or stuck in place. (p. 72) unique to eap is the focus on observable horse behavior using the spud’s framework. this model of intensive observation provides structure for the treatment team to stay within the model and resist interpreting client behavior, thus, allowing the client’s own interpretations and solutions to come forth. metaphors metaphors reflecting trauma-related challenges arise frequently as clients seek to make meaning out of their experiences (mccormick & mccormick, 1997; pernicano, 2014, 2015). the interplay that occurs between the horses and clients often feels familiar. clients describe their inner experience by relating it to what is happening externally in the moment. in an example from an actual session, the treatment team observed one horse putting its teeth on another horse’s side repeatedly. the client exclaimed, “why does he keep doing that to her?” the treatment team responded, “what is he doing to her?” the client said, advances in social work, spring 2017, 18(1) 394 “he’s beating her up! can you make it stop?” the client recognized a pattern with the horses and began to place her own narrative onto the experience. the treatment team probed, “what needs to happen to make him stop?” the client directed, “they need to separate.” as the session progressed, the horse behavior shifted. the horse that had teeth on her sides and was being “beaten up” walked away from the other horse as the client approached to “separate them.” the client said, “she left him but she needs protection.” for a client with a traumatic abuse history, the concept of protection and safety are paramount to continue to explore in session with the horses. as this article expands upon later, the ability to create distance from the actual trauma through the experience with the horses allows the client to find new solutions for themselves as it relates to protection in an abusive situation. the treatment team always follows the client’s lead. the mental health professional assesses when and if the client is ready to further explore the metaphor verbally. clients sometimes respond to the treatment team’s questions about the horses with stories from their own lives using the metaphors as a bridge. sometimes clients reveal histories of abuse and trauma for the first time in eap sessions. in the above-mentioned example, the one horse was being “beaten up” by the other horse and “needs protection.” by her own description, this client’s abuse history was playing out between the horses. in the eagala model, incorporating the interaction with the horses allows the metaphors to emerge by creating distance from the actual traumatic events that have occurred and allowing space for new interpretations (thomas & lytle, 2016). as the session continued, the client asserted that she and the treatment team needed to surround the horse to protect her and keep the other horse away. no matter how much the “abusive” horse tried to push his way into the circle of people, he was kept away from her. after several minutes, he walked away to the far end of the arena and stayed there for the remainder of the session. after a long pause looking in his direction, the client shared, “he’s just like my ex-boyfriend.” engaging with horses from a “self-distanced perspective” (kross & ayduk, 2011, p. 188) allows clients to manage memories of their traumatic experiences that may emerge in sessions, while receiving a non-threatening, constant feedback system from sentient beings. “the ability to self-distance in the retelling of a negative experience or story allows storytellers to retain some form of objectivity in how they see that story.…the third person allows a different perspective, shifting the client/storyteller from ‘recounting/reliving’ to reconstructing the story in a new way – a way that provides insight" (thomas & lytle, 2016, p. 155). the goal of eagala and other trauma-informed approaches is to move from problem-saturated narratives to more hopeful, solution-oriented narratives (abels & abels, 2001). the theories informing these trauma-informed approaches include cognitive theory (beck, 2011; ledley, marx, & heimberg, 2010), constructivist theory (buckman, kinney, & reese, 2008; granvold, 2008) and neuroscience (briere & lanktree, 2013; germer, siegel, & fulton, 2013). in eap, the narratives, often in the form of metaphors, are at first constructed by the client (e.g., “he’s beating her up! can you make it stop?”). with buck et al./equine assisted psychotherapy 395 reflective listening and feedback from the treatment team in a safe and affirming environment, the client then moves to changes in cognitive processing and more hopeful constructions of the horses’ and personal experiences (e.g., “she left him but she needs protection.”). these changes are facilitated at the neurobiological level as the limbic system is calmed through the establishment of trust and safety in a unique treatment setting. even clients who experience human relationships as threatening due to prior experiences are able to engage safely with the horses and develop new healing pathways. the client can move past being “frozen” in prior trauma reactions and cognitively, neurologically, and somatically move to empowerment and hope. presence full presence is often a challenge for people who are experiencing trauma symptomatology. a “common denominator of all traumas is an alienation and disconnection from the body and a reduced capacity to be present in the here and now” (emerson & hopper, 2011, p. xi). disembodiment is a powerful coping mechanism, yet one that does not easily allow engagement in the therapeutic process. although clients can feel initially anxious about interacting with horses in an eagala session, their perspective often shifts to feeling safe in the presence of a nonjudgmental being. the horses provide honest feedback free of ego, bias, or agenda, allowing individuals to be more receptive to the exploration and acceptance of the sensation. these feelings of safety and sensation are scaffolded by the rhythms of tail swishing, ear movements, hoofbeats and expressive exhales. once clients can experience safety and explore their metaphors and symbols with the horses, they are better equipped to process their emotions and make meaning out of their experiences in an emotionally safe manner (kross & ayduk, 2011). meeting standards although eap does not yet meet the gold standard for an evidence-based practice, it meets the samsha key principles for a trauma-informed approach. being a relatively new field, outcome studies were not published until 2008, thus only one meta-analysis has been conducted to date (wilkie et al., 2016). the emerging nature of this field has also limited the amount of targeted funding available to researchers often needed to conduct randomized-controlled trials. the vast majority of public and private funding on animalassisted interactions has gone to studies including canines. early indications, however, are that eap holds promise for work with at-risk populations (wilkie et al., 2016). additional, rigorously-designed studies are needed to further explore the potential of eap. the eagala model of eap meets the six key principles of a trauma-informed approach (samhsa, 2014). the key principles, as mentioned previously include: 1) safety, 2) trustworthiness and transparency, 3) peer support, 4) collaboration and mutuality, 5) empowerment, voice, and choice, and 6) cultural, historical, and gender issues. eagala’s code of ethics (eagala, 2015) directly links to these key principles. safety is paramount. trustworthiness and transparency are critical aspects of the eagala model. peer support can include either working with those with lived experience or in regard to children and adolescents, non-offending parents or caregivers who can give validation and voice to the children’s experiences. in eagala, one can work in groups advances in social work, spring 2017, 18(1) 396 of those with lived experiences or in the case of individual work, one can argue that the horses provide peer support, collaboration and mutuality affirmation in the most basic and pure ways. the eagala model is clearly client-directed, promoting empowerment, voice, and choice. finally, the eagala code of ethics promotes practice that is sensitive to cultural, historical and gender issues. “the ethics code is based on the fundamental values of overall safety and well-being of clients, foremost above all other considerations...it is our quest to build the emerging field of equine assisted psychotherapy as a valid, professional, safe, and respected instrument for growth and learning” (eagala, 2015, p. 20). further supporting the claim that eap is well-suited to trauma work is its synchronicity with peter levine’s work. levine (2010), a leading trauma therapist, developed steps that can help a person move from alienation and disconnection from their body to healing through somatic experiencing. these include establishing an environment of relative safety, supporting initial exploration and acceptance of sensation, and establishing pendulation and containment the innate power of rhythm. eap provides each of these. samhsa has been leading the way in promoting trauma-informed care in the u.s., acknowledging that both recovery and resilience are key outcomes for in both individual and family work. the eagala®-model of eap promotes these same tenets through its code of ethics, requiring clinicians to utilize empowering methods that provide voice and choice to those who have had none. limitations one clear limitation of eap is accessibility in terms of both location and cost. horses tend to live in barns and on land that can be inaccessible to public transportation, often requiring clients to have private transportation. this can be a significant barrier to access for clients in urban areas. further, the cost of maintaining a herd of horses and compensating two members of the treatment team is not insignificant. while some mental health professionals do accept insurance, the reimbursement rate is typically not enough to cover the entire session. some organizations, such as gateway horseworks of malvern, pennsylvania, have worked to reduce this barrier by operating as a non-profit and securing grants from local and national organizations (gateway horseworks, 2017). social workers are encouraged to learn more about eap by connecting with local treatment teams including equine specialists and behavioral health professionals, receiving training and attending demonstrations. eagala-certified mental health professionals and equine specialists are often willing to meet with behavioral health professionals and discuss their work. the evidence base for eap is limited due to both historical and practical reasons. social workers also need to support the building of an evidence base by engaging in research, serving as liaisons between university research teams and eagala teams, and referring research participants to ongoing studies. specifically, there is a strong need for randomized controlled trials that can isolate both the active elements of the treatment and shed light on the mechanisms of change. these studies then need to be replicated with varied populations with varied presenting issues. animal-assisted therapy, with horses or buck et al./equine assisted psychotherapy 397 other animals, is not for everyone, nor is it for every condition. more research is needed to identify those populations and those conditions for which it is most effective. next steps as the primary providers of mental and behavioral health services in the united states, social workers are keenly aware of the need for a portfolio of treatment methods to manage the increasing demand for services. vulnerable clients who have experienced trauma deserve to have an array of treatment options available in addition to or instead of traditional talk therapies. talk therapies are simply not efficacious for many who are struggling with the impact of trauma, who are alienated and disconnected from their bodies and unable to verbally process a myriad of sensations (levine, 2010). as kazdin and blaze (2011) suggest, “interventions that vary widely in their reach, focus, costs, effects, and other dimensions are crucial” (p. 33), including experiential and expressive therapies such as eap. the ethical call to meet the needs of vulnerable populations is loud. social workers are poised to take a lead role in promoting a robust, accessible and inclusive approach to the delivery of mental and behavioral health care services. with a core mission of enhancing human well-being and meeting the basic human needs of all people, the role of promoting the use of and research on interventions such as eap is a natural fit. the eagala model of eap is a particularly good fit with social work. perhaps most important is the core belief that people have the inherent capacity to recover and be resilient; they already have solutions to the challenges they face and can access them when provided the appropriate space to do so. this is evidenced by the way in which eagala supports client-directed work. another key congruence between social work and eagala is the way in which the treatment team allows individuals to be the experts in the arena, explicitly resisting a controlling role. eagala also challenges the assumptions of talk therapy by privileging the power of nonverbal and nonhuman communication. this explicit shift in power dynamics supports social work’s anti-oppressive and empowerment approach, allowing subjugated knowledge to emerge in treatment (dominelli, 2002; hartman, 1992). the american counseling association (2016) has already adopted practice competencies for animal assisted therapies. it is time for social work to join this movement and specifically consider the ways in which eagala might be an appropriate treatment for some clients. references 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(2008). therapeutic value of equine-human bonding in recovery from trauma. anthrozoos, 21(1), 17-30. doi: https://doi.org/10.2752/089279308x274038 zucker, m., spinazzola, j., pollack, a. a., pepe, l., & barry, s. (2010). getting teachers in on the act: evaluation of a theaterand classroom-based youth violence prevention program. journal of school violence, 9, 117-135. doi: https://doi.org/10.1080/15388220903479628 author note: address correspondence to: dr. page walker buck, lsw, associate professor, department of graduate social work, west chester university, west chester, pa, 19383. 610-430-4171, pbuck@wcupa.edu. https://doi.org/10.4088/jcp.13m08561 http://dx.doi.org/10.1037/str0000040 https://doi.org/10.1080/08927936.2016.1189747 https://doi.org/10.2752/089279308x274038 https://doi.org/10.1080/15388220903479628 mailto:pbuck@wcupa.edu microsoft word 12. montero_16139-attitudes toward same-gender adoption copyedit final ______________  darrel montero, ph.d., was an associate professor in the school of social work at arizona state university in phoenix. the author wished to thank the following organizations for their generosity in allowing the use of their survey data: ipsos global @dvisor conducted between and on behalf of reuters news via the ipsos online panel system (ipsos/reuters). copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 444-459   attitudes toward same-gender adoption and parenting: an analysis of surveys from 16 countries darrel montero abstract: globally, little progress has been made toward the legalization of same-gender adoption. of the nearly 200 united nations members, only 15 countries with populations of 3 million or more have approved lgbt adoption without restrictions. the objectives of this paper are, first, to provide a brief background of the obstacles confronting samegender adoption including the role of adoption agencies and parenting issues; second, to discuss the current legal status of the 15 countries which have approved same-gender adoption without restrictions; third, to report on recent public opinion regarding the legalization of same-gender adoption and parenting, drawing from previously published surveys conducted in 16 countries; and, fourth, to explore the implications for social work practice including social advocacy and social policy implementation. keywords: same-gender adoption, same-sex adoption, gay adoption, same-gender parenting to date, few papers have addressed the issue of same-gender adoption globally. as of 2013, only 15 major industrialized countries have approved same-gender adoption without restrictions. for the purpose of this paper, the term “without restrictions” refers to nations which allow joint adoption by same-gender couples, step-parent adoption (of their same-gender partner’s biological child), and adoption by a single gay or lesbian individual. although canada was the first country to approve same-gender adoption in 1999, the vast majority have only recently approved full legal adoption rights. the objectives of this paper are, first, to provide a brief background of the obstacles confronting same-gender adoption including the role of adoption agencies and parenting issues; second, to discuss the current legal status of the 15 countries which have approved same-gender adoption without restrictions; third, to report on recent public opinion regarding the legalization of same-gender adoption and parenting, drawing from previously published surveys conducted in 16 countries; and, fourth, to explore the implications for social work practice including social advocacy and social policy implementation. it was not until 2011 that the united nations human rights council passed its first resolution recognizing lesbian, gay, bisexual, and transgender (lgbt) rights, urging all countries to enact laws protecting basic lgbt civil liberties (dougherty, 2011). laws affecting lgbt people vary greatly from country to country, ranging from full legal recognition of marriage, adoption, employment, and full civil liberties to the criminalization of consensual same-gender relationships in 76 countries (council for global equality, 2011; united nations human rights, 2013). montero/attitudes toward same-gender adoption 445 historically, the first country to approve same-gender adoption without restrictions was canada in 1999. this was followed by the netherlands (2001), south africa (2002), and sweden (2002). most recently, on may 18, 2013, the french government approved same-gender marriage and adoption, despite france’s long religious tradition of opposition to this policy. the legislation is cited as the country’s most extensive social amendment since bringing an end to the death penalty in 1981 (cody, 2013). a wide range of international landmark legislation has marked a turning point for gay and lesbian couples who wish to adopt. namely, in england and wales, the adoption and children act of 2002 allowed for gay and lesbian couples wishing to adopt children (brodzinsky, 2005). however, it was not until 2005 that this act came into full effect and permitted same-gender couples the right to adopt children (logan & sellick, 2007). in 2007, the equality act (sexual orientation) regulations further mandated that lesbian and gay couples cannot be discriminated against by adoption agencies (samuel, 2010). agency constraints and successes in policy implementation although public and faith-based adoption agencies are required by law to comply with same-gender adoption statutes, there are numerous documented cases where agencies have chosen to disregard these laws. in the united states, where same-gender adoption is legal in some states, there have been cases of faith-based adoption agencies in boston, denver, the district of columbia, and rockford, illinois which decided to close their doors rather than be forced to comply with same-gender adoption laws (“catholic adoption,” 2011; filteau, 2006; kyle, 2013; “same-sex,” 2010). institutionalized bias against the lgbt community still can influence judges, legislators, casework experts, and individuals involved in the adoption process (brodzinsky, 2003). in england, some adoption agencies have witnessed targeted prejudice towards lgbt adoption, where adoption specialists were giving priority to heterosexual adoptive parents over homosexual parents (doughty, 2011; english, 2012; seal, 2009). seal (2009) reported data regarding gay men who had adopted children, and found that some adoption workers gave preferential treatment to wealthy married heterosexual couples over single gay men. as a result of england’s 2007 sexual orientation regulations, although some faithbased adoption agencies have stopped discriminating practices, others have ended their association with the church (doughty, 2011). britain’s catholic adoption society reported that they would close their doors if they were required to place orphans with same-gender couples (“catholic,” 2010). moreover, the muslim council of britain also sided with the catholic church and its adoption agencies (“muslims,” 2012). because of some of these selective practices, in england and wales, the national minimum standards for local authority adoption services have established guidelines that require reasonable practices within british adoption agencies. these guidelines provide that adoptive parents are to be treated fairly, with respect, and without prejudice (department of education, 2011). advances in social work, fall 2014, 15(2) 446 in 2008, the european court of human rights ruled that same-gender couples can adopt. their ruling prohibited the exclusion of gay individuals or couples from applying for adoption. the court concluded that the best interest of the child is of utmost importance, adding that prejudice based on sexual orientation should not stand in the way of care and love (“europe,” 2008). in 2013, a same-gender couple from austria sought to adopt a partner’s biological son. the jury believed the couple and child were a family, citing that same-gender parents are no more harmful to children than heterosexual parents. leaders of both amnesty international and the international lesbian, gay, bisexual, transgender, and intersex association stated that they hoped the judgment furthered equality for european families (cassell, 2013). in february 2013, puerto rico’s supreme court upheld a law prohibiting samegender couples from adopting. also in february, the federal constitutional court of germany ruled that same-gender couples in a civil union can legally adopt their partner’s non-biological child/ren. in may, portugal’s parliament voted to approve a law allowing same-gender couples to adopt their partners’ children. as well, in october the northern ireland high court maintained that a law allowing adoption only by heterosexual married couples or single individuals is illegal, regardless of their sexual orientation (franklin, 2013). however, opposition of same-gender rights and adoption is still prevalent, and it remains quite difficult for same-gender couples to pursue adoption globally. prejudice against lgbt people is rampant in many countries with large orphan populations. as such, overt policies and/or implied social attitudes exist against same-gender adoption. even the most forward-thinking adoption agencies are cautious about representing samegender adopters due to the challenges of working with anti-gay policies and laws (levine, 2013). recently, perhaps the strongest anti-gay response has been by vladimir putin. in 2012, the russian lower house of parliament prohibited the adoption of orphans by samegender couples from countries where same-gender marriage is legal (franklin, 2013). in addition, in 2013, putin’s anti-lgbt campaign continued by levying a $3,000 fine against any russian citizen who advocates for lgbt rights (gessen, 2013). unicef estimates that there are approximately 740,000 russian children in need of adoption, while only about 18,000 russian parents are seeking to adopt (heintz, 2012). same-gender parenting a serious roadblock facing same-gender couples seeking to adopt is the issue posed by some critics as to whether lgbt parents can offer the same quality of parenting as heterosexual parents (erich, leung, & kindle, 2005; erich, leung, kindle, & carter, 2005). however, there is substantial evidence that underscores the merits of and successes found in lgbt parenting. after reviewing the scientific literature, three major professional associations—the american psychological association ([apa], 2010), australian psychological society ([aps], short, riggs, perlesz, brown, & kane, 2007), and canadian psychological association ([cpa], 2006)—came to the conclusion that the montero/attitudes toward same-gender adoption 447 well-being of children with same-gender parents does not vary from that of children with heterosexual parents. the cpa (2006) based their position on a review of over 100 empirical studies. an analysis of this research suggests no consistent differences between the mental health and social personality of children raised by same-gender or heterosexual parents (“brief,” 2005). the australian psychological society (short et al., 2007) indicated that their research showed that same-gender parenting and their children’s outcomes are likely to be at least as favorable as those in families of heterosexual parents. numerous studies conducted from 1995 through 2013 underscore the conclusions reported by the apa, aps, and cpa (anderssen, amlie, & ytteroy, 2002; biblarz & savci, 2010; bos, gartrell, & van gelderen, 2013; bos, gartrell, peyser, & van balen, 2008; bos, gartrell, roeleveld, & ledoux, 2013; chan, raboy, & patterson, 1998; cianciaruso, 2013; flaks, ficher, masterpasqua, & joseph, 1995; goldberg & smith, 2013; golombok et al., 2003; golombok et al., 2013; patterson, 2008; perrin, 2013; tasker & golombok, 1995; veldorale-brogan, 2012; wainwright, russell, & patterson, 2004). similar policy statements have been advanced by an additional 14 professional groups regarding the viability of gay/lesbian adoption and parenthood. these professional associations include the american academy of child and adolescent psychiatry, american academy of family physicians, american academy of pediatrics, the american association for marriage and family therapy, american bar association, american medical association, the american psychiatric association, the american psychoanalytic association, the american sociological association, the child welfare league of america, the national adoption center, the national association of social workers, the north american council on adoptable children, and voice for adoption. methods the findings of this study are based on previously published opinion polls from ipsos global @dvisor (2013) conducted between and on behalf of reuters news via the ipsos online panel system in the following countries: argentina, australia, belgium, canada, france, germany, great britain, hungary, italy, japan, norway, poland, south korea, spain, sweden and the united states of america. an international sample of 12,484 adults aged 18-64 in the u.s. and canada (and aged 16-64 in all other countries) were interviewed. the ipsos global @dvisor (2013) conducts attitudinal surveys internationally on a regular basis. the purpose of the present study is to report a subset of the data this organization collected in its 2013 survey. numerous questions were asked by the organization on same-gender issues; however, these were not relevant to this article’s specific focus on same-gender adoption. within this context, i report the survey methodology below used by the ipsos global @dvisor. approximately 1,000 individuals participated on a country-by-country basis, except in argentina, hungary, norway, poland, south korea and sweden where each nation had a sample of approximately 500 respondents. weighting was then used to balance demographics and make certain that the sample reflected that of the adult population advances in social work, fall 2014, 15(2) 448 according to the most recent country census data and to present results intended to estimate the sample universe. the accuracy of ipsos polls is calculated by using a confidence interval (1,000 is accurate to +/3.5 percentage points, while a poll of 500 is accurate to +/5.0 percentage points in their respective general populations). all sample surveys and polls may be subject to other sources of error, including but not limited to coverage error and measurement error. additional information and parameters on confidence intervals and research methodology can be found on the ipsos public affairs (2013) website. limitations numerous scholars have reported the limits of survey research methodology (creswell, 2013; groves et al., 2013). as with all sample surveys, standard errors may include but are not limited to sampling errors, interviewer bias, nonresponse rate, social desirability response bias, types of survey questions (open-ended vs. closed-ended), and inter-rater reliability. the results may be impacted by the use of various terms to describe same-gender adoption (gay adoption, same-sex adoption, lgbt adoption, etc.). also, as is typical of survey data, results can vary by a country’s political climate, a newsworthy event, or a declaration from a major political or religious figure on same-gender adoption. in examining the question in table 2 (“do you think same-sex couples should have the same rights to adopt children as heterosexual couples do?”), perhaps if the question was worded using the term “same-gender couples,” “gay couples,” or “gay individual” instead of “same-sex couples,” it may have produced different responses. similarly, in table 3, the question reads: “do you think same-sex couples are just as likely as other parents to successfully raise children?” if the second survey used the phrase “effectively raised children,” it again may have produced different responses than what were reported here. finally, in both surveys, there could be potential ambiguity or loss of uniformity due to the questions being asked in different languages. thus, “same-gender couple” may not translate into a “gay or lesbian couple” as in the english language. despite these limitations, it is important for researchers to make an effort to report disparate global surveys and determine where the citizens of these 16 countries stand on their support or lack of support for the legalization of same-gender adoption and their views on parenting. results countries that have approved same-gender adoption with no restrictions as of november 2013, 15 countries have approved same-gender adoption without restrictions (see table 1). countries without restrictions refer to nations that allow joint adoption by same-gender couples, step-parent adoption, and adoption by a single gay or lesbian individual. canada was the pioneer country approving same-gender adoption in 1999, followed by the netherlands in 2001 and south africa and sweden in 2002. most recently, france approved same-gender adoption without restrictions in 2013. of the 15 countries that have approved same-gender adoption without restrictions, two thirds of these nations are located in western europe. the remaining five countries are found in montero/attitudes toward same-gender adoption 449 south america (argentina, brazil, and uruguay), north america (canada), and africa (south africa). table 1. countries that have approved same-gender adoption with no restrictions country legalized population (approximate in millions) argentina 2010 41 m belgium 2006 11 m brazil 2010 198 m canada 1999 34 m denmark 2010 6 m england 2005 53 m france 2013 66 m netherlands 2001 17 m norway 2009 5 m scotland 2009 5.5 m south africa 2002 51 m spain 2005 47 m sweden 2002 10 m uruguay 2009 3.5 m wales 2005 3 m sources: begley, 2013; “ultimate gay adoption guide,” 2013. note: upon initially focusing on the topic of same-gender adoption globally, the author was immediately confronted with the need to make the conceptual decision of how to organize the nearly 60 countries and jurisdictions that have approved some form of same-gender adoption. therefore, a decision was made to include countries based on three criteria that were met in 2013: (a) countries that have approved same-gender adoption with no restrictions—that is, nations which allow joint adoption by same-gender couples, stepparent adoption, and adoption by a single gay or lesbian individual; (b) countries with populations of 3 million or greater; and (c) countries in which every state, province, or territory approves same-gender adoption without restrictions. following the above criteria, although andorra and iceland met the no restrictions criterion, they did not meet the population threshold. in addition, although australia, mexico, and the united states met the population threshold, these countries were excluded because not every state and/or territory has approved same-gender adoption without restrictions. note: only countries with populations of 3 million or greater are included in this table since many countries with populations below 3 million are often geographically quite small and consequently unknown to many readers. for example, french guiana is 32,253 square miles with a population of approximately 250,000, while malta is 122 square miles and has a population of approximately 418,000. attitudes toward same-gender couples’ right to adopt children ipsos global @dvisor (2013) conducted an attitudinal study in 16 nations and asked a cross section of respondents the following question: “do you think same-sex couples should have the same rights to adopt children as heterosexual couples do?” table 2 advances in social work, fall 2014, 15(2) 450 reports a breakdown of the responses for each country from greatest to least support for same-gender adoption. column 3 reports “total agree,” which is the combined responses of columns 1 and 2, “somewhat agree” and “strongly agree,” respectively. table 2. attitudes toward same-gender couples’ right to adopt children, 2013 somewhat agree strongly agree total agree sweden 22% 56% 78% spain 20% 52% 73% germany 33% 37% 71% canada 25% 45% 70% australia 30% 37% 67% belgium 26% 41% 67% norway 26% 41% 67% great britain 31% 34% 65% united states 26% 38% 64% japan 45% 15% 59% france 22% 31% 53% argentina 19% 33% 52% south korea 35% 11% 46% hungary 24% 18% 42% italy 22% 19% 42% poland 14% 13% 27% question: “do you think same-sex couples should have the same rights to adopt children as heterosexual couples do?” note: columns 1 and 2 may not total column 3 because of rounding. source: ipsos global @dvisor (2013). of the 16 nations surveyed, 12 countries reported that a majority of the respondents interviewed agreed that same-gender couples should have the right to adopt. canada, germany, spain, and sweden report the greatest support, with more than 7 in 10 of their citizens supporting adoption. the four countries that fell below a majority ranged from 27% (poland), with the remaining three countries of italy, hungary, and south korea at approximately 40%. it is interesting to note that two counties in particular reported large differences between “strongly agree” and “somewhat agree” response categories. in japan, for example, 59% reported “total agree,” yet only 15% “strongly agreed” on the proposition of same-gender adoption. similar findings were reported for south korea, where a near majority (46%) answered “total agree,” while only 11% reported “strongly agree.” montero/attitudes toward same-gender adoption 451 attitudes toward same-gender couples to successfully raise children in 2013, ipsos global @dvisor also surveyed the same 16 countries and asked a cross section of respondents the following question: “do you think same-sex couples are just as likely as other parents to successfully raise children?” table 3 reports a breakdown of the responses for each country from greatest to least support that same-gender parents can successfully raise children. just as in table 2, column 3 reports “total agree,” which is the combined responses of columns 1 and 2, “somewhat agree” and “strongly agree,” respectively. table 3. attitudes toward same-gender couples to successfully raise children, 2013 somewhat agree strongly agree total agree sweden 24% 57% 81% norway 25% 55% 79% canada 28% 48% 76% germany 32% 42% 74% spain 24% 49% 73% australia 30% 42% 72% great britain 35% 37% 72% belgium 28% 42% 70% united states 26% 39% 66% france 25% 39% 63% japan 46% 15% 62% argentina 24% 34% 59% italy 26% 24% 49% hungary 29% 17% 46% south korea 36% 6% 42% poland 22% 15% 36% question: “do you think same-sex couples are just as likely as other parents to successfully raise children?” note: columns 1 and 2 may not total column 3 because of rounding. source: ipsos global @dvisor (2013). overall, for 12 of the 16 countries surveyed, a majority (51%+) supported the successful raising of children by same-gender parents. in fact, for 8 of the 16 nations, support for same-gender couples’ ability to successfully parent reached 70% or greater. swedes offered the greatest support on this issue, where more than 8 in 10 agree that same-gender couples can successfully raise children. of the four countries where a majority did not support parenting by same-gender couples, the same four countries—italy, hungary, south korea, and poland—also did not support the right to adopt by same-gender couples at a majority or higher level. japan and advances in social work, fall 2014, 15(2) 452 south korea stood out, given that in both cases a very small percentage reported “strongly agree” when asked about the ability of successfully raising children by samegender couples. finally, polish respondents reported the lowest support on this issue (slightly more than 1 in 3). discussion of the nearly 200 members of the united nations, only 15 countries have legalized same-gender adoption with no restrictions. an important pattern emerges among these countries: two-thirds of these nations are located in western europe. for decades, scholars have documented the origins and traditions of liberalism in this part of the world (de ruggiero, 1977; hlousek & kopecek, 2010; kirchner, 1999; leroux, 2011; moravcsik, 1995). their observations may, in part, explain the tolerance of these countries toward the issues faced by their lgbt citizens. in 2013, attitudinal surveys conducted in 16 nations indicate that a majority of these countries report support for same-gender adoption and recognize same-gender couples’ ability to successfully raise children. as noted earlier, regarding same-gender parenting, there is a large body of empirical studies which indicate that parenting by same-gender couples is equally successful when compared with heterosexual child-rearing. given the findings that public opinion impacts social policy formation (burstein, 2003; kenworthy, 2009; silver, 2013), we may anticipate more countries approving same-gender adoption in the future. social work practice even though numerous countries have prohibited discrimination against same-gender adoption, traditional attitudes and perhaps prejudice may still remain. therefore, it is important for social workers to make their clients aware of international adoption laws which allow for placements based on cultural values as well as what is in the best interest of the child (“adoption,” 2013). the results from these public opinion surveys may be useful for social workers who seek to advance social justice for their same-gender clients seeking to adopt (national association of social workers, 2012). globally, social workers who provide services to same-gender couples work in one of four distinct types of regions: group 1 includes those 76 countries where consensual same-gender relationships are criminalized; group 2 includes countries where homosexuality is not criminalized, yet full equal rights for members of the lgbt community are not granted; group 3 countries and jurisdictions (dependencies, municipalities, and territories) have legalized same-gender adoption with restrictions; and group 4 countries have legalized same-gender adoption without restrictions. we discuss the role for social workers practicing in each of these four environments. first, social workers who work with lgbt clients in group 1 countries where homosexuality is criminalized have the most challenging role when working with clients whose sexual preference is considered a crime. for instance, uganda, sierra leone, and senegal have declared homosexual acts illegal and anyone caught can be punished with montero/attitudes toward same-gender adoption 453 long jail sentences (“amnesty international,” 2013). consequently, these social workers may themselves encounter personal harm working with a member of the lgbt community. within this context, they may need the support of organizations such as amnesty international and united nations human rights council, as well as the larger global social work community, in seeking to reverse the criminalization of homosexuality. as a priority, these social workers need to work to decriminalize homosexuality before they can advocate for the possibility of marriage equality. group 2 countries include those where consensual same-gender relationships are not criminalized, yet basic civil rights have not been granted. social workers will need to advocate for their clients’ rights in terms of civil unions, adoption, and employment. group 3 includes countries and jurisdictions that have endorsed some form of legal same-gender adoption but with restrictions. in this context, social workers have important roles in both direct practice and macro practice. first, in direct practice, social workers will work with clients who seek full equality adoption rights currently enjoyed by their counterparts in only 15 countries. a critical role for social workers at the macro level will be to engage in social action and policy implementation to bring about the legalization of same-gender adoption. a number of scholars have stressed the importance of social workers being apprised of restrictions and exceptions that may be faced by their lgbt clients that are idiosyncratic to their country (davis, 2013; moore & brainer, 2013). therefore, it is useful for social workers to be fully informed about gay and lesbian adoption policies in the country in which they practice, since policies may vary widely. social workers advocating for their lgbt clients may encounter important hurdles. for example, male parents versus female parents may encounter more resistance to adoption in some context. this may be further compounded by demographics including ethnicity, religion, and socioeconomic status. all these factors can play a central role as to how social workers will deliver services. group 4 countries have legalized same-gender adoption without any restrictions. it is critical that social workers remain ever vigilant on two fronts: first, monitoring adoption agencies that seek to give preferential treatment to heterosexual couples in the adoption process, and second, countering the ongoing efforts in several countries to reverse the legalization of same-gender adoption. it is imperative that social workers remain organized and vocal in their opposition to attempts to reverse these hard-fought adoption rights. social workers should continue to inform themselves about same-gender adoption, since little research exists in this field. social workers should also educate their samegender clients about their rights to adopt, and introduce them to other clients who have previously gone through this challenging process. summary it has taken over half a century for the united nations human rights council to pass its first ever resolution protecting the rights of lesbians, gays, bisexuals, and transgender persons. this resolution seeks to protect the equal rights for all, regardless of sexual orientation. even with these modest inroads, russia, a powerful nation, has approved a $3,000 fine for any russian citizen advocating for homosexual rights, as noted advances in social work, fall 2014, 15(2) 454 previously. in addition, russia has halted all adoptions to countries which allow samegender adoption. this is particularly significant since according to unicef, nearly 750,000 russian children await adoption while only 18,000 russian citizens express interest in adopting. given their training and expertise, social workers are in a unique position to advance the basic rights of the lgbt community worldwide. references adoption and same-sex couples: types of adoption. 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(2004). psychosocial adjustment, school outcomes, and romantic relationships of adolescents with same-sex parents. child development, 75, 1886-1898. montero/attitudes toward same-gender adoption 459 author note darrel montero, ph.d., was associate professor and director, office of latino projects, school of social work, arizona state university. sadly, he passed away on september 17, 2014 after this article was accepted. address correspondence to his daughter, laura montero, 2781 w. macarthur blvd. #b104, santa ana, ca 92704. microsoft word 18. call et al_3502_leadership in sw education copyedit_final ______________  christine r. call, ph.d., is an associate professor in the msw program at the university of st. francis in joliet, il; larry w. owens, ed.d., is an assistant professor in the department of social work at western kentucky university in bowling green, ky; and neil j. vincent, ph.d., is an associate professor in the msw program at depaul university in chicago. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 594-612 leadership in social work education: sustaining collaboration and mission christine r. call larry w. owens neil j. vincent abstract: little research is available depicting how faculty members experience the leadership style of their academic leaders. this paper reports results from a qualitative analysis of responses of 233 social work faculty members from cswe accredited programs to an open-ended question about how they experience the leadership style of their current academic unit heads. the analysis incorporates feminist and professional social work perspectives. keywords: academic leadership, collaborative leadership, social work faculty, social work leadership, social work leadership standards the mission of the council on social work education (cswe) highlights the importance of preparing “competent social work professionals” through the development of policy and standards and “national leadership” (council on social work education, 2011). as the sole accrediting body for social work programs in the united states, cswe is responsible for defining what represents “competent preparation” of social work professionals and for ensuring program compliance with its standards. competent leadership at all levels of social work education is necessary to accomplish cswe’s mission. notably, cswe implemented a leadership institute in 2008 to foster education, training, and mentoring of social work leaders and to develop standards for educating competent social work leaders. across the social service sector, organizations such as the leader-to-leader institute recognize the importance of enhancing the leadership of social service organizations to better meet the needs of the communities served. although the importance of competent leadership is widely acknowledged, little research has been conducted to investigate leadership practices in social work education. the cswe has developed few guidelines to specify training requirements and leadership competencies. anecdotal information from colleagues both in and outside the academy prompted the authors to investigate how social work faculty judge the effectiveness of the leadership in their departments not only to further our understanding of faculty’s experiences but also with the intention of providing information that could help cswe set more specific standards for social work leadership practices in the academy. literature review the role of the academic leader is varied and complex (filan & seagren, 2003). yet, academic leaders often lack preparation and training for the role (cassie, sowers, & rowe, 2006; filan, 1999; filan & seagren, 2003; ginsburg, 2008; gmelch, 2004; hecht, advances in social work, fall 2013, 14(2) 595 2004). as hecht (2004) observed, “becoming an effective department chair is largely a process of self-education” (p. 28). faculty members often assume academic leadership roles lacking not only pertinent training but also a recognition that the pedagogical skills of successful faculty members do not necessarily predict success in a leadership capacity. gmelch (2004) noted that only about 3% of colleges and universities offer formal training and mentorship programs for new academic deans, chairs, and directors, although the leadership role in the academy is exceptionally challenging given the shared governance structure of the academic setting (cassie et al., 2006). in a study of academic leadership across departments, knight and holen (1985) surveyed faculty to examine the relationship between effective department leadership practices and the leader’s strength in initiating structure and consideration using halpin and winer’s leader behavior description questionnaire (lbdq) (halpin, 1966). initiating structure refers to “the leader’s behavior in delineating the relationship between himself [sic] and members of the workgroup, and in endeavoring to establish welldefined patterns of organization, channels of communication, and methods of procedure” (halpin, 1966, p. 86). consideration is defined as “behavior indicative of friendships, mutual trust, respect, and warmth in the relationship between the leader and the members of his [sic)] staff” (halpin, 1966, p. 86). the survey revealed faculty judge the most effective academic leaders to be strong in both initiating structure and faculty consideration. filan and seagren (2003) advocated adopting a transformational leadership approach within postsecondary academic settings. transformational leaders focus on “changing the organizational culture…engage the full person … [and] become a source of inspiration to faculty, staff, administrators, and students” (p. 26). they outlined six essential facets of effective academic leadership training: understanding self, understanding transformational leadership, building relationships, leading teams, strategic planning, and networking. in a different vein buller (2007) warned against the common false dichotomy that academic leaders represent the interests of either upper administration or the faculty. effective deans, chairs, and directors recognize the common feature of the academic leader’s role as middle management oriented (filan, 1999). several studies examined the role of social work academic leaders from the leaders’ perspective. rank and hutchison’s (2000) random sample survey of 150 social work leaders, 75 deans and directors from 460 cswe-accredited social work programs, and a like number of executive directors and presidents from 56 nasw chapters identified five essential leadership skills for the social work profession: proaction, values and ethics, empowerment, vision, and communication. these concepts comprise both task-focused and process-oriented leadership skills. house, fowler, thornton, and francis (2007) surveyed african american deans and directors of schools of social work to glean the quality of their experience as social work education leaders. most of the respondents reported sufficient to very sufficient levels of job satisfaction. furthermore, they identified the factors most relevant to successful academic leadership as administrative and organizational skills, openness to diverse opinions, and personal characteristics such as listening skills, respect for others, and call, owens, vincent/leadership in social work education 596 strong emotional intelligence. finally, the survey participants posited that professional mentoring, a strong educational background, community involvement, a variety of coping mechanisms, and an altruistic orientation as the qualities and resources they desired in future academic leaders. these findings are particularly relevant insofar as the social work profession continues to promote and support diversity among the social work leadership cadre. in the academic setting overall, the relative paucity of leadership preparation within the social work field significantly contrasts with the corresponding emphasis it enjoys in other disciplines, most notably business, that vigorously promote leadership training. brilliant (1986) characterized this relative inattention to leadership preparation as “the missing link” within the social work profession while noting that “leadership has no prominence in the social work curriculum” (p. 327) and highlighted the need for more leadership theory and practice in social work curricula. fisher (2009) reported social work leadership training is most effective when it is theory-based and emphasizes the development of leadership models in social work curricula. holosko’s (2009) content analysis of the professional literature identified five core attributes of social work leaders: vision, influencing others to act, team work/ collaboration, problem-solving capacity, and creating positive change. grant and crutchfield (2008) noted that a common feature of high-impact social sector organizations is shared leadership. they further observed that the leaders of these organizations are particularly adept at building coalitions and partnerships both within the organization and with strategic external partners. mary (2005) surveyed social workers regarding which style of leadership – transformational, transactional, or laissez-faire – they perceived as most effective. the results indicated that transformational leadership, with its focus on the “development of the fullest potential of individuals and their motivation toward the greater good” (p. 108), was seen by social workers as the style most strongly linked to positive leadership outcomes. in response to the perceived lack of emphasis on leadership development and training within the academy and profession, the council on social work education (cswe) prioritized leadership development of academic deans, chairs, and directors (fischer, 2009; holosko, 2009) and subsequently implemented the leadership institute in social work education (liswe) at its 2009 annual program meeting. in addition, cswe provides scholarships enabling emerging leaders in social work education to attend harvard’s management development program or institute for management and leadership in education summer institutes (cswe, 2010). moreover, since 1996 the association of baccalaureate social work directors (bpd) has stressed the importance of leadership training by offering a pre-conference workshop for new directors at its annual conference. concurrent with the above initiatives, emerging leadership theories challenge the traditional hierarchical view and practice of organizational leadership and management. feminist scholars rao and kelleher’s (2000) theory of leadership incorporates the need to transform institutions in such a manner as to promulgate cultural diversity and commitment to greater sharing of power and responsibility. consistent with nasw advances in social work, fall 2013, 14(2) 597 values, these concepts mesh with rao and kelleher's suggestion that leadership for transformation requires “being willing to take risks by questioning existing ways of working, and considering how tasks might be done differently if the primary motivation is a concern for equality and justice” (p. 76). transformational leaders are role models who articulate a vision, inspire and motivate, exhibit integrity and ethical behavior, encourage critical and creative thinking, foster collaboration, and attend to the needs and professional development of those they lead while recognizing and appreciating their contributions. transformational leadership is collaborative and empowerment oriented, hence supportive of the leadership development of followers (bass, 2008; bass & avolio, 1994; kouzes & posner, 2007). feminist relational theorists emphasize the importance of relational connections and promote the notion of “power with” as opposed to “power over” as the key to transforming relationships and, by extension, human organizations (fletcher, 1996; jordan, kaplan, miller, stiver, & surrey, 1991). lazzari, colarossi, and collins (2009) highlighted the challenges of introducing a feminist leadership perspective into a predominantly hierarchical leadership setting as they noted social workers often face “double or triple jeopardy when working in hierarchical organizations where patriarchal models of ‘power over’ dictate structures and processes and ‘power with’ is devalued and often punished” (p. 349), thus raising ethical concerns. insofar as equality, social justice, and the importance of relationship are codified concerns of social workers, it is important to understand how faculty members experience the leadership of their academic unit heads and in what ways these directors, deans, and chairs exemplify these values. research purporting to understand the specific leadership role of the faculty director in social work departments and colleges is limited. we found no prior studies that explore leadership styles of directors of social work programs from a faculty perspective. furthermore, there is little research exploring how deans, chairs, and department directors balance the task-focused and process-oriented needs of an academic department or identify ethical problems associated with various leadership styles. method this exploratory, mixed method study utilized a cross-sectional online survey of a national sample of social work faculty to explore respondents' assessments of their academic leadership. the researchers asked social work faculty to respond to both closed and open-ended questions to examine the following research question: how do social work faculty experience the leadership style of their academic unit head? more specifically the study sought to understand which qualities of academic leadership faculty perceive as ideal and which they perceive as less efficacious. this article provides a description of the research sample and reports on the qualitative analysis of survey participants' responses to an open-ended question about how they experienced the leadership practices of their current academic unit head. as social work faculty members from three universities, the researchers brought not only their own unique professional experiences with academic leaders to the study but also the like experience of other colleagues both past and present. the researchers viewed call, owens, vincent/leadership in social work education 598 and analyzed this exploratory study data primarily through a feminist lens focusing on relationship, revealing faculty experiences, and voicing a concern for ethical stances (jordan et al., 1991; olesen, 1996; patton, 2002). the researchers also analyzed the faculty responses from a professional social work perspective, incorporating the values and mission of the profession. from this perspective they examined whether the faculty members’ experiences were consistent with the professional ethics and values of the social work profession as espoused by the national association of social workers (2008) and incorporated in the accreditation standards of cswe (2012). both viewpoints are consistent with a critical worker theory (kincheloe & mclaren, 1996) that seeks to promote awareness of the faculty members’ experiences to not only satisfy research purposes but also acknowledge their perceived reality and thus support their empowerment. the researchers further sought to begin to understand the organizational context or “institutional location” (holstein & gubrium, 1996) in which faculty members operate in relationship to their academic leader. sampling social work faculty participants were selected in two phases. first, the researchers randomly selected 225 social work departments from a list of 537 accredited social work programs nation-wide. second, of the departments chosen, the researchers collected 2,337 faculty email addresses, excluding academic leaders, from departmental websites. a total of 372 faculty members volunteered to participate in the study for a 17% response rate. ninety-two emails were returned as undeliverable. survey the mixed-method survey presented 13 demographic items, 34 closed-ended items, and 3 open-ended questions exploring social work faculty’s experiences with their current academic leaders, their overall experience with former academic heads, and their sense of the qualities fundamental to efficacious social work leadership. thirty-two of the 34 closed-ended items were adapted from an unpublished instrument developed by philip w. cooke, dsw (2003) for assessing supervisor/work group leaders and two items were developed by the researchers. the results of the quantitative portion of the study and preliminary qualitative data were reported at several national social work conferences during the last several years. this article only reports on the qualitative analysis of survey participants' responses to the open-ended question: “please describe the leadership style of the current head of your social work academic unit.” data collection the national survey of social work faculty was conducted using a web-based survey development and implementation application. the researchers developed the survey online and conducted a pilot with three faculty colleagues, then revised the survey based on their feedback. initially, an introductory email was sent to briefly explain the study and inform faculty that an email formally requesting their participation would follow in two days. this survey email was sent with a link to the online document. a second email advances in social work, fall 2013, 14(2) 599 request was sent to potential faculty participants two weeks later. the survey was open for 28 days. description of the sample a majority of the study participants were white (76.4%) and female (71.4) with a mean age of 52 years. the other faculty members in the sample identified as 10% african-american, 5% latino/hispanic, 3% asian, 1.4% native american/indigenous and 2.2% identified as bi-racial or multi-racial (see tables 1 and 2). most participants had earned doctorates and taught at public universities. a slight majority of participants held the rank of either associate or assistant professor. a significant majority of faculty had accumulated nearly 15 years of academic experience and a like number of years of social work practice experience outside of academia. the participants had occupied their current positions on average approximately nine years. their current academic leaders had served in their leadership positions for about six years (see tables 2 and 3). a little over 14% of the faculty had previously served as a director or chair of their department. table 1. sample demographics: gender and race/ethnicity variable % gender female 71.4 male 28.6 race/ethnicity african american 9.5 asian 3.5 bi or multi-racial 2.5 latino/hispanic 4.5 native american/indigenous 1.2 white 76.4 other 2.3 table 2. sample demographics: age and academic background variable n mean sd % age 353 52.24 9.88 current position (years) 368 9.35 7.88 academic experience (years) 367 14.72 9.65 non-academic social work experience (years) 365 14.32 10.44 past director/chair? yes 14.3 no 83.9 chair in current position (years) 353 5.97 4.78 call, owens, vincent/leadership in social work education 600 table 3. sample demographics: academic unit variable n mean sd % total faculty per academic unit 342 18.98 13.20 chair in current position (years) 353 5.97 4.78 degrees offered 372 ph.d. 47.8 msw 81.7 bsw 71.8 type of institute 368 public 72.6 private 27.4 data analysis the responses to the open-ended question were analyzed using content analysis whereby the authors sought to delineate “core consistencies and meanings” (patton, 2002, p. 463) or themes. after each researcher independently completed a “close reading” (thomas, 2003) of faculty responses, the researchers met and discussed their initial reaction. all three researchers noted that faculty responses fell into three categories: primarily positive, primarily negative, or a mixed response. the authors next coded faculty members’ responses into one of these three categories. after completing this part of the content analysis, the researchers calculated the percentage of each response category. the authors then agreed to independently identify the leadership themes emerging from the faculty's responses concerning their experiences of their unit head’s leadership, coding each unique and distinct unit of meaning. responses considered irrelevant to the research question were not coded. the researchers reviewed the themes and coding of the responses until they came to consensus on the key themes imbedded in the faculty's responses. these responses were then categorized as either positive or negative leadership themes. the researchers then independently recoded the faculty responses using these agreed upon themes. after recoding the responses, the researchers met and shared their independent coding of each faculty's unique comments. during this process they continued to revise and refine the categories until they came to consensus. the process included identifying relevant sub-themes subsumed under major categories (thomas, 2003). results two hundred and forty-five faculty members answered an open-ended question prompting them to describe the leadership style of their academic unit head. of that number, 12 of the answers were not responsive to the question and thus were not included in the analysis, so the final number of respondents for analysis was 233. when the authors analyzed the social work faculty’s narrative responses regarding their experiences with their respective academic leaders, three primary categories emerged; namely, positive leadership qualities, negative leadership qualities, and a combination of positive and negative leadership qualities they termed mixed leadership qualities. of the advances in social work, fall 2013, 14(2) 601 233 responses to the question, 114 (48.9%) were primarily positive, 94 (40.3%) primarily negative, and 25 (10.7%) evenly distributed between the two poles. subsequent to this initial categorization, all positive and negative comments from each response were coded according to themes, positive themes first, then the negative. elements of the major themes were also identified to elucidate their meanings. six categories of positive leadership qualities and eight categories of negative leadership qualities emerged. the six categories of positive leadership qualities were: collaborative/democratic, advocate/ supporter, administrative/management skills, communication skills, integrity, and innovative/visionary. the eight categories of negative leadership qualities were characterized as: autocratic/authoritarian, unethical behavior, poor administrative skills, poor communication skills, non-supportive, poor relationship skills, not a strategic planner/lacks vision, and lacks knowledge of social work education. interestingly, though unsurprisingly, the positive and negative leadership themes often mirror each other. table 4 references the number of responses for positive and negative leadership qualities. table 4. positive and negative leadership themes: number of responses leadership theme total positive collaborative/democratic 144 advocate/supporter 138 administrative or management skills 72 positive communication skills 46 integrity 44 innovative/visionary 9 negative autocratic/authoritarian 99 unethical behavior 83 poor administrative skills 51 poor communication skills 49 non-supportive 48 poor relationship skills 15 not a strategic planner/lacks vision 12 lacks knowledge of social work education 7 positive leadership themes collaborative/democratic. of the six positive leadership themes that emerged from an analysis of the faculty responses, the quality most frequently attributed by faculty to their respective academic leader was a collaborative and/or democratic leadership style. while 144 comments were made that supported this theme, 58 specifically used the words collaborative or democratic to characterize their respective leaders’ styles. see figure 1 for a listing of positive leadership themes and descriptors. call, owens, vincent/leadership in social work education 602 figure 1. positive leadership themes and descriptors collaborative /democratic 144 advocate/supporter 138 collaborative/democratic 58 supporter 25 being open to faculty members 31 available/accessible 20 seeking faculty input demonstrating shared governance 20 12 connected with university/advocate on behalf of the department 18 seeking consensus 7 individual support/advocate 18 being collegial 7 attentive to needs 13 demonstrating inclusiveness 6 leads by example/role model/inspires 13 being transparent 3 acknowledges or promotes faculty accomplishments 10 involved in the community 8 supports students 7 advocate 3 strengths-oriented perspective 3 administrative/management skills 72 communication skills 46 competent/responsible/hardworking 19 positive, friendly, easygoing, calm 16 decisive 18 listens 8 no micro-management 8 keeps faculty informed 7 grant funding skills 6 conflict management skills 6 deals with issues 4 communication skills 5 organized 4 calm and reflective 3 meets deadlines 4 shares information 1 efficient 3 detailed oriented 3 administrator/manager 1 evaluator 1 problem-solver 1 integrity 44 innovative/visionary 9 respectful 13 innovative/supports innovation 4 diversity 7 visionary/ future perspective 3 fair 7 creative/ encourages creativity 2 honest 6 professional 5 integrity 3 social work values/ethics 3 leadership traits most frequently cited by faculty as conducive to establishing collaborative and democratic relationships with staff include being open to faculty members, seeking their input, and encouraging shared governance. less frequently noted indicators of a collaborative and democratic spirit of leadership were seeking consensus, promoting collegiality, and exhibiting transparency. one faculty member's comment succinctly articulated this theme: “open to ideas from multiple sources, supportive of faculty, listens to divergent view points, collaborative leadership style.” another person cogently encapsulated this leadership style in emphasizing how her leader “...has fostered a very cohesive and collaborative faculty environment which didn't exist prior to her advances in social work, fall 2013, 14(2) 603 taking the position.” another response focused on consensus-building activities and transparency: “i would describe the leadership style as leading by consensus. she asks questions, gathers information and opinions, suggests solutions gets consensus on them, communicates the decision then moves forward.” advocate/supporter. the theme of advocate/supporter was the next most commonly identified positive attribute faculty ascribed to their leaders with 138 comments representing this category. fifty of those surveyed specifically described their leader as a supporter, advocating in favor of either faculty or students, or both. others noted their leaders assumed the role of advocate on behalf of their department or college at their university. others recounted the ways they felt supported by their leaders in the sense that they presented as accessible, led by example, served as role models to inspire their colleagues or others, and attended to department members' needs by acknowledging and promoting faculty accomplishments, supporting the faculty and department through their involvement in both the academic and general community, or by incorporating a strengths-oriented perspective. the following comment, in particular, celebrates one leader's collegial activity that was seen to foster the development of community by focusing on faculty achievements: “an example of collegiality and development of community is starting each faculty meeting with publishing announcements of recent faculty accomplishments.” another survey participant commented in a similar vein: “he is supportive if you have a problem or issue, be it with students, colleagues, or the administration.” while another noted the director “…set an example of how he would like the rest of the faculty to be in terms of academic scholarship” and “...has been a positive advocate for issues regarding racial and sexual orientation diversity....” touching on several of the leadership virtues reported in this section, a faculty member writes: [the] director models the behavior she expects from faculty members. she is respectful, courteous, accessible, open to ideas, suggestions, and constructive criticism, and is very facultyand student-oriented in terms of being supportive to them in their respective roles (e.g., shares opportunities for professional development, including working together on manuscripts, projects, and job announcements with graduating students, etc.). she is always approachable, never seems unable to sit and listen to faculty during impromptu meetings. she maintains a calm demeanor at all times…. administrative/management skills. seventy-two respondents specified attributes of their leaders that straightforwardly categorized as strong administrative and managerial skills. others deemed their leaders competent, responsible, hardworking, or decisive; still others observed that their directors choose not to micro manage faculty. other descriptors of administrative competence faculty employed to describe their leaders included demonstrated grant funding skills, an ability to deal with issues, organized, ability to meet deadlines, detail oriented, efficient, a problem-solver, and an evaluator. one faculty member reported: “our chair thinks ahead and tries to prepare for situations and requirements (such as re-accreditation) well in advance, rather than waiting until we have to be in panic mode.” another focused on how the leader “deals with issues (students and call, owens, vincent/leadership in social work education 604 department) directly and promptly.” the following quote identifies several attributes of a leader with strong administrative and managerial skills: ‘manager.’ excellent at scheduling, good at meeting contract requirements for evaluating faculty etc…great at meeting deadlines and efficient at budgeting and securing temp faculty positions. i have no doubt all deadlines will be met, meetings will be established, and standards followed. positive communication skills. attributes subsumed under the category of positive communication skills were cited by 46 faculty, 5 of whom used the descriptor. the attribute most commonly specified was a positive, friendly, easygoing or calm demeanor while additional descriptors referred to important communication skills including: listens, keeps faculty informed, has good conflict management skills, is calm and reflective, and shares information. one faculty member noted: “she communicates clearly and frequently about department concerns...” and “...never seems unable to sit and listen to faculty....” with regard to conflict others described their leader as a “conflict manager” and “is willing to put department conflict ‘on the table’ and discuss it with faculty.” integrity. forty-four participants praised the integrity of their leaders with the majority citing respectful behavior toward others as an important attribute. others reported being fair, honest, and professional, or valuing diversity and upholding social work values and ethics as behaviors their leader exhibited. “she is respectful of different views and i always feel that i am treated as a professional and a valued member of the department.” another specifically discussed values: “is honest.... is ethical and understands boundaries.” one participant stated: “he has been a positive advocate for issues regarding racial and sexual orientation diversity.” innovative/visionary. nine comments characterized the academic head as a visionary or someone who has a future-looking perspective demonstrated through setting goals, developing resources, or holding meetings to discuss the vision of the program. other descriptors echoing this theme were “innovative”, “inspirational”, and “creative thinker.” one person observed that while their leader struggled with details “his overall vision of the program and support he provided to faculty, students and staff” was most important to him. another noted: “group meetings are held by their dean to discuss the vision of the school.” negative leadership themes autocratic/authoritarian. ninety-nine comments depicted academic leaders as autocratic and authoritarian. fifty-five of those surveyed used the words autocratic or authoritarian or informal terms such as “top-down.” other faculty language embodying this theme included “coercive”, “solicits no input” or “disregards faculty input or academic freedom”, is “secretive”, is “punitive”, “doesn’t communicate important information”, and “instills fear” and “silences faculty.” see figure 2 for a full listing of negative leadership themes and descriptors. advances in social work, fall 2013, 14(2) 605 figure 2. negative leadership themes and descriptors autocratic/authoritarian 99 unethical behavior 83 autocratic/authoritarian 55 favoritism 37 coercive 11 sexism 10 no input or disregards faculty input/academic freedom 10 unethical dishonest 9 8 doesn’t communicate important information 7 disrespectful abusive 6 4 punitive 7 not fair in distribution of work 3 secretive 6 takes credit for faculty work 3 instills fear and silences faculty 3 anti-religion 1 ageist 1 homophobic 1 poor administrative skills 51 poor communication skills 49 poor administrative skills 29 avoids conflict 9 micro-manager 7 fosters dissension/divisive 8 fear of change 3 poor skills in handling conflict 6 poor decision-making skills 3 reactionary 6 poor judgment 3 poor communication skills 5 disorganized 2 defensive 3 trouble making decisions 2 emotionally volatile 3 fear of disapproval 1 inflexible 3 lacks critical thinking skills 1 dislikes conflict/fear of conflict 3 takes sides in conflict 2 poor conflict resolution skills 1 non-supportive 48 poor relationship skills 15 uninvolved/not accessible/invisible 22 lacks accountability 5 with higher administration 9 passive aggressive 3 non-supportive 7 poor relationship skills 2 with faculty and staff – poor mentor 4 judgmental 1 not a role model 2 rude 1 laissez-faire 2 shaming 1 distant 1 not empathic 1 no recognition staff accomplishments 1 shallow 1 not a strategic planner/lacks vision 12 lacks knowledge of social work education 7 not a visionary/no vision/lacks vision 7 not a social worker 3 reactionary versus proactive 1 not an academic social worker 1 can’t see bigger picture/ 2 does not understand social work 1 little or no goals or planning 2 untenured academic 1 specific comments representing an autocratic or authoritarian style include: “pushes her agenda despite the objections of faculty – can be a bully...”, “unilateral transparency does not exist about many things...” and was “forced to resign at the end of the academic year due to autocratic leadership style.” and “very top down” and “we seem to have a theme, however, of important decisions being announced as if we all had call, owens, vincent/leadership in social work education 606 a hand in them, yet we’re all taken by surprise.” and “her way, her ideas, no input” and “he imposes his interests on the faculty.” the most disconcerting comment was: “staff are treated like servants.” unethical behavior. eighty-three faculty discussed behaviors of their leaders that would be considered unethical with nine specifically using the word “unethical.” behaviors that were specifically named to denote this quality include: “favoritism”, “sexism”, “disrespectful”, “dishonest”, “abusive”, “unfair in the distribution of work”, “takes credit for faculty’s work”, “ageist”, “anti-religious”, and “homophobic”. specific responses that exemplify this theme included: “male senior faculty favored;” “she is dishonest;” “he is also very sexist and is abusive toward women faculty and staff;” “people are afraid of him and if an individual disagrees with him, particularly in a public forum – including faculty meetings – he will later verbally berate the individual.” “cannot show vulnerability to her...otherwise, she capitalizes on it through verbally assaulting the particular faculty member.” “my unit head has made many disrespectful remarks over the past (e.g., ageist, sexist, anti-religious, anti-military”). “while repeatedly stating that we are a "family," the director utilizes a highly authoritarian style that effectively and consistently undermines…tenure-level, non-tenured faculty and enables him to repeatedly take credit for much of our administrative work....” poor administrative skills. fifty-one comments embodied the theme of poor administrative skills including 29 with a specific reference to poor administrative skills. other descriptors were: “micro-manager”, “fear of change”, “fear of disapproval”, “trouble making decisions”, “disorganized”, “poor decision-making skills”, “lacks critical thinking skills”, and “poor judgment”. comments that characterize this category include: “he has trouble making decisions because of the fear that people will disapprove of him personally.” “disorganized and erratic--does not remember important details, plans at the last minute, plans are often confusing and ineffective.” poor communication skills. of the 49 comments exemplifying this theme, five specifically cited their academic unit heads’ “poor communication skills.” other comments denoting this theme included: “fosters dissension/divisive”, “reactionary”, “defensive,” “inflexible”, or “emotionally volatile”. for example, one faculty member reported: “dislikes disagreements. plays faculty off of one another. creates a climate of tension and recrimination.” another reported their leader “fosters dissension and conflict to maintain control.” another identified how the director: “...becomes extremely defensive and angry when his decisions are challenged.” an important sub-theme that emerged as a recurring example of poor communication was 21 faculty’s portrayal of their leader's poor conflict resolution skills including: avoids conflict, poor skills in handling conflict, dislikes conflict, takes sides, and fear of conflict. examples included: “conflicts within the school are ignored by the leadership.” “instead of dealing with faculty conflicts that have been ongoing for years, he instead makes the decision to not hold departmental meetings on a regular basis.” non-supportive. forty-eight faculty members identified behaviors of their unit head they experienced as unsupportive. among these were an unwillingness to support or advocate on behalf of faculty in matters involving the higher administration of the advances in social work, fall 2013, 14(2) 607 academy, serve as a good mentor or role model, and recognize staff accomplishments. the following comments succinctly represent this set of faulty concerns: “the leader demonstrates the ability to toe the line of the university administration and not represent the best interests of the faculty” and “is not supportive of faculty in terms of their development, learning or accomplishments, especially the non tenure track faculty.” a sub-theme – namely, inaccessibility – emerged from the perception of 25 respondents who experienced their leaders as either inaccessible or uninvolved with them and, therefore, not available to be supportive. other comments included “invisible” and “laissez-faire.” “does not personally respond to e-mail or communication.” “…the door of the office is always kept closed.” “he is frequently out of town/country and has no real sense of what is happening in his own program.” poor relationship skills. while this category of “poor relationship skills” certainly overlaps with the three categories of non-supportive, poor communication skills, and unethical behavior, it seemed nonetheless important to highlight it as a separate category insofar as two faculty members explicitly cited “poor relationship skills.” additional descriptors relating to relationship shortcomings reported by 13 others include: “lack of accountability”, “little display of empathy”, or indulging in “passive-aggressive”, “shaming”, “rude”, “judgmental”, or “shallow” behaviors. one comment in particular pertaining to this theme was “...angry and shaming when his expectations are not met.” this category has a somewhat distinct feature as it designates behaviors that specifically undermine relationships, fostering disconnection and as such are the antithesis of the skills taught in social work practice. not a strategic planner/lack of vision. twelve faculty members described their directors as non-strategic planners, lacking in vision, or reactionary as opposed to proactive. one comment that incisively portrays this category is: “little ability to see big picture…very small thinker.” lacks knowledge of social work education. seven faculty expressed concern that their academic leaders were not social workers, did not understand social work, were not academic social workers, or were untenured and had little knowledge of social work education. one stated: “not being a social worker she doesn’t understand or value the profession.” limitations of the study although the results illumine to some degree how a substantial number of faculty members regard their academic leaders, the “typicality” (fossey, harvey, mcdermott, & davidson, 2002, p. 725) of their experiences can only be evaluated by other faculty as they consider the applicability of the results to their own situation and setting. additionally, as is the case with all qualitative research, the results may have been influenced by the researchers’ personal biases as social work faculty despite efforts to mitigate bias by the participation of three researchers in the analysis of the data. another limitation is that the researchers did not seek feedback from the participating faculty in reviewing or interpreting the analysis. future studies might seek to obtain participant input in designing the questions and interpreting the results. the researchers did not call, owens, vincent/leadership in social work education 608 categorize differences in experiences among adjunct faculty, junior faculty, and tenured faculty. in addition, the researchers did not categorize differences between female and male faculty, an important consideration since over 75% of the participants were female. future studies should seek to understand the differences and similarities in the experiences of these sub-groups of faculty. discussion this study explored social work faculty’s experience with leadership within their academic unit. while nearly 49% of faculty study participants reported primarily positive experiences with their social work unit leaders, 51% reported either mixed or negative experiences. as indicated by faculty, positive leaders facilitate a collaborative process and advocate for faculty. they are strong managers and effective communicators who lead with integrity and articulate a positive vision for their academic unit. the leadership characteristics reported by faculty in this study validate previous findings that identify effective leadership styles (grant & crutchfield, 2008; holosko, 2009, house et al., 2007; rank & hutchison, 2000). notably, nearly half of the faculty reported their satisfaction with their academic unit heads’ collaborative and supportive leadership style whereby leaders develop partnerships with faculty, university administration and the community, clearly confirming the positive impact of shared leadership described by grant and crutchfield (2008). this exploratory study is consistent with the findings of knight and holen (1985) who determined faculty consider the most effective academic leaders to be strong in both initiating structure and consideration, or more explicitly administrative and relationship skills. this study supports the role of inspiration in the process of engaging the whole person consistent with a transformational leadership style as faculty frequently reported their admiration for the positive leadership qualities of collaboration, mentoring, and integrity. slightly fewer than half of faculty members reported primarily positive attributes to portray their academic director or other academic unit head while 40% reported primarily negative leadership qualities. some portrayed their unit heads as autocratic decision makers who sometimes engage in unethical behaviors. others described their leaders as poor managers with inadequate or even deficient communication skills. still, others saw their leaders as uninvolved with and unsupportive of faculty. some noted their leaders were unable or unwilling to effectively resolve conflict within the unit while essentially modeling poor interpersonal relationship skills. these findings are important and suggest that a significant proportion of social work unit heads may be not only ineffective but also unethical in their leadership roles. of particular concern are faculty reports of specific unethical and oppressive behaviors by academic leaders, including disrespectful comments and behaviors, dishonesty, favoritism, sexism, and verbal abuse. lastly, a smaller proportion of study participants characterized their leaders as exhibiting leadership competencies in many domains while encumbered by deficiencies in others. advances in social work, fall 2013, 14(2) 609 implications for academic leadership the study has numerous implications for the development of effective social work academic leadership. the need for more training in general and more effective training in particular is evident and consistent with hecht's (2004) assertions that many academic leaders assume their positions without any formal training. few universities offer training to unit leaders (gmelch, 2004). the highly negative perceptions of some social work academic leaders by faculty participants in this study clearly validate the cswe’s commitment to training competent academic deans, chairs, and directors. the results of this study also mirror the need for more effective training as outlined by filan and seagren (2003). while a strong ethical foundation is certainly embedded in the six essential facets they outlined, the addition of ethics as a seventh facet could perhaps elevate expectations for not only our leaders but also social work faculty and students. a greater focus on ethical considerations surrounding team building, strategic planning, and networking could enhance academic leadership training. teaching leaders to practice mindful self-reflection to obviate ethical lapses and display respectful and culturally sound relationship-building skills is imperative in this age of globally connected learning environments. clearly, some faculty members in the study experienced their academic leaders as lacking positive relationship skills, with some reporting oppressive and even abusive behaviors. such reports are an anathema to social work’s mission, reminding us that for social work faculty the academy is also a site “within larger economies of power and privilege” (kinchelo & mclaren, 1994, p. 147), requiring further study. considering the results in this light may require social work academic leaders to initiate an on-going dialogue concerning the power relations in the academy and how faculty are socially and historically situated, as a first step in fostering a more empowered faculty. such a discussion would require the academy to more fully consider under what circumstances and in what manner faculty experience their subordinate social status, including a discussion of the intersectionality of age, ethnicity, gender, race, sexual orientation, socio-economic class, religious affiliation, among other discrete factors. the study validates cswe’s decision to create the leadership institute in social work education (liswe) at its 2009 annual program meeting and to support leadership development by funding scholarships for emerging leaders in social work education (cswe, 2010). this study suggests a need for significantly more emphasis on leadership, ethics, and empowerment – especially in doctoral and masters level programs. incorporating a substantive discussion of the nasw code of ethics (nasw, 2008) in all leadership curricula designed to train social work leaders is essential if we wish to remain true to our value base. while leaders who exhibit a mixture of leadership assets and liabilities, where the former outnumber the latter, would most likely benefit from leadership training, others judged to be more challenged by the rigorous ethical, professional, and relationship demands may need to be assessed for their capacity to continue in a leadership role. perhaps cswe should consider developing specific leadership standards for academic heads, including training requirements consistent with social work values and required for program accreditation. these could then suffice as criteria for evaluating academic leaders, addressing strengths and shortcomings. future call, owens, vincent/leadership in social work education 610 studies could concern how best to train, support, and evaluate academic unit heads and remediate, reassign, or otherwise resolve instances of non-adherence to these social work value-based standards of leadership competence. other studies could explore the consequences of incompetent and oppressive leadership compared to the benefits of more democratic and egalitarian leadership styles, specifically as it impacts workplace morale, faculty performance, and student learning. in this study faculty reporting positive experiences with their academic leaders generally attributed to their leaders 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(2000). leadership for social transformation: some ideas and questions on institutions and feminist leadership. gender and development, 8(3), 7479. thomas, d. r. (2003). a general inductive approach for analyzing qualitative evaluation data. american journal of evaluation, 27(2), 237-246. author note: address correspondence to: christine r. call, ph.d., associate professor, master of social work program, university of st. francis, 500 wilcox street, joliet, il 60435. email: ccall@stfrancis.edu _______ marlys staudt, ph.d. associate professor, university of tennessee, college of social work, knoxville, tn., 37996. mona williams-hayes, ph.d., lcsw. clinical director, kids first child advocacy center, lenoir city, tn., 37771. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 416-429, doi: 10.18060/22957 this work is licensed under a creative commons attribution 4.0 international license. secondary traumatic stress, burnout, and compassion satisfaction among child advocacy interdisciplinary team members marlys staudt mona williams-hayes abstract: recent research has examined the stress and indirect trauma experienced by helping professionals who work with survivors of direct trauma, including interpersonal violence. little of this research has focused on child advocacy center team members. this practice-based survey research addresses that gap. the study examined secondary traumatic stress (sts), burnout, and compassion satisfaction (cs) in interdisciplinary team members (n=36) of one child advocacy center in the southern united states, and explored relationships between cs, sts, and burnout. as assessed by the secondary traumatic stress scale, 50% of participants experience post traumatic stress disorder symptoms due to sts. based on the professional quality of life scale, burnout was low and cs was high. those with higher cs had lower burnout and sts. positive associations were also found between life stresses in the past year as measured by the social readjustment rating scale and sts and burnout, but not cs. practitioners, agency supervisors, and administrators need to be aware of the effects of trauma work, regularly assess for these effects, and provide opportunities for support and debriefing. schools of social work should consider developing and implementing specialized units on sts and self-care. keywords: secondary traumatic stress; burnout; compassion satisfaction; child advocacy centers; child sexual abuse; trauma; ptsd freudenberger (1974) was one of the first to explore burnout and did so among staff of the free clinic movement. in the 1980’s researchers began to study the rate of burnout in the helping professions and the factors that contributed to it (davis-sacks, jayaratne, & chess, 1985; etzion & pines, 1986; jayaratne & chess, 1984; maslach & jackson, 1981). maslach (1982) defined burnout as “a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do ‘people work’ of some kind” (p. 3). burnout is often a consequence of a stressful work environment and workplace characteristics, including few resources and high caseloads (kahill, 1988). although the first studies of burnout were in the 1970’s and 1980’s, it continues to be a focus of study (anderson, 2000; hamama, 2012a, 2012b; kim, 2011; lizano & mor barak, 2015; siebert, 2005; stevens & higgins, 2002). recent literature has also focused on secondary traumatic stress (sts), vicarious trauma (vt), and compassion fatigue (cf; baum, 2016; bride, 2007; conrad & kellarguenther, 2006; dagan, ben-porat, & itzhaky, 2016; schuler, bessaha, & moon, 2016). although each of these terms has differences in “theoretical origin and symptom foci” (bride, radey, & figley, 2007, p. 156), they are often used interchangeably to refer to the stress from working with traumatized clients. although there are subtle differences among https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) 417 sts, cf, and vt, according to stamm (2010), there is “no delineation between them sufficient to say that they are truly different” (p. 9). secondary traumatic stress refers to behaviors and emotions occurring from knowing or hearing about a traumatic event experienced by a significant other (figley, 1995). sts includes the indirect stress experienced by helping professionals who work with traumatized clients. even though the stress is indirect, the consequent behaviors and emotions are similar to those of posttraumatic stress disorder (ptsd), including hyperarousal, intrusive imagery, and distressful emotions (bride et al., 2007). in short, indirect or secondary exposure to a traumatic event or events, by hearing about it in a professional or personal relationship, can lead to secondary traumatic stress, and to symptoms of, or full-fledged ptsd. in a sample of licensed social workers in one u.s. state, bride (2007) found that 70% reported at least one sts symptom in the past week, and 15.2 % potentially met the criteria for ptsd. vt differs from sts because of its focus on cognitions, including changes in beliefs, hope, spirituality, worldview, and meaning, which come from caring for those who have experienced trauma (pearlman & saakvitne, 1995; sabin-farrell & turpin, 2003). subclinical signs of ptsd may also be present in vt (baum, 2016). professionals with vt experience transformation in schemas when one’s experiences do not conform to prior worldviews and ways of understanding (huggard, stamm, & pearlman, 2013). this transformation usually occurs gradually over time. in contrast, compassion fatigue is the “here and now” perception of trauma work (huggard et al., 2013, p. 131), including the distress and exhaustion that occur from witnessing the suffering or negative experiences of others (figley, 1995). stamm (2010) conceptualized compassion fatigue as consisting of two parts: burnout and sts. cf is the negative aspect of work that contributes to a helper’s professional quality of life, which refers to how professionals feel about their work as a helper. although burnout may also be present in cf/sts (bride et al., 2007), the latter can result from a single exposure to a traumatic event, even indirectly, whereas burnout is a process that occurs over time because of job stress (conrad & kellar-guenther, 2006). burnout is a broader term than cf or sts, and does not necessarily refer to trauma work. all of these phenomena have negative consequences for helping professionals (low sense of efficacy, hopelessness, etc.), can interfere with building positive relationships with clients, and may result in turnover (bride & kintzle, 2011; conrad & kellar-guenther, 2006). whereas cf is the negative aspect of professional quality of life, compassion satisfaction (cs) is the positive aspect that contributes to professional quality of life. cs refers to the sense of satisfaction, success, and accomplishment that comes from helping clients (stamm, 2002, 2005). silveira and boyer (2015) found that counselors who worked with youth who were victims of sexual abuse reported hope and optimism resulting from building positive relationships with children and families, and seeing them cope with and manage their adverse circumstances. the reciprocal and intense relationships that result in cf can also result in cs. helping professionals can have positive experiences from these relationships, just as the relationship is also a growth experience for clients. staudt & williams-hayes/secondary traumatic stress 418 professionals who work with physically and sexually abused children are at risk of cf, because they hear stories of harm and abuse that children experience, often from a trusted friend or family member. studies have reported high rates of cf in child protective service workers (conrad & kellar-guenther, 2006; meyers & cornille, 2002), and some studies have documented that social workers engaged in child protection work have higher rates of burnout than do social workers in other settings (maslach, 1982; sprang, craig, & clark, 2011). choi (2011) reported symptoms of sts among social workers who provide services to survivors of family violence or sexual assault. forensic interviewers with child advocacy centers have also shown signs of sts (bonach & heckert, 2012; perron & hiltz, 2006). taken together, these findings suggest that helping professionals who work with survivors of child sexual abuse and other family violence are vulnerable to cf. at the same time, cs may protect against the negative effects of cf. child protective service workers with high cs had lower rates of compassion fatigue and burnout (conrad & kellar-guenther, 2006). thomas (2013) also found a negative relationship between cf and cs among clinical social workers, and meadors, lamson, swanson, white, and sira (2009) reported that pediatric healthcare providers who scored high on cs had lower rates of burnout and sts. finally, a professional’s level of personal stress and recent losses can influence burnout, cf, and cs (bonach & heckert, 2012; thomas, 2013). in a sample of oncology social workers, recent personal losses were positively associated with burnout (simon, pryce, roff, & klemmack, 2005). personal distress was positively associated with cf and burnout and negatively associated with cs in a sample of clinical social workers (thomas, 2013). bonach and heckert (2012) found that significant losses in the past year was positively associated with sts in their sample of child advocacy center (cac) forensic interviewers. they suggested that stress accumulation might make workers more vulnerable to developing sts. although bonach and heckert (2012) and perron and hiltz (2006) studied sts among child advocacy center (cac) forensic interviewers, other cac team members, including law enforcement, child protective service workers, and therapists, are also subject to the stresses that occur from providing services to sexually abused and severely physically abused children. yet, research that has examined the needs of cac workers is slim (bonach & heckert, 2012). our study addressed this gap. this practice-based study examined cf (burnout and sts) among cac interdisciplinary team members in one geographic region of a southern state. we also sought to learn whether cf is lower when compassion satisfaction (cs) is higher, as well as whether stressful events occurring within the past year affected cf and cs. the research questions were: 1. what is the level of burnout, sts, and cs among the sample of cac interdisciplinary team members? 2. does burnout and sts vary by the level of cs? 3. is cumulative stress associated with cs, burnout, and sts? advances in social work, fall 2019, 19(2) 419 method setting the research took place in a child advocacy center in a southeastern us state. the cac provides assessment and treatment of children and youth identified by the state department of children’s services as severely physically and/or sexually abused. the average child served by this cac is an eight-year-old female who experienced sexual abuse. the cac’s primary treatment modalities are trauma focused cognitive behavior therapy and eye movement desensitization and reprocessing treatment. in addition to assessment and treatment, the cac provides school-based prevention programs and trainings to professionals involved with child abuse. the cac provides services to four rural counties. each county has an interdisciplinary team to coordinate investigations, services, and treatment for children and families. the team consists of professionals from law enforcement, cac, department of children’s services (dcs), juvenile court, and the district attorney offices. procedures the clinical director of the cac (the second author of this article) coordinates the interdisciplinary team in each county. she distributed a packet at one of the team meetings in each of the four counties. the packet consisted of a cover letter that contained information about the study and informed consent, as well as the survey (described below). the cover letter and the survey were in a manila envelope, with no names on the envelope or survey. team members who chose to participate returned the envelope with the completed survey at a designated location. these procedures ensured that the team members would not feel pressure to complete the survey. the clinical director does not exercise supervisory authority over the team participants thus decreasing the chance that they felt obligated to complete the survey. the survey took approximately 15 to 20 minutes to complete. those who completed the survey received a $20 wal-mart gift card. upon return of the survey, participants emailed their name and preferred mailing address to the first author, who mailed the gift card. the institutional review board at the university of tennessee approved the study procedures. measures the survey consisted of the secondary traumatic stress scale (stss), the professional quality of life scale (proqol), and the social readjustment rating scale (srrs), sometimes referred to as the life stress test. six questions pertained to personal and work demographics. stss. bride (2007) developed the stss to assess the frequency of sts symptoms among professionals working with traumatized clients. the stss consists of 17 items, answered on a scale of 1 (never), 2 (rarely), 3 (occasionally), 4 (often), or 5 (very often). participants rate each item according to how frequently they experienced it in the last seven days. there are three subscales: intrusion (five items), avoidance (seven items), and arousal staudt & williams-hayes/secondary traumatic stress 420 (five items). item examples from the intrusion subscale are: “reminders of my work with clients upset me” and “i had disturbing dreams about my work with clients.” examples of items on the avoidance subscale are: “i felt emotionally numb” and “i felt discouraged about the future.” item examples from the arousal subscale are: “i had trouble sleeping” and “i was easily annoyed.” the potential range of scores for the subscales and total scale are 5 to 25 for the intrusion subscale, 7 to 35 for the avoidance subscale, 5 to 25 for the arousal subscale, and 17 to 85 for the total scale. higher scores indicate more frequent sts symptoms. bride, robinson, yegidis, and figley (2004) reported the alpha for the measure as .93, with subscale alphas ranging from .80 to .87. the stss has good construct validity (bride at al., 2004; ting, jacobson, sanders, bride, & harrington, 2005). the alphas for the present study were .93 for the total scale, .80 for the intrusion subscale, .87 for the avoidance subscale, and .81 for the arousal subscale. as noted below, one of the subscales of the proqol measures sts. we used the stss in addition to the proqol because the stss provides information about the level of intrusion, avoidance, and arousal. since we were using the proqol to obtain measures of cs and burnout, we decided to also retain the sts subscale. proqol. the proqol measures the positive and negative effects of working with clients who have experienced trauma or stressful events (stamm, 2010). the proqol consists of 30 items, answered on a scale of 1 (never), 2 (rarely), 3 (sometimes), 4 (often), or 5 (very often). participants rate how frequently each item was experienced in the past 30 days. the proqol is comprised of three subscales: compassion satisfaction (10 items), burnout (10 items), and secondary traumatic stress (10 items). examples of items from the compassion satisfaction subscale are: “i like my work” and “i am proud of what i can do to help.” examples from the burnout subscale are: “i feel trapped by my job” and “i feel bogged down by the system.” item examples from the sts subscale are: “i jump or am startled by unexpected sounds” and “i can’t recall important parts of my work with trauma victims.” scores for each subscale are summed (sums can range from 10 to 50). higher scores indicate higher cs, burnout, or sts. stamm (2002) reported alphas of .87 for compassion satisfaction, .72 for burnout, and .80 for secondary traumatic stress. discriminant validity exists for the subscales, showing each is tapping into a different construct (stamm, 2005); it is not appropriate to add the subscales to obtain a total score. the alphas for the present study were .91 for compassion satisfaction, .82 for burnout, and .76 for secondary traumatic stress. srrs. the srrs measures the cumulative stress of individuals. participants check which of 43 life events have occurred over the past 12 months. each event has an impact score, ranging from 100 for death of a spouse to 11 for minor violations of the law. other events are personal injury or illness, marriage, death of a close friend, and trouble with the boss. the impact scores are added for a total score. this measure has been long in use, and researchers reported these life events correlated with health changes and medical visits (rahe, biersner, ryman, & arthur, 1972; rahe, mahan, & arthur, 1970). advances in social work, fall 2019, 19(2) 421 analysis we used the three approaches described by bride (2007) to analyze the stss scores. first, we compared scores of the present sample to the normative means and percentiles for each subscale and the total score presented by bride (2007). using percentiles from the normative sample, participants were classified as experiencing little or no, mild, moderate, high or severe sts, and likewise for the subscales of intrusion, avoidance, and arousal. a second approach is to consider those scoring at 38 or higher on the stss as potentially having ptsd due to sts. the third approach to scoring the stss is to use an algorithm whereby if at least one item on the intrusion subscale is endorsed, at least three items on the avoidance subscale are endorsed, and at least two items on the arousal subscale are endorsed, to then consider that ptsd may be present due to sts. an item that is marked occasionally, often, or very often is considered an endorsed item. based on the scoring protocol for the proqol (stamm, 2010), we reversed scored the designated items and then summed the items of each subscale. the subscale sum was then interpreted as low, average, or high on that concept (compassion satisfaction, burnout, and secondary traumatic stress). for the srrs we assigned impact scores to each item and added them for a total impact score. we used spss 23 for the analysis. we calculated frequencies and means to describe the sample and the scores on the measures. we conducted bivariate pearson correlations to examine the relationships among the measures, specifically whether there was an inverse relationship between cs and burnout and sts, and whether there were significant relationships between the srrs impact score and sts, burnout, and cs. given the small sample size, we used an alpha of .10. results participants surveys were distributed to 50 potential respondents. thirty-six returned the survey, for a response rate of 72%. of the 36 participants, 26 (72.2%) were female. the mean age was 40.8 (sd=12.6), ranging from 21 to 76. all participants were caucasian, consistent with the ethnic/racial makeup of the rural area. twelve (33.3%) of the participants were from dcs, ten (27.8%) were from cac, and nine (25%) were from law enforcement. the remainder were from juvenile court, from the da’s office/attorneys, or medical personnel. participants had a mean of 11.8 years (sd=11.5) employed in their profession and a mean of eight years (sd=5.8) working with abused children. research question one: what is the level of burnout, sts, and cs among the sample of cac interdisciplinary team members? the mean proqol cs subscale score for the 36 respondents was 39.4 (sd=5.8). this is in the ‘moderate’ range of cs (stamm, 2010). the mean proqol burnout subscale score was 22.8 (sd=6), which is in the ‘low’ range of burnout. table 1 shows the number of staudt & williams-hayes/secondary traumatic stress 422 participants who scored low, moderate, or high on the proqol subscales. as can be seen, all of the participants scored moderate or high on cs and low or moderate on burnout. there was evidence that suggested concerning rates of sts. the mean proqol sts subscale score was 22.8 (sd=5.3), in the moderate range. based on the proqol sts subscale, 44% (n=16) scored low in secondary traumatic stress and the remainder (56%, n=20) scored in the moderate range (see table 1). table 1. distribution of low, moderate, or high scoring on the proqol subscales subscale number and frequency all low moderate high cs 21 (60%) 14 (40%) 35 burnout 15 (44%) 19 (56%) 34 sts 16 (44%) 20 (56%) 36 table 2 shows how the sample scored on the stss. the classification into the five categories are based on the normative means and percentiles provided by bride (2007). seventeen respondents (50% of those with no missing data) had moderate, high or severe sts, based on the total score, with six participants scoring at the severe level of sts. when looking at those who scored at the moderate, high, or severe level on the subscales, table 2 shows that 41% were in this range on the intrusion subscale, 39% on the avoidance subscale, and 52% on the arousal subscale. table 2. distribution of little/no, mild, moderate, high, or severe scoring for total stss and the intrusion, avoidance, and arousal subscales number and frequency all little/no mild moderate high severe intrusion 5 (14%) 15 (44%) 1 (.03%) 6 (17%) 8 (24%) 35 avoidance 18 (50%) 4 (11%) 10 (28%) 4 (11%) 36 arousal 6 (17%) 11 (31%) 10 (29%) 3 (9%) 5 (14%) 35 total 7 (21%) 10 (29%) 8 (23%) 3 (9%) 6 (18%) 34 the second way to interpret stss scores is to consider those scoring 38 or higher as possibly having ptsd due to sts. a score of 38 on the stss is at the lower tail of the moderate range. based on this approach, 17 (50%) of 34 participants could possibly have ptsd due to sts. the third approach uses the algorithm described above. in the current sample, after applying the algorithm, 13 participants (38%) may have ptsd. research question 2: does burnout and sts vary by the level of cs? table 3 shows the correlations between the cs subscale of the proqol, the burnout subscale of the proqol, the sts subscale of the proqol, and the stss total score and intrusion, avoidance, and arousal subscales. participants with higher cs had statistically significant lower burnout and sts than did those with lower cs. the relationship between burnout and cs was stronger than the relationship between the sts measures and cs. advances in social work, fall 2019, 19(2) 423 table 3. pearson correlations between compassion satisfaction and proqol, stss subscales proqol and stss subscales compassion satisfaction n r p proqol burnout 33 -0.646 0.001* proqol sts 35 -0.308 0.072 stss intrusion 34 -0.322 0.063 stss avoidance 35 -0.340 0.045* stss arousal 34 -0.287 0.099 stss total 33 -0.390 0.025* *p<.05, **p<.01 research question 3: is cumulative stress associated with cs, burnout, and sts? table 4 shows that statistically significant positive relationships were found between srrs total impact score and the proqol burnout subscale, the proqol sts subscale, the stss total scale, and the three stss subscales. thus, participants who experienced more stressful events had higher burnout and sts symptoms. there was not a significant relationship between the srrs and cs. table 4. pearson correlations of srrs with cs, burnout, and sts title srss total impact score n r p proqol cs 35 -0.086 0.624 proqol burnout 34 0.388 0.023* proqol sts 36 0.520 0.001** stss intrusion 35 0.415 0.013* stss avoidance 36 0.416 0.012* stss arousal 35 0.399 0.018* stss total 34 0.420 0.014* *p<.05, **p<.01 discussion the purpose of this study was to examine cs, sts, and burnout in a sample of interdisciplinary cac team members. prior to discussing the implications, the substantial study limitations are noted. a primary limitation of the study was the small and homogenous sample. the study took place in one rural geographic region of one state in the u.s., and the small sample was composed primarily of female caucasians who worked on a cac interdisciplinary team. the lack of diversity of the sample limits generalizing the findings to helping professionals in other settings. the small sample size limits the statistical analyses to bivariate correlations. although participants included members of different disciplines, the sample size did not permit us to examine whether there were differences in burnout, sts, and cs by discipline. this is worthy of future research with larger sample sizes. staudt & williams-hayes/secondary traumatic stress 424 in relation to the first research question, we found that up to 50% of the participants may be experiencing ptsd symptomsdue to sts. the mean total stss score in the sample was 38.7 (sd=12.45), higher than the means found in other study samples. choi (2011) reported a mean on the stss of 32.07 in a sample of social workers who provided services to survivors of family violence or sexual assault. among cac forensic interviewers stss means of 36.69 and 34.17 have been reported (bonach & heckert, 2012; perron & hiltz, 2006). findings from the proqol sts subscale provide a somewhat more positive picture, as none of the participants fell in the high range for sts or burnout. still, over half were in the moderate range for burnout and sts. over half were in the moderate range of cs, and the remainder were high in cs. this is an overall positive profile, suggesting that the participants feel their work is important, but that they may still have some symptoms of sts that should be addressed (stamm, 2010). findings from the second research question showed that those with higher cs had lower burnout and sts. these findings are consistent with other studies showing thatthose with higher compassion satisfaction had lower burnout and secondary traumatic stress (conrad & kellar-guenther, 2006; stamm, 2002). the findings related to the third research question were consistent with the notion that personal experiences of the helping professional influence burnout and sts (siebert, 2005). our findings showed that recent stress events were positively associated with burnout and sts. the non-significant relationship between cs and recent life stressful events is noteworthy. studies with larger samples should examine whether personal life events in professional helpers influence their cs. professionals’ own life events may be so stressful that they interfere with their work with clients. conversely, one’s own experiences may increase compassion for others. of course, there is also the type and timing of events to consider. there are several possible reasons why the stss had different findings in relation to sts than did the sts subscale of the proqol. first, participants rated the stss items as to how frequently each was experienced in the past seven days, whereas they rated the sts subscale items according to how frequently each was experienced in the past 30 days. second, there may have been an ordering effect in the survey as the stss was the first instrument that participants completed, followed by the proqol. third, the alpha for the sts subscale in the current study was lower than that reported by stamm and lower than the current study’s alphas for the stss total score and subscales. more work on examining the concordance of various sts scales would be useful. craig and sprang (2010) found that professionals who worked with victims of trauma and reported the use of evidence-based practices had lower levels of burnout and higher levels of compassion satisfaction. the cac in this study uses trauma focused cognitive behavior therapy and eye movement desensitization and reprocessing, evidence-based interventions for trauma, including sexual abuse. this might partially explain the low level of burnout and high level of compassion satisfaction among the study participants. advances in social work, fall 2019, 19(2) 425 we did not include a measure of peer or supervisory support. studies that include measures of peer or supervisory support would shed light on whether and how social support moderates the effect of trauma work. study findings have implications for social work practitioners and for the curricula of professional schools. social work students and those already in the field should receive information about the potential impact of trauma work for themselves. this includes knowing what sts signs to look for as well as the need to incorporate self-care into their lives. bloomquist et al. (2015) found that msw practitioners infrequently engage in selfcare activities and that msw programs and employing agencies do not provide instruction on self-care activities. yet, these authors also found that study participants who practiced professional and emotional self-care had higher cs, which emphasizes its relevance to professional practice. educators might consider developing a specialized unit on sts and self-care and integrating it into required course work. thus, sts would begin to become a real and relevant issue that is present in working with clients who have experienced trauma. students will understand that they will need to address it in their future professional work and will learn self-care strategies to do so. supervisors and agencies need to provide opportunities for support to alleviate the effects of trauma work. prior to doing so, however, they need to understand the effects of trauma work. thus, it may be helpful to implement workshops for professionals, especially supervisors and agency administrators, which focus on the effects of working with traumatized clients. bonach and heckert (2012) noted that traditional support that encourages collegiality and team building might not be adequate and that it is important to provide “clinical” debriefings and proactive mental health care for professionals who work with clients with trauma. agencies should consider building in regular opportunities for support, debriefings, and even breaks from the usual work routine to provide workers some time to engage in self-care activities. we need to learn more about interventions for professionals with sts. it may be especially important to examine interventions that can take place in the work setting as a normal routine for workers who regularly work with trauma. there are over 900 cac’s in the united states. researchers should conduct more studies to understand the unique needs of these professionals who are daily on the frontline, providing specialized services to severely physically and sexually abused children. a recommendation is that future research use larger and more diverse samples than the current study. examining differences in sts, burnout, and cs by discipline and education level would be helpful it would also be beneficial if future studies asked respondents if they have had such training, maybe even where they received the training, for example, in college or as continuing education. having such training could be included as a covariate in future studies to assess the effectiveness of such training. our study took place in a rural region. future studies should include urban regions and test for differences in cf and cs across various geographic regions. research should include organizational variables as well as personal characteristics of the professionals to clarify who is most at risk of sts and burnout and what factors mitigate the risk. examples of personal characteristics that could be included are job satisfaction, spirituality, social support, trauma, and adverse childhood experiences. qualitative studies with in-depth personal interviews or focus groups would also be helpful to hear in the helpers’ own words how they experience sts, staudt & williams-hayes/secondary traumatic stress 426 their current knowledge of sts, and the coping strategies they use to deal with the effects of trauma work. although studies with larger sample sizes are necessary to increase generalizable knowledge about the effects of trauma work, the findings of this study begin to shed light on sts, burnout, and cs among cac team members. at the same time, smaller practicebased studies, such as the one reported in this article, can influence practices and policies within agencies, while informing future research. much more remains to be known about specialized cac services that aim to meet the needs of some of the most severely abused children and their families, including the level of sts and burnout among various team members, and the efforts they and their organizations use to address the effects of trauma work. references anderson, d. 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(2013). association of personal distress with burnout, compassion fatigue, and compassion satisfaction among clinical social workers. journal of social service research, 39(3), 365-379. doi: https://doi.org/10.1080/01488376.2013.771596 ting, l., jacobson, j. m., sanders, s., bride, b. e., & harrington, d. (2005). the secondary traumatic stress scale (stss): confirmatory factor analyses with a national sample of mental health social workers. journal of human behavior in the social environment, 11, 177-194. doi: https://doi.org/10.1300/j137v11n03_09 author note: address correspondence to dr. marlys staudt, 311 henson hall, college of social work, university of tennessee, knoxville, tn, 37996. e-mail: mstaudt@utk.edu https://doi.org/10.1300/j079v32n02_02 https://doi.org/10.1177/1049732314552284 https://doi.org/10.1300/j077v23n04_01 https://doi.org/10.1037/t66725-000 https://doi.org/10.1002/car.754 https://doi.org/10.1080/01488376.2013.771596 https://doi.org/10.1300/j137v11n03_09 mailto:mstaudt@utk.edu _______ elizabeth steiner, basw, ba, msw student at george warren brown school of social work, washington university, st. louis, mo. sandra wexler, phd, acsw, assistant professor, and rafael jacob engel, phd, associate professor, school of social work, university of pittsburgh, pittsburgh, pa. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 559-577, doi: 10.18060/23984 this work is licensed under a creative commons attribution 4.0 international license. examining experts’ arguments for increasing the minimum wage: insights for social work advocates elizabeth steiner sandra wexler rafael jacob engel abstract: the struggles of low-wage workers have increasingly become the focus of public debate, legislative activity, and widespread advocacy. advocacy can be viewed from the vantage point of claims-making, that is, how individuals and groups define and shape a social problem to influence policy. this paper describes the wage-related claims posted online by 17 experts who testified to a city council wage review committee in pittsburgh. our primary aim was to understand how experts constructed their claims; secondarily, we were interested in the rationales they offered for raising wages. we thematically analyzed the testimonies to identify how they shaped and defined their claims in favor of increasing wages. experts described the challenges faced by minimum wage workers and their families as well as by the community. they cited economic considerations, social and economic justice concerns, and moral justifications for raising the minimum wage, often combining arguments. social work advocates are important claims-makers, yet how they “speak truth to power” is not often systematically assessed. our analysis suggests social work advocates must be prepared to provide multiple arguments and to put a human face to any data presented. appeals should be made to both the heads and hearts of decisionmakers, while keeping social and economic justice arguments front and center. keywords: claims-making, minimum wage, low-wage workers, qualitative descriptive methods the struggles of american working families have become a focus of public attention, policy debate, and political campaign. wages have stagnated, with the purchasing power of the average wage received by private sector workers in non-management jobs remaining unchanged for almost four decades (desilver, 2018). concomitantly, income and wealth inequality has risen over the past 50 years. the top 1% of american families’ incomes were, on average, 26.3% greater than the incomes of the other 99% of the country’s families in 2015 (sommeiller & price, 2018). moreover, the wealth of the top 1%, compared to that of the “bottom” 99% of the country’s families, increased sevenfold between 1963 and 2016 (urban institute, 2017). proposed prescriptions range from raising the minimum wage to changing tax laws to implementing isolationist economic policies. in this article, we look at the arguments offered by a group of experts who voluntarily testified before a city council-appointed commission that was charged with making recommendations about the situation of lowwage hospital service workers. we analyze the claims these experts made and identify the implications of this type of claims-making activity for social workers interested in advocating for the economic well-being of workers and their family members. https://creativecommons.org/licenses/by/4.0/ steiner et al./examining experts’ arguments 560 background the current federal minimum wage of $7.25 per hour, set in 2009 (u.s. department of labor, n.d.), is not enough to keep a full-time, year-round single worker above the federal poverty threshold, no less a family (cooper, 2017). controlling for inflation, the federal minimum wage reached its highest value in 1968; between 2009 and 2016, inflation caused the $7.25 per hour minimum wage’s purchasing power to decline by almost 10% (desilver, 2017). the number of hourly workers in the u.s. earning such low wages is not trivial: approximately 2%, or 1.8 million people, earned at or below the federal minimum wage in 2017 (u.s. department of labor [us-dol], 2018) and about 30%, or 20.6 million individuals, are considered “near-minimum wage” workers, defined as those making “more than the minimum wage in their state but less than $10.10 an hour” in 2016 (desilver, 2017, fact 4, para. 1). low-wage workers face a multitude of hardships trying to make ends meet. they struggle to afford and maintain stable housing, experience difficulties making timely rent or mortgage payments (heflin, 2017; skobba et al., 2013; warren, 2018). food insecurity is also a problem (gundersen & ziliak, 2018; neckerman et al., 2016), with 11.1% of all american households and 29.1% of those below 185% of the poverty line being food insecure for at least part of the year in 2018 (coleman-jensen et al., 2019). further, many low-wage workers have little savings set aside for emergencies or retirement (rothwell & sultana, 2013). fully 39% of respondents in a 2018 national survey reported they could not afford a $400 unexpected expense and would have to borrow money or sell something to pay it (board of governors of the federal reserve system, 2019). additionally, lowwage workers and their families frequently have problems accessing health care services and purchasing medications, resulting in more negative health outcomes (heflin, 2017; lenhart, 2017; neckerman et al., 2016). to assuage these hardships, low-wage workers may seek financial and in-kind benefits from public sources or non-profit organizations (allegretto et al., 2013; guo, 2012; purtell et al., 2012). in 2012, fast-food workers in new york city walked off their jobs to demand union rights and an increase in the minimum wage to $15 an hour. organized by labor and community activists, this effort has come to be known as the fight for $15, reflecting advocates’ aspirational minimum wage rate. the fight for $15 has become a nationwide campaign to raise the wages of low-wage workers and has targeted its advocacy at changing localand state-level wage policies as well as those of businesses (greenhouse, 2015; rolf, 2016; tung et al., 2015). as of march 2019, 29 states and the district of columbia had enacted state minimum wage rates higher than the federal minimum wage (us-dol, 2019). fully 26 of the 29 states that have raised their state minimum wages have done so since 2014 (economic policy institute [epi], 2019). in addition to these state-level changes, the minimum wage rates of 41 cities and counties are now higher than their states’ (epi, 2019). despite these gains, debate continues to surround the minimum wage. opponents of raising the minimum wage suggest that doing so would harm employment, with businesses relocating to cheaper labor markets, reducing the number of employees or their work hours, or slowing the creation of new jobs (congressional budget office [cbo], 2019). advances in social work, fall 2020, 20(3) 561 economists who have advanced these arguments often cite basic labor supply and demand theories to support their predictions (cbo, 2019; lammam, 2014). research conducted in seattle since the city increased its minimum wage has found a decrease in employment hours and, consequently, worker income (jardim et al., 2017). proponents of raising the minimum wage assert that the effects noted in seattle may be exaggerated since the city-wide wage increase made it easy for companies to move outside the city’s boundary (long & plotnick, 2017). other studies have found little effect on employment following minimum wage increases (devinatz, 2013; tung et al., 2015), including in seattle (reich et al., 2017). those favoring a higher minimum wage see the increase as a way to alleviate many of the hardships faced by low-income workers. minimum wage increases have positive effects on children in low-income families, particularly those in single-parent households (cooper, 2017; gennetian et al., 2010; hill & romich, 2018). moreover, the use of public benefits has been found to decrease as a result of raised wages (cooper, 2016a), although this could be a proverbially double-edged sword if the increase in pay does not compensate for the value of the benefits lost (national conference of state legislatures, 2019). advocates also cite economic and social justice rationales for increasing wages. income inequality has increased in part due to wage stagnation (bivens et al., 2014; cooper, 2016b; pietrykowski, 2017); had the minimum wage kept up with productivity, it would have been nearly $19 an hour by 2016 (cooper, 2016b). moreover, low-wages disproportionately affect women and people of color (bivens et al., 2014; clark, 2014; tung et al., 2015). low-wage occupations are often associated with low skills; however, it may not be that these positions require skills that are “low,” but ones that are not valued (pietrykowski, 2017). finally, advocates for raising wages argue that there is a moral imperative and social responsibility to pay workers a decent wage (anker, 2011; konigsburg, 2017; rogers, 2014). quite simply, workers who play by the rules, these advocates argue, should not have to struggle to get by. low-wage work demeans and exploits workers (dobos, 2018). we have a collective responsibility as a society to return dignity to work and workers (thistlethwaite, 2009). raising wages would be one way to acknowledge the value of workers and the work they perform. applying a claims-making lens to assertions about wages advancing these arguments in the public and policy arenas can be seen as a form of claims-making (best, 2017; loseke, 2017). data and facts can create the basis for a claim, but it is their subjective interpretation as “problematic” that transforms a situation into a social issue (loseke, 2017). therefore, claims-making entails a subjective definitional process; claims are assertions made to persuade others “that there is a condition that should be recognized as troubling, that needs to be addressed” (best, 2017, pp. 14-15). claims can be made by individuals or groups, laypeople or experts, or those with direct experience of the situation or those who know about it from a distance. “activists often contribute enthusiasm, passion, and whatever organizational resources their movements steiner et al./examining experts’ arguments 562 may control, whereas experts provide authoritative knowledge” (best, 2017, p. 123). in the clamor of issues vying for a place on the public agenda, effective claims often are those that appeal to both the heads and hearts of decision-makers. social work, low wages, and economic justice the social work profession has a long history of working to alleviate the impacts of poverty and inequality on individuals, families, and society as well as advocacy for a more equitable and socially just society. the preamble to the national association of social workers (nasw, 2017) code of ethics speaks directly to the profession’s commitment to foster social justice, advocate for social change, and promote the well-being of both individuals – especially those living in poverty or facing oppression and marginalization – and society; in fact, one of the profession’s six ethical principles calls on social workers to “challenge social injustice”. one of the grand challenges for social work, an initiative launched by the american academy of social work and social welfare, is to reduce extreme income inequality (grand challenges for social work, n.d.). social workers act as claims-makers with and on behalf of clients and constituents whenever they engage in advocacy. yet how they “speak truth to power” often is not systematically assessed in terms of the formulation and effectiveness of their arguments. in what follows, we examine the testimony of experts who testified before a city councilappointed wage review committee to identify how they constructed their arguments to sway these decision-makers. we also examined the types of claims they made about lowwage hospital service workers’ wages and the rationales they offered in favor of raising the minimum wage. methods although pittsburgh has been repeatedly named one of the country’s most livable cities (eberson, 2018), there has been growing concern about whether it is a livable city for all of its residents. in 2015 the city council established a wage review committee charged with holding public meetings and making recommendations about service workers in the hospital sector, which includes the largest private employers locally and is dominated by two nonprofit health networks. the wage review committee held public hearings on october 22 and 23, 2015, and heard from over 150 members of the general public as well as from a variety of experts (wage review committee, 2015). the committee’s final report, including the complete testimonies, was posted online and made available to the public. given the public availability of the data, the university of pittsburgh’s irb approved this study as exempt. we used a qualitative descriptive approach, which is a form of qualitative investigation consistent with naturalistic inquiry, though less “encumbered by pre-existing theoretical and philosophical commitments” than approaches such as grounded theory or phenomenology (sandelowski, 2000, p. 337). although all qualitative research entails interpretations, qualitative descriptive studies are less interpretative than other qualitative research traditions. instead, qualitative descriptive studies emphasize “the presentation of the facts of the case in everyday language,” wherein analysis and interpretation stay close advances in social work, fall 2020, 20(3) 563 to the data without the need to have them fit a priori conceptual abstractions (sandelowski, 2000, p. 336). a qualitative descriptive approach was particularly well-suited for this study. we analyzed the testimony given by the experts to understand how they constructed their arguments about workers’ wages. twenty experts spoke before the committee; however, remarks by three experts did not touch on the situation of hospital workers and, therefore, were omitted. thus, the data set for the present analysis consisted of the testimonies of 17 experts, including: 4 labor union representatives, 9 community/special interest advocates, 2 academics/researchers, 1 healthcare industry consultant, and 1 public official. because there was no prescribed format, the testimonies varied in length, emphasis, and depth of content. the experts did not provide demographic information about themselves in their testimonies; however, based on their names, it appears that 10 were male and 7 were female. a content analytic strategy was used to organize and code the data. according to sandelowski (2000) and colorafi and evans (2016), content analysis is an appropriate analytic approach to use in a qualitative descriptive study. we treated the testimonies as stories told by the experts to the wage review committee and read them for common as well as unique thematic elements. four coders participated in the analysis. one was experienced in qualitative research and served as the lead coder, providing guidance and giving direction to the coding process. two were students whose involvement was designed to give them experience in qualitative methods. the fourth had some experience with qualitative research methods and qualitative coding; this individual also had given testimony at the hearing and is one of the 17 experts whose testimonies we analyzed. all members of the coding team were aware of this member’s participation in the original hearing and were sensitive to how that could impact the process of coding and interpreting the expert testimonies. moreover, because this was designed, in part, to be a training exercise, significant attention was given to disaggregating the steps in the coding process and involving all members in decisions. the four coders read all of the expert testimonies and independently generated an initial list of codes. the four coders used these initial codes with three testimonies. the lead coder then compared how the coders applied the codes to the three testimonies. to ensure there was a common understanding of the codes, the group discussed and jointly decided how to resolve differences. two additional codes were proposed through this process and each group member reviewed the three testimonies in light of them. after a discussion and reconciliation of this coding round, each of four coders was charged with coding the remaining 14 testimonies. the lead coder again compared the coding and facilitated the group’s discussion of coding decisions. the final coding scheme included seven themes shown in table 1. reviewing these themes and subthemes with an eye to understanding how the experts acted as claims-makers revealed a complex story that did not always line up neatly with the themes identified. in our presentation of findings, some themes and subthemes have more prominent roles than others, and one theme appeared more than once because of its varying subthemes. for instance, the themes things were better before, not the most livable steiner et al./examining experts’ arguments 564 city, characterization of hospitals in the region, economic control of large employers, consequences of low wages, differential impacts of low wages all contributed to the section on “framing the claim,” with things were better before and not the most livable city directly shaping the discussion of “remembering history.” the theme consequences of low wages supported the discussion of “individual consequences,” whereas the theme differential impacts of low wages informed the findings section with that title. multiple themes – not the most livable city, characterization of hospitals in the region, economic control of large employers, consequences of low wages – contributed to the “community consequences section.” the findings section entitled “making the claim: justifying raising wages as the solution” was based on the theme called redress – reasons to raise wages. finally, given our focus on claims-making by social actors, we present our findings in relation to the general categories represented by those testifying, rather than by individual names; this rationale also applied to the hospital systems, which are identified as hospital system a and hospital system b. table 1. final coding themes and subthemes i) things were better before ii) not the most livable city iii) characterization of hospitals in the region a. as wage setters b. as charities/nonprofits iv) economic control of large employers v) consequences of low wages a. microeconomic b. macroeconomic vi) differential impacts of low wages a. race b. gender c. intersection of race and gender vii) redress – reasons to raise wages a. need to address social and economic inequalities b. economic rationales c. moral arguments/conceptualizations of fairness viii) miscellaneous we adopted several procedures to foster trustworthiness (elo et al., 2014; lietz & zayas, 2010). first, all coders were involved in generating and refining the codes; all also had an equal voice in discussions to resolve coding disagreements. this participatory consensus approach to code development and application encouraged a more nuanced reading of the testimonies, while concomitantly strengthening the consistency of the coding. second, to ensure transparency and definitional clarity, we maintained a detailed audit trail. finally, we used peer debriefing to refine our analysis and elicit feedback on our interpretations. the analysis of the testimonies is a discrete investigation that is part of a broader effort to understand the impacts of low wages and wage changes on the lives of low-wage hospital workers. we presented our findings to our peers from the pittsburgh wage study team and have incorporated their feedback. advances in social work, fall 2020, 20(3) 565 findings the claim: low-waged hospital service workers deserve higher wages all 17 experts advanced the claim that wages for hospital service workers should be raised. although not all shared what they thought would be an adequate or appropriate wage range, several mentioned $15 an hour as a minimum wage rate. the experts built cases for their claims for higher wages by showing why low wages are problematic and why they should be raised. framing the claim: the problematic nature of low wages the experts cited historical comparisons as well as current indicators to demonstrate that hospital service workers’ low wages were problematic and merited a response. they described the individual and community consequences resulting from low-wages. remembering history. the experts looked to pittsburgh’s past and compared the contemporary experiences of hospital service workers to those of steel workers when that industry dominated the local economy. according to a labor union representative, “hospitals are the new steel mills, the giant employers of our economy,” a characterization he attributed to the city’s mayor. in the early 20th century, the region’s mills and mines were sites of significant labor struggles that culminated in the unionization of those industrial workers. labor union representatives, in particular, described the power of unions in transforming the pittsburgh economy during the 1900s, and drew direct parallels between the steel and healthcare industries. one said: “just as an organized, eventually middle class steel industry lifted many industry jobs in this region up, an organized, well-paying hospital sector will lift the service industry.” an academic/researcher also looked to pittsburgh’s industrial and union organizing history: the good jobs in the highly concentrated steel mills that powered pittsburgh’s economy in the last century didn’t start out as good jobs. . . . that gaping inequality disappeared because workers – the grandfathers and grandmothers of many people in this room – stood up and organized, because the community supported them, and because elected officials promoted policies to reduce poverty and income inequality. a public official compared current economic conditions to those of the past: that’s [us steel’s starting salary of $18.15 in 1968] just a different world from what we have now. it meant people had more money to spend, which meant more thriving businesses in our neighborhoods. but the more fundamental story is that too many people are just not getting paid enough to live a self-sufficient life and sustain a healthy economy for our city. individual consequences. the experts looked not just to the past, but also discussed how low wages affect people’s lives today. a community/special interest advocate refuted steiner et al./examining experts’ arguments 566 the contention that pittsburgh is one of america’s most livable cities, arguing: “it can’t be the most livable city if we don’t have the ability to enjoy the wonderful things this city offers.” according to one academic/researcher: we estimate that the median wage for service workers in pittsburgh hospitals is about $13.00/hour, or $27,000/year. to put this wage in economic context, the economic policy institute calculates that a single childless adult in the pittsburgh metro area needs just a bit above $13.04/hour to live a no-frills existence (no savings, no education, no travel outside of to and from work, all meals cooked at home and so on) without recourse to public assistance. this means that half of all hospital service workers in pittsburgh do not bring home enough to meet this basic childless, never-get-ahead standard. the experts identified a multitude of negative impacts that low wages have on individuals and families. the other academic/researcher noted: we know that low income is associated with poorer health, more chronic conditions, obesity, smoking, lack of access to health services. low income is associated with higher rates of school drop-out and poorer math and reading scores. it is associated with increased incidences of mental health [problems]. we know that life expectancy declines for low income individuals. a community/special interest advocate asserted, “many of us were particularly upset to hear that people working full time at [hospital system a] still had to rely on local food pantries to provide for their families.” a labor union representative spoke specifically to the impact of parental wages on children. she commented on the influence that a family’s socioeconomic status has on a child’s academic success: “family income is the #1 predictor of a child’s educational success. the #1 predictor. it’s not fair, but it is true. and it is not because rich children are smarter or harder working or better in any way.” according to her, parental low wages have a direct influence on children, because parents have less time and resources to dedicate to them. thus, the effects of low wages cast a wide net, crossing generations and creating long-lasting consequences. differential impacts of low wages. the experts noted that women and people of color are especially likely to experience low wages and to be negatively affected by them. a community/special interest advocate noted the connection between low wages and race, saying: low wages for hospital workers contribute to debilitating rates of poverty in pittsburgh's african american community. pittsburgh has the third highest rate of poverty among working age african americans of major u.s. metropolitan areas, and average wages for african americans in pittsburgh are second and seventh lowest in the country for men and women, respectively. others described the insidious consequences of low wages for women, especially women of color, and the undue burdens they experience. a community/special interest advocate pointed out that “single women’s share of the low-wage workforce (43%) is advances in social work, fall 2020, 20(3) 567 nearly double their share of the overall workforce (23%). and it is no secret that black women make less than white women.” another community/special interest advocate commented: “in pittsburgh, low wage employers play a central role in institutionalized racism and gender discrimination. the majority of hospital workers are women and lowwage service workers are disproportionately people of color.” community consequences. the effects of low wages are felt not only by those who work at these jobs but also by the region at the macroeconomic level. the experts identified implications for public benefits and services as well as for wages in other sectors. for example, to make ends meet, workers who earn low wages may use public benefits to cover food, housing, or health care expenses. the public official noted: [hospital system a’s] own advertised start rates are $11 an hour in the city; at that rate, working full-time, a single parent with one child would still be eligible for food stamps. we know that some start rates are even lower than that, some under $10 an hour. further, despite being among the biggest landowners in pittsburgh, the hospital systems’ nonprofit status exempts them from paying property taxes. the experts claimed that this affects not only the hospitals’ employees, but also the city at-large. these corporations [hospital systems a and b] are the region’s two largest employers, and they also receive multi-million-dollar subsidies from taxpayers, directly and through the publicly funded services like food stamps and energy assistance needed by their low wage workers. (community/special interest advocate) right now, a giant institution like [hospital system a], which is considered a “charity,” is not paying taxes toward the public services that support it, including port authority. without our transit system, how could the workers and patients get to the hospitals?. . . . in effect, we are all paying to provide for the transit system that helps subsidize [hospital system a] to be a poverty wage employer. (community/special interest advocate) in addition, the hospital systems’ position in the economy allows them to dominate the local labor market, determining the wages not only of their workforces but also influencing the wages of service workers in other sectors. an academic/researcher described this situation: it’s important to understand that dominant firms play a decisive role in setting employment standards not only within their own facilities, but in their industries more broadly, and indeed across the entire service sector. in pittsburgh’s labor market, hospitals are what economists call a price-maker – and, in this case, a “wage-maker.” a labor union representative asserted: the biggest low wage employers in pittsburgh are the hospitals. a hotel may employ hundreds of workers, but a hospital employs thousands, and many of those workers are in low paid service positions. their low pay dominates the local labor steiner et al./examining experts’ arguments 568 market, and effectively keeps down the standards for the rest of us in the service sector. making the claim: justifying raising wages as the solution having framed their claims – demonstrating why low wages are problematic – the experts then asserted why hospital service workers’ low wages need to be redressed by raising wages. the arguments fell into three categories: appeals to a moral imperative, appeals to social and economic justice, and appeals based on economic calculations. claims of a moral imperative: conceptualizations of fairness. appeals to a moral imperative focused on the social contract that forms the basis of society. such arguments are premised on the ethical commitments that exist among individuals and between individuals and the state. it is an emotional appeal to people’s sense of what is “right.” according to a community/special interest advocate: “in my opinion, if we want to indeed say as well as indeed do care for the workers in this city, then indeed we will make every step possible to raise the floor of the minimum wage hospital workers.” an academic/researcher more bluntly and explicitly challenged the committee, saying: the overriding question of our community is do we have a moral obligation to ensure [emphasis in original] that workers and their families can meet their basic needs? we need to ask ourselves if someone is playing by the rules of our society, should they have sufficient income to find adequate housing in safe neighborhoods? this expert continued, asserting that: “support[ing] higher wages for hospital workers . . . is the right thing to do.” claims based on social and economic justice. the second argument premised raising wages on principles of social and economic justice. power relations and inequality are expressed in the low wages hospital service workers receive. therefore, higher wages and better treatment for low-wage workers are part of the larger struggle to create a fairer, more equitable society. we have to correct this economic system whereby we are all clear that there are many people doing very well, increasingly so, but at the same time there is a huge and growing population that’s rubbing two nickels together trying to make a dollar out of ten cents. (community/special interest advocate) the profound social inequality and poverty we see in so many neighborhoods of our city is a product of this low wage service economy hospitals have shaped. quite simply, there is no way to make pittsburgh a livable city for all without transforming this injustice and lack of accountability at the heart of our economy. (community/special interest advocate) for a number of the community/special interest advocates, higher wages for hospital service workers was linked to their organizations’ social justice missions. whether concerned with the environment, housing, transportation, or reproductive health, advocates’ assertions rooted both their particular issues and the situation of low-wage advances in social work, fall 2020, 20(3) 569 workers in the struggle to create a more just society. one community/special interest advocate said: we see poverty level wages in major employers like hospitals as part of the public health and environmental challenge of this region. low wages interact with the problems of poverty and pollution, requiring a comprehensive analysis and a sophisticated policy and regulatory response. we call this environmental justice. another reported: reproductive justice is a when a woman has full access and ability to control her body. this includes when and how she can have children and how she raises them. i can’t say that we have reproductive justice if i can’t pay my rent, buy food, pay for childcare and a host of other needs like transportation and healthcare. claims drawing on economic rationales. finally, some of the experts based their appeals for raising wages on economic calculations citing the benefits higher wages would have on the economic health of the city. higher wages, according to them, would result in increased consumption and economic development throughout the region. if we assume that the lowest-paid hospital service workers see their wages rise to $15 an hour, and the wages of other service workers rise accordingly, then we would see over $100 million more in the pockets of hospital service workers, which would be a powerful stimulus to our local economy. it would also mean another $1 million for our city budget, and another $2 million for our public schools, just from those 11,000 workers. . . . the result of an across-the-board wage increase at these two large employers would mean that other lower-wage employers would have to raise their own wages as well in order to hold on to their employees. that’s the kind of economic development we want in the city of pittsburgh: a virtuous cycle where the frontline workers (that young man or woman with a high school diploma (or not)) have more money in their pockets to spend and stimulate our economy, encouraging the formation of new businesses and the creation of new jobs that also will pay better wages, and so on. all of this would also mean more money in the city’s coffers to fund our city services, as well, but the best part of all might be that actually would need less of those public services. (public official) the macroeconomic consequences of increased wages for hospital service workers could create an “economic impact [that] ripples through the entire economy and all wage-earners see an increase” (labor union representative). discussion as examples of claims-making, the testimonies proffered by the experts represented their efforts to build a case for increasing hospital service workers’ wages. constrained by time and the wage review committee’s attention, the experts had to make succinct arguments, yet ones that would be persuasive. their testimonies typically followed a pattern of laying out the problematic nature of low-wages, using value-laden and/or steiner et al./examining experts’ arguments 570 economic justifications for raising wages, and concluding with the benefits associated with increased wages. few offered their opinions about what would be an appropriate wage. their reluctance to do so may be a reflection of the lack of consensus about what a “sufficient” wage would be for service workers (anker, 2006; hirsch, 2017; kaufman, 2016). some experts used examples commonly reported in the literature about the consequences of low wages for individuals and families, such as food insecurity (colemanjensen et al., 2019; gundersen & ziliak, 2018; nord & parker, 2010), negative health outcomes (heflin, 2017; lenhart, 2017; neckerman et al., 2016), and the impacts on children (albelda & shea, 2010; hill & romich, 2018). others described differential gender and race/ethnicity impacts, stressing that women and people of color are more likely to receive low wages and be directly impacted by them (clark, 2014; cooper, 2017; tung et al., 2015). yet, the expert testimonies went beyond framing the consequences of low-wages for individuals and families. their testimonies also described the implications of low wages for the broader community, citing, for example, the cost of public benefits, a significant expenditure considering that between 2009 and 2011, 56% of state and federal spending on the earned income tax credit, medicaid, children’s health insurance program, temporary assistance to needy families, and food stamps went to working families (jacobs et al., 2015). essentially, the taxpaying public is subsidizing the low-wages paid by employers. the experts also considered the dominant role of the two local nonprofit health systems on wage structures, identifying impacts for service workers’ earnings that reach well beyond the hospital walls. the low wages offered by the two major local hospital systems allow other service sector employers to pay low wages too, and the pool of workers competing for these jobs has little recourse but to accept these low wage rates. thus, food servers’ and sales clerks’ incomes are affected by the hospital systems’ wage rates. the experts’ justifications for their solution – pay low-wage workers more – were consistent with the three broad arguments for raising wages found in the literature: economic considerations, social and economic justice concerns, and moral rationales. in making economic-based arguments, the experts referred to the negative economic effect of low wages, such as the reliance on public benefits, the reduced purchasing power of consumers, and the ability of these dominant institutions to undercut wages across the workforce, factors also discussed by allegretto and colleagues (2013) and kaas and madden (2010). to argue low wages are a social and economic justice issue, the experts stressed the importance of recognizing how low wages impact people of color and women more directly than other groups (bivens et al., 2014; cooper, 2017; tung et al., 2015) as well as how historical legacies find expression in current forms of wage inequality (pietrykowski, 2017). some also tied the issue of low wages to the social justice missions of their advocacy/special interest organizations. finally, experts putting forth a rationale based on an understanding of social morality argued there is a moral imperative to raise wages; these arguments were reflected in the literature about the social responsibility to pay decent wages (anker, 2011; konigsburg, 2017; rogers, 2014). advances in social work, fall 2020, 20(3) 571 although the experts may have used one argument more prominently, none used one type exclusively. for example, arguments focusing on economic justifications for increasing wages also incorporated an underlying moral reasoning. similarly, arguments based on social and economic justice rationales often had economic and moral elements interwoven. this type of multi-faceted presentation is not as commonly found in the academic literature, where specialties have become ever more narrowly focused and disciplinespecific. yet, the experts who gave testimony were tasked with appealing to a broad audience, not only to those in their field. we cannot know the extent to which these rhetorical decisions were conscious, but from the perspective of claims-making, it makes sense that the experts employed multiple arguments to advance their claims. by doing so, they increased the likelihood that their arguments would appeal to audience members’ varying interests, thus enhancing their claims’ persuasiveness. best (2017) suggested that activists and specialists may play distinct roles in the claims-making process, with activists bringing passion and specialists providing factual information. but both passion and data are needed to appeal to decision-makers’ hearts and minds. many of the experts testifying exemplified this approach, offering both factual and emotional appeals. for example, researchers/policy proponents provided much “hard evidence” statistics, charts, and citations but also invoked moral arguments, essentially making an emotional appeal that raising wages “is the right thing to do.” labor union representatives and community/special interest advocates offered emotionally evocative testimonies, along with some facts. limitations the findings in this research are limited by two factors. first, as is common in qualitative research, the data analysis and assignment of meanings are subject to the interpretations of this particular team of researchers. despite a coding process meant to limit personal biases, it is possible that another team of researchers could review the same data and identify other themes or interpret the themes in other ways. moreover, although we do not think the dual role of one of our team members as testifier and coder swayed the coding or interpretation, it is possible that subtle influences existed. second, these findings are not generalizable. the testimonies were offered by a self-selected group of experts (i.e., those who were willing to testify at a public hearing regarding hospital service workers’ low wages). as couper and miller (2008) and parkinson (2004) have suggested, people who voluntarily participate in satisfaction surveys or opinion polls, or public hearings for that matter, tend to hold strong positive or negative positions, and this certainly appears to be true of the experts who gave testimony to the wage review committee. thus, the study’s findings should not be taken as representative of the opinions of all experts with similar qualifications either in this region or in other parts of the country. implications for social work this analysis suggests a number of implications for training social work students and professionals as advocates. social workers need to understand different facets of an issue, steiner et al./examining experts’ arguments 572 be prepared to use multiple arguments, and be able to cite different forms of evidence. given that those who sit on decision-making boards are likely to come from diverse backgrounds, using several arguments will increase the likelihood of finding something that resonates with as many members of the panel as possible. similarly, having command of data is critical, but so too is being able to put a human face on the statistics, which is why sharing stories from our practice, clients, and constituents (as well as encouraging them to advocate publicly for themselves) are so powerful. appeals to decision-makers’ heads and hearts can be particularly effective. given the wide variety of social issues addressed by social work, practitioners are in a unique position to link inadequate income to a large number of other issues, as did the community/special interest advocates. whether the concern is for the environment, public transportation, education, health, or nutrition, connections can be made to the lives of lowincome workers and their families. it is important for social work students to learn about the intersection of income with such issues both in the classroom and in field placements. acquiring a commitment to and skills in advocacy should be a central feature of professional identity that students develop (bliss, 2015; figueira-mcdonough, 1993; gilster et al., 2020; hasson & sellers, 2019). finally, social work advocates should be careful in how they articulate recommendations; they need to avoid promising too much if the evidence is not there. the experts did not identify what an appropriate wage rate should be perhaps realizing that increasing wages even to $15 per hour minimum wage would reduce, though likely not eliminate, all of the hardships and challenges experienced by low-wage workers. conclusion social workers play an important role in the fight to increase the wages of low-income workers. regardless of field or form of practice, social workers share a professional and ethical commitment to advancing social and economic justice, mitigating the impacts of poverty, and advocating for policies and programs that would enhance the well-being of individuals, families, and communities. the continued rise of income and wealth inequality in american society adds urgency to taking action to realize these professional commitments. while their contributions may have been overlooked in the past, the covid-19 pandemic has laid bare how essential not just hospital service workers are to health care but how important low-wage workers, such as grocery clerks or delivery people, are to ensuring our personal and societal well-being. as active claims-makers, social workers are uniquely situated to describe the intersection of low wages with a variety of other social issues. the experts testifying exemplified constructing an effective argument by using a combination of emotion and fact in their testimonies and by employing more than one rationale as justification for their assertions. this is a model that can be emulated by all engaged in advocacy. references albelda, r., & shea, j. 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(2018). housing affordability and material hardship: does affordability measurement matter? journal of poverty, 22, 228-247. https://doi.org/10.1080/10875549.2017.1419527 author note: address correspondence to rafael jacob engel, school of social work, university of pittsburgh, 4200 fifth avenue, pittsburgh, pa, 15260. https://doi.org/10.1002/1098-240x(200008)23:4%3c334::aid-nur9%3e3.0.co;2-g https://doi.org/10.1002/1098-240x(200008)23:4%3c334::aid-nur9%3e3.0.co;2-g https://doi.org/10.1080/10875549.2013.775992 https://www.epi.org/files/pdf/147963.pdf https://www.americanprogress.org/issues/religion/news/2009/02/24/5614/progressive-fundamentals-the-dignity-of-work/ https://www.americanprogress.org/issues/religion/news/2009/02/24/5614/progressive-fundamentals-the-dignity-of-work/ https://rmw.nelp.org/wp-content/uploads/sites/2/2016/07/growing-movement-for-15-dollars.pdf https://rmw.nelp.org/wp-content/uploads/sites/2/2016/07/growing-movement-for-15-dollars.pdf https://apps.urban.org/features/wealth-inequality-charts/ https://www.bls.gov/opub/reports/minimum-wage/2017/home.htm https://www.bls.gov/opub/reports/minimum-wage/2017/home.htm https://www.dol.gov/agencies/whd/mw-consolidated https://www.dol.gov/agencies/whd/mw-consolidated https://www.dol.gov/whd/minwage/chart.htm http://apps.pittsburghpa.gov/district9/final.report_of_the_wage_review_committee_12082015_(1)_(1)_(1).pdf http://apps.pittsburghpa.gov/district9/final.report_of_the_wage_review_committee_12082015_(1)_(1)_(1).pdf https://doi.org/10.1080/10875549.2017.1419527 this work is licensed under a creative commons attribution 4.0 international license. adding trauma-informed care at a bereavement camp to facilitate posttraumatic growth: a controlled outcome study irene searles mcclatchey rachel frances raven abstract: background: studies on posttraumatic growth (ptg) among bereaved youth are rare; outcome studies on how to facilitate ptg among this population are even more scarce. objectives: this study examined the addition of trauma-informed care to bereavement interventions to foster ptg in youth attending a weekend-long bereavement camp. method: a total of 105 participants completed standardized measures of posttraumatic growth and posttraumatic stress disorder after which 52 of the participants took part in a camp session. ninety-five of the participants from both groups were posttested four weeks after the camp session. results: multiple regression showed that ptg scores were significantly greater at posttest for the treatment group. no significant changes in ptsd were found in either group, although the presence of dissociative symptoms decreased significantly among campers in the treatment group. conclusions: findings suggest trauma-informed care may increase posttraumatic growth among youth coping with loss. implications for future studies and clinical practice are discussed. keywords: posttraumatic growth; trauma-informed care; childhood bereavement; bereavement camp; posttraumatic stress disorder symptoms many children experience the death of a parent. there were 153 million orphans under the age of 18 worldwide in 2009 (united states agency for international development [usaid], 2012). twelve percent of these were double orphans, having lost both parents. in the united states, approximately 1.9 million children under the age of 18 received death benefits from a parent in 2014 (u.s. social security administration [ssa], n.d.). this estimate does not include children with uninsured, unemployed, or undocumented parents, suggesting that the number of children who have experienced the loss of a parent is higher. the loss of a loved one, though traumatic for anyone, can be especially difficult for children and adolescents. research has shown several short and long-term effects of parental bereavement in children: difficulties in school, developmental delays, higher rates of substance abuse, depression, deviance, increased risk of mortality into early adulthood, and numerous physiological, health, social and psychological issues (dopp & cain, 2012; ellis, dowrick, & lloyd-williams, 2013; li et al., 2014; mcclatchey, vonk, & palardy, 2009). however, data have also consistently presented the potential for positive change following a struggle with trauma, also known as posttraumatic growth, or ptg (kilmer, 2006; tedeschi & calhoun, 1995). this construct helps researchers investigate the transformative effects of distress and has been documented in youth following various traumas: illness, earthquakes, hurricanes, terrorism, and death of a loved one (arpawong, oland, milam, ruccione, & meeske, 2013; jia, ying, zhou, wu, & lin, 2015; kilmer & gil-rivas, 2010; laufer & solomon, 2006; lin et al., 2014). with the negative effects on children who have experienced loss, the ability to recognize, and possibly even encourage posttraumatic ______________________ irene s. mcclatchey, phd, lcsw is an associate professor and director of the master of social work program at kennesaw state university, kennesaw, ga 30144. rachel f. raven is a medical social worker and discharge planner at salude rehab in suwanee, ga 30024. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 349-368, doi: 10.18060/21239 https://creativecommons.org/licenses/by/4.0/ mcclatchey & raven/using tic at bereavement 350 growth through trauma-informed care is imperative (kilmer et al., 2014; steele & kuban, 2011). nevertheless, despite this stated need, there are few outcome studies examining whether trauma-informed care increases ptg in children. the current study is an attempt to fill this gap in the literature. definitions and distinctions ptg, though frequently studied amongst adults, has garnered little attention among children, with no clear standard for measurement in youth and few findings regarding the trajectory of growth (kilmer et al., 2014; kilmer et al., 2009). various studies have examined resilience in children, but researchers have only recently begun scrutinizing the role of trauma-informed care in fostering ptg (hooper, marotta, & lanthier, 2008; malchiodi, steele, & kuban, 2008; steele & kuban, 2011). posttraumatic growth stems from the idea of “cognitive processing,” which is the re-examination of beliefs that occurs after an unexpected trauma (tedeschi, calhoun, & cann, 2007, p. 398). though similar to resilience, ptg differs in that it denotes positive changes following distress, as opposed to “the ability to manage despite trauma” (levine, laufer, stein, hamama-raz, & solomon, 2009, p. 285). posttraumatic growth does not come from the event itself, but rather “the struggle in the wake of the trauma” (tedeschi & calhoun, 1995, p. 157). this struggle is a result of the traumatic events casting doubt on an individual’s pre-trauma perspectives: “shattering their assumptions about the world and forcing a reconfiguration of an individual’s goals, beliefs, and…worldview” (meyerson, grant, carter, & kilmer, 2011, p. 950). in the wake of disaster, there are countless adverse effects, but burgeoning literature in the last two decades has identified the many positive changes associated with posttraumatic growth (kissil, nino, jacobs, davey, & tubbs, 2010; levine et al., 2009; tedeschi & calhoun, 2004). these changes come in many forms, but tend to fall into a few main categories: changed self-perceptions, a different perspective on one’s relationships, a changed philosophy of life, and a deepening of one’s spiritual and existential being (calhoun & tedeschi, 2006). changed self-perceptions include an increased sense of survival, strength, and endurance; altered views concerning one’s relationships including deeper compassion and empathy, greater appreciation of one’s real friends, and an understanding of whom one can rely on; a new worldview as exemplified in modified values and priorities; and proliferation of one’s spiritual life providing a broader view of one’s existence (meyerson et al., 2011). however, not all researchers agree that cognitive change is enough to create personal growth. hobfoll and colleagues (2007) argue that there also needs to be some evidence of behavioral changes to show real posttraumatic growth. other researchers see ptg as having an illusory side in addition to growth (zoellner & maercker, 2006). posttraumatic growth and posttraumatic stress disorder the diagnostic statistical manual (dsm-5, american psychological association [apa], 2013) describes the diagnostic criteria for posttraumatic stress disorder (ptsd) to include having experienced, witnessed, or learned about a traumatic event happening to a advances in social work, spring 2017, 18(1) 351 close friend or family member, or being exposed to “repeated or extreme aversive details of the traumatic event” (p. 271). in addition, symptoms from each of the following clusters need to be present: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. the symptoms have to last more than one month, and cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning” (p.272) not caused by substance abuse or a co-occurring illness. posttraumatic stress disorder symptoms have been shown to be significantly associated with ptg in several studies (devine, reed-knight, loiselle, fenton, & blount, 2010; hafstad, kilmer, & gil-rivas, 2011; jia et al., 2015), with research suggesting that it may play a catalytic role in the posttraumatic growth process among youth (kilmer & gil-rivas, 2010; kilmer et al., 2009). zebrack et al. (2015), in their work with adolescent cancer survivors, found that ptg is not only related to ptsd, but is potentially predicated upon experiencing or re-experiencing some degree of distress. these findings have lead researchers to the two-dimensional stress response perspective (linley & joseph, 2004), which posits that growth and distress, rather than being opposite endpoints on the experiential scale, are instead independent dimensions capable of coexisting within an individual at the same time where “high scores on one dimension do not necessarily imply low scores on the other dimension” (p. 18). other studies have found no relationship between ptsd and ptg (glad, jensen, holt, & ormhaug, 2013; laufer, hamama-raz, levine, & solomon, 2009; phipps, long, & ogden, 2007). posttraumatic stress disorder and grief uncomplicated grief involves feelings of sadness, temporary lack of interest in regular activities, sleep and appetite problems, and inability to focus (friedman, 2012). some researchers have found that children generally do well in the grieving process (brown, sandler, tein, liu, & haine, 2007). other studies show that a fairly large number of children experience ptsd and complicated grief symptoms when losing a parent (mcclatchey et al., 2009). in addition, studies have shown that ptsd is present to an equal degree in bereaved children whether the death was expected or sudden and violent (kaplow, howell, & layne, 2014; mcclatchey et al., 2009). regardless of the number of bereaved children affected by ptsd, for those who are, the ptsd symptoms may interfere with the grief process (cohen, mannarino, greenberg, padlo, & shipley, 2002). ptg among youth although there has been a growing body of literature on ptg among youth following various events such as hurricanes (kilmer & gil-rivas, 2010), natural disasters (cryder, kilmer, tedeschi, & calhoun, 2006), earthquakes (jia, et al., 2015), terrorism (laufer & solomon, 2006), and illness (arpawong et al., 2013), few studies address posttraumatic growth among bereaved children and adolescents. ptg among bereaved youth may manifest as increased caring for and stronger bonds with loved ones and friends (oltjenbruns, 1991), gratitude, and an appreciation for life (brewer & sparkes, 2011). psychological distress and seeking support from adults are predictors of ptg among bereaved youth, but age, gender, ethnicity, time, or seeking support from siblings and peers mcclatchey & raven/using tic at bereavement 352 are not (wolchik, coxe, tein, sandler, & ayers, 2009). kilmer et al.’s (2014) recent literature review, though not an outcome study, discusses the implications of emerging ptg research and offers ways in which professionals can foster this growth in juveniles. current evidence has demonstrated the capacity for children and adolescents to experience ptg and has even uncovered some fundamental components of this process. however, as kilmer et al. (2014) underscore “it is imperative to acknowledge the variability in children’s psychological mindedness or self-understanding and awareness” (p. 507). by not just recognizing this adaptability in youth, but catering specifically to it, practitioners can begin to facilitate ptg through trauma-informed care. using trauma-focused cognitive behavioral therapy (tf-cbt), judi’s house, a nonprofit, community-based grief center, does just that. a ten-week intervention, including individual, family, and group modalities, this program is “designed to help promote emotional regulation and provide psycho-education about trauma and loss, grief reactions and responses, and diverse positive coping strategies” (p. 514). through the use of tfcbt, peer support, reflection and reframing practices, and carefully paced activities, professionals can expand on the judi’s house model and develop innovative strategies for fostering ptg in youth. again, there are no outcome studies on the effectiveness of the program. outcome studies there are few outcome studies on fostering posttraumatic growth among children, with recent literature only providing a glimpse of the possibilities. one study, completed by glad and colleagues (2013) examined the prevalence of ptg among 148 norwegian youth exposed to various traumas. each child was treated using trauma-focused cognitive behavioral therapy in a mental health clinic and was assessed for both ptsd and ptg at preand post-treatment. ptg increased significantly from preto post-treatment, with 15% of participants reporting positive changes at pre-test and 35% at post-test. however, the study lacked a control group. also, although there were clinically significant posttraumatic stress reactions displayed among all of the participants, ptsd was not found to have a substantial relationship with levels of ptg. little, akin-little, and somerville (2011) studied the efficacy of project fleur-de-lis, a program designed to help children in the aftermath of hurricane katrina. the project used a three-tier method, moving from least intensive to most intensive intervention: classroom-camp-community-culture based intervention (cbi), trauma-focused cognitive behavior therapy (tf-cbt), and cognitive behavioral intervention for trauma in schools (cbits). ptg, ptsd, psychosocial functioning, and depression were all assessed throughout the program. marked improvements were made in all areas and on every tier, except for tf-cbt, which did not have a significant effect on levels of depression. however, the sample was small and there was no control group. supporting ptg among bereaved children is an even less explored topic, with only a few researchers addressing this subject. wolchik and colleagues (2009) discussed an analysis of 50 adolescents and young adults who participated in a sub-study of a larger exploration. the respondents, aged 14 through 22, were randomly assigned to either a preventative group program for youth and caregivers or to a self-study program. six years advances in social work, spring 2017, 18(1) 353 after entering the study, participants completed the posttraumatic growth inventory (tedeschi & calhoun, 1996). participation in the family bereavement program, meant to enhance coping and the caregiver-child relationship, did not increase posttraumatic growth levels. both the small sample size and the fact that the intervention did not specifically address ptg were offered as potential reasons for this outcome. to better promote ptg among youth, the researchers recommend offering a therapeutic environment in which children who have experienced trauma can come together to share and discuss positive changes (wolchik et al., 2009). lin et al. (2014) studied 124 children orphaned by aids in central china. though ptg is not specifically mentioned, several themes of posttraumatic growth were addressed in the study. research participants were divided into an intervention group, which included six weekly sessions based on grief theory, and a control group. results demonstrated that children in the intervention group scored significantly higher than those in the control group in grief processing (thinking about the deceased, searching for meaning, having positive memories, talking and expressing feelings about the deceased), future expectations, hopefulness, and control, and significantly lower in trauma symptoms. however, trauma-informed care was not part of the intervention. in summary, few studies look at bereaved children and ptg. of those that exist, the treatment of one did not address ptg specifically (wolchik et al., 2009) and one did not measure ptg although it did measure cognitive growth (lin et al., 2014). the current lack of controlled research on effective ways to facilitate ptg among bereaved youth leads to the question: can adding trauma-informed care to grief interventions facilitate ptg among bereaved youth as suggested by some (kilmer et al., 2014; steele & cuban, 2011)? the current study, based on a subset of data from a larger study, describes, as far as the researchers know, the first controlled outcome study on fostering ptg in bereaved youth with a camp intervention that included trauma-informed care. method participants participants for this study were campers at a weekend-long healing camp for bereaved children and adolescents ages 6 through 17. this purposive sample was selected to examine the effect of adding trauma-informed care among bereaved youth in this non-equivalent comparison group study. bereaved youth were recruited for two separate camp sessions through the school system by a general announcement to school counselors three months before the first camp session and four months before the second camp session. after having registered their children for camp, the parents/guardians were informed of the research project via phone calls and email. a total of 67 campers signed up for the first camp session. the parents/guardians of 52 of the 67 participating campers (78 percent) agreed for their children to participate in the study. a total of 69 campers signed up for the second camp session, and parents/guardians of 54 of these campers (78 percent) agreed to allow their children to participate. all children whose parents allowed them to participate assented to do so except for one child in the second camp session. thus, a total of 105 campers were available for pre-testing. one month later 91 of the campers from the two sessions (87% mcclatchey & raven/using tic at bereavement 354 response rate) were available for post-testing (see figure 1). the 105 campers who completed the pre-test were mostly males (63%); 53% were caucasians; 39% african americans, 4% latino, and another 4% indian and pacific islander. forty-seven percent of the campers had lost a mother, 35% a father, 13% a sibling, and 5% a guardian or grandparent. the campers’ age ranged from 6 to 17 (m=10.72; sd=2.85). the majority of the children and adolescents had experienced a sudden loss (70%). sudden or unexpected causes of death included aneurysm, homicide, heart attack, accidental drug overdose, suicide, stroke, car and motorcycle accidents, sids, pneumonia, drowning, and asthma. expected causes of death included cancer, liver failure, end stage heart or kidney disease, chronic heart failure, chronic obstructive pulmonary disease, and alcoholism. time since death ranged from one month to 57 months (sd=11.30) (see tables 1 and 2). figure 1. flow of participants for the study’s procedures, assignment, follow-up, and analysis. notes. ptg=posttraumatic growth; ptsd=posttraumatic stress disorder; follow-up: both groups post-tested at same time four weeks after treatment group attended camp assessed for eligibility (n=136) enrollment assignment: both groups pre-tested at the same time after assignment to group before treatment group attended camp assigned to treatment group (camp) (n=52); received treatment (n=52) lost to follow-up (n=12); did not respond to emailed surveys; follow-up calls not returned; phones disconnected; children out of town for summer break analyzed (n=40 for ptg; n=40 for ptsd). excluded from analysis (n=0 for ptg; n=0 for ptsd assigned to comparison group (n=53) did not receive comparison manipulation (n=53) waitlisted to attend a later camp lost to follow-up (n=2) did not assent to do post-test analyzed (n=51) for ptg; n=48 for ptsd). excluded from analysis (n=0 for ptg; n=3 for ptsd) missing data on several ptsd items excluded (n=31) because parents did not give consent for study (n=30); child declined consent (n=1) advances in social work, spring 2017, 18(1) 355 table 1. gender, race, ages, type of loss, type of death, and ptsd dissociative subtype for treatment and comparison groups treatment group comparison group demographics n % n % 2 df p value gender female 21 40 18 34 0.46 1 .50 male 31 60 35 66 ethnicity caucasian 34 65 22 42 6.01 1 .02 african america 15 29 26 49 hispanic 3 6 1 2 indian 3 5 pacific islander 1 2 age groups [mean (sd)] 10.73 (2.72) 10.72 (3.00) 6-11 32 62 34 64 .08 1 .78 12-17 20 38 19 36 range 6-17 6-16 type of loss mother 18 35 31 58 father 20 38 17 32 sibling 12 23 2 4 g gparent 2 4 3 6 type of death sudden/violent 37 71 36 68 .13 1 .72 expected 15 29 17 32 ptsd dissociative subtype yes 29 56 28 58 no 23 44 20 42 .07 1 .80 notes. g gparent = guardian grandparent; ptsd = post-traumatic stress disorder. table 2. independent sample t-tests of mean differences in time since loss, ptg and ptsd index scores for treatment and comparison groups treatment group comparison group measure m sd n m sd n t df p value months 12.25 11.07 52 9.75 11.50 53 1.13 103 .26 range 1-48 1-57 ptg scores 30.40 6.46 52 27.21 7.08 52 2.33 102 .02* ranges 13-40 10-40 ptsd scores 24.85 17.64 52 26.75 19.45 48 -.51 98 .61 range 1-71 0-84 notes. ptg = posttraumatic growth; ptsd = post-traumatic stress disorder *significant at alpha ≤ .05 measurements posttraumatic growth. the researchers used the revised posttraumatic growth inventory for children (ptgi-c-r) (kilmer et al., 2009) to measure posttraumatic growth. this inventory is a 10-item self-report measurement revised from cryder et al.’s (2006) mcclatchey & raven/using tic at bereavement 356 posttraumatic growth inventory for children (ptgi-c). the ptgi-c-r assesses five ptg domains, including new possibilities, relating to others, personal strength, appreciation of life, and spiritual change using a 4-point scale with 1 representing “no change” and 4 representing “a lot.” questions posed in the different domains include “i now have a chance to do some things i couldn’t do before,” “i feel closer to other people (friends or family) than i used to,” “i can now handle big problems better than i used to,” “i appreciate (enjoy) each day more than i used to,” and “i understand how god works better than i used to.” the cronbach’s alpha for the ptgi-c-r in kilmer et al.’s study (2009) ranged between 0.77 and 0.81. for the current study cronbach’s alpha was 0.83 at pretesting, and .89 at post-testing. posttraumatic stress disorder symptoms. to measure posttraumatic stress disorder symptoms, the researchers used the fifth section of the university of california at los angeles (ucla) ptsd reaction index for dsm-5 (pynoos & steinberg, 2014). this is a 27-item self-report measure of thoughts, feelings, and behaviors that represent posttraumatic stress disorder symptoms linked to the dsm-5 (apa, 2013). the respondents rate items as they pertain to the past month, such as “i am on the lookout for danger or things that i am afraid of (like looking over my shoulder even when nothing is there)”, “i have trouble concentrating or paying attention”, “i have thoughts like, ‘the world is really dangerous’”, and “i have trouble going to sleep, wake up often, or have trouble getting back to sleep,” as none, little, some, much, or most. in addition, the scale contains 4 items to assess dissociative subtype, such as, “i feel like things around me are not real, like i am in a dream.” psychometric properties of the ucla ptsd reaction index for dsm-5 are not available but studies are currently being conducted (a. steinberg, personal communication, december 29, 2015). the ucla ptsd index for dsm-5 is created similarly to the ucla ptsd reaction index for dsm iv (steinberg & brymer, 2008). the ucla ptsd reaction index for dsm iv includes three ptsd symptom clusters (re-experiencing, avoidance, and arousal) whereas the ucla ptsd reaction index for dsm-5, in accordance with the dsm-5, includes a fourth cluster – negative alterations in cognitions and mood (apa, 2013; pynoos & steinberg, 2014). when scoring the scale, a score of 3 or 4 indicates that the symptom is present except for items 4, 10, and 26 where a score of 2 or higher indicates presence of the symptom. one or more dissociative symptoms indicate dissociative subtype. in the current study cronbach’s alpha was .90 at pre-testing and .92 at post-testing. procedures after the local university’s institutional review board gave approval for the study, the parents/guardians of campers, who had been recruited through the school system, were informed of the study by a phone call followed by an email to those who indicated interest in the study. the researchers attached a consent form to the email asking for the parents’/guardians’ permission for their children to participate in the study. the parents/guardians of the first camp session (camp a) who agreed for their children to participate (treatment group) brought signed consent forms to the camp when arriving to drop their children off for the weekend camp. graduate social work students, who had been trained in research procedures and the test instruments, asked the campers who had parental advances in social work, spring 2017, 18(1) 357 consent if they would assent to take part in the study. the graduate students found private spots to administer the instruments to those who assented. the campers then participated in the weekend long camp. meanwhile, campers who had signed up for the second camp session (camp b), to take place four weeks after camp a, served as the comparison group. the parents of the children in the comparison group had been asked to mail signed consent forms to the researchers in pre-stamped self-addressed envelopes. graduate social work students contacted these campers the week preceding camp a via email with an attached assent form. if the youth assented to participate in the study, they were directed to a qualtrics link (a software tool for the university’s researchers to use for on-line surveys) and were asked to assent once more on the site. they then completed the instruments using qualtrics. four weeks after camp a the campers in the comparison group arrived to camp b. upon their arrival, the graduate social work students administered the second testing— before the campers started participation in camp. in the week leading up to camp b, the campers from camp a were emailed a link to the instruments on qualtrics and were asked to complete the second testing. thus, the campers attending camp a (treatment group) were pre-tested right before camp a and post-tested four weeks later during the week immediately prior to camp b. the comparison group was pre-tested during the week prior to camp a and post-tested right before camp b four weeks later as they arrived to camp but prior to participating in camp (see figure 1).therefore, the comparison group did participate in camp, but only after the study was concluded. the intervention the intervention, developed by a social worker, consisted of a therapeutic weekend stay at a camp. the participants arrived on a friday afternoon and stayed until sunday afternoon. during the weekend, they participated in several recreational camp related activities such as a ropes course, canoeing, rock climbing, archery, etc. they also took part in grief-related activities such as poetry writing, journaling, arts performances, a balloon release, and a memorial service. in addition, the campers were divided into groups of six to eight campers according to age and developmental levels to receive six counseling sessions based on trauma-focused grief interventions. the camp follows the four assumptions and six principles of trauma-informed care as described by the substance abuse mental health services administration (samhsa, 2015). the four assumptions include basic realization of trauma and its affect; ability to recognize the signs of trauma; a response to trauma; and a pursuit to resist re-traumatization. the six principles stress safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, and awareness of cultural, historical, and gender issues. this approach is a philosophy that guides the camp agency in all of its aspects and for all its shareholders, such as campers, camper families, staff, volunteers, and funders. it is thus far more than a particular intervention. the counselors and co-counselors, the majority of whom were professional social workers and master of social work students, received extensive training in the approach and were provided with a scripted manual that integrates best practices in trauma intervention. these techniques included psycho-education, feeling identification, exposure, stress inoculation techniques, mindfulness, and cognitive mcclatchey & raven/using tic at bereavement 358 behavioral therapy. the intervention was based on work by cohen and mannarino (2004) and pynoos, steinberg, and wraith (1995). analysis and results the treatment and comparison groups the researchers first examined the treatment and comparison groups to see if they were comparable. chi-square analyses revealed that the groups were similar in regards to demographic variables such as gender, age group (6-11; 12-17), type of loss (mother, father), and type of death (expected, unexpected). however, the two groups were different in regards to ethnicities, such that the treatment group had fewer black participants than the comparison group, 2(1)=6.01, p=.02. independent samples t-test showed that the two groups were similar regarding time since loss and mean ptsd scores at pretest. the treatment group had higher ptg scores at pretest, t(102)=2.33, p=0.02. the campers who dropped out of the study at post-test were not different from those who remained in the study in regards to age group, gender, ethnicity, loss, mode of loss, time since loss, ptg and ptsd pre-test scores. ptg and ptsd scores after camp to examine whether ptg scores were different after the trauma-informed camp-based intervention, the researchers used a regression model to look for differences in total ptg scores between participants in the two camps at post-test controlling for total ptg scores at pre-test. several extraneous variables were added to the model to look for possible predictors of ptg but also to control for differences across the two camps. these variables included age groups (6-11, 12-17), ethnicity (white versus non-white), gender, time, type of loss (parental versus non-parental), and mode of loss (sudden/violent versus expected). the children who attended camp had statistically significantly higher ptg scores than the children in the comparison group at post-test (tx= -2.598; p=0.04). none of the covariates entered were significantly linked to ptg scores (see table 3). in addition, in a separate regression model, there was no relationship detected between ptsd and ptg scores (p=.63). table 3. regression coefficients model results for posttraumatic growth outcome posttraumatic growth outcome (n=91) variable b se p value f r2 camp -2.60 1.27 0.04* 7.55 0.42 age-group -1.67 1.26 0.19 ethnicity -0.95 1.28 0.46 gender 0.26 1.29 0.84 time 0.06 0.06 0.33 lossa -1.26 1.57 0.43 mode of lossb -0.78 1.28 0.54 ptg pretest scores .53 .09 <0.001 notes. ptg = posttraumatic growth; aparental versus non-parental; bsudden versus expected; *significant at alpha  .05 advances in social work, spring 2017, 18(1) 359 a similar regression model was used to examine the level of ptsd symptoms after camp. total ptsd scores at post-test were entered as the dependent variable and camp was entered as the independent variable. total ptsd scores at pre-test were entered as a covariate. the same extraneous variables entered in the first regression model, such as age group, ethnicity, gender, time, type of loss, and mode of loss, were also included in the model. the children who attended camp had lower total ptsd scores than the children in the comparison group. however, the difference was not statistically significant (tx=3.31; p=.34). none of the covariates were significant predictors of ptsd scores. furthermore, the researchers studied if participating in the camp decreased the possibility that the children would continue to experience dissociative symptoms. at the post-test, 14 campers (35%) in the treatment group experienced dissociative symptoms compared to 29 (56%) at the pre-test. in the comparison group, 32 campers (67%) experienced dissociative symptoms at post-test as compared to 28 (58%) at the pre-test. chi-square showed that this difference between the two groups at the post-test was statistically significant with children not attending camp having higher odds of continuing to experience dissociative symptoms than those children who did attend camp, 2(1)=8.77, p<.01. to investigate whether there were any differences in outcome among various demographic groups, a series of paired t-tests (ptgposttotal-ptgpretotal and ptsdposttotal-ptsdpretotal) were conducted on the treatment and comparison groups. the results indicated that there was a statistically significant increase in ptg in the treatment group for caucasian children, t(24)=3.30, p<0.01, but not for non-white campers; for those who had lost a father, t(14)=3.26, p=0.01, and among those participants who had lost a family member to sudden/unexpected loss, t(27)=3.11, p<0.01 (see table 4). there was also a statistically significant decrease in ptsd symptoms among males in the treatment group, t(22), p<0.04. none of these statistical changes were detected in the comparison group. table 4. paired samples t-test posttraumatic growth: treatment group paired differences 95% confidence level n mean sd lower upper df t p value power ptg overall 40 2.60 4.58 1.13 4.07 39 3.59 0.001* 0.95 whites 25 3.28 4.97 1.23 5.33 24 3.30 0.003* 0.91 non-whites 15 -1.47 3.74 -3.54 0.60 14 -1.52 0.15 0.24 females 16 3.13 4.12 0.85 5.42 15 2.94 0.01* 0.84 males 25 2.28 4.89 0.26 4.30 24 2.33 0.03** 0.65 father loss 15 4.40 5.22 1.51 7.29 14 3.26 0.01* 0.90 mother loss 12 -0.83 4.42 -3.65 1.98 11 -0.65 0.53 0.11 sibling loss 11 -1.45 3.11 -3.54 0.63 10 -1.55 0.15 0.30 sudden loss 28 2.86 4.87 0.97 4.74 27 3.11 0.04* 0.87 expected loss 12 -2.00 3.98 -4.53 0.53 11 -1.74 0.11 0.38 *significant at α ≤ .01. **significant at α < .05. mcclatchey & raven/using tic at bereavement 360 to examine whether camp had a different outcome for those campers who had experienced a sudden/violent loss versus those who had experienced an expected loss, a regression model using post-ptg scores as the dependent variable and camp, pre-ptg scores, type of death, and the interaction between camp and type of death as independent variables. the camp-type of death coefficient was not significant (p = .815). thus, camp had the same effect on the ptg scores for the two types of death. discussion in this study, the researchers examined the effects of a bereavement camp using trauma-informed care on posttraumatic growth and posttraumatic stress disorder symptoms among bereaved youth. to the authors’ knowledge, this is the first controlled outcome study of a program for bereaved youth applying trauma-informed care to examine its effects on ptg levels. the findings showed statistically higher levels of posttraumatic growth among youth participating in camp as compared to those who did not take part in camp. the results coincide with previous findings in pre-experimental studies examining ptg among youth that had experienced trauma (glad et al., 2013; little et al., 2011). ptsd symptoms decreased, but not to a statistically significant degree. however, the number of campers attending the treatment camp experiencing dissociative symptoms was statistically significantly lower after attending camp compared to the number of campers in the comparison group. in addition, the study showed that the effects of camp on ptg were statistically significant among white youth but not among non-white youth. it may be that the lack of diversity in counselor composition at camp did not allow for the same bonding between african american campers and counselors as for caucasian participants. schafer (2007) found that similarities, such as ethnicity, between the counselor and camper are important to a positive camp experience. it is also possible that different ethnicities react differently to trauma and this warrants more exploration. the change in ptg was also statistically significant among those campers who had lost a father but not for those who had lost a mother. for many of the families attending this camp, the deceased fathers were the primary providers. a new financial situation may have created extra struggles for those who lost a father. however, coming to camp and meeting others with similar struggles, may have given them a sense of increased strength and endurance (wolchik et al., 2009). in the current study, campers who had experienced a sudden loss also experienced a statistically significant increase in ptg levels but this was not the case for those campers who had experienced an expected loss. losing a parent suddenly and/or in a violent manner may create struggles for bereaved children and families, such as ruminations and feelings that the death could have been prevented (currier, holland, & neimeyer, 2006). this may in turn create feelings of guilt (nader, 2001). such feelings of guilt are highlighted at camp in the cognitive behavioral therapy (cbt) group counseling sessions. the use of cbt may help those with sudden loss to be able to let go of their guilt and create the noted posttraumatic growth in the group of campers who experienced a sudden loss. advances in social work, spring 2017, 18(1) 361 posttraumatic stress disorder symptoms declined to a statistically significant level among males in the treatment group but not among females. males oftentimes have a more difficult time than females to express emotions (chaplin & aldao, 2013). at camp, males are together with other children and teens their own age, who have had similar traumatic experiences. such peer support may facilitate processing, an important part of treatment for ptsd, and may have decreased their ptsd symptoms. limitations although the treatment intervention described in this study is cost-effective, convenient for participants’ families, and demonstrates positive findings, there are some limitations that need to be considered when interpreting the results. first, despite the fact that the quasi-experimental design controls for most threats to internal validity (campbell & stanley, 1963), there are some concerns including the hawthorne effect and the placebo effect. the hawthorne effect, also known as the observer effect, occurs when participants alter their responses or behaviors simply because they are being observed (mccambridge, witton, & elbourne, 2014). it is possible that the campers knew why they were being observed and responded in kind. the placebo effect occurs when participants describe themselves as feeling better because of beliefs about the treatment (rogers, 2014). the campers knew they were at a healing camp for bereaved youth and may have had preconceived expectations about the treatment rather than have experienced actual changes. further limitations include a lack of randomization, limited diversity among the participants, and a shortage of information pertaining to possible intervening variables. while the study did involve a comparison group, due to cost factors and various ethical concerns, the researchers could not incorporate a randomized control group. the treatment and comparison groups were different on two variables – ethnicity and ptg pretest scores. a selection-history threat is a possibility, i.e., some event other than the treatment took place that the treatment group reacted to, but not the comparison group (trochim, 2006). regression to the mean also needs to be considered. in addition, it is possible that if the treatment group had included a more diverse ethnic group, the results would have been different. furthermore, since the children and adolescents referred to the camp may be those who are struggling with their loss as opposed to children who are ostensibly coping well, the results of the study cannot be generalized to all bereaved youth. moreover, some intervening variables, such as level of relationship intimacy with the deceased and/or surviving parent/guardian or social supports, remain unknown. the subgroups examined were small and the statistical power insufficient to identify small differences between groups. finally, no method for family-wise error was used. therefore, care needs to be taken when drawing conclusions in regards to the effectiveness of camp. even if camp did influence posttraumatic growth, it is not known if this was due to the addition of trauma-informed care, or whether it was due to other aspects of camp. it may be that just sharing similar experiences with other campers in a therapeutic environment, as suggested by kilmer et al. (2014), created the positive change. additionally, having several social work students administering the instruments leaves questions about interrater reliability. it is also unknown what participants’ prior treatment experiences were. mcclatchey & raven/using tic at bereavement 362 finally, the authors of the ucla ptsd reaction index for dsm-5 (pynoos & steinberg, 2014) have not shared the instrument’s psychometric properties, making the measure’s convergent validity with ptsd symptoms unknown. in spite of and because of these limitations, there are significant implications for future research and practice. implications for future research and practice the findings of this research showed that those campers who had lost a father experienced ptg to a stronger degree than those who had lost a mother. this may be due to financial struggles. it would behoove researchers to include income or socioeconomic status (ses) in future studies to see if it has an impact on ptg. white campers in this study showed more growth in ptg than non-white campers. the possible impact of counselorcamper ethnicity on the outcome of ptg deserves examination. there are also other variables that were not addressed in this study. social support plays an important role in grief resolution among children (sveen, eilegard, steineck, & kreicbergs, 2014), but current studies on its impact on ptg are inconclusive (kilmer & gil-rivas, 2010; yu et al., 2010). future research may want to explore how social supports impact posttraumatic growth. furthermore, studies with more ethnically diverse participants are needed to examine the relationship between ethnicity and ptg. it would also be important to follow up with campers some time after camp to ascertain whether gains are enduring or temporary. finally, since there was no relationship between ptsd symptoms and ptg, is trauma necessary for growth after a death? or is horowitz (2010) correct in claiming that any successfully completed grief creates growth? one could argue that any bereavement creates a struggle of sorts, even if the death was not traumatic. as meyerson et al. (2011) state, the event is “shattering their assumptions about the world and forcing a reconfiguration of an individual’s goals, beliefs, and…worldview” (p. 950). it is the struggle that creates ptg (tedeschi & calhoun, 1995). is trauma-informed care and trauma interventions necessary to create this growth? in this study, ptsd symptoms did not decrease significantly, except among males; however, the possibility that the children would continue to experience dissociative symptoms did decrease significantly. in addition, children who had experienced a sudden death had a significant increase in ptg. these findings, and kirwin and hamrin’s (2005) claim that death of a parent is traumatic for any child, would support the use of trauma-informed care. however, more research is needed to examine the relationship between ptsd symptoms, ptg, and grief. the results from this study indicate that adding trauma-informed care can be a beneficial approach to guiding children and adolescents through grief and can be done is various settings such as in individual counseling sessions and group settings in schools, hospitals, and hospices. the camp setting used in this study is a convenient setting for most families, who bring their children to the camp setting for one weekend. more agencies that provide services to bereaved youth may want to explore the possibility of establishing weekend camps for their clients. the results also suggest the importance of having counselors from various ethnicities, who are culturally competent to adequately serve all bereaved children and adolescents. finally, it is recommended that social workers, counselors, and other professionals working with bereaved children and adolescents familiarize themselves with and educate themselves about trauma-informed care. bereaved advances in social work, spring 2017, 18(1) 363 children and adolescents deserve the guidance of well-informed professionals. references american psychological association [apa]. 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(2006). posttraumatic growth in clinical psychology: a critical review and introduction of a two component model. clinical psychology review, 26(5), 626-653. doi: https://doi.org/10.1016/j.cpr.2006.01.008 author note: address correspondence to: dr. irene mcclatchey, program director, department of social work and human services, kennesaw state university, 1000 chastain road, kennesaw, ga 30144, 470-578-6630, imcclatc@kennesaw.edu https://doi.org/10.1002/pon.3585 https://doi.org/10.1016/j.cpr.2006.01.008 mailto:imcclatc@kennesaw.edu microsoft word 02 fitch_18291_conceptual_framework_06-25-15_au_ce.docx ______________  dale fitch, phd, mssw, is an associate professor, school of social work, university of missouri. he is also the editorin-chief for the journal of technology in human services. copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 15-30 a conceptual framework for information technology in social work practice dale fitch abstract: this article describes how information systems research in the human services can be facilitated with a conceptual framework that addresses the fundamental roles of data, information, and knowledge in understanding organizational information systems. using methodologies originating in information systems and organizational research, the resulting conceptual framework explains how social work researchers are to understand information technology from the perspectives of clinical social work, supervision, social work administration, policy, and community collaborations. the article concludes by reminding social work researchers and educators that given that we have done little to educate our students on the differences between data, information, and knowledge, and to educate them based on research performed in our human services agencies, our professional practice relative to technology will not advance in the 21st century. key words: data, information, knowledge, information systems this article describes one researcher's academic journey that has focused on better understanding the roles of data, information, and knowledge and how those three entities are captured in human services information systems. as such, it may be considered a case study of what has been learned along the way thus the first person voice is used throughout. while some may consider it to be unorthodox to do so in a conceptual paper, this perspective may largely reflect the behavioral social science research paradigm dominant in social work. in contrast, much information systems research originated in the ethnography field as researchers attempted to understand the lived world of information technology users. in that vein, the use of voice, both first person and second person, was felt to be instrumental in better understanding the divergent perspectives oftentimes encountered with technology artifacts thus the use of first person voice should in no way be perceived as decreasing the rigor of that research (boyle & parry, 2007; robey & markus, 1998). after earning my mssw in 1984, i began my career as a caseworker in a large urban homeless shelter followed by positions as a therapist in a residential treatment center working with emotionally disturbed, adjudicated adolescents, and later with convicted sex offenders. interspersed were positions as a medical social worker at two university teaching hospitals where i focused on child abuse and service coordination for children with neurodevelopmental disabilities. thus my grounding in social work practice predated the internet age and much that is now referred to as information technology. nevertheless, i had a keen understanding of the role of “information” and its importance in social work. with the arrival of personal computers and the internet, and on realizing the possibilities of storing information in a digital format (i.e., no longer solely on paper), i began to understand what could be done fitch/conceptual framework 16 with that information. unfortunately, my practice also let me know what happens when information is not communicated. my position as a medical social worker led to my participation on several child fatality teams. more often than not, child fatalities were marked by a breakdown in information not communicated between individuals who operated in complex systems. interwoven with these individuals were the multifaceted interventions for children and families identified as high risk or receiving tertiary-level preventive services that extended across mental health, substance abuse, and/or domestic violence. in all of these circumstances, clinicians and program managers depended on the quality of information available to them at the time to make critical decisions. therefore, when i made the choice to pursue a research career after fifteen years of practice, the obvious path was for me to focus on improving the information systems used across mental health and social services through research on how organizations use information to facilitate their functioning and ideally organizational decision making whether the decision is made by a line worker, agency leadership, or an interagency community group. this article will describe how information systems research can be facilitated with a conceptual framework and conclude with implications for practice and research. conceptual framework as i began to explore information systems, i focused my research on three primary components: data, information, and knowledge (maier & hädrich, 2011; quinn & fitch, 2014). i used an ethnographic approach (lee, liebenau, & degross, 1997) to understand how human services organize their systems of information largely within a "soft systems" methodology (checkland, 1999). conceptually this would appear as: figure 1. data, information, knowledge conceptual framework. my early research revealed that agencies have multiple systems of information or ways of informing agency members. the explicit information system is best known as the system that contains information about the clients served by the agency and accessed through a computer. in addition, the implicit systems of information were paper records kept in file folders, post-it notes, agency forms, evaluation reports, and the information shared at shift change or staff meetings,. to make sense of this information and the underlying data, i needed theories and methodologies suitable for the task. over the years i have used checkland and holwell’s information, systems and information systems (1998), and checkland’s systems thinking, system practice (1981), which led to beer’s diagnosing the system for organizations (1985) and ulrich’s beyond methodology choice: critical systems thinking as critically systemic discourse (2003). taken together, these theories and methodologies have allowed me to diagnose agency systems data:  comprised of  datum, e.g., 1, 2, a,  b…  information:  labels applied to  data to inform, e.g.,  1 = yes, 2 = no  knowledge:  uses information to  answer a question, e.g.,  14 people indicated ‘yes’  and 10 indicated ‘no’  advances in social work, spring 2015, 16(1) 17  to find where in the process flow of going from data to information to knowledge a breakdown has occurred and to recommend solutions that are systemic (i.e., they not only address the problem at hand but also address design issues in the systems of information that could facilitate overall organizational decision making). collectively, my research has not only focused on information systems at the organizational level, but it also extends down to the ways: 1) data are recorded, and 2) expanded upward as information to address, 3) knowledge management within a learning organization, and, ideally, to 4) interagency systems. across these levels, my research challenges not only who can be involved in controlling these systems but also addresses who and what can be served by these systems. as outlined in the discussion that follows, misconceptualizations for any of these components either in use or in the design of information systems can hamper optimal organizational functioning. before describing how my research agenda has integrated the use of beer’s, checkland and holwell’s, and ulrich’s frameworks, each section will begin with a review of prior research to better understand how we have reached today’s common understanding of information systems in human services agencies and how that understanding may or may not serve the furtherance of more social work educators having research agendas that largely focus in this one area. data on the one hand, data are the most fundamental units of an information system and are often the element most overlooked. on the other hand, data are the primary focus of social work research whether they are quantitative or qualitative. for example, all social work research texts build upon the centrality of data in being able to answer research questions. oftentimes linked to the concept of a variable (information), researchers and educators spend considerable time and energy discussing data as a way to operationalize and measure concepts of interest. fortunately some social work scholars, most notably epstein, have tried to point out that our human services agencies collect a vast amount of data and that some of these data are amenable to research purposes (e.g., epstein, 1977, 2001; freel & epstein, 1993; grasso & epstein, 1993; joubert & epstein, 2005; schoech, quinn, & rycraft, 2000). while the importance of entering data into statistical software is valued while obtaining a bsw or msw degree, we devalue other forms of data by assigning them to paper or leaving them unstructured in a ms word document. doing so leaves the informing capacity of data with limited use unless they are manipulated again. the need for capturing this data digitally has been noted for several decades (e.g., schoech & arangio, 1979; semke & nurius, 1991), especially when doing so may facilitate organizational processes (coursen & ferns, 2004). for example, i have worked in and observed many agency settings in which staff still use tally sheets to record client outcomes or copy and paste data from one form to another, over and over, for different reports, despite the presence of information systems in the agency (fitch, 2014). this seeming disconnect between the need to capture data digitally and what many social workers experience when using their agency information fitch/conceptual framework 18 systems is quite perplexing. part of this disconnect comes back to how social work researchers and educators conceptualize the difference between data and information. colloquially, and sometimes professionally, people interchange the use. for example, it is not unusual to find these two sentences in the same paragraph: "…enters that information in a spreadsheet…" and "...involves the organization of data in columns." technically, data are entered into spreadsheets in which the column headings convey the information about what the data concern. some of this conflation might be attributable to early text in this area before the conceptual differences were more clearly identified. for example, the description of information technology applications in geiss and viswanathan’s (1986) edited text largely focus on shifting away from analog (paper, folders, etc.) to digital ways of handling data without explicating the larger information system that would need to align this data with organizational processes in an information system. in some of those situations, after analyzing the information and knowledge needs of the agency, i have worked with the agency database administrator to either create new structured data fields (e.g., last name, first name, address) in the agency’s information system and/or convert existing unstructured data fields (e.g., text or comment boxes) into structured ones. the use of data to inform and aid in organizational decision making will be discussed in the following section. my most recent project focusing on data (fitch, yoo, & mosa, 2013), with collaborators from engineering and computer science, involves the use of natural language processing to retrieve information from child and elder abuse case narrative data (i.e., text entered in a comments box on a form). this project stems back to my early research where i found that case narrative data were the most informative for abuse investigators and case managers (fitch, 2006). unfortunately, as unstructured data (i.e., free text), they are not amenable to data retrieval techniques available for structured data. however, in recent years the text-analysis tools available to researchers who do natural language processing have grown, so i began forming relationships with agency partners four years ago to secure access to case record data. the implications of this analysis are discussed in the next section, but the research in this one project hinges on the capacity to analyze massive amounts of text data–465,939 case records involving 9,057 children and families and a total vocabulary of 13,878,599 words. acquiring text analysis skills using r (wild, 2014) has taken some time, but the payoffs will be substantial as outlined in the following sections. information since information is so ubiquitous, how it is formed (data) and turned into knowledge is sometimes overlooked. fortunately, beer’s (1985) viable system model, based on organizational cybernetics, provides a perspective on information as a component of organizational functioning that has been most helpful. in sum, information provides the means for communication up and down organizational levels as agencies seek to meet clients’ needs and survive in ever-changing environments. however, it is in the unpacking of those two processes–communicating up and down organizational levels, advances in social work, spring 2015, 16(1) 19  and the three actors–clients, agencies, and environment–that the disconnects between data, information, and knowledge are likely to occur. existing literature in this area seems to cover all of these processes and actors and many extend over several decades (e.g., cnaan & parsloe, 1989; glastonbury, 1993, 1996; glastonbury, lamendola, & toole, 1988; lamendola, glastonbury, & toole, 1989; rafferty, steyaert, & colombi, 1996; steyaert, colombi, & rafferty, 1996). other research has focused on applications in hospital settings (auslander & cohen, 1992), child welfare (benbenishty & oyserman, 1991, 1995; benbenishty & treistman, 1998; oyserman & benbenishty, 1997), income support (dearman, 2005), and school settings (redmond, 2003). although some of these texts provide a methodology for information system design, how social work researchers think about information in its relationship to data and knowledge, while accounting for the communication needs among the actors, is usually underserved. that is, while doing a competent job describing how a particular application or system serves a need, how that system might fit into a larger conceptualization of data, information, and knowledge needs (i.e., the environment), is addressed less often. for example, missing from this literature is research in the larger information system field that addresses critical perspectives (adam, 2002; ulrich, 2003) and the issue of power in agency settings manifested through information system design (markus, 1983; wilson, 1997), which is particularly important due to fundamental power imbalances between clients and agencies and human services agencies and other organizations in the environment. for example, organizational dictates, by definition, flow down communication channels; returning communication channels are much more prone to blockage. the extent to which this upward communication is trying to convey information derived from practice data is the extent to which these data are now lost to the organization. using beer’s model, i have described information’s use by designing and implementing an online referral system for an interagency collaboration, creating forms that delivered data entered once to multiple users for multiple purposes, as a means to differentiate program functioning in a multi-program setting. i have also described the role of information related to the acquisition of competencies or skills in an educational setting, as the linchpin between evidence-based practice and practice-based evidence, and as a feature of privacy and communication for youth in foster care. each of these projects centralized the data-information-knowledge continuum prior to design of any specific application. doing otherwise may have overlooked an important actor or the ability to communicate up and down organizational structures, especially when the organizational structure is an interagency collaboration. returning to my natural language processing project, once we had a data management process in place for the 13,878,599 words (information), we needed a way to organize the words into a controlled vocabulary that could capture various types of abuse (e.g., physical abuse, sexual abuse or neglect). this task required us to produce a taxonomy from the vocabulary terms by arranging them into a hierarchy of supertypesubtype relationships (e.g., words associated with various forms of physical abuse) and then building a thesaurus that combined the controlled vocabulary terms with the taxonomy to capture the associated relationships between the supertype-subtype fitch/conceptual framework 20 concepts. after developing the category terms, the dataset contained 582,132 words; these words were further consolidated based on conceptual meanings resulting in 4,755 terms. how these terms are helpful for a child or elder abuse investigator will be discussed in the next section. knowledge beer’s viable system model asserts that any information system should be assessed by whether it facilitates acquiring knowledge because a viable system is one which can survive changing environments by having practices in place that insure the flow of information, beginning with data, up through the agency, processing that information, and then implementing operational changes via feedback back down through the levels of the agency. see figure 2. figure 2. data, information, knowledge feedback loop. making sure this feedback loop is operational is an essential aspect of systems theory in that all of the components are dependent upon feedback in order for the system to perform as designed. for example, referring back to figure 1, once we know 14 people indicated "yes" and 10 people indicated "no," it would be perfectly reasonable to use a feedback loop to ask the question why? doing so might entail gathering additional data organized via information such that the question might be answered. from an agency-based perspective, we can see clinicians making treatment decisions, program managers deciding on the design of their programs, and the executive leadership for the agency needing to decide the types of programs they are offering as an agency. all of these decisions are based on information comprised of data entered into the agency's information system and hopefully fed back to the user in a timely manner for their decision-making processes. on the one hand, most likely due to the dearth of information systems in the human services that function in a way that meets all of these decision-making needs, there is a concomitant lack of empirical social work research in this area. on the other hand, our profession has a tremendous amount of social work research taking place, evidenced by several journals and conferences, which is purportedly producing knowledge. the extent to which our research products are de-coupled from the information systems social work data  information  knowledge  feedback loop  new knowledge state results in new questions  necessitating either new monitoring of existing  data or generating new data  advances in social work, spring 2015, 16(1) 21  practitioners use is the extent to which we may be experiencing a fundamental feedback breakdown in the data-information-knowledge continuum in our profession. fortunately, some social work researchers have broached this topic over the years, most notably monnickendam (e.g., monnickendam, savaya, & waysman, 2005). to guide other social work researchers in this area and extend conceptual frameworks beyond beer, information systems and other researchers have approached this topic via decision support systems (ba, stallaert, & whinston, 2001; eom, 2000; mohan, muse, & mcinerney, 1998), decision-making (bharwani, 2006), design science (carlsson, 2007), and knowledge management (henry, 1974). indeed, maier and hadrich’s (2011) text on knowledge management systems covers the fundamentals of knowledge management from the inception of data, to information, and on to the culmination of knowledge that impacts organizational functioning. they specifically note that feedback is essential to improving the “quality of information” (p. 357) within the organization. while not delving into the depths of "how to," this text more than compensates by describing the broad range of data and information sources modern organizations must manage and use. many of my projects have used this conceptualization to understand agencies and how they work. specifically, i used organizational cybernetics to assess whether a public child welfare agency is viewed as a learning organization to the extent it leverages the skills gained by title iv-e graduates (fitch, watt, & parker-barua, 2014). my research was also the first study to use organizational cybernetics as the axial coding scheme for the qualitative analysis of the focus group data. my other applications of organizational cybernetics involve its use in understanding the need to balance the flow of evidencedbased practice data with practice-based evidence data (fitch, 2014). in this particular application, clinicians made treatment decisions, program managers decided on the design of their programs, and the executive leadership for the agency decided on the types of programs they were offering as an agency. all of these decisions were based on information comprised of data entered into their information system. finally, referencing the natural language processing project, the goal is to develop a system that will go by the moniker safety (semantic analysis for efficient text yield.) our next step will be to link the information produced from the vocabulary and taxonomy to an indexing algorithm so we will be able to detect severity of abuse, classify case narratives according to the abuse type, and alert the user to the case narratives that will be most informative for risk assessment decision making, saving invaluable time, effort, and possibly lives. already, our comparative analysis has shown that child and elder abuse terms drawn from articles in pubmed differ from the terms contained in the case narratives. the significance of this finding lies in that very difference. that is, most information retrieval algorithms rely on publicly available data for creating their vocabularies and taxonomies that, in turn, play a crucial role in the functioning of the algorithm. if we were to develop our algorithm based up pubmed articles, then we would be losing a large amount of information contained in the case records. instead, we used the data source most informative for that purpose, existing agency records. fitch/conceptual framework 22 system boundaries figure 3. agency system boundaries. when analyzing agency information systems, there always comes a point when the boundaries for the system have to be delimited because clients have lives before and after interacting with agency services. in previous iterations, agency information systems were referred to as management information systems (mis) because they were designed for management’s purposes. other iterations included decision support systems (dss), executive information systems (eis), etc., all largely serving the needs of management or administration. however, beginning in the late '80s, the notion of an eis being everyone’s information system began to take hold. the democratization of digital information access was beginning to be viewed as the only way to improve organizational efficiency since it is the operational level, or line workers, that creates the initial data. the human services are still uneven as far as the democratization of digital information access, and my research has shown that the delimitation of system boundaries (where the system entails all information systems and systems of information) plays an important role. figure 4. interagency system boundaries data  information  knowledge  system boundary  meta‐system boundary  advances in social work, spring 2015, 16(1) 23  fortunately, there has been relatively more social work research in the area of interagency information sharing (see figure 4) related to knowledge. this research has addressed the need for interorganizational systems in mental health (bloomfield & mclean, 2003; manderscheid & henderson, 2004), welfare services (harlow & webb, 2003), substance abuse services (hile, 1997), child welfare (howell, kelly, palmer, & mangum, 2004), homelessness (peressini & engeland, 2004), and juvenile justice (savaya, spiro, waysman, & golan, 2004). paradoxically, the internet has both facilitated and hampered interagency information sharing in this area. regarding the former, it is much easier to share information between agencies using secured and encrypted file exchange systems. regarding the latter, though, vendors have developed systems that have sometimes grouped agencies together into silos. for example, the homeless management information system (hmis) initiative been of tremendous help to homeless shelters that lacked any kind of information system, and it allows for the networking of these agencies in a community to facilitate information and referrals, service acquisition, and community-level outcome monitoring. unfortunately, if an agency serves the homeless as well as other client populations, then workers are forced to double (or triple) enter data into the hmis and any other system the agency might use (fitch, 2010). researching in this arena requires a careful assessment of decision-making needs across agency boundaries linked via information to the data that is already being entered by social workers. the most useful methodology has been ulrich's csh, which determines the boundaries by identifying who is involved and who is affected. the csh then delineates the former into who is served and for what purpose as well as who is a decision maker, which resources are used by the decision maker, and on what basis. those affected, the latter, serve the purpose of legitimation by acting as witnesses representing embodying values and worldviews. my most explicit application of this methodology was identifying the role of youth in foster care and shifting from a system where their use of social media was controlled by agency-set privacy policies to a system where the youth were allowed to decide about (or control) their own information (fitch, 2012). extending the boundaries in the other direction, one can easily see a foster care agency as a subsystem to a larger child welfare agency. each, in turn, would have its own information system. taken together, the “system” boundary then becomes a meta-system captured in figure 4. one can also envision a community collaborative on child well-being consisting of a child welfare agency, a mental health agency, and the school system. a quantitative application of csh occurs in fitch and jagolino (2012), where we employed system dynamics modeling using output data from three such agencies in minneapolis. here, too, the feedback emblematic of organizational cybernetics is prominent and illustrates the broad range of applications for these theories and methodologies. most importantly, all the knowledge gained from these studies was based solely on information already existing in human services agencies, information gathered as digital data. fitch/conceptual framework 24 two caveats as with any conceptual framework, some issues are included while others are excluded. two are notable in this area. the first pertains to the term "capta" used in checkland and holwell's text (1998, p. 90) and how they use it in their formulation of the continuum, specifically, data to capta to information. checkland prefers to speak of data as "facts" with selected facts becoming capta and meaningful facts becoming information. larger or longer-living meaningful facts are felt to be knowledge. while i find this conceptualization to be helpful in understanding some aspects of this issue, my preference is to examine the continuum from the perspective of users of information technology systems. all social work researchers certainly have a sense of capta, as not all pieces of data are used when we begin to operationalize information. for example, while it may be helpful to know an at-risk young adult's high school gpa, we may not need to know what grade they made in social studies in fifth grade. that data may be helpful (capta) for a junior high guidance counselor, but not necessarily when that person is a young adult. as such, social workers most likely engage in capta identification behavior, but only the results of that behavior will be seen in the data we gather in our information systems. the second caveat addresses the continuum, acknowledging the literature that has the continuum ending with wisdom (i.e., data, information, knowledge, and wisdom), especially as explored by rowley (2007). while many aspects of her article are absolutely fascinating, specific aspects of her argument extend beyond my use of data, information, and knowledge as represented in information technology systems. for example, rowley refers to "the hierarchy" in which she views one transforming into the other (i.e., data as an entity at a lower level in the hierarchy becomes information at a higher level in the hierarchy), which, in turn, becomes knowledge that can be used to create wisdom (p. 164). wisdom is further described as representing one's values, ethics, and aesthetics. while each of these elements certainly plays a role in practice, i am limiting my focus to those processes we can more operationally define and capture in agency information systems. for, as rowley notes in her conceptualization of wisdom, it is not an entity suitable for algorithms nor is it programmable. to the extent social work needs to engage in more formal research with information technology systems, it may be conceptually easier for us to focus on the first three parts of the continuum at this point in our profession. perhaps in the near future, when we have robust knowledge management systems, we should certainly revisit this issue incorporating the insights of rowley and others (e.g., bernstein, 2011; bierly, kessler, & christensen, 2000; zeleny, 2006). implications for social work practice the implications for social work practice must begin with the education of our bsw and msw students. our schools of social work need to examine how we prepare our students to be digital professionals of the 21st century. while our peer professions are educating their students via medical informatics and nursing informatics, social work has no such explicit curriculum. instead, we focus on some of the most complex aspects of advances in social work, spring 2015, 16(1) 25  knowledge generation in our research classes where students are exposed to “data” analysis using spss. this approach has two consequences. one, with the traditional research class as their only formal exposure to the data-information-knowledge continuum, our students’ awareness that all three are much more ubiquitous in agency settings is foreshortened. two, agencies do not routinely analyze their data using spss. if we are to expose our students to any data analysis tool, then we need to be teaching them the tools available in their agencies (e.g., ms excel). while the level of statistical sophistication in ms excel may not be commensurate to spss, sas or stata, perhaps that analysis is not needed for program-level data. in practice, we need to continuously train our staff to be aware of what they do when they handle data. do they find themselves entering the same data into multiple systems? do they find themselves using tally sheets to track client outcomes? are they spending more time managing paperwork than working with clients? the extent to which the answer to any of these questions is yes is the extent to which we are depriving our clients of the time and resources they should be receiving in face-to-face interactions. we have machines that can manage data, but those machines cannot do the work of social work. implications for social work research one might assume that as we are now more than a decade into the 21st century, almost fifty years after the advent of information technology in the corporate sector, thirty years after the arrival of the personal computer, and twenty years after the birth of the public internet, there would be a whole host of social work researchers focusing on the use of information technology in the human services. while many in the social work profession and academy do publish about information technology, we could probably count on one hand the number of tenured faculty members in our schools of social work who have an exclusive focus on information technology encompassing the whole of their research agenda. why? in his farewell editorial for the journal of technology in human services, schoech (2014), founding editor of said journal, made the following statement: walter hudson, an early it pioneer in practice software, years ago advised young faculty not to specialize in it until they earned tenure. his rationale was that few human service faculty understood it and the difficulties involved in it research and development. therefore, their it development work would be unappreciated and tenure could easily be lost. this advice probably still holds today. (p. 249) shoech was able to focus on it research and development and still achieve tenure, but he is a notable exception. most other tenure-seeking faculty have to include projects that are more easily accessible to our colleagues as we often define our research agendas by issues (e.g., poverty, domestic violence, etc.) or the populations we serve. how can we explain that our research agenda focuses on data, information, and knowledge? this article attempts to do so. while technology has evolved, the information requirements of human services agencies have remained largely unchanged. given that we have done little to educate our students on the differences between data, information, fitch/conceptual framework 26 and knowledge and to educate them based on the research that we ourselves perform in our human services agencies, our professional practice relative to technology will not advance in the 21st century. we need to ignore hudson’s advice, and, in doing so, we need to embrace our junior colleagues as they seek to advance social work practice. conclusion while our society continues to move in a more technological and digital direction, we have significant gaps in our field on what that progress will entail. if social work is not involved in the design of technological and digital systems for the human services, we will be left using tools designed by others who may not have our profession’s epistemological and values base. i have outlined the components of the systems used by the human services, namely data, information, and knowledge. my research has focused on distinguishing the unique aspects for each component and how they can relate to each other in performing stated functions. taken together, they can comprise systems whose boundaries must be determined and not left to assumption. if advocating for the rights of clients is the heart of social justice in social work, then the democratization of digital information access can rightly be viewed as one of those rights. future research as outlined above should and can seek to make those rights more explicit as we use information systems across the human services sector to improve organizational functioning and decision making. references adam, a. 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(2014). natural language processing. the comprehensive r archive network. retrieved from: http://cran.r-project.org/web/views/naturallanguageprocessing.html wilson, f. a. (1997). the truth is out there: the search for emancipatory principles in information systems design. information technology & people, 10(3), 187-204. zeleny, m. (2006). knowledge-information autopoietic cycle: towards the wisdom systems. international journal of management and decision making, 7(1), 3-18. author note address correspondence to: dale fitch, phd, mssw, associate professor, school of social work, university of missouri, 703 clark hall, columbia, mo 65211-4470, (573) 884-7405, email: fitchd@missouri.edu this work is licensed under a creative commons attribution 4.0 international license. destigmatizing experiences of combat veterans engaged in civilian disaster relief: implications for community transition derrick kranke june gin rebecca saia susan schmitz eugenia l. weiss aram dobalian abstract: combat veterans possess some attributes of differentness that may cause others in society to create stigmatized perceptions of them and devalue their skills. direct interaction/contact allows targeted individuals—in this case, combat veterans—to demonstrate their value by dispelling negative attitudes or beliefs others may have of them. a previous study reported that the disaster relief setting facilitates contact among combat veterans and non-military civilians. this study applied modified labeling theory (mlt) to assess if the stigma and labeling experience among combat veterans volunteering in disaster settings provides a nuanced understanding. semi-structured interviews were used to assess perceptions of male team rubicon (tr) members (n=9) who provide disaster relief in civilian settings. all participants served in combat. data were thematically analyzed. findings suggest 1) combat veterans were not stigmatized by their label; and 2) personal contact with civilians impacted by disaster helped tr members a) to demonstrate their value, and b) feel more optimistic about connecting with civilians in other contexts. our findings suggest that veterans working with peer combat veterans and civilians in disaster settings provided a destigmatizing condition whereby combat veterans felt less stigmatized by others and more interpersonally connected with civilians. it is recommended that since the majority of services for veterans come from civilian community providers, it is imperative that providers be sensitive to military culture and experiences of those serving in combat to avoid further stigmatization of veterans. keywords: stigma; contact; combat veterans; qualitative; modified labeling theory public stigma contributes to veterans’ struggle to reintegrate (blais & renshaw, 2013; britt et al., 2008; danish & antonides, 2013; hoge et al., 2004; kim, thomas, wilk, castro, & hoge, 2010; weiss, coll, & metal, 2011), particularly by reducing opportunities in education, employment, housing, and intimate relationships (sayer, carlson, & frazier, 2014). public stigma is a psychological and social process that recognizes and distinguishes human differences, which are then linked to negative stereotypes that place labeled individuals in separate categories with undesirable characteristics (link & phelan, 2001). differentness is the antithesis of what people in society want to feel (leavey, 2005). __________________ derrick kranke, phd, ma, is a health science specialist, veterans emergency management evaluation center (vemec), us department of veteran affairs, north hills, ca 91343; june gin, phd, is a researcher, (vemec), us department of veteran affairs, north hills, ca 91343; rebecca saia, ma, is a speech pathologist, glendale, ca 91202; susan schmitz, maidp, is a senior project director, (vemec), us department of veteran affairs, north hills, ca 91343; eugenia l. weiss, psyd, msw, is a clinical associate professor, university of southern california, suzanne dworak-peck school of social work, los angeles, ca 90089; aram dobalian, phd, jd, mph, is director, (vemec), us department of veteran affairs, north hills, ca 91343. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 630-644, doi: 10.18060/21275 https://creativecommons.org/licenses/by/4.0/ kranke et al./participants perspectives 631 combat veterans possess attributes of differentness from non-combat veterans (i.e., those veterans who have not been exposed to combat) and most others in society because military training can reinforce hyper-masculine behaviors, namely competitiveness, distrust of others, aggression, and emotional insensitivity (ashley & brown, 2015; brooks, 1999). in addition, combat veterans being exposed to or engaging in the atrocities of war can make civilians question whether or not these veterans can be trusted to not act aggressively towards others (mccann & pearlman, 1990; weiss et al., 2011). in some cases, the behaviors and tendencies in adapting hyper-masculine behaviors during military service inhibit the skills necessary for resilience and effective adaptation upon returning home (keats, 2010). combat veterans are inclined to interact with other combat veterans because of shared experience (ashley & brown, 2015; keats, 2010). extant literature indicates that individuals’ social network is typically made up of peers who are similar (aboud & mendelson, 1996). time spent during deployment could distance a service member from his/her social network at home, or change family dynamics upon his/her return. in contrast, time spent during combat deployment with peers can create a type of brotherhood because of enduring life-threatening situations together. as veterans return to civilian life, the connection to their combat unit may be disrupted and their social groups may expand to include more civilians. readjustment to society may be challenging because of trust issues between combat veterans and their family and friends who do not have experiences in war contexts. theoretical framework labeling is the identification of differences among a marginalized population which causes some in society to stigmatize and form negative conceptions of that targeted group (corrigan & kleinlein, 2005). as conceptions and stereotypes of targeted groups are confirmed in individual instances (i.e., the media or personal experiences), society members may distance themselves from the targeted group because of fear for their own well-being. ultimately, this process can lead members of society to deny meaningful social, economic, and employment opportunities to members of the targeted group. this labelling process may further contribute to self-stigmatization of those in the targeted group who may likewise adopt less than positive labels, internalizing negative beliefs about themselves and lowering their self-esteem (corrigan, 2005). modified labeling theory (mlt; link, cullin, struening, shrout, & dowhenrend, 1989) posits that individuals labeled for attributes of differentness likely respond in one of two ways, either 1) the person of a different attribute does not internalize the societal label, and consequently, has no negative consequences; or 2) the target of the label applies the label to his/her self and reacts by a) being secretive about the condition to protect his/herself from discrimination and other negative effects (goffman, 2009); and/or b) limits interaction to similar others. limiting interaction with others outside of their group allows members of stigmatized groups to empathize with and support each other. studies indicate that limiting interactions to those who are similar can reduce both social opportunities and the formation of meaningful relationships with others outside of the group (corrigan, 2005; kranke, floersch, townsend, & munson, 2010). the aforementioned reactions have advances in social work, fall 2017, 18(2) 632 several negative consequences: feeling shame from having to hide the condition, and/or disengagement from opportunities because he/she self-discriminates or considers themselves less than. ultimately, the effects of stigma and labeling can have negative implications for overall health and quality of life of the targeted individual (link et al., 1989). contextual factors in responding to labeling our previous study suggested that combat veterans volunteering in disaster relief settings with team rubicon (tr) reported improved reintegration into society because of the interaction with other combat veterans (kranke, saia, gin, heslin, & dobalian, 2016). team rubicon is an organization comprised of over 50,000 volunteers, primarily veterans of operation enduring freedom (oef) or operation iraqi freedom (oif). formed in 2010 by military veterans, tr deploys humanitarian aid teams to areas that are acutely affected by disasters, warfare, and other extreme events, both domestically and internationally (disaster response veterans service organization & team rubicon, n.d.). in many cases, tr members who were veterans faced similar reintegration barriers as other veterans, which helped them to normalize their shared experiences (klein, 2015). this analysis builds upon our earlier work by examining if and how volunteering in disasters along with other combat veterans and civilians alters the experience of stigma among combat veterans. since volunteering in disasters increases interaction with civilians, the study assessed if personal contact with (the other) civilians with no military background potentially eradicates the effects of stigma and labeling (corrigan, 2005). personal contact is an empirically-based intervention assumed to reduce stigma because it allows for the direct interaction with the target group. such direct interaction could contribute to others valuing their contribution and thus disconfirming negative attitudes or beliefs others may have of them (corrigan, 2005; kranke & floersch, 2009; weber & crocker, 1983). this study applied modified labeling theory (mlt), as it is instrumental in identifying the underlying assumptions of why stigmatized individuals react the way they do. thus, what we empirically know about the stigma of a combat veteran in the context of disaster relief is limited. this analysis was guided by the following research question: what is the experience of stigma among combat veterans in interactions with civilians while volunteering in disaster relief? methods sampling and design the design was a cross-sectional qualitative study. the protocol was approved by the u.s. department of veterans affairs greater los angeles healthcare system’s institutional review board. each participant gave written informed consent before participating in the study. researchers conducted semi-structured interviews with nine current tr members over a period of three months in 2014 at a secure and private setting on the west coast of the united states. the participants also completed a brief selfadministered demographic questionnaire prior to each interview. kranke et al./participants perspectives 633 participants were indirectly recruited through an email message sent by the tr program director to the entire tr roster of volunteers in the local area (n=155). the email announced the study, explained the inclusion criteria, and provided a contact number for the principal investigator (pi). interested veterans called the pi to obtain more information about the study. inclusion criteria were that the participants had to be at least 18 years of age, must be available for an in-person interview during the interview period, and must have been deployed on one mission with tr. participation in the study did not require prior military combat experience. sample demographics all participants (n=9) were males who served in combat—eight in oef and/or oif. the average age of study participants was 36 (sd=11.09; range 24-57). five participants were in the marine corps, and four were in the army. five reported as white and four reported as latino. participants had been separated from the military for an average of 10.4 years (sd=5.9; range 6-25). four were married, three were never married, and two were divorced/separated. instrument the semi-structured interview collected narrative data on tr perceptions of societal attitudes and behaviors toward combat veterans, and benefits/drawbacks of interacting with other combat veterans and civilians. the term “societal attitudes and behaviors” refers to self-reports of how participants perceived opportunities and marginalization in society as they related to reintegration concerns (i.e., employment, education, housing, social networks, and intimate relationships). the term “benefits/drawbacks of interacting” refers to how the interaction with fellow combat veterans improved or reduced opportunities. we were exploring both positive and negative responses from participants about their perceptions of societal attitudes and the benefits/drawbacks of interacting with civilian others. to elicit the data, the researchers asked each respondent a series of general questions about his life after deployment before and after joining tr. the interviewers used probes as needed to elicit data on the respondent’s perceptions of his daily activities, professional relationships, and physical and social environments. each interview lasted between 60 and 90 minutes. the participants received no compensation. to ensure data safety, the transcripts were stored in a password-protected computer that could only be accessed by researchers who were given permission by the principal investigator of the study. questionnaires were kept in a secure and locked cabinet. data analysis digital audio recordings of interviews were transcribed verbatim and transferred to atlas.ti, software specifically designed for qualitative data coding and management (muhr, 1993). two members of the research team conducted the thematic analysis, first by applying a priori codes, such as stigma (kim et al., 2010), shared experience (karp, 2006), and limiting interaction (kranke et al., 2010; link et al., 1989). the same two researchers also conducted open coding to identify relevant themes. we then sorted themes by shared content (i.e., “tr provides an environment where i can freely discuss my problems” and advances in social work, fall 2017, 18(2) 634 “i can be open with my peers in tr”). reporting of themes was based on substantive significance (patton, 2002)—in other words, how they informed the extant literature. in particular, we used the constant comparative method (boeije, 2002) using constructs of mlt (link et al., 1989) as a framework. we reported those themes that both aligned with constructs of mlt (e.g., public perceptions and limited opportunities) and those themes that added a nuanced understanding to the model (e.g., no shame or secrecy, expanding interaction beyond similar others, improved outlook). the sample size for this qualitative study was appropriate because the research question was exploratory in nature. for very detailed studies, the sample size can be in single figures (padgett, 2008). to establish the trustworthiness of the findings, the first and third authors created a codebook after each coded three interviews independently. they then reviewed the codes and created a master codebook that contained all of the codes from the first six interviews, and added any relevant codes to the remaining three interviews. when there was disagreement, the codes were expanded to include the characteristics that were evident across the narratives. as a cross-check, the first and third authors also conducted secondary coding of each other’s analysis. results thematic analysis revealed that the label of being a “combat veteran” is frequently associated with negative stereotypes, which some veterans then internalize and apply to themselves, as mlt (link et al., 1989) suggests. however, our findings show a more complex scenario. participants’ responses suggest that engagement in organizations like tr may be an avenue to promote interaction with civilians, thus alleviating negative stereotypes of the veterans and reducing the harmful impact of labeling. this section applies the components of the mlt to identify nuanced understandings of the stigma and labeling process by 1) illustrating the perceived societal stereotypes and marginalization of combat veterans in society; 2) demonstrating how combat veterans engaged in disaster relief respond to stigma and discrimination; and 3) elucidating how the context of volunteering and contact with non-military civilians in disasters can modify veterans’ responses to the labeling process. see figure 1. before joining tr: perceived stigma and marginalization from society team rubicon members believed that as combat veterans, they were socially stigmatized as being a burden on society. respondents identified their perceptions of societal views of “veterans as a demographic of liabilities with a lot of problems.” many of them had internalized these societal perceptions and viewed themselves as unable to cope. one veteran said, “as vets we are encouraged to see ourselves as damaged or in need of a crutch.” these perceptions marginalize and differentiate veterans as not being able to function in civilian society. veterans internalize these stigmatizing views into their own self-perceptions, contributing to their loss of self-confidence and feelings of being marginalized, separated, and isolated from society. figure 1. tr members’ response to public stigma and labeling societal conception of combat veteran “veterans are in need of a crutch.” “veterans are a demographic of liabilities.” resist negativity of label applied to self “we’re not a liability, we’re an asset.” no shame or secrecy about being a combat veteran “the culture is one of compassionate badasses.” connect with civilians to expand interaction “that's what it’s about . . . that moment of emotional connect— with the people that they are directly benefiting.” increased opportunities in society ““it’s [rubicon} groups to harness the skills of vets and give them good purpose and add real value to society.” before joining tr…………………after joining tr advances in social work, fall 2017, 18(2) 636 reduced opportunities. veterans who feel stigmatized often perceive that their veteran status limits their opportunities and that prospective employers will not want to hire them because of stereotypes about veterans’ abilities. team rubicon members described how they perceived their employment opportunities to be limited due to the marginalization of combat veterans, and that skills built in the military were not valued in civilian life. as one tr member described, “i’d just graduated. i wasn’t going to get hired any time soon because, you know, out of the 200 places i applied to i only had like maybe one response, two responses.” this exhaustive effort led him to the conclusion that, “i had no talents that were valued in the market.” this conclusion was devastating to him because “you did all of these great things (in the military) but now you have to start from, zero basically.” the marginalization of combat veterans in terms of employment opportunities gave some tr members a grim outlook. for instance, one participant said, “a lot of people will come back from iraq or afghanistan and assume that they can never find a career or opportunity later in life that will ever sniff the value they derived from what they did overseas.” another participant remarked, “i’m never going to have as important a role as i did when i was 19 years old.” they perceived that civilian life would be a letdown because their military experiences and skills were not valued at home. limited interaction. for tr members, social relationships with civilians, even family members, were fraught with an inability to connect or relate across the divide of their military experience and identity. one study participant mentioned they limited their interaction with non-veterans because they felt they had: “no connection, not even with my own family.” another combat veteran spoke of coming home from deployment and having a limited social network because “i didn’t have many, if any, civilian friends. my whole family, i just couldn’t relate to them, couldn’t talk to them.” one tr member identified how those with families experience an emotional rift with their own spouse or children, who “don’t understand why daddy or their husband is doing this (deployment).” another tr member described this divide in the context of coming home and reintegrating in a college setting with non-military students who have not experienced some of the atrocities or faced the hardships that combat veterans have endured. he described his perception that society seems to value what non-veteran college students can contribute over the contributions of veterans—despite veterans’ life-skills, experience, and actual service to society: “you're coming home and going to college and seeing these kids who know everything and have this happy-go-lucky attitude and you feel like they don't know everything.” veterans perception that their skills are devalued in contrast to those of civilians contributes to their sense of alienation and separation from the rest of society. these feelings may lead them to want to reduce their interaction with non-veterans. after joining tr: combat veteran response to stigma and labeling no shame or secrecy about combat veteran status. universally, all of the tr members in this study disputed societal perceptions of veterans being a liability and in need of a crutch: “we’re not a liability, we’re an asset.” they asserted their lack of shame or secrecy about their veteran status. one combat veteran demonstrated a valued shared identity by referring to themselves “a culture of compassionate bad-asses.” they were not kranke et al./participants perspectives 637 secretive about sharing their identities as combat veterans with other veterans and civilians in the disaster context because volunteering in tr offered a context for the veterans to openly discuss their experiences in combat. one tr member reported, “we all have our unique stories, and unique experiences we went through. but when we come back, it seems like we all go through the same thing . . . all our stories are the same.” it is likely that veterans in tr were motivated to expand their interaction to others in society because the shared experiences helped to reduce feelings of differentness or alienation in the larger context. interaction with others interact with similar others. connecting and interacting with others who share common attributes emerged as an important objective for these combat veterans. specifically, combat veterans who served in recent conflicts (oef/oif) found particularly strong connections or emotional attachments with other combat veterans who served during the same time period because of a shared understanding of the close, interconnected, interdependence inherent to the daily lifestyle that they had become accustomed to during their time in combat as described by this participant: when you're in the military, particularly when you're in combat, you experience pure, simple, collective living. we all take care of each other, we all support each other. there everyone eats the same thing, everyone sleeps in the same place, our objectives are clear. right? especially for a combat soldier; don't die, kill the enemy. team rubicon members are able to bridge the divide between combat and non-combat veterans, branches of service, and even include civilian first-responders in creating a shared identity encompassing anyone committed to service. one respondent described how creating this large, collective, shared identity helps to reduce their sense of differentness and isolation: you're with likeminded people; generally veterans have experienced some similar things whether the army, navy, air force, marines, vietnam, here and now, you're in for the same thing with the service. and a couple of the guys were just first responder test [phonetic] but they still, it's service, you know, service-oriented mentality persons. reshaping the other’s perception. there is an emotional and/or intellectual disconnect among some civilians and combat veterans because the former cannot comprehend or fathom the values and experiences of the latter. however, one tr member did not assign blame on society for its inability to comprehend combat veterans’ mentality. rather, he articulated a broader view of the uniqueness of the veteran experience and the value that it can offer to society. he views the challenge of translating that value to civilians optimistically, as a step toward creating jobs for veterans: we have the experience of being a relatively insignificant piece in a large, important machine. and that experience and when i'm trying to convince some of advances in social work, fall 2017, 18(2) 638 these companies to hire vets that's difficult to articulate, but a very important experience. by emphasizing valued attributes, this tr member sought to reframe an identity commonly perceived as stigmatized by society as a valued identity based on shared strengths and assets: “you want someone that knows how to be a team player, take someone who's learned how to be a team player by the boot.” connecting with the other. team rubicon participants reported that being able to help civilians through volunteering in tr’s disaster relief enabled them to apply the strengths gained through their military background in a setting where they are uniquely qualified to assist others. this opportunity led them to feel more optimistic about their ability to connect and reintegrate with civilians in a non-military context. for instance, one tr member said, “i'm in a good place now, i'm secure, and a lot of that i attribute . . . to go and face them and talk to others like with team rubicon.” another tr member described a change in his level of interaction with civilians, “before [tr] i didn’t talk to anybody. now i interact with everybody.” in addition, several tr members described the profound experience of providing disaster relief to a civilian. both examples demonstrate one of the first times the veteran was able to feel connected with civilians because it helped the veteran to see beyond his own struggles and focus instead on the value of human dignity in helping others in a noncombat setting: “that's what it’s about . . . that moment of emotional connect—with the people that they are directly benefiting.” another tr member described an observation of a fellow combat veteran connecting with a civilian victim of a disaster: “the [tr combat veteran] person’s hugging, this homeowner, this woman is just in tears, hugging this guy who’s got to be sitting at 260, you know, 6-9 and he’s just like, “don’t touch me, don’t touch me, get away,” you know. he’s about to go, he’s about to have a, uh, anxiety attack. and then all of a sudden it’s, it’s just tears coming out.” team rubicon emphasizes specific strengths of combat veterans: grit, perseverance, team work, camaraderie, loyalty to fellow military combat veterans, refusal to give up in face of adversity, and continuing to serve their country: “we’re all working together for that sense of pride in knowing that we’ve helped families out, that we’ve just saved lives in just a different form.” these core attributes are used by tr as tools to tackle the shared challenge of reintegration among recent oef/oif combat veterans, as one tr member puts it: “the common story of reintegration and isolation and lack of purpose seem to me, from my anecdotal experience, to be the common theme with this generation of veterans coming home.” all participants described tr as a vehicle for ending the cycle of stigma and marginalization associated with being a combat veteran (thus, possibly implying that engaging in tr provides a destigmatizing condition): “this is about being a support network for a very unique demographic of americans.” one member describes how tr helps veterans reintegrate by applying their distinctive skills to solve problems and demonstrating their resilience, rather than treating them as defective and in need of “fixing:” kranke et al./participants perspectives 639 we are consciously attempting to set the example for a generation of veterans. . . it's not only groups to support broken vets, it's groups to harness the skills of vets and give them good purpose and add real value to society. that's good for society and that's good for the members. everyone wants to have worth, everyone wants to contribute, particularly vets who are the type of people who took an oath to go fight a war for their neighbors. discussion the application of modified labelling theory (link et al., 1989) among combat veterans who engage in civilian disaster relief provided several novel findings. there were discrepancies with some of the responses regarding the experience of stigma and labeling, and there were differences in some of the underlying assumptions of those responses. the following paragraphs describe the nuanced understandings among this population and setting. while the mlt (link et al., 1989) posits that the perceived stigma and label of differentness makes the targeted individual secretive about their status or label to avoid rejection, our findings suggest that while combat veterans may initially experience social stigma around their identities, they are not secretive or shameful about being labeled a combat veteran. there are several possible explanations for this. first, the stereotype by some in society is linked with attributes such as: being a hero, and fighting for the country (brown, 1984; woolf, 2012), or possessing hyper-masculine values (keats, 2010)—all of which appear to be more desirable to society than those values associated with labels of mental illness or being a burden on society (corrigan, 2005). next, in being able to interact with civilians in a disaster context, where their military skills and identity are valued, participating in tr allowed veterans to transform their formerly devalued veteran identity among civilians into an identity that was valued and shared among those in society. second, although the mlt proposes that individuals with a label associated with differentness limit interaction to those they can trust or that have a similar condition to avoid discrimination or rejection (link et al., 1989), our findings indicate that these tr members did not limit interaction out of fear of rejection or discrimination from society. rather, our study suggests that tr members limited interaction to veterans (both combat and non-combat) because of their beliefs that civilians who have not served in the military cannot comprehend or appreciate their unique experience as combat veterans (as opposed to limiting interactions because of fear of rejection or discrimination). they believe that those who have never been in their shoes simply “don’t get it” (greden et al., 2010, p. 95). furthermore, our findings illustrate how volunteering in disaster relief helped to bridge the “us vs. them” gap (veterans versus civilians). the tr experience created a destigmatizing environment that fostered prolonged social interaction with civilians, which at the same time may have also made civilians realize the value of combat veterans because of the goodwill they demonstrated. some participants described how positive interactions with civilians opened the door for job opportunities outside of tr. ultimately, interaction with civilians increased tr members’ social capital and led to additional opportunities in advances in social work, fall 2017, 18(2) 640 society which consequently resulted in a positive transition for these veterans into the civilian world (kranke et al., 2016). implications for community transition it is estimated that half of those who meet criteria for mental health conditions such as posttraumatic stress disorder or major depression do not seek services (u.s. department of veterans affairs [va], 2011). the majority of services for veterans come from civilian community providers as opposed to social workers in uniform or providers from the va (weiss & albright, 2014). therefore, civilian providers must be sensitive to military culture and the experiences of combat veterans (coll, weiss, draves, & dyer, 2012) in order to not further stigmatize them. from these study findings, the implications for social workers interacting with veterans whether as mental health providers or as case managers, is that the focus of interaction should be on the relational and empathic aspects of psychotherapy or service provision in order to interrupt the internalization of negative selfstigma in veterans. taking an attachment-based perspective, a meaningful professional relationship with a civilian psychotherapist or case manager can support a positive sense of self in the client and can help shape affirming relationships with others (badenoch, 2008) including those that have never shared the combat experience. limitations and future research the findings of this study are not generalizable because of the small non-representative sample of male tr members. veterans who volunteered in tr may be unique because of environmental factors and support. one must be cautious when broadly applying these findings because the study participants were highly resilient and reacted favorably to uncovering stigmatizing beliefs and societal perceptions of themselves, as well as interacting with civilians. future work is needed to confirm the findings of this study, as well as examine the experience of stigma and labeling among combat veterans not engaged in disaster work. a broader perspective that assesses female tr members’ experiences may yield different findings because of gender differences in dealing with stigma. additionally, including a wider range of military service branches may provide a more holistic view of military culture and show potential variations of response to stigma and labeling. representation from various ethnic or racial groups may also yield different findings as some groups have been marginalized by society on the basis of race or sexual orientation. finally, the long term trajectory of these veterans is unknown because the study was crosssectional. personal contact and meaningful interpersonal relationships to overcome the effects of stigma and labeling can have long-term effects. conducting a follow-up study with this subset could yield insight about combat veterans’ integrating into civilian settings, and how that transition process impacts health behaviors as well as social, employment and educational opportunities. conclusion this study examined the experience of stigma and labeling among combat veterans in disaster settings by applying the mlt (link et al., 1989). we found that combat veterans were not stigmatized by their label because the stereotypes of being a combat veteran are kranke et al./participants perspectives 641 commonly linked with being a hero or fighting for their country. in addition, the combat veterans indicated they expanded their interaction beyond other veterans because the tr setting facilitated interaction among tr combat veterans and civilians victimized by disaster. volunteering in tr helped the combat veterans bridge the gap of us vs. them. they had emotional connections and attachments with civilians in disasters and with their civilian tr teammates. personal contact and interpersonal relationships with civilians may have had several effects. the combat veterans felt that they were of value to society again by serving their country through tr and saving lives in a different venue, thereby dispelling negative beliefs that the civilians they encountered may have had of them. these positive relationships may have also altered their sense of self and ability to connect emotionally with others. ultimately, our findings suggest that the disaster context helped the combat veterans in tr feel more 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(2012). competing narratives: hero and ptsd stories told by male veterans returning home, graduate theses and dissertations at university of south florida. author note: address correspondence to: derrick kranke, phd, 16111 plummer st. ms152, north hills, ca 91343. derrick.kranke@va.gov https://doi.org/10.18848/2156-8960/cgp/v01i02/41168 microsoft word 12 saxton_et_al_17952_advocating_for_change_au_ce.docx ______________ gregory d. saxton, phd, is an associate professor in the department of communication at the university at buffalo, suny. jerome niyirora, phd, is an assistant professor in the college of health sciences and management at the state university of new york polytechnic institute. chao guo, phd, is an associate professor in the school of social policy & practice at the university of pennsylvania. richard d. waters, phd, is an associate professor in the school of management at the university of san francisco. copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 154-169 #advocatingforchange: the strategic use of hashtags in social media advocacy gregory d. saxton jerome n. niyirora chao guo richard d. waters abstract: social media continues to change how advocacy organizations mobilize, educate, and connect with their constituents. one of the most unique yet understudied tools available on social media platforms is the hashtag. little research exists on how social work and advocacy organizations use hashtags, much less on how such use can be effective. this study examines the hashtag use by 105 constituent members of the national health council, a national us-based patient/health advocacy coalition. the study presents an inductive coding scheme of the types of hashtags employed, analyzes inter-sectoral differences in hashtag usage, and examines the relationship between hashtag use and measures of the effectiveness of social media messages. keywords: e-advocacy, hashtags, health, nonprofits, social media technology has significantly changed the landscape of social work practice, and perhaps no area has been impacted more over the past decade than community organizing and policy advocacy. social media platforms dominate discussions of online advocacy because of their ease of use and abilities to tap into peer-to-peer networks to spread advocacy messages (goldkind & mcnutt, 2014; guo & saxton, 2014). little research, however, has been conducted on the use of hashtags in relation to the success of advocacy efforts and social media engagement. hashtags, short words or phrases that follow the hash or pound sign (#), such as #stopdiabetes, #hiv, or #marchforbabies, are used on social media platforms to brand advocacy movements, archive messages for the movement, and allow those not personally connected to a user to see and comment on messages that use the hashtag (bruns & burgess, 2011). using hashtags with online advocacy efforts allows movements to spread organically to like-minded individuals and organizations and to spread virally to other users of the social media platform. the purpose of this research is to determine how advocacy organizations use hashtags on twitter, the types of hashtags being used, and whether using hashtags increases the level of engagement by those following advocacy efforts online. this research examines eight months’ of hashtag use on twitter by 105 organizational members of the national health council, a large us-based patient advocacy association. messages were examined for the presence of hashtags, the number and style of hashtags used, and how these hashtags impacted the number of times a message was retweeted, or shared, by other twitter users. regressions show hashtag use – and especially certain types saxton et al./#advocatingforchange 155 of hashtags – increased the level of engagement by those following the advocacy movements. this study informs theory and practice about how organizations can use social media platforms to best advocate for public policy and community organizing efforts. prior research social work and e-advocacy: from web 1.0 to social media the spread of computer-media communications has led scholars to study its implications for social work practice (e.g., anstadt, burnette, & bradley, 2011; perron, taylor, glass, & margerum-leys, 2010). one of the most prolific areas of research has been e-advocacy. advocacy—whether directly through lobbying or indirectly through grassroots mobilization, coalition building, or public education—is a core function of nonprofit organizations, for it is through such efforts that organizations can further represent the interests of their constituents (guo & saxton, 2010; mosley, 2013). social work in particular has a strong professional commitment to social justice and advocacy (queiro-tajalli, campbell, & mcnutt, 2003). not surprisingly, a large body of research has shown how new media are changing the nature of advocacy work. the first wave of research dealt with how early internet technologies, especially as websites and email, were changing advocacy and activism practices (hick & mcnutt, 2002). scholars explored the advocacy opportunities and challenges presented by these electronic media (mcnutt, 2008). scholars also sought to develop an understanding of the determinants of e-advocacy activities (goldkind, 2014) as well as what makes for effective use of the website for electronic advocacy efforts (edwards & hoefer, 2010). with the widespread and rapid adoption of social media platforms, a growing body of literature is now beginning to explore the intersection of social media and advocacy work. the earliest studies looked at adoption, or whether nonprofit advocacy organizations were using social media tools (bortree & seltzer, 2009). the next wave explored managers’ perceptions of social media for advocacy work (obar, zube, & lampe, 2012) along with the potential challenges of using social media tools (goldkind & mcnutt, 2014). research has also explored how these organizations were using social media for advocacy work (guo & saxton, 2014). e-advocacy messages and their effectiveness an examination of social media-based advocacy efforts ultimately involves a focus on organization-audience communication. the primary communicative tool on all social media platforms is the series of regular, brief discrete messages – the tweet, the status update, the video, or the photo – that is sent to an organization’s followers on twitter, facebook, youtube, or instagram, respectively. as a result, recent social media research in both a general organizational context (lovejoy & saxton, 2012; waters & jamal, 2011), as well as in the context of organizational advocacy, has come to focus on the nature of the messages organizations are sending. for instance, in a study of tweets (twitter messages) sent by 150 large advocacy organizations, guo and saxton (2014) found the most prevalent advocacy tactics reflected in the tweets were public education and grassroots lobbying with advances in social work, spring, 16(1) 156 some manifestations of research, coalition-building, public events/direct action, and voter registration and education. there were few instances of media advocacy, administrative lobbying, direct lobbying, or judicial advocacy. while the above studies are invaluable, scholars have yet to examine the efficacy of advocacy work on social media. a variety of potential approaches could be pursued, such as looking at the impact on policy or attitudinal change. although undoubtedly worthwhile, communication and public relations scholars have recently found an interesting alternative: examining the relationship between organizations’ social media messages and the immediate audience reaction that manifests in the form of such actions as liking, commenting on, or sharing an organization’s message on facebook or retweeting (sharing) or favoriting (archiving) a message on twitter (saxton & waters, 2014). this ability to measure the almost real-time public reaction to an organization’s advocacy messages facilitates a shift in measurement from the perceptual to the behavioral realm and provides organizations with a quantitative and comparable gauge to measure the relative effectiveness of their advocacy messaging strategies. here comes the hashtag social media have engendered new forms of communicating and interacting with the public. one of the most innovative tools is the hashtag. since twitter employee chris messina sent the first ever tweet containing a hashtag in 2007 (kirkpatrick, 2011), hashtags have become popular and spread to other social media platforms. hashtags indicate topics or themes, and they represent an important innovation in social media communication. first, the use of hashtags is powerful because it is participatory. hashtags are not decided in advance by a pre-determined set of users. the hashtag system constitutes a decentralized, user-generated tagging, organizing, and classification system. the hashtag classifies messages, improves searchability, and allows the organization to link messages to existing knowledge and action communities. it is this community element that undergirds the power of hashtags. briefly put, hashtags can lead to the formation of ad hoc publics (bruns & burgess, 2011) of networks that develop around the hashtag. these networks/communities can be ephemeral and arise in response to emergencies and crises, or they can be more stable, long-term communities of practice or knowledge that develop to spread ideas, news, or opinions on a given topic. despite their potential importance, neither scholars nor nonprofit organizations have closely examined hashtags. two areas that have not been addressed to date are the use of hashtags in advocacy work and the determinants of the effectiveness of organizations’ advocacy messages. this study addresses these areas by examining the nature and efficacy of advocacy organizations’ communication on twitter, focusing on the role of hashtags in connecting with audiences. saxton et al./#advocatingforchange 157 method our sample comprises the national health council’s (nhc) 105 member organizations. 1 the nhc is a patient advocacy organization whose mission is “…to provide a united voice for the millions of people living with chronic diseases and disabilities and their family caregivers.” its aim is to bring “…together diverse stakeholders within the health community to work for health care that meets the personal needs and goals of people with chronic diseases and disabilities” (nhc, 2015, para. 2). data from each organization’s twitter account were gathered for an eight-month period from january 1 through august 31, 2014. computer code written in python programming language (available upon request) was written to access the account-level details and the individual tweets sent by each of the nhc member organizations. these tweets were likely written and shared by nhc members for the purposes of advocating for their causes, publicizing their organizations, and interacting with their followers. these publicly available tweets provided researchers an unobtrusive way to investigate hashtag strategy and usage by nhc member organizations even though they were unaware of the research. given recent attention concerning the ethical use of social media updates, especially journalists quoting updates in news stories, the researchers turned to the association of internet research’s report on ethical decision-making and internet research (markham & buchanan, 2012) to ensure that the research design did not violate ethical principles. given that no individuals are quoted in the current study and that the research focused on reporting trends, it was deemed that the research met the association of internet research’s criteria for ethically sound studies. once the tweets were downloaded, the study employed a two-stage, mixed-methods approach combining quantitative and qualitative content analyses. the first stage involved an inductive analysis of the hashtags used in each tweet to identify communication strategies unique to the social media innovation. two researchers reviewed the data to create initial categories for the types of hashtags used by nhc organization members in their tweets. then, they worked to reduce the amount of overlap among the categories by providing clear operational definitions of the different categories that created the final typology presented in table 1. complementing this analysis was a series of quantitative content analyses used to identify the most popular hashtags and the general frequency of hashtag use. this mixed-method approach is in line with methodological literature, which sees content analysis (krippendorf, 2004) as more appropriate for positivistic evaluations of frequency distributions and qualitative inductive analyses (strauss & corbin, 1998) as more appropriate for grounded theory building. in the second stage of the analysis, a series of regressions was used to determine the relationship between hashtag utilization and the effectiveness of organizational messaging, as reflected in the number of retweets each message receives. collectively, these two sets of analyses allowed us to identify the types of hashtags organizations were using, how they 1 full list available at www.nationalhealthcouncil.org/pages/member-roster.php advances in social work, spring, 16(1) 158 were using them, and the relative effectiveness of the hashtag communication strategies we identified. results summary of nhc organizations’ twitter usage of the 105 organizations, two did not have a twitter account. four others with twitter accounts did not send a tweet during 2014. the remaining 99 organizations sent a total of 75,934 tweets from january 1 through august 31, 2014. two of the most important measures of public engagement on social media accounts are the number of followers an organization attracts and the number of times an organizations’ messages are shared, or reposted, by other users (saxton & waters, 2014). the number of followers, to start, is an indication of the size of the audience the organization is attracting on social media, for followers reflect users who have made the conscious decision to connect with the organization and see its messages. message sharing, in turn, occurs when a user finds an organization’s message valuable in some way and then chooses to forward the message to the user’s own followers. on twitter, this act of sharing is called retweeting, and is a critical means of ensuring the dissemination of an organization’s messages and reaching a bigger and more diverse audience (saxton & waters, 2014). the average organization in our sample received 6,432 retweets during the 8-month period (sd=14,934); this ranged from a minimum of 1 retweet to a maximum of 87,382. the average organization had 25,040 followers (sd=85,892) and followed 5,763 other twitter users (sd=30,105). there was a wide range on these two variables: from 91 to 684,086 followers and from 4 to 233,212 users followed. the organizations sent on average 767 tweets (sd=768.5) over the 8-month period (or 3.2 per day), with one organization sending as few as 2 and one as many as 3,087 (12.7 per day). organizations’ use of hashtags hashtag use was prevalent. the 75,934 tweets collectively contained 9,934 unique hashtags. the mean number of times hashtags were used was 853 (sd=969) and ranged from 0 to 4,720. the number of unique hashtags employed was fewer: an average organization employed 202 unique hashtags (sd=189.8) in their tweets over the eightmonth period, with a range from 0 to 770 unique hashtags. figure 1 shows a hashtag cloud based on all the hashtags. the larger the hashtag, the more frequently it appeared in the organizations’ tweets. a visual inspection shows heavy prevalence of hashtags denoting medical conditions (e.g., #diabetes), health goals (e.g., #endalz), policy advocacy (e.g., #passtheableact) and health-related events (e.g., #icebucketchallenge) and conferences (e.g., #asco14). to delve into the most frequently used hashtags further, figure 2 shows the number of times the top 25 most popular hashtags were used. the most popular hashtag, #endalz, was used 1,459 times by the 99 organizations over the eight-month study period. the 25th most-popular hashtag, #aca, was used 402 times. saxton et al./#advocatingforchange 159 figure 1. hashtag cloud based on frequency of hashtags in 75,934 tweets, 1/1/14–8/31/14  figure 2. frequency of use of top 25 hashtags in 75,934 tweets, 1/1/14 – 8/31/14  advances in social work, spring, 16(1) 160 figure 2 only shows the most frequently used hashtags. not shown is that a full 5,595 of the 9,934 hashtags (56.3%) are used only once and a further 1,250 hashtags (12.6%) are used only twice. with another 632 being used only 3 times (6.4%), a full 75.3% of all hashtags are only employed 1 to 3 times. thus, there is not a normal distribution or bell curve to the frequency with which the various hashtags are employed. instead, a few hashtags receive extremely heavy usage while the great majority of them are sparsely used. classifying hashtags to understand the types of hashtags advocacy organizations are using, the study took an inductive approach to see what categories of hashtags might help patient advocacy organizations deliver more effective messages to their target audiences. to develop the coding scheme, a random sample of 1,000 of the 75,934 tweets was analyzed. of these tweets, 226 were retweeted messages, or messages sent by other organizations that the organizations in our sample decided to re-post. given that the intentionality of hashtag use in such retweeted messages was less clear, the researchers decided to concentrate hand coding efforts on the 774 original tweets out of the random sample of 1,000 (83 of the 99 organizations are represented in this sample of 774 tweets). of these 774 tweets, 264 did not contain a hashtag, while 510 contained one or more hashtags. the hashtags in these 510 tweets were hand coded individually. based on the inductive coding of data, the 8-category coding scheme for hashtags presented in table 1 was developed. the table also shows how frequently each hashtag type occurred within this random sample of tweets. the most prevalent category is termed public education hashtags, which includes three types (medical condition, knowledge base, and policy) and account for half of the hashtags (50.4%). the second type of hashtag is the event hashtag (19.3%), which often reflects fundraising and awareness-raising events. the third type of hashtag (3.2%) is the call-to-action hashtag. these hashtags can be used to mobilize audiences for collective action, whether to engage in direct online or offline action or simply to assist in further disseminating its public education messages. tags that reflect the organization’s values and goals (9.0% of hashtags) are a fourth category of hashtags. values and goals hashtags help the organization differentiate itself from others in a way that helps serve to strengthen the organization’s brand. they are related to the fifth category of hashtags, called branding. branding hashtags (7.2%) employ some variant of the organization’s name, its programs, or slogans unique to the organization. dialogic hashtags (5.0%) serve to foster dialogue with audience members. the majority of these hashtags are chat-focused hashtags that serve as the focus for regularly scheduled chats with constituents. others either target audience members or ask questions to produce responses. what binds these dialogic hashtags is the relationship-building role they serve (bortree & seltzer, 2009; lovejoy & saxton, 2012). the emphasis is not specifically on informing or mobilizing the audience but rather on building a community of like-minded constituents that can then potentially be relied on in the future to help the organization meet its advocacy mission. saxton et al./#advocatingforchange 161 the final two types of hashtags are more descriptive. first, time and place hashtags (3.3%) serve to denote a time or place important to the tweet and organization. second, business hashtags (2.2%) are those related to business issues, specific sectors of the economy, or particular stocks. hashtags that were unrelated to any of these categories and deemed off-topic to the organizations were classified as miscellaneous; however, this category only contained two hashtags. table 1. hashtag codes with examples and frequencies hashtag category w/ definition examples freq % 1. knowledge & public education 413 50.5% medical condition–hashtag denoting disease or medical condition #diabetes, #hemophilia, #psoriasis (153) (18.7%) knowledge base–health-related research, knowledge, education #hearthealthy, #asthmaawareness, #alsresearch (231) (28.2%) policy–health-related public policy, public policy issues #sunshineact, #devicetax, #hccosts (29) (3.5%) 2. events–health-related event, conference, holiday #worldcancerday, #walktocurearthritis, #alsicebucketchallenge 158 19.3% 3. values and goals– organizational values or goals. useful for reinforcing the organization's core values and ultimate strategic goals. #stopdiabetes, #patientaccess, #coloncanceradvocate 74 9.0% 4. branding–organization-specific hashtags, unique organization identifiers, hashtags noting one of the organization’s program names #showupdifferently, #merckoncology, #uhfscholars 59 7.2% 5. dialogig–“chat” and dialogue hashtags #heartchat, #hemochat, #didyouknow? 41 5.0% 6. time and place–any time or location hashtag #puertorico, #summer, #capitol 27 3.3% 7. call-to-action–hashtags asking audience to do something #shareforawareness, #hugdontjudge, #raise100k 26 3.2% 8. business–related to business issues, stocks, companies, etc. captures a wide range of non-health, non-advocacy-related hashtags, used in the sample #biotech, #gm, #stocks 18 2.2% total 818 note: frequencies are the number of times each hashtag type was used in the 510 of 1,000 randomly selected tweets that were original (i.e., were not themselves retweets, n=774) and contained a hashtag (n=510). a total of 818 hashtags were included in these 510 tweets; percentages indicate proportions relative to these 818 hashtags. not shown is a miscellaneous category in which 2 hashtags (#free, #adoption) were placed. advances in social work, spring, 16(1) 162 comparing hashtag use across organizations the nhc organizes its members into five categories: patient advocacy organizations (n=46), nonprofit organizations with health interests (n=9), professional and membership associations (n=24), business and industry (n=23), and associate members (n=2). from a representational standpoint, the first two are heavily invested in patient advocacy, the middle category represents professional interests, while the final two for-profit categories focus more on representing business interests. for analysis purposes we considered three types of organizations: 1) patient advocacy nonprofits, 2) professional interest organizations, and 3) business interest organizations. the venn diagram in figure 3 shows the intersection of the 9,934 hashtags used across the three organization types. for instance, the patient advocacy organizations used 4,756 hashtags that were never employed by any business interest or professional interest organization over the 8-month period, 351 hashtags that were used by professional interest but not business interest organizations, and 462 hashtags that were used by business interest but not professional interest organizations. there were 386 hashtags that were crosssectoral, that is, not limited to use by just one sector or category of organization. in the multiple regressions, this idea resurfaces during examinations of the effectiveness of hashtags. figure 3. number of hashtags used in common across the 3 main organization types  patient advocacy professional interest business interest saxton et al./#advocatingforchange 163 relationship between hashtag use and message effectiveness a series of regressions are used to examine the relationship between the organizations’ use of hashtags and the effectiveness of the organizations’ messages. specifically, the analyses examine whether the use of hashtags leads to greater advocacy message effectiveness and which types of hashtags are most effective. dependent variable. our dependent variable for the regressions is audience engagement with organizations’ messages as measured by the number of retweets each message receives. table 2 contains summary statistics for the retweet count variable along with all other variables included in the regressions. there is substantial variability in the number of retweets a message receives. while the average is 3.58 retweets, the standard deviation is 11.49 and the range is from 0 to 897. table 2. descriptive statistics, jan. 1 – aug. 2014 for 60,919 tweets by 99 health advocacy organizations # obs. mean sd min max message attention measure retweet count 60,919 3.58 11.49 0 897 hashtag counts # hashtags 60,919 1.0911 1.03 0 10 sector-spanning hashtag 60,919 0.24 0.43 0 1 hashtag type public education 774 0.35 0.48 0 1 event 774 0.20 0.40 0 1 call-to-action 774 0.03 0.18 0 1 values and goals 774 0.09 0.28 0 1 branding 774 0.07 0.26 0 1 chat & dialogue 774 0.05 0.22 0 1 time or place 774 0.03 0.17 0 1 business 774 0.02 0.13 0 1 tweet-level controls # urls 60,919 0.65 0.50 0 4 # user mentions 60,919 0.72 1.03 0 11 # characters 60,919 112.92 28.10 5 153 photo 60,919 0.08 0.27 0 1 video link 60,919 0.01 0.08 0 1 account-level controls # followers 60,919 46.33 117.96 .09 684,09 # tweets (to 12/2013) 60,919 5,084.12 3,788.51 12 14,589 time on twitter (# days) 60,919 1,838.91 387.89 331 2,689 multiple regressions. table 3 presents results from a series of four negative binomial regressions. in each model the dependent variable is the number of retweets each tweet receives. each model contains the same suite of account-level and tweet-level control variables shown to be significant predictors of social media message sharing (saxton & advances in social work, spring, 16(1) 164 waters, 2014). what varies in each model is the specific hashtag-related variable. in model 1, the key independent variable is the number of hashtags contained in each tweet while the main independent variable in model 2 is a binary variable indicating the presence of a sector-spanning hashtag. in model 3, the primary independent variables are a series of dummy variables representing the 8 hashtag types in table 2. finally, all the abovementioned independent variables are included in model 4. table 3. negative binomial regressions, dependent variable is # of retweets (1) iv=hashtag count (2) iv=common hashtag (3) ivs=hashtag type (4) combined model coeff. se coeff. se coeff. se coeff. se hashtag frequency # hashtags 0.13** (0.01) -0.17 (0.11) cross-sector hashtag common hashtag 0.14** (0.02) 0.30* (0.15) hashtag type public education 0.57** (0.12) 0.71** (0.21) values and goals 0.46* (0.20) 0.52* (0.23) branding 0.37 (0.23) 0.57* (0.25) time or place -0.41 (0.34) -0.17 (0.36) call to action 0.51 (0.33) 0.70* (0.34) chat 0.35 (0.25) 0.48+ (0.28) event -0.17 (0.15) -0.01 (0.19) tweet controls # urls 0.21** (0.01) 0.17** (0.01) -0.03 (0.14) -0.08 (0.14) # user mentions -0.30** (0.01) -0.31** (0.01) -0.38** (0.07) -0.41** (0.07) # characters 0.01** (0.00) 0.01** (0.00) 0.01** (0.00) 0.01** (0.00) photo 1.11** (0.02) 1.11** (0.02) 1.29** (0.22) 1.27** (0.22) video link 0.72** (0.08) 0.74** (0.08) -20.99 (19830.9) -18.91 (7067.4) account controls # followers (1,000s) 0.004** (0.0001) 0.003** (0.0001) 0.003** (0.0005) 0.003** (0.0005) # tweets 0.0001** (0.0001) 0.0001** (0.0001) 0.0001** (0.0001) 0.0001** (0.0001) time on twitter 0.0003** (0.0001) 0.0003** (0.0001) 0.0005** (0.0001) 0.0005** (0.0001) constant -1.59** (0.05) -1.57** (0.05) -1.60** (0.38) -1.49** (0.38) n 60,919 0.22 -125402.09 15315.55** 60,919 0.22 -125537.93 15043.87** 774 0.26 -1609.51 234.54** 774 0.27 -1606.11 241.33** pseudo r2 log likelihood model sig. (2) + p < 0.10, * p < 0.05, ** p < 0.01; standard errors in parentheses; omitted (baseline) hashtag category for model 3 is business. with maximum-likelihood models such as in negative binomial regression, there is no traditional r2; for this reason, an analogous pseudo-r2 is typically reported. the r2 shown here is the ml (cox-snell) r2. saxton et al./#advocatingforchange 165 the results are highly robust to these alternative specifications. in the first two models, conducted on the entire database of 60,919 original tweets (15,015 of the 74,934 tweets were retweeted/non-original messages and were thus excluded from these analyses), the coefficient on the hashtag variable is significant. in both models—controlling for the number of followers, time on twitter, and the cumulative number of retweets sent, along with the length of the tweet and whether the tweet contains a photo, video, url, or user mention-the hashtag measure is associated with significantly more retweets than when a hashtag is absent. in particular, again controlling for the account-level and tweet-level measures just listed, a message is likely to receive significantly more retweets the more hashtags are included (model 1) and if the tweet contains a cross-sectoral hashtag (model 2). models 3 and 4, in turn, are conducted on the random sample of 774 hand-coded tweets. in both models the omitted category is business hashtags.2 thus, this is the baseline category against which the other hashtag dummy variables are compared. in model 3, the coefficients on two hashtag category variables are significant: public education and values and goals. in model 4, the coefficients on the “sector-spanning” variable and four hashtag category variables are significant: public education, values and goals, branding, and call-to-action. this means that tweets with a sector-spanning hashtag are significantly more likely to be retweeted by the organization’s constituents and that tweets with a public education hashtag, a hashtag related to organizations’ values or goals, a branding hashtag, or a call-to-action hashtag are significantly more likely to be retweeted by the organization’s constituents when compared to tweets with a business-related hashtag. the results for control variables are consistent across the four models. in all models retweets are associated with tweets that do not contain user mentions, are longer, contain photos, and which are sent by organizations with more followers, have been on twitter longer, and have sent more tweets. in two of the four models, the inclusion of hyperlinks and video links is also positively associated with retweeting behavior. discussion this study examined hashtag use by the 105 members of the national health council, a national us-based patient/health advocacy coalition. the study makes several significant contributions to the current literature. first, it improves scholars’ understanding of the use of hashtags in social media advocacy by presenting an inductive coding scheme of the types of hashtags employed. of the eight categories of hashtags, public education hashtags are far more frequently used than any other. such hashtags focus on educating the public, a key, long-term advocacy tactic and one for which social media is particularly well suited (guo & saxton, 2014). however, some of the less-frequently-used hashtag types deserve special attention, as they suggest interesting potential for the organization. values and 2 in a regression equation with a series of dummy (binary) variables it is typically necessary to omit one of the dummy variables. that variable serves as the baseline against which the regression coefficients for the other dummy variables may be compared. advances in social work, spring, 16(1) 166 branding hashtags, for example, help the organization differentiate itself from others in a way that helps to strengthen understanding of the organization. second, this study compares the different ways organizations can use hashtags to enhance the effectiveness of social media advocacy as measured by the number of retweets each message receives. three distinctive strategies of using hashtags were identified. the first strategy is simply to play the numbers game; that is, to increase the number of hashtags in a single tweet to boost the number of retweets. the second, and arguably more sophisticated strategy, is to find common ground with partners across sectors. this common-ground strategy focuses on identifying and including sector-spanning hashtags in a tweet. a third strategy refers to the selective use of certain types of hashtags. for example, the organization might choose to include particular types of hashtags (e.g., call-to-action hashtags) believed to be more noticed by followers. in the regression analyses, the effectiveness of these three strategies was tested and had significant and positive effects on the dependent variable (number of retweets received) when tested separately, offering evidence that each of the hashtag strategies helps to increase the level of audience engagement. when tested together, the significance of the hashtag count variable disappears; however, the sector-spanning variable and several hashtag type variables (i.e., public education, values and goals, branding, call-to-action, and chat and dialogue) were significant. this finding suggests that, among the three strategies, it is not the number of hashtags but rather the type of hashtags used that really matters. given that the type of hashtags is critical to social media success, it may be helpful to conclude the current study with a brief review of suggested best practices for using hashtags to advance organizational and advocacy messaging. first, it is necessary to use hashtags that are likely to advance the organization’s cause. although an organization can use generic hashtags, such as #cancer, organizational messaging becomes more memorable and serves for better brand recognition when a hashtag is more specific, such as #findacure or #cancersucks (ma, sun, & cong, 2013). when creating hashtags, organizations should ensure that they are not using a hashtag that has been trademarked or used before. reviewing hashtag directories like www.twubs.com can help organizations avoid using hashtags that are already in use by other campaigns. additionally, potential hashtags should be reviewed internally by an organization’s communications team and leadership, but they should also be tested with a few close outsiders (e.g., volunteers, key donors) to make sure that any potential social media mishap is averted. once an organization selects its hashtag, the next challenge is to grow a community around that hashtag. while regular usage of the hashtag may help increase the public’s association of the hashtag with a specific organization, it is more important to have active social media consumers also using the hashtag in positive messaging surrounding the cause and organization (kywe, hoang, lim, & zhu, 2012). organizations should consider how they can use hashtags to get individuals involved with an advocacy effort by creating a personal user experience—not simply focusing on the organization. for example, the red cross could have simply used the hashtag #npm14 to promote its campaign for “national preparedness month” in september, 2014. however, #npm14 became a widely successful saxton et al./#advocatingforchange 167 hashtag because users were encouraged to share how they were preparing for natural disasters. finally, regardless of what hashtag strategy an organization chooses, it is necessary to monitor how the hashtag is used by the public. continued evaluation of the hashtag’s usage is important for multiple reasons. first, it can be used to help determine what message points are reverberating among targeted audiences. these messages then can be used in other advocacy efforts to reiterate key messages to prompt further interactivity and engagement for the issue. on the other hand, if a hashtag has not been successful in generating interest in the organization, cause, or campaign, it can be retired and replaced by one that may generate that interest (kwye et al., 2012). second, it is helpful to see how the hashtag is being used by others so that campaigns can be cancelled if a hashtag has been used in a mocking manner. for example, in promoting nutrition in schools across the nation, first lady michelle obama spoke about the importance of healthy lunches and mentioned that students could share their #healthylunch using that hashtag; however, the hashtag usage was quickly overrun with pictures of questionable school lunches and accompanied by a sarcastic #thanksmichelleobama hashtag. monitoring may not be able to end mocking and scorn on social media, but it can empower the organization to address points of concern that are expressed by social media users. finally, the monitoring should be carried out across the social web. even though this study focuses on twitter hashtags, the hashtag has become commonplace across most social media platforms. an organization’s campaign that started on twitter may very well find its way to instagram, pinterest, youtube, and facebook. an organization that wants to become active in advocacy efforts must remember that social media platforms are interconnected, thus hashtag usage must be reviewed on all potential platforms to avoid potential communication blunders. this study also has implications for social work practice. for organizations that aspire to excel in their advocacy work on social media, tweets will get retweeted and noticed if they use sector-spanning hashtags. likewise, hashtags that educate the public, communicate core organizational values and goals, and engage the audience into action or dialogue are more likely to be shared with others. this study is a first step to fully understanding the strategic use of hashtags in social media advocacy. future research should test the classification scheme in other domains as well as interview social media advocates and marketers to determine whether the classification scheme aligns with their motivations for using hashtags. references anstadt, s. p., burnette, a., & bradley, s. 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(2014). what do stakeholders like on facebook? examining public reactions to nonprofit organizations’ informational, promotional, and community-building messages. journal of public relations research, 26(3), 280-299. doi: 10.1080/1062726x.2014.908721 strauss, a., & corbin, j. (1998). basics of qualitative research (2 ed.). thousands oaks, ca: sage. waters, r. d., & jamal, j. y. (2011). tweet, tweet, tweet: a content analysis of nonprofit organizations’ twitter updates. public relations review, 37(3), 321-324. doi: 10.1016/j.pubrev.2011.03.002 author note correspondence concerning this article should be addressed to gregory d. saxton, department of communication, university at buffalo, suny, 331 baldy hall, buffalo, new york 14260-1020. tel: (716) 645-1161. email: gdsaxton@buffalo.edu microsoft word 10 sorbring_et_al_18260_game-based_intervention_au_ce.doc ______________ emma sorbring, phd in psychology, is the research director for centre of child and youth studies at university west. trollhättan, sweden. email: emma.sorbring@hv.se. anette bolin, phd in social work, is a senior lecturer in social work at university west. trollhättan, sweden. email: anette.bolin@hv.se. jennie ryding is a research assistant at university west. trollhättan, sweden. email: jennie.ryding@hv.se. copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 125-139 game-based intervention–a technical tool for social workers to combat adolescent dating violence emma sorbring anette bolin jennie ryding abstract: the prevalence of dating violence is increasing, and effective prevention and intervention methods are needed to address this growing social problem. the use of online, game-based intervention programs opens up new possibilities for large-scale interventions through social work as well as individual outreach work. this study examined young people’s experience of an online game-based intervention programme designed to address dating violence among youths. swedish youths who took part in the intervention programme were interviewed in focus groups. the interpretation of the results was based on theories of learning through digital media; the results indicate that the use of a game as an intervention method for this socially sensitive topic was perceived as positive by the young people, who saw it as a new, engaging, and interesting method. the study indicates that young people’s perception is that they are engaged by and learn about dating violence through online games. this only holds true, however, if the game is played in a school context and not outside the classroom, since the game was not perceived as a real game. keywords: dating violence, social work methods, game-based, youth at risk information technology offers new ways for social workers to reach out to large groups, and young people especially benefit from the use of information technology. in order to create a valid, high-quality intervention that is not only easy for social workers to use effectively but also has the ability to impact young people’s behaviours, research that considers young people’s experiences of the use of online tools is needed. in this study we gather qualitative information directly from the young people who have taken part in a game-based intervention programme regarding dating violence. this provides useful information about how young people themselves evaluate the game, information that can be used to develop the basic methods used by social workers to address social problems such as adolescent dating violence. adolescent dating violence teenagers usually start to date when they are between the age of 13 and 15 years. indeed, 72% of all 8th and 9th graders in the usa (eaton et al., 2010), and 88% of teens 15 years or older in the uk report some sort of dating relationship (barter, mccarry, berridge, & evans, 2009). although dating is an important part of life, it can also cause a lot of pain (physical, emotional, and psychological). sorbring et al./game based intervention 126 abuse dynamics in adolescent relationships appear in a variety of forms, not limited to the more commonly recognised physical violence. according to saltzman, fanslow, mcmahon, and shelley (2002), dating violence can incorporate physical violence, sexual violence, psychological/emotional violence, and the threat of physical or sexual violence. much of the published literature on dating violence subsumes the latter category–threat of physical or sexual violence–into either physical, sexual, or psychological/emotional violence (leen et al., 2013), leaving three core categories. the first category is physical violence, which is the intentional use of physical force with the potential for causing death, disability, injury, or harm. the second category is sexual violence, which includes three elements: 1) the use of physical force to compel an unwilling person to engage in a sexual act (whether or not the act is completed), 2) an attempted or completed sex act involving a person who is unable to understand the nature of the act or to decline participation, and 3) abusive sexual contact such as intentional, unwanted sexual touching or intentional touching of a person of diminished capacity. the third and final category is psychological/emotional violence, which involves trauma caused by acts, threats of acts, or coercive tactics. such abuse can include, but is not limited to, humiliating the victim, controlling what the victim can and cannot do, withholding information from the victim, isolating the victim from friends and family, and denying the victim access to money or other basic resources. in a recent literature review, leen et al. (2013) observe that whilst data is difficult to compare due to methodological differences, 10-20% of all teenagers experience physical violence in adolescent dating relationship. prevalence rates for other abuse categories have been reported to be significantly higher, with victimisation through psychological/emotional abuse as high as 77% in general populations (tschann et al., 2009). leen and colleagues (2013) concluded in their review article of north american and european studies that psychological dating violence is more prevalent than physical and sexual dating violence and prevalence rates are similar for girls and boys across all forms of violence in the majority of the reported studies. gender differences, when they are present, mainly concern sexual abuse. although prevalence rates vary greatly between studies, common themes are the ubiquity of abuse dynamics in adolescent dating relationships and that dating violence is a concern for a large proportion of young people (leen et al., 2013). due to the negative impact that adolescent dating-violence (adv) has on the individual’s shortand long-term health (such as low self-esteem, negative selfconcept, anxiety, depression symptoms, suicide thoughts and attempts) as well as future negative relations (molidor & tolman, 1998; muños-rivas, gámes-guadix, fernándezgonzález, & lozano, 2011; o’donnell et al., 2006), there is a growing consensus about the importance of the development of effective, easy-to-facilitate, and large-scale intervention programs (edelen, mccaffrey, marshall, & jaycox, 2009). risk factors and intervention programmes extensive research on dynamic risk factors (i.e., those subject to change through intervention) has been conducted, particularly in the usa, revealing factors ranging from acceptance of rape myths (maxwell, robinson, & post, 2002) to having friends who perpetrate dating violence (mcdonell, ott, & mitchell, 2010). risk factors can be advances in social work, spring 2015, 16(1) 127 grouped into four broad categories: peer influence, substance use, psychological adjustment and personal competencies, and attitudes toward violence (leen et al., 2013). attitudes play an important role in the occurrence of adv; for example, attitudes that legitimize the use of violence are more common among individuals perpetrating adv (foshee, linder, macdougal, & bangdiwala, 2001; josephson & proulx, 2008; mcdonell et al., 2010; sears, byers, & price, 2007). the majority of prevention and intervention programs (especially in the u.s.) have aimed to change young people's attitudes and knowledge about adv, thereby indirectly reducing its incidence. the success of these interventions has varied from improvements in adolescents’ attitudes and behaviours that disappear at a six-month follow up (taylor, stein, & burden, 2010) to sustained, positive change over a period of several years (foshee et al., 2004). from traditional intervention programmes to game-based interventions interventions aimed at young people and intimate relations reported in the literature have, until now, mostly taken place in group-based programs conducted in a school context over several months, mostly during school hours (adler-baeder, kerpelman, schramm, higginbotham, & paulk, 2007; gardner, giese, & parrott, 2004). there have also been intervention programs conducted outside school settings (antle, sullivan, dryden, karam, & barbee, 2011; wolfe et al., 2003), although there is a risk that these interventions can exclude students who do not participate in after-school activities. consequently, the school setting provides a good environment to set up interventions since these types of programs reach most youth. although there are many benefits from working in a group, such as establishing group attitudes, starting a broader discussion, and gaining from others' experiences, interventions on a group level may exclude youth who do not want to expose their own experiences. for example, in the study by fox, hale, and gadd (2013), younger students reported feeling uncomfortable and anxious during group sessions and in role-play. moreover, findings from some intervention programmes have reported negative effects on abuse behaviour, potentially linked to peer influence (wolfe et al., 2003). dishion, mccord, and poulin (1999) argue that group interventions with deviant adolescent populations may be hampered by negative peer influence. given that general populations will presumably include some deviant tendencies, group-based interventions in primary settings will also possibly suffer from negative peer influence. the potential for individual engagement with an attitudinal and behavioural change intervention, as within a serious game-based intervention, reduces the risk of negative group effects identified by dishion et al. (1999). although some intervention programmes have demonstrated success in reducing risk factors and curtailing abusive behaviours, several concerns have emerged about these programmes. these concerns have precipitated the present design for a game-based approach. game-based learning include the use of “serious games” (learning games), which, unlike games created only for pleasure, are designed to achieve clearly stated learning objectives (michael & chen, 2006). young people see the digital world in which they have grown up as an everyday arena for knowledge improvement. consequently, game-based learning can appeal to the needs, expectations, and frames of reference for this group (felicia, 2009). for example, in the uk 100% of 6-10 years olds consider sorbring et al./game based intervention 128 themselves to be gamers, and similar trends can be seen in the rest of europe (de freitas, 2006). game-based learning has the ability to increase motivation and can thus create motivation levels necessary to maintain youths’ involvement and improve the chances of reaching expected learning objectives (wastiau, kearney, & van den berghe, 2009). game-based learning has been used for promoting knowledge and changing behaviours among young people in relation to relational and sex issues, as well as other healthrelated issues (connolly, boyle, macarthur, hainey, & boyle, 2012). jouriles and colleagues (2009) have recognized that virtual reality appears to be a promising tool to change women’s attitudes towards sexual harassment. furthermore, arnab et al. (2013) have shown that game-based learning has a positive impact on adolescents’ understanding of personal risk and the consequences of coercion. green acres high-an online game-based intervention overall, a game-based approach potentially provides a more easily implemented and scalable intervention, better able to be tailored to the circumstances of regions or countries, in addition to the benefits theorised for game-based learning more generally (connolly et al., 2012). in light of this, the present project designed and developed green acres high, a digital game for addressing adolescent dating violence. green acres high was created, designed and developed in the european project cava (changing attitudes to dating violence in adolescents). in summary, green acres high was constructed as a learning game-based intervention for school settings, with the aim of addressing risk factors in adolescents’ attitudes to abusive relationship dynamics and empowering adolescents to both take action within their own relationships and support peers’ actions in reducing abuse. the study targeted adolescents between 13–19 years of age. the lower ages of the age span is when most european teenagers start dating (eaton et al., 2010). the upper limit is not firm, but after the age of 19 young people start to move in together and adv becomes domestic violence. green acres high is divided into five chapters of adv-related content. each chapter focuses on a different element of the intervention programme. the five chapters can be played one by one or several at a time; however, the intervention is designed so that all lessons have to be played and in the right order. when the player advances in the chapters, the game incorporates increasingly complex content to build the player’s awareness of key adv dynamics. players sequentially engage with content about “healthy relationships,” “abuse and warning signs,” “risk factors,” “achieving healthy relationships,” and “safely seeking help.” the game includes different types of tests, tasks, links, and videos in order to capture as many aspects of e-learning as possible. after completing tests and tasks, the player is given feedback presenting the correct answers as well as an explanation of why the wrong answers are incorrect, for the purposes of motivating him or her and guaranteeing that the player is learning as much as possible when playing the game. the intervention programme was set up by social work students from a university in west sweden. the entire game–all five lessons, which take about 20-25 minutes to complete– was designed so it could be played over a period of weeks, either one lesson at a time or 2-3 lessons simultaneously. the game was in english. advances in social work, spring 2015, 16(1) 129 an american research group (elias-lambert, boyas, black, & schoech, 2015; schoech, boyas, black, & elias-lambert, 2013) has developed a school-based primaryintervention serious game called “choices & consequences” (c&c). green acres high and the c&c game have many similarities, such as exposing teenagers to different virtual situations and asking their opinion regarding safety. but there are also some differences: green acres high takes place in a school setting but c&c takes place during leisure time, and green acres high is played individually whereas c&c is played in groups. the evaluation of the c&c game shows that students playing the game liked the fact that it was interactive and, although the debriefing discussions with the group was perceived as one of the most positive elements with the game, some of the more quiet students requested the possibility to play the game as an individual. the present study the aim of the present study was to examine swedish adolescents’ attitudes towards the online game-based intervention for adv called green acres high focus group interviews were conducted with the aim of gaining insight into the participating adolescents” thoughts and ideas with regard to the usefulness of the game. methods participants three groups together totalling 12 participants were recruited, by one of the authors, from trial sessions of the green acres high game-based intervention that were conducted as part of the cava project during the fall of 2012. participants offered to voluntarily and anonymously sign up for a focus group interview. the participants were all students at upper secondary schools (i.e., high school) and between the ages of 16 and 18. the first focus group had three participants (two females and one male), the second group had five (all young women), and the third group had four (two females, two males), for a total of 12 participants: three young men and nine young women. three people were 18 years old (two young women, one young man), three were 17 years old (two males, one female), and six were 16 years old (all female). ten of the 12 participants (seven females, three males) had been in a relationship. procedures and data collection three upper secondary schools in the western parts of sweden agreed to take part in the study. third year university students studying social work carried out the serious game intervention at the schools over two separate occasions each lasting 1.5 to 2 hours. the sessions were held two to three weeks apart. during each occasion, the students each used a computer to play two or three lessons from green acres high. after the last of the five lessons, the students who wanted to be part of the focus group interview met with one of the authors. the focus group interviews were semi-structured with a set of questions determined in advance, allowing the participants to express their own thoughts and experiences sorbring et al./game based intervention 130 during the interview. the interviews were conducted in swedish and the quotes used in the result below were translated by two persons. all of the interviews took place at the participating students’ schools. the length of the interviews varied from 29 to 44 minutes. prior to the interviews the participants were informed about the purpose of the study, the use of the material, the voluntary nature of their participation, and that they could stop or leave the interview whenever they wanted. the participants were given a cinema ticket for their participation, although this was announced after the focus group interview had ended. analysis the focus group interviews were recorded using a dictaphone and transcribed verbatim. the transcriptions were coded using inductive thematic analysis in accordance with the procedures outlined by braun and clarke (2006). the three authors scrutinized the transcripts after completion of the transcriptions. a top-to-bottom, data-driven method was used, wherein the material itself generates concepts and themes. the analysis was first and foremost inductive, where the data itself gradually led to themes. the first step of the thematic analysis is to get to know the data and to gain familiarity with it. this was done when transcribing, reading, and re-reading the data. the second step was to generate initial codes, which involves a systematic coding of interesting features of the data and the collection of data relevant for each code. the different codes were later organized into potential themes. a process of determining and naming the themes took place to refine the specifics of each theme. the themes selected captured important and relevant information given by the respondents, representing the meaning of the data or a pattern in responses in relation to the research question. the purpose of the themes that emerged is to encapsulate the content of the dataset. the themes created needed to be reviewed in order to see whether they worked in relation to the coded extracts, as well as the dataset as a whole (braun & clarke, 2006). excerpts from the data were selected from the transcripts in order to highlight participants’ thoughts and expressions in relation to specific themes. ongoing discussions helped reduce potential disputes that occurred during the analytical process. the study has strong empirical roots, and an inductive approach was used with the intention of establishing conclusions based on empirical data. the study is therefore empirical-data driven (langemar, 2005). results the thematic analysis resulted in three different themes. themes 1 and 2 had one or two subthemes (see table 1). table 1: themes and subthemes themes subthemes 1. game-based intervention: a new and appreciated method 1.1 a game to be used in school but not otherwise 1.2 game + discussion = reflection upon adv 2. not a “real” game, but still ok 2.1 technical aspects of the game 3. impact of the game–increased awareness of dating violence advances in social work, spring 2015, 16(1) 131 theme 1: game-based intervention: a new and appreciated method the respondents were well aware of the increasing use of computers: “the concept [of a game-based intervention] feels right since the use of computers is more popular than ever. today it is natural to do everything on the computer” (young man/group 1). however, this participant also argued that computers are still perceived as something fun and entertaining, which can have a negative impact on how seriously the players view the game. some students may find it easier to listen to ordinary lectures than digital ones: “…you are not given the opportunity to play around as when you are doing it on the computer.” the idea of using a game as a tool for raising awareness and changing attitudes about a particular topic is, according to several of the respondents, fantastic, although they highlight the importance of the game being engaging and of high quality. if this were not the case, it would probably affect the players’ attention span and interest in the game: “the game has to be fun, but still educational, and with that you have succeeded” (young woman/group 2). the respondents felt that using a game for learning is a more enjoyable way of learning than listening to someone talking, since it allows for players to act individually: “this allows for the individual to take in information in a different way compared to traditional lessons” (young woman/group 2). some of the respondents believed that more enduring knowledge could be created through the medium of a game since players remember where the knowledge came from and, consequently, it becomes more tangible and lasting: “yes, you remember ‘when we played that specific game’ and that game was about this and that… i think you learn and remember better with any type of game, the game might make it easier to understand the context” (young woman/group 1). subtheme 1.1: a game to be used in school, but not otherwise. the participants thought that if they, or other students, were asked to play the game at home, it would probably not be taken as seriously as when playing it during school hours. they thought that the interest in the game would decrease if it were played in the home since there are other distractions in the home environment: “there is so much else you want to do when at home” (young man/group 3). participants also thought that the attention given to the game and its topic of dating violence would probably decrease in comparison to when playing it at school, and players would probably try to play it in the fastest manner possible: “no, i don’t think you would have taken it seriously. you would probably just be clicking your way through the game to be done with it” (young woman/group 2). at school, there is not much else to do, and players’ engagement with the game would therefore probably be different: “at school we are all doing the same thing… it’s a little bit more focused” (young woman/group 2). participants also presumed that many students would ignore the game if it was given as homework, something that would also affect the subsequent discussions: “i think a lot of people would skip playing the game at home. they might not feel that they need to discuss it anyway and that they can listen during the discussions without really discussing it and will therefore not take it as seriously” (woman/group 2). another positive aspect of playing it at school is that the support of both social workers and peers can be sought: “i think it’s better to play it at school so that you can be given help if needed and you can talk about it more” (woman/group 2). sorbring et al./game based intervention 132 subtheme 1.2: game + discussion = reflection upon dating violence. the adolescents highlight the need for discussions about both adv and the use of the game. they believe that discussions are an important part of using the game and should be included to achieve the best possible results. according to the respondents, discussing the content of the game provides the possibility of venting thoughts and questions that had arisen when playing the game. a young man in group 3 says: “it is better to use the game than not using it at all,” meaning that the game could be the starting point of a more widespread discussion about the topic. some of the respondents commented on the need for interactive discussions when addressing a serious issue such as adv: “i don’t think that the teacher should be talking in front of the class (about adv) but instead we should do it in groups, discuss it in the groups and so on. or that we have a discussion in the whole class, with each other” (young woman/group 2). the respondents believed that discussions can also promote a greater and more active engagement from the students while actually playing the game, since they know that the content will be discussed later and therefore they need to pay attention to the game: “i think that could do a lot [playing the game first and then discussing the topic]. and doing it directly afterwards and not waiting because then you will probably forget a lot” (young man/group 1). theme 2: not a real game but still ok although they found the game intervention to be useful in drawing attention to adv, several of the respondents commented that they did not experience it so much as a game, but more as a tool for sharing information and knowledge: “i didn’t really perceive it as a game, more as reading a book or something” (young woman/group 1). they did not perceive it as a game because it did not contain any of the gaming features common to digital games. according to the respondents the players’ task was mostly about going from one place to another and clicking through the game. they pointed out that since players have few opportunities to act autonomously, a true gaming experience was lacking: “the idea itself [a game about adv] is really important, but there was a lot of “click here and click there” so it didn’t really feel like a game, more like reading a book or something” (young woman/group 1). had players been allowed to act more independently, the game would, according to one of the respondents, have been more interesting and more interactive: “it would have been positive if you as a player were allowed to do more by yourself. it got very…you were shown what to do all the time” (young woman/group 1). while the game was perceived as interesting, there was no great feeling playing it: “it was ok. nothing that came out of it was extraordinary, no wow directly…” (young woman/group 2). subtheme 2.1: technical aspects of the game. some of the respondents commented that it was sometimes difficult to complete tasks due to a lack of knowledge about the nature of dating violence. because of this they all expressed a wish for a function enabling them to go back in the game to tasks and simulations already carried out: “it was a little bit annoying that you were not able to go back to previous chapters to see what has been said or the content in case you missed reading something or didn’t understand a certain part” (young woman/group 2). the respondents did find it useful that information was shared both through text and sound, although some found this rather annoying: “to advances in social work, spring 2015, 16(1) 133 hear the information is of course good, and in the english language and so on, but i think it would have been enough to read it because you will still understand what you are supposed to do and if you are supposed to do things differently” (young woman/group 1). some of the dialogues from “the messenger” (the avatar delivering the information) were considered to be a little too long, containing too much information, and that it would have been better if the information had been divided into several, smaller dialogue boxes: “it was a little bit annoying that you couldn’t skip the dialogues. you read all the text and then you were done but you still had to sit and listen to him (the messenger)” (young woman/group 1). overall they considered the messenger a useful feature of the game. some of the respondents also commented that they wished the game had contained some real-life video clips instead of animation, since it would have made the game more serious and closer to reality: “it (the game) should perhaps contain a reality video clip. like an introduction or something, something real (young man/group 1). the animation, some respondents claimed, detracted from the seriousness of the game and made the players perceive it as only a game and adv as something that doesn’t exist in reality: “something i feel in regards to this game, it was sort of, i think that it wasn’t really taken in a serious way, or how should i put it, it felt like it’s only a game, it doesn’t happen in reality, although, when you think about it, it does really happen in reality, after you have played the game, but at the moment it didn’t feel like it, it only felt like a game…” (young woman/group 2).the respondents were also positive towards the feedback given when playing the game because it facilitated an understanding of what was right or wrong and why. the respondents expressed that the feedback in the game enabled further knowledge to be gained. it was useful, for instance, to know why a certain answer was right and why another one was not correct: “yes, otherwise you would have been sitting there, clicking your way through the game and not really able to understand, and if you clicked the wrong one then you wouldn’t have known why it was wrong” (young woman/group 2). theme 3: impact of the game–increased awareness of dating violence when discussing the impact that this game-based intervention had on their views about adv, all of the respondents agreed that the game had at least opened their eyes to the issue. they also believed that it had raised their awareness and understanding both about the nature of adv, as well as the different signs and risk factors. however, participants could neither define nor concretize more specifically what they had learnt: “you knew that it existed, dating violence, but not like that” (young woman/group 2). some of the respondents expressed that even though they already knew about adv, they still did not consider it to be a serious matter. after playing the game, however, they changed their mind: “ don’t really know whether i learned something. i don’t know… maybe you will notice when you are in a situation like that and that you back off a little bit” (young woman/group 1) “but just the fact that it is eye-opening and gets you to think about it is erudition in itself… that’s enough i believe” (young man/group 1). sorbring et al./game based intervention 134 the game, according to the respondents, has enabled them to develop a different and more conscious awareness of adv, even though they admitted that the phenomenon might nevertheless occur: “perhaps you look upon it differently now. maybe you are more, maybe you didn’t think it was as bad as it sounded but after (playing the game) it was actually as bad…” (young man/group 1). discussion the purpose of this study was to examine adolescents’ subjective experiences of a game-based intervention addressing adv. the results show that the respondents perceived green acres high as an innovative intervention, although not really as a game, since a true game feeling was missing in that it did not contain very much actual gaming. nevertheless, the participants believed that, compared to using traditional teaching methods, using a game for an adv intervention could enhance changes in attitudes and knowledge about dating violence. other attempts to address the issue within school curriculums also show students gain an increased ability to identify unhealthy relations including dating violence (adler-baeder et al., 2007). in this sense teaching about dating violence is one way to combat the phenomenon. at the same time, research also shows that pupils can feel uncomfortable learning about dating violence through traditional methods such as role-play and in-group sessions (fox et al., 2013). in light of an increasing awareness of the prevalence of dating violence (leen et al., 2013), there is a need for approaches that are both more effective and which minimize students’ experiences of discomfort (fox et al., 2013). in that games can impact attitudes and bring about changes in behaviour on relational and sex issues (connolly et al., 2012), green acres high can in this sense be regarded as a useful digital tool in outreach social work with young people. however, as the students in this study quite clearly state, this is a game they would not play outside of the classroom and, were they asked to do so, they would not treat the subject seriously. this result emphasises the importance of using computer games to address dating violence in a school context. we propose that the combination of using an online computer game on a large-scale basis, together with more individualized small-group sessions of reflection and discussion, offers a new digital tool for outreach social work for young people and can constitute an innovative device in a toolbox that, traditionally, has been dominated by face-to-face interactive communication (adams, 2005; andersson, 2013; smith, 2005). outreach work is targeted at individuals and groups who otherwise are hard to reach and who need easily accessible linkage to support (andersson, 2013). indeed, this sort of digital intervention can be the answer to the call made by o´donnell et al. (2006) for social work interventions that, both at an individual level (for those who may have experiences of violence either from being abused or being an abuser), and on a group level, can lower the prevalence of dating violence. it appears that using the game in a school setting can enable social workers to reach and engage young people in a context where learning is in focus. the results clearly indicate that the young people will engage with the game during class. in line with advances in social work, spring 2015, 16(1) 135 previous research, one conclusion to draw is that the game appears to have the ability to increase motivation and increases the chances of reaching expected learning goals (wastiau et al., 2009), which can result in changed attitudes to dating violence. by being directed at a wider group of individuals, not just individual victims or perpetrators, knowledge can be shared. it can in this way become possible to reach young people who previously might not have reflected much upon the topic of dating violence. according to the respondents, knowledge about dating violence mediated by a digital game has greater chances of being remembered. this result accords well with other research, which indicates that the design of digital games is based on the principle that, in order to progress further in the game, players need to learn, to memorize, and to obtain additional information (felicia, 2009). in this way, cognitive processes of learning about dating violence can be enhanced. the young people in the focus group also highlighted the need for interaction and discussions with peers to be considered an important part of handling a socially sensitive topic such dating violence. in light of this finding, interaction with peers and social workers, in the types of debriefing sessions that felicia (2009) proposes, would function as way to solidly link the game with the anticipated learning outcomes. in addition, looking at the prevalence of dating violence (leen et al., 2013), there is the likelihood that some young people in the debriefing sessions would also have experiences of violence, either as victims or as abusers. consequently, social workers need to develop an awareness of individual young people’s potential vulnerability and, in line with the objectives of outreach social work (andersson, 2013), work actively to link them to other sources of support. conclusions and limitations using a serious game method in a school setting offers social workers an effective method of working with dating violence, both from the perspective of prevention and intervention. it is clear that young people today belong to the digital-gaming generation. new methods need to be used to attract their attention and to make social learning possible in an interesting and interactive way. social workers can use games to increase the motivation of players so that, through motivation, knowledge can be acquired and attitudes be changed (wastiau et al., 2009). since the use of game-based interventions by social workers is relatively new, further research into the effectiveness of this type of intervention is needed; longitudinal studies can identify long-lasting changes in attitudes, knowledge, and behaviour. since adv has proven to be an increasing, it is also important to find effective tools that can have a positive impact on young people’s behaviours and, in the long term, can decrease the prevalence of adv. it is important for social workers to listen to young people themselves to create tools that are interesting enough for young people to want to pay attention to them. the present study was limited with regard to the number of respondents and offers no generalization possibilities. it still provides valuable insights into adolescents’ subjective thoughts about a game-based intervention. more respondents would have given the study more depth. since this study was qualitative, it focused on examining subtle interactive processes taking place in specific contexts that are difficult to generalize, something important to remember when discussing the validity of a sorbring et al./game based intervention 136 specific study (smith, 2008). implications for practice in practice, it is recommended that green acres high be used in outreach social work with young people, with the aim of targeting dating violence from a preventative perspective as well as targeting individuals who may have experiences of violence either from being abused or being an abuser. for example, the finding that the young people indicated that they did not think dating violence was as bad as it sounded until after playing the game can enable social workers to work effectively with young people impacted by dating violence. the result also indicates that while the young people would not engage seriously with the game and the topic outside of a school environment, as the game is not a “real” game, it nevertheless works in a school environment “as there is not much else to do in a lesson” (young woman/group 2). subsequently, green acres high can function as an effective tool for outreach social work in a school context. in this sense social workers, in order to use green acres high, need to collaborate with school authorities to use class time for this purpose. as research indicates, collaboration between schools and social work can be problematic (farmakopoulou, 2002). for example, addressing issues of dating violence may not have the same priority for school authorities as for social workers. a further implication is that the suitability of a serious game targeting dating violence is age dependent. felicia (2009) recommends that the activities and types of skills in serious games be suitable for the target age group. in our view the targeted age group for green acres high should be contextually determined, depending upon the young people’s experiences of dating and intimate relations. in sweden, for example, the majority of fifteen-year-olds do not have experiences of dating and/or intimate sexual relations, and generally dating is more common in upper secondary school (16to 19years-old) (tikkanen, abelsson, & forsberg, 2011). with regard to the cognitive and emotional element of being able to link the game to one’s own or peers’ experiences during the process of reflection in the debriefing session, we believe that the game would not, in a swedish context, be suitable for a younger age group as it would be too far removed from the young people’s day-to day lives. the risk would be that learning about dating violence would not be meaningful and may be even harmful, as young people may get a feeling of disillusionment about intimate relations before they even have had a chance to gain their own experiences. references adams, r. 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(2009). how are digital games used in school? complete results of the study. retrieved april 4, 2014, from the european schoolnet website http://games.eun.org/upload/gis-full_report_en.pdf wolfe, d., wekerle, c., scott, k., straatman, a. l., grasley, c., & reitzel-jaffe, d. (2003). dating violence prevention with at-risk youth: a controlled outcome evaluation. journal of consulting and clinical psychology, 71, 279-291. author note correspondence can be addressed to emma sorbring, emma.sorbring@hv.se, university west, se-461 86, trollhättan, sweden. this project was supported by an ec daphne iii transnational action grant number just/2009/dap3/ag/1068 — 30-ce-0386806/00-15. microsoft word 11. castillo et al_2836_ghanaian bsw students_copyedit_final ______________ jason t. castillo, ph.d, is an assistant professor and samuel asante is a doctoral student (ph.d.) in the college of social work at the university of utah in salt lake city. peter dwumah and jonas asamanin barnie are faculty member lecturers in the department of sociology and social work at the kwame nkrumah university of science and technology in kumasi, ghana. david becerra, ph.d, is an assistant professor in the school of social work at arizona state university in phoenix. copyright © 2013 advances in social work vol. 14 no. 2 (fall 2013), 477-500 ghanaian bsw students' perceptions of poverty and social welfare policies in ghana jason t. castillo samuel asante peter dwumah jonas asamanin barnie david becerra abstract: in august 2010, data for this exploratory study were drawn from a sample of 185 undergraduate social work students from a public university in ghana. ordinal logistic regressions were run to analyze the relationship between social work students’ demographic variables and their perceptions toward poverty and social welfare policies in ghana. the results of this study found that social work students’ age, gender, marital status, number of children, socioeconomic status, and area of concentration affected their perception toward poverty and social welfare policies in ghana. the findings of this study point to several areas for consideration when developing or revising social work education curricula in ghana. keywords: social work students, poverty, social welfare policies, ghana since gaining independence in 1957, ghana has emerged as a shining example of a developing nation for the rest of the african continent. located in the western part of sub-saharan region, ghana, home to approximately 24 million people, is a nation with democratic norms entrenched in an active civil society, laws and rules that are respected, a well-managed economy, and a burgeoning middle class (cia world factbook, 2011a; cia world factbook, 2011b; ghana statistical service [gss], 2009; throup, 2011). however, despite the social and political gains that have been achieved, approximately 28% of ghanaians live in poverty and the nation remains well below the average of other nations on a number of health indicators including high malnutrition rates, high illiteracy rates, high communicable disease rates, inequities in immunizations among one-year olds, inequities in under-five mortality rates, poor health and sanitation facilities, and inadequate water supplies (index mundi, 2010; international labor organization [ilo], 2006; rolleston, 2011; united states agency for international development [us aid], 2010; world health organization [who], 2009). in ghana, the reduction of poverty and deprivation among vulnerable citizens was initially the responsibility of the traditional social support system—extended family members and clans (blavo & apt, 1997). marriage, family, and religion are the foundation of ghanaian society and serve as the most durable forms of social and economic security to ghanaians (laird, 2011; takyi, obeng-gyimah, & addai, 2006). castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 478 consisting of far-reaching reciprocal duties, obligations and responsibilities to one another, marriage, family, and religion render moral, spiritual, emotional, financial, and instrumental support to all ghanaians (avandel, 2011; sultan & schrofer, 2008). however, following the industrialization and urbanization of the nation, the traditional social support system has not been able to adequately respond to or meet the needs of the impoverished and vulnerable ghanaians (kreitzer, 2004). in response to these socioeconomic issues, successive public, private, and non-governmental organizations inclusive of the work of social work professionals have throughout the past few decades developed and implemented various economic and social initiatives intended to reduce the rate of poverty and deprivation among ghanaians in ghana. since the early 1960s, the government of ghana (gog), either independently or in cooperation with the private sector, non-government organizations, and/or private donors, has assumed responsibility in the reduction of poverty in ghana. in the 1960s, the gog emphasized public industrialization strategies in urban areas that were focused on expanding and improving labor, educational, and health care opportunities for ghanaians in urban areas (aryeetey & goldstein, 2000; kormey, 2009; obeng, 2008; social security and national insurance trust, 2011). in the 1970s, the gog emphasized local public industrialization strategies in rural areas that were focused on expanding and improving agricultural production rates, farm incomes, and the provision of water and farmer education (aryeetey & goldstein, 2000; whitefield, 2009). most recently, beginning in the 1980s, the gog in cooperation with and receipt of support from the world bank (wb) and international monetary fund (imf) has emphasized the need to achieve macroeconomic stability across the nation (aryeetey & goldstein, 2000; devereux et al., 2008; sowa, 2002). unfortunately, due to the growing mass of people leaving rural areas to urban areas, growing incongruity between the human capital of the population and the economic and social development initiatives of the state, increasing decision-making imbalance between the gog and non-government organizations, and the gog’s decreasing political and monetary support of the public social sector, these initiatives have largely failed to achieve what they were intended to do, decrease the rate of poverty and deprivation among millions of ghanaians (adema, gray & kahl, 2003; armah, 2009; aryeetey & goldstein, 2000; avendal, 2011; kreitzer, abukari, antonio, mensah, & kwaku, 2009), increase the rate of health insurance coverage among ghanaians (sultan & schrofer, 2008), and decrease gender disparities in the labor, educational, and government sectors of ghana (amu, 2006; apt, 2007; heintz, 2005; international fund for agricultural development [ifad], 2011; kimani & kombo, 2010; owusu & abdulai, 2009). while the abovementioned initiatives have not yielded the intended results, the initiatives have led the gog to adopt and integrate different and innovative approaches and systems into the traditional social support system in ghana, one of these being the institutionalization of a formal bureaucratic social welfare system, which was inclusive of the social work profession. in ghana, social work is a combination of traditional and western-imported methods and techniques (avendal, 2011). in pre-colonial ghana, social problems were addressed within the context of the traditional system, particularly advances in social work, fall 2013, 14(2) 479 the extended family system, which ensured security for and cohesion among members, provided mechanism for regulating human behavior, and controlled the economic life of individuals (avendal, 2011, blavo & apt, 1997). following periods of industrialization and urbanization in ghana, new social problems emerged, problems the traditional system was neither equipped for nor capable of managing effectively. to this end, the formal social welfare system inclusive of the gog and social work profession emerged as an alternative social support system to improve the health and well-being of ghanaian individuals and families in need—educational, employment, health, income, and social welfare services (blavo & apt, 1997). although no single unifying western—or african—social work theory or practice exists, western european ideas and models emphasizing individuals and psychotherapy have continued to prevail in the education of social work students and practitioners in ghana (asamoah, 1997; avendal, 2011; blavo & apt, 1997; kreitzer et al., 2009; leighninger & midgley, 1997; midgley, 1981). according to the international federation of social worker code of ethics (ifsw) (2012), “professional social workers are dedicated to service for the welfare and selffulfillment of human beings; to the development and disciplined use of scientific knowledge regarding human behaviour and society; to the development of resources to meet individual, group, national and international needs and aspirations; to the enhancement and improvement of the quality of life of people; and to the achievement of social justice” (p. 1). despite this stated mission, evidence suggests that social work professionals across the world are distancing themselves from working with poor and impoverished populations and instead working with moderate income populations and populations with non-chronic emotional issues (bullock, 2004; clark, 2007; hackett, kuronen, metthies, & kresal, 2003; limb & organista, 2003; ljubotina & ljubotina, 2007; weiss, 2005; weiss, gal, & cnaan, 2004; weiss, gal, cnaan, & majiaglic, 2002). contributing further to this issue is evidence indicating that social work students are more often being trained as micro practitioners specializing in counseling with an emphasis on psychotherapy with individuals, groups, and families (asquith, clark, & waterhouse, 2005; weiss, 2006) rather than macro practitioners specializing in policy practice and community organization with an emphasis on the political, economic, historical, social, and cultural understanding of populations, organizations, and communities (jacobson, 2001). with the economic and social challenges impacting millions of ghanaians, the formal bureaucratic social welfare system (kreitzer et al., 2009), and number of social work students graduating from social work educational programs and employed by the abovementioned social welfare system in ghana, it is essential that researchers examine ghanaian social work students’ perceptions of poverty and social welfare policies in ghana. the implications associated with the findings of this research will contribute to the: education and development of social work students; professionalization of social work students; shortand long-term viability and sustainability of social work educational programs; and the shortand long-term viability and sustainability of the social welfare policies and programs for poor and impoverished individuals, families, and communities in ghana. castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 480 literature review throughout the years, numerous studies have examined social work students’ perceptions of poverty and social welfare policies in their respective countries. a majority of these studies have occurred with social work students in developed nations and focused on factors ranging from students’ age, gender, race, ethnicity, nationality, socioeconomic status, place of residence, political assumptions, educational status, to course of study (i.e., bsw, msw) (ljubotina & ljubotina, 2007; nasser, abouchedid, & khashan, 2002; weaver & yun, 2010; weiss, 2005, 2006). missing from this research has been the examination of social work students in developing nations. given the limited amount of research on social work students in developing nations, the following literature review consists of literature primarily from developed nations but also inclusive of several developing nations including croatia, hungary, and zimbabwe. social work students’ perceptions of poverty feagin (1975) was one of the first researchers to systematically examine the beliefs and causes of poverty among different subgroups. he found 11 types of beliefs about the causes of poverty, which were later grouped into three categories. the first category attributed poverty to individual or internal causes—a specific lifestyle of the poor, such as lack of capability, effort, and laziness, or alcohol abuse. the second category attributed poverty to structural or external causes—unfriendly social, political, cultural, and economic factors such as uneven distribution of wealth, exploitation of the poor, or unequal opportunities. the third category attributed poverty to fatalism—bad luck, illness, fate, or god’s will. of these categories, the individualistic and structural categories have dominated the social, political, and economic landscape of nations worldwide, resulting in policy and program initiatives aligned with each respective category. social work students have maintained a variety of opinions or beliefs about poverty and poor populations many of which are similar to those mentioned previously. in a study comparing the attitudes regarding poverty among college students in south africa, lebanon, and portugal, south african students were more likely to blame the individual for their poverty than their portuguese and lebanese counterparts (nasser et al., 2002). in a cross-national comparison study of social work students, weiss (2006) found that brazilian students were more likely to attribute poverty to structural factors than were students from the other six nations. in their cross-national and cross-discipline study of undergraduate students, ljubotina and ljubotina (2007) found that compared to undergraduate agriculture and economics students, undergraduate social work students were less likely to attribute poverty to an individual’s personal characteristics. in their study comparing undergraduate social work and business students’ attitudes toward poverty, weaver and yun (2010) found that students who were female or with more leftist political views were more likely to attribute poverty to structural factors. in a cross-national study examining social work graduates attitudes toward poverty and the goals of the social work profession, weiss (2005) found that hong kong social work graduates attributed greater importance to psychological explanations of poverty and that australian social work graduates were more inclined than the brazilian, israeli, german, advances in social work, fall 2013, 14(2) 481 hungarian, zimbabwean, and american social work graduates to attribute poverty to structural causes. social work students’ perceptions of social welfare policies according to muuri (2010), social welfare policy is regarded as a way to support the less fortunate and to distribute life’s uncertainties more equally among different social groups. similarly, breznau (2008) associated social welfare policy with the state’s provision of health, education, shelter, and employment services to the general public. there have been several arguments regarding the relevance of social welfare policies in contemporary societies. while some individuals and groups accept and support the development and implementation of social welfare policies and programs, others vehemently oppose them (breznau, 2008). for supporters of social welfare policies, social welfare policy is a means to help out the least fortunate or poorest members of the society by creating or increasing social equality (breznau, 2008). brown and neku (2005) emphasized in their study that welfare policies seek to alleviate poverty among the most vulnerable and marginalized majority groups who have the lowest income and possess the least education and highest unemployment rates. findings from their study showed that participants who supported social welfare policies in the form of poverty alleviation programs believed welfare policies promote self-reliance. for those opposing social welfare policies, social welfare policy is detrimental to society and has done little or failed to reduce poverty. in his analysis of social welfare programs, murray (1984) found that social welfare policies and programs can lead to an increase in the rate of social problems such as poverty and crime. the study promoted individual initiative rather than government intervention to help low income populations meet the basic needs of life and insisted on a discontinuation of social welfare policies and programs. dollar and kraay (2000) asserted that a market economy emphasizing economic development is essential for growth and protection of the poor, whereas the provision of support through social welfare policies and programs have an undesirable effect on society. according to tanner (2012), despite nearly $15 trillion in total social welfare spending since the war on poverty was declared in the united states in 1964, the poverty rate is perilously close to where it was more than 40 years ago with a poverty rate of 15%. unlike the previous section where there have been a few studies examining social work students’ perceptions of poverty, less work has been done examining social work students’ perceptions of social welfare policies. however, a body of research examining social work students’ perceptions of the role of government in addressing social issues in various societies does exist (tam, 2003; weiss, 2003, 2006; weiss, cnaan, & gal, 2005; weiss et al., 2002; woodcock & dixon, 2005). the results of these studies have been mixed with some groups supportive and other groups less supportive of the government intervening in social issues, such as the alleviation of poverty. in a study comparing 429 first year social work students’ preferences of social policy for dealing with the needs of citizens in three countries—the united kingdom, israel, and the united sates, weiss and colleagutes (2002) found that the social work students castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 482 supported government intervention in the areas of housing, welfare, and redistribution of wealth. however, there was variation among students in regard to the degree of government support, with some students highly supportive and others less supportive of government intervention. students from all three of the universities responded with much indifference to their willingness to fund the welfare state and its program. in a study involving 239 social work graduates in hong kong and the people’s republic of china, tam (2003) found that while some social work students perceived the government as being responsible for the alleviation of social problems in society, other students perceived individuals as being responsible for the alleviation of their own social problems. in a study with 138 undergraduate social work students in israel, weiss (2003) found that social work students favored government social welfare programs as a means for dealing with poverty-related problems. in another study examining 223 undergraduate and graduate social work students at two universities in two countries, the united states and israel, weiss and colleagues (2005) found that social work students were supportive of the welfare state model. social work students in both nations indicated that the state should be responsible for welfare services for its citizens. however, social work students in the united states demonstrated more willingness to pay for the welfare state than their israeli counterparts, even though the level of support cannot be described as very high. in a study examining 781 final year social work students at leading schools of social work from ten countries, woodcock and dixon (2005) found that social work students expressed strong support for the state to intervene in alleviating poverty. preference for state intervention was highest among social work students in australia, hong kong, and the united states. the degree of difference in level of support for state intervention was greatest in brazil, australia, and canada and smallest in zimbabwe and hong kong. in a third study examining 514 graduating bachelor’s of social work students from five countries: brazil, germany, hungary, israel, and the united states, weiss (2006) found that social work students were more inclined to view the expansion of state government welfare provisions as the best means of dealing with poverty and less inclined to support the reduction of state government intervention in dealing with poverty. interestingly, with respect to extending state welfare assistance, brazilian social work students were more supportive of extending state provision than social work students in the other four nations. while the abovementioned literature is beneficial to understanding social work students’ perceptions toward poverty and social welfare policies, a majority of these studies have been conducted with social work students in developed nations with established social welfare systems. relatively little research has been conducted with social work students in developing nations, nations with substantial amounts of poverty and less developed social welfare systems. as such, this study will be the first to examine ghanaian undergraduate social work students’ perceptions of poverty and social welfare policies in ghana. advances in social work, fall 2013, 14(2) 483 purpose of the study to contribute to the abovementioned research, the goals of this exploratory study were to: (1) provide descriptive information about a sample of undergraduate social work students in ghana, (2) examine the relationship between ghanaian social work students’ socio-demographic characteristics and their perception of poverty in ghana, and (3) examine the relationship between ghanaian social work students’ socio-demographic characteristics and their perception of social welfare policies in ghana. given the economic and social challenges impacting millions of ghanaians, as well as the emerging development of the social work profession in ghana, the researchers deemed it important that further research be conducted with this population on this particular area of study. methodology design of study in august 2010, the researchers collected data from a convenience sample of undergraduate social work students enrolled in an accredited social work program at a university in ghana. this study received institutional review board (irb) approval from the first author’s u.s. institution and permission to conduct the study was received from department administrators at the participating university in ghana. the study required that participants complete a 42-item questionnaire consisting of five sections addressing: descriptive information (i.e., age, gender, marital status, number of children, socioeconomic status, and area of concentration); perceptions of the cause of poverty; perceptions of social welfare policies in ghana; perceptions of government response to poverty; and perceptions of social work policy education in the social work curriculum. administration of the questionnaires occurred during the undergraduate policy courses in the fall semester. participants were informed that the questionnaire would take about 10 minutes to complete, there were minimal risks associated with the study, and there were no direct benefits for participating in the study. measures dependent variables. the dependent or outcome variables in this study consisted of 10 items asking social work students about their perceptions toward poverty and social welfare policies in ghana. the first five items of the questionnaire consisted of questions asking students about their perceptions of the causes of poverty. using a 5-point likert scale, students were asked whether they 1 = strongly disagree to 5 = strongly agree that (1) poverty is caused by a lack of motivation, self-discipline, and work-ethic, (2) poverty is caused by social and structural forces (i.e., inequality), (3) people are poor because they belong to oppressed populations, (4) people are poor because they do not have equal opportunities, and (5) people are poor because they do not want to work. the remaining items of the questionnaire consisted of questions asking students about their perceptions of social welfare policies in ghana. using a 5-point likert scale, students were asked whether they 1 = strongly disagree to 5 = strongly agree that (1) social welfare policies have benefitted my family, (2) social welfare policies have a positive impact on society, (3) social welfare policies mostly benefit the poor, (4) social welfare benefits increase castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 484 poor families’ dependence on society, and (5) social welfare benefits undermine individuals’ willingness to work. independent variables. the independent variables in this study consisted of seven items asking social work students about their age, gender, marital status, number of children, socioeconomic status, and area of concentration. age was a categorical variable with four response categories ranging from 0 = 21-30 to 3 = 51-60. gender was a categorical variable with two response categories, 0 = male and 1 = female. marital status was a categorical variable with two response categories, 0 = not married to 1 = married. number of children was a categorical variable with two response categories, 0 = no children and 1 = one or more children. socioeconomic status was a categorical variable with two response categories, 0 = very poor-fair and 1 = good-very good. area of concentration was a categorical variable with two response categories, 0 = micro social work concentration and 1 = macro social work concentration. characteristics of the sample a total of 185 social work students in their third year (i.e., junior year) of college education participated in this study (65 females, 119 males) (see table 1). sixty-one percent of the participants were between 21-30 years of age. a majority of the participants were single (68%) and almost one-third of the participants were married (29%). sixty-three percent of the participants reported having no children. table 1. characteristics of participating ghanaian social work students n percent (%) age (years) 21-30 104 61 31-40 54 31 41-50 11 6 51-60 3 2 gender female 65 35 male 119 65 marital status not married 126 70 married 54 30 number of children none 90 63 some 53 37 socioeconomic status very poor-fair 83 46 good-very good 98 54 area of concentration micro 33 18 macro 150 82 note: because of missing data the totals do not equal the specified n = 185 advances in social work, fall 2013, 14(2) 485 forty-six percent of the participants reported having very poor-fair household incomes as adults. based on the overall mean scores, participants on average tended to agree that in ghana, people are poor because they do not have equal opportunities (m = 3.87), poverty is caused by social and structural forces (m = 3.85), and social welfare policies have a positive impact on society (m = 3.93) (see table 2). table 2. mean scores on ghanaian social work students’ perceptions of poverty and social welfare policies in ghana n mean scores sd range perceptions of poverty lack of motivation 184 3.29 1.141 1-5 social and structural forces 182 3.85 1.005 1-5 belong to excluded populations 179 2.96 1.242 1-5 unequal opportunities 178 3.87 1.140 1-5 do not want to work 182 2.73 1.430 1-5 perceptions of social welfare policies benefit family 184 2.96 1.101 1-5 positive impact on society 182 3.93 0.854 1-5 benefit the poor 184 2.62 1.209 1-5 increase poor families’ dependence on society 181 2.91 1.189 1-5 undermine individual’s willingness to work 184 2.40 1.155 1-5 encourage idleness among the poor 181 2.61 1.281 1-5 analysis plan using predictive analytics software (pasw) 18, several statistical procedures were used in this study, including spearman correlation coefficient tests and ordinal logistic regressions. bivariate analyses including spearman correlation coefficient were used to determine the strength of the relationship between the independent and dependent variables. ordinal logistic regression was used to predict the outcome of social work students’ perceptions toward poverty and social welfare policies (categorical criterion variables with more than two response categories) based on social work students age, gender, marital status, number of children, socioeconomic status, and area of concentration (predictor variables). results bivariate analyses several spearman correlation coefficient tests were conducted to determine the strength of the relationship between social work students’ age, gender, marital status, number of children, socioeconomic status, area of concentration and their perceptions toward poverty and social welfare policies in ghana (see table 3). a significant relationship (rho(169) = -.162, p < .05) was found between social work students’ age and castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 486 perception toward poverty—lack of motivation. older social work students tended to disagree that poverty was due to a lack of motivation. a significant relationship (rho(139) = .207, p < .05) was found between social work students’ number of children and perception toward poverty—social and structural forces. social work students with more than one child tended to agree that poverty was due to social and structural forces. a significant relationship (rho(175) = -.159, p < .05) was found between social work students’ area of concentration and perception toward poverty—belonging to an excluded population. social work students in the macro area of concentration tended to disagree that poverty is due to belonging to an excluded population. finally, a significant relationship (rho(139) = -.223, p < .01) was found between social work students’ socioeconomic status and perception toward poverty—do not have equal opportunities. social work students with higher socioeconomic status tend to disagree that poverty is due to unequal opportunities. no significant relationships were found between social work students’ age, gender, marital status, number of children, socioeconomic status, area of concentration and their perceptions toward social welfare policies in ghana. ordinal logistic regression analyses table 4 presents the results of the ordinal logistic regression analyses examining social work students’ perceptions toward poverty. the log of the odds of poverty being due to lack of motivation was negatively related to social work students’ age (p < .05). that is, older social work students were less likely to perceive that poverty is due to lack of motivation. students were asked whether they 1 = strongly disagree to 5 = strongly agree that “poverty is caused by a lack of motivation, self-discipline, and work-ethic.” the results indicated that for every one unit increase in the age category there was a 48% lower likelihood of choosing a higher category (or = .52). in other words, there is a negative association between social work students’ age and their perception that poverty was due to lack of motivation. the log of the odds of poverty being due to social and structural forces was positively related to the social work students’ number of children (p < .05). social work students with one or more children were more likely to perceive that poverty is due to social and structural forces. for every one unit increase in the number of children category there was a 264% greater likelihood of choosing a higher category indicating poverty as being due to social and structural forces (or = 3.64). the log of the odds of poverty being due to belonging to an excluded population was negatively related to social work students’ area of concentration (p < .01). macro-focused social work students were 68% less likely to perceive that poverty is due to belonging to an excluded population (or = .32). the log of the odds of poverty being due to unequal opportunities was negatively related to social work students’ socioeconomic status (p < .05). social work students with good-very good socioeconomic status were less likely to perceive that poverty is due to unequal opportunities (or = .48). the log of the odds of poverty being due to not wanting to work was positively related to social work students’ marital status (p < .05). married social work students were much more likely to perceive that poverty is due to persons not wanting to work (or = 3.13). castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 487 table 3. bivariate correlations (spearman rho) among ghanaian social work students’ perceptions of poverty and social welfare policies lack of motivation social and structural forces belong to excluded populations do not have equal opportunities do not want to work age -.162* .129 .046 .064 -.056 gender -.070 -.061 -.022 -.031 .129 marital status -.093 .084 .137 .030 .089 no. children -.117 .207* .031 -.013 .014 ses .061 -.037 -.099 -.223** .066 concentration .108 -.041 -.159* .057 .021 benefits family positive impact on society benefit the poor increase poor families dependence on society undermine individual’s willingness to work age .033 .052 .026 -.140 -.018 gender -.020 -.121 -.085 .102 .042 marital status .093 .091 .058 -.113 .021 no. children .058 .066 -.073 -.146 .004 ses .103 -.114 .005 .116 .080 concentration -.019 .061 .019 .098 .023 * p < .05 ** p < .01 *** p < .001 castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 488 table 4. ordinal logistic regressions: ghanaian social work students’ perceptions of poverty lack of motivation social and structural forces belong to excluded populations do not have equal opportunities do not want to work b or b or b or b or b or age -.645 (.329) .52* .042 (.340) 1.04 -.151 (.350) .86 -.231 (.327) .79 .067 (.307) 1.07 gender -.249 (.381) .78 -.232 (.384) .79 -.326 (.362) .72 -.187 (.376) .83 .620 (.359) 1.86 marital status .330 (.605) 1.39 -.409 (.613) .66 .805 (.676) 2.24 .347 (.620) 1.41 1.142 (.581) 3.13* no. children -.050 (.643) .95 1.292 (.661) 3.64* -.421 (.657) .66 -.154 (.657) .86 -.939 (.610) .34 ses .-.087 (.364) .92 .005 (.366) 1.00 -.186 (.349) .83 -.739 (.366) .48* .227 (.336) 1.25 concentration .712 (.456) 2.04 -.530 (.472) .59 -1.128 (.451) .32** .202 (.469) 1.22 .521 (.432) 1.68 n 127 126 122 121 126 * p < .05 ** p < .01 *** p < .001 standard errors in parenthesis gender (male = 0, female = 1) marital status (not married = 0, married = 1) number of children (no children = 0, one or more children = 1) socioeconomic status (very poor-fair = 0, good-very good = 1) area of concentration (micro = 0, macro = 1) advances in social work, fall 2013, 14(2) 489 table 5. ordinal logistic regressions: ghanaian social work students’ perceptions of social welfare policies benefits family positive impact on society benefit the poor increase poor families dependence on society undermine individual’s willingness to work b or b or b or b or b or age -.220 (.313) .80 -.176 (.330) .84 .639 (.322) 1.89* .111 (.333) 1.12 -.018 (.320) .98 gender -.092 (.358) .91 -.752 (.384) .47* -.598 (.370) .55 .265 (.367) 1.30 .542 (.368) 1.72 marital status .794 (.583) 2.21 .949 (.624) 2.58 1.094 (.601) 2.99 .499 (.610) 1.65 .584 (.616) 1.79 no. children -.188 (.614) .83 -.352 (.675) .70 -1.927 (.646) .15*** -1.267 (.652) .28* -.204 (.652) .82 ses .187 (.342) 1.21 -.458 (.362) .63 .338 (.350) 1.40 .461 (.348) 1.59 .410 (.352) 1.51 concentration .240 (.437) 1.27 .438 (.460) 1.54 -.066 (.446) .99 .801 (.457) 2.23 .365 (.445) 1.44 n 127 125 128 125 127 * p < .05 ** p < .01 *** p < .001 standard errors in parenthesis gender (male = 0, female = 1) marital status (not married = 0, married = 1) number of children (no children = 0, one or more children = 1) socioeconomic status (very poor-fair = 0, good-very good = 1) area of concentration (micro = 0, macro = 1) advances in social work, fall 2013, 14(2) 490 according to the models examining social work students’ perceptions toward social welfare policies in ghana (see table 5), the log of the odds of social welfare policies positively impacting society was negatively related to social work students’ gender (p < .05). female social work students were less likely to perceive that social welfare policies positively impacted society (or = .47). the log of the odds of social welfare policies benefitting the poor was positively related to social work students’ age (p < .05). older social work students were more likely to perceive that social welfare policies benefitted the poor. for every one unit increase in the age category there was an 89% greater likelihood perceiving that social welfare policies benefit the poor (or = 1.89). the log of the odds of social welfare policies benefitting the poor was negatively related to social work students’ number of children (p < .001). social work students with one or more children were less likely to perceive that social welfare policies benefitted the poor. in fact, for every one unit increase in the number of children category there is an 85% lower likelihood of choosing a higher category indicating that social welfare policies benefit the poor (or = .15). the log of the odds of social welfare policies increasing poor families’ dependence on society was negatively related to social work students’ number of children (p < .05). social work students with one or more children were less likely to perceive that social welfare policies increased poor families’ dependence on society. in fact, for every one unit increase in the number of children category there is a 72% lower likelihood of choosing a higher category indicating that social welfare policies increase poor families dependence on society (or = .28). discussion this exploratory study examined ghanaian undergraduate social work students’ perceptions toward poverty and social welfare policies in ghana. the results of this study found that social work students’ age, gender, marital status, number of children, socioeconomic status and area of concentration affected their perception toward poverty and social welfare policies in ghana. these findings seem relevant to the abovementioned literature and warrant further explanation. the findings indicating that social work students with one or more children were less likely to perceive that social welfare policies benefitted the poor and increased poor families’ dependence on society may suggest that social work students with one or more children are aware of the existing social welfare policies and programs and outcomes associated with these social welfare policies and programs. given this, the social work students may realize that one, the social welfare policies are not benefitting the poor, and two, without getting to or benefitting the poor, poor families cannot in turn become dependent upon society. the two findings that social work students with one or more children were more likely to perceive that poverty was attributed to social and structural forces and older social work students were less likely to perceive that poverty is due to lack of motivation are consistent with the belief that the nation’s institutional infrastructure comprised of informal networks of family members and religious institutions and formal networks including labor, educational, and government sectors are not adequately prepared or structured to respond to the needs impacting millions of poor ghanaians (adema et al., 2003; armah, 2009; avendal, 2011). social work students with one or more children may advances in social work, fall 2013, 14(2) 491 themselves be employed, generating an income, and maintaining a household, which come with costs and economic uncertainty, an uncertainty not necessarily of their own doing. with the increased responsibilities and costs associated with adulthood—marriage, parenting, employment, and managing a household—it is reasonable to assume that social work students with one or more children may attribute poverty to social and structural forces because they may believe poor persons are doing all they can with the resources available to them, yet they are or are close to experiencing economic challenges, challenges outside of their individual control. the finding that female social work students were less likely to perceive social welfare policies as having a positive impact on society may be attributed to the realization that considerable disparities exist between females and males in terms of educational, employment, income, and political opportunities (ifad, 2011; owusu & abdulai, 2009). when comparing females to males in ghana, females have less formal education (apt, 2007), have fewer employment opportunities with lower levels of advancement (amu, 2006), are concentrated in jobs with lower earnings (heintz, 2005), and are less represented in administrative and elected positions at the district, local, regional, and national level of government (kimani & kombo, 2010). given these inequalities, female social work students may not perceive social welfare policies as benefitting women or society. the finding that older social work students were more likely to perceive that social welfare policies benefitted the poor may suggest that older social work students are more knowledgeable and familiar with the principles and goals underlying the existing social welfare policies and programs (gobah & zhang, 2011; mensah, 2009; mensah, oppong, & schmidt, 2010). mindful of their own maturation, as well as accompanying life changes and conditions in life, older social work students may have some trepidation regarding their own shortand long-term security, thereby holding more positive attitudes toward social welfare policies benefitting the poor. several findings associated with social work students’ marital status, socioeconomic status, and area of concentration seems to diverge from the abovementioned literature and warrant further explanation. the finding that married social work students were more likely to perceive that poverty is due to persons not wanting to work may indicate that married social work students recognize and understand the discipline, sacrifice, and work ethic necessary to sustain a marriage and manage a household; thus they may perceive that people who are poor may be lacking the moral principles of discipline, sacrifice, and work ethic, all of which are necessary to keeping one out of poverty (johnson, 2010; otlin, 2008). the finding that social work students of higher socioeconomic status were less likely to perceive that poverty is due to unequal opportunities may suggest that these students believe they amassed all of which they are and have on their own. these students may also believe that persons of moderate or higher socioeconomic status have made good use of their time, are the best and brightest, and utilized to the fullest extent opportunities available to them, whereas persons of lower socioeconomic status did not, therefore they get what they deserve—lower socioeconomic status or poverty. with this, it is reasonable to assume that social work students with good-very good socioeconomic status may be unaware of the privileges and benefits afforded them because of their socioeconomic status. castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 492 finally, the finding that social work students interested in macro social work practice were less likely to attribute poverty to membership in excluded populations may suggest that social work students interested in macro social work practice may not be entirely aware of or understand the tenets associated with macro social work practice—policy and planning, policy advocacy, and community and organization, most of which acknowledge and account for differences between groups—social stratification. given the widespread belief that a higher educational degree leads to more power, authority, and prestige in the workforce (perbi, 2004), the social work students interested in macro social work practice, a majority of whom responded to administration and supervision, may be more motivated by the perceived power, authority, and prestige associated with administrative and supervisory positions rather than the values, principles, and responsibilities associated with macro social work practice. limitations although the results of this study provide evidence suggesting that social work students’ socio-demographic characteristics were related to their perceptions of poverty and social welfare policies in ghana, the results should be interpreted with caution, as the study contained several limitations. first, the sample consists of social work students from one social work program in ghana and is not based on a random probability sample; therefore the results cannot be generalized to all social work students in ghana. future research studies may be conducted with social work students at each of the three social work programs in ghana. second, this study utilized a cross-sectional design, so changes in social work students’ perceptions toward poverty and social welfare policies in ghana cannot be determined. it would be beneficial to replicate this study using a preand post test design over an extended period of time. third, the questionnaire that was administered was constructed by the researchers using previous literature and was not tested for construct validity, reliability, and responsiveness of the measures. it would be beneficial to replicate this study using instruments with demonstrated validity and reliability. fourth, the questionnaire was constructed using items and terms primarily associated with american and western european cultures and literature. it would be beneficial to refine the questionnaire by using terms that are more familiar to population being examined. despite these limitations, the results of this study may provide ghanaian social work program administrators and educators with information that may be further incorporated into their curriculum—poverty, gender issues, family issues, and social welfare policies in ghana. implications given the impact poverty is having on ghanaians, social work students in ghana should be introduced to the different definitions associated with poverty, theories of poverty, dimensions of poverty, impact of poverty on individuals, families, groups, organizations, communities, and nations, and impact of social welfare policies on alleviating and/or eliminating poverty among impoverished populations in ghana. with this, the examination of poverty and social welfare policies in the social work educational curricula should be grounded in a socio-environmental context and encourage social advances in social work, fall 2013, 14(2) 493 work students to think critically about the social, political, economic, historical, and cultural factors of poverty and social welfare policies in ghana. if social work students practice according to a socio-environmental view, it may lead to an understanding of poverty that is inclusive of both individual and structural factors, as well as inclusive of macro-oriented interventions—social planning and policy, community and organization development, and social and political advocacy. this would be a departure from the approach emphasizing the remediation and rehabilitation of women, homeless children, and persons with a mental illness, physical disability, or both, the approach which has dominated social work practice and education in ghana (blavo & apt, 1997; kreitzer, 2004; kreitzer et al., 2009; manful & manful, 2010). through this approach, social work students may develop further insight into the challenges impacting impoverished individuals, the existing structural inequalities impacting impoverished groups and populations, and the policy process at the district, local, regional, and national levels of government in ghana. since the results of this study indicated that students interested in macro social work practice were less likely to attribute poverty to membership in excluded populations, it is important to develop teaching strategies and educational opportunities to increase the understanding and empathy toward oppressed and excluded populations living in poverty. for example, females in ghana represent an oppressed group. studies have found that the cultural values in ghana lead to gender discrimination in education with a higher priority placed on educating male children over female children in order for females to contribute to household chores and learn home-making skills. as a result, females have much lower levels of education, much higher rates of illiteracy than their male counterparts and therefore, higher rates of poverty (jones & chant, 2009). empathy is essential to an increased understanding of others’ experiences and social conditions which can motivate students to become more socially engaged and promote social change (gerdes, segal, jackson, & mullins, 2011). social work educators in ghana can adapt empathy enhancement strategies that have been demonstrated to be effective in the u.s. to the cultural and social context of ghana. the use of role playing and gestalt techniques have been shown to be effective at increasing empathy (calley & gerber, 2008; pearson, russ, & cain spannagel, 2008) and can be used to promote opportunities to learn about the lives of females and oppressed and excluded populations living in poverty. another strategy that can be adapted to fit the cultural and social context of ghana is the intergroup dialogues method (nagda et al., 1999) which promotes interactions among students of different social, racial, and class groups in order to develop a greater understanding of issues of discrimination and social justice among various groups. in addition to the examination of poverty and social welfare policies in the classroom, social work students may benefit from practicum placements that provide them with the opportunity to work directly with individuals, families, and groups experiencing poverty and practioners, policymakers and organizations responsible for developing, implementing, and enforcing social welfare policies and programs intended to alleviate or eliminate poverty. through this approach social work students may be afforded a more organic and existential experience of what poverty looks and feels like among impoverished populations, as well as the institutional and political challenges castillo, asante, dwumah, barnie, becerra/perceptions of poverty in ghana 494 policymakers and practitioners experience in promoting, developing, and implementing social welfare policies. given the relationship between values, perceptions, and behavior, providing social work students with these experiences may result in social work students rejecting or modifying existing perceptions toward poverty, poor populations, and social welfare policies. the findings of this study also point out the need for further research. refinement of the survey instrument is needed to clarify several of the questions, particularly those questions addressing social work students’ socioeconomic status and area of concentration. further research is needed to explore more directly how social work students’ socioeconomic status and area of concentration influence their perceptions toward poverty and social welfare policies in ghana. future studies are needed to determine the efficacy of specific classroom and practicum placement experiences in influencing social work students’ perceptions toward poverty and social welfare policies. identifying the perceptions of social work students and other human and social service oriented students would also be beneficial given these groups of students may have direct involvement with poor populations or serve in influential, decision-making positions in the future. if social work is going to be the leader in ameliorating poverty among individuals, families, communities, and nations, it is imperative that social work students be provided with the opportunity to acquire and practice the knowledge and skills essential to working with poor populations and policymakers and practitioners committed to alleviating and/or eliminating poverty in ghana. finally, while the findings presented herein are primarily addressing social work students, faculty members, administrators, and programs in ghana, the findings may also be of interest to students, faculty members, administrators, and programs outside of ghana and the social work discipline. through this international and interdisciplinary exchange, students, faculty members, administrators, and programs across disciplines may exchange information and resources that lead to the development of social welfare policies and programs that contribute to the alleviation and/or elimination of poverty in 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(2009). country cooperation strategy at a glance: ghana. retrieved from http://www.who.int/countries/gha/gha/en/ author note: address correspondence to: jason t. castillo, phd., assistant professor, college of social work, university of utah, 395 south 1500 east, salt lake city, ut 84112. email: jason.castillo@socwk.utah.edu microsoft word segal et al_2042_copyedit final ______________  elizabeth a. segal, ph.d., is a professor, m. alex wagaman, msw, is a doctoral candidate, and karen e. gerdes, ph.d. is an associate professor, all in the college of public programs, school of social work, arizona state university in phoenix. copyright © 2012 advances in social work vol. 13 no. 3 (fall 2012), 541-560   developing the social empathy index: an exploratory factor analysis elizabeth a. segal m. alex wagaman karen e. gerdes abstract: social empathy, the ability to understand people from different socioeconomic classes and racial/ethnic backgrounds, with insight into the context of institutionalized inequalities and disparities, can inspire positive societal change and promote social wellbeing. the value of teaching social empathy and creating interventions that promote social empathy is enhanced by the ability to measure and assess it. this article provides a validation of the social empathy index, a tool that practitioners can easily use to assess individuals’ levels of interpersonal and social empathy. an exploratory factor analysis was used to validate the instrument and confirm the conceptual model for social empathy. keywords: social empathy, individual empathy, social change, instrument validation introduction in a community lecture in 2004, robert reich, the former secretary of labor, shared his insights regarding times when empathy and social caring transformed society, such as the civil rights movement in the 1960s. he viewed these points in time as few and far between. reich called for an enlightened self-interest to create more of these times but he did not define what he meant nor did he explain to the crowd how enlightened selfinterest could be cultivated. similarly, in the audacity of hope (2006) president obama wrote about the importance of empathy. referring to his colleague senator paul simon, obama wrote, “that last aspect of paul's character—a sense of empathy—is one that i find myself appreciating more and more as i get older. it is at the heart of my moral code, and it is how i understand the golden rule—not simply as a call to sympathy or charity, but as something more demanding, a call to stand in somebody else's shoes and see through their eyes” (p. 66). what would social policies look like if citizens demanded that they be created by policymakers who could see the world through the eyes of the people who would be most impacted? reich and obama were both describing a compassionate society with an intense, shared insight into the lives of others. the authors refer to the mechanism that enables such a society as social empathy. social empathy is the ability to genuinely understand people from different socioeconomic classes and racial/ethnic backgrounds within the context of institutionalized inequalities and disparities (segal, 2011). social empathy insights can inspire positive societal change and promote social well-being through the use of democratic processes, social tolerance, and civic engagement (morrell, 2010). more than a decade ago, hoffman (2000) recognized the broader social dimensions of empathy when he called for expanding the teaching of empathy to create a moral and just society segal, wagaman, gerdes/developing the social empathy index 542 by going beyond individual empathy. he wanted to teach children how to “extend empathy to other groups, so that children will be more aware of the impact of their actions on others who differ from them in obvious ways” (p. 294). social work, psychology, anthropology, evolutionary biology, social cognitive neuroscience, as well as many other disciplines, have all acknowledged the value of interpersonal empathy (de waal, 2009; decety, 2011; gibbons, 2011). however, very little has been written about social empathy or how to measure it. this article articulates a conceptualization of social empathy and reports on the development of a social empathy index (sei). in addition to measuring an individual’s level of social empathy, the sei has the potential to aid social workers in cultivating and promoting social empathy. the value of interpersonal empathy empathy is the ability to understand what other people are feeling and thinking and it is an essential skill in facilitating social agreement and successfully navigating personal relationships (de waal, 2009). it is critical to our survival because it requires the accurate perception, interpretation, and response to the emotional signals of others (preston & de waal, 2002). therefore, empathy is a key building block for prosocial behavior, or the actions people take that benefit others and society (eisenberg & mussen, 1989). there is substantial research evidence that empathy is important in the development of healthy relationships (toussaint & webb, 2005); it supplies the affective and motivational foundation for moral development (eisenberg & eggums, 2009; smetana & killen, 2008); and promotes helping and prosocial behaviors particularly during adolescence (batson, chang, orr, & rowland, 2002; batson, håkansson eklund, chermok, hoyt, & ortiz, 2007; mcmahon, wernsman, & parnes, 2006). for youth, higher levels of empathy are associated with increased conflict resolution (de weid, branje, & meeus, 2007) and willingness to come to the defense of a bullied peer (gini, albiero, benelli, & altoe, 2007). parental empathy has been cited as crucial for raising healthy children (curtnersmith et al., 2006) and partner empathy is cited as a key attribute in satisfying relationships (busby & gardner, 2008). the absence of empathy can lead to destructive behaviors and adversely affect relationships. a lack of interpersonal empathy is associated with narcissism, bullying, violent crime, abusive parenting, spousal battering, and sexual offending (covell, huss, & langhinrichsen-rohling, 2007; elsegood & duff, 2010; gini, albieri, benelli, & altoe, 2008; joliffe & farrington, 2004; ritter et al., 2011). in spite of so much compelling research on the value of empathy, definitions and conceptualizations vary greatly. the diversity of definitions and measurement devices makes comparisons between empathy studies challenging (gerdes, 2011; gerdes, segal, & lietz, 2010). what is missing? understanding empathy and the impact on society how does empathy play a role in the larger societal realm? is it a collection of individual levels of empathy, or is there a broader way to conceptualize the impact and influence of social empathy? a critical piece in understanding the macro impact of empathy is to consider context. for example, a great deal of research has been conducted advances in social work, fall 2012, 13(3) 543     on the phenomenon of bullying, raising concerns about the social interactions of youth and the lack of empathy. some researchers argue that school bullying is a social phenomenon that reflects power relations in certain contexts rather than just individuals with aggressive or “evil” behaviors (horton, 2011). in this example, understanding the broader social context of schools as well as the barriers to child development can provide greater insight into why empathic behaviors may be absent in social settings. this can be particularly damaging on a societal level. in a macro context, racism, sexism, and homophobia are behaviors that not only diminish the humanity of marginalized groups, but those committing such behaviors “lose sensitivity to those who are hurt; they become hard, cold, and unfeeling to the plight of the oppressed; and they turn off their compassion and empathy for others” (sue, 2010, p. 130). this process has been part of history. glick (2008) describes this phenomenon as “ideological scapegoating.” complex and difficult social, economic, and political situations can lead to social constructions based in stereotyping to understand complex situations and deal with the fear of misunderstood social events. fear is a trigger that can hijack the more complicated and involved cognitive processing of empathy (o’connor, berry, weiss, & gilbert, 2002). the extreme outcome of this phenomenon is that majority groups, lacking empathic accuracy and feeling fearful of changing social conditions, can become so unfeeling of those different than them that socially harmful behaviors such as slavery, apartheid, and genocide can become sanctioned and institutionalized (glick, 2002, 2005, 2008). in 1995, robert d. putnam published his article bowling alone: america's declining social capital (with a best-selling book on the subject five years later) in which he famously bemoaned the decline in civil engagement and membership in social groups. this decline meant people were more out of touch with others, with negative social outcomes. twenge (2006) captured public attention with her research on young people’s sense of entitlement and increased narcissism. twenge and campbell (2009) later codified the concept of a “narcissism epidemic.” the authors argue that the increase in narcissism is accompanied by a decline in warm and caring relationships and empathy. recently, konrath, o’brien, and hsing (2011) compared scores of college students on a common (although outdated) empathy measure and found a decline in scores over the past 30 years. headlines from newspapers that picked up the research heralded that young people today are less empathic than young people of thirty years ago. less pessimistic is rifkin’s (2009) review of empathy throughout history. he argues that we are on the opposite track and empathy has increased over time, but he warns that we are at a critical juncture in the history of our civilization and could see a backsliding of empathic concern. these social phenomena and research findings suggest a need to better understand empathy in the context of social relations, as well as the need to measure and assess levels of social empathy. the current research study applied rigorous scientific testing informed by professional values and practice experience in an effort to develop the social empathy index. segal, wagaman, gerdes/developing the social empathy index 544 what is social empathy? social empathy is the “ability to understand people by perceiving or experiencing their life situations and as a result gain insight into structural inequalities and disparities” (segal, 2011, pp. 266-7). the assumption upon which the concept of social empathy is built is that with socially empathic feelings and knowledge, people are more inclined to work to promote social and economic justice and social well-being (segal, 2007, 2008). engaging in social empathy requires people to see themselves in relation to the outside world, and may increase their sense of efficacy or impact on the outside world, and ultimately gain a sense of empowerment (wagaman, 2011). it is hoped that the development of social empathy can increase social engagement while promoting an individual’s own empathic abilities. greater social engagement helps a person develop as a member of the larger society and in turn creates community, cultivates democratic behaviors, and protects public interests (putnam, 1993). promoting social empathy has the potential to enhance social engagement, improve prosocial processes, and build better social policies and programs, all of which benefit both the individual and society. development of the social empathy index the sei was constructed using the model of social empathy outlined in segal (2011). the model identifies three components—interpersonal empathy, contextual understanding, and social responsibility. the model also makes the assumption that if all three of these components are engaged, the result will be actions that promote social justice (see figure 1). the conceptual framework posits that interpersonal or general empathy is the crucial underlying foundation upon which the larger perspective of social empathy can be built. for this reason the sei includes the 20-item empathy assessment index (gerdes, lietz, & segal, 2011), a measure of interpersonal or general empathy. figure 1 empathy contextual understanding social  responsibility historical background impact of systemic conditions social justice affective response / mirroring cognitive processing conscious decision-making how does social empathy lead to social justice? social empathy advances in social work, fall 2012, 13(3) 545     interpersonal empathy the empathy assessment index (eai) (gerdes et al., 2011; gerdes, segal, & lietz, 2010; lietz et al., 2011) is a critical and foundational part of the social empathy index. the 20-item eai has four components based on the most recent social cognitive neuroscience conceptualization of empathy: 1) affective response, 2) self-other awareness, 3) perspective-taking, and 4) emotion regulation. (decety & moriguchi, 2007) the four components represent the four isolable neural networks that mediate empathy in the brain. these networks process incoming information on a millisecond timescale allowing individuals to feel what others feel, perceive what others see or understand, and possibly even recognize the intentions of others (mar, 2011). the affective response component represents the affective resonance the perceiver experiences when observing the target’s affective state. shared representations through the mechanisms of perception-action coupling (preston & de waal, 2002) and simulation (goldman, 2006) mediate the experience of affective empathy. affective empathy is often referred to as mirroring, and occurs on an unconscious level. as such, it requires some amount of self-other awareness and perspective-taking in order to distinguish the true experience of empathy from emotional contagion or simple mimicry (walter, 2012). self-other awareness and perspective-taking are cognitive processes that move us from physically sharing an affective response to viewing what that response might mean for the other person. emotion regulation, the fourth component, supports and enables the process of empathizing with another person while preventing the affective response from turning into an experience of personal distress (decety, 2011). contextual understanding interpersonal empathy is often limited without an accurate assessment of context (singer & lamm, 2009). the degree to which people can empathize across cultures requires processing information contextually: “we need to identify and analyze more precisely and systematically the variety of cultural frameworks, social situations, and political-economic conditions that tend to either suppress and inhibit basic empathy or amplify it into a frequent and reliable means of knowing” (hollan, 2012, p. 76). thus, social empathy examines context and includes insight into the structural inequalities that may impact others’ lives, different from our own. a key skill that is part of contextual understanding is the ability to take the perspective of those who are in different life situations. perspective-taking on the individual level is included in the eai. but perspective-taking on a macro level is key to contextual understanding. such macro-perspective-taking can improve social relations by decreasing prejudice and stereotyping as well improving social coordination (galinsky, ku, & wang, 2005). the united states army recognized the need for its military personnel to become skilled in perspective-taking because of the need to bridge cultural gaps between u.s. soldiers and populations in the regions of operations. reflecting a macro viewpoint, the u.s. military focuses on “social perspective-taking.” “performed correctly, spt allows the soldier to accurately consider the host-national’s perspective without cultural bias and erroneous assumptions” (roan et al., 2009, p. v). the report segal, wagaman, gerdes/developing the social empathy index 546 goes on to cite that the value of spt includes the development of social understanding, improved intergroup relations, greater cooperation, and can lead to trust, respect, and good relations. therefore, the sei incorporated items to measure macro-perspectivetaking. while macro-perspective-taking can increase people’s perceptions of commonalities between their own identity group and other different groups, it may mask or reduce understanding of intergroup inequalities (todd, bodenhausen, richeson, & galinsky, 2011). dovidio, gartner, and saguy (2009) found that increasing perspective-taking abilities can improve understanding of groups’ commonalities and reduce prejudice, but inadvertently it may also lead to an underestimation of intergroup inequalities. this lack of understanding of inequalities between groups would be a deterrent to efforts for social change. thus, macro-perspective-taking is important, but alone cannot enhance social empathy. macro-perspective-taking needs to be coupled with contextual understanding. “the role of context therefore is a significant component of perspective taking, since an individual will need to consider all the factors when hypothesizing about the perspective of another person,” which is especially true when dealing with other cultures (roan et al., 2009, p. 4). in order to fully understand the life circumstances of different groups, examination of historical events and the place of group membership in society at-large are critical. for example, when viewing the experiences of different racial groups, macroperspective-taking involves the ability to imagine what life is like as a member of that racial group. in addition, historical events that have been brought to bear on that particular racial group must be understood. finally, how other groups in society view membership in that particular racial group must be examined. thus, the items developed to address contextual understanding included elements that would help to identify levels of macro-perspective-taking and macro-self-other awareness, that is, considering what the life experiences are of others from different social and economic backgrounds. when these skills are used, a better understanding of the societal context of inequality and the structural barriers that inhibit opportunity for some groups is achieved. social responsibility when accurate empathic insight into other people’s lives is gained, it is often followed by a sense of social responsibility (frank, 2001). because the impetus behind social empathy is to gain insights into the lives of others in order to create policies that address social concerns, the model assumes that a commitment to social responsibility accompanies social empathy. hoffman (2000) explains this relationship: if one thinks about how society’s resources should be distributed, one might focus on the implications of different distributive systems for oneself or for others. a self-serving perspective will lead one to prefer principles that coincide with one’s own condition: a high producer would choose output, competence, or effort and a low producer would choose need or equality. an empathic perspective, on the other hand, would lead one to take the welfare of others into account…[and] that leads one to imagine the consequences of different systems advances in social work, fall 2012, 13(3) 547     for society’s least advantaged people or for people who work hard (hoffman, 2000, pp. 230-231). using terms of the newer neuroscience, hoffman is describing perspective-taking and self-other awareness on a societal level leading to a sense of social responsibility. for the sei, measuring social responsibility was challenging. people may report a strong sense of responsibility, but whether they actually behave in that way is much more difficult to assess. in a self-report instrument, we decided that the best way to measure social responsibility was constructed through two types of questions, ones that identified beliefs related to social responsibility and ones that related to behaviors that correspond to social responsibility, which in the model are assumed to lead to social justice. the sei was therefore constructed with items designed to assess interpersonal empathy (using the 20 item eai), contextual understanding, social responsibility, and social justice. methods item generation given the development of the eai (empathy assessment index) and its validation in previous studies, the research team agreed that it fully captured general interpersonal empathy as conceptualized in the larger social empathy model, and assumed its inclusion in the final sei. therefore, the researchers worked only to develop an item pool for the remaining constructs. item generation for contextual understanding and social responsibility was based on the conceptualizations described above. content validity was addressed by constructing items that logically or theoretically connected to our conceptualizations (sartori & pasini, 2007). for example, contextual understanding items included asking about whether there are barriers such as lack of opportunities or discrimination that prevent some groups from succeeding in the united states, why people are homeless, and the importance of taking into consideration the political perspectives of other people even if we don’t agree with them. social responsibility items reflected beliefs in government involvement in social welfare, community service, and voting. social justice was constructed with items that asked about actions that people believed were important such as helping a person from a different race or ethnicity, helping people worse off, and taking action to help others (a full listing of all the items can be found in appendix a). once a pool of items was generated, they were reviewed by team members for face validity and pre-tested with a group of graduate social work students who then discussed the items after the pre-test. on the basis of the feedback within the research team and from the pre-test, items were edited for wording and comprehension. the result was a pool of thirty-eight items using the same 6-point likert scale (1=“never”, 2=“rarely”, 3=“sometimes”, 4=“frequently”, 5=“almost always”, 6=“always”) as the eai, grouped into the three general concepts discussed above. the contextual understanding component consisted of thirteen items, two of which were reverse-scored. the social responsibility subscale consisted of thirteen items. and the social justice subscale consisted of twelve items, one of which was reverse-scored. segal, wagaman, gerdes/developing the social empathy index 548 item testing the 38 sei items were combined with the 20-item eai creating a 58 item instrument. the eai items were presented first, with the sei items presented next in random order. as previously mentioned, all 58 items used the same 6-point likert scale. items were prefaced with the statement, “please respond to the following questions by selecting the choice that most closely reflects your feelings or beliefs.” the 58 items were loaded into qualtrics, an online survey software program. participants based on the 58 items in the sei and the intended analysis plan, a sample of 300 participants was sought (costello & osborne, 2005). participants were recruited for the study, as approved by the university’s institutional review board, from six bsw-level classes and one msw-level class. participation was voluntary and in some classes extra credit was offered. participants were provided a hyperlink to the survey, which was referred to as a “human relations survey” to minimize social desirability, and were instructed to complete the self-report questionnaire within 72 hours. all responses were anonymous. a total of 315 students started the survey process. fourteen students had missing data and were excluded from the analysis (4.4%). the final sample size consisted of 301 respondents whose ages ranged from 18 to 59 (m = 23.8, sd = 7.8). seventy-four percent of the sample was female (n = 224), 24% (n = 71) were male and 2% (n = 6) either reported other gender or did not report gender. of those who reported their ethnicity, 53% were caucasian (n = 157), 26.6% were latino (n = 79), 5.4% were african americans (n = 16), and 3% were american indian (n = 9). nearly 24% were freshman (n = 70), 20% were sophomores (n = 59), 27% were juniors (n = 80), 10.5% were seniors (n = 31), and 18.3% were first-year master of social work students (n = 54). just over 40% (n = 120) of the study participants described their families growing up as “poor” or “working class”, with another 40% describing their family growing up as “middle class”. fortyfour percent (n = 131) of the sample identified as social work majors followed by criminal justice at 27% (n = 79). just over half of the sample (54.5%) reported being employed at the time of the survey. approach to analysis descriptive statistics, zero-order correlations, subscale reliability analysis, and principal components analysis were used for item reduction. once reduced, resulting items were analyzed using exploratory factor analysis. although an a priori theoretical model existed at the time of data collection, a confirmatory factor analysis was not the most appropriate analysis for the data because of the high levels of collinearity between the self-other awareness and perspective-taking items of the eai with sei items. given this, and the lack of available theoretical guidance in the literature for conceptualizing and measuring the components of social empathy, an exploratory factor analysis was conducted. once a final model was obtained, estimates of subscale reliability were obtained using the newly theorized subscales. finally, eai component mean score and advances in social work, fall 2012, 13(3) 549     sei component mean score correlations were assessed for possible conceptual overlap or collinearity. results as indicated in appendix a, all of the items had means above the mid-point of the response scale. very few responses of “never” or “rarely” were found for any of the items, with only seven items (q27, q28, q29, q31, q32, q33, q35) having more than 10% of responses falling within these two response categories. the overall negatively skewed mean scores may be due, in part, to both the self-report nature of the instrument and the sample selection, most of which were in human relations-based majors. item reduction first round of analysis. item reduction activities based on a priori theory about social empathy began with subscale reliability analysis. table 1 summarizes the reliability coefficients, and identifies items that would increase the subscale reliability if deleted. all three subscales, as originally theorized, had high reliability, and few items that significantly impacted the overall reliability. further analysis that included examination of zero-order correlations between items, and correlations between items and their intended subscale mean scores provided further evidence supporting deletion of the four items identified in the reliability analysis, as well as others that appeared to be problematic. the third and final step in the first round of item reduction included principal components analysis (not shown here). principal components analysis (pca) is often appropriate for data driven item reduction because it results in uncorrelated composites of the variance in the items rather than identification of latent variables “pca is intended to simply summarize many variables into fewer components, and the latent constructs (i.e., factors) are not the focus of the analysis” (henson & roberts, 2006, p. 398). these analyses resulted in the elimination of 17 of the original 38 sei items (see appendix a). table 1: subscale reliability analysis of items as originally theorized subscale reliability coefficient m sd items, if deleted, increase α contextual understanding (13 items) 0.794 53.74 8.14 item 27 (.818); item 31 (.819) social responsibility (13 items) 0.910 59.27 10.99 item 37 (.914) social justice (12 items) 0.857 55.58 8.52 item 35 (.878) factor analysis. based on a priori theoretical understanding of social empathy, its components, and its relationship to empathy, the remaining items were hypothesized to be related to two, rather than three, underlying factors – contextual understanding of systemic barriers and macro level self-other awareness and perspective-taking. an exploratory factor analysis was conducted in spss on the remaining twenty-one items using principal axis factoring (paf) with an oblique rotation (oblimin, delta = .4) retaining two factors based on a priori theory. paf was selected as the most appropriate segal, wagaman, gerdes/developing the social empathy index 550 method based on the theoretical assumption that common variance among the items in each subscale can be accounted for by latent constructs, and that these constructs are correlated (costello, & osborne, 2005; pett, lackey, & sullivan, 2003). with a sample size of 301, the subject-to-item ratio was just under 8:1. three additional items were subsequently eliminated based on low loadings and/or cross-loadings. elimination of these items was affirmed through expert review by a leading scholar in the area of empathy. theoretically, the items appeared to fit well with the original constructs (e.g., “i think paying taxes is part of being a good citizen.” as a measure of social responsibility) but no longer were theoretically appropriate within the newly theorized constructs of contextual understanding of systemic barriers and macro self-other awareness/perspective-taking. a second exploratory factor analysis using paf and an oblique rotation (oblimin, delta = .4) was conducted on the remaining 18 items. oblique rotation was selected based on an expectation that the factors would be correlated. visual interpretation of the scree plot as well as a parallel analysis were conducted. based on the scree plot and the 95th percentile eigenvalues from random data, two factors were retained. the two factors had eigenvalues of 8.13 and 1.29 which accounted for 52.34% of the explained variance. after rotation, nine items loaded on each of the two factors with loadings ranging from .5 to .9 (see table 2). the two factors were correlated at .75. a subsequent reliability analysis on the sei indicated excellent internal consistency for both the contextual understanding subscale (.88) and macro soa/pt subscale (.87). relationship with eai items as previously mentioned, initial analysis found significant collinearity between selfother awareness (soa) and perspective-taking (pt) items in the eai and items in the original sei pool. theoretically, the authors found that this made sense conceptually and reconfigured the components of the sei to include a factor that measures macro soa and pt. in order to ensure that the eai subscales and the sei subscales are not redundant either conceptually or statistically, correlations were run between all 6 subscales as well as between the overall eai mean scores. the results can be found in table 3. as is shown, moderate correlations indicate relationships between the subscales but suggest that each subscale is, in fact, capturing distinct concepts. the social empathy subscale mean scores for contextual understanding of systemic barriers and macro soa/pt are correlated at .74 (p < .05). advances in social work, fall 2012, 13(3) 551     table 2: exploratory factor analysis of 18-item social empathy index (sei): factor loadings from the pattern matrix after oblique rotation item (see appendix a) factor 1: contextual understanding of systemic barriers factor 2: macro self other awareness and perspective taking q21 .47 .10 q39 .61 .11 q49 .54 .04 q25 .64 .06 q47 .54 .21 q53 .75 -.14 q52 .64 .12 q54 .73 .05 q55 .79 -.04 q33 .19 .54 q45 .17 .58 q50 .05 .63 q34 .15 .60 q48 .03 .56 q24 .24 .50 q28 -.03 .60 q40 -.08 .67 q42 -.04 .71 table 3: correlations between eai and sei components and total eai scores scale/component emotion regulation affect sharing perspective taking eai contextual understanding macro soa/pt self-other awareness (eai) – alpha = .64 .42** .55** .65** .84** .36** .50** emotion regulation (eai) – alpha = .68 .22** .35** .66** .14* .23** affect sharing (eai) – alpha = .58 .56** .74** .26** .38** perspective taking (eai) – alpha = .74 .83** .41** .58** empathy assessment index (eai) .38** .55** contextual understanding of systemic barriers (sei) – alpha = .88 .74** * = p < .05; ** = p < .01 segal, wagaman, gerdes/developing the social empathy index 552 discussion the sei measures two very important concepts for social work practice, general interpersonal empathy and social empathy. this research study is the first attempt to thoroughly explore the concept of social empathy. the results confirmed parts of segal’s (2011) original conceptualization of social empathy and allowed the researchers to finetune the components of the model (see figure 2). contextual understanding was supported as a key component of the model (see table 4). the nine items focus on systemic barriers to social and economic equality with attention on beliefs regarding the marginalization of certain groups in society. figure 2 table 5: final items for the sei components the social responsibility and social justice components were collapsed and the remaining nine items were re-conceptualized as macro aspects of self-other awareness (soa) and perspective-taking (pt) (see table 4). this finding makes sense considering pt and soa are key components of interpersonal empathy as well. they appear to be equally important when applied at a macro level. upon deeper analysis, it makes sense that social responsibility and social justice were not accurately conceptualized as part of the social empathy model. these two constructs are probably more precisely operationalized as action based outcomes. table 4 lists the 18 remaining social empathy items. these 18 items as well as the 20 items from the eai make up the 38-item sei. individual empathy contextual understanding of systemic   barriers macro  self‐ other   awareness  &   perspective‐ taking historical background impact of systemic conditions social justice affective response self-other awareness perspective-taking social empathy emotion regulation advances in social work, fall 2012, 13(3) 553     table 4: final items for the sei components contextual understanding of systemic barriers i believe there are barriers in the united states’ educational system that prevent some groups of people from having economic success. i believe that people who face discrimination have added stress that negatively impacts their lives. i believe people born into poverty have more barriers to achieving economic well-being than people who were not born into poverty i believe adults who are poor deserve social assistance. i believe government should protect the rights of minorities. i believe the role of government is to act as a referee, making decisions that promote the quality of life and well-being of the people. i think it is the right of all citizens to have their basic needs met. i believe that by working together, people can change society to be more just and fair for everyone. i think the government needs to be a part of leveling the playing field for people from different racial groups macro soa/pt i have an interest in understanding why people are poor. i can best understand people who are different from me by learning from them directly. i feel it is important to understand the political perspectives of people i don’t agree with. i believe it is necessary to participate in community service. i believe that each of us should participate in political activities. i believe my actions will affect future generations. i confront discrimination when i see it. i am comfortable helping a person of a different race or ethnicity than my own. i take action to help others even if it does not personally benefit me. segal, wagaman, gerdes/developing the social empathy index 554 the results of this study’s analysis helped to refine the conceptualization of social empathy as a construct with three components: 1) interpersonal empathy (as measured by the eai); 2) contextual understanding of systemic barriers; and 3) macro self-other awareness and perspective-taking (see figure 2). the original sei model was conceptually sound, but included some extraneous items and misidentified two components as social responsibility and social justice. in future research, a new data set will be used to perform a confirmatory factor analysis (cfa) using the new model. such an analysis would allow for further exploration of the possibility that social empathy, as a higher-order latent construct, may explain the high correlation between the two factors in the current study. if the cfa results are acceptable, then researchers can test the hypothesis that social empathy predicts or is positively correlated with actions of social responsibility and social justice. the current study is limited by the apparent homogeneity of the sample, which may be due to the sample having been drawn from social work education courses. while there were students from other academic majors in the courses, many of the students may have been influenced by a general “helping attitude” among those choosing the social work profession. to further test the psychometric properties of the sei, a more heterogeneous sample should be sought in order to more fully reflect the range of perspectives and views on the social empathy constructs. this will also allow for further testing of the impact of social desirability given the self-report nature of the instrument. in addition, future research is needed to explore how interpersonal empathy and social empathy are related and 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(2012). social cognitive neuroscience of empathy: concepts, circuits and genes. emotion review, 4(9), 9-17. author note: address correspondence to: elizabeth a. segal, arizona state university, college of public programs, school of social work, 411 n. central ave, suite 800, phoenix, az 85004. email: esegal@asu.edu advances in social work, fall 2012, 13(3) 559     appendix a summary statistics and subscale assignment of original item pool (38 items) of the social empathy index (sei) item content m sd subscale action as a result of analysis q21) i believe there are barriers in the united states’ educational system that prevent some groups of people from having economic success. 4.36 1.26 contextual understanding retained q22) i believe government should be expected to help individuals. 4.35 1.21 social responsibility eliminated in first round of item reduction q23) i seek to understand social problems. 4.46 1.24 contextual understanding eliminated in first round of item reduction q24) i believe my actions will affect future generations. 4.63 1.20 social justice retained q25) i believe adults who are poor deserve social assistance. 4.19 1.21 social responsibility retained q26) as members of society, i believe we should help people who are worse off than ourselves. 4.67 1.19 social justice eliminated in first round of item reduction q27) i believe people are rich because they worked hard. (reverse scored) 3.50 1.05 contextual understanding eliminated in first round of item reduction q28) i confront discrimination when i see it. 3.79 1.17 social justice retained q29) i believe success in life depends on where you were born. 3.05 1.12 contextual understanding eliminated in first round of item reduction q30) i think society should help out adults in need. 4.23 1.24 social responsibility eliminated in first round of item reduction q31) if a person is homeless, i believe it is the result of bad personal choices. (reverse scored) 4.03 0.92 contextual understanding eliminated in first round of item reduction q32) when i hear a prejudiced joke or comment, it bothers me. 4.05 1.41 social justice eliminated in first round of item reduction q33) i have an interest in understanding why people are poor. 4.00 1.36 contextual understanding retained q34) i believe it is necessary to participate in community service. 4.71 1.20 social responsibility retained q35) i struggle to speak up for someone or about an issue if what i say might make others angry or unhappy. (reverse scored) 4.16 1.09 social justice eliminated in first round of item reduction q36) i believe people get opportunities because they know the right people. 3.69 0.94 contextual understanding eliminated in first round of item reduction q37) i think paying taxes is part of being a good citizen. 4.29 1.27 social responsibility eliminated after first efa q38) i believe government should get involved in addressing social problems. 4.55 1.23 social responsibility eliminated in first round of item reduction q39) i believe that people who face discrimination have added stress that negatively impacts their lives. 4.75 1.24 contextual understanding retained q40) i am comfortable helping a person of a different race or ethnicity than my own. 5.46 0.96 social justice retained segal, wagaman, gerdes/developing the social empathy index 560 q41) i believe people should vote in public elections. 5.17 1.17 social responsibility eliminated after first efa q42) i take action to help others even if it does not personally benefit me. 4.64 1.12 social justice retained q43) i think society should help out families in need. 4.80 1.15 social responsibility eliminated in first round of item reduction q44) i believe the rich get richer while the poor get poorer. 4.21 1.30 contextual understanding eliminated in first round of item reduction q45) i can best understand people who are different from me by learning from them directly. 4.80 1.08 contextual understanding retained q46) i think volunteerism is a duty for us as members of society. 4.65 1.24 social responsibility eliminated in first round of item reduction q47) i believe government should protect the rights of minorities. 4.98 1.20 social justice retained q48) i believe that each of us should participate in political activities. 4.19 1.28 social responsibility retained q49) i believe people born into poverty have more barriers to achieving economic well-being than people who were not born into poverty. 4.82 1.14 contextual understanding retained q50) i feel it is important to understand the political perspectives of people i don’t agree with. 4.48 1.15 contextual understanding retained q51) i believe it is important for me to contribute to my community and society. 4.91 1.20 social responsibility eliminated in first round of item reduction q52) i think it is the right of all citizens to have their basic needs met. 5.05 1.12 social justice retained q53) i believe the role of government is to act as a referee, making decisions that promote the quality of life and well-being of the people. 4.49 1.25 social responsibility retained q54) i believe that by working together, people can change society to be more just and fair for everyone. 5.00 1.05 social justice retained q55) i think the government needs to be a part of leveling the playing field for people from different racial groups. 4.49 1.28 contextual understanding retained q56) i believe all people are entitled to the same civil rights and opportunities. 5.31 1.07 social justice eliminated after first efa q57) i believe that making society fair benefits everyone, not just people who are poor or discriminated against. 5.03 1.13 social justice eliminated in first round of item reduction q58) i think it is my responsibility to help those who are in need. 4.73 1.24 social responsibility eliminated in first round of item reduction _________ michael r. riquino, phd, msw, assistant professor, school of social welfare, university of kansas, lawrence, ks. van l. nguyen, phd, msw, independent researcher in salt lake city, ut. sarah e. reese, phd, msw, assistant professor, and jen molloy, phd, msw, assistant professor, school of social work, university of montana, missoula, mt. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 750-765, doi: 10.18060/24049 this work is licensed under a creative commons attribution 4.0 international license. using a transdiagnostic perspective to disrupt white supremacist applications of the dsm michael r. riquino van l. nguyen sarah e. reese jen molloy abstract: white supremacist applications of the diagnostic and statistical manual of mental disorders (dsm) result in the disproportionate labeling of black, indigenous, and people of color as violent or severely mentally ill. racial diagnostic disparities and misdiagnoses are endemic in social work practice, in part because of the dsm’s categorical classification system, which encourages reductive thinking and reinforces implicit racial biases. while courses on psychopathology are common requirements for clinical field placements, the mental health field’s reliance on the dsm often contradicts antiracist curricula. in an effort to address this paradox, we utilize pedagogical approaches that seek to critique and deconstruct white supremacist applications of the dsm while simultaneously preparing students to enter a field that relies so heavily on diagnostic labels. this is done in part by teaching students to shirk the dsm’s categorical perspective in favor of a transdiagnostic perspective—identifying symptoms or traits underlying human suffering that occur across diagnostic categories and are informed by macro systems of privilege and oppression. teaching students to adopt a transdiagnostic perspective may disrupt white supremacist practices in diagnostics by encouraging an acknowledgement of multisystem factors underlying human suffering without relying on discrete diagnostic categories that are prone to racial interpretations. keywords: dsm, white supremacy, transdiagnostic perspective applications of the diagnostic and statistical manual of mental disorders (dsm; american psychiatric association, 2013) in clinical social work practice are typically informed by white supremacist culture, which implicitly and explicitly codifies racism and privileges whiteness within institutional structures and individual perspectives. this results in the disproportionate labeling of black, indigenous, and people of color (bipoc) as dangerous or severely mentally ill. bipoc are more likely to be diagnosed with schizophrenia for symptoms that result in mood disorder diagnoses in their white counterparts (akinhanmi et al., 2018; olbert et al., 2018). children of color are more likely to be diagnosed with oppositional defiant disorder for symptoms that result in attentiondeficit hyperactivity disorder diagnoses in white children (ballentine, 2019). such racial diagnostic disparities are endemic in social work practice, in part because of the categorical classification system of the dsm, which encourages reductive thinking, reinforces implicit racial biases in a primarily white workforce, and supports a false dichotomy between micro and macro practice. while courses on psychopathology are common requirements for clinical social work about:blank riquino et al./using a transdiagnostic 751 field placements, the mental health field’s reliance on the dsm often contradicts antiracist curricula encouraged in msw programs. in an effort to address this paradox, we have incorporated pedagogical approaches that seek to critique and deconstruct white supremacist applications of the dsm while simultaneously preparing students to enter a field that relies so heavily on diagnostic labels. this is done in part by teaching students to shirk the dsm’s categorical perspective in favor of a transdiagnostic perspective (sauerzavala et al., 2017)—that is, identifying symptoms or traits underlying human suffering that occur across diagnostic categories—and then integrating that transdiagnostic perspective with critical and socioecological understandings to assess how suffering is informed by macro systems of privilege and oppression. teaching social work students from a transdiagnostic perspective may disrupt white supremacist practices in diagnostics by encouraging them to acknowledge multisystem factors underlying human suffering without relying on discrete diagnostic categories that are prone to racial interpretations. antiracist social work practice requires social workers to deeply interrogate their own perspectives and biases, and reflect on how their identities impact the spaces they inhabit. we believe teaching psychopathology from a transdiagnostic perspective supports these processes by encouraging social workers to engage in ongoing critical self-reflection and disrupt institutionalized ways of thinking about diagnostics. in this article, we will explore the extant impact of the dsm on the classification of psychological disorders, examine empirical evidence illustrating white supremacist applications of the dsm, explore pedagogical approaches we have employed to disrupt white supremacist applications of the dsm, and discuss the benefits of using a transdiagnostic perspective as it relates to antiracist pedagogy and practice. the influence of the dsm on the classification of psychological disorders the developmental history of the dsm, as well as the appropriateness of its fit within the social work profession (lyter & lyter, 2012), is rife with controversy given its increasing focus on biomedical and socially decontextualized perspectives of psychological disorders (see bredström, 2019; la roche et al., 2015; whooley, 2014). despite these controversies, social work practitioners, educators, and researchers have been tasked with utilizing the dsm in their practices while balancing its biomedical approach with strengths-based and socioecological perspectives (probst, 2013). this requirement is largely because social workers provide the bulk of mental health services in the united states (kourgiantakis et al., 2019) and “the dsm has become the standard in all facets of mental health, including clinical practice, insurance reimbursement, research designs, epidemiological studies, and public policy” (whooley, 2014, p. 92). the dominance of the dsm in the mental health field requires examining its influence on the classification of psychological disorders, particularly as it relates to its use of a categorical classification system and its decontextualized conceptualizations of mental distress. developers of the third edition of the dsm adopted a categorical classification system of psychological disorders in an effort to increase the reliability of diagnostic classification—meaning, experiences of mental distress were descriptively sorted into seemingly discrete categories defined by lists of signs and symptoms (riboni & belzung, advances in social work, summer 2021, 21(2/3) 752 2017). as rodriguez-seijas et al. (2015) described it, the dsm considers psychological disorders “to be dichotomous—being either absent or present. diagnostic decisions are made by determining whether a given patient’s clinical presentation meets a certain…criterion threshold, wherein each criterion deemed present counts equally toward the diagnosis” (p. 425). this categorical approach has persisted to the current fifth edition of the dsm despite its lack of validity (rodriguez-seijas et al., 2015; whooley, 2014), as well as its disregard for socioecological factors that contextualize the presentation and course of psychological disorders. reviewers of the dsm-5 attempted to address the issue of decontextualization by extending the dsm’s definition of culture and developing its cultural formulation interview. however, bredström (2019) noted these efforts were insufficient to address the complex socioecological contexts in which psychological disorders develop: “what we have is a manual that acknowledges that culture affects all disorders yet only presents some symptoms as culturally contextualized” (p. 360). critics of the dsm-5 have argued transdiagnostic and dimensional approaches address its current limitations (rodriguez-seijas et al., 2015; whooley, 2014). integrating a dimensional approach into the dsm-5—that is, assessing symptoms on a spectrum versus using criterion thresholds—was the initial goal of dsm-5 reviewers, as they believed doing so would elucidate biological etiologies of mental distress (whooley, 2014). further, such a change would have reinforced the appropriateness of adopting a transdiagnostic perspective in assessment given the substantial overlap in diagnostic categories. transdiagnostic factors may be less prone to diagnostic bias as they have been found to be relatively invariant across social positionalities (rodriguez-seijas et al., 2015). however, as bredström (2019) remarked, “the suggested move towards a dimensional model does not necessarily solve this [etiology] problem as it seems likely that it will focus on measuring severity and recognizing crosscutting symptoms, rather than locating suffering in its cultural context” (p. 360). ultimately, the dsm-5 retained a categorical approach to diagnostics while providing recommendations for continued research into the appropriateness of adopting a dimensional approach. disappointed in this decision, the national institute of mental health developed the research domain criteria (rdoc) framework to encourage researchers to focus on transdiagnostic etiologies using neuroscience techniques. whooley (2014) cautioned that despite rdoc’s focus on etiology, “rdoc is poised to accelerate the decontextualizing trend by (1) decoupling research and clinical concerns when constructing its [classification system], (2) proffering a reductionist brain-centric model of mental distress, and (3) privileging research built upon neural imaging technologies” (p. 94). we share this author’s and other scholars’ concerns regarding both the dsm and rdoc’s reinforcement of medicalization and biological reductionism. however, as noted earlier, we also recognize the dsm’s dominance in the mental health field and the need for social work students to be intimately familiar with the dsm’s classification system in order to effectively operate in the field and disrupt its white supremacist applications. the pedagogical approaches we espouse in this article align with that aspiration of dimensionalization while positioning suffering in socioecological context and allowing for an interrogation of etiology beyond the individual level; for example, how the social environment becomes internalized within individuals and manifests as symptoms riquino et al./using a transdiagnostic 753 or traits of psychological disorders. examples of white supremacist applications of the dsm the sequelae of racial diagnostic disparities can include differential access to services and recommended interventions (e.g., akinhanmi et al., 2018; gudiño et al., 2012; simpson et al., 2007), as well as white supremacist conceptualizations regarding the etiology of psychological disorders (see bredström, 2019; la roche et al., 2015). in this section, we begin by examining diagnostic labels disproportionately applied to bipoc compared to white individuals (i.e., schizophrenia and oppositional defiant disorder vs. major depressive disorder and attention-deficit hyperactivity disorder, respectively), as well as misdiagnoses that are more common among bipoc compared to white individuals (i.e., bipolar disorder and posttraumatic stress disorder). we then explore how racial diagnostic disparities can result in decreased access to treatment and resources, and how misdiagnoses can result in delayed or harmful treatments. finally, we explore the sociocultural impact of labeling bipoc with diagnoses that are generally perceived as dangerous or severely mentally ill, as well as racist conceptualizations regarding the origin of psychological disorders. specifically, we discuss the stark differences between conceptualizations of the so-called “war on drugs” that primarily impacted black individuals in the united states compared to the current “opioid epidemic” and its impact on white individuals in the united states. racial diagnostic disparities and misdiagnoses racial disparities in schizophrenia diagnoses, especially among black adults seeking mental health treatment, have been consistently documented (aggarwal et al., 2012; akinhanmi et al., 2018; eack et al., 2012; olbert et al., 2018; schwartz & blankenship, 2014). even when diagnoses such as major depressive disorder or bipolar disorder are warranted, bipoc individuals are more likely than their white counterparts to be diagnosed with schizophrenia—a diagnosis that is most often treated with intense psychotropic medication regimens and accompanied by significant social stigma. these disparities may be explained by the presentation of genuine symptom differences given the discriminatory and oppressive experiences of bipoc (feisthamel & schwartz, 2009). however, these disparities can also be explained in part by clinician perceptions of dishonesty when bipoc clients are describing their experiences of distress (eack et al., 2012; olbert et al., 2018). researchers have found “clinicians may fail to situate the diagnostic encounter in appropriate cultural context and misconstrue normative guardedness as paranoia” (olbert et al., 2018, p. 105). although client guardedness makes sense in a socioecological context, a decontextualized approach to diagnostics may amplify clinicians’ implicit racial biases and result in the pathologizing of normative behavior (metzl, 2009). decontextualization also shows up in posttraumatic stress disorder diagnostic practices. although bipoc are more likely to be diagnosed with posttraumatic stress disorder than white individuals (carter, 2007; helms et al., 2012), the dsm narrowly defines trauma and fails to acknowledge the potential for oppression and discrimination to advances in social work, summer 2021, 21(2/3) 754 be traumatic in the lives of bipoc (holmes et al., 2016). in essence, the dsm’s definition of trauma as “exposure to actual or threatened death, serious injury, or sexual violence” (american psychiatric association, 2013, p. 271) privileges interpersonal forms of violence as warranting attention while ignoring “multigenerational transmission of structural trauma (i.e., poverty, hunger, unemployment, mass incarceration) and historical trauma (i.e., slavery, genocide)” (holmes et al., 2016, p. 316). this conceptualization reifies the dsm’s micro-oriented focus, positioning trauma within interpersonal situations and suggesting an individual’s response to trauma is a failure to employ adequate coping strategies. given bipoc individuals are more likely to be diagnosed with posttraumatic stress disorder, this decontextualized focus pathologizes their experiences while ignoring potential socioecological sources of suffering. racial diagnostic disparities and misdiagnoses are not limited to bipoc adults. children of color are also more commonly labeled as having behavioral or severe emotional disturbances (visser et al., 2016). for example, parents and teachers are more likely to perceive black children as having attention-deficit hyperactivity disorder compared to white children (gudiño et al., 2012), and yet black children are more likely to be diagnosed with oppositional defiant disorder than attention-deficit hyperactivity disorder compared to white children (ballentine, 2019). these findings highlight the multiplicative impacts of racial bias: behavioral difficulties such as inattention and hyperactivity are disproportionately ascribed to black children, and then compounded by diagnostic attributions of oppositional defiant disorder rather than attention-deficit hyperactivity disorder. ballentine (2019) noted that stereotypes and implicit bias “may lead diagnosticians to perceive black children’s behavior as outwardly defiant and as the willful choice of a dangerous child associated with [oppositional defiant disorder], rather than through the biological mechanisms of [attention-deficit hyperactivity disorder]” (p. 7). such misdiagnoses serve to associate black children with more extreme behavioral difficulties and potentially lead to misperceptions of future conduct or antisocial behavior problems. rather than receiving greater access to indicated services or treatment, children of color are at a risk of being referred to school resources officers and juvenile court (evangelist et al., 2017; fader et al., 2014; haight et al., 2016), thereby reinforcing racial and ethnic disparities in the juvenile justice system via the school-to-prison pipeline (kim et al., 2010; mallett, 2016). in addition to reifying harmful stereotypes of bipoc and children of color, these diagnostic disparities and misdiagnoses can result in disproportionate access to services, delayed intervention, and even harmful treatments. akinhanmi et al. (2018) described how mistaking bipolar disorder for related diagnoses can delay the application of empiricallysupported psychotherapies or result in prescribing contraindicated medication regimens: “a misdiagnosis of bipolar depression as unipolar major depressive disorder with subsequent antidepressant treatment increases the likelihood of treatment non-response and/or antidepressant-induced mania/mood destabilization, while a misdiagnosis of schizophrenia limits the opportunity for treatment with lithium and/or mood-stabilizing anticonvulsants” (p. 507). olbert et al. (2018) noted how racial disparities in schizophrenia diagnoses may be related to other racial disparities experienced by black individuals with schizophrenia, including more frequent hospitalizations, higher antipsychotic doses, riquino et al./using a transdiagnostic 755 decreased quality of life, and poorer outcomes following first-episode psychosis. in a review of the burden of major depressive disorder on bipoc versus white individuals, kim (2014) found “that when [major depressive disorder] affects minority groups, it is usually untreated and is more severe and disabling compared to non-hispanic whites” (p. 2). this may be due in part to bipoc’s mistrust of mental health services, including personal experiences of racism from mental health providers who exhibited a lack of cultural sensitivity. labeling and the etiology of psychological disorders the impact of racial diagnostic disparities and misdiagnoses goes beyond the micro level. disparities and misdiagnoses contribute to sociocultural constructions of bipoc as dangerous, violent, or severely mentally ill. as outlined in labeling and identity theories (burke, 2010; hogg et al., 1995), these constructions can result in social stigma and perpetuate damaging perceptions of group identities. over time, racial diagnostic disparities can lead to etiological conceptualizations positioned within group identities instead of the oppressive systems affecting those groups. the disproportionate diagnosing of schizophrenia among black individuals led to researchers citing blackness as a risk factor for schizophrenia (metzl, 2009). when blackness is used as proxy for schizophrenia risk—that is, when mental health providers are taught that black individuals are more likely than other racial groups to experience schizophrenia instead of being taught that black individuals are more likely to be diagnosed with schizophrenia due to sociocultural misperceptions—it reinforces the notion that psychosis exists within black individuals instead of the systems they are required to navigate. these social constructions have impacted how public policies are shaped in response to psychological disorders affecting different group identities. reagan’s expansion of nixon’s war on drugs policies disproportionately impacted bipoc, who were more likely to receive longer prison sentences for using crack cocaine compared to their white counterparts for using powder cocaine (tonry, 1994). these harsh policies shifted public perception to the belief that certain individuals using drugs— namely, bipoc and poor individuals—were dangerous, violent, and a threat to the united states (netherland & hansen, 2016; tonry, 1994). this approach contrasts sharply with current rhetoric surrounding the opioid epidemic, which primarily affects white individuals misusing opioid medications (netherland & hansen, 2016). rather than criminalizing these behaviors, individuals affected by opioid use have been provided with resources or referred for treatment in order to address their behaviors and needs. although there is significant stigma surrounding substance use generally and opioid use specifically (tsai et al., 2019), this stigma disproportionately impacts bipoc and manifests as criminalization of substance use behaviors, decreased access to treatment and services, and more frequent attributions of personal blame for substance use rather than positioning the etiology of addiction within brain chemistry or a broken medical system (netherland & hansen, 2016). the ways in which the dsm has been weaponized to harm bipoc and support structures of white supremacy underscores the need for teaching social work students using pedagogical techniques that disrupt these oppressive practices. advances in social work, summer 2021, 21(2/3) 756 pedagogical approaches to teaching the dsm during our time as social work educators, we have repeatedly encountered an especially troubling pedagogical paradox—that is, balancing the need to critically examine and reject the ways in which the dsm reproduces racism and maintains white supremacy while simultaneously preparing social work students to function in a field that requires its use. like lyter and lyter (2012), we often wonder at the appropriateness of social workers providing diagnostic labels or if the dsm has any place in the social work profession when it so frequently runs contrary to the profession’s values and ethical principles. until such a determination is made to reject the dsm by the social work profession or the mental health community as a whole, we have endeavored to disrupt white supremacist applications of the dsm by teaching its content through perspectives that align with social work values and ethical principles. in this section, we discuss our pedagogical approaches to teaching psychopathology as it relates to our utilization of transdiagnostic, critical, and socioecological perspectives. we then discuss the impact of our positionalities on the formulation of this manuscript in an effort to demonstrate the reflexivity we encourage in our students. transdiagnostic perspective at its core, utilizing a transdiagnostic perspective involves rejecting the dsm’s use of a categorical taxonomy to describe psychological disorders and instead considering underlying symptoms and traits that cut across diagnostic categories and inform human suffering (fusar-poli et al., 2019). in their review of the transdiagnostic literature base, sauer-zavala et al. (2017) found that conceptualizations of the term transdiagnostic fell into two primary definitions: constructs that were descriptively transdiagnostic and those that were mechanistically transdiagnostic. they remarked, “whereas the designation ‘mechanistically transdiagnostic’ implies that the construct in question is causally related to a range of psychopathology, the term ‘descriptively transdiagnostic’ suggests only that a construct is present in multiple disorders, without regard to how or why” (sauer-zavala et al., 2017, p. 129). anhedonia—the inability to experience pleasure—is one example of a transdiagnostic construct. anhedonia is only listed once in the dsm as a diagnostic criterion of major depressive disorder (american psychiatric association, 2013), and yet individuals who experience anxiety, engage in substance use, or have trauma histories are also vulnerable to anhedonia, indicating it is not unique to one diagnostic label. further, systemic factors like oppression and poverty can result in anhedonia, suggesting individual treatment is insufficient to address its etiology. anhedonia is at least descriptively transdiagnostic, as it appears across diagnostic categories despite its singular inclusion in the dsm. it may also be mechanistically transdiagnostic, as anhedonia may play an explanatory role in the development or maintenance of multiple disorders beyond major depressive disorder, including posttraumatic stress disorder, schizophrenia, social anxiety disorder, substance use disorders, and even chronic pain conditions (bedwell et al., 2014; destoop et al., 2019). sauer-zavala et al. (2017) advocate reserving the term transdiagnostic for mechanistic riquino et al./using a transdiagnostic 757 constructs, as they believe doing so “may function to better inform treatment development, as strategies can be included that focus on these core deficits rather than targeting what may be more trivial disorder correlates” (p. 129). we recommend teaching students to recognize descriptively transdiagnostic constructs while emphasizing the importance of focusing on mechanistically transdiagnostic constructs and how they can inform goal setting and treatment planning. for example, consider racial trauma and its role in the development of posttraumatic stress disorder. the current conceptualization of posttraumatic stress disorder as outlined in the dsm fails to capture how experiences of discrimination and oppression may result in posttraumatic stress symptoms. as holmes et al. (2016) note, “the current definition of trauma conceptualizes violence within the cultural zeitgeist as primarily interpersonal and physical, while widely discounting systemic, institutional, and psychological trauma” (p. 315). in mental health settings that require dsm diagnoses for treatment, students would be hindered in their ability to provide helpful or accurate treatment if clients’ experiences of racism and subsequent racial trauma do not fit the diagnostic threshold for posttraumatic stress disorder as defined by the dsm. to overcome this, we teach students to recognize the descriptively transdiagnostic nature of the symptomatology of posttraumatic stress disorder, for example, the symptom cluster negative alterations in cognitions and mood is consistent with symptoms described in mood disorders like major depressive disorder, and the symptoms cluster marked alterations in arousal and reactivity is consistent with symptoms described in anxiety disorders like generalized anxiety disorder. with this knowledge, students can rely on alternative diagnostic labels in order to provide treatment in mental health settings that require dsm diagnoses while recognizing that racial trauma may be mechanistically informing the symptoms their clients are experiencing. like holmes et al. (2016), we teach our students to conceptualize trauma in the context of systems of oppression in order to “externalize the sources of symptomology. not only would this serve to depathologize marginalized groups, but accurately naming the problem (e.g., racism, sexism, heterosexism) is an essential first step to coming up with appropriate solutions (e.g., macrolevel interventions, policy change)” (p. 319). by using this mechanistically transdiagnostic understanding of racial trauma, we can teach students to adjust their treatment approach to address clients’ needs versus diagnoses. although utilizing a transdiagnostic perspective is a process-based approach to diagnostics, there are several concrete strategies we teach students to use in order to disrupt white supremacist applications of the dsm. when more than one diagnosis can parsimoniously explain a client’s symptomatology, we teach students to choose diagnoses based on chronicity (e.g., episodic, non-chronic disorders such as major depressive disorder carry less stigma than schizophrenia) and history of racist applications (e.g., children of color have disproportionately been given oppositional defiant disorder diagnoses when attention-deficit hyperactivity disorder diagnoses were appropriate). when chronic or stigmatized diagnoses are the most parsimonious choice to explain a client’s symptomatology, we teach students to provide provisional diagnoses as these are typically accepted by insurance companies. this allows students to conduct additional assessment to determine the appropriateness of their diagnoses. advances in social work, summer 2021, 21(2/3) 758 critical and socioecological perspectives although our pedagogy is focused on teaching students to identify mechanisms that transcend diagnostic categories, akin to the recommendations of the rdoc framework described earlier, the similarity ends there. our ultimate goal is to position transdiagnostic mechanisms within a socioecological framework rather than positioning them solely within individual-level variables, such as rdoc’s hyperfocus on brain circuitry. we believe consideration should first be given to the impact of systemic forces that result in maladaptive behaviors and functioning on an individual level. teaching students to understand the potential impact of rdoc on future diagnostic research and its sequalae— including clinical practice—prepares them to disrupt the further decontextualization rdoc is poised to reify. this pedagogy reinforces the notion of applying critical, antiracist perspectives when consuming research that exclusively relies on behavioral neuroscience techniques to the neglect of macro influences. to accomplish this, we teach our students to filter their transdiagnostic conceptualizations of psychological disorders through critical and socioecological understandings. this process involves recognizing etiologies both outside of and within individuals (cerulo, 2010), practicing critical self-reflection when conducting assessments (atteberry-ash et al., 2019), and acknowledging the role of intersectionality when meeting with individual clients (crenshaw, 1991). further, we promote the understanding of assessment as an opportunity to explore potential sources of power available to clients via internal strengths, family resources, and neighborhood and community networks. we challenge students to reject the notion that they are to act as experts in response to clients who are to act as victims of psychic stress. in this way, we promote a practice grounded in collaboration and mutuality. we challenge students to critically examine and deconstruct the forms and relations of power and inequality that infiltrate both the clinical relationship and the broader social context in which they are embedded. employing pedagogical techniques grounded in critical and socioecological perspectives may be especially relevant for the social work profession, which consists of a primarily white workforce. as olbert et al. (2018) noted, racial diagnostic disparities and misdiagnoses are “more extreme in studies with larger proportions of white individuals” (p.112). they recommended focusing on “primary prevention, reducing clinician bias, and improving awareness of the cultural mediation of psychotic symptom presentations” (olbert et al., 2018, p. 112). although contemporary events such as the covid-19 pandemic and ongoing protests against police brutality have raised the work of antiracist scholars to the level of public consciousness, calls for integrating antiracism into social work curricula are not new (abrams & moio, 2009; basham, 2004; nicotera, 2019). we echo antiracist scholars who reject the competency-based constraints of social work education and argue that “racial awareness is a formative process that involves cognitive, affective, and action-oriented changes that may not result from exposure to one or two courses” (abrams & moio, 2009, p. 255). riquino et al./using a transdiagnostic 759 figure 1. diagnostic decision-making process note. children exhibiting behavioral difficulties in school settings are commonly diagnosed with attention-deficit hyperactivity disorder or oppositional defiant disorder, but may be experiencing other psychological diagnoses such as anxiety disorders or trauma and stressor-related disorders. applying a transdiagnostic perspective involves possible diagnoses that might explain presenting problems and then identifying shared symptoms in order to determine which diagnoses most parsimoniously describe client symptomatology. contextual factors—including children’s trauma and developmental histories, social positionalities, and interpersonal and community variables that inform their school experiences—should ultimately inform the chosen diagnosis. doing so ensures diagnostic decisions are informed by critical and socioecological perspectives. presenting problem child exhibiting behavioral difficulties in a school setting (e.g., inattention, hyperactivity) possible diagnoses attention-deficit hyperactivity disorder oppositional defiant disorder posttraumatic stress disorder adjustment disorder generalized anxiety disorder shared symptoms angry/irritable mood argumentative behavior difficulty concentrating not following instructions psychomotor agitation contextual factors trauma history developmental considerations interpersonal/community factors social positionalities access concerns diagnosis as choice maximizing utility and minimizing harm by considering chronicity, history of racist applications, and use of provisional diagnoses transdiagnostic perspective critical and socioecological perspectives differential diagnosis decision-making process advances in social work, summer 2021, 21(2/3) 760 teaching students to adopt transdiagnostic, critical, and socioecological perspectives does not involve teaching students a list diagnostic strategies per se; rather, it requires teaching students to think of diagnostics as a decision-making process wherein these perspectives can be used to maximize the utility of the dsm and minimize the potential for racial harm. this process is visually represented in figure 1 using the example of a child exhibiting behavioral difficulties in a school setting. choosing culturally responsive diagnoses requires providing students with an in-depth understanding of transdiagnostic symptomatology and positioning that understanding within critical and socioecological perspectives. by focusing on the development of these perspectives among our students, as well as competency in using the dsm, we attempt to make the formative process of racial awareness (abrams & moio, 2009) explicit in our pedagogy. reflexivity and our positionalities encouraging critical self-reflection seems incomplete without discussing the impact of our positionalities on the formulation of this article. the first author identifies as a white, queer, cisgender man, and has been teaching bsw and msw practice-oriented social work courses since 2015. the second author identifies as a vietnamese, straight, cisgender woman whose teaching experiences have been situated in community practice settings focused on addressing racial and ethnic disparities in the criminal and juvenile justice systems. the third and fourth authors identify as white, straight, cisgender women, and have been teaching bsw and msw practice-oriented social work courses since 2017. our collaboration as scholars began while completing our doctoral studies together. we have relied on each other as research and practice consultants, peer debriefing team members, and teaching collaborators as we have developed our pedagogical and scholarly practices. the conceptualizations and arguments presented in this article are primarily informed by our collective experiences of privilege—namely our white, straight, and cisgender identities. we also recognize that the ways in which we individually navigate the spaces we occupy are unique to our respective experiences and complex, intersectional identities. our efforts to teach psychopathology using an antiracist pedagogy are rooted in our personal efforts to learn and implement antiracist frameworks in our respective scholarly activities. we have sought to integrate and center bipoc perspectives, youth voices, and other marginalized identities in our research efforts, and clinical and community practices. in this article, we aimed to highlight theories and research from bipoc scholars in the fields of psychopathology and antiracism, only to discover a dearth of bipoc voices in the literature on psychopathology. this disparity seems to mirror our earlier discussion on issues of access and structural barriers that hinder the elevation or centering of bipoc needs and perspectives. although any discussion of utilizing the dsm risks reifying white supremacy in clinical social work practice, our hope is that this article represents an authentic effort to practice the critical self-reflection we encourage in our students by reflexively acknowledging the limits of our personal experiences. our integration of transdiagnostic and critical perspectives in our teaching highlight one facet of our efforts to disrupt white supremacy in social work practice. until a new taxonomy is created to supplant the dsm— riquino et al./using a transdiagnostic 761 one rooted in antiracism—we will continue searching for frameworks and perspectives that pragmatically acknowledge the use of the dsm in the mental health field while actively critiquing the disparate harm it causes. we are committed to learning from individuals, scholars, and communities of color on how to respond to bipoc who have been impacted by the misuse of the dsm. benefits of using a transdiagnostic perspective the benefits of teaching students from a transdiagnostic perspective include preparing social work students for a future shift in thinking about the classification of psychological disorders and its potential impact on clinical practice, bridging the gap between research and practice given the increasing focus among researchers on mechanistically transdiagnostic processes, and encouraging complex and critical thinking across socioecological levels. a transdiagnostic perspective allows social work students to avoid falling into a deficit-focused mindset of pathologizing human suffering. rather, it allows them to conceptualize and contextualize the mechanisms and processes that initiate and maintain suffering, as well as those that promote wellbeing. we ultimately support the recommendation given by sauer-zavala et al. (2017) to focus on teaching mechanistically transdiagnostic processes as these can inform what they termed “shared mechanisms” treatments (p. 130). mechanistically transdiagnostic processes are especially relevant to the topic of white supremacist applications of the dsm given the potentially transdiagnostic role of oppression and racial trauma in the development and maintenance of mental distress. employing a pedagogy that integrates transdiagnostic, critical, and socioecological perspectives also has specific benefits for disrupting white supremacist applications of the dsm. these benefits include the consideration of racial trauma as a transdiagnostic process informing myriad disorders, as well as the conscious recognition of and decision to use fewer racially biased diagnoses when presented with such opportunities. for example, given the symptomatic overlap between the disorders described earlier (e.g., schizophrenia and mood disorders, oppositional defiant disorder and attention-deficit hyperactivity disorder), social workers can make a conscious choice to avoid reinforcing racist stereotypes by employing a critical lens during the differential diagnosis process. additionally, employing culturally sensitive assessment techniques can help social workers evaluate the potentially traumatizing effects of oppression and marginalization, thereby positioning the etiology of their clients’ suffering within deficit systems rather than within individuals. conclusion the pedagogical approaches we have outlined in this article are rooted in our epistemic affinity for pragmatism, as well as our deep commitment to antiracist social work practice. our recommendation to integrate transdiagnostic, critical, and socioecological perspectives is likely familiar to most social workers. they align with both the person-in-environment and biopsychosocial perspectives, which are foundational frameworks in social work education and practice. what we hope for, and have aimed to encourage in this article, is advances in social work, summer 2021, 21(2/3) 762 that social workers—practitioners, educators, and researchers alike—will apply the integration of these perspectives to the disruption of white supremacy. presently, social workers must learn the dsm in order to operate effectively in the mental health field, that is until a classification system is developed that balances contextualization, etiology, and antiracist principles. in the meantime, we believe employing the pedagogical approaches we have outlined in this article is one way to teach social work students to practice in the mental health field in a way that aligns with social work values and ethics. references abrams, l. s., & moio, j. a. 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(2014). nosological reflections: the failure of dsm-5, the emergence of rdoc, and the decontextualization of mental distress. society and mental health, 4(2), 92-110. https://doi.org/10.1177/2156869313519114 author note: address correspondence to michael r. riquino, school of social welfare, university of kansas, twente hall, 1545 lilac lance, lawrence, ks 66045. email: mriquino@ku.edu https://doi.org/10.1007/s10615-012-0394-1 https://doi.org/10.1016/j.cobeha.2016.12.011 https://doi.org/10.1080/00223891.2015.1055752 https://doi.org/10.1016/j.beth.2016.09.004 https://doi.org/10.5498/wjp.v4.i4.133 https://doi.org/10.1007/s11126-006-9022-y https://chicagounbound.uchicago.edu/cgi/viewcontent.cgi?article=1155&context=uclf https://doi.org/10.1371/journal.pmed.1002969 https://doi.org/10.1177/0009922815623229 https://doi.org/10.1177/2156869313519114 mailto:mriquino@ku.edu __________ rebecca bonanno, phd, lcsw, associate professor, suny empire state college, school of human services, selden, ny 11784; kristina veselak, phd, instructor, gateway community college department of social sciences, new haven, ct 06510. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 397-415, doi: 10.18060/22970 this work is licensed under a creative commons attribution 4.0 international license. a matter of trust: parents’ attitudes toward child mental health information sources rebecca bonanno kristina veselak abstract: mental health problems among children and adolescents are widespread. parents seeking information about child mental health problems and treatments face numerous barriers, including fear of stigmatization and uncertainty about where to seek help. in this qualitative study, seven parents whose children had experienced a mental health, behavioral, or emotional problem were interviewed about their attitudes and beliefs about child mental health information sources. analysis revealed that the concept of trust was an overarching theme in parents’ pursuit and evaluation of information. related themes included a preference for information from other parents with experience parenting a child with a mental health problem; seeking information from knowledgeable professionals with whom the parents had personal relationships; concerns about confidentiality and protection of privacy; and involvement of school personnel when seeking mental health information and help. findings support the need for improved mental health literacy among parents and suggest that social workers should play a more active role in educating families and service providers about child mental health. keywords: mental health literacy; child mental health; stigma; trust the centers for disease control and prevention have identified children’s mental health as a major public health issue in the united states (perou et al., 2013). an estimated one in five american youth aged 13 to 18 suffers from a mental health or learning disorder (perou et al., 2013). an international review of published studies (collishaw, 2015) found that clinical diagnosis and treatment of child and adolescent mental health disorders have increased in recent decades. mental health treatment is becoming more common among children and adolescents in the u.s., with the number of outpatient visits for youth nearly doubling between the periods of 1995-1998 and 2007-2010 (olfson, druss, & marcus, 2015). however, many children still do not receive the diagnoses and treatments that they need for optimal health and well-being (kataoka, zhang, & wells, 2002; merikangas et al., 2010). the need for proper and timely diagnosis and treatment is urgent, as suicide rates are rising among those in late childhood, and the presence of mental health disorders significantly increases the risk of suicide among young people (see bilsen, 2018, for review). early problem recognition and treatment have been linked with better outcomes for children and adolescents with behavioral health issues (mcgorry, purcell, goldstone, & amminger, 2011; o’connell, boat, & warner, 2009). parents are usually the first to notice signs of mental health issues in their children and have strong motivation to get their children needed help (boulter & rickwood, 2014). part of the help-seeking process includes acquiring information about child mental health problems and treatments. jorm et al. (1997) coined the term mental health literacy to mean, https://creativecommons.org/licenses/by/4.0/ bonanno & veselak/a matter of trust 398 “knowledge and beliefs about mental disorders which aid their recognition, management or prevention” (p. 182). previous studies of mental health literacy have shown that knowledge of child mental health issues among adults in the general public is low, with many people lacking accurate information and holding stigmatizing beliefs about mental health issues (pescosolido et al., 2008). lack of information and negative attitudes are linked to low service utilization and dropping out of treatment (bringewatt & gershoff, 2010; kazdin, holland, & crowley, 1997). while research has been conducted on parents’ help-seeking behavior (costello, pescosolido, angold, & burns, 1998; shanley, reid, & evans, 2008; stiffman, pescosolido, & cabassa, 2004), little is known about parents’ attitudes toward information sources and the factors that help parents determine which sources will be helpful and reliable. these issues exist at the nexus of help-seeking and information-seeking and, thus, this article draws on previous research in both arenas. there are few qualitative studies in the literature which elicit parents’ perspectives on the quality of child mental health information available to them or about the processes through which they seek and evaluate this information. because of the high level of stigma that surrounds child mental health problems, and mental health problems in general, it is important to understand parents’ perceptions and increase their access to accurate, trustworthy information sources. help-seeking for child mental health problems in the mental health context, rickwood and thomas (2012) defined help-seeking as “an adaptive coping process that is the attempt to obtain external assistance to deal with a mental health concern” (p. 180). whereas some adolescents reach out for help with mental health issues, particularly through informal sources (jorm, 2012), parents are typically responsible for seeking help for their children’s mental health difficulties (kerkorian, mckay, & bannon, 2006; stiffman et al., 2004). studies have found that help-seeking is not simply a linear process of identifying a need and finding treatment (shanley et al., 2008). parents often simultaneously seek help from multiple formal and informal sources. formal sources of help such as physicians and school personnel are common, as are informal (non-professional) sources such as friends and family members, particularly among non-white families (harrison, mckay, & bannon, 2004; lindsey, joe, & nebbitt, 2010; oh, mathers, hiscock, wake, & bayer, 2015; zwaanswijk, verhaak, bensing, van der ende, & verhulst, 2003). information-seeking for child mental health problems health information-seeking serves many coping functions for individuals facing a health challenge, including both problem-focused functions (such as better understanding the health challenge and making informed decisions) and emotion-focused coping functions (like reducing the negative effects of uncertainty and providing reassurance) (lambert & loiselle, 2007). health information-seeking behavior has been studied extensively and has recently focused on online searching for health information (diviani, van den putte, giani, & van weert, 2015; tustin, 2010; walsh, hamilton, white, & hyde, 2015). however, less is known about mental health information-seeking, and less still about the topic as it relates to parents searching for child mental health information. advances in social work, fall 2019, 19(2) 399 previous research has investigated the variety of information sources accessed by parents of children with mental health problems and their reasons for choosing these sources, but its scope is limited. mackintosh, myers, and goin-kochel (2005) found that parents whose children were diagnosed with autism spectrum disorders (asd) sought information from an average of seven different sources, including interpersonal contacts (e.g., family and friends), medical professionals, educators, written sources, and group gatherings. however, the researchers also reported that parents most often relied on other parents of children with asd. parents of children diagnosed with or at high risk for attention-deficit hyperactivity disorder (adhd) were found to seek several different sources of information about the disorder and its treatment, and frequently relied on the internet and health professionals for information (mackintosh et al., 2005). on the other hand, bussing, gary, mills, and garvan (2007) found social network sources of information (i.e., friends and family members) were less common among parents of children with adhd. these authors speculated that the preference for information sources outside of their social networks was an indicator of parental concern about the stigma surrounding mental health problems. trust and mental health helpand information-seeking a large body of research documents the importance of trust between health care consumers and providers (goodkind et al., 2010; murray & mccrone, 2015; thom, hall, & pawlson, 2004; verhaeghe & bracke, 2011). the concept of trust has been defined as, “a state of favourable expectation regarding other people’s actions and intentions” (möllering, 2001, p. 404) that exists despite an individual’s sense of vulnerability and uncertainty about future consequences. trust figures prominently in individuals’ perceptions of mental health care, affecting interactions between consumers and service providers, beliefs about the quality of treatments, decisions to obtain treatments, honest disclosure to providers, cooperation with treatment plans, and fear of stigma (brown, calnan, scrivener, & szmulker, 2009; gaebel et al., 2014). for parents, feelings of vulnerability and perceptions of risk are likely to impact their sense of trust as they pursue information and mental health treatment for their children. inquiring about a child’s concerning or problematic behaviors may be useful in acquiring information and receiving emotional support but may also expose both the child and parent to the negative attitudes of others, and perhaps even discriminatory treatment. pescosolido (2013) showed that, although knowledge about mental illness and mental health treatment has improved among americans over the last few decades, stigmatization of adults and children with mental illness is still prevalent, including indications that many adults prefer that their children avoid peers with mental health problems. adolescents with emotional or behavioral difficulties have reported perceived negative attitudes and poor treatment by peers, family members, and school staff (moses, 2010). a systematic review of parents’ perceptions of the barriers to pursuing mental health treatment for their children found that the absence of a trusting relationship with health care providers was a significant barrier (reardon et al., 2017). this same study found that parents were worried that providers would not listen to their concerns, and also feared being blamed for their children’s mental health difficulties. these risks impact a parent’s decision bonanno & veselak/a matter of trust 400 to seek help and information from medical and mental health professionals, which, in turn is likely to affect their mental health literacy. the significance of trust in the helpand information-seeking process, as well as the fear of stigma among parents seeking help for their children, have been established by previous researchers. the current study aims to link these concepts and address the absence of qualitative studies in this area by investigating parents’ perceptions of information sources on child and adolescent mental health. this study has a specific focus on parents whose children have experienced a mental health or behavior problem in the past. using in-depth semi-structured interviews, this study addresses the following research question: what are parents’ attitudes toward sources of child mental health information? methods the data presented here are part of a larger mixed-method study on mental health literacy carried out in a large suburban community in new york in 2017. participants and sampling. participants for this phase of the study were parents of children ages 4-18 who were residents of one large town in new york. using purposive sampling, participants were drawn from a pool of 213 parents who completed an online questionnaire for the larger study, and who indicated they would be interested in participating in an interview. the larger survey sample was created using convenience sampling. to recruit participants, the first author contacted public libraries, parent-teacher associations, and local parenting organizations for assistance reaching parents in the community. the survey link and information about the study were posted on social media forums in parentingand family-specific groups in the local area. paper flyers were posted in libraries, restaurants, shops, and community centers. these strategies were utilized in order to include parents of different racial and ethnic backgrounds, residents of different geographic parts of the town, and parents of children of different ages. interview participants were compensated with a $25 gift card from either target or kmart. fifteen parents participated in the interview phase of the larger study. once interviews were completed, the authors refined the research focus to examine perceptions of parents whose children had been diagnosed with and/or had received treatment for a mental health or behavioral disorder. seven of the fifteen participants met these criteria. data from their interviews were analyzed for this study. procedure. participants completed in-person interviews with the first author which lasted approximately one hour. interviews were guided by a semi-structured interview schedule and audio-taped for later transcription into written form. interview questions explored several aspects of mental health literacy and the data presented here focuses on particiants’ attitudes and beliefs about the quality and trustworthiness of the information they received, whether they had considered seeking child mental health information from other sources, and how they made decisions about the information-seeking process. advances in social work, fall 2019, 19(2) 401 table 1. participant profiles pseudonym gender age race/ethnicity education career/profession children’s ages child’s issue/diagnosis adrienne female 43 african american some college secretary 11 anxiety gloria female 48 caucasian master’s degree unemployed 14 family disruption; anxiety hannah female 43 caucasian associate’s degree social service worker (on disability) 18 anxiety, adhd, trauma jackie female 40 caucasian bachelor’s degree office worker for nonprofit agency 12 major depression, suicidal ideation, behavior issues michelle female 33 mixed racea bachelor’s degree nursing student 4 behavioral issues sylvia female 40 hispanic some college stay-at-home parent 17 behavioral issues, family disruption, suicidal ideation, depression tom male 40 caucasian master’s degree college counselor 11 specific phobia a african american and caucasian advances in social work, fall 2019, 19(2) 402 protection of human subjects. the authors obtained informed consent from each participant. all of the participants were given pseudonyms to protect their identities. the ethical execution of this study was overseen by the institutional review board (irb) where the first author is employed. data analysis. interview transcripts were analyzed using thematic analysis (ta). ta is a qualitative data analysis method for identifying and analyzing patterns of meaning in a dataset (braun & clarke, 2006). specifically, themes were defined as patterns of meaning within the data. drawing on the work of braun and clark (2006) and joffe (2012), the data coding and analysis processes were carried out in the following steps: 1. the researchers conducted several thorough read-throughs of the entire dataset (complete transcripts of all interviews). 2. the first author created a codebook with the initial codes that guided the thematic analysis. the codebook contained the name of the code, a definition, and an example. 3. in order to improve the reliability of the codebook, the first and second authors each coded two of the interviews in the dataset. where there were discrepancies, the researchers discussed and revised the relevant codes to make them more descriptive and better operationalized. 4. the entire dataset was coded again by the authors using the revised codebook. 5. the authors reviewed the initial themes and their corresponding extracted data. the authors then examined the data and considered whether they formed coherent patterns. when the authors did not agree that the data extracts fit the theme, they discussed disagreements and determined if the problem was with the theme itself, requiring it to be further refined, or if the data would be a better fit in another theme or should be discarded from the analysis. results data analysis revealed four themes related to participants’ abilities to access mental health help and information for their children, and parents’ levels of trust in these sources. these themes are: others’ firsthand experiences family and friends with professional experience, protecting privacy, and uncertainty about schools as information sources. trust emerged as an overarching and unifying concept for all of these themes. others’ firsthand experiences. several participants reported seeking information from other parents who had experienced mental health struggles similar to their own children. they often referenced friends or family members who had been or would be good sources of information due to their own personal experiences. the following quote from adrienne demonstrates the importance of firsthand experience: [i would only feel comfortable sharing concerns or asking for advice] if i knew that they had been in the same situation. (adrienne) advances in social work, fall 2019, 19(2) 403 similarly, michelle said: and i talked to a friend of mine who has kids who have ieps in the district to see, kind of, how did she go about it. (michelle) another respondent, gloria, discussed her sister: my sister is a social worker. she’s the one who has both boys that are adhd so i actually have approached her for [my son]…so i actually spoke to her and had my son see her mentor. i guess i’d go to her as a first line of defense. (gloria) for two of the respondents, reaching out to strangers online who had similar experiences was also helpful to understand the process of seeking help for a child with a mental health condition. in these cases, the sources of information were not personally known to the respondents, but the fact that they had lived through something similar was significant. for example, adrienne suggested that these online sources could give her some idea of what to expect: just seeing how they handle the situation, what steps they had to take, what they saw in their child, you know, the whole process, what happened, what they saw in their child, and what they did to get the child help and how it ended up. (adrienne) for sylvia, online testimonials from parents who had experienced a mental health issue with their own children provided comfort and support: it opened your mind a lot. it let you know that you’re not alone out there and that there is a solution…i mean, it doesn’t have to be a hundred percent [the same as what you are] going through but it’s nice to hear from a mother of a…teenager who her father abandoned [her], that she locks herself in the room or she blames the mother for everything. it’s part of like my own therapy. (sylvia) these respondents sought information from other parents who had been in similar situations. doing so helped inform the respondents, but also served as a source of comfort and made them feel less alone. firsthand experiences were highly valued by parents who had concerns about their own children’s mental health issues. friends/family with professional experience. several respondents referred to friends or family members who had professional experience with or knowledge of child mental health and suggested that these individuals would be good sources of information. for example, hannah said: well, what happened with me was i have an uncle who’s a psychiatrist. sometimes if he’s up in (a city to the north), he’s retired, i can call him sometimes and get information. (hannah) michelle, who was in nursing school, echoed this sentiment: at this point, [if my child’s behavioral difficulties continued], i would probably call one of my [nursing] professors. that’s what i’ve done in the past when i’ve needed help with certain things…i have a professor who i would probably consider a friend who i would probably talk to first. she has a big adolescent practice. (michelle) bonanno & veselak/a matter of trust 404 even if a person’s professional knowledge and experience were not directly related to mental health, someone with a scientific background or in another helping profession was also considered a good source for referrals and information. for example, michelle said: i have a friend who was a speech pathologist so i went and talked to her. similarly, gloria stated: my sister is a social worker. she's the one who has both boys that are adhd so i actually have approached her for [my son] when i was first getting divorced… (gloria) in this case, gloria had access to an information source (her sister) who had both professional expertise and personal experience with child mental health difficulties. additionally, gloria mentioned her ex-husband, a scientist, as a good possible starting point for accessing information related to child mental health: in addition, i should say also that my ex-husband is a microbiologist and he’s a scientist and so he also is from that scientific world so he knows people who could direct us towards other people. (gloria) the interpersonal resources discussed by these respondents have the combined qualities of being personally known to the parent (and, therefore, more trustworthy than other professionals), and having expertise or access to expertise. this adds complexity to the categories of informal and formal sources of help or information discussed in the literature (e.g., oliver, reed, katz, & haugh, 1999; rickwood, deane, wilson, & ciarrochi, 2005). here we find that some of the most valued sources of mental health information child are combinations of the informal (friends and family members) and formal (doctors and other helping professionals). protecting privacy. interpersonal information sources, such as friends and family members, were generally perceived to be trustworthy. respondents reported that they trusted these individuals to keep their child’s information confidential, and that this trust enabled them to approach friends or family members for help or information for their children. however, individuals further outside the parents’ intimate circles – acquaintances, or the parents of their children’s friends, for example – might not be perceived as trustworthy or protective of information about the child’s mental health issues. respondents had more concerns about protecting their children’s privacy with less familiar people. this concern was highlighted in a continuation of one of adrienne’s statements quoted above. when asked why she would reach out to another parent for information only if that parent “had been in the same situation,” she explained: …i'm just picturing my one friend, for example. she may talk to another parent, who may talk to another parent, who may talk to another parent, and these parents sometimes talk to their children. their children are blabbermouths. they'll go to school, and they'll mention to other kids, "my mom told me that emma’s [pseudonym] mom said emma blah, blah, blah." emma is my daughter…it would get around. you know what i mean?…. well, i'd have concerns about my daughter advances in social work, fall 2019, 19(2) 405 having to deal with hearing about her own issues at school because i've heard information about other kids through other parents. that's a very common thing that moms do sometimes. (adrienne) she later continued: if i were to talk to a parent, another parent, i would talk to my cousin because i know that she would be concerned about me and my daughter. she wouldn’t make it gossipy. some of the other parents that i talk to at school, they’re not all nice, and my concern would be protecting my daughter from getting her feelings hurt at school. (adrienne) some parents said that they would not seek help within their social media circles, or share anything about their child’s experiences in any public forum, due to privacy concerns. for example, jackie said: …i wouldn’t put something like this on [an online forum] because it’s not their business. not everybody understands and i don’t want [my son] suffering. so i would do it in a more discreet way. (jackie) respondents’ privacy concerns were largely connected to the issue of stigma surrounding mental health issues. parents were concerned about negative effects on their children if other people knew that they were suffering with a mental health or behavioral problem. for this reason, respondents reported avoiding publicly seeking information or help for their children. for example, gloria said: i tend to be big on privacy. i’m not one of those people who lives her entire life out there on social media and facebook, even though i know there are people who do that…i always feel that there are lines that need to be drawn and boundaries and that it’s not a good thing to necessarily just project everything out there…just because i know how cruel kids can be and especially with mental health, there does seem to be this stigma still where people are seen as weak or that “suck it up and deal” kind of thing. (gloria) privacy concerns were often at the forefront of respondents’ minds when they were considering how to go about obtaining information on child mental health issues or seeking help for their children. these concerns led parents to avoid public information forums, such as posting about their children’s issues online, or seeking information or help from someone they did not know well. uncertainty about schools as information resources. parents reported mixed feelings about reaching out to their children’s schools for information regarding child mental health issues. some respondents had trusting relationships with school professionals, such as teachers, guidance counselors, social workers, and psychologists, and would not hesitate to ask them for information. jackie, for example, reported positive interactions with her son’s school psychologist during a mental health crisis: [after my son expressed suicidal ideation] i emailed the school psychologist and they brought him down to talk to them…the school psychologist and i periodically texted while he was in the hospital, her checking up, making sure i was okay. i bonanno & veselak/a matter of trust 406 vented to her a little bit just because maybe of her position. the compassion, it just was easy to talk to her a little bit. i haven’t experienced any negativity from the school or on any level. his teachers, i had to fill out a lot of paperwork and stuff like that based on his behavior, his educational…i mean the whole nine yards. i haven’t seen him receiving any negative stuff from them. (jackie) other respondents seemed less trusting of the professionals at their children’s schools and felt that the school only needed to know about a child’s mental health issue if it was directly related to their school performance or behavior. these parents perceived of their children’s mental health struggles as largely separate from the school environment. gloria’s comments are illustrative: [if my son had another mental health problem in the future] i don’t think [the school] would be my first resource. i think i’d go the private route. either a psychologist or a social worker or a psychiatrist. for example, if he suddenly decided that he hated me and his father and he needed to talk to somebody or he hated our rules or he felt issues with his sexuality or he felt just depressed about everything and just hated everything, i don’t think i’d necessarily involve the school with that. that seems more like a whole life sort of issue and the school would sort of be a piece of it and yes, it would affect his school work obviously, but i don’t know that i would involve the school. (gloria) when asked if she got the school involved when her child was experiencing mental health issues, sylvia expressed a similar thought: no. no, i didn’t want to…i didn’t want to get the school involved or anything because i don’t know if you…there was nothing related with the school or with bullying or…i mean, if it was bullying because of school, of course, i would do it, but it was nothing related with school. it wasn’t a school issue. (sylvia) some respondents reported that they had not reached out to the school when their child was dealing with a mental health issue, but said that they might consider doing so in the future if they felt the situation warranted it. for instance, tom said: i would reach out to the school for information regarding my child, what’s going on with my child in the school, that kind of information. information about the disease itself or ideas for how to mitigate it or address it, maybe not as much. but i would see the school as a partner in that. institutions aren’t perfect, but the people in them mostly try to help. yeah, if my child was in some kind of psychological pain, i would definitely want the school to be an ally in that. (tom) overall, respondents’ perceptions of the school as a source of mental health help and information were mixed. while some parents reported very good, trusting relationships with school personnel, others were more wary of approaching the school for help with their child’s mental health issues. advances in social work, fall 2019, 19(2) 407 discussion this study, part of a larger mixed-methods study, aimed to understand the beliefs about sources of child mental health information among parents whose children had experienced mental health difficulties. analysis of participant interview data revealed several themes. some participants valued the personal experience of other parents whose children had experienced mental health problems when considering which sources of mental health information they would seek. one parent reported finding both helpful information and emotional comfort in online discussions of other parents with whom she was not acquainted. participants also sought information from those in their social networks— family members, professors, and others—who had professional knowledge about child mental health. parents trusted these sources, which were both personally known to them and believed to have specific expertise or access to expertise. whereas parents’ reliance on formal and informal sources of information has been documented in previous research (harrison et al., 2004; lindsey et al., 2010; oh et al., 2015; zwaanswijk et al., 2003), this study found that parents may draw on people in their lives (informal sources) who also have some professional expertise (formal sources). privacy emerged as an important theme, as parents expressed concern that the individuals from whom they sought information could be trusted to keep their child’s mental health struggles confidential. study participants had mixed views about seeking information from or involving school personnel in their children’s mental health issues. whereas some expressed trust in staff at their children’s schools, others felt that the school should only be involved if the children’s issues directly affected their school performance or behavior. in our analysis, the concept of trust emerged as an implicit, overarching theme in parents’ interviews. sociologists define trust in relational terms; that is, trust exists not in an individual, but in dyads, groups, or collectives (lewis & weigert, 1985). individuals make decisions about who they can trust based on both cognitive and emotional processes (lewis & weigert, 1985). the cognitive process involves using reason and weighing evidence for and against an object’s trustworthiness. parents must have some reason to believe that an information source is trustworthy in order to take the “leap of faith” in relying on the source (möllering, 2001). the emotional base of trust involves the mutual understanding that a breach or betrayal would cause damage to the relationship between the individual and the object of trust. some degree of familiarity with the objects of trust (in this case, information sources) is required for both the cognitive and emotional elements of trust to exist. adrienne’s quote about trusting her cousin as an information source because, “she would be concerned about me and my daughter,” illustrates the importance of the trustworthy relationship between the parent and the information sources. according to our data, interpersonal sources would also be more likely to protect the parent and child’s privacy, which engenders a more trusting relationship. seeking information about a child’s behavioral or mental health issues necessarily requires some degree of disclosure about the child’s problems. given widespread stigmatization of individuals with mental health problems, it is unsurprising that parents of children with such problems are fearful and uncertain about seeking information and bonanno & veselak/a matter of trust 408 support. several study participants suggested that their trust in some information sources— friends, family members, school personnel, and individuals who share information in online forums—was grounded in the fact that the sources themselves had personal experience with a child with mental health problems. it seems that parents valued the information these informal sources provided because they perceived a shared understanding gained through personal experience. for a parent to place trust in an interpersonal source of information, he or she must overcome the risks of uncertainty (brown et al., 2009). a parent might ask himor herself, “will this person judge me or my child? will my family’s privacy be protected? will i gain useful and accurate information?” participant data from this study suggest that parents perceive these risks to be minimized when the information source has gone through similar experiences and, therefore, taken similar risks. a parent is likely to place trust in another parent who would be similarly concerned about protecting their own child from stigma and poor treatment. an understanding of the concept of trust also sheds light on some parents’ ambivalence about seeking information from their children’s schools. whereas school personnel may have useful expertise in child mental health, parents may hesitate to approach the school as a source of help or information, due to the perceived risks involved in disclosure of their child’s issues. according to the data, parents may feel it is necessary to trust school personnel and seek information and help from them only when the child’s problems directly impact school behavior and performance. however, without this direct impact, some parents prefer to seek information and support from more trusted sources. strengths and limitations there is little research about parents’ perspectives on the child mental health information available to them. the in-depth interviews in this study begin to address the gap in the literature by giving voice to parents of children with mental health difficulties and shed light on how they make decisions when seeking help and information for their children. although this study drew on sound qualitative methods to collect rich data, the results should be interpreted bearing in mind the small sample size and the resulting difficulty generalizing findings to other populations. the sample was drawn from a larger mixedmethods study in which participants self-selected to complete an online survey. the data analyzed here present the beliefs and perceptions of parents in one community who had access to the internet in order to complete the survey, and who may have had a greater degree of interest in and knowledge about child mental health than parents in the larger population. participants all had at least some years of college education which may have increased the likelihood that they had awareness of and/or access to mental health information. the study’s authors selected participants purposively to represent the economic, educational, racial, and ethnic diversity of the community in which the study was conducted. despite these careful methods, the results should be interpreted with caution. advances in social work, fall 2019, 19(2) 409 implications social workers, public health workers, teachers, and other professionals can support informal helping relationships and interpersonal information-sharing by engaging in efforts to increase mental health literacy at the individual, community, and population levels. studies have found that parental knowledge about disorders and treatment is associated with more treatment-seeking, better quality treatment, and improved parental treatment decisions (jorm, 2012; mendenhall, 2012; mendenhall, fristad, & early, 2009). results from this study suggest that parents—particularly those whose children have experienced mental health difficulties—may be asked to share their knowledge about child mental health with other parents they know. therefore, increased parental mental health literacy may also have a positive effect on other families in the parents’ social network. research has found that even formal providers of mental health information and services, such as physicians, often lack adequate knowledge to properly identify the need for mental health services in children and may be unaware of the services available (stiffman et al., 2004). teachers have reported a lack of training and knowledge to adequately address the needs of children and teens with mental health difficulties (reinke, stormont, herman, puri, & goel, 2011). increased mental health literacy among professionals is crucial if parents are to obtain accurate information from the service providers they trust. professionals who work with parents and families can help educate clients, other professionals, and the general public about mental health disorders and services to reduce the stigma that surrounds these issues and that act as a barrier to appropriate and timely prevention, identification, and treatment. schools are excellent settings in which to promote child and adolescent mental health and well-being (franklin, kim, ryan, kelly, & montgomery, 2012; miller et al., 2019), and school districts are increasingly engaging in efforts to enhance the mental health literacy of both school personnel and students (eschenbeck et al., 2019; perry et al., 2014; whitley, smith, & vaillancourt, 2013). in 2018, the federal substance abuse and mental health services administration (samhsa) launched a grant program called project aware aimed at increasing awareness of child mental health and expanding states’ capacities to connect children and families with needed services; 24 states received funding to implement programming (samhsa, 2018). as the mental health knowledge of teachers and other school personnel increases and stigma decreases, it follows that schools will be in a better position to serve as trustworthy sources of information for parents with questions and concerns about their children’s mental health. further, broader public awareness and more open conversations about child and adolescent mental health, encouraged by project aware and similar programs, may help parents to feel more comfortable seeking information and help for their children. schools should consider expanding mental health literacy projects to specifically include education and awareness programs for parents. school social workers often work closely with families (kelly et al., 2010) and are therefore in an ideal position to enhance parental mental health literacy. the results of this study suggest that parents whose children are experiencing mental health difficulties are more likely to trust other parents whose children have had similar struggles. in light of this finding, school social workers should consider developing parent peer support groups bonanno & veselak/a matter of trust 410 and/or peer mentors to help parents connect with others who are in similar circumstances to gain support and education. mendenhall and frauenholtz (2013) argue that social workers, as the professionals who provide the most mental health services in the u.s. (heisler, 2018) and who have a mission to work toward social justice, are uniquely positioned to increase mental health literacy and reduce stigma. they call on social workers to take the lead in educating clients on micro and mezzo levels, to increase culturally-sensitive public information about mental health, and to advocate for policies and practices that reduce stigma and improve knowledge about mental health disorders and treatment. the current study echoes this call to social workers, as it is apparent that trust is a significant factor in parents’ approach to mental health care for their children. conclusion the confluence of worsening child and adolescent mental health and increasing stigmatization of mental health problems in the u.s. has created an urgent challenge for social workers. trust is essential to successful client-social worker relationships (behnia, 2008; christensen, 2013; smith, 2004). results from this study demonstrate that lack of trust is a barrier to parents’ pursuit of mental health treatment for their children. social workers who work with families must put trust-building at the center of their practice in order to increase parental mental health literacy and, ultimately, improve the well-being of young people. references behnia, b. 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(2013). promoting mental health literacy among educators: critical in school-based prevention and intervention. canadian journal of school psychology, 28(1), 56-70. doi: https://doi.org/10.1177/0829573512468852 zwaanswijk, m., verhaak, p. f., bensing, j. m., van der ende, j., & verhulst, f. c. (2003). help seeking for emotional and behavioural problems in children and adolescents. european child & adolescent psychiatry, 12(4), 153-161. doi: https://doi.org/10.1007/s00787-003-0322-6 author note: address correspondence to: rebecca bonanno, phd, lcsw, associate professor, suny empire state college, school of human services; email: rebecca.bonanno@esc.edu https://doi.org/10.2147/prbm.s38707 https://doi.org/10.1007/s10488-006-0107-6 https://doi.org/10.1007/s10488-006-0107-6 https://doi.org/10.1921/17466105.11.3.5 https://doi.org/10.1023/b:mhsr.0000044745.09952.33 https://www.samhsa.gov/newsroom/press-announcements/201804091100 https://doi.org/10.1377/hlthaff.23.4.124 https://doi.org/10.1016/j.apnu.2011.02.001 https://doi.org/10.1186/s12913-015-0793-4 https://doi.org/10.1177/0829573512468852 https://doi.org/10.1007/s00787-003-0322-6 mailto:rebecca.bonanno@esc.edu help-seeking for child mental health problems trust and mental health helpand information-seeking methods results uncertainty about schools as information resources. parents reported mixed feelings about reaching out to their children’s schools for information regarding child mental health issues. some respondents had trusting relationships with school profession... discussion strengths and limitations there is little research about parents’ perspectives on the child mental health information available to them. the in-depth interviews in this study begin to address the gap in the literature by giving voice to parents of children with mental health d... implications references microsoft word 15-3772 zerden et al social work with latinos in the new south final ______________ lisa de saxe zerden, msw, ph.d., is a clinical assistant professor in the school of social work at the university of north carolina at chapel hill; arianna taboada, msw, msph, is project manager at the ucla art & global health center, and quentin joshua hinson, msw, lcsw, lcas, is a clinical instructor in the school of social work at the university of north carolina at chapel hill. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 260-275 carolina del norte and the new south: social work practice with new latino immigrant communities lisa de saxe zerden arianna taboada quentin joshua hinson abstract: over the past decade, the latino population in north carolina has increased 111%. more than half of north carolina latinos are foreign-born and most face issues related to immigration, acculturation, and often, discrimination. this article provides a brief overview of the historical context in which social workers engaged with immigrant communities and argues that the profession brings strengths and unique skills to address north carolina’s latino immigrant population, historically, and within the current context. key social demographics of latino populations, sociopolitical realities, and theoretical and methodological issues related to the complex needs of this diverse population group are addressed. two examples of latino vulnerability in north carolina, hiv/aids and discriminatory local immigration enforcement practices, are discussed to further highlight the unique strengths and challenges social workers in north carolina and the new south face when working with latino immigrants. keywords: latino immigrants, immigration policy, acculturation, latino hiv/aids risks the latino population is the country’s largest growing minority group and is projected to comprise 45% of the u.s. population by 2030 (u.s. census bureau, 2010). currently, latinos/latinas represent more than 50.5 million individuals, or 16.3% of the total population and accounted for 56% of the u.s. population growth between 2000 and 2010 (u.s. census bureau, 2010). during that decade, seven southeast states had latino populations that more than doubled, including north carolina (pew hispanic center, 2011). the latinization of the “new south” as described by furuseth and smith (2006) has contributed to …transformative forces reshaping the character and dynamics of the region in our area. the immigration of both native and foreign born [latinos] and their role in the emerging nuevo south cannot be understood fully without interacting it with changes that are transforming the region’s economy and culture through…restructuring and globalization. (p. 15) it is important to recognize that hundreds of thousands of latinos have moved to north carolina and other southern u.s. states as a result of increasing labor demands, growth in the southern regions, and a cheaper cost of living (gill, 2012). due in part to these as well as other factors, north carolina experienced a rapid demographic shift from 1990 to 2000, with the fastest growing latino population in the nation (martinez & bazan, 2004). over the past decade, the latino population in the state has continued to grow, increasing from 378,963 in 2000 to 800,120 in 2010—a dramatic increase of 111% advances in social work, spring 2013, 14(1) 261 (pew hispanic center, 2011). with more than 800,000 latinos living in north carolina, this group accounts for approximately 8% of the state’s current population (u.s. census bureau, 2010). more than half of north carolina latinos are foreign-born (zota, 2008), and 35% report limited or no english proficiency (u.s. census bureau, 2005-2009). most face issues related to immigration and acculturation as well as discrimination in their new communities, and, one third are estimated to be undocumented (popke, 2011), adding an additional element of social vulnerability. many recent latino immigrants have found employment in north carolina’s agricultural sector, primarily as laborers on turkey and hog farms, or with landscaping and horticulture businesses; in the construction and construction-related trades, such as painting and carpet installation; in housekeeping services, and other service-sector jobs (gill, 2012; popke, 2011). the increase in labor-driven transnational migration is often attributed to the economic restructuring of the region that is tied to neoliberal policies (as exemplified by the north american free trade agreement [nafta] of 1994), coupled with the state’s history of weak unions and racially segregated labor (popke, 2011). despite the active recruitment of latino/latina workers by select industries, the local reception of the influx of latinos has been fraught with anxiety, fear, and larger sociopolitical challenges. these responses differ in degree and severity, often in relation to patterns of migration and reception. the changing landscape of rural communities in north carolina has been dramatic. major urban centers in durham, mecklenburg, and wake counties received large numbers of latino immigrants between the years 20002010 (nguyen & gill, 2010). however, rural counties within the state, such as cabarrus and duplin, experienced rapid demographic shifts, with the percentage of latino residents increasing by 1000% while other racial/ethnic groups remained the same or decreased (nguyen & gill, 2010; popke, 2011). social backlash became prominent as latino migrants intersected the lives of native-born carolinians. given the complex economic and labor-related drivers of demographic changes, latinos’ labor has been welcomed, yet the presence of a permanent latino community has not received the same reception (gill, 2012; johnson-webb, 2003). in both rural and urban settings, as the landscape of the state has begun to include brown faces, tiendas, taco trucks, and spanish-language signs and advertising, the conservative public reaction to the demographic shift has grown louder. paralleling this conservative backlash, academic and activist work focused on diversity has grown stronger (cravey & valdivia, 2011; cuadros, 2011; deguzman, 2011; palis, reilly, & valdivia, 2011). this is a trend that is echoed throughout historical accounts of communities receiving newcomers (abel, 2004; chavez, 2004; molina, 2006a, 2006b; portes & rumbaut, 2006). among states with a growing latino/latina population, north carolina has a somewhat unique history. although the state had been receiving mexican workers in small numbers since the 1940s (i.e., when the bracero program imported temporary mexican agricultural workers to the united states) north carolina did not begin to actively address the social, economic, and health disparities of latinos until the 1990s when a permanent latino community was established (martinez & bazan, 2004). the response of social services has been slow and hindered by many logistical and political challenges. one such challenge is the lack of professionals trained to address the unique zerden, taboada, hinson/carolina del norte and the new south 262 needs of this population. however, given the social work profession’s roots in social justice work, multisystemic orientation (i.e., micro, mezzo and macro) and person-inenvironment perspective, social workers are particularly well positioned to address the latino community’s needs through direct service, community practice, and political advocacy (garcia, 2009). this article offers an overview of social workers engaging with immigrant communities and argues that the profession brings strengths and unique skills to address north carolina’s latino immigrant population, historically, and within the current context. however, equally important are the limitations within social work education to educate professionals on the nuances of migration and acculturation theory and its application in practice. therefore, this article highlights key social demographics of latino populations, as well as theoretical and methodological issues related to the complex needs of this diverse population group. a review of these concepts will help prepare social work practitioners for a more comprehensive and culturally informed understanding of latino immigrant communities, and, in turn, promote development of culturally relevant interventions that consider sociopolitical realities. two examples of latino vulnerability in north carolina—hiv/aids and discriminatory local immigration enforcement practices—are discussed to further highlight the unique strengths and challenges social workers in north carolina and the new south face when working with latino immigrants. latino social, health, and economic vulnerabilities north carolina’s latino immigrants face complex and often multiple layers of social, health, and economic challenges, depending on various facets of human and social capital, including level of education, english language proficiency, documentation status, social support, level of acculturation, and ethnic identity (delgado, 2012). in particular, immigrant latinos in north carolina face major challenges to maintaining their health because of structural barriers such as lack of access to care, lack of linguistically and culturally appropriate services, inadequate transportation, lack of employer-based insurance, and prominent racial/ethnic discrimination (siman, 2009). latinos represent the racial/ethnic group most likely to lack insurance in north carolina, with an estimated 65% of adults and 30% of children uninsured. additionally, 29% of latino adults in north carolina report that they were unable to see a physician when needed in the past 12 months due to cost (north carolina office of minority health & health disparities and the state center for health statistics, 2010). perhaps most dramatically, latinas in north carolina have some of the highest rate of teen pregnancy in the country (martinez & bazan, 2004). data from multiple sources indicate that nationally, latinos suffer disproportionately from poverty and lack of access to health care (delgado, 2007), and that undocumented immigrants are even more vulnerable given their exclusion in federal health coverage, including the recent passage of the affordable care act (aca) in 2010 (galarneau, 2011). under the aca, undocumented immigrants are ineligible for medicaid and will not be allowed to purchase private insurance through new insurance exchanges (galarneau, 2011). advances in social work, spring 2013, 14(1) 263 according to the u.s. census bureau (2010), almost a quarter of u.s. latinos live below the federal poverty line, and 40% of the population is younger than 21 years of age, with limited formal education (warner et al., 2006). these social factors intertwine with and influence health and well-being, warranting social workers to examine not just individuals in their environment, but also, what kind of fit one’s environment has on individuals. this is known as the person-environment fit model and it has been used to explain some of the diversity in adjustment among latinos and their movement patterns (roosa et al., 2009). how well immigrants fit in their communities looks drastically different depending on the resources, support, neighborhood composition, and desires of individuals (garcia, 2009). critical consideration is needed of an array of factors influencing latino well-being which includes socioeconomic status; cultural attributes; neighborhood composition; social reception; language proficiency; legal status; access to health insurance; and access to appropriate preventative care, treatment, and service provision (centers for disease control and prevention [cdc], 2012; friedman, curtis, neaigus, jose, & des jarlis, 1999; vega & amaro, 2002). within-group variation in health outcomes is often obscured because data on the u.s. latino population is aggregated, perpetuating the false assumption that latinos are a homogenous group. many of the above characteristics do not account for the heterogeneity among this diverse group. specifically, in north carolina, two thirds of the latino population identifies mexico as their country-of-origin, followed in order by el salvador, honduras, guatemala, and costa rica. these numbers include immigrants, naturalized citizens, and u.s. born citizens (gill, 2012; u.s. census bureau, 2010). further, most data on latinos as a group fails to consider acculturation factors such as nativity, length of time in the united states, language spoken, developmental stage at age of migration, and other migration and immigration patterns that differ drastically within latino ethnic groups (zerden, lopez, & lundgren, 2010). the particular needs of latinos and immigrant communities have prompted social workers to think critically about the ways in which research and intervention efforts capture the immigration, migration, and adaptation processes. the policies and politics tied to the latino immigrant experience play a central role in the quality of services available in receiving communities. culturally-informed practitioners have a professional and ethical obligation to understand the cultural, gender, social, health, and economic nuances latino immigrant communities experience in light of their unique immigration circumstances and the ever-changing landscape of immigration policy (chang-muy & congress, 2009; derose, escarce, & lurie, 2007). overview of social work’s role in working with immigrants from the inception of social work, the profession has played a role in adapting to immigration and migration (chang-muy & congress, 2009). while a full history is beyond the purview of this article, the extent of racism and exclusion within early social work institutions such as settlement houses and charity organizations should not be negated. this declaration by a settlement house director, “you can americanize the man from southeastern and southern europe, but you can’t americanize a mexican” (as cited in iglehart & becerra, 1995/2000, p. 5) exemplifies a dominant and professionally zerden, taboada, hinson/carolina del norte and the new south 264 acceptable perspective at the turn of the nineteenth century. despite a longstanding commitment to immigrant populations, the professionalization of social work and the creation of formal social service organizations rarely met the specific needs of immigrants (iglehart & becerra, 1995/2000; katz, 1996). services were thought to be “culturally neutral” but often reflected the values and beliefs of dominant white culture (bent-goodley, 2005; katz, 1996), and thus, excluded ethnic and linguistic minority groups from mainstream formal services. therefore, ethnic service agencies took responsibility for providing the organizational structure and services to ethnic and linguistic minority groups (iglehart & becerra, 1995/2000). more recently, the social work profession has shown a renewed commitment to working with immigrant populations with respect and dignity. most notably, the national association of social workers (nasw) code of ethics frames standards for professional practice with immigrants in its sections on culturally competent practice (nasw, 2008). nasw recently added immigration status as applying to a category of people for whom social workers should oppose discrimination (nasw, 2012). similarly, the council on social work education (cswe) educational policy and accreditation standards speak to the importance of preparing culturally competent students for practice in global societies (chang-muy & congress, 2009; cswe, 2012). these changes have been reflected at a curricular level as social work educators have endeavored to better prepare students to work with an increasing number of clients who are immigrants settling into new communities (furman, negi, & loya, 2010; negi & furman, 2010). recently, many schools of social work have developed concentrations and certificate programs related to immigration and transmigration. these programs are designed to better prepare future social workers for the critical analysis required to effectively work with diverse groups of immigrants and the myriad of social, economic, political, legal and psychological issues associated with immigration (nash, wong, & trilin, 2006). several of the theoretical perspectives foundational to social work are also beneficial to assessing immigrants, their families, and community systems: empowerment theory (gutiérrez & lewis, 1999; weil, reisch, & ohmer, 2012), strengths-based perspective (saleebey, 2002), bioecological systems perspective (bronfenbrenner, 1979), and the risk and resiliency perspective (fraser, 2004). to adequately account for the nuances that shape individual and community risk and resilience across social work settings, social work students and practitioners need to understand immigrant issues through the lenses of human rights and social justice, which are core principles of the profession (congress, 2006; nasw, 2012; weil et al., 2012). for those interested in working with latino immigrant communities, this perspective includes understanding human rights issues in latin america, as well as the concepts and theories relevant to serving a diverse population. although the literature on migration as a human right is well developed (simmons, 1996; tazreiter, 2006; touzenis & cholewinski, 2009) and used in social work education, acculturation has been a debated concept in social and health sciences. the difficulty in teaching social workers about acculturation primarily stems from the fact that acculturation theory has been ambiguously defined and inconsistently used in social science research (hunt, schneider, & comer, 2004), despite being an important concept advances in social work, spring 2013, 14(1) 265 for social workers to understand in order to discern the structural forces that impact movement, migration, cultural values and health-seeking behaviors. acculturation theory the concept of acculturation has had a long history within social and behavioral sciences, especially among anthropologists and sociologists first documenting their encounters with indigenous populations (cabassa, 2003; hunt et al., 2004). early conceptualizations viewed acculturation as a unidirectional process in which a cultural group moved from a tradition-oriented phase, through a transitional phase, to a final, acculturated endpoint (cabassa, 2003; chun, organista, & marín, 2002; hunt et al., 2004; redfield, linton, & herskovitz, 1936). a more contemporary perspective rejects this linear view of culture and opts for a multidimensional approach throughout the life course (cabassa, 2003; chun et al., 2002) that represents a dynamic, context-dependent construct wherein individuals move along a continuum (yamada, valle, barrio, & jeste, 2006). acculturation as a continuum is a particularly important concept for latino groups who represent diverse migration patterns and points of entry (thomson & hoffmangoetz, 2009). whether the acculturation process occurs on a voluntary basis or is forced (e.g., refugees or laborers immigrating out of necessity), such a process contributes to acculturative stress, that is, the collective confusion and anxiety, loss of identity, and feelings of alienation against the larger society (portes & rumbaut, 2006; smokowski & bacallao, 2011). however, using acculturation as a concept in assessing the social, health, and political outcomes of latinos is a complex matter given the lack of standardized definition and measure, as well as the limitation that few assessments include specific health indicators (wallace, pomery, latimer, martinez, & salovey, 2012). measuring acculturation for latinos and limitations. although an array of acculturation measures have been designed to quantify the behaviors, values, and attitudes of the latino population, a major criticism within acculturation literature is the “lack of clear definitions and insufficient conceptualization of acculturation, its central concepts remain implicit, poorly stated, simple, ambiguous, and inconsistent” (hunt et al., 2004, p. 975; wallace et al., 2012). many studies have used acculturation theory to examine the relationship between acculturation and health outcomes among immigrant groups (abraido-lanza, armbrister, florez, & aguirre, 2006; delgado, 2007; zerden et al., 2010) without a more comprehensive analysis of the multiple systems at play (hunt et al., 2004) or cultural attitudes, knowledge, and beliefs that influence healthcare utilization (wallace et al., 2012). the majority of acculturation scales have been tested with nonprobability samples of predominantly mexican american subgroups of latinos who are often first-generation immigrants living in california or texas (yamada et al., 2006). one of the biggest limitations of acculturation theory in health outcome research has been identified as the overreliance on individual and culture-driven models to understand health disparities. zambrana and carter-pokras, (2010) state that this limitation “ignores the effect of residence in low-resource communities, low sep (socioeconomic position), the social construction of marked cultural identities, and institutional patterns of unequal zerden, taboada, hinson/carolina del norte and the new south 266 treatment, all of which contribute to health disparities” (p. 21). expanding social and public health research to include social determinants of health, as well as institutional and structural barriers to care will improve the understanding of health disparities by acknowledging that these facets often impact the ways in which individuals experience acculturation, migration and movement in the first place. case examples: health and political implications of hiv/aids and local immigration enforcement to build on the articulation of demographic shifts of latinos in the south as well as the ways in which theoretical constructs inform measurement and enumerate social, economic, and political conditions, the following section presents two case examples of vulnerabilities experienced by latinas/latinos in the southern united states. these case examples center on issues around (a) hiv/aids and (b) local immigration enforcement; our discussion focuses on how social work professionals are particularly equipped with the knowledge and skills to deal with these situations experienced by latinos in north carolina and other southern states. hiv/aids although hiv/aids knows no geographic, economic, or racial/ethnic boundaries, minorities disproportionately bear the burden of disease. this disparity has remained true for hiv/aids rates in the south where half of new hiv diagnoses among latinos occurred (cdc, 2012). from 2006 to 2009, 6 of the 10 states with the highest rates of hiv infection among latinos were in the south (cdc, 2012). nationally, latinos accounted for 13.4% of the population yet 18% of new hiv diagnoses from 2005 to 2008 were among latinos (cdc, 2012). the increasing population growth of latinos in the south over the past decade and disparities in health outcomes warrant greater focus on hiv/aids prevention, treatment, and care needs of latino communities. as demographic and geographic shifts continue to shape the landscape of hiv/aids among latinos is the united states, the person-in-environment perspective intrinsic to social work recognizes the multisystemic factors that perpetuate hiv/aids risks and the protective factors for which culturally appropriate interventions can be harnessed for latinos in north carolina specifically, and the southeast generally. there is significant evidence that shows how social marginalization and isolation experienced by latino immigrants can result in high-risk behavior associated with sexual practices and intravenous drug use (castillo-mancilla et al., 2012; ojeda et al. 2012; painter, 2008). research has shown that health interventions that are adapted to a specific ethnic group’s cultural and social context are more likely to increase effectiveness (bernal, bonilla, & bellido, 1995). social workers are well positioned to consider multiple factors of discrimination that subgroups might experience, and, within this context, provide services and lead advocacy efforts. the profession’s emphasis on cultural competency requires social workers to critically understand a context unique to latinos versus other racial/ethnic subgroups. culturally relevant and linguistically appropriate services are needed for counseling and testing services, educational materials, and prevention efforts. simply asking specific questions regarding a client or community’s legal, cultural, and advances in social work, spring 2013, 14(1) 267 linguistic context can dramatically improve the prevention or treatment approach and mitigate the potentially harmful effect of providing services based on assumptions or generalizations about an ethnic group (tervalon & murray-garcia, 1998). a strong understanding of acculturation can facilitate the provision of culturally and linguistically competent care. further, partnerships with community-based organizations serving the latino community in the south are necessary to promote trusted and safe environments in which latinos can seek social, psychological, and health support outside of the formal social service sector. the use of promotoras, or lay health workers, has a long history in both latin american and u.s. latino communities of effectively bridging the gap between the community and health services. promotoras are noted not only for increasing knowledge and promoting community-level change, but can actually facilitate individual behavior change, use of preventive service, and access to health care services at a relatively low cost (cohen, meister, & dezapien, 2004; ingram, gallegos, & elenes, 2005; love, gardner, & legion, 1997; nemcek, & sabatier, 2003; ramos, may, & ramos, 2001; ro, treadwell, & northridge, 2003). promotoras have been an effective community-centered intervention to reach vulnerable latino groups affected by hiv/aids (vega & cherfas, 2012). identifying promotoras in north carolina and other southern states is not only a valuable way for social workers to build community capacity through empowerment of community leaders but also to identify community needs and receive feedback about the cultural relevancy and feasibility of interventions within latino communities (vega & cherfas; 2012; witmer, seifer, finocchio, leslie, & o’neil,1995). furthermore, and particularly important in the case of hiv among north carolina latino immigrants, promotoras can help promote critical points of access for prevention, treatment and social support (aguilar-gaxiola et al., 2002; nemcek & sabatier, 2003). local immigration enforcement – 287(g) historically, public policies targeting immigrants have had a significant impact on latino communities; such policies continue to be fraught with controversy (abel, 2004; hernández, 2008; molina, 2006a, 2006b). with recent increases in the latino immigrant population, north carolina has been called “an important barometer of contemporary immigration debates for the nation and especially for the southeast, which has become a new frontier for latin american migration to the u.s.” (gill, 2012, p. 6). north carolina has joined several other states and local municipalities in adopting localand state-level strategies, arguably to address the lack of comprehensive immigration reform at the national level (idilbi, 2008). although neighboring southern states, including alabama, georgia, and south carolina passed stringent immigration laws similar to arizona’s sb1070, several north carolina counties and the city of durham opted to participate in the 287(g) program sponsored by u.s. immigration and customs enforcement (ice), a division of the department of homeland security (gill, 2012). the 287(g) program gives local law enforcement the authority to assess for immigration status and start deportation zerden, taboada, hinson/carolina del norte and the new south 268 proceedings for undocumented suspects who are detained, but have not yet been convicted of any crime (gill, 2012). although originally developed to promote safe and secure communities, the implementation of 287(g) in north carolina has repeatedly been recognized as a primarily anti-immigration initiative that heavily intersects with racial/ethnic discrimination and racial/ethnic profiling under the guise of reducing crime (gill, nguyen, parken, & weissman, 2009; idilbi, 2008; nguyen & gill, 2010; weissman, 2009). despite a dearth of literature available on the impact of 287(g) in north carolina specifically related to social work practice, evidence gathered by economists, lawyers, and policy makers has suggested that 287(g) is detrimental to latino immigrants’ experience with harassment and isolation, trust in public safety, and ability to contribute to local economies, which have been strengthened by latino small businesses and tax revenues (gill et al., 2009; idilbi, 2008; nguyen & gill, 2010; weissman, 2009). further, policies like 287(g) are suspected to severely threaten the physical and mental health of immigrants targeted by the practices generated by such policies (hacker, chu, arsenault, & marlin, 2012; mcleigh, 2010). when communities have enacted local enforcement of federal immigration policy, both documented and undocumented immigrants living in those communities have reported negative health effects such as heightened stress levels, fear of deportation, and emotional distress (hacker et al., 2012). these increased stressors lead to negative effects in wellbeing at the individual, family, and community levels. social work, as a field with a social justice perspective, should play a particularly critical role in both direct service and advocacy in response to 287(g). however, the symptoms mentioned above also result in limited help-seeking for health and social services, which are the primary points of contact where social workers and other helping professions are most likely to have direct contact with the latino population. anecdotal evidence from the experiences of one of the authors, a bilingual clinical social worker in north carolina’s triangle area from 2006 until 2010, during the enactment of 287(g) and the 2006 technical corrections act (which required a valid social security number to qualify for a north carolina driver’s license), corroborate that the policies severely limited the organization’s capacity to serve its target population. the social worker reported that once 287(g) was enacted, the agency’s latino clients reported increased fear and anxiety about leaving their homes and being targeted at license checkpoints. in addition, highly publicized cases that shed light on the racial profiling and victimization of latino immigrants exacerbated clients’ fears and increased their isolation by discouraging them from seeking social supports. clinical manifestations of anxiety and depression were compounded by acculturation stress and became more difficult to treat with access to treatment in jeopardy. conclusions: the role of social workers in the new south the recent demographic shifts, burgeoning latino communities, and accompanying vulnerabilities in north carolina suggest that through direct service, community practice, and political advocacy, social workers have essential skills and professional responsibilities to address the needs of latinos in the south. examples of the intensifying hiv/aids epidemic and discriminatory immigration policies prone to the south are but advances in social work, spring 2013, 14(1) 269 two examples of the needs latino immigrants and migrants will continue to face in the new south. although geographic factors, including rural isolation, cultural conservatism, and increased poverty are more pervasive in the south, the necessity for social workers to address the particular nuances of new latino immigrant communities has never been greater for the nation as a whole. however, identifying the skills and approaches that social workers bring and need to strengthen is critical. the theoretical orientation of social work education and the profession’s understanding of multisystemic social problems allow social workers to think critically about these issues, including hiv/aids prevention and treatment, and the impact of unjust and discriminatory immigration policies. in addition to providing culturally appropriate, trauma-informed direct services to address deleterious mental health effects of such policies, social workers can advocate for policy change at the local, state and federal levels. in addition, social workers are especially well equipped to involve latinos in such advocacy efforts, thereby empowering latinos to step out of the shadows and increase their sense of agency (belkin-martinez, 2010). these social work foundational skills must be examined within the historical context of the field and coupled with efforts in related fields such as sociology, public policy, public health, and law. historical perspectives from the field of social work trace a long history of work with immigrant populations, although noticeably void of some of the ethical principles of cultural competency and anti-discrimination that are now in place. social work educators must work to actively infuse the curriculum with content that addresses these principles and frames practice with immigrant communities in a social justice and human rights context. careful consideration of local and global policies and practices that operate in conjunction with one another to prevent or facilitate the human dignity of migrant populations is critically important, as is the understanding of nuances of language, culture, and acculturation. careful consideration of systems in the country-of-origin, transit, and destination are other ways in which social workers serving latino immigrant populations must engage with these concepts as they are defined across the americas, paying close attention to the ways in which the new south’s challenges can be attributed to a truly global issue. references abel, e. 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(fall) 38-44. retrieved from http://sogpubs.unc.edu/electronicversions/pg/pgfal08/article4.pdf author note: direct correspondence to: lisa de saxe zerden, msw, phd, clinical assistant professor, unc chapel hill school of social work, 325 pittsboro st. cb#3550, chapel hill, nc 27599-3550. email: lzerden@email.unc.edu microsoft word 11. maccio et al_17162-age differences in lgbt attitudes_copyedit final ______________ elaine m. maccio, ph.d., is an associate professor in the louisiana state university school of social work; sara mateer derosa, msw, is a medical social worker at the baton rouge general medical center; scott e. wilks, ph.d., lmsw, is a john a. hartford faculty scholar in geriatric social work and associate professor in the lsu school of social work; and amy l. wright, msw, is a ph.d. student in the lsu school of social work; all in baton rouge, la. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 428-443 age differences in lgbt attitudes toward marriage equality elaine m. maccio sara mateer derosa scott e. wilks amy l. wright abstract: the purpose of this study was to compare attitudes of older versus younger lesbian, gay, bisexual, and transgender (lgbt) individuals regarding marriage equality. data were collected via self-report questionnaires from 350 lgbt adults in a mid-size city in the southern united states. older and younger lgbt cohorts did not differ significantly in voter registration, political party affiliation, awareness of lgbt political issues, or voting on social issues. older lgbt adults were less likely to find same-sex marriage important. yet, age cohorts did not differ significantly on legalizing same-sex marriage. social work implications are discussed regarding this policy area. keywords: lgbt, marriage equality, older adults, same-sex marriage, voting behavior lesbian, gay, bisexual, and transgender (lgbt) older adults in the united states are estimated to number between 1.75 million and 4 million (administration on aging, n.d.), a sizeable population to be sure. this subpopulation is rich in historical knowledge with increasing demand for awareness and training that targets this underserved subpopulation (erdley, anklam, & reardon, 2014). scholarly literature on lgbt older adults is paltry; this lack of empirical data has been indicated as a crisis regarding sexual minority elders (brown & grossman, 2014). accordingly, few studies have investigated the lgbt and older adult social policy perspectives within this population. same-sex marriage, more recently referred to as marriage equality, emerged on the u.s. stage in 2003 when massachusetts made history by becoming the first commonwealth in the nation to legalize same-sex marriage, with the first of those marriages taking place in 2004 (goodridge v. department of public health, 2003). however, the lgbt community is not of one mind on this issue (lannutti, 2005). it is likely that views are split by, among other categories, age, much as ideas about heterosexual marriage are split along age lines in the heterosexual community (king & scott, 2005). marriage is typically the domain of young adults (under the age of 35) for whom it often is a rite of passage, compared with middle-age and older adults who have likely already married at least once (copen, daniels, vespa, & mosher, 2012). however, are we overlooking the importance that lgbt older adults place on marriage or, like their heterosexual counterparts, do lgbt older adults no longer consider it important, if they ever did? the purpose of this study is to compare the attitudes of older and younger lgbt cohorts regarding marriage equality. maccio et al./differences in attitudes toward marriage equality 429 literature review history of marriage equality the struggle for marriage equality has been around since the early 1970s (lewis & edelson, 2000), when at least three states, minnesota, kentucky, and washington, heard cases on it. the argument was the same as it is today, challenging the limitation of marriage as only that between a man and a woman, and asking for equal protection under the 14th amendment of the u.s. constitution (lewis & edelson, 2000). in 1993, the hawaii supreme court heard the case of baehr v. lewin in which the plaintiff, suing the state for refusing to issue a marriage license to her and her same-sex partner, cited sex and sexual orientation discrimination (lewis & edelson, 2000). after passing through the state supreme court, the trial court, and back, the supreme court of hawaii determined that the state was within its rights to limit marriage to different-sex couples (rimmerman, 2002). the year before the decision, the state legislature passed a constitutional amendment dictating the state’s right to limit marriage to that between a man and a woman. according to rimmerman (2002), although the law did allow domestic partnership benefits for same-sex couples, it strengthened the cause of those against marriage equality. while the marriage debate raged on, states were, in one form or another, legalizing same-sex relationships. hawaii was the first to legally recognize any kind of same-sex relationship (stein, 2012) with its passage of the reciprocal beneficiaries act in 1997 (burnette, 1998-1999), which provided some of the benefits afforded to married couples. vermont in 2000 was the first to legalize civil unions, and several other states followed suit (stein, 2012). during the 1990s, the united states saw further anti-gay and -lesbian legislation. the defense of marriage act (doma), which defined marriage as the union of one man and one woman and exempted states from being forced to recognize same-sex marriages performed in other states (defense of marriage act, 1996), was signed into law in 1996 by president bill clinton, despite his overwhelming support from the lgbt community in the 1992 presidential election (lewis & edelson, 2000; rimmerman, 2002). following in the footsteps of hawaii, over half of the united states enacted same-sex marriage limitations (lewis & edelson, 2000). by 1998, 98% of states had deliberated and 62% of states had approved measures barring same-sex marriage acknowledgment (haidermarkel, 2000). it was not until 1999 that the vermont supreme court decided in baker v. vermont that the state legislature was allowed to make decisions about gay and lesbian rights under the law (rimmerman, 2002), although it did not provide for the specific right of marriage. according to rimmerman (2002), conservative organizations, in response, lobbied against same-sex marriage recognition in neighboring states, such as new hampshire, and continued to work toward increasing the number of state bans. as much of a setback as these bans were to lgbt civil rights, they also exacted a toll on lgbt individuals psychologically. lgbt people living in states with proposed ballot measures to ban same-sex marriage in 2006 experienced greater levels of psychological distress and minority stress than did lgbt people living in states with no such ballot measures (rostosky, riggle, horne, & miller, 2009). repeated exposure to negative media advances in social work, fall 2014, 15(2) 430 campaigns and the heated public debates that ensued left lgbt people in colorado, idaho, south carolina, south dakota, tennessee, virginia, and wisconsin with greater negative affect and depressive symptoms. current state of marriage equality as of may 2014, the district of columbia and 18 states issued marriage licenses to same-sex couples (human rights campaign [hrc], 2014a). in contrast, 28 states have constitutional amendments banning same-sex marriage, and four states have laws that restrict marriage to a man and a woman (hrc, 2014b). in a major victory for proponents of marriage equality, the u.s. supreme court on june 26, 2013, rendered doma unconstitutional (united states vs. windsor, 2013). same-sex marriage statistics according to the u.s. census bureau, of the 116.7 million households in 2010 (lofquist, lugalia, o’connell, & feliz, 2012), approximately 0.55% were married (n = 131,729) or unmarried-partner (n = 514,735) households of same-sex couples (u.s. census bureau, 2011). gates, badgett, and ho (2008) reported that over 40% of same-sex couples have participated in some type of state sanctioned relationship recognition. however, marriage appears to be the preferred form of recognition, as only 10-12% of same-sex couples sought domestic partnerships or civil unions in the first year they were available; while in the first year of marriage equality, over one third of gay and lesbian couples married in massachusetts (gates et al., 2008). also, using data from the american community survey, gates et al. (2008) have shown that those seeking legal partnership status tend to be younger. this may be explained by the fact that lgbt older adults self-identified with the lgbt community later in life, while younger cohorts now self-identify as early as adolescence (muraco, leblanc, & russell, 2008). that is, when they were younger, lgbt older adults had coupled with same-sex partners long before same-sex marriage was available and either are not motivated to legalize those relationships or are no longer in them. other factors impacting marriage among lgbt older adults include the lack of role models within same-sex families during early development (muraco et al., 2008). attitudes marriage equality has been a contentious issue in united states domestic policy since its inception. while its prominence in the media may suggest universal support among lgbt adults, attitudes differ. for example, lesbians and gay men with greater internalized homophobia, less education, and lower rates of disclosure to their families have less favorable attitudes toward same-sex marriage (baiocco, argalia, & laghi, 2014). other studies have examined attitudes toward marriage equality based on whether or not an lgbt individual would marry if given the option. using data from an online poll of lgbt adults (egan & sherrill, 2005), approximately one quarter out of 748 participants who were surveyed would not choose to marry if it were legal. according to the services and advocacy for gay, lesbian, bisexual and transgender elders (sage) and the movement advancement project (map), the lack of marriage maccio et al./differences in attitudes toward marriage equality 431 equality has been identified as one challenge to healthy aging within the lgbt population (sage & map, 2010). specific obstacles include discrimination, legal inequalities, and dependence on chosen families, who are typically denied access to resources and privileges that legal and biological families are allowed (sage & map, 2010). in examining political participation and priorities, the hunter college poll (egan, edelman, & sherrill, 2008) revealed that protection from discrimination, both criminally and occupationally, was most important among those over age 65. younger lgbt adults consider marriage equality and parental/adoption rights to be the two most important; these issues were ranked only fifth and seventh, respectively, within the older adult population (egan et al., 2008). an earlier study (egan & sherrill, 2005) suggested that differences between the older and younger lgbt cohorts may be explained by the fact that the younger generation is less tolerant of relationship discrimination and has higher expectations of equality. this leads us to ask, then, with the rapid and numerous changes in relationship recognition, at both the state and federal levels, over the past 6 years (since egan et al.’s 2008 report), how does the issue of marriage equality, with its accompanying 1,138 benefits involving survivorship, taxation, retirement, and the like (shah, 2004), look to lgbt older adults now? methods design and sampling this survey research utilized a cross-sectional design, which was appropriate for the purpose of gathering demographic and descriptive data from a localized population never before sampled for a quality-of-life study. nonprobability sampling methods yielded 452 participants, 102 of whom were excluded for not meeting study eligibility requirements. thus, a final sample of 350 participants was used in the analysis. the sample was primarily white (84%), male (50%), and gay (47.1%), with a mean age of 37.1 years (sd = 13.16). complete demographic data can be found in table 1. survey the 53-item, quantitative and short-answer survey1 was developed collaboratively by graduate students in a service-learning course on social work with lgbt people and the board of directors of a local lgbt advocacy organization. for the purpose of this study, we looked exclusively at the survey’s two same-sex marriage items in regards to importance and legalization (e.g., “how important is it to you that same-sex marriage become legal in louisiana?”) and four of its political items in regards to voter registration, and political affiliation, influences, and awareness (e.g., “how aware are you of political issues and decisions regarding lgbt people?”). 1 this questionnaire can be made available to those who have interest in obtaining a copy by contacting the authors of this study. advances in social work, fall 2014, 15(2) 432 table 1. participant demographics (n = 350) characteristic n % m (sd) race european amer./white 294 84.0 african amer./black 28 8.0 hispanic/latino 7 2.0 biracial/multiracial 7 2.0 other 14 4.1 gender male 175 50.0 female 165 47.1 transgender 6 1.7 gender queer 4 1.1 age (18-82 years) 37.0 (13.16) sexual identity gay 165 47.1 lesbian 121 34.6 bisexual 29 8.3 queer 19 5.4 other 16 4.6 education high school/ged or less 15 4.3 some college 95 27.1 bachelor’s degree 100 28.6 some graduate 41 11.7 graduate degree 99 28.3 employment status employed full-time 212 60.6 unemployed 69 19.7 employed part-time 31 8.9 student 16 4.6 other 21 6.0 missing/invalid 1 0.3 household income $44,169 (41,125.7) relationship status partnered 147 42.0 single 179 51.1 married 14 4.0 separated/div./widowed 9 2.6 missing 1 0.3 maccio et al./differences in attitudes toward marriage equality 433 procedures the study was approved by the university’s institutional review board. lgbt individuals were invited to participate in a study on lgbt quality of life in a mid-size city in the deep south. individuals were eligible if they were at least 18 years of age and identified as lgbt or a related sexual identity (e.g., queer, questioning, same-sex attracted, etc.). they were excluded if they identified as heterosexual (and not also transgender) or acknowledged living outside the state. participants living outside the metropolitan area but within the state were retained to provide a broader perspective of quality of life across the state. the survey was offered in electronic and hard-copy formats; however, all participants completed the survey online. data analysis data were analyzed utilizing spss (version 21). descriptive statistics were used to summarize sample characteristics. chi-square was used for analyses with nominal and ordinal variables. to compare outcomes between younger versus older respondents, we dichotomized the sample according to age: those younger than 50 years (78.9%), and those 50 years and older (21.1%). because of the small number of participants in the 50+ age category, the response categories of some nominal and ordinal variables were collapsed. results the overwhelming majority (92.3%) of voting-eligible participants in the sample were registered voters, with more than half (54.9%) identifying as democrats. nearly two thirds (64.9%) reported being completely or somewhat aware of political issues and decisions affecting them as lgbt people. participants’ votes were influenced by social issues (74%) far and above any other factor. virtually all (95.4%) agreed or strongly agreed that samesex marriage should be legal, and 79.4% felt it was very or somewhat important to them personally. the sample was analyzed for its political involvement and awareness (see table 2), providing a context for similarities and differences between the age cohorts on the politically charged issue of same-sex marriage. younger and older lgbt cohorts did not differ in voter registration (χ2 = 3.311, df = 1, p = .069), political party affiliation (χ2 = 3.901, df = 3, p = .272), awareness of political issues and decisions regarding lgbt people in the greater metropolitan area (χ2 = 0.631, df = 2, p = .730), or voting on social issues (χ2 = 2.018, df = 1, p = .155). regarding the same-sex-marriage variables of interest (see table 3), a chi-square test of independence found a significant difference between younger and older lgbt adults on the importance of same-sex marriage (χ2 = 7.255, df = 2, p = .027). standardized residuals revealed a higher-than-expected count of lgbt older adults who find same-sex marriage somewhat or very unimportant. however, the same test found no significant difference on allowing same-sex couples to enter a legal union offering the same benefits of marriage (χ2 = 0.289, df = 2, p = .865). advances in social work, fall 2014, 15(2) 434 table 2. political involvement and awareness (n = 350) characteristic n % voter registration yes 323 92.3 no, eligible 18 5.1 no, not eligible 8 2.3 not sure 1 0.3 political party affiliation democrat 192 54.9 independent 67 19.1 none 38 10.9 republican 24 6.9 libertarian 13 3.7 other 14 4.0 missing 2 0.6 awareness of political issues and decisions regarding sexual orientation and gender identity completely unaware 23 6.6 somewhat unaware 63 18.0 neutral 36 10.3 somewhat aware 176 50.3 completely aware 51 14.6 vote influencer social issues 259 74.0 candidate 192 54.9 economy 175 50.0 political party 111 31.7 environment 92 26.3 race issues 39 11.1 religious issues 18 5.1 discussion this study examined attitudes toward same-sex marriage among younger and older lgbt adults. specifically, respondents were asked whether same-sex marriage should be legal and how important same-sex marriage was to them. the first question tapped into their global perceptions (i.e., should same-sex marriage be available in general), whereas the second question was more personal (i.e., does same-sex marriage matter to you personally). the issue of same-sex marriage is, among other things, a political one, so in order to gauge the nature of the sample’s overall involvement in the political process and investment in political issues, responses to the same-sex marriage variables are presented against a backdrop of the sample’s overall political awareness and involvement. that lgbt younger adults bear no significant difference from lgbt older adults in voter registration, party affiliation, political awareness, and voting on social issues suggests that the cohorts are more similar than different. statistically speaking, they are likeminded and relatively equally engaged and aware politically. maccio et al./differences in attitudes toward marriage equality 435 table 3. attitudes toward marriage equality (n = 350) characteristic n % importance of marriage equality very unimportant 44 12.6 somewhat unimportant 8 2.3 neutral 18 5.1 somewhat important 56 16.0 very important 222 63.4 not sure 1 0.3 missing 1 0.3 same-sex marriage should be legal strongly disagree 11 3.1 disagree 0 0.0 neutral 4 1.1 agree 23 6.6 strongly agree 311 88.9 missing 1 0.3 voter registration a gallup poll (gates & newport, 2012) found that three quarters (74%) of lgbt adults were registered to vote. nearly all voting-eligible participants in the present study were registered to vote. among them, similar rates of younger adults (93.7%) and older adults (98.6%) were registered to vote, whereas in the general population, 68.9% of younger adults (18-54 years) and 79.1% of older adults (55+) were registered (holder, 2006). party affiliation in singling out democratic, republican, and independent participants, our sample was more democratic (67.8%) and less republican (8.5%) than gallup’s (gates & newport, 2012) lgbt sample, which was 44% democratic and 13% republican. more than half (55%) of 18-34-year-olds in the general population identified as democrat, while 46% of those 35-64 and 48% of those 65 and older did (fisher, 2008). fisher (2008) reported that individuals 35-64 identified themselves as republican more (43%) than any other age group; only 35% of those 18-34 did so. unlike heterosexuals, lgbt younger and older adults may unite on social issues, particularly those that affect them as lgbt people (e.g., adoption, parenting, marriage, etc.), and may therefore find themselves more often on the same side of the political aisle. political awareness lgbt younger adults (64.1%) and their older counterparts (68.5%) do not differ significantly in being somewhat or completely aware of political issues and decisions regarding lgbt people in the local area. in a study to determine the environmental factors that increase awareness of ballot propositions (i.e., political awareness), nicholson (2003) reported civil liberties/rights as having the greatest impact, followed by media coverage. that virtually all lgbt political issues and decisions are about civil liberties and rights advances in social work, fall 2014, 15(2) 436 may explain, in part, the political awareness of nearly two thirds of our sample. there exist no empirical studies on the political awareness of lgbt individuals or of heterosexual individuals regarding lgbt issues. social issues voting researchers have noted voting influences ranging from voice pitch (tigue, borak, o’connor, schandl, & feinberg, 2012) to the economy (pew research center, 2012). in our sample, no other issue came as close to influencing the vote of either age group as did social issues. indeed, no other ballot measure is more motivating to any voter than one based on a social issue (biggers, 2011). social issues influenced the votes of lgbt younger adults (75.7%) slightly more than they did older (67.6%), although not significantly so. votes influenced by the candidate came in a distant second among both younger (54.3%) and older lgbt adults (56.8%), and votes were least influenced by religious issues (5.4% younger adults, 4.1% older adults). attitudes toward marriage equality legalization. as with lannutti’s (2005) mixed-age sample, the two lgbt age cohorts in the present sample agreed that same-sex couples should be allowed to be legally joined in a relationship that affords them the same rights, entitlements, and privileges as marriage, whatever it be called. however, whereas younger and older lgbt adults agree on legalizing same-sex marriage, younger and older heterosexual adults disagree. according to masci (as cited in becker & scheufele, 2011), 49% of young adults (< 30 years of age) favor same-sex marriage, whereas 65% of older adults (> 65) oppose it. these findings were echoed by becker (2012), who found millennials (ages 18-29) most supportive of same-sex marriage and the silent generation (65+) least supportive. perceived importance of marriage equality. although they agreed on legalization, younger and older lgbt adults disagreed on the institution’s importance. that is, older adults believe in legal recognition of relationships; they merely find that same-sex marriage is not for them. in fact, more older adults (6.8%) in the sample were already married compared to their younger counterparts (3.2%) and, coincidentally, more so to oppositesex partners (60%) than younger adults were (22.2%). more older adults (2.6%) were also separated, divorced, or widowed than were younger adults (1.1%). similar to our sample, more older adults (59.2%) in the general population are already married compared to their younger counterparts (43.1%) and were also separated, divorced, or widowed (33.7%) more than were younger adults (12.5%; u.s. census bureau, n.d.). in lannutti’s (2005) study of 288 lgbt individuals, younger participants recognized the importance of same-sex marriage as they grow older (e.g., making medical decisions, having access to a spouse’s health insurance), but this apparently did not immediately resonate with older adults in the present study. this could possibly be due to a generational difference in life experiences. indeed, children 10 years of age and younger have never been without marriage equality in at least one state in the u.s. even adolescents are unlikely to remember the time before marriage equality in this country. to underscore the generational point, today’s youth have very different expectations of themselves and others than did those before them (marzullo & herdt, 2011). maccio et al./differences in attitudes toward marriage equality 437 practice considerations our study revealed that although lgbt older adults support marriage equality on par with their younger counterparts, older adults find it not as important personally. personal preference about marriage aside, the lack of marriage equality has a significant impact on lgbt older adults of which this population may be unaware. for example, among baby boomers, lgbt individuals are more likely to be caregivers than those in the general population, and gay and bisexual men are more likely to be caregivers than their heterosexual counterparts (metlife, 2006). fewer resources may be available to caregivers who are not married to their dependent partners, including the family medical leave act, which protects only those couples who are married (u.s. department of labor, n.d.). until president obama urged the u.s. department of health and human services to initiate a policy to the contrary (obama, 2010), hospitals across the country could deny visitation to individuals whose same-sex partners were hospitalized. the new policy, implemented in 2010, applies to hospitals that receive medicare and medicaid dollars, and although most do, some do not. marriage equality would cover that gap, granting visitation to all couples regardless of the hospital’s participation in federal funding programs. in stein and bonuck’s (2001) survey of 575 lesbian, gay, and bisexual people ranging in age from 19-83, 72% reported familiarity with advance directives; however, only 38% had one. even among lgbt older adults, most (72%) had discussed advance directives with loved ones, but half (51%) had not actually prepared one (metlife, 2006). without an advance directive, the default surrogate-selection policies in some states will overlook the same-sex partner of an incapacitated or deceased individual in favor of those next in line, such as biological relatives (riggle, rostosky, prather, & hamrin, 2005). tax advantages and employee benefits (including death benefits) contribute to financial well-being among married partners, more so than among their unmarried counterparts; in turn, financial well-being becomes a significant contributor to physical and mental health (de vries, 2007). however, without marriage, surviving partners are left with estate taxes and other financial penalties following their partner’s death. moreover, surviving partners of unmarried same-sex couples are denied their deceased partners’ social security benefits (sugarman, 2008). surviving partners may be prevented from claiming their deceased partner’s remains and making funeral arrangements. this interferes with a critical component of grieving. for those lgbt older adults unable to marry their same-sex partners, this disenfranchised grief offers an additional layer of psychological distress uncommon among their heterosexual counterparts (mcnutt & yakushko, 2013). practitioners working with lgbt older adults presenting with custodial, legal, end-oflife, and related concerns should assess clients’ plans for themselves, their loved ones, and their estate in the event of their illness or death. it may be necessary to educate clients on their rights and responsibilities, rather than assume they already have this information, and present all available options for their consideration. knochel (2010) recommends a reciprocal beneficiary agreement, which extends to unmarried partners some of the same rights afforded married couples, such as the right to make medical decisions on a partner’s behalf and the right to inherit a deceased partner’s estate. until the issue of marriage advances in social work, fall 2014, 15(2) 438 equality is settled, practitioners must keep in mind the negative effect that anti-marriage equality campaigns and conversations can have on lgbt older adults (rostosky et al., 2009). negative reactions among lgbt individuals to these campaigns include fear, shock, and anger (russell, 2000). anti-gay politics, including said anti-marriage equality movements, contribute to a further deepening of disenfranchisement and psychological distress to this already marginalized group (lgbt older adults), which often leads to secrecy of loving, meaningful long-term relationships to avoid discrimination and ridicule (butler, 2004). the various types of difficulties and discrimination that can accompany the process of identifying as lesbian, gay, bisexual, or transgender often lead to psychosocial stressors within an individual’s life. given that a vast majority of lgbt individuals tend to seek out different forms of therapeutic treatment from mental health providers (haas et al., 2011), it is imperative that social workers are equipped with adequate knowledge and training before clinically treating this population. content focusing on lgbt individuals should be made mandatory within diversity and practice-related courses as opposed to solely within elective courses for social work students (martin et al., 2009). additionally, social work professionals should be responsible for commitment to attending annual, continuing education programs that contribute to their practice knowledge and sensitivity with lgbt issues (king, semlyn, killaspy, nazareth, & osbom, 2007). limitations a 2008 report by egan et al. stated that 20% of the lgbt adult population was 55 and older. our sample was slightly younger, with just 10.6% 55 and older. while egan et al. attribute the disproportionately low number to fewer lgbt older adults identifying as lgbt, we attribute our slim subsample to the potential inaccessibility of the online survey. as ubiquitous as computers have become, older adults lag behind younger age groups in access to and knowledge of computers (shapira, barak, & gal, 2007). with limited age and race representation in our sample, the results are not generalizable beyond a small segment of a population—a segment that is primarily white, young, and middle-class—in a mid-size city in the deep south. inviting participants using language such as lesbian, gay, bisexual, and transgender may have overlooked individuals who do not use those terms to identify themselves, particularly older adults (shankle, maxwell, katzman, & landers, 2003) and persons of color (millett, malebranche, mason, & spikes, 2005). additionally, many individuals within this population wish not to be aggregated as simply lgbt and prefer to be understood within their respective orientations (e.g., transgender aging persons; siverskog, 2014). securing adequate sample sizes to address this issue is difficult but, nonetheless, important for future research. further, the lack of standardization regarding the present study’s questionnaire is worth mentioning, as reliability and validity of the survey instrument are untested. summary this study aimed to compare attitudes of older versus younger lgbt individuals regarding marriage equality. older and younger lgbt cohorts did not significantly differ in voter registration, political party affiliation, awareness of lgbt political issues, or maccio et al./differences in attitudes toward marriage equality 439 voting on social issues. older lgbt adults were less likely to find same-sex marriage important. however, age cohorts did not differ significantly on marriage equality legalization. the future for social work researchers and practitioners working with older lgbt adults is looking brighter thanks to increased resources germane to this population, including the national resource center on lgbt aging (see meyer & johnston, 2014). we hope that, despite its limitations, this study adds to this brighter future by providing a snapshot of the marriage equality attitudes among younger and older lgbt adults. we believe that this study provides beneficial knowledge to social workers who practice with lgbt older adult clientele (individuals and families), and to social work educators who explore older, 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(n.d.). the family and medical leave act of 1993, as amended. retrieved from http://www.dol.gov/whd/fmla/fmlaamended.htm author note address correspondence to: scott e. wilks, phd, lmsw, john a. hartford faculty scholar in geriatric social work and associate professor, louisiana state university school of social work, 307 huey p. long field house, baton rouge, la 70803. email: swilks@lsu.edu microsoft word jensen-hart article final bb _____________ staci jensen-hart, msw, lcsw, acsw, is the director of the social work program in the department of sociology, social work, and criminal justice at idaho state university, pocatello, id. jeff christensen, bsw, student research assistant, is currently a graduate student in the counseling program at idaho state university. student research assistants, lacey dutka, lsw, and j. corey leishman, lsw, are now employed at the idaho department of health & welfare in child welfare. this research was supported by grant no. 1025 from the faculty research committee, idaho state university, pocatello, idaho. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 51-66 child parent relationship training (cprt): enhancing the parent-child relationships for military families staci j. jensen-hart jeff christensen lacey dutka j. corey leishman abstract: military families experience increased stress when facing issues of deployment, separation, and reunification. the increased stress impacts the parent-child relationship as well as child behavioral and emotional well-being. although recognizing the resiliency of military families, research points to the need to monitor parental stress both preand post-deployment and highlights the inherent risks that separation and reunification pose for the parent-child relationship bond. this pilot study was designed to explore the effectiveness of the child parent relationship therapy (cprt) training model as a proactive method of enhancing parent-child relationships, reducing parental stress, and preventing negative impact of military separations on children. keywords: child-parent relationships, filial therapy, military families introduction as growing numbers of children are affected by parental military deployment, it is essential that social workers implement effective practice methods to prevent negative impact on the parent-child relationship in military families. the impetus for this pilot study was the growing interest in providing on campus programming to address the needs of military families particularly as a number of military parents were attending the university. the purpose of the project was to contribute to expanding and refining the knowledge base in the field of social work with military families. given research findings supporting the effectiveness of child parent relationship therapy (cprt) training, groups based on this model were offered on campus for military families. specific research questions explored were: 1) does military parental participation in cprt impact the parent-child relationships, level of parental empathy and stress, and the adjustment of children to family stress and/or disruption? 2) what adaptations can be made in the recommended cprt ten-week model in order to meet the needs of military families on campus? 3) what are the specific challenges in maintaining and enhancing the parentchild relationship for military families on campus? advances in social work, spring 2012, 13(1) 52 literature review strengths and needs within the military family military families exhibit unique strengths but also face unique challenges (cozza, chun, & polo, 2005). military families experience increased amounts of stress in confronting issues of anticipated deployment, resulting separation, and post-deployment reunion (packman, paone, lebeauf, smaby, & lepkowski, 2006; palmer, 2008; rotter & boveja, 1999). although recognizing the resiliency of military families, research also points to the need to monitor parental stress both preand post-deployment and highlights the inherent risks that separation and reunification pose for the parent-child relationship bond. flake, davis, johnson, & middleton (2009) found that the most significant predictor of child psychosocial functioning during military deployment was parental stress. the impact on children of wartime separations depends largely on the remaining caregiver’s ability to respond to the needs of the child (yeary, 2007). the heightened stress often experienced by nondeployed spouses can impact children who may sense the tension within the family household. studies have raised concerns regarding the increased prevalence for children, ages three through five with a deployed parent, to exhibit symptoms of behavioral problems (chartrand, frank, white, & shope, 2008). in studies looking at child abuse, researchers have found that the most common predictors of child abuse potential among military parents were parental depression, parental distress, and family conflict (schaeffer, alexander, bethke, & kretz, 2005). for military personnel experiencing post-traumatic stress disorder (ptsd), the children may be at greater risk due to negative parent-child interaction related to the impact of parental ptsd on parenting skills, attachment, hostility, and violence (palmer, 2008). the increased use of national guard and reserve units in current conflicts has led researchers to consider the possible differences in stressors experienced by these families as contrasted with active military families (vogt, samper, king, king, & martin, 2008). for active military families, deployment may be considered a developmental or “normative” crisis as serving in a war effort is part of the job (chapin, 2011, p. 528). in contrast, reserve members hold civilian jobs and families are integrated to a lesser degree into military life and military support systems. in addition, national guard/reserve members tend to receive different training and typically experience fewer separations (vogt, et al., 2008). the literature urges researchers and practitioners to look for effective practice methods to help military families positively negotiate the challenges posed by family disruption (chartrand, et al., 2008; everson & figley, 2011; packman, et al., 2006; palmer, 2008). palmer (2008) encourages practitioners and researchers to consider utilizing a theoretical pathway that assesses risk and resiliency factors in order to assist in addressing the unique needs for military families. such a theoretical pathway suggests the effects of military life on child outcomes may follow an indirect path, involving parental stress and psychopathology, rather than military life itself directly negatively affecting children of military parents. treatment implications in adhering to such a model include increasing support during times of intensified stress in an effort to ameliorate negative effects. since the parent-child relationship serves as the mechanism by which risk and jensen-hart, christensen, dutka, leishman/cprt with military families 53   resiliency factors impact military children, the interaction between parents and children is a key issue in military children’s well-being (palmer, 2008). increased parental functioning leads to better child outcomes. research indicates that coping, parenting skills, and parent-child relationships may be important foci of resiliency-based interventions (palmer, 2008). the child parent relationship therapy (cprt) training model consistent with this theoretical pathway, the child parent relationship therapy (cprt) training group offers a strengths-based model to build resiliency while at the same time addressing risk factors associated with parental stress during the deployment cycle. cprt may be considered a type of inoculation in building resiliency as learning is focused on developing positive interactions and parenting skills which parents can utilize now and in the future to continue building positive relationships with their children. the child parent relationship therapy (cprt) training model is a well-established, evidence-based program designed to improve parent-child relationships (landreth & bratton, 2006). the foundational elements of cprt were established in the filial therapy treatment model designed by bernard and louise guerney in 1967. filial therapy is a therapeutic approach utilized by trained play therapy professionals who, in turn, train parents to be therapeutic agents with their own children (landreth & bratton, 2006). in 1991, landreth proposed a ten session filial therapy model called child parent relationship therapy (cprt) training. the cprt process entails both didactic and group process components offered in the context of a safe, supportive environment that encourages parents to explore feelings, attitudes, and perceptions of themselves, their children, and parenting (landreth & bratton, 2006). cprt offers parents the opportunity to learn how to create a nonjudgmental, accepting environment that enhances the parentchild relationship and facilitates personal growth and change for both child and parent. through group training and structured play sessions with their children, parents learn basic child-centered play therapy skills, such as reflective listening, recognizing, and responding to children’s feelings, therapeutic limit-setting, and building children’s selfesteem. in an age of precarious funding for social services and mental health programming, cprt training teaches enduring relationship skills to parents, thus empowering them to become therapeutic agents with their own children and effecting long-term positive change. cprt is one of the more well-researched treatment models within the field of child psychotherapy. in 33 studies involving over 800 subjects, the efficacy of this treatment methodology supports its usefulness with a variety of issues and with diverse populations (landreth & bratton, 2006). research demonstrates that the cprt model, drawn from filial therapy principles, has had positive impacts with populations in several settings including fathers incarcerated in prison (landreth & lobaugh, 1998), mothers incarcerated in jail (harris & landreth, 1997), and single parents (bratton & crane, 2003). in addition, a descriptive report of utilizing the cprt as a practice method specifically for military families supports its effectiveness (packman, et. al, 2006). advances in social work, spring 2012, 13(1) 54 relationship to social work theoretical foundations the ecological approach, a foundational theoretical framework utilized within the field of social work, considers the person in the environment. social workers operate upon the premise of considering the impact of interactions between systems, including family, job, living environment, and school. social workers strive to advocate for prevention and provide services which mitigate negative system impact for vulnerable populations. thus, research looks at a vulnerable family system in response to its environment and seeks to alleviate sources of tension within the system and the environment, thus improving the family’s overall well-being. social work also relies on the strengths perspective which focuses on seeking opportunities to build resiliency. the ecological systems and strengths perspectives are helpful in understanding resiliency of military families as a dynamic process that is influenced by new challenges, strengths, opportunities, vulnerabilities, and new competencies (saltzman, lester, beardslee, layne, woodward, & nash, 2011). the resiliency of military families may be influenced by the degree of family and community social support, developmental stages of children, strength of marital relationship, and other current dynamics within the system. repeated deployments may influence the system by either leading to new competencies or increased stress upon the system. methods this project utilized qualitative research methods. data collection strategies included observations of participant activity in group sessions as well as videotapes of parent-child interactions, interviews in the form of a focus group, and thematic coding of process notes taken by the primary researcher, student research assistants, and participant weekly written feedback of sessions. thus, trustworthiness and credibility of qualitative data were enhanced through observer and data triangulation in that several perspectives were compared in order to accurately represent data collected from different sources (padgett, 2008). data analysis was conducted by the lead researcher and student assistants. patterns in participant comments were determined by the three student assistants and lead researcher which enhanced validity. overall themes consistent in multiple data sources were coded by the lead researcher and corroborated through patterns identified in research assistant notes. in researching the feasibility of this project, the need for immediacy and flexibility in group formats was identified because military family life is often unpredictable given immediate deployment and relocation issues. thus, in addition to exploring the impact of cprt for military families, this pilot project also sought to determine effective procedural methods in delivering the cprt material for military families on a university campus. the cprt model calls for a ten-session intervention format. however, adaptations to the model may be necessary for military families in order to respond to the immediacy needs of this population. the literature provides some support in adapting the filial therapy model and cprt specifically in response to client needs. for instance, a five-week, bi-weekly session model was utilized with incarcerated mothers (harris & landreth, 1997). in another study, a three-week, twelve session intensive model was used with parents and children living in a domestic violence shelter (smith, 2000). jang (2000) jensen-hart, christensen, dutka, leishman/cprt with military families 55   reported on a condensed version of cprt that utilized a four-week, eight session model for korean parents and demonstrated improvements in enhancing parent-child relationships. since challenges in terms of time and schedule exist for military families, in this project three different formats were offered to participants: a ten-week group format for 1.5 hours each session, a five-week format with condensed material for two hours per session, and a brief three-session format with condensed material for three hours per session. because of these adaptations, fidelity to the recommended ten-week cprt model was not present. however, central cprt skills consistent with the foundational model of filial therapy were taught and practiced in each of these session formats. the essential skills which have been consistently supported by literature and were covered in the sessions included structuring play time to support relationship building, empathic listening, encouraging imaginative play, and limit-setting. chawla and solina-saunders (2011) reviewed the literature on the effects of deployment on child well-being and the parent-child relationship as well as major parent-child interventions and subsequently provided a rationale for the use of filial therapy with military families (p. 179). in addition to session content teaching cprt skills, focus group discussion also occurred during the last session with participants in order to evaluate perceptions of needs for military families within the community and the effectiveness of the project. it was hoped that 25 participants would be recruited for participation. however, after extensive recruitment efforts detailed below, only seven participants completed the sessions. procedures the principle investigator has a background as a clinical social worker with twenty years of experience working with children and families including training in play therapy as well as specific training in the cprt model. the principle investigator had started and sustained successful groups in response to client and community needs throughout her practice career. professional training in play therapy skills is necessary for primary facilitators in order to implement this group model. in assessing the need for this project and to ensure services were not being duplicated, several interviews were conducted with key personnel on the university campus including the director of the veteran’s sanctuary program, the student counseling center, and the psychology department. it was determined that given the number of veterans on campus and few existing resources for parents and children that the group may serve an important need especially since the local national guard was set to deploy within the year. during month one of the research grant period, materials were ordered and prepared. the cprt resource book and parenting manual (bratton, landreth, kellam, & blackard, 2006) were procured along with recommended videos and play kit toys. student research assistants were hired during month two of the project. in order to find research assistants, the principle investigator garnered names of junior and senior social work students who were recommended by past professors as students who held excellent beginning advances in social work, spring 2012, 13(1) 56 interview skills and good oral and written communication skills. e-mails were sent to this list of recommended students inviting them to contact the principle investigator if they were interested in the project. grant funding allowed for hourly reimbursement of research assistant time. three students indicated interest in the project and requested an interview. the interview consisted of questions regarding student interest, skills, and experience as well as information regarding the project details and expectations. the three students, one female and two males, who interviewed were selected as research assistants. the female student had personal active duty military experience in the army. she had been deployed to baghdad twice. her skills and experience were invaluable in recruiting participants, educating research staff as to proper terminology, and establishing initial rapport with participants. one of the male students’ fathers had served in the military in vietnam. the third male research assistant did not have personal military experience but held great respect for those serving in the military and was a father of three children. thus, the research team brought individual strengths which when combined provided a valuable base of experience needed to work with this type of group and population. training of research assistants also started during month two. assistants were trained in research ethics, the cprt model, and assessment/evaluation tools. six training meetings were held for two hours per meeting. assistants completed readings regarding the cprt model, articles, and ethics. recruitment of group participants also began. recruitment at this stage involved contacts with the university veteran’s sanctuary coordinator, university counseling center therapists, rotc and military science programs, officers in the veteran’s club, and community agencies serving veterans and military families including the family assistance center, county benefits, and va vocational rehabilitation. in community contacts, it was discovered that the local guard unit was set to be deployed during the first month in which groups were planned to start. thus, attempts were made to offer the group earlier in order to be available to guard members prior to deployment. although guard members facing deployment did not sign up, word about the groups spread and once the guard was deployed, their spouses made up the majority of participants in the cprt groups offered. additional recruitment efforts included posting flyers around campus and visibility of a booth at the community military appreciation day. a display was set up with group information which allowed military members and spouses to stop by the table and ask questions. the groups were offered free of charge and included materials at no cost. after initial recruitment did not result in great numbers, additional incentive was added through offering optional course credit and babysitting services. parents who took advantage of the babysitting signed a liability release form and volunteers from the student social work association provided services in an adjacent classroom to where parent sessions were held. jensen-hart, christensen, dutka, leishman/cprt with military families 57   participant description a total of seven (n=7) participants, six female and one male, participated in the groups. five of the females were currently spouses of deployed national guard members (n=4) or army (n=1). one of these females was also a veteran and had been previously deployed. another female (n=1) was active military and had recently returned from overseas deployment. the male (n=1) was military and had returned from deployment within the last two years. all participants were caucasian. participants were informed that the group was offered as a pilot research project and that the recommended tensession cprt model was being condensed in an attempt to explore different formats which may meet the needs of military families. the ten-week group was first offered in october. due to few participants, the start date was held off for two weeks in hopes of gathering more participants. several parties called but were more interested in the five-week format because of child care difficulties and travel distance. thus, the ten-week model was delivered as an eight-session format for 1.5 hours each session with one participant actively engaged. the participant was the wife of a national guard deployed member. this participant had two children, ages three (3) years and ten (10) months. the child of focus was the three year old female. child care was provided for these sessions. parent and child taping were completed on two occasions as pre/post evaluation. mother attended six of the eight sessions due to child illness and being out of town visiting her husband prior to overseas deployment. content was made up during subsequent sessions and was achievable because she was the only participant. the principle investigator and one student research assistant worked with this individual. although skills were able to be taught, the true nature of a group with involves social support was not able to be realized. the five-session format had five participants. two participants attended all five groups. three of the participants attended four of the sessions as one session overlapped with visits to deployed husbands prior to going overseas. the male participant had one female child, age eighteen (18) months. the active duty veteran female participant had one female child, age five (5) years. the other three participants were wives of deployed national guard members. one of these participants had two male children, ages three (3) years and sixteen (16) months with the three year old being the child of focus. another had one male child, age eighteen (18) months and a stepdaughter, age eight (8). the third had one female child, age three (3) years. two student research assistants helped the principle investigator facilitate this group. research assistants and other student volunteers took turns providing babysitting services on the premises. the three session format ended up with one participant. several additional people had indicated interest by signing up for the group but did not actually attend sessions because child care was not available for this group. the female participant had been active military with two deployments. her husband was currently deployed. she had two male children, ages three (3) years and eight (8) months. the child of focus was three years old. the principle investigator and one of the students facilitated these sessions. sessions were held on the main campus or a satellite campus location within a conference room or small classroom setting. video equipment and a play room were advances in social work, spring 2012, 13(1) 58 available for participant use in taping play sessions. several parents opted to tape sessions at home for convenience and less disruption for their child. these videotapes were shared with facilitators as well as group participants during group sessions. the cprt curriculum material (bratton, et al., 2006) was compacted through focus on skills in manual sessions one through six with brief review of skills detailed in subsequent sessions. as indicated in the initial research questions regarding adaptations for military families, specific information pertinent to military family needs such as an overall understanding of the potential impact of separations, unique stressors, and ways to maintain contact between child and active duty parent was included as an educational component in group sessions. it should be noted that this additional information deviated from the traditional cprt curriculum. for participants with children under age two, play session length, and toy content was modified for developmental appropriateness. parents were informed that the model addressed needs of children ages 2 through 10 years. although not substantiated by research on the cprt model, parental pre-learning of skills and relationship development may be considered a preventative approach. participants completed session feedback sheets following each session by writing answers to questions regarding what was most helpful, least helpful and suggestions. per model, play sessions were recorded and viewed in the group so that facilitators and group members could provide feedback, particularly focused on strengths. student research assistants and the principle investigator completed process notes regarding training procedure, recruitment, and session participation. finally a semi-structured interview guide was used to conduct focus groups regarding assessment of needs of military families and impact of group model participation at the completion of groups. following the completion of all sessions, the research team met for verbal processing regarding weaknesses and strengths of the groups and research process. results and discussion intake concerns of participants participants expressed concerns for their children at the beginning of group sessions including emotional expression, i.e., temper tantrums, yelling, hitting, screaming, no expression of feelings, (n=5), school behavior problems (n=1), sleep difficulties, i.e., nightmares, not going to bed, (n=2), and not feeling connected with child (n=1). student notes from the first session corroborate these expressed concerns: during the first session group members talked about the concerns they have with parenting…transitioning, worries about spoiling child while father is deployed, kids always want attention, school behavior and attachment issues from previous deployment. themes of improvement understanding child’s strengths and interests. the cprt curriculum encourages parents to focus on their child’s strengths. in doing so, participants gleaned new understanding about their own child’s personality. one mother delighted in her focused jensen-hart, christensen, dutka, leishman/cprt with military families 59   observations during home play sessions, “(my child) loves being in charge. (she) loves to flutter; very imaginative. (she) tells stories with the toys. (it’s) a real joy when not having to “mom” her. she loves her (play) time with mommy that is different.” other parents commented on seeing their child’s enjoyment in play, “(my) son loved the attention he received during the play session.” “(i) learned about myself as parent… (i) want to do play time more often because she (my child) loves it.” parents of children younger than two learned to consider their child’s developmental stage in play. one parent “improvised and had less structure of session.” another entered play with her 18 month old son with the expectation that sessions would be shorter (5 to 10 minutes) to accommodate for his developmental age. once the child appeared to lose interest, she would end the play session. imaginative play. three parents noted that their child’s imagination and general play outside of “special play times” were encouraged by participation in the cprt group. a student research assistant observed in a videotaped play session: i was able to see with her how she (the 3 year old child) was not only able to use her imagination but by mom reflecting it back on her, she was encouraged to use her imagination…anyways the little girl had picked up a pair of handcuffs and asked her mom what they were for. mom responded ‘what do you think they are’. the little girl used them to pick things up like a claw. it was one of those moments when you’re like ‘oh i see now how that works.’ process notes from the second session of the five-week format indicated that parents commented positively on their child’s imagination in structured play sessions at home. the children appeared to love the attention and became more talkative. the participant in the three-session format noted, “(my) child is asking for me to play more instead of demanding attention… recognizes he is noticed-not wanting to watch tv as much-wants to play even if i’m not playing.” use of relationship-building skills and generalization. skills which parents learned in the first session began to generalize to time outside of play sessions. the 30-second burst of attention (bratton, et al., 2006) was particularly helpful to parents. when using the 30-second burst of attention, parents stop what they are doing in response to a child initiating needs for attention. the parent turns to face child, makes eye contact, listens, and reflects. parents find that within 30-seconds the child’s needs have most often been met. one mother noted that the frequency of temper tantrums decreased almost immediately through using reflection, the 30-second burst of attention, and choice giving. another mother commented that she is thinking more about her response, rather than impulsively reacting, when the child is mean to his little brother. generalization of skills seemed to be related to parent personality and stress level as well as the number of sessions overall which the parent attended as indicated by student notes, “after the first session the little girl looked forward to coming to the school and couldn’t wait for her playtime with mom. mom also was very positive about the program and came prepared every week and was very involved.” in contrast, this student noted, advances in social work, spring 2012, 13(1) 60 “the mom in the other group was not nearly as energetic and seemed to be under a great deal of stress.” another student progress note points to skill development: by the time we were done with this group (8-session) the mom was an old pro. she picked up the concepts so well and was able to implement them into their play sessions extremely well. she was always so fun and positive about what she was learning and told us several times that she thought the group was a great asset to her and her daughter. in addition student research assistants were able to observe increased use of skill in the videotaped play sessions, “i also was able to see the progress made by the participants from one (session) to the next. it was easy to see the improvements and the increased use of what was taught after they had had the time to practice in between taping.” the cprt curriculum also encourages focus on parent strengths which tends to increase parental confidence and further motivates using the skills as student notes indicate, “one participant’s child just cried the whole time on the video, but it was good to see how the parent comforted the child and just held her until she felt better. it was a good teaching moment because the parent was concerned that it was a total failure.” another student observed the growing confidence of parents: i enjoyed seeing the progress that the participants made with each of their children as the sessions progressed. in the beginning session, the participants seemed uneasy, and i don’t think they were prepared enough to start doing the play sessions as quickly as we had them do it. as the sessions went on and the participants grasped the concepts better, they were able to improve their play sessions and also their relationships with their children. i liked seeing how at first the participants were awkward in their play sessions, and then towards the end they were comfortable and were able to more fully interact with the children. during focus group sessions, parents made the following comments regarding the impact participation in cprt had on their parent-child relationship: “(the group) has made a huge impact and has given me tools needed to continue building relationships in the future.” “i am communicating with her instead of at her.” “it has been positive…i have more insights into myself and my kids.” behavioral issues. parents noted that behavioral issues which had been of concern demonstrated improvement as indicated in focus group comments regarding the impact of utilizing skills learned in cprt on their parent-child relationship. one parent noted, “behavior better with child…more open and willing to talk about feelings.” student observation notes indicate similar improvement: the participants are starting to get closer to their children through these play sessions and one parent expressed how she has been getting more information from the child as to behavioral problems at school. this therapy is starting to show its worth and benefits to the participants. jensen-hart, christensen, dutka, leishman/cprt with military families 61   format preferences although the five-week and three-week condensed formats initially appeared more attractive to participants because the shorter duration was conducive to family time needs, these formats did not provide participants the depth of skill level and practice necessary. participants expressed that they wished they had done the longer group. student research assistants noted that the shorter duration also did not provide enough group time to establish solid rapport with participants. although offering child care increased participation, it was a challenge due to physical space limitations, inconvenient bathroom set-up, and sessions being too long and too late at night for children. such a need for childcare, however, highlights the needs identified of military families for support. participants were concerned about burning out family members and friends so did not want to ask them to babysit. student research notes are consistent with focus group feedback: five week sessions were too short and did not give them enough time to practice and develop the skills learned. the two hour sessions were too long; 1.5 hours suggested instead. most thought they would prefer a 10-week group. the fiveweek group was preferable for participant who had to travel long distance. thus, the session format tended to be the primary concern with parents feeling like the five and three session trainings contained too much information with not enough practice time in between sessions to fully integrate the skills. challenges of military life participant comments in this pilot project support literature findings regarding common stressors for military families such as incomplete understanding of the impact of deployment, impaired family communication, and impaired parenting (saltzman et al., 2011). not knowing; uncertainty. participants shared insights into the challenges of military life including unpredictability, “(i) didn’t expect him to be deployed when married.” in addition, participants expressed concern about how separations would impact their children as indicated by the following parent comments: “will issues come out—if so, what do i do?” “not knowing how or when kids will react. not sure how future will play out; general uncertainty.” “military thing is unexpected-not planned.” parents also noted concerns that other people sometimes carried a “misunderstanding of what service member is doing.” parenting concerns regarding balance of discipline. parents expressed concerns regarding the difficulty in achieving a healthy balance in discipline. one parent who had lived on a military base said, “after living on base i was concerned that some families ‘had it together’…this is the way it is…and other families overcompensated and gave way too much...spoiled…military brats.” another stated she “worries about kids becoming ‘army brats’; finding balance between too harsh and too lenient.” advances in social work, spring 2012, 13(1) 62 students also noted these concerns in research notes: everyone in the group agreed that juggling obligations will be one of the specific challenges faced when trying to maintain the skills used and live a military lifestyle. the male participant said he has anxiety which interferes with the amount of time and energy that he can focus on his daughter. adjustment issues including maintaining connection with child when deployed. the focus group discussions provided insight into challenges and adjustments required of military families particularly in maintaining a positive relationship with their children. comments from parents reflect these concerns: “(i) am short-tempered; react too quickly—react instead of think through things so catching self better.” “(i have a) hectic schedule…adjustment to ‘single’ parenting.” regardless of whether a parent works at home or outside of the home, deployment created stress as indicated by parent comments: “a stay-at-home parent has no break.” “when i work, i have no time or energy.” parents pointed out concerns about maintaining connections between children and deployed parents who are overseas. for instance, one parent said, “(i am) concerned about kids relationship with their father (who is away). how strong or weak relationship will be because of absences.” several mentioned concerns about the separation and resulting impact on relationship. reintegration also posed difficulties as one parent described, “homecomings-reintegration with everyone is challenging and an adjustment… (kids are at) different developmental stages when return.” parents discussed difficulties in maintaining connections due to time differences. for instance, young children may often be in bed when the deployed spouse is able to telephone. parents shared ideas on particular needs that they and their family have now as a result of involvement in the military. parents agreed that support and help in practical ways such as childcare and home maintenance were needed. parents felt they had little time for themselves and were reluctant to ask others for help too often. they also felt the need to release anxiety through exercise or being able to talk about personal and emotional needs with friends. needs cprt could address from these voiced challenges. techniques within the cprt curriculum which were particularly helpful as voiced by parents within this pilot study include reflective responding, structuring play sessions, limit-setting, and choicegiving. cprt can be of assistance to military families in coping with the challenge of uncertainty of military life as noted by student research assistant notes: the techniques and skills used in the cprt sessions seem to be really valuable, and i think it can be a beneficial part of helping military families transition. the members of the group seemed to express this also. several members said that their child/parent relationships have progressed since the beginning of the group. jensen-hart, christensen, dutka, leishman/cprt with military families 63   everson and figley (2011) note the importance of nondeployed spouses in considering the role of the family and spouses in maintaining morale and mental focus of military family members. additional factors highlighted in their research include the potential impact of multiple deployments on family stress as well as the acculturation process that must take place within military families in terms of learning a new language, adjusting after relocation, and required adaptations within the deployment cycle. learning proactive parenting skills such as those taught in filial therapy and cprt may assist military families in making healthy system adjustments in times of stress and change (chawla & solinas-saunders, 2011). although distinct issues may arise for active military families and national guard/reserve families, the unique needs of military families overall were considered in this pilot project. for instance, military toys and figures were included in the toy kits. awareness of the challenges faced by military families and the culture were essential to integrate as indicated by student notes, “(the lead facilitator) integrated military thinking in with the session handouts. i think this was a nice touch to the group session and helped the group members relate more with one another.” session evaluations by participants indicated that it was helpful to learn more about play and particular skills such as letting the child lead in play, the whisper technique, limit setting and giving choices. participants found the open discussion and conversation with other participants helpful in releasing concerns and frustration. three parents also commented on the benefit of viewing the videotapes of self and others as being a way to identify their own strengths as well as learn from others. student notes corroborate participant feedback, “i think the parents that participated in the group process had a strong desire to improve or change some aspects of the way they parented. as a free service, i think it was valuable to the participants.” another student wrote, “all the participants agreed that their participation in cprt has helped them to have more insight in to the relationships with their children.” conclusion due to the nature of a pilot study and low participant numbers, generalization of the findings is limited. the condensed trainings were limited in effectiveness due to the short amount of time to develop the group process, teach skills, and engage in practice play sessions. in addition, compacting curriculum compromised the breadth and depth of skill training offered by the cprt model. separating researcher and practitioner roles of the primary investigator/facilitator was challenging. to mitigate this challenge, student research assistants were primarily responsible for gathering data by taking session notes and reviewing initial participant feedback. despite the limitations, this study adds to the literature by demonstrating the potential of positive benefits to military family participants in the use of filial therapy constructs and the cprt model. insights offered by student research assistants and participants indicate the potential effectiveness of utilizing the child parent relationship therapy (cprt) training model with military families. parents participating in the sessions noted a sense of increased efficacy in utilizing proactive parenting skills as well as decreased advances in social work, spring 2012, 13(1) 64 emotional and behavioral concerns for their children. parents were able to identify characteristics about their children and their strengths which they had not noticed previously which may enhance parental empathy. building positive parenting skills and enhanced relationships through play can assist in reducing family stress throughout the deployment cycle. parents who participated in the five-session format benefited from having the opportunity to share concerns and ideas with other parents in a group setting. the two parents who engaged in individual sessions still reported benefits of learning the skills and having the special play time with their children. benefits reported in this pilot study are consistent with other research demonstrating the efficacy of the cprt model. recent literature has supported the findings in this pilot study. family-centered care, particularly in the form of resiliency training for families, has increasingly become a priority of the military health system (saltzman et al., 2011). chawla and solinas-saunders (2011) offer an extensive literature review which provides a rationale for the use of filial therapy with military parents and children. the idea of offering the course for university credit as a ten-week course appears to be promising for military and veteran family members on campus. conducting such groups on campus through social work programs may contribute opportunity for student learning through involvement in research and group processes as well as be of benefit to military families within the community or on campus. further research on the implementation of the cprt model with military families is warranted. suggestions for further study include research utilizing a larger sample size, pre/post measures, fidelity to the ten-week cprt model, longitudinal study information, and comparison of the model effectiveness for active military families and national guard/reserve families. references bratton, s., & crane, j. (2003). filial/family play therapy with single parents. in: r. van fleet & l.f. guerney. (eds). casebook of filial therapy (139-162). boiling spring, pa: play therapy press. bratton, s., landreth, g., kellam, t., & blackard, s. (2006). child parent relationship therapy(cprt) treatment manual: a 10-session filial therapy model for training parents. new york, ny: routledge. chapin, m. (2011). family resilience and the fortunes of war. social work in health care, 50, 527-542. chartrand, m, frank, d, white, l., & shope, t. (2008). effect of parents' wartime deployment on the behavior of young children in military families. archives of pediatrics and adolescent medicine, 162(11), 1009-1014. chawla, n., & solinas-saunders, m. (2011). supporting military parent and child adjustment to deployments and separations with filial therapy. the american journal of family therapy, 39, 179-192. jensen-hart, christensen, dutka, leishman/cprt with military families 65   cozza, s., chun, r., & polo, j. (2005). military families and children during operation iraqi freedom. psychiatric quarterly, 76(4), 371-378. everson, r. b., & figley, c. (eds.). (2011). families under fire: systemic therapy with military families. new york: routledge. flake, e., davis, b., johnson, p., & middleton, l. (2009). the psychosocial effects of deployment on military children. journal of developmental and behavioral pediatrics, 30(4), 271-278. harris, a., & landreth, g. (1997). filial therapy with incarcerated mothers: a five week model. international journal of play therapy, 6(2), 53-73. jang, m. (2000). effectiveness of filial therapy for korean parents. international journal of play therapy, 9(2), 39-56. landreth, g., & bratton, s. (2006). child parent relationship therapy (cprt). new york: routledge. landreth, g., & lobaugh, a. (1998). filial therapy with incarcerated fathers: effects on parental acceptance of child, parental stress, and child adjustment. journal of counseling and development, 76, 157-165. packman, j., paone, t., lebeauf, i., smaby, m., & lepkowski, w. (2006). when a parent gets deployed: helping military families deal with stress. vistas: compelling perspectives on counseling 2006. alexandria, va: american counseling association. padgett, d. (2008). qualitative methods in social work research. thousand oaks, ca: sage publications. palmer, c. (2008). a theory of risk and resilience factors in military families. military psychology, 20, 205-217. rotter, j., & boveja, m. (1999). counseling military families. the family journal, 7 (4), 379-382. saltzman, w., lester, p., beardslee, w., layne, c., woodward, k., & nash, w. (2011). mechanisms of risk and resilience in military families: theoretical and empirical basis of a family-focused resilience enhancement program. clinical child and family psychological review, 14, 213-230. schaeffer, c., alexander, p., bethke, k., & kretz, l. (2005). predictors of child abuse potential among military parents: comparing mothers and fathers. journal of family violence, 20(2), 123-129. smith, n. (2000). a comparative analysis of intensive filial therapy, intensive individual play therapy, and intensive sibling group play therapy with child witnesses of domestic violence (doctoral dissertation, university of north texas, 2000). dissertation abstracts international, a 62 (07), 2353. advances in social work, spring 2012, 13(1) 66 vogt, d., samper, r., king, d., king, l., & martin, j. (2008). deployment stressors and posttraumatic stress symptomatology: comparing active duty and national guard/reserve personnel from gulf war i. journal of traumatic stress, 21(1), 66-74. yeary, j. (2007). operation parenting edge: promoting resiliency through prevention. zero to three, 27(6), 7-12. author’s note: address correspondence to: staci j. jensen-hart, msw, lcsw, acsw, department of sociology, social work, and criminal justice, idaho state university, 921 south 8th avenue, mail stop 8114, pocatello, id 83209. e-mail: hartstac@isu.edu microsoft word 7-3766 cordero_negroni_leadership development final ______________ antonia elizabeth cordero, ph.d., and lirio k. negroni, ph.d., are associate professors in the school of social work at the university of connecticut in west hartford. the authors would like to acknowledge the university of connecticut school of social work students, alumni, faculty, and the greater hartford connecticut latino community for their invaluable contributions to the puerto rican/latino studies project. copyright © 2013 advances in social work vol. 14 no. 1 (spring 2013), 102-124   leadership development for latino community emancipation: an integrative approach in social work education antonia elizabeth cordero lirio k. negroni abstract: a primary goal of the social work profession is social justice advocacy for disenfranchised and oppressed communities such as the latino community. in the context of this paper, leadership development for community emancipation relates to efforts that foster indigenous community leadership designed to procure political rights or equality for their disenfranchised or devalued populations. the paper reviews the literature on latino/a leadership perspectives, leadership development trends, and best practices that serve as a compatible integrative latino/a approach. the approach proposes that the process of latino/a leadership development should be collective, culturally attuned, transformative, and community emancipatory. the authors present a model for students, alumni, and faculty that incorporates the approach through the use of three components: (1) sustained institutional commitment, support, and resources; (2) creation of leadership opportunities, mentoring, and modeling; and (3) leadership efforts that foster community emancipation. the approach has been successfully employed for over 30 years in a latino project at a new england school of social work. discussion of the model’s components, a case scenario, considerations for replication of the approach, and future research will be offered. keywords: latinos/as, leadership development, community emancipation, social work education leadership development is an important function for many fields and professional disciplines. effective leaders are much needed and valued. the literature on leadership is broad and diverse, ranging from characteristics and types of leaders, skills, theories, and approaches to leadership development. traditionally, leadership studies have been conducted in the private sector; however, because of surmounting social problems and the paucity of economic resources, studies have expanded to include leadership in public and community settings (mcgonagil & reinelt, 2011). consensus among leadership scholars about the primary characteristics of effective leadership include: someone who can influence, facilitate cooperation, inspire through their vision, demonstrate engagement, and interact and negotiate with others; in addition to possessing the ability to unite, encourage, and energize individual followers, groups, organizations, or communities. there are two distinct aims in the field of leadership development: leadership as a vehicle to achieve organizational management objectives, or a collaborative process between leaders and communities to achieve a change in targeted social problems advances in social work, spring 2013, 14(1) 103     (mcgonagill & pruyn, 2010). the goal of leadership as a collaborative process for social change is consonant with the mission and values of the social work profession and education. both the national association of social workers (nasw) and the council on social work education (cswe) have identified leadership development as essential for the profession to meet its mission, goals, and commitment to equality and social justice. nasw’s commitment to leadership development is reflected in the 10 social work imperatives adopted for the 2010-2020 decade (nasw, 2010). in 2008, cswe created a leadership institute to promote future leaders in social work education, higher education, and the social work profession. also, every year during cswe’s annual program meeting, two major events are celebrated: the leadership scholars in social work education program to train and mentor future leaders, and the leadership networking reception to support, encourage, and recognize new leadership in the social work profession (cswe, 2012). social work education identifies leadership competence as: (1) team building, (2) conflict resolution, (3) assessing personnel and maximizing productivity by recognizing system influences on individual and organizational functioning, (4) building professional relationships, (5) advocacy, and (6) managing group processes (sheafor, 2006). a primary goal of the profession is social justice advocacy for disenfranchised and oppressed communities. while there is inherent strength and resiliency within these communities, there remains a need to promote social justice to ensure their collective well-being, political and social emancipation (caravalho & kayama, 2011; farooqui, 2012; freire, 1974; giroux, 1992; omotoso, 2010). in this context, community emancipation is viewed as any effort to procure political rights or equality for disenfranchised groups. farooqui (2012) proposes education as the key to community emancipation. according to omotoso (2010), “…any form of education that does not give birth to emancipation is unjust. the implication is justice should be a summation of education and emancipation” (p. 228). this article focuses on leadership as a response to the latino community’s history of encountered invisibility, oppression, and discrimination in the united states; and their struggle to achieve fair treatment and emancipation. the term “latino/a” is used to refer to the diversity of over 19 countries or nationalities that make up the latino population. latinos are usually statistically overrepresented in experiencing many socioeconomic challenges. despite efforts to improve these inequities, socioeconomic conditions of many latino communities continue to worsen. as a result, there is a mounting call for more latinos/as who can take on leadership positions in education, program development, community organizing, community development, research, and policy that will initiate the changes needed to enhance the quality of life for latino communities while validating and affirming their cultural identity, values, and strengths. the following paper presents an integrative leadership development approach that has been employed for over 30 years in a latino project at a new england school of social work. prior to a discussion of the leadership development approach, a demographic profile of the latino/a population is presented, followed by a literature review on educational latino/a leadership perspectives, general leadership development trends, and best practices that serve as a compatible integrative latino/a approach. cordero, negroni/leadership development for latino community emancipation 104 demographic profile latinos/as latinos/as are ethnically diverse and represent 16.7% of the population of the continental united states (u.s. census bureau, 2011a). they represent the nation’s largest minority group. their size is expected to triple and account for most of the nation’s population growth from 2005 through 2050 (pew research center, 2008). latinos/as are younger than any other group in the continental united states – 1 out of 3 is under the age of 24 (pew research center, 2008). the majority of continental u.s. latinos/as speaks spanish at home: 56% speak only spanish, 26% speak spanish and english equally, and only 18% speak english (us census bureau 2011b). while latino/a poverty rates are higher (u.s. census, 2001b), educational attainment and average earnings are lower than other groups (u.s. census bureau, 2011c). latino workforce participation is larger than other groups (u.s. department of labor, 2011). as a commonwealth of the united states, the island of puerto rico contains an additional 3.7 million u.s. latino/a citizens who are not counted in the census of continental latino/a residents (u.s. census bureau, 2011d). the above profile characterizes latinos/as as the largest, youngest, and fastest growing u.s. population. despite having the highest work force participation, they have the lowest college attainment and average earning rates. as a population they are ethnically diverse, primarily spanish or bilingual speakers. thus, the above profile suggests that the ground is fertile for more latinos/as to emerge as leaders who can address the socioeconomic needs of their communities. literature review latinos/as educational leadership perspectives an increased commitment to latino/a leadership development is prevalent among numerous organizations and groups in the united states. the majority of these development opportunities have an educational leadership focus. it is widely recognized that increasing the number of latinos who successfully pursue associates, bachelors, graduate, and professional degrees is one of the most important and complex challenges for american colleges and universities (chapa & de la rosa, 2006; davis, 1997; leon & nevarez, 2007; mcwhirter, torres, salgado & valdez, 2007; miller & garcia, 2004; perna, 2006). the persistence of latino educational underachievement and underrepresentation in higher education has been reported in studies since the 1980s (pachon & moore, 1981, post, 1990; chapa & de la rosa, 2006; cooper & lious, 2007; deil-amen & turly, 2007; golderick-rab, carter, & wagner, 2007; louie, 2007; mcwhirter et al., 2007; oliva, 2008; perna, 2006; teranishi & briscoe, 2006). according to oliva (2008), some scholars who study limited college access and success for latino students, focus their research on individual-level factors such as students’ academic preparation, motivation, college-choice process, and presumed student or family deficiencies. nonetheless, there are studies that show a correlation between latino student college access and performance and the broader external social issues affecting them, including immigration status (cabrera & nasa, 2000; erisman & looney, 2007; nunez & carroll, 1998; oliva, 2008; perna, 2006; saenz, hurado, barrera, wolf, & yeung, 2007). oliva (2008) advances in social work, spring 2013, 14(1) 105     recommends that there should be a shift away from the examination of latino/a student and family deficiencies as related to college outcomes, and toward a holistic and systematic examination of their needs using a culturally appropriate lens. bordas (2001) adds the notion that effective leadership with latinos/as is a collective, people-oriented view that grows out of latino/a history and core values, and is responsive to the challenges latino communities face today. some of the core values that shape the collective latino/a identity are: familismo, personalismo, respeto, and confianza (bordas, 2001; cordero & negroni, 2009; mogro-wilson, 2011; negroni-rodriguez & morales, 2001). latino communities measure leadership actions through the lens of these core values (ballesteros, 2007; davis, 1997; rodriguez & villarreal, 2001). familismo is a commitment to upholding family values and supporting the integrity of the family unit. the family unit often extends beyond that of the nuclear family. personalismo is an intrinsic value in establishing cooperative and personal relationships. respeto is displaying social esteem and respect for an individual. elders and children, in particular, are highly regarded and socially esteemed. confianza is the process of establishing social intimacy and trust (cordero, 2008). as bordas (2001) states when describing effective cultural value-oriented latino/a leadership: trusted latino leaders are regarded as part of ‘the family’…unlike cultures that emphasize individualism, latinos emphasize ‘we’, belonging and to group benefit…one of the roles latino leaders play is being a trustee of their community’s future and the guardian of the children (p. 119). personalismo does not mean that the individual takes precedent over the family, the group or community. latino [leaders] are expected to respect and value the individual [student] in a collected context of the family or community. this establishes confianza (trust) and makes strong personal relationships. centering on personal relationships means [the leaders is] spending more time building rapport…it also means lifting the veil of professionalism and allowing people to get to know the leader as a real-life person (p. 124). ballesteros (2007) prescribes that, among mainstream societies that diminish the value of differences, latinos/as are compelled to preserve their rich cultural heritage; and, accordingly, leaders in educational institutions need to affirm latino/a students’ cultural pride on campus, and support course work on multiethnic/multiracial content, while promoting cultural exchanges with spanish-speaking countries. kane’s (1998) and perna’s (2006) research findings support the need to evaluate and attend to student issues in a culturally appropriate manner rather than by using a standard approach. “identifying what works for latino/a students in higher education is an important step to reach our national goals of degree completion, a highly competitive workforce, and civic leadership” (excelencia in education, 2012, p. 6). participation in university-sponsored latino/a student organizations provides a vehicle for students to have their first exposure to the work of community leaders (davis, 1997). in sum, scholars propose that more focus should be on the strengths of students, their families, and their communities in a culturally appropriate and effective manner (ballesteros, 2007; bordas, 2001; davis, cordero, negroni/leadership development for latino community emancipation 106 1997; molloy & elis, 2006; negroni-rodriguez, dicks, & morales, 2006; oliva, 2008; ramirez, 2006). with greater acceptance of new qualitative methodologies, and a stronger presence of minority scholars studying college access and success for underrepresented students, other questions are being asked and more culturally responsive findings are being produced regarding what works, and what does not, with latino/a students to facilitate their development as leaders (collins, weinbaum, ramon, & vaughan, 2009; miller & garcia, 2004; oliva, 2008, ramirez, 2006). in addition, due to the socioeconomic needs of surrounding latino communities, there is an increased demand for social work leaders who can collaborate with these and other latino communities throughout the nation. trends in leadership development leadership has disparate definitions based on its particular meaning to individuals, organizations, or communities. bennis in his early work, leadership theory and administrative behavior: the problem of authority (1959), observed that “probably more has been written and less known about leadership than about any other topic in the behavioral sciences” (hubbard, 2005, p. 4). a review of the literature indicates that the consensus among scholars in the field is more likely to focus on qualities, functions, and best practices in leadership development. since burns’ (1978) seminal book on leadership, scholars in the field have defined and ascribed the goals of leadership in many ways (ballesteros, 2007; bass, 1990; bennis & nanus, 1985; foster 2005; henderickson, 1989; mcgonagill & reinelt, 2011; northouse, 2009; ramirez, 2006; rodriguez & villarreal, 2001; w. k. kellogg foundation, 2004). in a study of leadership development trends in the united states, mcgonagill and reinelt (2011) encapsulate the following leadership qualities, functions, and development trends:  effective leaders can influence and manage followers or facilitate a collaborative process of mutual interests with a group or community. leadership abilities are shaped by personal qualities and include the process of personal growth. this growth enhances their understanding of the world’s complexities and deepens their ability to come up with creative actions and options (joiner & josephs, 2007).  ethics are recognized as an important element of leadership development because it takes into account social responsibility (collins, 2001; greenleaf, 1977; kellerman, 2004; senge, smith, kruschwitz, laur, & schley, 2008).  leadership functions are viewed within the context of activities versus roles. successful leadership outcomes result from leaders’ participatory activity with others and their capacity to cultivate or identify leadership qualities in others; rather than their vested authority and delegation to others.  leadership development has a dual emphasis on the individual and the system. there is equal importance in the development of individual leadership and the advances in social work, spring 2013, 14(1) 107     creation of an organizational culture where, in the absence of official leaders, basic leadership tasks are enacted and carried out (hubbard, 2005).  contemporary expansion of leadership development includes promotion of leadership networks that forge collaborative alliances among leadership groups to address complex multi-socioeconomic problems (gauthier, 2006; jordan, 2006; mckensie et al., 2008; senge et al., 2008).  eastern and indigenous traditional leadership perspectives have been included in order to address social justice inequities and access to underrepresented groups (adams, bell, & griffin, 2007; bordas, 2001; center for ethical leadership, 2009; griffin & ouellett, 2007; ramirez, 2006). best practices in leadership in the review of the literature, four areas emerge that the authors consider essential practices in latino/a leadership development. collective leadership. mcgonagill and reinelt (2011) maintain that while much of the research on leadership qualities and development have been historically studied in private sector settings, recent work has begun to study leaders in public and community settings. they found that innovative leadership development programs in public and community settings produce individual leaders within the shared context of organizations, communities, or fields for a variety of reasons:  developing leadership one person at a time often requires more than what a single leader can achieve and it is also too slow for achieving the scope and scale of leadership needed to transform communities and influence policy (enright, 2006).  developing teams of leaders, representative of the cultural context of their communities, can help them to support each other and validate their cultural realities in ways not supported by mainstream organizations (enright, 2006).  communities full of leaders enable more shared leadership as people assume civic leadership roles as their interests, needs, and circumstances change (ahsan, 2007). leadership is a communal relationship, one that occurs within a community of believers, representing a combination of ideas that are shared and transferred between leaders and followers (foster, 2005). foundations are increasingly investing in collective and network leadership efforts that address specific community organizational needs or social problems (hubbard, 2005; jordan, 2006; northwest area foundation, 2006; plastrik & taylor 2010; the california endowment, 2006; w. k. kellogg foundation, 2006). in short, effective leadership perspectives develop collective and collaborative relationships of leaders, within and outside of the community, that promote an exchange of ideas to create a shared communal vision. culturally-attuned leadership. with the wave of interest in organizational culture during the 1980s, there came a new leadership perspective that merged leadership with cordero, negroni/leadership development for latino community emancipation 108 organizational culture (schein, 1985). as early as 1989, henrickson believed that while recognizing the importance of the leadership process, transformational leadership was still failing to effectively integrate the importance of the leader-follower relationship. he believed disconnecting leadership from management and somehow integrating it with culture could provide important and fresh perspectives on the concept of leadership; asserting that it is not possible to effectively understand the nature of leadership without applying a cultural model (henrickson, 1989) or a culturally syntonic approach (manoleas & carrillo, 1991). current scholars believe that diverse, culturally-inclusive learning circles are a microcosm for working across differences and learning first-hand how to prepare individuals and groups to lead collectively with others whose cultures and practices differ from their own (foster, 2005; meehan & reinelt, 2006; reinelt, yamashiro-omi, & meehan, 2010). the leadership learning community (2010) views leadership as a shared, relational process that is fundamental to many cultures even though the dominant american model of leadership is deeply rooted in individualism. some scholars argue that if we add diverse perspectives and equity-based leadership approaches to status-quo leadership practices, educational leaders may be able to transform leadership practices and improve educational outcomes for larger numbers of culturally and linguistically diverse learners at every educational level (mckensie et al., 2008; tooms & boske, 2010). to summarize, leadership development perspectives need to be culturally-attuned to the populations or communities they address. transformative leadership. foster (2005) attributes the perspective of transformational leadership to burns (1978) and describes it as the ability of individuals to envision new social conditions and to communicate these visions to followers, requiring leaders to engage with followers from higher levels of morality. burns (2003) views leadership on a moral and value-driven basis, not as simply a managerial tool. he claims that, “the transforming leader looks for potential motives in followers, seeks to satisfy higher needs, and engages the full person of the follower” (burns, 1978, p. 4). the outcome of this leadership style is a mutual relationship that changes followers into leaders, and leaders into moral agents. the notion of moral leadership is a means for leaders to take responsibility for their leadership and seek to meet the needs of the followers (foster, 2005). transformative leadership “raises the level of human conduct and ethical aspiration of both the leader and led, and thus it has a transforming effect on both” (burns, 1978, p. 20). bass and riggio (2006) broaden the definition to include: “…leaders (that) help followers to grow and develop into leaders by responding to individual followers' needs, empowering them and aligning the objectives and goals of the followers, leader (s), and the larger organization.” (p. 3). in their discussion about educational reform, rodrigues and villareal (2001) propose that transformative leaders will be confronted with the task of facilitating the thinking of diverse stakeholders whose culture, values, and beliefs have not been acknowledged or appreciated; and that the leaders will need to foster a climate of interdependence, relevance, and shared accountability. therefore, leadership perspectives need to promote the development of equitable relationships between leaders advances in social work, spring 2013, 14(1) 109     and followers that transform their efforts to serve in the best interests of devalued and underrepresented communities. emancipatory leadership. transformative practices, which change social structures and forms of community, require that leadership be critical of current social arrangements, and that this critique be aimed at more emancipatory types of relationships (mckensie et al., 2008). foster (2005) ascribes the outcome of emancipatory relationships as “the gradual development of freedoms, from economic problems, racial oppression, ethnic domination, the oppression of women and so on, each of which has its own heroes and heroines: [eleanor] roosevelt, [winston] churchill, [mahatma] ghandi, [martin luther] king, [susan b] anthony are just some examples” (p. 33). emancipatory leadership, however, demands more than the qualities of enlightened individuals. the idea that leadership emancipation occurs within a community suggests that leadership ultimately resides in the community itself (foster, 2005). some scholars in the field of educational leadership development believe in a dynamic leadership process that focuses on how individuals and groups are connecting, organizing, thinking systemically, bridging, and learning to mobilize action on the scale needed to address socioeconomic inequities and injustices (foster, 2005; gauthier, 2006; jordan, 2006; mckensie et al., 2008). consequently, emancipatory leadership perspectives need to foster indigenous community leadership designed to gain political rights or equality for their respective disenfranchised groups. davis (1997) contends that the process of leadership by nature is self-perpetuating; and part of the leader’s work is involvement in the community that develops and mentors new leaders in skills development, participation in community activities, and an ongoing commitment to community improvement. in summary, leadership development is no longer a process of whom to recruit for leadership programs, but, a field that enables learning to identify and support leadership efforts that are collective, culturally-attuned, transformative, and emancipatory. a crucial element of this leadership development process is the location of a community or region where there is a need for social change. latino/a college attainment and improved socioeconomic conditions for latino communities are examples of a location and need. in other words, an effective leadership development process is comprised of the identification of individual, organizational or networks of leaders vested in a collaborative emancipatory relationship with specific communities or regions to tackle their need (social problems) (brabeck, walsh, & latta, 2003; annie e. casey foundation, 2006; leadership learning community, 2010; w. k. kellogg foundation, 2004). the above best practices are integrated in the leadership development model that is presented in the following section. the leadership development model the model presented in this paper has been implemented by the faculty members of the puerto rican and latino studies project (prlsp) at the university of connecticut school of social work. a description of both the school and the project precedes the presentation of the model. in addition, a case scenario depicting the development of a cordero, negroni/leadership development for latino community emancipation 110 project latina leader, and examples of project community emancipation outcomes are offered. the school of social work the university of connecticut which hosts the school of social work is a land grant state institution. the school of social work has an enrollment of more than 400 students and offers both masters and doctoral degrees in social work. by the academic year 20122013, the school had a dean and two associate deans, 27 full-time faculty members, and 38 fulland part-time staff employees. nine faculty members were representatives of different ethnic groups: two african-americans, one jamaican, three puerto ricans, one bolivian, one peruvian, and one african-american/puerto rican. seven members of the professional staff were either black or latinos/as. during that 2011-12 year, the total incoming student population was 179, and the ethnic student enrollment was 14 latinos/as, 49 african-americans, and 4 asians. the latino project in the early 80s, a group of latino/a faculty and alumni, concerned with the lack of latino/a representation in social work, developed the project. since its inception, the project ‘s mission has been to: 1) prepare social workers to competently serve the latino community by advocating and promoting change and 2) advance knowledge about the strengths, challenges, and resources of latino/a populations and communities. the project, initially funded by the national institute of mental health (nimh), provided financial support for 10 student scholarships, 2 faculty positions, and clerical support. after the nimh funding ended, the university institutionalized the project by funding the two faculty positions and increasing financial aid support for latino/a students in the graduate social work program. in addition to the traditional academic responsibilities, the project’s faculty is involved in latino/a leadership development as part of its commitment to the profession’s mission and new england communities. most of the school’s latino/a students have been born and/or raised in the united states. the rest have emigrated from latin american countries or migrated from puerto rico to pursue graduate education. in the last 10 years, an estimated 300 latino/a students graduated, creating a difference in the latino/a workforce of master social workers. in addition, within the school of social work’s doctoral program, currently celebrating its 10th anniversary, there has been one latina ph.d. graduate and four doctoral latino/a students in different stages of their doctoral studies. over 30 years, as a result of the project’s efforts, many graduates, particularly latino/a graduates, have gone on to serve in leadership roles promoting collective collaboration with latino communities and organizations. project latino/a graduates, acting in the capacity of practitioners, administrators, policy makers, researchers, educators, deans, judges, commissioners, cbo executives, and elected public officers, including the city’s mayor, have had leadership impact in institutions, organizations, and agencies serving latino communities, thus contributing to community emancipation. the project recognizes the importance of quantifying the contributions of its latino/a alumni and is currently in the advances in social work, spring 2013, 14(1) 111     process of tracking this data for future publication. the project is one of the few projects of its nature in schools of social work in the united states. the leadership development model social work education prepares professionals to pursue social justice for underrepresented populations, foster socioeconomic equity, and political empowerment for devalued communities. as is born out in the literature, fostering emancipatory leadership does not occur in a vacuum. the authors propose that for the process of collective, culturally-attuned, transformative, and emancipatory leadership development to occur in a higher educational institution, a model with the following components should be present: (1) sustained institutional commitment, support, and resources; (2) creation of leadership opportunities, mentoring, and modeling; and (3) leadership efforts for community emancipation. it is through the interaction of these three components that a collective, culturally-attuned, and transformative leadership process emerges, and, in turn, community emancipation takes place. institutional commitment, support, and resources. the higher education institution must be committed to leadership development. this commitment should be reflected by the presence of a supportive infrastructure, policies, and regulations that promote leadership development opportunities for students and faculty, and involvement in community partnerships that promote community emancipation. for example, it is only through the school’s sustained commitment that the project faculty continues to grow in its leadership development objectives, particularly in times of economic adversity. the project has increased from two to five faculty members, four full-time tenured latina members, and a recently hired full-time tenure-track member. through the years, the school’s cultural commitment and support has been a key to the project’s success in student and faculty recruitment, retention, and faculty tenure attainment. in addition, as the project has expanded, the school’s administration has supplied an equipped office, a web page, and staff support to help with annual and special program events. also, the school provides funding for the project to annually host various student and community events that foster leadership encounters and networks. this support is essential for leadership development opportunities to be created and leadership efforts to be implemented in the community to advance their emancipation. this academic year, the project hosted six events for hispanic heritage month and plans for an over 30 year project anniversary celebration, which will include acknowledgement of the project’s founder and past latino/a school alumni. creating leadership opportunities, mentoring, and modeling. as noted, the school’s community is composed of students, faculty, staff, and alumni. leadership development efforts at the school involve all of these sub-groups and reflect the school’s commitment to leadership as a competence and tool for community emancipation. these efforts promote needed personal growth, an increased sense of social responsibility, along with participatory activities. the project has created an infrastructure for leadership development that has contributed to the growth of a leadership culture; ultimately creating the project’s latino community milieu. leadership development occurs within cordero, negroni/leadership development for latino community emancipation 112 the context of faculty mentoring and modeling leadership skills and roles to new faculty. faculty also co-participates in different community efforts. these leadership opportunities are collective, culturally-attuned, and transformative. at the end of this section, a case scenario is presented as an example of how leadership opportunities are provided within the project’s community milieu. faculty remains alert to recognize leadership potential in students. opportunities for these discoveries occur in the classroom, through advisement, and by observing student participation in different school organizations and events. once leadership potential is assessed, mentoring relationships allow for a process of validation, orientation, and encouragement to take place. mentoring is a process by which more experienced and knowledgeable individuals (mentors) act as guides, role models, teachers and supporters of less experienced individuals (mentees) (luna & prieto, 2012). mentoring can help mentees develop a stronger sense of competence and identity, and can help them to cope with different stressors associated with their roles and responsibilities in life (bordes & arredondo, 2005). a factor that facilitates the development of these relationships is the notion that mentors and mentees have many characteristics in common. for example, having the same ethnicity can provide role modeling, cultural affirmation, pride (riveragoba & nieto, 2007), and the meta-message that advancement as a latino/a is possible (rojas-schwan, negroni, & santiago, 2012, p. 6). this is the case within the school’s project. the work done by the latin american student organization (l.a.s.o.) is an example of how leadership opportunities, mentoring, and modeling take place. a project faculty member serves as the advisor, in collaboration with the director of student services, to coach and mentor l.a.s.o. students who take on leadership positions in the organization. usually two students perform as co-chairs and in that leadership role they learn to 1) assess and represent latino/a students’ concerns, 2) coordinate student events of particular need and interest to the latino community, 3) recruit and engage students, alumni, faculty and community residents in the l.a.s.o. activities, and 4) collaborate with the project on events and activities of mutual interest. throughout the year, students observe project faculty engaged in similar leadership roles, which supports davis’ (1997) claim that latino student organizations serve as a central role in the emergence of latino/a leadership as a vehicle through which young people can begin the leadership process. another example of leadership opportunities are the field placement internships offered through the project. this year the director of the project is a field instructor for two latina msw students, a community organization, and an administration major. their field assignments and activities help promote the project’s engagement and collaboration with latino community constituencies within the school and outside community. some examples include, working on a grant to support community-based research activities; coordinating the school’s hispanic heritage month activities; and providing education through a community radio program. in these activities, student interns have the opportunity to be mentored and observe faculty modeling leadership skills to effect change within the local community. advances in social work, spring 2013, 14(1) 113     a third example pertains to research scholarships that are given to two students enrolled in a travel and study course to puerto rico. the course encourages students to examine social work practice that employs a humans rights and social justice lens. students submit a proposal for a research project about health disparities in puerto rico. the two scholarship recipients present the findings to the university community and community-based organizations in the area. a previous community research project, supervised by a project faculty and a practitioner, led to the creation of a video about the social and health inequities created as a result of the bombing in vieques. the video is available online as an educational tool to raise awareness of human rights violations, health disparities, and the need to advocate for social justice on behalf of puerto ricans living in vieques. as a result, students developed leadership skills necessary to collaborate and support the vieques community emancipation process. as with the previous example, project faculty facilitate leadership opportunities and mentoring of leaders in different developmental stages of students’ professional development, even after graduation. as latino/a social work alumni, project faculty continue to enhance leadership skills by helping them to become role models to those who are in earlier stages of their professional development. one example is the state’s chapter of the nasw latino/a network mentoring program. a network of latino/a chapter nasw members, supported by project faculty, coordinates and recruits seasoned latino/a professionals, many who are project alumni, to mentor latino/a graduates transitioning from school to professional social work employment. the following case scenario describes the development of a latina leader. it shows how the project’s community milieu led this individual to become an agent of change and emancipation within the latino community. olga was a bright first generation puerto rican student and the first person in her family to pursue graduate education. prior to her arrival to the school, she had not visualized her potential as a leader, nor did she have leadership role models in her family. but, the seeds of her leadership potential were planted at the undergraduate level, where she was supported and culturally validated by her educational institution. a latino colleague, who was an msw alumnus and member of the project, referred olga to one of the project’s latina faculty; who in turn, oriented and guided her during the application process. upon her acceptance to the msw program, the director of student services and the project faculty reached out to olga to welcome her and connect her with other students. olga began the msw program in a culturally holding environment, where her cultural identity and values were affirmed and appreciated. motivated and inspired by the leadership of the project latina faculty, olga hoped to “be a leader like them to help in my community.” mentored by the director of student services and the project faculty, olga agreed to become l.a.s.o. co-chair. as co-chair, she also joined a community-university partnership effort, led by a project faculty member, to plan a statewide youth conference; learning from her collaborations with other senior community social workers involved in this community-university partnership endeavor. as a result, her contributions to these activities were credited towards her field internship requirements. cordero, negroni/leadership development for latino community emancipation 114 olga joined the state’s nasw chapter latino/a network mentoring program to prepare for transition to her social work career. after three years in her first position in a youth services agency, she became supervisor and developed several grant-funded programs. as an alumnus, she remained involved in the project by supporting social action efforts and providing voluntary professional presentations. she asserts that the modeling and mentoring of other latina faculty motivated her to pursue a doctoral education. project faculty mentored her through her years as a doctoral student. as part of her dissertation, she founded a grassroots movement in a local community to support policies that benefit immigrant families. her research also explored the connection between acculturation and family relationships. as a seasoned and nationally recognized latina social worker and educator, her contributions have advanced different community advocacy actions and increased awareness of the importance of cultural sensitivity and competence. she has recently accepted a new position in washington, d.c. to conduct national community research examining the challenges faced by latino/a immigrants. she is currently a consultant to the united states department of human services and maintains involvement with the project. during her leadership journey, olga went through both personal and professional transformation, and the reaffirmation of her cultural identity and pride. she engaged in leadership efforts that were collective, culturally-attuned, transformative, and emancipatory. as a testament to the project’s community milieu, she continues to receive mentoring, attributing inspiration from the project faculty and other latino/a alumni. as her professional journey continues, she considers her belief and dedication to social justice a result of her experience with the collaborative gains made by the project and the latino community. leadership for community emancipation: partnership efforts. project faculty maintain community participation through allying with and supporting project alumni; and partnering with social service and governmental agencies, professionals and community activists in advocacy efforts that foster community emancipation. the following are examples of project partnership efforts: escúchenos conference. the annual escúchenos conference was conducted for eight consecutive years, originally organized by a group of child welfare and child advocacy community organizations, and led by project faculty. the escúchenos conference was created to address the needs of latino/a youth in the care of the state’s department of children and families (dcf). escúchenos in english means: listen to us. the conference had a non-traditional and unique format: youth presented their major foster placement concerns, while the adult professional audience, made up of dcf administrators, service providers and foster care policy-makers, listened to the issues and needs raised by the youth. the major goals of the conference included advocacy on behalf of latino/a youth (their individual needs); affirmation of their cultural identity; and attention to the homogeneous dcf cultural climate through activities that celebrate the latino/a culture such as the inclusion of latino food and music, dialogues and presentations on culture, cultural identity, and affirmations about the strengths of the latino culture. as a result of advances in social work, spring 2013, 14(1) 115     the conference proceedings, the recommendations were distributed to dcf, community agencies, and advocacy groups that could develop cultural activities and access to culturally sensitive services for latino/a youth. in sum, the expressed need of the youth for a greater connection to their culture led dcf to implement the following culturallysensitive actions: quinceañera program. this program enables dcf latina youth to participate in the long-honored latino coming-of-age tradition for teenage girls, which includes a mentoring component and incentives for the latina adolescent to succeed academically. the quinceañera program is intended to emphasize and develop cultural awareness, improve the girls' self-confidence and self-esteem, and encourage them to pursue higher education. the actual ceremony, clothes, and preparations for this event are paid for by dcf. ethnic hair and skin care policy. latino/a youth are now able to receive culturally appropriate hair treatments or skin care maintenance. products that may not be affordable or accessible to them or their foster care families are provided by dcf. college tours. the department’s bureau of adolescent and transitional services have instituted the hispanic association of colleges and universities (hacu) tours. these tours are designed to introduce latino/a youth to colleges whose student population is at least 25% latino/a (dcf, 2008). in effect, the project’s involvement in this community partnership gave an emancipatory leadership voice to foster children who ordinarily feel invisible and unheard. latino voters’ campaign. another example is the project’s two year involvement in the 2008 state-wide latino voters’ campaign initiative. in 2007, project faculty, students, and alumni became involved in a state-sponsored summit to generate voter education and registration targeted to the latino community. over the next year, project members, along with other grassroots committees operating in other states, took part in numerous grassroots efforts to register puerto ricans and other latinos/as to vote. in 2008, various voting campaign efforts hosted by l.a.s.o., the project, and a school’s institute for political social work were presented to the school’s community and the university community in general to increase latino/a political participation. this recruitment effort, led by a latina student leader, galvanized the campaign’s volunteer youths to register new voters on college campuses and in state-wide community summer events. in addition, on election day, the youth participated in door-to-door efforts to get individuals to vote and worked as volunteers at state-wide election polls. as a result of the campaign, the goal of registering 10,000 voters was doubled and 21,570 new latino/a voters were registered. in short, project partnerships foster and support indigenous community leadership, collaborate with key stake holders, and enlist and support grassroots community efforts that have a significant political impact. community advocacy groups. a third example has been the creation of community advocacy groups. one example is a grassroots community effort, initiated by a partnership of project faculty, professionals, and community members, to address the needs, aspirations, and contributions of the latina and latino lesbian, gay, bisexual, cordero, negroni/leadership development for latino community emancipation 116 transgender, queer, and intersexed (lgbtqi) population. this organization is meeting an important need in the latino community as it strives to promote equality for latinas/os and embraces social justice. this is the only organization in the state that is focused on achieving rights and opportunities for the latino lgbtqi population. examples of their accomplishments have been: participating in legislative hearings with government officials and press conferences on state issues affecting lgbtqi population; sponsoring fundraising events to advocate for and support lgbtqi community concerns; and sponsoring latino cultural events that represent the strengths, realities, and talents of the lgbtqi community. the above project-community partnerships involve groups of leaders, many of which are current students and established project latino/a alumni leaders, leaders within the profession, political and geographical community leaders, and project faculty. from these partnerships, new and established latino/a leaders are now sitting on advisory boards, commissions, and professional organizations at the local and national level; and contributing to an enhanced latino community that serves the well-being of its members and other surrounding disenfranchised communities; hence, supporting davis’ (1997) claim that many of the most prominent latino/a leaders credit their success to college or high school involvement in campaigns, protests, and service efforts to improve conditions for latinos/as. leadership development for community emancipation: replication considerations in the context of this article, leadership development is defined as a collective collaborative, culturally-attuned, and transformative process between leaders and communities to achieve a change in targeted social problems. the authors propose the following institutional, faculty, and community emancipatory considerations when replicating the proposed educational leadership development approach for disenfranchised students and communities. institutional considerations 1) institutions must have a commitment to addressing the needs of disenfranchised and oppressed communities; 2) institutions should be committed to developing culturally effective ways of recruiting and retaining latino/a students; 3) institutions must be committed to latino/a leadership development. such commitment can be demonstrated by the presence of a supportive infrastructure, e.g. the hiring of junior and senior latino/a faculty and staff; office space, and administrative and support services; and 4) institutions must support the development of a latino community milieu through which leadership opportunities, mentoring, modeling, and emancipatory community partnerships occur. faculty considerations 1) faculty should pay attention to the leadership potential of its students of color, facilitate and advocate for leadership development opportunities; 2) faculty need to model leadership skills and support the importance of leadership development for the advances in social work, spring 2013, 14(1) 117     social work profession; faculty should remember that they are teaching by example. in this sense, the service component of a faculty member’s workload acquires special meaning and value. 3) faculty should consider that mentoring is an important component of the work done in academia and they should be willing to “build their own capacities as mentors and to advocate for institutional practices that support mentoring practice.” (gutierrez, 2012). in particular, faculty need to be committed to mentoring devalued student populations to become emerging leaders. this requires a time investment with consistent and continuous effort since it relies on relationship building, often a cultural imperative with devalued student populations. among latinos/as, such mentoring relationships need to be culturally-attuned to values such as personalismo, familismo, and latino cultural traditions; and 4) involvement in community emancipatory efforts for historically oppressed communities should be an individual and collective faculty commitment. community emancipation considerations 1) collective and collaborative relationships of leaders should be developed within and outside of the disenfranchised community. these relationships should promote an exchange of ideas to create a shared communal vision; 2) the leadership activities should be culturally-attuned to the populations or communities they address, while also affirming their cultural identities; 3) relationships between leaders and followers should be equitable, transforming their efforts to serve in the best interests of devalued and underrepresented communities; and 4) indigenous community leadership should be fostered, and efforts to gain political and social equality for their respective communities should be supported. future research considerations the project’s model has not been systematically evaluated. however, if it is to be replicated, the authors suggest that an evaluation component be added to test its validity and generalizability. in addition, the evaluation could examine the relationship between project latino/a alumni and their success as social work leaders. a comparative study of the similarities and differences between project leaders and latino/a leaders from mainstream social work programs is another necessary examination. additional research could explore how ethnic group, acculturation, and gender differences among latino/a leaders influence their work with the community. in conclusion, the paper provides an integrative view of leadership development as a collective, culturally-attuned, transformative, and emancipatory process that can have a two-fold outcome:, successful educational latino/a leadership development, and emancipation for latino communities. the approach can be employed for other disenfranchised populations, as long as schools of social work create appropriate infrastructure and secure faculty commitments that create community milieus such as the one created by the school of social work’s project. leadership development efforts should begin with students, by providing leadership opportunities, mentoring, and faculty modeling. the authors also assert that for the leadership approach to be complete, emancipatory partnerships in and with the disenfranchised community are necessary. as cordero, negroni/leadership development for latino community emancipation 118 so aptly stated by freire (1970) “the oppressed must be their own example in the struggle for their redemption” (p. 54). references adams, m., bell, l., & griffin, p. 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(2004). building leadership for the 21st century: a report from global leadership scans. battle creek, mi: author. retrieved from http://www.wkkf.org/knowledge-center/resources/2004/09/building-leadership-forthe-21st-century-a-report-from-global-leadership-scans.aspx w. k. kellogg foundation. (2006). crossing boundaries, changing communities: lessons in collective leadership. battle creek, mi: author. retrieved from http://www.wkkf.org/knowledge-center/resources/2006/04/crossing-boundarieschanging-communities-lessons-in-collective-leadership.aspx author note address correspondence to: antonia cordero, ph.d., associate professor, university of connecticut, school of social work, 1798 asylum ave., west hartford, ct 06117. email: antonia.cordero@uconn.edu this work is licensed under a creative commons attribution 4.0 international license. editorial introduction to special issue on trauma karen m. allen virginia c. strand social work has always served society’s most vulnerable individuals and groups and it is difficult to think of an area of practice where one could avoid working with clients who have not been traumatized in some way. although the field of traumatology initially evolved in response to soldiers and veterans who were shell-shocked in the world wars, it has progressed beyond reductionist thinking that post-traumatic stress disorder is a pathology to an understanding of the significance and impact of trauma experiences in our lives. we now know that over one-third of adults are exposed to significant trauma as children and that the effects of these experiences are cumulative, complex, and often lifelong. repeated exposure significantly increases the potential for negative outcomes including depression, alcohol and drug use, obesity, sexually transmitted diseases, smoking, cancer, chronic heart and lung disease, and early mortality (centers for disease control, 2014). even before we are born, in utero exposure to maternal stress can cause epigenetic changes that negatively affect development and contribute to poor health by compromising the immune system and reducing the capacity to stave off disease (teicher, andersen, polcari, anderson, & navalta, 2002). contextual factors such as age, gender, ethnicity, and socioeconomic status including historical and cultural trauma exacerbate the negative outcomes associated with trauma exposure and further increase the risk of retraumatization; creating a vicious cycle that can persist through generations. over the past 35 years, our courage, compassion and skill in listening to the stories of our clients, bearing witness to unspeakable cruelties, assuring safety, restoring hope and demanding justice has begun to coalesce into a cohesive body of knowledge and empirically-tested interventions that promote healing (allen & wozniak, 2014; najavits, 2002). further, recognizing that to work effectively with traumatized clients practitioners must “face human vulnerability in the natural world and …the capacity for evil in human nature in order to bear witness to horrible events” (herman, 1999, p. 7). we have pioneered new understandings in compassion fatigue, vicarious trauma and secondary stress (figley, 2002). we have developed prevention and early intervention strategies such as stress inoculation and self-care techniques to help mediate negative outcomes and to promote the well-being of providers. moreover, as new models of care, best practices, assessment tools and empirical studies emerge, we have adapted trauma-informed treatments for traumatized individuals to whole communities and most recently to agencies and institutions in order to develop trauma-informed systems of care (strand, popescu, abramovitz, & richards, 2015). many agencies now recognize and promote trauma-based principles as a key component of interventions for complex psychological and social problems. samhsa (2015) has funded the national child traumatic stress network (nctsn, n.d.) for almost 20 years and recently endorsed principles and practices for trauma-informed systems. ____ karen allen, ph.d., is a professor and director, school of social work, indiana university bloomington, bloomington, in 47401. dr. virginia c. strand is a professor, fordham university graduate school of social service, west harrison, ny 10604 and co-director, national center for social work trauma education and workforce development. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), i-iii, doi: 10.18060/21630 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) ii beginning with early work in child welfare, the children’s bureau initiated a focus on trauma-responsive child welfare systems (2017). twelve schools of social work receiving traineeships through the national child welfare workforce institute (ncwwi, n.d.) now include a trauma lens in their child welfare courses. in 2012, cswe released its standards for advanced social work practice in trauma and many schools of social work now offer concentrations, specializations, or certificates in trauma-based care. a joint initiative between cswe and the national center for social work trauma education is scheduled to publish a curriculum guide for specialized practice in trauma by the end of 2017. this special issue of advances in social work recognizes the increasing role and importance of integrating trauma-informed care into our practices and into our educational programs. the issue presents 25 trauma related articles starting with conceptual and foundational articles, followed by empirical studies suggesting best practices, and culminating with articles describing emerging approaches in integrative and holistic care. beginning with two articles that explore integrating trauma-related content into curricula and pedagogy, the issue then provides an overview of the literature related to creating trauma-informed communities. we then present research that explores traumainformed interventions with specific populations including infants and toddlers, refugees, survivors of interpersonal violence, and male survivors of sexual abuse. the next section presents program and agency-based case studies that describe various strategies for implementing trauma-informed care such as staff training, learning collaboratives, interprofessional teams, and infrastructure development. empirical studies testing the effects of trauma-based care or curriculums follow and include one study evaluating outcomes for the core concepts in child trauma for child welfare curriculum utilized in a title iv-e university partnership, and another that assesses the effectiveness of a multiphase intervention with latino youth. additional studies describe the role that child attributes play in mediating the effects of trauma exposure and the relationship between adverse childhood experiences (ace) and youth arrested for sexual offenses. the issue concludes with articles describing innovative approaches in trauma therapy including work with children in a bereavement camp and an overview of equine-assisted psychotherapy for trauma survivors. we received a generous response to the initial call for papers for this special issue, which extended the anticipated timeframe for publication. we thank all of the authors and reviewers for their patience in working with us throughout the publication process. we would also like to thank margaret adamek, kadie booth, valerie decker, and michael hernandez for their help in bringing this issue to press. although we were unable to include all of the submissions in this issue, we were impressed with the scope of work being done in this field as well as the compassion, creativity and dedication of individuals working in this area. we look forward to the continuing evolution of our understanding of trauma and effective ways of addressing trauma and hope that this issue contributes to that process. respectfully, karen allen and virginia strand references allen & strand/tic editorial iii allen, k. & wozniak, d. (2014). the integration of healing rituals in-group treatment for survivors of domestic violence. social work in mental health, 12(1), 52-68. doi: https://doi.org/10.1080/15332985.2013.817369 centers for disease control and prevention, national center for injury prevention and control, division of violence prevention. (2014, may 13). prevalence of individual adverse childhood experiences. retrieved from: https://web.archive.org/web/20160404140139/http://www.cdc.gov/violencepreventio n/acestudy/prevalence.html/ children's bureau. (2017). children's bureau discretionary grant awards. retrieved from https://www.acf.hhs.gov/cb/resource/cb-discretionary-grant-awards council on social work education. (2012). advanced social work practice in trauma. retrieved from: https://www.cswe.org/getattachment/publications-andmultimedia/cswe-full-circle-(1)/newsletters-archive/cswe-full-circlenovember-2012/resources-for-members/traumabrochurefinalforweb.pdf.aspx/ figley, c. (ed.). (2002). treating compassion fatigue. sussex, u.k.: brunner-routledge. herman, j. (1999). trauma and recovery: the aftermath of violence from domestic abuse to political terror. new york: basic books. najavits, l. m. (2002). seeking safety: a treatment manual for ptsd and substance abuse. new york: the guilford press. national child traumatic stress network. (n.d.). home. retrieved from http://www.nctsn.org/ national child welfare workforce institute. (n.d.). what’s new. retrieved from www.ncwwi.org samhsa. (2015). trauma-informed approach and trauma-specific interventions. retrieved from https://www.samhsa.gov/nctic/trauma-interventions strand, v., popescu, m., abramovitz, r., & richards, s. (2015). building agency capacity for trauma-informed evidence-based practice and field instruction. journal of evidence-informed social work, 13(2), 1-19. teicher, m. h., andersen, s. l., polcari, a., anderson, c. m., & navalta, c. p. (2002). developmental neurobiology of childhood stress and trauma. psychiatric clinics of north america, 25(2), 397-426. doi: https://doi.org/10.1016/s0193-953x(01)00003x https://doi.org/10.1080/15332985.2013.817369 https://web.archive.org/web/20160404140139/http:/www.cdc.gov/violenceprevention/acestudy/prevalence.html/ https://web.archive.org/web/20160404140139/http:/www.cdc.gov/violenceprevention/acestudy/prevalence.html/ https://www.acf.hhs.gov/cb/resource/cb-discretionary-grant-awards https://www.cswe.org/getattachment/publications-and-multimedia/cswe-full-circle-(1)/newsletters-archive/cswe-full-circle-november-2012/resources-for-members/traumabrochurefinalforweb.pdf.aspx/ https://www.cswe.org/getattachment/publications-and-multimedia/cswe-full-circle-(1)/newsletters-archive/cswe-full-circle-november-2012/resources-for-members/traumabrochurefinalforweb.pdf.aspx/ https://www.cswe.org/getattachment/publications-and-multimedia/cswe-full-circle-(1)/newsletters-archive/cswe-full-circle-november-2012/resources-for-members/traumabrochurefinalforweb.pdf.aspx/ http://www.nctsn.org/ http://www.ncwwi.org/ https://www.samhsa.gov/nctic/trauma-interventions https://doi.org/10.1016/s0193-953x(01)00003-x https://doi.org/10.1016/s0193-953x(01)00003-x this work is licensed under a creative commons attribution 4.0 international license. developing trauma-informed care champions: a six-month learning collaborative training model samantha p. koury susan a. green abstract: this paper describes a six-month learning collaborative for service providers seeking to implement trauma-informed care (tic) into their agencies. although the professional literature on trauma-informed care has grown substantially over the past 10 years, little research has focused on how to effectively train agencies in creating a traumainformed culture shift. participants were trained as “tic champions” to help facilitate the creation of trauma-informed approaches in their agencies. through a parallel process, they learned the skills for planning and implementing a trauma-informed approach in their agency. at the completion of the training, trainers observed champions becoming more confident in their ability to assist their agencies in creating a trauma-informed culture shift. though quantitative studies evaluating the learning collaborative are needed, initial findings suggest the collaborative approach is an effective means of guiding champions through the process of becoming trauma-informed. keywords: trauma-informed care; agency change; training research indicates that trauma/adversity is a pervasive public health concern (hornor, 2015; roberts, huang, crusto & kaufman, 2014; substance abuse and mental health services administration [samhsa], 2014b). the adverse childhood experiences (ace) study found that more than one-half of the study participants experienced at least one adverse event such as physical or sexual abuse during their childhood (felitti et al., 1998). adversity does not necessarily equate to trauma; however, people who experience adverse events may perceive the events as traumatic. kilpatrick et al. (2013) found 89.7% of the 2,953 adults in their study reported having been exposed to at least one traumatic event as defined by the dsm-5’s criterion a (american psychiatric association [apa], 2013). due to the pervasiveness of trauma, multiple service sectors—beyond behavioral health— interact daily with individuals who have a trauma history (samhsa, 2014b). although it is not the role of all sectors to treat trauma directly by offering trauma-specific services, sectors that work with trauma survivors have the potential to re-traumatize, or replicate the dynamics of an individual’s trauma, through trauma-insensitive practices and procedures— thus worsening service outcomes. trauma-informed care trauma-informed care (tic) is an organizational approach that strives to prevent retraumatization while promoting healing. the tic service provider approaches each client with the assumption the individual may have experienced trauma (wolf, green, nochajski, mendel & kusmaul, 2014). service organizations themselves are starting to shift toward becoming trauma-informed systems of care in order to better address the needs of ___________ samantha p. koury, lmsw is project manager, institute on trauma and trauma-informed care, school of social work, university at buffalo, state university of new york, buffalo, ny 14260-1050. susan a. green is clinical associate professor, school of social work, university at buffalo, state university of new york, buffalo, ny 14260-1050. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 145-166, doi: 10.18060/21303 https://creativecommons.org/licenses/by/4.0/ koury & green/developing tic champions 146 individuals with trauma histories (bassuk, unick, paquette, & richard, 2017; wolf et al., 2014). professionals’ interactions with service recipients, as well as agency policies and procedures that are trauma-informed, reflect the paradigm shift from, “what is wrong with you?” to “what has happened to you,” and are anchored in the guiding values of safety, trustworthiness, choice, collaboration and empowerment (harris & fallot, 2001). becoming trauma-informed involves culture change within organizations, and incorporates all levels of staff, which often results in flattening the agency hierarchy (bloom, 2013). organizational culture refers to the shared, imbedded assumptions of staff members (schein, 2010). bloom (2006) argues that the majority of agency cultures are based on a medical model of treatment, and that this culture needs to shift away from a hierarchical power dynamic towards a more flattened, collaborative environment in order to be more trauma-informed. it is ultimately the function of leadership within an organization to identify the agency’s culture and transform it when it is no longer responsive to the environment (schein, 2010). leaders that champion the change process by being supportive and providing direction for change are critical (shultz, 2014). the development of “champions” is thus necessary for sustainability, as they continuously identify both the key factors contributing to sustaining organizational change and factors acting as barriers in order to address them (buchanan et al., 2005). buono and subbiah (2014) state that organizational change capacity is partially reliant on organizational members that have knowledge of change approaches and are willing to manage change—further contextualizing the importance and role of champions in the change process. these organizational members have the potential to mentor other staff, assess and monitor implementation goals, and assist in oversight of the overall change process, which helps build the infrastructure for sustainability (buono & subbjah, 2014). the development of internal champions is thus critical for trauma-informed organizational change. the existing literature on champions within trauma-informed organizations indicates they are the individuals who have knowledge about trauma and its impacts; prioritize sensitivity in all aspects of organizational functioning; and provide expertise to promote and support changes to policies, practices, and staff development (harris & fallot, 2001; jennings, 2009). while all staff members should have foundation knowledge around trauma and tic in a trauma-informed organization, tic champions think “trauma first” and highlight potential concerns to other professionals in the service delivery system (harris & fallot, 2001). frameworks for tic also delineate that champions of the approach are often necessary to initiate and sustain organizational change (samhsa, 2014a; harris & fallot, 2001). champions are able to facilitate change and function as part of the infrastructure for overall sustainability by taking on the roles of educator, mentor, coach, consultant, and/or advocate. training while there is a gap in the literature describing models of tic training, there is a growing body of literature around what content should be covered and the structure to use for staff trainings to effectively create trauma-informed culture change (harris & fallot, advances in social work, spring 2017, 18(1) 147 2001; jennings, 2009; samhsa, 2014a, 2014b). fallot and harris (2009) propose an initial kickoff training that covers the key components of trauma-informed cultures, the importance of applying tic to staff as well as clients, and the degree of importance trauma holds with the agency looking to be trained. short-term and long-term follow-ups to the initial training are recommended to deepen staff understanding of trauma, how to implement tic with clients, and how tic applies to them as staff (harris & fallot, 2001). similarly, samhsa (2014b) advises agencies to focus on the impacts of trauma and how agency practices can unintentionally replicate the dynamics of an individual’s trauma history and thus be re-traumatizing. training should also deliberately focus on ways the agency can prevent re-traumatization and how to identify, prevent, and address secondary traumatization and vicarious trauma. trauma and tic training content needs to be framed in overarching historical and cultural considerations (jennings, 2009; samhsa, 2014b). in light of tic’s emphasis on healing and growth, and the growing literature around the human capacity to bounce back and even flourish after experiencing adversity or a traumatic event, it is important for staff to learn how to promote resilience and posttraumatic growth (american psychological assocation, 2016; calvo, ukeje, abraham & libman, 2016; tedeschi & calhoun, 2004). there is some evidence that longitudinal, multifaceted, and interactive education strategies may be more effective for long-lasting changes in skills, attitudes and practice approaches than single-session workshops or trainings (hoge et al., 2007; pearce et al., 2012). tic implementation involves a culture shift that needs to be reflected in all aspects of agency functioning (harris & fallot, 2001). such a change arguably can take a few years to achieve. not surprisingly, samhsa (2014b) advises agency administrators to invest in tic trainings that are longitudinal, emphasize interactive and experiential learning activities, and are geared toward training a core group of staff who can then train other staff. further, in a review of tic in in-patient settings, muskett (2014) concurs that ongoing trauma-informed education and skill development, mentoring, and regular debriefing are key components of successful tic implementation. hall and colleagues (2016) explored the effectiveness of single day tic training for emergency department nurses and found that while the nurses’ understanding of tic increased, the participants were not confident in their ability to implement trauma-informed approaches due to various complexities of their work environment. without an organizational culture shift impacting policies, procedures, and day-to-day interactions, tic is not sustainable. based on the findings of hall et al. (2016), the evidence that longitudinal trainings may be more effective for creating longer lasting changes, and the training recommendations provided by harris and fallot (2001) and samhsa (2014b), an effective training model for tic implementation needs to be staged and offered over time. because of the difficulties in creating and sustaining agency cultural change to a tic approach, and the limited body of literature on tic training, the purpose of this paper is to fill the gap in the literature by describing the use of a six-month learning collaborative model for training tic champions. koury & green/developing tic champions 148 the learning collaborative an interactive learning collaborative model was created in order to train “tic champions” over a six-month period. the collaborative was developed based on the need to create sustainable trauma-informed organizational change and the literature supporting the use of longitudinal tic training. participants in the collaborative were trained on how to create trauma-informed agencies based on the components of effective tic training described earlier. by expanding a train-the-trainer approach, the learning collaborative not only provided champions with content and resources, but also promoted a parallel process through the trainers’ modeling of skills, activities, and discussions—putting the champions in the position to bring the information and resources back to their own agencies for planning and implementation. selection of champions the champion team was created as part of a state-wide initiative to build agency capacity for tic within the adolescent substance use system of care. applications were sent to multiple addiction programs across new york state and included information about the learning collaborative, expectations for being a tic champion, and the requirements for participation. champions were expected to attend and participate in all components of the learning collaborative, have the ability to implement changes in their agencies, and have the ability to train and coach other staff. harris and fallot (2001) stress the importance of administrative support for trauma-informed organizational change. thus, we requested applications to be filled out by both the tentative champion and their supervisor/administrator, as well as required a signed attestation of commitment to tic capacity building by the agency’s executive director. table 1 below depicts the questions asked in the application. table 1.questions on tic champion application questions for future tic champions questions for supervisor/administrator what is your “best hope” of being a tic champion? describe the future tic champion’s ability to implement changes in agency policy and practice to promote tic. what are you already doing that tells you, “i will be an effective tic champion”? describe the steps your agency has already taken to train staff or implement a tic approach to service delivery. how do you see yourself assisting in the implementation of tic at your workplace? describe your experience/ability in being a leader, trainer and/or mentoring others. describe your ability to implement changes in agency policy and practice to promote tic. advances in social work, spring 2017, 18(1) 149 applications were reviewed separately by two individuals who ranked each application based on the applicant’s ability to implement change, train other staff, and the changes their agency has already taken toward becoming more trauma-informed. thirty champions from across new york state were chosen based on mutual agreement of the reviewers. the majority of the team was comprised of individuals in middle-management roles such as clinical supervisors and program directors/coordinators, with a smaller portion represented by direct care staff. once chosen, the champions were e-mailed a congratulatory letter, details about the first in-person training and directions for creating an account to access the required online continuing education course. they were also sent a link to an online, 10 question tic knowledge and attitudes pre-test created by the authors and their colleagues via survey monkey to get a baseline assessment before any training began. individuals who were not chosen were also sent letters thanking them for their interest. foundational trauma knowledge as stated earlier, all agency staff working in a trauma-informed organization have foundational knowledge about trauma and tic (harris & fallot, 2001; samhsa, 2014b). before attending the initial training, champions were asked to complete a one and one-half hour online course titled “trauma 101: an overview of psychological trauma,” provided through the university at buffalo’s school of social work continuing education program to ensure they had a basic understanding of trauma, re-traumatization, the ace study, and an overview of harris and fallot’s (2001) five values of tic. to strengthen their knowledge around trauma and tic within the addictions field, champions were also asked to read the first chapter of greenwald’s (2014) child trauma handbook: a guide for helping trauma-exposed children and adolescents and an article titled “traumainformed care and addiction recovery: an interview with nancy j. smyth” (steiker, 2015). initial training all champions were required to attend a seven-hour, in-person training during the first month of the collaborative. champions received folders with various handouts to reference during the day, a copy of the powerpoint slides, and a document detailing the schedule for assignments, consultation options, and evaluations. after the champions introduced themselves, the trainers asked what needed to happen during the training to make it worthwhile. these “best hopes” were recorded on an easel in order to reference at the end of the day. using the work of steiker (2015), one of the trainers anchored the group around what it means to be a champion by talking about his own experience in organizational change. this discussion highlighted five pieces of advice to consider as a champion over the course of the collaborative: personally commit to the role of a champion, involve key stakeholders in their agency in the process, remember the importance of senior leadership support, ensure that an organizational assessment is conducted early in the process, and to be relentless in advocating for trauma-informed practices. koury & green/developing tic champions 150 the training then moved onto a brief review of trauma by taking a deliberate look at what the champions were already noticing in their work around trauma and addiction, and having an in-depth discussion around re-traumatization. the morning ended with the differentiation between the three levels of trauma practice: trauma-informed, the overarching umbrella consisting of the guiding principles of tic; trauma-sensitive, considering the physical environment and day-to-day interactions for the potential of retraumatization, as well as screening and assessing for trauma; and trauma-specific, providing evidence-based trauma treatments such as trauma-focused cognitive behavioral therapy (tf-cbt) and eye movement desensitization and reprocessing (emdr). table 2 below depicts the content covered and its objective. table 2. morning training content and objectives topic/discussion objective understanding trauma (lecture)  impacts on the body  historical trauma  impacts on world view  explain how trauma may affect individuals addiction and its impact (discussion)  what are you noticing about the individuals you treat?  what do you notice about your staff and how they “interface” with client’s addiction?  what do you notice about how you “interface” with the organization/system in regards to the treatment of addiction?  identify ways in which trauma impacts addiction  identify current staff and system interactions and procedures re-traumatization (lecture)  what is it?  the story of anna jennings (jennings, 1994)  how common mental health practices mirror the dynamics of a trauma experience  impact of re-traumatization on clients  impact of re-traumatization on staff  increase awareness of potential retraumatization through interactions, procedures and policies  recognize the impact of re-traumatization on clients and staff three levels of trauma practice (lecture)  trauma-informed  trauma-sensitive  trauma-specific  be able to articulate the difference between the three levels of trauma practice  identify the levels of practice that make sense for their organization the afternoon portion of the training focused on organizational change. the champions were first divided into five groups of six and given a large piece of paper with one of the five values listed on it. the group members were asked to come up with at least five things their programs are already doing that demonstrate organizational change for both clients and staff. the three trainers listened and asked prompting questions as necessary. each group reported what it discussed while other groups were invited to share additional thoughts. advances in social work, spring 2017, 18(1) 151 after reconvening as a big group, the champions learned about the steps for creating trauma-informed culture change in human service programs, completed the “traumainformed care in youth serving settings: organizational self assessment” (traumatic stress institute of klingberg family centers, n.d.) as an activity to demonstrate the various components of trauma-informed organizational change, and were given an overview of the ten implementation domains proposed by samhsa (2014a). table 3 provides an overview of the afternoon topics, activities, and objectives. table 3. afternoon training content and objectives topic/discussion objective five guiding values of tic (activity)  small group discussion of what is already happening in their programs around the five values  identify ways in which their programs are already using tic—strengths to build on  hear from other champions around what they have in place steps for tic culture change (lecture)  commitment by administration  universal screening, training/education, hiring practices  review of policies and procedures  assessment/evaluation (harris & fallot, 2001)  identify and understand what it takes to create a trauma-informed organization organizational self-assessment (activity)  completed the “trauma-informed care in youth serving settings: organizational self assessment” (traumatic stress institute of klingberg family centers, n.d.)  discussion around what it was like to complete the assessment  identify and understand what it takes to create a trauma-informed organization  identify areas of strength and improvement in own program implementing tic (lecture)  overview of samhsa (2014a) ten implementation domains  identify and understand what it takes to create a trauma-informed organization  have a basic understanding of the ten domains that will frame the rest of the collaborative lastly, the trainers reviewed the schedule for the remainder of the collaborative and introduced the team’s samepage—a private web page that served as the main center of communication between consultations. the champions were informed that later that day, they would receive an e-mail invitation to the samepage, their first homework assignment and a survey monkey link for the tic attitudes and knowledge post-test to assess for koury & green/developing tic champions 152 changes from before the training. the trainers later reviewed the changes on the survey from preto post-test in order to inform future trainings. samepage due to both the length of the collaborative, and the majority of it taking place in an online format, the trainers wanted to have an online space for the team to interact between consultations. thus, the trainers created a collaborative website on samepage for the champion team to use throughout the training as depicted in figure 1. access to the website was provided by e-mail invitation after the initial training, so that only participants in the collaborative could view it. the samepage was broken down into five sections: team files and resources, homework area, calendar, the “champion’s resource corner,” and a chat bar. the trainers uploaded resources including documents and handouts, posted the powerpoint slides after each consultation, and provided links to relevant tic websites and videos in the team files and resources section. the homework area provided a space for champions to upload each assignment for others on the team to read, and provided information on assignment due dates and how to upload assignments. the calendar denoted each of the consultation options as well as the date and location of the final training. the champions uploaded their own resources and asked for feedback on their ideas and plans around implementing tic in the “champion’s resource corner.” the “corner” provided a space where the trainers and team members could use samepage’s comment function to provide feedback on the uploaded material. lastly, the “chat bar” provided a quick way for the team and trainers to communicate. everyone with access to the page received an e-mailed each time a comment was left. the trainers often used the chat bar to figure 1.samepage example advances in social work, spring 2017, 18(1) 153 ask the team questions and provide reminders for upcoming consultations and assignment due dates. the team was informed that the samepage would be available to them even after the learning collaborative finished, so they would have a place with a collection of tic resources and a means to reach out to other champions after the trainers were no longer involved. monthly consultations the third component of the learning collaborative involved consultations from months two through five. the champions were required to attend one of the two, 90-minute consultations each month. in order to keep the group size manageable, each offering had no more than 15 champions. the consultations were held through blackboard collaborate—an online collaborative learning platform that allows for audio, video, and text chat. the champions were provided with detailed instructions on how to download and run the software in advance. one of the trainers was also available by telephone to troubleshoot any technology problems. general format. in order to further operationalize what is involved in traumainformed organizational change, the content of each consultation was anchored around two of samhsa’s (2014a) ten implementation domains. governance and leadership and policy were covered in month two, physical environment and engagement and involvement in month three, cross-sector collaboration and screening, assessment, treatment services in month four, and training and workforce development and financing in month five. the final two, progress monitoring and quality assurance and evaluation, were included in the final training. figure 2 example homework responses koury & green/developing tic champions 154 although the content differed for each consultation, there were some structural components that remained the same. each consultation started with a review of the day’s agenda and a report of the team’s homework responses. the trainers read the homework responses ahead of time so as to identify themes and create visual summaries for the homework report (see figure 2). the report focused on the themes while highlighting some examples that were already in place. the champions were asked to listen and notice if anything resonated with them. each consultation also included an activity making use of scaling questions from the solution-focused model (dejong & berg, 2013). the trainers compiled a list of “things to consider” for each domain—questions to operationalize the domains adapted from various sources (harris & fallot, 2001; samhsa, 2014a, 2014b; trauma informed oregon, 2015). the champions received the “things to consider” with space to write under each question ahead of time via e-mail and were asked to bring a printed copy to the session. during each consultation, champions were asked to choose one or two questions under each domain to look at more closely. the champions independently recorded their answers to the following three scaling questions: on a scale from 1 to 10, with 10 representing your program’s ideal implementation for that question and 1 being the complete opposite, where would you scale your agency right now? what is already happening that lets you know you are at that number (as opposed to a lower number)? and, what will be different if your agency were to move just one number higher on the scale? once the group reconvened, the champions shared one of the questions they thought about. the trainer then asked follow-up questions to help each champion come up with a next small step they could take in their role in order to help the program get one number higher on the scale. homework. before each consultation, champions were required to complete short homework assignments around the two domains to be reviewed that month. each domain had a total of two or three questions. the team was given approximately two weeks to complete each assignment before uploading their responses to the samepage for others to view. the purpose of having the champions complete the assignments ahead of time was twofold: to have the champions begin to think about how each of the domains apply to their program already (strengths and areas for improvement), and to help the trainers focus discussion questions around where the team was regarding its current level of implementation and understanding for each domain. table 4 below lists example homework questions. advances in social work, spring 2017, 18(1) 155 table 4. example homework questions hw implementation domain question example #1 governance and leadership discuss thoughts you have regarding what you might say/do in informing your leadership about tic and your best hope for your role within your agency. policy how do your agency’s written policies and procedures already include a focus on trauma-informed care, trauma-sensitive care, and trauma-specific care? #2 physical environment discuss how your organization considers the physical safety of clients and staff. how does the physical environment promote a calm and aesthetically comfortable setting? engagement and involvement discuss thoughts you have around including client, peer, family and staff voice and involvement in the planning, implementation and evaluation of tic in your agency. #3 cross sector collaboration is there a system of communication in place with your partner agencies working with the individual receiving services for making trauma-informed decisions? (samhsa, 2014a) screening, assessment, treatment services what screening/assessment tools are you using to screen for adversity (ace) and/or trauma (ptsd)? #4 training and workforce development what mechanisms and supports are in place to address the emotional stress that can arise for staff/volunteers/peers when working with individuals who have had traumatic experiences (i.e., vicarious trauma)? financing explore what is already in place or what will be in place to support/finance a trauma-informed initiative in your agency. #5 progress monitoring and quality assurance how is your agency tracking the use of trauma-specific screening, assessment, and treatment? evaluation how is your agency tracking the trauma-informed initiative/approach? content. as stated previously, each of the consultations were framed in two of the ten implementation domains proposed by samhsa (2014a). the content and structure of the consultations were formulated collaboratively by two of the trainers based on the literature (british columbia center of excellence for women’s health, 2013; harris & fallot, 2001; lipsky & burk, 2009; meichenbaum, n.d.; pearlman & mckay, 2008; samhsa, 2014a; samhsa, 2014b). the content was further adapted to fit the needs of the champions based on their homework responses. the consultations were largely discussion-based to give the champions opportunities to hear and learn from each other. resources in the form of readings, handouts, websites, and tools were also provided where applicable. table 5 showcases the content of each of the four consults and their objectives. koury & green/developing tic champions 156 table 5. consultation content consult topic/discussion objective(s) #1 governance & leadership policy creating culture change  review of the 5 guiding values and steps for creating organizational change (harris & fallot, 2001)  resource “creating cultures of traumainformed care” (fallot & harris, 2009) leadership and policy  introduction to the scaling questions (activity)  anchor around the nuances of each of the five values  recognize the “big picture” of tic organizational change  identify program strengths and areas of improvement  formulate a next small step #2 physical environment engagement & involvement agency walkthroughs  walkthrough goals  national center on substance abuse and child welfare[ncsacw] tic assessment project – physical space trauma triggers (video)  what are you noticing, or what has your agency put in place around triggers in the physical environment? (discussion) engagement: agency readiness  tic organizational change interview (video)  what are you experiencing in your own agency with regard to agency readiness for creating a trauma-informed environment? (discussion) role as a tic champion  10-minute solution-focused conversation (activity; fiske, 2010)  recognize aspects of the physical environment that may be retraumatizing/triggering  identify changes to address triggers in the physical environment  identify agency’s readiness for becoming trauma-informed  begin to identify who in their program might be a part of their tic workgroup/initiative  articulate their best hopes around their role as a champion  formulate a next small step to take in order to reach those best hopes #3 cross sector collaboration screening, assessment, treatment services collaborative partners  how might knowing where collaborative partners are in their understanding of trauma-informed, trauma-sensitive and trauma-specific services impact your own/your staff’s work with partners? (discussion) screening/assessment/treatment  resources – tip-57 pg 91-110 (samhsa, 2014b); “child and adolescent trauma measures: a review” (strand, pasquale & sarmiento, 2003); dsm-5 assessment tools and measures (apa, 2017)  if someone is referred to your agency, how do you know if they’ve already been  understand the implications of working with partners who are not trauma-informed, trauma-sensitive and/or trauma-specific  increase awareness of the importance of collaborating with partners around tic  identify resources for choosing appropriate screening/assessment tools  understand the importance of knowing what trauma screening/assessment tools have been used by referral sources advances in social work, spring 2017, 18(1) 157 consult topic/discussion objective(s) screened/assessed for trauma? what tools have been used? (discussion)  is there anyone in your agency you would see as a “trauma expert”? guest speaker  tic champion from a local agency came to talk about their process in becoming traumainformed, largely framed in the two domains for this consult  time for questions included  identify who, if anyone, in their agency is knowledgeable about trauma through education/training that could be a point person for decisions around screening, assessment, treatment and/or referrals  hear from a tic champion from an agency further in the process of becoming trauma-informed #4 training & workforce development financing staff training (provided during hw report)  resource – treatment improvement protocol [tip]-57 pg179-183; appendix b (samhsa, 2014b) supervision (provided during hw report)  resource – tip-57 pg 93, 191, 195, 197, 205 (samhsa, 2014b) agency supports  how are you/co-workers/staff managing around the loss of clients? what is in place for residents/clients? for staff? (discussion) impact of trauma on staff  secondary traumatic stress, vicarious trauma, compassion fatigue, burnout (overview)  what do you notice about individual/organizational risk factors? (discussion)  what do you notice about individual/organizational protective factors? (discussion)  awareness-balance-connection (abcs)  self-care assessment (activity)  coping  resources – professional quality of life scale [proqol] (stamm, 2010); university at buffalo school of social work self-care starter kit (butler & mcclain-meeder, 2015).  identify resources to address champion-stated areas of improvement around providing tic staff training and supervision  identify how they and others in their programs are managing (strengths) in face of the reality of losing clients  recognize the importance of agency supports for staff  understand the ways trauma can impact staff  identify what might put staff at a higher risk for being negatively impacted by trauma  identify what may decrease the risk of staff being negatively impacted by trauma  increase awareness of their own self-care  understand key components of effective coping  identify further resources for assessing and promoting self-care evaluations. each consultation had its own evaluation for the purpose of informing future consultations. the champions who attended any given consultation received a link to an online survey monkey to provide feedback. although they were encouraged to provide their feedback in order to help the trainers make adjustments to future consultations, koury & green/developing tic champions 158 their participation was completely anonymous and voluntary. using a likert scale, the champions completed the evaluation, which asked how helpful the components of the consultation were, how much the consultation helped their understanding of the content covered, and how much of the content they thought they would use in the planning and implementation of a trauma-informed approach. the evaluations also had two open-ended questions that asked the champions to indicate the most helpful part of the consultation and how the consultation could have been more helpful. evaluations were reviewed while planning for subsequent consultations and small adjustments were made to technology, facilitation style, and activities. final training the learning collaborative ended with a four-hour, in-person training during month six. the powerpoint slides were posted to the samepage so that the champions could print the slides if they wished. the trainers spent time checking in with the team by asking the champions to consider what they noticed different about themselves compared to the initial training. each champion was encouraged to share their thoughts about the training. the first half of the training focused on resilience and posttraumatic growth. the champions were divided into groups of three and were given a small slip of paper with questions about resilience. additional questions were provided after short periods of time for the groups to continue their discussions. after the group reconvened and talked about what came up for each of them, one of the trainers provided a brief overview of resilience and posttraumatic growth. the team then took a short break and reconvened to talk about their experiences being in a six-month learning collaborative and to have a deliberate conversation about the parallel process that occurred over the six months. in order to anchor a short discussion around the progress monitoring and quality assurance and evaluation domains, the team re-visited the same agency self-assessment they completed in the initial training. table 6 below depicts the content covered in the first half of the training and its objective. table 6. morning content and objectives topic/discussion objective(s) tuning into the work (small group activity)  what challenges have you witnessed your clients/other staff/organization overcoming in your work with them?  how have you been positively impacted by witnessing this resilience?  how has your perception of yourself been changed by witnessing this resilience? your perception of your work?  how has your world view been changed by witnessing this resilience?  recognize the positive impacts the work has on them advances in social work, spring 2017, 18(1) 159 topic/discussion objective(s) resilience/posttraumatic growth (lecture)  brief review of vicarious trauma & coping  transformation of vicarious trauma  defining resilience  interpersonal factors of resilience  vicarious resilience  posttraumatic growth  have a basic understanding of resilience, vicarious resilience and posttraumatic growth  identify ways to build resilience into the workplace parallel process (overview, brief discussion)  what was it like being in a 6-month learning collaborative?  deliberate look at everything involved in the collaborative and how each component promoted a parallel process—content and the means to bring the content to others  identify skills, discussion points, activities and other means of teaching and coaching that the trainers used during the learning collaborative  consider which means of teaching and coaching make sense in light of their role as a champion and where their agency is at agency assessment (activity, brief discussion)  filled out the same agency assessment they completed during the initial training and then compared  further understand the progress monitoring and quality assurance, and evaluation implementation domains  recognize any changes that have occurred over the course of the collaborative the remainder of the training was spent focusing on tic action planning through activities and discussion. first, the champions were given three circles divided into ten sections—each section labeled with one of the samhsa (2014a) ten implementation domains. in an activity adapted from integrative nutrition, inc. (2006), the champions were asked to place a dot on the line of each domain to visually display where they saw themselves—the center of the circle represented not being competent, while the periphery represented their ideal competence. they were then asked to consider their own level of competence on the first handout, their agency’s level of competence on the second handout, and their agency’s level of implementation on the third handout for each domain. once finished with the plotting, the champions were instructed to connect the dots on each circle to have an overall display of their competence, their agency’s competence, and their agency’s level of implementation. the back of each circle handout had a chart with each of the implementation domains listed in one column and space to explain the capacities and strengths associated with each. the champions were asked to pick just two domains to fill in on each chart based on their plotting on the front of the handout. once they finished working on the circles and their associated charts, the team was divided into pairs and given a handout with a ten-minute solution-focused conversation adapted from fiske (2010). using the framework provided, the champions had a conversation around implementing one of the domains they focused on in the previous activity into their work. each champion had the opportunity to be in the role of the person asking questions and the one answering questions. the solution-focused conversation framework helped each of the champions identify a next small step they could take in order to reach their ideal implementation for that domain. koury & green/developing tic champions 160 the trainers then handed out one additional chart titled, “trauma-informed care implementation action plan.” the chart listed all ten domains in one column, had a column to rate the agency on a scale from one to ten, a column for the champion’s next step, and a final column for the agency’s next step. the trainers explained that the chart would be filled out based on all of the action-planning activities and discussions they had up until that point, and could thus be used to create an action plan with others in their agency. the training concluded by having a short discussion around how the team would stay in contact after that day. the trainers then called each champion up one by one to receive their certificate of completion for the learning collaborative. the champions were informed that there would be additional resources posted to their samepage based on their conversations that day and that they would also be receiving one last online evaluation. the trainers thanked the champions for their participation in the learning collaborative and encouraged them to stay connected to each other. evaluation. the evaluation for the closing training was e-mailed later that day to those who attended. similar to previous evaluations, the final evaluation asked the respondents what was helpful, how well the training met their needs, how confident they felt in their role as a tic champion and if they felt they had the tools to create a tic implementation plan. additionally, there were three free-text questions that asked about what was most helpful about the training, what could have made the training more helpful, and a space for any other comments or feedback about the collaborative in general. trainer experiences in addition to online evaluations for each of the consultations, the trainers took note of their experiences facilitating the learning collaborative and debriefed together after each training or consultation. this activity allowed the trainers to recognize a number of strengths and challenges associated with the six-month learning collaborative. strengths the champions often verbally reported how they appreciated the learning collaborative occurring over a six-month period. tic was on the forefront of their minds because they had to be accountable to the trainers and to the rest of the team each month through submitting homework assignments and attending the consultations. otherwise, many stated tic would have likely been “lost in the shuffle” or consistently moved to the bottom of their “to-do” lists. the majority of the 30 team members were engaged and participated in all of the learning collaborative components. further, the homework assignments and consultations facilitated the champions’ thinking about tic, conversations with coworkers around tic, and how to apply the guiding values and implementation domains within their own programs more consistently than if they had only attended a regular training. much like buono and subbiah (2014)’s operationalization of the role of an internal change agent as regularly monitoring and overseeing the organizational change process, and harris and fallot’s (2001) recommendation for the identification of champions in order to keep the tic initiative active and in the forefront of all agency advances in social work, spring 2017, 18(1) 161 functioning, the learning collaborative helped model this expectation of being a tic champion. creating a sense of being a “champion team” was another apparent strength of the learning collaborative model. by the second or third consultation, the champions often consulted with fellow team members instead of asking the trainers facilitating the consultations. the champions also expressed that hearing from others on the team was helpful, not only because they were reassured by others being “in the same boat,” but also because they were able to think of new ideas and next steps by hearing what others were doing. such observations are in line with previous research findings that show some effectiveness of mutual aid group processes such as shared experience and building on others’ expertise/views increasing group member confidence and learning (finch & feigelman, 2008; shulman, 2008; steinberg, 2010). one of the champions suggested creating a contact directory of those who would be willing to stay in touch, and the others readily agreed. the champions also discussed the possibility of continuing to have their own “consultation calls” without the trainers in order to keep the process going. the team continued the process of mutual aid by deciding on their own that they wanted to stay connected even after the collaborative ended in order to keep helping and supporting each other (steinberg, 2010). lastly, the trainers noticed the champion team had grown in their ability to understand and think critically about tic. by the final training in month six, the champions were using the five values in their language more frequently and were able to articulate barriers and possible solutions to implementing tic within the ten domains. many of the champions reported a difference in themselves in month six compared to the first month of the collaborative—including feeling more confident in their understanding and ability to bring aspects of tic back to their programs. these observations resonate with findings and suggestions in the literature that longitudinal, multifaceted training programs may be more effective than single-day workshops in facilitating long-lasting changes and confidence in implementing tic (hall et al., 2016; hoge et al., 2007; pearce et al., 2012). challenges technology was the biggest challenge throughout the collaborative. despite one of the trainers making herself available to troubleshoot with the champions who were having difficulty, a portion of the team went through all of the consultations without having audio capabilities. even though an external headset was recommended for participation, not all of the champions were able to get one, and their computers were not equipped with microphones. these champions had to participate by typing their answers, comments, and questions into the “chat box.” one of the two trainers facilitating the consultations read these champions’ comments out loud and addressed what was said to include them as much as possible, but the flow of the consultations and ability to have an interactive group discussions were impacted by a portion of the team not having audio capacity. additionally, background noise from the room where the trainers were facilitating the discussions resulted in some champions having difficulty hearing the trainers. the trainers also purchased headsets after the first consultation, which significantly improved the audio. unfortunately, the blackboard collaborate technology occasionally lagged, skipped koury & green/developing tic champions 162 portions of the training, and even disconnected for some of the champions, which caused difficulties in the champions’ ability to participate. isolation and decreased interactions caused by technology challenges may be a factor that leads to dissatisfaction with the learning collaborative and/or inhibited learning (jang & kim, 2014; koutsoupidou, 2014). investigating other online learning platforms such as webex, where participants can participate via the telephone, might be worthwhile. another challenge was the lack of opportunity to make up any pieces of the collaborative that were missed. the dates of the consultations and closing training were selected by the trainers and given to the champions prior to the initial training. however, some champions missed one or two consultations due to technology, a work-related crisis, or being sick. one of the trainers made herself available to touch base over the telephone for 15-20 minutes for champions who were unable to attend a consultation and wanted to get caught up; however, these champions still missed the experience of being a part of the consultation with their peers. giving absent champions access to recordings of the sessions could provide some of the experience of being in the consultation that they missed. as blackboard collaborate does have the ability to record, it may be worth recording the sessions in a future learning collaborative for those who are absent to watch in addition to following up with one of the trainers. one last challenge was the small number of champions who completed the evaluations after each consultation and the closing training. though the evaluations were voluntary, the champions were encouraged each time to provide their feedback so that the trainers could modify future consultations to better meet their needs. additionally, those who did provide feedback did not always write an answer to the free text question of what might have made the consultation more helpful for them. the trainers made some adjustments based on the feedback that was given, especially around any technology challenges. however, it was difficult to know how the learning collaborative was being received by the team as a whole due to the low response rate. implications based on verbal reports from participants and the experiences of the trainers facilitating the learning collaborative, the model appears to have initial evidence of being an effective means of training tic champions. however, as the described collaborative was not a research study, further quantitative research is required in order to truly evaluate the effectiveness of the learning collaborative. evaluation tools other than those collected for the trainers’ use could be implemented to assess understanding and implementation steps taken throughout and the collaborative. follow-up evaluations after the completion of the learning collaborative would also be important in assessing long-term understanding and implementation, as the primary purpose of training champions is to build sustainability for tic organizational change. additionally, the participants in the learning collaborative were from agencies working with adolescents who have substance use diagnoses. facilitating the learning collaborative with different types of service providers while collecting data would increase the generalizability of the findings. future studies comparing the learning collaborative model to other means of tic training, such as single workshops, would also advances in social work, spring 2017, 18(1) 163 add to the literature by determining whether the collaborative is more effective than the comparison training modality. as more organizations and systems of care make the shift to becoming traumainformed, there will be an increasing need for effective training modalities. although further research is necessary to provide a better understanding of the learning collaborative model’s effectiveness, the collaborative is an example of how individuals from 30 different agencies can be trained and developed into tic champions, who are then in a position to train their co-workers and other staff, understand what is required to become a traumainformed agency, and help ultimately support their agency in the implementation of tic. references american psychiatric association [apa]. 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(2014). ‘we are civil servants’: the status of trauma-informed care in the community. journal of social service research, 40, 111-120. doi: https://doi.org/10.1080/01488376.2013.845131 author note: address correspondence to: susan a. green, school of social work, university at buffalo, 664 baldy hall, buffalo, ny 14260, 716-645-1249, sagreen@buffalo.edu http://store.samhsa.gov/shin/content/sma14-4884/sma14-4884.pdf https://ncwwi.org/files/evidence_based_and_trauma-informed_practice/child-and-adolescent-trauma-measures_a-review-with-measures.pdf https://ncwwi.org/files/evidence_based_and_trauma-informed_practice/child-and-adolescent-trauma-measures_a-review-with-measures.pdf https://doi.org/10.1207/s15327965pli1501_01 http://traumainformedoregon.org/wp-content/uploads/2016/07/guidelines-crosswalk-standards-of-care-for-trauma-informed-care.pdf http://traumainformedoregon.org/wp-content/uploads/2016/07/guidelines-crosswalk-standards-of-care-for-trauma-informed-care.pdf http://traumainformedoregon.org/wp-content/uploads/2016/07/guidelines-crosswalk-standards-of-care-for-trauma-informed-care.pdf http://traumaticstressinstitute.org/wp-content/uploads/2010/06/trauma-informed-care-org-self-assessment-final.pdf http://traumaticstressinstitute.org/wp-content/uploads/2010/06/trauma-informed-care-org-self-assessment-final.pdf https://doi.org/10.1080/01488376.2013.845131 mailto:sagreen@buffalo.edu _______ kristen faye linton, msw, ph.d., assistant professor, california state university channel islands health science. camarillo, ca. chrissy stamegna, b.s, veronica zepeda, b.s., and charles watson, mba, brain injury center of ventura county, camarillo, ca. graal diaz, ph.d, thomas duncan, d.o., and lauren van sant, d.o., ventura county medical center, ventura, ca. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 725-738, doi: 10.18060/23361 this work is licensed under a creative commons attribution 4.0 international license. the impact of a care transitions intervention on people with brain injuries and their caregivers kristen faye linton chrissy stemegna veronica zepeda charles watson graal diaz thomas duncan lauren van sant abstract: as our population ages, the prevalence of brain injuries increases due to strokes and falls. brain injuries are a leading cause of rehospitalization for patients, and most brain injury survivors experience depression soon after hospital discharge. this study assessed the difference between: 1) survivors of brain injury’s baseline and 30-day depression, functional ability, and quality of life and caregivers’ depression and caregiver burden among those that received the care transitions intervention, and 2) 30-day hospital readmissions between survivors of brain injury that received care transitions and a control group. the study used a quasi-experimental pre-posttest design. participants included people with brain injuries who received the care transitions intervention (n = 22) and their caregivers (n = 20) compared to a services-as-usual control group of brain injury survivors (n = 27). care transitions is a 90-day family-focused, home visitation, coaching hospital-to-home transition intervention. outcomes were self-reported baseline and 30-day depression, functional independence, quality of life, and caregiver burden. hospital record data was used to report readmissions. study results showed that there were statistically significant differences between depression, functional ability, and caregiver burden between preand post-survey scores among care transitions participants. care transitions’ participants experienced lower brain injury-related hospital readmissions than the services as usual control group. social work hospital discharge planning needs to continue beyond the hospital and include home visitation to ensure patient and caregiver needs are met post-hospital discharge. keywords: care transitions; brain injury; hospital readmission; depression; caregiver burden brain injury affects people of all ages. in 2014 alone 2.87 million hospitalizations, emergency department visits, and deaths combined occurred due to brain injuries in us (centers for disease control [cdc], 2018). since 2006, rates of brain injury-related emergency department visits increased by 54% (cdc, 2018). as the population ages, the prevalence of brain injuries due to a stroke or fall increases (cdc, 2018). brain injury is a leading cause of 30-day hospital readmissions (taylor et al., 2017). brain injury may be caused by an internal injury (i.e., stroke) or an external injury (i.e., trauma from a fall, motor vehicle crash, or assault, etc.). seventy percent of brain injury survivors and 20% of https://creativecommons.org/licenses/by/4.0/ linton et al./impact of a care transitions intervention 726 their caregivers experience mild depression within the first 90 days post-hospital discharge (kreutzer et al., 2009; ottenbacher et al., 2001). traditional discharge planning, including discharge planning in the hospital as well as one follow-up phone call by hospital personnel, has not met the ongoing needs of brain injury survivors and their caregivers who desire support with healthcare system navigation, equipment and medication information, brain injury symptoms, and community resources (linton et al., 2015). the centers for medicare and medicaid’s hospital readmissions reduction program (mmhrrp) lowers payments to hospitals with high 30-day readmission rates (centers for medicare & medicaid, 2020). as such, hospitals have a financial incentive to improve hospital-to-home care transitions. effective in 2012, mmhrrp was passed in section 3025 of the affordable care act to reduce payments to inpatient prospective payment system hospitals and to avoid excess readmissions. to avoid readmissions, the needs of people with brain injuries and their caregivers must be identified and met. individual patients directly diagnosed with these impairments are not the only ones affected. family caregivers take on the brunt of responsibility for ensuring that the patients’ needs are met (sander et al., 2019). according to the bowen (1978) family system theory, it defines family as a relationship and emotional system in which members are interinfluenced at individual, dyadic, systemic, and intergenerational levels. research shows that the burden of caregiving takes an immediate toll on the caregivers’ mental health (turner et al., 2010). this caregiving process starts with the patients’ transition from hospital to home; about one in five caregivers experiences depression during this transitional period (kreutzer et al., 2009; turner et al., 2010). care transitions interventions aimed at meeting the needs of patients and family caregivers have demonstrated effectiveness in improving patient outcomes among many populations (kansagara et al., 2016). kansagara and colleagues conducted research on mixed patient populations including older adults, patients with cancer, and those with other health conditions. however, scant research has been conducted on the impact of care transitions for people with brain injuries and their family caregivers (kansagara et al., 2016). the model of care that includes follow-up home visits with patients after hospitalization is inspired by hospital social work (sedgwick, 2012). hospital social workers have historically been asked to wear many hats. one-fourth of hospital social work referrals are for coping or community referral needs spanning from cleaning services for cluttered apartments to coordinating home-based recreational activities (reckrey et al., 2014). previous research on survivors of brain injury and their caregivers found that they desired a consistent social worker who met them in the hospital and addressed their questions after they left the hospital on a myriad of topics to further understand their brain injury, address financial and basic needs, and get referrals to community and medical services (linton et al., 2015). however, most hospitals have a small staff of social workers who may not have adequate time to commit to all of their clients’ needs, especially posthospital discharge. in many cases, patients may be referred to the hospital social worker only if they are a very high needs patient (gibbons & plath, 2009). thus, care transitions advances in social work, fall 2020, 20(3) 727 interventions were developed to meet the needs of patients and their caregivers that extend beyond their hospital stay. ethnic gaps in care for brain injury survivors in addition to the challenges brain injury patients and families encounter posthospitalization, there is evidence of health disparities among certain ethnic groups. between 2005 and 2014, latinx (latinas and latinos from latin america living in the u.s.) brain-injury survivors’ emergency room visit rates increased by 60.2% compared to 42.7% among white non-latina/o patients (hsia et al., 2018). thirty-day hospital readmissions, defined as any unplanned hospital admission since discharge, among brain injury survivors ranged from 17-18% for latinx and 10-14% for non-latinx survivors (gardener et al., 2018; ottenbacher et al., 2001). latinx brain injury survivors had statistically significantly higher readmission rates than white non-latinx controlling for age and sex (qian et al., 2013). this finding suggests that interventions aimed at addressing ethnic health disparities are important. caregivers the rate of depression among caregivers of people with brain injuries is high with about 40% of caregivers of people with brain injuries experiencing depression (loh et al., 2017). a study of patients with brain injuries and their caregivers found that caregivers had higher reports of depression during the patients’ hospital-to-home transition period (the first 90 days post-hospital discharge) compared to the general population (turner et al., 2010). predictors of caregiver depression include social support, educational background, and relationship to the patient (lou et al., 2015). recent research found that there was an interdependence among caregiver and patient mental health; moreover, caregiver depression worsened as patient depression increased (linton, 2020). caregivers of patients with brain injuries commonly experience caregiver burden, defined as perceived excessive care demands (griffiths et al., 2018). there are limited studies of caregivers of people with brain injuries. one study found that one-third of family caregivers of people with dementia experienced high levels of caregiver burden (jennings et al., 2015). certain ethnic groups, such as hispanics, tend to report higher levels of caregiver burden than non-hispanic whites due to an intense cultural sense of duty to care for loved ones (sander et al., 2019). this suggests the importance of providing culturallysensitive interventions to address caregiver burden. a pilot study of trabajadora de salud, a bilingual, bicultural hospital-to-home care transitions intervention designed specifically for latinx patients with brain injuries and caregivers found that brain injury survivors and caregivers experienced improvements in depression, somatic symptoms, and caregiver burden after receiving the intervention compared to a control group that received services as usual (linton & kim, 2018). study purpose previous research on care transitions included only a pilot study of the intervention with a small sample of latina/o participants (linton & kim, 2018). this current study linton et al./impact of a care transitions intervention 728 assessed the impact of care transitions among a larger sample of white non-latina/o, latina/o, and asian participants representative of the community in the study area. this study assessed the impact of the care transitions intervention on caregiver burden and depression among a general population of caregivers of people with brain injuries. the research questions included: 1) what is the difference between survivors of brain injuries’ baseline and 30-day depression, functional ability, and quality of life (qol) among those that received a care transitions intervention?, 2) what is the difference between hospital readmissions among survivors of brain injuries that received care transitions and a services-as-usual control group?, 3) what is the difference between caregivers’ baseline and 30-day depression and caregiver burden among those that received care transitions? methods design the california state university channel islands institutional review board approved this study, which used a quasi-experimental pre-posttest design. the care transitions intervention was delivered in person for 90-days starting once the brain injury survivor was home post-hospital discharge. surveys were completed at the beginning of the intervention and 30 days later after the most intensive part of the intervention. the intervention includes weekly home visits for the initial 30 days, and typically bi-weekly home visits for the remaining 60 days of the intervention. participants and setting study participants were recruited at an adult level ii trauma center (tc) in a rural area on the west coast of the united states between april 2017 and october 2018. the local population was majority latina/o and a common occupation was farm work, which is generally a low-paid profession with minimal healthcare benefits. the tc coordinator identified eligible participants and made appropriate referrals to care transitions coaches who visited the brain injury survivor in the hospital (for the initial visit) to inform them about the intervention. participant inclusion eligibility criteria were as follows: 1) the participants who had a brain injury must have had a mild, moderate, or severe brain injury, 2) a planned transition from hospital to home, 3) the ability to provide consent, 4) the ability to complete preand post-surveys, and 5) the ability to speak english and/or spanish. those who participated as a caregiver must be: 1) family members of the patient, and 2) had the ability to speak english and/or spanish. participants who were in transition from the hospital to another institution were excluded from the study. participation was voluntary. all participants provided written consent and chose whether to receive the care transitions intervention or not. those who chose not to receive care transitions were placed in the services--as-usual control group. since the research personnel had limited resources to collect data, the only outcome measured for the services-as-usual control group was hospital readmission. advances in social work, fall 2020, 20(3) 729 intervention and fidelity procedures the care transitions intervention (cti) was a 90-day family-focused, home visitation, coaching intervention. the original design of the intervention included only one initial home visit post-hospital discharge with weekly phone calls after the initial visit for 90 days. care transitions was adapted due to a pilot study conducted on latinas/os with brain injury demonstrating improved impact in an intervention group that received all home visits, compared to a control group that received only telephone calls (coleman, 2020; linton & kim, 2018). since latinx are about half of the population where the study was conducted, care transitions was adapted to meet their unique cultural and language needs by offering services in english and spanish, acknowledging bicultural and acculturation needs, and spending more time on personal connections and building rapport (see more in linton & zepeda, 2019). all patients and their family caregivers received one hospital visit and five home visits from a care transitions coach and community resources. care transitions coaches were not trained social workers in this intervention. this coach was certified as a brain injury specialist. coaches were also bicultural, embracing and understanding both traditional american values and traditional hispanic values. they were also bilingual, to address the unique needs of a large hispanic population in the study location, matching previous research that has found the effectiveness of these attributes in care transitions interventions for latinas/so/hispanics with brain injuries (linton & kim, 2018). during the hospital visit, the coach informed patients about the study and the intervention, and obtained written consent from the participants if they chose to participate. if the patient had any needs during the hospital visit, such as referrals, then the transitions coach provided that information. if the patient was hospitalized or in a rehabilitation facility for an extended period of time, the transitions coach would call to check in with the family on a weekly basis, until the patient was discharged. the hospital medical professionals informed care transitions staff when the participants were ready for discharge. the coach called the participants within 72 hours to schedule an initial home visit within the first week of hospital discharge. the initial home visit included completion of the pre-survey (described under measures), review of needs and goals for the patient and caregiver, and medication reconciliation for the patient. the medication review included collecting all medication and current prescriptions in the home. a pharmacist reviewed the list and provided a response about whether or not there were any potential medical conflicts. five in-person visits occurred with the patient and caregiver during the 90-day period following the initial home visit. common patient needs included: goal-setting, goal prioritizing, stable housing, skills on gaining independence, caregiver respite, motivation, and encouragement (as reported in linton & zepeda, 2019). in-person visits addressed the following topics: 1) brain injury education, 2) referrals for community resources, 3) help applying for resources and scheduling medical appointments, 4) addressing basic needs, 5) goal-setting, 6) assisting in healthcare provider communication, and 7) medication reconciliation. coaches would commonly provide patients with homework to practice skills to gain independence. they would build rapport with patients through hands-on creative activities, such as art, taking walks, or playing sports. it was through these creative rapport-building activities that coaches would learn what motivated their patients. linton et al./impact of a care transitions intervention 730 motivation was key in supporting patients in goal-setting. additional phone contacts varied based on the patient’s needs and desires. the initial 30 days of the intervention was the most intense with weekly home visits, while the following 60 days included primarily one home visit and phone call check-ins. after the 90-day intervention period, the patient and caregiver were transitioned to ongoing support services, such as support groups, workshops, and social activities. a random sample of case notes (10%) from home visits were reviewed to assess feasibility, acceptability, and fidelity of the intervention; no issues were found. certification for brain injury specialists required fulfillment of a 12-hour course covering cognition, guidelines for interacting and building rapport, brain injury and behavior, medical complications, self-medication management, and families coping with brain injury. three coaches met weekly with a supervisor and peers to “staff” their caseloads. data on potential confounding variables were collected, such as comorbidities, receipt of formal psychological therapy, and attendance at support groups. the authors assessed the relationships between these potential confounding variables and the outcomes. no significant relationships were found. study outcomes and measures self-report surveys pre-surveys were administered within one week of arriving home and post-surveys were administered 30 days after the participants arrived home. self-reported surveys were completed online or using a hard copy (depending on participant preference) and included demographic questions as well as the nine-item depression scale, the personal health questionaire-9 (phq-9, kroenke et al., 2001), which was distributed to all participants in the intervention group including tbi survivors and caregivers. depression was defined as feelings of sadness, hopelessness, and a loss of interest in previously enjoyed activities (american psychiatric association, 2013). the phq-9 has been assessed for validity and reliability among people with brain injuries (fann et al., 2005; perrin et al., 2013; α = .86.90). face and construct validity were determined by comparing the phq-9 to other common depression scales (fann et al., 2005). one item on the scale asked: “over the past two weeks, how often have you been bothered by any of the following problems? little or no interest in doing things” with options including: not at all, several days, more than half the days, and nearly every day. all items were added to obtain a sum of the items for a total score on the phq-9 (potential score range = 0 – 29). higher scores indicated more depression. the brain injury survivors in the intervention group were also asked: 1) one item from the functional independence measure (“how would you describe your overall level of functioningphysical, mental, emotional, or social from completely independent to totally dependent?”), and 2) one item on quality of life (“how do you rate your overall quality of life from very poor to very good?” with response options: very satisfied, satisfied, neutral, unsatisfied, very unsatisfied). the caregivers’ surveys also measured caregiver burden. caregiver burden was defined as the individual’s perception of problems or change in their own well-being due to their role as a caregiver (thornton & travis, 2003). four items from the modified advances in social work, fall 2020, 20(3) 731 caregiver strain index, which have demonstrated validity and internal and test-re-test reliability were used in the caregiver survey (potential range of scores = 0 – 8; thornton & travis, 2003). one example item was: “i feel completely overwhelmed.” response options included: yes, on a regular basis; yes, sometimes, and no. higher scores indicated more caregiver burden. hospital readmission data the tc provided data on the all-cause 30-day brain-injury related hospital readmission data among all brain injury survivor participants. no other demographic data were provided for the control group participants. data analysis to achieve an adequate power of 0.80 to test the hypothesis using a paired samples ttest, a sample size of 25 was calculated based on cohen’s d of 0.6 and power at .80 (analysis conducted using g*power, faul et al., 2009). paired samples t-tests were used to test the differences between self-reported preand post-survey scores on depression, functional ability, qol, and caregiver burden. analyses were conducted using ibm spss 18. the significance level for hypothesis testing was 𝛼𝛼 = .05. the tc’s 30-day readmission data was used to compare the frequency of readmission between the intervention and control group. results the total number of potential participants (identified as having a brain injury at the participating hospital) was 256; all were examined for eligibility, and a total of 120 were confirmed eligible based on eligibility criteria. a total of 50 participants consented to participate in the study, all of whom had complete hospital readmission data. twenty-two brain injury survivors and 20 of their corresponding caregivers received care transitions and completed preand post-survey data. twenty-seven brain injury survivors did not complete the intervention or the post-survey. caregiver data were not complete for two of the caregivers of patients in the study. the other 27 participants were placed in the servicesas-usual control group. descriptions of the brain injury survivors and caregivers are provided in table 1. brain injury survivors had an average age of 48 (sd = 17.61). the average age of caregivers was 65 (sd = 15.76). linton et al./impact of a care transitions intervention 732 table 1. descriptives of the brain injury survivors (n=22) and their caregivers (n=20) descriptives n (%) survivors caregivers gender male 14 (63.6%) 15 (75.0%) female 8 (36.4%) 5 (25.0%) race/ethnicity latina/o, hispanic 11 (50.0%) 8 (40.0%) non-hispanic white 9 (40.9%) 11 (55.0%) asian 1 (4.5%) 1 (5.0%) native hawaiian/pacific islander 1 (4.5%) primary language english 16 (72.72%) 14 (70.0%) spanish 6 (27.27%) 5 (25.0%) tagalog 1 (5.0%) insurance medicaid (medical) 10 (45.5%) private 5 (22.7%) no insurance 4 (18.2%) medicare 3 (13.6%) cause of the brain injury pedestrian/biker hit by a vehicle 5 (22.7%) car collision 4 (18.2%) fall 4 (18.2%) stroke 3 (13.6%) attacked 2 (9.1%) loss of consciousness 1 (4.5%) unknown 3 (13.6%) employment status not employed 18 (81.8%) employed full time 2 (9.1%) employed part time 2 (9.1%) injury impact on employment lost job due to injury 12 (59.1%) has not impacted job 5 (22.7%) impacted hours can work 2 (9.1%) impacted ability to perform duties at job 3 (13.6%) the analyses revealed statistically significant improvements in depression and functional ability between preand post-survey scores among care transitions participants (table 2). brain injury survivors’ quality of life improved but not at a statistically significant level. care transitions’ participants experienced lower brain injury related hospital readmissions than the control group (0% care transitions group compared to 7% services-as-usual control group). there were statistically significant improvements in selfreported depression and caregiver burden among the caregivers (table 2). advances in social work, fall 2020, 20(3) 733 table 2. differences between baseline and 30-day self-report survey results among care transitions participants: survivors (n=22) and caregivers (n=20) participants scale m (sd) t p baseline 30-day df survivors depressiona 17.94 (6.51) 14.11 (5.01) 2.81 .01* 21 functional abilityb 2.95 (0.94) 2.35 (1.13) 2.69 .01* quality of life 3.50 (0.89) 3.85 (0.58) -1.92 .06 caregivers depressiona 14.20 (5.09) 11.75 (1.82) 2.62 .017* 19 burden 12.65 (4.49) 10.00 (3.22) 3.00 .007* * p = < .05 ahigher score = more depression, bhigher score = more dependence discussion this study found that care transitions intervention demonstrates promise in improving depression, caregiver burden, and functional ability among brain injury survivors and their caregivers. the 30-day hospital readmission rate was 7% lower among brain injury survivors who received care transitions compared to a services-as-usual control group, indicating cost and time savings for those that received the care transitions intervention. costs for hospitalization due to brain injury vary from $8,000$33,000/visit (mcgarry et al., 2002). at minimum, care transitions potentially saved $12,000 per patient; if 7% of the 22 care transitions participants had been rehospitalized, it would mean that 1.5 persons were rehospitalized (costing a minimum of $8,000 each). in our study’s project, the care transitions coaches were paid $15/hour and worked 20 hours per week. two care transitions coaches were employed; their monthly salaries were $2,400 in total. there is no direct cost to the patient, as the care transitions intervention is free to them; this project was grant funded. in addition to preventing 7% hospital readmissions, the brain injury survivors that received care transitions improved in depression and functional ability, which can potentially relieve survivors’ dependence on other medical systems. chen and colleagues (2012) found that acute care only accounted for 46-65% of the medical costs survivors of brain injuries; the mean medical costs ranged from $32,000-$38,000 in the first year post-hospitalization. care transitions’ interventions have implications for hospital social workers, who often hold critical roles in discharge planning. previous research has shown that patients desired hospital social workers to spend more time with them post-discharge when questions arose (linton et al., 2015). social workers should be supported to conduct home visits with brain injury patients post-hospital discharge, to prevent hospital readmissions. advocacy is needed to ensure that post-hospital social work services are covered by health insurance policies, as insurance typically covers one post-hospital phone call only (see more discussion in linton et al., 2015). it should be noted that half of the brain injury survivors in this study self-identified as latina/o/hispanic, reflecting the surrounding population. latinx brain injury survivors are more likely to experience depression symptoms than white non-latinx (bombardier et al., 2016). latinx survivors reported statistically significantly higher levels of depression over time (linton & kim, 2018). one study found that one in two latinx survivors and one in linton et al./impact of a care transitions intervention 734 eight white non-latinx experienced depression (fei et al, 2016). functional ability is associated with depression (ottenbacher et al., 2001). care transitions may have the opportunity to close gaps in disparities experienced among latina/o/hispanic brain injury survivors and their caregivers (hsia et al., 2018). since family and personal relationships are so important to latina/o populations, the care transitions’ intervention embraces these characteristics by supporting the whole family and conducting face-to-face home visits to develop personal relationships with the family members over time. family caregivers are critical in meeting the needs of patients, but their own health needs are often overshadowed by the intense needs of the patient. family-centered care is a field in healthcare that fully acknowledges the family caregivers’ need as well as the patients’ needs (goldfarb et al., 2017). recommendations based on family-centered care include communicating with family members, family presence during medical recommendations, providing support for the family, and addressing environmental needs of the family (davidson et al., 2017). the family-centered care philosophy also recognizes the interdependence between the health of the patient and caregiver (linton, 2020). care transitions interventions need to embrace the patient and caregiver equally as both have unique needs (linton et al., 2015). future research should assess the impact of the care transitions intervention on the health status of caregivers. our study included limitations, such as short-term outcomes, limited sample size, inclusion of people with mild to severe brain injury, and attrition. this is the study’s first publication on results from 30-day outcomes, but 90-day outcomes are being measured currently. the sample size was small, yet appropriate to gain initial data. another weakness of our study is the lack of a control group for depression and caregiver burden. additionally, no random assignment was conducted, nor demographic data collected on those who chose not to receive care transitions. future research will include gathering data on those who choose not to receive the intervention for comparison purposes. given that this is a new program and enrollment occurs while patients are still in the acute care hospital setting, patients and families were often hesitant to enroll. this study was conducted in partnership with a local nonprofit, thus the decision to include people with mild to severe brain injuries arose from the nonprofit’s promise to serve people with all types of brain injuries. the general brain injury recovery information and local resources needed during the hospital-to-home transition are similar for people with both mild and more severe forms of brain injury. for example, people with brain injuries and their families need to know about rehabilitation services (i.e., physical therapy and occupational therapy), mental health services, and home health care, regardless of the severity of their injury. specific needs differ not only by brain injury severity, but also by familial resources and cultural needs. care transitions is a flexible intervention in that each individual home visit can be customized to meet the unique needs of the patient while maintaining an overall consistency in topics covered during the intervention for each brain injury survivor and caregiver. reasons for low sample size and/or attrition included: missing or inaccurate contact information, patient misconception of a brain injury, or refusing to participate in the program. it should be noted that since brain injury survivors were recovering from their injury, the mere lack of outside influences may have impacted their recovery as well. most survivors were recovering in the comfort of their own home advances in social work, fall 2020, 20(3) 735 during the initial 90-days post-hospitalization. the everyday stressors, such as work and driving, that influence most people were not experienced among participants, thus it may have helped to improve their mental health leading to more positive outcomes. however, research also shows that there is a direct correlation between the health of brain injury survivors and their caregivers (linton, 2020). outcomes for only one caregiver per family were measured in the current study; some brain injury survivors may have had more than one family caregiver. many participants lived with other people who may have positively or negatively impacted their outcomes. another important potential confounding variable is socioeconomic status. participants with greater economic and social resources may have had more help in recovering informally from friends or formally from paid caregivers (durish et al., 2018). conclusion hospitals may consider developing care transitions interventions, partnering with local organizations to conduct these interventions to improve discharge and adjustments made during patients’ transition home, or ensuring sufficient staffing of hospital social workers to conduct home visits. care transitions, the intervention provided in this study, aimed to meet the needs of both patients and caregivers during their transitions from hospital-tohome. the intervention has the potential to save patients and hospitals time and money due to lower hospital readmissions. hospital social work has transitioned more recently to focusing on discharge planning, but due to social workers’ time limitations, very little follow-up is being conducted to ensure that patients’ needs are met after they are discharged (linton et al., 2015). hospital social workers should advocate for hiring more social workers to ensure that sufficient time is given to conduct home visits in lieu of care transitions. a separate care transitions intervention may not be needed if hospital social workers were able to conduct home visits and support patients through their transition home. given the small sample size and lack of control group for all outcome variables, future research should be conducted to assess the efficacy of care transitions on improving brain injury survivors’ and caregivers’ depression, functional ability, and caregiver burden as well as preventing brain injury-related hospital readmissions. future research should also assess the impact of gender on caregiving as well as those caregivers that may be caring for young children and older adults simultaneously. when larger sample sizes are available, future research should also assess differential effects of the intervention on latina/o/hispanic participants as well as other populations. references american psychiatric association. 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(2010). caregivers of adults with traumatic brain injury: the emotional impact of transition from hospital to home. brain impairment, 11(3), 281-292. https://doi.org/10.1375/brim.11.3.281 author note: address correspondence to kristen linton, health science program, california state university channel islands, one university drive, camarillo, ca 93012. email: kristen.linton@csuci.edu. https://doi.org/10.1097/00005373-200212000-00020 https://doi.org/10.1053/apmr.2001.26088 https://doi.org/10.1053/apmr.2001.26088 https://doi.org/10.1016/j.pmrj.2013.05.018 https://doi.org/10.1080/00981389.2014.884041 https://doi.org/10.1161/circoutcomes.113.000211 https://doi.org/10.1016/j.apmr.2018.08.193 https://doi.org/10.1177/0886109912444103 https://doi.org/10.15585/mmwr.ss6609a1 https://doi.org/10.15585/mmwr.ss6609a1 https://doi.org/10.1093/geronb/58.2.s127 https://doi.org/10.1375/brim.11.3.281 mailto:kristen.linton@csuci.edu _____________ ande nesmith, ph.d., lisw, is an associate professor, school of social work, university of st. thomas, st. paul, mn 55105. copyright © 2018 author, vol. 18 no. 4 (fall 2018), 1147-1164, doi: 10.18060/21590 this work is licensed under a creative commons attribution 4.0 international license. reaching young people through texting-based crisis counseling: process, benefits, and challenges ande nesmith abstract: texting-based crisis intervention counseling reaches young people who suffer from mental health issues at high rates yet hesitate to seek help. as a new interface, it is neither well-researched nor well-understood. this study examined 49 randomly selected text counseling transcripts and key informant interviews with two counselors to identify unique characteristics of the text counseling process and learn texter reactions to the sessions. texters presented problems that were similar to those reported in voice-based hotlines. texters valued the privacy and flexibility of texting that permitted them to receive help immediately regardless of their location. counselors reported that they must be brief and direct with questions and avoid assigning emphasis to words. the written format required that both parties must be explicit and clear to convey their messages accurately. both texters and counselors suggested that the texting option might lead young people to seek help that they might otherwise avoid. recommendations include specialized training on strategies to assess and connect with texters using only the written word and research to develop best practices for texting-based crisis intervention services. keywords: crisis intervention; technology; at-risk youth; suicide prevention; texting counseling services crisis intervention services with a texting option is an innovative approach to reaching at-risk young people. texting-based hotlines are surfacing in large metro areas at runaway and homeless youth programs across the country (e.g., safe place (n.d.) in chicago; teen line (n.d.) in los angeles; the bridge for youth (n.d.) in minneapolis), yet little to no published information exists about their efficacy, intervention approaches, or even how much they are used. recently, the national crisis text line, inc. (crisis trends, 2016), made its aggregate data available online, but by and large, information about most text lines appears in program annual reports rather than peer-review research. this study aimed to address that gap by examining how texters convey whether or not their needs were addressed during the session, as well as techniques the counselors used to assess and connect with service users. texting-based crisis lines may appeal to young people because texting is currently the primary mode of communication among this age group (lenhart, smith, anderson, duggan, & perrin, 2015). because youth are comfortable with texting, these services may reach a cohort that is at high risk of suicide and other mental health problems (centers for disease control [cdc], 2014). preliminary evidence suggests that many young people do not choose between voice versus text crisis lines when it comes to highly sensitive and painful topics. rather, they would rather go without help than talk in person or on the phone (evans, davidson, & sicafuse, 2013; gibson, cartwright, kerrisk, campbell, & seymour, 2016). it is therefore important to understand texting-specific counseling strategies for https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2018, 18(4) 1148 providing crisis intervention and whether service users find the intervention useful in this new interface. literature review the goals of crisis intervention broadly are to assess, deescalate, establish a safety plan, provide support, and offer referrals, and have demonstrated positive impacts in voice calls (kitchingman, wilson, caputi, woodward, & hunt, 2015; ramchand, jaycox, ebener, gilbert & barnes-proby, 2017; stevens & ellerbrock,1995). in texting format, the goals of crisis intervention are no different, but there is some evidence to suggest the population reached through texting draws more adolescents, as will be discussed here. texting-based crisis counseling has the potential to reach an underserved population that is in urgent need of help. the most prevalent chronic conditions found in pediatric health care are mental health disorders (santor, poulin, leblanc, & kusumakar, 2007; saunders, resnick, hoberman & blum, 1994). untreated mood disorders such as depression are directly related to suicidal behavior which, in turn, is the third leading cause of death among young people aged 10 to 24 (cdc, 2014). a fraction of adolescents with depressive disorders seek professional help; in fact, the more severe the depressive symptoms, the less likely they are to pursue help (sawyer, sawyer, & la greca, 2012). this is reflected in voice-based crisis line use; in some studies, adolescents and young adults comprise as little as 2% of voice hotline users (gould, greenberg, munfakh, kleinman, & lubell, 2006) and 4% in the state affiliate of the national suicide prevention hotline used for this study (canvas health, 2011). adolescence is a time in which social connection and peer perceptions are of heightened importance, making stigma over mental health concerns particularly powerful. a study of high school student perceptions about mental health services found that stigma was the most-named barrier to accessing school-based services (bowers, manion, papadopoulos, & gauvreau, 2013). other barriers include: fear of family reactions, concerns about the expense of care, and lack of adequate services especially for trauma (bowers et al., 2013; lipmann, 2010). there is currently no research study or central location that tracks how many programs offer a texting option for crisis services. the few programs that do provide such services report positive findings and a rapidly growing volume of contacts from young people (kaufman, 2014). the national crisis text line (crisis trends, 2016) boasts messages numbering in the millions in the few years since its inception in 2013. the program used for the current study, txt4life, began in 2011 and reported a six-fold increase of use in its second year of operation, which included a dramatic rise in the percentage of adolescents and young adults seeking help compared with voice services (txt4life, 2013). txt4life has since closed, but there continues to be texting-based crisis lines both locally and nationally (crisis text line, 2018; samhsa, n.d.) there is a growing body of research pointing to the benefits of socially interactive technologies which may lead to more innovative use of it in mental health services. pew research found that 88% of teens use texting to connect with their friends with 55% texting friends daily and 83% reporting that social media made them feel closer to their https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/kitchingman,+taneile+a./$n?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/kitchingman,+taneile+a./$n?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/caputi,+peter/$n?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/caputi,+peter/$n?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/hunt,+tara/$n?accountid=14756 nesmith/ reaching young people 1149 friends (lenhart et al., 2015). as more people of all ages have embraced texting, it has become a more widely accepted means of communication. according to a 2014 gallup poll (newport, 2014), texting is now the most common form of communication among americans through age 50. electronic communication in mental health services has increased over the last decade. the first crisis line in the u.s. to accept text messages was launched in 2010 in nevada (evans et al., 2013). this line yielded immediate use among high schoolers, with more than half using it more than once. a systematic review of “telemedicine” found that providers used a variety of interfaces to conduct mental health interventions, including email, facebook, video conferencing, and online groups (martin et al., 2011). on the whole, while providers did not view these means as equivalently effective as face-to-face, they reported that they were adequate or almost as good. moreover, they observed significant improvements in their patients. other research provides examples of online venues to conduct longer-term counseling, including group therapy, and integrating cell phones into in-person therapy sessions rather than battling youth to put their phones away (dubus, 2015; koltz & tarabochia, 2014). the appeal of texting may be explained in part by the online disinhibition effect. suler (2004) examined this phenomenon to explain online behavior that is discordant with one’s in-person behavior, where positive expressions are more candid and negative ones may be more aggressive. one factor linked to this effect is dissociative anonymity in which the texter has control over nearly all information, especially affect, that is revealed about him or herself. that control may generate a sense of safety when discussing painful topics. another factor is the asynchronicity of the exchange which permits texters to delay revealing their immediate reactions, allowing them to “suspend time” while considering a response (suler, 2004). as an emerging mode of crisis service provision, texting-based counseling is not well understood. to some extent, this is an artifact of rapidly changing technology. research on technology and mental health services in the past ten years centered primarily on computerbased communication rather than mobile device communications, including email, online groups, chat rooms, or video-conferencing (krysinska & deleo, 2007; martin et al., 2011). however, receiving crisis services via a mobile device that allows one to access help in any location at any time is arguably different from computer-based services. after an extensive search of available research across several scholarly databases, only four studies surfaced that investigated some aspect of texting-based crisis intervention and one that assessed chat sessions (evans et al., 2013; gibson et al., 2016; haxel, 2013; mokkenstorm et al., 2017). evans et al. (2013) conducted a pilot study of a texting helpline, using focus groups with 113 high school youth and post-intervention demographic and service data from the crisis counselors. most (59%) of the youth accessing the services were not in crisis nor suicidal, but rather sought information or support. about a quarter (26%) of their texters closed the session without resolution, most often by not responding to further texts. the counselors provided very few referrals, in part because their texters did not want outside help. they also observed that youth reported they “preferred a text-based line specifically advances in social work, fall 2018, 18(4) 1150 because they would not be identifiable by voice cues and no one could overhear their conversations,” possible indicators of the online disinhibition effect (evans et al., 2013, p. 479). the texters also reported that the anonymity made it easier to disclose more details about their problems. haxell (2013) examined text transcripts and interviewed counselors in a new zealand program. while the service users had a choice between voice and text-based crisis lines, “20% of the helpline user screens would be filled with messages asking, if not demanding, that counselling be provided by text” (p. 149). the reasons users presented for choosing text-based services support the theory behind the online disinhibition effect: texting was less scary than talking, it was hard to talk when crying, or the texter was shy or struggled with talking. gibson et al. (2016) interviewed adolescents in new zealand who used at least one form of mental health services via in-person, phone, or texting. the formats that were not in-person were attractive to youth because they could “bypass adult control and use these privately and retain their sense of autonomy” (gibson et al. 2016, p. 1063). the participants who used text services indicated that they preferred texting over voice calls because it was a medium of communication they were used to and because it made them feel more confident about their communication. chat sessions are similar to texting, though they originated for use on a stationary computer rather than a mobile application, which offers less flexibility in use than texting. mokkenstorm and colleagues (2017) compared chat sessions in a netherlands program to voice hotline data from the u.s. the chat users were younger, had more mental health problems, and were more likely to be suicidal than hotline users. while up to 49% had elevated moods at the end of the session relative to the beginning, more often there was no change. given the risks associated with young people who grapple with mental health issues and the limited use of crisis hotlines among this same group, this is an important gap in service provision worthy of further investigation. the scant research available from the four studies on texting-based crisis services suggests that youth may be interested in, or even prefer, the texting or chat interface and the sense of anonymity may be an important factor. while only one study examined outcomes (martin et al., 2011), it is notable that it found some indications of improved mood. with so little research on the use of texting in crisis intervention services, there is much to be gained from continued examination of this modality. currently, this is not published data demonstrating how crisis counseling unfolds in a texting context or to what extent it is helpful or that users are satisfied with it. it is especially critical to understand the best counseling strategies in this context and to what extent users find these useful. the present study while crisis intervention programs routinely track statistics on presenting problems and categories of counselor actions, the analysis here contributes a perspective not wellstudied nor understood that of the texter. the anonymous nature of crisis lines makes it extraordinarily difficult to learn if the counseling session was helpful as there is not an nesmith/ reaching young people 1151 avenue for gathering follow-up information; therefore this study sought clues within the session transcripts. this qualitative study collaborated with a human services agency, canvas health, to answer two questions: 1) in what ways do those using texting crisis services communicate whether or not their needs have been addressed, at least for the shortterm?; and 2) how does the texting interface affect the counseling approach to assessing and connecting with service users? partnering agency and texting crisis program canvas health is a comprehensive integrated human service center that provides a wide range of mental and physical health services in several minnesota locations. this project worked with one of the agency’s programs, txt4life, which offers texting-based suicide prevention counseling services. their crisis line services aim to provide short-term help which can include (but is not limited to) establishing a safety plan to prevent self-harm, directing texters to longer-term local sources of support, or reducing the intensity of their emotional state. txt4life serves the entire state, though is accessible as a toll-free number to anyone in the u.s., and uses hipaa-compliant technology to offer confidential services with a trained counselor. various outcomes are tracked based on provided services and concrete action steps. text-based counseling quickly became popular. in 2014 when data for this study was collected, the program received 5,658 text calls, a figure that jumped to 9,968 texts one year later (txt4life, 2015). at the time, the agency was funded to provide texting services through midnight and again at 8:00am in the morning. those who texted during closed hours were offered the opportunity to use the 24-hour voice hotline. if they did not choose that alternative, their texting attempt was tracked and a counselor contacted them in the morning to offer support if they still wanted it. the agency now offers full 24-hour support for their texting line. in 2014, the program assessed all the text sessions of any length including those with non-crisis needs. the data revealed that 76% of the sessions ended with positive action steps, the largest share of which included personal care actions (18%) and internal coping strategies (17%; txt4life, 2015). in an effort to exclude sessions in which the texter only sought referral information, the current study selected sessions lasting at least 30 minutes to capture individuals with more complicated or serious concerns than the full spectrum of texter contacts. therefore, the data in this study likely reflect a narrower troubled group than the total population of texters in this program. while the agency did not report information about how many text sessions included only information or referral requests, they did report that 70% included supportive listening, which likely referred to the types of sessions included in this study. methods this study is primarily qualitative with some descriptive statistics, using counseling session transcripts to understand how texters expressed their needs and how both counselors and texters communicated via texting. the sample size and analytic methods are in keeping with qualitative approaches (corbin & strauss, 2008; creswell, hanson, clark, & morales, 2007). advances in social work, fall 2018, 18(4) 1152 sampling and data collection sampling frame. text sessions were drawn from 2014 data. to capture sessions that were most likely to include a counseling exchange, only text sessions lasting 30 minutes or longer were included. this duration was selected based on the agency’s annual data which showed that the conversation density (number of words) in a text session was comparable to about one-sixth that of a voice session of the same length (txt4life, 2015). for example, a typical 10-minute voice session would take about an hour in texting to exchange a similar amount of content. therefore, text sessions shorter than 30 minutes were similar to voice sessions less than five minutes and were likely to be requests for information. sampling. forty-eight text crisis counseling session transcripts were randomly selected. to ensure a representative sample throughout the course of the year, four randomly selected dates from each month in 2014 were used to select counseling sessions. for privacy reasons, the program supervisor extracted the text transcripts from each random date and redacted all identifying information prior to analysis. key informant interviews. because there is so little published information about the counseling process using a texting interface, key informant in-person interviews with the program’s two counseling supervisors were used to provide additional context to the transcript findings. these interviews were not intended in any way to serve as a broadly representative voice on counselor experiences. rather, they augment the main analysis of counseling transcripts by presenting the rationale for certain techniques used and to offer insight into how the texting format influenced the counseling process in this particular program. these were the only two staff at the agency who had experience with both voice and text lines and could provide a unique perspective about them. as supervisors, they monitored counseling sessions for both types of crisis lines and trained new counselors for the text line. analysis demographic information was gathered from the text sessions to the extent possible though it was optional, and most declined. the entire transcript from each session was examined, with particular attention to their presenting problems and the texter language and tone as the sessions closed. ascertaining outcomes is difficult with an anonymous short-term service. without directly-asked questions in a follow-up survey, it is more an assessment of hints and clues that may reveal whether users felt their needs were addressed, at least for the short-term. the counselor approaches to connect with the texter and the texter reactions were examined to help understand how those interactions unfold in a texting interface. to accomplish this, the analysis used an iterative process of reading, identifying patterns, negative case analysis (examples where a theme emerged differently), and constant comparison of themes (corbin & strauss, 2008; creswell et al., 2007; miles, huberman, & saldana, 2014). counselor interviews provided information about counseling and intervention techniques used that were specific to the texting format. drawing from a mixed methods approach and using an explanatory sequential design (haight & bidwell, 2016), the nesmith/ reaching young people 1153 specific counseling supervisor interview questions were developed after the text sessions were analyzed to elucidate features in need of further clarification. with only two interviews and direct questions, the analysis did not involve an in-depth analysis of patterns and themes. rather the findings from those interviews provide information about the intervention strategies used and observations about the impact of text counseling. ethical research with human subjects the research protocol for this study was approved by the principal investigator’s university institutional review board in advance of any data collection. an anonymous service by design, in most cases the staff also did not know the identity of the texter. texters were not required to provide names or any demographic information. in the instances where there was such data in the transcripts, the supervisor fully redacted all identifying information in the transcripts prior to making the data accessible for analysis. findings the findings present data from both the text transcripts and the counseling supervisor interviews. for each section, the findings from the transcript analysis are presented, followed by counseling supervisor perspectives on that topic. texter quotes are presented as received; any spelling errors or abbreviations reflect how they appeared in the original transcript. obtained sample forty-nine randomly selected transcripts representing all 12 months of 2014 were used. one texter initiated contact later in the same day and was included in the sample, increasing it from 48 to 49. the sample therefore represents up to 48 unique individuals, though given anonymity, there may be repeat texters who were not identified as such. of those who reported gender, 29 were female, eight male, and one transgender. two-thirds opted not to provide their age. of those who did, the vast majority were between 12 and 24 years old, averaging 18.5 years. there was one outlier who was 44 years old. most of the texters did not opt to report their ethnicity. of the ten who did, two identified as african american, one as hispanic, and the remaining were caucasian. seventeen different counselors facilitated the text sessions that were reviewed, averaging three text sessions per counselor. presenting problems the texters sought help in three broad areas: 1) their current emotional state reported as part of a pre-existing mental health condition causing chronic bouts of depression, anxiety, or suicidality, 2) a romantic interest yielding rejection, conflict, or abuse, or 3) family and peer relations, typically in regard to feeling isolated, unwanted, or unloved by family, or bullying by peers. disinhibition with texting both the text transcripts and the counseling supervisors revealed some indication of disinhibition linked to the anonymity of the texting interface. advances in social work, fall 2018, 18(4) 1154 texters. there was some evidence to suggest that texters would elect not to receive crisis services if they were not offered via texting. nearly a third (29.2%) of the texters originally texted during the night when the text line was not available. while they were given the option to use the voice line to receive immediate help, none chose that option. instead they waited until morning to text again or accepted support when a counselor texted them. as texters began sharing their reasons for seeking help, some explained that they chose texting because it was too difficult to talk to others in-person or over the phone about their concerns. below is an excerpt from a young person sharing for the first time her longstanding problem with self-harm and eating disorders. texter: well, i want to get help somehow but i'm too scared to tell my parents or any one at school. counselor: thank you for reaching out. i know it takes a lot of courage to speak up. could you tell what you're going through? maybe talking about it might help. texter: i've been self-harming and i've had an eating disorder for years and i feel like it'll never go away. counselor: i'm sorry to hear that. it must be very hard to pretend and hide this from your family. how have you been coping? texter: i don't know, it's kinda up and down i guess. counselor: are you receiving any services for your eating disorder and depression? texter: no. i've never really told anyone about it. another texter explained that she had not talked to anyone about her suicidal ideations and that she could not use voice services. counselor: who do you have that provides support? texter: i don't really talk to anyone about this so no one knows texter: i was looking for suicide hotlines online but since i can't really speak over the phone i decided text message would be best the texters sought help from a wide range of locations and situations. although not all texters shared their location, many did. while some were at home, especially during evening sessions, others mentioned that they were in class, in the school restroom, in the school cafeteria, at work, or on a walk. counseling supervisors. the counseling supervisors also observed that the privacy of texting ameliorated inhibitions. the anonymity really helps. people are honest very quickly, in our experience. as opposed to face-to-face or the [voice-based] calls who are less so. nesmith/ reaching young people 1155 one of the supervisors discussed the relevance in situations warranting mandated reports. the counselor explained that youth who were otherwise too afraid to report on their abuse and name their perpetrator in-person or by voice, were able to do it via texting. kids, you know, a 14 year old…who’s been a survivor of abuse – i think that it would be very hard for them to make the report on the phone or in person…like at school those counselors might know their parents or know their uncle or might know the perpetrator. whereas with us…you don’t have to look at us. you don’t have to hear us…so we’re telling them we’re mandated reporters upfront, making it their choice, then they’re willing to give us more information than they would otherwise. then we’ll get, “here’s my last thing, here’s the person in question. this is perpetrator.” after we started doing this, we experienced a spike over the last year in mandated reports due to kids sharing enough information to report. there were not examples of such abuse reports in the obtained sample of transcripts. however this comment was included here because, if it is reflective of a real phenomenon, it is an important issue worthy of future exploration. text session closings text statements were examined at or near the end of the sessions to identify two indicators of outcomes that might shed light on whether or not their needs were addressed: 1) if they reached a plan that they were willing to try, and 2) if their remarks offered any indication of whether or not they found the session to be helpful. the nature of the data is biased toward an absence of positive findings because the only way to know with certainty that a texter found it useful is if they explicitly volunteered that information. texters who offered no remarks about the services may have found them helpful, but simply did not state it; the converse could be true as well. four themes from the close of the conversations surfaced (see list below) . these were categorized by the texter remarks indicating the following: whether or not a plan for safety was established, or in cases where safety was not a concern, if at least a tentative plan for the presenting problem was achieved, and who initiated the closure. we also examined whether or not it was a jointly reached plan. 1. positive: (65%) a) the texter specifically indicated some satisfaction with the session toward addressing their needs, a plan was reached, and the session was jointly closed by texter and counselor; or b) the texter language was cautiously optimistic, a plan was reached, and the counselor initiated the close. 2. not in danger/no indication about whether their needs were addressed: (17%) the texter was not currently in danger. the texter did not provide language suggesting satisfaction or dissatisfaction with session. the counselor initiated the close. no plan regarding the initial presenting problem was created. 3. abrupt: (14%) the texter initiated the close abruptly without explanation. 4. vague: (4%) the texter initiated the close, offering a vague or generic reason. or the texter’s language in response to a plan was noncommittal. advances in social work, fall 2018, 18(4) 1156 positive closings. nearly two-thirds (65%) of the sessions ended positively. texters were not asked to report their satisfaction with the sessions in regard to meeting their needs, so it is not known definitively how many found the services helpful. this section describes both those who explicitly expressed satisfaction and those who might have found the services helpful but revealed it in indirect ways. of all the types of closures, a positive collaborative end to the text session was the most common. in these cases, there was some resolution with either a short-term plan to get through the day or night or a more extended plan, jointly reached by texter and counselor.  i’m sure [going for a run] will help me feel better about things. thanks for listening. i will text in tomorrow if i need to.  you've convinced me to reach out more for help, thank you!  thank you for your help. i feel better having a plan for what i'm going to do  i'm glad i reached out to you im beginning to feel a lil better i've calmed down  thank you i feel a lot more comfortable after talking to you…  thank you so so so much  ok thank you! and yes, thank you for talking to me! a texter who reaches out in crisis can have a positive outcome without necessarily sounding upbeat. some of the texters agreed to a plan using language that was cautiously optimistic. in the exchange below, the texter agreed to accept several referrals. the texter’s phrasing, “i think that will work” suggests that he or she was at least willing to try the plan. after this remark, the “okay” comments exude neither a positive or negative sentiment. they demonstrate that the texter was paying attention and accepted the referral information, though there was a significant lapse before acknowledging them, a common occurrence in the texting venue. counselor: so i found several counselors who specialize in self-harming. they accept sliding scale so you may still be charged but in a less amount. will that work for you? counselor: [10 minutes later] are you still there? texter: yes, i am still here. i think that will work. counselor: great! here are the two counselor's name and address. texter: okay counselor: also, here is a clinic that seems provide free services texter: okay counselor: i will let you go now. i hope you have a good night! :) not in danger, no indication if needs were addressed. seventeen percent of the sessions fit this category. these were often texters seeking to talk about their concerns, but they indicated no specific need beyond support. therefore unlike other sessions, counselors did not attempt to close the conversation with an offer of service referrals. in these sessions, nesmith/ reaching young people 1157 the texters also did not offer any information whether they found the session to be helpful or unhelpful. abrupt ending. in the sessions classified as having an abrupt ending (14% of sessions), the texter initiated the close suddenly without a plan and without any indication of whether or not the session was helpful. i have gym class so i have to go i have to go. my husband is home other examples of abrupt endings occurred when there was a long lapse in texter response. sometimes the counselor would ask if the texter still wanted to talk or if this was still a good time to talk and the texter replied “no.” other times they simply disappeared. one used the “stop” option offered to all texters to immediately close the session. while it is never known with certainty, some abrupt endings may be due to external factors that compel a texter to close quickly, such as someone walking in the room, or as one young texter reported, they were texting at school between classes and class was about to start. others may not want to continue the session and use these statements as a way to close the conversation. vague/ambiguous. the closings coded as vague were the smallest category (4%). here, the texter initiated the close, offering a generic reason, or the language in response to help was noncommittal. in these cases, the texter responses were increasingly delayed. they most often stated that they were tired and wanted to sleep, regardless of the time of day. i think i might take a nap for a while. im feeling very sleepy can we talk tomorrow? in these cases, the texter typically did not respond to specific counselor suggestions, or did not respond to counselor efforts to identify possible plans. counseling strategies – counseling supervisor perspectives the counseling supervisors were asked to explain the program’s intervention strategies, challenges, and strengths when using the texting interface. both observed that assessment and connection, each critical to the process, unfolded differently with text than with voice. assessment must occur quickly in crisis intervention and was challenging without sound-based cues. on the phone you’re picking up different cues. background noises, inflection, their tone, are they emotional? … you’re assessing based on the non-verbal cues you’re getting. are they outside or inside? are they pacing? are they crying? with text we don’t get any of that information. therefore, counselors had to explicitly ask questions they might otherwise detect in voice calls. the supervisors explained that new counselors were tempted to attach emotions or emphasis to the typed words and highlighted the importance of careful training. advances in social work, fall 2018, 18(4) 1158 what happens especially with new staff who don’t have any experience in the field is that they want to project some emotional situation to the text…they want to emphasize words…but you only have the words on the screen. that’s it. that’s all you have. you cannot under any circumstances put any weight on any of those words because you can’t infer inflection. unless they capitalize it. because there’s no bold. there’s no italics. there’s not anything else. the supervisors offered some insight into the unique effort and tactics required to cultivate a connection with texters with only the written word. both emphasized that they must be more direct and specific in their language than with voice conversations. one explained, everything that i want to convey, i have to convey through words…i have to make a more conscious effort to connect. whereas on the call side you can connect just through your tone of voice, being there, active listening and they know someone is listening. on the text side, you have to prove that you are listening…i have to kind of verbalize my active listening a lot…and we have to actively sound empathetic, because by nature, text messages do not sound empathetic. both counseling supervisors also explained that it was necessary to provide a single question or statement per text and wait for a response before moving on to another question or else risk that the texts become off-sequence, making it difficult to know which question the texter was responding to. in the following excerpt, the counselor made explicit empathic statements that could perhaps be delivered through vocal prompts (e.g., “mmhm”) in a voice call. the counselor kept the comments brief, one idea per text, to keep the texter engaged. short counselor texts also mirrored the typically short texter messages. the vast majority of texter messages across all texters were single sentences or phrases. near the end of this excerpt, the counselor touched on an important precipitating event that the texter started to deny but then revealed in the pursuant exchange. texter: i just want to talk. no i'm not in danger counselor: what did you want to talk about? texter: i'm falling apart and i feel so worthless counselor: that sounds overwhelming. counselor: i want to check in with you and ask; are you thinking about suicide? texter: i think about it every day.. i won't do anything though counselor: it must be hard to feel that way all the time. i'm glad to hear that you won't do anything though. counselor: why do you feel that you want to die? texter: i have people i would hurt... i feel like shit. i feel unwanted and worth less. my boyfriend never helps the situation counselor: i'm sorry to hear your boyfriend hasn't been helpful -is there anyone who is helpful? nesmith/ reaching young people 1159 texter: not really. i feel like everyone hates me counselor: did something happen to make you feel this way? texter: no… maybe idk* *idk is an abbreviation for “i don’t know” despite the challenges of texting-based counseling, the supervisors both highlighted the value of reaching people who might not otherwise seek help. one noted that when new staff were trained in both crisis line formats, they commonly asked if text lines are as effective as voice calls. my answer to that is, no, but that’s not the point. people are using this service who would not otherwise use it. like, they are not looking at it like, “i’m going to talk to my school counselor or text txt4life.” they’re looking at it only like, “i’m going to text” because they’re looking for something more anonymous, no faceto-face or voice. they want the privacy piece and impersonal as possible…the point is we’re getting people to reach out that wouldn’t normally reach out. the question therefore, according to the supervisors, was not so much one of whether or not texting-based crisis counseling is equivalent to voice-based hotlines, but rather whether or not the texter would receive any help at all without the text service. limitations the sampling frame in this study excluded sessions shorter than 30 minutes, thereby eliminating texters seeking only referrals and those who were not in crisis but needed a brief check-in, or other more straightforward needs. as such, this study sample was disproportionately comprised of those with more complex or more serious problems. it is important, therefore, to use caution when comparing these findings to those typically presented by other text lines that report on all text sessions. the anonymous nature of crisis lines limits access to information like demographics and outcomes post-session, both important to fully understanding the scope and needs of text line users. the key informant interviews can only speak to the techniques and approaches specific to the collaborating agency and should not be interpreted more broadly. discussion this study highlights benefits and challenges of texting-based crisis lines, as well as nuances of the counseling process. because it is an emerging medium for service delivery, most of the available information is found in program reports that are not peer-reviewed research and primarily provide descriptive statistics about users and services delivered. very little empirical information is available on texter reactions to counseling sessions or counseling strategies with texting. there is growing support for the value of texting-based crisis counseling. the texting interface is popular, especially among young users. this is evidenced in part by the growing volume of text calls. the program saw a six-fold increase in the year following the initial year of operation and has seen dramatic monthly increases in text volume since advances in social work, fall 2018, 18(4) 1160 then (canvas health, 2015). in 2014, they received 5,658 texts and one year later in 2015, this figured jumped to nearly 10,000 texts (canvas health, 2015). the largest such service in the u.s., the crisis text line, reports vast usage of their line since its inception in 2013 (crisis trends, 2016). this sheer usage suggests that young people view this as a viable modality to receive needed support. the counselors in this study argued that without texting, some youth in crisis may not otherwise seek help, a point also raised by several of the system users. the overall agency statistics and those from other research reveal that voice hotlines are underutilized by adolescents and young adults, whereas the text users disproportionately represent this same age group (gould et al., 2006; canvas health, 2011; txt4life, 2015). other research supports this phenomenon as well. for example, evans et al. (2013) reported that their text users rejected “outside help,” instead requesting more text options and that youth believed the text line would “help youth who might not otherwise seek help” (p. 480). gibson and colleagues (2016) also arrived at this conclusion, reporting that adolescents using texting services explicitly stated their preference for this mode over all others. the findings here offer some support of the online disinhibition effect (suler, 2004) as an explanation for the popularity of texting services. some of the texters in this study reported that it was the texting-based format that encouraged them to use the service, often sharing their struggles for the first time via text. this is consistent with haxel’s (2013) findings as well. both this study and haxel’s work suggest that texting creates room for dissociative anonymity (suler, 2004) in which the texter has control over information and verbal expression, allowing them to communicate more candidly than in-person, if at all. about two-thirds (65%) of the texters in this study gave some indication of a positive outcome. this is a larger share than mokkenstorm et al. (2017) found (49%) with chat sessions, though the comparison should be viewed with caution as the measures were different. this still leaves a third who did not explicitly suggest a positive outcome. these findings are tempered by the scope of anonymous crisis counseling. while counselors could do their best to reach a shared agreement of a safety plan, just as with any counseling situation, not all texters are ready for this, even for the short-term to get through the day. others, not in immediate danger, may have chronic presenting problems that cannot be reasonably resolved, even temporarily, during a text session. a higher rate of positive closings (76%) were reported when including non-crisis calls seeking information or other quick responses, all excluded from this analysis (txt4life, 2015). this is in keeping with at least one other texting program (evans et al., 2013). one of the greatest challenges for texting-based crisis counseling is assessing effectiveness. this is extraordinarily difficult in the context of anonymous crisis intervention, particularly determining impact after the session has ended. there is inherent bias in regard to who spontaneously provides feedback at a later date (mokkenstorm et al., 2017). post-session surveys also raise problematic issues with non-response, as those with some of the worst outcomes such as suicide, will, by definition, not be reachable. yet, midsession may not be the time that a texter thinks about saying “thank you” or sharing that it is making a difference. in fact, the nature of texting tends to omit this type of exchange. therefore, the absence of affirmative statements toward usefulness does not mean that a nesmith/ reaching young people 1161 session was unhelpful, only that it was not expressed at the time. nevertheless, there was some evidence of user satisfaction in the text transcripts; the majority of the texters provided some indication that the services were useful. the flexibility of texting is an important factor. unlike online chats or other telecommunication services, texters may reach out for help in any setting while retaining privacy from others in close proximity, freeing them to seek help at almost any time rather than waiting for an opportunity and space to have a private phone call. in fact, the texters in this study sought help while at work, during school, meals, and in the presence of friends and family, a feature also observed in haxell’s (2013) study. the benefit of immediacy is critical; texters do not have to delay seeking help until there is a private time or space. there are many similarities but also important distinctions between voice and text crisis counseling. the goals of crisis intervention to assess, deescalate, establish a safety plan, provide support, and offer referrals are the same whether the mode is texting or voice. just as with voice calls, counselors aim to connect with texters, reflect their feelings, gather information, and help them arrive at a short-term plan when necessary. the texters in this sample raised the same types and range of presenting problems as in voice-based calls. nevertheless, several critical differences between the two modes are important to understand. these differences lie in the way that texters share information, the flow of the sessions, and knowledge and techniques that counselors must have in order to engage effectively with the texters. without tone of voice or other sound-based cues, a counselor cannot know texter emotions until they are stated. in voice calls, counselors attend to cues from the caller’s tone, rapidity of speech, sounds of crying, and background noises. they also use their own vocal tone to influence interactions. without those conversational attributes in texting, questions must be framed more carefully and directly. exchanges must be brief, attending to a single idea per text, lest the exchange becomes off-sync and leads to confusion about which question or comment the response refers to. the counseling supervisors who provided context for this study emphasized that interpretation of texts must be drawn exclusively from typed words, avoiding the temptation to assign emotions to written statements when none have been expressed to avoid arriving at an inaccurate conclusion or assumption. ideally, a training manual would be created and made available for programs offering texting as a new service. it is possible that programs that have been in operation and have developed effective techniques specific to texting already have such manuals that could be modified for more general use. specialized training is important for any new programs or counselors new to this venue for crisis counseling. training should be comprehensive, but some key components should include assessing by asking critical questions directly, practicing not placing emphasis on certain words, and establishing a connection quickly through brief empathic statements delivered one at a time. the written nature of the texting interface has some advantages for supervision and training. examples of past sessions can be easily reviewed to demonstrate counseling strategies that work as well as those that are less effective. real-time supervision can be provided with a supervisor reading texts side-by-side with a new counselor, talking them advances in social work, fall 2018, 18(4) 1162 through sessions. with asynchronicity allowing for short delays, counselor and supervisor can discuss next steps together during the session. finally, research must catch up to the pace of technological changes in crisis counseling. very little is known about best practices, about the most effective ways to establish a connection with texters, or about what the system users value the most in texting-based crisis services. more research is needed to better assess outcomes and to examine the efficacy of various communication and intervention strategies. the young demographic of text line users represents the most vulnerable and most underserved in crisis counseling (santor et al., 2007; 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(2014, november). the new era of communication among americans. retrieved from http://www.gallup.com/poll/179288/new-era-communicationamericans.aspx ramchand, r.; jaycox, l.; ebener, p; gilbert, m; barnes-proby, d., & goutam, p. (2017). characteristics and proximal outcomes of calls made to suicide crisis hotlines in california: variability across centers, crisis: the journal of crisis intervention and suicide prevention, 38(1), 26-35. doi: https://doi.org/10.1027/02275910/a000401 safe place. (n.d.). txt 4 help. chicago, il. retrieved from http://nationalsafeplace.org/safe-place-teens/ santor, d., poulin, c., leblanc, j., & kusumakar, v. (2007). facilitating help seeking behavior and referrals for mental health difficulties in school aged boys and girls: a school-based intervention. journal of youth & adolescence, 36(6), 741-752. doi: doi: https://doi.org/10.1007/s10964-006-9092-z saunders, s. m., resnick, m. d., hoberman, h. m., & blum, r. w. (1994). formal helpseeking behavior of adolescents identifying themselves as having mental health problems. journal of the american academy of child & adolescent psychiatry, 33(5), 718-728. doi: https://doi.org/10.1097/00004583-199406000-00013 sawyer, m. g., sawyer, a. c. p., & la greca, a. m. (2012). help-seeking by young people with depressive disorders. prevention researcher, 19(4), 11-14. stevens, b.a. & ellerbrock, l.s. (1995). crisis intervention: an opportunity to change. eric digest edo-cg-95-34 . retrieved from https://www.counseling.org/resources/library/eric%20digests/95-034.pdf substance abuse and mental health services administration. (n.d.). national suicide prevention lifeline [1-800-273-8255]. retrieved from https://suicidepreventionlifeline.org/ suler, j. (2004). the online disinhibition effect. cyberpsychology & behavior, 7(3), 321325. doi: https://doi.org/10.1089/1094931041291295 teen line. (n.d.). teen line. text teen. los angeles, ca. retrieved from https://teenlineonline.org/ txt4life. (2013). annual progress report for 2012. minneapolis, mn: canvas health. txt4life. (2015). statewide expansion utilization report. minneapolis, mn: canvas health. author note: address correspondence to: ande nesmith, ph.d., lisw, is an associate profesor, school of social work mail scb 201, university of st. thomas, st. paul, mn 55105. nesm3326@stthomas.edu http://www.gallup.com/poll/179288/new-era-communication-americans.aspx http://www.gallup.com/poll/179288/new-era-communication-americans.aspx https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/jaycox,+lisa/$n?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/ebener,+pat/$n?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/gilbert,+mary+lou/$n?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/indexinglinkhandler/sng/au/barnes-proby,+dionne/$n?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/pubidlinkhandler/sng/pubtitle/crisis:+the+journal+of+crisis+intervention+and+suicide+prevention/$n/60904/docview/1800417791/fulltextwithgraphics/210452bcb8e048aepq/14?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/pubidlinkhandler/sng/pubtitle/crisis:+the+journal+of+crisis+intervention+and+suicide+prevention/$n/60904/docview/1800417791/fulltextwithgraphics/210452bcb8e048aepq/14?accountid=14756 https://search-proquest-com.ezproxy.stthomas.edu/indexingvolumeissuelinkhandler/60904/crisis:+the+journal+of+crisis+intervention+and+suicide+prevention/02017y01y01$232017$3b++vol.+38+$281$29/38/1?accountid=14756 https://doi.org/10.1027/0227-5910/a000401 https://doi.org/10.1027/0227-5910/a000401 http://nationalsafeplace.org/safe-place-teens/ https://doi.org/10.1007/s10964-006-9092-z https://doi.org/10.1097/00004583-199406000-00013 https://www.counseling.org/resources/library/eric%20digests/95-034.pdf https://www.counseling.org/resources/library/eric%20digests/95-034.pdf https://suicidepreventionlifeline.org/ https://doi.org/10.1089/1094931041291295 https://teenlineonline.org/ mailto:nesm3326@stthomas.edu _______ dianna cooper-bolinskey, dhsc, msw, core faculty in the msw program, capella university, minneapolis, mn 55402. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 239-255, doi: 10.18060/22622 this work is licensed under a creative commons attribution 4.0 international license. an emerging theory to guide clinical social workers seeking change in regulation of clinical social work dianna cooper-bolinskey abstract: u.s. regulation of social work began in the 1940s. by the mid-1990s, all jurisdictions within the united states regulated the profession through licensure. one purpose of licensure is to protect the public and the profession; however, legislation defining social work varies vastly among jurisdictions. the variation exists not only between jurisdictions, but also within licensure categories. the disparity within clinical social work continues without resolve. this qualitative study explored the barriers encountered and solutions used in three states as they secured laws allowing licensed clinical social workers to independently provide mental health services. grounded theory research, based on information from 12 historians, is used to develop a theory to aid advocates in jurisdictions not yet achieving fully independent practice of clinical social work. the emerging theory offers a complex-systems approach to using a strategic framework to overcome barriers when attempting policy change. the primary purpose of the research is to develop strategies that aid in securing changes in clinical social work regulation. the emerging theory may serve a broader purpose by supporting the association of social work board’s (aswb) goal of practice mobility and license portability. as advocates in various jurisdictions attempt to align regulations with the model social work practice act from aswb, they may experience barriers. this emerging theory could guide efforts to change clinical social work regulation. keywords: advocacy; barriers to change; changing legislation; clinical social work; grounded theory; jurisdictional regulation regulation of social work began in the 1940s (bibus & boutte-queen, 2011) and by 1992, every state within the united states regulated the profession within some categories of licensure (randall & deangelis, 2013). the purpose of licensure involves protection of both the public and the profession (association of social work board [aswb], 2016; bibus & boutte-queen, 2011; biggerstaff, 1995; council on social work education [cswe], 2018; groshong, 2009; marks & knox, 2015). essentially, licensure regulations establish that licensed social workers meet specific standards to practice, are monitored by a regulatory board, and practice within the guidelines specified in state statutes (bibus & boutte-queen, 2011; biggerstaff, 1995; cswe, 2018). while there are many benefits of professional regulation by licensure, one problematic inconsistency is the variation among jurisdictions with differing scopes and categories of practice (collins, coleman, & miller, 2002; mark & knox, 2015). this is especially true in the specialization of clinical social work (groshong, 2009). nurses and physicians are examples of professionals who are regulated by licensure and are perceived as having little variation in practice standards from one jurisdiction to another; in other words, providers and patients share some common ideas about the functions of a registered nurse (rn) or a cooper-bolinskey/an emerging theory 240 family practice physician (fpp) regardless of where services are provided (cooperbolinskey, 2017). however, social work has significant variations in regulations across the united states, leaving some question about the fulfillment of the purpose of licensure. marks and knox (2015) stated, “…though much progress has been made, there are many issues left to be resolved regarding professional regulation, including the balance of public protection, professional competence and practice, and addressing the need for consistency and continuity on a national and international scale” (p. 170). groshong (2009) stated, “there has been confusion between generalist social work practice and clinical social work practice which needs to be identified; there are differences that need to be accepted, and there are conflicts between the two groups that need to be resolved” (p. 16). regulation of licensed clinical social work is the primary interest underlying the research at hand. the purpose of the study is to help clinical social workers develop a useful understanding of the barriers encountered and solutions used to overcome obstacles when attempting to change policies that define the scope of practice. the results of the study can be used to advocate for changes in laws regulating clinical social work. background in order for the rationale for the study to be best relayed to readers, some historical context about the social work profession is important. additionally, it may be helpful to have a common understanding of social work practice and how the profession is regulated. the focus of the study remains on clinical social work, though it is important to understand clinical social work in the context of the broader scope of social work practice. a brief historical summary social work originated with volunteer efforts to care and advocate for abandoned children, people in poverty, and those who were otherwise disadvantaged in the late 19th century in europe and north america (stuart, 2013). social work evolved from volunteering and friendly visiting to an apprentice-based occupation in the early 20th century; this served as the springboard for later development of clinical social work (groshong, 2009). the 1930 census classified social work as a profession for the first time (stuart, 2013). social workers initially focused on the issue of poverty but quickly expanded efforts to serve children and families in other ways (stuart, 2013). in the 1930s, the profession began to be recognized as a service profession as a result of the growth of professional organizations, educational programs, and publications (dyeson, 2004; stuart, 2013). shortly after, the great depression and world war ii demanded social workers expand their focus to include mental health concerns (groshong, 2009, mcnutt 2013). according to mcnutt (2013), until the end of the 1950s, social work was a united profession with a rather clear, singular focus. the 1960s split attention of the profession between poverty (and programs to serve those in poverty) and mental health needs; this became a time of political activism (stuart, 2013) and brought disagreements within the profession as to its future direction (mcnutt, 2013). the profession continued to evolve with expanded use of multidimensional approaches and theories with intentional advances in social work, spring 2019, 19(1) 241 inclusion of mental healthcare, such as task-centered treatment, cognitive behavioral approaches, and reality therapy (groshong, 2009; mcnutt, 2013). though initial efforts for licensure began in the 1940s, the 1980s brought lobbying efforts for regulation of the profession together and many states were able to achieve professional regulation (bibus & boutte-queen, 2011; groshong, 2009). this time also highlighted the professional shift to include macro-micro divisions and the creation of generalist social work; it is essentially when multiple categories of social work practice emerged (mcnutt, 2013). by the 21st century, some levels of social work were regulated in all 50 states (clark, 2013; dyeson, 2004; stuart, 2013). licensing also facilitated the growth of private practice as many jurisdictions provided the standards for independent practice (stuart, 2013). in 2018, the association of social work boards (aswb) reported that bachelor of social work (bsw) practice was regulated in 42 jurisdictions, master of social work (msw) practice was regulated in 48 jurisdictions, independent advanced generalist practice was regulated in 16 jurisdictions and clinical social work practice was regulated in 54 jurisdictions (aswb, 2018b). jurisdictions include each of the states, districts, and commonwealths within the united states as well as the territories of guam, puerto rico, virgin islands, northern mariana islands, and american samoa (aswb, 2018b). on september 28, 2018, aswb reported there were 480,026 licensed social workers in the united states (aswb, 2018c), down from 495,130 in 2015 (aswb, 2015a). understanding divisions of scope of practice various groups of social workers chose multiple, different directions for professional practice; this expansion of focus for the profession created both positive and negative points of view about the profession. epple (2007) explained how some criticized the profession for abandoning its initial roots in advocacy for marginalized groups/populations and saw the added focus of mental health practice as confusing, unclear, and unnecessary. others applauded the profession for adding mental health advocacy and services not seen before for individuals and families (epple, 2007). some of the aforementioned debate continues even today, though many social workers agree with the expansion of foci within the profession and recognize the advantages the expansion created (cooper-bolinskey, 2017). weismiller and whitaker (2013) identify the themes of change in the profession as movement from public-agency auspices to private, nonprofit auspices; increasing numbers of social workers in private practice; and increasing identification of behavioral health and mental health as an area of practice specialization. social workers as mental health providers according to the national provider identifier (npi) registry, as of december 11, 2018, there are 996,266 licensed primary mental health providers in the united states (u.s. centers for medicare and medicaid services, 2018). the npi registry composition by provider type indicates the following providers: psychiatrists and neurologists, 62,094 (6.2%); physician assistants and clinical nurse specialists, 2,287 (<1%); psychologists, 175,021 (17.6%); clinical social workers, 266,779 (26.8%); counselors, 419,818 (42.1%); marriage and family therapists, 58,437 (5.9%); and other mental health cooper-bolinskey/an emerging theory 242 providers (social workers and nurses), 11,830 (1.2%; u.s. centers for medicare and medicaid services, 2018). the national association of social workers (nasw) reported 60% of mental health professionals are clinically trained social workers, compared to 23% of psychologists, 10% of psychiatrists, and 5% of psychiatric nurses (nasw, 2016). groshong (2009) reported that 96% of licensed social workers were providing direct services; the rate of actionable complaints against licensed clinical social workers was about 4% over the past 10 years. licensed clinical social workers are providing most of the mental health services in the country with few complaints by those receiving their services. certainly, licensed clinical social workers are well positioned to provide the much-needed mental health services needed within the united states (groshong, 2009). examples of current regulatory issues in 2017, when this study was being conducted, the researcher learned from interviewees that 10 jurisdictions did not allow licensed clinical social workers to diagnose mental health disorders. some states had vague statements outlined in their rules, and yet in other states licensed clinical social workers used diagnostic impressions to then provide and bill for mental health services. similarly, seven jurisdictions did not allow licensed clinical social workers to practice psychotherapy. yet, in some jurisdictions, services were provided using other but similar methods. these two inconsistent and practice-limiting issues for licensed clinical social workers are examples of the need for policy change (groshong, 2009). policy change provides consistency and supports aswb’s initiative to support practice mobility and license portability. the study was initially designed without any consideration of aswb’s initiatives; however, given the emergence of the initiatives and their value to the profession, it seems worthwhile to recognize how the study may support the initiatives. when policies are more consistent, practice mobility and license portability are more easily attainable. aswb initiatives aswb (2017) recognizes there are some problems associated with the current state of licensure; a few of the issues include lack of consistency in social work services across jurisdictions, confusion about the profession by clients and constituents, and the issues with mobility of social workers (the lack of reciprocity or transferability of licenses when social workers move among the jurisdictions). aswb’s model social work practice act serves as one method of addressing these issues (aswb, 2015b). the practice act defines recommended standards and scopes of practice for the profession within four categories of practice (bachelor, master, advanced generalist, and clinical). the association maintains the document, via regular updates by strategically created committees, in an attempt to establish common standards in social work practice among the various jurisdictions while assuring protection of the public (aswb, 2015b). the clinical social work association posits that the practice of clinical social work needs more clear and specific definitions that align across jurisdictions (groshong, 2009). in 2016, aswb began another initiative, social work practice mobility and license portability, to further address these concerns. the association created a website (aswb, advances in social work, spring 2019, 19(1) 243 2019) to offer easily accessible information and resources (aswb, 2017). one component of the initiative focuses on more similarities, fewer differences, which includes commonalities of education, examination, and experience. while the effort remains a work-in-progress, aswb professes dedication to this effort to achieve professional mobility and portability (aswb, 2017). this initiative is significant for many reasons. aswb’s initiative is supported by leadership from the national association of social workers (nasw) and the council on social work education (cswe), among others. the collaboration between aswb, nasw, and cswe presents a cohesive and united effort by multiple national professional social work organizations not seen in the past. secondly, the emphasis on social work as a healthcare profession highlights the need for nationally consistent definitions and services; this improves understanding of the profession. additionally, the consistency aligns much more closely with the purpose of licensure to protect the public and the profession (cooperbolinskey, 2017). a glaring issue that remains a concern with achieving mobility and portability is the need for changing policies in some jurisdictions to better align with the model social work practice act (aswb, 2015b). in addition to the need to modify social work licensure policies, clinical social work regulation also needs to be modified in some jurisdictions as well (groshong, 2009). this study is timely because it produces a useful tool to aid social workers in their efforts to change licensing laws. summary there continues to be no national licensure regulating professional practice; each jurisdiction regulates its own professional practice (cswe, 2018; randall & deangelis, 2013). social work remains a relatively young profession, providing a variety of different services and using a variety of different service mechanisms. as such, licensure laws continue to vary, with some differences impacting scope of practice (cooper-bolinskey, 2017). this study began with the researcher’s interest in understanding the variations in regulation of clinical social work. within this area of social work practice alone, there remain jurisdictional differences that impact scope of practice (groshong, 2009). for example, some (but not all) jurisdictions allow for licensed clinical social workers to provide services in private practice, some jurisdictions allow licensed clinical social workers to diagnose mental health disorders, and some jurisdictions allow licensed clinical social workers to bill for services under their own license as opposed to billing under a supervising provider (cooper-bolinskey & blower, 2016). these variations create confusion for clients, other providers, and even among social workers. in exploring the variations in scope of clinical social work practice, it became obvious there was little information available through a literature review. this remains a seriously under-researched topic. furthermore, regulations are difficult to access, read and interpret. aswb recently added to their website a database of regulations, allowing for comparison using search tools (aswb, 2018a). however, the broader context, or landscape, of scope of clinical social work practice within the united states is still difficult to access and cooper-bolinskey/an emerging theory 244 understand. with extensive time spent further exploring the literature, reviewing websites, consulting with association representatives, and speaking with national advocates, the researcher developed a better level of understanding of these issues which became the basis for executing the study. need for the study the researcher’s interest in jurisdictional differences within the scope of practice for social workers was confirmed through the literature review. social work regulation is not consistent nationally as some states do not regulate the various categories of social work practice. social work licenses have as many as 56 different titles across the various jurisdictions (cswe, 2018). the scope of practice across jurisdictions is quite inconsistent with some not allowing social workers to perform the same types of practice, although the educational requirements and qualifying exams are consistent (aswb, 2015b). while these examples are important, they represent only a sprinkling of the differences in social work regulations across jurisdictions. in order for the profession to have a reasonable platform to establish portability and mobility of licensure, there need to be effective strategies to use in changing licensing policy (cooper-bolinskey, 2017). results from this study may be useful to clinical social workers seeking to make changes through the policy process. methods this qualitative, inductive systems study utilized the corbin and strauss (2015) model of grounded theory, allowing a free-flowing, interpretive, and dynamic process to capture points that needed to be included in the analysis. data were collected from historians (i.e. study participants) through recorded and transcribed semi-structured interviews and provided documents. each historian was provided a copy of their transcribed interview to make corrections, comments, or simply accept without correction. each collection of data was analyzed individually, reviewed and coded, then added to the collective data set. with each addition of data, the most current data set was also analyzed. core categories and linking categories were noted as they emerged. data were collected until the data demonstrated saturation or until there were no more available and willing participants. corbin and strauss (2015) discussed the value of using computer assisted analysis in qualitative research, thus, nvivo 11 pro was used in data analysis (nvivo, 2017) along with note taking. summaries of each interview were written throughout the data collection process, analyzed independently, added to the collective data set and then analyzed at each addition of data until completion of all participant data collection. once the collection of themes related to barriers and solutions was complete, the research team used restrictive coding to categorize the barrier and solutions themes. an outline of the framework to stage the emerging theory was then constructed in consultation with the project consultant. following the corbin and strauss model of grounded theory, once the team reached consensus and a theory was developed, the formal writing of the study began. purposive sampling was used to assure selection of historians who had relevant knowledge on the topic and could provide differing perspectives. the three states of florida, minnesota, and texas were selected as sample states for this study based on four advances in social work, spring 2019, 19(1) 245 criteria: change of their legislation in the last 30 years to allow licensed clinical social workers to provide private and independent mental health services; there was some degree of difficulty in changing social work related legislation; aswb providing the name of at least one potential historian from the state; and variation in size, population, industry, political affiliation of the state, and type of regulatory board. the initial sample pool consisted of the individuals suggested by aswb, each state’s nasw executive director, and a member of each state’s regulatory board. additionally, snowball sampling was used to gather additional historians, as needed, until the data for each state was saturated or until no further historians were identified, whichever came first. coincidentally, all available and willing contacts were utilized as historians and the comprehensive evaluation of the data reached saturation. the collective group of 12 historians came from the three states of florida, minnesota, and texas, though two were considered national historians with substantially more experience than within the identified states. of the group, four were male and eight were female. one historian was a mid-career professional, eight were advanced career professionals, and three were retired. all of the historians had earned a master’s degree, 10 of which were in social work, whereas two had earned master’s degrees in other disciplines of study. six of the historians had doctoral degrees in social work, social policy, or law. all of the historians were licensed social workers (two were licensed under the grandfathering clause). all of the historians had substantial experience working with statelevel legislation related to social work regulation. every historian had at least 10 years of experience with legislative work and two historians had nearly 40 years of experience. seven historians had more than 30 years of experience working with social work regulation. of the 12 historians, nine (historians 1, 2, 3, 4, 5, 6, 8, 9, and 11) contributed a barrier theme; three historians (historians 7, 10, and 12) contributed content to support themes but did not define any new barrier themes. of the 12 historians, eight (historians 1, 2, 3, 5, 6, 8, 9, and 11) contributed a solution theme; four historians (historians 4, 7, 10, and 11) contributed content to support themes but did not define any new solution themes. based on the analysis of the full data set, saturation was achieved in both barrier and solution themes. while the study was able to reach its goal for number of historians, the researcher learned there was actually a quite small overall sample of possible historians for this type of study. additional historians were identified in each state, and were contacted for possible inclusion as the referrals were received, but no additional historians agreed to participate. to that end, even though it was unclear whether saturation was achieved per state, the researcher was comfortable reporting saturation was achieved based on the full data set in both barrier themes and solution themes. codes were established to organize content from each historian interview into the following categories: historian credentials, state information, legislative process, barriers, political climate or historic events, relationships among the mental health professions, and solutions. comments, phrases, quotes, and relevant points were identified and coded into each of the noted categories. summaries of the content from the interviews cooper-bolinskey/an emerging theory 246 were written under each heading of historian credentials, state information, legislative process, political climate or historic events, and relationships among the mental health professions. this arrangement helped to set the context for better understanding the barriers and solutions. these two categories of data were analyzed for themes then used in the development of the theory. results responses from all 12 historians were summarized into two analyses: one collective analysis of barrier themes and one collective analysis of solution themes used when working with legislation that regulates social work licensing. barriers the historians were asked to identify barriers, or problems, experienced in their attempts to pass or change legislation that regulates clinical social work licensing. historians described 21 barriers that were grouped, using restricted coding, into five categories to facilitate easier understanding and usage. table 1 provides a summary of the groups of themes emerging from the interviews along with examples of supporting responses. some responses are summarized for brevity while others are direct quotes. table 1. barriers experienced when attempting social work related legislation theme code supporting responses political/ legislative the political climate [h2] texas is primarily administratively managed by republicans. it is difficult to get funds shifted from the criminal justice perspective to the healthcare focus. [h1 (tx)] legislative work takes time [h2] on average, it takes 3 sessions, 6 years, to get a bill passed. [h2 (tx)] legislative sessions move quickly [h2] anything can happen when the laws are reviewed; while the legislature is in session changes happen quickly. [h2 (tx)] not valuing the need for licensure [h1] legislators ask from what the public needs to be protected. another question that kept coming up, “can regulation be managed in a less expensive way”? [h1 (tx)] unpredictable outcomes [h2] anything can happen once the bill is open and in discussion/review. people fear the risk of unwanted outcomes. [h2 (tx)] financial money [h2]–financial (state budgets) [h1] republican leadership who will not spend money. the state maintains a large "rainy day" fund. getting money for any services is tough. any bill with a fiscal note attached will be difficult to pass in the legislature. [h1 (tx)] money [h2]–financial (association funding) [h1] overcoming problems with not just passing social work legislation, but the right legislation, takes lobbying and outside help and associations often cannot afford the help. [h3 (n)**] logistics [h4] it can be challenging to coordinate meetings with the right people at critical times. clients with meaningful stories need to tell them to legislators, but getting the meeting times coordinated, managing work and transportation for the client, money to afford the travel, and even helping the client to maintain motivation to speak with the legislators until meeting time takes substantial time and commitment. [h4 (mn)] medicaid is a broken system [h1] mental healthcare is somewhat lost in the medicaid funding discussion. when combined with stigma, getting funding for medicaid is difficult. [h1 (tx)] advances in social work, spring 2019, 19(1) 247 theme code supporting responses the profession misunderstandings about the social work profession [h1]* social workers are “pigeon holed” as child welfare workers. few legislators understand social work as a mental health profession. getting clinical social work provisions for mental health services was not intuitive when legislators think of social workers as child welfare workers. [h1 (tx)] nature of social work [h1] people outside the profession devalue social work (i.e. social workers are helpers and will do what they do anyway) regardless of if the proposal is funded. social workers join the profession as micro providers and often do not see macro advocacy within their role. [h1 (tx)] specializations in social work [h5] having specializations written into legislation has lost basic uniformity of the profession nationally. state level specializations have produced more than 60 titles of social workers in the u.s. which are not consistently used among the states. [h5 (n)] lack of a unified plan for change [h3] individuals or associations do not have the same goals for the law. associations do not differentiate between clinical and macro practice. [h3 (n)] social work is a primarily female occupation [h9] most of the legislators are male and don’t think the same way as a female driven profession. [h9 (tx)] educational initially, social workers and legislators were not informed about certification or licensure [h6] they did not know what to do or how to start. [h6 (tx)] educational programs need overhaul [h9] new social workers need a stronger understanding of the link between policy making and professional practice. new social workers need to be better trained in public speaking. [how does one testify meaningfully before the legislature if they aren’t well prepared in public speaking?] [h9 (tx)] legislators having misinformed perspectives [h2] one legislator refused to support a bill because 5 constituents disagreed; he based opinion on 5 constituents and didn’t explore the perspective of the whole. governor and lieutenant governor sometimes sway legislators toward their perspective and legislators do not challenge it. this is the “kiss of death” for a bill. [h2 (tx)] miscellaneous /other media influence [h2] fake news and stigmas associated with political affiliation affect legislation. politicians are using twitter and limiting conversations on important issues to 140 characters. [h2 (tx)] inadequately designed legislative proposals [h3] scope of practice has to be well written and clear. clinical social work legislation has to address the ability to diagnose and the ability to perform psychotherapy. laws usually define the required exam, and some states do not clearly require the clinical exam. [h3 (n**)] influential opposition [h6] licensure related to social work practice was opposed by the nursing home industry and the department of protective and regulatory services (because they wanted status quo) and because they wanted to keep access to the social work associates as employees. the national association of black social workers criticized licensing as a device for consolidating power and as discriminatory. there were also some other associations that fought against clinical licensure. [h6 (tx)] opposition from psychology (or other mental health providers)? [h3] psychology is often the main objector when trying to design clinical social work legislation. they fight against the right to diagnose and the right to perform psychotherapy nearly every time it is in the proposed legislation. they seem to think these services are their domain. [h3 (n)] cooper-bolinskey/an emerging theory 248 theme code supporting responses incidental events [h11] brothers who were both in influential political positions took opposite positions on the social work bill. for whatever reason, the bill triggered competitiveness and their disagreements spread vastly causing nearly polar divides causing a very close vote. [h11 (mn)] notes: *a code, for example h1, identifies the historian from which the theme was initially identified. the initial comment from the historian supporting the theme is listed above. **n=national historian solutions historians were asked to identify solutions used in overcoming barriers in their attempts to pass or change legislation that regulates clinical social work licensing. historians offered a list of 22 solution themes. their solution-related themes were then grouped using restricted coding by the project team into three groups to facilitate theory development. table 2 provides a summary of the themes emerging from the interviews along with examples of supporting responses. some responses are summarized for brevity while others are direct quotes. table 2. solutions used in passing social work-related legislation theme code supporting responses intra professional (within social work) get the “players” on the same page (have a unified goal) [h3*] get everyone interested in the project on the same page before attempting to move the bill forward. [h3 (n**)] prepare – legislative work takes time and money [h3] social workers often get passionate about an issue, like not being able to diagnose. they want to jump in and make things right. the groundwork has to be laid for it to happen, and it takes lots of time and money to be ready. [h3 (n)] get social workers to engage [h2] get social workers involved [h1] make sure social workers understand the issues/needs to pass legislation and make sure they are not passive about the issues. get social workers to speak to legislators about importance of the bill and on the economic benefits. [h1 (tx)] importance of writing good social work legislative proposals (simplify the laws) [h5] social work laws have become too specialized, which creates confusion and diminishes the ability to promote a national platform. focus on making laws simpler and defining specializations in the rules. use aswb’s model social work practice act as a model for simple laws. [h5 (n**)] importance of writing good social work legislative proposals (get the right content in the laws) [h5] for clinical social work laws, make sure to include the right to diagnose and the right to perform psychotherapy in the law. address the proper level of aswb exam necessary for safe practice in relation to the scope of practice. for example, clinical social work licensure needs to require the clinical level of exam. [h3 (n)] support candidates who share social work values [h2] support candidates who share social work values. candidates who were endorsed and who win become legislative champions. [h2 (tx)] get all social workers licensed [h5] having states that do not regulate categories of social work practice and having social workers who practice unlicensed devalues the profession and protection of the public. [h5 (n)] work out professional problems within the profession, not in the legislature [h9] take problems to the professional organizations for resolve. it does not look good for the profession to air dirty laundry in the legislature. it’s more harmful than people know. [h9 (tx)] advances in social work, spring 2019, 19(1) 249 theme code supporting responses protect the discipline, just like other disciplines do [h8] social work must stay alert when other disciplines propose legislation and speak up, either in support or opposition. social work has to be invested in protecting our domain just as other professions do. [h8 (fl)] inter professional (with other professions) relationships (with legislators) [h1] spend a lot of time in the state house and never let a week pass without talking to legislators. know individual legislators well on both sides of the aisle. [h1 (tx)] relationships (develop coalitions and committees) [h1] nasw has lobbyists and a political action committee to help bills get on calendars and into committees. [h2 (tx)] relationships (networking) [h1] know people who know people who are good spokespersons for what social workers did for them. use them to testify in hearings, write letters, and to generally communicate with legislators. [h1 (tx)] relationships (find and work with allies) [h1] we found 2 sponsors that believed in social work who were willing to help us. it was extremely beneficial to have a state level society for clinical social work. they advocate for clinical when other associations will not. [h6 (tx)] relationships (know the opposition) [h1] use relationships to know the issues and know the opposition. [h8 (fl)] involve the public [h2] inform people through public service campaigns. solicit the public to speak to legislators and share their opinions and concerns. [h2 (tx)] broader perspective educate [h1] share information through brochures and pamphlets to legislators and the public. information helps individual legislators get on the same page; it helps them understand the issues and problems and overcome myths and stigmas. [h1 (tx)] make the cause real [h1] use stories that reach legislators and sprinkle in statistics, not vice versa. address depth of impact and use emotional appeal. always include money and statistics, and phrase the proposal in a way that supports a low budget request. [h1 (tx)] work the process [h2] as soon as issues arise that appear to be coming into a need for legislation change, start working the process. start talking with “legislative champions and partners” to get them on board and informed. [h2 (tx)] reframe issues [h2] use language that the legislators understand; do not force one’s agenda. the most direct route may be too direct. examples: underfunded medicaid vs workforce needs; practice act vs title protection. [h2 (tx)] use a narrow focus [h2] “you can’t do everything about everything, but you can pick one or two things and make a difference.” [h2 (tx)] prepare a strong defense to points of opposition [h8] once social workers know the opposition to the proposed legislation, it is essential to prepare a strong defense to present when the bill is heard. [h8 (fl)] know the political environment and the “hot topics” [h3] back in the 1990s when much of the legislative work for social work regulation took place, the political climate was much friendlier to regulation than it is today. [h3 (n)] timing [h6] a lawsuit exposed inadequacies of certification; it brought to light the need for licensure instead of certification. [h6 (tx)] use technology [h6] use technology to facilitate solutions via research, communication, and problem solving. [h6 (tx)] compromise/negotiate [h6] texas will never pass a practice act. ok, work with what they will accept. the social workers did not get exactly what was wanted, but did get a start toward regulation. the board used the rules to make further adjustments to address what the law did not. [h6 (tx)] cooper-bolinskey/an emerging theory 250 theme code supporting responses persistence and dedication [h6] "we worked like dogs, drew in everyone we knew, and drove the legislature crazy. we were not willing to give up." [h6 (tx)] be prepared to react quickly when legislature is in session [h11] time was running out on the last day of session and it was looking like the agenda was not going to reach the social work related bill. the sponsor interrupted the speaker and asked for a modification of the agenda, the bill was heard just before the session closed. the bill passed. had this not happened, it likely would not have passed even during the next annual session. [h11 (mn)] notes: *a code, for example h1, identifies the historian from which the theme was initially identified. the initial comment from the historian supporting the theme is listed above. **n=national historian discussion and emerging theory achieving success in passing legislation that regulates clinical social work licensing is a complex and multifaceted endeavor. there are significant potential barriers complicating a seemingly straightforward process. as with the discipline itself, the problems occur at the micro, mezzo, and macro levels and are so complex and intertwined that they are nearly undefinable. this study successfully identified some of the potential barriers, but perhaps more importantly, it has produced a strategic method for approaching policy proposals and passing social work related legislation. each of the emergent themes was somewhat simplistic, but when grouped via restricted coding into a systematic strategy, the themes reveal that social work related legislation is achievable. figure 1 provides a visual demonstration to aid in understanding how this systems approach works. this emerging theory requires understanding and synthesis of the study’s results. each of the barrier or solution themes, alone, essentially has little meaning. the barriers and solutions are interrelated, but not in a one-to-one linear manner. there is never only one barrier to passing legislation. if this were true, the solution would likely not require a systemic strategy. achieving policy change requires thinking in terms of systems and synthesis, knowing the environment, and making predictions using critical thinking and problem-solving strategies. as an example, legislators having misinformed perspectives is a complex barrier. the team proposing legislative change needs to understand political climate, historic processes previously used in legislative change, use relationships to be well-informed about specific barriers and who the players are, and know the resistance likely to present with the proposed legislation. given the complexity of barriers, and recognizing in many cases there are multiple barriers, it becomes important to recognize and develop a strategy (i.e. a strategic plan) involving multiple solution themes as a critical part of seeking legislative change. strategy helps assure systems issues are addressed from the beginning when early coordinated efforts begin, through the working phase when outreach and education occur, and through final phases when the proposed policy comes to the legislative floor. solution themes which may address the barriers vary by jurisdiction, but might include education, using relationships in multiple ways, preparing strong evidence to defend against opposition, and using real stories to add impact to the issue. advances in social work, spring 2019, 19(1) 251 political & legislative • political climate • legislative work takes time • sessions move & change quickly • not valuing licensure • unpredictable outcomes financial • money & financial (state budgets & association funding) • logistics & costs • medicaid is a broken system the profession (swk) • misunderstandings about the profession • the nature of swk • specializations in swk • lack of a unified plan for change • swk is a primarily female occupation educational • initially swkers and legislators were not informed about licensure, certification, & regulation • educational programs need overhaul • legislators have misinformed perspectives miscellaneous/other • media influence • inadequate proposals • influential opposition • how much opposition there is from psychology (or other mental health professions) • incidental events barriers solutions intra professional (within swk) • get the “players” on the same page • prepare-legislative work takes time & money • get swkers engaged & involved • support candidates who share swk values • the importance of writing good swk legislative proposals (simplify the law, get the right content into the law) • work out professional differences in the profession & not in the legislature • protect the discipline just like others do inter professional (with other professions) • relationships matter! (with legislators, develop coalitions & committees, networking, finding & working with allies, & knowing the opposition) • involve the public broader perspectives • educate • make the cause real • work the process • reframe issues • use a narrow focus • know political environment & “hot topics” • prepare a strong defense to points of opposition • use timely events (planned or sporadic) • use technology • compromise & negotiate • persistence & dedication • be prepared to act & react quickly when legislature is in session the team proposing legislative change identifies the most likely expected barriers. once the most likely expected barriers are identified, then the team designs a strategy of solutions with timelines. the legislative change systems theory the legislative change strategic plan figure 1. the legislative change systems theory advances in social work, spring 2019, 19(1) 252 the solutions identified by historians did not directly align with the barriers identified by the historians. the semi-structured interview format was not designed in a manner that would ensure alignment. the researcher recognized jurisdictions may have encountered barriers for which a solution was not clear, or perhaps there were several solutions which did not perfectly align with an identified barrier. the intent, from the onset of the study, was to ask broad and open questions promoting depth of thought about the issues and needs in changing social work related regulation. the identified barrier themes were broad enough to encompass several specific examples, yet specific enough to be understood and categorized. the solutions themes followed this same pattern. other themes may apply based on unique circumstances within any jurisdiction. as stated previously, it is assumed the barrier themes identified in this study offer valuable consideration to multiple jurisdictions that intend to address social work related legislative change, and the solution themes identified in the study offer valuable consideration in designing effective strategies to overcome the barriers. furthermore, this emerging theory may be useful in addressing changes to broader social work-related policies since many of the barriers and solutions identified in the study do not directly align only with clinical social work. limitations the first, and perhaps most obvious, limitation in the study was the small sample size of 12 historians from three states. a second limitation of the study was lack of representation from western and small states. these limitations were somewhat mitigated by having some historians who spoke to both barriers and solutions based on their experience in working with more than 25 jurisdictions. the sample of historians was professionally homogeneous; all but one of the historians identified as social workers and the 12th was licensed as a social worker under the grandfathering clause. although the study was designed to accept non-social work historians, snowball sampling did not lead to inclusion of politicians, governors, or individuals from other disciplines. having primary social workers as historians precludes the obviously valuable perspectives of the broader range of professionals involved in the legislative process. lastly, ethnicity of the historians was not collected within the study. impact and significance of study the knowledge acquired from this study was used to create an emerging theory based on a framework to strategically address the barriers experienced in three states during the process of changing legislation to allow licensed clinical social workers to provide private and independent mental health services. the emerging theory produced a framework constructed of the solutions used in the same three states to successfully achieve clinical social work legislation. one benefit of this study is its potential support for aswb’s mission to achieve practice mobility and license portability of social work practice. licensed clinical social work continues to have some inconsistencies in scope of practice. social workers, including licensed clinical social workers, may want to seek changes to facilitate scope of advances in social work, spring 2019, 19(1) 253 practice that aligns with the aswb model social work practice act (aswb, 2015b). the purpose of the emerging theory’s framework is to help social workers achieve legislative change, thus facilitating a more legally aligned, standardized scope of practice of licensed clinical social work across the united states. in doing so, the public, the profession, and other invested parties have a better understanding of the social work profession. having a more commonly understood scope of practice (i.e. licensed clinical social workers being able to provide private and independent mental health services nationwide) helps to fulfill the mission of licensure (i.e. to protect the public and the profession) in addition to facilitating aswb’s goal (i.e. to achieve practice mobility and license portability for social workers). although this emerging theory can serve many purposes involving social work related policy change, the most obvious, somewhat immediate, use includes facilitation of change in the states that do not have regulation in place for licensed clinical social workers to diagnose, as well as the states who do not have regulation in place for licensed clinical social workers to practice psychotherapy. conclusions social workers do not define social work practice; scope of practice is defined in regulations at the jurisdictional level. as such, the policies impacting licensed clinical social workers and their ability to perform private and independent mental health services vary among the jurisdictions of the united states (cooper-bolinskey, 2017; groshong, 2009). while states are making progress toward establishing a standard allowing for national reciprocity, there remain jurisdictions with significant variations in laws regulating clinical social work practice. these variations impact social work service delivery, accessibility to services by those in need of mental health services, and portability of social work licenses used to provide mental health services. the aforementioned emerging theory provides a resource to clinical social workers in need of guidance for changing social work related legislation. the resulting knowledge may well impact the resources, processes, or strategies used to facilitate change regulating social work practice. the public is better protected when clients have a good understanding of safe professional social work practice (marks & knox, 2015). the profession is better protected when scope of practice is at least somewhat comparable across jurisdictions (though jurisdiction-specific needs can be accommodated beyond common foundational practices; aswb, 2015b; cooper-bolinskey, 2017; groshong, 2009). portability of services is more achievable when there is a universally recognized legal standard of clinical social work practice (aswb, 2017; groshong, 2009). finally, a more universally recognized legal standard of clinical social work practice removes many unnecessary restrictions on wellqualified mental health providers, making more providers available to serve those in need of mental health services (cooper-bolinskey & blower, 2016; groshong, 2009). references association of social work boards [aswb]. 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(2013). social work practice: history and evolution. in t. mizrahi et al. (eds.), encyclopedia of social work. washington, dc: nasw press and new york, ny: oxford university press. doi: https://doi.org/10.1093/acrefore/9780199975839.013.620 national association of social workers. (2016). mental health. retrieved from http://www.naswdc.org/pressroom/features/issue/mental.asp nvivo. (2017). nvivo pro 11 for windows. retrieved from http://www.qsrinternational.com/nvivo/nvivo-products/nvivo-11-for-windows/nvivopro randall, a. d., & deangelis, d. (2013). licensing. in t. mizrahi et al. (eds.), encyclopedia of social work. washington, dc: nasw press and new york, ny: oxford university press. doi: https://doi.org/10.1093/acrefore/9780199975839.013.225 stuart, p. h. (2013). social work profession: history. in t. mizrahi et al. (eds.), encyclopedia of social work. washington, dc: nasw press and new york, ny: oxford university press. doi: https://doi.org/10.1093/acrefore/9780199975839.013.623 u.s. centers for medicare and medicaid services. (2018). national provider identifier registry file from december 11, 2018 [downloadable]. retrieved from http://download.cms.gov/nppes/npi_files.html weismiller, t., & whitaker, t. (2013). social work profession: workforce. in t. mizrahi et al. (eds.), encyclopedia of social work. washington, dc: nasw press and new york, ny: oxford university press. doi: https://doi.org/10.1093/acrefore/9780199975839.013.624 author note: address correspondence to: dianna cooper-bolinskey, 30 allendale, terre haute, in 47802. e-mail: dirucobo@hotmail.com https://doi.org/10.1007/s10615-007-0098-0 https://doi.org/10.1093/acrefore/9780199975839.013.620 http://www.naswdc.org/pressroom/features/issue/mental.asp http://www.qsrinternational.com/nvivo/nvivo-products/nvivo-11-for-windows/nvivo-pro http://www.qsrinternational.com/nvivo/nvivo-products/nvivo-11-for-windows/nvivo-pro https://doi.org/10.1093/acrefore/9780199975839.013.225 https://doi.org/10.1093/acrefore/9780199975839.013.623 http://download.cms.gov/nppes/npi_files.html https://doi.org/10.1093/acrefore/9780199975839.013.624 mailto:dirucobo@hotmail.com results barriers solutions _______ jordan j. steiner, ma, msw, lsw, is a doctoral candidate and laura johnson, phd, msw, lsw, is an assistant research professor, rutgers school of social work, new brunswick, nj. andrea hetling, phd, is an associate professor, edward j. bloustein school of planning and public policy, new brunswick, nj. hsiu-fen lin, ma, msw, lsw, is a doctoral candidate and judy l. postmus, phd, acsw, is professor and associate dean for research and faculty development, rutgers school of social work, new brunswick, nj. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 157-180, doi: 10.18060/22606 this work is licensed under a creative commons attribution 4.0 international license. creating a tool for assessing domestic violence risk and impact among tanf clients jordan j. steiner laura johnson andrea hetling hsiu-fen lin judy l. postmus abstract: the family violence option (fvo), a provision of the 1996 welfare legislation, allows states to waive certain program requirements for domestic violence (dv) survivors in order to protect them from danger or penalties. the absence of a standardized method for assessing risk and impact has been an impediment to states’ use of the fvo, particularly in the granting of waivers. the purpose of this study was to address this limitation by developing and testing a risk and impact assessment tool for dv survivors applying for waivers under the fvo. therefore, a collaborative effort between state administrators and researchers was formed which included input from welfare staff and dv advocates. background research included reviews of validated risk assessments and fvo policies, as well as primary data from focus groups and surveys with staff from the state human services organization, county welfare agencies, and dv organizations. a tool was then created with 131 questions covering demographics, abuse experiences, partner access and risk, perceptions of safety, and emotional health, and piloted in four counties. two hundred and thirty-seven completed assessments were analyzed using descriptive statistics, principal component analysis, and feedback from assessors. the final tool (n= 95 items) was informed by validated evidence and frontline practice wisdom, recommended to improve fvo utilization and survivor outcomes. from this study, the authors recommend that other states seeking changes to their fvo risk assessment policy and practice explore collaborative partnerships between practitioners and researchers in order to make decisions informed by best practices and systematic research. they should also pursue cross departmental training of risk assessment tools to prevent a siloed approach to fvo implementation. keywords: family violence option; domestic violence; temporary assistance for needy families; risk assessment domestic violence (dv) has negative effects on the lives of women in multiple ways. compared to women with no dv, survivors experience more pronounced adverse physical and mental health effects (bonomi et al., 2006), with worse negative health outcomes among female survivors as compared to male survivors (carbone-lópez, kruttschnitt, & macmillan, 2006). experiences of violence can also have a negative impact on survivors’ https://creativecommons.org/licenses/by/4.0/ steiner et al./creating a tool 158 financial health, ability to work, and ability to seek help, thus putting survivors at risk of experiencing poverty (meisel, chandler, & rienzi, 2003). for some survivors, public cash assistance, or welfare, is an important support and often a means to escape an abusive relationship. tolman and raphael (2000) report lifetime prevalence rates of dv for welfare recipients between 50% and 60%, and rates of current or recent abuse from 20% to 30%. moreover, several studies have documented the negative physical and mental health consequences of dv on survivors who are welfare recipients, demonstrating that abuse victims are more likely to report adverse physical health and increased mental health challenges than those who are not abused (allard, albelda, colten, & cosenza, 1997; barusch, taylor, & derr, 1999). those who struggle with stress, powerlessness, and social isolation associated with both dv and poverty may experience post-traumatic stress disorder (ptsd), depression, and other emotional difficulties (goodman, smyth, borges, & singer, 2009). in 1996, the personal responsibility and work opportunity reconciliation act (prwora, pl 104-193) modified the u.s. approach towards income support with temporary assistance for needy families (tanf), a time-limited and means-tested program mandating work requirements, paternity disclosure, and other conditions for recipients. although public cash assistance is an important support and often a means to escape abusive relationships, the 1996 welfare reform sharpened the crisis of economic security among female survivors on welfare. recognizing that dv survivors could face difficulty meeting the requirements of the 1996 welfare reform, senators wellstone (democrat, mn) and murray (democrat, wa) crafted the wellstone/murray amendment to require that states screen welfare recipients for dv, refer survivors to services, and waive benefits requirements through a waiver of good cause. before the final passage of the 1996 prowra, the amendment was converted to a state “option,” and adopted as the family violence option (fvo, pl 104-193). although 42 states have formally adopted the fvo and all others have implemented related services for dv survivors (holcomb et al., 2017), utilization and implementation vary widely (an, yoo, & nackerud, 2016). to be eligible for waivers under the fvo, survivors must be assessed for dv to determine which waivers are appropriate. however, no robust or standardized tool was made available to assist states in the 1990s nor has one emerged since that time. additionally, the waiver granting process as well as who screens and assesses risk among applicants and recipients varies from stateto-state (holcomb et al., 2017). therefore, although the fvo policy provides necessary protections for dv survivors on welfare, it fails in policy implementation due to the lack of a validated and standardized risk assessment tool. current project in response to this lack of a standardized and robust tool for use in fvo implementation, in july 2015, the new jersey department of human services (nj-dhs), division of family development (dfd), contracted with the center on violence against women and children at rutgers university school of social work to develop, implement, and test a risk and impact assessment tool for dv survivors applying for services and waivers under the fvo. four waivers are available to survivors in the study state, including ones from the 60-month time limit, compliance with work requirements, paternity advances in social work, spring 2019, 19(1) 159 disclosure for child support, and one allowing for more lenient access to emergency assistance. in order to accomplish this goal and advance significant policy change in this area, a diverse collaborative effort among the state-level administrators who sponsored the research and university researchers was formed. the project also depended on participation from dv survivors receiving tanf and staff at the county agencies and local dv organizations, contracted by the state to conduct the risk assessments. notably, this study provided the research team, which was comprised of faculty and students from the disciplines of social work and public policy with expertise in dv, with the opportunity to directly shape the policies and practices guiding the implementation of the fvo in new jersey. through this collaboration, the research team engaged in conversations with key stakeholders about the strengths and limitations of the fvo process and developed a risk assessment tool that was informed by evidence and guided by a commitment to developing an instrument that was sensitive to the unique lived experiences of the dv survivors seeking waivers. new jersey serves as a strong case study due to its diverse and representative characteristics in relationship to the u.s. population in terms of racial and ethnic diversity, including 70% white, 14.8% black, 9.8% asian, and 19% hispanic; the u.s. demographic racial and ethnic composition is similar at 76% white, 13.8% black, 6.1% asian, and 17% hispanic (u.s census bureau, 2015). risk assessment tool development: background research data were collected from multiple sources to inform the creation of the risk assessment tool. these data sources included reviews of fvo policies and practices across the u.s., risk assessment literature within and outside the tanf program, as well as surveys and focus groups with staff from the state agency, county welfare agencies, and dv organizations. state policy and family violence option literature review to understand the implementation of the fvo across the u.s., the research team gathered information from state websites and scholarly publications. the team also communicated directly with state agencies as needed. in reviewing state policies, the team focused on eight key areas: whether or not the state has formally adopted the fvo, the definition of family violence, how states inform clients of waivers, how they screen clients, who handles referrals, who completes the risk assessment, who grants waivers, and the types of waivers available. a comprehensive review of the literature was completed to understand best practices and policies on how dv is identified and how welfare departments across the u.s. assess risk. findings from the review indicate that implementation of the fvo, including specific rules and assessment processes, varies across states (holcomb et al., 2017). moreover, based partially on the great number of decisions made by risk assessors, the literature to date does not provide a thorough evaluation or guide to best practices. implementation decisions were based on local circumstances, including need, funding, and politics, and were found to not be solely tied to social science findings. the majority of the approaches steiner et al./creating a tool 160 to assessing risk of dv were more qualitative than quantitative in nature. as a result, we were unable to model our tool off a currently existing risk assessment in the u.s. research on the fvo highlights various challenges to conducting rigorous risk assessment. hahn and postmus (2014) discuss the importance of identifying abuse history as a first step to helping dv survivors move safely out of poverty. although screening for dv is the first mandated step of the fvo, research suggests that survivors are being screened by frontline workers at low rates (casey, davies, gifford, & menard, 2010; lindhorst, meyers, & casey, 2008; postmus, 2004) and that screening behaviors differ between states, organizational structure, the nature of the encounter, and workers’ length of employment (lindhorst et al., 2008). even in circumstances in which frontline workers are screening for dv as part of the tanf process, there are concerns that the screening is not done sensitively or in a way as to encourage disclosure. low rates of disclosure have been documented, with estimates of disclosure rates between 1% to 3% (saunders, holter, pahl, tolman, & kenna, 2005) and 10% (lein, jacquet, lewis, cole, & williams, 2001). based on findings from a longitudinal study, meisel and colleagues (2003) suggested that the disparity between the high percentage of serious abuse prevalence within their sample of survivors and the very low percentage of waiver use may be indicative of problems with the identification of survivors within the welfare system. survivors may also be reluctant to disclose the abuse due to concerns about how the disclosure will be perceived and responded to, with one study finding that tanf workers breached clients’ confidentiality and disclosed private information to the clients’ abusers (casey et al., 2010). in an examination of the fvo in maryland, hetling, saunders, and born (2006) found that women of color and those with less education are less likely to disclose dv to their caseworkers. given these limitations, hahn and postmus (2014) suggested providing tanf frontline workers with comprehensive training on the dynamics of dv, helpful assessment tools, and information about agency and community resources. further, cole (2001) discusses the need to understand how families and communities view survivors who leave their partners, as this is important in assisting them with risk assessments and future plans. there is thus an expressed need for sensitivity to individuals’ circumstances, as well as space for advocacy, within the risk assessment process (postmus, 2000). other scholars offer suggestions on how to improve the fvo waiver process. these recommendations include removing sanctions, screening every applicant for dv, and referring survivors for mental health services as appropriate (laakso & drevdahl, 2006). meier (1997) suggests that developing “objective” (p. 242) and scientific measures of screening might improve the screening process, but cautions around the risk of stigma and pathologization. review of risk assessment literature assessment and management of risk are critical components of the dv intervention process. building on the recommendation of meier (1997) for a more rigorous risk assessment measure in the fvo process, the research team conducted a comprehensive review of the dv risk assessment literature. the overarching goal of this literature review was to report on existing risk assessments used by dv providers to determine what, if any, advances in social work, spring 2019, 19(1) 161 could be adapted for use in the fvo process. the research team first documented the general process of assessing dv risk. overall, the process includes identifying risk factors, deciding on a method for measuring/scoring risk factors, creating a procedure to combine scores, and constructing the estimated risk of violence (monahan & skeem, 2014). the review covered three different types of risk assessment methods: unstructured clinical judgment (decision-making), actuarial assessments, and structured professional judgment (kropp, 2008). unstructured clinical judgment or decision-making is the more traditional method of a dv risk assessment. as part of unstructured clinical judgement, the risk assessor relies on his or her professional qualifications, experience, and discretion to determine survivor risk for future abuse. concerns around this methodology are centered on lack of reliability, validity, and accountability (kropp, 2008). actuarial methods of risk assessment are structured to predict specific behaviors using statistical models and formulas based on previous research to provide a probability of future violence. these actuarial methods have been criticized for their lack of practical utility, as they diminish professional discretion, do not inform practitioners about specific violence prevention strategies, and often include measurement error (kropp, 2008). the third method of risk assessment, structured professional judgment, strives to create a balance between the previous two. this method uses professional guidelines to set a minimum of risk factors for consideration while also incorporating experiential knowledge (kropp, 2008; nicholls, pritchard, reeves, & hilterman, 2013). the following questions guided the literature review: a) what is theoretically/empirically known about existing risk assessments used by dv organizations?, b ) how is risk assessed in other similar contexts?, c) how do existing risk assessments capture multiple forms of violence?, and d) what outcomes are associated with different approaches to risk assessments? with these questions in mind, the research team systematically reviewed academic databases and found that most risk assessments were perpetrator-focused, including such assessments as the domestic violence screening instrument (dvsi; stansfield & williams, 2014), and the brief spousal form for evaluation of risk (b-safer; storey, kropp, hart, belfrage, & strand, 2014), with minimal dv survivor-oriented risk assessments. findings from the risk assessment review suggest that existing unstructured clinical assessments aligned with the purpose of assessments in the tanf context, but lacked validity and reliability. additionally, while existing actuarial assessments demonstrated validity, such tools were less practical in the context of dv risk assessments related to welfare and the fvo. most existing risk assessments focused on predicting re-assault, severe violence, or lethal violence committed by perpetrators (e.g., campbell, webster, & glass, 2009; echeburúa, fernández-montalvo, de corral, & lópez-goñi, 2009; messing & thaller, 2014). these assessments were most commonly developed for use within the criminal justice system to assess for the likelihood of recidivism. risk assessments have also been used within clinical settings to help survivors to develop safety plans (e.g., campbell, 2004; echeburúa et al., 2009). although existing scales on dv capture multiple forms of abuse, there is no existing comprehensive risk assessment from a survivor perspective that is also related to welfare determinations. steiner et al./creating a tool 162 one risk assessment tool with potential relevance to the fvo process was the danger assessment (da; campbell, 2004). the da was developed to assist with the clinical prediction of lethality as well as guide intervention strategies (campbell, 1995). da items were thus incorporated into the fvo risk assessment developed by the research team. however, because the tool assesses for lethality alone, it is not sufficiently comprehensive for the fvo process. key stakeholder survey as a next stage in the data-gathering process, key stakeholders from the county welfare agencies, dv organizations, and the nj-dfd were surveyed to assess their attitudes and beliefs related to the fvo process (n=135). potential survey participants were recruited through key contacts at the nj-dfd and the new jersey coalition to end domestic violence (njcedv) who assisted with distributing the survey to organizational staff. the population sample size was not tracked, as the goal was just to gather feedback from as many key stakeholders as possible. the survey tool included seven scales asking about participants’ attitudes on the state’s tanf program and waivers; beliefs about the causes of dv; the relationship between county welfare agencies and dv organizations within new jersey; the perceived effectiveness of risk assessments; and professional confidence working with survivors. in addition, participants were asked questions about their personal experiences with welfare benefits and dv, as well as demographic questions. overall, participants included nj-dfd representatives (n=4), county-level welfare employees (n=79), and dv organization staff (n=52). analyses were conducted in spss version 23. the demographic characteristics of the survey participants are presented in table 1 and are also divided out by work agency. overall, the majority of participants (80.0%) identified as female and almost half (45.2%) identified as white. a bachelor’s degree was held by approximately 39% of those surveyed, with around 40% holding a master’s degree. approximately half were between the ages of 31-40 (25.9%) or 51-60 (26.7%). survey participants were also asked questions about their personal experiences with dv and welfare benefits, either about themselves or people they know. they answered “yes,” “no,” or “unsure” for each of the statements. more than three-fourths of participants (77.4%) knew someone personally who had experienced dv, although less than half (38.7%) had experienced dv themselves. while the majority of participants (75.9%) knew someone who received welfare benefits, only a small percentage (10.9%) of participants had personally received welfare benefits. of primary importance, survey participants acknowledged that the risk assessment tool should consider multiple types of abuse. in response to this, the research team chose to make the risk assessment tool comprehensive by covering all forms of dv (psychological, financial, physical, and sexual, along with stalking). focus groups with key stakeholders in-depth focus groups were also conducted with various stakeholders who were recruited through key contacts at the nj-dfd and the state dv coalition. these key contacts sent emails to eligible staff members about the research study; those interested advances in social work, spring 2019, 19(1) 163 contacted the research project coordinator to participate in a one-time focus group. eight focus groups were conducted—two with nj-dfd representatives (n=7), three with countylevel welfare employees (n=19), and three with dv organization staff (n=22). inductive thematic analysis was used to identify key patterns within the data (braun & clarke, 2006) using the qualitative data analysis program nvivo 10. the demographic characteristics of the focus group participants are also presented in table 1 and are divided out by work agency. almost all participants (97.9%) identified as female and over two-thirds (68.8%) identified as white, with 29% identifying as black, and 23% identifying as hispanic. about 38% of focus group participants were between the ages of 41 and 50, and 27% between 51 and 60. the focus groups served as a great source of information and largely informed the creation of the risk assessment tool. the themes identified centered on levels of risk and the process of recommending waivers. participants noted a lack of understanding of how each level of risk is defined, as well as how levels of risk relate to particular waivers. county welfare agency staff members indicated that they did not understand how risk assessors, who are dv advocates tasked with implementing the fvo risk assessment, come to determine clients’ level of risk and make recommendations to county welfare agency staff on which waivers survivors should receive. dv organization staff members also felt that the prior risk assessment tool was too subjective. finally, key stakeholders acknowledged that waivers are granted on an “all or nothing” basis, meaning that clients are typically granted either all waivers or none at all. advances in social work, spring 2019, 19(1) 164 table 1. key stakeholder sample characteristics survey focus groups all (n=135, 100%) hso (n=4, 3%) cwa (n=79, 58.5%) dvo (n=52, 35.5%) all (n=48, 100%) hso (n=7, 14.6%) cwa (n=19, 39.6%) dvo (n=22, 45.8%) gender female 108 (80%) 4 (100%) 58 (73.4%) 46 (88.5%) 47 (97.9%) 6 (85.7%) 19 (100%) 22 (100%) male 11 (8.1%) 9 (11.4%) 2 (3.8%) 1 (2.1%) 1 (14.3%) race/ethnicity white 61 (45.2%) 2 (50%) 34 (43%) 25 (48.1%) 33 (68.8%) 2 (28.6%) 11 (57.9%) 17 (77.3%) black or african-american 26 (19.3%) 1 (25%) 21 (26.6%) 4 (7.7%) 14 (29.2%) 5 (71.4%) 5 (26.3%) 1 (4.5%) other 29 (21.5%) 1 (25%) 10 (12.7%) 18 (34.6%) 2 (4.2%) 3 (15.8%) 3 (13.6%) spanish/hispanic/latino origin 26 (19.3%) 2 (50%) 6 (7.6%) 18 (34.6%) 11 (22.9%) 2 (10.5%) 9 (40.9%) age 21-30 19 (14.1%) 1 (25%) 6 (7.6%) 12 (23.1%) 7 (14.6%) 1 (14.3%) 2 (10.5%) 4 (18.2%) 31-40 35 (25.9%) 1 (25%) 23 (29.1%) 11 (21.2%) 7 (14.6%) 2 (10.5%) 5 (22.7%) 41-50 21 (15.6%) 17 (21.5%) 4 (7.7%) 18 (37.5%) 6 (85.7%) 7 (36.8%) 5 (22.7%) 51-60 36 (26.7%) 2 (50%) 19 (24.1%) 15 (28.8%) 13 (27.1%) 6 (31.6%) 7 (31.8%) 61 or older 8 (5.9%) 3 (3.8%) 5 (9.6%) 3 (6.3%) 2 (10.5%) 1 (4.5%) highest education level high school diploma or ged 4 (3%) 1 (1.3%) 3 (5.8%) associate’s degree 10 (7.4%) 7 (8.9%) 3 (5.8%) bachelor’s degree 52 (38.5%) 2 (50%) 41 (51.9%) 9 (17.3%) master’s degree 53 (39.3%) 2 (50%) 17 (21.6%) 34 (65.4%) phd 1 (0.7%) 1 (1.3%) other 1 (0.7%) 1 (1.3%) notes. hso=state human service organization; cwa=county welfare agency; dvo=domestic violence organization. percentages do not add up to 100% due to missing data. only survey participants were asked their highest education level. race/ethnicity categories were not mutually exclusive. steiner et al./creating a tool 165 initial risk assessment tool development the data collected through the comprehensive policy and literature reviews, surveys, and focus groups greatly informed the overall structure and content of the risk assessment tool. the research team structured the tool to be primarily quantitative in nature, with strategically placed open-ended questions to allow survivors a space to include information that was otherwise missed previously. the research team determined that the risk assessment should include risk of abuse as well as impact of abuse and that this should be measured using instruments validated with dv survivors where possible. to create a comprehensive assessment tool, the research team reviewed existing tools and validated measures used with survivors and/or perpetrators to determine whether the questions in these tools were suitable for use in the abuse risk and impact assessment process. in other areas of the risk and impact assessment tool, the research team created new questions based on feedback from the focus groups and surveys. as part of the risk assessment development process, the research team focused on survivors’ abuse experiences along with the possible impact of abuse, as this is the focus of the fvo. the researchers also recognized that the function of the risk assessment was to determine whether engaging in work activities as part of tanf would put survivors at risk for further abuse. relationship factors and abuser attributes might aggravate or mitigate potential risk. as a result, known risk factors for future abuse were also included in the risk assessment. lastly, the research team considered it important to consider survivor perceptions of safety as a factor that may influence how comfortable a survivor feels engaging in work activities. the development of a more standardized approach made the risk assessment tool less subjective; yet, the partner risk, partner access, and perception of safety questions, along with the open-ended questions, provided risk assessors with important background information to guide them in making recommendations for waivers for clients whose scores indicate a moderate or higher level of risk. ultimately, the research team created a pilot tool with 131 questions divided into six sections: 1) demographics; 2) abuse experiences (including emotional, financial, physical, stalking, and sexual abuse); 3) partner access; 4) partner risk; 5) perceptions of safety; and 6) emotional health (depression, anxiety, ptsd, and substance abuse). the pilot tool was then translated into spanish by the nj-dfd so that an english and spanish tool were available for use. emotional abuse. this section asked the client about their experiences with emotional abuse. questions included in this section were adapted from the validated danger assessment (campbell et al., 2009) and the abusive behavior inventory-r (abi-r; postmus, stylianou, & mcmahon, 2016). clients were asked to indicate how often in the past six months their abuser engaged in the following behaviors by indicating 0 (never) to 4 (very often) or yes/no depending on the question structure. overall, 11 items came from the 25-item abi-r and two items came from the 19-item danger assessment. financial abuse. this section asked the client about their experiences with financial abuse and is based on the validated scale of economic abuse-12 (postmus, plummer, & stylianou, 2016). clients were asked to indicate how often in the past six months their abuser engaged in the following behaviors by indicating 0 (never) to 4 (very often) or yes/no (4) steiner et al./creating a tool 166 depending on the question structure. all 12 items from the scale of economic abuse-12 were used, along with three items developed by the research team. physical abuse. overall, nine items were adapted from the abi-r (postmus, stylianou, & mcmahon, 2016) and five items were adapted from the danger assessment (campbell et al., 2009). two items were developed by the research team for the purpose of the risk and impact assessment tool. clients were asked to indicate how often in the past six months their abuser engaged in the following behaviors by indicating 0 (never) to 4 (very often) or yes/no depending on the question structure. stalking. this section asked the client about their experiences with stalking and was based on questions from the national intimate partner and sexual violence survey (u.s. centers for disease control and prevention, 2010). clients were asked to indicate how often in the past six months their abuser engaged in the following behaviors by indicating 0 (never) to 4 (very often). all seven items came from this tool. sexual abuse. this section asked the client about their experiences with sexual abuse; questions were adapted from the severity of violence against women scale (marshall, 1992; thompson, basile, hertz, & sitterle, 2006) and the abi-r (postmus, stylianou, & mcmahon, 2016). clients were asked to indicate how often in the past six months their abuser engaged in the following behaviors by indicating 0 (never) to 4 (very often) or yes/no depending on the question structure. overall, three items came from the abi-r and two items came from the severity of violence against women scale. partner access. this section was designed to gauge the level of access the abuser had to the client. these were generally yes/no questions that centered on current relationship status, the abuser’s current residence, and restraining order status. the questions in this section did not go towards the client’s score on the waiver recommendation guide; rather this information was intended to help in final considerations when recommending waivers. partner risk. this section looked at factors associated with abusers’ lethality risk in dv situations using questions adapted from the validated danger assessment (campbell et al., 2009). clients were asked to respond yes/no to questions regarding their abusers’ behaviors during the past six months. all three items came from the danger assessment. as with the questions in the partner access section, these questions did not go towards the client’s score, but rather were intended to help in final considerations when recommending waivers. perceptions of safety. this section looked at clients’ perceptions of safety within their communities, particularly in relation to fear of their abusers based on questions from the safety rating scale (culbertson, vik, & kooiman, 2001) and the violence against women survey (macmillan et al., 2000). clients were asked to indicate how safe they felt from 0 (always safe) to 4 (not safe at all) in a series of situations. while there was some overlap between the two surveys, approximately seven items came from the safety rating scale and two came from the violence against women survey. the remaining six items were adapted for the risk and impact assessment tool. these questions also did not go towards scores on the waiver recommendation guide and were included for consideration. depression. this section asked the client about feelings and behaviors associated with depression and the questions came from the validated 20-item center for epidemiological advances in social work, spring 2019, 19(1) 167 studies depression scale (radloff, 1977). clients were asked to indicate how often they experienced the listed feelings and behaviors during the past two weeks by indicating whether the feelings or behaviors occurred 0 (not at all) to 3 (nearly every day). anxiety. this section asked the client about feelings and behaviors associated with anxiety and the questions came from the validated generalized anxiety disorder-7 (spitzer, kroenke, williams, & lowe, 2006). clients were asked to indicate how often they experienced the seven listed feelings and behaviors during the past two weeks by indicating whether the feelings or behaviors occurred 0 (not at all) to 3 (nearly every day). post-traumatic stress disorder. this section asked the client about feelings and behaviors associated with post-traumatic stress disorder (ptsd). the questions came from the validated ptsd-8: a short ptsd inventory (hansen et al., 2010). clients were asked to indicate how often they experienced eight feelings and behaviors during the past two weeks by indicating whether the feelings or behaviors occurred 0 (not at all) to 3 (nearly every day). symptoms referenced in this scale fell into one of three categories, intrusion (four items), avoidance (two items), and hypervigilance (two items). participants needed to experience at least one symptom from each category for more than half of days or greater to meet the criteria for ptsd (hansen et al., 2010). substance use. this section asked the client about feelings and behaviors associated with substance use. the questions came from the validated cage questionnaire (ewing, 1984). clients were asked to respond yes/no to whether they experienced the four listed feelings and behaviors during the past two weeks. these questions were not intended to be used for diagnostic purposes but rather to gauge the emotional impact of the clients’ substance use experiences. this section was only one part of a comprehensive assessment of possible emotional impact of abuse, to mitigate victim blaming and denial of waivers based on responses. table 2 outlines the measures that were included in both the pilot and final versions of the risk assessment tool. to avoid the “all or nothing” predicament indicated by the focus groups, the research team developed a “score sheet,” or waiver recommendation guide, to assist risk assessors in determining whether risk or impact is low, moderate, or high, as well as which waivers could correspond with each type and level of risk and impact. as a result, the decision was made to use three levels (i.e., low, moderate, high). the guide was designed to help risk assessors tease out which waivers would be most appropriate for a client given their current situation. the research team drew on their expertise in dv (based on research and practice experience) along with the academic literature to identify these three categories of risk. for example, the research team recognized that certain types of abuse (e.g., physical) pose a greater risk for a survivor in terms of likelihood of future injury and health-associated impacts. as such, survivors received a greater risk level score for having experienced physical abuse, stalking, and sexual abuse in comparison to psychological and financial abuse. steiner et al./creating a tool 168 table 2. scales in pilot and final versions of risk assessment tool* risk/impact area scale name & authors sample item response structure # of items** pilot final emotional abuse danger assessment (campbell et al., 2009) “controlled most or all of your daily activities” 0 (never) to 4 (very often) or 0 (no)/4 (yes) 13 13 abusive behavior inventory – revised (abi-r; postmus, stylianou, & mcmahon, 2016) “called you a name and/or criticized you” financial abuse scale of economic abuse–12 (postmus, plummer, & stylianou, 2016) “demanded to know how money was spent” 0 (never) to 4 (very often) or 0 (no)/4 (yes) 15 16 new jersey assessment of domestic violence risk and impact (njadvri; postmus et al., 2017) “gotten in trouble at a job because of the abuse” physical abuse danger assessment (campbell et al., 2009) “has the severity or frequency of the violence increased over the past year?” 0 (never) to 4 (very often) or 0 (no)/4 (yes) 16 13 abi-r (postmus, stylianou, & mcmahon, 2016) “threatened to hit or throw something at you” njadvri (postmus et al., 2017) “if yes, was the weapon a gun?” stalking national intimate partner and sexual violence survey (u.s centers for disease control and prevention., 2010). “made unwanted phone calls to you or left you messages” 0 (never) to 4 (very often) 7 5 technology abuse cyber dating abuse scale (zweig, dank, lachman, & yahner, 2014) “used your social networking account without permission” 0 (never) to 4 (very often) 0 8 sexual abuse severity of violence against women scale (marshall, 1992; thompson, basile, hertz, & sitterle, 2006) “demanded sex whether you wanted it or not” 0 (never) to 4 (very often) or 0 (no)/4 (yes) 5 4 abi-r (postmus, stylianou, & mcmahon, 2016) “pressured you to have sex in a way you didn’t like or want” perceptions of safety safety rating scale (culbertson et al., 2001) “how safe do you feel in your home?” 0 (always safe/na) to 4 (not safe at all) 15 7 violence against women survey (macmillan, nierobisz, & welsh, 2000) “how safe do you feel taking public transportation during the day?” njadvri (postmus et al., 2017) “how physically safe do your feel from your partner today?” depression center for epidemiological studies depression (ces-d) scale (radloff, 1977) cesd–revised (cesd-r; van dam & earleywine, 2011) “felt bothered by things that usually don’t bother you” 0 (not at all) to 3 (nearly every day) 20 10 anxiety generalized anxiety disorder-7 (spitzer et al., 2006) “feeling nervous, anxious or on edge” 0 (not at all) to 3 (nearly every day) 7 6 ptsd ptsd-8: a short ptsd inventory (hansen et al., 2010) “recurrent thoughts or memories of the abuse” 0 (not at all) to 3 (nearly every day) 8 8 substance use detecting alcoholism: the cut annoyed guilty eye questionnaire (cage; ewing, 1984) “have you ever felt you out to cut down on your drinking or drug use?” 0 (not at all) to 3 (nearly every day) or 0 (no)/4 (yes) 4 5 njadvri (postmus et al., 2017) “in the last two weeks, how often did you drink alcohol or use drugs?” * risk assessment questions were adapted from items in these scales. the wording for some items was modified in the pilot tool and further modified in the final tool. after piloting the risk assessment, principal component analysis (pca) was used to reduce the number of items in some of the scales, as is demonstrated in table 4. however, additional items may have been added to the scales based on qualitative risk assessor feedback. as such, the number of items in the final risk assessment tool may be higher than the number from pilot tool, even though some items were removed. ** the total number of items for the pilot scale was 110. the total number of items for the final scale was 95. steiner et al./creating a tool 169 to clarify the process for completing the assessment and making recommendations on waivers, the following steps were involved. first, following each section of the risk assessment tool, space was provided to tally the score for each section. this was completed by adding the cumulative scores in each column. at the conclusion of the risk assessment, risk assessors used the waiver recommendation guide to determine the client’s weighted score, overall level of risk, and which waivers to recommend. this included the process of converting the client’s total score to a weighted risk level score. thus, a low cumulative risk score was associated with no waivers and a high cumulative risk score was associated with all waivers. for clients with moderate scores, the assessor could decide which waivers to recommend. therefore, on the waiver recommendation guide certain sections of the risk assessment tool are weighted greater than others. moreover, concerning impact, at the conclusion of the emotional impact section, there were also waiver guidelines. this allowed risk assessors to use the overall total impact level score to determine their client’s cumulative impact level. each cumulative impact level was associated with a waiver recommendation. thus, a low cumulative impact score was associated with no recommended waivers and a high cumulative risk score was associated with a recommendation for all waivers except for child support cooperation. for moderate scoring clients, which waivers to recommend was made at the discretion of the risk assessor. piloting of risk assessment instrument the new risk assessment tool was piloted in four counties in new jersey between june and december 2016. these counties were selected based on their perceived commitment to the study as evidenced by focus group participation, the number of risk assessments conducted during a one-quarter period, and diversity in the location and population of the county. each county that agreed to participate in the pilot received a three-hour training on the risk assessment tool, conducted by two members of the research team. the training was attended by both dv advocates in selected counties and county welfare workers. the training provided an overview of the materials that informed the creation of the risk assessment tool. thus the staff from the dv organizations and county welfare agencies were given an opportunity to see how their participation in the focus groups and surveys informed the first draft of the risk assessment tool. additionally, each section of the tool was reviewed in detail to clarify and review each question and the response options. trainees were taught to score the assessment using the waiver recommendation guide. overall, 237 face-to-face risk assessments were completed, ranging from 19 to 91 in each county. on average, the tool took between 45 and 60 minutes to complete. during the pilot phase, risk assessors reported that the previous risk assessment tool took between 60 to 120 minutes to complete. as such, the tool that was piloted was expected to be shorter. further, clients completed the assessment as part of a scheduled appointment with the risk assessor. the research team collected the completed assessments from the dv organizations approximately once a month and entered them into spss. for confidentiality purposes, no names were associated with the risk assessments. steiner et al./creating a tool 170 analysis of pilot risk assessment tool the risk assessments were analyzed using descriptive statistics and principal component analysis (pca). descriptive characteristics of the clients who completed the risk assessment are presented in table 3. almost three-fourths (73.1%) of the risk assessments completed during the pilot study were new risk assessments; the remaining were re-assessments, which occur every six months after an initial assessment is completed. similarly, three-fourths (75.5%) of participants identified their abuser as a former partner; 16.5% identified their abuser as a current partner; and the remaining identified their abuser as a family member (4.2%) or other individual (3.8%). the majority of participants identified as either black or african american (40.1%) or white, nonhispanic (30.4%). half of participants were between the ages of 26 and 35 (48.9%) and 86.5% were responsible for at least one child. almost 40% of participants had earned their high school diploma or ged while nearly 40% attended some college or were college graduates. table 3. survivor characteristics (n=237) characteristic n (%) risk assessment status new risk assessment 173 (73.1%) re-assessment 64 (26.9%) relationship to abuser former partner 179 (75.5%) current partner 39 (16.5%) family member 10 (4.2%) other 9 (3.8%) race/ethnicity black or african-american 95 (40.1%) white, non-hispanic 72 (30.4%) latina or hispanic 39 (16.5%) other 30 (12.7%) age less than 25 54 (22.8%) 26-35 116 (48.9%) 36-45 46 (19.4%) 46 or older 18 (7.6%) financially responsible for children, % yes 205 (86.5%) highest education level less than high school 52 (21.9%) high school diploma or ged 89 (37.6%) some college or college graduate 92 (38.8%) note. percentages do not add up to 100% due to missing data. the research team used pca to create a shorter version of the risk assessment tool and to identify critical items with the most explanatory power. pca is a type of statistical technique that identifies patterns within a dataset with the goal of extracting the variables advances in social work, spring 2019, 19(1) 171 with the most important information and can be used for data reduction by identifying items that are not important or repetitive (abdi & williams, 2010). in other words, pca is used to combine variables that account for the most total variation in the data and to eliminate the least important items. pca creates new variables, called principal components, to transform the original variables into linear combinations. the first principal component retains the largest possible variance explained, and each succeeding component accounts for the remaining variance (abdi & williams, 2010). the research team did not name the components, as the only function of the analysis was to determine whether any items could be reduced. to determine whether variables can be reduced, researchers must first look collectively at the total variance explained, the correlations to determine whether any items are highly correlated, and the strength of individual loadings on each component. for example, maiuro and colleagues (2000) developed a health provider survey for domestic violence with an initial pool of 104 items, and used pca to identify which items clustered together and dropped items with loadings of greater than 0.50 on the main components, resulting in 39 items for practice use. in this study, pca was used for all of the abuse scales from the abuse experiences section (i.e., emotional, financial, physical, stalking, sexual), as well as with two of the four scales to measure impact (i.e., anxiety, ptsd). this is referred to in table 4, which outlines the critical areas of the pca (see postmus et al., 2017 for additional information on pca results for all scales). pca was not used to analyze items in the partner access, partner risk, and substance use sections because these were nominal data. pca was also not used to analyze items in the perceptions of safety scale because these questions did not go towards the client score on the waiver granting guide, but rather was intended to help in final consideration of waivers. additionally, pca was not used to test the depression scale, as the decision had already been made to use the shorter 10-item version for the final instrument. this 10-item version was based on the cesd-r scale (van dam & earleywine, 2011), as a result of informal feedback received from the risk assessors. table 4. principal component analysis of seven risk and impact scales risk/impact area # of items tested # of components cumulative % of variance factor loadings # of items after pca emotional abuse 13 2 56.5 .46-.78 13 financial abuse 15 3 66.9 .50-.78 14 physical abuse 16 3 58.5 .35-.82 15 stalking 7 2 56.3 .50-.81 6 sexual abuse 5 1 68.6 .73-.92 4 anxiety 7 1 62.8 .70-.86 6 ptsd 8 1 57.5 .67-79 8 note. pca was not conducted on scales with nominal data (partner access, partner risk, and substance abuse questions), therefore, these items did not contribute to the client score on the waiver-granting guide (perceptions of safety scale) but rather were intended to help in final consideration of waivers, or scales where an abbreviate version of the measure already existed (depression scale). to perform the pca across seven scales, the research team first examined the correlation matrix among items in each scale. the majority of correlation coefficients were above 0.3, indicating the appropriateness for pca (tabachnick & fidell, 2013). second, steiner et al./creating a tool 172 bartlett’s test of sphericity was significant within all scales. the kaiser-meyer-olkin measure of sampling adequacy ranged from 0.778 to 0.924, between the commonly recommended value above 0.6, showing the sampling was adequate (streiner, norman, & cairney, 2015). third, the communalities were all above 0.3, indicating that the items shared some common variance. finally, the subject-to-item ratios spanned from 18:1 to 47:1 (osborne & costello, 2004). these overall indicators showed the pca was suitable for data extraction. emotional abuse scale. first, a pca was run on the 13-item emotional abuse scale. pca revealed two components that had eigenvalues greater than one, which cumulatively explained 56.5% of the total variance. assessment of the correlation and component matrices suggested that the items in the scale were strong and thus, none were removed. financial abuse scale. a pca on the 15-item financial abuse scale revealed three components with eigenvalues greater than one, which cumulatively explained 66.9% of the total variance. the items “demanded to know how money was spent” and “demanded that you give them receipts and/or change when you spent money” had a high positive correlation. as a result, these two questions were merged and the item was changed to “demanded to know how money was spent” (for example, “demanded that you give them receipts”). physical abuse scale. a pca on the 16-item physical abuse scale revealed three components with eigenvalues greater than one, which cumulatively explained 58.5% of the total variance. the items “threw you around” and “choked or strangled you” had a high positive correlation. as a result, the item “threw you around” was removed. stalking scale. a pca on the 7-item stalking scale revealed two components with eigenvalues greater than one, which cumulatively explained 56.3% of the total variance. the item "left you cards, letters, flowers, or presents when your abuser knew you didn’t want them" was found to contribute minimally to the scale; therefore, the item was removed. sexual abuse scale. a pca on the 5-item physical abuse scale revealed one component with an eigenvalue greater than one, which cumulatively explained 68.6% of the total variance. the items "demanded sex whether you wanted it or not" and "pressured you to have sex in a way that you didn’t like or want" had a high positive correlation. therefore, these items were merged to, "pressured you to have sex when you didn't want to or in a way that you didn't like or want." anxiety scale. a pca on the 7-item anxiety scale revealed one component with an eigenvalue greater than one, which cumulatively explained 62.8% of the total variance. the items "not being able to stop or control worrying" and “worrying too much about different things” were found to have a high positive correlation so the item “not being able to stop or control worry” was removed. ptsd scale. a pca on the 8-item ptsd scale revealed one component with an eigenvalue greater than one, which cumulatively explained 57.5% of the total variance. assessment of the correlation and component matrices suggested that the items in the scale were strong and thus, none were removed. advances in social work, spring 2019, 19(1) 173 finalizing the risk assessment tool the final risk assessment tool was also informed by field-based recommendations including additional questions, item rewording, assessment reordering, and scoring clarification provided by the risk assessors. for example, the financial abuse scale began with 15 items and ended up with 16 items (as indicated in table 2), despite one item having been removed as a result of the pca analysis. two additional questions were then added based on risk assessor feedback. the final tool integrated two significant modifications from the suggestions of risk assessors. first, the 20-item ces-d scale was replaced by the abbreviated 10-item cesd-r (van dam & earleywine, 2011) as clients often found the ces-d questions redundant. second, a seven-item technology abuse scale was also added as the risk assessors noted the new type of abuse experienced by survivors. the cyber dating abuse scale is a relatively new instrument that captures how a perpetrator can use technology to further intimidate the partner (zweig et al., 2014). due to the overlap of items with the stalking scale, the research team removed the item “sent you unwanted emails, instant messages, or sent messages through websites like facebook, snapchat, or instagram.” according to the feedback from risk assessors, such a standardized tool was beneficial to decrease the subjective nature of risk assessment and to improve the assessment process. risk assessors shared that the partner risk, partner access, and perception of safety questions, along with the open-ended questions, provided important background information to guide them when making waiver recommendations for clients whose scores indicate a moderate to high level of risk. the new tools intended to provide guidance on which waivers would be most appropriate for a client given their current situation, addressing a concern of focus group participants that previously waivers were granted on an “all or nothing” basis, meaning that clients were typically granted either all waivers or none at all. the more targeted approach of waiver recommendations in the new risk and impact assessment process received positive feedback. the final tool, made up of a total of 95 items, named the new jersey assessment of domestic violence risk and impact (njadvri), is available in its entirety for use by other states and can be found within postmus et al. (2017). strengths and limitations this project had several strengths as well as several limitations. some strengths include the use of triangulated methods to gather information from a range of sources about the gaps in the fvo process and needs both nationally and in new jersey. moreover, some validated measures were included in the scales, which allowed for the use of quantitative analysis to reduce items where possible to promote efficiency and thoroughness of the assessment. furthermore, the researchers had the opportunity to develop and then pilot the instrument. this provided an opportunity to both identify and remedy challenges that emerged and assure the development of a comprehensive assessment based on feedback from both dv advocates, county welfare workers, and state human services organization representatives. further, this study provided social workers with expertise in dv the opportunity to be directly involved in the shaping of fvo policies and practices in new steiner et al./creating a tool 174 jersey. finally, the assessment uses quantitative and qualitative information to comprehensively assess a client’s situation and is the first step towards standardizing a risk assessment tool for survivors of dv seeking waivers as part of the fvo process. however, there were some limitations to the project that are important to acknowledge. the finalized instrument was not validated. moreover, an investigation of how the final tool was implemented across the state was beyond the scope of this particular study. as a next step, researchers should conduct a similar study by collecting completed revised risk assessments from risk assessors and evaluating the scoring process. furthermore, data collection for the instrument occurred in only one state so the information collected as part of survey development is not generalizable to other states. finally, the researchers do not know whether the clients received the waivers recommended by the risk assessors. a potential limitation of the risk assessment instrument itself is that it takes approximately 45 to 60 minutes to complete. the research team felt it was important to capture the nuanced nature of the risk and impact of dv through a comprehensive tool that included both closed-ended and open-ended questions. preliminary feedback from the risk assessors suggested that this tool was easy to administer and score, thus serving as an improvement upon the instrument previously used which took even longer to complete. further, in order to complete the assessment, clients were required to schedule an appointment in advance and the dv organizations tried to eliminate hardships for survivors during this process by providing transportation and childcare, when able. however, it is possible that the tool could cause fatigue in clients. policy, practice, and research implications to improve fvo utilization and survivor outcomes, a standardized, yet flexible, tool is critical to assess risk and impact among survivors. in order to accomplish this goal and advance significant policy change in this area, a diverse collaborative effort among the state-level administrators who sponsored the research and university researchers was necessary. the project depended on and greatly benefitted from participation by staff from county welfare agencies, dv organizations, state human services organization representatives, as well as from survivors. as such, this study also describes ways in which scholars from social work and public policy can influence the policy arena by utilizing evidence-informed methodologies that prioritize practice-wisdom. while validated evidence and primary qualitative and quantitative research were critical components of building and testing the tool, the feasibility and strength of the tool also depended firmly on the incorporation of frontline practice wisdom through informal feedback from the risk assessors. moreover, the incorporation of practitioner viewpoints and collaboration with administrators supported the ultimate utilization of the tool and policy change. this allowed both policymakers, dv advocates, and county welfare practitioners to tackle the fvo policy challenges by helping adapt, create, and implement a robust and standardized tool assess risk among applicants. this tool enables workers to make informed decisions about which cases to offer waivers of good cause, as mandated by the statute of the fvo policy itself. the collaboration behind the project resulted in a strong and feasible change to the fvo policy in new jersey. advances in social work, spring 2019, 19(1) 175 based on this process and experience, we recommend that other states seeking changes explore partnerships with researchers in order to make decisions informed by best practices and systematic research. in our work on the risk assessment tool, we also found that facilitating and formalizing relationships between welfare caseworkers and dv advocates could be important in creating and sustaining practice improvements. a siloed approach to roles and responsibilities thwarts program improvements that cross departments and agencies. cross-training on dv and welfare for both fvo screeners and risk assessors would likely improve the policy’s efficacy. allowing for some flexibility within a formalized tool and assessment process is important in meeting the unique needs of individual survivors. this flexibility exacerbates the need for training and means that risk assessors should have a strong understanding and comfort level with working with survivors as well as a strong understanding of the policies and procedures that dictate those working in welfare organizations. finally, the research team recommends that policy change is not thought of as a completed task. considering the fvo risk assessment process specifically, tools and processes should be updated to reflect cultural and technological changes. assessment tools should also be revisited periodically to determine if questions are still appropriate. the questions related to cyber stalking that were added to the final tool are good examples of the need to revisit tools over time. policy makers and administrators must also assess confidentiality policies and practices, particularly in regard to data sharing and access. suggestions for future research additional research is needed that validates this risk assessment tool with the general welfare sample as well as with welfare organizations in other states. such research should also include evaluation of the screening and identification processes as well as the longterm outcomes of those survivors who were recommended for, as well as received waivers. more research is also needed which explores the scoring process for this revised risk assessment tool to test and explore whether the njadvri adequately identifies the risk and impact of current and future abuse. further research could also examine whether survivors desire the suggested 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(2014). technology, teen dating violence and abuse, and bullying: final report july 2013. washington, dc: urban institute. author note: address correspondence to: jordan steiner, ma, msw, lsw, doctoral candidate, rutgers school of social work, new brunswick, nj 08901. email: jjsteiner@gmail.com acknowledgements: the authors would like to thank the advocates, county welfare workers, state human services organization representatives, and survivors who took part in the research for this project. we are in their debt. additionally, this project was supported by the new jersey department of human services, division of family development. points of view in this document are those of the authors and do not necessarily represent the official position or policies of the department. mailto:jjsteiner@gmail.com microsoft word boys et al copyedit final     _________________  stephanie k. boys, ph.d., jd, msw, is an assistant professor of social work and carrie a. hagan is a clinical associate professor of law, both at indiana university on the indianapolis campus. valerie voland, msw, lcsw, is a social worker at indiana university health. copyright © 2011 advances in social work vol. 12 no. 2 (fall 2011), 241-254   lawyers are counselors, too: social workers can train lawyers to more effectively counsel clients stephanie k. boys carrie a. hagan valerie voland abstract: attorneys new to practice often find themselves completely unprepared to assist emotionally distraught clients. traditional law school curricula do not mandate coursework on how to interview clients or how to involve clients in the representation plan. the knowledge, values, and skills taught in schools of social work can be useful tools to address many common challenges faced by lawyers. the authors argue for transdisciplinary education in which social work educators teach courses in law schools. systems theory, cultural competence, and the strengths perspective are used as examples of practice approaches that could greatly enhance the services provided to clients seeking legal services. keywords: social work and law, interdisciplinary education, social work practice skills, transdisciplinary education introduction law schools teach students to think like lawyers, meaning how to break cases down into legal principles (wetlaufer, 1990). however, legal practice requires knowledge far beyond legal facts and analysis. inevitable questions asked by beginning attorneys include “what do i do when my client cries?,” “how do i handle clients who tell me more than i want to know?,” and “where do i send a client who needs psychiatric help?.” these are all questions answered in introductory social work courses. while lawyers sometimes try to deny the social work inherent in working with low income clients, many researchers argue it should be embraced (aiken & wizner, 2003; coleman, 2001). there are significant differences between the professional duties and ethics of law and social work; however, the knowledge and skills taught in schools of social work can be useful tools to address the common challenges faced by attorneys. there have been scholarly discussions about the need to form more cross-campus collaborations over the past several decades, but little has changed in universities or in the actions of faculty and students to further interdisciplinary work (weinberg & harding, 2004). the aim of this article is to demonstrate the benefits of transdisciplinary education. the authors argue for moving beyond the traditional academic interdisciplinary model of allowing students to take a few courses outside their field of study. instead, the authors propose shifting to a model in which knowledge and skills are shared from various disciplines that can benefit one another, and educators can teach across departmental boundaries. advances in social work, fall 2011, 12(2) 242    transdisciplinary work is not one discipline imposing its own values, knowledge, and practices on another discipline or deciding which discipline is the best to use in certain situations. instead it involves coming up with solutions that incorporate multiple ways of thinking, and collaboratively working together to serve clients and the community in a way that is better than segregated services (bronstein, 2003; voyvodic & medcalf, 2004; weinberg & harding, 2004). while transdisciplinary education has possible benefits for a multitude of fields and could be useful in both directions between law and social work, this exploratory article focuses on what social work educators should be called upon to teach in law schools. the authors first explore what is missing in law schools and why these deficiencies are problematic. next, theoretical constructs from social work that could fill the gaps in legal education will be discussed. the theories will be briefly explained, followed by a demonstration of their relevance to legal education and a pedagogical example of how they could be conveyed in a law school setting. barriers to developing transdisciplinary education with social workers in law schools are examined and recommendations for overcoming the barriers are explored. what is missing in law schools? practicing attorneys spend much of their time in direct interactions with clients who are experiencing multiple problems that cannot be solved by solely focusing on legal issues. for example, a client in the midst of a divorce proceeding may also be in need of services such as housing assistance, food pantries, day care, job training, and emotional support. therefore, law students may be better prepared to assist clients if they are trained in how to communicate, empathize, and interview clients, as well as to be aware of other resources that can help clients beyond merely legal resources. the most realistic way to prepare students for direct practice is to give them the opportunity to work with clients under supervision of practicing attorneys. however, the majority of law students graduate without a school-related internship, which is often referred to as clinical experience in law schools, or the benefit of instructor-supervised practice working directly with clients. not all schools of law offer clinical experience opportunities, and very few american law schools require an internship as part of the law school degree requirements (voyvodic & medcalf, 2004). social work students, in contrast, are required to participate in a practicum under the supervision of licensed social workers to gain direct practice experience with clients before graduating (voyvodic & medcalf, 2004). schools of social work and law take very different approaches to teaching “practice.” voyvodic and medcalf (2004) explain there is a sense of “academic illegitimacy” associated with pursuing hands-on practice as part of academic programs, and they argue for a re-examination of this longstanding belief. while professors of law may still object to clinical practice in law schools, there is a growing movement among clinical professors of law, who teach elective practicum courses, for interdisciplinary components to be added to clinical programs (voyvodic & medcalf, 2004). there is an emerging literature in legal journals, particularly clinical boys, hagen, voland/lawyers are counselors, too 243    teaching law reviews, discussing the ways in which social work practice skills could be useful tools for law students (aiken & wizner, 2003). for example, galowitz (1999) explains that she realized there is a need for social workers in law clinics after supervising a law student assigned to a case with a client referred to the clinic for housing problems. it quickly became apparent the client also had other barriers in her life, such as hiv positive status, threats of losing her food stamps eligibility, and problems paying her utility bills. galowitz states social workers can help law students view clients as whole people affected by multiple systems, instead of viewing clients only by their legal issue, so that client problems can be recognized before reaching emergency crisis situations (1999). others advocate for incorporating social work approachesinto legal education through a focus on social justice. the professional code of social work requires promoting social justice. lawyers and law students can play a more significant role as professionals if they move beyond just providing direct services to clients and see the importance of using their knowledge and skills to practice social justice on a macro level (aiken & wizner, 2003; rand, 2006). why truly integrated education is necessary the primary reason social work education is needed in schools of law is to ensure better services for clients seeking legal assistance. lawyers with some training in social work practice skills will have a more holistic toolbox from which to assist clients, will work more effectively in interdisciplinary teams, and will have better educational outcomes (colarossi & forgey, 2006; coleman, 2001). much of the work already performed by attorneys falls into the category of social work rather than law, especially when they are serving low income clients (aiken & wizner, 2003). attorneys are often asked to provide service referrals, mediate conflicts, and simply listen to a client’s dilemmas. research on the practice of law is scarce because most academic lawyers are not trained in empirical research methods, but in 1975 shaffer found that lawyers could spend up to 80% of their time with clients performing counseling duties, as defined by talking with clients about issues that do not result in progression of the legal case. yet the majority of attorneys have no educational background in counseling. workplace interdisciplinary partnerships between lawyers and social workers are becoming more common in practice areas such as family law, child abuse and neglect, and juvenile delinquency (allen-meares, 1998). defining roles and communication between the professions can often be difficult in the workplace when professional identity has already been solidified (allen-meares, 1998). if the professionals had prior training on collaboration during their education, it could enhance effective communication and understanding of each other’s skills and roles to ultimately better serve clients (katkin, 1974). the ability of social workers and lawyers to work together in the courtroom has long been shown to impact the quality of services provided to clients (shaffer, 1975; weil, 1982). additionally, evaluation of innovative transdisciplinary courses provides initial evidence that courses co-taught by social work and law educators results in better advances in social work, fall 2011, 12(2) 244    educational outcomes. colarossi and forgey (2006) used a pretest-posttest control group design to evaluate the effectiveness of a transdisciplinary social work and law course focused on domestic violence. the course, domestic violence: social work and law, was offered as an elective and either co-taught by a social work and a law professor with enrollment from both fields or a control class taught by an instructor from the student’s own profession. the results of the study indicate several themes: students involved in the transdisciplinary course experienced increased knowledge of domestic violence and of the roles that social workers and lawyers take in client intervention, students in the transdisciplinary course had fewer myths and stereotypes about domestic violence clients after completing the course (as compared with the control group), and the students in the experimental group experienced positive attitudes towards transdisciplinary education (colarossi & forgey, 2006). finally, social work educators should advocate for the value of their knowledge and skills to other professions. a qualitative study of lawyers found that attorneys were not aware of the professional duties and education of social workers, and believed they could perform the functions of a social worker as well as a professional social worker (weil, 1982). social workers are trained to advocate for others, but we also need to remember to advocate for ourselves. our knowledge is important. while other professions cannot and should not take on our professional roles, a background in some of our interviewing and assessment skills can ensure clients receive better services from attorneys and that attorneys can provide appropriate referrals to social workers and other professionals. examples of social work theoretical perspectives useful in law schools professional social workers employ a variety of theories to inform the practice skills they select for use with clients. the theories are used to help explain the nature of human behavior and interaction to achieve various practice goals. several of the essential goals social workers must achieve with clients are also essential goals attorneys must meet with each client. examples include interview structuring, information gathering, and goalsetting based on client decisions. both professions must prepare interview frameworks, and have the ability to maintain focus and know when to allow for deviation from the planned structure of the interview. social workers and lawyers must also conduct information gathering sessions. they must know how to make clients feel comfortable disclosing necessary information in order for the professional’s assistance to be effective. finally, both professions must set goals for the outcome of the client services, and the client’s input must be balanced with the duties of the profession. several theories borrowed from social work can help attorneys more effectively and systematically perform these tasks that the professions have in common. the following discussion of systems theory, cultural competence, and the strengths perspective is far from an exhaustive list of social work constructs that would be beneficial to future lawyers, but it is intended as a beginning discussion for social work educators to advocate for social work involvement in law school curricula. boys, hagen, voland/lawyers are counselors, too 245    systems theory systems theory, adopted from its origins in biology, is the primary perspective from which social workers evaluate client situations and needs (andreae, 2011). the theory explains connections between various systems, whether in the body or between individuals and their community. when used in the social sciences, systems theory demonstrates how an action on any system has a reverberating impact on many other systems (andreae, 2011; katz & kahn, 1978). how systems theory is useful in legal education. legal practice is typically focused on the individual; however, clients’ needs are often multifaceted and the decisions they make in a legal office can impact multiple systems in their lives. legal problems are often intermixed with social, medical, and economic problems (coleman, 2001). attorneys will provide more effective counsel if they understand systems and use the theory to help a client foresee all possible outcomes of legal action. for example, an angry father recently served with divorce papers may react by initially requesting his attorney take the most adversarial tactics available to fight for custody of his child. this single action will impact many other systems in his life. only a few of the impacted systems include: the child herself, the child’s school district, and each member of the larger family systems of both parents (e.g., whether grandparents/aunts/uncles/cousins will be able to easily visit the child). systems theory can also be useful in recognizing that clients often need services beyond what lawyers can provide; in this instance, it is important to recognize opportunities for crisis intervention services and other referrals. law students should be made aware of community resources and have a local guidebook on hand for referrals. examples of how to teach systems theory in a law school setting. socratic pedagogy, in which professor and student exchange questions on legal doctrine, dominates legal education (wetlaufer, 1990); however, the types of role plays incorporated into social work education could greatly enhance demonstrations of how to gather information from clients and determine service goals. systems theory, which is often difficult to explain abstractly, can be demonstrated clearly through example in a role play. the following example is one way to teach law students both the benefits of approaching client problems from a systems theory perspective and the ways the theory can be useful in skilled interviewing. provide one student with a scenario in which he or she is an attorney and her client has just received a settlement offer from her ex-husband regarding custody of their 10year-old daughter, casey. the instructor can play the client. the student will most likely begin with questioning the client on whether she understands the settlement. as the client, respond that you understand, and the only troubling stipulation is that the split of holidays means you will never have custody of casey on christmas. as the client, express in a timid way that you cannot make up your mind about what to do (be as indecisive as possible… worry that if you do not sign this settlement, your ex-husband might become angry and sue for full custody, resulting in a less favorable settlement). the lead author has utilized this scenario as a guest speaker in several clinical law courses, and the most common student attorney responses are “i can’t tell you what to advances in social work, fall 2011, 12(2) 246    do” and “do you want to take a few minutes to think about it?.” in order to avoid imposing their own agenda, students put the power of self determination on the client’s shoulders and offer no guidance. next, process the interaction. start by asking what the attorney did correctly. under legal professional standards, the student did not make any mistakes. she refrained from advising the client on a personal decision; however, the lawyer could have better served the client by helping her think through possible outcomes. systems theory can be used to guide the client through an interview based on “what if” scenarios. inform students they can ask “what if you sign this settlement today? tell me what christmas will be like.” this will allow the client to explore various systems that will be impacted by her daughter’s custody arrangement. next, the client must be asked what will happen if she does not sign. all possible outcomes should be exhausted to allow the client to determine the most informed decision for herself. after the discussion of systems theory, allow another student to conduct the client interview and incorporate systems theory. an additional way to utilize systems theory is to require a homework assignment students begin by brainstorming a list of all resources their clients might need, such as financial, food and housing assistance. next, ask students to research assistance available for each of these needs, such as tanf, food stamps and section 8 housing vouchers. finally, students should conduct research regarding specific details on how to apply for these programs. in the process, students will learn what community resources are available, where they are located, and what information clients will need to gather in order to apply. the assignment can be explained and debriefed in relation to systems theory as students brainstorm what services will be needed for clients in various situations. the completed assignment will be a valuable resource book for attorneys who plan to practice locally upon graduation, and a starting point for collecting a database of resources for those who relocate. cultural competence cultural competence involves the acquisition of knowledge about various cultures and traditions, and the practice of sensitivity and acceptance of diversity. students of social work are asked to reflect on cultural traditions and their own beliefs in exercises to develop acceptance, in order to avoid pushing their own agenda or assessment of client needs on a client (perry & tate-manning, 2006). how cultural competence is useful in legal education. attorneys have a similar requirement to respect client individuality and decisions. social work training techniques regarding cultural competence are an effective way to teach the importance of removing self from client decisions. it is important for all professionals serving clients to devote time to becoming aware of their own biases, prejudices, values, ethics, experiences, and assumptions about human behavior, because all of these attributes can influence interaction with clients and approaches to working with culturally diverse clients (perry & tate-manning, 2006). practitioners who do not practice cultural competence run the risk of detrimental outcomes for clients, including disrespect, discrimination, improper boys, hagen, voland/lawyers are counselors, too 247    assessment and/or intervention, and lack of access to needed services (simmons, diaz, jackson, & takahashi, 2008). the meaning of cultural competence is often misunderstood. practitioners, including both social workers and attorneys, do not need to be an expert in all cultural differences to be a culturally competent professional (simmons et al., 2008). cultural competence means being aware of potential differences in values, ethics, behavior, language, and religious practices of clients in order to be sensitive to their unique needs and circumstances (perry & tate-manning, 2006). being culturally competent is an ongoing process as social workers and attorneys continually encounter new situations and new clients (simmons et al., 2008). directly asking clients questions is an appropriate way of addressing cultural differences—one cannot be expected to know everything about all cultures. however, being aware of the impact of cultural differences can have a positive impact on client-practitioner interactions and client outcomes. clients can be asked about their culture, social background and preferences, such as how they would like to be addressed. cultural competence is becoming even more important as the united states is becoming increasingly diverse in terms of racial, ethnic, religious, social, and cultural differences. there has been a corresponding growth in the need for people in social services to develop skills and knowledge of cultural competence (simmons et al., 2008). cultural competence is also a useful construct for discussing accessible language. when teaching interviewing skills, a discussion of using language appropriate to the client’s needs is imperative. law school training aims to teach students to think and talk in legal language (wetlaufer, 1990); however, students must also learn how to undo this training when speaking with clients. legal terms can be used, but must be explained to clients in everyday language. lawyers need to approach and interact with clients for whom english is a secondary language differently than with those who are native english speakers. legal terminology is difficult for most people to understand and it is even more problematic for clients unfamiliar with the english language. additionally, the educational level and any disability the client may have must be taken into account. the concept of “starting where the client is” is necessary to match the style of communication the client takes. while the attorney must adopt a professional appearance to maintain trust, he or she must also avoid being condescending toward the client in order to maintain an open relationship. example of how to teach cultural competence in a law school setting. as with any type of social work theory, construct, or practice skill, there are many ways to teach the application of cultural competence. the authors have utilized the following exercise in a clinical law course and received positive, systematically derived qualitative feedback on its effectiveness from students, with the primary theme being that the exercise made them realize that flexibility is needed when working with clients because everyone will have differing needs. to complete the exercise, students are given a homework assignment of preparing a preliminary set of interview questions for a client who has made an appointment to file for a protective order. just like social work students, beginning law students working with clients tend to prepare in great detail and remain rigidly bound to the set of interview questions prepared in advance. during the next class session, ask a student to role play the attorney and the instructor will act as the client. as soon as the advances in social work, fall 2011, 12(2) 248    student begins on the line of scripted questions, interrupt that you are no longer sure you want the protective order. the student will most likely be at a loss for words now that the script is no longer relevant. the role play allows for class discussion of the need for flexibility and a brainstorming session on cultural competence. the client has made the effort to attend the appointment, which indicates she wishes to address the matter. ask the students to brainstorm what her reluctance could mean. a non-exhaustive list of discussion points includes: 1. cultural competence issues of education: she may not understand what a protective order is. 2. cultural competence issues of socioeconomic status: she may have limited financial resources and believe it is beyond her means to file a protective order. 3. cultural competence issues of culture: cultural differences may impact how openly a client will divulge relevant information. for example, native american cultures have a taboo of speaking of domestic violence in public. 4. cultural competence issues of background experiences: she may be an illegal immigrant and afraid that her status will be reported if she becomes involved with the justice system through a protective order. 5. cultural competence issues of recognizing when a referral is needed: she may not yet be ready to leave her partner. in this case, she should be given information for a local shelter and told to keep it in her shoe just in case. strengths perspective the strengths perspective is a practice approach that involves indentifying clients’ sources of resilience. the strengths model is based on six principles: the focus is on individual strengths rather than pathology, the community is viewed as a source of resources, interventions are based on client self-determination, the practitioner-client relationship is seen to be primary and essential, aggressive outreach is employed as the preferred mode of intervention, and people are seen as being able to learn, grow, and change (saint-jacques, turcotte, & pouliot, 2009). how strengths perspective is useful in legal education. social workers utilize the strengths perspective to facilitate the empowerment of clients and include them in the problem solving process (aiken & wizner, 2003). clients seeking legal representation are typically in a crisis situation and often feel hopeless. although it is not the role of the attorney to help the client emotionally work through the situation, the attorney’s representation can be more effective if the client can focus on resilience. clients who feel empowered will be more likely to be engaged in helping themselves. clients need to be motivated to do what is necessary to provide effective representation, such as returning phone calls, attending meetings, returning documents, and finding necessary evidence. the strengths-based approach to practice is sometimes misunderstood as an approach that only focuses on the positives in a situation or only on the potential benefits one can boys, hagen, voland/lawyers are counselors, too 249    experience from adversity. instead, strengths-based approaches do not ignore or minimize problems of clients, but make a point to assume all clients have competencies and strengths that can help them cope with and overcome their problems (sousa, ribeiro, & rodrigues, 2006). they also involve helping the clients view their identity as separate from their current legal problems (sousa et al., 2006). the barrier to the strengths-based approach is that many professionals who serve clients are trained in a deficit or problem-based approach. indeed, society in general is more problem-based or negatively focused, approaching life by identifying what is wrong. detrimental effects of the problem-focused approach can include frustration (by both the professional and client), stigmatization, apathy, a greater dependency on social services, and disempowerment (sousa et al., 2006). strengths-based approaches go beyond the identification of the problem to also identify what is working or has worked in the past and what can be learned from the situation. professionals then help clients identify and utilize their talents, values, competencies, skills, and knowledge to better their lives (early & glenmaye, 2000). a law student must learn the subtle art of applying a strengths perspective. out of context, the question “what good has come out of this?” or “how might you benefit from this bad experience down the road?” would only alienate an emotionally distraught client. timing and subtlety are keys to the use of strengths perspective by attorneys. seemingly insignificant comments, such as how bringing in necessary documents has moved the case along, can have a significant influence on how clients perceive their ability to help in resolving their legal problems, and therefore, their ability to be resilient in the face of the crisis. as their belief in their ability to overcome the problems increases, so will their motivation to engage in the representation process. example of how to teach strengths perspective in a law school setting. subtlety and timing are two very difficult practice skills to teach. the benefits of praising clients for helping with the process and reinforcing the progress when gains in the case are made can be discussed in theory; however, the practice needs to become a subconscious habit and part of the future attorney’s natural approach to work with clients. the skill of applying a strengths perspective begs for the institutionalization of social work education and practicum experience in a legal curriculum so that students can practice work with real clients under the supervision of professionals trained in both law and social work. internalizing the skills needed to work from a strengths perspective requires teaching students to restructure how they view their clients. legal educators often still use victim terminology when discussing clients. approaching the clients from a strengths perspective means viewing the client as someone who can assist in legal advocacy rather than as a victim who should be passive in case development. since paradigm shifts occur slowly, it is important to discuss the strengths perspective early in a course and to revisit the topic throughout the semester. therefore, an exercise on client strengths should be given in one of the first class sessions. a scenario describing a typical client seen in a law school clinic can be provided. for example, a client of a poverty law clinic often arrives at the clinic crying. she appears underweight and has stains on her jeans. the first thing she asks is if you know of any food or clothing pantries nearby. she is late for her advances in social work, fall 2011, 12(2) 250    appointment because her car broke down and she had to take the bus. when asked why she is seeking services, she responds that she has been denied tanf benefits unfairly. she says she documented every interaction she had with her county’s social services office and she gives you a pile of folders. when you open them, the documents are barely legible and it is clear she only has about a third grade writing ability. ask students what they think about the client in the scenario. students will generally respond that they feel sad for her, that she sounds pathetic and that they feel too overwhelmed by all the files to know where to start the process of helping her. next, ask students if this client has any strengths she can bring to the case (a brief definition of strengths prior to this discussion would be helpful). write the brainstormed list of strengths on the board. a non-exhaustive list of possible strengths includes: 1. she made it to the meeting. her car broke down, but she found an alternative transportation method. 2. though the first glance at the notes shows they are poorly written, they are meticulous. she documented each date so transcripts of phone conversations might be called into evidence. 3. she asked if you could recommend any food pantries or clothing resources. though she appeared to have malnutrition she is interested in networking to find resources. she also wants to appear more professional in her clothing, which will be helpful in court. after listing the strengths, a debriefing discussion should include issues of how to reframe the students’ thinking about clients. discussion should also cover how to encourage clients to focus on their resilience through subtle encouraging remarks, and how this can increase clients’ motivation to actively engage in their representation. the exercise can be revisited in class discussions throughout the course and in supervision meetings with students as they begin internship duties with clients. this exercise can also overlap with systems theory and cultural competency. systems theory can be seen in the client’s desire to connect with other resources and lawyers should be ready to encourage this sign of resiliency with a guidebook of resources. cultural competency can also be addressed by increasing student empathy for clients who are different from themselves. barriers to transdisciplinary education the two primary barriers to implementing transdisciplinary education are differences in teaching pedagogy and differences in professional ethics. differing pedagogy results in varying educational cultures, which makes a deviation from institutionalized teaching styles difficult to implement. additionally, lawyers and social workers are bound to different professional ethics and duties, and these differences must be understood by the social work educator who steps into the legal classroom. boys, hagen, voland/lawyers are counselors, too 251    differences in culture and pedagogy some of the differences between the educational culture of schools of law and social work are immediately clear upon observation through the classroom design, dress, and student-professor interactions. however, taylor (2006) conducted a systematic study of the pedagogical differences between law and social work. she separately observed law and social work classes to assess social interactions, educational techniques, and group dynamics in both disciplines. data collected involved different aspects of the social work and law classrooms, such as dress, language, layout of classroom, length of class, teacher-instructor interactions, and type of classroom instruction. she concluded law instruction tends to be lecture-based, focuses on summarization of cases, places little emphasis on personal reactions to course material, and allows little time for class discussion. social work instruction, in contrast, is discussion-based, focuses on personal reactions to material, and allows a great deal of time for class interaction. with the variations in culture and pedagogy, it will be difficult for a social work instructor to be accepted as a legitimate educator in a law school. beyond the basic differences in legal and social work education, legal education itself may make acceptance of varying pedagogies difficult. as weinstein (1999) states, “legal education, with its mission to train students to think like lawyers, indoctrinates the narrow focus and confined boundaries of linear thinking that define traditional law practice” (p. 340). this can further hinder openness to perspectives from other disciplines or alternative forms of pedagogy (weinstein, 1999). however, it is exactly this type of narrow consideration of issues and clients that transdisciplinary education aims to overcome. if collaboration is implemented at the university level, prior to student solidification of professional boundaries, the culture will slowly shift as each new class graduates. differences in ethics and duties social workers and attorneys are each bound by a code of ethics established by laws and professional organizations. there are two primary differences between the professions’ standards. first, attorneys and social workers are bound by differing ethical standards regarding client confidentiality and privileged information. the issue of confidentiality is most salient in cases of suspected child abuse. privileged information rights are trumped by child abuse mandatory reporting laws for social workers, but attorneys are not required to mandatorily report child abuse (st. joan, 2001). the issue has been addressed by law firms that hire social workers and several models for resolution have been developed. for example, social workers may be categorized as employees for the firm in some states, in which case the privileged information standard for attorneys is extended to the social workers (st. joan, 2001). alternatively, a model in which clients are informed that social workers and attorneys will be sharing information on their case and mandatory reporting laws are explained can be utilized (st. joan, 2001). the second major differentiation between the professions involves to whom the professional is responsible when working with clients (galowitz, 1999). for example, social workers may represent multiple family members with different or conflicting advances in social work, fall 2011, 12(2) 252    interests. they may serve as the family advocate, child protective investigator, fosterplacement worker, or parent worker (weil, 1982). the interests of the parents may differ greatly from what is in the best interest of the children, and social workers are expected to help families as a whole. lawyers, on the other hand, often represent only one client, not the entire family (weil, 1982). it is imperative any social work educator teaching law students be aware of the differences, which vary by state, and incorporates these differences into lesson plans. recommendations law schools prepare students to practice law in the form of developing legal arguments, but they do not prepare students to practice with real clients from whom they must procure the necessary information to prepare the legal arguments. it is imperative students be trained in interviewing and goal setting in order to provide the best services possible. thus, social work is a discipline with an abundance of knowledge and practice tools to offer law students. to ensure law students graduate prepared to counsel clients, the authors recommend several additions to traditional law school curricula. first, mandatory interviewing and counseling courses taught by social work educators should be implemented. second, law students should be required to complete practicum hours with supervision by practicing professions from multiple disciplines. finally, implementation of these transdisciplinary curricula adjustments should be monitored and evaluated for effectiveness with regard to student learning outcomes, client service outcomes, and longitudinal use by lawyers after graduation. most law schools offer elective courses on interviewing and/or counseling, but these classes are generally taught by practicing attorneys who have learned their skills in practice rather than from instruction on techniques grounded in empirically-based best practice approaches. the authors recommend that these courses be taught by social work educators, or possibly co-taught with both a legal educator and a social work educator. furthermore, we recommend the courses be mandatory rather than elective since all attorneys will have to interact with clients regardless of their specific area of practice it may also be beneficial to consider the implementation of a mandatory practicum for law students under the direction of both a law and a social work educator. students could greatly benefit from supervision from experienced professionals while working with clients during their education. otherwise beginning attorneys’ first experience working with clients could be at a firm, where superiors have their own heavy caseloads and little time for mentorship. a practicum is an important part of several practice-based professional schools, such as medicine, social work, and physical therapy. the lack of practical training in law schools is incongruent with the realities of the profession. the authors also recommend the transdisciplinary education approaches be monitored to ensure implementation is accepted by students, faculty, and university administration. the courses and practicum should also be evaluated for learning outcomes of students to see if students both perceive themselves to be prepared for practice and can demonstrate appropriate use of social work approaches. for example, law students could be pre and post tested with an interviewing skills assessment tool. boys, hagen, voland/lawyers are counselors, too 253    finally, longitudinal data should be collected to assess whether law school graduates continue to utilize social work approaches to practice after graduation. the time has come for social workers to advocate for themselves. we have effective and useful knowledge, values, and skills to offer other disciplines. clients will be better served if attorneys are trained in basic social work approaches to practice. lawyers will be able to better assist clients, and they will know when and how to refer client issues beyond their professional scope to social workers. we have much to offer law schools and it is time we told them. references aiken, j., & wizner, s. (2003). law as social work. washington university journal of law and policy, 11, 63-82. allen-meares, p. (1998). the interdisciplinary movement. journal of social work education, 34, 2-5. andreae, d. (2011). general systems theory: contributions to social work theory and practice. in f. j. turner (ed.), social work treatment: interlocking theoretical approaches (5th ed., pp. 242-254). new york: oxford university press. bronstein, l. r. (2003). a model for interdisciplinary collaboration. social work, 48(3), 297-306. colarossi, l., & forgey, m. a. (2006). evaluation study of an interdisciplinary social work and law curriculum for domestic violence. journal of social work education, 42(2), 307-323. coleman, b. (2001). lawyers who are also social workers: how to effectively combine two different disciplines to better serve clients. washington university journal of law and policy, 7, 131-158. early, t. j., & glenmaye, l. f. 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(2009). adopting a strengths perspective in social work practice with families in difficulty: from theory to practice. families in society, 90(4), 454-461. shaffer, t. l. (1975). lawyers, counselors, and counselors at law. american bar association journal, 61(7), 854-857. simmons, c., diaz, l., jackson, v., & takahashi, r. (2008). nasw cultural competence indicators: a new tool for the social work profession. journal of ethnic & cultural diversity in social work, 17(1), 4-20. sousa, l., ribeiro, c., & rodrigues, s. (2006). intervention with multi-problem poor clients: towards a strengths-focused perspective. journal of social work practice, 20(2), 189-204. st. joan, j. (2001). building bridges, building walls: collaboration between lawyers and social workers in a domestic violence clinic and issues of client confidentiality. clinical law review, 7, 403-467. taylor, s. (2006). educating future practitioners of social work and law: exploring the origins of inter-professional misunderstanding. children & youth services review, 28(6), 638-653. voyvodic, r., & medcalf, m. (2004). justice, ethics, and interdisciplinary teaching and practice: advancing social justice through an interdisciplinary approach to clinical legal education: the case of legal assistance of windsor. washington university journal of law & policy, 14, 101-132. weil, m. (1982). research on issues in collaboration between social workers and lawyers. social service review, 56, 393-405. weinberg, a., & harding, c. (2004). interdisciplinary teaching and collaboration in higher education: a concept whose time has come. washington university journal of law and policy, 14, 15-48. weinstein, j. (1999). coming of age: recognizing the importance of interdisciplinary education in law practice. washington law review, 74(2), 319-366. wetlaufer, g. b. (1990). rhetoric and its denial in legal discourse. virginia law review, 76(8), 1545-1597. author note: address correspondence to: stephanie k. boys, indiana university school of social work, 902 west new york street, education/social work building, room 4157, indianapolis, in 46202. email: sboys@indiana.edu _______________ amy b. murphy-nugen, phd, msw, assistant professor, and donna hensley beck (retired), dsw, msw, lcsw, department of social work, western carolina university, cullowhee, nc 28723. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 304-329, doi: 10.18060/20524 juxtaposing dreams and loss: the lived experience of homeownership and foreclosure amy b. murphy-nugen donna hensley beck abstract: symbolically and historically, the attributes associated with homeownership are positive; however, in light of the 2006 housing crash and subsequent 2008 financial crisis, scholars and laypeople continue to reassess the sacred position homeownership holds in u.s. culture and the market economy. using an interpretative phenomenological analysis, this study explored the meanings that five former homeowners associate with the lived experience of foreclosure. the findings reveal a juxtaposition that intersects the hopes and dreams of homeownership with the grief and loss of foreclosure. this polarizing experience uncovers the need for innovative policy and practice interventions. a discussion of implications for social work policy and practice include strengthening the bridge of micro and macro-level interventions and addressing hopes, dreams, disenfranchised grief, and loss in the context of homeownership and foreclosure. keywords: homeownership; foreclosure; interpretative phenomenological analysis; american dream; disenfranchised grief; micro-macro bridge a white picket fence, a lush green yard, a welcoming front door, a family room where relatives and neighbors gather to share the mundane, celebrate milestones, and comfort one another in time of need. these images evoke the quintessential homeownership experience that culturally defines the american dream. conversely, a contrasting image is painted when describing the nightmare experience of foreclosure—a broken fence, an overgrown or brittle brown yard, a bank notice on the door, boarded-up windows, and shelter for criminal activity. in the united states, the word homeownership conveys many social, economic and political meanings. homeownership is regularly cited as evidence of achieving a substantial part of the american dream (burchell & listokin, 1995; ronald, 2008), it symbolically communicates information about one’s social status and stability (schwartz, 2014), and it provides financial benefits in the form of tax breaks and other incentives (johnson & sherraden, 1992; stegman, quercia, & davis, 2007). in contrast, the word foreclosure conveys both financial and symbolic loss of one’s hopes and dreams. foreclosures result in housing and financial instability (pettit et al., 2009; u.s. department of housing and urban development [u.s. hud], 2009), individual and familial displacement (martin, 2010; saegert, fields & libman, 2011), loss of wealth in the accumulation of home equity, increased crime (apgar & duda, 2005; immergluck & smith, 2006), psychological distress (pickover & slowik, 2013; taylor, pevalin, & todd, 2007), community disruption (immergluck, 2009), and an eroding property tax base (pew charitable trusts, 2008; vidmar, 2008). these outcomes reflect both micro and macro advances in social work, fall 2016, 17(2) 305 phenomena, underscoring the need for social work practitioners and researchers to assess and intervene at both policy and psychotherapeutic levels. literature review micro-macro context: the personal is political between 1995 and 2005, 12.5 million individuals became new homeowners in the united states (corporation for enterprise development [cfed], 2008; joint center for housing studies, 2006). this ten-year span represents the largest period of homeownership expansion post-world war ii (cfed, 2008; joint center for housing studies, 2006). this substantial growth in homeownership occurred in an environment that offered low-interest rates, new loan products, and relaxed financial regulations (schwartz, 2014; u.s. hud, 2009). in 2006, the u.s. housing bubble burst placing “millions of homeowners and thousands of communities” in a historic foreclosure and financial crisis (cfed, 2008, p. 3). homeownership rates of owner-occupied units peaked in the fourth quarter of 2004, reaching a high of 69.2% (joint center for housing studies, 2012). following the aftermath of the 2006 housing crash, the rate of homeownership began to drop. at the end of the second quarter of 2015, homeownership rates of owner-occupied units dipped to 63.4%, which is the lowest level in approximately 48 years (u.s. census bureau news, 2015). conversely, as homeownership rates dipped, foreclosures increased. nationwide, at the end of the peak of the housing boom in 2004 through the stabilization of the foreclosure crisis in 2014, estimates indicate there were nearly eight million completed foreclosures (corelogic, 2015). currently, 427,000 homeowners are still in some stage of foreclosure, and a total of 464,995 homes were foreclosed upon in the 12 months preceding march 2016 (corelogic, 2016). a growing body of research establishes a relationship between the relaxed financial regulatory environment and the housing crash that began in 2006 (cfed, 2008; hud, 2009; schloemer, li, ernst, & keest, 2006; tetreault & verrilli, 2008). evidence also indicates that the foreclosure crisis unearthed critical weaknesses of the financial sector in the u.s., which played a significant role in the economic recession that started in 2007 and impacted economies around the globe (friedman, 2010; glaeser, 2010; solow, 2010; stein, 2010; temin, 2010; treas, 2010). when the u.s. housing market crashed in 2006, it ushered in an economic crisis that would become known as the great recession, and the country turned to economists and business professionals to provide explanations and forecast the fallout (friedman, 2010; glaeser, 2010; goodhart, 2010; mccarty, poole, romer, & rosenthal, 2010; solow, 2010; stein, 2010; temin, 2010; zingales, 2010). most of the discussion centered around traditional finance-oriented domains of business and economics; however, the crisis disproportionately impacted vulnerable populations—populations that often fall out of the purview of traditional financial and economic domains (hinze, 2011; waddan, 2010). for example, recent data demonstrates the lingering and lopsided effects of the housing crash. from 2007 to 2010, lower-income and middle-income families lost 41% and 39% of their respective wealth following the great recession compared to a 17% loss of wealth for upper-income families (pew research center, 2015). murphy-nugen & beck/juxtaposing dreams and loss 306 given the primary mission of the social work profession is to “enhance human wellbeing and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty,” (national association of social workers [nasw], 2008, para. 5), it is important for social work scholars and practitioners to analyze and respond to the fallout from this crisis. as a profession committed to addressing both person and environment, social work is uniquely positioned to strengthen its micro-macro bridge and respond to the policy and individual challenges associated with this issue. pearlmutter’s (2002) embrace of the mantra that the “personal is political” can help with understanding how systematic and regulatory failures result in individual homeowners experiencing the causes and consequences of foreclosure. further, wakefield (1988) notes social work’s unique ability to alleviate micro-level psychological and macro-level economic deprivation. this strength of our profession is further amplified in the recent unveiling of the american academy of social work and social welfare’s grand challenges initiative. the initiative is promoting an overall agenda that requires a deeper connection between the micro and macro levels in order to achieve “individual and family well-being, and, a stronger social fabric,” which ultimately results in a “just society that fights exclusion and marginalization, creates a sense of belonging, promotes trust, and offers pathways for social and economic progress” (american academy of social welfare and social work [aaswsw], n.d., para 5). homeownership is an integral piece of the social fabric of american society. yet the macro policies governing homeownership have not fully considered the micro-impact on the individual. further, foreclosure prevention and intervention responses are traditionally limited to financial considerations and exclude addressing psychological well-being. the absence of a holistic micro-macro approach has resulted in an unjust society where vulnerable homebuyers have been marginalized, isolated, and politically and psychologically disenfranchised. setting the scene for policy disenfranchisement u.s. housing policy represents a complex interaction of real estate, finance, construction, and low-income advocacy interests (johnson & sherraden, 1992; radford, 1996; ridenour, weld, & elson, 2012; sherraden, 1991). although piecemeal policies existed prior to the 1929 great depression, the first comprehensive housing policy began during the new deal when special interest groups jockeyed for acceptance of their competing agendas (radford, 1996). the pattern of privileging special interests of industry over the rights and needs of individuals has continued in our most recent housing crisis. since 2008, various programs have been introduced at the federal level to mitigate the foreclosure crisis. yet most of the foreclosure intervention programs have relied on voluntary participation of lending institutions and have experienced underwhelming levels of effectiveness (schwartz, 2014; united states department of treasury, 2015). the disconnection in housing policy and foreclosure response failed to fully address the needs of homeowners—both in restoring their financial situation and their psychological wellbeing (treas, 2010). advances in social work, fall 2016, 17(2) 307 comparing the government’s response to the financial sector with its assistance to individual homeowners, the following example demonstrates how the disconnection permeates through the micro-macro continuum. in the aftermath of the 2008 economic crash, congress passed and president george w. bush signed into law the housing and economic recovery act (hera) of 2008. a key program of hera was hope for homeowners, which provided $300 billion in federal housing administration (fha) guarantees to incentivize lenders to refinance delinquent home mortgages (national lowincome housing coalition [nlihc], 2012; u.s. hud, 2008, n.d.-a, n.d.-b; wheelock, 2008). the juxtaposition of size, scope, and success between hera and the troubled asset relief program (tarp) is notable. tarp, also passed in 2008 as part of the emergency economic stabilization act, provided $700 billion to financial institutions to mitigate the losses experienced during the economic crash (jimenez, 2010). hera was, in theory, the homeowner equivalent of the large-scale bail-out offered to banks and other financial institutions through tarp; however, homeowners were not offered an equivalent level of intervention. hera was intended to provide relief to 400,000 homeowners, but by september 2009 only 94 loans nationwide had been refinanced (congressional oversight panel, 2009). with its voluntary structure, hera failed to provide proper incentives to encourage lenders to participate meaningfully. the financial industry was made whole while the financial needs of individuals were inadequately addressed and their psychological well-being was completely ignored. this experience may be described through concepts of disenfranchised grief. in his theoretical framework, doka (2002) defines disenfranchised grief as the denial of the right to grieve. although this framework is inherently concerned with death, there is relevance to significant losses—such as one’s home (doka, 2002). further, doka (2002) contends that disenfranchised grief is inherently a politically derived experience. from his perspective, society sanctions who has the right to grieve and who must keep their grief invisible. in this manner, access to grief becomes a social justice issue—some individuals are empowered and supported in their grief while others are not. attig (2004) expands upon doka’s (2002) theoretical framework suggesting that, disenfranchisement of grief is a serious social failure in several distinct respects. some have urged that it is a failure of empathy, which it surely is. but it is not merely that; it is deeper and more serious. disenfranchisement of grief is a political failure involving both abuse of power and serious neglect. (p. 200) although attig discusses disenfranchised grief from a political lens, his conceptualization is limited. he suggests the denial for some to grieve is a political act; however, additional political disenfranchisement has occurred in the recent housing and foreclosure crisis. setting the scene for psychological disenfranchisement symbolically, the idea of the american dream is explicitly intertwined with the homeownership experience. woven together, cultural notions concerning the american dream—including ownership, freedom, self-reliance, mobility, optimism, or hope—are by virtue transferred to homeownership (doyle, 1992; dunn, 2006; mest, 2008; ronald, 2008). the concept of social and economic mobility is deeply embedded in the american murphy-nugen & beck/juxtaposing dreams and loss 308 dream, which is underscored in the belief that hard work results in financial success. the manifestation of this workforce effort is often a home, which also serves as a status symbol (ronald, 2008). for example, in a recent advertisement, a loan originator challenged potential homebuyers to be brave because that is how the american dream can be attained. while images in the ad depict american heroism and dreams achieved, rodriguez (2015) recounts a voice that compels americans to show their bravery, to achieve the american dream, by literally and figuratively buying into homeownership: the american dream is terrifying. american history is the history of the scary thing being the exact thing we have to do: cross that ocean, walk on that moon, fly. none of this makes rational sense. it only makes american sense. here, the hard things show us who we are. leaving your job to start your own thing. having a kid when you still feel like a kid. signing a 30-year mortgage on a home. scary? sure. but no match for our colossal self-belief. we’re supposed to do scary. without scary, we don’t get to be brave. buy in. (quicken loans, 2015, 0:00) in this ad campaign, homeownership is equated with some of the most iconic moments in u.s. history, including flying and walking on the moon. the viewer, or american consumer, is commanded to put aside any reservations about doing the hard, scary thing, in order to fulfill achievement of the american dream. similar to the ethically questionable marketing messages and loan products that were offered in the period leading up to the 2006 housing bust and subsequent great recession, the institutions responsible for gatekeeping and ensuring individuals meet underwriting standards are once again using powerful symbols and language associated with the american dream to sell, commodify and, sometimes, manipulate people's hopes and dreams (treas, 2010). the hope of achieving and realizing the benefits of homeownership is often part of this dream (beracha & johnson, 2012). in the process of finding a home, making an offer to buy, finding a mortgage, and acquiring a home, people move toward their hopes and develop goals in order to make the dream a reality (clapham, 2010). this process ideally culminates in a home, a place to gather as a family and to make a life together. the experience of home holds the celebrations of milestones and regular day-to-day living for a family. snyder (2002) further posits that hope theory includes the idea that goal attainment leads to better life satisfaction and less profound dissatisfaction. the theory states that this trajectory toward goal attainment begins early in life and is critical for success. in contrast, grief is an experience that affects most humans and has many common factors that are troubling to people experiencing loss (wilson, 2014). although grief is often associated with the death of a loved one, the experience of loss may also occur with other life events such as job loss or loss of material goods (papa & maitoza, 2013). the symptoms of grief include extreme sadness, rumination or excessive thinking about the loss, and the experience of feeling emptiness and sadness for a period of time (american psychiatric association, 2013). the loss of home may create a loss of belonging (clapham, 2010; tognoli, 2003). the loss of one’s place, in the context of home, may impact people’s attachments and the view that people have of themselves and the world in which they advances in social work, fall 2016, 17(2) 309 function (ben-yoseph, 2011; bowlby, 1980). further, the loss of one’s home can have profound psychological consequences resulting in disenfranchised grief. pickover and slowik (2013) report that the involuntary loss of one’s home may be a significant contributor to prolonged grief and psychological distress—including suicidal ideation and depression. disenfranchised grief may be further explained when viewed through our culture’s death and bereavement rituals. psychological distress has the potential to be magnified when access to traditional rituals are limited by the unacknowledged grief experience. rituals around the death of a loved one are thought to aid in the recovery process for the bereaved by making a public acknowledgement of the death and change in status of the bereaved (castle & phillips, 2003). in most communities in the united states, a bereaved person is surrounded and supported by loved ones, friends, and community members (reeves, 2011). in situations of disenfranchised grief, attig (2004) theorizes that people experiencing stigmatized loss may oppressively accept the idea that they are not entitled to grieve. for example, the shame associated with foreclosure has the potential to silence the grief experience (white, 2010). attig (2004) discusses this idea in his work and calls it an ethical failure in that it creates disenfranchised grief through a lack of respect. this ethical failure disallows public recognition of the loss, and the lack of respect dictates to the individual where and how they will grieve. when people are isolated from the public ritual of grieving, they may want to retreat to the private space of their home (attig, 2004). yet when one loses a home, the sanctuary of the private domain is lost. much like the death of a loved one, the place of home containing the traditions, celebrations, and memories of gathering is lost. neimeyer and jordan (2002) associate empathetic failure with disenfranchised grief. attig (2004) explains that this is a failure to recognize and to acknowledge a profound loss, which leads to the inability of a person experiencing loss to restore to a former, healthier state of functioning. this former state included the capacity for hopes and dreams. in essence, the result is the person experiencing loss is subjected to disenfranchisement twice—first, in their overwhelming loss of their home and second, in the lack of social support that contributes to an inability to return to a former state of hopefulness. given the sacred and symbolic place homeownership holds in the united states, the privileged position of ownership in housing policy, and the relatively unexplored personal experiences associated with foreclosure, an opportunity exists to develop knowledge in this critical area of scholarship. the purpose of this study was to address this significant gap in the literature in an attempt to explore how homeowners make sense and meaning of losing their home in foreclosure. methods the primary research question of this inquiry was: what are the meanings that homeowners associate with the lived experience of foreclosure? driven by the research question’s proposition to explore the meanings homeowners associate with the experience of foreclosure, a qualitative method was required to allow for deep and thick descriptions to be collected and analyzed (denzin & lincoln, 2000). specifically, interpretative murphy-nugen & beck/juxtaposing dreams and loss 310 phenomenological analysis was the chosen research approach used to guide this exploration (smith, flowers, & larkin, 2012). this project was approved by the indiana university institutional review board. research design and rationale interpretative phenomenological analysis (ipa) combines three philosophical foundations—phenomenology, hermeneutics and idiography—to approach qualitative and experiential research (smith et al., 2012). phenomenology provides a philosophical approach to study experience, hermeneutics is a philosophy concerned with interpretation, and idiography encapsulates a philosophical stance of the particular (smith et al., 2012). this three-legged philosophical stool provided the foundation to explore and interpret the particular experience of homeowners who lived through foreclosure. data collection one of heidegger’s prominent contributions to hermeneutic philosophy is the concept of fore-structure (smith et al., 2012). fore-structure, or the researcher’s previous knowledge and experience of the phenomenon, consists of three parts: fore-having, foresight, and fore-conception (benner, 1994; ginev, 2013; smith et al., 2012). fore-having, or pre-understanding, recognizes that an individual interprets a phenomenon through past experiences and knowledge (ginev, 2013). fore-sight describes the existence of a preexisting lens, or perspective, in which any particular individual views a phenomenon (benner, 1994). fore-conception acknowledges that an individual holds preconceptions about how the phenomenon will unfold (benner, 1994). to attempt to mitigate the interference of the ever-present fore-structure, heideggerian philosophy suggests researchers be transparent about their pre-understandings of the phenomenon of study (smith et al., 2012). for the purposes of this research study and in keeping with ipa methods, the researcher’s pre-understandings of foreclosure were examined in order to inform the potential influence on data collection. to further demonstrate transparency and coherence, and as a strategy for triangulation, the researcher maintained field notes and a reflexive journal to not only clearly illustrate the research process but also provide transparency of the author’s subjectivity and bias (yardley, 2000). in keeping with the attempt of ipa to invite research participants to extensively describe the lived experience of going from homeownership to foreclosure and to build initial rapport, semi-structured interviews began with the following question: "can you tell me how you came to be a homeowner?" additional broad, open-ended questions followed. the full interview schedule reflected questions posed by smith et al. (2012) representing descriptive, narrative, structural, contrasting, evaluative, circular and comparative inquiries. where necessary to elicit deeper and richer meanings, appropriate prompts and probes (van manen, 1990) were used—for example, "can you tell me more about that (experience, situation, etc.)?" "what do you mean by (specific word, phrase, etc.)?" "why?" "how?" "tell me what you were thinking or feeling when (experience, situation, etc.)". the researcher digitally recorded each interview. interviews lasted from 68 to 91 minutes. the researcher’s goal was to conduct each interview as a “conversation with a purpose” (smith et al., 2012, p. 57). advances in social work, fall 2016, 17(2) 311 yardley (2000) provides some examples of how a researcher may demonstrate sensitivity to context, including familiarity with relevant theoretical and practice literature, empirical data, sociocultural setting, participants’ perspectives, and ethical issues. the researcher was familiar with not only the theoretical and practice literature that focuses on housing and foreclosure but also the literature on phenomenology and hermeneutics. in addition, by nature of her professional and practice background, the researcher is acquainted with relevant empirical data on housing and foreclosure. further, the researcher is connected with the sociocultural context and anecdotal participant perspectives related to housing and foreclosure. she was also sensitive to power differentials between researcher and participant and incorporated empowering and emancipatory language and behavior into interactions with participants. the researcher encouraged participants to identify interview locations in which they would be most comfortable and where confidentiality would be maintained. one participant chose to meet in a private room at a local library, two participants identified local restaurants for the interview, and two others chose local coffeehouses. data analysis data was analyzed using the six-step model of smith et al. (2012): reading and rereading, initial noting, developing emergent themes, searching for connections across emergent themes, moving to the next transcript, and looking for patterns across cases. although the data analysis was conducted by one researcher, the six-step process is immersive and integrates layers of triangulating and data-checking. yardley’s (2000) evaluative criteria for rigorous qualitative research includes commitment and rigor which are manifested through the researcher’s “in-depth engagement with the topic; methodological competence/skill; thorough data collection; depth/breadth of analysis” (p. 219). by its very nature, ipa is concerned with deep exploration of a particular phenomenon. further, ipa provides a sound methodological framework to elicit thorough data and an immersion in data analysis. this process reflects the conceptual framework of the hermeneutic circle: the researcher moved back and forth from interpreting a “part”—a single word, phrase, interview, or episode—to the “whole”—a sentence, complete text, research project, or complete life— in an attempt to extract deep understanding of one’s lived experience (laverty, 2003, p. 39; smith et al., 2012, p. 28). participants there are three common ways a purposive sample is identified in qualitative studies: a) referrals, b) network contacts, and c) snowballing (smith et al., 2012). in an attempt to maximize opportunities to identify potential research participants, all three purposive sampling techniques were used. the researcher worked through a number of intermediary and service delivery organizations to identify possible participants. out of this extensive outreach effort, only one of the five participants was identified. the remaining four were identified through referrals from individuals who were aware of the research and who shared the research invitation and study information sheet with friends, family members, and colleagues. homogeneity of the sample was achieved by ensuring that all research murphy-nugen & beck/juxtaposing dreams and loss 312 participants had experienced foreclosure, which was the only inclusion criteria for the study. a $20 gift card was provided to each participant. the five participants were females, with three women being over 60 years of age, one woman aged 42, and one aged 28 at the time of the interview. three women were married, and two were divorced. one participant was black, and the remaining participants were white. all five participants were employed in some type of helping or social service profession. each participant experienced a pivotal life event that preceded their foreclosure—including a terminal cancer diagnosis, divorce, experience with predatory lending practices, and a costly bug infestation. four participants resided in indiana, and one lived in southern illinois. findings research findings reveal profound emotional connections between homeowners and their homes and a deep sense of psychological loss when homes go into foreclosure. three unifying themes associated with the experience of moving from homeownership to foreclosure emerged: hopes and dreams, transition from hopes and dreams to grief and loss, and grief and loss. accounts of homeowners reflect the disparate emotional high associated with homeownership and the psychological low of losing one’s home. prior to further articulating the juxtaposing themes of hopes and dreams and grief and loss, it is helpful to understand the parts of the sum context of the research participants. accordingly, a brief contextual profile is provided for each participant in the order they were interviewed (see table 1). to protect confidentiality, all individuals are identified by a pseudonym, and some personal information like geographic location or employer was modified. the researcher tried to maintain the authenticity and integrity of the lived experiences; therefore, de-identification modifications were only made when necessary. two participants were first-time homeowners. most of the homeowners purchased their homes in the late 1990s and early 2000s. only one purchased her home post-2008 economic recession. the first foreclosure occurred in 2004, and the last one was finalized in 2013. mortgage payment amounts varied over individual housing tenure. the average mortgage payment at the time of home purchase was $746 with a low of $350 and a high of $1,500. two of the mortgage payments remained consistent from time of purchase to foreclosure; however, two of the mortgage payment increased significantly. heather’s mortgage payment increased by 100% from the time of purchase ($350) to the time of foreclosure ($700). dorothy’s mortgage payment increased by 66% from the time of purchase ($600) to the time of foreclosure ($1000). the average housing tenure was 7.1 years with a range of 2.5 to 13 years. all but one homeowner experienced a change in mortgage servicer over the life of the loan. advances in social work, fall 2016, 17(2) 313 table 1. participant demographic, personal, housing, and mortgage characteristics linda helen dorothy heather jessica demographic, personal age at home purchase 53 53 47 27 26 age at foreclosure 61 60 52 40 28 age at interview 67 65 62 42 28 marital status at foreclosure married divorced divorced married married race white white black white white employer at home purchase not-for-profit community dev. org. state agency university, professional school correctional facility fast food restaurant pivotal life event cancer diagnosis divorce predatory loan refinance based on inflated appraisal in-laws move in; associated bug infestation housing characteristics location of home central in southern il northern in central in central in first-time homebuyer no no no yes yes purchase year 2000 2002 1999 1999 2011 foreclosure year 2008 2009 2004 2012 2013 years in home 8 7 5 13 2.5 mortgage payment purchase ($) 1500 450 600 350 830 foreclosure ($) 1500 550 1000 700 830 unifying experience of homeownership: hopes and dreams in the beginning of their homeownership experience, all participants expressed positive associations with their home. linda said, “it was wonderful.” heather acknowledged that, “oh, it was great, at first.” helen was enamored with her home and the perceived hopes it offered for her family. she “loved it at first sight” and dreamed about a “big yard for the kids to play in.” dorothy also expressed an emotional connection to her new home: i loved the whole process. i loved the thought of bein’ a homeowner. i loved the house. the participants’ homes came to represent much more than bricks and sticks. homeowners shared accounts of meaningful familial celebrations and community gatherings. memories and the physical space known as “home” became intimately intertwined. linda recalled: i was very fortunate, again, because of my circumstances. i can remember every christmas eve having 40, 50 people over for a dinner. most of ‘em were folks from other countries or—didn’t have family here, and we just had a huge amount of fun...and then we’d follow-up in the summer, and it was always, “we’ll go to linda’s place.” we’d have big picnics out in the side yard. it was a source of fun, of enjoyment. it wasn’t just a domicile for a place to live. it (home) was part of the living. murphy-nugen & beck/juxtaposing dreams and loss 314 heather also fondly recalled the memories associated with her home: i would think about christmases, and the birthday parties that we had, and friends coming over and laughing, all the stupid silly things we did, and family being over there, family and friends who’ve passed away. thinking of things that we did there. all those memories would just come back. i know those memories are still--they’re all in my mind. they’re not in that house. when i would think of the house, i would think of all those things. it would always come back to that. for heather, her home became the embodiment of her family: when you came home from work, even the smell--everybody has a certain smell. the smell of the house, it would just be like this is home, no matter what. it would be either a candle that i lit, or my [laughter]—a perfume that my daughter wears, or a cologne that my husband wore. you could smell that. the smell of my dog being in the room, or whatever. it would just—you just walked in. those were the smells. that’s my family [laughter]. in expressing their dreams regarding their homes, participants expressed a shared hope of the perceived freedom associated with ownership. the hopes helen associated with homeownership underscored the importance of ownership and accessibility: i think a lot of it is you’ve finally got something that belongs to you. it’s just exciting to actually look at all these places, and find something that you can actually—you think you can afford, and go with it. dorothy lit up with satisfying laughter when recalling what the initial experience of homeownership meant to her: it was mine. [laughter] all of the homeowners had hopes of customizing the homes to make them their own. redecorating and designing the home was associated positively with ideas and hopes about experiencing freedom of self-expression and ownership of a meaningful asset— cornerstones of living the symbolic american dream. linda spoke excitedly about her plans to rehabilitate her historic home and how these actions increased her self-worth: oh, having the old homes in the city— and being able to knock down walls and refurbish and see all of the wonderful craftsmanship—it gave you a sense of pride and dignity. heather equated homeownership with freedom—being able to do what she wants without having to ask permission. like linda, these actions were associated with a hopeful and positive sense of self. just the fact that i could have my own design, my own—i could be creative in the house, if i wanted to. i could paint it. i could change the carpet, if i wanted. hanging things on the wall, remodel it, if i wanted. i could make a kitchen into a bedroom, if i want—just having that freedom to do that, and to not have someone advances in social work, fall 2016, 17(2) 315 over you, saying no. i think it was freedom, to get to—and you thought, “i’m growing up. i have my own place now.” jessica, almost word-for-word to heather’s sentiment, expressed how she also associated homeownership with the aspirations of making the home her own: ... if i wanted to do something, i didn’t have to run it by anybody. i could just kinda do what i wanted to do. if i wanted to paint the wall, i could paint the wall; i mean, things like that, just having that freedom. transitioning from homeownership to foreclosure: the juxtaposition of hopes and dreams with grief and loss yet for all of the participants, whether due to a terminal diagnosis or a predatory loan, the excitement, dreams, and hopes they had associated with homeownership shifted to feelings of grief and loss at the time of foreclosure. linda’s terminal diagnosis abruptly put an end to familial and community gatherings when she subsequently lost her home to foreclosure: lots of memories. then, all of a sudden, within the course of a year, i’m told—i’m probably gonna die. i no longer have a job cuz i can’t do it—and lose a home. the person i was no longer existed. it was tough. heather, through different circumstances than linda, lost the ability to use her home as a gathering place. through noted shame, her family became disconnected and isolated from friends and family: ...because not only did we already have all this debt, our house is deteriorating. we have raccoons in our roof that we’re trying to get rid of. we have water. we now need a new roof. now, the house that i once loved is also—i’m starting to be shameful of it. i’m inviting less—because we can’t remodel because we can’t remortgage. all of these things are going through my head. i’m going to be stuck here. the many dreams of redecorating and refurbishing a home faded for these homeowners. heather expressed how the dreams and hopes that were once communicated to her about homeownership begin shifting to a new realization of worry and the absence of freedom: i think, at first, our parents are telling us, my husband’s parents are telling us, “this is what you want.” i think that’s what i thought. okay, this is freedom to do whatever i want—until all of these things start happening to the house. it’s taking a little less freedom because i have to worry about things that are happening to the home. i don't know how much they’re gonna be. i know we can’t fix it, whether electric, plumbing, whatever. we’re gonna hafta call or talk to somebody else to fix it. murphy-nugen & beck/juxtaposing dreams and loss 316 like heather, the hopes helen once dreamed of began shifting to the burdens of homeownership: sometimes it was just the upkeep of trying to—we had a pretty big-sized yard, going home and trying to push the mower and mow, after you’ve worked all day. come home to that, and not having the money that you needed to do the little things that you would’ve liked to’ve done, or purchased, or whatever. it was pretty well, you have enough to make the payment, to buy a few groceries. you make just maybe $100.00 too much to get any kind of assistance. it’s just kinda hard. likewise, the dreams that jessica had for decorating and customizing her home never materialized: ...because of my credit, and my student loans, and stuff like that, i could only afford so much for the house, so we had to take that into consideration. helen’s diminishing homeownership dreams started becoming more serious than not being able to decorate the home as she had hoped. she began worrying about long-term stability: i think what is in your mind from the beginning is i’m gonna have a place when i get older. i retire, i’m gonna have a place that’s paid for, and i’m not gonna have to worry about that in my old age. a place where the kids can come back with grandkids and that type of thing. it changes. once described as a place of freedom, heather now saw her home as a symbolic prison: to feeling like you’re a prisoner, almost. you’re no longer free because you don’t have the ability to sell it, because you can’t sell it in the condition that it’s in. as the youngest participant, jessica dishearteningly articulated the elusiveness of the hopes and dreams she once associated with homeownership: you think it's your house, but it's not. it's the mortgage company's house. it's almost like you're still paying rent. even though i could do what i want to the inside of the house—it still could be taken away. buying a home is most likely the largest purchase any of the participants will ever make. most participants did not feel like they were informed of basic knowledge concerning the home-buying process, refinancing, or general housing finance. helen admitted she was disconnected from fully understanding financing the purchase of a house, “…a lot of paperwork to sign. a lot of it you don’t even understand what you’re signing, but you go ahead and sign it.” helen was focused on the hopes and dreams she associated with homeownership more than fully considering whether she would be able to financially sustain the mortgage: i don’t think you do. i guess it’s because you want it so bad, you think you can. i think in my mind, i knew all along that i didn’t really think i could (afford it), but i went ahead and did it anyway. helen was driven by recapturing hours from her day. she had a long commute, was often tired, and wanted to buy a home that would give her some control over her daily schedule. advances in social work, fall 2016, 17(2) 317 even though she had reservations about her ability to make her mortgage payment, her desire to be closer to work overrode any of those considerations: i think it’s always there in the back of your mind, you’re wondering how you’re gonna keep up with it….down in your heart you’re not sure you can actually make it, but you want it so bad that you’re willing to try it. i think that’s how a lot of people lose their home. helen led a difficult life. from her perspective, homeownership offered an escape from these challenges, and she dreamed that it would lessen the burdens she felt intently. in pursuit of the hopes and dreams homeownership represented, helen disconnected from the reality of the tight financial margin she and her family experienced. ultimately, helen transitioned to foreclosure. unifying experience of foreclosure: grief and loss in its most fundamental and reductionist sense, a foreclosure represents the physical loss of a home. yet the common, unifying pattern of foreclosure among the participants in this study revealed that this lived experience represents significantly more than a simple disconnection from a physical structure. a profound sense of psychological grief and loss was associated with foreclosure. linda consistently used the word “diminished” to explain how facing foreclosure and the related financial challenges made her feel: you lose your whole perspective of who you are. i mean, one day you’re a successful person. you have family. you have friends. you have a good job. you don’t worry about money. you are the one that is the caregiver, the nurturer—and then all of a sudden, you don’t have the job, the profession. that’s your identity. you don’t have the home. you don’t have the security. you’re being told you’re less than what you oughta be. linda lost her sense of self—she was unable to save herself from foreclosure even though in her professional life, she was helping people to do the same on a daily basis. in addition to challenging her sense of self and personal security, the foreclosure caused helen to grieve over the loss of her future plans: i think it all goes back, again, to the security thing. getting older, and not having to worry about a home. a home is the biggest part, probably, of a person’s life. it may not be much, but at least it’s a place to sleep, a place to eat, and your family’s there with you, whatever. if you don’t have that, you really don’t have anything. from helen’s perspective a home represents a fundamental aspect of a person’s life. she goes as far as to say, “if you don’t have that, you really don’t have anything.” with similar magnitude, dorothy equated the house with her life. when she lost her house in foreclosure, through a deep depression, she also lost her fundamental sense of self: it would be different had i just been one of these people who—i don’t care about this. so what? they about to foreclose. i just go get me some place. no. this was murphy-nugen & beck/juxtaposing dreams and loss 318 an investment for me. this was my life. for me, it was devastating. it was [pause] the worst thing that could have possibly ever happened to me. heather was so intensely connected to the physical and emotional space of her home that when she lost it through foreclosure, she anthropomorphized the home and described the loss as a death: it is. it is a real sense of loss. i never thought i would feel like that, but yeah, it is definitely---but it’s still there. it’s almost like i would imagine people going through a divorce. it is almost like a death. that person’s still living and breathing. the house is still there. when the foreclosure occurred, it also represented a deeply personal disconnection from her family—or, at least, the space she associated with her family: i felt like i was giving that up…and to know that it would be empty…my husband, he works over there every once in a while. he’ll drive by it and just see all the curtains are still up. he’ll tell me. there’s just something. it’s just too emotional for me. because i know, now it doesn’t have those smells. it has a musty smell to it…it’s just too emotional to even—maybe later on i could do it, but not now. when heather was asked how she would feel if she chose to go by the home, she again personified the home, “i would feel like i would have to apologize, or to—i would feel so remorseful. i know i would just bawl, just because it’s almost like i gave up.” heather’s extremely emotional and raw response underscores the deep grief and loss she felt being disconnected from her home. for the youngest of the participants, jessica, her grief and loss experiences were multilayered. feelings of sadness, isolation, frustration and resignation underscore the loss of control jessica experienced. i felt like crying. i felt sad, and i just felt—i almost felt—and i was still with the whole situation trying to work it out and felt like nobody was wanting to work with me. i was trying. i knew i had to try, so it’s not like i was waiting till i was six months behind. i already knew. probably in the beginning, it was very exciting, very wow, this is mine. now, all of a sudden, it's not. it's just, i guess, the frustration. you think you have control in the beginning and then at the end, you realize how much control you don't have. confounding the grief and loss experienced by the participants was shame that often manifested itself as social stigma and isolation. for the participants in this study, public shame often occurred in the context of bankruptcy proceedings, which were associated with discharging their mortgage loans. in this public and legal forum, the participants disclosed and were judged on their debt obligations and financial standings. in linda’s case, she felt the judge demonstrated minimal regard and prejudged her foreclosure situation, which was related to a terminal cancer diagnosis: …he showed no compassion. he asked some fairly striking questions, like, “well, you’ve always had money. what happened? did you just twitter it away?" there was a presumption that you did something wrong. advances in social work, fall 2016, 17(2) 319 finally, he says, “okay, that’s enough. we’ll process this.” it was, even at that point, it wasn’t taking a look at everything that had been done or taking a look at the fact that i had tried to make this right. it was a presumption of “you’re guilty of something.” heather’s grief was also complicated by guilt, shame, and stigma, which were interwoven into her experience of foreclosure. the meaning she attached to the loss of her home was that it affirmed she was a bad, sinful person who had to confess her immoral behavior to family and friends—and, publicly, in court. it almost made you feel like—you’re in the federal courthouse. that, in and of itself, is—that’s where not great things happen. you’re in a courtroom, so it did make you feel like you had committed a crime, in a way. you had to confess: yes, these are all my debts. i’m showing you everything. heather’s personal grief and vulnerability were also heightened—feeling that she exposed her personal finances in a public court. she no longer viewed herself as the once-perceived responsible, mature adult who, for 13 years, managed to meet financial challenges and major home repairs to maintain a household. despite the discomfort and shame of her public court appearance, heather also acknowledged that seeing other families who had also endured financial challenges comforted her. in the space of public sharing and support, her sense of shame was lessened, yet the negative self-perception she accepted in the aftermath of losing her home was ever present: …just to know other people had to make that same decision as we did, and some people—the two ahead of us were in way worse condition than us. medical bills and the husband—one of ‘em had a heart attack, $200,000 in medical bills. she was on disability. he was a truck driver. she was a nurse, at one time. when she went on disability, there was no way that they could make it. it was just like, “okay, you’re not a bad person. there are other people.” heather found some comfort, and her shame and grief was diminished upon validation that she was “not the only one.” yet heather still found it difficult to inform family and friends about the loss of her home, underscoring the social stigma and isolation complicating her grief: i think i was still feeling a lot of shame from the bankruptcy. there was a few friends. it took me a long time to tell them. they knew we were moving to another community. they didn’t totally know why. there was one friend in particular where, i sat her down and just cried. she said, “i’m just so thankful it’s that and not that you’re dying,” because i wouldn’t normally make a special appointment to see her. she’s very good with her money. she’s very responsible. i was afraid of how she thought i would look. i didn’t wanna look bad, in her eyes, by making these decisions with my money.” like heather, jessica always considered herself to be a responsible person and took pride in her work ethic. when she was first married, she was employed as a restaurant manager. murphy-nugen & beck/juxtaposing dreams and loss 320 due to her heightened sense of personal responsibility, jessica internalized shame through the foreclosure and bankruptcy process: …it’s almost a little embarrassing cause people that know i lived there, they drove by it, and there’s this big foreclosure notice. it makes me feel like a failure. i mean, just not being able to take care of my responsibilities. i don’t wanna not pay my bills. jessica felt stigmatized as her identity was reduced to what she perceived as one of the worst experiences of her life. dorothy also noted the social isolation and lack of support she felt as she dealt with the loss of her home: i was really very hurt when i realized the depth of my depression that no one that i worked with seemed to be able to say, “hey, you need help. you need to seek counseling or something.” [pause] then, when i said, “hey, i realize that i’ve been in a very deep depression.” they’re like, “oh, yeah. we knew.” really? dorothy ended up dealing with her grief and depression on her own after realizing that she was not feeling or behaving like she wanted. discussion this study captured the lived experiences of the research participants as they reflected on the significance of their hopes and dreams in purchasing a home and the poignant consequences of the grief that they experienced when foreclosure occurred. the participants provided the researcher insight into their hopes and dreams in the statements they made about their experience of homeownership. they reflected on the pathway to homeownership, including gathering resources, saving money, establishing criteria for the home they wanted, dreaming about the events that would happen in this place, and planning how they would make their home their own. when they lost their homes to foreclosure, they experienced the shattering of their hopes and dreams, some comparing the foreclosure to a death. the hope of homeownership as part of the american dream is associated with financial security, paying for children’s college tuition, and retirement nest eggs (aguirre & martinez, 2014; clapham, 2010). the attainment of this goal is transformative. the hopes and dreams of homeownership include a better life for the homeowners and their children and a stable place to grow and make memories. aguirre and martinez (2014) conclude that homeownership represents security for families, especially for their children. in the current study, participants talked about their hopes. helen talked about a big yard for her children to play in. dorothy believed that the home would be an investment, and helen stated that the home would be hers when she retired. from these statements, their hopes and dreams are apparent: happy, healthy children; secure financial status; and security for retirement. all of these visions of the future included the home that they had purchased, a place where their futures would be lived. as the participants moved from the realization of their hope of homeownership into foreclosure, their hope eroded into grief. advances in social work, fall 2016, 17(2) 321 disenfranchised grief was uncovered in the phenomenological interviews that highlight the themes of grief, shame, hopelessness, and isolation. heather spoke of her shame as a sin when she was unable to repay her loan. all of the participants lost a place that they treasured and shared their lived experiences of loss. these personal tragedies were disclosed to very few people in their lives because of the deep sense of shame surrounding the events. the burden of this loss was not shared by those who might normally support them in a time of sorrow because of the disenfranchised grief. because of the shame associated with foreclosure, the grief experience may be silenced. the sacred space of home has been lost and no longer offers a refuge from the shame and grief experienced. in foreclosure, the space of home becomes contaminated by public shame, quite literally, as the failure is announced with a notice on the door, publication in the newspaper, and court proceedings to discharge the debt. in contrast to a death notice that compels others to send condolences and provide support, the notice of foreclosure may bring public shame leading to disenfranchised grief. a major theme uncovered included the grief associated with the loss of a home that impacted each participant in very significant ways. the participants described the yearning for the homes that they had no more. doka (2002) suggests that individuals experiencing loss may move through a transformative and resilience process that allows the person to transition from a yearning for something that cannot be recovered in the here and now to an acceptance of the new situation. yet this process is complicated when the person experiencing the grief does not have the support from others in their caring network due to the shame and secrecy associated with foreclosure. addressing the participants’ grief was non-existent in the current context of services available in the foreclosure process. implications for bridging micro-macro practice notably, the unrecognized phenomenon that the participants disclosed represents an area for social workers to study and to develop strategies to ameliorate the impact on people who are suffering. social work’s macro-micro bridge highlights the need to address the contributing factors that occur when social policy is lacking and to simultaneously work to assist persons who have been impacted by injustice. the social work profession has always sought to instill justice where it is lacking. home loss is not different than other forms of injustice. policy must be developed at the macro-level as well as interventions at the microlevel in order to better serve persons who are experiencing such loss. this study supports significant emotional, social, and psychological implications for persons experiencing the loss of home through foreclosure. the aaswsw’s grand challenges initiatives may further support this emerging research and practice agenda by providing a framework that encourages the development of scholarly research and evidence-based interventions to ameliorate associated micro-macro issues. the complexity of this phenomenon intersects almost all twelve of the aaswsw’s grand challenges. one major finding of this study is the juxtaposition between the hopes and dreams the participants articulated and the grief and loss they experienced when their dreams dissolved into heartache. participants universally acknowledged that they considered homeownership a major goal and dream to be attained. they also provided heart-rending murphy-nugen & beck/juxtaposing dreams and loss 322 narratives about the repossession of their dreams by financial institutions. this is similar to doka’s (2002) discussion regarding the attachments that humans develop for dreams and possessions. he reports that this is particularly true when our attachment to a dream is taken or never realized; the significance can be correlated to the person’s assessment of the value of the possession including the sentimental significance. all of the participants noted sentimental attachments to their homes. they described their attachment to their homes as places where celebrations were held and memories made. doka (2002) contends grieving associated with the loss of possessions falls outside of the grieving rules of american culture. the rules of grieving are cultural norms that are recognized and supported by customs, ceremonies and, in the macro arena, organizational bereavement policies. disenfranchised grief, in general, and the loss of one’s home, specifically, should be considered by grief counselors and psychotherapists (mortell, 2015). evidence-based practices should be developed to address the loss of one’s home in macro and micro systems, and they should include interventions at all levels. national standardized housing and foreclosure counseling content almost exclusively focuses on the financial nuts and bolts of the home-buying, foreclosure prevention, and intervention processes—minimizing emotional readiness and preparation (national industry standards committee, 2012). in light of the data provided in this study, research regarding new homebuyers’ hopes in the pre-buying process would be beneficial to determine how to best provide counseling regarding the reality of home buying while addressing the intensely emotional impact that these participants disclosed as they purchased homes. given the prominence of the american dream, many individuals will likely identify similar hopes and dreams as this study’s participants. additional research is needed to determine whether the associated hopes and dreams are a generalized phenomenon. as the financial readiness of a homebuyer is evaluated prior to home purchase, perhaps too, emotional readiness should be assessed. additionally, the development or modification of a grief scale to measure the psychological and emotional impact of foreclosure is needed in order to accurately identify areas that could be addressed in homeownership, foreclosure, and psychotherapeutic counseling programs. because of the lack of public support for people who experience the loss of home and place in our culture as it relates to foreclosure, this loss is likely experienced in solitude. an ability to experience the support of others could help the grieving individuals recover more quickly and return to their former level of functioning (blum & kingston, 1984; dupuis & thorns, 1998). consequently, one avenue for further study may include a mixed-method study that would include modified grief scales and qualitative interviews. limitations a common critique of qualitative research is that one cannot generalize the findings. unquestionably, the findings from this research reflect the unique and collective experiences of the five participants; however, to critique the study as lacking generalizability is to fundamentally misunderstand the utility of qualitative inquiry. the purpose of qualitative studies, in general, is to seek a thick, rich, and deep understanding of a particular topic. specifically, for this interpretative phenomenological study, the advances in social work, fall 2016, 17(2) 323 intention was to elicit how homeowners experience foreclosure. two substantial limitations that deserve critical reflection and discussion are: a) challenges identifying a sample, and b) gender representation. challenges identifying a sample. the researcher anticipated and respectfully understood that potential participants might avoid the study due to feelings of shame, stigma, wanting to move forward from the experience, or declining to reflect on a potentially traumatic life event. the researcher acknowledges significantly underestimating these or other likely concerns (i.e., time, availability for interview, etc.) on the part of potential participants. identifying participants represented one of the most intense and persistent efforts of the entire study. initially, in reflecting common practices of ipa, the researcher planned to interview six to 10 participants. while five participants may seem an inadequate sample, differences of opinion exist among phenomenologists regarding sample size. due to its qualitative approach, ipa privileges quality, and not quantity, of interviews (smith et al., 2012). further, through the rigorous data analysis involved in the smith et al. (2002) six-step process, the level of depth required for ipa analysis was achieved. gender representation. although a homogenous sample is often sought for qualitative research, the absence of the male voice is notable in this inquiry. the women in this study articulated their hopes and dreams of ownership as freedom—in terms of ownership and control but also in expression of self through decorating and designing their personal space. they spoke of their grief and loss as profound disconnection with identity, security, and stability. the meaning-making experience that men associate with homeownership and foreclosure remains unknown. conclusions five women who transitioned from homeownership to foreclosure shared their meaning-making experiences. the findings of this analysis uncovered a juxtaposition of the hopes and dreams associated with homeownership and the grief and loss related to foreclosure. reflecting the micro-macro bridge of person and environment, the findings revealed a shared experience of disenfranchised grief. policy failures, in combination with the participants’ pivotal life events, created an environment in which participants’ hopes and dreams transitioned into psychological grief and loss. a transformative opportunity exists to further strengthen current housing and foreclosure counseling programs by acknowledging the psychological dimension of disenfranchised grief. objective discussions need to acknowledge the connection and the emotional attachment of home that exists for individuals. by addressing the psychological readiness and emotional significance that individuals place on the hopes and dreams of homeownership, thriving individuals and empowered communities are more likely to occur. addressing issues of grief and loss is not a new concept for social workers; however, doing so in housing and foreclosure counseling presents an opportunity for ethical policy and innovative practice. murphy-nugen & beck/juxtaposing dreams and loss 324 references aguirre, a. jr., & martinez, r. o. 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(2010). learning to live with not-so-efficient markets. daedalus, 139(4), 3140. doi:http://dx.doi.org/10.1162/daed_a_00040 author note address correspondence to: amy murphy-nugen, department of social work, western carolina university, 4121 little savannah road, hhs 312, cullowhee, nc 28723. email: abmurphynugen@wcu.edu http://huduser.org/publications/pdf/int_foreclosure_rpt_congress.pdf http://portal.hud.gov/hudportal/hud?src=/hudprograms/keystatutes http://portal.hud.gov/hudportal/hud?src=/program_offices/comm_planning/communitydevelopment/programs/neighborhoodspg http://portal.hud.gov/hudportal/hud?src=/program_offices/comm_planning/communitydevelopment/programs/neighborhoodspg http://www.treasury.gov/initiatives/financial-stability/reports/documents/1q15_quarterly_mha_report_final.pdf http://www.treasury.gov/initiatives/financial-stability/reports/documents/1q15_quarterly_mha_report_final.pdf http://dx.doi.org/10.2139/ssrn.1494467 http://dx.doi.org/10.1080/08870440008400302 http://dx.doi.org/10.1162/daed_a_00040 mailto:abmurphynugen@wcu.edu microsoft word hamilton_erickson copyedit4 _________________ billy hamilton, bsw, is a law student at the william mitchell college of law in st. paul, mn and christina l. erickson, ph.d., is an associate professor in the department of social work at augsburg college in minneapolis, mn. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 420-430 urban heat islands and social work: opportunities for intervention billy hamilton christina l. erickson abstract: the urban heat island (uhi), formed by surface modification of soil and vegetation, increases minimum nighttime temperatures within cities and causes heatstress among dwellers. children, elders and low-income persons are disproportionately burdened by the uhi. these populations often lack the necessary biological, economic and social resources to cope with or prevent heat stress. because uhi’s are expected to increase with climate change, more social workers will be expected to serve the populations most affected by uhi. this paper addresses how the social work profession can play a role in efforts to address the effects of uhi’s on vulnerable populations. keywords: urban heat island, environmental justice, heat stress, climate change introduction science has determined that surface modification of soil and vegetation can increase temperatures. large amounts of soil and vegetation reduced to build city streets, homes and businesses increase temperatures. any city with significant amounts of surface modification experiences increased urban temperatures, whether its natural climate is temperate, tropical, warm or arid (harlan, brazel, prashad, stefanov, & larsen, 2006). excessive heat lingers in urban areas well past daytime, and temperatures remain elevated into evenings and nights. nighttime elevation of temperatures causes the most harm to urban dwellers. this increase in temperature within urban cores, when compared to adjacent rural and suburban areas, has been coined as the urban heat island or uhi. the uhi can negatively affect quality of life for urban dwellers. excessive heat can harm individual health and wellbeing, especially individuals in temperate climates not acclimated to long intervals of excessive heat or vulnerable populations such as elders, children and people without access to air conditioning (harlan et al., 2006). until recently, research and information on urban heat islands could not be found in journals on human services or social sciences as disciplines such as meteorology appeared to study uhi’s and their impacts on communities. however, this has changed within the last two decades. the twenty-first century has led to growing interest and awareness of how temperature can affect human experiences. recent research in the social sciences identify that urban heat islands appear to unjustly effect marginalized populations (harlan et al., 2006). science of the urban heat island there are three catalytic characteristics of cities that contribute to the uhi: surface modification, building density and population. while uhi occurs in all urban cores, variations in intensity are found due to season, geography and climate. when urban areas hamilton, erickson/urban heat islands and social work 421 develop, open-land and vegetation are replaced by industrial landscapes and infrastructure which include: buildings, skyscrapers, houses, cement sidewalks and paved roads. these structures absorb heat and subsequently warm their surroundings. the environmental protection agency summarizes the source of the urban heat phenomenon, “surfaces that were once permeable and moist [are now] impermeable and dry” (climate protection, 2008, p. 2). impermeable surfaces (such as stone, asphalt, brick and concrete) tend to be dark in color (for example, gray concrete, black tar roads, dark shingles) and they absorb solar energy at faster rates than vegetation and consequently warm their surroundings. the darker the surface landscape, the higher the rate at which it absorbs energy. the more surface energy absorbed, the more heat is released into the atmosphere. building density also contributes to the increased city temperatures. the majority of most buildings’ surface area do not face open air or spaces, instead they generally face other warm buildings with heat becoming trapped in the city. the trapped heat is then released during nocturnal times (at dusk and at night). therefore, cities become efficient heat incubators well past dusk (oke, 1997). this peak in temperature is most pronounced within 3 to 5 hours after sunset. the experienced elevated urban temperature, when compared to surrounding rural areas, is what constitutes an urban heat island. the size and population of the urban area will also determine the power and strength of the uhi. on an average night, cities with populations over one million can experience large differences in temperature, anywhere from 5°f to 20°f (oke, 1997). more importantly, as population rates increase in urban areas this difference in temperature is expected to grow. for example, including data during its period of urbanization from 1948 to 2000, baker and colleagues (2002) recorded an increase of minimum temperatures in phoenix, arizona. of particular significance is the sky harbor airport where, “the average daily minimum temperature…increased by 5.0c between 1948 and 2000 and the average daily average temperature rose by 3.1c” (p. 191). such elevated temperatures linger into the evenings and nights, when communities normally anticipate relief. urban heat islands also significantly lower the quality of water through thermal pollution. roofs, pavements, buildings or landscapes that reach “50 to 90°f (27 to 50°c) higher than air temperatures” transfer heat to water and increase storm water runoff. on average, runoff from urban areas tend to be “20-30°f (11-17°c) warmer” than runoff from rural areas (climate protection, 2008, p. 15). sewers release the heated runoff into streams, ponds, lakes and rivers. the increased temperature negatively affects these aquatic ecosystems. the majority of aquatic plants and life are especially sensitive to immediate changes in temperature. as a result, various types of aquatic life can encounter shock or die. the carcasses create bastions of bacteria contaminating drinking water. for low-income, warm, urban neighborhoods with streams and ponds, this does not bode well. advances in social work, fall 2011, 12(2) 422 effects on humans children children, especially infants, are in critical stages of biological development that make them ill-equipped to deal with heat stress. according to bartlett (2008), “their more rapid metabolisms, immature organs and nervous systems, developing cognition, limited experience and behavioral characteristics” explain why children are “more likely to have long-term repercussions than…adults” as a result of heat stress (p. 502). children are faced with higher rates of vulnerability than adults to respiratory-borne illness and, in some parts of the country, vector-borne illness (bullard, 2005). given that internal organs develop during infancy and that heat islands perpetuate an increase of pollutants in the air, children are among the most vulnerable to respiratory borne illnesses like asthma. for children of low-income families unable to afford treatment, this is especially dangerous and detrimental to a child’s biological and cognitive development. for example, in the urban community of waterfront south, new jersey, a community described as a “commercial corridor…with numerous industrial sites,” administrators at one of the community’s elementary schools report that “almost one-quarter of the students have asthma” (pp.128-129). children are disproportionately more vulnerable to heat stroke than adults because their thermoregulatory system, the system responsible for cooling the human body, is underdeveloped (casa, clarkson, & roberts, 2005). therefore, children are more sensitive to prolonged and dramatic increases in temperature. they also maintain a significantly decreased rate of sweat per surface area of the human body, making it difficult to adapt to heat stress. thus, children are anatomically prone to absorb heat from hot environments at high rates because of “large surface area to body mass ratio” (p.122). prolonged elevation of temperatures into evening and nighttime hours perpetuates their risk and vulnerability to heat related illness. between 1979 and 1999, the most recent national data available from the cdc, 4% of weather related deaths due to heat were of children (centers for disease control and prevention, 2003). this low number may likely be due to the fact that children are cared for and monitored by adults. elders, on the other hand, are less likely to have someone watching over them. elders elders are vulnerable to heat stress. in the most recent national data, 45% of deaths were to individuals over the age of 65 (centers for disease control and prevention, 2003). although thermoregulatory systems of the elders are developed, they may be damaged or impaired. elders are more “susceptible to heat related illness…because they are not often able to maintain hydration” (casa et al., 2005, p. 122). basu and samet (2002) find that the elders, like children, have a high sweat threshold that prevents their bodies from adapting to increases in temperature. another variable that makes elders more susceptible to heat related illness and death can be explained by consumption of prescription medications. basu and samet (2002) report that “persons with chronic diseases of the heart or lungs may be more susceptible to the effects of high ambient temperatures, especially if they take certain medications (e.g., diuretics, beta blockers, hamilton, erickson/urban heat islands and social work 423 and tranquilizers)” (p. 1219). these medications can “limit adaptive responses” to the body (i.e. crippling the body’s ability to sweat and cool itself in high temperatures). in light of increased temperatures during evening and nighttime hours, it is not surprising that the majority of people dying from heat related illness (heat stroke or exhaustion) in the united states are elder persons over the age of 65 (basu & samet, 2002). one would think that elders in mild and temperate climates are immune from heat stress. this may be the case for suburban and rural dwellers, unfortunately not for those residing in dense areas of northern cities. harlan and colleagues (2006) show, “more deaths are attributed to heat in temperate climates than in warm climates because people in temperate zones are less acclimated to high temperatures” (p. 2847). even elders residing in temperate urban climates cannot escape the fatal heat stressors resulting from the uhi. another reason elders are susceptible to heat stress is because many live alone and lack the necessary resources to cope with heat related stress. in chicago during the summer of 1995, one of the worst heat waves to ever hit the city claimed many lives and attracted global press. there were 525 chicagoans deaths that “were medically confirmed as ‘heat related’ (klinenberg, 1999, p. 255). of those 525 deaths, 73% were elders over the age of 65. most notably “the death rate for seniors above 65 was 16 times higher than the rate for those under 65” (klinenberg, 1999, pp. 255-256). low-income persons during the summertime, urban heat islands create a myriad of unmanageable consequences for low-income peoples and families. increased energy consumption and emissions of pollutants bolster heat-related illnesses and contaminate drinking water. while businesses and the middle and upper class are safely nestled inside air-conditioned spaces, many low-income persons cannot afford to turn on, let alone own, airconditioning units. the effects are deadly and according to klinenberg (1999), the majority of deaths from the heat wave that hit chicago were in “low-income, elderly, and african american…regions of the metropolis” (p. 250). these areas were also the areas with the recorded highest temperature, “those hit hardest by the heat-wave” (klinenberg, 1999, p. 250). klinenberg also concludes that income was a contributing factor to 700 mortalities reporting that, “of the fifteen community areas with the highest death rates during the heat wave, eleven contained unusually high proportions of people living below half of the official poverty line…in addition…[to having] high rates of seniors living alone” (1999, pp. 254-255). urban heat islands and social and environmental justice the united states environmental protection agency’s (epa) definition of environmental justice includes “the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and advances in social work, fall 2011, 12(2) 424 policies” (2011). to further clarify, fair treatment “means that no group of people, including racial, ethnic, or socioeconomic groups, should bear a disproportionate share of the negative environmental consequences resulting from industrial, municipal and commercial operations…” (center for disease control, 2008). low-income persons, children and elders do indeed bear a disproportionate share of the negative environmental consequences and lack the resources to cope with heat stress and elevated nighttime temperatures. this environmental injustice is an issue within the purview of social work, as those most seriously affected lack the biological, social and/or material resources to cope with the effects of the heat island. ruddell, harlan, grossman-clarke, and buyantuyev (2010) established that the effects of urban heat can be immediate and fatal. they concluded that “the types of people most vulnerable to risk of exposure to extreme temperatures are minorities, elderly, and low income residents” (p. 199). using available census data in the city of phoenix, ruddell and colleagues (2010) found that “median household income for the high heat intensity class was just over half the income of the low intensity class, and the percentage of minorities in the high intensity class was more than two times greater than the lower [heat intensity] class” (pp. 195-196). in other words, white, high-income earners can afford cooler temperatures and spaces at night, while ethnic minorities and the poor suffer disproportionately. harlan and colleagues’ (2006) study, which covers eight economically and ethnically distinct neighborhoods in the phoenix metropolitan area, identifies that the uhi disproportionally affects marginalized communities and that these communities lack the necessary “material and social resources to cope with this heat” (p. 2847). harlan and colleagues (2006) bring this issue to light by comparing eight phoenix neighborhoods. two neighborhoods of significance are black canyon freeway and historic anglo phoenix. black canyon freeway reports a median income of $25,785 with 43.8% people living in poverty. to add, 90.9% of the neighborhood is considered an ethnic minority and 10.4% of this community’s population is under 5 years of age and 6.8% is over age 65. historic anglo phoenix reports a median income of $77,404 with 9.8% living in poverty. 25.8% of the community reports being an ethnic minority and 14.4% is under age 5 and 5.8% is over age 65 (p. 2854). here we have two neighborhoods with starkly different socio-economic and racial differences. overall, “the difference between the lowest (historic anglo phoenix) and highest average summer temperatures (black canyon freeway) was 4 degrees celsius” (p. 2853). the data suggests that “socially and economically marginalized populations [are] more likely to live in heat-stressed neighborhoods” (p. 2848). those living in the hottest zones are more likely to be low-income persons of color. the higher the income, the more likely one is able to afford cool temperatures. the wealthy have power over the effects of the heat island whereas families of low-income do not. we speculate that families of low-income are fiscally and geographically unable to develop vegetative landscapes on or around their properties and lack the resources to develop “cool” buildings. because heat islands increase energy demands to cool buildings, urban cities report higher amounts of emissions from power plants and thus higher occurrences of smog formation (heat island group, 2000). this translates into, “steadily increasing downtown hamilton, erickson/urban heat islands and social work 425 temperatures over the last several decades which means that 5 to 10 percent of community-wide demand for electricity is used to compensate for the heat island effect” (climate protection, 2008, p. 13). smog increases with temperatures (heat island group, 2000). there is an increasingly clear link between heat islands and neighborhoods with higher ratios of low-income persons, elders and children. there is also a demonstrated lack of material and physiological resources to cope with the effects of heat islands. revisiting the 1995 heat wave of chicago offers us the chance to review responses to serious urban heat island issues and offers solutions to future social work interventions. the 1995 heat wave of chicago was fatal for a number of marginalized persons. klinenberg (1999) blames the lack of organization and activation of local, state and federal organizations on the high number of deaths of for these groups: during the heat wave several city departments failed to provide services that, had they been activated, would have saved hundreds of lives. the police department neglected to activate the local units designed to assist seniors, even though the heat wave represented precisely the kind of situation in which they would have been effective…the fire department, which is responsible for the office of emergency preparedness and disaster services, has no mechanism for issuing a heat emergency. the department of human services did little to contact isolated seniors to warn them of the dangers of the climate, nor did it provide adequate transportation and security to help vulnerable residents…the department of public health had no mechanism for coordinating emergency medical services…throughout the city, public agencies rejected offers from volunteers because they had no idea what to do with them (p. 257). klinenberg’s (1999) investigation paints a clear picture of what failed at the city and state level. it is important to note that the environmental protection agency (epa) does not offer direct emergency help for heat island disasters like that in chicago; rather, the national epa focuses on producing literature and directing communities to local and state preventative initiatives to alleviate the effects of the uhi. a full list of these initiatives is listed on the epa website. unfortunately, less than half of the states in the u.s. are represented in these initiatives (epa, 2010). however, the website allows people and agencies to submit state and local initiatives. although the epa has made strides to organize and coordinate efforts online, many local and municipal organizations lack structure and resources to adequately respond. intervention methods for social workers social workers can focus intervention efforts to accomplish two goals. first, they can further efforts to mitigate the uhi’s development (interventions to promote positive institutional change), especially given our current understanding of climate change. second, they can improve emergency responses and coping methods to heat waves and lingering nighttime temperature hikes from the uhi (interventions to promote improved residual policies). advances in social work, fall 2011, 12(2) 426 organizing and partnering to mitigate urban heat islands social workers can help communities or municipalities to gain an understanding of the uhi. they can organize meetings in dense urban areas. communities can identify who possesses expertise in community planning, advocacy and organization, connections with local government officials and city planners, or who is equipped with legal expertise. groups can begin to reach out to other social and environmental groups with similar agendas such as the sierra club, the nature conservancy, the audubon society or other local and national groups that have invested in curbing the effects of climate change or maintaining urban vegetation. by garnering attention and support, they are able to empower themselves to elect leaders with likeminded platforms and to influence change at the local level. fiscally, practical and structurally viable options to alleviate and eliminate the uhi and its negative effects upon marginalized persons include: subsidizing community gardens and tree planting, supporting and increasing vegetation, halting and reversing increased surface modifications, cool roof installments, and permeable and cooling pavement initiatives. group members can then collaborate with the epa to publicize, coordinate and organize their initiatives on the epa’s uhi website. plants and trees do mitigate the uhi. plants and trees are able to intercept solar energy before it hits buildings and paved surfaces. vegetation cools air through the process known as evapotranspiration. trees also disrupt and block people and buildings from freezing winds during the winter. although it depends upon climate, region and geography, the environmental protection agency (epa) (2012) reports that cities can save money by implementing full-scale vegetation initiatives. vegetation and trees also reduce the thermal heat absorbed by storm runoff which also preserves aquatic ecosystems in urban vicinities. tree planting programs can be cost effective and incentives should be offered to communities that plant them. in one experiment conducted in florida by parker (1981, as cited in akbari, 2001), measurements of energy consumption were taken before and after adding vegetation (trees, grass, bushes and shrubs) in the immediate area of an urban building. the result was a 50% savings in cooling costs (p. 12). this also decreases the amount of smog released into the atmosphere. first, trees absorb carbon dioxide and release oxygen through the process of photosynthesis. second, dwellings require less energy to cool and thus less electricity is demanded and used from power plants. the results are undeniably beneficial. if implemented on a national level, savings could be limitless (environmental protection agency, 2012). social workers can advocate for vegetation initiatives at the city or county level. programs such as that found in the city of minneapolis, in partnership with tree trust, is one example. for a small fee ($15-$25) residents can purchase a tree. in austin texas, efforts to mitigate uhi effects have resulted in “neighborwoods,” an effort to grow the urban forest. a non-profit project provided by treefolks provides free trees to families living in specified areas if homeowners agree upkeep the tree (www.http://www.ci.austin.tx.us/urbanheatisland/trees.htm). projects such as these are good models to emulate in communities. hamilton, erickson/urban heat islands and social work 427 another step to mitigate heat stress in vulnerable communities is through the use of cool roofs and high-albedo (reflective) building material. during the summertime, dark roofs absorb high rates of solar energy and, as a result, warm the atmosphere and the building beneath the roof. roofs covered with a white coating are engineered to reflect significantly greater amounts of solar energy, thus decreasing absorption of heat. aside from applying a particular white acrylic paint or elastomer designed for roofs, these cool roofs do not require any additional costs for maintenance. in one study conducted in an urban community of atlanta, georgia, a school rooftop with an unpainted, galvanized roof was painted with a white acrylic paint. the following year the school reported a 75% decrease in cooling costs (akbari, 2001). much like cool roofs, converting dark smooth pavements into cool high-albedo pavements increases reflection of solar energy back into space. this decreases the amount of heat trapped inside the urban ecosystem while alleviating the associated fiscal costs of cooling buildings. when these initiatives are combined they have a significant positive impact upon communities. another benefit of cool, reflective pavements includes a decrease in the demand for electricity and number of streetlights in urban areas. because cool surfaces reflect more light, the visibility for motorists, bicyclists and pedestrians on sidewalks and streets is significantly improved at dusk and at night. cool pavements and sidewalks curb the effects of both light pollution and energy consumption. there is a diversity of ways to mitigate the uhi. every community’s model will be different. as pointed out by a study that evaluated the effectiveness of mitigation strategies in the city of new york, cities ought to “implement urban heat island mitigation strategies appropriate to conditions in individual neighborhoods and communities” (rosenzweig et al., 2006, p. 4). for example, new york city has more skyscrapers and buildings than the city of minneapolis. it would make more sense for activists in new york city to first focus on developing initiatives for high-albedo roofs and pavements. in minneapolis, a city with more open space and fewer buildings, it would make more sense to develop initiatives to preserve unmodified soil and to implement more urban vegetation. by gathering a diversity of knowledgeable, specialized persons at the local level can tailor initiatives to the needs of each urban area. organizing and partnering to cope with urban heat island effects because we understand the strategies listed above require significant amounts of time, social workers will need to help vulnerable persons adapt to heat stress in the immediate future. efforts can help curb mortality rates until heat islands are reduced. plans must be designed according to each community’s respective demographics and infrastructure. as no two urban neighborhoods and communities are the same, adaptive plans should be localized to the community culture (rosenzweig et al., 2006). social workers must organize at local levels by reaching out to the medical, mental health and human service communities to compile resources and information. multilingual educational outreach with pragmatic, practical tips on how to prevent heatstroke and exhaustion is a first step. information ought to include suggestions on how to prepare for extreme heat, such as: stay indoors as much as possible, drink plenty of water, cover advances in social work, fall 2011, 12(2) 428 windows with tin foil or outdoor awnings (this can reduce the amount of heat that enters a home by 80%), spend the day at public facilities (like libraries or schools), limit intake of alcohol, stay on the lowest floor and out of sunshine if air conditioning is not available (fema, 2010). pamphlets should also include charts that illustrate the symptoms of heat related illness (heat cramps, sunburn, heat exhaustion and heat stroke) so people know when to go to the hospital. literature should also include locations of and directions to free cool zones for those unable to afford air conditioning or those especially vulnerable to extreme heat, like children and elderly persons. what can professionals do if their city does not already have designated cool zones? they can collaborate with city councils, law-enforcement agencies and fire departments to designate these zones. libraries, public schools and community centers make great locations for cool zones. these zones should be within neighborhoods with higher density of low-income persons, elders and children or in close proximity. in order to make sure the above strategies are correctly implemented, let us underscore past organizational errors that proved to be fatal. a key failure during the chicago heat wave of 1995 was the lack of organization between agencies and lowincome persons, elders and children. for example, the department on aging did not activate its own emergency measure to contact isolated elders living alone to warn them of heat stress. volunteers were “turned away from local agencies and the department of human services, the fire department and the office of emergency preparedness and disaster services did not issue a heat emergency” (klinenberg, 1999, p. 257). recognizing these failures is the first step to making certain they do not happen again. second, professionals must work with local agencies to decide the following: when to declare emergency heat waves, who can declare them, how to inform the public, where to implement free cooling zones and how to provide transportation to these cooling stations. social workers can collaborate with urban hospitals to prepare staff to accommodate for more patients during heat emergencies. these efforts will help save lives. future implications social workers have the potential to help eliminate the deleterious effects of the uhi and help empower vulnerable community members. however, we can expect many obstacles to prevent us from making change. in light of the current national political climate and anti-government sentiment, social workers will face an uphill battle. however, the battle is necessary, as increasing nighttime temperatures across the nation are breaking records every year. as reported in the washington post, “preliminary figures from the northeast regional climate center at cornell university show 28 cities from washington, d.c., to caribou, maine, set record highs for average temperature from march through august” (weil, 2010). these estimates do not bode well for those most vulnerable to heat stress. the social work profession’s applied and social justice strategies for intervention, in partnership with other groups, can reduce mortality and morbidity rates of marginalized persons as a result of the rise in the uhi. hamilton, erickson/urban heat islands and social work 429 references akbari, h. 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(1997). urban climates and global environmental change. in r. d. thompson & a. perry (eds.), applied climatology: principles and practice (pp. 273-287). new york: routledge. ruddell, d. m., harlan, s. l., grossman-clarke, s., & buyantuyev, a. (2010). risk and exposure to extreme hear in microclimates of phoenix, az. in p. s. showalter & y. lu (eds.), geotechnologies and the environment (2nd ed., pp. 179-202). doi 10.1007/978-90-481-2238-7_9 rosenzweig, c., solecki, w., parshall, l., gaffin, s., lynn, b., goldberg, r., cox, j., & hodges, s. (2006). mitigating new york city’s heat island with urban forestry, living roofs, and light surfaces. a report to the new york state energy research and development authority, 1-4. retrieved from http://www.giss.nasa.gov/research/news/20060130/103341.pdf weil, m. (2010, august 29). latest heat wave could set records. the washington post. retrieved from http://www.washingtonpost.com/wpdyn/content/article/2010/08/28/ar20100828038 06.html author note: address correspondence to: billy hamilton, bsw, augsburg college department of social work, 2211 riverside ave, cb 51, minneapolis, mn 55113. email: william.hamilton@alumni.augsburg.edu microsoft word 04_brown_and_park_20870_longitudinal_student_research ___________ jodi l. constantine brown, phd, msw is associate professor and director of online & offsite programs, department of social work, california state university, northridge, northridge, ca 91330-8226. hyun-sun park, phd, mssw, is associate professor, department of social work, california state university, northridge, northridge, ca 91330-8226. copyright © 2016 advances in social work vol. 17 no. 1 (spring 2016), 44-58, doi: 10.18060/20870 longitudinal student research competency: comparing online and traditional face-to-face learning platforms jodi l. constantine brown hyun-sun park abstract: this exploratory research compares longitudinal research self-efficacy and retention between a completely asynchronous master of social work (msw) online cohort and its traditional face-to-face counterpart. this study used a non-equivalent comparison groups design with two groups: online instruction only (n=16) and traditional face-to-face instruction (n=32), with pretest (time 1), posttest (time 2) and follow-up (time 3) standardized measures of practice evaluation knowledge (peks) and research selfefficacy (rses) in a beginning research methods course. results indicate that students’ knowledge and research self-efficacy improved between pretest and posttest and remained significantly improved at follow-up one year later, with no significant difference between online learners and traditional face-to-face students. students gain and maintain confidence in research methods and evaluation regardless of the learning platform utilized. keywords: distance learning; knowledge retention; research, self-efficacy online learning/distance education continues to grow in popularity, and the field of social work is no exception (buchanan & mathews, 2013; shorkey & uebel, 2014). despite skeptics criticizing online education in social work as not providing sufficient practice, engagement, and interaction time (allen & seaman, 2011; knowles, 2001; pearlman, weston, & gisel, 2010), the number of online msw-degree-granting programs continues to grow. as online learning/distance education instructional offerings expand, social work literature examining differences between online and traditional classroom teaching continues to develop. previous literature has explored different types of classes/teaching methods, with the majority of published articles focusing on practice and research methods classes (dennison, gruber, & vrbsky, 2010). the bulk of early literature developed around the idea of comparing web-based or online classes with traditional, non-hybrid, face-toface courses (dalton, 2001; harrington, 1999; hisle-gorman & zuravin, 2006; huff, 2000; kleinpeter & potts, 2003; royse, 2000; seabury, 2005; stocks & freddolino, 2000; westhuis, ouellette, & pfahler, 2006) but failed to use a design controlling for pretest scores (e.g., harrington 1999; hisle-gorman & zuravin, 2006; kleinpeter & potts, 2003), or use standardized measures of learning outcomes (e.g., harrington, 1999; royse, 2000; westhuis et al., 2006). further, the variability in programs and classes explored makes comparisons between study outcomes difficult. one of the challenges of building research knowledge in a developing area like distance education is consistent definition of terms. distance education is a means of asynchronously delivering a course online or through interactive television (vernon, vakalahi, pierce, pittman-munke, & adkins, 2009). quinn, fitch, and youn (2011) argue that synchronous technologies should be included in the definition of distance education. asynchronous online classes allow a course or assignment to be completed at a student’s discretion within a given timeframe, whereas synchronous classes are held live via the internet with the students and instructor engaging simultaneously (cummings, chaffin, & cockerham, 2015). advances in social work, spring 2016, 17(1) 45     studies comparing online, face-to-face, and hybrid (a mix of online and face-to-face meetings) program models continue to grow, but no studies to date explore differences in the retention of knowledge over time by learning platform. the current research study addresses this gap by examining the practice evaluation knowledge and research selfefficacy of online and face-to-face msw students over an 18-month period. online vs. traditional classroom platforms previous social work literature specifically comparing online vs. traditional classroom experiences in terms of research methods learning has examined differences in student satisfaction (faul, frey, & barber, 2004; ligon, markward, & yegidis, 1999; westhuis et al., 2006; york, 2008) showing mixed results ranging from higher overall satisfaction with web-assisted courses, to no difference in satisfaction levels by learning platforms, to higher satisfaction in the face-to-face classroom. while student satisfaction is considered an important part of successful online education (siebert, siebert, & spaulding-givens, 2006; stocks & freddolino, 2000), satisfaction does not necessarily equal effectiveness. students might be satisfied with their program, but have they learned? previous studies operationalize learning outcomes using course grades (harrington, 1999; hisle-gorman & zuravin, 2006; kleinpeter & potts, 2003; o’neill & jensen, 2014; york, 2008), exam scores (cummings et al., 2015; westhuis et al., 2006), and overall grade point average (gpa; cummings et al., 2015). o’neill and jensen (2014) compared final course grades and self-reported gpa for forty-four msw students enrolled in either a faceto-face (23 students) or an online (21 students) section of the same research course and found no significant differences between the two groups of students at the end of the course. cummings et al. (2015) found mixed results, with advanced-standing face-to-face students having statistically significant higher gpa scores than their online counterparts, but found no significant difference in gpa between non-advanced-standing face-to-face and online students. few studies comparing online with face-to-face learning practices have used standardized measures with demonstrated reliability and validity. stocks and freddolino (2000) examined comfort with technology and classroom environment in a sample of 60 msw students. using standardized measures of attitudes toward computers and technology use at the beginning and end of a research methods class with two sections (one online, the other face-to-face), they found no significant difference in the computer attitude scale between pretest and posttest and marginal differences in technology use between the two groups, with online students reporting greater comfort using technology than their face-to-face counterparts. buchanan and mathews (2013) used the kirk-rosenblatt research inventory (1981) to assess msw social work students’ beliefs, knowledge, and opinions about research, finding no statistically significant difference between main campus and satellite msw students’ knowledge. cummings et al. (2015) used a standardized measure of self-efficacy to explore differences between online and face-to-face students from the perspective of an overall program, finding no significant difference between online and face-to-face student outcomes (cummings et al., 2015). these results provide additional support of no brown & park/longitudinal student learning 46   significant difference between online and face-to-face learning platforms (wcet, 2010), but do not explore the retention of knowledge over time. knowledge retention one challenge educators face is choosing a learning strategy that will result in longterm retention of knowledge (beers & bowden, 2005). various theories posit strategies to improve knowledge and memory including, but not limited to, problem-based learning (beers & bowden, 2005; schmidt, 1993), integrating the arts in education (hardiman, rinne, & yarmolinskaya, 2014), team-based learning (macke & tapp, 2012), and diffuse learning (raman et al., 2010). outlining the myriad education mechanisms suggested to increase knowledge retention is beyond the scope of this article. the importance of examining knowledge retention, however, should not be overlooked (raman et al., 2010; wayne et al., 2006). if students do not retain knowledge, they may be less likely to successfully use their education and skills in the field, which is particularly important in helping professions such as social work. msw students are required to successfully complete at least two research courses to earn their degree, and many schools require additional research methods coursework. however, few studies have explored the degree to which students maintain their research methods knowledge over time. using a small sample (n=25) of undergraduate social work students, baker, pollio, and hudson (2011) found evidence that students maintain educational gains one year after a research methods class, but their study tested knowledge perception as opposed to knowledge gained and did not compare differences by learning platform. the current study this study builds on previous research by replicating the baker et al. (2011), pre/post/post study of bsw students using the same measure, the practice evaluation knowledge scale (peks, baker & ritchey, 2009), with a sample of msw students. further, we included a measure of research self-efficacy (rses, holden, barker, meenaghan, & rosenberg, 1999) and a comparison group of online distance learning students. this study compares practice evaluation knowledge and research self-efficacy learning outcomes between a completely asynchronous online msw research methods class and its face-to-face classroom counterpart using a quasi-experimental non-equivalent comparison groups design. using standardized measures of students' perception and confidence, this project builds on previous social work literature and adds to the ongoing online versus face-to-face classroom debate. based on previous literature, we hypothesized that there would be no difference between the research knowledge and self-efficacy of online students and face-to-face classroom students a) after completing a beginning research class, and b) one year after the class. method advances in social work, spring 2016, 17(1) 47     program/class description in fall 2012, a large public university on the west coast introduced a two-year, degreegranting, fully asynchronous online master in social work (msw) program. students in both the online program and face-to-face program follow a cohort model, meaning that students enter and exit the program together and take classes in a prescribed order. online students complete the program in two years. traditional students have the option of completing the program in either two or three years. all students in the current study were part of a two-year cohort. online students and face-to-face students differ in that online students follow a quarter system, taking two eight-week classes per quarter totaling four classes per semester. traditional face-to-face students take four classes over 16 weeks each semester. in order to graduate, all students must take and successfully complete three semesters of research methods: beginning research methods, advanced research methods, and a capstone project. the beginning research methods class focuses on problem formulation, operationalization, conceptualization, design, and measurement concepts, and students complete a single subject design over the course of the semester. the advanced research methods course focuses on sampling, ethics, program evaluation, qualitative research methods, and survey research and touches on statistical analyses. the capstone project gives students the opportunity to design and conduct their own small research project including data analysis and presenting results. students may choose to collect their own data, use agency secondary data previously collected for non-research purposes, use secondary data from publicly available sources (e.g., the general social survey or the national health and nutrition examination survey), or conduct a program evaluation. students in all cohorts receive the same content, and classes happen in the same semester for students in a two-year cohort (i.e., everyone in the cohort has beginning research methods their second semester, advanced research methods their third semester and capstone the semester before graduation.) sample the study population included msw students enrolled in one of three master’s level beginning research methods sections. instructor b taught one section online (n=21). instructor b and instructor p each taught one traditional face-to-face section (n=13 for instructor b; n=23 for instructor p) for a total of 57 participants. five students (3 face-toface; 2 online class) did not complete the pretest, and three different students (1 online class; 2 face-to-face) did not complete the posttest, resulting in a valid n=49 (n=18 online; n=31 face-to-face) between time 1 and time 2. between posttest (time 2) and one-year follow-up (time 3), two students left the online cohort for personal reasons; the remainder of the cohort (n=16) completed the time 3 measure. one face-to-face student who did not complete the time 2 measure did complete the time 3 measure resulting in a valid n=48 (n=16 online; n=32 face-to-face) between time 1 and time 3. design brown & park/longitudinal student learning 48   this study used a non-equivalent comparison groups design with two groups: one consisting of students who received online instruction only, and one group consisting of students who received only face-to-face instruction, with pretest and posttest measures of student competency for both groups. pretest competency scores were compared for all three sections. no significant differences in demographic variables or research competency scores were found between instructor b’s face-to-face students and instructor p’s face-toface students, so those face-to-face sections were combined and compared to the online student competencies. pretest measures were taken at time 1 in january 2013 prior to the first research methods class, time 2 in may 2013 after the first research methods class, and time 3 in may 2014 after two subsequent research courses (advanced research and capstone). measurement two standardized measures were used to assess student achievement of research competency: the practice evaluation knowledge scale (peks) and the research selfefficacy scale (rses). the peks was developed to measure social work practitioners’ beliefs about their knowledge of practice evaluation competencies and has demonstrated internal consistency and validity (baker et al., 2011, p. 558). example items include “i have been adequately trained to conduct practice evaluation” and “i am familiar with issues of reliability and validity.” the 8-item peks (α=.88) is measured on a scale from 1-5 where 1=strongly disagree and 5=strongly agree. the rses developed by holden, barker, meenaghan, and rosenberg (1999) has demonstrated internal consistency reliability, evidence of construct validity, and sufficient sensitivity “to detect change in students’ research self-efficacy from the beginning to the end of their participation in a single-semester research course” (p. 472). the 9-item rses (α=.95) is measured on a scale from 0–10 where 0=cannot do at all, 5=moderately certain can do, and 10=certain can do. items begin with the statement “how confident are you that you can…” and include “do effective electronic searching of the scholarly literature”? and “design and implement the best sampling strategy possible for your study of some aspect of practice?” data collection together the peks and rses total 17 questions. for the purpose of this study, each measure was included in an easily readable online chart where respondents were asked to click the button next to their response for each question. after receiving approval from the university institutional review board, pretest data were collected online via the class web pages. students were directed to a link to the survey prior to the first class session via an email message from the other instructor. students were assured that their instructor would not see their survey results until after the class ended, and then only in aggregate. each student has a unique login, so matching pretest with posttest data occurred seamlessly. there were no duplicate entries, meaning it was unlikely that students logged in under another students’ id to complete either the pretest (time 1) or posttest (time 2). advances in social work, spring 2016, 17(1) 49     follow-up (time 3) data collection began at the end of the third research (capstone) class, a full 18 months after the pretest, and continued for approximately one month. students were contacted via email, reminded about the study, and asked to complete the posttest using a class web page that was set up to collect their data with their unique login, thus allowing for pretest, posttest, and follow-up data to be matched easily. if students had difficulty navigating the webpage they were invited to return their responses via email, fax, or in-person. these responses were then entered into the database by hand by instructor b and checked for accuracy by instructor p. approximately one-third of the responses were recorded in this manner. data analysis descriptive statistics were used to summarize demographics. paired samples t-tests were used to determine differences between pretest and posttest knowledge and selfefficacy scores. one-way between groups analysis of covariance (ancova) was conducted to compare differences in learning platforms for research methods instruction for msw students. ancova tests the significance of group differences between two or more groups while controlling for one or more covariates (e.g., pretest scores) that may influence the dependent variable (tabachnick & fidell, 2007; wright, 2006). for the current study, the independent variable was the type of learning platform (online vs. faceto-face classroom), and the dependent variable consisted of scores on the peks and rses surveys administered at the end of the first research class (time 2) and again at the end of the third research class (time 3). participants’ scores on the peks and rses pretest surveys (time 1) were used as the covariate in the analysis. results sample demographics students ranged in age from 22–44 years (m=28.55; sd=5.79) and were mostly women (83%). the majority of students identified as hispanic (n=18), followed by caucasian (n=14). no significant differences in age, race, gender, or previous research experience were found between the online and face-to-face students (table 1). face-to-face students (m=2.36, sd=.96) scored significantly higher than online students (m=1.89, sd=.56) on item 1 of the peks (i have been adequately trained to conduct practice evaluation), t(50)=2.21, p=.03, two-tailed, d=0.59. the magnitude of the difference in the means (mean difference=.47, 95% ci: .04 .89) was moderate (cohen’s d=0.59). there were no statistically significant differences in any of the remaining peks or rses items for faceto-face or online students. table 1. student demographics by instructional method student demographics instructional method face-to-face f (%) online f (%) gender n=36 n=21 brown & park/longitudinal student learning 50   student demographics instructional method face-to-face f (%) online f (%) female 30 (83) 18 (82) male 6 (17) 3 (14) race/ethnicity n=33 n=19 african american 2 (6) 2 (11) asian american 2 (6) 1 (5) caucasian 11 (31) 3 (16) hispanic 11 (31) 7 (37) multiracial 5 (14) 2 (11) other (armenian, jewish) 2 (6) 4 (21) previous research experience n=33 n=19 none 6 (18) 2 (11) 1 class…a long time ago 1 (3) 5 (26) 1 class 10 (30) 7 (37) 2-3 classes 13 (40) 4 (21) 4+ classes / very comfortable 3 (9) 1 (5) knowledge retention pretest to posttest online and face-to-face students were grouped together for initial knowledge retention analyses. the peks composite scale (m=18.25, sd=5.47) demonstrated reliability (α=.88). results from paired samples t-tests indicate a statistically significant increase in peks scores from pretest (m=18.20, sd=5.34) to posttest (m=29.12, sd=4.53), t(48)=12.48, p<.001 (two-tailed), d=1.74. the mean increase in peks scores was 10.91 with a 95% confidence interval ranging from 9.11 to 12.72. cohen’s d (1.74) indicated a large effect size. the rses composite scale (m=486.92, sd=176.55) demonstrated reliability (α=.95). rses scores increased significantly from pretest (m=486.95, sd=165.38) to posttest (m=698.16, sd=126.73), t(48)=8.06, p<.001 (two-tailed), d=1.15. the mean increase in rses scores was 211.24 with a 95% confidence interval ranging from 158.56 to 263.84. cohen’s d (1.15) indicated a large effect size. see tables 2 and 3 for paired samples t-test results by individual items on the peks and rses. there was a substantial difference in program evaluation knowledge (as measured by the peks) and research self-efficacy (as measured by the rses) for all students (online and traditional face-to-face) after taking the foundation research methods course. we explored differences between time 2 and time 3 and found that only questions 1 (effective electronic searching of the scholarly literature) and 3 (review a particular area of social science theory and research, and write a balanced and comprehensive literature review) on the rses were significantly different between posttest (time 2) (q1 m=87.60, sd=13.63; q3 m=78.60, sd=15.52) and follow-up (time 3) (q1 m=92.60, sd=13.82), t (49)=2.29, p=.03 (two-tailed), d=0.32; (q3 m=87.80, sd=14.88), t (49)=3.77, p < .001 (two-tailed), d=0.53. none of the items on the peks, and no other items on the rses were significantly different between time 2 and time 3. table 2. paired samples t-test results for online student responses by item, pretest (time 1) and posttest (times 2 & 3) advances in social work, spring 2016, 17(1) 51     item time 1 pretest n=18 m (sd) time 2 posttest n=18 m (sd) t d time 1 pretest n=16 m (sd) time 3 posttest n=16 m (sd) t d peks 1 1.89 (0.58) 3.78 (0.64) -8.31* 0.8 1.94 (0.57) 4.25 (0.44) -15.36* 0.94 2 2 (0.68) 3.56 (0.78) -6.33* 0.7 1.88 (0.5) 3.5 (0.73) -6.78* 0.45 3 2.11 (0.83) 3.78 (0.8) -7.79* 0.78 2.06 (0.85) 3.81 (0.91) -7.00* 0.48 4 2.28 (1.01) 3.61 (0.69) -6.23* 0.69 2.25 (1.06) 4.06 (0.85) -6.53* 0.46 5 2.83 (1.09) 3.78 (0.8) -3.01* 0.35 2.63 (1.08) 4.12 (0.62) -5.47* 0.42 6 2.06 (0.72) 3.67 (0.76) -6.98* 0.74 2 (0.73) 3.75 (0.93) -5.91* 0.44 7 2.11 (0.83) 3.22 (0.8) -4.16* 0.5 1.88 (0.62) 3.18 (0.98) -4.39* 0.37 8 3 (1.18) 3.83 (0.7) -2.48* 0.27 2.81 (1.16) 4.06 (0.68) -3.87* 0.34 rses 1 72.22 (24.86) 90.56 (10.55) -3.57* 0.43 73.75 (24.18) 96.25 (7.18) -3.73* 0.48 2 78.33 (24.31) 92.22 (10.6) -2.55* 0.28 76.88 (24.14) 94.37 (7.27) -2.69* 0.32 3 60 (22.75) 77.78 (18.96) -2.67* 0.3 61.88 (23.43) 89.37 (11.23) -4.15* 0.53 4 58.89 (24.22) 80 (16.8) -4.03* 0.49 59.38 (24.89) 87.5 (9.3) -3.97* 0.51 5 50 (23.01) 75.56 (18.22) -4.29* 0.52 51.88 (24.82) 78.75 (15.43) -3.98* 0.51 6 47.22 (24.92) 72.78 (16.01) -4.29* 0.52 48.13 (26.38) 76.25 (16.27) -4.03* 0.52 7 46.67 (23.51) 73.89 (16.85) -4.72* 0.57 47.5 (24.9) 75 (18.97) -3.90* 0.5 8 45 (25.49) 72.22 (18.64) -4.42* 0.53 45.63 (27.07) 73.12 (18.51) -3.56* 0.46 9 56.11 (23.04) 82.22 (16.64) -4.20* 0.51 56.88 (24.41) 85 (18.25) -4.43* 0.57 note. peks=practice evaluation knowledge scale rses=research self-efficacy scale *p<.05 table 3. paired samples t-test results for face-to-face student responses by item, pretest (time 1) and posttest (times 2 & 3) item time 1 pretest n=31 m (sd) time 2 posttest n=31 m (sd) t d time 1 pretest n=32 m (sd) time 3 posttest n=32 m (sd) t d peks 1 2.29 (0.94) 3.68 (0.65) -6.74* 0.6 2.34 (0.97) 3.68 (0.93) -6.29* 0.56 2 1.94 (0.63) 3.58 (0.77) -10.01* 0.77 1.94 (0.61) 3.59 (0.87) -11.32* 0.8 3 1.9 (0.75) 3.52 (0.85) -9.08* 0.73 1.84 (0.72) 3.68 (0.96) -10.93* 0.79 4 2.26 (0.93) 3.74 (0.82) -8.91* 0.72 2.25 (0.98) 3.71 (0.95) -7.71* 0.65 5 2.74 (1.12) 4.13 (0.56) -6.42* 0.58 2.75 (1.16) 3.78 (0.75) -4.73* 0.43 6 2.23 (1.02) 3.9 (0.75) -8.67* 0.71 2.25 (1.07) 3.71 (1.02) -7.14* 0.62 7 1.9 (0.65) 3.06 (0.77) -6.44* 0.58 1.94 (0.76) 3.28 (1.02) -6.03* 0.54 8 2.9 (1.13) 3.45 (0.99) -2.02* 0.12 2.91 (1.14) 3.59 (0.87) -3.23* 0.25 rses 1 73.55 (19.41) 86.45 (14.5) -3.92* 0.34 71.56 (23.43) 91.87 (14.46) -4.40* 0.38 2 71.61 (19) 86.13 (13.34) -4.43* 0.4 71.88 (19.08) 90.93 (13.99) -5.60* 0.5 3 55.48 (21.1) 77.42 (16.32) -5.76* 0.53 55.63 (22.99) 87.5 (15.45) -7.34* 0.63 4 56.13 (22.76) 77.42 (18.43) -4.14* 0.36 56.25 (25.62) 80.93 (18.89) -5.39* 0.48 5 44.52 (20.3) 72.26 (16.87) -7.06* 0.62 44.38 (22.99) 76.56 (19.27) -7.69* 0.66 6 40.32 (18.88) 70.32 (20.08) -6.70* 0.6 40 (21.09) 75 (20.63) -7.50* 0.65 7 38.71 (19.1) 71.94 (20.07) -6.64* 0.6 38.44 (20.8) 74.06 (19.81) -7.93* 0.67 8 37.42 (19.14) 67.1 (22.98) -5.78* 0.53 37.81 (22.1) 73.43 (21.03) -7.60* 0.65 9 53.23 (27.98) 78.06 (19.4) -5.08* 0.46 53.13 (29.77) 85 (18.13) -6.21* 0.55 note. peks=practice evaluation knowledge scale rses=research self-efficacy scale *p<.05 online vs. traditional face-to-face platform brown & park/longitudinal student learning 52   our hypothesis stated that there would be no difference between the self-reported knowledge and self-efficacy of online and face-to-face students after the beginning research methods class and one year after the beginning research methods class. preliminary checks were conducted to ensure that there was no violation of the assumptions of normality, linearity, homogeneity of variances, homogeneity of regression slopes, and reliable measurement of the covariate. after controlling for pre-test scores, there was no significant difference between online and traditional face-to-face classroom students on posttest (time 2) peks scores f(1, 46)=0.01, p=.91, and posttest (time 2) rses scores, f(1, 46)=0.36, p=.55 after the first research class. there was no significant difference between online and traditional face-to-face classroom students on follow-up (time 3) peks scores f(1, 45)=1.51, p=.22 or follow-up (time 3) rses scores, f(1, 45)=0.09, p=.76 one year after the beginning research class. discussion the online students in this program completed a two-year, completely asynchronous, online msw program with the same 16 hours per week in a local field placement as students in the face-to-face cohort. the standards for the online program are the same as those for the traditional classroom, and the same faculty members teach in both programs. as such, and based on previous literature, the investigators expected to find no difference in learning outcomes between the online and traditional face-to-face classroom students. although not social work specific, meta-analyses comparing distance education and classroom instruction reveal somewhat mixed results with support leaning toward distance education being similar to traditional classroom instruction. allen et al. (2004) and sitzman, kraiger, stewart and wisher (2006) found no differences in educational effectiveness for distance learners, with effectiveness defined as assessment of student performance (e.g., grades) or acquisition of declarative knowledge. however, bernard et al. (2004) found wide variability and low effect sizes on various outcomes including student achievement, attitude, and retention. note that bernard et al. (2004) define retention as “the opposite of dropout” (p. 388) as opposed to the maintenance of knowledge. creating subsets of synchronous and asynchronous applications resulted in effect sizes for asynchronous applications favoring distance education (bernard et al. 2004). sitzman et al. (2006) found web-based instruction 6% more effective than classroom instruction for teaching declarative knowledge. the current study examined pre and posttest practice evaluation and research self-efficacy scores of students in an asynchronous, web-based, distance-learning classroom compared to a traditional face-toface classroom for research methods (declarative knowledge). meaningful gains between pretest, posttest, and follow-up support the effectiveness of online and face-to-face education as seen in significant gains between the three time periods for the two groups. further, finding no differences in the learning outcomes between the two learning platforms provides additional support that online and face-to-face learning modalities are equally effective. finding differences in learning outcomes would have resulted in adjustments being made to either course, depending on the nature and direction of those differences. advances in social work, spring 2016, 17(1) 53     despite a growing body of evidence that online learning or distance education is as effective as traditional face-to-face classroom instruction, the various types of online education make comparisons difficult. online learning or distance education ranges from in-service training on-demand via television and satellite (williams, nicholas, & gunter, 2005) to asynchronous electronic software content (harrington, 1999) to hybrid models combining face-to-face instruction with distance learning applications (ayala, 2009; osguthorpe & graham, 2003; york, 2008). the current study adds to the developing body of literature by using standardized measures of learning outcomes, a pre/post/post quasi-experimental longitudinal design, and controlling for instructor and content differences in that the same instructor taught both the asynchronous online and face-to-face beginning research classes. knowledge retention over time is one indicator of teaching effectiveness, and our results suggest that online learning platforms are at least as effective as traditional face-to-face classroom strategies in students maintaining their practice evaluation knowledge and research self-efficacy one year after taking a beginning research methods class. limitations while we were able to control for instructor and content differences between time 1 and time 2, we were not as fortunate between time 2 and time 3. online students maintained the same professor for all three research courses (beginning, advanced, and capstone), whereas the face-to-face students had the ability to choose their instructor for the advanced and capstone research classes. while faculty work together to ensure students are receiving standard content, there were likely differences in how that content was delivered. since there were four potential instructors for the advanced research class that occurred fall 2013 (instructor p and three additional faculty), and six potential capstone instructors during spring 2014 (instructors b and p and four additional faculty), there was too much variability to statistically control for potential instructor differences. the sample size of this study was small. although the use of small samples is common in social psychology (johnson & bachan, 2013) and education (cook & hatala, 2015), this limits the statistical power. a finding of no statistically significant difference between online and face-to-face students in this study may not indicate that there is no true difference but may also be a result of inadequate power. however, considering this study employs a theory-based prediction, strong design with longitudinal data, and standardized measures, the findings of this study may have meaningful educational implications. findings indicate increased student self-efficacy in research methods, which may translate into greater comfort recognizing and employing evidence-based practices in the field. however, results should be interpreted with caution considering the current study used self-reports of a non-random, convenience sample of graduate social work students from a single university. although there were no statistically significant differences between the face-to-face and online students at pretest, participants were not randomized into experimental and control groups, and it is possible that there are inherent differences between the two groups that account for the knowledge and self-efficacy gained. although randomization may not be realistic in this type of education research, selection bias remains brown & park/longitudinal student learning 54   a threat to internal validity with this non-randomized design. with the exception of the first item on the peks, there were no significant differences between the face-to-face and online students. conclusion as online learning and distance education continues to develop, msw programs have an opportunity to be on the cutting edge of this growth in the social work field. however, remaining on the cutting edge involves conducting research that goes beyond student satisfaction or course evaluations. our results indicate that students gain and maintain confidence in research methods and evaluation regardless of the learning platform utilized. using this model, we encourage future researchers to explore competencies and areas of social work practice beyond research methods. despite the limitations of the current study, our results add to the growing body of literature showing that successful student research learning and knowledge retention may occur equally well through online and traditional face-to-face learning platforms. future studies should continue exploring longitudinal research knowledge retention since the timing of content delivery in this sample differed by eight weeks (face-to-face students had a 16-week semester; online students had an eight-week course). it is possible that the shorter learning time could negatively affect longer-term retention of knowledge. furthermore, research about the quality of programs from the perspective of learning outcomes triangulated with faculty-measured student competency could provide useful knowledge for informed practice and policy. a major strength of this study is the use of standardized learning outcome measures taken at three different time points over 18 months, with findings suggesting that the modality of content delivery is less important than the content itself. implications for social work education include effectively utilizing a broad range of information and communication technologies and increasing accessibility to social work students in traditionally underserved areas. references allen, i. e., & seaman, j. 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(2008). comparing three modes of instruction in a graduate social work program. journal of social work education, 44(2), 157-172. doi: http://dx.doi.org/10.5175/jswe.2008.200700031 author note address correspondence to: jodi l. constantine brown, california state university northridge, department of social work, 18111 nordhoff street, northridge, ca 913308226. phone: 818-677-6010. fax: 818-677-7662. email: jodi.brown@csun.edu _______ kathryn levine, msw, phd, rsw, associate professor, faculty of social work, dawn sutherland, phd, professor, faculty of education, melanie janzen, phd, associate professor, faculty of education, university of manitoba, winnipeg, manitoba, canada.. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 252-265, doi: 10.18060/23696 this work is licensed under a creative commons attribution 4.0 international license. educating children in our care: an interprofessional dialogue kathryn ann levine dawn sutherland melanie janzen abstract: in canada, there is increasing recognition that poor educational outcomes of children and adolescents involved with the child welfare system represent an emerging crisis for youth, their families, and the broader society. interprofessional education and collaboration between educators and social workers may facilitate better outcomes for children in care. although interprofessional education (ipe) and interprofessional collaboration (ipc) are well established in the allied health fields, there is not an equivalent acceptance within the applied social sciences, specifically in education and child welfare contexts. this may partially be attributed to the “siloed” nature of these professions, which limits both capacity and opportunities for professionals to understand each other’s mandates, roles, and policies. the purpose of this paper is to describe the development, implementation, and evaluation of a graduate elective course for social workers and educators that was geared toward educational outcomes of children in care. thirty-eight students from both disciplines participated in a summer institute. although participants valued the content and process of the course, it is unclear whether these types of initiatives facilitate enhanced ipc. findings do however suggest that ipe initiatives targeted toward a specific population may have more positive outcomes, compared to general ipc. keywords: interprofessional education; educational child welfare; children in care in canada, the term “children in care” refers to a broad range of legal arrangements between families and the child welfare system that involves children who have been a) apprehended from their parent/guardian by a child welfare agency due to allegations of neglect or abuse; b) placed under the care of a child welfare agency on a voluntary basis by their parent/guardian; c) brought into the care of the child welfare agency for a temporary period of time on the order of a family court judge; or d) made a permanent ward of the province on the order of a family court judge. children in care may be placed in a variety of out-of-home arrangements, including emergency shelters, group homes, extended family/kinship care settings, foster care placements, or specialized treatment settings. notwithstanding the differences related to legal status or placement, there is increasing recognition that poor educational outcomes of children and adolescents in care represent an emerging crisis for youth, their families, and the broader society. despite beginning discussions at both policy and practice levels, views on how to deal with the multiple and complex issues associated with this concern vary considerably. although the acceptance of interprofessional education (ipe) leading toward interprofessional collaboration (ipc) is well-established within the allied health fields (ndoro, 2014), ipc has yet to be universally recognized within other professional contexts, https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 253 specifically education and child welfare. one rationale for engaging in ipc is the acknowledgment that “complex problems require complex solutions” (bridges et al., 2011, p. 1). improving educational outcomes of children in care represents such a challenge. in manitoba, the most recent data suggests that only about 30 % of this population will graduate on time from high school (brownell et al., 2015). in view of the fact that manitoba currently has over 10,000 children in care (manitoba government, 2019b), the possibility that 7000 children will not attain a high school diploma has significant negative social, political, and economic impacts. given that the two key professions of education and social work share responsibility for the educational experiences of children in care, a reasonable hypothesis is that outcomes may improve if educators and social workers collaborated within an interprofessional framework. prior to engaging in collaborative practice however, educators and social workers may benefit from experiential interventions designed to facilitate the communication, relational, and knowledge building skills that form the foundation of effective collaboration. this article describes the development, implementation, and evaluation of a graduate level elective course for social workers and practicing teachers with a specific focus on educational experiences of children in care. educational gaps of children in care it is well established that children in care are significantly more likely to experience poor educational outcomes compared to children who do not have child welfare involvement including: high dropout rates, low graduation rates, lower academic achievement, and lower participation in post-secondary education institutions (harker, 2004; kufeldt et al., 2003; pecora, 2012; piechser et al., 2014; romano, babchishin, marquis, & fréchette, 2015; rouse & fantuzzo, 2009; smithgall et al., 2004; stoddart, 2012; stone et al., 2006; trout, et al., 2008). there are a number of factors that contribute to these disparities. the manitoba task force on educational outcomes of children in care (christensen & lamoureux, 2016) concluded that minimal information sharing, multiple care placements, school transience, an absence of meaningful connections to culture, and the lack of school connectedness all contribute to poor outcomes for this group. children’s educational outcomes are further complicated by a siloed approach to practice that constrains professional interactions. these concerns are not limited to a particular discipline, but rather extend to a number of child and family-serving systems including both mandated services, health, education, and social service institutions, and non-profit organizations. as a result, professionals within these systems may lack the requisite knowledge and skills to effectively communicate and collaborate with each other. significantly, the task force reinforced the position that enhancing interprofessional collaboration was critical to addressing these barriers for children in care. therefore, in order to fully engage both groups of professionals as partners in improving educational outcomes, we need to advance our understanding of current perspectives on the dynamics of collaborative relationships between education and social work professionals. levine et al./educating children 254 background a comprehensive understanding of educational experiences of children in care must account for the critical ways in which historical factors influence present outcomes. in manitoba, both social work and education share a problematic history with respect to children and families involved with the child welfare system. they are but two examples of how structural inequities embedded in social institutions, governmental discourses, policies, and services marginalize many groups, based on particular social group categories including first nations status (blackstock, 2011). for many indigenous families, the disruptions that occurred through the forced removal of children from families and communities, and the use of educational systems in the form of residential schools as the primary vehicles of oppression continue to recreate inequities. these are currently manifest as significantly higher rates of involvement with child welfare systems as a function of intergenerational trauma and lower rates of educational attainment related to distrust of educational systems (o’neill et al., 2018). child welfare and education professionals are independently and universally mandated to work “in the best interests” of children. from a child welfare perspective, in addition to ensuring the child’s safety and security, section 2(1)b of the child and family services act of manitoba defines best interests as meeting “the mental, emotional, physical and educational needs of the child and the appropriate care or treatment, or both, to meet such needs” (manitoba government, 2019a, p. 1, emphasis added). correspondingly, the preamble of the manitoba public schools act states that “the purpose of the public school system is to serve the best educational interests of students” (manitoba government, 2019c, p.1). taken together, it is clear that representatives of the child welfare and education systems hold legislated responsibility for educational experiences of children in care. as an example of how to translate these policies into practice, the province of manitoba had developed a protocol for education and child welfare staff to navigate the administrative challenges associated with registering children in care in school (healthy child manitoba, 2013). despite the individual mandates and existing protocols, in addition to the position that interprofessional collaboration is unequivocally endorsed as “best practice” for working with youth (darlington & feeney, 2008, p. 195), ipc has not yet emerged as an intuitive approach to practice, a structural consideration within systems, nor an administrative expectation of educators and social workers. ipc is a framework through which educators and social workers could enact their collective responsibility to children in care. collective responsibility was a part of the educational reform movement in the late 1990’s. the educational research focuses teachers’ collective responsibility on learning. whalan (2012) in the book collective responsibility identifies five major discourses within the notion of collective responsibility for learning. they are: professional community, professional development, relational trust, accountability and efficacy (whalan, 2012). within the discourse on professional communities the focus is on the collective responsibility of teachers “…to commit to professional practices that focus on gains for student learning and social equity” (whalan, 2012, p. 43). there is little inclusion of professionals outside of education in the research on collective responsibility. child welfare is no different in that most child and family service legislation is silent about the advances in social work, summer 2020, 20(2) 255 obligation of child protection to work with other agencies, including schools. gallaghermackay (2017), in the book succeeding together, examines how the independent mandates of educators and child welfare staff operate contrary to ideals of collective responsibility. fineman’s 2005 (as cited in gallagher-mackay, 2017) notion of collective responsibility is applied to child welfare work and schooling and found to be in contradiction to current policies and practice. in essence, gallagher-mackay’s research findings describe how child welfare staff and educators work in separate spheres and closed systems. the expressed need for collaboration between educators and social workers is not a recent phenomenon. in 1921, pratt described how the educator’s requirement for knowledge of the “whole child” would “give this social worker the welcome which is now accorded to her by those of their own number who understand and by socially minded physicians, psychiatrists, and psychologists” (p. 96). unfortunately, pratt’s optimism was less prescient than the desired ideal, and in the current context, child welfare workers typically do not describe themselves as “welcomed” by school staff. research regarding these two disciplines has identified significant barriers to collaboration including adversarial relationships, differences in perceived importance or significance of childrelated issues, and differences in professional perspectives on how to address problems (altshuler, 2003; gallagher-mackay, 2017; garstka et al., 2014; isaksson & larsson, 2017). more recently, research by our team concluded that “competing discourses” regarding child-centered versus family-centered worldviews, the need for informationsharing versus the importance of maintaining confidentiality, and prioritizing either school continuity or placement stability, each reflect the different professional mandates and organizational cultures of educators and social workers (levine & sutherland, 2019). what became evident is that the relationships between the two disciplines reproduce the very conditions of disconnections that children in care and their families experienced, and serve as an additional barrier to improving children’s educational experiences. in response to these findings, our team undertook a research project that explored the process of facilitating systems change, with the goal of moving toward a model of ipc that focused on improving educational experiences of children in care. the study was located within a jurisdiction in winnipeg, manitoba in which two key administrators, representing child welfare and education, had established a working committee comprised of a number of representatives of the child welfare authorities and a group of interested teachers and administrators, to facilitate improved communication. this committee functioned as an advisory group to the research study in order to ensure that project activities were informed by the perspectives and expertise of the different stakeholders, as well as to facilitate communication between the research team and stakeholder groups. a key accomplishment of this committee was the institution of a number of professional development sharing days in which school division staff, child welfare workers, youth in care of child welfare agencies, biological family members, and foster care providers came together to listen to each other’s experiences, as one means of facilitating enhanced understanding of the perspectives of the different stakeholders. in other words, the sharing days became way in which the various stakeholders demonstrated and attempted to extend their collective responsibility for children in their care. levine et al./educating children 256 in addition to the data collected through the sharing days, the research team conducted an informal needs assessment with committee members to identify areas of opportunity that would facilitate interprofessional collaboration between the two systems. through this process, a number of gaps were identified. both educators and social workers reported inadequate knowledge of each other’s mandates, policies, and practices, and therefore some did not feel equipped to fully support educational experiences of children in care. as academics representing both disciplines, and after a curriculum scan, the project team determined that curricula from neither undergraduate-level social work nor education programs includes this content. we used these findings to shape the development of a graduate elective course for both social work and education students entitled educating children in our care: a interprofessional dialogue. interprofessional collaborative practice according to the world health organization (who, 2010), “interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve outcomes” (p. 1). our research team recognized that changes must occur in post-secondary pedagogies if these programs are to become places where interprofessional collaboration becomes instrumental in improving the academic achievement of children in care. we determined that exploration of interprofessional collaboration could frame a graduate level elective course for social workers and educators. we hoped that bringing together graduate social work and education students would acknowledge the failure of current systems to target educational disparities for children in care, enhance understanding of the links between interprofessional theory and practice, clarify how each profession values and promotes social justice, and ultimately, how collaboration could reimagine service provision for children and families. building on interprofessional education, interprofessional practice has been defined as a collaborative approach to address the needs of individuals, families, or communities (d’amour & oandasan, 2005). although readily accepted in allied health, ideas regarding interprofessional collaboration have yet to be embraced within other areas. at the same time however, particular social problems are creating a profound need for different approaches, specifically, educational outcomes of children in care. although social workers and educators each play a particular role in and share responsibility for educational experiences of children in care, they are socialized into very different discourse communities that limit the capacity for collaborative practice. course development educating children in our care: an interprofessional dialogue created a context for learning shaped by new ideas about opportunities for learning and professional development. our thinking about the intersections between education and social work was guided by the literature on interprofessional collaboration which also served as the conceptual framework for the course. these intersections were not only important pedagogical elements that framed course development and delivery, but became the key topic of class discussion. advances in social work, summer 2020, 20(2) 257 within the health services literature, there are four key domains that are integral to ipc; contextual, organizational, professional practice, and relational (bentley et al., 2018). we used the bentley model and had educators and social workers apply it to their professional settings. each domain is further delineated into a number of concepts that describe how ipc theory is translated into practice. the contextual domain refers to the settings in which collaboration is expected to occur, the stakeholders involved, and the characteristics of each discipline that influence the process. the organizational domain determines how educational institutions and social service agencies are mandated to meet the needs of children and families, how leadership practices within each system support collaborative practice, how each understands their own and others’ legal responsibilities, how the policy and administrative contexts of each profession facilitate or impede collaboration, and the degree to which there is congruence between discipline-specific contexts. the professional practice domain includes ideas regarding role clarification, recognition of the diversity and expertise of each profession, interprofessional ethics, decision-making, problem-solving, and service coordination for children and families. lastly, the relational or interpersonal domain focuses on issues of mutual respect, honesty, trusting relationships, communication, conflict resolution processes, and how these are manifest at a practice level. using this framework, the course objectives were; 1) to facilitate relationship building between educators and social workers; 2) to increase knowledge of each other’s policy, organizational, and professional contexts; 3) to develop more permeable professional boundaries through enhanced interpersonal communication; 4) to explore and consider various interprofessional responses to children in care including trauma-informed practice; and 5) to develop students' commitments to improving educational outcomes of children in care through the explicit recognition of collective responsibility. the course was offered as a 3-credit graduate level elective in the summer session of 2019. 38 students (32 education and 6 social work) registered and completed the course. the disparity in numbers may be partially explained by the different professional contexts. summer courses are ideal for educators pursuing graduate degrees. in contrast, social workers typically move into their advanced field placements during the summer, having completed their electives during the fall and winter terms. in addition to being cross-listed in two faculties, the course spanned two institutions as students from both the universities of winnipeg and manitoba were able to register. the course was held for four hours each morning for a two-week period. members of the research team, one from the faculty of social work, and one each from the faculties of education at each university, were the instructors for the course. funding to aid in course development was provided by the teaching and learning enhancement fund at the university of manitoba. course content building upon readings, case studies, guest speakers, and in-class collaborative activities, students were provided with multiple opportunities for collaborative practice, culminating in a group presentation that consisted of an interprofessional case study of children in care. within the contextual domain, our guiding questions focused on the social and historical factors in manitoba in regards to children in care. participants reviewed the levine et al./educating children 258 research on educational outcomes of children in care (brownell et al., 2015) and were surprised to learn that in canada, it was in only in 1996 that the last residential school closed (blackstock, 2011). they read the subsequent report of the task force on educational outcomes (christensen & lamoureux, 2016), and received a lecture from and discussed the recommendations with kevin lamoureux, one of the authors. building on this history, participants were introduced to the concept of “collective responsibility” for children in care. although educators and social workers can individually advocate for particular children, these actions cannot change the increasingly large and complex bureaucracies that are accountable for educational outcomes of children in care through a process of formal decision-making structures. it is only through acknowledging the need for comprehensive systemic change as a collective responsibility that educators and social workers can advocate for the necessary political changes that will benefit all children in care. within the organizational domain, our guiding questions encouraged participants to consider their particular contexts, and to explore how existing policies and protocols can inform collaborative practice and decision-making. collaboration begins from a shared knowledge base, and clearly, each system must understand the others’ mandates, policies, practices, and challenges. educators were not fully aware of how the child welfare system works, and child welfare staff do not fully understand the education system. in response, participants learned about the complexity of the current child welfare system in manitoba, which consists of four separate child welfare authorities that govern 53 individual child and family agencies, each with their own unique culture and climate. the education system is somewhat less complex; however, there are 38 different school divisions (not including locally controlled manitoba band operated schools which are funded and regulated by the federal government of canada) overseeing over 600 schools, each with their corresponding school-specific climates and culture. participants learned about the policy context of each profession and the expectations and constraints of each system. for example, in one activity geared toward roles and responsibilities, participants were presented with the professional code of ethics for social work (canadian association of social workers, 2005) and the manitoba teachers’ society code of professional practice that establishes standards of conduct for teachers, and were asked to note points of convergence and divergence. participants observed that the social work code is primarily focused upon protection of the public as recipients of social work services, including children in care, and the education code is focused upon regulating teacher behavior, which facilitated a thoughtful discussion on the implication of these differences for working together. within the professional practice domain, our guiding questions challenged participants to consider strength-based perspectives as a means of reconsidering their work with children and families. additionally, they were encouraged to approach children differently by learning about trauma-informed practice (morgan et al., 2015). a key tenet in trauma informed practice is shifting professionals’ from “what‘s wrong with you?” to “what has happened to you?” which can significantly change perceptions of all children and their behaviors. https://en.wikipedia.org/wiki/manitoba_band_operated_schools https://en.wikipedia.org/wiki/manitoba_band_operated_schools https://en.wikipedia.org/wiki/government_of_canada advances in social work, summer 2020, 20(2) 259 within the relational domain, our guiding question asked participants to reflect upon how interprofessional collaboration is manifest in practice, bound by both possibilities and realities. participants observed that system change does not always need to occur in a top down approach, but can occur at a grass roots level. this was made evident when a school administrator and child welfare supervisor attended the class as guest speakers and shared their experience of collaboration to ameliorate the long-standing and seemingly entrenched interprofessional conflicts and tensions. other examples included the sharing of a project in which a group of social workers, high school educators, and child advocates collaborated in the development of a school-based self-advocacy credit course for students involved with the child welfare system. education participants were encouraged by the idea that they too could collaborate with social workers to develop schoolspecific projects to support youth in care. evaluation methods as this was the first iteration of an interprofessional practice course that occurred within the context of a larger research project on collaboration, it was important to extend the evaluation beyond the likert scales that standard course evaluations typically employ. our team was interested in learning about the impact of the course on students’ attitudes, knowledge, and skills for collaboration, how the course may have invited educators and social workers to apply their learning to their respective settings through changed professional practice with children in care, and how the use of multi-disciplinary content affected students’ perspectives of each other’s disciplines. therefore, the evaluation focused upon two key questions: (a) what is the impact of participation in a course designed to enhance interprofessional collaboration, and (b) how might this impact educational experiences of children in care? using an online program (qualtrics), we constructed a survey that consisted of a series of open-ended questions that addressed 1) knowledge and skills needed for ipc (e.g., “how has your understanding of interprofessional collaboration (ipc) changed?” “in what ways have your skills regarding ipc changed?”); 2) interprofessional relationships (e.g., “what facilitates collaboration between educators/social workers?” “what do you think that educators and social workers could learn from each other?” “has your experience in the course changed your understanding of working inter-professionally?”); and 3) connections to practice (e.g., “how do you think the course content will help you work more effectively?” “in what way(s) do you think your new knowledge will benefit children in care?”). a final section included questions related to the evaluation of the learning activities (e.g., “which component of the class [lectures from instructors, guest lectures or projects] contributed most to your learning and why?” “how effective were the learning activities used in this course?” “which topic/teaching method did you find most/least useful?”). ethics approval was granted by the psychology sociology research ethics board at the university of manitoba. given that the participants were students in graduate studies, the invitation to participate in the research was released after the deadline for submission of final grades. using content analysis (hsieh & shannon, 2005), participant responses were downloaded from the program and then organized into the broad themes of course levine et al./educating children 260 objectives, content, structure, learning activities, and overall evaluation. seventeen participants, 4 social workers and 13 educators/administrators (45% in total) completed the survey. findings while all four ipc domains were represented in participants’ responses, shifts in their knowledge of roles and responsibilities emerged as a key theme. participants expressed an increased appreciation and respect for understanding each other’s professions, expanded their knowledge regarding each other’s roles, and reinforced the position that “relationships matter when it comes to getting things done” (educator). the majority of responses identified “increased understanding of systems” as a key factor that expanded their knowledge of ipc. for instance, educators described how reviewing the existing policies and protocols facilitated “increased understanding of child welfare workers’ perspectives and responsibilities.” other comments highlighted the recognition of how “systemic hurdles impede our work with children” (social worker). participants from both disciplines identified that their knowledge of interprofessional practice had expanded moving from “simply working together” to “identifying and breaking down the barriers between the two disciplines” to the recognition of “the ways in which the different professions are positioned with a certain lens and set of beliefs about our roles and responsibilities.” clearly, having professionals from both education and social work represented within the course, as students and instructors, was noted to be a clear benefit. responses highlighted how participants recognized how the reciprocal interactions of education and child welfare will impact children in care, both positively and negatively. one educator identified how they now have a “better understanding of the various factors that underlie reduced academic achievement for children in our care and how we need to work together in order to begin to address them.” another concluded that “how what we do in our role can positively or negatively impact on the others' areas of responsibility.” there was recognition that “educators can learn more about family dynamics that influence adaptive coping strategies and social workers can see how children are coping at school are they feeling safe enough to be learning?” in particular, the group projects that brought participants together were evaluated positively. one educator stated “i enjoyed working alongside a social worker and really learning what that job entails.” however, one caveat was that the groups were not numerically equal, with significantly more students from education compared to social work. recommendations around this issue identified greater efforts to recruit more equitable numbers from each profession. a number of participants indicated that the course gave them enhanced insight into the needs of children in care, and how to construct a “more robust team of support” (educator) that could respond in a more meaningful way, including “advocating within both systems.” there was increased recognition of the “whole” child in the context of their family and school domains, and the importance of shared, productive planning. educators expressed greater appreciation for family issues and social workers were able to identify schoolspecific coping strategies for children. several education participants suggested that they would have benefited from knowledge of children in care early on in their post-secondary programs, prior to beginning their teaching careers. as described by one participant, “they advances in social work, summer 2020, 20(2) 261 will now see themselves in my classroom” suggesting that all children’s experiences will be validated. the sessions on developing trauma-informed approaches to practice in the classroom were appreciated by students in both disciplines, and in fact, there was a desire for additional content in this area, including discussions related to caregiver burden when working with traumatized children. discussion a major objective of the course was to connect educators and social workers through the framework of interprofessional collaborative practice. findings from this exploratory research suggest that ipe for social work and education is an innovative approach in which students of different disciplines are encouraged to communicate around the needs of a particular population. it will be beneficial for future research to more rigorously assess the effects of ipe programs on participants’ capacities for ipc to strengthen the evidence base in support of these initiatives. for example, one goal of ipe is to reduce negative stereotypes held by professionals regarding different disciplines (bell & allain, 2011). although we did not assess these perceptions as a pre-test, evaluation comments suggested that course content encouraged participants to shift their understandings of each other by gaining a more informed perspective on each other’s roles, responsibilities, and structural constraints. there was recognition, even among members of the same discipline, that there can be misunderstandings regarding the scope of practice, and ipe invites one to reflect upon one’s own discipline, as well as others. future research that incorporates preand post-tests can address these limitations. as well, we also know that relationships are paramount to system change. prior research emphasizes the importance of the relational domain of ipc, and how interprofessional learning/education facilitates the development of authentic relationships that compliment professional relationships (carney et al., 2019, p. 120). however, what cannot be assessed is whether this particular ipe initiative will result in increased collaboration between educators and social workers in their daily practice, or whether ipc can result in more positive educational experiences for children in care. research on ipe within the allied health fields suggests that despite positive perceptions, there “is insufficient robust evidence to support its effectiveness on improved (client) outcomes” (illingworth & chelvanayagam, 2017, p. 817). however, despite the absence of evidence of improvement in general health outcomes, there is emerging evidence to support the position that interprofessional education focused on specific populations may hold more promise. findings from queen’s university suggest that an interprofessional educational course on individuals with intellectual or developmental disabilities resulted in improvements in student knowledge, attitudes, and skills (jones et al., 2015). similar improvements in interprofessional knowledge were found in programs focused on improving men’s health (sealey et al., 2017) and children’s social communication skills (coiro et al., 2016). accordingly, developing populationor issuespecific ipe courses that involve the relevant professions may be one means of researching the relationship between ipc and improved client outcomes. levine et al./educating children 262 conclusion despite the fact that many social workers are members of multidisciplinary teams during their professional careers, as students, they receive minimal formal content on interprofessional collaboration. ipc is not part of the current education curriculum, and of particular note for this paper, neither is content about children and families involved with the child welfare system. the availability of an elective course focused on the collective responsibility for children in care created an opportunity to invite change to participants’ perspectives toward 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(2010). framework for action on interprofessional education & collaborative practice. geneva, switzerland. https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng. pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 author note: address correspondence to kathryn levine, faculty of social work, university of manitoba, winnipeg, manitoba, canada, r3t 2n2. email: kathryn.levine@umanitoba.ca https://doi.org/10.1016/j.ecresq.2008.12.001 https://doi.org/10.1177/1557988315601725 https://www.chapinhall.org/wp-content/uploads/smithgall_educational-experiences-children-out-of-home_report_2004.pdf https://www.chapinhall.org/wp-content/uploads/smithgall_educational-experiences-children-out-of-home_report_2004.pdf https://www.chapinhall.org/wp-content/uploads/smithgall_educational-experiences-children-out-of-home_report_2004.pdf https://doi.org/10.1016/j.childyouth.2012.01.045 https://doi.org/10.1300/j479v01n02_04 https://doi.org/10.1016/j.childyouth.2007.11.019 https://doi.org/10.1007/978-94-6091-882-7 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 mailto:kathryn.levine@umanitoba.ca this work is licensed under a creative commons attribution 4.0 international license. trauma-exposed infants and toddlers: a review of impacts and evidencebased interventions alysse melville abstract: infants and toddlers are exposed to abuse and neglect at disproportionate rates compared to other children, setting a trajectory for disrupted developmental processes and increased vulnerability to future traumatic exposure. social workers encounter trauma– exposed young children across a number of systems, including but not limited to early childcare, family physical and mental health, court, and child welfare. it benefits social workers to have a working understanding of current research related to the bio–psycho– social impact of trauma on infants and young children and an awareness of current, research-driven interventions that can support young, at–risk children and families. this article reviews trauma-impacted development throughout the first two years of life with a discussion of current research exploring attachment and brain development and then discusses caregiver–child based interventions that work to repair disrupted attachment patterns, repair impaired regulatory processes, and return the caregiver–child relationship to a healthy developmental path. keywords: trauma; infant mental health; early childhood; attachment; development; intervention current national estimates suggest that children from birth to age two years old make up over a quarter of substantiated cases of child maltreatment and almost three-quarters of abuse and neglect-related fatalities (u.s. department of health and human services, administration for children and families, administration on children, youth, and families, & children’s bureau, 2015). the historical assumption of the natural resilience of very young children has been challenged by research showing trauma symptoms developing in children as early as three months of age (cordón, pipe, sayfan, melinder & goodman, 2004) and neuroendocrine responses to maternal trauma transmitted in utero (yehuda et al., 2005). despite the high prevalence rates of trauma exposure in children ages zero to two years, there is a dearth of available resources and interventions to address and mitigate trauma for infants and toddlers, especially targeted at social workers. this deficiency is evidenced by only seven out of 43 empirically supported treatments and promising practices listed by the national child traumatic stress network as appropriate for children ages zero and up, and of those, only two specifically and exclusively address early childhood trauma (child parent psychotherapy and attachment and biobehavioral catch-up, both reviewed below). social workers will no doubt encounter trauma–exposed infants and toddlers in their area of work, whether directly or through caregivers, and must be equipped to advocate for these at-risk children. this article explores the impact of trauma–exposure on children ages zero to two years, due to the disproportionately high rates of maltreatment exposure in this age range, with particular emphasis on the impact of trauma on attachment patterns, and a review of two promising evidence-backed interventions that are developmentally appropriate for infants and toddlers. ______________________ alysse w. melville, lcsw, is a doctoral student, school of social work, university of connecticut, hartford, ct. copyright © 2017 author, vol. 18 no. 1 (spring 2017), 53-65, doi: 10.18060/21287 https://creativecommons.org/licenses/by/4.0/ melville/trauma exposed infants and toddlers 54 early childhood trauma numerous types of trauma can impact infants and toddlers; these range from single, isolated traumatic events, such as natural disasters or car accidents, to chronic maltreatment and victimization, including domestic violence, neglect, physical abuse and sexual abuse. a traumatic event may be defined as an event that is overwhelming to the child’s senses or self-regulatory abilities, threatens the child’s well-being or that of their caregiver, indicates the world is uncontrollable and unpredictable, and/or involves stressors that exceed the child (or caregiver’s) normal resources (cordón, et al., 2004; van horn & lieberman, 2008). chronicity of trauma (streeck-fischer & van der kolk, 2000), the child’s pretrauma adjustment (feldman & vengrober, 2011), and the caregiver’s reaction to the trauma (devoe, klein, bannon, & miranda-julian, 2011) have all been linked to the severity of children’s post-trauma functioning. impact of adversity. a number of domains are impacted by early maltreatment, including cognitive, behavioral, socio-emotional, and health. compared to older children who have been maltreated, trauma–exposed children ages zero to two years are at greater risk for developing internalizing symptoms (kaplow & widom, 2007) and have difficulties with inhibitory control and working memory (cicchetti, cowell, rogosch, & toth, 2015). in addition, children who experience early adversity, such as abuse and neglect, are at greater risk than their non-maltreated peers for impaired executive functioning (deprince, weinzierl, & combs, 2009), a set of skills that predicts kindergarten school readiness (fitzpatrick, mckinnon, blair, & willoughby, 2014) as well as adult academic and job outcomes (miller, nevado-montenegro, & hinshaw, 2012). large-scale epidemiological studies such as the adverse childhood experiences (ace) study have analyzed the prevalence and effects of early childhood traumatic experiences in over 17,000 adults and have found relationships between early adverse childhood experiences and the prevalence of a number of adverse adult physical health outcomes (dong, anda, dube, giles, & felitti, 2003). further, although not specific to children zero to two years old, children under 6 experience more aces than any other age (thompson et al., 2015). multiple aces in early childhood are associated with impaired social-emotional development (mckelvey, whiteside-mansell, connors-burrow, swindle, & fitzgerald, 2016), increased risk of polyvictimization across childhood (grasso, ford, dierkhising, branson, & lee, 2015), belowaverage academic literacy skills and behavior problems (jimenez, wade, lin, morrow, & reichman, 2016), and increased rates of ptsd and internalizing symptoms in adulthood (grasso et al., 2015). taken together, these findings suggest that children zero to two years old are at risk of increased exposure to future experiences of trauma throughout childhood, as well as other potential negative developmental outcomes. diagnosis of early trauma. critics of the dsm-iv’s diagnosis of ptsd argued that it did not fit the complex symptoms that traumatized young children often present with (feldman & vengrober, 2011) as it was dependent largely on the individual’s ability to verbalize feelings, details, and expectations. in two studies that measured the impact of trauma on toddlers, none of the children in the study fit the formal dsm-iv criteria for ptsd (mongillo, briggs-gowan, ford, & carter, 2009). similarly, among children in treatment for trauma with the national child traumatic stress network, fewer than a quarter met the criteria for ptsd. other research found that assessment alternatives to the advances in social work, spring 2017, 18(1) 55 dsm-iv diagnosis (including changes ultimately adopted for use in dsm-5 [american psychiatric association (apa), 2013]) resulted in significantly more ptsd diagnoses in preschool-aged children, indicating that the dsm-iv may have underdiagnosed ptsd for a considerable number of preschool-aged children (scheeringa, myers, putnam, & zeanah, 2012). recent changes in the dsm-5 reflect the need for creating a developmentally appropriate diagnosis for traumatized children with the creation of a preschool subtype category for ptsd that helps to adapt the ptsd diagnosis to children under 6 years old (apa, 2013); however, these changes still do not reflect the specific impact of trauma on children ages zero to two years. in fact, although the dsm-5 notes that ptsd may occur at any age, it further clarified “beginning after the first year of life” (apa, 2013, p. 276). the limited assessment and diagnostic criteria addressing preverbal trauma, experienced by infants and toddlers, may limit insurance funding and federal medicaid funding for early intervention services for this population. development attachment the process of attachment is arguably most important in the earliest years, as it creates a biological framework for managing future stress and arousal (streeck-fischer & van der kolk, 2000), thus shaping how a child interprets and reacts to future experiences. as infants are not able to decipher between distinct, different arousal states or verbalize their needs, they are dependent on caregivers to modulate their arousal and to care for their basic needs (van der kolk, 2006). during times of intense arousal or distress, secure children will return to behaviors that center on their primary attachment figure, such as seeking attention from or proximity to their caregiver; these behaviors elicit predictable caretaking responses in secure caregivers (feldman & vengrober, 2011). as caregiver’s moderate infant arousal by providing comfort and stimulation as well as by providing care for basic needs (such as changing a diaper or providing food), the infant learns the process of co-regulation (ford, 2005). secure and sensitive caregiving provides a type of safeguard against hyper-arousal and disorganization and infants begin to develop a sense of self and awareness of body cues, setting the stage for future development of self-regulation and affect tolerance (feldman & vengrober, 2011). the relationship between early childhood trauma and attachment can be seen from a number of angles; namely, whether the attachment figure perpetrated the trauma, whether the emotional needs of the child were met after the traumatic experience, and to what extent the parent was affected by the child’s traumatic experience (pynoos, steinberg, & piacentini, 1999). the typical curiosity of the exploratory-orienting response that takes place as children begin to gain confidence in assessing and exploring the external world is also impacted by trauma, as children may instead choose to remain close to inconsistent or unpredictable caregivers. as children initially rely on their primary attachment figure’s appraisal of contextual danger, a child with a neglectful or maltreating caregiver may be vulnerable to being without such early messages of danger and risk exploring too much. conversely, the child may be exposed to a traumatized parent’s over-estimation of danger, which may become internalized to the child (pynoos et al., 1999). melville/trauma exposed infants and toddlers 56 in circumstances where the caregiver is unable or unwilling to provide early arousal modulation and basic care to young children, the child is at risk of exposure to overwhelming levels and durations of arousal. this lack of regulation risks imprinting in a child’s developmental processes that emotions and arousal in general are dangerous/frightening, leading to potential avoidance of arousal in the form of numbing/dissociation or a response in the other direction such as arousal in the form of aggressive behaviors (streeck-fischer & van der kolk, 2000). in the strange situation, often used to observe and assess a toddler’s response to separation from their primary caregiver, maltreated toddlers were found to be more likely to have disorganized attachments to caregivers (cicchetti & toth, 1995) as well as higher levels of cortisol after parental separation (twardosz & lutzker, 2010). research with infants raised in countries engaged in war found that the mother’s proximity to a traumatic event, not the child’s proximity, was correlated with traumatic symptoms in children (feldman & vengrober, 2011). infants’ and toddlers’ evaluation of danger relies mainly on referencing their primary attachment figure, which leads to the potential for traumatization through their attachment figure (pynoos et al., 1999). this may shed some light into the detrimental effects of witnessing domestic violence in the home. neurobiological development early childhood development of attachment occurs within the context of fast-paced neural development, thus making it nearly impossible to separate the infant’s growing primary attachment from the neurobiological systems that are developing around stress and affect regulation (twardosz & lutzker, 2010; van der kolk, 2005). as experience shapes the brain through neural plasticity, synaptic connections that are use-dependent, either become strengthened or pruned based on early interactions with caregivers. the hypothalamic-pituitary-adrenal (hpa) axis is one such “use dependent” system which moderates arousal and regulation through a series of chemical reactions in the limbic system (twardosz & lutzker, 2010). when an individual is stressed, cortisol is released through the adrenal gland as a result of the hpa-axis interactions, and stress responses such as increased heart rate, blood pressure, arousal and concentration are triggered (debellis, 2001; twardosz & lutzker, 2010). in normal development, the stress response triggered by activation of the hpa axis and the release of cortisol through the adrenal gland is regulated by the hippocampus (twardosz & lutzker, 2010). as the hippocampus triggers the stopping of the hpa-axis chemical interactions, the body is restored to homeostasis through decreased heart rate, blood pressure and arousal, thus allowing infants to flow in and out of states of arousal and regulation safely and with predictability. predictable coregulation by the primary caregivers aids typical functioning and development of the hpa axis (twardosz & lutzker, 2010). trauma-impacted development is also best understood through the intersection between neural development and social development, as it is difficult to address how trauma impacts attachment without a discussion of how attachment impacts the brain as well (van der kolk, 2005). just as young children in responsive attachment relationships are able to organize their internal biological framework around expectations of safety and responsiveness from their caregivers (streeck-fischer & van der kolk, 2000), early trauma can impact a child’s organization by creating expectancies of the world as unsafe and advances in social work, spring 2017, 18(1) 57 unpredictable (van der kolk, 2005). the earlier discussed “use dependent” plasticity of the brain creates neural changes in children with chronic traumatic stress; creating a template of danger and survival through which later relationships and experiences are evaluated and processed (debellis, 2001; pynoos et al., 2009). primary trauma-related alterations in infant brain structure are in the hpa axis and the hippocampus (debellis, 2001; ford, 2005). it is here that a major distinction between types of trauma becomes apparent; children with secure caregivers have a higher likelihood of developing a typical stress response system, as caregivers are able to continue to provide arousal modulation after a traumatic experience (lieberman, 2004). however, if the trauma involves neglect or other maltreatment from the primary caregiver, chronic traumatic events, or traumatization of attachment figures (feldman & vengrober, 2011), the hpa axis can become severely impacted (pynoos et al., 1999). this may also be the case if trauma responses from the infant are so severe that they challenge the resources of otherwise secure and attuned attachment figures, who may be unable to regulate the child in the face of such trauma responses (markese, 2011). the activation of the hpa axis results in behaviors consistent with duress, such as anxiety, hyper-arousal, and hyper-vigilance (debellis, 2001). chronic traumatic stress represents an over-activation of the hpa axis and a disruption to the hippocampal process of restoring homeostasis after duress, thus exposing children to abnormally long periods of hyper-aroused states (ford, 2005). the “use-dependent” plasticity of the brain begins to organize neural connections by prioritizing skills relevant to survival, interfering with the strengthening of connections relevant to safe attachment systems (pynoos, et al., 1999). the development of the pre-frontal cortex is shaped by early information that children receive from caregivers and the outside world, and is organized around early experiences, such as to expect stability/regulation, neglect/deprivation, or violence/fear (twardosz & lutzker, 2010). as the prefrontal cortex aids children in interpreting information they receive from the outside world, a child who has been impacted by chronic traumatic stress may begin to build a cognitive framework where all information received from the outside world is interpreted as dangerous, thus perpetuating the cycle of persistent arousal (twardosz & lutzker, 2010). although there is much yet to be learned about the impact of early maltreatment on brain development, the amygdala and hippocampus have been implicated in work related to early trauma exposure. for example, exposure to prenatal, antenatal, and postnatal maternal anxiety was associated with infant hippocampal growth (qiu et al., 2013). in addition, early trauma has been related to smaller brain volume, less connective matter, and neuronal losses in the corpus callosum and frontal cortex (debellis, 2001). treatment implications the complex and attachment-dependent nature of early childhood trauma emphasizes the need for therapeutic interventions that can include the caregiver–child relationship (lojkasek, cohen & muir, 1994). as discussed, trauma occurring within the developmental framework of early childhood has a direct impact on typical attachment processes, including trust formation and co-regulation which has an impact on the child’s arousal modulation and agency/exploration (pynoos et al., 2009; van der kolk, 2005). important melville/trauma exposed infants and toddlers 58 considerations for treatment include the intervention’s ability to address and repair disrupted attachment processes by taking into consideration the primary caregivers present and past trauma and their experience of the child’s trauma as well as whether the intervention is able to increase levels of mutual sensitivity (lojkasek et al., 1994). ford, albert and hawke (2008) suggest that interventions for early childhood trauma should emphasize increasing the ability of the child and the caregiver to consciously control and co-regulate their internal alarm system. it is important to note that not all attachment work needs to take place within the context of a biological parent–child relationship; other caregiving systems can include relatives, foster or adoptive parents, and residential staff (arvidson et al., 2011; ford, et al., 2008) and have been shown to similarly reduce cortisol levels and behavior problems in trauma-impacted youth (twardosz & lutzker, 2010). following are two evidence-backed interventions that effectively address risks associated with infant and toddler-exposure to trauma. child-parent psychotherapy (cpp) child-parent psychotherapy (cpp) is a relationship-based dyadic intervention for children from birth to age five who are experiencing difficulty as a result of traumatic events or relational disruptions (lieberman & van horn, 2011). cpp aims to address the young child’s experience of trauma through the lens of the relationship, by increasing mutual sensitivity and responsiveness between the infant and the caregiver (tucker, 2006), addressing the observable behavior of the infant (jones, 2006; lojkasek et al., 1994), and naming the unconscious processing that may be occurring as a result of the caregiver’s prior attachment systems and experiences (jones, 2006). the structure of the cpp model includes caregiver–child sessions that are structured to enable the parent and child to engage in free-play and spontaneous reactions to each other. these reactions may be explored in the moment by the clinician or reviewed during collateral sessions with the parent (lieberman & van horn, 2011). cpp supports the clinician’s use of modeling, interpreting for the child as well as the provision of unstructured, reflective developmental guidance as a way to support the typical developmental trajectory of the child (van horn, gray, pettinelli, & estassi, 2012). cpp is able to simultaneously address the child and caregiver’s experiences and reactions to trauma, while also restoring typical attachment patterns and the child’s developmental trajectory. maltreating families report higher rates of abuse and neglect in their own childhoods, as well as insecure attachment patterns with their own caregivers (toth, rogosch, manly, & cicchetti, 2006). because of the emphasis that cpp places on paying attention to the trauma of the caregiver’s past and his or her ability to process the child’s trauma, this dyadic form of therapy is also able to address the intergenerational transmission of trauma and attachment patterns from caregivers to their children (van horn & lieberman, 2008). cpp has been more widely studied with trauma–exposed pre-school populations (lieberman, ghosh ippen, & van horn, 2006). fewer studies have examined the impact of cpp with trauma–exposed children ages zero to two years. however, existing research with children ages zero to two years have found cpp to be linked to increased maternal empathy, and dyadic interaction, and decreases in infant’s avoidance, resistance, and anger (lieberman, weston, & pawl, 1991) as well as increased rates of secure attachment, advances in social work, spring 2017, 18(1) 59 compared to maltreated infants who did not receive cpp (toth et al., 2006). children have been shown to be susceptible to trauma exposure in utero through caregiver exposure to interpersonal violence, stress, and trauma (brand, engel, canfield, & yehuda, 2006). perinatal cpp begins intervention with dyads during the mother’s third trimester and continues until the child is 6 months of age. perinatal cpp with chronic trauma and interpersonal violence exposed pregnant mothers has been linked to decreases in maternal depression and post-traumatic stress symptoms, as well as increases in child-rearing attitudes, particularly with mothers with initially low maternal-fetal attachment (lavi, gard, hagan, van horn, & lieberman, 2015). cpp has been demonstrated to effectively address challenging early childhood behaviors related to trauma and attachment between caregivers and children, and has also been conceptualized as a developmentally appropriate intervention for pediatric medical trauma, such as invasive procedures or life-threatening illness (bergeron, 2017). limitations of cpp center on the importance of the availability and engagement of a primary caregiver. if a caregiver is not willing or able to engage in cpp treatment then the fidelity to the model is compromised. cpp has been adapted to be used with young children who are placed out of the home, emphasizing the need for children to experience security even within complicated kinship or foster placements (van horn et al., 2012). cpp is a trauma-informed, developmentally-framed dyadic model that addresses the child’s and caregiver’s individual experiences while emphasizing that of the attachment relationship. attachment and biobehavioral catch-up (abc) attachment and biobehavioral catch-up (abc) is a 10 session, manualized, relational model that was developed to target the physiological and behavioral impacts of trauma in early childhood (dozier, bick & bernard, 2011; dozier, peloso, lewis, laurenceau, & levine, 2008). abc uses the parent–child relationship to explore the impact of early trauma on the attachment relationship and to repair disruptions and distortions that occur as a result of altered stress-response systems and behavioral dysregulation in both children and their caregivers (dozier et al., 2011). throughout the 10 sessions, the clinician targets common trauma responses in attachment relationships, including the child pushing the parent away, the parent’s own experiences that may interfere with attachment, such as past or current stressors, and the trauma-impacted child’s adaptive physiological and behavioral responses (dozier et al., 2008). abc targets the behavioral and physiological dysregulation through play, during which time the clinician encourages and supports the parent in following the child’s lead, responding to the child’s cues, engaging with the child in regulating physical touch, and delighting in the child (dozier et al., 2011). abc addresses the parent experience through the use of videotaped parent-child interactions to show alternate attachment styles and emphasis on helping the parent become aware of automatic responses (dozier et al., 2011). in addition to caregiver sensitivity and maltreatment-related behaviors, studies of abc have also explored outcomes related to the neurobiological underpinnings of attachment, trauma, and stress. a study comparing abc to control interventions show significantly lower cortisol, a stress-hormone implicated in trauma and chronic stress exposure in children and adults, as well as fewer behavior problems post-intervention. in this study, melville/trauma exposed infants and toddlers 60 children in the abc intervention groups had levels of cortisol similar to children in the non-maltreated control group following treatment (dozier et al., 2008). differences in cortisol production between maltreated children who received the abc intervention in infancy/toddlerhood were observed through longitudinal follow-up in preschool (bernard, hostinar, & dozier, 2015). caregiver’s event-related potentials (erps), a neurobiological marker of processing of their children’s signals of emotion, and maternal sensitivity were enhanced in neglecting caregivers following the abc intervention (bernard, simons, & dozier, 2015). abc has been studied across a number of settings, including with children in foster care, caregivers in inpatient treatment programs, and in community settings. a follow-up study of the use of abc with children in foster care found that children who received the abc intervention prior to age two had stronger cognitive flexibility than a control group (lewis-morrarty, dozier, bernard, terracciano, & moore, 2012). in a study of the effects of the abc intervention with mothers and infants in a residential substance-abuse treatment program, mean scores on observed sensitive parenting behavior measures were three times higher for the abc intervention group than for the control group (berlin, shanahan, & carmody, 2014). additionally, abc has proven successful at improving parenting behaviors even when translated into community practice models of care (caron, weston-lee, haggerty, & dozier, 2016), demonstrating the ability to translate the abc intervention successfully into social work agencies and community practice. conclusion this article was written to provide an overview of the impact of trauma on the biopsychosocial development of children between birth and two years old, and as a guide for potential therapeutic interventions for this specific population. it does not cover all of the impacts of early childhood trauma, nor does it make a distinction between different types of trauma. it also does not provide a comprehensive or evidence-based review of the potential interventions, largely due to the minimal evidence-based research available for infant/toddler interventions. preverbal trauma must be assessed and addressed early, with developmentally appropriate interventions that target both the child and their primary attachment system and prevention models that focus on at-risk families and caregivers. social workers encounter a number of at-risk, marginalized populations, including infants and toddlers. social workers are poised as advocates for developmentally-sensitive, trauma-informed care and advocacy across a number of interdisciplinary settings. as more research uncovers the connection between early childhood experiences of trauma and adult mental and physical health problems (dong et al., 2003), and more social workers engage in health care fields, more opportunities may arise to intervene with trauma–exposed young children in these and other interdisciplinary settings. increased 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(2010). child maltreatment and the developing brain: a review of neuroscience perspectives. aggression & violent behavior, 15(1), 59-68. doi: https://doi.org/10.1016/j.avb.2009.08.003 u.s. department of health and human services, administration for children and families, administration on children, youth and families, children’s bureau. (2015). child maltreatment 2013. available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statisticsresearch/child-maltreatment van der kolk, b. a. (2005). developmental trauma disorder: toward a rational diagnosis for children with complex trauma histories. psychiatric annals, 35(5), 401-408. van der kolk, b. a. (2006). clinical implications of neuroscience research in ptsd. annals of the new york academy of sciences, 1071(1), 277-293. doi: https://doi.org/10.1196/annals.1364.022 van horn, p., gray, l., pettinelli, b., & estassi, n. (2012). child-parent psychotherapy with traumatized young children in kinship care: adaptation of an evidence-based intervention. in j. d. osofsky (ed.), clinical work with traumatized young children (pp. 55-74). new york: guilford press. van horn, p., & lieberman, a. (2008). using dyadic therapies to treat traumatized young children. in d. brom, r. pat-horenczyk, & j. ford (eds.), treating traumatized children: risk, resilience, and recovery (pp. 51-70). new york: routledge. yehuda, r., mulherin engel, s., brand, s., seckl, j., marcus, s., & berkowitz, g. (2005). transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the world trade center attacks during pregnancy. the journal of clinical endocrinology & metabolism, 90(7), 4115-4118. doi: https://doi.org/10.1210/jc.2005-0550 author note: address correspondence to alysse melville, school of social work, university of connecticut, 38 prospect street, hartford, ct 06103, 203-313-9498, alysse.melville@uconn.edu https://doi.org/10.1080/13698030600810359 https://doi.org/10.1016/j.avb.2009.08.003 http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment https://doi.org/10.1196/annals.1364.022 https://doi.org/10.1210/jc.2005-0550 mailto:alysse.melville@uconn.edu microsoft word agbenyiga_huang gendered immigration copyedit 2 _________________ debrenna lafa agbényiga, ph.d., is an assistant professor and assistant dean for equity, diversity and inclusive academic affairs, and lihua huang, msw, is a doctoral candidate, both in the school of social work at michigan state university. copyright © 2012 advances in social work vol. 13 no. 2 (summer 2012), 291-305 gendered immigration: implications and impact on social work education debrenna lafa agbényiga lihua huang abstract: gendered immigration is a frame of reference for contextualizing the need for gender-specific immigrant services. like other immigration societies, the united states disproportionately pays less attention to immigrant women. this article is a conceptual examination of the critical challenges faced by immigrant women from a global perspective. special attention is given to the importance of social work education regarding service delivery structures for an increasing number of immigrant women in the united states. keywords: gendered immigration, immigrant women, immigrant services, social work and education introduction since the last half of the 20th century, the landscape of immigration in the united states has been reshaped by non-european female dominance. currently, women constitute half of the total 95 million international migrants and accounted for 55.4 percent of the total immigration population in 2000 (unfpa, 2006). approximately half a million women immigrate to the united states each year. the majority of female immigrants to america originate from asia, south america, and africa (houstoun, kramer, & barrett, 1984). despite the increasing number of female immigrants, there has been disproportionate insensibility to gender-specific migration experiences, diversity in policy agenda setting, and human service delivery systems (espín, 1999; pittaway & bartolomei, 2001; pittaway & pittaway, 2004; rehn & sirleaf, 2002). hondagneu-sotelo (1999) noted that feminism and immigration were rarely coupled in the public sphere, although they are two of the most radically transformative forces that have significantly reshaped immigration in the united states. as noted by several immigration studies scholars, social work practitioners and various social science scholars are among the few public figures who are aware of the needs and strengths of women immigrants, and who theorize and share immigrant women’s stories while illustrating the importance of the intersection of immigration and gender (agger, 1994; berger, 2004; pittaway, 1999; veer, 1992;). thus, it has become more crucial to recognize that women immigrants have been situated in a critical position where powerful resistance is represented by multiple discrimination and oppression against them. this discrepancy is clear where unavailability and the inadequacy of immigration services, especially gendered-specific immigration services coexist with underutilization of services. the primary focus of this article is to contribute to what pedraza calls “gendered understanding of the causes, processes, and consequences of migration” (1991, p. 304), advances in social work, fall 2012, 13(2) 292 and to contribute to social work knowledge on how gendered immigration experience affects immigrant women’s acculturation and their relationship with human services organizations. while witmer and culver (2001) have criticized the overemphasis on pathogenic aspects of immigrants and revealed the resilience of immigrants in their work, knowledge on gendered immigration is equally important. the latter perspective includes not only information about the challenges that immigrant women face, but it also highlights the strengths that immigrant women utilize to cope with these challenges. understanding the challenges and needs of immigrant women call for attention and protection from the host society and mobilization of political, social, fiscal, and psychological resources. in addition to the aforementioned challenges, a greater vulnerability of immigrant women stems from a lack of access to necessary human capital, barriers to uncertain legal status, and a supportive human services sector. these challenges, coupled with the stress of motherhood in a new setting, culminate into the essence of why it is important to understand and study immigration from a gendered perspective. espín (1999) stated that because of the role that mothers play in culture preservation and gender norm transformation, the strengths perspective not only leads to successful acculturation of the first generation of women immigrants, but it also brings positive effects on second and third generation of women immigrants. more appealingly, from a macro perspective, the united nations security council resolution 1325 addresses the importance of women’s strength and participation in finding strategies to stop wars (un, 2000). therefore, the acknowledgment of immigrant women’s strengths and the roles that this strength plays in the resettlement process for them and their families is important for the development of policies and programs that provide the needed assistance for successful resettlement. ultimately, this article will draw attention to the following aspects that are required for a better understanding of gendered immigration from a social services perspective: (1) critical assessment of our knowledge construction of gendered immigration; (2) examination of the critical challenges faced by women immigrants; and (3) impact and implication of gendered immigration from a social integration perspective on social work education. epistemology of gendered immigration studies knowledge about gendered immigration and gender specific treatment in resettled countries has been developed among u. s. social scientists since the 1970s. this knowledge construction has taken an interdisciplinary research approach that has traditionally integrated demography, sociology, women studies, politics, social work, and nursing. this has culminated into three stages: women’s perspective, gender perspective, and transnational feminism. the stages illustrate a transformation of our knowledge among the immigrant women population. they each highlight various aspects of growth in our understanding of the challenges, strengths and processes that are inherently a part of the resettlement process. the key focus of the “women’s perspective” stage is “women and migration” (hondagneu, 2003), which reveals prior characteristics of immigration studies: women agbényiga, huang /gendered immigration 293 exclusion and invisibility, androcentric biases, and gender discrimination. during this period, the image and voice of immigrant women began to enter into the sphere of immigration studies, especially women as a measurable variable in quantitative immigration studies on labor markets and earnings comparisons. furthermore, during this early stage of knowledge construction, feminist scholars began to address the nature of multi-oppression of immigrant women, the otherness of immigrant women and men while emphasizing the otherness of immigrant women. in response to the complexities of immigrant women and their resettlement outcomes, a gender perspective was expressed in a 1984 special volume of international migration review on women and migration. this response led to knowledge creation of the second stage of gender specific migration research. in the second stage, “gender and migration” replaced “women and migration” as a key theme in immigration studies. the gender perspective suggests that a gendered society, not women alone, positioned not only the cause, but also the treatment of women’s disadvantaged resettlement processes and outcomes. research at this stage began to recognize intra-group differences. at this point, immigrant women were viewed as another outcome of gendered perspectives. therefore, within the context of immigration studies, immigrant women were no longer viewed as a homogeneous group. instead, it acknowledged that there is great diversity among immigrant women in relation to their resettlement outcomes within the context of their socioeconomic status, women’s liberation, health and mental health status, and gender relations from their specific cultural context. this evolution in gendered immigration led to transnational feminism, the third stage of gendered immigration. by the mid-1990s, transnational feminism emerged as a part of the transnational perspective of immigration research. from a transnational perspective, immigration acknowledges the fact that people are engaged in their home country and receiving country simultaneously which results in a back and forth movement of people, goods, money, services, and ideas between nations and states (mazzucato, 2006). although this perspective is not a new phenomenon within the realm of immigration, new technological advances have made the movement of communication between large distances possible with much greater frequency, speed and regularity than in the past (mazzucato, 2006). through this wave of understanding, the simultaneous perspective of immigration from a transnational immigration stance has led to newly informed scholarship with a focus on the transnational feminist perspective of immigration. women and their role in back and forth movement across nations and states goes beyond earlier labor market studies that were conducted during the first stage of gendered immigration knowledge development. (hondagneu-sotelo, 1999; 2003; mazzucato, 2006). the development of transnational feminism is rooted in postcolonial theory and it is defined as a contemporary feminist praxis in the globalization era (grewal & kaplan, 1994; kaplan, alarcon, & moallem, 1999). this approach pays attention to the intersection of national boundaries, class, race, gender, and sexuality. transnational feminist agenda theorizes a global communication network that facilitates transnational dialogue among women in the world. research on disadvantaged immigrant women and human service delivery which employs transnational feminism is tied to the following advances in social work, fall 2012, 13(2) 294 theories to better understand and serve immigrant women: gender relations, migration theory, identity theory, acculturation theory, globalization theory, post-positivism, otherness theory, and empowerment theory (agger, 1994; berger, 2004; meguid, 2006; pittaway, 1999; veer, 1992). the aforementioned enriched theoretical approaches allow immigration study from a transnational feminism perspective to concentrate on the intersection of mobile women across national boundaries and nations. furthermore, it is differentiated from international feminism in that it focuses on transnational feminism networks. that, in turn, offers the desirability and possibility of a political solidarity of feminists across the world. for human services professionals, transnational feminism offers a space to obtain knowledge for and from immigrant women networks and dialogues, which contextualizes migrant women experiences while facilitating solidarity amongst migrant women (mohanty, 2003). more importantly, this perspective serves as an entry point for researchers to begin to truly see, hear, and understand the diversity of immigrant women’s experiences and the complexities that play a significant part in supporting or hindering their successful resettlement. complexities and diversity of gendered immigration since 1965, the high degree of diversity among immigrant women has been a great frustration for those who seek a single theoretical framework or service model for understanding the experiences of all immigrants. in fact, some researchers refer to this unfamiliar diversity as inconsistent findings in immigrant studies (yakushko & chronister, 2005). this frustration stems from stereotyping, an assumption that treats immigrants as the “other” without differentiation. recent research illustrates the frustration of immigrant women due to ignorance of diversity by the conventional wisdom of the host society (berger, 2004; peleikis, 2000). murty (1998) noted the challenges of racial, cultural, linguistic, and religious diversity among immigrant women, and recognized the positive effects of the awareness of the diversity by the host society as an aspect of designing appropriate and responsive health care delivery structures. building from the existing body of knowledge on immigrant women, this section draws on three complexities with an understanding of diverse perspectives of gendered immigration: education, violence, health and mental health, and access to services as major aspects of women’s immigration experience. as transnational feminism suggests, all immigrants experience social, cultural, and psychological difficulties when they crossed geopolitical borders despite differences in gender, age, class, educational background, professional status, and personality. excitement, culture shock, loss, feeling of rejection, sense of alienation, confusion, feeling of being out of control, and acculturation stress are typical psychological effects of immigration among voluntary and forced immigration (berger, 2004; espín, 1999). the “gender-specific immigration experience” is the first complexity of immigrant women that provides an insight into their experience through their lens. gendered immigration adds the gender indicator to highlight individual aspects of immigration experiences and argues that immigrant women share common immigration agbényiga, huang /gendered immigration 295 experiences which differ from immigrant men. these experiences include lower social status, higher rate of dependence on the social welfare system, higher rate of health and mental health issues, traumatized pre-immigration and post-immigration experience, multiple family and work responsibilities, barriers to health services, social services, and education (agger, 1994; fowler, 1998; gany & bocanegra, 1996; jensen, 2006; meyer et al., 2003; veer, 1992). gender-specific immigration experiences cannot simply refer to disadvantages because this perspective falls in line with the past pathogenic aspect of immigration studies that scholars have worked to change through continued knowledge development (witmer & culver, 2001). current research, however, that includes the voice of women immigrants, illustrates women immigrants’ extraordinary resilience, flexibility, and effective problem solving skills (agger, 1994; berger, 2004; pittaway, 1999; pittaway & pittaway, 2004). despite multiple oppressions, immigrant women generally adapt faster to their new environment than their male counterparts. the immigration experience empowers immigrant women’s negotiation power and gender role expectations with both the home culture and the host culture (berger, 2004; mazzucato, 2006; world bank, 2006). research also shows that immigrant women often remit more financial support to their extended family in their home of origin more than men. this, in most cases, is a gender shift within the women’s cultural context (berger, 2004; world bank, 2006). although in general, these aspects of gender-specific immigration experiences have been reported across various ethnic immigrant groups, new scholarly knowledge also provides an opportunity for acknowledging and understanding the diversity within and across immigrant women. education the first complexity that highlights the within-group diversity among non-european immigrant women is that they are more diverse in their countries of origin, socioeconomic status, education background, and professional status. in 2000, 69% of indian immigrants aged 25 or older reported having college degrees, almost three times the proportion of the native population. during the same time period, only 4.2 percent of mexican immigrants had graduated from college (portes & rumbaut, 2006; zhou, 2002). immigrant women can be found in both highly skilled professional specialty occupations and unskilled labor-intensive occupations. studies show that 51 percent of indian immigrants are in professional specialty occupations, twice the proportion of native workers. the proportion of mexican immigrants who reported having such jobs was fewer than 5 percent (portes & rumbaut, 2006; zhou, 2002). meanwhile, female immigrants from the philippines and jamaica are concentrated in nursing (primarily as certified nursing assistants-cna), and those from mexico and central america are disproportionately concentrated in domestic work or menial factory jobs (zhou, 2002). ager, ager, and long (1995) examined the gender experience of mozambican refugees and found that gender inequalities exist in education, income, work burden, and health. portes and rumbaut (2006) research provides evidence that immigrant women’s income and education levels are statistically significantly lower than their immigrant advances in social work, fall 2012, 13(2) 296 male counterpart. in addition to their inferior educational status, immigrant women are also disproportionately affected by various type of violence as a part of their immigration process that can be traced from their country of origin to their new host country. that leads to various levels of stress and trauma for these female immigrants. violence research on domestic violence against immigrant women have focused on asian, mexican, central american, and south american women in family reunification. frye et al. (2005) found that in new york city, an immigrant’s background was associated with intimate partner perpetrated homicide. from 1990-1999, over 40 percent of the reported homicides were among immigrant women and 54.4 percent of all intimate partner homicides were immigrant women. both of these statistics indicate that immigrant women are at a higher risk of violence, especially intimate partner violence. orloff (2002) and raj and silverman’s (2002) work showed evidence that immigrant women became extremely vulnerable to domestic violence due to their immigration legal status. ward and vann (2002) and jansen (2006) reported gender-based violence in refugee settings where women’s bodies were called a battleground. although rapes and sexual violence are the top two identified forms of gender-based violence that refugee women experience in situations of armed conflict, other gender-based violence also greatly contributes to refugee women’s disproportionate vulnerability. child sexual abuse, forced or coerced prostitution, sex trafficking and other forms of sexual exploitation are determinants of refugee women suffering, social stigma, and a wide range of health and mental health concerns. for many, they suffer violence in silence in their home country that in some cases continues in the host country (meguid, 2006). the violence in their home country can be linked to those in refugee camps where some women also experience intimate partner violence as a backlash to their redefining gender roles which is a major aspect of post-immigration stress for women immigrants from various parts of the world (jansen, 2006; meguid, 2006; nicholson, 1997). in fact, espín (1999) found that most immigrant women identified a change of gender role expectations as a major consequence of immigration that can be positive and negative for women and their families. these shifts in gender roles and family commitment have forced women to remain trapped and isolated in an abusive relationship since their legal status and family structure is totally controlled by the abusive intimate partner. health and mental health factors current research illustrates that immigrant women were healthier at the point of their initial arrival in their host country. one common explanation is that of the health requirements mandated through immigration law. however, after their arrival, immigrant women experience higher health risks when they suffer physical exhaustion and psychological distress as a result of migration and access disparities within the health care setting (meleis, 2002). immigrant women commonly experience psychological distresses, post-traumatic stress disorder (ptsd), victimization, adaptation strategies, and identity changes (berger, 2004; frye et al., 2005; portes & rumbaut, 2006; yakushko & chronister, 2005). some emphasize negative physical, emotional, and mental health agbényiga, huang /gendered immigration 297 outcomes of migration and acculturation, and depict “loneliness and depression as a feature of everyday life” (anderson, 1987, p. 422). portes and rumbaut (2006) documented the association between immigration and mental disturbances through history, and pointed out that specific acculturation led to widely different mental health outcomes. several studies have also highlighted the health and mental health needs of refugee women and suggest that refugee women may be at greater risks than other immigrant women as a result of their migration experience (gagnon, marry, & robinson, 2002). like refugees, asylum seekers are forced to flee their country of origin as a result of war and human rights abuses. many of them experienced politically motivated rape, sexual slavery, prostitution, female genital mutilation, and other forms of gender-related persecution. studies have found that women refugees who survive gender-based violence normally suffer poorer physical conditions and post-traumatic stress that is directly connected to re-victimization of violence in their host country (jansen, 2006; meguid, 2006; nicholson, 1997). the incidence rate of ptsd among female asylum seekers is very high. although international tribunals have included gender-related claims, the extent of coverage in the united states for gender claims is inconsistent with international norms (bastien, 2002; meguid, 2006). in fact, many female asylum seekers are traumatized by the detention experience, which is usually ignored by the host country. bastien (2002) examined the physical and psychological impact of long-term detention on women asylum seekers and found double standards in the treatment of women and men asylum seekers around their living conditions, process time and support in understanding the process. the world health organization (who) identified seven common mental disorders among refugees and asylum seekers: depression, acute psychosis, chronic or long-term psychosis, mental disorders caused by hurtful and frightening events, mental disorders caused by beatings or other injuries to the head, emotional disturbances associated with intense fear and worry, and emotional disturbances related to poor sleep (1996). in light of this knowledge, most resettlement agencies lack the funding needed to screen for any type of mental illness and counseling services. this is leaving a number of immigrants, specifically women, with the lack of support and services needed to cope with the mental challenges that are brought on by their past experiences and current acculturation process. aranda et al. (2001) tested gender difference in depressive symptoms among mexican americans and found that immigrant women differ from men in terms of the sources of stress and social support associated with depression. for immigrant women, family and marital relationship were identified as significant sources of stress and social support. others have also found that family context was a determinant of women’s health (nimmagadda & balgopal, 2000). the health and well-being of immigrant women is further compromised because of how they view and define health. meadows, thurston, and melton (2001) found that immigrant women in their study viewed “health” as a physical experience, while abuse, emotional and mental health were not seen as part of illness, though they spoke freely about their feelings of sadness, depression, anxiety, and the traumatized past. these findings are consistent with other qualitative studies advances in social work, fall 2012, 13(2) 298 emphasizing the physical and mental health of immigrant women (berger, 2004; grunerdomic, 2000). different conceptualizations of health and mental health indicate the degree of health and mental health inequality and disparities among immigrant women. meleis (2002) claims that the host society misinterprets immigrant women’s responses to illness and health, and states that the result is that immigrant women experience greater health risks than their non-immigrant women and immigrant men counterparts. the lack of available and affordable gender specific immigrant services, gendered health disparities and higher rates of barriers to quality health care and mental health services lead immigrant women into greater health risks (meleis, 2002). access to services meleis’ work highlights the fact that immigrant women rarely have their own access to health care and other human services in general, and to health insurance in particular (2002). immigrant women who have access to services are less likely to have chronic illnesses (gany & bocanegra, 1996; kelaher, williams, & manderson, 1999). compared with other demographic groups of the population, immigrant women shared a common status of access and utilization of health services and social services. research suggests that immigrant women make considerably less use of mental health care services than native-born women (meleis, 2002). moreover, immigrant women more frequently use social work facilities and women’s crisis intervention centers than native women. furthermore, they consult social work agencies and women’s crisis intervention centers nearly one and half times more frequently than mental health care services. research shows that age and language has an impact on the service utilization of immigrant women (have & bijl, 1999; kelaher et al., 1999). meanwhile, an australian study showed that predictors of health service utilization were different for men and women. while age and lack of english proficiency appeared to be barriers to health service use for immigrant women, visa category and country of origin were more important determinants of health service use for immigrant men (kelaher, et al., 1999). beyond age and english proficiency, research has identified three other main barriers to immigrant women’s use and access to human services: socioeconomic status, legal restrictions, and cultural norms (have & bijl, 1999; raj & silverman, 2002). malgady and zayas, kaplan, turner, romano, & gonzalez-ramos (2001) implied cultural and linguistic factors in psycho-diagnosis. while evaluating the impact of linguistics, ziguras (2001) found that the use of bilingual staff directly led to less use of crisis intervention services and hospitals, better long-term improvement in social functioning, better compliance with medication, and greater satisfaction with services and its cultural sensitivity. an in-depth understanding of immigrant women and their need for human services and barriers to access to such services can be extremely beneficial for u.s. social work professionals as a foundation for facilitating better service delivery structures. this knowledge, combined with a deeper understanding of the gendered immigration process can be used to design stronger curricula that include a micro and macro perspective. agbényiga, huang /gendered immigration 299 implications for social work education although most u.s. social work programs are struggling with the inclusion of various aspects of diversity and international social work practice, the understanding of gendered immigration can no longer be ignored. as we continue to embrace the “good” aspects of globalization, we cannot ignore the challenges that we have as a global society from an increasing pull toward global understanding. this increased need for continued understanding of the global environment is most apparent in work with immigrants, refugees and asylum seekers (nash, wong, & trlin, 2006). increasingly, literature on globalization and international social work practice and education specifically links social work practice to resettlement, issues of citizenship, inclusion and participation in civil society (nash et al., 2006). according to powell (2001), civic social work is defined by a concern for the rights and needs of citizens—immigrants, asylum seekers and refugees seek integration (as opposed to assimilation) in their host country. they often join the poor and oppressed in an ongoing struggle for genuine inclusion and participation in an effort to exercise their civic right as well as duties. this new civic practice moves our educational learning as social workers away from the practice of assimilation into the practice and understanding of social integration. social integration has been defined by the united nations as an inclusionary goal, implying equal opportunities and rights for all human beings (un, 1994). therefore, this perspective of social integration as a means for becoming ‘more integrated’ also implies improving life chances (un, 1994). this civic and social integration approach as a part of social work practice with immigrants, refugees and asylum seekers is the foundational aspect of a new field of practice. from this perspective at a macro level, this new field of practice involves human rights, social justice and advocacy work, while at the meso level, community work plays an essential role, and at the micro level problem-solving with individuals and their families occurs (nash et al., 2006). thus, as a profession, we must begin to re-examine our social work curricula and begin to take a more inclusive approach to understanding the dimensions of gendered immigrations and how it intersects with our human services delivery systems and policy structures. this approach will need to take on a micro, mezzo, and macro frame of professional knowledge, skills, policy, and advocacy perspective. this perspective means that we need curricula that go beyond classes that include immigration aspects and gender dynamics as a topical area---we now need classes that are specific to understanding these issues and dynamics from a gendered perspective. as a profession, from a global perspective, we are the common thread within and across societies that play an integral part in the resettlement and cultural adaptation process with respect to immigrant women and their families. therefore, social workers have to move to the front line of this struggle to ensure that the voices of immigrant women are heard and become the common bond across regions to create one voice for the rights of immigrant women as a part of their citizenship in a civic society. furthermore, our professional commitment to integration (with inclusion and participation in all spheres of various social activities), rather than a focus on assimilation, from new settlers and the host population is a critical component to the successful outcome of the resettlement process (nash et al., 2006). advances in social work, fall 2012, 13(2) 300 while arguing that social work practice with refugees and immigrants requires specialized knowledge of the significantly unique issues of these populations, potockytripodi (2002) provides a very comprehensive account of best practice that are essential to this new and challenging field. in fact, she has systematically explored the many factors that practitioners need to recognize as important in the lives of this client group while using an analysis that reflects the micro, meso and macro levels of service (nash et al., 2006; potocky-tripodi, 2002). according to potocky-tripodi (2002), a good practitioner should be informed about human rights and social justice issues, as well as international and local law surrounding immigrants and refugees’ service delivery systems available to their clients. they should also look at key problem areas such as health, mental health, family dynamics, cultural diversity, language, education and economic circumstances and must be culturally competent to understand these aspects from a gendered perspective. following the same perspective, powell (2001) has proposed 10 core practice principles that inform civic social work as a new form of practice. the most prominent among these principles are social inclusion, trust and respect for clients and for their views on what works for them in order to promote users’ participation and empowerment that is missing at various levels in our current practice with immigrants and refugees. potocky-tripodi (2002) and powell’s (2001) work challenges social workers to broaden their perspectives while acknowledging the centrality of citizenship and inclusion as a part of their professional commitment to immigrant and refugee populations. this approach also acknowledges the importance and impact of working with this population from a gendered perspective that highlights the new knowledge structure for understanding the diversity of women in this population. furthermore, it provides the profession with a foundation for creating a curriculum that is inclusive of these issues to ensure that we have trained workers able to address the many challenges that the population faces. these include challenges that impede upon women’s ability to successfully resettle in their new civil society and become its active participants. this approach gives social work students and practitioners an opportunity to further understand the impact of the policy beyond dominant societal groups. furthermore, this perspective can be viewed at the micro and macro level as an important component for ensuring that these women become a part of the helping system structure within the agency and community setting. for this fact, the call for social workers to understand and specialize as migration professionals is long overdue. the time to commit, strategize, and implement this perspective is “now.” as social workers, we can change the impact of globalization and immigration on women. in turn, this will change the immigration process for the entire family. conclusion this article has reviewed some of the existing body of knowledge on gendered immigration and its theoretical development. based on transnational feminism, three attributes of immigrant women are depicted to gain a better understanding of immigrant women and their contexts. the article finds that in general, research has rethought, reconstructed, and reexamined gendered inequality and equality, and made immigrant women’s voices heard, and their image seen. from a transnational perspective, focus has agbényiga, huang /gendered immigration 301 been placed on the institutions and identities that immigrant women create through their simultaneous engagement in two or more countries adding to their voiced experiences (mazzucato, 2006). on the other hand, there are a number of biases in gendered immigration research. diversity and strengths perspective are key values for genderspecific immigration practice, policy, research, and education. this article suggests that a subcategory of gendered immigration should be included in social work education to create a better understanding of working with this population from a social integration perspective that allows them to fully become a part of their new society. as a profession, participation in future research on gendered immigration and the inclusion of gendered immigration in social work curriculum are two important and necessary next steps for the profession of social work. the aforementioned will give social workers an opportunity to better understand and engage in the diverse dimensions that immigrant women encounter as they engage in their new surroundings. furthermore, increased participation in research and practice with immigrant women will increase our professional status in the international gender-specific immigration human services domain that is rapidly increasing globally. references ager, a., ager, w., & long, l. 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(unpublished doctoral dissertation). university of melbourne, victoria, australia. author note: address correspondence to: debrenna lafa agbényiga, ph.d., school of social work, michigan state university, 254 baker hall, east lansing, mi. email: agbenyi1@msu.edu _______ jesse capece, phd., licsw, assistant professor, school of social work, rhode island college, providence, ri. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 578-595, doi: 10.18060/23895 this work is licensed under a creative commons attribution 4.0 international license. the effects of probation stipulations on perceptions of employability among people on probation in rhode island jesse capece abstract: roughly one-third of the people under the purview of the rhode island department of corrections are on active probation. people on probation are typically mandated to a variety of stipulations, such as meetings with their probation officer, court appointments, drug and/or mental health counseling, and crime-specific stipulations, such as anger management groups. evidence suggesting that mandating these stipulations reduces a person’s likelihood to be rearrested is minimal. in contrast, there is a wealth of evidence suggesting that stable employment decreases recidivism. a person’s perceptions of their employability have been demonstrated as a key component to both pursuing and maintaining employment opportunities. drawing on labeling theory, this study surveyed 170 persons on active probation to explore the correlation between probation stipulations and employability perceptions. results suggest there is a negative association between stipulations and perceptions of employability. social work practitioners working with people on probation or people who are incarcerated should work to increase their clients’ perceptions of employability. keywords: prisoner reentry, probation, ex-offenders, employability the vast majority (97%) of our nation’s two million incarcerated people have sentences that end in a release from prison (bureau of justice statistics, 2020). the majority of people who have been in prison will be mandated to some form of community supervision, such as probation, once released. these individuals will join an estimated five million americans already on probation or parole (bureau of justice statistics, 2020). community supervision is used, to some capacity, throughout the nation. some states rely on it more heavily than others. rhode island has the second highest rate in the nation of people under community supervision, with nearly 2,800 out of every 100,000 people being on either probation or parole (bureau of justice statistics, 2020). the rhode island department of corrections (ridoc) population report indicates that there were 26,039 people in the custody of the ridoc at the end of fiscal year 2017 (ridoc, 2017). only 2,958 (11.4%) of these 26,039 were incarcerated. the remaining 23,081 live in the community and are under the supervision of the ridoc, with the vast majority (96.9%) being on probation. rhode islanders on probation can be classified into three levels of supervision: active, low, or unsupervised. active supervision requires the most contact with the probation officer, while unsupervised requires the least. roughly 8,400 rhode islanders on probation are on active supervision, which carries the most requirements, including regular visits to the probation office, mandated drug treatment, or mandated mental health counseling. people on probation who demonstrate to the ridoc that they no longer need active supervision can transition to low or unsupervised status. as a result of some infraction or https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2020, 20(3) 579 added criminal sentence, people on probation can be transitioned back to active supervision. rhode island is pushing to rapidly exit people from the prison’s physical facilities, opting to put them under community supervision (beale, 2011; ridoc, 2015). people who were once in prison in rhode island must adhere to a variety of probation stipulations. prevailing evidence suggests that employment reduces recidivism (delgado, 2012; laub & sampson, 2003; petersilia, 2009). research on the impact of positive feelings of employability are limited and dated, though results suggest that they are positively correlated with employment outcomes (artess et al., 2016; daniels et al., 1998; green, 2011; herr et al., 2004). patterson (2013) suggests that reentry issues are not simply a matter of importance to people who have been in prison and their families, but to the entire community. indeed, successfully transitioning people back to the community after time in prison is essential to obtaining and sustaining the health and security of all members of a community (patterson, 2013). despite the importance of employment to reentry success (delgado, 2012; laub & sampson, 2003; petersilia, 2009), there is a lack of research on the impact of mandated probation on perceptions of employability. the goal of this study was to answer the question: how do probation stipulations impact self-perceptions of employability amongst people who have been in prison? this study hypothesized that people on probation with fewer stipulations will have more favorable perceptions of employability than people on probation with more stipulations. a secondary aim of this study was to contribute to the store of knowledge from which social workers working with people involved in the prison and policing systems might draw. people who have been in prison are disproportionately composed of people of color and people living in poverty (sentencing project, 2018). therefore, many probationers are not only historically oppressed, but are also current targets of systematic forms of oppression. social workers are professionally obligated to work with, advocate for, and conduct research on behalf of such populations and disseminate findings in order to inform policy (national association of social workers, 2017, preamble, ethical standard 6.04b). theoretical framework labeling theory is used to explain how an individual’s identity and behavior are influenced by the terms society uses to describe and understand them. when a community assumes that a group behaves in a deviant manner, such assumptions contribute to group members internalizing the label and developing a negative self-concept (lemert, 1951, 1967). the foundation of labeling theory was laid by george herbert mead (1934), who suggested that behaviors are driven by individual beliefs about self, and those beliefs about self are a reflection of other’s beliefs about them. lemert (1951, 1967) posits that deviant acts are social acts and, when repeatedly labeled as deviant in the eyes of society, people internalize the role of a deviant and it becomes a component of their identity. lemert further points out that everyone commits deviant acts, but not everyone is labeled as deviant. however, once a person is labeled as deviant and the characteristics of a deviant become part of that person’s identity, they then may use the label of deviant as a defense mechanism and as a justification for action. becker (1963) describes this as an alteration of selfcapece/effects of probation stipulations 580 concept, where the labels that larger society gives a person disrupt their self-image. it is possible that mandating people to attend events such as probation meetings, court appearances, and mandatory drug treatment among other stipulations, are all acting as reminders to people on probation of the deviant label they carry. kaopua et al. (2012) concluded that it is extremely difficult for a person to shake the stigma associated with the label of ex-convict. this researcher posits that the continuous reminder of one’s deviant label (by ongoing stipulations) negatively impacts their perceptions of employability. employment and recidivism significant hardship is associated with unemployment, both for individuals (schmitz, 2011) and communities (kuhn et al., 2009). unemployment among people who have been in prison is accompanied by the additional risk of an increased chance of recidivating. the leading reason that people do not return to prison is that they age (laub & sampson, 2001). when controlling for age, however, evidence suggests that employment is the largest contributor to a reduction in recidivism (laub & sampson, 2003). efforts to transition people from prison back to the community must be focused on employment issues if we wish to promote health and stability for individuals and communities (solomon et al., 2004). petersilia (2009) and delgado (2012), leading scholars in reentry efforts, echo these sentiments. both point to employment as the most important factor for successfully transitioning people from prison to communities. employment has been shown to bring significant benefits to individuals, in particular individuals belonging to historically difficult-to-employ populations, such as people who are homeless and people with cooccurring disorders (sun, 2012). release stipulations and employment outcomes the majority of the rhode islanders on probation have at least one mandated condition related to their release. mandated stipulations may include court appearances to pay various debts, such as restitution, child support, and/or arrearages, meetings with probation officers, treatment for substance use or mental health struggles, and/or participation in specialized programming like domestic violence or anger management classes. people on probation who do not adhere to these conditions could be sent back to prison. unfortunately, there is no data that demonstrates the frequency or number of people returned to prison because of missing a mandated appointment. worth noting, however, is that of the 12,933 commitments to the ridoc in fiscal year 2019, 26% (3,362) were for probation violations (ridoc, 2019). it is reasonable to assume that some of these violations are because of a failure to adhere to the mandated stipulations. previous research has suggested that a positive relationship exists between the intensity of probation and employment (petersilia & turner, 1991). researchers studied people on probation who were receiving intense and non-intense supervision. results suggest that people receiving more intense supervision were only slightly more likely to have a job than those with less intense stipulations. a limitation of the petersilia and turner (1991) study includes employment being defined as anything the study participants were employed to do during an entire year, which does not take into account critical details of a job, such as wages, hours worked per week, or length of time on the job. finally, this research, having advances in social work, fall 2020, 20(3) 581 been conducted nearly thirty years ago, does not account for various significant shifts in the employment market and probation population. more recent studies, however, suggest that there is a negative correlation between intensity of probation and employment outcomes. capece (2020) posits that the more probation appointments a person is mandated to attend, the worse their employment outcomes will be. employability race, gender, education level, and a variety of other factors can influence the likelihood of a person getting a job. those variables, along with some others that play a significant role in the lives of people on probation, are potential moderating variables in this study. these variables, which influence a person’s employability, are different than individual’s perceptions of their employability. there is some evidence of the role perceptions of employability play for people who have not been in prison (qenani et al., 2014). variables that influence a person’s employability include: race, gender, type of criminal conviction, support from family and friends, access to transportation, mental health, substance abuse, and education. race just as race-based implicit bias impacts a person’s experience in the criminal justice system, it also impacts their experiences in the labor market. various studies have highlighted the racial disparities that exist when it comes to employment outcomes (bertrand & mullainathan, 2004; pager & shepherd, 2008; tomaskovic-devey et al., 2005). an analysis of population data by pager and shepherd (2008) reveals that people of african-descent are twice as likely to be unemployed than people of european-descent. one reason for this disparity in unemployment is the discrimination that people of africandescent face when applying for jobs. bertrand and mullainathan (2004) posit that simply having a name that suggests to an employer that you are of african descent is enough to have your application for employment rejected. they arrived at this conclusion after sending identical resumes to employers with the only difference being the name of the applicant. results suggest that applicants named emily and greg were more likely to be hired than applicants named jamal and lakisha. similar discrimination was highlighted by tomaskovic-devey et al. (2005), who concluded that men of african-descent spend more time trying to obtain employment, yet ultimately gain less work experience and less work stability. additionally, once employed, wages of both african-descent and latinx-descent people are less than people of european-descent (pager & shepherd, 2008). gender a 2015 report from the bureau of labor statistics indicates that women earn an average of 82% of the median wages that men earn per week. earlier reports from the bureau of labor statistics (2020) suggest similar gender differences, with women regaining employment at a slower pace than men after the 2008 recession despite having attained higher levels of education. given these realities, it is essential to collect information about participants’ gender in this study of employment outcomes. capece/effects of probation stipulations 582 type of criminal conviction the nature of a person’s criminal conviction has shown to have an influence on the employment of people on probation. research suggests that people convicted of a drug offense or a traffic offense are more likely to be hired than those convicted of a violent crime (atkin & armstrong, 2011; giguere & dundes, 2002). research by holzer et al. (2003) reveals the intensity of the aversion that employers have to hiring people on probation who have a violent charge. results of their study show that 90% of employers disclosed that they would not hire someone convicted of a violent offense. additional aversion to hiring people convicted of sexual offenses is also documented (albright & denq, 1996). no specific research suggests that there is a causal relationship between having a specific crime(s) on one’s criminal record and self-perceptions of employability. nevertheless, it is likely that people with criminal records that carry additional social stigma, such as child molestation or murder, may have lower perceptions of employability than people with less stigmatizing criminal histories. support from friends, family and romantic partners the role of family members and their support are critical to psychological well-being (huffman et al., 2015). the support of family and friends also helps to enhance the selfesteem of those who are unemployed (maddy et al., 2015). social networks are critical to obtaining a job, as a person’s likelihood of doing so is greatly improved if they have a personal friend who works at that job (sterling, 2014). access to transportation access to transportation, particularly public transportation, impacts a person’s ability to find and maintain employment (fletcher et al., 2002, 2010). barriers to reliable transportation exist across a variety of settings, as both urban and rural residents struggle to get to work (angel & blei, 2016; fletcher et al., 2010). additional studies highlight the importance of having access to reliable transportation specifically among people involved in community supervision (bohmert & demaris, 2018). mental health and substance abuse a disproportionate number of people in prison or on probation have a mental illness compared to the overall us population (james & glaze, 2006; skeem & louden, 2006; steadman et al., 2009). according to a comprehensive assessment, 64% of people in local jails, 56% of people in state prisons, and 45% of people in federal prisons have symptoms of serious mental illness (james & glaze, 2006). additionally, nearly 50% of people in us prisons have a substance use disorder (chandler et al., 2009; mumola & karberg, 2006; peters et al., 1998). studies have demonstrated that the presence of mental illness, substance abuse, or both, is a barrier to obtaining and maintaining employment (atkinson et al., 2001; harris et al., 2014; pilkinton, 2010; poremski et al., 2014; stromwell, 2001). advances in social work, fall 2020, 20(3) 583 education level of education has long been a predictor of employment outcomes in the united states. data collected by the bureau of labor statistics (2018) highlight the differences in pay for various educational levels. median wages earned per week increased, regardless of gender or racial identity, at every education level ranging from less than a high school diploma to an advanced degree. individuals with advanced degrees, the highest level of education recorded, earned 300% more per week than those with less than a high school education, the lowest level of education recorded. this same report reinforces previously mentioned mediating variables of race and gender. within each category of education, women consistently earn less per week than men and african-descent people consistently earn less than latinx-descent people, who earn consistently less than european-descent people. additional demographics in their longitudinal study of people on probation, visher et al. (2008) posed a variety of questions related to potential mediating demographics. these items helped them to gather information on physical health, length of time since release from prison, and city/town of residence. demographic items about these issues were included in this research as control variables. perceptions of employability largely ignored by researchers is the possible connection between the perceptions of employability of people who have been in prison and their stipulations of release. this is unfortunate, as many researchers suggest that feeling employable plays a major role for people who have not been in prison when it comes to securing employment. green (2011) used nationally representative panel data from australia’s general population to show that an increased feeling of employability decreases roughly 75% of the negative effects of unemployment. green suggests that feeling employable combats the “misery multiplier” (p. 265) that magnifies struggles faced during periods of unemployment. herr et al. (2004) suggest that perceptions of one’s employability are heavily influenced by having a job in the first place, while artess et al. (2016) suggest that feeling employable is a catalyst for getting a job. though the direction of the causal relationship is ambiguous, it seems that quality of employment and perceptions of employability are linked. in testing the validity and reliability of a perceived employability scale, daniels et al. (1998) showed that an individual’s perception of their employment prospects impacts their ability to find and maintain a job. their perceptions are positively correlated with actual employment outcomes. similar suggestions are supported by qenani et al. (2014), who suggest that self-perceptions of one’s employability impact expectations of employment. though the sample for this study included undergraduate psychology students, their study does support the claims that perceived employability impacts employment expectations and that formal institutions, such as schools, can foster and boost feelings of employability. most of these studies have investigated the perception of employability on general or student populations; this has not yet been investigated for the formally incarcerated capece/effects of probation stipulations 584 population. additionally, these studies seem to measure the personal construction of perceptions of employability without also measuring how the environment contributes to those personal constructions. it is possible that environmental factors and experiences in the community have a significant influence on a person’s perceptions of employability. such factors were included as moderating and mediating variables in the present study. methods the goal of this study was to explore the association between release stipulations and perceptions of employability among persons on probation. given the myriad of potential mediating factors that exist in the relationship between probation stipulations and perceptions of employability, a larger sample is needed to establish an association. a crosssectional design was used to collect survey data during the spring and summer of 2017. participants were recruited in probation office waiting rooms and probation forums. probation forums are gatherings of many people on probation at one time. the forums are held at various locations throughout rhode island. the ridoc granted access to the probation office waiting rooms and forums for people on probation. potential participants were asked if they were willing to complete a survey about being on probation and their experiences with getting and keeping a job. the survey was conducted as part of a larger study measuring various employment outcomes. participants were asked to not put their name or any identifying information on the surveys. participants were given envelopes that contained the survey, an information sheet describing the study, a pen, and a $5 dunkin donuts gift card which was compensation for participants’ time. respondents were asked to put the completed surveys back into the envelopes and drop those envelopes into an opaque box near the exit of the room. participants were told that they did not need to answer any questions they did not want to and that they could keep the gift card even if they did not complete the survey. participants were in no way mandated or required to engage in the study. the study was approved by the university’s irb and the ridoc’s medical review advisory board. sample people on active supervision in rhode island represent the total population for this study (roughly 8,400), which was part of a larger dissertation project. this population includes many of the most recently released persons with the highest likelihood of returning to prison (ridoc, 2015). this population is an estimate, as the precise number continuously changes. a power analysis was conducted to calculate an adequate sample size for this study. power analysis is the ability to find a statistically significant difference when the null hypothesis is in fact false, or the ability to find a difference when a real difference exists (tabachnick & fidell, 2007). to ensure an adequate sample size based on the most complex questions on the survey, a sample of at least 170 participants was needed. this number was calculated using tabachnick and fidell’s (2007) formula of n ≥ 50 + 8m: where m is the maximum number of independent variables, which, for purposes of this study, was 15. therefore, 170 ≥ 50 + (8*15). advances in social work, fall 2020, 20(3) 585 instruments data were collected via a survey which employed multiple choice, fill-in-the-blank, and likert-scale questions. participants identified how many times per month they must attend different stipulations. perceptions of employability were measured by the 13-item self-perceived employability scale. the 13 items came from five previous studies that examined perceived employability (daniels et al., 1998; de cuyper et al., 2011; graffam et al., 2008; janssens et al., 2003; rothwell & arnold, 2007). participants answered these items by using a four-point likert-scale ranging from strongly agree to strongly disagree. the validity and reliability of the scale had not been assessed previously. the cronbach’s alpha of the scale when used in the study was .858, suggesting excellent internal consistency. extraneous variables extraneous variables were measured in a variety of ways. portions of the addiction severity index (asi) were used to measure current drug use and mental health struggles, both potential control variables (mclellan et al., 1992). moderating variables such as racial identity, type of criminal conviction, access to transportation and many others, were measured in the demographic section. results demographics and significant control variables table 1 summarizes the gender, race, and age of survey participants. as a result of missing data, some totals differ. table 1. demographic and control variables with a significant influence variables n (%) gender (n=168) male 144 (85.7%) female 21 (12.5%) transgender 3 (1.8%) race (n=168) white non-hispanic 62 (36.9%) black/african american 60 (35.7%) latino/hispanic american 38 (22.6%) other 8 (4.8%) age* (years, n=149) < = 32 54 (36.2%) 33-45 49 (32.9%) 46+ 46 (30.9%) * m=38.7, sd= 11.5, mdn=37, range=19-74 it is worth noting that the percentages of male and female study participants is nearly identical to the percentages of males and females currently committed to the ridoc (the capece/effects of probation stipulations 586 annual population report of the ridoc does not indicate the number of transgender people in their prisons): 84.4% and 15.6% respectively (ridoc, 2017). the most common racial identity of participants was white, non-hispanic (36.9%). the racial profile of the study sample, however, is substantially different than people imprisoned at the ridoc. racial identities of people currently imprisoned in rhode island is 51.7% white, 23.4% black, and 20.8% hispanic (ridoc, 2017). compared to the general us population, people of color are over-represented in the study sample. this reinforces existing data that suggests massive racial disparities in the prison and policing systems (sentencing project, 2018). independent variables table 2 summarizes the frequency that participants are mandated to attend specific probation stipulations. this table has been provided to give a sense of the frequency of appointments as well as the variety of stipulations to which they are mandated. appointments with probation officers was the most common stipulation to which participants must attend at least once per month (95.2% of participants must go to probation at least once per month). the average number of probation appointments per month was 1.4 (sd= .86). court appearances were the second most common stipulation to which participants must attend at least once per month (56.9% of participants must go to court at least once per month). the average number of court appearances per month was 1.6 (sd= .94). table 2. stipulations per month (n=168) stipulation attended at least once/month n (%) median mean (sd) probation 159 (95.2%) 1 1.4 (0.86) court 94 (56.9%) 1 1.6 (0.94) therapy/counseling 73 (43.2%) 2 2 (1.22) outpatient drug/alcohol treatment 48 (30%) 3 3 (1.66) alcoholics/narcotics anonymous 42 (24.9%) 3 3 (1.49) sex offender treatment 25 (15%) 3 2.9 (1.50) domestic violence classes 16 (9.5%) 3 3 (1.32) anger management classes 11 (6.8%) 2 2 (1.27) driver’s training 6 (3.5%) 2 2 (1.37) other 11 (7.9%) 1 1.7 (1.01) dependent variables table 3 summarizes the participants’ perceptions of employability. each of the 13 items in the employability scale (questions 1-12 and 15 in part 3 of the survey) were scored as follows: strongly disagree = 1; disagree = 2; agree = 3; and strongly agree = 4. the sum of the scores for these 13 items represents a participant’s overall perception of employability. roughly one-third perceived their employability in each category—weak, moderate, or strong, suggesting high variability. advances in social work, fall 2020, 20(3) 587 table 3. perceptions of employability (n=166) perceived employability* n (%) weak (33 or less) 61 (36.7%) moderate (34-40) 50 (30.1%) strong (41+) 55 (33.1%) * mdn=36, m=35.61, sd=8.55, range=10-52 table 4 presents the results of a pearson’s correlation between the dependent variable (perceptions of employability), the independent variable (mandated stipulations), and various control variables (variables 3 through 11). as expected, there was a negative correlation between the total number of stipulations a person on probation must attend each month and their perceptions of employability. although this association is statistically significant, the total variance in perceptions of employability that is explained by total stipulation was minimal. association of number of stipulations and perceptions of employability a standard multiple regression analysis, presented in table 5, was used to test if total stipulations per month predict participants’ perceptions of employability when controlling for age, use of public transportation as a primary form of transportation, a middle school education (dummy coded), and being homeless (dummy coded). these variables were included in the model as they were significantly correlated with perceptions of employability. the hypothesis, drawing from labeling theory, was that people on probation with fewer stipulations will perceive themselves as more employable than those with more stipulations. results of the regression analysis seem to suggest that there is a negative association between total mandated stipulations per month and perceptions of employability when controlling for other factors significantly correlated with perceptions of employability. while there was a statistically significant effect, the results are not substantive, as the total variance in perceptions of employability that was explained was minimal (11.9%). discussion results of this study suggest a negative correlation between number of stipulations and perceptions of employability among probationers. though significant, the associations are not substantive, given the minimal to moderate effect sizes. nevertheless, results have implications for both case and group work in settings with people who have been in prison as well as with policy advocates and researchers engaged in reform of prison and policing systems. as daniels et al. (1998) suggest, an individual’s perception of their employment prospects is positively correlated with their ability to not just find a job but maintain one as well. the correlation in the daniels et al. (1998) study between having a job and positive perceptions of employability supports such a conclusion. the strong cronbach’s alpha of the scale used in this employability scale (.858) further supports the reliability of the items used in the scale. results suggest that the questions originally used by daniels et al. (1998), de cuyper et al. (2011), graffam et al. (2008), janssens et al. (2003), and rothwell and arnold (2007) may work well in concert with one another. capece/effects of probation stipulations 588 table 4. perceived employability, independent and significant control variables table 5. multiple regression analysis predictors of perceptions of employability predictor b std. er. β total stipulations per month -.446 .152 -.329* age -.145 .079 -.204 public transportation .415 1.844 .026 education is middle school (dummy var.) 1.112 4.330 .028 homeless (dummy var.) -2.823 2.497 -.130 r2= .175 adjusted r2= .119 r= .419 *p < .01 variable m (sd) 1 2 3 4 5 6 7 8 9 10 11 1. perceptions (n=166) 35.6 (8.55) 1 -.155* .371** .121 .001 -.204* -.328** -.231** -.172* -.176* -.182* 2. total stipulations (n=170) 7.7 (5.24) 1 -.040 -.186* .284** .296** -.078 .090 .240** .145 -.051 3. friend/partner support (n=162) 5 (1.92) 1 .096 .015 -.062 -.170* -.002 -.197* -.037 .013 4. owns a car (n=170) - 1 -.198* -.281** -.110 -.172* -.661** -.327** -.096 5. drug use (recent) (n=167) 5 (7.45) 1 .377** -.096 .252** .177* .084 .124 6. mh disruption (recent) (n=160) 6 (5.5) 1 .072 .094 .264** .137 .109 7. age (n=149) 38.7 (11.52) 1 .087 .136 .006 .241** 8. drug conviction (n=158) - 1 .160* .223** .090 9. public transportation (n=170) - 1 .352** -.005 10. homeless (n=170) - 1 -.018 11. middle school educ. (n=170) - 1 * correlation is significant at the .05 level (one-tailed) **correlation is significant at the .01 level (one-tailed) advances in social work, fall 2020, 20(3) 589 a limitation of this study is the subjective nature of self-perceptions of employability. though the scale used in this study has a high cronbach’s alpha (.858), suggesting strong internal consistency, self-perceptions of employability likely encompass many other personal feelings and experiences. future researchers in this area may wish to use a qualitative research design. with a qualitative approach, researchers could explore, possibly in focus groups, the effects of probation stipulations on feelings of employability. a qualitative study that is longitudinal may produce an even greater understanding of the relationship among the main variables in this study and expose significant control variables not measured by a quantitative approach. an additional limitation of this study is its inability to specify the origin of the labeling people on probation may experience. this research is unable to specify whether internalized negative self-concepts are coming from the label of being a person with a criminal record, a person with a substance use problem, or a person with a mental illness, all of which lemert (1951) suggests carry negative labels. it is possible that participants with low perceptions of employability have such perceptions not because of the probation appointments to which they are mandated, but because of a substance use issue, a mental health issue, or another issue entirely. future researchers may wish to include items that measure the type and origin of negative labels that participants may have. implications for social work practice a variety of potential policy recommendations exist related to mandated stipulations. for example, a potential change to the stipulation of probation may be to allow people on probation to connect with their probation officers via internet-based video communication applications such as zoom, facetime, skype, or whatsapp. such measures have been used during the covid-19 pandemic, though it is unclear if these measures will continue postpandemic. permanently allowing such options could reduce the amount of time employed people on probation would need to take off of work and provide unemployed people on probation with more time to pursue and obtain a job. another recommendation would be to expand the hours that probation offices are open, allowing those people on probation who are employed or have job interviews to attend probation meetings at times that do not conflict with their pursuit and maintenance of employment. policy recommendations outside of the stipulation of probation might involve allowing people on probation opportunities to pay court fees online, as opposed to be required to physically appear in court. additional changes to the stipulation of probation might involve allowances to people on probation with no means of paying court costs the opportunity to not have to go to court to begin with. given the importance of positive perceptions of employability, practitioners may want to organize support groups for people who have been in prison and have a heavy set of stipulations to which they must adhere. worral et al. (2018) have highlighted the consistent pattern of effectiveness of support groups. in a support group setting, people on probation may find strength in the knowledge that others are experiencing the same barriers. additionally, people on probation in group settings may be able to share tips and techniques for how to successfully navigate the pursuit and maintenance of employment whilst having many mandated appointments. capece/effects of probation stipulations 590 conclusion highlighting clients’ strengths and abilities to positively contribute to the community is a task social workers engage in regardless of their area of practice. results of this study suggest that enhancing a client’s positive view of themselves may be of particular importance when working with people who have been incarcerated. if, as labeling theory suggests, people with criminal records have internalized the negative views the community has of them, then social work practitioners must work to counter such narratives. countering such narratives might extend beyond the person on probation themselves and extend to counteracting the narrative that exists in the community as well. if, for example, social workers were to engage with the business community, they may be able to mitigate negative stereotypes and facilitate employment opportunities for people who have been incarcerated. social workers working with people in the prison and policing systems should consider themselves on the frontline of combating the deep-rooted and historical negativity that is cast towards people with a criminal record. references albright, s., & denq, f. 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(2018). the effectiveness of support groups: a literature review. mental health and social inclusion, 22 (2), 85-93. https://doi.org/10.1108/mhsi-12-2017-0055 author note: address correspondence to jesse capece, phd., licsw, department of social work, rhode island college, 600 mount pleasant ave. providence, ri 02908. email: jcapece@ric.edu https://doi.org/10.1086/431779 https://www.urban.org/sites/default/files/publication/32106/411778-employment-after-prison-a-longitudinal-study-of-releasees-in-three-states.pdf https://www.urban.org/sites/default/files/publication/32106/411778-employment-after-prison-a-longitudinal-study-of-releasees-in-three-states.pdf https://www.emerald.com/insight/search?q=hugh%20worrall https://www.emerald.com/insight/search?q=richard%20schweizer https://www.emerald.com/insight/search?q=ellen%20marks https://www.emerald.com/insight/search?q=lin%20yuan https://www.emerald.com/insight/search?q=chris%20lloyd https://www.emerald.com/insight/search?q=rob%20ramjan https://www.emerald.com/insight/publication/issn/2042-8308 https://www.emerald.com/insight/publication/issn/2042-8308 https://doi.org/10.1108/mhsi-12-2017-0055 mailto:jcapece@ric.edu perceptions of employability largely ignored by researchers is the possible connection between the perceptions of employability of people who have been in prison and their stipulations of release. this is unfortunate, as many researchers suggest that feeling employable plays a ma... extraneous variables demographics and significant control variables table 1 summarizes the gender, race, and age of survey participants. as a result of missing data, some totals differ. independent variables table 2 summarizes the frequency that participants are mandated to attend specific probation stipulations. this table has been provided to give a sense of the frequency of appointments as well as the variety of stipulations to which they are mandated.... dependent variables table 3 summarizes the participants’ perceptions of employability. each of the 13 items in the employability scale (questions 1-12 and 15 in part 3 of the survey) were scored as follows: strongly disagree = 1; disagree = 2; agree = 3; and strongly agr... this work is licensed under a creative commons attribution 4.0 international license. identifying trauma-related and mental health needs: the implementation of screening in california’s child welfare systems brent r. crandal andrea l. hazen jennifer rolls reutz abstract: a central aspect of trauma-informed care in child welfare (cw) systems is the use of a trauma-informed screening process. this includes the use of a broadly administered measurement approach to assist professionals in identifying current traumarelated symptomology or a history of potentially traumatizing events. with a high prevalence of unmet mental health needs among cw-involved children, screening can be a crucial step as systems strive to identify children impacted by trauma. this paper offers a summary of cw screening approaches in county-administered cw systems across california. through a web-administered survey, 46 county administrators reported on their screening practices and perceptions. information about ages of children screened and screening tools used, perceptions of screening implementation priorities, degree of implementation and satisfaction with screening processes is provided. several implementation considerations for future trauma-informed care efforts are offered including maintaining a focus on childhood trauma, closing the science-practice gap, and evaluating the state of the science. keywords: childhood trauma; trauma-informed care; screening; implementation; child welfare with ongoing policy, research, and implementation efforts, screening has become a central and active aspect of trauma-informed care (tic; hanson & lang, 2016). a number of national organizations have encouraged the use of broadly administered measurement approaches to assist practitioners in identifying current trauma-related symptomology or potentially traumatic events in a child’s history, including the u.s. department of health and human services (dhhs), substance abuse and mental health services administration (samhsa; dhhs, samhsa, 2011); the national child traumatic stress network (nctsn; 2007); the attorney general’s national task force on children exposed to violence (2012); and the dhhs, administration for children and families (acf), administration on children, youth and families, children’s bureau (dhhs, acf, 2011). by and large, these organizations have emphasized the role of screening and identification as part of tic in child welfare (cw) systems. the role of cw systems includes promoting safety when children are at risk for maltreatment and enhancing wellbeing in instances where child maltreatment has occurred, making these systems particularly well-positioned to identify children who have been adversely impacted by maltreatment. given the advancing research on the lasting impact of adverse childhood ______________________ brent r. crandal, phd, co-director of the california screening, assessment, and treatment initiative, chadwick center for children and families, rady children’s hospital, san diego, california; andrea l. hazen, phd, research scientist at the child and adolescent services research center and the chadwick center for children and families, rady children’s hospital, san diego, california; jennifer rolls reutz, mph, co-director of the california evidence-based clearinghouse for child welfare, chadwick center for children and families, rady children’s hospital, san diego, california copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 335-348, doi: 10.18060/21278 https://creativecommons.org/licenses/by/4.0/ crandal et al./identifying need and tic 336 experiences across the lifespan (e.g., obesity, depression, heart disease, smoking, alcoholism; felitti et al., 1998; larkin, felitti, & anda, 2014), linking cw’s trauma screening efforts with a thorough mental health (mh) assessment and trauma-focused interventions could contribute to meaningful public health benefits. as ko and colleagues (2008) point out, “for the child welfare system to become increasingly trauma-informed, effective trauma screening and assessment protocols are needed at every level” (ko et al.; p. 398). in the u.s. general population, 61.8% of adolescents have been found to experience one or more potentially traumatic events (pte), such as interpersonal violence, accidents, injuries, or witnessing others experience a pte, with 32.7% experiencing 2 or more ptes (mclaughlin et al., 2013). almost all children who become involved in cw have been impacted by maltreatment, a specific subset of pte (dhhs, 2016) and 61.8% of the children and youth involved in current investigations are estimated to have previous reports of maltreatment (horwitz et al., 2012), indicating that the maltreatment has persisted over a period of time. although experiencing pte is fairly common in childhood, it is more common and more persistent for cw-involved children and youth, and children who experienced multiple ptes are more likely to develop posttraumatic stress disorder (ptsd; mclaughlin et al., 2013). cw systems are also well-positioned to identify children impacted by other forms of mh impairment. almost one-quarter of adolescents (22.2%) in the general population have experienced a significant mh need during their lives (merikangas et al., 2010). in contrast, approximately half (47.9%) of a nationally representative sample of children and youth investigated by cw services for child maltreatment were identified as having a significant mh need (e.g., emotional and behavioral problems; burns et al., 2004), indicating a high rate of mh need among cw-involved children and youth. moreover, the second wave of the national survey of child and adolescence wellbeing uncovered a stark underutilization of mh services among children and youth with significant mh need involved in cw services, with only one-third (33.3%) of these youth receiving mh services (horwitz et al., 2012). a disproportionate underutilization of mh services has been well-established among children and youth of color with significant mh need who are involved in cw compared to their white counterparts (garland et al., 2000; garland, landsverk, & lau, 2003; horwitz et al., 2012; kim & garcia, 2016). while underutilization of mh services is problematic in the general population (merikangas et al., 2010), cw-involved children and youth, who are already connected to social services providers and might presumably have greater access to other mh services, are still much more likely to have unmet mh needs. this is particularly true for cw-involved children and youth of color. with longstanding leadership from organizations like samhsa, nctsn, and acf, these findings have contributed to ongoing policy changes at federal, state, and local levels, resulting in widespread screening implementation efforts in cw systems across the nation. in california, similar to many other states, class action litigation has been spurred by advocacy groups on behalf of former cw-involved youth whose mh needs were unmet while involved in cw services (kosanovich, joseph, & hasbargen, 2005). the katie a. et advances in social work, spring 2017, 18(1) 337 al. v. diana bonta et al. class action settlement agreement (case no. cv-02-05662 ahm [shx]) [now referred to as pathways to mental health services (california department of social services [dss] & california department of health care services, n.d.)] established the requirement for each of california’s 58 county systems to implement screening procedures for identifying children and youth involved in cw with significant mh needs to help increase their access to mh assessment and treatment. technical assistance and implementation materials, including monthly phone calls, a practice manual, and a review of screening tools (crandal & conradi, 2013), have been provided by the state through pathways to mental health services. state leaders have facilitated opportunities to support california’s county leaders with the development of procedures to identify children and youth involved in cw whose well-being has been disrupted, particularly as a result of maltreatment, and ensure referral to assessment and treatment (see california department of health services, 2017; california department of social services, 2017 for more information). despite this new energy behind screening among children and youth involved with cw, there has also been considerable autonomy and some ambiguity for cw administrators and staff to implement the actual screening programs for the children and youth they serve, both in california and across the country. acf has provided funding to technical assistance teams in multiple states across three cohorts to support state screening efforts by way of five-year grants (dhhs, acf, 2011). however, in many cw systems, the mandates for screening led administrators to rapidly implement a screening process without piloting, technical assistance collaboration, or detailed planning. questions remain regarding the constructs targeted by screening practices, the screening tools utilized, the ways tools are utilized, the ways screening practices are tied to intervention, how key decision points are prioritized, and how decision makers perceive their implementation efforts. to date, there has been no systematic evaluation of how screening efforts have been implemented by cw leaders and staff. the california screening implementation under pathways to mental health services presents an opportunity to investigate how cw systems have responded to screening mandates and to offer new frameworks for other cw systems moving to implement similar screening processes. the current study provides an investigation into new screening implementation efforts in cw services by characterizing california’s cw systems’ screening approaches, offering examples of how this aspect of tic has been implemented in practice, and evaluating the diverse attempts to implement and sustain screening from a trauma-informed framework. research questions  following statewide implementation efforts, what are the characteristics of screening approaches used in county cw systems to identify trauma-related and mh needs?  in response to policy mandates accompanied by broad implementation support, what are cw leaders’ perceptions of the selection and implementation of screening approaches for identifying trauma-related and mh needs? crandal et al./identifying need and tic 338 methods procedure california’s cw system is county-administered, with oversight provided by the state’s dss. the authors developed a web-administered survey to obtain information on mh and trauma screening practices in each county. the survey invitation was disseminated through an email from the state’s association of human service directors to the association’s representative in each county cw agency. the california dss also endorsed the need for counties to complete the survey. the email recipient was asked to identify one respondent in their county with knowledge of screening practices for children involved with cw, from either the county cw or mh agency (based on the particular county system responsible for screening in that county) to complete the survey. in order to maximize the response rate, two reminder emails were sent by the state association. an in-person reminder was also provided at a standing monthly meeting attended by representatives from county cw agencies and staff from the california dss. the survey was administered between february 24, 2016, and march 23, 2016. sample the survey was completed by a respondent from 46 of the 58 counties in california. the breakout of respondents by position in their agency was as follows: director or chief, 13.0%; assistant or deputy director, 19.6%; manager, 47.8%; supervisor, 6.5%; and other, 13.0%. the participating counties represented 96.8% of the state’s population according to 2010 census information (u.s. census bureau, 2015), and they represented 97.4% of the 46,261 cw case openings that occurred in all counties in the state between april 1, 2015 and march 31, 2016 (webster et al., 2016). based on the national center for health statistics’ 2013 urban-rural classification scheme for counties (ingram & franco, 2014), the percentage of counties in the sample in each urban-rural category and the percentage of counties in that category statewide, shown in parentheses, were as follows: 17.4% were large central metro (13.8% of counties in the state), 15.2% were large fringe metro (13.8% of counties in the state), 23.9% were medium metro (22.4% of counties in the state), 13.0% were small metro (13.8% of counties in the state), 13.0% were micropolitan (13.8% of counties in the state), and 17.4% were noncore (22.4% of counties in the state). measure the web-based survey contained questions on screening practices for identifying mh and trauma-related needs of children involved with the cw system. respondents were asked to indicate the extent to which screening had been implemented in their county (e.g., full implementation, partial implementation, implementation being planned, or no plans for implementation), the degree of satisfaction with current screening procedures, and whether changes in screening procedures were being considered. the survey contained a list of tools commonly used to screen or assess mh and trauma-related symptoms (see table 1), and respondents were asked to indicate which tools were being used or considered by their county. an open field was included so respondents could also report on tools that did not appear on the list. an additional question asked about the age groups of children advances in social work, spring 2017, 18(1) 339 being screened or being considered for screening (ranging from infants to transition-age youth). finally, respondents were asked to rank order a list of 10 considerations (see table 2) for determining a screening procedure/selecting screening tool(s) ranging from 1 (most important) to 10 (least important). results screening implementation status with regard to implementation status, 84.8% (n=39) of respondents reported that a screening procedure to identify mh and/or trauma-related needs of children involved with cw had been fully implemented in their county, 13.0% (n=6) indicated a screening procedure had been partially implemented, and 2.2% (n=1) reported that a screening procedure was being planned. those who indicated that screening had been fully or partially implemented (n=45) were asked whether changes to screening were being considered (e.g., “we are thinking about changing our current screening tool(s)/procedures for mh and/or trauma-related needs”) and about satisfaction with screening (e.g., “we are satisfied with our current screening tool(s)/procedures for mh and/or trauma-related needs”). both questions were rated on a 5-point likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). out of the 45 participants who answered the question, 20% (n=9) agreed that they were thinking about changing current screening tool(s)/procedures, 26.7% (n=12) were not sure, 37.8% (n=17) disagreed, and 15.6% (n=7) strongly disagreed (m=2.51, sd=0.99). as for their satisfaction with current screening tool(s)/procedures, 20% (n=9) of respondents strongly agreed they were satisfied, 57.8% (n=26) agreed, 15.6% (n=7) were not sure, 4.4% (n=2) disagreed, and 2.2% (n=1) strongly disagreed (m=3.89, sd=0.86). screening tools being used and under consideration of the 46 participants, 44 reported use of at least one of the tools listed in the survey or reported use of at least one other tool that was not listed to screen for mh and/or traumarelated needs. information on reported use of each tool for these 44 participants is shown in table 1. the list of tools was presented in alphabetical order in the survey, but in table 1, the tools are grouped into categories: tools to assess mh symptoms completed by caregivers and/or youth; tools to assess trauma-related symptoms completed by caregivers and/or youth; tools completed by providers; and unknown. approximately half of the participants (52.3%; n=23) reported use of provider-completed tools only, 40.9% (n=18) reported use of both provider-completed and caregiverand/or youth-completed tools (mh and/or trauma), and 6.8% (n=3) reported use of caregiverand/or youth-completed tools only (mh and/or trauma). almost a quarter (23.9%, n=11) of the 46 participants reported that at least one tool was being considered for use in their county to screen for mh and/or trauma-related needs. information on tools being considered is also reported in table 1. of the 10 participants who answered the follow-up questions, 20.0% (n=2) were considering a providercompleted tool, 40.0% (n=4) were considering one or more caregiverand/or youthcrandal et al./identifying need and tic 340 completed tools, and 40.0% (n=4) were considering both provider-completed and caregiver-and/or youth-completed tools. table 1. screening tools being used and under consideration being used (n=44) being considered (n=11) screening tools n % n % mental health symptoms – caregiveror youth-completed ages and stages questionnaire: social-emotional (asq-se) 18 40.9% 1 9.1% child behavior checklist (cbcl) 3 6.8% 1 9.1% pediatric symptom checklist (psc) 1 9.1% strengths and difficulties questionnaire (sdq) 4 9.1% 2 18.2% treatment outcome package (top) 4 36.4% other 1 2.3% at least one caregiver-and/or youth-completed mental health tool 20 45.5% 8* 80.0% trauma symptoms – caregiveror youth-completed acute stress checklist for children (asc-kids) 3 6.8% 1 9.1% child ptsd symptom checklist (cpss) 1 9.1% children’s revised impact of event scale (cries/cries-8) 1 9.1% screen for child anxiety related disorder brief assessment of pts symptoms (scared-pts) 3 6.8% 2 18.2% trauma symptom checklist for children (tscc) 1 2.3% 1 9.1% trauma symptom checklist for young children (tscyc) 1 9.1% ucla ptsd reaction index (ucla ptsd ri) 2 4.5% 1 9.1% other 2 4.5% 1 9.1% at least one caregiveror youth-completed trauma tool 10 22.7% 2* 20.0% provider-completed child and adolescent needs and strengths-mental health or trauma version (cans) 14 31.8% 6 54.5% mental health screening tool (mhst) 27 61.4% 2 18.2% structured decision making (sdm)** 14 31.8% agency-developed tool 2 4.5% at least one provider-completed tool 41 93.2% 6 60.0% tool unspecified by respondent 2 4.5% 1 9.1% * number of respondents for these items=10 ** this row offers information on perception of use of sdm for screening purposes but is not representative of the proportion of counties who use sdm throughout the state for other purposes. age groups for screening the following proportion of county administrator respondents (n=46) reported screening or planning to screen these different age groups of children: infant (0-1 years) 84.8%, toddler (2-3 years) 91.3%, preschool (4-5 years) 97.8%, middle childhood (6-11 advances in social work, spring 2017, 18(1) 341 years) 100%, younger adolescent (12-14 years) 100%, older adolescent (15-18 years) 100%, and transition-age youth (19-21 years) 71.7%. considerations for determining screening tool(s) or procedures respondents’ ranking of considerations for determining screening tool(s) or procedures are reported in table 2. a list of 10 considerations was provided in the survey and the respondent was asked to place the items in order of importance. the item “it’s evidence-based or supported by research” was ranked as most important by 56.5% (n=26) of respondents (mdn=1.0), and the item “the tool(s) was designed to be completed by staff” was ranked as most important by 19.6% (n=9) of respondents (mdn=3.0). half of the items were ranked as most important by less than 10% of respondents, and three items were not ranked as most important by any of the respondents. table 2. ranking of considerations for selecting screening tool(s)/procedures considerations median range* high to low % of respondents that ranked consideration as most important other counties are already using it 6.0 1-10 8.7% it satisfies stakeholders (like county or state administrators) 5.0 1-10 4.3% it’s evidence-based or supported by research 1.0 1-10 56.5% children, youth, and families like it 6.5 2-10 staff like it 6.0 2-10 it doesn’t add extra strain on staff 6.0 1-10 4.3% it makes sense to me 7.0 2-10 the costs involved in using it 7.0 1-10 2.2% the tool(s) was designed to be completed by staff 3.0 1-10 19.6% the tool(s) was designed to be completed by parents/ caregivers and/or youth 8.0 1-10 4.3% *1=most important, 10=least important discussion this evaluation of the pathways to mental health services screening process implementation offers several findings germane to tic. most participants perceived their screening process as fully implemented and expressed satisfaction with the process. generally, these processes included screening all or nearly all ages of children and youth served, most commonly with practitioner-rated tools that examine general child functioning, potential for risk, or family strengths and needs. survey results also showed that a majority of respondents collectively viewed “evidence-based or supported by research” as the top consideration when determining a screening tool or process in their respective counties. although these findings are specific to california’s implementation of screening for cw-involved children, there are implementation considerations demonstrated here that can inform future attempts to broadly implement tic. crandal et al./identifying need and tic 342 tic implementation consideration 1: maintaining focus on childhood trauma after longstanding national emphasis on screening in cw as a crucial component of tic, california’s statewide screening implementation ultimately occurred as a result of class action litigation with an emphasis on access to mh services. a focus on mh services was intended to convey an inclusive array of services, targeting trauma-related as well as other mh needs a child may have. the california dss offered a practice model and technical assistance which included emphasis on the importance and role of tic in this implementation effort. disconcertingly, however, an open-ended focus on broad mh may have diluted the salience of identifying ptsdand trauma-related needs for the cwinvolved population at the county level, as evidenced by the 36 counties (78.3%) whose respondents reported no trauma-related content or results included in their screening tool approach. for more than a decade, tic researchers have highlighted the importance of linking trauma-related needs with research-based trauma treatment services (kerns et al., 2016; ko et al., 2008; taylor, wilson, & igelman, 2006), rather than general mh services (leslie, hurlburt, landsverk, barth, & slymen, 2004). advocates of tic need to ensure the mission and meaning of tic is directly translated into specific policies and implementation practices in future efforts, particularly within large multilayered systems where aspirational aspects of an effort may become attenuated across layers. tic implementation consideration 2: closing the science-practice gap of the four most commonly used tools used for screening reported in this survey, three are completed by professionals involved in the case, rather than by direct report from the child or caregiver. while there are examples of professionalor practitioner-completed measurement tools performing well and providing meaningful data, they are generally less represented in measurement literature (crandal et al., 2015). this may, in part, be due to the risk for measurement error because the targeted construct is distanced from the measurement source. for example, measuring a child’s trauma history or symptoms from the point of view of a professional produces a score that represents the professional’s knowledge of the child’s history or symptoms, which can vary widely based on each professional’s interactions with the child, familiarity with the child’s case, understanding of screening procedures, or skill investigating childhood trauma. high caseloads, overburdened workers, and strained organizations or systems may exacerbate these potential sources for systematic measurement error (podsakoff, mackenzie, lee, & podsakoff, 2003). since the psychometric performance of the practitioner-completed measurement method is not clearly established, particularly in applied settings, there is cause for caution when interpreting results from professional-rated screening tools. additionally, literature review of peer-reviewed published research on several of the most commonly reported tools used for screening in the respondent counties suggested these tools were not developed for use as mh or trauma screening tools and have not been evaluated for performance when used to assist professionals making screening decisions (i.e., cut scores, advances in social work, spring 2017, 18(1) 343 sensitivity, specificity, predictive power; crandal & conradi, 2013; haynes, smith, & hunsley, 2011). given these measurement concerns, the commonly implemented screening tools are often those with uncertain performance. nonetheless, a majority of survey respondents ranked “it is evidence-based or supported by research” as the highest priority consideration when determining screening tools or procedures. this illustration of a science-practice gap in cw has been noted by others (burns et al., 2004; raghavan, inoue, ettner, hamilton, & landsverk, 2010). in his study of the use of research evidence in public youth‐serving systems, palinkas (2015) found that systems leaders tend to rely on the availability of resources, local indications of a need, and their personal experience when deciding if they will use evidence to make changes. cw leaders were more likely than other system leaders to ignore evidence when making changes (palinkas, 2015). emerging literature on addressing the science-practice gap in cw calls for research-practice partnerships that build on cumulative and collaborative efforts to close the science-practice gap (aarons & chaffin, 2013; palinkas, 2015; palinkas, short, & wong, 2015; testa et al., 2014). future tic implementation efforts in cw should address the science-practice gap beginning with an awareness of the need for collaboration among leaders with diverse scienceand practice-related expertise. tic implementation consideration 3: evaluating the state of the science while there are research-practice partnership and implementation models for expanding access to evidence-based practices for child-welfare-involved children (palinkas et al., 2015; testa et al., 2014), these models have focused on increasing access to established evidence-based treatments. evidence-based screening for cw-involved youth, on the other hand, is still taking shape. evidence-based screening is commonly misrepresented as merely the use of tools that have produced data that was found to have strong reliability and validity, sometimes without regard for screening-specific test performance (e.g., sensitivity, specificity, predictive power). there are measurement tools which have performed well when screening for general mh needs (gardner, lucas, kolko, & campo, 2007; goodman, ford, simmons, gatward, & meltzer, 2000), as well as screening tools developed to detect trauma-related need or assess histories of childhood traumatic stress (conradi, wherry, & kisiel, 2011; crandal & conradi, 2013). however, only recently have these tools been evaluated in broad cw contexts to identify children who might benefit from further mh assessment and treatment (kerns et al., 2016). nonetheless, “screening should involve a system, not just a test,” (raffle & gray, 2007, p. 42) and a screening system that is evidence-based includes evaluation of the screening test performance as well as the outcomes for individuals involved in the process. to date, tic advocates do not have sufficient information about screening programs to determine how many children with positive screens are found to have serious mh conditions and benefit from treatment, how many children with positive screens are found to have no serious mh condition or do not benefit from treatment, how many children with negative screens later demonstrate significant mh need, or which services might be crandal et al./identifying need and tic 344 appropriate for children with negative screen results. researchers, policy makers, administrators, and other stakeholders are embarking on a nascent application of a longstanding element of tic. the barriers identified in the pathways to mental health services screening implementation process bring to light the importance of acceptability and feasibility in existing evidence-based screening models. meaningful steps remain to understand and implement this crucial component of identifying children whose well-being has been disrupted by traumatic events and develop evidence-based screening processes that are feasible to implement in cw systems. limitations the current study offers a point in time glimpse of an on-going, expansive implementation effort in a large state. there are a number of factors that have facilitated effective and ineffective aspects of implementation at the national, state, county, and local levels that are beyond the scope of this project. furthermore, although attempts were made to identify the most appropriate respondent, data were collected based on report from a single representative from each county. accuracy of the reported information was not assessed and the extent to which social desirability influenced responses is unknown. county screening programs are likely to involve multiple stakeholders with a range of perspectives and there may be additional information that was not captured based on the methodology used in this study. respondents from different counties may have different perceptions of screening and the distinction of screening from assessment, which could contribute to imprecision in the survey responses. finally, given the large countyadministered organization of california’s cw services, these findings may not generalize to all other cw settings. future research future attempts to explore broad screening implementation could include evaluations of fidelity and sustainment of the implementation effort (e.g., training and professional development among direct service staff, quality assurance monitoring, evaluating perceptions of the practice among staff providing the service) as well as evaluation of the effectiveness of the implemented tic practices. additionally, tic implementation models would be useful to support cw organizations looking to implement specific practices. for example, kerns and colleagues (2016) describe an approach to strengthening the cw workforce capacity to identify trauma symptoms for children and youth involved in services. this articles describes different screening approaches that were implemented or under consideration for implementation and leadership perceptions of those approaches in the context of a statewide effort. an implementation model, on the other hand, would examine the lessons learned from researchers and practitioners and concretize an implementation approach designed to be translated to different cw organizations. while further steps are needed to make trauma-related and mental health screening more accessible and practical for cw systems, this study offers information and considerations intended to encourage the progress of this crucial element of tic. advances in social work, spring 2017, 18(1) 345 references aarons, g. 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(2016). child maltreatment 2014. available from http://www.acf.hhs.gov/programs/cb/research-datatechnology/statistics-research/child-maltreatment u.s. department of health and human services, substance abuse and mental health services administration. (2011). leading change: a plan for samhsa’s roles and actions 2011-2014. (hhs publication no. [sma] 11-4629). rockville, md: author. webster, d., armijo, m., lee, s., dawson, w., magruder, j., exel, m., … & kai, c. (2016). ccwip reports. retrieved from university of california at berkeley california child welfare indicators project’s website: http://cssr.berkeley.edu/ucb_childwelfare author note: address correspondence to: brent crandal, phd, chadwick center for children and families, rady children’s hospital, 3020 children’s way, mc 5131, san diego, ca 92123, bcrandal@rchsd.org this study was supported by the children’s bureau, administration of children, youth, and families, grant #90c01101. the authors would like to thank the california department of social services and california welfare directors association administrators and staff who helped administer the survey used in this study, as well as the county administrators and staff who provided responses to the survey. we would also like to thank charles wilson, lisa conradi, jared martin, and jennifer demaree for their contributions to this project. http://www.hhs.gov/asl/testify/2011/06/t20110616a.html http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment http://cssr.berkeley.edu/ucb_childwelfare mailto:bcrandal@rchsd.org this work is licensed under a creative commons attribution 4.0 international license. conversation club: a promising practice in youth mentoring of migrants and refugees julia pryce michael s. kelly mary lawinger anne wildman abstract: this paper evaluates conversation club, a canadian after-school group mentoring intervention focusing on the expansion of the program across three separate regions of ontario. the authors use a multiple methods design, including questionnaires (n=101), post-session process data, and qualitative interviews (n=18), to evaluate how conversation club impacts members’ feelings of hope, belonging, sense of ethnic identity, and social support. a focus group (n = 7) with program facilitators was also conducted to explore the process of dissemination of the club across regions. findings suggest that conversation club holds promise for newcomer youth across settings. quantitative data showed significant change (p <.01) in levels of hope and sense of belonging. interviews revealed an increased sense of belonging, possibility, and social support, as well as improved confidence in communicating with others. insights regarding use of the club manual suggest the importance of integrating conversation club values with flexibility in facilitation to incorporate the strengths and opportunities of context across regions. study limitations, as well as implications for further social work research and dissemination of best practices in services for migrant and refugee youth, are discussed. keywords: migrant and refugee youth, group mentoring, adolescents addressing the international flow of immigrants and refugees is a major concern for governments around the world. in recent years, instability in the middle east and northern africa has caused a migration crisis (metcalfe-hough, 2015), with many people fleeing their native countries to avoid violence, as well as to seek improved economic opportunities. in 2015, there were 244 million international migrants, over 16 million of whom were refugees (migration policy institute, 2015). canada in particular has emerged as a country willing to accept immigrants and refugees while striving to provide resources to ease the cultural shock and isolation that can often accompany migration (kantor & einhorn, 2016; vieira, 2015). one in five people living in canada is foreign-born, and in 2018, canada plans to receive 310,000 additional immigrants (government of canada, 2017; statistics canada, 2011). in 2016, people from syria were the third largest source of immigrants to canada, making up 11.8% of the total immigrant population (government of canada, 2016; the canadian magazine of immigration, 2017). immigrants moving from india to canada, the second largest group, increased by 1% from 2015 to 2016 (government of canada, 2016; the canadian magazine of immigration, 2017). migrants coming from democratic republic of congo, _________________ julia pryce phd, lcsw is an associate professor, school of social work, loyola university chicago, chicago, il 60611. michael kelly, phd is a professor, school of social work, loyola university chicago, chicago, il. mary lawinger, msw, is a social worker with heartland alliance in chicago, il. anne wildman, msw is a school social worker in the state of illinois. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 767-787, doi: 10.18060/21650 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 768 egypt, nigeria, pakistan, and iran represent 0.9 to 3.8% of the canadian immigration population respectively (government of canada, 2016; the canadian magazine of immigration, 2017). of this foreign-born population, nearly 20% are newcomer youth (government of canada, 2016). although there is no single official definition, newcomer youth are typically defined as people between the ages of 12 and 24 who have been in canada for fewer than five years (affiliation of multicultural societies and service agencies of bc, 2016; gouin, 2016; ontario council of agencies serving immigrants, n.d.). in contrast to native-born youth, newcomer youth in canada (and throughout the world) face the challenges of behavioral and linguistic acculturation in their new country (birman & morland, 2014; bridging refugee youth & children’s services [brycs], 2010; mentor, 2009; oberoi, 2016). many immigrants (dubbed “newcomers” in this canadian context) struggle with a new language, a new school system, and potentially new social norms (birman & morland, 2014; brycs, 2010; mentor, 2009). newcomer youth often undergo a process of acculturation that is very different from that of their parents, as they feel more pressure from peers to let go of their foreign identity and embrace an identity rooted in canadian culture (birman & morland, 2014; oberoi, 2016). additionally, many newcomer youth experience parent/child role reversals due to their superior understanding of the local language and need to help their parents in many of the daily tasks required to successfully navigate a new community (mentor, 2009; oberoi, 2016). these new pressures of acculturation and familial needs and expectations can cause significant stress and feelings of isolation among newcomer youth, resulting in increased difficulty relating to canadian-born peers (birman & morland, 2014; mentor, 2009), an increased risk of emotional distress in comparison to their peers (hilario, vo, johnson, & saewyc, 2014), and specific stress related to exclusion, poverty, separation, and in some cases, trauma (mentor, 2009). interventions focused on the unique needs of newcomer youth are critical in addressing the challenges and increased risks they face, and in supporting these youth in a healthy process of integration into their new communities. conversation club: a group mentoring intervention for canadian newcomer youth for canadian newcomer youth, access to community services can serve as a protective factor in their migration and acculturation process (canadian pediatric society, 2016). these community services can include: after-school programs, leadership development trainings, basic health trainings and advocacy, mental health services, dating violence advocacy programs, substance use treatment, employment resources, crime prevention resources, and summer camps. “conversation club” (also referred to here as “the club”) is a school-based group mentoring program developed by big brothers big sisters (bbbs) of peel province in response to the needs of diverse youth in the community. the program began in 2009 in partnership with local settlement organizations and libraries. the club was quickly expanded to local schools and is now implemented in 14 sites, including high schools, libraries, community centers, and settlement agencies across ontario. pryce et al./conversation club 769 group mentoring with youth group mentoring is defined by kuperminc and thomason (2014) as “natural or programmatic mentoring contexts in which one or more mentors work with at least two” mentees (p. 274). mentees in group settings are free to try out new behaviors and to observe and learn from others’ behaviors (kuperminc & thomason, 2014). additionally, group mentoring can allow for more culturally attuned work, as some individuals, particularly ethnic minority groups, prefer working with peers with similar experiences versus with a one-on-one mentor from another culture (herrera, vang, & gale, 2002; kuperminc & thomason, 2014; lindsay-dennis, cummings, & mcclendon, 2011; utsey, howard, & williams, 2003). group facilitators are expected to create an atmosphere of collaboration, introduce and maintain direction, promote positive change, and keep the focus of the group (emelo, 2011; kuperminc & thomason, 2014). conversation club facilitators, above all else, aim to meet the newcomer youth where they are and work to implement lessons that properly address the needs reported by youth in the program. this sense of collaboration is intended to fuel passion in the newcomer youth and empower them to maintain their ethnic identity while exploring canadian culture and making new friends. group mentoring is one way to broadly address youth’s needs by helping them connect with other newcomers, learn the new language and culture of canada, and create their own sense of belonging and hope in their new environment. in order to do this, facilitators hear the experiences, hopes, and challenges of youth (mentor, 2009); create safe spaces of inclusion and belonging (mentor, 2009; patton, deutsch, & das, 2016); provide training in cultural competency (brycs, 2010; oberoi, 2016) and conflict resolution (deutsch, wiggins, henneberger, & lawrence, 2012); and involve youth with the program planning and shaping (brycs, 2010). due to their specific struggles, immigrants and refugees can experience significant benefits from mentoring (dubois, holloway, valentine, & cooper, 2002; rhodes, 1994). specifically, group mentoring can provide a foundation for newcomer youth to relate to peers their age (birman & morland, 2014; brycs, 2010; cawood & wood, 2014; crul & schneider, 2014; deutsch, reitz-krueger, henneberger, ehrlich, & lawrence, 2016; hilario et al., 2014; schmidt, morland, & rose, 2009) and receive peer and adult support through their adjustment process (birman & morland, 2014). mentees have a space to promote their bicultural identities (morland, 2007) and find and foster positive relationships in their new environment (birman & morland, 2014; cawood & wood, 2014; hilario et al., 2014; oberoi, 2016; schmidt et al., 2009). the core tenets of group mentoring among youth are fostering connection, cohesion, and mutual support (kuperminc & thomason, 2014). for these tenets to be achieved, safe spaces need to be formed in which culturally appropriate practices—including life skills, pro-social behaviors, critical thinking, and emotional coping—are promoted in alignment with specific cultural norms and expectations regarding adolescent development (oberoi, 2016; washington, barnes, & watts, 2014). especially among minority adolescents, group mentoring can create a sense of belonging (cawood & wood, 2014) that might not be experienced in individualized mentorships. this solidarity with other students not only advances in social work, spring 2018, 18(3) 770 allows adolescents to relate with others going through similar experiences (i.e., adjusting to a new country), but provides them the opportunity to support one another and give advice to peers in times of distress (jagendorf & malekoff, 2006). creating these sincere connections with others helps to solidify youth’s feelings of hope and belonging. expansion and dissemination of youth programs although the value of group mentoring in the field is well established, there are many challenges which need to be addressed when disseminating and scaling up group mentoring programs for youth (durlak & dupre, 2008; mcisaac, read, veugelers, & kirk, 2017). a common pitfall encountered in the dissemination process is that programs may be too complex for systems and providers to properly implement, which “may reduce adoption and diffusion of the program into systems” (ozdemir & giannotta, 2014, p. 112). researchers must focus on identifying the key elements of a program that make it effective in order to provide clear and simple guidelines for program facilitators that can be realistically implemented in provider settings (dubois, portillo, rhodes, silverthorn, & valentine, 2011; rajan & basch, 2012). more quotidian factors such as inclement weather, school holidays, and lack of suitable locations can also have a potentially negative impact on the implementation of group mentoring programs for youth (iachini, beets, ball, & lohman, 2014). in order to implement beneficial group mentoring interventions with newcomer youth in canada, there needs to be a clear purpose, an understanding of and planning for structural details (i.e., time and space), proper identification and/or creation of content that is appropriate and relevant for group goals, and, in many cases, support from schools and parents of the youth (brycs, 2010; jagendorf & malekoff, 2006; kurland, 1978; malekoff, 1997). for adult and peer facilitators alike, it is essential for them to pay attention to the process, structure, and boundaries of the group, form alliances with parents, teachers, and school administrators, stress confidentiality and trust among group members and leaders, and make a demand for work (jagendorf & malekoff, 2006). efforts such as these, as reflected in this paper, help to contribute to impactful programming throughout expansion to new contexts and agencies. the current study based on the program evaluation data from year one, we found that conversation club showed promise in addressing many of the important needs of its canadian newcomers (pryce, kelly, & lawinger, 2018). findings suggested improvement among participants, relative to a comparison group, on important metrics such as community belonging, ethnic and cultural identities, and hope for the future (pryce et al., 2018). despite the early promise of this intervention, the potential benefits of transferring these outcomes to newcomers in other settings had not been explored. based on the initial findings, the conversation club creators sought to expand the club to three sites in ontario (i.e., peel region, york, and ottawa), looking at this expansion from multiple methodological perspectives. pryce et al./conversation club 771 in this mixed methods study, we sought to replicate our initial quantitative findings showing conversation club’s promise as an intervention to positively impact newcomer youth’s sense of belonging and hope. we also explored qualitatively how conversation club youth viewed their experience in the club intervention and in canada more broadly. finally, because this study focuses on years two and three of the program evaluation, we report on focus group data with conversation club program staff regarding the utility of the club’s program manual and how to best scale the program up further. procedures survey data during the fall semesters of two school years, (2014-15 and 2015-16), we worked with conversation club facilitators to secure consent from conversation club youth and families to conduct the study (total n=149). based on the logic model developed with the conversation club program team, a questionnaire was developed to look at how the conversation club impacted newcomer youth’s sense of hope and sense of belonging in their new country. these youth completed a questionnaire that asked for demographic data (age, gender, race/ethnicity, time already in conversation club, immigrant status) and also asked the youth about their sense of belonging in the club and in canada via the perceived cohesion scale (pcs) (cronbach’s α=.96; bollen & hoyle, 1990) and overall sense of hope for the future via the children’s hope scale (chs) (cronbach’s α=.83; snyder et al., 1997). these scales were part of the initial program evaluation year, as the dimensions of hope and belonging were identified by program staff as meaningful in considering the impact of the program on youth participants. findings from year one indicated that conversation club youth (n=67) had statistically significant changes on belonging and hope as compared to the comparison group (n=25). the team elected to incorporate these measures into the program evaluation and expansion for years two and three, reported here. data were collected by the conversation club team and support staff in each site, and transferred by post to the program evaluation team, who then entered the quantitative and demographic data into spss for later analysis. interview and focus group data inclusion of qualitative methods reflects the effort, through this program evaluation, to understand the experience of the conversation club program from multiple perspectives. this mixed methods study employed methods sequentially (creswell, 2013), which allows methods to be used as follow up from lessons learned from a prior method. in this case, the core research question was focused on the impact of conversation club participation on hope and belonging across multiple sites. the qualitative data collection allowed us to better understand what aspects of the club facilitated belonging, and the process through which engagement in the club takes place. while we assumed that the two methods would hold equal weight in the design, challenges to quantitative data collection, and the richness of the interview data generated, resulted in the qualitative data assuming more dominance in the study, a process noted often by experts in mixed methods (creswell, 2013). advances in social work, spring 2018, 18(3) 772 at the conclusion of these two years, 18 interviews were conducted with a subset of conversation club participants across the three sites using a convenience sample. eight of the interviewees were female and ten were male. the use of qualitative methods offered the flexibility to look at the experience of club involvement from multiple viewpoints, taking into account environment and social context, while valuing the voice of participants across program levels (malson, 2010). these interviews were conducted by members of the conversation club team who were not facilitators of the youth’s specific club, so as to avoid any sense of coercion toward the interviewee. interviewers were initially trained by a research team member on skills important to qualitative interviewing. this training involved several didactic sessions, as well as role plays using the interview protocol, and group feedback to the interviewer. interviewers were then supervised by this same research team member through weekly group meetings focused on identifying challenges and uncertainties presented through the interview process. interviewees were invited by program staff to participate in an interview, and a separate consent was obtained from parents for this piece of the research. once consent was obtained, interviews took place in a private room separate from the conversation club during the same time as club sessions. interviews were audio recorded and transcribed for accuracy. the analyses for this study were carried out in a team environment in which members engaged collaboratively to both challenge and validate emergent themes (boyatzis, 1998; lyons, 2007). an open coding method was first used by two of the paper’s co-authors to capture initial themes. following this initial coding, two of four co-authors individually reviewed all of the interview transcripts, using open coding to organize content into conceptual categories (padgett, 2008) that reflected patterns and themes. these themes were organized into a larger outline that was elaborated on and challenged until consensus was reached. finally, the two coders returned to the transcripts with a coding book and coded all transcripts. also, at the conclusion of year two, the two lead authors on the project co-facilitated a focus group with seven conversation club staff from three sites (three veteran staff with several experiences implementing conversation club, and four staff representing two of the new agencies adopting the program, who each had one year of experience implementing the club). this focus group took place by phone and lasted 90 minutes. content focused on the challenges and opportunities encountered by staff in their use of the conversation club manual and was based on a set of questions developed in collaboration by the lead authors and veteran program facilitators. as a structure for cofacilitation, one lead author asked the questions while the other kept notes and transcribed verbatim key insights offered by the focus group participants. following the focus group, the two lead authors reviewed the notes and reflections together to identify themes around the manual and scaling up the intervention that are addressed later in this article. pryce et al./conversation club 773 findings demographics of the 149 conversation club members, 72 (48.5%) were male and 76 (51%) were female, and one student chose not to identify gender. while the group age ranged from 12 to 19, the average age was 15, and the average time the conversation club youth had been in canada was 31.6 months. 85% of the conversation club group members had permanent resident status in canada, and the average time of involvement in the club for this group was 10.25 months (this reflects the differences between the 2 new groups in york and ottawa, and the long-standing conversation club groups in peel). the club members described themselves as coming from 33 different countries, including china, syria, egypt, pakistan, the philippines, & india, making this the most diverse group of conversation club youth to date. table 1. demographic distribution of conversation club participants demographics participants male n (%) 72 (48.5%) female n (%) 76 (51%) age range 12-19 years average age 15 years avg. months in canada 31.6 months % permanent residents 85% findings noted in table 2 reflect a within-group t-test performed with usable data from 2014-2016. though the sample started with a total of 149 participants, several factors impacted study attrition, mostly due to students missing on the day of post-test, and some changing schools and leaving the group before the end of the program thus, the sample was reduced to 105 and 114 for the two scales. data from the within-group t-tests indicate that conversation club youth reported statistically significant change on their pcs scores (for both subscales of belonging and morale) and chs scores (showing increased hope on both subscales in terms of both agency and pathways). table 2. results of within-group t-tests for the treatment (conversation club) in peel, york, and ottawa 2014-2016 pre-test post-test subscale measure n mean st. dev n mean st. dev t-test pcs belonging 105 24.84 5.76 105 26.32 4.72 2.506* morale 105 17.50 5.88 105 25.64 4.43 9.326* chs agency 114 13.88 2.8 114 14.94 2.57 3.794* pathways 114 13.61 2.61 114 14.13 3.02 2.521* note. * = p < .025 (bonferroni adjustment for each scale) df = 104 for pcs and df= 113 for chs, based on usable pre-/post-tests. advances in social work, spring 2018, 18(3) 774 this data builds on data collected from year one of this pilot evaluation, which also reflected significant improvement in sense of belonging and experience of hope among the program group relative to the comparison group (pryce et al., 2018). process evaluation data participants in those two programs who were newly adopting conversation club were also asked to complete brief evaluations of their group sessions for the purpose of process evaluation. this involved rating the session on a scale of 1 (very bad) to 4 (very good; see table 3), and responding to an open-ended query requesting the rationale for their rating, their favorite part of the session, and what could have been done to improve the session. out of a total of 101 ratings by conversation club youth from october 2015-june 2016, a very strong picture emerged of the strengths of the conversation club program. 79.2% of the responses rated the club sessions as 4 (“very good”) and 12.9% of the remaining responses were in the “good” category, meaning that for these new sites, 92% of the sessions were rated positively by the youth involved. table 3. global ratings of program quality across sessions across new conversation club programs. rating # of responses % 3 or 4 (good or very good) 94 92.1% 1 or 2 (very bad or bad) 7 7.9% total 101 100.0% when asked why they gave the session the rating they chose, the conversation club youth reported “i had fun” (48.5%), “i liked playing games” (27.3%), and “it made me feel good or happy” (8.9%). the games the club youth cited that involved using english and conversing with each other were frequently cited in their narrative descriptions, followed by the activities where they were encouraged to talk about their country of origin. almost 50% of participants said a version of “nothing would make it better, it’s great already,” but there was a smaller group (30.9%) who provided constructive feedback, stating that they wished for more active gym-based games, like volleyball and basketball, or more field trips. qualitative findings across the eighteen interviews conducted with conversation club participants at the end of the program year, several themes emerged that assist in unpacking and illuminating the increased sense of belonging indicated by the quantitative data. the section below highlights some the most prominent themes. of note, pseudonyms are used to protect the confidentiality of participants. developing english language skills increases belonging increased agility in speaking english, and related confidence and sense of belonging, emerged as the strongest themes in the interviews focused on the impact of conversation pryce et al./conversation club 775 club. daniel, an older adolescent from the democratic republic of the congo, highlights some of this process in his reflection as associated with greater facility in speaking english, and related increased belonging and connection in relationships: there’s a lot of changes that i’ve seen and, i would say that one would be, uh, how to talk to people. yeah. ‘cause for me, like, my first time here, i never talk to anyone. […] so when i come, i join this group, they start teaching me good stuff which helps me, which gives me the word of discovering friends, of knowing how to be, ya know, nice to people. yeah. so. i would say the key for me to talk to people, it was conversation club, because that’s where i began. daniel’s poignant reflection, which includes a reference to his anxieties as he navigates a new culture and environment, speaks powerfully of the “start” that conversation club gives him in “discovering friends” and “knowing how to be nice to people.” this facilitated communication helped daniel have an increased sense of belonging in canada. daniel’s reflection is echoed by a large proportion of those interviewed; as comfort with english increased, so too did a perceived sense of connection, belonging, and confidence. as an example, christine, from china, shares: i think i might be more confident, because i was thinking, like, i am the english speaking not good. and now, i found someone is the same with me and everyone is the same. everyone use the less greater words to talk about things. it make me feel better. samantha, a student from jamaica, also reflects on the contribution of the club to her ability to communicate and interact with others, sharing: now, it’s like practicing how to talk to people and so when i go out into big society or bigger group, i can talk better each day and i can do my english more better. because talking to you guys, it’s like, i have to talk proper english, so it teaches me how to become better person and talk in proper english. aliyah expands again on this by linking this communication with self-improvement and connection with others. she states, when you hear people talking in the language that you’re not really familiar with, you start to learn. and you take chances, you start to talk to people, even though you’re not perfect, but you get perfect. that’s what i learned from conversation club. this increased confidence with english supports club participants not only in their sense of belonging in relationships, but in their feelings of competence in other spheres of life, such as classwork. danny, an eighth grader who moved to canada from pakistan, outlines this clearly when she shares how building confidence through conversation club assisted in her school experience: conversation club helped me bring up my confidence a little […] i can talk in front of people about something i know, but, like, when you need to present, like, a presentation or anything and when it’s all planned, that’s when i start messing things up. now it helped me when i’m presenting in class because in class i used advances in social work, spring 2018, 18(3) 776 to, like, my voice used to go down. i didn’t even notice about that, my teachers are like, “oh, yeah. that’s getting better than it used to be.” emmanuel, a second year high school student from india, continues this theme, affirming the impact of conversation club on his confidence, stating, “i learned that if you want to express yourself, you don’t need to fear what others are thinking of yourself. be confident and just say what you want to say. i have become more confident by joining this club.” club participation increases belonging one of the strongest themes that emerged from the interviews was in regards to the sense of belonging, and in turn, possibility that was associated with membership in conversation club. the majority of respondents discussed an initial sense of isolation and disorientation associated with relocation to canada, and the important way that involvement in conversation club assisted them in having a sense of community. emmanuel clearly expresses this experience of the club: this club is very nice; there is no discrimination. people don’t judge you on the basis of your looks or your caste or your background. […] everyone is just, has this experience to share how they feel and they’re encouraged to, like, express themselves, don’t feel left out. jake, also a student from india, echoes this experience, sharing his sense of belonging as something that is “taught” through the club, stating, “they talk equally. they always give us, like, a nice talk. they always teach us how to be, uh, how to be part in this group, and they always, uh, take care of us.” a core aspect of this experience of belonging comes from the inclusion demonstrated by the club. as mentioned by emmanuel above, some of this inclusion is experienced by a lack of focus on “looks…caste, or your background”. rachel, an older adolescent student from the democratic republic of congo, aptly describes this experience in her interview, stating, “when i joined conversation club, i feel like i’m not the only one, ya know. there are others and everyone is maybe interested in what i will say that or words or mistake, everyone like, people are interested in meaning, not mistakes.” this openness and lack of judgment can facilitate language, sharing, and, in turn, belonging. christine, from china, takes this sense of acceptance and belonging even further, stating, “i felt this, like, a big family, and everyone is talking, and everyone is happy, and everyone is friendly and kind, and that is it.” aliyah highlights this sense of family as beyond her daily experience of a traditional classroom, sharing: in the classroom, it’s like each and every individual, they just come to class with themselves and leave. conversation club is like a family. everyone has a responsibility for others, everyone has some kind of connection with others, they respect each other. that is the best thing, that’s the thing i love the most. here, aliyah touches on the fact that many conversation club participants come from countries where the dominant culture is more collectivistic than that in canada. migration from a collectivistic to an individualistic culture poses difficulties for immigrants, particularly for youth who must navigate between the cultures of their parents and their pryce et al./conversation club 777 new home (schwartz et al., 2015). although immigrant youth typically undergo significant acculturation, some research indicates that underlying values, such as collectivism, do not change significantly with the acculturation process (rosenthal, bell, demetriou, & efklides, 1989). conversation club provides participants with an opportunity to learn about and engage with canadian culture in a close-knit group setting which promotes feelings of familiarity and comfort. beyond feeling a sense of belonging to a group, many interviewees expressed a sense that such a belonging translates to feeling a part of the society as a whole. marva, who came to canada from india, makes this connection beautifully, stating, “it’s made me feel like i’m no different than the others and that i don’t have to change to fit into society and stuff.” joe, from pakistan, expands this further, linking his participation in the club with a greater sense of being a part of canada. he states, “it is a community, right, and community is a part of canada. so, like in canada, there is a lot of people from other countries, so, but we stick together. we feel like we are in canada.” manish and others echo this sentiment, stating, “of course, i feel canadian. ‘cause when i came here, i was feeling something away from the people here. but conversation club and other my friends, everyone, made me to be connected to canada. now i feel like a canadian.” many conversation club members appear to experience this increased sense of belonging through conversation club as an integral part of their development of identity as newcomers and canadians. interpersonal support increases belonging participants shared that the sense of belonging also comes from the increased social support and connection that all interviewed youth shared when reflecting on the impact of the club. this support was provided through connection to peers, as well as club facilitators and volunteer mentors. below is one of many examples, as articulated by daniel, of the experience of friendship and connection cultivated through the club: like right now, i can’t count how many friends i have because there are many. so conversation club helped me know how to talk to people, how to know people. whenever i walk in the hallway, i talk to them even though i don’t know them. the abundance of connections that daniel references is in stark contrast to the initial isolation experienced by many conversation club participants as expressed earlier in this section. connection extends beyond that with peers to program staff and mentors in the group, as expressed by students in referencing the role of program facilitators and mentors in the experience of building relationships through the program. the participants’ words exemplify the importance of these relationships in helping them feel included and empowered in the club. as james shares, they’ll just talk and help you, they’ll ask about school, they’ll talk more about their experience when they were at school. and then, ya know, they’ll just relate it and try to help you and give you advice and stuff. advances in social work, spring 2018, 18(3) 778 laura connects this experienced “friendliness” with an increase in energy that she has each day the club is scheduled. in referencing her experience of conversation club mentors, she shares: they’re friendly. they won’t be like, “i don’t want to help you.” they help us. like, like a sister or a brother, like that. so i never skip the conversation club. […] when it’s thursday, i feel, like, an energy. when it’s 3:30, “oh! conversation club! i need to go!” then i take every step and go fast. and if i see them, i feel happy. laura shares the support that she receives, “like a sister or a brother.” she translates that support to her enthusiasm for conversation club and making sure she attends as much as possible. this suggests that conversation club has the potential to overcome the common challenge of adolescent participation in after school activities by providing social support that participants do not find elsewhere. manish also articulates the unique support provided by facilitators and mentors, and the evolving role that they serve in his life. manish reflects, at first i joined conversation club, [staff] was like a teacher to me. but now, she’s more than a teacher, she’s a friend to me. she just tells what is good and what is bad. and it’s [conversation club] better than other organizations because my mentor, like, she is really good, she never yells at us. so it makes other students to feel comfortable and better. for manish, the friendly, accepting, advising support offered by conversation club facilitators and mentors set the program apart from other after school opportunities. the increased sense of belonging and safety from these adults translates to an increased investment in conversation club, as well as well-being and support. focus group data to further inform our understanding of what works within conversation club, and what needs to be adjusted or changed in order to further support its dissemination, we were able to complement our mixed method data by facilitating a focus group with club staff (n = 7; all female). this conversation was largely focused on challenges faced by staff in making use of the conversation club manual, a tool that had been developed for their use in the early phases of program dissemination. anecdotally, we were aware that staff were making minimal use of the manual (i.e., “i found the manual gives a few suggested ideas for activities and things to do during the club, but it’s more of almost a background before you even get to the club”), and yet that the larger mentoring organization was hoping to build off of this tool for further dissemination. however, our understanding was limited as to what was needed to make this manual more usable. through our focus group conversation, we were able to develop greater understanding in this area. first, we explored manual use to date more systematically. conversation club leaders reported using the manual mostly to orient themselves to the general goals and scope of the program, and to develop initial start-up activities (e.g., “i used the manual at the beginning of the session, but then as i got going, i didn’t really refer to it from there on pryce et al./conversation club 779 out”). they all reported that as written, the conversation club manual was not useful as an ongoing resource for regular consultation or for guidance in confronting challenges. next, our focus group addressed these limitations. participants were asked how additional programs within canada could adopt conversation club in a way that is faithful to its original mission, as well as being likely to promote the benefits that have been documented. according to the professionals participating in the focus group, the manual needed to be divided into broad phases that reflected the natural ebbs and flows of the club, including the initial phase (i.e., first month), middle phase, and culminating phase (i.e., last two months). they thought that these phases should be outlined and structured within a revised manual, using specific examples and suggestions from the sites currently implementing conversation club. according to focus group participants, these phases reflected the development of the group, from introduction, development, engagement, and the development of co-leadership with the conversation club youth (forsyth, 2018; northern & kurland, 2001; yalom, 1995). within each phase, participants proposed having a checklist that would help new conversation club groups implement the club with fidelity. this checklist needed to not only highlight important pieces, but also reflect practice wisdom developed through the pilot of conversation club across three regions. this needed to be sequential and structured in such a way that new facilitators are incentivized, at least structurally, to revisit the checklist within each phase. in addition to structural changes, participants highlighted the importance of “shared authorship” as a core value in working with conversation club youth, and one that needs to be outlined up front in a manual, as well as woven throughout suggested exercises and foci. according to participants, newcomer youth must have a voice in co-creating a program such as conversation club. as an example, one participant said, “they [youth] would see you as the leader, but there is that understanding that the mentors and the youths themselves are able to bring forward their own ideas and the direction of where they want their program and activities to go.” lessons learned over the last year confirm how important it is to both call for and demonstrate examples of how newcomer youth shared authorship works within conversation club, and how essential it is to the success of the program. finally, as is well supported in evidence-based work on the dissemination of programs (bernal, jiménez-chafey, & domenech rodríguez, 2009; kelly, raines, stone, & frey 2010; taussig et al., 2015), it is critically important to identify how and where new conversation club groups can tailor their work to their specific contexts as they adopt this exciting program. one participant summarized this by saying, “i tried to go along with activities [per the manual], but i found a lot of the youth were not really enjoying that…so informing a new staff member to remain flexible and just get the input of the youth would be very important.” the work on conversation club to date shows that having a basic structure for the phases of the program, with myriad opportunities for conversation club group mentor leaders to tailor the specific activities in each phase to the specific cultural contexts of the participating club youth, appears to have found a balance between keeping program fidelity while still allowing for adaptability and “shared voice” with conversation advances in social work, spring 2018, 18(3) 780 club youth. conversation club group leaders can add their own unique contributions, particularly by including youth voice in the creation and implementation of the club tasks and activities. our focus group data indicates that conversation club facilitators say they need some guidance in order to balance the important conversation club program components that will assure program fidelity with their own creative ideas in engaging youth voice. discussion and implications for research and social work practice this paper reinforces findings from our initial study (pryce et al., 2018) and further situates conversation club within the group mentoring literature as a promising intervention that merits further investigation, particularly for immigrant youth and adolescents (birman & morland, 2014). with its focus on creating a consistent, safe, and interactive space for newcomer youth, conversation club appears to support immigrant youth who often find themselves in a critical and risky transition. based on the quantitative and qualitative data described here, conversation club demonstrates strong potential as an intervention that can build newcomer youth’s sense of hope and sense of belonging to their new home. it is also of note that these outcomes, which were embedded in the initial logic model for this evaluation, were informed largely by the practice wisdom and expertise of the conversation club group leaders themselves and their creative application of the core ideas of conversation club within their specific contexts. the findings noted above have significant implications for social work practice. research in the area of program dissemination indicates that programs facilitated by social workers need to be flexible and adaptable (ozdemir & giannotta, 2014) to allow facilitators “to modify a program to make it more effective in a specific context” (durlak & dupre, 2008, p. 341). in order to achieve this, researchers must “identify critical program elements” (dubois et al., 2011, p. 79) so that energy can be devoted to ensuring that those elements are maintained, while offering facilitators clear guidelines as to where adaptation of the curriculum is and is not desirable. this also speaks to the importance of training social work practitioners and implementers of interventions such as conversation club in how to adhere to a manual for an intervention while remaining flexible in addressing the specific needs of individual participants. specific to conversation club, moving forward with the dissemination, it will be critical to utilize facilitator feedback in continuing to revise the manual to maximize program flexibility and fidelity. newcomers often face social, emotional, academic, and personal challenges as they seek to adjust to a new culture and language (gouin, 2016; hilario et al., 2014; oberoi, 2016). particularly given the unique relational needs of adolescents, the results of this intervention suggest the conversation club is offering much that these young people report to seek and value, particularly as they build on the adolescent’s need to find productive connections and engage in “shared voice” activities. it is important to note that this study indicates that group mentoring programs may be more effective for newcomer youth than would be individual mentoring programs. this possibility warrants further exploration in both research and practice settings. pryce et al./conversation club 781 results from this phase of dissemination of this promising program are encouraging for several reasons. in these two years, we saw significant and similar gains from preto post-test for all 3 regions on both the hope scale and perceived cohesion scale. significantly, this experience of hope and belonging appears to be manifest across youth migrants of 33 different countries, some of which represent nation states that maintain ongoing and persistent tensions (e.g., india/pakistan, syria/egypt). strikingly, conversation club appears to be a place where that tension is absent. in its place is the clear formation of a new community and one that appears to be able to celebrate ethnic differences while also emphasizing the newcomer youth’s transition to becoming part of canada. in summary, it is clear that the conversation club program has significant promise in impacting key adolescent outcomes of belonging and hope across 3 different regions of ontario. this initial data focused on dissemination suggests that conversation club is a program that can be disseminated to additional mentoring settings. conversation club appears to be able to engage and build on the strengths of young adolescents as well as young adult mentors preparing in engaging in supportive, collaborative relationships that enhance identity and development. these connections, between peers, mentors, and even to their homeland, offer a powerful sense of belonging and membership for these adolescents. as conversation club seeks to expand further in canada, and as others work to address the myriad needs and strengths of migrant and refugee adolescents, is it critical to maintain attention to the adaptability and flexibility of the conversation club program that has made it successful for many diverse young people. limitations while this study shows some positive outcomes, there are, as always, important limitations to bear in mind in interpreting results. the sampling plan represented a convenience sample of the youth that agreed to participate across three regions and does not include any comparison groups that could more fully show the impact of conversation club on its participants. from the quantitative component of the study, there was missing data (i.e., roughly 30-40 youth out of a total of 149 had missing data for some questions at post-test), and that missing data requires that the quantitative findings be interpreted with much caution; while not uncommon for a front-line program attempting to do an independent program evaluation in collaboration with our research team, this is still important to note. additionally, a significant limitation for the entire study (and indeed, the conversation club intervention overall) is the informal nature of how english language comprehension is evaluated. although this project took place in close partnership with program developers and staff, all of whom had history implementing the club with young people in their communities, all referrals for the program were made by schools and teachers in the english language learner (ell) classroom. researchers and the conversation club team relied on that assessment to establish how much english the participants had and their capacity to engage in the program and research protocol. future research needs to formally include a measure of english proficiency to enhance the strength of potential outcome findings. additional research is needed more broadly on conversation advances in social work, spring 2018, 18(3) 782 club, as well, both in terms of a larger sample in the club groups as well as having a comparison group, preferably one that is randomly assigned to a control condition. although this project benefits from qualitative data from two perspectives, including conversation club participants and facilitators, voluntary interviews at one time point provide a limited view into the experience of the club. further, given that this project served as an evaluation of the program and an exploration of considerations for dissemination, the focus of the interview and focus groups, while building on one another, do not serve to deepen the qualitative knowledge provided through this project. more depth in qualitative inquiry, perhaps using phenomenology or case study method, is merited in order to more deeply understand the meaning and experience available to immigrant and migrant youth through group-based mentoring programs. ensuring additional rigor through interpretation or other means (such as assessment of inter-rater reliability between coders) could also enhance this work. conclusion this mixed-method program evaluation continues to reveal encouraging findings that invite additional investigation into the potential scope and reach of conversation club to other areas of canada. this work represents strong collaboration from a dedicated set of practitioners and researchers and continues to spring from a “shared authorship” approach built on the wisdom of many years of building this innovative effort to incorporate mentoring into services for migrant and refugee adolescents. future work would do well to further investigate the ways by which conversation club can be feasibly and effectively translated to additional regions and settings, as well as ways by which membership in the club may impact more broadly the adjustment of newcomer canadian adolescents across this critically important developmental stage. references affiliation of multicultural societies and service agencies of bc [amssa]. 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(1995). the theory and practice of group psychotherapy. ny: basic books (az). author note: address correspondence to: julia pryce, phd, school of social work, loyola university chicago, 1 e. pearson, #544, chicago, il. 60611. 36tjpryce@luc.edu36t https://doi.org/10.17744/mehc.25.2.q3wda06r0ul0x97c https://www.wsj.com/articles/canada-outlines-plans-to-bring-in-25-000-syrian-refugees-1448402154 https://www.wsj.com/articles/canada-outlines-plans-to-bring-in-25-000-syrian-refugees-1448402154 https://doi.org/10.1080/10911359.2014.922789 mailto:jpryce@luc.edu abstract: this paper evaluates conversation club, a canadian after-school group mentoring intervention focusing on the expansion of the program across three separate regions of ontario. the authors use a multiple methods design, including questionnair... keywords: migrant and refugee youth, group mentoring, adolescents conversation club: a group mentoring intervention for canadian newcomer youth group mentoring with youth expansion and dissemination of youth programs the current study procedures survey data interview and focus group data findings demographics table 1. demographic distribution of conversation club participants process evaluation data qualitative findings developing english language skills increases belonging club participation increases belonging interpersonal support increases belonging focus group data discussion and implications for research and social work practice limitations conclusion references this work is licensed under a creative commons attribution 4.0 international license. students’ perceptions of service learning in an advanced research course stacy m. deck laneshia conner shannon cambron abstract: social work students are often anxious, apathetic, or resistant to learning research knowledge and skills. they may view research courses as irrelevant and disconnected from social work practice. studies suggest that service-learning improves learning outcomes in social work research courses, but less is known about the processes through which these outcomes are achieved. this study explored the perceptions of 70 masters-level social work students enrolled in an advanced research course that included a pro bono program evaluation of a shelter serving homeless men. content analysis of students’ narratives revealed three main themes. first, students perceived that they had changed their thinking about homelessness in positive ways. second, students made connections between their research experience and the social work curriculum. finally, an unanticipated theme of curriculum integration emerged. critical reflection about a meaningful experience—an integral aspect of service-learning—supported students in developing metacognitive insight. this helped students to develop and apply social work research skills. the service-learning project supported students’ mastery of other social work competencies and improved their integrated practice abilities. because this approach is effective in helping students to embrace research and integrate it with social work practice, application and evaluation of service-learning are recommended for social work education. keywords: service-learning; engaged teaching; social work; research competency; metacognition three decades ago, epstein (1987) referred to social work students as “reluctants” and averred that “no other part of the social work curriculum has been so consistently received by students with as much groaning, moaning, eye-rolling, hyperventilation, and waiver strategizing as the research course” (p. 71). notwithstanding calls in the ensuing decades to implement evidence-based practice (gambrill, 1999; thyer, 2004), and the profession’s ongoing commitment to research-informed practice (council on social work education [cswe], 2015; national association of social workers, 2008), more recent contributions to the literature suggest that social work students remain anxious, apathetic, and resistant to learning research knowledge and skills (harder, 2010; kapp, 2006; knee, 2002; steinberg & vinjamuri, 2014). importantly, some authors note that social work students see research courses as irrelevant and disconnected from social work practice (harder, 2010; hyde & meyer, 2004; shannon, kim, & robinson, 2012; steinberg & vinjamuri, 2014). therefore, it is unsurprising that social work practitioners’ use of research-informed practice is inconsistent at best (edmond, megivern, williams, rochman, & howard, 2006), ____________ stacy m. deck, phd, mssw, is an associate professor of social work at spalding university in louisville, ky. laneshia conner, phd, msw, is an assistant professor in the school of social work at the university of north carolina at charlotte in charlotte, nc. shannon cambron, edd, msw, is an associate professor of social work and bssw program director at spalding university in louisville, ky. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 456-473, doi: 10.18060/21548 https://creativecommons.org/licenses/by/4.0/ deck et al./student perceptions 457 and that practitioners often lack the values and skills that underpin the use of research in practice (shannon et al., 2012). the shift from an emphasis on measuring course objectives to assessing professional competencies has sparked a challenge in higher education. in social work education specifically, this has required a deeper consideration of how to best activate learning that is aligned with cswe research-related competencies. emerging social work literature presents evidence that engaged and/or service-learning approaches improve learning outcomes in social work research courses by increasing students’ motivation, knowledge, and skills (anderson, 2000; harder, 2010; hyde & meyer, 2004; kapp, 2006; knee, 2002). hands-on assignments and team-based work are described as essential for fostering learning that is interesting, authentic, and connected to the real world and students’ own lived experiences (harder, 2010; hyde & meyer, 2004; knee, 2002). steinberg and vinjamuri (2014) explain that this type of course design comes closest to hardcastle and bisman’s (2003) “research as practice methodology” model for teaching research as contrasted with the “educated consumer of research” and the “practitioner scientist” models (p. 32). some assert that participation in actual research activities as a part of the social work curriculum increases the likelihood that students will use research in their future practice (deck, platt, & mccord, 2015; hyde & meyer, 2004; kapp, 2006; shannon et al., 2012). kapp (2006) notes that gaining experience with conducting research in agencies, including exploring practice-related research and learning to design studies, develops skills that students will need in professional practice. while the connection between engaged and/or service-learning approaches and improved social work research course outcomes has been supported in the literature, less is known about the processes through which these outcomes are achieved. literature review adult learning according to adult learning theory, adults who invest energy in the learning process on their own can weigh the pros and cons of learning versus not learning difficult content (knowles, holton, & swanson, 2005). the principles of andragogy provide insight into strategies for facilitating adult learning including incorporating life experiences, fostering responsibility for one’s own learning, and employing a self-directed approach. adults arrive at institutions of higher education with a myriad of life experiences and varied educational backgrounds. differences in the amount and quality of those experiences increase the heterogeneity of adult learners. layne, fields, moyse-steinberg, krishna, and dinov (2009) proposed five adult learning principles that help social work students learn and apply evidence-based practices: (a) relevance, (b) a problem-focused process, (c) scaffolding, (d) hands-on learning, and (e) engineered failure. steinberg and vinjamuri (2014) described the implications of these principles for social work research courses. in keeping with the relevance principle, the authors suggested that educators help students connect theory with practice experiences as advances in social work, fall 2017, 18(2) 458 well as their personal goals and values by engaging in a research process that begins with selecting a problem and ends with applying findings in practice. problem-focused strategies are case-based with a focus on making meaning of evidence both conceptually and as a tool for research-based practice. the scaffolding principle suggests that students be given opportunities to think critically about varying perspectives and to synthesize new knowledge with their current practice approach. hands-on learning (i.e., real-time application of evidence-based practice principles) and engineered failure (i.e., “opportunities to develop skills for contextually meaningful professional practice”) are critical to this process of integrating new perspectives, information, and skills (p. 372). experiential learning kolb’s (1984) experiential learning theory proposed that learning is a transformative process of creating knowledge through experience. kolb’s four-stage model cycles from concrete experience and reflective observation to abstract conceptualization and active experimentation. hands-on learning provides an opportunity for learners to encounter tangible and transformative experiences. to develop students’ competency to respond to social concerns using best practices, experiential strategies should be employed across the social work curriculum (campbell, 2012; harder, 2010; shannon et al., 2012; wells, 2006). intentional use of community engagement, active learning, and reflection is critical to professional skill development for effective practice. in pursuit of this, there is growing evidence that meaningful connections can be made between the social work knowledge base and effective practice by embedding service-learning throughout the curriculum including in research courses (shannon et al., 2012). as a form of experiential education, service-learning extends beyond the parameters of this approach (campbell, 2012; jacoby, 1996). butin (2006) described service-learning as “an amalgam of . . . experiential education, action research, critical theory, progressive education, adult education, social justice education, constructivism, community-based research, multicultural education, and undergraduate [and graduate-level] research” (p. 490). service-learning bringle and hatcher (1995) defined service-learning as “a credit-bearing educational experience in which students participate in an organized service activity that meets identified community needs and reflect on the service activity in such a way as to gain further understanding of course content, a broader appreciation of the discipline and an enhanced sense of civic responsibility” (p. 112). this seminal definition reflected the meaning of service-learning specified in the national and community service act of 1990 (§12511), which explicitly describes service-learning as meeting community needs while enriching the academic curriculum. thus, service-learning emphasizes systematic linkages between classroom experiences and service activities (rhoads, 1998), it focuses on service as a means for learning (averett & arnd-caddigan, 2014), and it requires deliberate reciprocity among students, faculty, and community agencies (phillips, 2011). mutual deck et al./student perceptions 459 responsibility, accountability, and benefits for all parties are emphasized (hyde & meyer, 2004; jacoby, 1996; phillips, 2011). the values of social justice and citizenship underpin service-learning (donaldson & daughtery, 2011; phillips, 2011). phillips (2011) notes that “intentional, deep, and structured reflection… on the root causes of community problems, on the relationship between the service, community problems, and curriculum, and on the student’s role in the service activity” distinguishes service-learning from mere volunteerism (p. 3). in addition to promoting reflection, service-learning fosters critical thinking and problem-solving (cronley, madden, davis, & preble, 2014) and connects theory with practice experience (kapp, 2006). thus, service-learning is quite appropriate for social work education (cronley et al., 2014; robinson, robinson, & mccaskill, 2013; rocha, 2000; williams, king, & koob, 2002), aligns with its core values (e.g., service, justice, and the importance of human relationships) and the mission of the profession (phillips, 2011), and emphasizes collaboration with clients and stakeholders (robinson et al., 2013). despite this goodnessof-fit, the social work profession lags behind other professions in its integration of and research on service-learning (cronley et al., 2014; phillips, 2011; williams et al., 2002). research suggests that social work educators’ likelihood of using service-learning is driven by their beliefs about its effect on student outcomes and their expectation of obstacles they may encounter in its implementation (cronley et al., 2014). an even more basic problem is general confusion about what service-learning entails (phillips, 2011). though grounded in service, it must also include well-defined learning objectives (rhoads, 1998). finally, social work educators often use the terms service-learning, volunteerism, and field practicum interchangeably (phillips, 2011). lack of clarity about the meaning of service-learning has hindered its development, implementation, and evaluation in social work education (lemieux & allen, 2007). phillips (2011) contended that inadequate conceptual understanding of service-learning has resulted in “social work’s arrival as a late-comer to service-learning scholarship” as well as a lack of “broader disciplinary recognition of service-learning’s role in supporting social work as a civically engaged discipline” (p. 9). background for the current study it has been established that social work students often begin research courses with trepidation, viewing research as something unpleasant that must be endured in order to graduate rather than as a way to understand, develop, and/or apply evidence-based practice (steinberg & vinjamuri, 2014). applying adult-learning principles helps learners make meaning of practice-based research by integrating knowledge and skills (daley, 2001; layne et al., 2009; otto, polutta, & ziegler, 2009). in designing the advanced social work research course described here, the instructors adapted layne et al.’s (2009) learning principles for research-informed practice to the process of learning to conduct practiceinformed research. the curriculum for this required msw-level, concentration year class featured a service-learning component involving community-based practice (a pro bono applied advances in social work, fall 2017, 18(2) 460 research/program evaluation project for a local non-profit agency). students in classes offered during four consecutive years worked in task-focused small groups on courserelated activities that emphasized adult learning principles. course topics included: (a) ethical issues in program evaluation, (b) using logic models to describe programs and their theory of change, (c) needs/assets assessment and formative/process evaluation, (d) client satisfaction and cost effectiveness, (e) qualitative/mixed methods, (f) measurement tools and strategies, (g) inferential statistics, (h) data analysis and interpretation, and (i) writing and presenting evaluation reports. in keeping with adult learning principles as outlined by layne et al. (2009), the study of these research concepts and skills was made relevant and problem-focused through engagement in the service-learning project, which included evaluation design, research ethics approval, participant observation, face-to-face client interviews, data entry, analysis, and reporting. final products included a group paper, a class presentation of results to the agency’s executive director and board, and peer evaluations. the service-learning project provided scaffolding for the course via a hands-on learning experience. importantly, it offered opportunities for students to test and hone their assumptions, knowledge, and skills through engineered failure in a safe context that allowed them to learn from a direct feedback loop. use of these adult learning principles was intended to directly promote students’ development of competencies to conduct themselves as professional social workers, apply critical thinking, and engage in research-informed practice and practiceinformed research (cswe, 2008). a previously published quantitative exploration of course outcomes (deck et al., 2015) suggested that this service-learning model improved students’ perceived ability to perform program evaluation and research tasks skillfully, as measured by the evaluation selfefficacy scale (holden, barker, rosenberg, & onghena, 2007, 2008). the authors, who were also course instructors, noted unmeasured but observable changes in students’ mastery of core cswe competencies related to human rights and social justice, community context, and social work practice (cswe, 2008). anecdotally, these seemed to result from students’ meaningful, direct engagement with a vulnerable population, and from having the opportunity to directly affect program operations and community responses to this population through a hands-on experience of research and program evaluation. content analysis of existing course-related documents was used to explore students’ perceptions of the service-learning project and to gain insight into the competencies they believed they used to complete the project. these details were expected to complement the prior quantitative analysis of project outcomes by providing a deeper understanding of the process through which engaged, andragogy-based teaching methods can lead to increased research self-efficacy. through narrative analysis of themes identified in students’ written reflections on their service-learning experience, the present study aimed to provide insight into the meaning students made of the project and their perceptions of how this adult learning experience connected to their mastery of social work skills. methods data were collected between 2012 and 2015 from a convenience sample of four consecutive cohorts of msw students who were enrolled in a required advanced research deck et al./student perceptions 461 course in their concentration year. over this period, the course was taught by three instructors, all of whom used the same assignment on which this study was based. in the first year, the class was conducted using a traditional face-to-face approach; subsequently, the course transitioned to a hybrid model in which some of the material was delivered online. in all four years, the signature project for the course was a collaborative pro bono program evaluation for a non-profit agency that provides day shelter and services for homeless men. a collaborative relationship with this agency was originally established through professional connections between faculty and agency staff as well as faculty members who served on the board of directors for this agency and the local coalition for the homeless. faculty worked with the executive director and other key agency staff to design the evaluation and create the survey instrument. because the agency is required to submit an annual program evaluation to its funders, each annual survey included questions related to service utilization and client satisfaction. additional survey items that varied each year explored characteristics, conditions, and experiences of the agency’s homeless guests (i.e., trauma, access to health and mental health services, employment history, etc.). these questions were tailored to meet the agency’s needs for information as they explored options for improving existing services and adding new services and staff. sample in 2011-12 and 2012-13, there were two sections of the course. however, only one instructor retained copies of material submitted by students. data were available in those years for 11 and 14 students, respectively (two students’ assignments were missing for 2011-12). in 2013-14 and 2014-15, instructors for both sections retained student assignments. material for a total of 20 students in 2013-14, and 25 students in 2014-15 was available (data were missing for four students in 2013-14 and one student in 2014-15). in summary, this study was based on narratives submitted by an unduplicated total of 70 students over a four-year period. because narratives for the 70 students included in the study were de-identified, it is not possible to report detailed demographic characteristics. however, most students in the sampling frame (n=77) were female (84.4%), and about a third (35.1%) were african american or another racial/ethnic minority. data collection this study analyzed existing data provided by an assigned reflection paper. because student narratives were de-identified for research purposes, the study met the criteria for exemption from ongoing review under 45 cfr 46.101(b)(1) and 45 cfr 46.101(b)(4). the research ethics committee at spalding university reviewed the protocol before the study commenced. a challenge for practice-focused disciplines such as social work is to help students connect theoretical constructs of content to the application of direct practice. the advanced research curriculum described here concentrates on evaluation of service delivery in social work practice. overarching goals are: advances in social work, fall 2017, 18(2) 462 (a) to increase graduates’ use of evaluation methods by developing their confidence in their own ability to do so (via direct engagement during the course) (b) to enhance graduates’ valuing of research and program evaluation (via a direct experience of its relevance and potential impact on vulnerable populations). the intent was to create a bridge between the classroom and the community through a hands-on experience—the service-learning project. students were guided by faculty in designing the program evaluation, collecting and entering data, conducting analyses, interpreting findings, and reporting results. during one or more visits to the local day shelter, each student completed participant observation and one-to-one interviews with homeless men. after entering data into a password-protected, encrypted online database, small groups of students worked together to analyze and report findings for topicallyrelated subsets of data items. ultimately, these results were combined into a single, formal presentation to the agency’s executive director and board members, which subsequently informed the agency’s strategic planning efforts. this project afforded students a contextual learning opportunity shaped by the core competencies. a written assignment offered a chance for individual reflection on the service-learning component of the course, and was also the basis for shared reflection during in-class discussion. the instructions for the assignment prompted students to link their experience to identified competencies. they were encouraged to offer a meaningful response, but were given no other constraints or parameters. the following questions were used consistently by each instructor over the four-year period of the project: (a) how has the service-learning project impacted your thinking, either positively or negatively, about the homeless population? discuss two specific examples. (b) discuss three (of the ten) council on social work education (cswe) competencies that you have found most useful in completing service-learning activities such as instrument design/review, research ethics committee application, conducting interviews, completing participant observation, writing a literature review, etc. explain why these competencies were most useful. reflection papers were due at the end of the data collection period, and were worth up to five percent of the total points available for the course. data analysis shank (2002) defined qualitative research as a “systematic, empirical inquiry into meaning” (p. 11). in this study, the investigators aimed to gain a detailed, textured understanding of the meaning students made of the service-learning project, as well as the connections they made between this experiential learning activity and the formal social work curriculum. this understanding emerged inductively from close examination of student responses in their own authentic voice. to establish credibility, all student papers were typed verbatim into electronic files using microsoft word, and were identified only by the instructor’s name, the year deck et al./student perceptions 463 completed, and a sequential student identification number. two investigators (one of whom had not been an instructor in this course) analyzed the content of these narratives using open coding to determine themes and patterns in responses to the two questions. consultation with the third investigator, the principal instructor for the course, was used to make decisions about the coding process and to define concepts more precisely. through triangulation and peer debriefing, the investigators checked their perceptions and understanding of the data, probing for perspectives and biases that might otherwise remain unknown (lincoln & guba, 1985). findings content analysis of students’ narratives revealed three main themes. first, students perceived that they had changed their thinking about homelessness in positive ways. second, students made connections between their experience, the social work curriculum, and the requisite areas of competency in predictable as well as unexpected ways. finally, an unanticipated theme of integration emerged. impact of the service learning project the first part of the assignment invited students to reflect on whether they believed the service learning experience had a positive or negative effect on their thinking about homeless persons. across all four years, students consistently identified their experiences as positive, and described how the service-learning project helped them apply theory to practice. as an example, one student acknowledged beginning the project with a sense of pity for homeless persons who were presumed to be “drunks” and people with “mental issues.” this student articulated how direct connections with men at the shelter had changed the student’s perceptions: this learning experience has been a unique one. my personal and professional world has been stretched more than i thought it would from five simple interviews, a literature review, an observation, and preparing a presentation. it challenged my thoughts and helped me to see how much context affects my practice. it was a beautiful reminder that practice must constantly evolve just like the field of social work does. another student referenced concerns about the project prior to its execution, stating that she had been “fearful” of the interview process. she then reflected on benefits of the experience and the ways it affected her perspective on the engaged population: before visiting [the center], i had never met a homeless person. i was never able to hear the struggles firsthand. i think a lot of people assume that someone who is homeless is probably uneducated, mentally ill, or a substance abuser. people forget that these individuals are human beings with feelings, and intelligence, and a desire to get help, yet they often don’t have the resources to do so. it’s hard to think otherwise without hearing from individuals firsthand. this experience opened my eyes, helped remind me of the importance of social justice, and reinforced my belief that all individuals should be treated with fairness and respect. advances in social work, fall 2017, 18(2) 464 a few participants believed the experience had a “negative” effect, but only in the sense that they became more aware that homelessness among veterans and/or adult men is a reality in their own and other communities. curriculum and competency connections a second question asked students to identify competencies they developed during the project. over the four-year period, each of the ten cswe competencies was acknowledged by at least two students. the five most commonly mentioned competencies or skill areas were research, professional use of self, social justice, equity, and diversity. the most frequently named competency was research-informed practice and practiceinformed research. this was followed closely by professional use of self (i.e., attending to roles and boundaries, advocating for clients, practicing personal reflection, etc.). as the project clearly required both, these were intended and expected responses. however, many students also made connections between researchand practice-related competencies. for example, one student said, research has informed my practice and practice has informed my research. having worked with homeless women…last year, i was able to do a significant amount of research to inform my practice. through approaching this research into practice, i was able to learn a lot about myself and delivering my services. i was able to witness this knowledge and wisdom gained from my own practice in this service-learning project. the prevalent discussion of three additional concepts speaks to a secondary gain of the project. the frequency of mentions of social justice, equity, and diversity was separated by only one response from the top two themes. though each of the three is considered a foundational element of both social work practice and social work education, they are not concepts that are traditionally linked to research (or explicitly taught in research courses). in this course experience, students resonated with the concept of research as a practice tool that supports work for social justice and equity. diversity was framed primarily with a focus on homelessness as a category of difference. although the men they interviewed were racially diverse, students were particularly impacted by the causes and implications of homelessness that they heard described directly by those who are affected. one student explained: [being able to engage with diversity and difference in practice] allows for stereotypes to be minimized. seeing a wide age range, historical backgrounds, ethnic differences, and experiences is what allows for more effective services to be implemented as it allows for a larger population to be served and service providers to be knowledgeable about. it warrants acknowledging that approximately 15 percent of students responded to the question about competencies they used in the project by describing their own intrinsic strengths or abilities rather than discussing the cswe competencies as instructed in the prompt for the assignment. however, a thematic analysis of these responses revealed that deck et al./student perceptions 465 mentions of personal strengths and skills used to accomplish project tasks were clearly expressions of the top five competencies as identified by the other participants. integrated practice the discussion of competencies within a practice setting reflected an unanticipated yet tangible experience of integrated practice for participating students. the connections between skills, context, and community were evidenced not only by the acknowledgement of research and professional use of self as key competencies, but also in the exploration of how these were applied. in the process of using interviewing skills, for example, the implications of context and community became quite real. one student noted a clear interrelationship between direct practice, research, advocacy, and social change strategies: every one of the [five] men that i interviewed had been diagnosed or said they knew that they had mental illness. you read articles and it is common knowledge in our field that this is a big [precursor] to becoming homeless, but actually sitting down and talking to the men really had an impact on me. it made me feel that maybe there was something that i could help with or be a part of to empower these men living with mental illness, and that is exactly what this survey is meant for. student responses further indicated the application of effective engagement skills to ensure successful completion of the project. that is, practice skills were integral to the research process (and were improved by participating in the project). likewise, research skills were experienced as an equally integral part of ethical social work practice as opposed to a tool that is only employed by program evaluators and scientists. in other words, the nebulous, theoretical construct of integrated practice became real and relevant in its application. the impact on students is portrayed in this passage from one student’s narrative: one example i recall [of how my thinking changed] was when i was actually conducting the interviews. when we got to the last question, the gentleman told me that we need to know what it is to be homeless and not just doing a survey, or whatever we do. the gentleman explained that he was not that educated but unless you have lived every day in a homeless shelter for at least two months you don’t understand. i told the gentleman he was right, many of us do not know what it is really like, and i was sorry for that. i also explained that we do care, and want to do better. what i took from this is that we really don’t know what it is like… [it] is more than just learning all the stuff related to homelessness or research. there are experiences, feelings that become a part of who you are. in describing competencies developed through the service-learning project, this student noted that strengthening her ability to engage in research-informed practice “helped me see just how vulnerable and oppressed homeless men were and their culture of marginalization and repeated trauma.” advances in social work, fall 2017, 18(2) 466 discussion the service-learning approach for this graduate-level research course was associated with significant increases in students’ self-efficacy related to research and program evaluation skills (deck et al., 2015). importantly, through a process of reflecting on the experience, students also described changes in their knowledge, values, and skills in other areas of the social work curriculum. reflection helps students to “gain further understanding of course content, a broader appreciation of the discipline, and an enhanced sense of civic responsibility” (bringle & hatcher, 2002, p. 505) by providing an opportunity to think, feel, and do things differently and to make connections between inclass learning and experiential learning outside the classroom (campbell, 2012). jacoby (1996) emphasized that direct experiences are necessary, but not sufficient, for learning and development to occur. rather, it is reflection that explicitly fosters these servicelearning outcomes. effects of reflection for the four cohorts of students in this study, the service-learning project clearly opened a door to new perceptions of research (campbell, 2012). yet, students went beyond this in their comments. reflection—in writing as well as discussion with instructors and peers who shared the experience—gave them insight into ways that the research project connected to many other curriculum areas. because they moved from concrete experience and reflective observation to abstract conceptualization, students could link their realworld experiences to content they had previously learned in other classes (kolb, 1984). as evidenced by their narrative responses, they could envision ways to actively experiment with newfound understanding (e.g., notice “how much context affects my practice,” “constantly evolve” practice, treat all individuals “with fairness and respect,” “empower these men living with mental illness,” and so on). coulshed (1993) described this process as meta-learning, or developing higher reasoning and critical thinking abilities that helps make it possible for students to continue to apply knowledge they gain in future practice. one particularly important finding of this study is that new knowledge and skills gained in this course were meaningful to students. a constructivist perspective on learning suggests that educational activities should help students integrate thinking, feeling, and behavior. daley’s (2001) study of how knowledge becomes meaningful in practice for various professions including social work found that interaction with clients was often central to the process, especially if this involved an emotional encounter and/or challenged a practitioner’s existing knowledge, beliefs, or assumptions. reflection is central to processing experiences, exploring meaning, and deepening understanding. daley (2001) noted that powerful and memorable client encounters often lead professionals to restructure their work. in the current study, significant—and often emotional—interactions with homeless men elicited meaningful shifts in students’ perspectives and their orientation to professional practice (e.g., their personal and professional worlds were “stretched,” thinking was “challenged,” eyes were “opened,” and students gained “wisdom” by learning about themselves as this related to “delivering my services”). in other words, students deck et al./student perceptions 467 expressed awareness of how the service-learning project affected and changed them (yorio & ye, 2012). students also developed personal insight into social issues such as homelessness, mental illness, diversity, and oppression. yorio and ye (2012) proposed that “selfrevealing information, activated through the process of reflection, can become a source of self-development” (p. 12). this, in turn, affects students’ self-definition (i.e., “i was able to learn a lot about myself” and “actually sitting down and talking to the men really had an impact on me”), as well as their perception of themselves as leaders with a civic responsibility (i.e., “it made me feel that maybe there was something that i could help with or be a part of”). finally, the opportunity for immediate and real application of research knowledge and skills learned in the classroom changed their meaning for students. that is, information, theory, and techniques became more relevant. reflection and structured discussions developed students’ awareness of linkages between their service activities and educational outcomes. steinberg and vinjamuri (2014) noted that such reflection and discussion are “particularly useful in helping students who can articulate the relevance of research principles but have difficulty connecting this material to actual practice,” as well as those who “are quick to apply content but have difficulty grasping the nuances of important research constructs” (p. 375). the fact that this service-learning project required individual activities as well as small and large-group collaboration may have contributed to the positive outcomes in this research course. talking with members of peer groups can challenge assumptions, increase awareness of other perspectives, and enlarge each member’s point of view (coulshed, 1993; steinberg & vinjamuri, 2014). students with varying aptitudes in elements of the research process could learn these skills by observing one another in real time. lastly, working in small groups may have helped students who were anxious about the course to find mutual support through a shared experience (steinberg & vinjamuri, 2014). development of social work competencies research. the finding that using service-learning supported students’ development and application of social work research skills aligns with other studies (anderson, 2000; harder, 2010; hyde & meyer, 2004; kapp, 2006; knee, 2002). in a general sense, servicelearning has empirically demonstrated effects on academic learning, including cognitive development, critical thinking, and application of skills (cronley et al., 2014; phillips, 2011; williams et al., 2002; yorio & ye, 2012). eyler and giles (1999) explained that the observed positive effects of service-learning on cognitive development (including writing and problem-solving skills, critical thinking, and course performance) are a function of three factors: (a) students’ increased motivation to address community problems, (b) realworld opportunities to test theories and deepen understanding by directly applying knowledge and skills, and (c) exposure to others who are different. indeed, students in this course spoke of the importance of being able to directly and actively witness the ways that practice informed their research and research informed their practice. advances in social work, fall 2017, 18(2) 468 professional use of self. the literature also supports the notions that service-learning positively affects students’ personal and moral development as well as their sense of personal efficacy (cronley et al., 2014). yorio and ye (2012) referred to this outcome as development of personal insight, which encompasses identity, awareness of one’s strengths and weaknesses, professional aspirations, self-efficacy, self-esteem, persistence, and determination. they underscored the importance of reflection and social interaction— inherent in service-learning—in the enhancement of personal insight. williams et al. (2002) used bandura’s (1997) self-efficacy theory to explain the underlying process of self-development. self-efficacy, or a belief in one’s own capability, depends upon how students perceive their experience, the role they play in the learning process, and the meaning they assign to this process. service-learning involves students more directly in the learning process, and reflection supports them in noticing their perceptions and creating meaning. self-efficacy theory proposes that these conditions, in combination with experiences of agency and mastery, lead to generalizable performance expectancies, which are further associated with motivation, persistence, an ability to make decisions and set goals, and willingness to engage in learned tasks in the future. in other words, as one student in this study said, this project involved “more than just learning all the stuff related to homelessness or research. there are experiences, feelings that become a part of who you are.” social justice, equity, and diversity. research on service-learning outcomes reveals positive effects on students’ cultural competency, understanding of social issues, and civic engagement (cronley et al., 2014; phillips, 2011; williams et al., 2002; yorio & ye, 2012). yorio and ye’s (2012) conceptualization of understanding social issues as a learning outcome included students’ diversity/cultural awareness, perceptions of marginalized groups, ethical/moral decision-making, understanding of how to meet community needs, and commitment to the responsibilities of citizenship. coulshed (1993) argued that adult learners who confront uncertainty, as well as their own and others’ divergent assumptions about the nature of human behavior in social environments, may progress through confusion to arrive at a deconstruction of their own over-simplified thinking. while diversity and difference can be conceptually approached in the classroom, the experience of entering an unfamiliar place and functioning in an unfamiliar role—as students did in this project—can deepen social awareness, promote empathy, and increase tolerance and appreciation of persons who are different from oneself (williams et al., 2002; yorio & ye, 2012). building relationships with community partners, gaining a deeper understanding of social issues, and cultivating moral awareness can stimulate an understanding of and commitment to social justice (yorio & ye, 2012). in this sense, service-learning is consonant with the values and principles of the social work profession. phillips (2011) asserted that many scholars and practitioners see service-learning as a tool for social transformation. however, some have expressed concern that traditional service-learning approaches that position the university as a source of expertise and benevolence, and/or reinforce stereotypes and the status quo, do not align with the social work profession’s emphasis on strengths, empowerment, challenging privilege and oppression, and being client-centered (donaldson & daughtery, 2011; phillips, 2011). in one survey of social deck et al./student perceptions 469 work educators about perceived effects of service-learning, respondents were least likely to say that service-learning “has the explicit social justice aim of dismantling structures of inequality” (cronley et al., 2014, p. 161). when power and privilege are imbalanced among service providers and recipients, and self-determination is neglected, service-learning may undermine rather than promote social justice. donaldson and daughtery (2011) advocated for progressive service-learning models that involve service recipients in defining problems, identifying priorities, and making decisions, and that reinforce their existing and potential strengths and capabilities. servicelearning experiences that emphasize social work values should also lead students to question the distribution of power and resources. students involved in the service-learning project presented in this study made these connections, noting that “empowering these men” was “exactly what this survey [was] meant for.” asserting that “if we are to promote democratic citizenship in these challenging times, then we must foster in our citizens a commitment to caring,” rhoads (1998) expressed a critical point: “higher education has a major part to play in this process, and involving students in community service may be one vehicle for meeting this challenge” (p. 283). rhoads argued that development of positive regard for self and others is transactional, and that fostering relationships with diverse others through personalized service and meaningful interaction can heighten one’s ability to care. in this project, a commitment to serving and caring was most powerfully expressed by the student who acknowledged an inability to completely understand the experience of homelessness and expressed a desire to do better. integrated practice shannon et al. (2012) argued that widespread student dissatisfaction with social work research courses is due to the failure of these courses to incorporate research consumption, production, and integration outcomes, and the authors concluded that “demonstrating the usefulness of research to social work students through service learning projects [provides]… a more integrated experiential strategy” (p. 231). similarly, steinberg and vinjamuri (2014) maintained that when students believe that research skill development will improve their practice, their anxiety about research courses can be neutralized. a positive, yet unanticipated, outcome of this service-learning project was the depth of integration students described. as commonly taught, social work research is often esoteric and isolated from other areas of the core curriculum (kapp, 2006; shannon et al., 2012; steinberg & vinjamuri, 2014). however, students involved in this project not only described connections between research and practice, they also noticed how they had incorporated other areas of the social work curriculum. in response to cswe’s requirement to integrate research with practice, social work programs have experimented with situating integration efforts within a course, embedding integration experiences in practicum, and even overhauling the entire curriculum (kapp, 2006). some have incorporated a weaving session (colby, 2013) or transfer seminar (coulshed, 1993) to support students in synthesizing content across courses or the curriculum. coulshed (1993) referred to this metacognitive process as an opportunity for advances in social work, fall 2017, 18(2) 470 expanded learning. as expressed by students in this study, a service-learning experience in the advanced research course promoted reflection on their learning process and an active experience of weaving together all or many of the social work competencies. conclusion in summary, students who participated in a graduate-level research course with a service-learning project as the primary teaching-learning experience described learning outcomes in many domains that extended beyond the traditional, bounded content of social work research courses. furthermore, through the process of reflection—which is inherent in service-learning—students integrated their experiences in ways that allowed them to synthesize and apply knowledge, values, and skills that are often fragmented among social work graduates. this was not an incidental byproduct of service-learning, but rather an outcome that can be explained by adult learning theory (kolb, 1984). concrete experience and reflective observation are the sine qua non of service-learning, and the fact that they lead to abstract conceptualization and active experimentation is exactly what adult learning theory predicts. to date, the literature related to application and evaluation of service-learning in social work is underdeveloped and should be further explored (cronley et al., 2014; phillips, 2011; williams et al., 2002). this study contributes to that process in that it expresses—in students’ own words—the meaning made of a service-learning experience and the ways it affected their perception of knowledge, values, and skills. one participating student concluded that “it was a beautiful reminder that practice must constantly evolve just like the field of social work does.” it is to this explicit evolutionary challenge that social work educators are called. references anderson, s. 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(2006). teaching notes: making statistics "real" for social work students. journal of social work education, 42(2), 397-404. doi: https://doi.org/10.5175/jswe.2006.200400466 williams, n. r., king, m., & koob, j. j. (2002). social work students go to camp. journal of teaching in social work, 22(3-4), 55-70. doi: https://doi.org/10.1300/j067v22n03_05 yorio, p. l., & ye, f. (2012). a meta-analysis on the effects of service-learning on the social, personal, and cognitive outcomes of learning. academy of management learning and education, 11(1), 9-27. doi: https://doi.org/10.5465/amle.2010.0072 author note: address correspondence to: stacy m. deck, phd, mssw, spalding university school of social work, 545 south 3rd street, louisville, ky 40203. email: sdeck@spalding.edu https://doi.org/10.1177/1049731509333200 https://doi.org/10.1080/00221546.1998.11775135 https://doi.org/10.1080/08841233.2012.680867 https://doi.org/10.1080/08841233.2014.937890 https://doi.org/10.5175/jswe.2006.200400466 https://doi.org/10.1300/j067v22n03_05 https://doi.org/10.5465/amle.2010.0072 mailto:sdeck@spalding.edu _______ dawn apgar, phd., lsw, acsw, assistant professor/assistant chairperson, department of sociology, anthropology, social work, & criminal justice, seton hall university, south orange, nj. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 709-724, doi: 10.18060/24045 this work is licensed under a creative commons attribution 4.0 international license. increasing social work students’ participation in macro specializations: the impossible dream? dawn apgar abstract: much effort has been made to increase the number of social work students in macro practice specializations in graduate school. despite the development of pedagogical techniques which have shown to increase interest in and appreciation for macro practice, the proportion of macro students has stayed low and stable over time. using survey data collected from 474 master of social work students and graduates, this exploratory study identified both structural and attitudinal barriers which impede specialization in macro practice. data reveals that despite exposure to these methods, those whose original motivation to enter the profession was based on a desire to do clinical work are unlikely to concentrate on macro practice. structural barriers such as the lack of availability of macro programs also prevented increased specialization in macro practice. social workers who are black/african american are more likely to concentrate in macro practice, perhaps due to a recognition of the need for systems change in the united states to promote equal opportunities and rights for those who have historically been marginalized. findings indicate that current efforts to increase the number of graduates with macro specializations may not be effective. treatment of macro methods as a specialization, rather than integral to social work education, should be revisited if the profession wants to ensure enough graduates are able to make system-level changes to rectify current societal inequities. keywords: macro practice, social work education, pedagogy, specialization there has long been a concern that social work has strayed from its mission of working with those who are poor or marginalized and working towards societal changes which are rooted in social and economic justice (rubin & johnson, 1984; specht & courtney, 1994). the proportion of social workers practicing psychotherapy, primarily with middle-class, professional, white clientele, has significantly increased over the last three decades (holden & barker, 2018). while many working in the profession are helping individuals and families deal with the impact of serious social problems such as substance misuse, homelessness, and child abuse, there is long-standing criticism that far fewer in the profession are addressing the underlying policies and conditions which are root causes of these issues (abell & mcdonell, 1990; kayser et al., 1997; mattocks, 2018). undergraduate social work education has become a direct pipeline into masters in social work (msw) programs with 79% of those with bachelor’s degrees in social work (bsws) enrolling in msw programs or planning to enroll within two years of graduation (george washington university, health workforce institute [gwu], 2019). another 16% hope to enroll in the future, leaving only 5% planning on practicing social work at the bachelor’s level. according to the council on social work education (cswe, 2015), the main difference between undergraduate and graduate social work education is the ability of the latter to prepare students for specialized practice. cswe has granted discretion to graduate programs to choose their areas of specializations or concentrations, allowing them https://creativecommons.org/licenses/by/4.0/ apgar/the impossible dream? 710 to focus on specific populations, problem areas, methods of intervention, perspectives, or approaches to practice. given this latitude, half of existing programs have chosen to offer specializations in direct or clinical practice, with only 29% and 21% focused on advanced generalist or mezzo/macro work, respectively (cswe, 2019). the segregation between practice methods by most msw programs has essentially bifurcated the profession, relegating macro practice to “a marginalized subfield in social work” (fisher & corciullo, 2011, p. 359) despite its importance in the profession’s history and recognition as a professional strength (johnson, 1999; reisch, 2016). while there have been efforts to increase interest in macro methods among social workers, their success has been limited (hill et al., 2017), leaving some to question whether community practice and other indirect methods, which were integral to social work throughout its first century (1917–2020), will continue without significant changes occurring in social work education (gutiérrez & gant, 2018). this study examined the extent to which one’s original motivation to enter the social work profession is related to specialization. the study also provides critical information on the availability of macro specializations and coursework for those pursuing graduate social work degrees. using empirical data, this study identifies both structural and attitudinal barriers which may impede social work students from focusing on macro practice methods. enhancing the focus on macro practice has long been viewed as essential to the profession due to its linkage to social justice and advocacy (nasw, 2017, 2019). accomplishing the goal of having more students specialize in macro methods requires further inquiry to better understand the barriers that inhibit social work’s ability to realize this professional dream. literature review the need for social reform and advocacy aimed at ensuring the rights of those who have historically been oppressed, marginalized, and discriminated against has never been greater. in 2020, the united states held “one of the most consequential presidential elections in decades” with significant implications for the social work profession and those it serves (nasw, 2020a). there have also been widespread public calls to action to end violence against people of color after killings of unarmed black/african american citizens by police officers and others. these deaths have spurred massive protests across the nation and renewed public outcry to end racism. given these tragedies and the need for social action, social workers have been reminded of their professional responsibilities to help bring about system-level social changes including creating and advocating for policies and practices that produce equitable power, and that promote opportunities, treatment, and improved outcomes for all (nasw, 2020b). macro social work has an impact that interventions at the individual and family levels cannot, through the creation of policies and programs that are equitable and just (mizrahi & morrison, 2013). through macro methods, social workers can create professionallyguided interventions designed to bring about planned change in both organizations and communities (netting et al., 2016). while “macro practice” is a fairly recent term, the work done by social workers to help construct the nation’s welfare system, organize labor unions, pass laws aimed at equal protections and rights, and create social service organizations is advances in social work, fall 2020, 20(3) 711 rooted in the profession’s history (reisch, 2016). macro social work focuses on structural solutions to eradicate systematic inequalities and prevent social problems – not merely to ameliorate them. the current crises in the united states require dramatic reform and a renewed commitment by social workers to making political and systemic changes that are consistent with the value base of the profession. if social work is going to play a leadership role in needed reforms, the profession must embrace the call that “macro matters” (reisch, 2016). a hebrew teaching can be modified to best describe the imperative of the social work profession to embrace its macro roots, if not social workers, who have made professional commitments to challenge social injustice, then who? if not now, then when? (sefaria, n.d., pirkei avot 1:14). in order to prepare those entering the profession with the skills needed to be effective change agents, schools of social work must revisit curricula that create a macro-micro divide, or the offering of specializations which focus on one of these practice methods often leading to the exclusion of the other (reisch, 2016; rothman, 2012). since its inception in the early 20th century, graduate social work education has conformed to a typical structure of coursework spanning two years in length, with the first year devoted to foundation curriculum and the second to advanced curriculum in an area of specialization. while innovations to this structure have been proposed (colby, 2013), most programs adhere to the 2-year, full-time model, which was originally developed in response to policy statements generated in the 1930s by the american association of schools of social work (aassw) and perpetuated from the 1950s through the 1990s by cswe's curriculum policy statement (cps). current accreditation standards for graduate social work education focus on standards which require programs to articulate the ways in which they prepare students for specialized practice (cswe, 2015). specialized practice builds on generalist practice as it identifies the knowledge, values, skills, cognitive and affective processes, and professional behaviors that extend and enhance the nine social work competencies that are required in an area of specialization (cswe, 2015). specializations can be a focus on practice with a specific population, problem area, method of intervention, perspective, or approach to practice (cswe, 2018a). workforce data, gathered from a national sample of 1,405 recent msw graduates, indicate the focus of more than eight out of 10 of new social workers (81.5%) is on direct or clinical practice which aims at making change on an individual level (gwu, 2019). this micro method of practice differs from its macro counterpart with the former focused on work with individuals/families to support them through personal challenges and the latter aimed at understanding how problems originate, develop, and persist in large systems to intervene through policy or program creation/reform. the strong interest in micro practice may be attributable to several factors. historically, students have “stumbled upon” social work after considering other fields of study. abell and mcdonell (1990) found that over half of the social work students (54%) in their study reported considering another field of graduate study, most commonly psychology, before selecting social work. as psychology focuses on the scientific study of the human mind and its functions, social work students may begin their pursuit of social work with a apgar/the impossible dream? 712 predisposition toward working with individuals. in addition, research has shown that people choose social work as a profession due to their own personal experiences with trauma, early family dysfunction, or demands to provide caregiving at an early age (black et al., 1993; thomas, 2016). lastly, interest in micro methods has been attributed to licensure eligibility and student concerns about employability (hill et al., 2017). although social work practice addresses human behavior in relation to the social environment through a multilevel ecological model, msw programs have generally chosen to specialize professional training at a single level of practice, micro or macro, as allowed by accreditation standards (mcbeath, 2016). social work students in msw programs have traditionally gravitated toward micro specializations and courses, resulting in few or no macro course offerings in some msw programs due to a decreased demand (cswe, 2018a). to enhance interest in macro instruction, several national initiatives have been undertaken (hill et al., 2010), including conducting research aimed at developing pedagogical techniques to increase interest (mehrotra et al., 2018). based on a survey of cswe-accredited msw programs with macro specializations, rothman (2012) identified frequently noted problems which prevented increasing student interest in macro specializations, including lack of faculty support or interest; little or no hiring of macro faculty; and curriculum structures that are primarily clinical. rothman also cited licensure requirements in some states that require taking certain micro courses; the neglect of macro courses; a lack of encouragement for students to choose macro specializations; and inadequate resources as occasional barriers. rothman’s work implied that targeted action aimed at specifically addressing these challenges could help increase the proportion of students in macro specializations. to help implement rothman’s (2012) recommendations, the association for community organization and social administration (acosa) created the special commission to advance macro practice in social work (“the special commission”) (acosa, 2020). the special commission, comprised of prominent social work educators and leaders, has been working to ensure that 20% of all graduate-level social work students choose macro practice as a specialization by 2020 and that graduate programs offer comparable amounts of micro and macro content in both the classroom and field education (cswe, 2018a). while the work of the special commission to date has resulted in greater incorporation of the term “macro” into the 2015 epas and the development of a guide aimed at helping msw programs when conceptualizing and delivering curricula specialized for macro practice (cswe, 2018a), the feasibility of increasing the proportion of students in macro specializations is questionable given the barriers identified in the rothman report. this exploratory study aimed to evaluate whether acosa targets are realistic in the current academic climate by identifying structural and attitudinal barriers which impact students’ desire to pursue macro specializations. studying the views or attitudes of students is important as they can serve to promote or inhibit motivation to focus on macro practice. the study also provides critical information on the availability of macro specializations advances in social work, fall 2020, 20(3) 713 and coursework to those pursuing graduate social work degrees and examined relationships between student demographic data and interest in macro specializations. method data for this study were collected between november 2019 and march 2020. social workers attending 19 different professional development classes sponsored by five chapters of the national association of social workers (nasw), one university, and one public child welfare agency were asked to voluntarily complete an online survey administered via qualtrics before the programs began. a total of 706 social work attendees were eligible to participate with 474 fully completing the questionnaire (67% response rate). the anonymous survey consisted of close-ended questions assessing respondents’ original interests in entering the social work profession, their specializations in graduate school, and the availability of and participation in macro courses. to assess initial motivation for pursuing a social work degree, respondents were asked to self-report their desire for engaging in four types of practice, reflecting micro (working directly with individuals and/or families) and non-micro work (managing or administering social service organizations, formulating public policy, and/or engaging with communities and large groups on advocacy or other global issues). if none of these options fit, respondents were able to write in their own reasons for entering the field. all narrative responses were “back coded” to represent either micro or mezzo/macro interests that drove their initial motivation. social workers’ responses about their specializations in graduate school were also measured dichotomously. specializations in research, political advocacy, policy, or management/administration were considered macro-focused while those that involved case management, counseling, and direct work with individuals and/or families were coded as micro specializations. these research methods were not without limitations. data on initial motivation for entering graduate school were collected at the time of or after graduation. retrospective information can be prone to issues with reliability and validity. data was limited to that of msw graduates with no information obtained from graduate school administrators and faculty. such information may have been helpful in identifying impediments to offering macro practice specializations. despite these methodological shortcomings, this exploratory study provides insight into the structural and attitudinal factors which influence choice of graduate school specialization, a topic which has been understudied. this research was funded, in part, by a university research council grant that was received by the author and was approved by the university’s institutional review board. sample within the sample, there was much variability in the length of time since msw graduation. about 6% (n=22) were current msw students who were in the last semester prior to graduation. another 25% (n=119) graduated within the prior 12 months. half of the remaining respondents (n=233) had less than 10 years of experience with 21% of the sample (n=100) practicing for more than a decade. the average length of time since apgar/the impossible dream? 714 graduation was 5.3 years (sd=7.3). most respondents identified as female (88%) and were from diverse racial backgrounds – white (45%), black/african american (25%), hispanic/latinx (16%), asian/pacific islander (6%), and other (4%). thirty percent had their bsws. the majority (69%) of the sample completed their msw coursework face-to-face, while 25% had taken both inperson and online courses. six percent earned their msws completely online. while respondents had graduated from msw programs in 22 different states, as well as puerto rico, canada, and india, two-thirds (67%) were alumni of 30 accredited programs in two specific northeastern states. this distribution is not surprising as the study relied on a convenience sample, with 14 of the 19 trainings sponsored by nasw chapters in these two states. results data were used to gain an understanding of the extent to which social workers had the opportunity to or concentrated in macro practice. figure 1 illustrates that almost a third (31%) of social workers attended graduate programs that did not have macro practice specializations. of those who did have access to these specializations, about three-quarters (73%) chose to focus on micro or clinical methods, regardless of whether they specialized in working with a specific population or problem areas. thus, 88 out of 474 (19%) social workers in the total sample focused on macro practice (such as administration, policy, or community development) in graduate school. figure 1. breakdown of macro specialization selection based on availability figure 2 provides a breakdown of macro course availability, requirements, and enrollment of those who did not have the ability to concentrate in macro methods in graduate school (148 social workers; 31% of original sample). approximately two-thirds chosen specialization? availability of macro specialization? social work sample total sample (n=474) yes (n=326) 69% macro (n=88) 27% clinical (n=238) 73% no (n=148) 31% advances in social work, fall 2020, 20(3) 715 (68%) of those in graduate programs without macro practice specializations stated that they had access to macro practice courses, while about a third (32%) did not. over half (57%) of those who had access to macro courses stated that they were required for graduation. a third of social workers (33%) who did not have macro practice courses required for graduation elected to take them. figure 2. breakdown of macro coursework taken by social workers without macro specialization availability bivariate testing was used to examine the association between social workers’ initial interests in pursuing social work graduate degrees and their chosen specializations. table 1 includes the 88 social workers who concentrated in macro practice and the 386 social workers who concentrated in clinical methods (consisting of the 238 social workers who chose to do so despite having the availability of macro specializations and the 148 social workers who did not have a choice as they attended programs without macro specializations). results indicate that the specialization of students was strongly influenced by the initial motivation that drove their decision to pursue their graduate degrees, x2 (1, n=461) = 44.4, p<.0001, though different patterns emerged. macro courses taken? macro courses required for graduation? availability of macro courses? social work sample with no availability of macro specialization sub-sample (n=148) yes (n=100) 68% yes (n=57) 57% no (n=43) 43% yes (n=14) 33% no (n=29) 67% no (n=48) 32% apgar/the impossible dream? 716 table 1. comparison of initial motivation to pursue master of social work degree by specialization which of following types of work drove your initial decision to pursue your msw? working… specialization total macro clinical directly with individuals and/or families (children or adults) 51 (13%) cell a 331 (87%) cell b 382 (100%) in management/ administration, to formulate policy, or with communities/large groups 36 (46%) cell c 43 (54%) cell d 79 (100%) totals 87 (19%) 374 (81%) 4611 (100%) x2 (1, n=461) = 44.4, p<.0001 1thirteen social workers (12 with clinical specializations and one with a macro practice specialization) were not included in this analysis due to missing data on the reason that they decided to pursue a msw degree. not surprisingly, the vast majority (87%) of those who wanted to work directly with individuals and/or families chose to concentrate on clinical practice (cell b). only 13% who originally wanted to do micro practice work decided to pursue macro practice specializations (cell a). however, the reverse was found among those whose initial intentions were to work in management and administration, or with policy or large groups. the majority (54%) of those who chose to pursue social work due to macro interests ultimately pursued clinical specializations (cell d), while 46% stayed true to their initial motivation to study macro methods (cell c). interestingly, further analysis of those in cell d indicated that 47% (n=20) chose msw programs without macro specializations, even though they were driven to the profession due to its focus on management, policy, or changes in larger systems. table 2 confirms the expectation that interests at the time of graduate school admittance are strong predictors of specialization. those who had a strong desire to engage in macro practice when entering msw programs were more likely to concentrate in macro methods, while those who had no interest were not, x2 (2, n=474) = 91.0, p<.0001. while a small minority of social workers who were not interested at all in macro practice upon entrance into their graduate programs ended up in macro practice specializations (6%), a larger percentage of those very interested in macro practice (47%) ultimately chose to focus on clinical work. consistent with earlier analyses, 48% (n=20) of the 42 social workers who were very interested in macro practice when entering their msw programs attended programs without such specializations. advances in social work, fall 2020, 20(3) 717 table 2. comparison of initial interest in macro practice by specialization to what extent were you interested in focusing on macro practice when you entered your msw program? interest specialization total macro clinical very 48 (53%) 42 (47%) 90 (100%) somewhat 32 (12%) 224 (88%) 256 (100%) not at all 8 (6%) 120 (94%) 128 (100%) total 88 (19%) 386 (81%) 474 (100%) x2 (2, n=474) = 91.0, p<.0001 bivariate testing was done using all demographic data collected to identify any associations with those who concentrated in macro practice versus those who did not. no significant differences were discovered, with one important exception. thirty-nine percent of those who concentrated on macro methods were black or african american, while only 21% of those with clinical specializations identified as members of this racial/ethnic group, x2 (1, n=474) = 11.3, p<.001. discussion results indicate that there are both structural and attitudinal barriers which impede the proportion of social work student in macro specializations. structural barriers include the lack of availability of macro specializations with 31% of social workers attending graduate programs that did not have macro practice specializations. accreditation standards that mandate the need for a minimum of six full-time msw faculty are also structural barriers (cswe, 2015). graduate programs will be sensitive to market demands to attract sufficient numbers of candidates for ongoing sustainability. with only 13% of students interested in macro methods at the time of admission, programs with macro specializations are challenged in attracting enough students to cover costs associated with faculty salaries and ongoing operations. attitudinal barriers also exist with the majority of clinical students (67%) not interested in even taking courses in macro methods if they are not required for graduation. more than half of those who wanted to work in management/administration or do policy/community work upon admission graduated with clinical specializations. views which may have motivated them to focus on micro versus macro methods need to be better understood as they serve as attitudinal impediments for increasing the proportion of students in macro specializations. it is likely that existing structural and attitudinal barriers are related to one another as students may be more interested in clinical work due to recruitment materials which emphasize its importance. as there are more graduate programs with micro specializations and students interested in micro methods, open houses to prospective students may be prone to highlight teaching and research with individuals and families. the prominence of micro-focused programs, as compared to those with macro concentrations, may reinforce existing attitudes about the value of direct service over policy practice, administration, advocacy, and management. apgar/the impossible dream? 718 in this study, the proportion of graduates who concentrated in macro practice methods (19%) was comparable to a recent workforce survey that found that 18.5% of social workers were doing community organizing, advocacy, or indirect practice (gwu, 2019). both of these proportions were slightly higher than those reported in previous studies (hill et al., 2017; mattocks, 2018). the 19% approaches the goal established by the special commission of acosa to increase the enrollment of msw students in macro specializations to 20% by the year 2020 (acosa, 2020). while this study did not employ a probability sampling strategy aimed at generating a nationally representative sample, these findings are encouraging. however, this study’s findings indicate that it may be difficult to further increase the proportion of social workers specializing in macro practice for several reasons. the first is a structural barrier created by the principles of supply and demand in a competitive social work graduate school market. despite long-standing complaints by some that there are too many social work programs (lieberman & severson, 1998), the accreditation of new programs continues. between 2005 and 2015, the number of annual msws awarded grew from 16,956 to 26,329, an increase of 55.3% (cswe, 2018b). data collected in this study indicates that 83% of all msw applicants wanted to work directly with individuals or families. thus, for programs that are chasing the market, it is unlikely they are going to cater their recruitment and curricula to macro interests. current accreditation standards allow graduate programs to choose their areas of specialization or foci (cswe, 2015). thus, few, if any, new programs with macro specializations will likely be developed as msw programs may be reluctant to devote valuable resources to attracting only 17% of the applicant pool. this research indicates that about a third of social work students (31%) attend programs which do not even offer macro specializations. the lack of availability of macro specializations in social work programs is a structural barrier which impedes growth in the number of social workers focusing on these methods. this study’s findings also point to concerns about the continued viability of existing macro specializations. while the majority (69%) of social workers were in graduate programs with concentrations on macro methods, only about a quarter (27%) of those with the opportunity to choose macro specializations did so. as universities become increasingly competitive (musselin, 2018) and need to make resource allocation decisions consistent with their ability to gain market share (pucciarelli & kaplan, 2016), they will be tested in their continued commitment to fund macro specializations that are substantially under-enrolled when compared with their clinical counterparts in the same graduate programs. the relatively small size of macro-focused programs, in comparison to those with clinical specializations, makes them vulnerable for elimination and under-resourcing, jeopardizing their ongoing sustainability. social work education is in a predicament regarding its commitment to ensuring availability of programs specializing in macro methods. if macro specializations are not available, it is impossible to graduate more social workers trained with macro expertise. however, unless more students are interested in these specializations, new or small graduate programs will not be attracted to offering them as they need sufficient enrollment to sustain the six full-time graduate faculty currently required for accreditation (cswe, 2015). decisions to develop or continue offering macro specializations might need to be advances in social work, fall 2020, 20(3) 719 driven by a philosophical commitment by the administration of schools of social work to the importance of these methods, rather than in response to bolster program enrollments or meet market demand. achieving the modest goal of acosa to increase the number of social work students taking macro courses may also be difficult as data indicate only about half (48%) of those without the option to pursue macro specializations (n=148) even took courses in these practice methods (n=71; 57 required for graduation; 14 not required, but took). without the requirement to take macro courses, students are more likely to avoid these offerings. appealing to graduate programs without macro specializations to develop courses in these practice methods and requiring all clinical students to take these courses may help further the goal of helping clinical social workers understand why competency in macro methods are essential in today’s complex systems. this study found racial differences with black/african american social workers more likely to choose macro specializations than their counterparts. as people who are black/african american have experienced discrimination for centuries, they may be more likely to see the need for systemic change and advocacy for economic and social justice – leading them to concentrate on methods that will help bring about societal changes. bivariate analyses indicate that social workers select their specializations based on their initial motivation to pursue social work. attitudes favoring clinical work that serve as motivators for entering graduate school are barriers to enhancing the proportion of social workers ultimately specializing in macro methods. ensuring that the importance of macro practice is stressed in bsw programs may help with increasing the number of msw applicants choosing macro specializations, as most undergraduate social work students continue onto graduate study. this study found that there are some who do not end up in specializations consistent with their original interests in social work. the experiences of these social workers warrant further investigation. a minority (13%) of social workers who wanted to work with individuals and/or families upon admission ended up concentrating in macro methods. however, the majority (54%) of those who wanted to work in management/administration or do policy/community work upon admission graduated with clinical specializations. data revealed that about half of these students did so as they attended programs without macro specializations, suggesting that other factors, such as cost and proximity, may be more salient than specialization availability when making program decisions. if there is a desire to increase the number of students in macro specializations, additional research would help to identify the factors associated with choosing social work programs. a review of the literature indicates a dearth of data that can significantly explain why applicants choose to attend one social work program over another. additional research could provide insight into the reasons that more than half of those who initially entered social work education with interests in macro methods ultimately graduated with clinical foci. it may also be useful to further study the 13% of those who originally wanted to do micro practice but decided to pursue macro specializations. identifying tangible methods for enhancing interest in policy practice, management, and administration would be useful to social work programs who want to increase the number of students who choose macro specializations. apgar/the impossible dream? 720 donaldson et al. (2014) have posited that licensure regulations and enhanced employment opportunities steer students away from macro options. the degree to which these factors impacted the decisions of this target group needs to be better understood. while a small proportion of those who wanted to initially work with individuals and families chose to concentrate on macro methods (13%), the actual number of students is significant given the overall size of the cohort. understanding what drove them to switch to macro specializations despite their original clinical aspirations may be helpful to improving the proportion of students focusing on macro methods. a “build it and they will come” approach is not supported by this study. analyses demonstrate that student choice is largely driven by attitudes that motivate those to enter the profession, which disproportionately favor micro work. if there is a desire to increase the numbers in macro specializations, efforts should be made to recruit those with interests in public administration/health, policy, and law who enter social work education with an existing passion for work in larger systems. current efforts to convince those with a passion for clinical work of the importance of focusing on mezzo or macro methods will likely not be effective in a substantive way. the finding that those who are black/african american are more likely to specialize in macro methods is also important. students who have experienced marginalization and oppression while growing up may enter social work education understanding the importance of systems change to eradicate fundamental inequities in opportunities and treatment. less than half (45%) of the study sample was white, but data indicates that 70% of social workers overall and 85% of those who are licensed are white (klufts, 2020). thus, those in the profession function “in a system of white supremacy” and, “largely and collectively, benefit from white privilege” (corley & young, 2018; klufts, 2020, para. 5). thus, the majority of those entering the profession benefit from existing systems and structures. they may not be driven to specialize in methods which focus on promoting reforms to enhance opportunities for those who are marginalized or oppressed. clearly, social work education must elicit strategies to help those who have not experienced systematic discrimination based on race or skin color to understand the importance of dedicating their professional training to learning how to make systems-level, structural change. this challenge is one that exists globally and has been a challenge for social work as a profession (mindrup et al., 2011; wahler, 2012). until such discrepancies are addressed, it may be difficult to attract a mostly white social work student body to macro specializations. while not impossible, the goal of increasing the proportion of students in macro specializations requires the profession to tackle some of its long-standing problems such as competition with and delineation from other disciplines. this study clearly demonstrates that raising the proportion of social workers in macro practice specializations will require more than pedagogical techniques aimed at increasing interest in these methods. as often seen in social work practice, real change requires structural and systems-level interventions. reducing the number of full-time faculty required by accreditation standards for msw programs is needed to foster the growth of new macro-focused specializations at advances in social work, fall 2020, 20(3) 721 universities and colleges which have been reluctant to develop them based on market analyses (cswe, 2015). greater availability of macro specializations would help as nearly a third of social workers did not have the chance to focus on policy practice, advocacy, administration, or management. licensure requirements that often include the need to take psychopathology or other clinical coursework must be changed as they serve as impediments to obtaining licensure eligibility for those with macro specializations. this study clearly indicates that specialization in micro or macro methods is driven by attitudes that exist at admission. increasing the proportion of students in macro specializations will require enhanced recruitment of those who already understand the merits of system change and are committed to focusing their work in this area. enhancing the importance placed on macro content in undergraduate social work programs is a start as it may result in greater numbers of bsw graduates entering msw programs wanting to focus on macro methods. it is ironic that the fate of macro practice specializations rests with the very competencies that make these methods so vital to the social work profession. in the current climate of exposing racial injustice and discrimination, it is more important than ever to address the root causes of social problems which have existed for centuries, as well as reaffirm the profession’s commitment to social justice through systemic change. social workers must not affirm the status quo regarding structural inequities in society and social work education cannot be satisfied with the number of social workers specializing in macro practice. now is the time for action based on futurist thinking or dreaming big. the profession must remedy the divide which has caused social workers to have to choose between specializations in micro or macro methods. if the profession is to realize its mission of social activism and be comprised of those who are prepared to make needed system changes, we must embrace that “macro matters” for all social workers. references abell, n., & mcdonell, j. 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(2012). identifying and challenging social work students' biases. social work education, 31(8), 1058-1070. https://doi.org/10.1080/02615479.2011.616585 author note: address correspondence to dr. dawn apgar, department of sociology, anthropology, social work, & criminal justice, seton hall university, 400 south orange avenue, south orange, nj, 07079. email: dawn.apgar@shu.edu https://doi.org/10.1080/10437797.2016.1174652 https://www.socialworkhelper.com/wp-content/uploads/2013/06/acosa+report-by+dr.+rothman.pdf https://www.socialworkhelper.com/wp-content/uploads/2013/06/acosa+report-by+dr.+rothman.pdf https://doi.org/10.1080/00220612.1984.10778733 https://doi.org/10.1080/00220612.1984.10778733 https://www.sefaria.org/pirkei_avot.1.14?lang=bi https://www.sefaria.org/pirkei_avot.1.14?lang=bi https://doi.org/10.1093/sw/40.1.134 https://doi.org/10.1080/08841233.2016.1182609 https://doi.org/10.1080/02615479.2011.616585 mailto:dawn.apgar@shu.edu _________ lashawnda n. fields, phd, msw, assistant professor, school of social work, university of arkansas fayetteville, ar. renee m. cunningham-williams, phd, mpe, lcsw, associate professor and director, nida transdisciplinary training in addictions research (transtar) preand post-doctoral training program, george warren brown school of social work, washington university, st. louis, mo. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 354-373 doi: 10.18060/24151 this work is licensed under a creative commons attribution 4.0 international license. experiences with imposter syndrome and authenticity at researchintensive schools of social work: a case study on black female faculty lashawnda n. fields renee m. cunningham-williams abstract: there is little known about the experiences of black women in schools of social work, specifically those situated within research-intensive (r-1) carnegie-designated institutions. experiences of imposter syndrome and authenticity often result in negative experiences and poor professional outcomes for black women in academia. this study explores black women social work faculty members’ sense of self through the prisms of imposter syndrome and authenticity. social work is of particular interest in that it espouses a code of ethics and core values of service that if applied to the cultures within these schools, black women may have more equitable experiences. this article presents qualitative findings from nine in-depth interviews with black women faculty members at r-1 universities. findings revealed that black women faculty member’s experiences of imposter syndrome impacted many facets of their professional experiences from moments of paralysis to potentially unhealthy over-productivity. findings also highlight black women faculty members’ concerns around their colleagues’ professional and personal perceptions of them and this often prevented these women from presenting their authentic selves in academic settings. despite these barriers, some women chose to remain authentic regardless of possible backlash in refusing to assimilate into the dominant white culture. black women scholars cannot survive and thrive in social work education unless institutions build trust with these women by respecting their diverse backgrounds, racerelated research interests, and range of methodology. keywords: authenticity, hyper/invisibility, inclusion, imposter syndrome, social work faculty more than 100 years after the first black woman completed her doctoral education in america, black women continue to be underrepresented across all academic disciplines (howard-baptiste & harris, 2014). doctorate degree graduation rates across all disciplines for black women have improved from 6.5% to 10.4% of total degrees conferred between 1977 and 2018 respectively (u.s. department of education [us doe], 2019). yet in 2018, black women represented only seven percent of all college professors in the u.s. (nces, 2019). this percentage is even lower in research intensive (r-1), doctoral-granting institutions where blacks/african americans represented only 4.1% of all tenure and 5.26% of all tenure-track faculty members in comparison to baccalaureate status institutions, where this demographic accounted for 5.21% and 9.7% of tenure and tenuretrack faculty respectively in 2017 (vasquez heileg et al., 2019). historically and currently, these r-1 institutions are more often than not predominantly white (vasquez heileg et al., 2019). a predominantly white institution (pwi) refers to institutions in higher education with a white student enrollment at or above 50% (brown & dancy, 2010). about:blank fields & cunningham-williams/imposter syndrome & authenticity 355 black women faculty, finding themselves in the minority at these predominantly white research institutions, face unique challenges rooted in cultural differences, and both individual and institutional biases, making their experiences in these settings highly problematic. given social work’s long-term commitment to social justice (national association of social work [nasw], 2021), one might expect a healthier culture and more equitable experiences within social work education. social work’s code of ethics proscribes all forms of discrimination, demands cultural competence, and advocates on behalf of social justice, dignity, and respect for all (nasw, 2021). however, these statistics and lack of representation of black women scholars in r-1 institutions are concerning. and for black women scholars who are currently employed at predominantly white institutions, there are concerns about their experiences of racism and discrimination embedded in these structures (croom & patton, 2011). by exploring the participants’ sense of self through the prisms of authenticity and imposter syndrome, this study seeks to better understand these women’s unique experiences and inform institutional efforts toward inclusion, retention, and advancement among this segment of the professoriate. this article defines imposter syndrome as one’s hesitation in believing they are as intelligent, skilled and deserving of their success as their colleagues and often believe this unfounded truth will be discovered by others at any moment (abdelaal, 2020; clance & imes, 1978). in a chronicle of higher education blog, leonard (2014) wrote, it is crucial to note that impostor syndrome stems not just from the mismatch between the representation of an academic and one’s identity, but also from the daily experiences in which faculty, students, and administrators convey that you don’t belong, or that you don’t have what it takes. (para. 9) literature review history of oppression though black women are not alone in facing the challenges of assimilation into the academy or the absence of inclusion, they face fundamental and unique issues rooted in gender and race inequalities as faculty members (grant & ghee, 2015). consequently, these experiences result in pervasive racist and sexist discriminatory employment practices against black women (crenshaw, 1991). historically, black women’s employment in the united states is complicated and oppressive and can be understood from an intersectional lens. black scholar patricia hill collins (2002) has extensively written on this subject, stating: the vast majority of african american women were brought to the united states to work as slaves in a situation of oppression. race, class, gender, sexuality, nation, age, and ethnicity among others constitute major forms of oppression in the united states. however, the convergence of race, class, and gender oppression characteristic of u.s. slavery shaped all subsequent relationships that women of african descent had within black american families and communities, with employers, and among one another. it also created the political context for black women’s intellectual work. (p. 4) advances in social work, summer 2021, 21(2/3) 356 numerous laws and policies have reinforced the expectations that black women will survive and thrive while being discriminated against, overlooked for advancement, and overworked (collins, 2002). in response to either personal or learned experiences, black women may internalize racism resulting in moments of imposter syndrome and/or struggles with authenticity in white spaces. academic culture and climate retention of black women faculty members remains a challenge for research-intensive institutions of higher education, primarily due to climate and culture issues (allen et al., 2000; howard-baptiste & harris, 2014; marbley, 2007; pittman, 2012). as defined by stolp and smith (1995), climate represents the shared perceptions of an organization, whereas culture is the historical values, beliefs, norms, and myths understood by members of a community or organization. identifying with multiple marginalized identities, as black women do, may lead to a hostile climate wherein one’s credentials, expertise, professionalism, and contributions as a faculty member are regularly questioned (allen et al., 2000; marbley, 2007; mcgee & kazembe, 2015). these negative interactions within the academy can result in black women internalizing racist experiences causing them to struggle with imposter syndrome and/or authenticity when the issues are in fact external characteristics of an inequitable institutional culture. lee and leonard (2001) labeled the behavior in a hostile academic environment as “violent,” citing individual behavior or systemic practices rooted in the misuse of influence and power against black people at pwis of higher education. the authors use the term violence to identify ridiculing, threatening, intimidating, and gossiping behaviors. these experiences are in stark contrast to the six values espoused in the nasw (2017) code of ethics and core values of service, namely social justice, dignity and worth of the individual, importance, and centrality of human relationships, integrity, and competence. according to parsons and colleagues (2018), institutions that evolve beyond passive, independent, system-wide or department level policies around diversity and inclusion to actively problem solve at the departmental and institutional level will achieve greater success with improving their cultures and climates. relevant studies a study of 1,189 college and university faculty members at six institutions—three private and three public—found that when evaluating their experiences of the culture and climate of the institution, black women faculty members were the most dissatisfied of the four race/gender groups studied: white/male, black/male, white/female, black/female (allen et al., 2000). black women faculty members reported experiencing a reduced sense of community, limited satisfaction with the interactions they have with white faculty members, and less satisfaction with the organizational culture and climate in comparison to their white counterparts (marbley, 2007). in a study that examined stereotypes of black and white women among 109 white undergraduate students, donovan (2011) found numerous trends among white students. fields & cunningham-williams/imposter syndrome & authenticity 357 findings revealed that white students frequently assigned stereotypical characteristics to black women including the matriarch/sapphire historical stereotype of being loud, quicktempered, argumentative, dominating, tough, and strong (donovan, 2011). white students also assigned traits to the mammy stereotype including loyal, family-oriented, and kind (donovan, 2011). these stereotypes and images of black women are frequently captured in literature, media, and popular culture, and are deeply embedded in american society. collins (1991) explains, “portraying african-american women as stereotypical mammies, matriarchs, welfare recipients, and hot mommas has been essential to the political economy of domination fostering black women’s oppression” (p. 39). these oftenused stereotypical labels of black women could be seen as fluid, meaning a woman can find herself being viewed in one way or another or several ways at any given moment (collins, 1991). the findings of donovan’s 2011 study further underscore the unique experiences of black women providing an explanation for why imposter syndrome may surface as well as concerns of being authentic within academia. in lieu of authenticity, some black women engage in code-switching to dissociate themselves from these racialized and gendered stereotypes. code-switching occurs when people of different racial and/or ethnic backgrounds are present and one changes their vernacular and other forms of self-expression to better fit in (dunn, 2019). in 2015, mcgee and kazembe conducted a phenomenological study of black faculty members (50% female participants) in education departments at 13 institutions across the country. they found that when presenting their research, participants believed they faced racialized stereotypes in expectations to behave as performers, believing humor and smiling were as necessary to their scholarly presentations as the substantive content. additionally, participants reported receiving criticism for lacking scholarly integrity, leading to their experiences of pressure to counter and manage these stereotypes and biases, again presenting barriers to authenticity and feelings of inadequacy rooted in imposter syndrome (mcgee & kazembe, 2015). in 2018, allen et al. conducted a study to understand the barriers to research african american social workers encountered and overcame. they found that most of their sample (n=10) had similar experiences with the devaluing and constant questioning of research focused on african americans, as if this population was not worthy to be studied (allen et al., 2018). social work education despite social work’s core value of social justice (council on social work education [cswe], 2017), black social work faculty still experience discrimination due to their race and gender in academia. black women social work scholars’ experiences in the academy are often occurring within the predominantly white male academic context, which commonly leads to negative interactions with administrators, faculty, staff and students in response to the black women faculty’s gender and race (vakalahi & stark, 2010). when discussing their informal support group within their school of social work, comer and colleagues (2017) stated that women of color in higher education are often told they were hired due to their race and gender; this notion is in fact another way messages of inferiority and incompetence are perpetuated. social justice is a tenet of social work education and advances in social work, summer 2021, 21(2/3) 358 social work practice with the intention of disrupting and dismantling oppressive structures, except those within social work education (hudson et al., 2017). while there has been endless work towards equitable experiences for black women in social work education, there has not been much improvement, and each generation faces nearly identical challenges as those who came before them, even in the 21st century (vakalahi & stark, 2010). combating white supremacy continues to be a burden for black women in social work education. although there have been advances for this demographic, they continue to fare worse than white women and black men with regards to representation, tenure and promotion, and compensation in social work education (pewewardy, 2007). edwards et al. (2012) conducted a study about the experiences of african american female faculty in pwi schools of social work (n=108) and found that respondents from schools of social work with greater representation of black faculty members were more likely to have achieved tenure. this finding again speaks to the value of representation in academia and the ways it can support black women on their journey to not only survive within these institutions, but to thrive. while a substantial amount is known about the experiences of black females in higher education across disciplines, we know a lot less about the experiences and outcomes of black female faculty members at research-intensive schools of social work. the purpose of the present study is to help bridge this gap in the knowledge and determine if researchintensive schools of social work have more inclusive cultures as may be expected based on the pillars of the discipline and the nasw (2021) code of ethics. this information is important to support institutional efforts in the recruitment and retention of diverse faculty and result in potentially more culturally competent evidence-based practices. theoretical framework when seeking an understanding of the experiences of black women faculty in schools of social work at research-intensive institutions, this study used a case study methodology informed by black feminist theory (collins, 2002) and intersectionality (crenshaw, 1989, 1991; hooks, 1981). it is important to note that intersectionality was introduced by black scholars and black feminists, namely lorde (1984), hooks (1981) and crenshaw (1991), to broaden prior waves of feminism that often excluded race and the dual oppression of black women (nash, 2011). black feminist theory is built upon the historical collective struggle and resistance of black women regardless of their individual experiences and priorities (howard-hamilton, 2003). the feminist/intersectional case study methodology allows the capture of the historical, cultural, personal and social elements of this phenomenon while offering a platform centered on black women’s experiences in higher education (howard-hamilton, 2003; jones et al., 2013). it also lends itself to studying the complex and intricate details of a single case (stake, 1995), which in this case is black female faculty members at schools of social work. intersectionality describes how black women’s experiences are unique in that they are constantly coupled with their race and gender, resulting in black women having lived as “others” in society resulting in differentiating discriminatory experiences from both black fields & cunningham-williams/imposter syndrome & authenticity 359 men and white women (lloyd-jones, 2014; roberts, 2014). intersectionality is multidimensional in that it considers overlapping experiences related to marginalized identities and how these identities impact a person’s agency, viewpoints, and aspirations, including women of color faculty members facing presumptions of incompetence as instructors, researchers, and leaders in higher education (carbado et al., 2013; comer et al., 2017; jaysiiree et al., 2011). method recruitment and data collection the decision to use a case study methodology was first approved by the dissertation committee then an application was submitted to the institutional review board. the institutional review board (irb) at washington university in st. louis approved this project in september 2019 as the first author’s dissertation project. yin (2012) stated that case studies are frequently used to conduct evaluations, and one element of this study is the evaluation of the self-management of the participants. following irb approval, the first author sent an email to potential research participants following her website content review of the faculty member pages at the top 20 schools of social work (u.s. news and world report, 2019). requirements for inclusion in the study was to identify as black, female and a current faculty member at an r-1 school of social work. carnegie designation of r1, also referred to as research-intensive, are institutions that are doctoral universities with very high research activity (carnegie classification of institutions, 2021). participants from the authors’ home institution at the time of the study, washington university in st. louis, were excluded even if they otherwise met the inclusion criteria. as a former equity, diversity and inclusion practitioner within higher education, the first author relied upon years of experience in developing climate surveys supported by the current literature to craft the questions and execute the in-depth interviews. the goal of the interviews was to better understand how these women managed their sense of self. sample questions used for data analysis in this article include: • “how do you define inclusion and equity?” • “do you believe your race and/or gender have impacted your experiences in the academy independently or as intersecting identities?” • “have you experienced imposter syndrome (ask if definition needed) at any point throughout your journey to and as a faculty member?” • “do you present as your authentic self at work?” • “do you believe your experiences as a professor have been in alignment with the national association of social work (nasw) code of ethics?” these questions served as a guide and follow-up questions were asked based on responses. thus, all participants may not have been asked the exact same questions. advances in social work, summer 2021, 21(2/3) 360 analytical methods one goal of this study was to examine whether black female faculty members in schools of social work had similar experiences reported from other disciplines. as is the case in deductive coding, conceptual and empirical literature from various disciplines aided in interpreting the primary themes that emerged from the data collected. the deductive coding process involved a review of the literature on inequities and barriers to inclusion and success in the academy for black women faculty members to discover any existing themes and patterns about this topic (allen et al., 2018). examples of the deductive codes drawn from the literature are lack of social/political preparation, professional mentoring, and ambiguity of tenure and promotion. the first author used prior experience to guide the assignment of sub-themes to the data as some of the text could have been coded in many different themes, however; hierarchical coding allowed the text to be coded at different levels making distinctions between those data providing an overview and those which are more detailed (braun & clarke, 2006; king 2004). there were two rounds of coding by the first author to improve the clarity of the categories, themes and concepts (saldana, 2015). as previously mentioned, the first author has years of experiences as a diversity administrator in higher education that not only led to this line of inquiry but helped shape the interview questions. she conducted all the interviews and solely coded the data as the project was conducted as her dissertation study wherein research independence at this level is required. in addition to irb oversight of the project, a committee of faculty experts, chaired by the second author, approved and supervised the project. the first author identifies as a black woman faculty member at an r-1 school of social work housed within a predominantly white institution making her an insider to the experiences of this group. as such, to further ensure data integrity in data coding and analysis, the first author met with one committee member throughout this process, given her training and expertise in cultural anthropology and qualitative methodology. participant profiles the sample size of this study (n = 9) represents nearly one-third of the target sample of 30 who agreed to completing recorded, in-depth interviews about their experiences. two participants opted to meet inperson in october 2019, for audio-only recordings, and seven had online video-recorded interviews. study participants represented nine different r-1 institutions, with varying lengths of time and rank in the professoriate ranging from 220 years of experience with one professor, three associate professors and five assistant professors. all participants’ research related to either their race or gender. seven participants have doctoral degrees in social work with one being in education and another in sociology. all the study participants attended pwis for their undergraduate and graduate programs and all but one of the participants have worked full-time outside of higher education. finally, all but one of the participants are either the only or one of two black women faculty members in their schools of social work. table 1 summarizes the professional characteristics of the participants. fields & cunningham-williams/imposter syndrome & authenticity 361 table 1. participants professional characteristics participant name* academic rank (professor) years of experience ever attended an hbcu experience outside of higher ed social work phd doris associate 20 no yes yes dana full 15 no yes yes elise assistant 3 no yes no/education keisha associate 7 no yes yes laura assistant 3 no yes yes nicole assistant 3 no yes yes robin associate 15 no yes yes sheila assistant 4 no yes no/sociology tracy assistant 2 no no yes *pseudonyms used to protect participants’ identities. findings the in-depth interviews with black women faculty members at research-intensive schools of social work produced highly nuanced understandings of the experiences of these participants. while the larger study examines structural challenges in the institutional environment, this article focuses on the management of self in the face of institutional and internal racism, using individual-level experiences of imposter syndrome and authenticity as prisms to understand these experiences. this analysis produced two sets of themes, as outlined in table 2. table 2. data prisms and themes imposter syndrome primary prisms authenticity • lack of inclusion themes • self-management • productivity • code-switching • student interactions • appearance imposter syndrome study participants were asked to provide examples of how they managed in the face of such adversity. they were asked directly if they had ever experienced imposter syndrome and the ways in which it manifested for them. following are some of the responses that provide insight into how imposter syndrome was experienced as well as managed by these black women faculty members. productivity nicole shared, “i overprepare for meetings. i try to make sure i have three points i want to make; i arrive early, and i watch what i say.” she noted that this routine leads to a lot of anxiety and wasted time. she believed if she did not participate and add something of value to faculty meetings it would be a sign of deficiency and others may see her as incapable of meeting the standards of her position. nicole noted that other faculty members often sat advances in social work, summer 2021, 21(2/3) 362 silently in these meetings, but she believed she was managing other’s perceptions of her and that put her slightly at ease though it was laborious. elise expressed that she constantly feels pressured to be the best, resulting in exhaustion as she chases an unattainable goal of perfection. elise had only recently become aware of the term imposter syndrome after joining her institution three years prior. she said during orientation she heard it referenced numerous times and how the school did not want people to experience it, but they did not create a culture that reflects those wishes. she believed she never had a champion for her success upon arrival. elise had entered social work with a background in education and was only slightly hopeful that social work would be less toxic than higher education in general. dana, who is in her 15th year, stated, “even after all these years i still get nervous submitting manuscripts, presenting my research and applying for grants. i have come a long way, but i continue to have moments where i feel i do not belong, i am not good enough and i will be unfairly critiqued.” it was insightful to hear that after decades of success including scholarly and academic acclaim, dana continued to manage her reactions to both institutional and internal racism. tracy said, you know the way we normalize a workload that i think is really unmanageable and so when everyone around you is acting like it’s normal to be responsible for what you’re responsible for and you are drowning that makes for that misalignment, that feeling of i can’t do this. i can’t pull this off. you know this isn’t for me? i would say that’s really probably the only domain in which i feel a disconnect in belonging to the institution. her comment offers another perspective of how imposter syndrome can affect this group. lack of inclusion keisha shared that upon entering the job market she was often told she would easily secure employment because identifying as a black woman would allow an institution to check two boxes related to her as a diverse hire. this is what she believes was the catalyst of her struggles in her first few years to believe she had what it took to be successful and was not a hire to meet a quota. in her 7th year now, keisha believes that she secured tenure because she worked to meet and, in some ways, exceed the requirements. several of these statements are reminiscent of the age-old adage that black people must work twice as hard just to be seen as mediocre. black people often receive these messages early and often throughout their lives. erin shared in this sentiment and responded with “there’s nothing i can do other than kill myself trying to meet a certain mark which means i’m going to kill myself doing it right?” laura, who is in her second year as a faculty member, attributed her decision not to use the title doctor to her feelings of imposter syndrome. she believed it would cause people to have expectations of her she was not sure she could live up to, “i have students call me professor, not doctor. i often wonder if maybe i heard god wrong, and i’m not cut out for this career.” keisha, who has tenure, believed she has always experienced some element of imposter syndrome, though she does not recall the term being used until recently. from a very early age, she recalls being the only black girl/woman (or one of fields & cunningham-williams/imposter syndrome & authenticity 363 very few) in spaces she often felt she did not belong. it was not until college that she was exposed to other smart black females. while she feels she has come a long way with her self-confidence, she knows the work will be ongoing. doris, the participant who has been in the academy the longest, believed imposter syndrome is rooted in the reality that merit does not warrant outcomes. doris expressed having seen many colleagues who did not have the best academic records advance to leadership positions while some who had consistently achieved success were overlooked for these same opportunities. a few other study participants shared in this sentiment that hard work was not always equitably recognized or rewarded. these experiences were not exclusively along gender or race lines, but minoritized groups were more often in the exceptional yet overlooked group. student interactions most of the women reported getting decent evaluations, but some of the qualitative responses were more related to their race and gender than their performance as an instructor. keisha received a comment on an evaluation that her clothes were colorful and bright, which led to her revamping her wardrobe to be taken more seriously. others reported receiving feedback that used words like aggressive, intimidating and too familiar. these negative remarks, disruptive moments in the classroom and unwarranted reports of misconduct can feed into the feelings of imposter syndrome these women have experienced. it is important to note that three respondents reported receiving teaching awards, and they attributed these accolades to the authenticity they carry into the classroom with them. authenticity self-management this study found that six of the nine participants felt uncomfortable presenting their authentic selves at work at some point throughout their tenure as a faculty member. the respondents in this study sacrificed their authenticity by managing their speech, managing their research, managing their moods, managing the discomfort of others, code-switching and being overly critical of their appearances. nicole had several thoughts on how she moves throughout her school as a black woman. she emphasized wanting to “do it right” because it is important to her that no one ever thinks she was hired to meet a diversity need of her institution. being more specific, nicole said “it’s a lot of energy exerted because there’s this pressure because you feel like people are looking at you that way even if they never say it. you are always having to second guess what you wear, what you say." this is what led to nicole’s over-preparation for meetings as discussed earlier. code-switching when asking about authenticity, we talked about “code-switching,” a practice of changing one’s vernacular when interacting with those of different ethnic and/or racial advances in social work, summer 2021, 21(2/3) 364 backgrounds. the responses were consistent among the interviewees. although codeswitching was a common practice, as these women secured tenure many found themselves engaging in this practice less frequently. several of these women felt more comfortable being their authentic selves with their students than with their colleagues. when asked to elaborate, tracy said, “when i’m at the front of the classroom lecturing, my students get a pretty raw version of me. i am not concerned about tone, or vernacular in the same way i am during faculty meetings.” similarly, elise added that she does not present her authentic self because she does not trust that others do either. she believes people bring representatives of themselves to work and know what is acceptable or not; therefore, her white and or male colleagues may not share their thoughts of racism and or discrimination though it may be clear in their behavior. appearance even though many of the participants attended top-ranked schools for their doctoral studies and have a proven track record of academic success, at times their self-doubt and insecurities may surface if they show up in spaces in a way that someone has arbitrarily decided is unprofessional. it is these unwritten rules and additional layers of scrutiny that result in these women feeling they have to dress, speak and behave in a way that is acceptable to their superiors, colleagues and students. this self-censorship results in exhaustion while reinforcing their challenges with imposter syndrome and upholding white supremacy. three of the respondents were sure to present their authentic selves at work and sheila noted that “people are bothered by it and i love it.” she then states that she knows she is good at her job; her research is necessary and improving the lives of black people and she wants to challenge the academy to grow independent, innovative scholars. the more senior faculty members in the sample both show up as their authentic selves to their schools of social work. in different ways they expressed it was a journey to arrive at their current level of comfort. these changes were a result of securing tenure and surviving and thriving in the academy for an extended period of time. donna specifically stated, “they are going to see you as the problem, so you may as well be the problem.” despite having completed doctorate degrees, these women believe their competency is scrutinized because of their slang, tone, or even their fashion choices, leading them to question how authentic they can be within their professional spaces, engaging in code-switching and altering their person to conform and put others at ease. discussion this study explored the experiences of (n=9) black women faculty members at r-1, predominantly white schools of social work. we focused on how these women managed the internal and external racism through the prisms of imposter syndrome and authenticity. we sought to learn of challenges as well as strategies or tactics used to combat and overcome these experiences. findings from this study confirm that black women faculty in social work are having experiences comparable to those of black women across other disciplines in higher education. these findings are in line with a study of 14 black faculty fields & cunningham-williams/imposter syndrome & authenticity 365 members at a midwestern research-intensive institution (pittman, 2012), in which 86% of faculty members interviewed believed race played a significant role in their campus experiences in general and 71% of respondents felt that their race-related experiences were negative and included feelings of exclusion and tokenism. black women in the academy are often facing barriers to success due to stereotypes historically associated with black women. stereotypes reflect the power denied to minority groups, as others have been able to define themselves and control the narratives of their experiences and worth (howard-hamilton, 2003). it is important to note that the possibility of being associated with a stereotype is impactful before any direct consequences. study findings complement those of bradley (2005) who posited that institutions of higher education cannot ignore the likely impact these stereotypical images can have on the experiences of black women, considering how pervasive the images remain in popular culture. additionally, these stereotypes are cause for concern as they devalue black women and diminish perceptions about their intelligence, resulting in their feelings of inferiority in the academy (jones et al., 2013). collins (2002) noted that justification for race, gender, and class oppression is provided by the frequency of images of black women as “other.” it is this feeling of being seen as “other” that can lead to these scholars having to manage their responses to both internal and external racism which this study explored through the prisms of imposter syndrome and authenticity. when participants were asked why they continued to endure these often raging waters, they primarily spoke of the benefit of being able to ask and answer valuable questions they believed improved the human experience. many spoke of improving the lives of those with whom they share identities. there were also many references to the freedom and flexibility that being a professor afforded them. not feeling as though they are being micromanaged was important to many of the participants. another common response to why they remained in their positions was the students. they spoke of the black students who needed to see them to know that it was possible to pursue this line of work as well as to be a resource to these students. it was also a common response that non-black students needed to gain experience with black women as well. in preparation for direct practice and other career paths, these women felt they were broadening the cultural competency of students who may not otherwise encounter a black faculty member and engage in the conversations they were often having with their students about power and oppression. limitations there are a few methodological limitations this study encountered that are important to address in future research. this study interviewed current faculty members to understand their lived experiences, but it is worth noting these women have had time to develop coping mechanisms as they all attended predominantly white institutions prior to joining the professoriate. the tactics and strategies these black women have learned over the years allows them to survive and thrive as professors at r-1, predominantly white schools of social work; often labeled as hostile environments (lee & leonard, 2001). it would be useful to expand the study to black women who have left professorships to understand how they arrived at those decisions and what if anything could have led them to stay. advances in social work, summer 2021, 21(2/3) 366 another limitation of this study is that all the women interviewed attended pwis throughout their academic careers; it would be useful to interview those who have experiences in more diverse institutions and identify differences and similarities. future studies may also benefit from interviewing multiple faculty members from the same institution when possible to compare and contrast their experiences in hopes of gaining a richer understanding of the culture and climate. this study’s sample size (n=9) was a limitation even though the researchers sought additional participants from more institutions. however, researchers often believe theoretical saturation typically occurs between 10–12 interviews, and different approaches to qualitative research have various considerations which could result in a case study analysis being as small as a single case while many phenomenological studies have between six and 10 participants (breen, 2006; padgett, 2008). all the interviewing and coding was completed by the first author, resulting in the possibility of researcher bias. to prevent these biases and personal experiences from excessively influencing the study, use of a reflexive journal was implemented. this journal was used to critically examine why and how decisions were being made throughout the study. it was a priority of the first author to ensure that these decisions were being made in the best interests of the study and not being unduly influenced by the researcher’s own biases, perspectives, and personal narrative. in addition to the journal, the first author debriefed with dissertation committee members and doctoral student peers. despite these limitations, this study makes an important contribution to the literature by identifying key challenges identified by black women scholars in social work and r-1 institutions. implications implications for practice many of the practice considerations around supporting black female faculty members in research-intensive schools of social work are the responsibility of both the school and university leadership teams. these results have implications for hiring practices to support the entry and retention of black women faculty. for example, findings suggest the development of postdoctoral programs as feeder pathway programs into tenure-track faculty positions at the same institution. such an effort can be a part of a larger strategic planning document showing a true commitment to diversity as reflected by resource allocation (fries-britt et al., 2011). throughout their time in a post-doctoral program, black women scholars can be assigned mentors who can support them with socialization and understanding institutional norms that can reduce their instances of imposter syndrome. further development of their research agenda can also be a benefit to these fellows prior to the start of their journey to tenure, which can also help with confidence and a sense of belonging which is the opposite of imposter syndrome. another hiring practice these institutions may benefit from is cluster hiring. cluster hiring is a practice of bringing in multiple new employees together to create a cohort experience, which could eliminate the challenges of isolation and lack of representation this study discussed. specifically, authenticity was often more problematic for the women who were the sole or one of very few black faculty members at their institution. representation will fields & cunningham-williams/imposter syndrome & authenticity 367 reduce the hyper-visibility some reported as well as decrease moments or patterns of feeling invisible. attention also needs to be given to matters of inclusion and equity in academia at the institutional level as well. it is critical to acknowledge how a larger system of oppression comprised of economic, political and ideological forces that function to prioritize white male interests and positioning while guaranteeing black women are assigned to a subordinate status (collins, 2002). leadership is tasked with communicating the priority of equity and inclusion while backing this priority up with practice, policy, and procedures. for example, professional development targeting cultural competency as a requirement for all faculty members can improve the institution’s overall consciousness (dade et al., 2015). changing an institutional culture is a slow and arduous process but it is the only way black women will be empowered within higher education and comfortable being their authentic selves and knowing their worth through a critical mass of individuals with a changed consciousness (collins, 2002). creating and nurturing a culture of collaboration is important to aid in the success of black women faculty members. if faculty honor the rigor and quality of this research, it will help black women manage the challenges they face with imposter syndrome. ensuring prepared and dedicated mentors are available both within and beyond the schools of social work would support the success of this population (kelly et al., 2017). in addition to support, opportunities to create and maintain trust with black women faculty members is vital. when trust is absent, these negative experiences will continue to overshadow the positive aspects of these females’ professions. one way to build trust with black female faculty members is to host events that present opportunities to share the various supports the institution has in place. these events can range from welcome receptions for black women faculty members to meetings throughout the academic year to discuss any discrimination, isolation or other negative feelings they may have experienced (abdul-raheem, 2016). black feminist thought reminds us that even though these women may share identities, their experiences remain unique, and they may or may not arrive to a point of group knowledge, meaning they can benefit from a variety of supports specific to their needs (collins, 2002). transparency, empowerment and asking these individuals what they need are good ways to begin committing to genuine and informed change. a lack of transparency was often the source of mistrust. discussing changes that leadership would like to see as well as the plan of action to achieve the changes will let black women faculty members know that improving the culture is a priority and resources are being allocated toward improvements. this level of transparency is important in that it is an opportunity to provide support and respect to this group immediately who often believe they have not historically been afforded either. implications for research this case study highlighted the experiences of the nine black female faculty members at research-intensive schools of social work showing that their experiences are often inequitable and unnecessarily exhausting at best. these women have and advances in social work, summer 2021, 21(2/3) 368 continue to endure toxic work environments that create a climate in which they constantly question their decisions to stay and their ability to succeed. sadly, many of these internal battles remain present for those who have seemingly successfully navigated these difficult situations for as many as 20 years. specifically, the findings provided insight into the experiences of black women faculty members and imposter syndrome and the energy expended conforming to the expectations of the dominant culture and avoiding behavior that may be viewed as stereotypical. an area of further inquiry could be determining if there are mental health implications of the negative experiences these women shared. what are the true costs of feeling the need to work twice as hard as others to be average? what does one sacrifice when constantly censoring their language, appearance and general interactions with colleagues? it would also be valuable to expand the research to include black females who chose to leave academia. understanding if they left as a result of the “othering” related to imposter syndrome and/or authenticity as discussed by the women in this study is important. another line of inquiry would be to explore the experiences of former faculty members who are now administrators in leadership roles. critical lessons about the climate for administrators can be learned if these black women continue to deal with imposter syndrome and believing they cannot be authentic. it would be important to understand how their experiences have changed throughout their tenure in the academy. comparison studies based on age of participants and length of years in the professoriate could also be telling as to whether or not there may be generational changes in expectations surrounding equity and inclusion. are there any trends relating to authenticity and or imposter syndrome either increasing or decreasing? expanding this research to include adjunct faculty and current doctoral students who aspire to full-time faculty roles could provide an additional layer of understanding the experiences of this group. research that investigates the experiences of black women from graduate school through professorship could bridge a significant gap in the literature in social work education. understanding and closing leaks in the pipeline of black female social work faculty members at all types of institutions calls for further exploration. future studies examining specifically the experiences related to scholarship for the black women faculty members whose research centers black women could further our understanding of this subset of faculty members. according to crenshaw (1989), “black women are caught between ideological and political currents that combine first to create and then to bury black women’s experiences” (p. 160). many black women academics study black women utilizing black feminist thought and intersectionality theories to not only advance the experiences of black women but to control the narratives around said lived experiences. black feminist thought prioritizes empowerment and believes it is essential that black women intellectuals are committed to advancing the theme of selfdefinition because speaking for oneself and crafting one’s own agenda is essential to empowerment (collins, 2002). fields & cunningham-williams/imposter syndrome & authenticity 369 conclusion this case study of the experiences of nine black female faculty members at researchintensive schools of social work provided an opportunity for voices that are often silenced to be amplified. it is evident that the black female faculty members demonstrate determination and dedication despite the lack of representation, equity and inclusion within their institutions. each of the interviewees stated that no one had ever asked the questions of this study or inquired about their experience as a black female faculty member. black feminist thought and intersectionality speak to the power of a counter narrative that can only be created by providing a platform for the often-silenced voices of black women navigating multiple oppressed identities. although social work is guided by a code of ethics and values of service such as worth and dignity of the individual and social justice, these tenets are not translating to inclusive and equitable experiences for black women faculty members. it is not enough for black women to simply survive in higher education, rather inclusion and equity will be achieved when these women are able to thrive in healthy and inclusive environments. social work is of particular interest in that it espouses a code of ethics and core values of service that if applied to the cultures within these schools, may provide black women with more equitable experiences. black women scholars cannot survive and thrive in social work programs unless institutions build trust with these women by respecting their diverse research interests, choices of methodology, increasing representation across all academic ranks and fully adhering to the nasw code of ethics. references abdelaal, g. 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(2012). applications of case study research. sage. author note: address correspondence to lashawnda fields, ph.d., school of social work, university of arkansas, fayetteville, ar, 72701. email: lnfields@uark.edu https://doi.org/10.1080/01419870.2014.931988 https://files.eric.ed.gov/fulltext/ed386783.pdf https://nces.ed.gov/programs/digest/d19/tables/dt19_324.20.asp https://www.usnews.com/best-graduate-schools/top-health-schools/social-work-rankings https://www.usnews.com/best-graduate-schools/top-health-schools/social-work-rankings https://doi.org/10.1177%2f0886109910364343 https://stcl.edu/journals/hispaniclaw/2019/2019heilig1-31.pdf mailto:lnfields@uark.edu this work is licensed under a creative commons attribution 4.0 international license. equine facilitated therapy and trauma: current knowledge, future needs marlys staudt donna cherry abstract: equine-facilitated therapy (eft) is a relatively new treatment for trauma and ptsd. eft as well as animal assisted interventions in general have been introduced and implemented in mental health treatment for children and adults, though the research in support of these interventions has not kept up with practice. the purpose of this review is to examine the use of eft for clients suffering from trauma/ptsd. studies were included if ptsd/trauma was assessed and/or was measured as an outcome. a search of relevant databases resulted in nine peer-reviewed studies that met criteria. studies are summarized and implications for future research are discussed. in general, findings suggest that eft is a promising intervention for trauma/ptsd. recommendations include a call for more research that includes veterans as well as for research that explicates the mechanisms by which eft may be effective. keywords: trauma; ptsd; equine therapy; eft in recent years animal-assisted interventions (aai) have been increasingly used as an adjunct to traditional mental health treatment. as is often the case with the introduction of new interventions, the research has lagged behind practice: that is, aai’s have been implemented without research evidence supporting their effectiveness. however, this is beginning to change, and studies with more rigorous designs are increasing (hoagwood, acri, morrissey, & peth-pierce, 2016). the use of horses in treatment is one type of aai, and is often referred to as equinefacilitated therapy (eft) or psychotherapy, or equine assisted counseling. although the importance and relevance of humans interacting with animals has been noted for some time (amiot & bastian, 2015), it is only recently that horses have been integrated into mental health treatment. as is true with aai’s in general, literature is just beginning to emerge on eft (selby & smith-osborne, 2013). trotter (2012) describes three models of eft, each of which has an accrediting body. the certification board for equine interaction professionals (cbeip) offers credentialing for mental health professionals who incorporate horses into their practice. the professional association of therapeutic horsemanship international (path intl.) certifies equine specialists who partner with mental health professionals who use horses in treatment. in this model mental health professionals could also be credentialed as an equine specialist. the equine assisted growth and learning association (eagala) requires cofacilitators, one being an eagala certified mental health professional and the other being an eagla certified equine specialist. eagala also requires that activities be nonmounted, with the client on the ground. ______________________ marlys staudt, associate professor, college of social work, university of tennessee, henson hall, knoxville, tn, mstaudt@utk.edu or donna cherry, associate professor, department of social work, east tennessee state university, cherryd@mail.etsu.edu copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 403-414, doi: 10.18060/21292 https://creativecommons.org/licenses/by/4.0/ staudt & cherry/equine facilitated therapy 404 activities in counseling sessions using horses can vary widely, and include mounted and non-mounted exercises as well as caring for the horse (meinersmann, bradberry, & bright robers, 2008), and can occur in group or individual sessions. eft is pan-theoretical and can be integrated into treatment no matter the theoretical orientation of the therapist. most often it is complementary to or an adjunct to traditional therapy, though it can be a stand-alone treatment. while reviews of eft (anestis, anestis, zawilinski, hopkins, & lilienfeld, 2014; lentini & knox, 2009, 2015; selby & smith-osborne, 2013) and aai for trauma (o’haire, guerin, & kirkham, 2015) have been published, none have focused solely on eft applied to trauma. lentini and knox (2009, 2015) conducted two reviews of eft. study samples in the first review included adults with psychiatric disabilities, bereaved children, “at-risk” youth, and women with ptsd. the authors (2009) concluded the literature was “possibly convincing on an individual basis,” (p. 56), but called for more controlled, longitudinal, and larger studies. they also noted the need for studies with homogeneous and well described samples. their updated review in 2015 focused on eft with children and adolescents. the samples in the studies included youth with and without mental health diagnoses. many of the youth had autism spectrum disorder or were described as “at-risk.” acknowledging that more research is needed, they described the overall findings as “promising with regard to the effectiveness of eft for children and youth” (p. 300). selby and smith-osborne (2013) also concluded that therapies involving equines show promise in increasing psychosocial outcomes for youth and adults with chronic health conditions or disabilities, but noted the need for more rigorous research designs. in contrast, anestis et al. (2014), in a review of only experimental design studies, recommended that mental health programs not offer eft, stating “there is negligible evidence that it offers benefits to individuals with mental disorders or other psychological difficulties” (p. 1129). thus, reviews of eft to date offer different conclusions, most likely based on the criteria used for study inclusion and the approach to conducting the review. o’haire and colleagues (2015) conducted a systematic review of aai for trauma. they too concluded that aai’s show promise as complementary treatments to traditional services, but also called for more rigorous research. their review included what are referred to as “at-risk” samples in other reviews, and ptsd/trauma either was not measured or was not present in some of the study samples. of the ten articles included in their review, seven of the aai’s used dogs or a combination of animals. to the best of our knowledge, no review has focused on the use of equines in working specifically with individuals with ptsd and/or trauma symptoms. thus, the purpose of our study is to examine the peer-reviewed literature to ascertain what is known about eft with individuals who have ptsd/trauma symptoms. method we conducted a database search for studies that addressed the use of eft for individuals who had experienced trauma. we did not restrict the search based on years, because the literature in the field is recent; nor did we restrict the search to a certain type of study design. initially we conducted a wide search. for example, we included studies advances in social work, spring 2017, 18(1) 405 that provided eft to students at-risk, or to individuals with bereavement issues. our thinking was that some individuals in these study samples would have experienced trauma. however, it became difficult to decide which studies to include or exclude, and ultimately we included only studies that measured for trauma at assessment and/or included a measure of trauma as an outcome variable. the data bases searched were social work abstracts, scopus, cinahl, eric, web of science, psycharticles, psychinfo, and google scholar. we also examined the references of articles found through the database search for additional relevant articles. the search terms used were [(equine therapy) or (equine assisted) or (equine facilitated) or (therapeutic riding) or (therapeutic horseback) or (equine-facilitated) or (equineassisted) or (equine psychotherapy)] and [(ptsd) or (trauma)]. inclusion criteria were: 1) the study was published in a peer-reviewed journal; 2) the intervention used horses as the primary treatment or as an adjunct to traditional treatment; and 3) the sample consisted of individuals who were assessed for ptsd/trauma, and/or ptsd/trauma was measured as an outcome. at each stage of the search each of the authors read the abstract and then met to discuss which articles to include, and when a decision could not be made based on the abstract we obtained and read the full article to make a final decision. this process resulted in nine articles being included in the review. results table 1 shows highlights of the nine studies, wherein five consisted of adults and four consisted of youth. studies are presented in order of rigor (in terms of control for threats to internal validity) of the studies, from least (qualitative) to most rigorous (group comparison design). table 1 shows that standardized assessment or outcome for trauma was not included in the study by schroeder and stroud (2015). however, all the women were recruited from a domestic violence organization, in collaboration with their mental health services coordinator, and an inclusion criterion was the presence of ptsd symptoms. in addition, the treatment of trauma was the major aim of the group. table 1 also shows that studies of eft for trauma have all been published within the past seven years. the studies are summarized first for youth, then for adults. youth of the four studies with youth, one was a correlational single system study and three were intervention studies. yorke et al. (2013) recruited children 8 to 10 years of age from child welfare agencies, a woman’s shelter, and counseling agencies. children met the criteria for ptsd based on the child ptsd symptom scale. the purpose of the study was to ascertain whether children’s and horses’ heart and cortisol levels would fluctuate in tandem. using an abcba design across four children, correlation was found between child-horse pairs after a 12 day intervention where the children rode or otherwise interacted with their horse. the authors suggested that eft may be especially beneficial to children who are neurophysiologically deregulated. they also recommended more research on the process of eft, as increased understanding of the mechanism by which eft works can lead to improved eft programming. staudt/equine facilitated therapy 406 table 1. results of articles reviewed: ranked by design study population study design standardized trauma measures used child & adolescent, adults trauma assessment outcomes schroeder & stroud (2015) adults trauma, interpersonal violence one group, qualitative no no nevins, finch, hickling, & barnett (2012) adult war case study, pre-/posttest with multiple follow-up yes yes yorke et al. (2013) c&a abuse, general case studies, multiple baseline (abcba) yes no earles, vernon, & yetz (2015) adults trauma, life events pre-/posttest yes yes mccullough, risley-curtiss, & rorke (2015) c&a abuse/neglect, physical, sexual, or emotional pre-, mid-, and posttest yes yes shambo, seely, & vonderfecht (2010) adults trauma, interpersonal violence pre-, mid-, and posttest with follow-up yes yes goodkind, lanoue, lee, freeland, & freund (2012) c&a trauma, historical pre-/posttest with multiple follow-up; mixed methods yes no kemp, signal, botros, taylor, prentice (2014) c&a abuse, sexual (all), neglect and/or physical (some) pre-, mid-, and posttest within group comparison yes yes advances in social work, spring 2017, 18(1) 407 goodkind and colleagues (2012) reported on a project to develop, implement, and test an intervention for american indian tribal youth and their families. the community based intervention was based on the premise that historical trauma must be acknowledged and addressed in intervention programs. the study was open to youth aged 7-17 years. of 18 participants, 11 had clinically significant levels of exposure to violence and ptsd symptoms. trauma symptoms were not measured after the program. however, improvements were found in cultural identity, coping strategies, quality of life, and social adjustment. the 27 session multi-component psychoeducational group intervention included six equine sessions. two of the intervention studies focused on children who had experienced maltreatment or sexual abuse. mccullough and colleagues (2015) examined the outcomes of eight weekly outpatient equine facilitated psychotherapy sessions (for 1 ½ to 2 hours each) with eleven youth ages 10-18 who had experienced maltreatment and had posttraumatic stress symptoms, as measured by the children’s revised inventory of events scales (cries-13). in order to be included in the study, youth had to score a minimum baseline score of 12 points out of a possible 60 on the cries-13 or at least four questions answered at level 3, or “sometimes.” the equine sessions were structured using object relations theory and reality therapy. nine of the 11 youth had significantly decreased ptsd symptomatology scores at post-test, compared to the pre-test. possibly the strongest intervention study was conducted by kemp et al. (2014). the sample consisted of 15 children, 9 males and 6 females, ages 8 to 11 years, and 15 female adolescents, ages 12 to 17 years, all of whom were referred because of sexual abuse. assessment occurred at three time points: intake, after in-clinic individual counseling of an unspecified therapeutic modality (once weekly for about 6.5 weeks) but prior to eft, and after completion of eft. the eft was based on the eagala model and took place weekly for 9–10 weeks. different measures were used for the children and adolescents (see table 2). significant improvements were found for children on depression, internalizing, externalizing and total behavior child behavior checklist (cbcl) scores from time 2 to time 3, but not from time 1 to time 2. for the adolescents, significant improvements were shown from time 1 to time 2 for all measures except depression, and significant improvements from time 2 to time 3 were found across all measures. notably, the change scores from time 2 to time 3 were significantly greater than the change scores from time 1 to time 2. the findings suggest eft, although helpful for both groups, may be especially helpful for children. adults five studies were conducted with adults (table 3) including one qualitative design, one case study and three intervention studies. two studies consisted of samples with combat-related trauma and three had samples with non-combat related trauma. sample sizes were small, ranging from one to 16, and all studies used purposive sampling. combat trauma is unique as compared to other types of trauma and so the results are presented separately for combat and non-combat related trauma. staudt/equine facilitated therapy 408 table 2. summary of child and adolescent studies authors year participants intervention study design primary outcomes n age (years) gender (% female) trauma assessment yorke, nugent, strand, bolen, new, & davis 2013 4, purposive sample 8 to 10 unknown ptsd: met criteria per child post traumatic stress disorder symptom scale (cpss) 12-day riding/grooming humananimal bond (hai) intervention to study cortisol levels in childhorse pairs multiple baseline, abcba single case design. pilot study. meta-analysis of scd data: examined weighted-mean cross-correlation for each child/horse cortisol level during riding phase*** mccullough, risley-curtiss, & rorke 2015 11, purposive sample 10 to 18 45.5 childhood maltreatment (physical, sexual, or emotional abuse or neglect) with ptsd symptomatology equine-facilitated psychotherapy (efp); 8 weekly sessions (1.5 2 hours each), delivered by therapist. one group, quantitative, quasiexperimental, repeated measures (pre, midpoint, post). pilot study. ↓children's revised inventory of events scale (cries-13)* ↑human animal bonding (habs)* goodkind, lanoue, lee, freeland, & freund 2012 18 americanindian youth (13 families), convenience sample 7-17 (m = 11.1, sd = 3.2) 78 historical trauma assumed for recruitment purposes. trauma assessed by recent exposure to violence scale and childhood ptsd symptoms scale our life, a 6-month communitybased mental health intervention based on 4 components: heal historical trauma;, reconnect to culture; build parenting/social skills; strengthen family relationships through equineassisted activities. families met 3 evenings/week for components 13. 6 sessions (1x/month) equineassisted activities to build relationships, develop selfawareness and trust. one group, quasi experimental: mixed methods withingroup longitudinal design (5 time points over 18 months) ↑native american enculturation scale*** ↑harter self-perception profile for children*** ↑rosenberg self-esteem scale*** ↑children's coping strategies checklist*** ↑multidimensional student's life satisfaction scale (mslss)*** ↑social adjustment inventory for children and adolescents (saica)*** kemp, signal, botros, taylor, prentice 2014 30 purposive (8 indigenous, 22 nonindigenous) referred to sexual abuse agency 8 to 11 (15 subjects); 12 to 17 (15 subjects) 80 all victims of sexual abuse; some also neglect and/or physical abuse. equine facilitated program (eft) as adjunct therapy. in-clinic counseling for 6-7 weeks, followed by eft, 9-10 weeks, 90minutes each. delivered by counselors. one-group, repeated measures (time 1 (pre-counseling), time 2 (postcounseling, preeft), time 3 (posteft). program evaluation. child results for time 2 to time 3. ↓child depression inventory (cdi)*** ↓child behavior checklist (cbcl)int.* ↓child behavior checklist (cbcl)ext.* ↓child behavior checklist (cbcl) total*** . adolescent results. ↓beck depression inventory (bdi)*** ↓beck anxiety inventory (bai)*** ↓trauma symptom checklist (tscc)*** for each subscale (anxiety, depression, dissociation, ptsd, sexual concerns). all subjects, change-score comparison. all change scores (all measures) from time 2 to time 3 were significantly greater*** than those from time 1 to time 2 ptsd, posttraumatic stress disorder; -, not reported; pre-post, simple pre-test and post-test only; ab, waitlist + treatment; ↓, decrease; ↑, increase; ᶧp < 0.10; *p < 0.05; **p < 0.01; ***p < 0.001; advances in social work, spring 2017, 18(1) 409 combat nevins et al. (2012) conducted an ab single system case study with a 52 year-old combat medic. the intervention focused on natural horsemanship instead of psychotherapy but was delivered by a licensed mental health professional. it was a 5-part intervention covered in 4 daily sessions, totaling about 12 hours. from preto 12-week follow-up, the veteran’s ptsd symptoms improved dramatically as did his depression and other symptoms (see table 3). non-combat trauma each of the three non-combat related studies used eft delivered by mental health professionals. the qualitative study (schroeder & stroud, 2015) and one of the intervention studies (shambo et al., 2010) addressed interpersonal violence (ipv) with female-only groups. schroder and stroud (2015) developed an 18-hour, 2 hours per session, mindfulnessand cbt-based here-and-now intervention for women with posttraumatic symptoms and a history of ipv. based on self-report and observation, the four women improved in mindfulness and competence and demonstrated genuine communication with their horses as well as with each other and the facilitators. the authors attributed the use of regular here-and-now processing (as opposed to reliving trauma) as key to the success of the group. although the women had symptoms of posttraumatic stress, ptsd outcomes were not examined through self-report or observation. shambo et al. (2010) also studied women with a history of ipv. the six women presented with symptoms of or diagnosis of ptsd and/or borderline personality disorder. all were in psychotherapy but not showing clinical improvement. the 20-hour group mutual-aid intervention included both eft and psycho-education, and was delivered over 10 weeks. the model, based on kohanov (2003), was eclectic, and included somatic awareness and modulation, cbt, and assertiveness and boundary setting. from pre-test to the four-month follow-up, improvements were found for depression and dissociative symptoms. earles and colleagues (2015) examined the effectiveness of equine partnering naturally© (yetz, 2011), a 12 hour intervention provided over six weeks. the sample consisted of 12 women and 4 men who had experienced a traumatic life event, such as rape or a serious accident, and had ptsd symptoms. ptsd, anxiety, depression, and mindfulness had improved by the post-test. staudt/equine facilitated therapy 410 table 3. summary of adult studies authors year participants intervention study design primary outcomes n age (years) gender (% female) trauma assessment schroeder, & stroud 2015 4, purposive sample mid-20s to early 60s 100 symptoms of posttraumatic stress and history of interpersonal violence victimization equine-facilitated psychotherapy (efp) with here-and-now, mindfulness focus. 9-weeks, 2 hours per session plus post-group debrief. co-facilitated by master's level counselor and master's counseling intern. one-group descriptive study: observational and reflective. pilot study. observations: all members interactive (authentic disclosures among memberto-member, member to facilitator, and member to horse). reflections by subjects: ↑being mindful and aware of selves and in relation to others; ↑feeling capable and competent nevins et al. 2012 1 veteran, twicedeployed combat medic, operation iraqi freedom (oif) 52 0 assessed for ptsd and depression connection methodology -uses nonhippotherapy, nonpsychotherapeutic, natural horsemanship principles, delivered by licensed mental health professional. 4 hours of educational classes followed by 5-part intervention covered in 4 daily sessions, totaling about 12 hours. case study, quantitative, repeated measures (pre, post, followup at 2, 4, 6, and 12 week follow-up) preto follow-up results: 58%↓pclc (post-traumatic disorder checklist); 44%↓bdi-ii (beck depression inventory), from 25 to 14; 44%↑rses (response to stressful event scale); 68%↑msss (modified social support scale); qoli(quality of life index): 5%↓ happiness, 247%↑satisfied, 10%↓dissatisfied earles et al. 2015 16, recruited through mental health practitioners 33-62 (m = 51.25, sd = 9.99) 75 assessed: trauma life events and ptsd equine partnering naturally© program (yetz, 2011). equine therapy delivered by yetz. 2-hour sessions for 6 weeks. one-group, pre/post-test. each group consisted of 5-6 subjects. ↓ptsd checklist (pcl-s)*** ↓trauma emotion questionnaire* ↓generalized anxiety disorder scale** ↓patient health questionnaire (phq-9) * ↓alcohol use disorders identification test (audit)* ↑five facet mindfulness questionnaire *** shambo et al. 2010 6, purposive sample currently in psychotherapy without satisfactory results 18 yrs or older 100 history of traumatic interpersonal violence; dsmiv symptoms and/or diagnosis of ptsd or bpd equine-facilitated psychotherapy (efp) and psychoeducation group. 10 weeks, 2-hour sessions. cofacilitated by mental health therapists one-group, repeated measures (pre-, mid-, post-, and 4 month follow-up). pilot study. preto follow-up results: ↓hamilton rating scale for depression (hamd)** ↓beck anxiety inventory (bia) n.s. ↓dissociative experiences scale (des)* ↓outcome questionnnaire-45.2 (overall treatment effectiveness)* ptsd, posttraumatic stress disorder; -, not reported; pre-post, simple pre-test and psot-test only; ab, waitlist + treatment; ↓, decrease; ↑, increase; ᶧp < 0.10; *p < 0.05; **p < 0.01; ***p < 0.001; advances in social work, spring 2017, 18(1) 411 discussion the purpose of this review was to focus on the use of eft for ptsd and trauma. four studies included youth (goodkind et al., 2012; kemp et al., 2014; mccullough et al., 2015; yorke et al., 2013) . children who had experienced sexual abuse or maltreatment showed improvement in ptsd after eft, as well as in depression, anxiety, and internalizing/externalizing behaviors. historical trauma experienced by american indians and other groups is often overlooked in the trauma literature, but youth who participated in a multi-component intervention that included eft showed improvement in cultural identity, coping strategies, quality of life and social adjustment (goodkind et al., 2012). of the five studies with samples of adults, one included veterans (nevins et al., 2012) two included women who had experienced interpersonal violence (schroeder & stroud, 2015; shambo et al., 2010), and one included men and women with various traumatic events (earles et al., 2015). improvement was found in ptsd symptoms, mindfulness, depression, dissociative symptoms, anxiety, and depression. even though the review included only nine studies, each with limitations, the findings suggest that eft may be a useful intervention for youth and adults with ptsd and trauma symptoms as a result of child maltreatment and sexual abuse, combat, interpersonal violence, and other traumatic events. as discussed below, some of the studies also explored the mechanisms by which eft has effects. a limitation of our review is that we did not include theses, dissertations, or otherwise search for gray material. also, our review was limited to studies of eft where trauma symptoms were assessed and/or included as an outcome. this limiting of our search can be both a limitation and strength. as a limitation, studies that included samples of individuals who had been exposed to potentially traumatic experiences, but trauma itself was not explicitly assessed, were not included. inevitably some of the participants in these studies may have had trauma symptoms/ptsd. limiting studies in our review to those that measured trauma symptoms increases understanding about whether eft is effective in addressing trauma and ptsd symptoms, as well as how those with trauma experience eft. as many reviews of studies do, recommendations for more studies of increased rigor (increased sample sizes, explicit assessment for trauma, stronger designs, monitoring for treatment integrity, etc.) can be made. qualitative studies that address the acceptability of eft, including the perspectives of both clients and providers, as well as ascertaining the barriers and facilitators to eft implementation, are also needed. going beyond this, a number of recommendations can be made for future research. first, on a national level, more and more attention is being paid to the mental health needs of veterans. however, veterans do not always seek out traditional mental health services (nevins et al., 2012). only two studies were included in this review that focused on veterans, and one of the studies with veterans was quite non-traditional, focusing on telepathic communication between the horses and veterans. the acceptability and effectiveness of eft for veterans is a field ripe for future research. it seems plausible that eft could increase access to mental health services for veterans, but research is needed to test whether this is so. staudt/equine facilitated therapy 412 second, research is needed that further confirms, or sheds light on, the mechanisms by which eft leads to improved outcomes. some of the studies in this review touched upon this. for example, schroeder and stroud (2015) reported that group members remarked that the calm dispositions of the horses provided safety in relationship with their horse. moreover, increased effective interactions with other group members and the group facilitators were observed. the bond between horse and youth was measured by mccullough and colleagues (2015) and then correlated with change in ptsd symptoms, and findings partially supported this relationship. a suggestion for future research is to incorporate measures of the working alliance between the clinician and client and examine changes as horses are introduced into treatment. third, research is needed regarding when equine therapy may be contraindicated, as well as termination issues. if indeed the connection between the horse and client is central in the healing process, how is termination dealt with? are there any negative implications of developing a strong relationship with a horse during eft and then no longer having access to the horse? fourth, a challenge for researchers is to isolate the effects of eft from other treatment components. kemp et al. (2014) attempted to do that by administering measures after traditional counseling but prior to eft, then administering the measures again after eft. more studies like this are needed, as well as qualitative studies that gather the impressions of clients and treatment providers regarding the stand alone and interactive effects of traditional treatment and eft. finally, eft is a relatively new modality that offers promise for treating trauma/ptsd symptoms. as eft becomes more integrated into traditional mental health treatment, schools of social work (and of other helping disciplines) will need to address whether, how and where to implement it into the curriculum. although much remains to be learned, and more gaps in knowledge exist than those we have mentioned, the studies in this review provide a base upon which to build. references amiot, c. e., & bastian, b. 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(2013). equineassisted therapy and its impact on cortisol levels of children and horses: a pilot study and meta-analysis. early child development and care, 183(7), 874-894. doi: https://doi.org/10.1080/03004430.2012.693486 author note: address correspondence to: marlys staudt, associate professor, 311 henson hall, 1618 cumberland ave, knoxville, tn 37996-3333, phone: (865) 974-7502, mstaudt@utk.edu http://www.yetzmdonline.com/ https://doi.org/10.1080/03004430.2012.693486 mailto:mstaudt@utk.edu ___________ patricia m. reeves, phd, msw, professor, university of georgia school of social work, athens, ga 30606. trina c. salm ward, phd, msw, assistant professor, university of wisconsin-milwaukee helen bader school of social welfare, milwaukee, wi 53211. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 478-492, doi: 10.18060/22579 this work is licensed under a creative commons attribution 4.0 international license. dual master of social work – master of public health (msw/mph): lessons learned from program development and implementation in a southeastern university patricia m. reeves trina c. salm ward abstract: while there has been a proliferation of msw/mph programs concurrent with dramatic changes in the u.s. health system, there is minimal research on these programs. the purpose of this article is to describe the conceptualization, development, and implementation of an innovative msw/mph program at a southeastern university—the only such program in the state. our goal as the first two directors of the program, serving consecutively, is to share knowledge and offer “lessons learned” for universities seeking to develop or enhance an msw/mph program, as well as agencies interested in forming collaborative partnerships. “lessons learned” include the importance of strong ongoing communication among all msw/mph stakeholders, thoughtful consideration of the time demands associated with the program director’s role, viewing a developmental evaluation plan as a critical component for success, and recognizing the benefits of purposeful linkages between the two disciplines. keywords: msw/mph; public health social work; dual degree; joint degree despite spending more per person on health care than any other nation, the u.s. ranks as one of the worst among developed nations in risk factors for illness, as well as prevalence and mortality for multiple diseases (davis, stremikis, squires, & schoen, 2014; woolf & aron, 2013). moreover, wide regional discrepancies in the scope of health disadvantage exist within the u.s., with as much as a 15-year variation in life expectancy across the nation (kulkarni, levin-rector, ezzati, & murray, 2011). notably, residents of southern states report higher rates of being uninsured, less access to health care services, and a greater likelihood of experiencing chronic health conditions such as diabetes and heart disease (artiga & damico, 2016). poor health outcomes are due to multiple, often inextricably linked factors. for example, smoking, a negative health-related behavior, is associated with adverse social circumstances such as insufficient health care, low socioeconomic status, and an inadequate neighborhood environment (booske, athens, kindig, park, & remington, 2010; mcgovern, miller, & hughes-cromwick, 2014). each contributing factor interacts with the other in complex ways to influence health outcomes. while the trend toward improved health outcomes across the u.s. is generally upward, according to the centers for disease control and prevention (2013), advancement has not occurred as rapidly as desired nor have all segments of society accrued health benefits equitably. https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) 479 healthy people, the federal government’s science-based health initiative with 10-year national objectives, defines a health disparity as a “health difference that is closely linked with social, economic, and/or environmental disadvantage” (department of health & human services [dhhs], 2016, para. 1). the american academy of social work & social welfare (2013), in a groundbreaking initiative to “champion social progress powered by science,” articulated 12 “grand challenges for social work,” one of which is to “close the health gap.” similarly, the society for public health education (2015) identified “eliminating health disparities” as a goal it shares with healthy people (dhhs). the national prevention strategy, created under the auspices of the patient protection and affordable care act (2010), has recommended increasing workforce capacity as one of five ways to address health inequities (national prevention, health promotion, and public health council, 2012). approximately one-third of social workers practice in health-related settings, and the u.s. bureau of labor statistics (2015) has projected a 19% increase in need by the year 2024. to this end, social work scholars have proffered recommendations for education and training in transdisciplinary and implementation science (gehlert, hall, & palinkas, 2017). the need for increased workforce capacity has been underscored as well by the framing the future task force of the association of schools and programs of public health (2014), which identified understanding the social determinants of health as foundational knowledge in master’s-level public health education. furthermore, numerous professional associations and organizations have issued a clarion call to prepare health care professionals for work in increasingly interprofessional settings (council on social work education, 2016; haire-joshu & mcbride, 2013; institute of medicine, national academies of sciences, engineering, and medicine, 2015; interprofessional education collaborative, 2016; koh & sebelius, 2010; world health organization, 2010). understanding the social determinants of health and eliminating health disparities are cornerstones of most dual master’s degree programs in social work and public health (msw/mph), ideally positioning them to address the demand for increased workforce capacity. interestingly, the “goodness of fit” between the two professions is often attributed to a common, yet overly simplistic (mis)perception of the professions’ complementarity (i.e., social work emphasizes intervention at the individual level whereas public health focuses on prevention at the population). in fact, the professions share many synergies and commonalities—values (social justice, equity, focus on vulnerable and oppressed populations), theories (systems, ecological, health behavior), and approaches (culturally competent practice, interdisciplinary teams, client-centered and community-based practices (bronstein, kovacs, & vega, 2007; mccave, rishel, & morris, 2013; rine, 2016; ruth, velasquez, marshall, & ziperstein, 2015; sable, schild, & hipp, 2012)—that offer promise for addressing workforce development needs. indeed, the professions have a long history of collaboration (cederbaum, ross, ruth, & keefe, 2018), with the term public health social work (phsw) describing the integrated practice of social work and public health (ruth & sisco, 2008). moreover, individuals who possess the knowledge and skills of both disciplines can provide services effectively, efficiently, and economically. in partnership, social work and public health offer promising inroads in achieving health reeves & salm ward/dual master 480 equity, eliminating health disparities, and improving the health and well-being of all americans. conceptual framework development of an msw/mph program at our university was first explored in 2007 at a meeting attended by 12 faculty and administrators from the school of social work (ssw) and the college of public health (cph). both ssw and cph demonstrated investment from the outset, which was important in establishing a culture of cooperation and collaboration essential for developing and sustaining the venture. three principles reflecting the strategic plans of the ssw and cph were established to guide the joint effort: (1) we have a duty first and foremost, as faculty at the state’s flagship university, publicly supported through tax dollars, to serve the state’s citizens; (2) the ssw and the cph will marshal requisite resources, human and fiscal, to provide aspiring professionals with a world-class education to address critical health-related needs; and (3) both will demonstrate a deep, abiding commitment to designing, developing, implementing, and growing the msw/mph program. the overarching goal of our university’s msw/mph program—the only msw/mph program in the state—is to provide visionary leadership in preparing tomorrow’s health care professionals with the knowledge and skills to combat persistent social problems, such as health disparities, and to engage in the conduct of socially responsible research that advances evidence-based practice. furthermore, these efforts affirm aspects of our university’s mission, including excellence in research and public service, economic development, and technical assistance to address the needs of our state, as well as a strong focus on interdisciplinary research and education. program development despite the promise of dually-trained social work and public health professionals, literature on msw/mph programs is scant, especially recommendations for developing an msw/mph program (ziperstein et al., 2015). we endeavor to address this gap in knowledge by providing those seeking to develop an msw/mph program, or enhance an existing one, with the kind of information that would have been helpful to us as we conceptualized, developed, and implemented the msw/mph program at our university. sources of information for program development three sources of information assisted in the development of our msw/mph program: a literature review of msw/mph programs, interviews with existing msw/mph program directors, and an analysis of msw/mph program documents. we collected this information over a three-year period. literature pertaining to msw/mph programs, our first information source, was located in a variety of databases using search terms such as “public health and social work,” “msw and mph,” and “dual-degree programs.” since the original search in 2008 we have incorporated more recent literature—through 2018—into this manuscript. advances in social work, fall 2019, 19(2) 481 our second information source consisted of conversations with msw/mph program directors. there were 32 u.s. msw/mph programs at the time, with four in the southeast. five of the 32 msw/mph programs were aspirational peer institutions of our university. our university defines aspirational peer institutions as ones with a prominent research profile that our university “aspires to be like” (a. j. aycock, personal communication, november 15, 2018). aspirational peer institutions are determined by the vice presidents and deans of our university through an informal survey. msw/mph program directors were contacted via telephone or email. informal interviews, conducted by the first author, took place from 2009-2010 and were guided by questions pertaining to program structure, design and implementation considerations, and shared governance experiences. msw/mph program documents, our third information source, were collected from 2008-2010. they included web pages, programs of study, and print materials from msw/mph programs—tangible materials that shaped the evolving vision of our program. summary of information gathered with leadership provided by the first author, faculty members from the ssw and cph met regularly to review and discuss the information gathered. below are eight themes that emerged from our review, supported by literature existing at the time as well as literature published subsequently. • msw/mph programs are highly marketable in attracting graduate students who are academically gifted, committed, motivated, and organized (mcclelland, 1985; miller, hopkins, & greif, 2008; reardon, 2009; ruth, marshall, velasquez, & bachman, 2015; ziperstein et al., 2015). • the initial msw/mph program of study should target the greatest number of students in both disciplines (most often the clinical “area of practice” in social work, and health behavior in public health), with expansion to other configurations explored after the initial program is well underway. institutions use a variety of terms to refer to an “area of practice” including “concentration” (term used at the time at our institution), “track,” and “specialization.” thrust for the development of most msw/mph programs comes from the social work side of the partnership. • msw/mph programs are 86-93 credit hours. • most msw/mph programs are three years in length, with coursework in the first year in one discipline, coursework in the second year in the other discipline, and concurrent coursework in both disciplines during the third year (ziperstein et al., 2015). • completing an msw/mph program often entails a greater financial obligation for the student than completing an msw or mph, both of which typically require a two-year commitment (michael & balraj, 2003; ruth, wyatt, chiasson, geron, & bachman, 2006; ziperstein et al., 2015). • msw/mph students report a) difficulty integrating social work and public health concepts in coursework and field practicum experiences; b) are challenged in conceptualizing the application of social work and public health reeves & salm ward/dual master 482 skills in real-world settings; and c) reveal stronger identification with one discipline over the other (mcclelland, 1985; miller et al., 2008; ruth et al., 2008). • leadership in msw/mph programs is optimally provided by faculty with educational credentials and experiences that span both disciplines (ziperstein et al., 2015). • an evaluation plan, often accorded scant attention during program development, is as critical to program success as front-end design and implementation considerations (michael & balraj, 2003; ruth et al., 2008; ziperstein et al., 2015). program design in this section we address how the results, outlined above, informed the design of our msw/mph program of study. lead faculty for the required courses in ssw and cph reviewed course syllabi to identify those that met the competencies in both social work and public health. a sample program of study was developed and reviewed by the curriculum committee in each school/college, minor modifications were made, and the revised program of study was sent to the full faculty in the ssw and cph for final review. both faculties unanimously approved the revised program of study. the ssw did not undergo reaccreditation during the development of the msw/mph program, and endorsement of a dual-degree program was not required by the council on social work education (cswe). the cph, however, underwent its initial accreditation by the council on education for public health (ceph) during development of our msw/mph program and received the requisite approval from its accrediting body for the partnership. the cph’s accreditation process contributed to the length of time (four years) between our initial exploration of a dual-degree program in 2007 and enrollment of the first cohort of seven students in august of 2011 (graduated in december 2013). curriculum. at 91-credit hours, our program of study (see table 1) falls within the upper end of the 86-93 credit-hour range of u.s. msw/mph programs. our deans elected to enact the msw/mph program in phases, consistent with the recommendation reported above, with phase i targeting the concentration with the greatest number of students in their respective school/college. resource considerations (e.g., class size, faculty workload), coupled with concerns about program sustainability, also factored into the deans’ decision. thus, in phase i, only students in the clinical concentration (one of two concentrations in social work) and the health promotion and behavior concentration (one of five concentrations in public health) were eligible to enroll in the msw/mph program. phase ii, implemented in 2014, extended the msw/mph program to students in the community empowerment and program development concentration (social work) and gerontology concentration (public health). the original program of study served as the template for developing the curricula. plans to extend the msw/mph program of study to the remaining three concentrations in public health constitute phase iii and is yet to be enacted. table 1. dual degree msw-mph degree requirements summary as originally submitted msw (clinical practice concentration) double count mph (health promotion & behavior concentration) msw foundation course requirements • sowk 6011 (3cr) social welfare policy & the social work profession • sowk 6033 (3cr) direct practice methods • sowk 6074 (3cr) theory & practice with organizations • sowk 6044 (3cr) theory & practice with families • sowk 6055 (3cr) foundation practicum (16 hrs. weekly + seminar) • elective ii (3cr) msw clinical practice concentration • sowk 7203 (3cr) advanced social work practice with individuals • sowk 7222 (3cr) assessment & psychopathology • sowk 7223 (3cr) social work treatment with groups • sowk 7232 (3cr) advanced social work practice with families • elective iii (3cr) *sowk 7055 (12cr) concentration practicum • epid 7010 (3cr) introduction to epidemiology i (replaces sowk 6066 (3cr) foundation research methods) • sowk 6022 or hprb 7920 (3cr) theory • sowk 7206 or hprb 7470 (3cr) evaluation • elective (6cr) specific required course in one degree counted as required elective in the other • hprb 7010 social & behavioral foundations (required in ph) becomes elective i in sw • sowk 6082 cultural diversity (required in sw) becomes elective i in ph mph core course requirements • bios 7010 (3cr) introduction to biostatistics i • ehsc 7010 (3cr) foundations of environmental health • hpam 7010 (3cr) introduction to health policy & management • pbhl 8200 (1cr) hpb concentration core requirements • hprb 7270 (3cr) resource development & program implementation • hprb 7370 (3cr) social marketing of health: theory & process • hprb 7500 (3cr) community health • elective ii (3cr) *pbhl 7560 (6cr) internship/practicum pbhl 7800 (3cr) capstone social work credits: 45 double count credits: 15 public health credits: 31 total credit hours: 91 (45 sw + 30 ph + 15 double count credits) table notes: program requirements subject to change as they are reflective of the uga msw and mph program requirements. electives in sw and ph must meet the requirements for electives in their respective program. *dual advising required; must meet the requirements of both programs and contain an integrative component. reeves & salm ward/dual master 484 our msw/mph program of study is two-and-a-half years (seven consecutive semesters) in duration and follows a cohort model, though students have the option of matriculating for three years (eight consecutive semesters) to reduce the course load across semesters, enroll in graduate certificate programs, or pursue study-abroad opportunities. to address the issue of msw/mph students reporting difficulty integrating social work and public health concepts, we carefully synchronized concurrent social work and public health coursework each semester throughout the entire program of study. msw/mph students complete two field practicums: a one-semester (16 hour/week) msw foundation practicum and a two-semester integrated social work and public health concentration practicum during which they develop learning plans with objectives, activities, and interventions designed to achieve both social work and public health competencies. the integrated practicum is completed during the last two semesters in the program of study. it begins in the summer semester (sixth of seven semesters) as a block placement (40 hour/week) and continues into a 24-hour/week placement in the fall semester of the third year (culminating semester in our two-and-a-half-year program). field office directors in the ssw and cph work closely together to coordinate the field practicum by identifying sites (e.g., behavioral health clinics, health care settings) that meet the practicum requirements of their respective accrediting bodies and to ensure learning experiences for integrating the knowledge and skills of both disciplines. field instructors, who are agency employees, provide on-site supervision and must have the required social work qualification (msw degree, preferably with at least two years post-msw experience) to oversee the two-semester practicum. public health does not require a specific educational credential for field instructors. distinguishing features. below, we compare our program features with those of ziperstein et al.’s (2015) survey of 41 msw/mph programs in the u.s. to frame the salient features of our msw/mph program: • shorter program of study. whereas students complete our 91-credit-hour msw/mph program, comparable in credit hours with other msw/mph programs, in two-and-a-half years (seven consecutive semesters), the average length of time to complete an msw/mph program is three years according to ziperstein et al. of our 43 graduates to date, 32 (74.4%) completed the program in two-and-a half years, with the remainder extending their tenure an extra semester to obtain additional educational credentials (e.g., certificates) or to pursue study-abroad opportunities. • dual appointment in social work and public health. our university’s msw/mph program director holds a 50/50 joint appointment in the school of social work and the college of public health, although only two respondents (4.2%) in ziperstein et al.’s survey occupies a dual appointment. the majority, 56.2%, hold an appointment in schools of social work. the strength of this dual appointment is that it enables the msw/mph program director to fully function within each school/college, serve as faculty advisor in both, and bring experience and key insight into program implementation. additionally, our advances in social work, fall 2019, 19(2) 485 msw/mph program director has educational credentials and experiences that span both disciplines. • higher-than-average number of graduates. our msw/mph program graduates an average of 8 students per year (range: 7-12), for a total of 43 graduates since the first cohort completed the program in december 2013. ziperstein et al. reported an average of 7 graduates per year (range: 0-25) across 41 programs. • ongoing program evaluation. using a developmental evaluation plan, we collect comprehensive data, both quantitative and qualitative, to ensure that ongoing decisionmaking is a part of the development and implementation of our msw/mph program. only 29% of respondents in the ziperstein et al. survey reported engaging in any form of program evaluation. data in our msw/mph program are collected from a variety of stakeholders and include recommendations on course content and sequencing, experiences with the field placement process, field practicum feedback, grade point averages, certification and licensure information, and employment status, among others. our evaluation findings to date suggest that an msw/mph program that offers concurrent coursework in both disciplines throughout the program of study, an integrated field practicum, and a shorter program of study is valuable to students—findings that inform real-time programmatic decisions. recently published results of evaluation data from our program’s alumni and field instructors revealed alumni satisfaction with their experiences in our program, employment in phsw settings, and utilization of both social work and public health skills in their workplace, as well as field instructors’ positive impressions of student performance in the field placement and acknowledgement of the added value dual-degree professionals bring to their agency settings (salm ward & reeves, 2017). • integrative seminar. we have offered an integrative seminar in social work and public health for the past four years—a curriculum decision reflective of evaluation data provided by msw/mph students. although mcclelland (1985) recommended over 30 years ago that msw/mph programs include an integrative seminar, ziperstein et al. (2015) found that only 15% of msw/mph programs did so. a seminar examining the differences and similarities in the two professions, mcclelland asserted, would foster a sense of professional identity that draws on the strengths of both. the second author designed an integrative seminar, which students typically take during the semester preceding the two-semester integrated field practicum or during the first semester of the practicum. seminar students explore the development of a professional identity, which includes integrating, applying, and marketing the skill sets of both disciplines while considering potentially conflicting values and ethics. an additional goal of the seminar is to develop professional network linkages with individuals working in phsw settings. the format is both didactic and experiential, and includes lectures, discussion, largeand reeves & salm ward/dual master 486 small-group in-class activities, guest lectures by dual-degree professionals, and field trips to agencies that have hosted msw/mph students. course evaluations for the integrative seminar have been very positive, and it has attracted interest from students in traditional msw and mph programs who plan to practice in interprofessional settings. admissions process and advisement. there are two paths to admission to our msw/mph program: (1) prior to beginning graduate work with concurrent coursework beginning in fall semester of the first year, or (2) within the first semester of graduate study (in either discipline) with concurrent coursework beginning in spring semester of the first year. msw/mph students must apply for admission to both programs and be accepted into both (which have different admission criteria) before being admitted to the msw/mph program. once admitted, students are given a specialized program of study that reflects the various social work/public health configurations of our msw/mph program. the program of study includes course sequencing and prerequisite requirements, which must be followed to ensure program completion in two-and-a-half years (seven consecutive semesters). students graduate with master’s degrees in both disciplines, which a recent graduate enthusiastically described as “the educational bargain of a lifetime!” advisement is provided by the msw/mph program director in coordination with faculty members from each program. program direction. our msw/mph program director position was funded by the first author’s application to our university’s highly competitive interdisciplinary hiring initiative in 2013. the msw/mph program director oversees all aspects of the msw/mph program, provides course advisement, recruits potential students, serves as faculty liaison for msw/mph students in the two-semester integrated field practicum (which entails three site visits for each student), leads the evaluation of the program, maintains the program’s website and social media presence, and revises the curricula to reflect changes in the programs of study. prior to the msw/mph program’s inception in 2011, the ssw and cph deans appointed an advisory committee, which consists of faculty and administrators from both units. the committee meets once a semester and performs additional oversight duties, which include addressing course scheduling and sequencing concerns, reviewing program evaluation results, and serving as advocates for the program within their respective units, across the university, and at local, state, and national levels. lessons learned our goal, as the first two directors, serving consecutively, of our university’s msw/mph program has been to share what we have learned throughout the process of developing and implementing our dual-degree program. we hope our “lessons learned” will be helpful to universities seeking to develop or enhance an msw/mph program, as well as agencies interested in forming collaborative partnerships. advances in social work, fall 2019, 19(2) 487 strong communication strong, ongoing communication among all msw/mph program stakeholders— program director, students, advisory committee, field directors of both units, faculty, academic advisors, and alumni—is imperative. an issue that arises at any point in program implementation will likely have implications for other areas. keeping stakeholders “in the communication loop” generates high morale as well. program success is dependent upon stakeholders’ perceptions that their contributions are needed and valued. program director’s role dedicated, hands-on administration of an msw/mph program is a non-negotiable requirement for implementing a successful venture, given the director’s many critical roles and responsibilities. as a program grows (e.g., expansion of social work/public health program-of-study configurations, higher enrollment), the demands on the program director’s time increase exponentially. while we believe a joint appointment is essential for program success, with educational credentials and experiences in both disciplines strongly preferred, research-intensive universities may want to consider a non-tenure-track position for program director or, alternatively, to provide tenure-track faculty with a substantial reduction in teaching and/or service responsibilities. developmental evaluation plan all too often program evaluation, commonly acknowledged as an important need during the development phase of a new venture, fails to take place as planned, succumbing to the time demands of program implementation. a developmental evaluation plan, which not only supports strategic adjustments and timely corrections that are critical to a new program’s success but also enables planning for future needs, has been an integral aspect of our msw/mph program. for example, early in-context evaluation data from our first msw/mph cohort revealed challenges in locating integrated field practicum sites that would satisfy the field competencies of both disciplines, as well as confusion about expectations after entering the field. to address these concerns, field directors in the ssw and cph developed a clear, step-by-step procedure for identifying appropriate placement sites (see table 2), and the msw/mph program director worked closely with them to consolidate critical information into one syllabus. following this effort, field instructors (who provide on-site supervision) received a more detailed orientation to the msw/mph program—one that underscored the central role of the integrated field practicum within the program of study, highlighted the unique strengths and needs of dual-degree students, and emphasized the benefits that agencies could anticipate when serving as a field practicum site. our evaluation plan, administered by the msw/mph program director, is regarded as central to the success of our msw/mph program, which is touted by both deans as their most successful dual-degree program. across-discipline linkages an unanticipated “lesson learned” concerns how linkages across our two disciplines, forged not with the intent of benefitting our msw/mph program (e.g., collaborative reeves & salm ward/dual master 488 research projects, service on dissertation committees), have strengthened our program nonetheless. these linkages have fostered rapport between faculty (and students) and have provided greater understanding of the other discipline’s contributions to health and wellbeing. today, we purposely seek opportunities for partnerships between our two disciplines, knowing our msw/mph program will be stronger as a result. for example, in recent years, the ssw and cph have hired faculty members with degrees in both social work and public health. deeply invested in the success of our msw/mph program, these colleagues serve on the advisory committee, recruit students, and are natural champions of our program. table 2. two-step process for integrated msw/mph field practicum step 1 (process for identifying prospective practicum sites) 1. field staff from the ssw and cph review both programs’ field practicum handbook to understand the expected competencies and requirements (e.g., supervisor credentials). 2. field staff identify practicum sites that have hosted single-degree msw and mph students and have existing memoranda of understanding with both programs. 3. field staff identify additional sites that may meet the competencies and requirements for both programs and contact potential sites to assess interest in an msw/mph student. field staff highlight the added benefits/competencies of msw/mph students, as well as clarify expectations for supervision, learning plans, etc. 4. field staff formulate a written process that students will follow. 5. field staff review and update list of potential sites every year. step 2 (process for placing yearly cohorts) 1. field staff and msw/mph program director conduct a mandatory group orientation session for msw/mph students who will be entering the field. (session is held approximately two semesters before start of the field practicum.) orientation addresses: a. written process/timeline for identifying field practicum sites and required forms b. “talking points” pertaining to msw/mph competencies that students can use in interviews at prospective field sites c. examples of field practicum products (e.g., mph projects, msw assignments) to help students better conceptualize demonstrating competencies in the field 2. ssw and cph field staff jointly meet with each student to discuss areas of interest and possible practicum sites. 3. students interview at their preferred site; interviews at additional sites are scheduled, if needed. 4. after placement is finalized, student completes required ssw and cph field practicum paperwork. limitations several limitations may have influenced the conceptualization, development, and implementation of our university’s msw/mph program. relevant articles and pertinent documents pertaining to msw/mph programs may have been overlooked in the review. additionally, information provided by the directors of msw/mph programs was limited to informal interviews; inclusion of quantitative data (e.g., surveys such as by ziperstein et al., 2015) may have provided a more holistic understanding of program directors’ perceptions and experiences. our lessons learned are limited to experiences with our advances in social work, fall 2019, 19(2) 489 msw/mph program, which reflects particular structural and cultural influences. as others have suggested, a national, cross-program evaluation would be helpful to identify common challenges as well as the unique structural strengths of each program (michael & balraj, 2003; ruth et al., 2008; ziperstein et al., 2015). conclusion we have endeavored to share useful insights and “lessons learned” with those who are planning or have implemented an msw/mph program, as well as agencies seeking to establish collaborative partnerships, by providing concrete information about our university’s program, its strengths and challenges, and how we are addressing those challenges. we view the distinguishing features of our growing msw/mph program— two-and-a-half-year program of study (seven consecutive semesters) with concurrent social work and public health coursework throughout, program director’s dual appointment in social work and public health (with educational credentials and experiences in both), ongoing program evaluation guided by a developmental evaluation plan, and an integrated field practicum and seminar—as central to our program’s success. the u.s. ranks as one of the worst developed countries for health-related outcomes, with wide disparities among different regions of the u.s. the national prevention strategy has recommended increasing workforce capacity to address this critical concern (national prevention, health promotion, and public health council, 2012). understanding the social determinants of health and eliminating health disparities are cornerstones in social work and public health education. msw/mph programs, in uniting these two disciplines, afford great promise for improving the health and well-being of all americans. references american academy of social work & social welfare. 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(2015). mapping dual-degree programs in social work and public health: results from a national survey. advances in social work, 16(2), 406-421. doi: https://doi.org/10.18060/18372 author note: address correspondence to dr. trina salm ward, university of wisconsinmilwaukee helen bader school of social welfare, p.o. box 786, milwaukee, wi 532010786. e-mail: salmward@uwm.edu https://doi.org/10.1093/sw/swu060 https://doi.org/10.5175/jswe.2006.200404117 https://www.sophe.org/resources/category/health-disparities/ https://www.bls.gov/ooh/community-and-social-service/social-workers.htm https://doi.org/10.1001/jama.2013.91 http://www.who.int/hrh/resources/framework_action/en/ https://doi.org/10.18060/18372 mailto:salmward@uwm.edu microsoft word 3. nilsson_17679-empathy and compassion copyedit final ______________ peter nilsson, bssw, phd., is a senior lecturer in social work at dalarna university, sweden. the author would like to acknowledge the journal’s anonymous peer reviewers for their helpful comments on earlier versions of this manuscript. copyright © 2014 advances in social work vol. 15 no. 2 (fall 2014), 294-305 are empathy and compassion bad for the professional social worker? peter nilsson abstract: recent studies have shown that social workers and other professional helpers who work with traumatized individuals run a risk of developing compassion fatigue or secondary traumatic stress. some researchers have hypothesized that helpers do this as a result of feeling too much empathy or too much compassion for their clients, thereby implying that empathy and compassion may be bad for the professional social worker. this paper investigates these hypotheses. based on a review of current research about empathy and compassion it is argued that these states are not the causes of compassion fatigue. hence, it is argued that empathy and compassion are not bad for the professional social worker in the sense that too much of one or the other will lead to compassion fatigue. keywords: compassion fatigue, secondary traumatic stress, empathy, compassion empathy has for a long time been considered an essential part of good, professional social work (see gerdes & segal, 2011). compassion has perhaps been looked at with a bit more hesitation, but there are some who have claimed that it also can be of use for the social worker (figley, 2002; radey & figley, 2007). in the last decades, however, some researchers have pointed to a potential danger with empathy and compassion. this is that the empathic or compassionate social worker runs a risk of falling victim to compassion fatigue (adams, boscarino, & figley, 2006; conrad & kellar-guenther, 2006; dill, 2007; jacobson, 2006; jenkins & baird, 2002; radey & figley, 2007; simon, pryce, roff, & klemmack, 2005). “compassion fatigue” is a term that was introduced into social work research largely through the work of figley (1995). figley, along with pearlman (1995) and others, raised awareness of a new phenomenon observed in people working with traumatized persons. what was observed was that some helpers, due to being exposed to these persons and the stories of their traumas, came to experience symptoms of post-traumatic stress themselves. pearlman (1995) called this phenomenon “vicarious traumatization,” whereas figley (1995) referred to it as “compassion fatigue” or “secondary traumatic stress.” in the current literature all three of these terms occur, and they are used in many different ways. different writers disagree both with respect to how they define the symptoms of the state and with respect to how they specify the ways in which the symptoms are caused. most researchers define the symptoms as similar to those of post-traumatic stress disorder (ptsd) (e.g., bourassa, 2009; bride, 2007; bride & walls, 2006; figley, 1995; jenkins & baird, 2002; naturale, 2007), but there are some who characterize them in terms of stress (e.g., figley, 1995; jacobson, 2006), suffering (rotschild & rand, 2006), and a reduced capacity for being empathic (adams, boscarino, & figley, 2006; dill, 2007). while the symptoms are most often described as the result of being exposed to a traumatized individual and his or her descriptions and reactions to a traumatizing event (see, e.g., bourassa, 2009; figley, 1995; jenkins & baird, 2002; naturale, 2007), sometimes they are said to be the nilsson/are empathy and compassion bad 295 result of working in a helping profession (rothschild & rand, 2006) or of helping or wanting to help other people (e.g., figley, 1995; white, 1998). this diversity in the definitions of “compassion fatigue” can sometimes be found in one and the same writer. in his oft-cited definition from 1995, figley writes: “we can define sts [secondary traumatic stress, which figley used as a synonym for “compassion fatigue”] as the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person” (figley, 1995, p. 7). here figley describes both the symptoms and their causes in at least two different ways. focusing on the causes, we can see that they are said to be, on the one hand, the result of “knowing about a traumatizing event experienced by a significant other,” and, on the other hand, a result of “helping or wanting to help a traumatized or suffering person.” presumably, figley’s intention was that these phrases should be taken to mean the same thing. however, taken by themselves they certainly do not have to be read in this way: the first phrase is easily interpreted as saying that compassion fatigue is caused by the mere exposure to a traumatized individual, whereas the latter phrase could be taken to indicate that compassion fatigue is rather a frustration over not being able to help. although figley’s definition is ambiguous, in the actual text it is clear that he used “secondary traumatic stress” and “compassion fatigue” to denote symptoms of ptsd caused by exposure to a traumatized individual. figley has later proposed to distinguish compassion fatigue from secondary traumatic stress, using “compassion fatigue” to denote a state containing two components: secondary traumatic stress and job burnout (adams, boscarino, & figley, 2006). a similar strategy can be found in stamm (2010). according to her, compassion fatigue is a complex state consisting of two parts: burnout, which “is associated with feelings of hopelessness and difficulties in dealing with work or doing your job effectively” (stamm, 2010, p. 13); and secondary traumatic stress, which is described as symptoms characteristic of ptsd caused by secondary exposure to traumatic events (stamm, 2010). secondary exposure to trauma should be distinguished from primary exposure. according to stamm (2010), the latter is when a traumatic event happens to you directly. disaster responders and other professional helpers, who literally put their lives at stake as part of their jobs, run a constant risk of falling victims to such primary exposure. secondary exposure, on the other hand, is when you are exposed to traumatized individuals and their trauma. this happens to any professional helper who works with traumatized people and takes part in their stories. in some cases, but certainly not all, such exposure gives rise to traumatic stress. when it does, and when the stress is caused only by the secondary exposure, it is a case of, what stamm (2010) calls, “secondary traumatic stress.” the focus of this paper is secondary traumatic stress in stamm’s sense of the term, i.e., a state in which an individual experiences symptoms similar to those of ptsd as a result of secondary exposure to a traumatic event. however, in this paper both the term “secondary traumatic stress” and the term “compassion fatigue” will be used to denote this state. this should by no means be taken as a criticism of stamm’s nomenclature. it is only done for variation, and because both terms occur in the advances in social work, fall 2014, 15(2) 296 literature to be discussed (see, e.g., adams, boscarino, & figley, 2006; conrad & kellar-guenther, 2006; dill, 2007; jenkins & baird, 2002; radey & figley, 2007). among those who take compassion fatigue to be caused by secondary exposure to traumatic events it is sometimes suggested that empathy or compassion are the responsible mechanisms (adams, boscarino, & figley, 2006; conrad & kellarguenther, 2006; dill, 2007; jacobson, 2006; jenkins & baird, 2002; radey & figley, 2007; simon, pryce, roff, & klemmack, 2005; stamm, 2010). when it comes to compassion it has not been specified exactly how this works, but the idea seems to be that since compassion is a state of suffering with another person, too much compassion will result in too much suffering, and, in the end, compassion fatigue. when it comes to empathy there is at least one theory. according to hoffman (2000) compassion fatigue is empathic over-arousal. this is defined as “an involuntary process that occurs when an observer’s empathic distress becomes so painful and intolerable that it is transformed into an intense feeling of personal distress, which may move the person out of the empathic mode entirely” (hoffman, 2000, p. 198). thus, according to hoffman, compassion fatigue is a state which is brought about when a person experiences too much empathy with a person in distress, i.e., a state in which the distress felt as part of having empathy with the other becomes so strong as to turn into an actual personal distress. although it has never been substantiated that empathy or compassion are causes of compassion fatigue, the suggestion that they are certainly raises a worry concerning the proper role and function of empathy and compassion within professional social work. if either of these states is responsible for the emergence of compassion fatigue, and if compassion fatigue is bad for the professional social worker, then there is ground for claiming that empathy or compassion are, or at least can be, bad for the professional. the aim of this paper is, therefore, to consider and evaluate the suggestions that empathy or compassion are causes of secondary traumatic stress. put more specifically, the aim is to examine hoffman’s (2000) idea that compassion fatigue is caused by having too much empathy with a traumatized individual, and the related idea that compassion fatigue emerges as a result of feeling too much compassion for such an individual. the way to investigate these issues has been to review influential contemporary research about empathy and compassion. this is a blossoming field, with lots of research currently being performed within, e.g., social psychology and the neurosciences. obviously, it is beyond the scope of this paper to give a full review of this research. here focus has been on presenting findings and theories that pertain to what empathy and compassion are, and that are relevant for determining whether or not too much empathy or compassion can give rise to compassion fatigue. when it comes to empathy, a further complication is that different researchers use “empathy” to refer to many different states or processes. batson (2009, 2011) has counted eight different phenomena that the term has been used to denote, ranging from knowing about another person’s internal state to feeling concern for another in distress. in this paper, however, “empathy” is reserved for one, and only one, of the phenomena enumerated by batson, namely states in which an individual feels what another person is feeling, or could be expected to feel, but in which the former does not necessarily feel any concern for the latter. (usually it is also assumed that the nilsson/are empathy and compassion bad 297 empathic feeling is caused in a special way. more on this later.) “empathy” will be used in this way mainly because this is how hoffman (2000) uses the term (batson, 2009; davis, 1994). hoffman is, however, not alone in this. this usage is not uncommon among researchers in social psychology and the neurosciences (see, e.g. batson, 2011; davis, 1994 for references). “compassion,” on the other hand, will be used to refer to a state of feeling concern for a person perceived to be in distress. this is by far the most common way of defining “compassion” (for examples, see blum, 1994; eisenberg, 2002; goetz, keltner, & simon-thomas, 2010; hoffman, 2000; snow, 1991). however, as we shall see later, many researchers have used other terms to refer to this state. batson, at one point, actually used the word “empathy” (batson, 2009; goetz, keltner, & simon-thomas, 2010). today, batson (2011) and others (see davis, 1994; eisenberg & eggum, 2009; thomas, 2013) talk about it as “empathic concern.” compassion fatigue and empathic over-arousal this section investigates the hypothesis that compassion fatigue is caused through empathic over-arousal, i.e., the hypothesis that the emotional plight that constitutes compassion fatigue arises as a result of having too much empathy with a person in distress (hoffman, 2000). this idea will be evaluated against contemporary research and theorizing about empathy. in doing this we shall see that there are problems not only with the hypothesis, but also with the notion of empathic over-arousal itself. however, before looking at the problems we should note that compassion fatigue, in the sense we are interested here, bears some striking similarities to empathy, on at least one common understanding of the term. as we have seen, compassion fatigue has been described as a reaction of traumatic stress caused by secondary exposure to a traumatic event. this means, firstly, that the symptoms are caused by the knowledge or perception of another individual’s state or situation, and, secondly, that in many situations the person suffering from compassion fatigue will experience an emotion or affect that is similar to what the other person is experiencing or could be expected to experience. both of these features are prominent parts of empathy, on at least one understanding of the term. as already mentioned, “empathy” is used in many different senses in contemporary research, but according to one popular understanding empathy is a state in which you feel what another person is feeling (or could be expected to feel), and in which you feel it because of your knowledge or perception of this other person and her state or situation (see, e.g., decety & jackson, 2004; eisenberg & eggum, 2009; hoffman, 2000; nilsson, 2003). given these similarities it is easy to see the rationale behind the claim that empathy is what gives rise to compassion fatigue. it almost seems as if compassion fatigue is a kind of empathy, albeit one with a particularly negative effect on the empathizer. however, if we look more closely at how the term “empathy” is defined in the literature we shall see that, according to the views of some researchers, it is impossible to describe compassion fatigue as a kind of empathy. although these researchers characterize empathy as being caused in the same way as compassion fatigue, they have a way of describing empathic feelings that makes it impossible for such feelings to constitute compassion fatigue. this is because they define empathic advances in social work, fall 2014, 15(2) 298 affects so that they cannot, at least not by themselves, constitute a plight or burden for the empathizer. this view can be found in decety and jackson (2004).1 according to them there are three functional components that together give rise to empathy in humans: (1) emotional sharing between the self and the other; (2) awareness of the distinction between self and the other; and (3) “mental flexibility to adopt the subjective perspective of the other and also regulatory processes” (decety & jackson, 2004, p. 75). emotional or affective sharing is a necessary component of the experience of empathy. unless you experience an emotion or affect that is similar to what the other is experiencing (or, perhaps, what the other could be expected to experience) you cannot have empathy. however, not any kind of emotional sharing will do. according to decety and jackson, the empathic affect must also be coupled with an awareness of the distinction between self and other, and also be regulated in certain ways: empathy, as presented in our model, necessitates some level of emotion regulation to manage and optimize intersubjective transactions between self and other. indeed, the emotional state generated by the perception of the other’s state or situation needs regulation and control for the experience of empathy. without such control, the mere activation of the shared representation, including the associated autonomic and somatic responses, would lead to emotional contagion or emotional distress. (decety & jackson, 2004, p. 87) decety and jackson (2004) describe emotional contagion as the phenomenon of “sharing emotion without self-awareness,” something “which takes the form of ‘total identification without discrimination between one’s feelings and those of the other’ …” (p. 75). thus, emotional contagion is a state in which you do not simply experience a feeling as a result of being exposed to someone in a certain state or situation, but in which you also experience this feeling as one of your own, and, presumably, act accordingly. empathy, on the other hand, is a state of emotional sharing in which you continue to be aware of the distinction between yourself and the other, and of the other as the origin of your feeling. it seems natural to assume that, given this characterization of emotional contagion, a person who is infected by someone else’s distress or suffering will experience personal distress, i.e., he will take himself to be in an aversive state and he will take steps to relieve himself of his suffering. hence, it would seem as if self/other-awareness is an important tool for preventing emotional sharing from developing into personal distress. however, in relation to distress, decety and jackson mainly point to the importance of emotion regulation. as they note, there are studies showing that people lacking in emotion regulation – i.e., who tend to be overwhelmed by emotions – are prone to experience personal distress when being exposed to a person in need, whereas people who have the ability to regulate their emotions are not (decety & jackson, 2004). 1 see, however, decety and lamm (2006) for a different view. in this paper “empathy” seems to be defined in a way which does not put any restrictions on how painful or distressing it can be to empathize with a person in need. i am grateful to an anonymous referee for pointing this out to me. nilsson/are empathy and compassion bad 299 the main thing to note here is that according to decety and jackson (2004) empathy is, by definition, a state of emotional sharing that does not involve emotional contagion or personal distress. this means that you cannot empathize with another individual and experience personal distress as part of your empathic experience. hence, since compassion fatigue is naturally taken to involve personal distress in the view of decety and jackson, it cannot be described as a kind of empathy. it is important to note that this is a matter of definition. it is because decety and jackson define the term “empathy” in the way that they do that it is impossible, i.e., conceptually impossible, to claim that compassion fatigue is a kind of empathy. while decety and jackson are not alone in defining “empathy” in this way (see, e.g., nilsson, 2003), there are others who do it differently. hoffman, for example, defines “empathy” as “an affective response more appropriate to another’s situation than one’s own” (2000, p. 4), but he does not seem to put any restrictions on the intensity or painfulness of this affective response. as he himself writes, empathic distress, i.e., the empathic feeling that you experience when you empathize with someone in distress, can be so intense and aversive so as to “divert the attention of observers from the victim to their own very real distress” (hoffman, 2000, p. 198). thus, for hoffman there seem to be no sharp conceptual boundaries between, on the one hand, empathy and empathic distress, and, on the other hand, emotional contagion and personal distress. another researcher, whose view on empathy lands somewhere between those of hoffman, and of decety and jackson, is eisenberg. she defines “empathy” as “an affective response that stems from the apprehension and comprehension of another’s emotional state or condition, and which is similar to what the other person is feeling or would be expected to feel” (eisenberg & eggum, 2009, p. 71). by itself this definition does not say anything about the nature and intensity of the affective response. however, when discussing decety and jackson and their view on the importance of emotion regulation, eisenberg states that regulation of vicarious emotion is essential for empathy (eisenberg & eggum, 2009). nevertheless, eisenberg has, alongside with hoffman, been a proponent of the view that there is such a thing as empathic over-arousal. however, from eisenberg’s view of empathy it is not so easy to see how empathic over-arousal is possible. according to her, such over-arousal occurs when too much unregulated emotional sharing with someone in distress evolves into personal distress (eisenberg & eggum, 2009). her hypothesis is that whereas unregulated empathic distress may lead to personal distress, regulated empathic distress may instead lead to sympathy and empathic concern. this hypothesis seems plausible given the finding that people who lack in emotion regulation are more likely to react with personal distress when being exposed to a person in need than are people who are good at regulating their emotions (eisenberg & eggum, 2009). the problem is that this idea of empathic over-arousal is difficult to combine with eisenberg’s claim that emotion regulation is essential for empathy. to see this, consider the view of empathy, expressed by decety and jackson, that empathic overarousal is impossible, since empathy is constituted by a regulated affect. the latter implies that there cannot be “too much empathy” or “too much unregulated empathy.” empathy is by definition regulated. therefore it cannot turn into personal distress or, for that matter, compassion fatigue. since eisenberg claims to agree with advances in social work, fall 2014, 15(2) 300 decety and jackson that emotion regulation is essential for empathy, it should follow also from her view that empathic over-arousal is impossible, i.e., personal distress cannot arise as a result of too much empathy. therefore, as long as “empathy” is defined as a state of emotional sharing that is regulated in such a way that the empathic affect cannot amount to personal distress, empathy cannot turn into compassion fatigue. obviously, “empathy” must not be defined in this way, but, as the previous discussion has shown, if we do not adhere to this definition, there are still reasons to believe that a regulated type of empathy does not lead to personal distress or compassion fatigue. hence, there is reason to believe that empathy, or at least regulated empathy, is not bad for the professional social worker in the sense that it can give rise to compassion fatigue. fatigue from compassion while there is a theory of how empathy may give rise to compassion fatigue, there is nothing similar to be found regarding compassion. although there are writers who have suggested that compassion can give rise to compassion fatigue (radey & figley, 2007; stamm, 2010), it has never been spelled out exactly how this would work. however, since compassion is often described as a state of suffering with or for another person, it seems natural to assume that the idea is that too much compassion involves too much suffering, and, therefore, that too much compassion will lead to compassion fatigue. thus, the idea would be analogous to the idea of empathic overarousal, only in this case compassion fatigue consists in a “compassionate overarousal.” in contemporary research compassion is standardly described as an emotional concern felt in response to an individual perceived to be in need (see, e.g., blum, 1994; eisenberg, 2002; goetz, keltner, & simon-thomas, 2010; hoffman, 2000; snow, 1991). as already mentioned, most researchers distinguish between compassion and empathy by claiming that the former necessarily involves a concern for the other and a desire to relieve that person’s suffering, whereas the latter does not. some also claim that compassion necessarily involves an experience of sorrow or suffering on the part of the person feeling it – to feel compassion for another person is to suffer with or for that person (blum, 1994; eisenberg & eggum, 2009; snow, 1991). presumably it is this suffering that has led some to believe that compassion may be responsible for compassion fatigue. however, whether or not too much compassion can lead to compassion fatigue depends on what kind of suffering is involved in compassion. is it a type of suffering that is a plight or a burden for the person experiencing it, or is it some other type of suffering? as we shall see, a review of current research strongly suggests that the suffering of compassion is not a plight or burden for the person feeling it. this is suggested not only by empirical research, but also by some more philosophical considerations. it is, for example, clear that on our ordinary understanding of the term “compassion,” the suffering of compassion is not necessarily experienced as a burden. this is shown by the fact that there is no contradiction or oddity in saying “i feel compassion, and i do not mind it.” ordinary suffering, on the other hand, is by logical necessity nilsson/are empathy and compassion bad 301 experienced as a burden, since it is ordinarily a contradiction to say “i suffer, but i do not mind it” (hare, 1981; nilsson, 2011). there are also anecdotal observations suggesting that people do not in fact experience compassion as a plight. suppose, for the sake of argument, that they did. in that case we would expect them to avoid and regret feeling compassion. we would expect them to, at least sometimes, seek our compassion in response to their compassion, and we would, at least sometimes, be willing to grant them our compassion and sympathy on account of them feeling compassion. however, it seems fairly clear that people rarely, if ever, react in these ways. we do not avoid or regret feeling compassion because we take compassion, in and of itself, to be a burden for us. neither do we expect others to commiserate with us because we feel compassion, and we never feel compassion for someone solely on account of them feeling compassion for someone else. hence, there are prima facie reasons for believing that compassion is not a plight or a burden for the person feeling it (see nilsson, 2011 for a more detailed version of this type of argumentation). further support for this claim comes from a series of psychological experiments performed by batson and colleagues (for an overview, see batson, 2011). these studies show that there is a significant difference between two responses to a person in need: on the one hand, what batson nowadays calls “empathic concern,” which is the same as sympathy and compassion, and, on the other, what batson calls “personal distress,” which is a self-focused state wherein a person takes himor herself to be the victim of plight (batson, 2011). that there is a significant difference between these reactions is suggested, firstly, by one study showing that people who, after being exposed to a person in need, describe themselves in terms indicative of empathic concern (as being, e.g., concerned, softhearted, and compassionate) tend not to describe themselves in terms indicative of personal distress (being, e.g., alarmed, upset, disturbed, distressed), and vice versa (batson & coke, 1981). other similar studies have shown that compassion is experienced as distinct not only from distress, but also from sadness (see goetz, keltner, & simon-thomas, 2010). more support comes from batson’s long line of experiments showing that people who report feeling empathic concern tend to be motivated to help the other person for altruistic reasons, whereas those who report feeling personal distress tend to be motivated to help from egoistic reasons. thus, whereas those who feel empathic concern are motivated to help the other person for his or her sake, those who report feeling personal distress are motivated to help the other for their own sake, i.e., for the sake of relieving themselves of their distress (batson, 2011). this also suggests that compassion is in fact distinct from personal distress, and that the suffering of compassion is not experienced as a plight or burden. based on these findings batson (2011) is skeptical of the idea of empathic overarousal. however, it is important to note here that although batson mentions hoffman and eisenberg as proponents of the idea of empathic over-arousal, what batson is talking about is, strictly speaking, something else. he is skeptical of the idea that empathic concern, i.e., sympathy or compassion, can become so strong as to turn into personal distress. in other words, he is skeptical of the idea of compassionate overarousal. advances in social work, fall 2014, 15(2) 302 given that personal distress and empathic concern seem to be two distinct emotions, each lying, as batson (2011, p. 65) says, “on its own continuum,” it is difficult to see how too much of the latter could turn into the former. regardless of how strong or intense your feeling of compassion is it cannot, by itself, become a plight or burden for you. hence, there are no reasons for believing that compassion fatigue emerges as a result of feeling too much compassion. this conclusion is further strengthened by a recent study performed by thomas (2013). this study is unusual, and at the same time highly relevant, since it was an empirical study designed to actually investigate the correlations between, on the one hand, compassion fatigue, and, on the other hand, personal distress and empathic concern. “compassion fatigue” was defined as symptoms similar to the symptoms of ptsd, “which are all work-related and associated with secondary exposure to stressful events” (thomas, 2013, p. 372). it was measured using the professional quality of life scale-fourth edition, revised (proqol-iv-r) developed by stamm (thomas, 2013). personal distress and empathic concern were measured using davis’s interpersonal reactivity index (iri) (thomas, 2013). this is an instrument based upon a multidimensional view of empathy. it measures a person’s dispositions for perspective taking, empathic concern, personal distress, and fantasy, understood as a person’s tendency to imaginatively transpose himor herself into different situations (davis, 1994). unfortunately the iri does not measure a person’s tendency to experience empathy in the sense in which the term has been used in this paper. however, according to davis (1994), the empathic concern scale should be taken to measure an individual’s disposition for compassion. thomas’s study, which was conducted on a group of clinical social workers, showed a significant correlation between distress and compassion fatigue, but none between empathic concern and fatigue (thomas, 2013). hence, thomas’s findings support not only the claim that compassion fatigue does not emerge as a result of compassionate over-arousal but also the more general claim that compassion is not a cause of compassion fatigue. concluding remarks this paper has sought to show that there are reasons to believe that compassion fatigue does not arise through empathic or compassionate over-arousal. as this short review has shown, the evidence at hand suggests that compassion fatigue does not emerge as a result of having too much empathy with, or feeling too much compassion for, a person in distress. however, strictly speaking this review does not show that empathy or compassion play no role in the emergence of compassion fatigue. what it shows is that there are reasons for believing that neither empathy nor compassion turns into compassion fatigue. one can, however, imagine other ways in which empathy and compassion may cause compassion fatigue – if it is impossible or unlikely that empathy and compassion can turn into compassion fatigue, perhaps a certain amount of empathy or compassion for someone in distress has the capacity to cause a separate feeling of personal distress? to investigate this issue is beyond the scope of this paper. it should, however, be noted that there does not seem to be any empirical evidence confirming the existence of such a causal reaction. furthermore, the available research clearly suggests that personal distress arises under different circumstances and in different ways than nilsson/are empathy and compassion bad 303 empathy and compassion. while the latter two tend to arise when you have a clear grasp of the distinction between, on the one hand, yourself and your current situation, and, on the other hand, the other person and his or her situation, personal distress tends to arise when the distinction between self and other is blurred. while empathy and compassion go hand in hand with the ability to regulate one’s emotions, evidence suggests that those who lack in their regulatory abilities are more vulnerable for personal distress. finally, it should be noted that there are a number of studies showing that a subject instructed to imagine what it is like for another person to be in distress is likely to react with empathy or compassion, whereas a subject instructed to imagine what it would be like for oneself to be in the other’s situation is likely to react with personal distress (batson, 2011; hoffman, 2000; see also decety & lamm, 2009 for a neuroscientific perspective on this). these findings all suggest that personal distress arises through a different causal pathway than empathy and compassion. hence, the available evidence makes it reasonable to believe that empathy and compassion are not bad for the professional social worker in the sense that they put him or her at risk of developing compassion fatigue. references adams, r. e., boscarino, j. a., & figley, c. r. 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(2010). the concise proqol manual (2nd ed.). retrieved from http://www.proqol.org/uploads/proqol_concise_2nded_12-2010.pdf thomas, j. (2013). association of personal distress with burnout, compassion fatigue, and compassion satisfaction among clinical social workers. journal of social service research, 39(3), 365-379. doi:10.1080/01488376.2013.771596 white, g. d. (1998). trauma treatment training for bosnian and croatian mental health workers. american journal of orthopsychiatry, 68(1), 58-62. author note address correspondence to: peter nilsson, school of education, health and social studies, dalarna university, 791 88 falun, sweden. email: pnl@du.se ______ derrick a. kranke, phd, health science specialist, veterans emergency management evaluation center (vemec), u.s. department of veterans affairs, north hills, ca 91343, dakranke@gmail.com] copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 369-382, doi: 10.18060/22535 this work is licensed under a creative commons attribution 4.0 international license. self-change in facilitating empowerment: applying a narrative perspective to adolescents with a mental health diagnosis derrick kranke abstract: youth empowerment is a critical research area because it has implications for reducing adolescent mental health stigma while improving their life trajectory, engagement in treatment and meaningful opportunities, and increasing self-esteem. the present inquiry is derived from a larger study and strives to enhance knowledge of youth empowerment by using frank’s rhetoric of self-change—a form of narrative analysis—to understand events and reactive experiences of illness as occasions for changing the self. this narrative approach facilitated the development of a youth empowerment process because of its ability to identify similar characteristics across the three cases of youths included in this analysis. actively participating in age/developmentally appropriate activities put the adolescents on a trajectory towards attaining milestones in a timely manner coinciding with the developmental timeline of peers without mental health issues. additional research is needed to understand how the identified factors promote empowerment among adolescents with mental health issues. narrative research has implications for clinical social work because it illuminates strengths that can be beneficial in promoting positive interventions. keywords: adolescents; empowerment; qualitative; narrative; self-change; mental health adolescence is a period marked by many changes, particularly attention to and attainment of developmental milestones critical to transition to adulthood (kroger, 2007). leavey (2005) reports that adolescents with mental health issues are more likely to experience a delay in attaining developmental milestones, as they tend to focus on their symptoms and pathology rather than attending to the process and cognition involved with completing developmental tasks. an estimated 22% of adolescents experience mental health issues that cause impairment and distress (merikangas et al., 2010). some studies estimate that 46%-90% of these adolescents are stigmatized by a family member, peer, or educator (kranke, floersch, townsend, & munson, 2010; moses, 2010). many contextual factors impact how adolescents mitigate the stigmatized effects of mental health including treatment, familial and cultural beliefs, race and ethnicity, peer support, environment, previous exposure to trauma, self-esteem, gender, socioeconomic status, and type of disorder (hinshaw, 2005). goffman (1963) characterizes stigma as “possessing an attribute that makes him different from others . . . and of a less desirable kind. . . . he is thus reduced in our minds from a whole and usual person to a tainted, discounted one” (p. 3). individuals may be reluctant to interact with or befriend the stigmatized individual for fear of being the object of ridicule (hinshaw, 2009). consequences of stigma commonly include diminished social relationships and fewer opportunities for education, recreation, and/or career opportunities. . most research on adolescent mental health focuses on deficits; however, much can be gained by studying those adolescents who are thriving and overcoming the effects https://creativecommons.org/licenses/by/4.0/ kranke/self-change 370 associated with mental health concerns (morton & montgomery, 2013; wong, zimmerman, & parker, 2010). despite the ubiquity of stigma, some adolescents with mental health issues manage to escape being stigmatized or are somehow able to mitigate or deflect stigma. examining factors that promote well-being among non-stigmatized youth could raise awareness and improve health outcomes by making services more amenable to the needs and concerns of stigmatized adolescents. adolescents who mitigate mental health stigma may become more resilient in dealing with future challenges and have higher educational success (aspy et al., 2004; hinshaw, 2009). recent research has taken a shift by devoting more scholarship to identifying factors that promote empowerment among youth (wong et al., 2010). empowerment consists of psychological components involving self-esteem or self-efficacy and a social action component involving aspects of engagement in meaningful opportunities and control over one’s life situation (corrigan, 2005; rusch, lieb, bohus, & corrigan, 2006). a systematic review of evidence regarding impacts of youth empowerment programs on adolescents concluded that there is a paucity of research examining empowerment programs outside of education contexts (morton & montgomery, 2013). additionally, a gap still exists within the literature that pinpoints successful outcomes associated with those adolescents who feel empowered (ozer & schotland, 2011). since research is lacking on adolescent empowerment, qualitative research in the form of narrative analysis is a starting point to explore knowledge and identify core constructs of the phenomenon. background of the narrative approach frank’s (1993) approach of describing illness experiences in narrative form has been used to increase understanding of individuals’ course of illness with various physical, mental, terminal and/or chronic conditions (charmaz, 1994; crossley, 2000; taylor, 1996; wilkinson, 2000). the illness narrative is an individual reaction to being diagnosed and experiencing the illness. typically, a new sense of self replaces the old self. frank believes that the events and experiences associated with illness are occasions and pivotal moments for a transformation in one’s overall sense of self. frank (1993) describes four types of self-change rhetoric: 1) “the self as what i always have been”—continuity between former and present self; 2) “a self who i might become”—a radically changed self; 3) “cumulative epiphanies”—whatever the individual has become has been formed in and through illness; and 4) “reluctant phoenixes”—those who indicate minimal to no change in self -perception due to illness. the narrative rhetoric of “a self who i might become” was selected for this analysis because adolescents are at the passage to adulthood. the decisions they make, their methods of coping with stressors and illness, and potential for change and growth may all dictate some of the most formidable years of their lives and a self who they might become. the other three types of rhetoric from frank’s (1993) narrative model were not used for this analysis because "the self as what i always have been”– continuity between former and present self, and “cumulative epiphanies”– whatever the individual has become has been formed in and through illness--have a temporal component of living with their illness for a longer period of time than the adolescents in the present case studies. the rhetoric on “reluctant advances in social work, fall 2019, 19(2) 371 phoenixes”-who indicate minimal to no change in self from illness, was also not a good fit for the adolescent case studies featured in this analysis. frank (1993) lists guidelines/criteria by which narratives qualify as the rhetoric of “a self who i might become.” for instance, the element of “wholly new radically changed self” implies that the narrator has become a different person because of the illness experience. the narrator may speak of how his/her perspectives on the world have changed as a result of living with the illness. second, “the former view of disease from without is inadequate” implies that the narrator can only perceive the world through the lens of living with an illness. he/she can no longer see the world as his/her old self without having a disease. third, “new relation of self to others” implies that the illness experience allows the narrator to connect with others on a different level. some individuals may have cut off or limited connection with others because they were overwhelmed with the onset of their illness: however, incorporating their illness into their new sense of self allows him/her to move the focus from the self to external stimuli. in sum, the rhetoric describes the self as emerging from the discovery of illness as wholly new. for instance, a woman newly diagnosed with type ii diabetes must reconstruct a new self to continue living. she will have to account for the ways treating her diabetes may impact her daily routines, eating habits, medical care, as well as self and public perceptions. as the woman integrates the element or experiences with her diagnosis into her transformed sense of self, she may discover a vision of the person she might become. she may decide to become an advocate for individuals who also have diabetes, or she may not accept her diagnosis and decide to isolate herself from others. her life trajectory will be forever changed because of the type ii diabetes. she has a new perspective that impacts her relation of self to others. in this case, the woman’s view of herself without having the type ii diabetes will no longer be a valid perspective because the element of the type ii diabetes alters her life trajectory and must be accounted for in her present perspective because of its impact on all facets of her life. frank’s narrative approach (1993) has not been applied to the study of youth empowerment but has the potential to provide insight into that phenomenon because of its prior application to identifying novel aspects among individuals with other illnesses. frank’s narrative approach has been helpful in prior analyses of illness experiences to identify overlapping and common attributes. for instance, thornhill, clare, and may (2004) applied frank’s approach to adults recovering from psychosis to construct meaning of the illness experience into one of three genres – escape, enlightenment, or endurance. findings revealed unique aspects of the illness experience not previously found in other types of qualitative and quantitative analyses, while also confirming some previous findings. mcmahon, murray, sanderson, and daiches (2012) applied frank’s narrative approach to a study identifying how individuals make sense of living with fibromyalgia and incorporating the illness into their sense of self and identity. this study also found overlapping content in the narratives by recognizing five phases that embodied the illness experience from beginning to present. researchers who apply frank’s method commonly incorporate findings to address challenges participants experienced with their illness and factors that facilitate treatment and rehabilitation. kranke/self-change 372 this study applied the frank (1993) method of illness experience as narrative in an effort to increase understanding of the empowerment experiences of youth with a mental health diagnosis. this inquiry aims to identify and connect the critical events that can alter the course of adolescents’ trajectory to become empowered and even avoid mental illnessrelated stigma. the analysis applied frank’s mechanism of narrative analysis/rhetoric of self-change in presenting the perspective of three adolescents who felt empowered by psychiatric treatment. original study purpose, practicalities and context the original research project was supported by the national institute of mental health (kmh068584a1) and was based at an urban, private college in ohio. a university hospital institutional review board for human investigation reviewed and approved the research protocol. the data from this project were collected from 2006-2008 and originally intended to assess the subjective experience of adolescents using psychotropic treatment (n=40). adolescent mental health issues were in the beginning stages of being treated with adult dosages of medication, and little was known about how they made sense of the experience. we were curious to know the adolescent perspective of engaging in such treatment. how did the medication impact their social relationships? were they embarrassed to tell their peers about the use of medications? did the medication alter their sense of self and how they related to others? did they reap the intended benefits of taking medication? did the consequences of taking the medication lead to more or less meaningful opportunities? collectively, the concerns we wanted to address with the original study align well with the elements of frank’s narrative rhetoric of “a self who i might become.” while coding the qualitative portion of the full dataset, patterns emerged of adolescent concerns with feeling “different,” and developmental concerns related to attainment of milestones, peer perceptions of mental health treatment, and how they navigated the process of utilizing services. medication treatment facilitated a quicker maturation process among many of the adolescents. there were also varying levels of stigma among the sample: some reported no stigma while others reported some or high levels of stigma. within the last decade, a large body of literature examined the experience of stigma among adolescents (hinshaw, 2009; kranke et al., 2010; moses, 2010). however, the perspective of adolescents who have had a positive experience of mental health treatment and who have managed to avoid the cycle of stigma has not emerged in the literature. in the original study (kranke, floersch, kranke, & munson, 2011), an adolescent selfstigma process emerged from the data based on developmentally appropriate and sociocultural responses to mental health perceptions and utilization of mental health services. adolescents who self-stigmatized internalized shame related to their mental health diagnoses and were reluctant to engage in treatment because of how it made them feel “different.” the adolescent self-stigma model contained components associated with three critical events from the original adult self-stigma model (corrigan & watson, 2002): 1) exposure to perceptions of mental health diagnoses; 2) emotional reaction to mental health diagnoses and the need for treatment; 3) behavioral responses that impact engagement in treatment and meaningful opportunities. the adolescent self-stigma process proposes that adolescents with a mental health diagnosis “stereotype” by applying the mental health label advances in social work, fall 2019, 19(2) 373 to his/her self; “differentiate” by viewing oneself as inferior to others who are well; and “protects” his/her social capital by hiding the use of medication and the need for treatment to preserve social opportunities in the future and beyond. we were interested in learning from the perspective of adolescents with a mental health diagnosis who managed to avoid self-stigma. research design. a mixed method cross-sectional study of adolescents was conducted. the original study was exploratory in nature and focused on youth’s subjective experience with taking psychotropic medications. sampling. recruitment procedures included communication through face-to-face discussions with professional staff as well as flyers and posters targeting patients of an outpatient clinic within the division of child & adolescent psychiatry at a university hospital, community mental health outpatient settings, and an alternative high school for adolescents with emotional and behavioral problems. we maintained confidentiality of study participants by conducting the interviews in private and secure locations. inclusion/exclusion criteria. adolescents, age 12 to 17 years, meeting dsm-iv criteria (because the data were collected before 2013) for a psychiatric illness and who were prescribed a psychotropic medication were eligible for inclusion. since the study focused on adolescents on medication, individuals were excluded from participation when parents reported that the adolescent had not taken psychiatric medication at least once in the past 30 days. in addition to the data produced by a semi-structured instrument, we collected general information regarding adolescent and family demographics and psychiatric/medication treatment history. the k-sads-pl (kiddie schedule for affective disorders and schizophrenia) was administered as a research diagnostic instrument to categorize participant diagnosis (kaufman et al., 1997). interview design. digital audio recordings of interviews were transcribed and then analyzed using atlas.ti (muhr, 1993), a software program designed for qualitative data management and coding. the research team collected qualitative data using the teensemi, a semi-structured interview, to query adolescents about their perceptions of having a psychiatric diagnosis and of taking psychotropic medication. the teensemi was adapted from an adult instrument to obtain narrative data from adults with schizophrenia (jenkins, 1997) by modifying the 150 questions to be more specific to age-related concerns of adolescents. interviews lasted between 90-120 minutes and were recorded as audio wave files. typically, the use of semi-structured interviews may not yield the kinds of rich descriptions necessary for a narrative analysis. however, the semi-structured interview protocol contained questions that pertained to thoughts and feelings associated with taking psychotropic medication and we did not use guided language that may have directed the adolescent participants to describe negative or stigmatizing experiences (floersch et al., 2009). in addition, interviewers used probing questions to gather additional data when the participants described the course of their treatment experience, with an emphasis on changes in self/peer/family perceptions, as well as feelings about self in a temporal sequence. interviewers tried to follow the lead of the interviewee as much as possible (see table 1 for a list of sample interview questions). kranke/self-change 374 table 1. sample questions from semi-structured interviews 1. have you ever been given a diagnosis or name for the concerns we have been talking about? (probe for history) 2. what do you recall being told by others about the diagnosis? 3. how did you feel about the first time you heard the diagnosis applied to you? 4. what are your thoughts about how things will change with your concerns/diagnosis, as you grow older? 5. how long do you think you will need to take your current medication(s)? 6. while on medication, what things in your life do you think are improving? 7. what do you tell people about your concerns (or diagnosis) that we have been talking about? 8. are there things about your concerns that you prefer to keep secret from others? methods the present inquiry emerged as a result of the development of the self-stigma model from the initial study (kranke et al., 2011). twenty-seven adolescent narratives were considered “complete and consideration of alternative perspectives (i.e., before and after receiving diagnosis), and display of sufficient evidence” (yin, 2009, p. 185-188) in describing attributes/components of the self-stigma process. however, three of the adolescent narratives did not endorse any stigma themes commonly found among stigmatized individuals; namely secrecy, shame, and/or limiting interaction (kranke et al., 2010; link, cullen, struening, shrout, & dohrenwend, 1989). these three cases were considered unique from the other 24 narratives, thus were explored in greater depth in this inquiry. focusing on adolescents in the study who experienced the positive effect of mental health treatment could delineate factors that might facilitate a more positive trajectory for others. this perspective of examining “what worked” was timely and innovative as the social work field moves in the direction of appreciative inquiry for changing social systems: “1) a focus on changing how people think instead of what people do; and 2) a focus on supporting self-organizing change processes that flow from new ideas” (bushe & kassam, 2005, p. 161). the sample for this present inquiry (n=3) consisted of one adolescent who identified as a 17-year-old white female with major depressive disorder, a 14-year-old white female with bipolar disorder, and a 12-year-old african american male with attention deficit hyperactivity disorder. it is worth noting that the three adolescent cases in this study were not re-contacted after the initial study was completed. the author’s analysis of the three cases for this current inquiry began with identifying themes. “thematic analysis is a method for systematically identifying, organizing and offering insight into patterns of meaning (themes) across a data set” (braun, clarke, & terry, 2014, p. 95). the cases needed to contain similar elements of empowerment as those conceptualized in the extant literature, namely: supportive family and friends, school success, positive outlook/attitude, and involvement in treatment. these themes appeared to work together in helping participants to have a positive perception of their lives. the author conducted the narrative analysis by reading each interview in its entirety several times before assigning codes. the identified quotations pertaining to empowerment were coded advances in social work, fall 2019, 19(2) 375 in atlas.ti (muhr, 1993). the same quotes were then copied and pasted from different parts of the interview, using the hyperlink tool in atlas.ti, to connect the codes and quotations of each empowerment story into a word document. results the narrative rhetoric matching “a self who i might become” (frank, 1993) was hypothesized as the most suitable prior to analysis, and was confirmed as the most suitable rhetoric after data analysis per the attributes that embody this particular rhetoric. two of the adolescent narratives contained all three of the attributes, and one adolescent narrative contained two of the attributes (see table 2). the excerpts included in each narrative consisted of the turning point related to the adolescent receiving a diagnosis, which was the impetus for self-change, and youth self-reflection throughout the course of their illness (see table 3). table 2. endorsement of characteristics of “a self who i might become” narrative among adolescent cases participant element of rhetoric wholly new radically changed self former view of disease from without inadequate new relation of self to others a: 17-year-old white female w/mdd x x b: 14-year-old white female w/bipolar disorder x x x c: 12-year-old african american male w/adhd x x x kranke/self-change 376 table 3. illness narrative of “a self who i might become” participant excerpt coding components of adolescent empowerment process a: (17-yearold white female with mdd) “the first time i applied it (label) to me was probably after reading a big thick book. like the ultimate guide to teenagers or something. it was going off like oh your child might be depressed if it’s this and this and this. so i checked out the list of stuff. i’m like, ha, well that’s interesting. i may be depressed. okay, let’s go tell mom, so i did.” turning point/illness diagnosis diminish negativity of label and/or stereotypes. “if it (medication) didn’t really work, then i would not have improved. i would say that just an example that, look at me, cause my mom sees a big difference in how i used to be so horribly grouchy and now i’m a lot happier.” radically changed self and new relation of self to others normalize need to address emotions. “i used to spend all the time in my room, and now i’m upstairs with my family more. i spend more time with them, don’t fight as much.” radically changed self and new relation of self to others attribute positive changes and well-being to psychiatric treatment. “my home teacher mentioned that he wasn’t sure what to tell people about the improvement in mood, cause he didn’t know if i wanted to keep it a secret, which i don’t. it’s like go ahead and tell them. i would much rather be on the medication and be happy and be happy with myself and happy about life than a grouchy little demon hiding in my room.” her radically changed and new self is more of an extrovert and has enhanced confidence. using narrative to change perceptions of mental health treatment among peers. b: (14-yearold white female with bipolar disorder) “at first i was like, no, i can’t be bipolar, that’s just not me. i don’t want to be it. and then, when i started actually seeing what was really going on, i’m just like, oh my god, i can’t believe i said that i wasn’t this and now i am. my mom sat down and explained (diagnosis) to me, and we went and got some books from the library and we pretty much just read up on them.” turning point supportive parent helps adolescent to diminish any negativity associated with label and need for treatment. “i was getting brainwashed by one of my friends, by 2010, almost everybody in the world’s going to be on medicine. and then i started to see the truth, and it’s just all like, i feel like why would they put me on it if it really didn’t work.” old view of disease from without no longer adequate normalize illness and need for treatment by comparing the adolescent to millions of others in the world who use meds. “i started taking medicine and i would see {myself as} a total different person when i took the medicine. i mean i wasn’t so angry and i was able to have a good time and laugh and just have fun. i know for a fact that if i didn’t take my medicine that i’d be more aggravated and get in more fights. . . when i was off the medicine, i’d always get in trouble for aggression. right now i’m loving life. i have great friends. i mean there’s nothing better that i can ask for right now. i’ve made honor roll, moved from making straight f’s to straight a’s.” wholly new self and relation of self to others radically changed self attribute health and well-being to psychiatric treatment. c: (12-yearold african american male with adhd) “when i went to the doctor i was okay cause he told me what it was (diagnosis) and i wasn’t scared no more.” turning point of diagnosis diminish negativity of label after taking proactive approach to consult with doctor. “she (mother) said (treatment) was for me paying attention and doing my work and focusing and stuff. it’ll help me. i won’t get distracted so easily.” radically changed self mother diminished any potential fears of treatment by saying it would improve child’s well-being. “i got a lot of friends and mostly everybody that i knew had it, and they wasn’t ashamed of it, so i started to not be ashamed of it either. they just said, so what? and they just looked at it like a cold, not like a disease.” new relation of self to others normalize the illness as any other disease and as a shared experience. “my friends want me to take it (medication), because they want me to go on field trips with them.” old view of disease from without no longer adequate “i want to take my medicine cause i realize it’ll help me now. . . because of the medicine, now i got a full scholarship to go to camp.” new relation of self to others radically changed self attribute improvements to the psychiatric treatment. kranke./self-change 377 constructing the empowerment process identifying the most suitable rhetoric among frank’s (1993) four different types allowed for recognition of the underlying components of each case that led to feelings of empowerment. it was necessary to start the analysis among individual cases, and then assimilate these personal experiences to create a unifying general view (herzlich & pierret, 1987). each narrative contained a turning point when the adolescents were given a mental health diagnosis. indeed, their lives would be forever changed. supportive environments facilitated the adolescents to diminish negativity associated with the label. as the 17-yearold adolescent with mdd described, “ha, well that’s interesting, i may be depressed.” the positive exposure to perceptions of mental health diagnoses may have motivated these adolescents to further investigate and learn about their illness. therefore, the two older adolescents searched for more information in books and all three consulted with individuals they trusted as available sources to help normalize the need for treatment, identify their mental health diagnoses, and to realize they were not the only ones dealing with mental health diagnoses. as the 14-year-old female with bipolar describes, “by 2010, almost everybody in the world’s going to be on medicine.” their engagement in mental health treatment had an overt effect on their anger, depression, and/or outlook on life. as the male adolescent with adhd says, “i want to take my medicine cause i realize it’ll help me now.” shifting the focus from their illness allowed the adolescents to engage in similar age-appropriate activities as their peers. they attributed their growth to the medication and treatment (see figure 1). figure 1. comparison of processes constant comparative method after the analysis of each narrative was completed and assigned the rhetoric “a self who i might become,” two independent researchers with expertise in the areas of qualitative research and youth mental health conducted a constant comparative check (boeije, 2002). they independently examined the three cases and were instructed to assign their own rhetoric and write up their own rationale. then the researchers independently examined the appropriateness of the author’s rationale of the assigned rhetoric type. no discrepancies occurred in the constant comparative check of the rhetoric aspect. afterwards, the independent researchers determined the appropriateness of the components of the empowerment process based on commonality. when there were differences, we met process self-stigma empowerment perception of diagnosis stereotype diminish emotional reaction differentiate normalize behavioral response protect attribute kranke/self-change 378 as a group to expand particular components, so they were inclusive of characteristics that were meaningful and gave a more holistic description of the process (boeije, 2002). discussion the use of a narrative approach provided depth and increased understanding of empowerment among adolescents with a mental health diagnosis. findings illustrated that supportive family and friends, a positive outlook/attitude, and involvement in treatment were critical aspects to generating an environment that facilitated feelings of empowerment. the narrative approach espoused by frank (1993) was conducive to identifying a sequence of events that precipitated change and revealed a radically changed self. ultimately, the illness experience allowed each adolescent to take on more ageappropriate activities and mature perspectives. findings are consistent with several outcomes associated with adolescent empowerment. the analysis showed that actively participating in age/developmentally appropriate activities, such as forming friendships and connecting with peers who allow the adolescents to be themselves, put the adolescents on a trajectory towards attaining milestones in a timely manner that coincides with the development timeline among peers without mental health diagnoses (leavey, 2005). involvement in these activities also promoted a sense of normality—which was counterintuitive to stigma – and helped these adolescents avoid feelings of differentness. an additional nuance beyond willingly disclosing their need for treatment, was that the adolescents openly attributed their improved well-being to treatment. the treatment positively impacted the adolescents’ well-being, social relationships, and academic success. peers and family members were drawn to interact with these adolescents. attributing improvement to treatment likely restructured peers’ and family members’ destigmatized perceptions about the need for treatment. limitations first, the data were collected a decade ago. therefore, discussion around mental health stigma may in fact be very different at the present time. for instance, organizations such as the born this way foundation, l.e.t.s. (let’s erase the stigma) and active minds have come to the forefront in encouraging youth with mental illness to have pride in possessing characteristics associated with feelings of differentness. consequently, youth with mental illness are exposed to more positive messages in the media about living with mental illness. future research should assess how these organizations impact adolescent feelings of stigma. although the frank method (1993) is designed to organize narratives in such a way that demonstrates self-change, researchers must be mindful that the adolescents’ circumstances and backgrounds were not homogenous. two of the three adolescents identified as white. the one african american participant did not describe his race and/or culture as influencing his perspective. in contrast, the constructed self-stigma model among the other 24 participants contained aspects of race and culture as influencing attitudes toward treatment (kranke et al., 2011). advances in social work, fall 2019, 19(2) 379 using a narrative approach to understand the impact of illness and treatments can raise awareness of practical dimensions that must be taken into account when trying to empower adolescent clients. however, one must be cautious about these findings because the sample size (n=3) and qualitative nature limit generalizability. in addition, this study assessed only those adolescents who voluntarily engaged in treatment. adolescents who do not engage in treatment may have very different experiences. implications for social work practice narrative analysis has implications for clinical social work. the practice of documenting responses during a client interview, note-taking, and assessing client responses are part of a process to make an informed treatment recommendation. using narrative methods can inform social workers of the value or application of qualitative research integrated with their own practice skills. in doing so, they may realize a holistic and novel approach of understanding their clients’ background. the frank narrative approach (1993) illustrates the particular areas of strength within each of the three cases. for instance, the narrative approach highlighted how the 14-yearold female with bipolar disorder used books and other educational resources to enhance her understanding of her illness. she had a knack for reading and a propensity for learning. this behavior foreshadowed how applying herself academically would also reap benefits in school, as she made the honor roll. as a clinician, encouraging the adolescent in this case to apply herself academically improved her well-being but also opened the door for a self who she might become by maximizing her potential with opportunities in education. ultimately, the three case studies illustrated the power of self-reflection for improving difficult times in these adolescents’ lives while also increasing the likelihood of being able to succeed in overcoming future obstacles. adolescents have many competing forces that impact their ability to withstand stigma. although the three cases presented here did have similar attributes, clinicians must be mindful to approach each adolescent client individually. clinicians can help adolescents embrace a positive, empowering perspective of their illness by taking a strengths-based approach. encouraging adolescents to build on positive aspects of their lives could improve their outlook and increase the prospects of a self who they might become to sustain a satisfying life. references aspy, c. b., oman, r. f., vesely, s. k., mcleroy, k., rodine, s., & marshall, l. 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(2009). case study research: design and methods (4th ed.). thousand oaks, ca: sage. author note: address correspondence to dr. derrick kranke, veterans emergency management evaluation center (vemec), u.s. department of veterans affairs, 16111 plummer st., ms-152, north hills, ca 91343. email: dakranke@gmail.com https://doi.org/10.1080/13648470410001678677 https://doi.org/10.1177/0959353500010004003 https://doi.org/10.1007/s10464-010-9330-0 mailto:dakranke@gmail.com microsoft word hazle article copyedit bb _______ megan hazle, ma, is a project manager, sherrie l. wilcox, ph.d., ches, is research assistant professor, and anthony m. hassan, ed.d., lcsw, is a clinical associate professor and director, all at the center for innovation and research on veterans & military families (cir), school of social work, university of southern california. copyright © 2012 advances in social work vol. 13 no. 1 (spring 2012), 229-242 helping veterans and their families fight on! megan hazle sherrie l. wilcox anthony m. hassan abstract: this new generation of veterans is coming home to families, friends, employers, and communities that likely do not understand military culture, nor the effects that military service and reintegration have on a veteran’s life, leading to the next war – the reintegration war. military servicemembers, veterans, and their families face challenges within the reintegration war that are different from their civilian counterparts and are complicated by military-specific circumstances. in order to more effectively and efficiently address the challenges servicemembers, veterans, and their families face, we need to work together in a comprehensive effort. strategies are presented to help win the reintegration war and ease the transition for servicemembers, veterans, and their families. keywords: family members, military, reintegration, servicemembers, veterans the next war the current wars in afghanistan and iraq have collectively proved to be the longestrunning conflicts in the history of the united states. according to u.s. census data, approximately 2.3 million men and women have served in the u.s. military during this period (i.e., post-9/11)—a significant number that nonetheless only represents about 1% of the country’s population (u.s. census bureau, 2010). it is even more alarming that an estimated 2 million deployments have occurred during these wars (belasco, july 2, 2009), nearly enough for all military personnel to have been deployed at least once, although multiple deployments are more common. with the drawdown of u.s. military involvement in afghanistan and iraq, a large influx of military personnel will soon return home, separate from military service, and will need to adjust to life outside the wire. this new generation of veterans is coming home to families, friends, employers, and communities that likely do not understand military culture, nor the effects that military service and reintegration have on a veteran’s life, leading to the next war – the reintegration war. in the reintegration war, some of the challenges confronting veterans and their families are significant and indisputable, but not always visible (institute of medicine, 2010; tanielian et al., 2008). popular media typically focus on the highs and lows of military and veteran life, such as troop homecomings and military family reunions, war casualties, or suicides, and overlook the everyday struggles of reintegration that veterans and their families face. although many veterans grapple with physical or psychological wounds, the scope of challenges is broader and deeper than most realize. whatever their reasons for entering military service, or the politics behind the conflicts, this is a high-risk population in need and we all have a moral duty to support and care for them. a advances in social work, spring 2012, 13(1) 230 community-wide front is required to combat the many problems that they face, and in order to win this war we must fight our battles in coordination and with dedication. military families: who they are and how they serve no man is an island. that is, we cannot discuss the issues and challenges affecting servicemembers or veterans without considering their families. the military family can include parents, spouses, partners, siblings, children, grandparents, and other loved ones, who may serve as caregivers to wounded warriors (calhoun, beckham, & bosworth, 2002). these individuals form an important part of the veteran’s support network (wilcox, 2010) and their health and well-being are directly connected to those of their veteran. that is, a family member’s health and wellbeing is also affected by the stressors and challenges in the veteran’s life (bride & figley, 2009; chandra et al., 2010; lester et al., 2012; sheppard, malatras, & israel, 2010). the dynamic relationship continues throughout the servicemember’s career and can last beyond separation from the military. military families also have the unique challenge of “serving with their servicemember.” for example, while a servicemember is deployed to a combat zone, their family often worries about the health and safety of the servicemember, in addition to the added task of redistributing household roles to make up for the absence. once the servicemember returns home, the military family will need to readjust their mentality and household structure to their pre-deployment status, which can often be difficult, particularly for the non-military spouse. finally, after separation from the military, and throughout the servicemember’s career, military families will often relocate and re-adjust to their new home, and develop a civilian family pattern (pincus, house, christensen, & adler, 2001). beyond the homecoming: the reintegration war many of the reintegration war challenges that veterans and their families experience are similar to those in the civilian world. however, military populations have added unique challenges that may be affecting both veterans and their families, including military-related psychological trauma, military-related physical injuries, unique rules and regulations within the military, social stigma, lack of understanding in the community, lack of access to resources in the community, single parenthood, divorce, unemployment, lack of support for children, and other factors that make life less predictable and controllable. these circumstances, challenges, and problems affect veterans and their families, and hinder their reintegration into the civilian community. this section will describe some of the challenges veterans and their families face in the reintegration war. frequent relocation in a typical military career, servicemembers and their families will relocate every 3-4 years, often across the country and sometimes internationally. these frequent relocations impose additional stressors for the entire family and force them to transition into a new life at a new military installation. quite often, military installations are not located in the most desirable locations, and it is often difficult to find good schools for children and hazle, wilcox, hassan/helping veterans and their families 231 employment for the spouse. in addition to the typical family disruptions, relocations can lead to feelings of alienation and lack of community identification (burrell, adams, durand, & castro, 2006; burrell, castro, adler, & britt, 2006; mckain, 1973), particularly among those who live off-base. military families who are able and choose to live on base have the opportunity to live within a supportive community that understands the unique needs of military families. when they are connected to the military, servicemembers and their families usually maintain close ties to the base and its support services and schools. once they separate from the service and reintegrate into the civilian world, however, veterans and their families can feel adrift and unsure about where they could seek support or help, especially if they move to an unfamiliar town or another state. lack of access to and utilization of resources for veterans and military families it can be difficult to navigate through the maze of resources available for military populations (weinick et al., 2011). despite the many support services available for veterans and their families, it can be frustrating go to through the process of filing for government services or discouraging to search for help or support in their community. sometimes, especially in rural areas, veterans do not have access to a veterans affairs (va) office and civilian services are not available. in urban areas, an overabundance of service choices can be overwhelming and confusing, and as more servicemembers separate from the military and move to these areas, both government and community service organizations can also become overwhelmed by veteran needs (weinick et al., 2011). although veterans or families who persist in searching for help or support may find an available service, they are often confronted by well-meaning but uninformed providers who do not understand the scope of the challenges they face as military-impacted individuals. this is a significant barrier to care when we consider that many servicemembers and veterans harbor a stigma against seeking help, especially mental healthcare, and might become so frustrated by a provider’s ignorance of military culture and understanding of reintegration challenges that they discontinue treatment (bryan & morrow, 2011; kim, britt, klocko, riviere, & adler, 2011; mcfarling, d'angelo, drain, gibbs, & rae olmsted, 2011; vogt, 2011; weinick et al., 2011). single parenthood and divorce among servicemembers the levels of stress present in military marriages often lead to separation and divorce. research indicates that those who serve in the military often marry earlier and divorce earlier (hogan & seifert, 2010; karney & crown, 2007). the divorce rate among military-connected couples has risen steadily since 2001, and once separated from the military both veteran men and women have a higher divorce rate than comparable civilians (karney & crown, 2007). the divorce rate for female servicemembers is 2-3 times higher than that of their male counterparts (karney & crown, 2007). female servicemembers may deal with issues related to family role reversal, separation from their children, and instability in advances in social work, spring 2012, 13(1) 232 their marriages. in american culture, women are typically responsible for household management, are primary caregivers for children and aging parents, and are more likely to face overwhelming expectations upon their return home and reintegration into the community and their family life (coltrane, 2000). single parents, many of them mothers in the military, have the added stress of finding caregivers for their children while they deploy, another family transition that adds to the difficulties of reintegration and redeployment (kelley, herzog-simmer, & harris, 1994). interestingly, research indicates that it does not matter whether the deployed parent is the father or the mother, as both have equal effects on child behavior (kelley et al., 1994). thus, deployments and the military life, in general, are stressful and challenging for both male and female servicemembers, although the challenges to the female servicemember can be even more difficult. unemployment among veterans in the coming years, as the wars in iraq and afghanistan come to an end and the military budget declines, up to a million servicemembers in their prime working years are expected to separate from the military. this large group of separating servicemembers will need to find employment in the civilian job market. the rate of unemployment among veterans is on the rise and is expected to increase as more veterans enter the civilian workforce. the 2011 unemployment rate among post-9/11 veterans who served active duty was 12.1% (bureau of labor statistics, march 20, 2012), which was higher than the average national unemployment rate for 2011 of 8.95% (bureau of labor statistics, 2012). many veterans will have difficulty finding employment with companies that likely do not understand how their skills translate into the civilian work environment. on top of this, veterans also face the common misperception that all veterans suffer from ptsd or have some mental health problem that will not make good or reliable employees. in fact, over 80% of recent servicemembers have no reported mental health conditions (hosek, 2011). honorably discharged veterans often possess excellent leadership skills that translate well into the civilian work environment, in addition to experience working in diverse work environments. it will be important to ensure employees are aware of the benefits of hiring veterans and that veterans are aware of ways to translate their military skills into a civilian context. lack of support for military children military children face many challenges and destabilizing events unique from their civilian peers. they typically cope with the stress of their active duty parent’s absence due to training or deployment, in addition to the fear of loss and worry for their active duty parent’s safety. furthermore, military children often face challenges of reintegrating into a new military installation and school system every 3-4 years, which can disrupts their social ties, academic career, and daily routine. military children who have had one parent deploy to either iraq or afghanistan are more likely to be diagnosed with mental health problems, which increases with increased length of deployments (mansfield, hazle, wilcox, hassan/helping veterans and their families 233 kaufman, engel, & gaynes, 2011). those whose parents return with mental health problems or injury face even more stress at home and are more likely to experience problems of their own at home or at school. military family members, including military children, are also susceptible to secondary traumatic stress (galovski & lyons, 2004; herzog, 2008). when their home life is disrupted due to a parent deploying or returning home, a military child’s most stable environment is usually his/her school. however, most teachers and school administrators have never been trained in how to respond to or handle students with parents who are serving in the military. without support from the school, military-connected children are at increased risk of school violence, substance use, suicide, and dropping out of school (chandra et al., 2010; gorman, eide, & hislegorman, 2010; lester, leskin, et al., 2011; lester, mogil, et al., 2011). these findings highlight the need to ensure school teachers and administrators identify military children and know how to help them. additionally, it is important to ensure that children are receiving appropriate services to help prevent mental and behavioral problems related to a deployed parent. challenges among reserve and national guard members reserve and national guard members are generally similar to active duty forces, but are slightly older and more educated (department of defense, 2010). reserve and national guard members typically have a part-time commitment to the military. however, in recent years, more reserve and national guard members are being called to active duty, often to complete a deployment in a combat location. reserve and national guard members are disproportionately at risk for mental health problems, with reservists more likely to need mental healthcare services following deployment (schell & marshall, 2008; werber et al., 2008). reserve and national guard members face the added challenges of the frequent civilian-military-civilian transition and are often a long distance from a military installation, thus resulting in more difficulty accessing services and having a supportive environment (werber et al., 2008). thus, it is important to help ease the civilian-military-civilian transition for reserve and national guard members and their families to help ensure more positive adjustment. physical and psychological injuries due to advances in combat medicine, more servicemembers with disabling injuries are returning home than ever before. physical wounds suffered in combat include loss of limbs, facial wounds, burns, hearing damage, and traumatic brain injury (tbi), principally from explosions of roadside bombs or improvised explosive devices (ieds). wounds such as these are debilitating, at least to some degree, and can require long periods of reconstructive surgeries, rehabilitation, clinical therapy, as well as long-term care by the spouse or a family member, such as a parent. injuries such as tbi are additionally challenging because they can be difficult to diagnose and treat, especially if a veteran has trouble establishing the injury with the va and receiving disability benefits advances in social work, spring 2012, 13(1) 234 or health coverage for treatment (weinick et al., 2011). any of these injuries, however, is a significant stressor on a veteran’s life and that of his/her family. the invisible wounds of war, psychological responses to stress, typically posttraumatic stress, depression, and anxiety, have at long last been acknowledged by the u.s. government and general public as legitimate and serious injuries. symptoms of posttraumatic stress disorder (ptsd) involve three clusters: a) intrusion symptoms, b) avoidance symptoms, and c) arousal symptoms (american psychiatric association, 2000). these symptoms not only affect the veteran’s quality of life, but that of his/her family members. however, diagnosis and treatment are difficult because servicemembers have little incentive to report symptoms, due to fear of delaying their return home, fear of discharge, or fear of the stigma of mental illness (kim et al., 2011; kim, thomas, wilk, castro, & hoge, 2010; mcfarling et al., 2011; pietrzak, johnson, goldstein, malley, & southwick, 2009). although ptsd garners much attention in the realm of combat-related injuries, it is not the only mental health problem that servicemembers and veterans experience. research estimates that approximately 30% of servicemembers who deployed to iraq or afghanistan suffer from ptsd, depression, or tbi (tanielian et al., 2008). depression can impede personal relationships and career advancement, and cause emotional and financial stress in the family, while suicide attempts in particular produce complicated grief and guilt among surviving family members and unit members, and may result in life-long impairment requiring long-term care by a spouse or other family member (institute of medicine, 2010). substance use disorder has been increasing in recent years among military servicemembers and recent veterans (department of defense, 2011). returning servicemembers are at increased risk for self-inflicted and other-directed harms, including tobacco use, hazardous drinking, drug use, and accidental overdose. veterans and their family members who do not utilize treatment for mental health problems are at risk for self-medicating symptoms with alcohol or substances, which can further impair their reintegration and damage their personal relationships and financial security. unfortunately, like other psychological problems, treatment for substance use disorder also carries the burden of stigma associated with treatment (rae olmsted et al., 2011). military sexual trauma (mst) female servicemembers, who make up approximately 15% of military forces (department of defense, 2010), have high exposure (20-40%) to sexual assault during their service, known as military sexual trauma (mst) (kelly, skelton, patel, & bradley, 2011). mst also occurs in male servicemembers, but at a lower rate. however, the impact of mst is significant for both male and female servicemembers. sexual harassment and assault under deployment conditions are associated with a five times greater risk of developing ptsd among female servicemembers and six times greater risk of developing ptsd among male servicemembers, a higher risk than combat itself confers (kang, dalager, mahan, & ishii, 2005). these traumas are unique to the military experience, as the resulting diagnoses can include an element of “moral injury,” a hazle, wilcox, hassan/helping veterans and their families 235 violation of values and/or a betrayal of trust, which is caused by the assailant’s betrayal of the victim’s trust and expectation of protection from fellow servicemembers. summary the challenges described above are not a comprehensive list of the reintegration war challenges that servicemembers, veterans, and their families are facing. however, this list of challenges illustrates the broad scope of issues that we must consider when we seek to support or advance reintegrating veterans and their families. it is imperative that we, as family members, service providers, educators, employers, and community members, not only be fully cognizant of this scope of reintegration issues, but also be aware of how these issues reverberate through the veteran’s support network. in order to advance a comprehensive effort to strengthen the reintegration of veterans and their families into the community, we must communicate and cultivate a broader and deeper understanding of these issues within all levels of our society and government—on neighborhood, local, state, and national levels. our challenge the lack of quality care and support for reintegrating veterans and their families is a significant issue because the strength and viability of our all-volunteer force is undermined when the health and well-being of its members and veterans is so precarious. hundreds of thousands of servicemembers returning from iraq and afghanistan are projected to develop both visible and invisible wounds of war (institute of medicine, 2010; tanielian et al., 2008). additionally, all of these veterans and their family members are currently reintegrating into their communities or will be over the next several years. these are daunting numbers, which are complicated by the low access to and utilization of services, and even the low levels of military cultural competency among providers. recent research indicates that veterans were often unaware of available services, were unsure of whether the service would be helpful for their specific problems, lacked information about service locations, were uncertain of eligibility requirements, and did not know how to apply (schell & tanielian, 2011). despite recent efforts to increase access to appropriate care for veterans, veterans often encounter a civilian environment ill-prepared to accommodate them and their families due to a lack of understanding about the many challenges and issues that military-impacted individuals face. this shortcoming can be detrimental to the health and well-being of veterans and their families, especially if it discourages them from seeking the care or help they require. let us pause here for a moment to acknowledge that there is no silver bullet. the challenges of reintegration encompass such a multitude of factors and actors that no organization is or can be a one-stop shop for the needs of veterans and their families. each organization, be it a government department, non-profit organization, or local agency, has unique strengths and skills, and all of us must coordinate in order to accomplish the mission: to help veterans and their families reintegrate into the community. advances in social work, spring 2012, 13(1) 236 how to win let us examine how we can accomplish this mission. given the daunting reintegration challenges and associated issues facing our servicemembers, veterans, their families, and our communities, it is essential that government agencies, nongovernmental organizations, and professionals work together to create a model of public-private partnership that will enhance the care and services provided to veterans and their families. to begin, we must first fill the fundamental gap in our knowledge about the needs of reintegrating veterans and families and the experiences of those who use these systems to access help and resources, as well as research and learn about the best treatment practices that we can apply to these individuals. then, we need to identify our service capabilities. since none of us can fill every need of military-impacted populations, we must each identify the specific needs or issues that we are best equipped to handle. next, we must coordinate our response to the needs of veterans and their families by creating an integrated cooperation and referral system, which will facilitate timely access to competent and capable treatment and services. identify needs in the united states, where there is no universal conscription, the gap between civilian and military culture is significant. the u.s. military has its own distinct culture, and as in all cultures, it has developed its own language, symbols, norms, systems for rewards and punishment, and internal institutions to reinforce expectations. the insularity of military culture promotes unity and resilience for the rigors of war, but it can also leave servicemembers and their families less equipped and less comfortable in a civilian environment. at the same time, the widespread lack of understanding of military culture means that community behavioral health providers and other professionals are less effective in communicating with servicemembers, veterans, and their families, less prepared to recognize the constraints they face, and less able to choose interventions or approaches that are helpful. this shortcoming is significant because, for example, while military ethical standards and traditions are respected in principle by the civilian community, they carry added meaning not always recognized in a therapeutic encounter and can alter the success or failure of a therapeutic alliance. a veteran or family member who seeks out help can be dissuaded from pursuing treatment or assistance if the provider is not familiar with their most basic values and the constraints of their lifestyle. the general lack of understanding regarding military culture and its significance is the first gap in knowledge that every individual and organization that serves military-impacted populations must bridge. in addition, more research is needed on the effect of military culture on the lives of servicemembers, veterans, and their families across all demographics and military service requirements, especially regarding the effect that these factors have on reintegration. in 2009, to address this gap in knowledge, the school of social work at the university of southern california established the first-ever graduate military social work specialization in a major civilian research university and created the usc center hazle, wilcox, hassan/helping veterans and their families 237 for innovation and research on veterans & military families (cir), which strengthens the transition of veterans and their families into the community. cir’s creation was driven by our recognition of the critical and emergent need for qualified community providers to treat community-dwelling veterans and their families and rigorous applied research highlighting the challenges faced by, and unique strengths of, military-impacted populations. at cir, we leverage the unique educational and research resources of the university of southern california to optimally serve the nation’s veterans and their families by conducting practical research that informs policymakers and deepens the understanding of the obstacles faced by returning veterans and their families. this research informs the military social work specialization in the master of social work program at the school, as well as the continuing education courses that cir has developed for behavioral healthcare providers and other professionals who serve or work with military-impacted populations. specify service capabilities the needs and issues relating to reintegration span the entire life spectrum of servicemembers, veterans, and their families, employment, relationships, education, marriage, children, mental and physical health, legal issues, which no single organization can meet alone. if we are to successfully strengthen this population’s reintegration into the community, then we must each focus on the functions that we can best perform and cooperate to accomplish the tasks we cannot complete alone. as an example, cir is located in los angeles and is perfectly positioned to conduct research on the needs and reintegration experiences of military-impacted populations due to the large number of veterans—approximately 1,000,000—living in southern california. in addition, the u.s. department of veterans affairs estimates that an additional 27,000 veterans migrate to california each year. finally, orange county and los angeles county combined have the largest concentration of national guard and reserve forces anywhere in the country. california, and particularly los angeles county, therefore represents a highly significant testing-ground for evaluating and developing new community-based interventions that support positive functioning of veterans in a civilian environment and are socio-culturally adapted for ethnic diversity. for these reasons, one of cir’s strongest contributions to the effort of strengthening the reintegration of military-impacted populations is conducting research that will inform best practices for all service providers. furthermore, cir also contributes on the education and training front, by developing and providing innovative, research-informed instruction to social work students, behavioral healthcare providers, and other professionals that work with military-impacted populations. these providers and professionals are employed by other organizations or agencies whose focus and talent is in competently and efficiently deploying direct services to these populations. advances in social work, spring 2012, 13(1) 238 coordinate response finally, it is unlikely that the needs of veterans and their families, as well as the quality and access to care and qualified providers, will be adequately addressed unless local, state and federal agencies join forces. therefore, we need to create a coordinated approach to supporting and engaging veterans and their families by bringing together our diverse sets of resources and identifying new opportunities across the public and private sectors. to begin with, we must achieve greater coordination between the department of defense, the veteran’s health administration, and civilian health agencies in transferring patient records, sharing knowledge of efficacious and effective interventions, developing a competent workforce, and building community collaborations to serve veterans and their families. in the past, military and civilian services for veterans existed on parallel tracks, but today they are intertwined as never before, driven together out of necessity to address the widespread phenomenon of homelessness, drug abuse, and mental illness among vietnam veterans. local mental health clinics, school mental health programs, hospital emergency rooms, and other mental health-affiliated agencies are vital to providing care and support to veterans and their families. therefore, these civilian providers will require an understanding of the needs in military-impacted populations as well as facilitated access to their medical records, held by military or government agencies. next, a coordination effort is required to bring diverse resources together in order to identify new opportunities to cooperate across public and private sectors and develop approaches to providing care and support to veterans and their families. this coordination effort must be based in and informed by the needs of the local community, but also supported at the state level. as a southern california institution, cir maintains connections with hundreds of community care and healthcare organizations in the region, and connects them with its local, regional, and national partners in order to advance solutions in research and care for military-impacted populations. similarly, each region of the country needs an entity that can facilitate the connections, organization, and dissemination of information necessary to coordinate community response to the needs of local military-impacted populations and promote these needs and the needs of the service providers on both a state and national level. conclusion no one comes home from war unchanged. for some, leaving the combat zone marks the beginning of a new battle – to reconcile the emotional changes that have resulted from their experiences, to smoothly reunite with their families, to put the stresses of combat behind them, 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(2011). programs addressing psychological health and traumatic brain injury among u.s. military servicemembers and their families. santa monica, ca: rand corporation retrieved from http://www.rand.org/pubs/technical_reports/tr950. werber, l., harrell, m. c., varda, d. m., hall, k. c., becklett, m. k., & stern, s. (2008). deployment experiences of guard and reserve families: implications for support and retention. santa monica, ca: rand corporation retrieved from http://www.rand.org/pubs/monographs/mg645.html. wilcox, s. (2010). social relationships and ptsd symptomatology in combat veterans. psychological trauma: theory, research, practice, and policy, 2(3), 175-182. doi: 10.1037/a0019062 author’s note: address correspondence to: megan hazle, center for innovation and research on veterans & military families (cir), school of social work, university of southern california, 1149 s. hill street, suite h-1114, los angeles, ca, 90015. e-mail: hazle@usc.edu this work is licensed under a creative commons attribution 4.0 international license. socially isolated cambodians in the us: recommendations for health promotion s. megan berthold sengly kong jason ostrander seiya fukuda abstract: community organizations in the united states are severely challenged to serve cambodian refugees who experience health disparities associated with their traumatic experiences. community leaders have identified a sub-set of community members of particular concern: those at either end of the age spectrum (elders and young people) who are socially isolated. as part of a larger community-based participatory research project, we conducted a focus group with seven cambodian community leaders from six cities. the study sought to better understand the phenomenon of social isolation of cambodian elders and young people in order to inform health promotion efforts. cambodian leaders expressed keen concern for those community members who rarely seem to leave their homes or interact with the cambodian community. prominent themes identified by leaders related to isolation were: a generational pattern; benefits of extended family; health concerns; cultural influences and language; impact of stigma; fear and safety concerns; and lack of sufficient resources. in addition, leaders identified several possible solutions to address the phenomenon of social isolation in their communities. health promotion efforts with this population should identify isolated individuals and enhance their social connectedness and support networks as part of a larger integrated effort. keywords: cambodian; genocide; social isolation; community leaders; community-based health promotion concerned about socially isolated elders and adolescents in their families, cambodians in the united states have reached out to community leaders for help. the impact of exposure to trauma experienced in cambodia, during migration and in refugee camps, and/or in the united states, along with other factors such as social determinants, may interact to contribute to the problem of social isolation among some cambodian americans (wagner, berthold, buckley, kuoch, & scully, 2015). the elders are survivors of the genocide in cambodia, when an estimated 1.7 million cambodians were killed during the 1975 to 1979 reign of the khmer rouge (approximately 21% of the total population; kiernan, 2004). article ii of the united nations’ convention on the prevention and punishment of the crime of genocide defines genocide as “any of the following acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group, as such: (a) killing members of the group; (b) causing serious bodily or mental harm to members of the group; (c) deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part; (d) _________________ s. megan berthold, phd, lcsw, is an associate professor, school of social work, university of connecticut, hartford, ct, 06103. sengly kong, phd, is project coordinator, khmer health advocates, west hartford, ct, 06110. jason ostrander, phd, msw, is an assistant professor, department of social work, sacred heart university, fairfield, ct, 06825. seiya fukuda, ms, msw, is a research associate, u.s. department of veterans affairs, bedford, ma, 01730. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 808-832, doi: 10.18060/22318 https://creativecommons.org/licenses/by/4.0/ berthold et al./socially isolated cambodians 809 imposing measures intended to prevent births within the group; (e) forcibly transferring children of the group to another group” (un general assembly, 1948, pp. 1-2). an epidemiological study of a representative sample of cambodian refugees (aged 35 to 75, n=490) living in long beach, california (the largest community of cambodians in the united states) who survived the cambodian genocide documented an average of 15 different types of major traumas from the cambodian civil war and genocide experienced before their arrival in the united states (marshall, schell, elliott, berthold, & chun, 2005). such traumas include: exposure to bombings and combat; slave labor; starvation; separation from family members and kidnapping; brain-washing; being terrorized, including living under a constant threat of death; witnessing atrocities; murder of family members and friends; and other forms of torture. those with exposure to a greater number of types of trauma were more likely to have posttraumatic stress disorder (ptsd; marshall et al., 2005). despite their significant exposure to multiple severe traumas and consistent with findings across refugee populations (simich & andermann, 2014; wagner et al., 2015), cambodian refugees in the united states exhibit enormous strengths and resilience (griggsaito, och, liang, toof, & silka, 2008). many have demonstrated creative and successful mechanisms of coping, strategies for survival, and adaptive abilities to respond to intergenerational conflict (lewis, 2010). some community initiatives support intergenerational bonding through engagement activities meant to develop and nurture senior-youth relationships (yoshida, henkin, & lehrman, 2013). cambodian refugee elders have documented health and mental health disparities with higher rates of depression, ptsd, diabetes, hypertension, and cardiovascular disease than found in the general u.s. population (kinzie et al., 2008; marshall et al., 2005, 2016). among cambodian refugees (who arrived in the united states prior to 1995) and cambodian immigrants (arriving 1995 and later) seeking medical care, those who were refugees reported poorer health-related quality of life, overall health, and health status across all physical health conditions measured (sharif et al., 2018). cambodians who came as refugees to the united states as young children or adolescents experienced high rates of ptsd and depression associated with their experiences during the khmer rouge regime, in refugee camps, and exposure to community violence in the united states (sack et al., 1994). racial discrimination in the united states is also associated with ptsd and depression in cambodian adolescents (sangalang & gee, 2015). now in their mid-thirties to forties, some cambodian survivors who came to the united states as children or adolescents have become parents themselves. research with families of u.s. military veterans, holocaust survivors, and cambodian mothers in the united states with ptsd have found support for the intergenerational effects of trauma (bowers & yehuda, 2016; dekel & goldblatt, 2008; field, muong, & sochanvimean, 2013). specifically, role-reversing parenting (i.e., when a parent seeks to get their own emotional needs met by their child) mediated the intergenerational transmission of anxiety symptoms from cambodian mothers who had survived the genocide and were seeking treatment for ptsd in the united states (field et al., 2013). advances in social work, spring 2018, 18(3) 810 the american academy of social work and social welfare and aarp have identified social isolation as one of the grand challenges that must be addressed (lubben, gironda, sabbath, kong, & johnson, 2015). reports of poorly functioning, traumatized, and depressed cambodian adolescents, young adults, and elders who isolate themselves in their homes are deeply concerning for a number of communities (berthold et al., 2018; m. scully, personal communication, may 18, 2016). cambodian american leaders have struggled with how to understand and address the isolation of their elders and youth. some of these isolated individuals have died by suicide. the centers for disease control and prevention (2013) has called for increased training in refugee communities to expand awareness of suicide and increase the identification of those at high risk. social isolation is a prevalent and potentially modifiable risk factor that affects the health and mortality of elders (cornwell & waite, 2009; cudjoe et al., 2018; holt-lunstad, 2018; lubben, 2018; miyawaki, 2015; steptoe, shankar, demakakos, & wardle, 2013). socially isolated elders experience mental health issues such as depression (dorfman et al., 1995) and suicidal ideation (vanderhorst & mclaren, 2005). their social isolation can be exacerbated not only by personal factors but also by a variety of structural factors, such as living in a high-crime neighborhood (portacolone, perissinotto, yeh, & greysen, 2018). there is a growing body of research on adolescent internet usage, although few studies have focused on internet usage as a socially isolating factor among cambodian american youth. for more than a decade, surveys of u.s. households have reported adolescents spending greater amounts of time on the internet and socially isolating themselves from their families and peers (gross, 2004). turow (1999) reported that 60% of families in the united states expressed concern that their children were going to become socially isolated because of their internet usage. no statistically significant relationship was found between social isolation and well-being (i.e., loneliness, social anxiety, depression) in one study with a white, middle-to-upper class population (gross, 2004). many contemporary youths have unprecedented access to the internet and are “growing up wired” (spies shapiro & margolin, 2014, p. 1), using social networking sites (sns) as a primary means of establishing social connections and relating with peers (ellison & boyd, 2013). systematic reviews document mixed findings regarding the association between the use of the internet and sns and adolescent well-being and mental health (seabrook, kern, & rickard, 2016). some studies report that the social connectedness promoted by the use of sns may protect youth from mental health problems (ellison & boyd, 2013), while others find that problems with communication and managing expectations contribute to increased experiences of isolation (baek, bae, & jang, 2013; best, manktelow, & taylor, 2014). positive influences of sns on adolescent well-being may include more chances to associate with and enhance relationships with peers, including with those who may generally be less accessible, and more opportunity to self-disclose (spies shapiro, & margolin, 2014). these same authors identified potential risks associated with the use of sns, however, such as receiving negative feedback and pressure to self-disclose, as well as experiencing harmful social comparisons. in a u.s. nationally-representative sample aged 19-32, young adults with higher social media use reported feeling more socially isolated than those who used social media less (primack et al., 2017). the characteristics of social media use by young adults rather than the amount of time spent using social media may be what has the most impact berthold et al./socially isolated cambodians 811 on their mental health. problematic social media use of an addictive nature was found to be independently and strongly associated with greater depressive symptoms in young adults in a u.s. nationally-representative sample (shensa et al., 2017). humans are social beings and most belong to complex and intricate webs of social networks that allow for support, engagement and interpersonal contact. social supports have been shown to have positive health benefits (hurtado-de-mendoza, gonzales, serrano, & kaltman, 2014) and social attachments appear to be potentially beneficial in managing adversity and trauma (bryant, 2016). several theoretical frameworks including social ecological theory (bronfenbrenner, 1979), conservation of resources theory (cor; hobfoll, 2001), network individual resource (nir) model (johnson et al., 2010), and the network episode model (nem; pescosolido, 2006) all posit that networks are instrumental to stress responses and to coping with stressors. social ecological theory is often cited in social work literature (rotabi, 2007) and serves as a holistic theoretical approach to help understand the interconnectedness between cambodian refugees and their socio-political environments. bronfenbrenner (1979) separates the different levels of the environment into five nested subsystems: microsystem, mesosystem, exosystem, macrosystem, and chronosystem. this framework helps social workers to better understand cambodian refugees’ experiences, such as language difficulties, unemployment, family dynamics, community violence, and poor health outcomes (hepworth, rooney, rooney, strom-gottfried, & larsen, 2010). various deleterious effects are experienced by adults who have been exposed to childhood trauma in the absence of effective social supports (norman, hawkley, ball, berntson, & cacioppo, 2013). without social networks to create and establish social supports, social isolation may result (cacioppo & hawkley, 2003). social disconnectedness is also associated with damaging neuroendocrine effects (cacioppo, cacioppo, capitanio, & cole, 2015). social isolation, similar to more traditional clinical risk factors, has been found to predict mortality in a nationally representative u.s. sample (pantell et al., 2013). when considering the impact of social isolation, it is important to recognize the potential effect of cultural context. compared to the more individually-based culture predominant in the united states, cambodian refugees come from a group-based culture. as such, it is possible that the impact of social isolation may be intensified for cambodians. social isolation has both subjective and objective components (holt-lunstad, smith, baker, harris, & stephenson, 2015). subjective social isolation (self-report of loneliness and isolation) has been independently linked to mortality (luo, hawkley, waite, & cacioppo, 2012) and depression (vanhalst, goossens, luyckx, scholte, & engels, 2013). objective social isolation is seen in those who are socially disconnected from others, as measured by living alone, having a small social network, being unmarried, lack of regular participation in social activities, and limited contact with family and friends (holt-lunstad et al., 2015). southeast asian elders living in philadelphia were found to be socially disconnected and at risk for depression (kim et al., 2015). in this sample, those cambodians who were younger at the time that they immigrated had less depression than those who were older at immigration. social disconnectedness and co-occurring health conditions were found at high rates in a sample of cambodians in connecticut (berthold advances in social work, spring 2018, 18(3) 812 et al., 2018). lack of community and religious engagement were associated with their poor health outcomes. the living situation of cambodians in the united states is often quite different from their traditional life in cambodia (smith-hefner, 1999). in stark contrast to their experiences of residing in relatively small close-knit communities in cambodia prior to the khmer rouge regime, life in the united states is often difficult and isolating for cambodian elders (wagner et al., 2015). their communities in the united states are more dispersed, making it a challenge to access their social networks and socialize with friends without using a car or bus. elders are frequently dependent for transportation on their adult children who have busy lives and may not live with them. persistent isolation faced by these elders may exacerbate the adverse mental and physical health outcomes experienced from their exposure to trauma and torture in their home country, exposure to toxic stress (i.e., joblessness, poverty, gang violence) in the united states, and intergenerational role conflicts between traditional and acculturated values (dinh, weinstein, kim, & ho, 2008; smith-hefner, 1999). to date, health promotion efforts in cambodian american communities have been limited, in part due to lack of resources (kuoch, scully, tan, rajan, & wagner, 2014; sharif et al., 2018). existing efforts have largely been targeted at the chronic health of elders, including group treatment and health education programs for diabetes (berkson, tor, mollica, lavelle, & cosenza, 2014; wagner et al., 2015), integrated interdisciplinary models that attend to the whole person (grigg-saito et al., 2010; wagner et al., 2015), and preventive health measures (grigg-saito et al., 2008; nguyen, tanjasiri, kagawa-singer, tran, & foo, 2008). the use of traditional, complementary, and alternative medicine, including spiritual practices, is common in cambodia for treating chronic conditions (peltzer, pengpid, puckpinyo, yi, & anh, 2016) and was integrated with western healthcare in cambodian refugee and displaced persons’ camps in thailand (french, 1994). while cambodian americans continue to use complementary and alternative medicine in the united states, its use is often not integrated with western health and mental health care, with some notable exceptions such as the practices of the metta health center in lowell, massachusetts (grigg-saito et al., 2010). limited research has focused on factors associated with health behaviors and health outcomes in resettled cambodians (nelson-peterman, toof, liang, & grigg-saito, 2015) and understanding psychosocial factors related to exercise (coronado, sos, talbot, do, & taylor, 2011). little attention has been given to deepening the understanding of social isolation among members of the cambodian american community or to specifically targeting isolated individuals in health promotion efforts. this article reports findings from the final phase of a community-based participatory research (cbpr) study conducted collaboratively between cambodian leaders from six states in the united states, university researchers, and khmer health advocates (a cambodian non-profit organization). the purpose of the larger study was to build cambodian community capacity to design and conduct research related to the health of the estimated 327,719 members of the cambodian community in the united states (u.s. census bureau, 2016). a community survey was conducted in the initial phase of this study berthold et al./socially isolated cambodians 813 and concerns about socially isolated community members were reported by all study sites. we share the findings of a focus group of leaders from the six cambodian communities that sought, in part, to better understand the phenomenon of social isolation of cambodian elders and young people in order to inform health promotion efforts. methods design and participants. a single focus group was conducted to gain perspectives from community leaders regarding social isolation and other challenges and strengths of their communities. seven cambodian community leaders from the six study sites (two from connecticut) participated. this included 6 females and 1 male, aged 45 to 66, who were in leadership positions (i.e., directors or senior staff members) at cambodian non-profits in six cities or states in the united states: long beach, california; the state of connecticut; lowell, massachusetts; minneapolis, minnesota; portland, oregon; and philadelphia, pennsylvania. the leaders were highly educated (possessing at least some college to masters’ degrees), bilingual in english and khmer, and from the middle-class. all but one of the focus group participants were ethnically cambodian genocide survivors who came to the united states as refugees. the remaining participant was white and had worked in cambodian communities in the united states for approximately three decades. the leaders had extensive experience working with cambodian refugees and served small-to-large cambodian communities in the east, mid-west and west of the united states where approximately one-third of all cambodians in the united states resided. procedures. participants engaged in a 90-minute conference-call focus group discussing their community’s key health concerns. the focus group was conducted in spoken english and facilitated by the pi, co-investigator, and a graduate research assistant. semi-structured questions were asked of participants relating to their understanding of the health of the cambodian american community and concern about homebound members of the community. questions included, in part: “as a leader, how do you see the health of your community?”; “what do you perceive to be the most common health problems of cambodian american adults in your community?”; [after social isolation and homebound community members was raised by focus group members] “how much do you view members of your community being homebound as a problem? people who are isolated, who don’t leave their homes much is that a big problem in your community?”; and “what are your perceptions about how important community health workers are or aren’t to the health of your community?”. the focus group was audiotaped and transcribed verbatim, yielding twenty single-spaced pages of transcript. an informed written consent process was used, and the university partner’s irb provided oversight of this study. data analysis. the transcript was entered into nvivo for coding and data analysis. holistic coding was employed to identify underlying themes by "lumping" the narrative according to stories or broad topics (saldana, 2013). the pi, co-investigator, and a graduate research assistant coded the focus group transcript separately and met to discuss their coding decisions. this process continued until coding consensus was achieved. at the conclusion of each debriefing, memos were created to help document the team’s decisionmaking during the various phases of the research project and how these changes impacted the study. these steps increased the rigor of the study by helping to control for the advances in social work, spring 2018, 18(3) 814 researchers’ biases and positionality (padgett, 2008). once all the transcripts were holistically coded, the research team thematically analyzed the codes and condensed them into 13 broad constructs (padgett, 2008; saldana, 2013). this article reports on an in-depth analysis of the social isolation-related themes. results cambodian leaders expressed keen concern for those community members who rarely seem to leave their homes or interact with the cambodian community. prominent themes identified by leaders related to isolation were: a generational pattern; benefits of extended family; health concerns; cultural influences and language23t; 23tthe impact of stigma; fear and safety concerns; and lack of sufficient resources (see table 1). in addition, leaders identified several possible partial solutions to address the phenomenon of social isolation in their communities. table 1. social isolation themes 1. generational pattern 2. benefits of extended family 3. health concerns 4. cultural influences and language 5. impact of stigma 6. fear and safety concerns 7. lack of sufficient resources 8. possible partial solutions generational pattern of isolation. community leaders saw social isolation as a particular problem for two groups in the community: elders (variously defined as older than 50 and over aged 60 or 65 by others) and the younger generation (teenagers and young adults). leaders identified elders as particularly at risk of isolation if they were unemployed, lacked transportation, and were depressed. with respect to isolated youth, one leader remarked, “we hear about young people. usually they’re males and they’re in their 20’s, who never come out of their room.” other leaders indicated that this was the case in their communities as well, and that the problem extended to teenagers. benefits of extended family. among the key benefits of extended family discussed were the practical benefits of intergenerational aid provided by those in the younger generation to their elders. this aid included assisting elders to socialize outside of their home, encouraging them to be more physically active, and driving elders to their health appointments (occasionally interpreting for them at their appointments). one leader described intergenerational cambodian living arrangements, “we’re scattered, and a lot of parents live with their adult children that take good care of them already. so they provide transportation, have their own medical insurance for the parents.” elder grandparents may also provide valuable assistance for the younger generation. for example, they may provide care to grandchildren that in turn reduces their own social isolation. health concerns. a number of health concerns were seen as linked to isolation, either as a perceived cause of isolation and/or believed to result in isolation over time. youth and elders alike were known to be depressed and isolating themselves in their bedrooms or berthold et al./socially isolated cambodians 815 homes. leaders shared similar stories about the youth isolating themselves in their bedrooms. one leader explained that youth, age between 18, 19, 20, 22, some of them lock themselves in their room. what i learned, some of them, their parents didn’t want them to get out, so what they do, they lock themselves in their room and then they have internet, and they would spend hours and hours at night on internet or playing games, and they become a challenge for their parents to get them out, because they just lock themselves in. they become isolated and when their parents become concerned, sometimes it’s too late to get them out. leaders expressed concern about suicide being a problem among younger cambodians who were extremely socially isolated. one leader shared an example of a youth suicide and reflected that suicide in the younger generation was a problem in his community, just saturday, i went to the temple. this woman said her grandson just hanged himself or killed himself, he’s 21 years old. there must be something going on that we don’t know about in this age group. so that is depressing and it’s . . . an issue of concern for the family and for us as a community. so they [are] kind of hidden, but it’s also an issue for us to look into. one leader highlighted that some elders were isolated “because they still live in the past,” affected by symptoms of ptsd such as traumatic memories of their experiences during the genocide. those secluded in their homes were known to get less than adequate physical exercise that was believed to lead to worse physical health. several of the leaders asserted that less activity led to more smoking for some. closely related to their concerns about social isolation, the health of elders was seen as at risk for being compromised when they depended on others, such as children or other extended family members, for transportation to the doctor or for other daily necessities. a leader from the northeast stated that, children grow up, have family of their own and move out, and they come to visit their parents once or twice a week at the most. if parents feel like they can drive or they can go out on their own, they can get out and socialize among their peers, especially in the summer, but in the winter it’s hard for them to get out. so they are homebound and they are more depressed and they don’t do much physical activity, which puts more stress on their health as well, on their physical health. the inability to get out of the home to buy fresh vegetables was seen as contributing to elders eating larger quantities of salty fish paste and processed foods, which in turn was believed to lead to increased problems with high blood pressure, a condition the leaders knew was prevalent among genocide survivors in their communities. of keen concern to the leaders was that many in their communities relied on going to the emergency room for routine health problems, in part due to their isolation and difficulty getting to regular doctor visits. as one leader remarked, …we have new programs, it’s called er diversion, because why, because they use a lot of er or use emergency visit … for health care, for doctor visit…. they wait until they have problem, and they don’t have a primary care doctor. they just go advances in social work, spring 2018, 18(3) 816 to er...when they are sick, they just take themselves or take their children to the er and use that as their [laughs] their primary care doctor. so now we have a plan called er diversion, try to convert that system back to a primary care visit. cultural influences and language. the dynamics between parents, adolescents, and elders were described as having a strong cultural dimension, which appeared to interact with the problem of social isolation. some members of the older generation have limited or no english fluency and the younger ones frequently have limited fluency in khmer. language barriers between the generations may also contribute to the communication challenges experienced. as one leader put it, but the teenager, they also face that problem, why? because i heard somebody brought up about that they hide themselves in their room playing games, and they don’t understand how to explain, how to communicate with the parents, how to explain their feelings. the communication barrier between parents who lived through the genocide and their children who did not may make it difficult to understand each other’s experiences and needs. this is particularly challenging when it can be impossible to fully or accurately express the experience of genocide in words in any language. another leader commented that the barrier to communication related to the poor mental health of the parents. i see isolation mostly with the elderly, 55 and up, and the younger ones, the first generation that were born in cambodia then they came here. . . . [the children] cannot talk or express feelings to the parents. parents [are] depressed, so the children go their own way. the leaders were concerned that depressed and otherwise poorly functioning parents may be compromised in their ability to supervise their children. leaders also noted the influence of culture among cambodian elders who report their health as good or bad. the leaders explained that a negative complaint (i.e., that their health is not good) means (culturally) they are blaming their children for not taking good enough care of them. in keeping with cambodian culture, even under circumstances when they are isolated and their children and/or other family members are not providing them with sufficient assistance (including transportation to get them out of the home), elders are not supposed to complain. one participant commented, also another thing is that look at the cambodian culture. so we supposed not to complain. because nobody takes care of you besides yourself. the parent cannot say, not good, because otherwise, they say that the children not good to take care of you. another participant acknowledged that context (including whether they are asked when they are alone or in the presence of others) might influence the response of elders to being asked about their health. my mom for example, my mom cannot [laughs], if somebody ask her, she probably look around first, if her children [laughs]. if she say that she is not good, so it mean she blames her children, too. berthold et al./socially isolated cambodians 817 impact of stigma. stigma was another theme identified by the leaders that contributed to the isolation of elders in the home. the loss of employment was one identified source of stigma. the experience of loss of social status and stigma associated with loss of employment by cambodian elders is a phenomenon shared by older adults in the general population as well. the cambodian leaders explained that cambodians in the united states value being able to buy a house and car, and they do not want to be seen as unemployed or receiving unemployment benefits or other government assistance. one leader remarked that the parents are, what we learn is that people who are losing their jobs, if they are 50 years old to 60 years old, they don’t want to get out because they lose the job. they sometimes did not feel comfortable and the most people whom have a problem, the most of the seniors. it became apparent from the leaders that people felt others looked at them differently if they were not employed. a fairly common question asked when meeting others in the community is, “where do you work?” this question would be difficult and stigmatizing to answer for those unemployed, contributing to their preference to stay home to avoid such questioning. older cambodian men might find being unemployed particularly troubling, as culturally they are used to being the ones to financially support their families. fear and safety concerns. fear and concern for safety was another key factor identified as contributing to elders staying at home and parents keeping their children inside in the evenings. there were regional differences, however, with several of the communities being particularly noted for higher rates of community violence, including cambodian and non-cambodian gang violence. one of the leaders linked the low rates of high school completion and college attendance, and the high unemployment of youth, with involvement in crime, a problem the leader’s agency was insufficiently resourced to address. …it’s very, very limited to hire people, especially in [name of city]. about five hundred plus [cambodian] youth in [the city], and 46% graduated from high school, only about 10% go to college. so you can see the issue. if ten shootings in [this city], probably six, seven of them are by cambodian youth. leaders made a link between fear and safety concerns among their community members and the phenomenon of social isolation. lack of sufficient resources. cambodian leaders saw community health workers—or other staff members conducting outreach— as invaluable because they could check on homebound community members, assist them in leaving their homes, and connect them with activities. none, however, had the resources to afford robust outreach programs. most were working with small or bare-bones staff and could not meet the need in the community. i think we do need some kind of outreach, but also have to be the combination of socialization, sport activity, especially in wintertime. and also probably, just to bring the seniors as well as the youth and adults out of the home. so it mean[s] that the role of social services is very important here, because [my organization] is the only [cambodian] social / human services in [the state]. advances in social work, spring 2018, 18(3) 818 possible partial solutions. in the face of such challenges related to social isolation in their communities, leaders identified possible strategies and partial solutions. one leader spoke about having vans and staff members for driving elders to temples to socialize and get religious/spiritual support, and to take them to health appointments: . . . the most people whom have a problem, the most of the seniors. but we have five vans provide transportation to them every week. so that resolve[s] some issue[s] with the people who live in [name of city]. however, people living in another area, especially in [another city] area, it’s about 90 miles from us. those people don’t have [any] place to go. other leaders noted how they wished they had such resources in their communities, but they lacked sufficient funding. in addition, all leaders agreed that another critical resource was community health workers (chws) who are bilingual in khmer and english. 68tyeah, very, very important to have a community health worker, because translator come when needed, but a community worker be there to advocate and to also bridge the cultural gap . . .68t that’s 68twhat we need, because the community health workers have built a relationship with the community on an on-going basis, and also have built a relationship with the provider on an on-going basis. in relation to the problem of adolescents isolating themselves in their rooms, one leader had recommended to some parents to disconnect the internet and try to take their adolescent out and spend more time with the adolescent. discussion cambodian community leaders in this study identified two very socially isolated groups within their communities: elders and young people (teens and young adults). although the cambodian leaders represented six separate cambodian communities across the united states, most were experiencing similar challenges with these isolated groups. all but one of the leaders were themselves ethnically cambodian genocide survivors who came to the united states as refugees in the 1980s and had lived and worked in their cambodian community in the united states ever since. these community leaders provided contextual insights into some of the factors that may be contributing to social isolation. the cambodian leaders themselves had experienced many of the same or similar circumstances and losses that elders in their community faced. these shared experiences may have made them particularly attuned to the losses of the elders and to the challenges parents faced with teenagers isolating themselves. a shift in family culture, particularly given the younger generations’ more engaged participation in a new culture in the united states, and limited communication between family members due to language barriers, appeared to be pervasive factors affecting the cambodian communities. cambodian leaders explained that older generations possess limited english fluency and younger generations lack fluency in their native cambodian language of khmer. although intergenerational aid is often a significant benefit of an extended family (e.g., teens or young adults providing elders with transportation to medical appointments, the temple, and to visit friends; and with young people learning about their berthold et al./socially isolated cambodians 819 culture and heritage), many cambodian americans are severely limited in their verbal interactions across generations due to language barriers. further amplifying the social isolation of elders and adolescents are their fears and safety concerns within their own neighborhoods and communities. many elders report a fear of leaving their homes and parents keep their children at home because of community violence—specifically, cambodian and non-cambodian gang violence—which has been associated with adverse mental health outcomes (green, gilbertson, & grimsley, 2002). the barriers discussed above were perceived by the community leaders in this study and also supported in the literature (d’anna et al., 2017; wagner et al., 2015) as contributing to increased health concerns for these two isolated populations, impeding them from engaging in adequate physical exercise, purchasing healthy fresh fruits and vegetables, and accessing preventative health services. these circumstances make reducing negative health outcomes and implementing health promotion activities more challenging. it may seem surprising to some social workers that grief and loss were not mentioned by the community leaders as a theme in the focus group related to social isolation, given the history of genocide that they and their community members experienced. grief and loss are universal in the cambodian community, however, culturally it is not common for people to talk about this as a theme. the majority of cambodians are buddhists who focus on acceptance and maintaining a relationship with those who have died through traditional ceremonies that occur in community. there continues to be a give-and-take between the dead and the living as the living pray for guidance and blessing and the spirits of the dead offer comfort and protection. social isolation is therefore seen as a serious problem because those who are isolated have not only diminished contact with the living but also with the dead. given the association of social isolation with poor outcomes, including increased mortality and adverse mental health outcomes (cudjoe et al., 2018; holt-lunstad et al., 2015; lubben, 2018; pantell et al., 2013; steptoe, shankar, demakakos, & wardle, 2013; vanderhorst & mclaren, 2005), health promotion efforts should be directed to socially isolated elders and young cambodian americans. their communities, however, have severe resource constraints (kuoch, scully, tan, rajan, & wagner, 2014). cambodian community-based organizations in the united states have been pushed to the brink of financial collapse during this economically challenging time (t. kuoch and m. scully, personal communication, may 10, 2018). since this study concluded, one of the participating community-based agencies has closed. new and creative partnerships need to be developed to improve health outcomes for cambodian american elders and young people. social workers should partner with cambodian community-based agencies and community healthcare systems to aid in reducing unnecessary emergency room visits and provide necessary language services. one of the vital resources helping to bridge barriers to health promotion efforts is the excellent work being conducted by cambodian chws. unfortunately, most are working as volunteers and are not able to engage with all the cambodian americans who need their support. cambodian chws are bilingual and possess the required skills to provide federally mandated title vi translation services for advances in social work, spring 2018, 18(3) 820 social workers and other health personnel, which would reduce the unethical reliance on family members and nonprofessional interpreters (berthold & fischman, 2014). the chws have the skill set (language, cultural and ethnic expertise, and advocacy) and trust of the community to help increase long-term health outcomes and improve access to publicly funded community care (lu, d’angelo, kuoch, & scully, 2018; zahn, matos, findley, & hicks, 2012). implications for social work practice social workers play a critical role in providing quality services to refugees both in direct care positions and within interdisciplinary teams and should partner with chws to become trusted members of this community. the national association of social workers’ (nasw’s) (2016) standards for social work practice in health care settings recommends that assessments are customized for vulnerable populations, such as refugees. social workers must ensure that all facets of the refugee's life are taken into consideration when conducting an assessment and fully appreciate the interconnectedness and depth of the refugee's life journeys. this includes past experiences of trauma in their country of origin, during migration, and when resettling. further, social workers must understand and appreciate the link between trauma exposure and health risks for refugees, and culturally appropriate systems of care (ostrander, melville, & berthold, 2017). chws play an important role in ensuring that health care is culturally appropriate for cambodian americans. social workers should advocate to legislators for a significant investment of resources to support chws, which would ensure that the right to access health care for some of the most vulnerable and marginalized americans is realized, that the health care they receive is culturally appropriate, and that they receive preventive care services (nguyen et al., 2008; renfrew et al., 2013; taylor et al., 2013). employing chws would also ensure that health providers are in compliance with title vi (berthold & fischman, 2014; wagner et al., 2013). compared to the cost of medications and other treatment, the cost of funding chws would be modest. one study found a cost-savings and reduction in potentially dangerous medication errors when cambodian chws partnered with pharmacists using telemedicine to deliver medication therapy management (center for technology and aging, 2011). cambodian community organizations can also utilize bilingual chws to create, organize, and run online groups to support elders and young cambodians struggling with limited transportation, fears about community violence, and social isolation. cambodians have been early adopters of technology since they first came into the united states. they relied on videotapes for entertainment and information as soon as videotapes became available on a commercial level in the early 1980s. over the ensuing years, cambodian americans have been among the first to use the internet for communications with family across the united states and in cambodia. skyping and the use of facebook-messenger is common in cambodian communities in the united states and technology serves as a link between the young and the old (t. kuoch, personal communication, may 10, 2018). employing an online peer support model, cambodian elders and adolescents could develop quality peer relationships, enlarge their social networks, and decrease a sense of loneliness berthold et al./socially isolated cambodians 821 and social isolation. one study of online peer support groups with children aged 7 to 11 from predominantly white, middle to upper-class populations across canada suffering from asthma and their parents reported growth in supportive relationships with family and friends, increased self-confidence, and decreased loneliness and social isolation (stewart, letourneau, masuda, anderson, & mcghan, 2013). through the use of strategic and critical partnerships, chws, social workers, and their interdisciplinary colleagues could implement necessary trainings for health providers and non-profit agencies who work with cambodian communities. such trainings could focus on raising awareness and enhancing services for cambodian americans in the short term and increasing advocacy for health promotion resources in the long term. following the example of organizations in communities with high concentrations of cambodians such as lowell and lynn massachusetts, cambodian elders’ physical, mental, and social needs may be met through participation in social day care or adult day health centers (dubus, 2017). one possible model that could be considered is the development of a social enterprise for-profit arm of a community-based organization that has potential to generate additional revenue while combating social isolation in community members. rather than focusing efforts solely on the consequences of social isolation for individuals, promoting health requires addressing the root causes, such as structural factors contributing to the problem of social isolation. metzl and hansen (2014) define structural competence as “the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases…also represent decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures” (p. 128). social workers must not overlook how an individual cambodian’s lived experiences are shaped and constrained by structural factors that impact cambodian refugees every day, such as insurance companies dictating how long and what type of services they will cover, the effect that racism has on cortisol levels, the impact of community violence, the lack of culturally appropriate services and goods, and insufficient public transportation for daily living activities. limitations the non-probability purposive sampling employed in this study was a key limitation. the leaders in the focus group represented six large cambodian communities in the united states. thus, our findings may not be representative of the opinions or experiences of other cambodian community leaders or reflective of the situation of other cambodian communities in the united states, including regions where there are no cambodian agencies. further, the participants may have opened up more or given different descriptions if the focus group had been conducted in khmer. in addition, the findings came from only one focus group and were not meant to be generalized. the focus group explored multiple topics, therefore, we did not have time to probe further about social isolation. it is important to note that adolescents may not view themselves as socially isolated because they have access to vast social networks through the use of the internet. this study did not examine the nature of these networks or the type of support received by these adolescents via social media and the impact on adolescent well-being. advances in social work, spring 2018, 18(3) 822 the fact that the focus group occurred as a conference call could be seen as a limitation, in that it did not allow for face-to-face non-verbal communication. if the participants had been strangers, the remote nature of the focus group may have also complicated the development of trust and open discussion. in our case, all participants were well known to each other, having met in person previously on multiple occasions to work on various research and community projects. holding the focus group over the telephone allowed us to include leaders from around the united states, inviting a range of community experiences to be shared and accounted for. implications for social work research future research that examines the problem of social isolation with additional focus groups and key informant interviews involving more community leaders, as well as elders and youth would be valuable. one pressing concern expressed by the focus group participants was of adolescents isolating themselves in their bedrooms and spending significant time on the internet and playing video games. the leaders perceived that this was negatively affecting the adolescents’ well-being. given the relative lack of study of this phenomenon in cambodian youth and the mixed findings in the literature regarding internet usage and well-being (baek et al., 2013; best et al., 2014; ellison & boyd, 2013; seabrook et al., 2016), further study is needed to understand the prevalence and impact of isolating behavior by cambodian american teens. social workers should partner with cambodian community agencies to better study this phenomenon and to understand the adolescents’ perspectives and experiences. research regarding the risk factors for suicide in cambodian american community members, particularly in the young people, and on effective suicide prevention strategies is also a pressing need. in addition, outcomes research on interventions aimed at reducing the prevalence of social isolation in vulnerable cambodian elders and adolescents and its negative effects should be undertaken. several of the observations and insights expressed by community leaders in this study based on their experiences living in and serving their communities for many years are not well-documented in the literature and would warrant further study. for example, the literature has identified the impact of sociocultural factors and smoking in cambodian americans (e.g., smoking to cope with stress, combat hunger during the khmer rouge genocide period, and as part of buddhist religious ceremonies (friis et al., 2012)) but no literature was found documenting that less activity leads to smoking by some cambodian americans. in addition, previous research has found that lower acculturation and education as well as a history of severe and prolonged food deprivation/insecurity during the khmer rouge regime is associated with greater consumption of high-sodium asian sauces, lower consumption of vegetables and fruits, and other less healthy food behavior in cambodian refugee women in lowell, massachusetts (peterman, silka, bermudez, wilde, & rogers, 2011; peterman et al., 2010). further study is needed to determine if the inability to get out of the home noted by leaders in our study is related to eating behavior and health among isolated cambodian americans. research with non-cambodian mothers has found a strong association between postpartum depression and impaired parenting (muzik et al., 2017) and negative effects on child development (brummelte & galea, 2016). in a study of active child protective service berthold et al./socially isolated cambodians 823 cases in cambodian families in los angeles, maternal depression and/or ptsd was associated with poor parenting outcomes and neglect (chang, rhee, & berthold, 2008). further study is needed to examine whether there is a relationship between cambodian american parents’ mental health problems and poor functioning and their ability to supervise their adolescent children, a concern expressed by our study participants that they perceived to contribute to the adolescents isolating themselves in their rooms. further research is also needed regarding the leaders’ expressed concerns about the factors leading some cambodian youth to become criminally involved and the leaders’ perception that social isolation in their community members is associated with fear and safety concerns. findings from such research may contribute to the prevention of community violence and provide insights into strategies to reduce social isolation among vulnerable individuals. researchers and clinicians have long known that long-term social isolation can lead to damaging psychological effects in humans. recent research with mice has found that a brain chemical that causes stress, fear, hypersensitivity to threats, and aggression is overproduced in the context of chronic social isolation and that blocking the chemical can remove these negative effects of isolation (zelikowsky et al., 2018). possible therapeutic applications of these findings may yield benefits for socially isolated humans in years to come. regardless of possible clinical and pharmacological advances in the future, efforts to target the structural factors that contribute to creating social isolation are fundamentally needed (ostrander et al., 2017). conclusions cambodian leaders have explicitly identified social isolation as a major concern that must be addressed for cultural reasons and to reduce the risk of behavior-dependent chronic disease, such as type ii diabetes. anecdotal reports of suicide attempts of isolated cambodian youth in the united states are also particularly troubling to cambodian chws and leaders. health promotion efforts in this population should directly work to identify isolated individuals and enhance their social connectedness and support networks as part of a larger integrated effort. programs should consider working closely with public schools if possible, in order to share resources and information to better prevent, identify, and address youth social isolation. further, the social isolation of cambodians in the united states is a chronic community problem that requires a community solution (ostrander et al., 2017). the problem of social isolation is related to cultural and language isolation (i.e., lack of a common language between the generations). community-based organizations (cbos) and cambodian community members tend to be financially resource-poor. adequate funding is necessary to develop needed programming and infrastructure, and to undertake and evaluate longterm interventions that address broader structural factors and social determinants associated with the chronic health conditions and isolation that are prevalent in this community. despite their financial limitations, cambodian communities and cbos have other relevant cultural resources and expertise. many cambodian communities have chws with interpreting skills, cultural understanding, and knowledge of the traumas experienced by advances in social work, spring 2018, 18(3) 824 members that are necessary for effective interventions. community-based 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(2018). the neuropeptide tac2 controls a distributed brain state induced by chronic social isolation stress. cell, 173(5), 1265-1279. doi: 55thttps://doi.org/10.1016/j.cell.2018.03.03755t author note: address correspondence to: s. megan berthold, phd, school of social work, university of connecticut, 38 prospect st., hartford, ct 06103. 55tmegan.berthold@uconn.edu55t https://doi.org/10.1016/j.cell.2018.03.037 mailto:megan.berthold@uconn.edu the elders are survivors of the genocide in cambodia, when an estimated 1.7 million cambodians were killed during the 1975 to 1979 reign of the khmer rouge (approximately 21% of the total population; kiernan, 2004). article ii of the united nations’ c... design and participants. a single focus group was conducted to gain perspectives from community leaders regarding social isolation and other challenges and strengths of their communities. seven cambodian community leaders from the six study sites (two... data analysis. the transcript was entered into nvivo for coding and data analysis. holistic coding was employed to identify underlying themes by "lumping" the narrative according to stories or broad topics (saldana, 2013). the pi, co-investigator, and... results discussion muzik, m., morelen, d., hruschak, j., rosenblum, k. l., bocknek, e., & beeghly, m. (2017). psychopathology and parenting: an examination of perceived and observed parenting in mothers with depression and ptsd. journal of affective disorders, 207, 242-... ______________ kimberly pendell, msis, is the social work and social sciences librarian and associate professor in the university library, portland state university, portland, or, 97201. copyright © 2018 author, vol. 18 no. 4 (fall 2018), 1041-1052, doi: 10.18060/22180 this work is licensed under a creative commons attribution 4.0 international license. behind the wall: an exploration of public access to research articles in social work journals kimberly pendell abstract: despite implicit and explicit expectations that research inform their practice, social workers are unlikely to have access to published research articles. the traditional publishing model does not support public access (i.e., no publisher paywall barrier) to scholarly journals. newer models of publishing allow free access to research including open access publishing and deposit of scholarship in institutional or disciplinary repositories. this study examined public access to articles in the top 25 social work journals. a random sample of article citations from a total of 1,587 was assessed, with the result that 52% of citations had no full-text access. of the remaining 48% of citations with full-text access, it is questionable most will remain available long term due to possible copyright violations. citations from the random sample show only minimal usage of institutional or disciplinary repositories as a means of sharing research. establishing this baseline measure of access to research is an important first step in understanding the barriers for social workers in accessing research to inform practice. recommendations for increasing access to research include publishing in open access journals and utilizing full text repositories. keywords: research dissemination; scholarly publishing; open access; repositories; evidence-based practice as a social work librarian, i have many conversations with students regarding access to research articles. when students get close to graduation they often inquire if and how they might still use the library’s databases and full-text journal access. unfortunately, my answer is always disappointing. after graduation, their off-campus access to our electronic resources ends, and their only remaining means of access is to come into the library to use public access computers or connect to campus guest wi-fi, which of course hardly anyone has time to do with busy work days and other obligations. graduating social work students already know from their field placements that access to full-text journals is not often available from agencies either. in a focus group study on lifelong learning by jivanjee, pendell, nissan, and goodluck (2016), one msw student expressed her concern: i love libraries, but i know that my access to this library in particular is going to be next to nil once i graduate… there isn’t much out there for those of us that like research and want to base it [practice] on research. we are a little bit in a hole. (p. 267) the dean of the school of social work at my institution has informed me that she continually receives requests from alumni for off-campus access to databases and full-text journals. this access is seen as one of the most useful benefits they could receive. aside from stripped down alumni packages from vendors, academic publisher and other vendor https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2018, 18(4) 1042 licenses prevent the library from extending access to individuals not actively affiliated with the university. it is commonly recognized by librarians that even if licenses were to permit access equivalent to that of affiliated users, the cost and management of providing the level of access desired would be enormous and complicated. anecdotally, many fellow social work librarians are familiar with this dilemma of graduating students and alumni requesting services and resources that cannot be provided. that students and alumni expect, or at least hope, for access to research literature is understandable considering their recent education and the professional standards laid out for them. for example, the national association of social workers (nasw, 2017) code of ethics standard 4.01 outlines the expectation that: (b) social workers should strive to become and remain proficient in professional practice and the performance of professional functions. social workers should critically examine and keep current with emerging knowledge relevant to social work. social workers should routinely review the professional literature and participate in continuing education relevant to social work practice and social work ethics. (c) social workers should base practice on recognized knowledge, including empirically-based knowledge, relevant to social work and social work ethics. additionally, evidence-based practice (ebp), or similar research-informed practices in the field, overtly expect, or at least imply, that social workers have meaningful access to research relevant to their practice needs. it would also seem safe to assume that researchers want their efforts to influence practice in the field and improve the lives of the communities with whom they work. the nasw has expressed interest in connecting research to practice. the nasw action network for social work education and research (n.d.) states: “social work research provides empirical support for best practice approaches to improve service delivery and public policies.” additionally, an nasw (n.d.) advocacy briefing on social work research offers among its recommendations: “promote the dissemination and implementation of research into real world settings and to encourage communication between researchers and practitioners” (p. 2). observing the tension between production of research for the field and the field’s lack of access to research, this study attempts to answer an initial, primary question: if a practicing professional wants to read research literature, is the research literature available to them? ten years ago or more, the answer would likely have been “no,” as the traditional, subscription-based publishing model held content more firmly behind paywalls. the traditional model of publishing severely limits the public’s access to research literature, despite the content and peer review expertise provided by researchers, most often gratis (see figure 1). pendell/behind the wall 1043 figure 1. traditional publishing cycle for research articles figure adapted from creative commons (n.d.) however, new pathways to research articles have been created and cultivated, particularly open access (oa) publishing and use of disciplinary or institutional repositories (irs; see figure 2). articles published in oa journals, such as advances in social work and behavior and social issues are referred to as “gold” oa meaning that access is provided directly via the publisher. access provided via institutional or disciplinary repositories is referred to as “green” oa, and the articles are usually in manuscript form, either prior to peer review or post peer review (referred to as pre-print and post-print respectively). figure 2. open access publishing cycle for research articles figure adapted from creative commons (n.d.) research performed and article manuscript written article submitted to journal, peer review conducted article accepted, author transfers copyright to journal article published in journal behind paywall, indexed in databases and search engines libraries subscribe or public pays per article fee for access public has minimal access to current research knowledge research performed and article manuscript written article submitted to journal, peer review conducted article accepted, public or open access enabled in author agreement article published oa in journal and/or deposited in ir, indexed in databases and search engines public can freely access via journal website or ir public benefits from current research knowledge advances in social work, fall 2018, 18(4) 1044 the gold oa publishing model removes the cost burden of access from the public, replacing financial support for journals via a variety of models, such as subsidies, donations, or membership dues for professional association journals. repositories also provide public access to research, but a bit differently; the ability to deposit an article might be subject to an embargo period, or, at times, only the pre or post-print version may be deposited, not the publisher’s final formatted version. in the early 2000’s, irs were developed as universities leveraged new technology to create stable access to the research output of their communities. adding public access to this effort was a natural fit. additionally, disciplinary repositories were on the rise, particularly in the hard sciences where sharing research quickly is highly valued. both irs and disciplinary repositories serve as a primary means for sharing publicly funded research; for example, pubmedcentral (pmc), a health sciences research repository, has grown rapidly since the implementation of the national institutes of health public access policy of 2008 (national institutes of health, 2016). this study examines public access (i.e., no paywall barrier) to articles in the top 25 social work related journals. while none of the journals in the sample set are published oa, they each allow the author to archive a version of the article in an institutional or disciplinary repository. measuring the amount of engagement in self-archiving and availability of research in social work is an important first step in advocating for practitioner and public access. quantifying the societal or practice-related impact of freely accessible research literature is challenging; however, it is possible to identify benefits of oa indirectly, especially through the lens of inefficiencies. in a study of government officials’ use of research, performed early in the development of oa publishing, willinsky (2003) found that: the research that is most easily accessible, through portals and open-access sites, is most often consulted, as policymakers referred to how readily they were dissuaded from using pay-per-view and subscription services in their pursuit of knowledge. this means that they are tapping into a skewed and somewhat haphazard view of the current state of knowledge on a given topic. (p. 12) unfortunately, almost ten years later, look and marsh (2012) found similar results in their study of public sector employees. for example, the participants “noted that they submitted analysis or made decisions on the basis of potentially incomplete research as they had not been able to review all the relevant articles they had identified” (p. 29) or that decisions were delayed due to lack of access. given the demands on social workers to stay up-to-date in their practice, use research to inform decisions, and to participate in continuing education and lifelong learning, easy access to research literature can only be a benefit. but, the traditional scholarly publishing model is still focused on providing research to other researchers, and not extending into the practitioner and public audiences. as an example of a different approach to the dissemination of scholarship, advances in social work (aisw), one of the few social work oa journals, states in its open access policy “this journal provides immediate open pendell/behind the wall 1045 access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge” (aisw, n.d.). literature review aside from the earlier recommendation of promoting dissemination of research by nasw, there appears to be little, if any, conversation in social work related journals regarding access to research for practitioners. several keyword and related subject heading searches for open access or dissemination of research in social services abstracts, google scholar, and web of science returned very few relevant results. bowen, mattaini, and de groote (2013) was the only study found that explicitly addresses access to research literature and open access publishing. another, albeit brief, exception to the quiet was “suggestions to improve social work journal editorial and peer-review processes: the san antonio response to the miami statement” (holden et al., 2008) which offers fifty responses from a subcommittee of the society for social work and research presidential task force to an earlier “miami” statement, which was also concerned with improving journal publication processes. both of these statements centered on concerns regarding scholarly communication via social work journals (holden et al., 2008; schilling et al., 2005). recommendation 48 of the “san antonio” response states: “publishers should consider ways in which they can increase the free flow of scholarly communication (e.g., removing restrictive practices regarding the use of copyrighted materials, becoming a green journal, and removing publication process obstacles in the production realm)” (holden et al., 2008, p. 69). the primary source of any data or discussion regarding access to research literature in social work is primarily found in studies related to ebp because a key component of ebp is finding research that matches one’s particular clinical or practice question. often, the expectation that one can access the needed research is implicit, and perhaps taken for granted. but studies looking specifically at ebp in the field of social work have demonstrated that needed information access is not typically available: seven of the studies identified poor access to available research evidence as a barrier to ebp implementation. the need to invest resources in staffed library facilities and information technology to access web-based databases was identified as a requirement if there were to be a movement from ebp as an aspiration to a reality. (gray, joy, plath, & webb, 2013, p. 163) lack of access to information resources was also cited as one of the top three barriers to ebp in a study recent of romanian social workers (iovu, goian, & runcan, 2015). it is interesting to observe dramatic differences in engagement with ebp between practitioners in the field and students. van der zwet, weling, beneken genaamd kolmer, and schalk (2017) explored if social workers simultaneously enrolled in an msw program were more engaged with ebp than their non-enrolled counterparts. indeed, the difference appeared substantial; only 12.3% of social workers reported that they “use the internet to search for the best research evidence to guide my practice decisions,” in contrast to almost 60% of social worker/msw students. the study does not further clarify or explore what advances in social work, fall 2018, 18(4) 1046 type of information found on the internet is being used; however, articles seem likely to be part of this scope. additionally, 75% of msw students “often” or “very often” read research evidence as part of their ebp process, again in contrast to only 10.6% of practitioners (van der zwet et al., 2017, p. 84). a question that arises from this study is to what extent access plays a role in identification and use of research evidence. it can be assumed that the msw students in the study have full-text journal access via their university affiliation, while the practitioners do not. would we observe more use of research if practitioners had the same access as students? hardisty and haaga (2008) attempted to answer this question by exploring the impact of access to articles to influence behavior/practice change. their unique study explored participants’ behavior when asked to access an article that was freely available versus other means of access, including needing to pay for the article. a significantly higher proportion of participants read the article when it was freely available to them (70%; p. 831). the same authors also tested for the potential of the participants to implement recommendations from the article in a relevant hypothetical scenario, finding a positive result. “dissemination efforts that come with a price tag may prove less effective, even if they are promoted more heavily, than dissemination efforts that are free” (hardisty & haaga, 2008, p. 835). they conclude that “a more immediate practical implication of the present study is that scholars wishing to maximize the diffusion of their research among the professional community should deposit eprints of their work in oa archives” (p. 836). if the evidence points to access as a positive benefit to practitioners, why is more access not provided to practitioners via subscriptions? the cost barrier to academic journals is high for individuals and agencies. bowen and colleagues’ (2013) study of social work journal subscription cost data found an average of $121 per subscription for an individual, with much higher costs for institutions. the average yearly inflation rate for academic journals tends to hover in the 5%-6% range, but the projected increase for social sciences titles for 2017 was 7.2% (bosch & henderson, 2017). bowen et al. (2013) reasonably assert that “open access is particularly important when considering the needs of practitioners in less wealthy organizations, communities, and institutions in the united states and globally,” (p. 40) especially when promoting evidence-based practice. acknowledging that the high impact journals in the field of social work do not include any open access titles, there is another key pathway for researchers to share their work: institutional or disciplinary repositories. institutional repositories are the most viable path for stable, long term, and publicly/freely available sharing of research, outside of publishing in an oa journal, and irs are common at all major universities at this point. in 2017, there were 820 institutional repositories in the united states, canada, and the united kingdom according to the registry of open access repositories. disciplinary repositories, such as socarxiv, provide an open access platform for researchers to upload pre-prints and working papers; repositories such as pubmed central provide a platform for published papers. overall, social sciences disciplinary repositories are younger and smaller than those in the hard sciences, but they have seen growth in their collections. pubmed central and its counterpart, europe pmc, have grown significantly, assisted by being the recommended depositories for health sciences research subject to public access policies. pendell/behind the wall 1047 many irs are supported by the university library, with varying levels of promotion and support for depositing content. the rate of self-archiving in 2010 united kingdom was 34% for the social sciences broadly, and psychology more specifically (van noorden, 2012, p. 303). however, the united kingdom also has more robust public access policies in place than the united states. overall though, the rate of self-archiving of research articles by authors lags far behind its potential, especially when compared with the swift enthusiasm a publication sharing platform such as researchgate appears to generate. method in order to measure the level of public access to research articles in the field of social work, citation searches were performed on a sample set of articles from the top 25 social work related journals. using the eigenfactor metric of article influence for 2014, the top 25 journals in the international scientific indexing category of social work were identified (see table 1). eigenfactor’s article influence score measures the average number of citations to individual articles within a journal; this measure was selected as article level access was the primary concern for this study. ultimately, the bulk of the top 25 journal titles with high article influence are the same as those ranked by overall journal influence. i retrieved citations for articles published in 2014 from each of the journals using the social sciences index available via the web of science. as part of this process every attempt was made to accurately exclude citations for editorials, book reviews, letters, corrections, or other citations that were not recognizable as research articles. none of the 25 journals identified are open access; however, all of the journals allow for the deposit of a pre-print or post-print version in an institutional or disciplinary repository. all but five titles allow for paid open access of individual articles, as indicated by sherpa/romeo, an aggregator of journal oa policies (sherpa/romeo, n.d.; see table 1). the citation sample set was derived from citations from 2014, allowing for an over two year gap to account for the embargo period sometimes required by publishers prior to self-archiving in a repository. from the total number of 1,587 research article citations retrieved from the 25 journals, a random sample of 638 citations created by a random generator for google sheets was selected in accordance with a 95% confidence level with +/3 confidence interval. each citation was searched using the google scholar and doai.io in an off-campus, unauthenticated browser to avoid inaccurate access to full-text via ip recognition or institutional affiliation. google scholar is a well-known discovery and access point for scholarly journal articles; its search engine crawls academic publisher websites as well as institutional and disciplinary repositories, such as pmc. google scholar also crawls researchgate for full-text articles uploaded by its users. doai.io is the digital open access identifier, which utilizes an article’s digital object identifier (doi) to retrieve free access to a version of the article if available. each citation was searched using both applications because they demonstrate different access points for a given citation. neither of these discovery tools search full-text “pirate” sites such as scihub; access to full-text via those sites is not part of this study. advances in social work, fall 2018, 18(4) 1048 a pilot was performed with 20 citations, revealing that in addition to the planned recording of availability of full-text from an institutional or disciplinary repository, download availability of full-text via the social networking website researchgate should also be noted. therefore, the public availability, if any, of full-text (publisher pdf, postprint, or pre-print version) via a doi search of google scholar and doia.io was recorded, including the source of availability as follows: • repository (institutional or disciplinary) • researchgate • open access on journal website • other full-text access (e.g., personal or organizational website) table 1. journal sources of citations with eigenfactors, number of article citations, and romeo status eigenfactor article influence journal # of article citations 2014 (total = 1587) publisher romeo status 1.7 trauma, violence & abuse* 27 sage green 1.2 child maltreatment* 25 sage green 1 child abuse & neglect* 203 elsevier green 0.9 american journal of community psychology* 74 wiley yellow 0.8 social service review* 18 university of chicago green 0.6 family relations* 51 wiley yellow 0.6 journal of social policy* 37 cambridge u. press green 0.6 social policy & administration* 46 wiley yellow 0.6 research on social work practice* 65 sage green 0.5 journal of community psychology* 68 wiley yellow 0.5 health & social care in the community* 65 wiley yellow 0.5 health & social work 27 oxford u. press yellow 0.5 british journal of social work* 143 oxford u. press yellow 0.4 child & family social work* 44 wiley yellow 0.4 international journal of social welfare * 44 wiley yellow 0.4 qualitative social work* 43 sage green 0.4 children & youth services review 287 elsevier green 0.4 social work 44 oxford u. press for nasw yellow 0.3 social work in health care* 61 taylor & francis (routledge) green 0.2 journal of social work practice* 27 taylor & francis (routledge) green 0.2 international social work* 59 sage green 0.2 administration in social work (now human service organizations: management, leadership & governance) 35 taylor & francis (routledge) green 0.2 affilia journal of women and social work* 37 sage green 0.2 clinical social work journal* 40 springer green 0.2 australian journal of guidance and counselling 17 cambridge u. press green notes. * a paid open access option is available for this journal, as indicated by sherpa/romeo (n.d.) yellow: author can archive pre-print (pre-refereed) green: author can archive pre-print and post-print or publisher's version/pdf pendell/behind the wall 1049 findings and discussion as seen in table 2, no full-text access was found for 52% of articles, a slim majority of the total 638 citations investigated. the sample set of citations demonstrated only minimal use of institutional repositories as a means of sharing research. deposit of fulltext in the disciplinary repositories pmc and europe pmc was higher than that of institutional repositories, and likely can be attributed to funding agency or governmental requirements, as discussed earlier. within the parameters of this study, very few articles would be available to users not affiliated with an institution or some other form of subscription access without the popularity of researchgate, which accounted for 30% of full-text access. table 2. full-text availability of sample social work articles (n=638) access to article full-text # (%) not available 332 (52%) researchgate 191 (30%) pmc or europe pmc 43 (6.7%) institutional repository 35 (5.5%) other full-text access 22 (3.5%) open access on journal website 15 (2.3%) in regards to the high use of researchgate, it is likely that many articles uploaded to the platform are in violation of publisher copyright agreements. in fact, mass take down notices from publishers targeting researchgate have already begun (van noorden, 2017). as jamali (2017) notes, the number of recent articles on researchgate is “...not good for publishers as journals’ main revenue relies on newly published issues and that is why a lot of publishers apply embargo periods for archiving peer-reviewed versions of the articles” (p.252). jamali (2017) found over 78% of a random sample of 500 articles in researchgate were publisher pdfs (p.251). this study’s results demonstrate an even higher rate of deposit of publisher pdfs of the articles found in researchgate: 96% of articles on researchgate were publisher’s pdf version. ascertaining the means by which these articles were uploaded to researchgate, or the amount of them that are in violation of copyright is outside of the scope of this study. however, the legal complications of researchgate are important for our understanding of public access because this platform appears to be a primary means of access that would be otherwise unavailable. “to understand the role of researchgate in making full-text of papers freely available, it is enough to say that it is one of the top sources of full-text files found through google scholar” (jamali, 2017, p. 242). this will change quickly as publishers take legal steps to limit the extent of copyright violations via researchgate (van noorden, 2017). here the distinctions between irs and disciplinary repositories versus forprofit social network platforms becomes clearer: repositories are born with a different purpose and ethos, and are managed with an eye towards copyright compliance and long term access. advances in social work, fall 2018, 18(4) 1050 as a simple tracking of full-text availability, this study does not answer the question of why engagement in self-archiving is low. for example, the availability of institutional repositories to authors in the sample set and the amount of support offered by the institution is unknown. authors may struggle with self-archiving in repositories due to the “time and effort involved in determining or securing copyright” (palmer, teffeau, & newton, 2008, p. 25). or perhaps the low rate of deposit is due to lack of awareness and education regarding the purpose and utilization of oa, irs, and disciplinary repositories. further research related to both the researcher/author perspective and the practitioner/user perspectives is needed. it would be valuable to have a better understanding of whether researchers perceive the impact of their work primarily as citations from other researchers or for use by practitioners in the field. the level of awareness and understanding of options for sharing research among authors are also of interest. looking at practitioners/users, to what extent do they use, or wish to use, research articles to inform their practice? are the aforementioned pirate sites or other avenues (e.g. #canihazpdf on twitter) providing viable work-around access for savvy social workers? and for social work librarians, we must ask if teaching students to use expensive, licensed databases that lead to subscription-based full-text platforms is effective for students once they separate from the university. would it be helpful to discuss the economics of scholarly communication to increase understanding of how access is available or not available? additional research on topics like these, building upon this study, has the potential to inform us how researchers/authors think of dissemination of their work; how students are taught to find and access research; how access shapes decision-making in the field; and how it influences oa-related advocacy efforts in social work. conclusion the findings of this study establish a baseline measure of research article availability to practitioners and the public, assuming no personal and institutional subscriptions to individual journal titles. a significant amount of research published in core social work journals is not available to the practitioners or members of the public who would benefit from it. this is especially of concern as public skepticism of academia and scientific research increases. it is time for researchers, administrators, publishers, and librarians in the field of social work to increase openness and access to research. looking ahead, there are two immediate ways for researchers to move their scholarship from behind the publisher paywall: publish in an oa journal whenever possible and practice self-archiving in either an institutional or disciplinary repository. many will likely have the support of their university library in these efforts. clearly, there is at least some interest in sharing scholarship as demonstrated by the use of researchgate, but as noted, there are caveats to such platforms. librarians have a role in educating both researchers and students about the differing models of scholarly publishing, author’s rights, and public access indexing tools and oa full-text sources. a longer term recommendation for researchers and administrators in an academic settings to consider is rewarding oa publishing and/or repository archiving as a reflection of community engagement in processes such as promotion and tenure. in addition to the societal benefits of oa publishing, a majority of comparison studies have indicated that oa publishing also benefits authors by increasing pendell/behind the wall 1051 citations to their articles versus non-oa published articles (tennant et al., 2016). gold and green oa come with their own concerns and complications to be sorted out. however, the status quo of keeping research behind publisher paywalls costs the field of social work in ways that should not remain unexamined. references advances in social work. 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(2017, october 10). publishers threaten to remove millions of papers from researchgate. nature. doi: https://doi.org/10.1038/nature.2017.22793 willinsky, j. (2003). policymakers' online use of academic research. education policy analysis archives, 11(2), 1-23. doi: https://doi.org/10.14507/epaa.v11n2.2003 author note: address correspondence to: kimberly pendell, msis, university library, portland state university, 1875 sw park ave, portland, or 97201. kpendell@pdx.edu http://wiki.lib.sun.ac.za/images/e/e3/report-to-oauk-benefits-of-open-access-public-sector.pdf https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.socialworkers.org/advocacy/briefing/researchbriefingpaper.pdf https://www.socialworkers.org/advocacy/answer/ https://publicaccess.nih.gov/policy.htm http://hdl.handle.net/2142/8981 https://doi.org/10.1093/swr/29.2.119 http://www.sherpa.ac.uk/romeo/index.php https://doi.org/10.12688/f1000research.8460.3 https://doi.org/10.1080/02615479.2016.1266321 https://doi.org/10.1038/486302a https://doi.org/10.1038/nature.2017.22793 https://doi.org/10.14507/epaa.v11n2.2003 mailto:kpendell@pdx.edu ____________ emily l. mccave, phd, msw, lmsw, professor, department of social work, laura mutrie, msw, lcsw, director of field education and clinical assistant professor, department of social work, maya h. doyle, phd, msw, lcsw, associate professor, department of social work, stephanie jacobson, phd, msw, lcsw, associate professor, department of social work, and amber kelly, phd, msw, lcsw, associate professor, department of social work, quinnipiac university, hamden, ct. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 497-514, 10.18060/23673 this work is licensed under a creative commons attribution 4.0 international license. utilizing change leadership within social work education to prioritize and expand interprofessional education in a university setting: a case study emily l. mccave laura mutrie maya h. doyle stephanie jacobson amber kelly abstract: interprofessional education (ipe) is a critical educational component for promoting the quadruple aim of health care. additionally, interprofessional practice (ip) is included in the council on social work education’s (cswe) educational standards. yet, the organizational change required to integrate a social work program within established interprofessional education (ipe) curriculum is challenging given the resources required, such as personnel, time, and ongoing commitment among stakeholders. we present a case study of one msw program’s process for integrating social work within an existing ipe curriculum and formalizing ipe as a focus point programmatically. the bacharach approach, a change leadership model, is used to analyze the msw program’s approach to initiating and sustaining this change initiative. through strategic decision-making and capitalizing on momentum, the msw program has become a valued partner and leader of ipe endeavors and the msw program’s focus on ipe programmatically has been solidified. creativity, adaptability, advocacy, and relationship-building are key skill areas that social work educators can draw upon as they navigate organizational and programmatic changes focused on ipe. keywords: change leadership, interprofessional education, collaboration, social work education interprofessional education (ipe) is recognized as a critical preparatory component for meeting the quadruple aims of health care enhancing patient experiences, improving population health, reducing costs, and improving the work life of health care providers (bodenheimer & sinsky, 2014; institute of medicine, 2015; interprofessional education collaborative [ipec], 2016; rubin et al., 2017). according to the council on social work education’s (cswe) 2015 educational policy accreditation standards (epas), students must demonstrate competency in interprofessional collaboration and teamwork as part of their social work education. while the imperative for developing and providing ipe is clear, the challenge is creating pathways to implement and assess sustainable, high quality ipe given the considerable, yet critical, resources of personnel, time, and space (rubin et al., 2017). in this article, we offer a case study of one msw program, detailing the strategies used to initiate and expand the social work presence within existing ipe and to formally prioritize ipe programmatically within the msw program. the strategies discussed are presented through the lens of the bacharach approach for change leadership https://creativecommons.org/licenses/by/4.0/ mccave et al./utilizing change leadership 498 within higher education (bacharach, 2005, 2006). considerations and recommendations for other social work educators interested in similar organizational change are provided. relevant literature social workers have long worked in settings with professionals of other disciplines and as part of teams described as multidisciplinary, inter-disciplinary, and most recently, interprofessional (ip, dane & simon, 1991). the world health organization (who) defines interprofessional collaborative practice as occurring “when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings” (who, 2010, p. 10). interprofessional practice can exist in almost any setting that provides health or social services, including medical institutions and community practices, behavioral health settings, criminal justice and re-entry agencies, schools, as well as child welfare and aging settings. zerden et al. (2019) conducted a study of 395 msw students and field instructors who work as members of integrated interprofessional healthcare teams. more than half reported working with physicians and nurses in hospital settings. additionally, respondents worked in a variety of communitybased settings and identified a broad array of other professionals “including child protective service workers, speech pathologists, teachers or school administrators, recreation and vocational specialists, and peer-support specialists” (zerden et al., 2019, p. 3) as members of the integrated interprofessional healthcare teams. social work professionals are “ideally situated to participate and provide leadership” given the profession’s focus on “community involvement, family-centered care, and communication and ethics” (jones & phillips, 2016, p. 26). with social work’s ecological and biopsychosocial perspectives, social workers can contribute uniquely to interprofessional practice by recognizing strengths and challenges for clients on the personal, familial, community, and systemic level, while also gaining insight from fellow members of the ip team. specific challenges also exist for social workers practicing interprofessionally, including role delineation, diffusion, and expansion; boundary-stretching (or breaking); inflexible hierarchical structures; splitting within interprofessional teams; and personal or systemic communication breakdowns (kerson, 2004; oliver, 2013). social workers must juggle dual identities and potential identity threats between the values, ethics, and theoretical lens of the profession, and their immersion in and identity as part of an interprofessional team, whether it be in a school, a primary care setting, or within a medical specialty like oncology or nephrology (agresta, 2006; chatalalsingh & reeves, 2014; mcneil et al., 2013). often a sole practitioner may represent social work within a team or an agency, limiting access to intra-professional support and to discipline-specific supervision (oliver, 2013). it has been suggested that for physicians and nurses to understand how social work benefits clients, they need more access and co-location with social workers (ambrose-miller & ashcroft, 2016). a survey by west et al. (2017) revealed that social workers had a self-perception of lower prestige compared to other professions such as medicine, nursing, and pharmacy, which may negatively impact social workers involved in interprofessional practice. while zerden and colleagues (2019) found advances in social work, summer 2020, 20(2) 499 that the majority of social workers reported feeling supported and valued as members of the interprofessional team, they also found notable barriers for social workers on the ip team. these barriers include professional cultural differences, lack of knowledge by other team members of social determinants of health, lack of training regarding behavioral health for other team members, salary differences that created inequity on the team, reimbursement issues, and lack of adequate space. while social workers naturally bring their own professional competency to the interprofessional team, it is not a given that they have also developed competency in interprofessional practice, a different knowledge base and skill set. interprofessional competency can be introduced and practiced via interprofessional education (ipe, comer & rao, 2015; jones & phillips, 2016; kobayashi & fitzgerald, 2017; zerden et al., 2019), which occurs “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (who, 2010, p. 7). ipec, created in 2009, was sponsored by the councils for education of pharmacists, nurses, dentists, osteopathic doctors, public health professionals, and medical doctors (ipec, 2016). since then more than 60 other professional groups have become involved in the collaboration, including cswe. in preparing to be effective members and leaders of such interprofessional care teams, social workers benefit from opportunities to participate in interprofessional education (zerden et al., 2019). social work educators must create opportunities for their students to engage with team members from other professions, allowing them to attain the four core competencies for collaborative interprofessional practice: teamwork, shared values and ethics, understanding role and responsibilities, and effective communication (ipec, 2016). while social work education provides socialization to the profession, there is an additional need for socialization to interprofessional collaboration and communication (west et al., 2017). despite social work’s knowledge base and practice history with group work and teams, practitioners and students often feel inadequately prepared to effectively engage within interprofessional teams (comer & rao, 2015). for clients to receive the best access to services and to have effective treatment and discharge plans, social workers must, in particular, be able to effectively communicate with such teams (glaser & suter, 2016). interprofessional communication sub-competencies speak to the specific skills necessary for this work, including choosing effective techniques, providing information in easy to understand language, sharing information clearly, listening actively, giving constructive feedback, being respectful, having awareness of one’s unique perspective, as well as engaging in team-based patient-centered care (ipec, 2016). work has already been done to map the intersection of the core competencies for interprofessional practice with the epas competencies and to articulate naturally occurring opportunities for ipe within social work curriculum (rubin et al., 2017). additionally, comer and rao (2015) tracked responses of msw students who were enrolled in an interprofessional group, noting increased self-awareness around the importance in working with others and knowing the social work role within a team, as well as appreciation for gaining real life experience. crumb and colleagues (2018) studied the effects on social work students who participated in an interprofessional program that provided mental health services to college students. social work interns, advisors, and college students all reported mccave et al./utilizing change leadership 500 benefiting from the program, with social work interns indicating benefit from by utilizing their social work skills to administer assessments and assist college students with finding resources, while also practicing their group communication skills with other team members. kobayashi and fitzgerald (2017) demonstrated that students enrolled in a complex ip curriculum across co-located health programs from three universities found it beneficial to give and receive feedback across disciplines, and to have a platform to practice their skills. organizational change: the bacharach approach as a focus on integrating ipe within institutions of higher education continues to increase, added pressure may be placed on administrators and program faculty to prepare for both initiating and responding to change efforts to this end. similarly, as new programs are established, there is pressure to create a presence within existing ipe. in both cases, organizational change is necessary and requires thoughtful and strategic planning. one way to prepare is to draw on organizational approaches for managing change. the bacharach approach (bacharach, 2005, 2006; coley, 2020) is a model of change leadership that focuses on leaders as change agents within their institutions. the focus of the model is to win support and capitalize on momentum to push forward change efforts. this is done by adhering to four principles: 1) creating an agenda; 2) mapping the political terrain; 3) drawing support to your side; and 4) making things happen. the approach suggests that change is done organically when leaders empower themselves to guide change efforts through creating and sustaining momentum. there are four sources of momentum that can be capitalized upon: a) structural; b) performance; c) cultural; and d) political. the structural source of momentum focuses on promoting and sustaining capacity building, whereas ongoing monitoring and evaluation is the source of performance momentum. the cultural source of momentum is focused on promoting motivation to sustain change efforts and the last source of momentum, political, involves scanning the environment for potential resistance and mobilizing support for the change effort. the msw program in a school of health sciences: a case study stake (2005) describes how case study methodology allows us to learn what particular qualitative data can be gained from observing a single case, optimizing learning from the case before generalizing further. in this same vein, we describe the unique development and positioning of the msw program as an agent of organizational change and its key role in ipe development within a larger school of health sciences utilizing the bacharach approach. this msw program is relatively new, now in its 7th year, residing in the department of social work in a school of health sciences, which includes several other health programs, including occupational therapy (ot), physical therapy (pt), physician assistant (pa), diagnostic imaging (di), biomedical sciences (bms), and wellness/fitness. the school of health sciences is also co-located with the schools of medicine, nursing, law, and education. the medical school inaugural class and the msw program inaugural class both entered the university in 2013. consequently, the potential for creating meaningful ipe activities through partnerships across departments and school is great. advances in social work, summer 2020, 20(2) 501 the university has a center for interprofessional healthcare education (cihe), which sponsors ipe activities each semester, and offers students a program of distinction in interprofessional healthcare education. the distinction program requires completion of 60 hours of ipe activities, online modules and reflections prior to graduation. the cihe takes responsibility for space planning, distribution of any pre-reading materials, student registration, provision of supplies and/or snacks, and post-activity data collection. while the cihe has grown significantly over the past several years due to the commitment of faculty across schools, challenges remain. cihe has historically received minimal financial support from the university and limited infrastructure exists. availability of appropriate/adequate space for larger ipe events and conflicting student schedules by program and departments create barriers in planning. an additional unique challenge has been that, with the advent of a new medical school, the university does not have an academic medical center, thus efforts to deliver ipe have been primarily within the academic setting rather than the clinical setting; more elaborate relationship-building and contractual agreements are necessitated with clinical and field learning sites. creating an agenda given the unique academic context described above, the msw faculty chose to explicitly highlight interprofessional education as a primary focus within the program, thereby setting the agenda for initiating a social work presence within the university’s existing interprofessional education curriculum. this initially started by including language within its mission statement and program goals. the mission of “the msw program is to prepare social workers for specialized practice in the context of health and behavioral health settings through a curriculum that focuses on clinical practice, organizational practice, and interprofessional [emphasis added] teamwork….”. one of the msw program’s four program goals includes a focus on interprofessional practice, to “prepare social workers to engage in professional activities that promote interprofessional [emphasis added] collaboration and advocacy within diverse environments toward the enhancement of the human condition”. by including this language in both the mission statement and within one of the program goals, the msw program has a clear rationale and justification for not only initiating integration within existing ipe but also centering ipe as part of the explicit social work curriculum. mapping the political terrain as a new program within the school of health sciences, it was necessary to explore the extent to which social work was a welcome new addition within existing ipe and what potential barriers might be encountered. to facilitate this understanding, msw faculty participated in various meetings with program leaders and faculty within the other departments in the school as well as in the other schools co-located on campus in order to provide information about the msw program and communicate an interest in collaboration for ipe. additionally, msw faculty joined the ip planning committee organized by the cihe director as a way to foster connections and learn about existing ipe as well as new ipe initiatives and opportunities. fortunately, the terrain was such that the idea of creating a social work presence within existing ipe was very much appreciated from nearly all mccave et al./utilizing change leadership 502 programs. the initial barrier was the lack of awareness that the msw program existed, particularly as the program was within the college of arts and sciences for its inaugural year and housed on a different campus. despite the social work department having moved, both physically and structurally, within the school of health sciences, the dissemination and internalization of that fact was slow. another barrier that arose was differing academic and clinical/fieldwork schedules of students and faculty from different programs. social work, as the newest player, required additional accommodation to demonstrate involvement and gain credibility within a context that already included ongoing challenges for programs already engaged in ipe. consequently, over the next few years, the msw program became recognized as both an eager and valuable partner across schools. more recently the political terrain has shifted as upper leadership within the university has changed, including both the provost and the president. in 2018, the president launched a new university strategic plan, with its first goal being “build an institution-wide mindset that prepares graduates for 21st-century careers and citizenship” (quinnipiac university, 2019, p. 9). interprofessional competency is truly part of workforce development in social work, particularly for students in an msw program focused on roles in health and behavioral health settings. while dips in enrollment have been seen by undergraduate and graduate programs across disciplines nationally (mcfarland et al., 2019; okahana & zhou, 2018), the health sciences remain one of the fasting growing areas of employment. the u.s. bureau of labor statistics projects that social work jobs will grow by 11.5% between 2014 and 2024 (salsberg et al., 2017). in a competitive marketplace, providing a strong interprofessional education component can be an important selling point for attracting students to university programs. generating buy-in from the university and the schools of health science, nursing, medicine, law, and education has been essential to the growth of ipe activities and the integration of social work within these activities. drawing support to your side given that the msw program is not an independent school, but rather housed within the school of health sciences, it was important to draw on support at the school level for both integrating social work into existing ipe activities and centering ipe within the msw program. one way in which this support was garnered was reminding the various program leaders in the school that the importance of interprofessional education and practice was explicitly in the mission and values statement of the school of health sciences, which “offers a student-centered learning environment with interprofessional collaboration, innovative teaching and hands-on experience” and “values an interprofessional, client/patient-centered health care model and the translational science that supports it” (quinnipiac university school of health sciences, 2018, p. 2). having written language at the school level supports faculty across departments as they consider whether their time and energy put into ipe will be recognized. making things happen over the past six years, the msw faculty increasingly became involved with ipe activities based on their areas of expertise and interest. initially, msw faculty joined existing ipe activities, bringing in a social work perspective. from there, msw faculty advances in social work, summer 2020, 20(2) 503 began developing new ipe activities where social work has a major role to play along with other health professionals. despite only having six full-time faculty in the msw program, there has been a high level of participation in ipe events, with consistent requests from the cihe and faculty from other schools and departments for social work faculty and student representation in ipe activities. by having faculty participate in such events, they model the importance of interprofessional practice for msw students and can better encourage students to participate beyond the program requirements. table 1 highlights the breadth of ipe activities that msw faculty have been involved with and that meaningfully integrate social work students with interprofessional core competencies for each activity noted. creating and sustaining momentum structural momentum maintaining capacity for continued change requires significant resources, both in terms of time and money. one way this has been negotiated by the msw program is to seek out or participate in grant funded ipe activities. the scholarship of teaching and learning program (sotl) offers small grants for projects focused on testing innovative teaching methods and producing scholarship. one msw faculty member received two consecutive sotl grants, both focused on game-based ipe learning. one used a strategy board game to promote interprofessional practice (mccave, winter 2016) and the other entailed designing an escape room focused on teaching the core competencies for interprofessional practice. another msw faculty member received an internal global education grant to create an interprofessional credit-bearing course on trauma-informed practice for healthcare professionals, in coordination with local partners in barbados. capitalizing on external funding, one msw faculty member has been involved with the cihe’s low vision clinic, which was started with a community grant from the lion’s club. the low vision clinic (meriano & mutrie, 2016, march 5) is an innovative interprofessional clinic that operates at no cost to clients. it is offered one afternoon a week and provides occupational therapy (ot) vision evaluations and assistive technology to clients. clients are selfreferred or referred by their community health care providers. the msw faculty member offers social work assessments and a monthly social and emotional support group for clients and their caretakers/partners. each year, social work students are offered the opportunity to observe the support group and one student participates annually as full member of the team eventually completing assessments, following up on needs that clients have expressed, and consulting with ot faculty and students to provide quality, coordinated care and support. ot faculty have expressed the value of having the social work perspective represented, especially as it relates to the full bio-psycho-social-spiritual assessment of the clients who are often grieving not only the loss of vision but also a loss of independence, and experiencing the complications of multiple health and personal changes. mccave et al./utilizing change leadership 504 table 1. sample of ipe activities offered involving social work faculty and students event title topic(s) sw role timeframe/ format ipec competencies* holistic healthcare for transgender patients (mccave et al., 2019) ▪ gender identity ▪ chronic health condition ▪ healthcare disparities ▪ workplace discrimination lead developer, coordinator, facilitators 4-hour workshop ▪ teamwork ▪ ethics & values ▪ roles ▪ communication josh’s journey (cordeau et al., 2017; jacobson & mutrie, 2014, october 23-26) ▪ oncology ▪ hospice ▪ end-of-life ▪ adolescence lead developer ipe event coordinator, facilitator 3 hours ▪ roles ▪ communication harm reduction for healthcare providers ▪ addiction ▪ harm reduction ▪ chronic health condition ▪ homelessness ▪ trauma lead developer, liaison with community coalition 5-hour seminar ▪ teamwork ▪ communication simulation of an interprofessional pupil team (richards et al., 2019, oct 20-23) ▪ school ▪ individualized education planning ▪ chronic/rare health condition ▪ disability developer, facilitator, speaker 2 hours ▪ teamwork ▪ communication compassionate interprofessional care for a family impacted by als ▪ chronic health condition ▪ addiction ▪ end of life ▪ bias ▪ legal issues developer, facilitators, roleplay 1.5-hour case study ▪ values & ethics veterans interview: what, when, why and how it can be interprofessional ▪ veterans ▪ housing ▪ health conditions co-developer, msw student speaker 1.5 hours ▪ values & ethics ▪ roles ▪ communication the cardiac journey ▪ health condition co-developer, facilitator, speaker 2.5-hour seminar ▪ teamwork ▪ communication *teamwork; shared values and ethics; understanding roles and responsibilities; effective communication advances in social work, summer 2020, 20(2) 505 performance momentum over the past seven years, the msw program has monitored and made adjustments to the way in which ipe is integrated into the explicit social work curriculum. at its inception, the msw program included a required generalist course on interprofessional education as it related to special topics of interest, such as end of life care, public health social work, and adult trauma. this course exposed students to readings on the importance of interprofessional practice, the role of the social work profession within the health/behavioral healthcare team, and the roles and responsibilities of other professions typically involved given the course topic. guest speakers were routinely brought in to highlight this latter aspect. the course required a reflection paper on students’ developing professional identity not only as a social worker (i.e., uniprofessional identity) but also as an interprofessional practitioner. this assignment also required students to connect interprofessional practice to social work values and ethics. as faculty became more integrated into the larger university system and involved with cihe, the course evolved to include a requirement to attend two cihe-sponsored ipe events. the reflection paper then was able to move from a more theoretical reflection to one grounded on recent interprofessional practice experiences. the faculty chose the two ipe events for students to attend, both of which had a critical role for social work students. of note, this course was open to graduate students outside of the msw program, with medical students enrolling on occasion. while there certainly were benefits to this course, there was also a significant limitation that led the msw program to make a shift in the curriculum. for most of the classroom experience, msw students did not get the benefit of learning from and by peers in other health professions, a necessary element of ipe, aside from the two required events. while listening to a guest speaker from another profession is certainly beneficial, it does not meet the definition of interprofessional education, according to ipec (2016), unless there is ample time for students to engage in discussion with their peers from other health professions. given this limitation, after six years of offering the course, the msw faculty decided to remove the required course and instead require all students to complete a certain number of ipe activities prior to graduating. each student is required to log in their completed ipe activities using an online platform, which is also used to track field hours. advisors are required to monitor their advisees progress each semester. during the generalist curriculum, all students are required to complete four interactive online modules offered by the cihe, which provide a solid foundation on the core competencies of interprofessional practice. each module takes around 60-90 minutes to complete. generalist students are required to participate in a specific ipe event, called holistic healthcare with transgender patients (mccave et al., 2019) as well as attend one cihesponsored event of their choice. specialized students are required to serve as facilitators for the holistic healthcare with transgender patients ipe event and then choose two other cihe-sponsored events to attend. for the advanced standing program, specialized students are required to complete the online modules, attend the holistic healthcare with transgender patients ipe event, and attend one cihe-sponsored event of their choice. students in the traditional msw program will complete 20-25 hours of ipe activities by mccave et al./utilizing change leadership 506 graduation, while advanced standing students, on an accelerated track through the program, will complete 10-12 hours. all students can choose to complete 60 hours for ipe distinction at graduation, but this is more easily accomplished by undergraduates, in comparison to msw students tasked with academic work and 16-24 hour/week field placement schedules. the reconfiguration of the msw ipe course into the larger offerings of the cihe provides greater opportunity for students to undertake activities that meet their interest and practice needs and frees faculty course loads for other program needs and other ipe development. on several occasions, ipe activities have been piloted in specialization year elective classes, before being scaled up for a full cihe-sponsored activity. cultural momentum ipe has become a part of the culture of faculty scholarship within the social work department, as well as an explicit part of the msw curriculum. a motivating factor for development of and participation in ipe by social work faculty is its inclusion within the promotion, tenure, and review process within msw program. one of the ways in which the msw faculty have been able to increase their involvement in ipe learning activities is by having it explicitly supported by department and school leadership. ipe projects (see table 1) have been included as msw faculty move through review, promotion, and tenure processes, and are also included with annual faculty workload plans. the msw faculty have been able to consider their participation in ipe events as service, whether it be serving on a committee to develop an ipe event, and/or facilitating discussion, providing a social work perspective, taking part in a roleplay, or being a panel speaker during an ipe learning activity. additionally, msw faculty have made it a priority to gather data and disseminate their ipe work as scholarship through publications (cordeau et al., 2017; hughes et al., 2020; mccave, winter 2016; mccave et al., 2019) and presentations (defrancesco et al., 2015, feb 26-march 1; hartmann et al., 2017, oct 1-4) at the state, national, and international level. political momentum as msw faculty increased their involvement with ipe across the university, there was recognition that, politically, the msw program could capitalize on ipe leadership opportunities, to mobilize support for growth and scan for potential political obstacles and opportunities at various administrative levels across the university. two particular opportunities arose. first, as cihe began to grow, there was a recognition that sustainability required a pipeline for faculty development in ipe. this was done through the creation of the center’s ip fellows program. this two-year program involved having each of the deans from the three health schools appoint an ip fellow from their school. each ip fellow receives targeted training in ipe offered by an external organization (such as the nexus t3 interprofessional team development program), serves as a liaison to their school, and focuses on a year-long ipe project. the first ip fellow for the school of health sciences appointed was an msw faculty member. when additional funding became available for the first assistant director of the cihe, that same msw faculty member applied and was appointed by the three deans. in this role, the msw faculty member served as a liaison with all three health schools and their respective programs and was a advances in social work, summer 2020, 20(2) 507 part of high-level discussions with deans, the provost, as well as the university president as it related to ipe at a university level. recommendations for social work educators there is no one “right” method for approaching integration of social work into existing ipe or prioritizing ipe within social work education. utilizing an organizational change theory or model, such as the one discussed in this article, can be beneficial for approaching a change effort such as this in an intentional manner. insight into theories of change and change leadership can be helpful in understanding and building strategy on multiple levels, such as department, school, and university, when integrating and expanding ipe. further, exploring the literature for how differing universities approach the work is key. jones and phillips (2016) provide a number of examples of social work interprofessional programs and the roles of social work in interpersonal education at several universities, asserting that ipe must be part of social work’s educational preparation. they suggest strategies that expand the commonly used case example style for ipe group activities to include dialogue with and shadowing of other members of the healthcare team during fieldwork, interprofessionally co-taught courses, ip curriculum development, interdisciplinary team-based course assignments, and more. in this case study, success has occurred in large part due to creativity, adaptability, advocacy, and relationship-building. these skill areas may be worth consideration by other social work educators who wish to embark on a similar change effort. although every context is unique, those social work programs whose size is relatively small (i.e., < 100 students and < 10 full-time faculty) and that are part of a larger interprofessional school may benefit from engaging in similar approaches to that undertaken by this program. creativity joining existing ipe requires that social work educators think creatively as to how to meaningfully integrate social work in a way that is not an afterthought. given that ipe activities are often highly structured, particularly those that are case-based, social work educators need to present potential modifications as an opportunity to enhance the current activity and do so in a collaborative manner with those who initially created the activity and/or those who are currently implementing the activity. this requires out of the box thinking, particularly when an ipe activity has been implemented successfully for some time and there are reservations about making changes. similarly, creative thinking is required for developing new ipe activities that place social work along with other health professions at the center, rather than the periphery, of the learning experience. meded portal is a valuable resource for social work educators, as it has a special ipe collection that provides open-source ipe material for use and adaptation focused on a variety of health and behavioral health issues. one way to stimulate this creative thinking is to utilize existing structures that offer time for collaboration and reflection. for example, many universities require or offer faculty development trainings throughout the year. inviting presenters who can energize faculty about ipe development can be particularly fruitful as well as carving out time for mccave et al./utilizing change leadership 508 faculty across programs to reexamine current ipe activities and consider new opportunities. social work educators can also be creative as to how ipe is prioritized internally. as discussed in this article, this msw program made changes to its curriculum, established ipe requirements for students, and integrated ip language in the mission, goals, and within promotion and tenure guidelines. there are many paths to formally recognizing ipe as a valued component of social work education. through monitoring and evaluation, social work programs can adeptly decide which path may lead to more success. once ipe and social work education is integrated within the academic setting, future aspirations can be to adapt and integrate ipe learning activities into field education settings where interprofessional practice is likely occurring, such as hospitals, schools, nursing homes or palliative care settings, so that students can learn alongside agency staff and supervisors. well established ipe learning activities could be brought to agencies, thus providing field agencies with helpful staff development opportunities for both staff as well as student interns. offering such staff development could be an additional benefit to agencies hosting field placements, particularly if continuing education units (ceus) could be provided to agency staff. assessment of interprofessional competencies can also be incorporated into field evaluation. adaptability it is critical that social work educators are both adaptive and responsive to shifting landscapes, whether the change comes from the broader landscape of social work education (e.g., changing accreditation standards) or higher education (e.g., changing enrollment and demographics). political terrains and institutional priorities can shift with both anticipated and unanticipated changes in program, school, or university level leadership. social work educators need to navigate such changes using political savviness and drawing on knowledge and skills many already possess as a consequence of their own social work education and practice experiences (e.g., using swot analyses). further, social work educators may need to adapt when long time ipe partners are no longer available, whether they be faculty from other programs, community partners, or others. there may be times that social work faculty need to “carry” the ipe activity or initiative until new partners can be identified and fully integrated. in such times, it is beneficial for the social work leadership to recognize this extra work and adapt existing workload responsibilities if possible. advocacy integrating social work faculty and students into existing ipe activities and prioritizing ipe within social work education requires advocacy both within and beyond the program. for social work educators who are new to ipe or whose departments are unfamiliar with ipe development, it can be helpful to have an “ipe champion” who is willing to dive into the literature, seek out training and professional development, and bring back what has been learned to both the social work program and other health programs. social work educators who are in departments where there is resistance to devoting already stretched advances in social work, summer 2020, 20(2) 509 resources to ipe may find it beneficial to refer to both the epas standards and also the 2019 report issued by the national center for interprofessional practice and education (ipec) and the health professions accreditors collaborative (hpac) entitled guidance on developing quality interprofessional education for the health professions (hpac, 2019). it is notable that cswe made significant contributions to this report. this formalized recognition of the importance of ipe for health professions can be used as an effective advocacy tool at multiple levels (i.e., program, school, university). relationship-building integrating social work within ipe requires significant time dedicated to relationshipbuilding, particularly as a new program; fortunately, as social workers, this is an existing skill set can be easily tapped. setting aside time for multiple face-to-face meetings with those who may be potential partners is critical – one lesson learned is that only communicating via email can lead to miscommunication, confusion regarding expectations, and a limited understanding of the value that each discipline has to offer. the potential for miscommunication was heightened at the outset of the covid-19 pandemic, as ipe events involving multiple stakeholders had to be cancelled with little notice. in such challenging circumstances, communicating in a timely and responsive manner, often via virtual meetings, was critical for moving forward. heading into a new academic year in which ipe will be primarily delivered virtually will itself require collective interprofessional work to meet student needs. another way in which relationship-building is important is through commitment to creating sustainable ipe activities and initiatives. connecting faculty who have shared interests and expertise and cultivating those relationships can assist with creating and sustaining momentum for ipe activities that require a significant amount of time and energy. lastly, as new social work faculty are hired and brought into the social work program, it is essential that existing faculty connect them with current ipe partners while also capitalizing upon external relationships that the new faculty may have that could be incorporated into the ipe curriculum. future directions while the value of interprofessional education, practice, and collaboration is widely recognized, the evidence base for its effectiveness remains somewhat limited (reeves et al., 2017; zwarenstein & bryant, 2000; zwarenstein et al., 2009). this is primarily due to few randomized trials, lack of longitudinal evidence, and a narrow selection of source countries economically and geographically. this limitation also exists for this msw program as well. effective data collection and evaluation has been identified as the next priority as there has not been a process put in place to evaluate the impact for social work students specifically. while all students participating in ipe activities complete surveys disseminated through the cihe, the data gathered is cross-sectional, focused solely on the ip competencies, and is presented at the aggregate rather than at the program level. this msw program is interested in the impact of ipe not just immediately following the activity, but in the potential impact in field education and in future practice after graduation. social work educators have the potential to contribute evidence regarding the mccave et al./utilizing change leadership 510 overall effectiveness and positive outcomes of interprofessional collaboration across health professions. longitudinal data collection specific to social work is an important goal, whether gathered from students over their time of coursework, across student cohorts, or from msw alumni providing data about the impact of ipe on their current practice following graduation. conclusion while social workers are no strangers to working with other disciplines and on interprofessional teams, there is a growing need for targeted social work education centered on promoting competency for collaborative interprofessional practice. such interprofessional practice is essential for our students to go on to provide high quality care. additionally, acquiring competency in interprofessional practice has the potential to reduce burnout and role strain while providing much needed support to social workers. creativity, adaptability, advocacy, and relationship-building are skills that can be capitalized upon for successful integration of ipe into social work education and to integrate social work faculty and students into ipe. social work is a profession that often utilizes many of these same skills in daily professional practice and is thus uniquely positioned to be at the forefront of ipe development and sustainability. through intentional planning and purposeful engagement with university and community partners, social work educators can skillfully respond to the need for social work representation in ipe while modeling the importance of interprofessional practice and leadership to the next generation of social workers. references agresta, j. 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(2009). interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. cochrane database of systematic reviews(3), cd000072. https://doi.org/10.1002/14651858.cd000072.pub2 author note: address correspondence to emily mccave, department of social work, quinnipiac university, 275 mount carmel ave., nh-hsc, hamden, ct, 06517. email: emily.mccave@quinnipiac.edu https://doi.org/10.1002/14651858.cd000072 https://doi.org/10.1002/14651858.cd000072.pub2 mailto:emily.mccave@quinnipiac.edu _______ kerry adzima, associate professor of economics, department of economics, pennsylvania state university of erie, erie, pa. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 739-755, doi: 10.18060/23866 this work is licensed under a creative commons attribution 4.0 international license. the association of advanced math course-taking by american youth on subsequent receipt of public assistance kerry adzima abstract: helping people move to independence is often cited as a primary goal of public assistance policies in the united states. over the past several decades, welfare reform efforts in the us have promoted the idea of a work-first approach. research shows that this approach has discouraged or at least made it harder for some students to attend college while meeting the work requirements for aid. how can those students who need public assistance increase their chances of finding a sustainable job and thus not need to rely on the public support system after high school? to address this question, this study used a sample of 3,384 student responses from the national longitudinal study of adolescent to adult health and a recursive bivariate probit model to analyze the association between advanced math course-taking in high school and the probability of subsequent receipt of public assistance. the empirical results suggest that taking advanced math courses in high school is associated with a lower probability of receiving public assistance for recent graduates. these findings are particularly important for school social workers who work in conjunction with teachers and school counselors to help at-risk students improve their chances of future financial independence. keywords: income support, public assistance, advanced mathematics, work-first the call to address challenges in both the k-12 educational system as well as the income support system in the united states in the 1980s and 1990s continues to provoke debates decades later. additionally, the criticisms of past and current policy reforms remain a critical talking point for many u.s. politicians. in terms of education, the seminal report published by the reagan administration in 1983, a nation at risk, claimed that american schools were failing (national commission on excellence in education, 1983). the commissioned authors suggested that schools needed to adopt more rigorous and measurable standards for learning. the findings from this report ignited a wave of educational reform efforts. for example, education reform in the 1980s is best known for changing the educational landscape from a focus on inputs to a focus on outputs or student achievement (k12 academics, 2004). in the 1990s most states adopted an outcome-based educational approach (hamilton et al., 2008). this led to state committees adopting standards and then choosing appropriate quantitative assessments to measure student progress in meeting those standards. the standards-based movement resulted in the no child left behind act of 2001 which required states to develop assessments in basic skills in order to receive federal funding. more recently, the common core state standards initiative, sponsored by the national governors association (nga) and the council of chief state school officers (ccsso), has created educational standards in english, language arts, and mathematics with the intent of ensuring that all students graduating from high school are prepared to enter college programs or the workforce (common core state standards, 2020). finally, the most recent piece of legislation known as the strengthening https://creativecommons.org/licenses/by/4.0/ linton et al./impact of a care transitions intervention 740 career and technical education for the 21st century act, showcases the current administration’s focus on workforce development (ujifusa, 2018). the income support system in the united states has also been at the forefront of many political debates since at least the 1970s when the federal government began expanding benefits to working families. in addition to the earned income tax credit enacted in 1975, benefits to working adults also included the child tax credit, food stamps, health insurance, and state income supplement programs (sawhill & haskin, 2002). many argue that ronald reagan’s 1976 presidential campaign brought negative attention to the public assistance system, leading many u.s. citizens to believe that the system catered to people who did not want to work and who were fraudulently receiving benefits. in 1980, the reagan administration cut public assistance spending and gave states the option of requiring income support recipients to participate in workforce training programs. the next major reform to the income support system came about under former u.s. president bill clinton who promised to “end welfare as we know it” during his run for presidency (semuels, 2016, para. 3). in 1996, clinton signed into law the personal responsibility and work opportunity reconciliation act (prwora), ending the federal guarantee of assistance for needy families, and further promoting a work-based system of supports (1996, pub. l. no. 104-193). the act also replaced the federal assistance program known as aid to families with dependent children (afdc) with the temporary assistance for needy families (tanf) program which provides block grants to states. tanf added work requirements for aid, set caps on how long and how much aid a person could receive, and decreased the number of adults eligible for benefits (center on budget and policy priorities, 2020). with a booming u.s. economy in the late 1990s, there was a somewhat decreased focus on welfare reform as states continued implementing the work-first strategies encouraged by the prwora. in addition, statistics showed that in the years immediately following the change to tanf, the number of income support recipients went down dramatically from 5 million families in 1994 to 2.2 million families in 2000 and the labor force participation rate among low-income single-parent families was also shown to grow dramatically (greenberg, 2001). however, researchers were quick to claim that many former public assistance recipients who took low-wage jobs were not better off financially once the cost of commuting, health insurance, and child care were taken into account (brauner & loprest, 1999; hays, 2003; loprest, 1999; peterson et al., 2002). about a decade later, in the aftermath of the financial crisis and great recession, studies showed that roughly 52 million people or about one in five americans were receiving some form of government assistance and once again welfare reform resurfaced as a topic of major concern (united states census bureau, 2015). coincidentally, even before the great recession, which began in december 2007 and lasted until june 2009, researchers were starting to question whether the work-first approach actually promoted long-term self-sufficiency. for example, hotz et al. (2006) compared a human capital development approach to welfare reform which emphasizes education and vocational training programs to a labor force attachment (lfa) approach which emphasizes getting public assistance recipients into jobs quickly to help develop advances in social work, fall 2020, 20(3) 741 their skills. the results of this study disproved earlier findings from california’s greater avenues to independence (gain) program which claimed that a work-first approach is more sustainable. instead, the authors concluded that an educational approach is more effective in the long-run. in a related study, jacobs and winslow (2003) reported that “the long-term well-being of welfare mothers depends on their gaining the basic education and employment-related skills needed to obtain jobs that pay a sustaining wage” (p. 195). the authors also claimed that policy reforms make it much more difficult for public assistance recipients (in particular, single mothers) to pursue higher education. more recently, dave et al. (2012) found that welfare reform reduces the probability that adult women at risk of going on public assistance will enroll in college by 20 percent. the most current executive order known as reducing poverty by promoting opportunity and economic mobility was published in 2018. this directive focuses on improving employment outcomes by addressing the challenges that some populations face in finding and maintaining employment in order “to move people to independence”(section 2 (c) p. 19,542). specifically, the document encourages federal and state public assistance agencies to enforce current work requirements and to propose additional stronger requirements (the white house, 2018). given the number of changes to the educational and public assistance systems over the past several decades, researchers have studied a variety of issues related to these policy changes. in particular, one strand of literature focuses on high school curriculums and the returns to education. specifically, taking advanced courses in mathematics has been examined in relation to achievement outcomes such as test scores, high school graduation rates, college readiness, college entry and performance, college persistence, and labor market outcomes. however, although these outcome variables are related to the issue of public assistance reform, none of these studies looked directly at how taking more rigorous high school courses is related to income support participation. in this paper, the relationship between advanced mathematics course-taking and income support participation is examined by employing a survey that tracks students from high school through early adulthood. more specifically, this research seeks to examine if taking advanced math courses lowers the probability of income support receipt among american young adults. this secondary analysis provides a contribution to the literature by using an outcome variable that has not been directly examined in relation to advanced math course-taking in high school via empirical methods. literature review many studies and reports discuss the importance of a rigorous high school curriculum and its relationship to student success (byun et al., 2015). the link between advanced high school courses (in particular advanced math courses) and labor market outcomes or college entry and performance has also been studied to better understand achievement gaps based on gender, ethnicity, and socioeconomic status (attewell & domina, 2008; catsambis, 1994; davenport et al., 1998; klopfenstein, 2004; riegle-crumb, 2006). given the data limitations and the fact that student course selection is dependent upon the available options and school requirements, most of these studies do not provide evidence of causal relationships. for example, using the national longitudinal study of 1972 (nls72), linton et al./impact of a care transitions intervention 742 altonji (1995) employed an instrumental variables (iv) approach controlling for family background and found only a small, combined effect of an extra year of science, math, and foreign language. however, altonji et al. (2012) concluded that “estimates for particular courses are affected by the interaction of biases in the coefficients on the curriculum variables and/or the control variables” (p. 199). using the national longitudinal study of 1979 (nlsy79) and high school and beyond (hsb), levine and zimmerman (1996) applied methods similar to altonji (1995), and found that a year of math was associated with wage increases of 0.028–0.056 log points for men and approximately 0.044 for women, but found that science courses have little to no effect for earnings in young adulthood. the authors also revealed that both math and science courses boost educational attainment and increased the probability that women would work in fields that involve more mathematical reasoning. rose and betts (2004) used the senior cohort from the high school and beyond (hsb) transcript data from 1980 and analyzed the return of high school math by examining wages nine years after graduation. one of the main contributions of this study was to incorporate math courses by level—vocational math, prealgebra, algebra/geometry, intermediate algebra, advanced algebra, and calculus, instead of aggregate credits. the authors controlled for demographic characteristics, family-background variables, math grade point average, and math test scores and found that advanced math courses substantially raise wage rates. they found no evidence of this result for advanced science courses. a few studies employed a quasi-experimental design linking advanced math course taking in high school with labor force outcomes using wages as the dependent variable. for example, joensen and nielsen (2009) examined a pilot scheme used in select denmark high schools from 1984 through 1987 to identify the causal effect of advanced high school math on labor market outcomes. the pilot scheme allowed students to take advanced math in combination with chemistry instead of physics only. the authors found that taking the advanced math course in combination with the advanced chemistry course was associated with increased earnings between 0.20 – 0.25 percentage points depending on the particular model employed. the authors concluded that there is “clear evidence of a causal relationship between math and earnings for students who are induced to choose math after being exposed to the pilot scheme” (p. 171). in addition, goodman (2012) used pooled hsb data and transcript data from the national association for educational progress (naep) for the high school classes of 1987, 1990, and 1994, and took advantage of exogenous variation in state math course requirements implemented across different graduating classes to examine the causal effect of math course-taking on wages using a two-sample iv approach. the results of this study suggest that additional math courses have substantial value, significantly predicting improvements in wages, especially for black males. a related paper by sosa (2016) used local average treatment effect (late) parameters that have a causal interpretation to examine the impact of mathematics course taking in high school on labor market outcomes. the author found that on average, each additional year of math courses during high school is associated with an increase of around $2,359 in income at age 28 and around $2,135 in income at age 29 using instrumental variable (iv) estimates. advances in social work, fall 2020, 20(3) 743 research that focuses on the association between high school curriculum and college entry and performance is also abundant. for example, adelman (2006) found that coursework above algebra 2 significantly increases the likelihood of college completion. specifically, the authors reported that graduation rates for a bachelor’s degree increased by about 16 percent if students were in the top 40 percent of their high school curriculum and also took math above algebra 2 (adelman, 2006). attewell and domina (2008) considered both the equity concerns for disadvantaged groups accessing a rigorous high school curriculum as well as the ability of an intensive high school curriculum to yield payoffs in terms of college success. the authors found that students of lower socioeconomic status (whom were mostly black and hispanic in their study) have decreased access to a rigorous curriculum. in addition, the authors found that students who take a more intensive curriculum were more likely to go to college. likewise, many researchers suggest that the positioning of students into classes of mixed ability, that is, de-tracking mathematics classrooms, increases opportunities for student learning (burris et al., 2006). using survey data, boalar (2011) found that “students who worked in untracked groups had significantly moved up the social-class scale compared to their parents” (p. 10). methods to examine the relationship between advanced math course-taking in high school and a student’s subsequent participation in an income support program, a survey from the national longitudinal study of adolescent to adult health (add health) was used. the add health survey is based upon a nationally representative sample of adolescents in grades 7-12 in the united states. the cohort of students in this study were initially given a questionnaire in 1994 and then later given the opportunity to participate in a series of inhome interviews in 1995, 1996, 2001-2002 and 2008. it should be noted that because the add health survey design used a clustered sample, this study employs stata’s survey estimation commands in conjunction with the proper sampling weights developed by chen and chantala (2014). the dependent variable in this study, public assistance (pa), is a discrete binary response variable taking on a value of 0 or 1. in the third wave of data which were collected in 2001-2002, the respondents were asked the following question pertaining to public assistance that is used in this study: “are you currently getting afdc, public assistance, or welfare? “ for the question above, pa = 0 if a respondent answered that they did not receive assistance, and pa = 1 if a respondent answered that they did receive assistance. since the primary aim of this study was to examine the effect of taking advanced math courses on subsequent receipt of public assistance, the variable of interest “advanced math” is considered at the following course levels: algebra 1, algebra 2, precalculus, and calculus. for each course level, advanced math course-taking is a dummy variable taking on a value of 1 if the respondent took the course during high school and 0 if they did not. although a regular probit model is often appropriate when the dependent variable is binary, in this case, the variable of interest (advanced math) is likely endogenous which linton et al./impact of a care transitions intervention 744 requires the use of additional modelling techniques to account for selection bias. the endogeneity of advanced math is further complicated by the fact that it is also a binary variable. thus, to test for endogeneity and appropriately estimate this model, a recursive bivariate probit model is used (angrist & pischke, 2009; greene, 1998, 2000). following burnett (1997) who proposes a model of the joint determination of two binary choice variables, presence or absence of a gender economics course (y1) and presence or absence of a women’s studies program (y2), the author obtains parameter estimates for two equations by formulating the following model: f2 (y2) = φ(α′x2)y2 × [1 φ(α′x2)]1 – y2 u2 = y2 f2 (y2) f1 (y1) = φ(β′x1 + γu2]y1 × [1 φ(β′x1 + γu2)]1 – y1, where φ(•) is the distribution function of the standard normal distribution. estimates of [β′,γ, α′] were obtained by using “an iterated, seemingly unrelated marquardt-levenberg technique” (burnett, 1997, p. 372). in this case the “residual” in the second equation is being used to alleviate the simultaneity of the women’s studies variable in the gender economics equation. however, greene (1998) pointed out that the two step procedure used by burnett (1997) and as suggested by rivers and vuong (1988) is proposed for a probit model in which one or more of the right hand side variables are endogenous, but continuous. greene (1998) stated that “burnett’s use of the residual in the second equation would be appropriate if womstud were a continuous variable, but not a binary outcome” (p. 294). greene (1998) also mentioned that “the rivers and vuong technique dictates conditional maximum likelihood estimation at the second step, not nonlinear least squares” (p. 294). following greene’s (1998) suggested improvements of burnett’s model, a twoequation system is used here to examine the relationship between public assistance participation and advanced math course-taking. the two equations are defined as follows (see table 1 for definitions): • public assistance = f1(advanced math, gender, assistancebefore18, age, married, race, workforpay10hrs, child, momcollege), • advanced math = f2(gender, race, teacher trouble, momcollege, assistancebefore18). it should be noted that the demographic and background variables described were chosen based on data availability (what questions were asked in the survey) and previous literature focusing on the relationship between advanced mathematics courses and labor market outcomes. table 1 provides summary statistics for the variables used in this model. given a sample size of 3,384, table 1 shows that approximately four percent of the survey respondents were receiving public assistance. this percentage is fairly consistent with the national average in the united states which was just over six percent between 2000 and 2001 (national center for education statistics, 2011). in addition, approximately 89 percent of the respondents took algebra 1, 65 percent took algebra 2, 35 percent took precalculus, and about 11 percent took calculus. the sample was almost equally split by advances in social work, fall 2020, 20(3) 745 gender with 46 percent being male. about 73 percent of the respondents were caucasian and 17 percent were married at the time of the survey. the average age of the respondents was 22 and about 13 percent had earned a bachelor’s degree. the sample statistics also revealed that about 74 percent of the respondents worked for at least 10 hours a week and about 14 percent had lived in a household that received public assistance before they turned 18. finally, about 32 percent of the respondents revealed that their mother had a college degree. table 1. variable definitions and summary statistics (n=3,384) variable definitions mean (sd) age age (years) of respondent during the third wave of data collection 21.77 (1.77) gender 1 if respondent is male, 0 otherwise 0.46 (0.50) race 1 if respondent is white, 0 otherwise 0.73 (0.44) married 1 if respondent is married, 0 otherwise 0.17 (0.38) child number of children in respondent’s household 0.43 (0.83) workforpay10hrs 1 if respondent works at least 10 hours a week, 0 otherwise 0.74 (0.44) bachelor 1 if respondent has a bachelor’s degree, 0 otherwise 0.13 (0.34) public assistance 1 if respondent is currently receiving income support in 2000-2001, 0 otherwise 0.04 (0.19) assistancebefore18 1 if anyone in respondent’s household received public assistance before respondent turned 18, 0 otherwise 0.14 (0.35) momcollege 1 if respondent’s mother is a college graduate, 0 otherwise 0.32 (0.47) teacher trouble 1 if respondent claimed to have had trouble getting along with their teachers, 0 otherwise algebra 1 1 if respondent took at least algebra 1 in high school, 0 otherwise 0.89 (0.31) algebra 2 1 if respondent took at least algebra 2 in high school, 0 otherwise 0.65 (0.48) precalculus 1 if respondent took at least precalculus in high school, 0 otherwise 0.35 (0.48) calculus 1 if respondent took at least calculus in high school, 0 otherwise 0.11 (0.31) when considering the model’s specification, greene (1998) suggested that the estimators be written in simpler terms. let y1 = public assistance, x1 = all variables on the right hand side of the first equation except advanced math y2 = advanced math, x2 = all variables on the right hand side of the second equation. the initial estimation of the advanced math (y2) equation is done with the maximum likelihood probit analysis. in the second step, i use the predicted values from the advanced math equation which are the sample estimates of φ(α′x2), (i.e., the sample estimates of e[y2|x2]). the second step consists of maximum likelihood probit estimation of the y1 equation, with the right-hand side variables x1 and the sample estimates of e[y2|x2] or [φ(α′x2)] as shown earlier. using this two-step procedure provides consistent estimators linton et al./impact of a care transitions intervention 746 and appropriate asymptotic standard errors (greene, 1998). given the relationships among joint, conditional, and marginal probabilities, the following is true: prob[y1=1, y2=1] = prob[y1=1| y2=1] × prob[y2=1] = {bvn(y1, y2=1) / prob[y2=1]} × prob[y2=1] where bvn is used to denote the cumulative distribution function of the bivariate normal distribution. after inserting the variables of the model, and introducing the two parameter vectors as developed from burnett’s equations, the end result is: prob[y1 = 1, y2 = 1] = [bvn(β′x1 + γy2, α′x2, ρ) / φ(α′x2) ] × φ(α′x2) (remember, y2 = 1), in which φ(α′x2) = prob[y2 = 1]. after rearranging and cancelling like terms in the numerator and denominator, the bivariate probability is prob[y1 = 1, y2 = 1] = bvn(β′x1 + γ, α′x2, ρ). greene (1998) showed that there are four cases for this bivariate probit model that can be constructed analogously to the first. the remaining cases are as follows: prob[y1 = 0, y2 = 1] = bvn(-β′x1 γ, α′x2, -ρ), prob[y1 = 1, y2 = 0] = bvn(β′x1, α′x2, -ρ), prob[y1 = 0, y2 = 0] = bvn(-β′x1, -α′x2, ρ). according to greene (1998), these are “the terms that enter the usual likelihood function for the bivariate probit model. the counterintuitive result is that in the bivariate probit model, unlike in the linear simultaneous equations model, if the two dependent variables are jointly determined, we just put each on the right-hand side of the other equation (or, in our case, one of them) and proceed as if there were no simultaneity problem” (p. 295). results the maximum likelihood estimates of the four separate recursive bivariate probit models are presented in table 2. note that column 1 represents the model using algebra 1 as the variable of interest, column 2 represents the model using algebra 2 as the variable of interest, and columns 3 and 4 use precalculus and calculus as the variables of interest, respectively. before analyzing the coefficient estimates, it should be noted that knapp and seaks (1998) show that a likelihood-ratio test of whether the correlation coefficient of the residuals ρ (rho) is equal to zero can be used as a hausman endogeneity test in biprobit models. more specifically, ρ can be interpreted as the correlation between the unobservable explanatory variables of the two equations. as shown in table 2, the null of no endogeneity is rejected in three out of four specifications. thus, the recursive bivariate probit model is deemed appropriate and reliable for all cases except where algebra 2 is the variable of interest. advances in social work, fall 2020, 20(3) 747 table 2. recursive bivariate probit model coefficient estimates dependent variable: public assistance public assistance equation algebra 1 -1.9626** (0.4890) algebra 2 -1.3941* (0.5484) precalculus -1.8369** (0.3018) calculus -2.0440** (0.2982) gender -0.7528** (0.1508) -0.7415** (0.1402) -0.5948** (0.1421) -0.2948* (0.1355) race -0.0932 (0.1189) -0.0408 (0.1431) 0.0790 (0.1245) -0.0689 (0.0896) married 0.0613 (0.1319) 0.0143 (0.1305) -0.0045 (0.1006) 0.0599 (0.0791) work10hrs -0.3229** (0.0971) -0.3428** (0.1144) -0.2904** (0.1031) -0.2305** (0.0823) age 0.0330 (0.0346) 0.0255 (0.0342) 0.0265 (0.0263) 0.0369 (0.0217) child 0.1927** (0.0474) 0.1828** (0.0563) 0.1615** (0.0486) 0.1666** (0.0386) assistancebefore18 0.1118 (0.1288) 0.1281 (0.1629) -0.0480 (0.1309) 0.0103 (0.1201) momcollege -0.2477* (0.1258) -0.1627 (0.1380) -0.0290 (0.1133) 0.1328 (0.1222) bachelor -0.3763 (0.2533) -0.3249 0.2248 0.3517 (0.2247) 0.3870* (0.1622) constant -0.2086 (0.9142) -0.9973 (0.7340) -1.2300* (0.5520) -1.8915** (0.4957) advanced math equation gender -0.3495** (0.0745) -0.2413** (0.0550) -0.1752** (0.0549) 0.0895 (0.0718) race 0.1621* (0.0777) 0.2319** (0.0640) 0.3008** (0.0656) 0.0164 (0.0819) assistancebefore18 -0.4057** (0.0867) -0.3326** (0.0766) -0.2751** (0.0781) -0.2424* (0.1160) momcollege 0.3493** (0.1066) 0.3732** (0.0721) 0.3573** (0.0562) 0.4668** (0.0605) teachertrouble -0.4062** (0.0886) -0.3613** (0.0862) -0.3183** (0.0839) -0.3392** (0.1044) bachelor 1.10636** (0.1917) 1.3564** (0.1174) 1.0337** (0.0805) 0.7315** (0.0864) constant 1.2856** (0.0815) 0.1785** (0.0667) -0.7649** (0.0685) -1.6004** (0.0864) n 3,384 3,384 3,384 3,384 f 22.95 34.04 45.00 17.14 rho 0.7170* 0.5327 0.8337* 0.9821* note: standard errors are in parentheses and significance ** = p.< .01, * = p.<.05. linton et al./impact of a care transitions intervention 748 table 3. average marginal effects for the recursive bivariate probit model dependent variable: public assistance public assistance equation algebra 1 -0.4395* (0.1990) algebra 2 -0.2132 (0.1891) precalculus -0.4462* (0.2089) calculus -0.8165** (0.1534) gender -0.0673** (0.0118) -0.0929** (0.0310) -0.1666** (0.0273) -0.1741 (0.0967) race -0.0118 (0.0110) -0.0146 (0.0148) -0.0362 (0.0301) -0.0389 (0.0389) married 0.0060 (0.0127) 0.0020 (0.0176) 0.0015 (0.0343) 0.0279 (0.0371) work10hrs -0.0314** (0.0091) -0.0473** (0.0187) -0.0993** (0.0263) -0.1074 (0.0555) age 0.0032 (0.0035) 0.0035 (0.0055) 0.0091 (0.0101) 0.0172* (0.0080) child 0.0188** (0.0041) 0.0252** (0.0081) 0.0552** (0.0111) 0.0776** (0.0302) assistancebefore18 0.0178 (0.0110) 0.0305 (0.0162) 0.0742* (0.0294) 0.1044 (0.0728) momcollege -0.0301* (0.0133) -0.0368 (0.0223) -0.0850* (0.0353) -0.1298* (0.0625) bachelor -0.0555* (0.0284) -0.0569 (0.0680) -0.0969 (0.0771) -0.1201 (0.0719) note: standard errors are in parentheses and significance ** = p.< .01, * = p.<.05. advances in social work, fall 2020, 20(3) 749 when examining the public assistance equation, it should be noted that all four course levels were found to be negative and statistically significant. this implies that taking advanced math courses in high school is associated with a lower probability of needing income support shortly after graduation. in addition, gender was also negative and statistically significant in all specifications suggesting that males were on average less likely to become recipients of public assistance. the child variable was found to be positive and statistically significant, which says that having more children in the household is associated with an increased probability of the respondent participating in the income support system. momcollege was also found to be negative and statistically significant, but only in the first specification of the model where algebra 1 was used to represent “advanced math” courses. all variables in the advanced math equations were also statistically significant and had the expected sign in columns 1-3. in column 4, using calculus as the variable of interest, gender and race were not statistically significant. since the estimated coefficients do not quantify the influence of the explanatory variables on the probability that y = 1, researchers often calculate the average marginal effects to better interpret the model. thus, the coefficients in table 3 represent the average marginal effects and specify the average change in probability of requiring public assistance. the interpretation of the independent variables are described below in terms of percentage points after multiplying by 100. numerically, the strongest effect was exerted by the advanced math variables. specifically, when calculating average marginal effects, the estimated coefficient for algebra 1 is -0.4395 which implies that taking at least algebra 1 in high school decreases the respondent’s probability of requiring public assistance by 44.0 percentage points. similarly, taking at least algebra 2 in high school decreases the probability of receiving public assistance by approximately 21.3 percentage points, taking at least precalculus decreases the probability of needing public assistance by 44.6 percentage points, and taking calculus decreases the probability of needing public assistance by 81.7 percentage points. of the remaining control variables, gender, workforpay10hrs, child, age, momcollege, and bachelor are also found to have a statistically significant impact when considering the average marginal effects. for gender, being male reduced the probability of needing public assistance between 29.5 and 75.3 percentage points, working at least 10 hours a week reduced the probability of needing public assistance between 23.1 and 34.3 percentage points, and an additional child in the household increased the probability of needing public assistance between 16.2 and 19.3 percentage points. age and bachelor were only statistically significant when considering the effect of taking calculus on the probability of needing public assistance. in these cases, being older increased the probability of the respondent needing public assistance by 3.7 percentage points and having a bachelor’s degree decreased the probability of the respondent needing public assistance by 38.7 percentage points. momcollege was only statistically significant when considering the effect of taking algebra 1 on the probability of needing public assistance. in this case, if the respondent’s mother is a college graduate, the probability of the respondent needing public assistance was reduced by 24.8 percentage points. linton et al./impact of a care transitions intervention 750 discussion moving people to financial independence is a key policy directive in the area of welfare reform in the united states. for decades, a work-first approach has been the main tenet for achieving this goal. however, one of the unintended consequences of this approach has been a decline in college attendance for those students at higher risk for income support dependency (dave et al., 2012). with fewer at-risk students attending college, how can high school graduates find sustainable jobs that keep them from needing public assistance? with an economy that increasingly values a strong quantitative and analytical background, one way is for school social workers to help ensure that students are taking courses in high school that promote these types of skills. for example, algebra is likely the first subject in which students have an opportunity to develop logical thinking and analytical skills. more specifically, students in an algebra course are often asked to make decisions based on given information which helps them to develop problem-solving abilities. taking additional advanced courses in mathematics can serve to solidify and enhance the skills learned in previous courses, promoting retention and helping students to become more comfortable applying their skills to different situations. because disadvantaged students are less likely to have access to important information about curricular choices (hassrick & schneider, 2009), it is also important for social workers working within school systems to provide additional guidance to students and their parents starting in the middle school years, when gateway course selection begins. social workers can work directly with high school counselors and mathematics teachers to ensure that those students who are most at risk of being underserved are being educated about the importance of their mathematics course selections. another important role for school social workers is to help students understand how to take advantage of the skills they developed while taking advanced math courses. because each student’s situation is unique, the decision to pursue higher education or sustainable employment is often based upon many factors. the results of this study suggest that taking advanced courses in mathematics can reduce income support dependency and thus school social workers can help students understand how to best apply the skills they have developed. in some cases, encouraging the pursuit of higher education may be appropriate while in others pursuing sustainable employment will be the better option. finally, in addition, chavkin (1996) examined a pilot program called partnership for access to higher mathematics (path) that consisted of an innovative pre-algebra curriculum combined with social work services to students and families. the findings of this study revealed that “social work and mathematics within partnership programs can help students make academic gains” (p. 329). as chavkin (1996) pointed out, many students who have been tracked out of advanced mathematics courses face a variety of “serious health, social, economic, and motivational problems that prevent them from attending class and completing assignments. no matter how much these students want to succeed, life's problems are overwhelming to them” (p. 327). in general, teaching social and emotional skills in schools has been shown to have positive effects in a variety of areas such as behavior, attitudes, mental health, and academic achievement (durlak et al., 2011; sklad et al., 2012). by focusing on “the whole student,” social workers can help to resolve or advances in social work, fall 2020, 20(3) 751 mediate issues that occur outside of school, so that students have a better chance of success after high school by taking higher level mathematics courses. while this study provides some initial evidence that taking advanced math courses lowers the probability of future public assistance use, certain limitations of the analysis should be acknowledged. first, it is not entirely clear whether the link between math courses and public assistance is causal or if it merely reflects unobservable variability in student characteristics such as innate ability and motivation. however, it is noteworthy to mention that taking advanced math courses continues to matter after controlling for proxies of student ability (bachelor’s degree) and family background (mother’s education and previous income support as a child). a second limitation is that the study is only generalizable to students who just recently graduated in 2000-2001. because the question about public assistance was not available in later years, it is not clear how long the surveyed graduates received assistance. it is possible that in later years the respondents were able to find sustainable employment. future research that follows students beyond the first few years after graduation would provide a clearer and more robust analysis of the relationship between math courses and future income support. for example, long et al. (2009) analyzed data on students enrolled in florida’s public schools and colleges and found that high school courses “contribute significantly to their college readiness, with the largest gains occurring at algebra 2” (p. 25). in a subsequent study, long et al. (2012) used propensity score matching to estimate the differences in outcomes for students who take a rigorous course in high school. the authors found that students taking a rigorous course in high school were 5 to 6 percentage points more likely to enroll in college, complete more college credits, earn higher grade point averages, and were more likely to earn a bachelor’s degree. in addition, future studies that examine more recent data can provide information on how education reform since 2000 has affected the need for public assistance and whether or not a college preparatory approach is moving more high school graduates to sustainable employment. conclusion this paper contributes to the current literature on the effects of a rigorous high school curriculum and its relationship to student success by employing a unique outcome variable pertaining to subsequent receipt of public assistance. because respondents who take advanced mathematics courses are likely to have other characteristics that would lead them to have better market outcomes and thus not require income assistance, a recursive bivariate probit model was employed to account for selection bias. in addition, a variety of demographic and background variables such as gender, race, marital status, age, employment status, college degree, mother’s education, history of public assistance, and troubles in school were incorporated to help control for selection bias as well. the estimated coefficients and subsequent average marginal effects reveal that taking advanced math courses in high school is associated with a decreased probability of students receiving public assistance shortly after graduation. given this finding, more studies using receipt of public assistance as an outcome variable are warranted. linton et al./impact of a care transitions intervention 752 in particular, for the united states, income support reform efforts are often found to move public assistance recipients towards an employment track rather than toward higher education. although the importance of requiring advanced math course-taking for students on a college-preparatory track is well-established, instilling critical thinking and problemsolving skills through advanced math course-taking could prove to be just as important for non-college bound students on their path to independence. future research that examines the longer-term impact of taking advanced math courses for those students who choose the employment path will help determine if these math courses promote sustainable employment. references adelman, c. 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(2018, april 10). executive order reducing poverty in america by promoting opportunity and economic mobility. social programs. https://www.whitehouse.gov/presidential-actions/executive-order-reducing-povertyamerica-promoting-opportunity-economic-mobility/ author note: address correspondence to kerry adzima, department of economics, pennsylvania state university at erie, 5101 jordan road., black school of business, erie, pa, 16563. email: kak38@psu.edu acknowledgement: research questions were used from add health, a project directed by kathleen mullan harris and designed by j. richard udry, peter s. bearman, and kathleen mullan harris at the university of north carolina at chapel hill and funded by grant p01hd31921 from the eunice kennedy shriver national institute of child health and human development, with cooperative funding from 23 other federal agencies and foundations. special acknowledgment is due ronald r. rindfuss and barbara entwisle for assistance in the original design. information on how to obtain the add health data files is available on the add health website (http://www.cpc.unc.edu/addhealth). no direct support was received from grant p01-hd31921 for this project. https://doi.org/10.1162/003465304323031076 https://www.brookings.edu/research/welfare-reform-and-the-work-support-system/ https://www.theatlantic.com/business/archive/2016/04/the-end-of-welfare-as-we-know-it/476322/ https://www.theatlantic.com/business/archive/2016/04/the-end-of-welfare-as-we-know-it/476322/ https://doi.org/10.1002/pits.21641 https://aefpweb.org/sites/default/files/webform/41/alfredososa_coursetaking2016-03-01draft3.pdf https://aefpweb.org/sites/default/files/webform/41/alfredososa_coursetaking2016-03-01draft3.pdf https://www.edweek.org/ew/contributors/andrew.ujifusa_5926680.html https://www.edweek.org/ew/articles/2018/07/31/donald-trump-signs-career-technical-education-bill.html https://www.edweek.org/ew/articles/2018/07/31/donald-trump-signs-career-technical-education-bill.html https://www.census.gov/newsroom/press-releases/2015/cb15-97.html https://www.census.gov/newsroom/press-releases/2015/cb15-97.html https://www.whitehouse.gov/presidential-actions/executive-order-reducing-poverty-america-promoting-opportunity-economic-mobility/ https://www.whitehouse.gov/presidential-actions/executive-order-reducing-poverty-america-promoting-opportunity-economic-mobility/ mailto:kak38@psu.edu http://www.cpc.unc.edu/addhealth _______ j. jay miller, phd, msw is an associate professor and director of the self-care lab at the university of kentucky, lexington, ky, 40506. joann lianekhammy, phd is the program evaluation coordinator for family and consumer sciences extension, university of kentucky, lexington, ky, 40506. erlene grise-owens, edd is a principal partner at the wellness group, etc, louisville, ky 40203. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1250-1266, doi: 10.18060/22320 this work is licensed under a creative commons attribution 4.0 international license. examining self-care among individuals employed in social work capacities: implications for the profession j. jay miller joann lianekhammy erlene grise-owens abstract: increasingly, the social work profession recognizes the need for more attention to self-care. concomitantly, this growing awareness and ethical commitment is fostering a burgeoning self-care movement. however, despite recognition about the importance of self-care, there is a paucity of research that explicitly examines self-care practices among social workers. this cross-sectional study examined the self-care practices of individuals employed in social work capacities (n=1,011) in one southeastern state in the united states. findings suggest that participants in the sample engaged in personal and professional self-care practices only moderately. further, data suggest significant group differences in the practice of self-care, by relationship status, educational attainment, health status, and current financial situation, respectively. overall, results indicate selfcare as a potential area of improvement for participants in this study, in general, and perhaps for individuals employed in social work contexts, more generally. keywords: self-care; social work; wellness the profession of social work plays a crucial role in the betterment of society and human well-being (national association of social workers [nasw], 2008). this demanding role leads to particular challenges for social workers. research suggests that social workers may be at increased risk for a plethora of “conditions of professional depletion” (greville, 2015, p. 14). these conditions include compassion fatigue, vicarious traumatization, secondary traumatic stress, and burnout, among other problematic phenomena (e.g., adams, boscarino, & figley, 2006; dunkely & whelan, 2006; griseowens, miller, & eaves, 2016; lee & miller, 2013). moreover, social workers, and others employed in social service settings, may be disproportionately affected by cumbersome bureaucratic processes, funding cuts and restrictions, and changing political climates, when compared to individuals in other professions (e.g., whitaker, weismiller, & clark, 2006). systemically, these factors can impact adroit and effective service delivery. against this backdrop, increasingly, the social work profession recognizes the need for more attention to self-care. the national association of social workers (2008) issued a clarion call for self-care as “an essential underpinning to best practice” (p. 268). likewise, the international federation of social workers (2004) includes self-care as a core aspect of ethical practice. this growing awareness and ethical commitment is fostering a burgeoning self-care movement. however, despite recognition about the importance of self-care, there is a paucity of research that explicitly examines self-care practices among https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2018, 18(4) 1251 social workers. this study contributes to addressing this limitation in the current research and practice landscape. from the outset of this paper, it is pertinent to make a clear distinction. while all individuals taking the survey identified as a “social workers,” per definition, this may not be the case. this study occurred in a state with title and practice protection statutes. however, like many places, this state does have exemptions related to these laws. thus, some individuals who do not have a social work degree may engage in social work practice, and as such, refer to themselves as “social workers.” so as to acknowledge the uniqueness of the profession, we refer to participants in this study as individuals employed in social work capacities. conceptualizing self-care historically, self-care has been viewed through a medical prism, whereby, patients were encouraged to engage in self-care to assuage the negative outcomes with medical ailments. since gaining prominence in the literature in the 1960s (e.g., norris, 1979; valentine, 1970) this framework has shaped the paradigm of self-care. in 1983, this “medical” view manifested via a report in which the world health organization (who) defined self-care as “the activities individuals, families and communities undertake with the intention of enhancing health, preventing disease, limiting illness, and restoring health” (p. 2). this definition is focused on self-care as a means to improve medical outcomes for those being helped by medical interventions (i.e., patients). evolving framework and definitions more recently, the conceptualization of self-care is shifting to embrace a holistic perspective of the self. concomitantly, the conceptualization is acknowledging the humanity of all persons, both those being helped and the helpers, themselves. like the adage, “physician, heal thyself,” this shift is predicated on the notion that whilst self-care can be an effective tool to help patients deal with medical issues, it can also assist in professional practitioner well-being. this shift is necessitated by some of the aforementioned deleterious effects on practitioners, such as burnout, which then impacts quality of service (cox & steiner, 2013). with an understanding of systemic effects and parallel processes, the profession is recognizing the interactive effects of practitioner well-being on the quality of services, and, indeed, the viability of the profession. amidst this evolving conceptualization, defining self-care can be challenging. this challenge, in part, stems from the varied and subjective forms that self-care may take (lee & miller, 2013; smullens, 2015). for instance, dorociak, rupert, bryant, and zahniser (2017) defined self-care as a “multidimensional, multifaceted process of purposeful engagement in strategies that promote healthy functioning and enhance well-being” (p. 326). others have asserted that these domains include physical, spiritual, social, and psychological aspects of self-care (e.g., grise-owens et al., 2016). lee and miller (2013) denoted two domains of self-care: personal and professional. these authors described personal self-care as “a process of purposeful engagement in practices that promote holistic health and well-being of the self;” professional self-care was defined as “the process of miller et al./self-care 1252 purposeful engagement in practices that promote effective and appropriate use of the self in the professional role within the context of sustaining holistic health and well-being” (p. 98). despite the subjective nature of self-care, several authors have proposed universal concepts related to self-care (smullens, 2015). cox and steiner (2013) suggested two universal categories as “lifestyle choices and workplace adaptations” (p. 33). in fact, many concepts related to the practices of self-care can be universal (grise-owenset al., 2016). grise-owens and colleagues articulated that each practitioner needs to construct a specific self-care plan. this plan must be designed to fit the individual’s life circumstances and personal interests. at the same time, the self-care plan needs to encompass a range of universal considerations, such as relationships, physical health, and professional development. undoubtedly, the evolving definition of self-care needs to be grounded in both practice wisdom and formal research. this grounded understanding can inform the attention needed to promote holistic self-care as an ethical imperative in professional practice. importance of self-care research suggests that individuals employed in social service contexts are at an increased risk for vicarious traumatization, secondary traumatic stress, compassion fatigue as trauma-related stress, and professional burnout (e.g., adams et al., 2006; dunkely & whelan, 2006; newell & macneil, 2010). as well, social service workers are likely to be more sensitive to shifting political landscapes, funding cuts, and so on, when compared to individuals employed in other social contexts (e.g., lee & miller, 2013; whitaker et al., 2006). several authors have suggested that engaging in adept self-care practices may be one way to assuage some of these problematic circumstances (greville, 2015; grise-owens et al., 2016; weinberg, 2014). for example, salloum, kondrat, johnco, and olson (2015) suggested that engaging in self-care could help mitigate issues associated with professional burnout. pope, giger, lee, and ely (2017) and cohen and gagin (2005) made similar assertions. asuero et al. (2014) suggested that engaging in self-care may positively impact professional self-efficacy and professionalism and bush (2015) explained that self-care can improve services offered to clients. social work research about self-care literature, in general, and social work literature, specifically, is in the nascent stages of explicitly examining self-care as a professional practice among social workers. indeed, a leitmotif clear in the current literature is the need for more literature. for instance, nasw (2008) proclaimed that self-care, as a construct, had not been fully examined within the social work profession. bloomquist, wood, friedmeyer-trainor, and kim (2015) asserted that “a paucity of research exists with regard to social workers’ perceptions of self-care” (p. 294). miller, lianekhammy, pope, lee, and grise-owens (2017) reported that there are not as many research studies on self-care as one might expect. others have made similar advances in social work, fall 2018, 18(4) 1253 assertions (cox & steiner, 2013; grise-owens, miller, escobar-ratliff, & george, 2017; lee & miller, 2013). limitations notwithstanding, some researchers have examined self-care among social workers. for example, bloomquist and colleagues (2015) explored the relationship between self-care practices and professional quality of life. these authors found that while social workers valued self-care, they only engaged in self-care sparingly. miller et al. (2017) examined the self-care practices of social workers employed in healthcare settings. similar to bloomquist et al., these authors concluded that social workers in their sample only engaged in self-care at a moderate level. the implications derived from the literature are clear. recognition of the importance of self-care and the role it can play in moderating the challenges associated with professional social work practice is growing (e.g., cox & steiner, 2013; miller et al., 2016; smullens, 2015). however, few studies have explicitly examined the concept. if social workers are to provide adroit social work services, research must examine the self-care practices of these practitioners, and pursue strategies aimed at improving these practices. this paper seeks to achieve this important aim, and in so doing, address limitations in the current literature. study aim and research questions the overarching aim of this study was to explore the personal and professional selfcare practices of individuals employed in social work capacities in one southeastern state. specifically, this study was rooted in answering three distinct research queries (rq): rq1: how often do individuals employed in social work capacities engage in self-care practices?; rq2: are there group differences in self-care practices by demographic/professional characteristics?; and, rq3: what variables predict self-care practices? method research design, protocol, and sampling approach this study employed a cross-sectional survey design. an electronic survey was used to collect primary data from individuals who self-identified as individuals employed in a social work capacity in one southeastern state. the survey was sent to various agencies/organizations known to be associated with individuals employed in social work capacities. individuals were asked to forward the survey. survey data were collected and managed via an online survey system. all participants were offered the chance to enter their email address for a $500 cash card drawing. the incentive survey link was disconnected from the larger survey, thus, participants responses were anonymous. all data were collected during winter 2017. the protocol utilized for this study was approved by an university institutional review board (irb). miller et al./self-care 1254 instrumentation the instrument used to collect data for this effort was divided into two sections: (1) general demographic and professional information; and, (2) self-care practices. first, participants were asked to provide general demographic (e.g., age, race, education level, etc.) and professional (e.g., time in the profession, current practice setting, etc.) data. second, participants completed the self-care practices scale (scps; lee, bride, & miller, 2016) to measure self-care practices. scps is an 18-item instrument designed to measure the frequency of personal and professional self-care (i.e., nine items for personal self-care and nine items for professional self-care). for the purpose of this study, professional self-care was defined as “the process of purposeful engagement in practices that promote effective and appropriate use of the self in the professional role within the context of sustaining holistic health and well-being” (lee & miller, 2013, p. 98). exemplars of items from this part of the scale include “i take small breaks throughout the workday” and “i seek out professional development opportunities.” personal self-care was defined as “a process of purposeful engagement in practices that promote holistic health and well-being of the self” (lee & miller, 2013, p. 98). exemplars of items for this part of the scale include “when i am not feeling well, i take action to get better” and “i employ strategies to manage stress in my life.” scps utilizes a five-point likert scale ranging from 0 (never) to 4 (very often) and produces three scores: a summative personal self-care score (0-36), a summative professional self-care score (0-36), and a total score comprised of the sum of personal and professional self-care scores (0-72). for all three, higher scores indicate greater frequency in self-care practices. for this study, measures for personal (cronbach’s alpha=.80) and professional (cronbach’s alpha=.78) care displayed high internal consistency. scps has been used in other studies (e.g., pope et al., 2017, etc.) and has been observed to have acceptable psychometric properties (lee et al., 2016). results participants a total of 1,011 individuals employed in social work capacities participated in this study. the typical participant identified as female (88.3%), caucasian/white (85.8%), heterosexual (90.8%), and aged 40.1 years (sd=11.96). respondents worked an average of 40.6 hours per week (sd=10.03) with approximately 12.8 years (sd=9.86) of experience practicing social work. descriptive data for other demographic and personal/professional characteristics of the sample are presented in table 1. advances in social work, fall 2018, 18(4) 1255 table 1. demographic and professional characteristics n (%) gender (n=1009) male 108 (10.7%) female 891 (88.3%) other (ex. gender-expansive, gender fluid, etc.) 10 (1%) race/ethnic background (n=1005) white non-hispanic 862 (85.8%) black non-hispanic 107 (10.6%) american indian or alaskan native 4 (0.4%) asian or pacific islander 5 (0.5%) hispanic 10 (1.0%) biracial/multiracial 9 (0.9%) other (ex. jamaican, ashkenazi, etc.) 8 (0.8%) current relationship status (n=1009) married 621 (61.5%) partnered 68 (6.7%) divorced, separated, or widowed 118 (11.7%) never married 202 (20.0%) sexual orientation (n=1007) heterosexual or straight 914 (90.8%) gay, lesbian, or bisexual 85 (8.5%) other (ex. asexual, pansexual, etc.) 8 (0.8%) highest academic degree (n=1010) high school diploma/ged 19 (1.9%) associate’s 4 (0.4%) bachelor's 123 (12.2%) master's 836 (82.8%) doctorate 23 (2.3%) first professional (i.e., law, medicine, or dentistry) 5 (0.5%) social work degree (n=1011) yes 944 (93.4%) no 67 (6.6%) n (%) degree type basw/bsw 231 (24.4%) msw 713 (75.6%) employer type (n=955) non-profit setting 656 (68.7%) for profit setting 299 (31.3%) employer sector (n=956) public (e.g., governmental) 543 (56.8%) private (including private practice) 413 (43.2%) level of work (n=953) mostly micro-level work (e.g., clinical, individual therapy treatment, etc.) 484 (50.8%) mostly mezzo-level work (e.g., work with families, small groups, etc.) 181 (19%) mostly macro-level work (e.g., policy advocacy, community organizing, etc.) 66 (6.9%) my work is spread out equally across more than one area. 222 (23.3%) health status (n=1010) excellent 130 (12.9%) very good 439 (43.5%) good 336 (33.3%) fair 100 (9.9%) poor 5 (0.5%) current financial situation (n=1008) i cannot make ends meet. 52 (5.2%) i have just enough money to make ends meet. 305 (30.3%) i have enough money, with a little left over. 482 (47.8%) i always have money left over. 169 (16.8%) self-care scores as discussed, self-care was measured via the scps. on a scale of zero to 36, the sample had an average score of 24.2 (sd=5.32) on the personal self-care domain and 23.5 (sd=4.78) on the professional self-care domain. the mean overall self-care score for all participants was 47.7 (sd=9.00; out of a possible score range from 0 to 72). both of these miller et al./self-care 1256 scores indicate that participants engage in neither high, nor low amounts of personal and professional self-care. bivariate analyses an independent samples t-test was conducted for variables with two levels, namely employer type (for-profit/non-profit) and employer sector (public/private). results showed no significant differences in mean personal or professional self-care for employment type or sector. group comparisons for variables with three or more levels were assessed using one-way anovas, except when assessing gender and race. no statistical differences in personal self-care practices were found for gender, race, or sexual orientation. further, no statistical group differences were found in professional self-care practices among these variables: gender, race, sexual orientation, and level of work. results yielded significant findings for relationship status, educational attainment, health status, and current financial situation. refer to table 2 for means, standard deviations, and confidence intervals for significant variables. four levels of relationship status (married, partnered, never married, and divorced, separated, or widowed) were examined to investigate differences in self-care practices. results indicated a significant difference in personal self-care, f(3, 1007)=4.931, p<.01, and professional self-care, f(3, 990)=6.189, p<.001, among those with different relationship statuses. tukey’s post-hoc analysis revealed participants who never married reported less personal self-care practices compared to those who were married. for professional self-care, those never married had fewer reported practices on average compared to those who were married or those who were divorced, separated, or widowed. mean score differences for partnered respondents in personal and professional did not yield significant differences with any other level of relationship status possibly due to power issues as a result in sample size (n=68 vs. n=120+). further research is warranted to determine whether self-care practices of those in partnered relationships truly differ from those in other types of relationships statuses. mean differences in educational attainment (high school/ged, associates or bachelor’s, master’s, or doctoral/professional degrees) were significantly different for personal f(3, 1006)=3.213, p<.05, and professional, f(3, 992)=3.685, p<.05, self-care scores. post-hoc analysis examining pairwise comparisons between education levels did not yield significant differences in personal self-care scores. this discrepancy in results could be due to type i error with the anova or a lack of power to detect differences between comparisons in more conservative post-hoc analyses. however, significant differences were found in professional self-care between those holding a ph.d. or professional degree and an associate’s or bachelor’s degree, with those with a doctorates or professional degree reporting greater professional self-care. there were significant differences between varying levels of health (i.e., excellent, very good, good, fair, and poor) and self-care in both personal, f(4, 1005)=57.187, p<.001, and professional, f(4, 998)=21.210, p<.001, practices. follow-up analyses showed group differences in personal self-care was significant for all paired comparisons. all paired comparisons had significantly different mean professional self-care scores, except for fair vs. good and poor vs. fair pairings. mean scores for personal and professional advances in social work, fall 2018, 18(4) 1257 self-care held similar patterns in that as health of the respondent decreased, the number of self-reported practices decreased. group comparisons for current financial situation (i cannot make ends meet, i have just enough money to make ends meet, i have enough money with a little leftover, and i always have money left over) revealed significant differences in personal, f(3, 1004)=34.852, p<.001, and professional, f(3, 987)=21.120, p<.001, self-care. post-hoc pairwise comparisons showed significant differences in average personal self-care scores for all pairings, except between i cannot make ends meet and i have just enough money to makes ends meet. all pairings revealed significant differences in average professional self-care scores. table 2. self-care means and standard deviations for significant independent variables1 personal professional n m sd n m sd relationship status married 621 24.53 5.29 612 23.79 4.62 never married 202 22.91 4.95 197 22.31 4.85 divorced, separated, or widowed 120 24.44 5.94 119 24.23 4.93 educational attainment associate’s or bachelor's 127 23.21 6.06 123 22.57 5.27 doctorate/professional 28 25.82 5.65 28 25.43 4.83 health status excellent 130 27.47 4.63 130 26.02 4.23 very good 439 25.50 4.69 432 23.91 4.54 good 336 22.37 5.06 328 22.62 4.75 fair 100 20.57 4.75 98 21.51 4.82 poor 5 12.20 3.96 5 16.40 1.95 financial situation i cannot make ends meet 52 20.88 6.74 50 20.50 7.17 i have just enough money to make ends meet 305 22.60 5.10 300 22.56 4.37 i have enough money, with a little left over 482 24.49 4.82 475 23.70 4.42 i always have money left over 169 26.96 5.10 166 25.45 4.82 note: 1 p<.05 multivariate analysis a multiple linear regression analysis was conducted to assess the relationship between total self-care scores using explanatory variables for demographic and other personal/professional type characteristics. continuous variables (age and average hours worked per week) were added to the model. categorical variables (race, gender, relationship status, current financial situation, sources of income, employer type, and employer sector) were converted into dummy variables and included in the model, with the exception of the levels used as the reference group for comparison (identified in table 3). the regression results are summarized in table 3. the model was statistically significant, f(21, 652)=11.55, p<.001, r2 adj=.25. miller et al./self-care 1258 table 3. regression analysis summary model b seb ß p years in practice 0.05 0.05 0.05 0.35 age (year) 0.12 0.04 0.16 <0.001*** average weekly work hours -0.15 0.03 -0.17 <0.001*** health status -3.12 0.36 -0.30 <0.001*** relationship status reference partnered 0.86 1.41 0.02 0.54 never married -0.24 1.16 -0.01 0.84 divorced, separated, or widowed 1.07 1.33 0.04 0.42 married reference current financial situation i cannot make ends meet -5.57 1.61 -0.14 <0.001*** i have just enough money to make ends meet -4.32 0.95 -0.23 <0.001*** i have enough money, with a little left over -2.56 0.84 -0.15 <0.001*** i always have enough money reference income source single income/more than one source -0.41 1.27 -0.01 0.75 two incomes 0.70 1.06 0.04 0.51 more than two incomes 2.87 1.76 0.07 0.11 single income/one source reference race other race/ethnicity -2.05 1.78 -0.04 0.25 black 3.26 1.03 0.11 <0.001*** white reference gender all other types 0.92 3.84 0.01 0.81 male -0.04 0.97 0.00 0.97 female reference organization type for-profit setting -0.35 0.68 -0.02 0.60 non-profit setting reference employer sector public (e.g., government) 1.51 0.65 0.09 0.02* private reference note: r2=.27, r2 adj=.25 (n=674, p<.001) six explanatory variables were significantly related to differences in total self-care practices: age, average hours worked per week, health, current financial situation, race, and employer sector, even after controlling for all other variables in the model. for every 4year increase in age, total self-care score increased by .5 points. every 10-hour increase in work per week equated to a 1.5-point decrease in total self-care score. health was rated by respondents on a scale of 1 (excellent) to 5 (poor). each unit increase represented a decline in health status, which led to a decrease in total self-care score by 3.12 points. for current financial situation, those who “cannot make ends meet,” “have just enough to make ends meet,” and “have enough, with a little left over” showed lower total self-care scores by 2.5 5.5 points compared to respondents who “always have enough money.” race was a advances in social work, fall 2018, 18(4) 1259 significant predictor of total self-care score. the adjusted mean difference in total self-care score for black participants compared to white participants was 3.26 points with black participants reporting higher levels of self-care. lastly, participants working for employers in the public sector had higher total self-care scores (1.51 points) compared to those working for employers in the private sector. discussion this exploratory study examined the self-care practices of individuals employed in social work capacities in one southeastern state. for clarity, this section is presented in a format that explicitly mirrors the above posited research questions. rq1: how often do participants engage in self-care practices? overall, data from this study suggest that social workers in this sample engage only moderately in professional and personal self-care. mean scores for personal and professional self-care were 24.2 (range of 0 36) and 23.5 (range of 0 36), respectively. these data indicate that, overall, social workers in this study reported engaging in self-care “sometimes.” given existing, albeit limited, research in this area, perhaps these findings are not surprising. both bloomquist et al. (2015) and miller et al. (2017) concluded that social workers in their study engaged in self-care moderately. the lack of self-care practices may be associated with contextual factors. for instance, agency culture and organizational functioning definitely impact staff morale and effectiveness (kanter & sherman, 2017). as such, effective self-care can be a key strategy for offsetting deleterious effects of problematic organizational dynamics. however, self-care is misunderstood and underutilized; in part, this underutilization is due to the lack of skill development as part of professional preparation and development (smullens, 2015). social workers and individuals employed in social work positions receive very little, if any, explicit education or training associated with self-care (grise-owens et al., 2017). this training can help social workers develop tools and skills to better navigate the organizational contexts and professional stressors. this training can also help practitioners impact the organizational cultures in which they work. there are other plausible reasons as to why individuals reported engaging only moderately in self-care. for instance, participants in this study may not view self-care as important. said another way, they may not value self-care. or, they may not view self-care as connected to their professional practice. no matter the reason, these data lend credence to the notion that self-care is an area of growth for participants in this study, specifically, and perhaps for individuals employed in social work contexts, more generally. rq2: are there group differences in self-care practices by demographic/professional characteristics? analyses revealed several group differences related to self-care practices. for instance, current relationship status does appear to impact self-care practices. participants who never married engaged in personal self-care significantly less frequently than did individuals who miller et al./self-care 1260 were married. in terms of professional self-care, individuals who never married reported significantly fewer self-care practices than participants who were married, divorced, separated, or widowed, respectively. this finding merits further exploration and generates further critical questions. for example, relationship status could be related to income; married or partnered respondents would be more likely to have dual-incomes. more broadly, this finding generates questions about the impact of emotional supports on attention to self-care. there was also a difference between individuals at varied educational levels. specifically, those holding a ph.d. or first-professional degree indicated higher professional self-care practices when compared to those with an associates or bachelor’s degree. this finding may be linked with the related function of income (see below). also, presumably, increased educational attainment typically results in higher ranking positions, which often allow for greater control in job functions and greater rewards/recognition. these aspects contribute to greater job satisfaction, which contributes to self-care practices (cox & steiner, 2013; maclean, 2011). similarly, greater training and professional preparation can contribute to increased awareness about the importance of self-care or increased self-efficacy. cox and steiner summarized several studies that found selfefficacy mitigates high-stress working conditions. in a related factor, higher education attainment might indicate more opportunities for sustained supervision and/or mentoring. supervision and professional development are key aspects of professional self-care. interestingly, perceived health status and current financial situation both seemed to impact self-care practices for individuals in this sample. participants at each “level” of perceived health (i.e., excellent, very good, good, fair, and poor) indicated significantly higher self-care practices than the preceding level, with the exception of professional selfcare scores for those indicating fair vs. good and poor vs. fair health statuses. stated plainly, the poorer the reported health status of the participant, the less frequently the participant engaged in self-care practices. on the surface, this finding seems selfexplanatory and appears to be the proverbial “chicken and egg” cycle, in which of lack of self-care creates health issues, which lead to decreased self-care, and so forth. however, a more nuanced consideration is needed. traditionally, self-care has been framed primarily as physical activities completed after work hours, such as “going to the gym.” as noted in the introduction of this article, the definition of self-care is expanding beyond the traditional medical model and limited frame of physical health. this finding indicates the need to build a more expansive understanding of self-care that encompasses a holistic approach—beyond the parameters of the medical model. differences in self-care practices were also detected based on current financial situation (e.g., i cannot make ends meet, i have just enough money to make ends meet, i have enough money with a little leftover, and i always have money left over). typically, individuals in more stable financial situations engaged in significantly more professional and personal self-care practices (except for personal self-care scores between those who responded i cannot make ends meet and i have just enough money to makes ends meet). intuitively, these findings may be expected. certainly, finances are a significant life stressor. this finding points to the clear need to advocate for fair and just salaries in the advances in social work, fall 2018, 18(4) 1261 profession of social work and within organizations. at the same time, similar to the discussion above related to health, this finding may indicate the need for a more holistic approach to self-care. traditionally, self-care has been conceptualized as activities that involve cost, such as “going to the spa,” and so forth. a multi-faceted approach to self-care engages these traditional activities; however, this holistic approach expands self-care to a much more comprehensive practice. similarly, this finding needs to be examined more specifically. the survey did not ask for income, but rather the respondent’s assessment of their financial status. as such, this response may not relate as much to income-level as it does to financial satisfaction—or some combination of both. rath and harter (2010) reported on a gallup study examining financial well-being. the study found that people with the same levels of income differ in their assessments of whether that income is adequate. furthermore, rath and harter reported that the differences in perception are largely dependent on the respondent’s level of engagement in their work. higher scores of engagement correlated with higher scores of satisfaction with income. rath and harter (2010) concluded, “money is easily counted, but it is still a highly subjective variable” (p. 59). particularly given these interesting considerations, the current study’s finding points to the need for including financial wellbeing as part of self-care. rq3: what variables predict self-care practices? the exploratory model yielded a total of six variables that were significantly related to self-care practices. as indicated above, these variables are: age, race, health, current financial situation, average hours worked per week, and employer sector. for every 4-year increase in age, total self-care score increased by .5 points. this finding is congruent with previous studies that found a correlation between age and burnout, with younger workers reporting higher levels of stress (maslach, 2005). age may also interact with the variables of finances and level of education as mitigating factors—as discussed earlier. this finding may relate to the particulars of life stage; for example, parenting responsibilities can bring particular stressors for professionals. the interaction of life stage and self-care merits more critical exploration. race was the only other demographic category that was a significant predictor of total self-care score. the adjusted mean difference in total self-care score for black practitioners compared to white practitioners was 3.26 points. this finding is particularly intriguing. certainly, organizational and interactional discrimination contribute to individual workplace stress-levels (cox & steiner, 2013). members of marginalized groups have been found to experience stress that is additive to general stressors (cox & steiner, 2013; meyer, 2003). these findings about demographic differences merit ongoing critical exploration. as discussed above, health and finances correlated with self-care practices. for health, each unit increase represented a decline in health status, which led to a decrease in total self-care score by 3.12 points. for current financial situation, those who “cannot make ends meet,” “have just enough to make ends meet,” and “have enough, with a little left over” showed lower total self-care scores by 2.5 5.5 points compared to respondents who miller et al./self-care 1262 “always have enough money.” as discussed above, these findings merit further examination and point to the need for a more holistic approach to self-care. in a similar vein, the number of hours worked correlated with self-care. for every 10hour increase in work per week equated to a 1.5-point decrease in total self-care score. this finding underscores the traditional admonition for “work-life balance” as part of a self-care approach. however, using the holistic approach, this finding points to the need to more broadly conceptualize self-care. rather than limiting self-care to what employees do after work, an expansive framework would include how employees work. that is, self-care is not just about taking care of oneself in non-work hours, but, also how one practices selfcare in the workplace. this approach sees self-care as an ongoing lifestyle, rather than an emergency response to stress (grise-owens et al., 2016; lee & miller, 2013). limitations as with any research endeavor, this study is certainly not without limitations. all participants identified as an individual employed in a social work capacity in one southeastern state. each individual self-selected into the study, and respondents were overwhelmingly female and white. though these demographics may be reflective of the larger profession, a more heterogeneous sample may have yielded different results. certainly, future research may look to recruit a more diverse sample. further, as noted, differential groups sizes may have impacted the analyses (e.g., statistical power), specifically as it related to detecting group differences. and, the scale does not include secondary anchors that denote contextual data for ranking categories (e.g., frequency of “sometimes”). future studies should collect additional data related to significant findings (e.g., income) and look to control for those, and other, mediating/moderating variables that may impact self-care practices. implications adept and ethical social work practice requires that practitioners engage in self-care. thus, studies that examine self-care must also explicate pragmatic implications related to social work practice. in a key, overarching finding, data indicate that participants struggle to engage in apt self-care practices. also, certain factors are predictive of level of self-care. these findings have particular implications for administrators and supervisors. for example, administrators can advocate for just and fair wages and work hours. likewise, given that financial insecurity/dissatisfaction is a key predictor of low self-care, the organization could provide accessible resources for employees to learn personal financial management strategies. similarly, given the finding pertaining to age, supervisors can proactively support younger employees (in particular) in attention to self-care. since professional development and supervision are core aspects of professional self-care care, supervisors can promote self-care accountability processes as part of the supervision process and team culture. likewise, administrators can include attention to self-care as part of professional development plans and evaluation processes. awareness about the need for attention to practitioner well-being leads to the realization that both individual and organizational responses are necessary. as such, advances in social work, fall 2018, 18(4) 1263 agencies should engage in strategic initiatives aimed at improving self-care practices. these initiatives may take several forms. kanter and sherman (2017) advocated that organizations should take a “we-care” approach. these authors contended that traditional “wellness programs,” while helpful, are not sufficient for human services. these authors delineate facets of the we-care approach to organizational wellness. similarly, miller et al. (2016) provided a description of a comprehensive wellness initiative in a multi-state non-profit organization. more models of organizational wellness initiatives are needed. these models need to incorporate attention to professional development trainings for employees on how to engage in effective self-care. like any aspect of professional practice, adeptness in self-care needs to be taught and reinforced. professional development trainings can provide staff with the knowledge, skills, and values necessary for competence in practicing self-care. the development of self-care as part of professional practice should be integrated in social work curricula (grise-owens et al., 2017; nasw, 2008). the current study found that younger professionals tended to report lower self-care scores. this finding supports the need for preparation of professionals to ensure that graduates enter the field prepared to practice self-care. social work education inculcates core values and ensures core competencies of the profession; the council on social work education (cswe, 2015) delineates these competencies for accreditation purposes. progressively, self-care is being identified as a core competency (jackson, 2014). however, to date, cswe has not included self-care in its accreditation standards. a self-care competency framework should be developed to ensure best practices. likewise, models for integrating self-care into social work curricula are needed. finally, the profession of social work, as a whole, needs to promote self-care as a valid and essential aspect of professional practice. the nasw (2008) policy statement on selfcare is an excellent example of this promotion. more such statements are needed. building on these statements, pragmatic resources must be developed. for instance, professional organizations can support the development of materials and practice models for individuals and organizations. similarly, licensing/credentialing boards can support professional development of self-care practice. for example, all licensed professionals are required to complete ongoing continuing education trainings. professional boards can include trainings in self-care as one of these requirements. the crucial mission of the social work profession is laudable and essential. as such, the rewards of practicing in the profession are significant. at the same time, the need to address the costs borne by practitioners fulfilling the profession’s purpose is increasingly apparent. fulfilling the mission of the profession means sustaining the practitioners activating that mission. therefore, the profession of social work is compelled to support practitioner well-being, as an integral aspect of professional identity and purpose. references adams, r. e., boscarino, j. a., & figley, j. a. 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(2014). the ideological dilemma of subordination of self versus self-care: identity construction of the ‘ethical social worker’. discourse & society, 25(1), 8499. doi: https://doi.org/10.1177/0957926513508855 whitaker, t., weismiller, t., & clark, e. (2006). assuring the sufficiency of a frontline workforce: a national study of licensed social workers: executive summary. washington, dc: nasw. world health organization. (1983). health education in self-care: possibilities and limitations (report of a scientific consultation). geneva, switzerland. retrieved from http://apps.who.int/iris/bitstream/handle/10665/70092/hed_84.1.pdf?sequence=1&is allowed=y author note: address correspondence to: j. jay miller, college of social work, university of kentucky, p.o. box 221438, louisville, ky 40252. justin.miller1@uky.edu. https://doi.org/10.1177/0957926513508855 http://apps.who.int/iris/bitstream/handle/10665/70092/hed_84.1.pdf?sequence=1&isallowed=y http://apps.who.int/iris/bitstream/handle/10665/70092/hed_84.1.pdf?sequence=1&isallowed=y mailto:justin.miller1@uky.edu this work is licensed under a creative commons attribution 4.0 international license. epistemic injustice: towards uncovering knowledge of bisexual realities in social work research gio iacono abstract: lesbian, gay, bisexual, transgender and queer (lgbtq) individuals experience health risks, with bisexuals experiencing higher levels of health risk compared to heterosexuals, gays and lesbians. these disparities are often attributed to stressors related to minority status. while similarities among lgbtq experiences exist, it is plausible that bisexuals experience unique forms of marginalization, which may help explain the documented health disparities. bostwick and hequembourg highlight unique forms of marginalization that bisexuals experience vis-a`-vis microagressions, falling within the realm of the epistemic. fricker’s work on epistemic injustice emphasizes marginalization particularly as it is related to knowledge and experience. drawing on this scholarship, this paper provides a review of existing literature on the bisexual experience, and a discussion to provide a critical lens on bisexual marginalization in society and the minimal attention received in social work research. approaches to increase bisexual visibility and attention in social work research will be discussed. some approaches include: developing a queer theoretical perspective in practice and research to allow for greater problematization of social categories; and making a concerted effort to promote research that is inclusive of minority populations within the sexual and gender minority population group. this might include groups with intersecting points of marginalization, such as racialized and gender diverse individuals. keywords: bisexuality; epistemic injustice; microaggression; research bisexuality was historically seen as a way to understand physical sexual characteristics (i.e., exhibiting characteristics of both male and female sexes) through the fields of anatomy and physiology, as well as individual gender expressions (i.e., a combination of masculinity and femininity) associated with biological sex (macdowall, 2009). eventually, the science community started using the term “bisexual” as an exclusive term to understand a specific kind of sexuality, particularly sexual attraction to both cisgender men and women (not including trans and other gender non-binary identities; robinson, 2017). much of the literature on bisexuals has been collapsed with that of other sexual minorities such as gays and lesbians (fredriksen-goldsen, 2011; wallace, cochran, durazo, & ford, 2011), which may obscure accurate population estimates, as well as risk factors and realities of the bisexual community. while considering factors that may create variation among estimates of the bisexual population, such as limitations of survey methods, the williams institute reported estimates of the percentage of adults who self-identify as bisexual across nine population-based surveys, including national surveys from canada, the united kingdom, australia, norway, and the united states (gates, 2011). they reported estimates of the bisexual population ranging from 1.2-2.1% for non-us surveys, and 0.7-3.1% for usbased surveys. furthermore, a large-scale 2014 study by the national health interview survey (nhis) found that 0.7 percent of americans identify as bisexual (ward, ______________________ gio iacono, msw, is a ph.d. candidate at factor-inwentash faculty of social work, university of toronto. copyright © 2017 author, vol. 18 no. 2 (fall 2017), 563-582, doi: 10.18060/21427 https://creativecommons.org/licenses/by/4.0/ iacono/epistemic injustice 564 dahlhamer, galinsky, & joestl, 2014). research is increasingly showing that bisexuals experience significant health and mental health disparities compared to heterosexuals, gays and lesbians (bostwick, hughes, & everett, 2015; fredriksen-goldsen, kim, barkan, balsam, & mincer, 2010; gorman, denney, dowdy, & medeiros, 2015). it has been hypothesized that these disparities are largely due to discrimination (e.g., identity dismissal, dating exclusion, blame for spreading diseases) by heterosexual and gay/lesbian communities (robinson, 2017). within social work, research and discussions on sexual and gender diversity beyond gay and lesbian experience is largely absent (mcphail, 2004; mulé, 2008). empirical evidence points to unique forms of bisexual marginalization, vis-a`-vis microagressions, that fall within the realm of the epistemic (bostwick & hequembourg, 2014; ross, dobinson, & eady, 2010; tjepkema, 2008). as the study of knowing or knowledge, epistemology concerns itself with the nature of knowledge, how we come to knowledge, what we know, why we know, whether what we know is true, and understanding the limits of knowledge (steup, 2014). as epistemology involves understanding human knowledge construction, it is important to approach bisexual knowledge erasure and unintelligibility within an epistemological framework (fricker, 2007). given the small size of the bisexual population, and minimal attention placed on bisexuality in social work research, this paper aims to provide a review of existing literature on the bisexual experience and begin a discussion to increase understanding of, and provide a critical lens on bisexual marginalization and invisibility —referring to how the legitimacy and acceptability of bisexuality is questioned or denied in society at large. epistemic injustice refers to when one experiences prejudice and/or discrimination based on one’s construction of knowledge; one is wronged epistemically (i.e., wronged as a knowledge giver) (fricker, 2007). epistemic injustice includes microagressions, first introduced by pierce (1970), which are everyday verbal, behavioral, and environmental slights and indignities that are hostile and discriminatory in nature towards racialized communities, sexual and gender minorities, and other marginalized groups (sue, 2010). background and significance sexual and gender identities (e.g., heterosexual, gay, lesbian, bisexual, transgender, queer) can be seen as culturally specific and socially constructed (miller, andré, ebin, & bessonova, 2007). a common and historical understanding of bisexuality tells us that bisexual individuals are only attracted to males and females, with the biological deterministic assumption that sex and gender always co-occur and correspond with each other (mikkola, 2012). bisexuality has been traditionally regarded as a binary conception (e.g., attraction to only two genders), which has been challenged in recent years (robinson, 2017). this paper aims to move beyond a binary conception of bisexuality and sexuality overall. for the purposes of this paper, the term “sexual and gender minority” (sgm) as a population identifier is generally considered to encompass distinct identities separate from the “sexual and gender majority” (e.g., heterosexual, cisgender), a minority that may include lesbian, gay, bisexual, transgender, and queer groups (lgbtq), among many others. while, for the sake of convenience, these groups are all considered part of the same overarching sgm category or community (weiss, 2003), they have been shown to advances in social work, fall 2017, 18(2) 565 experience varying levels of risk for different health outcomes (bostwick & hequembourg, 2014; institute of medicine, 2011). placing sexual/gender identity in a majority or minority category is simplistic and perpetuates a binary way of understanding phenomena. research is beginning to uncover health disparities among minority groups within the broader sgm population (e.g., ross, et al., 2010). bisexuals may be at a higher risk than heterosexual individuals and, in some cases, at a higher risk than gay and lesbians for health and mental health problems, higher rates of mental health service utilization, substance use, as well as suicidality (e.g., bostwick & hequembourg, 2014; case et al., 2004; diamant & wold, 2003; jorm, korten, rodgers, jacomb, & christensen, 2002; kerr, santurri, & peters, 2013; ross et al., 2010; sarno & wright, 2013; tjepkema, 2008). meyer (1995) posits that such disparities are often attributed to stressors related to minority status, including experiences of prejudice and discrimination. the meyer (1995) minority stress model, widely used to understand various social factors that influence health in minority populations, posits that stigma and discrimination in society influence the health and mental health of sgm. multiple minority stressors such as homo/bi/trans-phobic prejudice and stigma, victimization, internalized homo/bi/trans-phobia, and hiding one’s sexual or gender identity, have been found to have adverse effects on the health and mental health of sgm populations (klein & dudley, 2014; lehavot & simoni, 2011). however, meyer (2003) acknowledges that the minority stress model fails to differentiate between differing realities that fall under the sgm banner. bisexuals may experience different stress-related experiences compared to other sexual minorities (bostwick & hequembourg, 2014). social work and sexual/gender minority issues social work is a profession that aims to support individuals, families, groups and communities in enhancing their well-being. in addition to individual and group problems, the profession also strives to promote social justice and is concerned with larger social problems such as poverty and institutional and systemic oppression, such as homophobia and transphobia (drover, 2013). though social work draws from the fields of psychology, sociology, philosophy, law, medicine and political science, to name a few, the values and approaches that inform social work thought, practice, and research center on the concept of person-in-environment. this approach considers the relationships and interactions between individuals, their support resources, communities, and societal and social forces. this focus on relationships is argued to be a distinguishing feature of the social work profession (canadian association of social workers [casw], 2000). accordingly, discussion of sgm issues, from a social work perspective, may allow for a deeper and richer understanding of sexual/gender minority issues that could lead to potential action in the social work profession, as well as in disciplines from which social work borrows. in social work, theory, research or practice, individuals are typically classified by group membership in order to conduct research, to plan political action and to inform practice, policy, and education. social workers aim to advocate on behalf of oppressed groups; however, the assumptions about the groups’ social categories (e.g., gay, lesbian, bisexual, woman, newcomer, black, and so on) remain largely unchallenged (mcphail, 2004). binary notions (e.g., male/female, gay/straight) prevail in many of social work’s traditional theoretical perspectives (e.g., structural social work). these notions are not iacono/epistemic injustice 566 merely in the field of social work but also found within many disciplines (e.g., psychology, sociology, law, etc.) and reflect the dominant culture (weiss, 2003). within social work, an appreciation of the diversity of sexual and gender identity is largely absent; it “has limited presence in policy, and lacks adequate funding, impacting on programming and services, detrimentally affecting practice” (mulé, 2008, para.16). the field of social work, with its ethical standards, could lead the way for other disciplines with respect to challenging these binary notions of identity. mcphail (2004) argues that incorporating critiques informed by postmodern and queer theoretical perspectives is beneficial to the social work profession since these approaches align with the profession’s value of selfdetermination, which allows individuals to define themselves as opposed to being defined by others. however, it has been argued that the social work profession holds a desire for certainty (martin, 1996), thus making it challenging to incorporate these perspectives. furthermore, lgbtq activists in social work and other disciplines have worked hard to increase political and social power through group visibility and identification. the reluctance by the social work profession to deconstruct and strip down concepts of social group identity is maintained by a concern that these already marginalized groups may become even more invisible and powerless (mcphail, 2004). queer theoretical perspectives in social work, while increasing, may be met with ongoing resistance. binary “logic” since there is a strong assumption of binary categories pertaining to sexual and gender identity (e.g., gay/straight, male/female) within social work, research in this area is generally dichotomized, which can foster rigid identity assumptions, a homogeneous understanding of research participants and results, and a divide between “normal” and “deviant” behavior, as well as masking inherent variation in different groups and populations (johnson & repta, 2012). bringing greater awareness to the complexity of sexual and gender identity could have transformative effects on how research is conducted. further, sexual and gender identity can be seen as temporally fluid, as they are not necessarily fixed points in one’s life (voss, browne, & gupta, 2014). some scholars in social work have begun to acknowledge and recognize the increasing evidence that sexual and gender identity are not binary categories, that binary categories might not even be an accurate way of understanding these phenomena (burdge, 2007; gringeri & roche, 2010). while an understanding that the binary model may be flawed has gained some traction in social work research, the majority of researchers continue to disregard this possibility, reinforcing the dichotomous paradigm (rassi, 2011). critiques from postmodern, poststructural, and queer theory perspectives, as well as from individuals or groups (e.g., transgender, bisexual, intersex) who do not “fit” neatly into binary categories remain absent within social work literature and research (gringeri & roche, 2010). the binary model is so deeply embedded and taken for granted within social work that it sometimes seems inescapable. the binary conceptualization, related to western logocentric thought, can be seen as the “desire for a centre or original guarantee of all meanings” which, according to philosopher derrida, has characterized western philosophy since plato (baldick, 2015, p.191). from a western perspective, binary terms are perceived as hierarchical, with one term valued (or “privileged”) and the other devalued advances in social work, fall 2017, 18(2) 567 (or “marginalized”), as well as mutually exclusive and oppositional (sands, 1996). social work theory, research, and practice largely follow this model (e.g., power/oppression, privilege/marginalization), remaining an essentialist enterprise (mcphail, 2004). for instance, at the risk of simplifying the rise of the gay/lesbian movement, gays and lesbians defined themselves as members of a sexual minority rather than challenging the construction of sexual identity in general (rust, 2000). however, it could be that the magnitude of stigma and oppression experienced by gays and lesbians at that time would have made challenging constructions of sexual identity unfeasible and too radical during that period. societal power structures and relations rely on an essentialist binary model; non-binary realities such as bisexuality upset these power structures and relations. it should not be surprising then that it is these “misfits” that are the most stigmatized, marginalized, and discriminated against in our society. power structures and relations also exist within the sgm population, commonly known as the lgbt community. according to weiss (2003), as the “lgbt community” was forming (for various sociopolitical reasons), power relations arose that led to four distinct groups (i.e., l/g/b/t), each with different social and power positions, with the binary identities garnering more power (p.53). discrimination and prejudice by gays and lesbians against non-binary identities such as bisexuals and transgender people can be seen as a reaction to political and social pressures that exist within the greater society at large. these reactions by gays and lesbians can be seen as coming from societal pressure to maintain certain binary power structures, in what has been argued to be an “accommodationist” attempt to fit into society, providing the message, for the sake of political progress, that gays and lesbians are the same as heterosexuals (“we are just like you;” weiss, 2003, p.30). thus, attempting to ameliorate these conditions (e.g., discrimination, microagressions, and erasure) that exist within the greater society at large for bisexuals and other non-binary identities will require challenging the rigid notions of essentialist dualities and their underlying structural power dynamics. challenges in research and scholarly inquiry research on sexual minorities, in social work and other disciplines, generally likens bisexuals’ experiences of marginalization to that of the experiences of gays and lesbians (mays & cochran, 2001), a comparison which reinforces a homogenous and narrow analysis of factors that negatively affect the health and well-being of bisexuals. this narrow analysis further contributes to the misunderstanding of, and invisibility, of bisexual realities and their unique experiences of marginalization. the institute of medicine (2011) acknowledged the problematic treatment of minority identities and realities (e.g., transgender, bisexual) within the sgm population (i.e., lgbtq community), asserting that there are distinct population groups that fall under the sgm banner, with their own specific health needs. this statement reveals some recognition that various sgm groups are often combined as a single entity for research (and for advocacy purposes). for research purposes, it is important to consider the complexity and intersectionality of the experiences of sgm individuals, as they are diverse and shaped by factors such as race, ethnicity, socioeconomic status, age, geographical location, and many more. intersectionality iacono/epistemic injustice 568 considerations in sgm research are critical as these intersectional factors can further exacerbate existing health-related issues (thoma, huebner, & rullo, 2013). even more puzzling, it has been argued that even queer theory, an epistemological position that appears to be significantly aligned with and supportive of bisexual realities, has also abandoned bisexuality as a topic of inquiry (bostwick & hequembourg, 2014; erickson-schroth & mitchell, 2009). the influential works behind queer theory, such as those by foucault (1978) and butler (1991), despite being in opposition to biological binary models of gender and sexuality, have all overlooked bisexuality as a topic to be taken seriously (gurevich, bailey, & bower, 2009). for instance, callis (2009) writes, in making reference to foucault’s (1978) analysis of the homosexual identity, that: …with no medical discourse, no scientifically granted truth and no reverse discourse, it is little wonder that bisexual identity has formed more slowly than others; the fact that foucault’s work can be used to explain this difference between homosexual and bisexual identities confirms that bisexuality would have been a fruitful topic for foucault to explore…the usefulness of bisexual identity to buttress foucault’s work also points to the utility of the subject for modern queer theorists drawing on foucault. (p. 226) while foucault’s theory of discourse can explain the western construction of gays and lesbians (foucault, 1978), it could also be used to provide an explanation of the lack of salience around bisexual identity. ultimately, greater diversity in sgm research is needed, a point of view that places a stronger focus on diverse bisexual populations, especially in the areas of mental health and health. further, while similarities among sgm groups’ experiences of marginalization do exist, it is plausible that bisexuals experience unique forms of marginalization due to their bisexual identity, which may help explain the documented health disparities among bisexuals (dobinson, macdonnell, hampson, clipsham, & chow, 2005; rainbow health ontario, 2015). some of these documented disparities among bisexuals include: higher reports (canadian and us) of anxiety, depression, suicidality, and self-harm, relative to gay and lesbian identified individuals (kerr, et al., 2013; king et al., 2008; steele, ross, dobinson, veldhuizen, & tinmouth, 2009; tjepkema, 2008). research has not been conducted evenly across sgm populations, with more research focusing on gays and lesbians than on bisexual and transgender people (rainbow health ontario, 2015). without “epistemological data to legitimize” bisexual issues, it will be challenging to develop and implement interventions and services for bisexuals, and to convince funders that bisexual health and mental health research and services are important (miller et al., 2007, p.4). epistemic injustice vis-a`-vis microagressions drawing on the theoretical work of fricker (2007), bostwick and hequembourg (2014) present a framework for understanding the lived experience of bisexual individuals and the marginalization they experience. within this framework, they “…posit that differences in prejudicial experiences do exist for bisexual groups, and that such differences reside in the realms of the epistemic, yet have very real implications…” (p. 488). advances in social work, fall 2017, 18(2) 569 epistemic injustice the philosophical work by fricker (2007) provides an explanation of how injustices relating to categories of knowledge and experience adversely affect bisexuals. fricker (2007) argues that individuals and groups can be wronged, silenced, and made unintelligible in their capacity as knowers. furthermore, epistemic relations occur within an environment of justice and fairness that is influenced by structural power dynamics and mutual understandings of what social identities should look like (bostwick & hequembourg, 2014). fricker (2007) suggests that there are two types of epistemic injustices. the first, called testimonial injustice, involves being wronged or not taken seriously in one’s capacity as a giver of knowledge. as an example of testimonial injustice, fricker (2008) states: “a speaker receives a prejudicially deflated degree of credibility from a hearer…an example might be that a jury does not believe someone simply because of the colour of his skin” (p.69). the second type of epistemic injustice, called hermeneutic injustice, occurs when an individual’s social experience is obscured or made unintelligible due to a structural prejudice and prevention through collective understanding (hawley, 2011). in hermeneutic injustice, society lacks a conceptual framework for understanding or taking seriously the claims of someone’s reality or experience. as an example of hermeneutical injustice, fricker (2008) notes: the difficulty of making sense of homosexual desire as a legitimate sexual orientation in a cultural-historical context where homosexuality is interpreted as perverse or shameful. in such a context, the gay subject cannot make proper sense of his sexuality, owing to the fact that gay people as such were prevented from making a full contribution to collective resources for social meaning, with the result that the forms of understanding available for making sense of homosexuality were crucially uninformed and distorted. (p. 70) similarly, bisexuals can experience testimonial and hermeneutical injustice in society (e.g., bostwick & hequembourg, 2014; ross et al., 2010; 2016; sarno & wright, 2013, which may be addressed through various methods in social work research and practice). microagressions microagressions, regarded as common slights and insults, drive and maintain oppressive discourses (smith, shin, & officer, 2012) and have been shown to have very significant consequences for sexual minorities. sue (2010) posits that microaggressions are “the brief and commonplace daily verbal, behavioral, and environmental indignities that communicate hostile, derogatory, or negative racial, gender, sexual orientation, and religious slights and insults” (p. 5). the literature suggests that the psychological impact of microagressions for sgm groups includes chronic stress, anxiety, depression, and lowered self-esteem, to name a few (nadal, rivera & corpus, 2010). in evaluating differences in the experiences of microaggressions among bisexuals and homosexuals, sarno and wright (2013) found significant differences between homosexuals and bisexuals for different types of microaggressions (e.g., assumed to be straight). bisexuals had more difficulty than their homosexual counterparts with internalized homophobia, biphobia, and iacono/epistemic injustice 570 identity confusion. a review of the literature confirms these findings (e.g., cox, berghe, dewaele, & vincke, 2010; kuyper & fokkema, 2011) and shows that a difference exists in how bisexuals experience and are affected by various forms of microagressions. some of these differences include: higher risk for health issues, greater hostility and discrimination, and higher levels of minority stress compared to gays and lesbians (e.g., herek, gillis, & cogan, 1999; hershberger, pilkington, & d’augelli, 1997; jorm et al., 2002). linking epistemic injustice to microagressions drawing on bostwick and hequembourg’s (2014) framework, it can be argued that testimonial and hermeneutic injustices, vis-a`-vis microagressions, are experienced by bisexuals recursively in a mutually reinforcing manner that seeks to erase bisexual individuals and communities. various forms of microagressions that drive the invisibility, erasure, and silencing of bisexual reality in research and other domains of social life place bisexuality, as a way of knowing and being, outside of the realm of intelligibility (bradford, 2004). epistemic erasure can be seen as a form of injustice that creates real consequences for bisexuals and other marginalized identities. epistemic injustice, both testimonial and hermeneutic, can translate to deeply painful experiences of exclusion and marginalization in various parts of bisexuals’ lives. the dismissal (i.e., testimonial) and lack of intelligibility (i.e., hermeneutic) experienced by bisexuals through the enactment of microaggressions can have deleterious effects. microagressions can contribute to experiences of epistemic injustice by invalidating, negating, or undermining bisexuals’ lived experiences. for instance, a microaggressive statement such as “bisexuals are confused and cannot be trusted” or “bisexuals are really gay/straight” can undermine their embodied experiences and reality (sue, bucceri, lin, nadal, & torino, 2007). an example of epistemic injustice through microagressions in social work may be the experience of having one’s sexual and/or gender identity invalidated by the practitioner’s negative assumptions or indifference. social workers may inadvertently commit microaggressions that lead to epistemic injustice by assuming that bisexuals are either homosexual or heterosexual (sarno & wright, 2013). they may do so because of dominant cultural notions of bisexuality as mentioned earlier, including the erroneous idea that bisexuality is a mere stopping place or phase of exploration until a true homosexual identity is accepted (bostwick & hequembourg, 2014). consequently, this attitude renders an enduring bisexual identity as invisible or unintelligible (sarno & wright, 2013). these epistemic injustices vis-a`-vis microagressions may help explain why bisexuals have the highest rates of mental health issues among sexual minorities (king & mckeown, 2003; jorm et al., 2002) and why they have uniquely negative experiences within the healthcare system (dobinson et al., 2005). for instance, because of bisexual invisibility, many healthcare providers, including lgbtq-friendly providers, are not always competent regarding bisexuality and are perceived by bisexuals as not inclusive of their identity and reality (dobinson et al., 2005; ross et al., 2010; 2016). bisexuals can also experience judgment or dismissiveness about their sexual identity from health care providers and social workers, as well as inappropriate questions about their sexual practices (eady, dobinson, & ross, 2011). moreover, helping advances in social work, fall 2017, 18(2) 571 professionals may assume the sexual identity of a client who is bisexual based on the client’s current sexual partner (s), thus rendering their identity and reality invisible (eady et al., 2011; page, 2004). bostwick and hequembourg (2014) have explored the ways in which microagressions drive epistemic injustices in bisexual women. they found seven “‘bisexual-specific’ microaggressions routinely experienced by participants and illustrative of epistemic injustice in action: hostility, denial/dismissal, unintelligibility, pressure to change, lesbian, gay, bisexual and transgender legitimacy, dating exclusion, and hypersexuality” (p. 492). these microaggressions reinforce cultural understandings of bisexual incomprehensibility as well as illustrate how bisexuals are regarded as untrustworthy. the authors argue that “the chronic subversion of bisexual…credibility through bisexualspecific microaggressions may be key to understanding the extraordinarily high rates of depression” (bostwick & hequembourg, 2014, p. 499). microaggressions also come from within the “community” (i.e., lgbtq communities) that could potentially be a site of support for bisexuals. this double exclusion, from both hetero and sgm populations, can exacerbate the negative effects of microagressions and epistemic injustice (hequembourg & brallier, 2009). an example that illustrates fricker’s work is the experience of bisexuals within healthcare, which either places them in a “straight” or “gay” box. the concept of bisexuality is largely disregarded or overlooked, except for in some clinics that may routinely work with sgm groups (e.g., lgbtq sexual health clinics; eady et al., 2011). this type of microaggression is problematic as bisexuals have unique health concerns and issues that are usually disregarded (miller et al., 2007). many issues, such as sexual health concerns, can be overlooked, resulting in potential harm (eady et al., 2011). the experiences of bisexuals highlight how the prevailing monosexual paradigm and rigid binary thinking in our society leads to microagressions contributing to epistemic injustice and oppressive outcomes. future directions there is no one solid, prescriptive, answer to the multifaceted issues raised in this paper. epistemic injustice, which translates into felt physical and psychological consequences for bisexuals, is cleverly invisible and insidious. we are in the infancy of social change with regards to sexual/gender liberation. in keeping with bostwick and hequembourg’s (2014) analysis, the following recommendations and suggestions are offered. queer possibilities despite queer theory’s relatively minimal focus on bisexual realities, this perspective still holds great potential to address epistemic injustices experienced by bisexual individuals. working within a queer theory epistemology, in any potential context (e.g., academia, policy, practice), can build understanding and greater awareness of the bisexual experience. in queer theory, attention is given to not only what is said, but also to what is not being said (horn, 2012). giffney (2009) states “there is an unremitting emphasis in queer theoretical work on fluidity, uber-inclusivity, indeterminacy, indefinability… and iacono/epistemic injustice 572 that which is unrepresentable…” (p. 8). the point of queer theory, then, with its focus on raising more questions and problematizing binary notions of sexuality/gender, is not to arrive at an answer about these issues; rather, its contribution to remedying bisexual epistemic injustices would be to bring to light issues to help improve the lives of not just bisexual-identified individuals, but also the lives of all people who are invariably impacted by the dichotomizing, binary understanding of gender, sex, sexuality, and all facets of life. the very essence of a contemporary understanding of bisexuality (i.e., understood as being attracted to multiple genders) unsettles and destabilizes categories of sexuality/gender (robinson, 2017). greater inclusion of bisexuality into works of queer theory would allow for a richer understanding of sexuality, as well as contribute to the undertaking of deconstructing the homo/hetero binary logic. da ̈umer (1999) argues that bisexuality can be conceptualized as “an epistemological and ethical vantage point” that can be used to destabilize binary categories of sexuality and gender (p.159). this viewpoint illuminates the potential for bisexuality to expose inevitable contradictions and ambiguities of all adopted identities (gurevich et al., 2009). more recently, sexuality researchers have described bisexuality as an umbrella term (including behavior, as a non-binary identity), that includes other non-monosexual identities (i.e., being sexually attracted to multiple genders) such as a pansexual, omnisexual, and fluid identities. this evolution refers to a shifting of perspective that emphasizes bisexuality as a non-monosexual reality that may include attraction to more than one gender (compared to more traditional views of bisexuality as being attracted to only men and women; flanders, lebreton, robinson, bian, & caravaca-morera, 2017; robinson, 2017). in recent research, pansexual individuals are generally grouped under the bisexual umbrella (mitchell, davis, & galupo, 2014), with bisexuals and pansexuals identifying in similar ways (i.e., romantic and/or sexual attractions to multiple and diverse genders, including non-binary genders; flanders et al., 2017). therefore, it is important to consider other non-binary forms of sexuality (e.g., pansexual, etc.) that bisexuality represents in our discussions of queering social work research and practice. terms like pansexuality, omnisexuality, and bisexuality (as being attracted to multiple genders) can help our profession generate more complex discussions of sexuality and gender identity and further the queering of social work (gringeri & roche, 2010; robinson, 2017). the marrying of bisexuality knowledge and queer theory allows for a stronger queer theory deconstruction enterprise, while also helping bring intelligibility to the bisexual experience, in its various forms. however, it is also important that we use identity locations, such as “bisexual,” as a strategic political tool without assigning ontological integrity to this identity (butler, 1991). from a social work perspective, it is critical that social identity groups, such as bisexuals, are intelligible in relation to lgbtq and human rights activisms. yet, it is also critical that we are not too rigid and limiting about social identification. this is the ongoing tension that the field of social work must grapple with: acknowledging that these social identities indeed are very much a reality for people while at the same time being careful not to simplify or dismiss the complexity that exists within a particular social category or identity. maintaining this tension in social work — affirming a bisexual identity that is used for political strategizing without assigning ontological integrity to it — may allow for greater visibility, empowerment, and acknowledgment of advances in social work, fall 2017, 18(2) 573 the diverse bisexual experience while simultaneously allow for social activism that addresses bisexual marginalization which creates deeply felt social and material exclusions (voss et al., 2014). bringing in a queer perspective to social work allows for a problematization of social categories and offers a broader approach for understanding sexuality. this reconsideration is in line with social work’s values of self-definition and social justice; queer theory allows us to acknowledge that many paths can take us there (mcphail, 2004). transformative research research has the potential to bring about social change. the enterprise of research has the potential to hold much influence in the public arena, despite the various power relations and power differentials that limit certain types of research. challenging sexuality and gender binaries within social work research and practice will likely come with resistance and difficulty. queering dominant perspectives through critical analysis within social work research is particularly challenging as everything could be questioned, reinterpreted, and rendered uncertain; surely this could bring some discomfort to researchers (mcphail, 2004). further, attaining funding for research that does not align with funders’ worldviews or political agendas could be a significant barrier. notwithstanding, upsetting normalized perspectives is necessary if we are to bring about liberatory social transformation for sexual and gender minorities. the failure to problematize these hegemonic definitions of sexual and gender identity can result in the continued marginalization for many groups, such as bisexuals. reflexivity can encourage researchers to examine power relations and dismantle hegemonic assumptions related to sexual and gender identity (brookfield, 1995), and help them become more aware of what knowledge and understandings they are creating and the ways they create this knowledge (steup, 2014). this reflexive process may be helpful for the task of problematizing binary thinking (mcphail, 2004). working reflexively also allows for the potential to make adjustments to research questions and methods in order to be more inclusive and reflect the realities and knowledge of research participants (ristock, 2001). there are no guarantees that reflexivity will bring about the hoped-for change in social work research practices, but it can certainly be helpful if done with integrity and authenticity. some other important ways, highlighted by mcphail (2004), of queering social work research include: avoiding discrete categories of gender and sexual identity in theoretical models and in explaining findings; speaking more tentatively and conditionally when attempting to make generalizations based on identity categories; and offering “disclaimers” as we attempt to wear identities lightly (laumann, gagnon, michael, & michaels, 1994). further, demographic questionnaires that have open-ended questions, instead of multiplechoice responses, could help with creating more freedom and fluidity with regards to participants’ expressions of multiple and intersecting identities. this strategy can also have implications for dissemination of research findings, as well as help regulate the inherent power of the researcher (fantus, 2013). broadly, i would strongly urge social work researchers working with gender and sexual diversity to make a concerted effort to promote research that is inclusive of minority groups within the sgm population, especially iacono/epistemic injustice 574 focusing on groups with even greater intersecting points of marginalization (e.g., racial and gender diversity). ultimately, these suggestions for social work research could create greater complexity and completeness of scientific understanding in sexual/gender diversity research and contribute to validating bisexuals’ and other sgm groups’ experiential knowledge, consequently reducing epistemic injustice (bell, 2014). embodied knowledge and multiple ways of knowing queer theorist sedgwick (2007), in confronting limitations of critical theory, argues for a “reparative reading” (p. 638) approach—alongside a critical theory approach—that takes into account the power of knowing through affect. sedgwick appears to be calling for multiplicity in knowing, which includes both critical approaches such as queer theory and poststructuralist readings of discourse, as well as felt, embodied knowledge as an important way of knowing. sedgwick also calls attention not only to material conditions but also to the body, with its intensities and knowledge, acknowledging emotions, tacit knowledge, and visceral lived experience (i.e., embodied knowledge). this emphasis is of critical importance, especially considering that embodied knowledge can be seen as a way of disrupting dominant forms of knowledge, and uncovering marginalized ways of knowing (wong, 2004). some critical social work scholars have pointed out the importance of embodied knowledge in order to engage in critical social work practice and research with social justice aims (bai, 2001; tangenberg & kemp, 2002). bringing awareness to our embodied knowledge can provide a path to addressing epistemic injustice. for researchers committed to uncovering issues pertaining to sgm issues, moving into life’s complexities can be unsettling and uncomfortable. researchers must strive not simply to remain within the cognitive realm of knowing but also to be open to bodily and emotive knowing with respect to relating to one another and the world surrounding them (wong, 2004). this critical awareness can help unsettle binaries and bring greater appreciation of and engagement with the fluidity of sexuality and gender. resistance building understanding and greater awareness of bisexuality as an intelligible identity can be seen as an act of resistance. bisexuals might distance themselves or confront negative messages about their realities; they could also educate others about inaccurate understandings and stereotypes and organize or join bisexual groups that seek to engage in activism and social activities (mcgrady, 2012). these approaches may help bisexuals increase their self-esteem and social support. however, resistance is also limiting; strategies such as distancing from others who enact stereotypes risk further segmenting subcultures and reproducing the negative meanings associated with a stigmatized status (lapinski, braz, & maloney, 2010). foucault (1978) argues that sgm groups, in using new words, ideas, and concepts to describe and speak about their distinctive and personal experiences, can begin to exercise power through this resistant language. bringing to light, through research and advocacy, someone’s multi-layered, and oftentimes conflicting narratives can pave the way for a greater understanding of obscured realities (fantus, 2013). sgm groups, in speaking their multiple truths, can feel empowered by challenging stigma and attributing stigmatization to other people’s prejudice (thoits, 2011). advances in social work, fall 2017, 18(2) 575 bringing it all together this paper has sought to develop a critical understanding of the realities of bisexual and other fluid identities in social work research. preliminary suggestions for social work have been offered as a precursor to eventual action. as bisexuality is rarely discussed as a topic unto itself (mcphail, 2004), it is important to generate a discussion about strategies and actions that uncover bisexual realities within social work. this paper could be used as a launching point for interrogating binary assumptions in social work that lead to epistemic injustices for bisexuals and other fluid identities. in line with social work’s approach of implementing collective social action, this writing stands in solidarity with other social work scholars’ (e.g., gringeri & roche, 2010; mcphail, 2004; mulé, 2008) who advocate for greater visibility of sexual and gender diversity in social work. given social work’s values of advocacy and social justice, increasing understanding and action to address the issues outlined in this paper could also impact other professions that interact with social work. this vision is important to maintain if we are to effectively address bisexual marginalization and epistemic injustice in society. references bai, h. 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(2004). knowing through discomfort: a mindfulness-based critical social work pedagogy. critical social work, 5(1). retrieved from http://www1.uwindsor.ca/criticalsocialwork/knowing-through-discomfort-amindfulness-based-critical-social-work-pedagogy author note: address correspondence to: gio iacono, msw, factor-inwentash faculty of social work, university of toronto, 246 bloor street west, toronto, ontario m5s 1v4. gio.iacono@mail.utoronto.ca acknowledgments: the author would like to thank neelu walia, dr. tara la rose and roz spafford for their immense support and very helpful reviews of this article. the author would also like to thank dr. wendy bostwick and dr. amy hequembourg for https://doi.org/10.1037/1099-9809.13.1.72 https://doi.org/10.1093/sw/47.1.9 https://doi.org/10.1521/aeap.2013.25.6.535 https://doi.org/10.1177/0190272511398019 https://doi.org/10.1080/00918369.2014.944055 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3698220/ https://doi.org/10.1300/j159v03n03_02 http://www1.uwindsor.ca/criticalsocialwork/knowing-through-discomfort-a-mindfulness-based-critical-social-work-pedagogy http://www1.uwindsor.ca/criticalsocialwork/knowing-through-discomfort-a-mindfulness-based-critical-social-work-pedagogy mailto:gio.iacono@mail.utoronto.ca iacono/epistemic injustice 582 providing inspiration and a solid theoretical framework to help generate critical discussions on bisexual well-being in the field of social work. epistemic injustice: towards uncovering knowledge of bisexual realities in social work research abstract: lesbian, gay, bisexual, transgender and queer (lgbtq) individuals experience health risks, with bisexuals experiencing higher levels of health risk compared to heterosexuals, gays and lesbians. these disparities are often attributed to stres... background and significance social work and sexual/gender minority issues binary “logic” challenges in research and scholarly inquiry epistemic injustice vis-a`-vis microagressions epistemic injustice microagressions linking epistemic injustice to microagressions future directions queer possibilities transformative research embodied knowledge and multiple ways of knowing resistance bringing it all together references gates, g. j. (2011). how many people are lesbian, gay, bisexual and transgender? ucla: the williams institute. retrieved from http://escholarship.org/uc/item/09h684x2 giffney, n. (2009). introduction: the ‘q’ word. in n. giffney & m. o’rourke (eds.), the ashgate research companion to queer theory (pp. 1-13). burlington: ashgate. johnson, j., & repta, r. (2012). sex and gender: beyond the binaries. in j. oliffe & l. greaves (eds.), designing and conducting gender, sex, and health research (pp. 17-37). thousand oaks, ca: sage. doi: https://doi.org/10.4135/9781452230610.n2 sands, r. g. (1996). the elusiveness of identity in social work practice with women: a postmodern feminist perspective. clinical social work journal, 24(2), 167-186. doi: https://doi.org/10.1007/bf02189730 microsoft word 01 wood_et_al_23845_voluntary_survivor_centered _______ leila wood, phd, mssw, assistant professor, center for violence prevention, the university of texas medical branch. dessie clark, phd, michigan state university. laurie cook heffron, phd, mssw, assistant professor, st. edward’s university austin,tx. rachel voth schrag, phd, lcsw, the university of texas at arlington, arlington, tx. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 1-21, doi: 10.18060/23845 this work is licensed under a creative commons attribution 4.0 international license. voluntary, survivor-centered advocacy in domestic violence agencies leila wood dessie clark laurie cook heffron rachel voth schrag abstract: voluntary, survivor-centered advocacy is a model of practice used in domestic violence organizations; however, more information is needed from the perspective of survivors on how to best facilitate survivor-centered approaches in a voluntary service format. this qualitative study used a thematic analysis to uncover core advocacy approaches from 25 female-identified survivors dwelling in domestic violence emergency shelter and transitional housing programs in two states. themes revealed that three core approaches aid a voluntary, survivor-centered advocacy model: 1) establishing a safe base for support, 2) facilitating access and connection, and 3) collaboration. advocacy approaches that emphasize safety, mutuality, and availability of support best engage survivors in voluntary services to address needs and meet goals. use of a strengths-based approach, psychoeducation, and resource-building contributes to the social and emotional well-being of survivors. findings indicate community dv advocates should use adaptable advocacy models aimed at service access, connection, and collaborative resource acquisition. voluntary, survivor-centered models use principals of trauma-informed care, though more widespread use of trauma-informed care (tic) in voluntary services are needed. advocates need organizational support to meet survivor needs. implications for research include the need for fidelity studies and longitudinal research. keywords: survivor-centered, trauma-informed, domestic violence agency, voluntary services, interpersonal violence, intimate partner violence services for domestic violence (dv) survivors have a long history of using empowerment and agency-building strategies that help survivors to advocate for needs and rights (cattaneo & goodman, 2015; wood, 2015). advocacy is a primary direct service model used with survivors in traditional dv services. at their core, advocacy services represent a departure from traditional case management in social services to an empowerment-based approach to work with dv survivors on their defined goals rather than providing a prescriptive, one-size-fits-all approach ( goodman et al., 2016b; sullivan, 2018; wood, 2014). per federal policy (the family violence and prevention services act of 1984 [fvpsa]) and in alignment with an empowerment perspective, advocacy services are typically offered on a voluntary basis, without service use as a condition for shelter or other resource use (nnawulezi et al., 2018). a growing body of research has recognized advocacy for dv and sexual assault survivors as a distinct service model ( davies & lyon, 2014; goodman & epstein, 2008; wood, 2014); however, more information is needed to enhance voluntary, survivor-centered advocacy practices (davies & lyon, 2014; goodman et al., 2016c; nnawulezi et al., 2018). given the centrality of survivor voices in the work of dv advocates, more information is needed on the perspective of dv survivors about advances in social work, spring 2020, 20(1) 2 what they need and want from their work with advocates, in order to further develop best practices. to amplify survivor voices in this area and enhance the efficacy of voluntary, survivor-centered models in dv agencies, the current study used thematic analysis to understand what advocacy approaches aid a voluntary, survivor-centered model from the perspective of those engaging in services. twenty-five dv survivors who were actively participating in voluntary advocacy services at emergency shelter or transitional housing programs participated in semi-structured qualitative interviews to share their perspectives about enhancing services. literature review dv is a pervasive public health problem. the centers for disease control and prevention (cdc) national intimate partner and sexual violence survey (nisvs) found that 37.3% of women reported experiencing violence by an intimate partner during their lifetime (smith et al., 2017). dv victimization can result in physical injury and chronic physical health problems, such as headaches, asthma, and diabetes, and may lead to hospitalization or death (breiding et al., 2014). mental health impacts from dv include post-traumatic stress disorder (ptsd), depression, anxiety, insomnia, substance abuse, and trauma symptoms (campbell, 2002). dv can also negatively impact economic stability, housing stability, and outcomes for children, and is a leading cause of homelessness in the united states (jasinski et al., 2002; klein et al., 2019). dv shelters, non-residential services, and housing programs are the mainstream refuge for survivors facing safety and economic challenges (baker et al., 2009; panchanadeswaran & mccloskey, 2007). the national network to end domestic violence (nnedv, 2017) estimates 1,910 dv-focused agencies exist in the united states to meet the needs of survivors and their children. an estimated 72,959 survivors are served in a single day, with 41,195 through shelter or transitional housing and 31,764 through non-residential care (nnedv, 2017). dv advocacy services dv programs aim to increase survivor social and emotional well-being by fostering self-efficacy and increasing access to resources and support, often through advocacy services (sullivan, 2018). advocate is the common term for a direct service worker in the field doing work that is generally not clinical in nature. advocates work with dv survivors to help increase safety, meet social and economic goals, access resources, and promote healing from trauma (goodman et al., 2016b; rivas & vigurs, 2018; sullivan, 2018). advocates frequently come from social work or other helping professional backgrounds (wachter et al., 2019; wood et al., 2019). advocacy contributes to increases in outcomes related to survivors’ well-being (sullivan, 2016). well-being includes emotional, social, and physical components such as perceived quality of life, feelings of support from others, and physical well-being (sullivan, 2016). previous research indicates that by providing information; offering encouragement, supportive counseling, and safety planning; and increasing access to resources and social support in advocacy services, survivors reported increases in safety, resource acquisition, and emotional and social well-being (constantino et al., 2005; haj-yahia & cohen, 2009; lyon et al., 2008; sullivan & bybee, 1999; tiwari wood/voluntary, survivor-centered 3 et al., 2010). additionally, advocacy has been shown to decrease negative outcomes such as subsequent experiences of violence and negative mental health symptoms (bybee & sullivan, 2002; sullivan & bybee, 1999). findings from wathen and macmillian (2003), sullivan and bybee (1999) and ramsey et al. (2016) indicated that advocacy significantly reduced subsequent victimization in dv survivors up to two years after exit from a shelter. goodman et al. (2016b) found that the alliance between the advocate and survivor was essential to increasing well-being. in a sample of 370 survivors, a stronger alliance predicted decreased depression and ptsd through empowerment-based safety. while shelters and housing programs remain the central hub of dv services, advocates also work in other institutional settings, such as non-residential services, courts, medical offices, law enforcement, and counseling agencies (allen et al., 2004). while variations in advocacy models exist, the 2010 update to the family violence prevention and services act (fvpsa) clarified that dv shelter supportive services receiving federal funding, like advocacy or counseling, must be available to service users on a voluntary basis, and that participation in services must not be used to determine shelter eligibility (u.s. department of health and human services, 2012). a voluntary service model, as outlined by fvpsa, provides respect for survivor autonomy and allows room for individualization based on each person’s unique circumstances and needs (missouri coalition against domestic & sexual violence, 2012). voluntary and low barrier, or more accessible, services are inherently more survivor-centered than mandated service models, and are linked to increased survivor autonomy and empowerment (nnawulezi et al., 2018). to enhance the effective implementation of survivor-centered voluntary advocacy services, an understanding of the perceptions of survivors using services is critical. survivor-centered advocacy. increasingly, survivor-centered advocacy, a service model based on a feminist, empowerment approach to promote individualized survivor well-being, is endorsed for voluntary dv services (davies & lyon, 2014). survivorcentered advocacy acknowledges the variety of needs of individual survivors and is sensitive to the diverse needs of survivors and their families. this approach allows survivors and advocates to shape services based on their own goals, with an emphasis on partnership between the survivor and advocate (goodman et al., 2016c). while few established models of advocacy have been empirically tested, available research suggests individualized advocacy services are effective in addressing social and emotional support needs (allen et al., 2013; bybee & sullivan, 2002; goodman et al., 2016b). two examples of survivor-centered advocacy are described below. the community advocacy project (cap) was designed to be a survivor-centered, short-term, intensive service model (allen et al., 2004; allen et al., 2013; bybee & sullivan, 2002; sullivan & bybee, 1999) and helped to establish evidence for core advocacy services. cap was found to be effective in increased outcomes such as safety, social support, quality of life, and well-being, especially when coupled with increased time with an advocate, and the ability to meet survivors in a safe convenient location (allen et al., 2004; bybee & sullivan, 2001). a process evaluation of cap from allen et al. (2013) highlighted that critical program components included orientation to the whole person, unconditional validation, and information provision and action (allen et al., 2013). the cap model has been adapted cross-culturally and has been disseminated in areas of latin advances in social work, spring 2020, 20(1) 4 america. findings in mexico have suggested similar efficacy after cultural adaptation (sullivan et al., 2016). another model of survivor-centered practice is the victim defined advocacy (vda) framework developed by davies and lyon (2014). this framework centers on survivor autonomy and empowerment, and the assessment of both batterer-generated risks and lifegenerated risks. these risks are posited to work across levels and systems to inhibit survivor’s quality of life and safety (davies & lyon, 2014). other key components of survivor-centered practice include advocates working with survivors to build partnerships, review risks, and identify options based on relevant priorities, decisions, and dangers (davies & lyon, 2014; goodman et al., 2016c). theoretical orientation. a feminist empowerment frame is a central theoretical construct in voluntary dv advocacy, rooted in the idea of undoing the abusive partner’s use of power and control. empowerment approaches seek to give power back to those who have been oppressed and are closely linked to feminist and critical interventions (dominelli, 2002), as well as crisis intervention models that emphasize personal agency and decision-making (roberts, 2007). cattaneo and goodman (2015) describe empowerment-based practice for dv survivors as an interaction with the social world where a person is able to act on meaningful goals, draw on support to meet those goals, and reflect on the extent to which the action taken results in desired progress. qualitative interviews with women staying in a shelter suggest that interventions are more meaningful when they seek to empower survivors through mutual power-sharing, information-giving, and advocacy (haj-yahia & cohen, 2009). voluntary and survivor-centered models of advocacy are closely theoretically linked to an empowerment perspective, but more information from the express perspective of survivors using dv services is needed to guide effective implementation (goodman et al., 2016c; sullivan, 2018). need for the current study. while many dv agencies strive for a survivor-centered voluntary service model, there is little guidance from the survivor perspective about how to best apply this advocacy approach. research in implementation science points to key characteristics of health and social service interventions that are likely to be successfully implemented with fidelity and longevity (damschroder et al., 2009). evidence finds stronger implementation outcomes for interventions when staff and agency leaders have a positive sense of the source and quality of the evidence surrounding the intervention, when they have a positive sense of the perceptions of clients related to the intervention, and when the intervention includes a clear set of manageable and defined tasks (damschroder et al., 2009). research supports the efficacy of advocacy service models such as cap (allen et al., 2004) and highlights the importance of the advocate-survivor alliance (goodman et al., 2016c). however, perceptions of voluntary survivor-centered advocacy services from the survivor perspective are lacking, and less is known related to the defined tasks of effective advocacy services. the survivor perspective of advocacy skills and approaches is crucial to help advance the successful uptake, implementation, and subsequent evaluation of a survivor-centered advocacy model. thus, to amplify the voices of survivors of violence, the current study used qualitative thematic analysis (braun & clarke, 2006) of narrative data from dv survivors at four agencies using a voluntary service model to explore what advocacy skills and approaches help survivors meet their needs. wood/voluntary, survivor-centered 5 method the data from this study are a component of a larger study that aimed to understand the experiences of services for dv survivors using shelter and transitional housing programs (wood et al., 2017). the current study focused on survivors’ perspectives of voluntary, survivor-centered advocacy approaches. the research question guiding the analysis was: “what approaches aid a voluntary, survivor-centered advocacy model?” twenty-five women participated in this study. the lead author recruited research participants from four non-profit organizations focused on serving survivors of domestic violence across two diverse states (one in a midwestern state and three in a large southwestern state). the participating organizations provide counseling and supportive services, shelter and other housing programs, and advocacy services for survivors. organizations selected were domestic violence focused-agencies known to the first author. all organizations identified as using a voluntary service model. participants included residents and former residents of shelter and transitional housing programs, all of whom had participated in advocacy services. the lead author worked collaboratively with agency staff in shelter and transitional housing programs to recruit participants using flyers and to schedule interviews with interested current and former residents who identified as dv survivors. an effort was made to recruit both shelter and transitional housing participants to gather a range of duration and intensity in the advocacy relationship. recruitment was open to participants of any gender and yielded a sample of all female-identified. table 1 describes selected characteristics of research participants, including the type of services received by participants, age, racial/ethnic background, and education. table 1. selected demographics of study participants (n=25) age years range 25-56 average 37.5 racial/ethnic background n (%) african american 8 (32%) latinx 4 (16%) white 11 (44%) multiracial 2 (8%) education some high school 7 (28%) high school graduate/ged 8 (32%) some college 8 (32%) college graduate 2 (8%) dv residential program shelter 15 (60%) transitional housing 10 (40%) data collection in-depth, in-person interviews were the primary data collection strategy. all participants received written information describing the study and information important advances in social work, spring 2020, 20(1) 6 for informed consent to participate, in addition to cash compensation ($20) for their time and expertise. interviews lasted on average an hour and were digitally recorded and transcribed. no identifying information was collected. the lead author, a social worker with extensive experience working with dv survivors, interviewed all participants inperson and on-site in a private area. the semi-structured interview guides designed for this study aimed to elicit participant experiences through open-ended questions about survivors’ experiences with advocates, their needs and preferences for advocacy services, and their observations and opinions of advocacy approaches. the interview protocol included broad open-ended questions about the experience in shelter, including: “what is it like to live here?”; “what do survivors need when they come to (agency)?”; “what was it like to work with your advocate?”; “how did you and your advocate approach your work together?”; “what support did you need from your advocate?”; “what would you change about services here?” this study was approved by and complied with the first author’s institutional review board at the time, texas state university. researchers assigned pseudonyms to each participant for the purposes of analysis and dissemination of findings. while the interview protocol did not ask about past abuse, interviews nonetheless held the potential of eliciting painful or traumatic memories of abuse and violence. at any point during the interview, if the participant experienced discomfort, they were free to pause or end the interview, though this did not occur in any interview. given the method of recruitment and collaboration with program staff, all participants who expressed immediate needs were referred to an on-call staff member who could address any concerns resulting from the interview. the interviewer distributed a resource list of additional services as needed. data analysis. researchers used thematic analysis approaches (braun & clarke, 2006; clarke & braun, 2013). the first and third author first read through the data for initial familiarization and beginning identification of themes. then they independently organized and developed initial codes, coded data, beginning with open, line-by-line process coding of full interview transcriptions to search for and categorize themes related to engagement with advocacy services (charmaz, 2006; clarke & braun, 2013). next, the researchers reviewed and mapped themes to examine relationships among the themes. a total of seven themes, with 18 subthemes, were in the final codebook. a final phase of analysis involved the reassembling and rich description of major themes identified during the initial phases of coding (braun & clarke, 2006; saldaña, 2013). the researchers engaged in memowriting and peer debriefing between coders throughout the analysis process. regular peer debriefing was used to resolve coding disputes and share analytical memos. the themes saturated across all participants are presented in this analysis. the following strategies enhanced the quality and rigor of this study: worthy topic, credibility, audit trail, and peer debriefing (creswell & miller, 2000; lietz et al., 2006). first, survivors’ perspectives on and experiences with the advocacy approach in the context of shelter and transitional housing represents a topic worthy of exploration and is relevant to both survivors and social service practitioners. second, researchers sought credibility through digital recording and transcription, multiple coders, and triangulation meetings. throughout the process, researchers maintained an audit trail of memos, methodological wood/voluntary, survivor-centered 7 decision-making and processes, and analysis decisions (rodgers & cowles, 1993). initial findings were reviewed with practitioner collaborators as a form of peer-debrief. findings to better facilitate the use of survivor-centered advocacy, this research explored survivors’ relationships with their advocates and how advocates helped to meet their needs and achieve goals using a voluntary service model. these findings underscore the help and potential healing benefit from advocacy services, and conversely, the hindrance of negative interactions between survivor and advocate. the relationship between the advocate and survivor during services is one that at its best, is built from collaboration, empowerment, mutual guidance, and the advocate’s skill, warmth, availability, and equitable treatment. the survivors’ motivation to work with the advocate to achieve goals also contributes. conversely, when the advocate and survivor relationship is less than positive, conflictual, or incomplete, there is a lack of fit between needs, approach, and skills. at its worst, the survivor may feel ignored, discriminated against, or actively silenced. participants in this study indicated that the best approaches for survivors and advocates for a voluntary, survivor-centered model are characterized by: a) a safe base for support, b) access and connection, and c) collaboration. a safe base for support. survivors emphasized the need they have for advocates to establish an emotionally and physically safe environment. establishing safety begins with the first interactions with advocates to take care of their immediate physical needs. commenting on her intake process, rhonda stated: they just did intake and gave me little bags with snacks in them and gave me my sheets and just calmed me down, told me everything was gonna be okay and just left me alone. let me be comfortable. safety is also clearly signaled by the built environment (e.g., gates and locks on the doors) as well as the structure of human resources and housing staff (e.g., staff on-call around the clock). however, advocates also play an important role in establishing safety and do so by developing kind, caring rapport with clients. many participants articulated that being able to talk to their advocate and receive empathic reactions were key to feeling not only physical safety but also emotionally safe in their relationship with their advocate. ruby described how her advocate helped establish safety through rapport-building: just being sweet and kind. that’s all it really takes –just be kind and sweet. just show that you really care, i mean, because you are working with these ladies individually, so just show that you care. that’s all it takes, to me, i think. yeah, it’s got a lot to do with [how] a person acts toward another person–not so much in letting their feelings be out there, but let them–make them feel safe and good about themselves because they already feel bad enough with their abuser because that’s what they do …just having somebody that lets you know that everything’s gonna be all right and that you are something, you are somebody, and you got somebody that cares about you and just that really. advances in social work, spring 2020, 20(1) 8 participants also identified the importance of confidentiality and privacy in ensuring their sense of safety. privacy included the need to maintain control over the speed and pacing of when and how much to share with an advocate. gracie, for example, remarked, a lot of times, i think, like even with me when i first got here, i didn’t feel comfortable talking in front of anybody. i didn’t want anyone to know my story. not feeling pushed, or even obligated, to share certain aspects of their life was important in boundary-setting and building trust. makayla recalled early interactions with advocates: listen, like when the person talks, and just invite them to be open and don’t be so pushy like asking them the same question, but re-wording it. i get that a lot, like i’m not understanding what you’re doing. i don’t know–just don’t be so pushy. safety is also facilitated by the advocates’ use of a non-judgmental and understanding approach, illustrated through their words and actions, and thus emerged as an important need expressed by participants. understanding means the advocate was aware of the challenges, barriers, and experiences of survivors. participants expressed the need for advocates to both sympathize and empathize with clients without expression of judgment for past actions. nicole emphasized that being understanding does not always necessarily mean being overly nice or avoidant. she described her advocate, she’s quite possibly the most understanding person i’ve ever met in my life, but at the same time, she just doesn’t take bullshit. one cue that an advocate may be understanding is if they have shared life experiences that might lead to increased empathy or the ability to connect with survivors, as makayla noted: the [staff] here–we’ve been through the same thing. knowing that there was somebody who went through the same thing, they weren’t judging me or looking at me like, ‘how could you be so stupid? why’d you stay for so long? why’d you have five kids and then leave?’ despite the potential benefit of advocates having a shared background with dv, survivors emphasized that non-judgmental understanding involves an acknowledgment of the diversity of possible survivor experiences and advocates’ recognition of their own limited knowledge, understanding, or shared experience. when asked what an advocate could do to better help survivors, ivy noted that refraining from acting as a judge could help to create a better connection: remember that you are not a judge. never to think, hard to say, ‘i know what you’re going through,’ because every single story is different. i’ve heard someone say it and i feel like–i don’t say it out loud, i think it to myself–they’re still in the beginning of this journey when they say, ‘i know exactly what you’re going through,’ or ‘i’ve been through the exact same thing,’ but i’m like, no, you weren’t there that night he da-da-da and i wasn’t there that night that he to you da-da-da-da, so no, we aren’t– an advocate, we all, need to remember that. while some advocacy approaches carry the unintended consequence of making a survivor feel judged, survivors recognize and articulate the mixed benefits of these wood/voluntary, survivor-centered 9 approaches. advocates can promote safety by explaining the voluntary nature of services. when services are not perceived as voluntary, the impact can be detrimental. for example, tammi described feeling as if she had to meet with her advocate every day. it’s really stressful for me. i’m having a lot of issues with anxiety and i almost feel like i’m in front of the teacher for an evaluation. access and connection. access and availability of the advocate helps facilitate connection to engage in work together, which is especially important when there is no mandate to use services. participants repeatedly asserted that the availability of and access to their advocates was important to both establishing rapport and getting their needs met. consistent, on-request availability provides survivors the opportunity to reach out to advocates as issues arise and facilitates feeling supported. participants also articulated the need for advocates to be explicit about what to expect as far as availability. makayla suggested, let them know ‘if you need somebody to talk to, i’m here to talk to you. you can talk to me about anything, feel comfortable, just knock on my door and we can talk. the perception of availability and accessibility is furthered by the presence (physical or electronic) of the advocate and by proactive check-ins to see if clients need support. when an advocate is perceived as hands-off, participants view this as advocates being inaccessible, thus limiting rapport and connection. not only does a hands-off approach inhibit their ability to interact with their advocates, but some participants perceived this as the mechanism through which their needs are left unmet, and thus they receive lower quality care. as gracie shared: yeah, i think they should offer us other counselors instead of the counselors that are here because they’re so busy–there’s so many people here that they can’t see us all and anytime if we have a crisis or are going through something, they’re booked out a week in advance, so what are we supposed to do? we have to just deal with it. participants were aware of the multiple demands on advocates’ time and scheduling. they regarded advocate availability with such importance that they may prioritize other survivors’ needs over their own. cheryl described reducing her use of the advocate so that other survivors had more opportunities: i’ll stay and deal with it, but a lot of the women here need more help than what i need and so i stand back and let my advocate who’s–my advocate’s not just my advocate, she’s other people’s advocate–so i try to stand back and let her do what she needs to do for them because they obviously need a little bit more attention than i do, and everybody’s story’s different and situation is different and their ability to work or not work because they’re bi-polar or they’re just afraid to leave… engaged listening, or listening that reflected active understanding of survivor needs, also facilitates access and subsequently, connection. participants identified a need for their advocates to not only listen to them but to hear them and reflect that in their interactions advances in social work, spring 2020, 20(1) 10 and engagements. paula clearly expressed the need for engaged listening to take priority over other tasks: listen to them. listen to them carefully. listen. carefully. and let them talk. let them talk. paperwork–no, don’t grab all that first. let them talk. listen, let them express themselves. let them get it out, get everything out. that’s a relief coming in places like this. you know what i’m saying? that’s a relief coming to a place like this, let me get it out instead of telling me, oh, sign this, these are the rules–no, let me get it out. let them spill their guts. i mean, for however long it takes, let them talk to you. they wanna tell you and they wanna tell you stuff that they’ve been wanting to say and then see, they’re holding it in and all they do is adding on to the anguish, the depression, the bitterness, until the next place. participants indicated that when advocates listen and as gracie noted “pay very good attention at what they say and don’t make them repeat themselves,” and reflect that information back, they are able to gather information to better inform their interactions with their clients in the future and promote a sense of alliance. engaged listening can have both a relieving and an empowering impact on survivors, as cheryl described: it just–it opens my heart up and opens my mind, i don’t know how to explain that. what does that do? it makes me feel awesome. it makes me so that i can go upstairs, it takes so much away from me to just listen to me that when i go upstairs, i’m not mad at (daughter) anymore, she could be screaming and hollering at me, but i’m not mad at her no more and i can understand where she’s coming from a little bit better because at first, we’re going at it, we’re going at it, and i’m not trying to understand her, i’m trying to get her to understand my point, but then when i walk away and i have a chance to talk to my advocate and she just listens to me and says things like, ‘well, how does that make you feel? how do you think that makes her feel?’ in engaged listening, advocates often respond with supportive efforts to help clients generate ideas about potential solutions to meet needs and accomplish goals. interestingly, survivors also identified the delicate balance between listening and using typical case management skills such as goal-setting and connecting clients to resources. for example, survivors reported differing perspectives on giving and receiving advice from advocates. some participants wanted advocates to listen and not give any feedback. others wanted advocates to actively listen so they could provide feedback and input, as brandi noted: no, they just need to sit down and listen. just listen to the clients. listen to them and hear them real good and then give them some feedback and then they’ll still talk. they’ll talk some more if you feel like you wanna talk to them, you know what i’m saying? i know you have different appointments–you can’t spend the whole day with one client. but at least give them 30 minutes and listen to them and then give them the feedback on what you heard them tell you. and some victims it motivates them, like me–it do. if i’m talking to you and you’re my counselor and i’m letting you know i’m depressed today, ok, when i’m depressed and i’m telling you, i want you to be able to give me some input back to let me know, ok, what can i do to make it better. wood/voluntary, survivor-centered 11 when advocates are perceived as available and accessible, survivors reported reaching out more frequently to address challenges and needs and engage in services. joy described how her legal advocate’s high level of access helped to build rapport and achieve goals: she’s a legal advocate over there. she helped me write out my divorce papers and my protection order and stuff and no matter what’s going on in my legal life, i always bounce everything off of her. she goes to every single one of my court hearings. that woman takes time out of her day to go to my court hearings!...i mean, she’s indispensable as far as i’m concerned. as far as that, but she more than anything else, she’s home, she’s family, i love her. collaboration. safety, access, and connection build the foundation for active, survivor-centered work on needs and goals in a voluntary service model. advocates not only offer resources and support to survivors, they may also help survivors to create a path forward or guide them to meet goals like exiting sheltering into safe affordable housing, addressing mental health care needs, or removing barriers to resource access. ivy used an analogy to describe the collaborative work of advocacy as paddling together: say you’re in a canoe and instead of going like that and shoving somebody out into the middle, give her a nice little kick-off and just let them drift, but if they start going towards the wall, they grab the paddle and let it slide back the right way– that’s more them instead of *swoosh*, stop it and turn it around. paddling, or collaborating together, represents using flexible skills and approaches to meet goals. one of the primary ways advocates collaborate to help survivors on their journey is through education and normalization. participants shared how their advocates were able to share information about available resources, common trauma reactions, untangle legal jargon, and breakdown strategies of abusive partners. providing information and support, especially about the impact of abuse, can help survivors to reduce blame and achieve goals. as elena noted, psychoeducation normalizes survivors’ experiences of the abuse, as well as the process of healing from violence: whenever i would tell her about the problems i was having with anger and stuff, she was–she would tell me that that was normal, basically and it’s nice being able to hear other people having similar situations and then you feel less crazy. i had told her one thing where he was mostly–he would just fuck with my head constantly and that was his game and he did it on purpose and the farther i got away from him, the more i realized examples, would write them down and talk to her and i told her that one time, one example i told her, i just asked him to hit me because i wanted him to get out the anger and she’s saying–she made me feel like that was not as crazy as i thought it was at that point because i just wanted him to get it out, basically, and it was very normalizing for me to realize that both i was doing well because she would comment about how i’m doing in dealing with everything and also that so many other people go through these same steps that i was and then when you fall back, she’s still there to tell you that you’re okay and you can keep on moving forward and also with different kinds of stuff of dealing with the stress. advances in social work, spring 2020, 20(1) 12 advocates also support survivor goals by engaging actively in advocating for clients to help them gain resources and meet goals. participants stated that their advocate needed to both work for them and with them. in discussing advocates working for them, participants talked about connecting through listening and the philosophy of survivordriven services. for example, brandi stated, “you work for me, i’m the one that’s the victim. without me, you wouldn’t have a job.” specific examples of working for participants include making calls, connecting to other services, lobbying decision-makers at housing and other resources, and motivating participants. survivors also identified the ability to advocate and vouch for survivors in difficult situations as a component of working for participants. as cheryl described: it’s my hope that my advocate can go to bat for me to section 8 and tell them, ‘look, since she’s been here, she has gotten her a car, she’s never been late on her rent,’ and they can go to bat for me to be able to get into section 8 instead of me being on housing authority property around all the people that i shouldn’t be around because of my drug charge, i’m hoping that she can go to bat for me and get me into section 8 so that i can be able to pay the lesser rent and take care of the children better. the ability for an advocate to work for or alongside survivors was perceived as an indication of caring and respect. furthermore, participants described relief that their advocates were partners and shared the workload of rebuilding their lives after fleeing abuse. shira shared an example: well, for instance, for this new place, we’ve been calling around, me and my women’s advocate have been–we got the section 8 list of apartments and we’ve been calling around. she would do half of them and i would do the other half just to see if we got anywhere and we came across two places that were accepting people by next month. unlike mandated or manualized service approaches, a voluntary, survivor-centered service model takes a flexible approach to advocacy. alongside advocating for and with survivors is helping assess needs and set goals to build a way forward. autumn described the importance of advocates’ skill sets including needs assessment and goal-setting: if your main goal is to get every woman here self-sufficient and learn about domestic violence so we don’t get back in the situationy you take that person and you immediately figure out what they need, what they have. take them and get stuff that they need so that the first priority can be, all right, you’re ready to go look for a job. goal-setting can also help increase hope and facilitate empowerment. leslie reported that in working with her advocate, each day, we’d come up with resolutions. i would just go by each day and we would meet each morning and she just gave me so much insight that each day, everything became, every goal became closer. tammi described the empowering impact of strengths-based goal-setting in the wake of emotional abuse: wood/voluntary, survivor-centered 13 they help focus you on certain goals that you need met and a lot of it really is empowering. if you’ve got somebody telling you forever you can’t do anything or you don’t do anything right or–a lot of people fall into that and when they’re away from it, they don’t know where to start from and it does give them a positive reinforcement. yes, you’re capable of doing this for yourself or getting employment to feel better about yourself, not just for money, but it helps redefine you or give you somewhere to start from. participants indicated that advocates must be ready and able to collaborate on what needs to be done, and when it needs to be done, in order to help meet the set goals. sherri reported that it is helpful for an advocate to provide a step-by-step guide, “this is how this process is gonna go. you’re here, you’re trying to get here, but if you don’t take these steps, you’re not going to get [there]. it’s laid out, simply.” sherri mentioned that, because “sometimes you’re thinking about all this other stuff that’s going on inside–junk inside of your head,” she needed “somebody who can kinda keep me on the straight and narrow.” discussion for the last decade, research has indicated the need to make voluntary dv advocacy more survivor-centered (davies & lyon, 2014; goodman & epstein, 2008; goodman et al., 2016c; sullivan et al., 2017). however, there is a dearth of information from the perspective of survivors on how to shift advocacy practice to meet these goals. interviews with 25 female-identified dv survivors in shelter and transitional housing helped to decrease this information gap. participants emphasized the need for a safe space, both physically and emotionally, in order to build rapport and connection. it is critical that advocates make time and space to engage in listening to survivors’ stories, and actively reflect that they have heard their needs. further, advocates need to be accessible and available to survivors to facilitate connection and engagement. feeling heard, as one survivor noted, opens hearts and minds for the work ahead. the perception of advocates as judgmental or unavailable can lead to service disengagement. finally, advocates and survivors collaborate to meet their goals through education, resource connection, and goalsetting. these findings provide further support for sullivan’s (2018) assertion that fostering social and emotional well-being for clients with activities such as safety planning, skillbuilding, increasing resource access and social support, and empathy are critical for survivors. there are several study implications to note. while safety is a bedrock of dv services, more attention is needed to the manner in which advocacy and other programmatic approaches hinder emotional and physical safety. this begins with intake and includes the built environment and agency rules (wood et al., 2017). refraining from judgment creates conditions where survivors can share their goals and needs without fear of repercussion. questions and statements during hotline assessments, intake, and advocate-survivor interactions need to be phrased carefully to minimize the impression of judgment. engaged listening helps promote what goodman et al. (2016b) labeled alliance between the advocate and survivor. however, a lack of availability or access to the advocate can hinder alliance and reinforce feelings of isolation. the widespread implementation of voluntary service models promotes the empowerment goals of advocacy but requires continual advances in social work, spring 2020, 20(1) 14 engagement with survivors to make sure services fit needs (nnawulezi et al., 2018). an implication of this study is the need to modify voluntary service practices to increase opportunities for survivor engagement while continuing to center agency and choice. this requires a careful balance of the survivor-driven orientation of voluntary services with the provision of support and information through regular communication, check-ins, and information sharing. such voluntary service models can be challenging to implement because advocates may focus strongly on avoiding being “pushy” or presenting services as a mandate and end up being overly hands off, to the point that clients do not feel like they can reach out. for advocates, it can be labor-intensive to navigate this line effectively. consistent with weintraub and goodman (2010), findings from this study support advocacy approaches that work both for and with survivors on their preferred goals. the results of this study further suggest that a survivor-centered approach also reflects a trauma-informed care (tic) approach. participants in this study expressed the importance of and need for establishing safety and providing education about the impact of abuse reflecting components also aligned with tic (hedden, 2015). the tic guiding principles as outlined by hedden (2015) are safety, trustworthiness, peer support, collaboration and mutuality, empowerment, voice, choice, as well as attention to social location. the traumainformed model of voluntary advocacy, when applied to interpersonal violence, typically focuses on understanding the individualized nature of trauma and responding with services that prioritize safety and maximize opportunities to regain autonomy by offering survivors choice in service and support use and options (nnawulezi et al., 2018; sullivan et al., 2017). trauma-informed models of advocacy have been previously noted to increase self-efficacy, feelings of safety, and empowerment (sullivan et al., 2017). the findings of this study support the body of literature that suggests advocates should focus on resource acquisition for survivors, as well as providing information and referrals for a variety of individualized needs (allen et al., 2004; davies & lyon, 2014; sullivan, 2018). however, resource referral alone is not sufficient. these data suggest that while advocates should provide resources to their clients, they should also ensure that those are the best resources to meet survivors’ individual needs and ultimately their goals. furthermore, resources should be presented to survivors with a collaborative road map to help survivors understand what services may be useful, when, and in what order. working from a survivor-centered, trauma-informed perspective requires a balance of engagement and listening that takes patience, skill, and emotional energy, in addition to organizational support (nnawulezi et al., 2018). as dv advocates already face significant challenges with low pay and occupational stress (kulkarni et al., 2013; slattery & goodman, 2009), using a trauma-informed and survivor-centered model also necessitates organizational support and ongoing training to help advocates thrive in their roles. as suggested by previous research, this may include increasing advocacy staff, providing high-quality supervision, and peer support (kulkarni et al., 2013; slattery & goodman, 2009). further, additional advocacy skills may be needed to best implement survivorcentered approaches and balance advocate workload, such as the use of social networkoriented approaches facilitated by peer engagement (goodman et al., 2016a) which aim to reduce isolation and increase support from the community. social network approaches may wood/voluntary, survivor-centered 15 be especially important for helping survivors create new social networks and to reengage with old networks for increased support (goodman et al., 2016a). limitations while this study offers critical survivor insights into the continued development and improvement of survivor-centered models of advocacy, limitations and the need for further research remain. given the scope and exploratory nature of the study, we did not investigate potential differences between the four agencies based on program structure, advocate training, and guidelines for service, leading to an inability to assess one advocacy model in particular. additionally, this study does not examine differences in advocacy needs based on factors such as race, ethnicity, gender, class, religion, immigration, or disability status, which may be critical to understanding survivor perspectives. future research should use a larger and more diverse sample and begin with an intersectional design to examine these critical issues. furthermore, while dv continues to disproportionately impact women, the authors acknowledge that a wide range of individuals, including men and those who identify as gender-queer and non-binary experience dv. the field will benefit from future research that explores the role of gender, as well as additional factors that may impact the needs of survivors and advocacy approaches in order to ensure they are appropriate and effective. furthermore, this study was strictly qualitative and focused on perceptions and experiences of advocacy. future studies incorporating quantitative methods may further examine implementation factors of advocacy models such as feasibility and resource use. recommendations this work points to the need for more research on survivor-centered, trauma-informed advocacy model implementation and fidelity, expanding the work of previous studies on the cap, vda, and other models of survivor-centered practice (allen et al., 2004; bybee & sullivan, 2001; goodman & epstein, 2008; goodman et al., 2016c; sullivan & bybee, 1999). the findings from this and other studies need to be tested on a larger scale with mixed-methods assessments. evaluation is needed to understand the outcomes of different survivor-centered advocacy approaches and how they compare with other service provision models. outcome evaluation work is also needed to assess the efficacy of differing models, particularly considering issues around mental health, addiction, and cultural intersections and adaption. additionally, more information is needed to guide the use of voluntary service models that typically accompany a trauma-informed, survivor-centered approach. the small body of literature on voluntary service models suggests it is an empowering approach (nnawulezi et al., 2018), but there is a dearth of information to guide implementation. without this evidence, data suggest that implementation will be less consistent (damschroder et al., 2009). the domestic violence field would benefit from future research and evaluation to establish models of voluntary service advocacy using survivor-centered and trauma-informed approaches. advances in social work, spring 2020, 20(1) 16 conclusion services for dv survivors have long used empowerment and agency-building strategies in advocating for survivors’ needs and rights. however, changes in dv services have shifted the ways in which advocacy operates and is often defined by service providers rather than survivors. using survivor-centered approaches may help to enhance the traumainformed model in dv services, and support a voluntary service model. this study further highlights and delineates the needs and corresponding skills survivors may need from their advocates. increased understanding of survivors’ advocacy needs, approaches to advocacy services, and advocacy skills required for service will lead to improvement in the overall quality and effectiveness of care for dv survivors. the findings of this study present a strong foundation from which future research can further explore the best practices for core dv advocacy services. references allen, n. e., bybee, d. i., & sullivan, c. m. 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(2010). working with and for: student advocates' experience of relationship-centered advocacy with low-income women. american journal of orthopsychiatry, 80(1), 46-60. https://doi.org/10.1111/j.19390025.2010.01006.x wood, l. (2014). domestic violence advocacy (doctoral dissertation). retrieved from https://scholarworks.iupui.edu/bitstream/handle/1805/5605/wood_leila_dissertation _april30.pdf;sequence=1 wood, l. (2015). hoping, empowering, strengthening: theories used in intimate partner violence advocacy. affilia, 30(3), 286-301. https://doi.org/10.1177/0886109914563157 wood, l., cook heffron, l., voyles, m. e., & kulkarni, s. (2017, online first). playing by the rules: agency policy and procedure in service experience of ipv survivors. journal of interpersonal violence. https://doi.org/10.1177/0886260517716945 wood, l., wachter, k., rhodes, d. m., & wang, a. (2019). turnover intention and job satisfaction among intimate partner violence and sexual assault professionals. violence and victims, 34(4), 678-700. https://doi.org/10.1891/0886-6708.vv-d-1800134 author note: address correspondence to leila wood, center for violence prevention, department of obstetrics and gynecology, the university of texas medical branch galveston, galveston, tx. email: leiwood@utmb.edu wood/voluntary, survivor-centered 21 appendix: interview questions gender identity ________________ racial/ethnic identity _________________ age __________________ what is your educational background? interview questions 1. this interview is about the services that domestic violence survivors receive. when did you last receive help or support from a domestic violence agency? 2. how did you come to need help from a domestic violence agency? 3. had you received help from a domestic violence agency before? 4. how did you pick which agency to contact? 5. what happen at your first experience at the agency? 6. walk me through the services you received. what happened first? how did you feel about it? what happened next? how did you feel about it? how did services end? 7. what do you think the agency’s philosophy or approach to working with survivors of domestic violence was? 8. how did the services work with your personal goals? 9. what were/are your main goals while receiving services? in what ways did the agency help you meet those goals? 10. what did you think about the agency rules and policies? 11. what impact did the services have on your life? 12. in general, what do survivors need when they come to get help? 13. if you could wave a magic wand and change one thing about how domestic violence agencies help survivors, what would it be? 14. what do you think is the cause of domestic violence? how has this changed over the course time? 15. what was your relationship like with other women seeking help at the agency? 16. what are the most important services or help you received? why? 17. what was the least important service you received at the agency? why? 18. how has your view of what help works best changed over time? 19. what would you tell a new advocate working at a shelter or agency about doing her job well? 20. is there anything else i should know about the best way to provide assistance to survivors of domestic violence? _______________ mary a. provence, msw, lcsw is a phd student, school of social work, indiana university, indianapolis, in 46202 copyright © 2018 author, vol. 18 no. 4 (fall 2018), 1053-1067, doi: 10.18060/22321 this work is licensed under a creative commons attribution 4.0 international license. from nuisances to neighbors: inclusion of patrons experiencing homelessness through library and social work partnerships mary a. provence abstract: public libraries have found themselves, often reluctantly, on the frontline of homelessness. by virtue of being temperature-controlled public spaces with free internet access, libraries provide daytime shelter for thousands of patrons experiencing homelessness. sometimes considered “problem patrons,” persons experiencing homelessness are at times unfairly targeted by library policies. violations create the potential for police involvement and arrest, and may contribute to the criminalization of homelessness. simultaneously, a trend is beginning to emerge of libraries providing or colocating social services for persons experiencing homelessness. as library services expand, schools of social work have the opportunity to lend both their research and practice expertise. specifically, schools of social work have the opportunity to partner with public libraries to conduct localized needs assessments of persons experiencing homelessness. needs assessments should include the direct surveying of patrons, including those experiencing homelessness, to make sure resulting recommendations for library programs and services will be inclusive of all patrons. keywords: criminalization; homelessness; libraries; needs assessment; problem patron libraries have a unique opportunity to interact with people experiencing homelessness. as public spaces that are warm in the winter, cool in the summer, and dry in the rain, with the added bonuses of free internet, computer, and bathroom access, libraries are natural gathering places for people experiencing homelessness. while librarians have struggled for decades to grapple with the issues surrounding patrons experiencing homelessness, some libraries are forging ahead to meet the social service needs of patrons experiencing homelessness (brashear, maloney, & thornton-jaringe, 1981; simmons, 1985). increasingly, libraries are acting as service delivery hubs. in 2009, the city and county of san francisco created the nation’s first public library social work position and hired leah esguerra, licensed marriage and family therapist, to assist patrons experiencing homelessness at the san francisco public library (l. esguerra, personal communication, november 13, 2018; public broadcasting services, 2015; tranin blank, 2014). other libraries are following san francisco’s lead. the pima county library in arizona, in partnership with their local health department, has a team of public health nurses including one full-time public health nurse who provides a variety of basic health services including case management (pima public library, n.d.). since 2013, the homeless engagement initiative of the dallas public library has served over 4,000 persons experiencing homelessness in various programs, mentoring, and “personalized assistance services” (dallas public library, n.d.b). the forsythe county public library in winston-salem, north carolina hired a peer support specialist who was formerly homeless (skinner, 2016). https://creativecommons.org/licenses/by/4.0/ provence/from nuisances to neighbors 1054 at the king library in san jose, california, homeless outreach workers from people assisting the homeless have office hours four days a week. in addition, their social workers in the library program provides in-person appointments with volunteer social workers affiliated with the national association of social workers (san jose public library, n.d.). patterned after the san jose program, social workers in the library in encinitas public library in san diego was created with the leadership of a san diego state university social work intern (copeland & sarvela, 2015). through a partnership with the university of pennsylvania, the south philadelphia community health and literacy center of the free library of philadelphia houses health clinics and a recreation center (morgan et al., 2016). the central library of the indianapolis public library (ipl) system has a resource room stocked with snacks, hygiene items, and lists of community resources where service providers meet with patrons experiencing homelessness. local service providers including the city’s blended response team regularly visit central library to check on patrons experiencing homelessness (personal communication, october 12, 2017, joan harvey, former ipl central librarian and current volunteer). while u.s. libraries are forming collaborations to provide services to this population, persons experiencing homelessness are not systematically being asked about their needs. a survey of the professional literature of the past ten years using ebscohost revealed six published studies that specifically included the input of people that were experiencing homelessness about their use of libraries. of these six, three were outside the u.s. in france, new zealand, and the united kingdom. (gaudet, 2013; hodgetts et al., 2008; muggleton & ruthven, 2012). of the three remaining u.s. studies (kelleher, 2013; mi, stefaniak, & afonso, 2014; skinner, 2016), only one (skinner, 2016) took place in the library. the forsythe county public library in north carolina gathered valuable input from patrons experiencing homelessness including their desire for something to do on sunday afternoons. as a result, a sunday movie matinee was started and draws between 50-100 persons each week (skinner, 2016). the direct input of patrons experiencing homelessness is needed in order to ensure their needs are included in library programming. to undertake a needs assessment of patrons experiencing homelessness, public libraries could benefit from the expertise of schools of social work. social work scholars, trained in research and practice, can assess the needs of patrons experiencing homelessness and make recommendations to assist libraries to ensure that their programs and services are accessible and inclusive (muggleton, 2013). such partnerships will further the profession’s goals of the pursuit of social justice through the fair treatment of oppressed populations. partnerships with public libraries will also provide schools of social work a new frontier of field placements for both research and practice for students at all levels of study. on this topic, the social work literature is deafeningly silent. a search of the social work abstracts of ebscohost in january 2018 using the terms “social work,” “library,” and “homeless” produced zero results. scope of homelessness in the united states before delving further into library-social work partnerships to assess the needs of patrons experiencing homelessness, it is helpful to understand the magnitude of homelessness in the united states. due to the transiency of persons experiencing advances in social work, fall 2018, 18(4) 1055 homelessness, determining the scope of homelessness in the united states is no easy task. according to the point in time (pit) count, there were 549,928 persons experiencing homelessness in the united states in january of 2016 (henry, watt, rosenthal, & shivji, 2016). while this number is high, some consider the estimate inaccurately low. the typical method used to conduct the point in time count does not capture “hidden homeless persons” who are “defined as those who live among, but not directly with, the residential population of a community” (agans et al., 2014, p. 218). the term hidden homeless describes persons sleeping on a private property but not in an actual house; instead, they are sleeping in a garage, shed, back porch, etc. (agans et al., 2014). in addition, the night time pit count often misses children and unaccompanied youth under the age of 25 (agans et al., 2014; travwer & aguiniga, 2016). consequently, the actual number of persons experiencing homelessness is likely much higher than the half million the pit reports. dennis calhune, a university of pennsylvania principal investigator of the pit reports, has been reported as estimating that in a year’s time, two million people experience homelessness in the united states (gee, barney, & o’malley, 2017). however, since more accurate data is not available, the pit count will be used for the purpose of this discussion. racial minorities are overrepresented in the homeless population, making up roughly 40% of the general population, but comprising 52% of the homeless population (henry et al., 2016; u.s. census bureau, 2016). african-americans comprise 13% of the general population and 39% of the homeless population (henry et al., 2016; u.s. census bureau, 2016). men are also overrepresented, making up 49% of the general population but comprising 60% of the homeless population (henry et al., 2016; u.s. census bureau, 2016). there were 1,770 transgender persons in the pit count which was .003% of persons identified in the count (henry et al., 2016). children made up 22% of the persons in the 2016 pit count; however, due to their fear of being discovered, the actual number of homeless children is thought to be higher (agans et al., 2014; henry et al., 2016; travwer & aguiniga, 2016). according to the 2016 pit count, 20% of the homeless population were mentally ill; 17% chronically used substances; 12% were victims of domestic violence; 7% were veterans, and 2% had hiv/aids (united states department of housing and urban development, 2016). in addition, 22% of those in the 2016 pit count were chronically homeless (henry et al., 2016). contributing factors. the factors contributing to homelessness include: a lack of affordable rental housing, a lack of living wage jobs, a lack of healthcare, domestic violence, mental illness, and addiction (national coalition for the homeless, 2009). a discussion of the impact of structural inequities on minorities, lgbtq+, immigrants, and veterans would be particularly helpful in understanding the context and causes of homelessness but is beyond the scope of this paper (nooe & patterson, 2010). in addition, the opioid crisis, immigration crisis, and natural disasters have also catapulted people into homelessness but are not addressed in this discussion (chatterjee, yu, & tishberg, 2018; luckman, strafer, & lipski, 2016; ryan & hartman, 2000). definitions. for the purpose of this discussion, people who are experiencing homelessness will be used to describe people who do not have permanent housing and whose sleeping arrangements are: a shelter, transitional housing, the street, a car, an abandoned building, a hotel/motel or single room facility, a prison or hospital without a provence/from nuisances to neighbors 1056 home to return to, or couch-surfing from place to place [section 330 of the public health service act (42 u.s.c., 254b) & hrsa/bureau of primary health care, program assistance letter 99-12, health care for the homeless principles of practice as cited by the national health care for the homeless council, n.d.]. library patrons whose circumstances meet this definition will be referred to as patrons experiencing homelessness. historical examination of attitudes towards library patrons experiencing homelessness prior to a needs assessment, it is important to understand the variety of attitudes that librarians have held in recent decades regarding patrons experiencing homelessness. libraries have struggled to decide if persons experiencing homelessness are problem patrons to be expelled or patrons to be served (bardoff, 2015; redfern, 2002; simmons, 1985). in the process of surveying illinois public and university libraries during 1978 and 1979, researchers created a three-tiered typology of “problem patron behavior” (brashear et al., 1981, p. 343). the lowest level was as follows: type one (relatively harmless nuisances): people who do not pose an overt threat or cause disruption, but who may generally be regarded as offensive by the staff or other patrons, such as quiet drunks, people who sit and stare for hours, or people who are offensively dirty and foul-smelling (brashear et al., 1981, p. 344). while the typology is specified to categorize behavior, it is clear by the definition of type one that people are being categorized as “nuisances” throughout the article. they are referred to as “problem patrons” who cause problems for “normal patrons” (brashear et al., 1981, p. 350). types two and three address patrons who are disruptive, threatening, or violent (brashear et al., 1981). by 1985, homelessness was added to brashear’s et al.’s definition, with the stipulation that “not all disheveled, fetid, or inebriated patrons are homeless” (simmons, p. 111). simmon’s literature review of that era demonstrates that when the needs of patrons experiencing homelessness conflicted with housed patrons, the housed patrons were usually favored. he postulates that if the needs of patrons experiencing homelessness were met elsewhere, they might not need to come to the library. he calls on librarians to advocate for the rights of persons experiencing homelessness, so that they will no longer have to use the library as their refuge (simmons, 1985). while the topic of adult library patrons experiencing homelessness was included in the literature throughout the 1980’s and early 1990’s, children were left out (dowd, 1996). to address this gap, a national study was conducted. sixty-five percent (n=83) of library children’s programming coordinators – some of whom were responding for multiple branches – described programming specific to the needs of children experiencing homelessness (dowd, 1996). these children’s coordinators agreed that they should provide “sensitivity, flexibility, and….a welcoming environment” for children experiencing homelessness (dowd, 1996, p. 159). advances in social work, fall 2018, 18(4) 1057 by the turn of the millennium, the argument over what to do about the “homeless problem” escalated. in his short, but oft-quoted opinion, cronin (2002) declared that libraries were not “a refuge for the homeless,” and librarians were not “surrogate social workers” (p. 46). however, by the mid twenty-first century, multiple voices were calling for fair treatment of homeless patrons. hersberger (2005) counters cronin and declares that lumping all homeless people into the category of problem patrons is “outright discrimination” (p. 200). ayers (2006) advocated for the expansion of library services for persons experiencing homelessness. wong (2009) believed it possible to respect the needs of both housed patrons and patrons experiencing homelessness. however, despite the calls of hersberger, ayers, and wong, the argument was not settled. many librarians, in a survey of 648 american library association (ala) external members, identified poor people as those “who are seen as a nuisance” (gieskes, 2009, p. 52). ferrell (2010) searched the library and information science abstracts database from the late 1990s forward, and discovered a consistent presence of articles related to “problem patrons.” from a symbolic interactionist approach, ferrell (2010) proposed that librarians examine who is placing the “deviant” label on a particular patron (p. 144). ferrell’s alternative approach challenged librarians to ask a series of questions to identify who is determining the behavior as “deviant:” the community (through laws and norms); the library (through policies, procedures, or norms), or the library staff (through their personal beliefs and values) (ferrell, 2010, p. 145). access to library services because of the tendency to label patrons without housing as problem patrons, persons experiencing homelessness do not always have fair library access (bardoff, 2015; ferrell, 2010). the american library association (ala) is clear about the need for fair access for persons experiencing homelessness. policy 61, now b.8.10, of the ala, entitled, library services to the poor, advocates for increased accessibility of libraries for people experiencing poverty: the american library association promotes equal access to information for all people, and recognizes the urgent need to respond to the increasing number of poor children, adults, and families in america. these people are affected by a combination of limitations, including illiteracy, illness, social isolation, homelessness, hunger, and discrimination, which hamper the effectiveness of traditional library services. therefore, it is crucial that libraries recognize their role in enabling poor people to participate fully in a democratic society, by utilizing a wide variety of available resources and strategies. concrete programs of training and development are needed to sensitize and prepare library staff to identify poor people’s needs and deliver relevant services (ala, 2012-2013, p. 40). the remainder of the library services to the poor specifies various ways for libraries to enact the policy; relevant portions of this policy will be highlighted throughout this discussion. provence/from nuisances to neighbors 1058 library policies negative attitudes towards and stereotypes of persons experiencing homelessness as being dirty or smelly have led to library policies targeting patrons experiencing homelessness including: rules against foul smells, luggage, sleeping, and tending to hygienic needs in library bathrooms (bardoff, 2015). hersberger (2005) emphasizes that such policies often have unequal enforcement. for example, a college student would probably not be kicked out of a library for falling asleep while writing a research paper, but it is probable that a patron experiencing homelessness could be expelled for falling asleep. the code of conduct policies of the libraries mentioned earlier which have some level of social services for patrons experiencing homelessness were reviewed. seven of the libraries posted their policies online. the eighth, the philadelphia free library, did not have their policy online and is not included. table 1 presents a summary of prohibitions that directly address persons experiencing homelessness. table 1. library policy prohibitions by location sleeping bathing large items, i.e. luggage/ bedrolls camping strong odor lying down using more than one seat asking for money dallas, tx x x x x x forsythe co., nc * x x indianapolis, in x x x pima co., az x x x x x san diego, ca x ** x x x x x x san francisco, ca x x x x x x x san jose, ca *** x x x x x x x notes: *prolonged sleeping prohibited; **use of facilities for “living or accommodation purposes” prohibited; *** sleeping while lying down prohibited. (dallas public library, n.d.b; forsythe county public library, 2017; indianapolis public library, 2011; pima county, arizona board of supervisors, 2015; san diego county library, n.d.; san francisco public library commission, 2014; san jose public library, 2014; & san jose public library, 2017a). the forsythe county library – the library that has published survey results that included patrons experiencing homelessness (skinner, 2016) – has the least number of policy barriers; instead of prohibiting all sleeping, forsythe prohibits only “prolonged sleeping” (forsythe county public library, 2017). the policy statements of each of the seven libraries indicate that violations of the code of conduct can result in suspension from the library. the san jose public library specifies suspension periods ranging from one day to two years depending on the severity of the offense (san jose public library, 2017b). san francisco differentiates suspensions based on severity and lists one to seven day suspensions for minor infractions but specify that persons sleeping or lying down will be asked to correct or leave but are not suspended (san advances in social work, fall 2018, 18(4) 1059 francisco public library commission, 2014). the remaining five libraries do not specify the length of the suspensions in the online codes of conduct. depending on the severity of the situation and the compliance of the patron, violations of the codes of conduct can result in potential law enforcement involvement up to arrest and prosecution where allowable by law (dallas public library, n.d.a; forsythe county public library, 2017; indianapolis public library, 2011; pima county, arizona board of supervisors, 2015; san diego county library, n.d.; san francisco public library commission, 2014; san jose public library, 2017a). the ala’s hunger, homelessness, and poverty task force (2005) admonished libraries who target patrons experiencing homelessness through “punitive policies” that are “at best misguided and, at worst, contribute to the criminalization of poor people” (p. 175). such policies that put patrons experiencing homelessness at risk of potential arrest may be similar in character to laws around the country that are “primarily intended to reduce the presence of homeless people in specific locations or in an entire community, in an effort to maintain or improve public safety, economic stability, and aesthetic appeal” (aykanian & lee, 2016, p. 183). instead of trying to address the systemic issues that cause homelessness, “the current restrictions on homeless people’s behavior in public space are clearly an effort to regulate space so as to eliminate homeless people, not homelessness” (mitchell, 2003, p. 167). public librarians often find themselves navigating the difficult space between patrons who are housed and patrons experiencing homelessness. the library policies that appear to target persons experiencing homelessness are often an attempt to maintain order and appease housed patrons. this is a difficult position for libraries to be in. to consider how to balance and navigate through these competing demands libraries face, let us look deeper at the philosophical underpinnings of these policies. attitudes towards persons experiencing homelessness: a new view a philosophical perspective that is helpful when considering how policy makers at both the library and local government level, as well as social work researchers, view patrons experiencing homelessness comes from the arbinger institute (2008). arbinger’s conclusions are in part based on the thoughts of heidegger, a philosopher who, in his seminal work published in 1926, being and time, “shifted the focus of the philosophical world away from the separate self and onto the idea of being with others” (arbinger institute, 2008, pp. 78-79). arbinger (2008) also delves into the thoughts of buber from his seminal work i and thou published in 1923 that proposed: …that there are basically two ways of being in the world: we can be in the world seeing others as people or we can be in the world seeing others as objects. he called the first way of being the i-thou way and the second the i-it way, and he argued that we are always, in every moment, being either i-thou or i-it seeing others as people or seeing others as objects (arbinger institute, 2008, p. 79). according to arbinger (2008), when we view others as people, we recognize that they have goals, ideas, thoughts, feelings, needs, and values that are as important to them as ours are to us. when we view others as objects, we view them in one of three ways: as provence/from nuisances to neighbors 1060 “obstacles” who are “in our way,” “vehicles” to use for our own purposes, or “irrelevancies” who are unimportant (arbinger institute, 2016, para. 2-3). using this framework, we can examine how library staff, patrons, and social work researchers view patrons experiencing homelessness. do we see them as individuals who are equal to us? are we willing to be attentive to the special needs persons experiencing homelessness bring to the public space of the library? or, do we see them as objects to be scorned and shunned? do we see them as obstacles who are in our way of having a quiet and undisturbed place to read, study, or relax? even more subtle, do we see persons experiencing homelessness as projects that make us feel good about ourselves for helping – at their expense? as a social work researcher, do i see them as an opportunity to put a scholarly feather on my curriculum vitae, or do i see them as people with individual identities, strengths, and needs to be discovered and reported so recommendations can be made for helpful change? whether librarians view persons experiencing homelessness as objects or as people impacts both the policies they create and how they are enforced. the ala’s policy on the poor necessitates the review of pertinent local library policies and their enforcement to see if they are unfairly targeting persons experiencing homelessness (ayers, 2006; hersberger, 2005). specifically, subsections b.8.10.1.1 and b.8.10.1.11 of the ala policy on the poor promotes “the removal of all barriers to library and information services, particularly fees and overdue charges” and “training to sensitize library staff to issues affecting poor people and to attitudinal and other barriers that hinder poor people's use of libraries” (ala, 20122013, pp. 40-41). being willing to honestly evaluate how we view persons experiencing homelessness and to change our attitudes when needed is critical to not only evaluating policies for fairness but also for planning services. the case for surveying persons experiencing homelessness because of the objectifying and patronizing of persons experiencing homelessness, services, when they exist, for the most part have been designed for them rather than with them. ala’s policy for the poor section b.8.10.1.9 directly calls for “community needs assessments, giving special emphasis to assessing the need so [sic, of] low-income people and involving both anti-poverty advocates and poor people themselves in such assessments” (ala, 2012-2013, p. 41). however, based on my literature review, talking directly to patrons experiencing homelessness at libraries in a systematic way has been rare. this neglect has been partially due to service providers relying on their own intuition about the needs of persons experiencing homelessness rather than conducting needs assessments that ask the population directly (acosta & toro, 2000). a longitudinal study of 301 persons experiencing homelessness, while somewhat dated and geographically specific to buffalo, ny, counters what may be a logical assumption: that housing is the number one need of people experiencing homelessness (acosta & toro, 2000). persons experiencing homelessness in their study had needs they considered more important than housing – safety and education (acosta & toro, 2000). it may seem intuitive to ask homeless service providers to identify the needs of people experiencing homelessness. advances in social work, fall 2018, 18(4) 1061 however, most service providers have not experienced homelessness, and while they are an important informant in helping libraries understand local services and collaboration opportunities, the primary starting point should be systematically asking the patrons experiencing homelessness to identify their needs. some researchers or librarians may argue patrons may be offended if we ask them if they are homeless, a concern kelleher (2013) expressed, choosing instead to research library usage by persons experiencing homelessness at places other than the library. the forsythe county public library overcame this quandary by administering the survey to all library patrons with a question about residence with a response option of “no permanent address,” allowing them to identify the needs of patrons experiencing homelessness without the risk of offending patrons (skinner, 2016, p. 5). the university of pennsylvania used the community-based participatory research (cbpr) approach to assess how library programming at the free library of philadelphia addressed social determinants of health (morgan et al., 2016). the cbpr approach provides a framework for conducting needs assessments of persons experiencing homelessness (leung, yen, & minkler, 2004). this model emphasizes researching “with” rather than “on” a given community and “shifts the decision-making authority away from experts and embraces the experiential knowledge of the average citizen” (leung et al., 2004, p. 500). the discovery of the needs of patrons experiencing homelessness should be a collaborative process that “exposes and challenges the structural powers that oppress” and leads to action (leung et al., 2004, p. 501). not only should patrons experiencing homelessness be asked what they need, they should have representation in the decision-making of library policies and services related to poverty and homelessness. after surveying 648 external members of the ala, the hunger, homelessness and poverty task force of the ala recommended that libraries include people who are poor as well as service agencies in their decision-making, emphasizing that being a librarian or a member of the ala should not be necessary to assist in decision-making around issues of poverty (gieskes, 2009). this call for action is also reflected in the ala’s policy manual section b.8.10.1.10 which calls for “promoting direct representation of poor people and anti-poverty advocates through appointment to local boards and creation of local advisory committees on service to low-income people, such appointments to include library-paid transportation and stipends” (ala, 2012-2013, p. 41). offering stipends and transportation for persons experiencing homelessness would help increase the feasibility of their participation. facilitating the participation of patrons experiencing homelessness in the decisionmaking process may help prevent the incorrect assumption that their needs are all alike (hersberger, 2005). too often, we deny patrons experiencing homelessness their unique histories of education, employment, housing, and/or military service. we fail to see their strengths and the individual reasons that have led them to be without a home (hersberger, 2005). needs assessments of patrons experiencing homelessness should be done at the local or regional level, to assess needs that may be geographically and historically specific, such as a factory closing down, an influx of immigrants, a natural disaster, or a local drug epidemic. provence/from nuisances to neighbors 1062 some may counter that libraries already have strapped budgets and are unable to conduct a needs assessment to determine the needs of patrons experiencing homelessness. partnering with a school of social work can provide scholarly research rigor, without the expense of hiring a research firm. such partnerships can also provide schools of social work with field placements for research and possibly practice. social work students, supervised by faculty, can create and administer surveys including in-person interviews with patrons. in partnership with patrons experiencing homelessness, social work students or faculty can analyze the data and make service recommendations. while kelley, riggleman, clara, and navarro (2017) did not interview persons experiencing homelessness, their needs assessment to determine if the local library needed a social worker provides an example of a local public library partnering with msw students at a private university. this undertaking met a need for the public library and provided field research experience for students. as libraries learn the needs of patrons experiencing homelessness through such research partnerships, it is critical to discuss next steps. muggleton (2013) provides great caution in this area: due to the isolation, stigma, and stereotypes that persons experiencing homelessness already face, we do not want to turn the library into a place that inadvertently leads to the further stereotyping of persons experiencing homelessness and a further separation of the housed and unhoused. libraries are “spaces of care where homeless people can be included” and can “be present as regular library patrons” (hodgetts et al., 2008, p. 950). having homeless-only services homogenizes, increases isolation, and may prevent people who do not want to be identified as homeless from seeking services (muggleton, 2013). instead, libraries can address the needs of patrons experiencing homelessness in the context of broader library services and programs: many of the services, such as job search assistance, that patrons experiencing homelessness find helpful are also useful to housed patrons (muggleton, 2013). by promoting inclusion of patrons experiencing homelessness in the larger context of library services, we can decrease isolation and provide the opportunity for housed and unhoused patrons to interact and learn from and about one another (gaudet, 2013; hodgetts et al., 2008; muggleton, 2013). conclusion the convergence of persons experiencing homelessness in the space of public libraries has brought both librarians and social workers to a new frontier of opportunity. every day librarians have the privilege to interact with patrons experiencing homelessness who “are seeking opportunities, however minimal, to help them further their education, find affordable and stable housing, and maintain gainful employment to have productive lives” (acosta & toro, 2000, p. 363). schools of social work can be instrumental in helping libraries to survey the needs of patrons experiencing homelessness and ultimately offer recommendations for programs and services that are inclusive of their needs to move us toward a more just society. as social work rises to meet the grand challenge of ending homelessness, interdisciplinary collaboration between the fields of library science and social work is pivotal to our success (henwood et al., 2015). depending on how we see our homeless neighbors as people or as objects will determine how librarians and social workers alike respond to this opportunity of convergence. advances in social work, fall 2018, 18(4) 1063 references acosta, o., & toro, p. a. 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(2009). homelessness in public libraries. journal of access services, 6, 396410. doi: https://doi.org/10.1080/15367960902908599 author note: address correspondence to: mary provence, msw, lcsw, school of social work, indiana university, 902 west new york street, indianapolis, in 46202. mscifres@iupui.edu https://doi.org/10.1606/1044-3894.2016.97.30 https://www.census.gov/quickfacts/fact/table/us/pst045217 https://www.hudexchange.info/programs/coc/coc-homeless-populations-and-subpopulations-reports/ https://www.hudexchange.info/programs/coc/coc-homeless-populations-and-subpopulations-reports/ https://doi.org/10.1080/15367960902908599 mailto:mscifres@iupui.edu the case for surveying persons experiencing homelessness references american library association. (2012, 2013). policy manual section b: positions and public policy statements b.8.10-10.1 policy objective (old number 61-61.1) (revised june 25, 2012 and jan. 27, 2013), 40-41. retrieved from http://www.ala.org/aboutala/... american library association’s hunger, homelessness, and poverty task force. (2005). are public libraries criminalizing poor people? public libraries, 44(3), 175. retrieved from https://hhptf.org/article/2/are-public-libraries-criminalizing-poor-people/ aykanian, a., & lee, w. (2016). social work’s role in ending the criminalization of homelessness: opportunities for action. social work 62(2), 183-185. doi: https://doi.org/10.1093/sw/sww011 ______ sara plummer, phd, msw, assistant director, basw program and assistant professor of teaching, rutgers school of social work, rutgers university, new brunswick, nj. jandel crutchfield, phd, lcsw, assistant professor, school of social work, the university of texas at arlington, arlington, tx. desiree stepteau-watson, phd, lcsw, associate professor & msw program director, department of social work, school of applied sciences, university of mississippi, southaven, ms. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 1006-1019, doi: 10.18060/24467 this work is licensed under a creative commons attribution 4.0 international license. the obligation of white women: dismantling white supremacy culture in social work education sara plummer jandel crutchfield desiree stepteau-watson abstract: on memorial day 2020, a white woman, amy cooper, was walking her unleashed dog in new york city. after being apprised of the leash law in that state by a man bird watching, ms. cooper proceeded to call the police stating an “african american man” was “threatening her life and that of her dog” (ransom, 2020). while this event may seem unconnected to the field of social work, it is a modern example of the way white women, including those in social work, use emotionality, bureaucracy, and the law to control black bodies. social work has been and continues to be, responsible for policies and practices that maintain white supremacy culture and criminalize black people. keywords: white supremacy, social work education, white women, racism, dominant culture historically, social workers have been the foot soldiers, and at times commanders, of racist policies that propelled oppressive and violent actions against black, indigenous, and people of color (bipoc). this paper will offer an exploration of how white women, the demographic dominant in the field of social work, have aided, abetted, and led racist policies and laws. social workers’ coordination and management of such activities as the eugenics movement (kennedy, 2008), and of virginia’s racial integrity act (ria) (mcrae, 2018) are just two examples of how white women in the field of social work worked to uphold white supremacy culture. the field of social work has long stated its values and ethics as an example of an antioppressive and social justice mission and goals. but just as ms. cooper’s response to the nyc event included “i’m not a racist” (aguilera, 2020, para. 18), the field of social work and in particular white women social workers and educators relied on their own definition of racism and oppression. the self-reflection in the field of social work has been and continues to be superficial and, with any self-run assessment, inadequate. it is far time for the field of social work and in particular, the white women, who make up the majority of the field, to reckon with their complicity and leadership in racist activities that have maintained and propelled white supremacy culture in social service institutions and the structures that support them. background on memorial day 2020, a white woman, amy cooper, walked her unleashed dog in central park. mr. cooper, a black man, who was bird watching in the same area apprised about:blank plummer et al./obligation of white women 1007 of her the leash law in new york. ms. cooper’s response was to call the police on an “african-american man” who was “threatening her life and that of her dog” (ransom, 2020). ms. cooper’s reaction and falsehood is a modern-day example of how carolyn bryant in 1955 used her privilege as a white woman to lie and cause the murder of emmett till (perez-peña, 2017). white women have used emotionality, bureaucracy, and the police to control and threaten black, indigenous, and latinx people, and they continue to do so today. while these past and present events may seem unconnected to the practice of social work, it is time to identify and examine how white women in general, and white female social workers specifically, have been at the forefront of actions that maintain white supremacy culture and further the criminalization of black and brown people. as a field that is majority white (68.8%) and female (83%; salzburg et al., 2017), it is necessary to analyze how white supremacy culture appears in social work. social work has long proclaimed its values and ethics as an example of its antioppressive and social justice platform. but just as ms. cooper’s response to the nyc event included a defensive retort of “i am not racist” (ransom, 2020), the field of social work, and, in particular, white women social workers, have hid behind the national association of social workers code of ethics (national association of social workers [nasw], 2008) to convey a facade of “cultural competence” and “inclusion” while its practices contradict those assertions. the social work profession has relied on its own definitions of racism and oppression (cswe, 2015), and in turn ignored and erased the concerns of bipoc individuals (faculty, students, and clients; dominelli, 1989; maylea, 2020). furthermore, the field’s propensity for self-righteous attacks and finger pointing externally has stifled significant internal reflection that is so greatly needed. white women and white social workers have and continue to be the foot soldiers, and at times leaders, of racist policies that have propelled oppressive and violent acts against black people. therefore, the profession must come to a reckoning with its legacy of racism and white supremacy culture before it can move forward. the authors will offer an exploration of how white women, the demographic dominant in the field of social work, have aided, abetted, and led racist policies and laws. the authors will provide suggestions on how the profession can address these inherent issues. what is white supremacy culture? perceived white supremacy has roots in the very founding of the united states, when indigenous persons were slaughtered and killed. those who survived were forcibly removed from their land and relocated to reservations (dunbar-ortiz, 2014). white supremacy was codified when africans were captured and enslaved so that their unpaid labor could be used as the economic foundation for building the united states. instilling the notion of a superior white race was necessary so that persons of european descent could continue their colonization efforts (kendi, 2016). in the united states and the rest of the americas, the notion of a superior white race was necessary to control the millions of enslaved africans. nogueira (2013) has said, “these hierarchical, unequal and inhuman relations between colonizers and colonized, which are based on race, mainly contributed to the foundation of global capitalism and all the modern western society” (p. 24) freire (2000) posits that dehumanization occurs when a people are oppressed that impacts both advances in social work, summer 2021, 21(2/3) 1008 the oppressed and the oppressor. in this form, when the oppressor experiences dehumanization it allows for further oppression to occur and sets the stage for perceptions of superiority to be embedded in both the oppressor and the oppressed. according to freire (2000), in his seminal work, the oppressed must emancipate themselves in order to become more fully human, and when the oppressed become more fully human then so do the oppressors. the modern day blacklivesmatter movement is seeking to emancipate black people from threats to their humanity, but in so doing, the oppressors will also benefit because they can become more fully human in the process. in the 18th century pseudo scientists propagated a “race theory” that suggested whites were genetically superior (billings, 2016), while people of color and especially people of african descent were said to lack intelligence, beauty, morality and humanness. the idea of a superior white race has become normalized and institutionalized (billings, 2016) such that, in general, those who consider themselves to be white accept all the unearned privilege without critically examining its origins (nogueira, 2013). rooted in history and custom, whiteness remains the standard by which all groups, including people of color, are judged and evaluated (sue, 2006). the vehement and violent pushback that black lives matter advocates experience (holloway, 2020) suggests that white superiority is so well entrenched in our society that the suggestion that black lives have merit is unfathomable. although, clearly not rooted in reality, because whiteness is not in fact superior to other groups, it is the perception of superiority that continues to plague all aspects of society, including social work education and the provision of social work services. despite the emphasis on equality, justice, and human rights, many white social workers enter and leave schools of social work without ever examining their internalized perceptions of superiority. even using the term white supremacy centers and empowers egregious whiteness while subliminally disempowering the agency, strength and truth of the power of black people (d. e. tolliver, personal communication, july 16, 2020). using this term implies the concept of power as if it were truth. in western worldview, dichotomous either/or thinking is embraced, and employing the use of the term white supremacy invokes its counterpartnon-white inferiority (d. e. tolliver, personal communication, july 16, 2020). white supremacy has often been associated with pictures of the klu klux klan, the confederate flag, or more recently as in charlottesville, virginia, white men with tiki torches (murphy, 2017), all images that evoke deep hatred of people who are not white. this extreme version, while representative of white supremacy culture, also erases the everyday white supremacy that is threaded throughout our society. in fact, it often only spotlights the male involvement in these acts. white women have been long absent from conversations related to white supremacy even though their presence has been evident throughout time. defining “white women” race is a social construct. while different cultures throughout time (for example the ancient greeks) have always deemed themselves superior to others, skin color and the idea of race was not always used to define and categorize people (biewen, 2017). created by prince henry the navigator from portugal and his biographer gomes de zurar, race was plummer et al./obligation of white women 1009 used to build a hierarchy by which to explain enslavement and maintain power (kendi, 2019). whiteness was created to uphold slavery and to withhold the voting rights of formerly enslaved black men. in a historical sense, whiteness helped to restrict the emerging political power of newly freed blacks. biological racists, such as samuel morton, continued to perpetuate the belief in inherent differences among humans by race, through the promotion of false statements around intelligence and ability based on such things as skull size (biewen, 2017). while it may be easy to place the blame on these racist theories and views on white men alone, it is necessary to point out that white women were just as invested in the economic and political benefits of enslavement and restricting freedom during reconstruction (jones-rogers, 2019). the dominant view of white women as being virtuous, vulnerable, and needing protection, particularly from black men who would want to sexually assault them is epitomized in the 1915 film “birth of a nation,'' (mcrae, 2018). as stated earlier the murder of emmett till, a black child, for supposedly whistling at a white woman store owner, further exemplifies both the power of white women and their perceived helplessness. despite popular views of white women being helpless, they have and continue to yield significant influence within society, including the promotion of white supremacy culture. indeed, history reveals that “white women have both shaped and sustained white supremacy politics” (mcrae, 2018, p. 3). the historical protection of white women throughout time, white women have actively worked to maintain their privilege and status by promoting white supremacy (mcrae, 2018). white women have always expressed their superiority in society and have used every tool possible to maintain a hierarchy of presence and power (jones-rogers, 2019). further, they have historically chosen their whiteness over their femaleness and over the rights of others (mcrae, 2018). just as white female enslavers did during antebellum times, white women today work tirelessly to maintain power and control and challenge those who try to interfere with that goal (jones-rogers, 2019). this could not be better exemplified than by the results of the 2016 election, with half of white women voting for donald trump, a man who based his platform on racism and misogyny (pew research, 2018). jaffe (2018) provides some insights into the white women’s vote for trump in 2016. white women who voted for him de-emphasized any sexist statements, indicating it was a characteristic they were willing to ignore or look past (as they have for centuries). additionally, the desire to maintain their wealth, rather than be potentially impacted by raised taxes pushed financially well-off women to choose trump. finally, xenophobia and outright racism sparked their vote for trump out of fear of increased immigration to the united states and an overwhelming and historical (and unproven) belief that there is a need to defend “white women’s purity” (jaffe, 2018, p. 21). therefore, as we examine the field of social work and its ties to white supremacy, it is essential to examine how white women have historically used their position to maintain their place of power through violence, policy, and the creation of false narratives about black men and women, evoking stereotypes that remain today. the majority of history has been crafted and written by white people, hence the term “whitewashed.” white women have crafted a historical narrative that frames their space in advances in social work, summer 2021, 21(2/3) 1010 the world as fragile, deserving, well-intentioned, and oppressed (glymph, 2008). additionally, white women have largely been absent from discussions surrounding the united states’ history of slavery, racism, and violence done to black and indigenous people. the protections white women have received in telling their history are unequal to any other group in our society, yet they are as culpable of the harm done to marginalized people as their white male counterparts. historical literature suggests white women were oppressed and subject to cruel patriarchy, and in turn innocent to the creation and perpetuation of slavery, yet white women found power and control in roles such as “plantation mistress.” true history suggests white women were not only as brutal as white men, but at times even more cruel and violent (glymph, 2008; jones-rogers, 2019). after reconstruction, white women across the nation used their power and privilege to maintain jim crow rules and led the resistance to racial equality (mcrae, 2018). from california to texas to massachusetts, white women led the call for such racist acts like forced eugenics and gathering support to end social security and income tax (mcrae, 2018). the violence of white women the assumption that white women were innocent bystanders in the genocide of native americans and enslavement of africans due to their own subordination as women is false and misguided. many white women were the direct recipients of power and wealth that arose from owning human beings (glymph, 2008). white women based their power and prestige through the promotion of the image of a well-kept and well-run home. black women, responsible for the majority of tasks necessary to maintain this image, were the primary recipients of their violence. violence by white women towards black women was used as a form of control to promote an air of perfection, a characteristic of white supremacy culture (jones & okun, 2001). further, white women justified their violence by blaming the enslaved individuals on their refusal to become “better girls” (glymph, 2008, p. 6), a clear desire to advance assimilation. if an enslaved woman did not live up to the expectations placed on them daily, they were deemed lazy, uncooperative, unlady like, and intentionally trying to sabotage the white woman’s place in society (glymph, 2008). once enslaved individuals were emancipated, white women continued to work to maintain domination and control over black people. with this newfound freedom, white women lost the ability to provide acts of “benevolence.” the changed landscape threatened the white woman’s place as a helper, a kind person meant to relieve the pains of the day (ignoring that this pain came from slavery itself; glymph, 2008). both men and women enslavers needed to see themselves as “honorable, just, and loved by their slaves” while simultaneously oppressing and abusing them (glymph, 2008, p. 29). these very women became future educators and social workers bringing with them their prejudices and racist beliefs. white women in social work according to the council for social work education’s 2018 survey of social work education in the united states, the majority of all students in part time or full time undergraduate, graduate, and doctoral programs are white (non-hispanic) and female. plummer et al./obligation of white women 1011 cswe (2018) also reported that part-time programs tended to have more underrepresented groups than did full time programs. this trend was also born out in the social work faculty educating these students but is even more skewed to white women at the faculty level. according to the survey (cswe, 2018) faculty members from underrepresented groups only made up 33.1% of full-time faculty members. similarly, those students that graduate from social work programs with bachelors, masters, and doctoral degrees are mostly white non-hispanic women. similar to the student demographic make-up in social work, the majority of currently practicing social workers are white women. salzburg et al.’s (2017) report to cswe also provided a snapshot of the demographics of the social work workforce. twenty-six percent of active social workers at that time were african american at the bachelor’s level, while 19% of active social workers at the master’s level were african american. for hispanic and latino social workers, 15% were practicing at the bsw level while just 10% were practicing at the master’s level. the majority, more than 75% of master’s level social workers are white and majority female and nearly 65% at the bachelor’s level. white savior complex and the draw to social work literature documents how popular culture of the white savior is popularized in the media, socializing a diverse group of viewers to the concept that white women are often the saviors of downtrodden black, brown, and other peoples of color (hughey, 2011). white savior movies reinforce white supremacy culture in fields like education, health, and social work in that white women are the sole individuals who can lift someone out of their despair. white savior movies demonstrate the unique kindness of a white person taking care or coming to the aid and rescue of a poor person of color. movies such as the blind side, the help, green book, the greatest showman, to kill a mockingbird, and others reimagine history to promote white supremacy and perpetuate stereotypes of the weak and unintelligent black person who needs saving (singer, 2020). beyond general media, social work historical narratives have also portrayed the settlement house movement started by jane addams as the major initiator of social work. this similarly, recreates the white savior model, while simultaneously skimming over the efforts of early black and brown social workers that also served their communities. early settlement houses and charity organizations were staffed by college educated white women from middle to upper class homes looking to obtain “personal fulfillment, selfrealization, and accomplishment beyond home” (iglehart & becerra, 1995, p. 112). their entrance into the field of social work was born from a desire to break free from the societal restraints placed on women at that time. further, they sought to gain a sense of self and accomplishment through the role of nurturer and “social mothering” (iglehart & becerra, 1995, p. 112). much of this caretaking was premised on making immigrants “americanized” based on christian values, subsidized by major corporations such as ford motor company (iglehart & becerra, 1995; martin & martin, 1995). therefore, it is essential that white women must reflect on why they entered the field of social work. whether it is due to the socialization from early viewing of films and movies or a genuine desire to want to help, white women should problematize any narrative that simply offers advances in social work, summer 2021, 21(2/3) 1012 a “wanting to help” motive that doesn’t acknowledge how this is influenced by white supremacy of them being the ones identified as saviors. in one particular op-ed by audrey batterham (2020) pushing back against the wrong of saving “we are just trying to save them from a moment in time or failure from sobriety, etc.” (para. 8) the portrayal of white women as do-gooders is upheld as just simply that. the author encourages other white social workers to acknowledge that they do want to “save” clients instead of feeling guilty about the savior complex. this speaks to the larger culture of white saviors in the profession, indeed this is who her op-ed is targeting as an audience. historical comparison to white women social workers comparing the historical behaviors of white women regarding race and racism to those today in social work, it is easy to identify some similarities. historically, white feminism is rooted in biases including racism, albinism, and anti-semitism that further marginalize black people (kendall, 2020). this history cannot and must not be swept aside, as understanding and learning from the past is necessary to change the process and structure of our world. as kendall (2020) stated, “when white feminism ignores history, it ignores that the tears of white women have the power to get black people killed” (p. 4), nothing is solved, and in fact conditions for marginalized people can be made worse. whitewashing the narrative the history of social work and its narrators have provided a whitewashing of history that has skewed and misrepresented the true social work narrative. the education of social work students has promoted a white/euro-centric narrative by focusing its content primarily on white women and men leaders in social work. black social work pioneers have historically been erased in the discussions of social work and social justice history (carlton-laney & carlton alexander, 2001). this exclusion can be considered a conspiracy of silence that not only disregards the work in the field of people who are not white, but negatively impacts the very people the field seeks to serve (carlton-laney & carlton alexander, 2001). this silence is evident in the textbooks that are adopted for each course and the majority of white male and female authors that are writing these books. individuals such as jansson (policy), hutchison (human behavior), rubin and babbie (research), and ellen netting and mary k. o’connor (organizational practice) have all been identified as canons in social work education and are all white. while perhaps unintentional, the use of content curated and explained by mostly white people, places the power in their hands to define and explain the social work profession. this focus on white voices in the profession’s assumed canons erases the contributions of black scholars who tend to be relegated to special journal issues or supplementary readings. books such as african american leadership and social work in the black experience provide content not addressed in typical texts used in courses such as introduction to social work. for example, individuals such as george haynes and e. franklin frazier, two of the first black professional social workers, and sarah collins fernandis (a settlement house pioneer and promoter of the family support approach to social work) are missing from the standard social work text (carlton-laney & carlton alexander, 2001; martin & martin, 1995). plummer et al./obligation of white women 1013 a clear review of the profession’s history is necessary to see how the foundation of our work was created and how it maintains a grip hold on current approaches (iglehart & becerra, 1995). racism within the field of social work can be exemplified in many different ways and social work has taken on white supremacy culture in many forms, including how white women interact with their clients who are overwhelming black and brown. our foremothers, jane addams and mary richmond have both been examined in the literature as having promoted anti-black approaches by upholding explanations for lynching, refusing to provide services to black migrants traveling from the oppressive south, and an assimilationist approach meant to rid black and indigenous people of their culture and pushing white culture as the preferred behaviors and values (iglehart & becerra, 1995). nowhere is this racism exemplified more clearly than in the child welfare system. views of african american and black women as mother figures have been falsely attacked and provided a negative and damaging narrative that harkens back to the antebellum period. enslavers would declare african women as emotionally unattached to their children to justify separating families (jones-rogers, 2019). male and female enslavers used this narrative to explain how taking babies from their mothers was not hurtful as african women are “cheerful beings” unable to process pain and when showing any form of grief were pathological and termed it “the sulks” (jones-rogers, 2019, p. 121). today, black children are disproportionately represented in referrals and opened cases across the united states. thirty-three percent of children in foster care are african american yet only make up 15% of the child population (child welfare information gateway, 2016; national conference of state legislatures, 2020). saving face and saving power today’s white women social workers demonstrate similar tools used by white enslavers to manage the expectations of their role and the optics connected to that role. black enslaved women were blamed for the violence they experienced at the hands of white women due to being “uncooperative” and “misbehaved” (glymph, 2008). refusal to follow the enslavers’ rules or any perceived missteps around plantation procedures was viewed as a lack of ability to build and maintain an ideal domestic home. punishment (in the form of violent acts), was deemed justified and viewed necessary to improve the behavior of enslaved women (glymph, 2008). this idea of white women domesticating the “uncivilized” black woman on a plantation doesn't fall far from the social work intent to establish euro-centric forms of childcare, mothering, and housekeeping espoused by the majority white women profession (iglehart & becerra, 1995; martin & martin, 1995). social workers enter the field wishing for a “better life” for their clients, without considering how that life is defined and by whom. clients are deemed resistant and noncompliant when they do not follow the goals and objectives deemed necessary by the social worker. clients then experience victim blaming when they do not conform to the social worker’s expectations. clients are then penalized for perceived misbehavior or misdeeds as outlined by rules born from white supremacy culture (iglehart & becerra, 1995; martin & martin, 1995). white women enslavers expressed a sense of anger and loss when emancipation was passed. formerly enslaved individuals' new position in society was viewed as the advances in social work, summer 2021, 21(2/3) 1014 withdrawal of the mistresses’ ability to exert superiority and power through demonstrations of kindness and good will towards enslaved individuals (glymph, 2008). white women social workers experience loss of power and control threatens their place in the world as saviors when their clients disagree with them or choose to terminate services. white social workers want to maintain their appearance of perfection and a white supremacy culture characteristic (jones & okun, 2001), and when a client does not advance in their assimilation minded ways they see this as a personal attack on their ability as a professional and individual. white women social workers today perpetuate the characteristic of perfection and blame their clients for putting that in jeopardy. individual pathology versus environmental impacts just as there was no consideration on how the institution of slavery (a brutal, violent, barbaric act) itself would impact the women and men enslaved (glymph, 2008) social work can perpetuate an individual pathology perspective rather than using an environmental lens. by blaming those who were enslaved for the violence they received, we see the seeds of the creation of personal character flaws and victim blaming to explain behaviors rather than an assessment of the environmental impact. this hypocrisy, so prevalent in white culture, is evident in the social work education and profession. while the profession promotes the use of person-in-environment (pie) perspective and the ecological model, much discussion around historical and social context is either over-simplified or missing (iglehart & becerra, 1995). as social work touts the use of pie, a perspective that proposes that clients' concerns are a result of the lack of resources and support in the community, the profession continues to primarily address clients’ needs on the micro/individual level. when clients refuse to comply, follow the rules, and change based on rules and policy that come from institutions that uphold and maintain white supremacy culture, one can compare social workers’ behavior to the “blind lashings” used by white women enslavers. this form of violence was a random form of punishment with the violence viewed as its own reward (glymph, 2008). inconsistent actions and constant vacillating between support and punishment (when clients are identified as resistant or non-compliant) can create a certain kind of violence and pain that further harms individuals’ psyches. a client is expected to trust their social worker, also knowing at any time the rules may be used against them to punish whatever perceived wrongdoing they were sent to services for in the first place. suggestions for moving forward in the framing of social work, social workers are often identified as white women who have been cast as merely cogs in a wheel in which they try their hardest to help people while working in a system they may or may not agree with. poor social workers, paid so little, yet working countless hours to help their clients ' is the story that is often told. they are selfless, placing clients’ well-being above their own, with little to no recognition and compensation. but in reality, social workers must recognize and admit they have helped enact policies and procedures that can be described as violent be it emotional, financial, psychological, and verbal towards bipoc. those who may not agree completely with plummer et al./obligation of white women 1015 agency or organizational rules surrounding the treatment of their clients are still culpable for the threats and actions they dole out. the field needs to address the racism baked into social work and begin taking steps to change if they truly want to be the profession of equality, empowerment, and anti-racism. critically review and learn from history the field of social work must reckon with its past actions and policies addressing black people and use that history to examine the damage that was done. history shares with us the understanding of our past errors and also sheds light on how those approaches inform our current work (iglehart & becerra, 1995). just as we complete full assessments of our clients, now is the time to assess how past racist approaches remain in place today. as iglehart and becerra (1995) state, “an understanding of social work’s responses today is predicated on an understanding of responses during its formative years” (p. 16). this includes the actions in practice and the education chosen to be shared by largely white individuals in the field. the social work profession needs to recognize and amend its complicity with the erasure of black leaders in the field of social work and social justice. martin and martin (1995) posit that early on, social work ignored the tools already used by black migrants to aid them in the daily existence in slavery. by only using a white lens, the authors suggest social workers lost the opportunity to learn and use the cultural and historical experiences of black people (martin & martin, 1995). the predominant social work model taught is based on western norms based in white supremacy culture adopted from european and calvinist values. this one size fits all approach has denied the voices of local cultures and assumes a superior model of existence. martin and martin (1995) used their platform over two decades ago to call out the social work profession and its missed opportunity to incorporate what they described as “salient elements of the black helping experience into social work practice (p. 3). rather, the authors suggest, black social workers bent to the dominant framework which perpetuated racial stereotypes and harmful forms of intervention. instead, the authors suggest, in order to make true positive change for black americans, what is needed is the incorporation of black culture and heritage (martin & martin, 1995). “most significant, social workers still have not figured out how to make effective use of black history, black culture, and the overall black experience for the maximum development and well-being of black people” (martin & martin, 1995, p. 10). social work cannot be a field that fully embraces social justice without understanding and incorporating black feminism and black liberation content. but this has been largely missing from the curriculum. curriculum committees that make recommendations on textbook adoptions must begin to engage in decision-making processes that incorporate an anti-racist lens. incorporating questions about whether white supremacy ideology is being upheld in prospective texts is an important starting point. broadening the pool of authors to include black authors is also recommended as a necessary aspect of decolonizing the social work curriculum. advances in social work, summer 2021, 21(2/3) 1016 deal with its white fragility the field of social work must reckon with its own white supremacy culture and how it has over time aided in the oppression of the very people they claim to want to empower. past concerns around racist views and actions in the field white women in social work education demonstrate what the author diangelo (2018) coined “fragility”. the idea of a social worker or social work educator who is white, having any form of bias or racist thoughts and behaviors is believed to be beyond the pale. the profession itself seems to have created a false sense of “wokeness” and immunity from examination of bias. the historical narrative suggests a profession that is focused on oppressive environments and free from any racist bias (iglehart & becerra, 1995). this warm blanket of protection can no longer be used to hide from an assessment of the micro, mezzo, and macro levels of social work education and practice on its white supremacy historical foundations and current practices. social work cannot and should not “be exempt from systematic scrutiny of its philosophies, practices, and popular myths” (iglehart & becerra, 1995, p. 88). suggestions for the profession to address the concerns outlined above include enhancing and increasing the focus on gatekeeping. increase and adjust gatekeeping white women should not pursue social work unless they self-reflect and clearly understand why they are interested in working in this field. unless racist views that uphold white supremacy culture are thoroughly examined, white women may perpetuate acts of violence towards their clients. white women who want to be social workers need to selfreflect on why it is they want to be involved in this field. have they thoroughly examined their own racist beliefs? do they know about white saviorism and how they are going to counter that? the field needs to reconsider how it manages gatekeeping into the profession which currently bends towards only those with high grade point averages (gpas) and very good writing skills. alternatively, schools can consider an alternative criteria in admissions to social work programs that includes a diversity statement. in order to protect future clients from potential harm, white women unable or unwilling to examine their biases potential should not be able to begin a program. conclusion social work is at an inflection point, in which all aspects of the profession and its educational foundation are being questioned. the historical treatment of marginalized individuals by the social work profession must be addressed proactively as opposed to retroactively. the assumption that the white dominant view is the only lens by which to address social problems is false and misguided. 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(2006). the invisible whiteness of being: whiteness, white supremacy, white privilege, and racism. in m. g. constantine & d. w. sue (eds.), addressing racism: facilitating cultural competence in mental health and educational settings (p. 1530). john wiley & sons inc. author note: address correspondence to sara plummer, rutgers school of social work, rutgers university, new brunswick nj, 08901. email: splummer@ssw.rutger.edu https://doi.org/10.1590/s0102-71822013000500004 https://doi.org/10.1590/s0102-71822013000500004 https://doi.org/10.1590/s0102-71822013000500004 https://www.nytimes.com/2017/01/27/us/emmett-till-lynching-carolyn-bryant-donham.html https://www.nytimes.com/2017/01/27/us/emmett-till-lynching-carolyn-bryant-donham.html https://www.pewresearch.org/politics/2018/08/09/an-examination-of-the-2016-electorate-based-on-validated-voters/ https://www.pewresearch.org/politics/2018/08/09/an-examination-of-the-2016-electorate-based-on-validated-voters/ https://www.nytimes.com/2020/07/06/nyregion/amy-cooper-false-report-charge.html https://www.nytimes.com/2020/07/06/nyregion/amy-cooper-false-report-charge.html https://www.cswe.org/centers-initiatives/initiatives/national-workforce-initiative/sw-workforce-book-final-11-08-2017.aspx https://www.cswe.org/centers-initiatives/initiatives/national-workforce-initiative/sw-workforce-book-final-11-08-2017.aspx https://www.cswe.org/centers-initiatives/initiatives/national-workforce-initiative/sw-workforce-book-final-11-08-2017.aspx https://www.glamour.com/story/the-help-white-savior-movies https://www.youtube.com/watch?v=wa5zwkfhlca mailto:splummer@ssw.rutger.edu _______ julie a. steen, phd, msw, associate professor, school of social work, university of central florida, orlando, fl. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 82-94, doi: 10.18060/23707 this work is licensed under a creative commons attribution 4.0 international license. the role of voice suppression in case managers’ job satisfaction and retention: a focus group inquiry julie steen abstract: with the goal of improving child well-being, child welfare agencies have begun to focus on the child welfare workforce and to advance strategies that address job satisfaction and retention. a qualitative approach was employed to gather the perspectives of case managers regarding these important issues. ten foster care case managers participated through three focus groups. responses were solicited using a semi-structured set of questions primarily focused on critical factors that affect job satisfaction and turnover. through inductive coding, a prominent theme emerged regarding the suppression of case managers’ voices. case managers described the suppression of their voices during decision-making in foster care cases by five types of actors, i.e., supervisors, judges, guardians ad litem, attorneys, and funding agency representatives. further, they described the negative effects this experience had on both themselves and the children and families they serve. these results demonstrate the importance of inter-professional interactions in the foster care field. further research is needed to identify the extent of this problem and the ways in which interactions can be improved and all voices can be considered. keywords: case manager; foster care; inter-professional; job satisfaction; turnover the field of child welfare is marked by longstanding workforce issues, including low case manager morale and high case manager turnover (edwards & wildeman, 2018; strolin et al., 2006). in response to these challenges, researchers and policymakers have issued recommendations for reform (briar-lawson, 2014; briar-lawson & zlotnick, 2003; casey family programs, 2017; pecora et al., 2018; willis et al., 2016). frequently absent from the process used to develop these recommendations is the perspective of case managers on what they need to effectively carry out their work tasks, what they need to be satisfied with their work, and what they need to remain on the job. though this study began with an evaluation of a child welfare workforce initiative aimed at case manager morale and retention, the qualitative portion of the evaluation allowed for the inclusion of the case managers’ perspective. this article reports on one of the threats to morale and retention that emerged from the qualitative portion, namely voice suppression, and provides a description of the suppression, its sources, and its effects from the perspective of case managers. https://creativecommons.org/licenses/by/4.0/ steen/role of voice suppression 83 literature review recent qualitative research points to the importance of respecting the perspective of case managers and the consequences of not doing so. griffiths and royse (2017) use the phrase “wanting a voice” when describing one of the themes that arose when they asked former child welfare workers “what would have helped [them] remain at the job?” (p. 82). they found that former workers wanted to play a role in the agency’s improvement and felt punished for trying to participate in problem-solving. their study is the primary source of information on voice suppression in the child welfare field. outside of this study, the concept of voice suppression has not been directly examined. while the suppression of the case manager’s voice in child welfare settings is seldom studied, the literature does include a focus on related concepts and their effects on case managers and case outcomes. organizational culture and climate are two concepts that are intertwined with voice suppression. the norms and mechanisms that guide case managers’ expression are part of organizational culture, and the tone and spirit of the response that meets case managers’ expression is part of climate. the organizational culture and climate of child welfare agencies are important variables that have been found to affect both case managers and clients. glisson et al. (2012) found that case managers had significantly higher job satisfaction when working for child welfare agencies with organizational cultures characterized by flexibility as opposed to rigidity. job satisfaction is also higher when organizational climates are characterized by case managers’ sense of positive engagement with their work and positive interactions with others in the work environment (glisson et al., 2012). organizations with these types of climates appear to produce better outcomes. specifically, children show greater improvement in well-being measures when served by child welfare agencies where case managers report positive engagement and positive interactions (glisson & green, 2011; glisson & hemmelgarn, 1998). likewise, organizational culture has a significant relationship with case managers’ intention to remain employed with the agency (ellett, 2009; kim & kao, 2014; westbrook et al., 2012). further, this research has been translated into an organizational culture and climate intervention that was successful in reducing case manager turnover (glisson et al., 2006). since the relationship between case managers and supervisors involves frequent communication regarding cases, supervision may serve as a venue in which case managers’ perspectives may be elicited or suppressed. qualitative research with case managers points to the importance of supervision (ellett et al., 2007; jacquet et al., 2007; morazes et al., 2010). in a study of 369 case managers, ellett et al. (2007) found that many believed supportive supervision was connected to retention. likewise, jacquet et al. (2007) and morazes et al. (2010) conducted interviews with 387 case managers, many of whom stated that the quality of the relationship with their supervisor was a major factor in their decision to stay or leave. quantitative research has repeatedly identified a relationship between supportive supervision and case manager retention (chen & scannapieco, 2010; chenot et al., 2009; dickinson & perry, 2002; griffiths et al., 2017; jacquet et al., 2007; kim & kao, 2014; lee et al., 2011; smith, 2005; westbrook et al., 2012; yankeelov et al., 2009). in addition, supportive supervision has been found to be a significant predictor of the case manager’s sense of empowerment and job satisfaction (barth et al., 2008; cearley, 2004; lee et al., 2011; strand & dore, 2009). in response to these findings, the field has invested advances in social work, spring 2020, 20(1) 84 in various types of interventions to improve supervision and thus stabilize the workforce (collins-camargo & millar, 2010; landsman, 2007; lietz & rounds, 2009). in previous studies, child welfare researchers examined the concepts of autonomy and participation in decision-making. these two concepts may be thought of as separate ends of a spectrum, with one representing independence and another representing collaboration. however, both involve inclusion of the case managers’ perspectives. early research identified lack of autonomy as having a significant effect on case managers’ intention to quit (mor barak et al., 2001). however, more recent studies have produced mixed results. kim and kao (2014) found autonomy to have a moderate effect on turnover intention, while westbrook et al. (2012) found no significant relationship between these two variables. the lack of a significant finding in the latter study may have been due to measurement error, since the autonomy subscale did not meet minimum requirements for reliability (westbrook et al., 2012). participation is another variable that has been described in the literature as an important factor in retention. as described earlier, griffiths and royse’s (2017) qualitative study found that case managers who left their positions believed they would have stayed if they had been given a voice in agency discussions. quantitative research further supports the idea that participation in decision-making is related to retention (hopkins et al., 2010; mor barak et al., 2006). contribution of present study much of the existing research regarding the case manager’s experience has been conducted based on presumptions regarding these experiences, and thus, entailed methods that limited the emergence of new themes. in fact, most of the data for the present study were collected during the course of an evaluation that used a deductive method. however, the evaluation also included an inductive approach through the use of focus group discussions where case managers expressed their beliefs regarding morale and retention. the research question for this portion of the study was as follows: what factors do case managers identify as influential in shaping job satisfaction and retention? method design this research was conducted during the course of a mixed-methods evaluation of a workforce initiative. the administrators of the agency were seeking to boost job satisfaction, decrease turnover, and improve case outcomes through the following three strategies: reducing caseload sizes, adding a career advancement ladder, and supplementing the existing training curriculum. the evaluation assessed the effects of these strategies through several data sources: survey and focus group data from case managers and secondary data regarding case outcomes and turnover rates. while the evaluation focused primarily on the effects of the three workforce strategies, the focus groups allowed case managers to offer their perspectives on additional factors that they believed were influential in the morale and retention of case managers. three focus groups were held during standard office hours in the agency’s private conference rooms. before discussions began, participants were informed of their rights and given a paper copy of the summary steen/role of voice suppression 85 explanation of research. this consent process, which is typically used in studies classified as exempt, was approved by the university irb before the focus groups were held. sample the participants were recruited using two methods: announcements within the agency and emails sent directly to the case managers by the principal investigator. this diversity of recruitment methods allowed participants to sign up privately through the researcher located outside of the agency or publicly through the agency’s staff. the final sample consisted of ten case managers who handled cases involving in-home supervision and outof-home placement. the ten participants represented 29% of the case managers employed by the agency. to protect the case managers’ identities, demographic information was not requested. however, the principal investigator noted that the sample included participants of diverse ethnicities. further, they had diverse levels of work experience, with some being in their first year of employment at the agency and others having had multiple years of experience. data collection case manager perceptions were elicited through the focus groups using a semistructured set of questions. the set of questions was primarily derived from the goals of the evaluation. as such, the majority of the questions addressed the effects of training, reduced caseload levels, and an enhanced career ladder on job satisfaction, turnover, and case outcomes. the portion of the study featured in this article includes some data from responses to these questions but is largely based on responses to the remaining questions that sought to identify any important issues that were not addressed in the more structured questions. examples include the following: “do you want to say anything else about morale?” “what do you believe is the leading factor in caseworker turnover?” “anything else to add?” two researchers attended each focus group and asked these questions as well as follow-up questions. analysis the analytic strategy adapted over time, shifting from the original goal of evaluation to the goal of describing the experiences of the case managers. for the purposes of evaluation, the transcripts were initially analyzed by the principal investigator using a deductive coding strategy that facilitated the collection of information regarding the effects of the workforce initiative strategies. in line with the goals of the evaluation, codes that represented positive, negative, and neutral effects of the initiative’s strategies were created before coding. during this initial phase of coding, the pre-existing codes failed to capture some of the experiences that case managers reported, in particular the experience of voice suppression and the profound effects this suppression had on themselves and their clients. therefore, a second round of coding was conducted using an inductive approach with a focus on voice suppression. the transcripts were reviewed, and all passages representing voice suppression were identified. using axial coding, these passages were classified into the following three categories: voice suppression; sources of suppression; and effects of suppression. coding then commenced within each category. coding in the first category advances in social work, spring 2020, 20(1) 86 (voice suppression) was descriptive in nature. coding in the second category (sources of suppression) was also descriptive. passages in the third category (effects of suppression) were analyzed through causation coding (miles et al., 2020). results suppression of case managers’ voices one of the primary concerns that case managers expressed during the focus groups was suppression of their voices. the case managers in the sample repeatedly described situations in which they voiced or attempted to voice their perspectives, but were overridden by other actors in the child welfare system. the examples they provided were all focused on the management of cases. as one participant stated: we’re not looked at as the expert on our case. the data reveal a frustration with this experience of having their voices suppressed, since they believed that they had valid perspectives that should be considered during decisionmaking. they have to take more into consideration of what the case manager sees on a daily basis. they’re the ones going into the home. they’re the ones coming back with tears in their eyes. as demonstrated by the above passage, the case managers described having a unique foundation of knowledge on their cases based on their direct experience with the families. when they presented these perspectives, they were met with direct and indirect forms of voice suppression (e.g., ignored, discounted, and silenced). sources of suppression the case managers described multiple actors who suppressed their voices. one participant characterized this situation as follows: there are so many people that play a part that override everything or can override everything you say or do. analysis revealed that these groups of people could be categorized into five sources of suppression. one of the sources was internal to the foster care agency, while the others were external. supervisors were described as an internal source of suppression. external sources of suppression included professionals within the funding agency and the legal system (e.g., judges, attorneys, and guardians ad litem). supervisors. supervisors were said to suppress case managers’ voices in case decision-making and in the assignment of risky tasks. in regards to case decision-making, one participant described this suppression in the following manner: if a supervisor does not allow the case manager to explain what they want or how they feel, or just says “no, it’s gonna be this way,” you’ve lost that case steen/role of voice suppression 87 manager…you’re not even giving them a chance to explain. and they’re the ones in the field doing it. supervisors were also said to suppress case managers’ concerns regarding safety. participants described the safety risks they took when interacting with clients who had histories of extreme violence. this interaction was considered particularly risky when they were alone with parents during home visits or alone with foster youths while transporting them for care. their supervisors were described as not being open to their concerns. [supervisors] don’t look at it as you don’t feel comfortable doing it. [they look at it] as you’re trying to get out of work…and that’s not really the case. they tell you, “well, you have to do it.” we don’t have a choice. you have to do it and you get no say in that. in these ways, case managers felt their voices were suppressed by supervisors. funding agency representative. since this was a private agency, the case managers’ choices were partially controlled by the agency that funded the foster care contract. the interactions with this funder were marked by voice suppression. sometimes, we see a problem with a family that we’re trying to remediate, so we can build this family back up. but then, we’re having our funding agency say “well, we’re not going to fund that because it wasn’t in the case plan or the judge didn’t order that.” in this context, the representative of the funding agency had the power to override the case manager’s recommendations. legal professionals. the legal system was a venue in which multiple actors, specifically judges, lawyers, and guardians ad litem, encroached upon case managers’ voices. these actors were described in different ways, with judges being the most respected of the three. they expressed a desire for judges to give their opinions greater consideration, particularly since they found the judges to be out of date on child protection issues. when the judge says they’re going home, sometimes we want to jump up and down and say no. but we don’t have a choice. the judge makes the final decision. we get that, but it’s just so sad. sometimes things are not really discussed. this is the way it’s going to be. and you just can’t go any further. that’s very frustrating. the relationship with the lawyers who represented the state took on a more hostile tone, with the suppression of case managers’ voice being overt and intentional. it’s very frustrating when you’re sitting there and you’re trying to say something and [the lawyers] don’t want to hear you or they don’t want you to tell the judge or they’re not backing us up. [the lawyers] yell at you sometimes when you try to speak up to defend yourself in court. they’ll tell you to hush up. advances in social work, spring 2020, 20(1) 88 the guardians ad litem also functioned in a way that resulted in the suppression of case managers’ voices. i would never try to send a kid home if i don’t think it’s a safe environment. when you think that’s ready, you have to convince 50 other people to jump on board with you…the [guardian ad litem] can object. the participants believed that the court system elevated the voices of guardians over that of case managers. it’s like what [the guardians] say in court is the gospel…a lot of times the judge sides with the guardians. the participants expressed great concern with this, since they believed that guardians did not have as much contact with the family and did not have the training necessary for this type of work. perceptions of the effects of voice suppression these forms of suppression were described as affecting both the case manager and the case outcomes. study participants believed that positive outcomes for the child were more difficult to attain when court decisions were based on uninformed opinions that overruled their own recommendations. in addition, tasks such as home visits had to be postponed in order to respond to perspectives, specifically supervisors’ voices, that were more valued by the system than their own. one case manager presented the following case as an example of these effects on case outcomes and how this then circles back to affect the case manager. [the voice suppression] stalls reunification. mom has been doing everything underneath the moon and stars. we see a behavioral change. we see a parent from the very beginning who has been aggressive and tenacious as far as going out and doing their case plans and changing for their kids. and then we’re halted by the [guardian ad litem] who says, “well, i think that, you know, there’s some kind of threat. i can’t put my finger on it, but there’s some type of threat in there.” our opinions, our education, our knowledge means nothing at times. so that goes back to morale and that goes back to retention. in this way, participants’ descriptions of voice suppression reflected a complex interaction of negative effects on both the case manager and the family. discussion one of the key findings of this study is that case managers described their work experience as being marked by voice suppression. this finding aligns with the results of griffiths and royse (2017) who interviewed case managers and found that voice suppression was a key issue for the participants in their sample. however, much of the data from their study reflected voice suppression during efforts to improve the agency as a whole, as opposed to voice suppression during case-level decision-making. it should be noted that ellett et al. (2007) and morazes et al. (2010) conducted similar qualitative studies on turnover and did not report voice suppression as a major issue of concern. steen/role of voice suppression 89 therefore, the possibility remains that this finding is sample-specific. on the other hand, the theme of voice suppression might be present in these studies but entangled with other themes related to organizational culture or to the source of suppression, such as supervisory relationships. similarly, voice suppression might be an inherent part of organizational rigidity, lack of autonomy, and lack of participation in decision-making, which have all been studied using quantitative methods (glisson et al., 2012; hopkins et al., 2010; kim & kao, 2014; mor barak et al., 2001, 2006). the second key finding is that case managers experienced voice suppression from multiple sources, including supervisors and legal professionals. past research, both quantitative and qualitative, provides a wealth of evidence that supervision is a critical factor in the child welfare workplace (barth et al., 2008; cearley, 2004; chen & scannapieco, 2010; chenot et al., 2009; dickinson & perry, 2002; ellett et al., 2007; griffiths et al., 2017; jacquet et al., 2007; kim & kao, 2014; lee et al., 2011; morazes et al., 2010; smith, 2005; strand & dore, 2009; westbrook et al., 2012; westbrook & crolley-simic, 2012; yankeelov et al., 2009). this study adds to this body of literature through additional detail on the ways in which supervisors suppress the case managers’ voice, specifically their concerns regarding their own safety and the well-being of the children on their caseload. likewise, this finding adds detail to the literature regarding the relationship between case managers and legal professionals. while ellett et al. (2007) and morazes et al. (2010) both describe case managers’ frustration with the courts, the nature of the relationships with legal professionals and the ways that these professionals suppress the case manager’s voice are seldom examined. the third key finding is that the case managers in the sample believed that voice suppression had negative effects on case managers and clients. the literature provides some support for a negative effect on case managers. though only one study directly suggests a relationship between voice suppression and turnover (griffiths & royse, 2017), many others focus on related concepts that affect job satisfaction and turnover. this finding regarding voice suppression reflects a desire for both autonomy and participation in decision-making, which have been found to have significant effects on case managers (hopkins et al., 2010; kim & kao, 2014; mor barak et al., 2001; 2006). the findings also reflect a frustration with rigidity in culture, i.e., “no flexibility in carrying out their jobs” which glisson and colleagues (2012) found to be significantly related to case manager outcomes (p. 625). little research has focused on the relationship between these concepts and client outcomes, but what is available suggests that the way child welfare professionals interact with one another affects child well-being (glisson & hemmelgarn, 1998). implications for practice these results highlight the importance of addressing the relationship between case managers and their professional partners (e.g., judges, attorneys, and guardians ad litem), which might be improved through inter-professional education. evaluations of interprofessional education in the field of healthcare have yielded evidence of positive impact for not only organizational culture and collaborative team behavior, but also service quality and patient outcomes (reeves et al., 2013). some efforts have been made to integrate interprofessional education into child welfare (gillespie et al., 2010; marsh, 2006), though most advances in social work, spring 2020, 20(1) 90 of these efforts focus on partnering with health professionals rather than legal professionals. an exception to this gap can be found in the work of faller and vandervort (2007), who presented a model used at the university of michigan for joint training of law and social work students. the field of child welfare might consider prioritizing and expanding these efforts with the goal of improving inter-professional communication in child welfare cases. these results also have implications for practice at the administrative level. just as administrators are encouraged to integrate the client voice into agency decision-making (mizrahi et al., 2009), so too should administrators consider the input of case managers and guard against the suppression of their voices. part of this involves the expectation that the agency’s supervisors use management styles that are less directive and more democratic. further, administrators have a responsibility to engage the funding agency to ensure that services recommended by case managers are funded. limitations and implications for research these results should be considered in light of the study’s limitations. ideally, qualitative research is conducted with repeated rounds of analysis and consultation with the participants, resulting in continued refinement of the results. the present study lacked this iterative process, since the researchers had access to participants only through the focus group discussion. another ideal condition in qualitative research is the presence of multiple methods of data collection to allow for triangulation. while the evaluation did involve multiple methods, this particular theme of voice suppression came directly from the case managers during the focus group discussions, which took place at the mid-point in the evaluation. the other methods were designed at the beginning of the evaluation and were of course guided by the goal of assessing the impact of the workforce initiative. thus, suppression of the case managers’ voice was not recognized as an important factor during the collection of quantitative data. however, the study did contain three separate focus groups, each of which spontaneously provided examples of voice suppression without being guided to do so. in this way, the repetition of narrative across the groups does provide some confidence in the conclusion that voice suppression is a common theme in the experience of the sample. lastly, these results are specific to the sample in which they were collected, and therefore, lack generalizability to the population of case managers. the sample may have been composed of case managers who had particularly negative experiences with voice suppression that motivated them to participate in the focus groups. the degree to which these results represent the views of case managers in general is unknown. additional research is needed to further understand the perspectives of all professional partners and stakeholders in the child welfare field. each narrative about one’s experience in the system and one’s view of interactions with others in the system can point to ways in which system functioning can be optimized. to extend this line of inquiry, this type of research with case managers should be replicated and similar research with other professional partners should be initiated. important questions remain regarding legal professionals’ perspectives on their role and the case managers’ role, in addition to their preferences regarding inter-professional communication. likewise, further research is steen/role of voice suppression 91 needed in line with the work of bogo and dill (2008) on the experience of the child welfare supervisor, their perceptions of supervision management styles, and their perceptions of case managers. conclusion this study contributes to the field’s understanding of the case manager experience and the suppression of their voices. too often, practice decisions and system reforms are structured by legislation that was developed without the consultation of those who directly experience the system. likewise, the design of child welfare research is often shaped by forces at the macro level, including federal and state standards, administrators’ agendas, and research funders’ preferences. in order to shift this trend, the voices of case managers should be elicited, reported, and integrated into decision-making to guide child welfare research, child welfare system reform, and most importantly, child welfare outcomes. references barth, r. p., lloyd, c., christ, s. l., chapman, m. v., & dickinson, n. s. 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(2011). psychological empowerment and child welfare worker outcomes: a path analysis. child & youth care forum, 40, 479-497. https://doi.org/10.1007/s10566-011-9145-7 lietz, c. a., & rounds, t. (2009). strengths-based supervision: a child welfare supervision training project. the clinical supervisor, 28, 124-140. https://doi.org/10.1080/07325220903334065 marsh, p. (2006). promoting children’s welfare by inter-professional practice and learning in social work and primary care. social work education, 25, 148-160. https://doi.org/10.1080/02615470500487622 miles, m. b., huberman, a. m., & saldaña, j. (2020). qualitative data analysis: a methods sourcebook. thousand oaks, ca: sage. https://doi.org/10.1080/10572252.2015.975966 mizrahi, t., humphreys, m. l., & torres, d. 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(2010). views of speciallytrained child welfare social workers: a qualitative study of their motivations, perceptions, and retention. qualitative social work, 9, 227-247. https://doi.org/10.1177/1473325009350671 https://doi.org/10.1016/j.childyouth.2010.06.006 https://doi.org/10.1300/j479v01n03_03 https://doi.org/10.1016/j.childyouth.2014.09.015 https://doi.org/10.1037/e522532014-205 https://doi.org/10.1007/s10566-011-9145-7 https://doi.org/10.1080/07325220903334065 https://doi.org/10.1080/02615470500487622 https://doi.org/10.1080/10572252.2015.975966 https://doi.org/10.1016/j.childyouth.2005.06.003 https://doi.org/10.1086/323166 https://doi.org/10.1177/1473325009350671 advances in social work, spring 2020, 20(1) 94 pecora, p. j., whittaker, j. k., barth, r. p., borja, s., & vesneski, w. (2018). the child welfare challenge: policy, practice, and research. routledge. https://doi.org/10.4324/9781351141161-2 reeves, s., perrier, l., goldman, j., freeth, d., & zwarenstein, m. (2013). interprofessional education: effects on professional practice and healthcare outcomes (update, review). cochrane database of systematic reviews, 2013(3), 1-47. https://doi.org/10.1002/14651858.cd002213.pub3 smith, b. d. (2005). job retention in child welfare: effects of perceived organizational support, supervisor support, and intrinsic job value. children and youth services review, 27, 153-169. https://doi.org/10.1016/j.childyouth.2004.08.013 strand, v. c., & dore, m. m. (2009). job satisfaction in a stable state child welfare workforce: implications for staff retention. children and youth services review, 31, 391-397. https://doi.org/10.1016/j.childyouth.2008.09.002 strolin, j. s., mccarthy, m., & caringi, j. (2006). causes and effects of child welfare workforce turnover. journal of public child welfare, 1, 29-52. https://doi.org/10.1300/j479v01n02_03 westbrook, t. m., & crolley-simic, j. (2012). perceptions of administrative and supervisory support in public child welfare. advances in social work, 13, 603-617. https://doi.org/10.18060/1955 westbrook, t. m., ellett, a. j., & asberg, k. (2012). predicting public child welfare employees’ intentions to remain employed with the child welfare organizational culture inventory. children and youth services review, 34, 1214-1221. https://doi.org/10.1016/j.childyouth.2012.02.010 willis, n., chavkin, n., & leung, p. (2016). finding “health” and “meaning” in texassized turnover: application of seminal management principles for administration and research in u.s. public child welfare agencies. advances in social work, 17, 116133. https://doi.org/10.18060/20856 yankeelov, p. a., barbee, a. p., sullivan, d., & antle, b. f. (2009). individual and organizational factors in job retention in kentucky’s child welfare agency. children and youth services review, 31, 547-554. https://doi.org/10.1016/j.childyouth.2008.10.014 author note: address correspondence to julie a. steen, school of social work, university of central florida, 12805 pegasus drive, orlando, fl, 32816-3358. email: jsteen@ucf.edu acknowledgment: this research was supported by a grant from the florida institute for child welfare. https://doi.org/10.4324/9781351141161-2 https://doi.org/10.1002/14651858.cd002213.pub3 https://doi.org/10.1016/j.childyouth.2004.08.013 https://doi.org/10.1016/j.childyouth.2008.09.002 https://doi.org/10.1300/j479v01n02_03 https://doi.org/10.18060/1955 https://doi.org/10.1016/j.childyouth.2012.02.010 https://doi.org/10.18060/20856 https://doi.org/10.1016/j.childyouth.2008.10.014 mailto:acrandel@nmu.edu this work is licensed under a creative commons attribution 4.0 international license. assessing refugee poverty using capabilities versus commodities: the case of afghans in iran mitra naseh miriam potocky shanna l. burke paul h. stuart abstract: this study is among the first to calculate poverty among one of the world’s largest refugee populations, afghans in iran. more importantly, it is one of the first to use capability and monetary approaches to provide a comprehensive perspective on afghan refugees’ poverty. we estimated poverty using data collected from a sample of 2,034 refugee households in 2011 in iran. we utilized basic needs poverty lines and the world bank’s absolute international poverty line for our monetary poverty analyses and the global multidimensional poverty index (mpi) for our capability analyses of poverty. findings show that nearly half of the afghan households were income-poor, approximately two percent of the households had less than usd 1.25 per person per day, and about 28% of the surveyed households were multidimensionally deprived. results suggest that 60% of the income-poor households were not deprived from minimal education, health, and standards of living based on the mpi criteria, and about 32% of the multidimensionally deprived households were not income-poor. these findings call for more attention to poverty measurement methods, specifically for social workers and policy makers in the field, to gain a more realistic understanding about refugees’ wellbeing. keywords: refugee, multidimensional poverty, absolute poverty, income poverty according to the united states council on foreign relations (2017), currently 28 conflicts are ongoing around the world, none of which are being resolved. these ongoing and unresolved conflicts are one of the main reasons that the population of forcibly displaced individuals rose to the record high number of 65.6 million in 2016 (united nations high commissioner for refugees [unhcr], 2017a). this means that one in every 113 people on the planet was either an internally displaced person (idp), an asylum seeker, or a refugee by the end of 2016 (unhcr, 2017a). refugees are forcibly displaced people who have crossed an international border based on a well-founded fear of persecution and sought protection in another country (unhcr, 2010). for this population, leaving home countries is usually abrupt and unplanned, as the majority flee war or conflict-affected areas (unhcr, 2017a). this abrupt and unplanned departure frequently leaves refugees with limited social and physical assets and places them at high risk of poverty (jacobsen, 2005). adding to this risk, most refugees can only afford to escape to neighboring countries (jacobsen, 2005); consequently, an overwhelming majority (84%) live in developing countries with limited resources (unhcr, 2017a). the combined lack of physical and social assets and limited resources in host countries puts refugees in vulnerable positions and prone to experience multiple ______________ mitra naseh, ms, ph.d. candidate, miriam potocky, ph.d., msw, professor, shanna l. burke, ph.d., msw, assistant professor, and paul h. stuart, ph.d., msw professor, at the school of social work, robert stempel college of public health and social work, florida international university, miami, fl 33199. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 853-873, doi: 10.18060/21635 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 854 deprivations. while studies on refugees’ poverty are scarce, they affirm high rates of poverty among some groups of refugees (alloush, gonzalez, gupta, rojas, & taylor, 2016; chaaban, seyfert, salti, & el makkaoui, 2013; hejoj, 2007; khawaja, 2003). this study aims to measure poverty and deprivation among one of the world’s largest refugee populations, afghans in iran. more specifically, this study aims to answer two research questions: 1. what are the poverty rates of afghan refugees in iran? 2. how do these poverty rates vary by the households’ demographic characteristics? to provide a comprehensive answer to the first question, this study utilizes both the capability and monetary approaches in poverty measurement. the study utilizes basic needs poverty lines and the world bank’s absolute international poverty line for the monetary poverty analyses and the global multidimensional poverty index for the capability analyses of poverty. to answer the second question, this study assesses poverty rates by age, gender, and occupational status of the head of afghan refugee households and by households’ refugee status and dwelling types in iran. state of knowledge on refugee poverty limited studies have been conducted on refugee poverty, particularly in developing countries. among the published studies in this field, the monetary approach to poverty is more common and studies with the capability approach are scarce. the literature on refugee poverty in general will be presented first, followed by the literature on poverty among afghan refugees in iran. moreover, since the focus of this study is on afghan refugees who live in iran as a temporary host country, only literature relevant to refugee poverty in temporary host countries will be reviewed. the countries that refugees first arrive to in search of safety and protection are known as temporary host countries. refugees in these countries generally receive temporary protection until they find a durable solution for their displacement. according to the unhcr, and based on the 1951 convention relating to the status of refugees, three categories of durable solutions exist: 1) voluntary repatriation to the country of origin, 2) local integration in the temporary host country, and 3) resettlement in a new country (unhcr, 2010, 2017b). among the studies that we retrieved on refugee poverty in temporary host countries is a study by khawaja (2003) in jordan. in this study, 60% of the refugees who were surveyed in 12 refugee camps said they did not have enough money to make ends meet. approximately 27% of the respondents to the same survey reported income that was below 50% of the income they said they needed. also in jordan, another study found that 41.8% of surveyed palestinian refugees in two camps lived below a poverty line set at 50% of the median self-reported needed income (hejoj, 2007). chaaban and colleagues (2013) found that 27% of refugees in lebanon were poor based on basic needs poverty lines, and 40% were multidimensionally poor based on the capability approach and the authors’ index capturing refugees’ health, food security, adequate education, access to stable employment, decent housing, and possession of essential household assets. income poverty rates for syrian refugees were 90% in jordan and 70% in lebanon based on the respective national naseh et al./assessing refugee poverty 855 poverty lines (unhcr, 2016). in a study among 545 households in three congolese refugee camps in rwanda, income poverty ranged between 73% and 76% and multidimensional poverty, based on the global multidimensional poverty index, ranged between 22% and 47% (alloush et al., 2016). the above-identified studies associated refugees’ poverty with place of residence, years of residence in host countries, household sizes, age groups, education levels, and employment of the head of the households. lower poverty rates were reported for refugees living in urban and rural areas (alloush et al., 2016; jacobsen, 2005), longer periods of residency in host countries (khawaja, 2003), higher levels of education (hejoj, 2007; khawaja, 2003), and households with an employed household head (hejoj, 2007). reported poverty rates were higher among refugees aged 60 and older (hejoj, 2007), those in retirement ages (khawaja, 2003), those living in refugee camps or settlements (alloush et al., 2016), and households with six or more children (hejoj, 2007). despite the large population of afghan refugees in iran, we found no previous study on afghan refugees’ poverty in this country. according to the unhcr latest global trend report, one in every nine refugees worldwide is from afghanistan and around 40% of this population resides in iran (unhcr, 2017a). lack of information and the political sensitivity of the topic for the iranian government could be among the reasons for the absence of studies in this field (tober, 2007). while lack of information is a major problem, the limited available reports and studies on afghan refugees indicate the existence of deprivation in different aspects of refugees’ lives, specifically in health and education. among the reported health concerns for afghan refugees in iran are high child mortality rates and malnourishment. a study on afghan refugees who lived on the border of iran, afghanistan, and pakistan reported a 50% death rate for children under the age of five (poureslami, maclean, spiegel, & yassi, 2013). another study on afghan refugees in the pakdasht area in iran indicated that 11% of the afghan children under the age of five were underweight and 8.5% were stunted in physical growth (abdollahi et al., 2015). a more recent study on afghan refugees in tehran and mashhad cities showed that over 60% of the surveyed households suffered from moderate to severe food insecurity (omidvar, ghazi-tabatabie, sadeghi, mohammadi, & abbasi-shavazi, 2013). moreover, studies on afghan refugees in iran indicated low levels of education among this population. adelkhah and olszewska (2007) reported that only 33% of the school-aged afghan children were enrolled in schools in 1998 and garakani (2009) reported that only 55% of the newlyarrived adult afghans in iran were literate in 2002. the preceding review on the state of knowledge on refugee poverty has demonstrated high rates of poverty among surveyed refugee groups, which calls for further investigations and poverty research among understudied refugee populations, like afghans in iran. moreover, these studies showed that different poverty measurement methods may yield different poverty rates among the same population, which highlights the need for more comprehensive approaches in poverty assessments. advances in social work, spring 2018, 18(3) 856 conceptual frameworks the conceptual models of the study are grounded in the monetary and capability approaches to poverty and deprivation. these two approaches underlie the definition of the outcome variable of the study, poverty rates. monetary approach to poverty the monetary approach to poverty is the most commonly used method for poverty calculations (laderchi, saith, & stewart, 2003). in this approach, a specific amount of money, the poverty line, separates poor from non-poor individuals or groups (laderchi et al., 2003). this approach was introduced by pioneers like booth (1887) and rowntree (1901) in the 19th and early 20th centuries and has remained the most convenient method for researchers, as it relies on widely available data on households’ or individuals’ expenditures or income (laderchi et al., 2003). in the monetary approach, different techniques are used to construct poverty lines. the most commonly used approach is the cost of basic needs (haughton & khandker, 2009). in this approach, the poverty line is set at the estimated cost of acquiring adequate nutrition and essentials of living, such as clothing and shelter (haughton & khandker, 2009). another widely used technique to define a poverty line with this approach is asking people what is the minimum amount of income needed to make ends meet? the answer defines a subjective poverty line (haughton & khandker, 2009). the third commonly used poverty line in this approach is the absolute international poverty line calculated by the world bank based on the minimum cost of essentials of living, which allows a cross-country comparison of poverty (haughton & khandker, 2009). in this study, we use the cost of basic needs poverty lines and the world bank absolute international poverty line for our monetary poverty analyses. although the monetary approach to poverty is the most commonly used method for poverty calculations, it has at least two major limitations associated with using money as a proxy to quantify deprivation. one of the main limitations is the flawed assumption of constant purchasing power of money over time and in different locations (abu-ismail, ellaithy, armanious, ramadan, & khawaja, 2015). defined monetary poverty lines are not constantly adjusted to take account of fluctuating exchange rates and inflation rates. another important limitation of the monetary approach to poverty is the assumption that a specific amount of money necessarily equals fulfillment of specific needs. for instance, a household that can afford primary schooling for children, but neglects it, or a household that has enough money for health care, but does not have access to it, is not identified as poor or deprived using the monetary approach to poverty. however, children of the first household are deprived of education and members of the second are deprived of primary health care. capability approach to poverty in the 1980s, the capability approach to poverty was introduced as a response to the above-discussed gaps in the monetary approach (laderchi et al., 2003). the capability approach was first presented in its modern context by the nobel prize winner in economics, naseh et al./assessing refugee poverty 857 amartya sen (robeyns, 2005). sen (sen & honderich, 1985; sen, 1988, 1999, 2000) pioneered the capability approach and his work was further advanced later by martha nussbaum (nussbaum, 1992, 2000, 2003). the capability approach explores the ability of individuals or groups to do what they want to and be what they want (functioning), based on their available opportunities and freedom instead of their amount of assets (income) owned (robeyns, 2005). this approach argues that wellbeing is about opportunities that individuals or groups have to live the lives that they have reasons to value (robeyns, 2005). such opportunities could vary among different people in different societies and could be affected by social values, cultural factors, social class, societal conventions, and customs (clark, 2005). therefore, this approach fits well with the prominent person-in-environment framework in the social work profession. like the capability approach, the person-inenvironment perspective highlights the importance of understanding individuals and their behaviors in relation with their environment and discusses that people’s lives are shaped and have meaning within their social structures (cornell, 2006). the capability framework as defined by sen is flexible, without a fixed list of capabilities (clark, 2005). however, during the past decades, several researchers have tried to define a list of capabilities for this approach to create an index (laderchi et al., 2003). among the more popular indices based on this approach is the human development index (hdi, robeyns, 2005). the hdi measures life expectancy at birth, adult literacy, educational enrollment, and per capita income (robeyns, 2005). the united nations development programme (undp) has utilized the hdi in its annual human development reports to assess welfare in different countries since 1990 (robeyns, 2005). however, since 2010, the hdi has been replaced in the annual human development reports with the global multidimensional poverty index (mpi) as a more comprehensive index (undp, n.d.). the mpi was designed by alkire and santos (2010) at the oxford poverty and human development initiative (ophi) with the financial support of the undp (ophi, n.d.). this index measures deprivation in three dimensions: education, health, and standard of living through 10 indicators (table 1). table 1 summarizes this index based on the undp technical notes on mpi (jahan et al., 2015). in this study, we use the mpi for our poverty analyses based on the capability approach. variables poverty is the outcome variable of the study, and, as discussed, it is defined by the capability and the monetary approaches. besides estimating the average poverty rates based on these two approaches, this study explores how poverty rates vary based on age, sex, and occupational status of the head of the households and households’ refugee status and dwelling types. in this study the outcome variables, poverty rates, are continuous (ranging from 0% to 100%), and households’ socioeconomic and demographic characteristics, as independent variables, are categorical. age, as the first independent variable of the study, has four age categories of household heads: adolescent (under the age of 18), young adult (ages 18-35), middle-aged adult (ages 36-59), and older adult (ages 60 and over). biological sex of the heads of the households, as the second independent variable of this study, has two categories, female-headed and male-headed. occupational status, as the next independent variable of the study, advances in social work, spring 2018, 18(3) 858 categorizes heads of households into two categories: employed with a paid job and unemployed (including unemployed individuals who are looking for a job, students, housewives, and those who listed their occupation status as others). refugee status of the households, as the fourth independent variable in this study, classifies households into two categories: documented and undocumented. refugees in iran are documented if they hold valid documentation issued by the iranian government and they are undocumented if they don’t have such a document (koepke, 2011). if the household head is documented it usually means that all the household members are documented, as refugee documentation cards are issued for a household as a unit in iran. dwelling type is the last independent variable in this study and classifies households into four categories: households living in urban areas, rural areas, settlements, and colonies. settlements are government-run camps, which are usually located in remote areas and far from main cities. refugees in settlements have access to some humanitarian assistance like free sanitary materials and food items, but usually have limited access to livelihood opportunities due to the remoteness of the camp locations. colonies usually consist of extended afghan family members or tribal members who live together in the form of a group. colonies are usually located on the outskirts of refugee-populated cities. table 1. dimensions, indicators, deprivation thresholds and weights of the mpi dimension indicator deprived if… relative weight education school attainment no household member has completed at least six years of schooling 16.7% school attendance a school-age child (up to grade 8) is not attending schoolp 1 16.7% health nutrition a household member (for whom there is nutrition information) is malnourished, as measured by the body mass index for adults (women ages 15-49 in most of the surveys) and by the height-forage z-score calculated based on world health organization standards for children under age of five 16.7% child mortality a child has died in the household within the five years prior to the surveyp 2 p 16.7% standard of living electricity not having access to electricity 5.6% drinking water not having access to clean drinking water or having access to clean drinking water through a source that is located 30 minutes away or more by walking 5.6% sanitation not having access to improved sanitation facilities or having access only to shared improved sanitation facilitiesp 3 5.6% cooking fuel using “dirty” cooking fuel (dung, wood or charcoal) 5.6% flooring having a home with dirt, sand or dung floor 5.6% assets not having at least one asset related to access to informationp 4 p and not having at least one asset related to mobilityp 5 p or at least one asset related to livelihoodp 6 p 5.6% p 1 p in order to avoid a mismatch between age of the child and beginning of the school year, a late enrollment for a period of up to 12 months was allowed. p 2 p in case that a survey fails to track time of death of a child, any death reported by mother (age 35 and younger) is considered. p 3 p definitions for drinking water and improved sanitation are extracted from the millennium development goals. p 4 p including radio, television or telephone (both landline and mobile telephones). p 5 p including bike, motorbike, car, truck, animal cart or motorboat. p 6 p including refrigerator, any size of land usable for agriculture, or livestock comprising of a horse, a head of cattle, two goats, two sheep or 10 chickens source: jahan et al. (2015). naseh et al./assessing refugee poverty 859 data analyses afghan refugee households’ poverty rates based on the monetary approach were calculated using the cost of basic needs poverty lines and the world bank absolute international poverty line. in this study, we refer to the former as the income poverty rate and the latter as the absolute poverty rate. income poverty rates were calculated by comparing afghan refugee households’ monthly income with the related cost of basic needs poverty lines in iran. refugee households’ monthly income was calculated based on the sum of the households’ monthly expenditures on food, clothing, health, education, tobacco, transportation, communication, housing, and energy, plus monthly savings. this calculated income was compared with the basic needs poverty lines that are adjusted for inflation from ghaedi’s (2010) study. a household was categorized as income-poor if the calculated monthly income was less than the basic needs poverty line for its household size. afghan refugees’ absolute poverty rate was calculated based on a comparison of daily individual incomes with the world bank absolute international poverty line, which was usd 1.25 per day per person at 2011 purchasing power parity (haughton & khandker, 2009). daily individual incomes were calculated by dividing households’ monthly income by the number of household members and an average of 30 days in one month. afghan refugee households’ poverty based on the capability approach was calculated using the global multidimensional poverty index (mpi). in this study, we refer to the poverty rate calculated based on this method as the multidimensional poverty rate. as noted earlier, the mpi consists of three dimensions and ten indicators. according to this index, a household is deprived in the first dimension, education, if none of the members have completed at least six years of schooling, or if any school-aged child (up to eighth grade) is out of school (jahan et al., 2015). in the second dimension of mpi, health, a household is deprived if any child has died within the five years prior to the survey, or any member is malnourished (jahan et al., 2015). in the present study, data on child deaths were collected for the year prior to the survey. the mpi measures malnutrition based on the body mass index for adults aged between 15 to 49 and the z score for height to age for children below the age of five (jahan et al., 2015). however, due to limitations of the dataset in this study, malnutrition was calculated based on the minimum food expenditure required for purchasing adequate monthly calories per adult (ages 15 and above). food acquisition and amount of money spent to purchase food could be a proxy indicator for nutrition (thornelyman et al., 2009; pinstrup-andersen, & herforth, 2008; zezza, carletto, fiedler, gennari, & jolliffe, 2017). minimum required food expenditures were extracted from khodadad-kashi and heidari’s (2009) study. those researchers calculated minimum monthly required food expenditures in urban and rural areas for 2,179 calories per day, which represents an average iranian diet according to pajouyan’s study (as cited in khodadad-kashi & heidari, 2009). for the present study, these estimated minimum required food expenditures were adjusted with the central bank of iran’s (n.d.) reported inflation rates for food and beverages in 2009 (30.2%), 2010 (9.9%), and 2011 (16.6%), resulting in minimum required food expenditures of irr 641,605 in urban areas and irr 530,018 in rural areas. per capita advances in social work, spring 2018, 18(3) 860 food expenditures were compared with these two numbers. to calculate the per capita food expenditures, households’ spending on food was divided by a weighted number of adults in the family (score 1 for members aged 15 or above, score 0.5 for members between the ages of 2 and 15, and score .25 for members under the age of 2). households living in settlements were excluded from malnutrition analyses as they receive food baskets from the world food programme in iran (world food programme, 2017). a household is deprived in the third dimension of the mpi, standard of living, if it does not have access to electricity, clean drinking water, improved sanitation, if it has “dirty” cooking fuel, a home with a dirt floor, or lacks assets (jahan et al., 2015). households’ assets in this method are related to access of information (radio, tv, land line telephone or mobile phone), mobility (bike, motorbike, car, truck, animal cart, motorboat), livelihood (refrigerator, any size arable land), or livestock (a horse, two goats, a head of cattle, two sheep, or 10 chickens) (jahan et al., 2015). according to the mpi definition, access to clean drinking water means water is available at the home or the source of clean drinking water is accessible within 30 minutes by walking (jahan et al., 2015). due to limitations of the dataset utilized, access to clean drinking water in this study was calculated based on the households’ access to piped water at home. moreover, according to mpi definition, unimproved sanitation includes using public or shared toilets or use of unacceptable privacy types (united nations, n.d.). since information about quality of facilities was not available in the selected dataset for this study, only households who shared a toilet or latrine were considered as deprived in this area. furthermore, due to limitations of the dataset and lack of information about house flooring, this indicator of the mpi (home with a dirt floor) was excluded from calculation. using stata version 14 (statacorp, 2015), for each household in the dataset, a score of 1 was assigned to each of the mpi indicators if that household was deprived in that area, and 0 was assigned if that household was not deprived in that area. for instance, if none of the members of a household had completed at least six years of schooling, a score of 1 was assigned to the first indicator of the mpi in the education dimension and if at least one member of a household had completed at least six years of schooling, a score of 0 was assigned to this indicator. in accordance with the mpi definition, the three dimensions of education, health, and standard of living were equally weighted as 1/3 or 0.33. all indicators within each dimension were also equally weighted. this means that each one of the two indicators in the first and the second dimensions were weighted as 1/6 (1/3 ÷ 2) or 16.7%. for the third dimension (standard of living), only five out of the six indicators were weighted, as information about house flooring was not available in the utilized dataset. therefore, each one of the five indicators was weighted equally as 1/15 (1/3 ÷ 5) or 6.7%. for each household, the deprivation score was calculated by summing the weighted indicators. in accordance with the mpi definition, a household was categorized as multidimensionally poor if the calculated deprivation score was 33.3% or greater. naseh et al./assessing refugee poverty 861 results demographic characteristics the demographic characteristics of the head of the households are shown in table 2. as seen, the vast majority of households were headed by young (ages 18-35) or middleaged adults (ages 36-59). female-headed households constituted a small portion of the sample, seven percent (142 households). similarly, households with unemployed or undocumented heads had a smaller representation in the sample. furthermore, nearly onehalf of the households resided in urban areas, more than one-third resided in rural areas, and much smaller percentages lived in colonies and settlements. table 2. poverty percentages by demographic characteristics of head of households demographic characteristic sample % (n) income poverty absolute poverty multidimensional poverty age 16-17 0.1% (2) 0% (0) 0% (0) 100% (2) 18-35 34.3% (697) 46.6% (325) 1.7% (12) 31.1% (217) 36-59 51.8% (1,054) 47.8% (506) 2.7% (28) 24.6% (261) 60+ 13.8% (281) 44.1% (124) 2.1% (6) 30.6% (86) biological sex male 93.0% (1,892) 46.0% (880) 2.1% (40) 27.2% (514) female 7.0% (142) 52.8% (75) 4.2% (6) 36.6% (52) occupational status employed 81.1% (1,649) 46.8% (771) 2.2% (36) 27.5% (454) unemployed 18.9% (385) 47.8% (184) 2.6% (10) 29.1% (112) refugee status documented 84.3% (1,715) 48.5% (832) 2.2% (37) 25.5% (437) undocumented 15.7% (319) 38.5% (123) 2.8% (9) 40.4% (129) dwelling type urban 46.0% (936) 71.8% (672) 1.6% (15) 36.0% (337) rural 36.9% (751) 20.5% (154) 2.4% (18) 20.2% (152) colony 9.5% (194) 13.9% (27) 0.5% (1) 26.8% (52) settlement 7.5% (153) 66.7% (102) 7.8% (12) 16.3% (25) research question 1: poverty rates the three different types of household poverty rates are shown in table 3. as seen, nearly half of the surveyed households were income-poor, meaning they lived with an average monthly income level less than the basic needs poverty lines. however, only about two percent of the surveyed afghan refugee households were living in absolute poverty, meaning living with less than usd 1.25 per day. finally, about one-fourth of the surveyed households were multidimensionally poor, meaning they had a total deprivation score of 33% or higher. table 3. household poverty rates (n=2,034) poverty type % (n) income poverty 47.0% (955) absolute poverty 2.3% (46) multidimensional poverty 27.8% (566) advances in social work, spring 2018, 18(3) 862 table 4 shows the percentage of households that were deprived on different indicators of the mpi broken down by the demographic characteristics of the head of the households. access to electricity, the first indicator in standards of living, was not displayed in the table since in this study, 100% coverage and zero deprivation was considered for this indicator. as demonstrated in table 4, the greatest deprivations were in the areas of nutrition and school attainment; over one-half of the households were at risk of malnutrition, and nearly half had no member (aged above 13) with at least six years of schooling. nearly one-fifth of households did not have access to private bathrooms. the remaining indicators showed much less deprivation. around 10% of the surveyed households had at least one schoolaged child out of school; did not have access to clean cooking fuel; and/or did not have at least one of the assets relevant to access to information, mobility, livelihood, or livestock. less than two percent of the households lacked access to piped water. four households reported a death under the age of five within the year prior to the survey. among the different age groups, households headed by an adolescent or an older adult had the highest rates of deprivation across different indicators of the mpi. households headed by an adolescent had the highest rates of deprivation in school attendance for children and access to sanitation, clean cooking fuel, and assets. households headed by an older adult had the highest rates of malnutrition and child mortality, and the lowest rate of access to clean drinking water. moreover, households headed by a female and an undocumented afghan had the highest rates of deprivation in all, except one of the indicators, access to clean drinking water. among the surveyed households, those headed by an unemployed individual had higher rates of deprivation in health dimension and standards of living. furthermore, the highest rates of deprivation in the two indicators of education were observed among afghans residing in colonies, the highest rates of deprivation in the two indicators of health were observed among afghans residing in urban areas, and the highest rates of deprivation in the four indicators of standards of living (excluding electricity) were observed among afghans residing in settlements. there were substantial disparities within households across the three poverty measures. around 60% (571) of the income-poor households were not multidimensionally poor. this percentage signifies that more than half of the households who had a monthly income below the income poverty lines in iran had access to minimum education, health, or standards of living; in other words, their combined deprivation score in the three dimensions of mpi was higher than the multidimensional poverty threshold. conversely, 32% (182) of the multidimensionally poor households were not income-poor. in other words, around one in every three households who were deprived from minimum education, health, and standards of living according to the mpi definition, had an income level higher than the income poverty lines in iran. moreover, 54% (25) of the refugee households who were in absolute poverty were not multidimensionally poor. this number demonstrates that over half of the refugees who did not have a minimum of usd 1.25 per day had access to minimum education, health, and standards of living according to the mpi definition. furthermore, 27% (545) of the multidimensionally poor refugees were not in absolute poverty. members of more than one in every four households, who were deprived from minimum education, health, and standards of living according to the mpi definition, had more than usd 1.25 per day. naseh et al./assessing refugee poverty 863 table 4. percentage of households deprived on mpi indicators and demographic characteristics of head of households demographic characteristic all % (n) edu 1p 1 p % (n) edu 2p 2 % (n) h 1p 3 p % (n) h 2p 4 % (n) sr 2p 5 % (n) sr 3p 6 % (n) sr 4p 7 % (n) sr 5p 8 % (n) age 16-17 0.1% (2) 50% (1) 50% (1) 50% (1) 0% (0) 0% (0) 100% (2) 50% (1) 50% (1) 18-35 34.3% (697) 61% (424) 8.8% (61) 45% (310) 3% (2) 1.3% (9) 24% (165) 12% (80) 1.4% (10) 36-59 51.8% (1,054) 34% (354) 11% (114) 63% (659) 0.1% (1) 1.6% (17) 12% (131) 8.3% (87) 0.9% (10) 60+ 13.8% (281) 42% (117) 8.9% (25) 64% (180) 0.4% (1) 2.1% (6) 21% (60) 14% (40) 4.3% (12) biological sex male 93.0% (1,892) 44% (826) 10% (183) 56% (1,064) 0.2% (3) 1.7% (32) 17% (318) 10% (187) 1.2% (23) female 7.0% (142) 49% (70) 13% (18) 61% (86) 0.7% (1) 0% (0) 28% (40) 15% (21) 7.0% (10) occupational status employed 81.1% (1,649) 45% (745) 11% (175) 55% (902) 0.2% (3) 1.9% (31) 17% (284) 10% (160) 1.3% (22) unemployed 18.9% (385) 39% (151) 6.7% (26) 64% (248) 0.3% (1) 0.3% (1) 19% (74) 13% (48) 2.8% (11) refugee status documented 84.3% (1,715) 40% (692) 9.0% (155) 56% (962) 0.1% (2) 1.5% (25) 17% (284) 11% (193) 1.6% (27) undocumented 15.7% (319) 64% (204) 14% (46) 59% (188) 0.6% (2) 2.2% (7) 23% (74) 4.7% (15) 1.9% (6) dwelling type urban 46.0% (936) 49% (456) 14% (126) 68% (635) 0.3% (3) 0.3% (4) 13% (117) 3.4% (32) 1.2% (11) rural 36.9% (751) 34% (254) 4.1% (31) 60% (451) 0.1% (1) 1.9% (14) 12% (87) 4.5% (34) 0.8% (6) colony 9.5% (194) 63% (122) 14% (28) 33% (64) 0% (0) 2.6% (5) 20% (39) 9.3% (18) 1.0% (2) settlement 7.5% (153) 42% (64) 11% (16) 0% (0) 0% (0) 6.5% (10) 75% (115) 81% (124) 9.2% (14) total % (n) 100% (2,034) 44.1% (896) 9.9% (201) 57% (1,150) 0.2% (4) 1.6% (32) 17.6% (358) 10.2% (208) 1.62% (33) p 1 p school attainment: no household member has completed at least six years of schooling p 2 p school attendance: a school-age child (up to grade 8) is not attending school p 3 p nutrition: household does not make minimum food expenditure required for purchasing adequate calories per person per day p 4 p child mortality: a child has died in the household within the year prior to the survey p 5 p drinking water: not having access to piped water p 6 p sanitation: not having access to a toilet or having access only to a shared toilet p 7 p cooking fuel: using a household energy source other than electricity, gas, or gasoline p 8 p assets: not having at least one asset related to access to information (telephone or desktop computer) or having at least one asset related to information but not having at least one asset related to mobility (motorbike, personal vehicle) or at least one asset related to livelihood (refrigerator) advances in social work, spring 2018, 18(3) 864 more specifically, in regard to the mpi indicators, around 48% (432) of the households without a member with at least six years of schooling, around 33% (67) of the households with at least one out-of-school child, around 39% (446) of the households at risk of malnutrition, 25% (1) of the households with child mortality, about 34% (11) of the households without access to piped water, around 38% (137) of the households without access to a private toilet, 25% (51) of the households without access to clean cooking fuel, and 21% (7) of the households without access to adequate assets for living were not income-poor. these percentages underscore that, despite facing deprivations in the mentioned indicators of the mpi, these households held income levels above the income poverty lines in iran. additionally, less than 15% of the households deprived in any of the 10 indicators of the mpi were in absolute poverty, meaning that their members had less than usd 1.25 per day. research question 2: poverty rates by demographic characteristics the three poverty measures broken down by the previously-identified demographic characteristics are shown in table 4. income poverty and absolute poverty rates were highest among households headed by middle-aged (36-59) adults. in contrast, multidimensional poverty was somewhat lower among households with middle-aged heads, affecting about one-fourth of these households, compared to nearly one-third of the 18-35 and 60+ age groups. among the youngest age group (consisting of only two households), neither was incomeor absolute-poor, though both were multidimensionally poor. income poverty, absolute poverty, and multidimensional poverty rates were considerably higher among female-headed households compared to male-headed households. households with employed and unemployed heads had similar rates of poverty on all three measures. income poverty was ten percentage points lower among undocumented than documented refugees. yet, the reverse was true for multidimensional poverty, being 15 percentage points higher among undocumented than documented refugees. the absolute poverty rate was similar for these two groups, around 2-3%. income poverty was far higher among households living in urban areas and settlements, compared to those in rural areas and colonies. absolute poverty was much higher among those in settlements compared to the other three dwelling types, yet the reverse was true for multidimensional poverty, which was much lower among those in settlements than the other three dwelling types. income and absolute poverty rates were the lowest among refugees living in colonies. discussion overall poverty rates were high among the surveyed afghan refugee households in iran. around half of these households were income-poor and more than one-fourth were multidimensionally deprived. the absolute poverty rate was low (around 2.3%), yet this rate was considerably higher than reported absolute poverty rates in iran of 0.3% in 2010 and 0.1% in 2013 (the world bank, 2017). these high rates of poverty highlight the need naseh et al./assessing refugee poverty 865 for further attention to poverty reduction strategies including humanitarian assistance in the short-term and investment in afghan refugees’ self-sufficiency in the long-term in iran. findings show that income and absolute poverty rates were higher among households headed by middle-aged adults. one reason for this result in our sample could be the larger average family size of this group (mean= 6.2). average family size among households headed by a middle-aged adult was more than twice the average family size of the two households headed by 16and 17-year-old afghans, 1.6 times larger than the households headed by young adults, and 1.1 times larger than the households headed by older adults. although the basic needs poverty lines are higher for larger households, the per capita income levels could be lower as the total income is divided by a larger number of household members. unlike income and absolute poverty rates, multidimensional poverty was the lowest among households headed by middle-aged adults, meaning that members of these households were less likely to be deprived in health, education, and standard of living. all poverty rates were considerably higher in female-headed households compared to male-headed households, which demonstrates vulnerability of this group. higher rates of poverty among female-headed households could be due to restrictions on access to the job market for female refugees in iran. refugees should apply for and purchase temporary work permits to be able to work in iran (giles, 2010; koepke, 2011). refugee men between the ages of 16 and 60 are eligible to apply for work permits through the ministry of labor in iran (koepke, 2011). some refugee women (e.g. female household heads) can also apply for work permits, but the mainstream of afghan women lack access to this document (giles, 2010). moreover, refugees in iran can only work in specific fields, which are mainly menial occupations that are enumerated periodically by the iranian ministry of labor (barr & sanei, 2013; rajaee, 2000). these labor-intensive occupations automatically exclude female refugees from access to the legal job market in iran. in our survey, only 28% of the female household heads were working compared to 85% of the male household heads. moreover, most afghan women who had a job at the time of the interview (about 63%) had some level of skill and could be categorized as skilled workers such as nurse, teacher, tailor, and hairdresser. however, most of the employed men (about 54%) were unskilled workers, for instance, construction worker, guard, brick factory worker, greenhouse worker, animal husbandry worker, well digger, daily worker, and garbage collector. it seems that for women, having a skill made it more likely to find a job. a similar situation has been reported among repatriated refugees in afghanistan (nurani et al., 2006). households with employed and unemployed heads had similar poverty rates. lowpaying legal fields for refugees and lack of job security in iran may explain this finding. most of the legal fields of work for refugees in iran are low-paid menial jobs. additionally, refugees must pay for costly temporary work permits to be able to work in these low-paid menial fields. according to koepke (2011), in march 2009, the average cost for a temporary work permit renewal was around usd 300 to usd 500. the high cost of temporary work permits forces a considerable number of refugees to turn to the informal job market in iran, with lower pay and higher risks of job insecurity. anecdotal data show that afghans earn 12% to 20% less than iranian workers in similar fields, despite working advances in social work, spring 2018, 18(3) 866 an average of 10% longer hours per day (abbasi-shavazi, glazebrook, jamshidiha, mahmoudian, & sadeghi, 2008). moreover, according to abbasi-shavazi and colleagues (2008), less than three percent of the afghans who work in iran have a written contract with their employer. in our sample, refugees were mainly involved in day labor jobs (28%), which are usually low-paying and labor-intensive with no job security. findings show that the multidimensional poverty rate was higher among undocumented than documented refugees (40.4% versus 25.5%). undocumented afghan refugees in iran are subjected to arrest and deportation to afghanistan (koepke, 2011); consequently, they live in fear and might lack access to health, education, and standards of living due to their limited rights in the country. despite this disadvantage, undocumented refugees in our sample had lower levels of income poverty. this could be explained by a younger average age of the heads of the undocumented households (39 years) compared to documented households (44 years). younger refugees might be more successful in sustaining long hours of labor-intensive jobs. this could be one of the reasons that the average monthly income level was higher among undocumented refugees (approximately usd 635) compared to documented refugees (approximately usd 619) in our sample. additionally, average household size was lower among undocumented refugees (about 4.9) compared to documented afghan households (around 5.4) in our sample. income and absolute poverty rates were the lowest among refugees living in colonies. as discussed earlier, refugees who belong to one tribe usually live in colonies with close and extended family members and high levels of bonding (koepke, 2011). the lower rates of poverty among afghans living in colonies could be an indication that family and social support could help refugees find better livelihood opportunities and sustain income levels higher than the monetary poverty lines. moreover, the multidimensional poverty rate was lowest among refugees who resided in settlements. this could be the result of access to food baskets in settlements that makes risk of malnourishment minimal among refugees in these settings in iran. despite low rates of multidimensional poverty, income and absolute poverty rates were high among refugees in settlements. as discussed, settlements in iran are in remote areas; therefore, settlement residences have limited access to livelihood opportunities. more than half of the income-poor households were not multidimensionally deprived, meaning that although they earned less than the required income for basic needs, they were able to fulfill minimum living requirements. refugees’ minimum living standard could be fulfilled despite low levels of income through humanitarian assistance, social support, and unofficial community credit systems. for instance, in our survey 82% of the income-poor refugees in settlements were not multidimensionally poor, which means that they had access to minimal standards of living despite low levels of income. as discussed earlier, refugees in settlements have access to some humanitarian assistance. findings also demonstrate that around one-third of the multidimensionally poor households were not income poor, meaning that members of these households were deprived from basic education, health, or standard of living despite reporting adequate income to meet their needs. lack of access to education, health, or standards of living could be related to lack of information or structural barriers instead of lack of money. for naseh et al./assessing refugee poverty 867 instance, in our sample refugees in colonies had the least amount of monetary poverty rates, yet more than half of the households had no adult member with at least six years of schooling and they had the highest rate of out-of-school children. as discussed earlier, colonies are usually located on the outskirts of cities, where access to schooling is limited. moreover, colony refugees are less integrated within the iranian society and might tend to place less value on education. limitations the dataset for this study was collected in 2011, and the findings may not represent the current situation of afghan refugees in iran. however, to the extent of our knowledge this dataset is the largest and most current research-based dataset on afghan refugees in iran. additionally, the utilized dataset in this study was collected by interviewers who were paid for completed questionnaires. potential related ethical challenges associated with payment to interviewers for completed questionnaires were minimal, for the interviewers were selected from an elite group of afghan refugees in order to ensure successful data collection. moreover, all interviewers were informed that the collected data will be cross checked. the utilized dataset in this study was collected by interviewers who were both afghan students and recipients of the albert einstein german academic refugee initiative (dafi) for pursuing university-level education in iran. furthermore, our crossed checked data, through 20 random phone call interviews with refugees who provided their contact information (close to 10% of the sample), showed no major discrepancies and affirmed acceptability of the collected data. nevertheless, bias was observed in selection of afghan communities by the interviewers, in that they mainly selected communities they were familiar with. furthermore, due to limitations of the dataset, child deaths were measured for the prior year instead of the prior five years; a proxy indicator was utilized to quantify malnutrition; and one indicator of the mpi, house flooring, was excluded. these modifications enabled the authors to calculate multidimensional poverty, but the computed rates might not be an exact representation of the official mpi. moreover, we estimated the minimum food costs based on the adjusted findings of the study by khodadad-kashi and heidari (2009) with inflation rates. although this adjustment enabled us to calculate malnutrition among the surveyed households, adjusted costs with inflation rates might not be exactly representative of minimum food costs in 2011. conclusion and implications in the absence of a prior published study on afghan refugees’ poverty and potential deprivation in iran, this study provides a baseline for future research and some basic information for policy makers and service providers. knowledge regarding afghan refugees’ poverty rates can help social workers, who are front-line service providers for refugees, to advocate properly and mobilize required support for better service provision for this group. moreover, findings in this study in addition to future research on refugees’ welfare and poverty could be influential for social workers involved in advocacy and policy making. such data can help plan short-term and long-term poverty reduction strategies. for instance, in case of lack of education and skills, long-term planning could influence human advances in social work, spring 2018, 18(3) 868 capital, or in case of malnutrition among children, food assistance programs in schools or communities can prevent future health problems. additional studies, specifically longitudinal research, are needed; meanwhile, our findings demonstrate high rates of poverty among afghan refugees in iran. the income poverty rates show a need for further attention to afghans’ self-sufficiency and livelihood opportunities in iran. furthermore, high rates of deprivation in educational attainment indicate a need for awareness-raising on the importance of education among afghans and call for further attention to structural barriers in access to education for this group. for this study, we calculated the malnutrition through a proxy indicator, but our findings demonstrate a need for further investigation in this field. social workers can contribute to the body of literature in this field by data collection and more importantly through fieldlevel research with afghan refugees. they can also promote education among their afghan refugee clients and advocate for refugees’ access to livelihood opportunities, education, and health in iran. findings in this study highlight higher rates of poverty and deprivations among female headed households, calling for further attention to this group. female-headed households constitute a small percentage of our sample, showing that they could be hard to reach. both aspects, vulnerability and being hard to reach, should be considered in resource allocation and service provision by social workers. therefore, priority should be given to female headed households in direct service provision and outreach programs. moreover, findings in this study illustrate high rates of poverty and deprivation even among households with an employed head. social workers should advocate for refugees’ rights in the iranian labor market, specifically for their access to job security and minimum wage. refugees could secure more sustainable jobs with higher incomes if they are provided free trainings in skills required in the iranian labor market. a secure job and access to minimum wage could also enhance refugees’ access to health and education. more importantly, our findings highlight some of the shortcomings of monetary poverty assessments in capturing deprivations that afghan refugee households might experience. despite income levels higher than the basic needs poverty lines or the absolute poverty line, a considerable number of afghan refugee households in our sample were not able to fulfill minimum education, nutrition, and standards of living for their members. for instance, undocumented refugees in our sample were less likely than documented refugees to be income poor, but they were experiencing considerably higher rates of multidimensional poverty. monetary methods could overlook deprivations experienced by the most vulnerable groups, as income and absolute poverty measures failed to capture multiple deprivations of the undocumented afghans in this study. considering the popularity of monetary poverty assessment methods, service providers, specifically, social workers, should be more careful in interpreting poverty rates. lack of poverty based on monetary poverty methods only shows income levels above the set poverty lines and should not be interpreted as lack of deprivations. for deprivation analyses and more comprehensive poverty assessments, service providers should listen to refugees and consider the deprivations identified by their clients, and more comprehensive indices like the mpi should also be utilized. naseh et al./assessing refugee poverty 869 references abbasi-shavazi, m., glazebrook, d., jamshidiha, g., mahmoudian, h., & sadeghi, r. 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(2017). food counts. measuring food consumption and expenditures in household consumption and expenditure surveys (hces). introduction to the special issue. food policy, 72, 1-6. doi: 35thttps://doi.org/10.1016/j.foodpol.2017.08.00735t author note: address correspondence to: mitra naseh, m.s., ph.d. candidate, school of social work, robert stempel college of public health and social work, florida international university, miami, fl 33199. 35tmahma024@fiu.edu35t https://doi.org/10.1016/j.foodpol.2017.08.007 mailto:mahma024@fiu.edu assessing refugee poverty using capabilities versus commodities: the case of afghans in iran state of knowledge on refugee poverty conceptual frameworks this work is licensed under a creative commons attribution 4.0 international license. implementation of trauma-informed care in a housing first program for survivors of intimate partner violence: a case study allison ward-lasher jill messing jillian stein-seroussi abstract: the intersection of trauma with the need for safe, stable, sustainable, and longterm housing is important when working with survivors of intimate partner violence (ipv). ipv advocacy agencies are advised to use a trauma-informed approach to help practitioners understand the impact of ipv on individuals. housing first, a model addressing homelessness that provides permanent housing without preconditions, has been found to increase housing stability for survivors of ipv. thus, we used a case study approach to examine how practitioners and administrators implement trauma-informed care in a housing first program for ipv survivors. trauma-informed care principles and the housing first model were found to be complementary. the majority of clients in this program retained housing up to 3-months after services ended and increased their safety and knowledge of domestic violence. combining housing first with trauma-informed care may increase success for survivors of ipv. keywords: housing first; intimate partner violence; trauma-informed care it is estimated that 35% of women have been abused by an intimate partner and approximately 24% have experienced severe physical intimate partner violence (ipv) in their lifetime (black et al., 2011). survivors of ipv commonly report experiencing psychological symptoms associated with trauma, such as depression, anxiety, fear, and ptsd symptoms (i.e., nightmares, avoidance, and dissociation; black et al., 2011). survivors of ipv have a multitude of needs (allen, bybee, & sullivan, 2004), though housing has been reported by survivors as one of the most needed services upon exiting a violent relationship (dichter & rhodes, 2011). this is because ipv is associated with housing instability (baker, billhardt, warren, rollins, & glass, 2010; pavao, alvarez, baumrind, induni, & kimerling, 2007), which leads to homelessness (baker et al., 2010). women who exit violent relationships are at risk for housing instability due to economic dependence in their relationship (postmus, plummer, mcmahon, murshid, & kim, 2012), lack of employment, economic disparities, and barriers to renting, such as poor credit or a criminal record (baker et al., 2010). thus, homelessness and housing instability for female survivors of ipv and their children are a primary concern among service providers (macy, giattina, montijo, & ermentrout, 2010). the intersection of trauma and housing stability among women exiting (or seeking respite from) violent relationships is the focus of this research. organizations providing services to survivors of ipv are encouraged to use a trauma-informed approach as a bestpractice (wilson, fauci, & goodman, 2015). there is evidence to suggest that a housing ______________________ allison ward-lasher msw is a doctoral candidate, school of social work, arizona state university phoenix, az, 85004. jill teresa messing, phd, msw is an associate professor, school of social work, arizona state university, phoenix, az 85004. jillian stein-seroussi, is a master’s student, school of social work, university of north carolina at chapel hill, carrboro, nc 27510. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 202-216, doi: 10.18060/21313 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 203 first model may be a successful approach to address the housing needs of survivors of ipv who are seeking services from domestic violence agencies (mbilinyi, 2015). thus, the goal of this case study is to describe and examine the intersection of a trauma-informed care approach and a housing first model within a single domestic violence program in the southwest u.s. ipv & housing instability a woman’s decision to leave her abusive partner is associated with more severe and frequent violence and is also a risk factor for homicide, making this a dangerous time in a survivor’s life (campbell, glass, sharps, laughon, & bloom, 2007). traditionally, one of the primary interventions for survivors of ipv is the provision of emergency shelter. shelters may reduce subsequent moderate and severe violence (messing, o’sullivan, cavanaugh, & campbell, 2016), providing women who leave an abusive partner a safe, temporary, and short-term place to stay where they can access ipv-related services, such as legal advocacy, education, and counseling (baker et al., 2010). but all too often, women exiting emergency shelters are not transitioning to permanent housing (sullivan, basta, tan, & davidson, 1992). requirements of longer-term transitional or permanent housing programs make it difficult for women with co-occurring issues, such as substance abuse or mental health diagnoses, to access these services (baker et al., 2010). an innovative approach to addressing the housing needs of survivors of ipv is a housing first model that advocates for individuals who are experiencing homelessness to receive permanent housing in the community without preconditions, such as substance use or mental health treatment (padgett, henwood, & tsemberis, 2015). the basic tenet of the housing first paradigm is that clients’ basic needs must be met (i.e., stable housing) before they can then focus on secondary needs (i.e., recovery; schiff & schiff, 2014). once permanent housing is attained, supportive services are offered that clients can choose to access, but are not required to stay in the program (padgett et al., 2015). although housing first has been successful as a model to address homelessness (montgomery, hill, kane, & culhane, 2013; patterson et al., 2013), it is a relatively new approach to addressing the housing needs of survivors of ipv. the washington state coalition against domestic violence implemented a housing first approach in several agencies statewide (mbilinyi, 2015). upon evaluation, they found that the vast majority of survivors were able to achieve and retain permanent housing, even with the significant barriers to housing clients faced (i.e., unemployment, criminal records; mbilinyi, 2015). thus, a housing first model may be a successful intervention for ipv survivors and, given the trauma caused by abuse, there is a need to elucidate the relationship between trauma-informed care and housing first in an ipv setting. trauma-informed care & housing first the specific components of a trauma-informed approach in ipv intervention (elliott, bjelajac, fallot, markoff, & reed, 2005; wilson et al., 2015) have been conceptualized as six principles: emotional safety, client choice, domestic violence education, relationship development, using an intersectional approach, and a strengths-based perspective (wilson et al., 2015). first, attending to a client’s emotional safety is an important component of a ward-lasher et al./a case study 204 trauma-informed approach. programs that are community-based and have flexible funding, such as housing first, give survivors greater control over their environment by choosing where they live within the community; this may make them feel safe and minimize retraumatization. ipv shelter services have been criticized for having strict rules (arnold & ake, 2013; mcdermott & garofalo, 2004), such as curfew and chores that can emulate the control of an abusive partner and limit client choice (messing, ward-lasher, thaller, & bagwellgray, 2015; stark, 2007). client choice is a component of trauma-informed care in ipv settings, and housing first models (with less restrictive rules and preconditions) have been found to increase clients’ choice when compared to traditional interventions (tsemberis, gulcur, & nakae, 2004). another component of a trauma-informed care model is relationship development (strand, hansen, & courtney, 2013; wilson et al., 2015). relationships between survivors and staff members should be collaborative (elliott et al., 2005) and supportive (wilson et al., 2015), which has been identified as a key component in a housing first approach to survivors of ipv (mbilinyi, 2015). domestic violence education is integral to strengthening coping skills within a traumainformed care model (elliott et al., 2005; wilson et al., 2015). housing first complements this principle by meeting the housing needs of clients first, leaving them better able to focus on understanding ipv and developing coping skills (mbilinyi, 2015). an intersectional approach to working with clients through culturally competent staff is another main component of trauma-informed services (elliott et al., 2005; wilson et al., 2015). ethnic minority, immigrant, or lesbian women may not be comfortable seeking services from domestic violence shelters because of language barriers, the stigma associated with seeking services, or fear of discrimination (baker et al., 2010). therefore, community-based services may be a more comfortable option for women with marginalized identities. within ipv intervention, housing first models have been identified as culturally responsive due to the survivor-defined nature of the intervention (mbilinyi, 2015). the final component of trauma-informed care is a strengths-based perspective that identifies client strengths and builds on them (elliott et al., 2005; wilson et al., 2015). the flexibility of a housing first model allows practitioners to safety plan, resource creatively, and empower survivors using their existing strengths (mbilinyi, 2015). trauma-informed domestic violence programs and the housing first model have the potential to support ipv survivors through the interconnection of the six principles within an evidence based practice framework (strand et al., 2013). study aims among survivors of intimate partner violence, the need for trauma-informed care and housing overlap. yet, to our knowledge, there is no research to date specifically examining the intersection of trauma-informed care and housing first models in a domestic violence agency. thus, we aim to answer the question: how is trauma-informed care implemented within a housing first model in a single domestic violence agency? advances in social work, spring 2017, 18(1) 205 method since the intersection of housing first and trauma-informed care in ipv interventions is understudied, we used a case study research design and methodology (yin, 2014). a case study is an ideal method of research when the purpose is to examine “a contemporary phenomenon in depth” (yin, 2014, pp. 16). the unit of analysis in this research is one agency in the southwestern u.s. that provides trauma-informed housing stabilization services for survivors of ipv using a housing first model. in case study research, it is best to use multiple forms of data (yin, 2014). therefore, in 2015, we conducted qualitative interviews with agency staff, observed a staff meeting, and analyzed secondary client outcome data provided by the agency. study site & client description in 2014 and 2015, the agency served a total of 226 individuals (91 adults, 135 children) in their housing first program. approximately half of the clients in the program were hispanic/latino/a (n=114), 20% were caucasian (n=45), 11% were african american/black (n=25), 10% were unknown (n=22), and 9% were categorized as other (n=20). in 2014 and 2015, 135 clients “exited” the program. of those, 111 were renting their own place, 20 were staying or living with a friend/family member, 3 owned a residence, and 1 was unknown. based on the agency’s survey data, 86-100% of clients were satisfied with the services that they received at the agency (average agreement rate of 97.1%). in 2014 and 2015, the average length of stay in the program was 11.3 months and 9.1 months, respectively. in general, the length of stay in the housing first program is 9 months. however, the agency recognizes that some clients may need more time to reach self-sufficiency due to significant barriers (i.e., documentation status) and will adjust clients’ length of stay in the program on a case-by-case basis. participants the participants in this study were seven employees of the agency (administrators n=3, practitioners n=4) who work directly with the housing first program. all participants were female. on average, participants had slightly more than 4 years of experience working with domestic violence survivors and just under 4 years of that experience was with this agency. the education level of participants varied from high school completion to graduate degree. two of the administrators held master’s degrees while one had a bachelor’s degree. two practitioners had master’s degrees, one had a bachelor’s degree, and the other had completed high school. data sources data from study participants were collected through interviews and direct observation of a staff meeting. qualitative interviews were conducted using a semi-structured interview guide, were audio recorded, and on average 1-2 hours long. for administrators, questions focused on the program’s mission, goals, and client outcomes. the interview guide for practitioners focused on examining their direct practice with clients of the agency (see table 1 for sample questions from the interview guide). the qualitative interview audio ward-lasher et al./a case study 206 files were first transcribed by the research team then transferred to dedoose (2016) for analysis. codes were developed based on the study aims and propositions (yin, 2014). each transcript was coded independently by two members of the research team for interrater reliability. one member of the research team attended an agency staff meeting and took detailed notes. table 1. sample interview questions administrators practitioners  what is the mission of the program?  what is the philosophy or theoretical framework?  what is a typical client for the agency?  what considerations are made when locating housing for a client?  can you describe your work here at the agency?  can you tell me a success story?  can you tell me about a time where these services were not helpful?  what considerations are made when locating housing for a client? data from the agency’s clients was pre-existing, de-identified data collected by the agency between 2014 and 2015. these data consisted of basic information including age, gender, ethnicity, and exit destination. the agency’s client data also consisted of responses to a quarterly survey administered by the agency that included statements related to client knowledge of domestic violence, client self-esteem, client safety, knowledge of community resources, and client perception of the program (see table 2 for sample agency survey items). client responses were reported as “agree” or “disagree” by the agency. the agency provided us with the total number of surveys completed and the survey responses tallied by quarter. in order to assess client outcomes using these pre-existing agency data, we averaged the percent of client agreement to each statement across quarters. the agency reported 67 responses to the survey, but could not provide information about whether clients responded multiple times or the response rate. table 2. survey distributed by the agency: sample items domestic violence education/knowledge  my child(ren) better understand domestic violence since receiving services  my knowledge about dv and its effects on my life has increased since receiving services  i better understand how domestic violence has affected my child(ren) since receiving services self-esteem/self-efficacy  my child(ren) has an increased sense of self-esteem since receiving services  i feel that i am (re)gaining control of my life after receiving services  i feel more self-sufficient after receiving services safety  my child(ren) better understand how to stay safe since receiving services  my safety has improved since receiving services  my knowledge of how to plan for my safety has increased since receiving services advances in social work, spring 2017, 18(1) 207 community resources  my knowledge of how to access short and long term resources available to meet my needs has increased  my knowledge of community resources and services has increased since receiving services program  i am satisfied with the services my child(ren) received  i feel that i met at least one goal on my case plan  i am satisfied with the services i have received at [the agency] results the results are organized to primarily highlight the data collected during qualitative interviews with participants (agency practitioners and administrators), while observational data and data from the survey distributed by the agency to their clients are supplemental. connecting trauma and housing participants recognized that, in order for their housing first program to be traumainformed, they need to connect trauma with housing stabilization services and interventions. one administrator stated, “all of our services are provided with the knowledge that trauma impacts people’s lives and thus their behavior.” the connection between trauma and housing was further described: “…another component that plays into the process of looking for permanent housing is also working through their trauma of what housing has looked like in the past and what housing will look like once they’re on their own...” specifically, participants connected housing and trauma by assessing physical and emotional safety and understanding how housing can “trigger” survivors of ipv, or lead to a memory or flashback of their trauma. practitioners discussed the location of client housing in relation to where their abuser and/or his family live; they also consider characteristics of the neighborhood that may provide emotional and physical safety. for example, one practitioner reported: so, things that we look at are: what area of town is safe?…if you go to the grocery store, are you going to run into him, or family or friends…we look at do they have access to a bus?…is it going to be a mile walk without street lights that they have to come home to at night? because of the need for emotional and physical safety, the agency needs a wide network of landlords in all areas of town in order to accommodate a survivor’s location preference. the vast majority (91-100%) of clients agreed that their safety had improved since receiving services (average agreement rate of 98.9%). housing can also create feelings of isolation or be a reminder of financial abuse based on a survivor’s experience of ipv. thus, practitioners need to assess for things such as: was [abuser] withholding the food stamps or money to get food? or was it that he was like ‘let’s just go shopping and buy everything’ at the beginning of the month and then at the end of the month you guys have nothing. ward-lasher et al./a case study 208 with the knowledge that housing and associated housing issues can be triggering, practitioners must prepare and assist clients in learning new coping strategies. trauma-informed interventions all participants said that, to be trauma informed, it was necessary to provide emotional support to survivors: “…provid[ing] the emotional support and [domestic violence] education to help them continue on their healing process.” practitioners dedicated specific counseling sessions to “processing abuse…[and] their emotions around it and offering support around that.” one practitioner discussed the importance of survivors processing the loss that is associated with their experience: “being able to grieve the loss of the relationship and… live with those feelings and not feeling guilt and not wanting to return…” some practitioners described their use of role-play as a way to provide support and prepare clients for a time when they may need to engage with their abusers. one practitioner stated that she uses “emotional safety planning where they have to [role play] a conversation with their abusers or exchange an email and what that could look like.” the agency also provides specific social work interventions with a trauma-informed approach, such as motivational interviewing, and refers clients to other community agencies that provide trauma-specific interventions. the majority of participants talked about the need to educate survivors about how trauma impacts their emotions and behavior. both administrators and practitioners said that domestic violence education was crucial to understanding the triggers associated with trauma and housing, and is an important part of helping survivors develop coping skills. one administrator discussed an “emergency self-care plan” the agency uses to assist with this process: [it] identif[ies] all of the things that might become triggering for them and identif[ies] how that looks, how that might play out, how that has played out in the past, to be able to identify ‘right now i’m in a crisis’, ‘right now i’m experiencing a panic attack’ and then being able to identify the way that they can self-soothe. it is also important to incorporate interventions that include education for the entire family about the impact of ipv. practitioners discussed helping survivors process their children’s behavior and assisting them in differentiating when the behavior is associated with trauma and when the behavior is “just age-appropriate.” according to the client surveys administered by the agency, 91-100% of survivors agreed that their knowledge of domestic violence increased since receiving services (average rate of agreement 98.9%). however, there was a wider range of agreement when assessing their children’s knowledge of domestic violence (50-100%; average rate of agreement 92.9%). engagement engagement with the staff and the program is an integral aspect of relationship development within the trauma-informed care principles. an administrator defined engagement as: “[a] therapeutic concept that it’s the relationship that gets you to the outcomes. so [practitioners] focus [on] the relationship that they build with the [client].” every participant (administrators and practitioners) discussed the concept of client advances in social work, spring 2017, 18(1) 209 engagement in the program as necessary to success. one administrator illustrated how trauma can impact a client’s willingness to engage with a practitioner: “so, sometimes keeping people at a distance keeps [the client] safe, because [they] don’t hurt. and so, [they] might not want to necessarily engage when [they’re] not feeling quite safe.” on the other hand, this initial skepticism may indicate healthy boundaries, a component that is taught in this trauma-informed care model. open and honest communication between the client and the practitioner was identified by all participants as a key aspect of engagement and relationship development. practitioners identified engagement as a partnership between them and the client and pointed out that facilitating this level of engagement “start[s] with me…being honest to them.” in a trauma-informed care model, it is important for practitioners to remember how trauma impacts a client’s willingness to engage: in a lot of situations, they couldn’t talk to anybody, because they were isolated. or if they said something to their abuser, like expressed how they felt or their thoughts, it could lead to them getting further abused or talked down to or whatever. according to practitioners and administrators, engagement with clients (or the relationship between clients and practitioners) directly impacts client outcomes. one administrator said that engagement is “…being authentic, genuine, honest, loving, caring, compassionate, unconditional…those are the, like, core pieces of the model that i think is where [clients] find the success.” building relationships with staff is seen as a core component of traumainformed intervention: to be able to build that relationship with the [client] to feel trust, to explore reasons why they’re doing certain things or feeling certain things. because if you don’t have that good relationship with somebody and that ability to have open and honest conversations and to look at those deep-rooted issues of domestic violence and how that’s playing out in their life, those barriers will continue to overcome, no matter how many resources, housing, subsidies you throw at them. engagement with the program is needed from clients, staff, and administrators for success. practitioners discussed the importance of their own engagement in open and honest communication with the program, their peers, and their supervisors. this was described as facilitating a culture where it is acceptable for practitioners to ask for help: “that open and honest communication, like being able to be honest and say like ‘i am burnt out right now. i need help. i need a different perspective on this situation.’” engagement also extends to family and friends. survivors commonly begin to evaluate their relationships with others based on their abuse experience and what they learn in the program: “we often hear [clients] start thinking about it very differently in the sense of like ‘i recognize this person did this and i recognize that it looked like something that i’ve experienced in the past.’” from a trauma-informed approach, the staff conceptualizes this as an opportunity: … to discuss the logistics of that relationship and whether it’s healthy or not and talk about what… [abuse] looked like in the past and what they’re doing right now ward-lasher et al./a case study 210 and how hard they’re working right now in thinking about what they want to do for their future. being a trauma-informed agency this agency stressed that being trauma-informed includes providing training and selfcare for practitioners. administrators discussed training their staff on how trauma can impact a survivor’s participation in the program and their decision making: a [client] may not be able to follow through with something, an interview or something they said they were going to work on, and how can we … look at and pay attention to the reality that there might be something underlying that, rather than ‘i just don’t want to do it’ or ‘i just didn’t have time’. one of the primary features of a housing first model is the exclusion of preconditions for enrollment into the housing program (i.e., substance use, mental health treatment). thus, it is important that staff is educated about the connection between trauma, substance misuse, and ipv: in terms of substance abuse, our philosophy here at [the agency] is that we understand that many people cope with their abuse through substance abuse to help numb out the feelings, to help escape those feelings. and it could be part of their abuse that their abuser made them use in order to stay weak, you know, not clear-minded. employee self-care is a major part of being a trauma-informed agency. one administrator said, “…to be a trauma-informed organization, like you have to take care of your staff the way you take care of your clients, because what’s good for them is good for us.” each practitioner spoke about the agency encouraging time-off and taking care of themselves individually and as a group. this was exemplified by one practitioner: our supervisors’ are super supportive about whatever it is we need, whether it’s a day or days…or an afternoon. and what we usually try to do at least once a month…is what we call a restorative meeting, when we’ll …meditation or we’ll do … self-care activities ... so those are always really helpful. this was evident within the agency culture. for example, during the staff meeting that was observed, “self-care was encouraged for both [clients] and staff.” discussion the intersection of trauma-informed care and housing first has the potential to improve the lives of ipv survivors who are at risk for homelessness. considerations of safety and trauma are an integral component of a program that locates permanent housing for ipv survivors. one of the main findings of this study was the need for emotional safety when locating housing for a survivor of ipv. any practitioner assisting survivors of ipv with obtaining permanent housing from a trauma-informed perspective needs to ensure that the environment is both physically and emotionally safe. a housing first program can create this safe space by asking clients where in the community they would feel the safest. advances in social work, spring 2017, 18(1) 211 survivors of ipv have reported both costs and benefits to seeking safety (thomas, goodman, & putnins, 2015). a housing risk assessment may be a useful intervention to assess a client’s level of risk for further violence, allowing a survivor to make an informed decision about available housing options. current housing assessment tools, such as the service prioritization decision assistance tool (spdat)/vulnerability index service prioritization decision assistance tool (vi-spdat) help agencies determine individual’s or family’s eligibility and urgency for housing assistance (orgcode consulting, 2017), but have not been identified as helpful tools for assessing risk for further violence in relation to housing needs. other tools commonly used by housing agencies are self-sufficiency matrices (ssms), which have a dual purpose of assisting practitioners with goal-setting based on their clients’ needs and evaluating progress in goal-attainment (richmond et al., 2015). ssms often include a domain to assess family relations and/or functioning (i.e., culhane, gross, parker, poppe, & sykes, 2008), however, there are few that are evidencebased (richmond et al., 2015). the use of risk assessment, such as the danger assessment, within an evidence based practice framework to assess a client’s level of risk for revictimization or lethality (campbell, 2003; messing & thaller, 2015) could be used when safety planning and considering various available housing options, while taking into account her risk. domestic violence practitioners working in housing first programs should consider that trauma related to a prior history of financial abuse may be triggered by financial assistance during stabilization in independent housing. survivors of ipv commonly experience financial abuse such as their partner withholding money or giving them a weekly allowance (postmus et al., 2012). practitioners in a housing first program can assess survivors’ experience with financial abuse and can provide interventions aimed at improving survivors’ financial literacy and increasing economic self-sufficiency, which are both associated with economic empowerment (postmus, plummer, mcmahon, & zurlo, 2013). the experience of financial abuse may be different for immigrant women who have additional barriers to work due to language, documentation status, and oppression (ayon, messing, gurrola, & valencia-garcia, in press). thus, cultural competency, which is necessary to understand ipv from the perspective of a survivor with a marginalized identity, is central to the trauma-informed care approach and should be explored in future research. a trauma-informed care approach is more than providing trauma-informed care services for clients; it means having a trauma-informed care approach for practitioners as well. social work practice with survivors of ipv is emotional work and practitioners risk burnout and secondary traumatic stress (powell-williams, white, & powell-williams, 2013; strand et al., 2013). similar to previous research (slattery & goodman, 2009; strand et al., 2013), practitioners highlighted the positive impact of the agency’s supportive culture and prioritization of self-care for practitioners individually and as a team. using a trauma-informed care model in services not only benefits clients but can also increase worker satisfaction (kulkarni, bell, & rhodes, 2012). a housing first model combined with a trauma-informed care approach has the potential to increase worker satisfaction by providing workers with flexibility and mobility to meet with survivors in their community (mbilinyi, 2015). ipv practitioners have ward-lasher et al./a case study 212 reported frustration and a lack of feeling successful in their jobs when survivors return to their abuser (powell-williams et al., 2013). permanent, safe housing that allows women to remain free from their abuser may have the added benefit of increasing job satisfaction for practitioners (mbilinyi, 2015). returning to an abusive partner was not reported among clients in this program. longitudinal research to examine the sustainability of housing and survivors’ relationship status after completion of housing first programs in domestic violence agencies is needed. strengths and limitations this research examines the intersection of trauma-informed care in a housing first model for ipv survivors. our analysis is limited due to the focus on a single program within a single agency; although the agency has other programs (i.e., shelter, community based services), those were not the focus of this inquiry. this limitation is offset by the strength of the case study design which allows an in-depth examination of a unique intervention for ipv survivors. additionally, the use of multiple forms of data in the analysis adds to the rigor of the study, including the dual perspective that was offered by data collected from both practitioners and administrators. because this is based primarily on workers’ perspectives, we do not know if the clients would report the same. workers may also feel compelled to speak positively of their organization in an effort to highlight the good in their program, a form of respondent bias (padgett, 2008). a major limitation of this study is the methods that the agency uses to evaluate client outcomes. the data were not available in their raw form. thus, we did not know response rates, whether clients took the surveys multiple times over multiple quarters, how long clients completing the surveys had been receiving services, or which phase of the program the clients were in when they completed the survey. the race/ethnicity of survivors who completed the surveys is unknown as well as whether the survey was completed in languages other than english. when examining agencies that are providing innovative services, ideally researchers would have collected both qualitative and quantitative data directly from the clients receiving services from that agency. suggestions for future research additional research with this agency and with agencies providing services to survivors of ipv through a housing first model is needed. in particular, researchers need to continue to explore how trauma-informed care and housing first models impact worker satisfaction, burnout, and secondary traumatic stress. additionally, future research should include longitudinal, quantitative studies examining both survivor and child outcomes related to housing, trauma symptomatology, and survivor-defined services. future research should also connect forms of abuse, risk, coping, and trauma with 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(2015). bringing trauma-informed practice to domestic violence programs: a qualitative analysis of current approaches. https://doi.org/10.1016/j.amepre.2006.10.008 https://doi.org/10.1177/0886260511421669 https://doi.org/10.1007/s10834-012-9330-3 https://doi.org/10.1080/02732173.2013.732904 https://doi.org/10.1177/1049731515596072 https://doi.org/10.1179/1573658x14y.0000000007 https://doi.org/10.1177/1077801209347469 https://doi.org/10.1037/ort0000044 https://doi.org/10.2105/ajph.94.4.651 ward-lasher et al./a case study 216 american journal of orthopsychiatry, 85(6), 586-599. doi: https://doi.org/10.1037/ort0000098 yin, r. k. (2014). case study research: design and methods. los angeles, ca: sage. author note: address correspondence to: allison ward-lasher, school of social work, arizona state university, 411 n. central ave, phoenix, az 85004, 602-639-1536, allison.ward@asu.edu https://doi.org/10.1037/ort0000098 mailto:melanie.sage@und.edu this work is licensed under a creative commons attribution 4.0 international license. the karen chemical dependency collaboration: lessons learned in using a collaborative framework to promote refugee integration jennifer mccleary tonya horn paw wah toe ehtaw dwee shana sniffen abstract: while refugee integration is defined as a bidirectional process of mutual learning and adaptation, in practice, the u.s. resettlement program continues to emphasize refugees’ acculturation processes and places little emphasis on cultural or logistical adaptation of existing services. when adaptation does happen, it is often structured around dominant notions of health and well-being. there is a need to explore bidirectional integration processes and existing systems adaptations to accommodate people with refugee backgrounds at the institutional level. this article details a framework to build a sustainable collaboration between a refugee community and existing health and social service systems to reduce harmful alcohol use. the conceptual framework emphasizes three components: 1) adaptation of refugees’ indigenous expertise, networks, systems, and resources; 2) adaptation of existing systems to serve new groups in culturally relevant and effective ways; and 3) the participatory processes through which refugees and existing systems collaborate to achieve mutual goals. this paper describes the application of this framework and concludes with a discussion of lessons to support replication of the framework in other settings. lessons learned include: equalizing power, paying attention to relationships and roles, engaging in deep cultural adaption of interventions, and building individual and organizational capacity to support partners. keywords: refugee resettlement; substance abuse; refugee integration; cultural adaptation a note from the authors: throughout the paper we use the language “people with refugee backgrounds” and “communities with refugee backgrounds” rather than “refugees” or “refugee communities”. we believe that overuse of the term “refugee” narrowly defines people according to one life experience, rather than recognizing the intersectional identities that people with refugee backgrounds carry (gender, race, ethnicity, etc.). “people/communities with refugee backgrounds” recognizes that it is part of life experience, but not the totality of it. additionally, the term “refugee” often carries with it implications of people who are traumatized, helpless, and victims, which can obscure the strengths and resilience of people who are refugees. _________________ jennifer mccleary, ph.d., msw is an assistant professor, department of social work, university of minnesota duluth, duluth, mn 55812. tonya horn, ph.d., msw is an assistant professor, school of social work, university of st. thomas, st. paul, mn 55105. paw wah toe is a karen community leader and a member of the karen chemical dependency collaboration, healtheast roselawn clinic, st. paul, mn 55117. ehtaw dwee is a karen community leader, a federal interpreter, and a member of the karen chemical dependency collaboration. shana sniffen, md is a primary care physician at healtheast roselawn clinic, st. paul, mn 55117. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 911-929, doi: 10.18060/21654 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 912 in 2016, approximately 85,000 people resettled to the united states as legal refugees (u.s. department of state, 2016). people with refugee backgrounds face a myriad of obstacles to successfully integrating into their new societies (strang & ager, 2010). most have been exposed to numerous life-threatening traumas prior to resettlement. upon arrival in a resettlement country, they often continue to face difficulty finding meaningful and living wage employment, learning a new language, accessing health care services, and adjusting to a new culture and climate (fazel, wheeler, & danesh, 2005). pre-and postmigration trauma as well as structural barriers, such as lack of living-wage employment or language barriers, contribute to elevated risk for mental health disorders such as posttraumatic stress disorder and depression, as well as increased substance abuse and family violence (fazel et al., 2005). since 2005, karen people have been resettling to the united states with refugee status in large numbers. karen people are an ethnic minority group in burma (also known as myanmar). for more than 60 years, since the granting of independence to burma, karen people and other ethnic minority groups have been engaged in conflict with the burmese government for their own autonomy (south, 2012). the burmese government has perpetuated widespread human rights abuses against karen people, including kidnapping and forced labor, imprisonment and torture, gender-based violence, and destruction of karen villages and farmland (shannon, vinson, wieling, cook, & letts, 2015). since the 1980s, more than 200,000 karen people and other ethnic minority groups have fled burma (the border consortium, 2016). many have fled to refugee camps in thailand or live as urban refugees in malaysia. a large wave of karen people began resettling to the united states with refugee status in the mid-2000s, and there are an estimated 70,000 karen people currently living in the u.s. (u.s. department of state, 2016). like all people with refugee status resettling to the u.s., karen people’s resettlement is facilitated by federal and state policies and programs that emphasize integration into existing communities (darrow, 2015). the concept of refugee integration lacks a standardized definition but can generally be described as both a process and goal of engaging newly resettling communities with existing communities. newland, tanaka, and barker (2007) define integration as “a dynamic, multidirectional process in which newcomers and the receiving communities intentionally work together, based on a shared commitment to tolerance and justice, to create a secure, welcoming, vibrant, and cohesive society” (p. 10). research on the processes and outcomes of integration has focused heavily on the adaptation processes of people with refugee status, including: language acquisition, employment, social connections, and access to health care (ager & strang, 2008). indicators of successful integration generally focus on economic or social achievements of people with refugee backgrounds (ager & strang, 2008; bakker, cheung, & phillimore, 2016). policies to facilitate integration almost exclusively fund programming that targets the adaptation of people with refugee backgrounds, rather than facilitating adaptation of existing services to meet the needs of new communities (kirkwood, mckinlay, & mcvittie, 2014; strang & ager, 2010). integration is a broad and complex process and a term with both popular and political usage. integration takes place on every level of society and in every sector of a community and involves a range of stakeholders such as law enforcement, politicians, employers, mccleary et al./the karen chemical dependency 913 neighbors, and refugees themselves. research on the processes of refugee integration has explored the impact of social capital on refugees’ ability to find employment, housing, and learn a language (elliott & yusuf, 2014); on the impact of policies in employment and housing sectors (mulvey, 2015); and on barriers to integration such as racism and hostility (dandy & pe-pua, 2015). research on integration has increasingly explored the ways in which institutions and institutional capacity in an existing community influence resettlement experiences. the scholarship suggests that the capacity of sectors such as health, employment, and education to receive refugees and encourage participation with these systems can impact integration (valtonen, 2004). in their definitive work on markers of refugee integration, ager and strang (2008) identified health outcomes and access to health care as a significant marker of successful integration for communities with refugee backgrounds. healthy practices such as routine primary care visits and nutrition were closely tied to positive health outcomes in burmese communities (lee, choi, proulx, & cornwell, 2015). lack of health insurance and other barriers to receiving health and behavioral health care for people with refugee backgrounds has also been shown to be associated with higher levels of mental and emotional distress (morris, popper, rodwell, brodine, & brouwer, 2009). access to health and behavioral health care that is culturally and linguistically relevant has been also shown to have a direct impact on reducing health and mental health problems in communities with refugee backgrounds (murray, davidson, & schweitzer, 2010). research and resettlement policies have placed the responsibility for adapting, adjusting, and integrating primarily on communities with refugee backgrounds despite the fact that most definitions of integration indicate that it is a two-way process that requires effort on the part of existing communities to adapt to newcomers (ager & strang, 2008; newland et al., 2007). adaptation of existing health and social service systems is needed to provide culturally relevant, appropriate, accessible, and effective services. one aspect of systemic adaptation, cultural adaptation of interventions, has received increasing attention over several decades resulting in a host of exemplars of culturally adapted services (barrera, castro, strycker, & toobert, 2013). cultural adaptation has been defined as “the systematic modification of an evidence-based treatment or intervention protocol to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns, meanings, and values” (bernal, jiménez-chafey, & domenech rodriguez, 2009, p. 362). cultural adaptation is one way of reducing some of the most significant barriers to accessing health care and social services, including language and differing health beliefs (healey et al., 2017). while cultural adaptation has received the most scholarly attention, there are other aspects of systems that require adaptation to meet the needs of communities with refugee backgrounds including adaptations to service delivery systems or geographic locations of programs. currently, there is sparse research on gold standards of cultural adaptation, and few models of mutual adaptation exist (epstein, santo, & guillemin, 2015; newland et al., 2007). furthermore, the processes through which existing systems adapt to accommodate new communities remain unexamined, with the exception of cultural adaptation of social services. there are numerous methods for cultural adaptation of mental health or other social service interventions, but there is no gold standard, and scholars follow a range of advances in social work, spring 2018, 18(3) 914 methods (epstein et al., 2015). attempts have been made to describe and categorize cultural adaptation processes, which can generally be divided into two categories. first, surface adaptations include the use of culturally relevant images, fonts, and language, and second, deep level adaptations include the integration of cultural knowledge, values, and beliefs (barrera et al., 2013). a systematic review of adaptation methods found that out of 31 studies only 14 included consultation with members of the community of interest in the process of cultural adaptation (healey et al., 2017). despite this finding, most adaptation frameworks highlight the importance of collaboration or consultation with members of the target community in adaptation procedures (barrera et al., 2013; castro & yasui, 2017; epstein et al., 2015). one of the authors of this paper has articulated a framework for a collaborative approach to integration (cook, 2016). this paper describes lessons learned from the application of a framework to promote integration within the health/behavioral health sector by building collaborative relationships between a refugee-background community and existing services. the karen chemical dependency collaboration the purpose of this paper is to describe the application of a conceptual framework for a collaborative approach to integration that was used to build a sustainable and effective partnership between a resettled refugee-background community and existing health and social service systems in st. paul, minnesota. one measure of integration is that people with a refugee background are able to access and benefit from health and behavioral health systems in resettlement (ager & strang, 2008). taking a bidirectional view of integration, this should imply that they are able to access services that meet their cultural and linguistic needs and that existing health and behavioral health services have actively reduced access barriers and adapted to meet the needs of the new community. while the surface or primary goal of the collaboration was to reduce harmful alcohol use in the st. paul karen community, the underlying or foundational goal of the collaboration was to build a network of mutual relationships to promote this kind of bidirectional integration between existing services and communities with a refugee background. harmful alcohol use in the karen community a small number of studies have identified risk factors that are associated with an increased risk for substance use in groups with refugee backgrounds (ezard, 2012; ezard et al., 2011; miremadi, ganesan, & mckenna, 2011; posselt, galletly, de crespigny, & procter, 2014). only a handful of studies could be identified that looked specifically at substance use with karen people who were refugees (ezard et al., 2011; mccleary & wieling, 2016). one found that karen people who were refugees were at increased risk for harmful alcohol use because of pre-migration trauma and post-migration stress (mccleary & wieling, 2016), and another found that karen people faced significant barriers to accessing culturally and linguistically relevant substance use treatment in resettlement (mccleary, shannon, & cook, 2016). there are no comprehensive epidemiological studies of alcohol or substance use in resettled karen communities, making it difficult to estimate prevalence or scope of substance use and associated health, social, and legal issues in karen mccleary et al./the karen chemical dependency 915 ethnic groups in the u.s. (semere, yun, ahalt, williams, & wang, 2016). however, the karen chemical dependency collaboration described below emerged as a direct result of karen community leaders, medical providers, and social service providers identifying harmful drug and alcohol use and related consequences as the most significant problem and unmet need facing the community. formation of the karen chemical dependency collaboration in 2013, one of the authors of this paper received a fellowship that provided protected time and funding to conduct a needs assessment and build a sustainable response to a significant health need within a community experiencing health disparities. drawing on previously developed personal and professional relationships within the karen community, this author worked with karen leaders and representatives of existing service agencies including health, law enforcement, and behavioral health to conduct a thorough needs assessment that included focus groups, individual interviews, and participant observation. the results of this needs assessment identified harmful alcohol and drug use as one of the most significant health problems facing the karen community in st. paul. the needs assessment, as well as other research conducted in partnership with the same community, identified preand post-migration risk factors for alcohol use that included exposure to trauma and human rights abuses and resettlement stress (mccleary & wieling, 2016). additionally, the needs assessment identified multiple barriers to accessing existing treatment systems including language barriers, difficulty navigating confusing and byzantine treatment requirements such as numerous intake appointments and treatment meetings, difficulty with health insurance, and treatment programs that did not reflect karen people’s cultural and conceptual understandings of alcohol and drug addiction and recovery (mccleary & wieling, 2016). in response to an increasing need for culturally and linguistically relevant responses to harmful alcohol use, the authors of this paper formed the karen chemical dependency collaboration (kcdc; hereafter “the collaboration”). the mission of the collaboration is to reduce harmful alcohol use in the karen community. all authors of this paper are members of the collaboration and three are its co-directors. the collaboration is a crosscultural, cross-professional group of approximately 30 individuals representing a range of organizations from numerous sectors. members include karen community leaders, physicians, mental health and substance use providers, law enforcement officers, probation officers, case managers, researchers, karen interpreters, public health nurses, and social workers. the collaboration strives to have at least 50% representation of karen members in every meeting and works to ensure cross-sector representation. the collaboration has met bi-monthly since 2014 and has developed four intervention areas to comprehensively address harmful alcohol use and associated consequences throughout the community. they include: develop community education, health promotion, and prevention tools; develop culturally and linguistically relevant substance use treatment and community-based recovery support services; increase the capacity of the karen language and karen interpreters related to interpreting in mental health and substance use settings; and train faith leaders who are often the first source of support for families. these intervention areas and the resulting strategies were identified by karen community leaders. one of the advances in social work, spring 2018, 18(3) 916 collaboration members had developed a general framework of collaborative processes to promote refugee integration. in the remainder of this paper we describe the framework and discuss important lessons learned from its implementation with the collaboration. the initial founding of the collaboration and its first years were financially supported by a fellowship received by one of the authors of this paper. the funding provided protected time in the form of salary offset to the author who acted as the primary organizer of the collaboration in its initial years as well as ancillary funds for supplies, food for meetings, and other expenses. in the beginning, most of the collaboration members attended meetings on a voluntary basis or as part of their employment. after this initial support the collaboration sought and secured foundation funding to support all of the initiatives. one of the founders of the collaboration is a primary care physician in a major health care system. many of the initiatives are located within the health care system, which allows for connecting behavioral and primary health care as well as promotes sustainability. collaborative framework to promote refugee integration one of the authors of this paper developed a general framework that has guided the work of the collaboration (cook, 2016). the framework is visually represented in figure 1. it consists of three components: the first describes the indigenous expertise, networks, socio historical structures and systems, and resources (human, social, cultural) that refugeebackground communities bring with them to resettlement and the processes through which they adapt and transform them for use in the resettlement context. the second consists of the resources of existing systems in the resettlement environment and the processes through which these systems adapt to serve new groups in culturally relevant, appropriate, accessible, and effective ways. the third and joining circle consists of the participatory principles, practices, and processes of mutual engagement through which representatives from new refugee-background communities and existing systems collaborate to facilitate mutual learning and adaptation to achieve mutual goals. this framework is based on a definition of integration as a bi-directional process (ager & strang, 2008) that recognizes the value of mutual learning and collaboration. it is a strengths-based, empowerment approach because it recognizes that communities with refugee backgrounds have existing strengths, strategies, and resources and may have significant knowledge and experiences adapting and transforming these resources and support systems in new contexts. the relationship between mainstream providers and representatives and providers from new resettlement communities in this framework is one of allies rather than of provider-client. in the project described in this paper, this framework was used to a guide a community-development approach to improving health, an indicator of integration, for the karen community. mccleary et al./the karen chemical dependency 917 figure 1. a collaborative model for promoting integration of existing systems and new refugee-background communities application of the framework the intention of the collaboration is to reduce harmful alcohol use in the karen community. karen community leaders and representatives initially identified four topical areas that warranted attention. members of the collaboration then formed smaller working groups over the past four years to create interventions that responded to each of the areas of need, which will be described below. founding members of the collaboration recognized that cross sector partnerships of this sort are notoriously difficult to build, maintain, and sustain. members of the collaboration also felt that the majority of approaches to refugee integration focused almost entirely on encouraging refugees to adapt and acculturate and promoted only surface level cultural adaptations on the part of existing services. the underlying intention of the collaboration was to provide space to identify the karen community’s strengths, strategies, and forms of problem solving and to engage existing systems in deeper levels of adaptation and learning and contribute to bidirectional adaptation. collaboration members used the framework described above as a guide to build partnerships across sectors, ensure adaptation on the part of both existing systems and karen people, and to center participatory processes and mutual learning. as such, the lessons described below are not lessons in developing alcohol treatment interventions but rather lessons learned in developing partnerships that promote bidirectional integration. in the following paragraphs we describe some of the ways we applied this framework specifically to relationship building and the development and evaluation of interventions. then, we focus on general lessons learned that could be applied to this type of collaboration in other sectors and places. advances in social work, spring 2018, 18(3) 918 indigenous strengths this framework for bidirectional integration requires that the indigenous expertise, ways of knowing, and problem solving strategies of communities with refugee backgrounds be central to the process of integration. to ensure that refugees’ expertise was a central part of decision-making and intervention planning throughout the work of the collaboration, time was provided at each collaboration meeting to hear from karen people. second, karen people were placed in central positions within the development of each intervention and their expertise was recognized as equal to that of existing social service providers. one example of this is the ways in which aspects of addiction, recovery, and wellbeing were negotiated. in the early days of the collaboration representatives of existing treatment services focused on getting feedback from karen people on how to adapt existing treatment modalities to better serve karen people. for example, providers asked karen people to advise on things like individual versus group treatment or ideas for relapse prevention. however, a lack of mutual understanding about concepts such as addiction, recovery, treatment, and relapse inhibited effective communication. mutual adaptation thus depended on mutual learning and developing a shared understanding of these concepts from both dominant and karen perspectives. existing systems the framework also requires that existing systems engage in adaptation on a number of levels, including adaptation of how existing treatment modalities were delivered and a deeper level of adaptation throughout the entire system. to this end, we intentionally recruited not only providers to be members of the collaboration, but also engaged with substance use treatment program directors and upper level administrators of health care systems. these members were best positioned to facilitate broader system adaptations that were needed to effectively serve karen patients. for example, the support of program directors was needed to approve new sites for offering treatment and new processes for securing consistent interpreters. building the capacity of organizations and agencies to engage in this kind of deeper level adaptation takes time and resources. much effort was spent educating both providers and upper level administration on the limitations of existing systems and the need to engage in mutual learning and adaptation to more effectively serve karen patients. this foundational work was necessary to achieve the collaboration’s objectives. mutual learning the center circle of the framework represents mutual learning and participatory practices. the collaboration meetings served as a space for karen community members and existing system representatives to come together and learn from each other. the collaboration met bi-monthly throughout its existence and many sub groups of the collaboration met independently outside of these meetings. meeting face to face with each other was a central aspect of this framework. two-hour collaboration meetings were structured to provide half of the time for mutual learning and half of the time for mccleary et al./the karen chemical dependency 919 participatory problem solving. mutual learning involved collaboration members presenting to the group and has included information about karen language and culture related to substance use, explanations of dominant treatment approaches in the united states, and relationship building between law enforcement and the karen community. this was an opportunity for all members to learn about each other and the sectors represented. it also fostered unique and beneficial partnerships such as between educators and probation officers to engage youth in substance use prevention activities. the second half of meetings were spent in participatory problem solving. smaller groups of members from a range of sectors met to discuss specific issues that have arisen in the development and implementation of various interventions. the collaboration has been most successful when there has been a specific topic to discuss in smaller groups such as adapting existing chemical health assessment tools to be more culturally relevant or engaging newer arrivals with refugee status in substance use education programs. collaboration members reported that they bring this mutual learning back to their respective agencies and communities and are often able to make immediate small changes to their service delivery. resulting interventions the collaboration identified four areas of need: culturally relevant substance use treatment, training for karen interpreters, capacity building for karen faith leaders, and culturally relevant prevention education. working groups have developed a range of programs and interventions in each area. some recent successes include the development of a manualized, culturally specific, trauma informed outpatient group treatment program for adult karen men who engage in harmful alcohol use. this program was co-developed by a karen professional with over 10 years of experience working in substance use treatment in refugee camps in thailand and other kcdc members with expertise in mental health and substance use treatment. the collaboration has also written a glossary of mental health and substance use terms that were negotiated, translated and back translated by a group of karen interpreters and health professionals. the glossary was used to train over 75 professional interpreters in minnesota. the collaboration developed several community education tools and offered trainings in the karen community. collaboration members have trained existing mental health and substance use professionals, probation officers, and other existing systems on working effectively with the karen community. recently, the collaboration has begun to expand its work into understanding and addressing substance use among karen youth. methods this paper does not report on a traditional research study but is a conceptual paper that describes the experiences of implementing an approach to supporting collaboration and integration in communities with refugee backgrounds. while it did not employ a traditional research methodology, per se, a systematic approach was used to develop this paper. first, the framework itself was developed out of a separate research project reported elsewhere (cook, 2016). approximately two years after its start, several collaboration members agreed to an internal self-evaluation in the form of individual interviews with founding advances in social work, spring 2018, 18(3) 920 members. a core team of collaboration members developed a semi-structured interview guide and informal interviews were conducted with about 10 members. the interview guide included topics such as reasons for participating in the collaboration, strengths and challenges of collaborative work, and ideas for enhancing collaborative work. all of the authors of this paper are founding members of the collaboration. the process of developing the lessons learned had several steps. first, we reviewed the results of the evaluation interviews. second, we developed a timeline of the collaboration noting important and formative events. third, we developed a list of lessons we learned as a result of these formative events. finally, we synthesized these lessons and summarized them in preparation for writing the paper. lessons learned numerous lessons have been learned over the past four years about building and maintaining a sustainable collaboration between representatives from the karen community and existing systems to respond to the problem of harmful alcohol use in the karen community. below are three important lessons are outlined. lesson one: learning how to share power a host of scholarship about building cross-cultural collaborations and community organizing emphasizes the importance of sharing power with community members (bryson, crosby, & stone, 2006; wallerstein & duran, 2008). generally, it is suggested that this be achieved through ensuring community representation in meetings and events. we found, though, that we needed to move beyond representation to consider how patterns and styles of communication both in and outside of formal meetings contributed to power imbalances. we also needed to learn how to develop specific mechanisms and processes for sharing power in practice. learning about and being responsive to different communication styles. karen collaboration members suggested that it was difficult for them to speak up in meetings that were facilitated in english and in a style that is reflective of dominant culture in america, partly because of cultural norms of respect. often karen collaboration members felt more comfortable communicating in one-on-one, informal settings with trusted members of the collaboration with whom they had a relationship, rather than in a large group setting. we found that other collaboration members were more likely to speak up in meetings that were facilitated in karen with interpretation for non-karen speakers, rather than the other way around. additionally, karen collaboration members were more likely to speak up in large group meetings if they were able to debrief with collaboration colleagues who had more experience in dominant modes of meeting and communicating before and after meetings to gain context and insight into nuances of discussions. once the collaboration started being responsive to multiple styles of communication and building the capacity of all members to respect, honor, and seek out multiple ways of communicating, power shifted to be more equalized between karen and non-karen members. part of sharing power in this way meant that non-karen collaboration members needed to let go of control and trust karen co-directors to run meetings in their own style mccleary et al./the karen chemical dependency 921 and language. lastly, shared decision-making consisted of continuously sharing ideas and being open to new ideas as the work unfolded. while the work of the collaboration aimed at advancing clearly outlined and agreed upon goals, the process often took a circuitous route, following an iterative, flexible process that incorporated new insights and understandings as they emerged. recognizing the cultural context of all knowledge to facilitate listening and learning. learning to share power also meant that collaboration members needed to recognize the contextual limits of their expertise and to validate other ways of thinking. a key way that we shared power was in recognizing the importance of context in leveraging power and accessing resources. for example, one of the first tasks the collaboration undertook was to develop a culturally and linguistically relevant outpatient group alcohol treatment program for adult karen men. initially, treatment provider collaboration members, all of whom were not karen, positioned themselves as the experts on treatment and addiction and karen members as experts on culture. the intention was to combine these seemingly separate spheres of knowledge and learn from each other. however, in positioning themselves as experts on addiction, providers failed to recognize the limits of their ways of knowing when applied to a karen context. we had to work hard to encourage providers to set aside their own paradigms and learn from karen people’s understanding, knowledge, and language related to addiction, substance abuse, and treatment, rather than filtering this knowledge through their own paradigm. for example, we encouraged providers not to assume that there were western or english equivalents for the things that karen people shared, but instead to seek to understand them in their own context. one example of this occurred during a collaboration meeting when a karen member described the nuances of saying “no” to an offer in karen culture. in discussing how to say no when offered alcohol as a form of relapse prevention, one karen collaboration member explained that for many karen people it is culturally taboo to say no to social offers and hospitality. a non-karen member responded that karen people needed assertiveness training to develop skills in saying no as a form of self-protection. this member saw reluctance to say no as lack of assertiveness rather than attention to cultural norms and practices. we also recognized that some non-karen providers had significant experience working with karen culture, for example, in mental health settings. however, we encouraged them not to view themselves as experts in karen culture, but to be perpetually humble about their knowledge and continue to learn from and recognize karen people as experts in their own culture. additionally, some karen collaboration members had both cultural and professional treatment knowledge. for example, one karen collaboration member had extensive professional training and experience in substance use treatment in the refugee camps, though he was not licensed to practice in the u.s. rather than placing collaboration members in silos of either having cultural knowledge or having treatment knowledge, we needed to recognize everyone’s multiple and overlapping areas of expertise and experience. one effective way to shift this power balance was to ask non-karen providers to critically interrogate the dominant assumptions and perceptions inherent in american models of treatment and shift from seeing these advances in social work, spring 2018, 18(3) 922 treatments as culturally-neutral to culturally-specific. this shift allowed providers to step back and make space for karen expertise in both culture and addiction and to recognize the cultural context of all knowledge. one example of this is illuminated by a lengthy discussion during a collaboration meeting of the concept of goal setting. in developing the treatment program, some members wanted to include sessions related to setting and achieving goals. substantial time was spent negotiating a karen translation for the word “goal”, which included negotiating the meaning of goal as a construct. as part of that conversation a karen member said that because many karen people have spent decades in refugee camps without hope of either repatriation or resettlement, they often did not have experience setting goals for the future. an aspect of goal setting is having a sense of autonomy over one’s future and this is limited in a conflict and refugee camp context. the karen member indicated that while karen people can and do set and achieve goals, the concept of goal setting needed to be considered within the context of a history of conflict and protracted internment in refugee camps. letting go of control and leveraging spheres of influence. one critical way in which power was shared was by actively allowing and trusting multiple leaders to leverage their own spheres of influence. karen co-directors of the collaboration had leadership in areas where their knowledge was most influential – most often in meetings with karen community partners and community members – and the collaboration followed their lead in these areas. this often meant that non-karen participants were in meetings held in karen language and may not know all the nuances and details being discussed. non-karen partners had leadership in areas of funding or navigating dominant systems and again others followed their lead in this area. this approach required letting go of control and deeply trusting each other’s intentions, competence, and understanding of what was specifically needed in various situations. the co-directors came to see themselves as standing back-to-back each leveraging their power in their own sphere of influence while standing together to move the program to fruition. lesson two: recognizing a variety of relationships, roles, and capacity collaboration scholarship emphasizes the importance of building trusting relationships as a foundation for engaging stakeholders (ball, 2008). throughout the lifespan of the collaboration, we came to recognize the importance of paying particular attention to the difference between relationships with individuals and with the organizations those individuals represent as well as recognizing the different roles that collaboration members have both within the collaboration and in the greater community. paying attention to these different roles was essential to building trust. building sustainable institutional partnerships. the collaboration has consisted of a variety of stakeholders. karen members attended collaboration meetings as representatives of existing agencies, ethnic community based organizations, karen churches, or as individual community members. most, but not all, non-karen collaboration members attended meetings as representatives of a particular organization such as a hospital, clinic, university, treatment facility, or social service agency. mccleary et al./the karen chemical dependency 923 one of the founding members of the collaboration joined as a representative of a major hospital system that provided both in-patient and out-patient substance use treatment. his presence represented an important relationship with an essential institution. as the manager of treatment services within the hospital system, his position provided access to important resources. unfortunately, within the first two years of the collaboration, he left his position and the collaboration no longer had a formal relationship with the hospital system. over the course of the next year, three other individuals filled his former role, meaning we had to work to rebuild the relationship anew with each person. ultimately, we learned that we needed to build sustainable relationships with institutions and not just with individual representatives of those institutions. we also came to recognize that while interpersonal relationships were critical to trust building and partnering, the institutional relationships were essential to building sustainable programs. building individual and organizational capacity to participate. many collaboration members attended collaboration meetings and worked on collaboration projects as part of their paid positions. however, several karen and a few non-karen collaboration members attended meetings on their personal time motivated by a personal commitment to the issue. additionally, some participated as representatives of their organizations, but their organizations did not have capacity to support much time to engage in work with the collaboration. this created an inequity and challenge to sustaining membership, because not all members were equally compensated for their equally valuable time and work. additionally, karen members had less capacity to engage with the collaboration because they more frequently did not have institutions to support their time involvement. all of the work of the collaboration has been dependent on all members having the capacity for mutual engagement. this mutual engagement is dependent on all members being actualized partners in all endeavors. often, this meant that the collaboration needed to support individual or institutional capacity building to participate on equal footing. because we recognized the value of karen representation in the collaboration and, in particular, the importance of involving a large, local karen-led nonprofit organization, we found ways to build the capacity of several partners to participate in the collaboration and to work on its strategic initiatives. for example, we tried offering gift cards to compensate collaboration members for their time to attend meetings when they were not supported by an institution. one significant way that we built institutional capacity for the collaboration was to secure funding to develop a few part-time, paid staff positions. we also created a shared position between the collaboration and a karen ethnic community based organization (ecbo). before we created this position, the karen ecbo wanted to be involved in collaboration work but had very limited staff capacity to contribute. a shared, paid position allowed for the ecbo to play a leadership role in the collaboration and provided an avenue for increased partnership between the collaboration and the ecbo in working on several collaboration initiatives. the person hired for the position was a karen person who had substantial training and experience with substance use treatment in refugee camps on the thai-burma border. because this person’s training was not recognized by u.s. licensing systems, he was prevented from using this knowledge and skill in a formal advances in social work, spring 2018, 18(3) 924 setting. a shared position between the collaboration and the karen ecbo gave this individual a formalized setting to contribute his skills and training. lesson three: adapt interventions at the paradigm level in addition to the implementation level cultural adaptation is often categorized as surface level – incorporating culturally relevant images, fonts, and language – or deep level – incorporating cultural knowledge, values, and beliefs and involving ethnic social support systems in interventions (barrera et al., 2013). one of the most successful outputs of the collaboration has been the culturally– specific outpatient group treatment program for karen men who engage in harmful alcohol use. the treatment is facilitated through the use of a provider manual (with ethnographic rationale) and participant workbook that were written by members of the collaboration. a small group of collaboration members engaged in an intensive process of developing the treatment program over the course of two years. often, developing culturally relevant programs involves adaptations that are focused primarily on implementation, such as offering a treatment group in a community center or substituting culturally relevant images. while this is an important aspect of service delivery, we found that significant adaptation was also needed at the paradigm level. we needed to think through not just how to translate words into karen but how to engage with a karen paradigm or cognitive framework around the meaning of addiction, treatment, and recovery. for example, we incorporated karen proverbs, metaphors, and commonly known tales as access points to karen ways of thinking. this meant that karen people needed to be present for and engaged with every aspect of the development of the treatment model. it also meant that we needed to privilege karen ways of thinking whenever possible. this theme is closely related to a previous lesson: recognizing the cultural context of all knowledge to facilitate listening and learning. overcoming challenges while the collaboration has been generally successful in relationship building and intervention development, there have been challenges along the way and we foresee several challenges in the future, particularly around replication of this type of collaboration. ongoing and deeply entrenched challenges for the collaboration are anticipated given limitations of existing agency, county, state, and federal policies. in particular, health insurance reimbursement requirements and policies regulating treatment delivery presented barriers that were difficult to overcome and required compromises that pushed against a pure application of the framework. for example, in order for treatment programs to be sustainable, they need to be delivered by a licensed therapist for insurance reimbursement purposes. because the karen community in st. paul is relatively new, at the time the treatment program was developed, there were no karen people who were licensed to provide reimbursable mental health or substance use treatment services. the program is jointly facilitated by a karen man with substance use treatment experience who has not been able to re-credential in the u.s. and a non-karen licensed social worker. thus, mccleary et al./the karen chemical dependency 925 interpretation services are required, which are an additional barrier as many karen people would do better working directly in their native language. as second challenge that we foresee in the future is difficulty with replicating the collaboration. st. paul, minnesota is home to a large, well-organized, and active karen community with a long-standing karen community based organization and a robust workforce of karen interpreters. several active community leaders are engaged with this project. additionally, several non-karen members of the collaboration have more than ten years of experience working with the karen community personally and professionally and were able to build on these long-standing relationships in founding the collaboration. lastly, the development of the treatment interventions have been spearheaded by a karen man who resettled to st. paul after working for many years as a counselor in one of the only drug treatment programs based in the refugee camps along the thailand-burma border. these strengths and experiences are unique and difficult to replicate in other geographic locations. discussion health outcomes and access to health care have been operationalized as markers of integration for communities with refugee backgrounds (ager & strang, 2008). achieving this indicator of integration requires bidirectional adaptation efforts on the parts of both new communities and existing systems. this paper describes the lessons learned over the past four years in applying a general framework for collaboration to reduce harmful alcohol use in the karen community and to, in turn, facilitate integration between a newly resettled community and existing health and social service systems. one of the overarching principles that guided the work of the collaboration was that integration is a bidirectional process (ager & strang, 2008; newland et al., 2007). in other words, the success of this collaboration was dependent on mutual learning, capacity building, and adaption. the guiding framework for collaboration had three components: first, resettlement communities’ indigenous expertise, networks, systems, and resources need to be recognized and adapted for use in the resettlement context; second, the resources of existing systems need to be adapted to be culturally relevant and accessible to resettlement communities; and third, integration is facilitated through participatory principles and practices that facilitate mutual learning and adaptation to achieve mutual goals. the lessons presented in this paper suggest that effective cultural adaptation of existing interventions may need to go beyond surface level adaptations. in this project, significant adaptation was needed at the paradigm level in addition to the implementation level, which included engaging karen knowledge and meaning around addiction, treatment, and recovery. additionally, and consistent with findings by epstein et al. (2015), castro & yasui (2017), and barrera et al. (2013), this project also demonstrated that developing deep collaborative partnerships with the target community was essential for achieving mutual adaptation. it offers several suggestions for facilitating mutual learning and adaptation related to equalizing power, learning about and being responsive to different communication styles, recognizing the cultural context of all knowledge, building advances in social work, spring 2018, 18(3) 926 sustainable institutional partnerships, and building individual and organizational capacity to participate toward mutual goals. the experiences of this collaboration suggest that the collaborative approach to integration framework described in this paper may be a useful model of mutual adaptation, which fills a gap in existing research (newland et al., 2007). implications for social work the framework described in this paper has several implications for social work practice with refugee-background communities. one of the primary functions of the framework is to provide mechanisms for ensuring the inclusion of refugee-background communities’ expertise, knowledge, and strategies in the adaptation of health and behavioral health systems. social workers have an ethical mandate to engage in strengths-based work, to recognize the ways in which traditionally marginalized voices are often obscured and to actively promote inclusivity and equity. one success of the collaboration, facilitated by the use of the framework, was engaging representatives across a diverse range of sectors for a sustained period of time. collaboration members include law enforcement officers, social workers, karen leaders, karen interpreters, doctors, researchers, and drug and alcohol counselors. there are limited opportunities for a diverse group of people to work together on community issues, and establishing structured spaces that provide opportunities for mutual learning and capacity building may be one way to enhance cross sector collaborations. another implication for social work is in the area of research. the framework described here would benefit from application in other geographic locations, with other communities, and in response to other issues of integration, such as employment or education. research that tests applications and implications of the framework are needed. references ager, a., & strang, a. 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(2008). the theoretical, historical, and practice roots of cbpr. community-based participatory research for health: from process to outcomes, 2, 25-46. author note: address correspondence to: jennifer mccleary, phd, department of social work, university of minnesta duluth, 1207 ordean court, duluth, mn 55812, 34tjmcclear@d.umn.edu34t. https://doi.org/10.1080/15325024.2014.965971 https://doi.org/10.1080/14672715.2012.672824 https://doi.org/10.1093/jrs/feq046 http://www.theborderconsortium.org/media/80489/2016-annual-report-jan-dec.pdf http://www.theborderconsortium.org/media/80489/2016-annual-report-jan-dec.pdf https://www.state.gov/j/prm/ra/index.htm https://doi.org/10.1093/jrs/17.1.70 mailto:jmcclear@d.umn.edu abstract: while refugee integration is defined as a bidirectional process of mutual learning and adaptation, in practice, the u.s. resettlement program continues to emphasize refugees’ acculturation processes and places little emphasis on cultural or ... keywords: refugee resettlement; substance abuse; refugee integration; cultural adaptation the karen chemical dependency collaboration harmful alcohol use in the karen community formation of the karen chemical dependency collaboration application of the framework the intention of the collaboration is to reduce harmful alcohol use in the karen community. karen community leaders and representatives initially identified four topical areas that warranted attention. members of the collaboration then formed smaller ... collaboration members used the framework described above as a guide to build partnerships across sectors, ensure adaptation on the part of both existing systems and karen people, and to center participatory processes and mutual learning. as such, the ... indigenous strengths this framework for bidirectional integration requires that the indigenous expertise, ways of knowing, and problem solving strategies of communities with refugee backgrounds be central to the process of integration. to ensure that refugees’ expertise w... one example of this is the ways in which aspects of addiction, recovery, and well-being were negotiated. in the early days of the collaboration representatives of existing treatment services focused on getting feedback from karen people on how to adap... existing systems the framework also requires that existing systems engage in adaptation on a number of levels, including adaptation of how existing treatment modalities were delivered and a deeper level of adaptation throughout the entire system. to this end, we inten... building the capacity of organizations and agencies to engage in this kind of deeper level adaptation takes time and resources. much effort was spent educating both providers and upper level administration on the limitations of existing systems and th... mutual learning the center circle of the framework represents mutual learning and participatory practices. the collaboration meetings served as a space for karen community members and existing system representatives to come together and learn from each other. the col... the second half of meetings were spent in participatory problem solving. smaller groups of members from a range of sectors met to discuss specific issues that have arisen in the development and implementation of various interventions. the collaboratio... resulting interventions the collaboration identified four areas of need: culturally relevant substance use treatment, training for karen interpreters, capacity building for karen faith leaders, and culturally relevant prevention education. working groups have developed a ran... methods this paper does not report on a traditional research study but is a conceptual paper that describes the experiences of implementing an approach to supporting collaboration and integration in communities with refugee backgrounds. while it did not emplo... lessons learned lesson one: learning how to share power lesson two: recognizing a variety of relationships, roles, and capacity overcoming challenges while the collaboration has been generally successful in relationship building and intervention development, there have been challenges along the way and we foresee several challenges in the future, particularly around replication of this type of coll... ongoing and deeply entrenched challenges for the collaboration are anticipated given limitations of existing agency, county, state, and federal policies. in particular, health insurance reimbursement requirements and policies regulating treatment deli... as second challenge that we foresee in the future is difficulty with replicating the collaboration. st. paul, minnesota is home to a large, well-organized, and active karen community with a long-standing karen community based organization and a robust... discussion references _________ elizabeth king keenan, phd, lcsw, professor, shuei kozu, phd, mha, licsw, assistant professor, caliyah meggett, msw graduate, evelyn saiter-meyers, msw graduate, hunter mayhew, master’s student, paige reynolds master’s student, department of social work at southern connecticut state university, new haven, ct. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 821-840, doi: 10.18060/24074 this work is licensed under a creative commons attribution 4.0 international license. deepening the learning: intersectional experiential activities to address white supremacy elizabeth king keenan shuei kozu hunter mayhew evelyn saiter-meyers caliyah meggett paige reynolds abstract: graduate students of multiple racial identities in predominantly white institutions enter social work programs with a wide range of knowledge about and experiences of white supremacy, particularly the ways in which structural forms of racism continue to inflict harm, block opportunities, and perpetuate wealth inequities. in addition, white students are often challenged to grasp the ways they have been socialized to participate in perpetuating white supremacy. this wide range of knowledge and experiences makes it likely that students will experience a range of emotions and defensive resistance necessitating skillful pedagogical design and facilitation of class interactions. intentional use of theoretical frameworks with experiential activities can deepen selfawareness and understanding of the systemic nature of white supremacy (okun, 2010). in this manuscript, four students and two instructors discuss their learning experiences within a course addressing white supremacy for students of multiple racial identities in a predominantly white institution. post-course dialogue amongst these multiracial authors identified six core areas of learning when examining intrapersonal, interpersonal, and structural racism, cultural wealth of bipoc peoples, and anti-racism actions. two primary implications for education are: weave conceptual frameworks with interpersonal experiential activities throughout the course design, and attend to interactional power dynamics during class meetings. keywords: racism, white supremacy, anti-racism, cultural wealth, social work education graduate students of multiple racial identities in predominantly white institutions enter social work programs with a wide range of knowledge about and experiences of white supremacy, particularly the ways in which historical and structural forms of oppression continue to block access and opportunities and perpetuate wealth inequities. in addition, white students are often challenged to grasp the ways they have been socialized to participate in perpetuating white supremacy. this wide range of knowledge and experiences makes it likely that students will experience anger, frustration, disbelief, sadness, anxiety, and defensive resistance during discussions about white supremacy theories and lived experiences (burghardt et al., 2018). courses examining racism, white supremacy, and other forms of oppression require particular attention to pedagogical design and implementation to support students’ capacity to engage in learning, with both each other and the instructor. intentional use of theoretical frameworks with experiential activities can deepen self-awareness and an understanding of the systemic nature of white about:blank advances in social work, summer 2021, 21(2/3) 822 supremacy (okun, 2010). in this manuscript, four students and two instructors describe their experiences learning within a course addressing white supremacy for students of multiple racial identities in a predominantly white institution. post-course dialogue amongst these six multiracial authors identified six core areas of learning when examining intrapersonal, interpersonal, and structural racism, cultural wealth of black, indigenous, and people of color (bipoc), and anti-racism actions. method this section explains the method of course construction, in course design, as well as how the six core learning areas were identified, in manuscript construction. course design this course is one of three required human behavior in the social environment courses in the msw program at a predominantly white public university in the northeast united states. course objectives include using theoretical frameworks to analyze the structural, economic, and psychosocial dimensions of white supremacy, racism, and other oppressions, and to apply this knowledge when engaging in conversations about experiences of interpersonal racism and inclusion. the four instructors who teach the course designed it. they selected theoretical frameworks, readings, course outline, learning activities, and assignments. instructors agreed on the importance of constructing shared guidelines with students at the beginning of the semester. instructors also viewed student participation in experiential activities as vital to promote learning about the systemic and structural nature of white supremacy and related forms of oppression. instructors identified two primary experiential activities with reflective assignments to support cognitive and affective learning. theoretical frameworks addressing forms of oppression and power (including bernal, 2002; jones, 2000; kendi, 2016; tew, 2006; young, 2004) are introduced in the first part of the course to examine the history of white supremacy and related oppressions. students then participate in the starpower simulation (shirts, 2013). this simulation enacts white cultural beliefs and power dynamics, including the collusive power to control the rules of the game by those with the most points. students experience a range of desires, feelings, and reactions as many strive to win and amass wealth while others feel alienated, powerless, or apathetic. a reflection paper, the first assignment for this course, invites students to reflect on what they experienced and the meaning they are making of the experience utilizing theoretical frameworks. some students express feelings of guilt and shame from occupying positions of power, while others find ways to protest against the silencing of their voices in rule making. theoretical frameworks examining cycles of socialization and liberation (harro, 2013a, 2013b), cultural capital (yosso, 2005), intersectionality (collins & bilge, 2016), and interpersonal racism (sue, 2010) are introduced in the second half of the course. after reflective discussions on their own positionalities (defined as role, status, and whether one is a member of the targeted group, a witness, or the perpetrator of harmful comments in a keenan & kozu/depening the learning 823 specific situation and setting, thurber & diangelo, 2018), students interview two people of differing positionalities about their experiences of interpersonal racism, belonging, and inclusion, then write a reflection and analysis. the instructors have found that when scaffolded within student engagement activities and theoretical frameworks, experiential activities can offer significant interactional opportunities to: 1) notice unconscious desires, assumptions, and beliefs associated with socialization into white supremacy culture, 2) highlight interpersonal and structural power dynamics, and 3) illuminate opportunities to disrupt white supremacy culture in practice interactions. manuscript construction at the end of the course, the two instructor authors each invited two students from their course sections to co-author this manuscript. all authors met seven times to share personal and professional experiences related to their positionalities, and to identify significant aspects of their learning in the course. during the first two meetings, each student shared what stood out for them (a concept, theory, activity, or assignment that they had learned in the class) to inform conversations by all authors about significant aspects of learning. the first author summarized the conversation, highlighted five core areas, and asked all authors to review and reflect before the next meeting. at the third meeting, authors noted that an additional aspect had been inferred but not explicitly identified. after discussion, authors reached consensus on six core areas of learning and created a writing process. the manuscript writing was emergent, iterative, and intentionally conversational. each author wrote one of the conceptual introductions and contributed to portions of the manuscript in between meetings. drafting began with conversational writing and brief conceptual introductions within each area. consensus was used to decide which draft portions would appear in the final manuscript. a short description of each author follows. • elizabeth (she/her/hers) identifies as a white, heterosexual, cisgender woman. elizabeth is a professor with 10 years of clinical practice experience. she has been engaged in community organizing and community leadership practice for the last 12 years. • shuei (she/her/hers) is an assistant professor. shuei was born and grew up in japan, having both japanese and chinese ancestors. shuei has more than 20 years of clinical experience, primarily in pediatric health care settings, as well as disaster intervention. • hunter (he/his) is a heterosexual, white, cisgender man completing his final year of the msw program. with the aadc credential and accelerated resolution therapy certification, he has worked in addiction treatment for 5 years at an outpatient counseling center for individuals with dual diagnoses under the supervision of a clinical psychologist. • caliyah (she/her/hers) is a biracial black and white, heterosexual, cisgender woman. caliyah is in her second and final year of the msw program. in addition to being a full-time student, she works in a therapeutic group home advances in social work, summer 2021, 21(2/3) 824 with adolescent girls. caliyah plans to pursue a social work career in crisis intervention. • paige (she/her/hers) identifies as a white, heterosexual, cisgender woman. paige is in her second year of a three-year msw program and is currently exploring her place in the social work field. paige plans to work with children and families who have experienced trauma. • evelyn (she/her/hers) identifies as a latinx, heterosexual, cisgender woman and is completing her second and final year of the msw program. evelyn plans to serve as a bridge for bipoc communities and mental health support services that are trauma and culturally informed. the six core learning areas are: 1. learning as a spiral; the initial sequence matters 2. socialization into white supremacy culture 3. learning about the matrix of power dynamics 4. moving out of binaries to view self and others intersectionally 5. applying a structural analysis of white supremacy within social work organizations 6. developing the capacity to respond to racist comments and advocate for equity the six areas each begin with a brief conceptual introduction, followed by author conversations. learning as a spiral; the initial sequence matters i’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. maya angelou (goalcast, 2017, para. 5) racism and social justice courses can be some of the most emotionally loaded and challenging courses to teach. for example, the different and sometimes conflicting worldviews between white and bipoc students may create divergent realities that confront instructors with pedagogical challenges (phan et al., 2009). for many white students, it is the first time they are faced with the reality that they have been enjoying white privilege throughout their lives. it is not uncommon for some white students to resent the course material, stating that they do not feel they experience privilege (fuller, 2016). thus, while attempting to create a courageous and trusting environment, the content of the course can create tension in the classroom. another matter to consider is the dynamic between the instructor and students. inherently, there is a power imbalance as the instructor has power over the students, particularly with students’ grades. the instructor’s race and experience with racism also play a role. according to ladson-billings (1996), white male instructors may be perceived by students as more “objective” and “scholarly” than bipoc cisgender female and transgender instructors. as a result, instructors are required to “engage in emotional labor keenan & kozu/depening the learning 825 and other caring work, which entails managing one’s own emotions as well as those of students” (miller et al., 2019, p. 491). instructors, therefore, need to create a trusting and supportive relationship while maintaining student interest, addressing classroom dynamics, and motivating student learning. garran et al. (2015) succinctly remarked, “social justice education is an emotional and psychological process, as well as an intellectual one” (p. 799). anti-racism training literature suggests that the intentional selection of pedagogical activities can strengthen student engagement in learning about how white supremacy relies on reinforcement within and between individual, group, and structural levels (okun, 2010). transformational learning theory supports the use of experience as the basis for learning about actions and interactions in various social systems (jones, 2009). pedagogical activities that incorporate critical analysis and discussion about such experiences in the learning process can create intense feelings within each student to help students mindfully use an anti-oppressive lens within the classroom, as well as in their social work practice. experiences of the initial sequence elizabeth: the beginning of the course feels the most tenuous for me because the students and i don’t know each other, and students usually bring a wide range of knowledge from experience and prior coursework. caliyah: i agree, elizabeth, that the beginning of the course is tough. not only was i unfamiliar with you as a person besides your obvious identity as a white woman, but as my professor, you were providing me with content about racism and white supremacy that made me aware of and challenged my personal beliefs, values, and biases. it was uncomfortable and sometimes awkward; i then understood why people choose to disengage and deny their privilege. paige: i am going to be honest when i say i did not realize the importance of this course in the beginning. class discussions were awkward because there was clear hesitation among the group to express their personal beliefs, values, and biases. as a white student, i was sometimes hesitant to raise my hand and express my opinion because i did not want my response to offend anyone or “show my whiteness.” i asked myself how my response would be perceived by others. using the class agreement to “listen with openness” during the awkward moments in the beginning of the course encouraged our learning. by listening with openness, each class activity gave a new perspective on each topic and why it was important to learn. the topics we discussed flowed together enhancing our spiral of learning. hunter: well said, caliyah and paige, and to elizabeth’s point i think the beginning of the course wasn’t just tenuous, it was frightening as well. the beginning of this course covered topics which were “uncomfortable” in the sense that i would have to confront two things, advances in social work, summer 2021, 21(2/3) 826 a) that the world is a beautiful but equally (or more accurately unequally) an aloof and cruel place, and that b) this course would require a deep examination of one’s self and their own individuality in context of systemic oppression. i was afraid realizing that i would have to confront my own guilt about the harm others have done in the name of white power, white supremacy, patriarchal hierarchies, or any other social construct used to perpetuate hate, stratification and humiliation. i was also worried that somebody could potentially hold me responsible, blame me, or assume that because of the privilege afforded to me as a white cisgender man in this society, i must be similar in ideology to those who perpetuate the oppression discussed in this course. i recognized that being afraid to participate would come at a very high cost. out of fear for being associated with groups responsible for long and unjust oppression toward others, i would in essence be recognizing the problem and choosing to do nothing, ironically facilitating a self-fulfilling prophecy. socialization into white supremacy culture race, gender, ethnicity, skin color, first language, age, ability status, religion, sexual orientation, and socioeconomic class form an evolving mix of social identities throughout the lifespan (miller & garran, 2017). children enter into a cycle of socialization without choice or control because they are born into an existing system of rules and roles. harro (2013a) states that those who are born into dominant or agent groups fit the “norm” without question; on the contrary, those who are born into target groups tend to be devalued by dominant cultures. the system of rules and roles is taught and modeled by family members and other loved and trusted people (harro, 2013a). these people shape development by communicating expectations for the rules and roles children must play to fit the “norm.” as children move into adolescence and young adulthood, socialization expands into a meso level where more people directly and indirectly communicate expectations and rules, reinforcing the roles they are taught to play. in the united states, the culture of white supremacy socializes people into social identity roles in a system of social identity hierarchies (harro, 2013a; jones, 2000). young (2004) discussed a similar concept a decade earlier, calling this a process of cultural imperialism. cultural imperialism involves the universalization of a dominant group that establishes the group’s culture as the norm. the dominant group reinforces its position in society by devaluing, marginalizing and exploiting bipoc individuals and cultures (young, 2004). it is important to recognize the power of white supremacy culture to systematically train people “how to be” within each social identity (harro, 2013a). young’s (2004) cultural imperialism and harro’s (2013a) cycle of socialization illuminate why treating each other with respect and appreciating differences should be simple, but isn’t. systematic conditioning by white supremacy culture actively perpetuates the harmful cycle. change, however, is possible when the cycle of liberation is used to cultivate keenan & kozu/depening the learning 827 awareness and understanding to interrupt and dismantle these oppressive dynamics (harro, 2013b). socialization experiences shuei: i have a very unique background of being mixed blooded between japanese and chinese. i was born and raised in japan, but spent a good majority of my adult life in the united states. my socialization process as a child was vastly different from my american friends. i have always been aware of racial discrimination as my grandparents, my parents, and myself have been subjected to discriminatory treatment in japan. yet, we were still able to “blend into the mainstream” because of our physical features, which made it impossible to tell us apart from the japanese, especially because we spoke japanese as a first language. our class and status within the small chinese community in japan also influenced who we were. i came to the united states first as a student, and i eventually became a social worker. as an adult, my professional identity became an important part of me, and shaped how i view the world. during my graduate education, i came across bell hooks’ writing, and it resonates with me well: while it is a truism that every citizen of this nation, white or colored, is born into a racist society that attempts to socialize us from the moment of our birth to accept the tenets of white supremacy, it is equally true that we can choose to resist this socialization. (hooks, 2003, p. 56) paige: i have witnessed the ignorance, obliviousness, and privilege that consists of “the core,” which is the source that keeps us in the cycle (harro, 2013a). i have been socialized by my parents, family, friends, teachers, and coaches who taught me to play the role of a white female in an affluent and predominantly white town in connecticut. i was socialized by the public schools i attended, where i learned that people of color were a minority and it mattered which college you chose to attend because they are differently judged and valued. i learned that i was always protected by the “bubble” that is my small town, especially if i fit the mold created by societal norms. we also learned to feel protected by officer friendly who came into our fifth-grade class to teach us that police officers were there to keep us safe. i am breaking the cycle now because i have begun to think, challenge, and question the system and see that something is wrong with this picture (harro, 2013b). i have begun to question where others were first socialized and how they may experience the perpetual cycle. i think about why a mother would tell her son to never bring a black girl home. i think about why someone would tell me whites are good and blacks are bad. and i question what is missing in the education system for k-12. advances in social work, summer 2021, 21(2/3) 828 evelyn: paige, my experience is similar but from an opposite perspective. my mother taught me from a young age: the key to success in this country is education. i grew up in a town where it was racially diverse and there didn’t appear to be any racial divide. my mother encouraged me to take advantage of each and every educational opportunity and reminded me that education was the equalizer. however, when i left home for college, i was shocked at how different my university was from my high school experience. i attended a private university in the same town in connecticut where you grew up. as you mentioned the town is a bubble and the university became a small microcosm of the bubble. the university i attended had predominantly white students, staff, and professors. my classmates were predominantly wealthy, irish american, catholic and from various northeastern wealthy enclaves. i felt lost because the lessons i had learned about equity and equality were not the lessons taught by my classmates who mocked the notion of white privilege, and instructors did not challenge the students. learning about the matrix of power relations when thinking about power, white supremacy culture views it as an asset, a resource accumulated as a means to qualify for leadership, control, and to be granted authority to make decisions that affect both individuals as well as large groups of people (pinderhughes, 2017; tew, 2006). this view is often held by people of higher socioeconomic status, such as the president of a country or the ceo of a company. consistent with white supremacy culture, the people who hold these positions are usually white men. this concept of power (as a resource) can instill feelings of powerlessness in people who do not occupy elite positions or belong to higher socioeconomic classes. these individuals may feel that they lack the necessary status, assets, or equity in opportunity to gain enough power and control to make meaningful decisions and access exclusive resources (pinderhughes, 2017). this can make change seem impossible and ultimately be avoided. tew’s (2006) power matrix offers a more dynamic perspective on power. the conventional concept of power includes the oppressive and collusive types that seek to obtain and maintain control over people through wealth and resources. this reflects a belief that there is a limited amount of power. if one person has power, then the other person has none, such as in cases of intimate partner violence where there is a perpetrator and a victim. tew (2006) establishes two additional forms of power that are more productive and challenge the idea of zero-sum power. these forms—protective and cooperative—are established on the belief that “power operates in all levels of human functioning and is critical to all relationships,” not just among those in positions of power (pinderhughes, 2017, p. 1). this reflects the idea of power as a collective value. equal rights and access to resources and services for everyone does not mean less for those who already possess that privilege. ultimately, tew’s (2006) concept displays the immense power and value in unity and collective action, which has an important place in dismantling white supremacist culture and the racism that has plagued society. keenan & kozu/depening the learning 829 views and experiences of the power matrix elizabeth: i remember thinking that power was always harmful. my community organizing work showed me that relational power is real and necessary to counter oppressive forms of power. i find the matrix helpful because it helps me notice when i feel pulled to enact oppressive power in practice (e.g., telling a client they “have to” do something because of program constraints instead of honoring the impact of those constraints in a conversation with the client). caliyah: you make a great point about the association between being powerful and being harmful, elizabeth. the starpower activity was instrumental in not only learning about, but experiencing, this matrix. the activity showed me what people are willing to do, almost subconsciously, to gain and maintain power. i personally experienced that inherent pull to do everything i could to obtain wealth, resources, and make decisions that benefited myself without even thinking about others. overall, the activity is effective in debunking common myths that are used to justify power and white supremacy (sensoy & diangelo, 2017), including statements such as, “i earned everything that i have,” and “anyone can make it if they work hard enough.” starpower displays that oppressed people remain oppressed not because of their own wrongdoing, but because of an individualistic system that naturally favors privileged people over collectivism and equity. shuei: the thought that power must always be harmful might be the consequence of how women are socialized. in social work, a field of predominantly white women, we often use the word “empowerment,” which is regarded positively. as women, to give power to someone else is encouraged, and yet, to seek or obtain a power for oneself is often frowned upon because women internalize the power imbalance in society, focusing on oppressive and collusive types. paige: i remember internalizing such power imbalance when i had a conversation with a white male on the topic of protesting for black lives matter. there were so many thoughts, feelings, and emotions running through my entire body at that moment; however, i remember feeling weak and powerless. i listened to his harmful words and thought to myself, “nothing i say will change his mind; i have no power in this situation.” when i was given a chance to speak, my words were shut down, but i’m learning that power is not always harmful, and that i am capable of obtaining power as a woman in society. advances in social work, summer 2021, 21(2/3) 830 moving out of binaries to view self and others intersectionally it is vital when critiquing and analyzing u.s. history to understand that it is based on a historical system of conscious and unconscious racism. yosso (2005) uses critical race theory (crt) as a “theoretical and analytical framework” in education to “challenge the ways race and racism impact educational structures, practices, and discourses” and illuminate the barriers to equitable education (p. 74). yosso’s (2005) conceptualization of community cultural wealth goes beyond the notion of simply identifying the issues of white privilege and institutional racism. community cultural wealth allows bipoc students to hear their stories for the first time and realize they are not alone, to find collective strength to fuel their ability to defy barriers in education. yosso (2005) argues that the community's cultural wealth framework acknowledges the disadvantages bipoc students face in higher education and other educational settings. however, most importantly, community cultural wealth focuses on the strategies, strengths, and innate experiences that people have acquired via their unique sociocultural and linguistic backgrounds (yosso, 2005). according to aragon (2018), counterstories are the strengths and resiliency factors that bipoc students possess via their cultural experiences inside and outside of their homes. aragon (2018) studied the experience of latinx, spanish-speaking women in college and found that students identified their parents’ encouragement for them to study as reasons to complete college and be the first to graduate in their families. aragon uses their experiences as an example of how cultural wealth strengthens bipoc students in education. although students may begin at a disadvantage, it is important to focus on the strengths of bipoc students to promote antiracist education. views and experiences of intersectionality evelyn: prior to this class, it was easy for me to focus solely on white privilege and the historical and institutional imbalance of power that “whiteness” holds in our culture. however, the coursework pushed me to think about my own intersectionality and positionality. i found it powerful to be asked to critically reflect on how my positionality “as a college-educated, middle class, light-colored, cisgender woman, married to a white man, latinx” worldview was formed. this course highlighted to me that i often, without realizing, have ignored my own positionality. i learned via the white supremacy iceberg (tmckinney, 2020) that colonial ideas are still thriving in my identity as a latinx, such as the jokes said amongst family or nationalistic pride or common tropes in caribbean beliefs. furthermore, i recognize the audacity of me saying to a client who is undocumented, that i understand their experience, simply for sharing some common heritage. those are some of the thoughts i have begun to unpack piece by piece. i have always thought of myself as an ally to other communities facing oppression or racism, but it wasn't until learning about “five faces of oppression” (young, 2004) that i really came to understand “mi lucha es tu lucha,” or “your battle is my battle, too.” https://www.facebook.com/followspan/ keenan & kozu/depening the learning 831 intersectionality shows us that we are aware that white supremacy’s tactics are not simply one form of oppression but rather that their effects are felt in various ways and in various communities. intersectionality helps us see that while white supremacy divides us, intersectionality allows us to dismantle it collaboratively. caliyah: as a biracial, black and white woman, i also have had to recognize the intersectionality of my targeted and dominant identities. at a young age, i learned that my light black skin is valued more in society than dark skin, which is privilege. at the same time, i have had my accomplishments and leadership positions questioned or minimized because of my race. as social workers, intersectionality allows us to stand in the gap between continually learning and reflecting on our own biases, while simultaneously advocating for and working towards a more racially just and equitable world. when we know better, we must do better. paige: i agree with caliyah. intersectionality allows us to reflect on our own biases and continually learn about ourselves and others. during this course, i was able to recognize my own biases and further examine my own power relations. i am a white woman who grew up in a predominantly white community where we were conditioned to ignore our “whiteness.” before this course i believed i had been the victim of “reverse racism.” now i know better; therefore, i must do better. i must be honest about my past biases and move forward with my new knowledge of intersectionality. my knowledge is power, and i desire to share my knowledge with others in how i react, respond, and advocate for others. applying a structural analysis of white supremacy within social work organizations cultural humility has become a powerful evidence-supported practice in the fight against racial inequities that exist in many institutions (mosher et al., 2017). practicing cultural humility and recognizing the impact of intersectionality is the responsibility of social work institutions, and can create a culture that represents equity of treatment, appropriate language assistance, employee accountability, cultural awareness, and inclusion while placing high value on constant reflection and challenging exclusive cultures (u.s. department of health and human services office of minority health, 2018). when an institution’s practices are guided by an exclusive white culture, however, specific moments of interpersonal racism can accumulate, causing substantial psychological distress as well as an increase in depressive thoughts and anxiety for bipoc individuals (robinson-perez et al., 2020). while certain policies have been enacted to reduce racism, the radical overhaul necessary to truly build cultural humility into these institutions seems to remain an unrealized dream of “progressive idealists” and bipoc staff. acknowledging this reality illuminates the importance of incorporating cultural humility in a course about racism, not only as a concept critical to social work education but also as an early pedagogical strategy to prepare students to confront devastating advances in social work, summer 2021, 21(2/3) 832 realities like the overwhelming presence of covert and overt white supremacist culture found in institutions. it prepares students to confront and respond to heartbreaking events like the killing of george floyd, which represents an institution’s failure to demonstrate equity in treatment, as well as empower students with the strength and courage to acknowledge, challenge, and dismantle white supremacist cultures within internship and workplace institutions. experiences of white supremacy within organizations elizabeth: i find this part of the course challenging because so many of the organizations in the area are predominantly white organizations that are “works in progress” with equity and inclusion. i try to stir student imagination to envision possibilities beyond what they experience at their internships and am also mindful of my own blind spots and limitations given my experiences working within these organizations. hunter: i find this discussion particularly important, elizabeth, because while some organizations are works in progress, i think others have yet to work towards any progress. i view this topic through my lens as a counselor in an outpatient addiction treatment center. the culture of an institution is made up of many aspects, including the practice model, how clients’ feelings and experiences are addressed, the way an assessment is performed, diagnostic criteria, staff training, and how an organization addresses problems. diversity in staff is not enough to say the organization is a culturally competent or humble place. the institutional culture impacts every part of the institution whether the staff is diverse or not. this means that social work institutions that embody a traditional white culture from the 20th century are not allowing voices of bipoc staff to be represented in organizational practices. staff diversity is important, but so is incorporating diversity into the culture of the program. recognizing issues, like historical trauma (barocas & barocas, 1979; degruy, 2005) or the underdiagnosing of ptsd in certain bipoc populations are both important concepts for staff training. adopting cultural humility must also become an organizational philosophy that guides all practices in an institution. evelyn: as we began to discuss leadership and company cultures in the social services field, i was inspired to put into words what i had experienced in my career thus far. while i enjoyed working in environments that celebrated diversity and equity, it became clear that an “invisible tax” was placed on bipoc staff to “unpack” the agency's policies and the purpose for interventions. i began to observe that leadership was predominately white and rarely represented the communities it was serving and the individuals it led. however, the greatest challenge i have experienced is being witness to interpersonal racism and obvious keenan & kozu/depening the learning 833 preconceived notions about poverty, class, racism, and gender around clients. the coursework focused on cultural humility is essential in preparing students to tackle the ethical challenges experienced in both their personal and professional lives because it beckons the student not to simply dismantle and build awareness, but rather become a lifelong student of self-awareness, introspection, and a responsibility to act. shuei: this is going to be an extremely important and challenging topic to keep in mind, given the current climate concerning police brutality and social workers taking on some aspects of work police officers have been handling, especially with the mental health crisis and working with homeless populations. i believe that social workers are better trained to address these matters than law enforcement officers. however, social workers should not simply replace the police officers. as we partner with them, we have obligations to train and enlighten police officers about institutional racism and work with them to change the organizational culture. having a few racial minority officers in the force will not make the police force “racially diverse.” if social workers are going to partner with police officers, as appears to be happening already in some parts of the country, social workers should work with them to change their culture to reduce institutional racism and become aware of internalized bias, especially regarding white supremacy, or the brutality toward people of color will continue to happen. caliyah: a large public outcry to defund the police has risen as a result of police brutality. this topic is of particular interest to me as i hold an undergraduate degree in criminal justice and have found my career passion at the intersection of the criminal justice and social work fields. police officers specialize in and are trained to respond to incidents that involve criminal acts and violence for law enforcement purposes. officers are less equipped and less trained to deal with mental illness, trauma, and special needs. i echo shuei when i say that this presents a unique opportunity for law enforcement agencies to partner with social workers and other social service agencies that specialize in the prevention of and response to issues such as addiction and homelessness. until this partnership exists in public service agencies and organizations, these issues will continue to be criminalized and perpetuate disproportionate minority contact, institutional racism, and use of excessive force. developing capacity to respond to racist comments and advocate for equity a wide range of knowledge, exposure, and experiences of white supremacy in our society influence the way students respond to racist comments and actions. awareness and critical analysis of interpersonal and systemic racism within organizations can fuel a sense advances in social work, summer 2021, 21(2/3) 834 of urgency for students to actively resist and shift oppressive power dynamics within interactions. some students might feel unsure, powerless, or fed up because they haven’t ever spoken up or because previous efforts have not had the impact they hoped for. there are also students who struggle with the reality that they have benefitted and enjoyed white privilege because they focus more on how they treat everyone “equally.” deciding whether and how to respond involves assessing specific situations and identifying possibilities based on one’s positionality (e.g., is the person likely to hear feedback or is the person more interested in debating what is “right”?). areas for advocacy and resistance can be illuminated by defining the difference between equity and equality and using questions to identify which groups are disadvantaged or privileged by a policy, procedure, or decision (racial equity tools, n.d.; center for urban education, n.d.). advocacy for equity inherently challenges white supremacy beliefs and assumptions, triggering claims and statements that justify the status quo or dismiss the request (e.g., maintaining individually-focused merit-based decisions that ignore the social capital that influenced achievement for white, middle class, and affluent students). examining these beliefs, assumptions, and other conditions perpetuating inequitable racial outcomes within specific institutions can inform specific policy and procedure advocacy strategies (see, for example, acevedo-garcia et al., 2020; metzger & khare, 2017). experiences of and responding to racism in graduate education shuei: as an instructor, the challenge for me is when inappropriate comments are made during the class time. i have to make a split-second decision as to if i should intervene or not, and leave it for students to respond to practice speaking up. this is especially challenging when i know students make those comments when they are wellintentioned. sometimes, students do not respond in the class but will write about it in the paper, making me wish i and/or they had spoken out. elizabeth: yes, i, too, experience this challenge. although i name the importance of bystanders speaking up when hearing a harmful comment, i find that many students wait for me to address it. i recognize the power in my role as instructor and, at the same time, that social workers need to be able to speak up in their practice. i encourage students to develop and practice habits that i also work at: to notice what stirs within them, welcome and work with those reactions, listen with openness and curiosity, and stay engaged in the conversation whenever possible. paige: one of the major components i took away from this course was how to respond to others during conversations with racial comments. i never recognized how important it was, especially as a white woman, to practice making a habit of speaking up rather than allowing my privilege to avoid the situation and brush it off because it did not directly affect me. being silent is a way of eliminating the uncomfortable keenan & kozu/depening the learning 835 conversations; however, i’ve noticed that being silent is a cop-out and does not promote the change that is needed throughout our country. i am appreciative of the awareness i now have and will continue to practice responding appropriately, leading with humility, and encouraging uncomfortable but necessary conversations both in my career as a social worker and in my personal life. in order to do so, i will continue to educate myself, listen with openness, and learn to find more confidence in my voice. i am determined to find my voice, encourage change, and be sure i am taken seriously. evelyn: paige, i underestimated how useful this class would be. to be honest, i felt that all of my peers and i would have already possessed great awareness around the issues of race. as individuals preparing to be social workers and clinicians, i felt my colleagues would be already comfortable discussing racism and how to pursue a life of anti-racism. of course, i now realize how much introspection was still needed by our classmates and myself. i was especially challenged when shuei led us in the starpower activity. i immediately felt frustrated with having to start at the lowest economic/privilege group. as i struggled to learn the “rules of the game,” i realized i was the only bipoc in the group. my teammates began to debate whether or not they should help me acquire more tokens, when suddenly a classmate asked if the team was “bailing me out” out of “white guilt” by asking: “are we going to keep giving our tokens to people because we feel guilty?” i have to say it stung to hear that comment. i just felt this heat consume me due to the embarrassment and shame i felt from that comment. i realized that it's the small, every day, personal offenses that need to be challenged as future clinicians. i felt so angry, and i didn't say anything because i didn't want to be the angry minority woman or attract any more attention. hunter: in agreement with paige, i found one of the most valuable areas in this class was the opportunities to have the culturally “taboo” conversations about white privilege that exists in the world. change will never happen if it is unacceptable to have conversations about racial inequalities, oppression, interpersonal racism, and other subjects determined to be taboo by social standards. our society must become a more acceptable place for these discussions about racism and white supremacy because it will not become easier unless it begins now. to acknowledge the problems from the past that are persisting in the present, and feeling too ashamed to discuss it openly, leaves us at risk for enabling it to keep occurring. developing greater capacity to have conversations about white supremacy, white privilege, oppression, and interpersonal racism is one of the more valuable skills that an individual can cultivate and is something that is important for all to explore in their day-to-day life. advances in social work, summer 2021, 21(2/3) 836 caliyah: paige, you make an excellent point about speaking up rather than staying silent in order to remain comfortable. as incidents of police brutality against black men and women came to light, including the murders of breonna taylor, ahmaud arbery and george floyd, there was a subsequent surge in the black lives matter movement. i remember scrolling through social media and feeling hurt, angry, and betrayed by the silence of my non-black friends. i took time to sit with my emotions but felt the need to address their silence. when i engaged in conversations with some of my close white friends, the overwhelming response was that they supported blm and wanted to say something; but they did not know what to say, and they were afraid of saying the wrong thing. my response to them was that i would rather them show up and speak up imperfectly than not at all. implications for social work education the findings from this dialogue between students and instructors provide pedagogical suggestions for courses on racism and dismantling white supremacy through course design and class meetings. course design instructors are encouraged to weave conceptual frameworks with interpersonal experiential activities throughout the course in the following ways: 1) provide opportunities for students to engage in self-awareness, reflection, and conceptual analysis of the experiential activities to connect affective, cognitive, and interpersonal aspects of white supremacy with systemic and structural dynamics; and 2) begin with a combination of student social identities, structural racism, and collective resistance. next, highlight the cultural wealth of bipoc peoples, followed by how interpersonal and organizational forms of racism impact society. finally, explore actions to dismantle white supremacy culture in social work practice. class meetings instructors are encouraged to attend to the interactional power dynamics between instructors and students in the following ways: 1) cultivate an environment of acceptance, respect, curiosity and care with shared class agreements and intentional inclusion of resistance and resilience of targeted groups; 2) foster cultural humility and an interest in hearing what students do not know or have experience with; 3) encourage students to speak up when a harmful interaction or comment has occurred; 4) provide support to students who have been harmed by another student’s comments; 5) model how to interrupt harmful interactions and directly respond to harmful comments; 6) facilitate reflection of the impact on the class; and 7) provide education to deepen understanding of the harm using social work values and conceptual frameworks. in addition, instructor flexibility to include current campus, local, and national issues throughout the semester strengthens student keenan & kozu/depening the learning 837 engagement while also providing immediate relevance for the urgency to dismantle white supremacy culture and structure. conclusions four students and two instructors in a course examining structural, systemic, and interpersonal racism found that simulations and interviews expanded and deepened learning. intentional sequencing of theoretical frameworks with experiential activities appear to positively influence learning across ecological levels: developing self-awareness and knowledge of structural racism provide a foundation for learning about socialization into white supremacy culture, interpersonal forms of racism, and analysis of structural inequities within organizational and institutional systems. personal awareness and knowledge of the pervasiveness of systemic racism fuel commitments to develop the capacity to respond to interpersonal racism and advocate for equity within organizational practices. to dismantle white supremacy cultural processes within class requires instructors to engage in emotional labor, make in-the-moment decisions to respond to harmful class interactions, and strive to model habits of being that communicate care, curiosity, humility, and respect. recognition and acceptance of the wealth of lived experience amongst students, as well as differing gaps in awareness and understanding, can create 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(2020, may 27). *some* of the ways people practice and reinforce white supremacy. https://arapahoe.extension.colostate.edu/2020/05/27/some-of-the-wayspeople-practice-and-reinforce-white-supremacy/ u.s. department of health and human services office of minority health. (2018). national clas standards. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 yosso, t. j. (2005). whose culture has capital? a critical race theory discussion of community cultural wealth. race, ethnicity and education, 8(1), 69-91. https://doi.org/10.1080/1361332052000341006 young, i. m. (2004). five faces of oppression. in l. m. heldke & p. o’connor (eds.), oppression, privilege, and resistance: theoretical perspectives on racism, https://doi.org/10.5175/jswe.2009.200700056 https://doi.org/10.1080/08841233.2018.1382273 https://www.racialequitytools.org/resources/fundamentals/core-concepts/racial-equity https://doi.org/10.1007/s10615-019-00711-5 https://crtda.org.lb/node/12108 https://doi.org/10.1177/1468017306062222 https://doi.org/10.1080/15313204.2017.1417941 https://arapahoe.extension.colostate.edu/2020/05/27/some-of-the-ways-people-practice-and-reinforce-white-supremacy/ https://arapahoe.extension.colostate.edu/2020/05/27/some-of-the-ways-people-practice-and-reinforce-white-supremacy/ https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 https://doi.org/10.1080/1361332052000341006 advances in social work, summer 2021, 21(2/3) 840 sexism, and heterosexism (pp. 37-63). mcgraw-hill. https://www.sunypress.edu/pdf/62970.pdf author note: address correspondence to elizabeth keenan, department of social work, southern connecticut state university, new haven, ct, 06515. email: keenane1@southernct.edu https://www.sunypress.edu/pdf/62970.pdf mailto:keenane1@southernct.edu ________ barbra teater, phd, lmsw, professor, department of social work, college of staten island, staten island, ny. jill chonody, phd, lcsw, associate professor, school of social work, boise state university, boise, id. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 694-708, doi: 10.18060/24218 this work is licensed under a creative commons attribution 4.0 international license. reconsidering how successful aging is defined: perspectives from community-dwelling aging adults barbra teater jill chonody abstract: successful aging is a prominent framework within gerontology, yet an understanding of how aging adults define “successful aging” is often missing in the social work discourse around what it means to age well. this cross-sectional, exploratory study used an online survey to explore community-dwelling adults’ (aged 55+; n=471) definition of successful aging, the underlying components across all definitions, and any differences in components based on whether or not the adults identified as aging successfully. summative content analysis yielded five main themes and 13 sub-themes for those who identified as aging successfully and five main themes and 11-sub-themes for those who identified as not aging successfully with elements of health constituting the largest percentage of responses across both groups. bivariate analyses found participants in the “not aging successfully” group mentioned elements of being healthy and financial security more than those in the aging successfully group, and elements of sustain participation, curiosity, and learning less than those in the “aging successfully” group. the findings illustrate the extent to which aging adults view successful aging as the presence of health and ability. social workers should be mindful to the ways in which adults view successful aging and the elements they believe to contribute to successful aging in order to provide and tailor programs, services, and resources that are supportive of aging adults’ needs and wishes. keywords: successful aging; ageism; self-determination; health; well-being successful aging is a prominent paradigm within gerontology and since its introduction has underpinned the way in which aging is viewed in the united states. initially mentioned in the gerontology literature by havighurst (1961) who argued a theory of successful aging should include elements of satisfaction and happiness (martin et al., 2015), the modern version of successful aging is often based on the framework proposed by rowe and kahn (1987, 1997, 1998). rowe and kahn posited a view of aging that delineated the difference between those individuals who aged “usually” and those who aged “successfully,” the latter of which referred to individuals who were at lower risk and had higher functioning, which was achieved through a combination of physical, cognitive, and lifestyle factors. in particular, rowe and kahn (1997) theorized successful aging as: (a) low probability of disease and disease-related disability; (b) high cognitive and physical functional capacity; and (c) active engagement in life. successful aging was achieved through healthy maintenance and “full engagement in life, including productive activities and interpersonal relations” (rowe, 1997, p. 367), and placed the emphasis on lifestyle choices in maintaining health and reversing disabling problems, which has been argued to “move successful aging further from the social determinants of health” (katz & calasanti, 2015, p. 27) and away from an acknowledgment of the influence of the environment on the aging process (teater & chonody, 2017). https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2020, 20(3) 695 the term “successful aging” is found throughout the gerontological literature and is often used interchangeably with optimal aging, productive aging, active aging, and healthy aging. despite expansions on the definition of successful aging by other theorists and researchers (see martin et al., 2015 and michel & sadana, 2017 for a review of these definitions), attempts to identify and measure successful aging have predominantly focused on one or more of the three components as identified by rowe and kahn (1997), thus leaving a limited and unclear picture of the extent to which people are aging successfully. for example, evans (2009) argued for the need to “find more effective ways to add life to years or to age successfully” (p. 424) and explored specific markers of successful aging among urban and rural older adults in iowa by operationalizing successful aging through the life satisfaction index and the depression scale. pruchno et al. (2010) examined early influences and contemporary characteristics of successful aging among older adults living in new jersey by including objective and subjective variables such as having few chronic conditions, maintaining functional ability, experiencing little pain, and self-rated successful aging. a criticism of the successful aging literature is the lack of a unified definition and measurement of successful aging (katz & calasaniti, 2015; teater & chonody, 2020), particularly that existing definitions do not take into account the views and perspectives of aging adults (cosco et al., 2013a; teater & chonody, 2019) or the potential non-biomedical constructs of this concept (carver & buchanan, 2016). based on this limitation, many researchers have subsequently attempted to garner the views of aging adults through qualitative methods of successful aging and how it relates to their lives (see cosco et al., 2013a and teater & chonody, 2019 for a review of the literature), or through systematic reviews of the literature examining the definitions of successful aging, and have explored the underlying dimensions or themes present across the definitions (bowling & dieppe, 2005; depp & jeste, 2006; reichstadt et al., 2010; teater & chonody, 2020). findings from such studies have highlighted that aging adults do not consistently view disease and disability as unsuccessful and have identified other factors as influential on their ability to age successfully, such as external elements, including financial resources and access to medical care, psychological elements of acceptance, coping, self-determination, and resilience, and other factors such as spirituality and/or religiosity, and gerotranscendence (i.e., the natural progression towards wisdom and maturation). aging adults’ perspectives on successful aging have illustrated this concept to be multidimensional and to include both internal (bio-psychosocial-spiritual) and external (socio-political-economic) factors that move the discourse of successful aging away from individual choice and responsibility to a more comprehensive view of the person in the environment. holding fast to the three criteria as specified by rowe and kahn (1997) is discriminatory to many older adults, particularly those who live with dependency and disabilities, including age-related disabilities (carver & buchanan, 2016; martinson & berridge, 2015; teater & chonody, 2017), and can be viewed as a form of ageism where older adults are held to middle-age standards (calasanti, 2003). katz and calasanti (2015) argue if older adults are “considered unsuccessful agers in theory, then such labeling deeply affects their treatment by health care regimes in practice” (p. 29), which will be exacerbated through an intersectional lens of gender and gender identity, sexuality, race and ethnicity, and socioeconomic status. teater & chonody/reconsidering how successful aging is defined 696 social work should be included as one of the disciplines at the forefront of the debate on what successful aging means and how it is used to identify and define people. this is particularly important as the narratives around what it means to “age” and what is needed to create an environment for individuals to “age successfully” are influencing the policies and practices that affect social work with aging adults. this knowledge can shed light on how successful aging is viewed by aging adults and the ways in which this term can be used to influence social work practice. therefore, this study sought to answer the following research questions: 1. what are community-dwelling aging adults’ (aged 55+) definitions of successful aging, and what are the components that comprise such definitions? 2. to what extent do the definitions and components vary by aging adults who identify as aging successfully and those who identify as not aging successfully? methods setting and sample the above research questions were answered through data collected from a crosssectional, exploratory study using online surveys. a questionnaire consisting of open and closed-ended questions was distributed electronically through the use of amazon’s mechanical turk (mturk), which is a survey participant strategy that provides a monetary reward for the completion of surveys ($0.75). recruitment of participants was based on established study criteria as set by the researchers (e.g., age of participant; location of participant) and the prepaid sample size (n = 500). amazon recruits the participants from their pool of workers until the set sample size is achieved at which time the study closes and the data are made available to the researchers in a spss file. workers over the age of 55 and living in the united states were recruited for this study. due to limitations with the age selection of mturk, this was the “oldest” population that could be selected for recruitment. moreover, past studies indicate that this platform is likely younger overall (e.g., pew research center, 2016). the relevant institutional review board approved the study prior to data collection. the participants were presented with a cover letter at the beginning of the survey that described the purpose of the study, detailed the confidential and voluntary nature of the study, and provided the contact information for the researchers. completion of the survey served as consent for participation. instrumentation two questions from the online survey were used in this study in order to answer the research questions. first, participants were asked to indicate the extent to which they agreed with the following statement, “i have aged successfully” (1 = strongly disagree – 6 = strongly agree). second, participants were asked an open-ended question of, “what does successful aging mean to you? (please define/describe it). finally, sociodemographics were collected to provide the context of the sample, which included identified gender, race/ethnicity, age, and sexuality. advances in social work, fall 2020, 20(3) 697 data analysis a total of 500 participants were recruited for the study. after cleaning the dataset and removing cases with missing data, a total of 471 participants were included in the analysis. the quantitative data were analysed in spss using descriptive statistics where percentages, frequencies, and/or measures of central tendency were calculated for the sociodemographic variables and level of agreement for aging successfully. the qualitative data were analyzed by the first author using a summative content analysis approach where the existing words or phrases in the responses were counted and collated followed by an exploration of the latent meanings and themes across the responses (hsieh & shannon, 2005). in particular, the summative content analysis consisted of the following steps as detailed by lune and berg (2017): (1) data were collected and “organized” to be read. the data were separated by those participants who answered a level of agreement and those who answered a level of disagreement to the question “i have aged successfully,” and the list of all responses were read in full across the two groups; (2) generate initial codes –the responses were re-read and initial codes of one word or a short phrase were generated that provided a brief summary or explanation of each data extract. through this process, 1,042 initial codes were identified for the aging successfully group and 247 for the not aging successfully group with many of the initial codes being duplicates. examples of initial codes across the two groups included: avoid assisted living; mental clarity; being healthy; having goals and aspirations; mobility; and no restrictions; (3) codes are transferred into categorical labels or themes – the initial codes were reviewed and collated with similar codes into potential themes, which resulted in 47 themes for the aging successfully group and 41 themes for the not aging successfully group. examples of themes across the two groups included: adaptation; coping; being healthy; financial independence; and selfdetermination; (4) review and sort themes – in this step, all the data extracts were re-read under each theme to ensure they formed a coherent pattern. themes were refined by collating similar themes and discarding themes which did not have enough support from the data or which were too diverse. for example, themes of sharing wisdom, helping others, and adding value to others’ lives were combined into a theme of generativity, and the themes of “the term makes no sense” (n = 1), flexibility (n = 1), and longevity (n = 1) were removed from the data analysis due to low sample size. this process resulted in 14 themes being identified for the aging successfully group and 11 for the not aging successfully group; (5) isolate meaningful patterns to define and name themes – the overarching themes across the two groups were reviewed to refine the specifics of each theme and determine each theme’s place and significance in telling the overall story, which resulted in the five overarching themes and 13 sub-themes for the aging successfully group and five overarching themes and 10 sub-themes for the not aging successfully group; teater & chonody/reconsidering how successful aging is defined 698 (6) identified patterns are considered in light of previous research and theories – the findings are presented below by describing each theme and including data extracts that provide support for the theme followed by a discussion of the findings considering previous research and theories. trustworthiness of the qualitative data analysis was enhanced through the following activities: (a) dependability was enhanced by creating an audit trail of the data analysis and by using direct quotes to support identified themes; and (b) while the first author conducted the coding of the data, credibility was enhanced by participating in regular peer debriefing sessions with the second author to explore codes, themes, and the final analysis (lincoln & guba, 1985). finally, the count data for the themes and sub-themes were entered into spss and separated by those who saw themselves as aging successfully and those who did not. a series of chi-square tests of independence were run to determine any statistically significant differences between the two groups (0 = did not consider themselves as aging successfully; 1 = saw themselves as aging successfully) on the 10 identical sub-themes and one theme of financial security (0 = did not identify a theme/sub-theme; 1 = did identify a theme/subtheme). alpha was set at 0.05. findings sample demographics the participants ranged in age from 55 – 81 years with a mean of 63.5 years (sd = 4.8). the majority of the participants identified as a woman (68.6%), as white (89.7%), and as straight/heterosexual (95.9%). the participants tended to agree with the item, “i have aged successfully” (m = 4.3; sd = 1.3) with over 80% (n = 378) indicating a level of agreement and nearly 20% (n = 93) indicating a level of disagreement with this item. table 1 provides the full details of the sample demographics. definitions and components of successful aging the participants’ definitions were often multi-dimensional, comprising several elements of physical and/or mental health, social engagement and relationships, participation in activities and hobbies, financial independence, psychological aspects, and elements of independence and self-sufficiency. the following is a definition provided by a participant from the aging successfully group, “remaining active and healthy, paying attention to selfcare, being social to the extent that i want to be, continue learning new things, keeping in touch with family and friends, trying to maintain a positive outlook. keeping the mind open to new adventures.” a definition from the not aging successfully group, was “being healthy, mobile, busy, social, having enough money to be at least moderately comfortable, companionship, love, engagement”. advances in social work, fall 2020, 20(3) 699 table 1. sample sociodemographics (n = 471) variable n (%) age (n=466, mean =63.5 years, sd=4.8) identified gender woman 321 (68.6%) man 147 (31.4%) race/ethnicity african american/black 23 (4.9%) american indian/native american 1 (0.2%) asian american/asian 4 (0.9%) biracial/multiracial 4 (0.9%) chicano/mexican-american 5 (1.1%) puerto rican 1 (0.2%) white (non-hispanic) 420 (89.7%) another racial/ethnic identity 10 (2.1%) sexuality asexual 1 (0.2%) bisexual 6 (1.3%) lesbian, gay, or homosexual 11 (2.4%) straight or heterosexual 449 (95.9%) don’t know 1 (0.2%) aged successfully (mean= 4.3, sd=1.3) strongly disagree 22 (4.7%) moderately disagree 24 (5.1%) slightly disagree 47 (10.0%) slightly agree 137 (29.1%) moderately agree 165 (35.0%) strongly agree 76 (16.1%) the content analysis of the definitions resulted in the following five themes that were identified across both the aging successfully (as) and not aging successfully groups (nas): (a) health; (b) choice & ability; (c) intrinsic factors; (d) engagement; and (e) financial security. thirteen sub-themes and 10 sub-themes were identified under the first four themes for the aging successfully and not aging successfully groups respectively; financial security did not yield any sub-themes. table 2 lists the five themes and sub-themes for each group, the accompanying number of responses that were counted under each theme and sub-theme, and the percentage of each theme and sub-theme for all of the responses of the two groups. the themes and sub-themes are detailed below with direct quotes provided by the participants. teater & chonody/reconsidering how successful aging is defined 700 table 2. themes by successful aging category themes & sub-themes f (%) χ2 df p aging successfully (n = 378)* not aging successfully (n = 93)* 1. health 313 (35.3%) 82 (41.0%) being healthy (actions taken…) 154 (17.4%) 49 (24.5%) 4.34 1 0.037 good physical health (absence of…) 67 (7.5%) 15 (7.5%) 0.13 1 0.716 mentally active (presence of…) 68 (7.6%) 18 (9.0%) 0.09 1 0.760 good mental health (absence of…) 24 (2.7%) ---- 2. choice & ability 198 (22.3%) 40 (20.0%) self-determination 52 (5.9%) 10 (5.0%) 0.59 1 0.443 self-sufficiency 146 (16.5%) 30 (15.0%) 1.29 1 0.256 3. intrinsic factors 186 (21.0%) 40 (20.0%) acceptance & adaptation 51 (5.8%) 17 (8.5%) 1.36 1 0.239 existence & essence 69 (7.8%) 11 (5.5%) 2.18 1 0.139 being happy & content 48 (5.4%) 12 (6.0%) 0.003 1 0.958 optimism 18 (2.0%) ---- 4. engagement 158 (17.8%) 20 (10%) social interactions & relationships 67 (7.6%) 13 (6.5%) 0.74 1 0.389 sustain participation, curiosity, & learning 63 (7.1%) 7 (3.5%) 4.93 1 0.026 generativity 28 (3.2%) ---- 5. financial security 31 (3.5%) 18 (9.0%) 9.96 1 0.002 total number of responses across themes 886* (100%) 200* (100%) *the number of responses is greater than the sample size as participants provided more than one response as part of their answer. health over 35% of responses from the aging successfully group and 41% of responses from the not aging successfully group were related to health. the following three sub-themes were present across both groups: being healthy; good physical health; and mentally active. for some participants, being healthy consisted of statements that merely stated, “be healthy” (as) or “maintaining good health” (nas), which indicated the presence of health while other participants provided responses that indicated actions or behaviors taken by an individual to maintain good health, for example, “exercise” (as), “drink water” (as), “remain physically active” (as), “good sleep” (nas), and “watch weight” (nas). while being healthy was described as maintaining health or engaging in behaviors that can sustain health, the subtheme of good physical health was comprised of quotes that indicated the absence of health, for example, having good physical health meant having “no major health issues” (as), “without disabilities, sickness” (as), “without pain” (nas), and “no diseases” (nas), which did not seem to imply an action on the part of the participant. the sub-theme of mentally active also indicated the presence of good mental health, for example, “brain sharp” (as), “strong mind” (as), “sound mind” (as), “brain healthy” (nas), “mental clarity” (nas), and “mind in gear” (nas). for the aging successfully group, there was a fourth sub-theme of good mental health, which was described as the absence of mental health difficulties, advances in social work, fall 2020, 20(3) 701 such as “no cognitive decline” (as), “no dementia” (as), “no memory loss” (as), and “no depression” (as). choice & ability over 22% of the responses from the aging successfully group and 20% of responses from the not aging successfully group were in relation to having a choice, being able to participate in decision-making, and being able to do what one has always been able to do and/or what one wants to do. two sub-themes comprised this theme, which included self-determination and self-sufficiency. participants across both groups defined successful aging as the ability to do what one wants to do and be able to do it independently (i.e., without help) and of one’s own accord. for example, “being able to do whatever you want without having the need of assistance from someone else” (as) and “being able to do the things you have always done and/or want to do” (nas). other examples of self-determination included, “being able to do what you desire” (as) and “still be able to try to do things that matter to me” (nas). the participants who spoke about being self-sufficient provided definitions that related to taking care of oneself and also not being a burden on others. for example, “that i can pretty much continue to take care of myself, home, life, food preparation, travel and pay the bills without having to agree to live in some sort of facility. i would remain at home until i die” (as); and “able to maintain one’s daily needs and ability to keep one’s home in good shape without relying on others” (nas). intrinsic factors intrinsic factors comprised 21% of all responses from the aging successfully group and 20% of responses from the not aging successfully group, and consisted of sub-themes of acceptance & adaptation; existence & essence; and being happy & content for both groups with an additional sub-theme of optimism for the aging successfully group. the elements under this theme were in relation to psychological and/or personal factors that are intrinsic to each individual, for example, coping and having peace, having a purpose, feeling gratitude, and having a positive outlook on life. the sub-theme, acceptance & adaptation, was mentioned by participants through the importance of accepting changes that come with the aging process and making adaptations along the way. for example, “accepting the changes in my body, strength, etc. and adapting to them” (as), and “successful aging to me means the ability to give up tasks you no longer can do, and replace them with things you can do” (nas). existence & essence was comprised of responses that related to the inner being of a person that spoke to having a purpose, a sense of humor, wisdom, spirituality, and being vibrant and alive. for example, “aging with grace and dignity” (as); “striving towards enlightenment and achieving spiritual freedom” (as); “being vibrant” (nas); and “having a purpose to waking up every day” (nas). being happy & content consisted of responses that referred to having inner peace, being happy and content with life, feeling good about oneself, living in the moment, and aging the way one feels comfortable. participant responses included, “being content with that stage of my life” (nas); “having inner peace”; (as); “being happy with who you are” (as); and “just to be content and satisfied with who you are” (nas). teater & chonody/reconsidering how successful aging is defined 702 finally, optimism was a sub-theme for the aging successfully group and included elements of a positive outlook and no worries about the future. example responses included, “positive outlook on life” (as); “being able to face the remaining years with enthusiasm and optimism” (as); and “having a good, positive attitude” (as). engagement engagement comprised 17.8% of all responses from the aging successfully group and 10% of responses from the not aging successfully group, and consisted of sub-themes of social interactions & relationships and sustain participation, curiosity, & learning for both groups with an additional sub-theme of generativity for the aging successfully group. the sub-theme of social interactions & relationships related to responses around being social or socially connected, accepting help from other people, and not being lonely. for example, participants expressed, “keep trying to connect with others. belonging to groups” (as); “having satisfying relationships with others” (nas); “participating in events with my children/grandchildren, vacations, dinners, and family time” (as); and “maintaining good social connections” (nas). the sub-theme of sustain participation, curiosity, & learning was described as including elements of being involved and engaged, opportunities to participate in democracy, remaining forward thinking, and having opportunities to learn and to grow. participant comments across the two groups included, “staying active, involved, learning new things, trying new things” (as); “active, engaged, having hobbies and activities that are fun” (as); “having the ability to learn new things” (nas); and “being able to continue your favorite activities and also to find new ones” (nas). finally, the sub-theme of generativity was a sub-theme for the aging successfully group and included elements of sharing knowledge, wisdom, and perspectives, helping others, and adding value to others’ lives, and caring for others and being useful. example responses included: “able to contribute to the development of younger family members out of my experiences” (as); “sharing and teaching your wisdom and knowledge to others, no matter what age” (as); and “to continue to care for others and serve a useful purpose to society” (as). financial security over 3% of responses from the aging successfully group and 9% of responses from the not aging successfully group were related to financial security. such responses were related to having enough money to meet basic needs as well as be able to retire and participate in hobbies and activities, such as traveling. participant responses included, “retire from work because i want to instead of have to” (as); “becoming financially secure” (as); “having enough financial security to do everything” (as); “sufficient funds” (nas); and “enough money to retire” (nas). differences in components based on aging successfully or not aging successfully the responses among the two groups were similar in terms of content and underlying dimensions except for three specific sub-themes that were present in the aging successfully group that were not present in the not aging successfully group: good physical health, optimism, and generativity. when ranking the five main themes in order of most frequently mentioned, both groups mentioned aspects of health most frequently, followed by choice & advances in social work, fall 2020, 20(3) 703 ability, intrinsic factors, engagement, and financial security. as table 2 reports, a series of chi-square tests of independence found three statistically significant differences between the two groups in number of responses on the sub-themes of being healthy; sustain participation, curiosity, & learning; and financial security. in particular, participants in the not aging successfully group mentioned elements of being healthy and elements of financial security more than those in the aging successfully group, and elements of sustain participation, curiosity, & learning less than those in the aging successfully group. discussion five main themes were found to constitute the underlying dimensions of the definitions of successful aging among individuals in the aging successfully group and in the not aging successfully group. for both groups, health was mentioned most frequently, which supports the underlying premise of successful aging as proposed by rowe and kahn (1997) as well as many studies that have attempted to examine the prevalence of successful aging by using operational definitions that reflect physical and/or cognitive health (cosco et al., 2013b; pruchno et al., 2010). the second most common theme was choice & ability where participants defined successful aging as having self-determination and being self-sufficient, followed by intrinsic factors where participants viewed successful aging as a state of mind or being that allowed for peace, acceptance, resilience, and meaning. such themes reflect elements of successful aging that is beyond the scope of rowe and kahn’s framework, as found in the examination of non-biomedical constructs by carver and buchanan (2016). these themes illustrate the desire for adults to have choice and control in the aging process and use their personal strengths and resources to move through the aging process and cope and adapt to changes including disease and/or disability. engagement was the fourth most commonly mentioned theme where successful aging was viewed as being engaged in social interactions and relationships, but also participating in society, activities, and having a sense of giving back--a component found in rowe and kahn’s framework, but extended by the aging successfully group through elements of generativity. finally, financial security was mentioned as the fifth theme across both groups where having enough money and being financially secure were included as part of successful aging— a missing element from rowe and kahn’s framework, yet found in other studies examining aging adults’ subjective views of predictors of successful aging (cosco et al., 2013a; stephens et al., 2015; teater & chonody, 2019). the five themes across the definitions support previous research that found aging adults’ definitions of successful aging are more multi-dimensional than typically defined by rowe and kahn (1997) and incorporates psychological elements and external factors as important to aging successfully beyond health, functioning, and social engagement (carver & buchanan, 2016; cosco et al., 2013a; teater & chonody, 2019). future research that includes successful aging as a variable should consider an operational definition of successful aging that is multi-dimensional to take into account the subjective nature of this concept. in particular, definitions and explorations of successful aging should include aspects of health and financial security and the extent to which these are perceived to contribute to successful aging and how they can serve as protective and risk factors of successful aging. teater & chonody/reconsidering how successful aging is defined 704 additionally, any future research or considerations of successful aging should acknowledge the socially constructed and subjective nature of this concept. in particular, the ways in which people view successful aging is variable and dynamic, and the extent to which aging adults identify as successfully aging differs by the way in which they define and perceive this concept, which may shift as they age. likewise, different perceptions of successful aging may be influenced by personal experiences with aging and perceptions of one’s own internal and external strengths and resources that individuals perceive they can use and access to age in ways they deem “successful.” thus, it is important to examine the ways in which adults view successful aging, the elements they believe to contribute to successful aging, and the extent to which they are able to age successfully in a way that is comfortable and supportive to them. although there were overall similarities across the two groups in this study, some statistically significant differences were found. for example, the not aging successfully group placed more focus on being healthy and on financial security than the aging successfully group, and the aging successfully group placed more focus on sustain participation, curiosity, & learning than the not aging successfully group. such findings highlight the ways in which individuals operationalize the term dictates how they hold themselves against the elements of this definition, which, again, could be based on their personal experiences with aging and their ability to access internal and external strengths and resources. for example, if someone does not have the financial security to engage in activities they deem (or need) to help them age successfully, or access resources (e.g., healthcare) that they deem (or need) to help them age successfully, then they may view themselves as aging unsuccessfully. likewise, the aging successfully group may have greater access to external resources through their financial means and, therefore, are able to focus on other activities that elevate successful aging beyond meeting basic needs of health and financial security (e.g., participation, curiosity, and learning). future research should examine definitions of successful aging in more depth while also considering the extent to which the environment and internal and external resources contribute to the differences in definitions. the findings from this study should be considered in light of several limitations. first, the use of a convenience sample limits the transferability and generalizability of the findings beyond the sample, particularly as the sample largely identified as white, female, straight/heterosexual, and as aging successfully. people from different cultural backgrounds or racial/ethnic identities may influence either (or both) the definition of successful aging and/or the primacy of the factor. for example, financial security could be elevated for some groups due to the experience or fear of low socioeconomic status. second, the participants are classified as mturk employees as they receive small monetary awards for completion of survey tasks, which is different than holding a full or part-time job in formal employment. therefore, it is unknown the extent to which the participants engage in the surveys due to financial need or as a hobby/pleasure, nor it is known whether the participants are employed full or part-time outside of the home in addition to these small survey tasks. these characteristics should be studied in future research to determine their relevance on how successful aging may be defined by a diverse group of older adults. third, due to the nature of the online survey, the researchers were unable to undertake member checking to establish the credibility of the findings, although other activities to enhance the trustworthiness of this advances in social work, fall 2020, 20(3) 705 study were implemented. finally, the use of an open-ended item on a survey for qualitative research did not enable the researchers to explore in more depth the meanings and definitions the adults attach to successful aging. for example, there is a possibility that some respondents disagreed that they were “aging successfully” because they did not yet see themselves as in the “aging” period of their lives. future research should replicate the study with diverse populations, including those who are disabled, residing in residential care homes, and individuals who are from older age groups, to further confirm and validate the findings, and should aim to include more in-depth qualitative studies to explore adults’ perceptions, definitions, and experiences with the term of successful aging. implications for social work practice based on the findings from this study, we suggest that there is limited utility of the term “successful aging” for social work and embrace the notion that social work can help shift the narrative about the aging process. sen’s (1987) capability approach, as applied to aging by stephens (2016), suggests that the current frameworks for understanding aging have influence on policies and programs as well as how older adults view themselves. thus, there needs to be a shift in the ways in which aging successfully and the aging process is viewed that takes into account the perspectives and values of aging adults as well as the social and environmental factors that contribute to differences in perspectives, experiences, and values. using a capability approach to understand the aging process re-focuses attention on aging adults’ capabilities, instead of highlighting deficits and losses, and the extent to which they are able to function in ways that they value versus what the dominant members in society determine or value. the approach shifts the thinking from aging people remaining young and fit to acknowledging and valuing the needs of aging adults in their actual circumstances, including the ways in which the environment supports the capability of aging adults rather than expecting individuals to take personal responsibility to age successfully. applying the capability approach to aging to social work practice means social workers, as well as the profession, need to be both inclusive and expansive when thinking about aging. this is consistent with a social work perspective that values strengths. social workers who practice with aging and older adults can start making small changes, such as the language they use and the areas they focus on in their practice. for example, ensuring that as social workers, we put self-determination at the forefront of all our work with aging and older people and seek to empower and elevate their strengths first. that does not mean that we overlook problems or pretend that challenges and barriers do not exist, but we can help mobilize resources and seek to avoid practices that may infantilize or place undue pressure on aging people to be “successful” in their aging process in some unrealistic and antiquated way. moreover, policies and programs have been developed around these ideas of “successful aging” and while keeping people healthy is important, shifts in these programs to promote choice as their hallmark can further support older people as they age. this study has highlighted that indeed health is the center of aging successfully, but health is variable and will change as people age. social work should elevate aspects of selfdetermination in practice and research alongside aspects of health. this points to the importance of highlighting the ways in which current health and social service programs and policies include or exclude certain groups of aging adults in accessing healthcare and other teater & chonody/reconsidering how successful aging is defined 706 resources to promote and sustain health. social workers can be critical change agents in tackling the social and environmental factors that influence the extent to which aging adults can age successfully according to their own values and wishes. for example, when working with aging adults to foster health and well-being, we may need to begin with an understanding of their financial resources, and assessment of their perceived health, alongside their values and wishes of what is important to them as they age. lastly, advocating for policy changes that stress choice, access to financial resources and supports, but also inclusion and variations to the aging process, can have an impact on social and cultural norms. for example, if a national policy existed to support and help fund aging in place initiatives, such as age-friendly communities, choice would be given back to aging people in a significant way. wrapping services around older people instead of isolating them in far off places supports self-determination as well as health. this is problematic for social work as we want to elevate strengths and resources, not encourage competition, which then ends in “success.” practitioners can help shift the narrative through their direct contact with older adults and by influencing policy and practice within their agencies. advocacy at the state and national level for policy level change that supports new language as well as selfdetermination and capability is equally important. for example, many older people desire to “age in place,” and policy that supports this is quintessential, such as greater home care assistance instead of moving people to facilities. to replace the term “successful aging,” we instead suggest the use of the term “actively aging,” which focuses on aging adults actively choosing to define what aging means to them and challenging societal expectations of a “right” or “wrong” aging process. this is based on the world health organization’s (2002) active aging policy and the six determinants of aging (teater & chonody, 2017). the term supports a capability approach to aging. actively aging “considers the interplay between individuals’ experiences, their meanings of aging, and their social, economic, political, and cultural environment and structures” (teater & chonody, 2017, p. 142). this holistic approach considers the person in the environment, promotes selfdetermination, and looks at aging from a developmental perspective. that is, we are all in a constant state of aging. older adulthood is not a specific time period, and even if it were, individual agency should be supported. this term creates greater inclusivity as there is no bar to reach and no competition to be had; rather, it suggests that we meet the person where they are and support their lives by elevating their strengths. in this framework, the word “actively” is used to “highlight that individuals do not need to engage in activities or be physically, socially, or politically engaged, but, rather, individuals are actively choosing the extent to which they are participating in decisions about their life” (teater & chonody, 2017, p. 142). moreover, this term also supports who’s (2007) global action and strategy plan, which includes improving communities to ensure that they are age-friendly, and is underpinned by the active aging policy (who, 2002). who (2007) defined age-friendly communities as a type of community that “encourages active aging by optimizing opportunities for health, participation, and security in order to enhance quality of life as people age” (p. 1). thus, inclusivity and self-determination are at the forefront of these policy shifts—both of which are in line with social work values and ethics. advances in social work, fall 2020, 20(3) 707 references bowling, a., & dieppe, p. 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(2007). global age-friendly cities: a guide. https://www.who.int/ageing/age_friendly_cities_guide/en/ author note: address correspondence to barbra teater, department of social work, college of staten island, 2800 victory blvd., staten island, ny, 10314. email: barbra.teater@csi.cuny.edu https://www.pewresearch.org/internet/2016/07/11/turkers-in-this-canvassing-young-well-educated-and-frequent-users/ https://www.pewresearch.org/internet/2016/07/11/turkers-in-this-canvassing-young-well-educated-and-frequent-users/ https://doi.org/10.1093/geront/gnq041 https://doi.org/10.1097/jgp.0b013e3181e040bb https://doi.org/10.1126/science.278.5337.367 https://doi.org/10.1126/science.3299702 https://doi.org/10.1093/geront/37.4.433 https://doi.org/10.1080/09581596.2016.1192583 https://doi.org/10.1080/08870446.2014.904862 https://doi.org/10.1606/1044-3894.2017.98.19 https://doi.org/10.1177/0091415019871207 https://doi.org/10.1080/00981389.2020.1731049 https://www.who.int/ageing/publications/active_ageing/en/ https://www.who.int/ageing/age_friendly_cities_guide/en/ mailto:acrandel@nmu.edu pew research center. (2016, july 11). turkers in this canvassing: young, well-educated and frequent users. https://www.pewresearch.org/internet/2016/07/11/turkers-in-this-canvassing-young-well-educated-and-frequent-users/ this work is licensed under a creative commons attribution 4.0 international license. perceptions of macro social work education: an exploratory study of educators and practitioners katharine m. hill christina l. erickson linda plitt donaldson sondra j. fogel sarah m. ferguson abstract: social work graduate education is responsive to and reflective of larger environmental forces, including economic and job market trends, regulations by diverse organizations, and student interests. a national online survey of macro social work educators (n=208) and macro social work practitioners (n=383) explored their perceptions of the intersections between these forces and graduate social work education. findings indicate that while there remains a consistent level of support for and inclusion of macro social work within msw programs from both groups, macro practitioners identified a concurrent experience of negative perceptions, attitudes, and experiences toward macro social work education while in their graduate programs. we suggest that social work programs seek out opportunities to integrate macro practice content and field experiences into their curriculum, so that students can be better equipped to respond to the complex systemic challenges they will encounter while in professional practice. keywords: social work education; social work licensure; macro social work macro practice is defined as social work practice with larger systems, such as communities, human service agencies, or public policy environments. cswe indicates that the number of macro social work msw graduates (inclusive of policy, administration, and organizing) has been consistent over the past twenty years at less than 10% of all msw students (cswe, 2015b, 2016). despite this, there have been growing concerns about the decline in the number of social work students with specialized macro knowledge and skills (fisher & corciullo, 2011). in 2013, the special commission to advance macro practice was formed to give focused attention to strengthening and advancing macro practice concentrations/specializations and curricula throughout cswe-accredited programs (association for community organization and social administration [acosa] 2017). this exploratory study investigated the impact of internal and external factors on macro practice in social work graduate education as perceived by faculty and practitioners specializing in this area. social work practice and education responds to and reflects the larger social, cultural, and political environments (lein, uehara, lightfoot, lawlor, & williams, 2017). since its _________________ katharine hill, msw, mpp, phd is an associate professor at the school of social work at st. catherine university and the university of st. thomas in st. paul, mn. christina erickson, msw, phd, is an associate professor in the department of social work at augsburg college in minneapolis, mn. linda plitt donaldson, msw, phd is an associate professor at catholic university, national catholic school of social service in washington, dc. sondra fogel, msw, phd is an associate professor in the school of social work at the university of south florida in tampa, fl. sarah ferguson, ma, msw, phd is associate vice president of academic affairs and academic dean at saint mary’s university in minneapolis, mn. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 522-542, doi: 10.18060/21455 https://creativecommons.org/licenses/by/4.0/ hill et al./social work liscensure 523 very earliest roots in both charity organization societies and the settlement house movement (lubove, 1977; wenocur & reisch, 1989), social work education has been influenced by several societal factors. the first is faculty expertise and competing practice orientations such as scientific casework, group work, community organization, and policy practice. the second includes those organizations that regulate educational content and practice. the council on social work education (cswe, 2015a) commission on accreditation develops educational standards that define competent social work practice at both the undergraduate and graduate levels and administers an accreditation process to ensure compliance with those educational standards. another important influence on social work education includes state licensure standards and the association of social work boards (aswb) which develops multiple social work licensing exams to reflect various social work degrees and specializations (i.e., bsw generalist, msw generalist, msw clinical). the academic environment of social work programs, as well as students’ expectations for their social work education and professional trajectories, also play a role in the implicit activities that promote educational content. finally, third-party reimbursement and employer hiring practices shape how social work opportunities are framed in the job market. taken together, these factors influence the profession in numerous, interrelated ways. literature review in 2014, rothman and mizrahi explicitly called for rebalancing social work education and field components with macro social work content, noting a clinical content dominance in these areas. these scholars argue that despite the historical emphasis on both the individual and community, micro and macro practice, our professional code of ethics, and numerous professional organizations representing macro practice, the profession is “preponderantly weighted toward clinical practice” (p. 92). data supports this. the number of graduate social workers with a clinical license dominates the professional landscape, as approximately 93% of post-msw licensee’s hold a clinical license (donaldson, hill, ferguson, fogel, & erickson, 2014). earlier, we suggested that there are interrelated factors that have worked to create this dynamic. examples follow. faculty orientation debates about the place of macro practice in social work have been present in the literature and in the academy for decades (ezell, chernesky & healy, 2004; hill, ferguson, & erickson, 2010; miller, tice, & hall, 2008; pine & healy, 1994). in 2012, acosa commissioned a study of their academic membership to better understand the state of macro practice in social work education programs. based on this study, rothman (2012) identified a number of factors that contributed to faculty concerns about macro social work education. among those factors were: lack of faculty interest in or understanding of macro practice, the marginalization of macro courses, declining curriculum space and field placement opportunities among clinically-structured programs, students being discouraged from selecting a macro concentration, and clinical social work licensing driving curricular decisions. one respondent wrote, “[clinically-bounded] licensure is the death of macro practice and is tragic for the future of social work” (p. 9). these results suggest that advances in social work, fall 2017, 18(2) 524 graduate social work curricula may favor educational content reflective of state licensing options, even if this is an unintentional outcome (miller, deck, grise-owens, & borders, 2015). fogel and ersing (2016) note that there has been a decline in completed social work dissertations with a focus on macro practice, and suggest that this decline may be related to fewer faculty members interested in and prepared to teach this content within schools of social work, an area that warrants further study. regulatory organizations most states have laws that require that graduates of msw programs achieve stateregulated licensure in order to practice as a social worker,. for the purpose of this article, the term “license” refer to those types of licenses that are available as options for msw graduates. the universal qualifier for social work licensing in the united states is for individuals to attain a social work degree from a cswe-accredited program and pass a licensing exam. most of these state laws are modeled after the association for social work board’s (aswb) model state social work practice act (bibus & boutté-queen, 2011). various types of social work licenses are available for post-msw students depending on professional experience, interest, and state board criteria. the types of licenses available vary from state to state. in addition, states have a variety of additional requirements for the types of licensure they offer (donaldson et al., 2014). indeed, some states have moved to include specific msw curricular content for advanced clinical social work licensure. required content that some states include is related specifically to clinical diagnoses and interventions and require field placements in clinical settings where students gain experience in clinical diagnosis and methods of treatment and intervention (donaldson et al., 2014). as state board requirements have become more specific, some schools have moved to ensure that their students, who will need the licensing credential to practice, have the requisite clinical coursework during their msw program (miller et al., 2015). thus, curricula have shifted in response to state board requirements, which in turn, are responding to workforce trends and/or legislative requirements. state board mandates for these additional requirements vary from state to state, limiting social workers’ ability to move among states and qualify for the same license. for example, a social worker may be licensed as a clinical social worker in one state but may be ineligible in the next state due to these expanded curriculum requirements, even though the student has passed the clinical exam and graduated. scholars have raised questions about the fit between content covered in licensure exams and content that is taught as part of the msw curriculum (black & whelley, 1999; cherry, rothman, & skolnik, 1989; strom & gingerich, 1993). biggerstaff (2000) identified multiple concerns with increased public regulation of social work practice, including the limitation of practice to “…certain theoretical and practice perspectives…” (p. 112) which are included in the statutory language, as well as the possibility that statutory language may limit the scope of practice, to the deficit of “…practice, future technological development and knowledge expansion…” (p. 111). there seems to be consensus that licensing requirements do, in fact, influence both social work practice and social work education (boutté-queen, 2003; cherry et al., 1989; ezell et al., 2004; strom & gingerich, 1993; wermeling, hunn, & mclendon, 2013). however, there is scant literature about how schools of social work hill et al./social work liscensure 525 specifically implement and infuse curricula content to help students pass licensing exams (miller, grise-owens, & esobar-ratliff, 2015). furthermore, the relationship between cswe competencies/practice behaviors and the content on social work licensure exams has not yet been examined. student expectations ezell and colleagues (2004) identified a number of challenges within social work education impacting student expectations after graduation including those in the implicit environment such as reports of social pressure from other students to select a clinical concentration, and negative attitudes among both students and faculty about macro practice and employability. rothman (2012) identified similar challenges including a lack of interest from faculty in schools of social work regarding macro practice, shrinking faculty numbers in macro concentrations, and social work curriculums that were overwhelmingly focused on clinical practice. difficulties with providing field practicum experiences for macro social work students have also been identified, such as a smaller number of placement opportunities and a lack of supervision for students in these types of placements (mor barak, travis, & bess, 2004). challenges to student expectations regarding selecting a macro concentration that are external to social work graduate programs include opportunities for professional identity development and identification of macro social workers as field instructors and mentors (hill et al., 2010; lightfoot, nienow, moua, colburn, & petri, 2016). when community practice social workers do not identify themselves professionally as social workers, the field loses role models and representation, both for other social workers and to other professions. additionally, social workers who practice with larger systems are not always supported or well-represented within the profession (moore & johnston, 2002; weiss, 2003, 2006). for example, many positions that macro practice graduates may compete for, may not be identified as “social work” positions in the job title, description, or requirements. while social workers’ knowledge, skills, and abilities may be an excellent fit for these positions, the positions may not be identified as specifically for social workers (pritzker & applewhite, 2015). employment opportunities are also part of the context for current social workers and students. market forces such as employment trends and third-party reimbursements as well as social trends and public policies have moved much of the profession towards a more clinical and micro direct-practice focus (gibelman, 1999; schneider & netting, 1999; specht & courtney, 1994). recent research suggests that graduate students are interested in obtaining their clinical social work license in order to increase their job opportunities and be recognized as a professional with specialized skills (miller, grise-owens et al., 2015). licensing implies that in order to have the “right to practice” (kleiner & krueger, 2008, p. 1), it is necessary for individuals to have specific expertise. thus, having a license indicates that the field has a “…specific skill applied to a specific function” (lubove, 1977, p. 23). as shown, there are many interrelated factors that influence content in social work education. as reisch (2015) indicates, given the new sense of “urgency” regarding the advances in social work, fall 2017, 18(2) 526 plethora of social and global problems and the cultural divide (p. 2), the need for macro practice “has become increasingly apparent” (p. 3). the authors of this study sought to learn from macro practitioners and faculty about their experiences of macro social work education within schools of social work, the barriers and supports for a macro specialization, as well as the effect of external factors such as employment trends, public perceptions, and state licensing on this content area in social work curricula. method funded by a two-year grant from the new york community trust, this study draws from data collected as part of a larger exploratory study on licensing and graduate education in social work (donaldson, fogel, hill, erickson, & ferguson, 2016). a survey research design was used to collect both open and closed-ended responses from two distinct groups—faculty who teach macro courses in accredited social work programs (e.g., social policy, community organizing, international social development, nonprofit administration, etc.) and self-identified social work macro practitioners. human subjects review and approval was obtained through the institutional review board of the catholic university of america. using a subset of the data collected in the larger project, this study explored following research questions: 1. what are the perceptions of macro practitioners and faculty of macro social work education? 2. what do macro faculty and practitioners identify as the internal and external influences on macro social work education? sample macro practitioner respondents. identifying macro social workers can be difficult. our first plan, to identify individuals through their licensure status (i.e., those with an advanced macro license) proved to be unsuccessful for several reasons. first, only three states offered an advanced macro license (donaldson et al., 2014). second, our collective professional knowledge told us that many macro social workers do not have an advanced license, and if they do, it is typically an advanced generalist license, not a macro license. finally, many of the lists of licensed social workers did not differentiate among licensee types nor did they include e-mail information. as an alternative, we ordered lists of social workers from the two state licensing boards (district of columbia and minnesota) that captured e-mail addresses and also differentiated between licensees. neither of these offer an advanced macro license; rather, both areas offer an advanced generalist license (an lisw) as well as an advanced clinical license (licsw). to supplement the list, we used a snowball sampling method to connect with macro social workers across the u.s., requesting they send out the survey via email to others. we also used snowball sampling methods to locate macro social workers without licenses, and posted notices on facebook, linkedin and other social media sites and listservs inviting participation in the survey. in addition, we culled the contact information from the macro practitioners in the membership lists of acosa, the network for social hill et al./social work liscensure 527 work management, and the social welfare action alliance. this approach yielded 383 respondents. in order to identify their expertise in macro social work, practitioner respondents were provided with an overview and definition of macro social work practice, and then asked if they identified as macro social workers. if they self-identified their primary professional interest in one of these areas, they were asked to complete the survey. faculty respondents. for our initial attempt to recruit a geographically diverse faculty sampling frame, we organized the list of cswe-accredited schools by census region and randomly selected 15 schools from each of the four regions. through online research and phone calls, we identified the faculty in those programs who taught macro courses, and gathered their contact information. in order to identify their expertise in macro social work, faculty respondents were provided with an overview and definition of macro social work practice, and then asked if they identified as macro social work faculty. those who self-identified their primary academic interest in one of these areas were invited to complete the survey. because response rates from this first random sample were too low to be meaningful, we instituted a snowball sampling approach to increase participation. we sent the survey out through the msw education listserv to macro faculty colleagues and invited colleagues to forward it to other macro faculty. additional sources we used included membership lists of the three primary macro-oriented social work associations: acosa, nswm, and swaa. these efforts increased the number of respondents to 208 educators. survey instrument the surveys were developed and distributed using qualtrics, an online survey tool. the instrument development grew from a review of existing literature and from the authors’ experiences as social work practitioners and academics. the faculty survey was pilot-tested with three faculty from cswe-accredited msw programs, and the practitioner survey was pilottested with four macro social work practitioners. the final surveys were made available in november 2012, and remained open until may of 2013. the faculty survey consisted of four sections: 1) msw program information, 2) barriers for student selection of macro concentration; 3) faculty attitudes toward licensing, and 4) faculty demographics. this article presents data from sections 1, 2, and 4; data from section 3 were discussed in previous publications. section one included seven questions about the macro components of their msw program, e.g., whether or not they offered a macro concentration, average student enrollment in concentration, and whether the concentration is growing, stable, or declining. section two included four questions related to faculty perceptions of student experiences in the msw program, particularly as it related to selecting a macro concentration. this section included a list of items which respondents were asked to rank as barriers, from 0 (not at all important) to 100 (extremely important), in selecting a macro concentration or program. barriers included licensing considerations, advice from peers, or the number of field placements available. section 4 included seven demographic items (e.g., position, number of years at institution, age, gender, race). the macro practitioner survey had five sections: 1) attitudes toward licensing, 2) licensure pursuit path, 3) experience in their msw program, 4) professional macro practice and social work identity, and 5) demographics. this article presents findings from the third advances in social work, fall 2017, 18(2) 528 and fifth sections. section three included four questions related to the practitioner’s experience in their msw program as a macro student: 1) did the program have a macrofocused concentration, 2) did the respondent choose the macro concentration, 3) six items related to school climate toward macro to which they responded yes or no (e.g., did they feel supported as a macro student, did they feel pressured to reconsider their choice in macro, did macro seem as important as micro practice, whether or not there was an emphasis on clinical social work), and 4) an open-ended question giving respondents an opportunity to share more about their msw experiences. data analysis the survey results for faculty and practitioners were analyzed separately. simple descriptive statistics, using spss software, were used for the quantitative data. for the open-ended responses, we followed the same approach that we had used in our larger study (donaldson et al., 2016), pairing the open-ended responses with the closed-ended questions that immediately preceded them. in both surveys, the open-ended questions included in this analysis follow multiple closed-ended questions, and provide respondents with the opportunity to expand upon their responses. for example, in the faculty survey, the first open-ended question asks respondents to identify possible reasons for enrollment changes in their macro programs. this question follows five closed-ended questions about the history and health of macro social work education in their msw program. thus we chose to view the responses to the open-ended questions as a continuation of respondents’ answers to the close-ended questions that immediately preceded them. findings while exploratory, the findings of this study provide some insight into the state of the macro specialization in social work educational programs, faculty’s perceptions of student’s attitudes towards macro concentrations, and current practitioner’s perceptions of their own macro practice education. this information provides some insight into how the social, cultural, and political contexts may be influencing macro social work practice. participant demographics table 1 presents the demographic characteristics of the faculty and practitioner respondents. fifty-one percent (n=70) of faculty and 57.6% (n=175) of practitioners reported having an advanced level social work license. of those who had a license, 71% (n=34) of faculty and 22.4% (n=39) of practitioners reported having a clinical license, 21% (n=10) of faculty and 63.8% (n=111) of practitioners had an advanced generalist license, and 8% (n=4) of faculty and 13.8% (n=24) of practitioners reported having a macro license. hill et al./social work liscensure 529 table 1. respondent demographics faculty (n=208) practitioners (n=383) n x̄ n x̄ average age 91 53 172 46 average years in social work 138 27.6 290 16 average years at current institution 138 12.7 -- avg. years in macro social work --138 11 n % n % graduate level license --212 68.2 advanced level license 70 51 175 57.6 advanced clinical license 34 71* 39 22.4** advanced generalist license 10 21* 111 63.8** advanced macro license 4 8* 24 13.8** *this is the percentage of the 48 faculty respondents who provided this information. ** this is the percentage of the 174 practitioners who provided this information faculty reports of availability of graduate macro content in their program fifty-seven percent (n=119) of faculty respondents indicated that a macro concentration was currently available in their msw program, and that their macro concentrations included content on administration and management (32.1%), community organization (25.8%), policy practice (20.6%), international social development (6.7%), and ‘other’ areas (5.7%), which included social enterprise administration, planning, organizational development, and organizational change. of the faculty respondents who were employed in social work programs that did not currently include a macro concentration, 70% (n=38) indicated that there was not currently any interest in creating a new concentration focused on macro practice. among faculty teaching in msw programs that currently have macro concentrations, 81 faculty members responded to the question about whether or not their programs were growing, stable, or declining. slightly more than half (52%, n=42) of the 81 respondents indicated that enrollment in their macro concentration was stable, while 23% (n=19) indicated that enrollment was growing and the same number (23%, n=19) that it was declining. respondents pointed to marketing efforts that began with entering msw students, flexible and diverse program options (including online msw programs with a macro focus), and specialized concentrations (for example, human resources, public and nonprofit management, and social, economic, or international development) within the macro curriculum as key components to their programs’ growth. several respondents from all kinds of programs (growing/declining/stable) also mentioned the impact of dual degree programs, such as msw/mph or msw/mpa, on their msw macro concentrations. a few of the respondents saw the dual degrees as detracting from the macro concentrations; others saw them as an area of strength for their programs. for programs that are declining in enrollment, open-ended responses referred to the impact of clinical licensure on curbing students’ interest in macro education. comments included “faculty are advising students that a clinical license will be critical for employment, even if the student aspires to a macro career” and “students seem very advances in social work, fall 2017, 18(2) 530 concerned about being able to get their license with an administration concentration.” respondents also discussed market forces, lack of faculty trained in macro practice, lack of field placements with “…msw agency supervision”, limited employment opportunities for macro practitioners, and “school’s ambivalence” about a macro focus. several respondents also indicated that macro faculty were retiring from their schools and were not being replaced. faculty perceptions of student attitudes toward macro practice education faculty who indicated that their msw programs included a macro concentration (n=119) were asked to rate statements about their perceptions of the importance of various factors in students’ selection of an area of emphasis in their msw concentration—either clinical or macro. each statement had a scale of 0 (not important) to 100 (very important). of the 119 faculty who indicated that their msw programs included a macro concentration, 109 completed the scale items. table 2. faculty perceptions of reasons students do not select macro concentration n x̄ σ perceptions that there are fewer jobs available for macro social workers 74 72.1 28.23 advice from peers to select a clinical concentration 74 70.7 26.59 licensing considerations 73 68.0 28.00 advice from faculty to select a clinical concentration 72 63.2 30.70 confusion about what macro social work is 71 59.9 23.23 perception that clinical social work is more lucrative than macro social work 70 59.0 31.83 advice from foundation year field instructors to select a clinical concentration 70 54.9 30.71 lack of role models 71 46.9 27.81 fewer course options/electives in macro concentration 69 45.3 27.42 don’t see a need for additional training in macro practice 68 43.9 27.62 fewer field placement options in macro concentration 66 37.0 27.96 as presented in table 2, the highest rated factors for student selection of concentrations included “perception that there are fewer jobs available for macro social workers” (�̅�𝓍= 72.1), “advice from peers to select a clinical concentration” (�̅�𝓍=70.7), and “licensing considerations” (�̅�𝓍= 68). the lowest rated factors were “fewer field placement options in macro concentration” (�̅�𝓍=37.0) and “don’t see a need for additional training in macro practice” (�̅�𝓍=43.9). although the standard deviations are fairly large, they do not change the overall interpretation of the responses. for example, for the first choice, “perception that there are fewer jobs available for macro social workers,” the standard deviation was 28.23. this is a fairly wide range of responses; however, within one standard deviation, they are all still positive (i.e., higher than 50, the midpoint of the scale), indicating that although there was a wide range of responses, 68% of faculty agreed with the statement (monette, sullivan, dejong, & hilton, 2014). hill et al./social work liscensure 531 following their responses to the scale questions, over half of the respondents (n=50 of n=77) provided an additional narrative comments. several themes emerged from these responses including a lack of “role models” or examples of macro social workers, students coming into msw programs with a clear clinical goal already determined, the mechanics of curriculum (i.e., selecting courses or tracks early in a program, the inability to move between or among concentrations, and/or the lack of macro content in the early parts of the msw curriculum), and a perception that there are not adequate jobs for macro social workers. for example, one respondent stated, “if macro concepts are not interwoven with theory and practice; how will students understand what macro social work is or how it ‘looks’ in the real world. similarly, how many faculty are involved in macro-level activities as part of their professional identities and how are they bringing it to their students? this isn't just about licensure. it's about us!” another faculty respondent identified licensing concerns for many students, stating, “desire to be a therapist rather than a social worker. fear of not getting enough content in mental health diagnoses to pass licensing exams. some states only license clinical social work.” another theme that emerged was concern that there is a divide in social work education and practice around macro vs. micro practice. for example, one respondent stated: “first – ‘macro’ practice does not exist. we do ourselves a great disservice when we use a term that really has no meaning and just serves to further bifurcate us.” another stated, “my real concern is that we have a clinical/macro split. we need to integrate the theoretical underpinnings of our profession. this will involve supporting the overall consciousness development of social workers.” faculty perceptions of program attitudes about macro curriculum faculty respondents reflected on their msw program’s unconscious or conscious bias or preference for clinical or macro social work practice in its curriculum and approach. a five-item likert-type scale was used, with responses ranging from 1 (strongly disagree) to 5 (strongly agree). the research team used spss to assess the reliability of the scale using cronbach’s alpha procedure for inter-item consistency. in doing so, the calculated cronbach’s alpha score came to .83; an alpha of .6 or higher demonstrates scale reliability (devellis, 2003). faculty reported that students felt supported in their msw macro concentration (59% agreed or strongly agreed with this statement). they were almost evenly split (41% strongly disagreed or disagreed; 45% agreed or strongly agreed) with the statement that students understood that macro social work practice is just as important as micro practice. however, faculty also supported (88% agreed or strongly agreed) the statement that the majority of msw students in their programs were interested in clinical practice, and 59% agreed or strongly agreed with the statement that students felt there was an emphasis on clinical social work practice (see table 3). advances in social work, fall 2017, 18(2) 532 table 3. faculty perceptions of student attitudes towards macro concentrations strongly disagree disagree neither agree nor disagree agree strongly agree scale item n (%) n (%) n (%) n (%) n (%) students feel that our msw program is supportive of those who pursue a macro concentration 3 (3.9) 18 (23.4) 13 (16.9) 25 (32.5) 18 (23.4) in our program, students understand that macro social work is just as important as micro (clinical or direct) social work practice 3 (3.9) 29 (37.7) 10 (13) 22 (28.6) 13 (16.9) in our program, students understand that clinical social work is more complex and needs more training than macro social work practice. 6 (7.9) 27 (35.5) 23 (30.3) 17 (22.4) 3 (3.9) the majority of the students in our program are interested in clinical social work. 2 (2.6) 3 (3.9) 5 (6.5) 23 (29.9) 44 (57.1) students report that they feel there is an emphasis on clinical social work in our program. 1 (1.3) 14 (18.2) 16 (20.8) 24 (31.2) 22 (28.6) table 4. macro practitioner experiences in their msw program* strongly disagree disagree neither agree nor disagree agree strongly agree scale item n (%) n (%) n (%) n (%) n (%) my program was supportive of students who pursued a macro concentration. 5 (2.6) 10 (5.2) 14 (7.3) 71 (37) 92 (47.9) i felt pressure from faculty or staff to reconsider my choice of a macro concentration. 91 (47.9) 69 (36.3) 14 (7.4) 11 (5.8) 5 (2.6) no one ever questioned my decision to pursue a macro concentration. 9 (4.7) 35 (18.4) 12 (6.3) 53 (27.9) 81 (42.6) in my program, i felt that macro social work practice was just as important as micro social work practice. 19 (10) 49 (25.8) 17 (8.9) 44 (23.2) 61 (32.1) the majority of the students in my program are interested in clinical social work. 11 (5.8) 11 (5.8) 13 (6.8) 51 (26.8) 104 (54.7) there was an emphasis on clinical social work in my program. 12 (6.3) 23 (12.1) 44 (23.2) 63 (33.2) 48 (25.3) *note: n’s vary due to variability in the number of responses to each item. hill et al./social work liscensure 533 practitioners’ recall of attitudes about macro education of 311 practitioners who responded to the items in this scale, 84% (n=249) indicated that their msw programs offered a macro-focused concentration and 78% (n=194) indicated that they selected this concentration as their area of study. to assess their experience in their programs as macro students, researchers included a 6-item scale (see table 4). using spss, the research team calculated a cronbach’s alpha value of .82 for this scale. when asked about their experiences as macro students in their msw programs, practitioners reported that they felt supported within their programs (85% either ‘agreed’ or ‘strongly agreed’ with this statement), and 71% agreed or strongly agreed that their decision to focus on macro social work practice was not questioned in their program. however, a smaller majority (55%) agreed with the statement that macro social work was seen as equivalently important to micro social work, and 58% felt that there was an emphasis on clinical social work in their programs. finally, eighty-two percent of respondents said the majority of students in their msw programs were, indeed, focused on micro or clinical social work practice. practitioner recollection of msw program bias and support narrative comments from practitioners reflected their varied experiences as macro concentration students. the majority were positive about their educational experience, with respondents mentioning “dedicated faculty” and a “committed cohort of other students” as key factors. respondents also pointed to prior work experience as a reason for pursuing a macro concentration, and many indicated intentionally selecting programs that had a specialty in a specific area of macro practice such as administration, policy, or community organization. challenges identified by practitioners mirrored faculty’s responses. they pointed to issues with finding field placements, accessing resources within their school including electives, and difficulties in finding macro employment after graduation. for example, one respondent stated, “the macro faculty was very supportive, but the program was given less emphasis and seemed like an afterthought.” another said: “the program itself was supportive, but in general macro students had less of a network, less access to professional resources, and fewer options for field placements with macro msws for supervisors.” another theme that emerged was students taking courses outside of a social work program in order to access macro coursework. one respondent said: 75% of my classes were clinical students, there were very few macro field placement options, and macro concentration classes were limited, so i sought macro classes from the public policy school. my professors were very supportive of macro practice and studies, but the infrastructure did not encourage the macro path. similarly, another respondent commented: advances in social work, fall 2017, 18(2) 534 it was a legitimized program, but in order to get what i wanted i took as many classes as i could in other departments like policy development and urban planning. the school did not see community organizing as a professional endeavor. finally, many respondents talked about feeling isolated or separated from a professional identity as social workers. for example, one respondent said: “although my cohort believed in the importance of macro level social work, we acknowledged that non-macro level students sometimes did not completely think that what we were doing was legitimate social work.” another said: “the teachers…never discouraged anyone from pursuing macro work but it was also clear that they considered macro level work to be, somehow, separate from the rest of the profession.” thus, although macro social work may have been part of the social work curriculum, some survey respondents did not feel integrated or connected with social work practice or its public mission. discussion this exploratory study found that both macro practitioners and faculty reported a solid level of support for the inclusion of macro education in graduate social work programs. faculty respondents reported experiencing strong support for macro-oriented curriculum, and approximately half reported that their macro concentrations were growing or stable. however, along with this perception of support, both faculty and practitioners also reported experiencing negative perceptions, attitudes, and experiences toward macro social work education in their msw programs. examples of barriers or challenges to macro education in their msw programs included challenges in finding field placements that included a macro perspective, a lack of larger institutional support, and/or competition for relatively scarce resources with other concentrations, and students’ concerns about employability as barriers to macro-focused msw education. finally, both the practitioners and the faculty reported that macro-oriented students were a minority in their msw programs, regardless of the health of the macro concentration. practitioners reported that despite feeling support from faculty members for their area of focus, factors external to the curriculum of their msw program, such as difficulty in finding macro-oriented field placements, institutional support for the concentration, and concerns about finding a job, challenged them in their macro educational experiences. both practitioners and faculty remarked on the smaller numbers of macro-oriented students compared with the number of clinical students, and the impact this had both on students’ experiences and on levels and quality of institutional support for macro students. several also remarked that they had to go outside of the social work curriculum to access appropriate or adequate macro content, and many identified a sense of professional isolation from their more clinically-oriented classmates. external influences on social work curriculum the findings from this study support previous work that showed that there are factors external to the social work curriculum that impact macro social work education (donaldson et al., 2014; netting et al., 2016; pritzker & applewhite, 2015; reisch, 2015; rothman, hill et al./social work liscensure 535 2012). these factors may include institutional demands within social work education, social work licensure, marketplace and professional demands, and macro social work identity development. msw programs are not immune to the challenges faced by institutions of higher education, such as enrollment, rising costs, and competing programs and opportunities. all of these concerns were reflected in our respondents’ answers to the survey questions. for example, some faculty indicated that macro faculty positions were not filled upon retirement, or that there was a lack of access to institutional and community resources for macro faculty and students. factors cited in previous research for the decline in macro social work enrollment and interest include a lack of support among other students, practicing social workers, and in some cases, field educators and faculty, for the pursuit of a macro concentration (ezell et al., 2004), competition for field placements (mor barak et al., 2004; rothman, 2012), and a belief that micro expertise should precede macro practice (zippay & demone, 2011). reported or perceived declines in students’ interest in pursuing macro practice in social work may also be related to competition with other master’s degrees in management, law, public health, or public policy (ezell et al., 2004; miller, hopkins, & greif, 2008). concerns about the requirements and expectations of clinical licensure were mentioned by both faculty and practitioners in their survey responses, most typically in conjunction with concerns about employability of social workers without a clinical license. contrary to the findings in some previous research, cswe (2015b, 2016) data indicates that the proportion of macro social work graduates has remained stable over the past two decades. msws with a clinical license dominate the professional landscape (donaldson et al., 2014). although the variability in state licensing options and subsequent requirements influence this number (some states only offer a clinical license; donaldson et al., 2014), the high rate of clinical licensure along with the movement of more proscriptive clinical content in social work courses raises questions as to whether licensing requirements influence social work curriculum, student choices, and perceived identity of graduate students. our results also indicate that there is concern about employment opportunities for macro-focused social workers, beyond worries about employability without a clinical license. starr, mizrahi, and gurzinksy (1999) posited that students believe that a macro emphasis may be detrimental to their employment possibilities; our survey findings show that these perceptions about employment persist. social workers who practice with larger systems are not always identified or well-represented within the profession (lightfoot et al., 2016; moore & johnston, 2002; weiss, 2003, 2006), which can also lead to a lack of mentors and role models for new social workers, as well as a loss of the public identity of social workers as social change agents. rothman (2012) reports that because licensing is geared toward clinical social work, “macro students feel that their employment options will be constrained because they will not be qualified to work in the much larger clinical arena if they are not able to get macro jobs or if they want to switch emphases” (p. 9). in contrast, pritzker and applewhite (2015) found that macro social work graduates were able to successfully compete for administrative and policy positions with graduates from other related disciplines (for example, law, public administration, or public health) advances in social work, fall 2017, 18(2) 536 and that macro graduates reported higher salaries than the national average for all social workers. thus, it is not evident that the demand for macro social workers is in fact weaker than for other types of social work practitioners. this leads us to wonder what other factors are shaping student, faculty, and practitioner perceptions -including those cited by rothman (2012), such as challenges in finding field placements, an emphasis on clinical practice within schools of social work, and licensure requirements. these are all areas in which we encourage further investigation and inquiry. both faculty and practitioner respondents reported that macro-oriented social workers often experience a sense of isolation from the larger social work profession and within the academy, both while they are pursuing their degrees and in the field. in addition to comparatively low enrollment numbers and licensure concerns, a lack of role models in practice settings and field placements contribute to this sense of isolation and are concerns in the education of macro social work practitioners (mor barak et al., 2004; rothman, 2012). field education plays a critical role in orienting msw students to various roles and opportunities in practice. mizrahi and dodd (2013) echo other researchers’ calls for an increase in field placements that provide opportunities to “...fulfill the mission of social work in the real world” (p. 595). they go on to note that field experiences are among the most critical elements in shaping social work identity, a belief that is repeated in much of the literature (mor barak et al., 2004; zippay & demone, 2011). indeed, han and chow (2010) found that students who participated in macro level field placements in their second year of their msw program were more likely to embrace a social-structural perspective of change. macro field opportunities would allow new macro practitioners to practice the social work competencies identified by cswe (2015a), as well as provide them with role models and mentors as they move into practice in an increasingly complex professional sphere. thus, the continuing issues in finding macro social work field placements have implications for educating the skilled social workers who are needed to respond to the demands of the social environment (reisch, 2015). macro social workers’ identity development there is an ongoing need for macro social workers to develop a sense of professional identity and connection with the profession in order for this area of practice and education to thrive (hill et al., 2010; lightfoot et al., 2016). some of our participants pointed out that many of the employment opportunities for macro social workers do not specifically require a social work degree or a social work license. indeed, many people with an msw may be working as analysts, researchers, or administrators, and may not be calling themselves social workers. this lack of public identification as a social worker disadvantages the profession in that it: a) lowers the visibility and perception of social workers as a good fit for this type of work, b) disadvantages new practitioners and students as they do not see role models and mentors in the profession in the same way that micro social workers do, and c) handicaps social work educators because it makes finding and sustaining field placements and other ‘real world’ learning opportunities particularly difficult. hill et al./social work liscensure 537 given the disadvantages stemming from the lack of public identification of macro practitioners, there are several easy strategies that can be used to promote macro social work. faculty who teach macro social work can urge graduating students to continue to make their social work identity visible in workplaces and other settings to help broaden the perception of social workers as community organizers, policy analysts, program administrators, and other macro change agents. in addition, promoting macro social work associations (hill et al., 2010), macro social work conferences and professional development opportunities specific to macro social work might assist macro practitioners see the value of social work-connected training and networking. professional social work associations, like nasw, must be prepared to respond to this demand as they have a role in shaping the public perception of social work. finally, many states link title protection for social workers to licensing status rather than degree earned. as mentioned above, few states offer an advanced macro license and most macro employment opportunities do not require licensure. as a result, the title protection laws may discourage macro social workers from pro-actively identifying as social workers to remain compliant with state laws about who can call her/himself a social worker. therefore, modifying state laws to link title protection to professional degree rather than license may open the door for macro social workers who are not licensed to reclaim their identity as social workers. study limitations the sampling approach was taken to reach as wide an audience as possible via an online survey. however, due to the wide range of diversity in social work licensing in the u.s., finding universally accepted language regarding state licensing requirements was a barrier. for example, exams do not include a macro option, but many practitioners mistake the advanced generalist exam and title for a macro exam and credential. state agencies who provide the licensing also vary between states. there are also, anecdotally, many macro practitioners who no longer identify as social workers, and locating them was difficult. concern about macro social work education and practice has implications for international social work. macro social work practice is essential in international contexts where social workers are engaged in infrastructure development, capacity building, peace building, and human rights practice. nevertheless, this manuscript remains largely focused on the u.s. context and we recognize that additional work is needed to further understand the impact of macro social work education on the preparation of social workers for international practice contexts. for reasons unknown to us, not all participants completed the entire survey. this is common in survey research, but, at times, these omissions made it difficult to draw conclusions in our understanding of the issues. additionally, future researchers would be well-served to explore in more detail the impact of the faculty role whether full or parttimeon their perceptions and experiences of the macro social work curriculum. finally, the intent and design of this study was exploratory; it was not intended to demonstrate causality or yield broadly generalizable findings (monette et al., 2014). instead, the researchers’ intent was to further explore the perceptions of both faculty and practitioners about the intersections of the social work environment (including, but not limited to advances in social work, fall 2017, 18(2) 538 licensure, professional regulation, identity, academic experience and institutional support) and social work graduate education for macro practitioners. conclusion social work’s professional identity and theoretical perspectives are rooted in “…a dual focus on individual and social change both in the united states and internationally” (mizrahi & dodd, 2013, p. 580). however, given the increasing emphasis on clinical interventions, the question arises as to whether social work education, as it currently stands, is imparting the full mission of social work as it is historically defined (d’aprix, dunlap, abel, & edwards, 2004). or, are social work programs being unduly influenced by social forces that have caused a slow but growing emphasis on clinical social work? reisch (2015) calls for a reintegration and refocus on macro practice in social work, in order to respond to the increasing need to honor our “…commitment to social justice and human dignity” (p.14). in our current social and political environments, there is clearly a need for social workers who are thinking, planning, and acting to address large system challenges. evidence of strengthening and advancing macro practice in msw programs would be program efforts to redress many of the imbalances described in this study. this includes offering a range of macro field placements and electives for macro students; ensuring that faculty who teach macro practice courses are experienced in those areas; creating a program culture where all forms of social work practice are equally valued; educating parttime faculty and field instructors about the importance and value of macro practice; and ensuring that generalist social work education includes equal educational and field experiences in micro, mezzo, and macro practice. cswe has affirmed the special commission goal to have 20% of social work students across the country enrolled in macro concentrations by the year 2020, otherwise known as 20 by 2020 (special commission to advance macro practice in social work, 2017). the challenge is to implement this goal in schools of social work. while attempting to strengthen the macro practice areas of social work education, one must be cautious about contributing to the bifurcation of the profession, and the micromacro divide expressed by some of the participants in this study. efforts by the special commission to advance macro practice and others who have been concerned about the erosion of macro curricula and specializations in social work programs seek to ensure that all social workers are prepared to engage in the full range of practice in which our profession is historically grounded and remains contemporarily mandated through the nasw (2017) code of ethics. at the same time, social work programs must provide specialized educational options for social work students who desire to work full-time in policy practice, community practice, administration, or international social development. the complexity of issues that social work clients face locally, nationally, and globally compel us to echo these calls for a refocus on the integration of macro practice content and the strengthening of macro practice specializations. it also challenges our colleagues to continue to wrestle with the questions and concerns raised in this study and in previous literature regarding the importance of macro practice skills and knowledge for social work practice. hill et al./social work liscensure 539 as we enter an era where the basic protections of human rights (e.g., health care, voting, access to free public education, freedom from discrimination) and protections to the environment are being eroded, the social work profession’s presence as community organizers and policy practitioners is urgent. in fact, addressing these challenges provide an opportunity for micro and macro social workers to work together to forge new partnerships so that the profession can provide bold leadership at national, state, and local levels. we are a profession that is rooted in the person-in-environment and have a range of models and frameworks that address the multi-systems challenges our clients, customers, and consumers are facing today. social work, united by our values and code of ethics, must be an integral part of dismantling systems of oppression and building environments that lift up the dignity of all people and help reweave the fabric of our communities. references association for community organization and social administration. 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(1999). influencing state policy in a time of devolution: upholding social work’s great tradition. social work, 44(4), 349-357. doi: https://doi.org/10.1093/sw/44.4.349 specht, h., & courtney, m. (1994). unfaithful angels: how social work has abandoned its mission. new york, ny: free press. special commission to advance macro practice in social work (2017). it’s time macro matters! retrieved from https://www.acosa.org/joomla/special-commission-resources starr, r., mizrahi, t., & gurzinsky, e. (1999). where have all the organizers gone? the career paths of community organizing social work alumni. journal of community practice, 63(3), 23-48. doi: https://doi.org/10.1300/j125v06n03_02 strom, k., & gingerich, w. (1993). educating students for the new market realities. journal of social work education, 29(1), 78-87. weiss, i. (2003). social work students and social change: on the link between views on poverty, social work goals, and policy practice. international journal of social welfare, 12(2), 132-141. doi: https://doi.org/10.1111/1468-2397.00251 weiss, i. (2006). modes of practice and the dual mission of social work. journal of social service research, 32(3), 135-151. doi: https://doi.org/10.1300/j079v32n03_08 wenocur, s., & reisch, m. (1989). from charity to enterprise: the development of american social work in a market economy. university of chicago press: chicago and urbana, il. wermeling, l., hunn, v., & mclendon, t. (2013). social work education’s effect on retention. journal of social work education, 49(2), 222-234. zippay, a., & demone, h. (2011). initial macro-level job responsibilities among msw graduates. administration in social work, 35(4), 412-424. doi: https://doi.org/10.1080/03643107.2011.599301 author note: address correspondence to: katharine hill, phd st. catherine university and university of st. thomas school of social work, 2115 summit avenue, scb #201, st. paul, mn 55105. katharine.hill@stthomas.edu acknowledgements: the authors wish to acknowledge the support of the new york community trust for this project. https://doi.org/10.1093/sw/44.4.349 https://www.acosa.org/joomla/special-commission-resources https://doi.org/10.1300/j125v06n03_02 https://doi.org/10.1111/1468-2397.00251 https://doi.org/10.1300/j079v32n03_08 https://doi.org/10.1080/03643107.2011.599301 mailto:katharine.hill@stthomas.edu funded by a two-year grant from the new york community trust, this study draws from data collected as part of a larger exploratory study on licensing and graduate education in social work (donaldson, fogel, hill, erickson, & ferguson, 2016). a survey ... sample the surveys were developed and distributed using qualtrics, an online survey tool. the instrument development grew from a review of existing literature and from the authors’ experiences as social work practitioners and academics. the faculty survey wa... the faculty survey consisted of four sections: 1) msw program information, 2) barriers for student selection of macro concentration; 3) faculty attitudes toward licensing, and 4) faculty demographics. this article presents data from sections 1, 2, and... the macro practitioner survey had five sections: 1) attitudes toward licensing, 2) licensure pursuit path, 3) experience in their msw program, 4) professional macro practice and social work identity, and 5) demographics. this article presents findings... _______ amy murphy-nugen, msw, phd, assistant professor, western carolina university, department of social work, 4121 little savannah road, cullowhee, nc, 28723. sunny harris rome, msw, jd, professor, george mason university, department of social work, 4400 university drive, msn 1f8, fairfax va 22030-4444. email: srome@gmu.edu copyright © 2019 authors, vol. 19 no. 1 (spring 2019), i-xii, doi: 10.18060/23885 this work is licensed under a creative commons attribution 4.0 international license. editorial now is the time: promoting social change through policy research, teaching, and innovation amy b. murphy-nugen sunny harris rome the aphorism, “may you live in interesting times” certainly resonates today. as we write this editorial, for the third time in u.s. history, the senate is deciding whether or not to impeach a sitting president. critical foundations of our constitutional democracy are being undermined before our eyes–including the balance of powers, access to the voting booth, and freedom of the press–while policy decisions are being made that further threaten the well-being of those already marginalized in our society, including (among others) people in poverty; refugees and other migrants; women; and racial, ethnic, religious, gender and sexual minorities. how did we get here? what can we do? because of the versatility of our profession, which prioritizes both the person and the social environment, social workers are wellpositioned to influence the course of events. we have the practice wisdom, the knowledge, and the skills. we understand how systems operate, and we know how to empower clients. while some of us are doing important work to heal wounds at the micro level, others of us are conducting research of social consequence, engaging in analysis and advocacy to influence government decision-making, educating our students for action, running for office, and fighting to ensure that everyone votes and every vote counts. meanwhile, the centrality of policy to social work is increasingly being recognized by the profession. the number of msw students enrolled in macro specializations is rising (council on social work education [cswe], 2015, 2019). organizations including influencing social policy (isp), the congressional research institute for social work & policy (crisp), and the humphreys institute for political social work are laying the groundwork for engagement. the special commission to advance macro practice in social work (sc) has helped make macro practice more visible (cswe and the special commission to advance macro practice in social work, 2018). the national association of social workers (nasw), council for social work education (cswe), and society for social work & research (sswr) are featuring policy speakers at their respective conferences. the grand challenges for social work (2020) have generated important policy recommendations. the national social work voter mobilization campaign (n.d.) is educating and mobilizing schools of social work for action. and, the journal of policy practice & research (2020) is gearing up to publish and elevate policy research. this special issue of advances in social work, which focuses on promoting social change through policy research, teaching, and innovation, contributes to our understanding of how policy impacts the social good, and how we as social workers can advances in social work, spring 2019, 19(1) ii impact policy. it is a testament to the numerous ways in which social workers can intervene: through policy analysis, teaching, research, advocacy, and electoral politics. there is a place for social work on the policy front; we need to claim it, without apology. below is a brief discussion of the historical and current contexts, followed by a brief description of the articles that comprise this special issue. the context over the last 40 years, neoliberalism and free market capitalism have dominated the american policy landscape, resulting in deregulation, decentralization, increased privatization, and austere social policies (bullock, twose, & hamilton, 2019; piven & cloward, 1993; schram, 2018). in neoliberal environments, powerful interests become more privileged, while the voices of individuals who are most vulnerable are muted or silenced. a few quick examples illustrate the point. in 1996, the u.s. congress passed, and president clinton signed, the personal responsibility & work opportunity reconciliation act (known as “welfare reform”) (u.s department of health & human services [hhs], 1996). this overhaul of the country’s primary income support program for low-income families with children prioritized reducing dependence (getting recipients off the welfare rolls) over poverty reduction. it eliminated the existing federal entitlement and substituted a block grant to be administered through a decentralized system in which each state – and, in some instances, each county – develops its own rules and programs. under this policy, receipt of benefits is premised on work, and limitations are imposed on the length of time people can continue to receive aid, regardless of need (hhs, 1996). in keeping with neoliberal and capitalist traditions, these changes reduce the social safety net for citizens who experience inadequate or lowincomes in exchange for increasing economic productivity. another example is the 2010 u.s. supreme court decision in the case of citizens united v. federal elections commission [fec] (2010). in this case, the court reaffirmed that money is a form of speech and that campaign contributions are thus protected under the first amendment. specifically, the court overturned previous decisions that had put limits on corporate campaign spending; there are now no limits to the amount corporations can spend for political advertising (contributed independently of a specific candidate or campaign through “super pacs”). citizens united concentrates this political influence among a few extremely wealthy individuals. for example, during the 2018 mid-term election, nearly 78% of all super pac spending was contributed by the top 100 donors (lau, 2019). the effect of this decision was to put more power in the hands of big business, diluting the influence of individual citizens and increasing racial bias in electoral politics (lau, 2019). in 2013, the supreme court issued another critical decision that typifies the trends of the last decade. in shelby v. holder (2013), the court invalidated a central provision of the voting rights act. this change had the effect of derailing the “preclearance” requirement under which states with a history of voter suppression had to get permission before implementing any changes made to their voting systems. until congress acts to remedy murphy-nugen & rome/now is the time iii the situation, voters in many states–particularly in the south–will have few protections at the ballot box. although these are just a few examples, they are emblematic of the challenges our democratic republic has endured under neo-liberal, corporate-privileging, and austerityfocused policy. power has become more concentrated, and the divide between those whose voices get amplified and whose voices do not has become more profound. these and other recent policies have a direct impact on individual self-determination and empowerment, and represent an assault on social, economic, environmental, and political justice. although the overwhelming policy trend of the last few decades reflects austerity, there were also significant policy developments that advanced individual well-being and community quality of life. ten years ago, in 2010, the affordable care and patient protection act (aca—commonly known as, “obamacare”) was enacted into law by the 111th congress and signed by president barack obama (u.s. department of health & human services, 2019). although the aca is primarily considered an expansion of the private health insurance market, it is the most significant healthcare policy since medicare and medicaid were enacted in 1965 (national conference of state legislatures, 2011). since its full implementation in 2014, the aca is credited with 20 million people gaining health insurance coverage—either through accessing coverage through the aca marketplace or through medicaid expansion (center on budget and policy priorities, 2019). despite its great promise, however, shortcomings remain. most notably, as of the printing of this editorial, 14 states have not adopted medicaid expansion: alabama, florida, georgia, kansas, mississippi, missouri, north carolina, oklahoma, south carolina, south dakota, tennessee, texas, wisconsin, and wyoming (kaiser family foundation [kff], 2020). an estimated two million adults who are characterized as low-income and uninsured fall into the medicaid coverage gap (garfield & orgera, 2020). these uneven outcomes are geographically concentrated in the south, which has intersectional implications for communities of color that are already likely to experience health disparities, along with inadequate access and coverage. note, too, that there is significant overlap between preclearance states impacted by the shelby decision and the states that have not adopted medicaid expansion. in addition to the implementation of aca, there have also been policy advancements at the state-level. for example, following the horrific aftermath of gun violence at sandy hook, the connecticut general assembly passed bipartisan-supported legislation limiting access to guns by individuals perpetrating domestic violence, banning bump stocks, and implementing expanded gun storage rules (larson, 2019). following gun violence at parkland school, florida was also able to pass gun safety legislation (mazzei, 2018). in addition, several states and localities have implemented minimum wage increases (arnholz, 2019). the lessons learned here are that advocacy efforts at the state and local level can also have a significant impact on policy. challenges of the moment the advent of the trump administration raised the stakes for social workers and for our clients. eight in ten americans feel political discourse has become less respectful and advances in social work, spring 2019, 19(1) iv more negative over the last several years (pew research center, 2019). further, 75% think violence is more likely toward groups that are the target of “heated and aggressive” rhetoric by elected officials (pew research center, 2019, para. 7). these perspectives are not outside of our current reality. following a three-year reported rise, in 2017, hate crimes increased by 17% (federal bureau of investigations [fbi], 2018). further, recognized hate groups in the united states are also increasing (fbi, 2018). from roughly 2014 to 2018, there was a 30% increase in the number of documented hate groups—representing a 20year high (beirich, 2019). demonstrations and rallies promoting hate-filled ideology have increased, along with violent acts. in 2018, 50 people were murdered by u.s.-based domestic extremists, representing the fourth-deadliest year for killings linked to domestic extremism since 1970 (anti-defamation league, n.d.). our campuses have not been spared from this growing ideological extremism and associated violence. several bigoted and racially-motivated acts have occurred on numerous university campuses over the last several years. one of the most notorious and hate-filled crimes occurred at the “unite the right” gathering of noted white supremacists on the university of virginia campus in charlottesville, which tragically culminated in the death of a counter protestor, heather heyer, and injured at least nineteen other individuals (atkinson, 2018; hartzell, 2018). grievously, there are more campus incidents than we can reflect upon here. yet what we witnessed at uva and charlottesville represents the inevitable outcomes that lie at the intersection of the increasing incivility and hate we are experiencing in our society—including on our campuses. in addition to the tragic loss of life, such extremism and resulting tragedies also have a chilling effect on civil discourse and engagement. although many factors beyond this increasing extremism likely influence people’s perceptions of political and civic engagement, it is relevant to consider that most people now find it “stressful and frustrating” to have political dialogue with individuals of differing perspectives. the number of people who report experiencing this frustration has grown from 46% in 2016 to 53% in 2018 (pew research center, 2018). approximately 66% of each of the youngest generations (generation zers, millennials, and xers) have a negative perception of the direction in which the u.s. is headed (parker, graf, & igielnik, 2019). although those who are youngest have the bleakest outlook regarding our national trajectory, the majority of all generations indicate that we are “going in the wrong direction” (boomers, 61%; silent generation, 53%) (parker, graf, & igielnik, 2019, para. 26). several well-being indicators demonstrate logical rationales for why most of the public holds a negative perception about our country’s future. although we are experiencing a cumulative low unemployment rate (currently 3.7%), the rate remains notably higher for black/african-americans (6.6%)—reflecting outcomes of the u.s.’s long legacy of historic and systemic oppression (u.s. department of labor, bureau of labor statistics, 2020). according to the most recent census data available, 13 million u.s. workers (8.3%) have more than one job, with 6.9% of multi-job workers holding more than two jobs (beckhusen, 2019). further, women (8.8%) were slightly more likely to hold a second job than men (8.0%) (beckhusen, 2019). the need to hold multiple jobs reflects insufficient pay, inadequate hours available at the first job, and/or limited growth potential. nationally murphy-nugen & rome/now is the time v and in many states, the minimum wage is $7.25 an hour—where it has remained since 2009 (u.s. department of labor, 2011). at the current minimum wage, a full-time worker would have to put in 127 hours every week to afford the fair market rent for a two-bedroom rental home (national low-income housing coalition, 2019). there is no locality in the u.s. where a minimum-wage worker, working 40-hours a week, can afford the fair market rent for a two-bedroom rental. meanwhile, although we have successfully expanded coverage of individuals with health insurance following the implementation of the aca, attempts to weaken the policy have resulted in two million more americans being without health insurance in 2017 compared to 2015 (u.s. census bureau, 2019). we are also seeing an increase in “deaths of despair” (case & deaton, 2017) or, what is understood to be a combination of drug overdoses, suicides, and alcohol-related deaths, resulting in a decrease in life expectancy for mid-life, non-hispanic whites with low-educational attainment. these bleak statistics represent the dire circumstances that our clients face and which we must confront through policy practice, teaching, and research. the next decade: from a moment to a movement amy often uses a quote appearing on the street art of the political activist known as bansky, “if you get tired, learn to rest, not to quit,” to encourage her students on the days when they feel particularly overwhelmed—offering further guidance that they can rest but they cannot retreat from the harsh and oppressive realities of the current policy and political landscape. particularly when it is hardest—when it is on the days that we learn the violence against women’s act (vawa) has not been reauthorized, when we learn another black person has been killed by law enforcement, when we learn we have lost more of our young people at another school shooting, when we learn there is an oil spill at standing rock, when we learn another state is purging voters from its voting rolls, when we learn puerto rico still has not received all of the emergency aid it was promised, when we learn more than 5,000 children were separated from their parents when seeking asylum…when we learn, when we learn, when we learn. it is on those days when the outcomes are most bleak, that the individuals, families, organizations, and communities we serve require us—in our unique and valuable capacity as research-informed social work advocates—to remain engaged alongside them in the pursuit of social, economic, environmental, and political justice. in this challenging policy moment, it would be understandable to choose to drop out of the fight. yet there is reason for hope. in 2018, despite attempts to disenfranchise voters through unconstitutional identification requirements, closing polls in certain localities, and other counter-civic engagement strategies, voter turnout increased for all age categories and major racial groups (misra, 2019). voter turnout in the 2018 mid-term elections was 11 percentage points higher than in 2014 (misra, 2019). the largest turnout increase was achieved by 18 to 29-year olds, a historic low-voting demographic (misra, 2019). their voting participation increased from 20% in 2014 to 36% in 2018—still room for growth, but representing a 79% increase in turnout (misra, 2019). this growing civic engagement and investment is encouraging. advances in social work, spring 2019, 19(1) vi over the next decade, as we have in the past, social workers will continue to encounter challenging social issues and oppressive policy prescriptions. yet we also have opportunities to make things better. most immediately, this coming year, the 2020 census will be undertaken to count all people for the critical purposes of determining how approximately $675 billion will be allocated to our communities, providing demographic information on which voting maps will be constructed, apportioning 435 congressional representatives, and providing accurate and relevant data to inform the development of social programs. decisions made based on census data will last and be multiplied over 10 years. it is critical for social workers to become engaged in local outreach efforts to ensure all people are counted. this year is also an election year—primary elections will be taking place soon. getting out the vote is a critical social work activity. if you are not already, we encourage you and your students to become involved. as we step into this new decade full of social work policy challenges and opportunities, it is our hope that the research you find within this special issue will both inform and inspire you to advance social change through policy research, teaching, and innovation. articles the articles in this special issue address how to promote social change through policy research, teaching, and innovation in the united states. the shared message they convey is the urgency of the moment and the promise of building a sustainable movement as we embark on the decade before us. the variety of this collection of 15 articles pays homage to the multiple ways in which social workers engage in the policy process, including research, analysis, advocacy, and political action. there is a wealth of content here that reflects our collective expertise: policy analysis frameworks, pedagogical and curricular strategies to strengthen policy content in the classroom, research that advances policy development over a range of critical social issues, meaningful connections forged between clinical and policy practice, and, opportunities for deeper political engagement and participation. the first set of articles provides three distinct and innovative approaches to conducting policy analysis. kanenberg, leal, and erich revisit mcphail’s feminist policy analysis framework by updating it with a focus on privilege, oppression, and intersectionality—a change that the authors assert is particularly relevant in today’s polarized political climate since it prompts the analyst to consider how an individual’s multiple identities intersect in experiences of discrimination, oppression, and other possible forms of marginalization. by using the resulting framework, the authors suggest researchers, practitioners, and students will become better informed advocates and agents of change. power and complexity are also addressed by manit, kolpakov, and eubank in the policy analysis perspective they present, a network perspective. the authors contend that both formal and informal network partnerships, consisting of capable governments, notfor-profit organizations, and for-profit private actors, are required to address increasingly complex social problems. in addition to providing a conceptual framework for understanding network analysis, the authors share an empirical case illustration to demonstrate how social work researchers and policy practitioners can advance policy development and implementation. such network analyses can inform strategies to build murphy-nugen & rome/now is the time vii partnership capacity, illustrate power and resource constraint considerations in policy implementation, and explain how network relationships influence policy outcomes. the importance of context intersects with barretti’s analysis of how social problems are constructed. barretti contends that language is important in how social problems are framed—influencing how a problem is perceived and ultimately how policy interventions are developed or not. in her article, she provides an overview of common policy analysis frameworks, summarizes findings of how social policy texts instruct analysis of social problems, and, presents an alternative matrix, problem-to-policy, which applies a social constructionist lens to the historical development of social problems and policy outcomes. an illustrative assignment is included to demonstrate how students may deepen their awareness and critical thinking about historical context, political/social/economic influences, claimsmaking and claimsmakers, ideological explanations and theories, policy responses, and new social problems. although many articles in this special issue have implications for teaching, the second set of articles focuses specifically on program, curriculum, and pedagogical considerations. curry-stevens, hawash, and bradley describe the journey of strengthening the macro concentration in the master of social work (msw) program at portland state university. this development is presented in four phases: hiring and curriculum improvements; reaccreditation opportunities; online innovation; and longer-term influence of horizontal and vertical integration. through their successful efforts in attracting more students into their “practice and leadership with communities and organizations” specialization, they gleaned valuable insights that will be useful to other universities and programs. lane, hill, ostrander, powers, rhodes smith, and hylton focus on voter engagement and the cultivation of political power as critical elements of social work practice. given the place of field education as social work’s signature pedagogy, they implemented a voter engagement model that was embedded in the field component at two schools of social work. their results have implications for empowering social workers to increase voter turnout of marginalized communities; leveraging linkages between field experiences and classroom activities; and, a number of relevant policy responses. at a time when voter disenfranchisement remains a significant concern, this article is timely for social work students, practitioners, and educators. the third set of articles addresses a variety of specific policy topics. several years postimplementation of the affordable care and patient protection act, faubert, weller, and ault explore the unmet health care needs of youth by health insurance type and status. the results of their study inform whether unmet health care needs are best addressed by public, private, or no health insurance. the results have implications for future healthcare policy decisions concerning medicare for all, not-for-profit public options, or expansions of the private health insurance market. using a critical analysis that integrates life course and equity perspectives, oswald, gardner, and giunta examine the lgbt elder americans act. the authors’ application of a life course perspective allows both social workers and policymakers to respond to historic and current circumstances that may be either oppressive or empowering for the community. their equity lens brings intersectional issues to the forefront for policy advances in social work, spring 2019, 19(1) viii development. the authors also advocate using their analysis framework to help shape an lgbt aging policy agenda. perkins and grossman address a critical issue in domestic violence but one that is rarely discussed, i.e., sibling violence. their article provides statistics on the prevalence of this problem, as well as key definitions. they discuss roles for social work practitioners and advocates, as well as future directions to advance policy responses to mitigate sibling violence. also related to domestic and intimate partner violence, steiner, johnson, hadley, lin, and postmus discuss a provision introduced in the 1996 welfare reform policy, the personal responsibility and work opportunity reconciliation act (prwora). the family violence option (fvo) allows states to waive specified requirements for individuals who are survivors of intimate partner violence. the authors address the absence of a standardized method for practitioners to assess this risk. their article presents results from a study to develop and test an instrument to be used for this purpose. also dealing with issues related to violence against women, maxwell and robinson examine the violence against women reauthorization act of 2013 and its implications for american indian/native american (aina) women. they contend there is a high prevalence of gender-based violence perpetrated against aina women. by using an indigenous-focused perspective, acknowledging social construction and historical context, integrating tribal critical race theory and using a feminist lens, they address implications for policy development that are responsive to aina women. lim and shafer also address policy issues for american indian (ai) families by conducting a replication of the fragile families and child well-being study. their research specifically looks at the participation of american indian families in marriage promotion programs and how the ai community views the relationship of marriage and beneficial outcomes for children. the final policy-specific article addresses issues in the criminal justice domain. rhodes, robinson, archibald, and van sluytman conducted a consent decree analysis examining u.s. department of justice (doj) investigations of law enforcement practices between 2008 and 2018. their findings indicate that social work values, advocacy interventions, and cultural training may help to decrease the number of excessive force complaints. the next article illustrates an example of where the interests of clinical social workers align with advocacy efforts. cooper-bolinskey presents an emerging theory to guide clinical social workers who are seeking changes to the regulation of their practice. the article discusses variations among jurisdictions with different scopes and categories of clinical practice and how these disparities impact clinical practice and client protection. she addresses barriers that social workers experience in attempting to influence the regulation of clinical practice. implications of her study include a discussion of public protections, professional fidelity, portability, and accessibility of clinical services. the last two articles focus on political participation of social workers. we intentionally end with these articles to not only share their informative empirical results but also as a call to action for more social workers to become active change agents in political spheres. ostrander, brian, and lane discuss the importance of political participation in creating social change while also noting that little has been explored about how clinical social murphy-nugen & rome/now is the time ix workers participate in large societal change. their study presents findings from clinical social workers and particularly explores the challenges that female clinicians experience, which may result in barriers to political engagement. meehan explores involvement in running for political office. his study presents results comparing msw and jd students. his results are discussed within the concept of political primary, which he defines as the value individuals assign to the ability of those in elected office to make a difference. he discusses the role social work education may offer in socializing students to political participation as part of their social work practice. we are encouraged to see an increase in interest among social work practitioners, advocates, and researchers in developing policy-informed research. the number of initial submissions to this special issue was overwhelming—in a very welcomed way. yet the special issue also reveals several gaps in research and advocacy that we hope our fellow social work practitioners, advocates, and researchers are currently exploring or will be inspired to do so with this message. among the issues notably missing from this issue are reproductive rights, migration, housing, mental health, education, food security, and gun violence. although we think the inclusion of refugee and migration content is certainly relevant to the focus of this issue, we want to acknowledge and thank advances in social work and guest editors, dr. popescu and dr. libal, for their recent special issue, social work with migrants and refugees. clearly, there is no shortage of opportunity for social workers to add to the scholarly work in these and other areas that are vital to informing social policy. we also note the absence of articles addressing global concerns: climate change, wealth inequality, the decline of democratic governments, and the growing impact and influence of social media—including widespread disinformation campaigns that contribute to apathy and disempowerment around the world. we hope you find the articles in this issue informative, useful, and motivating. although we are facing some daunting challenges, we celebrate the involvement in social workers in policy research, teaching, and practice. in that spirit, we acknowledge the heroes and sheroes who reflect our macro and policy roots: jane addams, dorthea dix, dorothy height, francis perkins, harry hopkins, whitney young, and the many social workers who hold public office at the national, state, and local levels. we recognize the enduring importance and impact of their work, and join them in shaping the future through policy change. references anti-defamation league [adl]. 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(2020). the employment situation: december 2019. retrieved from https://www.bls.gov/news.release/pdf/empsit.pdf author note: address correspondence to amy murphy-nugen and sunny harris rome: amy murphy-nugen, western carolina university, department of social work, 4121 little savannah road, cullowhee, nc, 28723. email: abmurphynugen@wcu.edu sunny harris rome, george mason university, department of social work, 4400 university drive, msn 1f8, fairfax va 22030-4444. email: srome@gmu.edu acknowledgements: we would like to especially thank valerie decker for her helpful guidance and dedication to every aspect of the editing process, unending patience, and her clever humor. special thanks are also directed to dr. margaret adamek for her thorough oversight and careful attention that was critical in bringing this special issue to publication. the journey of co-editing this issue has been a meaningful one—we deeply appreciate advances in social work dedicating this special issue to policy. deep gratitude is shared with all the authors—thank you for sharing your research on social work policy analysis, practice, curriculum, and social issues. we appreciate your commitment to advance and innovate policy advocacy, practice, and research to the benefit of individual well-being, community quality of life, and increased social and economic justice. we would also like to recognize everyone who took the time to prepare and submit an abstract and manuscript—although we were not able to include all articles in this issue, we were inspired by the depth of interest and commitment of our colleagues to this work. we sincerely hope that everyone will remain committed to advancing social work policy research, education, and innovation. https://doi.org/10.4135/9781526416001.n25 https://www.census.gov/newsroom/press-releases/2019/income-poverty.html https://www.census.gov/newsroom/press-releases/2019/income-poverty.html https://aspe.hhs.gov/report/personal-responsibility-and-work-opportunity-reconciliation-act-1996 https://aspe.hhs.gov/report/personal-responsibility-and-work-opportunity-reconciliation-act-1996 https://www.hhs.gov/healthcare/about-the-aca/index.html https://www.dol.gov/whd/regs/statutes/fairlaborstandact.pdf https://www.bls.gov/news.release/pdf/empsit.pdf mailto:abmurphynugen@wcu.edu mailto:srome@gmu.edu ____________ michael s. kelly, phd, is a professor, school of social work, loyola university, chicago, il, 60611. heather freed, lcsw, executive director, peggy kubert, lcsw, director of education, and sarah greibler, former director of research, erika's lighthouse, winnetka, il 60093. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1206-1217, doi: 10.18060/22305 this work is licensed under a creative commons attribution 4.0 international license. depression education as primary prevention: the erika’s lighthouse school-based program for high school students michael s. kelly heather freed peggy kubert sarah greibler abstract: major depression is a treatable and common mental health disorder for youth. untreated depression is a major risk factor for youth who become suicidal and die by suicide. recent focus in the school-based literature on creating universal mental health promotion programs have recognized the need for effective depression awareness education programs to assist youth in identifying symptoms of depression in themselves and their peers, and to encourage those youth to seek trusted adults for help. a quasiexperimental design (qed) was employed in two suburban chicago high schools (n=652) to evaluate the intervention, real teenagers talking about adolescent depression (rttaad), a video-based universal classroom discussion intervention created by clinical social workers, parents, and youth. the analysis showed that rttaad led to statistically significant changes in adolescent knowledge about depression and their stated willingness to seek help from trusted adults at 6-week follow-up compared to a control classroom condition. this study supports the notion that school social workers and other school mental health professionals need to allocate more time to primary prevention work to help build mental health awareness in their school communities and to help prevent depression and suicidal behavior. keywords: depression; youth; school social work; suicide prevention major depression is a prevalent disorder for young people. according to the national institute for mental health (2018), 12.8% of youth (ages 12-17) experienced major depressive disorder in 2016, suicide is the second leading cause of death for individuals between the ages of 10 and 24, and over 6,000 youth died by suicide in 2016. research continues to show a strong link between youth depression and risk of suicide attempts and completions (deutz, geeraerts, van baar, deković, & prinzie, 2016; goldston et al., 2009; miller et al., 2017; nimh, 2015). still, despite these serious outcomes from depression, many youth do not seek or receive the mental health treatment they need to treat their depression, increasing the chance that their depression might escalate into suicidal ideation (nimh, 2017). recent research has focused on using depression education as a prevention activity to increase the knowledge youth have about depression and suicide risk, to build their capacity to identify trusted adults in school and their community to help them and their peers, and to increase the help-seeking behavior of depressed youth (balaguru, sharma, & waheed, 2013; surgenor, quinn, & hughes, 2016). the present study extends that work using a one-session universal intervention (a school-based depression awareness curriculum) to assess whether youth’s knowledge and skills can be impacted by such an intervention. https://creativecommons.org/licenses/by/4.0/ kelly et al./depression education 1207 with depression being one of the primary mental health issues associated with suicide, and many youth reporting that stigma presents a major barrier to seeking help for depression, education in schools is viewed as a key component in preventing youth suicide (petrova, wyman, schmeelk‐cone, pisani, 2015; pisani et al., 2012; ruble, leon, gilleyhensley, hess, & swartz, 2013; surgenor et al., 2016; swartz et al., 2010). by offering depression education as a primary prevention strategy for youth, and addressing depression through school programs, a larger segment of the youth population can be reached (bevan et al., 2017). the evidence indicates that these interventions can be beneficial, though the evidence is still limited by a lack of rigorous randomized trials and quasi-experimental designs, though more rigorous trials have been conducted recently (singer, erbacher, & rosen, 2018; swartz et al., 2017). current research indicates that the more youth and school communities can learn about depression, the more likely it is for the stigma around mental disorders to be reduced and, in turn, for students to seek out help from trusted adults (joshi, hartley, kessler, & barstead, 2015; pisani et al., 2012; surgenor et al., 2016). school social workers (ssw) have long been at the front lines of providing support for youth within an ecological framework that addresses prevention as well as direct clinical problems (kelly, 2008; thompson, frey, & kelly, 2018). ssw have reported a high level of interaction with students who are depressed and suicidal (singer & slovak, 2011), and have worked to implement depression education and suicide prevention programs in diverse school contexts (ciffone, 2007; schmidt, iachini, george, koller, & weist, 2015; wright-berryman, hudnall, hopkins, & bledsoe, 2018). as with most problems ssw report working with, the challenge with providing prevention support for youth with depression is identifying interventions that are feasible to implement within the school context (kelly, raines, stone, & frey, 2010; singer et. al, 2018). the present intervention (real teenagers talking about adolescent depression [rttaad], 2015) builds on previous evidence-based interventions (e.g., break free from depression [bffd], boston children’s hospital, 2018; signs of suicide [sos], sos 2018) offered to youth in schools to raise awareness about depression and decrease suicidal behavior, but with some key differences. rttaad is shorter, free, and driven by youth’s voice in ways that distinguish it from the other established programs. it is designed to be implemented by any high school staff who want to bring the program to their campus with minimal start-up costs or training. like the other programs, rttaad uses video as its prime teaching tool, but unlike the multiple sessions of the other programs, the video and ensuing discussion are built around one typical 50-minute high school class session. teen voice is also included in other programs, though rttaad explicitly involves the youth themselves in creating the video content (not as actors or using scripted content) in direct collaboration with the mental health experts of erika’s lighthouse (el), the chicagoland-based non-profit organization that created rttaad. the youth in the rttaad videos are essentially “the voice” of the program, telling their stories and relating what they have learned about their own depression and how they decided to seek help. finally, in the interest of increasing the social validity of the program, all rttaad materials are free and require no additional training for use by a school mental health professional and/or health educator, making the program accessible to most any high school (sos charges for their training and materials, advances in social work, fall 2018, 18(4) 1208 and bffd requires an online train-the-trainers component that might prevent some schools from adopting the program quickly.) background on rttaad real teenagers talking about adolescent depression: a video-based study guide was created by the staff and advisory board of el to be a turn-key universal intervention for high school classroom environments (rttaad, 2015). while the clinicians and staff at el are clinical social workers with decades of experience in clinical work with youth, the organization’s advisory board is composed of adults and teens, many of whom are either suicide survivors and/or people who have suffered depression, who have come together to work to reduce the stigma around childhood and adolescent depression. the purpose of rttaad is to increase student knowledge about depression, reduce stigma surrounding depression, and increase the likelihood that students with depression will seek help. the program content, developed by a team of school-based mental health professionals, parents, and youth, draws on the latest evidence to help students understand that depression is common amongst youth, that it is serious and the largest risk factor for youth suicide, and that it is a diagnosable and treatable mental disorder with specific symptoms, and that peers are often the first to know of a teen’s depression. the tone of the program is critical to its success and is also derived from evidence-based concepts of safe and effective messaging for suicide prevention avoiding dark, sensational and fear-based messaging, and instead, providing a message that is positive, honest, fact-based, and inclusive (rttaad, 2015; singer et al., 2018). rttaad has been offered by el since 2011. to date, it has been implemented in over 60 schools, religious institutions, and health care settings. the program contains two sections, both to be delivered in a classroom setting by a classroom teacher, and preferably, with a school mental health professional co-leading the session. the first section of the program engages students in a beginning exercise that introduces mental health and depression concepts. students watch the 10-minute rttaad video in their class and then participate in a discussion with the facilitator about teen depression. though schools can use the materials themselves without contracting directly with el, it is considered best practice to have proper student support and school mental health infrastructure in place to handle the potential student response to rttaad. this includes the potential increase in self-referrals and peer referrals related to depression (rttaad, 2015). the second section of rttaad builds on the first with supplemental exercises to be led by the classroom teacher for a typical 50-minute class period. this session focused on stigma reduction, depression and brain science, and suggestions on how to help a peer with depression. (note: this program evaluation is restricted to only the first section, as el noted that at least some of the schools were not consistently implementing the second section, and they wished to evaluate the most commonly-used component of rttaad). rttaad is also equipped with facilitator teaching instructions which includes: a) a primer on depression; b) a mental health resource (“bookmark handout”) for students; c) an intervention tool that students can use at the end of the session to confidentially ask for kelly et al./depression education 1209 help; and, d) an appendix with other mental health resources and information (rttaad, 2015). though the program has proven to be popular and has numerous anecdotal examples testifying to its impact and effectiveness, to date no formal evaluation of rttaad has been conducted. the el team asked the first author to help them construct a study to examine the impact of rttaad. purpose of the evaluation the main objectives of the proposed evaluation were to examine the effects of rttaad on first-year high school students on knowledge of depression, help-seeking, and trust of adults related to help-seeking. specifically, the evaluation sought to test the following hypotheses: 1) students in rttaad classrooms will show increased knowledge about depression, stigma, and signs of suicide compared to a control group of similar first-year high school students. 2) students receiving the rttaad intervention will show higher scores on knowledge of help-seeking behaviors for depression and suicidal ideation compared to control group first-year students. 3) students receiving rttaad will show an increase in their reported trust of adults to help them or their peers with depression and suicidal behavior compared to students in the control group condition. method two chicago suburban high schools agreed to be part of the rttaad intervention study. both schools (referred hereafter as hs 1 and hs 2) agreed to have the program delivered to first-year students via their required health classes in accordance with the team’s research design goals. in collaboration with the first author’s institution, the team received approval for the research project from the institutional review board (irb), and the project followed typical research procedures for a school-based intervention study. in both schools, a pre-post-test wait-list control quasi-experimental design was used. the pre-test was delivered to both the rttaad groups (in their health class) and the control students (in their p.e. class) at the same time, and each condition received the posttest at 6 weeks after the rttaad intervention. the rttaad intervention was conducted by the second and third author of this paper (both of them creators of the intervention). this approach further ensured that the program was implemented with full fidelity. all students in the two schools’ control conditions received rttaad in the winter 2015 semester when the students in the p.e. class control condition had their health class. each student in the study (total n=652) completed a questionnaire that incorporated a depression knowledge scale created by the el team and two additional standardized scales, detailed below. measures. two standardized measures were employed for this evaluation: the helpseeking acceptability at school scale (hsa), a 4-item scale that tests youth’ willingness to seek help from an adult at school for mental health distress (wyman et al., 2008) and the adult help for suicidal youth scale (ahsy), a 3-item scale that tests adolescent’s advances in social work, fall 2018, 18(4) 1210 beliefs that there are trusted adults who can help them and their peers with mental health distress (schmeelk‐cone, pisani, petrova, & wyman, 2012). both scales were found in a 2012 study by schmeelk-cone and colleagues to have acceptable internal consistency (0.84 for hsa, 0.67 for the ahsy). according to these authors, the scales “provide researchers and program evaluators with psychometrically sound scales for measuring, within a school population, student norms and attitudes about help-seeking for suicide concerns” (schmeelk-cone et al., 2012, p. 169). table 1. codebook example for open-ended knowledge questions list 5 symptoms a teen might have to be diagnosed with depression – 0-5 points (note: each coder independently entered 1 point for any of the items on this list, and then compared their codes after completing them to get to acceptable inter-rater reliability.) 1. sad/always sad/constantly sad/sadness, depressed, feeling down 2. change in sleep, irregular sleeping patterns 3. sleeping too much, sleeping more, over-sleeping 4. sleeping too little, sleeping less, insomnia, not sleeping/not sleeping well 5. restlessness, agitation, feeling “sped up” 6. persistent crying, tearfulness 7. physical symptoms, aches and pains, headaches, stomachaches 8. trouble focusing, trouble concentrating, trouble paying attention, trouble making decisions 9. withdrawal from people/isolation, anti-social behavior, spending lots of time alone 10. loss of interest or pleasure in favorite activities 11. change in weight, weight gain, weight loss 12. change in appetite 13. loss of appetite, eating less, eating too little, not eating, not eating enough 14. increase in appetite, eating more, eating too much, over-eating 15. pessimism 16. fatigue, tired all the time/exhausted, no energy/loss of energy 17. feelings of worthlessness 18. feelings of guilt 19. feelings of hopelessness 20. thoughts of death, suicidal thoughts, any other signs of suicidal behavior 21. self-harm/self-injury, cutting 22. lack of hygiene, lack of self-care for appearance 23. low self-esteem 24. using/abusing drugs and/or alcohol 25. emotional numbness/apathy 26. feeling lonely/alone/loneliness 27. missing a lot of school, skipping school 28. drop in grades, failing classes, low motivation 29. reckless behavior (including examples of reckless behavior) 30. anger, irritability additionally, the el team created a knowledge instrument containing true/false items on depression, as well as six open-ended questions to evaluate the extent that students understood depression symptoms, strategies students could use to improve their mental health, the impact of stigma on help-seeking for depression and suicidal ideation, and kelly et al./depression education 1211 warning signs indicating a teen might be considering suicide. the final study instrument is available from the first author. two college-aged student research assistants coded the responses to the six open-ended questions, scoring them based on the quality of the answers. two el team members coded a sub-sample of responses to attain sufficient interrater reliability (irr) of .8 or above. all remaining responses were coded and all responses (both irr and the two separate coders’ work) were built into the analysis. (see table 1 for sample codes). the two high schools were chosen because they matched well on several school characteristics (see table 2). table 2. selected rttaad study high school characteristics school variables high school 1 high school 2 ses (low-income households) 13% 8% student mobility <3% <3% graduation rate 98% 95% students with ieps 10% 9% racial demographics white asian-american 61% 20.7% not available (illinois report card, 2018) the results from the two schools were combined for this analysis. a pre-post/test wait-list control group design was employed to test the study hypotheses. results demographics of the 652 first-year students in the study, 286 (43.8%) were male and 329 (50.5%) were female; 37 (5.7%) either chose to not identify their gender or left the section blank. no other demographic data was collected on the specific first-year students in this sample (i.e., ses, race/ethnicity). findings from rttaad questionnaire data based on an independent sample t-test analysis of the pre-and post-tests for the rttaad and comparison classrooms, the following preliminary results can be drawn from the data. student knowledge of depression. for the knowledge scale, participants in the rttaad condition showed greater increases in their knowledge score (m=0.67, se=0.08) than did those in the control condition (m =0.39, se=0.12). this difference was statistically significant t(650)=2.0209, p<.05. at 6 weeks post-test students who participated in rttaad had retained a statistically significant amount of new information about depression and how to deal with depression affecting either a peer or themselves. advances in social work, fall 2018, 18(4) 1212 for each of the 6 open-ended questions on the questionnaire, rttaad participants reported highly significant change from pre-to post-test (m=1.65, se=.09) compared to the control condition students (m=1.13, se=.08). this difference was statistically significant t(634)=4.3278, p<.0001. this means that a statistically significant portion of students in the rttaad condition could: a. identify up to five symptoms of depression b. accurately recount how long someone needs to be depressed to be diagnosed with depression c. identify up to three healthy ways that youth can take care of their mental health d. explain how stigma might prevent people from seeking help for their depression e. list two warning signs for someone considering suicide f. identify strategies to help a peer who is suicidal involving seeking out a trusted adult students’ willingness to seek help from trusted adults at school with depression and other mental health problems. participants in the rttaad condition showed greater change in their average score on the hsa (help-seeking acceptability scale; m=0.19, se=0.03) than did those in the control condition (m=0.09, se=0.04). this difference was statistically significant t(650)=2.0344, p<.05. at 6 weeks post-test rttaad, participants reported that they were more likely to see adults in the school as people they could seek help from if they were upset. students’ belief that adults could help one of their peers who is suicidal. students who participated in rttaad showed greater change in their average score on the ahsy (adult help for suicidal youth scale; m=0.26, se=0.03) than those in the control condition (m=0.10, se=0.04). this difference was statistically significant t(650)=3.2250, p<.0001. students who participated in rttaad were much more likely to view adults as helpful resources for an adolescent peer who was suicidal. overall, at 6-week follow-up across all three measures (the knowledge scale, the hsa, and the ahsy), rttaad appeared to have an impact on key areas of depression awareness/suicide prevention for first-year students in the rttaad condition compared to the control group classrooms. discussion and implications for additional research and practice this pilot evaluation confirms that rttaad can improve knowledge and attitudes on depression and help-seeking among youth, and these outcomes are consistent with the features of other interventions in the depression awareness/suicide prevention literature (klimes-dougan, klingbeil, & meller, 2013; petrova et al., 2015; swartz et al., 2017; whitlock, wyman, & moore, 2014). these initial findings show that rttaad is a promising intervention that merits further investigation, particularly for high school-age youth. based on the data described here, rttaad demonstrates potential as an efficient and basic intervention that builds awareness of what depression in teenagers looks like, how teens can recognize symptoms in themselves and/or their peers, and how they can identify and eventually turn to trusted adults at school to help themselves or a peer. kelly et al./depression education 1213 these preliminary results are encouraging for several reasons. first of all, this is the first trial of rttaad since its inception, and the results indicate that the anecdotal and intuitive appeal of this program is bolstered by empirical support. secondly, this trial tested the intervention in a real-world setting of two suburban chicago high schools. these two high schools are similar to other schools that have been working with el and the rttaad intervention for years. the fact that these changes were seen in two settings that closely match the school conditions that el is used to working in further validates the efforts of the team to deliver this program as it has been already doing. each of the key indicators (increased knowledge, increased willingness to seek help from school adults, increased belief in the ability of adults to provide real help to a suicidal peer) are considered essential to programs that are trying to increase depression awareness and impact help-seeking attitudes around teen suicide. rttaad impacted all of these indicators, and did so even after a 6-week follow-up period. it is also important to note that all of this is being accomplished by a remarkably brief and efficient intervention model, one that requires relatively little training to implement and very little time to conduct relative to other evidence-based depression awareness/suicide prevention curriculum. from this initial pilot study, there is preliminary evidence to support the notion that rttaad “works,” and does so largely in the ways that its creators intended it to work. the findings from this initial pilot study offer several important implications for school social workers (ssw) and other related school mental health professionals. due to high caseloads and other workplace demands, most ssw report struggling to find the time to deliver evidence-informed tier 1 and tier 2 interventions within the commonlyunderstood multi-tiered systems of supports (mtss) framework (kelly et al., 2016). this intervention offers an opportunity for ssw to address depression awareness and suicide prevention at the tier 1 universal level, and to work within their school community to build the capacity of other key stakeholders (teachers, administrators, peers, and parents) to make school communities more responsive to youth who struggle with depression and suicidal thoughts (erbacher, singer, & poland, 2014). that this could be done in a free and timelimited way makes rttaad a promising option for ssw looking to become more involved as change agents in mental health promotion and prevention work within their schools (avant & lindsey, 2015). limitations while this study shows some positive initial outcomes, there are important limitations to bear in mind when interpreting these results. the sampling plan and wait-list control design, while more rigorous than a simple pre/post-test design, was not a randomized trial, as both the rttaad and comparison group youth represented a convenience sample of schools who were willing to participate. the data was all youth self-reports about possible changes to their knowledge and attitudes. the study design did not allow the researchers to assess behavioral outcomes such as whether rttaad increased youth referrals for mental health treatment in the school setting, or a resulting decrease in suicidal behaviors among the youth of the two high schools. future research is needed to discern the behavioral changes stemming from rttaad. this is an area that the research team is considering as the next steps of developing the programs offered by el. advances in social work, fall 2018, 18(4) 1214 furthermore, though the two high schools used for this study shared many demographic and ses similarities, the specific youth themselves were not precisely matched on all demographic variables for the evaluation. this significantly limited this study’s ability to test rttaad’s impact on specific racial/ethnic minorities, as well as possible differential impacts of the intervention for lgbt youth. further research is needed to assess how well rttaad and other depression awareness interventions are culturally relevant to the wide diversity of youth in the u.s. further, because rttaad was facilitated by erika’s lighthouse staff and not the school’s own teachers, future studies would benefit from assessing the program’s impact when taught by health teachers or other faculty. conclusion the preliminary results discussed here represent encouraging findings that invite additional investigation into the potential scope and reach of rttaad to impact depression awareness/suicide prevention outcomes for early adolescent youth in middle and high school. this work stems from a collaboration of a dedicated group of practitioners and researchers, and follows a collective process built on the wisdom of several years of building rttaad. future work would do well to further investigate the ways by which rttaad can be feasibly and effectively translated to more diverse adolescent populations (e.g., rural youth, inner-city youth), as well as ways that the materials might be refined by future study to be more widely disseminated through face-to-face educational classroom instruction in the program as well as sharing the rttaad program via social media apps and other online tools frequented by youth. references avant, d. w., & lindsey, b. c. 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(2017). school-based curriculum to improve depression literacy among us secondary school students: a randomized effectiveness trial. american journal of public health, 107(12), 1970-1976. doi: https://doi.org/10.2105/ajph.2017.304088 swartz, k. l., kastelic, e. a., hess, s. g., cox, t. s., gonzales, l. c., mink, s. p., & raymond depaulo jr, j. (2010). the effectiveness of a school-based adolescent depression education program. health education & behavior, 37(1), 11-22. doi: https://doi.org/10.1177/1090198107303313 thompson, a., frey, a., & kelly, m. s. (2018). factors influencing school social work practice: a latent profile analysis. school mental health, 1-12. https://doi.org/10.1007/s12310-018-9279-y whitlock, j., wyman, p. a., & moore, s. r. (2014). connectedness and suicide prevention in youth: pathways and implications. suicide and life-threatening behavior, 44(3), 246-272. doi: https://doi.org/10.1111/sltb.12071 wright-berryman, j., hudnall, g., hopkins, r., & bledsoe, c. (2018). hope squads: peer-to-peer suicide prevention in schools. children & schools, 40(2), 125-126. doi: https://doi.org/10.1093/cs/cdy005 wyman, p. a., brown, c. h., inman, j., cross, w., schmeelk-cone, k., guo, j., & pena, j. b. (2008). randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. journal of consulting and clinical psychology, 76(1), 104-115. doi: https://doi.org/10.1037/0022-006x.76.1.104 author note: address correspondence to: michael s. kelly, phd, school of social work, loyola university, 1 e. pearson, room 542, chicago, il 60611. mkell17@luc.edu https://doi.org/10.2105/ajph.2017.304088 https://doi.org/10.1177/1090198107303313 https://doi.org/10.1007/s12310-018-9279-y https://doi.org/10.1111/sltb.12071 https://doi.org/10.1093/cs/cdy005 https://doi.org/10.1037/0022-006x.76.1.104 mailto:mkell17@luc.edu background on rttaad purpose of the evaluation method results demographics findings from rttaad questionnaire data student knowledge of depression. for the knowledge scale, participants in the rttaad condition showed greater increases in their knowledge score (m=0.67, se=0.08) than did those in the control condition (m =0.39, se=0.12). this difference was statisti... discussion and implications for additional research and practice limitations conclusion references avant, d. w., & lindsey, b. c. (2015). school social workers as response to intervention change champions. advances in social work, 16(2), 276-291. doi: https://doi.org/10.18060/16428 balaguru, v., sharma, j., & waheed, w. (2013). understanding the effectiveness of school‐based interventions to prevent suicide: a realist review. child and adolescent mental health, 18(3), 131-139. doi: https://doi.org/10.1111/j.1475-3588.2012.00668.x joshi, s. v., hartley, s. n., kessler, m., & barstead, m. (2015). school-based suicide prevention: content, process, and the role of trusted adults and peers. child and adolescent psychiatric clinics, 24(2), 353-370. doi: https://doi.org/10.1016/j.ch... kelly, m. s. (2008). the domains and demands of school social work practice: a guide to working effectively with students, families and schools. new york: oup usa. doi: https://doi.org/10.1093/acprof:oso/9780195343304.001.0001 kelly, m. s., frey, a., thompson, a., klemp, h., alvarez, m., & berzin, s. c. (2016). assessing the national school social work practice model: findings from the second national school social work survey. social work, 61(1), 17-28. doi: https://doi.o... kelly, m. s., raines, j. c., stone, s. & frey, a. (2010). school social work: an evidence-informed framework for practice. new york: oxford university press. doi: https://doi.org/10.1093/acprof:oso/9780195373905.001.0001 ______ monique a. constance-huggins, phd, associate professor and undergraduate program director, winthrop university department of social work, rock hill, sc. ashley davis, phd, clinical associate professor, boston university school of social work, boston, ma. jessica yang, phd, assistant professor, winthrop university department of social work, rock hill, sc. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 132-151, doi: 10.18060/22933 this work is licensed under a creative commons attribution 4.0 international license. race still matters: the relationship between racial and poverty attitudes among social work students monique constance-huggins ashley davis jessica yang abstract: the attitudes that social work students hold about race and poverty impact the effectiveness of their practice in the field. this study assessed color-blind racial attitudes and attitudes towards poverty of graduating bsw students (n=41) and msw students (n=128) from three accredited social work programs. results indicate a correlation between color-blind racial attitudes and attitudes toward poverty for bsw students, but not msw students. bsw students had fewer color-blind racial attitudes and more favorable attitudes toward poverty than msw students. several predictors of their attitudes were found: their educational status, personal experience of poverty, political ideology, and type of diversity course taken. implications include the need to approach diversity education from an anti-oppression approach. keywords: color-blind racial attitudes; racism; poverty; poverty attribution; social work education social workers need an understanding of diversity and difference to practice competently and effectively with the vast array of clients the profession serves (council on social work education [cswe], 2015). dimensions of difference include race, gender, age, disability, sexual orientation, and socioeconomic status, among other distinct and intersecting factors. beyond awareness of the various diverse identities is the knowledge that these backgrounds and identities may potentially influence one’s experiences and outcomes, such as poverty, discrimination, marginalization, privilege, and power (cswe, 2015). this understanding is essential, more so than ever before as the u.s. population continues to grow and become more diverse (u.s. census bureau, 2017a), and the political climate includes increased attention on the extrajudicial killing of unarmed black people, among other racially motivated injustices (pew research center, 2016). however, the extent to which workers engage diversity in practice and provide culturally competent services is shaped by the overall attitudes and beliefs that they hold about the social groups to which their clients belong (clark, 2007; hill et al., 2016; hudgins, 2015; van voorhis & hostetter, 2006). for example, despite african americans accounting for only 22% of those in poverty, compared to whites who make up 43% (u.s. census bureau, 2017b), african americans are often portrayed as the face of poverty in the u.s. this has further cultivated negative attitudes about african americans and the causes of poverty, which can impact social work practice. the more negative attitudes held about individuals in a certain group, the less likely a practitioner will provide effective services to members of that group (fitzgerald & hurst, 2017). https://creativecommons.org/licenses/by/4.0/ constance-huggins et al./race still matters 133 within american society, there are two broad and overarching narratives illuminating the attitudes about poverty and people who are poor. first is the narrative that poverty is the result of individual deficits or failures. this set of attitudes about poverty is akin to color-blind racial attitudes. since the civil rights movement, color-blind racial attitudes have been the dominant ideology held and taught in the u.s. (bonilla-silva, 2006; neville et al., 2000). this false belief contends that race does not matter and does not play a role in shaping outcomes. it perpetuates racism and white privilege by not acknowledging and addressing the very real disparities that exist between white people and people of color. a corollary argument could be made about the presence and impact of poverty: individuals are impoverished because of poor choices and personal shortcomings, rather than inequitable societal structures. on a micro level, social workers endorsing this attitude may engage in approaches to service delivery that ignore race and cultural differences, including norms, values, and strengths. on a macro level, social workers may fail to advocate for systemic change to ameliorate racism and white privilege (abrams & moio, 2009). the second narrative is that poverty is the result of structural or systemic failures, such as insufficient employment opportunities and low-paying jobs (hill et al., 2016; rank, 2006). from this perspective, social identities such as race and social class are considered overlapping and interconnected and may confer differing levels of privilege and disadvantage (collins & bilge, 2016). a growing body of research has documented the intersection of social identities and their effects on social and economic outcomes (e.g., black & veenstra, 2011; caiola et al., 2014). although attitudes toward race and poverty have been studied separately, little is known about their relationship or their responsiveness to pedagogical practices within social work education. more understanding is needed about the relationship between attitudes toward race and poverty, as these attitudes affect the strategies used to address persistent and pervasive inequities. minimal research exists on color-blind racial attitudes among social workers (loya, 2011) or social work students (davis, 2019), and to our knowledge, no research exists on the relationship between social work students’ endorsement of color-blind racial attitudes and their attitudes towards poverty. additionally, understanding how social workers think about and understand the causes of poverty is imperative since these attitudes in turn affect the strategies and policies they suggest to address poverty (weaver & yun, 2011). therefore, the current study examined the association between color-blind racial attitudes and poverty attributions among social work students preparing to graduate. the goal of the inquiry was to inform the inclusion and delivery of content on race and poverty within social work education. advances in social work, spring 2020, 20(1) 134 literature review color-blind racial attitudes and social work color-blind racial attitudes describe the belief that “race should not and does not matter” (neville et al., 2000, p. 60). more specifically, if race does not have a salient role in affecting people’s experiences and outcomes, then it should be de-emphasized. however, critical race scholars have documented the opposite, i.e., the reality of colorcoded differences in society, as well as the unique experiences of people of color (bonillasilva, 2006; delgado & stefancic, 2017; neville et al., 2000). thus, race still matters. recent research on implicit bias challenges the notion of a color-blind racial ideology; it would be harmful—and impossible—to espouse these attitudes when socialization about race is deeply and often unconsciously held (fitzgerald & hurst, 2017). there are three main tenets of color-blind racial attitudes. first, there is a denial of white privilege, where people do not acknowledge that white people receive societal benefits by virtue of their skin color. second, the existence of structural discrimination is denied, which implies that policies and programs are neutral in their impact on people of color. the final tenet is a lack of awareness of discrimination. many who hold this belief feel as though the u.s. has arrived at a post-racial society, where discrimination is a matter of the past. scholars have theorized that color-blind racial attitudes can negatively impact behavior, thereby impacting the quality of services provided by helping professionals. for example, burkard and knox (2004) presented 247 psychologists with vignettes of clients from different racial backgrounds. the participants who endorsed more color-blind racial attitudes had more difficulty empathizing with black clients and were more likely to attribute responsibility to their clients. despite the potential impact on practice, only a few empirical studies exist on color-blind racial attitudes in social work. existing studies begin to document the presence of these attitudes among social workers. for example, using the oklahoma racial attitude scale, loya (2012) found that over one-third of a sample of white social workers had negative racial attitudes. specifically, they were categorized as being dominative and conflictive. individuals holding the conflictive negative attitudes do not condone racism but oppose policies like affirmative action for minorities based on the assumption that the u.s. already promotes equal opportunity (la fleur et al., 2002). those with “dominative” attitudes deny the persistence of racism and uphold stereotypes of racial minorities (la fleur et al., 2002). less is known about the presence of color-blind racial attitudes among social work students. however, a growing body of literature demonstrates cause for concern. in one recent study, social work students who demonstrated more knowledge about the civil rights movement endorsed fewer color-blind racial attitudes (davis, 2019). it appears difficult for students to deny the effects of racism and white privilege when they possess knowledge about historical oppression and its legacy. color-blind racial attitudes have also been explored among students in related disciplines. neville et al. (2006) found that psychology students and mental health workers who held more color-blind racial attitudes had lower self-reported multicultural counseling awareness and knowledge and lower multicultural case conceptualization ability. this link between racial attitudes and effectiveness in practice points to the need for research to examine this connection. constance-huggins et al./race still matters 135 endorsement of color-blind racial attitudes may relate to a person’s socialization, lived experience, and educational attainment. beginning early in life, white people are socialized “to see everyone as equal and as individuals rather than as members of a particular ethnic group” (ryan et al., 2007, p. 618). conversely, people of color have lived experiences that confirm the reality of racism and influence their beliefs about race and ethnicity. people from other marginalized groups, such as women and members of the lgbtq community, may also be more cognizant of power differentials and injustice. further, individuals with multiple intersecting oppressed identities, such as being black and a woman, are even less likely to endorse color-blind racial attitudes (neville et al., 2000, 2014). education level and collegiate lived experience also influence the development of color-blind racial attitudes. with a sample of practicing social workers (n=179), bsw-level workers demonstrated less awareness of color-blind racism and racial privilege than their msw counterparts (loya, 2011). further, in a longitudinal study of white college students (n=847), neville and colleagues (2014) found that those who engaged in a greater number of diversity experiences (e.g., diversity-related courses and activities) and those who had a greater number of close black friends held fewer colorblind racial attitudes after four years in college. attitudes toward poverty and social work social work has a long tradition of addressing poverty and serving the poor. from the earliest days of the profession, charity organization societies coordinated efforts to address urgent urban social problems affecting individuals, families, and communities. their activities would later develop into well-known approaches to social work practice, including casework, family counseling, and community organizing (zastrow, 2013). friendly visitors of the charity organization societies closely monitored the requests for assistance from those in need, and encouraged the poor to be thrifty, pursue work, and become self-sufficient. the profession continues to address poverty and works to ameliorate its deleterious effects. in fact, the national association of social workers’ (2017) code of ethics states that the mission of the profession is: “to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (para. 1). given this overarching and clear mission to improve the lives of marginalized and impoverished communities, social work students are socialized into the values of the profession early in their educational training, and as practicing professionals they are expected to develop the ability to advance social and economic justice (cswe, 2015). the extent to which social work education fulfills this expectation is unclear. krumer-nevo et al. (2009) argue that social work educators cover poverty in an “extraordinarily superficial manner” (p. 226), which renders it a “marginal issue in social work practice” (p. 225). several studies have explored the effect of social work education on students’ commitment to the mission of the profession. mizrahi and dodd (2013) followed a cohort of msw students who were asked to rank the importance of the goals of the profession. at both the beginning and end of their studies, students endorsed the same primary goal of the profession: “to work to improve the conditions and quality of life for vulnerable/oppressed advances in social work, spring 2020, 20(1) 136 communities and populations” (p. 588). clark (2007) had similar findings with a 14-year study of msw students’ (n=2,213) perceptions of poverty. students began their graduate studies with a preference for societal/institutional methods for addressing poverty over individual adaptation, and by graduation, this preference persisted and increased. it appears as though the profession may attract students who already possess a commitment for addressing issues of social injustice and poverty rather than creating such commitments though pedagogical practices. professional attributions of poverty. explanations of the causes of poverty generally fall under three dimensions, as delineated by feagin (1972): individualistic, structural, and fatalistic. the individualistic explanation suggests that poverty is the result of personal failure and deficits such as laziness, lack of morals, and lack of middle-class values and beliefs. the structural explanation suggests that people are poor because of structural deficits such as lack of jobs, discrimination, and economic policies. the fatalistic explanation suggests that people are poor because of bad luck, or destiny, accordingly there is nothing they can do to escape poverty (weiss-gal et al., 2009). understanding social workers’ attribution of the causes of poverty is essential because perceptions influence behavior in practice, as well as relative support for policies to address poverty. robinson (2011) found that social workers who were more likely to attribute poverty to a breakdown in family were more likely to support the restrictive features of the temporary assistance to needy families program, such as time limits on benefits and family caps. in a qualitative study, carlson (2016) found that how child welfare workers explained the construct of poverty had implications for the services provided and the realms in which they sought to effect change. the influence of personal factors. just as racial attitudes are influenced by social identities and lived experiences, these personal factors have been found to affect social work students’ perceptions of poverty. using a sample of social work students (n= 264) from two western universities, castillo and becerra (2012) found that white students and male students were more likely than their counterparts to believe that people were poor because of individual shortcomings. those students who experienced poverty as a youth were less likely to attribute poverty to a lack of desire to work. in terms of educational status, castillo and bacerra (2012) found that msw students were more like to agree that poverty is the result of social-structural factors than bsw students. this study used a brief, researcher-constructed instrument to measure beliefs, and could be repeated using an instrument with demonstrated reliability and validity. in an earlier study of only undergraduates (n=119), schwartz and robinson (1991) found that bsw students developed beliefs about the causes of poverty that are consistent with the profession’s values, and as students approached graduation, they had a greater ability to differentiate between feagin’s (1972) three explanations of poverty. these studies lend support to further investigating the relationship between educational status and attitudes about poverty. constance-huggins et al./race still matters 137 relationship between color-blind racial attitudes and attitudes towards poverty presently, there are no empirical studies directly linking the endorsement of color-blind racial attitudes and attitudes to poverty. the ideas, however, are connected conceptually through frameworks such as critical race theory (delgado & stefancic, 2017; milner, 2013). attitudes towards poverty and color-blind racial attitudes are intrinsically linked when individuals espouse the belief that we are living in a world that is fair, just, and equitable, and that the causes of injustice fall squarely on the shoulders of individuals (lerner, 1980). furnham (2003) surmises that adopting beliefs that the world is just and equitable provides “psychological buffers against the harsh realities of the world as well as personal control over one’s own destiny” (p. 796). in essence, people long to feel as if they have done nothing to deserve negative outcomes that others experience and can deny the presence and effects of oppression and privilege. both color-blind racial attitudes and attitudes towards poverty are suggestive of the notion that the more strongly individuals believe that the world is just and equitable, the more strongly they would support the use of color-blind racial attitudes and individualistic causes of poverty as the means by which to explain racial and social class disparities, respectively. furthermore, individuals who believe that the world is fair and just are more likely to engage in victim-blaming and less likely to attribute the cause of social injustice, such as poverty and racism, to structural issues (bonilla-silva, 2006; feagin, 1972; neville et al., 2000). in essence, both color-blind racial attitudes and attitudes towards poverty minimize the role of structural factors in shaping individual outcomes and proposing realistic, equitable solutions. research questions based on the hypothesized conceptual link between color-blind racial attitudes and attitudes towards poverty, this study examined these attitudes among social work students. the study tested three hypotheses: a) there will be a negative correlation between colorblind racial attitudes and attitudes towards poverty; b) msw students will endorse more structural explanations of poverty than bsw students; c) msw students will have lower levels of color-blind racial attitudes than bsw students. additionally, the literature review supports the investigation of student-specific characteristics as possible predictors of students’ attitudes, including racial background, educational status (msw or bsw), personal experience of poverty, political ideology, and type of diversity course taken (bray & balkin, 2013; griffin & oheneba-sakyi, 1993; robinson, 2009; toporek & pope-davis, 2005). methods procedure convenience sampling was used to recruit participants at three cswe-accredited institutions: two private urban colleges in the northeast and one public university in the southeast. researchers administered a survey with standardized measures, as well as researcher-created questions to elicit information about demographic variables and courses taken. when completed together, the survey elucidated information about the background advances in social work, spring 2020, 20(1) 138 of students relative to their interactions with poverty and education as well as their attitudes about race and poverty. prior to data collection, the study was granted approval from the institutional review board. data were collected using both an electronic survey hosted by qualtrics and a paperand-pencil version. electronic data acquisition began with students reading an informed consent statement and then deciding whether to proceed with the online survey. penciland-paper data acquisition consisted of the distribution of a hard copy of the survey at the beginning of social work practice classes for both bsw seniors and graduating msw students with the permission of the instructors of those classes. again, students could read the informed consent and decide whether to proceed with the survey. at one of the sites, data were collected both ways to reach the most students. participation was voluntary, and no identifying information about the student or institution was collected. the response rate is not known due to the sampling method. nine online surveys were started but not finished; with less than 30% of the survey completed, these surveys were discarded as unusable. the remainder of the surveys (n= 169) were completed in their entirety with no missing data. student-specific variables. demographic variables in this study included age, gender (male, female, non-binary), race (white or person of color), student location (northeast or southeast), and educational status (undergraduate bsw or graduate msw). in addition to basic demographic variables, information about the students’ early life and family was obtained, including eligibility for free and reduced lunch (frl) in childhood (no = 0 and yes = 1), and whether or not their parents had a college degree (no = 0 and yes = 1). lastly, students were asked to report their political leanings (left, center, or right) and their current economic standing (i often go without basic needs, i sometimes go without basic needs, i never have any extra but my needs are met, i have enough money to meet my needs and a bit extra, or i have plenty). the categories of economic standing were used with permission from gentlewarrior et al. (2008). social work education variables. respondents were asked to provide information about their social work education experience by reporting whether they had taken a class related to diversity (no = 0 and yes = 1) and if they reported taking such a course, they were asked about its focus (multiculturalism or anti-oppression). multicultural education was described as increasing awareness about cultural norms and beliefs, and learning about diverse populations; anti-oppression education was described as confronting unequal power dynamics in society that reinforce oppression and privilege (morelli & spencer, 2000). color-blind racial attitudes. the color-blind racial attitudes scale (cobras; neville et al., 2000) is a 20-item instrument that aims to measure three constructs: unawareness of racial privilege (e.g., “everyone who works hard, no matter what race they are, has an equal chance to become rich”), unawareness of institutional discrimination (e.g., “social policies, such as affirmative action, discriminate unfairly against white people”), and blatant racial issues (e.g., “racial problems in the u.s. are rare, isolated situations”). participants indicated their level of agreement with each statement using a 6-point likerttype scale from 1 (strongly disagree) to 6 (strongly agree). several items were reverseconstance-huggins et al./race still matters 139 scored. higher scores indicated a greater unawareness or denial of racism. the cobras was normed with a social desirability scale, making it less likely that participants’ responses reflect this bias (neville et al, 2000). previous studies have established that cobras is both reliable and valid with cronbach alpha scores ranging from α = .68 twoweek test-retest reliability to α= .80 internal consistency for the unawareness of racial privilege subscale (neville et al., 2006; neville et al., 2000). attitudes towards poverty. the short form of the attitudes toward poverty scale (atp; yun & weaver, 2010) is a 21-item instrument that measures attitudes related to poverty and poor people. the atp aims to measure three attitudes: personal deficiency (e.g., “children raised on welfare will never amount to anything”), stigma (e.g., “an ablebodied person collecting welfare is ripping off the system”), and structural perspectives (e.g., “poor people are discriminated against”). participants indicated their level of agreement with each statement using a 5-point likert-type scale from 1 (strongly agree) to 5 (strongly disagree). several items were reverse-scored. higher scores indicate greater belief in the structural explanation of poverty, while lower scores indicated greater belief in individual explanations of poverty. this measure has been found to be both reliable and valid with cronbach’s alpha ranging from α = .93 upon assessment of internal consistency and a split-half reliability of α = .87 (yun & weaver, 2010). data analysis descriptive statistics were analyzed to categorize students’ demographics and characteristics, and assess their scores on the overall cobras, three cobras subscales, overall atp score, and three atp subscales. additionally, several tests of inferential statistics were conducted in order to gain further insight into relationships among variables including the relationship between color-blind racial attitudes and attitudes towards poverty, which enabled insight into the first aim of the study. t-tests were conducted to compare the scores between bsw and msw students on both measures, and correlations were conducted to assess the relationship between cobras and atp for bsw and msw students, respectively, illuminating insight into the second aim of the study. lastly, a stepwise linear regression was conducted to assess the demographic and educational determinants of color-blind racial attitudes and attitudes toward poverty to provide insight into the third aim of the study. it was important to assess not only the overall differences between msw and bsw students, but other variables that may contribute to lower levels of color-blind racial attitudes in students. ibm spss (version 21.0) was used to perform the statistical analyses. findings sample the sample comprised 41 bsw seniors and 128 msw students who intended to graduate in may 2017. participants were asked to self-identify their social identities. table 1 displays demographic and student-specific descriptive statistics. bsw students primarily identified their race as white (63%), their gender as female (88%), and their political tendency as liberal (64%). their ages ranged from 21-35, with a mean of 21.5 years old. advances in social work, spring 2020, 20(1) 140 the largest proportion of students (42%) described their economic situation as “always having enough money to meet my needs and a little bit extra.” growing up, just under half (47%) were eligible for free or reduced-fee lunch, and just over half (53%) had at least one parent who earned a college degree. table 1. demographic information (n=169) most of the msw students identified their race as white (66%), their gender as female (89%), and their political ideology as liberal (89%). their ages ranged from 21-49, with a mean of 28.4. as with the bsw students, most of the msw students (54%) described their economic situation as “always having enough money to meet my needs and a little bit n (%) bsw msw all educational status 41 (24.3%) 128 (75.7%) 168 (100%) ethnicity white 15 (36.6%) 84 (65.6%) 99 (58.6%) person of color 26 (63.4%) 43 (33.6%) 69 (40.8%) gender female 35 (85.4%) 110 (85.9%) 145 (85.8%) male 4 (9.8%) 9 (7%) 13 (7.7%) non-binary/queer 1 (2.4%) 4 (3.1%) 5 (3%) political ideology liberal 31 (75.6%) 102 (79.7%) 133 (78.7%) conservative 8 (19.5%) 16 (12.5%) 24 (14.2%) eligible for free & reduced lunch yes 18 (43.9%) 42 (32.8%) 60 (35.5%) no 20 (48.8%) 82 (64.1%) 102 (60.4%) parental college degree yes 22 (53.7%) 86 (67.2%) 108 (63.9%) no 16 (39%) 38 (29.7%) 54 (32%) economic status often go without basic needs 0 (0%) 0 (0%) 0 (0%) i sometimes go without basic needs 4 (9.8%) 10 (7.8%) 14 (8.3%) i never have extra but my needs are met 12 (29.3%) 34 (26.6%) 46 (27.2%) having enough money to meet my needs and a bit extra 16 (39%) 67 (52.3%) 83 (49.1%) have plenty-well off 5 (12.2%) 17 (13.3%) 22 (13%) taken a diversity course yes 36 (87.8%) 118 (92.2%) 154 (91.1%) no 2 (4.9%) 7 (5.5%) 9 (5.3%) type of diversity course taken multicultural 8 (19.5%) 31 (24.2%) 39 (23.1%) anti-oppressive 28 (68.3%) 84 (65.6%) 112 (66.3%) constance-huggins et al./race still matters 141 extra.” growing up, approximately half (51%) were eligible for free or reduced-fee lunch, and just over half (56%) had at least one parent who earned a college degree. most bsw students (87.7%) and most msw students (92%) had taken at least one diversity-related course during their social work education. the students who had taken such a course tended to describe it as having an anti-oppression focus, rather than a multicultural approach. aim 1: there will be a negative correlation between color-blind racial attitudes and attitudes towards poverty: the more color-blind racial attitudes held, the fewer structural explanations of poverty are endorsed. no correlation emerged between atp and cobra for msw students. however, for bsw students, there was a strong negative correlation between the total scores (r= -0.66; p < 0.001) and most of the subscales. all three subscales of the cobra scale were correlated with the total atp scale as well as the stigma subscale and the structural perspective subscale, but not the personal deficiency subscale. at the undergraduate level, there was a negative correlation between color-blind racial attitudes and attitudes towards poverty (see table 2). table 2. correlations among color-blind racial attitudes and attitudes towards poverty scales & subscales scales and subscales correlations (significance) attitudes toward poverty total deficiency stigma structural perspective graduate students color-blind racial attitudes total 0.096 (.28) 0.129 (.15) 0.067 (.45) 0.037 (.68) unaware -0.018 (.84) 0.075 (.40) -0.051 (.57) -0.053 (.55) discrimination 0.157 (.08) 0.157 (.08) 0.120 (.18) 0.105 (.24) racial issues 0.144 (.10) 0.010 (.24) 0.153 (.08) 0.064 (.47) undergraduate students color-blind racial attitudes total -.660 (<.001) -0.23 (.15) -0.613 (<.001) -0.712 (<.001) unaware -0.527 (<.001) -0.090 (.57) -0.497 (<.001) -.062 (<.001) discrimination -6.87 (<.001) -0.32 (.04) -0.641 (<.001) -0.653 (<.001) racial issues -0.547 (<.001) -0.228 (.15) -0.488 (.012) -0.586 (<.001) aim 2: msw students will endorse more structural explanations of poverty than bsw students. significant differences existed between bsw and msw students in their attitudes towards poverty. bsw students had significantly higher scores (m= 92.2 sd=10.46) than msw students (m=87.1 sd= 11.26; t(167)= 2.45, p < .05). this means that bsw students were more likely to espouse the structural explanations of poverty. additionally, there was a statistical difference between bsw students (m=26.6, sd=3.51) and msw students (m= 24.9 sd= 3.37; t(167)= -2.73, p < .01) on the structural perspective sub-scale, indicating that bsw students were more likely than their msw counterparts to attribute poverty to structural forces. there were no statistical differences for the personal deficiencies and stigma sub-scales (see table 3). thus, the second hypothesis was not supported as the more structural attitudes were seen for bsw students, not msw students. advances in social work, spring 2020, 20(1) 142 table 3. relationships between color-blind racial attitudes and attitudes towards poverty by educational status scales and subscales mean (sd) t-test msw (n=128) bsw (n=41) color-blind racial attitudes total 39.4 (12.9) 34.5 (12.8) -2.15* unawareness 15.9 (6.0) 13.5 (5.8) 2.26* institutional discrimination 14.6 (5.6) 13 (5.4) 1.60 blatant racial issues 8.9 (3.3) 7.9 (3) 1.66 attitudes towards poverty total 87.1 (11.3) 92.2 (10.5) 2.45* personal deficiency 30.1 (4.1) 31.3 (3.6) 1.73 stigma 32.2 (6.4) 34.2 (5.8) 1.72 structural perspective 24.9 (3.4) 26.6 (3.5) -2.73** p < .05* p < .01** aim 3: msw students will have lower levels of color-blind racial attitudes than bsw students. in terms of color-blind racial attitudes, there was a statistically significant difference between bsw and msw students. specifically, bsw students had significantly lower cobra scores (m=34.5 sd=12.79) while msw students were nearly five points higher (m= 39.4 sd=12.93; t(167)= -2.15, p < .05). this meant that msw students had greater unawareness or denial of racism. upon closer inspection of sub-categories, bsw students were significantly more aware of racial privilege (m= 13.5 sd=5.81) than were the msw students (m= 15.9 sd=5.96; t(167)= 2.26, p < .05). again, this was not the hypothesized finding, as the lower levels were seen for bsw students. linear regression analyses a stepwise linear regression was conducted to assess the extent to which demographic and educational achievement were determinants of color-blind racial attitudes. the educational status of students (bsw or msw) explained variations in racial attitudes, with master's level students having higher cobra scores than undergraduates (see table 3).the type of diversity training received also helped to explain variation in cobra scores. students who perceived their diversity class to focus on anti-oppression had lower cobra scores. poverty status as a youth, as measured by being eligible for free or reduced lunch, also explained the variance in cobra scores. individuals who were eligible to receive free or reduced lunch had lower cobra scores (see table 4). racial background, political ideology, and current economic standing were additional independent variables that were assessed but lacked sufficient statistical significance to be included in the model. stepwise linear regression was also used to assess the demographic and educational correlates of poverty attitudes to gain further insight into the unexpected and interesting findings observed with regard to two of the three study aims. as is shown in table 5, the educational status of students was a significant determinant of attitudes. the data reveal that masters level students had lower scores indicating greater belief in the individual explanation of poverty. the type of diversity class that students took was also associated with attitudes toward poverty. students who perceived their diversity course to focus on anti-oppression, rather than multicultural education, were more likely to subscribe to the constance-huggins et al./race still matters 143 role of inequitable structures in causing poverty. political affiliation also affected poverty attitudes. compared to liberals, conservatives tended to see poverty as a result of individual failure. lastly, attitudes towards poverty are determined by previous experience in poverty. students who were eligible to receive free or reduced lunch as a youth were less likely to blame the individual for poverty. racial background, parents’ level of education, and current economic standing were additional independent variables that were assessed but lacked statistical significance, and thus, were not associated with attitudes toward poverty. discussion this study explored color-blind racial attitudes and attitudes about poverty among social work students in three cswe-accredited schools of social work. results from this study were both surprising and affirming. the hypotheses that undergirded this study were that msw students, having benefitted from greater instruction and exposure to diversity content, would hold fewer color-blind racial attitudes and possess a greater appreciation for the structural forces that create a system of poverty. counter to the hypothesized results, findings from this study indicate that bsw students were more likely to have lower scores on the cobra and higher scores on the atp than msw students. these findings indicate that msw students are more likely to deny racism and white privilege and ascribe to the belief that poverty is more situated in individual factors rather than the structural forces that drive oppression. interestingly, the overall and subscale correlations that were observed between the cobra and the atp among the bsw students vanished when examined in the context of msw students. bsw students may learn about the concepts of oppression and privilege during a formative time in their development. often the undergraduate years are a time when students are exposed to new ideas and people, which can powerfully shape their beliefs about diversity and difference. another possible explanation for this finding is that among graduate students, there is a separate phenomenon that was being measured rather than a clear relationship between lower colorblind racial attitudes and attitudes about poverty. it is much easier to teach about these concepts in a classroom where students can gain appreciation for the theoretical mechanisms that produce and support poverty than it is to cope with the harsh realities and disparities that students observe once they begin working in the field. therefore, it is possible that after having spent more time working directly with clients, msw-level social workers are more likely to blame individual clients as it allows for catharsis from the frustrations of dealing with systemic and systematic poverty on a daily basis. some results of this study, however, were consistent with what is known about attitudes towards race and poverty and the importance of social work education. results were consistent with previous studies on students’ attitudes, indicating that anti-oppressive education leads to more awareness of racism and white privilege (abrams & gibson, 2007; abrams & moio, 2009; davis et al., 2014; heron, 2004; singh, 2019; williams & parrott, 2014. this finding supports abrams and moio’s (2009) critique that multicultural education focuses on beliefs and attitudes but does not draw attention to social injustices or structural forces, and thus, fails to mobilize students into social action. constance-huggins et al./the relationship 144 table 4. correlates of color-blind racial attitudes among students cobra total unawareness institutional discrimination blatant racial issues correlates b se t b se t b se t b se t educational status 5.83 2.49 .02 2.14 1.09 .05 2.59 1.11 .021 1.29 .630 .04 geographic location -6.18 3.21 .06 -2.22 1.41 .17 -2.32 1.44 .11 -1.74 .813 .033 course taken -7.24 2.54 .01 -3.88 1.11 .001 -1.96 1.15 .09 -1.34 .649 .042 free or reduced lunch status 4.20 2.21 .06 3.21 1.09 .004 .97 .564 .089 parent college -1.99 1.06 .06 political ideology -1.05 .767 .1730 r2 .017 .213 .086 .139 table 5. correlates of attitudes towards poverty among students atp total personal deficiency stigma structural perspectives correlates b se t b se t b se t b se t educational status -4.71 1.94 0.016 -1.76 .078 .023 -1.82 1.154 .117 -1.18 .58 .04 geographic location 2.93 2.50 .243 2.20 .962 .037 1.20 1.49 .422 .30 .74 .69 course taken 5.82 1.99 .004 3.81 1.18 .002 2.10 .592 .000 free or reduced lunch status -3.69 1.73 .034 -1.86 1.03 .07 -1.44 .51 .006 parent college political ideology -10.01 2.36 .001 -3.68 .70 .000 r2 .278 .057 .14 .34 constance-huggins et al./the relationship 145 additionally, the lived experiences of students prior to entering the program were observed as predictive of their attitudes towards race and poverty. not surprisingly, students who reported being eligible for free or reduced lunch as children were more aware of white privilege compared to those students who did not meet this criterion for lowincome status. based on the just world belief (lerner, 1980), those students with firsthand experience of poverty would be more aware of the role of structural forces, such as white privilege, in shaping people’s lives. in terms of attitudes towards poverty, an expected result is that students who indicated that their diversity course took an anti-oppression approach were more likely to view poverty as a result of structural deficits. this was expected as anti-oppression education emphasizes the role of macro forces in social and economic outcomes. another expected finding was that students who experienced poverty growing up were less likely to perceive poverty as an individual problem. this finding echoes those in castillo and becerra’s (2012) study, as they also found that students who were eligible for free or reduced-fee lunch attributed poverty to individual factors. students who identified with a conservative political ideology were also more likely than their liberal counterparts to blame individuals for their poverty. while social workers who hold conservative views and those who favor liberal views may want to help people who are poor, their beliefs about the cause of poverty may differ greatly, from individualistic to structural to fatalistic (feagin, 1972). these beliefs, in turn, influence the policies and practices that they endorse to ameliorate poverty (rosenwald et al., 2012). limitations this study had a number of limitations. first, the bsw sample size was small and limited power to detect results free from type-1 and type-2 errors. a larger sample size could have yielded more significant findings or perhaps the true nature of the relationships; further research is needed to more fully understand these findings and their meaning. second, the small sample size of overall participants and of bsw students in particular limited the comparison between bsw and msw across institutions or regions. it is possible that regional differences may exist between undergraduate and graduate students; however, we were unable to thoroughly assess those differences. third, this crosssectional study does not capture the students’ attitudes at the beginning of their program and at the end. a pre-/post-test design could provide insights into the efficacy of the pedagogical approaches used in the program and could document changes in students’ thinking over time. further, by examining the syllabi of the diversity courses taken by students, it would be possible to determine whether the course was taught from a multicultural or antioppression approach, and to compare this focus to students’ perception of the course. lastly, this quantitative study does not provide a deep understanding of how students’ attitudes affect their practice, especially in their field placements. despite these limitations, however, the current study is still instructive of students’ attitudes towards race and poverty and points to implications for social work education. advances in social work, spring 2020, 20(1) 146 implications for social work education the findings from this study suggest the need to approach diversity education from an anti-oppression approach. an anti-oppression (or specifically, anti-racist) framework highlights the structural forces in society that affect outcomes for marginalized groups (abrams & gibson, 2007; abrams & moio, 2009). while it is important to develop multicultural knowledge and awareness, ortiz and jani (2010) purport that it does not stimulate students to challenge the just world belief or engage in social action. critical race theory is an example of an anti-oppression approach that can be helpful in raising students’ consciousness about the systems of oppression and privilege (kolivoski, weaver & constance-huggins, 2014). by zeroing in on the racial power struggles in the u.s., critical race theory suggests that racism and white privilege are tightly and invisibly woven into the fabric of society (delgado & stefancic, 2017). secondly, educators can help foster more positive and realistic attitudes about race and poverty by infusing such content across the curriculum and inviting students to reflect on the meaning of their own lived experiences. infusing anti-oppression content across the curriculum, instead of teaching it solely in selected diversity courses, demonstrates a social work program's commitment to social, racial, and economic justice. social work educators need to help students grasp poverty as a social justice issue that can be addressed on all levels of policy and practice (hill et al., 2016). future studies could explore whether and how anti-oppression approaches are used throughout curricula in social work programs that use an infusion model. if these implications are taken in sum and integrated into bsw and msw curricula, perhaps meaningful and permanent gains can be achieved with regard to educating our students about the important issues of race, power, and privilege. such changes are desperately needed in the evolving landscape of social work practice as the u.s. becomes more diverse. further, the current racial and political climate, in which hate crimes are on the rise and black people are the most frequent victims (eligon, 2018), necessitates that social workers are race-conscious and actively work against the systems that reinforce oppression and privilege. social workers engage in clinical practice and policy practice within the very institutions that have long created and reinforced pervasive inequities, and thus, have an opportunity and a responsibility to advocate for justice on both micro and macro levels. further, within agencies and communities, social workers often hold leadership positions in which they can help clients and colleagues challenge their beliefs about why racism and poverty exist, and mobilize together to effect social change. conclusion this study makes an important contribution to the diversity discourse by shedding light on social work students’ attitudes towards race and poverty. given that attitudes shape behavior (carlson, 2016), it is imperative to gauge the attitudes of social work students as they prepare to 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(2013). introduction to social work and social welfare: empowering people. pacific grove, ca: brooks/cole. author note: address correspondence to dr. monique constance-huggins, department of social work, winthrop university, 701 oakland ave., 134 bancroft hall, rock hill, sc 29733. e-mail: hugginsm@winthrop.edu https://doi.org/10.1037/1099-9809.11.3.259 https://www.census.gov/library/stories/2017/08/changing-nation-demographic-trends.html https://www.census.gov/library/stories/2017/08/changing-nation-demographic-trends.html https://www.census.gov/data/tables/2018/demo/income-poverty/p60-263.html https://doi.org/10.5175/jswe.2006.200303147 https://doi.org/10.1080/08841233.2011.539125 https://doi.org/10.1093/sw/54.2.125 https://doi.org/10.1093/bjsw/bcs113 https://doi.org/10.18060/437 mailto:hugginsm@winthrop.edu _______ austin g. oswald, phd student in social welfare, cuny graduate center, new york ny 10016; daniel gardner, professor, hunter college silberman school of social work, new york, ny 10035; nancy giunta, professor, hunter college silberman school of social work, new york, ny 10035 copyright © 2018 authors, vol. 19 no. 1 (spring 2019), 121-137, doi: 10.18060/22613 this work is licensed under a creative commons attribution 4.0 international license. the lgbt elder americans act: a critical analysis of policy through life course and equity perspectives austin g. oswald daniel gardner nancy giunta abstract: the social positioning of lesbian, gay, bisexual, and transgender (lgbt) older adults is influenced by a constellation of historic and contemporary policies that shape the way they interact with the world around them. although the past few decades have witnessed several legislative decisions that reflect a more open stance toward lgbt individuals, there remains a lack of federal policies that protect them. this paper provides a critical analysis of the lgbt elder americans act of 2019, a bill amending the older americans act of 1965 to include lgbt older adults in the definition of those with “greatest social needs” for the purpose of service planning and implementation. as a theoretical framework, we apply a life course perspective and an equity lens to examine the promise and limitations of the lgbt elder americans act in meeting the needs of lgbt older adults. it is critically important for social work practitioners, policy makers, and scholars to understand the principles that drive policy debates so that they can advocate on behalf of the most vulnerable members of the population. we offer three recommendations for future policy making: i) apply a life course perspective to understand the lived experiences of lgbt elders; ii) apply an equity lens to public policy; and iii) expand research to guide and advance policy development. keywords: gerontology; policy change; sexual orientation; gender identity; lgbt; older adults; lgbt elder americans act the population in north america is becoming older and more culturally diverse, and will continue to do so well into the future. although the united states does not collect consistent and accurate data on sexual orientation and gender identity, it is estimated that the number of lesbian, gay, bisexual, and transgender (lgbt) adults over age 65 is between two and seven million (grant et al., 2010). the growing number of lgbt older adults in the u.s. suggests an essential role for social workers and policy makers who are concerned with developing ethically and culturally responsive policies that address the complex and multifaceted needs of a diverse and often marginalized aging population. this paper provides a critical historical analysis of the lgbt elder americans act, h.r. 1777 (2019) reintroduced to the 116th congress. the bill, introduced in both branches of the 115th congress (s. 2089 and h.r. 4222), and then only to the house of representatives in the 116th congress (h.r. 1777), proposes to amend the older americans act of 1965 to include lgbt older adults in the definition of those with “greatest social needs” for the purpose of service planning and implementation. the authors present an historical overview of the proposed bill, its anticipated aims, and its potential impact on service recipients. we then apply a life course perspective and an equity lens to frame the advances in social work, spring 2019, 19(1) 122 analysis and highlight the strengths, challenges, and ideological principles underlying the bill. ultimately, we aim to provide social work practitioners, policy makers, and scholars with a more critical understanding of the lgbt elder americans act and its socio-political contexts. historical background lgbt older adults represent a highly diverse, distinct, and rapidly growing segment of the population. the past few decades have seen unprecedented increases in lgbt visibility as several policies and legal decisions have begun to reflect a more open stance toward them. the supreme court decision in obergefell v. hodges (2015), for example, confirmed the fundamental right to marry among same-sex partners for the first time in u.s. history. the advent of nondiscrimination policies in some state and municipal jurisdictions has made lgbt people a protected population under the law (movement advancement project, 2019). although in the last decade several policy changes have been enacted that protect the rights of lgbt people, most lgbt older adults have lived the majority of their lives within an oppressive social system (kite & byrant-lee, 2016). thus, in order to evaluate the impact of social policy on the lives of lgbt elders, we must understand their socio-political context from a life course perspective. several pivotal moments throughout history have contributed to the advancement of lgbt rights. parks (1999) identifies three distinctive periods in lgbt history (the prestonewall, liberation, and gay rights) and explains that each era represents a unique cultural standpoint, political struggle, and societal attitude toward lgbt people. she notes that adults 65 and older who came of age prior to gay liberation in the 1960s-1980s experienced intense stigmatization. others have found that widespread discrimination throughout u.s. history created a culture of fear and stigmatized identity for lgbt people. for example, a qualitative study of 37 lesbian and gay people who came of age prior to gay liberation found that many of the participants described a stigmatized identity rooted in layers of discrimination where they judged others and themselves for their sexual orientation (rosenfeld, 1999). rosenfeld concluded that many lesbian and gay people in this age cohort managed their sexual orientation by concealing their identity and passing as heterosexual in their public and private lives. the late 20th century marked dramatic shifts in societal attitudes toward lgbt people. prior to this period, lgbt status was criminalized and pathologized in most jurisdictions. many policies and laws of this time were largely oppressive and punitive, including the “lavender scare” of the 1950s, which propagated the belief that lesbian and gay people were communists and therefore represented serious security risks. executive order 10450, signed by president eisenhower in 1953, permitted investigation of and overt discrimination toward federal lesbian and gay employees, and created widespread job insecurity and terminations (national archives, 2016). additionally, anti-sodomy laws criminalized same-sex desires up until the supreme court decision lawrence v. texas (2003) and permitted law enforcement to raid lgbt establishments and prosecute people for expressing their sexual orientation and gender identity (kane, 2003). finally, the term “homosexuality” was included as a mental disorder and classified as “paraphilia” and “sexual orientation disturbance” in the diagnostic and statistical manual of mental oswald et al./lgbt elder american act 123 disorders (dsm) until 1973 (american psychiatric association, 1974). lgbt people were stigmatized and pathologized within medical communities, and this resulted in many being subjected to aggressive medical treatments such as electroconvulsive therapy to “cure” their mental disease (drescher, 2015; pillard, 2009). the most recent edition of the dsm replaced the diagnosis of “gender identity disorder” with “gender dysphoria,” acknowledging that gender variance in itself is not a clinical disorder (american psychiatric association, 2013). the fight for civil rights for lgbt people was brought to light through social movements and resistance (murib, 2017). the mattachine society, homophile movement, and daughters of bilitis in the 1950s; the stonewall riots in 1969; and the efforts of actup on behalf of people living with aids during the 1980s and 1990s, for example, challenged dominant assumptions about acceptable human behavior (d’emilio, 1998). these lgbt political movements increased the visibility of discrimination based on sexual orientation and gender identity. they also provide evidence for the role of advocacy in advancing social justice, and illustrate the dynamic nature of social change. although strides have been made, progress is tenuous and more work is needed in the ongoing struggle for lgbt rights. even with recent developments in lgbt rights, many lgbt elders continue to carry the weight of their prior historical times (fredriksen-goldsen, 2011; herek, chopp, & strohl, 2003; institute of medicine [iom], 2011; meyer, 2003; oswald & roulston, 2018). thus, their social positioning must be understood from an historical perspective that takes into account their experiences with discrimination and stigmatization. social positioning of lgbt elders several studies have found that lgbt elders encounter financial difficulties that are a result of their minority status (emlet, 2016; espinoza, 2014). the distinct financial concerns of lgbt people can be linked to discriminatory laws that increase their risk for economic insecurity. u.s. 20th century laws permitted overt discrimination of lgbt people in the workforce and created uncertainty for many, resulting in cumulative financial disadvantage in later life. espinoza (2014) conducted a large survey of lgbt people between the ages of 45 and 75, and found that 51% of the older lgbt subjects reported extreme concerns that they would be unable to support themselves in later life. financial distress reported by the participants in espinoza’s study is corroborated by research that points to high rates of poverty among lgbt adults in the u.s., with transgender elders and lgbt elders of color being the economically worst-off and most reliant on public assistance (badgett, lau, sears, & ho, 2007; dodd, 2014; emlet, 2016; espinoza, 2014) lgbt older adults also experience unique relational constraints that shape their social networks and family structures. heteronormative laws that prohibited same-sex unions, policed gender expression, and criminalized/pathologized people’s desires have influenced the social connections of lgbt elders. lgbt older adults often lack critical social and familial supports; they are less likely to be in relationships, less likely to have children, more likely to live alone, and more likely to report excessive loneliness (espinoza, 2014; fredriksen-goldsen, 2011; metlife, 2010). they are more reliant on friends than family for instrumental and emotional support (shippy, cantor, & brennan, 2004; smith, mccaslin, advances in social work, spring 2019, 19(1) 124 chang, martinez, & mcgrew, 2010). studies have also found that lgbt individuals experience robust social networks with meaningful relationships and social connections (grossman, d’augelli, & hershberger, 2000; mcgovern, gardner, brown, & gasparro, 2017). discrimination against lgbt elders has negative implications for health outcomes, which scholars have linked to a number of health disparities (fredriksen-goldsen, 2011; iom, 2011). a growing body of literature documents a wide range of risk factors, health outcomes, and health care experiences among lgbt people. for example, lesbian woman are less likely to have health insurance and to seek preventive care (valanis et al., 2000; zaritsky & dibble, 2010), and gay men are disproportionately affected by hiv/aids compared to their non-lgbt age peers (brennan-ing, seidel, larson, & karpiak, 2017; snyder, 2011). there is a dearth of empirical research about transgender and bisexual health, but evidence is emerging that uncovers serious health disparities. transgender people experience elevated rates of hiv/aids and are less likely to have health insurance when compared to the general population (clements-nolle, marx, guzman, katz, 2001). people who identify as bisexual more often report poor physical and psychological health outcomes (fredriksen-goldsen, 2011; gonzales & henning-smith, 2017; veenstra, 2011). overall, lgbt older adults rate their health more poorly than their non-lgbt aged peers (emlet, 2016; fredriksen-goldsen, 2011). minority stress theorists attribute lgbt health inequities to oppressive social structures, suggesting that lgbt people experience chronic stress as a result of stigmatization (meyer, 2003). older lgbt individuals may be especially vulnerable to minority stress as they have lived the majority of their lives in a heterosexist and homophobic/transphobic culture. it is important to note that lgbt elders are a heterogeneous population with intersecting oppressions of race, gender identity, class, immigration status, disability, and sexual orientation. studies that compare the health of lgbt older adults with the general population have found substantial inequities within and across the lgbt population (fredriksen-goldsen, 2011). collins (2000) explains that systems of inequity are interconnected and shape an individual’s social location and interactions with the world. research shows that individuals with multiple marginalized identities face multiple forms of discrimination that converge into social, health, and financial disparities (carter & reardon, 2014; maccartney & fuwa, 2006; veenstra, 2011). although less is known about the impact of intersecting oppressions in the older lgbt community, research points to heightened disparities for them (van sluytman, 2013). balsam, molina, beadnell, simoni, and walters (2011) found that lgbt people of color experience psychological distress resulting from racism in the lgbt community and heterosexism in racial/ethnic communities. francis and acey (2013) suggest that homophobia and transphobia are more prevalent in racial and ethnic minority communities, resulting in lgbt elders of color experiencing an exacerbated sense of isolation. the current u.s. wage gap is magnified for people with intersecting oppressed identities, which is associated with significant financial difficulties in later life, particularly for women of color, immigrants, and lgbt individuals (badgett et al., & ho, 2007; chapman & benis, 2017; smith & fernandez, 2017). maccartney and fuwa’s (2006) study on intersecting inequality found that individuals are penalized for oswald et al./lgbt elder american act 125 each of their marginalized statuses, which has a cumulative effect resulting in disadvantage. lgbt elders constitute a diverse group of individuals that occupy multiple intersecting identities and social positions. historic and current u.s. policies, whether seemingly neutral or openly discriminatory, have had a profound impact on the social positioning of lgbt elders. although a number of discriminatory policies have been resolved in recent times, lgbt elders continue to be affected by a lack of comprehensive federal protections. political discourses and lgbt aging in contemporary politics, the constructs of sexual orientation and gender identity, as well as lgbt policy making and advocacy, may be understood within the context of two divergent political ideologies: social democracy and social conservativism. these two political ideologies proffer opposing views about lgbt individuals and legislation upholding their human rights and dignity. social democracy places emphasis on liberal democratic participation and humanitarianism. it supports legislation like the lgbt elder americans act because it aims to improve the lives of lgbt individuals by dismantling economic and sociostructural forces that prevent lgbt elders from realizing their full potential (mullaly, 2007). social democracy argues that it is the responsibility of government to ensure the welfare of all citizens, and pro-lgbt legislation is one strategy to offset the injustices that lgbt elders face. on the other hand, social conservativism is rooted in moral principles and economic liberalism in the free-market economy, which serves to promote social control and the erosion of protections for individuals. it supports policies that uphold socially and fiscally conservative ideals of a heteroand cis-normative society (mullaly, 2007). according to social conservativism, nondiscrimination bills such as the lgbt elder americans act are fundamentally flawed because they increase spending on social welfare programs and create unnecessary dependency on government supports. in the field of gerontology, estes (2001) offers the political economy of aging theory as a critical framework positing sex and gender systems as structural forces, along with the public and private sectors, in the construction of old age discourse in today’s environment. incorporating sexual orientation and gender identity into public policy is consistent with both the political economy of aging and an ideological orientation toward social democracy. lgbt elder americans act the lgbt elder americans act, h.r. 1777 (2019), introduced in the 116th congress, amends the older americans act (oaa) to promote equitable treatment of lgbt older adults by identifying them as a population of “greatest social need” (civic impulse, 2017). the oaa was originally passed in 1965 to develop and support a range of critical social services aimed at assisting elders to remain independent and engaged throughout their lives. the oaa highlights the vulnerabilities of older people and authorized federal funding to finance aging services, research, and training programs (administration for community living [acl], 2017), and provides a wide range of services for individuals advances in social work, spring 2019, 19(1) 126 aged 60 and older and their caregivers, including nutritional programs, transportation services, senior centers, elder abuse prevention programs, disease prevention and health promotion programs, family caregiver support, and job training and supportive employment, among other services. anyone over the age of 60 is eligible to receive services, however priority is given to individuals deemed most vulnerable. currently, the oaa has defined vulnerable populations as older adults who are low income, holocaust survivors, institutionalized, frail, indigenous, racial/ethnic minorities, and elders who live with disabilities and chronic conditions. during multiple reauthorizations since 1965, the oaa has been amended and adjusted through a primarily bipartisan legislative process. in the 2000 reauthorization, for example, the national family caregiver support program was added to support family caregivers of older adults as well as older adults caring for young children. in 2016, the reauthorization included an amendment to increase the protections for highly vulnerable older individuals. the most recent amendments included provisions to strengthen the office of long-term care ombudsman, elder abuse screening and prevention, and adoption of evidenced-based programs (acl, 2017). organizations are now required to “collect and analyze best practices related to responding to elder abuse, neglect, and exploitation in long-term care facilities, and publish a report on them” (acl, 2017, p. 335). despite these welcomed amendments, there remains a lack of protections for lgbt older adults in the oaa, which leaves them at elevated risk for a number of disadvantages. the lgbt elder americans act, s. 3575 (2011) was first introduced in the 112th congress by senator michael bennet (d-c), but was not enacted. the bill (s. 1765) was reintroduced by bennet in the 114th congress, again (s. 2089) in the 115th, with six democratic co-sponsors. a companion bill, the ruthie and connie lgbt elder americans act, h.r. 4222 (2017) was introduced in the 115th congress by rep. suzanne bonamici (d-or) with 28 co-sponsors. it was reintroduced in the 116th congress as h.r. 1777 (2019) by bonamici and 42 co-sponsors, all democrats. at the time this paper was published, the ruthie and connie lgbt elder americans act, h.r. 1777 (2019) was active and awaiting review by the senate’s sub-committee on health, education, labor, and pensions. the bill proposes to address several important issues that are of paramount concern for lgbt people as they age. the lgbt elder americans act recognizes that lgbt elders are a vulnerable population, makes explicit their distinct needs, and proposes a set of initiatives to ensure their equal treatment under the law. the bill recommends ongoing funding for the national resource center on lgbt aging under the auspices of the oaa, which would generate, implement, and evaluate evidence-based interventions designed to address practical problems affecting lgbt elders. the national resource center would also serve to educate providers about the special needs of lgbt older individuals and provide resources and training to better meet the needs of this population (sage, 2012). in addition, the bill would authorize more federal funding for research to determine the needs of lgbt older people and evaluate the effectiveness of services to meet their bio-psychosocial needs. emphasis is placed on applied research with the goal of translating findings into interventions that target structural issues, including building advocacy efforts to combat stigma and discrimination that impacts lgbt older adults (kennedy, 2011). in sum, the oswald et al./lgbt elder american act 127 bill attempts to ensure that lgbt elders “receive the unique services and supports they need to improve their economic security, social support, and overall health” (sage, 2012, p. 1). lgbt elder americans act: a theoretical analysis due to political ideologies with opposing views about lgbt people, the lgbt elder americans act has met resistance in congress. as a consequence, this legislation must be examined through theories that take a bipartisan approach to understand the complexities of lgbt aging. in this section, we offer an analysis of the lgbt elder americans act through a life course and equity perspective in order to understand the promise and limitations of this proposed policy. life course perspective laws and policies that aim to improve the lives of lgbt older adults must consider how cohort effects shape the needs and experiences of diverse elders. a life course perspective pays particular attention to how one’s trajectory influences social, health, and economic outcomes (fredriksen-goldsen et al., 2014; mayer, 2009). the perspective encourages an understanding of the interplay of the personal with the structural to understand how biographies, structures, and social movements interact in dynamic ways over the life course (elder, 1998; o’rand, 1996). the life course perspective is a useful theoretical lens for analyzing the lgbt elder americans act because sexual orientation and gender identity are dynamic cultural constructs that carry different meanings depending on history and geography. indeed, the experiences of lgbt individuals who came of age prior to gay liberation are vastly different from those who came of age during a time of marriage equality. a number of scholars have found that the cultural and political context is as important to health and aging as biology and genes (scharlach, 2017). this is true for lgbt elders who have spent the majority of their lives interacting with oppressive policies designed to marginalize them. the lgbt elder americans act takes a comprehensive approach to address how the social positioning of lgbt older adults, who are over age 60 at this time in history, is shaped by discrimination and stigmatization. in fact, not all individuals age well or equitably. lifelong exposure to structural injustices is particularly pernicious for lgbt older adults who are left to manage the additive effects of ongoing health, social, and economic disadvantages throughout the life course. the inequities that disproportionately affect lgbt elders are often avoidable and can be resolved through policies that close the gaps, which prevent them from growing old in a society that is inclusive and equitable for all. an important aspect of the lgbt elder americans act is the addition of sexual orientation and gender identity to the oaa’s list of those with greatest social needs. this will be a major step in addressing the challenges that lgbt elders experience, as it will mandate federal funds to finance services that address the needs of lgbt individuals in later life. to date, little oaa funding goes to programs that explicitly target lgbt elders, and services for this population are lacking (espinoza, 2012). this is problematic because the number of lgbt older adults is advances in social work, spring 2019, 19(1) 128 increasing along with their visibility in aging services. funding needs to be allocated to programs that target the distinct needs of lgbt elders. applying a life course perspective to analyze the lgbt elder americans act suggests that the bill acknowledges structural injustices that accumulate across the life course. the bill does not address the circuits of disadvantage and dispossession that affect lgbt individuals, particularly those with intersecting minority statuses, resulting in greater social, health, and economic disadvantages in old age. instead of preventing the accumulation of disadvantage, the bill would fund services that ameliorate the impact of cumulative hardship experienced by lgbt elders. a more proactive policy intervention would include nondiscrimination laws that protect individuals at all stages of the life course. the equality act, h.r. 5 and s. 788 (2019), reintroduced to the 116th congress by representative david cicilline (d-ri) and senator jeff merkley (d-or), is an example of a proactive lgbt policy. the equality act seeks to amend the civil rights act of 1965 to include sexual orientation and gender identity. this bill would prohibit discrimination in housing, employment, marriage, public accommodation, health care, credit, courts, and the private sector. if passed, the equality act would be instrumental in reducing the additive effects of structural disadvantages that lgbt individuals accrue across the life course. equity lens according to krieger and colleagues (2010), an equity perspective is “the instrumental use of human rights concepts and methods for revealing and influencing governmentmediated processes linking social determinants to health outcomes, especially in relation to the principles of participation, nondiscrimination, transparency, and accountability” (p. 748). consistent with an equity approach, the lgbt elder americans act endeavors to shift political processes by lifting the human rights and dignity of lgbt older adults. the bill would introduce federal protections for lgbt elders that promote their equal rights under the law, build a knowledge base around lgbt aging, and provide real-world solutions that address the challenges that lgbt elders face (civic impulse, 2017). as such, it supports the notion that disparities are not because of individual choice, but are products of structural injustices that marginalize individuals across the life course. the lgbt elder americans act would be the first federal law to mandate data collection, analysis, and reporting on the needs of lgbt elders, their experiences with discrimination, and the utility of services to support this population (kennedy, 2011). currently, most national and state surveys do not ask questions about sexual orientation or gender identity, making it difficult to estimate the number of lgbt people and the extent of their needs (espinoza, 2016; healthy people, 2017). the lack of accurate information leaves lgbt older adults at particularly high risk of receiving inadequate care, and government intervention is required to improve our understanding of their experiences (healthy people, 2017; iom, 2011). such efforts are instrumental in promoting the health equity of diverse elders by providing a means to measure their needs while also guiding supportive services for lgbt older adults. oswald et al./lgbt elder american act 129 an important aspect of an equity approach to public policy is the role of intersectionality in understanding how race, ethnicity, sexual orientation, gender identity, nationality, class, and disability interact to create unequal opportunities and outcomes for individuals that intensify in later life (fredricksen-goldsen et al., 2014). although the lgbt elder americans act calls for the inclusion of sexual orientation and gender identity among other vulnerable groups, it does not make explicit the need to allocate additional funding to services that target lgbt elders with multiple minority statuses. in order to address the nexus of inequity that many lgbt elders experience, policy makers should advocate for an intersectional equity approach that addresses the dynamic interaction of privilege and oppression across the life course. finally, lgbt elders have demonstrated significant resilience throughout their lives, and an equity approach to policy would acknowledge the strengths of this community (fredricksen-goldsen et al., 2014). indeed, lgbt elders constitute an activist cohort who effectively built communities that challenged dominant norms and customs of acceptable human behavior. for example, they successfully transformed cultural conventions around families and caregiving to include chosen families that are not based on legal or biological status. fredriksen-goldsen et al. (2014) recommend that “families of choice and next-ofkin that are not partners or legal family members are also considered in policy advocacy efforts” (p. 659). as such, the oaa’s family caregiving supports and other services must make explicit the inclusion of diverse family forms in their programming. implications for social work as the u.s. population continues to age, social work practitioners, policy makers, and scholars must consider how well current laws and policies meet the needs of the increasingly diverse demographic landscape. currently, u.s. federal policies are lacking when it comes to lgbt people and their protections under the law. lgbt elders are a unique segment of the population who have been shaped by historical and current experiences of oppression and resistance; innovative policies are needed to promote their wellbeing (espinoza, 2016; fredriksen-goldsen & espinoza, 2015). as such, there is a critical need for social workers practicing in various settings to take the lead as policy experts and advocates, particularly in regard to inequities within u.s. policies and the need for redress among marginalized groups. social work is a politically engaged profession with a long history of advocacy work. however, schools of social work offer clinical practice specializations at a significantly higher rate than policy, suggesting a need to advance the profession’s capacity in social policy analysis, advocacy, and development (council on social work education, 2017). it could be argued that clinical social workers treat the symptoms of an unjust society, rather than dismantle the structures that produce them. social work is uniquely positioned to create systemic change through policy advocacy and community organizing, yet centering clinical practice in modern social work marginalizes these macro-level skill sets. training social workers to critically examine u.s. policies and the underpinning factors that impose and/or support social inequality is essential to addressing the structures of domination that affect the populations we serve. in light of these concerns, we offer three recommendations for future policy-making that might produce better outcomes for lgbt older adults: i) advances in social work, spring 2019, 19(1) 130 apply a life course perspective to understand the lived experiences of lgbt elders; ii) apply an equity lens to inform policy development; and iii) apply research evidence to guide and advance social policy. recommendation i: apply a life course perspective to understand lived experiences over time the positionality of lgbt elders is shaped by historic circumstances of marginalization and oppression, and discriminatory policies throughout u.s. history. policy advocates must critically examine structural forces that have affected the lives of lgbt people over the life course (fredriksen-goldsen, 2016; fredriksen-goldsen & espinoza, 2015; fredriksen-goldsen & muraco, 2010; kite & byrant-lee, 2016). radical shifts in lgbt rights over the past 50 years suggests that different generations have different experiences, and policy needs to attend to the unique generational concerns of lgbt individuals (espinoza, 2016; fredriksen-goldsen et al., 2014). therefore, social policies must be both reactive and proactive in order to account for the multiple factors that shape lgbt aging. improving lgbt people’s economic, social, and health statuses in all stages of the life course is a pro-active approach that attends to the unique needs of lgbt people at different developmental stages (stark, folbre, shaw, smeeding, sandstrom, shaw, lee, & chung, 2005). additionally, we need bills like the lgbt elder americans act to respond to the history of inequality in u.s. legislation. by applying a life course perspective, policy makers can respond to historic and current circumstances that create inequities for lgbt people of all ages. recommendation ii: apply an equity lens to inform and shape policy development lgbt older adults comprise a diverse group of individuals with intersecting identities, and an equity approach to policy is necessary to address the multiple intersecting oppressions and privileges within the lgbt community. lgbt identities are embedded within a matrix of domination related to race, class, gender, sexual orientation, immigration status, nationality, and disability (balsam et al., 2011; collins, 2000; defilippis & anderson-nathe, 2017; fredriksen-goldsen et al., 2014; murib, 2017). to date, achievements made by the lgbt movement have focused on the most privileged members of this community (e.g., middle class, white, cisgender, gay men and lesbians), and policy makers must move the most marginalized members (i.e., queer people of color, transgender people, lgbt immigrants) into the center of policy debates (defilippis & anderson-nathe, 2017; murib, 2017). there has been limited attention to the particularities within the lgbt community in u.s. federal policy, and it is critically important that policy makers are attuned to the various degrees of marginalization within this unique community of people (murib, 2017). an equity approach to public policy addresses diversity and intersectionality and moves beyond mainstream issues that fail to account for multiple minority statuses (defilippis & anderson-nathe, 2017; fredriksen-goldsen et al., 2014; murib, 2017). oswald et al./lgbt elder american act 131 recommendation iii: expand research to guide and advance an lgbt aging policy agenda despite a growing empirical and historical literature, relatively little is known about the experiences of lgbt elders, which limits the ability of policy makers to estimate the extent and nature of their needs (espinoza, 2016; healthy people, 2017). in order to be effective, policy makers, service providers, and researchers require adequate data to inform their work. in 2014, the administration on aging added demographic questions about sexual orientation and gender identity to the national survey of oaa participants and collected data in 2015 and 2016. however, efforts to better understand the service needs of lgbt users of oaa services came to a halt in 2017, when such questions were removed from the national survey of oaa participants (cahill & makadon, 2017). future policy should mandate collection of data on sexual orientation and gender identity in national, state, and local agency surveys (espinoza, 2016). as the lgbt elder americans act suggests, formalized, systematic, and permanent structures are needed to support ongoing lgbt aging research, policy, and service delivery. creating infrastructure to support a rigorous national research agenda will build an evidence base to document the numerous inequities that affect lgbt individuals throughout the life course. conclusion until recently, federal legislation has ignored the needs and experiences of lgbt people, and the current assortment of laws and policies that protect them are insufficient (fredriksen-goldsen, 2016). research has found that lgbt individuals are susceptible to economic, social, and health disparities at different developmental stages that culminate in serious disadvantages in later life. the lgbt elder americans act has the potential to improve the social positioning of lgbt older adults. dominant ideologies in contemporary u.s. politics, however, are decimating laws that protect lgbt people. therefore, the lgbt elder americans act is a contested and polarizing bill. social work practitioners, policy makers, and scholars are being called upon to advocate for policies that dismantle historic inequalities in u.s. legislation. applying empirical research grounded in a life course and equity perspective can help social workers move beyond partisan debates on lgbt rights toward a greater understanding of the ways in which biographies and structures interact to produce unequal opportunities and outcomes for individuals. educating social workers with a working knowledge of policy analysis and the legislative process is essential for them to advocate for future policies that improve the lives of underserved and underrepresented populations. schools of social work need to provide the infrastructure for students to develop advanced understanding of policy development and the political and ideological realities, strategies, and considerations that drive it. empowering social workers at all levels of professional practice to critically analyze existing policy structures and develop and advance progressive policies is a necessary step to create a just and equitable society for all. advances in social work, spring 2019, 19(1) 132 references administration for community living [acl]. 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(2010). risk factors for reproductive and breast cancers among older lesbians. journal of women’s health, 19(1), 125-131. doi: https://doi.org/10.1089/jwh.2008.1094 author note: address correspondence to: austin g. oswald, doctoral fellow at silberman aging, silberman school of social work at hunter college, 2180 3rd ave, new york, ny 10035. email: aoswald@gradcenter.cuny.edu https://doi.org/10.1001/archfami.9.9.843 http://www.asaging.org/blog/disparities-and-invisibilities-shifting-perception-life-course-lgbt-elders-color http://www.asaging.org/blog/disparities-and-invisibilities-shifting-perception-life-course-lgbt-elders-color https://doi.org/10.1186/1475-9276-10-3 https://doi.org/10.1089/jwh.2008.1094 mailto:aoswald@gradcenter.cuny.edu _______________ sara l. schwartz phd, msw is a clinical assistant professor, eugenia l. weiss, psyd, lcsw is a clinical associate professor and senior associate dean of faculty affairs, and june l. wiley, phd, msw is a clinical associate professor and assistant dean, virtual academic center, at the suzanne dworak-peck school of social work, the university of southern california, los angeles, ca 90015. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1103-1112, doi: 10.18060/21619 this work is licensed under a creative commons attribution 4.0 international license. innovative strategies for building community among faculty who teach in virtual environments sara l. schwartz eugenia l. weiss june l. wiley abstract: a previous qualitative study (schwartz, wiley, & kaplan, 2016) described the faculty experiences and reflections of delivering master of social work (msw) education via a virtual platform at the university of southern california, suzanne dworak-peck school of social work during its initial years of operation. thematic analysis revealed a need for community building amongst geographically diverse faculty. given social work’s emphasis on the person-in-environment perspective, it is imperative to consider the experiences of those individuals responsible for executing virtual technology-supported programs and delivering education via virtual platforms. the current paper describes innovative institutional and programmatic interventions implemented to promote community and collaboration among faculty who teach virtually. creating strategic opportunities for virtual and ground-based faculty to connect informally and formally has the potential to foster a culture of inclusivity, connection, and a productive community of practice. keywords: virtual teaching; dispersed faculty; community of practice the use of internet technology in the delivery of social work education is a rapidly evolving phenomenon. although the profession of social work has used technology to access individuals and train them to serve hard-to-reach communities for many years, over the past decade we have witnessed unprecedented growth in the application of technology to social work education. as of 2016, over 80% of accredited bachelor of social work (bsw) and master of social work (msw) programs around the united states now offer some form of hybrid or online programming (robbins, coe regan, williams, smyth, & bogo, 2016). additionally, the american academy of social work and social welfare (aasw) has identified one the profession’s grand challenges to include the use of technology in ameliorating societal ills, through the challenge of “harness[ing] technology for the social good” (uehara et al., 2015, p. 3). examining the ways that technology can be effectively applied to the education and training of social workers is an important area of inquiry given the demands for online programming in higher education and the global need for training qualified practitioners. a robust literature examines the experiences of students enrolled in online programs and their educational outcomes. research has focused on the many advantages of online education, particularly with regards to increasing access to individuals with disabilities and those living in hard-to-reach communities (bryant, garnham, tedmanson, & diamandi, 2015; reamer, 2013; stolzer, 2012; tandy & meacham, 2009). overall student satisfaction https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2018, 18(4) 1104 and learning outcomes are consistent across education delivery types, (i.e., traditional onthe-ground and online; ayala, 2009; cappiccie & desrosiers, 2011; constantine brown & park, 2016; cummings, chaffin, & cockerham, 2015; hill jones, 2015; wretman & macy, 2016; york, 2008). challenges associated with online education include difficulties with virtual communication with classmates, inexperience with virtual learning tools, and lack of perceived student-instructor connection (noble & russell, 2013; secret, bentley, & kadolph, 2016). however, a systematic review of papers published prior to 2013 finds students are largely satisfied with virtual education experiences (wretman & macy, 2016). there is far less known about the experiences of instructors in virtual education as compared to what we know about online students or faculty teaching in traditional classroom settings (nicklin, mcnall, cerasoli, varga, & mcgivney, 2016). here we define virtual education as comprising synchronous live classroom discussions where students and faculty interact at the same time and virtually face-to-face through adobe connect technology (as opposed to online programs comprised of only asynchronous course work). recent and emerging literature informs us that virtual faculty are largely satisfied with their instruction, particularly appreciating the flexibility, work-life balance, and student diversity in the virtual classroom (huang & hsiao, 2012; peach & bieber, 2015; schwartz, wiley, & kaplan, 2016). challenges identified by virtual faculty include technology comfort level, availability of support and training, and feelings of alienation from peers and the larger organization (curry, 2016; dolan, 2011; levin, whitsett, & wood, 2013; lloyd, byrne, & mccoy, 2012; milton, sinclair, & vakalahi, 2016; smith, 2015). given social work’s emphasis on the person-in-environment perspective, it is imperative to consider the experiences of those individuals responsible for executing virtual technologysupported programs and delivering education via virtual platforms. drawing a parallel to organizational workplaces beyond institutions of education, one of the most pressing challenges facing managers of dispersed virtual workspaces is building an environment that promotes trust, connection, and a sense of belonging among distributed employees (milton et al., 2016; wenger, mcdermott, & snyder, 2002). a defining feature of working in virtual teams is that communication primarily occurs through the use of virtual tools as modes of communication, which can influence outcomes and experiences in a number of ways related to frequency of interaction, quantity of information shared, timeliness of communication, and engagement with colleagues (marlow, lacerenza, & sales, 2017; sardeshmukh, sharma, & golden, 2012). research on communication and satisfaction of virtual teams is conflicting, with some studies finding that workers are more satisfied with low levels of communication with colleagues and others are less so (akkirman & harris, 2005; cooper & kurland, 2002). previous findings on virtual education in an effort to examine faculty experiences and reflections on delivering msw education via the university of southern california suzanne dworak-peck school of social work, virtual academic center (vac) during its first four years of operation, an exploratory cross-sectional study was launched in 2014 (see schwartz et al., 2016). nonprobability quota and purposive sampling strategies were used and semi-structured telephone interviews were conducted with 25 faculty members. the interview questions schwartz et al./innovative strategies 1105 included: “from your experience, what are the opportunities and challenges of being an instructor on the vac?” and “how do you experience community in the vac?” the sample represented faculty from tenure line (n=5; 20%), and non-tenure clinical teaching (n=7; 28%), non-tenure clinical field (n=1; 4%) and adjunct part-time faculty (n=12; 48%). data collection and interview selection adhered to traditional grounded theory techniques (charmaz, 2014; glasser & strauss, 1967). data were uploaded into nvivo 10 software for data management and thematic analysis. the inductive qualitative analysis resulted in the identification of three overarching themes. the first theme focused on building a geographically diverse academic community, the second on community building among faculty, and the third on community building among faculty and students. interviews from this previous study suggested that virtual faculty felt dissatisfied with their opportunities to communicate with colleagues about work processes in a meaningful way. this is reflected in the following quote by a caucasian, male 50-year old full-time clinical field faculty member (non-tenure track): you also don’t really have casual interactions with the other professors. sometimes like on the ground you’ll be talking and realize oh we’re both having this issue with this student. it wasn’t a groundbreaking huge thing but casually talking you realize oh we are having this common experience, or with this group of students or whatever it might be. again, you have to be very intentional about having those meetings but you don’t have those sort of casual things where you learn about things as a group and that connection is harder. a quote from another virtual instructor, a female, a full-time clinical teaching faculty (non-tenure track) in her seventies addresses the lack of satisfaction with communication and community building: i think starting in january, maybe this past year, [the program director], widely began to have meetings of the full-time [faculty], i guess the lead vac faculty meetings, but those meetings have not really generated the kind of interaction, or at least the kind that i need, with my peers. they’ve been more structured and more informational, top down informational kinds of things…. as the vac has grown in enrollment from its first cohort of 88 students to a current enrollment of approximately 2,000 students, hiring additional faculty has been critical to respond to the growing demand. these hires ensure that all students regardless of academic center enrollment (on-the-ground versus virtual) have instructors who bring exceptional academic and real-world experiences to their classroom, thereby creating an optimal learning environment. the current paper focuses on how the school of social work has addressed the theme of community building gleaned from the schwartz et al. (2016) study and emerging research on the needs of geographically dispersed virtual instructors. innovative strategies for community building wenger et al.’s (2002) community of practice model considers the vital roles played by organizational communities in facilitating knowledge management, learning innovation, and outcome achievement. this model, in conjunction with other literature on advances in social work, fall 2018, 18(4) 1106 building community in virtual environments, provides a framework from which the school launched several strategies to address the needs of vac faculty with limited opportunities for face-to-face interaction with their supervisors and peers. wenger et al. (2002) offer insight into building effective communities of practice in geographically distributed communities, asserting that these communities can be developed and nurtured by attending to four key development areas. first, it is important to achieve stakeholder alignment, which in large organizations is most effectively achieved by developing smaller sub-communities that facilitate small group connection, local variation, and connection to the larger community of practice. second, the organization must create structures that promote connections among people within and across subcommunities. third, it is important to recognize that distributed community members do not naturally bump into each other, thus it is necessary to create opportunities for all participants to maintain visibility through teleconferences, newsletters, email threads, and face-to-face meetings that rotate locations. finally, organizations need to incorporate networking opportunities to create a web of trust across the larger community using strategies that can include small group projects, meetings, displaying the faces and bios of distributed workers on the organization’s webpage, and organizing in-person small group visits (wenger et al., 2002). these recommendations echo suggestions by other authors acknowledging the necessity of creating pathways for virtual employees to informally and formally communicate with each other in order to build trust, develop community, create opportunities for employee development, operationalize best practices, and achieve organizational outcomes (adedoyin, 2016; akkirman & harris, 2005; cooper & kurland, 2002; milton et al., 2016). to promote faculty development across program location and career track and to provide greater opportunities for engagement, collaboration, and community building, usc’s vac launched five innovative strategies that were rolled out incrementally 20122016: 1) semi-annual virtual academic center faculty retreats, 2) monthly hybrid faculty meetings, 3) the virtual water cooler, 4) wellness activities, and 5) the virtual book club. semi-annual virtual academic center faculty retreats the usc suzanne dworak-peck school of social work began sponsoring semi-annual virtual academic center faculty retreats in 2012. these meetings are mandatory and all expenses are paid for full-time virtual faculty. for part-time adjunct faculty, attendance is recommended, but not required (or funded). the meetings are held twice a year – once during the fall semester and once during the spring semester. the retreats assemble fulltime vac faculty, who also serve as lead instructors for part-time faculty, to address issues pertinent to the school and the virtual program. the fall retreat occurs during the annual council of social work education annual program meeting held in different regions of the country, which permits faculty to convene at a location that may be closer to their residence. the spring retreat requires faculty to assemble on the university campus, typically around the time of graduation ceremonies in order to encourage virtual faculty to attend these celebrations. these retreats reflect wenger et al.’s (2002) suggestion that inperson meetings be hosted in alternating locations. schwartz et al./innovative strategies 1107 consistent with the idea of strengthening the sense of community, the day-long retreat agendas incorporate topics that are identified as meaningful to faculty along with topics established by the administration to respond to policy and related academic matters. examples of recent topics include: diversity and inclusion in the classroom; building mentorship relationships among faculty; curriculum revisions; and student competency evaluations. program agendas are created to allow for ample socialization time during breaks, meals, and activities provided by the school’s wellness committee, whose purpose is to promote healthy living and to provide tools for faculty to engage in and practice selfcare. hybrid faculty meetings while the faculty retreats respond to the geographic distance that exists among the full-time vac faculty with limited opportunities to engage with one another in the same locale, other community building efforts have also been established. at the time of the schwartz et al. study (2016), virtual instructors logged into faculty meetings to observe the proceedings but had few options to interact with their colleagues in the meeting. in order to conduct the most effective faculty meetings that capitalize on all faculty resources, the school began to explore ways to ensure that all faculty members, regardless of rank or geography, are able to fully participate in faculty meetings and that their involvement be recognized and valued. to facilitate this change, a protocol was unanimously approved by the faculty and administration and put into place to host hybrid meetings which required school funding to build technologically equipped meeting rooms. fiscal budgeting to build out technology capacity was instrumental for hybrid meetings and is in line with the larger university strategic plan to enhance technology. these updated meeting rooms have the capacity to display the faces of virtual faculty logged into the meeting on large screens and enable remote faculty to participate in real time via the chat box or audio system. a new procedure for hosting hybrid faculty meetings was distributed to all faculty and these changes coincided with a restructuring of the msw program into three separate departments (e.g., children, youth and families; social innovation and change; adult mental health and wellness). both the new hybrid meeting protocols and departmentalization appear to have facilitated faculty connections and are in line with the wenger et al. (2002) recommendation for creating smaller sub-communities or hubs that relate to the larger, more complex organizational community as well as creating ways for virtual faculty faces to become recognizable. virtual water cooler some of the strategies used to build community among virtual faculty have evolved from the faculty as bottom-up interventions. for instance, beginning in 2016, three vac faculty launched the virtual water cooler whereby faculty recreate the water cooler experience (i.e., times for informal gatherings and sharing). unlike the faculty meetings and retreats that are convened to address academic and policy matters of the school, these virtual “water cooler” sessions are primarily for the faculty to chat and virtually meet faceto-face about topics of interest to them and to become acquainted with one another. these water cooler sessions echo wenger’s et al. (2002) “communities of practice” in that this advances in social work, fall 2018, 18(4) 1108 need to meet and share information has arisen from the faculty (not created by administration) based on their shared experience of being virtual faculty and wanting to engage in topics of mutual interest (p.130). the water coolers are typically held three times a semester and do not have specific agendas. however, sometimes the water coolers organically concentrate on a particular topic such as opportunities for advancement within the school, classroom management strategies, and current events (e.g., elections, natural disasters, etc.). wellness activities another activity designed to foster community building has been the creation of the school’s wellness committee, as previously mentioned. the committee’s focus on healthy living encourages the participation of all faculty—on-ground and virtual. what makes the group’s work attractive for the virtual faculty is that the design of the activities permit participation regardless of where faculty are physically located. for example, the wellness committee has sponsored virtual bus tours, learning about various regions of the country and the world via the use of the electronic platform, negating the need for faculty to be physically present. when these activities are designed to foster physical activity, they are coordinated so the members can join a local physical activity group, providing feedback and photos to the rest of the faculty of what occurred. these activities, such as virtual yoga sessions or smoothie challenges, create opportunistic chances to support, interact, and engage with colleagues that can help build what wenger et al. (2002) refer to as a “web of trust.” virtual book club finally, as another step in enhancing the faculty’s sense of community, a subcommittee of the wellness committee, the virtual book club, began in the fall of 2016. the wellness virtual book club explores diversity through fiction. book club members select a book for the month and convene to discuss the book on the virtual platform, with member’s rotating facilitation duties each meeting. the book club was intended to engage faculty in a shared experience and stimulating discussions with other faculty who can bring diversity of geographic location and individual expertise to the forum. a small group of about a dozen faculty consistently attended the book club in 2016 and 2017, reading and discussing eleven books. conclusion over the past decade, the profession of social work has leveraged technology in such a way that the field has undergone considerable shifts in the education and training of social workers as well as the ways that services may be delivered to clients (e.g., tele-mental health). in fact, one of the profession’s stated grand challenges for the next decade is to establish new ways to use technology to foster social good (uehara et al., 2015). while internet technology creates unique opportunities to engage with hard-to-reach populations and to train a geographically diverse workforce around the country, it remains important to consider one of the basic tenets of the profession – to view the person in his/her environment. schwartz et al./innovative strategies 1109 as the profession continues to advance its use of technology and more virtual education programs are launched, it is imperative to examine how this new paradigm shift is experienced by the people who spend considerable time working in virtual spaces. schwartz et al.’s (2016) findings that virtual instructors often feel disconnected from the larger university culture and alienated from geographically distant colleagues is reflected in other published work examining online education. dolan (2011) and curry (2016) found that online adjunct faculty often feel disconnected from the larger organization, that they are not presented opportunities to get to know and trust their colleagues and that they are often not recognized as valuable resources for the organization. cooper and kurland (2002) find that professional alienation is inversely linked with virtual employee professional development, suggesting that telecommuters have limited opportunities for informal learning, interpersonal networking, and mentoring which directly impacts employee development. smith (2015) echoes a concern for lack of formal mentoring opportunities available to virtual faculty in usc’s virtual academic center, particularly for those faculty who hold part-time adjunct positions in the school. these findings are relevant to the schwartz et al. (2016) study given that almost half of the respondents identified as adjunct faculty. the challenges identified above are reflected in wenger’s et al. (2002) seminal work on cultivating communities of practice and adedoyin’s (2016) examination of virtual communities of practice. the authors consider geographically distributed communities that cannot rely on face-to-face meetings, asserting that this distance creates unique challenges for creating and being a part of an organizational community. as a response to both the schwartz et al. (2016) study and a growing literature considering the community building needs of online faculty, usc launched the five strategies to facilitate formal and informal opportunities for faculty across rank and campus location that are presented in this paper. implications for future research and practice there is anecdotal evidence that these five strategies are fruitful in building connections among dispersed faculty at this particular school of social work by generating new opportunities to get to know one another, which is one of the first steps of building a successful community of practice. the new hybrid meeting technology has created ways for virtual and ground faculty to begin to visually recognize each other, which has translated to informal gatherings at professional meetings. twice-a-year in-person meetings for full-time virtual faculty provide opportunities for both informal and formal interaction, which has cultivated a sense of community amongst a geographically dispersed faculty and increased the engagement of virtual faculty in hybrid meetings. new collaborations have been established through these relationships, which is evidenced by new partnerships on conference presentations, curricular design, and peer mentorship groups. these new collaborative efforts and anecdotal evidence of increased engagement suggest that the tactics employed by the usc suzanne dworak-peck school of social work to engage virtual faculty and build community are working. this has implications for other schools launching online social work programs with a geographically dispersed faculty body. these strategies may also be useful for ground-based faculty in large advances in social work, fall 2018, 18(4) 1110 institutions who may have few opportunities to build connections, collaborate with peers, and develop efficient communities of practice despite a shared physical campus. in order to more comprehensively assess the effectiveness of these community building strategies, a mixed-methods evaluation is under development. evaluation of these interventions will entail the use of an online survey of virtual faculty with regards to their perceived sense of community in relation to the aforementioned initiatives. in-depth faculty feedback will also be attained through interviews. through the evaluation we seek to learn what activities the faculty are participating in and whether or not these initiatives are helpful in their perceptions of community building. we also hope to glean information about the potential barriers for participation. this information may be useful to develop and implement additional interventions to improve faculty members’ sense of community in the virtual teaching environment which can, in turn, enhance job satisfaction and performance in the classroom. references adedoyin, a. c. a. 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(2008). comparing three modes of instruction in a graduate social work program. journal of social work education, 44(2), 157-172. doi: https://doi.org/10.5175/jswe.2008.200700031 author note: sara l. schwartz, phd, msw, suzanne dworak-peck school of social work, the university of southern california, 1150 s. olive street, suite t-1100, los angeles, ca 90015. saraschw@usc.edu https://doi.org/10.1080/10437797.2016.1218222 https://doi.org/10.1111/j.1468-005x.2012.00284.x https://doi.org/10.18060/20875 https://doi.org/10.1080/10437797.2016.1112630 https://doi.org/10.1007/s10615-014-0510-5 https://doi.org/10.1080/15228835.2012.699510 https://doi.org/10.1080/08841230903022118 http://aaswsw.org/wp-content/uploads/2015/12/wp3-with-cover.pdf https://doi.org/10.1080/10437797.2016.1198293 https://doi.org/10.5175/jswe.2008.200700031 mailto:saraschw@usc.edu _________ jemel p. aguilar, phd, lcsw, associate professor, department of social work, southern connecticut state university new haven, ct. elisabeth counselman-carpenter, phd, lcsw, associate professor, school of social work, adelphi university garden city, ny. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 1020-1044, doi: 10.18060/24400 this work is licensed under a creative commons attribution 4.0 international license. ‘the mirage of action’: exploring the social work professions’ perpetuation of white supremacy through ‘well-intentioned’ actions jemel p. aguilar elisabeth counselman-carpenter abstract: this autoethnographic study highlights complex strategies for maintaining white supremacy used by “well-intentioned” heterocentric white female social workers that are enacted under the guise of practicing anti-racism in social work practice settings, classroom environments, policy initiatives, and advocacy work. using autoethnography was both unplanned and deliberate. unplanned, we needed a research method that allows us to explore the untouchable subject of heterocentric white female social workers and deliberate in that we could use our experiences to break ground and establish white supremacy among heterocentric white female social workers that espouse anti-racist values as an area of study. we draw on education, anthropology, sociology, and other disciplines to name some of the ongoing challenges to dismantling racism, colonialist, and reformer narratives in social work, and identify strategies used by all white folx, but particularly heterocentric white female social workers to neutralize the suggestion or accusation of their acts as racism. we name three challenges to dismantling racism among heterocentric white female social workers: hiding behind the data, anti-racist book clubs, and crying and comfort. we conclude with further questions for those who hold power in the field and a reflection upon our own continued intersecting struggles with these concepts. keywords: white supremacy, social work, heterocentric white women, discomfort, racism social work education strives to enhance practice across client systems, with the ultimate goal of attaining social and economic justice for all, but particularly for marginalized populations. a competency-based approach to educating and training social work students is used ostensibly to address diversity, oppression, and social justice. however, social work education has historically and continually failed to meet inclusive, diversity-related professional goals (lasch-quinn, 1993; specht & courtney, 1994; turner et al., 2018). scholars continually demonstrate that social work education does not change social work students’ oppressive and racist beliefs (corley & young, 2018; danforth et al., 2020; lee & bhuyan, 2013; mclaughlin, 2005; mcmahon & allen-meares, 1992; tolliver et al., 2016; turner et al., 2018). while some scholars focus on educational techniques, others focus on the concepts in this area of study. while there is a significant body of literature on racism in the social work profession, diversity, anti-racist social work education, and the intersection of social work and structural racism in society, little has been written in social work literature about the particular and unique ways in which heterocentric white women maintain white supremacy within social work. this article attempts to highlight the complex strategies which are used by “well-intentioned” heterocentric white female social workers to maintain white about:blank advances in social work, summer 2021, 21(2/3) 1021 supremacy under the guise of practicing anti-racist work. we choose to highlight white supremacy among heterocentric white women social workers because the profession was founded by heterocentric white women the “friendly visitors” and women and white people dominate the profession (center for health workforce studies, 2006; chapman & withers, 2019; trattner, 1999). surprisingly, there is a myth that experiencing gender oppression allows women to better recognize oppression and subsequently dismantle it (amico, 2017; collins, 1990; diangelo, 2018; frankenberg, 1993; trepagnier, 2010/2017; turner et al., 2018). while we attempt to explore heterocentric white female social workers and white supremacy, this article will not give you answers. we are not here to discuss solutions to racism and white supremacy in social work because all too often discussions of racism quickly offer solutions that do not necessarily end racist behavior, but can mask some people’s racist behavior in language, beliefs, and behaviors that seem anti-racist (trepagnier, 2017). similar arguments apply to discussions of oppression in society. instead, we discuss three of these strategies evident in “well-intentioned” heterocentric white female social workers that occur in practice, classroom, policy and advocacy work. to guide our construction of this problem, we draw on research in education, anthropology, sociology, and other disciplines and autoethnography to begin to explore some of the ongoing challenges in dismantling racism, colonialist, and reformer narratives in current social work education and practice, to identify strategies used by all white folx to upend change efforts, and how heterocentric white female social workers employ these strategies and neutralize the suggestion or accusation of their acts of racism. these strategies prevent the uncomfortable yet necessary conversations about racism and limit social workers from deepening their awareness and authentic conversations around anti-racism. white supremacy and social work the social work profession has referential texts including dictionaries, encyclopediae, and handbooks. shockingly, the national association of social workers (nasw) press social work dictionary does not include a definition for white supremacy (barker, 2014). neither does the comprehensive handbook of social work and social welfare (rowe & rapp-paglicci, 2008; thyer, 2008; white, 2008), the oxford university dictionary of social work and social care (harris & white, 2013), the taylor and francis dictionary of social welfare (timms & timms, 1982/2016), nor the nasw encyclopedia of social work published by oxford university press (mizrahi & davis, 2020). is white supremacy ignored by the profession? as white supremacy is not defined in the prominent reference works for the social work profession, it should not be surprising that it is typically overlooked in social work education. the merriam-webster dictionary (2020) defines white supremacy as “the belief that the white race is inherently superior to other races and that white people should have control over people of other races and the social, economic, and political systems that collectively enable white people to maintain power over people of other races” (para. 1). walsdorf, and colleagues (2020) expand upon the system purported in the above definition and describe white supremacy as “...an intricate and interconnected system of structures aguilar &counselman-carpenter/mirage of action 1022 and processes by white people maintaining control and control power, wealth, and resources” (p. 66). in contrast to walsdorf and colleagues’ notion of white supremacy as a system, diangelo (2018) defines white supremacy “...as an overarching political, economic, and social system of domination” (p. 42). chapman and withers (2019) seem to focus on the interactive components and as they define white supremacy as referring “...to normative and even liberal discourses, practices, and structures that give disproportionate value to white bodies, minds, institutions, countries, values, and mores” (p. 5). informed by these definitions, we consider white supremacy as an (1) interpersonal, organizational, and societal phenomenon in which whiteness is assumed to be the norm, (2) that the feelings, behaviors, and thoughts of white people supersede all other groups, (3) that passing as white is perceived as beneficial in different contexts, (4) that institutions are structured so that white people can have power over marginalized populations, (5) that white people have greater access to power, wealth, and resources, and, (6) that white people use tactics to maintain control, power, and resources in ways that are detrimental to marginalized groups. while some might not view this definition of white supremacy as comprehensive enough, these six pillars of white supremacy uphold american society and align with social work thinking about systems interactions. these pillars also suggest that other social groups are examined against this “norm,” and allow us to include tactics for dodging cultural diversity (pewawardy, 2003). these tactics for dodging cultural diversity will be discussed later in this paper. these tactics will be linked to white fragility (diangelo, 2018), white silence (saad, 2020; sue, 2015); silent racism (trepagnier, 2017), and other forms of oppression that white people overtly and covertly commit against marginalized populations (turner et al., 2018). white supremacy has been at the roots of social work since its inception (lasch-quinn, 1993). while ida b. wells and other women of color were just as important as jane addams to the history of social work, it is often addams and her white sisters that are the focus of social work history (beck, 2019; chapman & withers, 2019; trattner, 1999). the phenomenon of “friendly visiting” and the charity organization society (cos), through which middle-class white women “helped” under the auspices of providing moral guidance, evolved into casework (beck, 2019; chapman & withers, 2019; trattner, 1999). additionally, throughout the birth and infancy of the united states of america, white supremacy acted as a sieve during the developing racial contract that was codified into laws enabling whiteness to be protected through social capital. white supremacy thus buoyed friendly visiting and consequently wormed its way into casework, social work practice, research, education, licensing, and accreditation (almeida et al., 2019; chapman & withers, 2019; lasch-quinn, 1993; lopez, 2006). since friendly visiting and the settlement house era, the field of social work has not made much progress towards decolonization (gray et al., 2013). examples in practice include the biopsychosocial assessment which is rooted in white values and belief systems around problem formation, strengths, and treatment planning (almeida et al., 2019; mcnay, 1992) as well as using the dsm-v as a diagnostic tool that is based on a western medical model which pathologizes client responses to individual, collective, and systemic traumas (jacob et al., 2013; kriegler & bester, 2014); also, in social work education courses labeled as “diversity” or “cultural competence”, in which whiteness is held to the advances in social work, summer 2021, 21(2/3) 1023 standard from which “others” deviate and become “otherized,” are numerous. almeida and colleagues (2019) make a critical point in stating “...terms like multiculturalism, intolerance, diversity, cultural competence, cultural humility, and cultural sensitivity all emerged without an interrogation of cultural imperialism and coloniality” (p. 159), that further perpetuates oppressive structures throughout the profession. because space restricts the depth and breadth in which we can discuss how deeply white supremacy operates within social work and few researchers are examining white supremacy or racism within social work, we chose to examine three strategies that enact white supremacy particularly by cis-gendered, heterocentric white female social workers: hiding behind the data, antiracist book clubs, and crying and comfort. we start this contribution to the profession with a description of our positionality to orient readers to who we are. our positionality we have intentionally chosen for elisabeth counselman-carpenter to share her story first, and for it to be a shorter narrative in part to challenge the significant space that white voices take up in discussing racism and to acknowledge her own participation in societal and professional white supremacy. jemel aguilar’s story and positionality has been intentionally placed second and is more detailed in order to dovetail into the discussion of strategies. second author i am a white, cisgender, feminine-presenting lesbian single mother. i look like the folx about whom this article is written, and i have benefitted from a long-standing system of white supremacy and multiple levels of privilege that in addition to being white include being highly educated, able-bodied and cis. however, as a sexual minority and a womxn, i have often been sandwiched between oppressors and the actions of oppression. folx with dominant identities often mistake me for “one of them” and have the expectation that i will toe the line of the dominant narrative while supporting the agendas and narratives of microaggressions discussed in this article. when i do not support these efforts to continue harnessing dominant agendas, i have been openly and privately punished by my colleagues. subsequently, there is a constant hyper-vigilance required to survive as a junior faculty member who is profoundly dependent on the whims and opinions of senior faculty members, all of whom bear more dominant identities than my own. this hypervigilance is compounded then by the need to professionally and personally support students who share some of my marginalized identities. as one of the only faculty that teaches courses about non-dominant identities and openly shares their queer identity as well as the challenges of working-outside-the-home single motherhood, i am also seen by students as a person to whom to turn about non-dominant identity struggles. students regularly come to me for support with the coming out process, the transition process, single parenting, and how to navigate queerness in today’s professional world. this leads to a splitting of my identities as oppressed or oppressor, rather than a holistic perspective of my multiple identities that come with privilege and exclusion simultaneously all of which influence how i am in the classroom, research, and the world. aguilar &counselman-carpenter/mirage of action 1024 first author i am a puerto rican gay male with an invisible disability that passes as a black gay male without a disability. passing as a black male, i have had many personal and professional discriminatory experiences from white-identified people that resemble those described by black men in the social media, news outlets, and research literature including stories of white women’s purse clutching on elevators, being called on to be the voice for black or brown people, and interpersonal interactions that fetishize, tokenize, and patronize me. many others assume that i am able-bodied and openly mock me when i acknowledge my disability or quietly mock the limitations forced upon me by my disability. despite other people’s views of me and my disability, i tenaciously pursued higher education in a field that i believed was “open to the diversity of experiences and backgrounds.” i paid my way through undergraduate and each social work graduate program by working several jobs and many times was touted as the token “black face in social work” so that students of color would attend the program in which i studied or worked. throughout my entire educational experience, as the “model” bipoc student, i often contended with offensive comments by well-meaning heterocentric white women attempting to prove to me their own personal anti-racist stance. it never occurred to these same well-meaning white women that they were also ignoring the many other parts of me that did not fit with their anti-racist, color-bind lens. as a social work student taking my one required “diversity” course, the course text naturally assumed that i, the reader, was a white female social worker headed into practice with non-white, lesbian or gay, low income or poor, non-english speaking people. transfolx, bisexual-identified people, those questioning their gender identity or sexual orientation, allies, and others were not included in these pages. needless to say, i did not read the book. the class was tedious and slanted to the cis-gendered well-meaning heterocentric white women in the room. i did not yet know that this trend would continue throughout my career. a recent discussion among a group of primarily white social workers ignited my desire to throw down the gauntlet and stand up to the social work profession’s placating of heterocentric white female social workers in diversity and other courses created to meet the cswe standards for accreditation of social work education. i dare to discuss white supremacy in social work, yet honestly, i actively choose not to teach diversity courses in social work programs. i find the discussion of diversity in social work limited and a parsimonious approach that favors the education of heterocentric white female social workers at the cost of marginalized populations and the simultaneously of identity. here is my wish list: i would like the jargon used by social workers to mask their oppressive ideologies to end. i would like all social workers to be uncomfortable as all social work courses will discuss oppression in all its forms and target deep-seated beliefs that social workers hold about marginalized populations. i believe we, social workers, must identify how white supremacy exists in social work and is maintained as well as we must talk about our roles in oppression before we can engage in anti-oppressive practice. i say this because i see the world – both social work and american societies – through inextricably linked lenses that are not accounted for in the concepts of diversity, advances in social work, summer 2021, 21(2/3) 1025 intersectionality, or anti-racism. i begin this entry into the uncomfortable and threatening discussion of white supremacy acknowledging that my outward resistance to teaching diversity courses in social work programs adds to white supremacy. while my resistance to teaching diversity courses is still a part of me, my professorship and doctoral degree places me in a position of authority. while some white students and professors will see me as a black professor, or a black male professor, students with marginalized identities must experience an educated person with marginalized identities in a position of authority that stands steadfast in the face of white supremacy. social workers with marginalized identities do not have to placate white folx, pander to their insecurities about their role in racism or white supremacy, and can pursue higher education without compromising themselves, their identities, or relinquishing their relationship to their marginalized communities. people with marginalized identities should unequivocally not accept the compartmentalized views of white folx, especially in social work. queering the methodology autoethnography is a methodological approach that can aid in understanding life experiences, meanings, social problems and practices from new angles (bochner, 2016; bochner & ellis, 1996; jensen-hart & williams, 2010). autoethnography in social work is a relatively new approach to qualitative data collection and analysis in that a social work abstracts and socindex search in 2020, using the keywords “autoethnography” and “social work” yielded only approximately 74 english language, peer reviewed articles on a variety of topics including racism (battle, 2017; crawford, 1994), sexism, and homophobia (turner et al., 2018). autoethnography as a methodology allows researchers to reflect on their experiences. for example, as people with marginalized identities during the backdrop of the murders of african american at the hands of the police, a pandemic that is disproportionately killing marginalized community members, and a political structure that is dismantling protections against gay men, lesbians, transgender folx, populations of color, and low income populations across the united states of america, we used these experiences coupled with the research literature to create an autoethnographic account of white supremacy in the social work profession and among “well-intentioned” heterocentric white female social workers. unlike other forms of qualitative data collection, analysis, and presentation that demarcate “the literature,” “the data,” and “the analysis” in the presentation of the qualitative results, autoethnography interlaces the data with scholarly literature on the phenomenon or other articles that can inform the interpretation of the researchers’ experiences. thus, the presentation of the results is a narrative that does not differentiate the data from what is used to interpret or expand upon it (ellis, 2008). when we decided to engage in a discussion about white supremacy in social work, we considered several typical research options and found those data collection and analysis methods as lacking. we then turned to both our backgrounds in qualitative methodology. as we discussed the trajectory of this project, we shared our own stories of witnessing and being assaulted by the oppression of heterocentric white female social workers. we reflected on our experiences as students, educators, and practitioners and began to identify several common themes, not in the typically qualitative nomenclature, that resonated with our multiple aguilar &counselman-carpenter/mirage of action 1026 identities. we used our stories and experiences to guide a search of the social work literature and then expanded into other disciplines because of the limited theorizing and research into the ways in which white heterocentric female social workers enact white supremacist ideologies in spite of aligning themselves with anti-racist ideologies. as discussed earlier, with the absence of social work literature as a guide on the topic of white supremacy, we turned to other bodies of knowledge to frame and understand our experiences, to examine the assumptions in the research literature, and to build a body of this research in the social work profession. we selected experiences from our histories that allow us to illustrate the different tactics and strategies that white female heterocentric social workers have used with us or around us to impede discussions about oppression, racism, and homophobia. these tactics and strategies support white supremacy by silencing the voices of marginalized folx. we narrowed in on three tactics and strategies that are present in fields such as education and anthropology but remain lacking in social work literature: hiding behind the data, anti-racist book clubs, and crying and comfort. the results presented in the following sections are sometimes found in literature in other disciplines as indicated by citations included, but rarely in social work. hiding behind the data “let’s do a survey to find out more...” is a thinly veiled supremacist tactic of delay, burden, and redirection. as applebaum (2017) states “it is easier to over-intellectualize one’s experience with white fragility by choosing to research it rather than sitting with the discomfort” (p. 863). how many times have you heard the statement: “we should really survey the students and faculty of color before moving forward with this training, workshop, webinar, program, or policy change?” the surveys and assessments often mentioned in these statements might repeatedly occur without much or any implementation of the results. but this process of survey and data analysis is a multistep process that accumulates added damage to marginalized scholars. continual surveys and assessments slow down change and delete the voice of the students and faculty of color with the click of a key. this micro-strategy of assessing without discussing or implementing is designed to delay and derail progress toward toppling dominant norms that are many times rooted in white supremacist thinking and beliefs. the decision to research a phenomenon affecting marginalized populations is then usually followed up by a “request” for a junior faculty member to volunteer to be the coordinator and administrator of the survey. many junior faculty members are already burdened by the publish-or-perish structure of higher education, are assigned to teach the least palatable or worst scheduled sets of classes, and to advise students while participating in department and school wide committee work. if this junior faculty also holds a marginalized identity, then they carry the burden of also being the “go to” for students who share their identities or perceived to share them on top of requests to coordinate surveys about marginalized populations. this co-location of the request and research on marginalized populations for the education and knowledge expansion of, many times, people with white identities is akin to asking marginalized people to speak on behalf of advances in social work, summer 2021, 21(2/3) 1027 their communities but with added work and the emotional burden of researching marginalized populations for the benefit of white folx. a sub-process in the research tactic occurs in the “testing” the survey to see if it answers the “right” questions and taps into the “right” audience as well as determining the reliability, validity, and rigorousness, and trustworthiness. ultimately, the survey has to then be approved by senior faculty, program coordinators, and the chair, only to then be debated over at a department or school-wide faculty meeting, effectively stalling the project. the presence of racism in research is relatively well acknowledged within the academy as evidenced by what types of research are privileged, who is conducting the research, how instruments and research questions are constructed and overall biased data collection (d’eon, 2019; damian & gonzalez, 2020; hardeman & karbeah, 2020; zuberi & bonilla-silva, 2008). however, research within academic institutions that explores the experiences of faculty and students with marginalized identities has a specific set of barriers and delay tactics that are challenging. many times, questions about the intent of the researchers, the potential of the researcher to influence or bias data collection, and how the results might be used to subversively delay the project by keeping it in a planning phase thereby never quite evolving to data collection and dissemination. the tacit implication of these arguments is that the data on racism or white supremacy can be weaponized, and thus heterocentric white folx must scrutinize the data collection instruments and “all (white) parties involved” must agree with the research process and data collection. this cumbersome process for the junior faculty of color does not even include the formal university research approval protocol and depending on the size of the department and program, can take weeks and months before approval, and then and only then does data gathering begin (arday & mirza, 2018). meanwhile, in the wake of these tactics, the junior faculty member of color loses valuable research and scholarship time for studying their area of interest. unfortunately, this process does not ease in that the next delay and diversion strategy occurs when the data are processed, and the results are finally complete. the delays under the guise of debate are thus an effective strategy to distance oneself from participation in active social action and change. in contrast to focusing on elevating the voices of those surveyed or highlighting actual problems or concerns at hand, arguments often erupt about “the data” including how it is being analyzed, presented, and widely disseminated, rather than an actual discussion or actions about the phenomenon under investigation. questioning the data might appear through statements or questions such as “how do we know this is how people really feel,” “is that everyone’s feelings because i know [x] number of [insert group] that do not feel that way,” “i don’t know if that is accurate, maybe respondents did not understand the question,” “you should look at this [opposite method than was used] to see if more people feel that way.” if one is too busy looking at the construction or deconstruction of the research method or “looking at the data”, then it perpetuates absolution from white guilt. moreover, white faculty can then congratulate themselves for “deeply exploring” antiracist topics and convince themselves that they are actually “taking action” when in reality, no action is occurring. for the junior faculty of color and other populations of color that took the time to answer the survey and share their life experience, the inaction leads to aguilar &counselman-carpenter/mirage of action 1028 repeated silencing and side-lining of respondent’s stories that were harvested at the expense of dominant folx feeling satisfied by their work. the final stage, and perhaps the most paralyzing, is the silencing that takes place when findings are shared with a greater audience. again, it is common to hear, “well, we’ve learned that we really need to research and explore this more deeply”, a statement that leads to inertia as the voices of those who need to be heard languishes in an excel workbook or word document. silencing also demonstrates the strength of white exceptionalism as in these phenomena would “never” happen at “our” social work program or institution. once of the authors conducted a mixed method study of the marginalized student population in a social work program in a very large doctoral granting state university that illustrates many of the tactics and strategies described. once data were gathered and analyzed, the data from that study produced unflattering results for the program. while processing the results in the faculty group, a white female social work professor inquired of the junior faculty of color who gathered and analyzed the data, “did you slant the results so that you can gain more power?” another white faculty member said, “we shouldn’t listen to that, obviously, they were not happy with the program.” in another study at a different university, the project examined the perspectives of marginalized faculty and students as well as proposed targets for improving the experiences of these groups and produced very unflattering results in which specific racist, sexist, homophobic, and ableist experiences were included. in subsequent meetings to review the results, the authors of this paper observed white, primarily female staff and faculty discussing two results out of the seven that were produced. the two results focused on developing a faculty-led group to address diversity and the need for innovative teaching modalities for faculty development. the results that focused on the deconstructing power structures, calls for changes in leadership because of the oppressive tactics such as tokenism that was frequently employed by leaders, a request for spaces for marginalized populations to organize and collaborate, and a change in policies that inhibit the growth of marginalized populations were completely omitted from the discussion. these are just two examples of how faculty with dominant identities, such as heterocentric white female faculty can spend an entire academic years’ worth of faculty meetings debating how to study phenomena, rather than taking action, on the oppressive structures derived from white supremacy. ultimately, hiding behind the data is a form of intellectualization, first introduced as a defense mechanism by freud who argued that intellectualization allows for the conscious analysis of an event in a way that does not provoke anxiety. in short, racism makes white people anxious, including those in social work where the majority are white heterocentric women (trepagnier, 2017). admitting one’s participation in and intergenerational perpetuation of white supremacy also makes white people anxious (trepagnier, 2017). designing and asking questions, organizing painful narratives into tables, pie charts, and figures, as well as calling for more research allows white people to distance themselves from their anxiety by intellectualizing the process. another problematic facet in conducting research within one’s program or about one’s students is that white faculty can hide behind the work done by scholars of color. one example of this occurred during a meeting attended by both authors. a junior faculty advances in social work, summer 2021, 21(2/3) 1029 member of color called out a racist statement made by a white, more senior faculty member during a small, diverse group of mostly untenured junior faculty. the faculty of color stated to the white faculty member, “...this conversation here, right now in this moment, is an example of white supremacy and demonstrates racist behavior on your part.” the white heterocentric faculty member responded by saying she would send the faculty member a folder of articles written by female scholars of color that would support the idea that he was being overly sensitive to the topic at hand. she continued on by saying she was highly informed on the topic because she frequently read research by female scholars of color and wanted to share her expertise from a feminist perspective. after the interaction, the faculty of color learned that the heterocentric white female faculty member discussed the incident with two other white female faculty members that were in the meeting and they both questioned, “why does he (the faculty member of color) treat you this way?” in this situation, the white faculty member hid behind her interpretation of female scholars of color and used that research as a weapon. the white heterocentric female faculty member also then collaborated with other white heterocentric female faculty members to weaponize the interaction as the faculty member of color’s problem. in this vein of action, the white faculty member deflected the notion of her white supremacy through the shield of female scholars of color. additionally, the white faculty members collectively created an intellectual divide between the claims of female scholars of color and the male faculty member of color. these tactics in sum are drawn from the legacy of white supremacy in america. research is an important and vital tool to bring about social and individual change, yet research is also weaponized to prevent white discomfort. hiding behind the data is an active form of white resistance masquerading as a form of action. anti-racist book clubs and trainings alicia garza, co-founder of the black lives matter movement, which flourished in the spring of 2020 but was co-founded in 2013 after the shooting death of trayvon martin, defines it as an “ideological and political intervention in a world where black lives are systematically and intentionally targeted for demise...an affirmation of black folks’ contributions to this society, our humanity, and our resilience in the face of deadly oppression;” (blacklivesmatter.com/herstory, paragraph 3). the number of invitations each author received via emails, tweets, and flyers encouraging us to join anti-racist book clubs, reading groups, discussion and processing groups was startling and overwhelming. we received lists of books, blogs, and videos to consume, and even found ourselves passing on and sharing some of these resources with colleagues, friends, and families. passing on this material felt like action, it mimicked actions to dismantle white supremacy. similarly, inaction that can look like action can be seen in the phenomenon on instagram for #blackouttuesday. this online media event took place in late may 2020 when folx posted a simple black square sometimes with a related hashtag #blacklivesmatter as a gesture of solidarity with the protests that followed the murders of george floyd and breonna taylor. approximately 28 million posts appeared on that day, but due to the social media algorithms protest organizers did not reach their intended audience or stayed informed with what was happening in the world around them (sinanan, 2020). in a similar fashion, as has been highlighted in the reflection on research discussion earlier, reading a text distances us aguilar &counselman-carpenter/mirage of action 1030 from stories and narration about the painful consequences of living in a world framed by oppression and oppressive practices. consuming media and text written by folx of color that challenges and calls out white supremacy and colonialist culture is critically important! however, we argue that the intended meaning of elevating voices of people of color and the dynamic process of sitting in the discomfort of one’s own white history gets lost because joining and participating in a book club allows for the delusion of action by hiding behind text as well as perpetuating elitism. we have heard white heterocentric female social workers say, “i understand racism because i have read [fill in author],” when we have repeatedly witnessed their racist and oppressive actions. thus, it is not enough for texts to be accessible to those who already may participate in book clubs, have access to well stocked libraries with inclusive programming and who, during the covid-19 pandemic, could participate in the cashless process of ordering a book on amazon from the luxury of their own devices. how are these texts made accessible to all white folx those who live in rural locales, who may not be able to read, or who may not value the written word as transformational? why are women of color, like layla saad, that outwardly challenge white supremacy by asking white folx to delve into their participation in white supremacy receiving death threats? a question often asked, particularly in education, is “what can whites do” (matias & mackey, 2016)? while reading can help one understand how race impacts marginalized communities, it cannot be the exit on the highway of understanding one’s own supremacy history. unfortunately, book clubs such as these continue to perpetuate the myth of the white savior, and typically allow white folx to “liberate” or “empower” folx of color. we argue that this extends to “liberating” other “less-woke” white folx through the book club as well – a dangerous thought process that continues to perpetuate dominance of one group over another. another danger of antiracist book clubs, particularly if homogeneous in nature, is that similar to white-dominant classroom, diversity training, and accountability groups, there is often an assumption that similarities between folx will result in experiences similar in personal viewpoint (gillespie 2002). however, as patel (2016) states, “…interrupting the material purposes of racism requires more than endless dialogue” (p. 82). moreover, using the term “book club”, “reading group” or “discussion group” insinuates something social or optional and that people have chosen to come together to process something. there is a performative nature to these types of gatherings especially within the social work profession that purports action over discussion. frankenberg (1993) agrees that "...fundamentally, one needs to change the structure in order to change the white subject and that by paying too much attention to the white subject, activities run the risk of neglecting the structure they seek to change” (p. 896). right now, many white social workers are having an existential crisis when realizing they have participated in generations of dominance and have perpetuated white supremacy, even as well-intentioned crusaders of social justice. however, many trainings, book clubs and discussion groups only perpetuate a type of navel-gazing at these existential crises and inhibit long-term changes in strategy or tactics that dismantle white supremacy (frankenberg, 1993), because people can feel like they have completed an action by reading a book without changing anything within themselves, interpersonally, or in the structures of white supremacy. advances in social work, summer 2021, 21(2/3) 1031 this focus on reading over action belies an underlying tenet in social work education that combines academic knowledge (reading and thinking) with field practice (action). social work is a practical field, in which a large portion of education is spent as an intern in an educationally grounded service role in community, agency, policy or administrative settings. social work education’s adherence to field education strives to link classroom learning with professional experience. the action-oriented foundation of field practice is a pivotal part of social work education and seems to be in direct contrast to the white supremacy that we are calling out in anti-racist book clubs, but field education also suffers from the mirage of “doing” as it relates to dismantling white supremacy. literature and research on anti-racist field education is lacking in social work publications and the field experience has been called out for not addressing the needs of students of color, and indigenous and aboriginal students, let alone their clients with these identities (dominelli, 1989; gair, et al., 2015; walter et al., 2011). while it is beyond the scope of this particular article, challenging the perpetuation of white supremacy in field education coursework and practice is desperately needed. reading is one pillar upon which awareness about one’s role in white supremacy can be built, but it is not in itself a dismantling action. as tre johnson (2020) stated frankly and accurately in the title of his oped piece in the washington post, when black people are in pain, white people just join book clubs. book clubs, discussion groups and trainings are a part of unlearning white supremacist cultural norms, but participation must accompany action that allows for discomfort. we agree with frankenberg’s call to be pragmatic when exploring our relationship to racism and to avoid being “...mesmerized by it and thereby frozen into inactivity” (p. 187). in short, the answers to racism go much deeper than just reading and discussing. classes on diversity, oppression, and social justice focus on the discrimination of groups by another group. in the united states of america, white people and white-passing people of color are at the top of the oppression hierarchy and able to exercise power over other populations. they rule social groups through creating, supporting, maintaining, or ignoring systemic obstacles to success, creating stereotypes of marginalized populations that are repeatedly displayed in media and other parts of society, and dismissing the value or co-opting the contributions of marginalized populations in many segments of american society as already discussed. in many instances, cis-gendered heterosexual white women, are discriminated against because of their gender, but simultaneously hold valuable privilege because they are a part of the segment of society that can exercise control over marginalized populations. in the social work classroom, control is exercised when information that challenges heterocentric white women social worker’s beliefs including their color-blind, anti-racist, anti-homophobic, and anti-oppressive attitudes. control is enacted through “white tears.” moreover, white tears and the accompanying linguistic weapon of “feeling safe” drive how others surrounding heterocentric white female social workers should and do respond to the threats perceived against heterocentric white female social workers (accapadi, 2007; trepagnier, 2017). despite the absence of safety afforded to black men and women, transgender men and women, and other marginalized populations, cis gendered heterocentric white female social workers weaponize “feeling safe” in the social work classroom, field placement, and social work profession (boys et aguilar &counselman-carpenter/mirage of action 1032 al., 2018; holley & steiner, 2005; quiros et al., 2012) rather than face discomfort about their beliefs and actions. white tears and “feeling safe” are ways that redirect uncomfortable conversations about race, homophobia, and transphobia, among other aspects of diversity or oppression towards silence and avoidance (accapadi, 2007) and are symbolic ways that crying leads to comfort. a final concern with anti-racist book clubs and related discussion groups is that they tend to prioritize one marginalized identity over others and do not consider the interlocking and indivisible aspects of multiple identities as well as an overarching examination of oppression. these social activities also privilege the written word over other forms of knowing. finally, these spaces allow for the crying and comforting discussed in the following section to be perpetuated in a socially acceptable format. crying and comfort all people at some point in time cry in reaction to emotional distress and are comforted by those around them. crying is seen as an external manifestation of stress, discomfort, or injury and people are socialized to act in accordance with another’s distress. while people of all genders cry in many different situations, this section delves into crying as a deflection strategy that is expended by heterocentric white women in social work classrooms, practice settings, and organizational environments to solicit comfort and redirect assertions of racism or oppressive behavior that challenges self-beliefs about one’s anti-racist attitudes. historically, “white women’s tears” have been, intentionally or not, the catalyst for a response from those around them and are well documented as detrimental to marginalized populations such as black men, transgender women, latino men, and women of non-white ethnic backgrounds (dorr, 2004; hamad, 2020). contemporary social media and news outlets, for example, depict how white women’s tears have been deadly to marginalized populations and black men in particular. lynching and incarceration of black men to protect heterocentric white women is widely evident in the history of black-white relations. research on white tears focuses mostly on discussions about racism, but white tears can also be applied to other “isms” including cisgenderism, ableism, ageism and homophobia. applying our interpretation of white tears to educational, organizational, and social settings can help bystanders actively witness how collective attention is redirected from uncomfortable conversations about heterocentric white women’s participation in oppressive actions and structures towards topics that are more identity-congruent such as white supremacy among klu klux klan members or hate groups (accapadi, 2007). white tears derive from conversations or situations that directly or implicitly threaten the privileges of heterocentric white women in social work and american society (accapadi, 2007). case example as an msw student, jemel aguilar was placed in a non-profit organization that serviced children and families throughout an urban and suburban area. as part of the placement, jemel aguilar was tasked with conducting a psychotherapy group for elementary school students with internalizing disorders. each week, jemel aguilar would advances in social work, summer 2021, 21(2/3) 1033 attend an msw field seminar through his university where social work interns would share their experiences from the previous week and a field instructor would link the field experiences to the classroom material. a fellow classmate, a heterocentric, white woman, discussed working primarily with an african american adolescent young woman who was struggling with interacting with peers. during one class, jemel aguilar discussed a situation in which he was walking down the hall of the school and a student walked by and said “nigger” to the author, which the students in the author’s group overheard and reacted to when the group began to meet. jemel aguilar discussed the incident with his social work supervisor – a cisgendered heterocentric white woman – who in turn spoke with the principal – a cisgendered heterocentric white male. the principal decided that the group services were no longer needed and that jemel aguilar was not to return to the school. when the author brought this scenario to his peers in the field practicum group, the cisgendered heterocentric white woman began to cry and said “i am sorry. the girl that i am working with said that i am her mentor. but i am white, and she is black.” the group began to comfort her highlighting how connected the student of color clearly was to her. the rest of the group session focused on comforting her and explaining what she is doing well in this therapeutic relationship. the comment that jemel aguilar experienced and the subsequent actions by the school staff were never discussed or revisited. this example clearly demonstrates how often, particularly in social work educational settings, the needs of white women supersede the experiences of marginalized populations, which is also supported by the research (dorr, 2004; hamad, 2020; tate & page, 2018). it is important to note that white tears might not always happen quickly such as at the start of a conversation about oppression, but as the conversations about oppression continue and the threats to privilege accumulate the tears will appear and divert the discussion elsewhere. avoiding discomfort on the part of white faculty can also appear through grade inflation, which often occurs in response to worry about triggering [white female] students’ tears at not getting a perfect or “good enough” grade. thirty years ago, scholars wrote about the problematic nature of grade inflation in social work, and today grade inflation remains a problem in social work programs to the point where social work program grades are often the highest across graduate programs at respective universities (miller, 2013). likewise, field evaluation scores and performance rates are also often inflated and not an accurate representation of a student’s practice and interpersonal skills (sowbel, 2011). through inflating student grades, an educator can avoid uncomfortable conversations about a student’s skill and development as well as attitudes that reinforce white supremacy or ways of participating in oppressive structures that maintain white supremacy as the educator avoids and participates in the student’s avoidance of their own discomfort. in short, social work educators do not like making social work students uncomfortable by asking them to integrate into their professional and personal identities with constructive criticisms that accurately depict the steep learning curve students must overcome to devote oneself to social work practice particularly the difficult skills recognizing white supremacy, dismantling privilege, and engaging in anti-oppressive practice. aguilar &counselman-carpenter/mirage of action 1034 discussion as we said at the beginning of this article, we do not intend to provide answers or solutions to the tactics and strategies that white heterocentric women use to limit uncomfortable information that challenges their identities as non-racist. as we have said, these strategies inhibit, purposefully or subconsciously, the dismantling of white supremacy and center the experiences of white heterocentric women while continuing to sideline already marginalized populations. hiding behind the data, book clubs, and crying and comfort are three such strategies, but others do exist. although we do not have answers, and our study has limitations, we offer implications for social work teaching and practice as well as accreditation and action-oriented behavior change research. limitations the most significant limitation to this study and autoethnography as a methodology is that it cannot be generalized. we have shared from our experiences, positionality and own bias the strategies we have identified and tied to the prior literature. while there are many advantages to autoethnography, this particular methodology is limited by two other important aspects: the feelings that are triggered within the reader might be uncomfortable or difficult to sit with because the shared narratives may evoke unpredictable responses and willingness, truth-telling, and vulnerability in their self-disclosure requires researchers to share their experiences that can be difficult to replicate or follow upon critical examination of the research (bochner & ellis, 1996; méndez, 2014). implications for social work teaching and practice social work is a difficult profession, and when done well, it is always an uncomfortable process. in the first steps of training future social workers, social work educators struggle to both communicate the intricate reality of white supremacy and maintain the needed discomfort with oppression. additionally, social work educators must maintain the delicate balance between intricate reality and needed discomfort while educating social workers for practice. when students are uncomfortable with course materials or a grade, we discuss triggers and content warnings. while these messages are important for many of our social work students that come to our profession because of their own trauma histories, all social work students must learn to hold their own pain and prevent this pain from becoming an obstacle to helping care for the pain of others. this extends out from trauma histories and into difficult conversations about race, racism, white supremacy, privilege, oppression, and anti-oppressive practice. so, when we rush to comfort white heterocentric women’s discomfort, we continue to invest in white innocence as illustrated previously throughout this contribution to social work (razack & fellows, 1998). we do not intend for our experiences to be generalized to all social work programs across north america, however, we do feel that social work education and all programs need to reflect on their role in maintaining white supremacy in the classroom. one such reflective response could be focusing on what applebaum (2017) refers to as a “pedagogy of discomfort” (p. 863), which “...counters universal expectations that teachers must create advances in social work, summer 2021, 21(2/3) 1035 comfortable environments for students and assumes that discomfort can foreclose learning and obstruct change. discomfort thus becomes synonymous with the possibility of individual and social transformation” (p. 863). applebaum's statement speaks to the discussion of crying and comfort discussed earlier but also how social work curriculums are conceptualized, created, disseminated, and evaluated. similarly, applebaum (2017) also states that white women, one of the groups that dominates social work education, have developed strategies to talk about race and culture that often fall into “... areas of ‘safe’ and ‘dangerous’ differences, ‘pleasant’ and ‘nasty’ differences, and generating modes of talking about difference that evade questions of power” (p. 869). in what ways are social work educators, social work students, and the profession truly intervening in these attempts to maintain power through comfort while in the social work classroom? this is an important question because of the widely held idiom, “what happens in the classroom will happen in the field.” these efforts to manage the discomfort and draw attention away from white supremacy and white people’s roles, benefits, and privileges in a society built on white supremacy can initiate several defensive tactics such as ethnic cheerleading, non-engagement, performativity, crab theory behavior, and polite avoidance (pewawardy, 2003). for the profession and social work educators to let these behaviors “slide” in favor of student comfort or other allied ways of maintaining student comfort is to maintain white supremacy within the social work education and, upon graduation, in the social work profession. foundational and advanced practice, policy, and field practice courses need to be embedded with readings, media, role plays, and other action-oriented learning activities that inspire discomfort along with strategies to hold and stay within that uncomfortable space. in addition to being uncomfortable and holding our students accountable to the spirit of the core values of the social work profession, we must stop avoiding truly and kinesthetically uncomfortable conversations in our classes. while we might intellectually or theoretically discuss race and racism, typically listed in a singular “diversity” course or a human behavior class, our educational training does little to prepare social workers to address the needs of diverse people (ladson-billings, 2000). hence social work does not prepare graduates to address diverse clients. eventually, as social work students become social work leaders whether as administrators, educators, scholars, or practitioners – they still do not the understand the subtle and intricate ways that white supremacist thinking and behaviors are maintained in social work and society. and similar to teachers, who step into leadership after time in the classroom, social work educators are sorely lacking in how to move social work students from an intellectual discourse about racism to anti-racist practices in the field. social work education does not discuss how to navigate racially diverse staff, clientele, schools and hospitals, nor does it unpack the privileges perpetuated by segregated social workspaces and the silent racism of white heterocentric social workers. classes on diversity, oppression, and racism need interventions that are behavior change oriented and evidence based. a recent podcast by the new york times, entitled the book of statuses, has begun to explore segregation, desegregation, and the powerful role a small group of people white folx, place in shaping the entire system (joffee-walt, 2020). conversations such as this one, however, have not yet been broadly broached in social work education. multiple aguilar &counselman-carpenter/mirage of action 1036 theorists identify that social justice education, whose purpose is to disrupt dominant beliefs and practices, requires discomfort to stimulate growth and learning (berlak, 2004; garrison, 1999; kumashiro, 2002; mayo, 2002; zembylas, 2018), but we would argue that the majority of social work education has not yet met the requirements to call itself social justice education. social work is founded in colonialist and reformer values in which untrained “social workers”, then known as friendly visitors, sought to help those identified as poor, impoverished and “less than” through personal example, which is white exceptionalism and moral persuasion. what would social work look like if we began dismantling the very history on which we were founded? the answer to this question or at least a discussion about this topic remains mired in white silence. implications for cswe epas and social work accreditation the council on social work education (cswe) commission on accreditation is involved in establishing standards for social work education and accrediting social work programs in the united states of america. accreditation establishes standards for social work education that defines competencies that social work students and social work programs must enact along with the implicit and explicit behaviors exhibited through coursework, field placements, and other learning activities. accreditation standards, in essence, are a speech act that is both an expression and the performance of an act (butler, 1988). cswe’s educational policy and accreditation standards (epas) expresses how social work education should be and the courses enact the performance of the social work act. competency two of the cswe (2020) epas asks social workers and the educational systems that train them to “...engage in diversity and difference in practice, focus on highlighting social workers’ views of their clients and how the social worker may ‘understand’ difference” (p. 4). we believe that this understanding should include also experiencing discomfort about racism, relinquishing the strategies and tactics that prevent discomfort, as well as challenging the continuity of white supremacy that directly flows into and influences social work. the competency could hypothetically read, “social workers will engage with their discomfort about white supremacy, racism, oppression and how it will or does shape their selection of practice populations, assessment of population, interventions, outcome evaluations, and dissemination of outcomes.” as competency two is currently written, it is not surprising that social work programs have just one course on diversity, oppression, or social justice versus widespread integration of this content in all courses in the social work curriculum and field practice, as well as the continued avoidance of actual behavior change that challenges white supremacy and the strategies that heterocentric white female social workers use to alter the course of uncomfortable conversations. as butler (1988) eloquently states, …analysis of the place of whiteness in the racial order can and should be, rather than an end in itself, only one part of a much broader process of social change leveled both at the material relations of race and at discursive repertoires. it is not, in any case, realistic or meaningful to reconceptualize whiteness outside of racial domination when, in practical terms, whiteness still confers race privilege. (p. 243) advances in social work, summer 2021, 21(2/3) 1037 following the observations of silence in the social work profession and education around white supremacy, white supremacy is not addressed in the accreditation standards despite white supremacy history in shaping social work and american society. out of nine educational policy and accreditation standards (epas) that guide assignments, evaluation, syllabi, and program development for the bachelor’s and master’s level (cswe 2015), not one epas currently speaks to or hints at white supremacy, racism, sexism, homophobia, or ableism. after the death of george floyd, a black man killed by law enforcement officers in minnesota in may 2020, the council on social work education issued the following statement on social justice: epas require that social work programs prepare students to understand the forms and mechanisms of oppression and discrimination and recognize the extent to which our culture’s structures and values oppress, marginalize, alienate, or create privilege and power. educational standards also require students to understand the global interconnections of oppression and strategies to eliminate structural barriers to ensure that social goods, rights, and responsibilities are distributed equitably. the social work education standards are updated every seven years, and work has already begun on updating standards for 2022. we are calling on cswe’s members, educators, social workers, and others to help us provide epas, resources, and guidance that support our profession’s ideals. let us work together and continue to ensure that the 47,000 graduates of social work programs each year are a mighty force for good—one ready to identify and address threats to social justice. (p. 2) payne and askeland (2008) argued that western social work has the potential to impose postcolonial “cultural hegemony” by imposing its beliefs onto other cultures. an analysis of the cswe statement above aligns all marginalized groups with white heterocentric female social workers that are a part of, and explicitly or implicitly support, the people, systems, and structures that oppress them, rather than differentiating the positionality of individuals who have developed through and within historical trauma and experienced structural oppression. what will the process of developing the new 2022 epas look like in terms of critical analysis and authentically addressing how epas can challenge white supremacy, postcolonial “cultural hegemony,” by undermining tactics we have discussed in this article that are embedded so deeply in social work curriculum? at the bare minimum and as a starting point for addressing white supremacy in social work education and practice, we suggest and hope for the following cswe competency as a starting point: challenge one’s own participation in white supremacy. conclusion writing this article was intimidating, painful, confusing, overwhelming, and eyeopening. in discussions, we were unsure if we could achieve our goal given the enormity of the problem we saw within the profession and the potential for retaliation that is similar to what other truth speakers have experienced. after all, we both have experienced professional and personal punishments for speaking the truth to racism and oppression. we aguilar &counselman-carpenter/mirage of action 1038 were drawn, at first, to providing answers to a problem that extends far beyond our reach. we have grappled with and discussed some questions that could not be answered. therefore, we selected a research methodology that helped up present our truths, not answers. we hope this foray will continue to authentically deepen the discussion about white supremacy in social work and move the profession towards lasting behavior change. elisabeth counselman-carpenter has asked herself how this article will be received by folx of color since she is a white person who has been complicit in perpetuating white supremacy through her own personal and professional life. other reflexive questions include: conversely, how will this article be received by white folx who may see her positionality as potentially traitorous? is writing this article action-oriented or contributing to the concept that writing more words on a page is enough? how can i challenge my use of these strategies while also calling them out? elisabeth counselman-carpenter and jemel aguilar both received disparaging comments via social media based on prior work they have completed and currently hold junior faculty, and thus, professionally tenuous, status. jemel aguilar questioned whether writing this would result in white silence and silent hostility towards him from white folx and “can’t we all get along” from folx of color. in other discussions of ideas presented in this contribution, social workers of color said, “you just need to forgive and forget” while white heterocentric female social workers stated, “oppression is just going to happen and there is nothing you can do about it.” we are not willing to lie down and take the assault like “good little social workers.” our journeys with power, oppression, privilege and at opposing ends of white supremacy have brought us together as an unlikely duo in attempting to challenge the myriad of stagnation we see within our field. at the end of the day, we write this because we are both passionate about social work, we are tired of the different ways we continue or enact white supremacy because it is time to dismantle the glass house social workers have built for ourselves. our questions, doubts and fears continue to grow during these unpredictable times, and we can only hope to hold each other and our colleagues accountable in finally being the changemakers for which we have congratulated ourselves for being since the inception of our field. references accapadi, m. m. 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(2008). white logic, white methods: racism and methodology. rowman & littlefield publishers. author note: address correspondence to jemel p. aguilar, department of social work, southern connecticut state university, new haven, ct, 06515. email: aguilarj2@southernct.edu https://doi.org/10.1080/17449642.2018.1428714 mailto:aguilarj2@southernct.edu _________ zoila a. del-villar, edd, adjunct assistant professor, silver school of social work, new york university, new york, ny. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 636-653, doi: 10.18060/24168 this work is licensed under a creative commons attribution 4.0 international license. confronting historical white supremacy in social work education and practice: a way forward zoila del-villar abstract: oftentimes, social work education is in denial of its seductive and pervasive relationship with white supremacy, as if it is exempt in power relations rooted in racial formation. the present paper investigates the historical legacy of racial formation within the united states context and its inception in the field of social work. this paper provides comprehensive definitions of the key terms used in teaching social work practice from an anti-racist social justice lens. whiteness theory is used to highlight the way social work has perpetuated white supremacy in the evolution of the profession and black feminist standpoint is used to examine the experiences of non-white women as they interface with racist and oppressive social systems. i advocate for the use of a social justice pedagogy in social work education to help students think critically and reflectively about their future practice to better understand the oppressive power structures in many of today’s agencies, organizations, and institutions. keywords: social justice education, racial formation, pre-service social workers, racial inequality and social services social work education is neglectful of the role white supremacy plays in the past, present, and future by not adequately acknowledging the profession’s responsibility in disrupting racist and oppressive systems. in fact, social work education is informed by the values of neoliberalism: a system of social governance where the ideals and needs of capitalism have been embraced by the state which has largely withdrawn from regulatory practices controlling companies, corporations, and entrepreneurs in the united states and globally (hooks, 2014; marthinsen et al., 2019; morley et al., 2017). examples of neoliberal values in social work include but are not limited to the “increased privatization of services, the use of the voluntary or third sector, and social workers being controlled by managers whose emphasis is on completing bureaucracy speedily to meet targets” (rogowski, 2018, p. 73). plainly stated, neoliberalism forces social work programs to prioritize the creation of a one-size-fits-all model rooted in transactional services. this analysis also argues that the use of social justice education is a powerful platform to address and dismantle white supremacy inherent in social work curricula, programs, and practice. the current paper provides a critical perspective of the historical legacy from the 1400s to the present day to further examine the intersection of racial formation and social work. in doing this, it also urges the need for paradigm shifts in the training of social workers in the united states and beyond. this paper enriches existing social work literature by exploring the ways social justice education propels the learning and training of pre-service social workers. the implementation of counter-narratives into the social work curriculum is paramount because it allows students to think more critically about their role as historical and political subjects within the broader construction of power relations (razack & jeffery, 2002; todorova, about:blank del-villar/confronting historical white supremacy 637 2019; wagner & yee, 2011). pedagogies of this kind are ideal for undergraduate and graduate social work courses, as they help pre-service social workers reconcile their positionality and disrupt hegemonic interactions between individuals, groups, and communities (kohl & mccutcheon, 2015; smith, 2012; smith, 2015; wane & todd, 2018). this paper is composed of three sections: the first section, the explication of key terms defines concepts that emerge from the literature on social justice education. the second section, the intersection of racial formation and social work, contextualizes the study by providing a brief overview of racial formation as well as the social, political, and historical contexts in which social work education in the united states is embedded. the third and final section, disrupting neoliberal social work and enacting social justice, synthesizes the importance of social justice education to mediate the abuse of power in social work practice. section three also outlines the implications for practice and future research to ensure social justice in and outside the classroom. however, while this paper outlines both concepts and historical information that should be included in social work curricula, the particulars on how best to integrate these learnings are beyond the scope of this paper. explication of key terms throughout this paper, the author employs several key concepts that emerge from the literature on social justice education. the following definitions provide the foundation for the rest of this paper: hegemony is the political, economic, and cultural control of one group over another and allows for distinctions between individuals while simultaneously policing the bodies and militarizing the state borders of those constructed as others (giroux, 1981; gramsci, 2000; todorova, 2019). hegemony will be presented as the unifying concept that allows for interpersonal, cultural, institutional, and systemic oppression and marginalization by the social work profession within the united states. hegemony is the unifying concept that allows for interpersonal, cultural, institutional, and systemic oppression and marginalization by the social work profession within the united states. neoliberalism in education is a function of hegemony in that its rationale is to organize, regulate, and define the basic principles and workings of the state, national, and global economy (giroux, 1981). for example, the focus of social work education has shifted from meeting the needs of service users to the assessment and calculation of cost and liability (hooks, 2014; macias, 2013; morley et al., 2017). accordingly, neoliberalism and hegemony work simultaneously to maintain silence regarding issues of race and other sources of oppression (wagner & yee, 2011). this paper presents neoliberalism as a concept used to contextualize social work education in that students are taught to memorize information related to best practices, social welfare policy used to police bodies, and foreign policy used to justify violent military practices in the united states and abroad (morley et al., 2017; todorova, 2019). https://docs.google.com/document/d/0b-8eahyki0g-u05lq0mtoel6bdjva3vqzhvcd1k3a1c5mlzn/edit#heading=h.41mghml https://docs.google.com/document/d/0b-8eahyki0g-u05lq0mtoel6bdjva3vqzhvcd1k3a1c5mlzn/edit#heading=h.meukdy summer 2021, 21(2/3) 638 decolonization in education is about repositioning the way indigenous peoples regard themselves and their relationship to the work and the way non-indigenous people regard indigenous peoples (smith, 2013; wane & todd, 2018). this entails verbal acknowledgment, willingness to be challenged, openness to one’s accountability, and expression of one’s complicity in perpetuating colonial forms of oppression in globalization, patriarchy, land occupation, capitalism, and various forms of violence (smith, 2013; wane et al., 2011). this paper acknowledges how imperative decolonization is in the training of pre-service social workers informed by ideals of social justice education. racial formation refers to the process by which social, economic, and political forces determine the content and importance of racial categories, and by which they are in turn shaped by racial meanings (omi & winant, 1994). racialized people are groups of people not racially constructed as white. bipoc refers to black, indigenous, and people of color and is particular to the united states context and refers to historical references to racialized peoples who were subjected to enslavement, colonization, and exploitation (garcia, 2020; todorova, 2019). this paper views the process of racialization as nuanced, dynamic, fluid, and particular to one’s social construction and regional location. other/otherness/othering emerged in postcolonial studies and has evolved into an interdisciplinary concept that has taken on various meanings (lévinas, 1947/1987; heidegger, 1927/1962; staszak, 2008). in this paper, the author argues how the notion of othering and representations of non-dominant groups in the united states has shaped the profession of social work education. white supremacy refers to the social, institutional, and cultural power over and benefits from the exploitation of racialized and indigenous people in the united states and globally (people’s institute for survival and beyond undoing racism, 2018). it is the dominant ideology of the western hegemony under which this paper was written. whiteness theory posits that “white people '' are not born but made (aveling, 2004; leonardo, 2002; todorova, 2019). plainly stated, whiteness comes into being through performance, repetition of exclusionary narratives, and practices that normalize otherwise socially and culturally constructed hierarchies of superior and inferior peoples and their cultures (aveling, 2004; leonardo, 2002). furthermore, social groups imagined as white can also be unmade by fostering imaginations conducive to relational and non-violent identities. hence, in this paper, the term racial whiteness is used to refer not just to a group of people racialized as white but also to social and cultural representations and discourses giving meaning to white and non-white racial signifiers. black feminist standpoint is a feminist epistemology that counters the white supremacist capitalist patriarchy by exploring systems (collins & bilge, 2016; hill collins, 1986). it proposes that, while living life as a black woman may produce certain commonalities of outlook, the diversity of class, religion, age, and sexual orientation shapes individual black women’s lives. it is imperative in social work to incorporate the experiences of non-white women in the training and education of pre-service social del-villar/confronting historical white supremacy 639 workers. the use of a black feminist standpoint in this paper is political and counterhegemonic. the history and intersections of racial formation and social work in the united states the field of social work is informed by the values of neoliberalism: a system of social governance where the ideals and needs of capitalism have been embraced by the state which has largely withdrawn from regulatory practices controlling companies, corporations, and entrepreneurs in the united states and globally (marthinsen et al., 2019; morley et al., 2017; rogowski, 2018; todorova, 2019). much like a company or a factory, capitalist notions of cost, accounting, and profit have come to inform how states and local governments plan and deliver welfare services to their citizens. the same logic informs the professional canon of social work, where the prevailing model of “positive social work” is essentially paying low wages to social workers, rebranded as “cost-effective service delivery” to “clients.” yet, the majority of social workers in the united states, are members of privileged racial and economic groups. the field of social work within the united states is rooted in historical classist, racist, gendered, islamophobic, and xenophobic structures that are a direct by-product of imperialism, colonialism, and the neoliberal hegemony within the united states (bhuyan et al., 2017; miller & garran, 2017). the training and education of pre-service social workers therefore must address these issues directly. thus, racial formation theory teaches us that racial imaginations have permeated all levels and institutions of american life, becoming foundational ingredients of hegemonic cultural and economic institutions, as well as social behaviors, customs, and individual beliefs (feagin & elias, 2013; kandaswamy, 2012). omi and winant (1994) further conceptualize race relations in the united states as the social construction and interpretation of differences used to justify the oppression of black people, the stealing of native american land, the exclusion of chinese and japanese immigrants, the annexation of mexican land yet the denial of citizenship to latina/o people, as well as colonization of foreign lands reaching to the philippines. as result, in the united states, the white/nonwhite binary has been rigidly defined and enforced as a line separating the haves and havenots (husain, 2019). furthermore, skin color differences have been used in educational, political, and cultural narratives to explain perceived differences in intellectual, physical, and artistic temperaments, and to justify unequal treatment of racially identified individuals and groups (hooks, 2014; husain, 2019; bhuyan et al., 2017). racial formation is embedded in social, cultural, and economic relations in the united states further supporting white racial privileges in all professional fields, including social work (leonardo, 2002; fellows & razack, 1998). the social work profession must be also understood within the contexts of us imperialism, colonialism, and patriarchy (dei, 1999; hooks, 2000a). ideas of gender have developed in relation to practices of colonialism, slavery, racialized labor exploitation, and defining national identity: manhood and womanhood have been thus constructed in relation to colonial male governments and nation-state citizens and female domesticity and care for summer 2021, 21(2/3) 640 family, men, and elders (kandaswamy, 2012, p. 29). european and american imperialists also displaced (physically and emotionally) indigenous peoples and african slaves (dei, 1999; pateman & mills, 2007), making them non-national subjects upon whose labor and land us wealth and capitalism grew (fast & collin-vézina, 2010). colonial and capitalist projects intersected further with patriarchal structures and institutions which exploited and victimized differently racialized women physically and sexually (hooks, 2000a; pateman & mills, 2007; wane et al., 2011). the classification of black women as lascivious and white women as pure was invented to elevate male power, maintain racial hierarchies, and justify the subordination of all women (hooks, 2000b). colonial, patriarchal, and racial ideas and structure, in turn, have shaped the field of social work: white women have dominated the profession as middle class and culturally privileged subjects who deliver “care” to non-white communities treated as people in need of proper uplifting and reform. the following section provides an overview of this historical legacy from the 1400s to the present day to examine the intersection of racial formation and social work in greater depth while making the case for the need for social justice education pedagogies in the training of social workers in new york state and beyond. euro-american imperialism colonialism: 1450–1890 the world under colonialism was and still is divided into binary groups based on power and domination (el-lahib, 2017) rationalized by presumed biological inferiority (bonillasilva, 2017). race is a category grounded not in biological difference, but rather in what perceived bodily differences come to mean in the context of particular social struggles (hosang et al., 2012; omi & winant, 1994). these binary groups contributed to constructing indigenous peoples and african slaves as other through a racial contract that included the colonizers and the colonized, conquerors and conquered, master and slave, male and female, white women and non-white women (el-lahib, 2017; mills, 2014). the racial contract is a metaphor used to justify the extreme forms of state-sanctioned dehumanization and social and economic exploitation of racialized and indigenous people (leonardo, 2002; mills, 2014), as well as the violent persecution of enslaved african islam and indigenous spirituality and forced conversion to christianity (fast & collin-vézina, 2010; husain & howard, 2017). histories of colonization and oppression cannot be separated from everyday acts of racial gendered violence. for example, the intersection of colonialism and patriarchy is directly correlated to the marginalization and exploitation experienced by women of color today. african slaves were the property of slave masters, and enslaved african women “could be replaced or increased by breeding, but unlike the breeding of livestock, the slave masters themselves participated directly in the reproduction” (pateman & mills, 2007, p. 144). rape was a tool of oppression and became the pinnacle of racism and gendered violence perpetrated by extreme hyper-white masculinity (hunter et al., 2010). racialized and indigenous people thus (necessarily and appropriately) developed adaptive strategies to face oppression, domination, and victimization that are still used in the present day. for example, hardy (2013) identified race-related trauma wounds such as internalized devaluation, assaulted sense of self, and internalized voicelessness: : del-villar/confronting historical white supremacy 641 internalized devaluation is a direct by-product of racism and is inextricably linked to the deification of whiteness and the demonization of people of color, while assaulted sense of self is the culmination of recurring experiences with internalized devaluation, and internalized voicelessness is the inability to defend against a barrage of unwelcome and unjustified negative, debilitating messages. (pp. 25-26) such maladaptive coping mechanisms are the “legacy of colonial history that has shaped social structures underlying racial order” (el-lahib, 2017, p. 646). maladaptive coping can be understood as a form of mental slavery that has resulted in bipoc seeking or being remanded to services in a social welfare system that mirrors the racial hierarchy of formal colonialism. degruy-leary’s (1994) theory of post-traumatic slave syndrome provides a lens for understanding the psychological consequences of formal colonialism, institutional racism, and systematic marginalization. historical trauma is multigenerational and, when combined with the absence of opportunity to heal or access to available physical and mental health resources, continues to impact children whose parents suffer from post-traumatic slave syndrome and often exhibit the same socialized behaviors. key behaviors and patterns surface as lack of self-esteem, rage manifested into violent anger, and internalized racism. these behaviors and patterns have been pathologized, and the profession of social work exploits and profits from them (abbasi, 2020; kroehle et al., 2020; morley et al., 2017). the impact of race on social work is evident in the broader historical racial formation illuminated above and must be read critically as an aspect of current and past legislation, policies, and the delivery of social service in the united states. the progressive era: 1890–1920 the emancipation proclamation was in 1863, and most consider that the war ended in 1865 with the surrender of lee at appomattox, which might mark the true end of “formal slavery.” however, the structural and institutional racism that emerged during the colonial era were left untouched by reconstruction, securing political, economic, and cultural hegemony in the united states. for example, black codes in 1865 and 1866 were blatant attempts to continue slavery by forcing african americans to contract work one year in advance or risk being arrested (bonilla-silva, 2017). like miller and garran (2017), bonilla-silva (2017) contends, “jim crow laws involved the disenfranchisement of blacks, racial separation in public accommodations, segregation in housing, schools, the workplace, and in other areas to ensure white supremacy” (p. 45). additionally, the 13th amendment, ratified in 1865, resulted in high rates of incarceration for minor infractions and crimes, and charged large fines that african americans could not pay (alexander, 2011; miller & garran, 2017). at the same time, the cultural genocide and erasure of indigenous people continued through mass killings, broken treaties, and the enforcement of boarding schools (miller & garran, 2017). these are prime examples of how hegemony functioned politically, economically, and culturally during the progressive era. whiteness has had a violent career both physically and systematically in the united states. the aggression of the white race is intimate slavery, segregation, and discrimination. summer 2021, 21(2/3) 642 building on this notion of hegemony and the legacy of the eugenics left by social reformers of this era, the social work profession emerged with the creation of charity organization societies in 1877 in urban areas impacted by poverty. the sole function of charity organization societies was to preserve the economic, political, and cultural hegemony of whiteness in the united states. at the time, social workers were exclusively wealthy white christian female reformers who sought to assimilate and ease the transition of the high numbers of migrants from what was considered the “other europe” (todorova, 2019, p. 2), including ireland, italy, romania, croatia, and poland, who were viewed as helpless and needing to be saved (miller & garran, 2017). social work in this era facilitated the social and material privileges through membership of whiteness (badwall, 2015; gregory, 2021; tascón & ife, 2019). whiteness was and continues to homogenize diverse ethnic populations into a single category for racial domination (leonardo, 2002), and white identities continue to be the foundation of social, political, national, and geopolitical relations (hunter et al., 2010; leonardo, 2002). during the progressive era, charity and social services were viewed as the christian church’s responsibility (warde, 2016). thus, the church deemed it necessary to determine who was worthy of aid. plainly stated, services were available to the european migrants, whom white americans came to refer to as “ethnic whites,” but were denied to black, asian, and indigenous americans. interventions ranged from “friendly visitors” to families in need, to teaching financial literacy and modeling a professional work ethic (miller & garran, 2017; morgaine & capous-desyllas, 2014; warde, 2016), as well as religious conversion. husain and howard (2017) have asserted that conversion to christianity among ethnic white communities followed in line with the historic racialization of religion during formal colonialism. following the work of charity organization societies were settlement houses. the settlement house movement is associated with jane addams, a white social worker of the time. it is important to highlight that, like charity organization societies, settlement houses only served ethnic white clients and did not challenge systematic racism (miller & garran, 2017; warde, 2016). the goals of charity organization societies were to engage in research about poverty, provide aid to ethnic white people experiencing poverty in their transition to the united states, and support needy families through positive role-modeling (morgaine & capous-desyllas, 2014), also performed by wealthy christian women. as a result of the exclusionary practices of charity organization societies and settlement houses, bipoc created their social network and service programs. bipoc organized based on shared victimhood and focused on fostering racial pride, mutual aid, and a sense of community in opposition to hegemony (gregory, 2021; miller & garran, 2017; smith, 2012). these social services and programs are reminiscent of the indigenous practices of collectivism and sharing (fast & collin-vézina, 2010; schiele, 2017; wane et al., 2011; warde, 2016). this movement was led by ida b. wells, a black organizer, journalist, and social worker of the time, although the history of social work is typically linked to addams, not wells (hutchison, 2016). jane addams’ status as a white woman and heroine of social work juxtaposes the silencing of social workers of color, who were pivotal to the foundation of social work as a field. there remains insufficient dialogue between the gender hierarchy and racial hegemony as it relates to the profession of social work (smith, del-villar/confronting historical white supremacy 643 2012). thus, deconstructing how the traditions of social work are implicit in race relations and gender hierarchy is essential for the education of present-day social workers. the classification of “white” was subject to challenges brought about by the influx of “ethnic whites” such as southern europeans, the irish, and jews, who were culturally different from anglo-saxons. the new working class now considered white were recent immigrants, who organized on racial lines as much as on traditionally defined class lines. for example, the irish on the west coast engaged in vicious anti-chinese race-baiting and committed many pogrom-type assaults on chinese in the course of consolidating the trade union movement in california (fellows & razack, 1998; warde, 2016). simultaneously, newly assimilated jews more closely aligned to whiteness, received employment opportunities that created generational wealth and further excluded an estimated two million blacks who migrated to the northern and western parts of the country (bonillasilva, 2017; warde, 2016). capitalists throughout the united states also adopted racial practices in their hiring, company policies, and daily activities (bonilla-silva, 2017). african americans were denied access to certain jobs and were paid lower wages, while ethnic whites, who had been recruited to the united states for their labor, became the foundation of the country’s unionized workforce. as a result, institutional labor produced particular forms of white middle-class masculinity, as ethnic whites were able to obtain union positions not afforded to racialized and indigenous bodies (gregory, 2021; hunter et al., 2010; warde, 2016). the assimilation of ethnic whites into whiteness facilitated access to union protections. this enabled ethnic whites to develop generational wealth not afforded to indigenous people and former slaves, who likewise migrated to the northern united states for jobs. at the same time, the elimination of european migrants’ ethnic identities served to maintain hegemonic dominance (el-lahib, 2017). racialized bodies were also excluded from work that would have provided generational wealth (roediger, 1999). the new deal: 1930–1950 similar to the progressive era, the new deal did not challenge institutional and systemic racism. the new deal created a series of employment projects and social insurance programs as a response to the great depression (miller & garran, 2017; morgaine & capous-desyllas, 2014; warde, 2016) that further elevated white supremacist capitalist patriarchy. the expansion of social service programs created a growing need for social workers (gerig, 2007), but poverty-impacted, non-white bodies were effectively excluded from these positions because they were not afforded the power, social capital, and education necessary to access them. by contrast, white women were explicitly educated and hired to be social workers (hooks, 2000a, 2000b). during the new deal, the role of social workers shifted from assimilating european migrants into whiteness to sustaining hegemony and white supremacy under the guise of “protecting the state.” various pieces of legislation were enacted between the late 1800s until after world war ii both to deny citizenship to racialized and indigenous peoples and to restrict their migration (husain & howard, 2017; warde, 2016). for example, social workers, backed by anti-immigrant laws, identified and reported mexican americans and summer 2021, 21(2/3) 644 chinese americans for deportation when their physical labor was no longer needed due to the migration of ethnic whites (miller & garran, 2017). in other cases, the social work profession was complicit in not challenging violent immigration policies and legislation, such as the native american reorganization act of 1934, which perpetrated the loss of culture and heritage among indigenous peoples (miller & garran, 2017), and executive order 9066, which forced the internment of japanese americans into camps (miller & garran, 2017; warde, 2016). during this period, federal legislation also justified the militarization of state borders and furthered racial hierarchies (el-lahib, 2017). smith (2012) reminds us “regardless of how long any particular group of immigrants resides in the united states, they generally become targeted as foreign threats” (p. 69). the legacy of racial conflicts and policies shaped the interests (or priorities) of the united states and in turn, led to the consolidation of institutional patterns that perpetuated the color line within the working class. speaking specifically of racial hierarchies, smith (2015) introduced the concept of the oppression olympics, which contextualizes how racialized people have been socially constructed to compete for scarce resources. smith further explains that white supremacy and the heteropatriarchy are the building blocks of governance within the united states, based on what she calls the “three pillars of white supremacy”: slavery/capitalism, genocide/colonialism, and orientalism/war (smith, 2015, p. 1). indeed, she asserts, “white supremacy is constituted by separate and distinct, but still interrelated, logics” (smith, 2015, p. 1). the logic of slavery/capitalism renders black people into property that is inherently enslavable, while the logic of genocide/capitalism describes indigenous people as a “present absence” so the heteropatriarchy and white supremacy can gain access to their land, resources spirituality, and culture (smith, 2015, p. 68). lastly, the logic of orientalism/war deems what was historically called the “orient or asia” to be inferior and an ever-present threat to the west (smith, 2015, p. 264). such racial hierarchy is instrumental in sustaining capitalism (el-lahib, 2017) and rationalizes the dehumanization and degradation of people constructed as non-white—that is, of racialized people. the civil rights era: 1958–1968 by the 1960s, social workers and other helping professionals began to see how institutional racism, poverty, and marginalization affected various groups of people and that traditional social work theories did not apply to people of color, women, people who are financially exploited, people with disabilities, military families, and senior citizens (bonilla-silva, 2017; gerig, 2007; miller & garran, 2017; morgaine & capous-desyllas, 2014). during the civil rights era, many social workers collaborated with organizations such as the student nonviolent coordinating committee (sncc), the national association for the advancement of colored people (naacp), the southern christian leadership conference (sclc), the black panthers, the revolutionary action movement, and move (bonilla-silva, 2017) to combat poverty and racism, particularly the high rates of unemployment affecting black men (gerig, 2007; miller & garran, 2017; morgaine & capous-desyllas, 2014). del-villar/confronting historical white supremacy 645 through collaboration and organizing, social workers and bipoc achieved a great deal during the civil rights movement for black men and white women. however, during this period, the social work profession did not address the daily exploitation of racialized women, nor did it disclaim heteronormative eurocentric social work theories and models of practice that did not apply to individuals experiencing social oppression and marginalization. the automation of agriculture in the south and the augmented labor demand of the postwar boom transformed black people from a largely rural, impoverished labor force to a largely urban, working-class group by 1970. as the liberal welfare state moved rightwards, the majority of black people came to be seen, increasingly, as part of the underclass and/or as state dependents. simultaneously, third world impoverishment and indebtedness fueled immigration from asia and latin american countries, which created the oppression olympics (smith, 2015) among black people, indigenous persons, and asians, sustaining a racial gendered class divide among women, described as the “race to innocence” by fellows and razack (1998). hughey et al. (2015) remind us that historic and “contemporary immigration policies and practices serve as racial mechanisms in a racialized social system” (p. 1353). the illusion of a post-racial era: 1970–present by 1970, it was declared unethical to deny social welfare services based on race, gender, or class (gerig, 2007; warde, 2016). however, social work practice was still dominated by traditional theories created by and for white bodies (hutchison, 2016), which diminished and invalidated the experience of historically racialized individuals and communities seeking services (harlow & hearn, 1996). outside of the united states—in canada, england, and austria—social work practitioners underscored poverty and marginalization through the lens of wider political and structural inequalities, sought to provide space for individuals, families, and communities to express their needs, and sought to address individual, local, national, and global levels of inequality in their practice. unfortunately, because this framework, which came to be known as anti-oppressive practice, did not center race, it furthered the division of women by race and class (todorova, 2018; warde, 2016). during the same period, in the united states, queer and bipoc women were having discussions about the intersections of race, class, gender, and the ways social services demonized service recipients, which came to be known as anti-racism work (harlow & hearn, 1996; hosang et al., 2012; krumer-nevo, 2009; mclaughlin, 2005; warde, 2016). neither anti-oppressive practice nor anti-racism work reached u.s. social work education until the late 20th century, and when they did, anti-oppressive practice became the preferred framework among progressive, white social workers precisely because it ignored race and did not challenge the racial hierarchy embedded in social work. the feminization of poverty during the late 20th century illustrates why practitioners need to have an anti-racism framework and not simply engage in anti-oppressive practice. although poverty increased among all women from 1967–1978 (hooks, 2000a, 2000b), it only became thought of as a women’s issue when high rates of middle-class white women divorced in the 1980s and 1990s and experienced financial insecurity (hooks, 2000b). as summer 2021, 21(2/3) 646 such, poverty was understood as an individual phenomenon resulting from a woman’s disconnection from her nuclear family and the loss of her husband’s income, rather than a systemic by-product of the capitalist patriarchy (franklin, 1992; hooks, 2000b; warde, 2016). the social welfare system, through racist, gendered, and classist policies, privileged white women who were divorced with resources from the state, while non-white women who bore children outside of marriage were denied state funding to support their families (hooks, 2000a; mills, 1997; wane et al., 2014). it is not by accident that the “welfare queen” stereotype of the 1980s coincided with the feminization of (white women’s) poverty. this characterization of racialized women as unable to take care of their children due to the primacy of their sexual desires validated the neoliberal belief that the use of social services was rampant and fraudulent among black women. this stereotype was also used to justify institutional surveillance of black women and their children and the construction of barriers to social service resources. this is another prime example of the control that white hegemony has over social, cultural, and political discourse, and is tantamount to colonialism. access to resources is an issue not just in the united states, but globally. the state creates and maintains social welfare policies, foreign policies, organizational practices, and broader governmental entities while simultaneously sustaining the racialized gender order of white privilege based on racial hegemony (hunter et al., 2010; wane et al., 2014; warde, 2016). as stated earlier, during the progressive era, financial assistance and aid were regulated by the church. the funding practices of that era are mirrored in contemporary government-funded social service programs, local and national nonprofit organizations, and global nongovernmental organizations, which play a role in setting the global neoliberal agenda (choudry & kapoor, 2013, p. 462). in exchange for material and financial resources provided by the government, nonprofit, and nongovernmental organizations, racialized and indigenous peoples are no longer in control of their narratives and free will. funders, whether public or private, determine funding priorities based on their political ideology and interests (kivel, 2007; morgaine & capous-desyllas, 2014), creating hegemonic conditions and limitations of services for those in need (bundy-fazioli et al., 2013). the three pillars of white supremacy set up the conditions for bipoc to always be in competition for resources in the united states and abroad. indeed, as benn-john and de mello (2018) assert, resources are always limited, and grant-funding programs are generally time-limited and fail to address underlying issues that are deeply gendered and raced. smith (2007) describes this funding hierarchy as the “nonprofit industrial complex,” a system of relationships between the state (or local and federal governments), the wealthy, private foundations, and nonprofit and nongovernmental social service and social justice organizations that results in the surveillance, control, derailment, and everyday management of political movements. furthermore, she claims that this complex pits organizations against each other rather than encouraging collaboration and forces racialized and indigenous people experiencing financial deprivation to compete for scarce resources at the individual, community, and systemic levels (macey & moxon, 1996; morgaine & capous-desyllas, 2014; smith, 2007; warde, 2016). marsiglia and kulis (2009), meanwhile, highlight how problematic and ineffective neutral social service del-villar/confronting historical white supremacy 647 programs are and suggest that many agencies assume and impose heteronormative middleclass values and simultaneously overlook and deemphasize the cultural and social strengths among groups who continue to face marginalization and systematic oppression. the authors fail to underscore the importance of decolonization during the education and training of pre-service social workers. marsiglia and kulis (2016) suggest that travel abroad programs provide social work students a sufficient “understanding of traditional culture…and the possible tension and contributions clients may be experiencing” as they are forced to assimilate to american culture (p. 352). this view of social work education underscores neoliberalism in that those who can pay for experience have access to it (furman et al., 2021). also, mere access does not teach pre-service social workers to deconstruct these values or discourage them from imposing these values abroad. in a similar vein, choudry and kapoor (2013) introduced the term “ngoization” in reference to the professionalization and institutionalization of social action, and suggested that institutions that receive funding have a profound impact on communities locally, nationally, and globally, shaping rather than supporting them. thus, nonprofit and nongovernmental organizations are complicit in the process of colonization, hegemony, and neoliberalism (choudry & kapoor, 2013; furman et al., 2021; marsiglia & kulis, 2016). likewise, government social services are a function of hegemony and neoliberal politics, where power is accorded, distributed, withheld, and/or denied based on race, gender, class, and sexuality (dei, 1999). social services are meted out to optimize efficiency rather than to address human needs fully (hill collins, 2002; hooks, 2000a; lorde, 2012). to counter institutional and systemic racism in social welfare programs, it is essential for pre-service social workers to examine their thinking processes and emotions, and explore their socially constructed identities, social relations, and structures of inequality based on power, privilege, and oppression. understanding racial formation in the u.s. context is paramount to disrupting structures of inequality embedded in the social work field. however, traditional social work education focuses instead on how to pass exams, fill out paperwork, work individually, and not challenge the system. social work education is reduced to a form of theoretical memorization, where knowledge is presented as something and only given to those who can afford it (gramsci, 2000). in his text on discipline and punish, foucault (1984) reminds us that the more knowledge one accumulates, the more useful one becomes to the state and its borders. thus, the state teaches, corrects, trains, controls, and manipulates pre-service social workers as political investments (ball, 2012; foucault, 1984). this section highlights the role the field of social work has played in sustaining racial formation in the united states by examining the progressive era, the new deal, the civil rights movement, and the post–civil rights era. the creation of social identities such as race and class was and remains an attempt to maintain hegemony and justify the oppression, marginalization, and exploitation of the other—and specifically racialized women. the creation of social welfare programs has reconfigured formal colonization. as a result, social workers are trained in this system and become servants of the state, regulating financial resources and perpetuating the gendered and racial exploitation of black, indigenous, queer and trans people that were fundamental to formal colonialism. summer 2021, 21(2/3) 648 pre-service social workers must learn to theorize the multiple intersections of individuals, groups, and communities constructed as the other to achieve personal, institutional, and systematic transformation. the next section discusses the organizations using social justice work and then examines the current literature on using social justice pedagogy to address power, privilege, and oppression in social work education. indeed, social justice education must be embedded in social work education and specifically in practice courses to position pre-service social workers for transformative work with and among individuals, families, and communities impacted by systems of oppression and marginalization. enacting radical social work education must also involve the unlearning of colonial knowledge, and demanding the decolonization of pre-service workers training well. such practice displaces euro-american ideals and norms as “truth” and the only way of knowing, replacing them with an epistemological forest where european, indigenous, black, white, and other ways of knowing are equal and equally thriving (macias, 2013; todorova, 2019). disrupting neoliberal social work and enacting social justice although this paper conceptualizes the profession of social work with existing systems of oppression, it proposes a new direction in the teaching and training of pre-service social workers. to combat white supremacy, i argue that naming the historical legacy of racial formation and its inception in the field of social work furthers discourse in the training and education of pre-service social workers. although critical discourse in itself does not erase societal power structures, the use of counter-narratives in classroom settings can awaken, provide insight, and disrupt harmful power structures within the profession of social work. through this dynamic process, educators and students alike learn to become critically reflexive and honor different ways of knowing and being; thus, transcending the social worker-client relationship to one that centers healing and collaboration through reciprocity. one way to move this work forward is by creating a framework that integrates the key concepts discussed earlier in the paper to uncover the historical legacy of white supremacy. more specifically, a study can be done to compare the learning experience of students engaged in this framework and those who are not. such an expansion would reconstruct old paradigms and make way for new social work pedagogies and practices. ultimately, this paper documents the legacy of racism and oppression in the united states as it relates to social work; 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(2014). ruptures: anti-colonial & anti-racist feminist theorizing. springer. warde, b. (2016). inequality in u.s. social policy: an historical analysis. routledge. author note: address correspondence to zoila del-villar, silver school of social work, new york university, new york, ny 10024. email: zdv1@nyu.edu https://collectiveliberation.org/wp-content/uploads/2013/01/smith_intro_revolution_will_not_be_funded.pdf https://collectiveliberation.org/wp-content/uploads/2013/01/smith_intro_revolution_will_not_be_funded.pdf https://doi.org/10.1525/california/9780520273436.001.0001 https://archive-ouverte.unige.ch/unige:77582 https://archive-ouverte.unige.ch/unige:77582 https://doi.org/10.1007/978-3-030-01539-8 https://doi.org/10.1007/978-3-030-01539-8 https://doi.org/10.1007/978-94-6091-603-8 https://doi.org/10.1007/978-94-6091-603-8 mailto:zdv1@nyu.edu explication of key terms the history and intersections of racial formation and social work in the united states euro-american imperialism colonialism: 1450–1890 the progressive era: 1890–1920 the new deal: 1930–1950 the civil rights era: 1958–1968 the illusion of a post-racial era: 1970–present disrupting neoliberal social work and enacting social justice 2017 advances in social work reviewers and affiliations we would like to acknowledge the contributions of the following individuals who reviewed manuscripts for advances in social work in 2017. without their time and expertise, advances in social work would not be possible. shauna acquavita, university of cincinnati margaret adamek, indiana university kylie agllias, newcastle university, australia jemel aguilar, southern connecticut state university karen allen, indiana university* cecilia ayón, arizona state university stephanie baird, university of toronto adrienne baldwin-white, arizona state university christine barnes, louis stokes cleveland va medical center bob bennett, indiana university larry bennett, indiana university rosalyn bertram, university of missouri kansas city andrea black, university of louisiana at monroe jennifer blevins, university of minnesota lisa blitz, binghamton university samantha brown, university of denver barb burdge, manchester university joan carlson, indiana university kala chakradhar, murray state university christina chiarelli-helminiak, west chester university johnson chun-sing cheung, the hong kong polytechnic university michael clarkson-hendrix, fredonia state university of new york kathryn collins, university of maryland lisa conradi, chadwick center for children and families, rady children's hospital san diego laurie cook heffron, st. edwards university, austin, tx marcus crawford, university of texas at arlington james daley, indiana university sheila dennis, indiana university hillary dolinsky, university at albany eileen dombo, the catholic university of america amy doolittle, university of tennessee chattanooga tonya edmond, washington university in st. louis james ellor, baylor university susan elswick, university of memphis gretchen ely, university at buffalo, state university of new york lorena estrada-martinez, university of massachusetts boston michelle evans-chase, rowan university anne farina, saint louis university kathleen farkas, case western reserve university thomas felke, florida gulf coast university dale fitch, university of missouri gail folaron, indiana university karen ford, james madison university shirley gatenio gabel, fordham university barbara gilin, widener university philip gillingham, university of queensland, australia jillian graves, eastern michigan susan green, the state university of new york at buffalo james hall, indiana university scott harding, university of connecticut kate hendricks thomas, charleston southern university robin hernandez-mekonnen, stockton university steven hoffman, university of texas at san antonio carol hostetter, indiana university patricia howes, indiana university jeremiah jaggers, indiana university isaac karikari, indiana university michael killian, university of texas at arlington hea-won kim, indiana university sung-ju kim, monmouth university julia kleinschmit, university of iowa andrzej klimczuk, warsaw school of economics, poland athena kolbe, brockport university david kondrat, indiana university debra kram-fernandez, empire state college (suny) amy krings, loyola university marie lacroix, university of montreal susan larimer, indiana university kathy lay, indiana university christopher layne, university of california, los angeles jessica lee, indiana university jill levenson, barry university kathryn libal, university of connecticut* diane loeffler, university of kentucky mayra lopez-humphreys, cuny college of staten island susan mapp, elizabethtown university, pa christie mason, loyola university chicago carol massat, indiana university nicholas mazza, florida state university jessica mccallister, university of new england jennifer mccleary, university of minnesota duluth lisa mcguire, james madison university jane mcpherson, university of georgia alysse melville, university of connecticut kathleen monahan, stonybrook amy murphy-nugen, western carolina university debra norris, university of south dakota kieran o'donoghue, massey university, new zealand manoj pardasani, fordham university kay paris, lincoln memorial university, tn sudershan pasupuleti, university of cincinnati katherine perone, western illinois university phu phan, california state university dominguez hills barbara pierce, indiana university david pooler, baylor university marciana popescu, fordham university* gerald powers, indiana university nivedita prasad, alice salomon hochschule, university of applied sciences, berlin larry reynolds, marian university karen rice, millersville university rebecca rouland polmanteer, university at buffalo school of social work mary santhosam, university of madras, chennai, india janki shankar, university of calgary elithet silva-martinez, university of puerto rico greta slater, ball state university alexa smith-osborne, university of texas at arlington marlys staudt, university of tennessee ginny strand, fordham university* patrick sullivan, indiana university iona thraen, university of utah wendy turner-frey, university of southern indiana sarah twill, wright state university karen vandeusen, western michigan university amy ward, eastern central university, oklahoma ineke way, western michigan university allison west, johns hopkins university joanne westwood, university of stirling, scottland, uk jennifer willet, university of nevada samantha wolfe-taylor, indiana university susan yoon, the ohio state university pinar zubaroglu, fordham university *special issue guest editor _______ dale dagar maglalang, phd, ma, msw, postdoctoral research associate, center for alcohol and addiction studies, brown university school of public health, providence, ri. smitha rao, phd, msc., msw, visiting assistant professor, college of social work, the ohio state university, columbus, oh. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 672-689, doi: 10.18060/24145 this work is licensed under a creative commons attribution 4.0 international license. “theory’s cool, but theory with no practice ain’t shit…”: critical theories and frameworks to dismantle racism in social work education and practice dale dagar maglalang smitha rao abstract: as it stands today, social work education falls short in providing critical theories and frameworks that reflect the experiences of black, indigenous, and people of color (bipoc). such insufficiencies maintain racism and other forms of oppression that plague both social work pedagogy and praxis. to challenge and dismantle hegemonic curricula, social work education needs to do more to provide the knowledge and tools necessary for anti-racist social work. the purpose of this article is to present five critical theories and frameworks written by indigenous and people of color scholars that social work educators, researchers, and practitioners can integrate into their teaching and practice to raise the critical consciousness of social work students. these five postulations are compa love, racial triangulation theory, breath of life theory, kapwa, and cultural wealth. the article will also discuss implications for social work education and practice. centering the voices of under-represented scholars whose epistemologies are rooted in the lived experiences and communities that the field of social work traverses provides a pathway for social work education and practice to be tailored towards self-determination for all. keywords: social work, theory, education, critical pedagogies, anti-racism scholarship and the news of the day point to continued hate crimes and worsening racial tensions in the united states (u.s.) in recent years (horowitz et al., 2019), though racism has been an enduring presence in this country (sweet, 1997). the september 2020 presidential memorandum to federal agencies, vilifying and threatening to put an end to trainings and workshops that tackle issues of racism and sexism, is just the latest in a long line of institutional attempts to stymie any progress in advancing racial justice in the u.s. (vought, 2020). racism is deeply entrenched in all aspects of u.s. culture, society, and institutions that unjustly normalized inequities (kendi, 2016). among these institutions worth examining and catechizing is the field of social work, specifically social work education. social work education is guided by numerous theories and frameworks that inform critical analysis, research, and practice. these terminologies need to be defined distinctly from one another. a theory is a set of interrelated concepts that explain or predict a phenomenon, while a theoretical framework is a set of theories and concepts that one uses to conduct, analyze, and interpret the data in a research study (kivunja, 2018). social work, a multidisciplinary field, is inundated with varying information from different academic disciplines held together with the purpose of helping individuals, communities, and populations access their needs at micro and macro levels, and develop skills and tools to promote their overall well-being and self-determination (parsons, 1991; tower, 1994). about:blank maglalang& rao/theory’s cool 673 although this sense of benevolence is promulgated by social work, it would be remiss to ignore social work’s history of racist actions through the establishment of settlement houses that refused to provide services to the black and african american population (berman-rossi & miller, 1994), and culpability in injustices against the internment of japanese americans (park, 2008), as well as their role in the american eugenics movement (park & kemp, 2006), to name a few. therefore, while known theories and tools can be helpful in social work education and practice, there have been contentions among social work scholars concerning the use of informed postulations. thyer (1994, 2001) has argued that teaching theories in social work education is unnecessary because classes are geared towards superficially exposing students to myriad theories rather than providing an extensive understanding of a select few. they further contend that the social work curriculum does not distinguish evidence-based versus nonevidence-based theories leading to ineffective practice, and that social work practice should be performed more inductively through observation rather than being guided by theory. however, other social work scholars challenge thyer’s claims. gomory (2001) discussed that theory is a precursor to one’s observations because theory is integrated among humans and other species biologically through identifying the information needed to uncover what biologically is limited to reveal and broaden what is not learned. others also affirmed that theory is a foundation that imparts a tested explanation of how certain interventions and practices might transpire (gentle-genitty et al., 2007). beyond the dispute of using theories and frameworks, scholars have also discussed their efficacy and applicability to various groups and populations. critics of social work education argue that the theories and frameworks used in social work education and training are irregular, individuated, and are derived primarily from psychology and psychotherapy (herz & johansson, 2011). this approach falls short of encompassing the critical structural, organizational, social, and cultural factors that social workers must be cognizant of (herz & johansson, 2011). the proliferation of neoliberal policies has and continues to shape and dictate social work education and practice, particularly in the u.s. (singh, 2014; specht & courtney, 1994). scholars argue that social work education and subsequently its potential application in the field have shortcomings such as a problematic binary and oscillating approach to cultural competence and multiculturalism (constance-huggins, 2012; jani et al., 2011). social workers are taught to have generalized and stereotypical perspectives on people’s race, ethnic groups, gender, and other identities without having a firm grasp of the context and the complexities of power differentials once the intersections of identities are considered (dominelli, 2018; sue, 2006). these essentialist views are reified in social work’s tendency to develop and promote specific methods and approaches that do not apply to individuals and groups that are not part of mainstream society – white, male, and middle-class (herz & johansson, 2012). a critical review of 1,168 articles in social work journals found that the majority primarily utilized theories from psychology and very few employed branches of race and feminist theories (gentle-genitty et al., 2007). nevertheless, the evident paucity of critical theories and frameworks written by and for black, indigenous, and people of color (bipoc) and other underrepresented groups is indicative of the allegations that the advances in social work, summer 2021, 21(2/3) 674 academic field of social work remains racist (corley & young, 2018; mcmahon & allenmeares, 1992). indeed, theories and frameworks can be oppressive; however, they can also be liberating particularly when written to center the experiences of bipoc and authored by those with lived experiences in these communities (solorzano & bernal, 2001). anti-racist social work education concretized in theories and frameworks exist (allan et al., 2009; dominelli, 2018) and have influenced anti-racist social work practice (bhatti-sinclair, 2011). building on previous work that embodied critical theories and frameworks in social work (allan et al., 2009) – anti-racist social work (dominelli, 2018), liberation health model (martinez & fleck-henderson, 2014), and critical race theory (delgado & stefancic, 2012; nakaoka & ortiz, 2018; ortiz & jani, 2010) – the purpose of this article is to discuss critical theories and frameworks written by indigenous and people of color scholars that social workers can integrate into their education and practice to address and dismantle racist pedagogy and praxis. we take a wide-ranging view of social work education encompassing pedagogical practice, theoretical content, as well as disrupting oppressive systems in the classroom and through social work practice. the five theories and frameworks discussed in this article are: compa love (hannegan-martinez, 2019), racial triangulation theory (kim, 1999), breath of life theory (blackstock, 2011), kapwa (david et al., 2017; desai, 2016), and cultural wealth (yosso, 2005). compa love was chosen because it helps social work educators humanize their students, which is useful in teaching social work education. racial triangulation theory illuminates racial power analysis in relation to whiteness. breath of life theory provides a different way of understanding how first nations view the world to ensure the safety of first nations children that can be applied in other settings with a thorough assessment. kapwa and cultural wealth are strength-based concepts derived from the experiences, culture, and traditions of filipino and latinx communities. these theories and frameworks consider the different aspects of social work education and practice that will assist educators and students in de-centering eurocentric epistemologies of social work education. we submit that these theories and frameworks be approached with an intersectionality framework (crenshaw, 1989, 1991) to distinguish disparities and understand the complexities in which social constructs are entangled and imbricated. uplifting and borrowing from fred hampton of the black panthers, “theory’s cool, but theory with no practice ain’t shit” (malloy, 2017, p. 9), this article will also discuss implications for social work education and practice. through these critical theories, we aim to raise the critical consciousness (freire, 2000) of social workers to commit to true liberation and self-determination for all. theories and their social work application this section will outline the basic tenets of the five theories advanced by indigenous and poc scholars and examine how they have been operationalized in other settings to envisage their application to social work education and research with the goal of influencing and elevating anti-racist practice in the discipline. table 1 summarizes the definitions and potential application of the five theories to social work education and practice. advances in social work, summer 2021, 21(2) 675 table 1. theory definitions and application to social work education and practice theory definition translation education practice compa love a transformative re-framing of the self, rooted in radical love. originating in education pedagogy, this can potentially extend into practice. demonstrate and engage in critical inquiry in the classroom to draw authentic relationships with students to inform classroom pedagogies. understanding experiences of compounded trauma among communities and clients to co-create spaces of solidarity. social work practitioners can also locate their role in connecting communities to resources to help them achieve their life’s potential. racial triangulation theory allows us to understand power differentials among racial/ethnic groups controlled by white supremacy. this theory and its extension, the racial position model, helps social work educators provide students with a critical understanding of power analysis and challenge stereotypes and ideologies about different racial/ethnic groups. practitioners can use the tenets within this theory to challenge their own and others’ assumptions that their clients/ communities they work with fit prevalent stereotypes and understand heterogeneity within groups. breath of life (bol) theory recommends a balance between relational worldview principles comprising cognitive, spiritual, and emotional domains to allay structural risk factors affecting the welfare and safety of first nations people. introducing bol as an extension of, and an indigenous alternative to, the personin-environment principle of social work can expand social work students’ grasp over professional values to incorporate emotional, spiritual, cognitive, and physical domains. practitioners can use bol to integrate structural and systemic aspects of community work with a lens rooted in intergenerational knowledge and wisdom to achieve collective community actualization. kapwa a way of understanding and interacting with one another that allows people to acknowledge each other’s humanity and interconnectedness through humanization, unifying the physical, spiritual, and intellectual, and decolonization. kapwa provides students of social work a framework of relationality to appreciate connections within seemingly disparate living systems and complements a move toward culturally sustaining pedagogy in the classroom. keeping the universality of shared humanity at its core, practitioners can employ kapwa to adopt a culturally-rooted perspective to thinking in systems and understand system interdependencies. cultural wealth communities of color have their own set of knowledge, skills, and tools to challenge racism and other forms of oppression. instructors can utilize this model to flip the dominant narrative rooted in the deficit framework to support firstgeneration or bipoc students identify barriers in their everyday education and life to recognize resources and strengths. practitioners can use cultural wealth to situate racism and associated structural barriers and identify resources and assets within communities to challenge oppressive structures. advances in social work, summer 2021, 21(2) 676 compa love compa love, a shortened version of compañero/a/x, provides a transformative reframing of being an educator and rooting oneself in radical love as the quintessential guide in teaching. with this understanding, compa love can be used to frame social work education and practice. hannegan-martinez (2019) argues that educators need to eliminate the practice of punk love, the practice in which an educator is cognizant of the issues affecting students but not actively engaging and addressing these inequities in their praxis, thus reproducing oppressive systems and behaviors. the three reifications of punk love are colonial love, tough love, and conditional love (hannegan-martinez, 2019). colonial love is the embodiment of performing as a savior of under-resourced groups to relieve their guilt rather than acknowledging the agency, assets, and wealth of their students. tough love is fostering high expectations and wielding punitive classroom practices when students are not able to meet set standards, rather than understanding the inequities that students are facing, which may affect their academic performance. conditional love is a deficit approach of educators only committing themselves to students who perform well academically and engage in the classroom while ignoring disengaged students. compa love, on the other hand, challenges educators to recognize the humanity and interconnectedness of students and themselves through addressing the intellectual, emotional, and physical needs of their students (hannegan-martinez, 2019). emotional love is manifested through rituals rooted in the experiences of the students and sharing of their histories and backgrounds; spaces are created to allow students to be vulnerable to allow for empathy for one another, engendering healing. students cannot be expected to thrive in the classrooms if their most basic material needs are not met. tangible love encourages educators to consider partnering with community organizations and other resources to provide students their most basic necessities. finally, intellectual love embodies the praxis of a culturally sustaining pedagogy (csp) that shifts from a deficit framework that often depicts bipoc students as broken; instead, csp equips students with skills and tools to develop critical consciousness and shows them that they are experts of their own experiences, cultivating transformational resistance. social work implications of compa love whereas freire’s pedagogy of the oppressed remains a central text for many social work educators, his treatise on the locus of love in pedagogical practice has been overlooked by most as an emancipatory political stance in the classroom (darder, 2011). compa love expands this framework and can be a powerful tool, where to love is to commit to the lives and collective liberation of all (hannegan-martinez, 2019). while students have disparate life experiences that often include adversities leading to chronic and long-term trauma, bipoc students, particularly in u.s. social work classrooms, often deal with the added trauma of living, witnessing, and navigating racist systems and institutions with an onus on themselves to learn the tools to dismantle these structures. student social workers go on to be change agents in varying capacities in the real world, maglalang& rao/theory’s cool 677 which adds to their experience of compounded trauma. compa love can guide instructors to demonstrate and engage in a critical inquiry to draw authentic relationships with students as well as inform and influence pedagogical design. departing from the more prevalent trauma-informed care, compa love provides the foundation for social workers to embrace a multifaceted discernable love that informs their practice. emotional love can be woven into the classroom culture through rituals, activities, and creating shared spaces that foster a brave, healing solidarity among students toward common causes rooted in their identities and experiences. to operationalize intellectual love, social work instructors can take a cue from ethnic studies coursework and csp to help students connect classroom learning with historical knowledge from their own and other linguistic, racial, and ethnic groups (california department of education, n.d.) to foster a pluralism in thought and practice. this can cultivate a shared connection with other cultures, a critical component of dismantling dominant hegemonies of knowledge, and lead to a true democratization of education (paris, 2012). as evidenced in the case study by hannegan-martinez (2019), tangible love can at times be more challenging to achieve in the classroom. conversely, in a social work context, tangible love ought to be a more instinctive measure actualized by connecting students to internal and external resources and organizations that can help meet their material needs when required. compa love provides tools for social work educators to showcase intellectual, tangible, and emotional love by encouraging students to be vulnerable in the classroom, connecting students to resources in the community, and highlighting bipoc students’ agency in resistance and societal transformations. this theory therefore demonstrates the need for and way toward a common liberatory praxis based on a recognition of the importance of lived experiences in transformative education. racial triangulation theory the racial triangulation theory asserts that asian americans serve an intermediary role in the u.s. that glorifies them as model minorities pitted against black and african american people while simultaneously being ostracized as perpetual foreigners, denying them acceptance as americans, in other words, white (kim, 1999). through the intricate and enmeshed methods conceptualized through ideologies, policies, and institutions that white society engages in, white supremacy endures. the valorization of asian americans has been enacted historically through such means as asian americans heralded to be academically successful despite the challenges of racism and other forms of discrimination, essentially chastising other communities of color for not being academically resilient (wu, 2014). these generalizations overlook the inequities within asian ethnic groups that show some southeast asian ethnic groups having one of the lowest educational attainment of any racial and ethnic group (lópez et al., 2017). this also does not ignore the fact that some asian american groups have actively engaged in preserving this contradicting image that allows asian americans to be in proximity to whiteness through partaking in support of eradicating affirmative action through groups such as students for fair admissions led by white conservative edward blum (chuh, 2018). nevertheless, such propinquity to whiteness but non-acceptance into whiteness is sanctioned through the ostracization of asian americans by being portrayed as perpetual foreigners. asian americans have been depicted historically overtime as not american by being a threat to the safety of the advances in social work, summer 2021, 21(2/3) 678 american people as “yellow peril” and in the incarceration of japanese americans in internment camps (lee, 2015), demonstrating that while asian americans may be in proximity to whiteness through their scholarship and being apolitical, they remain dubious and distrusted because of their physical appearance. more recently, racial triangulation theory has been extended to include latinx americans through the racial position model. in this model, the framework posits that whites, asian americans, african americans, and latinx americans are situated in four quadrants within the two axes of subordination: perceived inferiority and perceived cultural foreignness (zou & cheryan, 2017). within this model: …whites are treated and perceived as superior and american; african americans as inferior and relatively american compared to latinos and asian americans; latinos as inferior and foreign; and asian americans as foreign and relatively superior compared to african americans and latinos. (zou & cheryan, 2017, p. 697) through these frameworks and models, perceptions of belonging and positionalities in proximity to whiteness allow certain racial groups to have access to some power and resources. however, it is important to note that heterogeneity within the numerous identities that people hold may place them in different parts of the model depending on the context, and native americans and mixed-race individuals who may pass as white or not are not considered in these models. social work implications of racial triangulation theory the occupational and social stereotyping of asian americans in the u.s. impacts knowledge and research on experiences of asian americans in the u.s. (kiang et al., 2017) and this holds true within the social work profession as well. the proportion of asian americans in social work remains among the lowest. according to 2018 data from the council on social work education (cswe), asian americans constituted 3% of the total population of students enrolled for a bachelor of social work (bsw) in the us and 5% among all master in social work (msw) graduates in the country, and this classification includes pacific islanders (salsberg et al., 2019). as the racial triangulation theory posits, asian americans are not a monolithic group but are treated as such and often employed as a wedge by a white supremacist system to maintain a racist and unequal order. this comes to bear in social work classroom and field settings, where asian americans are either invisibilized, invalidated, stereotyped, or face other forms of microaggressions (spencer, 2017). social work syllabi tend to ignore or even uphold stereotypical representations of racial groups such as equating asians with east asians, and largely invisiblizing the diversity and differences within and among asian groups. further, classroom examples from social work research on socio-economic disparities either treat asians as white adjacent, or disregard the demographic. the model minority myth lumps multiple asian identities together and fails to recognize specific struggles and contexts of individual asian american students or groups that social workers interface with. in the context of their field placements too, asian american social work students experience a tussle between their ways of knowing and the dominant frameworks within social work maglalang& rao/theory’s cool 679 with care interventions such as culturally informed notions of kinship and interdependence often challenged and minimized by non-asian instructors at school or at the field setting (chung, 2006). an awareness and discussion of the racial triangulation theory can help social work educators, students, and practitioners inquire into these inequities in and through their classroom, field, and practice settings. in fact, both the racial triangulation theory and the racial position model allows us to critically analyze racial power inequities to understand the positionalities of how white supremacy controls how different racial groups are perceived and pitted against each other. these frameworks challenge existing differentials in power structures and the status quo. without this framework, social work education ignores this gap in the disparities in racial groups (e.g., asian americans) who are assumed to be model minorities and a monolith, but actually encounter inequities by ethnic groups. understanding and employing a racial power analysis guided by this framework will help identify how perceptions of racialized minorities are influenced by white supremacy culture, and is a necessitous step toward culturally sustaining anti-racist social work practices. breath of life (bol) theory the breath of life (bol) theory postulates that relational worldview principles must be in balance to assuage the structural risk factors affecting the welfare and safety of first nations1 children (blackstock, 2011). the relational worldview principles are composed of four domains: cognitive (e.g., self & community actualization, role, etc.), physical (e.g., food, water, housing, etc.), spiritual (e.g., spirituality, purpose, etc.), and emotional (e.g., belonging, relationship, etc.) that are interconnected and exist in multiple realities and generations (blackstock, 2011; cross, 1997). the concept of balance across these principles pertains to the idea that the survival of individuals is intertwined with the health and well-being of people from different generations, realities, and the universe (blackstock, 2019). these principles must be situated within the various cultures and contexts of first nations. in addition, these principles must be enacted with the understanding that to fathom the experiences of children in first nations, the experiences of the previous seven generations must be accounted to comprehend the child presently and how interventions and services might consequently affect the next seven generations, suggesting that behavior, trauma, and coping strategies are passed on through numerous generations (blackstock, 2011). finally, first nations also recognize that alternate realities exist, meaning that these realities affect one another, and interventions can alleviate structural risk factors in alternate realities. antithetical to western perspectives, bol encourages that the effects of structural factors be gauged beyond the individual and through the individual’s family and community. blackstock suggests that bol can also be applied in other fields outside of child welfare and other cultural groups through critical cross-cultural assessments (blackstock, 2011). 1 blackstock is based in canada where the term “first nations” denotes indigenous peoples distinct from métis and inuit. advances in social work, summer 2021, 21(2/3) 680 social work implications of breath of life (bol) theory as a first nations theory, the bol theory offers social workers an alternative to the western theories they are used to engaging with, that are steeped in academic and social hegemony. postulated as an indigenous “theory of everything” (blackstock, 2019, p. 857), bol is a deeper dive into the interconnectedness of our world. it goes further beyond the “person-inenvironment” principle that social workers learn that seeks to understand individuals and their behaviors within the context in which they live and act (kondrat, 2013). social workers accustomed to western theories and ways of knowing might find the indefinite boundaries of the bol confounding. however, in the spirit of how blackstock intended it, social workers should recognize this as an invitation to explore how the bol theory can strengthen and inform concepts integral to our profession, such as equity and non-discrimination in areas of public health, educational outcomes, gerontological social work, embedded within social, racial, and environmental justice. for instance, bol may offer an alternative perspective to understanding needs and issues that older adults face as they deal with multiple challenges and stressors. bol can turn to the valued knowledge of elders in the community to access the spiritual, emotional, cognitive, and physical domains and the connections therein to achieve the best potential outcomes. as blackstock (2011) suggests, a multigenerational perspective is essential to understand and achieve community actualization and for a relational view of issues affecting individuals, households, and communities over time and interconnected realities. the bol theory offers a way of integrating and examining structural aspects of issues, including and beyond those that first nations communities and families face, with a lens rooted in the intergenerational knowledge and wisdom, and presents newer epistemes for social work researchers and practitioners to understand and alleviate the human experience. kapwa scholars argue that kapwa’s etiology has been present since pre-colonial philippines despite the colonization by spain and the u.s. that attempted to transform its meaning through religion and the english language (reyes, 2015). kapwa is perceived as the core aspect of filipino values, pertaining to being one with others (enriquez, 1994). kapwa is not constrained by the bounds of orthodox definitions of what constitutes relationships with people – blood, origin, social status – instead, it recognizes that an individual has a shared identity or inner self with others (david et al., 2017). this value challenges western concepts that often individuates the person from others. while kapwa is the center, it must be operationalized in partnership with other filipino values such as pakikiramdam (being able to empathize with others), hiya (shame), utang na loob (gratitude), and pakikisama (companionship; david et al., 2017; enriquez, 1994). these values shape the worldview of filipinos and how they approach, interact, and be in community with one another. more recently, the concept of kapwa has been extended in other iterations such as critical kapwa which provides a framework to healing from the intergenerational trauma passed on in filipino families and communities because of colonization (desai, 2016). its three tenets are humanization, on becoming diwa(ta), and decolonizing epistemologies. humanization allows individuals to critically perceive themselves and others operating in social systems and structures that are oppressive and capitalistic that value production over humanity. on maglalang& rao/theory’s cool 681 becoming diwa(ta), diwa meaning spirit and diwata meaning deity, encourages the unity of the physical, intellectual, and spiritual spheres through practicing spirituality that allows one to have a more in-depth comprehension of one’s humanity. finally, decolonizing epistemology refers to the use of indigenous spirituality and ideologies to serve as counternarratives to western beliefs and practices. kapwa provides a different way of understanding and interacting with one another that allows people to acknowledge each other’s humanity and interconnectedness. social work implications of kapwa an appreciation of kapwa can help social workers working with filipino individuals and groups but also with other groups, given that the universality of shared humanity is central to common progress and action. at personal, community, and societal levels, this framework can help view and create a shared connection with others in the community and can also extend to the social and natural environments. kapwa provides a culturally-rooted complement to the human security framing where human needs and human security are prioritized over national, religious, and prestige frameworks (lagdameo-santillan, 2018). for social workers, the embeddedness of the self within this larger shared space helps to situate filipino client’s and groups’ life experiences within the context of their colonial history and post-colonial but racialized current being, while not essentializing this to all filipino experience. analogous to the bol theory, critical kapwa harkens to indigenous spirituality and philosophies as a foil for dominant western ideologies that have long focused on individuality, personal agency, and autonomy, ignoring the networks and kinship to family, community, and the systems we are nested in (david et al., 2017). this relationality can aid social workers to join the dots between interconnected but seemingly disparate living systems; by viewing the self in the other, kapwa helps us identify with communities and individuals that we work with. kapwa can be put into practice in the social work classroom by incorporating the research of curammeng and colleagues (2016) that examined how the ethnic studies praxis story plot (espsp) developed by pin@y educational partnerships (pep) affected multiple aspects of student learning in k-college classrooms. the common goal in espsp is liberatory education and action for both instructors and students and it centers the realities of students, encouraging them to challenge dominant frameworks by channeling everyday lives and realities of the students. five key aspects of this framework are exposing the problem, identifying oppressive action, identifying trauma/tension, moving toward action and resistance, to then reflect and find deeper connections with their world and lived experiences (curammeng et al., 2016). social work educators can use similar tools from community-responsive literacies to develop critical pedagogies in their classrooms and build kapwa. cases and examples from non-dominant frameworks and communities can be a way of encouraging student social workers to reflect by relating and connecting them with their experience; teasing out parallels in stories of injustices as well as community triumphs while drawing connections to their own communities, and inquiring how the learning or story impacts themselves as social workers (curammeng et al., 2016). in social work practice, implementing one of the tenets of critical kapwa, humanization, can be integrated in a clinical and macro setting by acknowledging the advances in social work, summer 2021, 21(2/3) 682 effects of colonization of the philippines by spain and the u.s. which has fostered colonial mentality among filipinos, affecting their mental health and overall well-being (david et al., 2017). scaffolding clients to locate their experiences and behaviors in the aftermath of colonization and arguably, current efforts of neo-colonization, social workers can help clients understand the systemic factors affecting their mental health and well-being. thus, these issues are then not individualized and internalized. cultural wealth cultural wealth argues that bipoc communities have their own set of knowledge, skills, and tools to challenge racism and other forms of oppression (yosso, 2005). rooted in critical race theory (crt), cultural wealth de-centers deficit notions of cultural capital – white and middle class – that allows for the social and economic mobility of certain groups. cultural wealth is reified through its six tenets: aspirational, navigational, social, linguistic, familial, and resistant. yosso (2005) explains that people of color can use their cultural wealth to access resources that are relevant to their experiences through the ability of bipoc to have hope despite systemic racism (aspirational capital), using their cultural language to access non-eurocentric experiences (linguistic capital), rich familial history (familial capital), using their resources within their ethnic enclaves (social capital), learned strategies in navigating bureaucratic and racist institutions as a bipoc (navigational capital), and learning and applying historical forms of resistance of bipoc to challenge oppression (resistant capital). while cultural wealth can be considered as an iteration of the strengths-based approach through its principles of using an individual’s experiences of adversities as a starting point in engendering transformation and realizing their resilience and access to protective factors within their family and community (saleebey, 2008), they are distinct from one another. scholars argued that the strengths-based perspective is a neoliberal approach, in that it focuses on the individual’s autonomy and perspective of the world, leaves the responsibility to the community of the individual to fix the problem rather than holding the government accountable to provide services and ignores the intersectionalities of race, gender, and class as systemic barriers (gray, 2011). cultural wealth succeeds in explicitly naming racism and other forms of oppression, recognizing that barriers are present at all levels of the community, institutions, and systems, and derives its assets from a collective community with shared identity and culture that shifts away from individual responsibility. social work implications of cultural wealth social work educators can work with students to move beyond the six tenets identified in the model to uncover other forms of cultural assets. for instance, a study on the experiences of first-generation latinx students at the university of texas in san antonio found that these students were often characterized within deficit frameworks and educators internalized these assumptions (rendon et al., 2014). the research identifies and provides examples of strategies employed by students within the academic context and adds perseverance, ethnic consciousness, spirituality/faith, and pluriversality or multi-epistemic skills of operating in multiple different worlds (rendon et al., 2014) to examples of cultural maglalang& rao/theory’s cool 683 wealth. in the social work classroom, the cultural wealth model can help bipoc students identify and name resources that are available to them to realize their own goals and chart out their practice framework. for social work educators, researchers, and practitioners, this would mean privileging the lived experience of cultural minorities and not trying to recast their experiences within dominant narratives and systems of knowing. in social work education, this would also mean turning prevailing student success frameworks on their head to employ a cultural asset view of ensuring a successful and transformational college experience for bipoc students in social work. to advance an anti-racist practice and research program, the aspirational capital in the cultural wealth model encourages students to keep pushing to achieve that goal in the face of roadblocks or antagonistic environments. it also provides a blueprint for social work educators to encourage students to bring their community or family knowledge, language, and experiences to the fore in articulating their role in creating systemic change in their place of work and communities. conclusion students of social work are exposed to a range of traditional theories to inform their work with clients and communities. however, these theories and the extant social work curriculum as a whole promotes and maintains institutional racism that shapes how social workers practice (de silva et al., 2007). these general theories are inadequate to understand behaviors and contexts to work with clients and larger systems and processes because they do not do full justice to developing an understanding around nuances of varied lived experiences of individuals and communities that social workers work with. this is particularly important since in the coming decades u.s. society is projected to be older and more ethnically and racially pluralistic (vespa et al., 2020). teaching theories and frameworks that do not reflect the communities that social workers traverse will only sustain oppressive practices and inequities. multiple parallels exist between the theories presented in this article and various aspects can be borrowed from the theories to inform, build, and supplement social work theories for practice. these include a sense of interconnectedness, as seen in compa love, bol, and kapwa; and a departure from the deficit framework as seen in the cultural wealth model and compa love. in the same vein, some of these theories also mirror the universal connectedness and harmony espoused within the ubuntu philosophy (ncube, 2010). racial triangulation theory and racial position model present tools in critically analyzing power relationships manifested in otherness and perceived superiority in proximity to whiteness that highlights how white supremacy has divided and disproportionately controlled access to resources for bipoc communities. while the theories and frameworks discussed provide critical understanding, we offer the following strategies for educators and practitioners to avoid pitfalls in misusing the aforementioned theories and concepts. first, to avoid misappropriating these epistemologies rooted in the experiences of specific groups and cultures, educators and practitioners must have a thorough assessment and analysis of the individuals and communities in which these theories and frameworks are being applied to, as suggested by bol (blackstock, 2011). second, social workers must practice constant self-reflexivity advances in social work, summer 2021, 21(2/3) 684 (lynch, 2006; pillow, 2003) to discern how their identities, positionalities, and knowledge might cause harm in attempting to apply these theories and frameworks that might be more damaging than beneficial to the communities they are working with. third, social workers must constantly educate themselves through various methods such as books, articles, lectures, community events, webinars, documentaries, and podcasts written and created by bipoc scholars and creatives to gain a deeper understanding of the historical and contemporary experiences of bipoc populations. we argue that the work of educating must not come at the intellectual and emotional labor of bipoc communities who are often relegated to perform this labor in social work classrooms and institutions where they are under-represented and not financially compensated. fourth, social workers must have a critical understanding of power dynamics and analysis in relation to race, gender, sexual orientation, ability, economic, and immigration status among others in assessing social work literature and in practicing social work through some of the theories mentioned in this article and other theories in the extant literature. finally, we encourage social work educators and practitioners to be present and support organizing and advocacy efforts led by bipoc communities. these theories and frameworks are meant to engender active participation in challenging, transforming, and revolutionizing institutions and systems to ensure they are equitable and racially just. there are numerous other theories and frameworks from the global south and those proposed by bipoc scholars that can be employed within the social work classroom to contextualize student, client, and community experiences toward a critical liberatory antiracist praxis. the theories outlined in this paper are an attempt to provide a pathway to offer social work educators, researchers, and practitioners, newer ways to unravel the complexities within which they operate while placing the learner, client, and community at the center. scholars and practitioners of social work can use these theories or frameworks as a whole, or in parts to meet the needs of their education and practice that may be limited because of the eurocentric and neoliberal curriculum that many social work classrooms may instruct. they may face potential resistance from traditionalists espousing normalized racist beliefs but we argue that in order for the field to move toward racial justice and equity, these brave and critical oppositions must be enacted. we hope that social workers will continue to disrupt and dismantle the ways in which we learn, build knowledge, and practice through intentionally seeking scholarly works that are written by bipoc scholars with lived experiences and authentic commitment in the communities they live and work with. we deem that these will be critical in preparing anti-racist social workers committed to true liberation and self-determination for all. references allan, j., briskman, l., & pease, b. 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(2017). two axes of subordination: a new model of racial position. in journal of personality and social psychology (vol. 112, issue 5, pp. 696-717). american psychological association. https://doi.org/10.1037/pspa0000080 author note: address correspondence to dale dagar maglalang, center for alcohol and addiction studies, brown university, box g-s121, providence, ri 02912. email: dale_maglalang@brown.edu https://doi.org/10.1080/10437797.1994.10672225 https://doi.org/10.1080/10437797.2001.10779034 https://doi.org/10.1093/sw/39.2.191 https://www.whitehouse.gov/wp-content/uploads/2020/09/m-20-34.pdf http://www.jstor.org.proxy.bc.edu/stable/j.ctt5hhphr https://doi.org/10.1080/1361332052000341006 https://doi.org/10.1037/pspa0000080 mailto:dale_maglalang@brown.edu microsoft word 02 cho_et_al_23675_gender_diff_ipv ______________ hyunkag cho, ph.d, associate professor, school of social work (swk), michigan state university, east lansing, mi. jisuk seon, phd, postdoc researcher, school of swk, washington university, st. louis, mo. ga-young choi, phd, associate professor, school of swk, california state university, los angeles, ca. soonok an, phd, assistant professor, department of swk and sociology, north carolina a&t state university, greensboro, nc. ilan kwon, ph.d, adjunct lecturer, school of swk, michigan state university, east lansing, mi. yoon joon choi, phd, associate professor, school of swk, university of georgia, athens, ga. seunghye hong, phd, associate professor, myron b. thompson school of swk, university of hawaiʻi at mānoa, honolulu, hi. jungeun olivia lee, phd, assistant professor, suzanne dworak-peck school of swk, university of southern california, los angeles, ca. esther son, phd, assistant professor, school of health sciences, department of swk, college of staten island, the city university of new york, staten island, ny. sung hyun yun, phd, associate professor, school of swk, university of windsor, windsor, ontario, canada. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 22-44, doi: 10.18060/23675 this work is licensed under a creative commons attribution 4.0 international license. gender differences in intimate partner violence victimization, helpseeking, and outcomes among college students hyunkag cho jisuk seon ga-young choi soonok an ilan kwon yoon joon choi seunghye hong jungeun olivia lee esther son sung hyun yun abstract: many college students experience intimate partner violence (ipv). although receiving help from formal and informal sources may ameliorate possible negative impacts of ipv victimization, the outcomes of help-seeking are not always positive. this study used survey data collected at six universities across the united states (u.s.) to examine gender differences in ipv, help-seeking, and its outcomes (n=3,070). major variables included ipv victimization, ipv consequences, help-seeking, and outcomes. descriptive and bivariate analyses revealed higher rates of victimization among females as well as poorer health status, higher levels of depression, and more daily routine problems. females also used more formal help, and reported it as being useful more often than males. inversely, more males than females reported that informal supports were helpful. recommendations include social workers providing tailored services both for male and female survivors, service providers developing educational programs that target informal help sources, and social work education providing relevant trainings. keywords: intimate partner violence; gender; help-seeking; college many college students encounter intimate partner violence (ipv) and suffer a wide range of behavioral, mental, and physical health outcomes. importantly, ipv victimization during young adulthood, including the college years, is likely to lead to continuous victimization in adulthood, possibly throughout a lifetime (greenman & matsuda, 2016; smith et al., 2003). it is critical for ipv survivors to seek help to reduce both the negative consequences of ipv and the likelihood of future victimization. indeed, after victimization, most survivors seek help from a variety of sources, both formal (e.g., police, health clinics) and informal, such as family and friends (cho & huang, 2017). however, the outcomes of advances in social work, spring 2020, 20(1) 23 help-seeking are not always positive, and are sometimes even detrimental to the survivors’ well-being, which may lead victims to avoid it in the future (laing, 2017; rich & seffrin, 2013). there seem to be gender differences not only in ipv victimization, but in helpseeking as well. for instance, females experienced more physical but less psychological violence than males (breiding et al., 2014); and males sought more informal but less formal help than females (cho et al., in press). however, study results on these aspects of ipv are somewhat limited, due to small sample sizes, inclusion of only certain types of ipv (e.g., physical or sexual violence), exclusion of help-seeking outcome measures, and a lack of gender perspective. this study attempts to fill this gap by using a large, relatively recent dataset to examine gender differences in ipv victimization, help-seeking, and its outcomes. gender differences in ipv prevalence and consequences ipv involves physical, sexual, and psychological violence against an individual by current or former intimate partners, such as a boy/girlfriend, dating partner, or spouse (campbell, 2016). physical violence is the intentional use of physical force with the potential for causing death, disability, injury, or harm; sexual violence is a sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse; psychological violence is the use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally, and/or exert control over another person, which can take the form of threats that is the use of words, gestures, or weapons to communicate the intent to cause death, disability, injury, or physical harm (breiding et al., 2015). ipv also takes the form of technological violence that consists of acts through technology that are intended to cause harm to intimate partners as well as control partners’ behavior (watkins et al., 2018). at least one in five college students has endured ipv (wasserman, 2003). ipv prevalence varies when examining specific types of violence. approximately 22% of college students suffered physical violence, while 52% reported psychological victimization in the past year (gover et al., 2008). another study reported that about 30% of female college students had experienced sexual or physical violence, and that 83% had been victimized by psychological violence during their college years (fass et al., 2008). a review of the results from nine studies found that ipv prevalence rates among college students ranged from 1% to 31% for physical violence, from 10% to 77% for psychological violence, and from 10% to 36% for sexual violence (scherer et al., 2016). overall, psychological violence seems to be the type of ipv college students face most frequently, followed by physical and/or sexual violence (cho & huang, 2017; fass et al., 2008; gover et al., 2008). there are gender differences in ipv experiences, but with variations across studies (dardis et al., 2017; saewyc et al., 2009). according to a study with 254 college students, while females and males reported similar rates of psychological (female, 83% and males, 87%) and sexual (females, 30% and males, 27%) violence victimization, male students reported more physical violence (42%) than females (32%; fass et al., 2008). another study found no gender differences in physical victimization, but more psychological victimization for females (57%) than males (50%; gover et al., 2008). a 2017 study of 704 cho et al./gender differences in ipv 24 college students found no statistically significant difference between males and females in physical, sexual, or psychological victimization (dardis et al., 2017). gender differences in ipv prevalence appear to be far from consistent. different methodological approaches in previous studies may account for the gender differences in ipv prevalence among college students. for example, some studies included many types of ipv, reporting higher overall rates of ipv (amar & gennaro, 2005) than other studies that measured ipv using one or two violence types, such as physical, psychological, or sexual (gover et al., 2008; saewyc et al., 2009). some studies reported higher rates of ipv by asking about lifetime prevalence (garcia-moreno et al., 2006; kilpatrick et al., 2000), compared to those asking about ipv experienced only in the past six or 12 months (daley & noland, 2001). similarly, studies measuring ipv experiences with all partners in current and prior relationships tend to report higher ipv rates (gover et al., 2008). thus, variations in ipv estimates among college students reflect the use of different measures (hamby, 2016; harned & vict, 2001; woodin et al., 2013). ipv leads to acute and chronic physical and mental health problems, including injury, depression, anxiety, low self-esteem, suicide attempts, substance abuse, and sexually transmitted diseases (breiding et al., 2014; jina & thomas, 2013; lutwak, 2018). sexual assault victimization, for example, was associated with female college students’ poor selfesteem, depression, anxiety, suicidal ideation, and substance abuse (banyard & cross, 2008; neville et al., 2004; santaularia et al., 2014). a nationally representative study in spain of 10,171 women over the age of 16 found that physical and sexual violence predicted poor health symptoms such as anxiety, sadness, wanting to cry, mood swings, and insomnia (domenech del rio & sirvent garcia del valle, 2017). technological violence, such as cyberbullying and cyber dating abuse, among college students appeared to predict low self-esteem and heightened emotional distress (hancock et al., 2017). research on ipv consequences indicates there are gender differences. for example, harned and vict (2001) found that both female and male student survivors of physical and psychological ipv showed similar levels of depressive and anxiety symptoms at lower levels of ipv aggression, while at higher levels of aggression female student survivors showed more depressive and anxious symptoms than males. in a sample of 502 italian university students, romito and grassi (2007) found that female student survivors who experienced high levels of ipv reported increased depression and a greater frequency of panic than those who experienced low or no ipv. while both men and women reported depressive symptoms after ipv (porcerelli et al., 2003), female survivors tended to experience more depression and anxiety than males (ehrensaft et al., 2006; fergusson et al., 2005; romito & grassi, 2007). female survivors of severe violence were 3 times more likely to be clinically diagnosed with depression than male counterparts (kars & o’leary, 2010). male survivors seemed to suffer primarily from disruptive behavior disorder and substance use, while the list of mental health issues for female survivors was much larger, including suicide attempts and internalizing disorders (afifi et al., 2009; coker et al., 2002; romito & grassi, 2007). a study on post-traumatic stress disorder (ptsd) showed that women were more likely to report ptsd than men, with one explanation being that women more often felt higher levels of fear of their partners (caldwell et al., 2012). female survivors, compared to their male counterparts, were more likely to get injured during an advances in social work, spring 2020, 20(1) 25 incident of ipv (breiding et al., 2014; straus & gozjolko, 2014). moreover, women tend to sustain the negative effect of physical injuries longer than men (hamberger & larsen, 2015). intimate partner homicide disproportionately affected women; 54% of female homicides are committed by a present or former intimate partner, compared with up to 30% for male homicides (guth & pachter, 2000). velopuloset al. (2019) reported even higher homicide rates for women than men (79% vs. 21%). overall, female survivors seem to suffer more severe consequences from ipv victimization compared to males. gender differences in survivors’ help-seeking ipv survivors may reduce both the negative consequences of ipv and the likelihood of future victimization by seeking help. the majority of ipv survivors who seek help handle the negative health consequences through formal sources such as mental health professionals or domestic violence service agencies, and/or through informal sources such as family members or friends (ansara & hindin, 2010). studies in north america have consistently found that ipv survivors are more likely to seek informal than formal help (cho & huang, 2017; coker et al., 2000; edwards et al., 2011). in a recent study of ipv among college students, for example, approximately 89% of the students sought informal help and only 23% of the sample sought formal help (cho & huang, 2017). in a populationbased sample, ansara and hindin (2010) reported a similar pattern: approximately 81% of women and 57% of men who had experienced physical or sexual ipv sought help from an informal source, whereas about 64% of women and 32% of men sought formal help. the most commonly reported informal sources of help include family members and friends (ansara & hindin, 2010; cho & huang, 2017; edwards et al., 2011), and oft-reported formal sources of help are health professionals and counselors (ansara & hindin, 2010). understanding differences and similarities in help-seeking behaviors of men and women victimized by ipv is somewhat difficult using the existing literature, as most studies focus on ipv suffered by either men or women, and they use different measures of ipv or of help-seeking. nevertheless, recent ipv research reflects that higher rates of women than men seek help for psychological (fortin et al., 2012), physical, or sexual ipv (ansara & hindin, 2010; coker et al., 2000). in one study by edwards et al. (2011), female college-age survivors preferred disclosing their ipv experiences to female friends (73%), followed by male friends (25%), sisters (25%), or mothers (23%). only 5% of the female students who disclosed ipv to a helping source reported disclosing it to a counselor, and none reported seeking help from a medical doctor, law enforcement, or a priest or minister (edwards et al., 2011). similarly, in another study, male survivors of ipv reported the use of informal help more than formal help. approximately 77% of males revealed that they sought informal help from male friends or a neighbor, which are the most frequently reported sources of help (douglas & hines, 2011). in the same study, almost 44% of men sought help from a domestic violence agency, and close to a quarter of the men (23.4%) used a domestic violence hotline, although only 18% sought help from medical professionals (douglas & hines, 2011). however, ansara and hindin (2010) reported that very few men who experienced physical or sexual ipv used male-focused survivor services such as a men’s support group (3.7%) and crisis hotlines (3.8%). cho et al./gender differences in ipv 26 one of the limitations of ipv research is the underrepresentation of sexual minorities (calton et al., 2016). most studies have examined only heterosexual intimate relationships (e.g., ansara & hindin, 2010; douglas & hines, 2011) or have not reported study participants' sexual orientation (e.g., edwards et al., 2011). as a result, gender differences in help-seeking behaviors of ipv survivors in non-heterosexual relationships are relatively unknown. nonetheless, the few existing studies suggest that ipv survivors in nonheterosexual relationships are less likely to seek help due to the barriers that heterosexual survivors do not encounter. for example, the survivors who are closeted could be threatened by their partners to disclose their sexual orientation to their families, friends, and/or employment if they attempt to seek help (calton et al., 2016). the abusers may use homophobia as a tactic to stop the survivors from seeking help, telling them that they are not welcomed or believed by service providers (calton et al., 2016; duke & davidson, 2009). service providers’ lack of understanding of the needs of non-heterosexual ipv survivors may create unique challenges for the survivors. for instance, ard and makadon (2011) pointed out a lack of sensitivity among medical service providers when assessing non-heterosexual patients' ipv experiences. providers tend to refer to survivors' partners as husbands (wives) if the survivors are women (men), assuming heterosexual relationships for all patients. moreover, not all states provide legal protection (such as protective orders) for non-heterosexual ipv survivors under domestic violence statutes (calton et al., 2016; duke & davidson, 2009). homophobic attitudes of law enforcement and ipv service providers, and the operation of domestic violence shelters centered around heterosexual female ipv survivors may also act as barriers for non-heterosexual ipv survivors seeking help (calton et al., 2016). gender differences in the outcomes of help-seeking existing studies have measured the outcomes of help-seeking behaviors through the lens of their perceived helpfulness or their impact on mental health/well-being including psychological distress, depression, posttraumatic stress disorder, substance abuse, or selfesteem (douglas & hines, 2011; fortin et al., 2012; sylaska & edwards, 2014). coker and colleagues (2000) found that a large portion of the survivors of physical ipv reported that formal sources were helpful. more specifically 85% of female survivors reported doctors/nurses to be helpful, 80% found mental health counselors/therapists to be of value, and 67% reported domestic violence shelter staff were helpful. while the majority of male survivors in their study also reported these formal sources as being beneficial, the sample size of men was too small to make a meaningful comparison. multiple studies show that survivors perceive friends to be the most useful and supportive informal source of help (sylaska & edwards, 2014). at the same time, friends have also often been reported as the least helpful source of help (edwards et al., 2011). it appears that survivors perceive their informal sources as helpful when survivors receive emotional support or tangible support (e.g., being offered a place to stay), or obtain practical advice (e.g., being encouraged to seek legal or counseling support). on the other hand, survivors consider the informal sources as unhelpful when they do not take ipv situations seriously, blame the survivors, or pressure the survivors to take specific actions such as breaking up the relationship (edwards et al., 2011; sylaska & edwards, 2014). advances in social work, spring 2020, 20(1) 27 survivor services such as domestic violence agencies, shelters, and crisis hotlines are among the core resources for ipv survivors. however, the literature suggests a notable difference between women and men when it comes to the outcomes of using such services. for example, female rape survivors who had assistance from rape survivor advocates, compared to those who did not work with advocates, reported more positive experiences in accessing legal and medical systems to remedy their ipv-related issues (campbell, 2006). moreover, a study that followed female ipv survivors for two years showed that 24% of women who received help from advocates were free from ipv, compared to only 10% of women who did not (sullivan & bybee as cited in bennett et al., 2004). contrary to such findings, studies that focused on men indicate that men perceived survivor services as unhelpful or less helpful (douglas & hines, 2011; tsui, 2014). negative experiences of male survivors’ service utilization may result from a lack of services available to males (tsui, 2014) and from being rejected by service providers claiming that they only help women (douglas & hines, 2011). in sum, the current literature suggests there are gender differences in ipv victimization among college students, their help-seeking, and the outcomes. however, previous study results are not consistent and are somewhat limited in their methodology. many studies relied on small samples; included only certain types of ipv, thereby not representing the whole scope of ipv; did not measure help-seeking outcomes; and/or included only one gender, and thus were not able to examine gender differences. this study strengthens the current literature by (a) collecting data from a large sample of college students; (b) including a variety of ipv types; (c) measuring perceptions of the helpfulness of helpseeking after ipv; (d) examining gender differences in all of these aspects of ipv; and (e) including non-heterosexual ipv survivors. the current study aimed to answer four research questions: (a) what are the differences in characteristics between ipv survivors and those not experiencing ipv?, (b) are there gender differences among ipv survivors by ipv types experienced, health, and help-seeking behaviors?, (c) are there gender differences in helpseeking outcomes among ipv survivors?, and (d) are there gender differences among ipv survivors who did not seek any help in reasons for not seeking help? methods study sample the data are from cross-sectional online surveys conducted from 2016 through 2017. undergraduate and graduate students at six universities across the u.s. were recruited to participate, including east-coast, west-coast, southern, and midwest universities. each university recruited students independently, using convenience sampling methods, such as student mailing lists and student organizations. all survey participants, except those at two universities where incentives were not allowed, were given the option of opting into a raffle for gift cards. each university implemented the surveys independently. the current study sample consisted of 3,070 undergraduate students who had been in romantic relationships for at least a month, which was likely to indicate that they have had intimate partners. this study was approved by the institutional review boards at each of the participating universities. cho et al./gender differences in ipv 28 measures ipv victimization ipv victimization was measured with five different types: threats, physical, sexual, technological, and psychological victimization. questions on threats, and on physical and sexual violence were adopted from the partner victimization scale (hamby, 2013); questions on technological violence were from southworth, finn, dawson, fraser, and tucker (2007); and psychological violence questions were from ansara and hindin (2010). participants were asked whether they had ever experienced such violence by their current and/or previous romantic partners, including boyfriends, girlfriends, husbands, or wives. there were a total of 12 items used (cronbach’s alpha=0.78): one for threats (e.g., “not including horseplay or joking around, my partner threatened to hurt me and i thought i might really get hurt”), three for physical victimization (e.g., “not including horseplay or joking around, my partner pushed, grabbed, or shook me”), one for sexual victimization (e.g., “my partner made me do sexual things when i did not want to”), two for technological victimization (e.g., “my partner sent emails or text messages to threaten, insult, or harass me”), and five for psychological victimization (e.g., “my partner tried to limit my contact with family or friends”). each item was rated based on a 4-point likert scale ranging from 0 (never) to 4 (four times or more). the sum of each of the five ipv types was obtained and dichotomized: 0= ”no victimization by a certain type of ipv”, and 1=”at least one victimization by that type”. another variable was created to represent overall ipv victimization by adding all of the items in the scale together; it was also dichotomized: 0= ”no ipv victimization” and 1=”at least one ipv victimization”. ipv consequences ipv consequences were measured with three questions adopted from the partner victimization scale (hamby, 2013). those who had experienced ipv victimization at least once were asked: whether they had physical injuries (e.g., “were you physically hurt when this happened?”) or daily routine problems (e.g., “did you miss any days of school, work, or your normal routine because of what happened?”), and how much they were afraid (e.g., “thinking back to when it happened, how afraid did you feel?”) at the most recent ipv incident. while physical injuries and daily routine problems had two response options, “yes” or “no”, feeling afraid had three response options, “not at all”, “a little”, and “very”. help-seeking and outcomes to those who had experienced at least one type of ipv victimization, their help-seeking behaviors were assessed using a single item—"have you talked about any of these incidents with any agencies or persons?”—with “yes” or “no” response options. participants who answered “yes” to this question were considered as having sought any help after ipv victimization. those who had sought help were then asked to identify which types of help they used from among 13 help sources. seven help sources (e.g., medical services, shelter, and police) were considered formal help; six sources (e.g., family, friends, and coworkers) were considered informal help. with “yes” or “no” response options, participants were asked to indicate as many help sources as they used. outcomes of helpadvances in social work, spring 2020, 20(1) 29 seeking were asked of those who reported having used at least one help source (“do you think the assistance you received was helpful?”), with “yes” or “no” response options. if the participants did not use any help source, they were asked about the reasons for not seeking help. twelve reasons were provided (e.g., private or personal matter, no insurance, and afraid of reprisal by partner); the list was informed by the national crime victimization survey (langton et al., 2012). participants were able to check multiple reasons. physical and behavioral health self-perceived health status was measured with two questions: “how would you rate your overall physical health?” and “how would you rate your overall mental health?” respondents were offered five response options—“excellent”, “very good”, “good”, “fair”, and “poor”—which were dichotomized for the analysis: “good”(combining excellent, very good, and good) and “not good” (combining fair and poor). depression was measured by the center for epidemiologic studies depression scale (radloff, 1977), which consisted of 20 items assessing how often during the previous week the participants had experienced symptoms regarding restless sleep, poor appetite, and feeling lonely. the 4-point likert scale response options ranged from 0 (rarely or none of the time [less than 1 day]) to 3 (most or all of the time [5-7 days]). the sum of each item was calculated and treated as a continuous variable, ranging from 0 (no depressive symptoms) to 60 (the highest depression). the reliability of this scale was 0.92. body mass index (bmi) was measured to see if ipv was associated with physical health and calculated using participants’ reported weight in pounds and height in inches. specifically, it was calculated by dividing weight by height squared, and multiplied by a conversion factor of 703 (centers for disease control and prevention [cdc], 2014). based on commonly accepted bmi classifications, such as underweight—under 18.5, normal— 18.5 to 25, overweight—25 to 30, and obese—over 30 (cdc, 2014), two bmi categories were created: under or normal weight (under 18.5-25) and overweight (25 to over 30). alcohol use was measured by asking “in the past 12 months, how often did you usually have at least one drink? it means either a glass of wine, a can or bottle of beer, or a shot or jigger of liquor (i.e., 1 1/2 fluid ounces) either alone or in a mixed drink,” with six response options ranging from 0 (did not drink) to 5 (nearly every day). responses were reduced to three categories: non-drinker (did not drink), casual drinker (less than once a month to one-two days per week), and heavy drinker (three-four days per week and nearly every day). drug use was measured by asking “in the past 12 months, how often did you use marijuana, hashish, cocaine, heroin, lsd, or prescription drugs for any reason other than a health professional said you should use them?” with the same response options as were offered regarding alcohol use. responses were reduced to three categories: non-user (did not use), casual user (less than once a month to one-two days per week), and heavy user (three-four days per week and nearly every day). cho et al./gender differences in ipv 30 demographics characteristics various demographic characteristics were included to describe the sample. age was asked in years and treated as a continuous variable. gender was assessed as “female,” “male,” or “other.” participants who identified themselves as “other (e.g., transgender)” were excluded in the analyses due to their small number. sexual orientation was subsequently asked with six response options (“heterosexual or straight”, “gay or lesbian”, “bisexual”, “transgender”, “don’t know”, “other”) and dichotomized for this study as heterosexual (heterosexual or straight) and non-heterosexual (all other response options). race was asked with “asian, pacific islander,” “black, african american (nonhispanic),” “spanish, hispanic, latino,” “white, caucasian, european (non-hispanic),” “american indian, native american, native canadian, first nations,” multi-ethnic,” and “other.” school years were measured with 5 categories: “freshman,” “sophomore,” “junior,” “senior,” and “other.” additional demographic information was collected from participants, including questions about religion, financial security, residence, internationality, ipv training, and neighborhood environments. religion was measured with seven categories (e.g., no religion, christianity, hindu) and reduced for this study to a dichotomous variable: religious and non-religious. financial security was measured with six categories, ranging from “very secure” to “very insecure,” and dichotomized into secure and insecure. residence was measured by asking if the respondent lived in a college dorm: “yes” or “no”. internationality was measured by asking if the respondent was an international student or born abroad: “yes” or “no”. ipv training was measured by asking if the respondent had taken any class and/or training that discussed relationship violence: “yes” or “no”. current and childhood neighborhood environments were measured by asking “how true is each of the following statements about your neighborhood when you were a child?” and “how true is each of the following statements about your neighborhood where you live most of the time?” using the neighborhood cohesion and safety scale (alegria et al., 2004). this scale consists of seven items to assess participants’ perceptions of neighborhood cohesion (e.g., “people in my neighborhood could be trusted”) and safety (e.g., “i felt safe being out alone or with my family in this neighborhood during the night”) based on a 4-point likert scale, ranging from 0 (not at all true) to 3 (very true). the sum of each item was calculated and treated as a continuous variable, ranging from 0 to 21. higher points indicate higher levels of perceived neighborhood cohesion and safety. the reliability of this scale was 0.83 (current neighborhood) and 0.87 (childhood neighborhood), respectively. analysis we ran multiple descriptive and bivariate analyses. first, the sample was split into two groups: ipv (those who reported any type of ipv victimization, n=1,901) and non-ipv (those who did not report any ipv victimization, n=1,169). separate bivariate analyses were conducted with each of the two groups to examine whether there were gender differences among all demographic variables, and in the physical and behavioral health variables (research question 1). we then looked to see if there were differences between groups. next, with the ipv group (n=1,901), we analyzed ipv types, consequences, and help-seeking by gender (research question 2). third, for those who sought any type of help advances in social work, spring 2020, 20(1) 31 (n=519), help-seeking outcomes were analyzed by gender (research question 3). finally, for those who did not seek any help (n=1,116), each of twelve reasons for not seeking help was analyzed by gender (research question 4). in all of the analyses, frequencies and percentages were reported for categorical variables; means and standard deviations were reported for continuous variables. pearson’s chi-square tests or independent t-tests were conducted for all bivariate analyses to examine gender differences in ipv experiences. effect sizes were reported by cramer’s v for the chi-square tests and cohen’s d for the ttests. in addition, we conducted a series of post hoc analyses for pairwise comparison using the bonferroni adjusted alpha levels per test to protect from yielding inflated type i errors (macdonald & gardner, 2000). spss v. 22 was used for all analyses. results table 1 shows the sample characteristics for those who experienced ipv victimization and those who did not. nearly 62% of students experienced at least one type of ipv victimization. regardless of gender, the respondents reporting at least one type of ipv were engaged in risky substance use, and reported health concerns, more than those reporting no ipv victimization. in addition, many gender differences were found among ipv survivors. to be specific, compared to male students with ipv victimization, female counterparts reported older age (t(800)=0.75, p < 0.01, d=.58), more hispanic origin (χ2(4)=8.33, p < 0.05, v=.01), less safe neighborhood in childhood (t(500)=-2.05, p < 0.05, d=.06), poorer physical and mental health status (χ2(1)=30.64, p < 0.001, v=.20; χ2(1)=7.71, p < 0.01, v=.13, respectively), and higher depression scores (t(661)=5.40, p < 0.01, d=.41). post hoc comparisons using the adjusted bonferroni correction showed significant gender differences in behavioral health. specifically, more male students reported mental health as “good” (0.05/4=.0125) while more female students were non-drug users (0.05/6=.0083). however, the other variables showed no gender differences. except for psychological violence, female students experienced significantly more ipv victimization than male students (table 2). of the five ipv types, psychological violence was the most prevalent for both male and female students, followed by physical violence. sexual violence showed the biggest gender difference, with 47.3% of female students and 14.3% of male students victimized (χ2(1)=147.17, p < .001, v=.32). each post hoc comparison using the adjusted bonferroni correction (0.05/4=.0125) for the five types of violence indicated that all pairwise gender differences, except for psychological violence, were significant. among those who experienced any type of ipv victimization, female students suffered from all three types of consequences more than their male counterparts being physically hurt, feeling afraid when victimized, and having problems with daily routines afterwards. the biggest gender difference was found in feeling afraid; 66.5% of female students were a little or very afraid, while 75.8% of males did not feel afraid at all (χ2(1)=209.61, p < .001, v=.17). however, each post hoc comparison using the adjusted bonferroni correction for physical injuries (0.05/4=.0125), daily routine problems (0.05/4=.0125), and feeling afraid (0.05/6=.0083) showed that none of pairwise comparisons was significant. advances in social work, spring 2020, 20(1) 32 table 1. gender differences in ipv victimization, demographics, and physical and behavioral health (n=3,070) ipv victimization (n=1,901) n (%) / m(sd) a no ipv victimization (n=1,169) n (%) / m(sd) a demographics female male  2 / t female male  2 / t agea 22.4 (5.86) 22.1 (4.64) 0.75** 21.1 (3.80) 21.5 (4.80) -1.55 race/ethnicity white black hispanic asian multi-ethnic 1014 (68.5%) 83 (5.6%) 128 (8.6%) 120 (8.1%) 135 (9.1%) 296 (73.1%) 16 (4.0%) 20 (4.9%) 35 (8.6%) 38 (9.4%) 8.33* 600 (70.8%) 55 (6.5%) 39 (4.6%) 94 (11.1%) 59 (7.0%) 233 (73.5%) 13 (4.1%) 14 (4.4%) 37 (11.7%) 20 (6.3%) 2.72 sexual orientation heterosexual non-heterosexual 1266 (85.7%) 212 (14.3%) 364 (88.1%) 49 (11.8%) 1.67 755 (89.6%) 88 (10.4%) 288 (90.3%) 31 (9.7%) 0.13 financial security insecure secure 927 (62.9%) 547 (37.1%) 247 (60.4%) 162 (39.6%) 0.85 444 (53.1%) 392 (46.9%) 153 (48.6%) 162 (51.4%) 1.89 religion no yes 465 (31.5%) 1013 (68.5%) 156 (37.7%) 252 (61.8%) 6.64* 240 (28.7%) 596 (71.3%) 120 (37.9%) 197 (62.1%) 8.96** school year freshman sophomore junior senior other 241 (16.9%) 285 (20.0%) 290 (20.4%) 382 (26.9%) 224 (15.8%) 34 (8.7%) 77 (19.7%) 100 (25.6%) 159 (40.7%) 21 (5.4%) 61.65*** 145 (17.9%) 191 (23.6%) 184 (22.7%) 218 (26.9%) 71 (8.8%) 45 (14.5%) 64 (20.6%) 79 (25.4%) 108 (34.7%) 15 (4.8%) 12.41* ipv training no yes 694 (47.8%) 757 (52.2%) 212 (52.5%) 192 (47.5%) 2.73 381 (51.2%) 363 (48.8%) 159 (53.9%) 136 (46.1%) 0.61 dormitory resident no yes 1047 (70.8%) 431 (29.0%) 309 (75.7%) 99 (24.3%) 3.79 557 (66.6%) 279 (33.4%) 215 (68.0%) 101 (32.0%) 0.21 advances in social work, spring 2020, 20(1) 33 table 1. gender differences in ipv victimization, demographics, and physical and behavioral health (n=3,070) ipv victimization (n=1,901) n (%) / m(sd) a no ipv victimization (n=1,169) n (%) / m(sd) a demographics female male  2 / t female male  2 / t international student no yes 1389 (94.5%) 81 (5.5%) 388 (95.6%) 18 (4.4%) 0.74 771 (92.1%) 66 (7.9%) 292 (93.0%) 22 (7.0%) 0.25 current ncsa,b 14.76 (4.29) 15.54 (4.05) -3.26 15.75 (3.96) 16.23 (3.81) -1.88 childhood ncsa,b 16.59 (4.55) 17.16 (4.15) -2.05* 17.60 (3.81) 17.54 (4.10) 0.19 health physical health not good good 73 (18.4%) 1213 (81.6%) 52 (12.6%) 362 (87.4%) 7.71 102 (12.0%) 746 (88.0%) 39 (12.3%) 279 (87.7%) 0.01 mental health not good good 369 (24.8%) 1117 (75.2%) 50 (12.1%) 364 (87.9%) 30.64*** 112 (13.2%) 736 (86.8%) 29 (9.1%) 289 (90.9%) 3.64 bmi under/ normal overweight 896 (66.2%) 457 (30.7%) 200 (51.9%) 185 (48.1%) 26.22 553 (73.8%) 196 (26.2%) 181 (59.9%) 121 (40.1%) 19.74*** depressiona 18.01 (12.06) 14.52 (11.06) 5.40 12.85 (10.12) 11.57 (9.23) 1.89 alcohol non-drinker casual drinker heavy drinker 184 (12.5%) 1153 (78.1%) 140 (9.5%) 43 (10.4%) 311 (75.5%) 58 (14.1%) 7.87 139 (16.5%) 651 (77.1%) 54 (6.4%) 50 (15.8%) 221 (69.9%) 45 (14.2%) 18.21*** drug non-user casual user heavy user 941 (63.4%) 448 (30.2%) 95 (6.4%) 229 (55.3%) 127 (30.7%) 58 (14.0%) 26.71*** 612 (72.2%) 210 (24.8%) 26 (3.1%) 199 (62.4%) 80 (25.1%) 40 (12.5%) 39.99*** * p < .05, ** p < .01, *** p < .001 (significant results after adjusted bonferroni correction) a frequency (percent) for categorical variables (no denotation), mean (standard deviation) for continuous variables b neighborhood child safety scale advances in social work, spring 2020, 20(1) 34 after ipv victimization, female students sought some type of help more than males (36.3% vs. 17.1%, χ2(1)=46.25, p < 0.001, v=.11). of those who sought help, female students sought formal help more than males (53.9% vs. 29.3%, χ2(1)=12.53, p < 0.001, v=.23). female and male students who experienced ipv victimization relied equally on informal help (88%). based on each post hoc comparison using the adjust bonferroni correction, only formal help (0.05/4=.0125) was significantly different by gender. table 2. gender differences in types of ipv victimization, ipv consequences, and helpseeking (n= 1,901) female n (%) male n (%)  2 ipv victimization ipv types physical psychological sexual technological threats 730 (49.1%) 1317 (88.6%) 701 (47.3%) 609 (41.0%) 463 (31.1%) 164 (39.6%) 368 (88.9%) 59 (14.3%) 91 (22.0%) 57 (13.8%) 11.68** 0.03 147.17*** 49.35*** 48.86*** ipv consequences physical injuries no yes 1106 (83.9%) 212 (16.1%) 320 (90.4%) 34 (9.6%) 9.34 feeling afraid not at all a little very 434 (33.5%) 550 (42.5%) 310 (24.0%) 263 (75.8%) 74 (21.3%) 10 (2.9%) 209.61 daily routine problems no yes 1082 (82.7%) 226 (17.3%) 332 (93.3%) 24 (6.7%) 24.34 help-seeking any help no 829 (63.7%) 287 (82.9%) 46.25*** yes formal 254 (53.9%) 17 (29.3%) informal 411 (87.3%) 51 (87.9%) * p < .05, ** p < .01, *** p < .001 (significant results after adjusted bonferroni correction) when survivors sought formal help, just under half of female students and only a quarter of male students reported it as helpful (χ2(1)=8.36, p < 0.01, v=.17; table 3). for informal help, 71.6% of female students and 87.3% of male students found it helpful (χ2(1)=6.20, p < 0.05, v=.01). each post hoc comparison examining the helpfulness of formal or informal help using the adjusted bonferroni correction (0.05/4=.0125) revealed that none of the pairwise comparisons were significant. advances in social work, spring 2020, 20(1) 35 table 3. gender differences in helpfulness of help-seeking type of help seeking helpful? female n (%) male n (%)  2 formal help no yes 251 (54.1%) 213 (45.9%) 41 (74.5%) 14 (25.5%) 8.36 informal help no yes 132 (28.4%) 332 (71.6%) 7 (12.7%) 48 (87.3%) 6.20 * no significant results after adjusted bonferroni correction. the most reported reason for not seeking help by both men and women was that they thought it was a private or personal matter or they took care of it themselves (table 4). two reasons that showed the biggest gender differences were “others would not think it was important enough” and “did not want to get partner in trouble,” which were more prevalent among female students than males (21.1% vs. 12.2%, and 15.8% vs. 9.8%, respectively; χ2(1)=11.09, p < 0.01, v=.25, χ2(1)=6.38, p < 0.05, v=.02). there were some survivors, though only a few, who reported that they had difficulty because of their sexual orientation; this was more prevalent in male students than females (3.5% vs. 1.4%, χ2(1)=4.58, p < 0.05, v=.03). table 4. reasons for not seeking help female n (%) male n (%)  2 a private or personal matter or took care of it myself 621 (74.9%) 204 (71.1%) 1.62 no insurance 25 (3.0%) 8 (2.8%) 0.04 did not want to get partner in trouble 131 (15.8%) 28 (9.8%) 6.38* afraid of reprisal by partner 77 (9.3%) 15 (5.2%) 4.65* fear of losing children or more trouble 12 (1.4%) 2 (0.7%) 0.97 they would not think it was important enough 175 (21.1%) 35 (12.2%) 11.09** they would be inefficient, ineffective 120 (14.5%) 32 (11.1%) 2.00 they would be biased, would harass me, cause me trouble 49 (5.9%) 13 (4.5%) 0.78 did not want to or could not take timetoo inconvenient 154 (18.6%) 50 (17.4%) 0.19 hard to find or get help because of sexual orientation 12 (1.4%) 10 (3.5%) 4.58* * p < .05, ** p < .01, *** p < .001 (significant results after adjusted bonferroni correction) a.  2 for each reason (yes vs. no)  gender (female vs. male) discussion the study results demonstrate gender differences in the type of ipv experienced, factors and health issues associated with ipv victimization, and help sources utilized. our study findings suggest that all types of ipv victimization experiences other than psychological violence are disproportionately high among female students. our findings are consistent with prior studies reporting no gender differences in the prevalence of psychological violence (cho & huang, 2017; dardis et al., 2017; fass et al., 2008; gover et al., 2008), and prominent gender differences in other types of ipv including sexual violence (breiding et al., 2014). our findings are in contrast to other studies reporting that the prevalence of physical violence is equally distributed across gender (dardis et al., 2017; cho et al./gender differences in ipv 36 gover et al., 2008) or that it is more prevalent among male students (fass et al., 2008). such inconsistencies may be due to differences in methodology across studies, such as sampling, measurement, and not factoring in self-defense (allen et al., 2009). demographic factors associated with ipv victimization varied between the two genders. female survivors were older, more often of hispanic origin, and from less safe childhood neighborhoods than males. it would be premature to suggest that female students with such characteristics are victimized more than male students. nonetheless, further research may prove worthwhile as such gender differences were not found among the students not victimized by ipv. consistent with previous study results, female survivors reported poorer mental health than male survivors (afifi et al., 2009; kars & o’leary, 2010). this difference may have stemmed from their unique ipv victimization experiences, given that more female survivors than males were physically hurt and afraid when victimized, and had problems with daily routines afterwards. it may be that the more ipv one experiences, the more severe the consequences, both in the shortand long-terms. however, it is also possible that females in poor mental health in younger ages might have been more vulnerable to ipv than males, which may have resulted in more severe consequences following ipv victimization. not many survivors sought help; only 36.3% of females and 17.1% of males. given the numerous health and social consequences of ipv, this low level of help-seeking is alarming. study findings regarding reasons ipv survivors do not pursue assistance are particularly informative. many survivors who did not seek any help reported that they considered ipv to be a private, personal matter, or not important, which aligns well with the existing literature (e.g., douglas & hines, 2011; edwards et al., 2011). it may be that many still believe ipv is a private matter and do not want to involve other parties, including providers of the services designed to help victims. the study findings revealed interesting gender differences in the reasons for not seeking help. female survivors who did not seek help were much more likely to report that they did not want to get their partner in trouble and/or were afraid of reprisal by their partner than male survivors (15.8% vs. 9.8%, 9.3% vs. 5.2%, respectively), suggesting that female survivors perceive help-seeking as a potential danger to their relationship or their safety. in comparison to female survivors, some male ipv survivors did not seek help because of their sexual orientation, either they were unable to find services for themselves or feared they may not get the appropriate help they needed. while a lack of services for males and non-heterosexual survivors has been consistently reported (carvalho et al., 2011; douglas & hines, 2011; tsui, 2014), it has rarely been identified that male non-heterosexual survivors may face more challenges than female counterparts. this study provides evidence that, in fact, there are additional challenges for non-heterosexual male ipv survivors in accessing services, which signifies the need for services targeting male non-heterosexual survivors. when survivors in this study sought help, they used informal help much more often than formal help, which is consistent with the literature (cho & huang, 2017; coker et al., 2000; edwards et al., 2011). there were differences in the perceived helpfulness between the two help types— many survivors reported that informal help was effective but only about half of survivors reported that formal help was useful. it is concerning that formal help, such as physicians and police, was not used by survivors frequently and, once used, advances in social work, spring 2020, 20(1) 37 was not found to be beneficial. there seemed to be gender differences in the type and the perceived effectiveness of the help that survivors received, although they were not statistically significant. first of all, female survivors were more likely than males to use formal help and found it useful. as discussed earlier, such gender differences may be related to a lack of services for males and limitations in the services that are available, in which male survivors, especially gay men, may be treated with less welcoming attitudes than females (douglas & hines, 2011; tsui, 2014). another gender difference was that, although females used informal help as often as males, they found it less useful than males. this may be due to the “negative” help female survivors often receive from informal help sources, such as not taking ipv situations seriously and/or pressing them to take certain actions against their preferences (edwards et al., 2011; sylaska & edwards, 2014). future research is needed to confirm these relationships that were suggested but not found to be significant statistically. the study findings should be interpreted in the context of a few methodological limitations. this study used cross-sectional survey data, and was, therefore, not able to substantiate potentially causal relationships. although recruited from diverse areas of the u.s., the sample was not nationally representative. some gender differences and other relationships that were found to be significant might have been affected by the sample limitations. while this study inquired about sexual orientation of the respondents, those identifying as others were excluded from the analysis. they may include trans-identified, non-binary, or gender fluid-identified students, who may often experience the highest rates of violence and be excluded from help-seeking for many reasons (schwab-reese et al., 2018). bivariate analyses were primarily used to identify significant associates of ipv, help-seeking, and gender differences. multivariate analyses of variables found to be significant in this study, including the differential effects of the associated factors and potential interactions among them, are recommended for future research. conclusion gender differences were apparent in ipv experiences, helping-seeking behaviors, and the perceived helpfulness of formal and informal resources among college students in the current study. the study findings suggest important implications for intervention strategies to prevent and intervene in ipv among young adults, particularly on college campuses. furthermore, the findings yield implications for crucial roles social workers could play to empower college ipv survivors to seek help. first, the disproportionate concentration of ipv victimization experiences among females suggests a need to engage both males and females in campus interventions to educate them about power dynamics in romantic relationships. since female students suffered from more severe ipv consequences than males, it is important that service providers, such as community domestic violence advocates and social workers, on-campus counselors, and student health center professionals, consider the severe negative consequences of ipv among females when planning prevention and intervention programs. at the same time, a significant number of male college students experienced ipv, implying that campus service providers need to exert greater effort in making the services available for male student survivors. cho et al./gender differences in ipv 38 only a small portion of the survivors of ipv in the current study sought any type of help following their ipv experiences. for both female and male survivors, the most-often reported reasons for not seeking help were that they considered ipv to be a private/personal matter, believed that helpers would not take ipv seriously, and felt that seeking help was inconvenient. such perceptions on the survivors’ part suggest that campus communities must take steps to eliminate the stigma facing survivors of ipv. these remedies are crucial for empowering both genders to reach out for help, but it might be even more important for male survivors of ipv. male survivors may feel more stigmatized or embarrassed in the context of official settings, where helping professionals may minimize their ipv experiences and their detrimental impact (tsui et al., 2010). making services and resources available by eliminating the stigma toward ipv can also encourage male survivors in same-sex relationships to seek help as they may currently experience more severe stigmatization due to their sexual orientation, in addition to being male survivors. social workers should also invest efforts to inclusively and sensitively serve this population. for example, it is important that they are conscious about their known or unknown bias and potentially discriminatory attitudes toward non-heterosexual ipv survivors (ard & makadon, 2011; calton et al., 2016). for social workers to engage in such reflective practice, they first need to understand the struggles and challenges nonheterosexual ipv survivors might experience. social work education and social service agencies serving ipv survivors should provide relevant trainings for social workers to effectively reach out to and assist this population (calton et al., 2016). in college contexts, such efforts to enhance sensitivity toward non-heterosexual ipv survivors should also be made by not only helping professionals (e.g., counselors and health service providers), but also academic instructors and staff so that the survivors feel more comfortable in approaching informal and formal sources of help. furthermore, future research needs to comprehensively explore gender, beyond the male/female binary, which will produce a better understanding of non-heterosexual college students’ help-seeking behaviors. in turn, such knowledge could yield implications for tailored social work practice and policy to better assist non-heterosexual college students suffering from ipv. finally, both female and male survivors sought informal help more often than formal help after experiencing ipv victimization. social workers can be at the forefront of developing and implementing educational and communicative programs in collaboration with colleges, targeting such sources of informal help as family and friends so that survivors can receive and/or be guided to the appropriate help. furthermore, through these programs, social workers could educate community members, who might be the informal sources of help to survivors, about “how to respond to the disclosure of ipv” (edwards et al., 2011, p. 515). our findings revealed gender differences in the perceived helpfulness of the assistance sought. for victim services to be effective, future research needs to examine what aspects and processes of help-seeking are perceived by the survivors as being helpful, or not, and the role gender plays in those relationships. references afifi, t. o., 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(2018). the cyber aggression in relationships scale: a new multidimensional measure of technology-based intimate partner aggression. assessment, 25(5), 608-626. https://doi.org/10.1177/1073191116665696 woodin, e. m., sotskova, a., & o’leary, k. d. (2013). intimate partner violence assessment in an historical context: divergent approaches and opportunities for progress. sex roles, 69(3-4), 120-130. https://doi.org/10.1007/s11199-013-0294-z author note: address correspondence to dr. jisuk seon, brown school, washington university in st. louis. campus box 1196, one brookings drive, st. louis, mo 63130. e-mail: jseon@wustl.edu _______ kerri fisher lcsw, full-time, senior lecturer, garland school of social work, baylor university, waco, tx. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 690-707, doi: 10.18060/24184 this work is licensed under a creative commons attribution 4.0 international license. an experiential model for cultivating cultural humility and embodying antiracist action in and outside the social work classroom kerri fisher abstract: social workers in academia may enjoy seemingly endless discussions and debates on ever-evolving “diversity concepts” including privilege, oppression, microaggressions, and white supremacy culture, but students and would-be allies are often stymied, if not altogether lost by the enormity of overcoming injustice. the 7e model for cultural humility and antioppressive practice provides specific and creative opportunities for personal and systemic change offering fledgling antiracists both structure and freedom on their unique paths to activism and allyship in keeping with their own individual, intersectional identities and bio-psycho-social development. the seven experiences discussed in the model (exposure, engaging, examining, evaluating enacting, educating, and evolving) are defined and explained. teaching tools are provided. keywords: anti oppressive practice; white supremacy culture, cultural humility, dei curriculum evaluation as a black woman teaching in a predominantly white institution, i find that my students, colleagues, and community are often stymied by the enormity of overcoming racial injustice. many, though not all, are willing learners, but their success as would-be change-makers is impeded by white supremacist norms in the academy including dichotomous thinking, perfectionism, and the right to comfort (okun, 2010). if there is only “one right way” and if imperfect practitioners will be “canceled”, emerging social workers are disincentivized from mining their intellectual and emotional depths for fear of what lies beneath polite professionalism. many approaches to comprehensive antiracist change suffer from either a lack of specificity or a lack of flexibility, leaving emerging professionals confused and ultimately disengaged from antiracism as a central, ongoing tenet of all of their professional endeavors. this is why a clear but adaptable model is needed that guides individuals through a set of experiences both personally and professionally, and which can begin and be reiterated throughout a social work curriculum in and outside the classroom. the 7e model for cultural humility and antioppressive practice, presented here for the first time, offers students and professionals a personal and professional pathway for deconstructing racism and reconstructing antiracism in thought, word, and deed. the model is informed by both critical race and intersectionality theories, and is also buoyed by the lifelong practices of cultural humility and counterintuitive solidarity. each of these grounding concepts and practices is explained below. about:blank fisher/experimental model 691 grounding concepts & practices critical race theory critical race theory is born of legal scholarship and informs social work practice with its acknowledgments that 1. racism is a permanent and embedded 2. race is socially constructed 3. whiteness is a commodity that can be bartered for goods, services, and opportunities 4. white individuals and institutions can choose to be or appear to be anti-racist when it benefits the white stakeholders (interest convergence) 5. intersectional identities affect racism’s overall impact 6. storytelling and counter-storytelling are key to understanding race and racism accurately 7. ahistoricism and colorblind classical liberalism must be identified and critiqued (daftary, 2018, p. 442) in particular, the 7e model encourages critical self-reflection around the permanent and embedded racism in individuals & institutions, engagement, and emphasis on counternarratives from black, indigenous, latino(a)(x), asian, biracial, multiracial, and other nonwhite groups, and levying the commodity of whiteness (or any other privileged identity) for the benefit of antiracist initiatives. i hesitate to use the recently popularized bipoc label for fear that it might have the unintended effect of erasure of my latino(a)(x) and asian colleagues and collaborators in the fight for racial justice. lusk (2017) addresses the need for a critical lens in social work supervision and leadership in order for cultural competence to be enacted effectively. intersectionality though intersectionality is a recognized component of critical race theory, the work of dr. kimberlé crenshaw deserves its own explanation as a fundamental element of the 7e model. many social work educators have articulated the need for intersectionality in any cultural competence instruction (robinson et al., 2016; ross, 2010). crenshaw, along with other legal scholars, recognized the many ways that marginalizations in multiple identities such as race and gender overlap and in so doing create barriers in a person’s life that might otherwise be avoided. for example, in the degaffernreid case famously analyzed by crenshaw (1989), five black women who filed an employment discrimination case against general motors, were told that they could not have been discriminated against because there were both women and black people employed at the company. the ruling judge failed to take into consideration that it was, in truth, the overlapping of their identities—blackness plus femaleness, that created the discrimination and thus the block in their professional progress. advances in social work, summer 2021, 21(2/3) 692 although no two people nor marginalizations are exactly the same, it seems that using anti-oppressive work in one area of learning can often be adjusted and appropriately generalizable to other areas of learning. students are done a disservice when educators seek to combat inequity for one or two groups due to personal connection or mounting public pressure. true justice in education comes from always asking the question, how can we create the least restrictive environments for all students? those who desire to be "problack" educators must remember that some black students are also gay students. those institutions desiring to be queer-friendly campuses have to recognize that some of their queer students are also religious minorities. for those communities priding themselves on being multiculturally inclusive, it will be of utmost importance to listen to the voices of women from all those cultures rather than histories, traditions, and desires, offered exclusively through the male lens and the male gaze. cultural humility cultural humility is a term coined by physicians dr. melanie tervalon and dr. jann murray-garcia (1998), who came to understand that the nurses they were training not only had preconceived race-based notions about patients but also that some of their notions seemed, at times, to be academically sanctioned misinformation. they came to believe that the formerly hailed cultural competence model might have the unintended consequence of giving health professionals a misguided sense of expertise just because they read a book or heard a lecture about working with patients from certain racial or ethnic backgrounds. instead, the doctors suggested, a better approach would be one of cultural humility, the tenets of which they identified as “a commitment to lifelong learning & critical selfreflection, challenging power imbalances, and holding institutions accountable for and to the communities of color which they purport to serve” (tervalon & murray-garcia, 1998, p. 118). ortega and faller (2011) and gottlieb (2020) have expanded upon tervalon and murray-garcia’s concept of cultural humility as a strong philosophical fit for the social work profession in particular. many have written about the pros and cons of both cultural competence and cultural humility in the field of social work. critiques of cultural competence include ambiguous and inconsistent definitions held by practitioners, a focus on mastery (static endpoint) rather than accountability (ongoing assessment; fisher-borne et al., 2015), a tendency toward an imprecise conflation of race and culture (jani et al., 2016), and a diversion from a central emphasis on the impact power and oppression (abrams, 2009). cultural humility has also been critiqued, especially when lifelong learning has been overvalued at the expense of critical self-reflection, addressing power, and institutional accountability. though social workers should be open to learning about the impact of clients’ intersectional identities, more onus should not be placed on marginalized individuals/groups to be the teacher of their experiences for counselors, case managers, or other social workers in the community when ample research, literature, and art exists for those interested in educating themselves. because both cultural competence and cultural humility have been repeatedly misunderstood and misapplied, it is helpful that the latest update to the nasw code of fisher/experimental model 693 ethics (national association of social work, 2021) now elevates tervalon and murraygarcia’s cultural humility orientation, in the ethical standards section reminding social workers of our ethical obligations not only to “obtain knowledge” (1.05d) through “critical self-reflection” (1.05c) but also to “demonstrate understanding” through “holding institutions accountable” (1.05,d) and “taking action against oppression, racism, discrimination, and inequities (1.05, b) counterintuitive solidarity finally, at the center of any good cultural humility is counterintuitive solidarity, a practice named and described by dr. drew hart. hart (2016) suggests that individuals with political and social power have never tended to easily and accurately intuit the plight of the disenfranchised. if critical race theory affirms for learners that racism is a permanently embedded part of culture, counterintuitive solidarity reminds learners that it took many complicit, silent, and/or apathetic white individuals choosing to believe or hide behind the religious, sociological, and supposedly scientific rationales for its continued existence. rather than assigning villainy or idiocy to those who came before, educators should instead encourage students to assume such patterns of behavior continue among the socially, financially, politically, and historically, privileged and powerful. whose voice is getting drowned out today? what are they saying? who benefits from not listening/knowing/believing them? counterintuitive solidarity asks antiracist allies and advocates to remember the sins of the past and assume that nothing will or can change without listening, trusting, and following the collective voice of those who are oppressed today. figure 1. 7e model for cultural humility and antioppressive leadership fisher, 2010/202 advances in social work, summer 2021, 21(2/3) 694 introduction & structure the 7e model for cultural humility and antioppressive action depicted in figure 1 is a culmination of 15 years of experience as a social work practitioner, field director, and educator. the model moves from intrapersonal work connected to the "lifelong learning and critical self-reflection" tenet of cultural humility and moves increasingly into interpersonal and institutional level action in keeping with the tenets of "challenging power imbalances" and "holding institutions accountable" (tervalon & murray-garcia, 1998, p. 118). step-based models can easily become cemented in individual minds and collective consciousness as linear, hierarchical, and static—a very western, “objective” manner of engaging information, when in truth, much of life and learning tends to be interconnected, dynamic, and cyclical (if any structurally reliable pattern exists at all). for that reason, the 7e model uses the word "experience" rather than "step" to describe states of awareness and action. experiences sometimes happen in the order described, and at other times they happen concurrently or partially concurrently. most educators can attest to the variety of learning trajectories in the lives of students, colleagues, and loved ones who have joined the path of peace-making resistance. below each of the seven experiences is described, for ushering students through exposure, engaging, examining, evaluating, enacting, educating and evolving. "encounter" experiences: exposure & engaging encounter experiences are any experiences (whether incidental or intentional) in which an individual has occasion to observe, consume, or participate in an activity that is foreign to their own intersectional identities and experiences. an easy way to identify such experiences is to consider what students are reading, watching, listening to and/or attending. many students have had limited academic encounters with the offerings of nonwhite scholars, artists, and citizens, a phenomenon known as invisibility (pharr, 1988) or erasure. when students have been exposed to such offerings the content is often singular and/or distorted by the white gaze (paris & alim, 2014), for example, when every case study offered features straight, young, black men struggling with drug misuse or every “hispanic heritage” month is celebrated by a cursory “taco tuesday” mixer. this is why an intersectional approach is so important in teaching and offering antiracist encounter experiences. students who identify as black, indigenous, latino(a)(x), asian, biracial, multiracial, or otherwise non-white do not benefit from repeatedly being cast as “other” and, in fact, are in danger of experiencing vicarious trauma when every class reading, lecture, or activity reminds and reifies the notion that whiteness is the default experience against which all other experiences are compared (cunningham, 2004; pharr, 1988). using an intersectional approach offers the opportunity for students to toggle back and forth between reading/watching/listening/attending from the perspective of privilege and marginalization, as it is unlikely that many students in a given classroom inhabit all marginalized identities. additionally, antiracist education is not truly antiracist if only one version of, for example, indigenous identity is offered for exploration. fisher/experimental model 695 four tools that can help educators and students to create and/or mine student encounter experiences in and outside of the classroom are the course content check (table 1), social location inventory (table 2), relational inventory (table 3), and content intake log (table 4). these tools can be found in tables 1-4 of this paper but descriptions and tips for use are offered below. encounter tool tips 1. it is important that cultivated encounter experiences feature art, literature, scholarship, and activities that are created by, and not simply about individuals from a marginalized group. a white writer who is an american citizen by birth is likely to have a very different take on a mexican immigration narrative than a mexican or mexican-american writer. 2. it is important that would-be antiracists are encouraged to resist the urge to compare “our best with their worst” (mclaren, 2004, p. 149). if an instructor assigns only one article about muslim-identifying black men, she should consider and/or discuss with students the potentially deleterious effects of such a choice. 3. it is important to remember and remind students that cultural events/activities should be attended only by invitation so as not to exploit a marginalized ingroup experience for the benefit of the dominant-group need. encounter tool descriptions the course content check (table 1) is a tool that helps instructors make sure that their in-class offerings have been intentionally selected for intersectionally diverse course content and that this intentionality is not left up to students to notice or intuit. it is important to highlight black and brown voices and to offer an explanation wherever certain perspectives have been left out. both the intersectional social location inventory (table 2) and the relational inventory (table 3) are tools that can be used inside or outside of class for students to acknowledge and engage their own intersectional identities/lived experiences, which then inform where there might be gaps in natural learning opportunities and point to places where more exposure and engagement are needed. these tools also encourage examination and could therefore be considered reflective experience tools. the most immediate exposure/engagement tool to use as an encounter experience assessment and intervention is the content intake log (table 4). taking inventory of reading, watching, listening, and participation habits allow students to make goals for change. for example, if a student finds that they engaged no content offered by black creators in the last year, and if they are being taught that racism is permanent and embedded and must be combatted with counternarratives, then perhaps the student will make a goal for increased exposure to black created content in the year to come. advances in social work, summer 2021, 21(2/3) 696 table 1a. course content check encounter experiences tool 1: course content check (intersectional decentering of dominant groups) 1. “by” not “about” content check: how many content elements (readings, videos, guest speakers, etc.) are written/provided by (as opposed to about) non-dominant status individuals/groups? 2. “about content” check: how many content elements (readings, videos, guest speakers, etc.) are about (though not necessarily by) non-dominant status individuals/groups? 3. bias check: when non-dominant groups are featured, how frequently is the appearance evidently one of pity, shame, trauma, dysfunction, or otherwise stereotypical representation? 4. strengths check: when non-dominant groups are featured, how frequently is the appearance evidently one of strength, dignity, beauty, competence, leadership, etc.? 5. person first check: when non-dominant groups are featured, are they exclusively used to speak on issues related to their marginalized identity? (example: i invite my one asian-american colleague to speak in my class each year about asian identity and not about his research area which is actually aging.) 6. visibility check: what can i do to make unseen contributions seen? (example, showing photos /video clips of black writers/researchers during in-class lecture lest students presume the writer/researcher/artists from their course outlines are all or mostly dominant group contributors.) 7. presumed center/ re-traumatization check: have i given options and/or trigger warnings where to read, watch, listen-to, or engage a piece of assigned content could be retraumatizing for marginalized individuals, or have i (inappropriately) presumed all of my students will be in the dominant group? (example: if i assign a video-clip that shows a person with a disability/disorder getting cruelly taunted, whether or not i am aware of a student with that particular disability/disorder i might need to write in a trigger warning, and i might choose to offer alternative content in the instructions for individuals who share an identity with the person being bullied in the video. it is best if this is written into the instructions from the outset, and not merely granted as an exception for a student who voices discomfort.) * 8. thomas theorem check: what is perceived as real is real in its consequences. therefore, how must i clearly articulate/verbalize my rationale/reasoning for any controversial/missing material? (example: saying to students “this semester 8 out of 10 of our guest speakers were straight, white, women. i want to let you know that i worked to get a more diverse panel to better represent our community of practitioners, but several bipoc who i invited were unexpectedly unable to attend. additionally, i am new in town and unaware of any queer practitioners at this time, but it is my priority to find out for my next round of guest speakers.”) * this is not to indicate that emerging practitioners should never be asked to engage tough and even potentially wounding material to prepare them for work in the field, but rather to be cognizant of the age/stage and mental health of the learners in any given classroom setting. fisher/experimental model 697 table 1b. course content check (continued)* marginalized group appearance in course content (unit/week) nature of appearance (by? about? +, -) relevant notes/ exclusions, etc. women black people latino(a)(x) people asian-american people indigenous people international people and/or people who have immigrated people with/from low ses lgbt/queer people people with disability/ disorder(s) older adults people who are religious minorities future planning: *note: table filled out using course syllabus advances in social work, summer 2021, 21(2/3) 698 table 2. intersectional social location inventory table 3. relational inventory encounter experiences tool 2: intersectional social location inventory hp=historically privileged ho=historically oppressed questions for reflection 1. fill in the historically privileged and historically oppressed groups for the country where you live/serve/practice. 2. make note of the number of squares where you fall into the hp category. 3. what do you notice? 4. how do you feel? 5. how is this information helpful? 6. how is it challenging? 7. where might you have gaps in your learning and/or the need to practice counterintuitive solidarity? encounter experiences tool 3: relational inventory 1. how many people of color (or other marginalized group) have i had a meaningful conversation within the last week/month? were these conversations reciprocally meaningful? what evidence do i have for that? (consider context, power differentials, etc.) 2. how many people of color (or other marginalized group) live on my street or in my neighborhood/apartment complex? 3. how many people of color (or other marginalized group) have i invited to my home? 4. how many people of color (or other marginalized group) do i work/attend school with? 5. if i am a part of a faith community, how many people of color (or other marginalized group) are in my faith community? 6. if i am a part of civic or recreational groups, how many people of color (or other marginalized group) are in these groups with me? 7. what do i want for my life and the life of my loved ones with regard to relational intimacy/community with people who are different from me/us? 8. what will i commit to do doing in the next week/month/year of my life in this area (without being inappropriate, self-involved, exploitative, etc.)? fisher/experimental model 699 table 4. encounter experiences tool 4: intake log encounter experiences tool 4: intake log visual arts and literature 1. in the last month/year how many books/pieces of art have i consumed? 2. how many/what percentage were created by people of color? 3. how many/what percentage were about race/racism/antiracism? 4. what number/percentage of my intake do i want to commit to in the next month/year? 5. how will i hold myself accountable? (tell a friend, join diverse book/arts club, use an app to track…) bonus: be sure and take note of other intersections as well as you curate your consumption. how many women of color are on your list? how many black/latinx/asian/ native/ people of color? queer? muslim? 65 and older? with a disability and/or mental health diagnosis? television, film, theatre 1. in the last week/month how many television/film/theatre productions have i consumed? 2. how many/what percentage were created by people of color? 3. how many/what percentage were about people of color? 4. what number/percentage of my intake do i want to commit to in the next month/year? 5. how will i hold myself accountable? bonus: be sure and take note of other intersections as well as you curate your consumption. how many women of color are on your list? how many black/latinx/asian/ native/ people of color? queer? muslim? 65 and older? with a disability and/or mental health diagnosis? news and social media 1. where do i get the majority of my news and social commentary? 2. what evidence do i have that i am getting news from reputable, well-researched, journalistic news sources? 3. how many individuals, institutions, and/or businesses of color do i follow on social media? 4. how many of the individuals, institutions, businesses of color that i follow regularly and explicitly address issues of race/racism? 5. how often do i retweet/repost or otherwise publicly share the voices/experiences of people of color? what do i want to commit to and how will i be held accountable? financial and participatory support 1. where did i spend/donate my time in the last month/year? 2. where did i spend/donate my money in the last month/year? 3. how many of the events/organizations/opportunities were created/run by people of color? 4. how many of the events/organizations/opportunities specifically work specifically in the area of antiracism? 5. what number/percentage of my time/resources do i want to commit to over the next month/year? 6. how will i hold myself accountable? ** if you feel tentative perhaps combat the “right to white comfort” that characterizes white supremacy culture by holding yourself to the “comfortably uncomfortable metric”—just as in physical exertion one must push to the point of taxation but not to the point of injury. in some instances, we must move beyond even “comfortably uncomfortable” but it is a starting place for emerging antiracists. reflective experiences: examining & evaluating reflective experiences can happen before, during, or after encounter experiences and are characterized by examining thoughts, feelings, and actions in anticipation of, or in response to, engaging with new people, content, and/or experiences. initially, "examination" is meant to be practiced as a non-judgmental self-observation, simply noticing changes in the three b’s “body” (ex: sweat, tears), “brain” (ex: judgments, defense mechanisms) and “behavior” (ex: yelling, leaving). advances in social work, summer 2021, 21(2/3) 700 racism has so thoroughly and appropriately been vilified (if only theoretically) in polite culture, that students often have a difficult time admitting to racism in thought, word, or deed. this is why teaching specific ways to self-examine is key to successful reflective work. once students have been able to notice body, brain, and behavioral reactions in reflective experience tool 1: three b examination process (table 5), they can evaluate whether any of their initial responses are worth keeping or worth letting go. if the systems and cultures socializing students and educators are inundated with "ist" (rhymes with mist) and "ic" (rhymes with sick) ways of being it only makes sense that some "ist" (racist, classist, sexist, heterosexist, ableist, ageist) and "ic" (xenophobic, islamophobic, transphobic) notions and behaviors have become a part of everyone. it is helpful to remind students of the maxim “we are not responsible for our first thought, but rather for our second thought and our first action.” table 5. reflective experience tool 1: three b examination process reflective tool 1: three b examination practice try asking the following reflective questions after one or more of the following encounter experiences: • a visit to a new restaurant that is ethnically/culturally different than your own • a conversation with a friend from a marginalized identity of which you are not a part or which you share but have been asleep to/divorced from in some way • a book, song, podcast, show, film, or any art by (or potentially about) a person/group a marginalized identity of which you are not a part or which you share but have been asleep to/divorced from in some way brain • what are my automatic thoughts? • what are my judgments? • what am i avoiding/resisting/refusing? • what are any alternative/opposing narratives i am coming up with in contrast with what i am being asked to believe/hear/experience? body • is my heart racing? • am i flushed/hot? • sweaty? • crying? • clinched? • numb? • do i have excess energy? • am i exhausted? behaviors • am i leaving/quitting or trying to leave/quit? • am i zoning out? (dissociating) • raising my voice? • refusing my voice? fighting? because it is challenging for emerging antiracists to evaluate whether an initial response may have been racist, it is important to provide specific definitions and examples of racism in action that can be referred back to for evaluation purposes. depending on the course and instructor, various definitional tools might be selected as a racial litmus test. suggested materials include suzanne pharr’s (1988) mechanisms of oppressions updated by hutchison (2016), sue et al.’s (2011) microaggressions and tenets of white supremacy culture as named by okun (2010) and saad (2020). because students sometimes struggle with real-time analysis the reflective tool 2: retrospective engagement journal (table 6) offers practice examining and evaluating scenes from their individual racial socialization at an earlier stage in their growth and development. fisher/experimental model 701 table 6. reflective tool 2: retrospective engagement journal reflective experiences tool 2: retrospective engagement journals (race) 1. my first positive/proud awareness of race/ethnicity* was when__________________________? 2. my first negative/shame inducing awareness of race/ethnicity was when_________________________? 3. what was i told explicitly about my race/ethnicity? (think of direct teaching/comments which came from family, friends/neighbors, school/educators, faith community, media, etc.) 4. what was i told explicitly about people who were different from me in terms of race/ethnicity? (think of direct teaching/comments which came from family, friends/neighbors, school/educators, faith community, media, etc.) 5. what did i see modeled for me in terms of belief/treatment of people who were my race/ethnicity? 6. what did i see modeled for me in terms of belief/treatment of people who were not my race/ethnicity? *this can be done for any intersectional identity including: gender, socioeconomic status, orientation, gender identity, religion, nationality, ability, age. interventive experiences: enacting & educating while encounter and reflective experiences primarily help students develop the “lifelong learning” and “critical self -reflection” tenets of cultural humility, interventive experiences move into the more actively antiracist tenets of challenging power imbalances and holding institutions accountable. educating & enacting change means practicing microresistance in interpersonal relationships and macroresistance strategies when the systems and institutions of which we are a part are guilty of white supremacy in policies, procedures, or practices. microresistance strategies (table 7) the term microaggression has come under some academic scrutiny, however microresistance strategies are labeled as such not because they are small resistances to inconsequential racism, but rather because they are resistances that take place repeatedly at the interpersonal rather than the systemic level. the four interpersonal, microresistance strategies suggested are check-in, find out more, open the front door (ganote et al., n.d.) and self-care. advances in social work, summer 2021, 21(2/3) 702 table 7. microresistance strategies for potential allies interventive experiences tool 1: microresistance strategies for potential allies (strategies for combatting microaggressions interpersonally) check in ask one or more of the following: 1. do you want/would it be helpful to discuss/debrief? 2. how do you feel? 3. what do you need? 4. anything else? ***always be careful not to put the burden of responsibility/emotions/ next steps on the victim, and always take into consideration what they have already requested in prior circumstances. find out more sometimes we want to intervene, but we are unsure if a microaggression has even occurred or we don’t feel we have relevant information to make the situation any better. if you find yourself in this situation take some time to seek and find what is needed through academic articles/texts, literature, art, media, and/or via appropriate conversations with willing friends/ relatives/experts from the marginalized identity that are hoping to better understand/engage. remember to ask the following: 1. is my research current or seminal? 2. is it from a reputable source? 3. have i consulted the voices of those who have been oppressed? open the front door (otfd) (ganote et al., n.d.) tell the one who has aggressed what you observe, think, feel and want instead. (what do i) observe: • provide empirical data: what did you see, hear, taste, smell, feel? (what do i) think: • provide relevant data (research, resources, counter-stories) • provide your opinion/belief (what do i) feel: • for example: offended, confused, sad, frustrated, angry (what do i) desire • i’d prefer/like it if… • in the future i would rather…. • instead of ___________, please… self-care if you are the individual who has been microaggressed, if you are in a mental health crisis, or otherwise in danger outside of your own moral conviction, choose one or more self-care practices from the multidimensional list below. allies also cannot intervene at all times at our highest capacity. sometimes we have to take care of ourselves and choose to rest for a time in order to be effective and enduring long-term co-laborers. this option should be considered with extreme self-honesty. • practical: walk away and avoid engaging the situation further • physical: eat well, rest, exercise, explore, play games, engage nature, etc. • emotional: debrief with a safe person, journal, exercise, pray/meditate • spiritual: breathe/be still, engage nature, attend a faith/community service, • mental: unplug from screens/devices, make a list, create something • social: spend time with loved ones, attend a fun activity, make plans fisher/experimental model 703 check-in. encouraging the practice of checking in with those who are the victims (or potential victims) of interpersonal degradations ensures that emerging anti-racists do not inadvertently make a bold and potentially harmful decision without consulting those who will be most impacted by the resulting consequences of such an action. find out more. sometimes students are unsure whether or not an interpersonal indignity has even occurred. for this reason, find out more encourages them to research the interpersonal behavior in question without putting the responsibility on a black, indigenous, latina(o)(x), asian, biracial, multiracial or otherwise non-white individuals to do the bulk of the emotional labor unnecessarily. open the front door (otfd). ganote et al. (n.d.) have provided a great step by step process for intervening when an interpersonal indignity occurs. the suggested steps are “o”, or “observe”, which consists of naming the observed microaggressive indignity, “t & f”, or “thoughts and feelings, which means “reporting personal thoughts and feelings about the problematic behavior, and finally “d”, or “desire”, which means expressing a clear directive for different behavior in the future. a sample otfd communication might look like this: • observe: i noticed that you repeatedly interrupt and talk over students of color in the classroom. • thoughts: this is not rare. it actually happens a lot in higher education settings even unconsciously. • feelings: it makes me concerned though, about your future in social work if you are unwilling to hear out people who are different than you. • desire: the eye-rolling has to stop and i would like you to try and notice when, how, and over whom you are speaking in my class. self-care. finally, though the 7e model is predominantly a tool for allies, it is important to acknowledge that self-care and opting out of the conversation are important options for students who are experiencing racial trauma and vicarious trauma in and outside of their academic institutions. macroresistance strategies (table 8) macroresistance strategies are named as such not because they are more important than interpersonal (micro) strategies but because they are ways of engaging at the systemic level of change. the four categories of macroresistance strategies are interrogate, disrupt, advocate and create. • interrogate. these are strategies that center around asking questions and gathering data which will ultimately get conversations and collaborations started in an agency, institution, and/or community setting. • disrupt. these strategies focus on interrupting false information, accusations, and suppositions that result in ongoing actively and subtly racist policies, procedures and practices. advances in social work, summer 2021, 21(2/3) 704 • advocate. this macroresistance category encourages taking a stand through opportunities like voting, raising awareness, financial contributions, and levying privilege. • create. finally, students are asked to consider designing and implementing curriculum, groups, programming, art, and other generative experiences in the systems where they work and serve. reminders for each of these resistance categories are provided in the interventive experiences tools provided in the appendices. these can be used in the classroom by providing students with case studies and having them choose two or three of the resistance strategies they might employ, or in field education as examples of evidence that can be cited on learning contracts and evaluation tools. table 8. macroresistance strategies interventive experiences tool 2: macroresistance strategies for potential allies (strategies for changing systems and processes) interrogate (questioning people and systems) • ask “why” and other challenging questions of people in power to seek clarity about their language/actions. “what are we going to do to change things? by when? how? who do i need to speak to? • identify potential allies willing to ask hard questions and offer answers along with you. • check in with individuals/groups who might have been negatively impacted by a situation, program, policy to help you have a sense of what to question with power-players. practice counterintuitive solidarity. • use survey, focus group, & feedback loops to gather circumstance/agency specific data in order to better hold systems accountable. disrupt (interrupting ignorance and hate) • say “stop”, “wait a second”, “please don’t”, “that’s not true” etc… • provide relevant data. “did you know?” or “have you seen/heard/read/watched?” • provide correction or modeling for misinformation, out of date language, etc. (in the moment, or at a later time) • lead or commission a training on language, practices, processes • report/turn in “ist” or “ic” behavior • refuse to participate/boycott • make a scene/protest • run/volunteer for office/leadership position advocate (using our voices and bodies for change ) • meet with a power player • levy privilege and pass the mic • spend/donate/raise money • raise awareness online or in person (beware of virtue signaling) • vote/campaign for candidate/team leader/award winner to see change create (using our talents/skills) • make space: offer/highlight diverse storytelling/counter-storytelling (through language, art, media, etc.) • start a group (support/educational/task) • write a policy/process • write a curriculum • replace or overhaul a tradition • develop a program • make art/media that speaks to difference/justice maintenance experience: evolving any model must have a maintenance mechanism and any antiracist model must honor the requirement to evolve because systems will always continue to find ways to evade and fisher/experimental model 705 pervert justice. truly humble and anti-racist activists must be agile enough to take in new data, learn fresh terminology, and employ emergent strategies. it is important for educators to model and narrate the ways that they are ever-evolving in their own antiracist work. ways to demonstrate evolution include regularly updating class content, noting language changes (especially those related to marginalized identities) and encouraging students to share their ongoing expertise through in-class conversations, discussion boards, and extracurricular leadership. students and educators should also remember that even those evolving in one area of antioppressive work such as race might find themselves in the encounter stage of engaging with another intersectional identity such as religion, spirituality, and worldview (rsw). conclusion social work educators must simultaneously provide students a path to deconstruct selfsatisfied, self-inflated, self-congratulation, and to reject the unhelpful illusions of progressive purity and perfect advocacy which keep would-be interrupters, resisters, and creators from interrupting, resisting and creating for fear their offerings will never be good or right enough. it is the role of the educator to see, hear, and raise up whole people who own, articulate, and wield the mixed bag of privileges and marginalizations their identities have provided, and offer places at the table of justice for storytellers and statisticians, fledglings and sages alike. the 7e model for cultural humility and antioppressive practices offers an organized, approachable process for lifelong commitment to strategic and spontaneous allyship through each experience life and education have to offer. references abrams, m. 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(2016). multicultural social work practice: a competency-based approach to diversity and social justice (2nd ed.). jossey-bass. tervalon, m., & murray-garcía, j. (1998). cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. journal of health care for the poor and underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233 author note: address correspondence to kerri fisher, garland school of social work baylor university, waco, tx, 76798. email: kerri_fisher@baylor.edu https://doi.org/10.1037/0003-066x.62.4.271 https://doi.org/10.1353/hpu.2010.0233 mailto:kerri_fisher@baylor.edu _______ kidist mulugeta, ba, ma, independent researcher, the hague, netherlands. hone mandefro, ba, msw, ma, lecturer, and ajanaw alemie, ba, msw, assistant professor, department of social work, university of gondar, gondar, ethiopia. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 532-558, doi: 10.18060/23674 this work is licensed under a creative commons attribution 4.0 international license. vulnerability, legal protection, and work conditions of female domestic workers in addis ababa, ethiopia kidist mulugeta hone mandefro ajanaw alemie abstract: domestic workers are one of the most vulnerable groups of workers. in ethiopia, however, the vulnerability, legal protection, and work conditions of female domestic workers are not well-documented and researched. hence, the purpose of this study was to investigate the vulnerability, legal protection, and work conditions of female domestic workers in addis ababa, ethiopia. a cross-sectional qualitative research design was employed using in-depth interviews, key informant interviews, and focus group discussions. the study participants were 15 domestic workers, three officials from the office of labor and social affairs, and five brokers of domestic workers. findings indicate that female domestic workers experienced abuse in various forms including verbal or psychological abuse, physical abuse, and sexual assault. female domestic workers in the study area had few or no labor rights or protection. they rarely had clear contractual relations, worked long hours for low pay, and had little or no privacy. there is neither a proper state institution to promote the rights of domestic workers nor a strong viable movement among or on behalf of domestic workers. hence, a relevant legislative framework developed by the city and national governments, and strong advocacy efforts to expose their working conditions are needed to improve the work conditions of female domestic workers. keywords: addis ababa, ethiopia, female domestic workers, legal protection, work conditions, vulnerability domestic work has been one of the oldest occupations for millions of women around the world (international labor organization [ilo], 2010). all over the world, an important army of workers performs domestic tasks in private households in exchange for remuneration and/or board and lodging (ramirez-machado, 2004). according to the estimates of the ilo (2010), at least 52.6 million men and women were employed as domestic workers across the world. to put this into perspective, if all domestic workers worked in one country, this country would be the tenth largest employer worldwide (ilo, 2010). domestic work is an important source of employment, and accounts for 1.7% of total employment worldwide and some 3.6% of all wage employment (ilo, 2013). the sector has particular importance in developing regions, such as latin america and the caribbean, where 11.9% of all paid employees are domestic workers. likewise, domestic workers account for 8.0% of workers in the middle east and 4.6% in africa (ilo, 2013). women in ethiopia occupy a low status in the traditionally patriarchal society. women experience lower socioeconomic status in general, and hence there is an unequal power relationship between men and women. women face multiple forms of deprivation. genderhttps://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2020, 20(3) 533 based discrimination, lack of protection of basic human rights, violence, lack of access to productive resources, education and training, basic health services, and employment are widespread. ethiopian women suffer from work stereotypes and gender distribution of labor and more are occupied in economically invisible work (un women, 2014; wabekbon development consultant, 2006). the gender parity index (gpi) at the primary school level was 98% in 2009/10 and dropped to 96% in 2012/13, indicating higher gaps in the enrollment of girls. this educational disparity is attributed to socio-economic challenges such as girls’ responsibilities for time-consuming household chores and institutional challenges including the lack of gender-sensitive facilities and services at all levels. the majority of ethiopian women have low levels of participation in formal sales and services, professional, technical, or managerial occupations. the largest rates of unemployment are recorded among adult and young women. male employment was 84.7% in 2005 and 82.7% in 2013 whereas female employment was effectively static at 69% and 69.8%, respectively (un women, 2014). a conservative estimate indicates that at least 248,600 women are employed as domestic workers in ethiopian cities. estimates from the ministry of labor and social affairs (molsa) shows 1.5% of women in the country are currently working as domestic workers (namukasa, 2011). annabel and tekleab (2007) reported that 15% of the female adolescent population in addis ababa were domestic workers, most of whom had migrated from rural areas. these domestic workers are often not aware of their rights and have little access to legal protection as they work within the confines of private homes and are thus vulnerable to domestic violence, abuse, and exploitation. the lack of protection of domestic workers in egypt, ethiopia, and mali resulted in the violation of their rights which in turn exposed them to abuse and exploitation (african union, 2015). previous studies on the background of domestic workers revealed an apparent reluctance of female citizens from addis ababa to pursue domestic work (getachew, 2006). as a result, most domestic workers in addis ababa came from amhara, oromia, and southern regions. a study in addis ababa found that “poverty of the family is the single most important cause (destitute family, disintegration of family or death of one or both parents) of children entering into domestic work” (kifle, 2002, p. 26). getachew (2006) added additional push factors that included escape from family violence, escape from unhappy and early marriage, and attraction to city life. as a result, the majority of domestic workers in ethiopian cities are migrants from rural areas (namukasa, 2011). most domestic workers in the study area have a low education level. for instance, a previous assessment of the educational level of domestic workers in gulele sub-city of addis ababa found that only 40% of the respondents had attended primary school while the majority (60%) were considered illiterate (getachew, 2006). the dominance of women with low educational qualifications in the domestic work sector reflects the fact that the work does not require sophisticated skills or expertise. the work outlined in many families requires only the energy of youth and minimal orientation (kifle, 2002). the paths to joining the domestic labor market are important to understanding the situation of domestic workers. kifle (2002) identified two main paths through which women become employed as domestic workers. the first is through a broker (delala in mulugeta et al./vulnerability, legal protection, & work conditions 534 amharic) where domestic workers are usually employed with a modest wage, and the second is through relatives or friends of the family in which the child finds temporary lodging with no pay. the invisible work site (the home), the low status of the work, and the low level of education of the workers leaves domestic workers vulnerable to exploitation and abuse. at the theoretical level, legal protection for domestic workers is unavailable to some extent; however, at the practical level, legal protection is rarely implemented. with the background of the critical global situation of domestic workers, and also the historical lenience of a patriarchal culture until recently in ethiopia, the work conditions, legal protection and capability of domestic workers to claim their rights is a neglected and under-researched area, resulting in many domestic workers accepting precarious and irregular employment relations and a life lived at or under the poverty threshold (ramirez-machado, 2004). previous studies on domestic workers in ethiopia have neglected the legal protection of workers and focused on describing the vulnerabilities and work conditions of domestic workers from the perspective of domestic workers themselves. the views and perspectives of brokers and concerned government officials have not been taken into account. for instance, annabel and tekleab (2007) examined the invisibility and vulnerability of domestic workers in addis ababa, while tagesse and dubey (2017) addressed the forms of violence against female domestic workers in hossana town, southern ethiopia. kedir and rodgers (2018) provided an account of the profile of domestic workers, the significant drivers of participation in the provision of domestic services, and the welfare of unpaid and paid domestic workers in ethiopia. this study examined the legal protection, vulnerability, and work conditions of female domestic workers from the perspective of domestic workers, brokers, and government officials. furthermore, whilst much scholarly attention in the field of domestic work focuses on protecting the rights and security of foreign/migrant domestic workers, the nature of domestic service work undertaken within national borders has largely escaped the attention of both researchers and public policymakers (kedir & rodgers, 2018). hence, this study examined the following research questions: • what are the experiences and vulnerabilities of female domestic workers in yeka sub-city addis ababa, ethiopia? • what are the work conditions of female domestic workers in yeka sub-city of addis ababa, ethiopia? • what factors do female domestic workers identify as correlated to such problems in their work environment? • to what extent are the available rights of female domestic workers observed and implemented in the study area in relation to ilo labor mandates and other national legal instruments? advances in social work, fall 2020, 20(3) 535 definition and scope of domestic work the ilo (2011) convention on domestic workers takes a broad definition of domestic workers. according to ilo convention (no. 189), article 1: (a) the term “domestic work” means work performed in or for a household or households; b) the term “domestic worker” means any person engaged in domestic work within an employment relationship; and (c) a person who performs domestic work only occasionally or sporadically and not on an occupational basis is not a domestic worker. (p. 1) a domestic worker may be working in a country of which she/he is not a national. domestic work includes mental, manual, and emotional aspects, including care work that is necessary to maintain people and communities (anderson, 2000). however, there is no commonly agreed-upon definition across countries for what constitutes domestic work. the ilo’s definition of domestic workers, which is based on the international standard classification of occupations (isco), included four categories of domestic workers: (1) housekeepers and related workers, (2) childcare workers, (3) home-based personal care workers, and (4) domestic helpers and cleaners. a combined list of the four types of occupations mentioned above would give us a relatively comprehensive list of domestic workers including maids, cooks, waiters, gardeners, gatekeepers, chauffeurs, care takers, babysitters, and so on (chen, 2011). while the shared characteristics among domestic workers (low status, low educational level, mostly lacking protection, etc.) are profound, we should also note that considerable heterogeneity exists within the domestic worker’s population and that the similarities should not mask the differences. one criteria of heterogeneity among domestic workers is the employment arrangements. some domestic workers are hired by the employing household themselves or via a third-party agency. some of the domestic workers work for a single employer, while others work for multiple employers. some live within the premises of the house of their employer, while others live in their own home or with relatives. some domestic workers may specialize in one specific task, while others are responsible for a variety of tasks (chen, 2011). feminization of domestic work from a historical perspective, one transformation of domestic work worldwide is the feminization of this form of labor. studies indicate that domestic servants have not always been exclusively women. until the middle of the 19th century, the work was predominantly done by men in many european countries (lutz, 2002). following the industrialization and urbanization of many western countries, the transformation of the rural servants into urban domestic workers, as the trend was known, led to feminization of domestic workers as a characteristic of urbanization and industrialization (friese, 1991, cited in lutz, 2002). even then, hill (1996) argues, there were sexual divisions of labor between male and female servants in the tasks they were assigned. according to ilo (2013), in the contemporary world, domestic work remains a heavily female-dominated sector: women account for 83% of all domestic workers. women’s share mulugeta et al./vulnerability, legal protection, & work conditions 536 among domestic workers ranges from approximately 63% in the middle east to 92% in latin america and the caribbean. this makes domestic work a particularly significant source of wage employment for women, who often face greater obstacles than men in finding paid employment. globally, one in every 13 female wage workers is a domestic worker (or 7.5%); the ratio is as high as one in four in latin america and the caribbean (26.6%) and almost one in three in the middle east 31.8% (ilo, 2013). however, in ethiopia, it is likely that domestic work has been women’s occupation throughout history. historical perspectives usually do not address this gender dimension of the issue. during the long extended time of slavery in ethiopia, from which domestic work evolved and which was abolished only in the first half of the 20th century, female slaves usually served in the home while male slaves worked in the agricultural fields (pankhurst, 1968; cited in tesfaye, 2007). social work, power, oppression and human rights historically, the social work profession has identified the oppressed and marginalized as its focus areas and challenged inequities among individuals and groups. social work originated from humanitarian and democratic ideas, which prompted the profession to challenge oppression, discrimination, and the unequal distribution of resources. this core value of challenging inequities, promoting democratic ideals, and championing human rights now forms part of the social worker’s code of ethics. since its inception, social work has been a human rights profession; the struggle for human rights remains a vital priority for the social work profession in the twenty-first century. principles of human rights constitute an integral part of social work education, policy, and practice (reichert, 2011). the primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of all people who are vulnerable, oppressed, and living in poverty (nasw, 2017). oppression is an unjust use of authority or power over an individual or group. the different forms of oppression may be based on race, ethnicity, class, wealth, gender, and age. each form of oppression creates a unique injustice and an inequitable power structure that allows it to both exist and perpetuate (appleby et al., 2007, as cited in reichert, 2011). power despite the presence of some form of labor legislation, domestic workers remain a vulnerable group and experience oppression in the form of exploitation, marginalization, powerlessness, violence, and some class-based cultural imperialism (donald & mahlatji, 2006). employers exercise a high degree of control over domestic workers. this extends to both their work and personal lives and is implemented through close supervision, suspicion regarding honesty, and restrictions on freedom of movement. close supervision undermines the women’s self-esteem and autonomy in performing their tasks and reinforces their lowly status. relationships characterized by suspicion reflect a fundamental lack of trust and respect (barrett et al., 1985). social workers are charged with the responsibility to challenge individual and social realities that create and perpetuate oppression and discrimination of vulnerable groups and advances in social work, fall 2020, 20(3) 537 individuals, thereby minimizing oppressive and discriminatory power relations and structures. challenging oppression clearly is related to exercising human rights. humanitarian and democratic ideals are anathema to oppression, which stems from inequitable distributions of power. in the struggle to reduce oppression, social workers must promote human rights (reichert, 2011). domestic workers are one of the vulnerable groups and the focus of social work interventions and services. violence and abuse in the domestic arena touches all areas of social work including children, family, and community lives. hence, social workers are responsible to intervene and work with the victims, their families, and perpetrators of abuse. in recent years, the issues of domestic workers and their legal and social protection have been promoted by ilo (2011), human rights watch (2006, 2008) and others as human and labor rights issues. the general tone of the activities of human right advocates is as follows: domestic/household workers have to be recognized as workers/employees. they need to be covered by labor legislation in each and every country, like any other workers. there is no place for “servitude” or discrimination in legislation. the vulnerability of migrant domestic/household workers needs extra attention. (international restructuring education network europe and international union of food, agricultural, hotel, restaurant, catering, tobacco and allied workers’ associations, 2008, preface) this study follows a human rights approach which “emphasizes that the rights of domestic workers are universal, stringent entitlements” (albin & mantouvalou, 2012, p. 67). the year 2006 was a relevant point of departure as it marked the beginning of global efforts towards achieving protection for domestic workers all over the world. human rights advocates and associations of domestic workers, whenever they exist, push towards the recognition of domestic workers as “workers” entitled to protection of their human and labor rights. these pressures culminated in the adoption of ilo convention no. 189 (ilo, 2011, r2010) and supplementing recommendation no. 201 (ilo, 2011, r201) which aimed at regulating the terms and conditions of work for domestic workers and which was used in this study as the standard to compare the realities of the living and working conditions of domestic workers. ilo convention no.189 is an attempt to provide a framework for governments to provide domestic workers decent work, one of the human rights particularly promoted by ilo. thus, the convention is intended as a human rights instrument with an explicit claim of decent work as a human right for domestic workers. this study, therefore, used a human rights-based approach as a framework to analyze the legal protection and work conditions of female domestic workers in the study area. mary robinson, former high commissioner for human rights defined the human rightsbased approach as: a means of describing situations not in terms of human needs, or areas of development, but in terms of the obligation to respond to the rights of individuals. mulugeta et al./vulnerability, legal protection, & work conditions 538 this approach empowers people to demand justice as a right, not as a charity. (de alwis, 2008, p. 4) the rights-based approach identifies claim-holders and corresponding duty-holders. the approach seeks to make duty-holders accountable to claim-holders, both in terms of protecting, promoting, and advancing these rights and in terms of preventing the violation of those rights (de alwis, 2008). theoretical framework: feminist social work theory since the early 1970s, the feminist perspective has been one of the predominant theoretical models in the domestic violence field, undergirding many programs, interventions, advocacy efforts, and legislative agendas (mcphail et al., 2007). within social work, feminist thinking has a long history with several distinct perspectives. all of the perspectives share a deep concern for personal and social growth, as well as a linking of the personal and the political (payne, 1991). despite the existence of feminist thinking, feminist social work theory and practice as a theoretical construct is fairly new, appearing formally on the academic social work scene in a significant way during the late 1970s and early 1980s (dominelli, 2002). feminist social work as a form of practice takes women’s experience of the world as the starting point of its analysis and focuses on the links between a woman’s position in society and her individual predicament, responds to her specific needs, and addresses structural inequalities. feminist social work emphasizes addressing women’s needs in a holistic manner and dealing with the complexities of their lives – including diverse forms of oppression impacting women’s lives. its focus on the interdependent nature of social relations ensures it also addresses the needs of those women that interact with the needs of men, children, and other women (dominelli, 2002). hence, the human rights framework and feminist social work provides an important theoretical guide to understand the vulnerability, violence, abuse, and exploitation of domestic workers. the historical lenience of a patriarchal culture in ethiopia, the invisible work site (the home), the low status of the work, and inadequate legal protection exposes domestic workers to abuse and exploitation (ramirez-machado, 2004). in this study, the feminist social work theory helped to analyze the dynamics of abuse and exploitation as experienced by domestic workers. vulnerability, legal protection and work conditions of domestic workers domestic workers are one of the groups most vulnerable to exploitation, abuse, violence, harassment, and forced labor (chuang, 2010; ilo, 2018; ramirez-machado, 2004). one of the sources of vulnerability is the intimacy that often characterizes the relationship between the employer and the domestic worker. mantouvalou (2012) explained that such a “sense of intimacy can be false, though, because the relationship between the domestic worker and the employer is characterized by a difference of status that the latter is often keen to maintain” (p. 132). sometimes the status difference can also have a cultural component in which the cultures of domestic workers serve as a basis for advances in social work, fall 2020, 20(3) 539 creating an asymmetric status between employing households and domestic workers. rural styles of dressing, walking, and speaking which were taken as epitomes of backwardness and lack of civilization by the urbanite-elite employers are sources of vulnerability for domestic workers in addis ababa (getachew, 2006). another source of vulnerability for domestic workers is the invisible site of work. the location of domestic labor (the home) leaves workers more vulnerable to abuse by employers (mantouvalou, 2012). domestic work is hard to supervise because accessing private homes is considered a violation of privacy. live-in domestic workers are the most vulnerable. as domestic workers are living and working in their employer’s home, their personal autonomy and mobility is negatively impacted and this can influence decisions as to their future, including the decision to start a family of their own (tijdens & klaveren, 2011). ramirez-machado (2004) pinpoints that “the vulnerability [to abuse and discrimination] of domestic workers comes from the relationship of submission and their isolation” (p. 3). human rights violations against domestic workers such as physical violence, psychological violence, and sexual violence have been reported in several studies (e.g., getachew, 2006; tesfaye, 2007). in ethiopia, as in many parts of the world, the extent of sexual violence of domestic workers is not fully known. many women do not want to disclose their experience of sexual abuse and only a small portion of women report such cases (anderson, 2000). despite the lack of complete data, sexual abuse remains a common experience for many women. domestic workers are more vulnerable to sexual abuse because they spend their time hidden in private homes, are in inferior positions, and are mostly women (anderson, 2000). violence is a pattern of behavior employed by one person in a relationship to control the other (yigzaw et al., 2004). domestic violence is a common problem experienced by domestic workers. violence can take three main forms: verbal or psychological abuse (including physical intimidation, threats of abandonment, and uttering humiliating things), physical abuse (any form of violent act which can result in physical harm including slapping, punching, kicking, beating with any object, twisting the arms, strangulation, using a knife or a gun) and sexual violence (an attempt or actual forced sex without the consent of the other party; getachew, 2006; tesfaye, 2007; yigzaw et al., 2004). even though domestic violence is perhaps the most frequent type of human rights abuse in the world, in most studies the analysis of domestic violence is often restricted to violence against family members like women and children (tesfaye, 2007). thus, many studies ignore domestic violence against non-family members who reside within the same home such as domestic workers (getachew, 2006). however, the lower and “outsider” status given to domestic workers leaves them prone to a number of abuses. despite growth, domestic work is poorly regulated, leaving the domestic labor workforce often unprotected by labor laws around the world. domestic workers who work in isolation, where nobody is watching, are particularly vulnerable to violence and harassment at work. a workforce 67 million strong, domestic workers provide essential care in private homes; yet, they frequently suffer forms of violence and harassment, exploitation, coercion, ranging from verbal abuse to sexual violence, and sometimes even death. mulugeta et al./vulnerability, legal protection, & work conditions 540 domestic workers who live in the homes of their employers are especially vulnerable. for many, daily abuses like lack of rest and non-payment of wages can quickly turn into forced labor (d’souza, 2010; ilo, 2018). only about 10% are covered by labor legislation to the same extent as other workers, while more than 25% are completely excluded. less than half (45%) of domestic workers have no entitlement to weekly rest periods/paid annual leave, and more than a third of women domestic workers have no maternity protection (marcadent, n.d). legal instruments relevant to domestic work the law is an important tool to promote legal and labor rights of women. in recent years, the issue of abuse and exploitation has been one agenda of international organizations like ilo, human rights watch, and other regional entities. in 2011, ilo endorsed convention no. 189 (decent work for domestic workers) along with recommendation no. 201 that would provide protection to domestic workers in ratifying countries. human rights watch (2006, 2008) has published a series of reports on the human right violations of domestic workers especially in middle eastern countries. thus, domestic work is recognized as a form of labor and is already under existing international labor standards and human rights frameworks (cf. the ilo convention no. 189 of domestic workers). however, still in the 21st century, domestic work around the world is mainly informal and characterized by widespread violations of human and labor rights, ranging from the worst forms of child labor and bondage (caracciolo et al., 2011). for the purpose of this study, two distinct sources of rights for women in ethiopia were discussed: national laws and regional or international conventions. international conventions in addition to local efforts, the government of ethiopia has been among the first to become a signatory to the many international conventions (biseswar, 2008). some of these ratified conventions include: the convention on the elimination of all forms of discrimination against women (cedaw; 1981), and the ilo convention on domestic workers (2011). of these conventions, hainfurther (2009) argues that, cedaw is the most comprehensive and all-inclusive international convention in relation to promoting the rights of women. cedaw is the sole international legal instrument specifically designed to promote and protect women’s rights in a holistic and systemic way. cedaw addresses gender inequalities in all spheres and at all levels within the family, community, market, and state. cedaw recognizes and addresses violations of women’s human rights in the private sphere of the home. furthermore, among the ilo instruments, ethiopia is a party to the ilo convention no. 189 which provides important legal protection for domestic workers. the ilo convention on domestic work is the major international legal instrument to promote decent work for domestic workers. this convention set the standards that states should strive to fulfil for domestic workers. the major components of this proclamation include: advances in social work, fall 2020, 20(3) 541 formation and termination of contracts, working hours and time off, remuneration, freedom of movement, and working conditions. national laws the federal constitution of ethiopia (federal democratic republic of ethiopia [fdre], 1995) has demonstrated renewed legislative support for women thorough its various articles. for instance, article 25 of the constitution prohibits discrimination based on gender. article 35, which is entitled to and exclusively deals with the rights of women, has a total of 9 sub-articles detailing the rights of women, among others, to equal enjoyment of rights, entitlement to affirmative action, equal rights of property ownership, equality in employment and payment, and right of access to family planning education, information, and capacity. a number of other constitutional provisions, namely those embodied in articles 7, 33, 38, 42 and 89 also have a direct bearing on the protection of the rights of ethiopian women (biseswar, 2008). however, the labor law proclamation number 377/2003 excludes domestic workers from coverage (fdre, 1995). although article 3 (sub-article 3) of the proclamation states that the council of ministries will issue a special regulation concerning domestic workers, no such kind of regulation has been issued so far. this exclusion is contrary to cedaw’s demand of states to abolish “all other private instruments of any kind with a legal effect which is directed at restricting the legal capacity of women and shall be deemed null and void” (article 15 sub-article 3). the only legal document issued by the ethiopian state that addresses domestic workers explicitly is the ethiopian civil code which was endorsed in 1960 during the imperial government (civil code, 1960). a separate section in the code deals with the contracts of domestic servants living in their employer’s home. accordingly, article 2601 states that where the employee lives with the employer's family, the latter shall regard the livingquarters, food, times of work and rest and take all reasonable steps to safeguard the health and moral well-being of the employee (civil code, 1960, article 2601, p. 432). article 2602 declares the obligation of employers to look after the employee. however, sub-article three of the same article gives the power to the employer to “set off any expenses which he thus incurs against the wages that become due during the period of illness” (civil code, 1960, article 2602, p. 433). since the country was under feudalism, it is not surprising at that time the law reflected such paternalistic views since the awareness of human rights was low and employment protection was limited to the government sector. in sum, there is a lack of adequate legal protection for domestic workers in ethiopia. this has taken two manifestations: 1) in a form of constrained protection as reflected in the civil code of the country which has limited provisions on domestic workers where the intention seems to be humanitarian and not rights-based, and 2) total exclusion from labor laws of the country thereby lack recognition of domestic workers. for instance, the us department of state (usdos, 2015) country report on human rights practices states that ethiopian law specifically prohibits some categories of workers, including domestic workers, from organizing unions and notes that the informal sector as such, which includes domestic work, “is not unionized and is not protected by labor laws” (usdos, mulugeta et al./vulnerability, legal protection, & work conditions 542 2015, section 7a). however, the country has ratified the cedaw, which can serve as a ground to claim the rights of domestic workers. this study, therefore, inquired about the extent to which the available rights of domestic workers are observed and implemented in the study area using the lens of national and relevant international human and labor rights instruments. method research paradigm the study purports the social constructivism research paradigm which assumes that individuals seek understanding of the world in which they live and work, where they develop subjective meanings of their experiences. these meanings are varied and multiple, leading to a search for the complexity of views rather than narrowing the meanings into a few categories or ideas. hence, the approach of this study was to rely on the participants’ views of the meaning and experience attributed to the work conditions, violence, and vulnerabilities of female domestic workers (creswell, 2018). in this study, the social constructivism philosophy made it possible to employ a qualitative descriptive method using in-depth interviews, key informant interviews, and focus group discussion to collect data. hence, in this study, the assumptions of social constructivism were relevant to explore how female domestic workers experience their work conditions, and the violence and vulnerabilities related to their work conditions and environment. research design this study used a cross-sectional, descriptive qualitative design to examine the vulnerability, legal protection, and work conditions of female domestic workers. in this regard, the primary aim was to search for hidden meanings, non-obvious features, multiple interpretations, implied connotations, and unheard voices (have, 2004). given the invisible nature of the domestic work site and the power differential between employer and employee, a qualitative approach was felt to be best suited to uncover such complexities and to examine the work conditions and vulnerabilities of female domestic workers. study participants and selection procedures the study participants were domestic workers, officials from the local labor and social affairs office, and brokers of domestic workers. thus, the study aimed to consider the abuse, exploitation, and living and working conditions of domestic workers from the multiple perspectives of domestic workers, officials, and brokers of domestic workers. participants were selected using purposive sampling techniques. purposive sampling is a method commonly used in qualitative research that permits the researcher to carefully select participants because they represent some feature or process the researcher is interested in exploring (silverman, 2000). the identification and selection of domestic workers was done through a local ngo in the study area which provides direct support for domestic workers to attend education and to protect themselves from hiv/aids. the name of the ngo is not disclosed here because the organization requested to remain confidential. the inclusion criteria for domestic workers included: (1) migrant workers from regions advances in social work, fall 2020, 20(3) 543 outside of addis ababa; and (2) having experience as a paid live-in domestic worker. the decision to limit the sample to paid, live-in workers is related to their increased interaction with employers. data collection techniques and procedures three data collection techniques were employed: 1) direct, in-depth interviews with female domestic workers; 2) key informant interviews with brokers and officials from the labor and social affairs office; and, 3) focus group discussions with domestic workers. the interview guides were prepared to structure the points to be discussed during each interview. two focus group discussions (fgds), each consisting of seven female domestic workers, were conducted within the premises of the non-governmental organization office. the participants of the fgds were the same as the interview participants. the focus of the fgds was to uncover the underlying reasons behind the current working and living conditions of female domestic workers. focus group discussions were employed to triangulate, substantiate, and cross-check responses of the in-depth and key informant interviews and to obtain information that may not be captured through key informant interviews (kreuger, 1998). accordingly, taking points from the completed interviews, discussants were asked to share their view on factors that could explain any possible exploitation or abuse. the researchers facilitated the fgds. the in-depth and focus group interviews with female domestic workers generated detailed data in response to questions such as: whether they are obliged or not to remain in the household or with its members during their periods of rest or leave (article 9); are they benefiting from minimum wage standard, if any like other workers (article 11); to whom do they report any actual or potential human rights violation threats by their employer or the middle persons and if any, what is the legal remedy they have been given so far by any concerned organization? finally, what measures do they take in the absence of such legal help; are they informed of the employers or the host family`s ongoing situation such as the size of the household, tasks they are going to carry out, the working hours, and accommodations? are they aware they have human rights that should be respected like every citizen? does the reality usually meet their expectation which is based on the information they have been given by the middle person when they are employed? some of the questions asked for the key informant interviewees were: • had you personally have any contact with domestic workers in the town? • is there any program/intervention that your office is implementing in relation to domestic workers? • did your office ever receive any complaint from domestic workers? o if yes, would you summarize the main issues of complain so far? o what did happen to the complaint? • if you were asked to summarize the problems faced by domestic workers in the city, how do you answer that question? • do you think ethiopian law recognizes domestic workers as workers? mulugeta et al./vulnerability, legal protection, & work conditions 544 o if yes, would you direct me to the relevant laws? o if not, what is the position of your office on whether they need to be recognized as workers or not? • what do you think are the factors that limited the legal recognition of domestic workers as workers? the in-depth and key informant interviews were conducted at different locations. some of the interviews with domestic workers took place in the cafeteria taking into account confidentiality, and some in the premises of the ngo office. interviews with brokers were conducted in their offices or in the cafeteria around their work site suitable to conduct the interviews. interviews with officials from the labor and social affairs office were conducted in their offices. the interviews and focus group discussions were conducted in amharic language. the interviews were tape-recorded. the duration of each interview ranged from 40-60 minutes. the duration of each focus group discussion ranged from 6090 minutes. data analysis techniques to analyze the qualitative data, thematic analysis was used. transcribing and reading through the data is the first major procedure of data analysis in qualitative inquiry (creswell, 2003). according to braun and clarke (2006), there are six phases for conducting thematic analysis which guided the data analysis of this study. the first step is familiarization with the data. initially, the verbal and nonverbal utterances of the in-depth interviews, key informant interviews, and fgds were transcribed into written form. then, the transcribed notes were read and re-read repetitively to uncover its original meanings as shared by participants. the second phase was coding, through which the researchers aim to generate succinct labels that can identify important features of the data; coding the entire dataset, then collating codes and extracting relevant data. thirdly, searching for themes was accomplished by examining codes and the collated data to identify significant patterns of meaning. each code was written on a separate piece of paper and organized into theme-piles. in organizing main themes and sub-themes, codes that did not seem to belong anywhere were collated and incorporated into miscellaneous categories. fourthly, themes were reviewed carefully by checking candidate themes against the dataset to determine whether each of the themes really provided a convincing story to answer the research questions. themes were also refined, split, combined, or discarded. the fifth phase was defining and naming themes so that the themes and data both coalesced meaningfully while simultaneously maintaining identifiable distinctions between them. after developing a detailed analysis of each theme, an informative name for each theme was given. in the final write-up, the researchers sought to weave together the analytic narrative and data extracts and contextualize the analysis in relation to existing literature. ethical considerations given the hierarchical relationship domestic workers have with their employers, cautious measures were taken to ensure their safety. one such measure was to maintain the confidentiality of the participants. only pseudo-names are used for domestic workers. advances in social work, fall 2020, 20(3) 545 secondly, verbal consent was taken from every respondent. to ensure voluntary and informed consent, the researchers provided a clear description of the purpose and procedures of the study. participants were told they could decline to answer any question they were not comfortable with, they could decline to be recorded at any point of the interview, and also, they could stop the interview at any time. in addition, based on the request of the nongovernmental organization where domestic workers were recruited for the interviews, the name of the organization was not disclosed. results and discussion fifteen female domestic workers were selected to participate in the study. the average age of participants was 29 years old with a range of 21 to 37 years. participants worked as a domestic worker for an average of 7 years (range of 4 to 12 years). three participants came from oromia region, eight were from amhara region, three were from the southern region, and one was from tigray. ten participants were divorced, three were single, one was married, and one was widowed. concerning the participants’ educational level: seven were uneducated, six attended up to primary school, and two attended secondary school. the key informants for the study were brokers of domestic workers (through whom domestic workers are connected to households) and officials from the labor and social affairs office of addis ababa city government. eight key informants were interviewed. three of the key informants were from the labor and social affairs office of addis ababa (one chair of the office, one social worker and one lawyer) while the remaining five were brokers of domestic workers in the study area, megenaga area of yeka sub-city, addis ababa. work and living conditions of female domestic workers contract formation. the ilo convention no. 189 emphasizes the need for formal contracts between employers and domestic workers (ilo, 2011).the contract is a document that outlines the agreed upon terms in the event of a dispute. however, participants indicated that most (12 out of 15) do not have written contracts. one domestic worker, who had been working for five years in different households explained: i did not enter into any contract. i came to the broker and waited for people who wanted to hire a domestic worker...if the broker asked me to deal with them, i ask the range of jobs to be done and tell them my salary. if they agree, then i will go with them trusting their words. similar stories were reported by other participants. some of the domestic workers – particularly those with few years of service, with no or little education, and those who migrated recently from rural areas— did not know what “contract” means. they had little awareness of contracts and their relevance and hence they did not request a contract. in addition, the brokers are well-informed of the terms of the verbal agreement and serve as witnesses in times of dispute. the verbal agreement usually is focused only on the amount of salary. mulugeta et al./vulnerability, legal protection, & work conditions 546 even when written contracts are produced, as was the case for three of the domestic workers, they have very limited general statements and are very brief. ideally, according to the ilo convention 189, the contracts should include many details about where the work will happen, time of work, rest hours, salary, and so on. of the many details that are supposed to appear in the contract, only two appear: name of both employer and employee and the amount of salary to be paid to the domestic workers. there is a pre-arranged form for both parties to sign once the salary amount is filled in. precarious working conditions work hours and time off. domestic workers practically have no definitive work schedule, and often work long hours. the work hours of many domestic workers we talked to were extended. many work for more than 16 hours per day. one domestic worker stated that in every household she worked for in the last ten years, the rule was that “domestic workers should work every time as long as there is something to be done.” another domestic worker explained that “usually i wake up 5:00 am to prepare breakfast for everyone in the house and then go to bed around 12:00 am after ensuring that everyone has got dinner.” many of the domestic workers do not have any days off. one respondent stated that: having rest day is unimaginable in many ways. the task is so enormous and i am overloaded that i should work every time to finish. the madam does not want me to have a break and i cannot remember a day i took a rest. she also stated that she sometimes argues with her madam on her overload and work without rest. however, her employer becomes nervous and frequently nagged her saying “you are here to work, not for vacation.” however, some domestic workers mentioned that they agree with their employer to have a day off during the time of employment and have one day a month to rest. accordingly, the last sunday of each month is their day off. however, they have no freedom to go out alone to the city without an accompanying household member. while many took it as a way of controlling and compromising their freedom, some of the domestic workers took it as provision of protection from the household to any possible danger while in the city. article 11 sub articles 1(e) of the cedaw requires states to grant a paid leave for women workers. however, in violation of this right, findings showed that many domestic workers are forced to work long hours and are denied the right to rest and have leisure. this is also contrary to article 7 (g) of the ilo domestic worker’s convention no. 189 which demands paid leave and daily, weekly, and annual rest for domestic workers. although the ilo domestic worker’s convention no. 189 article 10 requests at least 24 consecutive hours of rest per week, this seems a pie in the sky for many domestic workers in the study area. furthermore, while the workers sometimes complained, employers still required them to work long hours. low remuneration. the monthly salary of domestic workers at the time of data collection was in the range between 500 and 650 birr (28 36 usd) per month. at its face advances in social work, fall 2020, 20(3) 547 value, this money cannot be considered as lower income by the country standard especially given the expectation that the food and accommodation of the workers is to be covered by employers. even this amounts to almost two times the initial salary of public servants i.e, 357.00 birr (21 usd) who work only 40-46 hours per week according to the labor laws of the country. however, the amount of money domestic workers earn is extremely low when we consider the long hours of work. if we break down this amount into payment per hour even a worker who worked for 14 hours, the smallest hours of work reported by participants of the study, then the maximum payment will be 1.5 birr (0.09 usd) per hour. this payment is lower than ¼ of the lowest minimum wage for civil servants in the country. furthermore, some employers never pay the promised salary to domestic workers. many of the participants had experienced dismissal without any salary after working for years. one participant, for instance, explained that, it has been four months i am struggling to get my salary of six months from a household i have worked for 2 years. she always told me she will pay me in sum and it was better for me if the money is saved with her. but, after six months she dismissed me without my salary. yet, many of the domestic workers consider their present plight as a sacrifice for their better future, although they are insecure about what their life looks like in the future. one domestic worker said, “i am serving others hoping i will get something to serve myself later.” inadequate and abusive living conditions inadequate food and accommodation. regarding food, in many cases discriminatory and dehumanizing practices were reported. one of most frequent forms of such dehumanizing practices is providing different food for domestic workers. one domestic worker says in her current household, she has never had the privilege to eat the same food as other household members. “i always eat the same food, shero [a kind of sauce prepared from bean powder and is the cheapest food] with injera” (local bread prepared out of powder of a tine grain called teff). she says she never had adequate food to eat as her quota is two injera per day and injera is given to her counted accordingly to keep separate for herself. for many domestic workers, hunger is the most challenging problem since they have to work for long hours without taking proper food. one participant said she usually eats bread with tea in the morning and injera with sauce in the evening, and nothing in between. another participant said she left a household recently because she was always hungry. this participant added that she was supposed to work full day and night without any adequate food and even without mentioning it to her employer. in relation to accommodations, most domestic workers indicated that they sleep in corridors or on a sofa within the salon. some also reported that they sleep in the kitchen area of the house. one of the domestic workers indicated that she was forced to sleep on a veranda of the house: mulugeta et al./vulnerability, legal protection, & work conditions 548 when the madam’s friends come to the house to take drugs and chat together, they would not leave the house until late in the night and sometimes would stay at home throughout the night. in other days i sleep on the sofa but when they come, i have to sleep on the veranda. i have been sleeping there for three months. this is contrary to even the humanitarian notion embedded in the rather outdated 1960’s civil law of the country. although article 6201 of civil law does not promote rights of domestic workers, it demands employers of domestic servants to give adequate accommodation within their house. similarly, it violates article 11 (e) of the cedaw which demands the right to protection of health and to safety in working conditions. as the stories presented above show, this law indeed has been violated and domestic workers are provided with inadequate accommodations. the interview with officials in the labor and social affairs office indicated that there is little awareness of this right among workers and employers, and there has never been any inspection by the state related to implementing the provisions in the civil law or in the cedaw. violation of privacy. every participant indicated they experienced denial of privacy of varying degrees. in many cases, employers had a great degree of control over the workers’ personal affairs. for instance, employers get furious to find out that their live-indomestic workers were involved in any sexual relationship. reportedly, employers control their worker’s social lives and do not allow them to develop any relationships with other people. domestic workers have restrictions on the calls they receive from relatives and friends. some employers do not even allow any calls from outside while many allow only limited calls. one participant stated that her previous employer snatched her cell phone soon after she arrived in the house and told her that any kind of phone call is not allowed from her relatives and friends. the other participant said she left her previous home because she was not allowed to talk over the phone to her boyfriend. brokers whom we interviewed however saw the restriction of cell phones by employers differently. they explained that employers fear that by using cell phones domestic workers may make arrangements to steal expensive materials and runaway or they may give information to some other person to do the same and that such experiences happened to some employers. the agony: female domestic workers experience of violence and abuse verbal abuse. verbal abuse is commonly experienced by domestic workers (getachew, 2006; tesfaye, 2007). in this study as well, verbal abuse against domestic workers was found to be frequent and widespread. the most common forms of verbal abuse mentioned by domestic workers included nagging, the use of derogatory labels, and jokes about domestic workers and their mistakes. some other frequently mentioned types of verbal abuse included: “telling you to do something is like pouring water on a stone, for both there is to no effect,” “you lazy...you are so dull, you stupid...” the verbal abuse by the employers towards their domestic workers reflects the inferior position they ascribe to the workers. one of the domestic workers explained how her advances in social work, fall 2020, 20(3) 549 former employer used derogatory names to call her to deliberately hurt her psychologically: “she always calls me ‘slave’ and had never used my name. every time i pass beside her and every time she looked at me in a way to remind me of my inferior position.” in this study, attempts were made to identify the perpetrators of the violence committed against domestic workers. the main perpetuators of verbal abuse according to domestic workers were female employers. many of the domestic workers indicated that they have been belittled, nagged, threatened, or humiliated by madams (wives) more so than by male employers. this is contrary to the widely held view that men are the main perpetuators of violence and women are the victims (getachew, 2006). however, this could also be understood as a result of more frequent interactions between domestic workers and madams compared to domestic workers and male employers. many of the domestic workers indicated that they usually take orders from the wives, and the male employers have little role in giving them orders. thus, the frequent contact between domestic workers and wives can be understood as leading to verbal abuse by wives against domestic workers. in some households, children were identified by domestic workers as the main perpetuators of verbal abuse. this indicates that domestic workers get the lowest status within the family below everyone in the household, including children. physical abuse. physical abuse is not uncommon against live-in domestic workers. a significant number of stories of physical abuse were obtained from the in-depth interviews with domestic workers. the most common forms of physical abuse were slapping, being spat on, being kicked, or having nearby objects thrown at them. presumed causes for physical abuse as viewed by the workers were mistakes while working, answering back to the instructions of employers, disagreements with family members, and sometimes even in the absence of any obvious reason, as a form of employers letting out their anger and frustrations. as with verbal abuse, the main perpetuators of physical abuse against domestic workers were reported to be women. this emanates from the fact that the women (mainly housewives) are the ones who usually given instructions to domestic workers. for instance, one of the domestic workers with more than seven years of working in different houses explained her situation with her current employer: i have been in conflict with the wife/mother of the house ..., she does not like the things i do and how i do them. so, she usually gives me specific instructions. but since sometimes i get overwhelmed by the workload around the house, i would either forget them or do them in another way. when this happens, she will abuse me and also beat me. another source of conflict between women and domestic workers is suspicion by housewives of any love affair between male employers and domestic workers. such distrust will cause negative views by wives against domestic workers, which is expressed through abuse against domestic workers. one domestic worker explained: the madam suspects me having a special relationship with her husband. she controls me in every detail like trying to make sure that i and her husband are not in the same room and are not talking. so, she expresses that by hitting and nagging mulugeta et al./vulnerability, legal protection, & work conditions 550 me always. one day i was watching a movie on tv and she was asleep. the husband was also watching the movie and i was watching it sitting on the sofa with pyjama. all of a sudden, she came and beat me and told me that i should stop trying to seduce her husband otherwise she will beat me again and again. because of such frequent suspicions, many of the domestic workers indicated that they would prefer to work for single men than married households to avoid such abuses. however, female employers were not the only perpetuators of physical violence. for some domestic workers, violence came from other household members. children also abuse domestic workers physically. one participant, who worked as a domestic worker for the last seven years, stated that in her current household, the biggest threat comes from the daughter in the family. she stated, “their daughter moved from abroad recently and she is making my life full of misery since her arrival. she always orders me to do many things and if i hesitate to do them, she slaps and hits me.” sexual violence. the experiences of sexual abuse reported by the domestic workers ranged from unwanted body contact to attempted rape. the main perpetuators for sexual abuse were male employers and male adolescents in the home. strangely, among the five attempted rapes reported by three domestic workers, four of the perpetuators were older men. this is culturally unacceptable among many ethiopians who consider elderly people as wise, knowledgeable, and having ethics. this finding is also contrary to the widespread belief that sexual violence against domestic workers is mainly triggered by youth (yigzaw et al., 2004). the characterization of elderly people as ethical, moral, and wise is contrary to their practice of sexual harassment against domestic workers within this sample. explaining the silence: constrained capacity of female domestic workers and unnoticed plight of female domestic workers the data about the work and living conditions of female domestic workers have clearly indicated how female domestic workers are enduring abuse, exploitation, and human rights violations. there is widespread violation of domestic workers’ rights: restrictions on freedom of movement and communication, lack of adequate living and working conditions, denial of salary, refutation of privacy, and verbal, physical, and sexual abuse. one could therefore understand that the abuse domestic workers are experiencing rises to the level of trafficking. despite the high level of abuse and exploitation, there is no organized movement to enable domestic workers to claim their rights. under cedaw, women are guaranteed the right to equal exercise of the freedom of movement to protect their rights and to dismantle any disadvantage based on sex. however, there is no movement among domestic workers themselves or on behalf of them in the country to advocate for better living and working conditions for domestic workers. the lack of organized movement from the domestic workers themselves could be due to the nature of the work site since it is invisible which makes it difficult for domestic workers to come together and discuss their common problems. it seems that either their plight as domestic workers goes unnoticed or nobody cares enough to advocate on their behalf. advances in social work, fall 2020, 20(3) 551 then what would be the main explanations for the lack of an organized movement against this gross injustice? one of the reasons for this may be related to the characteristics of domestic workers themselves. due to historical, socio-political, and economic discrimination against women, domestic workers lack adequate awareness of human rights themselves, have low capabilities, and have no fall-back alternatives. many of the workers in this study area were uneducated and none of them have education exceeding secondary school. participants of the focus group discussion thought that their low level of education constrained their capacity to know their rights and also their capacity to claim their rights. “i am uneducated, hence don’t know anything” was the common phrase that came again and again even during the focus group discussion. similarly, a key informant from the labor and social affairs office explained: one of the reasons for their acceptance of compromised working conditions, as i think is that most of them are not [well] educated. in some cases, where we had tried to help domestic workers, we realized that they do not know about rights issues. in a way this points out the need for awareness creation and capacitybuilding among the domestic worker’s community. the above quote indicates that there is a kind of victim-blaming from those officials who are partly responsible for creating good working condition for domestic workers. the institutional structures and policies are not responding well to the plight of domestic workers. brokers also stated that though some employers want to hire educated workers, many prefer that domestic workers be less educated to enable them to “control and suppress them.” as a result, migrants from rural areas and those who are less educated are preferred because their salary will be less than the educated ones. this indicates that the power inequality or powerlessness of domestic workers due to the oppression of their employers and brokers contributed to the violation of rights and violence and abuse of domestic workers. in addition, the widespread poverty in rural areas and lack of any other better opportunity in the city forces them to endure the exploitation hoping for betterment of their situations in the future. almost all domestic workers in this study hoped one day to save money and start their own life rather than going back to the rural areas. hence for them, today’s exploitation and abuse are a sacrifice for their better future life, albeit the reality seems darker than they thought (tegegne, 2009). furthermore, the hidden nature of the work site for domestic workers also contributed to their silence. domestic workers live within the home, or on the same property as the employing family. often, the family forbids the worker from leaving the premises alone – and sometimes the worker will not be allowed to leave at all. some employers compound domestic workers’ isolation; this kind of seclusion involves forbidding any contact with the outside world – even through telephone or mail. the social exclusion created by the cloistering of migrant women in domestic service can take a heavy toll: many women do not have the opportunity to form friendships or create social ties. the resulting solitude exacerbates women’s constructed vulnerability to abuse and deprives them of support networks when violations occur. the state apparatus offers little help to alleviate the plight of domestic workers in addis ababa. the labor and social affairs office of yeka sub-city is at present lacking both the mulugeta et al./vulnerability, legal protection, & work conditions 552 legitimacy and the manpower to assist domestic workers. its lack of legitimacy emanates from the absence of a proper legal framework to oversee the situation of domestic workers. a key informant from the office said, “we had a number of cases where domestic workers come to us seeking assistance. however, mostly we do a kind of mediation between employer and employees since we lack the legal ground to inspect any violation.” that is because the labor law proclamation no. 377/2003 excludes domestic workers stating that the council of ministers will issue a specific regulation on domestic work (fdre, 2003). however, after 15 years, the specific regulation has still not been issued. this indicates that both the legal and institutional structures lack appropriate responses for the problems and needs of domestic workers. in addition, there are also key country-level factors that have a role in explaining the silence about human rights violations against domestic workers. the first and perhaps the most important is lack of political will at the country level. plus, most politicians and policy-makers are personally benefiting from exploiting their own domestic workers. in fact, so many people in the cities are benefiting from rural domestic workers that it seems no one wants to speak up against the abuses. there is marginal emphasis on protection of workers in general and informal workers in particular. at one point the issue of legal protection for domestic workers was raised by one member of the parliament as an issue of concern. this lack of political will is also at the centre of the exclusion of domestic workers in many laws including the ethiopian labor law proclamation no. 377/2003. the proclamation no. 377/2003 does not include domestic workers (fdre, 2003). article 3 sub article 2(c) states that the proclamation does not include verbal contracts for personal service for non-profit making purposes. furthermore, there is no proclamation that included the issue of domestic workers in the country’s legal regime. this causes lack of de facto and de jure vulnerability of domestic workers in the country. the failure of ratification of many laws relevant to domestic workers including ilo convention no 187 is also related to lack of political will and commitment. the second country-level factor playing a role in perpetuating the human rights abuses experienced by ethiopian domestic workers is the lack of attention the issue has received among non-state actors. most of the civil societies working in ethiopia focus on issues like poverty reduction, health sector expansion, and vulnerable and orphaned children. “even though there has been a proliferation of civil societies in ethiopia in the last two decades, they focus heavily on food security and have almost no real links with ethiopian organisations outside of government” (center for international studies at dublin university, 2007, p. 9). hence, it could be argued that the plight of domestic workers is confined to the households for which they work. they remain voiceless with no advocate to expose their miserable working and living conditions. implications for practice, education and future research the findings of this study pinpoint a number of implications for social work practice education and future research. given the gross human rights violations that domestic workers experience, such as precarious living and working conditions, physical, sexual and psychological abuses and exploitation, social workers need to be knowledgeable and skilled in identifying, assessing, and intervening with domestic workers. social work advances in social work, fall 2020, 20(3) 553 training institutions are responsible to train and educate their students by incorporating course content on domestic violence in general, and with domestic violence against domestic workers in particular. in addition, including a feminist analysis of the issues and problems of domestic workers is also needed to enhance students’ knowledge and understanding about the nature of domestic work and the plight of domestic workers. for a further understanding of domestic work and domestic workers in ethiopia, additional research focusing on broader issues and areas of domestic work that can guide policies and interventions on domestic workers would have a significant contribution. limitations of the study a lack of well-organized statistics conducted on the area of domestic workers in ethiopia was one of the challenges for this study. for instance, in selecting participants for the study, researchers intended to understand the major reason women migrate from rural to urban areas. knowing this would have enabled researchers to ensure diversity in terms of the factors in selecting participants. however, no such data was found. secondly, this study is a limited assessment of the vulnerability, legal protection, and work conditions of female domestic workers in the study area and its findings cannot speak about all the situations of domestic workers in addis ababa and/or in ethiopia. conclusion the findings of the study further support that there is a rhetoric commitment to women’s rights in ethiopia. the ethiopian constitution (article 35) declares equal rights of women in every aspect including in work and in some way calls for affirmative action to balance historical injustice against women. similarly, in theory the national women’s policy goals aim to bring equality to women, albeit that is too far to see at the moment. however, though the national women’s policy identifies special vulnerable groups of women, domestic workers are not mentioned. in addition, if domestic workers are not part of the “women” group, they have been excluded from key labor laws such as labor law proclamation no. 377/2003 (fdre, 2003). female domestic workers in the study area were subject to gross human rights violations, exploitation and abuse such as lack of clear contracts and inapplicability of contracts, long hours of work, violations of privacy, verbal, physical and sexual harassment, inadequate food and accommodation, and poor payment. however, it is fairly difficult to argue that this violence and abuse against domestic workers emanates only due to the lack of legal protection for domestic workers. for instance, the country has ratified cedaw and is party to the ilo convention no. 189 (although not yet ratified and domesticated). cedaw prohibits any indirect discrimination of women in any sector and obliges states to ensure that the rights of women are protected. as such, the cedaw could serve as a base to advocate for eradicating gross unjust practices like abuse and the inhumane treatment of domestic workers by their employers. for example, even by the outdated, civil code of the country (article 6201), employers are obligated to give adequate accommodation to their domestic workers which, as the findings showed is not observed or investigated by any government entity. mulugeta et al./vulnerability, legal protection, & work conditions 554 although legal protection for female domestic workers is limited in ethiopia, some cultural factors (view of domestic workers as inferior and denial of any rights), illiteracy and severe poverty among workers themselves, contribute to the persistence of abuse against domestic workers and the persistent silence. the state has failed to show any political commitment to address these injustices. the national government also limited the spectrum for advocacy by civil societies mainly through a recent law which bans ngos getting their funding from abroad to work on 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(2011). domestic workers, their wages and work in 12 countries. university of amsterdam, the netherlands. https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---travail/documents/publication/wcms_214499.pdf https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---travail/documents/publication/wcms_214499.pdf https://doi.org/10.1177/1077801207302039 https://www.csvr.org.za/publications/1589-the-best-kept-secret-violence-against-domestic-workers https://www.csvr.org.za/publications/1589-the-best-kept-secret-violence-against-domestic-workers https://www.uni-kassel.de/upress/online/frei/978-3-86219-050-8.volltext.frei.pdf https://www.uni-kassel.de/upress/online/frei/978-3-86219-050-8.volltext.frei.pdf https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.ilo.org/travail/whatwedo/publications/wcms_travail_pub_7/lang--en/index.htm https://www.ilo.org/travail/whatwedo/publications/wcms_travail_pub_7/lang--en/index.htm https://www.semanticscholar.org/paper/migrant-women%e2%80%99s-vulnerabilities%3a-a-research-in-tegegne/ae475e489214bb45c98fb45021278d5a9a28cbd7 https://www.semanticscholar.org/paper/migrant-women%e2%80%99s-vulnerabilities%3a-a-research-in-tegegne/ae475e489214bb45c98fb45021278d5a9a28cbd7 https://www.semanticscholar.org/paper/migrant-women%e2%80%99s-vulnerabilities%3a-a-research-in-tegegne/ae475e489214bb45c98fb45021278d5a9a28cbd7 http://etd.aau.edu.et/handle/123456789/7067 mulugeta et al./vulnerability, legal protection, & work conditions 558 https://www.semanticscholar.org/paper/domestic-workers%3a-their-wages-andwork-in-12-tijdens-klaveren/e3fe191a0eb231d84773bf4c10ee5b0c1180169b un women, (2014). preliminary gender profile of ethiopia. https://20122017.usaid.gov/sites/default/files/documents/1860/preliminary%20gender%20profil e%20of%20ethiopia%20nov%2017%20final.pdf usdos us department of state. (2015). country report on human rights practices 2014 -ethiopia. https://www.ecoi.net/local_link/306259/429638_en.html wabekbon development consultant. (2006). ethiopia: country gender profile. https://www.jica.go.jp/english/our_work/thematic_issues/gender/background/pdf/e06 eth.pdf yigzaw, t., yibric, a., & kebede, y. (2004). domestic violence around gondar in northwest ethiopia. ethiopian journal of health development, 18(3), 133-139. https://doi.org/10.4314/ejhd.v18i3.9846 author note: address correspondence to kidist mulugeta, independent researcher, the hague, netherlands. email: kiddomul@gmail.com https://www.semanticscholar.org/paper/domestic-workers%3a-their-wages-and-work-in-12-tijdens-klaveren/e3fe191a0eb231d84773bf4c10ee5b0c1180169b https://www.semanticscholar.org/paper/domestic-workers%3a-their-wages-and-work-in-12-tijdens-klaveren/e3fe191a0eb231d84773bf4c10ee5b0c1180169b https://2012-2017.usaid.gov/sites/default/files/documents/1860/preliminary%20gender%20profile%20of%20ethiopia%20nov%2017%20final.pdf https://2012-2017.usaid.gov/sites/default/files/documents/1860/preliminary%20gender%20profile%20of%20ethiopia%20nov%2017%20final.pdf https://2012-2017.usaid.gov/sites/default/files/documents/1860/preliminary%20gender%20profile%20of%20ethiopia%20nov%2017%20final.pdf http://www.ecoi.net/local_link/306259/429638_en.html https://www.jica.go.jp/english/our_work/thematic_issues/gender/background/pdf/e06eth.pdf https://www.jica.go.jp/english/our_work/thematic_issues/gender/background/pdf/e06eth.pdf https://doi.org/10.4314/ejhd.v18i3.9846 mailto:kiddomul@gmail.com definition and scope of domestic work feminization of domestic work social work, power, oppression and human rights theoretical framework: feminist social work theory legal instruments relevant to domestic work limitations of the study _________ dashawna j. fussell-ware, lsw, doctoral candidate school of social work, university of pittsburgh, pittsburgh, pa. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 298-310, doi: 10.18060/24126 this work is licensed under a creative commons attribution 4.0 international license. gray clouds over ivory towers: struggles facing black, first-generation social work research doctoral students dashawna j. fussell-ware abstract: black, first-generation doctoral students can be classified as those who belong to the african diaspora and come from families with parents who do not have bachelor’s degrees. data shows that over half of black doctoral degree recipients, across all fields, have first-generation status, and literature has shown that these students experience several challenges during their doctoral journey that their peers do not. this paper details six of these challenges for black, first-generation research doctoral students in social work programs. these challenges result in educational disparities disfavoring these students, and, as such, social workers are compelled by our code of ethics to work against these forms of social injustice. this conceptual discussion uses critical race theory and social capital theory to explain the continued existence of these challenges, followed by recommendations that social work educators, academic institutions, and educational organizations can use to improve conditions for black, first-generation social work research doctoral students across the country. if social work educators take this critical issue, its associated challenges, and the proposed recommendations seriously, they can begin to create safe and actively anti-racist and anti-classist academic environments that are conducive to the success of this student population. keywords: black, first-generation, doctoral students, challenges, critical race theory, social capital theory, classism in 2019, 14.5% of social work phd graduates identified as black or african american. this is a decrease from the 16% of graduates that used this racial/ethnic identification in 2017, the next most recent year for which the council on social work education (cswe) provides detailed racial/ethnic identification data online (cswe, 2018, 2020). available data from cswe shows that the percentage of black graduates from social work research doctoral programs is usually higher than the 2018 national black phd graduation rate of 7% (national science foundation [nsf], 2019). however, what someone is least likely to find is reputable, reliable, and accurate data on how many black graduates were first generation doctoral students who came from families with parents that do not hold bachelor’s degrees. this data is virtually non-existent for the discipline of social work, specifically. as a profession that upholds the virtues of diversity and social justice, social work research doctoral programs should invest in initiatives to support black, firstgeneration students. these initiatives should be in addition to efforts that ensure school environments are safe and conducive to the success of this population. this paper will focus on how schools of social work and national social work education organizations should and can support black, first-generation social work research doctoral students in a way that is actively anti-racist, understanding of cultural and background differences, and supportive of optimal student development and success. first, readers will be provided with an explanation of why this is a critical issue for social work education. about:blank fussell-ware/gray clouds 299 next, two theoretical frameworks through which to view this challenge will be discussed. this will be followed by a presentation of relevant literature concerning the experiences of black, first-generation research doctoral students from social work and other disciplines. lastly, largely influenced by relevant literature, a series of recommendations for how to address this critical issue is offered. for the purposes of this paper, “black” is defined as any individual belonging to the african diaspora and “first-generation” is used to describe a student whose parents do not hold a bachelor’s degree. a reader may be asking why this paper focuses on black first-generation research doctoral students as opposed to first-generation research doctoral students in general, or all first-generation research doctoral students of color. the simple answer to this question is slavery. regardless of where they hail from, every member of the african diaspora has been touched by the legacy of slavery. black, first-generation research doctoral students, whether they are domestic or international students, carry the consequences of slavery with them throughout their doctoral journeys. when discussing slavery and its connection to black, first-generation research doctoral students’ experiences with higher education, there are two important facts to discuss. first, scholars have found that the legacy of slavery is connected to the educational attainment gap between blacks and whites to this day (bertocchi, 2015; bertocchi & dimico, 2012, 2014). the cited research only discusses the education gap related to the undergraduate level. however, with, as disclosed earlier, a 2018 black phd graduation rate of only 7% (nsf, 2019), it should be safe to assume that the legacy of slavery could be influencing the phd attainment gap between blacks and whites as well. second, many of the institutions where black, first-generation research doctoral students earn their degrees were built by enslaved africans and their descendants or benefited from their enslavement (clarke & fine, 2010; reilly, 2017; smith & ellis, 2017). when only considering institutions that house social work phd programs, this list includes schools such as the university of pittsburgh, the university of georgia, rutgers university, columbia university, florida state university, the university of alabama, louisiana state university, etc. with these two facts in mind, it is the opinion of this author that institutions of higher learning owe it to black students to be invested in their educational success in a way that is unique to this population. why is this a critical issue for social work education? over half of 2019 black doctoral degree recipients across all disciplines met federal criteria for first-generation student status (nsf & national center for science and engineering statistics [ncses], 2020). this is the highest rate among any racial group. data shows that first-generation doctoral graduates face additional hurdles during and after the process of earing their degree. the nsf (2015, 2019) reported that first-generation doctoral graduates take longer to finish their degrees and leave their programs with higher levels of graduate school debt than other graduates. unfortunately, it appears that the same circumstances are also true for black doctoral graduates, in general. if both black and firstgeneration students, regardless of race, face the same additional hurdles, individually, the advances in social work, summer 2021, 21(2/3) 300 intersection of these two identities may be tragically harmful to black, first-generation students seeking to earn their doctorates. some may consider time spent finishing a doctoral degree and the accumulation of student debt during a doctoral program to be individual attributes. however, when looking through the frames of critical race theory and social capital theory, one quickly realizes that these educational inequities may be an example of anti-black, systemic, institutional, and interpersonal racism. thus, eliminating these inequities should be a high priority for social work education leaders and stakeholders. however, if the data alone is not enough to move social work educators into action, they should take note that there have been calls for social work academia to invest in the education of black social workers, specifically, since the early 20th century. the national association of black social workers (nabsw) was founded in 1968 when a group of black attendees at the national conference on social welfare disengaged from the conference and drafted a position statement detailing their grievances (nabsw, n.d.; original steering committee of the nabsw, 1968). these grievances included a lack of black representation on the national conference on social welfare board and planning committee, the conferences’ perpetuation of white racism through the selection of certain conference awardees, and that white social workers were not involving themselves in solving the problem of white racism. the most relevant demand in the nabsw 1968 position statement to the current work is their demand “that people who speak, write, research, and evaluate the black community be black people who are the experts in this area” (original steering committee of the nabsw, 1968, p. 10). this demand echoes a call that was made over 30 years earlier by another social work pioneer. in “the need and education of negro social workers”, forrester b. washington (1935) explains that black people were the most impacted by the great depression but were benefiting the least from economic recovery programs. he espouses that only social workers were up to the task of providing relief for black people, during that time, and that the best social workers for the job were black social workers. he presents several reasons to justify this declaration, including the idea that black social workers are more knowledgeable of resources in black communities and that black social workers are equipped to build better rapport with black clients because of their shared racial identification and the social consequences of that identification. as mentioned above, when washington’s article was published, the united states was in the throes of the great depression. however, the past looks very similar to the present. what the great depression was for washington is what the current covid-19 pandemic is for today’s social workers. as was true nearly 90 years ago, african americans are disproportionately impacted by this outbreak (modlin, 2020; price-haywood et al., 2020) amid 400-year-old and everpresent racial violence at the hands of law enforcement and white supremacists. with this in mind, washington’s declarations may still be quite relevant today. as such, social work education needs to be invested in ensuring the success of black social work students as one pathway of achieving racial and social justice for all black people. black social work scholars study several different topics and populations. however, black social workers have been calling on social work academia to invest in the education fussell-ware/gray clouds 301 and training of black students if for no other reason than to work to create a more just society for the black people that our discipline serves. this ask may seem practice-oriented but, as mentioned earlier, the 1968 position statement from nabsw also called for the recruitment of black social work researchers, placing the responsibility on the shoulders of social work doctoral programs as well. regardless of what black, first-generation social work research doctoral students choose to study, this author believes that it is past time to heed this call. theoretical frameworks as previewed earlier, the struggles of black, first-generation research doctoral students in social work academia can be framed using social capital theory and critical race theory. this section of the current work will discuss how these two theoretical frameworks explain the existence of the educational disparities facing this group of students. social capital theory social capital theory (bourdieu, 1986), in its simplest terms, says that individuals receive tangible and intangible benefits resulting from membership in a particular group. in his seminal work, bourdieu (1986) explains that the amount of these benefits that an individual receives is influenced by the size of the network to which they belong. this theory can be used to frame the challenges faced by black, first-generation social work research doctoral students in one of two ways. the first method of framing is that black, first-generation research doctoral students do not have a network to provide access to tangible and intangible benefits such as additional financial support, knowledge of the higher education system, and academic and/or professional support because of their firstgeneration status. the second option for framing this issue is that if a black, firstgeneration social work research doctoral student does put together a network for themselves before they begin their phd program, it may not be large enough to amass as much social capital as their white or legacy peers. this, in part, may explain why simply being a first-generation student makes the journey towards a doctorate more difficult and, sometimes, longer than second, third, or fourth-generation students. however, in addition to a lack of social capital, black, first-generation social work research doctoral students face increased obstacles in the larger society as well due to anti-black racism. this phenomenon is best framed using critical race theory. critical race theory critical race theory seeks to explain the experience of black people living in america. it has been used to frame racism in the criminal justice system, health disparities among racial/ethnic minorities, educational inequities among black youth, etc. the first tenet of critical race theory is often called the ordinariness of racism. in critical race theory: an introduction (delgado et al., 2017), this tenet explains that racism is just the way we do business in american society and it “is difficult to address or cure because it is not acknowledged” (p. 8). this concept alone provides an explanation of why black advances in social work, summer 2021, 21(2/3) 302 doctoral students have a harder time in doctoral programs than their non-black counterparts. higher education, like other systems in american society, is rooted in racism and often upholds white supremacy at the expense of black students. unfortunately, instead of actively working against this enmeshed racism, academics and educational leaders ignore this reality and pretend that institutional anti-discrimination policies are enough. this attitude is due to white fragility and the desire to avoid hard and frank conversations. furthermore, two additional tenets of critical race theory are intersectionality and anti-essentialism and the concept of whiteness as property. the idea of whiteness as property was first presented by cheryl i. harris (1993). harris explains that just possessing white skin affords white people certain privileges that non-white people cannot access. when considering this tenet in addition to knowledge of social capital theory, it would appear to be fair for one to say that just being white provides additional social capital for white social work research doctoral students in general that black social work research doctoral students will never be able to gain. regarding intersectionality and antiessentialism, this tenet espouses that an individual is not just black, or male, or christian. we all have multiple identities that intersect, with some providing privilege, and others resulting in marginalization and oppression. again, social capital theory and critical race theory provide a plausible explanation for why the intersecting identities of being black and first-generation can result in additional barriers for black, first-generation social work research doctoral students while they work towards their degrees. using these two theoretical frameworks, social work education leaders and stakeholders should consider the support and success of black, first-generation social work research doctoral students a matter of social justice. two of the core values of social work are service and social justice. our code of ethics (national association of social workers [nasw], 2017) presents ethical principles based on these core values that are intended to guide our practice. the ethical principal related to service is that “social worker’s primary goal is to help people in need and address social problems” (nasw, 2017, ethical principles, para. 3). regarding social justice, all social workers are meant to “challenge social injustice” (nasw, 2017, ethical principles, para. 6). as shown here, the educational inequities that black, first-generation social work research doctoral students face is a prime example of social injustice influenced by racism and historical oppression. as such, all social workers, both in the field and in “ivory towers,” are compelled to do something about it. challenges faced by black, first-generation social work research doctoral students after an intense search of several sources, this author found only one piece of scholarly literature that focused on the experience of black, first-generation social work research doctoral students. howard (2017) provides a conceptual framework for these students navigating their doctoral programs. however, it is important to note that in this work, howard’s definition of “black” is limited to african americans. also, her definition of “first-generation doctoral student” is specifically for “students who are the first in their fussell-ware/gray clouds 303 family to attend a doctoral program” (p. 514, emphasis in original). both definitions are different from the two used in this paper which, again, are inclusive of all people of african ancestry regardless of their country of origin and attribute “first-generation” status to those whose parents do not have bachelor’s degrees. underdevelopment of research skills the unique challenge for black, first-generation social work research doctoral students that howard presents is that, during their msw programs, this population of students may overly internalize our professions’ focus on clinical skills at the master’s level. as a result, they may not develop the caliber of research skills needed in order to be successful in a research doctoral program. their white classmates or those who are not first-generation may also internalize this focus but are more likely to have an external network of academic and professional mentors to provide additional support and opportunities to build these skills, or increased access to build this network. this has the possibility to leave black, first-generation students at a stark disadvantage as they enter phd programs. in addition to this unique challenge faced by social work research doctoral students, howard and scholars from other disciplines have discussed challenges that face black, first-generation doctoral students, in general, that social work education should be paying attention to and working to counteract. feelings of otherness first, several scholars have written about how black, first-generation students encounter feelings of otherness or not belonging in their doctoral programs (gardner, 2013; gardner & holley, 2011; viaud, 2014). this is often in combination with feelings of isolation due to experiences of being the only black person or person of color in the room (vickers, 2014). these scholars report that black, first-generation doctoral students often find themselves feeling alienated from their classmates as a result of their first-generation status. students have discussed feeling as if their peers have a leg-up and frame of reference that they do not have because of their backgrounds. unfortunately, these feelings of otherness are not limited to the academic setting. these students have expressed feeling disconnected from their family, friends, and communities of origin as a result of their pursuit of a doctorate (gardner, 2013; gardner & holley, 2011; holley & gardner, 2012; howard, 2017; shavers & moore, 2014; vickers, 2014). in these settings, black, first-generation doctoral students feel pressure to watch the language they use in order to ensure their family and friends understand them and to not be accused of being “uppity” by the people they have grown up with. they also acknowledge knowing that while they receive invaluable support from these familial sources, individuals back home do not really understand their school experiences or the doctoral program process. gardner and holley (2011) refer to it as living in two worlds, but howard (2017) frames this issue using w.e.b. dubois’ (1903/2007) concept of “double consciousness.” black, first-generation doctoral students are forced into a position where they do not feel totally accepted in their programs and no longer fit in at home. advances in social work, summer 2021, 21(2/3) 304 imposter syndrome “imposter syndrome” is a term coined by clance (1985) and is summarized by brems et al. (1994) as “individuals’ feelings of not being as capable or adequate as others perceive or evaluate them to be.” (pp. 183-184). black, first-generation doctoral students have detailed struggles with imposter syndrome (gardner, 2013; gardner & holley, 2011; holley & gardner, 2012; vickers, 2014). gardner and holley (2011) explain that the feelings of guilt or failure that are a component of imposter syndrome result from the internalization of classist assumptions that are made both for and by first-generation doctoral students of color, resulting from their lack of social and financial capital and advantage. these students must fight through these feelings of guilt and failure that have led them to believe they have not earned the right to be in their programs despite knowing that they worked hard to gain admission. they often have an irrational fear that someone will discover that they are a “phony” and are not really good enough to be there despite any high praise they may receive to the contrary. financial concerns furthermore, black, first-generation doctoral students have reported that financial concerns are a major challenge for them while pursuing their degrees (gardner, 2013; gardner & holley, 2011; holley & gardner, 2012; howard, 2017; vickers, 2014). many black, first-generation doctoral students come from financially disadvantaged backgrounds. their family may depend on them to financially contribute whether they are living with their family or not. on the other hand, students may not be expected to financially contribute but know not to expect substantial financial support from their family as they pursue their doctorate. restrictions on outside employment in some doctoral programs, less knowledge of sufficient funding sources, and lack of available familial financial support may prolong time to degree for these students or be the reason why they drop out of their programs. navigating the system to continue, black, first-generation doctoral students often enter their doctoral programs with less knowledge of how to navigate the system (gardner, 2013; gardner & holley, 2011; howard, 2017; vickers, 2014). this challenge can be viewed directly through the social capital theoretical framework and connected to the history of obstacles to education for black people in the united states. as mentioned earlier in this work, the justification behind a singular focus on black, first-generation social work research doctoral students as opposed to all first-generation students is the negative impact of slavery on the educational attainment of generations of black people. yes, the percentage of bachelor’s degrees and doctorates conferred to black men and black women have, for the most part, been consistently increasing since the late 1970’s (snyder et al., 2019), showing that black people are making progress towards overcoming this history of obstacles to our education. however, over half of black students who received doctorates fussell-ware/gray clouds 305 in 2019 were still first-generation doctoral students (nsf & ncses, 2020), representing the continued legacy of the historical exclusion of black people from higher education. since these students are the first in their families to complete bachelor’s degrees and pursue graduate degrees, they may have to work harder to access information about how the doctoral education system works. they often depend on mentors who have already been through the process to guide them and give them advice to be successful. if they do not gain access to mentors, many black, first-generation doctoral students resort to trying to learn as they go. while some of these students do well on their own, this can be especially draining because, through interactions in and out of the classroom, they pick up on the fact that some of their peers have knowledge that they do not (gardner & holley, 2011). this can lead to increasing feelings of otherness and imposter syndrome. acclimating to a racist academic environment lastly, but probably most importantly, upon entering their doctoral programs, especially at predominantly white institutions, black, first-generation students are often forced to acclimate to a eurocentric, racist, and potentially unsafe environment (howard, 2017; shavers & moore, 2014; viaud, 2014). unfortunately, in these environments they experience racism and general disrespect at the hands of white faculty, staff, and classmates (viaud, 2014; vickers, 2014). for black, first-generation students, succeeding in academia requires exhibiting traits and enduring situations that challenge and are, simply, incompatible with their cultural norms. students who exhibit difficulty or failure to “successfully” assimilate into the “culture of academia” are at risk for harmful consequences. the most harmful of these consequences is attrition. however, these students may also experience negative psychological effects, such as feelings of failure or of dealing with the implicit opinion expressed by academics that the values they may hold as a black person are not suited for life in academia. this connection between experiences of racism and decreased mental health has been written about by several scholars (lewis et al., 2015; oh et al., 2014; williams, 2018). their work has shown that exposure to racism and discrimination can lead to increased depressive and anxious symptomatology, isolation, and general psychological distress for black people in general. in addition to these general consequences, when it comes to black doctoral students specifically, scholars have reported that racism and discrimination in academia can lead to isolation, feelings of invisibility, and the development of potentially unhelpful defense mechanisms from the emotional harm of racism, etc. (barker, 2016; blockett et al., 2016; collins, 1990; gildersleeve et al., 2011; haynes et al., 2016; nagbe, 2019). social work doctoral programs are not exempt from being hubs for racism, antiblackness, and eurocentrism. the primary theories and ideologies upon which we often build our practice, even with diverse populations, were created by white people. black, first-generation social work research doctoral students, as part of the academic socialization process, are expected to internalize these theoretical frameworks and are often encouraged to use them to frame their work, even if their research focuses on the experience of non-white populations. implicit and explicit standards for doctoral student behavior and professionalism in social work programs are often eurocentric and reinforce white advances in social work, summer 2021, 21(2/3) 306 supremacy. again, our code of ethics calls upon us to “treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity.” (nasw, 2017, ethical principles, para. 10). this does not always happen in our research doctoral programs for black, first-generation students, and that fact is unacceptable. fortunately, there are ways our profession can change things for the better which will be the focus of the final section of this work. recommendations for change based on the literature and current understanding of the challenges faced by black, first-generation doctoral students, this author has several recommendations for what social work educators can do to ensure the success of black, first-generation research doctoral students in social work phd programs. however, for the sake of brevity, this work will focus on four recommendations. this sample of recommendations includes: 1. the group for the advancement of doctoral education in social work (gade) should modify their current phd program quality guidelines to explicitly state expectations for the support of students coming from marginalized, oppressed, and underserved backgrounds. an additional modification to the quality guidelines should state explicit standards for the appreciation of diversity and for actively anti-racist and/or anti-classist environments in social work research doctoral programs. one example of these suggested guidelines is the expectation that syllabi for social work research doctoral program classes will be reviewed and, if necessary, revised as a mode of reducing harm to black students in the classroom. doctoral student groups in schools of social work have already begun to call for similar modifications and have provided resources to support these endeavors (university of pittsburgh school of social work anti-racist doctoral program student committee, 2020). 2. cswe and/or gade should create formal supports at the organizational level for black, first-generation doctoral students and other first-generation doctoral students of color. a beneficial mode of support would be the creation of a national network comprised of current first-generation doctoral students of color and mentors who are former first-generation doctoral students of color. this network would provide students an opportunity to connect with those who are currently sharing their experience and receive mentorship from those who have come before them, opening the door for the building of social capital. 3. schools of social work that house research doctoral programs should invest financial resources into the creation of scholarship funds for black, firstgeneration research doctoral students. scholarship funds would be dispersed to students once a semester, with the inclusion of summer terms, if necessary, and would not have a work requirement attached. this form of financial support would help mitigate the extra financial burdens that black, firstgeneration students often face during the pursuit of their doctorates. in fussell-ware/gray clouds 307 addition, it could decrease the amount of student loan debt that these students leave their programs with. 4. as highlighted in the section of this article discussing challenges facing black, first-generation social work research doctoral students, there has been a very small amount of research done on the experiences of this specific population. gade, cswe, the society for social work and research, and any other interested parties should invest in efforts to collect empirical data about the experiences of these students. surveys of experiences with racism in their institutions, satisfaction with their programs, and other relevant constructs, using validated measures, would substantiate much of the qualitative work on black and/or first-generation phd students that has been done in other disciplines as well as potentially serve as a starting point for change in social work academia. conclusion a review of the literature revealed what was already known to most: black, firstgeneration doctoral students face significant challenges during their doctoral education and are still at significant disadvantages after they earn their degrees. these include an increased amount of time to earn their degree, higher amounts of student debt upon completion, and negative psychological consequences. the most egregious of these consequences, however, are the instances of racism and disrespect these students experience in the academic environment at the hands of white faculty, staff, and classmates. unfortunately, social work academia, even with our profession’s commitment to social justice and promoting diversity, still contains all these hurdles for black, first-generation social work research doctoral students. however, the execution of initiatives to address these challenges, like the ones detailed above, can help shift social work doctoral education to be actively anti-racist, safer, and more supportive for this vulnerable group of students. references barker, m. j. 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(2014). black female voices: self-presentation strategies in doctoral programs at predominately white institutions. journal of college student development, 55(4), 391-407. https://doi.org/10.1353/csd.2014.0040 smith, s., & ellis, k. (2017, september 4). shackled legacy: history shows slavery helped build many u.s. colleges and universities. american public media website. https://www.apmreports.org/episode/2017/09/04/shackled-legacy snyder, t. d., de brey, c., & dillow, s. a. (2019). digest of education statistics 2018 (nces 2020-009). national center for education statistics, institute of education sciences, u.s. department of education. https://nces.ed.gov/pubs2020/2020009.pdf university of pittsburgh school of social work anti-racist doctoral program student committee. (2020). syllabus review: guiding questions [unpublished student committee recommendations]. https://www.socialwork.pitt.edu/sites/default/files/ardpsc_syllabus_review_guiding_ questions.pdf viaud, k. m. (2014).. pursuing the doctoral degree: a symbolic interpretation of firstgeneration african american/black and hispanic doctoral students (doctoral dissertation). https://escholarship.org/uc/item/1g31w2vz vickers, t. (2014). the (in)visible road map: the role of mentoring for first-generation black female doctoral students at predominantly white institutions. louisiana state university and agricultural and mechanical college. https://digitalcommons.lsu.edu/gradschool_dissertations/1477/ washington, f. b. (1935). the need and education of negro social workers. the journal of negro education, 4(1), 76-93. https://doi.org/10.2307/2292089 williams d. r. (2018). stress and the mental health of populations of color: advancing our understanding of race-related stressors. journal of health and social behavior, 59(4), 466-485. https://doi.org/10.1177/0022146518814251 author note: address correspondence to dashawna j. fussell-ware, 4200 fifth avenue, 2117 cathedral of learning, pittsburgh, pa 15260. email: daf119@pitt.edu acknowledgements: the author would like to thank drs. valire carr copeland, rosalyn denise campbell, and james p. huguley for their support during the preparation of this manuscript. https://time.com/5013728/slavery-universities-america/ https://doi.org/10.1353/csd.2014.0040 https://www.apmreports.org/episode/2017/09/04/shackled-legacy https://nces.ed.gov/pubs2020/2020009.pdf https://escholarship.org/uc/item/1g31w2vz https://digitalcommons.lsu.edu/gradschool_dissertations/1477/ https://doi.org/10.2307/2292089 https://doi.org/10.1177/0022146518814251 mailto:daf119@pitt.edu abstract: black, first-generation doctoral students can be classified as those who belong to the african diaspora and come from families with parents who do not have bachelor’s degrees. data shows that over half of black doctoral degree recipients, ac... why is this a critical issue for social work education? theoretical frameworks social capital theory critical race theory challenges faced by black, first-generation social work research doctoral students underdevelopment of research skills feelings of otherness imposter syndrome financial concerns navigating the system acclimating to a racist academic environment recommendations for change conclusion references _________ selena t. rodgers, phd, lcsw-r, professor of social work and founding director if the master of social work program, city university of new york, york college, queens, ny. copyright © 2021 rodgers, s. t., vol. 21 no. 2/3 (summer 2021), 438-459, doi: 10.18060/24159 this work is licensed under a creative commons attribution 4.0 international license. next wave of post traumatic slave syndrome survivors: black women resisters in academia selena t. rodgers abstract: this study seeks to deepen our understanding of the survival adaptive behaviors, particularly features of post traumatic slave syndrome (ptss), identified by black women professionals who exist at the margins in academia and society. to date, exploration of posttraumatic growth has not been researched concomitantly with ptss. by examining these variables collectively, this study’s model provides an original contribution to a growing but insufficient literature on black women professionals who endure institutional racism. using the listening guide, this study presents data from seven (7) black women professionals in higher education. the study finds interviewees adopt angry black women and strong black woman schema, and ptss features as a survival strategy stemming from gender discrimination rooted in proximity to whiteness and habitual attacks on their professional acumen. congruently, learnings revealed (1) identity and positionality, (2) generational [in]visibility, (3), professional rage located, and (4) voices of ppttg— prayers, people, trials, tribulations and god. dismantling white supremacy must center black women's survival herstories and healing at the intersection of anti-black racism and hidden systematic policies. practice models that nuance ptss trauma-informed assessments, the addition of ptss to the dsm, and widely accepted african-centered paradigms are essential for this wave of race work. keywords: black women professionals, post traumatic slave syndrome, posttraumatic growth, voice-centered, anti-black racism, social work education it is not that black women have not been and are not strong; it is simply that this is only a part of our story, a dimension, just as suffering is another dimension— one that has been most unnoticed and unattended to. (bell hooks, talking back, 1989, pp. 152-153) before skipping to cavalier hashtags, illusory moments of cohesiveness, and shortlived movements, full understanding of black women resisters’ historical analyses, labor, and their experiences is central to disrupting white supremacy. from africa to the americas, during the antebellum era, [new] jim crow, civil rights, and now “post-racial” era, white supremacy has aimed to sustain white domination over black women, and their storytelling of transgenerational stressors has been dismissed from history (bonilla-silva, 2015; perlow et al., 2018; sule et al., 2017). from the lynching of mary turner and her unborn baby, the execution of breonna taylor, to institutionalized racism endured by black women professionals in academia, white supremist values continue to serve to oppress, marginalize, isolate, govern, police, subjugate, reduce, and justify control and violence against black women (beauboeuflafontant, 2009; collins, 2000; spencer & perlow, 2018). in academia, these efforts show up as overt and subtle experiences of discrimination, including silencing of black women’s about:blank rodgers/next wave of ptss 439 voices and positionality. compared with their colleagues, disrespect is seen in the refusal to recognize their experiences, lack of acknowledgement of scholarly accomplishments, non-supportive attitudes of colleagues, and unequal racialized labor and service assignments (daniel, 2018; speakes-lewis, 2018). the subtle abuses of power, policies, administrative practices, and controlling images also referred to as race-based stereotypes, myths and characterizations—angry black woman (abw) or sapphire “…ha[ve] many different shadings and representations: the bad [b]lack woman, the [b]lack “bitch,” and the emasculating matriarch (harris-perry, 2011, p. 88). the strong black woman (sbw) schema or superwoman alleges that black women can withstand anything, because they were physically and psychologically suited for enslavement (bent-goodley et al., 2012). as summarized by woods-giscombé et al. (2016) superwomen have a perceived obligation to (1) present strength, (2) suppress emotions, (3) resist feelings of vulnerability and dependence, (4) succeed despite limited resources, and (5) prioritize caregiving over self-care. for black women in academia, racialized subtleties show up as unreasonable service demands, marginalization of scholarship, uneven parity of opportunities that converge to reinforce sbw schemas, and hierarchical structures that usurp their voices and social mobility. while no studies were found collectively examining race-based stereotypes, post traumatic slave syndrome (ptss) features and accounts for posttraumatic growth (ptg) in black women professionals; the sbw schema is evolving in the research literature. harris-perry (2011) found that “strong” was a term often used to categorize black women, with varied meanings. within focus groups, some respondents interpreted the word strong as positive or a symbol of strength, while others were concerned with the psychological effects of strong black woman ideology on black women (harris-perry, 2011). in another study, abrams et al. (2019) examined sbw in 194 participants (of which 98 were college students), the researchers found evidence of the sbw schema (selfsilencing) which has been linked with depression among black women’s mental health (abrams et al., 2019). according to the centers for disease control (cdc, 2018), table a-7c (pp. 1-4), black females 18 years of age and older reported sadness (12.6%), hopelessness (7.1%), worthlessness (4.6%), and felt that everything is an effort (14.1%). these results necessitate continued exploration. specifically, how are ways of giving voice related to adaptative behaviors and ptg? fisher and colleagues (2017) assert an urgency for social workers to acknowledge and respond to issues of race and racism. advances in social work’s special call for work regarding “dismantling white supremacy in social work education” – specifically regarding policies and administrative practices that are overtly and covertly racist, oppressive, and inherently supportive of white supremacy culture – is timely. post traumatic slave syndrome theory joy degruy (2005) coined the term “ptss theory,” which she describes as “the manifestations of an institutionalized legacy of traumas…reflected in many behaviors and beliefs passed down to subsequent generations” (p. 125). degruy notes three “adaptive advances in social work, summer 2021, 21(2/3) 440 survival behaviors” (p. 123) that reinforce positive and negative actions through the socialization process: vacant esteem is the state of believing oneself to have little or no worth, exacerbated by the group and societal pronouncement of inferiority…that is intergenerationally transmitted through three levels: family, community, and society (p. 129). another manifestation of adaptive survival behavior, ever present anger…[is]...both a response to the frustration of blocked goals and the fear of failure (p. 135). racist socialization is the most insidious and pervasive symptom of ptss in our adoption of the slave master’s value system…the belief that [w]hite, and all things associated with whiteness are superior; and that [b]lack, and all things associated with blackness, are inferior. (p. 139) degruy’s (2005) position is that blacks collectively and culturally have residual and sustained historical trauma passed down through familial interactions and parenting patterns, community practices, beliefs and values, laws, institutions, policies, and media. the diagnostic and statistical manual (dsm) of mental disorders, 5th edition: dsm-5 is the gold standard authoritative mental health diagnosis (american psychiatric association [apa], 2013; williams et al., 2018). black women professionals’ stressors include accumulated generational stressors different from the dominant white culture interpretation and pathology found in the dsm. there is little agreement how to operationalize historical and contemporary trauma in general and in black women professionals in academia. conceptually, spencer and perlow (2018) extend degruy’s ptss theory, adding “master”—post traumatic slave master syndrome (ptsms)—to capture ways the actor perpetuates historical patterns of lynchings towards black women resisters. consequences of ptss in black women resisters for bipoc—black, indigenous, and people of color—in academia, vacant esteem is a consequence of questioning their competences and devaluation of their research (daniel, 2018; gutiérrez y muhs et al., 2012). controlling images have been used to “justify black women’s oppression” (collins, 2000, p. 69). from slavery to new jim crow (alexander, 2012), controlling images include sapphire, “the angry [b]lack woman [who] has many different shadings and representations: the bad [b]lack women, the [b]lack “bitch,” and the emasculating matriarch (harris-perry, 2011, p. 88). angry black women [abw], sistas with attitude, superwoman and strong black woman [sbw] are characterizations used to sustain domination over the lives of black women (harrington et al., 2010; west, 2018). these racialized stereotypes include self-doubt and may lead to traumatic outcomes (campbell, 2019). in a study of 609 black women recruited from two college campuses, researchers (jerald et al., 2017) found that being aware that others hold negative stereotypes of one’s group predicated negative mental health outcomes (e.g., depression, anxiety, hostility), and ultimately impacted diminished self-care behaviors and increased maladaptive behaviors for coping. the weathering of cumulative environmental stressors (social isolation, invisibility, alienation, hostile work environment, labels of incivility and accusations of nonrodgers/next wave of ptss 441 collegiality) is emotional labor that can exacerbate a myriad of adverse outcomes on black women’s sexual health, reproductive health, physical health and psychological health (harrington et al., 2010; prather et al., 2018; sule et al., 2017; williams et al., 2018). st. vil et al. (2019) offered a ptss conceptual framework to aid social workers to center african american experiences within a historical trauma-informed perspective as response trauma-specific intervention. compounding environmental stressors have been passed down intergenerationally and internalized by black women professionals, yet their stories have gained little traction in the empirical literature. the perpetual and intersecting claims of ignorance and silence, alongside the incalculable amount of time spent resisting white supremacy and the white fragility defense (daniel, 2018; diangelo, 2018; smith et al., 2020; sule et al., 2017), have left black women professionals feeling trapped to cope with racial battle fatigue, emotional labor, and negative career-related consequences (corbin et al., 2018; speakes-lewis, 2018). this study privileges the voices of black women resisters who have turned their ever-present anger and rage into a protective superpower to combat weaponized conditions against them. the psychological ptss marker—racist socialization—is another consequence for professionals who are black and female, stuck at the intersection of “double jeopardy” (beal, 2008). born out of a generation that actively speaks out against violence, the sojourner syndrome, a term coined by mullings, is characterized as “an interpretive framework that speaks to the historical dialectic of oppression, resilience, and resistance” (mullings, 2005, p. 79). sojourner syndrome is further explained as a survival strategy response for black women who are generationally positioned with compromised and detrimental health consequences (i.e., reproductive) due to the multiplicative effects of racism alongside intersecting identities, including gender, class, and age (mullings, 2005). within this lens and figuratively akin with sojourner truth’s life story, black women “who have faced discrimination, persecution, oppression, and a substantial history of trauma use protective factors to defend themselves from the horrors of their realities” (campbell, 2019, p. 216). correspondingly, this study analyzes the adjustments of racialized stereotypes, ptss and adaptations, highlighting ptg as a protective factor of black women professionals in academia. posttraumatic growth in black women in contrast to the dysfunctional behaviors proposed by ptss (degruy, 2005), there is an analysis reflecting on the adjustments and adaptions to trauma. posttraumatic growth was coined to describe the experience of positive changes or strengthening that may occur as the result of an extreme stressor, suffering, or trauma (tedeschi et al., 2018). the model of ptg pertains to five domains: (1) renewed appreciation of life, (2) new possibilities (3) enhanced personal strength, (4) improved relationships with others, and (5) spiritual change (tedeschi et al., 2018). there is evidence documenting ptg in black women. for example, in a mixed-methods study, manove et al. (2019) reported small to moderate ptg outcomes in 26 black mothers who self-identified as having low income and whose homes were damaged or destroyed by hurricane katrina. the authors reported that the disaster of advances in social work, summer 2021, 21(2/3) 442 katrina created new opportunities for survivors who formerly experienced oppression (i.e., improved neighborhoods, educational and economic opportunities, and increased racial diversity). in another study, evans et al. (2013) conducted an exploratory study examining ptg and psychosocial and behavioral correlates among a sample of predominantly african american women living with hiv in underserved and under-resourced communities in mississippi. they found that ptg was correlated with church attendance and aforementioned posttraumatic growth domains (evans et al., 2013). the widely accepted afrocentric paradigm (see, ani, 1994; martin & martin, 2002) and healing domains that attend to degruy’s ptss model (campbell, 2019; carruthers, 2018) are culturally significant for black women and cannot be detached from their being. there is recent evidence documenting ptg in black youth recovering from historical trauma and systemic violence (ortega-williams, 2017). nevertheless, the aforementioned studies do not account for contemporary race-based stereotypes of black women professionals who fall above the poverty threshold. while ptg (tedeschi et al., 2018) and ptss (degruy, 2005) refer to growth accompanying suffering, these themes have been researched separately and included black women who reported low socio-economic status. by examining ptss and ptg collectively in black women professionals, this study’s model provides an original contribution to a growing but insufficient empirical literature. focus of article the study extends degruy’s (2005) hallmark writings on ptss and adds another dimension to the ptg research, contributing a social work perspective regarding gender discrimination, rooted in proximity to whiteness and habitual attacks on the professional acumen of black women who exist at the margins of academia and society. the current research endorsed a heteronormative perspective and reflection of most of the black women interviewed. the research question was: how do black women professionals make meaning within the narratives that specifically relate to their perceptions of themselves, their worlds, and the context in which they work? by examining strength, resilience, adjustments, and adaptions, this study seeks to deepen our understanding about these survival behaviors: (a) vacant esteem, (b) ever present anger, and (c) racist socialization, all of which are features of ptss, and discourses ptg outcomes identified by black women professionals. method this is an exploratory qualitative design. specifically, participants completed a semistructured standardized survey, through a web-based survey platform. seven qualitative interviews were completed which is the focus of this article. the interviews focused on the participant’s perception of gendered racism and the role of race-based stereotypical images on their psychological functioning and used the listening guide, a voice-centered relational (vcr) tool (beauboeuf-lafontant, 2008; brown & gilligan, 1993). interview questions used to frame ptss (degruy’s 2005) in the current study include: (1) “how rodgers/next wave of ptss 443 would you describe the role of controlling, race-based stereotypical images (i.e., angry black woman, strong black woman) and their impact on the psychological functioning of black women professionals?” (2) “what is your perception of gendered racism for black women professionals?” (3) “how would you describe posttraumatic growth (ptg) in black women professionals?” participants participants were recruited through snowball sampling and met inclusion criteria. participants in the current study included self-identified black or african american women professionals in higher education living in the united states, age 21 and over, englishspeaking, who experienced or were exposed to historical trauma rooted in controlling racebased stereotypes. the participants’ pseudonyms are—umoja, kujichagulia, ujima, ujamaa, nia, kuumba, and imani. they were aged 42 to 72 years old, held a masters (n=5) or doctoral (n=2) degree, and worked in higher education (n=6). one participant was enrolled in a graduate degree program. participants mostly reported annual income between $60,000 and $100,000. five of seven participants were married, living with a domestic partner or widowed. three of the participants had children and all were living in the northeastern or southern region of the united states. data collection qualitative collection took place over a 6-month period and was part of a larger study. the purpose of the interviews was to create a safe space where black women professionals could use their voices to tell their stories. participants described experiences and gave examples of gendered racism and psychological distress they faced as black women professionals. at the request of participants, interviews were recorded in a private office, apartment, or home with only the principal investigator (pi) present. interviews ranged from 60 to 120 minutes. the pi obtained institutional review board approval that included verbal consent to audio-record participants. pseudonyms were used to ensure confidentiality. the study was funded by an institutional grant. data analysis following each interview, audiotapes were uploaded to the pi’s secure research program, transcribed verbatim using nvivo software to develop a thematic codebook, and reviewed by the pi for consistency. initial open coding was conducted by the pi and the research team (pi, graduate social work scholar, research assistant). inter-rater reliability and validity procedures included member checking (the pi returned to participants to verify the preliminary findings) and triangulation across participants to ensure that findings were in agreement (creswell & creswell, 2018). research themes were then organized into categories within a chart. adhering to the member check process, participants were asked to review the pi’s interpretation of their transcript and comment on statements identified as inaccurate, omitted, or unclear. advances in social work, summer 2021, 21(2/3) 444 the listening guide increases the accuracy of thematic analysis, transcription, and a platform to attentively listen (and re-listen) for emergent themes from each participant’s stories and how those themes relate to each other (barros-gomes & baptist, 2014). for the sake of brevity, more details concerning the listening guide have been identified elsewhere (gilligan et al., 2003). the listening guide honors the legacy of storytelling and oral tradition rooted in african descendants (martin & martin, 2002). to ensure black women professional’s voices were heard, four sequential readings/listenings were employed: (1) listening for the plot, which entails understanding the overall story; (2) writing “i-poems,” focusing on how women describe themselves in the first person; (3) listening for contrapuntal or multiple voices such as, contradictory, passive, active, emotional, intellectual, first, and third person; and (4) composing an analysis exploring the research questions and emerging themes (gilligan et al., 2003). the listening guide data analysis has been used to study the different voices of black women in their career development (abkhezr et al., 2018; beauboeuf-lafontant, 2008). this study extends the existing vcr literature to analyze the relationship of black women professionals to ptss and ptg. specifically, the listening guide (gilligan et al., 2003) was used to check the preliminary themes identified during the initial analysis; the pi listened to participants’ audio recordings in full and noted initial thoughts on their narratives. subsequently, the pi then re-listened to the recordings, chronicling ways the participants self-named characteristics for giving to their existence (see i-poems, table 1). afterwards, the pi listened to the recordings to identify overlapping themes. the intended outcome of this data analysis was to identify emerging themes and their relation to the study research question. selective coding was based on emerging themes and supported by direct quotes from participants. this research employed draucker et al.’s (2009) distress protocol as a guide to assess risk related to emotional distress among participants who engage in research on traumatic or aversive events and may exhibit a host of reactions (e.g., crying) when recalling negative experiences. questions asked in the interviews encouraged reflective processes about the emotionally charged issue of ptss. the pi, a skilled licensed clinical social worker, has been trained to uncover signs of distress. for several participants, indications of distress included noticeable tears or requests to pause the interview. assessment was facilitated by the pi using the dsm-iv-tr (apa, 2000, p. 34) global assessment of functioning (gaf) to screen the participant’s level of functioning. exclusion criteria included cutoff scores between 0-50 (serious symptoms, e.g., suicidal ideation, etc.) on a scale of 0-100. rodgers/next wave of ptss 445 table 1. listening for i-poems, contrapuntal voices and race-based stereotypes experienced by black women professionals (n=7) participant’s voice i-poems contrapuntal or multiple voices abw/sapphire sbw umoja, 50, married college student scholar i am black, this is how god made me, i love that i am dark-skinned, i love my hair i love my heavy voice angry, aggressive, the “n” word, loud argumentative, black ugly “b” abw may be describing myself, because that is how i see myself. i learned to be aggressive. she upheld that household. i learned how to be strong through my grandmother …so i learned how to multi-task & be a superwoman. kujichagulia 51, married college counselor i am african american i am black #black…grace… i am strong, i am a sistah strong, encouraging, intimidating, natural, spiritual, real i definitely feel that black women are seen as “spitfire” if she chooses to say that was wrong & i am not going to take it… ms. angry black girl. always have a ‘tude’… she can do it all. she does it all… her men aren’t around so she has to do it all. ujima 42, single college professor i am afro-american i am strong, i am secure i am confident angry, oppositional, defiant, aggressive, strong, intimidating we are looked upon as always having to be angry black woman, even before given the opportunity to prove ourselves, we are stigmatized as being the angry black woman. because i present myself as “strong” black woman then negative terms are used to describe me. ujamaa 72, widowed college professor i am black, i am bold i am a chance-taker, i am fearless, i step out on faith & do not worry about opposition aggressive, opinionated, argumentative, judgmental, talkative, intimidating feminist in this regard… i am not saying that is a term used to describe them, but that is what comes to mind. …we have within our race a lot of superwomen… but every superwoman has a kryptonite… [crying] so, every now & then, she don’t make it! nia 54, domestic partner college professor i am american, i am suitably aggressive, i am empathic, i can have any characteristic inappropriately dressed, unacceptable, not acceptable, inferred aggressiveness, coming across as smart …sapphire…is meant to be negative… i think sapphire is a positive term… i am talking about “professional women sapphire”…they are aggressive about their business… women who feel they can’t let other women down or men down...who work to death… kuumba 42, single college professor i am an african in america, i am strong, i am resilient, i am an outlier angry, aggressive, confrontational, argumentative, loud, intimidating …we are depicted as sassy…angry. let me be clear…what i am experiencing is silent rage. being a strong-black-womanman is unhealthy, dangerous… wearing an s on our chest says to the world we can handle anything & everything…but at what cost?... imani 70, widowed college professor i am black, i am friendly i am even-keeled, i am a family member/person nice, talkative, agreeable, seasoned, knowledgeable, black b [husband] …i do not have an example of an angry black women... black women who have gotten that title, because they are seen in the community, in the church… as really being able to get things done…we do have a lot of… superwoman who have been able to keep things together for our community & race. note: the table is organized according to the nguzo saba, which in swahili means the seven principles. rooted in kawaida theory, the nguzo saba was introduced by maulana karenga in 1965 as the minimum set of african values that african americans need to rebuild their heritage & restructure daily lived experiences (karenga, 1988, 1993). the nguzo saba is widely celebrated during kwanzaa, an african american & pan-african holiday. in addition, the bold type reflects the multifaceted forms of oppression reinforced by the social construction & institutionalization of racialized stereotypes & controlling images ascribed by others to black women professionals. it also highlights the experiences heard from participants. advances in social work, summer 2021, 21(2/3) 446 reflexivity in interpreting research themes qualitative study compels the researcher to examine self-awareness, difference from and identification with the narrator as the story is told, and the influence the researcher has on study participants (creswell & creswell, 2018). brown and gilligan (1991) argue that use of the listening guide (vcr tool) demands researcher reflexivity, a focus on researcher–participant relationships, brings issues of interpretation and representation of people’s lives into the analytical foreground, and is a solution to challenging issues raised for both the pi and the researched. in addition, reflection is employed to analyze the pi’s subjective responses introspectively because those responses potentially influence process and outcome, integrity, credibility, and the trustworthiness of qualitative inquiry (creswell & creswell, 2018). the pi privileged an analysis in which underlying beliefs were framed by the research question included in the interview guide. the framework assumed that black women professionals likely reported contemporary race-based stereotypes and ptss features. to uphold professional social work values, research integrity also included reflective dialogue with colleagues. the pi’s lens was heightened by her own positionality. the pi acknowledges her race, gender, and social class identities—black, cisgender woman, heterosexual, educated, middle class, and immersed in advocating against white supremacy in the academy, scholarship, governance, union, and public spaces—which intersect with structurally and socially constructed focal points (collins, 2000; rodgers, 2017; rodgers & lopezhumphreys, 2020) of participants in the current study. the pi kept a journal to be cautious of her voice aligning with participant narratives. results within the listening guide (i.e., i-poems, contrapuntal or multiple voices, and racebased stereotypes), the pi heard participants’ voices to produce table 1 and provide a foundation for the below themes which emerged from the interviews with black women professionals in response to the research questions underpinned by theoretical frameworks. moreover, table 1 and the study themes share the concept of voicing participants’ exemplar statements. specifically, the key findings identified in table 1 tended to give voice to black women professionals’ articulations of encounters with race-based stereotypes, features of ptss and stories of adjustments and adaptations. the themes are categorized according to voices of (1) identity and positionality, (2) generational [in]visibility, (3), professional rage located, and (4) voices of ppttg—prayers, people, trials, tribulations and god. voices of identity and positionality imani, a 70-year-old widow, retired college professor, and cancer survivor, was born and educated in the segregated south. raised by her maternal aunt who worked as a domestic servant, imani moved to new york city when she was 18 years old. in imani’s rodgers/next wave of ptss 447 voice: having been raised in the south, we knew our place. i remember my aunt saying, “know your place.” know your place came north with me! it was a part of me in my marriage. it matured with me as i progressed, even at 70, i know my place. …i think the pattern is something that follows you... at the other end of the spectrum of vacant esteem is a concept that the author is calling present esteem—the state of perceiving oneself and others to have worth and purpose, embodied by black women professionals who concomitantly resist white supremacy and restore features of african-centered worldview for themselves, family, community, and humanity. nia, age 54, resides with her domestic partner. she is a college professor, who grew up in a mid-western state during the civil rights era: reflecting on an article i read some years ago, the actor, diahann carroll, who was actually the first african american woman to get a major primetime tv drama played a nurse in the 1970s. it was called “julia.” don’t you know your place? i read this ebony or jet article where she discusses this; she essentially wrote back saying, my place is here. other black actresses of that era would say the roles they could get, were limited to maid, mammy, or to be somebody’s whore or prostitute. carroll’s response showed that she knows who she is. kuumba, a 42-year-old, single, college professor, was born in a major u.s. metropolitan city in the northeast. another example of present esteem was voiced by kuumba: my ancestors have fought for our place in society. yet structural practices assert policies that tell me to, “stay in your place little black girl.” i am tired of having to defend that my place is where i say it is!” i know that always having to defend my place was trauma to my body and ultimately led to my hysterectomy. voices of generational [in]visibility umoja, 50, who is married and a graduate student, was born in the united states and raised in the deep south by grandparents. as a little girl, she listened to frequent family conversations about the assassination of martin luther king, jr., the bloody sunday protest march in selma, and the bombing of the 16th street baptist church. umoja elaborates on racist socialization: my grandparents taught me…i have to portray myself to look like her if i want to be a part of this society if i want to be able to take care of my family. if i…[wear]…hair nappy or in braids, they look at me in a different way compared to if i had my hair straight...i conduct myself the way they [white women] do in order for them to see me and get raises on the job…i have to conduct myself in their image and have had to change my entire image. these have caused me daily distress…when i hit the door, i am no longer me. distress is having to be two people.…can’t separate the two…[tears up]. as i sit here and talk to you and i think about how far i have had to come and because of these psychological advances in social work, summer 2021, 21(2/3) 448 stressors it has created a lot of problems with my health. i have to go out into the world and sort of forget about my blackness…i have to live in a white world. it has caused me at times, depression and i have had to be on medication. kujichagulia, asserted: i am horrified that in this day and age, that so many of our beautiful sisters of every different hue continue to feel “ugly, unworthy, and as though they don’t count.” tv, imagery, magazine, we are made to feel that we are not wanted and have no worth. i am completely exhausted. i personally feel offended when our beautiful sisters are not able to walk in their natural selves. “i hope i did not say too much” black get back, white is right…i love it when we [black women] say, yeah, my body is a little rounder, and my hair is nappy. and so, what? i love it when celebrities stand and reflect their natural self. ujamaa, 72, a widow and retired professor, was born and educated in the segregated south. ujamaa echoed similar sentiments as umoja of being dismissed and ignored in public spaces, because of being a black (dark complexion) woman. in ujamaa’s voice: i know racism is there so i do not go out expecting it not to be there…when i go out, there is a very strong possibility that when i interact with white people they are going to say or do something that is going to be condescending or patriarchal. i experience this mostly from white women. i remember even as a faculty member, when people have come in the office and would defer to the white secretary and not to me even after they found out who i was. voices of professional rage located kujichagulia, 51, a married college counselor, born in the united kingdom, was raised by black women, and moved to the united states when she was a year old. the example of this theme is heard through the voice of kujichagulia: i definitely feel that black women/african american women are seen as “spit-fire” if she chooses to say that was wrong and i am not going to take it. wounded people walk with a great deal of hostility that causes us to lash out, hurt others, and live the negatives…she is just so angry all the time. ujima, 42, is a single, college professor born and educated in united states and raised by her mother. in the voice of ujima: people find that just being a black woman, you are supposed to be submissive. so, if you present yourself another way, then you are a person that can be intimidating…so i pretend to be submissive. participant (kuumba) verbalized ever present anger as: i reject being branded an angry black woman for demanding respect. speaking up and speaking out against white supremacy is the rich legacy my ancestors left me. i do not need anyone’s permission to use my voice in opposition of unearned power and white domination when it directly restricts my…liberty, and pursuit of my rodgers/next wave of ptss 449 blackness and my womanhood. in the voice of assata shakur, “i have nothing to lose but my chains.” voices of ppttg—prayers, people, trials, tribulations, and god umoja described post traumatic growth: …i know the trials and tribulations that have come with this body, and i have some flaws now, because of the life’s journey and the road bumps i had to endure…i am praying as i am driving. i am a superwoman. i could not be a superwoman unless i have a relationship with god. my religion is very, very important…i want to say 98 percent of everything i do includes god, includes devotion...i’ve learned to pray. imani stated: posttraumatic growth to me is showing the strength and resiliency and all of those things that will help them get back on target. ptg is god. god made me who i am. i am just different. my husband you call me a black b-i-t-c-h because i went to church a lot. i am so thankful to have my church family and friends. they are my ptg. discussion this study deepens our understandings about the unique narratives of black women professionals within a voice-centered domain. each of the participants voiced ways they identified themselves. their self-definitions were immersed in positive themes of strength and blackness aligning with earlier research (harris-perry, 2011) which report that black women have crafted alternative images of themselves. each of the seven women also used their multiple voices to describe their perceptions of labels ascribed to them by others (see table 1 for details) as a way to justify and sustain agency over themselves. listening to their voices individually and collectively, the themes heard in their stories congruently undergird controlling images, ptss and ptg adaptive survival behaviors, intergenerational strength, and contributions that they bring from their african ancestors. umoja’s voice, “it has caused me at times, depression and i have had to be on medication” brings to light the significant impact controlling and race-based stereotypical images have on the psychological well-being being of black women. this finding is consistent with earlier research reported by abrams et al. (2019). the acquisition of intersectional occurrences of race-based stereotypes and ptss can also result in negative reproductive health outcomes. kuumba’s voice, “i know that always having to defend my place was trauma to my body ultimately led to my hysterectomy” speaks to the ways sojourner syndrome (mullings, 2005) operates in the lives of black women, resulting from multiplicative effects of racism and sustained oppressive circumstances. with respect to gendered racism, black women professionals in this study share many adaptive survival behaviors akin to those found in the earlier conceptual work on ptss (degruy, 2005). these oral histories and traditions of survival behavior are interwoven advances in social work, summer 2021, 21(2/3) 450 and passed down from prior generations through familial relationships, community bonds, and social transmission (ani, 1994; degruy, 2005; martin & martin, 2002; halloran, 2019). for example, imani shared her experience of being raised by a village of relatives who, paradoxically, nurtured her and yet reinforced self-doubt and white supremacy values. imani’s reference to her aunt’s verbal command, “know your place” aligns with vacant esteem (identity and positionality) and feelings of inferiority and self-doubt that slavery fostered (campbell, 2019). unlike degruy’s vacant esteem, this study revealed a new construct—present esteem. nia and kuumba named their liberatory voices to assert their location in opposition to sustained white supremacy. multiple voices in this research validate racist socialization (generational [in]visibility). umoja and kujichagulia voiced the insidious nature of european standards of beauty. umoja mentioned her grandparents taught her to look like [white] society if she wanted to be able take care of her family. voices described in table 1 and examples of umoja and ujamaa’s reports of emotional distress related to their being dark-skinned are attributes of habitual covert and passive-aggressive attacks on their personal characteristics, professional acumen, and reinforce colonial beauty standards. umoja’s willingness to endure, even alter herself (also referred to as code-switch or double consciousness) might be assessed by mental health experts who rely on the dsm as a schizophrenic way to cope with isolation and internalized racism (cross & strauss, 1998; du bois, 1920/2011; halloran, 2019). moreover, existing between dual identities— blackness while navigating everyday whiteness—becomes part of umoja’s adaptive survival skills. these findings confirm the work of harris-perry (2011) who explores the confluence of racialand gender-based stereotypes that have been used to control and subjugate black women in america. umoja’s skills allow her to shift and exist within dominant white society and speak to the physical complications and mental health disorders that the centers for disease control and prevention (brody et al., 2018) enumerate. this finding is consistent with early research (jerald et al., 2017) that revealed being aware that others hold negative stereotypes about black women is a predictor of mental health outcomes, including depression. white male domination was expressed by some participants (umoja and imani) surviving the white supremacy/black racial stereotype binary for silencing, masking and know their place. professional rage located in black women resisters—kuumba and kujichagulia showed up as switching between their superpower (cooper, 2018) and justified anger (rage). towards surviving “post-racial” america neutral rhetoric (bonillasilva, 2015), they use their voices of “spit-fire” and “sass” as liberatory practices to speak against gendered suppression, controlling images, and colorist microaggressions (hall & crutchfield, 2018; hunter, 2007; mena & vaccaro, 2017; spencer & perlow, 2018). in analyzing tedeschi et al.’s (2018) ptg framework, black women professionals in this study held a master’s degree or phd. this finding upholds scholars’ (e.g., atta, 2018; bent-goodley et al., 2017; campbell, 2019) assertations that protective factors such as religious beliefs and spirituality including healing circles and movement, can help black women professionals to reclaim their present esteem, total selves, and ritualistic movement. it has also played a crucial role in the survival and connectedness passed down generationally by african slaves and their descendants. this finding also acknowledges rodgers/next wave of ptss 451 early research (manove et al., 2019) that reported ptg among black women with historical experiences of depression voiced new educational opportunities following the disaster of hurricane katrina. the finding of ppttg—prayers, people, trials, tribulations and god, adds to the ptg model, specifically, spiritual change, improved relationships with others, and personal strength. in the face of umoja’s daily microaggressions and imani’s verbal abuse by her husband, they voiced endorsing religious and spiritual rituals, such as god, prayer, going to church, and devotion as anchors for their existence and strength. previous research (evans et al., 2013) found church attendance and older age was associated with new possibilities and personal strength. the findings also affirm earlier empirical findings supporting the need for incorporating afrocentric paradigms for african-descended people to restore family structure, community connections, communal existentialism, spirituality, survival, oral tradition, and rituals (ani, 1994; atta, 2018; martin & martin, 2002; mazama, 2002; rodgers-rose, 1972), which accord well with holistic experiences of black women. strengths and limitations this research aims to expand the literature on historical trauma, specifically ptss. the core strength of this study is that black women professionals’ voices are no longer isolated from discussions about ptss. instead, their counterstories, naming or voicing one’s own reality (hudson-weems, 1993; landson-billings & tate, 1995), are shifting the existing narratives toward empirical discussions of present esteem, spit-fire, and sass. several limitations are also noted. first, the small sample size of seven may not reflect the voices of all black women professionals therefore, the study used a non-representative sample, thus the study findings cannot be generalized beyond this sample. second, as a black woman professional with similar experiences as the participants, there is the potential for biased interpretations of participants’ oral stories. to reduce this bias, the principal investigator (author) maintained a reflexive journal throughout the data collection process (creswell & creswell, 2018), discussed transcriptions with the research assistant, and invited university fellows to critically review qualitative analysis, pose questions, and offer feedback. in keeping with gilligan’s et al. (2003) listening guide method, the research team cross-checked the data analysis multiple times. this process enhanced the maximum confirmability and trustworthiness of the findings (creswell & creswell, 2018). third, because the sample of black women professionals is educationally privileged (master and doctoral level education), additional exploration is needed to determine how education might affect study variables. fourth, this research endorsed a heteronormative perspective and reflection of majority of the black women interviewed, and therefore limited the translatability, diversity, and inclusivity of black female and non-binary identities. future investigation must address this omission. advances in social work, summer 2021, 21(2/3) 452 implications the unique contribution of this study is documenting a descriptive experience as well as a prescriptive strategy for the survival adaptive behaviors, particularly features of post traumatic slave syndrome and posttraumatic growth, identified by black women professionals. more specifically, this paper describes their actual experience; and then goes further to prescribe policies and practices that will empower these women’s lives. practice. black women’s holistic wellness extends the margins established by the diagnostic criteria outlined in dsm-5. the current research gives voice to black women professional’s adaptive survival responses to ptss and disrupts practice changes to the dsm-5 (2013), the authoritative guide for diagnosing mental disorders for health care professionals around the world. the study’s findings also support the implication that assessment and interventions must include sustainable interventions (anti-black racism, diversity, equity, and inclusion—abrdei) trainings grounded in community care approaches that empower and center storytelling, language and liberatory strategies to protect future generations of african ancestry against transgenerational trauma (campbell, 2019; jones, 2020). policy. laws are needed to decolonize precolonial beauty standards that foster an environment that privileges black women while disrupting values of whiteness phenotype (barlow & dill, 2018). the crown (creating a respectful and open world for natural hair) act of 2019 (2020), under the fair employment and housing act (feha) and education codes will ensure a sense of belonging to society and protections against discrimination that umoja and bipoc women with ethnic hair textures endure. the findings also call for position statements [black papers] and policy reform. towards addressing the disparate institutional policy responses impacting black women’s health and wellness, stakeholders (barlow & dill, 2018) call for transdisciplinary courses to be produced in black studies and other fields (history, journalism, nursing, sociology, social work, women’s studies), including race-based scholarship. regardless of education and social status, findings for this study reveal that even black women professionals are forced to conform to the pathology of white america’s norms through domination of racist socialization, gendered, racial, colorist microaggressions (hall & crutchfield, 2018; perlow et al., 2018; smith et al., 2020), and the killing of black women professionals. maliciously calculated, on september 22, 2020, the same day no murder charges were returned for the three officers involved in the killing of breonna taylor, donald trump, the 45th president of the united states, issued an executive order “on combating race and sex stereotyping” (exec. order no. 13950, 2020). the eo instructed that no divisive rhetoric would be tolerated by that administration. the 46th united states president joe biden issued an executive order “advancing racial equity and support for underserved communities through the federal government" (exec. order no. 13985, 2021) revoking eo 13950. to memorialize ancestor taylor, funding in her name is needed to expand racial justice initiatives that center black women’s voices and curriculum that combats performative activism and white supremacy rhetoric. rightfully taking a seat at the executive branch table, united rodgers/next wave of ptss 453 states vice president kamala devi harris can serve as a superlative bipoc voice for the next wave of black women’s health imperatives, social justice priorities, and global goals. conclusion this study gives us a glimpse of the lives of a few black women professionals. however, articulations and consequences of adaptive survival behaviors are not yet well understood. future research is likely to reveal a greater range of solutions for the effects of ptss. solutions can revolutionize the ways that social work and health care practitioners serve the mental, emotional, and physical needs of black women professionals. future studies with larger numbers of participants may also provide a greater argument for why ptss and ppttg cannot be gainsaid; together, they provide a critical theoretical framework for addressing the invisibility of black voices. social justice race work scholars (i.e., fisher et al., 2017; hall & crutchfield, 2018; ortega-williams et al., 2019) call for justice frameworks to respond to historical traumas and colorist microaggressions. as such, ptss must become part of the larger dsm discussion. whether protecting forebearer’s stories, fighting for justice against neolynchings of breonna taylor and unnamed generations (spencer & perlow, 2018), or advancing the wellness of black women professional resisters in academia who have suffered from race-related trauma, disrupting white supremacy must be at the forefront of everyone’s agenda. the resurgence of the racial, hyper-sexual female objectified on stage (i.e., saartjie “sara” baartman [1789-1815] hottentot venus, enslaved women purchased at auction blocks) was perceptible in 2019. chicago male police officers inhumanly bound naked black social worker anjanette young and placed her on worldwide display. within the context of healing justice work (carruthers, 2018), this author calls social workers to action to communally respond to insidious acts of violence and their consequences inflicted on black women’s bodies. this article ends where it started—with black women professionals talking back and speaking forward to defy societal white supremist structures that seek to silence and dominate their stories and lives. even the most subjected person has moments of rage and resentment so intense that they respond, they act against. there is an inner uprising that leads to rebellion, however short-lived. it may be only momentary, but it takes place. that space within oneself where resistance is possible remains. 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(2018). treatment interventions for intimate partner violence in the lives of african american women: a social just approach. in s. gelberg, m. poteet, d. d. moore, & d. coyhis (eds.), radical psychology: multicultural and social justice https://doi.org/10.1089/heq.2017.0045 https://doi:10.1080/10911359.2016.1259927 https://doi.org/10.1093/sw/swaa041 https://trace.tennessee.edu/jaepl/vol25/iss1/9/ https://doi.org/10.4018/978-1-5225-5942-9.ch009 https://doi.org/10.1215/15366936-6955175 https://doi.org/10.1093/sw/swz002 https://doi.org/10.1007/s40615-016-0328-7 https://doi.org/10.1007/s40615-016-0328-7 https://doi.org/10.4324/9781315527451 rodgers/next wave of ptss 459 decolonization initiatives (pp. 89-110). lexington books. https://psycnet.apa.org/record/2018-41065-004 williams, m., metger, i., leins, c., & delapp, c. (2018). assessing racial trauma within a dsm-5 framework: the uconn racial/ethnic stress & trauma survey. practice innovations, 3(4), 242-260. https://doi.org/10.1037/pri0000076 woods-giscombé, c. l., robinson, m. c., carthron, d., devane-johnson, s., & corbiesmith, g. (2016). superwoman schema, stigma, spirituality, and culturally sensitive providers: factors influencing african american women’s use of mental health services. journal of best practices in health professions diversity: research, education, and policy, 9(1), 1124-1144. https://pubmed.ncbi.nlm.nih.gov/33043323/ author note: address correspondence to selena t. rodgers, department of social work, city university of new york, york college, queens, ny, 11451. email: srodgers@york.cuny.edu https://psycnet.apa.org/record/2018-41065-004 https://doi.org/10.1037/pri0000076 https://pubmed.ncbi.nlm.nih.gov/33043323/ mailto:srodgers@york.cuny.edu it is not that black women have not been and are not strong; it is simply that this is only a part of our story, a dimension, just as suffering is another dimension—one that has been most unnoticed and unattended to. (bell hooks, talking back, 1989, p... method _________ alexis jemal, phd, jd, ma, lcsw, lcadc, assistant professor, silberman school of social work, hunter college, new york, ny. jenna frasier, msw is yoga teacher, graduate, silberman school of social work, hunter college, new york, ny. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 708-729, doi: 10.18060/24151 this work is licensed under a creative commons attribution 4.0 international license. the intrepid elective: transforming potential for consciousness to action in and with social work education alexis jemal jenna frasier abstract: the field of social work has a professional and ethical commitment to social justice. however, scholars have identified potential dangers that may threaten that commitment. to transform dangers into opportunities that strengthen social justice service, schools of social work could incorporate critical pedagogy within the master of social work (msw) curriculum. by training future social workers in critical social work practice, social work education becomes an advocate for marginalized populations. if not educated from an anti-oppressive framework, social workers have the potential to harm, oppress, and control rather than support and serve. the weight of this responsibility and firsthand social work education experiences led to the development and implementation of an elective course in critical social work informed by the critical transformative potential development (ctpd) framework. the course follows a method that puts the ctpd theory into practice to bridge the micro-macro divide by engaging students in actively dismantling ideologies and practices of dominance. the course aims to produce anti-oppressive social workers who can better navigate social justice terrain. a student’s perspective on the course highlights strengths and areas for improvement. future iterations of this class or similar courses of study could be adapted by and adopted for other social work education institutions. because social work education is fertile ground to plant seeds that will grow social workers rooted in anti-racism and anti-white supremacy, there is the opportunity, with a radical education, to transform the field in a critical direction, better prepared to overcome the social justice challenges of the era. keywords: critical consciousness, white supremacy, social work education, elective the field of social work has a professional and ethical commitment to social justice (national association of social work [nasw], 2017). social justice can be characterized as a comprehensive economic, social, and cultural construct having overlapping components that are grounded in practices and pursuits of equality, resource distribution and allocation (cook, 2019; johnston, 2009). reisch (2002) further describes the concept of social justice as an ever-evolving idea that functions to maintain equitable or oppose inequitable existing conditions and holds individuals and society accountable for remedying injustices. one issue preventing the field from accomplishing its social justice mission is the micro-macro fissure embedded in the field’s foundation (androff & mcpherson, 2014; bussey et al., 2021). this long-standing tension about what “social justice” means and how to engage – whether to focus on micro-level or macro-level factors – dominates social work practice and is reflected in social work education (finn & molloy, 2020; morgaine, 2014). about:blank jemal & frasier/the intrepid elective 709 indicative of this division is that some schools of social work require prospective students in their applications to choose tracks (e.g., clinical, management, or community organizing) or concentrations that reinforce the micro/macro divide. the tracks bolster pseudo binary objectives of micro (individuals, families, and groups) and macro (community organizing, management, advocacy, and policy) in social work education and practice, which undermines the social work notion of person-in-environment (austin et al., 2016; reisch, 2007; rothman & mizrahi, 2014) and the social ecological perspective (bronfenbrenner, 1977). both perspectives emphasize interconnectedness of micro, meso, macro contexts and incorporate the axiom that macro processes have micro consequences. programs, policies, and practices that treat behaviors as if they exist in a micro vacuum by solely focusing on the individual level—allow invisible, inequitable socio-structural factors to continue unchallenged (jemal et al., 2019a; windsor et al., 2015). in social work institutions familiar to the authors, admitted students follow a specific course of study with minimal to no cross-track interaction except, possibly, through some elective course offerings. although not scientifically studied, it is no secret that some students who pursue an msw often had/have an interest in psychology; but chose to pursue social work as a fast track to clinical practice (i.e., therapy; apgar, 2020). most msw students choose the micro/clinical focus (harrison et al., 2016; varghese, 2013) and some schools only have a clinical program (apgar, 2020). yet not all us master of social work programs infuse social justice content throughout the curriculum (tisman & clarendon, 2018). particularly, the lack of social justice content may be more noticeable amidst the clinical concentrations. thus, this structure of education with the forced track selection, the actual selection of the clinical focus by the majority of social work students as a fast track to clinical practice, and the lack of social justice content infused throughout curriculum, could be interpreted as social work, through its educational process, stating that macro practice does not matter (reisch, 2016) and, as such, abandoning its social justice mission (sprecht & courtney, 1994). another obstacle potentially thwarting the field’s social justice mission is that social work has a dialectical character, containing both repressive and liberating dimensions. as a result, the field has oscillated between being a mechanism of social control and source of liberation (bussey et al., 2021). one result of these tensions is that mainstream social work has too often tiptoed around major issues of power and coercion, especially regarding class, sexual orientation, gender, and black, indigenous, and other people of color (bipoc) racial oppression (feagin et al., 2015). this is problematic since the social work profession grants access to communities who are constantly marginalized by society. these communities share intersecting identities – often low-income, lgbtq+, black and/or people of color, disabled, undocumented, women and children – and bear the most visible effects of oppression, such as poor health outcomes, employment and housing discrimination, and disproportionate interactions with the criminal justice system. the lived experiences often demonstrate how environmental and socio-political processes have individual-level outcomes (dunlap & johnson, 1992). oppression is rooted in colonialism and white supremacy culture, which okun & jones (2016, p. 28) describe as “powerful precisely because it is so present and at the same time so very difficult to name or identify,” shaping both inner and outer worlds. advances in social work, summer 2021, 21(2/) 710 whereas the term [white supremacy] has historically been associated with hate groups such as the ku klux klan, scholars now recognize white supremacy to be a cultural, economic, and political system that sustains white people’s dominance over virtually all sectors of society and through which implicit and explicit ideas about white people’s superiority are reproduced through every day dynamics in a wide variety of institutional and social settings. (grzanka et al., 2019, p. 479) white supremacy shapes the political and socio-economic contexts in which we operate; and both the formal and informal rules by which we live (kendi, 2016; wilkerson, 2020). in essence, white supremacy culture is within and reproduced by all the institutions of our society as evident by racial disparities. it “saturate[s] the everyday mundane actions and policies that shape the world in the interests of white people, so that they can enjoy structural advantage and rights” over people of color at the collective and individual levels (gillborn, 2006). moreover, oppression shapes our thoughts, emotions, and personality, and thus functions simultaneously as a historical, psychological, socio-political, and cultural experience (berila, 2014). without the work of critical reflection (and still at times, even with it), social workers are inevitably bound to perpetuate the harms of white supremacy and oppression. as james baldwin and other scholars have keenly noted in different ways, we can’t claim what we can’t name, and we can’t face what we can’t claim, and we can’t change what we can’t face. in other words, we cannot claim (or be accountable for) issues that we cannot “see” or perceive. naming makes the invisible, visible (i.e., awareness). for example, in what ways has the field of social work named its history of involvement in racist tactics, practices and policies, the consequences of which are still felt today? practicing from a white supremacist starting point with a white supremacist process leads to white supremacist outcomes that circle back to the starting point, creating a selfperpetuating and self-replicating, viral cycle (jemal, 2018). apparently, we cannot change what we have not claimed to be in our field of expertise. as social workers, we should be anti-oppression experts. yet some social workers support “all lives matter” campaigns. in response to reparation discussions, they say “black people had slaves too,” or “my grandparents, who were treated very poorly when they first immigrated to this country with nothing, worked very hard to earn what they had and bequeathed to their children.” or, if not saying or thinking these ideas, many social workers (including social work educators) are uncomfortable with the discomfort of having difficult discussions about racism (i.e., white supremacy/privilege and/or bipoc racial oppression) and other isms (e.g., classism, sexism, heterosexism). as a result, the topic is avoided to the detriment of their own learning, the students’ education, and potential future social justice advocacy efforts with clients. since racism is inherently part of the culture in the us, following the status quo, usually through avoidant action, is a path of violence and perpetual racism. every member of this society is part of the systems of racism whether intentionally or unwittingly, and thus, no one can escape the perpetual decisions to maintain or dismantle these oppressive systems with each thought and every action (feagin et al., 2015). it is impossible to remain neutral. for example, imagine you are a social worker at a halfway house. the organization has a zero-tolerance policy for intimidation. due to racist, socio-cultural ideas of blackness being jemal & frasier/the intrepid elective 711 scary and dangerous, and the angry black woman stereotype, white women residents often “feel” intimidated by the very existence and presence of the black women residents. the white residents make formal complaints (creating a hostile environment for the black women, which makes the black women very angry and unable to fully participate in their treatment process; jemal et al., 2019b). having complaints filed against you constitutes a violation of probation or parole and the black women are reincarcerated, thereby perpetuating the racial disparity in the criminal justice system. macro forces have micro consequences and those micro consequences (e.g., rage) can elicit macro responses (e.g., stringent policies on anger expression that align with white ideals, norms, and values). moreover, the example demonstrates how racism through or met with non-critical action can perpetuate racism. yet to prepare students for similar scenarios, many institutions of social work education familiar to the authors meet the council on social work education’s (cswe) cultural competence accreditation requirement by offering a stand-alone course that focuses on issues of diversity and inclusion (gabbard et al., 2011). although wellintentioned, the impact is problematic in that practices may camouflage racism since cultural competence does not stretch far enough or dive deep enough to reach antioppressive practice (abrams & moio, 2009). first, the msw curriculum, particularly for the clinical track, often places responsibility for educating about or addressing systems of oppression/privilege within macro practice (harrison et al., 2016), and thus, clinically focused courses do not engage in critical consciousness raising but instead emphasize interpersonal differences in identity through the multiculturalism approach and cultural competency (bussey et al., 2021; fisher-borne et al., 2015; tisman & clarendon, 2018). second, bifurcating and then relegating social justice knowledge to non-clinical practice reinforces the false micro-macro practice dichotomy, “perpetuating the micro or macro choice rather than incorporating micro and macro practices into all social work practice” (bussey et al., 2021, p. 3). third, a cultural competency standard without critical discussion reifies the idea that cultural competence and humility is sufficient. however, a truth for a client is that a white supremacist, patriarchal, and heterosexist culture may be the root cause of the harm experienced by the client. for example, a social worker’s ability to truly affirm a transgender client depends on micro forces, such as using correct pronouns, and macro forces, such as understanding how the structure of cisnormativity impacts their experience (shelton et al., 2019). the social worker, to satisfy their office policies, may require a trans client to complete medical forms that lists gender within a male/female binary. also, the client may experience anxiety when they attempt to use gendered bathrooms. thus, the root cause of harm lies within a structure of intersecting oppressions and persists despite the social worker’s ability to engage with diversity that barely scratches the surface. in this way, social work education, and eventually social work practice may directly or indirectly reinforce dehumanizing (e.g., racist, classist, sexist, heterosexist) structures of society by not challenging, disrupting, dismantling, and replacing those normative social structures with strong anti-racist, liberating alternatives (feagin et al., 2015). "therefore, we must take this moment to honestly examine how social work curriculums go beyond teaching an appreciation for physical or cultural diversity and empower the next generation of social work practitioners to dismantle institutional racism” (cswe, 2020, para. 4). advances in social work, summer 2021, 21(2/) 712 schools of social work and social work educators have a responsibility to develop social workers who can expertly perform their social justice professional duties. thus, it is imperative that the educational foundation of the field of social work wrestles with and interrogates its oppressive roots and current practices. to disrupt structural patterns of oppression (internal and external to the field), anti-oppressive frameworks within social work education can consider a focus on structural competence (i.e., a lens that emphasizes engagement with systemic causes of oppression as they relate to and perpetuate issues on the individual level) which could better prepare students to bridge consciousness and action, respond across multiple dimensions and intersections of power, privilege, and oppression, and dismantle dehumanizing contexts (shelton et al., 2019). in essence, it is incumbent upon institutions providing social work education, responsible for training and socializing new social workers, to integrate an anti-oppressive framework. to that end, social work education (as defined by cswe’s accreditation standards, each school’s curriculum committee or some other means) needs to be held accountable for incorporating and integrating anti-oppression frameworks and practices (e.g., antiracism) into all curricula. organizing efforts by msw students in the new york city area have been the driving force behind demands for classes that incorporate anti-oppression / anti-racism perspectives within the foundational curriculum (columbia school of social work activists, 2017; nyu silver school of social work, “action against racism,” n.d.). anti-racism-informed social work education will not only educate students on how to do clinical practice, community organizing, or manage non-profits, but will provide guidance on how to practice, organize and lead in a way that does not perpetuate white supremacy. when lacking awareness, accountability, and the skills or tools, the potential for action that produces change at multiple system levels is greatly reduced. inequity (i.e., oppression for marginalized identities and privilege or supremacy for socially dominant identities) flourishes in societies with cultures that lack transformative potential; that is, the ability to critically perceive socio-political contradictions and act against dehumanizing conditions and realities (freire, 1970/2000). should all social work be critical-radical social work (jemal, 2017b) that addresses the root causes of social inequity, such that the integration of micro-macro practice would define the social work field in entirety (carruthers, 2018; jemal, 2017b; reisch, 2007)? the fact that there is a designation as “critical social work,” insinuates that not all social work (practice or education) is critical. an education predicated on critical-radical social work should be the norm rather than the exception (abrams & moio, 2009; bussey et al., 2021). critical social work is concerned with the dehumanizing aspects of society and works toward social justice (deemed an ethical and sociopolitical imperative of social work) at the intersection of micro and macro practice to identify and address root causes of social injustice (fook, 2003). one way to advance critical social work practice is to offer critical social work education. the elective, “critical social work: bridging the micro-macro divide,” was created in 2019 to transform social work education’s potential to act against white supremacy and other forms of ideologies of dominance, structural violence, and dehumanization. this conceptual paper details the elective course and provides one student’s experience of the elective course as an example of a strategy to address the lack of critical social work education at their institution. particularly to persons having jemal & frasier/the intrepid elective 713 intersecting, marginalized social identities, as is the case for both authors, it is important that social work fulfills its social justice commitment. people come to the field for different reasons, but hopefully people stay in the field because they internalize an urgency to have a social justice-oriented practice. as such, the purpose for creating this class was twofold: 1) to develop students’ capacity to address dehumanizing realities; and 2) to develop students’ skills to facilitate this process for others to address dehumanizing realities. since education is inextricably linked to what and how to practice in socio-political environments, the creation of an elective course is one strategy to create change within social work education and with social work education when students work to dismantle the systemic racism and oppression created by white supremacy culture. in this way, education is a form of dual-level advocacy: 1) advocating for the student to receive a rigorous education that will allow them to address white supremacy and other forms of dehumanization, and 2) advocating for the future clients of students to receive aid in eradicating the oppression they experience. the elective the elective course, critical social work: bridging the micro-macro divide, was collaboratively created by the first author, a doctoral student in social welfare, and a second year msw clinical student. the team grounded the course in the first author’s critical transformative potential development framework. the course is our attempt at a pedagogical innovation to address issues of social injustice, such as white supremacy and inequity in the curriculum. the first author taught the course for the first time in the spring semester of 2020. the second author was a member of that first cohort. transformative potential transformative potential is a strategy theorized to address inequity within our personal lives, professional workspaces, and the world (jemal, 2018; jemal & bussey, 2018). it is grounded in ecological systems theory (bronfenbrenner, 1994), marxism, critical race theory (delgado & stefancic, 2012), critical consciousness (freire, 1970/2000), and intersectional theory (crenshaw, 1989; hill collins, 2000). transformative potential constitutes developmental levels of consciousness and action that cultivate capacity and produce potential to transform the contextual factors and relationships that perpetuate inequitable conditions and unjust outcomes at one or more socio-eco-systemic (e.g., individual or institutional) levels (jemal, 2017a, 2017b). transformative potential balances individual needs and the need for social reform. a person with a high or critical level of transformative potential is theorized to critically reflect on inequitable conditions and actively work to produce equitable change. transformation (of oneself, relationships, or environment) requires the simultaneous processes of reflecting and acting. merely reflecting on realities without corresponding action will not lead to transformation; and, moreover, one cannot truly understand a problem without interrogating one’s relationship to the problem and taking informed action involving the problem (freire, 1970/2000). thus tp consists of two dimensions: transformative consciousness and transformative action. transformative consciousness refers to the degree of awareness of systemic, institutional, and historical forces that both promote and limit opportunities for specific groups within advances in social work, summer 2021, 21(2/) 714 one or more socio-ecosystems (e.g., microsystem, macro-system). transformative consciousness acts as a lens for understanding how people are impacted by structural and historical oppression and includes three hierarchical levels—denial, blame, and critical consciousness. transformative action is defined as individual or community action to dismantle inequity (i.e., privilege and oppression) at one or more levels of the socioecosystem (jemal & bussey, 2018) and has three tiered levels—destructive, avoidant, and critical action (see figure 1). figure 1. levels of transformative consciousness and transformative action note. figure 1 depicts the two dimensions of transformative potential with the levels of the transformative consciousness and transformative action dimensions (jemal, 2018). both dimensions (transformative consciousness and action) determine one’s level of transformative potential, indicating how likely one is to transform (from personal to environmental transformation). the goal in transformative work is to facilitate an individual's or community's potential to transform consciousness into action by progressing from lower levels of consciousness (i.e., blame or denial) and action (i.e., destructive or avoidant) to developing critical consciousness and action, which would produce critical transformative potential. critical transformative potential positions people to be “transformers”: to make meaningful change in themselves, in relationships, and within communities. however, it is important to note that critical consciousness does not ensure engagement in critical action. to bridge this potential divide, the critical transformative potential development framework (“framework”), a philosophical and practice-based theory, incorporates accountability/responsibility and efficacy. this framework is theorized to make it more likely for critical transformative potential to manifest. critical transformative potential development framework. the cornerstone of critical social work is the development of critical transformative potential (tp). critical jemal & frasier/the intrepid elective 715 social work struggles to interrogate and understand society and then to disrupt the oppressive realities, “the taken-for-granted, ‘natural’ order that supports it and makes it possible” (feagin et al., 2015, p. 17). the framework speculates that participants (here, msw students) will be much more likely to engage in critical action if they consciously identify an issue and understand its structural linkages and perceive the ability to create meaningful change via their actions (watts et al., 2011). moreover, critical tp comprises information, interrogation, inspiration, imagination, innovation, and intervention, all of which begin with “i.” coincidentally, the first step in developing critical tp begins with the self (“i”) as the subject for action and transformation: self-awareness and self-work to examine one’s social location and address one’s own internalized privilege, oppression, prejudices, biases, and discriminatory behavior. built from this logic, the four dimensions of the framework—critical consciousness/awareness, accountability/responsibility, efficacy/ability, and critical action—are pathways that enable people to develop the potential to transform themselves, relationships, communities, and/or sociopolitical realities. awareness is the naming of social injustices that can lead to accountability (i.e., claiming one’s role) for perpetuating white supremacy and responsibility for taking social justice action. once able to perceive the problem and recognize our accountability, identifying a role for ourselves in creating a solution, we can then develop the skills and obtain the tools needed to increase our self-efficacy to be involved, empowered to effectively face the challenges by engaging in anti-oppressive action needed to eradicate inequity and injustice. the elective course had four units that focused on each dimension of the framework. implementing critical transformative potential development there are numerous ways to put theory into practice to develop critical transformative potential. one potential method, the integrated transformative potential intervention development (intrepid) method, designed to engage each pathway of the framework, structured the elective course (see figure 2). the method has four components that align with the process of critical transformative potential development: 1) critical dialogue, 2) critical participatory action research (cpar) approaches, 3) skill building, and 4) critical action project experiment (cape). critical dialogue. the purpose of critical dialogue, a central tool for developing critical consciousness (garcia et al., 2009; gutierrez & ortega, 1991), is to engage participants in the critical reflection component of freirian (1970/2000) praxis: reflection and action. critical dialogue is grounded in group work, critical thinking, and community organizing literature (windsor et al., 2014b). group meetings incorporate the co-learning, non-hierarchical process and encourage participants to engage with and reflect on content that breaks down the barriers of siloed knowledge; draws connections between past, present and future; links the socio-ecosystems, with awareness of how macro processes influence micro consequences; and, develops a deeper understanding of how marginalizing processes (e.g., racism, sexism, classism) impact lives and behavior (diemer et al., 2006; windsor et al., 2014a). one tool to promote critical dialogue is the posing of reflective questions that interrogate power dynamics and the relationship to violence. questions direct attention to advances in social work, summer 2021, 21(2/) 716 the historical events, intersecting socio-structural forces, multi-systemic factors, and attributions that go beyond an individual’s behavior to question context and environment that create and maintain systemic inequity over time (jemal, 2017a; windsor et al., 2014a). the questions within dialogue allow exploration of how “knowledge is created and maintained by larger socio-political forces” (garcia et al., 2009, p. 32). a social work for liberation uses questions to: “uncover the hidden aspects of these concrete, historically given social arrangements” (feagin et al., 2015, p. 16) to provoke discussions about the status quo, making the invisible, visible; promote the ability to analyze or identify the meaning of experiences and events; and, then elicit how participants would improve the situation or take action to promote equity (feagin et al., 2015; watts et al., 2002). figure 2. the intrepid method to develop critical transformative potential critical transformative potential note. figure 2 depicts the four domains of the critical transformative potential development framework (numbers 1 – 4) with the components of the intrepid method (letters a – d; bussey et al., 2021). in social work education settings, as with this elective, educators can engage students in critical dialogues, encouraging structural analysis of individuals and communities, as well as critical reflexivity about self in relation to systems of privilege and oppression (ferguson & smith, 2012). reflective questions can facilitate students to interrogate how social work is part of the political, social, and psychological status quo. to ignore or deny the sociopolitical and psychological standpoints of the profession’s thinking and practice is to ensure that the field will stay rooted in racist practices, policies, and culture (feagin et al., 2015). despite challenges posed by multiple conceptualizations of anti-racism, c. skill building d. critical action project experiment (cape) b. critical participatory action research (cpar) a. critical dialogue 1. critical transformative consciousness (awareness) 2. accountability 3. efficacy (ability) 4. critical transformative action jemal & frasier/the intrepid elective 717 compounded by the theory-to-practice gap, students’ participation in critical dialogue will develop critical thinking skills that are the foundation of anti-oppressive and liberating social work practice (jemal & bussey, 2018). moreover, a parallel process occurs in social work education in which critical discussions aim to raise both the educator’s and the student’s consciousness, mimicking and modelling what should occur between a student as practitioner and their clients. further, by intentionally drawing the connection between social structures and individual experience, social work educators may bridge the artificial micro/macro divide, moving future clinicians towards practice that consistently works to both eradicate systems causing inequity and addresses the suffering individuals and communities experience living under inequitable conditions. the professional duty to work towards social justice requires that social workers get comfortable with the discomfort of facilitating delicate and nuanced conversations about inequity and structural violence. for example, this class used the liberation health model to guide critical dialogue to illuminate social issues from different angles, such as the personal, (and the often hidden) institutional and cultural factors underlying issues of concern for social workers (kant, 2015). sociometry. the intrepid method begins with critical dialogue; however, there is a pre-dialogue step that prepares participants for critical, productive, and effective dialogue. the dialogue prep step is to build sociometry. sociometry, from psychodrama and sociodrama practice, entails discovering hidden connections between people (moreno, 1953). if a person has one or more marginalized social identities, then they most likely experience chronic attacks on their wellness as a human being simply for being human. when we are connected through the experiences of our humanity, then we build relationships and develop empathy and are better able to practice open-minded listening, find healing in another’s shared narrative, as well as work, learn and grow together. it is important to note that the piloting of this elective course influenced the critical transformative potential development framework in that relationship building (affinity) was extracted as a fifth dimension. in the framework used to inform the elective, affinity and awareness were combined in unit one, but will be separated in future iterations of the course. thus, the revised framework is relationship-building (affinity), awareness, accountability, ability, and action. this class is an example of theory in action and how reflection on action changes theory, or in other words, constitutes praxis (freire, 1970/2000). critical participatory action research (cpar). cpar is an umbrella term that is used to describe various approaches, practices and methods to conducting research, which typically are: socially-engaged and, possibly, politically-inspired; non-traditional in form and approach; and, particularly participatory (i.e., engaged participation from the target population; those with lived experience; and/or those who are most directly impacted) and collaborative (e.g., partnerships with others who have different areas of expertise) to create multi-experiential and multidisciplinary teams (tuck & guishard, 2013). the research is often conducted for, by, and with the participant group. action research models enhance the community’s capacity to address their own interests (tuck & guishard, 2013). the values of cpar create a space conducive to the innovative synergy produced from a various mix of knowledge(s) that lead to holistic and dynamic discoveries for problemadvances in social work, summer 2021, 21(2/) 718 solving to take place. the elective course offered cpar so students could access conceptual frameworks that counter structural violence (that includes imposing white, eurocentric frameworks on communities of color; stoudt et al., 2012). cpar advances the accountability/responsibility dimension of the intrepid method in two ways: 1) cpar centers the voices of those most impacted, and 2) cpar facilitates the development of radical imagination. first, cpar engages students in a process of inquiry and data collection that centers the perspectives, ideas, and objectives of those historically and socially marginalized. second, radical imagination tapping into the unknown (haiven & khasnabish, 2010) is developed by amplifying voices that have been silenced and bringing together diverse wisdoms. lived experience provides an understanding superior to those intellectuals who only study the issue from an advantaged vantage point (feagin et al., 2015). listening to and learning from those with lived experience provides a key to unlock a new world of unexplored possibilities and potentialities. people with good intentions, passion, and the desire to intervene may not know what to do because they are constrained or limited by the tools that already exist. cpar helps us determine our role in maintaining the problem, as well as what to do to be part of the solution as visionary activist-researchers. for this prong, one assignment had three components. for part a, students researched a socio-cultural and/or socio-behavioral health issue of interest and created an annotated bibliography. then they engaged in member checking by identifying individuals with lived experience and shared the findings from the annotated bibliography. lastly, for part c, they synthesized and discussed their findings from parts a and b. they summarized how their findings from the annotated bibliography converged or diverged with their findings from the member checking process. then they discussed how their thinking had been informed to imagine potential actions to address the social issue. the next step is to determine how to put the “what” into action. skill-building for efficacy. social justice work depends on knowing how to transform consciousness into action. learning how to do is the essence of the ability/efficacy-dimension. the elective course encouraged students to develop transformative efficacy through skill development. students researched and learned skills needed to make change. one assignment invited students to select a skill, develop an exercise to learn that skill, and then use that exercise to teach their colleagues in the class. sharing knowledge and building from the resources that already exist in the community is community empowerment and capacity-building. in addition to the new skills shared between the students, the important lesson here was that our role as social workers is not about empowering the disempowered or being a voice for the voiceless, but facilitating access to resources or a platform, so marginalized communities can empower themselves and be heard. collective power is needed for effective critical action and action is needed for learning and to build power. with that idea in mind, one important trap to avoid is the feeling that you will never know enough or should wait to act until you know everything possible. learning often introduces us to the area of what we didn’t know, we didn’t know; and the endless contents of that box can be frightening and immobilizing. thus, the elective course invited a student company of applied theatre practitioners to start the process of putting “know how” into action through embodied experiences that engage multiple jemal & frasier/the intrepid elective 719 faculties, access points, and ways into doing this work starting from the knowledge already possessed. critical action project experiment (cape). critical social work not only discusses liberation and eradicating white supremacy; it also helps innovate the means to that end. the framework asserts that once participants develop higher levels of awareness of systemic factors; hold themselves accountable for addressing the issue; and cultivate efficacy, then they will develop and execute action strategies that continue to develop critical transformative potential. the cape’s purpose is to provide opportunities for people to begin action efforts or to try new methods for critical action in a supportive and collaborative environment. a potential pitfall to avoid here is believing that the cape should constitute action that solves the problem in a single attempt, or must be life changing, revolutionary, or worthy of a macarthur fellowship. to the contrary, critical action can be incremental, planting seeds that may not bear fruit in our lifetime. critical action can be ripples, that start the chain reaction of change, or waves as powerful as tsunamis, that demolish pillars upholding structural racism or anything in between. capes are usually designed to have one to four goals in mind: 1) to work bottom up and begin community organizing efforts against inequity; 2) to improve coping strategies with inequity and its harmful consequences; 3) to work top down with those who are positioned at the top of the social hierarchy to redistribute power; and/or, 4) to heal from and address the impact of historical oppression and trauma at the intrapersonal, interpersonal and community levels that manifest in interpersonal violence and community harm. in this way, students’ capes can take place at their places of employment, field placements, or school of social work. within the school setting, capes can: 1) address educational policies and/or administrative practices that are overtly and/or covertly racist, oppressive, and inherently supportive of white supremacy culture; and 2) suggest pedagogical innovations to address white supremacy and contribute to race and equity in the curriculum. lastly, a main objective for the cape is to reinvest in relationships and community. in this manner, capes can focus on one or more of the dimensions of the ctpd framework (awareness, accountability, ability, action) or can work in each dimension simultaneously. critical social work with capes that apply empathic concern and humanizing action can dismantle social injustice and support liberation. a student’s perspective why choose this course? the promise of an anti-oppressive learning opportunity is what brought me as a second year msw student to the elective course. the course held the goal of assessing and building structural competence with social work students so that we may practice taking transformative action grounded in critical consciousness ideology. this felt familiar to me as a social work student within the community organizing track, where we were often pushed to consider our power and positionality from a strategic perspective in organizing efforts. who or what is the target? what relationships need to be built? is there buy-in from the community? am i part of the community i’m looking to serve or an outsider? none of advances in social work, summer 2021, 21(2/) 720 these questions can be answered without a clear understanding of how you relate to the issue and to those most directly impacted by the issue with whom you organize. on a personal level, this also felt familiar to me as a queer, gender fluid black person in social work school. i often found myself in small conversations of enlightenment around my gender and sexuality – explaining my use of a “they” pronoun when i completed a form for the field office, answering questions from confused peers about what happens inside of our third-floor gender neutral bathroom, and more. these small moments of disruption of cis-hetero-normativity felt in their own way transformative. the critical social work elective seemed to offer the kind of intentional space to reflect on exactly these types of moments, looking at how our identities shape our experiences to understand how critical consciousness shapes (or does not shape) our behavior. from that point of awareness, we as social work students might use that knowledge to take radical action. a student’s reflections on the course syllabus. the course syllabus seemed to be the first place it began the work of disrupting white supremacy. throughout my graduate career, if not all my formal education, i walked into classrooms where the syllabus consistently assigned readings holding the theories of cisgender, straight, white men. this course syllabus clearly centered sources each week that were predominantly black and/or people of color, directly combatting the function of white supremacy to frame whiteness as the official source and authority on all things, from theory to practice. instead, it strategically and sparingly used white voices to lay the foundation of the course. additionally, the syllabus complemented scholarly sources with non-traditional sources, making use of websites of local organizations working towards a national day of racial healing, podcasts from racial justice thought leaders, and articles highlighting “artivists” (artist/activist) practicing these tenets of transformative social work in some capacity. these non-traditional resources helped me make a direct tie to skill in action, grounding my understanding of radical social work as something that is not only possible, but in many ways already happening. accountability and healing within affinity groups. affinity groups provide space to build relationships with others who share similar burdens, to hold us accountable to the work of unpacking those burdens, and healing what lies at the core to take action. to that end, one of the most impactful components of this course for me was my cape group. we formed with the shared goal of unpacking cis-hetero-normativity as a socio-behavioral health issue under the framework of queer liberation. the topic felt especially poignant as a group comprised of three queer, genderqueer people of color (poc; including myself) and a cisgender white woman. our work together throughout the semester brought to light a reality of being within a genderqueer poc body in a white supremacist society: our existence is resistance, and every exchange holds transformative potential. my colleagues and i found that we each brought with us experiences, professionally and personally, where our very presence in a space problematized the “natural” order of things, shifting foundational assumptions that work to deconstruct cis-hetero-normative narratives. during a group exercise, i shared the following experience i had as a yoga teacher working with young people. in one conversation with these elementary student yogis, i revealed that i jemal & frasier/the intrepid elective 721 had a girlfriend instead of a boyfriend. this revelation was met with a mix of shock, awe, skepticism, and curiosity because i am someone who was assigned female-at-birth and who they read as female. this small exchange with my students, which lasted no more than a few minutes, planted a seed of possibility outside of the status quo for these young people. my colleagues shared similar moments of enlightenment as clinical social work interns at sexuality and gender affirming practices, where they were able to challenge the notion of the therapist as a blank canvas by openly identifying parts of their identity such as race, gender, and sexuality, at the start of their clinical relationships with clients. however, it felt awkward to me to have someone within the group who did not hold these identities or openly acknowledge the gaps between our experiences. the intersections of our identities were visible as it became evident that while my white colleague held race consciousness, there was a lack of gender consciousness. in this sense, there was an element of feeling watched or observed as we dove into these conversations about experiences of cis-heteronormativity that prevented me from feeling truly comfortable being vulnerable. vulnerability is where change happens, and i think about what levels of transformative potential i cut myself off from by not openly acknowledging this discomfort with my group. to that end, intersectional affinity groups may be something to explore in future iterations of the course. somatic experiencing and role-play are essential. exercises in role-play and experiential learning may also help create more space for authentic moments of vulnerability. these types of exercises that tap into subconscious responses shaped by white supremacy, and provide opportunities to decolonize the psychic space, have the potential to be transformative (wong, 2020). to be fair, the original curriculum included more opportunities for group-based mutual learning and role-play, yet this was severely impacted by the sudden mid-semester switch to virtual learning due to covid-19. this disruption coincided with the murders of ahmaud arbery, breonna taylor, george floyd, and tony mcdade. in a sense, the class took a shift to creating space to process the trauma of experiencing and living through a pandemic having a disproportionate impact on bipoc communities, in addition to the violent, visible displays of structural racism. i found myself in many of our online small group debriefs grappling with the social work profession’s complicated relationship to state-sponsored violence, which is deeply rooted in white supremacy. class activities provided examples of how transformative consciousness does not always translate into transformative action. the class participated in a virtual group exercise utilizing an applied theatre in education approach. the 60-minute exercise included a scenario in which our class supported a white school social worker in understanding and addressing a black parent’s claim of their child experiencing racism in a private school. i noticed that there were gentle pushes from my white classmates throughout the scenario to help the social worker to understand the parent’s position – asking her if she talked to the parents, reminding her that the parents might have a different perspective from her as people of color, and so on. however, i was surprised and frustrated that none of my white colleagues attempted to “call in” the social worker or explicitly connect with her as a white person who has gone through a similar process of engaging with white fragility (i.e., white defensiveness; diangelo, 2018). throughout the semester, advances in social work, summer 2021, 21(2/) 722 this course asked my colleagues and me to assess our ability to critically respond to oppression, but this end of semester role-play was a window into how we respond in the moment, rather than recalling an experience or talking about how we would respond in theory. similar exercises that elicit authentic, realistic responses make it possible to unpack the difficulty of turning transformative consciousness into action. mindfulness practice to support student exploration. to aid these deep dives into critical social work, it might be beneficial to incorporate elements of a mindfulness practice for students. this could have a two-fold effect: aiding in the emotional management of explicit discussions of oppression and aiding in healing. drawing upon the wisdom of feminist theorists like bell hooks and gloria anzaldúa, asher (2010) writes, “we need to think and feel our way out of oppression and colonization” (emphasis in original, p. 399). a learning space that is committed to anti-racism frameworks can and should bring up a wide variety of emotions linked to the continued subjugation of parts of our identities. this includes continually pushing back against white supremacy’s hallmarks of defensiveness, fear of open conflict, right to comfort, and objectivity over emotion (okun & jones, 2016). while offering a mindfulness component is certainly not an antidote to all that can arise in the course, it is an opportunity to sit and be present for all the responses that arise within us, a chance to “surrender to the weight of being healed” (owens, 2016, p. 74). future directions the second iteration of this class that occurred spring 2021 incorporated applied theatre conventions to develop each dimension of the framework. applied theatre organically and intrinsically encompasses the intrepid method. applied theatre may develop awareness using various techniques and conventions that facilitate dialogue, questioning, and reflection (thompson, 2012). one element that strengthens the effectiveness of anti-racism work with applied theatre is the aesthetic distance provided. aesthetic distance allows participants the space to perceive issues from different viewpoints, to try different perspectives, and to think critically about topics that normally may engage their defensive tactics (jackson, 2008). these techniques can tap into radical imagination that allows people to envision the unknown. the impossible becomes possible once it is imagined. applied theatre can generate creativity (i.e., figuring out what to do) and spontaneity (i.e., figuring out how to do), two key components for inciting critical action, leading to alternative solutions and methods (moreno & fox, 1987). for example, improv theatre uses the “yes and” method. participants can practice saying “yes” to ideas and then contributing ideas to improve the ideas, rather than discarding an idea for its negatives before exploring potential positives. particularly, sociodrama and applied theatre techniques seem to be good strategies and methods for the iterative process of generating ideas and putting ideas into action encompassed in freirian praxis. creative methods can be used to develop efficacy by getting people unstuck and out of their heads; and, consequently into their bodies. theatre is an embodied experience. as such, there is a process of remembering who you are. oppression chips away at a person’s identity until an imposed identity is accepted. when we are no longer our whole, authentic selves, but only bits and pieces of who we are meant jemal & frasier/the intrepid elective 723 to be, we cannot realize our full potential or achieve our purpose. that is when we have internalized oppression and have come to believe the culturally dominant reality-distorting myths and false messages with which we’ve been bombarded. it is through “remembering,” wherein we piece ourselves back together again acknowledging and celebrating our intersecting identities, that we embrace our greatness. that is an act of resistance against white supremacy. tools of applied theatre provide opportunities for behavioral rehearsal and role play so participants can play out ideas, test options, enact various scenarios in a safer environment, and receive feedback to effect better outcomes (lerman, 2003). these techniques, and others, may help develop the skills and comfort level to take action in the real world. one limitation of this course is that it is an elective. in other words, if there is a pattern of clinical students taking “clinical” courses, then this course may be more popular with non-clinical msw students, thus limiting the course’s ability to bridge the micro-macro divide. a few students have commented that this course should be required in the first year. that would allow data to be collected on a non-self-selecting population to further test the course’s validity. it is important to note that, although the course has great potential, there is no empirical evidence to support its effectiveness at putting consciousness into action. however, in addition to being a method of intervention, applied theatre is also a method of inquiry and, as such, can be used to assess and gauge the course’s impact and to inform future directions for the course (leavy, 2015; o’connor & anderson, 2015). more research is needed to understand if and how this course bridges the micro-macro divide and, by extension, if this framework and method develops critical transformative potential as theorized. conclusion social work education is fertile ground to plant seeds that will produce social workers rooted in anti-oppressive and anti-white supremacy transformative potential whose work will steer the field in a radical direction. social work education and practice are interdependent, such that education informs practice and practice influences education. this paper about an elective course in critical social work attempts to bridge the gap between theory, education, practice, and research. the class was informed by the critical transformative potential development framework and incorporated the integrated transformative potential development (intrepid) method to create and nurture critical social work practitioners. “practitioners of [critical social work] study current social realities so they and others can better transform them” (feagin et al., 2015, p. 24). through project-based, interactive learning process and group work, the students simultaneously developed their own transformative potential while learning how to facilitate the development of transformative potential in others (e.g., family, friends, co-workers, employers). as such, this course operated on three levels: 1) a critical examination of social work practice and education for developing critical transformative potential; 2) an engagement of students in development of their critical transformative potential; and 3) gaining familiarity with how to develop critical transformative potential in the field (i.e., the field of social work and in the field with clients). the elective puts theory into practice by transforming consciousness into action within education to support students to advances in social work, summer 2021, 21(2/) 724 challenge white supremacy and other dehumanizing ideologies in their educational institutions, communities, and in collaboration with the future clients they will serve. however, what the class was designed to do and how it presents to a second year msw student may differ. sometimes there is a translation gap; that is, ideas and intentions get lost in translation when converted from the abstract existing in someone’s mind to implementation living in practice. exploration of student experiences expressed in the student evaluations will facilitate the iterative efforts to improve the class. hopefully, this class will have a positive correlation with how the student practices in the field and how they will continue to practice once graduated. if social work is to become a stronger theoretical and practice-based framework that restructures systems of inequitable social relations for the greater human good by disrupting oppressive realities and assisting people struggling for liberation from the structures of domination, then social workers need to decide on the type of social work they will practice and whose interests they will serve (feagin et al., 2015, pp. 24-25). once this is decided, then social work education must be structured to carry out this mission. the way social work education is currently structured sends a clear message about the field’s priorities. in an effort to practice what i teach, and to teach what i research, and to research what i practice; the creation and development of this new elective course is an example of my cape as an msw professor to explore how to incorporate the critical transformative potential development framework and the intrepid method into social work education. i created a theory-informed course that may address white supremacy in social work education and beyond. also, the fact that this class led to a collaboration between a professor and a student who both identify as people of color and occupy other marginalized statuses is a major step toward addressing white supremacy in social work education. as social work becomes more diverse in terms of who does the work, the field can embrace a broader array of human perspectives and knowledge, and more critical questions are raised about traditional perspectives and hidden societal realities (feagin et al., 2015). moreover, bridging the micro-macro divide is an anti-racist approach that is the cornerstone of critical pedagogy. the inclusion of critical pedagogy within mainstream social work education may 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(2020). “please call me by my true names”: a decolonizing pedagogy of mindfulness and interbeing in critical social work education. in s. batacharya & y. r. wong (eds.), sharing breath: embodied learning and decolonization (chap. 9, ebook). au press. https://read.aupress.ca/read/sharing-breath/section/b9887116-43a4-44c4a5d9-9fde9b62e417 author note: address correspondence to alexis jemal, silberman school of social work, hunter college, new york, ny, 10035. email: alexis.jemal@hunter.cuny.edu https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1741&context=open_access_dissertations https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1741&context=open_access_dissertations https://doi.org/10.1037/1524-9220.3.1.41 https://doi.org/10.1002/cd.310 https://doi.org/10.1037/a0037929 https://doi.org/10.1016/j.ijlp.2014.02.023 https://doi.org/10.1080/1533256x.2014.962141 https://read.aupress.ca/read/sharing-breath/section/b9887116-43a4-44c4-a5d9-9fde9b62e417 https://read.aupress.ca/read/sharing-breath/section/b9887116-43a4-44c4-a5d9-9fde9b62e417 mailto:alexis.jemal@hunter.cuny.edu _______ beth sapiro, lcsw, phd, assistant professor, department of social work and child advocacy, college of humanities and social sciences, montclair state university, montclair, nj, and elizabeth b. matthews, msw, phd, assistant professor, graduate school of social service, fordham university, new york, ny. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 655-674, doi: 10.18060/23926 this work is licensed under a creative commons attribution 4.0 international license. both insider and outsider: on conducting social work research in mental health settings beth sapiro elizabeth b. matthews abstract: the mental health clinic poses unique challenges for social work scholarpractitioners. the familiar setting, the nature of mental health data collection, and the researcher’s clinical training and experience all complicate efforts to maintain a reflexive stance in research. additionally, conducting research in a clinical environment risks replicating a hierarchical medical model in the research relationship. using a theoretical framework of critical realism, two doctoral-level scholar practitioners analyzed the advantages and challenges of conducting research in a clinical setting. audit trails and experiences of peer debriefing from their dissertation research served as the basis for this conceptual analysis. the analysis considers the impact of the clinic setting on the power dynamics of the research process, as well as the researchers’ subjective experiences throughout the process of data collection. the authors discuss the risks of othering and the challenges of straddling insider and outsider identities as scholar-practitioners in clinic settings. to navigate these dual identities of researcher and clinician, the authors recommend maintaining awareness of power dynamics and discourses, debriefing regularly with peers and mentors, introducing reflexive practices into both interviews and writing, and moving beyond binary identities in order to occupy a “space between.” keywords: mental health setting; power dynamics; research relationship; social work research; practice-based research social work research is invariably influenced by the contexts within which it takes place (houston, 2010; longhofer & floersch, 2012). both real and socially constructed characteristics of the research setting can influence the power dynamics that exist between researchers and participants. in particular, in many social work practice settings, including child welfare agencies, schools, and outpatient clinics, social workers represent authority figures (shulman, 2016) with power to affect the life circumstances of their clients (kondrat, 1999). for practitioner-researchers, conducting research in mental health clinics poses unique challenges. clinical research settings have the potential to activate specific aspects of both interviewers’ and interviewees’ identities as researchers, clinicians, and/or clients. in clinic-based research, the familiar setting, the collection of mental health data, and the researcher’s clinical training and experience complicate the process of conducting research. wearing “dual hats” of practitioner and researcher in such a setting can both facilitate and inhibit the researcher’s capacity to navigate the power dynamics between the researcher and research participants. this conceptual analysis examined the context of the mental health clinic as the setting for two research projects, both conducted by practitioner-researcher doctoral students. for https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2020, 20(3) 656 this analysis, we reviewed the literature on reflexivity and research in mental health settings. we then applied a critical realist framework in order to analyze how the context of the clinic shaped both the process and power dynamics of the research; specifically, we explored how power and authority were negotiated in the mental health clinic in the arena of othering (sands & krumer-nevo, 2006). we applied three distinct context-specific approaches to reflexivity, each of which were particularly salient in our experience as social work researchers in mental health clinics. the first analyzed the social and discursive context of the mental health clinic; the second identified the impact of the researcher’s own subjectivity, particularly for practitioner-researchers working in mental health settings; and the third perspective examined the intersubjective dynamics between researchers, clients, and service providers in the clinic setting. we identified advantages and disadvantages of holding a practitioner-researcher identity while conducting research in mental health settings, and based on the analysis, we recommend reflexive practices that can aid social work researchers working in this context. theoretical paradigm this analysis was grounded in the philosophical paradigm of critical realism (houston, 2010; longhofer & floersch, 2012). critical realism is a philosophy of social science that seeks to discover “the deeper structures and relations that are not directly observable but lie behind the surface of social reality” (longhofer et al., 2013, p. 158). this stance acknowledges that events and behavior that take place in the real world cannot be meaningfully understood without exploring how individuals make sense of them, based on their assumptions and prior experiences (maxwell, 2013). in this analysis, a critical realist perspective allowed us to recognize both the reality of mental illness, as well as the social discourses that construe how mental illness is perceived, conceptualized, and discussed by providers, clients, and mental health service researchers (longhofer & floersch, 2012). social work practice typically takes place in complex open systems, where the occurrence of events depends on all the observable and unobservable conditions produced in a given context or environment (longhofer et al., 2013). consequently, houston (2010) argued that social work researchers should explore the enabling or constraining unseen generative mechanisms (such as social roles, beliefs about authority, or discourses) relevant to social work practice, and consider how these mechanisms interact in a particular context, time, and with human agency. in this way, social work researchers can explore the interface between the “micro” and the “macro” in a given context (houston, 2010). in any institution, unseen mechanisms function to reproduce social positions and relations (houston, 2010). in this conceptual paper, we analyze how the institutional context of the mental health clinic influenced the process of social work research in that setting. as part of this analysis, we explored the intersubjective and systemic power relations inherent in the mental health clinic, and the impact of these dynamics on research conducted in clinic settings. in keeping with the emancipatory goals of critical realist research (houston, 2010), we explored ways that the power dynamics of the mental health clinic are both reinforced and challenged by participants in social work research. we also found that holding dual practitionerresearcher identities had us straddling the insider-outsider divide in the clinic setting, which had both constraining and facilitating effects on our efforts to navigate these dynamics with sapiro & matthews/both insider and outsider 657 client and provider participants. see table 1 for a summary of our efforts to analyze the impact of the clinic context on the research process. table 1. the impact of the clinic context on social work research 1. the social and discursive context of the clinic has both enabling (transference) and constraining (discourse of mental illness) effects on data collection. 2. the clinic context contributed to researchers experiencing role conflicts and challenges in managing research relationships. 3. the clinic context influenced intersubjective dynamics in research relationships with providers and clients. reflexivity in research for several decades, the insider/outsider debate in the sociological literature has considered the significance of researchers’ social locations in terms of their claims to knowledge (griffith, 1998). researchers with shared lived experience, tacit knowledge, and a high degree of familiarity with the people they study operate as “insiders”; those without the intimate knowledge, shared lived experience, or membership in the community they study approach their research from an “outsider” perspective (dwyer & buckle, 2009; griffith, 1998). researchers’ social locations also influence the assumptions and paradigms they bring to interpreting data (berger, 2015; collins, 1986). the researcher’s knowledge is thus necessarily partial and situated within the researcher’s personal and cultural history (collins, 2000). each position carries unique implications for a researcher’s work; for example, researchers who share a lived experience with participants may have an easier time understanding nuanced reactions and thus enlisting participants (berger, 2015). participants may perceive researchers with insider status as more sympathetic and may disclose more accordingly. however, these investigators may also incorrectly assume similarities in experiences, and may risk blurring boundaries or projecting their own beliefs or perceptions onto participants (berger, 2015). researchers who are outsiders are less likely to experience this kind of role confusion and may have an easier time approaching their work with “eyes open” (asselin, 2003, p. 100). conversely, an outsider’s unfamiliarity with a group may lead them to miss subtle nuances in the research and could increase the likelihood of interpreting data through dominant stigmatizing discourses (berger, 2015; collins, 2000; tew et al., 2006). patricia hill collins’ concept of the “outsider within” (collins, 1986, p. s14) challenges the either/or dichotomy of the insider/outsider debate. collins identifies the unique vantage point of black women in sociology, who have acquired the “insider” perspective of sociological training (which has typically reflected the experiences of white men) while retaining the standpoint of an oppressed social location at the intersection of racism, sexism, and classism (collins, 1986, 2000). researchers’ positions throughout the research process are often fluid, and researchers may find themselves moving between insider and outsider status at various points in the research process, depending on the ways their identity as researcher is constructed in the interactions of research relationships (berger, 2015; dwyer & buckle, 2009; griffith, 1998). advances in social work, fall 2020, 20(3) 658 reflexivity, defined as “our human capacity to consider ourselves in relation to our context, and our contexts in relation to ourselves” (longhofer & floersch, 2012, p. 513) can help researchers make sense of these complex relationships, and is a key component of a critical realist analysis of social work research (longhofer & floersch, 2012). reflexive practices help investigators to recognize the ways in which they function as an integral, influential part of the research setting, process, and interpretation (probst & berenson, 2014), and assist researchers in identifying their biases and reflecting on the emotional impact and power dynamics of the research. by engaging in this process, researchers are better able to illuminate their assumptions and eliminate the presumed neutral, authoritative stance (krumer-nevo & sidi, 2012). building this awareness allows researchers to learn from these moments of vulnerability during the research process (goldstein, 2017). both researchers hold identities as clinical practitioners and as mental health researchers. throughout this analysis, we used multiple practices of reflexivity to explore how both the context of a mental health clinic and our dual identities affected the process and dynamics of social work research in two different studies. reflexive research in mental health settings power relations in the clinic context conducting reflexive research in mental health services is well-served by an acknowledgement that the concept of mental illness itself is a contested domain (tew et al., 2006). numerous approaches to understanding emotional and behavioral challenges exist, ranging from sociological theories of social or political deviance to neurochemical disease (lacasse & gomory, 2003). research in mental health clinics must contend with the dominant biomedical paradigm, or “medical model” of mental illness, which is grounded in a hierarchical approach to expert knowledge and relies on terminology of psychiatric disorder that is frequently stigmatizing (tew et al., 2006). the biomedical paradigm situates the mental health researcher within a position of authority and power relative to their participants (kondrat, 1999). yet a researcher’s work is also reliant upon participants’ willingness to share their substantive and experiential knowledge and expertise about the topic of interest (brinkmann & kvale, 2005). while a researcher’s power is grounded in their choice of research topic, the direction of the interview, and the interview questions, respondents also make conscious choices about their disclosures during the research process, including decisions to withhold information or terminate participation (anyan, 2013). if this duality of power and control remains unaddressed and unresolved, research may merely replicate the prevailing hierarchy of “expert knowledge” by failing to authentically capture the lived experience of the research participant. avoiding this risk requires careful attention to complex dynamics of power, control, and dominance between the investigator and participants, as well as an awareness of how these dynamics influence the knowledge-building process (riley et al., 2003). conducting reflexive research is facilitated through acknowledging participants’ expertise and affirming their right to decide what information to share with the researcher – skills that are often overlooked or underdeveloped within current hierarchical approaches to the researcher-participant relationship. sapiro & matthews/both insider and outsider 659 personal reflexivity in the clinic context researchers are both affecting and affected by the research conducted (few, 2007; probst & berenson, 2014). research that involves active listening to stories of pain, abuse, and neglect takes an emotional toll on the researcher (coy, 2006). practitioner-researchers have training and experience in dealing with emotionally distressing disclosures; yet, if not addressed properly, these can lead researchers to emotionally withdraw from the research out of self-protection (konrad, 2007). this process may be further complicated for those whose clinical social work training gives them insider familiarity and lived experience as a provider of mental health treatment (dobson, 2009; dwyer & buckle, 2009). in this case, clinical training and practice experience can function as a form of habitus (longhofer & floersch, 2012). bourdieu’s concept of habitus describes the embodied personal dispositions that guide individual action as a result of socialization (bourdieu & wacquant, 1992), such as the conventions associated with professional social work training. having a shared sense of language, values, or culture carries with it an existing set of assumptions that can impede the researcher’s ability to process stories that contradict expected narratives, maintain a critical perspective, or encourage participants to speak in ways that challenge an accepted discourse (asselin, 2003; dobson, 2009; van heugten, 2004). the structure of social relations in a mental health clinic can unconsciously activate the institutional habitus of practitioner-researchers and influence interpretations throughout the research process (longhofer et al., 2013). as social work clinicians and researchers, the authors also faced the challenge of maintaining dual identities of practitioner and scholar. instances where the priorities or normative behaviors associated with each identity diverge can create role conflict for the researcher, as she must decide which part of her professional self to draw upon in that moment (colbourne & sque, 2004). personal reflexivity increases one’s awareness of this conflict and requires the researcher to reflect carefully on how her own values and assumptions carry forward into the research process. intersubjective dynamics in the clinic context reflexive practices in clinic-based research require attention to the interpersonal dynamics that occur when the dual subjectivities of researcher and participants meet (goldstein, 2017; jensen, 2012). when researchers invite participants to speak from a particular subject position, they in effect invite them to occupy a specific identity, which may be stigmatized (jensen, 2012). these invitations carry the risk of othering, defined as perceiving people who have been marginalized as foreign, one-dimensional, or a fundamentally different them, in contrast to us who are not suffering, devalued, or marginalized in this way. in research, othering can reflect an effort to seek distance from distressing narratives (konrad, 2007; krumer-nevo, 2002), or a researcher’s tendency to focus on a single dimension of a person’s identity (sands & krumer-nevo, 2006). research with users of mental health services carries unique risks of othering. dominant narratives around health and disability create a binary between those who are healthy and those who are sick (butler et al., 2007; read, 2016). the medical paradigm advances in social work, fall 2020, 20(3) 660 has created normative expectations for recipients of care to behave as cooperative and compliant patients (mccreaddie & wiggins, 2009), while privileging the perspectives of social workers’ expert opinions to define the experiences of others (butler et al., 2007; tew, 2008). practitioner-researchers who have been socialized into these models of understanding, such as the medical model, may risk unintentionally subordinating or pathologizing users of mental health services throughout the process of data collection and analysis (tew et al., 2006). researchers may also find that clients have learned to speak in institutional discourses and may share only the stories they believe interviewers want to hear (butler et al., 2007). for these reasons, research in mental health settings ideally involves both the standpoints of those with insider knowledge along with research frameworks that allow for rigorous analysis (tew et al., 2006). power relations in research are not static; both the researcher and research participants may feel powerful and powerless at different points (goldstein, 2017; jensen, 2012; krumer-nevo, 2002). one sign that othering has been taking place during research is the presence of a shock. such shocks, which can be intentional or unintentional, are unexpected statements or actions by a research participant that generates a cognitive and emotional reaction of surprise in the interviewer (sands & krumer-nevo, 2006). sands and krumernevo (2006) offer several examples of shocks in research interviews, including unexpected emotional reactions (such as participants crying, flirting, or becoming hostile) and research participants who switch roles and ask the interviewer questions. the interviewer’s surprise indicates that her implicit expectations have been disrupted and reveals a clash between the narratives of individuals occupying different positionalities (sands & krumer-nevo, 2006). by puzzling or disarming interviewers, interviewees who deliver shocks gain a chance to renegotiate their stories and resist being depicted in stereotypical ways (sands & krumer-nevo, 2006). case summaries of research projects sapiro has previous clinical experience working as a social worker with adolescents in community-based outpatient mental health services. her dissertation focused on how older adolescents living with mood and anxiety disorders experience their relationships with friends, family, and helping professionals. the dissertation project was part of a larger pilot study of an intervention designed for transition-age youth receiving mental health services. the study included multiple forms of data collection, including quantitative surveys and qualitative interviews with both clients and service providers at an outpatient mental health clinic. data analysis consisted of thematic analysis of interview transcripts. sapiro used several methods to ensure the rigor of her qualitative data analysis, including keeping an audit trail of memos throughout the process of data collection and analyses, consulting with both peers and mentors during the process of analysis, and triangulating analysis by having a second coder analyze code transcripts and review the findings. throughout the analysis, consulting with the second coder helped sapiro become aware of blind spots in her interpretation of data because of her own clinical training and experience. during coding, sapiro also coded for references made by participants to the research relationship; these observations serve as the basis for the current analysis. sapiro & matthews/both insider and outsider 661 matthews previously worked as a clinical practitioner in a community health center. her dissertation examined how electronic health records were being used in therapy and tested the relationship between in-session computer use and the client-provider relationship. this mixed-methods project used video-recorded therapy sessions and postvisit surveys completed by therapists and clients in order to explore the relationship between the frequency and manner of in-session computer use and the therapeutic alliance. matthews used several methods to ensure the reliability and rigor of her coding and analysis. this included co-coding of therapy sessions by a doctoral level research assistant, paired with routine peer debriefing. the audit trail detailing these processes provided the basis for the present study. both studies were approved by the authors’ institutional review boards. the context of the mental health clinic as an institutional social setting (houston, 2010), the functioning of the mental health clinic depends on reliable patterns and practices among administrators, service providers, and clients, much of which were familiar to the authors as former clinicians. this social structure had both enabling and constraining effects (houston, 2010) on our efforts to conduct research in the clinic setting. advantages of the clinic setting as part of participation in both research studies, clients evaluated their experiences receiving mental health services at the clinic. those who felt positively towards the clinic often transferred these warm feelings to the researchers, making the clinic context an enabling factor in some circumstances. in sapiro’s experience, several participants commented that they felt comfortable participating in the study because of the positive associations they had with the clinic and its staff. one participant reported, “i love talking to people here, because every person i’ve met here is a pleasure.” similarly, matthews found that when providers expressed comfort with research participation, clients were more accepting of the study as well. further, clinicians often brokered matthews’s initial introduction to clients. in these conversations, the established trust and rapport in the clientprovider relationship were extended to matthews, allowing her to seamlessly initiate a discussion of research participation. for sapiro, conducting interviews in therapeutic offices also benefited from this association, as participants were used to talking about themselves in this setting, especially about topics they may not easily discuss with others. one youth participant made this explicit when she reported that her experience being interviewed felt similar to her experience in therapy: “i guess it was nice ‘cause i never like, i mean i guess i’ve spoke about it with [my therapist]. i never really like talk about it with anyone else.” when asked about her experience participating in the interview, another youth participant reported, “it’s the same thing as talking to my therapist.” advances in social work, fall 2020, 20(3) 662 challenges of the clinic setting: the discourse of mental illness a critical realist analysis identifies potentially oppressive dynamics of power in a given setting (houston, 2010). in addition to the advantages of conducting research in the clinic, this setting meant that the power dynamics of the therapeutic relationship were highlighted in research interviews. in many ways, qualitative interviews mirror therapeutic interviews: both involve empathic listening, bearing witness to disclosures, and allowing space for participants to develop new understandings of themselves (coy, 2006; goldstein, 2017). the asymmetrical power dynamics of research interviews also mimic those of therapeutic interviews, in that the researcher is the identified “expert” or authority figure who sets the agenda, asks the questions, determines what constitutes data, and retains privilege in interpreting, defining, and writing up the interview (brinkmann & kvale, 2005; krumernevo, 2002). for example, when sapiro asked a youth participant at the conclusion of the interview if there were other questions she should have asked but did not, the participant replied, “oh, i have no idea ‘cause i don’t know what you’re supposed to ask,” implying that the researcher alone held responsibility for directing the research interview. interview dynamics manifest differently depending on the research questions and study design. in participatory action research, for example, researcher authority is more explicitly addressed compared to traditional research interviews (padgett, 2016). regardless of how dynamics of power and authority are ultimately negotiated between the researcher and participant, the presence of this asymmetry persists. in this way, the research relationship echoes but does not disrupt the medical model of expertise and authority in the mental health clinic (tew, 2008). in each of our experiences, we identified ways that participants engaged with or resisted the dominant biomedical discourse of mental illness. our research in mental health clinics seemed to bring to the forefront participants’ feelings about their providers as significant medical authority figures. within the health care context in particular, the construct of a good patient places expectations on individuals to demonstrate a sense of gratefulness towards providers, and a willingness to adhere to prescribed treatment (mccreaddie & wiggins, 2009). much like social desirability can shape participant responses (devellis, 2003), expectations of good patients are salient to clients, who in turn may suppress behaviors or emotions in order to embody the attitudes and characteristics desired by their providers (campbell et al., 2015). in this way, conducting research within the clinic itself complicated and in some ways constrained the process of uncovering clients’ authentic feelings about providers and their care, as the context seemed to activate their desire to perform the good patient role. for matthews, this was apparent in several interviews, where clients offered unprompted reassurances about their loyalty to their provider while completing survey questions relating to their relationship quality and satisfaction. being situated within the therapeutic setting, clients appeared reluctant to betray their providers by exposing ruptures in their relationship or desires for a different type of care. in three separate instances, clients penciled unprompted positive statements into the margins of the paper survey after endorsing an item that could be considered unfavorable to a provider’s behavior during session. for example, one client wrote “these are not important to me, i trust [provider]” after endorsing two items that suggested her provider was not transparent or collaborative sapiro & matthews/both insider and outsider 663 in her note-taking. this need to justify or offset their negative rating with praise seemed to highlight the client’s unwillingness to appear critical of their provider. in response, during the rapport-building stage, matthews was careful to review confidentiality of the data, to normalize the experience of having both positive and negative reactions to therapy, and to distinguish her role from an administrator or evaluator of the clinician’s work. sapiro’s dissertation was part of a larger study described to participants as a way to improve services for young people receiving mental health treatment. perhaps inadvertently, this framing of the research emphasized the power that social workers possess to label, diagnose, and interpret behavior (butler et al., 2007). despite researchers’ efforts, by conducting research in a mental health clinic, the roles and power of the clinician and the researcher were often blurred in the minds of participants, adding to the power differential in the interview. in sapiro’s experience, the biomedical model of mental illness was reinforced through some of the language used by the larger study, which surveyed youth participants about their symptoms and asked about previous hospitalizations. some participants referenced the stigmatizing language of mental illness, while others found ways to reclaim it as a point of pride. following consultations with her second coder, sapiro identified the habitus of clinical social work in her tendency to use clinical terms (such as defenses, coping mechanism, or social anxiety) to describe research participants. in a memo from the data analysis, sapiro wrote, [second coder] notices that just because someone self-identifies as very shy, does not automatically mean that they have social anxiety it may be regular adolescent shyness. my bias may be towards diagnosis, because of my background and because the interviews are taking place in a clinical setting. this framework undoubtedly contributed to sapiro seeing participants through the dominant or “insider” lens of mental illness and mental health services (read, 2016), in spite of all of her efforts to the contrary. in this way, conducting research in a mental health clinic poses risks for othering. one research participant referenced this idea explicitly. in describing her general unwillingness to participate in therapy, she described how she did not want to be treated in any clinical or other encounter: it’s like they look at all the clients or patients, whatever, the same, you know. she’s someone who went through this or this happened, you know. i have more to my life than being this little like a lab rat that you’re testing. throughout the research process, we found that participants actively engaged with the norms, logic, and dominant biomedical model of the mental health clinic. researcher experience in the clinic setting our second analysis of the impact of the clinic context involved reflection on our subjective reactions and interactions during the research process, focusing specifically on how clinical training shaped our thoughts and behaviors as mental health service advances in social work, fall 2020, 20(3) 664 researchers (longhofer & floersch, 2012). for both authors, our past experiences as clinical social workers contributed to role conflicts and challenges with managing researcher relationships during data collection and analysis. role conflicts as both of us brought our past experiences of clinical social work to our research, an initial task was to negotiate a new role, as researcher and doctoral student, within a familiar setting. being trained as social workers required effort to ensure that our research curiosity was not limited by a clinical lens. clinical training can serve as a kind of habitus, or disposition, that can affect a researcher’s experiences with participants and with interpretations of their narratives (longhofer & floersch, 2012). we each encountered instances where our dual identities came into conflict, leading to dilemmas during data collection. matthews video-recorded therapy sessions and coded them for particular behaviors related to providers’ computer use. viewing these recordings provided opportunities to witness both exceptional and problematic therapeutic work. in one instance, she observed a session in which a client disclosed suicidal ideation and the clinician failed to adequately address the risk. in spite of a strong sense of professional obligation to protect the safety and well-being of the client, matthews recognized that her role as a researcher, rather than a clinician, placed new limitations on her opportunities to intervene. matthews used peer debriefing to process and consider this conflict. through gentle probing, despite her lingering discomfort with this scenario, matthews recognized that, particularly as the client in question was actively engaged with both a therapist and a psychiatrist, asserting any type of clinical expertise into this scenario would have overstepped her boundaries as an outsider and academic researcher. sapiro experienced a different version of this conflict when interviewing clients in a mental health clinic. interviewing participants in acute emotional distress engendered feelings of sadness, anxiety, and exhaustion, even when she was able to help connect these research participants to mental health services. during the interviews, sapiro was aware of the potential need to stop the research and contact a supervisor in the event of a participant who appeared to be at risk of harm to self or others. although the need never arose, staying alert to this possibility meant an inability to fully disengage from clinical assessment during the research interview, and may have contributed to the use of clinical terminology in interpreting data as described above. coy (2006) and colbourne and sque (2004) have described similar conflicts, noting that, when conducting research with people in distress, researchers with practitioner experience may struggle to divorce themselves from the role of a clinical professional. though the skills learned as a clinician may be helpful for gaining insight into respondent behaviors and establishing rapport during interviews, they can also obfuscate the goal of the research project and the role of the researcher. careful reflection must be used to determine when the employment of clinical skills is a useful tool, as when fostering rapport, or broaching sensitive topics, and when role conflict is arising due to an unwillingness to “let go” of one’s clinical role. for both authors, “letting go” was uncomfortable, though peer debriefing helped us reflect on the challenges of being a researcher, rather than a sapiro & matthews/both insider and outsider 665 clinician. in these situations, we were reminded that in spite of our clinical training, we were still “outsiders” in these clinics. managing research relationships matthews conducted her research within a mental health clinic that was a former place of employment, which raised specific challenges in establishing and maintaining research relationships with the agency. matthews’s lingering feelings of affiliation with the clinic created loyalty tugs (brannick & coghlan, 2007), where she felt compelled to prioritize the desires and expectations of the organization over those of the study, even when they clashed with her priorities as a researcher. for example, during the project, she needed to both ask for logistical assistance from already overburdened staff members, and tactfully decline administrators’ requests to view study data for their own purposes. in these instances, she struggled to balance the desire to maintain a positive working relationship with the organization, while upholding the standards of ethics and rigor in her research. fortunately, during this time matthews was simultaneously involved in another study involving primary data collection with a different group of mental health clinics. the two studies served as a useful exercise to compare and contrast approaches towards establishing a working relationship with familiar versus unfamiliar organizations and staff. this reflection helped matthews identify instances where her discomfort was triggered by an inclination to operate according to the chain of command that defined her former role as a clinician (insider), rather than her current role as an independent researcher (outsider). intersubjective dynamics in the clinic setting power is omnipresent in social interactions (houston, 2010). the final application of critical realism to these studies involved a focus on how the stratified social world of the mental health clinic, with its particular power dynamics, manifested in the research relationships we developed with both service providers and clients. these examples illustrate how the research relationships were affected by the researchers’ identities as both insiders and outsiders. relationships with providers in matthews’s experience, the existing trust and rapport clinicians had with clients meant that providers functioned as gatekeepers to client access. providers served variably as a bridge or buffer between the researcher and the clients, either facilitating or precluding access to potential respondents depending on their own assessments of clients’ suitability for research participation. in several instances, providers buffered access by preempting attempts to recruit client participants if they assessed the individual to be acutely distressed or in a delicate stage of treatment engagement. coy (2006) identified a similar dynamic, whereby researchers assumed the task of evaluating a potential respondent’s fitness to participate. though a well-intentioned effort to protect vulnerable clients from undue harm, by determining their ability to participate on their behalf, these decisions ultimately minimized client autonomy and reinforced providers’ power over participants. this placed matthews at the intersection of two principles of ethical research: autonomy, in which the advances in social work, fall 2020, 20(3) 666 respondent’s decision authority is respected, and beneficence, which demands research participants are not harmed by the research process. for sapiro, the power dynamics in interviews with providers offered several examples of shocks that suggested these interviews were taking place in the arena of othering (sands & krumer-nevo, 2006). as a clinical social worker, sapiro saw herself as an insider: she identified with the clinicians and expected these interviews to proceed without friction. however, a number of staff members seemed to feel nervous, uncomfortable, or somewhat reluctant to be interviewed, and expressed this in a variety of ways: by joking, by presenting as standoffish, or by acknowledging a wish to have prepared for the interview in advance. for example, one provider reflected on her experience responding to sapiro’s questions: it makes me have to think because, you know, i didn’t know what the interview was gonna be about, right…. so i had no way to mentally prepare, which is something i always like to do, right, is mentally prepare for whatever i know is coming. i couldn’t mentally prepare, so i definitely had to think more as i was talking to you, which is fine, you know. these reactions served as a corrective shock to sapiro’s assumption that her status as a presumed insider would facilitate the interview process and reduce interview-related anxiety. upon further reflection, sapiro recognized that providers’ reactions could have reflected general attitudes about research participation. in addition, clinicians who are accustomed to assuming a position of relative authority in their therapy offices may find being the interviewee, rather than the interviewer, to be uncomfortable or unexpected. matthews also had an experience of assuming to be an insider, only to find that she was perceived otherwise. data collection relied heavily on earning the trust of providers working within the agency. having the shared experience of being a clinical social worker who had worked within the organization, matthews began her recruiting of provider participants with the expectation that her shared group membership would award her a degree of cultural capital (bourdieu, 1986). she anticipated gaining trustworthiness and buy-in from providers through her insider status. despite the purposeful disclosure of her shared background, matthews was surprised to discover that she was viewed first and foremost as an academic researcher, rather than a former clinical employee or colleague. ultimately, the attempt, and failure, to connect with providers using this assumption of “sameness” squandered precious opportunities to gain their buy-in for this study. being more aware of how providers were perceiving her would have enabled matthews to forge a more authentic collaborative relationship with providers. relationships with clients the dynamics of interviews with clients also reflected meetings in the arena of othering. research participants knew that they were participating in these studies based on their status as clients of the mental health clinic (jensen, 2012). with this knowledge, they both engaged with and resisted the stereotypes of mental illness and client-provider relationships in various ways. this played out in the frequent conformation to the role as the good patient observed during matthews’s interviews with clients, where clients offered unsolicited assurance of their appreciation of and connection to their providers. there were sapiro & matthews/both insider and outsider 667 also instances of clients subtly bucking these expected norms and behaviors of compliant patients. these behaviors were most apparent during the video-recorded sessions, when several clients engaged in a dramatized process of primping for the camera, in an apparent attempt to take ownership and control of the recording process. in the middle of one session, one respondent took a moment of silence between he and his therapist as an opportunity to make faces at the camera, demonstrating that his awareness of his research participation had not waned, even as the camera rolled silently in the corner of the office. sapiro interviewed one young woman who was very clear about her intention to challenge stereotypes by representing herself as a young person who lives with mental illness and has a very supportive group of friends: people with mental illnesses, alright, they’re portrayed in like a certain way, and i feel that now when i’m telling you about how i have friends and everything like that and how like i live fairly happily for most, for a good part of my life. it’s very important to me to talk to somebody else, to let them know that there’s that stigma, like what you’re talking about that like mentally ill people can’t hold friendships, they can’t have like interpersonal relationships, things like that. and i think that that’s something that people shouldn’t look at and they shouldn’t think that, you know, someone is like sick so it prohibits them from doing x, y, z. before, during, and after interviews, youth participants made a number of comments that referenced the power dynamics of the interviews, reflecting their awareness that as the researcher, sapiro retained both the audio record and the interpretive privilege over the stories that they had shared. a number of participants commented that it was their first time being audio-recorded for an interview. at the beginning of her interview, after reviewing the purpose of the interview and giving consent to audio-record, one participant commented, in jest, “wow, i feel really weird. i feel like i’m being interrogated.” at the end of the interview, sapiro asked her to reflect on her experience, and her response reveals both the similarities and differences between participating in research and being a patient at the clinic: i’ve never done like part of a research kind of study thing, so i’ve always wanted to. i don’t know why. i’ve always wanted to be like a guinea pig, you know. i mean, i don’t really feel [like one], probably because like, i don’t know, you know, like i know i’m a guinea pig, but i don’t feel like a guinea pig right now. so it’s okay. like i’m not in a lab getting like blood taken or something. another young woman demonstrated acute sensitivity to the potential for adults to abuse the power they have over young people. she described her encounters with certain teachers at her school in this way: there are other teachers who are just like, i’m sorry, i can’t do that for you because i don’t know, like they don’t have to or whatever it is… they’re like i’m sorry, i can’t do that for you or because you know, they don’t feel like it and it’s just, like, taking extra time out of their day. and they also, like don’t, like, give the student any power; it’s just like whether i feel like doing it or not for you. advances in social work, fall 2020, 20(3) 668 in her two interviews with this participant, sapiro was conscious to be as transparent as possible in her role as an interviewer and a collector of survey data. at the end of the second interview, the youth said to sapiro, “you’re really good at your job.” sapiro was grateful for the compliment as a novice researcher and thanked her. the participant continued, “you’re not like one of those gynecologists who doesn’t tell you what they’re going to do and then just sticks you with things.” once again, an interviewee delivered a shock that prevented sapiro from seeing herself as an innocuous or benevolent researcher who stood apart from the medical bureaucracy of the clinic. it is difficult to imagine a more invasive metaphor for research participation, even for a young person who actively consents to participate. recommendations using a critical realist analysis, we highlighted how the context of the mental health clinic impacted multiple components of the research process. as early-career researchers, this reflection sensitized us to practices that can enhance our awareness of the role of context in future research projects. drawing from these experiences, we offer several recommendations for practitioner-researchers looking to maintain a reflexive stance while conducting research in familiar clinical environments. these recommendations are summarized in table 2. table 2. summary of recommendations reflexive practice associated skills, strategies & actions recognize power dynamics • consider how & why power dynamics may shift throughout the process • partner with service users in research use debriefing • schedule debriefing regularly as a tool for reflection • seek out peers & mentors who may have particular insight into the research project or population of focus be alert to discourses • proactively explore how participants understand their experience • explore what principles & practice models guide practitioners in the research setting recognize “both/and” status • identify & challenge one’s own automatic assumptions • partner with collaborators whose standpoints differ from your own interview and write reflexively • leave room for persistent follow-up questions to elicit complexity • portray participants authentically & avoid stereotypical depictions recognize power dynamics critical realism recognizes the omnipresence of power dynamics in social interactions, especially in stratified social settings such as agencies (houston, 2010). the hierarchies of mental health clinics and the power dynamics of the client-provider relationship manifested as unseen mechanisms in each of our studies in several ways. as researchers, it is incumbent upon us to recognize these dynamics and their impact on research participants. in any social work setting, including schools, child welfare agencies, or other systems of care, people’s prior experiences with social workers (as well as researchers and other authority figures) will impact how potential research participants experience their interactions with researchers in these settings. these power dynamics are not simple or sapiro & matthews/both insider and outsider 669 straightforward, as our experiences demonstrate; rather, they are constantly shifting depending on the particular individuals and agendas involved. we recommend that researchers partner with service users in the development of research projects, in order to ensure that their valuable standpoint is incorporated into each level of the research project (tew et al., 2006). use debriefing for both authors, the process of debriefing with both colleagues and mentors was an important strategy for managing the unavoidable challenge of conducting research with people in pain. just as regular supervision helps clinicians reflect on their work and identify emotions and dynamics within the therapeutic relationship (d'cruz et al., 2005), regular debriefing with peers and mentors serves a similar function throughout the research process. peer debriefing is an established method for maintaining rigor and credibility in qualitative research (shenton, 2004). for us, peer debriefing also helped us interrogate our assumptions and reactions, process the dilemmas that arose during data collection and analysis, and differentiate our dual and sometimes competing identities as scholars and practitioners. in sapiro’s experience, having a peer coder who was not a clinical social worker helped correct for some of her biases in interpretation owing to her clinician habitus. both researchers were also fortunate to have academic mentors with clinical backgrounds. these seasoned scholars, who had both worked as clinicians and conducted research in clinical settings, were clearly able to understand and respond to instances of conflict as described in the preceding sections. for example, when matthews was surprised that providers perceived her as an outsider, her mentor related by reflecting on specific instances where her own experience as a case manager influenced her research relationships with case management programs. hearing these experiences, in addition to witnessing how this mentor navigated current research relationships, offered a model for how to resolve tensions between the practitioner and researcher role. similarly, sapiro found it invaluable to talk through with her mentors the ethical dilemmas inherent in conducting research with participants in various levels of emotional distress, as well as how to manage situations in which respondent well-being trumps the collection of research data. we recommend that practitioner-researchers in particular deliberately make room for reflection during debriefing sessions, and seek out mentors, colleagues, and peers to help them identify the conscious and unconscious dynamics present in their research. be alert to discourses in each of our studies, we identified diverse ways that people conceptualized and made sense of their psychological distress. suffering that was labeled as mental illness was variously understood by research participants as a response to trauma, a quirk of the brain, or a source of vulnerability and shame. a critical realist approach to mental illness recognizes that the suffering of individuals living with mental health difficulties is real, and at the same time, people can construe this suffering in various ways, each of which can have different effects on individual life experiences. our experiences as researchers in mental health clinics reminded us of the need to be aware of the discourses that we and advances in social work, fall 2020, 20(3) 670 others rely on to make meaning of our own and others’ experiences. during our research projects, we witnessed clients both resisting and embracing conventional notions of ‘mental illness’ and ‘mental health patients,’ each of which uniquely influenced how participants related to and responded to the research process. drawing from these experiences, we recommend that practitioner-researchers proactively explore how participants understand their suffering, and consider how various constructions of mental illness affect both researchers and participants. we also recommend that social work researchers investigate the models of practice that social workers in various settings use to make sense of their work, and consider if and how these models could be oppressive and/or emancipatory for service users. these efforts can promote more respectful and authentic relationships with clients, increasing the potential for more meaningful and complete study participation from client respondents. recognize insider/outsider status as “both/and” both authors experienced instances of wrongly assuming insider status. particularly for matthews, many challenges stemmed from her assumption that she was carrying out her study as both a professional and organizational insider. at various stages of the project, both authors found this expectation to be alternately validated and violated, creating challenges that required careful and explicit reflection. our experiences confirm those of other scholars who recognize that researchers are constantly moving between insider and outsider status in research relationships (griffith, 1998). especially when investigating dimensions of social difference and marginalization, researchers are often both insiders and outsiders (collins, 2000; griffith, 1998). to this end, dwyer and buckle (2009) suggest that conceptualizing oneself as either “out” or “in” imposes reductive and arbitrary expectations of complete sameness or difference. instead, these authors offer an alternative framework of occupying the “space between,” to fully appreciate the complexity of human experience and recognize more authentic instances of similarity and difference that cut across group membership or affiliation. in keeping with our emancipatory goals of conducting research with members of marginalized communities, challenging the automatic categorization of participants is one way of interrogating assumptions associated with dominant patterns of thought (collins, 1986; griffith, 1998). similarly, collins (2000) reminds researchers that our knowledge is inevitably partial and situated within our social locations and personal histories. collaboration with people whose standpoints differ from our own increases the potential for new insights and angles of vision (collins, 2000). interview and write reflexively reflexivity also requires attention to the representation of the other in the research, since writing about members of marginalized groups has the potential to either challenge or reinforce stereotypes (collins, 2000; krumer-nevo & sidi, 2012). in all of the research interviews, we approached participants with the assumption that they were the experts on their own life experiences and worked to listen intently and respectfully while staying aware of what we did not know and wanted to know. when research participants are members of marginalized groups, there can be a tendency for people to present themselves in ways that conform to stereotypes (sands & krumer-nevo, 2006), such as the idealized sapiro & matthews/both insider and outsider 671 compliance of a “good patient” (mccreaddie & wiggins, 2009). researchers and participants alike may unconsciously expect interviews to follow “master narratives” that reflect the beliefs of dominant groups about groups that are stigmatized or subjugated (collins, 2000; sands & krumer-nevo, 2006). these narratives often preclude the representation of members of marginalized groups as multifaceted and complex individuals (sands & krumer-nevo, 2006). in our experience, participants engaged with these stereotypical controlling images (collins, 2000) in various ways. the challenge is to listen in a more complex way that rejects the stereotype, affirms the interviewee, and helps her present herself in a fuller way (krumer-nevo, 2002). one way to get underneath this mainstream discourse is to leave room for persistent follow-up questions, which can reveal complexity behind a seemingly simpler narrative (gilligan, 2015; krumer-nevo, 2002). as one example, sapiro asked each research participant to reflect on their experiences being interviewed, as a way to invite participants to actively shape their own representation in the interview, as well as comment on the dialogue between interviewer and participant (collins, 2000; krumer-nevo & sidi, 2012). while the practice of reflexivity was particularly salient throughout the data collection and interpretation phases, the final challenge involved efforts to avoid othering in the writing stage of this project. as practitioner-scholars who toggled between insider and outsider statuses in the clinic settings, we both were conscious of how our identities influenced the collection and interpretation of data, as well as the ways that they were constructed in interactions with research participants (griffith, 1998). given the restricted and frequently pathologizing nature of a clinical lens, sapiro endeavored to represent participants in their full complexity and inconsistency, in order to ensure that the descriptions did not conform to stereotypical depictions of a problematic, blameworthy, or pitiable person. in the same way, sapiro attempted to represent the many strengths of research participants without romanticizing them or minimizing the challenges they faced. this effort sought to counter some of the common tendencies by which members of marginalized groups are often othered in social work research (krumer-nevo & sidi, 2012). while our social locations as practitioner-researchers contributed particular standpoints to this research (collins, 2000), we were also reminded of the need to collaborate with service users whose perspective provides a necessary corrective to our own blind spots. conclusion throughout this paper, we have discussed several challenges encountered in our experiences conducting clinic-based research while holding dual identities of both researcher and practitioner. we have also identified ways in which deliberate engagement in reflexivity helped uncover ways that the context influenced our research, through unconscious expectations, assumptions, and pre-existing patterns of 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(2004). managing insider research: learning from experience. qualitative social work, 3(2), 203-219. https://doi.org/10.1177/1473325004043386 author note: address correspondence to beth sapiro, department of social work and child advocacy, montclair state university, 1 normal avenue, montclair, nj, 07043. email: sapirob@montclair.edu https://doi.org/10.1177/1049731512445509 https://doi.org/10.1016/j.ijnurstu.2009.01.008 https://doi.org/10.1177/1473325013506248 https://doi.org/10.1177/1473325016652679 https://www.qualitative-research.net/index.php/fqs/article/view/713/1545 https://doi.org/10.1177/1077800406288623 https://doi.org/10.3233/efi-2004-22201 https://doi.org/10.1177/1473325008093702 https://www.birmingham.ac.uk/documents/college-social-sciences/social-policy/iass/publications/social-research-mental-health.pdf https://www.birmingham.ac.uk/documents/college-social-sciences/social-policy/iass/publications/social-research-mental-health.pdf https://doi.org/10.1177/1473325004043386 mailto:sapirob@montclair.edu both insider and outsider: on conducting social work research in mental health settings beth sapiro elizabeth b. matthews theoretical paradigm advantages of the clinic setting researcher experience in the clinic setting managing research relationships intersubjective dynamics in the clinic setting relationships with providers relationships with clients using a critical realist analysis, we highlighted how the context of the mental health clinic impacted multiple components of the research process. as early-career researchers, this reflection sensitized us to practices that can enhance our awareness ... recognize power dynamics critical realism recognizes the omnipresence of power dynamics in social interactions, especially in stratified social settings such as agencies (houston, 2010). the hierarchies of mental health clinics and the power dynamics of the client-provider re... use debriefing interview and write reflexively _____________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2018 author, vol. 18 no. 4 (fall 2018), ii-iv doi: 10.18060/22908 this work is licensed under a creative commons attribution 4.0 international license. editorial: innovations in social work margaret e. adamek social work is a diverse, growing, and dynamic profession with new areas of practice emerging all of the time. in the fall 2018 issue of advances in social work we are pleased to present 14 manuscripts--11 empirical, 3 conceptual--written by 38 authors from 13 states across the u.s., representing the east coast (ct, fl, ma, ny), the midwest (ky, il, in, mn), the west (ca, id, or) and the south (la, ms). three papers address cutting-edge issues relevant to social work research, five papers present innovations related to teaching, and seven papers present practice-related advancements. a diverse array of topics are addressed including public access to research, social work in libraries, young minority fathers, social work supervision, virtual teaching, resilience of msw students, perinatal depression, text-based crisis counseling, gun safety, civic engagement, depression education for high schoolers, sbirt implementation, evidence-based practice, and selfcare among social workers. we are privileged to offer the contribution of these scholars and practitioners to advancing the knowledge base of the profession. research innovations based on her expertise as a social work librarian, pendell questions the ability of social work practitioners to fully carry out research-informed practice when their access to published research is largely restricted by paywalls. finding that over half of a random sample of articles from the top 25 social work journals did not offer full-text access, pendell encourages social work authors to publish in open access journals and use full-text digital repositories. provence reviews public library policies that treat individuals experiencing homelessness as problem patrons, essentially criminalizing homelessness. in support of the trend of public libraries hiring social workers, provence calls for schools of social work to partner with public libraries to assess the needs of patrons, particularly those with social service needs, so that public libraries can be inclusive and supportive of all patrons. young minority fathers are another underserved population. to enhance services to this population, mogro-wilson, loomis, hayes, drake, martin-peele, and fifield conducted face-to-face interviews with young fathers participating in a larger rct of a fatherhood intervention to examine their perspectives on recruitment and retention strategies. the young fathers preferred non-traditional strategies such as intensive community outreach, culturally competent recruiting specialists, and flexible contact methods. teaching innovations pedagogical innovations in social work are typically designed for bsw students or msw students. one school included an experiential exercise in a bsw practice course that involved msw students as peer supervisors. each bsw student was matched with an https://creativecommons.org/licenses/by/4.0/ adamek/editorial iii msw student who was taking a course on supervision. fisher, simmons, and allen used mixed methods to evaluate the semester-long supervisory exercise. the goal of the exercise was to help bsw students be better prepared to take advantage of supervision once they entered their field placements. while literature on strategies for effectively engaging students in online courses has grown tremendously, there is much less attention to the need for community among online instructors. schwartz, weiss, and wiley describe a variety of institutional and programmatic interventions designed to promote community and collaboration among faculty who teach virtually. creating strategic opportunities for virtual and ground-based faculty to connect both informally and formally has the potential to foster a culture of inclusivity, connection, and a productive community of practice. acknowledging that many students come to social work education with substantial trauma histories, thomas and beecher conducted a study to examine the association between adverse childhood experiences (aces) and resilience in a sample (n=139) of msw students. interestingly, their data showed a positive relationship between higher ace scores and resilience. social work educators are called to acknowledge risks associated with students’ avoidant coping and provide learning experiences aimed at developing students’ capacities for increased awareness and acceptance of challenging experiences—their own and others. a sample of 177 msw students from five public universities in california were surveyed by goyal and han regarding their course instruction related to perinatal depression (pd). less than one in five acknowledged receiving such training which is concerning given the well-documented association of pd with child abuse/neglect and domestic violence. to promote maternal and infant well-being, goyal and han advocate for content on early pd screening, identification, and referral to be incorporated into both msw curricula and continuing education. practice innovations in our increasingly digital world, providers need to be adept at meeting the needs of clients using various technology formats. nesmith examined the counseling process between young adults seeking crisis intervention and providers who use a texting format for counseling. the privacy and flexibility afforded by texting might lead some individuals to seek help who might otherwise avoid face-to-face intervention. nesmith encourages the development of best practices for texting-based crisis intervention. logan-greene, sperlich, and finucane argue that social workers are in an excellent position to encourage gun safety with at-risk populations such as families with children, families experiencing violence, and individuals at risk of suicide. their review of social work sources indicates that clinical guidelines and research on preventing gun violence has lagged in social work compared to other disciplines. service-learning is an increasingly popular pedagogical approach. lim, yang, maccio, and bickham explored the utility of service-learning compared to traditional-learning methods in advanced policy courses. service-learning may be used not only to enhance advances in social work, fall 2018, 18(4) iv policy practice efficacy, but also student engagement and enthusiasm in relation to policy advocacy. peers are a strong influence in adolescence. while typically we think about peer influence among youth as a negative force, kelly, freed, kubert, and greibler demonstrate how peer influence can be leveraged as a tool for combatting depression and preventing suicide among youth. they report on their evaluation of the intervention, real teenagers talking about adolescent depression, a video-based classroom discussion intervention created by social workers, parents, and youth. ultimately, building mental health awareness in school communities is critical to helping to prevent depression and suicidal behavior. evidence-based protocols such as sbirt are heralded as best practices in working with individuals facing substance addiction. however, the effectiveness of such protocols may be compromised by a lack of congruence to model fidelity. vinjamuri, ogden, and kahn examined how social work faculty, student, and fieldwork instructor approaches to using the evidence-based sbirt protocol affected implementation and model fidelity. efforts to find a fit between the protocol, settings, and professional approaches to social work often led to implementation but questionable model fidelity. repeated exposure to new material and opportunities to engage with it, having specific tools, and supporting learners’ efforts to uphold social work values can promote faithful implementation. chonody and teater explored social workers’ perceptions of evidence-based practice (ebp) as either a process, a product, or some combination. given the centrality of ebp in social work and based on their findings, chonody and teater recommend that instruction on the process of ebp be offered as mandated continuing education hours, much like ethics has been added as a requirement in some states. self-care is one of those things that we all know we need to do, and yet many of us fail to prioritize in our lives. miller, lianekhammy, and grise-owens examined the self-care practices of over 1,000 social workers, finding only moderate involvement in personal or professional self-care. if social workers are to excel in caring for others, we must find ways to take better care of ourselves in the process. we hope that our readers find value in this set of empirical and conceptual papers as we endeavor to contribute to the advancement of scientific knowledge in social work. in this issue we have included acknowledgements of 139 individuals who reviewed manuscripts in 2018. these reviewers represent 6 countries, 33 states and 2 territories, and 71 different colleges or universities. without their contribution to the manuscript review process, advances in social work would not be possible. in memoriam finally, we would like to acknowledge the untimely passing of our colleague, dr. jim hall, who served as both board member and reviewer for advances in social work throughout his tenure at indiana university school of social work. we are saddened by this loss, but are very grateful for his many contributions to the journal and to scholarship in the field. we are reminded of the fragility of life and the importance of each moment. accordingly, we encourage all of us to intentionally value and support all those in our learning communities. __________ isaac karikari, phd, msw, assistant professor, university of north dakota, department of social work, grand forks, nd. james r. brown, phd, msw, assistant professor, indiana university school of social work, bloomington, in. gifty dede ashirifi, phd student, indiana university school of social work, indianapolis, in. james storms, m.s., school counselor, custer baker intermediate school, franklin, in. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 61-81, doi: 10.18060/22928 this work is licensed under a creative commons attribution 4.0 international license. bullying prevention in schools: the need for a multiple stakeholder approach isaac karikari james r. brown gifty dede ashirifi james storms abstract: since bullying is an ecological and systemic phenomenon that occurs in multiple contexts with multiple actors, it makes sense to consider the perceptions of multiple stakeholders and their relationships with one another and in relation to bullying prevention in schools. using a non-probability, purposive sample, this study examined the perspectives of 45 school stakeholders, namely, principals, school social workers, bus drivers, and parents from an urban school district in the midwest. the study unveils some of the implicit and explicit challenges associated with bullying prevention efforts. for example, bullying can be quite nebulous because people tend to look at the issue through the prism of their own experiences and positions, limiting their understanding of other stakeholders. some stakeholders’ perspectives may be muted when bullying behaviors are discussed or reported. overall, the findings support the use of multi-stakeholder approaches in developing a more holistic view of bullying. recommendations include avoiding the reification of the views and voices of a select few and having a more open system of dialogue among stakeholders to create inclusion when addressing bullying. keywords: bully prevention; stakeholders; interventions; schools research suggests that bullying is pervasive in schools (national academies of sciences, engineering, and medicine [nasem], 2016; robers et al., 2015; vaillancourt et al., 2010) and remains a serious precipitating factor for mental and emotional disorders, violent and aggressive conduct, physical injuries, and poor academic outcomes. bullying is also associated with poor educational outcomes including low student retention and teacher attrition (dake et al., 2003; mehta et al., 2013; olweus, 1993; whitley et al., 2013). nationally, 17.9% to 30.9% of students mostly in 4th to 12th grades are impacted by school bullying. further, 6% to 14.8% of the students experience cyber-bullying (nasem, 2016). these estimates are based on nationally representative samples from the school crime supplement (scs) of the national crime victimization survey (ncvs), the national school-based youth risk behavior survey (yrbs), the health behavior in school-aged children (hbsc) survey, and the national survey of children's exposure to violence (natscev) with data from the 2009 to 2013 school years. other estimates of bullying among high school students nationwide, based on the 2015 and 2017 yrbs reports, show prevalence rates of 20.2% and 19%, respectively (centers for disease control and prevention, 2018). https://creativecommons.org/licenses/by/4.0/ karikari et al./bullying prevention in schools 62 in view of the ominous effects of bullying, including student suicides, school bullying remains a major social problem and public health concern (cornell & limber, 2015; nasem, 2016). despite the pervasiveness of bullying, its manifestations may vary from one context to another (hong & espelage, 2012). people’s views of bullying are likely to be shaped by factors such as their social and cultural orientation as well as their perception of the world around them. in addition, both personal and professional experiences serve as filters for how people may explain or interpret bullying behavior (bourdieu, 1984; reeddanahay, 2005). these multiple contexts contribute to the likelihood of both deliberate and unintended bias in bullying discourse. therefore, multiple and counter-perspectives, are essential to consider in creating a comprehensive understanding of the complexity of bullying (bradshaw et al., 2013; flygare et al., 2013; hong & espelage, 2012). further, research involving different stakeholders and the synthesis of multiple perspectives can aid in the critical examination of bullying to facilitate the development of viable solutions (hong & espelage, 2012; hymel & swearer, 2015; kim, 2017). thus far, such research appears to be limited. therefore, this study examined key stakeholders’ perceptions of school bullying and prevention efforts. literature review bullying is described as deliberate acts of repetitive abuse intentionally aimed at an individual or group by another individual or group (aalsma & brown, 2008) and may occur in a number of forms, including physical, verbal, or written acts of aggression. bullying can also be relational, and is often characterized by power differentials (oliveira et al., 2018; olweus & limber, 2010). school bullying is a complex phenomenon that defies spatial boundaries because it is not confined to any one particular place within the school environment (richard et al., 2012; vaillancourt et al., 2010). for instance, in a study of 2,766 dutch schoolchildren, fekkes, pijpers, and verloove-vanhorick (2005) found that bullying occurred in almost every conceivable space within the school environment including the playground, classrooms, school canteens (cafeteria), gym, and bathrooms. the study participants also noted that bullying occurred by bicycle racks outside the school and near their homes. in robers and colleagues (2015) indicators of school crime and safety report, students in the u.s. reported bullying occurring in similar areas as well as on school buses. several studies, domestic and international, have corroborated these findings (e.g. oliveira et al., 2018; richard et al., 2012; vaillancourt et al., 2010). in an attempt to understand and address bullying, there has been a significant focus on the perspectives of students; specifically, as aggressors, victims, and bystanders (ross et al., 2017). teachers are fairly represented in bullying research literature as well, and most perceive bullying to be a major problem (bradshaw et al., 2013; hayes, 2017). however, the extent to which teachers consider bullying to be a problem tends to vary based on factors such as the type of bullying, the characteristics of the teachers and the students in their care (bell & willis, 2016; eden et al., 2013; espelage et al., 2014). some teachers have considered physical and cyberbullying to be more serious problems than other forms of bullying (bell & willis, 2016; eden et al., 2013). male teachers, special education teachers, and teachers of younger students have expressed greater concerns about cyberbullying being a problem than female and general classroom teachers, and teachers advances in social work, spring 2020, 20(1) 63 of older students. teachers’ perceptions have been reflective of students concerns about the incidence of bullying suggesting some degree of consensus (eden et al., 2013; espelage et al., 2014). in comparison, scant attention has been paid to the views of school principals (foody et al., 2018), social workers (slovak & singer, 2011), and bus drivers (brown et al., 2018; de lara, 2008). however, it is important to note that these are key actors in the school ecology who constitute an essential resource when assessing bullying, seeking to understand students’ behavior, and intervening as needed. in the immediate school context, principals’ serve as primary gatekeepers with oversight of programming and general administration, and ensuring a supportive climate is provided for students (melik-stepanyan, 2014). social workers also have critical roles in addressing students’ behavioral and mental health problems (whitley et al., 2013), while parents play a primary role in socializing children about social norms and expectations (fekkes et al., 2005). bus drivers (and attendants/monitors) are also covert and overt observers, as well as critical informants of students’ behavior outside the primary school environment (de lara, 2008; mcnamee & mercurio, 2008). considering the multiple interactional contexts in the ecology of schools, a multi-informant or multi-stakeholder approach, as used in this study, enhances the representation of stakeholders and promotes a wider understanding of a phenomenon as complex as school bullying. previous research suggests principals and parents acknowledge bullying does occur, but differ in what they consider bullying. further, principals are more likely to underestimate the incidence of bullying, while parents are more likely to perceive bullying victimization (newgent et al., 2009). previous research also indicates that bus drivers report bullying to be a systemic problem, and express concerns about the lack of parental accountability and responsibility, and lack of support from school administrators including inconsistent responses to student misconduct (brown et al., 2018; de lara, 2008). in soliman’s (2017) exploratory study in illinois, school social workers identified limited communication with students and parents as a problem and expressed the view that the inclusive engagement of constituents was necessary in promoting a prosocial school climate. in comparison to other stakeholders, bus drivers are rarely included or prioritized in most discourses on bullying and bullying prevention (de lara, 2008; putnam et al., 2003). similarly, though previous research highlights the key role social workers can play in addressing school bullying, it appears they are often homogenized under the label of school staff and for that reason their unique experiences and perspectives become unclear or get lost (slovak & singer, 2011). theoretical framework: ecological systems theory and habitus this study uses bronfenbrenner’s (1979, 1986) ecological systems (eco-systems) theory and bourdieu’s (1984) concept of habitus to develop an understanding of bullying that is grounded in critical perspectives. bronfenbrenner’s eco-systems theory posits that the interplay of factors across multiple environments (or systems), namely, the micro, meso, exo, and macrosystem, provides a framework for understanding human behavior (bronfenbrenner, 1979, 1986). the microsystem encompasses primary or direct karikari et al./bullying prevention in schools 64 relationships and interactions, such as what happens within a person’s family. the mesosystem refers to interconnections that occur with multiple microsystemsfor example, how a school may be linked to a family. the exosystem refers to a sphere within which an individual may not have direct engagement yet is profoundly impacted by the interactions or actions that occur there. examples of exosystem factors in school bullying include neighborhood characteristics and the urbanicity of schools (i.e., the impact of a school’s urban location; nasem, 2016). the macro system is another indirect or distant sphere that also has a profound impact on an individual. the macro system encompasses things such as politics, social and cultural norms, economic structures, and religious beliefs (bronfenbrenner, 1979, 1986; nasem, 2016). for instance, legislative efforts at the federal and state level include civil rights laws aimed at guiding how schools respond to bullying and protect students (cornell & limber, 2015). within eco-systems theory, distal and proximal relationships, interactions, and actions are noted to impact social phenomena including individual development (nasem, 2016). through the lens of the eco-systems framework, factors such as parent-teacher/staff relations, school-community partnerships, policies and legislative provisions, and even the socioeconomic conditions of families are linked to bullying (hong & espelage, 2012; hymel & swearer, 2015). complementing the application of eco-systems theory in the current study is bourdieu’s (1984) concept of habitus. habitus encapsulates the entire gamut of people’s interactions in formal and informal, social and professional networks, and how these experiences become embedded or ingrained in an individual (bourdieu, 1984; shimoni, 2017). further, habitus reveals the intuitions and schemas people develop over time through those experiences. as experiences accumulate, they become part of a person’s worldview, influencing how they perceive and interpret events both consciously and unconsciously (subconsciously; bourdieu, 1984). the application of habitus in this study is helpful in showing how the positionality of these stakeholders parents, social workers, principals, bus drivers and their attendants shapes their views on bullying (bourdieu, 1984). for example, principals’ response to bullying is likely to be shaped by bullying policies from the school district, state, or federal government (a macro system factor in eco-systems theory), in cases where such provisions exist (cornell & limber, 2015). having to interpret and apply the policies may mean making the determination of whether a particular report qualifies as bullying. with that being said, the reports that come to principals are often secondary reports from teachers, parents, students, and bus drivers and attendants (newgent et al., 2009). depending on the extent to which those making or bringing the reports know or understand the policies, their views about what constitutes bullying may be different. further, not everyone may know or understand the investigative process (where such mechanisms exist) used to establish if an incident qualifies as bullying or not. on the other hand, some stakeholders, like parents and even principals, may not have a complete view of bullying on the buses or in the classrooms. by applying the concept of habitus, these researchers seek to highlight the distinctions in how people view bullying. though the stakeholders may be in the same ecology (i.e., school community), that does not mean that they will share the same views. in the present study, the researchers believe that exploring the perspectives of these stakeholders provides useful information for a comprehensive advances in social work, spring 2020, 20(1) 65 understanding of bullying to further inform the development of effective anti-bullying programs and interventions. method participants to interview bus drivers, parents, principals, and social workers, a non-probability sampling method (purposive and maximum variation sampling) was used (padgett, 2008). table 1 shows the demographic characteristics of the 45 study participants. table 1. stakeholder demographics (n= 45) bus drivers (n = 18) parents (n = 4) principals (n = 9) social workers (n = 14) gender female 16 4 7 14 male 2 2 ethnicity black 18 1 2* 1 white 3 7 13 *black/biracial all the participants were from the same urban school district where an empathy-based bullying prevention program was being implemented in the elementary and middle schools. all four parents were affiliated with the same school. there were 64 schools in this school district and at the time of the study, 36 schools had received the empathy-based bullying prevention program. recruitment recruitment of participants took place after receiving approval from the institutional review board of the researchers’ institution. the researchers specifically sought constituents of the school district who may have insight on student behavior and events in the schools. again, the goal was to include people with different positions/roles in the school environment. this was intended to enhance the chance of having a sample with varied experiences. for parents, the invitation for participation was extended through the leaders of parent associations of schools that had received the empathy-based bullying prevention program. for school principals, invitations were extended to principals of schools that had received or were receiving the program. for bus drivers and attendants, an email was sent to the bus garage. for social workers, an email was sent to the coordinator for support services for the school district. the invitations for participation included a description of the study and an explanation of the study procedures. details presented included: informed consent processes, confidentiality, and the option for participants to discontinue their participation at any time, the mode of data collection (audio-recorded focus group discussions), the duration (approximately 50 minutes), and a sample of the questions/topics to be discussed. karikari et al./bullying prevention in schools 66 procedure focus groups and transcription. overall, there were seven focus group discussions–two separate focus group discussions with social workers, two with school principals, one with parents, and two with bus drivers and bus attendants. each focus group discussion lasted approximately 90 minutes, exceeding the initially estimated time of 50 minutes. the focus group discussions were audio-recorded and subsequently transcribed. study participants self-selected a color or spice as a pseudonym to ensure confidentiality. in line with the objective of the study, focus group discussions supported the examination of diverse experiences and contrasting viewpoints in a time-saving and cost-effective manner. through moderated interactions, the focus groups inherently allowed for a triangulation of sources and an opportunity for gaining critical insights (nyumba et al., 2018; padgett, 2008). there was some overlap between the collection and analysis of data. we adapted the theoretical sampling process from grounded theory. this was done in a manner that could be best described as quasi-theoretical sampling, because we were not necessarily guided by an emerging theory (see glaser & strauss, 1967, for more on “classical” theoretical sampling). some of the data analysis steps such as memoing and coding were conducted during the intervening periods of data collection with the different stakeholders. as a result, preliminary findings from the data collected from early focus group discussions informed subsequent ones (glaser & strauss, 1967). for instance, some of the questions posed to principals were informed by insights gained from the focus group discussions with bus drivers and attendants and social workers. positionality. the two lead authors were hired independently by an outside public health agency to measure changes in schools’ climate related to bullying. although no money was paid to the researchers, the twoyear project did buy out two university courses. the two lead researchers acknowledged biases and subjectivity within the frame of this research continuously throughout the research process. each of the lead authors believe that school bully prevention efforts, especially regarding empathy training, can be helpful in developing supports for students who bully. however, both lead authors felt that the limited dosage of the programing (twice per classroom) would not significantly impact incidences of bullying. the lead authors were also aware that certain groups of people who provide services to schools and students are underrepresented in bullying prevention and bullying research. this explains the engagement of bus drivers and attendants in order to learn more about their perspectives on school bullying. data analysis the transcribed interviews were deductively and inductively coded using maxqda, a computer-assisted qualitative software. the analysis of the data was not linear or hierarchical, but more cyclical and iterative. to ensure the trustworthiness of the findings, the following steps were taken. first, data were independently coded, using analytic and reflexive memos to keep track of the process and ensure auditability. second, notes were compared to determine the points of convergence and divergence in the conclusions. this second step constituted a form of triangulation (analyst/investigator triangulation) which advances in social work, spring 2020, 20(1) 67 allowed for prolonged engagement with the data and served as a good way to test the credibility of findings (lincoln & guba, 1985; padgett, 2008). member checking with participants was also completed, which included initial debriefings with participants immediately after the focus groups. this approach was used to give study participants an opportunity to quickly clarify points they had made. the transcribed data were shared with participants who provided their email addresses to be reviewed for accuracy, and to allow an opportunity to provide feedback if changes were needed (lincoln & guba, 1985). based on participants’ interest and availability, additional conversations took place about the study and interpretations. though invitations for member-checking were extended to all participants, participation in these processes were voluntary, and not all the study participants took part. for the next level of analysis, thematic analysis (braun & clarke, 2006; dixon-woods et al., 2005) of the transcript data was conducted. using both a semantic (descriptive) and latent (critically interpretive) lens (braun & clarke, 2006; dixon-woods et al., 2005), major recurring themes were identified. to examine how these themes aligned with each other, and which of those themes was better suited in conveying the main point, we adopted the constant comparative method, which is common in grounded theory (glaser & strauss, 1967). in addition, elements of meta-ethnography, namely, reciprocal translational analysis and refutational synthesis were applied (dixon-woods et al., 2005; noblit & hare, 1988). in reviewing the independent accounts and experiences of the four groups of stakeholders, the meta-ethnography approach (specifically, reciprocal translational analysis and refutational synthesis) enabled us to examine the extent to which those accounts were similar and the extent to which they stood in direct opposition to each other (dixon-woods et al., 2005; noblit & hare, 1988). though the focus groups were conducted separately, with this approach to analysis, we were able to examine the narrative data as though the participants were in direct conversation with each other. overall, the eclectic approach we adopted facilitated the comparison and contrast of the views expressed by the various stakeholders. this made it possible for us to see arguments and counterarguments related to the incidence of bullying in schools, efforts to address the issue, and the stakeholders’ respective roles or lack thereof. finally, synthesized conclusions were distilled. findings this research examined the perspectives of school principals, social workers, bus drivers /attendants, and parents on bullying. specifically, the study focused on their views of what constitutes bullying and its prevalence; forms, causes, and enablers; the dynamics of stakeholder involvement or inclusion in interventions; and variations in applying bullying policies. perspectives on what constitutes bullying and its prevalence the participants unanimously noted that bullying occurs in their respective schools (including the buses) and the school district as a whole. however, they differed on the prevalence of bullying and how other stakeholders understand the phenomena. for instance, there were principals who did not try to quantify the prevalence of bullying in their schools. nevertheless, they suggested that the level of bullying was low: karikari et al./bullying prevention in schools 68 at least at my school we have a very high needs population but the bullying piece is kind of a slim slice of that [ms. sage, principal]; [and] ours [her school’s] isn't extreme bullying and i think sometimes it’s misunderstood by students because the term is used so loosely. sometimes it can just be age-appropriate misconduct towards your peers [ms. pepper, principal]. ms. pepper’s comment about “age-appropriate misconduct” may be reflective of the notion that there are certain behaviors that are linked to a person’s developmental stage. ms. sage also added that, “about 95% of [her school’s] reported bullying is peer conflict.” in the same vein, some parents and social workers noted that the overestimation of bullying was quite likely because, on the part of both students and parents, “sometimes peer conflict gets confused with bullying.” ms. pink, a social worker, mentioned that investigations of reported bullying cases in the past year in her school showed that, “99% were peer conflicts; kids being mean to each other [and] its rarely been an act of bullying.” a parent explained that the confusion surrounding what bullying means or entails was common with younger children who interpret “everything like, when somebody is just a little mean to them or maybe doesn't want to play with them on the playground” to be bullying. it is quite evident that there is some framing of the perceived bullying behavior in a developmental context. though it is important to avoid misclassifying behaviors and wrongly using the term bullying, overly subscribing to developmental frameworks could result in the normalizing of problem behaviors. in contrast, the bus drivers and attendants noted that acts of aggression were rife on the buses. there was some support for this assertion from other participants. ms. clove, a principal, acknowledged, “the buses are very problematic.” ms. yellow, a social worker, also shared that, “the bus is a hotbed for bullying.” however, there were some contrary opinions, some of which seemed to question the veracity of the bus drivers’ and attendants’ reports. ms. rosemary, a principal, made it clear she did not think “the bus drivers see much of anything” and they were “just kind of oblivious.” she buttressed her point with a situation involving four students who were spitting on each other, however, “the driver…had no idea.” it appears the fact that “they [i.e. students] were in the back, he's driving he can't see” was not given careful consideration in her assessment of the bus drivers. to the bus drivers’ defense, ms. clove elaborated on the challenges bus drivers face: it’s hard on the buses because many of our buses are full, there is only the driver and not a monitor [attendant] on the bus to help address some of the situations and so the driver can't necessarily stop what they are doing in order to address the situation that is happening. for mrs. mint, a parent like many others that live in a mile or less radius from their school suggests the “buses can be a real great incubator of bullying because you’ve got such a range of kids…proximity of travel is so small, even if there was bullying it certainly wouldn’t happen very much.” within bus drivers and attendants’ discourse about bullying, there was no reference to students and parents’ difficulties in distinguishing between conflicts and bullying. further, in discussing the occurrence and prevalence of bullying, some of the accounts bus drivers advances in social work, spring 2020, 20(1) 69 and attendants gave were of situations that may not be classified as bullying. for example, ms. coal, a bus attendant, shared that, “i have a little boy [on her bus]…one little girl was singing, he say, he didn't want to hear no singing, he took his belt off and whopped her face.” this was clearly an assault that could meet a higher threshold of aggression. yet using the definition of bullying which emphasizes the repetitiveness of actions (aalsma & brown, 2008; olweus, 1993), this particular incident would not qualify as bullying. the principals shared that “repetition” was a critical element in determining whether an action was bullying. to provide some clarity about how bullying is defined, ms. pepper, a principal, said, “repeated behaviors that are making another person feel uncomfortable, intimidated or unsafe,” and mr. basil, another principal, added, “with the emphasis on ‘repeated’ we have to constantly remind our students.” with this in mind, if a bus driver or attendant reported a one-time incident like ms. coal’s to a principal, the attempt to make the appropriate classification could potentially put them at odds with each other. forms, causes, and enablers of bullying the participants noted that bullying occurred in different forms, and shared examples of physical, verbal, and non-verbal acts of bullying. they also indicated that bullying was not a strictly gendered, male-dominated practice. though mr. blue, a bus driver, shared an example that involved “…the guys…intimidating the girls on the bus,” another bus driver noted that girls bully as much as boys do. a principal also mentioned that contrary to the belief that the “mean girl behavior” mostly occurs in middle school, some of it “starts as early as second or third grade.” this was corroborated by a parent, mrs. red. based on her children’s experiences, she shared that, “with the girls, there is even probably some bullying…the beginning stages of it...at a younger age...with my son, i have seen more of that in the middle school.” these views also suggest the participants perceive that bullying occurs across grade levels and may be occurring earlier than one may typically assume. the social workers and principals also noted the incidence of cyberbullying. for example, ms. clove, a principal, noted that for the last two years, in contrast to traditional bullying, her school dealt “…with just an insane amount of social media bullying.” concerning the causes of bullying, the participants made some sociological, ecological, and psychosocial attributions. on the sociological and ecological level, the participants talked with passion about the impact of the communities and neighborhoods students lived in, and more specifically, the home environment. some participants expressed the view that bullying in the school was possibly a reflection of what occurred in the neighborhoods and homes of the students. a social worker, mrs. lime, shared that, “i have a neighborhood that has a lot of challenges and that comes into the school with the kids.” mrs. gold, another social worker, shared a similar experience about her “old school” where the students’ “neighborhood was such that it was so violent” that it negated efforts to promote positive behaviors because “there was a different mentality and culture, [and] different outlook.” in contrast, she compared the old school to her new school, noting that, “they [students in her new school] have the support at home basically…and [in] their neighborhood.” karikari et al./bullying prevention in schools 70 the parents also provided a contrast of the effects of neighborhoods and the home. they attributed the low prevalence of bullying in their children’s school to the neighborhood they resided in and active support from other parents. mrs. oro, a parent, conveyed this point : i think there is a really strong neighborhood community here and that's not to be in anyway undervalued because i think the value of having just a strong parent community is huge in terms of helping our kids...i think what helps bring it all together is the fact that they share this common language that they all understand, practice and its re-enforced here [in the school], and then the kids take it home and its re-enforced at home. additionally, on the importance of the home (and parents), principals and parents shared that efforts to address bullying involved enlisting the support of the parents in changing the behavior of students. however, mr. parsley, a principal, added that, “it’s even more challenging when that [bullying] behavior is learned from the parent.” in line with this thought, the bus drivers revealed that, they get bullied by both the kids and their parents, and the “school system gets bullied by the parents.” these findings suggest variances within ecologies and an association between school bullying and the homes or neighborhoods of students. behavior that may be normative at home or in neighborhoods may not be acceptable in the schools (nasem, 2016). therefore, problems emerge when students are unable to successfully conform to the code of conduct at their schools. additional views were shared about the school environment and climate. mrs. salmon, a social worker, shared that her school experienced “a significant increase in bullying issues” following a change in leadership (the principal). she added that following the change, “the discipline and climate is not as consistent as it was previously…and things are not well communicated in that arena.” the bus drivers also expressed concern about principals’ handling of student misconduct, because the students continued to act with impunity. per ms. white, a bus driver, they wondered why the policies spelt out certain consequences “but none of that is happening.” ms. yellow, a social worker, also shared that based on the district’s policy on bullying, they documented reports and followed the steps such as “…calling parents and so forth. but...the end of that policy rests with the administration.” these points appear to highlight the lack of resolute action from some principals resulting in an environment where student misconduct and bullying became prevalent. some of the principals stated that the school environment was sometimes a confluence of tensions, dysfunctions, and several unmet needs, and they had to deal with several issues that extended beyond providing education. for example, ms. pepper mentioned that her population of students was “high with domestic violence, and alcohol and drug abuse” and she had to deal with “title ixs, and cps [child welfare cases with child protection services].” this state of affairs often impacted principals’ ability to deal with bullying in a manner they desired. ms. sage summed it up this way: advances in social work, spring 2020, 20(1) 71 we have a huge population of very very high need mental health issues in our parents as well as in our students…so while we would like to have more [support] groups with bullying, and more...supportive kind of things, a lot of the times it’s kind of putting out fires. on the psychosocial level, some principals, social workers, and bus drivers and attendants mentioned or alluded to the mental and emotional health of students. the bus drivers and attendants talked about some students “being on medicine.” the social workers shared that the emotionally handicapped (eh) kids were “just a real big problem,” and on the bus, they were “instigating trouble with others, and picking on the kindergartners [and] first graders.” they, therefore, recommended that instead of having them on the “regular bus…those kids need to come on their own bus.” some of the principals also suggested there was an association between mental health and bullying, with ms. pepper, one of the principals, saying, “typically those kids that are bullying have mental health issues.” alienation and exclusion of several stakeholders in bullying interventions bus drivers/ bus attendants. despite the occurrence of bullying on the buses, the bus drivers and attendants stated that they were generally alienated from bullying prevention programs/interventions. most of the bus drivers shared that there was a lack of alliances or partnerships with the schools (and principals). one bus driver, mrs. turquoise, highlighted the issue of alienation: …i think you guys [researchers]…and you're gonna work with the schools. you see, that's what the schools won't do with us and that's where the problem is. you guys can probably go in there and work with them but as far as [the schools] helping us out dead end. only one bus driver indicated that bullying was not a problem on her bus because her school treated her reports with the seriousness they deserved and responded with students being “suspended from the bus.” based on these submissions we inquired of the principals if they received reports of bullying on the buses from the drivers. the principals responded in the affirmative, with one of them adding that they did so “constantly.” further, in what appeared to be a striking contrast to virtually all of the bus drivers and attendants’ reports of being on an island and having essentially no support from schools and the district in bullying prevention, mr. basil, a principal, shared that as employees of the school district, “…the bus drivers have to go through the [bullying] presentation anyway...and they are trained in bullying prevention and awareness.” mrs. blue, a social worker, shared that the bus drivers in her school were trained annually and were included in bullying prevention efforts. she added that the training focused on her school’s programming and it’s distinctiveness from other schools “…so that they are also hopefully using the same language and carrying that over onto the bus so that they [students] are hearing it no matter where they are once their school day starts.” for another school, the social worker, ms. teal, shared the principal’s initiative of teachers karikari et al./bullying prevention in schools 72 volunteering as “bus buddy person” to promote more prosocial behaviors. regarding how reports from bus drivers were handled she stated: i understood from our training for bullying at the beginning of the school year that all staff were to be using the same forms. but transportation [bus drivers], they still use their own forms...then in my building those are given to our in-school suspension person...who works with the buses and he handles some of it, some of it he refers to me, it really varies. i'm not sure how consistent it is. not only does ms. teal’s account highlight variations in the approaches adopted by schools, it also makes one wonder the extent to which the use of different forms impacts how bus drivers’ reports are handled. such a lack of consistency could be detrimental to efforts to address bullying. in what may be a nuanced suggestion of other factors contributing to problems on the buses, ms. pepper, a principal, added that, “i think [bus drivers] need more intense training on building relationships with kids and behavior management [ms. sage, another principal chimed in: “with kids and parents”] that's a huge issue.” this seems to suggest that bus drivers are partially responsible for the challenges they have with students on the buses due to a deficit of skills. this view appears to be corroborated by ms. lime, a social worker, who noted that when incidents happen on the buses: the children feel more comfortable bringing it to a staff member than discussing it with the bus drivers or the attendants…they don't feel listened to when they talk to the bus drivers or attendants so they bring it in to the school. school social workers. some social workers shared their own experiences with alienation and exclusion. however, their experience appeared to be qualitatively different from the bus drivers, because unlike the bus drivers who largely operate outside of the schools (albeit still within the school’s ecology), the social workers operated within the schools. for these social workers, it was more like a betrayal by their schools. they expressed concerns about their lack of inclusion regarding how their schools’ interface with non-profits and outside agencies that provide anti-bullying and prosocial programs. in some cases, they were not introduced to the representatives of the outside agencies. in direct reference to a representative of the agency running the empathy-based program, a social worker told the representative, “i didn't know who you were but you come in my building.” in addition to feeling side-lined, they suggested that the decision-making processes about bullying prevention was sometimes powerand clout-based. mrs. green shared, “i don't feel like i have any power because when i go to my administrators, sometimes my suggestions fall on deaf ears.” in contrast to the feelings of alienation and exclusion shared by some social workers and bus drivers, the parents shared that they had a great relationship with their children’s school. the school was responsive and open to their input, and some of the efforts to support bullying prevention through music and entertainment had even been initiated by parents. advances in social work, spring 2020, 20(1) 73 variations in applying bullying policies all the participants pointed out that the school district had a “step-by-step” policy for addressing bullying. per the policy, when a report or allegation of bullying is made, an investigation must be conducted. if substantiated, sanctions were to be applied. in some schools, the reports or allegations of bullying were “investigated by a social worker, or by another staff person” (shared by mrs. gray-1, a social worker). mr. basil, a principal, shared that in his school, “usually, it’s me [him] and my social worker interviewing witnesses or targets, and bullies.” some of the social workers felt that “schools are pretty uniform on that policy.” however, others indicated that, “there's probably variance throughout the whole process.” the principals also indicated that there were some variations and subjectivity (due to differences in interpretation of the policy) in how the policy was applied across the district. the bus drivers and attendants demonstrated awareness of the policy. however, they noted that it was not effectively applied when they reported bullying on the bus. the parents also demonstrated an awareness of their school’s policy. mrs. red, one of the parents, referenced the application of the policy in a situation that involved her family and that of another student. she stated that “the principal, the teacher, our social workers” worked with both families “to document everything and make sure that nothing was falling through.” discussion this study examined and synthesized the perspectives of multiple stakeholders– principals, social workers, bus drivers and attendants, and parents on the incidence of bullying and bullying prevention in an urban school district. the findings demonstrate some striking similarities as well as differences in the perspectives of stakeholders. overall, the findings support the use of multi-stakeholder approaches in developing a more holistic view of bullying. incidents of bullying cause consternation in schools and with parents, yet how stakeholders respond to bullying–actual or perceived–can be a source of further concern (mehta et al., 2013). in the ecology of schools, where several stakeholders are present, differences in perspective are not uncommon, especially when people have different roles and functions in their unique spaces (adelman & taylor, 2000; beddoe, 2019; newgent et al., 2009). considering different perspectives can contribute to building a stronger case about the nature of bullying, especially when perspectives are confirmatory and complementary. on the other hand, such differences can result in tensions and potentially undermine the effectiveness of bullying prevention efforts. in line with the concept of habitus (bourdieu, 1984), these differences may be linked to ways stakeholders perceive and understand bullying relative to their positions and experiences. as suggested by some respondents, having a more open system of dialogue among stakeholders could create a healthier way for addressing bullying. with this in mind, even contrasting views can generate a comprehensive and holistic picture (kim, 2017). when the study participants discussed bullying, they shared their experiences from different contexts, yet confirmed the ubiquity of bullying–occurring across grade levels, in karikari et al./bullying prevention in schools 74 a variety of settings, and being non-gendered (nasem, 2016; robers et al., 2015). however, contrasts in how bullying is perceived also became apparent. the extent to which study participants emphasized the technicalities of bullying and its definition varied. our findings show the existence of a district policy that includes a framework for determining if an incident is actual bullying. through the lens of that policy and the framework, some participants–i.e., principals, social workers, and parents emphasized bullying as a complex and technical issue. from the principals’ administrative standpoint, the district policy shaped how they responded to reports of bullying from parents. further, from the principals’ accounts, which are complemented by some of the social workers and parents, there is an indication that the response and efforts to address bullying are systematic and that an objective outcome is sought. yet, there is also some indication that the interpretation and application of the policy is characterized by some degree of subjectivity across schools. this is evident in the principals’ discourse and what some of the social workers and bus drivers and attendants shared. this finding suggests fidelity in the implementation of the district’s policy may be lacking. fretwell (2015) emphasizes the need for fidelity in the implementation of anti-bullying policies, noting that their effectiveness is hindered when they are not properly implemented. there may be other motivations for the emphasis on the technicalities of bullying by principals, some social workers, and the parents. the emphasis could be rooted in a deep concern about students and an attempt to avoid or minimize situations where they are wrongly labeled as bullies especially with the increasing shift towards criminalization which could result in involvement with the juvenile justice system (cornell & limber, 2015). also, it is important to recognize that student suspensions could put a strain on school/family relations. another motivation could be that, for these participants, having a low bullying record may be incentivized because a high prevalence of bullying compromises the image of their schools (cornell et al., 2013). in comparison, the same cannot be said of the bus drivers and attendants. this could possibly explain why there was limited emphasis on the “technicalities” of bullying or concerns about overestimation in their discourse. for bus drivers and attendants, there may be more of a primary concern with stopping any form of aggressive and disruptive conduct on the bus. hence, the “technicalities” of conflict or bullying may be secondary considerations in how they discuss bullying. the findings also show variations in opportunities for stakeholder inclusion in bullying prevention. the inclusion or exclusion of stakeholders in bullying prevention may be determined by several factors including dynamics that may be unique to each school. of importance is the disposition of the administrative team. some of the accounts of noninclusion seem to be illustrative of the phenomenon of working in host settings or engaging with external systems (beddoe, 2019; dane & simon, 1991). in reference to social workers, dane and simon (1991) define host settings as “organizations whose mission and decision making are defined and dominated by people who are not social workers,” and the social workers are seen as “resident guests” (p. 208). this definition also applies to the bus drivers and attendants’ engagement with the schools. advances in social work, spring 2020, 20(1) 75 beddoe (2019) notes that marginalization sometimes occurs in host settings. there may also be the delegitimizing of the “guests” experiences and views or attempts by the host agency to highlight the inadequacies of the guests instead of acknowledging their own failings. in this study, one principal felt bus drivers were oblivious to what happened on the buses, raising questions about the credibility of their accounts. it can be argued that principals with views like this may be less receptive to or limit the inclusion of bus drivers in bullying prevention. other principals suggested that the bus drivers contributed to the problems on the bus due to a lack of skills in engaging with parents and children. on the contrary, some social workers and most of the bus drivers and attendants perceived principals to be complicit in the prevalence of bullying. this was based on their experiences of alienation and non-inclusion and the view that principals were not taking resolute action resulting in a climate that fomented bullying. despite this view, it is possible that principals may be working to address bullying; however, they may be constrained by other demands and pressures including limited resources (lloyd, 2018). several principals alluded to how they had to provide or coordinate social services for students and their families. hence, the perceived complicity may be a result of a failure to appreciate the challenges principals and schools face. there may also be real cases where principals are complicit. however, that cannot be considered true for all schools. though most of the bus drivers indicated the schools were unwilling to work with them to address bullying, the social workers reported more varied experiences. some social workers felt included and played an integral role in bullying prevention in their schools while others felt side-lined. the parents interviewed in this study also shared positive experiences of inclusion in their children’s school. from our findings, we conclude that the school district can be conceptualized as a large eco-system, and the individual schools constitute unique eco-systems embedded within a larger one. thus, the dynamics of each school may be different. for that reason, differences in the experiences of stakeholders are not unusual (fretwell, 2015; nasem, 2016). the sample of parents in this study, for instance, had no complaints to make about their school. though they acknowledged their school was not perfect, they stated that they themselves “live kind of inside a bubble.” again, some social workers reported good experiences, whereas others had challenges in their schools. likewise, the principals provided some indications that they differed in how they facilitated processes. we also conclude that each group of stakeholders can be viewed as a subsystem of a school’s ecology. some of the interactions between these subsystems are characterized by a lack of openness. that lack of openness can result in fragmented relationships, and consequently, a fragmented understanding of and response to bullying. conversely, the lack of openness could be the result of fragmented relationships (fretwell, 2015). the application of eco-systems theory in this study engenders an understanding of the multilevel factors that impact bullying in terms of its occurrence, as well as responses to bullying. in this study, the impact of the district’s policy (a macrosystem factor) on schools and school-family interactions (the mesosystem level) was evident. though definitive causal inferences about bullying cannot be made in this study, most of the participants believed that bullying was associated with neighborhood and home factors illustrating the karikari et al./bullying prevention in schools 76 perceived impact of the exosystem, mesosystem, and microsystem on student behavior (nasem, 2016). using bourdieu’s concept of habitus was also essential in highlighting the unique positions and experiences of the stakeholders (bourdieu, 1984; shimoni, 2017). this concept is a helpful guide on how to avoid overgeneralizing and identifying fault lines in bully prevention efforts. limitations and future research some limitations were recognized in this study. though the study involved different groups of stakeholders which allowed for different perspectives to be garnered, the actual sample size of some of the groups was limiting. for instance, there were only four parents, all from the same school. there was also a lack of gender and racial/ethnic diversity among the different groups of stakeholders. of a total sample of 45 participants, only four were males. the relative homogeneity of the study’s sample has implications for its transferability to other contexts or situations. lastly, teachers and students’ voices were not included in this inquiry. nonetheless, this study provided an avenue for the inclusion of stakeholders such as bus drivers and attendants and social workers whose perspectives are often not heard. another possible limitation involves our positionality in this study. the two lead authors conducted the study as independent evaluators for an agency that was providing an empathy-based bullying prevention program to schools. though we maintained our professionalism and objectivity, it is possible our affiliation with the agency may have resulted in a desirability bias. it is conceivable that some participants may have provided responses to project a positive image of themselves and/or their schools because of the stigma attached to school bullying (kaminska & foulsham, 2013). research and evaluation of bullying prevention efforts need to continue as part of initiatives aimed at developing viable solutions (espelage et al., 2014; gentle-genitty, et al., 2017). it may also be necessary to review our notions and definitions of who we consider to be a stakeholder in our bullying prevention efforts (anderson-butcher et al., 2006). future research should further examine the impact of policies on how bullying is defined and the resulting interventions. finally, future research can offer an in-depth look at the nature of stakeholder interactions relative to bullying. conclusion these findings provide depth over breadth on bullying prevention and may be transferable regarding readers’ experiences within urban schools. the study revealed that bullying can be quite nebulous because people tend to look at the issue through the prism of their own experiences and positions. competing interests through roles and tasks may be experienced, even when trying to solve the same general problem like bullying. therefore, a contribution from this study is the use of an eclectic and multi-stakeholder approach in the attempt to engender a balanced perspective of bullying and bullying prevention. in working with multiple stakeholders, care must be taken in order not to reify the views and voices of a select few. it is important that schools stay attuned to the unique needs and concerns of different constituents within the school environment to increase buyadvances in social work, spring 2020, 20(1) 77 in and enhance the chances of success in bullying prevention. greater inclusivity within bullying prevention must be elevated to better serve stakeholders and the students they support. the school social workers in this study were integrated in delivering schools’ bully prevention activities and therefore must assert to their building principals the importance of being introduced to outside agencies who are invited to provide bully prevention programs. such introductions create a platform that would enhance an outside agency’s ability to understand the language of the school building, what is being done already, and what could be targeted to address needed service gaps. though social work practice often involves multiple systems, it is not uncommon to find social workers primarily focusing on direct or micro practice at the individual and small group levels. in the context of schools, this is evident in the attention given to individual and group counseling, behavioral management, etc. (anderson-butcher et al., 2006; soliman, 2017). greater emphasis on systems-thinking is needed in social work education and practice. school social workers should harness their knowledge of organizational dynamics and their advocacy skills to create open systems of dialogue not only for themselves but other stakeholders. having open systems of dialogue can help in achieving greater consensus among stakeholders and capitalizing on their knowledge and experiences to ensure better bully prevention outcomes (anderson-butcher et al., 2006; kim, 2017). references aalsma, m. c., & brown, j. r. 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(2013). promoting mental health literacy among educators: critical in school-based prevention and intervention. canadian journal of school psychology, 28(1), 56-70. https://doi.org/10.1177/0829573512468852 author note: address correspondence to dr. isaac karikari, department of social work, gillette hall 225 centennial dr, stop 7135 grand forks, nd 58202-7135. email: isaac.karikari@und.edu https://doi.org/10.1177/0143034311415906 https://doi.org/10.3886/icpsr23041 https://doi.org/10.1057/978-1-137-59298-9_2 https://doi.org/10.1057/978-1-137-59298-9_2 https://doi.org/10.5465/amp.2016.0073 https://doi.org/10.1093/cs/33.1.5 https://doi.org/10.4148/2161-4148.1017 https://doi.org/10.1177/0829573509358686 https://doi.org/10.1177/0829573512468852 mailto:isaac.karikari@und.edu _______ stephanie lyons, msw, director of field education and associate clinical faculty, indiana university school of social work, stuart m. schrader, phd, msw, ma, clinical associate professor, behavioral sciences, indiana university, erika galyean, lcsw, associate clinical faculty, indiana university school of social work, and laura romito, dds, ms, mba, assistant dean, professor, indiana university school of dentistry, iu interprofessional practice and education center, indianapolis, indiana. caroline everidge, msw, lsw, health & human sciences extension educator, purdue university, huntington, indiana. margaret smith, msw, project consultant, indianapolis, indiana. surendra reddy mandapati, dds, associate dentist, vogue dental, peoria, illinois. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 115-134, doi: 10.18060/23681 this work is licensed under a creative commons attribution 4.0 international license. a collaborative assessment of barriers to oral health care: are social workers needed? stephanie lyons stuart schrader erika galyean laura romito caroline everidge margaret smith surendra reddy mandapati abstract: oral health disparities are pervasive. interprofessional education and collaborative practice experiences may be a means to address this problem in oral healthcare settings. this project aimed to determine: (1) barriers involved in patients’ access to oral health care at an academic dental school clinic, (2) dental students’ perceived ability to address patients’ needs and/or care barriers, (3) the ability of current clinical operations’ to address access to care issues, and (4) the potential role of a licensed health care social worker integrated into the clinic. investigators conducted three focus groups –one student group (n=5), one clinical staff group (n=7), and one clinical faculty group (n=5). further, investigators administered two needs assessment surveys in the dental school – one with students, staff, and faculty (n=144) and the second with the school’s dental patients (n=150). investigators employed descriptive and inferential statistical analyses to evaluate the survey data. five principal barriers to oral health care for dental patients were identified from focus group and survey data, inclusive of patients, students, staff and faculty perspectives: (1) lack of financial means, (2) lack of/inadequate insurance, (3) limited/no transportation, (4) general health problems, and (5) language barriers. more female patients (38.7%) than male patients (8.1%) reported financial barriers to accessing oral care. including licensed social workers in an academic dental clinic may help address patient barriers to care and support interprofessional collaborative practice. keywords: interprofessional collaboration, oral health disparities, licensed health care social worker, needs assessment the benefits of incorporating social work practice within health environments are welldocumented within the scholarly literature (kitchen & brook, 2005; zulman & grant, 2016). in these environments, social workers have proven to be valuable in the roles of team coordinator, referral source, mental health clinician, and patient advocate (kitchen & brook, 2005; maramaldi et al., 2014). as such, collaborative efforts could be beneficial in other health care settings, such as dental clinics (petrosky et al., 2009). while the about:blank lyons et al./collaborative approach 116 collaboration between social work and health professionals has a long history, the collaborative relationship between social work and the oral health care field is more recent (marks & shaul, 2010; petrosky et al., 2009; weiyu et al., 2015; zittel-palamara et al., 2005). further, social work involvement in free healthcare and student-run health and dental clinics serving vulnerable populations has found social work to be underutilized (warren et al., 2017). “oral health is a key indicator of overall health” (who, 2018, para 1), and for this paper’s focus, the terms health and healthcare are inclusive of oral health and oral healthcare. in the u. s. and around the world, there is a strong link between oral health and the social determinants of health (who, 2018). renzhaho and de silva-sanigoski’s (2013) study of over 4,500 families found lower oral health in children associated with increased parental psychological distress, poor family functioning, and increased child conduct and mental health problems. a review of the literature on dental and social work healthcare collaborations identified various valuable social work functions and areas of expertise that are needed in healthcare service delivery for the general population and, in particular, for vulnerable populations (i.e., children, minorities, homeless persons, and individuals with mental illness, and/or disability). social work interventions such as clinic-based counseling, case management, and resource brokering can increase health-related quality of life (warren et al., 2017). further, social workers can conduct community and patient needs assessments to identify gaps and specific areas for intervention. social workers can provide psychosocial support and outreach to connect patients with private and public health insurance to address health needs (stephens & thomas, 2015). background the surgeon general released a report in 2000 on the state of oral health care in america that outlined the existing disparities in accessing oral health care for vulnerable populations (department of health and human services [dhhs], 2000). those who are racial and ethnic minorities, children, low income, older americans, and those living with disabilities or chronic health issues have worse oral health (dhhs, 2000). twenty years later, these disparities are still in existence (rollins et al., 2019; satcher & nottingham, 2017). in response to the surgeon general’s initial report, the american dental education association (adea, 2017) published a paper urging academic dental institutions to work towards improving the state of oral health in the us by focusing on existing barriers and by working to implement newer models for delivery of oral health care. innovative models focus on oral health and its relationship to overall health and ideally include non-traditional oral health providers. this paper contends that the dental profession alone cannot solve the issue of access to care (adea, 2017). collaboration with other health care professionals, such as social workers, can help oral health providers work towards solutions. this commitment was reinforced through adea’s support of dental education programs working within an integrated health system to care for patients with special needs (i.e., individuals with developmental or other disabilities, children, older adults; adea, 2018). advances in social work, spring 2021, 21(1) 117 additionally, barriers to oral health care noted by the indiana state department of health (2016) illustrate specific oral health disparities between children receiving care from medicaid/chip versus children not enrolled in these benefit programs. among youth ages one day through 20 years old enrolled in medicaid/chip, only 48.4% had a dental visit within the past year compared to 78.3% of children within this age group without medicaid/chip (isdh, 2016). rationale when serving vulnerable populations, primary healthcare and primary oral healthcare providers experience similar challenges in assisting patients with overcoming social and economic barriers to healthcare. suresh et al. (2016) underscore the importance of close collaboration among the varied health professionals for integrated healthcare, such as dentists, physicians, social workers, and nutritionists working together to reinforce healthcare concepts with patients. in a 2019 systematic review focusing on the integration of oral health care with primary healthcare, interprofessional collaboration was identified as a vital element of this evidence-based approach (prasad et al., 2019). the aims of the primary oral healthcare approach are to promote health equity and healthcare access and to empower health promotion and oral disease prevention through risk and oral health evaluation, preventative measures, and education (prasad et al., 2019). social workers bring many strengths to improving the micro, mezzo, and macro-level health and well-being of individuals, families, and communities (zerden et al., 2017). social workers employed in health and dental settings often act to bridge primary and behavioral health care by fulfilling three primary roles: behavioral health specialists, care coordinators, and community outreach coordinators (fraser et al., 2018). the tradition and contributions of medical/health social workers have been around formally since the early 1900’s when first written about by cannon (1913) and cabot (1919). oral health is critical for physical, emotional, psychological, and socioeconomic wellbeing, not only at the individual level but also at the interpersonal, community, and societal levels (mertz, 2016). disparities need to be more thoroughly investigated in all aspects of oral health care, including the allocation of resources for oral health care (national research council, 2011); use of oral health care services (vujicic & nasseh, 2014), quality of oral health care (como et al., 2019); and, financing of oral health care, specifically, the burden of dental payments for both individuals and households (national research council, 2011; vujicic et al., 2016). with its perspective of person-in-environment, social work is well-positioned to address patient risk factors and the social determinants of health (fraser et al., 2018). as such, the us department of labor (2018) expects a 22% increase in social workers in health care settings over the next ten years. this expansion of social work in interprofessional health teams is essential for the success of integrated, comprehensive health care because of their unique training in behavioral intervention and psycho-socio-cultural risk factors (stanhope et al., 2015). while the role of social work in physical health settings has been well-documented, it has been less evident in oral health care settings. social workers can critically assist dentists in holistically treating patients by helping to manage the myriad of other social and practical lyons et al./collaborative approach 118 needs that arise in dental settings. further, addressing patient care that includes the patient’s medical, dental, and psychosocial history has been shown to improve patient outcomes (sabato et al., 2018). the value of integrating social workers in primary care health settings to address psychosocial issues impacting patient health has been extensively discussed in the literature (mcgregor et al., 2018). although limited, two articles that describe collaborative oral health programs with integrated roles for social work include the eastman dental center (edc, petrosky et al., 2009) and the counseling advocacy referral education and service (cares) program (zittel-palamara et al., 2005). the cares program and edc social work models illustrate that integrating a social worker into an academic dental clinic can have positive outcomes for both patients and dental schools by overcoming the social barriers and meeting the needs identified for their respective communities. the social workers employed with cares (zittel-palamara et al., 2005) and edc (petrosky et al., 2009) assessed patient needs and connected patients, students, staff, and faculty to community resources. these programs showed that patients assisted by social workers were able to more effectively access needed care. in addition, there was an added financial benefit to the dental school due to a reduction in the number of missed appointments. while the above examples suggest that various vulnerable populations experience disparities in oral health care, there is limited data on this topic. the present study surveyed staff, students, faculty, and patients to identify the needs of vulnerable patients served by the dental school. the study explored dental student clinical care and self-reported discomfort in supporting patients’ psychosocial challenges and how the dental school’s clinical operations might be improved by including a social worker. the specific aims of this study were to explore: • what are the barriers involved in patients accessing oral health care? • what is the comfort level of dental students in addressing patients’ needs and/or barriers to accessing care? • how helpful are clinical operations in addressing access to care issues? • what is the expected role of a licensed social worker if integrated into clinical dental operations? method the study participants included faculty, staff, students, and patients at the indiana university school of dentistry (iusd). initially, faculty, staff, and students participated in a survey, and in the following year, patients participated in a similar study using a convenience sampling technique. a focus group of faculty, staff, and students was also conducted to generate ideas related to access to care issues and explore how a licensed social worker could address them within the clinic. this section includes survey and focus group design, procedures, and analysis. institutional review board approval (irb protocol # 1711241723) was granted. advances in social work, spring 2021, 21(1) 119 table 1. survey questions students, staff, and faculty patient 1. which gender do you most identify with? 2. which race and/or ethnicity do you most identify with? 3. which category below includes your age? 4. please indicate your (student) class status below. 5. how long have you been employed at iusd (staff or faculty member)? 6. are you a full-time or part-time employee (staff or faculty member)? 7. please indicate which employment category best represents your current role at iusd (staff or faculty member). 8. please review the list of barriers in accessing oral health care and patients’ possible concerns in getting to iusd, continuing treatment, reliably showing up to appointments, or in feeling comfortable and satisfied with dental treatment at iusd. please check all which of you have personally observed with iusd patients. 9. of the items you previously checked, please identify the top three concerns or patient needs you have observed most often. 10. students; on a scale of 1-5, with 1 being very uncomfortable and 5 being extremely comfortable, rate your comfort level in directly assisting patients with the following needs. faculty/staff; on a scale of 1-5, with 1 being very uncomfortable and 5 being extremely comfortable, rate how comfortable you feel in working directly or indirectly with a dental student to assist patients with the following issues. 11. students; on a scale of 1-5, with 1 being very uncomfortable and 5 being extremely comfortable, rate your comfort level in providing outside referrals and resources to patients in the following areas. faculty/staff; on a scale of 1-5, with 1 being very uncomfortable and 5 being extremely comfortable, rate how comfortable you feel in working directly or indirectly with a dental student to provide patients resources and referrals in the following areas. 12. please list the top 3 areas in which you feel students could use more assistance with providing referrals to patients. 13. please add anything else you feel is important for us all to know about in terms of how best we can increase access to care for our patients: 14. please review the list of barriers in accessing oral health care and patients’ possible concerns in getting to iusd, continuing treatment, reliably showing up to appointments, or in feeling comfortable and satisfied with dental treatment at iusd. please check all areas in which you believe a licensed health care social worker would be valuable in assisting patients and increasing their access to care. 15. please identify any other additional roles in which you believe a licensed social worker could be of value within iusd. 1. which gender do you most identify with? 2. which race and/or ethnicity do you most identify with? 3. what is your current age? 4. how long have you been receiving dental services at iusd? 5. on a scale of 1-10, with 10 being extremely satisfied, please rate how satisfied you have been with your overall care at iusd. 5a. please explain your rating. 6. please review the list of barriers in accessing oral health care and patients’ possible concerns in getting to iusd, continuing treatment, reliably showing up to appointments, or in feeling comfortable and satisfied with dental treatment at iusd. please check all which of you have personally observed with iusd patients. 7. of the items you previously selected, please click and drag the top three concerns and/or needs you have experienced most often or have most affected your access to dental services 8. considering these top three concerns/needs, on a scale of 1-10, with 10 being very helpful, how helpful have iusd students and faculty been in assisting you to address these needs? 8a. please explain your rating. 9. please add anything else you feel is important for us to know in terms of how we can best help patients access oral health care services. 10. please select all of those in which you believe a social worker would be valuable in assisting patients and increasing your access to care. 11. please identify any other roles in which you believe a social worker could be of value within iusd. lyons et al./collaborative approach 120 survey design two surveys were designed for the study: (1) faculty, staff, and students survey and (2) patient survey. the patient survey and the faculty, staff, and student survey included various common question formats such as multiple-choice, likert rating scales, and openended questions (see table 1). survey items for staff, faculty, and student participants within the iusd clinic included: demographic information, perceptions of patient barriers and access to care issues, comfort level in addressing these patient issues, and perceptions of the potential role of a social worker within dental clinics. survey items for patient participants within the iusd clinic included: demographic information, patient care needs and barriers, access to care, and the role of social work within dental clinics (see table 1). survey procedure procedurally, during the first survey, staff/faculty/student participants received an electronic invitation to participate. before completing the online survey, participants reviewed an informed consent document. after reading the study information sheet, participants anonymously completed the online survey within qualtrics. during the second survey, investigators approached patients in various dental clinic waiting areas and invited them to participate in the survey anonymously. if patients agreed to participate, investigators provided them with a secure laptop to complete the qualtrics survey and, if needed, offered spanish translation assistance. before completing the survey, patients reviewed an electronic informed consent document. although patients were provided laptops to complete the survey independently, many patients requested that investigators read the survey questions aloud or navigate the touchpad and keyboards for them. survey analysis for both surveys, univariate descriptive data was analyzed. additional inferential data analysis involved conducting chi-square tests to examine similarities and differences. these similarities and differences were between and across demographic groups and the various study factors--perceived patient needs, barriers in accessing care, perceived student comfort level in addressing patient barriers, and the expected value of introducing a health care social worker to clinical operations. focus group design after the first survey was completed, iusd faculty, staff, and students were invited to participate in focus groups partly informed by preliminary descriptive survey data. the goal of each focus group was to generate more specific ideas regarding possible solutions for addressing access to care issues and exploring the potential role of a future social worker within iusd clinics. each focus group followed a semi-moderated schedule of five questions (see table 2). advances in social work, spring 2021, 21(1) 121 focus group sampling recruitment for focus groups included convenience sampling whereby faculty, staff, and students were invited from general email distributions within the school to participate when and if available. a snowball technique was used to recruit additional focus group participants. student leaders recruited student focus group members. the human resources director recruited clinical staff members. the faculty president recruited faculty focus group members. overall, 17 participants attended three focus groups (5 students, 7 staff, and 5 faculty). focus group procedures focus groups were organized by roles within the dental school. three focus groups were conducted: one student, one clinical staff, and one for clinical faculty. each focus group lasted between 45-60 minutes. no financial incentive was provided; however, lunch was provided to participants. the same investigator moderated focus groups, and each session was audio-recorded for future analysis. see table 2 for focus group questions. table 2. focus group questions 1. i’d like to start by hearing about the most significant barriers you have observed and, more specifically, how you have seen these barriers addressed in the clinic environment? 2. what additional resources do you think would be necessary for iusd to address these barriers? 3. what are your experiences with health social workers and what do you view their role to be within a medical environment? 4. what do you see as the most valuable role a licensed social worker could take within the iusd clinic? 5. do you have any additional comments or information that would be helpful for our research team to know? focus group analysis following each focus group, the audio recording was listened to by the researcher and thematically analyzed. using a social constructivist approach, emerging themes were identified until categorical saturation was reached (braun & clark, 2006; flick, 2002). in the final analyses, categorical themes were related to the salient literature. results survey participants table 3 offers an overview of all sample survey participants by gender, race, and type of participant. a total of 172 faculty/staff/students and 159 patients voluntarily completed a survey. of those participants, 28 faculty/staff/ students and 9 patients did not fully complete surveys. students who participated in the study represented 8% of the total student population. staff and faculty represented 21.9% and 20.1% of the total surveys completed, respectively. the majority of respondents for both the students, faculty, and staff (80.6%) and patient (71.3%) surveys identified as white, with nearly 12% of patients lyons et al./collaborative approach 122 identifying as african-american. slightly more than half (53%) of the patients who completed the survey reported having been a patient at the school’s clinic for at least six months. table 3. gender and race of survey participants faculty/staff/ students (n=144) patients (n=150) gender male 46 (31.9%) 74 (49.3%) female 97 (67.4%) 75 (50.0%) unknown 1 (0.7%) 1 (0.7%) race african american 9 (6.3%) 18 (12.0%) asian/pacific islander 9 (6.3%) 6 (4.0%) white 116 (80.6%) 107 (71.3%) latin american 4 (2.8%) 8 (5.3%) multiracial 1 (0.1%) 4 (2.7%) others 2 (1.4%) 5 (3.3%) prefer not to answer 3 (2.1%) barriers in accessing oral health care: perceptions of faculty, staff, students, and patients the most frequently reported patient barriers, according to faculty/staff/students surveys combined, included: (1) financial barriers (93.1%), (2) lack of dental insurance (84.7%), (3) lack of reliable transportation (78.5%), and (4) inadequate dental insurance coverage (75.7%). the terms financial barriers, lack of dental insurance, inadequate dental insurance, and reliable transportation were the verbiage presented in the survey as they are commonly used survey terms in the literature. the financial barrier item indicated that someone does not have enough money to pay for their dental care, notwithstanding any private or public insurances, as dental insurance generally only pays up to 50% of all restorative care. the term lack of dental insurance means not having any dental insurance, while inadequate dental insurance means not having enough coverage. not having reliable transportation refers to the inability to consistently make one’s dental appointment or make it on time. patients according to the patient participants, the most frequently reported patient barriers included: (1) lack of dental insurance (25.3%), (2) financial barriers (24%), (3) lack of reliable transportation 7.3%), and (4) inadequate dental insurance coverage (8.7%). more female patients (38.7%) reported financial barriers than male patients (8.1%; χ2 (1) =19.354, p<.001). likewise, there was a higher percentage (37.3%) of patients age 30-60 years who reported that financial barriers impacted their ability to access oral health care compared to patients in the other age groups (27.6% below 30, 12.9% 61 above; χ2 (1) = advances in social work, spring 2021, 21(1) 123 9.882, p=.007). the most frequently reported barriers to oral health care are shown in figure 1. figure 1. most frequently reported barriers to access oral health care staff, students, and faculty focus group perceptions of patient barriers in accessing care focus group data provide an increased understanding of student, staff, and faculty perceptions related to patient access to care. the most frequently cited barrier by the focus group participants was long appointments and wait times. long appointments and wait times are commonly reported issues in dental schools as appointments generally take about 25-35% longer because one is receiving care from student providers. while financial barriers were reported as the primary barrier in survey responses, this was the second most frequently cited barrier during focus group conversations. participants discussed how payment plans are helpful in mitigating financial concerns, but they do not cover all patient needs. in addition, other financial barriers related to transportation and not being able to take time off work created difficulty for patients. when discussing barriers to accessing care, focus group participants often mentioned long appointments and wait times. more specifically, faculty/staff/student participants reported that many patients could not afford to take time off work for a 3-plus hour appointment. those needing care in the school’s dental specialty clinics (e.g., orthodontics) were placed on long wait lists, which faculty/staff/student participants suggested is not 25.3% 24.0% 8.7% 7.3% 78.4% 96.1% 69.6% 82.4% 86.0% 90.0% 80.0% 82.0% 90.7% 93.0% 79.1% 69.8% 0% 20% 40% 60% 80% 100% lack of dental insurance financial barriers inadequate dental insurance transportation faculty staff student patient lyons et al./collaborative approach 124 realistic for patients who need more immediate care. faculty/staff/student participants also added their concerns about (1) transportation, (2) uninsured patients, and (3) language barriers. first, faculty/staff/student participants were concerned about patient transportation needs, such as having adequate access to public transit and alternative forms of transportation such as medi-cab. secondly, faculty/staff/student participants expressed concern that uninsured patients are not sure how to navigate various insurance or health care systems and that there is currently not enough staffing and/or training to assist patients with these issues. additionally, faculty/staff/student participants reported that some patients do not fully understand their private or public insurance coverage. participants believed that patients assumed their insurance will not cover the proposed treatments and therefore need to pay out-of-pocket, which may lead to missed appointments and not getting the needed care. finally, faculty/staff/student participants reported experiencing language barriers within the clinic. two focus groups (faculty and students) reported ineffective interventions to address language barriers. some suggested that the languagetranslator telephone line is tedious, inconvenient, and slows down the clinical workflow. often, bilingual staff and/or students assist with patients who are non-english speakers. however, this approach reduces staff resources and distracts students from other responsibilities. possible solutions for addressing patients’ access to care several solutions to access issues were explored by focus group participants. the focus group participants suggested that financial barriers could partly be addressed through more effective discounts and payment plans and by adding more considerations and structure to the process of receiving financial assistance. both student and faculty focus groups noted how some faculty give patients discounts more often than others. given that each clinic operates differently in terms of providing discounts, a more uniform policy and procedure could help patients access care. finally, some participants suggested increased clinical efficiencies, such as having more faculty members in the clinic to supervise additional dental students to reduce the length of appointments and wait times. comfort level of students in addressing patient barriers and in providing resources survey participants rated the comfort level of students in addressing various patient barriers. dental students were asked to rate their comfort level, while staff and faculty rated their perception of the comfort level of students in addressing patient barriers. students most frequently reported feeling uncertain, uncomfortable, or very uncomfortable in assisting patients during their clinical encounters with the following issues: (1) helping patients access reliable transportation (83.3%), (2) addressing reports of elder abuse (76.2%), (3) assisting and treating patients with schizophrenia (76.2%), (4) addressing suspected use/abuse of opioids (73.8%), and (5) responding appropriately to a patient who reports suicidal ideation (73.8%; table 4). students, staff, and faculty were each asked in what areas students feel uncomfortable in addressing psychosocial barriers to care. students’ self-rated levels of discomfort were generally higher than the perceptions of faculty and staff. as table 4 displays, students advances in social work, spring 2021, 21(1) 125 generally reported a relatively high level of discomfort or uncertainty with helping patients across five areas of need. discomfort was operationalized as respondents reporting a combination of feeling “uncertain,” “uncomfortable,” or “very uncomfortable” in addressing certain patient barriers. there were not many areas of agreement between the groups. students (83.3%) and faculty members (73%) agreed that transportation was the area that students felt most uncomfortable assisting with; however, less than half of staff members (47.1%) recognized that this was a considerable discomfort for students. for students, schizophrenia (76.2%) and elder abuse (76.2%) were the second-highest areas of discomfort, while suicidal ideation (73.8%) and suspected use/abuse of opioids (73.8%) were the third highest areas of discomfort. for staff, suspected use/abuse of opioids was rated the most uncomfortable area for students (72.7%), while schizophrenia (61.8%) and suicidal ideation (61.8%) shared the second-highest area of discomfort. faculty rated transportation as the highest area of student discomfort in assisting dental patients, followed by schizophrenia (63.9%), suicidal ideation (62.2%), and opioid abuse (62.2%) (table 2). while roughly half of the faculty (55.3%) and staff (50%) agreed that students were uncomfortable addressing elder abuse, over three-quarters (76.2%) of students rated themselves as uncomfortable. table 4. student, staff, and faculty perceptions regarding the students’ discomfort in addressing patient psychosocial barriers to care patient barriers to care agreement that students are uncomfortable n (%) students (n=42) staff (n=33-34) faculty (n=36-38) suicidal ideation 31 (73.8%) 21 (61.8%) 23 (62.2%) transportation 35 (83.3%) 16 (47.1%) 27 (73.0%) schizophrenia 32 (76.2%) 21 (61.8%) 23 (63.9%) elder abuse 32 (76.2%) 17 (50.0%) 21 (55.3%) suspected use/abuse of opioids 31 (73.8%) 24 (72.7%) 23 (62.2%) areas in which students require more resources to assist patients in accessing care considering that students felt discomfort with certain patient issues and that staff and faculty generally concurred, it was important to inquire about what resources the participants viewed as valuable for assisting patients with referrals and resources. interestingly, the three sets of respondents reported four key sets of referral information that patients most needed. only one of those overlapped directly with the area of students' discomfort with patients (substance use/abuse; 51.8%). respondents (n=56) reported that the students likely need further resources and/or referral information for the following: (1) mental health needs (58.9%, n=33), (2) financial assistance (46.4%, n=26), and (3) transportation (41.1%, n=23). respondents’ previous recognition that students may have some difficulty with mental health issues such as suicidal ideation and schizophrenia is congruent with the identified need for further mental health referrals and resources. each focus group discussed the clinical need for a centralized physical and/or online location for referral information and adjunctive interprofessional health care resources. lyons et al./collaborative approach 126 patient perceptions of iusd’s helpfulness in addressing barriers to accessing care patients were asked how helpful iusd was in assisting them to access care. the overall mean was 8.2 (sd=2.275) on a scale ranging from 1 (not at all helpful) to 10 (very helpful). patients rated their level of satisfaction with their overall care at iusd as 8.8 (sd=1.78) on a scale ranging from 1 (extremely unsatisfied) to 10 (extremely satisfied). additionally, no statistical differences were found using the manney-whitney u test and the kruskal wallis test on these two items by patient age, gender, or race. student challenges in demonstrating helpfulness with patients faculty and staff members reported that a few dental students have difficulty consistently using lay terms to describe oral health care needs and treatment plans. staff also reported that some students need to express more empathy, work more toward efficient problem-solving with patients, and more effectively recognize certain nonverbal cues of patients. additionally, some focus group students shared that some of their peers were not interested in working with “difficult patients,” patients facing certain access to care barriers, or even patients with special care needs. there was concern that some students might not show an appropriate level of caring and empathy for the treatment and inclusion of a diverse patient population. one participant reported that a few students, and some staff, do not always greet patients and focus enough on patient satisfaction. expectations for the possible introduction of a licensed social worker over one-third of patients (37.3%) and most students, staff, and faculty respondents (93.8%) agreed that a social worker could be of assistance with financial barriers. other areas that a social worker would be helpful within the dental clinic selected by patients were lack of dental insurance (36.7%), lack of reliable transportation (28%), language barriers (22.7%), and childcare needs (20.7%) (see table 5). students/staff/faculty expected that a social worker could assist with financial barriers (93.8%), transportation (86.4%), childcare needs (70.4%), lack of dental insurance (65.4%), and language barriers (51.7%). table 5. beliefs about the value of a social worker: patients (n=150) and students, staff, & faculty (n=81) patient barriers endorsement of social work benefit patients students/staff/faculty financial barriers 56 (37.3%) 76 (93.8%) lack of dental insurance 55 (36.7%) 53 (65.4%) lack of reliable transportation 42 (28.0%) 70 (86.4%) language barriers 34 (22.7%) 45 (51.7%) childcare needs 31 (20.7%) 57 (70.4%) staff, student, and faculty perceptions of additional roles of a social worker staff, students, and faculty (n=82) identified additional areas in which a social worker could be of value. after the issues noted above, the most frequently reported areas in which a social worker would add value in a dental clinic were: addressing suspected domestic advances in social work, spring 2021, 21(1) 127 violence (77.8%), mental illness (72.8%), substance use/abuse (72.8%), suspected elder abuse (72.8%), and suspected child abuse (72.8%; table 6). figure 3. expectations for how a social worker might be of assistance in a dental clinic: comparison of students (n=42), staff, (n=34) and faculty (n=38) figure 3 illustrates the differences, though not statistically significant, between students, staff and faculty in their expectations of how a social worker might assist in a dental clinic. 89.30% 75% 64.30% 75% 67.90% 60.70% 60.70% 60.70% 91.7% 87.5% 79.2% 70.8% 79.2% 75.0% 70.0% 83.3% 93.3% 90.0% 83.3% 70.0% 70.0% 76.7% 80.0% 66.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% financial barriers transportation domestic violence mental illness substance use elder abuse child abuse childcare needs faculty (n =38) staff (n = 34) students (n = 42) lyons et al./collaborative approach 128 table 6. perceptions of additional roles of a social worker with assisting patients and increasing access to care by staff, students, and faculty (n=82) social worker could help with patient needs affirmative n (%) suspected domestic violence 64 (77.8%) mental illness 60 (72.8%) substance use/abuse 60 (72.8%) suspected child abuse 60 (72.8%) suspected elder abuse 60 (72.8%) focus group expectations for a social worker within both staff and faculty focus groups, participants (n=8) shared instances in which they had worked with a social worker in other health settings and had found their support helpful. participants expressed that social workers could assist with addressing barriers, tracking patients for future appointments or referrals, and providing critical and essential psychosocial resources. in both the focus groups and open-ended survey responses, most individuals within iusd do not clearly understand the role, duties, or value of a health social worker. no students and only one faculty member had any prior experience working with social workers. all staff in the focus groups reported having had some brief interactions with social workers. as such, each group expressed that students would need significant education on the role of a social worker and how they might specifically work with them in the clinic. they also reported that orientation and training are likely needed for staff and faculty as well so that a social worker could collaboratively and effectively assist patients. finally, the staff and faculty focus group participants suggested that the current lack of foundational knowledge and understanding about interprofessional education and practice might improve once the clinic fully integrates a social worker. discussion this preliminary study and corresponding analyses illustrate numerous patient barriers, as reported by patients, faculty, staff, and dental students. in response to the department of health and human services initial report (2000) and the adea (2017), two dental schools have demonstrated the ability to address barriers similar to those reported in the present study by integrating a social worker into their patient clinic (petrosky et al., 2009; zittelpalamara et al., 2005). this study’s key findings are further discussed below in conjunction with the social work intervention approaches found within these two university dental clinics. patient barriers involved in accessing oral health care the most frequently reported perceived patient barriers to oral health care identified in the present study were: (1) lack of financial means, (2) lack of or inadequate private or public insurance, (3) limited or no transportation, (4) general health problems, and (5) advances in social work, spring 2021, 21(1) 129 language barriers. these barriers were similar to those identified by the cares program at the university at buffalo (zittel-palamara et al., 2005). addressing patients’ needs and barriers to accessing care consistent with previous research (petrosky et al., 2009; zittel-palamara et al., 2005), dental students in this study were uncomfortable addressing certain barriers to treatment. a health social worker integrated into the dental school can help mitigate such issues. the areas that caused the most discomfort for dental students included: assisting patients with transportation and responding to elder abuse, symptoms of mental illness, suspected opioid use, and suicidal ideation. this finding supports integrating a licensed social worker into the dental clinic to provide clinical consultation of patients and training of dental students in how to address these issues when they arise in the clinic. these findings support the role of the social workers employed with cares (zittel-palamara et al., 2005) and edc (petrosky et al., 2009) programs as they often serve as referral sources for such issues. social workers in these environments effectively connected patients, students, staff, and faculty to community referrals and resources. limitations this study had several limitations. the initial survey instrument of students, staff, and faculty revised following implementation to improve our likelihood of getting more patients to answer the subsequent shorter overall needs assessment survey. electronic surveys, especially when completed on a mobile device, can lead to a lower response rate. for example, 29 patients began the survey but did not make it past the demographic section. individuals who skipped or did not complete portions of the survey, which may have been due in part to the length of the survey or attempting to complete the survey on a phone or other small mobile device, were not included in the analyses. the study included three focus groups. however, the original goal was to conduct nine. it was extremely difficult to recruit participants. individuals who did show up to the focus groups shared that many of their peers/colleagues were not interested in participating because “social work” is out of their scope of practice. they did not understand a social worker’s relevance to their immediate job or learning. this limitation demonstrates a key challenge in addressing the barriers mentioned previously – a willingness for health professionals to collaborate with each other and the patient/client. faculty, staff, and student education on the value of icp and the role of the social worker in dental practice is crucial to establishing a culture of interprofessional collaboration in the dental school clinic and encouraging a team-based approach to solving the complex mix of factors that impact patients’ access to oral healthcare. lastly, some non-participants remarked that they were exceedingly busy with competing priorities and could not participate in the surveys or focus groups. strategies to integrate social work into dental settings participants reported that a licensed social worker could potentially address many access to care issues in the dental clinic. in order to address these issues, clear strategies lyons et al./collaborative approach 130 need to be identified so that the social worker is effectively integrated into the dental team. integration strategies include identifying solutions for operational concerns, programmatic opportunities, and interprofessional education training. social workers can address operational concerns by collaborating with the dental clinic’s quality improvement and compliance teams as well as impact the financial position of the dental clinic. as recommended by participants in the study, items to be addressed include language barriers and long appointment/wait times. the social worker can also develop a referral resource system to assist in addressing the access to care issues. finally, the social worker can attend to operational concerns of financial impact by increasing patients’ preventative and maintenance care, which can reduce the utilization of high cost, non-specialized emergency department visits, increase clinic-based patient treatment, and increase patient-canceled clinic appointments vs. no-shows (lyons, 2020). financial barriers could be addressed more effectively by offering individualized payment plans and implementing a sliding fee scale based on the patient’s income. additionally, standardized policies and procedures regarding fee discounts and payment plans across each of the clinics could be implemented, so that faculty and students apply them to patients in a uniform and equitable manner. with these net changes, there may be an increase in reimbursement rates. two suggested programmatic opportunities which support the clinic operations and patient care include telehealth technology to support language interpretation services and consults with behavioral health specialists. an interactive telehealth language support system offers the ability to have synchronous face-to-face video interactions for all forms of interpreting between the interpreter, patient, and provider to better address language barriers encountered during in-clinic care. iusd could more fully utilize its existing chairside monitors to provide online streaming of general, medical, and dental education, provide face-to-face language services, and telehealth or telebehavioral health services. in addition to conferring with a social worker about resources and referral needs on this telehealth platform, an interactive chairside mobile referral and resource platform could be used to find, promote, note, and share critically important information (e.g., domestic violence-related resources). importantly, it is necessary to implement an intentional training program for all dental students, faculty, and staff on interprofessional education and collaborative practice. research evidence indicates that ipe is considered to be an essential element in modern health sciences education (lash et al., 2014) and that engaging in ipe can reduce stereotyping, improve one’s willingness and preparedness to collaborate with others (gunaldo et al., 2020), and provide a greater appreciation of the roles and skills of other professionals in an interprofessional care team (mckinlay et al., 2019). engaging in interprofessional learning can improve students’ knowledge and skills in preparation for collaborative practice and increase favorable attitudes regarding various aspects of interdisciplinary teamwork, such as communication and shared problem-solving (dyess et al., 2019). the school’s dental and dental hygiene students currently participate, with learners from up to eight other professions, in a university-wide, competency-based, multiadvances in social work, spring 2021, 21(1) 131 component foundational ipe curriculum. the components of this core curriculum occur in a sequenced fashion throughout the students’ respective educational program and currently include exposure-level and simulation experiences. the last two components of the core curriculum, currently in development, offer clinical experiences in collaborative care. integrating a social worker into the dental school’s clinical operations would provide the opportunity for dental students and faculty to engage in team-based care and would provide the framework for a clinical component of the core ipe curriculum. some dental school faculty also participate in the core curriculum as facilitators of one or more of its components. however, faculty appreciation of, and skills in, interprofessional collaborative practice varies widely, and all dental faculty, especially clinical faculty, would benefit from additional training. the dental school’s credentialing and professional development continuing education offerings could include sessions on ipe/icp to enhance faculty buy-in and willingness to participate in interprofessional collaboration. likewise, knowledge of ipe/icp among dental school staff members is not extensive, and they would benefit from an understanding of the advantages of interprofessional collaborative practice and the skills required for effective teamwork, as well as the specific role and value of a social worker in the oral health care setting. similarly, edc worked to train all clinic providers within the school to understand the role of the social work professional and how one can address patient problems (petrosky et al., 2009). in sum, findings from this needs assessment support the 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(2016). transforming care for complex patients: addressing interconnected medical, social, and behavioral challenges. journal of general internal medicine, 31(2016), 263-264. https://doi.org/10.1007/s11606015-3554-5 author note: address correspondence to stuart m. schrader, dept. of biomedical sciences & comprehensive care, indiana university school of dentistry, 1121 w. michigan st. b26, indianapolis, in, 46202. email: sschrade@iu.edu about:blank about:blank about:blank#tab-6 about:blank about:blank about:blank about:blank about:blank about:blank about:blank about:blank about:blank about:blank _________________ amy killen fisher, jd mssw is an associate professor and msw field education director, department of social work, university of mississippi, university, ms38677. chris simmons, phd, msw is an instructor, school of social work, university of south florida, tampa, fl, 33620 . susan c. allen, ph.d., mssw, is an associate professor and msw program director, department of social work, university of mississippi, university, ms, 38677 copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1085-1102, doi: 10.18060/21556 this work is licensed under a creative commons attribution 4.0 international license. introducing bsw students to social work supervision prior to field: a bsw-msw student partnership amy killen fisher chris simmons susan c. allen abstract: little empirical information exists about how social work students are prepared to utilize supervision in practice. this study describes an experiential exercise designed to introduce bsw students to social work supervision prior to their field experience. msw students enrolled in a supervision practice course provided mentored supervision to 42 bsw students in an introductory skills course. the skills course involved a progressive role-play that spanned the whole semester. mixed methods were used to investigate bsw student perceptions of the exercise. according to survey data, bsw students reported a strong working alliance with msw students and high satisfaction with the supervision they received. qualitative data revealed two overarching categories of students: 1) students who reported benefiting from the exercise, and 2) students who reported mixed benefits or no benefits. students who understood the role of the supervisor were also more likely to reported that they benefited from the exercise. students who were unclear about the role of the supervisor reported mixed or no benefits of the exercise. recommendations for social work educators relate to the need for educators to provide information on the use of supervision for bsw students, the necessity for guiding student reflections as part of the supervision exercises, and considering the developmental levels of students when crafting educational interventions. keywords: bsw, supervision, supervisee, experiential learning, mixed methods, training all social work graduates are expected to possess competency in a wide array of subjects. social work educational programs have the responsibility for developing “the substantive content, pedagogical approach, and educational activities that provide learning opportunities for students to demonstrate the competencies” (council on social work education [cswe], 2015, p. 6). one way that social work graduates are expected to demonstrate competency is through “the use of supervision and consultation to guide professional judgment and behavior” (cswe, 2015, p. 7). supervision is central to social work and particularly for its signature pedagogy—field education. both students and practitioners consider field education to be the most critical component of preparation for practice (bogo, 2010). generally, a student’s first exposure to the supervisory relationship occurs during field education. within that setting, quality supervision can help improve student skills (deal, bennett, mohr, & hwang, 2011) and also help students weather the emotional situations inherent in the practice of social work (litvack, mishna, & bogo, 2010). once students graduate, supervision helps foster and https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2018, 18(4) 1086 maintain professional growth, protect against burnout, and ultimately produce better client outcomes (kadushin & harkness, 2014). despite the cswe competency requirement and the importance of supervision in practice, there is little empirical information about how social work students are prepared to utilize supervision in practice (everett, miehls, dubois, & garran, 2011; miehls, everett, segal, & du bois, 2013). there is an abundance of literature exploring what is “good” social work supervision (kadushin & harkness, 2014; shulman, 2010) and how to teach social work supervisors how to provide good supervision (bennett & deal, 2012; bogo, 2010; fisher, simmons, & allen, 2016). most empirical investigations about supervisees ultimately center around how supervisors can use the findings to provide better supervision (bogo, 2010; kanno & koeske, 2010; miehls et al., 2013). nonetheless, the wealth of field companion books that introduce social work student to the nature, structure, and purpose of the supervisory relationship as revealed by a google search (“social work field education books”) demonstrate the necessity for orienting students to the supervisory relationship. additionally, the mounting evidence that an alarming proportion of supervisees receive inadequate and even harmful supervision creates a sense of urgency for empowering supervisees with skills and knowledge about supervision is supported by (ellis, berger, hanus, & ayala, 2014; mcnamara, kangos, corp, & ellis, 2017). the purpose of this article is to describe an innovative experiential exercise introducing pre-practicum bsw students to the use of supervision and to report the results of a pilot study of bsw students’ perceptions of the exercise. suggestions for future development of the exercise and evaluation are presented. relevant literature social work supervision the authors use the conceptualization of social work supervision provided by kadushin and harkness (2014): administrative, educational, and supportive functions of supervision are used to “direct, coordinate, enhance, and evaluate the on-the-job performance” of the supervisee (p. 11), with an eye toward enhancing both daily practice skills and the overall professional development of the supervisee. the administrative function deals with tasks such as paperwork, employment evaluation, and adhering to agency policy; the educational function has to do with facilitating the continuing education of the supervisee; and the supportive aspect includes meeting emotional needs of the developing social worker. the inclusion of the supportive and educational aspects of supervision is necessary for positive outcomes for both workers and clients, (e.g., reducing child welfare worker turnover; renner, porter, & preister, 2009) and increasing worker empowerment and satisfaction (mor barak, travis, pyun, & xie, 2009). indeed, social work practitioners report their greatest supervisory needs are the educational and supportive aspects of supervision (hair, 2013). strong supervisory relationships can be nurtured through the supervisory working alliance (bordin, 1983). according to bordin, the supervisory working alliance is developed through mutual agreement on goals and tasks, with strong supervisory bonds. killen fisher et al./introducing bsw students 1087 goals refer to the types of changes that are to take place in supervision; tasks are behavioral objectives accomplished by the supervisor and supervisee to reach mutually agreed upon goals; and bonds are feelings of liking, caring, and trusting within the dyad which help to sustain the relationship. in addition, supervision satisfaction is linked to the quality of the supervisory relationship and attention to all three aspects of supervision (mor barak et al., 2009). the supervisory relationship can predict the quality of the therapeutic alliance (depue, lambie, liu, & gonzalez, 2016) and has the potential to positively affect client outcomes (horvath, del re, flückiger, & symonds, 2011). a positive supervisory relationship engenders trust (renner et al., 2009). psychological empowerment of the supervisee through power sharing between supervisor and supervisee results in the supervisee having a sense of control and competence, a sense of self-efficacy, and ownership of actions (lee, weaver, & hrostowski, 2011). training students to use supervision despite the centrality of supervision to social work, few studies explore how students are prepared to use supervision. one study proposing a developmental model for practicum supervision explored student perceptions. as part of a mixed methods design, everett et al. (2011) assembled post-practicum students into focus groups and asked, “did you feel prepared to make use of supervision, and, if not, what were you surprised by?” (p. 255). the authors reported that students did not feel prepared and were even confused by the term supervision. when queried about preparedness for the supervisory relationship, students offered the following comments: i wasn’t. i had a professional job before coming here and think i have never had to go in and say this is what i am doing and like it just felt like really weird. i had no concept of how to use her in the beginning. (everett et al., 2011, p. 260) similarly, another student shared: “i didn’t get it at all. i didn’t understand what it was about—the whole thing puzzled me—even the term supervisor—it had a really different connotation” (everett et al., 2011, p. 260). the authors concluded that “students lack adequate preparation about the function of supervision in social work practice” (everett et al., 2011, p. 263). they urged social work educators to prepare students to use supervision using role-play, case presentations, readings, and discussion. using focus groups, miehls et al. (2013) explored msw student expectations and experiences of supervision. the researchers specifically questioned the students about their understanding of supervision prior to beginning field. although students could not recall information about course content on supervision, several students had a general idea that supervisors provide help with both direct practice and mentoring. however, other students expressed confusion about the structure of supervision sessions and the nature of the supervisory relationship. lack of structure (e.g., not collaborating on agenda setting) was cited as one reason for dissatisfaction with supervision. another reason for dissatisfaction was a lack of conflict resolution bolstered by power differentials in the relationship. the advances in social work, fall 2018, 18(4) 1088 study results suggested a lack of clarity about the “content, frequency, nature, and focus of agency supervision” (miehls et al., 2013, p. 143). in other words, many social work students finish coursework with little idea of what supervision should be, much less how to develop and utilize the supervisory relationship. the authors argued that one solution would be to train students regarding what to expect from and how to use supervision. in light of these findings and proposals, the authors developed an experiential exercise with the hope of introducing bsw students to supervision prior to their field experiences. experiential exercise on the use of supervision the authors designed an experiential exercise involving both bsw and msw students, wherein bsw students enrolled in a required introductory skills course received social work supervision from second-year msw students learning supervisory skills. the msw students had all completed at least one practicum prior to the experience and thus had been exposed to social work supervision in the field. the exercise was designed to teach the msw students how to provide social work supervision while simultaneously exposing bsw students to the range of practice behaviors that social workers encounter in their daily work, including the use of supervision (for an exploration of this exercise from the msw perspective, see fisher et al., 2016). a specific aim for the bsw students was to introduce them to the process of decision-making regarding clients while seeking supervision and thereby engaging in reflective practice. the exercise has been used at this institution during the fall semester for four years. the exercise utilized the elements of kolb’s (1984) four-part experiential learning cycle: abstract concept, concrete experience, reflective observation, and active experimentation. due in part to the ability of experiential learning to bridge the gap between theory and practice (lu, dane, & gellman, 2005), this model is often used in social work (anastas, 2010; pugh, 2014). students may begin kolb’s cycle at any stage, depending on their learning style. due to its flexibility, the model is able to accommodate all types of learners (anastas, 2010; pugh, 2014). table 1 provides an overview of the assignments, the learning objectives, and the timing of each assignment that was part of the bsw exercise. the experiential component of the bsw introductory skills class began with students learning about each stage of the planned change process, from intake and engagement to termination, and the skills germane to each stage (abstract learning). the role-plays were based on predetermined scripts. the bsw students follow one case across the semester progressing from engagement to termination. the role-play scripts were constructed by both bsw students and the instructor at the beginning of the course. bsw students conducted and video-recorded 30-minute individual sessions with a classmate or an instructor-approved participant who was willing to play the role of the client. there was one client session per stage: engagement, exploration, assessment, treatment planning, and termination (concrete experience). killen fisher et al./introducing bsw students 1089 table 1. components of the experiential exercise on supervision assignment experiential learning objective timing pre-self-assessment reflection beginning of the semester in class lecture and discussions of topics (planned change process and skills) abstract concepts weekly throughout semester five recorded role-play sessions with “clients” concrete experience active experimentation beginning at middle of semester and continuing biweekly until complete session notes and log concrete experience reflection immediately following each role-play “client” session supervision reflection following each role-play “client” session post-self-assessment reflection end of the semester the bsw students were presented with varying opportunities for reflective observation. first, the bsw students were required to review their own sessions, write a self-reflection, and create progress notes for each session. next, bsw students were assigned msw student supervisors. bsw students met with the msw student supervisors for 30 minutes a week for five face-to-face sessions. students were responsible for negotiating times to meet. msw student supervisors were instructed to vary supervision based on the bsw student’s developmental needs. msw student supervisors conducted at least one live supervision session and reviewed student tapes in other sessions. for each recording, the bsw students identified the part of the tape they wanted to present in session. for at least one session, the msw supervisor reviewed the entire recorded roleplay. the students initiated supervision in as realistic a manner as possible, with the msw student supervisor providing appropriate forms and paperwork (informed consent, necessary releases, etc.) to explain, review, and sign in the first session. also during the initial session, the msw student supervisors and bsw supervisees developed goals and a contract for supervision. for subsequent sessions, the bsw students participated in setting the goals and agenda for each session and were responsible for choosing what part(s) of the role-play recordings they wanted their supervisor to review. the supervision sessions occurred after each recording was made but ideally before the next recording so that students could incorporate supervisor input (active experimentation). the exercise culminated with a final self-reflection activity, a post-self-assessment, in which each bsw student provided a written self-assessment of his or her progress toward mastering the skills covered during the semester. by the time the supervision began, the msw students were familiar with bordin’s (1983) supervisory working alliance and shulman’s (2010) parallel process model, and had learned about the administrative, educational, and supportive functions of supervision (kadushin & harkness, 2014; shulman, 2010). they had also delved into the study of developmental supervision, which sees supervision as having a trajectory with a beginning, middle, and end (shulman, 2010), because supervisees are more satisfied with supervisors advances in social work, fall 2018, 18(4) 1090 who attend to their developmental needs (everett et al., 2011). msw students were, therefore, instructed to assess supervisee developmental level and vary their supervision based on each bsw student’s developmental needs. to ensure quality supervision for the bsws, each msw student recorded at least five supervisory sessions for review by the msw instructor, produced written reflections and notes on each session, and received group input on their supervision. although msw students provided supervision, the ultimate responsibility for promoting and evaluating the bsw students’ interview skill acquisition rested upon the bsw instructor. both msw and bsw students received course credit for their participation in the clinical supervision exercise. no students were enrolled in field at the time of the exercise. methods this pilot study addresses a gap in the literature by exploring the experiences of bsw students participating in a training exercise in supervision. more specifically, this study addressed the following research question: what were the perceptions of the bsw students regarding the training exercise focused on the use of supervision? the design of the study was an embedded mixed methods approach. after approval by the institutional review board, the research team used both quantitative (surveys) and qualitative (focus groups) approaches to explore the research questions. the description of the samples, procedures, and results for each portion of the study are provided below. surveys (quantitative) participants. a purposeful sample of bsw students was recruited from a csweaccredited program at a midsized state university in the southeast. the participants were 42 students enrolled in two sections of an introductory practice skills course. the sample was comprised of students who were african american (61%), white (35%), and other (4%). the majority of students (93.5%) were female. most students were between the ages of 18 – 24 (70%), while 30% were 25 and older. procedure and instruments. survey data was collected in two waves during fall 2014 and fall 2016. bsw students completing the survey in fall 2014 were invited via e-mail to complete two online surveys, the working alliance inventory–trainee (wai-t; bahrick, 1990) and the supervision satisfaction questionnaire (ssq; ladany, hill, corbett, & nutt, 1996), each containing likert-style scale survey items. the e-mail included a link to an online consent form and to the online survey. fall 2016 survey participants completed both surveys prior to their participation in the focus groups described below. in 2014, extra credit was offered to students who completed the questionnaires, and extra credit plus pizza was offered in fall 2016. incentives can increase participation, although other factors also influence the decision to participate (rickles, 2010; sharp, pelletier, & lévesque, 2006); intrinsic motivation may be the more important incentive rather than rewards (omori & feldhaus, 2015). working alliance inventory—trainee (wai-t). the wai-t was used to assess each bsw student’s perception of the strength of the supervisory relationship using the factors killen fisher et al./introducing bsw students 1091 contained in bordin’s (1983) definition of the supervisory working alliance: goals, tasks, and bonds. the 36-item self-report instrument includes such items as “[supervisor] and i collaborated on setting goals,” “we agreed on what is important for me to work on,” and “my relationship with [supervisor] is very important to me”). each of the three subscales contains 12 items, which are rated on a 7-point likert-type scale ranging from 1 (almost never) to 7 (almost always). higher scores reflect increased strength in each domain. with respect to validity, the wai-t was validated by asking seven expert judges to rate the relevance of each item on the three supervisory working alliance subscales (i.e., goals, tasks, and bonds; bahrick, 1990). in addition, the wai-t was positively related to supervisee satisfaction and favorable supervisory racial identity interactions, but negatively related to supervisee role conflict and role ambiguity (ladany & lehrman-waterman, 1999). in the current study, the wai-t showed good internal consistency. the cronbach’s alpha were α = .90 (goals), α = .89 (tasks), and α = .88 (bonds). supervision satisfaction questionnaire (ssq). the ssq was used to assess student supervision satisfaction, which is also linked to the quality of the supervisory relationship and attention to all three aspects of supervision (mor barak et al., 2009). the ssq contains 8-items rated on a 4-point scale that measures satisfaction with various aspects of supervision. sample items include, "how would you rate the quality of supervision you have received?” and “has the supervision you received helped you to deal more effectively in your role as a social worker?” scores for the scale are obtained by summing the item ratings. the reliability coefficient for the ssq was .96. data analysis. a series of chi-square goodness-of-fit tests were conducted to describe a) the extent to which bsw students perceived that they had a strong working alliance (i.e., goals, tasks, and bonds) with the msw student supervisors; and b) the extent to which bsw students were satisfied with the supervision they received from msw students. responses on the wai-t were dichotomized into strong or weak bonds and high or low for goals and tasks. if students reported “often,” “very often,” “always” in response to positive statements or “never,” “rarely,” “occasionally,” or “sometimes” to negative statements, they were coded as strong/high. in contrast, if students reported “never,” “rarely,” “occasionally” or “sometimes” in response to positive statements or “often,” “very often,” or “always” to negative statements, they were coded as weak/low. results are presented using descriptive statistics. prior to the implementation of this exercise, bsw students received peer mentoring from other bsw students who had taken this introductory practice course the previous semester and were given the wai-t and ssq to assess working alliance and satisfaction with supervision. about 50% of the students surveyed reported a strong working alliance and satisfaction with supervision they received. therefore, if the null hypothesis is true, we would expect about 50% of the students to report a strong/high working alliance and high satisfaction with supervision after receiving msw supervision. if the null hypothesis is not true, however, more students would report a strong working alliance and high satisfaction with supervision after receiving msw supervision. advances in social work, fall 2018, 18(4) 1092 focus groups participants. focus group participants were bsw students recruited from the most recent cohort who participated in the supervision exercise. the sample (n=12) was comprised of 6 african american and 6 white students. all 12 focus group participants were females between the ages of 20-22. procedure. focus group participants were recruited via email. along with the recruitment email, students were sent a link to an online sign-up sheet for the scheduled focus groups. as previously discussed, extra credit points and pizza were offered as incentives to attend the focus groups. students who signed up for the groups were sent confirmation and reminder emails prior to each focus group session. the pizza incentive did not appear to influence a social desirability bias because students seemed equally willing to offer criticism of the exercise as they did favorable comments (cyr, 2016). the following questions were used to guide the focus group discussion: 1. talk about this experience and what it was like for you. 2. what did it mean? 3. what, if anything, did you learn? 4. now that you have had this experience, what else do you think you need to know about supervision? 5. do you think this experience will be helpful to you in the future? if so, please say specifically what you think was helpful. if not, please try to state specifically what was unhelpful? 6. think about the process of this exercise. what was helpful? what was not helpful? what do you think you could have used more or less of? 7. what, if any, skills or competencies do you think you have developed as a result of this exercise? data analysis. a thematic analysis of data was employed (thomas, 2006). data analysis relied on video recorded during each of the two focus groups. the videos were transcribed with participants identified by code names. transcripts were imported into nvivo software package 11 (qsr international, 2015) for text retrieval and flexibility of organization and linking after manually completing initial coding. the primary unit of analysis was individual comments. the responses of students were entered into a columned matrix that enabled consideration of what themes might be indicated and labeled with preliminary codes. as this was the first attempt in this series of investigations to understand how bsw students experienced supervision, the authors elected to provide a more detailed account of a particular set of themes in the data, i.e., student comments that reflected a perception that the exercise was or was not helpful or beneficial (braun & clarke, 2006). underlying categories in each of those themes were identified and clustered into matrices (miles, huberman, & saldaña, 2014), recognizing that category construction is not always unambiguous (saldaña, 2016). the authors reflected, compared, and discussed interpretations using miles and huberman’s (1994) interactive model of data analysis. a general inductive approach using killen fisher et al./introducing bsw students 1093 thematic analysis was employed to develop the framework of the underlying structure of experiences (thomas, 2006). the framework was illustrated using excerpts from the raw data and presented in the findings (fereday & muir-cochrane, 2006). results survey results results indicated that the distribution of the responses to the wai-t and ssq following the implementation of the msw supervision exercise was not the same as the distribution for peer supervision. bsw students reported a strong working alliance with msw students and high satisfaction with the supervision (see table 2). based on the odds ratio, students were 5 times more likely to report a strong emotional bond (86%) as opposed to a weak emotional bond (14%). they were 4.3 times more likely to have a high level of mutual agreement (81%) than a low level of mutual agreement (19%) on goals. students were 6 times more likely to have a high level of agreement (86%) than a low level of agreement (14%) on tasks. with respect to satisfaction with the supervision they received, students were 5 times more likely to report high satisfaction (81%) than low satisfaction (19%). table 2. results of the chi square tests (n= 42) (χ2) df p-value or working alliance inventory – trainee (wai-t) bonds 21.43* 1 <.001 5.0 goals 16.10* 1 <.001 4.3 tasks 21.43* 1 <.001 6.0 supervision satisfaction questionnaire (ssq) supervision satisfaction 16.10* 1 <.001 5.0 note: or = odds ratio focus group results the analysis of the narrative data identified two categories of how bsw students experienced the supervision process: (1) those who found it a positive and helpful experience, and (2) those who had a mixed experience and/or did not see it as beneficial as it could have been. sub-categories were identified within these two broad categories. helpful experiences. among those who found the supervisory exercise beneficial and experienced a degree of learning, bsw students identified such themes as learning to improve performance and relate the experience to actual practice. these students also tended to define the experience as more one of mentorship. they were able to identify the skills they learned as a result of the supervision they received, and how to use the experience to prepare for future use of supervision. improve future performance. students expressed gaining understanding and insight into what they were doing well, as well as how to improve by observing and discussing other students’ video interviews and receiving feedback from the msw student supervisors. one student stated: advances in social work, fall 2018, 18(4) 1094 i felt it was very good practice. in one of my videos i was focusing on the client’s husband instead of the client, and my supervisor reminded me to focus on my client—the wife, even though i wanted to help the husband, too. other statements included “i learned to ask them if they have any questions. i felt that i did a good job, but i forgot to ask if they had any questions about what i was saying,” and “every time we would get a new topic in class we would also ask our supervisor how it would relate to real life social work.” in discussing how the supervision sessions were structured, one student said, “we would make our videos together and then talk about them and the different scenarios. it was like getting insight on more than one example.” another bsw student had this to say about the videos of the client sessions: “we would watch them and discuss what was done well. she had a checklist and would see if we were progressing. that was really helpful, because we were confused going in, but she helped make it a lot more clear.” importance of relationship. students expressed seeing the exercise as the msw student being more of a mentor, giving suggestions about being a successful student rather than helping develop practice skills. “i looked at this as more a mentor thing than a supervisor.” this was also indicated through statements such as, “not only was she excited about the videos, she wanted to know more about us as well. she was concerned about our lives” and “i liked my supervisor, too. she also helped me with my question about graduate school.” one bsw student suggested, “i think it would be good to have this for all social work majors. once they declare, pair them up with someone who can guide them.” on discussing the mentoring aspects of the relationship, one student said, “that’s what my supervisor was like [mentor]. she would tell me about different teachers, insight into what to expect in our classes and the work load.” similar statements were “i felt that they were able to give me valuable feedback on the path to graduate school,” and “i learned about the license exam. that was probably the most helpful thing because i did not really know about it.” mixed experiences and/or less beneficial. students who had mixed and/or less beneficial experiences of the exercise identified such themes as feeling unsure and not certain, feeling misguided, being frustrated, finding the exercise time-consuming, or not wanting feedback about performance. stress and frustration. the most typical experience of students who did not find the exercise beneficial was frustration and added stress. this was indicated in responses where those exact terms were used, but also alluded to, as in the students who said, “i felt like it could have been more” and “it just seemed a little random. they felt sort of rushed and stressed…going through the motions and meeting the steps we had to meet.” some students with frustrating experiences seemed to have initial hopefulness, as illustrated by statements like “…maybe i’ll meet with her by the end of the semester” and “i had wanted it to go better than it had.” more benefit to the msw students. students who identified themes of the self-serving aspect of the msw student participation also expressed disappointment and a feeling of having been misled. for example, one student said: killen fisher et al./introducing bsw students 1095 i felt a little misguided. i thought it was 100% for our benefit, and i did not realize that we were partaking in their assignment. it kind of changed the way that i looked at it. i felt that it was only important to them because they were getting a grade and not for helping us. i like my supervisor, but i think it changed the dynamic of the meetings. another student agreed, saying “it was more like their assignment that we were helping with than a tool for us.” however, one student expressed just the opposite, stating “up until right now i didn’t know that they were only using us to practice being a supervisor.” role of supervision for learning. some of the bsw students thought the exercise was intended to help them complete the role-play interview assignment and achieve a better grade, thus they were frustrated that the review occurred after their assignment was completed. for example, a student expressed the following: by the time that i would meet [with my supervisor], i would have already turned in my video and i didn’t really care about what anyone else had to say about it. i did not have a grade on it yet, so i did not need someone critiquing it. i would have appreciated help a week earlier. this theme related to bsw students not having a grasp of supervision’s role in practice, or the purpose of the exercise and how it could be helpful in the future. utilizing supervision. students knew little about social work supervision prior to the exercise, in theory or in practice. only two students expressed any prior knowledge of the role of supervision in general, and none expressed awareness that they would have supervision in field practicum or in social work practice at the bsw level. a little more than half of the focus groups participants also found the process useful in terms of increasing knowledge about the purposes and use of supervision. for example: i could tell that she actually took her time with this assignment. she brought notes telling me what i could do to improve. i could tell that she really took the time to watch each one. she was able to watch my videos and tell me, “you need to ask more questions.” those students also expressed awareness of how the exercise could contribute to their use of supervision in future coursework and practice. several of them appreciated the one-onone attention. i think that it will be really helpful to have someone guide you. when we first started, i had no idea what we were supposed to do with the video. the supervisor really helped everyone in our group focus and figure out what we were doing. also, “[t]hey can prepare you for when you are ready to be out on your own,” and i think it will be helpful next semester when we are taking the practice classes. we can use this to be more helpful to clients and maybe get a better grade. my supervisor taught me that an introduction is more than just about our name and title. it’s about making the client feel comfortable before jumping into the session. advances in social work, fall 2018, 18(4) 1096 examples of learning from supervision include, “she gave me good feedback on the second [video of a session]. the first one she mainly talked about what i had done. she didn’t really tell me what i could have done better. she watched our second video and gave us some advice on what to do in the third.” another student stated: my advisor watched all of our videos and then went through and gave us the positives and negatives. when she watched our videos, she would ask a lot of questions and would point things out. i was able to use her advice. however, it is important to note that, even though it was explained to students during class, there was little awareness in about half of the bsw students of using supervision to identify and reflect on what worked and what did not work after a client session. one student stated: i guess i don’t really know what was expected of me before supervision meetings. i’m not really sure what i would need to bring to the table. i wish we would have been given a goal of what we were supposed to have gotten out of supervision. one revealing statement that seemed to indicate another disconnect between msw student supervisor and bsw student supervisee was: she asked about my goals and i really did not have any, but she kept pressing me so i answered the first thing that i thought of, “active listening.” so, every time we spoke we had to talk about active listening, even though i didn’t care. we had already gone over it in class; i know what to do. discussion we introduced the concept of supervision to the bsw students with the aspiration of providing an orienting experience to social work supervision prior to field. the survey results indicate that the bsw students were generally satisfied with their supervision and perceived that a strong working relationship and alliance had been formed. the information from the bsw students who participated in focus groups helped clarify the experiences of both those students who were satisfied and perceived a strong supervisory working alliance and those who did not. qualitative data revealed that the bsw student supervisees who reported being very clear on the dual role of supervision as being supportive of professional development as well as skill development (kadushin & harkness, 2014) tended to be satisfied with their supervision. however, bsw students who were less clear on the role of supervision believed their supervisors’ role was to tell them what to do on the next recording. these students tended to express more dissatisfaction with the project. the bsw students’ characterization of their relationship with their msw supervisors as being “more of a mentor” revealed potential insights into their perception of the supervisory relationship. “mentor” was the term supplied by the bsw students themselves; the focus group facilitator did not explore its meaning. the students’ label of mentor might indicate that the supportive functions of the supervisory relationship (kadushin & harkness, 2014), as well as bonds of trust and respect (bordin, 1983), were present. the killen fisher et al./introducing bsw students 1097 comments also suggest that professional development is important to these bsw student supervisees, as shown by positive comments about the msw supervisors answering questions about the licensure examination. limitations and implications for future research more information is needed on how supervisees perceived the supervisory relationship. for example, what did the students mean by “mentor” and is the inference above correct? also, did unhappy supervisees express their dissatisfaction or disappointment to their supervisors, and if so, in what manner? did they feel that they could have questioned their supervisors? also, the current exploration did not include gathering any information regarding both msw student supervisor and bsw student supervisee levels of experience. more information is needed regarding if and how experience affects student perceptions of the exercise. another useful area for investigation includes examining the effect of adding very specific procedures regarding the information provided to bsw students on the function of social work supervision and reflection opportunities for the bsw students throughout the project. although the purpose of supervision was very explicitly addressed in the project documentation (the supervision contract includes both the msw student supervisor professional disclosure statement and a place to insert goals of the supervisee; the informed consent for supervision includes a statement that msw student supervisors will be using recordings for class assignments), this study did not explore the process through which some of the bsw student supervisees arrived at the end of the project with very little understanding of the purpose of social work supervision. recommendations the results suggest that while the exercise has utility, there is room for improvement. student reflections can and should be used to assess strengths and limitations in the educational process of a social work program. just as reflection enables social workers to consider alternate perspectives, understanding how student social workers make connections in practice can assist educators to help students move toward professional development (williamson, hostetter, byers, & huggins, 2010). perhaps the most striking need revealed by this investigation is the importance of the bsw instructor assuming an active role in teaching bsw students about supervision. even students in the field practicum sometimes have insufficient knowledge about supervision and how to utilize supervision for growth (miehls et al., 2013; moorhouse, hay, & o’donoghue, 2014). understanding how to use supervision takes time; thus, learning in this area should be “more robust” (moorhouse et al., 2014, p. 47). these topics need to be part of bsw practice classes prior to the practicum experience as bsw student understanding of supervision cannot be assumed. we suggest creating a script or other materials explaining the function and purpose of social work supervision, and providing that to the bsw students. a quiz or other means of evaluating learning is imperative. furthermore, the bsw instructor in projects of this type must attend to the developmental needs of the bsw students. the need clearly exists to help students develop advances in social work, fall 2018, 18(4) 1098 the ability to deepen their thinking, to articulate their process of thinking through how they reach conclusions, and to understand and plan what to do with the increased understanding and awareness (sussman, bailey, richardson, & granner, 2014). one mechanism for facilitating and tracking this development could be to have the bsw students do more group reflection, e.g., during class, on their practice videos and to elaborate on how or why they made their decisions (lee & fortune, 2013). this mechanism would also quite directly satisfy the reflection component of experiential learning as described by kolb (1984). in addition, students in the beginning stages of the education process have little or no experience to connect with theory and practice; they need clear guidelines in the form of rules (davys & beddoe, 2009). these students are often functioning in very basic stages of cognitive complexity (simmons & fisher, 2016) wherein learners believe there are black and white answers to all problems and that authority figures will provide all of the needed answers. this may explain why students voiced dissatisfaction with supervisors who did not tell them what to do on their next recording. these supervisors were essentially not giving them the “right” answers to the problems they faced. in order to assist students in moving beyond the basic level of cognitive development, a balance of support and challenge is necessary. structure and guidelines, along with positive feedback and support, is necessary to help students reflect on their actions and the outcome of those actions. because the demand for reflection can be overwhelming in students who are not ready for that level of complexity, both the bsw instructor and the msw student supervisor must guide students in both thinking about the experience, and in reaching for the understanding and growth that comes from thinking through and talking aloud about the experience (davys & beddoe, 2009). the bsw instructors and the msw student supervisors need to initially take a more directive role while also helping bsw students see how to use the experiences in the video being reviewed to learn strengths and areas for improvement and plan for the next interview session, even if it is “a totally different scenario.” it will likely also be helpful for the bsw students to observe skilled supervisors in action in order to fully understand that good supervisory skills include asking questions and encouraging reflection. this might assist bsw students in being more open to participating in the process by connecting it with their learning needs (i.e., to develop practice skills), and how that is reciprocal in the development of msw student supervision skills. specific reflection by the student supervisee, guided by the msw student supervisor, to help the supervisee use insights in planning for the next interview/intervention will possibly enable the bsw student to develop an appreciation for the role of supervision. a final recommendation is that if there is more than one instructor involved in the project, they should meet regularly to compare notes. ensuring that all students are receiving the same information is essential, as is regularly checking in on progress and problems encountered along the way. conclusion this preliminary investigation of student perceptions of the exercise suggests that it has promise for teaching bsw students how to use supervision. however, the investigation also revealed 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(2010). i found myself at this practicum: student reflections on field education. advances in social work, 11(2), 235-247. author note: address correspondence to: amy fisher, jd, mssw, department of social work, university of mississippi, 205 longstreet hall, p.o. box 1848, university, ms, 38677, afisher@olemiss.edu https://doi.org/10.1037/cjbs2006014 https://doi.org/10.1080/10437797.2016.1198290 https://doi.org/10.1080/10437797.2014.856233 https://doi.org/10.1177/1098214005283748 mailto:afisher@olemiss.edu all social work graduates are expected to possess competency in a wide array of subjects. social work educational programs have the responsibility for developing “the substantive content, pedagogical approach, and educational activities that provide l... supervision is central to social work and particularly for its signature pedagogy—field education. both students and practitioners consider field education to be the most critical component of preparation for practice (bogo, 2010). generally, a studen... despite the cswe competency requirement and the importance of supervision in practice, there is little empirical information about how social work students are prepared to utilize supervision in practice (everett, miehls, dubois, & garran, 2011; miehl... the purpose of this article is to describe an innovative experiential exercise introducing pre-practicum bsw students to the use of supervision and to report the results of a pilot study of bsw students’ perceptions of the exercise. suggestions for fu... relevant literature social work supervision the authors use the conceptualization of social work supervision provided by kadushin and harkness (2014): administrative, educational, and supportive functions of supervision are used to “direct, coordinate, enhance, and evaluate the on-the-job perfo... strong supervisory relationships can be nurtured through the supervisory working alliance (bordin, 1983). according to bordin, the supervisory working alliance is developed through mutual agreement on goals and tasks, with strong supervisory bonds. go... the supervisory relationship can predict the quality of the therapeutic alliance (depue, lambie, liu, & gonzalez, 2016) and has the potential to positively affect client outcomes (horvath, del re, flückiger, & symonds, 2011). a positive supervisory re... training students to use supervision despite the centrality of supervision to social work, few studies explore how students are prepared to use supervision. one study proposing a developmental model for practicum supervision explored student perceptions. as part of a mixed methods design... when queried about preparedness for the supervisory relationship, students offered the following comments: i wasn’t. i had a professional job before coming here and think i have never had to go in and say this is what i am doing and like it just felt like really weird. i had no concept of how to use her in the beginning. (everett et al., 2011, p. 260) similarly, another student shared: “i didn’t get it at all. i didn’t understand what it was about—the whole thing puzzled me—even the term supervisor—it had a really different connotation” (everett et al., 2011, p. 260). the authors concluded that “st... using focus groups, miehls et al. (2013) explored msw student expectations and experiences of supervision. the researchers specifically questioned the students about their understanding of supervision prior to beginning field. although students could ... experiential exercise on the use of supervision the authors designed an experiential exercise involving both bsw and msw students, wherein bsw students enrolled in a required introductory skills course received social work supervision from second-year msw students learning supervisory skills. the m... the exercise utilized the elements of kolb’s (1984) four-part experiential learning cycle: abstract concept, concrete experience, reflective observation, and active experimentation. due in part to the ability of experiential learning to bridge the gap... the experiential component of the bsw introductory skills class began with students learning about each stage of the planned change process, from intake and engagement to termination, and the skills germane to each stage (abstract learning). the role-... the bsw students were presented with varying opportunities for reflective observation. first, the bsw students were required to review their own sessions, write a self-reflection, and create progress notes for each session. next, bsw students were ass... the students initiated supervision in as realistic a manner as possible, with the msw student supervisor providing appropriate forms and paperwork (informed consent, necessary releases, etc.) to explain, review, and sign in the first session. also dur... by the time the supervision began, the msw students were familiar with bordin’s (1983) supervisory working alliance and shulman’s (2010) parallel process model, and had learned about the administrative, educational, and supportive functions of supervi... to ensure quality supervision for the bsws, each msw student recorded at least five supervisory sessions for review by the msw instructor, produced written reflections and notes on each session, and received group input on their supervision. although ... supervision satisfaction questionnaire (ssq). the ssq was used to assess student supervision satisfaction, which is also linked to the quality of the supervisory relationship and attention to all three aspects of supervision (mor barak et al., 2009). ... data analysis. a series of chi-square goodness-of-fit tests were conducted to describe a) the extent to which bsw students perceived that they had a strong working alliance (i.e., goals, tasks, and bonds) with the msw student supervisors; and b) the e... focus groups discussion we introduced the concept of supervision to the bsw students with the aspiration of providing an orienting experience to social work supervision prior to field. the survey results indicate that the bsw students were generally satisfied with their sup... qualitative data revealed that the bsw student supervisees who reported being very clear on the dual role of supervision as being supportive of professional development as well as skill development (kadushin & harkness, 2014) tended to be satisfied wi... _________ mohan vinjamuri, lmsw, phd is an assistant professor, department of social work, lehman college city university of new york, bronx, ny 10468. lydia p. ogden, msw, phd is an assistant professor, simmons university school of social work, boston, ma 02115. jessica m. kahn, lmsw, phd is an associate professor, department of social work, lehman college city university of new york, bronx, ny 10468. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1218-1236, doi: 10.18060/22333 this work is licensed under a creative commons attribution 4.0 international license. student, faculty, and field instructor approaches to sbirt implementation: implications for model fidelity mohan vinjamuri lydia p. ogden jessica m. kahn abstract: informed by an empirically-based implementation model, this study examined how social work faculty, student, and fieldwork instructor approaches to using the evidence-based sbirt protocol affected implementation and model fidelity. data were obtained from two rounds of focus groups with three groups of stakeholders (faculty, students, and fieldwork instructors) about their experiences teaching, learning, using, and supervising sbirt and were analyzed using a hybrid inductive and deductive process. analyses yielded three main categories of approaches: those that impeded implementation and model fidelity; those that supported implementation but were not congruent with model fidelity; and those that supported both implementation and model fidelity. lack of consciousness about model fidelity was an issue across groups. efforts to find a fit between the protocol, settings, and professional approaches to social work often led to implementation but questionable model fidelity. repeated exposure to new material and opportunities to engage with it, having specific tools, and supporting learners’ efforts to uphold social work values can promote faithful implementation. keywords: evidence-based practice; implementation science; model fidelity; sbirt implementation science and evidence-based practice (ebp) have been a central concern of social work for decades, leading to significant changes in the profession as evidence increasingly informs social work practice, administration, and policy. an ongoing challenge of the profession has been delivering evidence-based interventions within agencies to clients in ways faithful to the protocols upon which the scientific evidence was established. in 2005, mullen, shlonsky, bledsoe, and bellamy asserted that social work lacked literature that empirically examined and addressed barriers and facilitators to implementation. since then, knowledge and information developed by social work and other professions have been used to address these issues (acri et al., 2017; atkins & frederico, 2017; cabassa, 2016; gray & schubert, 2012; kerner & hall, 2009; otto, polutta, & ziegler, 2009). as a result, protocols are now being designed to maximize diffusion so that, while establishing the evidence, researchers consider how the intervention will be adapted and integrated into routine practice (kerner & hall, 2009). nonetheless, much work remains to be done to establish evidence-based practices in real world settings. in particular, understanding of what happens between development of the scientific evidence and implementation of the evidence-based protocol in practice remains incomplete (gray & schubert, 2012). https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2018, 18(4) 1219 one aspect of implementation involves transmission of knowledge across social work faculty, fieldwork instructors, and students. how these three groups of stakeholders approach scientific information and how their respective approaches might affect the role of evidence in social work have received limited attention to date. this focus group-based study addresses this important ongoing issue and contributes to knowledge about how an evidence-based protocol reaches clients and whether it reaches clients in a way faithful to the original model. informed by the authors’ (ogden, vinjamuri, & kahn, 2016) empirically-based model of barriers and facilitators to implementing an ebp in student fieldwork placements, this study addressed the question: what were the approaches of faculty, students, and field instructors to implementing sbirt that impeded or promoted model fidelity? for the purpose of this project we defined “approaches" as the combination of self-reported perspectives, attitudes, and actions around sbirt implementation. background in 2005, fixsen, naoom, blase, friedman, and wallace found “the science related to implementing ebps and programs with fidelity and good outcomes for consumers lags far behind the development of them” (p. vi). arguably, this remains the case in social work today (cabassa, 2016). aarons, hurlburt, and horwitz (2011) wrote about implementation science as a quickly growing discipline with lessons learned from business and medical settings being applied in social service settings. however, they cautioned that it is unclear how well results from other types of organizations translate to settings with different historical origins and customs, such as public mental health, social service, and substance misuse sectors. within social work there are no agreed-upon standards or steps to implementation or universal definition of what the science of implementation involves (atkins & frederico, 2017). varying depictions of implementation science have emerged in the literature. palinkas, he, choy-brown, and hertel (2017) defined implementation science as the “generation and application of models and conceptual frameworks that identify potential barriers, facilitators, the process, and outcomes of program, practice, and policy implementation” (p. 182). implementation of a new ebp can happen at various levels from the “paper” level with new policies and procedures; to the “process” level with trainings, supervision, and different reporting forms; and through the “performance” level with real, functional changes to operational impact with good effects for clients (fixsen et al., 2005). however, implementation must be distinguished from adoption, which is merely a decision to use an evidence-based intervention (mitchell, 2011). implementation aims to achieve regular use of evidence-based interventions. sustaining the practice is key. delivering complex social interventions requires a comprehensive implementation strategy, including specific actions within a planned, long-term implementation and maintenance process (mildona & shlonsky, 2011). thus, in real-world settings, stages of implementation and maintenance are not necessarily linear but are, rather, dynamic. key features and impediments of successful implementation implementation and model fidelity can be promoted successfully. existing lists of factors needed for successful implementation are invariably lengthy and complex, vinjamuri et al./identifying how social workers’ 1220 suggesting implementation requires more than training practitioners (aarons et al., 2011; bhattacharyya, reeves, & zwarenstein, 2009; fixsen et al., 2005; kerner & hall, 2009; mildona & shlonsky, 2011; mitchell, 2011; palinkas et al., 2017). nuanced, dynamic interactions affect implementation, and ideal circumstances are not always possible to attain. implementation can be impeded at any stage of the process, with impediments coming from individual practitioners or agency and organizational factors. using a multi-systemic lens, palinkas et al. (2017) identified several barriers to implementation, including the limited time and resources of practitioners, insufficient training, lack of access to peer-reviewed research journals, lack of feedback and incentives for use of ebps, assumptions behind the design of research trials, and inadequate infrastructure and systems to support implementation. focusing on organizational factors, mitchell (2011) cited culture, climate, structure, mission, and philosophy of the organization plus leadership and network connectedness. agencies may also struggle to provide training and supervision, incentives for practitioners, material resources, and administrative support. in terms of practitioner-specific barriers, gray and schubert (2012) described resistance to change, especially when new ideas are inconsistent with organizational beliefs, and mitchell (2011) identified the attitudes of providers, such as skepticism about the clinical value of ebps. acceptance of a new protocol can be particularly challenging if it was developed for and tested with client populations with relatively simple problems, homogeneous groups, or when perceptions of inconsistencies between protocol and recognized characteristics of effective programs appear. real or perceived mismatches to client populations and their complex needs can also impede implementation. practitioners may also be resistant if they are concerned about clinical freedom and the ability to respond to individual client needs. while these factors have not all been exhaustively or empirically examined, they serve as a guide for this study. to date, data-derived, specific measurement instruments to guide the process of implementing and evaluating the implementation of an evidence-based protocol are lacking. the current study aimed to add information about the implementation process, focusing upon factors that impede or promote model fidelity as a protocol is implemented. an sbirt-based implementation model previously, the authors (ogden et al., 2016) used focus group data to develop a model (herein referred to as “the implementation model”) that identified barriers and facilitators to implementing sbirt in social work student fieldwork placements (see figure 1). development of the implementation model revealed issues related to model fidelity. subsequent focus groups affirmed further model fidelity issues, which became the focus of the present study. the following is a basic overview of the implementation model, which is provided to contextualize this inquiry and findings. advances in social work, fall 2018, 18(4) 1221 (ogden et al., 2016) advances in social work, fall 2018, 18(4) 1222 the implementation model (ogden et al., 2016) identified multiple interacting factors influencing students, faculty members, and fieldwork instructors. these three stakeholder groups can also be considered representative of practitioners, trainers, and supervisors, respectively. all of the identified factors can serve as either barriers or facilitators to implementing an evidence-based practice. the factors in the implementation model include intrapersonal characteristics, as well as mezzoand macro-level factors. intrapersonal characteristics of receptivity, comfort, and flexibility affect an individual’s approach to new knowledge. also at the individual level are the practitioner’s perception of the fit between the protocol and professional values, responsibilities, and practices plus one’s sense of mastery of the material, authenticity in implementing it, and confidence in doing so. mezzoand macro-level factors that can affect implementation include agency factors, such as the population served, the agency’s theoretical orientation, established approaches to treatment, consequences of the protocol for clients, bureaucratic processes, agency flexibility, agency support, and supervisor support. the implementation model shows how these factors work in dynamic ways, often compounding or counteracting each other and leading to an undetermined net effect. how the factors connect to model fidelity is of particular concern to the present study because data used to develop the implementation model suggested wide variance. the current study is a first step towards understanding the dynamic interplay between factors that promote the use of sbirt and those that contribute to model fidelity. to date, this implementation model appears to be the only one grounded in sbirt-implementation data directly connecting social work education to implementation and practice. the implementation model provided the central analytic frame but was also critically examined throughout the analytic process. design the present study used a train-the-trainer model. faculty with expertise in the screening, brief-intervention, and referral to treatment (sbirt) protocol used materials provided by the substance abuse and mental health services administration (samhsa, 2011) to train all social work faculty in an urban college in the northeastern united states. the nine hours of training included a specially created sbirt manual, role-plays, and videos as well as dialectic and lecture-based instruction. in turn, those faculty then trained all graduating bachelorand master-level social work students to use sbirt. student training occurred over several weeks during required core curricula courses. the training was the same for undergraduate and graduate students. the students received at least four hours of training in the classroom, which included lecture, discussion, role-play, and videos. all students received the sbirt manual, which they could bring to their fieldwork placements, plus visual aids, which are an integral part of the sbirt implementation process. training was completed by the end of the first semester, and students were charged with using sbirt in their fieldwork agencies for one semester. fieldwork instructors were charged with supervising students’ use of sbirt. all fieldwork instructors received the same basic information about sbirt: through emails and telephone conversations, faculty advisors and field education staff informed fieldwork instructors that students were receiving sbirt training and were expected to use it in field. fieldwork instructors also received an electronic version of the sbirt manual and were advances in social work, fall 2018, 18(4) 1223 asked to review it. the social work faculty advisors, who had been trained in sbirt and were teaching it to the students, conducted on-site visits with every fieldwork instructor and student dyad. at those meetings, the faculty advisors provided basic introduction to the sbirt protocol, answered questions, and told the fieldwork instructors what to look for when supervising sbirt. for additional training, fieldwork instructors were invited to participate in voluntary three-hour trainings at the college provided by project faculty. furthermore, the social work department offered voluntary advanced sbirt training and specialized training for sbirt with older adults. although not all fieldwork instructors attended the additional voluntary trainings, all received the sbirt manual and engaged in in-person discussions with trained faculty members about sbirt and its role in their agencies. some fieldwork instructors did not allow their students to use sbirt in their fieldwork placements. at the end of each academic year of the study, faculty, students, and fieldwork instructors participated in focus groups that examined the factors that impeded or promoted the implementation of sbirt. methods sample and recruitment this article reports on second and third year focus group evaluation data of a threeyear sbirt training grant. the training model is described more thoroughly elsewhere (ogden et al., 2016). the present study examined data from end-of-year focus groups with students, faculty, and fieldwork instructors, with one of each group held in 2015 and 2016, totaling six focus groups. student recruitment. for student recruitment, all faculty members teaching sbirt used a script to ask their sbirt-infused course sections for one volunteer to participate in the focus groups, making clear that participation would have no effect on their grades or academic standing. undergraduateand masters-level social work students were recruited for the same focus groups. in year 2, there were 222 students (90 msw and 132 ba) in total with 15–25 students per sbirt-infused course section and 12 sections. in year 3, there were 226 (73 msw and 153 ba) students in total with 15–25 students per section and 12 sections. in the project’s second year, there were 12 students (6 msw and 6 ba) in the student focus group. in the third year, there were 13 students (8 msw and 5 ba). students were provided with a $25 gift card incentive for participating. faculty recruitment. all faculty teaching sbirt were asked to join the focus group with the exception of the three who had designed and facilitated the sbirt training in order to decrease social desirability bias in focus group discussions. as compensation for participating in the project, faculty received two weeks of summer salary. this compensation was provided to pay for their time attending sbirt trainings and retreats, as well as the additional work of learning and incorporating new material into their courses. there were nine social work faculty participants in the second-year faculty focus group and nine participants in the third year. fieldwork instructor recruitment. all current fieldwork instructors (186 in year 2 and 192 in year 3) were sent an e-mail requesting their voluntary participation in a focus vinjamuri et al./identifying how social workers’ 1224 group. six participated in the second-year focus group. of these participants, two received the additional voluntary sbirt training. fifteen fieldwork instructors participated in the third year focus group. of these participants, ten received the additional voluntary sbirt training. fieldwork instructors who participated in the focus group received a $25 gift card. research participant protections several steps promoted protection of research participants. focus group participation was voluntary for all participants. because providing detailed demographics could have easily led to identification of the participants, particularly in the faculty focus group that drew from a very small population, demographic information was not collected from any focus group participants. confidentiality was maintained throughout focus group participation, recording, and transcription. all participants provided informed consent to be audio-recorded. during focus groups, members received random numbers as identifiers, which ensured anonymity in the discussion and recording. identifying information regarding individual interviewees was, therefore, not available in transcripts, which promoted the integrity of data analysis as well as protected confidentiality. focus group audio recordings were professionally transcribed. all study data were stored on passwordprotected computers in locked offices. institutional review board approval was granted by the host college. focus group procedure the focus groups were held each year within one month of completion of the academic year that included the sbirt curriculum. focus groups lasted 60-90 minutes with moderation provided by faculty involved in the sbirt project evaluation team. all six groups involved in-depth discussions guided by moderators using semi-structured, openended interview questions informed by the implementation model. the discussions addressed topics such as participants’ experiences learning, using, teaching, and/or supervising sbirt; difficulties and barriers encountered in implementing sbirt; the role of the agencies and academic institutions in implementation; the impact of the protocol on perceptions towards people who use substances; and recommendations for improving the training. data analysis verbatim transcripts of the six focus groups were the source of data for the present study. analysis involved thematic coding of the transcripts, guided by the hybrid process of inductive and deductive thematic analysis described by fereday and muir-cochrane (2006). a codebook was developed using the authors’ implementation model, which originated from focus group analysis of the same project’s first year (ogden et al., 2016). using this codebook, each author reviewed transcripts identifying the presence of factors from the implementation model while remaining open to new codes that expanded on existing concepts or illustrated new phenomena or processes. the rigor of the study was enhanced by the input of multiple researchers throughout the analytical process. each focus group was coded by at least two authors. creation of audit trails delineated clear pathways advances in social work, fall 2018, 18(4) 1225 from codes to analytical and process memos. analytical memos included examples of existing codes and new codes that emerged, their definitions and illustrative quotes, and the story of the relationships among the codes. the relationships between new codes and existing codes were discussed amongst the authors and documented in analytic and process memos. constant comparison was the central analytical process leading to the organization of initial codes into categories of inductively-identified themes. transcript data were repeatedly analyzed, each time using codes that emerged in the previous stage of the analysis as a temporary conceptual framework, while the authors remained open to discarding and creating new concepts and categories. the authors engaged in reflexive discussion wherein ideas and assumptions were considered, challenged, and debated, ensuring that individual researcher biases and opinions were moderated so that the emerging analysis was grounded in the data. results analysis of focus group data from six focus groups, collected over a two-year period, led to an in-depth understanding of approaches that supported or presented barriers to sbirt implementation and model fidelity from the perspective of three groups of stakeholders. these approaches fell into three categories: approaches that impeded implementation and model fidelity; approaches that supported implementation but were not congruent with model fidelity; and approaches that supported both implementation and model fidelity. while some approaches appear to be transferable to the implementation of ebps more generally, some appear to be specific to sbirt and/or the sbirt project from which the data were drawn. approaches that impeded implementation and model fidelity approaches that impeded implementation and model fidelity of the sbirt protocol had two common elements. first, some participants expressed viewing the universal screening principle as optional, which immediately meant that model fidelity was not followed since universal screening is a key element of faithful implementation of sbirt. thus, lack of universal screening was a primary indicator of model infidelity. second, participants identified barriers to fully using sbirt in fieldwork agencies related to the degree to which sbirt fit with existing policies, practices, and systems and the level of support provided by fieldwork instructors. viewing the universal screening principle as optional. the sbirt for substance use protocol begins with the premise that almost anybody can be misusing substances, including alcohol, and, therefore, the brief screening for substance use should be used with every client. this is central to the model’s public health approach of targeting individuals without severe substance use disorders who would benefit from reducing their substance use (samhsa, 2011). however, across all stakeholder groups, data emerged delineating times when the students did not use the universal screening principle. several factors contributed to this breach in model fidelity. fieldwork instructors sometimes viewed asking about substance use as inappropriate for their client populations and therefore, did not permit the universal screening. other vinjamuri et al./identifying how social workers’ 1226 times, they chose clients within their agencies who they thought would be appropriate. for example, one fieldwork instructor stated: my student was very excited to use the sbirt but she had three components of her field placement, and it was only appropriate to be used in one of the components because she was in one component where they had home visits where they had a questionnaire where they asked questions about drug and alcohol use so it’s appropriate in that one. but the other two components, one was interviewing parents for a head start program and the other was interviewing parents for a parenting program. and i had requested that for those two parts that she not use it. it is unclear how this fieldwork instructor decided that the screening was acceptable in some circumstances and not in others, as substance use can certainly be a contributing factor to problems in parenting. however, this approach seems to have been typical, as several field instructors identified populations, or sub-populations, for whom they felt using sbirt was inappropriate. therefore, model fidelity was lacking in those cases as the result of ideas about who should or should not be screened for substance misuse. stereotypes about substance users contributed to the belief amongst fieldwork instructors and students that some clients should not be screened for substance misuse. as in the above example where the fieldwork instructor believed some parents did not need to be screened, stereotypes included beliefs about what substance users looked like, how they behaved, and whom one should screen for substance misuse, as well as what non-substance users looked like. for example, one student explained not using sbirt because, “i work with older adults, so, sixty and older. i pretty much didn’t encounter any client who would currently be using alcohol.” because of the clients’ older ages and the services provided, that student did not even ask if the clients ever drank alcohol. some faculty accepted students’ perceived inabilities to implement sbirt, colluding with and enforcing student preconceived notions about substance users and where substance use screening can occur. other faculty did address students’ preconceived notions, but these could be so entrenched that even faculty feedback did not change students’ fixed beliefs or affect their client interactions: i had a handful of students who seemed to not want to use it in the field, one who didn’t even sign the agreements and was absolutely not interested and said, “we’re not comfortable using it with kids.” . . . i consistently pointed out, having had experience with kids, that they start engaging in these behaviors a lot younger than we think, so that bringing it up in a way that they can understand . . . in a way that’s comfortable, is important, because it needs to be addressed. some faculty did successfully address students’ preconceived notions, and their students developed an understanding of the reality of not being able to “tell” if someone used substances. those students then employed the universal screening protocol. in other words, their stereotypes were successfully challenged: my professor, she always told us, “no matter what population you’re in, it’s important to ask this question.” . . . because you never know, what—what the advances in social work, fall 2018, 18(4) 1227 client’s been through or—or if they’ve used that and how that could’ve affected them . . . we have to know everything about the person . . . from this training, i’ll know that [substance use screening] is something important and no matter where i’m at, i should ask those questions ‘cause it could be beneficial. encountering and responding to agency barriers. practices are not introduced in a vacuum; rather they are introduced in the context of existing practices, policies, and systems. as in the present study, it is often left to individual practitioners to determine how a new practice will or will not fit in. fieldwork instructors were particularly conscious of contextual factors and how they affected staff buy-in to new ebps. for example, some described intake forms they were required to use and that could not be changed easily. others were positioned to respond to such barriers more actively: we have a form that was part of the intake process which i intend to revamp and substitute it with . . . the sbirt [forms] because i find it more humanistic and that’s where i am. and that’s probably going to take place this summer, with my social work staff, because i want them all to buy into it. . . . the substance abuse counselors are not using the model which is very upsetting for me. being positioned to address agency barriers and encourage buy-in was an important factor affecting implementation. the fieldwork settings also influenced students’ experiences using sbirt due to the level of support fieldwork instructors provided. a student described this phenomenon: my supervisor didn’t know sbirt . . . so that was one problem and, you know, many of our [client] interactions were very quick and . . . and the only question they want you to ask is if . . . they have a current problem or if they have a history of alcohol abuse or substance abuse. students often faced the problem of knowing more about the intervention than their fieldwork instructors. this may represent a common barrier: if a practitioner receives training and wants to bring it to an agency, that practitioner would need to educate both superiors and peers, possibly creating complicated workplace dynamics. agency contexts affected the messages students received about the fit of sbirt with their work, which may have been contrary to the student’s perceptions and plans. for example, one faculty member described students who were eager to implement sbirt but who were told by their fieldwork instructors and/or other agency personnel that sbirt did not fit with the agency’s work: some of [the students] had very short-term interactions with clients and so then if you're only going to talk to somebody once then you're not going to do a substance abuse screening . . . that’s what they were told . . . the response i would say was disappointing overall, but that’s not the student’s fault. it’s not because they weren’t enthusiastic . . . it was just, [sbirt] didn’t fit. while the sbirt model posits that a brief, single time interaction is in fact an ideal place for conversations about substance use, beliefs and stereotypes about substance use, and, vinjamuri et al./identifying how social workers’ 1228 relatedly, perceptions about what substance use screening and intervention is and where they fit inhibited their use in practice. in some cases, existing protocols impeded implementation by portraying a new practice as burdensome. one fieldwork instructor said: i think the biggest barrier though is the fact . . . that the agencies usually have their other tools that [they are] using . . . like the assessment package is so huge that to incorporate something else kind of seemed like a burden. perception of burdensomeness of an intervention by fieldwork instructors and other agency personnel thus emerged as a significant barrier to implementation. approaches congruent with implementation but not model fidelity two themes emerged that supported implementation of sbirt but appeared to compromise model fidelity. the first theme is described as “finding a fit.” finding a fit between sbirt and existing practice allowed components of sbirt to be implemented; however, it likely compromised model fidelity because pieces of the protocol were altered or omitted so sbirt would fit better with usual practice. as a result, participants considered their practice to be consistent with sbirt, but they were not using sbirt in ways true to the evidence-based protocol. in line with the implementation model, flexibility that promotes implementation is desirable; however, straying from what the research indicates is effective to engage in selective or modified activities might be just as ineffective as not using any elements of an established protocol. the second theme, “being thrown off by client reactions,” concerns reactions to clients who responded to sbirt in a negative way. client reactions could move a student from using sbirt as taught to ending the protocol prematurely or altering the intervention, which in both cases compromises model fidelity. finding a fit. some participants showed receptivity and flexibility, searching for a fit between sbirt and practice-as-usual while demonstrating their desire to use sbirt. however, it became clear from the data that some participants were picking and choosing aspects of sbirt based on what worked with their existing practices. furthermore, as participants grew more comfortable with the material, they wanted to make it their own, fitting it into their existing practice approaches so that it felt authentic. however, this approach may have compromised model fidelity. for faculty, finding a fit meant adding in their own exercises as they were teaching. although this was encouraged by the project directors to improve faculty buy-in, it also meant that a single model for teaching was not followed. as one faculty member shared: i got more comfortable with the material and the format of it that i too wanted to do more with it. so, i tried doing some role plays toward the end but i found that it was hard to balance whether or not i was going too much outside of the evidencebased model versus being very prescriptive in terms of what is supposed to be there . . . but as i got more familiar with it and felt more comfortable, i wanted to do more interactive activities. advances in social work, fall 2018, 18(4) 1229 significantly, faculty expressed adding to material but never described skipping any pieces of it, and, aware of the issue of model fidelity, appeared to have adhered to a level of model fidelity despite instructional innovations. fieldwork instructor approaches to sbirt emphasizing authenticity were more problematic from a model fidelity perspective. one field instructor described, “you don’t get everything, but you take away the most important points. what’s important to you.” this type of approach was common among fieldwork instructors, whose discussions never addressed model fidelity or the importance of “getting everything,” which is central to model fidelity. a “take away the most important points” approach inherently compromises model fidelity. students described a similar “take away the most important points” approach to sbirt: i use sbirt in a very loose, unstructured way; i used it in a way that just suited me based on the placement that i was at; on top of it, my placement did not want to turn the school into a drug rehab center ‘cause like all the kids were like smokin’ weed and drinkin’ on the weekend. while the student seemed to be implementing sbirt, it was not in a way that was faithful to the full sbirt protocol. participants used their preconceived notions to pick and choose not just “if” they would use it but also when and how to do so. being thrown off by client reactions. the sbirt training delivered as part of the present study could not cover all material necessary to respond to clients in real life situations, including the more complicated emotional responses many people will have in discussing how substances are affecting their lives. as a result, not knowing how to handle client reactions was a barrier to fully implementing sbirt, and evidence suggests that it led to a breakdown in model fidelity. one fieldwork instructor described a student’s use of sbirt as follows: she did the sbirt with that person and the person wasn’t a drug or alcohol user, but apparently there was a family member that was a drug and alcohol user, and the minute she brought up the topic she wasn’t able to continue with the rest of the interview . . . because the parent just fell apart and started talking about this family member and all these issues. and then my student felt like she wasn’t prepared, like, how to react to that happening. students who got “stuck,” not knowing how to respond, often did not fully implement the protocol. for example, one student working with high school students explained, “i didn’t know where to go when someone says, “i don’t have a problem with my cocaine; i don’t— i don’t care to change it . . .” another student experienced clients who became “aggravated” or “angered” and wanted additional training on how to “move on” in those situations. limits of training is another aspect of implementation not identified in the implementation model but that was clearly significant. vinjamuri et al./identifying how social workers’ 1230 approaches congruent with implementation and model fidelity several themes emerged from participants who implemented sbirt in ways that were identified as likely to promote model fidelity. these themes were: repeated learning, having the right tools, and a desire to uphold social work values. repeated learning. participants who experienced repetitive exposure to sbirt material seemed to have a deeper understanding of the material, which in turn facilitated their implementation of the protocol with a greater likelihood of maintaining model fidelity. among the faculty, this shared attitude is encapsulated in one of the participant’s comments that “the more frequently you do it, the easier it becomes and you can easily weave it in” and another who described being able “to teach it and help the students to learn it in just a more knowledgeable way” by the third year. students were also aware of the importance of repeated learning and expressed the importance that material “was reiterated a bunch of times by my professor.” another student observed that faculty used various pedagogical strategies to repeatedly convey content “because he wanted us to get a concrete foundation of this training, so when we go out in the field we can use it and implement it in the right way.” fieldwork placements were another venue for repeated learning that provided opportunities for practice, which was appreciated by students. as one student stated, “the more you use it, the more you become familiar and be able to apply it fully.” in contrast to the theme of “being thrown off by client responses,” the repeated learning added confidence to implement the material and opportunities for students to have the experience to “actually practice it in real life” and, when clients responded, to discover, “oh—it really works!” students who saw field as an opportunity for repeated practice gained confidence in fully implementing the protocol. having and using the right concrete tools. faculty approaches that promoted implementation and model fidelity included using a wide variety of training tools. these included concrete tools such as videos, role-plays, and feedback on process recordings. specific and pointed feedback on process recordings was particularly important to students: the professor did use the process recordings . . . to help us and tell us where – to give us pointers to where we could ask some questions and why, and . . . to just give us insight on how we could have did something better, or add to it. this pointed feedback was likely central to model fidelity as specific correctives could be made. active teaching and learning also happened in interactions between faculty and fieldwork instructors: in my [agency] visits a couple of times i actually brought out that laminated [visual aid] and sort of walked [the field instructors] through it, which definitely seemed to be helpful. they felt as overwhelmed, the ones who had not been exposed to it before, felt as overwhelmed i thought as our most overwhelmed students did . . . so when i broke it down for them in the visit, also it was face-to-face in that initial advances in social work, fall 2018, 18(4) 1231 visit, that seemed to help out. and a lot of times then they were like “oh, okay, so this is kind of what we do already.” faculty members also saw that having concrete tools increased student confidence and considered that the concreteness of the tools and specificity of the practice might contribute to model fidelity and certainly to implementation: i felt that the students had a vocabulary, they had words to use to make the assessment, because i think that they want words to use for everything. they want to know what do i say in this situation, that situation, and every situation, so this was something that gave them some words to use which was helpful. and we talked about how you use the words and it’s not just the words themselves, but it’s how the engagement and the warm handoff and all that, but it was a process, it was very concrete steps and visual aids, a lot of things. for students, having and using concrete tools, such as the sbirt manual and visual aids that were developed for this specific sbirt project and the reliable and validated substance use disorder measures, promoted comfort and confidence and contributed to an affinity towards using a universal screening approach. one student said, “so every time i had to use it, i would actually go to the [sbirt manual] and make sure i know where to go if we continue the process.” approaching the practice in close consultation with the sbirt manual allowed students to feel they had a “safety net” that increased a sense of “i know what i’m talking about” and “helped me feel more confident in speaking with clients and i was able to refer back to a secure resource.” using the sbirt manual in this way is consistent with model fidelity, as students stayed close to practice taught in the classroom. one student described, “in class when we got all the charts, it was much easier to bring that up . . . knowing that you have that information.” that student also appreciated the sbirt manual’s “listing of drugs and possible outcomes of over-usage and things like that. so i’m not so familiar with those types of drugs but by having that, my knowledge just got extended and now, talking to someone who is using that substance, i’m more informed.” by contrast, not having the right tools can lead to lack of implementation and lack of model fidelity as illustrated by one student who “lost the paper” s/he was using as a cue during the sbirt interviews and “after that . . . there was no more structure.” the student understood model fidelity was lost, even without using that term. fieldwork instructors sometimes approached the tools, particularly the sbirt manual and standardized assessments, as “a script” or a “formula” from which to practice and used it to help focus on the details of the protocol. those who saw the benefit of paying attention to the details saw the connection between the details and the overall philosophy of the practice and its fit within social work values. desire to uphold social work values. among all participants there was a desire to uphold the core social work value of respecting the dignity and worth of the person. this value prevailed over concerns about model fidelity. however, many participants identified motivational interviewing, which underlies sbirt, as being in line with this core social work value. for those participants, model fidelity was not just about adhering to concrete steps in practice but adhering to the spirit of practice. as one faculty member described: vinjamuri et al./identifying how social workers’ 1232 my approach really is about how do we not judge and not stigmatize, and i like . . . talking about how do we challenge our own assumptions about people. so that way it fit… my professional identity . . . that we’re a profession that’s about working with marginalized communities . . . the sbirt approach is very much about how . . . you help a group that’s already feeling marginalized feel less so. similarly, some students articulated that fit with social work values was central to their implementation of the protocol: “the opportunity for a client to make choices is very, very, very important. but not the social worker or the social work intern making a choice for the client. that is really a big, big difference.” another student said: i think it gave me a better perspective as far as treating the person as a whole. you know, not just the mental health issues, not just the substance abuse issues, not just the environmental issues, just as, the person as a whole. and, you know, helping develop a complete plan, treatment plan. i think it’s helped me for that. seeing a fit with professional values was thus in line with implementation and model fidelity. discussion this article builds on the implementation model created by the authors (ogden et al., 2016) and helps develop urgently needed implementation knowledge and theory by examining processes through which an evidence-based protocol reaches clients and whether it does so with model fidelity. our findings confirmed, added, and developed several impeding and promoting factors already theorized in implementation literature. the implementation model provided a useful framework to find points of intervention to promote model fidelity during the implementation process. findings of the present study were focused on sbirt and implementation that moves a practice directly from an educational setting to the field; however, the implications are transferable to other evidence-based protocols. approaches that impeded both implementation of sbirt and model fidelity to the protocol were viewing the universal screening principle as optional and the ways in which participants encountered and responded to agency barriers. specifically, practitioners were affected by agency-level buy-in, level of knowledge and training, and perceptions about the degree of fit between the ebp and agency clients and services. one striking feature of the focus group data was the lack of consciousness of model fidelity as an issue across all three groups. no participants explicitly discussed model fidelity; rather, problems with model fidelity were detected through critical data analysis. this may be a central problem with implementation of ebps into social work practice: social workers “take away the most important points” as they subjectively see them, rather than adapting new material with model fidelity in mind. as such, practitioners and social work faculty alike need training in identifying barriers to model fidelity that will also raise consciousness of this aspect of implementation. additionally, when agencies implement new protocols and when practitioners are trained, the importance of model fidelity should be explicitly addressed with those charged with applying the protocols with the clients. raising consciousness and awareness of how one’s practices may or may not promote model fidelity moves advances in social work, fall 2018, 18(4) 1233 practitioners from merely deciding to use an ebp to critically evaluating how one is using it and client outcomes (mitchell, 2011). challenges experienced by students as they responded to the uncomfortable situation of trying a new practice, and sometimes to negative client responses, suggests a need for training to help students and other practitioners to use a new ebp practice as given, with particular attention paid to the discomfort that may arise. helping practitioners understand and grow from discomfort that comes with practices can address practitioner-specific attitudinal barriers towards implementation, such as resistance to change (gray & schubert, 2012) and skepticism about a new practice’s clinical value (bellamy, bledsoe, & traube, 2006; mitchell, 2011). given that consciousness of ethical issues is a central element of evidence-based practice in social work (gambrill, 2007), finding fit between new practices and values, and simultaneously striving for model fidelity, is an integral part of providing ethical services to clients. highlighting the relationship between scientific practice and ethical practice is key. results of this study shed further light on how agencies and practitioners can move from “process” to “performance” levels of implementing new ebps (fixsen et al., 2005) by revealing elements central to the faithful implementation of a new practice. these include repeated exposure to new material and opportunities to engage with it, having specific and concrete tools that remind practitioners of a new practice and support them in its use, and validating and supporting learners to uphold social work values in their new practice. thus, passive learning is not likely to lead to faithful implementation; conversely, active and repeated learning likely supports implementation with good model fidelity. these findings are consistent with what adult learning principles identify as key elements of integrating new knowledge: finding applicability and relevance, being co-authors in one’s learning, and engaging in active problem-solving (knowles, 1980, 1984; plack et al., 2007). additional and ongoing training closely tying new practices to social work curricula and existing agency practices might help students feel more comfortable in fully and faithfully using a new practice, while honoring clients’ responses to the new practice. consistent with previous recommendations (fixsen et al., 2005), our findings suggest the central importance of skillful and timely supervision and coaching throughout the implementation process and add the need to focus particularly and explicitly on approaches to model fidelity. the current study, both in design and results, illustrates the importance of understanding stakeholders’ needs and perspectives and of providing open channels of communication to create and sustain successful implementation (mildona & shlonsky, 2011). finally, this study highlights a larger workforce issue: fieldwork instruction is a voluntary activity. mandatory training is thus infeasible. prior to the students’ expected use of the sbirt protocol, all of the fieldwork instructors in this project received information about sbirt in the form of written materials and conversations with faculty. however, not all fieldwork instructors attended the additional voluntary trainings that could have increased their knowledge, competence, and commitment to sbirt. invariably, this leads to inconsistencies in implementation of evidence-based practices and supervision of students. this aspect of our social work professional pedagogy, integral to how the vinjamuri et al./identifying how social workers’ 1234 profession trains future professionals, can stand in conflict with faithful implementation of an evidence-based protocol when using this type of design. further examination on how to resolve this conflict is warranted. limitations and strengths of the study the current study has several limitations. given that not all fieldwork instructors participated in additional sbirt training beyond the basic introduction, knowledge of sbirt and supervision around sbirt was inconsistent. some fieldwork instructors could have had up to nine additional hours of training, while others may have merely reviewed the manual and had a single conversation about it. there is likely some self-selection bias in the results, given that those who volunteered for the focus groups may be those who had strong responses towards sbirt, either positive or negative. focus groups in general present other limitations: while providing detailed information elicited through group interactions and participant sharing, social desirability bias likely hinders comments that sway too far from any particular group’s norm (hollander, 2004). finally, given the scope of this study, perceptions of sbirt were not elicited directly from clients, who are the fourth key stakeholder in the implementation process. one strength of this study is its use of triangulation in data collection and data analysis: data were collected from three groups of stakeholders, and the three authors engaged in a rigorous multi-stage constant comparison coding and analysis process to determine the key themes, which supported the integrity of the analysis and transferability of the findings. finally, the study incorporated both inductive and deductive processes of generating knowledge, using an existing model grounded in data about sbirt implementation, which enhanced the richness and trustworthiness of the findings. while using an existing model developed by the researchers as an analytical lens to provide sensitizing concepts, the authors also generated themes that added depth of understanding for how barriers and facilitators interact to promote and/or impede effective implementation of an evidencebased practice. implications for future research clearly defined model fidelity measures may help further determine the existence, source, and extent of factors that impede or promote model fidelity. awareness of model fidelity needs to be improved in order to help practitioners, especially students and fieldwork instructors, to think about model fidelity as they learn and apply new practices. combining model fidelity training with training in an ebp would be useful for implementation and deserves further research attention. with these considerations in mind, we recommend the development of a diagnostic tool to assess for individualand organizational-level barriers and facilitators to both implementation and model fidelity. references aarons, g. a., hurlburt, m., & horwitz, s. m. 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(2011). white paper on screening, brief intervention, and referral to treatment (sbirt) in behavioral healthcare. retrieved from www.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf author note: mohan vinjamuri, lmsw, phd, department of social work, lehman college city university of new york, 250 bedford park blvd. west, bronx, ny 10468. mohan.vinjamuri@lehman.cuny.edu https://doi.org/10.1016/j.chiabu.2011.07.001 https://doi.org/10.1016/j.childyouth.2010.10.003 https://doi.org/10.1332/1744264052703159 https://doi.org/10.1080/01488376.2016.1182097 https://doi.org/10.1177/1049731509333200 https://doi.org/10.1177/1049731516666329 https://doi.org/10.1016/j.ambp.2007.04.006 http://www.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf _______ patricia stoddard-dare, msw, phd, professor, school of social work; kelle k. deboth, mot, phd, assistant professor, health sciences; madalynn wendland, dpt, associate professor, health sciences, cleveland state university, cleveland, oh. ryan suder, phd, otr/l, bcp, clinical manager, cleveland clinic children’s hospital, cleveland clinic lerner college of medicine, cleveland, oh. joan niederriter, msn, phd, associate professor, school of nursing, cleveland state university, cleveland, oh. rebecca bowen, ma, ccc-slp, clinical research associate, the american speech-languagehearing association, rockville, md. sara dugan., pharm. d., associate professor of pharmacy, northeast ohio medical university, rootstown, oh. miyuki tedor, ma, phd, associate professor, department of sociology, cleveland state university, cleveland, oh. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 216-235, doi: 10.18060/23656 this work is licensed under a creative commons attribution 4.0 international license. an interprofessional learning opportunity regarding pain and the opioid epidemic patricia stoddard-dare kelle k. deboth madalynn wendland ryan suder joan niederriter rebecca bowen sara dugan miyuki tedor abstract: an interprofessional response is needed to mitigate the deleterious effects of the opioid epidemic. here we describe an interprofessional workshop for n=307 students from social work, pharmacy, medicine, nursing, occupational therapy, physical therapy, and speech-language pathology designed to help prepare professionals to work competently in interprofessional teams while serving clients impacted by substance misuse. a total of n=201 participants provided informed consent and completed a preand post-test electronic survey to measure the influence of the interprofessional workshop. findings from a paired sample t-test reveal statistically significant differences at post-test regarding participant’s self-described confidence 1) identifying their values and beliefs as they relate to substance misuse, 2) responding appropriately when interacting with someone with problematic substance use, 3) quickly finding local harm reduction resources, and 4) quickly finding local, available treatment resources for a person struggling with addiction. these findings suggest this educational curriculum is valuable in achieving its stated goals. although future research is needed, findings from this study may be useful to health education systems across the country. this interprofessional education program can be emulated to aid in developing confidence in students and seasoned professionals in the healthcare workforce. keywords: interprofessional education; opioid epidemic; substance use disorder; drughelp.care the united states is in the midst of an opioid epidemic. a report from the centers for disease control and prevention (cdc, 2018) indicates that over 70,000 people lost their lives in 2017 due to drug overdose. multiple factors are responsible for this epidemic, and sadly the healthcare system maintains some responsibility for this current situation. leading up to the opioid epidemic, well-intentioned changes in the healthcare system contributed to an increase in opioid use disorders. specifically, pain was conceptualized as the 5th vital sign (phillips, 2000), and coordinated efforts at that time focused on reducing patient self-reported pain (baker, 2017). concurrently, the misconceived notion that prescription opioid medications were safe with a low potential for misuse and addiction proliferated (van zee, 2009). there was increased reliance on opioid medication rather than other approaches to address and manage patient pain (fields, 2011), adding to the rise https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 216 of physical dependence and subsequent opioid use disorders (compton et al., 2016; edlund et al., 2014). most healthcare professionals are aware today that prescription opioids are highly addictive, and efforts have been taken to reduce reliance on prescription opioids to treat pain and to monitor use when they are indicated (dowell et al., 2016). numerous systems are responsible for the opioid epidemic, and thus dedicated involvement of multiple systems is required to resolve the crisis. reviews of the records of people who have experienced an opioid overdose suggest these individuals are likely to interact with at least one health professional in the six months preceding their overdose (wagner et al., 2015). as such, all health professionals should be prepared to screen for problematic substance use and refer patients to assessment, treatment, and harm reduction resources. additionally, health professionals should understand how pain plays into the initiation, continuation, and relapse of substance misuse. finally, health professionals should form a solid understanding of the roles and responsibilities of interprofessional team members working together to address opioid misuse. interprofessional education interprofessional collaborative practice (ipcp) is a concept previously referred to as “multidisciplinary care” or “interdisciplinary care.” ipcp is characterized by healthcare professionals of diverse disciplines working together to make decisions regarding patients’ health while applying their specific discipline’s knowledge and skills (bridges et al., 2011). research indicates that ipcp is effective in stimulating collaborative care between healthcare professionals to improve the quality of care and outcomes for clients or patients (schwindt et al., 2017). interprofessional education (ipe) is defined by the world health organization (2010) as “students from two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes” (p. 7). previous studies have indicated the potential for ipe to create positive attitudes toward future interprofessional work and collaboration, and to promote a reduction in clinical errors while improving the quality of team functioning, patient care, and patient outcomes (sytsma et al., 2015; wamsley et al., 2012). to aid entry-level healthcare professionals in learning the concepts of ipcp, exposing students to ipe is valuable. table 1. accreditation standards by discipline discipline accreditation body accreditation standard(s) social work cswe (2015) competency 1, 6, 7, 8 pharmacy acpe (2016) standard 11, key elements: 11.1, 11.2, 11.3 medicine lcme (2020) standard 6.4, 7.9 aoa 2014 nursing acen (2019) standard 4.6 occupational therapy acote (2013) standard b.5.21 physical therapy capte (2016) 6f, 6l3, 7d7, 7d12, 7d13, 7d34, 7d39 speech-language pathology asha/caa (2019) standard 1 (1.1, 1.2, 1.3) based on the collective experience, conventional wisdom, and culmination of learning about ipe of the current authors, the model for ipe should be developmental, integrated (including facilitation of practice-based experiences), and team-based. health profession stoddard-dare et al./interprofessional learning 217 students are obliged to engage in ipe for programs to remain accredited (see table 1 for accreditation standards by discipline). integrating ipe into health professional students’ curriculum results in student gratitude towards social interactions with professionals from different disciplines, a desire to collaborate more often, and an enhanced understanding of the professional training of other professional disciplines (sytsma et al., 2015). the interprofessional workshop a group of dedicated interprofessional faculty from two partnering midwest universities facilitated the workshop that is the focus of this paper. the group was comprised of at least one faculty member from social work, pharmacy, medicine, nursing, occupational therapy, physical therapy, and speech-language pathology. the group met for two hours per month to design interprofessional workshops, and the event described in this paper is one of the events this group developed and facilitated over a two-year period. the workshop was tightly structured and took place in a conference hall with audiovisual equipment to display presentation content. a total of 307 students attended the event as part of a requirement for a course they were enrolled in at their respective departments. based on information collected during event registration, participants were seated at a round table with approximately ten students representing various disciplines equally distributed among tables, and their tablemates became their interprofessional team members. a total of 28 interprofessional faculty members served as facilitators for one or two tables during the event. the workshop began with a brief introduction (5 minutes) and two guest speakers—a police officer, and a person in recovery. the police officer described a local police-assisted addiction recovery program called safe passages, where police officers help facilitate entry into treatment rather than arrest for individuals struggling with substance misuse (20 minutes). this speaker helped students to think broadly about various professional’s contributions, even unconventional and innovative contributions, in helping to address the opioid epidemic. the police officer provided the following innovative examples: 1) police paying out of their own pocket for a hotel for people struggling with addiction while they wait for a treatment center to open in the morning, 2) partnering with people in recovery they had come to know due to prior arrests, 3) police visiting local treatment centers to better learn about the facilities and the services provided, 4) transporting people struggling with addiction to treatment centers instead of jail, and 5) social workers joining police in emergency response teams to meet with individuals in their home shortly after an overdose to encourage them to seek treatment. the second speaker was a person in long term recovery from an opioid use disorder who shared her experiences of becoming addicted to physician-prescribed opioids for pain. she also shared her encounters and interactions with healthcare professionals over the years, which both helped and complicated her path toward sobriety at various moments in her journey (20 minutes). the next component of the workshop was a brief overview of each profession’s role in addressing the opioid epidemic (20 minutes). students then heard from a guest speaker who specializes in pain management and shared information about the bio-psycho-socialspiritual manifestations of pain and various nonpharmacological approaches to address advances in social work, summer 2020, 20(2) 218 pain (20 minutes). following a break (10 minutes), students were directed to their interprofessional teams. they were asked to reflect (5 minutes) on the question, “how do you see yourself in your future profession regarding these issues?” students were then introduced to drughelp.care, a website that helps treatment providers quickly find treatment and harm reduction resources for their patients (2 minutes). subsequently, students were redirected to their interprofessional teams and were given a case study: a pregnant mother, named pamala, with a substance misuse history who became physically dependent on opioids following a serious car accident and a subsequent 12-month vicodin prescription that, once discontinued, developed into heroin misuse (8 minutes). a copy of the case study is available (deboth et al., 2019). while reviewing the case study, the interprofessional teams worked through a series of prompts (35 minutes), such as, 1) share with the group, your role in addressing pamala’s needs considering your profession. 2) pharmacy students, speak about the most common opioids that are misused and what medications can be used to help treat opioid addiction. 3) please share about the value of medication-assisted treatment for pregnant women with opioid use disorders. 4) for occupational therapy, speech-language pathology, and physical therapy, at what point or points in pamala’s timeline would your services be most beneficial for prevention and treatment? 5) social work students, discuss what might be the most appropriate level of care for pamala. 6) utilize self-reflection to share something that stood out for you. the event ended with a (5 minute) wrap-up where the main points were reinforced. the next section describes each professions’ role in addressing the opioid epidemic, methods to reduce pain, and a new web-based tool used during the event, drughelp.care. profession’s role in addressing the opioid epidemic individuals struggling with substance misuse have unique bio-psycho-social-spiritual needs. interprofessional health care workers provide patients with access to a wide variety of services and treatment options tailored to their specific needs. in the section below each profession’s role pertaining to substance misuse treatment is described (see table 2 for a summary). it is of value to note that professionals may have overlapping roles. an important contribution of interprofessional education is understanding the roles of various professions and learning to communicate and collaborate in an interprofessional team to advance patient well-being. social workers partner with individuals, groups, families, and communities to promote well-being and enact social change. the core values of social work include “service, social justice, dignity and worth of a person, importance of human relationships, integrity and competence” (national association of social workers, 2017, p. 1). social workers, advocate for people who are poor, vulnerable, or disenfranchised providing counseling and engaging in community organization, administration, policy advocacy, research, and education. stoddard-dare et al./interprofessional learning 219 table 2. roles of interprofessional team members in substance misuse treatment profession role social workers prevention, screening, assessment, diagnosis, counseling, crisis intervention pharmacists assist in medication selection, dispense medication, dose adjustment, monitor efficacy, adverse effect management licensed physicians examine patients, complete a medical history, order tests, diagnose conditions, provide treatments and medical counseling, prescribe medication nurses assessment which includes physical exam and review of symptoms and concerns; referral; education; provide treatments and medications; advocacy occupational therapists (ots) prevent or adapt to injury, illness, or disability; help adapt environments, conserve energy, and decrease pain; promote engagement in meaningful life activities physical therapists (pts) restore function and reduce reoccurrence of pain through exercise, manual therapy, patient education, and stress management speech-language pathologists (slps) work with infants with neonatal abstinence syndrome on feeding difficulties and later possible deficits in language and/or literacy; provide therapies to improve cognition, speech, language, and swallowing for overdose survivors with brain injuries specific to problematic substance use, social workers provide school, community, and family-centered interventions aimed at prevention (ramos et al., 2018). social workers also play an integral role in the diagnosis and treatment of substance use disorders. using a bio-psycho-social-spiritual approach, social workers provide screening and assessments to help identify the needs of clients who are struggling with substance misuse. social workers serve as case managers, facilitate intake, develop treatment plans, provide psychoeducation, and facilitate individual, group, and family counseling for substance misuse and co-occurring mental health disorders. social workers make referrals to and consult with other professional entities. for instance, social workers collaborate in interprofessional teams to determine the appropriate level of care for a client struggling with substance misuse based on a variety of factors including housing stability, interpersonal relationships, co-occurring mental and physical health conditions, and history of relapse. finally, social workers have expertise in crisis intervention and help with crisis planning (american society of addiction medicine [asam], 2020). pharmacists have expertise in optimizing patient-centered medication treatment outcomes that are safe and cost-effective. pharmacists monitor and dispense medication and provide education. part of their monitoring includes checking and updating the prescription drug monitoring program (pdmp). the pdmp is a state-wide prescription registry designed to track when, where, and who prescribes and fills certain prescription medications that have a high propensity for misuse. this information can be used to identify and intervene when misuse is suspected. palliative care and mental health pharmacists provide consultation, assist in medication selection, dose adjustment, monitoring of efficacy, adverse effect management, and medication regimen considerations such as drug interactions for pain or treatment of opioid advances in social work, summer 2020, 20(2) 220 use disorder. in an interprofessional team, pharmacists serve as experts on the use of medications in a treatment plan which is salient for a person at risk for, or struggling with an opioid use disorder. some patients perform better in treatment when comorbid psychiatric conditions are treated with medication; therefore, consultation with a psychiatrist is suggested for dually diagnosed clients. medication-assisted treatment (mat) is a therapeutic approach that combines medication and counseling and is a best practice for treating opioid use disorders (national institute on drug abuse [nida], 2016). use of mat may decrease the amount and frequency of illicit drug use, decrease crime and the spread of contagious disease, reduce cravings and the euphoric effects of a drug, and improve treatment retention (substance abuse and mental health service administration [samhsa], 2018). interprofessional team members should be familiar with common medications that are used by patients struggling with opioid use disorders and pain such as buprenorphine/naloxone (suboxone), naltrexone (vivitrol), methadone, and naloxone (narcan) which should be routinely prescribed as part of a safety planning protocol to patients at risk of opioid overdose (nida, 2016). licensed physicians and other providers such as nurse practitioners and physicians assistants examine patients, complete a medical history, order tests, diagnose conditions, and provide treatments and medical counseling. primary care providers, emergency room physicians, and psychiatrists are especially likely to interact with clients struggling with opioid use disorders. medical doctors confirm an opioid use disorder diagnosis and help to diagnose and treat the patient’s co-morbid medical conditions and physical dependency, which is essential in determining the appropriate level of care for the patient. physicians review past medical history and test results to develop a treatment plan. physicians carefully consider pain management strategies, weighing the need to reduce pain enough to minimize the risk of improper self-medication of pain with the risk inherent in opioid use. prescribers are urged to follow recommended guidelines for opioids to reduce the risk of misuse and increase positive patient outcomes (dowell et al., 2016). although it is considered an evidence-based intervention, mat has been underutilized (jones et al., 2015). to encourage and support physicians samhsa sponsors the provider clinical support system (pcss), which is an online portal that provides free training, mentoring, and other resources for dea waivered providers to promote the use of medication-assisted treatment and best practices for patient pain management (pcss, 2020). in the traditional role of caregiver, nurses provide treatments and medications prescribed by state-authorized providers; assist the patient physically; gather health data and symptoms; and educate the patient and family members about their health and medications. specific to substance use disorders, both social workers and nurses engage in assessment, referral, education and advocacy. a nurse’s assessment of a patient includes a physical exam and a review of psychosocial concerns, familial history, and current and past drug use (dahn, 2016). like other members of the interprofessional team, nurses also provide education about the dangers of opioids and proper and responsible use of prescribed opioids, including disposal of unused medications (waszak et al., 2018). both stoddard-dare et al./interprofessional learning 221 social workers and nurses advocate for patients and for policies that support people impacted by opioid use disorders (clark, 2014; messer, 2017). overall, nurses are a valuable part of the interprofessional healthcare team that implements evidence-based practices to address substance misuse in emergency, inpatient, and primary care settings (agency for healthcare research and quality, 2016; korthuis et al., 2017). occupational therapists (ots) work with people across the lifespan to improve health and wellbeing and to prevent or adapt successfully to live with injury, illness, or disability (american occupational therapist association, 2014). occupational therapists help patients at risk of becoming opioid dependent improve quality of life, coping, and selfmanagement skills by helping them engage in activities they need and want to perform (chikwanha, 2019; costa, 2016; jedlicka et al., 2011; rojo-mota et al., 2017; rowe & breeden, 2018). since chronic pain is often a precursor to substance misuse, ots use therapeutic modalities to help adapt environments, conserve energy, and decrease pain (lagueux et al., 2018). ots can also provide education on safe medication management, secure medication storage in the home, and signs to recognize substance misuse and overdose while also educating about the effects of substance use in daily life (mccombie & stirling, 2018). additionally, ots can focus on improving engagement in meaningful life activities for those who have spent excessive time on substance use routines and patterns (wasmuth et al., 2014). people struggling with substance spend a considerable amount of time trying to obtain and using drugs, ots help those individuals repurpose their time to instead engage in meaningful activities. physical therapists (pts), as movement specialists, work to optimize function for movement-related tasks (american physical therapy association [apta], 2018, 2019 2020). after a comprehensive examination, pts implement a plan of care that includes various interventions such as aerobic training, strengthening exercises, manual therapy, functional training, adaptive equipment, posture/balance training, and patient education (apta, 2009, 2018, 2020). pts consult with an interprofessional team to maximize the clinical impact of services provided while working to enhance the quality of life of patients (apta, 2018). a plan of care is selected for individuals with or at risk for opioid misuse to restore function and reduce reoccurrence of pain through exercise, manual therapy, education on healthy sleeping habits, and stress management (apta, 2018; fernández-delas peñas, 2015; finan et al., 2013; holth, 2008). by promoting a lifestyle that embraces regular exercise, pts can help patients lessen the need for pharmacological alternatives (apta, 2011, 2018). speech-language pathologists (slps) work with individuals across the lifespan to prevent, assess, diagnose, and treat deficits in communication (including speech, language, voice, and stuttering), social skills, cognition, and swallowing (american speechlanguage hearing association, 2019). slps assist individuals impacted by the opioid epidemic, serving both pediatric and adult populations. for example, slps work with infants suffering from neonatal abstinence syndrome (nas) on feeding difficulties such as poor feeding efficiency, uncoordinated sucking, rejection of the nipple, cough, and reflux (proctor-williams, 2018). a portion of infants with nas go on to experience developmental, behavioral, and educational challenges as children (e.g., deficits in language and/or literacy) and receive treatment from slps. in the adult population, slps advances in social work, summer 2020, 20(2) 222 work as part of an interprofessional team to treat patients who have an acquired brain injury. anoxic and hypoxic brain injuries, common in individuals who have survived an opioid overdose, can result in devastating impairments in the areas of cognition, speech, language, and swallowing (adams et al., 2019). addressing pain in those at risk or struggling with opioid use disorder chronic pain management is a complex task best managed by an interprofessional team (evans et al., 2016). using a bio-psycho-social-spiritual approach helps deliver a wellrounded, individualized treatment for those patients who live with chronic pain and either have an opioid use disorder or are at risk for one (eccleston et al., 2013). the interprofessional approach addresses the multiple needs of the individual with chronic pain including but not limited to physical and mental health, socialization, school or workrelated tasks, sleep hygiene, mindfulness, acceptance and coping, and leisure reintegration (ali et al., 2017; black & kashikar-zuck, 2017; cohen et al., 2017; dysvik et al., 2010; fisher et al., 2014; hesse et al., 2015; simons et al., 2010). the interprofessional team’s approach should focus on the engagement of the individual with chronic pain to activities that interest them, such as leisure or sport. the team can help by slowly reintegrating the patient into actions that are either modified or adapted to make them successful and achieve a feeling of accomplishment. meanwhile, the treating team needs to focus on teaching mindfulness skills that help the patient better cope and/or accept the chronic pain and improve her ability to move forward in life with reduced reliance on, or cessation of opioids. mindfulness activities can include yoga, guided meditation, and positive affirmations (society, 2019). the interprofessional team members need to recognize that failing to address or undertreating pain can lead to self-medicating and can be a barrier for achieving and maintaining abstinence from illicit drug use. correspondingly, trauma, depression, anxiety, and poor sleep are pain facilitators that also need to be assessed and addressed by interprofessional team members (harding et al., 2018). one overarching goal for all providers is to keep the substance-using patient engaged in treatment. one evidence-based approach, motivational interviewing, helps to evoke motivation for treatment and builds and supports a strong therapeutic relationship that improves treatment engagement and retention (miller & rollnick, 1991; providers clinical support system, 2017). drughelp.care this interprofessional workshop introduced students to drughelp.care, an innovative and free website that allows substance misuse treatment provider agencies to easily register the number of treatment slots they have available on a daily basis. this website is fully searchable so it can be used by health professionals to find available treatment that matches an individual’s characteristics and treatment needs. for example, website visitors can search for available treatment by level of care, type of insurance, dual diagnosis specialty, medication assisted treatments that are permitted, and specialty populations served such as pregnant women, minors, veterans, or transgender clients. harm reduction resources are also included such as where to find narcan, syringe exchange sites, fentanyl testing strips, and pregnancy prevention services. in 2018 drughelp.care debuted and was piloted in stoddard-dare et al./interprofessional learning 223 northeast ohio. originally designed as a tool for professionals, due to the web application’s success and center for disease control and prevention grant funding, drughelp.care will be expanded to include a user interface for those struggling with addiction and their friends and family members and has a goal of reaching other geographic areas. first responders have indicated drughelp.care improves their ability to quickly find available treatment that matches the treatment needs and personal characteristics of the person seeking treatment (vanallen, 2018). participants at the interprofessional workshop were shown a 3 minute video (stoddard dare, 2020) on how to navigate drughelp.care and were empowered to use this web tool to facilitate a warm handoff to available, compatible treatment for their patients who need substance misuse assessment or treatment. during the small group exercise portion of the workshop, in addition to considering their role, participants were asked to consider what treatment and harm reduction services the case study patient needed, and to use drughelp.care to search for available treatment. purpose and justification this interprofessional workshop was designed to help health professionals to understand their role in addressing the opioid epidemic and feel competent in working with patients struggling with substance misuse. the value of this specific interprofessional workshop curriculum was evaluated by measuring improvement in student’s self-reported confidence in four domains: 1) identifying their values and beliefs as they relate to substance misuse, 2) responding appropriately when interacting with someone with a substance use disorder, 3) quickly finding local harm reduction resources, and 4) quickly finding local, available treatment resources for a person struggling with substance misuse. each of the four domains measured are salient in reducing opioid addiction and overdose death. first, facilitating examination of a professional’s values and beliefs is important because it is through this process professionals can identify sources of bias and identify areas where stigma might inadvertently impede patient care. second, some health professionals might not feel fully competent and confident responding appropriately when interacting with someone struggling with problematic substance use. therefore, it is essential that all health professionals know and understand their role and responsibility when it comes to pain management and helping to prevent opioid use disorders or relapse. third, harm reduction refers to a series of services and resources that can help to save the life of someone who is struggling with an active opioid use disorder or relapse. if every health professional was aware of local harm reduction resources and routinely connected those in need with these resources, overdose deaths and other comorbidities would decline (hawk et al., 2015). finally, oftentimes there is a small window of time when a person struggling with substance use disorder is amenable to treatment. for this reason, being able to quickly find local, available treatment resources for a person struggling with substance misuse is essential and life-saving. taken together, this educational session and corresponding assessment of the outcomes are of importance. method a nonprobability sample of n=307 students representing eight health professions (social work, occupational therapy, physical therapy, speech therapy, nursing, pharmacy, advances in social work, summer 2020, 20(2) 224 and medicine) was invited to participate in an online pretest survey. the survey examined their confidence in four domains, “identifying my own values and beliefs as they relate to substance misuse,” “responding appropriately when interacting with someone with a substance use disorder,” “quickly finding local harm reduction resources for a patient struggling with alcohol or drug addiction,” and “quickly finding local, available substance misuse treatment resources for a pregnant woman struggling with addiction.” a variable was created for each of the four domains, and they were measured on a five-point likert scale (1=strongly disagree to 5=strongly agree). students were then invited to attend a two-and-a-half-hour interprofessional workshop and were then asked to complete an online posttest survey examining the same content. a total of 201 students completed and returned the consent forms and completed the pre and posttest surveys, and thus the analytic sample includes only those students. using the survey data, we aimed to assess the value of a specific interprofessional workshop curriculum in achieving statistically significant improvement in students’ selfdescribed confidence regarding four substance misuse related areas. data were analyzed to calculate the pre-test and post-test measures of student’s confidence in four domains (values and beliefs, responding appropriately, quickly finding harm reduction resources, and quickly finding treatment resources) using a paired sample t-test. results of 307 students who attended the interprofessional workshop, a large number of them were from pharmacy (n=80; 26.1%), nursing (n=76; 24.8%), or occupational therapy (n=45; 14.7%), and fewer students were from physical therapy (n=39; 12.7%), speechlanguage pathology (n=34; 11.1%), and social work (n=33; 10.7%). only students who signed the consent forms and completed both preand post-surveys were included in the analytic sample (n=201). a high percentage of occupational therapy (100%), physical therapy (97.4%) and speech-language pathology (94.1%) students from the original pool of attendees met this inclusion criteria. fewer of the pharmacy (66.3%), social work (39.4%) and nursing (18.4%) students completed all required documentation. analysis and results in the analytic sample, there was a statistically significant difference in pre-test (m=4.21, sd=.720) and post-test (m=4.41, sd=.560) scores for students who attended the interprofessional workshop regarding their self-described confidence identifying their values and beliefs as they relate to substance misuse t(200)=-3.372, p=.001. further, there was a statistically significant difference in pre-test (m=3.58, sd=.863) and post-test (m=4.07, sd=.697) scores for students who attended the interprofessional workshop regarding their confidence in responding appropriately when interacting with someone with a substance use disorder and t(200)=-8.057, p<.001. additionally, there was a statistically significant difference in pre-test (m=3.30, sd=.954) and post-test (m=4.27, sd=.572) scores for students who attended the interprofessional workshop regarding their self-described confidence quickly finding local harm reduction resources, t(200)=-13.365, p<.001. finally, there was a statistically significant difference in pre-test (m=3.07, stoddard-dare et al./interprofessional learning 225 sd=1.020) and post-test (m=4.22, sd=.634) scores for students who attended the interprofessional workshop regarding their self-described confidence quickly finding local, available substance misuse treatment resources for a person struggling with addiction, t(200)=-14.316, p<.001. table 3. comparison of confidence pre and post workshop (n=201) confidence in… mean (sd) t pre post values and beliefs 4.21 (0.72) 4.41 (0.56) -3.372* responding appropriately 3.58 (0.86) 4.07 (0.70) -8.057** finding local harm reduction resources 3.30 (0.95) 4.27 (0.57) -13.365** quickly finding local, available substance misuse treatment resources 3.07 (1.02) 4.22 (0.63) -14.316** *p=.001, **p<.001 discussion this paper described a workshop that builds on a call for interprofessional education focused on opioids (kaufman, 2019) and helps to extend the emerging literature regarding empirically evaluated opioid-specific interprofessional education opportunities (brooks et al., 2017; fusco et al., 2019; hager et al., 2018; monteiro et al., 2017). we find statistically significant increases in all four outcome variables measured among students who attended a two-and-a-half-hour interprofessional workshop. aside from statistical significance, the practical significance of these findings also needs to be considered. of importance, we observe students moving from a neutral rating of their confidence to a category of agreement for three of the four variables measured. specifically, for questions about their confidence in their ability to respond appropriately, we observe an increase from 3.58 (neutral) to 4.07 (agree). similarly, we observe an increase from 3.30 (neutral) to 4.27 (agree) for confidence to quickly locate harm reduction resources, and from 3.07 (neutral) to 4.22 (agree) for confidence in quickly finding locally available treatment resources. on a practical level, the ability to increase students' levels of confidence in a short two-and-a-half-hour educational session is encouraging. one unique facet of this workshop, the use of drughelp.care, merits further consideration. successful replication of these outcomes would no doubt be increased by a community's effort to encourage registration of local treatment and harm reduction resources with drughelp.care prior to a workshop. efforts to promote community registration with drughelp.care can be led by local drug and mental health boards, universities, treatment provider agencies, medicaid providers, laypersons, or members of any profession mentioned here. advances in social work, summer 2020, 20(2) 226 limitations this study is not without limitations. first, it relies on the participant’s self-reported perceptions of their confidence. these perceptions may be subject to a social desirability bias and may not correspond to actual changes in behavior. additionally, confidence was measured on a five-point likert scale which limits variability, and qualitative comments were not collected. an additional limitation is uneven participation in the study component of this event by students from various disciplines. future research should use a uniform procedure within all participating disciplines to solicit informed consent from all students who participate in this workshop. finally, this research relies on a nonexperimental design, and a randomized experimental design is always preferred. implications for practice while the overall value of interprofessional education has already been established, we find that an interprofessional education event can increase student’s confidence to understand their values and beliefs, respond appropriately, and find treatment and harm reduction resources in a timely way for patients struggling with opioid use disorders. given the broad scope of the problem and the grave outcomes of opioid use disorder when left untreated, it makes sense to support interprofessional education efforts like the learning opportunity described here. universities could consider adding a similar interprofessional education event to their curriculum focusing on both opioids and other substance use disorders. beyond college students, healthcare leaders such as healthcare institutions and community health boards could consider hosting a workshop like the one described here for existing licensed professionals. finally, an interinstitutional summit that brings together students and professionals could be valuable to share lessons learned and exchange ideas. implications for policy although further research is needed, our findings reinforce the value of interprofessional educational experiences to help address the opioid epidemic. professional bodies such as the cswe have codified interprofessional skills as an essential component of professional competency. given the apparent value of interprofessional workshops such as the one discussed here, universities and health institutions could consider organizational policy and structural changes necessary to facilitate the logistical execution of interprofessional education events such as designated funding, finding a common meeting time, and awarding workload credit to staff that plan and facilitate these events. funding opportunities that could help to fund these workshops are emerging throughout the country as the federal and state governments search to curb the opioid epidemic (nida, 2019). implications for research following the lead of others who have published in this emerging area, future research should include additional indirect measures as well as direct measures of student’s increase in knowledge (monteiro et al., 2017) and their subsequent changes in practice behaviors. stoddard-dare et al./interprofessional learning 227 conclusion to address the opioid crisis, we aimed to assess the value of an interprofessional workshop curriculum in improving student’s readiness to intervene with patients struggling with opioid misuse. our findings suggest this educational curriculum is valuable in achieving its stated goals. specifically, we find statistically significant improvement in students self-described confidence identifying their values and 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(2010). framework for action on interprofessional education and collaborative practice. https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng. pdf;jsessio author note: address correspondence to patricia stoddard dare, school of social work, cleveland state univeristy, 2121 euclid avenue, rt 1431, cleveland oh 44115. email: p.stoddarddare@csuohio.edu https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessio https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessio mailto:p.stoddarddare@csuohio.edu ________ brenda m. mack, dsw., assistant professor, department of social work, bemidji state university, bemidji, mn. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 596-614, doi: 10.18060/23897 this work is licensed under a creative commons attribution 4.0 international license. the resiliency-focused supervision model: addressing stress, burnout, and self-care among social workers brenda m. mack abstract: social workers often deal with complex, challenging, and emotionally exhausting situations that can negatively impact their mental and physical health. when a helping professional is in distress, client care may be compromised. therefore, the necessity of wellness practices to reduce stress and mitigate burnout is gaining recognition in the social work profession. the national association of social workers (2013) asserts that supervisors are responsible for recognizing and responding to supervisees’ work-related angst. however, there is little research published that addresses pre-burnout symptoms and self-care practices in the supervisory process. the resiliency-focused supervision model (rfsm), a culturally-responsive, strengths-based framework, was developed to assist supervisors in helping supervisees to manage stress, avoid burnout, and be successful in the workplace. the rsfm’s interrelated domain areas include: 1) structural/environmental, 2) relational, 3) work self-care, and 4) life self-care. the rfsm is a practical, pragmatic option for supervisors to use in partnership with social workers to promote good health, well-being, and resiliency. keywords: stress, burnout, supervision, self-care, resiliency self-care in the social work profession has emerged as a means to build a resilient workforce (newell, 2017; smullens, 2015). best practices are being researched and implemented to help social workers rebound from adverse work-related experiences so that compassionate, effective human services work continues (miller et al., 2018; newell, 2020). to combat the problem of social worker stress and burnout, the national association of social workers (nasw, 2008, 2013) recommends implementing organizational, educational, and research-informed strategies. nasw (2008) highlights the importance of supervisors addressing self-care with supervisees through education and resource allocation. nasw’s self-care policy statement is a call to action for those in the social work profession to generate innovative and concrete solutions. as a result, the resiliency-focused supervision model (rfsm) was created by mack (2020) as an approach to assist supervisors and supervisees to address stress and burnout by strengthening resilience. newly appointed and veteran supervisors may be interested in a framework to guide conversations during supervision to help supervisees think critically and reflectively about their emotional wellness. wilkins et al. (2017) found that while almost all supervisors of child and family social workers check-in with supervisees at the beginning of supervisory sessions, once case-specific discussions begin, emotionallyfocused conversations discontinue. the rfsm builds on the supervisory best practice standards established by nasw (2013) and is meant to guide supervisors in their role with supervisees and raise awareness of evidence-informed practices. the model prompts supervisors to help supervisees develop, implement, and modify a work/life self-care plan. the purpose of this article is to describe the model and its utility in the supervisory process. https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2020, 20(3) 597 framing the problem over one-third of social workers employed in the profession consider resigning from employment due to work-related stress (center for health workforce studies, 2006). wermeling (2013) found that 31% of social workers have left the field and another 13% are likely to leave their jobs. social workers who are burned out detach from work-related activities and become less productive, lack commitment to their employers, have thoughts of resigning, quit their positions (maslach et al., 2001), and may develop physical health issues (kim et al., 2011). those in the helping professions who are overly stressed or burned out are more likely to experience emotional exhaustion and fatigue, mental health symptoms, job dissatisfaction (dane, 2000; smullens, 2015) and may be less effective with clients (kim et al., 2011; maslach et al., 2001). interestingly, helping professionals who work with child abuse survivors experience higher rates of burnout symptoms due to stressful events in their personal lives (staudt & williams-hayes, 2019). in response to growing concerns within the profession, supervisors, organizations, and governing bodies are interested in solutions that reduce social worker stress and burnout. definitions work-related stress is an emotional or physical response to occupational stimuli. stress disrupts an individual’s healthy state of being and prompts the fight, flight, or freeze response (lloyd et al., 2002). stress is a risk factor that may lead to burnout. maslach et al. (2001), explain burnout as “a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism and inefficiency” (p. 397). burnout may be a result of untreated stress and can contribute to social workers showing a lack compassion or empathy toward others (smullens, 2015). in 1974, renowned psychologist, herbert freudenberger coined the term job burnout to describe work-related stress that manifests in physical and behavioral ways. freudenberger’s (1974) seminal article indicated that a lack of inspirational leadership lowered staff morale and contributed to provider mental and physical fatigue. freudenberger’s direct link of burnout to leadership influenced the development of the rfsm. “self-care is the thoughtful and mindful engagement in a healthy lifestyle that builds resilience to endure personal and professional challenges and demands” (mack, 2020, p. 20). according to the university of buffalo school of social work website (n.d.), practicing self-care can help social workers effectively deal with stress and increase their mental and physical vitality. nasw (2017) implicitly recognizes self-care in its code of ethics, specifically in standards 1.01 about client care, 2.08-2.09 about capability and competence, and 4.05 concerning impairment. nasw (2008) calls upon social workers to engage in self-care and recommends “the promotion, support and modeling of the practice of professional self-care by social work supervisors with social work supervisees” (p. 270). engaging in self-care helps to strengthen resiliency among social workers. resiliency “is a dynamic and fluid process that enables individuals to cope and recover from stressful work situations” (acker, 2018, p. 716). supervisors who follow nasw’s recommendations may be better prepared to help supervisees bounce back from mack/resiliency-focused supervision model 598 challenging and difficult circumstances, while empowering them to thrive in their personal and professional environments. research about stress, burnout, and self-care during the 1980s and 1990s, stress and burnout research with those in the helping professions included quantitative and longitudinal studies with larger sample sizes and expanded to additional occupations beyond health and human services (maslach et al., 2001). the findings of these studies led to a greater understanding of the signs, symptoms, causes, and interventions for stress and burnout (schaufeli et al., 2009). in 2002, lloyd et al., conducted a literature review of studies specifically about stress and burnout among social workers. they discovered that very few studies existed on these topics with social work participants and were unable to find empirical data that compared social workers to other helping professionals (lloyd et al., 2002). kim and stoner (2008) surveyed a randomly selected group of 346 social workers about job stress, autonomy, and professional support that impacted burnout and employment retention. results indicated that social workers who reported elevated feelings of job-related stress experienced burnout and the desire to leave their employment positions (kim & stoner, 2008). studies that explore self-care among social workers are starting to emerge in the literature. in 2018, miller et al., surveyed 1,100 social workers and discovered that participants only moderately engage in self-care activities. the researchers recommend that supervisors address self-care with supervisees. effective, enduring supervision may be a key for social workers to understand and overcome work-related stress and burnout through intentional self-care practices. the rfsm was developed to address self-care in the supervisory process and help supervisees operationalize a health and wellness plan. the model aims to be a viable option for supervisors to help bolster social workers’ resiliency. the resiliency-focused supervision model the resiliency-focused supervision model (rfsm) includes three domains: 1) structural/ environmental, 2) relational, and 3) work/life self-care components, which are separate but interconnected concepts. the rfsm builds on the author’s 20 years of supervisory experience and a qualitative, exploratory study conducted in 2019 with supervisors of social workers in a large midwestern state (mack, 2020). the model also draws upon empirical studies of human service provider stress, burnout, and self-care practices dating back to the early 1970s and the self-care framework developed by lee and miller (2013). while the lee and miller framework primarily supports the individual practitioner in developing self-care strategies, the rfsm focuses on the shared responsibility between supervisors and practitioners in implementing resiliency-building best practices. the rfsm addresses the importance of the professional relationships and the workplace environment in which supervisors guide supervisees as they develop and implement self-care plans (see figure 1). advances in social work, fall 2020, 20(3) 599 figure 1. the resiliency-focused supervision model *components based on lee and miller’s (2013) self-care framework. structural/environmental the structural/environmental domain of the model includes formats and types of supervision such as formal, informal, peer, internship, technical, client-centered, clinical, and reflective. supervisees’ health and wellness can be addressed by supervisors within the various formats and types of supervision by creating an environment where these topics are strategically infused into conversations or added as agenda items for discussion. within the various types of supervision, supervisors have an opportunity to help supervisees raise their awareness about the signs and symptoms of work-related stress and encourage them to practice self-care. this domain also encompasses the setting, longevity awareness, cultural-responsiveness, and care planning components. this aspect of the model prompts supervisors to consider the nuances of addressing stress, burnout, resiliency, and self-care within the different types of supervisory meetings and settings. for example, during a group supervision session, if a supervisee looks exhausted and is short-tempered with coworkers the supervisor can initiate a follow-up conversation during a regularly scheduled, formal, one-to-one supervisory session. the supervisor may determine that a private, indepth discussion with the supervisee, outside of the group environment, is the most relational: (present, strengthsperspective, supervisee-centered, instilling hope) work/life self-care: (*role/responsibilities, *reducing negative stress, *selfassertiveness, *knowledge development, supervision, autonomy, compassion, self/staff morale, *physical, *emotional, *social, *recreational, *spiritual, financial, contemplative, gratitude, self-compassion, hope) structural/ environmental: (format, type, setting, longevity awareness, culturalresponsiveness) mack/resiliency-focused supervision model 600 appropriate response. application of the rfsm works best when supervisors and supervisees meet on a consistent basis. however, supervisors and peers can use the model to guide discussions and identify resiliency-building strategies during infrequent, irregular, or spur-of-the-moment supervisory sessions. for instance, a group of supervisees, with five or more years of experience may decide to meet three times a year over the lunch hour to offer each other support and feedback. they can use the rfsm to discuss stress prevention and emotional wellness strategies and problem-solve implementation barriers regarding self-care practices. formal, informal, peer, internship, and technical supervisors and supervisees may engage in one or multiple types of supervision where they focus on the topics of stress, burnout, and resiliency-building. understanding the structural formats of supervision can help them determine when, where, and how-to best address wellness topics. formal supervision may involve regularly scheduled meetings between a designated supervisor and supervisee for an uninterrupted, appropriate duration of time. informal supervision may include unscheduled emergent or non-emergent sessions or conversations between a supervisor and a supervisee to debrief after a challenging client session. peer supervision may be defined as scheduled or spur-of-the-moment individual or group meetings with colleagues that may or may not be facilitated by a supervisor. internship supervision may be identified as a learning process facilitated by a field placement site supervisor with social work students. technical supervision may focus on the operational and administrative duties and responsibilities of a social worker. client-centered, clinical, and reflective addressing job-related challenges and the emotional and physical outcomes that social workers experience can occur within the various types of supervision, such as clientcentered, clinical, or reflective. the rfsm can be embedded into the different types of supervision to guide conversations about stress, burnout, self-care, and resiliency-building practices. client-centered supervision may occur when the supervisor focuses on a supervisee’s caseload by gathering information and offering advice and directives regarding client care. clinical supervision is a didactic process where a supervisor informs, teaches, and directs supervisees in assisting individuals, families, and groups (munson, 2001). reflective supervision may be described as supervisee-driven wherein the social worker brings up client-related issues while the supervisor guides a feelings-identification and critical-thinking process. supervisors and supervisees involved in one or multiple types of supervision simultaneously are encouraged to consider the benefits of interweaving health, wellness, and self-care discussions on a consistent and regular basis. the self-care starter kit available on the university at buffalo’s school of social work website may be a helpful resource for supervisors and supervisees to use when engaging in resiliency-building conversations (butler & mcclain-meeder, 2015). advances in social work, fall 2020, 20(3) 601 setting and longevity awareness the setting component of the rfsm includes time and space issues. supervisory sessions can occur in a variety of locations such as in a supervisor’s office, live on-line using a software platform such as zoom or google meet, or in a conference room during group supervision. supervisors who are concerned about supervisees in emotional distress may decide that an individual, face-to-face, uninterrupted meeting in a professional, comfortable space is the best option to address concerns. they may determine that peer supervision, where social workers support one another, is the most effective way to address work-related stress using problem-solving solutions (chiller & crisp, 2012). using the supervision process to tackle these issues can be helpful for social workers during all phases of employment, yet the focus may vary depending on tenure and experience. cleveland et al. (2019) found that neophyte social workers need emotional support from supervisors and peers to strengthen their resiliency. therefore, supervisors may want to consider the training and mentoring needs of newly hired versus veteran supervisees and respond accordingly. they may want to consider developing a supervision plan with each supervisee that includes the purpose, frequency, and duration of supervisory sessions based on individual needs. cultural-responsiveness and self-care planning the culturally-responsive component of the rfsm includes awareness regarding supervisors’ and supervisees’ unique cultural identities and addresses self-care in a thoughtful, respectful, and culturally-appropriate manner. through the supervisory process, supervisors can initiate and guide discussions regarding power differentials, oppression, marginality, discrimination, or microaggressions that impact supervisees’ well-being (o’neill & fariña, 2018; varghese et al., 2018). together, the supervisors and supervisees can engage in a problem-solving process to promote equity, inclusivity, and justice for supervisees. these strategies and solutions may also be included in supervisees’ individualized work/life self-care plans. an effective individualized self-care plan should reflect the values and beliefs of the supervisee which are supported by the supervisor. supervisors may consider referencing cross’ (1988) model of cultural competence, ortega and faller’s (2011) cultural humility framework, and the varghese et al. (2018) trauma-informed culturally-competent recommendations to self-assess their culturally-responsive supervisory practices. further, they may want to offer suggestions to their agency boards or administrators about implementing organizational policies and procedures that create an inclusive work environment that honors diversity and equity. relational the relational domain of the rfsm highlights the importance of interpersonal connections between supervisors and supervisees in addressing stress, burnout, and resiliency. supervisors can build resiliency among supervisees using a strengths perspective, being present in the moment, applying a supervisee-centered approach, and by instilling or fostering hope regarding work successes. the relational components of the mack/resiliency-focused supervision model 602 rfsm build upon nasw (2008) best practice standards in social work supervision while explicitly prompting supervisors to attend to the emotional health and wellness of supervisees. the relational domain primarily focuses on the supervisor and supervisee relationship, yet recognizes the importance of supervisees having healthy interpersonal relations with co-workers, family members, and friends. strengths perspective social workers are trained to use the strengths perspective, which is an empowerment approach to working with clients (saleebey, 1992). supervisors may want to consider using this approach during interactions with supervisees as the strengths perspective can be the impetus to supervisees feeling hopeful and open to strategies that may reduce symptoms of stress and burnout. koenig and spano (2007) support using the strengths perspective in the supervisory process to increase supervisees’ sense of hope and effectiveness when working with clients. when supervisors focus on building supportive, empathetic relationships with supervisees, it may be more comfortable for both parties to address the topics of work-related stress, burnout, and self-care practices. present, supervisee-centered, and instilling hope supervisors who are present and alert during supervisory sessions may be more attuned to the needs of their supervisees and better able to pick up on verbal and non-verbal cues. supervisors might consider ways to create a distraction-free meeting such as turning all cell phones to silent or posting a do-not-disturb sign on the door. supervisors who give their undivided attention to supervisees demonstrate an investment in the professional relationship when they reduce distractions, set appropriate boundaries, and focus on their responsibilities in the moment. the rfsm is a supervisee-centered approach that focuses on the strengths and needs of supervisees. supervisors help supervisees identify job-related challenges and together they problem-solve solutions. strategies that support a supervisee-centered approach involve the supervisees creating the agenda for supervisory sessions and letting them set priorities for the discussions. during the supervisory meeting, supervisors are encouraged to address supervisees’ feelings of hope regarding job success. social worker hope, defined as having goals, determination, and problem-solving capabilities prevents burnout (schwartz et al., 2007). supervisors can raise supervisees’ awareness about this research finding and help identify interventions wherein supervisees feel more optimistic and hopeful. a supervisor’s genuine, caring approach may help supervisees feel supported and hopeful. in addition to individual sessions, it is recommended that group supervision sessions occur to instill and strengthen social workers’ feelings of hope (koenig & spano, 2007). the concept of hope is also included in the work/life domain for social workers to consider when developing their individualized self-care plan (see appendix a). work/life self-care addressing work/life self-care can start with supervisors helping supervisees identify self-care practices that may prevent or reduce work-related stress and burnout symptoms. advances in social work, fall 2020, 20(3) 603 supervisors and supervisees can engage in thought-provoking discussions about these topics using both open and close-ended questions (see appendix b). then, supervisees can start creating self-care plans based on discussions with their supervisor and the selfreflection that occurs during or outside of the supervisory session. supervisees are the primary decision-makers in identifying activities to include in their unique, individualized work/life self-care plans. supervisors can assist in the development and implementation of these plans, for example, by encouraging supervisees to take their earned vacation time or refrain from checking work-related e-mail when they are not working. regular follow-up discussions between the supervisor and supervisee can help determine whether the plans should continue, change, or be modified. work self-care the rfsm builds upon the professional self-care recommendations to address jobrelated stressors that impact employees’ well-being specific to their work role (lee & miller, 2013). the professional self-care domain consists of job duties, work-related responsibilities, role clarity, professional self-awareness, support from colleagues, training opportunities, and activities that boost morale (lee & miller, 2013). when supervisees identify self-care activities in one or more of these areas, it may require a supervisor to follow-up and take action. for example, a social worker wants to attend a local conference to learn about culturally-responsive mindfulness practices to reduce stress and follows the agency policy by getting the supervisor’s approval to attend the training. the agency will cover the expense of the conference once the supervisor completes the required paperwork. the supervisor’s action step supports the supervisee’s professional self-care activity of attending a training regarding contemplative practices to increase resiliency. along with lee and miller’s (2013) components, the rfsm’s work self-care domain includes autonomy, compassion for others, acknowledging work successes, and self/staff morale components. autonomy. supervisors may want to consider allowing supervisees to be self-directive in completing job tasks and give them decision-making authority regarding their work schedules. previous studies suggest that employees with greater job autonomy are less likely to experience burnout or resign from their current employment situations (kim & stoner, 2008), especially for child welfare workers employed for less than three years (boyas et al., 2013). given this data, administrators, leaders, and supervisors can be strategic when recruiting millennials and recent graduates and highlight the autonomy and freedom given to employees after adequate training and onboarding have occurred. examples include offering supervisees flexible work schedules and work-from-home options that align with the agency’s mission to assure quality client care. compassion for others. social workers who are empathetic, compassionate, and focus on the positive impact they have made in the lives of others are better able to deal with work-related stressors (harr et al., 2014). supervisors can guide and mentor supervisees in building compassion satisfaction by intentionally addressing this during supervisory sessions. for example, supervisors may ask supervisees compassion-related questions about their work with clients and acknowledge when empathy and kindness are displayed. supervisors might suggest that supervisees regularly reflect on positive work-related mack/resiliency-focused supervision model 604 experiences and identify examples of helping others. these strategies are meant to energize social workers to effectively cope with challenging situations and scenarios. work success. social workers often serve clients who are dealing with difficult, adverse, or traumatic situations. over time, repeated exposure to other people’s adverse experiences may negatively impact their own well-being (staudt & williams-hayes, 2019) and morale especially when they are exhausted, feeling vulnerable, or emotionally triggered in their professional lives. focusing on adverse experiences for an entire supervisory session may be overwhelming and emotionally depleting, therefore, it is helpful for supervisors to deliberately focus on positives by interjecting the discussion with reminders of more uplifting experiences or rewarding outcomes. supervisors may want to consider timing issues, their tone of voice, and when it is appropriate to change topics based on the supervisees’ verbal and non-verbal cues. for example, the supervisory session may start with a supervisee discussing the biggest challenges of the week while the supervisor listens attentively and with empathy. at some point in the session, the supervisor may prompt the supervisee to share any successes or inspirational moments that have recently occurred. the supervisor can highlight successes they know about and acknowledge the supervisee’s skills, abilities, and efforts so the supervisee can feel more positive or re-energized. self/staff morale. supervisors might consider a balanced approach in which they listen to the challenges and frustrations of their supervisees and help them focus on positive client-specific outcomes. consider a scenario where a social worker, employed by a human services organization, is experiencing symptoms of stress and burnout. that individual feels unhappy, exhausted, and hopeless, and focuses on the negative, frustrating facets of the job. the supervisor can help the supervisee address negative thought patterns by listening and making recommendations to ease dissatisfaction early in the supervisory process. the supervisor can encourage the supervisee to discuss the source of their stress and their thoughts and feelings during supervisory sessions. by doing so, the supervisee may feel relieved and supported which could result in their having a more energized, hopeful demeanor. the supervisor is tasked with helping the supervisee cope effectively with work-related challenges and problem-solve morale issues. supervisors can help supervisees to focus on positive client outcomes and encourage them to talk about these situations with their colleagues. another strategy to consider is the development and implementation of staff satisfaction initiatives, such as, agency on-site and virtual employee bulletin boards where all staff members post positive work-related comments or statements of appreciation. supervisors, administrators, and leaders who focus on multiple morale-boosting solutions may build resiliency with individuals and create a healthy organizational culture and climate (pittman, 2020). the morale component is a part of the work self-care domain within the rfsm and intersects with the life self-care domain (see figure 2). advances in social work, fall 2020, 20(3) 605 figure 2. the rfsm’s work/life self-care domain and components *components based on lee and miller’s (2013) framework. note. a work/life self-care figure that highlights the importance of healthy personal and professional relationships and includes components to consider when developing an individualized wellness plan. life self-care self-care includes wellness choices and activities that enhance an individual’s emotional and physical health (lee & miller, 2013). a personal self-care domain created by lee and miller (2013) includes social, emotional, and behavioral components. for example, an individual’s self-care plan may include having coffee with a friend, watching inspirational videos, and exercising. self-care practices in each of these areas will vary based on supervisee interests and desires. the rfsm life self-care domain builds on lee and miller’s framework and includes financial, contemplative, gratitude, self-compassion, and hope components. financial. financial wellness is an important component of life self-care. a career in social work has been identified as one of the most stressful, underpaid occupations (dickler, 2009). lack of financial resources to meet cost-of-living needs can contribute to social workers’ worries, therefore, addressing their financial self-care is recommended. examples include having social workers develop and adhere to a budget, establish an emergency fund, or negotiate salary increases. supervisors can advocate for larger budgets to pay their supervisees more fairly, help them better negotiate salary increases, share information about student loan forgiveness programs, and provide opportunities for social workers to learn more about budgeting, retirement planning, investments, and mortgages. there are a variety of ways to raise the issue of financial wellness in supervisory processes. for instance, supervisors can share self-care plan templates that include financial wellness work categories: •*role/responsibilites •*reducing negative stress •*self-assertiveness •*knowledge development •supervision •autonomy •compassion for others •self and staff morale life categories: •*physical •*emotional •*social •*recreational •*spiritual •financial •contemplative •gratitude •self-compassion •hope b a l a n c e mack/resiliency-focused supervision model 606 examples, strategies and activities, or they may invite a financial self-care expert to speak during a group supervision session. financial self-care may be a sensitive topic. therefore, it is recommended that supervisors use a variety of approaches in addressing economic well-being and pay attention to supervisees’ verbal and non-verbal cues and responses. contemplative. the contemplative component includes mindfulness and meditative practices that may help supervisees manage work-related stress symptoms, increase cognitive clarity, and experience feelings of calmness and peace. mcgarrigle and walsh (2011) found that human service workers who engaged in peer-group mindfulness exercises increased their ability to manage stress. in addition to group contemplative practices, supervisees may choose to engage in individual activities that produce the same results. using technology and software applications (apps) such as calm, headspace, or insight timer may prompt supervisees to engage in contemplative exercises throughout their days and in a variety of settings including a home, office, or vehicle. supervisors may have to advocate for agency policy changes to support the appropriate use of calming apps on the job. gratitude. the gratitude component connects to the field of positive psychology and studies that focus on helping individuals increase feelings of joy and happiness (rippsteinleuenberger et al., 2017; seligman et al., 2005). for example, every evening, individuals write about three positive things that happened during their day or, once per month they compose a gratitude letter for someone and visit face-to-face to read its contents (seligman et al., 2005). social workers who express gratitude and appreciation toward themselves and others may find these deliberate acts increase their feelings of positivity. many supervisors demonstrate their appreciation of supervisees by providing them with direct, specific, positive job-related feedback and are encouraged to continue this practice. self-compassion. neff (2011) describes self-compassion as an individual life-altering and transformational concept that fosters feelings of positivity and hope. social workers often help others deal with traumatic, painful life events. in certain circumstances, jobrelated experiences may haunt them or cause them to fixate or ruminate on negative clientrelated outcomes. when social workers fail to show self-empathy and kindness toward themselves, this may result in increased feelings of shame and inadequacy (neff, 2011). this may negatively impact their overall health and well-being. neff (2011) challenges individuals to treat themselves with kindness and compassion just as they would a friend who is hurting. supervisors can use this information during supervision by recognizing and responding to supervisees who describe themselves in a shame-based, self-defeating manner. using a step-by-step, empowerment self-talk worksheet (see appendix c) is a tangible tool that can be completed during and outside of the supervisory session. supervisees who use the tool will engage in a cognitive restructuring process to reframe negative thoughts and self-talk (clark & beck, 2012). hope. when social workers are optimistic, focus on the positive aspects of their lives, and envision a future where they thrive, they strengthen and foster feelings of hopefulness (koenig & spano, 2007). the hope self-care component includes acknowledging personal strengths and assets and identifying future goals. as social workers work toward accomplishing these goals, they are encouraged to celebrate their successes with family, advances in social work, fall 2020, 20(3) 607 friends, co-workers, and supervisors. having the support of others helps social workers to feel hopeful, build resiliency, and create meaningful, fulfilling lives. supervisees can include strategies to increase feelings of hopefulness in their self-care plans to avoid or reduce symptoms of stress and burnout. organizational culture a complementary component of the rfsm moves beyond the bi-directional relationship between the supervisor/supervisee and focuses on organizational culture and climate factors. supervisors have an opportunity to influence organizational policies, procedures, and practices to enhance the health and well-being of employees. for example, supervisors can advocate for an employee wellness policy with strategic initiatives and having self-care and resiliency-building professional development trainings for all employees (miller et al., 2018). doing so may result in social workers feeling less stressed which can have a positive impact on workforce morale and retention rates (mor-barak et al., 2001). organizational culture and climate issues may be adjusted to include best practices to create a positive, culturally-responsive work environment. pittman (2020) identifies eight neuroleadership strategies to improve the culture and climate within human service organizations, which may increase resiliency among staff. pittman (2020) offers recommendations for organizations to consider that align with the rfsm practices and strategies to help supervisors support supervisees in combatting stress and burnout. other best practice examples include offering organizational self-care and mindfulness programs for social work employees (alenkin, 2019; mcgarrigle & walsh, 2011). engaging in these programs where supervisees learn to apply stress reduction strategies can be included in their rfsm work/life self-care plans. finally, organizations are encouraged to offer additional training for supervisors to be effective leaders, continuing education opportunities for both supervisors and supervisees, plus regularly scheduled and ad hoc individual and peer supervision sessions. implications the rfsm intersects with nasw’s (2013) best practice standards in social work supervision, code of ethics (2017), and professional self-care and social work policy statement (2008). nasw offers general recommendations about social worker self-care as connected to ethical standards relevant within the profession. nasw (2008) identifies existing models that increase compassion satisfaction and reduce secondary or vicarious trauma. however, there is no mention of a framework that can be used to build resiliency through a combination of organizational, supervisory, and individual self-care policies, procedures, and practices. the rfsm was developed to address this gap and help meet the needs identified in human services research studies and by nasw. there seems to be agreement across the social work profession that self-care and resiliency-enhancing practices are a necessity in building and maintaining a healthy, vibrant, effective workforce (nasw, 2008). in response to the limited social work specific models, the rfsm was developed as a comprehensive, systematic approach that includes the integration of organizational, supervisory, and individual strategies that may reduce work-related stress and burnout in social workers. the model is both research and practicemack/resiliency-focused supervision model 608 informed, building on the findings of health and human services studies and incorporating experiences from the author’s role as a clinical supervisor of social workers and mental health professionals for over two decades. because the rfsm is newly created, studies to evaluate the model’s usefulness and effectiveness are needed. the rfsm is meant to be a training model for administrators and supervisors to use to build a resilient workforce and help supervisees develop and implement an individualized work/life self-care plan. supervisors can proactively inform social workers about the signs and symptoms of stress and burnout and self-care practices that promote wellness. supervisors concerned about supervisees who exhibit signs and symptoms of stress and burnout can use the rfsm to ask relevant questions and problem-solve solutions during supervisory meetings. supervisors can help all supervisees develop and implement tangible, strengths-based, culturally-responsive self-care plans. the plans are flexible and adaptable and may include a combination of supervisory, personal, and professional wellness strategies. another proactive resiliency-building approach for supervisors to consider includes training all newly hired social work employees on the signs, symptoms, and impact of stress and burnout as part of the on-boarding process. the rfsm may be useful for social work organizations as a guide for supervisors and supervisees in effective 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(2017). what happens in child and family social work supervision? child & family social work, 22(2), 942-951. https://doi.org/10.1111/cfs.12314 author note: address correspondence to brenda m. mack, department of social work, bemidji state university, 1500 birchmont dr. #35 bemidji, mn, 56601. email: brenda.mack@bemidjistate.edu https://doi.org/10.1136/bmjopen-2017-015826 https://doi.org/10.1093/sw/40.2.280 https://doi.org/10.1108/13620430910966406 https://doi.org/10.1300/j147v31n04_08 https://doi.org/10.1037/0003-066x.60.5.410 https://doi.org/10.18060/22957 https://socialwork.buffalo.edu/resources/self-care-starter-kit/introduction-to-self-care.html https://socialwork.buffalo.edu/resources/self-care-starter-kit/introduction-to-self-care.html https://doi.org/10.1080/00377317.2018.1439826 https://doi.org/10.1080/03643107.2012.693057 https://doi.org/10.1111/cfs.12314 mailto:brenda.mack@bemidjistate.edu advances in social work, fall 2020, 20(3) 612 appendix a work/life self-care plan template with examples to strengthen resiliency among supervisees self and staff morale: practice empowering selftalk; model compassion, respect, and culturalresponsiveness for clients & co-workers during group & peer supervision; complete random acts of kindness autonomy: make daily decisions regarding client care & resources offered; work a flexible work schedule and have fridays off. supervision: engage in 1 hour of individual and group supervision per month; attend a monthly peer supervision gathering. knowledge development: attend free on-line trainings on mindfulness & meditation; read peer-reviewed journal articles about social work topics self-assertiveness: ask for help in addressing complex client situations regarding personal safety concerns reducing negative stress: refrain from checking emails during non-work hours role/responsibilities: social worker care coordinator, working mon-thurs, 8am-6pm work self-compassion: read books & articles on self-compassion; daily engagement in positive self-kindness and self-talk recreational: weekly scrabble games with family; daily sudoku spiritual: go on nature walks; pray; attend weekly worship services financial: put money into an emergency fund each pay period; create and follow a monthly budget life balance hope: write about hopes & dreams in an ejournal; take action to accomplish personal and professional goals compassion for others: work with others using a strengths-based perspective; focus on specific examples of resilience among clients gratitude: write & send 1 gratitude letter a month to someone who has made a difference in my life contemplative: meditate for 10 minutes every morning; engage in deep-breathing throughout my day social: frequent online coffee chats & game nights with friends emotional: say “no” to energy-draining requests physical: yoga 3x’s per week; run 3x’s per week advances in social work, fall 2020, 20(3) 613 appendix b questions to prompt self-care discussions between supervisors and supervisees questions supervisor supervisee roles/ responsibilities does my supervisee have a detailed job description? what does my supervisee need from me to better understand roles and responsibilities? do i fully understand my roles and responsibilities in my organization? if not, what do i need to ask my supervisor about to get more clarification? reducing negative stress what negative work-related stress is my supervisee experiencing? what coping strategies can i offer to help reduce the stress? what advice does my supervisor have regarding helping me reduce my negative stress? what solutions can we come up with together to address work-related stressful situations? selfassertiveness does my supervisee advocate for work-related needs? how can i help my supervisee meet these needs? if i am unable to help, support, or authorize a specific request made by a supervisee, have i initiated a conversation to explain decisions? have i assessed my needs in the work environment? what will help me meet my needs? in what ways can my supervisor help me meet my needs? knowledge development what are my supervisee’s knowledge development needs? what is the organization or agency’s policy about supervisee professional development and continuing education? what are my training and continuing education needs? what options do i have within my organization to get my training needs met? supervision what format and type of supervision am i providing for supervisees? how am i addressing supervisee health and wellness during supervisory sessions? am i comfortable in addressing my work-related stress during supervisory sessions? what do i need during my supervisory sessions to strengthen and build my resiliency? autonomy does my supervisee have a clear understanding of when to independently make work-related decisions and when input from myself or others is required? have i discussed job flexibility options with my supervisee? do i understand my job-related autonomy? what are the flexibility options of my job? compassion for others how does my supervisee demonstrate empathy for clients and co-workers? what can i do to help my supervisee build or strengthen compassion satisfaction? what can i do to build and maintain my empathy for clients and co-workers? how do i demonstrate compassion with my clients and coworkers? self/staff morale what can i do to increase supervisee morale? what steps can i take to help my supervisee feel valued and appreciated? how can i focus on the difference i am making with others in my job? what do i need from my supervisor to help increase my morale? what can i do to help increase morale among co-workers? additional work/ life self-care questions what physical, emotional, social, recreational, and spiritual self-care techniques does my supervisee engage in to reduce stress? have i provided support to my supervisee regarding any financial, contemplative, gratitude, and selfcompassion self-care practices? is there anything else that i can do to support my supervisees in practicing self-care? what do i need so that i can develop and implement self-care activities and practices? what support do i need from my supervisor to implement my work/life self-care plan? advances in social work, fall 2020, 20(3) 614 appendix c. empowerment worksheet old patterns new patterns example: “i’m a terrible social worker, i make so many documentation errors” _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ example: shame, frustration, anger _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ example: avoid completing paperwork, short-tempered with coworkers and family _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ feelings thoughts behaviors example: the best part of my job is working with clients and documentation of sessions is necessary and important” _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ example: hopeful, optimistic _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ example: ask supervisors and co-workers for help, complete documentation in a timely manner, request additional training if necessary _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ this work is licensed under a creative commons attribution 4.0 international license. environmental migration: social work at the nexus of climate change and global migration meredith c. f. powers cathryne l. schmitz christian z. nsonwu manju t. mathew abstract: environmental migrants are caught at the nexus of the climate crisis and the global migrant crisis. the problems of the migrant crisis are recognized globally as they are linked to the complex issues being addressed by the united nations’ sustainable development goals. the complexity of the issues makes it difficult to grasp the breadth and depth of this crisis. as a result, it can be understood as one of the “wicked problems” requiring us to respond through a lens that recognizes the interconnections of humans and the broader ecosystems within the physical surroundings. when approaching the migrant crisis from this perspective, professionals are challenged to create transdisciplinary, community-based response systems which are holistic, multi-pronged, and inclusive of migrants’ voices and strengths. storytelling provides a venue for highlighting migrants' voices, engaging in change, and creating the space for individual and collective healing. social workers are increasingly being called upon to become trained in this practice and to engage in complex change systems alongside other disciplines and community members. as they provide prevention, mitigation, resettlement, and relief efforts, social workers become a part of a global community of leaders engaged in transformative change. by working to address these challenges, they are securing a better world not only for environmental migrants, but also for our planet as a whole. keywords: environmental migrants; climate crisis; indigenous biophilia framework climate change and environmental degradation, significant factors of the climate crisis, precipitate deteriorating environmental, political, and economic systems that are creating a global migrant crisis (besthorn & meyer, 2010; black et al., 2011; brown, 2008; drolet, 2017; united nations high commission on refugees [unhcr], 2009). in fact, climate change has been acknowledged as the most significant threat to present and future generations of the global community, creating unprecedented migration (unhcr, 2009; un environment, 2016; un trust fund for human security, n.d.). such threats from natural occurrences include the slow onset of environmental degradation, as well as extreme weather patterns and correlating droughts, desertification, storms, volcanic eruptions, earthquakes, tsunamis, and rising sea levels. these threats are exacerbated by human behaviors in two ways: (a) in our contribution to global warming and toxic environments, and (b) in the way we create built environments in areas that are at risk for such threats and yet are unequipped for and/or biased in the way we address the devastation of such crises when they occur. thus, the problem of the global migrant crisis lacks _________________ meredith c. f. powers phd, msw is an assistant professor, school of social work, university of north carolina greensboro, greensboro, nc 27402. cathryne l. schmitz, phd, msw is a professor emerita, school of social work, university of north carolina greensboro, greensboro, nc 27402. christian z. nsonwu, ba, is a msw student, school of social work, university of north carolina greensboro, greensboro, nc 27402. manju t. mathew, ma, women and gender studies, university of north carolina greensboro, greensboro, nc 27402. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 1023-1040, doi: 10.18060/21678 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 1024 recognition of the interconnections of humans and the broader ecosystems. approaching the migrant crisis in its complexity, challenges social workers and other professionals to create response systems which are inclusive of migrant voices, vulnerabilities, and strengths while validating the environmental crisis that precipitates this migration crisis. this requires tackling climate change and the resulting migration crisis simultaneously. estimates of the number of environmental migrants vary widely; ranging from 25 million to 1 billion, with the most widely accepted estimate of 200 million (intergovernmental panel on climate change [ipcc], 2015; international organization for migration [iom], 2018b). as defined by the iom, environmental migrants are those displaced and/or migrating as a result of natural and human-made disaster events, as well as ongoing, deteriorating environments that create conditions that are not sustainable for life (iom, 2018a). they experience significant loss and trauma, but in many instances, are resilient and make remarkable recoveries (weng & lee, 2016). although all persons moving for environmental reasons are protected by international human rights law, these rights are often not easily upheld, in transit or in relocation. persons displaced within their country of origin due to natural or human made disasters, are covered by provisions laid out in the guiding principles on internal displacement (iom, 2015). environmental migrants are further recognized officially by the iom as: ...persons or groups of persons who, for reasons of sudden or progressive changes in the environment that adversely affect their lives or living conditions, are obliged to have to leave their habitual homes, or choose to do so, either temporarily or permanently, and who move either within their territory or abroad. (iom, 2018a, para. 1) this definition acknowledges that environmental migrants are forced to leave, or decide by choice to migrate, due to deteriorating environmental conditions and extreme environmental events; this may occur within and/or across international borders for brief, prolonged, or permanent periods of time (iom, 2015). thus, while the term environmental refugee continues to be a matter of debate, for purposes of this article, we will use the term environmental migrants to refer to those who migrate due to environmental perils, regardless of their legal status as refugees. environmental migrants are a diverse group and some are eligible to receive legal refugee status due to other displacement criteria. current international policies, however, do not include climate change and environmental hazards as the basis of becoming a refugee, and the term environmental refugee is not a legal term or status (unhcr, 2016). the way in which some migrants’ hardships are legally recognized and thus provided with aid and resources, while others are excluded (e.g., environmental hardships), is one aspect of the complexity. social workers play instrumental roles in helping environmental migrants overcome the challenges faced at each stage of their journeys, from working to mitigate climate change issues that cause displacement, to helping rebuild and reestablish people in their homes of origin, to assisting with resettlement and building new lives, and to being advocates to change the policies and laws to include environmental refugees (powers & powers et al./environmental migration 1025 nsonwu, in press; drolet, 2017). while addressing issues faced by environmental migrants, social workers not only collaborate with professionals in the social and natural sciences, but also with communities around the globe to address the united nations’ sustainable development goals (ifsw, 2017). according to the global agenda for social work and social development, professional social workers are to promote community and environmental sustainability while also advocating for social and economic equality, the dignity and worth of all peoples, and attending to the importance of human relationships (international association of schools of social work, international council on social welfare, and international federation of social workers [iassw, icsw, & ifsw], 2012). social workers, as interdisciplinary partners, are able to address these four interwoven agenda items in addition to the united nations’ sustainable development goals through providing leadership on climate advocacy and action, and by working with environmental migrants to rebuild their lives. the interwoven complexity of the global climate and migrant crises environmental migration occurs at the nexus of complex and interwoven concerns: the global climate crisis and the global migrant crisis. these problems are so large, complex, and interconnected that they cannot be solved, but due to their nature we have to intervene; these crises therefore fit kolko's (2012) definition of a wicked problem. they have many causes, ongoing processes of spiraling change, complex social interactions, multiple interpretations, conflicting goals, and an interdependency further complicated by the transnational nature of the issues. in attempting change, it is necessary to recognize that there is no one solution and there is great potential for unforeseen consequences (brown, 2010). although the climate crisis and the migrant crisis are interwoven, environmental migrants have little recognition globally of their status as migrants with legitimate human rights claims for permanent resettlement because the intersection is not validated. this century, the world is facing a global climate crisis with issues of sustainability due to overpopulation, overcrowded cities, the depletion of environmental resources, limited food supplies, and pollution of air, water, and land (brown, deane, harris, & russell, 2010). climate science has established the contributing role of human behavior in global warming; 97% of climate scientists are in agreement (cook et al., 2016). further, humans have been frustrated as they have struggled to increase food and energy production (brown et al., 2010). “it is the sum of the local issues that has generated the global issues in the first place. thus, we can appear to be locked in an endless spiral from which there is no escape” (brown et al., 2010, p. 3). these social-environmental problems cannot be solved with the tools of the last century these are not individual issues, but rather have implications inclusive of communities, regions, and countries devastated by environmental change. while there are no final solutions, transformative change will require validation of the degradation and an understanding of the collective impact and context for change. experts warn that the climate crisis will exacerbate environmental migration well beyond what we have previously seen (taylor, 2017). the migrant crisis as enmeshed with the climate crisis is further aggravated by conflicts that erupt due to depleted resources advances in social work, spring 2018, 18(3) 1026 along with related economic, social, and environmental injustices (ipcc, 2015). “environmental justice occurs when all people equally experience high levels of environmental protection and no group or community is excluded from the environmental policy decision-making process, nor is affected by a disproportionate impact from environmental hazards” (council on social work education [cswe], 2015, p. 20). the impact of the climate crisis is further intertwined with issues of violent conflict; cultural, economic, and environmental injustice; and displacement. in a study conducted in 2015, evidence showed that the effects of global climate change have sparked armed conflict; it has significantly contributed to the armed conflict and eventual civil war in syria (kelley, mohtadi, cane, seager, & kushnir, 2015; welch, 2015). this evidence points to the spiraling nature of the issues and to the concepts many scholars have theorized for years, that the scarcity of resources (i.e., food, shelter, water) lead to major violent conflicts as the effects of climate change worsened. environmental migrants often flee their homes of origin due to violent conflict and/or because they face hardships (e.g., starvation) that result from climate change and prolonged conflict. their experience of loss is multi-layered, including the loss of family, friends, and home as well as the general comfort of the familiar, including culture and language, which impact whole communities. the sights, sounds, relationship patterns, interactions, structures, language, and communication patterns of their new surroundings are unfamiliar (deepak, 2018; powers & nsonwu, in press). demographic factors influence the need for and path of migration. “it is incumbent upon professionals committed to social and economic justice, to comprehensively understand the range of obstacles facing immigrants and refugees and empower them in their struggle to make a healthy adjustment” (schmitz, vazquez jacobus, stakeman, valenzuela, & sprankel, 2003, p. 135). vulnerable populations are more burdened by environmental degradation and climate change; as a consequence, these influences are more prevalent in the migrant crisis. an expanded analysis thus considers how demographics not only influence who migrates, but also explores more deeply why they are at higher risk and consequently more likely to migrate. populations at highest risk and most heavily impacted include populations of color, those in the global south, low economic status, and women and children (alston, 2013; parry, canziani, palutikof, linden, & hanson, 2007; united nations women watch, 2009). gender, race, economic status, and religion are closely linked to the discrimination faced by migrants before, during, and after migration (soylu & buchanon, 2013). the history of displacements and fear that compound the transitions faced by migrants (devore & schlesinger, 1998; schmitz et al., 2003) is further aggravated for women and girls, especially women and girls of color (lie & lowery, 2003). in order to address the complexity, the analysis needs to be expanded to include the multiple, intersecting issues. as migrant communities share their stories, our understanding of their experience of loss and trauma takes shape; the claiming of collective agency has a role in framing the healing process. environmental migrants have too often been subjected to chronic injustices, which are then exacerbated by environmental disasters. for example, in sri lanka people who were fighting against waste being dumped in their communities then endured a massive landslide, which wiped out over 100 homes in the area and resulted powers et al./environmental migration 1027 in many losing their lives (reuters and the associated press, 2017). another tragic example includes the hurricanes that devastated families’ homes and livelihoods in puerto rico creating displacements and environmental migrations. these communities were already vulnerable socially, politically, and economically due to extreme environmental injustices from the hazards of 23 superfund sites, former us military bomb test sites, and local corporate waste of coal ash; these hazards were exacerbated by the hurricane damage (atkin, 2017). kenya is a country that has faced significant hardships including climate change, environmental migration, political violence, and loss of the ecology for supporting food production and a clean water supply (opido, odwe, oulu, & omollo, 2017). because wicked problems, as they overlap, have no single answer, we must therefore embrace multi-pronged processes and systems for change that are inclusive of the local community (balint, stewart, desai, & walters, 2011). wangari maathai modeled the multi-pronged approach to change as she addressed the interconnection of environmental, social, and political problems. it was in her community that she began her path as an activist and change agent to rebuild the ecosystem, repair the fundamental connections of people to their environment, and overcome political violence. she began the process by working locally on very practical issues and building community and collective change in the process. this served to mitigate the need to migrate. she was able to see beyond the immediate presenting problems in the community to address them holistically, taking into account all of their complexity. as the ecosystem healed, so did the community. she poignantly stated, recognizing that sustainable development, democracy and peace are indivisible is an idea whose time has come… today we are faced with a challenge that calls for a shift in our thinking, so that humanity stops threatening its life-support system. we are called to assist the earth to heal her wounds and in the process heal our own indeed to embrace the whole of creation in all its diversity, beauty and wonder. (maathai, 2004, para. 7, 22) wangari maathai grew up in a village in kenya that had a vibrant and self-sustaining ecosystem. when she returned home after completing bachelor's and master's degrees in biology in the united states, she found an ecosystem that had collapsed. in kenya, she completed her ph.d., becoming the first woman in east africa to earn a doctorate. she engaged the women of the community in germinating, growing, and planting trees. because she was only organizing women, she was ignored by the repressive, patriarchal government. this project blossomed into the very successful green belt movement (maathai, 2003; merton & dater, 2008); at the point that it was apparent that an effective movement was taking root, she (and the movement) became a threat, engendering a violent response. the movement occurred at the nexus of multiple struggles, including climate change, environmental degradation, gender oppression, and violent conflict with governmental oppression (strides in development, 2010). the women stood boldly in the face of violence, and engaged the community to challenge the repression; through her work, maathai was the first woman in africa to win the nobel peace prize in 2004. maathai created a movement with multiple threads that promoted processes engaging civic advances in social work, spring 2018, 18(3) 1028 dialogue, critical assessment, and mechanisms that facilitated the empowerment of the community toward transformative change (strides in development, 2010). lens for critical exploration and engagement the migrant crisis, approached as a communal problem, can be more deeply understood by including the broader social, political, and biophysical context into our analysis. like all such complex struggles, intervention failures often result because the nature of the problem is not understood and therefore responses are off target (watkins & wilber, 2015). problems cannot be solved “with the same level of thinking that created the problems—we need a new level of thinking. the first step to bringing a new level of understanding to the nature of these complex issues is to dissect the features of extremely complex, difficult, or ‘wicked problems’” (watkins & wilber, 2015, p. 4). engaging holistic, collective, and complex frameworks for action supports the potential for creating systems and processes for change within communities. life on earth is not just composed of interactions between humans, but also includes the interconnectedness of humans, entire ecosystems, and the physical environment. life here denotes countless species of flora and fauna that live on the planet; all things, living and non-living, human and other than human, are connected in the large matrix of life on earth (canty, 2017). it is this interactive relationship of life within a physical space/place that forms the backdrop for the development of the biophilia framework. the term “biophilia” was first used by harvard zoologist e. o. wilson (1984) to describe "the innate human urge to affiliate with other forms of life" (p. 85). use of the biophilia framework expands the depth of analysis for the migrant crisis by helping us to recognize the interconnectedness of species with each other and with the ecosystem/environment (lysack, 2010; rabb, 2017). destruction of the ecological environment, negatively impacts the quality of human life materially, psychologically, and spiritually (kellert & wilson, 1995). biophilia involves an awareness of the interconnectedness of nature and understands the role of humans as only one aspect in nature. dr. maathai's work exemplifies the application of this framework. analytic assessment with a biophilia framework involves not just accounting for a physical place inclusive of sun, wind, rain, land, lakes, rivers, and oceans, but also the components of spiritual relationship to a place, a sense of belonging to the local components of nature and understanding their importance and striving to respect these aspects (lysack, 2010; rabb, 2017). it is the well-being of these relationships that creates and sustains life on this planet. environmental degradation and climate change is resulting in a loss of a species and altered landscapes, and thus is a pivotal, precipitating factor in the migrant crisis. understanding these connections and trying to address aspects of the biophysical context through a biophilia framework allows us to more critically analyze and mitigate the migrant crisis. as a prime example, water is often referred to biologically as an inanimate aspect, yet, water is life. humans rely on water for our personal consumption, and without it would surely die within a few days (packer, 2002). communities rely on water for our agriculture, household needs, and countless other purposes. in addition, water provides a context for life for many species, and water in many forms of weather slowly and dramatically shapes powers et al./environmental migration 1029 and reshapes landscapes. global changes to the environment severely affect seawater and air temperatures, creating glacial melting and creating a significant sea level rise over the past century (garner, 2015). shifts in ocean currents and large weather events off continental coastlines have major impacts including hurricanes, cyclones, and typhoons. these storms can have a dramatic impact from heavy rainfall, flooding, storm water surges, and high winds, even if they do not make landfall. such events not only harm human and other forms of life, but also alter the entire ecosystem and physical space, many times creating the need for environmental migration. humans have always oriented themselves by establishing a direct, personal, and communal relationships to places in the landscapes with which they have interacted (cajete, 1999). it is the well-being of these relationships that can sustain or denigrate life on this planet. while the biophilia framework embraces the connection of people to place and the nature, inclusive of all life (besthorn & saleeby, 2003), indigenous biophilia, further explicates and emphasizes these links while also adding the additional layers of oppression and power dynamics across culture, place, and nature (cajete, 1999). through an indigenous biophilia lens, complex change systems can be embraced. for example, indigenous biophilia knowledge is increasingly acknowledged “as valuable for adaptation to climate change” (williams & hardison, 2013, p. 531); there is some concern, however, about humankind’s ability to adapt are strained given how rapid the changes are occurring (mclean, 2010). indigenous biophilia knowledge, in recognizing the link of people with place, nature, community, and tradition (cajete, 1999), promotes respect for human and other than human and mindfulness when creating change, even small changes, as they can have drastic consequences for the entire ecosystem. the cultural activities, traditions, and stories of one’s own community reflect the context for social and environmental relationships (cajete, 1999). the specifics are understood in relation to the whole, and the principles are experienced within everyday circumstances (kawagley & barnhart, 1999). indigenous biophilia sets the framework for ecological transformation (cajete, 1999) as well as a context for exploring tribal oppression and engaging resistance (norgaard & reed, 2017). decline in the natural world is related to social and political disruptions (colomeda, 1999; norgaard & reed, 2017), in turn creating more environmental migrants. engaging complex change systems approaching environmental migration, and the overarching global migrant crisis as a wicked problem highlights the complexity of the issues, challenging us to think beyond simplistic uni-dimensional interventions. without embracing a holistic overview, the need to engage in complex, transformative processes and systems of change can be glanced over (bradshaw, 2009). vulnerable and marginalized prior to migration, individuals, families, and communities seeking refuge too often face additional struggles as their safety and status is further marginalized on the journey. thus, the global migrant crisis requires multipronged systems of response that are inclusive of the collective and individual voice of the migrants. while environmental migrants confront unique risks as historically marginalized groups, they also present individual and collective strengths such as agency, resilience, and the potential for healing (weng & lee, 2016). advances in social work, spring 2018, 18(3) 1030 the power for collective healing should not be overlooked in developing systems of response to the migrant crisis. social healing and resilience can be built in communities experiencing sustained violence (lederach & lederach, 2010). the building of resilience is linked to strengths, temperament, and environmental context (hutchinson, stuart, & pretorius, 2010) with studies highlighting the importance of social connection for building community resilience (ellis & abdi, 2017). the agency and power of environmental migrants is recognized and becomes a base for empowerment thru policy action: "the meaningful participation of immigrants and refugees in challenging immigration and labor policies is in itself a path toward healing" (deepak, 2018, p. 120). gendered risk factors and the promotion of healing through the empowering quality of collective resistance can be analyzed through the lens of postcolonial feminism (deepak, 2018), which is inclusive of the voices of indigenous women and critical reflection of racial domination (spurlin, 2010). the postcolonial feminist perspective provides a framework for rethinking “the risk factors for poor mental health as embedded in oppressive structural, historical, and political factors rather than solely in individual experiences" (deepak, 2018, p. 120). response processes and systems with environmental migrants that focus on deficits, dependency, and models of helplessness negate the potential impact of collective agency in the change process (weng & lee, 2016). the experiences and transnational context facing immigrants impact health and mental health promoting or compromising mental health (deepak, 2018). these factors impact the individual and collective resilience reinforcing the need for community leadership. community embedded healing communities are sites for collective action, holding the potential to function as spaces for transformative change. through collaborative community development, individual and communal issues can be interconnected creating the potential to support holistic models of sustainable change (orr, 2004). while the meaning of community varies widely at the local and global levels, community remains the context for organizing, developing, and changing social, economic, and political systems (gamble & weil, 2010). "neighborhood and community organizing takes place when people have face-to-face contact with each other, allowing them to feel connected to a place" (gamble & weil, 2010, p. 122). communities are rich in the resources necessary for healing and recreating home, offering with the possibility for supporting sustainable development and addressing climate change. the impact of the greenbelt movement (merton & dater, 2008) as the beginning process for community development provides lessons on community and environmental healing. within the indigenous biophilia framework, it is understood that community and environmental healing and sustainability, at the local and global levels, depends on respect for and maintenance of the earth’s ecosystems, which forms the basis for the wellbeing of current and future generations (cajete, 1999; kellert & wilson, 1995; lysack, 2010; rabb, 2017; sustainable human, 2014). healing is facilitated when collective narratives are explored and respected. storytelling can be used at the community level to develop and redevelop narrative. the voice of environmental migrants can be recognized and empowered through storytelling and narrative. through storytelling, processes of change are envisioned and supported powers et al./environmental migration 1031 (senehi, 2002). with the rise in nationalism across the globe, engaging the narrative becomes even more important. anti-immigrant sentiments set the stage for the development of a negative context, increasing the risk of trauma in adjustment. through story and empowering, strength-focused narrative can be highlighted while negative messages are contextualized and deflated. connecting with our own or others' stories of strength and resilience in the face of social upheaval, war, and trauma can be an antidote to what might otherwise be the internalization of a sense of powerlessness, depression, fear, or even shame. (senehi et al., 2009, p. 90) storytelling gives voice to the unique experience of intergroup and cross group conflict. it can also give voice to processes and pathways to change toward a place of peace (senehi, 2002), and transformative change based in community narrative. the transformative change required to create sustainable communities that engage social, economic, political, and environmental justice requires a shift. remediation and the building of resilience requires identifying strengths in individuals, families, and communities and mobilizing collective action through policy, advocacy, and/or community organizing. the intersection of human systems, the ecology and physical space, and other wildlife creates a juncture for healing. as bell hooks (2008) reminds us through her storytelling, there is healing power through connection to the earth. in belonging: a culture of place, hooks (2008) visualizes the mountains as the context of a sustainable and lush ecology, creating a love and warmth for deep connection to natural surroundings. she highlights a sense of belonging embedded in the natural ecology, and a deep connection with place-the “culture of place”. hooks (2008) demonstrates a biophilia framework as she points out how nature becomes a teacher and healer if we listen. through such a biophilia framework, we reconnect to the true position of human life within the context of nature, and thus are able to explore and engage in related healing processes that have been lost in modern life. for example, when muslim refugees from somalia came to lewiston, maine in 2001, they were welcomed by some residents and feared by others because of their race and religion (ellison, 2009). lewiston was a decaying former mill town with large homes, low crime, and decent schools. initially the level of hostility toward this new population rose. the new members of the community along with their allies stood non-violently in the face of violence. over the years, they have built community businesses, rejuvenated the economy and the community, and connected to the land through farming. their connection to the land and skills for farming have been shared as they build a new community embedded in place highlighting the link across community, biophilia, and identity. similarly, litfin (2014) underscores the link between community and sustainability as she explores the power of ecovillages across the globe. these communities create healing and sustainability as they operate at the juncture of the economic, ecological, and political context, particularly accounting for the significance of local control. the value of regaining the lost connection with nature has the potential to help create a better life (hooks, 2008). we are challenged by hooks to consider the ways it is possible to live in a sustainable manner. advances in social work, spring 2018, 18(3) 1032 making peace with the earth we make the world a place where we can be one with nature. we create and sustain environments where we can come back to ourselves, where we can return home, stand on solid ground, and be a true witness. (hooks, 2008, pp. 25-26) when she gives voice to a type of healing and peace that stops the exploitation of our earth, she pays tribute to the flora and fauna and the way all our lives are interconnected. social work: interdisciplinary partner as social work looks to address the global migrant crisis and mitigate environmental migration, we can be leaders in addressing the root problems of climate change and environmental degradation. if we are to promote sustainable communities and environments and support the resettlement of environmental migrants who have no hope of returning to their home, then it is critical that social workers who have not yet joined the professional agenda, be trained to work alongside those social workers who have taken up the fight to address the climate crisis. social workers seeking to address the migrant crisis, by working as partners who engage in response systems alongside other professional disciplines and community members can help highlight the interconnections to the climate crisis. social work is a profession that operates in the nexus of multiple systems and disciplines, making it particularly well poised to address environmental migration as one piece of the complex migrant crisis. social workers, trained to work across disciplines and within a collaboratively global context, bring a unique lens to practice in communities struggling with climate change and inadequate resources, such as those touched by the migrant crisis. these response systems can range from prevention and mitigation to resettlement and relief efforts to address climate change and environmental degradation. social workers can also bring critical questions to the dialogue, such as: how does climate change and environmental degradation compound factors faced by vulnerable/marginalized people and communities? what ripple effects have been created by environmental migrants on their families, communities of origin, communities of resettlement, the ecosystem as a whole? social workers also have the knowledge and training for building the relationships needed to support environmental migrants in the building of capacity for empowerment, action, the forging of new links, and the establishing of working within relationships with a respect for differences. the profession has a rich history of working with communities as they form and re-form. social work professionals can be a part of the capacity building that develops as groups move beyond intergroup and intragroup conflict to dialogue that explores multiple perspectives. as part of a multi-pronged response system for the migrant crisis and the related climate crisis, university-community collaborations can enrich the development by bringing together resources for the benefit of all. in addition, social workers enrich community/university coalitions (schmitz, matyók, sloan, & james, 2012), bringing resources to the work in community. the biological and physical sciences have an extensive base of knowledge in the environmental sciences that focus on climate change; the social and human sciences have powers et al./environmental migration 1033 tended to lag behind (schmitz, stinson, & james, 2010). this is shifting as the need for integrated responses to address the impact of climate change and environmental degradation on human communities and their social, economic, and political systems is being recognized. besthorn and saleeby (2003) underscore the alignment of social work with the biophilia framework. the indigenous biophilic framework is even more closely aligned with social work as it incorporates not only nature and place, but also community, oppression, and power dynamics (cajete, 1999). social workers and social work education are increasingly turning a focus toward recognizing climate change and environmental degradation and the related environmental injustices as having a major impact on human communities. expanding to take an ecosystems perspective provides a framework for students to engage in practice the recognizes the adverse impact of climate change and environmental degradation (schmitz et al., 2010) and the connections to the migrant crisis. further complicating the issues is the tendency for professional disciplines to educate students in silos, poorly prepared for interdisciplinary responses (orr, 2011). new methods are called for as we delve into problems which are multi-faceted by definition (brown et al., 2010) the complex and multilayered concerns of the migrant crisis cut across disciplines requiring education inclusive of the social and natural sciences, as well as indigenous knowledge. while western science and education tend to emphasize compartmentalized, decontextualized knowledge, indigenous peoples have traditionally acquired knowledge through direct experience with the natural environment (kawagley & barnhart, 1999). williams and hardison (2013) call for bringing scientists and indigenous peoples together to collaborate and exchange knowledge" (p. 531). “our incapacity to deal with wicked problems...is related to their complexity, to the compartmentalization of scientific and professional knowledge” (lawrence, 2010, p, 16). in addressing this shortcoming, it is important to integrate “the work of the academic disciplines with other forms of knowledge” (lawrence, 2010, p. 17) through transdisciplinary inquiry and response, which we will use here as synonymous with interdisciplinary. trandisciplinarity "is taken here to be the collective understanding of an issue; it is created by including the personal, the local and the strategic; as well as specialized contributions to knowledge" (brown et al., 2010, p. 4). thus, social workers operating with interdisciplinary partners have the experience and knowledge to be leaders in addressing the push toward and consequences of environmental migration at home, in transition, and upon resettlement. conclusion as a profession, social work is mandated by our global agenda to promote community and environmental sustainability while also advocating for social and economic equality, the dignity and worth of all peoples, and attending to the importance of human relationships (iassw, icsw, & ifsw, 2012). we are increasingly recognizing our interdisciplinary partnership role to become leaders in addressing the wicked problems of the climate crisis and the migrant crisis. although we acknowledge that social work is addressing these issues of the migrant crisis, it is often done separately from addressing the intersecting issues of the climate crisis. caught at the nexus of climate change and environmental deterioration, environmental migrants lack adequate support because the intersection is not advances in social work, spring 2018, 18(3) 1034 recognized and validated. there are increasing numbers of social workers who do embrace the urgent need to address the climate crisis in their work, we are calling attention to the need to further train and encourage social workers to highlight the voices and needs of environmental migrants experiencing the impact of the climate crisis (powers, 2016); climate change is the precipitating and compounding factor for the migration crisis. in addition to working to mitigate climate change issues that cause displacement, helping rebuild and reestablish people in their homes of origin, promoting individual and community healing, and assisting with resettlement and building new lives, social workers can also be advocates to change the policies and laws to include environmental issues as justification for refugee status and thus increased aid. the united nations’ sustainable development goals provides a framework through which we can increase our interdisciplinary responses as we work on climate advocacy and action, and address environmental migration. for example, social workers can help to mitigate environmental degradation and climate change by working to reduce toxins and promote clean water and sanitation, or working with urban planners to mitigate risks for vulnerable populations in case of disaster. in order to address environmental migration, social workers must engage in complex change systems which are holistic, multi-pronged, and inclusive of the biophysical environment and an indigenous biophilia framework and environmental migrants’ voices and strengths. understanding these connections and trying to address aspects of the biophysical context through an indigenous biophilia framework allows us to more critically analyze and mitigate the migrant crisis. only then, can we hope to move forward, and address environmental migration. references alston, m. 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(1984). biophilia. cambridge, mass: harvard university press. author note: address correspondence to: meredith c.f. powers, phd, department of social work, school of health and human sciences, university of north carolina at greensboro, 259 stone building, greensboro, nc 27402-6170. mcfpowers@uncg.edu https://www.un.org/humansecurity/wp-content/uploads/2017/10/human-security-and-climate-change-policy-brief-1.pdf https://www.un.org/humansecurity/wp-content/uploads/2017/10/human-security-and-climate-change-policy-brief-1.pdf http://www.un.org/womenwatch/feature/climate_change/downloads/women_and_climate_change_factsheet.pdf http://www.un.org/womenwatch/feature/climate_change/downloads/women_and_climate_change_factsheet.pdf http://news.nationalgeographic.com/news/2015/03/150302-syria-war-climate-change-drought/ http://news.nationalgeographic.com/news/2015/03/150302-syria-war-climate-change-drought/ https://doi.org/10.1007/s11266-015-9636-5 mailto:mcfpowers@uncg.edu _______ tracy soska, msw, lsw, clinical associate professor emeritus, school of social work, university of pittsburgh, pittsburgh, pa and adria e. navarro, phd, lcsw, associate professor, department of social work, azusa pacific university, azusa. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 409-423, doi: 10.18060/23658 this work is licensed under a creative commons attribution 4.0 international license. social workers and public libraries: a commentary on an emerging interprofessional collaboration tracy m. soska adria navarro abstract: a growing interprofessional collaboration between social work and library professionals has fueled the emergence of library social workers and the exploration of libraries as a setting for social work. this exciting partnership evolves from common historic roots, a strong alignment of values, and effectively addresses changing community needs that aligns with both professions. social work and public libraries are both products of the progressive era along with the rise of charitable organizations and settlement houses. in examining the evolution of libraries in the wake of changing technology and patron populations, social workers are critical community allies to respond to diverse community needs. social workers, human service providers, and funders also now see public libraries as community centers and civic hubs, as well as even settlement houses for the 21st century. libraries serve as civic hubs that are essential connectors of information, education, resources, and access that addresses human needs. this commentary’s aim in exploring library social worker practice encourages community-university partnerships between our public libraries and the academic programs of social work and library science that strengthen civic and community engagement. social work practitioners and educators are encouraged to spend more time at their public libraries through interprofessional internships, class projects, applied research, and dual-degree curricular development that can prepare next generation practitioner to work and lead in these community centers. keywords: whole person librarianship, library social work practice, community engagement, lifelong community learning centers, interprofessional collaboration from a shared progressive legacy to community-centered partnerships social workers looking for an innovative career pathway and opportunities to enhance community partnerships for extended social service reach should look to interprofessional collaboration at their public libraries. these inclusive and visible community institutions are reinventing themselves to better and more strategically address community needs, as well as to stay relevant and impactful to their patrons and community residents. in this challenging effort, social workers represent a logical professional partner. this article explores the roles of the public library, and how they parallel the progressive era roots of social work’s settlement house legacy (yan, 2004). we examine how social services can be integrated with librarianship, and how social workers and social work educators might practice more effectively in the future through interprofessional education (ipe) and collaboration. with more than 16,500 public libraries in the united states, this number reflects on the historic value we hold for these institutions (american library association, 2019). when industrialist and early philanthropist andrew carnegie first seeded libraries in the https://creativecommons.org/licenses/by/4.0/ soska & navarro/social work & public liibraries 410 industrial valley towns near pittsburgh, he recognized the importance of education and the potential for public libraries to help individuals, especially immigrants, to learn and participate in american society and the economy (van slyck, 1995). the ideal was that social improvement through educating the masses would lift them out of poverty, and carnegie’s libraries had a deep impact on american culture. it is important to recognize, however, that in the deep south, libraries were segregated and hardly equitable in resources (graham, 2002). yet, the notion of libraries as social institutions serving as educational centers for society, has held steady over the years. programs remain free and open for patrons now from all socioeconomic classes and ethnic/cultural backgrounds a bastion to democracy and participation. writing in the nation, publisher, vanden heuvel (2015) acknowledged that the access to social life provided by public libraries must be supported by public and private funding, and argues that america “not abandon the egalitarian living rooms that our public libraries have become” (para 6). libraries have long been sources of books and information for their communities; residents have considered them as one of our most important community assets (pew research center, 2013). a pew research center study titled, “how americans value public libraries in the their communities,” found that while 67% of respondents felt a public library closing would have an impact on their family, fully 90% of respondents thought such a closing would adversely impact their community (pew research center, 2013). public libraries have multiplied, survived, prospered, and embraced change. public libraries have continued to evolve in an effort to stay relevant with community and patrons’ needs. many have become community hubs or third places (butler & diaz, 2016; oldenburg & brisset, 1982) – naturally-occurring places in communities where people congregate and interact. more than merely books and computers, libraries are places where individuals gather to explore, interact, and imagine. university of kentucky professor pat litzelfelner (2018) contends that today’s public libraries are an evolution of the settlement houses. she notes that libraries share many of our social work perspectives beyond this historical comparison with the settlement house movement, in terms of: a) a commitment to social justice as places of social inclusion, b) working from a strengths perspective in terms of connecting to natural occurring resources, and c) stressing the importance of human relationship as places for people to connect and build social capital. zettervall and nienow (2019) similarly underscore the progressive era roots of both libraries and social work’s settlement houses, and, in many ways, they showcase how social work and librarianship can be described as “sister professions” (p. 1). the authors compare and contrast their respective values and perspectives through their concept of whole person librarianship. social work’s settlement houses provided educational, artistic, and social programs for immigrants, the poor, and the working class. established as community centers, settlements engaged people of different socioeconomic and cultural backgrounds to share knowledge, skills, and social capital. settlement houses offered formal classes, provided meeting spaces for clubs and associations, held free concerts and lectures, conducted training for employment and english literacy, and instructed on cooking, nutrition, and public health needs (yan, 2004). one could look at the earliest carnegie libraries that still remain in pittsburgh industrial towns like braddock – the first carnegie advances in social work, summer 2020, 20(2) 411 library – and homestead to find concert halls, classrooms, and large event rooms, as well as even gymnasiums, bowling allies, and swimming pools. as davies (1974) notes in his book. “public library as cultural and social center,” addressing this concept of providing such larger social services dates back to the nineteenth century’s voluntary uplift and cultural societies, and, yet, he argues libraries should keep to being places for books and readings and librarians to fields like history, printing, writing, and publishing. however, libraries in the 21st century are reexamining their roles in responding to their communities. many libraries, like their settlement house kin, are focusing on the needs of immigrants and refugees by helping them acclimate and transition to their communities and the united states, as well as helping them with language skills, tutoring, job searches, technology, and social service resources to help with housing and other pressing individual and family needs. for example, in the pittsburgh/allegheny county region in pennsylvania, public libraries in communities of baldwin, brentwood, and whitehall boroughs are engaging with large groups of somalian and nepalese/bhutanese refugees who have resettled in subsidized housing complexes in their communities. the three libraries combined to host a cultural festival in the area as both a welcoming and an orientation to the immigrants and refugees that are settling in these communities, setting up businesses, buying homes, and becoming library patrons, public school students, and neighbors. libraries are reaching out to newcomers by providing access to many learning and cultural enrichments opportunities, not only for these refugees, but for other patrons and the communities at large. public libraries have become a vital hub for the immigrant and refugee communities in many cities, with this pittsburgh area example being replicated across the country. public libraries today provide similar programming, including: employment search; computers/internet instruction; ged and english as a second language classes; enrichment programs for adults and children; speakers/lectures; book, chess and science clubs; summer tutoring and reading programs; and room for a range of group meetings from alcoholics anonymous (aa) to foster parenting. teens have positive interactions and develop interests, seniors interact with others avoiding isolation, children find safe after-school space, and any patron can find the computers and online information to connect with today’s virtual world (cabello & butler, 2017; zettervall & nienow, 2019). the public library association’s libraries online (edwards et al., 2013) detailed “23 reasons why public libraries are community-centered,” (para. 1) including the roles of libraries as: a) community builders – helping residents understand and civically engage in their communities, even solving social problems; b) centers for diversity, inclusion, and global perspectives; c) hubs for arts and culture to enrich and enliven community life; d) life-long learning centers where residents learn from one another and engage in civic discourse; and, e) champions for children and youth development, relationship building, and learning. what the fields are telling us about human service collaboration in libraries in an evaluative study of the social workers in a san jose library, luo and colleagues (2017) found that the social work program aimed at advancing social justice by providing access to social service information, particularly to disadvantaged populations using the soska & navarro/social work & public liibraries 412 libraries. the authors stressed that interactions between human services and libraries do not represent a new connection and are rich with studies on building internal library capacity to respond to such human service informational needs (luo et al., 2017). they further note, “more importantly, there is a dearth of scholarship and research regarding collaborative service models that partner these two disciplines to better meet community needs (luo et al., 2017, p. 76). as authors, we have also found studies and scholarly articles lacking in this vein, but, again, this is an emerging area of interprofessional collaboration. litzelfelner (2018) references libraries as one of western society’s first great experiments in social justice, striving to provide “free access to all.” vanden heuvel (2015) notes “after all, you can’t get more populist than the public library” (para. 2). zettervall and nienow (2019) have begun referring to this growing social work focus within public libraries as “whole person librarianship,” a lens through which they see a “social work approach to patron services” (p. 1). in examining how library staff address psychosocial issues that patrons present, wahler and colleagues (2020) conducted a study of psychosocial needs and service gaps in a large metropolitan library system. their study underscores how social workers can assist libraries in responding to patron psychosocial issues (wahler et al., 2020). public libraries have taken on social service programming to benefit patrons and their communities and are seeking collaboration with social services to enhance their ability to build stronger connections to resources to meet the changing and expanding community needs (lloyd, 2020). more recently, public libraries are hiring social workers, initially to assist with persons experiencing homelessness who find libraries safe havens (knight, 2010; shafer, 2014), as was the case for a san francisco public library, the first to hire a social worker (blank, 2017). now social workers in libraries also work with children afterschool, assist new immigrants and refugees transitioning to life in their new countries, as well as with idle youth and isolated seniors. others seeking information on social and mental health needs are turning to their libraries for help (dankowski, 2018). this emerging human service collaboration is not unique to social work. a university of pennsylvania study found, “public libraries are dynamic, socially responsive institutions, a nexus of diversity, and a lifeline for the most vulnerable among us” (cabello & butler, 2017, p. 4). the study focused on partnering between philadelphia libraries and the university to respond to social determinants of health through university training for librarians to become community health specialists offering public health programs to their patrons (cabello & butler, 2017). thus, many libraries are exploring partnerships with other disciplines, notably social work, public health, and health-related professions (blank, 2017), such as the pima county library system in arizona, which was the first library to hire a public health nurse to work on community health needs. butler and diaz (2016) reported that with health care and other social issues libraries utilize the trust and access characteristics of a third place, serving a hub role in the community through partnerships with other institutions to connect people with services and assistance. community needs and visitor requests often strain and overwhelm library funding, as libraries work to retrain staff, in search of the right mix of skills (butler & diaz, 2016). butler and diaz (2016) argued that policymakers and government officials need to advances in social work, summer 2020, 20(2) 413 recognize this challenge and incorporate libraries into planning and budgeting designed to build healthy and vibrant communities. the hawaii public library system, for example, sought major funding over fiscal years 2018 and 2019 to hire a manager responsible for training library staff statewide and creating partnerships with social service agencies (friedheim, 2017). public libraries and social work collaboration the evidence notes that librarians are not trained to handle many of the issues they now encounter, such as resources for homelessness, substance abuse, and mental health issues; thus, some libraries have hired social workers to help address patrons’ social service needs (blank, 2017; butler & diaz, 2016; cabello & butler, 2017). the san francisco public library recognized a number of the library patrons were experiencing homelessness and, therefore, determined they would add a caseworker to provide assessments and interventions, such as case management and housing assistance (daigneau, 2010). in 2009, leah esguerra became the nation’s first full-time, library psychiatric social worker; she was hired to do outreach to patrons in need of social services, particularly homeless patrons (shafer, 2014). similarly, the d.c. public library hired a social worker to help improve outcomes for homeless patrons (shafer, 2014). public library professionals do their best to serve whoever walks through their doors as ably and as knowledgeably as they can. despite their best intentions, homeless patrons sometimes need more immediate, skilled, or complex assistance than a single library visit can provide. in the downtown carnegie library of pittsburgh, a social service staffer and a social work intern were integrated into the library personnel, not only to support the significant at-risk and homeless populations that come into the free space, but also to assist with the growing number of opioid overdoses that were occurring at the library (h. anderton, personal communication, july 29, 2019). as a free and public space, many urban libraries have become vital refuges for people with an array of social, mental health, and health issues (blank, 2017; cabello & butler, 2017). as libraries take on these new challenges and build social capital, they are looking for social work partners with expertise to collaborate with libraries and library science professionals (kelley et al., 2017). public libraries online (nemec-loise, 2014) described the washington, d. c. public library’s newly appointed health and human services coordinator as a social worker, operating on a system-wide basis by developing programs and partnerships focused on awareness and sensitivity within the library and among its staff. we found a number of notable examples across the united states that have built on this model of social work and public library collaboration (see table 1). social work is increasingly collaborating with public libraries, not only in the u.s., but in canada and around the world. articles and anecdotes from online sources, as well as in peer-reviewed journals in both social work and library science fields have examined this growing community collaboration between library and social work professionals using the library setting as a community and information center to underscore the importance of this partnership (blank, 2017; hines, 2015). such partnership connects shared professional http://www.civilbeat.org/2017/02/libraries-struggle-with-a-new-role-social-services-center/ soska & navarro/social work & public liibraries 414 missions to support democracy, provide open access to resources, and work toward social justice. it is encouraging to see this interprofessional collaboration growing globally. table 1. examples to address patron's psychosocial needs in public libraries location public library (pl) activities employee community library azusa, ca a library grant was used to add a part-time msw social worker, a position adopted as a line item in the city budget. testimony provided in support of the county’s measure h, a sales tax designed to prevent and reduce homelessness. this measure passed and funded a library toolkit, called neighborhood connections with steps and sample documents for replicating their community resource specialist position (kelley et al., 2017). ✓ ✓ ✓ chicago, il an experienced youth social worker was added at oak park pl, an innovative approach to both policing the library’s unsupervised youth, as well as providing services to all marginalized patrons who frequent the library (oak park library, 2018). ✓ ✓ dallas, tx the dallas pl launched their “homeless engagement initiative” in 2013 (urban libraries council, 2017). ✓ denver, co a team was created to visit homeless and low-income women in day shelters, providing classes for job interviews and technology skills, as well as access to library services through transit tokens and library cards (campbell, 2018). ✓ ✓ evanston, il hired their first full-time social worker. she used presence behavioral health's limited social work student intern hours, with a partnership that then continued as a city-funded social work position (evanston public library, 2020). ✓ glendale, ca an experienced social worker was hired 20 hours weekly, initially funded through the california state library’s mental health initiative specifically referred to as the healthcare worker grant (t. barrios, personal communication, april 11, 2018). ✓ hartford, ct a free program of support and assistance was created, “the american place,” to aid new immigrants acclimating to the city (hartford public library, 2018). ✓ new york, ny a partnership between queens borough pl and the area's largest healthcare provider, queens health network, was designed for health-related and community-centered programming targeted at the needs of their immigrant populations (wahowiak, 2018). ✓ ✓ san jose, ca partnered with people assisting the homeless (path) to provide outreach and social work services at dr. martin luther king, jr. library (luo et al., 2017). ✓ note: employee-involves social worker as an employee; communityservices occur outside the library; library-community services/ programs in the library. beyond the united states, the edmonton public library (canada) established an outreach services team headed by a social worker that focuses on support and advances in social work, summer 2020, 20(2) 415 empowerment of residents and patrons to access social services they might otherwise be reluctant to access (blank, 2017; edmonton public library, 2020). the library provides a safe and welcoming space to connect to these resources. winnipeg public library (canada) also added a social worker to help anyone needing assistance with emergency shelter and housing, social assistance, employment, counseling, mental health programs, health care information and more (cbcnews, 2018). melbourne’s public library added a full-time social worker to work with patrons in crisis and with special needs. (clark, 2019). collaboration between libraries and social workers seems to be gaining ground outside the united states. funders are also exploring this emerging community collaboration opportunity as strategically important to sound community service delivery and coordination. for example, in the greater pittsburgh region, libraries are studying their community’s demographics, surveying residents, and identifying information and program needs. these needs have often revolved around health, mental health, substance abuse, and other social issues. the jefferson regional foundation, a community health foundation created when a major health insurer purchased the jefferson regional hospital, has invested in public libraries in its service area. the foundation, headed and staffed by social workers, sees public libraries as growing community centers. it has invested in community mapping and demographic studies, as well as a community assessment process to engage the libraries with their community stakeholders and constituencies through a civic engagement partnership with the allegheny county library association, a state federated system for county public libraries in this region (m. phan-gruber, personal communication, july 18, 2019). libraries are now actively represented within the jefferson regional collaborative, a coordinating network among community and nonprofit human service organizations (jefferson regional foundation, 2020). development of social work education partnerships schools of social work have brought both practice and research capacity to support libraries in their efforts to enhance social services programming and access to resources by supporting community needs assessments, information and referral, and outreach (provence, 2018). as many library social workers have come on board to assist with supporting homeless and other disadvantaged patrons (aykanian et al., 2020), social work interns have also been added at libraries to assist these populations and others. in some instances, libraries can provide field supervision, and in other settings an external field supervisor is arranged to support the msw intern. while not an exhaustive catalog, several schools of social work partner with public libraries including. the university of maryland baltimore school of social work (umbssw) through its social work community outreach services (swcos) conducts internships that partners with the enoch pratt free library system to provide information referral and support to patrons. students also organize peer support groups, recruit community volunteers, help in training staff on social services and benefits, and assist with youth programming. swcos provides field instruction for these students (umb-ssw, 2018). in a university-community partnership, one of azusa pacific university’s graduate social work classes provided a community needs and social service survey for the nearby soska & navarro/social work & public liibraries 416 public library. this class project helped underscore the social service needs of library patrons. the findings were used to help secure grant funding for hiring a part-time social worker, which has expanded to two social work staff now included in the city’s budget. they both address the varied needs identified in the social work class’ survey (kelley et al., 2017). at the university of pittsburgh, social worker interns have been placed at an urban carnegie library and three other suburban allegheny county library association (alca) libraries. student interns received field supervision from their respective library directors and field instruction from an emeritus faculty member. (m. jenkins & k. degnian, personal communication, february 27, 2019) the new social worker, a social work careers magazine, reported “public libraries add social workers and social programs” (blank, 2017), adding they should spur greater interest in both internships and potential dual-degree studies. social workers and social work educators would do well to spend more time at the library by positioning their organizations and schools to partner and innovate with these vital civic hubs. national conferences of the council on social work education and the network of social work management in 2018 highlighted interprofessional collaboration and social service innovation respectively, with presentations on library social work, and library and social work professional collaboration (soska, 2018; soska & navarro, 2018; nienow & zettervall, 2018). library social work has become a cutting-edge practice in communities, becoming a career pathway on micro, mezzo, and macro levels. whole person librarianship: a social work approach to patron services (zettervall & nienow, 2019) showcases interprofessional guidance for libraries seeking to partner with social service organizations, hiring a social worker, or considering a social work internship. zettervall and nienow (2019) have also developed an online presence at whole person librarianship (n.d.), a virtual community for mutual exchange of dialogue on ideas and resources among both librarians and social workers seeking to build these interprofessional collaborations. guidance is provided for library professionals to better understand the perspective of “person in environment” and serving through “relationships as the new reference collection” via library patron services, library organizations, and the larger community; they also provide important implications for social work education and practice (zettervall & nienow, 2019, p. 11). implications for social work education and practice today, libraries are increasingly partnering with social workers and social services significantly in response to their communities and patrons, but libraries have also progressively evolved into de facto community centers and vital lifelong learning hubs. whether they resemble the social work settlement houses or model a more neighborhoodcenter approach, libraries provide an important setting for social workers and social service organization to interact, outreach, and partner. as zettervall and nienow (2019) underscore, library and social work professionals need to better understand one another to more fully actualize this interprofessional collaboration. from the social work lens, this interprofessional movement holds several timely implications and opportunities for professional education and practice. advances in social work, summer 2020, 20(2) 417 first, as libraries adapt and respond to the changing needs of their community and patrons in the 21st century, their role as community learning and civic hubs should see them collaborating more and more with social workers and social service agencies. clearly, social workers and social work managers are recognizing libraries provide vital outreach opportunities to educate and connect with those in need of social service information and resources. while some outreach has occurred in the past, the complexity of social issues involving substance abuse, mental health, health, aging in place, immigration, and many other community needs require social workers to spend more time at their public libraries. as referenced in the literature and the american library association the state of america’s libraries 2020, library member surveys, patron focus sessions, and community forums demonstrate that community residents look to their libraries as places to access information and resources on the interpersonal, relational, and social issues that challenge their lives (american library association, 2020; kelley et al., 2017; lou et al., 2017; wahler et al., 2020). whether a library chooses to hire a social worker or not, public libraries offer essential outreach settings to educate and connect with those in need. in the perspective of “whole person librarianship,” libraries are searching for partnerships and social service providers need to utilize these community hubs. secondly, from our assessment of the library and social work fields, librarians are recognizing the limitations of their professional role in social service information and provision. as has often been the case at least in urban libraries, libraries have been employing full and part-time social workers to assist in responding to patron social service needs. while early social work positions have largely focused on the needs of homeless and transient populations, the safe space offered in libraries includes patron populations youth, elderly, immigrants/refugees, adults seeking help with technology, and those just in need of that safe haven who bring into the library the great human service needs and even life traumas. the rise of suburban poverty, especially in first-ring suburbs, and the recent rise in refugee and immigrant populations gathering in suburban communities, have also increased the needs and issues faced by patrons coming to the libraries (kneebone, 2017). the national association of social workers (nasw), social work magazine, and library professional journals have helped bolster library social work as a new career area beyond just a new practice setting. given the growth of this emerging employment opportunity, social workers and social work schools should prepare for this exciting interprofessional practice setting. thus far, this library social worker career pathway has been one more providential than planful; however, as we explored, several social work schools are focusing on this social service setting and career pathway in ways that are making this transition more intentional. social work educators and professional practice organizations are encouraged to respond to this new community setting and career opportunity. some social work programs have utilized student service-learning partnerships with libraries to bridge a collaboration, and others have begun to utilize social work field placements to foster these connections with local public libraries and to prepare social work students to practice in this setting. nasw has shared timely stories and postings about library social workers, while the council on social work education has provided conference sessions on this emerging interprofessional collaboration, each advancing examples of schools building such soska & navarro/social work & public liibraries 418 partnerships for field and classroom connections to public libraries. in whole person librarianship (zettervall & nienow, 2019) social work educators can find clear guidance to prepare for such field and classroom partnerships, as additional literature from both social work and library professionals continue to grow and highlight effective models and approaches of library social work partnerships. while the intent of this discussion is not to provide a “how-to” on building such social work library collaboration, there is encouragement for social work educators and their academic institutions to explore this setting for internship and employment opportunities that will further the development of both professions and partnerships between them. interprofessional activities encourage and deepen the dialogue between schools of social work and library and information science. librarian and social work professional associations might also better prepare professionals in both fields to work toward a collaborative future in library community centers. zettervall and nienow (2019) stress the importance for librarians and social workers to gain a greater understanding of one another’s profession and to work to foster interprofessional collaboration in their communities, especially within public libraries. while these professions share a common legacy and many noted similarities, they also have differences and limitations that encourage cooperation towards mutual benefit. interprofessional dialogue may be as simple as visiting cross-discipline colloquia or developing shared programs and events that bring students, faculty, and practitioners together. educators might strive for common field sites for social work and library science students at a local public library. while partnerships are growing between public libraries and schools of social work, presently, only one school dominican university has a master’s-level, joint degree in social work and library sciences. few educators are developing specialized interdisciplinary study options or dual degree programs, with time and the current climate; the landscape is ready to support such interprofessional learning. some discussion around the implications for joint degree study is useful in this commentary, as already some social workers hold professional degrees in information and library science. notably, social work academic librarians often hold degrees in both professions to serve the students more ably in their unique library environment. a few social workers with a dual master of library and information science (mlis) have specialized in the “information management” aspect of the library and information science profession. this pathway has most often led to career pathways in larger, often public, human service agencies and departments at county and state levels. here they work as managers of human service information systems and records for monitoring, evaluation, and planning. this seems another appropriate career pathway for such social work and library/information science dual degrees. we would also argue that as libraries grow their role and evolve as the new community centers, civic hubs, and settlement houses, this may present an organizational setting where dual degrees or at least interdisciplinary study would be advantageous. managing and leading today’s libraries as community centers and with great focus on social service needs would suggest additional professional background or study in social work. more specifically, a focus on advanced generalist or macro specialization that prepares a social advances in social work, summer 2020, 20(2) 419 worker for greater organizational and community practice could offer a competitive edge in this emerging landscape of our libraries. mlis programs do not generally provide significant preparation in social services, intensive community practice, or organizational leadership that are so essential to running community centers or nonprofit organization, especially in challenging urban and community settings. however, mlis programs are more intently incorporating greater organizational leadership and community engagement curriculum, as well as providing options for interdisciplinary study. drawing on cross-disciplinary study in university settings with social work macro practice, public administration, or related disciplines with nonprofit and organizational leadership curriculum could be valuable in preparing the next generation of library directors. at the very least encouraging elective study in social work programs, particularly in macro social work specialized areas, might provide opportunities for developing these next generation leaders in the field. this exchange may also provide greater interdisciplinary exposure to mlis students and professional opportunities for social work students to explore dual degree and elective interdisciplinary study in library and information science. while most states that certify public libraries require library directors to hold an mls/mlis degree, a case may be made that the future calls for enhancing these positions with opportunities for cross professional education in social work. in addition, increasingly complex human service information systems and libraries of the future must be strong in library and information science, yet, also, in social service organizational management and community engagement practice. the competitive advantage of the mlis and msw as preparation might spur collaboration between schools of social work and schools of library and information science to begin discussions to build interdisciplinary and dual degree study in more university settings. we encourage continued dialogue on interprofessional education in these fields to evolve the needed interprofessional education that might address the emerging leadership workforce for library community centers and human service information systems. conclusion the role of libraries as community and civic centers, which has resulted from changing community needs, technology, and competition in the library landscape, has emerged as at timely and topical theme in popular literature. we have found this topic much less prevalent in the scholarly literature in both in library science and social work fields. however, as social work has focused on more interprofessional education and practice, this topic is trending for research and study, at least in our opinion. the literature, especially in library and information science, has strongly supported writing about the changing landscape of libraries and their rise as community and civic centers, and our hope is to encourage greater research and study on areas of interprofessional collaboration. the rise of the library social work positions presents an exciting challenge for advancing interprofessional education and practice for social work and library professionals, which we hope will further spur scholarly examination. soska & navarro/social work & public liibraries 420 we have briefly explored the important, common legacy of social work and libraries, as well as past and current parallels between social work and public libraries, especially from a social work perspective. commentary has covered why and how social work partnerships have grown in public libraries – in the u.s. and around the world – and examined the emerging needs and types of activities that have spurred opportunities for greater social work collaboration with and in community libraries. this commentary has sought to advance an understanding of the importance for social work practitioners, managers, and educators to reach out and engage with public libraries, as well as schools of library science. engagement serves to develop vital partners in social services for our communities, provided in ways that are mutually beneficial as they build social capital and better respond to community needs. innovative social workers are encouraged to spend a little more time at their public libraries and to build effective collaborative and interprofessional partnerships to address their community’s human service needs, as well as expand the scope of social work education and practice with libraries, the library profession, and its 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(2018, october). social workers need to spend more time at their public libraries. paper presented at the annual program meeting of the council on social work education, orlando, fl. university of maryland-baltimore school of social work. (2018). social work community outreach services: education & service. https://www.ssw.umaryland.edu/swcos/our-work/education--service/ urban libraries council. (2017). homeless engagement initiative. https://www.urbanlibraries.org/innovations-old/2017-innovations/race-and-socialequity/homeless-engagement-initiative vanden heuvel, k. (2015, june). why public libraries matter. the nation. https://www.thenation.com/article/why-public-libraries-matter/ van slyck, a. (1995). free for all: carnegie libraries & american culture 1890–1920. university of chicago press. wahler, e. a., provence, m. a., helling, j., & williams, m. a. (2020). the changing role of libraries: how social workers can help. families in society: the journal of contemporary social services, 101(1), 34-43. https://journals.sagepub.com/doi/abs/10.1177/1044389419850707 wahowiak, l. (2018, october). libraries, public health work together on community health: settings serve as community hubs. the nations health. https://thenationshealth.aphapublications.org/content/48/8/1.2 whole person librarianship community of practice. (n.d.). private online google group. https://groups.google.com/forum/#!members/wpl-cop yan, m. c. (2004). bridging the fragmented community: revitalizing settlement houses in the global eras. journal of community practice, 12(1-2), 51-69. https://doi.org/10.1300/j125v12n01_05 zettervall, s. k., & nienow, m. c. (2019). whole person librarianship: a social work approach to patron services. libraries unlimited. author note: address correspondence to tracy soska, school of social work, university of pittsburgh, pittsburgh, pa 15260 email: tracy.soska@gmail.com https://www.ssw.umaryland.edu/swcos/our-work/education--service/ https://www.urbanlibraries.org/innovations-old/2017-innovations/race-and-social-equity/homeless-engagement-initiative https://www.urbanlibraries.org/innovations-old/2017-innovations/race-and-social-equity/homeless-engagement-initiative https://www.thenation.com/article/why-public-libraries-matter/ https://journals.sagepub.com/doi/abs/10.1177/1044389419850707 https://thenationshealth.aphapublications.org/content/48/8/1.2 https://groups.google.com/forum/#!members/wpl-cop https://doi.org/10.1300/j125v12n01_05 mailto:tracy.soska@gmail.com __________ lamont d. simmons, edd, msw, assistant professor, salem state university school of social work, salem, ma 01970, lsimmons@salemstate.edu copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 290-310, doi: 10.18060/22647 this work is licensed under a creative commons attribution 4.0 international license. sustaining trajectories: black males persisting in undergraduate social work education lamont d. simmons abstract: while the literature is replete with studies on persistence among students across academic majors, few studies examine the nature of persistence among black males enrolled in baccalaureate social work programs. this qualitative study offers some insight into how a sample of four black male graduates from an accredited baccalaureate social work program persisted toward degree attainment. three themes emerged from this study: (a) family encouragement and support, (b) sense of belonging, and (c) presence of black male professors. findings suggest the need for social work educators to consider programmatic initiatives acknowledging the role of families in persistence efforts, facilitating connectedness, and recruiting black male professors or other black male mentors. keywords: black males; persistence; qualitative research; social work education; undergraduate the academic literature loosely defines persistence as a student’s motivation to earn a degree at any institution and the considerable efforts they expend to do so (tinto, 2017). in recent years, much has been written about black male persistence in higher education (brooms & davis, 2017; harper, 2012; palmer, wood, dancy, & strayhorn, 2014; wood, 2014). the concern with high dropout and underachievement has given rise to studies examining the challenges that black males face in higher education, together with differential factors that enable these students to persist and achieve academic success (brooms, 2019). even with studies centering on black male persistence across a range of academic contexts, little attention has been given to persistence among black males specifically enrolled in baccalaureate social work programs (beadlescomb, 2019; bowie, cherry, & wooding, 2005; giesler, 2013). a few studies have focused on recruiting students of color in social work programs (bowie, nashwan, thomas, davis-buckley, & johnson, 2018; raber, tebb, & berg-weger, 1998; rogers, 2013; wilson, 1999), career choices of black msw students (bowie et al., 2005), and student success in doctoral social work education (johnson-motoyama, petr, & mitchell, 2014). though these studies enrich understanding of student experiences in social work education, they largely ignore a population of students whose experiences are unfamiliar to social work researchers and educators. for this reason, studies are needed to document the experiences of black males in social work education. holsey-hyman’s (2015) dissertation study focused on understanding persistence among black students in a bachelor of social work (bsw) program at a historically black college. the study assessed students’ perceptions of background and environmental factors that influenced their persistence. the findings showed that non-academic factors (e.g., age, gender, race, family support, financial factors, etc.), a positive learning environment, and supportive social work faculty were central to their wherewithal to persist in completing https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) 291 the degree. though the study produced thematic findings relevant to black bsw students altogether, the findings were not disaggregated by gender as only two black males were interviewed for holsey-hyman’s (2015) study. the current state of black male persistence in baccalaureate social work programs is largely unknown (bowie et al., 2018). however, we know from recent data that 64% of black males fail to persist across academic programs over 6 years (national center for education statistics, 2016). given this percentage, it is possible that black males enrolled in baccalaureate social work programs fail to persist at high rates and also experience high levels of underachievement. studies are needed to help social work educators better facilitate black male persistence by equipping them with resources and strategies to bridge the persistence and achievement gaps. social work educators who invest in practices that improve black male persistence are helping to ensure the availability of skilled black male professionals. this is important given the growing number of clients of color requiring social services (bowie et al., 2005), along with the capacity of black male professionals to understand and be sensitive to the unique experiences of these clients (beadlescomb, 2019). more so, their presence in the field supports the profession’s adherence to promoting equity and diversity. the purpose of the present study was to explore persistence through the lens of black male graduates from an accredited baccalaureate social work program. for this study, persistence was defined operationally as a student’s wherewithal to remain in their bsw program until degree attainment (berger, ramirez, & lyons, 2012; hagedorn, 2012). the primary research question addressed was: “how were black males influenced to persist in a bachelor of social work program?” the study aimed to expand the visibility of black males in the social work literature and encourage future scholarship aimed at understanding their lived experiences in social work education and practice. literature review theoretical framework: conceptual model of black student attrition bennett and bean’s (1984) conceptual model of black student attrition forms the basis of the literature review and explains persistence as it relates to black students enrolled at historically white institutions (hwis). the model includes hypothesized relationships between several predictor variables (e.g., test scores, parental education, pre-college performance, and preparedness) in relation to the variable “intent to persist.” also included are predictor variables the researchers deemed as appropriate to black undergraduate students, including developmental stages of ethnic identity (extent of openness to human diversity and ethnic difference), interracial contact, satisfaction and transitional trauma experiences (alienation students experience when confronted with unfamiliar norms in college). applying regression analysis to explain black male persistence, bennett and bean (1984) found that satisfaction, less trauma, and preparedness were positive influences on their persistence. while these findings advanced understanding of black male persistence, the variable “positive interracial contact” mediates “satisfaction:” which is significant in “intent to persist.” of itself, this supports the need for hwis to develop campus-based programs that encourage interracial peer contacts. simmons/sustaining trajectories 292 background factors scholars have linked student persistence to background factors such as race, gender, parental education, family income, and age (astin & oseguera, 2005; choy, 2002; tinto, 1993). achievement disparities across race and gender indicate that black males are least likely to persist in college (harper, 2012). continuing-generation students, usually defined as students having at least one parent with a four-year degree (stephens, fryberg, markus, & covarrubias, 2012), are more likely to persist than first-generation students. the notion here is that parents with an earned bachelor’s degree possess academic capital that can be socially reproduced (brown & davis, 2001). hence, knowledge from higher education experiences means that parents can impart to their offspring what it takes to persist and succeed in college (allen, 2010; strand, 2013; strayhorn, 2006). a few studies confirm the relationship between economic capital and persistence. low-income students who are disproportionately older and categorized as racial minorities are less likely to persist compared to their higher-income peers (bowen, chingos, & mcpherson, 2009; reason, 2003). often, work and family commitments preclude these students from engaging fully in their studies, thus decreasing the likelihood of persisting (kezar, walpole, & perna, 2015). college readiness and persistence cognitive measures like high school grade point average, standardized test scores (astin & oseguera, 2005; choy, 2002; lotkowski, robbins, & noeth, 2004), and advanced placement courses (klopfenstein & thomas, 2009; palmer, davis, & hilton, 2009) have been linked to college readiness and persistence. strong performance on standardized tests (e.g., act, sat) has been associated with cognitive development and academic gains for black males (strayhorn, 2010). advanced placement courses have been linked to readiness, and in shaping student efficacies to persist in college (klopfenstein & thomas, 2009; schwartz & washington, 2002; strayhorn, 2008b). menson, patelis, and doyle (2009) noted that black males who participate in advanced placement courses build positive study habits, research skills, and higher-level thinking. notwithstanding existing research showing the predictive power of cognitive measures on college readiness and persistence, mounting research suggests that for black males, the integration of cognitive, psychosocial (e.g., motivation, social interaction, self-efficacy, and esteem), and institutional factors (e.g., racial climate, peer and faculty support) contributes to their persistence (bush & bush, 2010). academic and social integration persistence has been linked to the extent to which students integrate with the academic and social structures of their higher education learning environments (braxton & hirschy, 2005; seidman, 2005). rooted in sociological models of student departure, academic and social integration are the means by which students “interact with a range of people and situations on campus … [and how] they derive meaning from those interactions” (tinto, 2005, p. 319). academic integration is manifested when students feel connected to their academic learning environment (xu & webber, 2018). students can integrate themselves into their learning environment in many ways, such as attending classes, forming healthy advances in social work, fall 2019, 19(2) 293 relationships with faculty, and accessing departmental resources (e.g., academic advising, tutors, writing support, scholarships) that facilitate academic persistence and achievement (braxton & hirschy, 2005). social integration considers how students engage in meaningful interactions with a range of people (e.g., professional staff and peers) on campus and the extent of involvement in campus-based activities (xu & webber, 2018). for black males, early and continued engagement in the fabric of campus life is seen as significant to persistence and degree attainment (pascarella & terenzini, 2005). sense of belonging the notion of sense of belonging is well-documented in the higher education literature and is directly associated with persistence and educational outcomes (hurtado & carter, 1997; rhee, 2008). according to hausmann, ye, schofield, and woods (2009), sense of belonging is the “psychological sense of identification and affiliation with the campus community” (p. 650). for black males, high levels of engagement with students across campus contribute to their sense of belonging. in studying the relationship between peer interactions and a sense of belonging at hwis, strayhorn (2008a) found that black males who “interacted with diverse peers reported higher levels of sense of belonging than those who did not interact with diverse others” (p. 513). this finding reified the power of crosscultural interactions on satisfaction, self-concept, and belonging and their impact on black male persistence. somewhat different, brooms (2019) found that peer interactions between black males in male-centered campus-based programs were central to black males cultivating a sense of belonging. these cultural communities serve as safe venues for black males to bond, build cultural connections, experience empowerment, and develop a sense of self and identity. the findings from both studies confirm that when black males interact with different and same-race peers, they experience greater satisfaction and less alienation (astin & oseguera, 2005; bennett & bean, 1984; leppel, 2002), and acquire the social and cultural capital needed to persist and succeed in college (strayhorn, 2008a). meaningful relationships with black faculty little research examines black male student-faculty relationships in social work education, especially with regards to how these relationships influence persistence. existing research underscores the importance of these relationships on black male persistence (umbach, 2006). brooms and davis (2017) noted that “strong bonds developed in student-faculty relationships can be significant in students’ satisfaction, retention, and persistence” (p. 321). similarly, komarraju, musulkin, and bhattacharya (2011) suggest that student-faculty relationships are linked to “increases in motivation, career aspirations, and persistence” (p. 339). while black male social work students can benefit from meaningful relationships with black social work professors, these relationships are less probable, given that only 16% of full and part-time faculty in u.s. accredited social work programs are black (council on social work education [cswe], 2016). for accredited programs lacking ample representation of full-time black faculty, a purposeful (re)assessment of their implicit curriculum could warrant practices that aggressively recruit and retain these faculty (peterson, farmer, & zippay, 2014). simmons/sustaining trajectories 294 persistence in the current study while the extant literature is replete with information on persistence, there are noticeable gaps in the literature as it relates to persistence among black males enrolled in baccalaureate social work programs. the lack of research inhibits social work administrators and educators from gleaning information and converting findings into practices that positively promote student persistence (giesler, 2013). further complicating the study of persistence is the scarcity of black male social work majors, which translates into fewer opportunities for researchers to collect data on a range of issues impacting their persistence. the present study adds to the literature about how black males persist in social work education and offers suggestions on how administrators and educators can strengthen their trajectories toward degree attainment. methods this qualitative research study employed in-depth interviews and a strategy of prolonged engagement (padgett, 2008) to understand how black males were influenced to persist in an accredited undergraduate social work program. the study’s constructivist epistemology facilitated the researcher’s understanding of how black male participants made sense of their persistence in social work education (crotty, 1998). sampling the study involved participants from a large, public research university in the southern part of the united states. institutional data show that the university enrolled 21,301 students, including 17,176 undergraduate students in fall 2016. black males comprised 36.6% of undergraduate students. purposive sampling was used to select the study participants. this technique involves purposefully selecting willing individuals with knowledge of some experience or phenomenon (miles, huberman, & saldaña, 2014; patton, 2015). participants were selected from a sampling frame, which consisted of nine alumni who earned a bachelor's degree in social work between 2009 and 2016. the time frame helped to increase the number of black males who could be asked to participate in the study. this was an important consideration given significant gender, racial, and ethnic imbalances across social work programs where black males are proportionally underrepresented (warde, 2009). initial emails were sent to recruit potential study participants, and four confirmed their interest in participating in the study. another email providing a full explanation of the study’s purpose and procedures was sent to those who agreed to participate in the study. participants signed consent forms confirming their participation in the study. pseudonyms of aaron, barry, carl, and damien were used to protect the participants’ personal identities. the age range of the participants was 22 to 45. one participant identified as a veteran. two participants identified as first-generation college students, indicating that neither of their parents earned a four-year degree. all participants were professionals in the field of social work after earning their bachelor’s degree, and one participant was working toward a master’s degree. the university’s institutional review board (irb) reviewed and approved the study. advances in social work, fall 2019, 19(2) 295 data collection and analysis each participant was involved in one semi-structured, face-to-face interview. interviews occurred in september and october of 2016 and lasted between 60-90 minutes. an interview guide (see appendix a) consisting of nine open-ended questions aided in eliciting factors that contributed to their persistence. the guide included questions about participants’ preparation for college, involvement in campus-based activities, relationships with faculty and peers, and other factors that enabled their persistence. interviews were digitally recorded with participant permission and transcribed verbatim shortly afterward for analysis. a general inductive approach was used to analyze the interview data and identify themes relevant to this study. more efficient than structured design methodologies (e.g., case study, phenomenology, grounded theory, ethnography, narrative inquiry, etc.), this approach enables “research findings to emerge from the frequent, dominant, or significant themes inherent in raw data” (thomas, 2006, p. 238). apart from limitations, this approach can produce rich insights and lead to additional research that could generate more conclusive findings especially in situations where low population prevalence is a challenge (singh, 2007). in this study, data analysis began with open coding, which allows researchers to examine distinct concepts from the data and break them into manageable categories (gläser & laudel, 2013). open coding involved carefully reading the interview transcripts and examining the hand-written comments recorded in the margins of each transcript. comments from transcripts appearing to reflect some recurring patterns were grouped and used to construct themes, which were then presented as the study’s findings. credibility and optimization of rigor padgett (2008) discusses various techniques designed to optimize rigor in qualitative social work research, including the use of member checks. member checks aided in establishing the present study’s credibility. qualitative researchers use this technique to validate their interpretations of the data to avoid misconstruing the way participants make meaning of their experiences (maxwell, 2013; merriam & tisdell, 2016). specifically, the participants had a chance to correct errors or address what they perceived as erroneous interpretations of their narratives (lincoln & guba, 1985). they were emailed a scanned, marked-up copy of their printed interview transcript and asked to provide preliminary feedback on comments and interpretations of the data. maxwell (2013) said that such feedback is the “single most important way of ruling out the possibility of misinterpreting the meaning of what participants say and do and the perspective they have on what is going on” (pp. 126-127). participants had an opportunity to review the comments on their transcripts and each felt that the notes and identified themes adequately captured their experiences, supporting the rigor of the data collection and data analysis process. thematic findings thematic findings were produced in relation to the participants’ responses to the interview questions (see appendix a). three major themes emerged from the interview data: (a) family encouragement and support, (b) sense of belonging, and (c) presence of simmons/sustaining trajectories 296 black male professors. the first theme reflects how family members and significant others were essential to their wherewithal to persist. the second theme focuses on a sense of belonging, which suggests that black males are more likely to persist when they feel connected, supported, and satisfied with their academic experiences (brooms, 2019; strayhorn, 2017; wood & ireland, 2014). the third theme describes how the presence of black male social work professors influenced their persistence. in different ways, each theme speaks to the need and benefit of establishing or maintaining existing relationships with others (e.g., family, peers, professors) who can encourage or inspire persistence. family encouragement and support the participants acknowledged parents, extended relatives, and significant others for helping them stay focused while pursuing their social work degree. carl, who early in his trajectory considered departing college altogether, credited his mother for encouraging him to remain in his program. he spoke of how his mother deterred him from leaving college: my mom especially [supported me] [be]cause she’s the one who encouraged me to keep going when i thought about dropping out. she would always talk to me if i was having problems with different classes and things. she always encouraged me to keep going. carl’s mother supported him in other ways. when carl experienced transportation hardships after matriculating in his social work program, his mother made sure he got to campus to attend class. he said, “she did whatever she could to get me here [to campus]. she would pick me up from the bus station. she wanted to make sure i went to school and finished.” with his mother’s support, carl was able to attend class and persist in his social work program. growing up in a single-parent household, barry’s mother had always supported his endeavors. she made no exception to this when he enrolled in the navy immediately after high school and later, as an undergraduate social work student. barry offered a brief reflection on how his mother encouraged him to be a successful social work student: my mom kind of prepared me [for the real world]. [she said] i love you but the world doesn’t. you are a black male, you gotta work twice as hard to get half of what you need. no one was going to get you anything. so as i got older, she was like… “you have the mentality. you have the smarts to do this, to do that. you have to work.” she said, “twice as hard.” barry recalled his mother saying that he needed to work “twice as hard.” according to white (2015), this catchphrase is often echoed by black parents explaining to their children the impact of racial discrimination against marginalized individuals amid various educational and occupational spaces. heeding his mother’s empowering words, barry grew confident and managed to persist in the face of being black and male in his social work learning space. aaron’s experience as a social work student was replete with periods of academic frustration and subpar course grades. his fiancée, who aaron identified as a major source of support, was central in encouraging his persistence. he said: advances in social work, fall 2019, 19(2) 297 one of the major persons that really pushed me was my fiancée. and the reason why i say this is because umm…she was there when i was crying. she was there when i was frustrated with school. when i was frustrated with going to class. she was like, “you gotta do this. you are needed to do this. i know you could do this.” and she really pushed me to do the work and to put my all into the work. the encouragement and support from aaron’s fiancée enabled him to persist and realize his goals of earning a social work degree and subsequently, securing professional employment in public child welfare. through introspection, aaron acknowledged the reality of many black males who matriculate in academic programs but fail to persist. reflecting on this reality had solidified his commitment to sustain his trajectory as a social work student. “finishing my degree as a black young male was important because a lot of black men start but they don’t finish. and she [fiancée] always talked to me about continuing my path and that’s what i was doing.” damien’s relationship with a “distant” cousin was important to his path of earning a social work degree. his cousin, then a social work major at a different college, provided damien with the emotional support that helped sustain his academic trajectory. the excerpt describes how they supported each other in their pursuits to earn a social work degree: i have a cousin who went to [college name]. she began the social work program the same time i did and we used to try to keep up with one another as far as staying on track. we would always tell each other and text each other, “we’re gonna get through it. it’s getting hard but we’re gonna get through it.” we always encouraged one another and we both finished in fall of ’14 from social work. damien’s godmother, sister-in-law, and first cousin are social workers. they also encouraged his persistence by showing genuine interest in his academic pursuit and wellbeing. he said: they were really ecstatic about me studying social work and encouraged me along the way. every time they saw me they would ask, “how you doing,” you know. “you haven’t called me in a while. i’m here if you need me.” stuff like that. these “check-ins” reinforce the importance of family capital in fostering persistence. in higher education, family capital represents how family members invest their time, effort, and resources to ensure the persistence and academic success of children or relatives (gofen, 2009). through family membership, damien had access to a supportive family network of social workers who were critical facilitators of his persistence and success. sense of belonging as mentioned, “sense of belonging” concerns the extent to which students feel connected to their campus community. some participants experienced difficulties establishing a sense of belonging as social work students. damien did not feel strongly connected to his female-dominated social work program, but easily “fit in” in an ethnicbased student organization designed to provide activities and resources to meet the needs of black males, as well as enhance their persistence. the organization seemed vital to providing a nurturing space that cultivated damien’s belonging and persistence. he said: simmons/sustaining trajectories 298 and with my activities in organization x [pseudonym], you have really good people…the same people who are the same color as you. and all trying to achieve a well above [grade point] average. and you want to be in that setting, too. to be inspired to be successful. but as far as organization x, we played together. did homework…studied together. went out together. you know, socialized. so i think organization x was very helpful…uh, very supportive. though the organization was peripheral to the academic and social components of his social work program, being involved extended damien’s networks to the broader campus community (e.g., friendships with other black students, professional student support staff). these networks enabled access to campus resources (e.g., needs-based book vouchers, spanish tutor) that aided his persistence as a social work student. aaron was disheartened by limited opportunities to interact with other black males in his social work courses. this impacted the extent of his connectedness and engagement in course dialogue aimed at facilitating his academic growth and professional character as a social worker. one can sense his frustration from this comment: there was some topics in social work [courses] you wanted to talk about as a male but you didn’t make a statement because you were the only one [only male]. and especially the only black male in class. i was in a room full of women and couldn’t really connect to them. there was an instance when aaron found solace seeing another black male in one of his social work courses. in his interview, he stated “yes we got some brothas’ up in here. but then when i didn’t see him a few weeks in the semester, i was like ‘oh crap, i’m back to myself again.” understandably, aaron would be disappointed with the other student’s departure, given the existing narratives of achievement disparities between black male college students and their race and gender counterparts. in response to the student’s departure, aaron said that he was “back to being a square peg trying to get into a round hole.” the statement reveals him questioning his belonging as a social work student, particularly with feeling alienated as a black male and his wherewithal to persist in a female-dominated social work program. carl, too, was frustrated “seeing a lot of women and not seeing other black men in social work.” compared to aaron, he was more self-conscious about engaging in course dialogue--so much so that he sometimes would wait “until class [was] over to talk to professors.” while he did not expand on the meaning behind this remark (despite several probes), it appears his choice to “wait” speaks to apprehension about being negatively evaluated by peers for offering opinions through his gendered and racialized lens. strayhorn and saddler (2009) noted that for black males, feeling constrained in the classroom can adversely affect their sense of belonging, engagement with peers, and achieving an end-goal to earn a degree. unlike other participants, barry bonded with a white social work student who identified as lesbian and was also a student veteran. his interactions with her helped solidify his sense of belonging and in due course, positively influenced his persistence. he said: advances in social work, fall 2019, 19(2) 299 the one young lady that identified as lesbian…we pushed each other a lot. i think her and i talked, texted and emailed probably more during this program. so most times, it was that push…that drive. having somebody else that when you don’t feel like finishing to say, “hey we got this” or “hey we can get this research paper done.” with her being older [non-traditional student], we were able to connect on some things a little better which made me understand the urgency of getting through school. barry’s relationship with another social work student compelled him to consider the importance of “knowing different kinds of people outside of who i already know.” seemingly from this comment, barry realized the value of engaging in interactions with diverse peers who were and can be critical to stimulating his persistence. initial findings from this theme show the importance of ethnic-based student organizations in helping black male social work students establish a sense of belonging and subsequently, find worth in persisting. according to the literature, these organizations provide welcoming spaces, academic support, and engagement opportunities with campus stakeholders (e.g., student support staff, advisors) who may function as gatekeepers to persistence (harper & quaye, 2009; kuk & manning, 2010; padilla, trevino, gonzalez, & trevino, 1997). partaking in diverse peer interactions was also fundamental to a sense of belonging. for example, barry’s “friending” with a white lesbian veteran social work student resulted in a supportive relationship that seemed to engender his belonging and persistence. strayhorn (2008a) acknowledged the power of diverse interactions in assisting black males to establish a sense of belonging. these interactions promote high levels of satisfaction with academic programs and help black males “feel at home or feel they are a member of a place or community” (tinto, 2005, p. 319). it was the social work community in which barry established a meaningful peer relationship that became integral to his persistence. the findings also showed how the shortage of black males in baccalaureate social work programs could inhibit belonging among black males already matriculated in these programs. this causes some concern given existing research suggesting that black males establish a sense of belonging when they feel connected to other black males (strayhorn, 2008b). some participants reported isolation and discomfort being the only black male in their white, female-dominated social work courses. aaron, in particular, feared engaging in course dialogue, believing his perspectives would be considered invalid or not resonate with his female peers. he said: i felt isolated because there was some topics…or some things you wanted to talk about as a male, but you didn’t raise your hand or make a statement because you’re the only male, and especially the only black male in class. you try to fend [defend] certain things and then you get beat down. it’s like pitchforks and torches and you find yourself sitting in the corner and nodding your head. i felt like a nobody cause you know, i was in a room full of women. feeling isolated or not welcomed can force black males to question their belonging, especially in social work programs where they often are the only “one.” simmons/sustaining trajectories 300 presence of black male professors the participants discussed how the sole black male social work professor influenced their persistence, and how he pushed them to achieve academically. aaron mentioned how this professor helped to build his efficacy to persist. he recalled during informal conversations how this professor was “always pushing me to do what i had to do to graduate.” aaron also remembered internalizing encouraging phrases from this professor affirming his need to persist such as “you can make it” and “you can easily get the degree.” these affirmations were indicative of this professor’s concern for aaron’s academic wellbeing and trajectory in social work education. more so, these encouraging messages helped aaron believe that he could achieve academic success and graduate with a social work degree. this professor impacted other participants in different ways. after several social work courses with female professors and experiencing racism from a white male professor in a general education course, barry felt relieved “seeing a male, black professor” in his social work program. he noted, “as a black man…to see another black man in social work with the title ‘doctor’ made me proud.” setting aside pride, he remarked how this professor pushed him in class and instilled him with confidence to succeed: before i took dr. [name withheld] for research, i knew it was gonna be hard because we [students] was talkin.’ then when i took him, he just kept on pushing us and pushing us. when we’d get frustrated with something from not knowing the material or getting bad quiz grades, he kept on saying to the class “you got to embrace challenges.” so by the end of the semester, i realized that he wanted us to be successful as social work students. this had instilled a lot of confidence in me mainly because it was an african american man who was saying this to us. for damien, connecting with this professor helped sustain his motivation to persist as a social work student. he said: access to dr. [name withheld] was wonderful. like, i could email him anytime. meet him in his office during office hours. he even gave me his cell number. we had a great rapport and it was a great networking [opportunity]. he even wrote me a reference for graduate school. he kept me motivated and made me want to do better in all my courses so that i can be a great social worker. discussion the thematic findings led to several general conclusions about how the participants in this study persisted in their baccalaureate social work program. the first theme emphasized the relationship between family encouragement and persistence. in examining external factors of persistence among students of color, maramba and palmer (2011) found that family members were essential to their persistence and degree attainment. the finding in this particular study shows how core and extended family members aided in the participants’ wherewithal to persist and sustain their trajectories. though familial support is not guaranteed, this study reinforces the critical role that families can play in the academic success of black males enrolled in baccalaureate social work programs. it also advances in social work, fall 2019, 19(2) 301 speaks to the importance of families to provide emotional support to black males struggling to negotiate their persistence in learning environments where they often are marginalized and rendered invisible (giesler, 2013; hyde & deal, 2003; teasley, schiele, adams, & okilwa, 2018). the second theme revealed that black male student representation in social work programs can help instill a sense of belonging. the presence of other black males can reduce isolation, marginalization, and increase connectedness (strayhorn, 2008a). the findings from this theme also give attention to how ethnic-based student organizations enhance belonging and persistence for black males. these spaces can be sanctuaries for black male social work students to build community with other black males, feel valued and supported, and receive the social capital necessary to strengthen their persistence and academic success (brooms, 2019). the last theme showed how participants attributed their persistence to the presence of, and relationship with a black male social work professor. their collective remarks centered on how this professor was encouraging, always available, and invested in their academic growth. the mere presence of this professor was elemental to strengthening the participants’ capacities to cope with the stress and burden of being male and black in their social work program. indeed, this finding substantiated how black male professors are important to the academic well-being of black male social work students. limitations this study was not without limitations. the study was restricted to a single social work program at a large public research university. conducting this research across programs at multiple institutions could undoubtedly increase the pool of black males and in turn, extend the breadth and depth of thematic findings. transferability of findings to black males in undergraduate social work programs is cautioned, as qualitative research studies aim to achieve a deep understanding of phenomena through small sample sizes (gheondea-eliad, 2014; merriam & tisdell, 2016). notwithstanding the sample size (n=4), the narratives were essential to developing findings that characterize participant persistence. the last finding reflects the importance of black male professors in facilitating persistence but disregards contributions to persistence by other social work faculty. as this study was conducted at a specific institution, black male social work students attending other institutions (e.g., private, historically black colleges, small liberal arts colleges) might differ in their perspective of how diverse social work faculty influence their persistence. the study also relied on individual interviews to provide substantive participant data. future studies should incorporate multiple data sources (e.g., focus groups, artifacts, critical incidents, journaling) and structured design methodologies that would deepen understanding (patton, 2015; radford, 2006) of factors that lead to persistence or early departure among black males in baccalaureate social work programs. implications overall findings provide insight for social work education administrators and advisors responsible for facilitating persistence among black male bsw students. we know from simmons/sustaining trajectories 302 the study participants that family and significant others are essential to persistence. therefore, administrators should consider programmatic initiatives that acknowledge the importance of families in the success of black male students. as they exist, social work orientations can be conduits to these initiatives. in addition to presentations that introduce students to social work, orientations can include family panels that integrate thorough discussions on how families can facilitate persistence and success. for families of black males, these thoughtful discussions can address pressing questions or concerns, and convey messages that family support is a critical component for black males to sustain their trajectories as social work students. having black male alumni and black professors can be meaningful and reinforce to families that persistence and success are possible despite real or pending obstacles. faculty and advisors should be cognizant of the role student affairs offices play in involving families in persistence and success. these offices can implement campus-based programming that includes students and families, or even evidenced-based initiatives that engage families in supportive processes that cultivate positive educational outcomes (maramba & palmer, 2011). the study showed that belonging and persistence are attained when black males bond with other black males. faculty and professional advisors can facilitate connectedness by encouraging involvement in campus-based organizations offering networking opportunities with black males in different academic programs. indeed, ethnic-based organizations offer black males a communal space that can be responsive to their ethnic and gender needs. they can also provide students with cultural activities and resources not available in their social work program. learning environments should be structured so black males feel supported and encouraged to share viewpoints (saunders & kardia, 1997). this could support their capacities to develop a sense of belonging and “fit in” as social work students. thus, pedagogical efforts should focus on legitimizing black male perspectives and concerns in a manner that precludes them from feeling constrained and marginalized. teaching methods that inspire students to engage in diverse interactions can significantly impact the extent to which these students feel they belong. heterogeneous learning experiences (e.g., small groups, debates, service-learning projects) expose black males to students from different backgrounds (strayhorn, 2008a). these collaborative experiences leave them feeling satisfied and connected, as well as more willing to engage in intense classroom dialogue (fischer, 2007; strayhorn, 2008a; tinto, 2005). black male social work professors matter. their presence can have a significant impact on the persistence of black male students. they can serve as mentors, role models, and gatekeepers for helping black males negotiate their social work educational experience. notwithstanding standard policies on recruiting, hiring, and retaining qualified faculty (cswe, 2015), it is incumbent upon baccalaureate social work programs to continually find ways to enrich the diversity of program faculty. these programs must be aggressive in recruiting and hiring ethnic and culturally diverse social work faculty (quaye, tambascia, & talesh, 2009). an aggressive approach can provide a diverse crossrepresentation of faculty available to strengthen the persistence and academic experiences of black males who still experience dismal graduation rates compared to their gender and racial counterparts (harper, 2012; u.s. department of education, 2015). however, when advances in social work, fall 2019, 19(2) 303 black male social work professors are not present, bsw programs can provide mentoring support by pairing students with black male msw students, black male professors from other departments, or black male professional staff. conclusion this study examined persistence through the lens of black male graduates from an accredited baccalaureate social work program. findings affirmed that family support, peer relationships, sense of belonging, and black male student-faculty relationships influenced black males’ persistence in a baccalaureate social work program. the findings substantiate the relationship between non-academic factors and persistence and uniquely emphasized that black male social work professors are key to black male student persistence. this specific finding is indicative of the need for social work programs to prioritize and incorporate in their strategic plans the hiring of black male professors. while social work programs are accountable for ensuring academic success for all students, they have a special responsibility to students from underrepresented groups and those at-risk for early program departure. concerning black males, program administrators and educators must be intentional in enhancing their educational outcomes (cswe, 2015). they must be proactive in addressing problems related to retaining black males and be responsive in developing program initiatives that influence their persistence. therefore, they should be prepared to (re)examine and modify their program’s implicit curriculum for ensuring their academic success and degree attainment (bogo & wayne, 2013). this might mean having a supportive faculty and staff structure, practices that promote meaningful interactions and belonging, and a commitment from the social work program and institution in strengthening black male persistence. references allen, q. 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(2002). predicting academic performance and retention among african american freshmen men. naspa journal, 39(4), 354-370. doi: https://doi.org/10.2202/0027-6014.1178 seidman, a. (2005). where we go from here. in a. seidman (ed.), college student retention: formula for student success (pp. 295-316). westport, ct: praeger. singh, k. (2007). quantitative social research methods. new delhi: sage. stephens, n. m., fryberg, s. a., markus, h. r., johnson, c. s., & covarrubias, r. (2012). unseen disadvantage: how american universities’ focus on independence undermines the academic performance of first-generation college students. journal of personality and social psychology, 102(6), 1178-1197. doi: https://doi.org/10.1037/a0027143 strand, k. j. (2013). best practices for ensuring the academic success of first-generation college students. washington dc: council of independent colleges. strayhorn, t. l. (2006). factors influencing the academic achievement of first-generation college students. naspa journal, 43(4), 82-111. doi: https://doi.org/10.2202/00276014.1724 strayhorn, t. l. (2008a). fittin’ in. do diverse interactions with peers affect sense of belonging for black men at predominantly white institutions? naspa journal, 45(4), 501-527. doi: https://doi.org/10.2202/0027-6014.2009 strayhorn, t. l. (2008b). the invisible man: factors affecting the retention of lowincome african american males. nasap journal, 11(1), 66-82. strayhorn, t. l. (2010). when race and gender collide: social and cultural capital’s influence on the academic achievement of african american male and latino males. review of higher education, 33(3), 307-332. doi: https://doi.org/10.1353/rhe.0.0147 strayhorn, t. l. (2017). factors that influence the persistence and success of black men in urban public universities. urban education, 52(9), 1106-1128. doi: https://doi.org/10.1177/0042085915623347 strayhorn, t. l., & saddler, t. n. (2009). gender differences in the influence of facultystudent mentoring relationships on satisfaction with college among african americans. journal of african american studies, 13, 476-493. doi: https://doi.org/10.1007/s12111-008-9082-1 teasley, m. l., schiele, j. h., adams, c., & okilwa, n. s. (2018). trayvon martin: racial profiling, black male stigma, and social work practice. social work, 63(1), 37-45. doi: https://doi.org/10.1093/sw/swx049 thomas, d. r. (2006). a general inductive approach for analyzing qualitative evaluation data. american journal of evaluation, 27(2), 237-246. doi: https://doi.org/10.1177/1098214005283748 http://www.crlt.umich.edu/gsis/p3_1 https://doi.org/10.2202/0027-6014.1178 https://doi.org/10.1037/a0027143 https://doi.org/10.2202/0027-6014.1724 https://doi.org/10.2202/0027-6014.1724 https://doi.org/10.2202/0027-6014.2009 https://doi.org/10.1353/rhe.0.0147 https://doi.org/10.1177/0042085915623347 https://doi.org/10.1007/s12111-008-9082-1 https://doi.org/10.1093/sw/swx049 https://doi.org/10.1177/1098214005283748 advances in social work, fall 2019, 19(2) 309 tinto, v. (1993). leaving college: rethinking the causes and cures of student attrition (2nd ed.). chicago, il: university of chicago press. doi: https://doi.org/10.7208/chicago/9780226922461.001.0001 tinto, v. (2005). moving from theory to action. in a. seidman (ed.), college student retention: formula for student success (pp. 317-333). westport, ct: praeger. tinto, v. (2017). reflections on student persistence. student success, 8(2), 1-8. doi: https://doi.org/10.5204/ssj.v8i2.376 umbach, p. d. (2006). the contribution of faculty of color to undergraduate education. research in higher education, 47(3), 317-345. doi: https://doi.org/10.1007/s11162005-9391-3 u.s. department of education, national center for education statistics. (2015). the condition of education 2015 (nces 2015–144). retrieved from https://nces.ed.gov/fastfacts/display.asp?id=40 warde, b. (2009). why social work, and what does the future hold? the narratives of recently graduated hispanic and african-american male bsw and msw students. journal of ethnic & cultural diversity in social work, 18, 129-145. doi: https://doi.org/10.1080/15313200802595369 white, g. b. (2015). black workers really do need to be twice as good. retrieved from http://www.theatlantic.com/business/archive/2015/10/why-black-workers-really-doneed-to-be-twice-as-good/409276/ wilson, p. p. (1999). a social work imperative: recruiting african american males into the profession. journal of cultural diversity, 6(3), 77-84. wood, j. l. (2014). examining academic variables affecting the persistence and attainment of black male collegians: a focus on academic performance and integration in the two-year college. race ethnicity and education, 17(5), 601-622. doi: https://doi.org/10.1080/13613324.2012.733687 wood, j. l., & ireland, s. m. (2014). supporting black male community college success: determinants of faculty-student engagement. community college journal of research and practice, 38(2-3), 154-165, doi: https://doi.org/10.1080/10668926.2014.851957 xu, y. j., & webber, k. l. (2018). college student retention on a racially diverse campus: a theoretically guided reality check. journal of college student retention: research, theory & practice, 20(1), 2-28. doi: https://doi.org/10.1177/1521025116643325 author note: address correspondence to dr. lamont d. simmons, school of social work, salem state university, 352 lafayette street, salem, ma01970. e-mail: lsimmons@salemstate.edu https://doi.org/10.7208/chicago/9780226922461.001.0001 https://doi.org/10.5204/ssj.v8i2.376 https://doi.org/10.1007/s11162-005-9391-3 https://doi.org/10.1007/s11162-005-9391-3 https://nces.ed.gov/fastfacts/display.asp?id=40 https://doi.org/10.1080/15313200802595369 http://www.theatlantic.com/business/archive/2015/10/why-black-workers-really-do-need-to-be-twice-as-good/409276/ http://www.theatlantic.com/business/archive/2015/10/why-black-workers-really-do-need-to-be-twice-as-good/409276/ https://doi.org/10.1080/13613324.2012.733687 https://doi.org/10.1080/10668926.2014.851957 https://doi.org/10.1177/1521025116643325 simmons/sustaining trajectories 310 appendix a interview guide research question: how were black males influenced to persist in a bachelor of social work program? 1. what led you to pursue a bachelor’s degree in social work? 2. in what ways did your high school prepare you for the academic demands of a social work education? 3. tell me about those people, if any, who encouraged your success as a social work student? 4. what motivated you to earn your social work degree? 5. what social work programs or other campus activities were you involved in? 6. how often do you interact with minority or non-minority faculty in your social work program? probe: how have these interactions influenced you to do well as a social work student? 7. what obstacles did you experience as a social work student? how did you overcome those obstacles? 8. what has been your greatest challenge as a black male in pursuing your social work degree? 9. tell me about the satisfaction of your experience as a college student in your social work program. menson, r. p., patelis, t., & doyle, a. (2009). new england’s state of college readiness. new england journal of higher education, 23(5), 22-23. merriam, s. b., & tisdell, e. j. (2016). qualitative research: a guide to design and implementation (4th ed.). san francisco, ca: jossey-bass. miles, m. b., huberman, a. m., & saldaña, j. (2014). qualitative data analysis. a methods sourcebook (3rd ed.). thousand oaks, ca: sage. doi: https://doi.org/10.1080/10572252.2015.975966 national center for education statistics. (2016). the condition of education 2016 (nces 2011-144). washington, dc: us department of education. retrieved from https://nces.ed.gov/pubs2016/2016144.pdf white, g. b. (2015). black workers really do need to be twice as good. retrieved from http://www.theatlantic.com/business/archive/2015/10/why-black-workers-really-do-need-to-be-twice-as-good/409276/ wilson, p. p. (1999). a social work imperative: recruiting african american males into the profession. journal of cultural diversity, 6(3), 77-84. wood, j. l. (2014). examining academic variables affecting the persistence and attainment of black male collegians: a focus on academic performance and integration in the two-year college. race ethnicity and education, 17(5), 601-622. doi: https://doi... wood, j. l., & ireland, s. m. (2014). supporting black male community college success: determinants of faculty-student engagement. community college journal of research and practice, 38(2-3), 154-165, doi: https://doi.org/10.1080/10668926.2014.851957 xu, y. j., & webber, k. l. (2018). college student retention on a racially diverse campus: a theoretically guided reality check. journal of college student retention: research, theory & practice, 20(1), 2-28. doi: https://doi.org/10.1177/152102511664... appendix a interview guide research question: ______ sarah j. faubert, llmsw-macro, project manager, grand valley state university kirkhof college of nursing, grand rapids, mi 49503. bridget e. weller, phd, associate professor, western michigan university school of social work, kalamazoo, mi 49008. anna k. ault, ba, freelance writer, mclean, va 22101. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 106-120, doi: 10.18060/22624 this work is licensed under a creative commons attribution 4.0 international license. health insurance and youths’ unmet health care needs: using the 2016 national survey of children’s health to inform social work policy advocacy sarah j. faubert bridget e. weller anna k. ault abstract: this study examined the relationship between youth health insurance status, insurance type (public versus private), and youths’ unmet health care needs. a secondary analysis was conducted using data from the 2016 national survey of children’s health, a nationally representative, cross-sectional survey of u.s. youth. the sample included data from caregivers of 40,723 hispanic, non-hispanic black, and non-hispanic white youth (0-17 years old) and was 49% female. mplus 8.2 was used and statistical models accounted for the complex survey design. using unweighted and weighted descriptive statistics and weighted probit regression models, we found that youth without health insurance were significantly more likely to have unmet health care needs compared to those with either public or private health insurance. we further found no statistically significant difference in unmet needs between youth with public and private health insurance. our findings suggest that increased access to health insurance coverage, regardless of insurance type, may be an important policy focus when addressing youths’ unmet health care needs. our findings can be used to guide future social work advocacy regarding health insurance policy. keywords: health insurance; unmet health care needs; youth; social policy; aca poor health outcomes, disruptions in individual functioning, and complications with family finances have been found to be associated with youths’ unmet health care needs (glewwe, west, & lee, 2018; lindly, chavez, & zuckerman, 2016). compared to youth with health insurance, the risk for having unmet health care needs is higher for youth without health insurance coverage (derigne, porterfield, & metz, 2009; kreider et al., 2016; miller, nugent, gaboda, & russell, 2013). legislators across the political spectrum have responded to this issue through federal health insurance policy reforms that aim to meet health care needs for all youth. the current landscape of federal health insurance policy has largely been shaped by the patient protection and affordable care act (aca). established by the obama administration in 2010 and implemented on a national scale in 2014, the aca is a set of programs intended to expand access to health insurance, both in the public and private sectors (blumberg, holahan, karpman, & elmendorf, 2018). it aims to (a) increase the number of individuals with health insurance coverage through both medicaid expansion and the establishment of a health insurance marketplace, (b) improve the affordability of health insurance plans through subsidies and tax credits, and (c) ensure that health care plans provide adequate coverage by mandating essential health care services (feldman, https://creativecommons.org/licenses/by/4.0/ faubert et al./health insurance and youth 107 buysse, hubner, huffman, & loe, 2015; ortega et al., 2018). the aca also prohibits insurance companies from denying enrollment and coverage based on pre-existing conditions, amount of care sought, or the cost of care (fry-bowers, 2015). in addition, the aca allows young adults up to age 26 who do not qualify for employment-based insurance to remain on their parents’ plan (levitt, 2017b). despite its attempts to expand access to health insurance, debates on the aca’s efficacy remain. some policymakers argue that repealing the aca, with its individual and employer mandates, would allow individuals more autonomy over their own health care (levitt, 2017b), thus promoting personal accountability and decreasing the prevalence of unmet health care needs. conversely, others argue that, should it be repealed, participation in insurance plans would decrease, thus increasing premiums for those who remain insured and ultimately increasing the number of individuals with unmet health care needs (eltorai & eltorai, 2017; mulligan, 2017). at the heart of both of these perspectives is a common goal—creating a policy structure for health insurance that can address the health care needs of people of all ages, including youth. to create the most effective policies to address youths’ health care needs, nationally representative information is needed to examine whether private or public health insurance better meets youths’ health care needs. further, this information can offer an additional perspective to current debates surrounding the implementation of a fully-public, single-payer health care system. the purpose of the present study was to address this ongoing debate by estimating youths’ unmet health care needs by health insurance type and status, six years post-aca enactment. this study addressed two research questions: “what is the prevalence of unmet health care needs among u.s. youth with public, private, and no health insurance six years post-aca enactment?” and “is there a difference in unmet health care needs by insurance type and status among u.s. youth six years post-aca enactment?” addressing these research questions will indicate which type of insurance coverage better meets youths’ health care needs. should one insurance type better meet youths’ needs, then social workers can use this information to advocate for expansion of that type. if no differences are found between insurance types, then social workers can advocate for efforts that continue to expand youths’ access to both types of insurance. addressing the research questions will also indicate the degree to which having insurance improves the likelihood of children’s needs being met. results for this study will expand current knowledge on the individuallevel impact of social policy, particularly the “hot-button” issue of health care reform. literature review current state of health care policy in an often-heated political climate, few modern issues are as contentious as health care reform. passed into law in 2010 and fully implemented in 2014, the patient protection and affordable care act (aca) aimed to increase lowand middle-income individuals’ access to health insurance through both the expansion of medicaid eligibility and the creation of a government-subsidized insurance marketplace (levitt, 2017a). the implementation of the aca reduced the number of uninsured individuals in the u.s. by advances in social work, spring 2019, 19(1) 108 over 19 million between 2010 and 2017. between 2015 and 2017, a total of 519,000 youth aged 0-17 acquired insurance coverage (blumberg et al., 2018). despite the increase in individuals with insurance, ideological debates about the aca continue. these disagreements have interrupted traditional problem-solving procedures between the legislative and executive branches, requiring judicial intervention (bagley, 2016). in 2014, the house of representatives sued the obama administration over funding strategies for insurance plans under the aca. plaintiffs claimed a cost-sharing provision of the aca violated the appropriations clause of the u.s. constitution because the provision gave the secretary of health and human services the power to issue reimbursements to insurers without appropriations set aside by congress for this purpose. in u.s. house of representatives v. burwell (2016), the u.s. district court for the district of columbia ruled in favor of the house, indicating that the secretary could not issue reimbursements to insurers without congressional appropriation. as a result, the choice to expand medicaid had to be determined by each individual state (eltorai & eltorai, 2017). over time, despite the initial opposition of their governors, several states including idaho, louisiana, maine, and nebraska have expanded medicaid through ballot initiatives and legislation, demonstrating a growing interest in expanding public insurance options. as of 2019, 37 states and the district of columbia have chosen to participate in medicaid expansion, whereas 13 states, primarily located in the south, have chosen not to expand. currently, one southern state (georgia) is considering expansion (kaiser family foundation, 2019). as the 2020 election draws nearer, a popular issue among democratic candidates is the concept of medicare for all (wilensky, 2019). the most popular incarnation of this fullypublic health insurance involves a government-run single-payer system through which all individuals in the u.s. would receive their insurance coverage. should this legislation be implemented, it would dismantle the private health insurance market and fundamentally change how the entire health care field operates (wilensky, 2019). insurance type and unmet needs prior research has demonstrated that uninsured youth experience the highest rate of unmet needs (clemans-cope, kenney, waidmann, huntress, & anderson, 2015; flores et al., 2017; kreider et al., 2016). unmet need refers to any instance in which a youth did not receive some or all of the care they required for their health (miller et al., 2013). in one study, uninsured youth were 2.94 times more likely to have an unmet need than youth with insurance (derigne et al., 2009). another study determined that uninsured youth with special health care needs were 2.7 times more likely to have an unmet need related to cost than youth with insurance (miller et al., 2013). on average, families of uninsured youth spend $2,885.75 more out of pocket each year than families with insurance (flores et al., 2017). unmet need also seems to be associated with the type of insurance a child receives, though previous research on this issue is inconclusive (devoe et al., 2011). on one hand, families with private insurance have historically reported higher frequency of unmet need when compared to families with public insurance such as medicaid or the children’s faubert et al./health insurance and youth 109 health insurance program (derigne et al., 2009; miller et al., 2013). the reason for these findings may be increased out-of-pocket spending associated with private insurance (kreider et al., 2016); research has indicated increases in families’ out-of-pocket health care spending is associated with unmet health care needs for youth (karaca-mandic, choiyoo, lee, & scal, 2014). on the other hand, some studies have indicated differences in unmet need and ability to access care for youth insured by various sources of public insurance (kreider et al., 2016). although publicly insured families have reported cost of care to be one third of that for families with private insurance, families with public insurance report two to three times more trouble finding a provider who will accept their insurance than families with private insurance (miller et al., 2013). in a study by clemanscope et al. (2015), parents of youth covered by the public children’s health insurance program were equally likely to report an unmet need – including vision and dental care needs – as parents of youth covered by private plans. because of this conflicting research (and the ongoing political debate), more information is needed to determine if private or public insurance more effectively reduces unmet need among u.s. youth. although previous studies have found differences in youths’ unmet health care needs based on their insurance type, these findings cannot be generalized to most youth in the u.s., as most studies have focused solely on youth with special health care needs (e.g., derigne et al., 2009; miller et al., 2013). to better understand how insurance type and status relate to the unmet needs of most youth in the u.s., both with and without special health care needs, our research used nationally representative data. in doing so, we aim to address the significant gaps in the literature to inform the policy advocacy efforts of social workers nationwide, so that the health care needs of youth may be better addressed. methods data source we conducted a secondary analysis using the 2016 national survey of children’s health (nsch), which is a nationally representative dataset published by the child and adolescent health measurement initiative (child and adolescent health measurement initiative [cahmi], 2018). nsch is sponsored by the maternal and child health bureau, which is part of the u.s. department of health and human services. this survey focuses on youths’ health and well-being and therefore contains data on a variety of health outcomes, as well as factors that may contribute to these outcomes. like other nationally representative and publicly available datasets, the strengths of nsch include the incorporation of data from many cases, timeliness of reporting, and the ability to compute national estimates (blair, 2016). the use of the 2016 data in the current study is important because similar data are expected to be collected annually after this point in time (cahmi, 2018). nsch is comprised of caregiver reports of non-institutionalized u.s. youth, ages 0-17 (cahmi, 2018). because of the random recruitment strategy employed, caregivers’ data represent hispanic, non-hispanic black, and non-hispanic white youth from all 50 states and the district of columbia. if more than one eligible youth resided in the home, data were collected regarding one randomly selected youth in the home. because individual advances in social work, spring 2019, 19(1) 110 cases were deidentified and a secondary dataset used, this study was found exempt by the institutional review board at western michigan university. in the current study, we used a subpopulation of caregivers who completed the nsch. in particular, we decided to include only data about hispanic, non-hispanic black, and nonhispanic white youth because data from other racial/ethnic groups cannot be used for national estimates (cahmi, 2018). to avoid misrepresenting the data, youth who have both private and public insurance were excluded; thus our analysis was conducted using data from youth who had only public, only private, or no insurance coverage for the entire 12 months prior to the study. measures all measures were used in accordance with the 2016 nsch guidelines (cahmi, 2018). consistent with previous research, we examined seven unmet needs: forgone health care, medical care, dental care, vision care, hearing care, mental health services, and other types of care (kreider et al., 2016; lindly et al., 2016). forgone health care was assessed based on caregivers’ answers to the question, “during the past 12 months, was there any time when this child needed health care, but it was not received?” response options were dichotomized (yes, no). caregivers who reported “yes” were then asked to indicate on a checklist which type of care was not received. the checklist included medical care, dental care, vision, hearing, mental health services, and other. if caregivers indicated yes to one of these items, youth were considered to have that unmet need. thus, for each item on the checklist, dichotomized response options were created (unmet need, received needed care). insurance type and status were measured by combining two aspects of the survey. caregivers first responded to the question, “during the past 12 months, was this child ever covered by any kind of health insurance or health coverage plan?” there were three response options (yes, this child was covered all 12 months; yes, but this child had a gap in coverage; and no). if caregivers responded “yes, but this child had a gap in coverage,” this case was excluded from the current study, as prior research indicates gaps in coverage can lead to a variety of outcomes depending on other factors not included in the current dataset (e.g., federico, steiner, beaty, crane, & kempe, 2007). if caregivers responded “no,” this case was included in this study and coded as “no insurance coverage.” if caregivers responded “yes, this child was covered all 12 months,” the caregiver indicated the type of health insurance. consistent with coding recommended by cahmi (2018), the types of insurance were then coded as public (medicaid, medical assistance, or any kind of government assistance plan for those with low incomes or a disability); private (insurance through a current or former employer or union, insurance purchased directly from an insurance company, or tricare or other military health care or coverage through the affordable care act or other private insurance); or no current insurance. these response options were combined with the first question above to create a variable that indicated insurance type and status (12 months of only public insurance, 12 months of only private, and 12 months of no insurance coverage). using these response options, we then created three dichotomous variables (12 months of only public insurance versus 12 months of only private insurance, 12 months of only public insurance versus 12 months of no faubert et al./health insurance and youth 111 insurance coverage, and 12 months of only private insurance versus 12 months of no insurance coverage). we included the following covariates: gender, age, race/ethnicity, family structure, income (based on federal poverty level), caregivers’ highest level of education, primary language spoken in the home, metropolitan statistical area status, and child has special health care needs. these were chosen for inclusion because previous research has shown an association between these covariates, unmet needs, and insurance status (e.g., devoe et al., 2011; kreider et al., 2016; ortega et al., 2018), and because they are typically used in research conducted with this dataset (e.g., butler, weller, & titus, 2015; weller, blanford, & butler, 2018). we categorized race/ethnicity as hispanic, non-hispanic black, and nonhispanic white because previous studies that both used this dataset and examined race and ethnicity applied these categories (e.g., guerrero, zhou, & chung, 2018; zickafoose & davis, 2013). analysis analyses were conducted using mplus 8.2 (muthén & muthén, 1998-2018). we accounted for the complex approach to data collection in the statistical models by including sampling weights as well as specifying stratification and clustering as recommended by the nsch codebook (cahmi, 2018). to address research question one, we obtained weighted and unweighted statistics. to address research question two, multivariate probit regression was used. probit models were estimated using weighted least squares with mean and variance adjustment estimation (wlsmv) and specified theta parametrization. estimates were considered significant if p-values were less than .05 and the 95% confidence interval excluded zero. although findings from research question one indicated events per predictor variable were low (i.e., low counts of events compared to non-events), research indicates that regression models with categorical outcomes and wlsmv estimation can be used in these situations (crone & finlay, 2012; hox & maas, 2001; vittinghoff & mcculloch, 2006). the number of covariates to include in the probit models was in alignment with recommendations by vittinghoff and mcculloch (2006). sensitivity analyses were conducted to examine probit models with the inclusion of various combinations of covariates. missing data were addressed using the complete case method (muthén & muthén, 1998-2018). results results represent non-institutionalized hispanic, non-hispanic black, and nonhispanic white youth in the u.s. between the ages of 0 and 17 (n=40,723). the prevalence of u.s. youth with public, private, and no health insurance in 2016 was 33.3%, 60.6%, and 6.1%, respectively. these weighted percentages indicate that private insurance plans remain the largest provider of insurance for youth in the u.s. table 1 presents sample characteristics by insurance type (private, public, and no coverage). as shown, based on p-values less than .05, some of the sample characteristics differed statistically by insurance type and status. for family status, poverty level, and education (all of which were collapsed to include three categorical options), we found advances in social work, spring 2019, 19(1) 112 significant differences between public and private, public and no insurance, and private and no insurance. for child’s age, which also had three categorical options, we found a significant difference between public and private insurance as well as public and no insurance. further, for race, which also had three categorical options, we found a significant difference between public and private insurance as well as private and no insurance. see table 1 for details about the response options of each sample characteristic. for sample characteristics with two response options we also found some significant differences. youth who resided in a metropolitan statistical area, defined as one or more counties that contain a community of 50,000 people or more with adjacent counties from which people commute into the larger community (u.s. census bureau, 2018), were significantly more likely to have public (14.5%) versus private (10.9%) insurance and no (14.7%) insurance versus private (10.9%) insurance. compared to youth whose primary language was english, youth whose primary language was other than english were significantly more likely to have public (22.5%) versus private (5%) insurance, no (31.2%) versus public (22.5%) insurance, and no (31.2%) versus private (5%) insurance. youth with special health care needs were more likely to have public (25%) versus private (16.5%) insurance, public (25%) versus no (12.7%) insurance, and private (16.5%) versus no (12.7%) insurance. however, not all sample characteristics differed statistically by insurance type and status. for example, no significant difference was found between gender and insurance type and status; the percentage of females for public, private, and no insurance was 49.2%, 48.4%, and 54.1%, respectively. faubert et al./health insurance and youth 113 table 1. sample demographics unweighted number (weighted %) p valuesa total sample (n=40,723) public insurance (n=7,542) private insurance (n=31,780) no insurance (n=1,401) public vs. private public vs. none private vs. none gender female male 19,769 (49.0) 20,954 (51.0) 3,628 (49.2) 3,914 (50.8) 15,433 (48.4) 16,347 (51.6) 708 (54.1) 693 (45.9) 0.56 0.12 0.06 child’s age 0-5 11,594 (31.9) 2,322 (33.7) 8,958 (31.3) 314 (28.7) <.001* <.05* 0.5 6-11 12,098 (33.9) 2,470 (36.0) 9,213 (32.7) 415 (34.6) 12-17 17,031 (34.1) 2,750 (30.4) 13,609 (36.0) 672 (36.7) race/ethnicity hispanic 4,998 (26.8) 1,730 (40.0) 2,916 (17.6) 352 (46.0) <.001* 0.071 <.001* non-hispanic black 2,548 (13.6) 1,066 (21.3) 1,329 (9.0) 153 (17.8) non-hispanic white 33,177 (59.6) 4,746 (38.8) 27,535 (73.4) 896 (36.2) family structure two parent home 32,869 (75.9) 4,044 (57.5) 27,868 (86.9) 957 (65.0) <.001* <.01* <.001* one parent home 4,613 (15.3) 2,004 (26.6) 2,389 (8.8) 220 (18.8) other 2,614 (8.8) 1,325 (15.9) 1,121 (4.3) 168 (15.3) poverty level <100% 3,701 (20.6) 2,409 (42.8) 950 (6.0) 342 (44.2) <.001* <.05* <.001* 100-199% 6,069 (21.3) 2,895 (36.7) 2,801 (12.3) 373 (27.1) 200-399% 12,733 (27.4) 1,676 (15.7) 10,646 (34.8) 411 (18.8) 400%+ 18,220 (30.6) 562 (4.7) 17,383 (46.9) 275 (9.8) caregiver highest level of education <high school grad. 815 (8.6) 523 (17.5) 132 (1.6) 160 (29.4) <.001* <.001* <.001* high school grad. 4,820 (19.9) 2,235 (35.7) 2,243 (10.8) 342 (31.6) >high school grad. 34,214 (71.5) 4,519 (46.8) 28,871 (88.2) 824 (38.8) primary language other than english 1,795 (12.4) 835 (22.5) 752 (5.0) 208 (31.2) <.001* <.01* <.001* msab 4,610 (12.4) 1,319 (14.5) 3,074 (10.9) 217 (14.7) <.001* 0.95 <.05* has special health care needs 9,139 (19.1) 2,356 (25.0) 6,506 (16.5) 277 (12.7) <.001* <.001* <.05* *indicated significant at a p-value less than .05. aweighted chi-square statistic. bmsa refers to metropolitan statistical area. advances in social work, spring 2019, 19(1) 114 table 2 presents the prevalence of unmet health care needs by public, private, and no health insurance among u.s. youth in 2016. as shown, 2.6% of the total sample had unmet health care needs. across the various types of health care needs, dental care was the most prevalent unmet need (1.5%) followed by both mental health services (0.8%) and medical health care (0.8%). further, 3.3% of youth with public insurance and 1.4% of youth with private health insurance reported overall unmet needs. regardless of type of insurance, across the various types of health care needs, the most common unmet need was dental followed by mental health services. approximately 10% of youth with no insurance coverage had unmet needs, with 8% reporting an unmet need for dental care and 4.3% forgoing needed medical care. table 2. prevalence of unmet health care needs among u.s. youth, 2016 unweighted number (weighted %) total sample (n=40,723) public insurance (n=7,542) private insurance (n=31,780) no insurance (n=1,401) forgone health care unmet need 834 (2.6) 288 (3.3) 415 (1.4) 131 (10.1) received needed care 39,802 (97.4) 7,224 (96.7) 31,317 (98.6) 1,261 (89.9) medical health care unmet need 234 (0.8) 64 (0.9) 107 (0.4) 63 (4.3) received needed care 40,390 (99.2) 7,444 (98.1) 31,617 (99.6) 1,329 (95.7) dental care unmet need 377 (1.5) 134 (1.9) 160 (0.7) 83 (8.0) received needed care 38,750 (98.5) 7,041 (98.1) 30,439 (99.3) 1,270 (92.0) vision unmet need 129 (0.5) 46 (0.6) 47 (0.2) 36 (3.5) received needed care 40,495 (99.5) 7,462 (99.4) 31,677 (99.8) 1,356 (96.5) hearing unmet need 49 (0.3) 18 (.4) 19 (0.1) 12 (1.4) received needed care 40,575 (99.7) 7,490 (99.6) 31,705 (99.9) 1,380 (98.6) mental health care unmet need 257 (0.8) 92 (1.0) 141 (0.5) 24 (1.7) received needed care 34,801 (99.2) 6,329 (99.0) 27,236 (99.5) 1,236 (98.3) other health care unmet need 113 (0.4) 47 (0.6) 51 (0.2) 15 (.7) received needed care 40,511 (99.6) 7,461 (99.4) 31,673 (99.8) 1,377 (99.3) table 3 presents the probit results examining differences in unmet health care needs by insurance type and coverage. as shown, youth with public versus private insurance had no significant difference in any unmet health care needs. for example, youth who have forgone health care were equally likely to have public versus private insurance (b = .04, 95% ci [-.142, .227], p-value = .65). similarly, no significant difference was found between youth with public versus private insurance for medical health care (b = -.01, 95% ci [-0.304, 0.281], p-value = .94). faubert et al./health insurance and youth 115 table 3. differences in unmet needs by insurance type and status among u.s. youth in 2016 unmet need public vs. private insurance public vs. no insurance private vs. no insurance b p 95% ci b p 95% ci b p 95% ci forgone health carea,b 0.04 0.65 [-0.142, 0.227] -0.67 <0.001* [-0.893, -0.445] -0.72 <0.001* [-1.055, -0.381] unmet vision carea 0.17 0.38 [-0.212, 0.561] -0.74 <0.001* [-1.065, -0.422] -0.71 <.01* [-1.173, -0.251] unmet other health carea 0.11 0.59 [-0.280, 0.492] -0.17 0.305 [-0.495, 0.155] -0.64 <.01* [-1.053, -0.219] unmet medical health carea -0.01 0.94 [-0.304, 0.281] -0.75 <0.001* [-1.012, -0.477] -0.72 <0.001* [-1.074, -0.36] unmet hearing carec -0.05 0.87 [-0.658, 0.556] -0.62 <.05* [-1.196, -0.049] -0.89 <0.001* [-1.317, -0.463] unmet dental carea 0.13 0.30 [-0.120, 0.384] -0.74 <0.001* [-1.000, -0.469] -0.75 <.01* [-1.232, -0.268] unmet mental health care a -0.1 0.45 [-0.325, 0.143] -0.35 <.05* [-0.665, -0.027] -0.5 <.01* [-0.786, -0.218] a model controlled for race/ethnicity, income, geographic region, and special health care needs. b health care need refers to any health care need (e.g., medical, dental, vision). c models for private vs. public and public vs. no insurance controlled for race/ethnicity, income, geographic region, and special health care needs. model for private vs. no insurance controlled only for children with special health care needs due to the small cell size. *p<.05, **p<.01, ***p<.001 advances in social work, spring 2019, 19(1) 116 youth with no insurance were significantly more likely to have six of the seven unmet needs than youth with public health insurance. for example, youth with no insurance coverage were more likely than youth with public health insurance to have foregone care (b = -.67, 95% ci [-0.893, -0.445], p-value = <.001). similarly, unmet needs for medical care were more likely for youth with no health insurance than youth with public health insurance (b = -.75, 95% ci [-1.012, -0.477], p-value = <.001). the only unmet need that did not differ significantly for youth without health insurance from youth with public insurance was “other” unmet need, which measured miscellaneous health care needs that did not fit the predetermined categories. youth with no insurance were significantly more likely than youth with private insurance to have unmet needs in all reported categories, including in the miscellaneous other health care category. youth without insurance were more likely than youth with private insurance to forgo needed care (b = -.72, 95% ci [-1.055, -0.381], p-value = <.001) and experience an unmet medical need (b = -.72, 95% ci [-1.074, -0.36], p-value = <.001). discussion the present study examined youths’ unmet needs by insurance coverage and status, six years post-aca enactment. overall, the majority of u.s. youth had private, followed by public, health insurance, with a relatively small percentage of youth not having any insurance coverage. among youth with either private or public insurance, few caregivers reported that their child had an unmet health care need and no significant differences were found between unmet needs and type of insurance. this finding confirms some prior research (devoe et al., 2011), yet is contrary to other studies that did find a discrepancy between coverage types (e.g., derigne et al., 2009; kreider et al., 2016). similar to prior research, we found unmet health care needs were more likely among youth without health insurance coverage than youth with either public or private insurance (derigne et al., 2009; miller et al., 2013). debates surrounding health insurance policy persist as liberal and conservative policymakers argue that public or private insurance is the preferable solution to the health care issues faced by individuals in the u.s. (levitt, 2017b). our research indicates this argument is inconsequential – both private and public insurance appear to be able to meet the needs of u.s. youth who have access to coverage. indeed, we found no significant difference in unmet needs between youth with public and youth with private insurance. moreover, youth with health insurance, regardless of the source, were more likely to have their health care needs met than youth without health insurance coverage. our findings suggest that increased access to health insurance may be a crucial factor in addressing youths’ unmet health care needs. therefore, important next steps include policy solutions that can increase the accessibility of health insurance for all youth. the aca has increased access to both private and public health insurance across the u.s. (blumberg et al., 2018); therefore, we posit that the aca may be a valuable tool in meeting youths’ health care needs. to reach the remaining population of uninsured youth in the u.s., our findings suggest further expansion of the aca to support increased access to both the private and public insurance marketplaces. further, because insurance coverage faubert et al./health insurance and youth 117 appears to be a crucial factor in meeting youths’ health care needs, our findings may offer support for a fully-public, single-payer health care system. in particular, a policy that ensures health insurance for all youth could eliminate the disparities between youth with no insurance and youth with insurance, thus more effectively meeting all youths’ needs. however, as public and private insurance did not differ in their ability to meet youths’ needs, our findings do not support for one type of insurance coverage over another. although this study contributes to the national debate on health insurance, further research is needed. future studies should analyze youth who experience a gap in health insurance to examine how these gaps impact health care needs (federico et al., 2007). research is also needed to understand why a small percentage of youth with health insurance, either public or private, had unmet needs. additionally, research needs to replicate the findings in this study both with later versions of this dataset to establish trends and using other nationally representative datasets such as the national health interview survey (centers for disease control and prevention, 2019) and the fragile family and child well-being study (princeton university, 2019). lastly, because hispanic and nonhispanic black youth are less likely to be covered by health insurance than non-hispanic white youth (ortega et al., 2018), additional studies should examine differences in unmet health care needs and health insurance coverage by race/ethnicity. limitations although this study contributes to current research by providing an updated view of the health insurance status of youth in the u.s., it has several limitations. the crosssectional nature of this study precludes comparisons across time, making it impossible to determine exactly which policies have had the most impact on access to health insurance. further, because of changes to data collection procedures, results from this study cannot be compared to previous versions of the national survey of children’s health (camhi, 2018). coding the insurance variable into a private versus public dichotomy ignores the potential differences between individual insurance companies. moreover, the sample of u.s. youth used in this study excludes institutionalized youth and youth not identified as hispanic, non-hispanic white, or non-hispanic black. conclusion in sum, the purpose of this study was to address ongoing debates surrounding health policy, particularly access to health insurance and its influence on u.s. youth, by estimating and comparing youths’ unmet health care needs by health insurance type and status. results revealed no significant difference in unmet needs for youth with public versus private insurance but did support prior research in identifying differences between youth with and without insurance coverage. results from this study can inform future policy advocacy efforts. in particular, our findings suggest that increased access to insurance coverage, regardless of type, may be a major factor in reducing youths’ unmet health care needs; therefore, expanding access for all youth should be a priority for social work advocacy. advances in social work, spring 2019, 19(1) 118 references bagley, n. 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(2013). medical home disparities are not created equal: differences in the medical home for children from different vulnerable groups. journal of health care for the poor and underserved, 24(3), 1331-1343. doi: https://doi.org/10.1353/hpu.2013.0117 author note: address correspondence to: sarah j. faubert, llmsw-macro, grand valley state university cook-devos center for health sciences, suite 323, 301 michigan st ne, grand rapids, mi 49503. fauberts@gvsu.edu https://doi.org/10.1097/dbp.0000000000000363 https://doi.org/10.1371/journal.pone.0082570 https://doi.org/10.1016/j.socscimed.2017.03.055 https://doi.org/10.1016/j.acap.2017.07.006 https://fragilefamilies.princeton.edu/about http://www.childheathdata.org/ https://doi.org/10.1093/aje/kwk052 https://doi.org/10.1016/j.jadohealth.2017.12.020 https://doi.org/10.1353/hpu.2013.0117 mailto:fauberts@gvsu.edu _______ mary twis, phd, lmsw-ap, assistant professor, department of social work, texas christian university, fort worth, tx. don greenwood, lmsw, guidance consultant, compsych employee assistance programs. morgan files, msw, program support specialist, traffick911, dallas, tx. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1006-1023, doi: 10.18060/25577 this work is licensed under a creative commons attribution 4.0 international license. enhancing student commitment to the micro-mezzo-macro continuum: the macro practice assignment mary twis don greenwood morgan files abstract: despite the importance of macro practice to the social work profession, research related to social work students’ preparation and enthusiasm for macro practice suggests that there is significant room for improvement within macro social work education. the purpose of this report is to describe and explore a novel macro social work pedagogy that is designed to encourage student engagement within macro practice social work courses. the macro practice assignment (mpa) offers students a real-world learning exercise with embedded micro, mezzo, and macro social work applications with one vulnerable population. the results of a multiple case study exploring the effectiveness of the mpa reveals that the mpa 1) reduces students’ negative perceptions of macro practice courses and careers, 2) fosters students’ interest in future macro practice, and 3) helps students see macro practice as a necessary component of the micro-mezzo-macro practice continuum. in order to address shortcomings in macro social work education, educators should consider adding real-world macro practice learning exercises such as the mpa, grounded in bloom’s taxonomy, with the goal of enhancing social workers’ lifelong commitment to macro practice. keywords: human trafficking; teaching in social work; macro practice; human trafficking education; social work education macro social work education typically addresses core social work competencies related to engaging, assessing, intervening, and evaluating practice with organizations and communities (council on social work education [cswe], 2022). although learning objectives related to these competencies are essential for budding social workers, students who enter the field with more interest in direct practice with individuals, families, and groups may find macro social work instruction to be less immediately relevant to their professional goals than instruction in other types of social work (crutchfield et al., 2016). this is problematic, since a commitment to macro practice is core to the social work profession. even social workers primarily engaged in micro or mezzo practice are ethically obligated to apply macro social work skills within their direct practice contexts (national association of social workers [nasw], 2021). the purpose of this paper is to describe and explore a novel macro practice pedagogy that we designed to encourage student engagement within a macro practice social work course. we developed the macro practice assignment (mpa) to offer students a real-world learning exercise with embedded micro, mezzo, and macro social work applications. first, we describe the mpa, its theoretical grounding, its learning objectives, and its promise for transformational social work education. we then report the results of a mixed methods about:blank twis et al./enhancing student committment 1007 multiple case pilot study, which we undertook to answer questions about 1) students’ understanding of and commitment to the micro-mezzo-macro practice continuum after completing the mpa, and 2) students’ development of micro, mezzo, and macro practice skills related to one specific vulnerable population that students engaged through the mpa. first, we review the literature related to the importance of macro practice and students’ perceptions of macro social work education in order to lay the foundation for why experience-based assignments like the mpa ought to be considered for implementation in macro social work practice courses. literature review the nasw (2021) code of ethics encourages social work professionals to advocate for social justice, to enhance the well-being of all people, to meet basic needs, and to empower groups of people who are oppressed and vulnerable. the code of ethics also encourages social workers to increase institutional and community responsiveness to individual and community needs (nasw, 2021). of course, social workers can carry out these ethical obligations within the context of micro, mezzo, or macro practice, or some blend thereof (austin et al., 2016). research related to social work practice, however, indicates that most early career social workers enter the profession with a near-singular focus on micro or mezzo practice (austin, 2019; mcbeath, 2016; reisch, 2017; salsberg et al., 2019). unfortunately, macro practice has historically been overlooked as a career goal by social work students and early career practitioners alike (salsberg et al., 2019), despite the fact that macro practice can sustain and positively impact quality of life through important social work activities like advocacy, policy creation, administration, evaluation, community organizing, and more (hill et al., 2017; netting, 2005; salsberg et al., 2019; rothman & mizrahi, 2014). in addition to the positive outcomes associated with these macro practice activities, scholars have noted that macro practice is uniquely suited to examine and address the underlying structures of society that lead to and compound systemic oppressions and inequalities like racism, sexism, and poverty (netting, 2005; reisch, 2017). despite perceptions to the contrary, macro social work practice is not a niche subspecialty within the profession, with few accompanying job prospects (ezell et al., 2004). social work graduates with macro specializations report that they are able to obtain jobs within the profession (pritzker & applewhite, 2015; zippay & demone, 2011), including jobs that tend to have greater than average salaries for social workers. for instance, zippay and demone (2011) found that social work graduates who specialized in macro practice often engage in activities like supervision, program development, planning, and program evaluation. pritzker and applewhite (2015) likewise found that macro practice graduates reported frequent engagement in activities like evaluation, project management, budgeting, advocacy, and coalition building, and that their jobs were also open to other professionals with graduate degrees in public health, public administration, and business. the wide range of macro practice jobs available to social work graduates— and the importance of macro practice skills and activities for the successful completion of these jobs—points to the reality that macro social work education is as practically relevant advances in social work, fall 2022, 22(3) 1008 to social work students as it is a vital component of ethical and competent social work practice (ezell et al., 2004; hill et al., 2017). students’ perceptions of macro social work education unfortunately, a variety of evidence suggests that social work education does not adequately prepare graduating students to a) demonstrate a commitment to lifelong macro social work practice, b) effectively apply macro practice skills, nor c) compete with other professionals for macro practice-focused jobs. for instance, in a national survey of graduate social work students, salzburg and colleagues (2019) found that most recent social work graduates over 82%, in fact work directly with individuals or groups, while roughly 8% work in indirect roles such as administration or research, and only about 5% work in community practice or community organizing roles. these employment trends are mirrored when examining graduate social work students’ professional interests and intentions. in the same study (salsberg et al., 2019), the authors found that nearly 82% of recent graduates reported that they were most interested in micro social work practice, whereas only 9% stated that they were most interested in indirect or macro practice. social work educational programs in the united states, likewise, are largely focused on direct practice and clinical social work specializations rather than social work administration or community practice (ezell et al., 2004; hill et al., 2017; liddell & lass, 2019). within this social work educational environment, perhaps it is unsurprising that macro social work students have reported dissatisfaction with macro practice course material and experiences (deal et al., 2007; hill et al., 2017; liddell & lass, 2019). course content and field experiences are meant to provide students with the professional skills to meet their social work professional goals, so it is concerning that the students who are most interested in carrying forward the macro practice torch report that they lack the same educational opportunities as social work students who are more interested in micro and mezzo practice (deal et al., 2007; hill et al., 2017; liddell & lass, 2019). for instance, liddell and lass (2019) found that nearly 42% of students enrolled in a community practice program strongly disagreed that the quality of community practice course material was equal to the quality of clinical practice course material. the authors also found that roughly 42% of the student participants felt that instructors covered community practice course material insufficiently and that the material lacked the same depth as clinical material (liddell & lass, 2019). although this is but one study, the results are troubling because the sample was comprised of students who evidenced some predisposition towards macro social work practice, rather than viewing it as a necessary educational nuisance on their way to a social work degree, as some social work students do (crutchfield et al., 2016). research has also found that macro practice students were often told by social work educators that it is difficult to obtain a job and pass the licensing exam with a concentration in macro practice – which perhaps speaks to the content of licensing exams (plitt donaldson et al., 2016). social work students often perceived their foundational social work courses to be void of relevant examples of macro practice and social work administration (ezell et al., 2004; zerden et al., 2016). likewise, faculty members who teach macro practice often feel unsupported by their departments and institutions while teaching macro content (rothman, 2013). additional research on macro social work education suggests that macro students twis et al./enhancing student committment 1009 are significantly more dissatisfied with their field placements, and significantly less confident in their preparation to meet workplace demands than their micro practice-focused peers (deal et al., 2007; iverson et al., 2021; williams-gray, 2014). in light of these findings, it is reasonable to hypothesize that the inattention to macro social work education may lead to future generations of social workers feeling ill-equipped to independently apply macro practice skills, theories, and concepts that are important for effective macro practice (deal et al., 2007; netting, 2005). in order to address these shortcomings in macro social work education, various authors have suggested that professors assigned to teach macro practice courses could or should implement community-based or service-learning projects in their classes (crutchfield et al., 2016; lucero et al., 2017). these types of projects can foster an understanding and application of macro practice skills and knowledge, thereby addressing some of the deficits associated with macro practice education. lucero and colleagues (2017) described one project in which a macro practice course partnered with a community institution to help implement a statewide survey. the qualitative student responses at the end of the course revealed that students had increased understanding, perceptions of competence, interest in macro practice, and willingness to shift their professional goals to include macro practice activities following the completion of the project (lucero et al., 2017). in describing and examining another macro practice activity, crutchfield and colleagues (2016) found that prior to completing a service-learning project, social work students initially reported a limited understanding of macro practice. at the end of the project, however, the students reported an increased awareness of macro practice strategies and skills, including advocacy skills that are applicable to micro, mezzo, and macro levels of practice. the results of the studies accompanying these activities suggest that practical, in-class projects that encourage students to apply macro knowledge and skills have the potential to bolster professional interest in macro practice, and better equip students to incorporate macro strategies into their social work careers. however, these studies did not explicitly examine how or whether students’ understanding of the micro-mezzo-macro practice continuum developed as a result of completing the projects, nor how or whether their micro-mezzomacro practice skills developed concurrently with the projects. we developed the macro practice assignment (mpa) described below, and a corresponding multiple case study, to address these unanswered questions about macro practice pedagogy. macro practice assignment (mpa) description given both the importance of macro practice, and the limitations of macro social work education cited above, we created the mpa to encourage social work students to meaningfully engage in macro social work education—with the hope that doing so would encourage lifelong engagement with macro practice. we hypothesized that delivering the mpa would reduce students’ negative perceptions of macro practice courses and careers, foster their interest in future macro practice, and help them see macro practice as a necessary component of the micro-mezzo-macro practice continuum. here, we describe the seven components of the mpa, each of which is grounded in bloom’s taxonomy. bloom’s taxonomy calls on educators to build students’ knowledge by first exposing them to factual knowledge, then conceptual knowledge, procedural knowledge, and finally metacognitive knowledge (anderson & krathwohl, 2001; anderson & sosniak, 1994; advances in social work, fall 2022, 22(3) 1010 bloom & krathwohl, 1956). we designed the components of the mpa to guide students in their acquisition of these layers of knowledge about both macro practice and one specific vulnerable population. in figure 1, we illustrate how the components of mpa build students’ knowledge layer by layer, according to the parameters laid out by bloom’s theoretical model. the assignment’s focus on one vulnerable population was by design. curriculum crowding is an ongoing concern in social work education that we sought to address in this project. we hypothesized that providing in-depth information about a specific vulnerable population/practice area through the mpa would provide students with a clear illustration of the relevance of macro social work practice with the population. we believe that the mpa can be modified to fit various class sizes, collaborating agency needs, and vulnerable populations. the mpa as we describe it here is specific to a macro practice course taught in both spring 2020 and spring 2021. the mpa ran for the duration of the 15-week course; students worked on the individual and group components of the mpa while learning macro practice course content on a weekly basis. (specific course syllabus, class schedule, assignment instructions, assignment requirements, and grading rubrics are available for review upon request.) pre-course collaboration with agency serving a vulnerable population. prior to beginning each semester, we collaborated with a non-profit agency providing a range of services to a vulnerable population. in this iteration of the mpa, we selected an agency serving domestic minor sex trafficking (dmst) survivors. we encouraged the non-profit terms, theories, definitions, and basic elements of macro social work practice, and of working with a specific vulnerable population. mpa components include instructor-guided readings. factual conceptual understanding interrelationships between factual concepts. mpa components include legislative bill monitoring work, grant application, and community meeting reflection. connecting factual and conceptual knowledge to practice. mpa components include the needs assessment and community intervention report. procedural metacognitive self-reflection on macro practice procedures and application to practice. mpa components include all selfreflection activities. figure 1. the mpa mapped to bloom’s taxonomy framework twis et al./enhancing student committment 1011 agency (hereafter called community agency) to articulate 1-2 macro-level goals they would work towards if they had student volunteers available to help accomplish the goals; after they articulated these goals, we included the goals in the course syllabus. these goals became the overarching goals for students when they began working on the mpa. importantly, students were not graded on whether or not they accomplished their assigned overarching goals for community agency. instead, the goals offered the students a lowstakes opportunity to simulate and reflect on micro, mezzo, and macro practice skills through the completion of mpa components. the mpa components, in turn, existed in service to the eventual completion of the community agency’s aspirational goals. although students did not actually participate in the pre-course collaboration component of the mpa, this work is crucial for the success of the mpa and the course itself. precourse collaboration allows the mpa to unfold as a partnership that exists in service to the agency, rather than a partnership that exists in service to the students. instructor-guided readings. the mpa began with students reading six articles pertaining to human trafficking populations. again, we believed this level of population focus was important for building students’ buy-in to course activities, and exposing them to a new content area that they would otherwise only encounter through elective-type courses. the articles included information about human trafficking, and about micro, mezzo, and macro practice skills that social workers use with human trafficking survivor populations. students completed these readings individually. community meeting reflection. the students then attended a community meeting organized by the community agency. the meeting offered students an opportunity to observe stakeholders discussing human trafficking and community agency’s initiatives. students then completed an individual assignment where they reflected on a) what they expected from the meeting, b) how the meeting did or did not meet their expectations, c) whether or not the meeting adhered to social work values, and d) how they would apply macro practice concepts to improve or enhance the meeting’s processes. legislative bill description and monitoring. next, students were required to identify state-level policies relevant to community agency and/or the human trafficking survivor population. students then submitted an individual paper where they a) identified a bill from a recent state legislative session, b) identified how and why the bill was relevant to community agency and/or human trafficking survivors, c) described the bill’s process through the legislative system, and d) described the bill’s potential impacts on community agency and/or human trafficking survivors. grant proposal. prior to the start of each semester, we set aside roughly $400 from a small community engagement grant for use in the mpa. the purpose of the grant proposal component of the mpa was to give students an opportunity to practice writing a grant proposal. students were instructed to use any funds they received towards the implementation of their selected macro intervention with community agency; the selected macro intervention was to move community agency closer to its stated goals. students were instructed to work in their groups to complete the grant proposal, which we then funded for the students. grant totals ranged between roughly $100 $250. advances in social work, fall 2022, 22(3) 1012 needs assessment and community intervention report. this report served as the culmination of students’ work over the course of each semester. students worked in groups to discuss a specific need of community agency or the human trafficking population it served. after deciding upon a need to address through selected macro interventions, the students prepared focused 20-page papers that a) provided a description of the local human trafficking survivor population and community agency’s related need, b) discussed the general changes and interventions that needed to occur so that community agency could better meet clients’ needs, c) described what their group did during the mpa with community agency, and d) identified and described how student activities met the needs identified in sections a-c of the paper. self-reflection. the final mpa activity was a self-reflection. in this paper, students individually reflected on a) what they learned as a result of the mpa, b) what was rewarding and frustrating about the experience, c) how they intended to apply their learning to future work, and d) how the project advanced human rights and social, economic, and environmental justice. case study research questions throughout the development and implementation of the mpa, we attempted to adhere closely to the principles of bloom’s taxonomy (anderson & krathwohl, 2001; anderson & sosniak, 1994; bloom & krathwohl, 1956) to ensure that students were, indeed, developing their macro practice competencies through the mpa. the assignment’s theoretical underpinnings, however, did not provide us with assurance that the mpa is a uniquely effective macro practice pedagogy, nor did it provide us with evidence that the mpa encourages increased levels of student engagement in macro practice (or micro and mezzo practice, for that matter). as a result, we chose to scrutinize the mpa through a research study, spanning two different semesters and iterations of the course, in order to answer the following research questions: 1) how does students’ understanding of, and commitment to, the micro-mezzomacro practice continuum develop as a result of completing the mpa? 2) how do students’ micro-mezzo-macro practice skills—related to one specific vulnerable population engaged through the mpa—develop during the mpa? answers to these research questions will inform whether the mpa is worth adapting, implementing, and further analyzing as a potentially promising and transformational macro social work pedagogy. methods this research study adheres to a mixed methods multiple case study design (creswell, 2013; gustafsson, 2017; zach, 2006). we selected this approach because it is effective for answering exploratory research questions about an area of interest—particularly in cases where the sample size is constrained, but the depth of data is not (creswell, 2013). although we believe this method is appropriate for initial explorations of the mpa, the twis et al./enhancing student committment 1013 inherent limitations of a case study design mean that we would likely select a different method for subsequent inquiries into the mpa’s feasibility, future analyses of the specific student learning outcomes associated with the mpa, and whether these students’ learning outcomes are enhanced by the mpa in comparison to other macro social work pedagogies. despite our small sample size and the limitations of case study research (yin, 1994), the study design lends strength and reliability to our findings, because it provided us with multiple data types (quantitative, qualitative) and multiple data sources to answer our research questions (zach, 2006). sampling and participants before we began collecting data from our study sample, we sought institutional review board (irb) approval. the university irb granted an exemption for this study because study procedures were determined to pose minimal risk to participants. for the study, we sampled two separate cohorts of social work graduate students over two semesters of the macro practice course (spring 2020 and spring 2021). all of the students included in the study were enrolled in the same generalist social work program. both semesters of the course were held at a private university in a large metropolitan area in the southwest united states. although the course was intended to be held in-person, the course instructor (first author) moved the spring 2020 course to an online format shortly after the mid-term because of campus closures related to the covid-19 pandemic. the course remained online-only for the spring 2021 semester. since the students in this study were all enrolled in a two-year social work graduate program, none of the students had any social work experience prior to fall 2019 and fall 2020, respectively. none of the students had previously taken a macro practice course. of the 15 students included as participants in the study, 5 took the course in spring 2020 and 10 took the course in spring 2021. twelve of the students (80%) identified as female and three of the students (20%) identified as male. eleven of the students (73.3%) identified as non-hispanic white, three of the students (20%) identified as hispanic, and one student (6.6%) identified as african american. on the first day of the class in each semester, all 15 students said they intended to find employment in direct practice social work (micro or mezzo) upon graduation. instruments and procedures mixed methods multiple case study designs require researchers to use several instruments, measures, or data collection approaches (gustafsson, 2017), in order to enhance the depth of data collected and allow for improved data triangulation. for the purposes of this study, we used three separate data collection tools in order to gather a wealth of data from our small sample. the tools included a knowledge, skills, and behaviors inventory (preand post-test), focus group prompts, and a reflection journal. knowledge, skills, and behaviors inventory. after we collected informed consent from the students in january 2020 and january 2021, a research assistant distributed an 18question knowledge, skills, and behaviors inventory via qualtrics prior to the delivery of course content (see table 1 for questions in the inventory). this instrument is not validated, which is a limitation of the design, but we were unable to locate a relevant, reliable, and advances in social work, fall 2022, 22(3) 1014 validated instrument for our purposes. we developed this inventory to assess students’ knowledge of human trafficking as a social issue, and to assess how they might apply a range of social work skills and behaviors to three human trafficking case vignettes. we wrote these case vignettes because they correspond with relevant and diverse fields of social work practice, including medical social work, community mental health, and social work in a criminal justice setting. we also wrote questions related to human trafficking knowledge that we were able to pull from the individual mpa readings. once the students had completed the pre-test, they were briefed on the mpa. the same knowledge, skills, and behaviors inventory was distributed to our sample at the end of the semester in april 2020 and april 2021. focus groups. in addition to the preand post-tests, we deployed focus group prompts to the students in late-april 2020 and late-april 2021, with the intent of gathering narrative data about the mpa and students’ new understandings of micro-mezzo-macro practice and human trafficking. we initially intended for the prompts to be delivered through in-person focus groups, but we had to move the data collection in spring 2020 to an online discussion board format because of the effects of covid-19 on the macro practice course. thus, instead of a conversational focus group, responses were constrained into a written response format. our plan was for a research assistant to run the focus groups so students could speak more freely, but this became impossible with the online discussion format. as a result, it is possible that students censored their responses, since they knew the course instructor would read their answers. in spring 2021, we conducted the focus group via zoom, and transcribed the recordings for subsequent analysis. we decided that this was the best approach to data collection, since the instructor had seen student responses in the previous year’s discussion board. the 12 questions posed via focus groups are available for review upon request. example questions include: “how do you feel your participation in this course’s macro project has influenced your future social work practice?” and “describe the social work skills that you believe are most important when working indirectly (macro practice) with sex trafficking survivors?” reflection journal. finally, we asked students to individually reflect and journal on what they learned from the mpa and how they intended to apply their learning to their future micro, mezzo, and macro social work practice. this reflection journal was a component of the mpa itself. the specific prompts for the reflection journal were: “how do you intend to apply what you learned in this class to your future work?” and “how did your work on this project advance human rights and social, economic, and environmental justice?” students received points for the journal if they completed it, but the content itself was not graded. analysis we first conducted descriptive statistical analyses on the preand post-test data. due to our small sample size, and some study attrition between preand post-tests, we were unable to conduct inferential statistical analyses. several students did not complete the post-test since they did not attend the class in which it was administered. consequently, we used abbreviated procedures to conduct a qualitative content analysis of the focus group twis et al./enhancing student committment 1015 and reflection journal data (hsieh & shannon, 2005). the first author coded the focus group and reflection journal data, and after checking these codes against the second and third authors’ interpretations of the data, the first author then returned to identify corresponding exemplar quotations. because the narrative data was brief and consistent, and already organized by question prompt, we present participants’ responses in the findings section by reporting the narratative data with question prompts rather than by qualitative themes. since all three data collection methods inquired about students’ knowledge, behaviors, and skills, we were able to triangulate findings from each data collection tool to help answer the study’s research questions. findings first, we present quantitative findings associated with the preand post-test knowledge, skills, and behaviors inventory, and then the qualitative findings associated with the discussion board and reflection journal data. we believe that these findings provide evidence that the mpa may be an effective novel pedagogy for macro social work education, because the mpa appears associated with improvements in students’ understanding of the micro-mezzo-macro practice continuum, and modest gains in their social work skills application with a vulnerable population. preand post-test findings first, we present student gains in social work skills application. in looking only at the knowledge, skills, and behaviors inventory preand post-test findings, it appears that students experienced modest changes in human trafficking knowledge, skills, and behaviors during the course of the mpa. see table 1 for preand post-test results. the students appeared to enter the course with a high level of knowledge about human trafficking and how to apply micro and mezzo practice skills to human trafficking populations. overall, they performed well on the inventory, scoring an average of 12.87 points (71.5%) on the measure. this suggests that students began the course with some baseline knowledge of the vulnerable population, and how they might apply their social work skills in work with human trafficking survivors in a variety of social work settings. of note, though, there were several questions on which the students performed more poorly than others. the questions that fewer than 70% of students answered correctly were q2, q9, q10, q11, q12, q16, and q17. interestingly, only one of these questions (q2) was designed to measure human trafficking knowledge; the remaining five questions were designed to measure social work skills and behaviors. it appeared that at the beginning of the mpa, students had greater difficulty understanding how to apply skills with human trafficking populations than they did in recalling facts related to human trafficking. although only thirteen students took the post-test, and it was not possible to know who completed it. post-test results suggested that students improved slightly in their knowledge of human trafficking and how to apply social work skills with this population following completion of the mpa. to begin, participants’ average scores increased from 12.87 (71.5%) to 13.69 points (76.1%) in their post-tests. of course, there are many confounding advances in social work, fall 2022, 22(3) 1016 factors that may have produced this result, but it appears that students experienced slight increases in knowledge and skill application with human trafficking survivors as a result of completing the mpa. table 1. knowledge, skills, and behaviors inventory: preand post-test results inventory question inventory responses pre-test n=15 post-test n =13** 1. according to the trafficking victims protection act, sex trafficking occurs—even in the absence of force, fraud, or coercion—when an individual exchanges sex for money or goods and is: a. an adult female b. *under the age of 18 c. an immigrant without legal docs d. unable to speak english 0 (0%) 13 (87%) 2 (13%) 0 (0%) 0 (0%) 11 (85%) 2 (15%) 0 (0%) 2. which of the following do experts largely consider the most significant risk factor for domestic minor sex trafficking? a. female gender b. male gender c. identifying as lgbtq d. *running away/homelessness 3 (20%) 0 (0%) 2 (13%) 10 (67%) 0 (0%) 0 (0%) 0 (0%) 13 (100%) 3. which of the following methods of coercion is most likely to be used by sex traffickers to gain control over their victims? a. physical restraints b. locked doors c. *threats d. drug restraints 0 (0%) 0 (0%) 11 (73%) 4 (27%) 0 (0%) 0 (0%) 10 (77%) 3 (23%) 4. at-risk youth are most likely to be trafficked for sex by: a. a federal law officer b. a businessperson c. a stranger d. *a family member/romantic partner 0 (0%) 3 (20%) 0 (0%) 12 (80%) 0 (0%) 0 (0%) 0 (0%) 13 (100%) 5. what is the first service that sex trafficking survivors typically require upon exiting the sex trade? a. an appointment with a mh clinician b. job placement services c. education/loan deferment services d. *crisis intervention services 3 (20%) 1 (7%) 0 (0%) 11 (73%) 0 (0%) 0 (0%) 0 (0%) 13 (100%) 6. as a social worker, which of the following is not considered a helpful behavior when working with a sex trafficking survivor? a. *relating to survivor’s experiences b. building a positive rapport c. articulating empathic understanding d. paraphrasing diverse needs 15 (100%) 0 (0%) 0 (0%) 0 (0%) 10 (83%) 1 (8%) 0 (0%) 1 (8%) 7. which of the following mental health disorders is a possible outcome of sex trafficking victimization? a. adhd b. bipolar disorder c. *post-traumatic stress disorder d. narcissistic personality disorder 0 (0%) 0 (0%) 15 (100%) 0 (0%) 0 (0%) 0 (0%) 12 (92%) 1 (8%) 8. social workers should consider using all but one of the following skills while working with sex trafficking survivors. which of the following skills should not be used by a social worker with this population? a. *pressing for details b. providing an orientation to services c. closed/open-ended questioning d. dedicating adequate time for discussion and questions 15 (100%) 0 (0%) 0 (0%) 0 (0%) 13 (100%) 0 (0%) 0 (0%) 0 (0%) 9. which of the following components of simone’s presentation do you think led to the social worker’s suspicion of human trafficking? a. simone’s age b. simone’s race and ethnicity c. *simone’s history d. simone’s manner of dress 3 (20%) 0 (0%) 9 (60%) 3 (20%) 3 (23%) 0 (0%) 6 (46%) 4 (31%) 10. which of the following is most suggestive that simone might be a victim of sex trafficking? a. her revealing clothing b. her difficulties with her stepfather c. her age d. *her boyfriend’s age 2 (13%) 0 (0%) 3 (20%) 10 (60%) 1 (8%) 0 (0%) 4 (31%) 8 (62%) twis et al./enhancing student committment 1017 table 1. knowledge, skills, and behaviors inventory: preand post-test results inventory question inventory responses pre-test n=15 post-test n =13** 11. which of the following behaviors is the most significant red flag for human trafficking? a. tommy’s frequent phone use b. simone’s reference to antibiotics c. simone looking at tommy d. *simone admitting that she ran away from home 0 (0%) 0 (0%) 14 (93%) 1 (7%) 0 (0%) 0 (0%) 9 (69%) 4 (31%) 12. why is it essential that all members of simone’s healthcare team be informed about the np’s and social worker’s suspicions of human trafficking? a. witnesses b. informed due to liability c. *wraparound services possible d. reporting to hotline 1 (7%) 2 (13%) 9 (60%) 3 (20%) 0 (0%) 0 (0%) 11 (85%) 2 (15%) 13. which of brian’s characteristics, or presenting concerns, might lead the social worker to suspect human trafficking? a. brian’s age b. *brian’s romantic involvement c. brian’s gender d. brian’s anxiety and depression 0 (0%) 15 (100%) 0 (0%) 0 (0%) 0 (0%) 13 (100%) 0 (0%) 0 (0%) 14. which factor is most indicative that brian might be a victim of sex trafficking? a. brian’s history with bullying b. brian’s bisexual identity c. *the power differentials with partner d. brian’s childhood history of sexual abuse 0 (0%) 0 (0%) 12 (80%) 3 (20%) 0 (0%) 3 (23%) 9 (69%) 1 (8%) 15. when the social worker begins to suspect that brian is a victim of trafficking, which of the following is the most appropriate question to ask? a. “have you ever wondered…?” b. “what does richard do for work…?” c. “why are you spending time…?” d. *“i’m feeling genuinely concerned…” 0 (0%) 2 (13%) 0 (0%) 13 (87%) 0 (0%) 0 (0%) 1 (8%) 12 (92%) 16. which of the following risk factors might lead the staff social worker to most suspect that jennifer is a victim of sex trafficking? a. *jennifer’s relationship with parents b. jennifer’s tattoos and piercings c. jennifer’s age d. jennifer’s race/ethnicity 8 (53%) 0 (0%) 7 (47%) 0 (0%) 6 (46%) 0 (0%) 7 (54%) 0 (0%) 17. which of the following social work behaviors is the most important one for the social worker to exhibit while working with jennifer? a. personally relating to experiences b. *empathizing with jennifer’s pain c. communicating familiarity d. understanding everything that jennifer is divulging 0 (0%) 3 (20%) 0 (0%) 12 (80%) 0 (0%) 5 (38%) 1 (8%) 7 (54%) 18. when interacting with jennifer, which social worker skill is the most important for assisting an individual in her position? a. *assessing jennifer’s resources b. setting strict boundaries c. being available 24 hours a day d. growing comfortable with stories of abuse 11 (73%) 3 (20%) 0 (0%) 1 (7%) 9 (69%) 4 (31%) 0 (0%) 0 (0%) average score 12.9 (71.5%) 13.7 (76.1%) *correct answer; **post-test results n = 13, unless participant left answer blank focus group and reflection journal findings when we triangulated the preand post-test findings against this study’s qualitative findings, we observed increased evidence beyond the inventory that, after completing the mpa, macro social work students a) develop micro-mezzo-macro practice skills, and b) display an understanding of the micro-mezzo-macro practice continuum. since student responses were fairly brief, we have included a selection of their responses below. advances in social work, fall 2022, 22(3) 1018 focus group prompts. in response to a range of questions about macro social work, micro social work, human trafficking, and students’ future professional goals, participants spoke very positively about the mpa. in particular, they felt that the mpa provided them opportunities to apply skills, engage in meaningful practice, become more motivated for macro work, and build the depth and breadth of their social work knowledge. to begin, over half of the students said that the mpa offered them an opportunity to apply a range of social work skills to a real-world scenario, and that this was valuable for their learning even when it was challenging. one student said, for instance, that “the [mpa] was massive and the group element was quite tricky at times…but i still was able to learn a lot about myself and about this issue.” the group activity itself was an opportunity for students to learn more about how to engage in mezzo practice with a team. similarly, seven students referenced the meaningful practice offered to them by the mpa as an important element of learning. these students highly valued the real-world scenario and practice experience they gleaned from the mpa. one student commented, for example, “we have talked about in the course how it’s important to work with people who have differing opinions than us, because things don’t always come together when everyone is the same.” similarly, the ways in which students were required to engage with a vulnerable population, collaborate with an outside agency, and collaborate with each other, meant that students were able to practice group work and interpersonal dynamics in the context of macro practice, thereby developing the depth and breadth of students’ knowledge base. one student explained, “having to dive head-first into this project while working through class material provided a huge variety of lenses through which to view the issue and i would have to say that has been my biggest takeaway.” perhaps most important for this study’s purposes, a majority of the students commented that they began the mpa with little affinity for macro work, but left the mpa with a newfound motivation to engage in and appreciate macro social work practice. one student said, “firstly, when beginning this class, i would have to say i personally was fairly adamant about not going into macro practice in the future. while i still feel like micro work is where my skill set functions best, this class and this project has taught me that both macro and micro work go together and you cannot have one without the other.” contact the author for additional focus group responses. reflection journals. students provided similar responses to the discussion board in their reflection journals, even with different question prompts. every sampled student stated that the mpa provided them with increased motivation for macro practice, allowed them to apply their skills, and expanded the depth and breadth of their knowledge. one student shared she felt committed to engaging in macro social work throughout her career: “as future social workers, by working on this project, all of the knowledge we have gained will travel with us throughout the entirety of our careers and we will be equipped to continuously support human rights and all forms of justice through the work that we as individuals will do.” another student commented that she sees the direct application of her newfound depth and breadth of knowledge to her future career: “post-graduation, i want to go into medical social work and i wonder if i will ever come into contact with someone touched by human trafficking—i feel the chances are high that i might, and with the knowledge gained from this project, i know that i will be more equipped to understand twis et al./enhancing student committment 1019 their experience and also possibly the ways in which i can be of the most help to them.” although these comments did not diverge much from the focus group responses, when we directly asked students about the relationship between macro social work and the social work value of social justice, they quickly made connections between the two. one student explained how she infused principles of social justice into the mpa: “overall, the project led to a product that would have highlighted lived experiences, represented a diverse range of people, increased awareness of human trafficking, and emphasized the need for this population to have access to quality resources and care.” as seen in these responses, students viewed the mpa positively and saw its relevance to their careers and lives. discussion the findings from this study suggest that the mpa is an effective approach to help graduate social work students develop an increased understanding of, and commitment to, the micro-mezzo-macro practice continuum, and that they also gained micro, mezzo, and macro practice skills with one specific vulnerable population. although this is a small case study, the quantitative and qualitative findings suggest that students may improve, in particular, their applied behaviors and skills with human trafficking populations. findings also suggest that students demonstrate an increased interest in macro practice, and an increased awareness of how macro practice is relevant to micro and mezzo social work, and vice versa. our qualitative findings further suggest that the effectiveness of the mpa is grounded in the ways in which it encourages knowledge depth and breadth, skills application, and skills practice. these themes—which we observed throughout the narrative data—align well with the elements of bloom’s taxonomy that we sought to infuse into the mpa. we aspired to expose our students to factual knowledge through the mpa’s required readings; to conceptual knowledge through the community meeting reflection, the legislative bill description and monitoring assignment, and the grant proposal; to procedural knowledge through the completion of the needs assessment and community intervention report; and finally meta-cognitive knowledge through the self-reflection paper. it appears as though these knowledge elements and corresponding activities, purposefully infused into the mpa, enhanced student motivation for macro practice and student recognition that macro work is transformational social justice work. of course, it is possible to include these knowledge elements into many different types of macro practice assignments. my own (first author) undergraduate macro practice course included a community engagement assignment, in which we completed a macro activity for a local non-profit. the mpa is perhaps unique, however, in that we designed it to focus specifically on one vulnerable population, we selected readings that applied to micromezzo-macro interventions, we required students to work together (mezzo practice) towards the same goal, and we ensured that all components of the bloom’s taxonomy model were methodically included in the assignment. we also ensured that students made real-time connections between the mpa and micro and mezzo interventions they had to complete in order to achieve their goals. this last step was an important consideration for the mpa. unfortunately, macro social work is all too often siphoned off from micro and advances in social work, fall 2022, 22(3) 1020 mezzo practice. as a result, many social workers are unable to immediately identify the connections between all forms of social work practice (crutchfield et al., 2016; lucero et al., 2017). increased intentionality in social work education, through the mpa or similar learning activities, may help to reconnect these forms of practice in the minds of the next generation of social workers. our positive findings suggest that social work educators should consider implementing the mpa—or an activity that includes all of the knowledge components referenced above—in macro social work classes. doing so may lead to enhanced outcomes in both the short-term and long-term. in the short term, students exposed to the mpa may demonstrate increased knowledge and application of appropriate social work behaviors and skills with vulnerable populations, and an increased recognition that micro, mezzo, and macro practice exist along a continuum. in the long-term, students exposed to the mpa may be more likely to meaningfully engage in macro practice throughout their careers, whether they are employed in an official macro practice context or not. limitations we undertook this multiple case study to explore a novel macro social work pedagogy with a small sample of graduate social work students. we believe that a multiple case study design was appropriate for our research questions, but the study has several limitations which should inform the interpretation of its results. to begin, we relied upon a small and non-representative sample of graduate social work students, which means that generalizability should not be assumed. moreover, there were many confounding factors in the study; it is quite possible that student improvements were the result of course content rather than the mpa, other social work courses, field placement experiences, and more. causality, therefore, cannot be assumed. due to the small sample size, we were also unable to conduct inferential statistics to determine if student changes on the preand post-tests were statistically significant, nor were we able to link positive student assessments of the mpa to actual long-term behavioral change. the pre/posttest measure was also not a validated measure. finally, the narrative data may be limited by the fact that the pi was the course instructor, and had to collect this data from students in writing due to pandemicrelated issues with the focus groups. despite these limitations, we believe that there is some evidence to support the mpa as a promising pedagogy. future research should investigate whether these findings hold true with a larger randomized sample of students, and with correspondingly robust research methods that are more equipped to answer research questions related to causation. conclusion although this mixed methods multiple case study relied on a small sample of macro practice students in one graduate social work program, findings suggest that the mpa is a promising macro social work pedagogy. the mpa appeared to enhance students’ knowledge, behavior, and micro-mezzo-macro practice skills with vulnerable human trafficking populations, and also appeared to improve students’ understanding of, and commitment to, the micro, mezzo, and macro practice continuum within the social work twis et al./enhancing student committment 1021 profession. findings suggest that the mpa can help students understand the relevance of macro practice to their future goals; it is for this reason that social work educators may find the mpa to be particularly useful for students who take macro practice courses because they are required, and not because they find macro content to be immediately relevant to their professional goals. references anderson, l. w., & krathwohl, d. 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(2014). preparation for social service leadership: fieldwork and virtual organizations that promote critical thinking in administration practice. journal of teaching in social work, 34(2), 113-128. https://doi.org/10.1080/08841233.2014.892050 yin, r. k. (1994). case study research: design and methods. sage. zach, l. (2006). using a multiple-case studies design to investigate the informationseeking behavior of arts administrators. library trends, 55(1), 4-21. https://doi.org/10.1353/lib.2006.0055 zerden, l. d. s., sheely, a., & despard, m. r. (2016). debunking macro myths: findings from recent graduates about jobs, salaries, and skills. social work education, 35(7), 752-766. https://doi.org/10.1080/02615479.2016.1188915 zippay, a., & demone, h. (2011). initial macro-level job responsibilities among msw graduates. administration in social work, 35(4), 412-424. https://doi.org/10.1080/03643107.2011.599301 author note: address correspondence to mary twis, department of social work, texas christian university, fort worth, tx 76109. email: mary.twis@tcu.edu https://www.socialworkers.org/linkclick.aspx?fileticket=elsqud1s2qi%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=elsqud1s2qi%3d&portalid=0 https://doi.org/10.1080/08841233.2014.892050 https://doi.org/10.1353/lib.2006.0055 https://doi.org/10.1080/02615479.2016.1188915 https://doi.org/10.1080/03643107.2011.599301 mailto:mary.twis@tcu.edu enhancing student commitment to the micro-mezzo-macro continuum: the macro practice assignment mary twis don greenwood morgan files abstract: despite the importance of macro practice to the social work profession, research related to social work students’ preparation and enthusiasm for macro practice suggests that there is significant room for improvement within macro social work ... macro social work education typically addresses core social work competencies related to engaging, assessing, intervening, and evaluating practice with organizations and communities (council on social work education [cswe], 2022). although learning ob... the purpose of this paper is to describe and explore a novel macro practice pedagogy that we designed to encourage student engagement within a macro practice social work course. we developed the macro practice assignment (mpa) to offer students a real... the nasw (2021) code of ethics encourages social work professionals to advocate for social justice, to enhance the well-being of all people, to meet basic needs, and to empower groups of people who are oppressed and vulnerable. the code of ethics also... despite perceptions to the contrary, macro social work practice is not a niche subspecialty within the profession, with few accompanying job prospects (ezell et al., 2004). social work graduates with macro specializations report that they are able to ... students’ perceptions of macro social work education unfortunately, a variety of evidence suggests that social work education does not adequately prepare graduating students to a) demonstrate a commitment to lifelong macro social work practice, b) effectively apply macro practice skills, nor c) compete ... within this social work educational environment, perhaps it is unsurprising that macro social work students have reported dissatisfaction with macro practice course material and experiences (deal et al., 2007; hill et al., 2017; liddell & lass, 2019).... in order to address these shortcomings in macro social work education, various authors have suggested that professors assigned to teach macro practice courses could or should implement community-based or service-learning projects in their classes (cru... macro practice assignment (mpa) description given both the importance of macro practice, and the limitations of macro social work education cited above, we created the mpa to encourage social work students to meaningfully engage in macro social work education—with the hope that doing so would e... the assignment’s focus on one vulnerable population was by design. curriculum crowding is an ongoing concern in social work education that we sought to address in this project. we hypothesized that providing in-depth information about a specific vulne... pre-course collaboration with agency serving a vulnerable population. prior to beginning each semester, we collaborated with a non-profit agency providing a range of services to a vulnerable population. in this iteration of the mpa, we selected an age... instructor-guided readings. the mpa began with students reading six articles pertaining to human trafficking populations. again, we believed this level of population focus was important for building students’ buy-in to course activities, and exposing ... community meeting reflection. the students then attended a community meeting organized by the community agency. the meeting offered students an opportunity to observe stakeholders discussing human trafficking and community agency’s initiatives. studen... legislative bill description and monitoring. next, students were required to identify state-level policies relevant to community agency and/or the human trafficking survivor population. students then submitted an individual paper where they a) identif... grant proposal. prior to the start of each semester, we set aside roughly $400 from a small community engagement grant for use in the mpa. the purpose of the grant proposal component of the mpa was to give students an opportunity to practice writing a... needs assessment and community intervention report. this report served as the culmination of students’ work over the course of each semester. students worked in groups to discuss a specific need of community agency or the human trafficking population ... self-reflection. the final mpa activity was a self-reflection. in this paper, students individually reflected on a) what they learned as a result of the mpa, b) what was rewarding and frustrating about the experience, c) how they intended to apply the... case study research questions throughout the development and implementation of the mpa, we attempted to adhere closely to the principles of bloom’s taxonomy (anderson & krathwohl, 2001; anderson & sosniak, 1994; bloom & krathwohl, 1956) to ensure that students were, indeed, develo... methods sampling and participants before we began collecting data from our study sample, we sought institutional review board (irb) approval. the university irb granted an exemption for this study because study procedures were determined to pose minimal risk to participants. for the s... instruments and procedures mixed methods multiple case study designs require researchers to use several instruments, measures, or data collection approaches (gustafsson, 2017), in order to enhance the depth of data collected and allow for improved data triangulation. for the pu... knowledge, skills, and behaviors inventory. after we collected informed consent from the students in january 2020 and january 2021, a research assistant distributed an 18-question knowledge, skills, and behaviors inventory via qualtrics prior to the d... focus groups. in addition to the preand post-tests, we deployed focus group prompts to the students in late-april 2020 and late-april 2021, with the intent of gathering narrative data about the mpa and students’ new understandings of micro-mezzo-mac... reflection journal. finally, we asked students to individually reflect and journal on what they learned from the mpa and how they intended to apply their learning to their future micro, mezzo, and macro social work practice. this reflection journal wa... analysis we first conducted descriptive statistical analyses on the preand post-test data. due to our small sample size, and some study attrition between preand post-tests, we were unable to conduct inferential statistical analyses. several students did no... findings preand post-test findings first, we present student gains in social work skills application. in looking only at the knowledge, skills, and behaviors inventory preand post-test findings, it appears that students experienced modest changes in human trafficking knowledge, skill... the students appeared to enter the course with a high level of knowledge about human trafficking and how to apply micro and mezzo practice skills to human trafficking populations. overall, they performed well on the inventory, scoring an average of 12... of note, though, there were several questions on which the students performed more poorly than others. the questions that fewer than 70% of students answered correctly were q2, q9, q10, q11, q12, q16, and q17. interestingly, only one of these question... although only thirteen students took the post-test, and it was not possible to know who completed it. post-test results suggested that students improved slightly in their knowledge of human trafficking and how to apply social work skills with this pop... focus group and reflection journal findings when we triangulated the preand post-test findings against this study’s qualitative findings, we observed increased evidence beyond the inventory that, after completing the mpa, macro social work students a) develop micro-mezzo-macro practice skills... focus group prompts. in response to a range of questions about macro social work, micro social work, human trafficking, and students’ future professional goals, participants spoke very positively about the mpa. in particular, they felt that the mpa pr... to begin, over half of the students said that the mpa offered them an opportunity to apply a range of social work skills to a real-world scenario, and that this was valuable for their learning even when it was challenging. one student said, for instan... reflection journals. students provided similar responses to the discussion board in their reflection journals, even with different question prompts. every sampled student stated that the mpa provided them with increased motivation for macro practice, ... discussion references ______ marquita walker, phd, interim chair and associate professor, department of labor studies, indiana university school of social work, indianapolis, in 46202, marqwalk@iupui.edu copyright © 2020 author, vol. 20 no. 3 (fall 2020), x-xiii, doi: 10.18060/24867 this work is licensed under a creative commons attribution 4.0 international license. editorial gender bias in employment: implication for social work and labor studies marquita r. walker gender bias in employment is not a new phenomenon. the historical devalued status of women and equity-seeking groups preserved in cultural and social gendered roles permeates the workplace and contributes to institutional structures which are fashioned by and reproduced through traditional norms and mores relegating women and equity-seeking groups to secondary status roles. the question then becomes is the continuation of these reinforced structural norms in the best long-term interest of all humanity? what are we giving up when we relegate over half of the world’s population to secondary and devalued status? what gains could be made if all workers were given the same opportunities, supports, and encouragements to reach their full potential. this special section of advances in social work reflects how gender bias in employment, as evidenced from women’s placement relative to men’s placement in the global labor market in which women’s earnings are less than men’s earnings, contributes to and reinforces the reproduction and maintenance of institutional power structures which contribute to disparities in gender equalities and result in discrimination against women and equity-seeking groups in the workplace. the marginalization of women and equityseeking groups in employment occurs through overt or covert practices even when antidiscrimination legislation is in place. according to political economy theory, the labor force is a gendered field with historical influence, unequal power relations, and unequal access to resources among and between groups that contributes to gender oppression, especially in the absence of collective action. the confluence of historical oppression expressed by workers across the global lends itself to the intersection of collective and social action to correct injustices and secure for global workers a more equitable power dynamic within the employment relationship. because the disciplines of labor studies and social work are partners in the search for social justice, their convergence provides a platform from which to launch an exploration of ways to correct this power imbalance. researchers and practitioners in the fields of social work and labor studies share a long history of collaboration in alleviating social suffering and promoting social justice dating back to the late nineteenth century when jane addams, founder of hull house, a settlement house in chicago created to help the indigent, “advocated for policy initiatives to protect working women and orphans and to improve working conditions for wage workers” (rosenberg & rosenberg, 2006, p. 296). the settlement movement, which sought social reform through the eradication of poverty, unemployment, and economic inequality and led to the development of the national women’s trade union league, was supported by jane addams and lillian wald who provided support in organizing workers into unions, supporting striking workers, and helping create the amalgamated clothing workers of america (axinn & stern, 2001), the women’s shirt makers, the dorcas federal labor mailto:marqwalk@iupui.edu https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2020, 20(3) xiv union, and the chicago women’s trade union league (reisch & andrews, 2001; rosenberg & rosenberg, 2006). addam’s initial relationship with the labor movement is reactive as she tries to settle disputes through mediation and voluntary arbitration between workers who visit hull house and their employers. the intensity of her actions increases as she becomes acquainted and works with mary kenney, a union organizer for the ladies’ federation labor union (lflu). kenney, an immigrant bindery worker spending 70 plus hours per week in the factory, is fired for demanding a raise and looks to the lflu for help. addams offers support for kenney by allowing organizing meetings to occur at hull house and offering publicity and city connections. this mutual understanding of women’s working conditions and the need to be proactive leads to a “long engagement with the labor movement” (knight, 2005, p. 15). the founding principles of social justice, civil rights, and poverty alleviation continue to bring together social work and labor unions in an expanded twenty-first century mission focusing on concerns about social and economic changes in state and national government policies, growing poverty and inequality, exclusion, marginalization, and discrimination. building on these disciplinary connections strengthens the commitment to develop strategies to address local and global inequities exposing covert and overt policies that affect women’s ability to reach their full potential. institutions, as social constructs, are fashioned by collective choices. both direct and indirect historical bias, formed by powerful entities’ past choices against women, result in depressed economic and social empowerment of women, a disproportionate share of women in precariat and informal employment, more women in unpaid and caregiving work, fewer women entering science, technology, engineering, and mathematics (stem) careers, depressed wages, and limited opportunities for women in male-dominated work arenas. the current state of economic and social gender bias leading to discrimination is unacceptable but not inevitable. reductions in gender inequality have been addressed to some extent through legislation, but collective action is necessary to eliminate gender inequities. the aim of this special section, “gender bias in employment: implication for social work and labor studies” is to address ways of increasing women’s power in the workplace through institutional policies aimed at eliminating direct and indirect gender discrimination. gender discrimination has significant economic costs for individuals and families, broader communities, and the global marketplace. the empirical evidence linking gender discrimination in social institutions to per capita income is robust and reducing gender discrimination is not only good economic policy, but also right and just. contributions to the section address either theoretical or practical approaches that explore ways in which gender bias in employment is influenced through existing institutional structures and policies and include recommendations for reaching gender equality through regional, national, and global policymaking. using thematic content analysis informed by grounded theory, alex redcay, ph.d., lcsw, millersville university and wade luquet, ph.d., lcsw, gwynedd mercy university explore gender expansive behavior, expression, and identity in the hiring, walker/editorial xv promotion, and retention of transgender individuals which result in increasing levels of job insecurity by reviewing workplace discrimination legal cases involving transgender individuals in “institutional change and transgender employment.” though some public support for protections does exist and some firms and local and state governments have voluntarily added sexual orientation and gender identity to their non-discriminatory policies which prohibit discrimination against lgbtq workers, there still does not exist a comprehensive non-discriminatory law which includes gender identity. consequently, though discrimination may be reported, much is never legally challenged. redcay and luquet survey 139 transgender-identified workers who respond to openended questions about their work experience and advice they might give to fellow transgender workers. the authors conclude the workplace for transgender workers is both hospitable and hostile and surmise the revision of non-discrimination policies to include gender identity and expression would lead to change if followed by action and enforcement. the impact of employment discrimination against lgbtq workers negatively contributes to their mental and physical wellbeing, ability to secure gainful employment, and subsequently maintain decent living standards as well as highlighting institutional discriminatory barriers in place which impede transgender workers from reaching their full potential as employees. corrective action must encompass changes in local, state, and federal laws to include workplace protections for transgender workers. kidist mulugeta, ma, erasmus university rotterdam, hone mandefro belay, msw, ma, university of gondar, ethiopia, and ajanaw alemie desta, msw, university of gondar, ethiopia, analyze the vulnerabilities, legal protections, and work conditions of female domestic workers in addis ababa, ethiopia using a human/labor rights-based approach. employing a cross sectional qualitative research design using in-depth interviews and focus group discussions, their findings indicate female domestic workers experienced verbal/psychological/physical/sexual abuse, had no labor rights or protections, rarely had clear contractual relations, worked long hours for low pay and had little to no privacy in the workplace. though the convention on the elimination of all forms of discrimination against women (cedaw), which prohibits indirect discrimination of women in any sector by employers, and the international labor organization (ilo) convention no. 189, which establishes global standards for domestic workers, could serve as platforms for employer civility toward female domestic workers, the state lacks political commitment to enforce these protections, and cultural factors such as illiteracy and poverty among the workers contribute to a cloak of silence shrouding the suffering of female domestic workers. recommendations to correct these injustices include developing a relevant city and country legislative framework to advocate for and protect female domestic workers. based on a “claims-making” framework, which posits data and facts construct a basis for a claim which is open to subjective interpretation and transforms a situation into a social issue which must be recognized and addressed, elizabeth steiner, research assistant, university of pittsburg, sandra wexler, ph.d., acsw, and consultant, university of pittsburg, and rafael jacob engel, ph.d. and associate professor, university of pittsburg, advances in social work, fall 2020, 20(3) xvi use a qualitative descriptive approach to examine 17 experts’ claims-making arguments for raising the minimum wage for hospital workers in pittsburg, pa in their article “examining experts’ arguments for increasing the minimum wage: insights for social work advocates. advocates for and against raising the minimum wage provided rationale for their positions during a city-council-appointed commission meeting held to determine recommendations for raising low-wage hospital service workers’ wages. the authors reviewed the claimsmakers’ testimonies and thematically segregated them into three broad arguments: economic considerations, social and economic justice concerns, and moral rationales. findings conclude social work advocates construct a more effective argument for raising the incomes for low-waged workers by using a combination of emotion and more than one rationale for the justification of their assertions. references axinn, j., & stern, m. (2001). social welfare: a history of the american response to need (5th ed.). allyn & bacon. knight, l. (2005). "a plucky thing to do": jane addams befriends the workers. humanities, 26, 12-15. reisch, m., & andrews, j. (2001). the road not taken: a history of radical social work in the united states. brunner/mazel. https://doi.org/10.4324/9781315800646 rosenberg, j., & rosenberg, s. (2006). do unions matter? an examination of the historical and contemporary role of labor unions in the social work profession. social work, 51, 295-302. https://doi.org/10.1093/sw/51.4.295 https://doi.org/10.4324/9781315800646 https://doi.org/10.1093/sw/51.4.295 _________ nicole janich, phd, msw, research assistant professor, natasha s. mendoza, phd, msw, associate professor, cynthia mackey, msw, graduate research assistant, nidia hernandez, lcsw, msw, mpa, graduate research assistant, abigail henderson, ms, analyst & project coordinator, and tama reily, msw, academic professional, in the school of social work at arizona state university, tempe, az. rachel lundwall, ma, administrative program specialist in the school of medicine and public health at the university of wisconsin-madison, wi. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 59-76, doi: 10.18060/24056 this work is licensed under a creative commons attribution 4.0 international license. supporting independent living through interdisciplinary service learning: the community collaborative model nicole janich natasha mendoza cynthia mackey nidia hernandez abigail henderson tama reily rachel lundwall abstract: service learning within independent living facilities may be a highly effective means to address the service gaps that challenge older adults and people who are disabled. we present a new approach to service learning by leveraging opportunities for community–university partnerships. the community collaborative model (ccm) represents synergy between organized independent living and higher education at arizona state university and led by the school of social work. the ccm is a unique collaborative service learning program aligned with current thinking about independent living, supportive services, and community-based service learning. we share lessons learned from the challenges of establishing this program, which included institutional hurdles, maintaining adequate physical space, student-focused planning, varying levels of preparedness, and stigma related to service use. in conclusion, we recommend means to (1) build interprofessional teams, (2) seek support and commitment of faculty partners, (3) ensure sustainability via community liaisons and clinical supervisors, and (4) create space for reflective practice. keywords: service learning, interdisciplinary, independent living service learning is a common activity for degree programs in higher education focusing on health or social services (krout & pogorzala, 2002; roodin et al., 2013; seif et al., 2014). this approach to learning allows students to gain real-world practice experience while also providing a necessary community service (hyde & meyer, 2004; miller et al., 2017). the service learning model includes some common elements that are necessary to achieve the goals of improving student education and serving communities: programs and activities are developed in collaboration with communities; the services provided respond to community needs; students typically lead activities with faculty and staff oversight; and students engage in intentional reflection on their experience (gibson et al., 2011; oakes & sheehan, 2014; seif et al., 2014; seifer, 1998). traditional settings for service learning activities include agencies and clinics in the community or within facilities housed on a college campus (krout & pogorzala, 2002). with an increasing number of independent living facilities and other homeand community-based programs serving the growing older adult population (muramatsu et al., 2010), opportunities for non-traditional about:blank advances in social work, spring 2021, 21(1) 60 service learning activities are more available. we present the community collaborative model (ccm) as a new approach to service learning that leverages opportunities for community–university partnerships. in this paper, we describe the implementation process of the ccm and offer recommendations for practice to assist staff and faculty who may want to adopt the ccm in their own academic institutions. the purpose of this article is to apply a conceptual model for service learning and delineate its implementation. while historical data are presented, this paper should not be viewed as an empirical piece; rather, it is a starting place from which to build future research. independent living a primary component of the ccm is the independent living facility with which arizona state university partners. the term independent living is a residential term usually associated with foster youth (okpych, 2015), people who have disabilities (nosek et al., 1992), and older adult populations (muramatsu et al., 2010). independent living facilities (ils; also referred to as home or community-based services) are “sheltered” environments designed to meet the specific needs of a community (rossen & knafl, 2003). for older adults and adults with disabilities, the acceptance of ils has increased due to evidence that they provide residents with a sense of agency; residents can make decisions about community activities, housing, employment, and other factors that contribute to a comfortable lifestyle (townley et al., 2013; white et al., 2010). studies indicate that lifestyle interventions implemented in ils can improve health and satisfaction (clark et al., 2012), and community-based living contributes to well-being (xiao et al., 2016). however, ils have been critiqued for a lack of focus on teaching people to successfully build relationships within their communities (white et al., 2010). people who have disabilities have expressed discontent with ils due to the lack of person-centered case management, delays in access to necessary services, and barriers to accessing health care information due to low-income status (administration for community living, 2018). some studies suggest that residing in independent living is associated with declining health and quality of life and increased use of health care (castle, 2001; rossen & knalf, 2007). conversely, some studies suggest that older adults engage in increased physical activities once they relocate to an independent living facility (castle, 2001; rossen & knalf, 2007). mcreynolds and rossen (2004) suggest that physical activity, nutrition, and social supports contribute to optimal aging and are key components in high quality il settings. in il settings with combined service learning opportunities, residents may experience positive outcomes also associated with optimal aging. service learning within independent living settings service learning in il settings may involve social engagement between residents and students through coordinated groups and activities. this engagement can alleviate the social isolation experienced by many older adults. because social isolation can impact physical and mental health, the social component is an essential focus for professionals working with this population (bonifas, 2019). according to cacioppo and colleagues (2011), social isolation has been found to be as strong a risk factor for morbidity and janich et al./independent living 61 mortality as smoking, sedentary lifestyle, and high blood pressure. additionally, lack of social engagement and relationships has a significant correlation with mortality (holtlunstad et al., 2010). older adults and those with disabilities are at higher risk for social isolation. the promotion of socialization and inclusiveness among residents is a main component of service learning in ils. service learning within il facilities may be a highly effective approach to address the service gaps that challenge older adult and disabled populations. moreover, students have found that their service learning experiences serve as a bridge from their education to direct practice with community partners (cress et al., 2005). service learning in these settings can improve students’ attitudes and knowledge about older adults and address common stereotypes about aging (krout et al., 2010; oakes & sheehan, 2014). growth in the older adult population and independent living facilities creates an opportunity for universities to establish new approaches to service learning that address the challenges of more traditional approaches (krout & pogorzala, 2002; white et al., 2010). whereas traditional service learning approaches would require the student to venture into external community-based organizations, we present a model of service learning that integrates the community into the university setting and leverages university resources (e.g., interprofessional access to health and behavioral health specializations) to enhance the experience for service users. for the past few decades, independent living settings for older adults and for those who have disabilities have provided students with opportunities for community-based service learning activities (krout & pogorzala, 2002). additionally, student-run clinics that provide care for underserved populations have existed since the 1960s but have increased over the past two decades (seif et al., 2014). the changes in the older adult population and increasing attention to alternative care models have led to the development of creative community solutions founded within institutions of higher education (krout & pogorzala, 2002). examples of communities adding to this trend include kendal facilities at dartmouth in new hampshire, meadowood at indiana university in indiana, and the pines at davidson college in north carolina (krout & pogorzala, 2002). alternative models reduce limitations for students and community members to provide and receive services, respectively. by making independent living settings part of campuses, social work educators can address some of the limitations previously reported in traditional service learning experiences, such as delays in accessing services, establishing community relationships, and receiving education and supports to increase autonomy (administration for community living, 2018; white et al., 2010). the alternative model of bringing residential communities into campuses can also address the issue of limited placements available for students, which is a common challenge in traditional community-based service learning programs (gibson et al., 2011). the model described in subsequent sections is an alternative approach that makes the il facility part of a university campus. the model improves upon the traditional service learning approach by increasing potential student placements, creating an environment conducive to interdisciplinary collaboration across university departments, and improving accessibility of services for il facility residents. advances in social work, spring 2021, 21(1) 62 community-based service learning at arizona state university aligned with current thinking about independent living and service learning, we describe an alternative approach to community-based service learning that we refer to as the community collaborative model (ccm). the development of the ccm was strongly guided by the arizona state university charter, which describes a vision of inclusion, of generating research that has value to the public, and—most importantly—of responsibility to the communities served. with this mission in mind, the ccm has potential to more effectively address the needs of older populations within their environment (e.g., herbert & molinsky, 2019) while also providing learning opportunities for more students representing multiple disciplines. the ccm brings the community members and students together in a common setting within a university. this model can decrease the burden on community members in need of services and provides learning opportunities for students in an interdisciplinary environment. we share lessons learned from the challenges of establishing this model, including institutional barriers, maintaining adequate physical space, planning around student schedules and varying levels of preparedness, and distrust among communities’ members towards universities and research. we conclude with recommendations for staff and faculty from academic institutions wishing to develop similar service learning programs. the following sections offer an overview of the activities that occurred through common stages of implementation as described by fixsen and colleagues (2009): exploration, installation, implementation, innovation, and sustainability. we do not describe these stages sequentially, as the activities often did not advance through each stage in an ordered manner. the process of implementing this model was complex and frequently involved trials of feasibility for each activity as is typical for the implementation of any program (fixsen et al., 2005, 2009). as challenges appeared or activities became unnecessary or no longer feasible, plans were adapted. successfully implementing innovative practices often required a combination of multiple implementation strategies (kirchner et al., 2020). while the implementation of this program did not necessarily follow a linear trajectory of implementation phases, we offer a description of implementation strategies that occurred over time and have continued to evolve. community collaborative model (ccm) exploration the ccm is a service learning program housed within a federally subsidized independent living facility across the street from the arizona state university downtown campus. the residents include low-income older adults (65+) and adults who have disabilities. most residents have fixed incomes and rely on social security, social security disability, or retirement benefits as their sole source of income. consequently, most residents fall below the poverty level and experience chronic financial and material hardship, including food insecurity. the university was able to develop a partnership with the building owners and lease part of the first floor of the building to create an office space for a research center and a clinical space for the service learning program. through a janich et al./independent living 63 multitude of free onsite services (e.g., basic medical checks, case management, exercise, education), the program offers university students from a variety of disciplines (e.g., nursing, social work, recreational therapy, music, and others) service learning opportunities in a real-world environment. more importantly, this model provides residents of the facility opportunities for a variety of health and social services, including social interaction, cognitive stimulation, exercise and recreation, and case management. prior to developing the service program, the onsite research center conducted a comprehensive community needs assessment of the il facility. after determining that social isolation and frequent use of emergency services (e.g., calling 911, using emergency room or urgent care) were critical issues for the residents, the research center established the “community collaborative” program. the program and space were strategically designed to respond to residents’ perspectives and service needs. community needs can range from mental health, physical health, transportation, advocacy, and other social services. thus, the collaborative offers a range of services, classes, activities, and events to residents. the flexible approach of meeting resident needs has allowed students opportunities to provide services in consideration of culture to the residents (e.g., encouraging residents to tell their origin stories in narrative psychoeducation group). because the ccm functions as a service learning opportunity, students are able to tailor activities to the needs of the residents. based on individual or group needs, students have the ability to collaborate with other disciplines and modify services and activities to align with specific needs. for example, physical activity was important to residents despite having physical limitations, so students developed a chair yoga program that every resident could participate in, regardless of their physical abilities. additionally, because residents represent many different cultures and ethnicities, students created activities for residents to attend events that allowed them to learn about different cultures. for example, students learned about residents’ cultures while getting to know them, then scheduled events that allowed residents to bring food or other items that represented their culture to share with others. overall, this collaborative method, which considers the residents’ perspectives when identifying service needs that students can support, aims to improve the residents’ quality of life through a holistic, integrated care approach. exploration phase: needs assessment. in 2013, a sample of residents in the subsidized housing property completed a needs assessment to inform the planning and implementation of a long-term collaborative partnership between the university and the property. the assessment tool was created in collaboration between faculty and students from key departments in the university (i.e., social work, nursing, recreational therapy, and nutrition), and was designed to determine the needs of the residents in order to offer services that addressed those needs. the assessment was approved by the university’s institutional review board in 2012 and was completed using a confidential, structured clinical interview design with a convenience sample of fifty residents from a total population of 294 residents. a larger sample was not feasible due to distrust among residents toward the university and difficulty getting in touch with many residents. participants were asked about health and behavioral health status, psychosocial status and needs (e.g., employment, socialization, education, food insecurity, financial), service utilization, and quality of life. each interview lasted about 60 minutes, and residents were advances in social work, spring 2021, 21(1) 64 compensated with a $10 gift card. the structured interview needs assessment measured health-related quality of life using 32 items across seven of the eight domains measured by the sf-36® health survey version 2: physical functioning, role-physical (role limitations due to physical health), bodily pain, general health, vitality, social functioning, and mental health (mchorney et al., 1994). our instrument did not assess the role-emotional domain from the sf-36® health survey. however, it did include items from the ucla loneliness scale (russell et al., 1978), the sense of community sub-scale (perkins et al., 1990), and modified versions of items from lubben’s (1988) social network scale. assessment findings indicated that many residents experienced chronic illness and other health conditions—including hypertension (50%, n=25), high cholesterol (46%, n=46), diabetes (38%, n=19), and arthritis (25%, n=25)—in addition to mental illness (52%, n=26). one of the more commonly reported findings was a high degree of social isolation, loneliness, and feeling disconnected from the community. nearly half (n=23) indicated they “often” or “sometimes” had nobody to talk to, 36% (n=18) reported “often” or “sometimes” feeling completely alone, and 52% (n=26) felt that very few of their neighbors knew them. the assessment also revealed a high use of emergency health services despite many (n=48) having regular access to a health care provider. forty percent (n=20) of participants indicated they had called 911 and 60% (n=30) had used an emergency room or urgent care at least once within the previous 12 months. priority needs were determined based on the findings of the needs assessment and the services and activities available given the departments involved. after identifying the priority needs of the residents, the key decision-makers (faculty and students from previously mentioned departments) focused on developing activities that would serve as the foundation of the ccm. residents were not included in the decision-making beyond providing feedback through the needs assessment because the program was not yet established. however, a resident council was created for residents to voluntarily participate in program planning as the program became established. installation the key findings resulted in the creation of the community collaborative, an interdisciplinary program tailored to address the issues of social isolation and loneliness and the management of chronic health conditions to decrease the reliance on emergency services. the physical space in the building was built in consideration of resident needs with plans for the space discussed before implementation with consideration of the potential for services. the ccm included rooms for one-on-one and small group activities, an office for students, faculty, and staff to keep records and notes, and an open space for socialization. the entry way into the space was a door connected to the lobby of the residential building for easy access. this program required the involvement of students from multiple disciplines, including social work, nursing, recreational therapy, nutrition, and music. prior to services beginning, the interdisciplinary team planned what activities and services would occur based on the needs assessment and coordinated the schedules of students to ensure student availability was spread across semesters in order to avoid gaps in services. under supervision from faculty and staff, students from multiple disciplines are able to translate skills from the classroom into real-world settings, practicing janich et al./independent living 65 interdisciplinary collaboration while meeting the specific needs of residents. students in health-related disciplines could work with residents on lifestyle changes and the management of chronic conditions while students from other disciplines, such as social work, could focus on social activities, skill-building, and case management (e.g., assistance and referrals for food, financial, and other immediate needs). these experiences were built into policies and procedures prior to the start of the program. implementation and innovation the program began operating in the fall of 2016, and since that time, 68% (n=197) of residents have engaged in program services at least once. based on daily attendance and activity tracking completed by students and staff, an average of 15 residents engage in the program daily. the most common services residents engaged in were community building activities (e.g., group socialization, attending special events), case management, and psychosocial activities (e.g., using computers, attending writing group, games, arts and crafts). residents have been able to participate in university-sponsored and community events such as a residents’ artist group made up of ten residents, six of whom exhibited and sold art in a university-hosted art show and a writing group in which one member was able to publish their first book. between 2016 and 2019, the program offered service learning experiences to 325 students in music, nursing, nutrition, recreational therapy, and social work. benefits to students include the opportunity to participate in cross-disciplinary teams to gain exposure to the theories and practices of other disciplines and to learn from collaborative experiences with other students and faculty. through their service with residents, students also gain insight into the challenges faced by older adults and witness the impact of services and policies for this population. students are integral in promoting the empowerment of residents and building a stronger sense of community. social work students are coached in motivational interviewing as part of their field education--they use techniques to enhance motivation among residents, thus empowering them to engage with their community. as such, students benefit from seeing the positive impacts they have on the lives of residents across the course of a semester or year. illustrating other positive outcomes, a member of the social work faculty and a student conducted a small study with the ccm and found improvements in student learning outcomes in the areas of communication and teamwork, interprofessional interactions and relationships, communication processes, and relationships (bonifas & garbe, 2017). the ccm is centered around residents and students who develop a collaborative relationship based on service provision, education, and community-building. although the program is grounded in social work, it is affiliated with multiple university departments to meet the interdisciplinary needs of residents. the social work faculty involved with developing the program were able to obtain buy-in from other departments because the ccm provides their students with service learning experiences. the program offers services addressing physical, mental, emotional, and social components of health and wellbeing as follows: advances in social work, spring 2021, 21(1) 66 ● recreational therapy. students from recreational therapy provide recreational activities and leisure education, including adapted yoga and dance, guitar lessons, and creative arts and games. these students also organize community events for residents, such as a spring fling and fall festival. decisions made related to these activities and others were made by staff, faculty, and students initially. however, a resident council was established later in the program to ensure residents had a voice in decisions being made about program activities. ● nutrition. nutrition students offer nutrition and health promotion education, including education on nutrition-related health problems, individual nutrition plans, and recommendations for healthy eating on a budget. students also organize a food drive for residents each spring, provide a food cart at all times for residents to take items as needed, and connect residents with community agencies that address food insecurity. ● music therapy. music therapy students facilitate group sessions of active music-making, including creating, singing, moving to, and/or listening to music. sessions are focused on reduction of stress, community building, and inclusion through interactive musical performances and creative collaboration. ● nursing. undergraduate nursing students provide basic nursing services, such as monitoring vitals (i.e., blood pressure, pulse, and respiration rate) and blood glucose checks, wound checks, and health promotion education. doctorate level nurse practitioner students offer more comprehensive assessment services, including home visits, health promotion, and wellness education. ● social work. social work students provide individual counseling and biopsychosocial assessments, case management services, psychosocial education, support groups, group socialization, and community building activities. the ccm is depicted in figure 1. the model operates through partnerships between community and university partners comprised of fields such as social work, recreational therapy, music, nursing, and nutrition, and health promotion. based on discussion with residents and observations of students, new partners and services are added as new needs are discovered, such as dentistry and career services. the program oversight comes from staff within the research center housed in the residential building. a program manager who is a staff member of the host research center is responsible for most of the oversight. when new needs are identified, this individual works with other departments to determine potential services and connects with new departments or outside community agencies to coordinate a partnership for services. the costs associated with the ccm are supported by donors and the college. donor support provides for expenses such as stipends for social work students, and materials for services and events (e.g., paper, plates and cups, art supplies, gift cards, food). the college and host research center cover the salary of the program manager who provides oversight of students in collaboration with faculty from other departments. students from disciplines outside of social work provide services for no cost and receive service learning credit through their department. janich et al./independent living 67 figure 1. the community collaborative model (ccm) sustainability the model is sustainable due to not only the infrastructure and support provided by the university but also the ability of the research center staff to independently oversee and coordinate activities. this structure takes the burden off faculty, who are traditionally given the responsibility to oversee service learning without additional resources and time (gibson et al., 2011). another unique aspect of the ccm is that the program space is embedded not only into the residential building in the community but also in the university’s existing infrastructure. the clinical space used by students and accessible to residents is leased by the university, and staffing is jointly supported by the university and the research center providing the oversight. staff and faculty overseeing the program are trained through opportunities to build knowledge in areas related to field instruction and service; events are available through the school of social work and its various research centers. further program faculty are evaluated yearly in a process that requires them to articulate professional improvement goals and account for previous performance as it relates to ccm note. the figure illustrates the interconnectedness between community and university partners, student-led services, residents (service recipients), and the center. advances in social work, spring 2021, 21(1) 68 work. this creates a sustainable service learning environment that can independently function year-round (given donor contributions). the partnerships form the interdisciplinary network of students, faculty, and staff to provide key services to residents, who are at the center of the model. the services received by residents can be categorized into four types of needs: psychological, physiological, community building, and social. the ccm brings about a mutually beneficial exchange that gives students opportunities to learn while providing valuable services to a vulnerable population. currently, the ccm is in a state of continuous implementation and innovation. new practices are frequently implemented based on new needs that arise, and activities that are no longer needed or sustainable go away. sustainability is always being considered and often influences changes to the program. once the program settles into a set of standard practices, a process of evaluation will be put in place to continuously examine outcomes at the resident, student, and institutional level. sustainability: challenges and considerations. community collaborative faculty, staff, and students generated creative solutions to a variety of challenges since the program was first implemented. when establishing the ccm that serves both students and residents, several factors must be considered prior to beginning service provision (ordered by priority): (1) physical space, (2) stigma, (3) institutional challenges, (4) student availability, and (5) perspectives and needs of students. these five themes were identified from interdisciplinary collaboration among research center staff and faculty affiliates including representatives from social work, nursing, recreational therapy, nutrition, and music. these themes are common issues that arose since the start of the program and have become regular topics for discussion among collaborators. physical space. planning for a physical building space is as important as planning for time-related challenges. the ccm could not exist without the physical space existing within the residential building. this had to be developed before the program activities could be planned. program space affects program delivery; participants may be hindered if the space is too small. there needs to be substantial, wide-open space to allow free traffic, including space for people using walkers and wheelchairs to easily maneuver among the furniture and other people. the space should have enough separate enclosures/rooms to allow for the programming being delivered (e.g., a quiet space for meditation activities, yoga, and tai chi) while group socialization is going on in a larger community space. the space should also be situated so that noise-producing program activities (e.g., music therapy and guitar lessons) can be conducted without disturbing surrounding living and office spaces. acoustics in the space are also important when working with people with hearing impairments. in our case, we were able to separate noise-producing activities by booking space in the university’s conference and event space located in the same building. an ongoing challenge related to space was that the ccm existed within a larger shared space. within the same building, there are office spaces for staff and faculty from two separate research centers. noise from the ccm activities occasionally disrupted work within other professional spaces. due to how the space was built, research center employees either had to walk through the ccm (which could disrupt activities) or walk outside the building in order to get to the other side. janich et al./independent living 69 stigma. we urge new programs to be mindful of stigma. this issue came up before the program was implemented. in order to determine the needs and plan for services, a needs assessment had to be conducted which required participation from residents. to increase participation in this process and beyond, trust between the university and residents is critical to dispel the beliefs residents have about being used for research purposes. in the ccm, there are two sides to the experience of stigma. the first is the resident’s perceptions of institutions of higher education. when the ccm first opened, many residents expressed feelings that the university was only there to use the residents as subjects in research. residents would speak about this during group socialization activities and in one-on-one conversations with staff and students which would be documented in program notes. during this process, we learned that it is essential to address this misconception with residents early on. looking back, our plans should have included time to connect with residents and discuss what research is and is not, as well as the concept of voluntary participation. we knew that there would be faculty and students interested in conducting research studies in the space with residents and with students, but this could have been introduced in a way that reduced the distrust experienced by residents who sometimes expressed feeling like research subjects, and always under scrutiny. although the extent of the distrust towards the university was not measured, concerns by residents were often noted and discussed among staff, faculty, and students. due to the distrust that developed around research activities, we limited the research activities initially in order to keep residents engaged in the program. a policy was eventually established requiring approval from program management. the program manager now consults with other program staff or faculty to make decisions regarding what research activities are allowable on a case-by-case basis. the other side of the stigma issue pertains to students and staff. we made an assumption that students and staff coming from helping professions would have an understanding of the difficulties facing the older adults and people with disabilities and mental illness; however, we learned that was not the case, and education around these populations was necessary. for example, some students believe common myths about mental illness such as the misconception that people who have a mental illness are more prone to violence. compounding the issue is the fact that students lacked a basic foundation related to mental health, and were often unfamiliar with the appropriate language to use regarding people who have mental illnesses and disabilities. these education issues with students are addressed as they come up. ultimately, it is crucial to focus on educating students and staff on common misunderstandings related to the residential population. institutional challenges. less tangible but equally critical considerations relate to the potential for distrust of institutions (i.e., the university) among disadvantaged populations. therefore, affiliated faculty and staff must avoid overpromising and under-delivering and must be up front about what the program can offer and its limits (e.g., interns cannot provide home-based case management services). additionally, given that the program is part of an academic institution and uses a collaborative model, approvals for changes must often go through multiple layers and disciplines. this can create delays in services for residents and difficulties in getting students needs met. while securing funding from the institution has great benefits, it is unlikely to cover all costs. therefore, it is important to advances in social work, spring 2021, 21(1) 70 continuously search and apply for additional funds. efforts may be challenged because research funds would often require collecting data from residents, which brings a unique set of challenges. trust may be impaired if faculty use the population to further research goals. in our case, we looked toward foundations that fund programs and were able to secure a small amount of funding to cover the costs of equipment and supplies. in this case, the funding came through a donor that was able to commit to continued donations each year. student availability. semester and holiday breaks cause a sudden termination of services, typically for 2to 3-week periods. the disruption to some services (e.g., counseling) can result in some residents feeling abandoned (based on observations and discussion among students and residents). as a result of this observation, it became a necessary program activity to talk openly with residents about approaching breaks. it is also necessary to create interim plans where needed and to build interest and enthusiasm for activities in the upcoming semester. disruptions also occur when student cohorts change each semester and academic year. student rotations create difficulties with continuity of care (bonifas et al., 2017) and often resulted in disappointment and lack of trust from the residents. the need to repeatedly start fresh in establishing rapport between students and residents is an ongoing struggle that students, faculty, and staff attempt to mitigate wherever possible. for other programs interested in implementing the ccm, we recommend building a staff and faculty team that can have a consistent presence. this way, even though students inevitably turn over, residents will always have a few people with whom they can develop long-term rapport. in addition to consistency in personnel, it helps to develop ongoing, consistent programming that occurs regularly. for example, in our program, we have some activities and traditions that occur regularly regardless of student availability, such as guitar lessons, music therapy, an annual bingo event, and health and nutrition fairs. the most recent challenge related to availability came about with the covid-19 pandemic. the clinic space had to be closed, and students and staff were unable to be on campus. as a result, staff and affiliated faculty had to develop a plan to stay connected with residents as well as meet the needs of students who had educational activities to fulfill. for this situation, faculty and staff created alternative learning activities for students while still offering services to residents. some of the activities and services included: 1) a phone line for students and staff to provide friendly and empathetic support for residents who need to talk and a help line for information and resources related to covid-19, 2) students and staff creating a weekly newsletter (print and digital) with links to a private facebook page for residents, positive new stories, and ideas for things to do, and 3) students hosting virtual group sessions via a video-conferencing platform. perspectives and needs of students. faculty and staff have learned that mandated practicums do not always produce committed or enthusiastic students. resident participation—and thus the community collaborative program—depends on students having the mindset and skills to engage vulnerable and disenfranchised populations. students are not expected to be outgoing, but they should demonstrate qualities such as sincerity, compassion, tolerance, patience, and a real interest in learning about residents’ lives and histories. interviewing and selecting students through an application process janich et al./independent living 71 helped identify students who were the best fit for the program. the staff member who manages the program had the best understanding of the skills needed for the success of the program, so they conducted the interviews and selected the students. in general, the ideal student was comfortable with, and had some experience engaging with, the population being served. level of education was less of a consideration since the program sought to attract students from all levels ranging from undergraduate to doctoral. because students enter the program with different levels of experience, knowledge, and ability, some will need more guidance than others. all students attend an orientation on their first day to learn about program policies and procedures. additional training may be scheduled based on needs. program staff and faculty can meet students where they are and provide optimal instruction and support for skill development through weekly meetings with students to establish learning goals and activities and to follow-up on progress. recommendations for service learning and community embeddedness the ccm created the ability to provide specialized services for residents in a subsidized housing unit near campus. undergraduate and graduate students from multiple disciplines such as social work, nursing, recreational therapy, and music are uniquely positioned at the community collaborative to build on the foundation of their service education. to that end, we offer the following recommendations: • assemble a team of dedicated collaborative partners with a shared program vision. these partners can be identified based on their ability to fill a service need for the client population. in our case, the core partners consisted of social work, nursing, recreational therapy, nutrition, and music departments because each contributed to fulfilling a specific need of residents. as the program develops, new partners are added to address new needs. ideally, this team should agree on a shared vision with the understanding that the program is continuously evolving to meet the needs of clients and students. the team should be able to commit ongoing time to help develop the programming and student curriculum and meet with program staff and students regularly to address concerns and brainstorm solutions. sharing the work across several departments provides resources and increases the capacity to provide the type of programming and oversight needed for an interdisciplinary service learning program. • gain support and commitment from the departments and schools involved in the program to ensure allotment of time for faculty partners to play an active role in the program, especially to offer interprofessional education sessions to students. establishing regular meetings for program partners to meet and discuss challenges and solutions, and provide training and oversight to students is critical to the success of the interdisciplinary activities. • consider assigning at least one long-term staff person to the community collaborative. this person should serve as a liaison between residents, students, the university, and other partners. the existence of this role creates continuity in care and ensures effective program management. advances in social work, spring 2021, 21(1) 72 • bring an independently licensed clinical social worker into the program to provide clinical oversight, guidance, and instruction to students during service delivery. issues arise daily when working with a population in which mental health needs are high. in our program, we were able to have a part-time licensed social worker in the clinic who could be compensated as a faculty associate within the school of social work. this individual serves as the field instructor for social work students and is able to provide clinical supervision. salary is determined by the school of social work, not the research center. • incorporate a weekly or at a minimum monthly interprofessional day to allow students of various disciplines to have scheduled time to work interprofessionally and engage in supervision and reflection. discussion with the ccm, residents in il settings and students from multiple disciplines (i.e., social work, nursing, recreational therapy, and music), come together to form a unique and innovative organization. the ccm, established through needs assessment and interdisciplinary experience, is a foundation on which future education, practice, and research efforts are placed. implications for interdisciplinary education include determining means by which students can continue to grow interprofessionally. with the ccm, service learning has involved traditional tenets of community service combined with education (e.g., krout & pogorzala, 2002; roodin et al., 2013; seif, et al., 2014). however, there is much more room to grow as creative interdisciplinary partnerships continue to flourish with the myriad programs arizona state university has to offer. for example, initial conversations and collaborations have begun with criminal justice (related to security) and emergency management (related to disaster planning). educational innovation via interprofessional collaborations clearly leads to implications for practice including those we noted related to (1) physical space, (2) stigma, (3) institutional challenges, (4) student availability, and (5) perspectives and needs of students. as the ccm evolves and students, faculty, and staff become more familiar with the model, implications for practice mean increased sophistication of services offered (e.g., moving from basic case management to evidence-based interventions). lastly, as practice becomes more robust within the ccm, so do implications for research, which are well-aligned with the fundamentals of implementation science. through time, we engaged in stages of exploration, installation, implementation, innovation, and sustainability (fixsen et al, 2009), and noted the common challenges related to feasibility (fixsen et al., 2009; fixsen et al., 2005). as the ccm continues to evolve, we note that future research should build on the conceptual framework of the ccm, further testing its feasibility and establishing more substantial means for sustainability. on-going data collection benefitted the program through the needs assessment being used to inform services, and daily logs of participation to understand what services were most utilized and inform outreach efforts to engage more residents. data collection was janich et al./independent living 73 modified over time, which has improved the model as a result. initially, resident participation in the collaborative were tracked by students and staff using sign-in sheets when residents came in and a daily log of services and activities. due to limited resources, this data was tracked on paper and had to be entered into an excel spreadsheet to summarize the data. the process was improved by converting the daily logs into an electronic form submitted via qualtrics (an online survey tool) which made the data more accessible daily. additional data collection in the form of anonymous surveys and focus groups also contributed to helpful feedback to inform program activities. in summary, we note that this paper is necessarily preliminary, as the process of creating the ccm has continued to evolve. we acknowledge the strong need for ongoing and continuous evaluation of the ccm, but we must also accept that limited resources have contributed to this shortcoming. the next step for the ccm will be to use the initial needs assessment to inform a new needs assessment and conduct an outcome evaluation to understand the benefits and barriers that exist within this model. going forward, we suggest this work and similar endeavors require innovation to both support the ccm and contribute to the knowledge base, making both viable. as the ccm becomes fully actualized, we aim to capture data that describe our program and offer empirical support related to successful outcomes for both students and residents. conclusion by highlighting lessons learned and offering practical recommendations for service learning programs based in independent living facilities, we hope faculty and staff in other universities are better prepared to engage in similar efforts. the ccm is truly an exemplar of service learning because it brings the university to where the clients are, rather than relying on people in the community to come to us. through ongoing and supportive services, il residents have the opportunity to gain an enhanced sense of individual agency for a longer amount of time and feel like part of their larger community. in sum, the community collaborative will continue to evolve and grow with the changing needs of the surrounding community. and faculty, staff, and 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(2016). living arrangements and quality of life: mediation by physical function and depression. western journal of nursing research, 38(6), 738-752. https://doi.org/10.1177/0193945915621260 author note: address correspondence to nicole janich, school of social work, arizona state university, phoenix, az, 85004. email: njanich@asu.edu https://doi.org/10.1007/bf00922690 https://doi.org/10.1080/02701960.2012.755624 https://doi.org/10.1177/1049732302239409 https://doi.org/10.1177%2f0193945906292539 https://doi.org/10.1207/s15327752jpa4203_11 https://doi.org/10.3109/13561820.2014.921899 https://doi.org/10.1097/00001888-199803000-00015 https://doi.org/10.1097/00001888-199803000-00015 https://doi.org/10.1007/s10464-013-9578-2 https://doi.org/10.1177%2f1044207309350561 https://doi.org/10.1177/0193945915621260 mailto:njanich@asu.edu __________ rebecca g. mirick, licsw, phd, assistant professor, salem state university school of social work, salem, ma 01970; stephanie p. wladkowski, licsw, phd, associate professor, eastern michigan university school of social work, ypsilanti, mi, 48197. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 349-368, doi: 10.18060/23220 this work is licensed under a creative commons attribution 4.0 international license. making it work: pregnant and parenting doctoral students’ attributions of persistence rebecca g. mirick stephanie p. wladkowski abstract: while doctoral education is growing in the united states, attrition from doctoral programs is high; 40-60% of students who begin doctoral programs do not complete them. previous research has explored reasons for attrition, but little research has examined persistence, and none have looked at persistence for women during and after pregnancy. this qualitative study explored female doctoral students and graduates’ (n=28) attributions of persistence to completion in their professional healthcare doctoral programs (57% social work) after a pregnancy and/or birth. two primary themes emerged from this study. first, women attributed their persistence in the program to internal resources such as determination, organization, discipline, and the ability to assess needs and shift resources, schedules, plans, or expectations to meet those needs. second, some women attributed their ability to persist in their program to good luck, in terms of fertility, pregnancy timing, expectations of the student, and family friendly advisors and programs. dissertation chairs and advisors can use these findings to more effectively support pregnant and parenting students, including helping them build important skills and reflect on implicit messages about caregiving women who are doctoral students. keywords: pregnancy, doctoral education, student parents, persistence, attribution theory doctoral education is growing in the united states, with 55,000 doctoral degrees awarded annually (national science foundation, 2017), 379 in social work specifically (council on social work education [cswe], 2018). yet, many doctoral students leave their programs before graduation. attrition rates in doctoral programs are between 40-60%, with variation by student demographics, discipline, and university (bair & haworth, 1999; council of graduate schools [cgs], 2009; gardner, 2009a; sowell, allum, & okahana, 2015). doctoral program completion rates are higher for stem fields such as engineering and life sciences, compared to physical and mathematical sciences, and social and behavior sciences (cgs, 2015; sowell et al., 2015). the seven year completion rate for social and behavioral sciences, the field with the lowest rate of completion, was only 36% in 2015 (cgs, 2015). those who are underrepresented due to race/ethnicity, gender, or citizenship are at higher risk of leaving their programs before graduation (mcbain, 2019). women with children, who comprise approximately 7-8% of doctoral students (golde & dore, 2001; kulp, 2016, 2019; mason, goulden, & frasch, 2009) are one atrisk group. this is particularly relevant within social work doctoral education, as women comprise 75% of social work doctoral students (cswe, 2018). within doctoral education, women with children often encounter additional barriers to program completion, slowing down their https://creativecommons.org/licenses/by/4.0/ mirick & wladkowski/making it work 350 progression or leading them to leave programs altogether (gardner, 2009b; mason, wolfinger, & goulden, 2013). these barriers include the balance of multiple roles and responsibilities (castelló, pardo, sala-bubaré,, & suñe-soler, 2017; dickerson et al., 2014; mcalpine & norton, 2006; smith, maroney, nelson, abel, & abel, 2006), childcare needs (brown & watson, 2010; spaulding & rockinson-szapkiw, 2012), financial challenges (spaulding & rockinson-szapkiw, 2012; wao & onwuegbuzie, 2011), and a lack of systemic supports for doctoral student parents (springer, parker, & leviten-reid, 2009). in addition, tower and latimer (2016) describe the disadvantage that women face within the academy, saying “gender plays a role in the type of work that women conduct in the academy as well as how it is devalued, invisible, or unrewarded” (p. 319). implicit biases against women caregivers are present in many academic programs (drago et al., 2006), leading to different challenges for mothers than for other students (carter, blumenstein, & cook, 2013). for all doctoral students, navigating doctoral education can be challenging, isolating, and stressful (cockrell & shelley, 2019; dickerson et al., 2014; rockinson-szapkiw, spaulding, & bade, 2014; smith et al., 2006). women with children must address these typical challenges of doctoral education as well as the additional barriers described above. the majority of the research has focused more on attrition (i.e., students leaving doctoral programs) than persistence (i.e., students remaining in doctoral programs through completion; rockinson-szapkiw et al., 2014). little is known about how women doctoral students understand their ability to persist through doctoral education and the factors to which they attribute their success (mcalpine & norton, 2006). literature review attrition attrition is a sizable issue within doctoral education (bair & haworth, 1999; cockrell & shelley, 2011; macalpine & norton, 2006), especially in fields like social work, which is experiencing an insufficient number of doctoral graduates to fill open academic positions in bsw and msw programs (kurzman, 2015). this is problematic for institutions, programs, and students. programs and institutions may experience a financial impact from decreasing enrollments (mcbain, 2019) and be unable to fill open faculty positions with qualified candidates (kurzman, 2015). doctoral students may experience a negative emotional impact from leaving their programs (mcbain, 2019), and have often committed significant financial resources, made geographic moves, and given up other opportunities for graduate school (cockrell & shelley, 2011). some underrepresented groups are at higher risk of attrition (gardner & holley, 2011; mcbain, 2019; sowell et al., 2015), suggesting attrition may be a social justice issue. while a solid body of research has focused on attrition, it is also critical to understand student persistence, especially persistence of individuals within underrepresented groups (gardner & holley, 2011; mcbain, 2019). in some fields, such as social work, little is known about the experiences of doctoral students (anastas & kuerbis, 2009). gardner (2009b) argued that attribution theory, particularly weiner’s theory of motivation, is important to consider when exploring doctoral student attrition. weiner advances in social work, fall 2019, 19(2) 351 (1985) examined the ways in which individuals understand and explain the outcomes of opportunities or activities. in other words, it is not clear to what factors an individual attributes their success or failure. in some circumstances, individuals may credit their success to their own actions or traits, while in other situations, individuals may assume their success occurred because of factors outside of their control. when a student leaves a doctoral program, other students try to explain their departure in ways which make sense to them, but which may not include all of the complexities of the student’s situation. these explanations, known as attribution narratives, can influence students’ beliefs about their own ability to achieve success in doctoral education, and therefore, impact attrition rates (lovitts, 2001). faculty and students have different attribution narratives to explain student attrition (gardner, 2009b). faculty primarily credit attrition to student characteristics, such as lack of motivation, insufficient academic preparation, or personal problems (e.g., mental health problems). in contrast, students identify specific personal situations (e.g., marriage, children, medical issues), departmental problems (e.g., lack of financial support, problematic advising), and lack of integration into academia or the field (gardner, 2009b; lovitts, 2001). lovitts (2001) found financial challenges were very common, with almost one-third of students attributing attrition to this issue. persistence while much research has explored student attrition, factors impacting student persistence in doctoral education has been less well-studied (rockinson-szapkiw et al., 2014). as the doctoral experience can be challenging, isolating, and lonely (dickerson et al., 2014; lovitts, 2001; spaulding & rockinson-szapkiw, 2012), it is important to understand the resources and skills which facilitate students overcoming these challenges and persevering through their doctoral programs. these include a strong support network, motivation, organization, and time-management skills (mcalpine & norton, 2006; spaulding & rockinson-szapkiw, 2012). when program directors understand the factors which facilitate student persistence, they can create and support initiatives to foster student persistence. a strong support network facilitates doctoral student persistence (adorno, cronley, & smith, 2015; dickerson et al., 2014; martinez, ordu, della sala, & mcfarlane, 2013; mcalpine & norton, 2006; spaulding & rockinson-szapkiw, 2012). personal supports outside of the academic program, such as partners, spouses, family, and friends, support student persistence (adorno et al., 2015; dickerson et al., 2014; rockinson-szapkiw et al., 2014). one study found that having a spouse increases the likelihood that students graduate from a doctoral program (lott, gardner, & powers, 2009). student characteristics, such as discipline, motivation, the ability to work independently, and self-direction are linked with persistence (gardner, 2009a; grover, 2007; mcalpine & norton, 2006; spaulding & rockinson-szapkiw, 2012). in particular, students who are intrinsically motivated for both personal and professional reasons are more likely to remain in doctoral programs (spaulding & rockinson-szapkiw, 2012; wao & onwuegbuzie, 2011). organization and time management skills support student success mirick & wladkowski/making it work 352 and students often credit their ability to persist in doctoral programs to these skills (martinez et al., 2013; spaulding & rockinson-szapkiw, 2012). in a qualitative study of doctoral students, students described the “purposeful management” of “their time, priorities, and roles and responsibilities” as an important factor in their success as a doctoral student (martinez et al., 2013, p. 45). doctoral student mothers while the process of obtaining a doctoral degree is challenging for all students (dickerson et al., 2014; spaulding & rockinson-szapkiw, 2012), doctoral student mothers encounter additional barriers to completion. these barriers can include juggling multiple roles (castelló et al., 2017; mcalpine & norton, 2006), childcare needs (brown & watson, 2010), a system that provides few supports for doctoral student mothers (springer et al., 2009), a gendered academic culture which propagates gender inequities (drago et al., 2006; mason et al., 2013), and guilt or lack of desire to sacrifice family to balance school and family needs (mcalpine & norton, 2006). most importantly, the gendered nature of academia (tower & latimer, 2016) creates a disincentive for women to openly discuss the challenges of parenting (armenti, 2004; drago et al., 2006). due to caregiver bias, women who openly discuss parenting, share stories of their families, or otherwise make their families more visible (armenti, 2004; drago et al., 2006) may experience negative consequences such as assumptions that they are not fully committed to their work or are less serious about their teaching and scholarship, which have a deleterious effect on their careers (drago et al., 2005). as a result, many women who are parenting choose to keep motherhood invisible, remaining silent about the strategies they use to balance family and academic responsibilities (armenti, 2004; drago et al., 2005, 2006). for all doctoral students, life events such as an illness or the death of a family member can slow or halt a student’s progression through the program; the birth of a child and the loss of a pregnancy are both examples of these type of life experiences (spaulding & rockinson-szapkiw, 2012). one of the biggest challenges for doctoral students with children is trying to balance the competing roles of parent and doctoral student (brown & watson, 2010; castelló et al., 2017; dickerson et al., 2014; smith et al., 2006; washburnmoses, 2008). the time and energy required to meet family responsibilities is frequently given as an explanation for doctoral program attrition (beer & lawson, 2017; castelló et al., 2017; gardner, 2009b; lovitts, 2001). in spite of additional challenges to program completion, many women doctoral students with children overcome these barriers to successfully complete their doctoral work. this success requires sacrifice, commitment, and a lot of hard work (mcalpine & norton, 2006; spaulding & rockinson-szapkiw, 2012). little research has explored how doctoral student mothers understand their success. specifically, to what factors do they attribute their ability to complete their doctoral programs? this qualitative study explored women doctoral students’ and graduates’ understanding of their ability to persist in health care related doctoral programs during and after a pregnancy. advances in social work, fall 2019, 19(2) 353 methods procedures data for this study were pulled from a broader study exploring the experiences, challenges, and supports of pregnant and newly parenting doctoral students (see mirick & wladkowski, 2018; wladkowski & mirick, 2019, 2020). the data analyzed for this smaller study focused on women’s explanations of their success with doctoral education while pregnant and/or parenting small children. study participants were women who had experienced a pregnancy within the past ten years as a doctoral student, in a health care related program (e.g., social work, nursing, clinical psychology, occupational therapy). following institutional review board (irb) approval at the researchers’ institutions, the research advertisement was shared through the researchers’ personal and professional networks. in addition, the advertisement was emailed to social work doctoral program directors belonging to the group for the advancement of doctoral education (gade) with a request to share with students and alumnae. interested participants contacted the researchers via email and were screened for eligibility prior to study enrollment. participants the sample (n=28) identified as white (92.9%, n=26) with one identifying as asian/pacific islander (3.6%) and one as multiracial (3.6%). participants had a mean age of 35.7 years (sd = 3.95). all participants were married during their doctoral program; 89.3% (n=25) to men and 10.7% (n=3) to women. the participants were currently enrolled (46.4%, n=13) or had graduated from (53.6%, n=15) 23 different u.s. doctoral programs. more than half of the programs (60.7%, n=17) were in the northeast, with 17.9% (n=5) in the midwest, 14.3% (n=4) in the south, and 7.1% (n=2) in the west. a little over half (57.1%, n=16) attended social work programs, with the others in psychology (14.3%, n=4), nursing (7.1%, n=2), health care communication (7.1%, n=2), and 14.3% (n=4) in other health care fields such as occupational therapy and behavioral analysis. most (92.9%, n=26) had experienced both pregnancy and birth during their doctoral studies. eleven (39.3%) had been pregnant multiple times during their doctoral studies. three women (10.7%) gave birth to twins. see table 1 for full list of demographics. data collection semi-structured interviews were conducted over a four-month period. interviews were conducted face-to-face, by telephone, or via skype based on participant preference and geographic location. all interviews were audio-recorded and transcribed verbatim. the full interviews focused on the broader experiences of pregnancy and parenting while enrolled in a doctoral program, including challenges, communication, programmatic culture, and supports. the interviews included questions about experiences with pregnancy and the transition to parenting, what made these experiences easy or hard, the supports available to them, and the culture about women caregivers within their programs. mirick & wladkowski/making it work 354 table 1. participant demographics n (%) race/ethnicity white 26 (92.9%) asian/pacific islander 1 (3.6%) multiracial 1 (3.6%) current student yes 13 (46.4%) no 15 (53.6%) geographic location of program northeast 17 (60.7%) midwest 5 (17.9%) south 4 (14.3%) west 2 (7.1%) married yes 28 (100%) no 0 (0%) gender of spouse male 25 (89.3%) female 3 (10.7%) multiple pregnancies in doctoral program no 17 (60.7%) yes 11 (39.3%) number of children while in doctoral program 0 2 (8.7%) 1 6 (26.1%) 2 12 (52.2%) 3 3 (13.0%) twins no 25 (89.3%) yes 3 (10.7%) field of study social work 16 (57.1%) psychology 4 (14.3%) nursing 2 (7.1%) health care communication 2 (7.1%) other (e.g. ot, audiology, nutrition, behavioral analysis) 4 (14.3%) data analysis the data were analyzed using thematic analysis (braun & clarke, 2006). in order to ensure interrater reliability, three transcripts were chosen at random. each researcher completed an independent line-by-line review of these three transcripts to identify preliminary codes and to establish an initial coding structure for the remaining transcripts. throughout each step of analysis, definitions of codes were discussed and modified or adjusted as needed. to assess frequency of code use, bias in code assignment, and variability of code applications across transcripts, the evolving coding framework was advances in social work, fall 2019, 19(2) 355 reviewed against all of the transcripts. for this specific study, analyses were focused on themes about success attribution for persisting in doctoral degree programs during and after pregnancy. in order to increase trustworthiness and avoid researcher bias, researcher colleagues reviewed and provided feedback on the interview guide. in addition, a thorough audit of field notes and the analysis process was conducted. at the conclusion of each interview, participants were encouraged to contact researchers with any additional thoughts or realizations from the interview, but no feedback or additional data were received. findings two main themes emerged as participants described their experiences. first, 85.7% of participants identified internal resources which supported their persistence (n=24), such as discipline and organization (75.0%, n=18), determination (66.7%, n=16), and the ability to assess their own needs and mobilize resources to meet these needs (70.8%, n=17). second, 53.6% of the participants (n=15) attributed at least some of their ability to persist to good luck, which applied to both physical health and their needs as a doctoral student. see table 2. table 2. themes in doctoral students’ persistence theme subthemes n internal resources 1) discipline and organization (n=18) 2) determination (n=16) 3) awareness of needs (n=17) 24 luck 15 internal resources most participants (n=24) identified internal resources that supported their ability to continue in their doctoral programs during and after pregnancy. these internal resources were organized around the three sub-themes of: a) discipline and organization, b) determination, and c) the ability to continually self-assess needs and mobilize resources to meet these needs. discipline and organization. many participants (n=18) described a high level of internal discipline and organization that helped them to manage the competing demands of pregnancy/parenting and doctoral work. participants described carefully organizing their responsibilities and their time in order to be able to complete all required doctoral tasks. for many participants, this organization began during—or even before—their pregnancies. in planning pregnancies, participants looked ahead at program milestones to ensure that a pregnancy would not delay their progression. for example, one participant described the calculations that went into timing her pregnancy, saying: “i wanted to make sure i was in a place where getting pregnant again wasn’t going to set me back an entire year.” from this statement, it appears that this participant began planning before conception. once they were pregnant, many participants described increasing productivity during pregnancy (e.g., completing assignments, studying for comprehensive exams, collecting data) to create time for a leave post-birth. this careful planning often began in the early stages of pregnancy. for example, one participant described preparing for her comprehensive exam early in her mirick & wladkowski/making it work 356 pregnancy, saying: “i had done a lot of preparation beforehand, knowing what i was going to do in my comps and what the subject was going to be.” planning ahead was an important strategy that participants used to be able to remain productive and successful in their programs after giving birth. in addition to planning, participants’ ability to manage their time, creating time to complete schoolwork, positively impacted persistence. participants described being strategic, carefully organizing their days and weeks to maximize efficiency. often, this strategic planning involved the creation of firm boundaries between academic and family life. this strategy created protected time to meet both sets of needs, as one participant described: i had to be very disciplined in terms of how i lived my life. so, when i was at work, i was at work and then i would come home and i would have very dedicated time for being a mom with my son and then he would go to bed and i would have very dedicated time for when i was writing or reading or whatever i had to be doing. so i had a schedule… monday, tuesday, wednesday i worked from 8-10pm and…saturday mornings i worked for four hours [5am to 9am] and i worked at naptime and on sundays and i just protected those times. so the things that were hard were: my husband has to go to the grocery store or if my son was not taking a nap, my husband had to be the one who was trying to get him to go to sleep because i really prioritized those times for my scholarship activities…that was time i was not messing with. i was committed to it and i had to fulfill it. and i would log it and that would really help me too because i would look at the log and l needed to complete a certain number of hours and if i did not complete them, i would have to make them up at some point later in the week. participants described being intensely disciplined in their use of child-free time in order to be able to use this time to the fullest. part of this organization meant participants took advantage of all childfree time to create opportunities to complete academic work. this included family visits, naptime, weekends, and evenings after a child went to bed. one participant described foregoing sleep during visits from extended family members to make progress on her dissertation: my mother came out for a week and my mother-in-law came out for a week … so that they could watch my son and i could just write write write write write in long stretches, and i would like stay up until 1, 2, 3 in the morning writing and then get up with my son at like 6 in the morning. participants described carefully organizing their lives, even before the birth of their babies, to create time for both school work and parenting, which required high levels of discipline and planning and offered little time for leisure. determination. some participants (n=16) described being driven by an intense determination to complete their doctoral work, which was not diminished by their experiences with pregnancy or transitions to parenthood. in fact, many participants described an increased determination after they had a child, which motivated them to reorganize their lives or give up leisure time to complete the necessary tasks. participants’ advances in social work, fall 2019, 19(2) 357 determination to complete their doctoral programs was motivated by diverse factors. for some, the desire to be role models was a powerful motivator, as described by this participant: my focus on finishing is much stronger than it was before, because i have two little ones that need to see this. i want them to see this. i want them to be at graduation next year. i want them to see mommy walk across the stage. i want them to have a positive female role model in their lives. for participants like this one, persisting in the program became not just an individual achievement, but something they were doing for their children as well. for some participants, the inflexible deadline of a due date motivated them to complete program milestones, such as comprehensive exams, dissertation proposals, data collection, or dissertation defenses. this participant shared: [pregnancy] almost became more motivating because i was doing a study and i wanted to finish data collection before i had [older son]…. and my younger son was born two weeks after graduation. … he was motivation for getting through. negative experiences, such as the stress and loss that accompany infertility and/or pregnancy loss, also had the potential to motivate participants to persist. one participant described her increased focus on the completion of her doctoral work after a difficult second trimester pregnancy loss: i felt like…i can't let this stumbling block [miscarriage] stop me from moving on at least in my career. so to make up for the fact that i lost that opportunity [pregnancy] i felt like i really had to finish my dissertation immediately. and so i just put my nose to the grindstone…my dissertation chair was really supportive…she worked hard, i worked hard. but we made it happen superfast and i attribute that to having had the miscarriage, that it lit a fire. while this participant was motivated by the loss of her pregnancy, other participants found negative experiences with caregiver bias increased their motivation to persist in their doctoral programs. for these participants, their anger and frustration were motivating and they were determined to prove biased faculty wrong. one participant described her reaction, saying: once they told me that they didn't think i could do it [having a baby and doctoral work]… i turned around and told them they could go fuck themselves and raced through…i'm like, “don't tell me what i can't do. i can do whatever i want to do.” another participant describes a similar reaction to an administrator’s comment that most women students could not complete the program after having a child, saying, “i think that [doubt] instilled a little bit of fear in me, but also a little bit of drive in some way.… that’s not going to be me, i’m going to make it through the program.” while encounters with caregiver bias were frustrating, for some participants, they increased their drive to persist. awareness of needs and mobilization of resources. participants (n=17) described continually shifting needs through their pregnancy and transition to parenting. they mirick & wladkowski/making it work 358 credited their ability to persist in their doctoral programs during and after pregnancy to their ability to continually assess their needs as they progressed through the program. once a need was identified, participants described the ability to access resources, creating an environment in which they were able to successfully meet doctoral program milestones. these needs were diverse and included both physical and logistical challenges, such as pregnancy symptoms, increased workload, and a greater need for financial resources. for some participants, pregnancy complications such a nausea, high blood pressure, or preterm labor created new physical needs even before the baby arrived. in order to continue to progress through their programs, participants needed to continue their doctoral work while coping with these symptoms. one participant, who struggled with pregnancy-related nausea, described adapting her schedule: i could study from home so if i had to throw up (because i threw up the first few months before i went on medication) i could just go to my bathroom and throw up and then just go back and do work. this participant was able to manage her physical needs and continue to meet the academic expectations by adjusting her work location. due to the inflexibility of teaching schedules, course schedules, or the timing of comprehensive exams, some participants found they needed childcare for infants still too young for daycare programs. these participants needed to mobilize their personal networks to create safe childcare options for their infant(s). they described using family, doctoral student peers, or available financial resources for infant childcare, which allowed them to continue successfully in their program. one participant said, “i taught that fall…he [new baby] was five weeks old at that point and he stayed with one of my friends when i had to teach classes, because he wasn’t old enough for daycare yet.” this participant used friends to address childcare needs, but another participant used financial support from her family. she described how she managed to write her comprehensive exams only a few weeks after her daughter was born, saying: my baby gift from my grandmother was she paid for someone to come and hold the baby so i could work … she cooked us some meals and folded some laundry and just held the baby … [baby] was too little [for daycare]. this participant was able to use mobilize her extended family’s financial resources to pay for in-home childcare. after a needs assessment, some participants identified a need for more time to complete doctoral work. these participants mobilized resources to create that time, by rearranging childcare and schedules, decreasing work hours, or relying on local or visiting family for support. for example, one participant described this process, saying: so this is the first semester where i’ve been working full-time and trying to juggle school and as a result, i’m going down to part-time at work april 1st because it’s just too much. i can’t do it all. i need to finish this dissertation and having that extra time off from work will be helpful. advances in social work, fall 2019, 19(2) 359 these needs for extra time tended to fluctuate or change as participants progressed through the program, so flexibility and continued assessment was necessary in order to be able to continue to be successful in the program. this participant described these changing needs, saying: i had set up my schedule so that i would have one day of childcare extra beyond my job, so that day that i had childcare, i would work on my dissertation. but the last year that didn’t end up being enough. so my husband would take my son on the weekends both mornings and i would do work. program milestones, comprehensive exams, data collection, or dissertation writing could change time demands significantly. participants understood their ability to recognize and adjust to these changing needs as pivotal in terms of their ability to continue in their programs. some participants described changing financial needs with the birth of their child. as a result, some participants described taking non-academic jobs with higher salaries or access to benefits such as healthcare and maternity leave, which allowed them to remain in their doctoral programs while addressing their current financial needs. this participant described using non-academic skills in order to increase the family income without working more hours, saying: the things that my colleagues were doing like being a research assistant and getting publications and getting paid thirteen dollars an hour…i opted…to take a job…because it paid double…i needed to do that…to do the things i needed to do as a parent. sometimes, participants’ most effective response to a thoughtful self-assessment of their needs was to change their own expectations. some participants described realizing that they needed to change the pace of their progression through the program, as one participant described, “i think we all have to go[at a] pace that's right for us.” sometimes changing these self-imposed expectations involved self-reflection on internal expectations, as this participant described: the biggest challenge was recognizing that i was not going to be able to do any of those things a hundred percent…my expectations of myself had to shift, that it just wasn’t reality that i was going to be able to do this big dissertation that i envisioned. participants described having to regularly reflect on their needs if they wanted to be able to continue to successfully progress through their doctoral programs. luck while many participants cited specific examples of their own internal resources, a majority (n=15) attributed some of their ability to persist to factors outside of their control; they had just gotten lucky. participants felt lucky about pregnancy timing, fertility, physical health, and the presence of specific people as supports, such as faculty, mentors, or chairs. mirick & wladkowski/making it work 360 participants discussed the impact of pregnancy timing within an academic calendar, which could allow for a leave after a child’s birth and the completion of program milestones. some participants intentionally timed pregnancies for early summer babies, but many acknowledged that this type of control over pregnancy timing is not always possible and really due simply to good luck in terms of fertility and full-term pregnancies. participants expressed gratitude for their good luck when their pregnancy was timed well, as this participant described, “it was lucky that i just happened to get pregnant in august because it coincided with the schedule for the school year so that i would be able to finish my classes.” this participant recognized the role that her well-timed pregnancy made in her ability to complete that semester’s coursework and avoid falling behind her peers. the ability to become pregnant easily, without any or much medical intervention, was seen as helping students persist in their program. participants recognized fertility was simply due to chance, versus something that was within their control, as this participant described, “my husband and i were very lucky and i was young, so we had statistically a much surer shot of getting pregnant quickly but that is not always the case.” participants who did use fertility treatments thought they were better able to continue in their program through that process when the interventions worked quickly. one participant described her experience as lucky, saying: the reason [getting pregnant] didn't really impact my functioning in the doctoral program is that we had a very fortunate and a not typical infertility experience… at no point did we try an intervention that wasn't successful…and our insurance paid for it so financially was not that stressful so for us…our infertility experience is not typical. participants understood fertility as due to random chance, but perceived easy conception as helpful in terms of success in the program, as they did not have to manage many medical appointments or cope with a significant financial burden due to multiple interventions. participants believed an uncomplicated pregnancy supported their ability to progress through their programs during pregnancy. for example, an easy pregnancy allowed participants to continue working productively, remain present and active on campus longer, focus on school work versus being distracted by anxiety or physical symptoms, and keep their pregnancy secret. they acknowledged that the presence or absence of pregnancy complications was out of their control. one participant remarked, “i was very lucky…i had a relatively easy pregnancy. i didn't have a lot of morning sickness…and i actually didn't share with my advisors or my mentors until i was five months.” another participant echoed this, saying, “i think i was lucky. my pregnancy was pretty uneventful. he was born a little bit early, but by and large, uneventful, and i really was able to work up until the end.” an uncomplicated pregnancy allowed participants to be more productive, setting themselves up for an easy transition back to work after the birth of their baby. participants were vocal in attributing their success to these factors (fertility, timing, health), while also acknowledging these factors were out of their control. participants perceived the availability of a supportive culture for mothers in their program as based entirely on luck. one participant described the administrators and faculty in her program, saying, “i think i lucked out. the program director for the phd advances in social work, fall 2019, 19(2) 361 program…my supervisors at my assistantship…and the faculty that i had in my immediate circle…were [all] really supportive.” some participants described themselves as lucky to have been assigned a certain dissertation chair who was supportive of their parenting journey, as this participant said, “i was lucky to have found him [advisor].” participants perceived the creation of supportive networks within doctoral programs as outside of their control. these relationships were attributed to chance. discussion participants identified individual characteristics such as discipline, organization, and work ethic as integral to their ability to continue in their doctoral programs, reflecting some of the existing research on doctoral student persistence (dickerson et al., 2014; rockinsonszapkiw et al., 2014; spalding & rockinson-szapkiw, 2012). a high level of discipline and time management allowed women to create necessary work time for themselves. this is similar to dickerson et al.’s (2014) findings, which highlight the importance of organization and time management skills for persistence. research on persistence has identified internal motivation as integral to persistence (spaulding & rockinson-szapkiw, 2012). while participants in this study agreed with this, they described their motivation for completion as changing in the process of pregnancy and early parenting. some women found new reasons to be motivated to continue in their program, such as the desire to be a positive role model for their child. others were motivated by anger and frustration and wanted to be successful to disprove the caregiver bias they encountered from faculty and administrators. the importance of motivation and determination was clearly reflected in the narrative data (castelló et al., 2017; grover, 2007; rockinson-szapkiw et al., 2014). spalding and rockinson-szapkiw (2012) found that the ability to reassess needs and make necessary structural changes was a critical component of persistence for doctoral students. the participants in this study described similar continual assessment of needs, and identified the importance of adjusting their schedule, study plan, and expectations of themselves to meet these changing needs. for participants in this study, in comparison to non-parenting doctoral students, these needs tended to focus on the intersection of school and child-related issues, such as maternity leave and childcare. students’ needs could change as their children entered a new developmental stage, such as becoming mobile or entering preschool, or as they entered a new stage in their program (e.g., data collection or dissertation writing). participants often described accessing their social network to address some of these needs. although much of the existing research does not explicitly look at the experiences of doctoral student mothers, studies have found that a strong social network is an important factor for doctoral program persistence (adorno et al., 2015; mcalpine & norton, 2006; spaulding & rockinson-szapkiw, 2012). the findings of this study suggest that many women have the internal resources and strong support network to manage pregnancy and parenting while continuing to successfully progress through a doctoral program. these characteristics have been identified as critical for persistence in doctoral programs for all students, not just women who are pregnant or parenting (mcalpine & norton, 2006; rockinson-szapkiw et al., 2014; spaulding & rockinson-szapkiw, 2012). women who are pregnant and/or parenting without a strong support system, either socially or financially, may struggle to remain in a mirick & wladkowski/making it work 362 doctoral program. financial needs were often greater than before a child was born, due to the cost of childcare. participants gave examples of relying on family members, especially parents and in-laws, for necessary childcare which mitigated these financial pressures. women without financial resources such as a working spouse or opportunities to work outside of her doctoral program, had increased financial needs that might make doctoral education infeasible. doctoral students can find their study timeline lengthened by life events, such as the birth of a child or a pregnancy loss (mcalpine & norton, 2006; spaulding & rockinson-szapkiw, 2012), but for women without sufficient financial resources or support network, these life events may have the potential to halt progression completely. these findings demonstrate a unique narrative of doctoral program persistence for women with children. research on attrition is primarily deficits-based, focusing on individual and departmental factors (gardner, 2009b; golde, 2005). doctoral faculty tend to attribute attrition to individual student characteristics, highlighting the ways in which students are lacking the personality characteristics, motivation, or preparation necessary for doctoral level work (gardner, 2009b; lovitts, 2001). these findings suggest a more nuanced attribution of persistence. the narrative the participants shared is one of determination and perseverance—this narrative declares that it will be hard work, but many women have what it takes to successfully be both doctoral students and mothers. women may find this persistence narrative more empowering than narratives about attrition, which tend to be more focused on deficits (gardner, 2009b; lovitts, 2001). while this is an inspiring narrative, academic culture often does not support open discussion of women parenting within academic institutions; instead, women can be penalized if they are perceived as less committed or less productive due to caregiving responsibilities (drago et al., 2006). to avoid this caregiving bias, many women in academia choose to perpetuate the narrative that women can parent within academia without any impact on productivity or stress, instead of having transparent and open conversations about strategies for effectively managing family and academic responsibilities simultaneously (drago et al., 2006). this cultural context may limit women’s ability to openly share their own narrative about attributions of success. in contrast, a second attribution narrative also emerged from these findings. in this narrative, women downplayed the difficult work they put into remaining in their doctoral programs. instead, some women attributed part or all of their success to factors outside of their control, referring to it as “good luck”. good luck took many forms, including healthy, well-timed pregnancies, supportive advisors and programs, and family-friendly administrators. this attribution narrative may be harder for women to use to mobilize factors that facilitate persistence, as it suggests that at least some of their ability to continue in a doctoral program was due to factors they could not control, such as physical health or faculty and programmatic supportiveness of doctoral students with children. in light of continual silence in academia about the difficulty of managing parenting and work responsibilities for women (drago et al., 2006; young & wright, 2001), this narrative of persistence based on good luck may have more traction as competing narratives of hard work and intense discipline may not be publicly shared. advances in social work, fall 2019, 19(2) 363 while research on persistence is important, future research should also explore the experiences of women who left their doctoral programs during and after a pregnancy. it is critical to understand the reasons that women leave programs, differentiating between negative experiences, such as when students “drop out” because they felt they could not keep up or meet the expectations of the program, and positive experiences, such as when priorities or motivation changes and students leave the program because they felt this was a better choice for them and/or their families (willis & carmichael, 2011). women in this study recognized the importance of reflecting on their own needs through their pregnancy and during the transition to parenthood, suggesting that for some women, leaving their doctoral program may not be a negative thing, but instead, a response to an assessment of their current needs and priorities (golde, 2000, 2005; mcalpine & norton, 2006). in the same vein, conceptualizing “success” post-graduation needs to be reconsidered, as choosing a less prestigious academic position or leaving academia altogether may be an intentional decision on the part of women who do not perceive academia as a workplace that fits their needs (mason et al., 2013). social workers, along with other health care professionals, have practice-focused career opportunities available to them, perhaps making this shift from an academic career trajectory easier than those in fields with fewer non-academic options. anastas and kuerbis (2009) reported that only 50-60% of social work doctoral graduates had obtained academic positions by graduation. limitations as with all research, this research study has limitations. first, although research clearly demonstrates the fact that women of color tend to have different, more challenging experiences in graduate education (brown & amankawaa, 2007; brunsma, embrick, & shin 2017), this sample was primarily white and therefore, the experiences of women of color were not included. in fact, participants in the study were similar in not just race, but also age and marital status. this excludes the voices of single mothers and those pursuing a doctorate who are younger. though this study focused on women who experienced a pregnancy, there might be some key similarities or differences for women who pursue parenthood in other ways, such as a partner’s pregnancy, surrogacy, or adoption and the narrative of persistence available to them. these questions were not explicitly explored in this study. while participants described many similar experiences, this research does not allow for differences by field to be determined. in fact, almost half of the participants were social workers, so these findings may more accurately represent the experiences and culture of social work doctoral programs than those in other fields. for example, attrition rates in mathematics and computer science fields tend to be much lower than in the social sciences (bair & haworth, 1999). implications these findings can be used by doctoral programs interested in supporting pregnant and parenting women doctoral students. the student’s relationship with their advisor or dissertation chair is often seen as a critical component of doctoral student persistence (mcbain, 2019; springer et al., 2009). mcbain (2019) says, “a student’s connection with his or her chair/advisor is arguably the most important relationship they will develop mirick & wladkowski/making it work 364 through the course of their study. this relationship has a profound effect on whether the student successfully completes the doctoral degree” (p. 2). chairs/advisors have a unique opportunity to support pregnant and parenting doctoral students. for some, this may require training in order to develop effective skills for supporting this group of students (springer et al., 2009; young, vanwye, shafer, robertson, & poore, 2019). chairs/advisors can incorporate the factors identified by this study, including time management skills, reflection and assessment of needs, and mobilization of resources, and encourage students to engage in these practices. as with any professional skill, some students may need more resources or skill development in order to be successful and chairs/advisors should be knowledgeable about the on-campus resources available to support students (springer et al., 2009). chairs/advisors should consider the implicit messages within their guidance and advice. in addition, they should be aware of prevalent attribution narratives of persistence and attrition and adopt narratives which empower students and offer stories of hope and success, as attribution narratives impact students’ beliefs about their own self-efficacy and outcomes (lovitts, 2001). mentors who are mothers can serve as role models. when role models decide to be transparent about the challenges experienced and the strategies used to navigate them, they send the message that students can balance both the role of student and parent. by breaking the silence about these challenges (drago et al., 2006; young & wright, 2001), mentors can create a space for frank, useful conversations about barriers such as role conflict, caregiver bias, and work-life balance. conclusion the topic of persistence within doctoral education has received little research attention, and no research has explored persistence for pregnant and parenting women doctoral students. this is particularly true in social work, where there is a dearth of research on the experiences of doctoral students (anastas & kuerbis, 2009). social work doctoral programs should focus on supporting all students in their programs, including mothers, reflecting the social justice values of the profession. the attrition of social work doctorate student mothers from doctoral programs and from academic positions post-graduation decreases the diversity of bsw and msw faculty, and adds to the problem of insufficient social work doctoral program graduates to fill open faculty positions (kurzman, 2015). these findings provide a window into how some women doctoral students experience their own success, accessing internal resources, and also highlight their attributions of success. schools of social work, and chairs/advisors of women doctoral students with children, can use these findings to support and guide pregnant and parenting students to successful 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(2019). factors affecting phd student success. international journal of exercise science, 12(1), 34-45. retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6355122/ author note: address correspondence to: rebecca g. mirick, licsw, phd, assistant professor, salem state university school of social work, salem, ma 01970; email: rmirick@salemstate.edu https://cgsnet.org/ckfinder/userfiles/files/doctoral_initiative_on_minority_attrition_and_completion_2015.pdf https://cgsnet.org/ckfinder/userfiles/files/doctoral_initiative_on_minority_attrition_and_completion_2015.pdf https://doi.org/10.28945/1589 https://doi.org/10.1177/0192513x08329293 https://doi.org/10.1177/0886109915622527 https://doi.org/10.28945/1505 https://doi.org/10.1177/0741932507312014 https://doi.org/10.1037/0033-295x.92.4.548 https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1046&context=tqr https://doi.org/10.1080/26379112.2019.1654394 https://doi.org/10.1080/10437797.2019.1656580 https://doi.org/10.1080/10437797.2001.10779074 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6355122/ mailto:rmirick@salemstate.edu _________ hsun-ta hsu, phd, associate professor, ashley givens, phd, lcsw, assistant professor, rachel bailey, lcsw, msw, assistant clinical professor, and ché wilson, ba, msw student, school of social work, university of missouri, columbia, mo. ryan rattliff, msw, junior grant writer, scribe, llc, charlotte, nc. virginia ramseyer winter, phd, associate professor, school of social work, university of missouri, columbia, mo. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 533-552, doi: 10.18060/24969 this work is licensed under a creative commons attribution 4.0 international license. awareness of racism among social work students in a challenging era: an application of social ecological model hsun-ta hsu ashley givens rachel bailey ché wilson ryan rattliff virginia ramseyer winter abstract: this study focused on understanding individual (e.g., political identity and alignment of social work core values with the black lives matter movement and the all lives matter argument) and social environmental correlates (e.g., social network composition) of awareness of racism among social work students. a convenience sample of social work students (n=98) recruited from a major midwest land grant university completed an online anonymous survey with questions covering individual characteristics, social network information, and attitudes toward social phenomena. the color-blind racial attitudes scale was used to assess overall awareness of racism, white privilege, institutional racism, and blatant racism. regression models were conducted to identify correlates of these domains of racial attitudes separately. liberal political view identification and alignment of black lives matter (blm) movement with social work core values were associated with better awareness of racism across all domains; aligning all lives matter with social work core values was associated with unawareness of overall racism, institutional racism, and blatant racism. finally, discussion on racial issues with network members was associated with better awareness of overall racism, white privilege, and blatant racism. social work programs should facilitate inter-group dialogues to build consensus on countering racism. discussions on the mission and the context of blm and its opposition efforts should also be incorporated in the curriculum. finally, more emphasis on the impact of institutional racism should be included into course activities to further discussion on such topics within students’ network. keyword: awareness of racism; social work student; social work education; social network; color-blind racial attitudes the racial composition in the united states is increasingly diverse. the most recent census data shows decline, albeit small, in the white population for the first time since 1790, and a significant increase in people identified as people of color (brookings institute, 2021; u.s. census bureau, 2021). however, such a demographic shift has triggered concerns regarding racial tension generally (craig & richeson, 2014, 2017). recent social unrest across the united states surrounding racial injustice highlights racism as a critical social and public health crisis that needs to be addressed (american public health association, 2021; centers for disease control and prevention, 2021). as a profession centered on social justice, social work is poised to address racism and discrimination from about:blank advances in social work, summer 2022, 22(2) 534 multiple levels of practice. in fact, the national association of social workers (nasw) has recently updated the code of ethics to explicitly add confronting discrimination, oppression, racism, and inequality into one of the core values (barsky, 2021). guided by the nasw code of ethics, institutes of higher education need to equip students to engage in practice at all levels (e.g., clinical work, community organizing, and policy advocacy) from an anti-racist lens, as they are likely to work with racial minorities who may be disproportionately impacted by adverse social, economic, educational, and health and mental health outcomes (boddie et al., 2019; iceland, 2019; paradies et al., 2015). as part of this educational imperative, social work programs must ensure that students are engaged in coursework that moves them beyond understanding cultural competence within the classroom setting to incorporating these values and ethics within all settings. in fact, avoidance of difficult or perceived controversial topics is not an option for social work students who are required to assess implicit bias, address biases through reflection and supervision, and promote the knowledge that race significantly impacts a person’s life experience. guided by the newly revised nasw code of ethics, effective engagement and intervention with clients and communities can only be achieved with explicit discussion about race, acknowledgement of social determinants of race, and emphatic belief in and utilization of culturally competent skills in social work curriculum. in order to foster students’ capacity in assessing self-biases and countering racism and discrimination, social work educators need to have awareness about malleable factors associated with students’ perceptions of racism to develop curriculum and design courses accordingly. such understanding is especially critical in the current era, as students enter social work programs with increasingly divergent backgrounds that may shape their diverse view on race and racism. the social ecological model (sem; yarrow & zaslow, 1981) posits that individuals’ beliefs, attitudes, and behaviors may be the products of their personal and social environmental properties, hence providing an appropriate theoretical model to understand awareness of racism among social work students. one’s social relationships with others (i.e., social network) can be considered as their immediate social environment. the social networks in which individuals are embedded greatly impact their perceived norms and behaviors (montgomery et al., 2020; sijtsema & lindenberg, 2018). in fact, the sem has been used to explicate specifically the relationship between micro (i.e., intrapersonal) and meso (i.e., interpersonal) level correlates, including the influence of immediate and extended relationships on attitudes toward race and appreciation for diversity (bowman, 2012; ibrahimi et al., 2020; priest et al., 2014; spencer, 2007). findings from previous literature on racial attitudes supports the sem proposition in that individuals’ personal characteristics and social network properties may critically influence their racial attitudes. at the individual level, multiple studies have identified individuals’ age (e.g., being of an older generation; davis & proctor, 1984; hunt, 2007; weigel & howes, 1985) and political affiliation (e.g., identifies as political conservative; feldman & huddy, 2005; weigel & howes, 1985) may be associated with less awareness of racism. some studies (craig et al., 2020; grollman, 2018; spanierman et al., 2012) also suggested that underrepresented group status may have impacts on the extent to which one recognizes and acknowledges racism and discrimination. individuals who belong to marginalized groups are also more likely to be aware of racism and discrimination than hsu et al./awareness of racism 535 their peers who identify as belonging to heteronormative, cisgender groups (flores, 2017). in some instances, students who identify as lgbtq+ report higher levels of awareness and understanding of racism than their counterparts (danforth et al., 2019). however, awareness does not always translate to positive experiences. prior research demonstrates a complex interplay within minority status communities in which inequity and discrimination still exists (ghabrial, 2017; gray et al., 2015; han, 2007). from a “person in environment” perspective, studies also found the critical role individuals’ social network play in formulating and modifying their racial attitudes. for example, from a social norms lens, studies suggest that parents’ racial attitudes may have great implications on their children’s perceptions on race and racism (aboud & doyle, 1996; pauker et al., 2018b), whereas peers may play a critical role in tolerance of racism among youth and young adults (tan et al., 2010). from an exposure and interaction perspective, studies highlight the importance inter-racial exposure and interaction experiences may have, not only on white individuals’ awareness of racism (pauker et al., 2018a), but also on racial minority individuals’ racial attitudes (shelton & richeson, 2006). finally, from a communication perspective, being able to have difficult dialogues, about topics such as the impact and experience of racism, with network members was also found to be helpful in raising awareness of racism and more positive racial attitudes (danforth et al., 2019; lopez, 2004). although research focusing on racial attitudes and awareness of racism in higher education (e.g., college students) has been abundant (lopez, 2004; loyd & gaither, 2018; smith et al., 2017), studies focusing on such a topic targeting social work students specifically, remain relatively scarce or limited to a descriptive nature (danforth et al., 2019; loya, 2011). to our knowledge, only one study conducted by danforth and colleagues (2019) investigated individual and social network level correlates of racial attitudes among white social work students. consistent with previous literature, danforth et al. (2019) suggested that individuals’ age, political views (i.e., liberal views as compared to conservative views), and awareness of an on-campus racial justice protest were associated with better awareness of racism. adopting the sem, danforth et al. (2019) also pointed out that more discussion on racial justice with peers may help promote students’ awareness of blatant racism. although past research provides critical insights on racism awareness among social work students, it has largely only focused on white social work students rather than including racial minority students. other studies have pointed out that racial or ethnic minorities may perceive racism in different ways and may have diverse racial attitudes toward other racial groups (richeson et al., 2005; smith et al., 2017). therefore, expanding on past research through the assessment of the experiences and attitudes of students of color is imperative for social work programs to fully address racism, oppression, and discrimination with all students. this is especially relevant as social movements and advocacy efforts that significantly impact black and brown communities continue to push for substantial overhauls of the u.s. institutions and systems social work students learn about and navigate. advances in social work, summer 2022, 22(2) 536 for instance, danforth et al. (2019) utilized data collected in 2015, which may not capture the impacts of the recent prominent nationwide black lives matter (blm) movement and the social tension surrounding it. it should be noted that although the blm movement originally started in 2013 in response to the trayvon martin case, it gained further domestic and international attention and significant momentum in 2020 after the killing of george floyd (bell et al., 2021). in essence, the blm movement is a challenge to the criminal justice system, and further expanded the call for action to address the injustice, racism, and discrimination faced by black communities (mayorga & picower, 2018). considering the widespread debates and clash between blm and its opposition efforts (e.g., all lives matter; alm), how social work students understand and perceive these debates may be critical in shaping their perceptions regarding racism. more importantly, with the nasw code of ethics and core values heavily emphasized in social work education as the ultimate guidance of social work practice, how social work students perceived the mission of blm or its opposition in relation to social work core values may be critical in shaping or justifying their awareness and stance regarding racism within society. previous research has illustrated perceived professional values on real world practices among helping professionals (kaya & boz, 2019; pattison & pill, 2020). further understanding on this topic will have critical implications on social work course development in terms of whether and how to incorporate the blm and its counter efforts in the curriculum. current study informed by the sem (yarrow & zaslow, 1981) and expanding on previous literature (danforth et al., 2019; loya, 2011), the purpose of the study is to explore individual and social network level correlates of social work students’ awareness of racism. specifically, to address the current gap in literature identified above, we aim to (1) explore the malleable individual level factors (e.g., a student’s perceived alignment of black lives matter with social work values) associated with social work students’ awareness of racism and (2) identify social network factors associated with social work students’ awareness of racism. findings of this study will provide critical insights to inform social work programs and educators on curriculum development to enhance students' competencies in countering racism. method study design the current study utilized a cross-sectional survey, which served as the baseline data from a pilot evaluation study conducted by a school of social work in a major midwestern public university. this pilot evaluation study is part of the school’s coordinated effort to understand and promote inclusion, diversity, and equity (ide) within the social work program and the surrounding communities by facilitating student driven events and reviewing and modifying program policies. specifically, the evaluation study aimed to adopt a longitudinal design to investigate the potential impact of such an effort in hsu et al./awareness of racism 537 promoting ide among social work students over time, with the baseline data focused on exploring social work students’ awareness of racism and its correlates at the individual and social environmental levels. considering the sensitivity of the topics covered in the study, the baseline data were collected during 2020 via anonymous self-administered computerassisted surveys. students were not compensated for completing the survey. this study received approval for exemption from the irb at the university. sampling and data collection the pilot evaluation study used convenience sampling to recruit students from the school of social work. with the evaluation nature of the study, all students enrolled in the bsw, msw, and phd programs during the fall semester in 2020 were considered eligible for the study. based on enrollment record, 342 students were eligible for the study. recruitment emails briefly explaining the purpose of the evaluation study and a link to the anonymous online survey were sent out to social work students via internal listserv maintained by the school of social work. since no identifiable information was collected, reminder emails were sent to all students multiple times via the same listserv as suggested by previous literature on non-face-to-face data collection (crawford et al., 2001). students who clicked the survey link were directed to a consent page detailing the study purpose and activities where they could choose to take the survey by clicking “yes, i want to participate in the study.” at the beginning of the survey, to ensure students’ anonymity as well as avoid duplicates, a unique identification code for each participant was generated based on the following formula: first letter of mother’s first name, number of older brothers (living and deceased), number of younger sisters (living and deceased), number representing the birth month, and first letter of the middle name. among 342 individuals included in the social work student listserv, a total of 121 students agreed to participate in the study, and 98 completed the survey (response rate=28.7%). the self-administered anonymous survey lasted no more than 15 minutes and involved two major components: personal level characteristics and social network properties. for the individual level components, information regarding demographics (e.g., age and gender identity), political identity, awareness of racism, and awareness and perceptions of the recent blm movement were collected. this study adopted the egocentric social network approach (campbell & lee, 1991) to explore social work students’ network composition. specifically, students (i.e., ego) were asked to nominate 7 people (i.e., alters) with whom they had interacted within the past 3 months. students were then asked for their relationships and interactions with the alters and their perceived alter characteristics (e.g., perceived alter race and perceived alter attitudes toward individuals with a different race than theirs). measurements outcome the outcome of interest in the study is awareness of racism measured by the colorblind racial attitudes scale (cobras; neville et al., 2000). cobras is a 20-item 6-point advances in social work, summer 2022, 22(2) 538 likert scale including three sub-scales assessing individuals’ unawareness of white privilege, institutional discrimination, and blatant racial issues. the unawareness of white privilege and the unawareness of institutional discrimination subscales both contain seven items (sample item: “everyone who works hard, no matter what race they are, has an equal chance to become rich”; “it is important that people begin to think of themselves as american and not african american, mexican american or italian american, respectively”), and the unawareness of blatant racial issues includes 6 items (sample item: “racism is a major problem in the u.s.”). the response options range from 1 (strongly disagree) to 6 (strongly agree). with 10 items reverse coded (neville et al., 2000), the sum scores for the overall cobras scale (range between 20 to 120) and the three subscales (unawareness of white privilege, range between 7 to 42; institutional discrimination, range between 7 to 42; and blatant racial issues, range between 6 to 36) were calculated. the higher the scores, the higher an individual’s unawareness of racism (i.e., “color-blindness of racial attitudes”; neville et al., 2000) in general or in specific corresponding domains. it should be noted that the cobras does not specify scoring thresholds as high or low colorblind racial attitudes; therefore, all outcomes of interest (i.e., general color-blindness of racial attitudes, unawareness of white privilege, institutional discrimination, and blatant racial issues) in the study are continuous variables. independent variables adopting the sem and informed by previous literature, this study involved both individual and social network level independent variables. individual level independent variables included in the study are rurality of residence, political identity, and awareness and perception of the blm movement. self-report rurality of residence was a dichotomous variable as living in a rural area coded as 1, and other (i.e., urban, and suburban areas) coded as 0. political identity was also a dichotomous variable (1=self-identified political view as liberal; 0=all others, including conservative and moderate). awareness of blm is measured using a dichotomous variable with 1 representing “aware of recent events related to the blm.” perceptions regarding blm, as whether it aligns with social work core values, was captured by using two separate dichotomous variables, perceived blm movement as aligning with social work values (coded as 1) and perceived alm as aligning with social work values (coded as 1). in addition, although not the focus of the study, since the school provided a book focusing on addressing racism as pre-semester recommended reading as part of the efforts to promote ide, completion of the recommended reading or not was also included as an independent variable in the current study (dichotomous variable; 1=had completed the recommended reading). informed by previous literature (danforth et al., 2019; lopez, 2004; pauker et al., 2018a; tan et al., 2010), for social network level correlates, this study focused on three constructs: inter-racial exposure (e.g., social network diversity and homophily), subjective racial norms (e.g., perceived network racial attitudes), and communication (communication with network members on racial issues). social network diversity was captured via two variables: ego-alter racial homophily and network member racial diversity. ego-alter racial homophily is a continuous variable representing number of hsu et al./awareness of racism 539 nominated network members (the alters) who shared the same racial identity with the participant (the ego). network member racial diversity is also a continuous variable depicting the number of different race and ethnic groups within an individual’s network. perceived network racial attitudes is a continuous variable representing the number of social network members whom respondent perceived as having negative attitudes toward individuals who have a different racial identity as theirs. finally, communication with network members on racial issues is a continuous variable depicting the number of network members with whom a respondent had talked about racism or race related issues. demographic controls in addition to independent variables of interest discussed above, this study also included demographic characteristics, including age, race and ethnicity, gender identification, and sexual orientation, as control variables. considering the small sample size of the study (n=98), and that over 87 percent of the participants identified as white, in this study race and ethnicity was treated as a dichotomous variable (1=racial minority, including black, latinx, multiracial and others; 0=white). gender identity is a nominal variable including three categories: cisgender male, cisgender female, and gender minority (i.e., transgender male, transgender female, non-binary, and others). sexual orientation is a dichotomous variable, with 1 representing sexual minority (i.e., lesbian, gay, bisexual, queer or questioning, and others) and 0 as heterosexual. analysis linear regression models were conducted to explore individual level and social network level correlates of social work students’ awareness of overall racism, white privilege, institutional racism, and blatant racism, separately. constrained by small sample size, to achieve parsimonious models, we first conducted bivariate linear regression analysis to identify independent variables to be included in the final models. independent variables found to be significant in the bivariate analysis (i.e., p<.05) were included in the final multivariate linear regression model of the corresponding outcome. however, demographic controls were entered in all final models regardless of their significance in the bivariate analysis. advances in social work, summer 2022, 22(2) 540 table 1. descriptive statistics of social work students (n=98) n (%) / mean (sd) demographic controls age (years) 28.7 (8.94) race/ethnicity white 86 (87.8%) black 5 (5.1%) latinx 1 (1%) multiracial or others 6 (6.1%) gender female 84 (85.7%) male 12 (12.2%) gender minority 2 (2%) sexual orientation sexual minority 25 (25.5%) heterosexual 73 (74.5%) independent variables rurality of residence rural 23 (23.5%) urban or suburban 75 (76.5%) political identity liberal 58 (59.2%) non-liberal 40 (40.8%) black lives matter (blm) awareness of blm 94 (95.9%) align blm with sw1 core values 75 (76.5%) align all lives matter with sw core values 23 (23.5%) have read designated reading on racism 22 (22.5%) outcomes of interest color-blindness of racial attitudes… overall 38.3 (18.88) unawareness of white privilege 15 (8.27) unawareness of institutional racism 13.9 (7.12) unawareness of blatant racism 9.4 (4.67) social network composition # different racial groups within the network 1.8 (0.93) # nm2 sharing same racial identity as sw student 5.6 (1.97) # nm with negative views toward those w/different race 1.5 (1.61) # nm with whom sw student talks about racial issues 5.4 (2.05) 1sw=social work; 2nm= network member(s) results table 1 illustrates the descriptive analysis results of the study. social work students in this study had relatively high awareness of racism across the different domains. specifically, for unawareness of white privilege, our participants averaged 14.9 (sd=8.3; the original cobras’ unawareness of white privilege sub-scale range is 7 to 42 with higher scores indicating higher unawareness of racial issues); for unawareness of institutional hsu et al./awareness of racism 541 discrimination, the average was 13.9 (sd=7.1; the original cobras’ unawareness of institutional discrimination sub-scale range is 7 to 42); and finally, for unawareness of blatant racial issues, the average among our participants was 9.4 (sd=4.7; the original cobras’ unawareness of blatant racial issues sub-scale range is 6 to 36). students who participated in the study were predominantly white (88%), cisgender female (86%), and resided in urban or suburban areas. one fourth of the respondents identified as sexual minority. most respondents (96%) were aware of the blm movement, and 76% aligned blm with social work core values. however, 24% aligned alm with social work core values. it should be noted that these two variables are not mutually exclusive. in fact, a further investigation suggested that 25% of students aligned both blm and alm with social work core values. in terms of social network properties, the respondents’ network racial composition is fairly homogenous (m=1.8; sd=0.9) and are likely to share the same racial identity with the ego (number of network member sharing the same racial identity with the student: m=5.6; sd=2.0). negative attitudes towards people with a different race were not prevalent among students’ networks (m=1.5; sd=1.6). finally, students on average talked about race-related issues with 5.4 of their network peers (sd=2.1). table 2 demonstrates the final multivariate regression analysis results. f-tests comparing final multi-variate models with intercept only models (i.e., models without independent variables) suggested all our multi-variate models perform significantly better than the intercept only models (overall color-blind racial attitudes: f=12.81; unawareness of white privilege: f=14.59; unawareness of institutional racism: f=8.83; unawareness of blatant racism: f=9.26) liberal political view identification and alignment of blm movement with social work core values were associated with lower unawareness of racism across different domains, including overall unawareness of racism (β =-11.2; 95% ci=18.5, -3.9; β =-16.3; 95% ci=-24.7, -7.8; respectively), unawareness of white privilege (β =-4.3; 95% ci=-7.3, -1.2; β =-8.8; 95% ci=-12.3, -5.2; respectively), unawareness of institutional racism (β =-4.1; 95% ci=-7.3, -1.0; β =-3.6; 95% ci=-7.1, -0.1; respectively), and unawareness of blatant racism (β =-2.5; 95% ci=-4.5, -4.5; β =-3.5; 95% ci=-5.8, 1.2; respectively). alignment of alm was, however, positively associated with unawareness of overall racism (β =11.5; 95% ci=4.1, 18.9), institutional racism (β =6.3; 95% ci=3.1, 9.4), and blatant racism (β =2.6; 95% ci=0.6, 4.6). as for social network correlates, only having more network members with whom students talked about racial issues was associated with lower awareness of overall racism (β =-1.6; 95% ci=-3.1, -0.1), white privilege (β =-0.8; 95% ci=-1.3, -0.2), and blatant racism (β =-0.6; 95% ci=-1.0, 0.2). advances in social work, summer 2022, 22(2) 542 table 2. linear regression analysis of color-blindness of racial attitudes color-blindness of racial attitudes… overall (r2=64.7) unawareness of white privilege (r2=66.2) unawareness of institutional discrimination (r2=53.9) unawareness of blatant racial issues (r2=54.5) β 95% ci β 95% ci β 95% ci β 95% ci demographics age -0.04 -0.37, 0.28 -0.01 -0.14, 0.14 0.01 -0.14, 0.14 -0.03 -0.12, 0.06 race/ethnicity racial/ethnic minority -3.16 -11.08, 4.76 -3.28 -6.64, 0.07 0.03 -3.37, 3.44 0.40 -1.78, 2.59 gender (ref: male) female 0.55 -8.19, 9.28 2.47 -1.02, 5.95 -1.20 -4.83, 2.44 -0.35 -2.55, 1.86 gender minority 0.74 -20.54, 22.02 2.09 -6.80, 10.98 -0.49 -9.62, 8.63 -0.64 -6.42, 5.15 sexual orientation sexual minority -1.48 -8.58, 5.61 -0.40 -3.32, 2.52 -0.99 -4.04, -2.05 0.42 -1.46, 2.30 rurality of residence rural 5.82 -1.21, 12.85 2.47 -0.48, 5.42 1.66 -1.33, 4.66 1.67 -0.24, 3.58 political identity liberal -11.23** -18.52, -3.94 -4.27** -7.34, -1.20 -4.12* -7.26, -0.99 -2.45* -4.45, -4.45 black lives matter (blm) align blm with sw core values -16.26*** -24.70, -7.82 -8.76*** -12.31, -5.21 -3.56* -7.12, -0.01 -3.51* -5.79, -1.24 align alm w/sw core values 11.49** 4.07, 18.92 2.62 -0.48, 5.72 6.25*** 3.05, 9.44 2.60** 0.57, 4.62 social network composition # of nm w/negative views toward those w/different race -0.27 -2.29, 1.75 -0.42 -1.25, 0.41 0.04 -0.82, 0.91 0.05 -0.49, 0.59 # of nm w/whom sw student talks about racial issues -1.63* -3.12, -0.14 -0.76** -1.33, -0.19 -0.44 -1.08, 0.19 -0.59** -0.98, -0.21 note. *p<.05; **p<.01; ***p<.001 alm= all lives matter; nm= network member(s); sw=social work hsu et al./awareness of racism 543 discussion and implications on social work education in this study, we sought to investigate individual and social network correlates with awareness of racism among social work students at a large midwestern university. cobras (neville et al., 2000) does not specify scoring thresholds for an individual to be considered as high or low colorblind racial attitudes (i.e., unawareness of white privilege, unawareness of institutional discrimination, and unawareness of blatant racial issues), and direct comparison with other studies may not be feasible due to methodology differences, however, our findings indicate social work students in the current sample demonstrate better awareness of racism across domains as compared to the general population (brigham, 1993; lo et al., 2016). it is possible that students self-selected into the social work program because they were aware of potential injustices faced by disenfranchised populations, including racial minorities. it is also likely that social work programs, guided by nasw core values, emphasize competencies in identifying and addressing health, social, and economic disparities faced by vulnerable populations in course activities and field practices that facilitate students’ awareness of racism. nonetheless, multiple individual and social network correlates regarding awareness of racism among social work students were identified. individual correlates consistent with previous literature (danforth et al., 2019; feldman & huddy, 2005; weigel & howes, 1985), our findings indicate social work students’ political identity may be associated with their awareness of racism. specifically, social work students who identified with liberal political views showed better awareness of white privilege, institutional discrimination, and blatant racial issues, compared to students who identified with moderate or conservative political views. it should be noted that conservative political values may not include acceptance of racism, and our findings do not suggest social work programs should focus on promoting liberal political views with the goal of raising awareness of racism. rather, social work programs should be cognizant of the fact that students come from diverse backgrounds (council on social work education center for diversity and social & economic justice, 2017), including political views, when fostering students’ awareness of racism. previous literature highlights the experiences of alienation among conservative students in social work programs (lerner, 2020). such sense of alienation may detach students from the social work curriculum activities, and thus hinder the educators’ efforts in fostering meaningful discussion on diversity and awareness of racism. under the current polarized social and political atmosphere, engaging conservative social work students in constructive dialogue and interactions with students coming from the other side of the political spectrum through in-course and off-course activities may facilitate better perceptions and awareness of racism. recent studies have suggested using inter-group dialogues builds consensus across diverse groups on hard topics to promote social justice (dessel et al., 2006; ruggiano et al., 2020). such a strategy should be incorporated in social work courses to enhance understanding of various political views among social work advances in social work, summer 2022, 22(2) 544 students and develop consensus on countering racism. social work programs should also emphasize constant self-evaluation of personal beliefs and professional values among students, especially when working with vulnerable populations with whom students may not share the same racial and ethnic identity. contradicting previous literature, which suggests awareness of recent racial protests may be associated with more awareness of racism (danforth et al., 2019), our study found that awareness of the blm movement was not associated with colorblindness of overall racism, white privilege, institutional discrimination, and blatant racial issues. it is probable that almost all students in the study were aware of such a movement and racial protests across the united states given the high profile of george floyd’s murder at the time of data collection. however, the current study also found that students’ perceptions of blm and alm aligning with social work core values may be associated with their awareness of racism. it should be noted that, in this study, it is not mutually exclusive for students to identify blm over alm or vice versa as aligning with social work core values. in fact, over 25 percent of the students identified both as aligning with social work values. aligning both blm and alm with social work values may be that the rhetoric “all lives matter” could appear to align with several tenants of the nasw code of ethics, particularly the values “social justice” and “dignity and worth of the person,” which require social workers to challenge social injustices and respect inherent dignity and worth of the person. likewise, the blm movement’s alignment with the nasw code of ethics could be justified using those same tenants. although the current study did not investigate students’ knowledge and familiarity with the mission and contexts of the blm movement and alm, considering alm is a retort originated in response to the blm movement, and that there is little information available on its cause, it could be the case that students are not fully aware of the mission and cause of blm and the contexts of alm to be able to distinguish the two, beyond their titles. as multiple studies have pointed out, alm can be seen as a strategy to shift the discussion from “do black lives matter?” to “which lives matter?” as an effort to maintain the status quo (atkins, 2019; kesier, 2021; west et al., 2021). therefore, it is not surprising, without fully understanding the contexts of blm and alm, when controlling for all other attributes, students who considered the current blm movement to align with social work core values showed better awareness of racism across the domains measured, while students who considered alm to align with social work core values demonstrated lower awareness of racism in all domains measured, except for white privilege. although cultural competency, discrimination, and racism are often discussed in social work classes, specific discussion and differentiation of blm and alm and how those may be associated with social work core values should be further covered. with the polarized reactions individuals may have in regards to racial protesting—blm and alm—it can be difficult to facilitate discussions on whether and how social work values may be reflected or not in these ideologies. nonetheless, to advance social work students’ understanding and awareness of racial issues in the society, social work programs and faculty must facilitate more discussions on such difficult topics both in class and out of class to ensure students fully understand the core values behind the social work profession and their applications in promoting racial awareness and justice in our current context. hsu et al./awareness of racism 545 social network correlates although previous literature suggests inter-racial interaction and exposure (pauker et al., 2018a; tan et al., 2010) may help facilitate positive racial attitudes and better understanding of racism, the study failed to identify significant associations between social work students’ network compositions (i.e., racial homophily between social work students and racial diversity within their networks) and their awareness of racism across domains measured. given we only asked students to nominate 7 network members, it is possible that our insignificant findings were because most students’ “close networks” comprised members with whom they shared the same racial identity, and that their networks are homogenous in racial composition. such close networks may also not capture students’ social network members on social media or online forums, where virtual interaction, information dissemination and exchange on sensitive issues may be more vibrant (amaya, 2017). future studies should aim to expand the number of network members nominated to capture both social work students’ core and peripheral social network members with the goal to investigate whether social network racial composition may be associated with social work students’ awareness of racism. this study also did not identify significant association between network normative influences (i.e., the prevalence of negative racial attitudes among network members) on social work students’ awareness of racism. limited in the number of social network members nominated, with on average only 1.4 out of 7 nominated network members (sd=1.6) perceived to be holding negative views toward people with a different race, such lack of variance may contribute to our insignificant findings. finally, our study suggested that talking about race related issues with more social network members was associated with better awareness of racism in general and across all domains measured in the study, except for institutional racism. such findings were consistent with previous literature (danforth et al., 2019) in that more discussion on sensitive and difficult issues, including racial disparities and racism, may help promote positive racial attitudes and awareness. based on this finding, social work programs should facilitate more discussions among students on race related topics to foster awareness of racism. compared to white privilege and blatant racism, institutional discrimination or systemic racism may be more covert and less covered in the education system; therefore, it is possible that discussion topics between social work students and their network members may be limited to overt racism and recent prominent racial discrimination incidents, rather than institutional discrimination. to facilitate understanding and discussion on institutional discrimination and systemic oppression among social work students, it is critical for students to understand not only the historical context of institutional discrimination, but also how such form of racism may be covert and embedded in the fabrics of the society that lead to adverse intergenerational social, ecological, educational, and health outcomes among racial minorities. introducing critical race theory (crt; abrams & moio, 2009; delgado & stefancic, 2012; kolivoski et al., 2014; rosen et al., 2017) along with diverse theories (e.g., feminist theory and system theory) already covered in social work curriculums may be crucial in fostering awareness advances in social work, summer 2022, 22(2) 546 and discussion of institutional racism. although considered controversial by some (butcher, & burke, 2021), crt is not simply a paradigm through which individuals view historical inequities; it is a paradigm for addressing inequity and the social institutions that create and sustain such inequity (abrams & moio, 2009; delgado & stefancic, 2012; fisher-borne et al., 2015). while originally composed to articulate and expose racial inequities within the judicial system, delgado and stefancic (2012) outline basic premises on which crt is built: the assertion that the common nature of racism allows it to be overlooked; it is beneficial to subgroups of society, which warrants little social disruption to acknowledge it, let alone take action to lessen its severity; and, as race is socially constructed, so are its implications (delgado & stefancic, 2012). applying crt to social welfare and social work topics compels social work students and faculty to center their identity within larger society as well as challenge their viewpoint of institutions and the treatments vulnerable subgroups face. strengths and limitations this study has some limitations. first of all, using data only collected at one timepoint, we are not able to establish the causal relationships between the identified correlates and the outcome, awareness of racism. the design of the study, self-administered anonymous online survey without compensation for participants’ time and efforts, led to a low participation rate and small sample size, which limits our external validity and our capacity of conducting a more comprehensive analysis. with such a design, to reduce student burden, we are also not able to collect more detailed information (e.g., detailed understanding of blm and alm, comprehensive social network information) from students. despite the limitations mentioned above, this study expands on previous limited understanding of correlates of social work students’ awareness of racism and provides recommendations on strategies that can be incorporated in social work programs to facilitate and harness awareness of racism, a critical precursor to counter racism, among social work students. furthermore, the current study provides a foundation for future research to expand upon in terms of exploring and examining social work students’ racial attitudes and awareness of racism using a more comprehensive design. conclusion anti-racism has been highlighted as a grand challenge in social work education, research, and practices, by major social work professional associations, including the council on social work education, the national association of social workers, and the society for social work and research. findings of this study suggest that social work programs should facilitate discussions on racism and racial discrimination among students across political ideologies. social work programs should also include in depth discussions on alignment and application of social work values on prominent social movements (e.g., blm) in a timely manner. finally, creating and fostering a space among student networks to discuss the implications of overt and covert discrimination faced by people of color may be critical to facilitate awareness of racism among social work students. hsu et al./awareness of racism 547 references aboud, f. e., & doyle, a. b. 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(1985). conceptions of racial prejudice: symbolic racism reconsidered. journal of social issues, 41(3), 117–138. https://doi.org/10.1111/j.1540-4560.1985.tb01132.x west, k., greenland, k., & van laar, c. (2021). implicit racism, colour blindness, and narrow definitions of discrimination: why some white people prefer ‘all lives matter’ to ‘black lives matter’. british journal of social psychology, 60(4), 11361153. https://doi.org/10.1111/bjso.12458 yarrow, l. j., & zaslow, m. (1981). review of the ecology of human development: experiments by nature and design. american journal of orthopsychiatry, 51(2), 363– 365. https://doi.org/10.1037/h0098898 author note: address correspondence to hsun-ta hsu, school of social work at the university of missouri columbia, mo. email: tah@missouri.ediu https://www.census.gov/newsroom/press-releases/2021/population-changes-nations-diversity.html https://www.census.gov/newsroom/press-releases/2021/population-changes-nations-diversity.html https://doi.org/10.1111/j.1540-4560.1985.tb01132.x https://doi.org/10.1111/bjso.12458 https://doi.org/10.1037/h0098898 mailto:tah@missouri.ediu ______________ stephanie bosco-ruggiero, ma is a doctoral student at the fordham university graduate school of social service, new york, ny and former student peer network coordinator at the national child welfare workforce institute (boscoruggier@fordham.edu). sharon kollar, lmsw is the linkd coordinator at the national child welfare workforce institute and adjunct instructor at the school of social welfare at the university at albany, albany, ny. (skollar@albany.edu). virginia strand, dsw is a professor at the fordham university graduate school of social service, west harrison, ny and the university partnership facilitator at the national child welfare workforce institute (strand@fordham.edu). robin leake, ph.d is an associate professor at the university of denver graduate school of social service, denver, co and the lead evaluator at the national child welfare workforce institute copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 170-183 supporting child welfare traineeship students through an online peer network stephanie bosco-ruggiero sharon kollar virginia c. strand robin leake abstract: this article describes the implementation of an online peer network for social work traineeship students pursuing or continuing careers in child welfare. literature on best principles and practices for facilitating an online community is reviewed, and an explanation of how these best practices were used is provided. initial program design and program developments, which took place over four years, are described. an overview of the evaluation data and how the program evaluation was carried out is presented. the article concludes with a discussion about successes and challenges experienced in building the peer network and further research needed to understand benefits of the use of online communities and social media in social work education. keywords: online communities, social media, traineeship, evaluation, social work education increasingly, social media and online communities are being used in social work practice, administration, research, and education: to facilitate interand intraagency collaboration and build communities of practice or professional networks (greenhow & robelia, 2010); in professional practice with clients (giffords, 2009; mishna, bogo, root, sawyer, & khoury-kassabri, 2012); to disseminate information (hitchcock & battista, 2013); to support social work education and continuous learning (davis & goodman, 2014; dunworth, 2009; kilpeläinen, päykkönen, & sankala, 2011; moore, 2008; quinney, 2005); to help bridge research and practice (lewis, koston, quartley, & adsit, 2010); and in community organizing and advocacy (edwards & hoefer, 2010; parrott & madoc-jones, 2008; young & delves, 2009). online community platforms used in social work include wikis (kilpeläinen et al., 2011), blog sites (hickson, 2012; young & delves, 2009), email list serves (murty, gilmore, richards, & altilio, 2012), discussion forums/boards (quinney, 2005), and ning sites (davis & goodman, 2014). social media used in social work includes linkedin, facebook, and twitter (hitchcock & battista, 2013). online communities now offer many of the same features as social media and vice versa. for example, many community mailto:boscoruggier@fordham.edu mailto:skollar@albany.edu mailto:strand@fordham.edu bosco-ruggiero et al./supporting child welfare 171 platforms offer friending, following, and commenting features while social media channels allows for the creation of private groups, document sharing, and email lists. the differences between community platforms and social media are lessening while interfaces and sharing of content across platforms (e.g., “share on twitter”) is increasing. despite increasing use of online community platforms and social media in social work, concerns remain that social workers are not being adequately prepared to use technology (giffords, 2009; hitchcock & battista, 2013; kilpeläinen et al., 2011; parrott & madocjones, 2008; perron, taylor, glass, & margerum-leys, 2010; young & delves, 2009) and that social work organizations are underutilizing these online tools (baker, warburton, hodgkin, & pascal, 2014; edwards & hoefer, 2010). social work programs play an important role in introducing to students how they can use social media and online communities in their professional work and in instructing students in the use of these technologies. there are a variety of ways in which social work educators and schools can integrate social media and/or online communities into courses or programs. for example, course instructors might require students to enroll in an online community for students in the course or integrate blogging into course assignments. programs might require students to develop professional profiles on linkedin or create an online portfolio. this article examines the national child welfare workforce institute’s (ncwwi) development of an online peer network to support bswand msw-level students participating in child welfare traineeship program. it details the establishment, development, and growth of an online peer network that utilized two popular online platforms (ning and facebook) and presents results from the program evaluation. online peer networks and communities of practice in social work due to the stressful nature of their work, social workers and social work students may greatly benefit from the support and camaraderie of a peer network (bergart & simon, 2005). while in-person networking may be preferable, it is not always a realistic option for social workers who have major constraints on their time, work in rural areas, and/or have few on-site professional development opportunities (bergart & simon, 2005). online communities offer professionals and students more options for networking and may better meet their professional, social, and practical needs (dunlap & lowenthal, 2011). students or professionals of color and those in rural areas may particularly benefit from online communities which can connect them with professionals from different backgrounds and introduce them to a wider array of professional opportunities (davis, deil-amen, riosaguilar, & gonzález canché, 2012; davis & goodman, 2014). wenger, white, and smith (2009) view technology and community as interactive; in their view, the right platform can contribute to a community’s sustainability and help a community build a sense of identity and purpose. selecting a platform or social media site that best meets potential members’ needs is important. organizations or instructors may want to survey potential members during the selection process. advances in social work, spring 2015, 16(1) 172 literature review principles and practices for building effective online communities an art and science to building effective online communities has emerged. prior to developing an online community for the traineeship students, ncwwi staff reviewed the literature on best practices and principles for building successful online communities. online communities must be well facilitated (berlanga, rusman, bitter-rijpkema, & sloep, 2009; charalambos, michalinos, & chamberlain, 2004; wenger, macdermott, & snyder, 2002). simply making a community available does not mean people will join or actively participate. a facilitator must understand how to build a strong and sustainable community (backer, 2008; fayard & desanctis, 2005; waltonen-moore, stuart, newton, oswald, & varonis, 2006), set the stage for positive member interaction by modeling a friendly conversational rhythm (fayard & desanctis, 2005), guide the group in resolving and negotiating conflicts (berlanga et al., 2009; charalambos et al., 2004; olofsson, 2007), seek feedback from members on the strengths and challenges of the community, and direct solution-focused discussions around identified challenges. community facilitators should understand how to motivate members to participate. cultivating a dedicated core group of members who consistently contribute to the community and model active participation is one tool for increasing motivation (wenger et al., 2002). a facilitator also should create a safe space for members to interact (backer, 2008; charalambos et al., 2004; gerard, 2012). one option is to offer varying levels of privacy within the site (e.g., only friended profiles can see certain posts) (berlanga et al., 2009). facilitators must also learn how to increase member commitment. they should limit the size of a community and narrow its focus (backer, 2008; kraut, resnick, & kiesler, 2012). they should create opportunities for members to shape the structure, function, content, policies, and operations of the community (berlanga et al., 2009). encouraging social and professional interaction (backer, 2008; dunworth, 2009) may also increase commitment. social presence theory suggests members will feel more satisfied and connected to their community (ho, quinton, zia, laubach, & bittner, 2012) when they sense other members are real people and when they are able to express their thoughts and feelings authentically (lowenthal, 2010). ncwwi student traineeship peer network: program description over the last decade, attention to the recruitment and retention of competent child welfare staff has become a priority in the field (depanfilis & zlotnik, 2008). schools of social work have responded to this challenge with educational programs designed not only for currently employed child welfare staff returning for graduate degrees but also by preparing social work students at both the bsw and msw levels for child welfare practice (zlotnik & pryce, 2013). it is within this context that two federal initiatives emerged which supported child welfare traineeship programs at schools of social work. one was the ncwwi, which from 2008-2013 focused on building the capacity of the nation’s child welfare workforce and supporting the development of skilled child welfare leaders. twelve traineeship programs bosco-ruggiero et al./supporting child welfare 173 prepared a diverse group of bsw and msw students for client-centered practice informed by child welfare and leadership competencies. a second federal initiative started in 2008 also supported traineeship students through five child welfare comprehensive workforce projects. the ncwwi student peer network supported bsw and msw students from 17 traineeship programs. the student peer network coordinator (“the coordinator”), in partnership with ncwwi staff and traineeship program faculty, was responsible for the network’s development and implementation. the three main goals of the peer network were to offer students opportunities for professional and leadership development, professional and social networking, and peer support for improved practice. the central components of the peer network were two online communities and a webinar series. online platform the team chose ning after considering a number of platforms including linkedin, an email listserv, google group, and wikispace. ning sites are customizable for private groups and offered a wider variety of features than other platforms. the ning site included personalized member profile pages, a chat room, private messaging, a discussion forum, blog space, photo and video sharing, closed and open groups, content pages, event calendar, and an option to add external apps. the ning site was easy to set up and customize. an informal survey was sent to new traineeship students each fall to gather information about their interests to generate useful content for the site early on. ning allowed for social and professional interaction in a safe space. only traineeship students were invited to join the site, and the coordinator and several other staff members were the only non-student members of the site. discussion forums (see figure 1), groups, the blog space, and an event calendar offered space for professional networking while photo-sharing and private messaging offered space for social interaction as well. the peer network was marketed through a flyer, a letter from the coordinator to new traineeship students, presentations by staff during student orientations (either virtual or inperson), and by faculty. at the beginning of the first year of the program, all traineeship students who provided a valid email address were invited to join the site. upon joining, new site members were required to answer several profile questions including year in the program, program name, and fieldwork site. they could include more detail in their profile by answering optional questions related to their professional experience and career goals. webinars all traineeship students, including site members, were invited to participate in professional development webinars. initial webinar topics were selected based on an informal poll of peer network members. webinar topics included how to achieve quality, commitment, and competence in the child welfare workforce; secondary traumatic stress; systems of care; and career development. professionals from the field as well as seven students were presenters. webinars were recorded and archived on the ning site for later viewing. advances in social work, spring 2015, 16(1) 174 figure 1: ning site discussion forum leadership group to motivate students to participate in the peer network, the coordinator organized a student leadership group that guided peer network activities and modeled active participation. over four years, the leadership group included five to nine students from different schools. program developments to ensure the community was well facilitated, the coordinator’s hours were increased during the second year. this allowed more time to add site content, obtain feedback from members, and write to individual members to encourage them to participate. to encourage professional networking, the coordinator created groups on the site around specific topics and schools. group features included discussion posting and resource sharing. members of groups were offered the option of meeting by teleconference, but only several calls were held due to difficulty in finding a time when all members of a group could meet. bosco-ruggiero et al./supporting child welfare 175 towards the end of year two, in response to student and faculty feedback, the coordinator developed a facebook group to complement the ning site. facebook group features include status updates; photo, video, and link sharing; a calendar; document uploading; and polls. all students were invited to join the group by the beginning of year three. also in year three the coordinator began sending ning site members weekly ebulletins that profiled students, highlighted resources, and listed upcoming events. a monthly update also was sent to program faculty to keep them updated about student peer network activities and resources. evaluation the traineeship peer network team worked with ncwwi program evaluators at the butler institute for families at the university of denver to develop evaluation questions to help answer the following research questions: 1) how successful was ncwwi in developing a peer network that engaged bsw and msw students and supported their professional development, and 2) how can the peer network be improved and maximally benefit student members? method questions about the peer network were embedded in the traineeship program’s formal survey of students, the stipend student inventory (ssi), which focused on student competencies and experiences. the ssi was administered annually online via qualtrics to all bsw and msw traineeship students at program entry in the fall, in the spring, and in the summer after students graduated. the peer network section of the ssi asked questions about site and feature usage, participation in webinars, and the usefulness of other activities. the coordinator gathered additional evaluation data by observing member activity on both sites, using google analytics, reviewing webinar evaluations, and from informal feedback from faculty. google analytics provided data on site visits, page visits, and the location, number of sessions, visits to specific pages, and geographic location of site visitors. observing activity on both sites allowed the coordinator to monitor which features were used most frequently. data downloaded from ning provided information on member log-on patterns (e.g., date of last log-on) and the number of members receiving broadcast messages. during the first years of the project, the team used evaluation data to enhance program goals and strategies and modify ssi peer network evaluation questions to better capture information about barriers and facilitators to program implementation. results member totals over four years, 245 students participated in one or both of the peer network sites: 233 joined the ning site and 74 joined the facebook group (table 1). fifty-two percent of traineeship students joined the ning site by the end of year four while 16% joined the advances in social work, spring 2015, 16(1) 176 facebook group. demographic data was available through the ssi for 232 of the 245 traineeships students who joined at least one of the peer network sites. of those known, 47% were bsw students while 53% were msw students. the racial/ethnic background of the students was 42% white/caucasian, 32% black or african american, 12% latino or hispanic, 11% american indian or alaska native, and 2% other (i.e., mixed race, asian, pacific islander). the majority of students were female (87%). table 1: cumulative ning and facebook member totals over four program years year 1 year 2 year 3 year 4 ning 50 120 165 233 facebook n/a n/a 53 74 table 2: ssi respondents by year ssi administered recipients completed surveys (response rate) # ning participants (% of completed surveys) # facebook participants (% of completed surveys) annual spring 2011 students 127 (79%) 59 (46%) - annual spring 2012 students 111 (77%) 56 (50%) 34 (31%) annual spring 2013 students 119 (64%) 40 (34%) 48 (40%) follow-up summer 2011 graduates 33 (50%) -- follow-up summer 2012 graduates 101 (69%) 35 (35%) 22 (22%) follow-up summer 2013 graduates 121 (47%) 20 (17%) 33 (27%) -= no data due to question not asked ssi respondent demographics table 2 reflects the number of ssi respondents by year. of the 357 respondents who completed the ssi over four years, 25% were bsw students and 44% were msw students. in identifying ethnicity, 52% were white/caucasian, 21% black or african american, 15% hispanic or latino, and 8% american indian or alaska native. the majority of respondents were female (91%). peer network engagement and usage ning site visits (see definition of “visits” below) increased between years one, two, and three but decreased in year four (see table 3), perhaps because the program was coming to a conclusion. use of mobile devices to view the ning site increased each year. the most frequently used ning site features were the discussion forum, blogspace, and photo-sharing (see table 3). the most frequently viewed content on ning was the home page, member pages, archived webinars, discussion forum, topical groups, and blogspace. school-specific groups were not widely used. one hundred and sixty-five members (71%) of the ning site created an expanded profile by answering the optional profile questions while 68 (29%) answered the required questions only. on facebook, all discussion posts were viewed by a majority of members although only a small number of members started new discussions. upon joining the facebook bosco-ruggiero et al./supporting child welfare 177 group, students were asked to introduce themselves via a status update, and most did. like ning, facebook activity also decreased in year four. figure 2: ning site visits over four years* * site “visits” are defined by google analytics as the total number of sessions during the specified date range, including repeat sessions by the same user. table 3: ning and facebook feature usage over four years feature total by end of year four ning site discussion forums 16 discussion forum replies 61 discussion forum views 541 photos posted 100 blog posts 14 blog comments 14 blog views 352 events 47 groups 15 group discussions 16 group discussion replies 22 group discussion views 169 group comments* 16 videos posted 8 facebook group discussion and reply posts** 140 facebook events added 22 * group comments feature is used to post brief messages but is not a threaded discussion **excludes staff posts student satisfaction and utility ratings according to ssi data, over the duration of the program, students' most frequent reasons given for visiting a site were to access resources, learn about challenges other students were facing, read about upcoming events such as webinars, and learn more about 443 847 1,001 639 2,930 0 500 1000 1500 2000 2500 3000 3500 year 1 year 2 year 3 year 4 total (4 years) ning site visits (excluding staff) advances in social work, spring 2015, 16(1) 178 content featured in broadcast messages from the coordinator. in 2011, 82% of annual ssi respondents said they felt the ning was easy to navigate. in 2013, 78% of annual ssi respondents indicated they received the monthly e-bulletins sent by the coordinator and of those, 71% found them useful. in the 2013 annual and follow-up ssi, students and alumni reported high overall satisfaction with the peer network since they first joined (70% of students and 55% of alumni were satisfied/highly satisfied). of the students responding to the 2013 annual ssi, approximately 65% said resources on ning were helpful in their coursework and careers, and more than 70% reported ning enabled them to connect with other students across the country. fifty percent of respondents said they received support from other students through the network. webinars most students (68% in 2011 ssi; 66% in 2012 ssi) unable to attend live webinars cited scheduling conflicts and work/school priorities as the main reasons for not attending. for those who attended, satisfaction with webinars increased each year. in the 2011 ssi, 64% of respondents said they learned useful information from webinars, increasing to 76% for students and 91% for alumni in 2012. several student presenters noted the experience enhanced their leadership skills and was highly rewarding. future peer network activity at the end of year four, all ssi respondents were asked how likely they were to participate in a future student peer network hosted on ning, facebook, linkedin, or an email list serve. more than 50% of respondents indicated they were likely to participate on any platform, suggesting online peer networking and community building is a useful activity for many social workers and a variety of platforms can be used. discussion based on data gathered during four years of the program, the peer network largely met its goals of offering students additional opportunities for professional and leadership development. while it also met its goal of offering students opportunities for professional and social networking, it did not fully meet its goal of facilitating peer support for practice improvement. less than half of eligible students participated in the peer network. it became evident during the course of the program that many traineeship students struggle to balance school, work, and family, leaving little time to participate in a peer network. a core group of students regularly contributed to the peer network, and it was evident these students highly valued the peer network. one of these student said she was sorry more students had not actively participated. the ning site’s capacity to help students co-create and shepherd knowledge was manifest in use of the blog space, discussion forum, and groups. ning and facebook offered excellent platforms for fostering professional and social interaction. student interaction bosco-ruggiero et al./supporting child welfare 179 on the sites generally centered on professional topics, but frequent photo-sharing, for example, suggests many students also enjoyed the opportunity to interact with other students on a more social level. active facilitation was critical to the success of both sites. when the coordinator’s time on the project was increased, she was able to engage with students individually and encourage them to make specific contributions such as posting a discussion or writing a blog. the bi-modal distribution of the peer network between students' experience in the field and those with little to no experience necessitated creating a community relevant to each. informal feedback suggested many experienced students believed the peer network was oriented toward students with less experience. to better engage experienced students, the coordinator developed a webinar, resource page, and group on supervision and management. she also developed a group and several career development webinars for students with less experience. schools of social work or traineeship programs interested in supporting students through an online peer network should consider students’ level of professional experience. some students noted they wanted to be engaged in the peer network as professionals, not just as students; therefore, programs may want to shape the peer network to appeal more to students’ sense of professional identify. evaluation strengths and limitations the evaluation was primarily developmental in design, allowing the program team to respond to data with needed program modifications. the collaborative approach between the evaluation and programs teams to identify relevant evaluation questions was a major strength of the evaluation. other strengths included the evaluation’s capacity to capture barriers and facilitators to implementation, measure real-time site usage through site observation, and use data from google analytics and ning. as the program evolved, ssi evaluation questions about the peer network were revised. a limitation of the evaluation was the lack of consistency in questions about the peer network from year to year. although valuable annual data was collected, the team could not compare some measures across student cohorts. another weakness of the evaluation was the low alumni response rate. future studies might increase response rates by using pop-up surveys embedded in social media or community sites or by conducting focus groups of users and non-users. conclusion increased use of technology can enhance social work education and practice. schools of social work are encouraged to consider using online community platforms or social media to enhance student comfort with these technologies and to support their learning and professional development. as schools of social work migrate toward offering full or hybrid online education, online community-building for students and professionals will only increase in importance. specifically, supporting social work students and alumni as they transition into child welfare careers has emerged as an important issue for educators and administrators (anderson, coulborn faller, & leake, 2013). online communities and social media can advances in social work, spring 2015, 16(1) 180 play a role in the professional socialization of students entering the field (miller, 2010) and as a transition support for professionals continuing their careers at an agency after earning a professional degree. a community facilitator of an online community for social work students must be given adequate time to devote to the task of facilitation. he or she must become familiar with the best principles and practices of online community engagement including developing a community identity, creating a safe space, motivating members to participate, and increasing member commitment. the facilitator also should review current literature on social presence in online communities. further research is needed to better understand how social work programs can optimally use online communities and social media to support social work students and alumni. potential research questions include: what is the aptitude of entering students in the use of these technologies? to what extent are programs encouraging use of these technologies? what do we know from social work alumni about how these technologies are being used in 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(2013). status of the use of title iv-e funding in bsw and msw programs. journal of public child welfare, 7(4), 430-446. author note the authors wish to thank the national child welfare workforce institute (ncwwi) partners—university at albany/suny, university of denver, fordham university, university of iowa, michigan state university, university of michigan, university of maryland, university of southern maine, portland state university, and the children’s bureau/acf/dhhs—whose strong collaboration made this work possible. the work for this publication was funded by the us-dhhs, acf, children’s bureau, award #90ct0145. this article is solely the responsibility of the ncwwi and does not necessarily represent the official views of the children’s bureau. correspondence can be addressed to boscoruggier@fordham.edu. _________ roberto r. aspholm, phd, lgsw, associate professor, school of social work, university of st. thomas, st. paul, mn. nathan aguilar, lcsw, phd candidate, school of social work, columbia university, new york, ny. christopher st. vil, phd, associate professor, school of social work, suny university at buffalo, buffalo, ny. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 1-26, doi: 10.18060/27396 this work is licensed under a creative commons attribution 4.0 international license. deaths of despair in black and white: gun violence, political economy, and the case for macro intervention roberto r. aspholm nathan aguilar christopher st. vil abstract: this article argues that elevated levels of gun homicide and gun suicide among younger black men and middle-aged white men, respectively, are the consequences of a political economy that produces widespread despair among the most vulnerable segments of the laboring classes. understood in this way, these phenomena share a common etiology whose roots can be traced to two major, temporally distinct developments: (1) postwar shifts in the political economy that redefined central cities as sites of black dislocation, and (2) the more recent intensification of globalization and investor class power that has redefined smaller cities, towns, and rural communities as sites of white dislocation. these transformations have rendered working-class blacks and whites (and others) vulnerable to a wide range of maladies and adverse social outcomes, including involvement in gun violence. in addition to examining these political-economic transformations and their effects on black and white working-class communities, this article also explores the divergent racialized manifestations of gun violence within these demographic groups. while micro and mezzo interventions are typically stressed to respond to these issues, their ultimate resolution requires recognition of their common roots in conditions of structurally imposed despair and the concomitant remedy of those conditions at the macro level. keywords: deaths of despair; gun violence; deindustrialization; globalization population-level trends in rates of gun homicide and gun suicide among black and white men demonstrate an essentially inverted relationship in terms of both race and age. gun homicides among black men peak at approximately 100 per 100,000 from late adolescence through the mid-thirties and then diminish dramatically as age increases; levels of gun homicide among white men remain at very low levels, at or below 5 per 100,000, throughout the age distribution. accordingly, the difference in gun homicide rates for black and white men is greatest during early adulthood and diminishes with age. on the other hand, rates of gun suicide among white men outpace those among black men across the entire age distribution and increase with age to nearly 35 per 100,000 at ages 75–84. among black men, gun suicides remain below 15 per 100,000 across all ages and generally decrease with age beginning in the mid-thirties. as such, the difference in gun suicide rates among these groups increases with age and is greatest among older adults (see figures 1a & 1b). in exploring and making sense of these patterns, this article makes a case for linking gun homicides and suicides within these demographic groups on a basis that goes beyond the focus on firearms as a mechanism. specifically, the ensuing analysis argues that elevated levels of gun homicide among younger black men and elevated levels of gun about:blank advances in social work, spring 2024, 24(1) 2 suicide among older white men are best understood as divergent, racialized manifestations of structurally imposed despair. figure 1a. gun homicide rates among black and white males in the us, 2018–2021 figure 1b. gun suicide rates among black and white males in the us, 2018–2021 source: centers for disease control and prevention, 2023b. 0 20 40 60 80 100 120 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84 ra te p er 1 00 ,0 00 age range gun homicide blacks whites 0 5 10 15 20 25 30 35 40 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84 ra te p er 1 00 ,0 00 age range gun suicide blacks whites aspholm et al./deaths of despair 3 the focus on black and white men in the current analysis is advantageous for several reasons. one is that, with the notable exception of elevated rates of gun suicide among young american indian/alaska native men, rates of gun homicide and suicide are highest among these two respective demographic groups. in this sense, an analysis of firearm deaths among these populations addresses them in their most acute demographic manifestations. another advantage to this approach is that blacks and whites have historically occupied opposing poles in the nation’s hierarchy of racial ascription (fields, 1990; wacquant, 2022). in other words, within the u.s. context, these groups are assumed to be—and, in many ways, have been—most dissimilar to one another and have the least commonality of experience on a broad range of social, economic, and political measures. the focus on black and white men in this article in no way diminishes the reality that gun violence affects other racialized and gendered populations as well. indeed, connecting these seemingly disparate issues as experienced by black and white men might provide a helpful model for understanding similar phenomena as experienced by other groups. moreover, because nearly 80% of all homicides and more than half of all suicides in the united states involve firearms, insights regarding the nature of firearm-involved deaths shed light on these phenomena more generally as well (kegler et al., 2022). the following analysis utilizes the “deaths of despair” concept that has emerged in recent years to describe rising rates of death from alcoholic liver diseases, drug overdoses, and suicides among middle-aged, working-class whites. economists anne case and angus deaton (2020) conceptualize these divergent forms of mortality collectively as deaths of despair, noting that “all the deaths show great unhappiness with life, either momentary or prolonged” and that, as such, “it is tempting to classify them all as suicides” of varying fashions (p. 39). they link sharp increases in such deaths to political-economic transformations that have immiserated widening segments of the white working-class in recent decades: the loss of well-paid, meaningful, unionized work; the decimation of local industries; the collapse of family and community life in many locales. these developments have led to a range of social, economic, and health maladies, including increasing rates of divorce, greater social isolation, widening poverty and joblessness, deteriorating physical health, and intensifying levels of pain. case and deaton also note that similar trends were observable in black working-class communities a half century earlier, as central cities lost unionized manufacturing jobs by the thousands: “what happened to blacks and whites differs perhaps more in when than in what” (p. 62). the analysis that follows elaborates on this connection with respect to trends in gun homicides and suicides in several ways. first, it situates these trends within a more robust exposition of the political-economic transformations in black urban working-class communities during the final third of the twentieth century and in white small-town and rural working-class communities since the 1980s. such an account is needed because, while case and deaton (2020) persuasively argue that deaths of despair occur “when society fails to provide some of its members with the framework within which they can live dignified and meaningful lives” (p. 8), their analysis fails to adequately explain how and why this happens (aspholm, 2021). this article also explores the sharply racialized patterns of the respective gun homicide and gun suicide phenomena. although “race” is often employed as an independent variable in research, as a purely ideological construct, advances in social work, spring 2024, 24(1) 4 race is incapable of explaining social reality (fields, 1990; zuberi, 2003); the present article develops an alternative analysis in which racialized subjectivity is a dependent variable. in addition, while suicide, including gun suicide, is readily understood in terms of despair, gun homicide is less so; the proceeding analysis makes a case for such an understanding. finally, implications for social work are explored, particularly the need to address the political-economic roots of gun violence in its various manifestations at the macro level. the political economy of despair the following sections provide an account of political-economic transformations in black urban working-class communities and white nonmetropolitan working-class communities that precipitated increasing levels of gun homicides and gun suicides among men in these respective locales. the former took shape in the postwar period with longlasting effects; the latter has been a more recent development, playing out largely over the last three decades or so. gun homicide in the deindustrialized city in the three decades following world war ii, the american economy grew rapidly, and an increasing share of the nation’s gross domestic product went to workers. the new deal transformed u.s. economic policy and labor relations, funded massive social welfare programs and infrastructure projects, and created a general framework for economic intervention and social engineering on behalf of the laboring classes (fraser & gerstle, 1989). union membership peaked at one-third of all workers during the 1950s, and inequality declined precipitously. widening segments of the black population shared this general upward trajectory, even before the passage of landmark civil rights laws during the 1960s, as increasing numbers of blacks deserted the sharecropping economy of the jim crow south and secured work in unionized urban manufacturing and related industries in the north (lichtenstein, 2002; stein, 1998). yet the expanding economy and widening prosperity masked emerging contradictions in the postwar economic and social order that became increasingly apparent by the mid1960s. as a central component of the nation’s commercial keynesianism, the federal government underwrote a massive expansion of homeownership opportunities for the nascent middle class and widening segments of the white working class via insurance for private-sector mortgage loans through the federal housing administration and veterans affairs (jackson, 1985). these policies were animated by a desire to promote macroeconomic growth via the home construction industry, which had been dormant since the onset of the great depression, and to counteract labor militancy by providing workers with a material and ideological stake in the affluent consumer society as “homeowners” (self, 2003). both due to the emphasis on new constructions and deference to the prerogatives of the private banking and real estate industries, existing housing in centralcity neighborhoods was largely excluded from eligibility. moreover, because these policies were designed to bolster and not replace private market actors, and because policymakers lacked a commitment to upending existing racially tiered housing markets, federal housing policies adopted the discriminatory practices of the banking and real estate sectors, aspholm et al./deaths of despair 5 effectively starving black neighborhoods of mortgage capital and barring blacks from new suburban developments (hirsch, 2000; reed, 2020). at the same time, the burgeoning black urban working class confronted the disappearance of unionized industrial work from the cities to which they were migrating. automation and cybernation in manufacturing increasingly rendered less-skilled labor redundant, leading to waves of layoffs beginning in the 1950s. black workers, who often lacked the seniority and advanced training of their white counterparts, were disproportionately affected by these layoffs; racism exacerbated the issue (stein, 1998; sugrue, 1996). beyond this, the late 1950s witnessed the earliest phases of what would become a decades-long exodus of manufacturing work out of central cities (wilson, 1987, 1996). this process was facilitated by federal underwriting of highway construction and massive suburban development. as with automation, it was fueled by corporate profitseeking: manufacturers abandoned central cities for suburbs, small towns, and semi-rural areas, particularly those located in the sun belt, in search of cheap land, lower taxes, lax environmental regulation, and more pliable labor forces (gordon, 1977; walker 1981). in short, by the mid-1960s, the industrial economic base that had long attracted and sustained the urban laboring classes was rapidly collapsing. the implications of these transformations for central cities in the decades following world war ii included the loss of millions of residents and millions of manufacturing jobs. in black communities, rates of joblessness and poverty reached unprecedented levels. for example, by 1970, detroit had lost a staggering 700,000 white residents, nearly half its peak total from merely two decades prior. before the close of the 1970s, the nation’s former manufacturing capital had also lost 185,000 manufacturing jobs, 55% of its total from the late 1940s. by 1980, nearly two in three black detroiters were jobless, more than double the rate from three decades earlier (sugrue, 1996). similar trends played out across the country, particularly in other heavily industrialized cities, including chicago, st. louis, philadelphia, cleveland, and baltimore, as well as industrial suburbs and satellites like east st. louis (il), gary (in), and camden (nj) (vergara, 1995; wilson, 1987, 1996). these losses devastated municipal tax bases and curtailed cities’ capacity to respond to the growing needs of their increasingly poor and jobless residents (reed, 1999). in moving away from new deal–era approaches to addressing inequality via public works programs and expanded protections for workers, the targeted initiatives of the federal government’s war on poverty were incapable of addressing structural unemployment (fraser & gerstle, 1989; reed, 2020). by the late 1960s, these deteriorating central-city conditions came to be collectively referred to as the “urban crisis” (sugrue, 1996; weaver, 2017). while economic growth and landmark civil rights policies facilitated previously unknown mobility for millions of blacks, others faced a dramatically worsening quality of life. conditions in the most distressed black urban communities continued to decline in the ensuing decades, as joblessness and poverty proliferated, the black middle class moved out of historic ghettos, and local institutions and infrastructure crumbled. the class-diverse ghettos of the mid-twentieth century were transformed into hyperghettos, “an urban wasteland doubly segregated by race and class” (wacquant, 2010, p. 216; wilson, 1987). in chicago’s most dispossessed communities today, for example, half of all residents live in poverty, three in four working-age individuals are jobless, and over 90% of residents are advances in social work, spring 2024, 24(1) 6 black (farooqui, 2017). such conditions have left black urban working-class communities vulnerable to all manner of social maladies, from familial dissolution and cyclical drug crises to rampant street crime and mass incarceration (johnson, 2023; liebow, 1967; wacquant, 2008). within this context, beginning in the late 1960s, gun homicides reached heights not seen since the great depression. on one hand, similarly conspicuous increases were observable across all demographics; all age ranges and racial/ethnic groups as well as both men and women saw their rates of homicide victimization roughly double between 1960 and the early 1970s. yet male homicide rates were four times the rates for females throughout this period, and rates among black men were ten times the rates among their white counterparts.1 while the nation’s overall homicide rate rose from 4.7 to 9.8 per 100,000 between 1960 and 1973, rates for black men increased from just over 40 to nearly 80 per 100,000 (see figure 2). the highest rates of homicide were seen in midwestern and mid-atlantic cities deep in the throes of deindustrialization: by 1970, st. louis, cleveland, and detroit led the nation in per-capita homicide, and baltimore, chicago, and philadelphia also ranked among the top ten (klebba, 1975). levels of homicide among black males largely persisted at these levels through the mid-1990s, with a slight decline from the mid1970s through the mid-1980s before a resurgence through the decade that followed. figure 2. homicide rate in the us and among white and black males, 1960–1995 sources: centers for disease control and prevention, 2020a, 2020b; klebba, 1975. note: data from 1960–1967 is age-adjusted, while the data for more recent years is not. on the demographic groups comprising the racial categories from 1960–1967, see note 1. in turn, from the mid-1990s through the turn of the century, levels of gun homicide dropped precipitously and stabilized thereafter through the mid-2010s. the causes of this 0 10 20 30 40 50 60 70 80 90 1960 1965 1970 1975 1980 1985 1990 1995 ra te p er 1 00 ,0 00 year united states white males black males aspholm et al./deaths of despair 7 drop are disputed and complex, but likely involve some combination of the end of the crack cocaine crisis, changes in policing, rising imprisonment, and increased civic engagement in urban communities (barker, 2010; blumstein & wallman, 2006; sharkey, 2018). yet, even during this period of relative decline, the gun homicide rate among young black men never fell below 55 per 100,000 (see figure 3). by comparison, this is roughly equivalent to jamaica’s world-leading homicide rate of 52 per 100,000 (united nations office on drugs and crime, 2023). recent years, moreover, have witnessed a dramatic reversal, as homicide rates began trending upward in the mid-2010s and have exploded since 2020. indeed, in 2021, the rate of gun homicide among young black men reached its highest point ever, at 106.6 per 100,000. as with the preceding decline, the causes of the recent resurgence in homicide are multifaceted and debated, but likely include pandemic-related strains and disruptions, the delegitimation of law enforcement in the wake of george floyd’s killing, concomitant changes in police behavior, and the historic proliferation of firearms during a period of immense political and social unrest (lopez, 2021; singal, 2021). indeed, firearms have come to play an increasingly central role in homicides, particularly among young black men: from 1979 (the earliest year for which such data is available) to 2021, the percentage of such homicides involving a firearm rose from 76% to 95%. figure 3. homicide and gun homicide among black males ages 15–44, 1979–2021 sources: centers for disease control and prevention, 2020a, 2020b. gun suicide in the hollowed-out heartland spurred by the deep recession of the mid-1970s and jimmy carter’s inability to stabilize the economy, ronald reagan’s election in 1980 ushered in what came to be known as the “neoliberal revolution” in american political, economic, and social life. this revolution has been defined by a frontal assault on organized labor, economic policy that 0 0.2 0.4 0.6 0.8 1 0 25 50 75 100 125 19 79 19 81 19 83 19 85 19 87 19 89 19 91 19 93 19 95 19 97 19 99 20 01 20 03 20 05 20 07 20 09 20 11 20 13 20 15 20 17 20 19 20 21 pr op or tio n ra te p er 1 00 ,0 00 year homicide rate gun homicide rate gun homicide as a proportion of all homicide advances in social work, spring 2024, 24(1) 8 prioritizes controlling inflation over full employment, welfare retrenchment, tax cuts for the wealthy and corporations, government deregulation, the privatization of public goods and services, and an ideological commitment to entrepreneurialism and markets (harvey, 2005). these features have become durable political orthodoxies over the last four decades, embraced with varying degrees of enthusiasm by both democrats and republicans, and inequality has intensified steadily since the close of the 1970s: the top 1% of earners have doubled their pre-tax share of national income to 19%, while the top 0.1% have tripled their share of national wealth to 18% (saez & zucman, 2020). the hollowing out of the american heartland over the last three to four decades has been facilitated by these transformations, as the balance of class power has shifted decisively toward capital and as the market economy has assumed an increasingly global character (harvey, 2001, 2005). the effects of these developments have been felt throughout society, and processes of abandonment strikingly similar to those that gutted black urban working-class communities beginning in the 1960s have decimated white working-class communities in smaller cities, towns, and rural regions in the decades since the 1980s. unionized employment in extractive industries like mining and timber declined as jobs were mechanized, new technologies rendered extractive resources redundant, and operations were offshored; mines, smelters, sawmills, and other centers of small-town industry were shuttered, from the coalfields of appalachia to the copper mines of butte, montana, to the forests of the pacific northwest (lee et al., 1990; leech, 2018; zipper & skousen, 2021). historically, these locales had been hotbeds of militant labor unionism; today, they are largely jobless regions facing vast health and ecological crises (hamby, 2020; marcus, 2000). in rural areas, the corporatization of agriculture has had a similar effect, displacing smaller farming operations, which are unable to compete with industrialscale agribusiness, and putting hundreds of thousands of independent farmers out of business (clapp & isakson, 2018). these dynamics have been fueled by intensifying financialization, as private equity firms have looked toward small-town and rural america for investment opportunities, and prioritization has shifted to short-term profits, as opposed to long-term solvency and community wellbeing (alexander, 2017; edelman, 2021). similar processes have played out in traditional manufacturing, as industries shuttered and moved operations to the global south where land and labor are cheaper, workers enjoy fewer rights, and environmental regulations are often nonexistent (harvey, 2001, 2005). the share of manufacturing jobs in nonmetropolitan counties fell by half, from 20% to 11%, between 1970 and 2015, with the vast majority of this decrease taking place after 1990 (ulrich-schad & duncan, 2021). often, these were the same industries that had initially relocated to smaller cities, towns, and rural communities from central cities during the postwar decades (gordon, 1977; walker 1981; wilson, 1987). liberal trade agreements eliminating tariffs and other trade barriers have been central to this project, leading to the loss of millions of manufacturing jobs in the united states as well as the subordination of governments worldwide to the dictates of multinational corporations (harvey, 2005). the offshoring of unionized jobs, the proliferation of state-level right-to-work laws, and a series of labor-hostile supreme court decisions have decimated labor unions and facilitated dramatic upward redistribution (rosenfeld, 2014; mcalevey, 2016). because of the relative overrepresentation of whites in the ranks of private-sector unions, they have felt aspholm et al./deaths of despair 9 the effects of these developments acutely: of the 1.8 million fewer unionized workers in the united states since the turn of the century, 93% of this decline—1.67 million—has been concentrated among white male workers (maisano, 2021). within this context, small towns and rural areas have witnessed dramatic declines in population, owing to a combination of falling birth rates, massive outmigration, and increasing mortality rates (johnson, 2022). in many locales, essential services have been gutted, infrastructure has eroded, and local institutions, including mutually owned banks, credit unions, family-owned stores and restaurants, local newspapers, medical facilities, and agricultural cooperatives, have withered and collapsed (edelman, 2021). physical and mental health have declined, and social and familial bonds have come unraveled for widening segments of the white working class (case & deaton, 2020). alcohol and drug abuse offer temporary reprieves for many but take an enormous toll on health, mortality, and community life (garriott, 2011; monnat & rigg, 2018). figure 4. gun suicide rate among black and white males, select age groups, 1999– 2020 source: centers for disease control and prevention, 2023a. these developments have also manifested in increased rates of gun suicide (and suicide more generally) among middle-aged white males (see figure 4). while rates of gun suicide among white males in adolescence and early adulthood are about 20% higher than among their black counterparts, this disparity increases to 300% by early middle age and to nearly 500% by late middle age (see figure 1b). much of this difference among middle-aged men has come about over the last two decades, as rates of gun suicide among whites in this age group, which had been relatively stable prior to 1999, have increased between one-third 0 5 10 15 20 25 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 20 18 20 19 20 20 ra te p er 1 00 ,0 00 year united states black males white males white males, 45–64 advances in social work, spring 2024, 24(1) 10 and one-half. notably, such rates are only approximately half the rates of suicide among these populations more generally, and these latter rates have shown similar increases. these increases in suicide, as well as increases in deaths from opioid overdoses and alcoholic liver diseases, among white men over the last quarter century have been driven almost entirely by increases among the working class (case & deaton, 2020). while rates of gun suicide are highest among older white men (see figure 1b), this has been a much longer-standing issue (mellick et al., 1992). recent developments appear to have had little effect on suicidality among older white men; while levels of gun suicide have increased marginally among this demographic over the last quarter century, these increases have paled in comparison to those among middle-aged white men (see figure 5). this makes sense, since changes in labor markets, job loss, and industrial abandonment are likely to have less impact on retirees than their working-age counterparts. figure 5. increases in gun suicides among white males, select age groups, 1999–2020 source: centers for disease control and prevention, 2023a. note: percent increases were calculated by comparing average rates for the three-year periods 1999–2001 and 2018–2020. the colors of despair how might these distinctly racialized patterns of gun violence be explained? stated differently, why is despair so much more likely to lead to gun homicide among black men and gun suicide among white men? racial difference might appear as a reasonable explanation; after all, the comparison being made is between two putative racial groups. as historian barbara fields (1990) points out, however, as an ideology, race “does not 0 5 10 15 20 25 30 35 40 45 45–54 55–64 65–74 75–84 pe rc en ta e in cr ea se age group aspholm et al./deaths of despair 11 explain anything, but is itself part of what needs to be explained” (p. 107). attempting to explain such differences via race’s seemingly more benign counterpart, culture, likewise fails to resolve the conundrum: because culture is not encoded in human dna, its nature and development also require explanation. in short, invoking race or culture as explanations for patterns of gun violence elides how racialized subjectivities and culturally patterned behaviors emerge in the first place. as such, they are less explanations for observed patterns of gun violence than alternatives to an explanation. a model for a more promising approach to constructing a textured and historically grounded account of racial subjectivity can be found in righteous dopefiend, a photoethnography of a community of homeless heroin addicts in 1990s san francisco. during their research, authors philippe bourgois and jeff schonberg (2009) observed that black heroin users almost always injected directly into their veins, while white users often injected into muscle and fatty tissue, a practice known as “muscling” or “skin-popping.” locating a suitable vein and successfully executing a direct injection often took a great deal of time and effort and increased the risk of overdose as well as hepatitis c and hiv infection but also provided users with a distinctly euphoric high. injecting into other bodily sites was convenient but did not produce a similarly blissful pharmacological effect and routinely led to abscesses and other infections. these divergent practices represented one manifestation of racialized patterns of both substance abuse and cultural praxis within the community, wherein blacks generally maintained a boisterous and affirming “outlaw” disposition while whites typically presented as dejected and timid “outcasts.” in exploring what accounted for these distinct racial subjectivities, bourgois and schonberg noted that “the down-and-out way of being in the world common to most of the whites was reinforced by the absence of a culturally celebrated model for performing outlaw masculinity on the street among middle-aged white men.” on the other hand, “fashionable hip-hop youth culture in the 1990s and 2000s had created a positively inflected linguistic term for overforty-year-olds, o.g. (original gangsta), with which african american and latino homeless injectors could self-identify” (pp. 91-92). the divergent racial subjectivities described by bourgois and schonberg (2009) constitute a productive model for exploring the racialized contours of gun violence among young black men in urban working-class communities and middle-aged white men in small-town and rural working-class communities. in this case, the roots of distinctive racial subjectivities leading to elevated levels of gun homicide among younger black men in urban areas and gun suicide among older white men in nonmetropolitan communities can be traced to the processes of mass suburbanization, urban demographic transformation, and class decomposition that took shape in the postwar decades. following bourgois and schonberg (2009), we take up here the task of exploring the fashioning of these subjectivities and their manifestation in distinctly racialized patterns of gun violence. deaths of despair “in black” among younger black men in urban working-class communities, the manifestation of despair in gun homicide has been shaped by several factors specific to this milieu and age demographic. first, because of their size and complexity and the attendant shift beyond advances in social work, spring 2024, 24(1) 12 primary social relations, cities consistently experience levels of interpersonal violence much higher than suburban or nonmetropolitan communities (park & burgess, 1925). global studies of homicide, moreover, have found both that young men are the most likely demographic to engage in interpersonal violence and that inequality, poverty, and low levels of development are the key determinants of homicide rates the world over (fajnzylber et al., 1999; united nations office on drugs and crime, 2011). thus, demographic shifts beginning in the late 1960s with the first wave of baby boomers coming of age, combined with rapidly deteriorating conditions in black urban communities, especially rampant joblessness among young men, created the precise conditions for interpersonal violence to proliferate in these locales. research on urban working-class communities of color since the 1960s has often emphasized gang wars and violent competition over drug markets as proximate causes of elevated levels of gun violence. by the late 1960s, in the wake of the collapsing urban industrial economy and civil rights insurgency, street gangs had gained a new and more durable social currency among young blacks for whom the possibility of solidarity on the shopfloor or in social movements had been foreclosed. in this context, incipient gang organizations and attendant gang wars emerged as a new kind of “cause” to which dispossessed and disaffected black youth might direct their untapped energies and talents (davis, 1990; diamond, 2009; hagedorn, 2008; schneider, 1999). the illicit drug trade, moreover, from the heroin crisis of the 1960s and 1970s to the crack cocaine crisis of the 1980s and 1990s, provided new opportunities for economic subsistence and, in some cases, considerable upward mobility for this same demographic. unregulated by the state, control of drug markets is determined by extralegal means, and given the desperation of those vying for remunerative work in the drug trade, this has often involved violence (bourgois, 1995; cooley, 2011; forman, 2017; venkatesh, 2000).2 in a more general sense, gun violence emerged from more mundane social dynamics within the context of widespread joblessness and strained police-community relations. the capacity to defend oneself and one’s loved ones against potential danger helped facilitate freedom of movement and access to public leisure space and became an important marker of social status, particularly among those for whom conventional success was furthest from reach (anderson, 1990, 1999; karandinos et al., 2014). in a similar sense, gang membership and participation in the drug economy have constituted means by which dispossessed and disaffected young people can affirm both their dignity and their agency in a society that offers them few avenues for asserting either (bourgois, 1995; hagedorn, 2008; phillips, 2012). the confluence of these conditions formed the basis of the “outlaw” racialized subjectivity identified by bourgois and schonberg (2009), a subjectivity assumed by segments of the most dispossessed and disaffected strata of the black working class from the late 1960s onward. in other words, “gang member,” “gangster,” “hustler,” “trapper,” “driller” and similar archetypes are not byproducts of a transhistorical “black culture,” much less of an ostensible racial essence (bourgois & schonberg, 2009; oliver, 2006). rather, these racialized subjectivities and the violence they condition and give pattern to emerged and proliferated in response to the contours of life in jobless urban ghettos following deindustrialization. understanding these phenomena in any meaningful aspholm et al./deaths of despair 13 way requires their reinterpretation as dependent, not independent, variables in a historically grounded analysis. recent years have witnessed a dramatic decline both in conventional gang ideologies and organizations as well as in the illicit drug economy, phenomena that fueled much central-city gun violence from the late 1960s through the 1990s. the end of the crack cocaine crisis and the spread of cell phones have laid waste to the once-booming illicit drug economy in distressed working-class communities of color, alternately diminishing and decentralizing the drug trade (bowser et al., 2017; edlund & machado, 2019). for this and several other reasons, broad-based gang alliances and cross-neighborhood gang organizations have fragmented (aspholm, 2020; phillips, 2012). thus, neither ideological gang wars nor competition over open-air drug markets is a major factor in lethal gun violence among young black men today. rather, this violence is increasingly fueled by the foreclosure of these outlets for the talents and aspirations of dispossessed black youth. as the ideologies and structures of once-powerful street gangs have shattered and the economic opportunities of the drug trade have disappeared, a new despair has emerged with the recognition that avenues for economic security, social mobility, and a dignified sense of self have been ruptured not only via conventional channels but via illicit ones as well. in this context, the solidarity expressed through collective violence and the esteem that derives from participation therein have emerged as alternative wellsprings of meaning and purpose for desperate black youth (aspholm, 2022). in this sense, the decline of traditional gang hostilities and drug-related violence reveals the more fundamental reality that gun violence among young black men is fueled by structurally imposed despair. thus, while gang wars and the drug trade may have been proximate causes of gun violence and may have even produced independent effects on levels of such violence among black men in previous decades, neither has ever been adequate as an explanation for gun violence. the salience of these proximate causes is best understood against the backdrop of structural joblessness and widespread poverty within black urban working-class communities. killings related to these dynamics, in other words, constitute deaths of despair in their own right. deaths of despair “in white” unlike homicide, suicide is readily apprehended as a manifestation of despair: an individual has concluded that life is no longer worth living and death is preferable. yet, ever since emile durkheim’s (1897/1951) seminal suicide: a study in sociology, we also know that suicide is a sociological phenomenon that cannot be understood outside the societal and communal contexts in which it takes place. for example, owing to a range of factors, including lower levels of social integration, less access to mental health services, and greater access to firearms, levels of suicide are consistently higher in rural areas than in urban areas (casant & helbich, 2022). moreover, research in countries throughout the world, including the united states, has found that rates of suicide increase along with socioeconomic precarity and macroeconomic downturns. this includes higher levels of suicide among the unemployed, those with lower incomes, those in lower-skilled occupations, males with lower levels of education, and renters, as well as increases in advances in social work, spring 2024, 24(1) 14 suicide rates tied to rising levels of unemployment, economic contraction, and periods of recession (gunnell & chang, 2016; platt, 2016). many of these trends have also sharpened in recent decades, as social class and rurality have become stronger predictors of suicide (pettrone & curtin, 2020; platt, 2016; singh & siahpush, 2002). in all cases, these trends are much stronger among men than women (gunnell & chang, 2016). given the consistent linkages between socioeconomic dislocation and suicide, the discussion of the hollowing out of the heartland provides the interpretive key for recent increases in suicide among middle-aged white working-class men over the last quarter century. studies of life in distressed small-town and rural communities shed additional light on this phenomenon and its relation to racialized subjectivity. though preceding the contemporary uptick in suicidality among white workers, research in rural communities in the wake of the farm crisis of the 1980s offers an illuminating case in point. following a boom in commercial agriculture in the 1970s fueled by the opening of agricultural trade with the soviet union and historically low interest rates, private and public institutions flooded the sector with cheap credit, and family farming operations expanded. the early 1980s saw a reversal in trends, as trade with the soviet union was suspended, markets for agricultural goods contracted, interest rates soared, and land values declined (dudley, 2000). this downturn caused widespread debt and displacement among family farmers: farm assets nationwide depreciated by 30% between 1981 and 1987, and by 50% in the corn belt and great lakes regions; farm equity fell by more than a quarter; more than onefifth of farms were deemed vulnerable or marginally solvent; foreclosures swept through the heartland (barnett, 2000). in this context, suicide among struggling and displaced male farmers skyrocketed in places like rural minnesota and oklahoma. the rugged individualism promoted by family farming—in contrast with the solidarity of urban industrial shopfloors—encouraged the internalization of financial stress and failure within farming communities that, beyond the objective distress of such circumstances, contributed to elevated suicide rates (dudley, 2000; ramírez-ferrero, 2005). more recent research indicates that farmers confronting increasing precarity not only face mounting psychological distress but also lack social support that might help them through times of difficulty (heaberlin & shattuck, 2023). small towns and smaller cities ravaged by deindustrialization confront similar challenges. solidarities rooted in the shopfloor (or mineshaft) dissolved, as such workplaces were first transformed in ways that undermined such solidarity and, eventually, the workplaces and their labor unions disappeared altogether (dudley, 2021; leech, 2018). moreover, as these communities suffered massive outmigration, especially among younger generations, families became fragmented and local institutions that had sustained social life collapsed (edelman, 2021). all these developments served to undermine social ties and increase isolation among remaining residents, in turn, contributing to suicidality, which, under such circumstances, becomes “the affective atmosphere through which precarity is known and embodied” (dudley, 2021, p. 204). notably, the loss of meaningful work and social integration has largely occurred among middle-aged adults, thus helping explain the increase within that population, specifically. the racialized subjectivity of dispossessed small-town and rural working-class whites does not replicate the white urban “outcast” of bourgois and schonberg’s (2009) study. aspholm et al./deaths of despair 15 nor could it, given the vastly different histories and locations of these respective populations within the political economy. while in both cases, the violence of these populations is generally, if differentially, internalized, small-town and rural whites largely retain their self-image as salt-of-the-earth americans; they simply believe that they have somehow personally failed to live up to that archetype. as fields explains, “we have a white working population that, by and large, expected to be taken care of, to be treated fairly, so long as they abided by the rules” (leanza, 2016). yet, while resurgent investor class power and the global “race to the bottom” have gutted their communities and eroded their livelihoods, these communities “don’t have a language for talking about why they are angry and why they feel aggrieved.… they can’t frame it in terms of a class grievance having to do with inequality. because we don’t have that language available.” in the absence of a compelling account of their predicament, suicide becomes a viable option in the face of not only material hardship but the perception that such hardship was somehow self-inflicted (dudley, 2000; heaberlin & shattuck, 2023; ramírez-ferrero, 2005). indeed, research suggests that expectations of adversity—born from longstanding experiences of adversity—and the existence of social institutions that provide support in the face of hardship may militate against suicidality among blacks and other people of color, whereas many whites lack both this disposition and access to such supports (early & akers, 1993; oquendo et al., 2001). in the end, nothing inherent in “whiteness,” or in some ostensibly durable “white culture,” necessarily translates into heightened gun suicide rates among middle-aged white men. like patterns of gun homicide among young urban black men, these patterns must be explained historically without reliance on reified ideological constructs. indeed, in this sense, it is also worth noting that, prior to the mass postwar suburbanization of whites and concomitant urbanization of blacks, the vast majority of gang members as well as perpetrators and victims of urban homicide (firearm-related and otherwise) were white (diamond, 2009; schneider, 1999; thrasher, 1927).3 these realities were fueled by conditions in urban slums similar to, though less extreme than, those confronting blacks in the post–civil rights era hyperghetto: poverty, joblessness, overcrowding, municipal neglect, and the like. they were also reflected in popular stereotypes about irish, italian, and other european ethnics as brutish and violent (gardaphé, 2006; szczypa, 2021). postwar changes in urban demography effectively eliminated these social phenomena and rendered their archetypes obsolete in the popular imagination. while racist tropes about black criminality have certainly existed since the postbellum period, only since the 1960s have street gangs and gun homicide become primarily associated with black (and latino) americans—in practice as well as perception (coughlin & venkatesh, 2003; johnson, 2023; schneider, 1999). transformations in the social construction of race and racialized subjectivities and their effects on patterns of gun violence, in other words, have followed transformations in the political economy, demographic geographies, and prevailing local conditions. advances in social work, spring 2024, 24(1) 16 implications for social work both the black urban working-class communities and their rural and small-town white counterparts described in this article might be productively understood as “sacrifice zones,” places where “the marketplace rules without constraints, where human beings and the natural world are used and then discarded to maximize profit” (hedges & sacco, 2012, p. xi). thriving locales once synonymous with industry, opportunity, and prosperity, from urban centers of industry to the rural heartland, have been abandoned and left to implode when doing so proved profitable for the investor class. it is imperative to recognize that this process of profit extraction and subsequent abandonment is a hallmark of the capitalist political economy. marx (1885/1992) initially observed and remarked on these dynamics a century and a half ago, and these practices have only intensified over the intervening period, creating vast unevenness and inequality across geographical space the world over. geographer david harvey (2001) refers to this structural tendency as the “spatial fix,” a reference to “capitalism’s insatiable [addictionlike] drive to resolve its inner crisis tendencies by geographical expansion and geographical restructuring” (p. 24). in places that have suffered such abandonment, levels of joblessness approach and often exceed 50%, from the former copper-smelting town of anaconda, montana, to the erstwhile auto-industry satellite of flint, michigan, to the one-time industrial hub of chicago’s south and west sides (u.s. census bureau, 2023). but this is not only a problem of geography; the u.s. economy requires mass joblessness throughout society in order to function. with a working-age population of nearly 210 million, a labor force of about 165 million, and an unemployment rate of 5% (the rate that the federal reserve considers “full employment”), somewhere between one quarter and one-third of all working-age americans—some 58–68 million people—are jobless at any given time. thus, as literary theorist walter benn michaels (2011) points out, unemployment is “both a problem and a solution. it’s a problem for the unemployed, who want work, a solution for employers who not only want workers but also want the cheapest ones they can get.” the reserve army or labor, or relative surplus population of the unemployed, thus constitutes “not a group but a structural element” of the economy (see also marx, 1867/1990). interpretations of gun homicides and suicides among scholars, social workers, and other helping professionals, and the wider public typically fail to locate the structural roots of these problems in the political economy. accordingly, the interventions that flow from such misrecognition leave the structures that fuel these problems entirely intact. in black urban communities, gun homicides are interpreted alternately as matters of misguided policing or infectious disease–cum–cultural pathology; the solutions are thought to be improved policing or micro-level behavioral modification strategies (aspholm, 2020). suicidality in white small-towns and rural communities, meanwhile, is highly medicalized, and efforts to expand access to addiction and mental health treatment are cast as solutions (dudley, 2021; heaberlin & shattuck, 2023). to be certain, these interpretations and their attendant remedies are preferable to more traditional tendencies that cast these problems as simple matters of morality or personal aspholm et al./deaths of despair 17 willpower, and such programs may help to reduce some distress in the short term. therapeutic models like cognitive behavioral therapy, for example, have shown promise in assisting gunshot victims develop healthier responses to conflict and in treating posttraumatic stress and depression, key risk factors in suicidality (hofmann et al., 2012; watkins et al., 2018). culturally appropriate and community-grounded interventions geared toward helping men move away from gendered stoicism and establish supportive networks, particularly in ways that tap into and enhance existing strengths within communities, represent other fruitful frontiers of gun violence prevention practice (fuller & goodman, 2020; mckenzie et al., 2018). the provision of practice guidelines for social work students to speak with clients about gun safety are also important, especially considering that social workers are more likely to support gun control policies and less likely to own guns than their clients (hodge, 2003; logan-greene et al., 2018). more promising still are approaches to environmental design that address ecological factors contributing to gun violence. recent research indicates that addressing neighborhood blight, for example, may not only reduce levels of gun violence but also improve residents’ perceptions of crime and safety (branas et al., 2018). such mezzo-level interventions recognize and address variations in private and public investment and productively move the focus of intervention from the behaviors of community members to the obligations of the state. recognizing that structural change to improve the lives of the most dispossessed and disaffected communities in our society often happens at a glacial pace, more immediate services and supports are, indeed, essential. as new dealer and social worker harry hopkins famously quipped in response to criticism that his proposed public works program would damage the economy in the long run, “people don’t eat in the long run—they eat every day.” nonetheless, the main argument of this article is that patterns of rising gun homicides and suicides in the united states have been driven by structural shifts in the political economy from the postwar period through the current neoliberal era. as such, structural remedies are essential to their resolution. in this sense, the kinds of interventions discussed above must be recognized as post hoc remedies to structurally imposed suffering. and, to the extent that prioritizing one set of interpretations and solutions necessarily entails deprioritizing others, they aid and abet that structure by reifying it—that is, by locating the causes of and solutions to these issues in the individuals and communities victimized by societal inequality, or, at best, in the institutions tasked with responding to and managing that inequality. recognizing gun homicides and suicides as consequences of the politicaleconomic structure requires thinking about solutions in political-economic terms: public works programs, direct income provision, expansion of the social wage, a revitalized labor movement, comprehensive and universal healthcare, and the like. in this vein, it is worth noting that hopkins’s admonition about the necessity of addressing people’s suffering straight away was not a call to ignore the structural source of that suffering; it was a call to address that structure with all due urgency. reconsidering strategies to address the current political-economic crisis in our country will have implications for how we educate social work students to interpret and respond to the structural issues giving rise to social maladies such as homicide and suicide. while advances in social work, spring 2024, 24(1) 18 social work’s person-in-environment orientation represents a promising point of departure for interpreting how social problems are embedded in and produced by the social structure, dominant accounts tend to fall short of this ideal, failing to adequately link these problems to the wider structural features of society (corrigan & leonard, 1978; mullaly & dupré, 2018). social work courses encourage students to direct attention toward individuals and communities experiencing the deleterious consequences of the political-economic structure and away from the structure itself, whose interrogation would raise broader questions about the effects of fundamental features and contradictions of an advanced capitalist economy. the predictable result is training practitioners to address structural problems via individual solutions (fenton, 2019; morley, 2019). a more robust exposition of social problems that situates them more firmly within the political economy and the social structure it creates and reproduces would help disrupt these tendencies. at its best, such an approach would also situate domestic policy matters within a global framework that connects political economy with broader geopolitical dynamics (hare, 2004; putnam, 1988). how might such approaches to social work education contribute to stimulating interest in often-marginalized practice modalities in areas like community organizing, political advocacy, and social policy? how might they spark the development of new approaches to practice? how does structurally imposed despair manifest in other demographic groups, including women, latinx populations, native americans, asian americans, immigrant communities, and queer populations? how might social workers engage these communities in organizing across demography and geography to address people’s felt needs at the structural level? what role might popular political education and engagement play in linking and mobilizing such diverse communities and perhaps even functioning as a discrete protective factor against social maladies like gun homicide and suicide? how can social workers continue to meet the immediate needs of vulnerable populations at the micro level while simultaneously challenging the prevailing political-economic structure at the macro level? these are the kinds of questions that social work practitioners, educators, and researchers might productively take up—or, in some cases, continue to explore—moving forward. in the end, the meaningful resolution of the ongoing crises of gun homicide among young black men in dispossessed urban communities and gun suicide among middle-aged white men in dispossessed small-town and rural communities cannot occur at the micro or mezzo level. thinking about these issues in political-economic terms allows us not only to connect the respective plights of these communities—whose problems and interests are typically regarded as distinct, if not antagonistic—but to connect their potential resolutions as well. clarity on these matters among practitioners, scholars, and educators is paramount to social work’s capacity to confront these issues in all such professional domains. conclusion this article connects trends in gun homicides and gun suicides by applying and elaborating the “deaths of despair” concept to link the impact of political-economic transformations in black urban working-class communities beginning in the 1960s and in white small-town and rural working-class communities since the 1980s. in doing so, we aspholm et al./deaths of despair 19 present an analysis that encourages an understanding of gun homicides among young black men as a manifestation of structurally imposed despair similar to suicide among middleaged white men. the focus on divergent manifestations of gun violence among black and white men should not be interpreted to suggest that these issues are not pertinent to other racialized or gendered populations. rather, this is an attempt to link these issues among populations for which differences rather than similarities are typically stressed in both social science research as well as public discourse. it is our hope that the similarities in deaths of despair among blacks and whites discussed in this article encourage a recognition of their common political-economic roots in social work education and contribute to an emphasis on political-economic solutions to these problems in practice. notes 1. the homicide rates among whites reported in these figures are likely artificially inflated, and the rates among blacks are likely artificially depressed due to how these demographics were constructed in the data set. “white” includes puerto ricans and mexican americans, groups that today are generally recognized as hispanics or latinos and as distinct from non-hispanic whites. with higher rates of poverty and urbanicity, these groups likely experienced higher levels of homicide than their white counterparts. on the other hand, rates reported for black men in this figure are, in the data, reported as “all other” and include not only blacks, but also american indians, chinese americans, and japanese americans, groups with lower rates of homicide than blacks. nonetheless, blacks comprised 89% of this demographic group, making it a reasonable, if imperfect, proxy for this group (klebba, 1975). 2. moreover, because gun homicides tend to occur within the context of groups—street gangs, neighborhood crews, drug organizations—such incidents have a propensity to fuel further violence; gun homicides, in short, tend to fuel additional homicides (papachristos et al., 2013; papachristos & wildeman, 2014). in contrast, suicide, a quintessentially solitary act, lacks this collective feature. this difference, along with more widespread dispossession within black urban communities, as compared to their white rural counterparts, explain the higher rates of homicide among black men as compared to suicide rates among white men. 3. gordon parks: the atmosphere of crime, 1957 (meister, 2020) offers a stunning photographic depiction of multiracial criminality on the historical precipice of vast urban demographic transformation. references alexander, b. 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(2003). thicker than blood: how racial statistics lie. university of minnesota press. author note: address correspondence to roberto r. aspholm, school of social work, university of st. thomas, st. paul, mn, 55105. email: asph9195@stthomas.edu https://doi.org/10.1177/0190272510377880 https://newleftreview.org/issues/ii133/articles/loic-wacquant-resolving-the-trouble-with-race https://doi.org/10.4324/9781351068000-15 https://doi.org/10.4324/9781351068000-15 https://www.frontiersin.org/articles/10.3389/fnbeh.2018.00258 https://www.frontiersin.org/articles/10.3389/fnbeh.2018.00258 https://doi.org/10.1177/0042098016640487 https://doi.org/10.2307/215208 https://doi.org/10.1016/j.exis.2021.100990 https://doi.org/10.1016/j.exis.2021.100990 mailto:asph9195@stthomas.edu _______ ryan f. savino, lmsw, mba, phd student in social welfare, the graduate center, city university of new york, new york, ny. elizabeth a. bowen, phd, associate professor and andrew irish, msw, phd candidate, university at buffalo school of social work, buffalo, ny. amy k. johnson, phd, msw, research assistant professor, ann & robert h. lurie children's hospital of chicago, northwestern university feinberg school of medicine, chicago, il. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 675-693, doi: 10.18060/24293 this work is licensed under a creative commons attribution 4.0 international license. evaluating the impact of in-home behavioral health services on housing first residents’ emergency room and inpatient utilization ryan f. savino elizabeth a. bowen andrew irish amy k. johnson abstract: individuals experiencing chronic homelessness are highly marginalized and frequently access acute healthcare services. this program evaluation used secondary data collected from adults experiencing chronic homelessness (n=133) who participated in a housing first program offering in-home behavioral health services within a large midwestern city. participant demographics (e.g., gender, race, age) and data on health factors (e.g., substance misuse and mental health symptoms, and er visits and inpatient hospitalizations) were collected at program enrollment and at 6-month and 12-month follow-ups. high proportions of missing data led the evaluators to exclude 12-month follow-up and in-home behavioral health data from the analyses. neither inpatient nights nor er visits changed significantly between enrollment and 6-months. males were disproportionately hospitalized throughout the study, suggesting a need for gendertargeted services. higher rates of hospitalization among african americans at enrollment subsided by follow-up. future evaluation should examine if in-home behavioral health services reduced racial health disparities. acute care use was low overall, likely because of the stabilizing impact of housing. data limitations suggest a need for more robust study designs to identify causal factors and to enrich our understanding of the role of behavioral health intervention within the housing first paradigm. results underscore the importance of using empirically-supported assessment tools to evaluate consumers' individualized needs and responsively allocate supportive services. keywords: dual diagnosis; emergency room; homeless; hospitalization; housing first; in-home; sbirt the u.s. department of housing and urban development (hud) revealed that 567,715 u.s. residents were homeless at a single point in time in january 2019 (henry et al., 2020). the literature has traditionally distinguished between people experiencing homelessness chronically, episodically, or transitionally (mcallister et al., 2011). under hud's current definition, individuals considered chronically homeless must possess a disabling mental or physical health condition and experience either a continuous period of homelessness exceeding one year, or four or more discrete episodes of homelessness in the preceding three years, totaling 12 months or more (u.s. department of housing and urban development, 2015). this definition builds upon hud's prior conceptualization of chronic homelessness by requiring that discrete episodes total 12 months or more (byrne & culhane, 2015; henry et al., 2020). in 2010, investigators found that homeless persons https://creativecommons.org/licenses/by/4.0/ savino et al./evaluating the impact of in-home 676 accounted for only 0.25% of the u.s. population, yet represented 0.5% of the nation’s er users (ku et al., 2010). similarly, although individuals experiencing chronic homelessness constitute only a fraction of the homeless population, they account for a majority of the group’s housing and healthcare resource consumption (aubry et al., 2013; henry et al., 2020; larimer et al., 2009; wright et al., 2016). physical health problems, substance misuse, and mental health conditions are more prevalent among people experiencing homelessness, particularly chronic homelessness (jaworsky et al., 2016). risk accumulation theory attributes this population's high incidence of psychiatric and physical morbidity to overexposure to adverse life events (lippert & lee, 2015; oppenheimer et al., 2016). barriers to preventative healthcare can exacerbate health disparities, driving frequent hospital use (chwastiak et al., 2012; khandor et al., 2011; white et al., 2016). meta-regressions of persons experiencing homelessness across western europe and north america yield elevated random-effects pooled prevalence of 11.4% for major depressive disorder, 23.1% for a personality disorder, 12.7% for a psychotic disorder, 37.9% for alcohol dependence, and 24.4% for drug dependence (fazel et al., 2008). people living as homeless with serious mental illnesses also make greater use of psychiatric hospitals and less use of outpatient mental health services than their housed peers (folsom et al., 2005). relative to a matched-comparison domiciled group, wadhera et al. (2019) found that hospitalizations for persons experiencing homelessness were disproportionately due to mental illness (at rates of 38% vs. 13%) and substance misuse (at rates of 14% vs. 5%). the researchers also observed that psychiatric, but not physical illnesses, were associated with homelessness chronicity (wadhera et al., 2019). however, improved access to ambulatory care alone, through mechanisms such as insurance coverage expansion, may not translate into wholesale acute care reductions among people contending with chronic homelessness (hwang et al., 2013; lin et al., 2015). housing first has emerged as a promising model of permanent supportive housing to address these complex health and social needs (henwood, hsu, et al., 2013; rog et al., 2014). through housing first, consumers are not required to abstain from substances or to achieve psychiatric or medical stability to enroll in housing; instead, they are given access to a variety of supports as they work toward individualized goals and reside independently (nelson, 2010). housing first programs lower mortality rates (henwood et al., 2015) and healthcare costs (larimer et al., 2009). housing first is also associated with increased perceptions of consumer choice and mastery—factors theorized to allay psychiatric symptom severity (greenwood et al., 2005). compared to usual care (outpatient mental health and substance misuse services, sobering services, and shelters), housing first recipients spend less time homeless or psychiatrically hospitalized (brown et al., 2016). moreover, several landmark studies challenge the assumptions inherent to treatmentcontingent (continuum of care) models, with treatment-non-contingent (housing first) program participants demonstrating either comparable or reduced mental health and substance misuse severity relative to continuum of care participants (groton, 2013), as measured by the addiction severity index (mclellan et al., 1980), colorado symptom index (boothroyd & chen, 2008), alcohol use quantity form (sobell & sobell, 1992), short inventory of problems (blanchard et al., 2003), dsm-iv alcohol dependence advances in social work, fall 2020, 20(3) 677 checklist (american psychiatric association, 2000), and drug and alcohol follow-back calendar (new hampshire dartmouth psychiatric research center, 1995). yet the housing first evidence base has several notable limitations (trilling, 2016). criticisms include an overlap between housing first developers and evaluators—elevating the potential for conflicts of interest (groton, 2013), limited evidence regarding the efficacy of housing first in reducing substance misuse (clifasefi et al., 2016), methodological inconsistencies in outcome monitoring (groton, 2013; trilling, 2016), and overgeneralization in housing first's implementation, particularly at the policy level (clifasefi et al., 2016; johnson et al., 2012; trilling, 2016). research among those experiencing chronic homelessness is also scant, and questions remain as to how to best link housing first residents with critical health services. transportation barriers (bancroft, 2012), neighborhood security concerns (hsu et al., 2016), and exclusionary bans from areas surrounding vital services (bancroft, 2012) may temper treatment accessibility as well as perceptions of choice (macnaughton et al., 2015). inhome behavioral health services stand to mitigate some of these barriers. an evaluation of a supportive housing program in portland, oregon highlighted associations between offering on-site services, substantial declines in healthcare expenditures, and concurrent reductions in er use and inpatient treatment (wright et al., 2016). excluding studies of assertive community treatment, which emphasizes community-based and in-home services (aubry et al., 2016) and research demonstrating that integrated auxiliary services improve housing stability and psychiatric symptoms (mchugo et al., 2004), in-home behavioral health research among housing first participants is limited. this study aimed to address this gap by evaluating outcomes from a novel in-home behavioral health program for housing first residents with chronic health conditions (including physical health, mental health, and substance misuse). methods program description this evaluation examined data from access to wellness (atw), an evidence-based, in-home behavioral health program developed by the aids foundation of chicago and funded by the substance abuse and mental health services administration (samhsa). atw is a recovery-oriented program constructed to improve the health and stability of individuals confronting chronic homelessness. the program combined a housing first model with evidence-based behavioral health services delivered in participants’ homes. program interventions incorporated two evidence-based practices (ebps) identified by samhsa—screening, brief intervention, and referral to treatment (sbirt) and motivational interviewing (mi). trained clinicians delivered sbirts in participants’ homes. sbirt is an integrated public health method that comprises three main elements: rapid, standardized screening to assess substance misuse severity and identify appropriate treatment level; brief intervention aimed at fostering participants’ awareness and insight into their substance misuse; and referral to substance misuse and mental health treatment as indicated (substance abuse and mental health services administration, 2015). the savino et al./evaluating the impact of in-home 678 sbirt strategy has a promising degree of empirical support and is associated with decreased frequency and severity of drug and alcohol use, increased use of specialized substance misuse treatment, and lower rates of er use and inpatient hospitalization (aldridge et al., 2017; gryczynski et al., 2011; pecoraro et al., 2012). atw service providers implemented a modified form of sbirt which focused on mental health concerns in addition to sbirt's typical emphasis on problematic substance use. empirical support for similar modifications is limited; however, topitzes et al. (2017) altered the sbirt format to screen for both trauma and alcohol misuse among primary care patients and noted favorably high referral rates to specialized treatment. atw also incorporated mi techniques to address participants’ ambivalence toward seeking traditional substance misuse or mental health services in specialty settings. mi is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (rollnick & miller, 1995). the atw program was staffed by a three-person clinical team that included a mental illness and substance abuse counselor, a certified alcohol and drug counselor, and a registered nurse. both clinicians and agency-based case managers (to whom each participant was assigned) were trained to use mi. atw supplemented these low-threshold ebps with health assessments and brief mental health or substance misuse counseling provided by study clinicians in participants’ homes. participants one hundred thirty-three participants completed surveys at enrollment. all program participants had at least one chronic physical health condition (including, but not limited to, hiv/aids), as well as frequent co-occurring mental health and substance misuse. prior to program entry, participants were screened to confirm their status as chronically homeless per hud criteria. participants resided in scattered-site or project-based apartments in the chicago area. the sample had slightly more men (53%) than women (47%) and was primarily african american (69%). participants ranged in age from 20 to 72, with a mean of 46 years. monthly income was low at enrollment (m=$984, mdn=$952) and remained low at 6-month follow-up (m=$1067, mdn=$974). disability benefits (social security disability income or supplemental security income) and other forms of public assistance were the most common income sources. a majority of participants (82%) had mental health symptoms at enrollment, while 45% had substance misuse symptoms, and 39% had cooccurring disorder symptoms. procedure trained evaluators administered paper-pencil versions of the center for substance abuse treatment government performance and results act (gpra) tool at program enrollment and 6-months and 12-months post-enrollment (samhsa, 2012). evaluators compensated participants with incentives for their time (gift cards valued at $10 at baseline and $20 for each follow-up). data were collected for program evaluation and project improvement purposes and released to the study authors for secondary analysis. all data were de-identified and stored on password-protected computers accessible only to the study advances in social work, fall 2020, 20(3) 679 authors. the study received an exempt determination from the principal investigator’s university for the secondary analysis. variables and measures participant demographic variables, health variables, and er and inpatient hospitalization outcomes were included in the analysis and described below. program use variables (sbirts, case management encounters, and mental health and substance misuse counseling treatment hours) were inconsistently reported and exhibited large amounts of missing data, precluding imputation or process evaluation (saunders et al., 2006; stefancic et al., 2004). demographic variables. demographic variables were gender, race, age, income, and health insurance status. participants self-reported gender, race, and insurance status at study enrollment and age and income at both enrollment and 6-month follow-up. options for gender included male, female, or transgender. participants could select multiple racial and ethnic categories (african american, asian american, native hawaiian or pacific islander, alaska native, white, american indian, and hispanic or latino). the researchers dichotomized these responses as african american or other race to compensate for low cell counts and to simplify demographic analyses (murad et al., 2003). evidence that distinct, systemic factors influence african americans' entry into homelessness prompted the evaluators to include race as a demographic variable (jones, 2016). age was a continuous variable reported in years. monthly income was also continuous and included income earned from wages; public assistance, retirement, and disability benefits; non-legal sources; financial contributions from friends and family; and other sources. participants also reported if they had health insurance. health variables. health variables included screening positive or negative for substance misuse symptoms, mental health symptoms, or co-occurring symptoms, using the 16-item self-report substance abuse and mental illness symptoms screener (samiss). the samiss is a screening instrument designed to identify substance misuse, mood and anxiety disorders. it has an 86% sensitivity and a 75% specificity for substance misuse and a 95% sensitivity and 49% specificity for mental disorders when compared to the structured clinical interview for dsm-iv (breuer et al., 2012, 2014). outcome variables. self-report tools assessed participants’ er visits and inpatient hospitalizations at program enrollment and 6and 12-months post-enrollment. a dichotomous variable indicated if respondents reported er use or inpatient hospitalization for any reason (physical, mental, or substance misuse) in the 30-days prior to each data collection point. er visits and inpatient hospitalizations at enrollment and 6-months functioned as the primary outcomes. neither outcome variable had missing data at enrollment. ten participants were missing er and inpatient hospitalization data at 6-month follow-up for the following reasons: discharge for program violation (n=1), discharge due to incarceration (n=1), and missingness for unknown reasons (n=8). nine additional participants were discharged between 6and 12-month follow-up for reasons including death (n=5), involuntary discharge for nonparticipation (n=1), involuntary discharge for program violation (n=1), voluntary discharge against staff recommendation (n=1), and savino et al./evaluating the impact of in-home 680 discharge for unknown reasons (n=2). at 12-month follow-up, inpatient hospitalization data were missing for 43 participants (32%) and er visit data were missing for 44 participants (33%) for unknown reasons. to prevent erroneous generalizations from these data (benston, 2015; dumville et al., 2006) and in the absence of rigorous explanatory factors to substantiate imputation (saunders et al., 2006; thabane et al., 2013), the researchers excluded 12-month follow-up data from the analysis. analysis univariate statistics were calculated to describe the sample (n=133). the authors conducted chi-square analyses to compare self-reported er use and inpatient hospitalization outcomes at baseline and 6-month follow-up for each demographic and health factor. mcnemar’s chi-square was used for repeated measures analyses. the researchers employed non-parametric tests rather than a technique such as linear regression because er and inpatient data were not normally distributed (ghasemi & zahediasl, 2012; mchugh, 2013). we also applied maximum likelihood chi-squares when minimum expected cell count assumptions were violated (mchugh, 2013). er data proved nonnormally distributed based on a significant shapiro-wilk value (p<.001), skewness of -0.17 (se= 0.22) and kurtosis of 4.72 (se=0.43). inpatient data was also non-normally distributed as evidenced by a significant shapiro-wilk value (p<.001), skewness of 4.04 (se= 0.22), and kurtosis of 31.39 (se=0.43). after excluding participants with missing data, a smaller sample (n=123) was available for repeated measures analysis. bivariate results highlighted relationships that were statistically significant (p<.05) or marginally significant (p<.10) (dahiru, 2008; wainer & robinson, 2003). due to sample size limitations, multivariate analyses were not conducted. results univariate and bivariate analyses are depicted in table 1. during the 30 days preceding baseline data collection, 17% of participants reported er visits and 11% reported inpatient hospitalizations. by 6-month follow-up, 24% of participants reported er visits and 11% reported inpatient hospitalizations. chi-square analysis underscored an assortment of marginally significant associations within these data. changes in er use between program enrollment and 6-month-follow-up were not statistically significant according to mcnemar’s chi-square test. no psychiatric symptoms were associated with er visits or inpatient hospitalizations at either intake or 6-month follow-up. several variables maintained marginally significant (p<.10) associations with acute care outcomes. for instance, participants with inpatient hospitalizations at enrollment were males (73%) by a marginally significant majority above females (27%), χ2 (1, n = 132) = 2.80, p = .094, v=.15. this gender disparity continued at 6-month follow-up, at which time males were responsible for 71% of inpatient visits and females for 29% of inpatient visits, χ2 (1, n = 122) = 2.91, p = .088, v=.15. gender was not related to er visits. at enrollment (but not at 6-month-follow-up), african americans composed a higher proportion of inpatient hospitalization users (87%) than other racial groups (13%), maximum likelihood ratio χ2 (1, n = 133) = 2.78, p = .095, v=.135. advances in social work, fall 2020, 20(3) 681 table 1. univariate analysis of sample descriptives and bivariate analysis of inpatient visits and er visits collected at intake and six months independent variables n (%) sample n (%) intake 6 months inpatient hospital visits (n = 15, 11%) er visits (n = 22, 17%) inpatient hospital visits (n = 14, 11%) er visits (n= 29, 24%) gender: male (cisgender) 70 (53%) 11 (73%)* 9 (41%) 10 (71%)* 15 (52%) race: african american 92 (69%) 13 (87%)* 14 (64%) 12 (86%) 19 (65.5%) insured at intake 62 (63%) 11 (85%)* 11 (73%) 7 (70%) 16 (70%) mental health problem screened positive intake screened positive 6 mo. 108 (81%) 95 (78%) 13 (87%) - 20 (91%) - 11 (79%) 11 (85%) 25 (86%) 25 (86%) substance abuse problem screened positive intake screened positive 6 mo. 59 (44%) 39 (32%) 8 (53%) - 10 (46%) - 8 (57%) 6 (46%) 12 (41%) 8 (30%) dual disorder problem screened positive intake screened positive 6 mo. 52 (39%) 36 (30%) 8 (53%) - 10 (46%) - 7 (50%) 6(46%) 10 (34%) 8 (30%) m (range) age (years) 46 (20-72) 49 (24-71) 43 (23-57) 50 (33-61) 47 (23-61) monthly income ($) at intake at 6 mo. $984 ($91-2606) $1067 ($0-2607) $1159 ($0-1973) - $ 1111 ($0-2252) - $1009 ($0-1585) $1063 ($0-1659) $1025 ($0-2359) $1195 ($0-2607) *p<.10 notes. the participant who identified as transgender was not included in the bivariate analyses of gender and er use and hospitalization. actual n for each analysis ranged from 88 to 133, depending on the amount of missing data. savino et al./evaluating the impact of in-home 682 insured participants constituted a higher proportion (85%) of those hospitalized at intake than uninsured participants (15%), maximum likelihood ratio χ2 (1, n = 98)= 3.30, p = .069, v=.173; this relationship was absent at 6-month-follow-up. furthermore, being insured was not associated with er utilization. finally, neither participant age nor income was associated with er use or hospitalization. discussion although the proportion of atw er users increased (from 17% to 24%) between baseline and follow-up, neither er visits nor inpatient hospitalizations displayed statistically significant changes. generally, housing first residents’ health stabilizes over time (jaworsky et al., 2016), so the distinction between current findings and extant research could be salient. twelve-month data exclusion and the resulting brevity of the study’s follow-up period (6 months) compared with prior research (e.g., leff et al., 2009) may have contributed to the absence of statistically significant acute care changes. outcomes could also be an artifact of a floor effect, signifying that more sensitive measures are needed. that said, we suggest that the lack of a significant increase in acute care use may denote a short-term stabilization effect given the poor health trajectories of many formerly homeless individuals, even after permanent supportive housing enrollment (henwood et al., 2015; 2018). by monitoring participants who use acute care services post-enrollment, housing first program managers and service providers could begin to identify if participants possess distinctive features, targeting services accordingly. kerman et al. (2018) identified subgroups of housing first consumers who—similar to the present study's participants— did not display diminished service utilization after housing first enrollment and argued that consumers' discrepant housing stability levels mediated these differences. consequently, housing stability measures may enhance outcome monitoring and service planning among social workers practicing in a housing first context. using assessment tools to systematically evaluate consumers’ individualized needs and collaboratively and responsively allocate services is consistent with the ethos of evidence-based social work practice (chonody & teater, 2018; drisko, 2014). this practice also embodies social workers’ ethical responsibility to practice in a manner that maximizes consumer selfdetermination and demonstrates competence and commitment to clients (national association of social workers, 2017). because housing first is an inherently flexible model—in contrast, for example, to manualized interventions—finding ways of efficiently and effectively tailoring services to meet housing first residents’ varying needs is a priority area for further social work research and practice (henwood, cabassa, et al., 2013). gender differences were notable, if not generalizable, in our evaluation—specifically, cisgender males’ elevated inpatient use. evidence for systematic gender differences in hospitalization among housing first residents (srebnik et al., 2013) and the utility of tailoring programs to address sociodemographic differences is inconclusive (peressini, 2007). male atw participants' elevations in inpatient hospitalization may stem from an increased incidence of health problems that necessitated admission but were not captured by study tools. obtaining consumers’ consent to coordinate care between area hospitals and housing services could improve social work practice by enhancing interprofessional advances in social work, fall 2020, 20(3) 683 collaboration and the continuity of care, as well as clarify the possible sources of this gender discrepancy. a group of australian investigators noted that involving hospital staff more seamlessly in supportive housing was associated with reductions in hospitalizations (wood et al., 2019). likewise, comparisons of programs integrating housing and auxiliary services with scattered services reinforce the importance of service integration, especially among males (mchugo et al., 2004). relationships between race and hospitalization also differ across studies. for instance, white, homeless women who misused substances exhibited higher rates of hospitalization than other racial groups in an investigation conducted by gelberg et al. (2009), but disparities diminished after controlling for vulnerability factors (e.g., psychiatric hospitalization, abuse history, pregnancy). in the present evaluation, african american consumers had higher levels of inpatient hospitalization at enrollment but not at 6-month followup. though atw services may have reduced repeat hospitalization among african americans, some evidence suggests that housing stability itself is associated with improved health outcomes (jaworsky et al., 2016; kerman et al., 2018). this is important to consider in light of the over-representation of african americans among people experiencing homelessness. in 2019, hud found that african americans composed 40% of the homeless population but only 13% of the us population (henry et al., 2020). further research and evaluation could establish if atw lowered engagement barriers associated with perceived racial stigma and service avoidance (skosireva et al., 2014; weisz & quinn, 2018) with aims to adopt anti-oppressive practices at both the direct practice and systems level (stergiopoulos et al., 2016). in contrast to our predictions, substance misuse and co-occurring symptoms were not significantly related to er visits or hospitalizations. persons navigating homelessness with substance misuse and co-occurring disorders are historically prone to er visits and hospitalizations, even relative to other chronically ill individuals (lin et al., 2015; minassian et al., 2013). access to in-home behavioral health services and permanent supportive housing appears to have stabilized or, for some subgroups (african americans), reduced er and inpatient use. if these findings are reflective of lower psychiatric morbidity among atw consumers, they could also inform the nature of atw's services. for example, mi experts suggest that mi appears less effective—or potentially even contraindicated— among those demonstrating readiness for change, suggesting that as atw consumers' behavioral health stabilizes, alternative interventions may become more appropriate (hettema et al., 2004). insured participants' elevated rates of hospitalization at enrollment may result from lowering treatment barriers that typically persist for those living as homeless, despite obtaining access to health insurance. indeed, other investigators found that publicly insured individuals experiencing homelessness use both more ambulatory and acute care services—even in nations offering universal healthcare (hwang et al., 2013; lin et al., 2015). by including pre-enrollment and post-enrollment insurance data, atw could clarify if consumers who are uninsured before enrollment account for a disproportionate number of hospitalizations and whether those stabilize over time. if this trend exists, it might suggest that high baseline hospitalizations are a function of addressing previously unmet healthcare needs. if supported, this finding could impact social work evaluation and savino et al./evaluating the impact of in-home 684 practice, suggesting that lacking insurance pre-enrollment is an indicator that a participant may benefit from additional staff support. in addition to linking participants to health insurance resources, this support should include referring service users to free or low-cost preventative care and screening programs to identify and treat underlying health conditions. federally qualified health centers and clinics funded through the health care for the homeless program offer excellent resources for linking currently or formerly homeless individuals to essential healthcare services (zlotnick et al., 2013). limitations this program evaluation study has several limitations. the evaluation relied on program data collected and entered by a large team of staff across multiple locations, limiting the researchers' oversight of collection procedures and resulting in considerable missing data for some variables. missing data and the small size of the sample prevented multivariate analyses and led to the exclusion of both behavioral health intervention data (relating to sbirts, case management interventions, etc.) and 12-month follow-up outcomes from data analyses. regardless of associations between demographic variables and hospitalizations within the atw data, the evaluation's methodology prohibits causal inferences and prevents the evaluators from dismantling which factors (e.g., housing, inhome behavioral health, demographic factors) mediated outcomes. another limitation lies in our operationalization of chronic homelessness. in 2015, after data collection supporting the present evaluation ceased, hud adopted a revised definition of chronic homelessness which required discrete episodes to meet or exceed a 12-month aggregate (u.s. department of housing and urban development, 2015). the revised definition captured the heaviest users of shelters and, in effect, targeted those most in need of housing support (byrne & culhane, 2015). since the former definition served as an inclusion criterion, program participants may comprise a group less prone to housing instability than chronically homeless individuals under the current definition (byrne & culhane, 2015). program effectiveness may be resultantly understated, as housing first now targets higher-risk persons than during data collection. the exclusion of fidelity measurements for behavioral health interventions represents another study limitation, meaning that sbirt or mi interventions may have varied in their adherence to evidence-based protocols. while challenges to ensuring treatment fidelity in a supportive housing environment are not exclusive to the atw program, the issue is nonetheless deserving of attention based on potential treatment outcome implications (mcgraw et al., 2010). several fidelity measures for sbirt and mi do exist for application to future research and practice, although they are in varying stages of development and psychometric validation (moyers et al., 2005, 2016; pantalon et al., 2012; vendetti et al., 2017). self-report biases are a fundamental concern to researchers of homeless health disparities (gelberg & siecke, 1997). factors associated with underor over-reporting of health care use among homeless research participants include recall period (clifasefi et al., 2011; somers et al., 2016), alcohol use severity (clifasefi et al., 2011), service type (e.g. psychiatric hospitalization or er use; somers et al., 2016), an active mental health diagnosis (hwang et al., 2016), and homelessness chronicity of two years or greater advances in social work, fall 2020, 20(3) 685 (somers et al., 2016). despite these factors, hwang et al. (2016) and somers et al. (2016) supported the use of self-reports with the homeless population, citing their overall consistency with administrative records. conclusion chronic homelessness is a potent risk factor for repeat hospitalization, which ambulatory care alone does not adequately address. housing first inverts treatment-asusual by prioritizing permanent supportive housing without requiring psychiatric stabilization, lowering morbidity and mortality rates. consumers' relatively low rate of er use and hospitalization is noteworthy, considering that all consumers had chronic physical health or psychiatric diagnoses, perhaps reflecting the potency of addressing structural barriers via in-home behavioral health services. males' marginally higher inpatient use may merit tailored services, although program administrators and direct service staff should continue to monitor these outcomes to see if they persist. reductions in african americans' inpatient use also warrant ongoing evaluation to determine if they are sustained by current atw consumers or are reproducible among future cohorts. subsequent research should employ fidelity metrics and more robust designs, such as randomized controls, to compare outcomes for housing first residents receiving in-home health services to usual care (linking participants with community providers). such research could inform the design of evidence-based service packages to reduce hospital use and improve health outcomes. this issue remains critical as the social work profession strives to reduce health disparities and ensure health equity for marginalized groups, including formerly homeless individuals enrolled in housing first programs. references aldridge, a., linford, r., & bray, j. 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(2016). formerly homeless people had lower overall health care expenditures after moving into supportive housing. health affairs, 35(1), 20-27. https://doi.org/10.1377/hlthaff.2015.0393 zlotnick, c., zerger, s., & wolfe, p. b. (2013). health care for the homeless: what we have learned in the past 30 years and what’s next. american journal of public health, 103 suppl 2(suppl 2), s199-s205. https://doi.org/10.2105/ajph.2013.301586 author note: address correspondence to ryan savino (rsavino@gradcenter.cuny.edu) acknowledgement: the authors would like to thank the aids foundation of chicago and the access to wellness program team for their support. ryan savino was affiliated with the university at buffalo at the time of the study. http://www.jstor.org/stable/3699919 https://doi.org/10.1037/sah0000093 https://doi.org/10.1353/hpu.2016.0104 https://doi.org/10.1108/hcs-09-2018-0023 https://doi.org/10.1377/hlthaff.2015.0393 https://doi.org/10.2105/ajph.2013.301586 mailto:rsavino@gradcenter.cuny.edu this work is licensed under a creative commons attribution 4.0 international license. feasibility, acceptability, and clinical trends of a mindfulness-informed child welfare intervention: implications for trauma-informed practice samantha m. brown jennifer bellamy abstract: exposure to stress and early life trauma have been linked to child maltreatment and parental substance misuse. these issues often co-occur, yet few child welfare services target their shared underlying causes in a single intervention. teaching mindfulnessinformed strategies to substance-misusing families in the child welfare system may be one promising trauma-informed approach. as part of a larger pilot study testing the initial efficacy of a mindfulness-informed intervention for parents in public child welfare, this study explored the feasibility, acceptability, and clinical trends of the intervention using weekly reports of stress, coping, and mindfulness. findings show support for the feasibility and acceptability of the intervention as well as positive responses to the intervention on measures of stress and mindfulness. however, the impact of the intervention varied with regard to improving weekly coping among participants. implications for the integration of mindfulness into child welfare practice as a trauma-informed approach are discussed. keywords: child welfare, coping, mindfulness, stress, trauma early adversity can impact multiple domains of an individual’s life. two pernicious, and frequently co-occurring risk factors, often linked to childhood adversity are maltreatment and parental substance misuse. approximately one-half to two-thirds of child welfare cases involve parental substance misuse (national center on addiction and substance abuse at columbia university, 2005). the consequences of concomitant parental substance misuse and child maltreatment are significant. parents with substance misuse tend to remain involved in the child welfare system longer (u.s. department of health and human services, national clearinghouse on child abuse and neglect, 2003) and have an increased likelihood of termination of parental rights (harris-mckoy, meyer, mcwey, & henderson, 2014). however, child welfare services tend to focus on addressing the symptoms of substance misuse and parenting, rather than their shared underlying causes, including parental stress and trauma. child welfare-involved parents have experienced their own histories of trauma as a population (national child traumatic stress network, 2011). for example, oliver (1993) found that approximately one-third of parents who maltreated their children have experienced abuse in childhood. although trauma-informed services have become more common in child welfare, substance misuse treatment programs and parenting services tend to be delivered to parents in silos. parents’ own trauma histories, in combination with additional stressors associated with the demands parents must meet in the context of child welfare, highlight the need to develop practice approaches that are trauma-informed and that target the underlying mechanisms implicated in both substance misuse and maladaptive parenting. mindfulnessinformed programs may be one promising approach that offers this support to families ______________________ samantha m. brown, phd, ma, lpc is a postdoctoral fellow (t32 mh015442), school of medicine, university of colorado, aurora, co 80045. jennifer bellamy, phd is an associate professor, graduate school of social work, university of denver, denver, co 80208. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 369-386, doi: 10.18060/21281 https://creativecommons.org/licenses/by/4.0/ brown & bellamy/feasibility, acceptability 370 using a trauma-informed perspective (follette, palm, & pearson, 2006). mindfulness has been used with a variety of groups with high levels of trauma, including child abuse survivors (kimbrough, magyari, langenberg, chesney, & berman, 2010) and combat veterans (king et al., 2013). mindfulness is defined as a nonjudgmental acceptance and awareness of present moment experiences (bishop et al., 2004; kabat-zinn, 1994). it has been conceptualized by an awareness of present moment experience with a quality of curiosity, and by the ability to decenter or distance oneself from unpleasant thoughts and feelings without being carried away by them (lau et al., 2006). teaching mindfulness to families aligns with traumainformed child welfare practice such that strategies can be used to help target stress and coping with the potential to improve long-term parent-child interactions and family functioning. for example, individuals exposed to adversity may struggle to adaptively cope, thereby affecting self-regulation skills (cloitre et al., 2009) and engaging in more avoidant-related coping (benotsch et al., 2000) in the presence of distressing thoughts and feelings. exposure to stress and impaired coping may in turn increase the likelihood of unhealthy behaviors such as substance use or hostile parenting practices. cultivating mindfulness may help to counteract the effects of previously avoided internal experiences as well as habitual, impulsive behaviors (kabat-zinn, 1990). in a review, mindfulness has been shown to buffer against maladaptive behaviors and, instead, replace these behaviors with controlled coping responses (weinstein, brown, & ryan, 2009). in addition, because experiencing adversity may result in avoidant-related behaviors subsequently impacting parent participation in treatment (littell, alexander, & reynolds, 2001; littell & tajima, 2000), promoting acceptance and awareness through mindfulness may also positively affect parents’ engagement in child welfare services more broadly. prior research demonstrates that mindfulness-based interventions are effective in reducing stress (carlson, speca, patel, & goodey, 2004; williams, kolar, reger, & pearson, 2001), trauma symptoms (kimbrough et al., 2010; king et al., 2013), and substance misuse (bowen et al., 2009), as well as improving parent-child interactions (duncan, coatsworth, & greenberg, 2009a). despite progressive efforts to improve outcomes for child welfare-involved families with substance misuse, few programs target stress-precipitated child maltreatment and concomitant substance misuse in a single intervention. as such, this study is part of a larger pilot study testing the initial efficacy of a mindfulness-informed intervention for parents in public child welfare. the goals of this study were to pilot a new mindfulness-informed child welfare intervention and explore the feasibility and acceptability as well as assess participants’ response to the intervention using weekly clinical reports of stress, coping, and mindfulness. advances in social work, spring 2017, 18(1) 371 method sample and procedure this study was conducted in an urban area in the rocky mountain region of the united states. the sample of participants were recruited by child protection caseworkers and health department nurses. caseworkers and nurses referred parents for participation in the mindfulness program if the following criteria were met: 1) the family was involved in, or at risk for involvement in, child welfare, 2) substance misuse was a presenting concern, and 3) children remained in the home with parents or parents had weekly visitation with their children. the caseworkers and nurses gave recruitment flyers to eligible parents, and the parents were instructed to release their names and phone numbers to the principal investigator if they were interested in participating in the research study. participants were then contacted by phone by the principal investigator to confirm eligibility and consent to participation. the study procedures were approved by the authors’ institutional review board. the mindfulness program implemented in the present study was delivered to parents in six weekly, in-home sessions, lasting approximately one-hour. the first 5-15 minutes of the session included a weekly check-in about participants’ stress experiences and use of mindfulness-informed strategies. next, participants were provided with psychoeducational content on issues related to stress, triggers, parenting, and the use of mindfulness techniques to address these domains. the last 15 minutes of the session included an experiential mindfulness-informed exercise, which participants could use in their day-today lives. participants also completed brief questionnaires in each session that assessed stress, coping, mindfulness, and their reaction to the session content. in addition, at the conclusion of the six-session intervention, participants completed a program satisfaction questionnaire to assess their experiences and thoughts regarding the acceptability of the program. sessions were developed and delivered by a masters-level, licensed counselor. in contrast to traditional cognitive-behavioral therapies, it is recommended that providers delivering mindfulness are trained in implementation and engage in their own mindfulness practice (segal, williams, & teasdale, 2002). as such, this provider received specific training in mindfulness, which included approximately 24 hours of in-person training, consisting of didactic and experiential education and clinical skills practice, in addition to an online training on mindfulness developed by kabat-zinn (2015). mindfulness-informed intervention for child welfare-involved parents the intervention included sessions on mindfulness (i.e., awareness of present-moment experiences), cognitive reappraisal (i.e., changing the meaning of emotionally triggering stimuli), and savoring (i.e., selectively focus on positive stimuli) that were adapted from an extant mindfulness program (mindfulness-oriented recovery enhancement; garland, 2013) that has demonstrated positive effects on stress and substance use among adult populations (garland, gaylord, boettiger, & howard, 2010), but has not been used with brown & bellamy/feasibility, acceptability 372 parents in child welfare. additional sessions on stress, mindful parenting, and future planning were developed by integrating theory and research on parent-child relationships, family functioning, and mindfulness-based parenting (e.g., duncan, coatsworth, & greenberg, 2009b; hillson & kuiper, 1994; kabat-zinn & kabat-zinn, 1997; patterson, 1982). in addition, in order to provide an individualized and flexible intervention to meet multiple familial needs and align with the constraints of the child welfare system, sessions were delivered in family’s homes and session content was tailored to address each family’s unique stressors and strengths. sessions were delivered for approximately one hour as prior research indicates that standard 2.5-hour mindfulness-based sessions may be too long for vulnerable populations (dutton, bermudez, matas, majid, & myers, 2013). as such, the newly developed mindfulness program for child welfare-involved parents aimed to increase parents’ awareness regarding the triggers associated with stressful situations and substance use, and provide insight into how automatic maladaptive patterns of coping may lead to dysfunctional parent-child interactions. parents were taught both formal and informal strategies including mindful breathing, reappraisal, savoring of pleasant experiences, and mindful parenting such that they could pay attention to and self-regulate their own thoughts and feelings in present moment experiences, while also responding to their children in a conscious effort by attending to their child’s needs. the content of each of the sessions are presented in table 1. table 1. outline of mindfulness-informed program session # training sessions 1 introduction to mindfulness, automatic habits, and maladaptive behaviors 2 mindful reappraisal 3 savoring positive experiences and interactions with children 4 understanding impulses and relationship to stress 5 mindful parenting 6 mindful planning in the context of parenting measures demographics. a basic demographic questionnaire was administered to parents to capture parent characteristics as well as their mental health, substance use, and child welfare histories. stress. the short stress state questionnaire (sssq; helton, 2004) was used to measure weekly state stress. the sssq is a 24-item instrument comprised of three domains of stress (distress, worry, and engagement). only the distress subscale was used in the present study. since participants were taught skills that aimed to increase positive emotions under conditions of stress, the distress subscale was used to measure changes in reports of negative affect-emotion. participants were asked to rate statements on the degree to which they agree with how they felt during the past week (1 = not at all; 5 = extremely). eight items comprise the distress subscale, ranging in scores from 8-40. the sssq distress subscale demonstrates high reliability (cronbach’s α = .87; helton, 2004). coping. coping was examined using the brief cope (carver, 1997). the brief cope includes 14 scales of two items each, which participants rate on a 4-point scale from 1 (i advances in social work, spring 2017, 18(1) 373 haven’t been doing this at all) to 4 (i’ve been doing this a lot). to align with the reappraisal skills taught to participants in the mindfulness intervention, only the positive reframing subscale was used in this study. therefore, scores range from 2-8. this subscale was hypothesized to assess changes in weekly coping, though prior reliability estimates of this subscale yield a questionable cronbach’s α of .60 (yusoff, low, & yip, 2010), perhaps due to the subscale being comprised of only two-item indicators. mindfulness. to assess state mindfulness that can vary in a short period of time, the toronto mindfulness scale (tms; davis, lau, & cairns, 2009) was used. thirteen items comprise the two factors (curiosity and decentering) of the tms. mindful curiosity refers to the awareness of present moment experiences with a quality of curiosity. mindful decentering captures how well participants are able to distance themselves from situations that may provoke unwanted thoughts or feelings. after engaging in a brief 5-10 minute mindful breathing and/or experiential exercise, participants were asked to rate items on a scale from 0 (not at all) to 4 (very much). internal consistency reliability include a cronbach’s α of .88 for curiosity and .84 for decentering (davis et al., 2009). scores on the mindful curiosity scale range from 0-24 and on the mindful decentering scale from 028. feasibility. intervention feasibility was determined by recruitment, retention, and treatment attendance rates among parents involved in the child welfare system with cooccurring substance use. three measures of recruitment and treatment attendance were used for this study: 1) the number of participants enrolled in the intervention, 2) the number of participants who dropped out prior to completion of the post-intervention questionnaires, and 3) the number of intervention sessions attended. acceptability to parents. to assess the acceptability of the mindfulness-informed intervention, we assessed participant’s perspectives of the intervention, overall, as well as during individual sessions. with regard to the acceptability of each session, participants were asked four questions to assess their reaction to session content. specifically, participants were asked to rate on a 5-point likert-type scale (1 = strongly disagree; 5 = strongly agree) if they gained something positive from participating in the session, if the session raised emotional issues they had not expected, if they gained insight about their experiences during the session, and if the session made them think about things they did not want to think about. these questions were selected in order to understand the degree to which each session helped participants cultivate awareness regarding their experiences within the session as well as identify whether session content may have been more detrimental to participant outcomes. these ratings were subsequently used to inform future adaptations to the intervention. a program satisfaction questionnaire was also administered to assess the acceptability of the overall program. participants completed 10 items (e.g., “the program i received was a big help to me”; “i got the kind of help through the program that i needed”; “i enjoyed learning about the concept of mindfulness”; “i would recommend this program to other families”) in which they rated the way they felt about the services they received on a 5point scale (1 = none of the time; 5 = all of the time). percentages of each of the 10 items were computed for analysis. the survey also consisted of five open-ended questions brown & bellamy/feasibility, acceptability 374 describing the benefits and challenges of participating in the intervention as well as recommendations for future iterations of the mindfulness sessions. data analysis descriptive statistics (means, standard deviations, or percentages) were used to describe the sample characteristics, as well as the feasibility and acceptability of providing this intervention in the context of child welfare. this can be examined by describing the proportion of families retained and number of sessions attended, and by participants’ reactions to session content and overall program satisfaction levels. to analyze the openended questions on the participant satisfaction questionnaire, a template approach (crabtree & miller, 1999) was applied such that a priori codes were used that were associated with the strengths and weaknesses of the program. specifically, these codes were used to address the open-ended program satisfaction questions that included the following: 1) what were the benefits of participating in this program?, 2) what were the drawbacks of participating in this program?, 3) what did you notice change in yourself since participating in this program?, 4) how could sessions be improved? and 5) what else would you like to add that relates to your experience while participating in this program? an iterative process was used to identify codes within these a priori categories and were subsequently grouped into themes. two coders reviewed participant responses and percent agreement was calculated with high rates (90%) of inter-rater reliability. participants’ scores from the stress, coping, and mindfulness questionnaires were aggregated and their mean scores were calculated to evaluate weekly group-level trends of the mindfulness-informed intervention. although primarily used for single-subjects research, a similar procedure to the percentage of nonoverlapping data (pnd) metric (scruggs, mastropieri, & casto, 1987) was used to understand weekly clinical trends. the pnd metric is a systematic approach used in single-subjects research that produces a common outcome metric across participants, allowing for ease of data interpretation and providing meaningful information on whether or not a program is beneficial to participants. to calculate the pnd for this study, the proportion of data points in the treatment condition that exceeded or fell below the baseline value was identified. the intervention was designed to increase mindfulness and coping among participants, and therefore, the proportion of treatment data points that exceeded the baseline value was calculated to determine if the intervention had positive effects on these domains of functioning. in contrast, the intervention was designed to decrease participant stress. as such, the proportion of treatment values that fell below the baseline data point was calculated to identify reductions in stress. according to guidelines established by scruggs and mastropieri (1998) for singlesubjects research, and which were applied to the aggregated mean scores in this study, pnd scores greater than 90 indicate extremely successful treatments, scores that range from 70 to 90 represent successful treatments, scores from 50 to 70 are questionable, and scores less than 50 are often identified as unsuccessful treatments. for example, if half of the treatment data points in the current study for participant mean scores (3/6 sessions) do not exceed the baseline level mean score, then the pnd score is 50%, thereby indicating that advances in social work, spring 2017, 18(1) 375 the intervention was not beneficial to participants in a particular domain. in addition to calculating the pnd statistics, participants’ aggregated graphical data were displayed to provide visual insight into how intervention participants changed over time on outcomes of stress, coping, and mindfulness across each of the six weekly sessions. results feasibility over the recruitment period, 15 participants were selected to participate in the mindfulness-informed intervention. one parent selected to participate in the intervention dropped out prior to the start of the intervention and three others dropped out early in the program (after the second or third sessions) due to moving to another state, personal life changes and feeling overwhelmed, or being unreachable at subsequent contacts by the researcher. thus, 11 of the 15 parents (73%) were retained in the program. with respect to treatment attendance, on average, parents completed 5.8 (sd = .40) sessions. the provider sent weekly reminders to participants and flexibly scheduled sessions, which may have positively contributed to study participation. the primary barrier to attending all six mindfulness sessions included frequent rescheduling due to other demands parents had to meet, such as attending other child welfare-mandated services or visitation with children. sample characteristics eleven parents completed the mindfulness-informed intervention. eight were mothers (72.7%) and three were fathers (27.3%) who identified racially and/or ethnically as white (n = 9; 81.8%), black (n = 1; 9.1%), and puerto rican (n = 1; 9.1%). participants averaged 33.18 (sd = 11.05) years in age, ranging from 21to 53-years-old. slightly less than half of the sample were employed (n = 5; 45.5%) and resided within lower socioeconomic status (ses) households (n = 6; 54.6%) or middle ses households (n= 4; 36.4%). one parent was in a higher ses household (9.0%). approximately half (n = 6; 54.5%) of the participants had been previously reported for abuse and neglect to child welfare and nearly half had been previously diagnosed with a mental health and/or substance use disorder (n = 5; 45.5%). acceptability to parents ratings of session content indicated that all of the participants gained something positive out of each session, with the majority of participants strongly favoring the content on mindful parenting. in sessions where participants rated that the content raised emotional issues or elicited unwanted thoughts, they also indicated that they gained insight into their experiences during these sessions. table 2 displays the frequencies of parent ratings of session content. brown & bellamy/feasibility, acceptability 376 table 2. participant ratings of reactions to session content (n=11) reaction to session item strongly disagree n (%) disagree n (%) neutral n (%) agree n (%) strongly agree n (%) session 1: introduction to mindfulness, automatic habits, and maladaptive behaviors gained something positive 4 (36.4) 7 (63.6) raised emotional issues 4 (36.4) 2 (18.2) 3 (27.3) 2 (18.2) gained insight 7 (63.6) 4 (36.4) thought about unwanted things 3 (27.3) 4 (36.4) 3 (27.3) 1 (9.1) session 2: mindful reappraisal gained something positive 5 (45.5) 6 (54.5) raised emotional issues 5 (45.5) 2 (18.2) 3 (27.3) 1 (9.1) gained insight 1 (9.1) 6 (54.5) 4 (36.4) thought about unwanted things 5 (45.5) 3 (27.3) 2 (18.2) 1 (9.1) session 3: savoring positive experiences and interactions with children gained something positive 5 (45.5) 6 (54.5) raised emotional issues 4 (36.4) 3 (27.3) 2 (18.2) 1 (9.1) 1 (9.1) gained insight 4 (36.4) 5 (45.5) 2 (18.2) thought about unwanted things 4 (36.4) 5 (45.5) 2 (18.2) session 4: understanding impulses and relationship to stress gained something positive 5 (50.0) 5 (50.0) raised emotional issues 3 (30.0) 2 (20.0) 2 (20.0) 2 (20.0) 1 (10.0) gained insight 1 (10.0) 6 (60.0) 3 (30.0) thought about unwanted things 5 (50.0) 2 (20.0) 2 (20.0) 1 (10.0) session 5: mindful parenting gained something positive 3 (27.3) 8 (72.7) raised emotional issues 4 (36.4) 2 (18.2) 2 (18.2) 2 (18.2) 1 (9.1) gained insight 6 (54.5) 5 (45.5) thought about unwanted things 8 (72.7) 2 (18.2) 1 (9.1) session 6: mindful planning in the context of parenting gained something positive 3 (30.0) 7 (70.0) raised emotional issues 2 (20.0) 2 (20.0) 4 (40.0) 2 (20.0) gained insight 1 (10.0) 5 (50.0) 4 (40.0) thought about unwanted things 6 (60.0) 2 (20.0) 1 (10.0) 1 (10.0) findings from the overall post-program satisfaction questionnaire indicated that the majority of parents felt they benefited from the intervention. ninety-one percent (n = 10) of participants indicated that, “all or most of the time,” the program was a big help to them, they got the kind of help through the program they needed, and they learned a lot about how to manage their stress. moreover, all (n = 11) participants reported they enjoyed learning about the concept of mindfulness. several themes were identified from the open-ended questions on the program satisfaction questionnaire. parents reported that the program helped them to (a) recognize triggers to stressful situations, (b) become calmer and more attentive, and (c) improve communication with their child. for example, when asked about what was helpful through participating in the program, one parent stated, “…i learned how to step back and look at a situation, take a deep breath, and not stress about the future…[i could] focus on the here advances in social work, spring 2017, 18(1) 377 and now.” another parent said, “…it helped me to be more aware…and brought to my attention behaviors that i was doing that i didn’t like.” when asked about how the session content had been applied to interactions with their children, one parent stated, “we are communicating better…not as many screaming matches and not at the level that it used to be.” one parent also reported, “i have been able to listen and be more attentive to my daughter.” in addition, parents expressed that the “in-home aspect [of the program] was good” and they appreciated the individualized nature of the program. for areas of improvement, parents stated that some of the visual content used to discuss the relationship between substance use and stress could be updated. weekly clinical trends as illustrated in figure 1, mean score ratings for participants on measures of stress, coping, and mindfulness suggest that the mindfulness-informed intervention was helpful in reducing stress and promoting mindful curiosity and decentering, but questionable for fostering positive coping. despite subtle decreases in weekly reports of stress across participants, the pnd statistic for stress (1.00) indicated that all treatment data points fell below the baseline stress score. trends illustrate that a greater decrease in stress was reported among participants at the fifth session, but slightly increased by the final session. evaluation of the pnd statistics for mindful curiosity (1.00) and mindful decentering (1.00) indicated that all data points in the treatment phase exceeded the baseline subscale scores. trends illustrate that, as a whole, participants reported an increase in awareness and ability to step back from situations without getting taken over by them from baseline. these trends remained predominantly stable until the fifth and sixth sessions at which point there were greater increases in mindfulness. finally, the pnd statistic for the coping subscale (.67) demonstrated that four data points in the treatment phase exceeded the baseline score with the greatest increase at the final session, suggesting that mindfulness-informed training may have been questionably helpful in promoting positive reframing as a coping mechanism for participants. discussion findings from the present study suggest that a brief mindfulness-informed intervention for this sample of child-welfare involved parents can be feasibly integrated in public child welfare and is acceptable among parents. in addition, findings suggest that the intervention shows positive changes over time on weekly outcomes, specifically improving state mindfulness and reducing stress, but it may be less useful in increasing the coping skill positive reframing. brown & bellamy/feasibility, acceptability 378 22.73 21.45 21.09 21.40 21.18 16.10 18.55 0 5 10 15 20 25 b t1 t2 t3 t4 t5 t6 s s s q m ea n s co re s stress 6.00 6.00 6.09 6.18 5.50 6.09 6.60 4.5 5 5.5 6 6.5 7 b t1 t2 t3 t4 t5 t6 b c o p e p o si ti v e r ef ra m e m e a n s co re s coping 16.45 17.82 17.91 17.73 17.80 19.27 21.00 14.64 16.27 17.09 17.73 17.90 17.18 18.90 0 5 10 15 20 25 b t1 t2 t3 t4 t5 t6 t m s m in d fu l c u ri o si ty a n d d ec en te r m ea n s co re s mindfulness mindful curiosity mindful decenter figure 1. participant mean scores derived from the short stress state questionnaire distress subscale, brief cope positive reframing subscale, and toronto mindfulness scale mindful curiosity and mindful decenter subscales. advances in social work, spring 2017, 18(1) 379 that the intervention was found to be feasible, as evidenced by recruitment, retention, and treatment attendance rates, may offer a promising approach to address the needs of child welfare-involved families. of the parents recruited, few dropped out of the intervention, and when they did it was generally due to time constraints or other concerns not related to the intervention itself. with regard to treatment attendance, of the 15 families randomly allocated to the intervention, 11 participated in at least five of the six sessions. given that this is a challenging population with many barriers to treatment, attrition is in line with prior research using similar samples (e.g., beasley et al., 2014; gopalan et al., 2010). rates of attrition may have been supported by the intentionally brief, flexible, and individualized aspects of the program, as evidence suggests that parents benefit more from programs that are delivered in-home and tailored to meet their unique needs, compared to rigid, group-delivered manual-based programs (kendall & chu, 2000). the use of a mindfulness-informed intervention for this sample of child welfareinvolved parents with substance misuse was also found to be acceptable. positive session ratings and qualitative feedback indicated that the intervention was well-received, as parents endorsed multiple benefits of the program. consistent with previous reports (e.g., lundahl, risser, & lovejoy, 2006), a number of participants indicated the individualized nature of the program was especially favorable for them such that it allowed for more continuity between sessions compared to their prior experiences in group settings. moreover, for many participants, the session specifically pertaining to mindful parenting was the most highly rated. although mindful parenting techniques were infused within each session, parents noted that, from this later session, they gained the most insight into their experiences and received resourceful information from which they could use mindfulness-informed skills as a means to cope with stress in the context of parenting. this suggests that future adaptations to the program should include enhanced content on mindful parenting that is introduced at the start of the program and is a more central focus in additional sessions. this content could potentially replace some of the less preferred content rated by participants. some of the less preferred content, from the parents’ perspective, included the sessions on savoring and understanding the relationship between impulses and stress. because participants reported many daily stressors, it may have been difficult to broaden their positive emotions in a single session on savoring. parents also reported increased distress at the third session on savoring and therefore may have been hyper-focused on negative thoughts and feelings. moreover, in the session that highlighted the relationship between impulses (e.g., use of substances) and stress, participants reported that, in addition to stress, many impulses arose from boredom or social pressure. adapting this content to include discussions about these differential associations may improve acceptability and would benefit from testing in future studies. it is important to note that, in light of these findings, the majority of parents involved in the current study identified racially and ethnically as white and therefore may not be representative of the larger child welfare population. racial and ethnic minority families are often overrepresented in the child welfare system, and research finds that there may be cultural differences regarding their attitudes toward mindfulness practice (dutton et al., 2013). notably, researchers have designed mindfulness-based interventions that are culturally suitable for vulnerable populations. for example, dutton and colleagues (2013) brown & bellamy/feasibility, acceptability 380 conducted focus groups to inform the implementation and enhanced tailoring of mindfulness-based stress reduction for low-income african-american women with histories of trauma. they found that shorter sessions, diverse applications of both informal and formal mindfulness practice, and clarification of participants’ expectations regarding mindfulness practice (e.g., religious beliefs associated with mindfulness) may improve the feasibility and acceptability of mindfulness programs among this population (dutton et al., 2013). although some qualities from the mindfulness intervention for child welfareinvolved parents described in this study are consistent with qualities from dutton and colleagues’ (2013) work, their findings have important implications for future research on the feasibility and acceptability as well as adaptation to the current intervention, particularly with a larger and more diverse sample of parents involved in the child welfare system. despite questionable results of the intervention on parents’ coping skill of positive reframing, it appeared that most parents successfully changed in their weekly stress levels, mindful curiosity (i.e., ability to attend to present moment experiences with a quality of curiosity), and mindful decentering (i.e., awareness of one’s experiences without being carried away by them). the initial steps in mindfulness are to increase awareness of where attention gets drawn to and bring it back to the present moment, as well as to note these experiences rather than label or place judgment on them (bishop et al., 2004). this was a central focus of the mindfulness-informed intervention – particularly attending to thoughts, feelings, and sensations, and recognizing automatic patterns of behavior such as maladaptive parenting and substance misuse – and therefore may support participants’ improvements in these specific domains. however, the majority of participants had a substantial increase in their mindfulness curiosity and decentering scores from baseline in sessions five and six, which may indicate that these mindfulness skills required more practice or that the specific content and exercises taught to parents (e.g., mindful parenting, planning for the future) may have been a factor in enhancing parents’ ability to better let go of unwanted thoughts, feelings, and sensations. these findings are promising as prior research suggests that brief mindfulness-based training can improve state mindfulness with the potential to spill over into other domains of individual functioning. specifically, increases in mindfulness have been associated with reduced fatigue, anxiety, and trauma (kimbrough et al., 2010; zeidan, johnson, diamond, david, & goolkasian, 2011), improved affect (brown & ryan, 2003), and better communication (barnes, brown, krusemark, campbell, & rogge, 2007), qualities that may be particularly important in healthy family relationships. the majority of participants reported slight reductions in stress across treatment sessions, with the greatest decline in stress in session five. only minor reductions in stress across the other treatment sessions may be attributed to high levels of stress often found in families involved in the child welfare system (curenton, mcwey, & bolen, 2009), and the complex, cumulative stressors reported by the participants in this study. for example, many of the participants reported stressors centered on finances, multiple demands of service providers, and interpersonal problems. as these stressors may be more persistent in the lives of child welfare-involved parents and may be exacerbated in particular situations (e.g., receiving a bill in the mail when financial strain already exists), experiencing such advances in social work, spring 2017, 18(1) 381 stress may have contributed to the varying reports of stress across participants. although there were only slight decreases in stress during the intervention, it is promising that parents also reported improvements in mindfulness such that these skills may have served as potential buffers against new and persistent stressful experiences. future studies might test the extension of sessions, add additional stress-reduction approaches, or identify other opportunities to practice mindfulness strategies in order to increase the effectiveness of the approach in reducing stress. findings should be considered in light of the study’s limitations. first, this pilot study included a small homogenous sample, which may in turn limit generalizability of the feasibility, acceptability, and weekly trends of the mindfulness-informed intervention among larger, diverse samples. second, although the pnd metric is a common and systematic approach to evaluate outcomes of single-participant research, the small sample size also reduced statistical power, limiting the opportunity to conduct more traditional and rigorous statistical analyses of the weekly outcome data. third, as this intervention was designed to reduce participant burden, delivery of content within six sessions may have not allowed for ample time to identify important trends of the program on weekly outcomes of stress, coping, and mindfulness, and may have not provided sufficient time for parents to realize the maximum benefit from the intervention. fourth, since it was postulated that affecting stress and coping in child welfare-involved parents would lead to positive family functioning outcomes in the long-term, a heterogeneous measure of coping consisting of more than two-item indicators as well as observational data collection methods may have provided more accurate measures on these outcomes. finally, some dimensions of feasibility and acceptability were not measured in this pilot study, and future research would benefit from including standardized measures of these constructs. despite these limitations, this study has several important implications for practice. stressful life events, including involvement with child welfare, may lead to significant consequences for well-being and parenting. an individual’s history of adverse experiences may contribute to automatized and habitual ways of thinking and behaving (dumas, 2005). for example, the use of behavioral disengagement techniques to cope with stress, such as substance use, may serve to relieve unwanted distress and be implemented without conscious intent. these, often maladaptive, coping strategies may be particularly effective and reinforced because they reduce distress in the immediate term (sinha, 2001). however, teaching mindfulness to parents has the potential to disrupt automatic, maladaptive coping patterns (e.g., substance use; bowen et al., 2009) and increase individuals’ attention to triggers associated with stressful situations (creswell & lindsay, 2014). when parents have more attentional control over their thoughts, feelings, and sensations, they may be better equipped to respond in a more controlled, rather than reactive, manner even under conditions of stress. participating in a brief mindfulness-informed program may in turn facilitate parents’ ability to engage in other child welfare-mandated services. anecdotal reports by participants indicate that mindfulness helped to provide a sense of calmness physiologically as well as increase attention in the present moment. practicing mindfulness may therefore create a greater capacity to deal with unpleasant situations, and also help parents put aside negative feelings and thoughts associated with the demands of the child brown & bellamy/feasibility, acceptability 382 welfare system. this is particularly well-suited to parents with a history of trauma, which can include physiological problems and difficulty with focus or attending. mindfulness also has the potential to transfer to parent-child interactions and help parents mindfully attend to their children’s behaviors (e.g., singh et al., 2010), perhaps providing an opportunity to enhance overall family functioning. teaching mindfulness practice to both parents and children may be another particularly fruitful enhancement to the current intervention, and future studies would benefit from rigorous measurement of parent, child, and family outcomes. other adaptations to this mindfulness-informed intervention might include additional mindfulness-informed strategies that also promote the use of alternative emotional, cognitive, and behavioral coping strategies. given the types of stressors families faced (e.g., finances, pressure from service providers, interpersonal problems), practical guidelines for handling these stressors and refinement of the intervention to meet the individual needs of families may also be a favorable enhancement. taken together, the data indicate initial support for the use of a brief mindfulnessinformed intervention for child welfare-involved families with substance misuse. this study adds to the growing body of literature on mindfulness practice such that it may be a useful and feasible approach to integrate within public child welfare settings. however, given the range of stressors likely experienced by participants in the current study and the variability in affecting the domain of coping, mindfulness-informed training may better help families reach their full potential if it is delivered in conjunction with other therapeutic skill-building programs. an integrated mindfulness intervention for targeting stress and improving coping may in turn better serve as a trauma-informed approach and impact longterm family functioning for child welfare-involved families with substance misuse. references barnes, s., brown, k. w., krusemark, e., campbell, w. k., & rogge, 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(2011). mindfulness meditation improves cognition: evidence of brief mental training. conscious cognition, 19, 597-605. doi:https://doi.org/10.1016/j.concog.2010.03.014 author note: address correspondence to: samantha m. brown, department of psychology, university of denver, 2155 s. race street, denver, co 80211, 303-8717774, samantha.m.brown@ucdenver.edu acknowledgements: funding for this study was provided by the new york community trust fahs-beck fund for research and experimentation, the american psychological association section on child maltreatment, and the society for social work and research. https://doi.org/10.1177/074193258700800206 https://doi.org/10.1007/s10826-009-9267-9 https://doi.org/10.1007/s002130100917 http://nccanch.acf.hhs.go/ https://doi.org/10.1016/j.jrp.2008.12.008 https://doi.org/10.4278/0890-1171-15.6.422 https://doi.org/10.1016/j.concog.2010.03.014 mailto:samantha.m.brown@ucdenver.edu this work is licensed under a creative commons attribution 4.0 international license. a multi-systems life course perspective of economic abuse kameri christy valandra abstract: intimate partner violence (ipv) against women slowly moved out of the private sphere and into the public realm in the united states in the early 1970’s. while progress has been made regarding psychological, physical, and sexual trauma related to ipv, it has been only in the last decade that attention about ipv has included an examination of the impact of economic abuse (ea). this is disturbing given that ea is one of the eight spokes on the power and control wheel (pcw) and many women state that they are not able to leave or get away from the abusive relationship due to financial reasons. using a multisystems life course (mslc) perspective, this paper considers the importance of elevating ea as a form of ipv-related trauma. we examine ea’s differential impact among women, review current practices and policies, and conclude with implications for micro, mezzo, and macro levels of trauma-informed practice with survivors of ea. keywords: economic abuse; multi-systems life course; and culturally responsive practices violence and abuse against women by their current or former intimate partners slowly moved out of the private sphere and into the public realm as an issue for consideration in the united states in the early 1970’s (mccue, 2007). at first, attention focused on physical abuse, with the addition of emotional and sexual abuse following at the end of the 1970’s. it was not until 1993 that all 50 states criminalized marital rape (bergen & barnhill, 2006). much less attention has been given in the literature to an examination of economic abuse (ea; adams, sullivan, bybee, & greeson, 2008; postmus, plummer, mcmahon, murshid & kim, 2012). furthermore, a 2014 national poll commissioned by the allstate foundation revealed that 78% of the public respondents had never heard the term economic abuse in relationship to intimate partner violence (ipv). while respondents believed economic abuse to be the least common type of ipv, the survey indicates that 99% of people “who have been victim of domestic violence have also experienced financial abuse” (allstate foundation, 2017, p.3). the authors acknowledge that ea is not gender-restrictive since it can be experienced by both men and women. nor is ea an exclusive form of ipv. survivors often experience economic, physical, sexual, or emotional abuse simultaneously (johnson, 2015). for the purposes of this article, the focus is on women survivors. applying a multi-systems life course perspective (mslc; murphy-erby, christy-mcmullin, stauss, & schriver, 2010), we discuss the complexities of economic abuse and how it is experienced differentially by women. lastly, we review current practices to address ea, and present micro, mezzo and macro practice implications to address ea from a mslc perspective. to facilitate readability, a key of acronyms used in the article is included in the table 1. ___________ kameri christy, phd, msw, is professor, school of social work, university of arkansas, fayetteville, ar 72701-1201. valandra, phd, msw, mba, lcsw is assistant professor, school of social work, and director of african & african american studies, university of arkansas, fayetteville, ar 72701-1201 copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 80-102, doi: 10.18060/21288 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 81 table 1. acronyms ea economic abuse eapcw economic abuse power and control wheel fvo family violence option ida individual development accounts ipv intimate partner violence ipv-ea intimate partner violence and economic abuse lgbt lesbian, gay, bi-sexual, transgender mafm moving ahead through financial management mslc multi-systems life course pcw power and control wheel reap realizing your economic action plan prwora personal responsibility and work opportunity reconciliation act tanf temporary assistance for needy families vawa violence against women act understanding economic abuse and its impact while there is a paucity of scholarship on economic abuse, there has been an increase of publications on this topic since the early 2000’s (see for example, adams et al., 2008; hahn & postmus, 2014). for this paper, the definition of ea provided by adams and colleagues (2008) is used: “economic abuse involves behaviors that control a woman’s ability to acquire, use, and maintain economic resources, thus threatening her economic security and potential for self-sufficiency (p. 564).” ea behaviors include preventing work outside the house, preventing ownership of personal possessions, preventing financial documents from being titled in a woman’s name, preventing a woman’s right to a bank account or other measures intended to prevent women from attaining monetary success (domestic abuse intervention programs, n.d.). ea may include such sabotage strategies such as physical harm, destruction of possessions or transportation, theft of keys or money, harassment at a woman’s place of work, physical restraints, or other measures intended to harm a woman’s chance of obtaining and/or maintaining gainful employment (adams et al., 2008). economic abuse and socio-economic status are closely linked but are not synonymous. for example, we know that ipv is reported more among low-income women (weaver, sanders, campbell & schnabel, 2009); however, women from seemingly moderateand higher-income levels can experience economic abuse by a partner (outlaw, 2009). ea is as prevalent as physical, psychological and sexual abuse, and is used by an intimate partner to gain control of a woman’s life through economic means (adams et al., 2008; hahn & postmus, 2014). in a study comprised primarily of african american (48%) and white (45%) women (n=103) receiving ipv services, 99% reported experiencing some type of economic abuse (adams et al., 2008). similarly, postmus and colleagues (2012) found that 94% of the 120 (55% white, 20% african american and 15% hispanic) female survivors of ipv reported economic abuse by their partner. in studies from the general public, 14% of new mothers indicated they had been economically abused (schrag, 2015). outlaw (2009) found that the “risk of physical violence among those whose access to money was christy and valandra/a multi-systems life course 82 controlled by another was 4.68 times greater than for those not experiencing economic abuse” (p. 267). conceptual framework for understanding economic abuse ipv is a complex and multifaceted phenomenon, with ea playing a central role. ea affects all aspects of life for individuals, families, communities, and society. for example, in the area of employment, over $8 million paid workdays and $5.8-12.6 billion are lost every year (national coalition against domestic violence [ncadv], 2015) due to such ea behaviors as harassment while on the job and absenteeism. we applied a mslc perspective to address the complete context of ea. mslc is comprised of three theories and one perspective: (1) life course, (2) ecological/systems, and (3) symbolic interactionism theories, and a perspective of social change (murphy-erby et al., 2010). a mslc perspective provides a way to unite the profession, expands and strengthens micro level practice through its consideration of macro level issues, and leads to the provision of more effective and efficient services. in this way, a mslc perspective serves to address the historic tension between micro versus macro practice (austin, coombs & barr, 2008; haynes, 1998). this integrative practice perspective views well-being and social change as interdependent (enhancing both social functioning and social conditions) and should be applied in all stages of practice such as engagement, assessment, intervention, and evaluation (murphy-erby et al., 2010). anchored in an intersectional perspective of multiple and overlapping social relations, ecological/systems theory posits that organisms exist within the context of multiple interrelated, dynamic systems (e.g., biological, political, and social). in other words, what happens in one realm impacts other realms, and these interactions occur bi-directionally (bronfrenbrenner, 1989). the integration of symbolic interactionism into mslc requires us to pay attention to the social construction of meanings, symbolism, and roles when considering the behaviors at the micro, mezzo and macro levels (blumer, 1969). life course theory asserts that historical, social, and political contexts influence the important turning points, transitions, and trajectories of organisms. the context is understood as the exchanges between internal free will and external forces (elder, 1995). while the interaction between the person and environment is important, a social change perspective draws attention to the reality that free will may be constrained by powerful social forces. a social change perspective “adds an emphasis on the relationships among social justice, social change, and social action by considering issues of power and oppression and strategies for actively challenging the status quo to promote social change” (murphy-erby et al., 2010, p. 1). although there are overlapping themes between these theories and this perspective, each is needed to address gaps or limitations that exist in each of the other three. for example, life course theory does not speak to issues of power, privilege, or social action. similarly, ecological/systems theory, while understanding contextual factors, fails to place strong emphasis on an in-depth analysis of time and place, or key historical events. likewise, symbolic interactionism has been applied mostly to micro-level interventions; it has been underutilized regarding mezzo and macro-structures. additionally, social change advances in social work, spring 2017, 18(1) 83 as a perspective allows a view of social movement and change that is often considered dichotomous, and minimizes the potential of individual empowerment. therefore, mslc is not used as four separate theories/perspectives but rather as an integrated whole whose intersecting concepts reinforce each other (murphy-erby et al., 2010). the overlapping aspects of the theories and perspective contained within mslc demonstrate the concept of intersectionality as a perspective paradigm. in the same way that intersectionality attempts to understand multiple crucial, overlapping, and integrated systems of oppression experienced by an individual or larger system, mslc asserts that individuals, groups, communities, and organizations with which social work intervenes are complex entities that cannot be wholly understood from one theoretic approach. mslc integrates multiple theoretical frameworks, and thus is like an intersectionality perspective in its capacity to drive holistic examination and interpretation. understanding ea from a mslc perspective life course (elder, 1995) and symbolic interactionism (blumer, 1969) theories suggest an examination of ea relative to ascribed gender roles and life trajectories. the evolution of perceptions, policies, and practices pertaining to ea have been impacted by roles and meanings ascribed to men, women, marriage/intimate relationships, and money. historically, the united states has supported a strong family ethic, “featuring a male breadwinner and an economically dependent female homemaker” (abramovitz, 1996, p. 2). along with this ethic is the presumption of men as strong, self-sufficient, head of the household and women as weak, dependent, less competent, and less intelligent than men. these beliefs unfortunately reinforce the concept of a husband-wife household where the man is all-knowing and makes all decisions, including the financial ones (abramovitz, 1996). these meanings, compounded with a middle class, traditional life course perspective of women staying home to care for family members, sets the stage for certain behaviors to be overlooked and/or condoned. consequently, it may be difficult for women and the rest of society to view behaviors such as taking (stealing) the woman’s money, generating debt in her name, or forbidding her from going to school as economic abuse (adams et al., 2008). when a woman suffers in an environment of ea, the effects can extend far beyond her immediate situation. ea can affect both her life course and that of her children. the woman’s employer may also feel impacts such as increased health expenses for the woman and her children, as well as decreased employee productivity. furthermore, the economic health of the greater society can be affected by the woman’s curtailed participation in the workforce (trygged, hedlund, & käreholt, 2014). given the ubiquitous nature of ea, addressing it will involve cultural change at the individual, community, and societal level. drawing upon symbolic interactionism, ecological/systems theories, and a social change perspective, prevention and intervention require collaboration among systems/groups and a shift in the meaning our culture ascribes to such concepts as money, family (hawkins & kim, 2012), gender roles/expectations, and ipv. within a social change perspective, the act of ascribing meaning to those concepts is informed by a consideration of issues of power, privilege, and inclusion. such consideration is required christy and valandra/a multi-systems life course 84 to reveal the existence of ea and to unveil the secrets behind who benefits and who loses from the current economic system and ea. an analysis of how the gender pay-gap provides a contextualized examination of women’s vulnerability to ea by an intimate partner using the mslc perspective will help illustrate the above assertions. the difference between what women make in the workforce compared to men can be attributed to macro, mezzo, and micro factors. the persistent existence of a gender wage-gap can be understood, in part, by overarching intersectional ideologies of patriarchy, heterosexual marriage and the nuclear family, and capitalism. these prevailing ideologies are influential in the development of a system of social control and paternalism regarding the subjugation of women’s labor, reproduction, and right to self-determination (day & schiele, 2012). the national women’s law center (2016) indicates that some of the reasons include lack of laws requiring equal pay for equal work, negative stereotypes about mothers and women being discouraged from entering better paying fields. research has also shown that ipv is correlated with lower pay (adams et. al, 2008). therefore, it can be convincingly argued that historical and systemic structures of gendered income inequality, inaccessibility to viable wage-earning resources (employment, education, affordable daycare, etc.), and socially accepted and perpetuated gender-based cultural norms and laws, in effect, exacerbate women’s susceptibility to economic deprivation and ea by an intimate partner. the 21% difference in the pay women receive compared to men (american association of university women, 2016) has multiple ramifications. while distressing, reporting the wage gap at 21% is misleading. compared to white, heterosexual, cisgendered, fathers and older men, the disparity is often more egregious with pay differences of 40% for african american women, 45% for latina, 21% for lesbians, 33% for transgendered women, 27% for mothers and 27% for women ages 45-64 (national women’s law center, 2016). additionally, women living with disabilities earn on average 28% less than men living with disabilities (national women’s law center, 2016). lower wages mean less income for not only the woman but for the entire household (systems theory). whether a single head of household or a dual-income household, fewer financial resources can limit the ability to pay bills and purchase adequate food and shelter (mickelson & hazlett, 2014; page-reeves, 2011). economic hardship is also associated with financial reliance on men and the inability of women to leave an abusive relationship (abramovitz, 1996; sanders, 2015). critiquing consequences of the wage gap from a mslc perspective, children, families, local communities (including schools), and the national budget are disadvantaged in a selfperpetuating cycle of ea of women, leading to economic hardship for the woman and her children, which in turn can lead to economic vulnerability and ea for children when they become adults. some long-term effects include poorer public education for the children, which often results in low graduation rates and low rates of post-secondary education/training (hawkins & kim, 2012). inadequate educational facilities and experiences can cause students to devalue education and themselves (purtell & mcloyd, 2013). they may believe that the roles ascribed to their financially struggling parent(s) will be the same that they will bear as adults (purtell & mcloyd, 2013). this belief is an advances in social work, spring 2017, 18(1) 85 outgrowth of economic insecurity and is often realized as children grow up to find themselves doing low-wage work as adults and at risk for ea from an intimate partner. incarceration is also linked to children’s expectation that their roles in adulthood will mirror those of their financially struggling parents (purtell & mcloyd, 2013). women’s differential experiences of ea from a mslc perspective mslc demands of practitioners a critical and contextual analysis of the intersectional complexity of ea to better serve the diverse needs of survivors and to advocate for systems change. a mslc wage-gap analysis serves as a means of understanding how the intersections of culture, class, race, and ethnicity differentially magnify women’s experiences of ipv-ea (see figure 1; bent-goodley, 2005; rennison & planty, 2003; sokoloff & dupont, 2005). previously articulated pay disparities experienced by women of color and poor, lesbian, and older women (national women’s law center, 2016) suggest that some women are also vulnerable to intersectional structures of race, class, sexual orientation, and age inequality that can exacerbate their vulnerability of ipv-ea by partners (bent-goodley, 2005; sokoloff & dupont, 2005). the historical context of enslavement and colonization, for example, is acknowledged in ipv-related scholarship as critical to understanding the needs of both survivors and men of color who commit violence and to providing culturally-sensitive services (gondolf & williams, 2001; mceachern, vanwinkle, & steiner, 1998). in the united states, the legacy of slavery and colonization has resulted in longstanding structural income inequality, economic oppression, and negative stereotypes in which women of color are disproportionately represented as a high-risk group for ea (rennison & planty, 2003; valandra, murphy-erby, higgins, & brown, 2016). brush (2004) notes that in the united states women of color are disproportionately represented among recipients of public welfare, a context in which poverty, welfare, work, and vulnerability to ipv and ea intersect. the disproportionate representation of women of color in the low-income sector of society increases their vulnerability to structural conditions of race-, class-, and genderbased discrimination limiting their accessibility to formal economic resources and increasing the likelihood of experiences of generational poverty (corcoran, 1995). in a study examining ea survivors’ use of informal economic resources, pyles (2006) found that poor, incarcerated women, who were disproportionately african american/black and latina/hispanic, more frequently relied on money and gifts from family, payday loan services, pawning items, selling blood or plasma, and illegal informal activities such as writing bad checks, while white women were more likely to use credit cards to access resources. the findings from these studies illustrate the importance of using an mslc perspective to illuminate the links between the structural context of economic marginalization and exploitation and its intersections with interpersonal ea in the lives of women of color living in poverty (sokoloff & dupont, 2005). an mslc analysis of ea in the lives of poor women of color alerts scholars and practitioners to recognize the ways in which oppressive structures such as patriarchy and poverty shape cultural contexts and impact the incidence of ipv-ea and its economic christy and valandra/a multi-systems life course 86 consequences in marginalized communities. within this context, symbols of safety (police authorities, criminal justice) in one community can be experienced as symbols of oppression in another and result in barriers to service utilization (campbell et al., 2008; renzetti, 1998; sokoloff & dupont, 2005). for example, in an examination of cultural context in the experiences of african american women ipv survivors, researchers found that women’s concerns about further economic strife in their families associated with the possible incarceration of male abusive partners influenced their decisions regarding whether to report violence to police authorities (campbell et al., 2008). the symbolism and meaning women of color give to the systematic incarceration of men of color has significant implications for addressing ea through culturally responsive, oppression sensitive practice. the application of the mslc perspective, thus, also entails a critical assessment of how service delivery systems intended to support survivors of ea and violence may be structured in ways that perpetuate cultural barriers, stereotypes, and discriminatory treatment of women of color (valandra, 2007; west, 1999). ten different tactics of abuse, including ea, were found in a study investigating how particular structural-, cultural-, and community-level factors, influenced specific abuse tactics experienced by 29 mexican immigrant women recruited from two geographically diverse sites (kyriakaskis, dawson, & edmond, 2012). the abuse tactics employed by husbands were inextricably linked with cultural expectations of married mexican women and reflected patriarchal expectations of women in mexico (kyriakakis et al., 2012). ea in this study consisted of economic deprivation, the prevention of women from working, taking women’s paychecks, and allotting them allowances. consistent with mslc’s emphasis on social change, domestic violence researchers who promote the examination of the intersections of structural and interpersonal factors on women’s experiences of ipv and ea also argue for the importance of interventions that not only address women’s specific needs, but also challenge cultural and structural conditions that can fuel ea (sokoloff & dupont, 2005). critiquing current practice interventions from an mcls perspective literature on ea in the united states is sparse; however, a few articles do discuss direct and policy practice interventions. most of the current interventions involve the (1) use of the power and control wheel (pcw; christy-mcmullin, 2011), (2) provision of financial literacy and empowerment education, with emphasis on the applicability (hahn & postmus, 2014), and (3) use of individual development accounts (idas) developed specifically for survivors of ea (see table 2 for a summary of recommendations for each intervention; hahn & postmus, 2014). figure 1. mslc analysis of wage-gap influence on ea risk •historical devaluation of women and women's work •cultural norms and ideologies devaluing women's roles and accessiblity to viable wages •inadequate equity policies •less tax money to fund national budget and societal needs macro-level (society) •economic vulnerability •poor community resources •lower tax revenue •inadequate public education funding and quality •unemployment and underemployment mezzo-level (communities and households) •economic vulnerability •increased vulnerabilty to ea •low graduation rates •low educational outcomes •generational poverty •poverty in retirement •inability to pay bills •lower wages •incarceration •increased stress, health problems •premature, preventable death micro-level (woman and children) christy et al./a multi-systems life course 88 power and control wheel developed in the mid-1980’s, the pcw intervention tool explicitly identifies eight abusive strategies employed within a context of a larger system of abuse (domestic abuse intervention programs, 2011). the abusive tactics identified on the pcw include using (1) intimidation, (2) emotional abuse (3) isolation, (4) minimizing, denying and blaming (5) threatening to take children, using them to relay messages, (6) male privilege, (7) economic abuse and (8) coercion and threats (domestic abuse intervention programs, 2011). the pcw is based on data collected from female survivors over several months and has been translated into more than 40 languages (domestic abuse intervention programs, 2011). the pcw allows practitioners to help clients determine, and sometimes come to terms with their situation, while also clearly defining abuse as a way that an abuser attempts to control or limit the victim. it can be useful in helping survivors break through a pattern of denial and minimization about abusive patterns of behaviors (christy-mcmullin, 2011). ea is clearly identified as one of the eight strategies listed in the pcw’s larger system of abuse (domestic abuse intervention programs, 2011). since the creation of the original pcw, numerous other wheels have been adapted in recognition that women’s social location in relation to the environmental context influences their experiences and responses to ea such as the equality wheel (domestic abuse intervention programs, 2011), lesbian gay bisexual transgender (lgbt) wheel (nw network, n.d.), teen dating violence wheel (national center on domestic and sexual violence, 2017) and economic abuse power and control wheel (eapcw; arizona coalition to end sexual and domestic violence, n.d.). like its predecessor, the eapcw has eight categories of abuse operationalized; (1) legal issues, (2) employment and workplace, (3) finances and credit, (4) child support, (5) welfare, (6) housing, (7) child care, and (8) education and training (arizona coalition to end sexual and domestic violence, n.d.). as with the original, the eapcw can be used to help allies, survivors, and offenders to better understand the tactics of ea. the prevalence of utilization and the development of other pcws suggest it is an effective intervention. however, the authors could not find research to support this assumption. nevertheless, it is worthwhile to analyze the eapcw from a mslc perspective to potentially expand the interventions that are used with it. advances in social work, spring 2017, 18(1) 89 table 2. practice recommendations relevant to economic abuse mslc application practice implications power & control wheel 1. consider the historical/political/ social context of ipv-ea 2. recognize meanings, values and assumption around ea, finances and women’s roles 3. assess impact of current life trajectory on self and others 4. acknowledge and work with the many systems involved and impacted by ea 1. use the eapcw along with pcw 2. provide client-centered training on ea and the eapcw 3. use cognitive-behavioral therapy to challenge woman’s sense of selfagency; make explicit the role of culture, privilege and oppression 4. discuss trajectory of the woman, her children and family 5. work with various systems to bring about social change 6. develop appropriate system for timely referrals financial literacy education 1. consider the historical/political/ social context of finances, work and women 2. recognize meanings, values and assumptions around ea, finances and women’s roles 3. assess impact of current life trajectory on self and others 4. acknowledge and work with the many systems involved with and impacted by ea and the lack of financial literacy 1. adequately fund programs specifically for survivors of ipv-ea, e.g., reap and mafm 2. change perceptions and expectations around finances and women 3. provide financial literacy education to frontline workers 4. engage multiple systems, e.g. workplace or religious community, in providing financial literacy education 5. train frontline workers on how to present culturally relevant financial literacy education to their customers 6. advocate for social and economic justice reforms that affect conditions of poverty, racism, sexism, and homophobia 7. conduct oversight and evaluation of the fvo’s implementation financial asset building 1. consider the historical/political/ social context of assets and ipv 2. recognize meanings, values and assumptions around ea, financial assistance, economic security and assets 3. assess impact of asset accumulation on the trajectory on self and others 4. acknowledge and work with the many systems involved with and impacted by ea and assets 1. adequately fund ida programs for survivors of ipv-ea with vawa funding 2. change perceptions and expectations around financial assistance and ea 3. provide ea training to ida providers/administrators to create culturally relevant programming to their customers 4. advocate for social and economic justice reforms 5. conduct oversight and evaluation of ida program implementation advances in social work, spring 2017, 18(1) 90 a first step would be for direct practice practitioners to specifically use the eapcw instead of relying solely on the original pcw. while using this wheel, practitioners can explore the historical context of financial knowledge, decision-making processes and resources, ipv and ea, along with the meaning made of these concepts by the women, their families of origin, their current family structure, members of the larger community, and their hopes for the future. further application of mslc is an assessment of the family’s life course trajectory to understand the specific manifestations of ea within the family system. making explicit the role of culture and ascribed meaning should also include a discussion of how the woman perceives herself and her self-agency. with this, practitioners should be aware of and introduce such concepts as privilege and oppression. intermingled within this assessment should be conversations about how different systems have been and may be impacted in the future given the status quo, as well as the systems that can provide support and resources to the woman, her children, and her partner. it is not enough to merely understand this impact, but social workers using mslc would also consider interventions that change the status quo. to better explicate the application of a mslc perspective, we will take one of the tactics from the eapcw, ‘employment and workplace,’ (arizona coalition to end sexual and domestic violence, n.d.). to provide more specific examples of assessment and interventions. we must consider not only the many systems (e.g, legal, state agencies, employers, religious, and/or family) impinging upon the woman, but the meanings and values held by the woman, her family, and various systems. some of the negative assumptions might include: women should not be in the workforce; women are not as reliable in the workforce as men; poor women and women of color are lazy and do not want to work; staying home to take care of others is not really work particularly when talking about women of color and low-income women because middleand upper-income and white women have been allowed, even encouraged to work in the home; women enjoy/deserve abusive relationships; women can leave the abusive relationship if they so choose and if a woman left her abusive partner the abuse would stop. assessing the different meanings and values held can shape how much or little power/influence each of the various systems has on the woman across her work life. while these various systems may not always agree, some may have more power/influence. for example, lawmakers have the power to support or oppose laws that provide more employment resources and support for women who are experiencing ea, and laws mandating equal pay for women and increasing the minimum wage. regardless of public policy on these issues, employers have the ability to incorporate these policies into their organizations. the status quo benefits those who hire women at a lower wage rate; however, not addressing economic abuse, women are less able to be productive due to ea, which costs the employer more money. interfering with the work trajectory of a woman has severe consequences in the present for herself (e.g., stress, health problems, inability to pay bills and homelessness), her children (e.g., lack of access to a good education and educational materials), and society (she will be paying less into the tax system). her future (e.g., poverty in retirement) and those of her children (limited educational and employment as adults) and society (less money paid in taxes results in less public revenue) can be negatively impacted as well. advances in social work, spring 2017, 18(1) 91 hahn and postmus (2014) noted that women often feel ostracized from using social services because workers are untrained in how to work with women experiencing ipv. from a mslc perspective, client-centered training regarding survivors of abuse is a necessity in state agencies like the division of children and family services that see ipv on the frontline most often. one intervention could be to standardize the use of the pcw and eapcw. these wheels provide enough examples of abusive behaviors and control tactics used by abusers that they can be used and adapted by advocates. additionally, therapists using cognitive-behavioral therapy can use the wheels to facilitate a better identification of behaviors and understanding of the client’s thoughts and feelings about those behaviors and an avenue to reframe labels and stigma (symbolic interactionism). furthermore, the eapcw can be used to assess the depth of economic abuse and can be highly useful for practice with ea survivors in (1) helping them understand key tactics used to keep women in abusive relationships (social change), (2) helping them develop strategies to address financial needs (systems) and (3) pointing to potential goals a woman might want to set for herself (life course). the eapcw can also be used to train service providers and to increase public awareness of ea (christy-mcmullin, 2011), whereby a system of referral (thereby changing the status quo) could be designed and used to provide connections to culturally appropriate services in an improved period. financial education and literacy the purpose of financial education is to increase one’s financial literacy, which is “the ability to discern financial choices, discuss money and financial issues without (or despite) discomfort, plan for the future, and respond competently to life events that affect everyday financial decisions” (vitt et al., 2000, p. xii). the u.s. department of treasury, social security administration, and obama administration showed an understanding of the interconnection between financial literacy and ipv for girls/women (gjertson, 2011). however, it is important to move beyond traditional perceptions that financial literacy education alone will change behaviors/outcomes (hawkins & kim, 2012). knowledge alone may not change behavior/outcomes and focusing on financial literacy education as a solution has the potential to victim-blame by implying that “financial literacy alone can produce long-term change in consumer financial markets and absolve public and private entities of their responsibilities” (hawkins & kim, 2012, p. 194). therefore, changing structural barriers, such as low-paying jobs, lack of high quality childcare (fine & weis, 2000) and lack of safe, affordable housing should go hand-in-hand with financial literacy education. turning first to financial literacy education, as demonstrated by a 2014 study conducted by the world bank, gallup, and george washington university, almost half of the u.s. adult population (43%) is financially illiterate (mcgrath, 2015). further, only 52% of women in the u.s. are financially literate, compared to 62% of men (standard & poor, 2015). without economic empowerment (financial knowledge and skills), women suffering from ea may experience less economic self-efficacy and face more challenges in becoming financially self-sufficient (adams et al., 2008). given that economic dependence on their partner is one of the main reasons women remain in abusive christy and valandra/a multi-systems life course 92 relationships (sanders, 2011), providing programs that increase women’s financial literacy may increase economic self-efficacy (hahn & postmus, 2014). reap and mafm literacy programs. two research-supported financial literacy and economic empowerment education courses described by hahn and postmus (2014) are “realizing your economic action plan,” (reap) and “moving ahead through financial management” (mafm). both are designed to empower women before, during and after the process of acknowledging ea in their relationship, and potentially leaving an abusive relationship. the programs seek to educate in such a way that women who are afraid to leave abusive relationships because of limited financial resources, employability, and economic prospects learn the steps to take to strengthen their financial competency, making an escape from an abusive relationship more possible (hahn & postmus, 2014). to do this, reap has developed a 12-hour curriculum across five economic facets. these facets are: (1) money and power, (2) developing a cost-of-living plan, (3) building and repairing credit, (4) banking and investing, and (5) oppression and economic abuse. hahn and postmus (2014) found that women in the reap group had statistically significantly higher scores on financial self-efficacy than did the control group. additionally, the program respondents reported they had learned new financial knowledge from the classes. a collaborative effort, allstate foundation and the national network to end domestic violence created the mafm program (hahn & postmus, 2014). its curriculum focuses on: (1) economic abuse and relationships, (2) financial fundamentals, (3) building a financial base, (4) creating long-term financial success, and (5) financial strategies for immigrant and refugee women (hahn & postmus, 2014). a pre-test/post-test non-experimental design was used and findings indicate significant increases in women’s financial literacy, economic empowerment, economic self-sufficiency, and economic self-efficacy. additionally, 88% of participants could clearly identify signs of economic abuse, 88% had developed financial goals after the course, 76% had developed a budget, 71% had taken steps to start paying off debt, 64% had accessed records of their credit history, and 22% started a retirement account. in-depth analysis showed that participants’ heightened levels of financial literacy and economic self-efficacy predicted economic empowerment (hahn & postmus, 2014). applying a mslc perspective to financial literacy of women who experience ea involves an assessment of symbols; traditions; life trajectories; historic, social, and political contexts; diversity and culture; systems and resources, as well as a call for social change. as discussed previously, women are less likely to be financially literate than men. this may be in part such symbolism as men being the “head” of the household and/or the “primary breadwinner,” as well as an assumption that men should make the financial decisions in the family. as for low-income individuals and families, public misperceptions that low-income families do not need financial education may contribute to the 17% gap in financial literacy between the wealthiest 60% and poorest 40% of households in the u.s. (standard & poor, 2015). changing these perceptions and expectations is critical because financial literacy “shapes the life course in other, extended ways by enhancing access to investment income, asset accumulation and asset protection” (vitt et al., 2000, p. xiii) for advances in social work, spring 2017, 18(1) 93 women and their children. additionally, it must be recognized that the type of information needed regarding finances changes over the course of people’s lives to assist with transitions and life trajectories. two federal policies created to specifically address ipv are violence against women act of 1994 (vawa) and an amendment to the personal responsibility and work opportunity reconciliation act (prwora) of 1996, the family violence option (fvo) of 1996. one intention of vawa was to create opportunities for economic empowerment for women surviving ipv by allocating funds for services and further research to determine appropriate practices for intervention. however, according to hahn and postmus (2014), vawa has largely failed in that regard, with limited rental housing opportunities being the only services consistently funded by the legislation and focus instead being largely shifted to criminalization of abusers. johnson (2015) argues it has led to a focus on safety (short-term goal) rather than security (long-term goal). similarly, the explicit goals of the family violence option (fvo), (1) screening for intimate partner violence, (2) providing appropriate referrals in cases of ipv and (3) waiving time limits and work requirements of women experiencing ipv, are not being met (lindhorst & padgett, 2005). the fvo and vawa are examples of policies that could be augmented to provide specialized, culturally responsive services to economically empower women who experience ea. department of children and family services (dcfs) workers are oftentimes the front-line for ipv intervention. however, they often the lack knowledge of or ability to uniformly implement this policy, which results in the services, waivers and extensions allowed by the policy not being provided to eligible recipients (an, yoo, & nackerud, 2015). advocacy and promotion of the fvo as required national policy is needed to promote an effective and consistent system of implementation for the fvo. in addition to changing the fvo from an optional to a required policy, it will be important that (1) state workers receive ongoing training, (2) accountable oversight of the policy’s implementation is established and maintained, and (3) regular evaluation of the implementation of the fvo occurs. the on-going culturally-responsive training of state workers would especially benefit poor and women of color who are largely represented among service recipients of state welfare programs and ea. additionally, culturally-responsive financial literacy training for frontline community and state workers will enable them to provide specific case management services for women who want to leave abusive relationships, but do not have sufficient economic prospects such as employability, access to financial education, stable credit, or other assistance options. workers need to learn how to identify ea correctly and understand general mechanics of it, allowing for the development of a system of referral that can be used to provide connection to culturally-appropriate services in an improved timeframe. the training should also include content on how to advocate for social and economic justice reforms within the system that affect conditions of poverty, racism, sexism, and homophobia (christy-mcmullin, 2011; coker, 2000; richie & kanuha, 1993). in order to provide resources that will enhance individual women’s economic empowerment, workers need to receive financial literacy education training. this will increase both their own financial literacy and provide them with firsthand knowledge of issues clients may face (christy-mcmullin, 2011). christy and valandra/a multi-systems life course 94 other systems, such as workplaces, could help increase the financial literacy of the public by offering financial literacy training. the workplace is a good location for many individuals, with the rewards being “mutually beneficial for both employer and employee. we urge many more employers to offer personal finance courses… and we support public policy initiatives that offer incentives to those employers who do” (vitt et al., 2000, p. xvii). other systems, such as faith-based or community organizations (vitt et al., 2000) can be important resources in providing financial education. another useful strategy would be to target specific populations for financial literacy education. one example is domestic violence agencies since women who access them “are one of the many groups that could benefit substantially from financial education programs, especially those that meet their unique needs by providing content on economic abuse and economic safety plans” (postmus, p. 1, 2011). as noted by sanders, “low-income women [also] face significant challenges to building financial security, as they often lack resources, knowledge, and access to financial services” (2011, p. 1). developing financial assets historically, researchers have equated economic security with employment and/or income (christy-mcmullin, 2002). however, in the past 30 years, some scholars have begun to advocate for the importance of including financial assets in our definition of economic security (johnson, 2015; sherraden, 1988). in a review of the literature, pageadams and sherraden (1997) found financial assets have a positive relationship with psychological well-being, physical health, life satisfaction, and child well-being. they also report a negative correlation between assets and economic strain, alcoholism, and depression. while there have been few studies to examine the relationship between asset ownership and ipv (hahn & postmus, 2014; sanders, 2014), two studies indicate a negative relationship between owning a home and ipv (christy-mcmullin & shobe, 2007; peterson, 1980). in his groundbreaking book, assets and the poor, sherraden (1991) proposed a change in policy that would create individual development accounts (idas) to assist low-income workers with building financial assets. his rationale, in part, is that the united states has a long history of upperand middle-income earners benefiting from a redistribution of public funds to support their asset-building activities, such as homeownership and retirement accounts. however, public support for providing similar help to low-wage earners has been slow (murphy-erby, jordan, shobe & christy-mcmullin, 2009). opponents of idas typically espouse the beliefs that low-income workers are poor due to their inability or unwillingness to manage their money properly (murphy-erby et al., 2009). consequently, while most are not concerned with significantly more public funds going to middleand upperincome earners, as well as large corporations, the same support for subsidizing lowwage earners is minimal (christy-mcmullin, 2000). one of the goals of ida policy is to provide more social and economic justice to the working poor (murphy-erby et al., 2009). publically subsidized idas were first created through the assets for independence act (afia) of 1998, and are designed to help low-income persons attain and maintain assets to develop a long-term sense of economic well-being (hahn & postmus, 2014). most programs also offer a financial literacy component. many states have implemented idas advances in social work, spring 2017, 18(1) 95 using “savings” from their temporary assistance for needy families (tanf) funds. during the first 10 years of afia, over 600 ida programs have been funded, with more than 60,000 idas opened nation-wide. idas use a match-ratio to match contributions made by account holders, up to $20,000 yearly in some states (hahn & postmus, 2014). ida programs have the potential to counteract the tactic used by abusive partners to “isolate women from financial resources and engage in antics that prevent women from gaining economic independence” (sanders, 2011, p. 1). additionally, asset accumulation may (1) decrease a woman’s vulnerability to ipv-ea and (2) provide a woman more options if she experiences ipv (christy-mcmullin, 2000; johnson, 2015; sanders, 2011). asset-building programs, such as idas, have been minimally used in the field of ipv to help empower impoverished survivors of ea (hahn & postmus, 2014). while little research has been conducted on the success of idas for ipv survivors (hahn & postmus, 2014), sanders and schabel (2008) found that in less than four years, 75 participants saved, on average, $845. each woman received a match of approximately $1,573. they were able to use their funds to pay for such assets as (1) vehicles and registration, (2) post-secondary education, (3) home repair and (4) home purchase. in a later study of 125 ipv survivors, sanders (2014) found that ida participants saved on average $1,310 (median $1,500) over a 2.5-year period. coupled with the matched deposits and earned interest, the women had an average savings of $3,041 and a median savings of $4,394. as with the pcw and financial literacy education, application of mslc to asset development is complex and comprehensive. attitudes about welfare and financial assets need to be challenged at multiple levels; individual, family, community, and government. while most of the public understand that welfare is the transfer of public funds from one group to another, a large segment do not understand that policies such as tax breaks and deferments are not only welfare, but also that the majority of these transfers go to middleand upper-income workers and large corporations (sherraden, 1991). proponents of multicultural interventions to address ipv and ea argue that policy reforms must be tailored to the diverse needs of marginalized women whose experiences of ea are often exacerbated by structural economic and social conditions and inequities (dasgupta, 1998; richie, 2000). expanding the number of ida programs of survivors of ipv-ea, and having them administered by staff with training in ipv-ea, would help remedy some of these conditions and inequities. to do this, modifying vawa (1994) to include administrative and evaluation costs, as well as matched funds for ipv idas has the potential to increase the number of ida programs designed specifically for survivors of ipv-ea. along with increased funding, policymakers and practitioners need to be aware of cultural issues that may exist when women attempt to save money for themselves. for example, money and property may not be viewed as belonging to an individual or family, but rather to the community (hawkins & kim, 2012). consequently, joining an ida program in which individuals save money for themselves to purchase an asset for themselves may be viewed as disrespecting cultural norms. such individuals may experience pressure to share their money rather than depositing it in an ida (hawkins & kim, 2012). allowing community-held assets as an approved use of money from an ida may be one solution to this conundrum (jorgensen & morris, 2010). additionally, women experiencing ea often have financial needs beyond the approved purchases of home or christy and valandra/a multi-systems life course 96 business ownership, such as transportation, quality childcare, healthcare (johnson, 2015), and/or hiring a lawyer. restricting allowable purchases only reinforces patriarchal assumptions that women are not able to make good decisions on their own (johnson, 2015). conclusion the use of a mslc perspective to illuminate the importance of ea as a significant form of ipv-related trauma offers social workers an integrated, multidimensional approach of assessing, intervening, and preventing ea across all systems of direct, policy, and social justice practice. additionally, specific strategies for addressing ea-specific ipv can be more effectively tailored to meet the diverse and intersecting needs of women based on their differential experiences relative to their sociocultural identity within the larger community and society as well as the specifics of their family life course trajectory. additionally, a mslc lens facilitates the use of the eapcw as a more effective assessment and intervention tool for practice with survivors, offenders, and secondary ea trauma survivors as well as a training tool for practitioners providing services across all systems of practice. social workers should consider the complexity and interplay of power, privilege, and oppression within the context and roles of historical, cultural, and societal structures, norms, and scripts that place women at risk for ea. as such, social workers are better equipped to provide integrative, culturally inclusive, oppression-sensitive ea services that meet the needs of multiple levels of the practice landscape including direct practice, policy advocacy, community development, and structural systems change. references abramovitz, m. 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assistant professor, department of sociology and social work, university of portland, portland or. gita r. mehrotra, phd, msw, associate professor, school of social work, portland state university, portland or. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 311-330, doi: 10.18060/24095 this work is licensed under a creative commons attribution 4.0 international license. interrupting white supremacy in field education: experiences of microaggressions in placement settings anita r. gooding gita r. mehrotra abstract: as social work’s signature pedagogy, field education socializes students into their professional roles as practitioners. however, for students and field instructors of color, racial microaggressions add another dimension to the practice experience. utilizing findings from a qualitative study exploring the experiences of black, indigenous, and people of color (bipoc) social work students and agency-based field instructors, this paper highlights experiences of microaggressions in field placement settings. specifically, bipoc students and field instructors described being tokenized in agencies, feeling invisible in placement settings, experiencing microaggressions from service users or students, and witnessing microaggressions. experiences of microaggressions had emotional impacts, and affected participants’ sense of professional identity and confidence. based on findings, we share recommendations for addressing racial microaggressions within social work field education in order to promote racial equity, including: grounding microaggressions in an ecological approach, unpacking the concept of professionalism, and building capacity of field instructors and agencies to respond to racism and microaggressions. addressing microaggressions in field education is necessary to support bipoc students in field placements, honor the work and well-being of racialized social workers who serve as field instructors, disrupt white supremacy, and move the social work field forward in regard to anti-racist practice. keywords: field education, microaggressions, racism, field instructors, students of color while the field of social work has long held social justice, diversity, and valuing individual differences as central tenets of the profession, given the history of social work and its current manifestations, racism and white supremacy are still woven into the fabric of the field. as social work educators committed to racial, social, and economic justice, attention to the ways that racism operates within social work education is paramount. white supremacy holds whiteness as the default standard to which all other groups are compared. through this lens, racism is explicitly and implicitly imposed upon communities of color. sue (2006) notes that whiteness is the color standard that “racial/ethnic minorities are evaluated, judged, and often found to be lacking, inferior, deviant or abnormal” (p. 15). sue (2006) goes on to say that in order to minimize racist forces, whiteness must be made visible. taking the position that whiteness, white supremacy, and racism must be made visible and disrupted within social work education, in the discussion that follows, we specifically explore experiences of racial microaggressions in field education. given that field is a core component and signature pedagogy of social work education, understanding race in field placement settings is critical to addressing issues of race and equity in the curriculum, and is needed to realign our anti-racist practices as a field. about:blank advances in social work, summer 2021, 21(2/3) 312 in the discussion that follows, we use the term black, indigenous, and people of color (bipoc) to reference groups who have faced historical marginalization due to race, and to acknowledge the particular ways black and indigenous communities have been affected by white supremacy, which has then shaped how other racialized groups have been treated in the united states (bipoc project, n.d., para. 2). this project upholds and is informed by the tenets of critical race theory (crt) which asserts that racism is a well-established part of society and given its deep entrenchment within customs, experiences, and structures of society, racism should be viewed as central to human experience (crenshaw et al., 1995; solórzano & bernal, 2001). in addition, society racializes different groups differently depending on labor market needs and to establish political dominance (taylor, 2009). processes of racialization serve to ascribe a racial identity to particular groups for the purpose of continued exclusion, oppression, and marginalization. due to differential racialization, groups that are considered “outsiders” have decreased access to resources and opportunities (constance-huggins, 2012). therefore, in addition to bipoc we also use the term “racialized” to refer to individuals who have been categorized/racialized as non-white by society-at-large. critical race theory explains that racist forces must be resisted by rejecting standards and institutions which uphold white power (bell, 1995); thus, resisting white supremacy in social work education requires a close look at microaggressions which operate as a site of racism and white supremacy. attention to these issues is necessary to further our understanding of race and equity in social work curriculum and to truly center anti-racist education and practice. microaggressions chester pierce, one of the first practicing black psychiatrists at harvard university medical school, is credited with coining the term “microaggressions” based on his experiences treating black patients (pierce, 1970). decades later, particularly over the past 15 years, a proliferation of research on racial microaggressions has taken place across disciplines. today the most commonly used definition of microaggressions is based on the work of sue et al. (2007): “brief and commonplace daily verbal, behavioral and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults to the target person or group” (p. 273). while pierce and sue et al.’s work initially focused on racial microaggressions, over time the discourse and research has expanded to include microaggressions related to sexual orientation, religious identity, mixed race identity, gender, and ability (see nadal et al., 2016; sue, 2010; sterzing et al., 2017). this body of work has provided an important intervention into racial justice discourse by validating and providing language for every day, interpersonal, and nuanced forms of racism and oppression that are experienced on a regular basis by marginalized groups. smith (2008) states that racially stigmatized groups often deal with racial battle fatigue as a result of pervasive microaggressive insults. these repeated acts of microaggression cause psychosocial, physiological, and behavioral stress reactions for people of color across contexts. microaggressions are now widely understood as causing psychological, physical, and social harm (wong et al., 2014). gooding & mehrotra/interupting white supremacy 313 although it is often assumed or implicit, it is important to name that microaggressions are linked to and reflective of the larger socio-political context and structural conditions of racism. though they can be small everyday acts, microaggressions have significant causes and impacts, and serve to maintain racism and inequity. in recent years, the social work literature has been attentive to the experiences of microaggressions on marginalized populations (including recent special issues of the journal of ethnic and cultural diversity in social work in 2017-2018). this work embodies social work values and takes an ecological approach as it demonstrates keen appreciation of microaggressions as embedded within social context and macro-level structural racism. while some of this literature has focused on microaggressions in the social work classroom (see hollingsworth et al., 2018; pérez huber & solorzano, 2018; spencer, 2018; wong & jones, 2018) to date there is no research that specifically examines the experiences of, and interventions for, racial microaggressions in field education settings. race and field education while there is a paucity of literature on race and field education generally, we do know that bipoc students often encounter race-related barriers in field placement interviews, during supervision, and while building relationships with agency staff (razack, 2001). in addition, bipoc social work students have shared that they struggle to have cross-cultural conversations with their field instructors around race-related issues, and experience racial tensions at their placements (daniel, 2007). social work practitioners in the field are also witnessing and experiencing microaggressions. in a recent qualitative study, weng and gray (2020) interviewed 30 practicing service providers regarding their perceptions of microaggressions in social service settings. participants shared that racial microaggressions were pervasive in practice and evident in the ways bipoc clients were treated, especially when their cultural preferences and knowledges were disregarded. additional microaggressions reported by service providers included ways service users were stereotyped and blamed for their circumstances. it is clear that race-related issues and microaggressions exist in practice contexts, and thus have an impact on the experiences of both students and field instructors. white supremacy and professionalism white supremacy holds whiteness as the default standard to which all other groups are compared, including in a professional context. in the workplace, white supremacy culture explicitly and implicitly privileges whiteness and may discriminate against non-white professionalism standards (gray, 2019). as social work’s signature pedagogy (council on social work education, 2008), field education offers a unique site to view how white supremacy operates within both social work education and in agency settings, because it is the site where students are socialized into their professional identities and roles as practitioners. advances in social work, summer 2021, 21(2/3) 314 while today the concept of professionalism is often taken for granted in social work, over 100 years ago, abraham flexner claimed social work did not meet the criteria necessary for professions: intellectual with high individual responsibilities, material collected through science and learning, practical techniques taught through education, selforganized, and increasingly altruistic (flexner, 1915). flexner’s impact created the development of social work associations, standardized curricula (which now include courses on research), and the creation of a specific social work method (austin, 1978). during this time, mainstream social work centered on settlement houses and supports for white immigrants and migrants (berman-rossi & miller, 1994). however, racialized immigrants had to develop their own agencies to address social service needs; especially since racism and cultural barriers impeded any chance of assimilation into mainstream american culture. mexican immigrants created informal kinship groups, or mutualistas, to enhance cultural identity and political strength (reisch, 2008). these groups were not about assimilation but offered cultural activities alongside legal and economic assistance. for chinese immigrants, most of whom were men, associations focused on housing and small business loans. reisch (2008) notes, “isolated and seemingly self-sufficient, these developments in asian and latino communities were virtually ignored by white social workers for decades” (p. 793). meanwhile, reformers in the black community advocated for funding from white benefactors. using the terms “racial uplift instead of equal rights” (hounmenou, 2012, p. 653), black female reformers created black settlement houses. these houses offered space for black activism, training, education, recreation, and more (hounmenou, 2012). social work has since progressed to be more inclusive, yet implicit discourses about who is considered a professional social worker and who is not continues today;-these ideas are grounded in a color blind approach which assume race does not impact practice. badwall (2015) contends that the social work discipline has struggled to accept race and racism as central to the practice experience of bipoc social workers because it assumes that an acknowledgement of race will detract from an objective and “professional” social work practice. badwall (2015) posits: racialized workers cannot be seen as liberal, moral subjects when racism is named, as the very naming of racism disrupts both the ideals of the profession and the neoliberal underpinnings of the state. being seen as moral subjects requires an erasure of race, which is impossible for racialized people. (p. 19) in other words, badwall highlights the unspoken tension between being a racialized person and the stated ideals of the social work profession, which does not always acknowledge the ways race, racism and white supremacy affect the social work practice landscape or how professional identity is viewed and experienced. drawing from qualitative research conducted with bipoc students and field instructors, we use participant narratives to illustrate some of the dimensions of microaggressions experienced in field settings and their unique impacts. we then follow with recommendations for addressing microaggressions in order to improve field education experiences for bipoc students and field instructors, and to promote racial equity within this critical part of social work education. gooding & mehrotra/interupting white supremacy 315 overview of the study the discussion presented here is emergent from a larger project exploring experiences of social workers of color. this two-pronged study was focused on how bipoc students (msw and bsw) and field instructors make meaning about their experiences in field education. while a fuller discussion of our design and methods is detailed elsewhere (mehrotra & gooding, in press), we offer a brief overview here to provide context for the discussion regarding microaggressions that follows. research design in this study, we conducted semi-structured interviews with bsw and msw bipoc students who had completed at least two quarters (20 weeks) in their internships, and held both focus groups and interviews with field instructors who provide supervision to social work students in community settings. in order to be eligible to participate, students and field instructors had to identify as black, indigenous, and/or people of color, including: black/african american, native american/indigenous/american indian/alaska native, asian/asian american; arab/middle eastern, hispanic/latinx/chicanx, or mixed race/multiracial. study sample the sample consisted of 42 bipoc students–27 msw, 15 bsw–and 24 bipoc field instructors. the sample reflected demographics of communities of color in the region and in the west coast public university where the research took place, particularly in regard to gender, racial/ethnic background, and age. of the sample, 24 students self-identified as latinx (including self-identification as: latino/a, mexican, mexican-american, hispanic, “brown”), 10 as mixed race/multiracial (including: african american/native american, vietnamese/white, multiracial/african american, latino/mixed race), five as asian/asian american (including chinese american, south asian, filipino, asian american), two as african american, and one as native american. thirty-three participants identified as women, eight identified as men, and one participant identified as non-binary. for the 24 field instructors, data were collected from three focus groups (with 12 participants total) and 12 individual interviews. within the sample, 11 field instructors identified as african american/black, four as latinx (including latino, mexican american, “brown”), five asian/asian american (asian/korean, asian indian, vietnamese) and five multi-racial/mixed race (native american/white, biracial, multiracial, native hawaiian/japanese, asian/white, black/white). seventeen field instructors identified as women and seven identified as men. as a whole, field instructors had a significant amount of practice experience (ranging from eight to 37 years). across both students and field instructors, a range of field settings were represented, including: healthcare, schools, mental health, culturally-specific agencies, state agencies and community-based organizations. advances in social work, summer 2021, 21(2/3) 316 data analysis interview and focus group questions focused on motivations for becoming a social worker (and/or field instructor), experiences in field placements (including within agency settings, with the university, and with clients), and experiences with supervision. given the exploratory nature of the study, thematic analysis was used to make meaning of student and field instructor narratives. the data were analyzed by the authors who engaged in consistent peer debriefing about emergent themes and meanings. as two bipoc researchers who have a personal and professional relationship to field education, the authors engaged in a consistent reflexive appraisal process to account for bias or gaps. this process included memo-writing and peer debriefing throughout the analysis process (padgett, 2008). microaggressions in field settings across interviews, two types of microaggressions were consistently shared by participants: a feeling of being tokenized (i.e., being included or singled out as a person of color to promote the illusion of inclusion and/or to represent one’s racial/ethnic group, but not for one’s individual qualities; hired to appear that the organization supports diversity but not to actually change the culture or promote equity within the organization, etc.), and invisibility or “not being seen” in the placement context. students shared their experiences with direct microaggressions from clients as well as colleagues, and also noted the indirect experience of witnessing microaggressions within their agencies; particularly seeing microaggressions directed toward clients. in their narratives, many participants discussed the salience of context in understanding racialized dynamics and harm that they experienced in placement settings. for example, several students highlighted that even if they did not directly experience racial microaggressions, the perception of white privilege and lack of consciousness about race and racism in their field site impacted their sense of safety and their ability to speak openly about racialized experiences. one student shared specifically about hearing her field supervisor and other staff explicitly minimize and ridicule the concept of white fragility, which the student felt set the tone for what she could and could not talk about in her placement with regard to race. these contextual experiences shaped bipoc students’ experiences, regardless of whether or not students experienced microaggressions explicitly. in the discussion that follows, pseudonymous have been used to maintain participants’ anonymity. being tokenized both students and field instructors voiced that they sometimes felt tokenized as a person of color in different ways in the field education process. this was also complicated as participants understood the importance of their presence as racialized social workers to make change in the field or agency, but also felt the negative impact of feeling like the token person of color. gooding & mehrotra/interupting white supremacy 317 one msw student talked about being expected to speak for all latinos or being asked to work with latinx clients even when they were not the most skilled social worker for the clients’ needs: i get kind of tokenized….like if they have a question about anything about latino population it comes to me and i kind of feel like i speak for that [...] so i think sometimes they assign me cases based on the culture, but they’re not giving the client the best treatment possible. – msw, latinx, female another msw student reflected on being specifically held up in his placement setting as an “exception” – a particular form of tokenization: “i’ve been told twice that i’m one of the good mexicans or i’m one of the mexicans that is making this country better not worse.” – msw, latinx, male field instructors (fi) also discussed being tokenized, both by the social work program and by students. one asian american field instructor who has served in this role for many years spoke to this: “one of the challenges that i have faced is sometimes i feel like i'm being asked to be a field instructor because they want to have someone of color to be a field instructor…” – fi, asian, female. in her narrative, this field instructor emphasized that despite this experience of tokenization, she was committed to supporting bipoc students by serving as a field instructor. another field instructor working in a healthcare setting, spoke to some of the unique dynamics of being tokenized as an african american woman (in a specific geographic and political context) by white students when they first meet her: now on the other hand, supervising students who are not people of color, that brings into who i am, what i represent to them as a black woman. and this whole ... liberalism area thing then kicks into play with initial idolizing. but idolize in a very different way from how poc would idolize me. it's idolizing me without any context really of anything about me or who i am. what you see is a skin color, and something within you tells you that you should, because it's west coast city or whatever, that you should think a certain way about me. – fi, black, female invisibility/not being seen another type of microaggressions that students discussed was numerous ways that they felt invisibilized, not seen, or not respected as a professional within their agency context. while some of these experiences were linked to their institutional role/position as an intern, there were also ways that racial microaggressions played out specifically to invisiblize racialized students. in particular, students discussed being confused with other people of color in the agency, people in the organization not remembering or acknowledging them, and not being viewed as the social worker. several students talked about being confused with other bipoc individuals in the organization. for example, one bsw student in a school-based setting shared, “there’s been like others of just people calling me belinda instead of susana, because belinda is the only other latina in the school. and it’s just like seriously guys? we don’t even look alike. advances in social work, summer 2021, 21(2/3) 318 come on.” – bsw, latinx, female another microaggression related to invisibility that several students talked about was the feeling that others in the agency (both clients and other staff) did not remember or acknowledge them. one student recounted an experience of being part of an interdisciplinary team and not feeling seen by the other staff: and like having people, the counselor and psychologist like ask me, ‘so who are you, what do you do?’ [...] and having that happen multiple times...it was hard to not walk out of that meeting and feel some type of way. and i think that’s happened a lot this year. like, meeting people who i’ve already met, or teachers who i’ve already met and being like, ‘so who are you again?’ [...] i feel like, there’s some dynamic of power happening there. – bsw, latinx, male another msw student talked about not being acknowledged in the lunchroom while seeing white people having a different experience: ...just going into the lunchroom with older white folks. the way they just stand there. they don’t even say hello. they don’t even acknowledge you. and then when someone else walks in the room and you notice that, i mean it might be because i’m a minority, but i notice that they’re white and they’re like ‘hey, how it’s going?’. but yet, i wasn’t…i didn’t get that kind of greeting. and so, for me, that’s just uncomfortable. – msw, latinx, female another dimension of invisibility that participants recounted was not being seen as the social worker or professional in their placement setting. one black male msw student whose practicum was in a medical setting shared about his experience of being viewed as a service user: simply my presence in the emergency department is in many cases this anomaly, where people kind of like stare at me and watch me walk through the hallway. people, for a while, assumed that i was the spouse or the partner of patients or the brother of patients. and people, doctors walked up to me and shook my hand, told me they were sorry for my loss, right or they’re sorry that i had to be in the hospital to that effect. this student continued on to share how he attempted to address this microaggression over time as a way to make himself and his role as the social worker visible: and so, what i realized was it was important for me to start and keep in mind i’m wearing a name tag, a name tag that’s attached to my chest. so, if they just look beyond my skin they will see the name tag. and so, i began to kind of step back and whenever they approached me, i would kind of just hold my hands to my side and look at them and then look directly at the patient or the client that i was working with. and after a while i would notice doctors walk toward me to kind of give me this sorry you’re here and they would look at me. and i would kind of look at my name tag. they would look at my name tag and then they would either just walk away or they would talk to the person that i was standing next to who was actually the patient. or the patient’s family member. – msw, black, male gooding & mehrotra/interupting white supremacy 319 experiencing microaggressions from service users or students in addition to racial microaggressions that were experienced in the larger agency context (i.e., from staff or colleagues), students also shared about experiencing racial microaggressions directly from clients. for example, one msw student recalled: …most recently there was a client who was like kind of agitated and he called me a gook. and i haven’t even grown up like hearing that term a lot. so, i don’t even know if i’m pronouncing it right. but i just heard it and i was like wait a second. like remembering, you know, that is not a nice word to say. [...] i’ve had a couple of clients who asked me like…this is like after a couple of minute conversation in english, they ask me like ‘can you speak english?’ – msw, asian, male another student remembered racial microaggressions she experienced from a client when on a home visit: ...i went to a client’s house with a case manager and they just kind of singled me out in the room. and we were just there to assess him [...] and he’s like, ‘well what is this mexican doing in the room?’ i was like, like i didn’t react at the moment or you know, not acknowledging it kind of and then i was like, ‘oh i’m in an intern. i’m in school, i’m doing this…’ and then like throughout the whole assessment, he just kept making like microaggressions and like ‘oh yeah, i used to work with like mexicans and then i gave up my job…’ – bsw, latinx, female bipoc field instructors also recounted experiences of being questioned by white students which felt like a racialized microaggression. one black male field instructor working for the state talked about the challenge of working with one white student who he felt did not respect his experience and knowledge: “...when i'm providing information they would do like a second fact check with a white person as if maybe i am not quote unquote an expert in that area of work. [...]” – fi, black, male another field instructor also shared an experience where she felt that a white student was patronizing her and questioning her knowledge: i have had a couple of students that are from dominant culture and one in particular...she was always bringing me journal articles and telling me about books about people of color and different things [...] it felt really condescending and i didn't like it...but it was a good, we had a really good discussion about that because finally i said, ‘hey, you know, you don't have to bring me stuff, i said, first of all i don't have time to read it i said, and secondly i already have a lot of lived experience’” – fi, asian, female witnessing microaggressions in addition to being direct recipients of microaggressions in field settings, students also reported that they witnessed microaggressions happening to others, most often service users, and were negatively impacted by seeing this. as one participant stated: advances in social work, summer 2021, 21(2/3) 320 there was one time a clinician, who identifies as white, i was shadowing and they... the orientation was over, the client was ready to leave and they made a comment as in, ‘i will follow you out.’ and i don't hear them say that that often to that many clients but it just kinda stuck with me because that person identified as african-american and it just reminded me of my experience and people i know experiences of being followed or watched in spaces by people of the dominant culture. – msw, mixed race, male another student talked about feeling indirectly impacted by microaggressions that they heard in their field agency: i’ve witnessed like some strange comments that were definitely like microaggression, racial things. they weren’t necessarily directed towards me, but definitely still like minimized me as like a person, because it was things about like, you know, nationality and things like that. and what being american in cause in the moment it was being portrayed that being american is being white. if you’re white, you’re american. so, it othered everyone else as being non-american. so, things like that. – msw, mixed race, female impacts of microaggressions bipoc students and field instructors who experienced and/or witnessed microaggressions in field placement settings were impacted by these experiences. while existing research on microaggressions has captured how people are affected by and cope with microaggressions in various settings, (see wong et al., 2014 for a comprehensive review), one unique impact of microaggressions in the field education context is that it affects one’s professional sense of self and meaning-making about identity. managing microaggressions also had emotional effects on participants and meant doing additional labor – most often invisible and/or emotional labor that is not required in the same way from white counterparts. professional identity and inability to bring one’s whole self it is well-established that one of the primary functions of field education is professional socialization and, specifically, helping students to grow into their professional identities. throughout their narratives, many bipoc students named the ways that they navigated their personal identities and field experiences in relationship to their professional identity. this included code-switching (adjusting one’s style of speech, appearance, behavior, and expression in order to fit in to the dominant culture), feeling like they had to minimize their racial/cultural identities, and feeling insecure or inadequate in their roles. while students articulated this differently, across participants who experienced microaggressions, many discussed how racism and microaggressions had impacted their professional sense of self and/or their professional confidence. one bsw student specifically recalled how she felt pressure to present as “professional”, but she still felt inferior based on her racial identity: i experienced a lot of microaggressions [...] i’ve been trying to make them aware of it. and it’s just not going anywhere. and so, like as much as i try to present gooding & mehrotra/interupting white supremacy 321 myself as professional or educated, i feel like there’s still that barrier because of the way i look. and it’s just like no matter how much i try to put my best foot forward, there’s always gonna be a look of ‘okay like your opinion was good, but it wasn’t great’…” – bsw, latinx, female some students also felt that in order to be a professional social worker, they had to quiet expressions of their cultural and racial identities in order to avoid being stereotyped. as one latinx student shared: it is also just hard feeling like i can’t be my boisterous self, because i have to be my professional self. [...] i have to like quiet myself because i don’t want them to think like, ‘oh she’s just the angry mexican girl’. and so, that’s been really tough, because you don’t get to feel like you can be who you are... – bsw, latinx, female as noted by this student, many participants directly and indirectly spoke to the feeling that they could not bring their whole selves to practice, and the divide they felt between their personal identities and professional selves. one field instructor who has been in the field for many years also reflected on how this played out for her when she was a student: ...i dealt with discrimination within my placement settings. both my undergrad and my grad placements, my field instructors were white women, and i just had a difficult time. i struggled with that relationship and never felt like i could truly be myself. it was just all kind of like pretending and felt like i was always being judged differently [...] you had to kind of walk that line of not saying too much, not exposing yourself and some of your areas of weaknesses versus strengths. and i just think it was just very difficult. – fi, black, female one student witnessed her bipoc field instructor grapple with not being able to bring her whole self to her practice, and the pressure to assimilate to the dominant culture’s ideas of professionalism: ...my field supervisor cried a lot, because she felt like she can’t bring her whole self to the work. [...] you can’t bring, as a person of color you have, in order to fit into the mainstream, you know, you have to kind of fit into the mainstream, white mainstream, in order to be accepted, because you know we’re already looked at as different. we’re already looked at as deviant or not conformed, poor. you know, there’s all this perception and biases against people of color. – msw, mixed race, female overwhelmingly, participants felt that they had to adhere to certain standards of professionalism (as defined by the dominant culture) in order to be a successful social worker but that doing so meant they were not able to bring their full authentic self as people of color without feeling critiqued or judged. emotional labor and toll both students and field instructors also noted the emotional toll and additional emotional labor that they had to do as a result of microaggressions they experienced and/or witnessed. sometimes this was emotional labor that students had to do to make sense of advances in social work, summer 2021, 21(2/3) 322 their experiences and navigate within dominant culture agencies. for some field instructors and students, this entailed having to call out racism, interrupt microaggressions, and/or having to educate others about their racial/ethnic group or about oppression. one bsw student spoke about the emotional toll of experiencing microaggressions: yeah, so going back to the whole microaggressions and the racism i’ve been experiencing at my agency. i thought i was just going crazy to be honest. and i feel like just that, like even that in itself is a common thing that we experience as people of color. like feeling like we’re going crazy, but in reality we’re not. you know what we’re experiencing is pretty real and we need to be able to bring that to the surface and be able to talk about that. – bsw, latinx, female one field instructor noted the additional labor she had to do with white students in interrupting microaggressions that they perpetrate: i think with white students it can be another level of labor where there are microaggressions that happen that now i've got to navigate interrupting for a student that feels a little bit different than it does for staff. and some of it is maybe i start to get too careful and not wanting them to feel like they can't be at this internship but also feeling like it's important to point it out. i also sometimes don't have the energy to do that labor anymore. – fi, mixed race, female both bipoc students and field instructors were impacted by microaggressions in terms of their personal and professional sense of self and the emotional toll and labor they incurred. these impacts are important to the specific context of field education given the role of field placements in nurturing professional identity of social work students, and the importance of attending to student and field instructor labor and well-being. discussion and recommendations for addressing microaggressions in field education bipoc student and field instructors’ narratives illustrate the pervasive and complex experiences of microaggressions that impact field education for both bipoc students and field instructors. students experience direct microaggressions from both service users and agency staff while they also witness microaggressions happening to others, including clients. in addition, for racialized students, navigating microaggressions also connects to how they make meaning of their personal and professional selves. bipoc field instructors also experience microaggressions in unique ways given their role; for instance, bipoc field instructors in this study noted the ways that their knowledge and/or authority was questioned by dominant culture students. across both students and field instructors, some of the common negative impacts of these experiences were: emotional toll (and often invisible) labor and effects on professional identity and confidence. findings from this research suggests that in order to understand and address racial microaggressions in a meaningful way in field education, we must attend to varied dimensions of these experiences in our agencies as well as in our curricula. based on the learnings from this research, in the section that follows, we make recommendations to the social work field on ways to address microaggressions in the gooding & mehrotra/interupting white supremacy 323 context of field education. these include understanding microaggressions in their ecological context and unpacking the construct of professionalism. there are also concrete steps field education programs can take immediately to address microaggressions, including: expand notions of self-care to incorporate community care and attention to impacts of racism and oppression; train field instructors and agency staff; use the supervisory space to increase students’ critical consciousness; integrate conversations about microaggressions into field seminar and site visits and; support more research on bipoc field experiences. ground understandings of microaggressions in an ecological approach the ecological approach centers the reciprocal relationships which exist between the individual and their environment across micro, mezzo and macro levels (abramovitz & sherraden, 2016). a significant finding in this study was that microaggressions were experienced and witnessed by students, their fellow interns, field instructors, and service users. when organizational culture, policies, and practices are factored in, it is clear that microaggressions are ecological – they occur at the individual level with students and field instructors, the mezzo level at staff and community meetings, as well as within organizational structure and society at large. also, though it is beyond the scope of the discussion presented here, students also shared experiences of structural racism that they witnessed in their agencies–thus, again, highlighting the importance of understanding racism in field in a broader context. an ecological approach to microaggressions also understands that microaggressions are linked to larger structural conditions (i.e., structural and systemic racism), and if these structural links are not clearly delineated, then microaggressions have the potential to get reduced to individual/interpersonal behaviors– which could further an individualistic, neoliberal perspective that places blame on individual and interpersonal behaviors as opposed to a focus on dismantling oppressive structural conditions. in situating microaggressions within an ecological context, social work education is charged to acknowledge microaggressions as insidious and endemic, place microaggressions within a larger understanding of institutionalized racism, and tangibly consider the ways it affects all levels of practice for racialized social workers. unpack the concept of professionalism bipoc students and field instructors in the present study shared the myriad ways they were made invisible and/or othered within their agencies, such as when they were confused with another bipoc person at the agency, were not viewed as the social worker, or were assumed to be service users. issues around professionalism also arose when participants sensed that they could not bring their whole selves into the work due to feeling a disconnect between their personal and racialized identities and professional identities. given that field education is a site for professional socialization and identity development and the impacts of microaggressions on these processes for students of color, attention to how we think about professionalism is necessary in determining how to best advances in social work, summer 2021, 21(2/3) 324 nurture the growth of racialized social workers. as badwall (2015) shared, there remains an implicit tension between being a racialized person and the stated ideals of the social work profession. further, professional standards can often reinforce dominant culture values and ideologies (gray, 2019). central to addressing microaggressions in social work field education is the unpacking of the discourse of professionalism. namely, that professionalism is a dominant culture construct that has historically marginalized racial minority groups (i.e., discussion on flexner in literature review; badwall, 2015; mehrotra et al, 2019), and that continues to be reinforced in placement settings where bipoc students and practitioners are implicitly and explicitly told that they do not belong in those settings, and must assimilate in order to validate their credentials. to address microaggressions in practice, social work educators and practitioners must discuss the complex construct of professionalism in classes, in field seminars, and during supervision. we must ask, what would it look like to socialize bipoc social workers into a field that acknowledges the impact of race on the practice experience, and defends their right to practice in ways that validate theirs and their community’s histories and lived experiences? expand notions of self-care students and field instructors in the present study spoke of the emotional toll of experiencing and witnessing microaggressions. it is therefore woefully apparent that the harm caused by racial battle fatigue (smith, 2008) cannot be undone without an expanded discourse around self-care for communities of color within the field of social work. acknowledging the reality and impact of microaggressions makes room to address an issue which can make practice emotionally, physically, and psychologically exhausting in unique ways for bipoc social workers. we must expand the discourse of self-care to explicitly include rest from the emotional labor of navigating microaggressions and discuss community care as a tool to challenge individualist notions of care. community care is the idea that a group’s needs are best met when members come together and share responsibility in ways that facilitate trust and reciprocity (sambile, 2018). in her now viral 2019 post, community organizer nakita valerio exclaimed, “shouting ‘self-care’ at people who actually need ‘community care’ is how we fail people” (valerio, 2019, para. 4). her quote highlights something many historically marginalized groups already know – a simple bubble bath may feel pleasant but does not interrupt the systemic oppression marginalized groups face on a daily basis. as such, we recommend that social work programs offer community care options for bipoc students and field instructors. these could include spaces in field seminars where bipoc students can have conversations with each other about the realities of their field experience and process about microaggressions. schools can also offer ceu events, donate their space to community organizations doing racial justice work, and host mentoring and networking events specific to bipoc social workers to support community care efforts. gooding & mehrotra/interupting white supremacy 325 training for field instructors and agency staff the current study illustrates the pervasiveness of microaggressions in agency contexts – it is experienced by students, field instructors and service users. both students and field instructors navigated how to call out racism, interrupt microaggressions, and educate others on top of their work responsibilities. for students in particular, microaggressions affected their learning in field and their professional growth. since racism is deeply entrenched in society (crenshaw et al., 1995; solórzano & bernal, 2001) and in our field, it is vital that field instructors and agency staff are trained to expect, and react to racial microaggressions and incidents in field placements, especially since we know that the broader agency context matters when crafting meaningful field experiences for students of color (mehrotra & gooding, in press). therefore, another way social work education can address microaggressions in field is to offer racial justice and skills-based trainings on racismrelated topics, including interrupting microaggressions, to all agency staff who interact with students. since not all practitioners are ready or willing to engage in conversations about race and practice, trainings are key to the development of their critical consciousness. fortunately, there are already systems in place to make trainings accessible to field instructors and agency staff. many social work programs offer year-long seminars in field instruction for supervisors, alongside ceu events. these are perfect spaces for staff who work with students to engage in racial dialogue, process its effects on their own and their students’ practice, and gain relevant training on interrupting oppressive language and acts. it is important to note that trainings are one piece of the puzzle. as finn and jacobson (2008) highlight, “the everyday struggle for social justice demands ongoing vigilance, resistance and courage” (p. 15). therefore, addressing structural racism is a continuous process and should be approached as such, but training can be an important step in supporting racialized students and field instructors in placement settings. integrate discussions about microaggressions into supervision, field seminar, and site visits findings in this study showed that students experienced and were affected by various microaggressions in placement settings. therefore, supervisors must have conversations with bipoc students about microaggressions they may be experiencing and/or witnessing and how to navigate their professional identity as a racialized person. in fact, the ability for field instructors to discuss issues of race and racism is critical to meaningful field experiences for students of color (mehrotra & gooding, in press). therefore, students and field instructors must be able to speak frankly about how structural issues – particularly around race – may be at play within the supervisory relationship, within the agency, and in the profession. in doing so, supervisors model how to engage in conversations about race and practice, and help facilitate feelings of trust and safety in the supervisory relationship. field seminar is another important site for social work educators to attend to microaggressions in field. seminar instructors and field liaisons are often the first point of contact for students experiencing issues during their placements; especially if they are advances in social work, summer 2021, 21(2/3) 326 unable to discuss any issues they are having with their field instructor. therefore, curricula for field classes must incorporate content and discussions about microaggressions, such as how to interrupt them, its impacts on the practice experience, as well as the emotional labor that takes place when practicing with a client or colleague who holds biased opinions about your racial community. in doing so, all students – bipoc or otherwise – have a chance to think about what microaggressions mean for their field placement experiences, and are better equipped to interrupt them when they arise. in order to address racial incidents in field and to support bipoc students, social work educators must engage in meaningful conversations about race in field placements. site visits provide another way for instructors and liaisons to take the lead on creating a safer field environment for their students. at these visits, it is useful to ask questions such as: how do you engage in conversations about race and racism in placement and during supervision? how does agency policy address racial incidents when they occur? what supports and resources do you as the field instructor need in order to interrupt oppression at your agency? these questions help to normalize discussions of race and racism and illustrate that the social work program is serious about the emotional, psychological, and physical safety of its bipoc students, and is committed promoting anti-racist practice in field. more research on bipoc experiences in field the final way social work can challenge microaggressions is to learn more about how they operate in field education as well as how they impact students' learning and field instructors' experiences with students. to date, the research on bipoc students and social workers is very limited, and even more so in regard to field education. this project was conducted as part of a larger exploratory study broadly looking at field placement experiences of bipoc students and field instructors. we did not ask questions specific to microaggressions, yet these incidents emerged from participants discussing their experiences of field education more broadly. future research should ask questions specific to racism and microaggressions in field so that social work can better understand race and the practice landscape from the perspectives of bipoc social workers. in addition to race, students and field instructors are likely experiencing microaggressions due to gender, sexuality, immigrant status, disability (etc.), all of which require future exploration. furthermore, microaggressions present differently across racial groups and more research is needed on how structural oppression informs the microaggressive experiences for specific racial groups. per our findings, it is also necessary to explore the ways power dynamics are complicated when a bipoc social worker experiences microaggressions from a service user they are working to support, or when bipoc field instructors experience racism from white students. finally, more research is needed to learn the myriad of ways bipoc social workers respond when they encounter microaggressions in their practice. for instance, in our study, some participants spoke to their supervisors, some deflected, and some directly addressed the issue with the perpetrator. learning more about bipoc experiences of experiencing and witnessing microaggressions will help other racialized social workers consider how best to address microaggressions in their own practice. gooding & mehrotra/interupting white supremacy 327 limitations while this study’s sample reflects the demographics of the study location, it is not representative of the bipoc community as a whole. for example, there was limited representation of indigenous social workers, participants who identified as immigrants and refugees, or african-americans. given the realities of colonization and anti-blackness, these perspectives are necessary to the conversation. in addition, this project took place in a predominantly white city within a predominantly white state. microaggressions may present differently in a more ethnically, racially and culturally diverse geographic location. finally, we mentioned earlier that this project emerged from a larger exploratory study on bipoc field experiences. therefore, we have only captured some of the ways microaggressions affect the practice experiences of bipoc students and field 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(2018). students’ experiences of microaggressions in an urban msw program. journal of social work education, 54(4), 679-695. https://doi.org/10.1080/10437797.2018.1486253 author note: address correspondence to anita r. gooding, department of sociology and social work, university of portland, portland, or 97203. email: gooding@up.edu https://www.flare.com/identity/self-care-new-zealand-muslim-attack/ https://doi.org/10.1080/02650533.2018.1553871 https://doi.org/10.1007/s12552-013-9107-9 https://doi.org/10.1080/10437797.2018.1486253 mailto:gooding@up.edu interrupting white supremacy in field education: experiences of microaggressions in placement settings anita r. gooding gita r. mehrotra abstract: as social work’s signature pedagogy, field education socializes students into their professional roles as practitioners. however, for students and field instructors of color, racial microaggressions add another dimension to the practice expe... microaggressions race and field education white supremacy and professionalism overview of the study research design study sample data analysis microaggressions in field settings being tokenized invisibility/not being seen experiencing microaggressions from service users or students witnessing microaggressions impacts of microaggressions professional identity and inability to bring one’s whole self emotional labor and toll discussion and recommendations for addressing microaggressions in field education ground understandings of microaggressions in an ecological approach unpack the concept of professionalism expand notions of self-care training for field instructors and agency staff integrate discussions about microaggressions into supervision, field seminar, and site visits more research on bipoc experiences in field limitations while this study’s sample reflects the demographics of the study location, it is not representative of the bipoc community as a whole. for example, there was limited representation of indigenous social workers, participants who identified as immigrant... conclusion ________ keith adamson, phd, rsw, assistant professor, factor-inwentash faculty of social work; rachelle ashcroft phd, rsw assistant professor, factor-inwentash faculty of social work; sylvia langlois, m.sc. ot reg. (ont.), faculty lead ipe curriculum and scholarship, centre for interprofessional education, associate professor, occupational science and occupational therapy, university of toronto, toronto, ontario, canada. dean lising pt, bscbio, bscpt, mhsc, collaborative practice lead, strategy lead, ipe curriculum, director, boost! (building optimal outcomes from successful teamwork) program centre for interprofessional education, university of toronto, university health network, toronto western hospital, toronto, ontario, canada. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 454-472, doi: 10.18060/23602 this work is licensed under a creative commons attribution 4.0 international license. integrating social work into interprofessional education: a review of one university’s curriculum to prepare students for collaborative practice in healthcare keith adamson rachelle ashcroft sylvia langlois dean lising abstract: the university of toronto interprofessional education curriculum (ipe) is an exemplar of advancing interprofessional education with a focus on preparing students for practice in healthcare settings. our paper begins with a detailed overview of the university of toronto’s ipe program including the range of participating faculties, an overview of the curriculum including examples of learning activities, and the social work specific expectations that are embedded in the core and elective components. following, is a discussion on mitigating the challenges and engaging opportunities associated with integrating social work in a healthcare-focused ipe program at a major canadian university. our exploration of mitigating challenges and engaging opportunities will span five key areas: a) creating meaningful learning experiences for social work students; b) implementing mandatory or elective ipe participation; c) scheduling of ipe activities; d) the role of social work faculty in driving student involvement in ipe; and e) strengthening social work professional leadership for ipe. keywords: interprofessional education; social work; university; collaborative practice in healthcare in recent years, there has been recognition that health challenges have become more complex, necessitating the involvement of additional health professionals. interprofessional collaborative teams that bring together a mix of healthcare providers, including social workers, are considered important means for providing quality care, particularly for patients with more complex health challenges (donnelly et al., 2019; institute of medicine, 2015; pullon et al., 2016). collaborative care models as well as the collaborative working relationships among the various health professionals working within these models have also become increasingly more complex (steihaug et al., 2016). there is international consensus of the importance of including interprofessional education (ipe) across health professions to ensure students have the necessary knowledge, skills, and abilities needed to succeed in collaborative healthcare contexts (frenk et al., 2010; institute of medicine, 2015; nester, 2016; world health organization, 2010). strengthening ipe will help strengthen collaborative practice and collaborative models of care, both of which are necessary to improve quality of care, patient safety, patient outcomes, as well as https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 455 promote more efficient use of human resources within the healthcare system (hellquist et al., 2012; institute of medicine, 2015). ipe refers to a pedagogical approach that brings together students from across health professions to learn together in a collaborative manner (al-sheikh & hmoud, 2018; buring et al., 2009). by doing so, students have an opportunity to learn with and about each other as part of the curriculum (anderson et al., 2019). there has been substantial international commitment to lead curriculum and pedagogical changes to better respond to the need for transformative collaborative models of care (rubin et al., 2017). as such, universities are poised to make significant contributions towards the creation of a new generation of healthcare workers and as a by-product of such influence may lay the ground towards carving out the next iteration of a modernized healthcare system. given the high priority placed on ipe, universities in canada, the united states and around the world are developing and striving to increase ipe programming more than ever before (anderson et al., 2019; buring et al., 2009). some universities have adopted an approach that brings students from different health professional programs together into an integrated ipe framework (anderson et al., 2019; vankuiken et al., 2016). despite the success of building knowledge, teamwork skills, and capacity for collaborative care, variations in the involvement of integrated ipe across health professions within higher education institutions remain (anderson et al., 2019). medicine, nursing and pharmacy are pioneers of ipe, while more understanding remains needed about the engagement of other professions in ipe, including social work (de saxe zerden et al., 2018). our intent in this paper, is to highlight how social work has been incorporated into a robust integrated ipe model at the university of toronto (ut) in toronto, canada. to illustrate how ut has developed an exemplar ipe curriculum, we will share examples of learning activities including the social work specific expectations in both the core and elective components. through this exploration, we will provide an overview of curriculum and illustrate the benefits of including social work in an integrated ipe program. by doing so, we hope to inspire greater inclusion of social work in other educational ipe programs. social work and ipe social workers in healthcare settings have historically engaged in collaborative practice with physicians, nurses and other healthcare disciplines (ashcroft et al., 2018). integrative collaborative models of healthcare, such as primary care and behavioral mental health, are continuing to expand and resulting with an even greater surge of social workers practicing in collaborative healthcare settings (ashcroft et al., 2018). there is a dearth of knowledge pertaining to the experiences of social work students in existing ipe programs, as well as the experiences of social work faculty teaching in ipe (archibald & estreet, 2017; jones & phillips, 2016). although the profession of social work has demonstrated longstanding support for collaborative practice, social work students are rarely included in ipe learning opportunities (rubin et al., 2017. greater inclusion of social work in ipe is needed in order to prepare social workers for the current demands of complex healthcare contexts and complex patient care needs. there are two key reasons why university programs need to include and enhance ipe in the training of social work students. first, there is an increasing demand for adamson et al./integrating social work 456 interprofessional collaborative practice in healthcare (ashcroft et al., 2018). social workers are the third largest group of professionals integrated in new primary care models following physicians and nurses (ashcroft et al., 2018). as such, social workers have a major presence in the healthcare field as members of interprofessional teams and need to be adequately prepared with current health related content in order to be able to contribute to patient care in the most effective manner (kobayashi & fitzgerald, 2017; de saxe zerden et al., 2018). kobayashi and fitzgerald (2017) also suggest that creating and offering ipe opportunities for social work students reinforces the importance of including social workers as essential participants in collaborative healthcare teams. second, ipe provides social work students the opportunity to learn how to collaborate and navigate complex interactions within the interprofessional team context (de saxe zerden et al., 2018). the numerous challenges that social workers encounter in the process of collaboration within interprofessional healthcare settings have been well documented (ambrose-miller & ashcroft, 2016). ipe provides social workers with the opportunity to develop early skills that will help them navigate complexities and strengthen relationships within interprofessional team settings (de saxe zerden et al., 2018). though schools of social work teach collaboration, it is often from the stance that teaches about collaboration as opposed to how to collaborate (rubin et al., 2017; de saxe zerden et al., 2018). rubin et al. (2017) emphasize that though social workers are well versed in principles of interdisciplinary collaboration they are rarely paired with other professions in the classroom to practice such collaboration. ipe can help mitigate this disparity. along with the benefits for social work students, there are vast benefits for students across all health disciplines when social work is included in ipe. including social work in ipe enhances the curriculum for students from other disciplinary backgrounds (de saxe zerden et al., 2018). social work students bring a unique disciplinary perspective that includes educational instruction in group facilitation, patientcentered approaches to care, developing therapeutic relationships, biopsychosocial assessment, understanding the role of empathy in care, patient engagement, social justice, social determinants of health, and community building (archibald & estreet, 2017; charles et al., 2011; de saxe zerden et al., 2018). when social work students are included in ipe, students from other disciplinary perspectives have a greater understanding of group process, can better engage in difficult conversations, feel more confident when encountering situations of adversity, and have improved group decision-making abilities (charles et al., 2011). in fact, social work students provide the most unique perspective in ipe on the interconnected nature of social categorizations such as race, class, and gender and its relation to access to healthcare and healthcare outcomes (charles et al., 2011). despite the multiple benefits of including social work, there are a number of barriers that need to be overcome in order to optimize social work’s engagement in ipe. integrating social work in ipe means having to address systemic and institutional barriers in order to provide social work students with the opportunity to practice and demonstrate their expertise with students from other healthcare schools. some of these barriers include: physical separation of campuses, scheduling conflicts for interdisciplinary classes, limited administrative resources, rigid curricula, workloads across faculties/schools, and resistance to the implementation of ipe within academic settings (jones & phillips, 2016; olenick, et advances in social work, summer 2020, 20(2) 457 al., 2019; waggie & laattoe, 2014). more understanding about social work’s involvement in ipe across different university contexts, will help identify ways that social work educators and administrators can address some of the inherent barriers to collaborative learning. interprofessional education program at the university of toronto the delivery of ipe programs and opportunities varies across universities and colleges that educate health and social professions, thus complicating the discussion of how the development of interprofessional collaborative competences in social work education can be understood and enhanced. the ut’s ipe curriculum is an example of an exemplar program that includes students from a range of health disciplines, including social work. a description of program elements anchors the discussion of ipe opportunities for an augmented, formal, and explicit engagement of social work students. the ut program was initially established in 1996 with only four programs: medicine, occupational therapy, physical therapy and speech-language pathology. with the support of the council of health sciences, the curriculum expanded to formally include dentistry, kinesiology, medical radiation sciences, nursing, pharmacy, physician assistant, and social work in 2007. like other academic institutions, the ut has experienced the challenges of non-homogeneous health profession education programs. for example, the level of profession preparation varies from undergraduate to graduate; lengths of professional programs range from four years of undergraduate education (medicine and dentistry) to two years of graduate studies (occupational therapy, physical therapy, speech-language pathology, social work) to one year of graduate study (advanced standing social work). the participating student body is large, with each cohort including approximately 1,300 students and a total of about 4,600 students. program-specific curricula do not align with each other in content or in scheduling. nor is there congruence in the scheduling of experiential learning opportunities among the programs. by affording a degree of flexibility, the ut ipe curriculum has been responsive to differing program structures and curricular needs, permitting enhanced adoption and integration. the goal of the ut ipe curriculum is to prepare both system-ready and collaborativeready practitioners who are able to apply foundational competencies to enhance patient/client outcomes. the ipe curriculum is competency-based, built on an original competency framework created for the ut (ut, 2007) and later used as the foundation of the american interprofessional education collaborative (2016) core competencies and adapted in the canadian interprofessional health collaborative (cihc) framework (2010). here, collaborative competencies are described as the dimensions of competence which every profession needs to collaborate within its own ranks, with other professions, with non-professionals, within organizations, between organizations, with patients and their caregivers, with volunteers, and with community groups (barr, 1998; molitor, naber et al., 2019). competencies addressed in the canadian and american competency frameworks are similar, although the categorization of dimensions and nomenclature varies somewhat. adamson et al./integrating social work 458 within the ut context, interprofessional learning activities address the domains of collaboration (role clarification, team functioning, collaborative leadership), communication (interprofessional communication, interprofessional conflict resolution), and values and ethics (patient/client/family/community-centered care). by grounding the ipe curriculum on these collaborative competencies, all learning activities address knowledge, skills, behaviors, and attitudes pertaining to collaborative practice, and also support alignment with profession-specific competencies. the ipe curriculum is developmental (exposure to immersion to competence), longitudinal (across the educational experience) and integrated into profession-specific programs. again, programs have adopted varying approaches to advance the degree of integration of learning to enable students to understand that collaboration with other health professionals is core to the practice of their own profession. integration of collaborative competency development has taken several forms across the health profession programs at ut, including creation of a separate ipe course, assessment of content in professionspecific courses, reference to content and process components in course materials, and a workplace-based assessment addressing collaboration. the curriculum was based on the following guiding principles: • consideration of and alignment to health and social system needs; • application of a developmental approach of curricular offerings (exposure to competence); • inclusion of developmental practice-based learning activities; • cohesion between the curriculum offered on campus and at practice settings, enabling development of collaborative competencies to a point of integration into practice; • integration of ipe curriculum content (where it is discussed and assessed in program-specific curricula); • longitudinal curricular experiences where there is an opportunity for relationship building and ongoing competency development with students from different professions; • engagement of clinical faculty across the curriculum to ensure relevance of education to collaborative practice; • engagement of patient partners to ensure relevance and application to clientpartnered care/management. the ipe curriculum includes both core learning activities that take place on campus and in practice settings as well as a number of elective learning activities that students can choose to attend. core learning activities ipe core learning activities are requisite for students in the eleven health profession programs mentioned previously, so they have been carefully developed to ensure relevance. these core learning activities are designed for progressive learning, with foundational elements taught earlier in the curriculum and opportunities to engage in casebased discussions with profession-specific contributions at a later stage. a curriculum advances in social work, summer 2020, 20(2) 459 summary of the core learning activities that take place on campus are outlined in table 1 and the core learning activities that take place within the practicum setting are outlined in table 2. table 1. ipe curriculum-core campus based components (within the university) year 1: exposure campus-based core learning activities year 2: immersion campus-based core learning activities teamwork: your future in healthcare • 2.5-hour workshop: students hear from a patient about their journey in the healthcare system, view skits demonstrating interprofessional teamwork, and discuss responses to these experiences in small groups • competencies emphasized: collaboration (team functioning) and communication collaborating for quality • 2.5-hour workshop: students learn strategies to promote quality care and promotion of safety as a team • competencies emphasized: collaboration (team functioning) and communication roles and team dynamics • 2.5-hour workshop: students work in small groups to explore the roles of various health professionals and consider how to enhance team dynamics • competencies emphasized: collaboration (role clarification, team functioning) palliative care or head and neck cancer case-based discussion • 2.5-hour workshop: students participate in simulated team discussions to consider the dimensions of the patient/family/caregiver experience and collaboratively prepare care plans • competencies emphasized: collaboration (role clarification, team functioning), communication values and ethics (patient/client/family/ communitycentered care) understanding patient/client partnerships in a team context • 2.5-hour workshop: students hear from a patient partner and participate in a reader’s theatre script exploring how the team can include and partner with the patient • competencies emphasized: values and ethics (patient/client/family/community-centered care) conflict in interprofessional life • 2.5-hour workshop: students work in small groups to consider and practice strategies in managing conflict among health professionals and in teams • competencies emphasized: communication (conflict resolution) faculty-led learning activity • various activities developed by smaller number of programs to address specific collaborations (e.g., safe prescribing and medication reconciliation for nursing, medicine, and pharmacy) • competencies emphasized: dependent on objectives of learning activity developed interfaculty pain curriculum • 3-day activity using lectures and workshop formats students learn about the complexities of managing acute and persistent pain in pediatric and adult populations using an interprofessional approach. they spend about 40% of their time working in small groups synthesizing information learned, preparing management plans, and evaluating collaborative competencies and approaches • competencies emphasized: collaboration (role clarification, team functioning), communication, values and ethics (patient/client/family/ communitycentered care) adamson et al./integrating social work 460 table 2. ipe curriculum core practice based components (field placement) flexible activities • shadowing a team member (exposure) self-directed 3hour activity where students interview and shadow two team members and complete a briefing, debriefing and reflective assignment. • analyzing interprofessional interactions with team members (immersion) self-directed 1-hour activity where students analyze their interactions with another health care professional or those within a team using the jefferson team observation guide. they complete a briefing, debriefing, and reflective assignment. • collaborating with team members (immersion to competence) self-directed 1-hour activity where senior students collaborate with a student from another profession or a team member to assess a patient, provide an aspect of care, or plan non-clinical activities. or • structured ipe placement students from various professional programs who have overlapping schedules while they are in practice settings participate in facilitated activities to develop team competencies over a period of several weeks. elective learning activities approximately 60 ipe elective learning activities are offered annually. they have been designed to accommodate smaller groups of students (typically between 20 to 90). these activities are hosted on the university campus and in the toronto area hospitals. elective learning activities are developed with university faculty and/or ipe leaders from the toronto area network of teaching hospitals. topics vary, allowing students to pursue areas of interest. examples of campus-based activities include dying and death, the health mentor program (student groups are paired with an individual experiencing a chronic health challenge), and empowering clients in an hiv context. examples of hospital-based electives include sexual assault and domestic violence, suicide risk assessment, and patients with complex needs: listening as a team. in each activity, faculty ensure that there is a good mix of professions so that discussions enable interprofessional learning. faculty leaders in each of the health profession programs determine the minimum number of electives that their respective students must complete. a record of attendance is maintained, ensuring that all program requirements have been met. although students have some choice around what elective learning activities they want to attend, there are minimum parameters that are determined by each health profession program. ultimately, programs are responsible for curriculum choices for their students therefore, there is a measure of flexibility. advances in social work, summer 2020, 20(2) 461 collaborative leadership is a distinct, higher-level competency addressed in the ut ipe curriculum. it encompasses shared decision-making and individual accountability, where the two components of task-orientation and relationship-orientation are balanced (cihc, 2010). the development of collaborative leadership competencies may be best addressed through longitudinal experiences in the context of team engagement. for example, the following three longitudinal elective opportunities built within the ut ipe curriculum exemplify collaborative leadership and are popular with social work students: i) the interprofessional medical and allied groups for improving neighborhood environments (imagine). this interprofessional student-run community health initiative is designed to provide holistic care to the underserved and homeless populations of downtown toronto, ontario. the imagine clinic allows students to work in a collaborative team of students from disciplines such as medicine, nursing, pharmacy, physiotherapy, as well as social work to perform a collaborative assessment and co-create an interprofessional management plan for clients. ii) the ipe senior project learning activity. this activity involves a partnership between the ipe curriculum and community organizations. organization representatives present an issue of concern that would benefit from an interprofessional perspective. student teams work collaboratively throughout a term to understand the organization’s culture and needs, and to develop a potential solution. they communicate their recommendations in a business presentation to a panel of organization representatives and faculty. an example of a recent partnership is with the distress centre where students developed support programs for survivors of youth suicide. iii) the interprofessional student facilitator education program. this program is directed to senior students to support building of ipe facilitation competencies. participating students focus on theory, key strategies, tools and specific learner-related issues. students apply skills learned in two facilitation opportunities with experienced interprofessional educators, where they are increasingly involved in co-facilitation with another student and receive specific feedback to enhance their skill development. program requirements for social work students the ipe program requirements are voluntary and are separate from the requirements for the msw degree at ut. however, students participating in ipe will receive a certificate upon completion of the outlined social work ipe program requirements. there is a slight difference in the requirements for students admitted in the two-year msw program (students without a bsw upon admission) versus students admitted in the one-year advanced standing msw program (students with a bsw upon admission) as illustrated in table 3. adamson et al./integrating social work 462 table 3. ipe curriculum program requirements for social work ipe activities program two-year msw advanced standing core 4 3 elective learning 3 3 to qualify for the certificate of completion, social work students in the two-year program must complete the following four core ipe activities: i) teamwork: your future in interprofessional health care (completed in year one); ii) conflict in interprofessional life (completed in year two); iii) case-based: palliative care (completed in year two); and iv) structured ipe placement or flexible components (completed in year two). social work students who are in the advanced standing program are required to complete the same core activities as above, with the exception of i) teamwork: your future in interprofessional health care. social work students in both the two-year program, as well as the advanced standing program, must also complete a minimum of three elective learning activities. although this is the minimum requirement needed to achieve the certificate of completion, students are welcomed to enroll and participate in even more ipe learning activities. for example, one social work student in the two-year program completed a total of 19 ipe activities which far exceeded the minimum requirement of seven (four core and three electives). upon completion of each ipe learning activity, students are sent an online evaluation survey to complete, which includes both quantitative and qualitative response options. our aim below is to provide insight into some of the student experiences in ipe by sharing some of the evaluation data the organizers received anonymously through the online course evaluation tool for the core activities held 2018-2019. overview of social work ipe core learning activities teamwork: your future in interprofessional health care in this introductory ipe learning activity, social work students join their peers from ten other professional programs who have all been assigned to small groups. they hear from an individual who has experienced the healthcare system and are challenged to consider how care could have been improved with greater collaboration among team members. they view two skits, one demonstrating adequate health care delivered in a multi-professional format with limited interaction among the various health professions, and a second where enhanced collaboration improves the patient/client experience. following each component, students engage in discussions regarding their response and recommendations for better teamwork. this introductory teamwork learning activity has a high participation rate of social work students because it has been embedded into the curriculum of an already existing msw course. the evaluation for the teamwork activity was completed by 111 social work students, with all students being in their first year of study. when asked what students liked best about this ipe activity, students identified numerous aspects of the event including the demonstrated skits and role play which enlivened the experience for them; the small group conversations, where they were able to meet new people from other professions, and the advances in social work, summer 2020, 20(2) 463 opportunity to share insights from their respective professions with students in other health professions. when asked what students liked the least about the event, students overwhelmingly identified logistical issues related to the size of the collaborative groups to which they were assigned. for example, some students felt overwhelmed by the number of students in the room. although a rich learning opportunity, the most frequent recommendation given by students on how to improve this activity was to have smaller groups and fewer students in the room. conflict in interprofessional life within the activity titled conflict in interprofessional life, students assess their own conflict styles and reflect in student teams on their responses to interprofessional conflict. through review and roleplay of an interprofessional team conflict, they consider professional perspectives and apply communication tools to find common ground. working with other health professional students, social work students debrief on the key learnings and practices that they can apply in different team contexts. in asking students to identify what they liked best about the conflict in interprofessional life event, social work students described both content as well as the group processes. for example, students suggested that the conversations were engaging and were well facilitated which enhanced effective communication amongst the student group members. additionally, students described that they liked the opportunities for discussion and role play that were embedded in this activity. when asked what they learned in the conflict in interprofessional life event that applies to future practice, social work students stated that they learned a number of applicable skills including: building effective communication with interdisciplinary teams, skills needed to nurture collaboration, and the ability to identify and prevent future conflict in interprofessional teams. students also enjoyed the opportunity for personal reflection which enabled them to identify and better understand their own individual style of managing conflict and how it might apply to negotiating difficult circumstances around patient care. case-based: palliative care in this simulated team meeting, social worker students and their peers represent their professional perspectives in sharing information and management planning. participation fosters a sense of preparedness for a subsequent “patient/client/family meetings” involving a client with advanced disease. students gain insight into an interprofessional team approach to delivering care and maintaining quality of life, by exploring relevant issues as well as team dynamics enhancing optimal care. of the 24 social work students who completed the on-line ipe evaluation for the palliative care event, 22 of them were in the two-year social work program and two students were in the advanced standing msw program. when asked what students liked best about the palliative care activity, students highlighted that they enjoyed the interactive case-based approach of this event that was done in a way whereby all professions were able to contribute to the discussion. in response to the question asking students what they learned from the palliative care event that they will apply in their future practice, students adamson et al./integrating social work 464 highlighted that they had a better understanding about the importance of teamwork, the goals of palliative care, how to develop a collaborative plan of care, and lastly, that interprofessional teams can be non-hierarchical and respectful. social work students reported that this learning activity was very relevant to their profession. when asked how the palliative care event could be improved, again students highlighted the logistical issues including the need to have more time because students felt that it was a little too short. some students, however, indicated that the palliative care learning activity was their favorite ipe event of the entire ipe curriculum. across all ipe core activities, social work students emphasized the benefits of the interactive approaches to learning. the engaging format of learning helped to model for students some of the conversations, communication styles, collaborative goal attainment, and case-based assessments that are inherent to interprofessional practice. the key challenges that social work students identified across the core activities largely pertained to logistical issues such as group size, timing, and environmental issues. mitigating challenges to enhance social work’s integration in ipe though the ut ipe provides a robust opportunity for students from social work and other health disciplines, there are some challenges that exist with integrating social work in a healthcare-focused ipe program. by identifying and exploring these challenges, our aim is to help better prepare the development of future ipe programs, and to propose ideas that will further enhance the development of collaborative competencies within social work education. scheduling of ipe activities logistics such as scheduling of activities are essential considerations that can help facilitate student engagement or deter participation (borduas et al., 2006; west et al., 2016). a significant challenge for ipe organizers at ut is coalescing the various schedules and requirements of all the professional health schools given the large numbers of students across each of the disciplinary programs who participate in ipe. although seemingly rudimentary, the logistics of scheduling requires considerable attention in order to ensure effective representation from the range of health disciplines in order to achieve optimal group sizes and group balance (jones & phillips, 2016; kahaleh et al., 2015; oandason & reeves, 2009). one of the challenges for social work is that clinical placement schedules can create an obstacle to broad participation in ipe activities (rubin et al., 2017). social work students at ut, like elsewhere, have a very rigorous 8 month, 3 days a week, clinical practicum whereby they are embedded off-campus within an organization. clinical practicum for social work students begins in september and ends in april of the following year. some curriculum activities such as conflict in interprofessional life, take place on days when most of the social work students are in their practicum placements which means that they are in a clinical practicum located off-campus on those days. travelling back to the university campus in order to engage in ipe activities can act as a logistical deterrent, especially if their placement sites are far from the university. one of the ways that we are advances in social work, summer 2020, 20(2) 465 striving to resolve this challenge is to educate practicum supervisors about ipe so that they may allow students some flexibility in their clinical practicum in order to attend ipe events. additionally, at ut we are exploring ways of having social work students complete ipe activities within their clinical practice settings in order to facilitate more engagement from those students who are unable to make it to ipe events due to logistical reasons. given the length of social work placements in practice settings, these flexible activities hold a great deal of promise. social work faculty representatives involved in ipe are collaborating with the centre of interprofessional education (cipe) about how to develop and structure activities within clinical practicum settings to better meet the needs of social work students who may not be able to attend on-campus ipe events. perhaps one area for future exploration is to determine how to offer some aspects of the ipe curriculum in an on-line format while still maintaining the richness and intent of collaborative learning (bluteau et al., 2017). the ut faculty have been experimenting with a few learning activities that are offered fully online and some that are blended opportunities. the emergence of the covid 19 pandemic has accelerated this evolution to a full-scale online learning curriculum, complementing large scale core activities and small-scale electives. these online synchronous video-conferenced activities required the innovation of new facilitation and logistic strategies given the potential screen fatigue of sitting in front of computers for long periods of time, which could pose a risk to student engagement. new virtual engagement strategies included videoconferencing norms, stretch breaks, team simulation videos, realtime polling, and the use of chat boxes/reaction to encourage participation. through the use of large group teaching, interprofessional small group virtual breakouts and virtual ipe facilitation training, the ut ipe program has managed to maintain student evaluation scores that have met or exceeded past scores. students have also appreciated the benefits of accessibility, while maintaining social distancing requirements and eliminating past barriers of geography, and travel. however, the impact of online learning needs further exploration beyond simply student satisfaction, as engagement can vary or remain “hidden” as even with encouragement, not all students will be present via video camera. we are continuing to seek creative ways of engaging students, such as an on-line game that can be a source of learning about the roles of a range of interprofessional healthcare providers. there will be much to learn about the impact of virtual ipe experiences within academic settings. strengthening social work professional leadership for ipe there is a role for social work’s professional leadership bodies to help strengthen social work’s engagement in ipe. mathews et al. (2011) demonstrated the powerful influence that regulating bodies have in the development of ipe. ipe has been incorporated into health education and practice to the extent that is thus far in part because professional regulating bodies have incorporated ipe into accrediting requirements (mathews et al., 2011). in order for schools of social work in canada and the united states to further implement and promote ipe, we encourage social work regulators to consider strengthening requirements for ipe. we also strive to develop a network of social work leaders who are driving ipe across canada, the united states, and elsewhere internationally. we encourage social work leaders across universities to embrace opportunities that enable us to dialogue about our shared interest in ipe, describe the multitude of ways that social work supports and adamson et al./integrating social work 466 includes ipe in curricula. at ut we are currently exploring ways that we can help drive a leadership network such as this. developing this community, will help establish a current state of ipe specific to social work as well as position the profession to strategically plan for advocacy towards accreditation requirements. creating meaningful learning experiences for social work learners’ reactions to ipe are more favorable when students perceive there to be a direct link between their current educational experiences and their future practice (oandasan & reeves, 2005). social work students engaged in ipe learning activities need to feel that ipe is important to their profession-specific learning (lucasa et al., 2020; oandasan & reeves, 2005). this means that there should be strong themes of social justice and other psychosocial components connected to the ipe opportunity. it also needs to be evident to social work students that curriculum goals and the collaborative competencies are relevant to their immediate learning needs and future social work practice (de saxe zerden et al., 2019; oandasan & reeves, 2005). michalec et al. (2017) found that elements that were internal and external to ipe programs such as assignments, anticipatory socialization, and insufficient professional identity formation were found to impact students' perceptions of ipe programs and possibly their engagement with ipe goals. they added that factors related to an ipe program's structure and implementation, as well as factors outside the program, may affect students' perceptions and willingness to engage in ipe (michalec et al., 2017). to demonstrate relevancy to social work practice, ipe curriculum needs to be inclusive of elements related to psychosocial risk and protective factors; behavioral health assessment, screening, and intervention; social determinants of health; population health; social justice, population health; and cultural inclusivity (rubin et al., 2017; de saxe zerden et al., 2019). social work educators, including those acting as ipe faculty representatives, play a critical role in helping to develop and ensure that ipe curriculum is inclusive of critical content and reflective insight required for social work students’ future practice (rubin et al., 2017; de saxe zerden et al., 2019). mandatory or elective ipe participation there are variations in how ipe can be embedded in the overall program curriculum which can influence students’ perceived status of the educational offerings (oandasan & reeves, 2005; west et al., 2016). for examples, there are benefits to having ipe offered as both formal and informal components of the overall disciplinary curriculum, as well as mandatory or elective participation (oandasan & reeves, 2005; walmsley et al., 2018). one of the challenges faced with the ut ipe is that participation in the ipe curriculum is voluntary for social work students, which means that it is an elective on top of the existing social work program curriculum. this is unlike the other various other disciplines (medicine, nursing, occupational therapy, pharmacy, etc.) that require students to complete ipe as a mandatory component of their professional curriculum. the challenge that this creates is that although social work has been participating in the broader ut ipe program for nearly two decades, the level of engagement of social work students is less than students from the other health disciplines. when ipe is not a mandatory component of the social work program, the importance of ipe becomes a tough sell to students and advances in social work, summer 2020, 20(2) 467 requires considerable faculty encouragement to engage students (mladenovic & tilden, 2017; oandasan & reeves, 2005). this creates several challenges. first, ipe does not have as widespread of a reach across social work as it does for other health disciplines which means that social work students may not be as fully prepared for practice in healthcare settings as they could be (de saxe zerden et al., 2019). logistically, this creates difficulties to construct ipe student groups that are representative of all health disciplines when there is a drastic range of participation numbers from each of the health disciplines. when students from other health disciplines do not have adequate exposure to the role of social work in the range of ipe activities, it may then perpetuate some of the barriers that social workers have historically faced in healthcare contexts (de saxe zerden et al., 2019). at ut, we are seeking to resolve this barrier by exploring ways to integrate ipe into existing courses so we can ensure ipe is not an add-on but part of foundational component of social work’s professional education. our aim is to increase ipe learning activites as mandatory components of social work courses while still enabling students to have choice about the range and depth that they wish to pursue (mladenovic & tilden, 2017; oandason & reeves, 2005. the role of social work faculty driving student involvement of ipe faculty play an essential role in creating an environment that is conducive to the goals of ipe, acting as role models by demonstrating ipe principles in teaching, and helping to engage students’ enthusiasm to participate in ipe specific events (borduas et al., 2006; lindqvist et al., 2019; oandason & reeves, 2009). faculty beliefs about ipe can be an inhibitor or facilitator to ipe adoption within the school of social work because students are influenced by values and behaviors modeled by their mentors (wike et al., 2019). two members of the social work faculty act as ipe representatives at ut. the role of the faculty representatives is to help contribute to the development of ipe curriculum, address logistical needs of ipe planning relevant for social work, promote ipe learning activities to the social work student body, and act as a liaison for social work students who may have questions or wish to discuss ipe. faculty attitudes, knowledge, and skills help promote or contribute to the involvement of ipe (borduas et al., 2006; sundberg et al., 2019). the two authors (ka/ra) who are currently acting as the ut social work faculty representatives for ipe bring an expertise of collaboration in healthcare from our own clinical practice experience and research domains. this specialized knowledge is an asset to understanding the range of challenges that social work students, like social workers in healthcare, encounter when integrating into teams with a range of different disciplinary perspectives (de saxe zerden et al., 2018). it is important to note, however, that there are a range of specializations within social work. for example, at ut there are six field of study specializations that social work students can choose from including: mental health and health; gerontology; children and families; indigenous trauma and resilience; social justice and diversity; and human services management and leadership. it may be easier for students and faculty to see the relevance of ipe as it relates to healthcare collaboration, and less so for other areas within which social work practices (olenick et al., 2019). however, as faculty representatives we advocate for the inclusion of social work students from across all social work fields of study in ipe and strongly believe in the adamson et al./integrating social work 468 importance of preparing all social work students with the skills and capacity to collaborate effectively on interprofessional teams. vankuiken et al. (2016) suggested that advancing ipe from isolated initiatives to an interprofessionally integrated program requires commitment from a dedicated group of social work faculty from across multiple streams or specializations. to be effective, faculty representatives need to have developed skills for nontraditional teaching methods including interdisciplinary problem-based learning and have knowledge and skills to design and help implement ipe activities (bordus et al., 2006; doll et al., 2018). at the organizational level, universities can help support faculty in the development of these skills and allocation of time to adequately participate as ipe representatives (borduas et al., 2006; mladenovic & tilden, 2017). at ut, faculty are provided with a range of teaching supports through the centre for teaching support & innovation and other opportunities that can help in the development of this foundation. for example, ut has a five-day ehpictm program (educating health professionals in interprofessional care) meant to teach community healthcare professionals and university faculty about ipe and collaboration. the program as it stands is an internationally acclaimed program that can be customized and locally contextualized so that it is tailored to address the needs of a respective organization or audience. ipe facilitator workshops target faculty and clinicians who are interested in facilitating ipe learning activities within the curriculum. tailoring and maximizing the use of this local resource for a social work audience may further demonstrate that ipe can be creatively shaped by social work values of social justice and equity. lastly, ut faculty representatives from all health disciplines regularly meet and have formal and informal opportunities to develop these skills through participation with ut ipe curriculum. conclusion universities are poised to make a significant contribution towards the creation of a new generation of workers in health and social care systems. future generations of social work students will be part of the next iteration of a modernized system. social work educators should place a high priority on ipe, given the important role that social workers play within the health and social care systems. though social work educators have been meaningfully involved in ipe for at least a decade, there is opportunity for social work educators to further strengthen their influence on ipe within university integrated programs, by seeking greater flexibility of ipe programming, strengthening social work faculty leadership presence in ipe, reflecting on the mandatory nature of social work student participation in broad based university programming, and supporting the training of social work faculty across multiple specializations to drive broad adoption of ipe within the profession. references al-sheikh , m., & hmoud, m. 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(2007). framework for the development of interprofessional values and core competencies. https://ipe.utoronto.ca/sites/default/files/2012corecompetenciesdiagram.pdf wike, t., grady, m., massey, m., bledsoe, s., bellamy, j., stim, h., & putzu, c. (2019). newly educated msw social workers’ use of evidence-based practice and evidencesupported interventions: results from an online survey. journal of social work education, 55(3), 504-518. https://doi.org/10.1080/10437797.2019.1600444 vankuiken d. m., schaefer, j. k., hall, m. f., & browne, f. r. (2016). integrating interprofessional education into the curriculum: challenges and solutions for a university without a medical centre. journal of interprofessional care, 2, 5-11. https://doi.org/10.1016/j.xjep.2015.12.002 waggie f., & laattoe, n. (2014). interprofessional exemplars for health professional programmes at a south african university. journal of interprofessional care, 28(4), 368-370. https://doi.org/10.3109/13561820.2014.891572 walmsley, l., fortune, m., & brown, a. (2018). experiential interprofessional education for medical students at a regional medical campus. canadian medical education journal, 9(1), e59-e67. https://doi.org/10.36834/cmej.42175 west, c., graham, l., palmer, r., miller, m. f., thayer, e., studber, m., awdishu, l., umoren, r., wamsley, m., nelson, e., joo, p., tysinger, j., george, p., & carney, p. (2016). implementation of interprofessional education (ipe) in 16 u.s. medical schools: common practices, barriers and facilitators. journal of interprofessional education & practice, 4(september), 41-49. https://doi.org/10.1016/j.xjep.2016.05.002 world health organization [who]. (2010). health professions networks nursing & midwifery human resources for health: framework for action on interprofessional education and collaborative practice. author. https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng. pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 author note: address correspondence to keith adamson, factor-inwentash faculty of social work, university of toronto, 246 bloor street west, toronto. ontario, canada, m5s 1v4. email: keith.adamson@utoronto.ca https://doi.org/10.1080/13561820.2019.1586658 https://ipe.utoronto.ca/sites/default/files/2012corecompetenciesdiagram.pdf https://doi.org/10.1080/10437797.2019.1600444 https://doi.org/10.1016/j.xjep.2015.12.002 https://doi.org/10.3109/13561820.2014.891572 https://doi.org/10.36834/cmej.42175 https://doi.org/10.1016/j.xjep.2016.05.002 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 mailto:keith.adamson@utoronto.ca ___________ heather kanenberg, phd, lmsw, associate professor & bsw program director, roberta l. leal, phd, lmsw, assistant professor, and dr. stephen “arch” erich, phd, lcsw, professor emeritus, university of houston-clear lake. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 1-22, doi: 10.18060/22639 this work is licensed under a creative commons attribution 4.0 international license. revising mcphail’s feminist policy analysis framework: updates for use in contemporary social policy research heather kanenberg roberta l. leal stephen "arch" erich abstract: in 2003, mcphail published a feminist policy analysis framework concluding that the many available methods of policy analysis across disciplines, including social work, treated policies as gender-neutral compositions. mcphail (2003) asserted that these methods denied the many ways that institutions and policies of society are organized by the concepts of gender, therefore presenting incomplete products of analysis. this guiding purpose for the development of mcphail’s (2003) feminist policy analysis framework endures a full fifteen years later. in the years since publication of mcphail’s framework, advancements have been made in both feminist theory and in policy analysis methods. this conceptual article outlines a much-needed revision moving the framework into a contemporary position with the inclusion of a focus on privilege, oppression, and intersectionality. the revised framework presented herein is a more conceptually comprehensive and practical model for use by all, but particularly social work students and scholars. the revised model represents an update rendering it more effective in today’s polarized political climate as well as with the recently revised social work educational policy (council on social work education, 2015). a revised framework of feminist intersectional policy analysis is presented, including guiding questions and conceptual complexities to consider in the work of analysis. keywords: feminist; policy; analysis; intersectionality; social work policy analysis is commonly conceptualized as “neutral” and yet, this approach is inadequate in developing a full understanding of the policy under study (shaw, 2004). this central message was the guiding purpose for the development of the feminist policy analysis framework by mcphail (2003). the need to develop a method that acknowledges the way gender is used to organize societal structures, and is regulated through policies, is essential and relevant fifteen years after original publication (mcphail, 2003). in order to arrive at an accurate answer about the effectiveness of any given policy and its impact on society, scholars and practitioners must include explicit analysis of gender and gender identity, race, socio-economic status, sexuality, and more. applying theories and methods and moving beyond this neutral veil to directly address issues of gender and intersecting identities in relation to policy are necessary to allow for a deeper understanding of the systems and processes of oppression and domination (dill & zambrana, 2009; hankivsky & cormier, 2011). of primary concern is the capacity to address the reality that the public discussion over time has been dominated by white cisgender males which has resulted in a society filled with notions, policies, regulations, and conventions that are constrained and preferential (harding, 1998). https://creativecommons.org/licenses/by/4.0/ kanenberg et al./revising mcphail’s 2 mcphail’s feminist policy framework, as developed 15 years ago, is grounded in feminist theory and is a product of synthesizing multiple feminist analytic perspectives on policy (mcphail, 2003). as there is no one feminist theoretical perspective, neither is there one single approach to social policy analysis (dinitto, 2016; hyde, 2000; karger & stoesz, 2014; midgley, tracey, & livermore, 2000). grounded in feminist theory and social policy discourse, the mcphail framework is an appropriate fit for many analyses regarding process, goals, and outcomes. use of mcphail’s feminist policy framework to examine and identify issues within modern and historical policy allowed for the determination of the gendered nature of these structures to our society. the inquiry and study of policy through a feminist lens, resulted in well-crafted and feasible recommendations for reform that acknowledge women’s intersections with the policies and programs under study. the products of a feminist policy analysis provide a tool to aid social work researchers and educators, in ameliorating injustice both in practice and in the classroom, for those who are multiply-marginalized (e.g., transwomen of color, migrant women, incarcerated women). social work professionals are intrinsically connected to the community due to the nature of their educational preparation and the many roles they serve in the community. this results in social work professionals having a wealth of knowledge and foresight about the implications of policy change. even if not consciously, direct practitioners see the impact of policies, both positive and negative, every day on their clients. the misstep in policy development and advocacy occurs when social workers fail to develop the political will to share their insights and information with the decision-making authorities or to work to become the decision-making authority. despite this reality, social work professionals— whether they practice at the micro, mezzo, or macro level—have the acumen, training, and knowledge to synthesize research and experiential data to provide a richer, fuller, and more nuanced understanding of the context within which any policy operates. further, the multitheoretical training of the profession, coupled with the professional mandate to work toward advancing social justice, leaves social work professionals well-situated to do the work of policy analysis. in this article, we present a review and critique of policy analysis methods, including mcphail’s feminist policy analysis framework (mcphail, 2003). an explanation and integration of intersectional theories in the work of policy analysis is provided. critique of the historical and current analysis methods results in a needed revision to the mcphail framework. ultimately, a new conceptual framework known as the intersectional feminist policy analysis framework is presented for social work practitioners and scholars to use as they work to promote social justice for those who are multiply-marginalized. literature review feminist theories feminist theory has evolved over time to represent many standpoints which ultimately share some thematic similarities in both focus and intention. while not exhaustive, among the many feminist theoretical orientations there are: liberal feminisms, radical feminisms, socialist feminisms, lesbian feminist theories, cultural and ecofeminisms, postmodern feminist theories, global feminisms, black feminisms, and black feminist criticisms advances in social work, spring 2019, 19(1) 3 (crenshaw, 1989; hooks, 2012; mcphail, 2003). feminist theory has long focused on the issue of gender as well as other marginalized groups and elucidated the notions and implications of patriarchy in social interactions as well as social institutions. efforts to bring exploitation and domination to an end have been of primary concern for feminist scholars and activists (hooks, 2012). the feminist movement has altered the lived experience of society by asserting that laws and policy should embody awareness that women are the equals of men and are deserving of equal opportunities and rights (hooks, 2012). feminism resulted in a transformed experience of the economy, of employment, and social structures often at the cost or oversight of the varied experiences of those who represent multiple domains of diversity in their identities beyond gender (hooks, 2012). feminist theories have also offered a more revelatory analysis of the interconnectedness of gender, race, ethnicity, and class. these theories ask for all women -and all peopleto develop a critical consciousness that would allow for the analysis and dismantling of patriarchy and privilege which would shift traditional notions of “positions” in society. feminist theory is more productively conceived as a multifaceted, fluid undertaking than as a bounded field (hawkesworth & disch, 2016). feminist theories and feminist research are focused on challenging the assumptions about cisnormativity and heterosexuality as well as the primary constructs of gender, sex, and privilege as being some part of the natural stable identity (butler, 1998; hawksworth & disch, 2016). rather, these are political constructs that have been constituted over time including tenuous interactions among many, ultimately varying across domains of culture, time, social structures, and more. feminist theory is centered in the struggle to end sexist oppression (hooks, 2000) and has the power to transform all lives in profound and lasting ways. the goal is not to privilege any one group of women, a singular race/ethnicity, or class of women and does not privilege women over men. hooks (2000) asserts that race and class oppression should be recognized as issues with the same import as sexism if we are to engage in the struggle to end the ideology of domination that permeates social, economic, and political structures. to critically assess the injustices perpetuated by those with privilege and power, an emphasis has developed within feminist theory to analyze laws and policies granting rights, opportunities, privileges, and immunities to white men, cisgender individuals, those without physical or mental health conditions and those who were systematically denied to women, people of color, and people living with disabilities (hawkesworth, 1994). feminist scholars have levelled efforts at public law and public policy as a target for change for the past several decades (hawkesworth, 1994; marshall, 1999; mcphail, 2003). early feminist scholarship explored the historical experiences of women as autonomous beings with agency and as contributors to the social, political, and economic aspects of life. this trend has continued to add other perspectives such as: critical race theories, intersectionality theory, and feminist critical analysis. kanenberg et al./revising mcphail’s 4 intersectionality in two central pieces of scholarship crenshaw (1989, 1991) introduced the interdisciplinary theory of intersectionality. these pieces presented a theory rooted in the use of critical race theory and black feminism as a tool to understand the marginalization of black women within the antiracist theory as well as anti-discrimination law (crenshaw, 1989). in their work, crenshaw seeks to ensure political and social associations along the intersections of gender and race/ethnicity in our society do not distill down to one unit or exclude and marginalize those who are different (crenshaw, 1991). crenshaw asserts that work in both academic and political realms has branded one identity category as dominant (gender) and this has resulted in the use of social power to marginalize and oppress those who represent multiple undervalued identity positions in society. the theory of intersectionality in essence identifies groups at the intersection of two or more identity categories who are then included in an analysis rather than left out of focus and subsequent potential political action (crenshaw, 1989, 1991). crenshaw (1989, 1991) criticized previous theorizations of feminism for largely reflecting the ideas and oppression of white women, as well as, anti-racist doctrine for largely ignoring how issues of sex interact with race. in doing so, they specifically argued that looking at marginalization based solely on sex or race is inadequate to properly identify the concerns and needs of black women who experience discrimination on the basis of both gender and race. importantly, they identified specific examples of how the narrow interpretations of existing law and social policy ignored the multiple marginalization experiences of black women. thus, providing clarity that people who are marginalized in multiple ways (e.g., latinx women, transwomen of color, migrant women) are likely to have different experiences than those who suffer marginalization in only one dimension. crenshaw’s groundbreaking work has served as a foundation for the continuing theoretical development of the theory of intersectionality (hankivsky, 2018; nash, 2008). intersectionality has shown great promise as a means of improving our understanding of people and their status in society in terms of multiple relative oppressions and/or privileges (see corus et al., 2016; hankivsky, 2018; mansfield, welton, & grogan, 2014; pearson & jackson, 2000). in addition, intersectionality encourages critical reflection allowing researchers and decision-makers to consider the inherently complex relationships and interactions between relevant social factors. unlike its theoretical predecessors, intersectionality focuses on the voices that have not been heard; those who do not fit neatly into a particular social category. further undergirding this approach are those who have experienced discrimination, as intersectional theorists see them as having an epistemological advantage, that is critically important when creating a vision of a just society (matsuda, 1987). over the last 25 years, intersectionality has increasingly become connected with feminist thinking and practice (bastia, 2014; carastathis, 2014; marecek, 2016; yuvaldavis, 2006). for example, the common approach in social work is now accepted practice to consider a variety of biopsychosocial characteristics, as well as their cumulative effects at micro, mezzo, and macro levels as a result of the connection (hankivsky, 2012). moreover, the theory of intersectionality, integrated with feminist theory, has served as a advances in social work, spring 2019, 19(1) 5 conceptual base for studies analyzing the effects of discrimination that included multiplymarginalized persons who embody two or more of the following characteristics: sex, race, ethnicity, sexual orientation, gender, gender identity, nationality, age, physical ability as well as any other relevant statuses considered in combination with one another rather than independently (hankivsky, 2012). from an intersectional perspective, multiple relative oppressions as well as multiple relative privileges may be considered together. dill and zambrana (2009) explain this by pointing out that an intersectional analysis serves to reveal the way enmeshing of social systems play a role at the individual level in the way identity is performed, but also at the structural level in the many ways that inequalities and injustices are bred, cultivated, and extended. nash (2008) asserts that there have been minimal efforts to study subjective social positions that are either partially or wholly considered privileged. nash (2008) also notes that intersectionality has become a primary analytic tool for theorizing about identity and oppression while also questioning whether intersectionality is a theory of subjective marginalization or a general theory of identity. key characteristics of this paradigm, according to hankivsky and colleagues (2014), include the position that no life or lives can be reduced down into a single factor which describes identity. it is impossible to understand the depth of the lived experience and those living it by distilling focus onto or prioritizing any one characteristic or factor (hankivsky et al., 2014). this becomes even more challenging when considering those commonly considered categories or locations such as race, ethnicity, sex, gender, gender identity, sexuality, nationality, and physical ability; these are all social constructs that are fluid, dynamic, and ever-changing in response to what is transpiring in the environment, politics, and more (hankivsky et al., 2014). phenomena like power, place, and time are influencing each of those social locations that a person can possess and these locations in-turn influence the other social locations and identities leaving the interactions inseparable from the experience of the social structure. this interplay of the nuances of identity, this intersectionality, is then a focus of any work that is done to develop an understanding of oppression and discrimination. hankivsky (2012) argues that, the promotion of social justice and equity is of foremost importance and should be the goal when the intersectional paradigm is applied. this is exemplified when in the extensive efforts to use the theory of intersectionality as a conceptual basis for policy analysis, hankivsky (2012) identified the following guiding principles [considerations] for future researchers: “intersecting categories, multi-level analysis, power, reflexivity, time and space, diverse knowledges, social justice, and equity” (p. 35). despite intersectionality’s widespread acceptance as an improved way of understanding the lived experiences of multiply-marginalized people, there remain unresolved concerns. nash (2008) and hankivsky and cormier (2011) discuss a variety of concerns including ontological, epistemological, and methodological issues. for instance, intersectionality’s conceptual complexity and nuanced and fluid understanding of identity create practical concerns centered on what, how, and when to measure issues of interest (nash, 2008). carbado, crenshaw, mays, and tomlinson (2013), aptly point out that intersectionality cannot be applied in a perfectly comprehensive way with the assumption it will recognize and identify the intersectional powers and problems that trouble society. for example, as fausto-sterling (2012) posits, asking questions about the future of gender, kanenberg et al./revising mcphail’s 6 questioning the necessity of only two gender categories, and searching for deeper understanding of the link between sex and gender are the very questions that propel society into an advanced conceptualization of how intersectionality is flexible. indeed, just as differing levels of knowledge and awareness affect one’s ability to recognize privilege, power, and oppression, so too is the capacity to consider the ways those who are multiply marginalized experience social and cultural surroundings. it is through an in-progress consideration of intersectionality that scholars recognize the obligation to persist on an ongoing basis to move intersectionality to uncultivated domains (carbado et al., 2013). policy analysis policy analysis requires the systematic investigation of a social policy or set of policies and is clearly an influencing factor if not a driving force of social work practice (karger & stoesz, 2014). policy analysis can be used to review the interconnectedness of policies and gender and allows us to conceptualize and bridge the issues with their extensive fiscal and socio-political impact upon community well-being. public policy analysis (ppa) has been studied for decades and is now a branch of many academic disciplines including social work, political science, law, and economics (midgley et al., 2000). inquiry into social policy has many approaches and dozens of models of analysis are available for researchers (dinitto, 2016; dunn, 1994; gilbert & terrell, 2013; jansson, 2003; karger & stoesz, 2014; marshall, 1999; midgley et al., 2000). as dunn (1994) asserts, the goal of policy analysis is to ensure that the debates concerning policy and the discourse around relevant knowledge associated with policies in consideration, promotes both collective and individual understanding of policy analysis, and ultimately improve policies. through thorough analysis, a policy’s impact on target populations, other programs, and other social policies, as well as the administrative organizations implementing said policy, can be articulated and utilized to ensure that the most worthwhile solution is pursued (karger & stoesz, 2014). however, when policy research is conducted, the use of a systematic framework for analysis to inform the decision-making process helps to reduce costs and unintended and preventable injuries (amin et al., 2011; karger & stoesz, 2014). according to mansfield et al. (2014), the traditional approach to policy analysis has been linear and presumably absent of value judgements. the scientific application of policy analysis has been employed in a manner in which multidisciplinary frameworks have been devalued or ignored, thus their products have been lacking in nuance and depth (e.g., nation at risk, the american competitiveness initiative, & educate to innovate; mansfield et al., 2014). this misstep on the part of traditional models of analysis allows for a position of (false) neutrality, rather than inclusion, toward policies, which have actually acted to manifest discriminatory practices toward traditionally oppressed and marginalized groups (mansfield et al., 2014). for example, research has found that the economic policies which led to the united states’ 2008 great recession have compounded inequalities for these members of society across gender, family composition, race, among others (cingano, 2014). the voting rights act, in its constitutional history and legitimacy, has been re-interpreted in recent years to oversimplify and objectify the criteria within the nuanced legislation, as a means of suppressing voting for those who are older adults, persons of color, and people living in poverty (baldwin, 2015; levitt, 2017). current advances in social work, spring 2019, 19(1) 7 nondiscrimination policies at the state and local levels permit discrimination in employment and housing for nonbinary individuals and certain immigrant populations (movement advancement project & gladd, 2011). historical analysis of the new deal (dill & zambrana, 2009) reveals a nationally endorsed program of social insurance that provides generous benefits to disproportionately more white and male workers, while creating a concurrent state supported system of underfunded benefits for those who have inconsistency in their employment; a group comprised of primarily women and people of color (gordon, 1994). analyzing policies to best understand the potential manipulation of resources, the wielding of power, the manifestation of oppressive forces, and differential impact upon populations can result in a more just and equitable society. in short, policy analysis should not be an exercise in presumed neutrality, rather intentionality, otherwise we risk further marginalization and oppression of the most vulnerable members of society by failing to acknowledge the systemic privileges bestowed upon white, cisgender, ablebodied, native-born men. feminist policy analysis in contemporary policy analysis, the official authorities hold the positions of power and, therefore, possess the capacity to decide priorities for social, economic, immigration, educational, defense, regulatory, and healthcare policies (marshall, 1999). feminist scholars have long asserted that policy analysis is too often silent on the issue of gender as well as other variables of identity that lead to marginalization, resulting in traditional policy analyses with limited and contradictory understandings of the ways in which women’s lives are affected by policy (harding, 1986; shaw, 2004). feminist theory and its use of a holistic lens through which it views the interconnectedness of the material, social, spiritual, and intellectual components of the lived experience suggest it is well suited as a frame for scrutinizing social policy and resource allocation (robbins, chatterjee, & canda, 2006). feminist policy research brings gender into analytical focus, exploring the ways in which gender is constructed by the policies of the welfare state. it examines the role social policies play in ordering gender relations in a variety of contexts and environments (sainsbury, 1999). perhaps one of the most straightforward and germane assertions of feminist analysis is that it is impossible to understand the social policies of our society without appreciating how they deal with women and traditionally marginalized groups (pascall, 1997). feminist policy analysis also allows for critical review of those who create the policy as well as those targeted by the policy. without question, the themes emphasized in policy analysis conducted by social work professionals as well as the major tenet of feminist theories fuse together nicely as one analytically explores how the personal is political within any policy under review. lastly, by reviewing federal, state, or organizational policy with a feminist lens, outcomes and proposals for policy reforms are more likely to meet the needs of those using the programs and services. kanenberg et al./revising mcphail’s 8 the feminist policy analysis framework mcphail (2003) presented a framework of policy analysis from within the field of social work that moves beyond viewing the world in gender-neutral terms. their review of the mainstream policy analysis models of the time as well as the few feminist frameworks available led her to a chasm. seeing no clearly explained comprehensive framework to analyze policy with a “gendered lens” she developed one (mcphail, 2003). this framework of analysis includes a series of questions that are not without challenge to apply as they often conjure the tensions and controversies that stem from long-standing debates within feminist thinking (mcphail, 2003). nonetheless, mcphail’s feminist policy framework serves as a means for making women as well as other marginalized groups visible via systematic evaluation of social policy which ultimately has profound implications for society. mcphail’s feminist policy analysis was the first of its kind from the discipline of social work, with grounding in both feminist thought and systematic policy research. mcphail (2003) asserts that the goals underlying the framework include identifying the assumptions and stereotypes of women that are embedded in policy as well as ending the traditional patriarchal oppression of women. the process of analysis with mcphail’s feminist policy analysis framework is pursued in an effort to address power disparities between women and men with the ultimate goal of bringing a more equivalent balance of power and control between women and men (mcphail, 2003). underlying mcphail’s feminist policy framework are values shared by both feminist theorists and the social work profession. proceeding with feminist values of refusing to allow false equivalencies, rethinking power, appreciating the process equally with product, using women’s realities as the base from which to work, and acknowledging that all things personal have political roots, the framework upholds many of the six core values asserted by the national association of social workers code of ethics (mcphail, 2003; national association of social workers [nasw], 2017). in addition, mcphail’s feminist policy analysis framework is not entrenched in one feminist theoretical perspective (e.g., liberal, radical, black, social, lesbian). instead it is inclusive of questions and perspectives that can be shared by many feminist perspectives in an effort to honor multiple feminist identities and to enhance the product of the analysis. the final value inherent in mcphail’s feminist policy analysis framework is the assertion and acknowledgement that all policy affects women (mcphail, 2003). women are not just affected by public assistance and child care policy as is generally assumed. indeed, women are directly and differentially affected by policies regarding social security, homeland security, immigration, mental health, education, healthcare, and tax policies. the feminist policy analysis framework developed by mcphail (2003) is a collection of questions to be asked of a policy and constitutes a systematic feminist analysis. the questions provided explore major themes of feminist analysis which are the issues of equality; special treatment and protection; the myth of gender neutrality; multiple identities; context of the policy; language; rights and responsibilities; the symbolic versus the material; role equity and change; and the access to/assignment of power (mcphail, advances in social work, spring 2019, 19(1) 9 2003). ultimately, this was an effort to be purposefully inclusive of those who experience marginalization. revising mcphail’s feminist policy framework as is asserted by mcphail (2003), not all questions in the framework are always relevant and many are dependent upon the policy being studied. in addition, the list of questions in the feminist policy framework is not exhaustive, as it would be impossible to develop one list that is considered a comprehensive analysis for all social policies. there have been advancements in the way policy is conceptualized in the past 15 years. in addition, feminist and intersectional theories and thinking have evolved and changed in the decade since the original publication of mcphail’s feminist policy framework (mcphail, 2003). recognizing these factors, the feminist policy framework has been revised in a move toward more inclusively reflecting the most current understandings of social issues, lived experiences, social contexts and structures, the certainty of multiple marginalization in today’s society, and more. the fundamental feminist lens used in shaping mcphail’s original feminist policy framework and the themes identified as key elements of the framework remain. this revision of mcphail’s original feminist policy analysis framework into the new intersectional feminist policy analysis framework is an effort to bring intersectional theories to bear on policy frameworks to make them more inclusive. there was a decision to tether the assessment to a focal point at the center – gender – while risking the critique of essentialism. in this intersectional feminist policy analysis framework, the intersectional qualifiers come after the identification of woman to speak of the multiple categories of human experience. while some might advocate for an annihilation of the existing systems of categorization, from a social policy standpoint, such an act would not serve the current goal of bringing more and more people into a state of recognition and inclusion by the state. revisions to the framework: patriarchy/gendered policy questions of relevance, necessity, and feasibility have led to the removal of some questions and alteration of the original mcphail framework (2003). there were questions outlined in the original equality, special treatment/protection, context, material/symbolic reforms, and other sections that were included in other areas, deemed irrelevant, or inconsequential to an analysis of social policies of today and, thus have been removed from the original model. edits in the form of additional areas of analysis are centered on the feminist and intersectional tenets of patriarchy and oppression. revisions to the original framework include adding the terms gendered policy and oppression to the guiding questions of the framework. the term gendered, is often defined as specifically relating to, preferencing or biased toward one gender (new oxford american dictionary, 2001). gendered policy is a term used in policy analysis and particularly feminist policy analysis. it relates to policies with differential impact upon men and women revealing cisgender normativity and binary understandings of gender. one difficulty in advancing the understanding of gendered policy is the nature of the current kanenberg et al./revising mcphail’s 10 approach to policy discourse which understands gender equality as gender neutrality and refuses to acknowledge the presence and influence of patriarchy (breitkreuz, 2005). this means caregiving, family responsibilities, and the economic implications of these issues are assumed to be the same for men and women (breitkreuz, 2005). as has been articulated, the inequalities that exist in the economic opportunities afforded to women and men result in a significant disadvantage for women (breitkreuz, 2005). however, use of the typical and traditional methods of policy analysis does not yield the requisite information. the more traditional methods of analysis do not account for the impact of gender/gender identity in the ways that policies affect the populous (sapiro, 1990). frequently, patriarchal and paternalistic understandings about the nature and influence of gender are embedded in the policies and these are not highlighted or identified. in addition, there is often an assumption of cisgender as the norm and the foundation upon which policies are built. the resulting products of the traditional models of policy analysis offer incomplete understandings of how social policies impact women – cisgender and transgender – and nonbinary individuals and the ways in which their wellbeing is linked to the general welfare of society (sapiro, 1990). jordon (2006) drawing on the work of esping-anderson set the stage for improving gendered policy analysis by ensuring it clearly addressed the effects of patriarchy. an emphasis in policy analyses on the ability of civil and social systems to empower women (while delineating transgender and cisgender distinctions) and liberate them from oppressive patriarchal family relationships (dill & zambrana, 2009; hankivsky, 2012; jordan, 2006) promotes a richer more authentic understanding of ways in which we can promote women’s freedom and autonomy. ultimately, an improved gendered policy analysis strips out assumptions and brings the differential treatment of women and men into focus (hyde, 2000). additionally, gendered policy analysis can help to name the cisgender normativity and binary understandings of gender that permeate social, economic, and health policy. by engaging in an analysis and identification of gendered policy, one is able to detect the consequences of customary and established approaches and the methods by which they serve the patriarchal structure of the state (hankivsky & cormier, 2011; hyde, 2000). social policies make possible the reproduction of gender norms and roles and binary understandings of gender, thus supporting male privilege within a cisgender assumption of culture (hyde, 2000; movement advancement project & gladd, 2011). perhaps of primary importance as one attempts a feminist intersectional policy analysis is recognizing the bulk of the social policies that affect cisgender and transgender women most intensely are not aimed at them as a primary subject, but through them (sapiro, 1990). revisions to the framework: oppression the concept of oppression has been the focus of volumes of study which explore issues of difference from race and gender to class and physical ability (anderson & collins, 2004; freire, 1970; ore, 2006; robbins et al., 2006; turner, singleton, & musick, 1987). in their formative work, the pedagogy of the oppressed, friere (1970) begins the work with a conceptualization of oppression as dehumanization or the theft of humanity and justice from individuals or peoples. this thievery of humanity serves as a barrier or impediment advances in social work, spring 2019, 19(1) 11 to the process of becoming more completely human for those subjected to oppression (friere, 1970). turning now to the profession of social work and its focus on oppression, gill (1998) proceeds with an understanding of oppression as “…a mode of human relations involving domination and exploitation economic, social, and psychologic between individuals; between social groups and classes within and beyond societies" (p. 10). further, gill (1998) views oppression as a dynamic process that affects virtually all interactions and relationships when woven into our culture, systems, and structures. oppression is a central term of political discourse and is not often used in the mainstream as it is incompatible with the expression of individualism that dominates our societal and political structures (van wormer, 2004). oppression is personal and political as it relates to the impact of exploitation upon people (van wormer, 2004). mcphail’s original feminist policy analysis framework is changed here using oppression as defined by turner et al. (1987) and frye (1983) in their similar conceptualization of the term. turner and colleagues (1987) articulate that oppression is best understood as a systematic denial which results in the inability of people to access the goods, services, and resources of their surrounding communities. they also assert, at the procedural level oppression constitutes explicit actions by a group of individuals that are intended to leave or push people into a subordinate position in society (turner et al., 1987). building on frye’s (1983) definition, johnson (2006) further asserts that oppression may include factors such as social relationships between subordinate positions in society and in order for an individual to feel oppressed they must also belong to an oppressed category. in addition, oppression can vary in intensity, the more thorough the denial of power, tangible resources and assets, and privilege, the more intense the oppression (turner et al., 1987). frye (1983), a foremost feminist theorist focusing on the concepts and constructs of oppression, explains oppression as a dichotomous experience that both attracts and resists. frye (1983) notes that the word "oppression" is rooted in the concept of pressing and that “something pressed is something caught between or among forces and barriers which are so related to each other that jointly they restrain, restrict or prevent the thing’s motion or mobility” (p. 2). restraining subordinate groups to “fit” a culturally defined category forces those who are members of an oppressed group to be perceived as an outsider (johnson, 2006). the concept of restriction and preventing access to resources or movement and mobility in one’s lived experience echoes the work of turner et al. (1987). when lived experiences of whole groups are ignored, options and opportunities are denied or nonexistent (dill & zambrana, 2009). frye (1983) presents the concept of the double-bind as the experience of oppressed people(s) who are forced into situations with very few solutions and each of these solutions is certain to result in deprivation, disadvantage, or condemnation. frye’s (1983) feminist lens draws attention to women as an oppressed population and asserts that there are systematic forces and obstacles that make women vulnerable and highly susceptible to penalties, loss, and disapproval. she provides examples of such double binds which constrain women’s lives including “whether one works outside the kanenberg et al./revising mcphail’s 12 home or not, is on welfare or not, bears children or not, raises children or not, marries or not, stays married or not, is heterosexual, lesbian, both or neither…” (p. 4). each of these and many other factors in women’s lives serve to limit the potential and feasibility of any alternative due to the tensions in which they exist and the consequence each factor carries (frye, 1983). using social factors, such as gender, to define standards for humanity reduces people to a single dimension further excluding oppressed groups and potentially leading to ideas or experiences of inferiority (johnson, 2006; ore, 2018). when analyzing the lived experience of those oppressed, they are best understood as living in a cage in which all possible options include seemingly insurmountable barriers that result in restricted movement and immobilization. these forces and barriers are intentionally built into the structures that bind the person to their circumstances and prevent mobility to a status of power or privilege. frye (1983) indicates, when one is reviewing policy, society, community, social experiences, and more it is possible to engage in such analysis while failing to recognize factors which cage and oppress women. negative meanings and values assigned to these factors lead to assumptions that being female is harmful (ore, 2018) thus making it essential to consider such experiences in any analysis. to honestly identify oppression, according to frye (1983), it is necessary to look beyond essentializing moments or experiences and to use a systemic lens. doing so allows one to view the full context of the structure recognizing the interrelatedness of the forces and phenomena which are systematically associated resulting in the immobilization of women. intersectionality challenges traditional modes of knowledge (dill & zambrana, 2009) allowing for a more fluid understanding of lived experiences of and structures surrounding those in oppressed groups. revisions to the framework: integrating intersectionality it is important to acknowledge the fluidity and nuance in the lived experience of any one person as a result of policy implementation. further an emphasis on understanding the many ways inequality is perpetuated through policy is at the heart of any policy analysis informed by intersectional theory. identity is complex and includes membership in multiple groups as well as individual characteristics; identity is not singularly shaped by the race, class, ethnicity, gender, gender identity/expression, physical ability, sexuality, religion, nationality, migration status, incarceration history, and more (dill & zambrana, 2009). instead, there is a combination of all characteristics which impact the lived experiences of people and results in some statuses as more valued or privileged than others in our hierarchically organized social structures (dill & zambrana, 2009). when one engages with an analysis informed by intersectional theory, the resulting knowledge is generated from and about oppressed groups. it is essential to look at the social locations of those impacted by the policy and the ways in which the policy might advance or perpetuate systems of inequality. this knowledge makes obvious the domains of power present in our society and the many ways in which oppression is ordered and preserved through multiple aspects of identity concurrently (crenshaw, 1991; dill & zambrana, 2009). table 1 integrates intersectionality into mcphail’s original feminist policy analysis framework. the new additions are indicated by italicized text. advances in social work, spring 2019, 19(1) 13 table 1. the intersectional feminist policy analysis framework* intersectional identities a. how do diverse and intersecting identities such as gender, race, ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability, interact with other identity categories? b. are white, middle-class, able-bodied, cisgender, heterosexual women the assumed standard for all women? c. how are systems of power and inequality (racism, classism, colonialism, cisnormativity, heterosexism) used to control or oppress those who occupy different social locations? d. does the policy address the multiple identities of women? the multiple oppressions an individual woman may face? state-market control a. does the policy oppress women who experience multiple levels of inequality due to their identity by creating a double bind for women with regard to the issue of labor? are women limited and/or constrained in their participation in the labor market due to the policy (e.g., eligibility criteria, benefits, geographic limitations, wait lists)? b. is the unpaid and/or underpaid labor and work of caring provided by vulnerable groups considered and valued or taken for granted? is there wage theft or subordination of workers transpiring? c. does the policy contain elements of social control of cisgender women, transgender women, nonbinary individuals, migrants? are there other social locations of women that result in social control of their identity due to devaluing or creating of additional inequalities? d. does the policy replace the patriarchal male with patriarchal state? e. how does the policy mediate gender relationships between the state, market, and family? for instance, does the policy increase different groups of women’s’ dependence on the state or men? if so, which women (race, ethnicity, class, sexual identity, gender identity/expression, religion, national origin, documentation status, migration status, carceral status, ability/disability, and more) are impacted most? f. what is the policy’s view of women as charity recipients vs. worker-citizens? paying special attention to women’s identities along lines of race/ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability, or other identity categories. kanenberg et al./revising mcphail’s 14 table 1. the intersectional feminist policy analysis framework* equality a. does the policy achieve gender equality? is there equality of results or disparate impacts? is there inequality between cisgender and transgender or nonbinary individuals? b. does the policy treat people differently in order to treat them equally well? does the policy consider gender differences and resultant discrimination based upon race, ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability in order to create more equality? c. if the positions of women and men were reversed, would this policy be acceptable to men? special treatment/protection a. does any special treatment of women and those who occupy different social locations (race, ethnicity, class, sexuality, etc.) cause unintended or restrictive consequences? b. is there an implicit or explicit double standard regulating the lives of women who represent varied race, ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability identities? c. does being labeled different and special cause a backlash that can be used to constrain rather than to liberate women? gender neutrality a. does presumed gender neutrality hide the reality of the gendered nature of the problem or solution? context a. are women clearly visible in the policy? b. does the policy consider the historical, legal, social, cultural, and political contexts of women’s lives and lived experiences both now and in the past? c. does the policy make an “essential woman” visible (white, able-bodied, cisgender, and privileged) while leaving others in shadow? coming out of theories of essentialism where ‘essence’ forms ideas around entire categories and becomes a way of making problematic blanket statements. d. is the white, cisgender, heterosexual, able-bodied male experience used as a standard? are results extrapolated from male experience and then applied to women? how are the specifics of a variety of women’s experiences centered to inform the policy (i.e. how are the intersections of a woman’s identity brought to light in the policy?)? e. have the programs, policies, methodologies, assumptions, and theories been examined for bias at the intersections of gender race/ethnicity, sexual identity, cis-privilege, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability identity? f. is women’s biology treated as normal rather than as an exception to a male-defined norm? is womanhood not defined in biology? are transgender women treated as equal to cisgender women? advances in social work, spring 2019, 19(1) 15 table 1. the intersectional feminist policy analysis framework* language a. does the language infer white, cisgender, heterosexual, able-bodied male dominance or female invisibility? b. are gendered expectations and language encoded in the policy? are those expectations present cisnormative? c. is there acknowledgement of multiple identities (race/ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability) present in the language of the policy? equity/rights and care/responsibility a. is there a balance of rights and responsibilities for women and men in this policy? how are multiply marginalized groups rights and responsibilities acknowledged in the policy? b. does the policy sustain the pattern of men being viewed as public actors and women as private actors or does the policy challenge this dichotomization? are there groups made invisible based on their race/ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability identities within the policy? c. are women penalized for either their role as wives, mothers, or caregivers or their refusal to adopt these roles? d. does the policy pit the needs of women against the needs of their fetus or child(ren)? does the policy address the needs of certain women but not others? are certain fetuses/children valorized while others are deemed punishable? e. does the policy oppress women by creating double binds for women with regard to physical and psychological well-being? a. does the policy limit and or restrict women’s access to healthcare and behavioral healthcare? b. do women experience restrictions to their children’s access to healthcare and behavioral healthcare and/or restrictions to access to healthcare and behavioral healthcare for their families as a result of the policy? c. are there other social, economic, logistic, or environmental forces specifically related to the policy that create a double bind for women related to physical and psychological well-being? material/symbolic reform a. is the policy merely symbolic or does it come with provisions for funding, enforcement, and evaluation? b. are special interest groups involved in overseeing the policy implementation? how do those in power over the policy implementation get to their position (hired, government appointment, etc.)? do those with power represent a diversity of perspectives and identities? c. is litigation possible to refine and expand the law’s interpretation? d. what is the strength of authority of the agency administrating the policy? e. is there room to transform a symbolic reform into a material reform? how? kanenberg et al./revising mcphail’s 16 table 1. the intersectional feminist policy analysis framework* role change and role equality a. is the goal of the policy role equity or role change? b. does the type of change proposed affect the chance of successful passage? c. does the policy impact women’s economic autonomy as a step toward equality? does it pay special attention to the differences of women along their race/ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, and ability/disability identities? power analysis a. are women representing diversity along race/ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability identities involved in making, shaping, and implementing the policy? b. does the policy work to empower women of varying race/ethnicity, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, ability/disability identities? c. who has the power to define the problem? what are competing representations of the problem? d. how does this policy affect the balance of power? are there winners and losers? is a win-win solution a possibility? other a. is the social construction of the problem recognized? what are alternate representations of the problem? b. does this policy constitute backlash for previous policy gains for multiply marginalized groups? c. how does intersectional feminist scholarship inform the issue? d. what organizations representing women of color and women with differing identities were involved in the policy formulation and implementation? was there consensus or disagreement? e. where are the policy silences? what are the problems for women of color, women with disabilities, immigrant women, formerly incarcerated women, queer women, trans women, and more that are denied the status of problem by others? what policy is not being proposed, discussed, and implemented? f. how does the policy compare to similar transnational policies? are there alternative models that can be learned from and borrowed from? g. does the policy blame, stigmatize, regulate, or punish women? or does it specifically blame, stigmatize, regulate or punish, marginalized groups of women such as poor, queer, trans, undocumented, incarcerated, and/or abused women of color? * intersectionality is woven throughout mcphail’s original feminist policy analysis framework using italicized font. conclusion when undertaking an analysis of policy, it is requisite that the efforts stem from a position of understanding the multiple identities which interact and impact each member advances in social work, spring 2019, 19(1) 17 of society. as was stated at the world conference against racism, racial discrimination, xenophobia and related intolerance (2001): an intersectional approach to discrimination acknowledges that every person be it man or woman exists in a framework of multiple identities, with factors such as race, class, ethnicity, religion, sexual orientation, gender identity, age, disability, citizenship, national identity, geo-political context, health, including hiv/aids status and any other status are all determinants in one’s experiences of racism, racial discrimination, xenophobia and related intolerances. (§119) by altering mcphail’s feminist policy analysis framework to be informed by an intersectional approach, we underscore the many concurrent interactions of discrimination as a result of the multiple identities that define people. the manifestation of these forces of multiple marginalization in policy become clear to the analyst. this work requires that the researcher, highlight the many ways in which discrimination and marginalization can occur in the lives of people subjected to and subjugated by the policies under review. it is the responsibility of the researcher to make present and visible the historically underrepresented and oppressed by focusing on the complexity of social policies and the structures used to promote inequality (dill & zambrana, 2009). to be clear, there is no singular characteristic of identity (race, class, gender identity, sexuality, nationality) that can explain the human condition without understanding its connection to other characteristics (dill & zambrana, 2009). thus, our efforts to frame the revised model of analysis in terms of understanding race, ethnicity, class, gender, gender identity, sexual orientation, and those who are multiply marginalized, will always fall short. it is a beginning, an advancement over other models and methods of analysis, designed to prompt analysts to consider the complexity of identity and its contribution to inequality when situated in the social structures of today’s society. when considering how to help advance the understanding of current and future social work professionals, the curriculum is a key tool by which we can reach students. the council on social work education (2015) declares that, the purpose of the social work profession is to promote human and community well-being. guided by a person-in-environment framework, a global perspective, respect for human diversity, and knowledge based on scientific inquiry, the purpose of social work is actualized through its quest for social and economic justice, the prevention of conditions that limit human rights, the elimination of poverty, and the enhancement of the quality of life for all persons, locally and globally. (p. 2) in pursuit of social justice and improving quality of life, there are several competencies identified that students of social work, graduating from accredited programs, should have mastery over. there is an expectation that students will complete their social work education with mastery in improving human rights, as well as social, and economic, justice. students are also expected to demonstrate mastery in the ability to use research to guide their practice as well as using their practice wisdom to then shape the exploration of new scientific understandings of their work (cswe, 2015). there is also a requirement that kanenberg et al./revising mcphail’s 18 students of social work are prepared to engage in the work of understanding policies and their impacts (cswe, 2015). competency in each of these areas of practice and/or skill sets requires that students have awareness and abilities with understanding social policies and social structures. having the skills to engage in an intersectional feminist policy analysis, rooted in an understanding of the multiply marginalized groups of society will allow students to be informed advocates as well as agents of change. it is an opportunity to ensure the curriculum of any program helps students to advance their knowledge of the most current understandings of the way social structures and forces influence the well-being of people who represent diversity of race/ethnicity, age, sexual identity, gender identity/expression, class, religion, national origin, documentation status, migration status, carceral status, and ability/disability identities. additionally, the outcomes of an intersectional feminist policy analysis will provide the data and evidence needed to support efforts for social change. the clearly articulated, ordered, intersectional feminist policy analysis framework lends itself to the classroom and use with students as it provides a concrete outline to guide the new student in their endeavors. by focusing on the intersectional feminist policy analysis framework faculty will be able to explain how questions, for which the default is not the white, cisgender, heterosexual, able-bodied male, advance critical thinking and leads to a more nuanced understanding of those who are multiply marginalized as well as the concepts of privilege and oppression. references amin, m., maclachlan, m., mannan, h., el tayeb, s., el khatim, a., swartz, l., … schneider, m. 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(2006). intersectionality and feminist politics. european journal of women’s studies, 13(3), 193-209. doi: https://doi.org/10.1177/1350506806065752 author note: address correspondence to: dr. heather kanenberg, associate professor, university of houston-clear lake bsw program, 2700 bay area blvd, box 22, houston, tx 77058. email: kanenbergh@uhcl.edu https://doi.org/10.1080/00221546.2004.11778896 https://doi.org/10.1093/sw/30.5.461 https://doi.org/10.1093/bjsw/bcl096 http://www.un.org/wcar/durban.pdf https://doi.org/10.1177/1350506806065752 mailto:kanenbergh@uhcl.edu ______________ maureen rubin, ma, msw, ph.d., director, calming chaos co., burr ridge, il. lisa de saxe zerden, msw, phd, senior associate dean for msw education john a. tate early career scholar for children in need unc chapel hill school of social work chapel hill, nc. lisa e. mcguire, msw, phd, social work department head, james madison university, harrisonburg, va. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), i-x, doi: 10.18060/24406 this work is licensed under a creative commons attribution 4.0 international license. editorial leveraging the power of social work through interprofessional education maureen rubin lise de saxe zerden lisa mcguire interprofessional education (ipe) “occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (world health organization [who], 2010). with a commitment to foster collaborative practice, social work faculty have provided leadership in incorporating ipe in social work and other discipline’s curricula and training for more than a decade (konrad et al., 2017; nimmagadda & murphy, 2014; jones & phillips, 2016). yet, now more than ever, as the country and world grapple with responding to the covid-19 pandemic and the resultant deleterious impacts on society, effective collaboration has never been more critical. likewise, the black lives matter (blm) movement has impacted the nation as the country reckons with racial and social disparities across every sector of society. the impetus for this special issue pre-dated the covid-19 and blm momentum; however, the 19 papers included in this special issue highlight the interconnected nature of social conditions across systems that necessitate interprofessional, coordinated responses. this special issue reinforces the importance of collaboration, teamwork, inclusivity, and diversity. the power of social work, in partnership with other professions and/or disciplines, in communities locally and globally is essential to effectively meeting some of society’s greatest challenges. context of ipe in social work across many fields of practice, social workers have been involved in collaborative practice, likely since the founding of the profession. recent findings from the national academies of science, engineering, and medicine (2019) consensus study focuses on the need to integrate social care in health care delivery and serves as an important milestone for the profession to be recognized as an integral part of improving the nation’s health. although ipe has been around for several decades, in the late 1990s and early 2000s, health systems began to identify the vital need for improved outcomes across several complex health challenges (who, 2010). the social work profession saw a renewal in how their perspective was valued to address complex and intersecting social conditions. as social determinants of health came to be more understood as driving factors in inequitable outcomes, social work has seen growth in how others recognize the value of the social work profession. it has become increasingly apparent that systemic change is needed and requires social work’s expertise to promote and renew health and wellness in the lives of individuals, families, groups, and communities as well as to impact policy development. the emphasis on the social determinants of health has led to a renewed emphasis on ipe in social work programs and the education of future practitioners. in 2015, ipe was formally introduced to the profession in the educational policy and accreditation standards (epas). inclusion in epas signaled that ipe is an essential component of required social work competencies to prepare students for https://creativecommons.org/licenses/by/4.0/ rubin et al. et al./leveraging the power of social work ii professional practice. in 2016, the council on social work education (cswe) became a member of the interprofessional education collaborative (ipec), which included the profession’s voice on par with other health professions to promote, encourage, and support collaborative practice. recently, social work has joined with 23 other professions to communicate and collaborate among their accrediting bodies to develop quality ipe (health professions accrediting collaborative, 2019). social work involvement in ipe and collaborative practice initiatives has been evident over the years as early adopters participated in and “voiced” the role of the profession in formal professional networking opportunities such as the nexus summit (held annually in minnesota and co-hosted by the national center for interprofessional practice and education), the american interprofessional health collaborative (aihc), and the national collaborative on improving clinical learning environments (ncicle), or the all together better health (atbh), an international conference (held biennial) organized by the interprofessional.global. in 2018, the chair of the cswe council on conferences and faculty development, along with ipe leaders across the nation, worked to develop a one-day summit on ipe in conjunction with the annual program meeting, organized by cswe. thought leaders were invited to share their work and discuss ways to advance ipe within social work education and bolster ipe with other professions to foster collaborative practice. one of the outcomes of this summit was a call for a special issue dedicated to social work’s role within ipe. thus, advances in social work agreed to publish a special issue on social work and ipe as a way to collate empirical work, advance the professions’ leadership in the field, and explore applications of ipe and collaborative practice across the micro-macro continuum. this special issue highlights how the integration of social work with other disciplines has advanced innovative programs, resulted in novel teaching activities and learning opportunities, and promoted shifting perspectives to embrace client and community well-being. furthermore, as is described within the included articles, ipe is presented as a way for learners and practitioners to gain insight into their own professional identity and to identify ways to partner in a mutually respectful professional engagement. interestingly, in alignment with epas 2015, we noticed that the terms “interprofessional” and “interdisciplinary” were used interchangeably as we have seen in some of the included articles. smith and clouder (2010) provide clarification on the differences and similarities of the terms “interdisciplinary” and “interprofessional” in their analysis of various definitions used by scholars from different vantage points over the years. disciplines can be understood as a branch of learning or field of study that typically includes theoretical and methodological contributions whereas “professions” are associated with “ideology….occupation or career, vocation, or calling, which involves advanced or specialized knowledge” (p. 2). professions have values, beliefs, and ethics and fall within official regulatory bodies, and often involve licensing of some kind to serve the public (smith & clouder, 2010). webster’s dictionary defines interprofessional as work “occurring between or involving two or more professions or professionals” while interdisciplinary is defined as “involving two or more academic, scientific or artistic disciplines.” in this issue, we conceptualize “interprofessional” as being inclusive of social work, health and allied professions, and “interdisciplinary” encompassing business, art, technology, and others that may fit the definition of a discipline. advances in social work, summer 2020, 20(2) iii social work everywhere the literature and evidence to support ipe in social work is emerging and shows promise as demonstrated by the array of articles within this special issue. social work programs have been creative in collaborating with units across campus, between and among other campuses, and through community partnerships to infuse ipe in numerous ways to enhance collaborative practice and develop collaborative practitioners. while ipe is most frequently cited within health care or clinical settings (thistlethwaite et al., 2010; zwarenstein et al., 2000), as guest editors, we were purposeful to include examples of ipe that partnered with other fields such as nursing, law, oral health, recreational therapy, public health, pharmacy, and others, to highlight the breadth of social work practice across the life course, micro-macro continuum, in the u.s. and internationally. readers will see applications of ipe concepts developed and applied in various settings that include physical and behavioral health, child welfare, geriatrics, human trafficking, public libraries, and policies. in this regard, social work, along with other professions, contributes in settings everywhere. within this issue, we are pleased to highlight the conceptualization, design, and implementation of core social work values across sectors. one of the highlights of this special issue includes the diversity of articles published and their approach to furthering the social work profession’s impact through interprofessional efforts across the micro, mezzo, and macro continuum. as guest editors, categorizing the following papers was not an easy feat given the unique features of each article but also their shared similarities— mainly in promoting how the social work voice enhanced efforts and contributed to solutions. however, in an effort to capture common themes and extend social work’s role in ipe and collaborative practice in a systematic manner, we have organized this special issue around four broad domains: (a) ipe and curricula exemplars, (b) simulation and field education, (c) macro practice and policy, and (d) social work leadership. ipe and curricula exemplars mapping accreditation standards to curriculum and to the granular level of courses ranging from foundation to advanced levels is a comprehensive task in social work education. the transition to competency-based education in social work in 2008 (cswe, 2008) provided an impetus to measure knowledge, values, and skills that students need to demonstrate to progress through the program. the 2015 epas (cswe, 2015) has nine competencies and ipe is included in competencies 1, 6, 7, and 8. for example, competency 8 states “…social workers value the importance of inter-professional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary, inter-professional, and inter-organizational collaboration.” one method of providing ipe content in social work education is through a dedicated course. as an exemplar, mulvaney and colleagues describe a course addressing the needs of older adults focusing on the practice, knowledge, and skills of health professions students across nine disciplines. this article describes a competitive, gamified team-based learning approach and other experiential learning opportunities for students to improve practice skills in geriatric care. within the special issue, two articles focus on the curricular rubin et al. et al./leveraging the power of social work iv response to the opioid epidemic. kim, elze, and ohtake describe how a case-based discussion enhanced social work students’ attitudes and self-efficacy measured by pre-andpost-test ratings. ipe was offered through the office of interprofessional education with support from schools of medicine and biomedical sciences, dental medicine, nursing, pharmacy and pharmaceutical sciences, public health and health professions, and social work. stoddard-dare and colleagues discuss how a large ipe training event for social work, pharmacy, medicine, nursing, occupational therapy, physical therapy, and speechlanguage pathology students facilitated participants’ critical thinking about pain management and reversing opioid overdose trends in their state. given the multifaceted ways people with substance misuse interact with a variety of service systems and health professions, these papers demonstrate how addiction cannot be effectively addressed in silos as well as how ipe engagement is a step towards improved service delivery. these articles may help readers replicate something similar within their social work programs to address the complex challenges of substance misuse. several of the papers highlight innovative programming, assessment, and student engagement activities to strengthen ipe and enhance collaboration. for instance, giesler and colleagues describe how the specialized needs of children and families in rural southeastern idaho have been interprofessionally addressed by students in an ipe course for more than 30 years. the knowledge, impact, and competency gains of students involved in this course serve as an exemplar, while also providing a focus on the unique needs of rural communities. levine, sutherland, and janzen apply ipe concepts to the child welfare and school systems to work within these large systems to improve services to highly vulnerable children. simulation and field education as field education is the signature pedagogy of social work education, students must learn to apply knowledge gained through their courses to demonstrate their social work values and skills, as well as their cognitive and affective processes in practice (cswe, 2015). realistically, not all field placements are able to provide opportunities to facilitate students to master competency in all nine areas; hence, some educators have enhanced students’ ability to gain required competencies by using simulation experiences. field education and simulation are fertile opportunities for innovative ipe learning endeavors with several other professionals. while ipe has been emphasized in federal grants such as the health resources service administration behavioral health workforce education and training grants (bhwet) for msw students (fraher et al., 2018; mancini et al., 2019; rubin & kilgore, 2020; zerden et al., 2017), several manuscripts in this special issue operationalize what this means for students and field instructors. padykula, berrett-abeb, and haven conducted a needs assessment to prepare agencies more systematically for integrated, interprofessional education realities to enhance the quality of field education for bhwet trainees. another paper related to field placement by clarkson-hendrix and warner examined students’ satisfaction with integrated behavioral health field placement experiences with other disciplines. also, within field education, kozakiewicz, pope, and battjes describe a program from the michigan state university school of social work to train future social workers advances in social work, summer 2020, 20(2) v and lawyers from an interprofessional perspective through a variety of community-based advocacy projects that involve law and social work services for children. preliminary results are promising and demonstrate how this program has achieved intended outcomes across a variety of stakeholders. likewise, copenhaver and crandell-williams focus on the role of ipe at the bachelors level, something that is often overlooked within the literature. in this study, undergraduate social work and nursing students participated in clinical supervision groups during their field experiences. quantitative and qualitative results demonstrated student-participants enhanced their interprofessional knowledge and communication skills. another example that reinforces the need for communication and collaboration skills can be found in it’s time to go! unfolding interprofessional simulations to health care communications by kolomer and cunningham. in this work, students from three healthcare disciplines participated in simulations with patient actors to increase communication and collaboration skills used in hospital discharge planning and follow-up care in a home setting. relatedly, hitchcock and colleagues’ paper titled using a standardized patient model for interprofessional team training in social work focused on a single-session training for the development of a treatment plan, using a case study augmented with video technology and the use of standardized patients. macro practice and policy as a profession that has long embraced an ecological perspective and has worked to facilitate change across system levels, it is exciting to see the concepts of interprofessional collaborative practice and ipe applied beyond direct service situations and to include human rights, policy practice, and community development. this special issue highlights several unique and innovative partnerships to address important challenges facing our society. one such example was operationalized by deluca-acconi, velazquez, rabeno, and graham who describe a curriculum in partnership with a human rights organization to better prepare the next generation of advocates. they engaged in ipe with bsw students to understand, defend, and advocate for human rights and the pursuit of systemic change. likewise, in the creation of a human trafficking course: interprofessional collaboration from development to delivery, lucio, rapp-mccall, and campion describe how they successfully delivered a course on human trafficking to a non-profit agency in africa using an asynchronous, online, interprofessional course. the authors describe the life cycle of the project from conceptualization to implementation and conclude by sharing initial impacts of their efforts. social work has been integrated into community practice and non-traditional settings, which underscores the social considerations emerging in places that have not always understood what the profession brings to the table. soska and navarro’s efforts to bridge social work professionals and social work services within public libraries describes how this partnership has been successful in efforts across the country and how to further encourage this type of interprofessional collaboration throughout communities across the country. rubin et al. et al./leveraging the power of social work vi social work leadership an exciting group of articles highlight the important leadership roles that social work programs are taking in the area of ipe. social workers bring a systems perspective and an understanding of group work and policy practice, ideally suited to champion ipe activities across the bureaucracies of higher education. in order to build effective educational experiences that prepare students for modern practice, academic units must overcome barriers to working outside of their academic unit. at times this requires working with a program next door, across campus, or sometimes across institutions. articles included within this special edition provide exemplars for how social work knowledge and skills are highly valued in the creation and expansion of ipe endeavors. the voice and leadership of social work is exemplified in the jones et al. article that highlights a team-based approach to a longitudinal course in partnership with a medical school. social work’s leadership resulted in learners’ enhanced sense of identity and purpose as they continued through their health professions’ training. rishel, guthrie, and hartnett in who am i and what do i do? developing a social work identity through interprofessional education and practice, examine the importance of a cohesive professional identity for social work students. this paper explains how a training program to prepare students for collaborative practice in integrated behavioral health settings was developed and implemented, also connecting to the bhwet ipe efforts previously mentioned. the importance of social work leadership is further demonstrated by adamson, ashcroft, langlois, and lising as they share lessons in the development of a universitywide ipe partnership in canada. these authors discuss how social work leadership facilitated meaningful ipe learning experiences and consider the implementation factors that include scheduling, administrative complexities, and participation through faculty leadership. amato et al.’s jumpstarting cross-disciplinary collaboration in undergraduate social work education focuses on the interprofessional training of undergraduate teacher education students along with social work and pre-occupational therapy students. these authors describe a 2-year long project in a k-12 setting and highlight the importance of ipe being expanded into non-healthcare settings. in the final article of this special edition, mccave, mutrie, doyle, jacobsen, and kelly demonstrate how social work can transform ipe partnerships. they incorporate a change leadership model to analyze the integration of the msw program in the current ipe curriculum. their findings highlight the importance of creativity, adaptability, advocacy, and relationship-building as key skills for social workers to promote and implement ipe. in summary, there are a few key themes that stand out in looking at ipe in its entirety. the first key theme is the breadth of social work educators, across the u.s. and canada, who are using ipe in innovative ways. this includes innovations across program levels (both bsw and msw) as well as across service delivery systems and at the micro, mezzo, and macro levels. second, it is clear that social work educators are striving to fulfill the professional mission of social work by promoting collaborative practice to improve client well-being while continuing to advocate for social and economic justice for several vulnerable populations including foster children, people with substance misuse those who advances in social work, summer 2020, 20(2) vii are homeless and older adults. the social work voice seems well-respected when raising issues around health disparities, unequal access to services, and ethical practice concerns which seemingly could have a powerful impact on both ipe, collaborative practice, and the overall quality of healthcare delivery. finally, social work educators are contributing their considerable professional knowledge and skills to improve ipe and practice by bringing expertise in areas such as an ecological perspective, group/team building, cultural humility, engagement skills, and a deep understanding of the social determinants of health. it is no surprise that social workers are becoming leaders in the development and implementation of interprofessional education. looking forward it has been a joy to read and work with so many social work educators who are actively engaged in ipe. given the breadth of articles presented in this special issue, social work professional involvement clearly has potential to address these complex social challenges across systems. an overview of the articles in this issue also raises some important questions about the future of ipe in social work and health and social services in general. one way forward is to think of ipe engagement as a continuum and an ever-present responsibility to fulfill our professional mission. many of the examples included initiatives that should be engrained and sustained rather than being time limited. ipe warrants continual engagement and assessment to evaluate how it impacts practice across multiple service delivery systems and the desired outcomes it is intended to achieve. the articles in this special issue provide a glimpse into the kinds of practice that have the potential to make great impact and hopefully inspire additional innovations given the continuing challenges before us. future research is needed to evaluate the long-term impact of these educational efforts to determine how they translate to lasting practice change and system transformation. while ipe is important at the individual student learner and curriculum levels, more information is needed about how this translates to population health outcomes. as is evident from the articles included in this special issue, ipe in social work has grown exponentially over the last decade. developmentally, the time is right for the profession to examine ways to sustain innovative programming and ensure ipe is threaded through mainstream curriculum in undergraduate and graduate level social work programs. this requires further work on the upcoming 2022 epas revisions in how ipe is conceptualized and integrated within the competencies. there is some concern that ipe, as it currently exists within epas, may be interpreted by programs as an additional bonus rather than as a clear expectation for all student learners enrolled in accredited programs. our hope is that this special issue may spur additional interprofessional learning experiences to ensure more comprehensive infusion through social work curricula and assessment of such competencies. working with administrators, faculty, and others across campus to determine what competencies and accreditation needs can be met across programs through ipe efforts may be one way to initiate and sustain change. additional challenges have come with the growth of online programs across the nation, and the rapid transition to remote instruction given the covid-19 pandemic. it will be interesting to learn how best to creatively engage in ipe and to prepare the future workforce for collaborative practice using virtual technology. it is possible that programs are rubin et al. et al./leveraging the power of social work viii collaborating with field agencies to infuse ipe or could be using online learning management systems. however, building an evidence-base on conceptualization, implementation, and impact will continue to benefit the profession, and ultimately, those who receive social work services. while simulation and/or standardized patients are used in some programs, as evidenced in some papers in this issue, there remains limited research from social work to support this work. it may be that not all universities have the resources needed for a simulation lab or have access to existing simulation equipment. therefore, finding ways to partner with units on campus who have these resources may be a place to start. further, there is increased availability of virtual simulation programs and trainings which may be available online that do not require physical space or equipment. we look forward to seeing an expansion of the literature on simulations and best practices engaging standardized patients in ipe initiatives. while discussing these innovations, it is important to note that there are many administrative barriers that make ipe somewhat complicated or difficult to implement (breitbach et al., 2013; hammick et al., 2007). often, administrative processes can stifle ipe collaboration, including divergent academic calendars, field vs. classroom schedules, diverse registration processes, to name a few common challenges. an additional layer involves the practicality of financing ipe. as workload credits and expectations are unique at each institution, it remains tricky to pay for ipe development, teaching, and related activities. these financial constraints to ipe need further attention. while there is no easy answer to these barriers, our vision for programs is to start small and include additional professions and disciplines as the activity continues. ipe activities should not be a volunteer labor of love and it will be up to social work educators and administration to recognize the value and investment that is required for quality ipe activities. this is certainly an area in need of further research and development. as the covid-19 pandemic and response continues to impact how social work education will be offered in the immediate and not-so-distant future, educators will be challenged to consider how ipe can be integrated into what is already an unprecedented learning environment. despite the challenge, the articles in this issue inspire hope that it is possible—and vital. undoubtedly, the lessons from within this special issue speak to the central themes of collaboration, teamwork, social justice, and the power of social work to provide more holistic services. as ipe champions and guest editors for this special issue, we recognize that the synergy between the ethos of social work and key features of ipe are strongly aligned. social work educators and practitioners need to own this expertise. we are grateful to advances in social work and all contributing authors for highlighting what we do as a profession, how we contribute across a variety of sectors, and our impact on general and specialized population groups. without shining a light on these efforts, others may not know the innovation, creativity, and leadership that the social work profession brings to ipe. references breitbach, a. p., sargeant, d. m., gettemeier, p. r., ruebling, i., carlson, j., eliot, k., kienstra, k., & gockel-blessing, e. a. 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(2018). social work student and practitioner roles in integrated care settings. american journal of preventive medicine, 54(6), s281-s289. https://doi.org/10.1016/j.amepre.2018.01.046 hammick, m., freeth, d., koppel, i., reeves, s., & barr, h. (2007). a best evidence systematic review of interprofessional education: beme guide no. 9. medical teacher, 29(8), 735-751. https://doi.org/10.1080/01421590701682576 health professions accreditors collaborative. (2019). guidance on developing quality interprofessional education for the health professions. health professions accreditors collaborative. https://healthprofessionsaccreditors.org/wpcontent/uploads/2019/02/hpacguidance02-01-19.pdf jones, b., & phillips, f. (2016). social work and interprofessional education in health care: a call for continued leadership. journal of social work education, 52, 18-29. https://doi.org/10.1080/10437797.2016.1112629 konrad, s., cavanaugh, j., rodriguez, k., hall, k., & pardue, k. (2017). a five-session interprofessional team immersion program for health professions students. journal of interprofessional education & practice, 6, 49-54. https://doi.org/10.1016/j.xjep.2016.12.007 mancini, m. a., maynard, b., & cooper-sadlo, s. (2019). implementation of an integrated behavioral health specialization serving children and youth: processes and outcomes. journal of social work education, 1-16. https://doi.org/10.1080/10437797.2019.1661905 national academics of sciences, engineering, and medicine. (2019). integrating social care into the delivery of health care: moving upstream to improve the nation’s health. the national academies press. https://doi.org/10.17226/25467 nimmagadda, j., & murphy, j. i. 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(2020). integrated care workforce development: universitycommunity collaboration, social work education, 39(4), 534-551, https://doi.org/10.1080/02615479.2019.1661987 rubin, m., konrad, s., nimmagadda, j., scheyett, a., & dunn, d. (2018). social work and interprofessional education: integration, intersectionality, and institutional leadership, social work education, 37(1), 17-33, https://doi.org/10.1080/02615479.2017.1363174 smith, s., & clouder, l. (2010). interprofessional and interdisciplinary learning: an exploration of similarities and differences. in a. bromage, l. clouder, j. thistlethwaite, & f. gordon (eds.), interprofessional e-learning and collaborative work: practices and technologies (pp. 1-13). igi global. https://doi.org/10.4018/978-1-61520-889-0.ch001 thistlethwaite, j., moran, m., & world health organization [who] study group on interprofessional education and collaborative practice. (2010). learning outcomes for interprofessional education (ipe): literature review and synthesis. journal of interprofessional care, 24(5), 503-513. https://doi.org/10.3109/13561820.2010.483366 who. (2010). framework for action on interprofessional education and collaborative practice. https://apps.who.int/iris/handle/10665/70185 zerden, l. d. s., jones, a., brigham, r., kanfer, m., & zomorodi, m. (2017). infusing integrated behavioral health in an msw program: curricula, field, and interprofessional educational activities. journal of social work education, 53(sup1), s59-s71. https://doi.org/10.1080/10437797.2017.1288595 zwarenstein, m., reeves, s., barr, h., hammick, m., koppel, i., & atkins, j. (2000). interprofessional education: effects on professional practice and health care outcomes. cochrane database of systematic reviews, (3). https://doi.org/10.1002/14651858.cd002213 author note: address correspondence to maureen rubin, calming chaos co., burr ridge, il. email: rubinm10@gmail.com acknowledgement: we are grateful for the tireless support and guidance of assistant editor, valerie decker, through this process. https://doi.org/10.1080/02615479.2019.1661987 https://doi.org/10.1080/02615479.2017.1363174 https://doi.org/10.4018/978-1-61520-889-0.ch001 https://doi.org/10.3109/13561820.2010.483366 https://apps.who.int/iris/handle/10665/70185 https://doi.org/10.1080/10437797.2017.1288595 https://doi.org/10.1002/14651858.cd002213 mailto:rubinm10@gmail.com this work is licensed under a creative commons attribution 4.0 international license. financial capability and asset building: a transformational practice framework edward scanlon cynthia k. sanders abstract: the promotion of financial capability and asset building (fcab) is an important and fitting professional activity for social work, which has long been concerned with the economic well-being of individuals and families. financial capability is attainable only if we assist clients by helping them to build new skills while simultaneously helping them to connect to economic opportunity structures such as savings, job training, or credit repair programs. we propose a person-environment-centered process model for use in fcab endeavors, using case vignettes to illustrate the application of the process. by drawing upon several theoretical perspectives such as humanistic social work, cognitive behavioral theory, motivational interviewing, solution-focused brief therapy, and diffusion of innovations theory, practitioners may increase clients’ likelihood of successfully connecting to opportunity structures. attention to behavioral, cognitive, emotional, and policy feedback processes may help to provide the “missing link” between individual financial behavior and the institutional opportunities offered by fcab programs. keywords: financial capability; direct practice; financial literacy; person-environment practice; economic well-being the promotion of financial capability and asset building (fcab) is an important and fitting professional activity for social work, which has long been concerned with the economic well-being of individuals and families. because financial capability has been conceptualized as the result of the interaction of human agency (the ability to act) with social structures (institutions which create the opportunity to act), it is congruent with social work’s emphasis on person-environment practice (birkenmaier, sherraden, & curley, 2013; johnson & sherraden, 2007; kemp, whittaker, & tracy, 1997). however, theoretical perspectives in the financial capability field and the asset building field have been conceptualized in relative isolation from one another. financial capability has relied more heavily upon an individualistic view of economic actors, and focuses upon helping individuals to learn new skills, knowledge, and practices, often ignoring clients’ social and economic contexts. those working to help individuals gain financial knowledge have relied upon individually-focused interventions such as financial education (collins & o’rourke, 2009) and financial therapy (archuleta & grable, 2011). conversely, the asset building field, which helps individuals and families to accumulate wealth through savings or investment (sherraden, 1991), has focused more on structural theories, such as asset theory and behavioral economics, and has had relatively little to say about micro-level skills or theories (despard & chowa, 2010; sherraden, laux, & kaufman, 2007). we believe that the theoretical differences between these two elements of the fcab field have _________________ edward scanlon is associate professor and associate dean for academic programs, school of social welfare, university of kansas, lawrence, ks 66045. cynthia k. sanders, phd, professor, school of social work, boise state university, boise, id. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 543-562, doi: 10.18060/21245 https://creativecommons.org/licenses/by/4.0/ scanlon & sanders/financial capability 544 led to a lack of role clarity on the part of agency level staff tasked with the delivery of these programs. it is important for social work to incorporate both structural and individual factors in our understanding of financial capability. failing to incorporate a structural view of fcab can lead to a sort of victim-blaming in which individuals are assigned responsibility for their financial circumstances without acknowledgement of the social, political, and economic systems that shape financial life chances (olen, 2012). at the same time, while structural theories are appropriate frameworks for constructing social policy and programs, they are less useful as a guide for direct practitioners who contend with the complicated dynamics of human behavior and interpersonal interaction. while the specific structural changes needed for a fully inclusive and just financial system are beyond the scope of this paper, working directly with clients to promote financial capability requires an understanding of the political and economic environments in which clients live, and it requires an understanding of relevant psychological and behavioral characteristics that impact outcomes. in this article, we present a theoretically-driven, person-environment framework for fcab practice. we suggest a model for use by social workers practicing in settings that focus on promoting financial well-being, such as individual development account (ida) programs, low-income housing-based services, financial self-sufficiency, and employment or job training programs. we propose a five-stage process model for fcab, illustrated by several case vignettes. by drawing upon insights from several theoretical perspectives, such as humanistic social work, cognitive behavioral theory, motivational interviewing, solution-focused approaches, and diffusion of innovations theory, practitioners may be able to assist clients in a more thoughtful and purposeful way. attention to behavioral, cognitive, emotional, and policy feedback processes may provide the missing link between individual financial behavior and the institutional opportunities offered by fcab programs. ontological assumptions in the social sciences: holism, methodological individualism, and critical realism before we suggest some basic elements of a direct practice model, it is important to note that the practice of financial capability and asset building raises critical questions about the nature of social reality, particularly the ways in which individuals and society are conceptualized. within the discipline of philosophy, ontology is the study of the nature of being, and is also concerned with how things which exist relate to one another (blaikie, 1993). debates exist in the philosophy of social science that center on the ways in which society is conceptualized, particularly in terms of differing views of the relationship between social structure and human agency. two dominant perspectives in the social and behavioral sciences are 1) holism, and 2) methodological individualism (zahle & collin, 2014). those whose ontology is grounded in holism contend that social institutions and forces shape human behavior and the opportunities and choices that are available to individuals. in this view, social structures precede individual action, and social forces and institutions advances in social work, fall 2017, 18(2) 545 are themselves the proper unit of analysis for understanding human behavior (blau, 1977). conversely, methodological individualists focus on the idea that human beings are free agents who make rational decisions, and see society as the sum of the choices and behaviors of vast numbers of individual actors. individual behavior is viewed as the appropriate unit of analysis, and individual choices and decisions precede social structures. this ontological perspective can be seen in the assumptions of neo-classical economics and in certain social science perspectives such as rational choice theory and the theory of planned behavior (kjosavic, 2003). a critical realist view of the relationship between structure and agency suggests a different perspective. philosopher bhaskar’s (1975) transformational model of social action posits that individuals live within, and are impacted by, social structural arrangements, but they are also capable of responding to, and altering, those structural forces. similar dialectical views of reality can be found in the work of scholars such as giddens (1984) and bourdieu (1980), who also focus on the interactions of social structures and individual agency. referring to this as structuration theory, giddens (1984) suggested that structures exist and allow the reproduction of society across space and time. individuals experience these structures as trace memories and also work in various ways to transform those structures. in that process, they themselves are transformed. in giddens’ view, society is like a wall made up of bricks which are continually reconstituting themselves. giddens rejects the notion of duality, and the idea that structure and agency are separate processes. instead, as it is for bhaskar, this process is transformational in the sense that society and individuals are constantly recreating one another, mutually altering each other’s properties and structures. similar views can be seen in the french sociologist bourdieu’s (1980) conceptualization of social life, with his emphasis upon constructs of field and habitus. financial capability and asset building as a transformational social process among the helping professions, a unique contribution of social work has been its emphasis upon viewing clients and their environments simultaneously. the personenvironment perspective is built upon an assumption that neither methodological individualism nor holism is fully capable of explaining human functioning. rather, social work has staked out a position which is compatible with that of bhaskar (1975), giddens (1984) and bourdieu (1980)—the notion that structure and agency are dialectically-related. our professional commitment is to intervene simultaneously with social environments and with individuals and to work to ensure a goodness-of-fit between the two (germaine & gitterman, 1980; meyer, 1983). this is, in essence, a transformational view of human nature. financial capability theory begins with similar assumptions about human nature. the idea of financial capability is based upon an implicit critique of the methodological individualism embedded in traditional financial education training. the traditional approach to financial education has assumed that individuals can receive education about financial issues (i.e., banking, credit cards, investing), and then, once exposed to essential knowledge, will begin to behave in ways that are financially logical, goal-directed, and sound. johnson and sherraden (2007) and birkenmaier and colleagues (2013) offer a more scanlon & sanders/financial capability 546 sophisticated approach by suggesting that individuals will not develop financial capability simply through gaining knowledge. instead, they suggest financial capability requires financial inclusion; individuals must be connected to institutional structures which provide them with the opportunity to save, use credit, and invest. when financial education is combined with financial inclusion, financial capability can be built. in our view, the financial capability approach is truly a person-environment perspective which links social structures and human agency. and what is more, this view is compatible with a critical realist view; financial capability, as conceptualized, appears to be what bhaskar (1975) refers to as an emergent property, which is a new social entity that is more than the sum of its parts. in other words, as opportunity structures (incentivized savings, credit access) interact with financial education and new financial experiences for individuals, a new social property (financial capability) is created. and, as more financial capability is built, it is plausible that individuals will be even more likely to successfully access structural opportunities such as asset-building programs, promoting the virtuous cycle which sherraden (1991) hypothesized about in the early asset-building literature. linking individuals and opportunity structures: a focus on process the central task of fcab social work should be to connect clients successfully to opportunity structures that may improve their financial well-being. these opportunity structures, such as employment, savings, fair credit, and job training, facilitate individual and family well-being. in the fcab context, beverly and sherraden (1999) have suggested that institutional features of asset building programs are largely responsible for promoting the accumulation of wealth. on the other side of the person-environment configuration, we propose that there are also individual facilitators (which are behavioral or psychological in nature) that promote fcab. there is precedence for this view. in their model of determinants of asset building, beverly and colleagues (2008) acknowledge the relevance of individual factors, including three psychological variables: future orientation, motives for saving, and perceived ability to save. we suggest that additional individual-level psychological and behavioral characteristics may also promote financial capability (see figure 1, including: 1) trust (a belief that an fcab program is honest, reliable and effective), 2) engagement (feeling attracted to, and willing to participate in, fcab activities), 3) commitment (an authentic agreement to work to achieve financial goals), 4) financial problem-solving skills (cognitive and behavioral skills that can be used to help achieve fcab goals), 5) perseverance (continued effort at fcab activities despite facing short-term setbacks or obstacles), and 6) self-reflection and abstract thinking (awareness about one’s own financial behaviors and the ability to apply fcab knowledge to different financial circumstances). advances in social work, fall 2017, 18(2) 547 figure 1: psychological and behavioral characteristics which facilitate the use of financial capability and asset building programs a focus in direct practice in fcab should be helping individual clients to develop these behaviors and attitudes so that they may more effectively link to opportunity structures. providing linkages to services is a “tried and true” social work role described in basic social work practice texts; it has long been considered to be one of the core roles of the professional social worker (kirst-ashman & hull, 2011). some theorists have even argued that social work is boundary work intervening in the transactions that occur between individuals and social, economic, cultural, and political structures across various stages of the life span (germaine & gitterman, 1980). but doing successful boundary work— effectively connecting clients to services and programs—requires the thoughtful application of theory and skills. we cannot simply refer clients to services, or provide them with information about program availability, and assume successful outcomes will follow. instead, social workers must encourage this linkage to opportunity structures, and purposively engage in a helping process that facilitates trust, engagement, commitment, perseverance, problem-solving, and self-reflection. we posit that those factors, successfully developed and enhanced, may increase the likelihood of successful boundary work. at the same time, direct practice fcab workers must still consider ways of impacting and shaping those opportunity structures so that they are accessible, safe, and non-exploitative, particularly for financially vulnerable populations. individual characteristics •thinking •trust •engagement •commitment •problem-solving skills •perseverance •self-reflection & abstract opportunity structures •job training •credit repair •fair lending •banking access, incentivized saving •social benefits •asset protection outcome financial wellbeing scanlon & sanders/financial capability 548 social workers in direct practice can use practice theories and skills to help clients to cultivate and develop these qualities. we again refer to bhaskar’s (1975) insights, suggesting that these qualities are not simply inherent in some individuals—rather they are, at least in part, emergent properties that can arise through positive and purposeful interactions between direct practitioners and consumers. helping these qualities emerge may best be achieved through a deliberative fcab practice process model which moves through stages parallel to those typically included in a generalist model of social work practice (kirst-ashman & hull, 2011). we view this as a five-phase process which includes: 1) rapport building and engagement, 2) securing goal commitment, 3) overcoming obstacles and developing financial strategies, 4) celebrating and reflecting on goal attainment and future ambitions, and 5) evaluating practice and diffusing knowledge. to successfully navigate each phase of the framework, practitioners may draw from different models of practice. in the following section, we describe the theories most appropriate for each phase. table 1 is included as a graphic depiction of these stages and the related practice theories that we view as most promising for utilization by practitioners. rapport-building and engagement in any process in which a social worker and a client work together to achieve a goal, little can be accomplished unless rapport is built. the goal of this initial phase is to increase the client’s trust in the program and the worker, and to begin the process of establishing a sense of engagement in the fcab process. building trust is essential; previous research on asset building programs has demonstrated that participating with an agency that is trusted throughout the community is key for the process of recruiting participants (shanks, nicoll, & johnson, 2014). similarly, key staff members who are able to foster a sense of trust and build rapport with clients can be extraordinarily helpful in linking clients to fcab programs and policies (scanlon & wittman, 2010). rapport-building has long been viewed as a core element of the social work helping process, with roots in the writings of the professions’ pioneers. relationship as a key to change was an idea that was deeply embedded in the work of scholars such as taft and robinson, whose functional school thinking influenced numerous social work approaches that followed (ehrenreich, 1985). the concept is compatible with the views of humanistic social work (payne, 2011), which is based in part upon roger’s (1961) notion that genuineness, warmth, and empathy are the building blocks of change. as social workers begin work with clients, conveying warmth (a general sense of positive regard for the client), authenticity (sincerity and a natural sense of self) and accurate empathy (accurately understanding the thoughts, feelings, and meanings of another person) helps clients to feel supported, listened to, and treated with respect and in a non-judgmental way. attention to these common factors of change in working with financial consumers has previously been suggested by despard and chowa (2010) and by johnson and sherraden (2007). social workers at this stage would also be wise to draw upon open-ended questions to help clients’ stories unfold, particularly those stories which relate to client’s relationships with education and training, money, spending, bill-paying, saving, investment, paying taxes, and so forth. knowledge of clients’ financial struggles and successes, for example, could help the worker to understand the client’s concerns, values, and motivations for advances in social work, fall 2017, 18(2) 549 participation in fcab. providing clients with clear, honest, and effective feedback, and providing them with the information they need in a timely and efficient manner, will go a long way toward developing trust and promoting engagement. motivational interviewing scholars, for example, emphasize that sharing information in a clear and collaborative manner helps to build relationships because the clinician avoids a condescending expert tone, instead helping the client to identify information that is most helpful to them (rollnick, miller, & butler, 2008). congruency between what workers believe and the information that they provide to clients is also key to building trust. generating trust, then, depends upon a social worker’s ability to provide clients with honest and accurate information about financial products and institutions. an important competency for social workers to demonstrate at this phase is a clear understanding about the risks and benefits associated with financial services. social workers should have knowledge and information that helps them to educate clients about financial products, including those that are predatory in nature, or are otherwise a poor fit for their financial objectives (collins & birkenmaier, 2013). helping clients choose the best fcab opportunities that match their goals, and highlighting those products that have been vetted as secure and non-exploitative of consumers, are essential activities for generating trust. through such rapport-building activities, the linking properties of trust and engagement can begin to solidify, helping clients to be more receptive to learning about fcab opportunities which may be available to them. an example follows: case example: building rapport with jeannine. jeannine is a 36-year-old woman who has two children, amy, 16, and darrell, 12. jeannine has recently graduated from a welfare-to-work program, and has begun working as a certified medical technician. jeannine has struggled financially throughout her adult life, and was raised in a household by a single mother who also faced chronic difficulties in making ends meet. jeannine is now working at her first full-time job with benefits, and is extraordinarily proud of what she has accomplished. despite her newfound success, jeannine has trouble with budgeting, and with saving money. she also is aware that she has a poor credit rating, and was recently turned down for a credit card.. she has been referred to the financial opportunity center by a former academic advisor from her community college certified nursing assistant program. as she begins the intake process, she becomes quiet and somewhat evasive. lourdes, jeannine’s social worker and financial coach, senses jeannine’s hesitancy, and is aware that jeannine is not verbalizing her concerns. lourdes again explains the role of the financial coach, and reiterates the importance of confidentiality and the steps that the financial opportunity center takes to ensure the privacy of confidential information. lourdes uses exploration skills to see if this information is helpful to jeannine, who replies that it does ease some of her concerns. the social worker then uses reflective listening skills to gently suggest that jeannine still seems uneasy. jeannine explains that she is embarrassed by her credit rating and her history of bill-paying, and is worried that this process will bring her to the attention of collection agencies. lourdes acknowledges her concerns, and validates her skill in protecting her own interests. moreover, she scanlon & sanders/financial capability 550 suggests to jeannine that she has a right to make her own decisions, reinforcing her belief in her client’s right to self-determination in making financial decisions. lourdes’ skills in reflecting her concerns and responding to them in a factual and non-judgmental fashion helps jeannine to feel more trusting and willing to return to learn more about services available through the center. as trust builds, lourdes works with jeannine to find credit card offers with the lowest fees and interest rates, and a credit limit that will reduce her likelihood of experiencing repayment difficulties. providing accurate information about safe and non-predatory credit opportunities helps to demonstrate concern and strengthens their alliance as jeannine begins to trust the worker’s authenticity and desire to help. securing goal commitment as basic rapport and trust are built, social workers can begin to move toward understanding clients’ specific financial strengths and needs, and begin to establish fcab goals. while the details of a thorough assessment process are beyond our scope, social workers should begin using exploration skills (northen, 1995) to gather data and assess clients’ financial needs in areas such as human capital, earnings, expenses, budgeting, saving, credit rating and use, and investment. attention should be paid to both strengths and concerns, and clients should be helped to articulate their own financial concerns and goals (sages, griesdorn, gudmunson, & archuleta, 2015). in this phase, the purpose of the social work intervention is to enhance motivation and to secure a commitment to a set of authentic, mutually-constructed fcab goals. goalsetting with clients in any endeavor should be an iterative process, one in which client goals and worker input are shared with one another (egan, 1998; woods & hollis, 1964). however, there are many pitfalls in the process that social workers have referred to as the contracting phase of practice. for example, social workers can assume that they have established mutual goals with clients without having actually secured a commitment to change. this may occur because clients are responding to social desirability pressures from the social worker, agreeing to goals to which they are not committed, or it can occur because social workers simply write intervention plans and contracts without seeking any input from clients. this often occurs when goals are selected in a cookie cutter approach where all clients are assigned the same goals. too, workers are sometimes rushed to complete work with clients, and close the deal before clients are ready to commit to action plans. finally, clients may disengage at the goal-setting phase because they may not feel confident about their ability to commit to programmatic requirements. working with clients to make sure they understand their options, are truly in agreement about goals and objectives, and feel confident that they can meet them, are all central components of any planned change process (miller & rollnick, 2012). the idea of using motivational interviewing and related theories of change for financial interventions has been recommended by earlier scholarship in this area (despard & chowa, 2010; kerkmann, 1998; klontz, horwitz, & klontz, 2015). motivational interviewing skills can be particularly useful at the goal-setting phase as a technique that can help to increase motivation and to secure an authentic commitment to goals. helping clients to articulate their own motivations for fcab, and considering the advances in social work, fall 2017, 18(2) 551 pros and cons of participation could be helpful. workers should be mindful of 1) setting a contractual agreement only when a client appears ready, 2) reinforcing the client’s own motivations and goals, rather than imposing their own goals, and 3) finding ways to help clients boost their confidence in their ability to meet goals (miller & rollnick, 2012). in the next vignette, we present an example of mutually establishing goals in building financial capability. case example: goal setting with james. james is a 39-year-old male with a history of drug addiction and incarceration for minor offenses. he has struggled financially much of his adult life, but in the past, was successful as a cosmetologist, specializing in styling hair in the african american community. while he can no longer afford to be in his own salon, he currently works at a retail hair salon earning just above minimum wage plus tips. he is proud of his talent, and he has been referred to an ida program to save money to start his own business. he would like to save enough to afford to rent space in a salon near his home, but he is concerned about starting out again on his own without savings to help him transition from paid to self-employment. james has attended his first orientation class for the ida program, where he learned about the program and the $500 annual match cap. participants are encouraged to save $40 per month so they may capture all of the available annual match funds. however, he did not return to complete his paperwork to enroll into the program. his social worker contacts him and he states, “you want me to agree to save $40.00 a month and not withdraw any money without your permission. i’m just not sure i can save that much every month…what if i have an emergency?” the worker uses empathic listening skills with james, acknowledging his concerns and encouraging him to come in for an additional meeting. during their time together, the worker helps james to express his reasons for wanting to save, which include a desire to “be his own boss,” a desire to impress his family that he is achieving goals, and a desire to earn a higher income. he is also encouraged to express his reservations, which include his fearfulness that $40 a month is too much for his budget, and his fear that he will not be able to access funds if he needs them. the worker helps him to balance these “pros and cons” of savings, and clarifies his concerns about emergency withdrawals. she also reviews some of his recent past successes and connects those to her belief that he has the capacity to save. after some discussion, james agrees to participate and sets a goal of $25 per month with the assurance that his deposits can vary if necessary. james and his worker reinforced his commitment by calling his girlfriend during the session to share his saving goals with her and to seek her willingness to help encourage him to save. james has entered into the fcab process with increased confidence and an authentic commitment to his saving goal. scanlon & sanders/financial capability 552 overcoming obstacles and developing financial strategies during what we might refer to as the work phase of fcab, clients will be engaged in active work to meet the goals they established in the previous stage. completing job training, repairing credit, opening savings accounts and making deposits, completing and following budget plans—all of these are examples of fcab opportunities that may be available to clients. as clients begin to participate fully in fcab programs, some will succeed without encouragement, others will benefit from participation in structured activities such as financial education classes and activities, while others will not participate at all. helping clients to brainstorm ways to meet their fcab goals requires creativity and initiative on the part of the social worker, who can help clients to succeed and overcome obstacles. the attainment of financial capability can be enhanced through helping clients to develop financial problem-solving skills and to persevere in the face of setbacks and adversity. a variety of problem-solving skills might be useful for fcab participants. research has indicated that successful savers use a variety of cognitive and behavioral strategies designed to identify and set aside funds for saving (beverly, sherraden, & schreiner, 2003). while these strategies have not been linked to direct practice, it is notable that the use of cognitive behavioral therapy techniques to increase financial well-being has been suggested previously (ford, baptist, & archuleta, 2011). connecting the use of these observed saving strategies with cognitive behavioral practice methods in an intentional way could increase client success in fcab activities. for example, the use of daily thought records, spending logs, and cognitive restructuring techniques might be helpful in creating behavioral strategies and mental accounting techniques to help build clients’ financial problem-solving repertoires (nabeshima & klontz, 2015). using insights from solutionfocused treatment has also been suggested by kim and elliott (2013) as a technique for promoting financial literacy. during any process of behavioral change, clients inevitably face some setbacks or obstacles to success. helping clients to continue despite setbacks or adversity is key to any change effort. providing encouragement, providing verbal affirmation of the difficulty of fcab, and reframing setbacks or mistakes as part of an ongoing learning process can help clients to continue with their efforts. these are sometimes referred to as affirming skills, the ability to provide support to clients during a difficult verbal interaction or a point in the change process. to support and encourage a client to make positive change is important. when clients stop reaching their goals, social workers may lapse into being judgmental on the one hand, or becoming overly comforting and placating on the other. acknowledging the setback, reframing it as a normal part of change, and helping the client to consider different behavioral options moving forward are essential steps in providing support. these again are skills and strategies used in the common factors approach to social work intervention (cameron & keenan, 2010). case example: financial skill development with li chin. li chin is a client of a faith-based social service agency which has recently launched a homeownership ida program. she has engaged with the agency and her social worker, and has made a commitment to participating in the program, motivated by her desire to raise her two children in a single-family home rather than the apartment they advances in social work, fall 2017, 18(2) 553 currently occupy. despite her commitment to save for a home, li chin has little experience with budgeting and saving, and wishes to learn new skills. katrina, a social worker, is leading a savings club for participants in the ida program. the club holds social events, fundraisers, group meetings, and financial education classes. to help li chin and the other clients find new ways to save money, katrina uses techniques drawn from cognitive behavioral therapy. each client keeps a daily spending log in which they record expenditures and the degree to which they felt they needed the purchase. later, the members review their purchases at the savings club meeting and discuss whether purchases are a “want” or a “need.” li chin has identified several items that she buys weekly that are not necessary, and that could help her save the $50.00 per month she has set as a savings goal. li chin also has learned some cognitive skills to help her decrease spending, and has created a behavioral plan of writing a check to deposit into the ida on bill-paying day, thus helping her to cognitively reframe her saving as a debt that she must pay. during the group, li chin has shared her strategies with other club members, and has gained some new behavioral and cognitive skills from other’s suggestions as well. promoting self-reflection and abstract thinking termination has been referred to as the neglected phase of social work practice (fox, nelson, & bolman, 1969), but close attention to what happens during endings is important for the ongoing well-being of fcab participants. as clients end their work in fcab and reach their financial goals, social workers should engage in termination tasks designed to anchor their gains and help them to plan for future goals. termination of involvement with the fcab program should be seen as the beginning point of applying and deepening newly developed financial capabilities. this requires a process of self-reflection on the process of fcab, and encouragement of the skill of abstraction—applying recently gained skills to new and less familiar financial challenges. ford and colleagues (2011) acknowledge the need to attend to termination phase issues in financial work with clients. first, celebrating their accomplishments could be a helpful way to recognize new successes and prompt clients to reflect on their efforts. engaging in a social ritual, such as a “graduation,” can be affirming for a client who has achieved success, and can communicate hope and possibility to other clients still working toward their goals. particularly with group-based processes (job training classes, etc.), such a process can also provide a chance for clients to terminate their relationships with one another and with the agency, and can help clients to express and resolve feelings they may have about relationships that are ending (anthony & pagano, 1998). further, a review of the process they have undergone in fcab can be helpful in reflecting upon what they have accomplished and to consider the nature of the new skills and knowledge they have gained. such self-reflection can help to anchor their gains, and assist them in thinking abstractly about how their new skills and knowledge could be applied in different financial situations and future goal attainment. in cognitive-behavioral theory, workers often engage in relapse prevention sessions at the end of their work (marlatt & donovan, 2005). similarly, helping clients to think about the financial circumstances they are likely to face and to consider scanlon & sanders/financial capability 554 how they might apply their new capabilities could be a helpful intervention at this stage. in this vignette, we consider termination tasks with a young adult client: case example: termination with joshua. joshua is a 22-year-old participating in a youth employment program, earning his ged while gaining skills in the construction trades. the program assists youth in their first employment settings to leverage the experience to begin to develop new financial capabilities. joshua has completed the two-year program and has secured work in construction, and has completed adult living skills, money management skills, and related classes. joshua also has his first checking account and debit card, and recently passed his ged exam. during his final meetings with tonya, his social worker, they review his progress in the program, and recount the “highs and lows” of the experience. she also reminds him of the goals he has accomplished, and they discuss the progress he has made on his goals in job skill acquisition, money management, and bill paying. tonya helps him to review some of the challenges he may be facing soon, including the new credit card offers he has received. they discuss the capabilities he has developed that he can draw on in future financial transactions, and discuss area resources that he may access as he faces his next financial hurdles, such as getting his own apartment and making major purchases such as furniture or a car. joshua exits the program feeling proud of what he has achieved, and with a greater ability to apply his new skills to upcoming life transitions. evaluating practice and disseminating knowledge in the generalist model, the final stage of practice is evaluation of outcomes (kirstashman & hull, 2011). in fcab practice, the social worker’s role should be to evaluate the effectiveness of interventions, and to gather information about client’s perceptions of practice interventions, program features, and relevant financial policy. to address the impacts of larger systems of financial opportunity on client well-being, the most feasible course of action for social workers in fcab settings is to systemically use their knowledge of client experiences to provide feedback to promote effective, safe, and accessible policies and programs. while direct practice workers may not be able to regularly lobby policymakers regarding the regulation of financial products, for example, they can gather data that explores the factors that helps clients to achieve greater financial well-being and those that create barriers to financial capability. understanding real-world client experiences with banks, credit unions, savings accounts, debit and credit cards, and job training programs allows workers to document financial narratives and then introduce them to other professionals through presentations, trainings, and agency-level advocacy regarding the design of programs. similarly, fcab workers could use their practice-based findings to help inform policy briefs and social media campaigns, or to craft legislative testimony. diffusion of innovations theory (rogers, 1962) suggests that social change can be the result of the diffusion of ideas, which are taken up at various rates depending upon a variety of factors such as their riskiness, cost, or perceived ability to help solve a problem. policy scholars have used diffusion of innovations theory to describe the successful dissemination of policy ideas, and have emphasized the importance of policy entrepreneurs who actively work to disseminate policy innovations and to persuade policy-makers to adopt new advances in social work, fall 2017, 18(2) 555 practices (berry & berry, 1999). grinstein-weiss, wagner, and edwards (2005) have applied this model to the development of individual savings account legislation in various u.s. states, and their work helps to clarify the role of fcab workers in impacting the environment of financial policies and programs through idea diffusion. in other words, fcab social workers can work to use their knowledge to inform and shape the actions of policy entrepreneurs working in the fields of financial social work and economic wellbeing. this process of evaluation and diffusion of best practices is consistent with the principles of evidence-based practice (proctor, 2004), practice-based research (dodd & epstein, 2012) as well as the council on social work education’s (cswe, 2015) educational competencies which require social work students to learn to evaluate their practice and inform policy and practice through their findings. proctor (2004) notes that evaluating and reporting findings related to one’s practice is especially important when a practitioner has engaged in an innovation of an empirically established best-practice. in this case example, we explore a social worker’s role in using practice-based research data to contribute to the process of improving opportunity structures to make them more accessible and appealing to clients. case example: miguel’s use of client data to impact programs and policy. miguel is an fcab provider who is working to launch a new individual development account program. miguel leads outreach and enrollment activities, and he is working in a rural area that has many immigrants and refugees, including people who are undocumented residents of the u.s. after talking with a potential client named ana marie, who declines to work with him, he has noted that many of the people with whom he speaks are hesitant to participate because they believe that they do not have adequate identification to open a savings account. miguel creates a spreadsheet which documents the number of potential accounts that he is unable to open, and the stated reasons from clients for opting out of involvement in the program. he shares this documented concern with his agency director and works with the agency’s program managers to find a list of acceptable documents that can be used at area banks in lieu of a state-issued driver’s license. this information is then disseminated throughout his agency and partner agencies, and miguel shares this knowledge through a statewide listserv group targeted to fcab providers in his state. miguel and his co-workers also have learned that some u.s. cities are issuing their own identification cards separate from state i.d.s, and they are planning a meeting with an area city councilperson to propose a similar policy for their own small town. scanlon & sanders/financial capability 556 table 1. stage specific skills in a financial capability process model stage essential tasks related skills theoretical base rapportbuilding and engagement • clarify roles • establish confidentiality • learn about how client decided to consider fcab activities • conveying warmth • demonstrating authenticity • use of reflective listening • common factors theory • humanistic theory securing financial goal commitment • clarify motivations for participation • clarify clients’ values • evoke clients’ hesitancies or misgivings about involvement • help clients consider the pros and cons of involvement • mutually select fcab goals and authentically commit to participation • assess client’s financial strengths and needs • use of reflective listening • asking evocative questions • assessing readiness to commit to fcab • psycho-social assessment skills • contracting and intervention planning skills • strategically offer suggestions for goals • motivational interviewing • task-centered social work practice overcoming obstacles and developing financial skills • review progress on agreed upon goals • document and explore successes and set backs • identify cognitive and behavioral solutions to problems • clarify, reinforce, and anchor cognitive and behavioral strategies • exploring, elaborating, and affirming skills • reframing behaviors • cognitive interventions • behavioral interventions • solution-focused interviewing • cognitive behavioral therapy • brief solution focused treatment encouraging self reflection and abstract thinking • review successes and unmet goals in fcab • reflect on knowledge gains and behavioral successes • frame new skills, knowledge, and successes as financial capability • help clients to think about and prepare for future • exploring, elaborating skills • summarizing skills • reframing behaviors • relapse prevention planning skills • motivational interviewing • cognitive behavioral therapy • task-centered social work practice • common factors theory evaluation of practice and the diffusion of knowledge • evaluating practice outcomes quantitatively and qualitatively • disseminate findings formally and informally to practitioners, researchers, and policy-makers • documenting client perceptions • mining data for themes and patterns • oral and written communication skills appropriate for the effective expression of practice research findings • diffusion innovation theory advances in social work, fall 2017, 18(2) 557 discussion and conclusion in this paper, we have contended that the individual must be considered as a conscious and purposeful actor in the fcab process. arguing against both structuralism and methodological individualism, we suggest that the individual is neither the sole determinant of their economic capabilities, nor a passive recipient of structural forces that determine their outcomes. rather, human beings act within the economic and social context available to them, with varying degrees of success in achieving financial capability. we believe that this transformational practice framework is a needed corrective to the structuralism that has dominated asset-building, and to the individualism that dominates financial counseling practice. what is more, an examination of these ontological underpinnings of financial capability and asset building theory provides us with an opportunity to truly explore the reciprocal nature of human reality and social work’s emphasis upon the person-environment configuration. our model is based on four assumptions: 1) that psychological and behavioral characteristics matter in the development of financial capability, particularly trust, motivation, commitment, problem-solving skills, perseverance, and self-reflection, 2) that these core psychological characteristics can be consciously promoted by social workers during the fcab process, 3) that the skills and perspectives that drive direct practice in social work generally are applicable to direct practice in fcab, and 4) successful fcab practice requires a simultaneous focus on both micro and macro levels of reality. we presented a five-stage model that parallels the stages in generalist social work (kirstashman & hull, 2011), suggesting that the individual determinants of fcab can be encouraged and fostered through the use of basic interviewing skills and by drawing on insights from models such as motivational interviewing, cognitive behavioral therapy, solution focused work, and diffusion theory. while such perspectives have been suggested before in the literature on financial education, counseling, therapy, and coaching, we argue that what makes the social work perspective distinct is that it maintains the personenvironment perspective throughout. we contend that it is the transactions between individuals and opportunity structures that should be the focus of financial social work. the purpose of such direct practice interventions in fcab should be on helping clients to modify their behaviors in order to interact with financial opportunity structures in meaningful, conscious, and careful ways, and on shaping programs and policy to provide financial programs that are safe, accessible and effective. focusing on these transactions and the client characteristics that can promote connections to such structures could be what makes financial social work distinct from those approaches taken by other human service professions. we recognize, of course, that our work is speculative, and it is a proposed model based more upon theory than on empirical studies. this is to be expected as we are attempting to develop an idea that has been somewhat overlooked in the fcab field. more work must be conducted in this area, including systematic research using rigorous research designs and measurement. moreover, we acknowledge that there are significant barriers to such research. the concern that fcab must be accomplished with minimal staff time due to costs constraints will be a serious and genuine concern. the long-standing debate about scanlon & sanders/financial capability 558 whether fcab services should be high touch or low touch will also continue to drive the climate around this topic (mahon, 2006). we believe our framework can be a contribution to curricula in social work education. despite the formal commitment of the cswe and the national association of social workers (nasw) who profess adherence to the dual roles of social work practice, in the preponderance of schools, the curriculum is primarily clinical in nature (rothman & mizrahi, 2014). while action is needed to strengthen the place of macro practice itself within social work education, it is also necessary to demonstrate to more clinically-oriented social work students and practicing social workers the relevance of clinical theory and practice to issues such as financial functioning and well-being in addition to the common emphasis of clinicians on matters such as social relationships and mental health. from a more clinical standpoint, financial capability work provides the profession of social work an arena in which to bridge a gap between the historical emphasis of asset building work on building institutional structures and opportunities such as individual development accounts (sherraden, 1991) with a more active micro practitioner role in the financial lives of their low-income clients. cswe (2017) has begun to address this formally through the creation of their clearinghouse for economic well-being in social work education. opportunities for social workers to engage in fcab practice may be growing. for example, the local initiatives support corporation (lisc) in 2004 launched their financial opportunity centers, which employ financial coaches to promote financial well-being (roder, 2015). they now have 70 such centers across the us, which indicates awareness that direct practice relationships and methods are important in promoting financial capability (walker & huff, 2012). moreover, the american academy of social work and social welfare has identified building financial capability practice methods as part of its grand challenges for social work initiative (sherraden et al., 2015). we feel hopeful that interventions designed to create opportunity structures and foster individual-level behavioral change will continue to grow. focusing on structures and individuals in tandem is essential if we wish to optimize client financial well-being and capabilities in the years to come. it is exciting to us that the profession of social work, with its attention to both individuals and the environments they inhabit, is well-poised to provide leadership in this important field of practice. references anthony, s., & pagano, g. 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(2012). expanding financial opportunity: lisc’s experience with scaling up financial opportunity centers. retrieved january 16, 2015 from http://community-wealth.org/content/expanding-financial-opportunity-lisc-sexperience-scaling-financial-opportunity-centers woods, m., & hollis, f. (1964). casework: a psychosocial therapy. new york: random house. zahle, j., & collin, f. (2014). rethinking the individualism-holism debate: essays in the philosophy of social science. london: springer. doi: https://doi.org/10.1007/978-3319-05344-8 author note: address correspondence to: edward scanlon, phd, school of social welfare, university of kansas, twente hall, lawrence, ks 66045. escanlon@ku.edu https://doi.org/10.1007/s12114-014-9185-y https://doi.org/10.1007/s12114-014-9185-y https://doi.org/10.1300/j125v15n03_02 http://community-wealth.org/content/expanding-financial-opportunity-lisc-s-experience-scaling-financial-opportunity-centers http://community-wealth.org/content/expanding-financial-opportunity-lisc-s-experience-scaling-financial-opportunity-centers https://doi.org/10.1007/978-3-319-05344-8 https://doi.org/10.1007/978-3-319-05344-8 __________ cristina mogro-wilson, phd, associate professor, university of connecticut school of social work, hartford, ct 06103; alysse m. loomis, phd, assistant professor, university of utah college of social work, salt lake city, ut, 84112; crystal hayes, msw, phd candidate, university of connecticut school of social work, hartford, ct 06103; reinaldo rojas, phd, assistant professor, central connecticut state university department of social work, new britain, ct 06050. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 311-328, doi: 10.18060/22581 this work is licensed under a creative commons attribution 4.0 international license. emerging bicultural views of fatherhood: perspectives of puerto rican fathers cristina mogro-wilson alysse melville loomis crystal hayes reinaldo rojas abstract: puerto rican fathers remain an understudied population despite the growing latino community in the u.s. understanding how puerto rican fathers perceive their roles as fathers can inform our conceptualization of their engagement with children as well as the development of culturally-specific parenting interventions. in this qualitative study, focus groups were conducted with puerto rican men to identify their perceptions of their role as a father and how individual, child, and cultural influences may relate to these roles. parenting roles identified by fathers in the study were: being there, maintaining open communication, building confidence, preparing for adulthood, teaching culture/values, and providing a role model for their children. the study also explored father and child characteristics, history with their own father, and a hybrid cultural perspective as influences on puerto rican fathers’ perceptions of their parenting roles. due to the increasing population of puerto rican and other latino sub-groups, providers and social workers working with puerto rican families should understanding the perceived parenting roles within families to better engage and support fathers and families within this growing population. keywords: parenting, fatherhood, parent-child relationships, latinos; puerto rico there is a large body of research linking father’s engagement with their children to positive child outcomes (boyd, ashcraft, & belgrave, 2006; byrd-craven, auer, granger, & massey, 2012; coley, 2003; webster, low, siller, & hackett, 2013). however, fatherhood research has been critiqued for the relative inattention to differences in parenting for fathers based on race/ethnicity (cabrera, west, shannon, & brooks-gunn, 2006). this is particularly the case for latino subgroups as research looking at parenting within specific latino subgroups is even more scarce. latinos continue to be one of the fastest growing minority populations in the u.s. (passel & cohn, 2008). puerto ricans are the second largest latino subgroup in the u.s. (u.s. census bureau, 2017), with the population growing in the u.s. from 5.4 million in 2016 to 5.5 million in 2017 (center for puerto rican studies, 2018). despite this rapid growth, little is known about the unique experiences of puerto rican fathers. research that captures the diversity of racial and/or ethnic minority subgroups is an important part of developing culturally-informed interventions to support ethnic minority fathers who have been traditionally underserved. as this population continues to grow, research that can inform policies and practices surrounding family and child wellness is even more needed. https://creativecommons.org/licenses/by/4.0/ mogro-wilson et al./emerging bicultural views 312 the parenting role and fatherhood involvement father’s engagement with children is tied to a range of positive outcomes for children, such as their psychosocial functioning (byrd-craven et al., 2012; coley, 2003; webster et al., 2013) and adolescent substance use (boyd et al., 2006). father engagement has been found to vary based on the father’s race/ethnicity. in a recent study of fathers of infants, african american and latino fathers were found to be more engaged in caregiving and physical play with their infant children compared to white fathers (cabrera, hofferth, & chae, 2011). african american fathers have been found in some studies to be more involved than latino fathers (bronte-tinkew, carrano, & guzman, 2006; fagan, 2000), but in other studies this difference was found to be non-significant when taking into account father’s education level (leavell, tamis-lemonda, ruble, zosuls, & cabrera, 2012). of note, few studies explore how fatherhood differs among latino subgroups. some literature on fatherhood suggests that fathers’ engagement with their children is child gender-dependent, with gender-related patterns of father engagement with children evident as early as 2 years old. in a study of african american, white, and latino fathers, all fathers were found to use more rough, physical play with sons and more literacy activities with daughters (leavell, et al., 2012). in this study, the impact of the child’s gender was also found to be dependent on the father’s ethnicity; latino and african american fathers of sons were found to engage in more visiting than white fathers of sons. however, in other studies of diverse groups of fathers, no relationship was found between the child’s gender and father involvement (roopnarine, fouts, lamb, & lewis-elligan, 2005). father engagement has been associated with their perceptions of their roles as fathers, with fathers who hold more positive perceptions being more involved in caregiving, warmth, nurturing, physical care, and cognitively stimulating activities (bronte-tinkew, et al., 2006). a clearer understanding of how specific racial and ethnic subgroups of fathers perceive their role as fathers can help to build a conceptualization of fatherhood engagement to support the development of culturally-appropriate fatherhood interventions. this may be particularly important for latino fathers, especially subgroups such as puerto rican fathers, who are often aggregated in fatherhood research. understanding more qualitatively the parenting roles of puerto rican fathers can also help to inform the development of accurate assessment tools relevant to fatherhood (parke et al., 2004). the importance of fathers as role models has been discussed within the literature as a growing sense of paternal responsibility, in which fathers are aware of how children see them. the focus on paternal responsibility has led to a shift in behavior during the transition to fatherhood, in which fathers change negative patterns of behavior as a result of becoming fathers (foster, 2004). the way we conceptualize and assess fathers’ involvement, particularly for minority fathers, is crucial in moving social work research forward (finley & schwartz, 2006). over time the idea of a father being “present” or not has changed into a more multidimensional construct (lamb, pleck, & levine, 1987). however, much of the fatherhood research simply looks at hours spent with a child. to continue thinking about father involvement only in terms of quantity of time limits the possibilities and impact both advances in social work, spring 2019, 19(1) 313 on the child and father and does not capture the social, psychological, and emotional components of parenting (finley & schwartz, 2006; hawkins & palkovitz, 1999). research on fathers has found that generally father’s involvement in their families and child’s lives is growing (lamb, 2010) and there are a variety of roles that fathers play. some studies have identified the importance of “being there” and sharing time with their children as an important part of fatherhood (foster, 2004; lemay, cashman, elfenbein, & felice, 2010). other identified roles within the fatherhood literature include providing financial and emotional support, serving as a role model, and teaching skills and values (lemay et al., 2010). parenting in latino families traditional gender roles in latino families have been hypothesized to influence how fathers perceive their roles as well as their engagement with their children (leavell et al., 2012). often in traditional latino families, cultural characteristics such as familismo, or the central role of the family, respeto, obedience of children to adults and authority figures, and traditional machismo, or high masculinity, is also emphasized in parenting practices (mogro-wilson, 2013; mogro-wilson, rojas, & haynes; cruz et al., 2011). for example, negative aspects of machismo known as macho, representing hostility and dominance, were found in one study to be negatively linked to paternal involvement in latino fathers (glass & owen, 2010). however, there are positive components of machismo, also known as caballerismo, which have been positively associated with an increased participation, monitoring, and love shown to children in latino and puerto rican families (cruz et al., 2011; mogro-wilson et al., 2016). latino fathers had a strongly held belief in familismo, and that puerto rican fathers use bidirectional respect (respect of the child and of the child to the parent) to monitor their children (mogro-wilson, 2013; mogro-wilson et al., 2016). research specific to latino families has found that gendered socialization occurs more intensely in homes with a more traditional division of labor, especially in families in which there are opposite sex siblings, which allows for a gendered, parent-child “pairing off” (crouter, manke, & mchale, 1995; raffaelli & ontai, 2004), which has been found to contribute to fathers identifying more with same-sex children (bumpus, crouter, & mchale, 2001). research regarding the role of latino fathers identified an “emerging, hybrid fathering style that blends traditional with more modern views of parenting” (cabrera & bradley, 2012, p. 233). this may be conceptualized as acculturation to u.s. cultural values while retaining traditional cultural values. intergenerational influences also affect fathers’ approach to parenting. as men become fathers and learn how to parent, they often integrate the way they were raised into how they parent their own child. as intergenerational family systems theory posits, parenting styles are often passed down through generations. parenting the way their fathers did can lead men to either maladaptive or positive ways of fathering (brotherson, dollahite, & hawkins, 2005). understanding these intergenerational influences within latino culture is important, as the value of familismo and respeto for their elders are cornerstones of the cultural values of latino men. the influence of intergenerational fathering has not been explored for puerto rican fathers. this study sought to use focus groups to qualitatively explore the mogro-wilson et al./emerging bicultural views 314 parenting roles identified by puerto rican fathers and how child, individual, and cultural factors might relate to those roles. methods sample and design using convenience sampling, participants were recruited from a community organization within a densely puerto rican neighborhood in a northeastern city. the community agency provides behavioral health services to adults and children, substance abuse programs, parenting education, and elderly services. participants were invited via flyers that were posted at the agency and through direct invitations from agency employees. to be eligible for the study, participants had to identify as puerto rican, male, 18years or older, and had to have at least one child (mogro-wilson et al., 2016). the participants completed a one-page survey that collected information about their age, place of birth, years in the u.s., as well as number and ages of children. length of time in the us was used as a proxy measure of acculturation. a semi-structured focus group approach was used to collect data. focus groups are used in qualitative research to allow participants to explore how their culture influences their perceptions and experiences (levers, 2006). focus groups are a more practical means of qualitative data collection, and also allow for analysis of group interaction as participants interact and respond to each other (kitzinger, 1995). using focus group methodology with cultural groups has led to confirmation of previously identified cultural constructs as well as identification of new or shifting constructs (house, stiffman, & brown, 2006). this study sought to identify new and shifting constructs related to puerto rican fathers’ perceptions of their parenting roles. the 18 fathers recruited for the study were divided into four focus groups of 4-5 participants each. all focus groups were facilitated by a doctoral student with research training particular to qualitative methods and focus groups. in an effort to increase the comfort level and disclosure from participants, the facilitator was also a member of the community and a bilingual puerto rican father. the focused conversation method (fcm) developed by stanfield (2000) was used to enable conversation to move from surface-level ideas to more in-depth beliefs (mogro-wilson et al., 2016). all focus groups were conducted primarily in english, although due to the bilingual facilitator, some participants responded to questions in english and spanish. the focus groups lasted for approximately one hour and concluded when the focus group reached theoretical saturation and little new information emerged from the listed questions (morgan & krueger, 1998). after the focus group participants were informed of the purpose of the study and its risks and benefits, they signed a consent form. to protect confidentiality, participants were assigned numeric id codes to be used in lieu of their names. at the conclusion of the groups, participants were given a $20 gift card and were entered into a drawing for an ipad (mogro-wilson et al., 2016). all research was approved by university’s institutional review board. advances in social work, spring 2019, 19(1) 315 table 1. focus group questions question follow-up probes how has being a father influenced your life? none how do you show your child warmth and love? none how do you control or monitor your children’s behavior? how do you make sure what they are doing is correct and they are not getting into trouble? do you negotiate rules? or do you explain them? or do you make decisions together? is this different in public than at home? what role does respect, or respeto, play when you are parenting? none how do you develop your relationship with your child? do you get along well with them? what activities do you do together? do you feel like you can trust them? how do you increase trust? how does being puerto rican influence your parenting? how does this make you a different parent than being, say, not puerto rican? often there is an importance of the family and extended family (familismo). how does this play a role in you being a father? do you get a lot of family support in your role as a father? the participants were asked seven primary open-ended questions in the focus groups, with seven sub-questions embedded within the primary questions (table 1). the questions explored participants’ perception of their role as parents and the intersection of parenting with their culture. the focus groups started with the fixed set of questions (see table 1) and following the participants’ lead as the discussions developed (morgan & krueger, 1998). data analysis the focus group discussions were recorded, transcribed by a research assistant into microsoft word, and formatted to delineate individual participant responses. participant responses in spanish were translated by a research-trained outside source to eliminate researcher bias in translation and then back-translated to ensure accuracy. the transcripts were then entered into nvivo software (qsr, 2011) for coding and analysis. content analysis was used during the coding process (krippendorf, 2012). two trained graduate research assistants were involved in the data analysis. a primary coder developed the codebook during the primary wave of coding and then recoded the transcripts using the codebook during a second coding wave. intra-rater reliability was established between the first and second wave of coding to determine consistency associated with the identified codes. discussion between the trained research assistants mogro-wilson et al./emerging bicultural views 316 occurred when confusion or issues in coding presented themselves, which led to good interrater reliability (at 80% reliability). inter-rater reliability was determined through side-byside coding comparison using visual coding functions within nvivo. coders discussed differences in interpretation of coding nodes and how these differences reflected individual biases and beliefs. in this way, the interrater reliability process reflected a fluid process in which variations in interpretations of coding became a part of the analysis process and is reflected in the discussion of results. after themes related to role perceptions and cultural influences were explored, the cross-coding matrix function in nvivo was used to examine associations among identified themes and individual, child, and social influences. this function allowed the authors to identify constructs that overlapped frequently, by visualizing when themes related to role perception were mentioned at the same time as the themes related to child, father, or cultural influences. this approach added depth by highlighting factors (including father demographic variables) that may influence roles that fathers expressed within the focus group. data from the demographic survey were included in the data analysis process to explore variations in participant responses. functionality of the qsr nvivo (2011) software allows for using case attributions to compare responses of demographic groups, such as country of birth and age of participant. pseudonyms were assigned to participants for purposes of confidentiality. table 2. participant demographics (n=18) characteristics mean (range) n (%) age 37.67 (25-59) born in pr 10 (56%) age moved from pr 13.90 (3-26) born in u.s. 8 (44%) lives with mother of children 15 (83%) number of children 2.39 (1-6) average age of first child (years) 11.31 (0.5-23) gender of first child male female 8 (44%) 10 (56%) findings of the 18 fathers who participated in the focus groups, over half (n=10) were born in puerto rico. fathers had an average of two children and their first child was on average 11 years old, with a range of 6 months to 23 years (see table 2). six themes were identified by fathers as components of parenting: (1) being there; (2) building confidence; (3) preparing for adulthood; (4) maintaining open communication; (5) teaching culture/values; (6) providing a role model. factors identified in prior research (individuality of the child, intergenerational influences, and father nativity) were also explored in relation to the themes identified by participants. advances in social work, spring 2019, 19(1) 317 themes: parenting role of fathers being there. puerto rican fathers described “being there” as spending quality time with their children, being available to their children, and spending time together. for example, one father shared: i think one of the biggest things regardless of gender is just spending time with them. and it’s spending time with them not with things that you want to do...spending time with things that they want to do, things they like to do, things that they’re interested in. (miguel) this theme was also discussed by another father, both in terms of physically “being there” and being there during good and bad points in the child’s life. he shared: it’s just being there for them. like, i get to their level...you know, my job is to make sure that she knows that if she looks to the side daddy’s there playing with her. and that she knows that i’m going to be there in the good and in the bad. (roberto) building confidence. participants identified building confidence as an intentional process by which they foster and encourage confidence and self-esteem in their children. fathers identified the use of their relationship with their children as an important strategy to build and ensure a foundation of confidence in their children. for example, roberto shared: i’ll try to build her confidence. i’ll take her to a park where there’s nothing but boys playing and i’ll be like yo, we got next. and i’ll let her, you know, let her play so she doesn’t feel like she can’t have a confidence or have good self-esteem about herself. another father speaking about a daughter mentioned strategies for promoting confidence, including talking in a respectful tone: i try to talk to her mother and her sister, her half-sister, in respectful ways around her. i'm trying to set the tone now, so that it kind of just becomes natural and she understands, you know, the value that i have of her, um, as a female. and the confidence and the feelings i want her to have about herself. (tristan) preparing for adulthood. fathers identified helping children to prepare for adulthood as part of their parenting role. participants considered it important that their children--both daughters and sons-were ready for adulthood, were good citizens, and could contribute positively to society. some participants talked about preparing their daughters for adulthood by making sure they are independent and capable of contributing to society as illustrated in the following quote: “i have to make sure she’s strong, can take care of herself when i’m not around. that she is, you know, a productive member of society. a woman that respects herself” (tristan). other participants mentioned that preparing their sons for adulthood involved preparing them to take care of their current and future family and getting them ready to face the difficulties of life. participants expressed their desire to help their sons build skills mogro-wilson et al./emerging bicultural views 318 to be family leaders in the future and face the challenges that being a father could present. for example, one participant noted: i always let my son know that “this little girl right here [his sister] is your responsibility when i’m not around...you’re going to grow up to be a man someday and you know, you need to learn to be in charge...how to take care of your family.” (miguel) nuanced differences were observed around raising sons and daughters. participants expressed a desire for their sons to be the traditional caretaker of their families, following the caballerismo cultural value. however, the fathers did not express a submissive role for their daughters, rather a desire for them to be independent and productive. maintaining open communication. fathers in this study reported that maintaining open communication with their children was an important part of their parenting. fathers mentioned interest in talking to their children, allowing them to ask questions and share things without fear of retribution, and valuing their children’s thoughts and opinions. for example, participants highlighted the importance of having an open chain of communication in which both the father and the child’s perspectives were valued. study participants demonstrated a deep understanding about parent-child relationships, particularly when it comes to maintaining open communication and its connection to the healthy development of their children. this commitment to meaningful open communication and their belief that it matters is illustrated in the following quote: “i think that’s the key in everything. talk to me, i listen. i talk to you, you listen” (john). participants who talked about the importance of open communication with their children also talked about seeing children as individuals and displayed more hybrid modern cultural views. some participants reported that open communication with children was not traditionally valued within the puerto rican culture, reflecting a cultural shift towards valuing children’s communication. for example, one participant stated: that has to be cultivated early, where you create an environment that communication is valued and that they have a voice. you know, and that goes against...how we were brought up. so, it’s a conscious decision that you have to make that i’m holding on to my culture or taking the good things about how i was raised, but i have to incorporate some of these other values and modify to some extent. (tristan) teaching culture/values. fathers reported that teaching children culture/values was part of their role as parents, particularly among those participants who endorsed more traditional cultural views. participants reported teaching their children about traditional cultural aspects of respeto and benidicon, saying “i’m trying to teach her an extra level of respect. as when you see an elder to ask for blessing. for me, that’s the ultimate sign of respect.” (luis) another father discussed intentionality around teaching their children cultural values, noting that these values may differ from other families but that they were central to expectations for family members. this father noted: advances in social work, spring 2019, 19(1) 319 you know, i’m not going to tell them ‘because i said so.’ i’m going to explain to them the reason why. we hold certain values, maybe their [family] values are different, i’m not judging them. but this family has certain values and you’re going to follow these values as long as you live in this house. (adrian) being a role model. fathers stated that acting as a role model was an important part of their parenting role. fathers mentioned leading their children by example, teaching through action, modeling positive behavior for children, and showing the importance of the role of the father. according to participants, modeling behavior is important due to children’s perception abilities and behavioral learning through observation, for example: and always lead by example. ‘you’re swearing. you ever see me swearing? i don’t swear. you know, if you don’t see me do it that means it’s not appropriate. if you don’t see me smoke you know, you shouldn’t do it’. you know, you got to lead by example first. (adrian) another father discussed how his perception of being a role model shapes his own behavior, noting “...if i do something bad, i don't want them to get into anything bad in life, i gotta be a role model. i cannot do it. so i cannot go back to them and tell them no you cannot do this, then i go and do it” (luis). this father was reflecting on acting as a role model for how he wanted his children to act, and not setting a double standard through his own behaviors and actions. influences on fathers’ perceptions of their role as parents the following section describes how factors such as the individuality of the child, intergenerational influences, and father nativity related to the six themes. understanding how these three influences interact with perceptions of parenting can help disentangle the layers of experiences of puerto rican fathers. individuality of the child. individual child’s personalities were mentioned as more influential than child’s gender on fathers’ approach to parenting. fathers identified the importance of getting to know their children as distinct individuals, separate from the fathers themselves, with unique likes, dislikes, and interests. one father noted: your kids are individuals that you’re raising and they’re different than you. you know, and some of them might look a little more like you and they might have some of your habits, but they are still a different person. (jose) the importance of seeing children as individuals seemed to contribute to a more open or flexible style of parenting and allowed fathers to develop individual relationships with their child regardless of the child’s gender. intergenerational influences. intergenerational influences in this study included fathers’ perception of their own father’s role in childhood, namely changing or maintaining patterns of behavior that they identified in their own fathers. ten of the 18 fathers identified wanting to parent differently than their own father by changing behaviors they observed as they were growing up. some fathers reported intentionally changing intergenerational mogro-wilson et al./emerging bicultural views 320 patterns, such as “being there” for children after recognizing that their own fathers were not present during their childhood. for example, marcus shared: i never grew up with my father...what my father did to me i don’t want to do [to] my kids. so...i’m just waiting for 3 o’clock to come, to come pick them up...playing with them, riding bikes whatever i got to do just to be there for them. another example of intergenerational change reported by participants was establishing enhanced emotional connections with their children after recognizing that their own father did not express or encourage the expression of emotions. for example, one father said: i made a decision early in fatherhood that i was going to be a little different than my father...i think i made a decision early that i was going to be a little different, and show a lot more love to my kids. (miguel) in addition, intergenerational cultural changes were identified, reflecting father’s roles going from traditional cultural values toward a hybrid cultural perspective. for example, one father said: i am very in touch with my culture and i do feel that’s extremely important to really try to learn the values of the culture and what that means and try to give some of that to your own children. but for example, what i’m trying to say that is not every tradition in the culture i necessarily agree with. (carlos) as the previous quote illustrates, several fathers noted that they felt a responsibility to instill in their children the same cultural tenants they grew up with. however, fathers also identified a desire to challenge some of the typical cultural norms while maintaining other traditional cultural values. father nativity. fathers born in the u.s. more frequently identified open communication as an important part of their role as fathers, compared to fathers born in puerto rico, which may reflect the norms of u.s. society in which communication is valued within relationships. contrary to what was expected, fathers who have spent less time in the u.s. were more likely to display a hybrid perspective of their role in parenting, and fathers born in the u.s. were more likely to value upholding traditional values. for instance, a father who lived in the u.s. for two years said: ...in puerto rico normally the mother is always the one going to the schools, the fathers always working. but we should change that, you know, whoever got the chance like us right now in here? (felix) discussion participants identified six components of their parenting roles: being there, building confidence, preparing for adulthood, maintaining open communication, teaching culture/values, and providing a role model. fathers discussed their parenting roles in relation to influential factors identified by prior research, including the individuality of the child, intergenerational changes, and father nativity. there were a variety of ways in which the puerto rican fathers in this study were involved in their children’s lives which may inform future social work research related to measuring the quality of the relationships advances in social work, spring 2019, 19(1) 321 instead of solely counting hours and the various ways fathers influence their children both directly and indirectly. similar to other fatherhood literature (lemay et al., 2010), “being there” emerged as a primary theme in the puerto rican fathers’ discussion of their role perception. other research involving latino children and their fathers have connected fathers’ ability to watch a child play and allow them to explore in a way that was less directive leading to fewer behavioral problems (shears & robinson, 2005) and less aggression in children (mcdowell & parke, 2009). in our study, fathers were highly engaged with their children in a developmentally appropriate way, by wanting to play ball with their son or playing dolls with their daughters. this is similar to findings reported by ashbourne, daly, and brown (2011) and finley and schwartz (2006) who described nurturing fathering as when fathers were there “in the moment” when the child has a need or want. the findings from this study suggest that these puerto rican fathers may be expressing the cultural construct of familismo by being there for their children in a nurturing manner. in addition, there was endorsement of the cultural construct of bidirectional respeto between the child and the father. the importance of respect for elders or older relatives in the family to support the child was also discussed, once again stressing the importance of familismo. the fathers supported their children without focusing solely on the gender of the child, and in doing so broke some of the traditional machismo values and aligned further with the caballerismo cultural values of fathers, where there is a more egalitarian respect for the opposite gender, along with a sense of commitment to the family (torres, solberg, & carlstrom, 2002). however, the importance of maintaining these cultural values in parenting was important for the fathers, particularly those born in the u.s. further exploration of expanded cultural values such as personalismo, simpatia, and other common latino cultural values is necessary to further explore their influence on parenting. there were some contradictory findings, where fathers born in the u.s. (conceptualized in this study as more acculturated) wanted to maintain traditional cultural values and roles of fathers in relation to mothers. those fathers born outside the u.s. (conceptualized as less acculturated) focused on changing the way things were in puerto rico and having more egalitarian roles between fathers and mothers. however, this difference did not hold up in communicating with the child, where u.s.-born fathers felt strongly about open communication between the child and themselves, compared to fathers born in puerto rico. in this study, the individuality of the child appeared to play a role in the father’s parenting more so than the child’s gender. this is a construct that has been changing over time, with the importance of the child’s gender being less influential in parenting today (pleck & masciadrelli, 2004). findings from this study corroborate this point considering that participants discussed the influence of children’s unique personalities more than they mentioned the influence of the child’s gender on their parenting. for the participants in this study, the fathers’ relationships with their own fathers were identified as an important factor in their own parenting. prior literature has found that well developed relationships with their own fathers tend to lead to positive relationships with their own children (shears, robinson, & emde, 2002). in this study, participants identified http://onlinelibrary.wiley.com.ezproxy.lib.uconn.edu/doi/10.1111/j.1750-8606.2012.00249.x/full#cdep249-bib-0040 mogro-wilson et al./emerging bicultural views 322 the ways in which they wanted to be different from their fathers. more than half of the fathers reported wanting to be a different type of father than their own father. intergenerational relationships are influenced by many factors including beliefs of how a father should provide financial support, how often they play with children, as well as gender beliefs (taylor & behnke, 2005). fathers in our study identified wanting to be different than their fathers by being there more often for their child, being more involved in their child’ lives and schooling, and playing and spending time with their children on activities the child enjoyed. further research could further explore these issues for latino fathers and how acculturation plays a role. the blending of traditional values and cultural pride with a call to adopt more modern values of parenting identified by fathers in this study reflects a potential shift in the dynamics of puerto rican families. the findings contrasted with u.s.-born fathers, who reported a greater adherence to traditional values, primarily referenced through larger family structures and experiences of their own childhood. this may reflect a reverse acculturation effect, in which fathers who were born in the u.s. may feel more strongly that they need to hold onto traditional cultural perspectives, while those who moved later in life to the u.s. may feel more compelled to adapt a hybrid style of parenting that combines u.s. and puerto rican values. as latino generational status changes, so does acculturation level and these changes seem to impact parenting in different ways. how these changes manifest for latino fathers, and puerto rican fathers in particular, has not yet been fully explored (falicov, 2007). as the puerto rican population grows in the u.s. over the next several decades, research should further explore the trajectory of this hybrid cultural shift, and the impact of this shift across generations of puerto rican families. this finding contradicts a previous study by mogro-wilson (2008), where more acculturated latino families demonstrated decreased monitoring and control towards their child, which in turn lead to more negative adolescent outcomes such as alcohol use. however, mogro-wilson (2008) included a primarily mexican american sample, and thus perhaps the differences seen in acculturation varied based on the latino subgroup. in addition, these findings were for mothers and fathers, not fathers specifically. more research is needed to look at the important ways acculturation differs for latino subgroups and for fathers specifically. this study paralleled findings related to a hybrid cultural shift or biculturalism regarding parenting among latino fathers highlighted previously (cabrera & bradley, 2012), and suggests the need to value both traditional and modern parenting practices when working with puerto rican fathers. valuing both cultures and/or the recognition that dual cultures are important when raising children challenges the belief that one culture is emphasized over another within the latino community (cortés, rogler, & malgady, 1994). findings suggest a reverse-acculturation effect, in which fathers born in the us were more likely to be influenced by traditional cultural views than fathers with less time in the u.s. similarly, fathers who were born in the u.s. spoke more frequently about their role as a father in teaching culture and values than fathers born in puerto rico. fathers born in the u.s. spoke about carrying traditions, teaching their language, sharing culture and heritage with children, and the importance of passing culture down through generations. advances in social work, spring 2019, 19(1) 323 social work research and thus practice, must be responsive to the changing demographics of fathers in the u.s. which include growing numbers of latinos from ecuador, colombia, venezuela, guatemala, and the dominican republic (u.s. census bureau, 2017). while the research on latino fathers continues to grow, the primary knowledge base is built from the non-latino white narrative and is devoid of cultural considerations and factors that influence latino populations differently (cabrera & garcíacoll, 2004). in addition, finding ways to engage fathers in a culturally appropriate framework is important to supporting child wellness (webster et al., 2013). to promote family and child success, future research may focus on the specific impact of father-child relationships on child-specific outcomes, as well as the development of father-specific programs that emphasize important roles noted by puerto rican fathers. applying the findings from this study can help develop best practices to support puerto rican fathers, and promote their involvement and impact on their child’s lives. the opportunity to involve fathers in clinical work and in therapy can help the family system and the home environment. this study provides practical ideas from fathers that can assist clinical social workers in their practice to help fathers become more involved in their children’s lives. for example, fathers spoke about providing opportunities for developing the child-father relationship through developmentally appropriate activities, such as going to the movies, riding bikes, and playing with dolls. in addition, the amount of pride that puerto rican fathers have for their culture can be leveraged in interventions where clinical providers can help modify goals of the treatment to align with cultural values of the importance of the family. a better understanding of how culture plays a role in parenting will help interpret parenting roles, particularly in a child welfare system, and lead to a more nuanced understanding of latino families. finally, given the current political climate, where latino fathers are often not seen as contributors to our society and the fabric of our communities, there is a lot of future work to be done to integrate family policies to involve fathers from the prenatal stages into schools and community activities. there are few home visiting programs specifically for fathers, and fewer school outreach programs for fathers in particular. programs aligned with cultural latino values, that acknowledge the parenting role of the father, and also recognize the importance of the individuality of the child, father generational status and nativity can assist policy implementation within child welfare, health, and school systems. limitations despite maintenance of rigorous research methods, such as inclusion of a second coder, systematic coding using nvivo, and transparency within the research design, this study does have some limitations. a small sample size recruited within only one area of the u.s. limits our ability to generalize the study findings. while some of the findings suggested differences in role perceptions between us-born fathers and those born in puerto rico, these differences were not found for all themes which may reflect the small sample size rather than a true lack of differences. further, selection bias may influence the generalizability of the findings as it is possible that only committed fathers elected to participate in the study or responded to the questions within the focus groups. additionally, as this was a small sample the findings should be replicated with a larger sample. for mogro-wilson et al./emerging bicultural views 324 example, more research is needed to assist in explaining why fathers in our study seem to be involved with their boys and girls in a similar way, which is not characteristic of traditional latino families. in this study, the primary coder conducted two waves of coding to establish the codebook and develop depth around established codes. the use of memos and other tools were not used to help coders establish inter-rater reliability; future work should consider using this approach. to establish a level of concurrence between the first and second coder, many discussions were needed between the coders to establish good inter-rater reliability. this is hypothesized to be due to bias among the coders and was discussed to inform the further development of codes. only one of the two coders was a parent, and the parent coder identified this as influential to exploring the constructs that influence role perception among fathers. this identification was explored in informing a deeper understanding of themes and contributed significantly and positively to the qualitative research process. it is also important to note that neither of the coders is a father, which may contribute to biased results related to the themes that were identified through coding. however, one of the coauthors, who was also the focus group facilitator, was a puerto rican father. it is virtually impossible to control for all researcher bias within qualitative research; however, this bias was managed by ongoing consultation with a fatherhood expert, who provided perspective on coding structures. conclusion the findings in this study highlight the importance of better understanding how latino fathers perceive their parenting roles. these findings can help inform social work practice with puerto rican fathers by placing emphasis on the importance of the role of the father when working with families and promoting understanding of the role culture plays in parenting. social workers must continue to value the role fathers play in the development of children and families. in addition, practice with puerto rican fathers should involve work around the interaction with their child(ren) and focus on the development of the father-child relationship by emphasizing what the fathers in this study have identified as key components to fatherhood: being there, building confidence, preparing for adulthood, maintaining open communication, teaching culture/values and being a role model. the themes identified in this study begin to unpack how the relationship between a father and child develops and what sustains it. this focus goes beyond solely the hours spent in tasks of childcare, and creates space to continue the discussion around the direct and indirect ways fathers have an influence on their children. further research on how to integrate these findings into interventions and current evidence-based practices for latino fathers and families is necessary. in addition, research that investigates similarities and differences of latino subgroups on how men experience fatherhood will be informative. finally, there is a need to continue our work in the classroom in social work education where we can prepare students to work with family units and parents. by continuing to work with fathers, we liberate the mother as the sole responsible adult to contribute to their child’s development. advances in social work, spring 2019, 19(1) 325 research is needed to explore ways to support and engage fathers with implications that extend across a variety of settings, including schools, health settings, and social services. due to the increasing population of puerto rican and other latino sub-groups, providers and social workers working with puerto rican families should understanding the perceived parenting roles within families to better engage and support fathers and families within this growing population. references ashbourne, l. m., daly, k. j., & brown, j. l. 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(2013). understanding the contribution of a father’s warmth on his child’s social skills. fathering, 11(1), 90-113. doi: https://doi.org/10.3149/fth.1101.90 author note: address correspondence to: cristina mogro-wilson, phd, associate professor, university of connecticut school of social work, hartford, ct 06103; email: cristina.wilson@uconn.edu https://doi.org/10.4324/9781410609380 https://www.pewresearch.org/wp-content/uploads/sites/5/reports/85.pdf https://doi.org/10.1023/b:sers.0000018886.58945.06 https://doi.org/10.1037/0012-1649.41.5.723 https://doi.org/10.1080/1357527042000332808 https://doi.org/10.1002/imhj.10005 https://doi.org/10.3149/fth.0302.99 https://10.0.4.13/0002-9432.72.2.163 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=acs_17_5yr_dp05&src=pt https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=acs_17_5yr_dp05&src=pt https://doi.org/10.3149/fth.1101.90 mailto:cristina.wilson@uconn.edu emerging bicultural views of fatherhood: perspectives of puerto rican fathers cristina mogro-wilson alysse melville loomis crystal hayes reinaldo rojas abstract: puerto rican fathers remain an understudied population despite the growing latino community in the u.s. understanding how puerto rican fathers perceive their roles as fathers can inform our conceptualization of their engagement with children... keywords: parenting, fatherhood, parent-child relationships, latinos; puerto rico methods sample and design the participants were asked seven primary open-ended questions in the focus groups, with seven sub-questions embedded within the primary questions (table 1). the questions explored participants’ perception of their role as parents and the intersection... data analysis findings of the 18 fathers who participated in the focus groups, over half (n=10) were born in puerto rico. fathers had an average of two children and their first child was on average 11 years old, with a range of 6 months to 23 years (see table 2). themes: parenting role of fathers being there. puerto rican fathers described “being there” as spending quality time with their children, being available to their children, and spending time together. for example, one father shared: i think one of the biggest things regardless of gender is just spending time with them. and it’s spending time with them not with things that you want to do...spending time with things that they want to do, things they like to do, things that they’re ... this theme was also discussed by another father, both in terms of physically “being there” and being there during good and bad points in the child’s life. he shared: it’s just being there for them. like, i get to their level...you know, my job is to make sure that she knows that if she looks to the side daddy’s there playing with her. and that she knows that i’m going to be there in the good and in the bad. (roberto) building confidence. participants identified building confidence as an intentional process by which they foster and encourage confidence and self-esteem in their children. fathers identified the use of their relationship with their children as an impo... i’ll try to build her confidence. i’ll take her to a park where there’s nothing but boys playing and i’ll be like yo, we got next. and i’ll let her, you know, let her play so she doesn’t feel like she can’t have a confidence or have good self-esteem a... another father speaking about a daughter mentioned strategies for promoting confidence, including talking in a respectful tone: i try to talk to her mother and her sister, her half-sister, in respectful ways around her. i'm trying to set the tone now, so that it kind of just becomes natural and she understands, you know, the value that i have of her, um, as a female. and the c... preparing for adulthood. fathers identified helping children to prepare for adulthood as part of their parenting role. participants considered it important that their children--both daughters and sons-were ready for adulthood, were good citizens, an... maintaining open communication. fathers in this study reported that maintaining open communication with their children was an important part of their parenting. fathers mentioned interest in talking to their children, allowing them to ask questions an... teaching culture/values. fathers reported that teaching children culture/values was part of their role as parents, particularly among those participants who endorsed more traditional cultural views. participants reported teaching their children about ... another father discussed intentionality around teaching their children cultural values, noting that these values may differ from other families but that they were central to expectations for family members. this father noted: you know, i’m not going to tell them ‘because i said so.’ i’m going to explain to them the reason why. we hold certain values, maybe their [family] values are different, i’m not judging them. but this family has certain values and you’re going to foll... being a role model. fathers stated that acting as a role model was an important part of their parenting role. fathers mentioned leading their children by example, teaching through action, modeling positive behavior for children, and showing the import... and always lead by example. ‘you’re swearing. you ever see me swearing? i don’t swear. you know, if you don’t see me do it that means it’s not appropriate. if you don’t see me smoke you know, you shouldn’t do it’. you know, you got to lead by example ... another father discussed how his perception of being a role model shapes his own behavior, noting “...if i do something bad, i don't want them to get into anything bad in life, i gotta be a role model. i cannot do it. so i cannot go back to them and t... influences on fathers’ perceptions of their role as parents individuality of the child. individual child’s personalities were mentioned as more influential than child’s gender on fathers’ approach to parenting. fathers identified the importance of getting to know their children as distinct individuals, separat... your kids are individuals that you’re raising and they’re different than you. you know, and some of them might look a little more like you and they might have some of your habits, but they are still a different person. (jose) the importance of seeing children as individuals seemed to contribute to a more open or flexible style of parenting and allowed fathers to develop individual relationships with their child regardless of the child’s gender. another example of intergenerational change reported by participants was establishing enhanced emotional connections with their children after recognizing that their own father did not express or encourage the expression of emotions. for example, one ... i made a decision early in fatherhood that i was going to be a little different than my father...i think i made a decision early that i was going to be a little different, and show a lot more love to my kids. (miguel) discussion for the participants in this study, the fathers’ relationships with their own fathers were identified as an important factor in their own parenting. prior literature has found that well developed relationships with their own fathers tend to lead to po... limitations _______ margaret amenuke-edusei, ba, mph, phd, lecturer and coordinator of social work program, department of social sciences, central university, tema, ghana, and charles m. s. birore, phd, associate professor, the ethelyn r. strong school of social work, norfolk state university, norfolk, va. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 756-777, doi: 10.18060/23663 this work is licensed under a creative commons attribution 4.0 international license. the influence of sociodemographic factors on women’s breast cancer screening in accra, ghana margaret amenuke-edusei charles m. s. birore abstract: ghana has a relatively low incidence rate of women’s breast cancer compared to more developed countries. however, the breast cancer’s mortality rate is higher in the former compared to the latter. in ghana, the role of social work in health care is limited or is not recognized. the purpose of this study was to explore the influence of sociodemographic characteristics, access to healthcare providers, and physicians’ recommendations on ghanaian women’s breast cancer screening practices. a crosssectional survey and convenience sample were used to collect data from 194 ghanaian women after approval was obtained from two institutional review boards, authors of instruments used, and the participants. univariate, chi-square, and logistic regression statistics were used to analyze data. seventy-one percent of the participants reported practicing breast self-examination (bse) and 14% reported mammogram screening. while educational level and employment were positively associated with bse, a regular visit to healthcare providers was negatively associated with bse. income and physicians’ recommendations were positively associated with mammogram screening. ghanaian women’s low level of mammogram screening calls for first, increasing breast cancer awareness and education to counteract negative personal and cultural beliefs relating to breast cancer and screening. second, social workers in collaboration with health professionals and social justice agencies should advocate and lobby for health insurance legislation which mandates coverage of mammogram screening services. finally, introducing oncology social work to the curriculum of social work educational programs in ghana is needed to prepare social workers to address psychosocial challenges relating to breast cancer. keywords: breast cancer, breast neoplasm, breast self-examination, mammogram screening, sociodemographic factors, mammography, africa early diagnosis of cancer is critically important because it increases the chances for successful treatment and management of the disease (world health organization [who], 2019). however, despite advancements in technology and scientific methods in early diagnosis, prevention, and treatment of cancer, women’s breast cancer remains a major global health problem, affecting more than 2.5 million women worldwide (bray et al., 2018; who, 2019; 2020). the causes of breast cancer are unknown, but the risk factors include gender, age, previous breast cancer disease, family history of cancer, physical inactivity, obesity, exposure to high radiation, and high levels of stress (chiriac et al., 2018; who, 2018). https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2020, 20(3) 757 literature review this literature review focuses on a brief overview of the incidence and mortality rates of women’s breast cancer in ghana and other countries, women’s breast self-examination (bse), and mammogram screening. other variables reviewed include age, marital status, level of education, income, occupation or employment, health insurance coverage, and access to healthcare provider including, regular visits to health care providers and physicians’ recommendations for mammogram screening. the three most widely used breast cancer screening procedures across the globe are bse, clinical breast examination (cbe), and mammography (american cancer society [acs], 2017; international agency for research on cancer (iarc, 2016). digital mammography is considered the superior method because of its ability to detect extremely small cancerous tumors, which cannot be detected by bse or cbe (edgar et al., 2013). in this study, cbe was not investigated because of the limited number of trained healthcare professionals who perform such procedures in ghana. incidence of breast cancer the latest statistics indicate that in 2018, the age-standardized incidence and mortality rates of women’s breast cancer in ghana were 34 and 17 per 100,000 women, respectively. in the united states, the age-standardized incidence and mortality rates of women’s breast cancer were greater than or equal to 73 and 12.3 per 100,000 women, respectively (bray et al., 2018; iarc, 2018). although the incidence rates are higher in more industrialized countries such as the united states than in less industrialized countries such as ghana, the mortality rates are relatively lower in the former countries compared to the latter. the lower death rates in more industrialized countries are partly attributed to increased women’s breast cancer awareness and early detection of the disease. lack of awareness and screening protocols, limited or lack of access to diagnostic services for early detection, and lower standards of healthcare facilities contribute to higher mortality rates in less industrialized countries (acs, 2018; da costa vieira et al., 2017; francies et al., 2020). early diagnosis of breast cancer is important because it leads to early treatment, and thus better outcomes and higher survival rates (acs, 2018). ghana underreports cancer statistics because of inadequate trained personnel and equipment (laryea et al., 2014). in 2012, the government established the only populationbased cancer registry in kumasi, the second-largest city in the country. however, the registry is limited to only kumasi and its immediate surrounding areas. as a result, breast cancer data in the country are largely underreported. a report on cancer statistics in 2014 indicated that breast cancer ranked highest among all the types of female cancer in the registry, representing 36%, followed by cervical cancer (26%) and ovarian cancer (8%) (laryea et al., 2014). it is unknown whether the report would have revealed higher statistical rates on breast cancer if the data covered the entire country. underreported data raises many uncertainties and concerns about the actual incidence of breast cancer among women in ghana. breast self-examination (bse) involves a woman’s self-physical and visual examination of her breasts to determine any unusual changes such as change of skin color, amenuke-edusei & birore/sociodemographics & women’s breast cancer 758 detecting a lump, nipple discharge, pain, or size change (acs, 2017). currently, bse is an optional form of breast cancer screening because its effectiveness in reducing mortality rates of women’s breast cancer has been questioned (acs, 2018; nci, 2017). according to the national cancer institute (nci, 2017), regular bse is not recommended for breast cancer screening because, in clinical trials, bse alone does not reduce breast cancer death rates; hence, both acs (2018, 2019) and the united states preventive services task force (uspstf, 2016) no longer recommend regular bse practice. however, dey (2014) found bse to be an important alternative procedure in low-middle income countries where healthcare resources are scarce. additionally, iarc (2016) noted that women who practiced bse regularly were more likely to detect breast tumors themselves at their earliest stage and had higher survival rates compared to those who did not. in ghana, cultural beliefs play a major role in women’s attitudes toward the causes, prevention, and treatment of diseases, including breast cancer (atobrah, 2012; opoku et al., 2012). many ghanaians attribute diseases to spiritual and supernatural causes. their strong faith in god, fear of removal of the breasts, and denial are factors associated with reluctance to screen and seek treatment for cancer (opoku et al., 2012). mammogram screening. mammogram screening involves taking a picture of the breast using x-rays and then looking for tumors and abnormal breast cells in a woman with no symptoms of breast cancer (nci, 2017). findings from randomized controlled trials (rcts) and systematic reviews show that mammograms are effective in detecting breast cancer tumors early, thus, leading to early treatment and reduced mortality rates, especially for those over 50 years (chan & so, 2015; marmot et al., 2013; myers et al., 2015; nelson et al., 2016; uk independent review panel, 2012). however, cohort studies have revealed that mammogram screening poses substantial harm because it induces women into overdiagnoses (false-positive test results), which increases the risk of developing cancer (gøtzsche & jørgensen, 2013; jørgensen et al., 2017). over-diagnoses expose women to more radiation, stress, breast cancer–specific worry, distress, discomfort, cost of diagnoses, and surgery (jørgensen & gøtzsche, 2009; nelson et al., 2016). the latest who (2020) guidelines for mammogram screening practices no longer recommend such practices among women aged 40-49. while women aged 50-54 should undergo mammography yearly, those aged 55 and older should screen biennially. the latest acs (2020) guidelines no longer recommend bse; however, yearly screening should start at age 45-54, and biennial screening should start at age 55 and older. women have an option of starting mammography at age 40. sociodemographic factors and breast cancer screening a synthesis of the literature shows associations between sociodemographic factors of age, marital status, educational level, income, and employment or occupation, and bse and mammogram screening (park et al., 2011). there are mixed findings on the influence of age on breast cancer screening practices. while tavafian et al. (2009) found a lack of association between age and bse, akhigbe and omuemu (2009) and park et al. (2011) reported an association between increasing age and bse. these researchers found participants who practice bse, or those who undergo mammogram screening are typically 50 years and older. however, other studies have shown that mammography use is more advances in social work, fall 2020, 20(3) 759 common among younger women than older ones and that younger age is positively associated with breast cancer screening practices (alkhasawneh, 2007; renshaw et al., 2010; secginli & nahcivan, 2005). marital status. a wealth of literature indicates an association between marital status among different racial and ethnic populations and breast cancer screening (ahmadian et al., 2012; boxwala et al., 2010; kiguli-malwadde et al., 2010). park et al. (2011) found that among 4,139 korean women, married women undertook mammography and papanicolaou smears significantly more than unmarried ones. similarly, ahmadian et al. (2012) and boxwala et al. (2010) reported that more than 65% of their married participants versus about 20% of unmarried ones adhered to mammography. despite the positive correlation between being married and mammogram screening, other researchers (secginli & nahcivan, 2005) found a lack of association between marital status and mammogram screening. in these studies, married women were disproportionately represented, which might have accounted for the differences in the findings. overall, the literature shows that having a husband, partner, or significant other may either positively or negatively influence breast cancer screening among women across the globe (hinyard, et al., 2017). educational level. likewise, there are contradictory findings on the influence of educational level on women’s breast cancer screening practices. on the one hand, researchers report positive associations (boxwala et al., 2010; park et al., 2011) and on the other hand, esteva et al. (2008) reported a lack of such association. in a sample of 160 asian-indian women in the united states, boxwala et al. (2010) found college-educated women more likely to participate in mammogram screening compared to those without a college education. opoku et al. (2012) and renshaw et al. (2010) reported similar findings. by contrast, esteva et al. (2008) reported that women with a college education had a higher risk of non-attendance and were significantly less likely to participate in a population-based breast cancer-screening program. additionally, bse was higher among women without any formal education compared to women who had secondary and tertiary education. income. the literature indicates an association between income and breast cancer screening practices (edgar et al., 2013; gregory-mercado et al., 2007; litaker & tomolo, 2007). while litaker and tomolo (2007) and gregory-mercado et al. (2007) found women from high income households more likely to participate in mammogram screening compared to those from low-income families, park et al. (2011) and renshaw et al. (2010) reported an association between living in less affluent or economically deprived areas and non-participation in mammogram screening. these findings underscore the importance of exploring the degree to which income influences women’s breast cancer screening practices in ghana. employment and occupation. the literature shows inconsistent associations between breast cancer screening practices and employment status: full-time versus part-time, employed versus unemployed, or retired (ahmadian et al., 2012; boxwala et al., 2010; esteva et al., 2008; jensen et al., 2012). for instance, jensen et al. (2012) found that unemployment was associated with non-participation in screening practices. similarly, ahmadian et al. (2012) found that among iranian women, about 67% of participants who adhered to mammogram screening within the previous two years of the study were amenuke-edusei & birore/sociodemographics & women’s breast cancer 760 employed full-time compared to only 16% of part-time employed or unemployed women. in a sample of 160 asian-indian women, boxwala et al. (2010) reported that almost 75% of the fully employed participants adhered to breast cancer screening practices compared to their part-time counterparts. in the united states, litaker and tomolo (2007) reported similar findings. by contrast, esteva et al. (2008) reported that more than two-thirds of their participants who had mammogram screening were unemployed or retired compared to about 34% who were employed. access to healthcare providers: the extent to which women in ghana have access to healthcare providers is not known, although that knowledge is important in the early detection of breast cancer. recent information on health insurance coverage in ghana indicated that less than 40% of the population is covered (amu et al., 2018); hence, it is necessary to find out how ghanaian women access healthcare services. access to healthcare providers in this study comprises health insurance coverage, regular visits to healthcare providers, and physicians’ recommendation for breast cancer screening. these variables are reviewed to determine how they influence breast cancer screening. in many parts of the world, health insurance coverage is reported to have had a strong association with women’s breast cancer screening practices (ahmadian et al., 2012; sutradhar et al., 2016). the findings of many recent studies indicate that health insurance coverage significantly correlates with participation in breast cancer screening (ahmadian et al., 2012; esteva et al., 2008; park et al., 2011). thus, this variable was tested among the ghanaian sample to determine its influence on mammogram screening. regular visits to healthcare providers and physicians’ recommendations for screening were shown to have positively influenced bse and mammogram screening practices. most women learn about breast cancer and the importance of screening through such visits and recommendations create a sense of urgency (boxwala et al., 2010; guvenc et al., 2012; secginli & nahcivan, 2005). guvenc et al. (2012) and schueler and colleagues (2008) reported that approximately half of their participants received breast cancer and screening information from their physicians and cited physicians’ recommendations as a major reason for their mammogram screening. using a population-based research approach, the purpose of this study was to explore the influence of sociodemographic characteristics and access to a healthcare provider on women’s breast cancer screening practices in ghana. the broad research questions (rqs) and hypotheses (h0) for the study were: rqs: 1. what are the levels of bse and mammogram screening among ghanaian women? 2. what are the factors that influence breast cancer screening practices among ghanaian women? h1: there are significant levels of bse and mammogram screening among ghanaian women. h2: there are significant associations between sociodemographic factors and access to healthcare provider variables and breast cancer screening among ghanaian women. advances in social work, fall 2020, 20(3) 761 methods study design and participants a cross-sectional survey was used to collect data from a sample of 210 ghanaian women to explore the influences of sociodemographic characteristics and access to healthcare providers and their recommendations on breast cancer screening. appropriateness of exploratory and descriptive research, suitability for correlation inquiry, one-point in-time data collection, diverse group sampling, and cost-effectiveness dictated the selection of this design (creswell & creswell, 2018). a study site was randomly selected from eleven sub-districts in the accra metropolitan area. the authors selected this area because it includes the capital city of the country and has the few breast cancer screening facilities and trained healthcare professionals in the country. ethical considerations and procedures the institutional review boards (irb) from a university in the southern united states and the study site country’s health service granted permission to conduct this study. the authors completed the online collaborative institutional training initiative (citi) program on human subject protection and research integrity. written permission to use the instruments from the developers was obtained. participation in the study was announced in the selected churches involved in the study, and informed consent was obtained from all participants. participants’ privacy, confidentiality, and anonymity were maintained. sample and sampling. the study involved women aged 18 and older who were residents of the ayawaso central sub-district in the accra metropolis. this area had approximately 40,000 women (ghana statistical services [gss], 2012). however, the number of women in the target age group who attended the selected churches in the subdistrict was 1,390. a convenience sample of 210 women without any sign of breast cancer was drawn from two churches. the authors used the raosoft (2004) sample size calculator to determine the required sample size with 5% margin of error and 95% confidence level for this study. sixteen participants did not complete a substantial number of items in the questionnaire and therefore, were excluded from the data analyses, leaving the final sample size at 194. the 16 participants constituted less than 10% of the required sample and thus produced no bias in the results of the study (langkamp et al., 2010). measures the authors used a self-administered questionnaire to collect data face-to-face by employing the services of a trained research assistant who distributed the questionnaires to participants and collected them at a later date. the researchers adapted questions from the breast health questionnaire [bhq] (shirazi, 2006) to measure breast cancer screening practices and elicited information about participants’ sociodemographic characteristics. regarding sociodemographic characteristics, information was collected on age, marital status, education level, household monthly income, and employment status or occupation. shirazi (2006) reported the bhq overall internal consistency reliability ranged from 0.79 to 0.99 and cronbach’s alpha values ranged from 0.69 to 0.88 for its scale and sub-scales, amenuke-edusei & birore/sociodemographics & women’s breast cancer 762 respectively. there was no report on cronbach’s alpha for the breast cancer screening items. the items selected from the bhq were used for the first time among ghanaian women. they were suitable to use because they had been tested among women of african descent and the items were clear and easy to understand. the items were also selected based on the literature and recommendations from breast cancer experts. four items measured bse and five measured mammogram screening. the cronbach’s alpha value for the bse (4-items) in the ghanaian sample was 0.74. an example of the bse item was, “would you say you practiced bse?” with four response options from 1= (once a month), 2= (once every 2 months), 3= (once every 3 months), and 4= (not at all). regarding the mammogram screening, participants were asked “have you ever had a mammogram?” with dummy coded-response options; 1=yes, and 0=no. the participants who answered “no” to this question responded to an open-ended follow-up question such as, “can you tell me the reasons why you did not have one?” the participants who answered “yes” were asked “when was your most recent mammogram?” this question had four response options from 1= (less than one year ago), 2= (1 year ago), 3= (more than 2 years ago), and 4= (other). two yes/no questions asked about participants’ personal and family history of breast cancer. these included “has anyone close to you ever been diagnosed as having breast cancer?” and “have you ever been told you had breast cancer?” another question also assessed participants’ experiences with breast abnormality with four response options: 1= (unusual pain), 2= (swelling), 3= (lump), and 4= (none of these). three yes/no items measured participants’ access to healthcare providers (i.e., “do you have health insurance? do you have a healthcare provider whom you visit regularly? has a physician advised you to undergo bse and/or mammogram screening?) data analysis the authors screened the data for accuracy using visual and computerized examinations of entry errors, missing data, and outliers to meet the required assumptions of the selected statistical tests (tabachnick & fidell, 2012). statistical package for the social sciences (spss) version 18.0 was used to analyze data at three levels of statistical tests: univariate using percentages, means, and standard deviations, bivariate using chisquare test, and logistic regression. results sociodemographic characteristics the sample consisted of 194 women aged 18 to 72 years, with a mean age of 42.15 (sd = 12.80). more than half (53.1%) of the participants were 40 to 59 years, about 40% were below age 40, and 7% were 60 years and older. a little over half (52.6%) of the participants were married, 18.6% were separated, divorced or widowed, and 26.8% were single or never married. while 42.3% had completed middle school or some secondary school education, 37.6% had completed training college. only 7.2% of the participants had a university degree, and 2.6% had no formal education. regarding type of occupation, advances in social work, fall 2020, 20(3) 763 26.8% were traders, 26.8% were teachers and other civil servants, and 13.9% were nurses. while 9.3% identified themselves as self-employed, about 11.3% reported being unemployed/retired or students. table 1. sociodemographic characteristics of the participants (n=194) characteristic n (%) age [m =42.2, sd= 12.80] 194 (100%) 18-29 50 (25.8%) 30-39 27 (13.9%) 40-49 103 (53.1%) 60-69 13 (6.7%) 70+ 1 (0.5%) marital status married 102 (52.6%) separated/divorced/widowed 36 (18.6%) never married 52 (25.9%) no response 4 (2.0%) level of education completed no education 5 (2.6%) middle/junior sec. school 82 (42.3%) secondary school 20 (10.3%) training college/diploma 73 (37.6%) university 14 (7.2%) type of occupation nurses 27 (13.9%) traders 52 (26.8%) teachers/other civil servants 52 (26.8%) self-employed 18 (9.3%) unemployed 3 (1.5%) retired 5 (2.6%) students 14 (7.2%) no response 23 (11.9%) household monthly income in ghana cedi below 500 127 (65.5%) 500–999 26 (13.4%) 1,000–2,999 21 (10.8%) 3,000–4,000 + 15 (7.7%) no response 5 (2.6%) ever experienced breast cancer signs and symptoms unusual pain, swelling, lump 23 (11.9%) abnormal mammogram 7 (3.6%) no signs and symptoms 160 (82.5%) no response 4 (2.0%) family/friend with breast cancer yes 28 (14.4%) no 165 (85.1%) no response 1 (0.5%) amenuke-edusei & birore/sociodemographics & women’s breast cancer 764 a majority (65.5%) of the participants reported a monthly household income below 500 cedis (approximately $100 us in 2020). regarding family history of breast cancer, 14.4% reported having a close relative who had breast cancer, and about 12% experienced unusual pain, swelling, or lump (s) in their breasts. fewer than 4% of the participants reported an abnormal mammogram in the previous year. see table 1 for the complete breakdown of the participants’ sociodemographic characteristics. bse and mammogram screening practices what are the levels of bse and mammogram screening practices among ghanaian women? regarding the practice of bse, 192 (99%) of the 194 participants responded to this question. as presented in table 2, the majority 136 (70%) reported that they had practiced bse. however, only 82 (42%) practiced bse once a month as recommended by medical experts. while more than three-quarters (n = 148) reported that they knew how to perform bse, only about half (n = 99) reported that a healthcare provider taught them how to perform the procedure. table 2. participants’ number and percentage of bse practices (n = 194) bse number (%) ever practiced bse? yes 136 (70.1%) no 56 (28.9%) no response 2 (1.0%) know how to perform bse? yes 148 (76.3%) no 45 (23.2%) no response 1 (0.5%) ever taught how to perform bse? yes 99 (51.0%) no 94 (48.5%) no response 1 (0.5%) frequency of bse once a month 82 (42.3%) not once a month 112 (57.7%) pertaining to mammogram screening, 117 participants met the eligibility criteria of being 40 years or older to participate in such a screening program. hence, only this group of the study sample was included in the mammogram screening analysis. as presented in table 3, 116 (99%) of the participants responded to the question of whether they had ever had a mammogram. sixteen (13.7%) reported they had undergone the screening procedure. of this number, about half (n=7, 43.75%) underwent the procedure in the previous year. advances in social work, fall 2020, 20(3) 765 thirteen (93%) of the participants who underwent mammogram screening cited routine regular medical check-up as the reason for their most recent mammogram screening. however, 59 (59%) of the 100 participants who reported non-participation in the screening procedure gave various reasons for not doing so. the most frequent reasons cited were not having signs of breast cancer, not being aware of breast screening, and not receiving recommendations from physicians. table 3. participants’ mammogram screening practices (n=117) mammogram screening n (%) ever had mammogram? yes 16 (13.7%) no 100 (85.4%) no response 1 (0.9%) the most recent mammogram ≤ 1 year 7 (43.75%) 2 years and more 7 (43.75%) no response 2 (12.5%) reason for the most recent mammogram routine medical check-up 13 (92.9%) follow-up 1 (7.1%) reason for not having a mammogram 59 (59%) have no sign of breast cancer 16 (27.1%) not aware of screening 15 (25.4%) physician did not recommend it 7 (12.0%) had not thought about having one 5 (8.5%) have financial difficulties 5 (8.5%) other reasons 11 (18.5%) chi-square test analysis of sociodemographic factors are there significant associations between the demographic factors (age, marital status, educational levels, occupation/employment, income) and bse and mammogram screening among ghanaian women? the results of the pearson’s chi-square analysis did not show a statistically significant association between age and bse, χ2(1,194) = .81, p = .369, phi = .06. participants aged 18 to 39 were not different in the practice of bse from those aged 40 and older. bse’s relative odds ratio value for age (or = 1.3) showed that older participants were 1.3 times more likely to practice bse compared to their younger counterparts. in addition, a nonstatistically significant association was found between age category and mammogram screening, χ2(1,116) = 1.60, p = .281, phi = .10. the results of the chi-square analysis showed a non-statistically significant association between marital status and bse, χ2(2, 189) = .85, p = .652, cramer’s v = .07; and marital status and mammogram screening, χ2(2, 112) = .66, p = .418, cramer’s v = amenuke-edusei & birore/sociodemographics & women’s breast cancer 766 .077. additionally, there were no differences in bse and mammogram screening between married participants and those who were separated, divorced, widowed, or never married. the pearson’s chi-square analysis revealed a statistically significant weak positive association between educational levels and bse, χ2(2,192) = 9.09, p = .011, with a small effect size, indicating cramer’s v-value of .22. participants holding a university education were 3.7 times (or = 3.7) more likely to practice bse compared to those with a lower level of education. participants who completed middle or some secondary education and those who completed college were 2.6 times (or = 2.6) more likely to practice bse compared to those who had no formal education or did not complete middle or secondary school, respectively. non-statistically significant associations were found between educational levels and mammogram screening, fisher’s exact test (116) = 4.64, p = .094. the pearson’s chi-square and fisher’s exact analyses revealed a statistically significant moderate positive association between occupation/employment status and bse, χ2(3,169) = 19.76, p < .001, with a medium effect size cramer’s v-value of .34 (cohen, 1988). bse’s relative odds ratio showed that nurses were 9.6 times (or= 9.6) more likely to practice bse compared to teachers and other workers. bse’s relative odds ratio showed that traders and self-employed participants were four times (or = 4) less likely to practice bse compared to teachers and other workers. non-statistically significant associations were found between occupation/employment and mammogram screening, fisher’s exact test (108) = 3.04, p = .321. the results of the pearson chi-square analysis indicated a statistically significant association between household monthly income and mammogram, fisher’s exact test, (112) = 5.14, p = .020. participants with monthly household income below 500 cedis were 4.5 times (or = 4.5) less likely to participate in mammogram screening compared to their counterparts with household monthly income ≥ 500 cedis. chi-square test analysis of access to healthcare provider are there significant associations between access to healthcare provider (health insurance coverage, regular visits to healthcare providers, and physicians’ recommendations) and bse and mammogram screening among ghanaian women? the results of the pearson’s chi-square analysis revealed non-statistically significant associations between health insurance coverage and mammogram screening, χ2(1, 115) = .102, p = .749, phi = -.030). regular visits to the healthcare provider had a weak negative association with bse, χ2(1, 191) = 5.18, p = .023, with a small effect size of -.17 phi-value. participants who did not regularly visit their healthcare provider were 2.2 times (or = 2.2) less likely to practice bse than those who regularly visited their healthcare provider. there was no statistically significant association between regular visit to the healthcare provider and mammogram screening, pearson χ2(1, 115) = .050, p = .823, phi = -.021. the chi-square result also indicated a statistically significant association between physicians’ recommendation and mammogram screening, fisher’s exact test (115) = 11.93, p = .001. participants who received mammogram screening recommendations from advances in social work, fall 2020, 20(3) 767 physicians were 63 times (or = 63) more likely to undergo mammogram screening compared to those who did not receive such recommendations. logistic regression analysis which sociodemographic and access to healthcare provider variables predict bse and mammogram screening among ghanaian women? the results of a binary logistic regression analysis using the forward likelihood-ratio method revealed that occupation, wald (1, 154) = 7.21, p = .007, or = 3.19, 95% ci (1.37, 7.50), and age wald (1,154) = 5.24, p = .022, or = 1.04, 95% ci (1.01, 1.07) significantly predicted bse. nurses and other civil servants were three times more likely to perform bse compared to self-employed and unemployed participants. likewise, older participants were significantly more likely to practice bse than their younger counterparts. physicians’ recommendations, wald (1, 111) = 14.01, p < .001, or = 76.60, 95% ci (8.01, 732.57) and household monthly income, wald (1, 111) = 6.93, p = .008, or = .114, 95% ci (.023, .574) emerged as significant predictors. the cox and snell r2 and the nagelkerke r2 results showed that occupation accounted for 3.1% to 4.4%, and age accounted for 2.9% to 4.2% of the variances in bse, respectively. the cox and snell r2 and the nagelkerke r2 results showed that a physicians’ recommendation accounted for 22.3% to 43.4%, and household monthly income accounted for 5.4% to 10.5% in mammogram screening, respectively. in total, the model accounted for 27.7% to 53.9% of the variance in mammogram screening. discussion the purpose of this study was to explore the influence of sociodemographic characteristics and access to healthcare provider variables on bse and mammogram screening practices among women in ghana. consistent with the literature (opoku et al., 2012), this study indicated a moderately high level of bse and a very low level of mammogram screening practices among the ghanaian women. two factors may account for the low level of mammogram screening among the ghanaian sample. the first one relates to overall negative perceptions about breast cancer and mammogram screening, which ghanaian women often link to mastectomy or death (opoku et al., 2012). the second factor relates to the low-income level of approximately two-thirds of the participants. the findings show that among selected sociodemographic variables, only education and occupation were associated with bse, and income and physicians’ recommendations were associated with mammogram screening. as reported in the literature (boxwala et al., 2010; park et al., 2011; opoku et al., 2012), it appears that women with university or college education are more likely to practice bse than those with less education. nurses and teachers were more likely to perform bse than traders and self-employed or unemployed women. bse’s awareness among nurses and teachers may account for their greater bse practice compared to other professionals. such findings underscore the importance of raising bse awareness through education among women without college or university education. the moderately high knowledge and practice of bse among more educated women in the sample appear not to have much influence on their mammogram amenuke-edusei & birore/sociodemographics & women’s breast cancer 768 screening as indicated in the literature (akhigbe & omuemu, 2009; ibrahim & odusanya, 2009). however, awareness creation alone may be inadequate unless motivation such as pleasure, fear, pain, and prompts are applied as well as developing skills that can influence people’s behavior change (fogg, 2009). the statistically significant association between higher income and mammogram screening highlights the importance of affordable mammogram screening, which may be a serious concern among the low-income women who cannot afford mammogram screening. previous studies (opoku et al., 2012; park et al., 2011; renshaw et al., 2010) are consistent with this study’s findings and support its hypothesis. additionally, that finding suggests the need for more advocacy and lobbying by social workers and health-related professionals for national legislation mandating health insurance coverage for mammogram screening services. consistent with the works of parsa et al. (2008) and tavafian et al. (2009) among iranian and malaysian women, non-significant associations were found between age and bse and mammogram screening. however, other researchers (akhigbe & omuemu, 2009; park et al., 2011) who studied african and korean samples observed inconsistencies. for marital status, we found no difference in bse and mammogram screening between married and unmarried women. such outcomes were unexpected, but are consistent with previous studies conducted among non-african women (parsa et al., 2008; secginli & nahcivan, 2005; tavafian et al., 2009). as expected, physicians’ recommendations were positively associated with mammogram screening; and that observation underscores the critical role of physicians in ensuring mammogram screening among african women. furthermore, this finding supports the hypothesis and is consistent with the literature (boxwala et al., 2010; guvenc et al., 2012; secginli & nahcivan, 2005). social workers could play an important role in reinforcing the physicians’ recommendation for mammogram screening. working as a team with the physicians and other health professionals in the hospital, clinic, or other health centers, social workers could provide physicians with the outcomes of the psychosocial-emotional and spiritual assessment of the targeted women to help understand their needs and challenges. despite the strong influence of physicians’ recommendation on mammogram screening in this study, it is important to note that only a small percentage of women in this study participated in the procedure. in africa, including ghana, there is a high patient-physician ratio. for example, in 2012, there was one physician per 10,000 patients (abdulai et al., 2017). in 2020, no change was observed (statista, 2020). despite this challenge, it is evident that physicians play a major role in encouraging their female patients to undergo breast cancer screening. in this sample, health insurance coverage and regular visits to healthcare providers were not associated with mammogram screening. we did not expect these findings, as they are inconsistent with the literature (ahmadian et al., 2012; esteva et al., 2008; park et al., 2011). lack of insurance coverage for mammogram screening poses a threat for many ghanaian women’s ability to screen for breast cancer. the lack of insurance coverage may account for this finding because mammogram screening depends on one’s financial advances in social work, fall 2020, 20(3) 769 capability (opoku et al., 2012). this financial barrier calls for revision of the existing health insurance policy in ghana that may favor free or subsidized mammograms for women. about one-third of the participants reported a regular visit to a healthcare provider, and half reported that they had been taught how to perform bse. however, their regular visits were negatively associated with bse practice. additionally, there was no association between regular visits to healthcare providers and mammogram screening. we did not expect these findings because they contradict the literature (guvenc et al., 2012). there are four possible explanations for the above findings. first, perhaps there are no breast screening conversations between women and their healthcare providers during these visits. second, there may be other socioeconomic and cultural factors relating to less emphasis on bse and mammogram screening on the part of both women and healthcare providers. third, in ghanaian society, women rarely undergo mammogram screening because the public considers it unnecessary unless someone has visible signs and symptoms of the illness. finally, socio-cultural factors contribute to reluctance to undergo mammogram screening including, but not limited to women’s fear of cancer diagnosis, death, stigma, and diagnosis procedures; belief in traditional treatment (herbal medicine); and gender roles and household decision-making whereby a woman must consult with a husband or boyfriend for her breast screening (akuoko et al., 2017). therefore, it is appropriate to conclude that women’s regular visits to healthcare providers do not increase or guarantee bse and mammogram screening. the results of the logistic regression analysis suggest that occupation and age predicted bse, consistent with the literature (boxwala et al., 2010; guvenc et al., 2012) and income and physicians’ recommendations predicted mammogram screening (opoku et al., 2012; park et al., 2011). nurses and other civil servants among the sample are more likely to perform bse compared to other participants. as discussed earlier, nurses, teachers, and other civil servants might have received breast cancer and screening information as opposed to other participants. likewise, older women are more likely to practice bse compared to their younger counterparts, probably because they are aware that as one grows older the risk of developing breast cancer increases. implications of the findings social workers play varied roles in addressing social and health problems particularly for vulnerable and economically challenged people in society. such important roles include advocacy, provision of psychosocial services, and linking people to available resources. this study found a moderately high level of bse and a very low level of mammogram screening practices among ghanaian women. this information is useful for oncology social workers and other healthcare professionals in ghana (nurses, public health, medical specialists) practicing in various settings. the first practice implication relates to increased promotion of breast cancer and screening education by social workers, especially oncology social workers and health practitioners. ghanaian women’s low levels of and negative perceptions toward mammogram screening (due to fear of mastectomy and death) should be redressed through health education to mitigate personal and cultural beliefs relating to breast cancer. oncology social workers can provide psychosocial services, including amenuke-edusei & birore/sociodemographics & women’s breast cancer 770 counseling for anxiety and depression associated with screening, diagnosis, and treatment of women’s breast cancer. these professionals can work collaboratively with targeted women’s groups to educate them about the importance of bse and mammogram screening for early detection and treatment. given that oncology social workers do not exist in ghana, and that there is a limited number of medical oncologists in the country (e.g., only 12 oncology physicians and 59 oncology nurses in 2018) (matthew, 2018), there is an urgent need for oncology social workers in this country. introducing oncology social work curriculum in colleges and universities, which offer social work academic degree programs is critical to help address psycho-social-emotional-spiritual problems associated with breast cancer. the second practice implication involves encouraging women’s participation in breast cancer screening practices. it is imperative that women should not only be encouraged to participate in mammography programs, but also should be taught how to perform bse by paying attention to unusual changes in their breasts in terms of skin color, feeling a painless lump, unusual nipple discharge, or any unusual changes in the breasts. bse may save many lives by early detection beginning at age 20 and treatment of breast cancer in low-and middle-income countries where health resources and diagnostic tools are insufficient or unavailable (johnson, 2019). although acs (2020) and who (2020) no longer recommend bse, it is still useful for women in resource-constrained countries to detect any abnormality of their breasts early. depending on assessed risk factors, annual mammogram screening should start at age 40 in such resource-constrained countries (johnson, 2019). our study revealed that educational level and occupation (or employment) was associated with bse and that income and physicians’ recommendations were associated with mammogram screening. these findings have other practice implications for oncology and hospital social workers and other health professionals. first, although education and occupation (employment) are important for improving bse, they may be inadequate for influencing mammogram screening. second, while financial resources are critical for mammogram screening, practitioners must consider cultural beliefs toward such screening to improve the screening services, especially in african countries and elsewhere where such beliefs are strong. the findings showed that physicians’ recommendations were positively associated with mammogram screening. however, health insurance coverage and women’s regular visits to healthcare providers were not. these findings have further practice implication for oncology and hospital social workers, and health professionals. it appears that when women visit their healthcare providers for breast cancer checkup, and the physicians ask them to undergo the screening procedure, women adhere to their advice. however, women do not normally have conversations with the physicians about cancer, especially breast cancer, and the screening options available if they do not exhibit any such symptoms. lack of such conversation among women could be associated with fear of mastectomy and its stigma, preference for consulting traditional healers and prayer camps, and lack of or inadequate information about breast cancer and the importance of screening for early detection and treatment. in the future, regionally or nationally representative studies focusing on the influence of cultural values and beliefs, stigma, and fear of breast cancer advances in social work, fall 2020, 20(3) 771 on women’s mammogram screening practices would provide useful information for improving such screening practices in ghana. oncology and hospital social workers and other health professionals in ghana and elsewhere in lowand middle-income countries should deliberately develop breast cancer awareness programs to educate the population and encourage women at risk (based on age and family history of cancer) to have conversations with their healthcare providers about such diseases. the more women are aware of breast cancer, the more knowledge about it, and the more conversations take place with physicians, the more likely that the fear of mastectomy, its stigma, and other socio-cultural beliefs about the disease will be addressed. given a limited number of medical oncologists in ghana, it may be important to train all primary care doctors on how to encourage and engage women in conversations regarding breast cancer and the importance of screening practices. the policy implications of these findings include the development of health insurance policies to cover mammogram services, especially for low-income families. such health policies at the local, district, and central governments may save many lives in lowand middle-income countries such as ghana. social workers and other health professionals in collaboration with social justice agencies locally and internationally have an important advocacy role to play to ensure that policymakers enact appropriate health policies if they are unavailable or are reformed and implemented if they are available. policy obstacles to improved mammogram screening services in ghana and other countries like ghana include lack of government and private employers’ investment in employees’ health in terms of financing preventive measures such as screening and diagnoses of breast cancer and other diseases. in this regard, social workers are responsible for linking women who need mammogram screening services to available free or subsidized funds for screening and/or treatment that can help ease financial burden on women and their families. another policy obstacle relates to the exclusion of funding for mammogram screening by the national health insurance scheme in ghana. the development and implementation of financial appropriation policy for mammography would ensure high-quality screening outcomes, enhance consistency and high standards of services by healthcare providers, and call for adequate infrastructure in terms of human and financial resources. excluding women’s breast cancer screening and diagnostic services from the national health insurance scheme is a social justice issue. this problem calls for policy advocacy in the sense that social workers and all civil and human rights activists and advocates locally and internationally have ethical and professional responsibilities to tackle such social justice issues. such exclusion deprives those who need the services and the opportunities to improve the quality of their lives. limitations and future study this study provides information about bse and breast cancer screening among ghanaian women. this information may be useful to social workers, health practitioners, other social service professionals, and psychotherapists. however, the study may have limitations worth noting. the first limitation relates to the use of a convenience sample, which limits the generalizability of the findings to the larger population. the second amenuke-edusei & birore/sociodemographics & women’s breast cancer 772 limitation concerns the self-reported information, which might have influenced the participants’ responses to questions in accordance with what they perceived as socially desirable. finally, the sample size of 194 may not represent the national state of women’s breast cancer screening practices. regarding future studies, empirical evidence suggests that increasing awareness and early detection of breast cancer through mammogram screening are the gold standards for effective treatment outcomes and survival. a very low level of mammogram screening in ghana, therefore, calls for further investigation using a nationally representative sample to determine the extent to which breast cancer knowledge, beliefs, and awareness influence screening practices among ghanaian women. such a study would provide useful information to improve prevention strategies, including early detection through screening. conclusion ghanaian women’s low levels of mammogram screening and negative perceptions toward breast cancer could be addressed through health education to counteract negative personal and cultural beliefs relating to the disease. although college and university education and occupation or employment appear to be important for improving bse, they had no influence on mammogram screening in this study’s sample. it is important, therefore, to be aware that while financial resources are critical for mammogram screening, practitioners, including oncology and hospital social workers should address cultural obstacles to such screening through health education and counseling to enhance women’s participation in mammogram screening, especially in african countries (including ghana) where such beliefs are strong. the physicians’ recommendation for mammogram screening among african women appears to be an effective strategy for motivating women to undergo breast cancer screening. however, the lack of health insurance coverage for mammogram is a financial barrier for many ghanaian women. this financial obstacle calls for the public and private health insurance providers to consider including mammogram screening in the national health insurance scheme. women’s regular visits to healthcare providers do not guarantee mammogram screening. the benefits of mammogram screening in lowand middleincome countries such as ghana, must therefore, be discussed widely by health and social services professionals, and women should be encouraged to perform bse and engage in mammogram screening. references abdulai, t., abobi-kanbigs, d. a., joseph, s. k., adiboka, a. g., & solomon, c. 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(2020). breast cancer. https://www.who.int/cancer/prevention/diagnosisscreening/breast-cancer/en/ author note: address correspondence to margaret amenuke-edusei, central university, faculty of arts and social sciences, social work unit, p. o. box 2305, tema, ghana. email: mamenuke@central.edu.gh https://doi.org/10.1089/jwh.2007.0603 https://doi.org/10.1016/j.ijnurstu.2005.02.004 https://www.statista.com/statistics/1122671/density-of-medical-doctors-in-west-africa-by-country/ https://www.statista.com/statistics/1122671/density-of-medical-doctors-in-west-africa-by-country/ https://doi.org/10.1177/0969141316654940 https://doi.org/10.1186/1472-6874-9-37 https://doi.org/10.1016/s0140-6736(12)61611-0 https://www.uspreventiveservicestaskforce.org/uspstf/document/recommendationstatementfinal/breast-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/document/recommendationstatementfinal/breast-cancer-screening https://www.who.int/en/news-room/fact-sheets/detail/cancer https://www.who.int/en/news-room/fact-sheets/detail/cancer https://www.who.int/cancer/prevention/diagnosis-screening/en/ https://www.who.int/cancer/prevention/diagnosis-screening/en/ https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/ https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/ mailto:mamenuke@central.edu.gh _________ michael rangel, msw, ma, independent scholar and youth support manager, skyart.chicago, il copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 978-988, doi: 10.18060/24173 this work is licensed under a creative commons attribution 4.0 international license. is there a place for us? social workers of color as outside agitators within the profession michael rangel abstract: the outside agitator narrative has been used to discredit and harm people of color for decades. currently, it is being used as a forceful tactic to separate the movement for black lives from the broader narrative that racism is deeply rooted in american social structures, institutions, and everyday life. this article examines the implications of how the profession of social work has similarly and simultaneously maintained a culture of white supremacy and racist ideologies in our work. as outsiders in a predominantly white profession, social workers of color act as outside agitators when dispelling myths and practices used in and for communities of color. by centering the lived experiences and knowledge of social workers of color, all social workers can increase their awareness of racism within our profession and work together to dismantle the culture of racism and white supremacy that persists within social work. keywords: social workers of color, outside agitator, social work profession outside agitators have historically been represented as unfamiliar forces enacting violence and unruliness in spaces where injustice occurs. from the civil rights era to this moment in history for black lives, outside agitator narratives and depictions have intently, yet simultaneously blamed and ignored the progression of a movement. in the context of social work as a profession, the representation of an outside agitator narrative has been used to displace and erase social workers of color from being represented and heard in a profession that is predominantly white. according to “profile of the social work workforce” report by the council on social work education, 68.6% of social workers identify as white, 21.6% as black/african american and other racial and ethnic groups with percentages below four percent (salsberg et al., 2017). in recent years, due to an increase in what i consider a more visible and tangible white supremacy that has been further institutionalized by racist government leaders, it has become normal for social workers of color to be perceived as unruly and overly-critical of the profession at large because of our larger relationship with the state and these institutions. simultaneously, social workers of color are unruly for advocating for their communities and participating in protests, campaigns, and scholarship that promotes racial justice. for actual outsiders of the profession, social work seems to be at the forefront of social change; but what is actually happening is a dismissal of a much more rooted and deeper racial and systemic inequity and injustice plagued by policing, hyper-incarceration, human caging, and death (jacobs et al., 2021). i conceptualize systems interchangeably, both as institutions and structural agencies, but also as the systems we tend to use in social work of the individual, family, community and society which influences our interpretation throughout this paper of the systems we may agitate. within the profession of social work, people of color have continuously contested the very nuances and complexities of social work as it is today. by about:blank rangel/is there a place for us? 979 continuing to teach and practice predominantly white ideologies and practices, the entire profession continues to replicate existing systems of oppression. in this conceptual paper, i use historical analysis and critical race theory to consider the problems that happen as social workers of color live and practice within the profession with an outsider perspective and social positioning. over the last century, the profession has grown accustomed to accepting western and white understandings of social work. there is a fundamental need for a critical cultural competency and dialogue of practices rooted in the liberation for people of color, but where is it in social work? the myth is that social workers cannot challenge and critique the very practices we learn and teach. casting social workers of color as instigators of dissent when challenging the profession of social work as a whole has consequently obscured the myriad of instances in which social work does not challenge its complicity and complacency in white supremacy. this paper will work through the archival reconstruction and reimagine social work’s possibilities for social workers of color as being their own agents of change and knowledge producers. first, i provide a brief contemporary framing of this issue and its connection to the political and public discourses happening both within and outside of the profession. second, through archival reconstruction, i expand possibilities for social work with a genealogical tracing of the outside agitator narrative in the civil rights era to that of todays fight for black lives. working through this history, i expand theorization of “outsider” narratives and posit a reimagination of possibilities for social workers of color. and finally, centering social workers of color, specifically black and brown social workers, in the profession of social work as leading experts in work that affects our communities, our livelihood, and ourselves. deconstruction of dominant narratives and building powerful narratives challenges our epistemological processing of what it means to be a social worker, what is the social work profession’s intentions and impact, and how can we all, in this moment and through this movement, dismantle white supremacy and racism in our society and in our profession. through social work, white supremacy is embedded in processes that diagnose, treat, analyze and theorize about people of color’s experiences and trauma, but then do nothing to change social work’s involvement in it. it reflects how our profession’s broader affinity for blaming its internal divisions on the work of external adversaries has created dissections. this is a call to action for all social workers to work towards the re-imagination of a world without white supremacy while working towards the liberation for all people of color at its core. in writing this i am enraged, and devastated, and grieving. i am agitated. i am angry. we will not and should not accept that the lives of marginalized people are disposable to the state that perpetuates doctrines and laws that facilitate racism, displacement, and an ultimate corporeal and social death. social work was originally intended to participate in the welfare of people within the limits set by these existing values of white supremacy and racism. now more than ever, it is imperative we engage in the work of changing our society, starting with the basic values of our society and disinvesting in oppressive political, cultural and social systems. amongst the scenes of police guarding buildings and capital of the state, there is a clear choice of whom this country wants to see alive. living in hope advances in social work, summer 2021, 21(2/3) 980 and catastrophe, the collective process and work needed in our profession is dependent on our ability to work towards a future together. we agitated in the summer of 2020, the uprising for black lives perpetuated a reaction and narrative that undermines the impact “justice” and social work has had on our democracy. president trump’s authoritarian and militarized response and push for escalated police presence enacted a summer of violence onto not only american streets, but international response. this parallels with the ongoing debate between social workers and the national association of social workers’ response calling for more police presence in social work spaces and practices, such as the opinion piece in the wall street journal by national association of social workers chief executive officer angelo mcclain (mcclain, 2020). all the while, news outlets and the media have characterized protestors and community organizers as depersonalized and dehumanized criminals and agitators. these narratives have historically and internationally been used to discredit insurgent movement building and protests against injustices happening all around us. from tunisia’s jasmine revolution, minneapolis and ferguson, to egypt’s arab springs – civil resistance continues to challenge state powers (busby, 2020). and specifically the practice of civil resistance in these critical moments emphasizes that there is neither law, nor order. in response to a ploy to label outside agitators as harmful and violent people to the movement, it is necessary that we re-convene and re-construct our understanding of the term and recognize the grievances and expressions of people being affected by the institution or issue in question. the outside agitator narrative and its history across time exemplify the multifaceted ways in which white supremacy and racism have coerced institutions into blaming outsiders, erroneously claiming agitations as a behavior of nonmembers of the institution. specifically for balfour and colleagues (2020) in unmasking administrative evil, they point to the ways in which there is a private versus public phenomenon that occurs when naming who is for and or against the institution. in this case, people of color have historically been pitted as inherently “bad” to counter the actual oppression that whiteness produces and sustains. the agitator response and narrative has been widely used in the aftermath of police violence unrest, specifically in the cases of trayvon martin, michael brown, freddie gray, and now; breonna taylor, george floyd and elijah mcclain (muwakkil, 2020). the outside agitator trope has been used for a long time in the united states to reinforce the unruly tradition of american racism and white supremacy. now in the trump era, modern day segregationists who support draconian, militarized, panic and response to civil uprisings are using this same tool of “distraction and division” (freire, 1968/2018, p. 141). this label has historically and is contemporarily used to bend towards a system of escalated violence rather than towards justice and allows powerful and privileged people, such as the american president of 2020, to avoid acceptance of the reality a deeply racist system has created from then to now. there is no “outsider” for communities of color, for they are inside the totality of systemic oppression in the u.s. (chowdhury, 2014). the u.s. government is aware of the violence, the anger, the death and the continual disregard for marginalized people, rangel/is there a place for us? 981 specifically in this movement for black life. perhaps the resurgence of the “outside” narrative is necessary to government officials at a time like this where justice for black people is an injustice to the legacy of white supremacy that is critical towards the legacy of the united states of america. can justice only occur if it is for and by the insider? but then, who is declared and presumably on the inside? with recent actions and exchanges by the government, there is a clear decision for who technically in our society is on the inside. the insidiousness of outsider narratives in the summer of 2020, amongst the stresses of the presidential election and the heightened presence of whiteness, was an overand recriminalization of black people as “looters” and the glorification of white protesters and white social workers wanting to “help” as innocent bystanders (an example we will re-visit as it pertains to social workers)—a narrative of white saviorism and white vigilantism we are all too familiar with when glimpsing into the past from ferguson to sanford to katrina. to be an outsider instigates the idea that there is no place for those who live within the margins to be on the “inside.” the outsider is usually a person or group of people who hold oppositional ideologies and practices that differ greatly from the insiders. as an outsider, there is usually only one way to access the inside, and that is to conform, adjust, and assimilate to the actions and behaviors of the insiders. the social work profession has long used this practice to regulate and control the lives of women of color through the welfare state, through responses to gender violence, and state violence (kim, 2018). it can be noted and observed that there is an under-reporting and un-reporting of writings from within the profession of social workers who are aware of the injustices that occur in the profession of social work as a whole. in writing this paper, it is clear that our grievances and agitations go much unwritten and unannounced, but not unnoticed. it seems fitting that these stories and experiences occur together, in intimate and closed settings. but, in this particular time in history against white supremacy and racism, it is imperative more narratives from social workers of color are told, written, and taught. though we witness extreme stories of state violence and injustices, the less reported and coded way of being an agitator plays a major role in this outsider rhetoric as well by exemplifying the tactics to restrict coverage, mobilization, policy change, and actual transformative justice. even in the profession, through journals and articles on cultural sensitivity, diversity and inclusion, and race related topics, much of the rhetoric is created by and for white social workers to be digestible and comfortable conversations. in assigning characteristics and behaviors to agitator narratives, the larger deployment of violence disproportionately affects communities of color, primarily black and brown communities. the reliance on a fixed system with the inability for black and brown people to grieve or express their feelings, shifts the focus to the protection and prioritization of white anger and power. the problem with the outside agitators is two-fold. one, it perpetuates echoes of the agitator as being “outside” of the affected group or group in question. this perpetuates the idea that those “locals” on the inside are not inclined to disagreement or opposition. second, it causes concerns that there is a political or extraneous agenda that comes along with the outsiders that is foreign and not contingent on the ideologies of the “insiders.” both of these problems with this trope then justifies violent resistance by the “insiders” to change, and historically have been used to repeatedly marginalize real opposition and ignore systemic racism (zhou, 2020). wouldn’t this cause advances in social work, summer 2021, 21(2/3) 982 you to be agitated too? however, in no way does an agitation for the system mean that you should be placed on the outside. but, social workers of color are accustomed to acting and performing within the margins--this narrative is not new, but it is contingent on the ethics and profession of social work to acknowledge and change that. echoes of the agitator in 1964, the governor of alabama, george wallace said, “we have never had a problem in the south except in a few very isolated instances and these have been the result of outside agitators” (the gilder lehrman collection, n.d., para. 4). this was a response to the civil rights movement happening throughout the south. the perpetual use of the outsider agitator rhetoric in issues pertaining to racial justice allowed the government and court officials to cast suspicion on the actual legitimacy, saliency, and scope of racial justice (bloom, 2020; collins, 2020; eidman-aadahl, 2020). images of heavily armed white police forces confronting and attacking black and brown protesters have transcended time and space, from this current moment to that of the civil rights era to the rebellions occurring during slavery. though technologies, institutions, and governmentality have changed, the echoes of the agitator persist. the distinction being made between outsiders and the people occupying space and participating in civil resistance has precedent in a long history of race relations in this country. ferguson and minneapolis are certainly not selma, tulsa, birmingham, or little rock, but even those who are familiar with the rhetoric and public discourse can acknowledge the unruly comparisons and striking similarities of the outside agitator narratives. i am not going to provide numbers of arrest that exemplify that outsiders are not from the inside because how do you measure grief or exhaustion or death, or in this specific case black grief or black death? here i stop and think about christina sharpe’s (2016) book, in the wake, and how she navigates black temporalities, care, flesh, performance, and movement. sharpe’s work is critical here because it tells us how black resistance of non/being has been used to impose grief, loss, memory, and death onto those outside of any possibility for protections or citizenship or visibility by the state. regardless of who was arrested in this time, who “looted”, and who challenged the state – our focus should be on the historical lineage of the outside agitator myth and just how prevailing it has traveled time. the outside agitator narrative can be traced back to instances of black rebellion in us histories and the commonwealth’s justification for enslavement (bloom, 2020). specifically, the example of the 1811 german coast uprising which was the largest slave revolt in us history that made governor claiborne of the territory of new orleans control the immigration of enslaved and free black people from the caribbean because he insisted on outside help to the rebels (dormon, 1977). though this could not be proven, it exemplifies one of the earliest instances where behaviors and characteristics of those inside the revolt were undoubtedly cast on outside influences. during the reconstruction era, ida b. wells, an acclaimed journalist, speaker, and social justice advocate, led an international fight against lynching and protested these murders publicly (bay, 2009). wells combated the erosion of black civil, social, and rangel/is there a place for us? 983 political rights that plagued the jim crow south and influenced life for black people during this time. a leader in the anti-lynching movement, wells faced many social and cultural challenges, often being placed on the outside of organizations and movements she is credited for starting, largely due to her race and gender (bay, 2009). well’s life provides invaluable historical testimony to her critical resistance and persistence of an outside agitator narrative that has greatly impacted modern day social work, but most importantly the legacy she left for social workers of color. in the civil rights era, the outside agitator narrative was perpetually used in the descriptions of leaders who were challenging the racial divide in america. in 1965, protesters in selma were attacked, beaten, and tear-gassed by the alabama police for being blamed as outsiders to the city, even though many of those on the bridge that day were residents of the city (fortin, 2020). often during the outside agitator narratives of the 1950s and 1960s, the term was used as a distraction by popular media and the government from civil resistance and demonstrations that demanded justice and lawful basic human rights. these ideas in the civil rights era were a part of the greater racist ideologies that these ideas of basic human rights could not have come from black people in the south, or that the ideas could even be their own (fortin, 2020). similarly, in ferguson in 2014 and baltimore in 2015, responders filled the streets to protest the killing of michael brown and then freddie gray. commentators and headlines referred to the protestors and those arrested as “outsiders” (chowdhury, 2014) and from out of state where again, the idea to protest and resist the injustices of racial policing and police killing were outside ideas. the echoes of the agitator have traveled throughout time and space and do so in a continuum of racial injustice and civil resistance that is the true spirit of america. the history of the outside agitator is long, drawn out, and perpetual, but this is not the last time we will engage in this narrative. until justice is here, the echoes of the agitator will live on in the resistance and fight for our lives. outsider narratives and notes from the margin blatant denial is a powerful tool for the government, elected politicians, and white social workers in leadership. the re-framing of national issues as non-localized shifts responsibility and incentive to act (turner, 2020). this shift acts as an anchor to delay action and redirect the course of legal responsibility that was initially being challenged. in doing so, government officials and the ruling class blame the violence on the victims. thus, rather than admittedly calling out the larger institutions and people at fault, the blame is on the members who might hold actual grievances for the harm and violence done. so, calling to those of us/them/we that live in the margins is essential in accessing the knowledge and the teachings from inside the outsiders’ experiences. much of the workings of social work with social workers of color revolve more around our recruitment and retention than our teachings and education (castex et al., 2019). with the publishing of ethnic minorities in social work education in 1970 authored by carl a. scott (1970), the sentiment remains the same to this day, that there is a clear distinction of who choses to be social workers and who is fully accepted into the profession. many social workers from marginalized backgrounds enter the field with the hope of fighting injustices, advances in social work, summer 2021, 21(2/3) 984 but are constantly met with instances of bias, stereotypes, discrimination and harm from the profession (castex et al., 2019). other workings noted from the margins that affect our accessibility and ability to be a part of the profession include the consistent and persistent use of cultural competency. in its origins, cultural competency was the means for working with non-white racial, ethnic, and cultural groups and with it came the deficit-oriented depiction of people and communities of color (abrams & moio, 2009). though fortunate to have texts such as doman lum’s social work practice and people of color: a process stage approach (1999) and culturally competent practice: a framing for understanding (2003), the need is for an understanding that goes beyond a consensus that marginalized communities and people color suffer and are in need. there is a need for more than self-awareness or skill development, but an accountability and accessibility for social workers of color will be directly impacted by the profession. the dialogue must become clearer that the first step is to not call it “cultural competency,” but the work should not and will not stop there. i follow the critiques of social work scholars who have noted the inability of cultural competency to reach far enough for social workers to challenge institutional racism, white supremacy, and oppressions (abrams & moio, 2009). it should lead to a practice and strategy for the clients and community we all so intently work to support. it should be focused around and center justice. i include this section because it requires a reading of the outside narrative as more than an agitation to the institution or the system, but a reading of the performance and production of the outsider and its necessity to the profession. if in our trainings we were given direction to read foundational texts by black and brown scholars such as angela y. davis’s women, race, and class (1981) or are prisons obsolete? (2003), fellow social worker charlene carruthers (2018) unapologetic: a black, queer, and feminist mandate for radical movements, or audre lorde’s (1984) sister outsider, we would/will be better equipped as social workers and scholars to interact in the scenes of marginalization that haunt this country. if able to enter spaces with a better framework of the history communities of color have lived and are living through, social workers will be able to critically engage in rhetoric and public discourse surrounding issues of racism, anti-blackness, anti-immigration, and the prison industrial complex that directly and indirectly greatly impacts the lives of social workers of color. social workers of color in these streets in the portrayal of the outsider and the history of the agitator, there is a specific place for social workers of color in this diaspora. initially, i think about the reverberation of jane adams and other white women as being the core producers and executives to the profession of social work. but, with the framework of critical race theory, we can assess how racism is an ordinary and everyday occurrence for people of color, and in this instance, social workers of color (abrams & moio, 2009). in doing so, we can notice how white created and produced social work excludes racial and minority perspectives and experiences to indirectly justify and legitimize its power in the profession. by using critical race theory, social workers of color can actively tell the alternatives to history and acknowledge the rangel/is there a place for us? 985 intersectionality of their lives that our profession does not include (abrams & moio, 2009). from the national association of black social workers, to the asian pacific islander social work council, to the association of latina/latino social work educators, the role and influence of social workers of color is astronomical and largely benefits a social work where critical race theory and ethnic studies is used to pursue justice and dismantle white supremacy. though critical race theory helps social workers notice how racism is embedded into the policies and practices of society, can it do the same in noticing how racism is embedded in our profession? social workers of color encounter more than representational policy barriers, but formidable societal, educational, and economic barriers that are present before, during, and after their social work education (castex et al., 2019). so can a shared professional identity occur in social work if there is a racist structure that impacts social workers of color? possibly, but it will not look like a social work created by jane adams or mary richmond. it will carry over ecological and self-identity perspectives and systems theories, and the persons-in-environment approach, but can these dispute white supremacy and not reinvent or rename it? will this social work hold space for clinical, communal, and comparative social work that can be interdisciplinary and multifaceted? can our classrooms teach both historical and contemporary epistemologies of social work that has at its praxis the profession, and not resurgent aesthetics of racism and white supremacy? the outsider agitators’ agitation to the systems will perpetually exist as long as there is a ruling class and race of people deciding what is and is not justice. one of the most noted figures in the civil rights era, martin luther king jr. wrote, “whatever affects one directly, affects all indirectly. never again can we afford to live with the narrow, provincial ’outside agitator‘ idea. anyone who lives inside the united states can never be considered an outsider anywhere within its bounds.” (king, 1963, as cited by eidman-aadahl, 2020, “so on we go…”, para. 2). the claims of an outsider being present in civil resistance, uprisings, and social work fail to recognize the basic realities of the economic and social conditions that exist for communities of color in the us. to be poor and black in this country is recognizable to the outsiders narrative, that aims to police, violate, and control these bodies reasoned to be left in the margins. as kanishka chowdhury, professor of english and director of the program in american culture and difference at the university of st. thomas discusses it in his article, outsiders in ferguson (2014), ordinary people cannot expect those in power, the true outsiders, to solve any problem for the greater good, for the people. in social work, to be an agitator is where resistance and revolution must start and will include insiders and outsiders to the profession. there is no better time than now to consistently and comparatively challenge and critique the systems that sustain violence and white supremacy in our communities and in our profession. conclusion it is now time to re-read our work, be critical in our formations, and use our imagination for how we can survive in both the inside and outside of social work. maybe it’s not even our words, maybe it’s a gesture or embodiment of what it means to be both a person of advances in social work, summer 2021, 21(2/3) 986 color and a social worker, on top of other identities that complicate and beautify our life. our insurgent histories and imaginaries conscript our capacity to imagine what is possible in the profession. but what does it mean to search within the outside of our profession? how can we as social workers of color, who code switch on command and navigate predominantly white spaces, use this skill and this tool to do the work both within a system that does not recognize us; and at the margins where we are from? what does this say about social work if the inside is uninhabitable to us? is it meant for us to live inside at all? i want this to be a very important ethical and critical tool that comes from us working for and within our communities. whether in community, in our homes, or in an institutional setting, there needs to be a deeper investigation into how and why social workers of color are not being incorporated into the education and practical training of social workers and why when we do, there is a hesitation and reluctance to our inwardness. this conceptualization of social workers of color as outside agitators is related to the idea that social work as a profession is sustained and constructed as a place for only white people. i write this as a both/and critique of social work; where both social workers of color and white social workers can engage in critical discourses over the ongoing harm social work as a whole perpetuates onto social workers of color and where white social workers can gain a perspective and a tool that can support them in actively implementing not just academic reform to their practices, classrooms and interventions, but actual social and communal justice. but most importantly, i write this for the social workers of color that are fighting for their safety and their space on a daily basis in a profession that largely rejects our place in it. once we begin to understand that it is not the past we must reconcile, it is the present, then our work for the future begins. references abramovitz, m. 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(2020, june 15). social workers cooperate with police forces. the wall street journal. https://www.wsj.com/articles/social-workers-cooperate-with-policeforces-11592255480 salsberg, e., quigley, l., mehfoud, n., acquaviva, k. d., wyche, k., & silwa, s. (2017). profile of the social work workforce: cswe report. https://www.cswe.org/centers-initiatives/initiatives/national-workforceinitiative/sw-workforce-book-final-11-08-2017.aspx scott, c. a. (1970). ethnic minorities in social work education: a collection of papers highlighting developments and issues concerning faculty, students, and curriculum in social work education. council on social work education. sharpe, c. (2016). in the wake: on blackness and being. duke university press. https://www.dukeupress.edu/in-the-wake zhou, l. (2020, june 15). the trope of “outside agitators at protests, explained. vox. https://www.vox.com/2020/6/3/21275720/george-floyd-protests-outside-agitatorsferguson-civil-rights-movement author note: michael rangel, skyart, chicago, il 60617. email: michvrangel@gmail.com https://www.wsj.com/articles/social-workers-cooperate-with-police-forces-11592255480 https://www.wsj.com/articles/social-workers-cooperate-with-police-forces-11592255480 https://www.cswe.org/centers-initiatives/initiatives/national-workforce-initiative/sw-workforce-book-final-11-08-2017.aspx https://www.cswe.org/centers-initiatives/initiatives/national-workforce-initiative/sw-workforce-book-final-11-08-2017.aspx https://www.dukeupress.edu/in-the-wake https://www.vox.com/2020/6/3/21275720/george-floyd-protests-outside-agitators-ferguson-civil-rights-movement https://www.vox.com/2020/6/3/21275720/george-floyd-protests-outside-agitators-ferguson-civil-rights-movement mailto:michvrangel@gmail.com _________ michael l. clarkson-hendrix, phd, msw, assistant professor of social work, department of sociocultural and justice sciences, college at fredonia, state university of new york, fredonia, ny. lynn a. warner, phd, professor and dean of the school of social welfare, university at albany, state university of new york, albany, ny. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 283-299, doi: 10.18060/23377 this work is licensed under a creative commons attribution 4.0 international license. a mixed methods examination of msw student satisfaction with integrated behavioral health field placements michael l. clarkson-hendrix lynn a. warner abstract: social workers must be prepared to work effectively within systems that attempt to maximize coordination where integrated behavioral health care is provided. current students are the profession’s pipeline to the behavioral health workforce. if social work students are dissatisfied with the training they receive in integrated health care settings, they may be deterred from interprofessional collaborative practice. this study examined msw students’ satisfaction with integrated behavioral health field placement experiences. thirty-three students completed an online survey that asked about factors associated with field placement satisfaction, and nine of these students participated in two focus groups to explore other aspects of the field setting that influenced satisfaction. survey results revealed that as role ambiguity increased, student satisfaction decreased. focus group findings uncovered that the profession’s influence within the field setting and the presence of support by professionals from other disciplines promoted students’ satisfaction. these results suggest that educators should help students develop skills in tolerating role ambiguity and asking for role clarification as part of supervision when placements are in these settings. msw faculty and field education directors may want to collaborate with integrated behavioral health providers to assess organizational climate and identify ways to foster inclusive interprofessional collaborative practices and a culture of crossprofession respect. keywords: student satisfaction, integrated behavioral health, field placements; ipe behavioral health conditions are prevalent in the united states, yet most people experiencing mental health and substance use problems do not receive the treatment they need (park-lee et al., 2017; substance abuse and mental health services administration, 2017). since the passage of the patient protection and affordable care act (aca) in 2010, significant transformations in the financing, structure, and delivery of health care have been underway to address this gap. for example, reimbursement models are moving from feefor-service to value-based approaches that reward providers for delivering comprehensive services, including preventative interventions (asarnow et al., 2015; rishel et al., 2016). health care is increasingly being provided in patient-centered medical homes that coordinate health and behavioral services and address individual gaps in care (horevitz & manoleas, 2013; runyan, 2011). there is growing evidence that the integration of behavioral health screenings and interventions into primary health care settings has yielded positive outcomes. for example, an integrated brief, problem-focused behavioral health intervention in military primary care settings resulted in significant mental health symptom reduction that was maintained at two years post-intervention (ray-sannerud et al., 2012). additionally, screening and brief trauma treatment in rural primary care offices resulted in https://creativecommons.org/licenses/by/4.0/ clarkson-hendrix & warner/mixed methods examination 284 significant reductions in posttraumatic stress symptoms and physical health complaints (osofsky et al., 2017). given these substantial transformations in the delivery of behavioral health care and acceptance that effective interprofessional education is linked to successful interprofessional collaborative practice (world health organization, 2010), social workers must be prepared to work effectively within systems that attempt to maximize coordination, and in settings where integrated behavioral health care is provided (bilodeau et al., 2010; lundgren & krull, 2014). professional staff, including social workers, need to be able to provide brief, outcome-driven, and team-based care (collins et al., 2010; horevitz & manoleas, 2013) in an interprofessional and team-based environment (horevitz & manoleas, 2013; rishel et al., 2016). various national foundation and federal government agency efforts aim to prepare future social work professionals for practice in an integrated care environment. for example, the conrad n. hilton foundation (2019) is supporting initiatives that include training more providers on screening, brief intervention and referral to treatment (sbirt) approaches. a strategic priority of the health resources and services administration (2019) is to develop interprofessional practice competencies of the health care workforce, including social workers, by expanding training and technical assistance opportunities for students and providers and offering scholarships as well. finally, schools of social work are creating specializations and concentrations in integrated behavioral health to prepare students for practice, which includes didactic and simulation-based instruction. there is growing evidence about the impact of these educational initiatives, especially as they relate to social work students’ improvements in knowledge, attitudes, and confidence to practice in integrated care settings (collin et al., 2019; habib et al., 2019; rishel et al., 2016) and skills (acquavita et al., 2019). there is also evidence of gaps in students’, faculty’s, and fieldwork instructors’ knowledge, attitudes, and skills in implementing evidence-based practices adherent to model fidelity in integrated care settings (vinjamuri et al., 2019). however, there is a dearth of information about social work students’ experiences in integrated behavioral health field placements. we define integrated behavioral health field placements as those where students are expected to conduct behavioral health assessments, interventions, or referrals in interprofessional contexts. field education is designated as the signature pedagogy of social work education (council on social work education [cswe], 2015; wayne et al., 2010), and field placements are where professional norms and commitment are most directly established. consequently, a better understanding of factors associated with students’ positive experiences in integrated behavioral health placements is warranted. to contribute to the growing body of research on preparing social workers for effective practice in the evolving health care system, the current study examined msw students’ satisfaction with integrated behavioral health field site experiences. advances in social work, summer 2020, 20(2) 285 students experiences with integrated behavioral health field placements in higher education, student satisfaction is expected to be positively associated with the quality of instructional methods and is a proxy for how well a learning environment supports academic success (cleak & smith, 2012; elliott & healy, 2001; garrison et al., 2010; lo, 2010). according to the few published studies reporting on social work students’ satisfaction with their field experience, the following factors are positively associated with satisfaction: perceptions of self-efficacy (kanno & koeske, 2010), perceptions of the quality of supervision (kanno & koeske, 2010; wang & chui, 2016), provision of supervision by a person employed by the agency as opposed to an outside supervisor (cleak & smith, 2012), and students’ achievement motivation, preparedness for field, and supportiveness of other students (wang & chui, 2016). students’ reported levels of burnout and strain were negatively associated with field placement satisfaction (kanno & koeske, 2010). research on experiences of students whose placements have been in integrated behavioral health care settings is scant. according to an evaluation of an integrated behavioral health care training program for the canadian primary care workforce, there were significant increases in knowledge among family medicine, nursing, and social work students after completion of classroom and practicum training components (bilodeau et al., 2010). in addition, a survey sent to social work, medicine, and nursing students at the onset of an interprofessional education program found that although students held generally positive attitudes towards interprofessional collaboration, medicine students were less positive towards interprofessional collaboration when compared to social work and nursing students (park et al., 2013). moreover, a survey of social work, nursing, medicine, and other allied health sciences students found that, compared to students with no or negative past experiences of interprofessional collaboration in integrated behavioral health care settings, those with positive ones also reported feeling more comfortable relying on other professionals within their health care teams (lee & shipe, 2014). furthermore, narrative data provided by msw students who completed an integrated behavioral health training program revealed three areas of impact: by the end of their training, participants were able to describe key integrated practice concepts, apply the concepts in practice, and articulate the importance of interprofessional relationships to their professional development (rishel et al., 2016). study purpose with current students as the profession’s pipeline to the health care workforce, more data on social work students’ experiences in integrated behavioral health placements are needed. the bureau of labor statistics (2018) projects that the number of employment opportunities in health care social work is expected to grow by 17 percent (30,600 jobs) between 2018 and 2028. the vast majority of these opportunities will likely be in integrated behavioral health care settings that require competency in interprofessional collaborative practice. if students are not satisfied with the training they receive in integrated behavioral health settings, they may be deterred from interprofessional collaborative practice, undermining the positive patient health outcomes envisioned within a transformed health care system. clarkson-hendrix & warner/mixed methods examination 286 to examine msw students’ satisfaction with integrated behavioral health field site experiences, this study examined data collected as part of a larger evaluation of a social work training initiative. quantitative data were used to examine correlates of social work students’ overall satisfaction with their experiences in integrated behavioral health field placements, and qualitative data were used to explore students’ perceptions of what impeded or promoted their field placement satisfaction. method data were collected as part of the evaluation of a project funded by the health resources and services administration’s (hrsa’s) mental and behavioral health education and training grants program. the training initiative aimed to increase the capacity of the social work profession within its region to serve the mental and behavioral health needs of veterans, military personnel and their families, and medically underserved rural communities. data on a range of factors assumed to be associated with students’ preparedness and commitment to social work behavioral health practice were collected, including attitudes about interprofessional practice (bronstein, 2002; luecht et al., 1990) and levels of professional well-being (danna & griffin, 1999; jones et al., 2010; stamm, 2010). partner schools in the multi-institutional consortium developed field placements in collaboration with health care agencies that served the military community (inclusive of active duty, veterans, and their families) in urban and rural areas or residents of underserved rural communities in a large northeastern state, and provided learning opportunities for integrated behavioral health care delivery. several of the seven schools of social work involved in the consortium were part of multi-disciplinary colleges where classes included social work students and students in other graduate programs, including human development, clinical mental health counseling, public administration, and marriage and family therapy. interprofessional training experiences for students in the consortium varied across the schools but typically included working in teams that included a combination of physicians, psychiatrists, nurses, and physical therapists. over the course of the multi-year project, three cohorts of students were recruited for second-year placements through a selective application process. the selection process and related materials were developed collectively by the consortium members, but each program implemented the selection process locally. for example, a standard set of essay and interview questions, as well as an applicant rating form were developed, and participating schools made additions for their school-specific purposes. the opportunity was publicized to all msw students entering their advanced concentration field placement. interested students submitted an application that included a brief essay about their interest in the practice area, a transcript, a current resume, and contact information for professional and/or educational references. applications were reviewed and rated by teams at each school. teams included a combination of faculty, field unit staff, field instructors experienced with mental and behavioral health services to veterans and services in rural underserved areas and, after the project’s first year, current trainees. the most highly rated applicants were then invited to an interview with members of the review teams. selected students received a stipend of $5,000 per semester for two semesters. advances in social work, summer 2020, 20(2) 287 to reinforce knowledge of clinical practice with medically underserved communities, the students completed four online educational units. three educational units were the same across the three cohorts and covered interprofessional practice principles and concepts, an overview of trauma-informed care, and military cultural competence. for the first two cohorts, the fourth educational unit focused on cultural competence with medically underserved communities, and for the last cohort the unit was an overview of depression, delirium, and dementia in older adults. educational units were presented in two stages. first, students reviewed online asynchronous content (e.g., videos, prerecorded webinars, practice guides) and prepared responses to questions to stimulate participation in the second stage. then, students engaged in faculty-led synchronous discussions that provided opportunities for students to reflect on the connection between classroom, online, and fieldbased learning. procedures a mixed methods approach was used. quantitative survey data were augmented with qualitative data. quantitative data were collected with an online survey that included items about student satisfaction with the field experience, the extent of collaboration occurring at the placement, perceptions of interprofessional education, role stress, professional quality of life, and demographics. all students were invited to complete the online survey two to three weeks prior to the end of their placements each academic year. students were informed that completion of the survey was voluntary and that, if they agreed to participate, they could skip any questions or exit the survey at any time without penalty. voluntary consent was assumed if students completed the survey via the link provided in the email. to ensure confidentiality of responses, the survey did not collect student names. focus groups were conducted with the narrow purpose of exploring preliminary results from the quantitative survey. students were asked specific questions to help illuminate aspects of role stress and to provide specific examples of positive and negative interprofessional experiences. in contrast to the survey, which was conducted with each program cohort, focus groups were conducted only with the last cohort. students were verbally invited at the end of the two synchronous sessions occurring in the final weeks of the training program to participate in a focus group. focus group duration was determined by student availability, with one group lasting for fifteen minutes and the other one lasting thirty minutes. because the online sessions had focused on many of the same themes that were asked about in the focus groups, students in the focus groups were encouraged to summarize salient points from those online sessions. this approach, combined with the fact that groups were comprised of small numbers of students who had spent the year interacting with each other in the online environments, yielded efficient responses to the questions. there were no incentives for participating in the focus groups. focus groups were audio-recorded with blackboard collaborate software, and the first author transcribed the recordings for analysis. this project was exempt from institutional review board approval as it was limited to investigating the training program’s instructional strategies. clarkson-hendrix & warner/mixed methods examination 288 participants thirty-three out of forty-one students completed the survey (response rate of 81%). the majority of respondents, similar to the cohorts of students who participated in the program, were female (81.8%) and white (90.9%). slightly more than half (51.5%) were between the ages of 22-25, and slightly less than half (45.5%) had no prior paid human service experience before enrolling in their msw program. both focus groups were comprised entirely of women, with four in one group and five in the other. measures student satisfaction with field. students were asked to indicate how satisfied they were with their field placement using a five-point response scale ranging from 1 (never satisfied) to 5 (always satisfied). preliminary analysis revealed a skewed distribution (none of the students selected 1 or 2 for the item and less than 5 students selected 3). consequently, responses were recoded into a dichotomous variable, with “almost always satisfied” and “always satisfied” coded 0, and “satisfied half the time” coded 1. these values were interpreted as “extremely satisfied” and “satisfied,” respectively. the values were ordered in this way so that results could be interpreted in terms of factors that were associated with not being satisfied and that could be targeted to improve student satisfaction. professional quality of life. professional quality of life was measured using the 30item professional quality of life scale (proqol; stamm, 2010), which was designed to capture the workers’ feelings as they relate specifically to their tasks as a professional helper. although students’ placements are pre-professional experiences, students’ feelings in relation to their work as helpers are expected to be associated with their level of satisfaction with the field placement. the proqol is comprised of three subscales: compassion satisfaction (10 items) refers to positive feelings related to helping others; burnout (10 items) speaks to exhaustion, frustration, anger, and depression; and secondary traumatic stress (10 items) is a negative feeling driven by fear and work-related trauma. responses for proqol items ranged from 1 (never) to 6 (very often). higher scores on the compassion satisfaction subscale indicate frequent positive feelings in relation to helping others while higher scores in the burnout and secondary traumatic stress subscales indicate frequent negative feelings. initial analysis indicated low internal consistency for the burnout subscale, but after removing seven items from it, internal consistency reliability for each subscale was sufficient to excellent (compassion satisfaction α=.89, burnout α=.88, secondary traumatic stress α=.92). role stress. role ambiguity and role overload scales were used to assess role stress. management literature (danna & griffin, 1999) and prior research (jones et al., 2010) identified a relationship between role stress and job satisfaction. since task similarities exist between a social worker’s job and a student’s field experience, role stress would also likely be related to student satisfaction. role stress measures were adapted from jones, norman, and wier (2010). this was done by substituting “at my field placement” for “at my work” in the item stems. role ambiguity was measured with five items, such as “at my field placement, i feel certain of how i will be evaluated,” “at my field placement, i advances in social work, summer 2020, 20(2) 289 know exactly what is expected of me,” and “at my field placement, there are clear, planned goals and objectives for my learning." responses were based on a seven-point scale ranging from 1 (strongly disagree) to 7 (strongly agree) and reverse-coded so higher rather than lower scores indicated elevated levels of ambiguity. internal consistency reliability for the role ambiguity subscale was excellent (α=.87). role overload was measured with three items. these items were “at my field placement, i am given enough time to do what is expected of me,” “at my field placement, it often seems like i have too much work for one person to do,” and “at my field placement, the performance standards for my field placement are too high.” responses ranged from 1 (strongly agree) to 7 (strongly disagree). the response to the initial item was reverse-coded. internal consistency reliability for this subscale was sufficient (α=.80). extent of interprofessional collaboration. perceptions of the occurrence of interprofessional collaboration were measured using the index of interdisciplinary collaboration (bronstein, 2002). students knew they were recruited for a specialized initiative focused on developing interprofessional competencies. if the quality and extent of interprofessional collaboration was limited, we expected overall student satisfaction with their field placement experience to be affected. the index of interdisciplinary collaboration consists of 42 items containing five subscales: interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on process. responses ranged from 1 (strongly disagree) to 5 (strongly agree). interdependence, collective ownership of goals, and reflection on process demonstrated adequate internal consistency reliability (α=.75, α=.87, and α=.83). to achieve this level of reliability for the interdependence and collective ownership of goals subscales, it was necessary to remove six of the thirteen items and four of the eight items, respectively. two subscales, newly created professional activities (6 items) and flexibility (5 items), were insufficient in their internal consistency reliability. therefore, single items from these subscales were used in analyses. newly created professional activities was measured by the item, “organizational protocols reflect the existence of cooperation between professionals from different disciplines.” flexibility was measured by the item, “i am not willing to sacrifice a degree of autonomy to support cooperative problem-solving.” since responses to these individual items were skewed, the variables were recoded: responses to newly created professional activities were either 0 (strongly agree) or 1 (neither agree nor disagree, agree), which were interpreted as “extremely present” and “present,” respectively. responses to the flexibility item were either 0 (neither agree nor disagree, agree, strongly agree) or 1 (disagree, strongly disagree), and interpreted as “inflexible” and “flexible,” respectively. perceptions of interprofessional education. perceptions of interprofessional education were measured using a subset of fifteen items from the 18-item interdisciplinary education perception scale (luecht et al., 1990). the training initiative was focused on preparing students for practice in interprofessional settings. therefore, students’ positive or negative perceptions of professions within their field setting would likely have impacted their student satisfaction. the interdisciplinary education perception scale measures students’ affective perceptions of their own profession and other allied health disciplines in interdisciplinary settings (luecht et al., 1990). the subset of items was chosen based on clarkson-hendrix & warner/mixed methods examination 290 their applicability to students’ experiences and were adapted to refer to “social workers” rather than “individuals in my profession.” items assessed perceptions of social workers’ competence and autonomy, the need for cooperation amongst professionals, whether cooperation occurred, and if the student understood the value of other professions. responses ranged from 1 (strongly disagree) to 4 (strongly agree). by removing three items, adequate internal consistency reliability was achieved (α=.84). data analysis quantitative. measures of centrality (i.e., mean, standard deviation) and dispersion (i.e., range) were assessed for continuous variables. for categorical variables, the percentage of observations in each category was examined to determine their relative distribution. due to the small sample size, several steps were taken to improve power to detect significant relationships between the predictor variables and student satisfaction. these included improving the precision of the measures, as described above, and limiting the analysis to bivariate rather than multivariate logistic regressions. qualitative. thematic analysis was used to explore meaningful patterns in the focus group data that could assist in further understanding what promoted or impeded student satisfaction with their integrated behavioral health field experience. themes were identified on the semantic rather than latent level in alignment with the purpose of the study, which was to identify themes from the perspective of participants rather than explore the construction of these perceptions. results quantitative frequency distributions in table 1 showed the majority of students were extremely satisfied with their field placement experience (78%) and the rest were satisfied (22%). for professional quality of life, on average students indicated positive feelings of compassion satisfaction (m=5.25 on a 6-point scale). by the end of their field placements, burnout (m=1.94 on a 6-point scale) and traumatic stress (m=1.86 on a 6-point scale) were low. mean scores for role ambiguity (m=2.69 on a 7-point scale) and role overload (m=2.10 on a 7-point scale) were low. for perceptions of interprofessional collaboration, averages were moderate to moderately high for the interdependence (m=3.79 on a 5-point scale), reflection on process (m=3.48 on a 5-point scale) and collective ownership of goals (m=3.72 on a 5-point scale) subscales. the majority (75%) of students indicated newly created professional activities were present at their field placements. just under two-thirds (63%) of students agreed flexibility was occurring in their field placement. finally, concerning culminating perceptions from the interprofessional education perceptions scale, on average, they were moderately high (m=2.99 on a 4-point scale). advances in social work, summer 2020, 20(2) 291 table 1. descriptive statistics variables n n (%) dependent variable student satisfaction with field: satisfied (ref.: extremely satisfied) 23 5 (22.8%) predictor variables, categorical flexibility: flexible (ref.: inflexible) 27 17 (63.0%) newly created professional activities: present (ref.: extremely present) 28 21 (75.0%) predictor variables, continuous n m (sd) range burnout 23 1.94 (0.87) 1.00-4.67 collective ownership of goals 24 3.72 (0.74) 2.00-5.00 compassion satisfaction 22 5.25 (0.60) 3.90-6.00 interdependence 27 3.79 (0.50) 2.57-5.00 interprofessional education perceptions 30 2.99 (0.37) 2.08-3.67 reflection on process 23 3.48 (0.58) 2.20-4.40 role ambiguity 24 2.69 (0.97) 1.00-4.60 role overload 23 2.10 (0.85) 1.00-4.67 secondary traumatic stress 21 1.86 (0.74) 1.20-4.70 bivariate results. results from bivariate logistic regression analyses are presented in table 2. only role ambiguity was significantly associated with students’ field experience satisfaction (or=1.52, p<.05). as role ambiguity increased, student satisfaction decreased. compassion satisfaction, burnout, secondary traumatic stress, role overload, various aspects of interprofessional collaboration, and perceptions of interprofessional education were not associated with students’ overall satisfaction with their field experience. table 2. bivariate logistic regression results for student satisfaction with their field experience predictor variables student satisfaction with field: satisfied (reference category: extremely satisfied) b se p r2 or 95% ci for or burnout 0.49 0.28 0.08 0.21 1.63 [0.94, 2.84] collective ownership of goals -0.27 0.19 0.16 0.10 0.76 [0.52, 1.11] compassion satisfaction -0.31 0.16 0.05 0.34 0.73 [0.54, 0.99] flexibility -2.34 1.24 0.06 0.19 0.10 [0.01, 1.08] interdependence -0.21 0.16 0.20 0.08 0.81 [0.59, 1.11] interdisciplinary education perceptions -0.09 0.11 0.38 0.03 0.91 [0.74, 1.12] newly created professional activities -1.67 1.18 0.16 0.08 0.19 [0.02, 1.90] reflection on process -0.15 0.10 0.16 0.09 0.86 [0.70, 1.06] role ambiguity 0.42 0.19 0.03 0.42 1.52 [1.05, 2.21] role overload 0.06 0.21 0.77 0.004 1.07 [0.70, 1.61] secondary traumatic stress -0.01 0.07 0.90 <0.001 0.99 [0.86, 1.14] note. or = odds ratio; ci = confidence interval clarkson-hendrix & warner/mixed methods examination 292 qualitative two themes characterized aspects of students’ field experiences that either promoted or impeded their satisfaction. these features were profession’s influence and professional support. profession’s influence. in a number of instances, students identified professional authority in group interactions connected with satisfaction with their field experience. when professionals from other disciplines (e.g., nursing, psychiatry, medicine) were perceived as valuing social workers’ contributions to the group, students were satisfied with their experience. at the same time, lack of respect toward social workers diminished satisfaction with their placement. for example, one student stated: “i feel like if you have good interprofessional collaboration, you have people who listen to you and value your opinion…. i feel like that's really important to this quality of life …(and) desire to continue in the field.” in contrast, another participant discussed that in her field experience social workers were disproportionally allotted undesirable tasks in comparison to professionals from other disciplines. she linked the allotment of these tasks to less satisfaction with her field experience. she stated: i think it can help with…field placement satisfaction or whatever, but i think it can go the other way, too, only because you are now working with all these people and maybe it’s only specific to my placement, but you get, oh this gets dumped on the social worker, that gets dumped on the social worker, so having all of these other people (like), “oh can you cover this?” “can you cover that?” another focus group participant alluded to the relative status of the psychiatric profession. in her case, the psychiatrist fostered a positive team climate within the unit, and the participant had a positive perception of their field experience. this participant confided to the group: everybody kind of leans on everybody. well the psychiatrist trumps us all, but she doesn’t really play a power role in a sense. you really rely on everybody, and there’s a lot of good communication and everybody's part of what’s going to happen next so in a power role, in a sense, she really relies on everybody. there’s a lot of communication and everybody is part of what is going to happen. these examples illustrate that expressions and perceptions of professional hierarchy may influence students’ satisfaction. perceptions of being treated in an egalitarian way by professionals in other disciplines and experiencing positive interprofessional leadership by a psychiatrist were connected with satisfaction. on the other hand, satisfaction was impeded when social workers were tasked with more mundane responsibilities such observing or escorting clients or cleaning up after them. professional support. several students described experiencing support from professionals from other disciplines at their field placement. in instances where they received assistance from professionals in addition to their social work field instructor, they advances in social work, summer 2020, 20(2) 293 felt more satisfied. in contrast, when the student felt isolated in relation to others, they felt less satisfied with their field experience. one student reported a fulfilling experience, which was connected to being able to access professionals around her. the available support of an interprofessional team made her feel good about her field experience. she stated: it has made things a lot less stressful for me because i feel like i always have someone i can go to and someone kind of on the journey with me with the clients and really we are working together, and i'm not out there alone so i feel that really makes it a great experience for me. another student in the focus group in a similar behavioral health field placement talked about the relief she felt working in a setting where she had the support of her field instructor and other professionals. the ability of professionals from different disciplines to provide help to her put her at ease. she stated: it’s very affirming cause i don’t like to be out in this work or anything like that because i’m always worried about what’s going to happen to the people that i see if i’m not there and for me having collaboration (with other professionals in my field placement), i knew that if i had to be sick or one of my kids was sick, or i couldn’t be there for any reason that there was someone who could step right up and take over. in contrast, upon hearing of the instances of professional support, another student shared there was not as much support from the professionals in her field placement, and she was not as satisfied as the other students with her experience. she described her challenge as follows: if i have a client that i'm having an issue with i can always go and talk to them (nurses and doctors in the office), but, a lot of the time we are both so busy that we are not able to schedule meetings, or there’s nothing formally put in place. it’s more that i would have to basically be more of a go getter and go talk to them about the client if there’s a concern that i have or an issue, or if i need clarification on something. but, other than that, we are like, i'm in my part of the office, and they are in their part of the office, and the only real collaboration is just through the referral process. for these students, the intensity of support from field instructors and professionals from other disciplines affected students’ culminating satisfaction with their field experience. access to multiple professionals promoted positive feelings about their field placement, as did knowing that a team member was available to meet clients’ needs if the student needed to be away from their placement. in contrast, isolation from interprofessional team members within the field setting impeded satisfaction. discussion the main purpose of this study was to understand msw students’ experiences and satisfaction in integrated behavioral health field placement settings. understanding these clarkson-hendrix & warner/mixed methods examination 294 factors may be important in sustaining a robust pipeline of social workers who are competent to practice in the evolving health care delivery landscape. at the end of their placement, the majority of participants were extremely satisfied with their field placement experience. bearing in mind that researchers have utilized differing measures for student satisfaction with their field experience, this level of satisfaction is higher than that reported by other studies of msw students’ field experiences (cleak & smith, 2012; fortune et al., 2001; kanno & koeske, 2010; wang & chui, 2016), possibly because of the selective nature of the program and participants’ receipt of stipends. results of quantitative analyses showed that role ambiguity was inversely associated with student satisfaction with their overall field experience. to our knowledge, there is no research on role ambiguity in the context of social work students’ field experiences. however, the current study’s finding is consistent with those from a range of studies of job satisfaction among health and human service workers (e.g., chung & chun, 2015; gillet et al., 2016; jones et al., 2010; paoline et al., 2015; smith et al., 2011). qualitative data revealed that professional influence and professional support were intertwined with student field placement satisfaction. students who perceived that the social work profession’s role was not respected relative to other professions at the setting tended to feel less fulfilled with their experience. in contrast, participants who sensed their profession’s input was valued by practitioners from other professions tended to be more satisfied with their experience. limitations several limitations to this study are noted. first, data were collected from a homogenous and distinct group of students. they were interested in the populations served by the training program prior to their involvement and the program provided them a stipend. consequently, replication with diverse students in interprofessional placements that are not part of a special, paid initiative is warranted. regarding the quantitative findings, a skewed distribution in the outcome variable and the small sample size precluded conducting multivariate analyses. in addition, the implementation of multiple bivariate logistic regressions inflated the chance of type i error. concerning the qualitative findings, the themes may have overemphasized aspects of collaboration in identifying what promoted or impeded student satisfaction because a focus of the initiative overall was preparation for interprofessional practice. implications this exploratory study provides insights into msw students’ experiences and satisfaction in integrated behavioral health field placements. results suggest that social work educators may want to help students develop self-regulatory skills to tolerate role ambiguity and communication skills in role clarification as an ongoing part of supervision when placements are in integrated settings. these skills align with cswe’s (2015) competency-based education framework, in particular, competency 1, demonstrating ethical and professional behavior. first, tolerating role ambiguity assists in managing stress reactions related to role uncertainty in a way that preserves a student’s capacity for advances in social work, summer 2020, 20(2) 295 effective judgment, behavior or communications. second, role clarification assists students in understanding what is expected of them as well as what is expected of other professionals in the setting and facilitates effective communication about unique, intersecting and allied scopes of practice. proficiency in these skills could also promote an appreciation of the importance of interprofessional teamwork in interventions as part of social work practice (competency 8). similarly, field instructors in integrated behavioral health settings may benefit from coaching on how to monitor students’ experience of role ambiguity and how to develop student strategies to manage role ambiguity. in light of a prior study that found social work students perceived themselves as having lower professional prestige than nursing, pharmacy, and medical students (west et al., 2017), there are concerns that students may internalize negative attitudes about the profession unless social work educators strategically manage professional socialization. msw faculty and field education directors may want to collaborate with integrated behavioral health providers to assess organizational climate and identify ways to foster inclusive interprofessional collaborative practices and a culture of cross-profession respect. substantial investments are being made to prepare social work students for interprofessional practice, including curriculum and field placements where interprofessional knowledge and competencies are developed. this study identified role clarity, profession’s influence, and professional support as salient aspects of social work students’ satisfaction with interprofessional field placements. to ensure the social work profession’s position in the evolving health care delivery landscape, training and education may need to directly address students’ attitudes and appreciation for their unique professional expertise. simultaneously, capacity-building in the host field agencies may require advocacy and data regarding the impact of social work on health outcomes. as the value of social work increases in health and behavioral health care agencies, msw students’ experiences in interprofessional placements may be more satisfying and foster their commitment to pursue a career in this arena. references 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(2010). framework for action on interprofessional education & collaborative practice. http://www.who.int/hrh/nursing_midwifery/en/ https://doi.org/10.18060/2953 https://doi.org/10.1037/a0027029 https://doi.org/10.18060/18765 https://doi.org/10.1037/a0023454 https://doi.org/10.2466/01.07.21.pr0.109.4.243-251 https://www.hrsa.gov/about/strategic-plan/goal-2.html https://doi.org/10.18060/22333 https://doi.org/10.1093/swr/svw010 https://doi.org/10.5175/jswe.2010.200900043 https://doi.org/10.18060/19809 http://www.who.int/hrh/nursing_midwifery/en/ advances in social work, summer 2020, 20(2) 299 author note: address correspondence to michael clarkson-hendrix, department of sociocultural and justice sciences, state university of new york at fredonia, 280 central ave, fredonia, ny, 14063. email: michael.clarkson-hendrix@fredonia.edu acknowledgements: the authors thank the partner members of the consortium at the university at albany, suny (katharine briar-lawson, estella williamson [currently at seattle university]), university at buffalo, suny (nancy smyth, diane elze, laura lewis), binghamton university, suny (laura bronstein, paul gould [currently at simmons university], nazareth college-college at brockport, suny (virginia david, debra fromm-faria), roberts wesleyan college (david skiff [currently at liberty university], laura ribbing), syracuse university (carrie jefferson smith, kristin esposito). mailto:michael.clarkson-hendrix@fredonia.edu this work is licensed under a creative commons attribution 4.0 international license. competency curriculum intervention: student task self-efficacy and attitudes in child welfare barbara pierce taekyung park abstract: three cohorts of bsw and msw title iv-e and ncwwi student scholars (n= 125) were educated using a university-agency developed competency-based curriculum and field placement. in order to determine if this curriculum and field placement would improve perceived competence and attitudes toward child welfare work, pre and post-field placement surveys were used. statistically significant change was demonstrated for most competencies. attitudes toward child welfare work demonstrated no change from the favorable attitudes students had before entering their field placements. there were no statistically significant differences between bsw and msw students. students who had higher perceived competence endorsed motivation and intent to remain in child welfare. based on the findings, we recommend key strategies to keep up the morale of bsw and msw graduates in child welfare agencies: transition-to-work initiatives by schools, mentoring programs by agencies, manageable caseloads, and the application of skills and knowledge learned. keywords: child welfare students; competencies; task self-efficacy; work attitudes for too long social work organizations that specialize in public child welfare have faced considerable difficulties in recruiting and retaining qualified, experienced practitioners. as a result, the ability of organizations to provide effective services to their clients may be compromised (daly, dudley, finnegan, jones, & christiansen, 2001). while the status quo of public child welfare invites many, often conjectural explanations, the hereand-now of how to curb or even to fix the endemic turnover in public child welfare demands increased vigilance and attention. through their research, ellett, ellis, westbrook, and dews (2007) have already established the structural persistence of such turnover. willis, chavkin, and leung (2016) agree but go a step further to indicate that turnover is to be expected for a variety of reasons, some of which can be healthy for the agency. these authors describe means by which agencies work not to cut the rates of turnover but to reduce its impact on the agency. their study does not necessarily take into account the disruption to children and families when they lose a caseworker for reasons such as low pay or high caseloads. the negative impact of turnover on children in the foster care system is well-documented. for example, flower, mcdonald, and sumski (2005) indicate that higher permanency outcomes for children occur when they have the same caseworker throughout their time with the agency. much of the research on turnover and retention strategies has addressed two key concerns: the importance of retaining highly educated and skilled workers; and, absent that, the negative impacts on the worker, client, and agency experience in the wake (mor barak, nissly, & levin, 2001). as noted above, flower and colleagues (2005) established that ______________________ barbara pierce, phd, lcsw is an associate professor, school of social work, 902 west new york street, indiana university, indianapolis, in 46202. taekyung park, msw, is a doctoral student, school of social work, 902 west new york street, indiana university, indianapolis, in 46202. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 490-506, doi: 10.18060/21394 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 491 permanency outcomes for children (74.5% of the cases) are much higher when the same caseworker follows a client from start-to-finish. without that consistency, negative effects quickly surface in ways that impede social workers from remaining on-the-job. first, there is the physical toll: because the existing workforce is often required to assume the responsibilities and assignments of departed workers, workloads tend to balloon beyond the limits of what can be accomplished conscientiously and effectively (webb & carpenter, 2011). as a result, the performance level of those still employed lessens (iglehart, 1990). a second issue is the emotional toll: because the morale of colleagues left behind in these circumstances suffer, stress, burnout, and trauma routinely fill the vacuum (iglehart, 1990). agencies that must endure the loss of employees also suffer, particularly in terms of direct and indirect costs (lambert, cluse-tolar, pasupuleti, prior, & allen, 2012). mor barak et al. (2001) have grouped the direct costs of employee turnover into three categories: “separation costs (exit interviews, administration, functions related to terminations, separation pay, and unemployment tax); replacement costs (communicating job vacancies, pre-employment administrative functions, interviews, and exams); and training costs (formal classroom training and on-the-job instruction)” (p. 627). retention, then, precludes these negative effects and preserves those limited resources that agencies can ill-afford to spend on processes better avoided. the best benefit is that families will receive the services they need from the seemingly simple act of keeping caseworkers on the job, which allows for caseworkers to get to know families better and to shepherd them through the successful completion of a case plan. research on child welfare worker’s turnover or retention and attitudes toward the work has identified more than 20 factors that impact turnover including job satisfaction, selfefficacy, organizational commitment, work conditions, supervisor support, stress, secondary trauma, etc. (landsman, 2008; mor barak et al., 2001). of those, job satisfaction was identified as a direct predictor of turnover or retention among child welfare workers (chen & scannapieco, 2010; ellett et al., 2007; hopkins, cohen-callow, kim, & hwang, 2010; levy, poertner, & lieberman, 2012; strolin-goltzman, 2010). low job satisfaction has a negative impact on employee’s desire to stay and commit to child welfare work. while we know much about workers attitudes regarding job satisfaction and retention behavior, less is known about pre-service student attitudes and behaviors with regard to attitudes toward working in child welfare or perceived self-efficacy. this paper aims to enhance knowledge about social work students by testing one means of correcting the turnover problem, that is, by implementing competency-based education for social work students, thereby increasing self-confidence, and ultimately self-efficacy. the literature appears to link self-efficacy and attitudes toward child welfare work and retention in the child welfare workforce (ellett, 2000; jayaratne & chess, 1984; siefert, jayaratne, & chess, 1991; tracy, bean, gwatkin, & hill, 1992). thus, we expect that graduating students with high self-efficacy and favorable attitudes toward working in child welfare may enhance retention. pierce & park/competency curriculum 492 literature review self-efficacy self-efficacy has been defined as “beliefs in one’s capabilities to organize and execute the courses of action required to produce given attainments” (bandura, 1997, p. 3). not surprisingly, it also comprises matters of competence. hughes, galbraith, and white (2011) contended that self-efficacy signifies the cognitive perception of competence, which bear comparison with pajares and schunk (2002), who noted that perception of self-efficacy answers “can i” questions. additional refinements have appeared in the literature. maddux (1995) recognized the need to partition self-efficacy into task self-efficacy and coping selfefficacy. task self-efficacy evinces the simple ability to perform a task, while coping selfefficacy figures as grace under pressure: the confidence needed to perform well under challenging circumstances (rogers, markland, selzler, murray, & wilson, 2014). the current study defines task self-efficacy as the perceived competence to perform a task ably. self-efficacy, as an agent of retention, has benefited from its established and recognized association with intent to remain and attitudes about working in child welfare (ellett, 2000; jayaratne & chess, 1984; siefert et al., 1991; tracy et al., 1992). for social workers, acquisition of the knowledge and skill to produce an outcome starts in the social work educational program and becomes fully realized in the agency. ellett (2000) surveyed 941 public child welfare workers in arkansas and louisiana regarding intent to remain employed. intent to remain employed was positively correlated with human caring, selfefficacy, and perception of a professional organizational culture (administrative support). intent to remain employed was negatively correlated with professional organizational culture deprivation (lack of professionalism and commitment). the study also demonstrated that those workers with social work degrees had higher scores on measures of intent to remain. similarly, cole, panchanadeswaran, and daining (2004) randomly surveyed 500 maryland social workers. based on 232 responses of workers who completed surveys on perceived workload, efficacy, and job satisfaction, they observed that higher levels of perceived efficacy were correlated with higher job satisfaction. in addition, cole and colleagues (2004) found that “perceived efficacy mediated the relationship between perceived workload and job satisfaction” (p. 8). we may reasonably conclude that lack of self-efficacy indeed looms as one reason why those new workers with high caseloads and little experience are often the first to leave agencies. with the support of title iv-e funding, public child welfare agencies and child welfare educators mapped a strategic course to provide consistency in quality child welfare services by recruiting and retaining qualified child welfare workers (hartinger-saunders & lyons, 2013). this funding became available in the 1980s and provides scholarships to students in publicly funded social work programs who wish to work in public child welfare in exchange for a required number of years of payback employment to a public child welfare agency (zlotnik, 2002). studies designed to investigate the effectiveness of title iv-e programs via the retention rates of those workers who graduated from its programs have confirmed that stipend program graduates were and continued to be more likely to stay in public child welfare after the required service years (ellett et al., 2007). both the stipends and field placements provided to social work students interested in child welfare have advances in social work, spring 2017, 18(1) 493 served as a useful incentive in the field of child welfare. overall, then, evidence appears to demonstrate that title iv-e programs assist agencies to retain caseworkers (dickinson & perry, 2003; gansle & ellett, 2003; jones & okamura, 2000; rosenthal & waters, 2006). money alone, however, does not give a full picture of the success of title iv-e programs. when they gain child welfare knowledge and practice through field placements, social work students develop confidence in their ability to practice. in fact, jones and okamura (2000) found title iv-e program graduates scored higher than non-title iv-e graduates in work knowledge and confidence in child welfare. building on past successes of title ive, additional funding from the national child welfare workforce institute (ncwwi) via the us children’s bureau (strand, dettlaff, & counts-spriggs, 2015) allows for more flexible use of funds in support of developing and enhancing university-agency partnerships to educate students and provide leadership for the development of innovations to recruit and retain child welfare workers. student attitudes toward child welfare work the literature on student perceptions or attitudes toward child welfare work is sparse. perry (2004) found that msw students who were interested in working in public child welfare wanted to work with economically disadvantaged populations and had personal growth goals. seroka and zugazaga (2008) reported high student satisfaction with their internships and subsequent placements and found high overall satisfaction levels particularly among the white students. nearly three-quarters (74%) of all graduates intended to remain employed in the child welfare field. alperin (1998) noted that satisfaction with the internship was the largest predictor of intent to accept employment at a child welfare agency. other studies on msw graduates who were specially educated through title iv-e programs revealed that title iv-e participants were better equipped with knowledge and skills necessary for the work and provided better outcomes than their counterparts (bagdasaryan, 2012; leung & willis, 2012; williams, kirk, & wilson, 2011). leake, deguzman, rienks, archer, and potter (2015) likewise found high levels of satisfaction among ncwwi partnership trainees upon final evaluation. traineeship students felt “ready” for the job (leake et al., 2015, p. s310). however, some title iv-e graduates reported that their newly acquired skills were not put to good use in their agencies when they return to work (fitch, parker-barua, & watt, 2014). new social workers in child welfare agencies report that high caseloads too soon after initial employment was a key predictor of their leaving the job (weaver, chang, clark, & rhee, 2007). studies on student attitudes toward child welfare work and what it might take to persist or remain employed were not evident in the literature. competency-based curriculum according to council on social work education (cswe, 2015), “competencies are measurable practice behaviors that are comprised of knowledge, values, and skills” (p. 3). school of social work are expected to increase students’ knowledge, values, and skills along with confidence in the ability to do the job. competency education is thought to improve the ability of learners to actually perform more accurately and professionally. social work programs began to teach from a formally developed competency-based pierce & park/competency curriculum 494 curriculum in 2008 when the council on social work education released the educational policy and accreditation standards (epas) outlining core competencies for social work education (cswe, 2015). these competencies were to be measured at least partly in the field where students are observed actually practicing the desired competency. at the same time, some states and universities began to identify core competencies for child welfare practice (clark, 2003). california’s child welfare partnership, known as california social work education center (calswec), developed competencies in the 1990s with other states following suit (clark, 2003). measuring competence with child welfare across the country is difficult as there is no one set of core competencies for child welfare such as there is for general social work education (leake et al., 2015). leake et al. (2015) defined a set of child welfare competencies and evaluated perceived competence for ncwwi students nationally and demonstrated increased perceived competence in the ncwwi traineeship student population. the state child welfare agency in louisiana partnered with seven public universities to develop a common set of competencies based on the calswec competencies but tailored for the education of title iv-e and ncwwi students. this study assessed changes in perceived competence and in attitudes toward child welfare work in this student population. methods the aim of this study was to identify potential growth in perceived competence and changes in attitudes toward child welfare work from pre-to-post field placement. seven universities and the state agency developed and implemented a mutually agreed-upon set of competencies in their child welfare curriculum. all universities transparently demonstrated where in their curriculum specific competencies were met and all agreed to use the same field evaluation tools. of note is the knowledge that the state agency was undergoing a massive leadership overhaul that created increased turnover and other workforce issues within the agency. all members of the partnership agreed to continue, however, with the use of the competency-based curriculum. the general line of inquiry included testing the effect of the competency-based curriculum on students’ perceived competence and analyzing student attitudes toward the work. within this evaluation study, we hypothesized that: 1. overall students will show increased confidence in competence from pre-to-post internship; 2. student attitudes toward doing the job of child welfare work from pre-to-post will diminish due to agency workforce issues; 3. students with higher perceived confidence in competence will have more positive attitudes toward child welfare work; and 4. there will be no difference between msw and bsw graduates in competence and attitudes toward child welfare work. university institutional review board permission was granted for the conduct of this study. participants three cohorts of student social workers over three years (n=125) in child welfare programs at seven universities in louisiana were asked to participate in the survey. all used the same set of university-state agency developed child welfare competencies. both bsw (n=58) and msw (n=35) students were included in this study. thirteen students did advances in social work, spring 2017, 18(1) 495 not report their programs. the sample comprised title iv-e scholars (n=76) as well as students selected to receive national child welfare workforce institute (ncwwi) stipends (n=49). there was no appropriate comparison group as all child welfare students in one state participated in this study. given that the state partner had a vested interest in having trained employees at the end of the educational intervention, random assignment (perhaps by school) was not acceptable. design and data collection this study used a pre-post survey design. in order to assess student attitudes toward child welfare as a field of practice, for purposes of recruitment and retention and perceived competence, all child welfare students (title iv-e and scholars) completed a survey prior to the start of their field placements and again at the completion of placements. students beginning their final field placement completed their pre-survey at one of two regional orientations at the beginning of the fall semester, at which time they also completed a basic demographics inquiry. the post-survey was administered prior to graduation in either december (when necessary to accommodate those institutions that had december graduations) or april (immediately prior to may graduations). measures and data analysis a 13-item scale mirroring the state competencies was developed to measure the degree of students’ perceived confidence in their ability to answer the “can i” question. that is, “how confident am i that i can do a particular competency measure”. degree of perceived competence was used in this study to operationalize task self-efficacy. the scale asked students to assess their ability to meet the identified competencies using a seven-point likert-type scale with responses ranging from 1 (no confidence) to 7 (complete confidence). for the attitude variable, a 10-item scale was developed to measure attitudes toward child welfare work. this scale also used a seven-point likert-type rating, ranging from 1 (strongly disagree) to 7 (strongly agree). cronbach’s alpha determined reliability coefficients of 0.9 for the competency survey and 0.8 for attitude toward child welfare work. relevant statistics included descriptive statistics and paired-t tests to identify overall change from preto poston each scale. the bonferroni correction was applied to minimize type-i errors due to multiple tests. as computed for both scales, the significance level at 95% confidence using the bonferroni correction was 0.004. multiple linear regression analyses determined the relationships between students’ confidence level and attitudes toward public child welfare and an independent samples t-test measured differences between bsws and msws. results a total of 125 title iv-e and ncwwi scholar students completed the internship in this state during the test period. however, only 115 completed the pre-survey and 93 completed the postsurvey process. differences in graduation times may account for the loss of some data (december vs. may). the mean age of respondents was 28 (sd=8.6), pierce & park/competency curriculum 496 61.1% were below 25 years, 91.5% were female, and 68.8% were african american. of these, 60.2% completed internships in rural communities, 62.4% obtained the bsw, and 37.6% completed the msw. most students had no previous child welfare experience. students came from the seven participating title iv-e child welfare programs in social work schools in the state, which includes two historically black colleges and universities (hbcu). see table 1. table 1. characteristics of post-survey study participants (n=93) frequency (%) bsw msw total age below 25 & 25 43 (46.0%) 14 (15.1%) 57 (61.1%) over 25 15 (16.1%) 21 (22.6%) 36 (38.7%) total 58 (62.4%) 35 (37.6%) 93 (100%) gender female 52 (56.0%) 33 (35.5%) 85 (91.5%) male 5 (5.4%) 2 (2.2%) 7 (7.6%) total 57 (61.3%) 35 (37.6%) 92 (100%) ethnicity african american 40 (43.0%) 24 (25.8%) 64 (68.8%) caucasian/white 18 (19.4%) 10 (10.8%) 28 (30.1%) other 1 (1.1%) 1 (1.1%) total 58 (62.4%) 35 (37.6%) 93 (100%) internship place urban 27 (29.0%) 10 (10.8%) 37 (39.8%) rural 31 (33.3%) 25 (26.9%) 56 (60.2%) total 58 (62.4%) 35 (37.6%) 93 (100%) competence paired t tests were conducted to identify differences between preand post-measures of attitudes toward child welfare work. the bonferroni correction was applied to decrease type 1 errors due to multiple tests. the adjusted alpha was 0.004. hypothesis one states that overall students will report higher confidence in competence from pre-to-post internship. overall, students reported a relatively high confidence level in their ability to meet the child welfare competencies by post-test. students also reported an increase in confidence from preto post-survey. the overall mean for the competency scale on the pre-survey was 68.20 (sd=14.37); whereas the mean for the post-survey was 74.52 (sd=9.65). a statistically significant increase in confidence occurred from preto posttesting, t (92)= -4.27, p.< .001. thus, hypothesis one was supported. although increases for most individual items appeared, only eight items reached statistical significance individually after the adjusted alpha level was applied. the eight items were: understanding social work values; history of child welfare; writing court reports; assessing risk to children; making sound placement decisions; knowing different supervisory styles; successfully engaging with a parent; and analyzing, formulating, and influencing social policy. students rated themselves as least confident in working with the courts. ability to testify in court demonstrated a drop in confidence after students had the actual experience of attending court in their field placements; still, the result was not statistically significant (m1=4.80, m2=4.82). of the competencies that did see statistically significant growth, writing court reports remained the one that students felt least confident in being able to do (m1=4.23, advances in social work, spring 2017, 18(1) 497 m2=4.99). students felt most confident in their ability to understand social work values and ethics (m1=5.86, m2=6.35). we tested effect size using cohen’s d. effect sizes of 0.5 to 0.7 indicate moderate effect size and 0.8 and above are considered large. the overall effect size was .40, which is a small effect size. individually engaging, assessing risk, making sound placement decisions, and understanding social work values and ethics showed the highest effect sizes in this sample. all were in the moderate range (see table 2). table 2. pre/post-tests difference in perceived confidence confidence mean (sd) cohen’s d t sig. pre (n≈93) post (n≈93) apply critical thinking skills 5.67 (1.01) 5.94 (0.88) -0.29 -2.2 0.03 understand the social work values 5.86 (1.05) 6.35 (0.71) -0.55 4.45 <.001* apply strategies of advocacy 5.46 (1.12) 5.74 (1.03) -0.26 -2.12 0.04 understand the history of child welfare 5.27 (1.36) 5.85 (1.06) -0.48 4.07 <.001* write court reports 4.23 (1.89) 4.99 (1.6) -0.43 -4.17 <.001* testify in court 4.8 (1.77) 4.82 (1.54) -0.01 0.16 0.87 understand and can work with family group decisionmaking 5.58 (1.24) 5.83 (0.97) -0.22 -2.03 0.05 assess the risk to children 5.18 (1.49) 5.89 (0.95) -0.57 4.55 <.001* make sound placement decisions 5.17 (1.51) 5.99 (0.82) -0.67 -5.14 <.001* make adaptations to work with families 5.77 (1.2) 6.1 (0.83) -0.32 2.39 0.02 know different supervision styles 5.02 (1.55) 5.62 (1.15) -0.44 -2.96 <.001* successfully engage with a parent 5.22 (1.5) 5.92 (0.97) -0.55 -4.62 <.001* analyze, formulate and influence social policy 4.96 (1.53) 5.5 (1.14) -0.38 3.3 <.001* overall mean 68.2 (14.37) 74.52 (9.65) -0.4 -4.27 <.001* * statistically significant at 95% confidence with bonferroni correction (p.</ =.004). sd: standard deviation attitudes about working in child welfare paired t tests were conducted to identify differences between preand post-survey for attitudes. the bonferroni correction was applied to decrease type 1 errors due to multiple tests. the adjusted alpha was 0.004. hypothesis two states that there will be a negative change in attitude from pre to post survey. attitudes about working in child welfare were actually positive and remained so over the course of the internship. the overall mean for the attitude survey was not pierce & park/competency curriculum 498 statistically significantly different from preto post-testing t(90)=.26, p=.79 and there were no individual items in which the pre to post scores were statistically significant. thus, hypothesis two was not supported. means were high indicating positive attitudes remained stable over the course of the internship. while decreases in means existed in some categories, the differences were not statistically significant (see table 3). concerning single items for this survey, students remained motivated and persistent in helping children and families (m1=6.32, m2=6.38); rebounded and persisted after setbacks (m1=5.93, m2=6.00); were proud of their work (m 1=6.43, m2=6.52); felt confident in their abilities (m1=6.25, m2=6.34); felt personal accomplishment (m1=6.43, m2=6.38); continued to want to help others (m1=6.80, m2=6.80); and believed that child welfare work offered opportunities to make a difference (m1=6.72, m 2= 6.62). students were also concerned that some clients did not receive the services they deserved (m1=6.39, m2=6.40). students were asked if they would delay personal plans to help a client and in fact they continued to endorse that attitude but were not as inclined to do so (m1=6.14, m2=5.90). table 3. pre/post-test differences in perceptions of child welfare work perceptions of child welfare work mean (sd) t sig. pre (n≈91) post (n≈91) i feel i am working hard but rarely see results. 5.25 (1.43) 5.12 (1.47) -0.75 0.46 i remain motivated and persist in helping children and families. 6.32 (1.04) 6.38 (0.74) 0.56 0.59 i rebound and persist after setbacks in efforts to accomplish goals. 5.93 (1.37) 6 (0.74) -0.44 0.66 i am proud of my work. 6.43 (1.01) 6.52 (0.65) 0.81 0.42 i am confident in my ability to perform services in child welfare. 6.25 (1.12) 6.34 (0.79) -0.69 0.49 i feel a sense of personal accomplishment through my work. 6.43 (0.96) 6.38 (0.76) -0.39 0.71 i chose this profession because i want to help others. 6.8 (0.76) 6.8 (0.48) 0 1 i would delay personal plans in order to help a client who needs assistance. 6.14 (1.02) 5.9 (1) -2.03 0.05 it bothers me that some clients don’t receive the services they deserve. 6.39 (1.04) 6.4 (0.88) -0.09 0.93 i believe my work in child welfare will offer opportunities to make a difference. 6.72 (0.8) 6.62 (0.63) -1.12 0.27 overall mean 62.07 (7.86) 62.38 (5.21) 0.26 0.79 * statistically significant at .05 with bonferroni correction (p. < /=.004). sd: standard deviation confidence and attitudes toward doing child welfare work hypothesis three stated that students with higher confidence in their competence would have more positive attitudes toward child welfare work. linear regression was performed advances in social work, spring 2017, 18(1) 499 to evaluate how well confidence in child welfare work predicted students’ attitudes toward the job. the correlation between perceived confidence in competence (task self-efficacy) and attitude toward the job was statistically significant (r=.56, p.<.01). the regression equation for predicting students’ attitude toward the job was found to be y`=39.9 + .3 × x. in this sample, 31% of the variance in attitudes toward the job can be explained by students’ perceived confidence in their ability to meet the competencies. that is, the students who had high perceived confidence in their competence were more likely to have better attitudes toward the work of child welfare (r2 =.32, β =.30, p<001). thus, hypothesis three was supported. differences between bsw and msw students an independent samples t-test was used to determine whether level of education (bsw or msw) made a difference in competence or attitude toward child welfare work. findings demonstrated that for this sample there were no significant differences between msws and bsws in perceived competence, t(92)=1.258, p=.218), or attitude toward child welfare work, t (2)=1.301, p=.457. discussion and implications overall, this study demonstrates high levels of confidence in competence or task selfefficacy for most competencies and growth in most areas among bsw and msw child welfare students. further, attitudes toward child welfare work were positive and remained so throughout the field placement despite a difficult leadership transition at the agency. students with higher perceived competence were more likely to have more positive attitudes toward the work of child welfare. there were no statistically significant differences between bsw and msw students. competence overall, students’ confidence in their ability to meet the competencies or task selfefficacy grew from preto post-survey. students had the most confidence in their ability to understand social work values and ethics, a topic emphasized in their social work programs. they experienced growth in this area perhaps as they began to apply values and ethics in case situations in the field. students experienced statistically significant change in perception of competence from pre to post in a positive direction. the field placements gave them experience to practice knowledge, values, and skills initially learned in the classroom. students also reported growth from pre to post in their perceived confidence to write an effective court report as they were able to practice writing these reports with their field instructors. a decrease in perception of competence in testifying is not surprising. working with the courts can be difficult, in light of the specialized vocabularies and procedures; nevertheless, enhanced training in this area would serve all parties well. as it turns out, those students who attended court with their field instructors actually lost confidence over the course of the internship, once the realities of how difficult testifying were demonstrated. child welfare courses in schools of social work should therefore become more attentive to this dimension of social work practice by offering more pierce & park/competency curriculum 500 instruction and practice in testifying in court before students engage in the actual field experience. attitude toward child welfare work this study revealed no statistically significant differences from preto post-internship with regard to attitudes toward child welfare work. in this instance, non-significant results were considered positive. students started out with positive attitudes and did not appear to lose their enthusiasm or desire to work with children and families in public child welfare. although slight drops in attitude did occur, they were not statistically significant. of note, this survey was conducted in a state that had experienced massive changes in the administration of the public child welfare agency during the time students were in their internships. even though staff turnover increased, student attitudes remained high and positive. a number of possible reasons can account for their equanimity. first, students tended to be placed with field instructors who had worked in the public child welfare agency for several years. those instructors may be considered as stayers, which likely translated into a more positive attitude about their work in general, which they then transmitted to students. second, students were actively recruited to the title iv-e and ncwwi programs and were mentored by child welfare faculty who approached the field with enthusiasm. third, students did not have independent caseloads and thus did not have to bear the weight of that responsibility alone. such burden, over time, sometimes comes with a price. at the beginning of the process, student attitudes were strong and remained positive. task self-efficacy and positive perceptions of the work regression analysis revealed that students who had higher confidence in their competence were more likely to have positive perceptions about doing the work of child welfare. one of the items measured was intent to remain motivated to persist working with children and families and remain on the job. this result confirms previous findings of cole et al. (2004), ellett (2000), siefert et al. (1991), tracy et al. (1992), and jayaratne and chess (1984), all of whom demonstrated links between self-efficacy in ability and retention. students and workers who feel competent or have high self-efficacy are more likely to remain motivated and to meet the challenges they face in the internship or workplace. differences by education in this study no differences were found in the areas of competency, or attitude toward child welfare work, that is, intent to remain in child welfare work, based on educational level or program. perceived competence and intent to remain were high in our sample and echo the results of ellett (2014) with regard to higher performance on standardized measures and remaining employed. while some literature has demonstrated a difference between bsws and msws with regard to retention (lewandowski, 1998; nissly, mor barak, & levin, 2005), others found no difference (rosenthal & waters, 2006). our study compared attitudes along with perceived competence. because these students were all exposed to the same educational competencies and similar curricula across programs and schools, it is not surprising that there are no statistically significant differences among these advances in social work, spring 2017, 18(1) 501 students. it is important to build strong competency-based curricula to help students to understand the realities of child welfare work. implications overall, the students in this study had statistically significant gains in perceived competence and began their final year in school with very positive attitudes toward the work of child welfare and ended with the same positive attitudes despite agency issues. these students appeared ready and willing to do the job as they graduated. chances are many title iv-e and ncwwi scholars have the same positive outlook and self-efficacy when they graduate from their social work programs. yet, turnover remains a huge concern as we see graduates having caseloads too high too quickly (weaver et al., 2007) and msws reporting that their education is not valued or put to good use in their agencies (fitch et al., 2014). while educators seem to be doing a good job with competency education and keeping morale high while students are in school, they tend to lose track of their graduates after graduation. transition-to-work initiatives may be helpful as faculty can remain somewhat involved with their students for a time after graduation in order to provide support and encouragement during the first year of employment. agencies can facilitate a smooth transition to professional child welfare by offering mentoring programs for the first year of employment. agencies should aim to keep caseloads down initially as students in public agencies rarely carry a full caseload and the new graduate must learn to manage a vast array of practice skills and responsibilities. further, agencies who expend time and money in educating msws can elicit and encourage ideas from new graduates. this may help to keep morale high for the msw graduate and enable agencies to benefit from new evidence-based approaches. strengths and limitations of the study and future research the major strength of this study collected data on a student population (rather than agency workers) specifically by its inclusion of three cohorts from seven universities over the course of their internships. while there is no comparison group, this study reports on all of the child welfare scholars within a three-year period in one state. its major limitation is that it only looks at perceptions of competence rather than actual demonstrated competence. the competency-based curriculum, however, was successfully implemented to improve students’ perceived competence in child welfare. these students started their careers in child welfare with high task self-efficacy, in general. another strength of this study is the further refining of the term self-efficacy by specifically using the term task self-efficacy and operationalizing it as perceived confidence in abilities or answering the “can i” question. maturation, always a concern with pre-post designs, is certainly a limitation. yet, the competency curriculum was reinforced throughout the curriculum and field placements so it seems likely that this intervention had a positive effect on students’ perception of competence. also, attitudes were highly positive to begin with and did not change over time. creating a scale to measure self-efficacy and attitudes toward child welfare work is another limitation since there are existing scales for self-efficacy (chen & scannapieco, 2010; ellett, 2000; hughes et al., 2011). although reliability of those scales were tested pierce & park/competency curriculum 502 and presented, further study needs to examine the validity of the scale. however, the measures in this study were developed specifically for child welfare workers. this aspect could have contributed to high cronbach alpha scores. future studies should examine both task and coping self-efficacy over the long-term in the transition from students to workers, particularly once the latter continue employment in their post-payback period. approached that way, such a study could help establish a more certain longitudinal link between self-efficacy and attitudes toward child welfare work and possibly retention with a more refined understanding of self-efficacy. selfefficacy, of course, faces repeated storms in the workplace. the key is in keeping it afloat and moving toward its port: continuity in work with children and families. conclusion it is important for title iv-e and ncwwi programs to evaluate workers’ perceived competence as it may have an impact on future retention. this study aimed to identify differences in perceived competence and attitude toward child welfare work preto postfield placement after initiation of a statewide competency-based curriculum within seven state university child welfare programs. there were no differences among programs or level of education, perceived competence was improved, and attitudes toward the work were positive and remained so. those with higher perceived competence appear to have more positive attitudes toward child welfare work. while this study used perceived competence as a measure of task self-efficacy, further work in refining self-efficacy measures for child welfare could enhance our knowledge of student and worker efficacy as students make the transition to full-fledged social workers in their agencies and begin the challenging work of caring for children and families. references alperin, d. e. 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(2016). finding “health” and “meaning” in texassized turnover: application of seminal management principles for administration and research in u.s. public child welfare agencies. advances in social work, 17(2), 116133. doi: https://doi.org/10.18060/20856 zlotnik, j. (2002). preparing social workers for child welfare practice: lessons from an historical review of the literature. journal of health & social policy, 15(3/4), 5-21. doi: https://doi.org/10.1300/j045v15n03_02 author note: address correspondence to: barbara pierce, phd, lcsw, school of social work, 902 west new york street, indiana university, indianapolis, in, 46202. https://doi.org/10.18060/20856 https://doi.org/10.1300/j045v15n03_02 _______ cole hooley, phd, lcsw, assistant professor, school of social work, brigham young university; yi wang, phd, msw, assistant professor, school of social work, the university of iowa; and david r. hodge, phd, msw, professor, school of social work, arizona state university, and senior nonresident fellow, program on religion and urban civil society, university of pennsylvania. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 778-800, doi: 10.18060/23975 this work is licensed under a creative commons attribution 4.0 international license. clergy-provided mental health services: a strategy for addressing disparities in scale-up efforts cole hooley yi wang david r. hodge abstract: most individuals with mental health needs do not receive professional care. one strategy to narrow this service provision gap is task-shifting, a process where certain responsibilities are shifted to less specialized workers. approximately 25% of those who seek mental health care turn to clergy. this study investigated the suitability of using clergy to scale-up mental health service provision by assessing perceptions of satisfaction and helpfulness with clergy-delivered services. using data from the national comorbidity survey replication (2003), we found most respondents (n=204) who went to clergy reported satisfaction with their care (92%) and that the services were helpful (94%). ordered logit regression revealed that racial/ethnic minorities and individuals for whom religion was more salient were disproportionately likely to find clergy-delivered mental health services satisfying and helpful, while older adults were more likely to report the services were helpful. the results suggest incorporating clergy in mental health scale-up plans via task-shifting may be a viable option, particularly for addressing the mental health needs of underserved racial and ethnic minorities, as well as older adults. social workers— at least in theory—are well-positioned to collaborate with clergy in the process of implementing task-shifting. keywords: health disparities; underserved populations; mental health services; scaleup; task-shifting, clergy for decades, researchers have noted that most people with mental health needs do not receive professional treatment (substance abuse and mental health services administration, 2017; wang et al., 2005). furthermore, quality mental health services have been inequitably distributed with, for example, racial and ethnic minorities having less access and receiving inadequate care (puyat et al., 2016). consequently, narrowing the treatment gap by scaling-up mental health services to achieve more equity is a pressing public health concern (institute of medicine, 2015). unfortunately, shortages in the mental health workforce exist, hindering scale-up efforts (health resources and services administration [hrsa], 2016). researchers have documented the persistence of behavioral healthcare workforce shortages (hoge et al., 2013). the hrsa (2016) projects the mental health workforce will need a quarter of a million additional providers to meet the demand for mental health care by 2025. the workforce shortages vary substantially by discipline and geographic region (hrsa, 2018). furthermore, the number of mental health profession shortage areas has increased over https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2020, 20(3) 779 time (national academies of sciences, engineering, and medicine, 2017). fortunately, strategies exist to narrow this workforce gap. several recommendations have been made to remediate workforce shortages, with some organizations and municipalities implementing various initiatives (covino, 2019). for example, olfson (2016) recommended: expanding loan repayment programs, increasing medicaid reimbursement rates, augmenting training opportunities for social workers in evidence-based practices, and enhancing integrated care models (olfson, 2016). covino (2019) outlined efforts by seven states to address mental health workforce issues. examples included encouraging graduate programs to train students in evidence-based practices, establishing health care corps to bolster new professionals in the workforce, initiating cash incentive programs for workers, implementing performance-based bonuses, and starting a supervision training course (covino, 2019). these efforts have made progress towards increasing and retaining the behavioral healthcare workforce; however, the gains pale in comparison to the projected workforce needs (covino, 2019; hoge et al., 2017). one recommendation that has yet to be fully implemented is to train family members, peers, and others in certain behavioral healthcare practices (covino, 2019). the world health organization (who, 2008) has promoted the use of task-shifting as one scale-up strategy to bolster the existing health service workforce. who (2008) defines task-shifting as “a process whereby specific tasks are moved, where appropriate, to health workers with shorter training and fewer qualifications” (p. 7). one example of task-shifting is training teachers and community health volunteers to provide trauma-focused cognitive behavioral therapy (tf-cbt) to children in schools and community settings (dorsey et al., 2020). teachers and volunteers are trained in the tf-cbt model by experienced counselors and receive regular supervision and support in the implementation process (dorsey et al., 2020). task-shifting has been deployed for several behavioral health concerns (deimling johns et al., 2018; javadi et al., 2017). systematic reviews of behavioral health task-shifting have found the strategy to be both feasible and effective, resulting in improved behavioral health outcomes (deimling johns et al., 2018; grant et al., 2018; javadi et al., 2017). in addition to the teachers and volunteers cited above, other programs make use of lay community health workers (hoeft et al., 2018). one potential category of lay workers for task-shifting is clergy and other spiritual advisers. there are approximately 395,000 clergy in the united states (association of religion data archives, 2000; united states census bureau, 2012). these individuals interact with a substantial percentage of the american public. according to the pew research center (2014), 36% of the general public attend religious services weekly, and 53% report that religion is a very important component of their lives. furthermore, religion tends to be more salient in communities that are underserved in the area of mental health services including blacks, hispanics, women, older adults, and people with low incomes (newport, 2012). people often turn to clergy for assistance when they experience problems. indeed, clergy have been functioning as de facto frontline mental health workers for decades (weaver et al., 2003; wong et al., 2018). clergy provide various types of emotional support to their congregants, with individuals frequently seeking clergy out for mental health hooley et al./incorporating clergy 780 concerns (hedman, 2014; vanderwaal et al., 2012). clergy report dedicating, on average, 15% of their time to pastoral counseling activities, which by one estimate would yield approximately 138 million hours of mental health support services per year (weaver et al., 2003). clergy help people cope with a wide range of stressors, life transitions, and mental illnesses (payne, 2009, 2014; vanderwaal et al., 2012). furthermore, approximately onethird of church attendees belong to a congregation that provides formal support for individuals with a mental illness (wong et al., 2018). wang et al. (2003) found that 25% of adults who sought mental health services turned to clergy for care. among adults aged 55 and over, approximately 32% of individuals with a serious physical or emotional problem sought help from clergy (nguyen et al., 2020). most of those who saw clergy decided to work with them exclusively and did not receive adjunctive services from physicians or mental health professionals (wang et al., 2003). various explanations have been offered to explain why some people prefer to receive services from clergy (payne, 2009, 2014). clergy often have long-term relationships with their congregants which is conducive to building trust and observing shifts in mood/behavior (ellison et al., 2006). many individuals believe religion is an important dimension of wellness (pew research center, 2014), and may prefer providers who can incorporate spiritual resources into service provision in a culturally competent manner (chalfant et al., 1990). less stigma may be associated with seeking help from clergy, along with an absence of fees and quicker access to services (payne, 2009, 2014; vanderwaal et al., 2012). some have posited that certain racial and ethnic groups may be inclined to seek out assistance from clergy rather than other providers due to distrust based on historic abuses by the health care system (brown & mccreary, 2014). individual characteristics such as race/ethnicity, age, education, religious salience, and the nature of the presenting problem have been associated with seeking mental health care from clergy (brown & mccreary, 2014; chatters et al., 2011; dalencour et al., 2017; nguyen et al., 2020). another possibility is that the services provided by clergy are effective, mitigating the need to obtain services from traditional mental health providers. indeed, some evidence suggests the services delivered by religious leaders, delivered in churches, or therapies that accommodate client religious/spiritual practices may be effective (gonçalves et al., 2015; hook et al., 2010; worthington et al., 2011). questions remain, however, about the perceived satisfaction and helpfulness of clergydelivered mental health services. our use of the phrase “mental health services” views mental health care as a continuum of services provided by socially sanctioned helpers (e.g., social workers, psychologists, clergy; jameson & naugle, 2013; milstein et al., 2008). these helpers provide a range of services—from prevention through intervention—aimed at improving individuals’ emotional, psychological, and social lives (milstein et al., 2008). relatively little research has examined the perceived satisfaction and helpfulness of clergyprovided mental health services using cross-group comparisons (ellison et al., 2006; neighbors et al., 1998; veroff et al., 1981). to address this gap, the present study examined two key outcomes across several groups, namely clients’ perceived: 1) satisfaction with, and 2) helpfulness of clergy-delivered mental health services. satisfaction with services is an important dimension to consider when assessing the quality of mental health care (fortin et al., 2018). in the broader health services literature, advances in social work, fall 2020, 20(3) 781 patient satisfaction is associated with positive clinical outcomes (doyle et al., 2013). the mental health services literature has not identified consistent socio-demographic predictors of satisfaction, and limited research exists on satisfaction with clergy-delivered mental health care (fortin et al., 2018). the extant research suggests that members of racial and ethnic minority communities generally find clergy-delivered mental health services satisfying (john & williams, 2013; neighbors et al., 1998). the methods employed in these studies, however, preclude making national cross-group comparisons. systematic reviews on faith and traditional healing in mental health have identified helpfulness as a good proxy for service effectiveness (nortje et al., 2016; van der watt et al., 2018). research suggests that clergy-delivered services are generally viewed as helpful (van der watt et al., 2018; veroff et al., 1981). however, as is the case with satisfaction, the methods used in the existing research do not allow for national cross-group comparisons. to address these limitations, the present study used a nationally representative dataset to investigate clients’ perceived satisfaction with, and helpfulness of, clergy-delivered mental health services. to help determine the suitability of using clergy as scale-up mental health service providers, this study was guided by four questions. among clients who receive mental health services from clergy 1) how satisfied are clients with the services they received? and 2) how helpful are the services? what predictors are associated with clients’ perceived 3) satisfaction, and 4) helpfulness of services. based upon the extant literature, we tentatively hypothesize that most clients will report being satisfied with services and will report the services as helpful. we also expect that several variables will predict both satisfaction and helpfulness including potentially race/ethnicity, age, and religious salience (ellison et al., 2006; john & williams, 2013; neighbors et al., 1998; wang et al., 2003). methods sample to answer these questions, the authors used data from the national comorbidity survey replication (ncs-r; alegria et al., 2016). the ncs-r is a nationally representative survey conducted in 2003 with approximately 10,000 respondents (kessler & merikangas, 2004). although the ncs-r was administered in 2003, it continues to be widely used due to the breadth of mental health variables included in this dataset (kolla et al., 2020; stickley et al., 2020). pertinent to our study, the ncs-r included information regarding mental health treatment receipt, satisfaction with treatment, and helpfulness of service provision (kessler & merikangas, 2004). following the procedures used by other researchers (kovess-masfety et al., 2010), we used a subset of ncs-r for our study. the ncs-r screened for lifetime mental health service use using various questions (e.g., “did you ever in your lifetime go to see any of the professionals on this list for problems with your emotions, nerves, or your use of alcohol or drugs?”). respondents who had received services in their lifetime were given a list of mental health providers, one of which was, “a religious or spiritual advisor like a minister, priest, or rabbi.” respondents hooley et al./incorporating clergy 782 were asked when they last received services from the providers they selected. additional questions for each provider were asked of those who reported receiving services within the past 12 months. some 249 individuals reported receiving mental health services from clergy in the prior 12 months. among these, 45 (18.1%) had missing values in the predictor, dependent variables, or weighting variable. sensitivity analyses showed that observations with missing values did not differ statistically from the remaining sample; and models with imputed data had the same results as models using list-wise deletion. therefore, individuals who had valid responses to all the variables in our models were included in our analyses. after applying the survey weights (kessler et al., 2004), we ended up with a study sample of 204. variables dependent variables the two dependent variables in this study were client perceptions of satisfaction and helpfulness of clergy-provided mental health services (harris et al., 2020; lippens & mackenzie, 2011). client satisfaction was assessed with the following item: “in general, how satisfied are you with the treatments and services you received from the spiritual advisor or religious leader in the past 12 months?" participants indicated their response on a five-point ordinal likert scale (“very satisfied,” “satisfied,” “neither satisfied or dissatisfied,” “dissatisfied,” or “very dissatisfied”). consistent with other studies (o’connell et al., 1999), preliminary analysis revealed that few respondents reported any degree of dissatisfaction. consequently, the variable was recoded into three categories as follows: “very dissatisfied/dissatisfied/neither satisfied or dissatisfied,” “satisfied,” and “very satisfied” (alang & mcalpine, 2020, 2019; lippens & mackenzie, 2011). helpfulness was measured with the following item: “did the spiritual advisor help you a lot, some, a little, or not at all?” few respondents reported receiving little or no help. as was the case with the satisfaction measure, we followed common practice and collapsed the responses to create a new variable consisting of three categories: “not at all/ a little”, “some”, and “a lot” (alang & mcalpine, 2019, 2020; lippens & mackenzie, 2011). predictor variables the selection of predictor variables was based upon previous studies investigating the use of clergy in mental health service provision (kovess-masfety et al., 2010; wang et al., 2003). drawing from this work, the demographic predictors included in the present study consisted of sex, age, race/ethnicity (non-hispanic white, black, hispanic), education level (less than high school, high school, some college, college graduate), employment status (employed, unemployed/not in labor force), marital status (married/cohabiting, divorced/separated/widowed, never married), and geographic region (northeast, midwest, south, west). religious salience indicators included: frequency of attending religious services (never, less than once a month, one to three times per month, about once a week, more than advances in social work, fall 2020, 20(3) 783 once a week), and the importance of one’s religious beliefs (not at all important, not very important, somewhat important, very important). we calculated a sum score of religious salience by adding the standardized attendance frequency and the standardized rating of religious importance. analysis all univariate tests and ordered logit models were conducted using stata v14. univariate analysis was used to answer the first and second research questions, specifically, by examining the responses to the questions about clients’ perceptions of satisfaction with, and helpfulness of, clergy provided mental health services. ordinal logit regression models were used to answer the third and fourth research questions regarding predictors of satisfaction and helpfulness. multinomial and generalized ordered logit models were used as robustness checks. these robustness-check models confirmed the findings for both ordinal logit models. we also ran the model predicted probabilities based on average marginal effects. average marginal effects compute the marginal effect of the predicted coefficients for each observation at its observed values and then computes the average of these effects (long & freese, 2014). the authors conducted diagnostic tests to ensure the assumptions of ordered logit regression were not violated. they assessed multicollinearity using the variance inflation factor (vif) and pairwise correlations. the mean vif was 1.19 and none of the pairwise correlations were above the .6 cutoff. these values suggest that multicollinearity was not problematic (kutner et al., 2004). we assessed the parallel lines assumption or proportional odds assumption using the brant test (long & freese, 2014). the results were not significant, indicating we could assume the relationship between all pairs of groups was the same. results sample description table 1 presents the demographic characteristics of the sample (n=204). respondents were mostly female (n=144, 70.6%), white (n=151, 74.0%), employed (n=139, 68.1%), and married/cohabiting (n=100, 49.0%). about one-third of respondents resided in the midwest (n=64, 31.4%), and in the south (n=66, 32.4%), while the rest lived in the northeast (n=31, 15.2%) and the west (n=43, 21.1%). ages ranged from 18 to 84 years, with a mean age of 38.1 years (sd=13.44 years). a majority attended at least some college (n=128, 62.7%), attended church services at least weekly (n=124, 60.7%), and viewed religious beliefs as very important (n=171, 83.8%). hooley et al./incorporating clergy 784 table 1. descriptive characteristics of sample (n=204) characteristic n (%) sex male 60 (29.4%) female 144 (70.6%) ethnicity white 151 (74.0%) black 31 (15.2%) hispanic 22 (10.8%) education level less than high school 25 (12.3%) high school graduate 51 (25.0%) some college 71 (34.8%) college graduate and above 57 (27.9%) employment status employed 139 (68.1%) unemployed or not in labor force 65 (31.9%) marital status married/cohabiting 100 (49.0%) divorced/separated/widow 49 (24.0%) never married 55 (27.0%) us geographic region northeast 31 (15.2%) midwest 64 (31.4%) south 66 (32.4%) west 43 (21.1%) religious services attendance never 14 (6.9%) less than once per month 31 (15.2%) 1-3 times per month 35 (17.2%) about once per week 67 (32.8%) more than once per week 57 (27.9%) importance of religious beliefs not at all important 1 (0.47%) not very important 9 (4.41%) somewhat important 23 (11.27%) very important 171 (83.82%) satisfaction with clergy-based mh care very dissatisfied, dissatisfied, neutral 16 (7.8%) satisfied 50 (24.5%) very satisfied 138 (67.7%) perceived helpfulness of clergy-based mh care not at all, a little 13 (6.3%) some 48 (23.5%) a lot 143 (70.1%) mean (sd) age (range 18 ~ 84) 38.1 (13.44) religious salience score (range -5.24 ~ 1.53) -0.003 (1.63) advances in social work, fall 2020, 20(3) 785 satisfaction and helpfulness of clergy-provided mental health services univariate analysis indicated our first and second hypotheses were supported. most respondents reported being either very satisfied (n=138, 67.7%) or satisfied (n=50, 24.5%). in other words, 92.2% (n=188) of respondents indicated some degree of satisfaction with the mental health services they received from clergy. similarly, most respondents reported the degree of helpfulness of clergy-delivered mental health services as “a lot” (n=143, 70.1%) or “some” (n=48, 23.5%). put differently, 93.6% (n=191) of respondents indicated the mental health services they received from clergy were helpful. table 2. differences in predicted probabilities and odds ratios of client satisfaction with clergy-delivered mental health services for selected groupsa (n=204) satisfaction with clergy-delivered mental health services odds ratio c characteristics dissatisfied satisfied very satisfied exp(b) all b 0.089 0.207 0.704 sex (female vs. male) 0.013 0.017 -0.029 0.837 age (every one standard deviation increase) -0.028t -0.041 0.069t 1.556 ethnicity black vs. white -0.082** -0.146* 0.229** 4.864* hispanic vs. white -0.069t -0.112* 0.180* 3.132t hispanic vs. black 0.014 0.034 -0.048 education level high school vs. less than high school 0.017 0.018 -0.035 0.832 some college vs. less than high school -0.020 -0.026 0.046 1.289 college vs. less than high school -0.063 -0.105 0.167 2.858 some college vs. high school -0.036 -0.045 0.081 college vs. high school -0.079 -0.123* 0.202t college vs some college -0.043 -0.078 0.121 employment status employed vs. unemployed/not in labor force -0.034 -0.042 0.075 1.556 marital status divorced/widowed vs. married -0.021 -0.026 0.048 1.332 never married vs. married -0.025 -0.033 0.058 1.423 never married vs. divorced/widowed -0.004 -0.006 0.010 u.s. geographic region midwest vs. northeast 0.058 0.078 -0.136 0.426 south vs. northeast 0.068t 0.087 -0.155 0.383 west vs. northeast -0.014 -0.027 0.041 1.374 south vs. midwest 0.010 0.010 -0.019 west vs. midwest -0.072 -0.104t 0.177t west vs. south -0.082* -0.114* 0.196* religious salience score (every one standard deviation increase) -0.035* -0.055** 0.090** 1.816** a predictions based on estimated coefficients of the ordered logit model, calculated as average marginal effects. b average predicted probabilities of all sample participants. c indicator variables odds ratio is exp (b), continuous variables odds ratio based on one std1 deviation increase. tp<.10, *p<.05, **p<.01, ***p<.001 hooley et al./incorporating clergy 786 satisfaction ordinal logit we modeled the first ordered logit regression with perceived satisfaction as the dependent variable (χ2 =38.47, df =14, p=.0004). the pseudo r2 suggested that the predictors in the model explained 11.3% of the variance. the odds ratios and average marginal effects of the weighted ordered logit model are shown in table 2. in keeping with our expectations, race/ethnicity and religious salience were significant predictors of satisfaction. the odds ratios of black versus white and hispanic versus white are estimated as 4.864 (p<0.05) and 3.132 (p<0.10). this means the odds of rating “very satisfied” versus the combined outcomes of “satisfied” and “very dissatisfied/ dissatisfied/ neutral” are 4.864 and 3.132 times higher for black and hispanic participants relative to their white counterparts. the difference between hispanic and white participants was only significant at a non-traditional, trend level (i.e., <0.10 instead of < 0.05). as for religious salience, the odds ratio is estimated as 1.816 (p<0.01). this means the odds of rating “very satisfied” versus the combined outcomes of “satisfied” and “very dissatisfied/ dissatisfied/ neutral” are 1.816 times higher for participants as their religious salience score (a sum score of standardized religious attendance and religious importance) increases by one-standard deviation (1.63 units). this outcome suggests our third hypothesis was supported. helpfulness ordinal logit we modeled the second ordered logit regression with perceived helpfulness as the dependent variable (χ2 =33.68, df =14, p=.0023). the pseudo r2 suggested that the predictors in the model explained 10.5% of the variance. table 3 presents odds ratios and average marginal effects of the weighted ordered logit model. consistent with our expectations, race/ethnicity, age, and religious salience were significant predictors of helpfulness. the odds ratios for black versus white and hispanic versus white are respectively estimated as 3.390 (p<0.10) and 5.117 (p<0.05). this means the odds of rating “a lot” versus the combined outcomes of “some” and “not at all/ little” are 3.39 times higher for black participants and 5.12 times higher for hispanic participants relative to their white counterparts. the difference between black and white participants was only significant at a non-traditional, trend level (i.e., <0.10 instead of < 0.05). the odds ratio of age is estimated as 1.623 (p<0.05), meaning the odds of rating “a lot” versus the combined outcomes of “some” and “not at all/ little” are 1.623 times higher for participants with each one-standard deviation (13.4 years) increase in age. religious salience was also a significant predictor of helpfulness. the odds ratio for this predictor is estimated as 1.582 (p<0.01). this means the odds of rating “a lot” versus the combined outcomes of “some” and “not at all/ little” are 1.582 times higher for participants as their religious salience score (a sum score of standardized religious attendance and religious importance) increased by one-standard deviation (1.63 units). accordingly, our fourth hypothesis was supported. advances in social work, fall 2020, 20(3) 787 table 3. differences in predicted probabilities and odds ratios of perceived helpfulness of clergy-delivered mental health services for selected groupsa (n=204) helpfulness of clergy-delivered mental health services odds ratioc characteristics not at all/ little some a lot exp(b) allb 0.077 0.221 0.702 sex (female vs. male) 0.031 0.056 -0.087 0.596 age (every one standard deviation increase) -0.026* -0.050* 0.076** 1.623* ethnicity black vs. white -0.064* -0.130* 0.195* 3.390t hispanic vs. white -0.075* -0.164** 0.239** 5.117* hispanic vs. black -0.011 -0.034 0.044 education level high school vs. less than high school -0.005 -0.007 0.012 1.060 some college vs. less than high school -0.039 -0.062 0.101 1.701 college vs. less than high school -0.066 -0.126 t 0.193t 3.055t some college vs. high school -0.034 -0.055 0.089 college vs. high school -0.061 -0.119 0.181 college vs some college -0.028 -0.064 0.092 employment status employed vs. unemployed/not in labor force -0.032 -0.052 0.084 1.606 marital status divorced/widowed vs. married -0.026 -0.042 0.068 1.483 never married vs. married -0.033 -0.054 0.087 1.671 never married vs. divorced/widowed -0.007 -0.012 0.019 u.s. geographic region midwest vs. northeast 0.016 0.030 -0.045 0.756 south vs. northeast 0.023 0.042 -0.065 0.674 west vs. northeast 0.025 0.045 -0.070 0.655 south vs. midwest 0.007 0.012 -0.020 west vs. midwest 0.009 0.015 -0.025 west vs. south 0.002 0.003 -0.005 religious salience score (every one standard deviation increase) -0.025* -0.048** 0.073** 1.582** a predictions based on estimated coefficients of the ordered logit model, calculated as average marginal effects. b average predicted probabilities of all sample participants. c indicator variables odds ratio is exp (b), continuous variables odds ratio based on one std. deviation increase. t p<.10, *p<.05, **p<.01, ***p<.001 discussion the treatment gap for mental illnesses is among the highest in the larger health sector (trautmann et al., 2016). this has led to calls to scale-up care (chisholm et al., 2016). in light of the shortages that exist among the professional mental health workforce (health resources and services administration, 2016), the who (2008) and other organizations have suggested using task-shifting as one option to address this emerging crisis. this study examined the suitability of using clergy to scale-up mental health service provision by measuring clients’ perceptions of satisfaction with, and the helpfulness of, clergy-delivered hooley et al./incorporating clergy 788 mental health services. unless clients are satisfied with the services they receive and view them as helpful, it makes little sense to consider clergy as candidates for task-shifting. consistent with our hypotheses, individuals who received mental health services from clergy were likely to find it satisfying and helpful. approximately 92% of respondents reported that they were either very satisfied (68%) or satisfied (24%) with the services. similarly, 94% of respondents reported the services helped them some (24%) or a lot (70%). racial and ethnic minorities, older adults, and individuals for whom religion was more salient were particularly likely to report the mental health services they received from clergy were helpful. these findings are consistent with prior research (payne, 2014; wang et al., 2003, 2006; weaver et al., 2003). this study also investigated the determinants of perceived satisfaction and helpfulness of clergy-delivered mental health services by conducting a cross-group comparison. prior research has found that racial and ethnic minorities generally find clergy-delivered mental health services to be satisfying (john & williams, 2013; neighbors et al., 1998). for the broader population, overall levels of perceived helpfulness and satisfaction with other mental health professionals is similar to those for clergy (e.g., harris et al., 2020; lippens & mackenzie, 2011). in some cases, levels of perceived helpfulness of clergy are higher than some professional categories (kuramoto-crawford et al., 2015). this work confirms this finding and extends it by illustrating that some racial and ethnic minorities—namely individuals in the black and hispanic communities—are more likely to find the services satisfying or helpful than their white counterparts. this finding has important implications for addressing health disparities in mental health service provision. implications for mental health service provision in the present study, the groups who were more likely to find clergy-delivered mental health services satisfactory and helpful are typically underserved by mental health professionals (puyat et al., 2016; wang et al., 2006). blacks, hispanics, and other racial and ethnic minorities are particularly disadvantaged when it comes to obtaining mental health services, as they frequently have less access to mental health services and are less likely to receive quality care (lukachko et al., 2015; mcguire & miranda, 2008). similarly, older adults have low use of mental health care, partially due to the discomfort associated with seeking formal mental health services (byers et al., 2012). older individuals tend to have shrinking networks of social support, resulting in increased reliance on informal systems of care that exist outside of the formal mental health system (wrzus et al., 2013). vulnerable populations may be especially likely to benefit from clergy-provided services since the services often circumvent the barriers that inhibit the receipt of traditional mental health care (vanderwaal et al., 2012). approaching a clergy person for support does not typically carry the stigma that deters many from seeking mental health treatment from traditional venues (payne, 2009, 2014). for example, older adults may already be embedded in a congregational context in which seeing clergy is normative. in addition, the costs for usual services can impede many from receiving care (payne, 2014). clergy generally do not charge fees for their services (payne, 2009). therefore, receiving help advances in social work, fall 2020, 20(3) 789 from clergy is less stigmatizing, more affordable, and individuals often have a shared cultural connection with the provider (vanderwaal et al., 2012). there have been calls for increased collaboration between clergy and mental health providers to overcome years of distrust (aten & worthington, 2009; breuninger et al., 2014; sullivan et al., 2014). commentators have noted that collaboration can be mutually beneficial (oppenheimer et al., 2004). some clergy feel they are well-positioned to treat mental illness (hedman, 2014; payne, 2014), seeing mental health education as an expression of their vocation (hedman, 2014), while others who feel less qualified may still be willing to counsel individuals with mental illness (farrell & goebert, 2008). attitudes towards referring clients vary, with some clergy willing to refer clients for professional care while others are hesitant (ali & milstein, 2012; pillion et al., 2012). while progress has been made (breuninger et al., 2014; sullivan et al., 2014), historically, psychotherapists have been far less willing to refer clients to clergy for spiritual help (oppenheimer et al., 2004). notwithstanding the important role clergy could play in mental health service scale-up efforts, additional facets of their service should also be considered. for example, serving as a clergy person is taxing and may lead to burnout (jackson-jordan, 2013). adding mental health service tasks without commensurate support could lead to further depletion of clergy. another pertinent issue is training. knowledge about mental illness among clergy varies widely (vermaas et al., 2017). many clergy have expressed interest in mental health-related training, and initial studies have found that even brief training can increase clergies’ sense of competence in dealing with mental health issues (chevalier et al., 2015; payne, 2014). questions remain, however, about how much training should be required (payne, 2014). as is the case with all scale-up efforts, infrastructural challenges exist concerning incorporating clergy. historical barriers exist between the mental health establishment and many religious institutions, which require addressing (queener & martin, 2001; weaver et al., 2003). questions also exist about what sort of tasks would best fit clergy, what supervision structures/capacity are necessary to support the execution of those tasks, and how social workers might participate in this process. implications for social work in theory, social workers are well-positioned to collaborate with clergy in the process of implementing task-shifting (williams et al., 2014). many social workers are already embedded in congregations (garland & yancey, 2014). in some cases, congregations employ social workers along with clergy (lehmacher, 1997). these congregationallybased social workers are perhaps ideally situated to facilitate linkages between the profession and clergy. also significant, are the growing number of social work programs offering msw students the opportunity to obtain a joint master of divinity degree (muehlhausen, 2010). such dual degree graduates may also be uniquely equipped to broker task-shifting arrangements. more specifically, these and other social workers might provide clergy education, training, and supervision, while engaging with faith communities to raise hooley et al./incorporating clergy 790 awareness and reduce stigma regarding mental health challenges (vanderwaal et al., 2012; williams et al., 2014). it is important to note, however, that task-shifting is not a panacea and unresolved issues remain regarding social work participation in this process. some clients may wish to see clergy due to the distinct set of spiritually-informed services they offer. furthermore, individuals for whom religious salience is a key dimension of their identities may be hesitant to work with traditional mental health professionals due to concerns about the providers’ lack of religious competency (oxhandler et al., 2015. as alluded to above, antireligious bias (hodge, 2007; thyer & myers, 2009), as well as racial bias (corley & young, 2018), has been documented in the social work profession. this may help explain why members of the black community are disproportionately likely to avoid seeking professional help due to concerns about lack of respect for their religious beliefs (boorstin & schlachter, 2000). another challenge pertains to what might be called turf sharing. for task-shifting to function effectively, mutual respect needs to exist between clergy members and social workers. accordingly, it is critical that social workers engage with clergy as equal partners in the task of helping people struggling with mental health challenges. toward this end, adopting an approach grounded in cultural humility can help social workers to build bridges with clergy (gottlieb, 2020). despite these potential challenges, the larger umbrella of the u.s. mental health care system might be strengthened if social workers and clergy develop professional relationships that are meaningful, bidirectional, and intentional. these collaborative relationships might take many forms. for example, they could include training clergy in foundational mental health approaches such as motivational interviewing; clergy-delivered training to mental health providers on culturally-responsive practices with people of faith; partnered care delivery with clergy and other providers addressing different components of care; embedding clinical practitioners in churches and clergy in clinics; or, cofacilitation of treatment groups and community workshops. the permutations of possible collaborations are vast. perhaps most importantly, collaboration between social workers and clergy would potentially aid in the provision of more affordable, culturally-sensitive mental health care for marginalized populations. limitations this study’s contributions should be interpreted in the context of the following limitations. first, the study dataset provides a nationally representative snapshot of mental health service use; but the ncs-r was not specifically designed to assess clergy-delivered services. as such, the generalizability of the findings may be uncertain. ideally, our findings might be validated using samples comprised solely of recipients of clergydelivered mental health services. nonetheless, using a subset of nationally representative surveys to explore questions on religion and mental health service use is a common practice (kovess-masfety et al., 2010; lukachko et al., 2015; nguyen et al., 2020). in theory, such a subset should be nationally representative of the underlying group, in this case, people who obtained mental health services from clergy during the prior year (babbie, 2016). advances in social work, fall 2020, 20(3) 791 the results of the current study need to be interpreted with caution because of the small sample size. for instance, it is possible that individuals who are older, less-educated, racial or ethnic minorities, and male were underrepresented in our study due to error associated with small sizes. although the ncs-r is still in wide use, it is important to note that roughly 20 years have transpired since the data were collected. it is possible that perceptions concerning clergy-provided mental health service have changed over the intervening years (pew research center, 2019). another limitation involves the nature of self-selection. to be included in our study, individuals needed to endorse receiving mental health services from clergy in the past 12 months. endorsing such an item implies respondents recognized their need for services and viewed clergy as addressing that need. it is possible other individuals had the same mental health needs and received similar services from clergy, but did not consider it a mental health service. the ncs-r survey item that asked about the receipt of mental health services featured a list of traditional mental health service providers (e.g., social workers, psychiatrists, psychologists) along with clergy. this list hopefully primed respondents to consider potential mental health services they may have received from clergy. however, it is possible that they viewed their interactions with clergy differently from the other listed professionals due to the spiritual vocation of clergy. alternatively, some individuals may have experienced clergy-delivered support as unhelpful, but did not report it. another potential limitation is the use of single items to determine perceived satisfaction and helpfulness. ideally, multi-item measures would have been used to measure these constructs. however, single item measures have been used in mental health services research (lippens & mackenzie, 2011), and researchers are finding increasing utility in single item measures (ahmad et al., 2014). this suggests some degree of confidence in the findings is warranted. conclusion this study examined the suitability of including clergy as providers in mental health scale-up plans based on the perceived satisfaction and helpfulness of their services. using a nationally representative dataset allowed for cross-group comparisons which adds to the current literature on clergy-delivered mental health care. nearly all the clients found clergy-delivered mental health care satisfying (92%) and helpful (94%), particularly racial and ethnic minorities, older adults, and individuals for whom religious salience is an important dimension of their identities. given the percentage of people who turn to clergy for mental health services, clergy could be a substantial resource for scaling-up mental health care (young et al., 2003) especially for blacks, hispanics, and older adults. given that members of these communities have traditionally been underserved in the mainstream mental health system, the results can potentially play an important role in reducing mental health disparities. several questions remain about the role of clergy in mental health service scale-up efforts that future research might examine. the extant research outlines clergy attitudes towards mental illness, their willingness to provide care, and referral practices. conversely, much less is known about how large, public mental health systems can meaningfully hooley et al./incorporating clergy 792 incorporate clergy in scale-up efforts. historically, clergy and mental health professionals have operated largely in parallel and disconnected tracks. additional research on the best ways of leveraging these parallel systems of care is needed. areas of exploration include: how clergy can be supported in their gate-keeping functions, how to support clergy involved in direct counseling efforts (e.g., training and supervision structures), the degree to which clergy training should include mental health topics, congregant attitudes towards seeking help from clergy with subjects taboo to their religion, how the mental health system can better refer clients to their religious leaders and communities, best practices for engaging and retaining cross-discipline partnerships, and how to ensure safety and quality care. additional research is needed on the nature of clergy-delivered mental health services. for example, relatively little is known about the specific practices clergy employ (content of the care), the “dosage” of care they provide, the 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(2013). social network changes and life events across the life span: a meta-analysis. psychological bulletin, 139(1), 53-80. https://doi.org/10.1037/a0028601 young, j. l., griffith, e. e. h., & williams, d. r. (2003). the integral role of pastoral counseling by african-american clergy in community mental health. psychiatric services, 54(5), 688-692. https://doi.org/10.1176/appi.ps.54.5.688 author note: address correspondence to cole hooley, phd, lcsw, school of social work, brigham young university, 2166 jfsb, provo, ut, 84602. email: cole_hooley@byu.edu funding: funding for this project came in part from the generosity of the national institute of mental health under grant t32 mh019960 data availability statement: data for this study came from the publicly available national comorbidity survey replication. the data are managed by the inter-university consortium for political and social research (icpsr). https://doi.org/10.1080/00981389.2014.880391 https://doi.org/10.1176/appi.ps.201600457 https://www.who.int/healthsystems/ttr-taskshifting.pdf?ua=1 https://doi.org/10.1002/jclp.20760 https://doi.org/10.1037/a0028601 https://doi.org/10.1176/appi.ps.54.5.688 mailto:cole_hooley@byu.edu methods sample variables analysis results sample description satisfaction and helpfulness of clergy-provided mental health services satisfaction ordinal logit helpfulness ordinal logit discussion implications for mental health service provision implications for social work limitations conclusion references funding: funding for this project came in part from the generosity of the national institute of mental health under grant t32 mh019960 data availability statement: data for this study came from the publicly available national comorbidity survey replication. the data are managed by the inter-university consortium for political and social research (icpsr). this work is licensed under a creative commons attribution 4.0 international license. working with refugees in the u.s.: trauma-informed and structurally competent social work approaches jason ostrander alysse melville s. megan berthold abstract: social workers, government, and non-governmental organizations in the united states have been inadequately prepared to address the impact of trauma faced by refugees fleeing persecution. compounding their initial trauma experiences, refugees often undergo further traumatic migration experiences and challenges after resettlement that can have long-lasting effects on their health and mental health. micro and macro social work practitioners must understand the impact of these experiences in order to promote policies, social work training, and clinical practice that further the health and well-being of refugees and society. social workers are in a unique position to provide multi-dimensional, structurally competent care and advocacy for diverse refugee populations. the experiences of cambodian refugees will be used to examine these issues. we will explore the benefits of an ecological perspective in guiding interventions that support refugees, and will apply the framework of structural competence to highlight multidimensional implications for social work with refugee populations. keywords: refugees; trauma; ecological perspective; structural competence of the 21.3 million refugees worldwide, more than 3.3 million (15.5%) have been resettled in the united states since 1975 (united nations high commissioner for refugees, 2016). refugees are individuals who were forcibly displaced from their home and across an international border due to conflict or persecution. a refugee is a person who, owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country. (un general assembly, 1951, article 1[a][2]) they flee seeking safety. oppression, discrimination, war, and other traumatic experiences are common (unhcr, 2016). as global crises continue, and the need for refugee resettlement grows, social workers must rise to address the unique needs of this population. the refugee experience does not simply begin upon entry in the host country, but instead is comprised of a “continuum of displacement, transition, and resettlement” (catolico, 2013). working with refugees requires an understanding of their pre-migration, migration, and post-migration trauma and other experiences (george, 2012). _____________________ jason ostrander, phd, msw is assistant professor, department of social work, sacred heart university, fairfield, ct 06825. alysse melville, msw, lsw is a phd student, school of social work, university of connecticut, hartford, ct 06103. s. megan berthold, phd, lcsw is associate professor & director of field education, school of social work, university of connecticut, hartford, ct 06103. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 66-79, doi: 10.18060/21282 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 67 pre-migration & transition many refugees have been forced into migration and resettlement due to exposure to violence and/or other traumas in their home country, including political violence, discrimination, child abuse, war, human trafficking or other human rights violations. refugees report high rates of torture, including witnessing torture of family members or others, physical beating, rape/sexual assault, and deprivation of food and water (hooberman, rosenfeld, lhewa, rasmussen, & keller, 2007). estimated rates of torture exposure reported by refugees living in the united states range from 21% (steel et al., 2009) to 44% (higson-smith, 2015). however, these numbers may underreport the true rate, in part due to stigma and fear associated with disclosure experienced by survivors. malnutrition is also a common pre-migration experience of refugee adults and children. a recent study of 982 refugee children aged 0 to 10 newly arrived in the united states found that 45% experienced at least one form of malnutrition (dawson-hahn, pak-gorstein, hoopes, & matheson, 2016). unfortunately, with a few notable exceptions (willard, rabin, & lawless, 2014), refugee screening upon arrival in the united states often does not include assessment of exposure to torture and other traumas pre-migration. only half of u.s. states reported providing any mental health screening to recently arrived refugees, and of those, less than half directly asked refugees about war trauma or torture exposure (shannon et al., 2012). this was despite the fact that refugees experience high rates of trauma during the premigration and transition experience. many communities do not offer culturally-appropriate and linguistically accessible services to treat trauma and torture in any or all of the refugee groups resettling in their area, a violation of refugee rights to adequate health care (united nations committee on economic, social and cultural rights, 2000). trauma in one’s home country is often not the sole adversity experienced during the process of refugee migration. poorer outcomes have been noted for refugees who are displaced into temporary or institutional accommodations, such as refugee camps, compared to those who are placed in permanent, private residences in the host country (porter & haslam, 2005; steel et al., 2009). many refugee camps have documented patterns of abuse, excessive force, inhumane treatment, health risks (including communicable disease and lead exposure), and other human rights violations (janmyr, 2014). resettlement issues that impact refugees upon resettlement include potential marginalization, socioeconomic disadvantage, acculturation difficulties, loss of cultural and social support, and cultural bereavement (porter & haslam, 2005). these issues must be considered as part of the migration experience. refugee families may resettle into temporary or unstable housing and face employment and financial stressors. in addition, studies of post-migration challenges that refugees in developed countries face have documented exposure to community violence (berthold, 2000), limited social networks (dharod, xin, morrison, young, & nsonwu, 2013), difficulty finding formal childcare (morantz, rousseau, banerji, martin, & heymann, 2013), and food-related challenges (dharod et al., 2013). ostrander et al./working with refugees 68 current federal support for refugees resettling in the united states covers health care, financial subsidies, case management services, english as a second language classes, and employment/job readiness services (office of refugee resettlement, 2016). as noted above, refugees may be screened in the states in which they resettle; however, the screening content (namely whether it includes physical and/or mental health screening) is at the discretion of state policies, and often is merely an informal, conversational screening, if any (shannon et al., 2012). benefits offered to refugees are limited to an 8-month period, after which only provisionary support is offered to those who qualify. as an acknowledgement of the high prevalence of torture experienced by refugees and asylum-seekers (and some other immigrants) in the united states, federal support is provided to agencies that deliver specialized services to torture survivors. the torture victims relief act (tvra) of 1998 recognizes the need that many torture survivors have for rehabilitation, and outlines the authorization of u.s. funding to provide treatment and social and legal services for torture-exposed refugees, research, as well as training to support health care providers working with these refugees (tvra, 2016). the services for survivors of torture program of the office of refugee resettlement provides approximately $10.5 million annually towards grants to agencies to provide traumainformed, holistic, and strengths-based services to torture survivors and their families to promote rehabilitation (orr, 2016). however, support for refugees varies significantly at the state level, with little consideration by federal agencies for the health needs of incoming refugees when deciding resettlement locations (agrawal & venkatesh, 2016). despite the efforts of the torture victims relief act, there are insufficient specialty clinics to serve all tortured refugees in need. u.s. social service systems often remain complex and difficult to navigate, and some torture survivors face eligibility restrictions for these programs, leading to difficulty accessing or paying for health care services (ku & matani, 2001; national consortium of torture treatment programs, 2015). this paper seeks to explore the experience of cambodian refugees in the united states more than three decades’ post-resettlement. this case study of a single refugee group will be used to better understand the ecological impact of the refugee experience, and to provide recommendations for practice, policy, and education for those working with and advocating for refugee populations. cambodian displacement &transition in refugee camps one of the largest genocides in the past century was perpetrated in cambodia from 1975-1979 by the khmer rouge. approximately 1.5 million cambodians died as a result of starvation or murder (kiernan, 2008). those who survived recounted high rates of trauma and torture, including near-death starvation, death threats, forced labor, the murder of family members or friends, and witnessing beatings and killings (marshall, schell, elliott, berthold, & chun, 2005; mollica, brooks, tor, lopes-cardozo, & silove, 2014; mollica et al., 1993). additionally, head trauma has been reported by those who survived the genocide, with prevalence rates documented as high as 18% (mollica et al., 1993). advances in social work, spring 2017, 18(1) 69 following the end of the pol pot regime in 1975, over 500,000 fled cambodia to be resettled in host countries (tasker, 1993). during the time of transition, many cambodians were settled temporarily in refugee or displaced persons camps. some cambodians spent many years in these thai-cambodian border camps, where reports of lack of food, water, shelter, and medical care were documented (mollica et al., 1993). those who survived the khmer rouge regime were more likely uneducated and unskilled laborers, and also more likely to be widowed women (kula & paik, 2016). while high rates of poor self-reported health, ptsd, and depression have been documented in cambodians in a thai-cambodian border camp (mollica et al., 1993), a number of protective factors, such as positive work status and economic activity, involvement in religious practices, and involvement in caretaking activities have also been identified (mollica, cui, mcinnes, & massagli, 2002). such protective factors would be valuable to promote in current refugee and displaced persons camps and in countries of resettlement. cambodian resettlement approximately 190,000 cambodian refugees resettled in the united states following the end of the pol pot regime (national cambodian american health initiative, 2007), with the highest numbers arriving between 1979 and 1986 (kula & paik, 2016). most had limited proficiency in english and were faced with restricted education and employment opportunities upon resettlement. coupled with the impact of their traumatic experiences, these factors compromised the early efforts of cambodian refugees at becoming selfsufficient. during initial resettlement, much of the support to the newly arriving cambodians came in the form of time-limited cash assistance from the office of refugee resettlement. cambodian mutual assistance associations (cmaas), community-based organizations founded in the 1980s to support acculturation and resettlement, provided grass-roots community support. the cmaas were staffed with cambodians and provided support in a number of areas, including medical translation, advocacy, family supports, and navigating social services (ncahi, 2007). in the 1990s, there were around 150 cmaas nationwide; however, decreases in federal policies that impacted refugee and immigrant communities resulted in increased difficulties for resettled cambodians as well as for the cmaas, which have since dwindled to approximately seven today (lu, 2016). once resettled in the united states, many cambodians experienced high rates of poverty and community violence (berthold, 2000; kula & paik, 2016; marshall et al., 2005). as noted above, cambodians resettling from thai-cambodian border camps also had documented rates of poor self-reported health, depression, ptsd, various somatic complaints, physical pain, and functional limitations (mollica et al., 1993). by 2014, the u.s. census had documented over 326,000 cambodian residents in the united states, of whom 51% were foreign-born (us census bureau, 2014). in recent years, documentation of health disparities in the cambodian community have proliferated. more than two decades after resettling in the united states, cambodians continue to experience high rates of past-year depression (51%) and ptsd (62%), much greater than the 7% and 3% rates for the same conditions found in the general u.s. population (marshall et al., 2005). comorbid ptsd and depression continued to be experienced by many cambodians three decades after resettling in the united states (berthold, kong, mollica, kuoch, scully, & ostrander et al./working with refugees 70 franke, 2014). additionally, cambodian refugees have disproportionate rates of selfreported poor health, compared to both the general population and other asian populations (wong et al., 2011), with higher than average rates of diabetes and cardiovascular risk factors (marshall, schell, wong, berthold, hambarsoomian, elliott, & gregg, 2016). the current poverty rate for cambodians is around 17.5%, a rate 2% higher than that of the general population and 5% higher than composite asian populations (us census bureau, 2014). a 2013 study of cambodian refugee women documented persistent high rates of household food insecurity, even two decades after resettlement (peterman, wilde, silka, bermudez, & rogers, 2013). those who resettled earlier (in the 1980s) reported greater persistent food insecurity than those who arrived later. additionally, over one-third of cambodians over 25 have less than a high school diploma (kula & paik, 2016), highlighting ongoing economic and educational disparities impacting the cambodian community. differential generational impacts have been observed between cambodians who resettled in the united states as adults, as young adults, and as young children, as well among their u.s. born offspring. cambodians in the united states have often found themselves trying to “straddle” different cultural systems, those that promote traditional cambodian values and those shaped by mainstream western values. many younger cambodians do not speak khmer well or at all, and are unable to communicate effectively with those from older generations, some of whom have limited english proficiency, thus limiting the cultural “passing down” of knowledge and sharing of experiences. despite these cultural challenges, cambodians have exhibited great resilience in creating new strategies and environments to respond to intergenerational conflict (lewis, 2010), such as the creation of programs to support intergenerational bonding through senior-youth engagement activities (yoshida, henkin, & lehrman, 2013). whole community models of intervention have been successfully used with cambodian refugees to address health and mental health disparities within the community (wagner, berthold, buckley, kuoch, & scully, 2015). these interventions are relationshipdriven, culturally-centered, and address physical-psychosocial-spiritual needs and engage community health workers as supports to clinical care. community health workers have served as a bridge between western services and cambodian refugees (lu, 2016). interventions that engage the community with a culturally-appropriate, strengths-based approach have included faith-based outreach by temples, churches, and other faith-based groups. these efforts combine health education outreach by faith communities, involvement of revered community elders, and transportation support. such wholecommunity interventions have proved beneficial in increasing communication between cambodian refugees and health care providers, medication compliance, and cultural competence in health care providers, and at the same time decreasing chronic disease symptoms (grigg-saito, och, liang, toof, & silka, 2008; grigg-saito et al., 2010; wagner et al., 2015). however, obtaining ongoing funding to sustain such community-driven interventions and securing buy-in from busy health care professionals may be a challenge to implementing whole community models for refugees. advances in social work, spring 2017, 18(1) 71 theoretical lens refugees and asylum-seekers continue to seek to enter or resettle in the united states as persecution persists and wars rage in countries such as syria, iraq, and afghanistan. ecological theory provides support for the importance of a multi-dimensional treatment approach by social workers serving refugees, and is a prominent and oft-cited theory in the social work literature (rotabi, 2007). this framework serves as a holistic theoretical approach to help understand and organize information about refugees and their sociopolitical environments in the united states. refugees and their families do not exist in isolation and are engaged in larger social systems, which intertwine with individuals and communities. bronfenbrenner’s (1979) ecological framework posits an interconnectedness between a person and his or her environment. in order to apply this framework to understand the experiences of refugees, we must conceptualize these refugees as embedded in an interactive multi-leveled system, which are separated into five nested subsystems consisting of the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. societal problems, such as poor health outcomes, family dynamics, community violence, unemployment, and language difficulties, fit well within this model (hepworth, rooney, rooney, strom-gottfried, & larsen, 2010). a structural competency approach is congruent with an ecological framework and can assist social workers to frame and organize the life experiences and multisystem forces, such as economic, political, and social determinants that impact refugees. metzl and hansen (2014) define structural competency "as the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases…also represent decisions about such matters as health care and food delivery systems, zoning laws, urban and rural ostrander et al./working with refugees 72 infrastructures” (p. 128). this approach has five intersecting skill sets: 1) recognizing how economic, physical, and socio-political structures shape clinical interactions (i.e., insurance companies dictating how long and what type of services they will cover); 2) developing clinical language to explain the impact of social environments on one's health (i.e., the effect racism has on cortisol levels); 3) understanding the importance of culture for different class and ethnic groups and recognizing how structural inequalities and barriers can manifest themselves as interpersonal communication and institutional practices; 4) understanding that structures, such as laws and policies, that shape health and illness are not immutable and can be altered through structural interventions (i.e., creation of an intervention program to address rural mental health needs); and 5) developing structural humility in order to hear and understand the nuances in individual clients stories (metzl & hansen, 2014). incorporating ecological theory and structural competency into practice will not only strengthen social workers’ understanding of the unique and potentially traumatic experiences of resettling refugees, but also the contextual factors that impact them daily in their new communities (e.g., neighborhood violence, the lack of culturally appropriate services). implications for social work it is incumbent upon social workers to understand the health statuses, psychosocial well-being, and challenges faced by refugee populations in the united states in order to promote appropriate policies, educate interdisciplinary health teams, and inform clinical social work practice. trauma-informed social workers do not ask refugees, “what’s wrong with you?” instead, they ask “what happened to you?” (substance abuse and mental health services administration, 2014). trauma-informed systems of care, framed by ecological theory, expand the focus of intervention from the therapeutic hour between a social work practitioner and refugee to encompass the broader agency and organizational systems as well as relevant structural factors in society. practice implications implementing a structural competency approach within a trauma-informed system of care provides social work practitioners with the tools to look beyond microsystem interactions (e.g., social worker and client) and encourages them to look more holistically at structural inequalities and social determinants (i.e., racism and discrimination) that shape and constrain an individual's experiences (metzl & hansen, 2014). this is reinforced by a human rights-based approach to clinical practice (berthold, 2015). social workers play a critical role in providing quality services to refugees in a variety of direct care positions, including as members of interdisciplinary teams. the nasw (2016) has recently supported such practice-based interventions through a recommendation in the standards for social work practice in health care settings manual, which recommends that assessment processes are customized for a number of vulnerable populations, including refugees. ways in which assessments may be adapted for refugees, however, are not explicitly outlined. when conducting assessments, social workers must ensure all facets of the refugee's life are evaluated, which cannot be limited to the present. rather, social work professionals must understand the interconnectedness and depth of the refugee's life journeys which advances in social work, spring 2017, 18(1) 73 include past experiences of trauma in his or her home country, during migration, and when resettling in the new host country (george, 2012). social workers must also be aware of the link between trauma exposure and health risks for refugee populations, and can provide psychoeducation to refugees as well as to providers in the different systems of care working with refugees. social workers should work with cultural humility (metzl & hansen, 2014) and determine if potential formal and informal natural supports such as immediate and/or extended family, places of worship, and other social networks can support a refugee during his or her resettlement process. educational implications given our global society, schools of social work should embed a broader understanding of the experiences of immigrants, asylum-seekers, and refugees into mandated course work. social workers are practicing in diverse settings (e.g., hospitals, schools, child welfare) where they are called to serve refugee populations. at present, u.s. social work programs are struggling to include this vital material as well as content on human rights (healy & wairire, 2014). schools of social work could play a significant role in training interdisciplinary healthcare teams and organizing and developing curricula framed by a structural competency approach. critical components could include content on the migration experience, health outcomes, trauma, trauma-informed systems of care, evidence-based intervention strategies, and policy objectives. in fact, the international federation of social workers (ifsw; 2012) has recommended that refugee studies, crosscultural practice, and access to specialized training in working with refugees and victims of torture and other traumas be implemented within current social work curricula. such curriculum could be helpful to social work students and practitioners, including healthcare professionals, when conducting trauma assessments and treatment planning with refugees (agbenyiga & huang, 2012). policy implications social workers have historically worked in the trenches with our nation’s most vulnerable populations and engaged in advancing human rights, social action, and social and economic justice. these concepts are embedded in the profession’s code of ethics (nasw, 2009) and educational requirements for social work program accreditation (cswe, 2015). refugees do not have the right to fully engage in the political system when they first arrive in the united states, which leaves them voiceless. to fill this void, private and non-profit partners can join with social workers as advocates and political partners to improve services and change laws and federal government policies affecting refugee populations. these coalitions could include churches, buddhist temples, mosques, and other faith-based organizations which traditionally have served as safe havens for many refugees and as a critical community support. as noted earlier, a fraction of states requires mandatory mental and physical health screenings of refugees and an even smaller proportion include screening questions relating to traumatic experiences. social work organizations should work with state and federal elected officials to implement mandatory screenings for all refugees at the time of arrival to assist with their successful resettlement. for example, willard, rabin, and lawless (2014) successfully used a short trauma and ostrander et al./working with refugees 74 torture screening tool with resettled iraqi refugees in utah. when thorough screenings are not conducted, refugees may not receive the services they require to promote their right to health and successfully integrate into their new home. of note, in 2016 president obama announced an increase in refugee admissions from 70,000 to 85,000 for fiscal year 2016 and to 100,000 for fiscal year 2017. however, at the time of this writing, president trump lowered the cap, by more than half, to 50,000 refugees, through the signing of executive orders which went into effect on june 29, 2017. the u.s. congress has not allocated the appropriate funding for services to meet the growing needs of refugees. these funds are necessary to help refugees rebuild their lives and to become productive citizens in their new homes. conclusion the nasw code of ethics (2009) mandates social workers to obtain education and information about issues pertaining to ethnic and cultural diversity, to not support or facilitate means of discrimination, and to work to prevent and eliminate such discrimination through social and political action. a policy statement on immigrants and refugees from nasw (2015) promotes social work education, practice and advocacy around global migration and refugee resettlement and supports policy changes that would better support various refugee groups, including families and children. likewise, ifsw (2012) supports practice models that involve robust participation of refugees during each stage of intervention and prevention, and advocates for social workers to be engaged in advocacy of refugee needs and rights in order to educate the general public, influence policies in government, as well as in different agencies. structural competence can support existing social work theories, such as ecological theory, in identifying skill sets that go beyond traditional cultural humility in working with trauma-exposed refugees. this article explored the experiences of cambodian refugees in order to highlight the various structural forces impacting one trauma-exposed refugee population. as the number of refugees resettling in the united states continues to rise, much can be learned from the long-term resettlement outcomes of cambodian refugees in the united states so that other more newly arriving refugee populations may be spared from experiencing some of the same preventable health and social problems. references agbényiga, d., & huang, l. 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(2013). strengthening intergenerational bonds in immigrant and refugee communities. philadelphia, pa: the intergenerational https://doi.org/10.1080/15562948.2012.674324 https://doi.org/10.1001/jama.2009.1132 http://www.refworld.org/docid/4538838d0.html http://www.refworld.org/docid/3be01b964.html http://www.unhcr.org/en-us/figures-at-a-glance.html http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=acs_14_1yr_s0201&prodtype=table http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=acs_14_1yr_s0201&prodtype=table https://doi.org/10.1007/s11892-015-0618-1 https://doi.org/10.1007/s10903-013-9817-5 https://doi.org/10.1007/s10903-010-9392-y advances in social work, spring 2017, 18(1) 79 center at temple university. retrieved from http://education.temple.edu/sites/education/files/uploads/misc/metlife1112_web.pdf author note: address correspondence to: jason ostrander, phd, msw, sacred heart university, department of social work, 5151 park ave, fairfield, ct 06825, ostranderj@sacredheart.edu http://education.temple.edu/sites/education/files/uploads/misc/metlife1112_web.pdf mailto:ostranderj@sacredheart.edu _______ cyndi amato, msw, assistant clinical professor, bsw program director, school of social work; shelley cohen konrad, phd, lcsw, fnap, professor, director school of social work, director center for excellence in collaborative education; lane w. clarke, phd, associate professor, education department; caryn husman, ms, otr/l, associate clinical professor, health, wellness and occupational studies program director; audrey bartholomew, phd, associate professor, chair of education department; caroline beals, ms, otr/l, assistant professor, department of occupational therapy, university of new england. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 473-496, doi: 10.18060/23654 this work is licensed under a creative commons attribution 4.0 international license. jumpstarting cross-discipline collaboration in undergraduate social work education cyndi amato shelley cohen konrad lane w. clarke caryn husman audrey bartholomew caroline beals abstract: this paper examines the integration of undergraduate teacher education students into interprofessional activities with social work and pre-occupational therapy undergraduates. like health professionals, school-based professionals work across disciplines daily and come together for critical decision-making on behalf of vulnerable and special needs students. although evidenced-based pedagogy in interprofessional education (ipe) has become common in graduate and professional health education, less is known about its implementation in undergraduate education and with non-health-related disciplines. this article describes a 2-year interprofessional undergraduate simulation project with social work, teacher education, and pre-occupational studies students working prospectively in a k-12 school setting. survey data found that students gained confidence in their disciplinary roles as well as in their abilities to communicate and collaborate effectively as a result of participation in the school-based simulation and related activities. the project highlighted the benefits of situating theory-driven undergraduate interprofessional learning in settings beyond healthcare and the need for developing assessment tools inclusive of undergraduates and relevant to a range of workforce environments. keywords: simulation, interprofessional education, collaboration, undergraduate social work education, occupational therapy interprofessional education (ipe) has become a common, evidence-based pedagogy in the education of health and social care professionals. interprofessional education is defined as when students from two or more professions participate in interactive, shared learning opportunities with the goal of improving future collaborative practice in a host of settings (world health organization, 2010). when to infuse interprofessional practice competencies into curriculum is still a subject of debate; however, there is a body of literature suggesting that the earlier students are introduced to ipe, the more engaged they become with collaborative learning throughout their educational programs (pardue, 2013; ruebling et al., 2014). early cross-professional opportunities foster students’ relational confidence, a key attribute of communication and team-based skills. frequent interprofessional interaction through curricular and extracurricular activities promotes a https://creativecommons.org/licenses/by/4.0/ amato et al./jumpstarting cross-discipline collab 474 culture of psychological safety, which is the belief that one can offer ideas, alternative perspectives or risk making a mistake without fear of negative repercussion. studies indicate that health professions students’ early zeal for teamwork and collaboration ebbs over the course of their education (pardue, 2013; ruebling et al., 2014). students engaged in interprofessional interaction throughout their studies particularly immersive activities relevant to their future practice maintain positivity about their skills for collaborative practice and teamwork (mcfadyen et al., 2010; pardue, 2013). the importance of interprofessional health professions education is well-validated (gray et al., 2015; howell & cleary, 2001; johnson, 2017). large-scale reviews examining the effectiveness of ipe offer evidence for improved team-based and communication skills, confidence, collegiality, and mutual respect amongst students. a growing body of findings indicate that those exposed to ipe are better prepared for team-based collaborative practice (cohen konrad et al., 2017; cox et al., 2016). in 2016, the national interprofessional education collaborative published an update of its 2011 collaborative competencies report broadening its reach “to work together across disciplines, organizations, and sectors on innovative strategies to improve population health” (ipec, 2016, p. 4). ipec’s expansion of team membership opened opportunities for teacher educators, among others, to engage in collaborative learning across fields beyond healthcare. though the benefits of ipe have been supported in academic literature, full integration into health professions curriculum has been slow to develop. formal training is commonly conducted in academic silos with knowledge, skills, attitudes, and approaches reflective of single-discipline perspectives. although such pedagogy is necessary for learners to hone their unique professional skills, absence of instruction in collaborative practice leaves graduates underprepared for the contemporary team-based workplace. undergraduate training for disciplines outside of the health professions is similarly uniprofessional with little or no curriculum devoted to intersectional roles and responsibilities. for k-12 teachers, who interact with multiple fields of practice in schools and other educational environments, lack of collaborative learning opportunities leaves a gap in their formal training. collaborative learning opportunities at our university are well integrated into social work and occupational therapy (ot) curriculum but are just emerging in teacher training curriculum and practice. opportunities to advance student collaborative learning in preparation for work in school-related settings are vast given the varying professionals employed to attend to increasingly complex student needs (e. g. teachers, social workers, occupational therapists, school nurses, psychological examiners, speech and language practitioners, and system administrators). to be effective in contemporary public education, teachers need wide-ranging skills as well as appreciation for the impacts of adversity and sociocultural factors on children’s learning (mcmahon et al., 2012). collaborative learning alerts future teachers to the collaborative capacities of other professionals, including social workers and ots who are often employed within school settings (stone & charles, 2018). this paper describes benefits, challenges, and theoretical insights learned from a twoyear undergraduate interprofessional simulation project that brought together social work, advances in social work, summer 2020, 20(2) 475 pre-occupational therapy, and teacher education students. we detail the context and integration of selected learning theories and how these and critical teaching methods incorporate ipec (2016) competencies while simultaneously meeting each professions’ accreditation standards and ethical codes (see table 1). exemplars of student activities and case scenarios will be offered to illustrate the implementation of cross-disciplinary learning and its benefits and challenges. the paper will conclude with a discussion of recommendations and implications for undergraduate collaborative shared learning organized around common educational goals that aim to improve the greater good. interprofessional competencies and learning theories the u.s. interprofessional education collaborative (ipec) articulates foundational competencies for collaborative practice considered relevant to be an effective member of any team in any setting. competencies focus on how best practice is conducted across content areas. ipec collaborative competencies include: competency 1: values and ethics for interprofessional practice; competency 2: knowledge of other’s roles and responsibilities; competency 3: interprofessional communication and competency; and 4: teams and teamwork (ipec, 2016). according to reeves and hean (2013), collaborative learning models generally reflect a blend of education, relational, and social engagement theories to achieve desired educational outcomes. kolb’s (1984) experiential learning theory, a 4-tier scaffolded learning process, is a useful and relevant framework to guide design of ipe undergraduate experiences. the first tier, concrete experience, begins with the presentation of new material. the second tier, reflective observation, has students individually and collectively observe and ponder new material from a critical standpoint. tier three, abstract conceptualization, prompts students to be curious about new material, asking questions within the confines of a psychologically safe learning environment. the final tier, active experimentation, has students applying their new learning in direct, simulated or real-world activities. attitudinal change instigated through affective learning is another critical component of interprofessional education. students enter health, social care, and other fields of practice with presumptions and stereotypes about other professions and future clients, and the problems they face. contact hypothesis theory (hewstone & brown, 1986) informs pedagogy aimed at changing attitudes and opening channels of active interchange, curiosity, and iterative learning. facilitation of experiential inquiry is critical to creating an environment of mutual respect and trust. relational learning theory informs the context in which students from varying backgrounds and disciplines learn with and from each other. according to browning and solomon (2006), relational learning methods attend to how information is shared and transformed. learning activities are designed so that students have opportunities to practice together, tolerate differences, apply diverse knowledge to problem-solve, and then build capacities to address and manage ethical dilemmas and difficult encounters. within a relational learning paradigm, collaborative competencies are readily translated into learning outcomes as they promote mutual respect, responsive and reflective practice, and amato et al./jumpstarting cross-discipline collab 476 person-centered care. cultural humility is a critical aspect of relational learning. browning and solomon (2006) describe cultural humility as willingness to place a foot in both worlds – the world of the patient/client/family as well as the worlds of differing workplace disciplines. altogether, these learning theories informed the interprofessional simulation project aligning it with overarching principles of collaborative practice. they provided a coherent framework for designing, implementing and assessing undergraduate learning activities. they guided the development of a collaborative learning environment where students felt safe to make mistakes, address differences, deal with complexities, and learn how to effectively communicate with others. social work students collaborative learning opportunities introduce bachelor’s in social work (bsw) students to elements of interprofessional inquiry, collaborative generalist practice, teamwork, and exposure to disciplines they will encounter in future workplace settings. paraphrasing bronstein (2003), interdisciplinary and collaborative learning promotes the achievement of goals that cannot be reached when individual disciplines act solely on their own. for bsw students, learning with other disciplines enriches foundational knowledge and builds skills for integrated micro, mezzo, and macro practice. the national association of social work (nasw) code of ethics delineates social workers’ ethical obligation to cross-professional cooperative, respectful, and collaborative exchange to fully serve the best interests and needs of clients (nasw, 2017). principles inherent in both the national association of social workers (nasw, 2017) and the international federation of social workers (ifsw, 2018) code of ethics empower social workers to be collaborative practitioners, maintain ethical responsibilities to colleagues, and transcend disciplinary boundaries. the ipec (2016) core competencies complement social work’s ethical standards by identifying the obligation to work together across all levels of practice. specific to the school setting, the nasw (2012) school social work standards empowers school social workers to be leaders in “developing a positive school climate” while working collaboratively with administration, colleagues, families, and others to “increase accessibility and effectiveness of services” (p. 13). experiential interprofessional opportunities elevate student’s understanding of how communication and collaboration enhances the quality of life of their clients. social work education emphasizes the intersectional nature of human problems and thus the implicit need for interdisciplinary, cross-sector collaboration. yet while in principle social workers value “interdisciplinary collaboration and multidisciplinary practices, they are rarely paired with other professions in the classroom or intentionally taught about counterparts’ roles and expertise over the course of their baccalaureate and graduate education” (rubin et al., 2017, p. 4). according to rubin and colleagues (2017), “ipec core competencies resonate with the vision of social work education and the core learning outcomes prescribed for students” (p. 20). they align with the tenets of generalist social work education and conform to the commission on accreditation (coa) of the advances in social work, summer 2020, 20(2) 477 council on social work education’s (cswe, 2015) nine education policy and accreditation standards (epas) competencies (cswe, 2015). wedding integrating these core competencies in the generalist social work curriculum ensures quality and continuous improvement of accredited social work programs. epas competency 1 and ipec competency 1 (values/ethics for interprofessional practice) deepen social work students’ understanding of their responsibility to engage in ethical and professional behavior in their coursework and in the field. they reinforce social work as a value-based profession, one that elevates human dignity and calls upon social workers’ ethical responsibility to challenge barriers to social inclusion. the key tenets of cultural responsiveness are woven throughout ipec’s core competencies aligning with epas competency 2 which engages students in learning about diversity and difference, asking them to reflect upon assumptions that impede effective service and disrupts the formation of healthy, productive cross-professional collaboration. epas 8 explicitly addresses the critical nature of building skills for collaborative social work practice. it identifies comparable competencies to those cited by ipec and emphasizes the value and “importance of interprofessional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary, interprofessional, and inter-organizational collaboration” (cswe, 2015, p. 9). curriculum inclusive of these ideals teaches students critical skills for health-promotion and equitable care. pre-occupational therapy students the american council for occupational therapy education (acote) and the american occupational therapy association (aota) goals and ethics similarly align with ipec (2016) core competencies. like social work epas competency 8, acote standard b requires ot programs to prepare students to understand the roles and responsibilities of other team members and navigate team dynamics to provide patient and population-centered care (aota, 2018). ot philosophy is consistent with ipe’s foundation in person/patient-centered care. aota recognizes that ot practitioners must be prepared to collaborate across professions to provide high quality services (aota, 2015). respect for human dignity, diversity and difference is at the core of ot’s professional code of ethics (coe, aota, 2015). mutual respect is an ethical standard for practice inclusive of clients, families, populations, and other professions. in combination, ot accreditation standards and their coe conforms to the principles and aims of ipec’s core competencies, seeking commonalities across ethics, values, skills, and practices. ipe methodology is steadily emerging within the field of graduate-level ot professional training with documented benefits, including improvement in role clarification (halle et al., 2019; mellor et al., 2013; shoemaker et al., 2014), increased value for the contributions of other professionals, and teamwork (morrell et al., 2018; moyers et al., 2014). undergraduates who plan to pursue a professional ot degree, however, have limited ipe opportunities to develop foundational collaborative practice attitudes and skills. amato et al./jumpstarting cross-discipline collab 478 ot curricula is required to integrate learning opportunities that facilitate both understanding and active application of interprofessional collaborative skills (aota, 2015). contact hypothesis theory (hewstone & brown, 1986) offers useful guidance as it calls for scaffolded exposure to experiential learning opportunities that specifically target novice learners’ learning levels, cognitive development and nascent professional identities. ot faculty systematically increase students’ engagement with collaborative competencies through thoughtful exposure, repetition, assessment, and application of collaborative encounters, building students’ disciplinary confidence and their teamwork skills. in educational settings, ot’s facilitate academic success by ameliorating developmental and organizational challenges faced by children with and without disabilities (aota, 2011). they consult with teachers to adapt curriculum and technology to effectively produce student learning. according to pardue (2013), undergraduate ipe learning for pre-occupational therapy students “imparts an academic foundation whereby ipe learning contributes to future graduate study” (p. 98). teacher education students integration of interprofessional core competencies for collaborative practice is equally important for teacher education curriculum, yet, unlike the other two professions, teacher education does not use ipe competencies. however, in practice, teachers communicate across disciplines, particularly as members of pupil evaluation and other problem-solving teams. teachers collaborate with parents, community and social service personnel, law enforcement, and a range of health professionals to ensure that students are receiving appropriate education, especially those who have disabilities and medical and behavioral health conditions (d’agastino, 2013). according to mcmahon and colleagues (2012), an effective teacher in today’s educational climate requires skills and understanding of how to work within a professional community—much like a health professional. these authors emphasize the importance of training teachers to work in community and collaborative settings with colleagues from a range of professions and disciplines. while interprofessional education is not specifically named in teacher education accreditation standards, collaborative approaches are validated by the interstate teacher assessment and support consortium standards. (intasc, council of chief state school officers [ccsto], 2013). many of these standards incorporate the ideals of the ipec (2016) competencies, and collaboration with professionals, families, communities and learners is threaded throughout the document. the introduction to the intasc standards, a “new vision of teaching and improved student achievement,” articulates a less isolated expectation for teachers “just as collaboration among learners improves student learning, we know that collaboration among teachers improves practice (ccsto, 2013, p. 4). standard 10, leadership and collaboration, specifically links teaching to interdisciplinary practice, stating that “the teacher seeks appropriate leadership roles and opportunities to take responsibility for student learning, to collaborate with learners, families, colleagues, other school professionals, and community members to ensure learner growth, and to advance the profession” (ccsto, p. 45). knowledge and application of interprofessional competencies have much to offer future teachers who will naturally interact with other professional fields of practice to improve children’s academic and behavioral success. advances in social work, summer 2020, 20(2) 479 preparing teachers with strengths in teamwork, self-efficacy, communication, problemsolving, and shared decision-making is compatible with the values of the education profession. despite the many ways in which teachers are called upon to collaborate with others, teacher education has yet to adopt ipe competencies or cross-professional methods as common pedagogical practice. a study was conducted in 2019 to learn whether k-12 personnel had exposure to interprofessional collaborative concepts in their preparatory education (clark et al., 2019). it found that school personnel understand interprofessional collaboration to be valuable for student success, effective teaching, and improvements in school culture. yet, while teachers recognize the benefits of integrated, collaborative practice in education, few school personnel receive explicit continuing education or training in teamwork competencies and ipe is absent from teacher education curriculum (clark et al., 2019). research investigating interprofessional content and methodologies in teacher education points to its advantages. interprofessional shared learning experiences have been shown to improve the preparation and quality of teaching for both typical and atypically developing students (kaufman & ireland, 2016). this important finding acknowledges the increasingly complex academic, emotional, and social needs of students and their families. theories that guide interprofessional learning, for example relational learning (browning & solomon, 2006) and contact hypothesis theories (hewstone & brown, 1986) address the critical nature of having students explore uncertainty, complexity, and ethical quandaries such as how teachers can meet these complex needs. guidance from these theories facilitates meaningful, cross-perspectival experiences whereby future educators encounter vexing problems within the safety net of a collaborative learning environment. implementing ipe in undergraduate education there is continuing debate as to the best time to introduce students to interprofessional collaborative learning. novice learners typically have little knowledge of their chosen field of practice and likely little or no exposure to clinical experience. without prior professional experience, ipe core competencies may seem abstract; students want to learn the nuts and bolts of their profession, not elusive concepts or ‘soft skills’ (oandasan & reeves, 2005). many feel they already know how to be on teams, having been involved in team-based sports or other group activities. on the other side of the debate, proponents of early introduction to ipe view it as a pathway to building necessary skills that will mature as students advance in their studies (pardue et al., 2018). regardless of professional identity, ipe competencies promote productive and respectful communication that benefits the classroom and students’ overall performance. further, learning with diverse classmates sets the stage for reducing stereotypes and common misunderstandings of the roles that others will play on future teams. amato et al./jumpstarting cross-discipline collab 480 table 1. disciplinary competencies for interdisciplinary practice ipec competency social work (cswe, 2015) occupational therapy (aota, 2018) education standards (intasc, 2013)) competency 1: values and ethics for interprofessional practice epas 1: demonstrate ethical and professional behavior: social workers understand the value base of the profession and its ethical standards. social workers understand the role of other professions when engaged in interprofessional teams. acote standard b.1.5: demonstrate an understanding of the ethical and practical considerations that affect the health and wellness needs of those who are experiencing or are at risk for social injustice, occupational deprivation, and disparity in the receipt of services. intasc standard 9 9(o): the teacher understands the expectations of the profession including codes of ethics, professional standards of practice, and relevant law and policy. competency 2: knowledge of other’s roles and responsibilities epas 8: intervene with individuals, families, groups, organizations, and communities. social workers value the importance of interprofessional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary, interprofessional, and inter-organizational collaboration. acote standard b.4.28: develop a plan for discharge from occupational therapy services in collaboration with the client and members of the interprofessional team by reviewing the needs of the client, caregiver, family, and significant others; available resources; and discharge environment. intasc standard 10 10(l): the teacher understands schools as organizations within a historical, cultural, political, and social context and knows how to work with others across the system to support learners. competency 3: interprofessional communication epas 8: intervene with individuals, families, groups, organizations, and communities: social workers value the importance of inter professional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary, interprofessional, and interorganizational collaboration. acote b.5.21 effectively communicate and work interprofessionally with those who provide services to individuals, organizations, and/or populations in order to clarify each member’s responsibility in executing an intervention plan. intasc standard 10 10(n): the teacher knows how to work with other adults and has developed skills in collaborative interaction appropriate for both face-to face and virtual contexts. competency 4: teams and teamwork epas 8: intervene with individuals, families, groups, organizations, and communities: social workers value the importance of inter professional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary, interprofessional, and inter-organizational collaboration. acote standard b.4.25: demonstrate knowledge of the principles of interprofessional team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patientand population-centered care as well as population health programs and policies that are safe, timely, efficient, effective, and equitable. intasc standard 10 10(e): working with school colleagues, the teacher builds ongoing connections with community resources to enhance student learning and wellbeing. advances in social work, summer 2020, 20(2) 481 tenets from adult learning theory (hewstone & brown, 1986; kolb, 1984) offer a tiered approach that prepares students for learning together. it supports a developmental learning process, one that addresses cognitive readiness and promotes experiential, relational, and interactive teaching methods. undergraduates are most familiar with lecture-style, single-discipline teaching methods and so the transition to more active engagement with students and faculty outside of their discipline can be challenging. undergraduates are in the formative stages of forging their professional identities and respond more favorably to active collaborative learning relevant to their own life experiences (oandasan & reeves, 2005). ipe facilitation motivates students to learn about teamwork and associated competencies, and then learn “by doing” through activity-based experiences (snyman & geldenhuys, 2019). it fosters students’ self-confidence as they build their professional identities while simultaneously gaining skills to be productive members of present and future teams (labrague et al., 2018; lockeman et al., 2017). faculty model and facilitate respectful communication and collaboration making it psychologically safe for students to be curious and critically explore each other’s views and beliefs. in the process, students observe how other disciplines conceptualize and achieve common goals, noting how roles are similar, complementary, and distinctive from one another. students then apply what they have observed in active learning, for example, in simulated case studies. simulation bridges classroom and experiential learning and is recommended as a modality for teaching interprofessional collaborative competencies (labrague et al., 2018). interprofessional simulation is specifically designed to engage students from two or more disciplines in an interactive experience based on relevant content and common learning outcomes (decker et al., 2015). simulation affords students opportunities to enact roles and responsibilities based on scripted case scenarios with actors and other methods employing many of the principles of good practice in undergraduate education, including active learning and cooperation among students (chickering & gamson, 1987). case-based simulation is commonly used with graduate-level and professional students; less is known about the use of simulation with undergraduates. emerging literature, however, has shown that undergraduate students participating in ipe simulation develop foundational communication skills, gain understanding of the cross-professional team, and build reflective and analytical skills (hardisty et al., 2019). framing ipe experiences conceptually as a starting point for skill development justifies early exposure to collaborative learning. when successful, students bring what they learn from introductory ipe activities into other experiential learning experiences, learn to communicate effectively, respect others, and value alternative perspectives. this benefits all educational experiences, offering a strong argument for early exposure to interprofessional experiences. undergraduate interprofessional simulation project social work, pre-occupational therapy, and teacher education students were introduced to ipec competencies through a shared interprofessional simulation project (isp). faculty collectively developed isp content, activities, and learning objectives based on adult amato et al./jumpstarting cross-discipline collab 482 learning theories and ipe study findings. learning objectives included: demonstration of cross-professional communication, use of collaborative teamwork skills, and recognition of the benefits and challenges of interprofessional practice. faculty prompted students to be critical thinkers using disciplinary and interdisciplinary communication skills, and cultural responsiveness to assess the needs and challenges of the student, family, and school system. the multi-step experience included: (a) classroom instruction on the topics of interprofessional education and communication and collaboration; (b) viewing a video of an exemplar interprofessional practice situation between the three professions (year two only); (c) introduction of the case study that would be the basis for the live simulation, including discipline specific instruction; (d) day-of-simulation activities, including an icebreaker and a pre-planning meeting among the disciplines; and (e) participation in the simulated meeting with the parent. case scenarios were designed with students’ cognitive development and learning levels in mind, each based upon a school-based scenario. case studies integrated social determinants of health, calling students’ attention to issues of diversity, economic disparities, and access to school and community resources within familial and community contexts. the case of brian below illustrates a scenario used for the simulation sessions: brian, a 15-year-old biracial cisgender boy was diagnosed with mild autism at age three (3). before a move, he lived in a racially and economically diverse community. his current school is in a mostly white, affluent district where there are high academic and extracurricular expectations and where parents are apprehensive to acknowledge their children’s learning difficulties. being a biracial youth with autism has made it very difficult for brian to fit into his new environment. early in his transition, brian’s mother, lori, reached out to advocate for her son’s special needs. she provided case files from the previous school district to the special education teacher, occupational therapist, and social worker. a meeting was scheduled for lori to meet with these three professionals. students first worked within their discipline to discuss relevant information and then in interdisciplinary teams to discuss and prepare for the scheduled simulated meeting with the parent. students were asked to discuss and reflect upon brian’s situation, their roles in working with him and his family, share thoughts about how to effectively communicate with brian, the family and each other, and to ultimately develop an intervention plan. the isp culminated in a live simulation with an actor playing lori, brian’s mother, and debrief with students of the collaborative team. the ipe simulation project used a team-based learning (tbl) model. central to tbl is the design of cases that require effort to address the complexity and context of people’s circumstances (hrynchak & batty, 2012). since the simulation was intended for undergraduates the case was set at moderate complexity to facilitate student success. team goals included: (a) setting collaborative priorities, (b) addressing ethical and logistical dilemmas, (c) identifying sociocultural and personal factors that affect care plans, and (d) devising a viable team-based plan of intervention. for faculty, the simulation offered a venue to observe and evaluate students’ proficiencies in these nascent areas of practice. advances in social work, summer 2020, 20(2) 483 for students, it provided an experience to gain a foundational “real life” understanding of the communication and collaboration skills required to engage in interprofessional practice. prior to the day of the isp activity, students in each of the professions were given the common case study, along with discipline-specific information, supporting materials as well as relevant readings and resources. the goal of this pre-isp activity was to build students’ confidence in their disciplinary knowledge and identity. to illustrate, social work students were provided information about the availability of school and community resources, as well as child and family history collected by the child’s previous school social worker. pre-occupational therapy and education students were also provided information relevant to their roles in the school setting. isp students discussed the case scenario with their classmates and course instructor in advance of the simulation. in the first year, collaborative activities were scaffolded according to kolb’s (1984) experiential tiers throughout the semester. following kolb’s guidance, instruction began in the classroom with didactics introducing the ipec competencies and the intentions of interprofessional practice (tier one). next, students employed reflective observation to ponder the case scenario to reflect on from a critical standpoint (tier two). faculty then encouraged students to critically expand their understanding of the case scenario and discuss strategies with classmates and the course instructor from the perspective of their discipline (tier three). the simulation engaged students in active experimentation and application of new knowledge (tier four). it added elements of relational learning (browning & solomon, 2006) whereby students were actively engaged in learning with and from each other, practicing together, tolerating differences and applying shared and diverse knowledge to problem-solve and make decisions together. immediately following the simulation, students debriefed the isp with classmates and faculty using this opportunity to reflect upon their experience and observations. it concluded with students being sent an electronic recording of the team meeting and asked to complete two measures: (1) a self-assessment using the collaboration self-assessment tool (csat; ofstedal & dahlberg, 2009); and (2) a self-designed interprofessional education perceptions questionnaire, both of which were administered as a pretest measures in their respective classrooms. a post-project survey was also administered. the csat and the self-designed questionnaire were subsequently replaced in year two with the interprofessional collaborator assessment rubric (icar) tool (curran et al., 2011). the second year followed a similar trajectory with slight changes in pedagogy and assessment based on feedback from the students’ first-year evaluations. in addition to the tiered preparatory activities, students were shown a case scenario video in their disciplinespecific classes, one that was different from the selected case study used in the live simulation. the video showed a parent-school meeting between a social worker, teacher, and occupational therapist acted out by faculty with an actor playing the role of the parent. the purpose of this activity was twofold: first, it showed faculty modelling interprofessional competencies to address students lack of clinical experience to reference; second, it introduced students to the interprofessional collaborator assessment (icar) amato et al./jumpstarting cross-discipline collab 484 (curran et al., 2011). the students used the icar to rate the professionals depicted in the faculty-led video as a way to bring familiarity with the tool as they complete it as a selfassessment following their participation in the live simulation. method a mixed methods approach was used to assess isp outcomes. the university institutional review board approved the project for the two-year period it was conducted. in year 1, two quantitative assessment tools, the c-sat (ofstedal & dahlberg, 2009) and a self-designed interprofessional education perceptions tool were used. in year 2, the icar (curran et al., 2011) was used to evaluate undergraduate student’s perception of competencies in areas of communication and collaboration. both years, a post-project survey was administered to students. overarching questions included: (1) does early participation in an interprofessional simulation influence undergraduate students’ selfassessment of their ability to collaborate and communicate?; and (2) how does early participation in an interprofessional simulation influence undergraduate students’ understanding of interprofessional practice and its importance? recruitment students (n=72) were recruited from social work, pre-occupational therapy, and teacher education in their sophomore year of study. in year 1, there were 10 surveyed groups, each with 4 students, with a total of 40 students; in year 2, there were 8 surveyed groups, each with 4 students, with a total of 32 students. isp participation was a course requirement integrated into the curriculum for all disciplines. participants were randomly assigned to survey groups composed of at least one representative from each discipline. data collection in the first year, data were collected from two quantitative assessment tools, the csat (ofstedal & dahlberg, 2009) and a self-designed tool to measure interprofessional education perceptions. qualitative and quantitative data were collected via a post-project survey developed by the faculty (see addendum). the post-project survey was a qualitative measure using open-ended questions and likert scale ratings to assess communication and collaboration skills and students’ understanding of interprofessional practice. in year 2, quantitative data were collected with the icar (curran et al., 2011), a competency-based rubric that assesses performance in communication, collaboration, roles and responsibilities, collaborative patient/family centered approach, and conflict management during interprofessional encounters (curran et al., 2011). this tool was chosen for its interprofessional focus and because the subtests could be used separately. for the purposes of the isp, only the communication and collaboration subtests were used. year 2 students also completed the post-project survey, which was revised slightly to align with the icar instrument subtests of collaboration and communication. to address the anticipated inflation of students’ self-assessment, the icar was introduced to students after they viewed the video of a school-based interprofessional team meeting with a parent acted out by a paid actor and faculty with several years of practice advances in social work, summer 2020, 20(2) 485 experience. this video modeled a team meeting, which students could use as a reference to more accurately assess their own ability after participating in the live simulation. instead of the pre/post-test study design, faculty decided to review videos of the student team meetings and rate them using the icar which would then be used as a comparison to students’ self-assessment. difficulty in scoring arose when the faculty could not reach consensus on how to define the rating scale criteria used in the icar (i.e., minimal, developing, competent, mastery). the central question was whether to rate at students from the interprofessional skill level they should possess at this early stage of development or from a much more refined stage where mastery in their disciplinary field could be demonstrated. this discrepancy was not anticipated and because a shared understanding of the criteria could not be reached, the data were not analyzed as intended. data analysis in year 1, students rated their perception of collaboration by completing pre and posttests before and after the simulation. a significance level of .05 was used to measure the difference in the pre and post-test scores. in year 2, students rated perception of collaboration and communication via the icar. the following represents the average icar scores of students’ self-assessment following the live simulation and demonstrates their inflated self-efficacy in the areas rated. a scale of 1-4 is used on the icar with 4 representing “mastery”: (1) respectful communication included three subsets with average scores between 3.17-3.41; (2) communication strategies included 4 subsets with average scores between 2.65 and 3.35; (3) collaborative relationship had 1 subset with an average score of 3.38; (4) integration of information from others had 1 subset with an average score of 3.03; and (5) information sharing included 2 subsets with an average score between 3.06 and 3.08. figure 1. change in perception of communication and collaboration 36% 61% 3% 31% 61% 8% 0% 20% 40% 60% 80% 100% changed a little bit changed a lot changed drastically year 1 year 2 amato et al./jumpstarting cross-discipline collab 486 students each completed a post-project survey consisting of likert scale and openended questions via an online survey tool. data culled from the likert scale questions showed 61.11% of students in year 1 (y1) and 61.0% of students in year 2 (y2) believed that their perception of communication and collaboration “changed a lot.” of students reporting, 2.7% (y1) and 8.5% (y2) believe their perception of communication and collaboration “changed drastically.” see figure 1. qualitative analysis utilized coding, descriptive analysis, and thematic analysis of the data related to the central ideas, or codes extracted from the data collection (atkinson, 2005). survey results were analyzed using a process of thematic analysis completed by three of the team members. the project team independently reviewed student responses to the open-ended questions and grouped responses by similar content. next, the project team convened to compare their individual analysis, organize the responses, and analyze the response groups for codes. the student responses were then coded and used to develop themes that answered the two overarching questions that drove this project. see table 2. themes that emerged from the students' comments related to question 1: “does early participation in an interprofessional simulation influence undergraduate students’ selfassessment of their ability to collaborate and communicate?” included: (1) increased confidence in the ability to communicate and collaborate; and (2) recognition of skills needed to communicate and collaborate effectively. themes that emerged related to question 2: “how does early participation in an interprofessional simulation influence undergraduate students’ understanding of interprofessional practice and its importance?” reflected the following: (1) recognition of benefits of interprofessional practice; and (2) clarified understanding of roles. table 2. qualitative themes regarding communication and interprofessionalism question 1: does early participation in an interprofessional simulation influence undergraduate students’ selfassessment of their ability to communicate and collaborate. theme exemplar(s) increased confidence in the ability to communicate and collaborate • this experience really helped me to work on my collaboration and communication skills by making me feel much more confident and comfortable with expressing my ideas/opinions and maintaining good listening skills, such as active listening and eye contact. • i think that prior to this simulation i was too nervous to speak up alone. during this experience i was able to speak confidently knowing that i was part of a team who could back me up if i choked up. recognition of skills needed to communicate and collaborate • i feel that my ability to collaborate with professionals in other fields has improved by being put in a situation where we need to lean on one another and be open to other perspectives in order to complete a task (in this case, the meeting). • i realized how important it is to communicate clearly and effectively. it's also important to incorporate the other health professionals and (that) the parents/students be involved in the conversation. advances in social work, summer 2020, 20(2) 487 question 2: how does early participation in an interprofessional simulation influence undergraduate students’ understanding of interprofessional practice and its importance? recognition of benefits of interprofessional collaboration • i think having the time to plan the meeting with other people and then carry out the plan was very beneficial. • i learned that you have to work within a team in order to complete a goal. i also learned that since we are working towards a common goal, that it is essential for professionals to work together. i do not think anything would be accomplished if the different professions did not work together. clarified understanding of roles • this experience showed me the role of other professionals and the role of my profession and how we can all work together for a common goal. • i think this experience helped me to see the various ways different professions interact with each other and how important this is. the information i was given was very different from the other team members and when we discussed this, it revealed a lot more about [simulation student] than i knew. it is important for everyone to share what they know and collaborate in order to develop a plan that is going to work for him. • i think it is important working with other professions because a lot of people are not able to work in other professions until they are in their field. so, getting that experience we sort of got a head start. • the idea of using information from each profession was very insightful. before the simulation i had no idea of what a social worker could offer to a student with autism and i learned a lot about how we could work together using the child's interests. limitations because of the unique combination of education, social work, and ot in the school setting, it was challenging to identify a tool to measure school-related collaborative competencies for this specific group of undergraduate students. one limitation was that the quantitative self-assessment tools used, the c-sat, self-designed interprofessional perceptions questionnaire and icar, were designed for graduate level education and the health care setting. during year 1 of the project, the c-sat, a validated assessment tool, was used to assess communication and collaboration and the self-designed interprofessional perceptions questionnaire was used to assess the students’ perceptions of ipe. the team was aware that a self-designed assessment tool could not be validated and the data would not be reliable, however it was used to gain insight into the impact the activities had on students’ interprofessional education perceptions. a deeper analysis of the c-sat results raised questions of the reliability because (1) it was normed on a graduate population, (2) high measures were likely the results of students’ inflated self-efficacy, (3) undergraduates are at the beginning stages of this type of collaboration, and (4) this single incidence was their only experience participating in a collaborative interprofessional activity. in year 2, the icar was selected because its adaptable subtests allowed for targeted assessment of the project aims. the communication and collaboration perception subtests were selected as measures as they closely aligned with the isp setting, goals, and our undergraduate population. analysis of the data again raised concerns regarding the developmental stage of undergraduates' professional growth and ability to self-assess. for amato et al./jumpstarting cross-discipline collab 488 example, the icar uses a 4-point scale, with 4 representing mastery and average scores on all subsets were between 2.65 and 3.38. many students rated themselves higher than seemed reasonable in these domains. according to other studies, this finding is not unusual (pardue, 2013; ruebling et al., 2014). the post-project qualitative survey tool was designed for the isp project and thus poses a limitation as it cannot be generalized to other undergraduate simulation activities or to other populations of students. further, it was only administered post activity and therefore changes in attitudes and behaviors cannot be effectively measured. despite the perceived and practical limitations of the quantitative and qualitative assessment instruments, the pedagogical updates to year 2 offered positive steps towards identifying methods for teaching students to observe and evaluate the skills of interprofessional teams, and understanding of undergraduate interprofessional learning in the future. discussion the use of interprofessional simulation in undergraduate education is gaining momentum, though research validating its outcomes are sparse. this project explored how early participation in the isp influenced undergraduate students’ self-assessment of their ability to collaborate and communicate across disciplines, and their understanding of interprofessional practice and its importance in their chosen fields. collaborative learning with social work, teacher education, and pre-occupational therapy students is relatively unique, as ipe has historically focused on student preparation in healthcare at the graduate level. the 2016 ipec update encouraged the expansion of intentional team preparation to fields beyond healthcare underscoring the intersectionality of practices necessary to improve overall health. the report states its aims “.... to prepare professionals in health and other fields … for professional activities that impact population health, and to work together across disciplines, organizations, and sectors on innovative strategies to improve population health.” (ipec, 2016, p. 7). the simulation immersed students in a learning activity where they were asked to actively listen, gather information, and then strategize ways to address the client’s needs. student discussion was guided by interprofessional facilitation methods, kolb’s four tier experiential adult learning model, and elements of contact hypothesis and relational theories (browning & solomon, 2006; hewstone & brown, 1986; hrynchak & batty, 2012; kolb, 1984; reeves & hean, 2013). faculty prompted students to engage in casebased critical and contextual thinking inclusive of the values and roles of their professions. they were further directed to consider the attitudes and skills needed for teamwork and for building relationships with each other. student comments in the post-simulation survey demonstrated a burgeoning understanding of collaborative practice and its complexities. students gained a deeper understanding of how effective communication is inextricably connected to successful collaboration and an appreciation for the distinct roles and perspectives of their future discipline, and that of others. they were also inspired by the opportunity to collaborate advances in social work, summer 2020, 20(2) 489 through ipe practices early on in their education; likely increasing trust in the educational process and engagement in future ipe endeavors. the use of an intentional, scaffolded approach to the live simulation activity was essential given that undergraduate students have little if any understanding of their own profession, let alone how professionals in other fields interact with and rely on others. but undergraduates certainly know about teamwork, most of them having participated in sports, band, and other activities that require a coordinated team effort. offering this opportunity early in students’ progression allows them to draw upon what they already know about success and failure in teamwork and creates a foundation for understanding the broader concept of collaboration. although students consistently overestimate their team prowess, gaining confidence in their individual and collaborative expertise has its fair share of benefits. introductory collaborative learning experiences, especially for those at the beginning of their undergraduate professional programs, should be viewed as the starting point for future learning activities. as one isp student stated: “the experience taught me important and effective communication skills that a textbook simply can't teach.” another student referred to their isp experience as getting a “head start” on learning to work collaboratively across professions. the relational aspect of the experience was highly valued. students felt supported by each other and comfortable asking questions, risking critique, and learning from each other, key aspects of browning and solomon’s (2006) relational learning model. for generalist social work students, the isp fulfilled cswe’s requirement to demonstrate competence “in real or simulated practice activities situations” (cswe, 2015). levels of competency build over time as new concepts are continually introduced throughout the curriculum giving students multiple opportunities to achieve epas competencies in preparation of interprofessional and interdisciplinary practice. social work students’ reflective practices complement knowledge increasing their affective learning capacities. like social work, ots practice across clinical and community settings working in interprofessional and interdisciplinary teams. however, most interprofessional learning in social work and pre-occupational therapy curriculum focuses on clinically-based medical case scenarios, not situations encountered in community-based settings such as schools. there remains limited research on the benefits and challenges of these common collaborations (bose & hinojosa, 2008). moreover, institutions housing these health professions have not capitalized on learning opportunities that would significantly improve teamwork in schools, within special education, and in other educational settings. to be effective practitioners, ots, social workers, and educators need more exposure to each other’s roles and responsibilities and to specific training that incorporates interprofessional competencies. implications implications derived from this two-year interprofessional simulation project apply to both research and higher education. longitudinal studies looking at the benefits and challenges of introducing undergraduates to ipe pedagogy would be a logical next step. amato et al./jumpstarting cross-discipline collab 490 we suggest that undergraduate and graduate ipe experiences in non-health-related collaborative learning environments be explored. specifically, opportunities to create and evaluate collaborative learning opportunities with students in professions like social work, ot, and teacher education who naturally work together in k-12 settings should be taken. creation of continuing education and training for teacher education teams in interprofessional collaboration is recommended to support interventions addressing the intersectional and complex needs of children, families, and communities. this work represents a new frontier for infusing collaborative competencies and practices in school settings and other fields where professions work together. measurement tools that are reflective of undergraduate collaborative competency and those specific to fields outside of healthcare, for example school settings, corrections facilities, and childcare, need further exploration and development. instruments inclusive of the roles and responsibilities within these environments would improve the validity of data gathered from studies like the isp and conforms to the intentions of the revised 2016 u.s. ipec core competencies. conclusion the merriam-webster (2020) definition of jumpstart speaks to imparting fresh and renewed energy to something that needs a boost. it utilizes the language of connection as a source of reenergizing something that may be suffering from overuse or in need of revival. the isp provided fresh energy to undergraduate engagement in collaborative learning through experiential, simulated activities. it provided important insight and experience with an intentionally designed, multi-tiered, theory-informed interprofessional learning experience. most student participants found the isp positively changed their initial perceptions of collaboration and communication. students encountered the rigors of engaging in collaborative practice and gained confidence in their disciplinary and collaborative abilities. overall, they described the isp as a productive, pre-clinical learning experience that gave them early insight into “what it's like working with other professionals.” ipe promotes connected learning to improve knowledge, skills, and attitudes with the long-term goal that these assets are fully actualized when students graduate into their professional lives. the author team agrees with 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(2014). virtual patient care: an interprofessional education approach for physician assistant, physical therapy, and occupational therapy students. journal of interprofessional care, 28(4), 365-367. https://doi.org/10.3109/13561820.2014.891978 snyman, s., & geldenhuys, m. (2019). exposing an interprofessional class of first years to an underserved community contributed to students’ contextualisation of the determinants of health. journal of interprofessional care, 33(3), 280-290. https://doi.org/10.1080/13561820.2019.1566219 stone, s. i., & charles, j. (2018). conceptualizing the problems and possibilities of interprofessional collaboration in schools. children and schools, 40(3), 185-192. https://doi.org/10.1093/cs/cdy011 world health organization. (2010). framework for action on interprofessional education and collaborative practice. https://apps.who.int/iris/handle/10665/70185 author note: address correspondence to cyndi amato, school of social work, university of new england, decary 410, me 04005. email: camato@une.edu https://doi.org/10.1080/13561820500083550 https://doi.org/10.1080/10901020802668043 https://doi.org/10.3109/13561820.2012.721815 https://doi.org/10.1891/9780826140142.0008 https://doi.org/10.3109/13561820.2013.751293 http://dx.doi.org/10.1080/02615479.2017.1363174 https://doi.org/10.3109/13561820.2013.829421 https://doi.org/10.3109/13561820.2014.891978 https://doi.org/10.1080/13561820.2019.1566219 https://doi.org/10.1093/cs/cdy011 https://apps.who.int/iris/handle/10665/70185 mailto:camato@une.edu advances in social work, summer 2020, 20(2) 495 appendix. post project survey questions – years one and two year one survey year two survey • please indicate your academic major • please indicate your class level • did you watch the video of your simulation meetings (preconference and meeting with parent)? • do you think this interprofessional experience changed your ability to collaborate and communicate? o not changed at all o changed a little bit o changed a lot o changed drastically • please describe how you think your ability to collaborate with professionals in other fields has changed. • do you think this simulation experience changed your perceptions of interprofessional practice? o not changed at all o changed a little bit o changed a lot o changed drastically • please describe how you think your perceptions of interprofessional practice have changed. • did this simulation help you... o develop a deeper understanding of your own professional role o understand the roles of other professions o increase your comfort and skill in communication o learn to be a respected team member o gain confidence in collaborating across disciplines ▪ not at all ▪ somewhat ▪ yes ▪ absolutely • please indicate your academic major • please indicate your class level • do you think this interprofessional experience changed your ability to collaborate and communicate? o not changed at all o changed a little bit o changed a lot o changed drastically • did the activities in this experience help you... o improve your respectful communication skills? o acquire and/or improve effective communication strategies? o develop collaborative relationships? o integrate information shared by others? o share information with others? • if you think this experience helped change your skills, perceptions, values of ipe in other ways, please describe them here. if not, leave this blank. • do you think this simulation experience changed your perceptions of interprofessional practice? o not changed at all o changed a little bit o changed a lot o changed drastically • did the activities in this experience help you... o understand the value of interprofessional teams including improving services for students and reducing costs? o understand the role of you and your peers on an interprofessional team? o enhance your educational experience and ability to work on an interprofessional team? o believe students from different educational-related fields should be educated to establish collaborative relationships? ▪ did not help amato et al./jumpstarting cross-discipline collab 496 • how interested would you be in participating in this type of simulation experience again? o not at all interested o somewhat interested o interested o absolutely interested • how important do you think it is for other students in your same course of study to participate in this simulation experience? o not at all important o somewhat important o important o very important • any other comments that you would like to share with us? ▪ somewhat helped ▪ helped a lot ▪ i already had this skill/knowledge/viewpoint • if you think this experience helped change your communication and collaboration skills in other ways, please describe them here. if not, leave this blank. • consider how your skills have improved as a result of this experience. please indicate how valuable you found each part of the experience. o mini lecture on ipe o mini lecture on communication and collaboration o watching the simulated meetings on video o discussion of the case study ahead of simulation o simulation experience o watching your own video and reflecting on your communication and collaboration skills ▪ not valuable at all ▪ somewhat valuable ▪ very valuable • how important do you think it is for other students in your same course of study to participate in this simulation experience? o not at all important o somewhat important o important o very important • please indicate if you participated in the simulation experience last year. • if you have participated in the experience before, did you find it helpful to participate in it again? • please elaborate on why you found participating in the experience again helpful or not. • how interested would you be in participating in this type of simulation experience again? • any other comments that you would like to share with us? _______ joe kozakiewicz, jd, lmsw, clinical assistant professor, director of chance at childhood program; delanie pope, jd, clinical assistant professor, chance at childhood staff attorney; kimberly battjes, lmsw, senior clinical instructor, program coordinator of chance at childhood program, michigan state university, east lansing, mi 48826. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 300-319, doi: 10.18060/23658 this work is licensed under a creative commons attribution 4.0 international license. michigan state university’s chance at childhood program: interprofessional social work/law education, field practice, and community-based advocacy joe kozakiewicz delanie pope kimberly battjes abstract: a key component of all graduate level social work programs is the field-based educational experience designed to provide students the opportunity to practice while under the supervision of both a field-based mentor and a faculty member within the school. social work programs must develop and maintain ties with organizations and agencies within the community to facilitate a wide variety of options for students. separately, social work schools are increasingly developing relationships with other professional schools, most often with law schools, to allow students to study from an interprofessional perspective. in this article, the authors review existing literature regarding social work interprofessional education, focusing on law and social work. the authors will describe michigan state university’s school of social work chance at childhood program, designed to train future social workers and lawyers from an interprofessional perspective in the classroom, in the field, and in a variety of community-based advocacy projects. finally, the authors will discuss the results of preliminary research efforts designed to measure the program's effectiveness at achieving the program goals set forth in the program’s logic model. keywords: interprofessional education; law and social work; child welfare; children's law; interprofessional outreach; interprofessional field education in recent years, educational institutions have placed an increased emphasis on interprofessional education. schools of social work have joined this trend, seeking partnerships with schools in a variety of other disciplines including law, medicine, and psychology. interprofessional programs may take a variety of forms, varying in formality of the arrangements and the extent of content being delivered. social work schools and law schools are frequent collaborators due to the intersection of practice between these two professions, particularly in fields such as child welfare, immigration, adoption, domestic violence, and mental health. legal education began as an apprenticeship focusing on the development of practical skills (wilson, 2018). yet in recent decades legal education has been often criticized for its ivory tower approach to the training of new attorneys (holland, 1999). as discussed below, many law colleges in recent decades have developed clinical programs designed to focus on the nuts of bolts of effective lawyering. as schools of social work have historically emphasized fieldwork as a key component of the educational experience, this development provides new opportunities for interprofessional collaboration. because social work educators have long recognized the importance of providing students with experience in https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 301 the field through some form of apprenticeship, schools of social work must develop ties with a variety of community-based organizations to facilitate placement opportunities for students. these relationships also provide the foundation for students, as well as faculty, to work with community leaders to meet pressing community needs, to advocate for social change, and to design, implement, and disseminate research that enhances knowledge regarding social work practice and policy. one way in which the michigan state university (msu) school of social work (ssw) seeks to achieve these goals is through the chance at childhood program (cac), an innovative child welfare program providing interprofessional law and social work education, and community-based advocacy, primarily within a clinical setting. due to the relatively recent development of interprofessional clinical programs such as cac, little research has been conducted to determine the effectiveness of such programs as a model for interprofessional social work education. educators seem to have developed such programs by accepting the largely anecdotal notion that an interprofessional approach in areas where the practice of social work and law intersect education will better prepare students for practice, and enable graduates to better serve clients and stakeholders involved in the systems where these professionals practice. while preliminary data demonstrate the program’s effectiveness regarding some specific program goals, the study remains ongoing. in this article, the authors will review the existing literature regarding social work interprofessional education, focusing specifically on law and social work in the field of child welfare. the authors define the term interprofessional education as follows: educators and learners from 2 or more . . . professions and their foundational disciplines who jointly create and foster a collaborative learning environment. the goal of these efforts is to develop knowledge, skills and attitudes that result in interprofessional team behaviors and competence. (buring et al., 2009, p. 2) throughout the literature review, the authors use the term interdisciplinary, as opposed to interprofessional, when the cited authors use that term, even though the programs and/or practices the authors described closely align with buring and colleagues’s definition above. special attention will be placed upon interprofessional field education. second, the authors will describe in some detail the program components of cac to explain how cac is designed to provide students with an interprofessional education both in the classroom and in the field, and to also illustrate how cac effects community-based advocacy as part of msu broader educational mission. third, the authors will present preliminary research results addressing the effectiveness of cac's approach from the perspective of students, patrons of cac’s services, and several different stakeholders. literature review in the late nineties, universities begun providing students with increased opportunities to participate in interprofessional and/or inter-professional programs (brandon & knapp, 1999; casto et al., 1998; donnelly, 2019; institute of medicine, 2015). interprofessional kozakiewicz et al./msu’s chance at childhood 302 education focuses on more than one discipline, seeking to impart in students not only some amount of general knowledge regarding the student’s “non-primary” field, but perhaps even more importantly, an appreciation for the expertise and the ethical perspective of the other field. inter-disciplinary education and practice refers to actual collaboration among working professionals from more than one discipline or profession (forgey & colarossi, 2003; mccroskey, 1998). as discussed below, cac combines interprofessional education in the classroom setting with inter-disciplinary practice in a field placement; thus, both terms describe the experience of students participating in cac. henceforth, the authors will use the term interprofessional when referring to the cac program, though both terms are descriptive of this program. since the 1960s, many institutions of higher education have developed and implemented interprofessional programs through a variety of strategies (newell, 2001). professional graduate school programs, including social work schools, have sought opportunities to develop relationships with other schools in a wide variety of human service fields when practice opportunities bring graduates from the different fields together. mccall (1990) notes that, in training students to work with children, youth, and families, several academic departments including psychology, education, sociology, psychiatry, public health, pediatrics, and nursing overlap with social work (p. 1321). similarly, other authors note the variety of academic disciplines that overlap in practice areas touching upon the dynamics of domestic violence (lia-hoagberg et al., 2001). patti and hentschke (1998) write that, in the field of child welfare, the social worker ''needs the skills and perspectives of the police officer, the doctor, the nurse, and the lawyer at various points in time" to effectively manage a case (p. 258). while any field could benefit from interprofessional training, the field of child welfare has a great need as it requires the expertise of social workers, lawyers and judges, medical and mental health professionals, and law enforcement to address the complex needs of one of the most vulnerable populations. methods of delivering interprofessional education to social work students may take a variety of forms, ranging from informal relationships where students are encouraged to take course work in another discipline to formal joint-degree programs through which students earn degrees from the participating schools or colleges (brandon & knapp, 1999; jankovic & green, 1981; kopels & gustavsson, 1996). brandon and knapp (1999) point out that regardless of the precise form of the interdisciplinary venture, the underlying premise is that an interdisciplinary perspective will better prepare students for practice in their intended fields and might promote their employment in a competitive marketplace (p. 886). practitioners, as well as educators, acknowledge the benefits of an interprofessional perspective as the basis for effective practice in a variety of fields as well as for effective professional education (brammer, 2020; brandon & knapp, 1999; glynn, 1994; liahoagberg et al., 2001; preston-shoot, 2019). human service fields in general (including both social work and law) are under special pressure to integrate interdisciplinary themes to better effect service delivery in the field (brandon & knapp, 1999, pp. 876-877). further, the universities' development of interdisciplinary programs is, in large part, a response to advances in social work, summer 2020, 20(2) 303 demand from practitioners to create such programs for students who will join them in the field (brandon & knapp, 1999, p. 878). schools of social work have responded to these demands by developing partnerships with schools in a variety of other disciplines (jankovic & green, 1981; kopels & gustavsson, 1996). these authors stress the importance of training and education in multiple disciplines for social work graduates to effectively practice in the human service fields. the partnership between social work and law is particularly appealing. numerous authors have noted that social workers must understand the legal system and legal processes to advocate effectively for their clients (deck, 2016; forgey & colarossi, 2003; jankovic & green, 1981; haight et al., 2015; kopels & gustavsson, 1996). kopels and gustavsson (1996) stress that: social work educators have a growing responsibility to make students aware of the implications of the lawincluding the effects of legal mandates on practice and social worker liability, the legal aspects of the workers' roles in client settings, and the legal rights of social work clients. (p. 115) beyond the field of child welfare, law and social work practice intermingle in a number of areas including, criminal justice, work with elders, school and education issues, and issues surrounding mental and physical disabilities. many educators recognize that social workers require knowledge of the law to practice effectively in these varied areas because practice in these areas regularly require interaction with attorneys, and often appearances in court (albert, 2000; madden, 2003; saltzman & furman, 1999; stein, 2004; deck, 2016). without some understanding of substantive law and court processes relevant to their practice and area, social workers would struggle to practice in a competent, and thus ethical manner. glynn (1994) notes that attorneys should be trained from an interdisciplinary perspective, because effective advocacy in many legal specialties requires the knowledge of fields such as social work. for instance, a family law or child welfare attorney without any knowledge or training in domestic violence, substance abuse, or child development would be unable to effectively advocate for a party to a case focused on such issues. attorneys in these fields only very rarely can rely on qualified experts to assist them given the financial limitations of most clients often dealing with financial stress due to poverty or changes looming as a result of pending or recent divorce. glynn (1994) adds that students working in an in an interdisciplinary collaborative process benefit from observing practice from the perspective of a different profession, often a profession with very different values, ethical standards, and definitions of success (p. 619). further, effective "family law practice makes it essential that law students have at least a rudimentary understanding not only of the roles that non-lawyers professionals play, but of the theories and assumptions on which they rely" (o'connell & difonzo, 2006, p. 534). the administration on children, youth, and families (2017), heimov et al.(2017), faller and vandervort (2007), coleman (2001), maschi (2017), and deck (2016) echo this sentiment, while stressing the challenges in maintaining ethical practices within interdisciplinary partnerships and with balancing the differing perspectives of the respective professions. more recently, gerber et al. (2019) refers to the success of a law and social work interdisciplinary team approach for foster care cases. gerber et al. (2019) https://www-sciencedirect-com.proxy1.cl.msu.edu/science/article/pii/s019074091930088x#bbb0020 kozakiewicz et al./msu’s chance at childhood 304 asserts that through providing higher quality services, an “interdisciplinary law office approach to parental representation may save millions of government dollars” (p. 52). the recognition of the special law and social work relationship has led to the development of a variety of interprofessional law and social work programs. research conducted by miller et al. (2008) reveals that the most common interdisciplinary program offered in schools of social work is a partnership with a law school. other common partnerships include business and law, medicine and social work, and law and medicine. taylor (2005) describes how the differing educational experiences of future lawyers and social workers often lead to conflict in professional practice and notes how interdisciplinary education and training may reduce the occurrence of such conflicts and improve inter-professional cooperation. scarnecchia (1997) describes how an interdisciplinary program at the university of michigan is designed to address the lawyer’s need to integrate social work, psychology, medicine, and education into an effective legal practice. duquette (1997) recognizes the clinical aspect of this program as integral to providing students an opportunity to develop practical skills in a real-life setting. at fordham university, galowitz (1999) notes the importance of social work skills and to promote effective legal practice. galowitz specifically describes the value of the social worker's ability to "assist the lawyer in understanding or relating to the client, thereby assisting in the delivery of legal services to the client" (p. 2125). while these programs emphasize the need for interprofessional law and social work education, each is a college of law. cac provides an exception to this rule, as cac is housed within michigan state university’s school of social work. the authors are unaware of any other interprofessional law and social work program that is housed within and funded by a school of social work. in contrast to the relatively recent focus on interprofessional education, schools of social work have always emphasized fieldwork as a key component of the students’ educational experience (goldstein, 1993; kourgiantakis et al., 2019; riitta-liisa, 2020; vassos, 2019). goldstein notes that, as with other professional fields, a "period of apprenticeship remains indispensable to the attainment of professional status" (p. 170). mccroskey (1998) states that the process of "linking classroom and practice sites is essential to student learning and reinforcing for practicing professionals" (p. 13). further, foley (1998) concludes that students especially value preparation for inter-professional cooperation when that training includes "extensive experience in a real-world context" (p. 226). knapp et al. (1994) emphasize that effective interprofessional education requires application of the interprofessional model to the field practicum site. limiting the interprofessional perspective to the classroom does not provide students with a sufficiently meaningful interprofessional experience. as casto et al. (1998) note, students benefit from placements in community-based interprofessional agencies where they can apply and learn from an interprofessional perspective. oates and gaither (2001) similarly underscore the value of service learning, or experiential learning geared toward the provision of needed community services. wilson et al. (1994) describe a field practicum site in which students in special education, nursing, social work, and psychology programs worked together and were supervised by professionals in fields different from their own. advances in social work, summer 2020, 20(2) 305 in addition to providing students with “real-world” experience, field placements represent one way in which social work schools provide service to the larger community. universities, particularly those in urban settings, have come under great pressure to assist in the process of solving social ills (mccall, 1990). placing students within community agencies is one way to meet community needs. many universities play an important role in developing and fostering such community-based initiatives (gatz & o'hearn, 1998). a more directed approach is through the creation of clinical programs, established within the community and focusing on identified community needs, and that are staffed by students satisfying their field placement or other experiential learning requirements. lerner et al. (1998) specifically identify the importance of universities integrating knowledge across multiple academic disciplines and diverse professional activities to improve circumstances for children, youth, and families in their communities. as a landgrant university, with a long history of focus on community needs, this theme resonates especially strongly throughout msu. it is from this perspective that the authors will examine cac as an example of msu's commitment to meet the challenges described above. program overview consistent with its land grant mission, msu provides, through the efforts of msu extension, resources and learning opportunities to individuals, communities, and businesses in all of michigan’s 83 counties. during the 2017-18 academic year, over 32,000 students participated in extension supported community-engaged learning and/or community service opportunities. consistent with msu’s outreach mission, the msu school of social work created four distinct “community programs,” one of which is cac. each community program provides service, outreach, and teaching through field education placements, and seeks to develop best practices, and provide research opportunities to study program development and sustainability. table 1 sets forth a brief description of cac’s program components. table 1. chance at childhood program components program component brief description 1) the family advocacy certificate program allows law students and social to earn a certificate upon graduation indicating they have completed all of the program’s interdisciplinary training components 2) cac law and social work clinic law and social work students work in teams to advocate in the michigan family court for children and families 3) the cac impact center the center provides a safe setting for parents to exercise court-ordered supervised parenting time 4) cac ingham county self-help center law and social work students assist unrepresented parties with completing their court filings 5) other community outreach and advocacy cac staff and provide free trainings to professionals as well as many community groups and organizations cac’s individual program logic model described in table 2 for students and community services. advances in social work, summer 2020, 20(2) 306 table 2. msu chance at childhood logic model-students resource/inputs activities/outputs short term goals long term goals • orientation • learning agreement • field liaison/liaison groups • field instructors/ • other agency staff • students • community programs infrastructure (policies, procedures) • complete student learning agreement • fulfill requirements of clinic syllabus including law student’s development of providing competent representation; striving to promote justice, fairness, and morality; striving to improve the profession; and professional selfdevelopment. • assign learning experiences and provide opportunities with clients for observation and engagement • provide instruction, modeling and training by mentors/supervisors • provide law students with professional rules of conduct modeling and training. • provide reflective social work supervision about student learning objectives, needs and progress • complete all required internship and field instructor evaluations • create portfolio of assignments to demonstrate student learning • students will increase knowledge related to practice with children and families involved in the family court system • students will increase skill in core social work competencies and practice behaviors (field instructor assessments and student self-assessments could be used here) • law students will increase knowledge of family law and associated advocacy skills for representing children and families in the court system. • students will increase commitment to social work values • law students will practice zealous representation of clients within parameters of professional rules of conduct. • students will increase job preparedness for future employment in with children and families involved in the family court system • cac alumni are involved as leaders, field instructors and mentors in their areas of professional practice • cac alumni are involved as family court attorneys and working in the court system in their areas of professional practice • cac alumni remain in social work practice and family law practice • cac alumni engage in lifelong learning through continuing education and legal trainings advances in social work, summer 2020, 20(2) 307 table 2. msu chance at childhood logic model-community services resource/inputs activities/outputs short term goals long term goals • funding (parking, programming, faculty) • time • space • students • partnerships • surveys • clients • community resources • conference rooms • office supplies • printed material • parking availability • ingham county self help center • clinic children’s law hotline • represent select clients in domestic relation matters • cac faculty provide effective legal representation • provide interdisciplinary professional/ce training in child welfare • handle court appointments to represent children • mandated reporter brochures/trainings • community based partnerships • outreach to contribute to informed professionals • parents are well-informed about their legal rights and the legal processes involved to protect those rights • parents are able to file their legal paperwork properly • cac faculty and students are knowledgeable about and utilize best practices • courts have the information they need to make effective decisions in cac cases • professionals and community partners who provide services/develop policies regarding the family court are knowledgeable about and utilize best practices • parents effectively advocate for themselves within the court system • underrepresented populations in michigan have effective representation in court • courts efficiently and fairly process pro se cases after selfhelp center intervention • social work and legal professionals in michigan are well-informed about best practices regarding practice in the family court • children served by cac are placed in family settings that maximize physical, emotional, and mental well-being advances in social work, summer 2020, 20(2) 308 the ssw’s other three community programs are fame (fostering academics, mentoring excellence), the kinship care resource center, and veterinary social work services (vsws). fame is a resource center for msu students who are alumni of the foster care system, were in kinship care, have experienced homelessness, or are otherwise independent. fame provides support and resources to these students to improve the odds of their success during their collegiate experience on msu's campus and during their transition to becoming msu alumni. the kinship care resource center is a non-profit statewide organization. the center supports michigan kinship families by utilizing research to provide education and outreach for communities, agencies, and individuals serving those families. finally, vsws is a collaboration between the school of social work and the college of veterinary medicine. vsws provides emotional support and educational and referral services for clients, veterinarians, medical staff, and support staff of the msu small animal clinic, oncology center, and large animal clinics. cac differs from these other community programs in a number of ways. first, cac partners with the msu college of law, and is organized around an interprofessional social work/law focus. further, cac is the only community program offering students a certificate program requiring specialized coursework and field placement criteria. cac’s broad mission (through collaboration with the msu college of law) is to promote and protect the well-being of children and families through integrated social work, and law education and advocacy. specifically, the certificate program, offered to both law and graduate level social work students, is designed to cross-train social work students and law interested in legal advocacy on behalf of children and families involved in michigan’s family court. cac is comprised of several components, each designed from an interprofessional perspective. together these components provide students with both interprofessional classroom education and interprofessional community-based fieldwork. the program focuses on the field of child welfare, which, for purposes of this program, includes all those legal proceedings directly affecting the rights of children. thus, legal proceedings that many practitioners consider children's law or family law issues fall within the scope of cac’s curriculum. 1) the family advocacy certificate program all students seeking to earn cac’s family advocacy certificate must enroll in the cac law and social work clinic, described below. in addition, law students are required to choose a minimum of two options from a menu of courses covering topics related to children's law. most law students have no difficulty meeting this requirement, as the students admitted to cac tend to focus their studies in the area of family law. social work students must enroll as “guest students’ in the college of law in order to take one law school elective from the same menu the law students choose from. these students are thus placed with law school students who have had the benefit of already completing at least one year of law school studies, a daunting challenge for any graduate student. advances in social work, summer 2020, 20(2) 309 students from both schools must also complete a graduate-level social work course in child welfare. this course is designed to present students with an overview of the child welfare system from both the practice and policy perspective. in this circumstance, it is the law students who must venture into foreign territory. however, teaching styles among faculty in the ssw are not terribly dissimilar from the teaching methods and techniques those students experienced during their undergraduate careers. this is in stark contrast to the experience of those social work students who are exposed for the first time the socratic method of teaching that is so common in many law school classrooms, and foreign to students from most other disciplines. finally, all certificate students must successfully complete the integrative seminar in law and social work. the goal of this seminar is to provide an overview of all areas of the law in which children's interests are directly affected. the content of the course includes child custody, child protection, juvenile justice, adoption, and other areas of family and children’s law. the course is not intended to provide students with in-depth knowledge of these areas of law. rather, the focus of the seminar is to present these substantive areas of law as a means to discuss the lawyer’s and the social worker’s roles, tasks, and ethical obligations in working with clients involved in such cases. given this approach, the seminar is taught by the program director, a jd/lmsw, and includes presentations from other professionals in both the legal and social work fields. in leading the class discussion, the instructor presents an overview of the substantive laws involved in each topic area. class discussion focuses on how lawyers and social workers can follow the legal standards while adhering to their professional norms and ethical standards, and while ensuring the protection of children’s interests. for instance, lengthy, and often passionate discussion tends to arise regarding the conflicting professional ethical obligations involving client confidentiality and mandated reporting of child abuse. diversity issues are raised in all class discussions to heighten students’ awareness of how race, class, gender, and other factors impact practice decisions and court outcomes. classroom discussions inevitably raise conflicts between the ethical obligations and practices of lawyers and social workers. adherence to these differing obligations often leads to misunderstanding, if not outright conflict, among social workers and lawyers who do not understand the other profession’s standards. it is not difficult to generate lively class discussions. all the social work students have had at least one prior field placement, and many of them have had some work experience. these students can present and discuss a variety of relevant real-life experiences. fewer law students in the program have relevant work experience, but many of the law students in the seminar are enrolled concurrently in the cac clinic (or have worked in the clinic in a previous semester) and are thus able to draw upon their clinical experiences that often neatly mesh with the topics raised in the seminar. thus, seminar discussions tend to be richly based in circumstances and events the students will encounter in their professional practices. seminar students must also complete an extensive research paper and present their findings to the class. the students' topics must be pre-approved but may cover any topic covered in the seminar. a number of students have had their papers published in peerreviewed publications. the seminar provides students with a wide-ranging introduction to interprofessional child welfare practice. kozakiewicz et al./msu’s chance at childhood 310 2) cac law and social work clinic the cac law and social work clinic opened in the fall of 2003. the clinic provides students with an opportunity to gain practical experience in a variety of cases involving families and children. each student admitted to cac is required to spend a minimum of one semester in the clinic. due to the differing requirements of the two schools, law students are required to work 16 hours per week for one semester. law students may complete a second semester if invited to do so. social work students are required to work 16 hours per week for two consecutive semesters. faculty and students advocate for children in a variety of legal proceedings and advise practitioners and community members on a wide range of child welfare issues. the circuit and probate courts in various michigan counties assign cases to the clinic. students form two-person interprofessional teams and are assigned cases from at least two or three different counties. handling cases in different counties allows students to compare how practices differ among counties and increases their opportunities to meet and network with other professionals in the field. cases assigned to the clinic have included custody, guardianship, adoption, and supervised parenting matters. for several years, under terms established through a state grant, the clinic also contracted with the state court administrative office to modify child support orders for incarcerated persons. once admitted to the clinic, students are assigned to two-person teams comprising one law student and one social work student. law students typically complete courses in evidence, court procedures, and legal ethics prior to joining the clinic. in particular, their experience allows students to make recommendations that are both pragmatic and likely to be adopted by the court. social work students generally have some specialized knowledge of child development, child-trauma-informed care, mental illness, substance use and disorders, and domestic violence–subjects that are essential to determining the best interest of minor children in many court proceedings. despite these different skill sets, students work as equal members within their teams. that is, tasks are not divided among team members based on their status as either a law or social work student. rather, team members work together in every task involved in their cases. students jointly review legal files, court social files, psychological evaluations, and other reports. students also jointly conduct interviews, visit homes, prepare reports, and prepare to testify in court. the student team’s combined expertise aids the court by ensuring that pertinent questions are asked, and that a thorough analysis of the evidence is conducted. in one case, for example, a student team discovered that a father had abused the family pet. recognizing that pet abuse may suggest a high risk of domestic violence or child abuse, the team crafted a recommendation to the court that addressed these specific concerns. in another case, the team’s social work expertise led the students to alert the court to a child’s potential autism, even before a formal diagnosis had been made. in cases involving parents addicted to heroin, interprofessional student teams were able to educate judges and parent attorneys regarding available treatment programs, and the likelihood of setbacks and ultimate success. unsurprisingly, the opioid crisis has created an urgent need for an interdisciplinary approach to such cases. in sum, the combined experience and expertise of the law and advances in social work, summer 2020, 20(2) 311 social work students provides a more holistic approach to solving the complex problems facing families today. many students are initially surprised to realize the extent to which the best interests of the child often conflict with the interests of the child's parent and the interests of other adults involved in the child's life. exposing the students to this reality is consistent with cac's mission. the decision to focus the clinic's caseload on court-appointed cases requires a great deal of relationship building with courts to develop a viable student caseload. this partnership with the courts allows students to work as true advocates for children, as opposed to advocating on behalf of adults who often are unable to differentiate between their own interests and the interests of their children. though students are scheduled to spend at least four hours each week in the clinic workspace in order perform telephone intakes, students must maintain flexible schedules in order to conduct interviews, appear in court, and attend meetings outside of “regular” work hours. most of the students' work takes place outside of the clinic's physical space, often during evenings and weekends. given the nature of the cases handled in the clinic, students often exceed the number of hours they are scheduled to work in any given week. additionally, it is impossible to predict which of the clinic's cases may prove more demanding. some student teams may become overwhelmed with particularly complex cases, while other teams may be less challenged. faculty directly and clearly apprise students of these challenges during the cac application process. as a result, students in the clinic tend to be willing and able to adapt to these and other real-life trials. while the focus on interdisciplinary team approach to cases is crucial to cac's mission, this approach also poses certain challenges. first, as occurs in any program, students experience conflicts over work ethics, schedules, and sensibilities about and approaches to cases. these conflicts are dealt with as opportunities for learning and improving interpersonal communication skills. fortunately, clinic faculty have encountered very few of these conflicts, but when they have arisen, faculty have intervened as facilitators, emphasizing that the students must reach an agreement as to their recommendations to the court. thus far, students have been able to work through their conflicts and differences of opinion. the team approach has also led to unique challenges when students have jointly prepared reports and then testified in court. as both students sign their reports and recommendations, some attorneys have required that both students testify, which tends to displease the court. in other circumstances, the court has requested one student to testify in the presence of the other student and has then allowed the second student to briefly add to or comment on the first student's testimony. in other cases, the court has had both students testify simultaneously, answering questions posed to them as if they were a single witness. despite these challenges, through handling real cases in an inter-professional partnership, students are able to gain an understanding of how the law and social work professions complement as well as conflict with one other in child welfare practice. kozakiewicz et al./msu’s chance at childhood 312 3) the cac impact center cac collaborates with the ingham county friend of the court to provide supervised parenting time (spt) pursuant to orders issued by family division judges. cac will collaborate with other counties when at least one parent resides in ingham county, or the impact center is located roughly halfway between the parents’ residences. courts order spt for a variety of reasons, most often due to substance abuse issues, domestic violence, and in order to reunify an absent parent with his or her child. whatever the specific circumstances, a judge must determine that it would be unsafe for the parent to spend time with the child(ren) without supervision in order to qualify for these services. cac provides center-based supervision, following safety protocols to ensure that children and parents are provided with a neutral, safe, and engaging environment. the impact center’s space consists of two elementary sized classrooms and a gymnasium on msu’s campus. cac is able to provide free supervision to parents, typically bi-weekly for 2 hours at a time. cac students are trained in best practices and shadow an experienced student supervisor before being assigned a case of their own to provide supervised parenting time. typically, the social worker and law student will team up until they are comfortable doing supervision alone. following each visit, students produce a report for the court that details everything that transpired during spt. to evaluate the effectiveness of this program, and to ensure that all student clinicians conduct themselves in a professional and respectful manner, cac faculty designed surveys to measure parents’ and children’s satisfaction. impact center surveys have thus far been collected for only the most recent semester, spring 2019. ten participating families completed the surveys. sixty percent of participants identified as female, 30% as male, and 10% declined to answer. regarding the age of participants, 30% were under 25, 20% were between 25 and 35, 20% were between 30 and 45, and 30% were between 45 and 55. of the nine participants who responded to the question, 55% identified as the non-custodial parent and 45% identified as the custodial parent. finally, regarding the ethnic/cultural background of participants, 40% of patrons identified as caucasian/white, 50% as african american/black, 10% as latino/hispanic, and 10% as native american or indigenous person. survey results illustrate that both custodial and non-custodial parents alike felt respected, as 100% “strongly agreed” or “agreed” with the statement “my student was respectful.” further, when asked if their student was professional, 100% of parents “strongly agreed” or “agreed.” surveys for the children focused on their feelings of safety and the friendliness of the students. overall, 80% of the children indicated that they felt safer having parenting time in the impact center than in some other location. 100% of the children responded that their supervisor is “friendly” and “listens to them.” cac provides an invaluable service to the community through spt provided at the impact center. between the fall of 2015 and the spring of 2019, the number of student hours served per academic year increased from 700 to just over 1200. during this time, cac provided over 3,600 hours of direct supervision, saving the county approximately $96,000. while cac typically maintains between 10 and 14 open cases at a time, demand for this service greatly exceeds the program’s capacity. as with most of cac’s outreach advances in social work, summer 2020, 20(2) 313 efforts, students fill a void within the community, but much more is needed to ensure that all families and children have meaningful access to justice. 4) cac ingham county self-help center the chance at childhood ingham county self-help center is a free service offered at the veteran’s memorial courthouse in lansing, michigan. this program is designed to aid self-represented patrons involved in domestic relations matters. most patrons seek help with child custody, child support, parenting time, and divorce matters. during the course of a typical semester, the self-help center operates between six and eight hours per week, at times when the court schedules full family division dockets. on average, the center serves between 130 and 200 patrons in a semester. all patrons are asked to complete a survey after they receive services. surveys are designed to gage patrons’ level of satisfaction with the services they received, and to collect demographic data. during the spring 2018 semester, which is representative of other semesters during which cac offered self-help services, of the 52 patrons that completed surveys, 52% (27) identified as male and 48% (25) identified as female. 37% (19) of patrons were between the ages of 18 and 29 years old, 38% (20) were between the ages of 30 and 39 years old, 12% (6) were between the ages of 40 and 49 years old, 10% (5) were between the ages of 50 and 59, and no clients were over the age of 60 years old. given that patrons seek help with active family court cases, it is unsurprising that the demographics skew toward younger adults. regarding our patrons’ reported highest level of education, 5% (2) of survey participants reported having some high school education, 15% (15) had a high school diploma or ged, 44% (19) completed some college, and 16% (7) were college graduates. regarding household income, 19% (9) of this group reported a household income under $10,000, 31% (15) between $10,000 and $20,000, 8% (4) between $20,001 and $30,000, 13% (6) between $30,001 and $40,000, 10% (5) between $40,001 and $50,000, and 19% (9) over $50,000. finally, regarding the ethnic/cultural background of patrons who participated in the spring 2018 survey, 51% of patrons identified as caucasian/white, 40% as african american/black, 4% as latino/hispanic, 2% as middle eastern, and 2% as multiracial. our surveys also seek to capture patron satisfaction. results from the group described above indicate that 92% (48) strongly agreed that the center was helpful, 96% (50) strongly agreed that the students were respectful, and 96% (50) strongly agreed that they had been respectfully listened to. moreover, 96% (50) strongly agreed that they were given information that helped them better understand their situation, and 92% (48) strongly agreed that they understood the next steps they needed to move ahead in their case. 5) other community outreach and advocacy cac provides students with a variety of opportunities to engage in interprofessional community-based advocacy. the kinship care resource center at msu opened in 1999 to provide support for kinship caregivers throughout the state of michigan. given its mission and services, the center was made part of cac in 2004, and while it currently kozakiewicz et al./msu’s chance at childhood 314 operates now as a separate community program, cac continues to provide a variety of services to kinship care’s clients. the kinship care resource center (kcrc) serves kinship care families across the state by providing information and referrals to resources and services for caregivers and the children they are raising. kcrc also offers support to professionals serving kinship families. center staff seek to provide resources both from the social services perspective as well as the legal perspective. specific legal concerns and questions are referred to the cac clinic. cac faculty also provide training for professionals working with kinship families, and directly to kinship caregivers. working with the kinship care center also allows cac students to help meet this specific population's needs from both the social work and legal perspectives, and to provide much needed advocacy for new statewide policies to better serve this population. in addition to the kinship care resource center, cac provides outreach to professionals and community members throughout the state of michigan in several other ways. first, faculty and students placed in the clinic provide legal advice to professionals and laypersons throughout the state. through the clinic's toll-free number, calls are received covering the full spectrum of issues addressed by laws intended to protect children’s health and safety. some of these calls are referred to students who do legal research; however, faculty answer most of questions that students receive. while clinic faculty do not represent the adults seeking advice, basic legal information is provided and callers are often referred to other agencies that can better address a caller's specific needs. advice and referrals are provided free of charge. cac also has formally collaborated with volunteer advocates of mid-michigan (vamm), an agency affiliated with the student advocacy center in washtenaw county. through this partnership, law and social work students were trained to advocate for k-12 students facing school suspension or expulsions. students sought to contribute to vaam’s overarching mission to end the “school to prison pipeline.” in addition to advocating for individual students, cac students conducted outreach activities to inform parents and schools of these services. program faculty and students also speak to various community groups, including grandparents' groups, men's parenting groups, employer-facilitated groups, and other organizations regarding the many issues that families often encounter in the family court system. such presentations are made to both laypersons and professional. for over ten years, cac has partnered with michigan’s statewide court improvement program, developing and presenting many trainings for child welfare professionals, including the development of a series of videos depicting best practices in a series of child welfare hearings. cac is currently working with the michigan department of health and human services to update and distribute cac’s series of mandated reporter pamphlets. over fifty thousand copies of these pamphlets (specifically designed for teachers, law enforcement, medical professionals, social workers, and other mandated reporters as defined by michigan law) have been already distributed throughout the state of michigan. through these various community-based endeavors, cac is able to affect the outreach mission of msu. this provides both law students and social work students with a wide advances in social work, summer 2020, 20(2) 315 variety of opportunities for interdisciplinary child welfare field experience. students gain the interdisciplinary perspective in these endeavors by working hand-in-hand with students and professionals based both in social work and law, and through joint legal and social work supervision by cac faculty and the practitioners involved in these many and varied projects. program feedback in addition to the data presented above, cac regularly collects data from our community partners and from our student graduates to measure the program’s effectiveness at achieving the goals set forth in cac’s logic model. one primary research question focuses on whether program alumni believe that an interprofessional approach to child welfare education is, in fact, beneficial to students. related considerations include whether interprofessional education in general, and the completion of the cac program specifically, provides any benefit to students in terms of the jobs they obtain, the salaries they earn, their effectiveness as professionals, and their longevity in the field of child welfare. preliminary alumni survey data suggests that alumni do believe that participating in cac better prepared them for practice in the field, and “set them apart” when applying for child welfare-related positions. of the 28 alumni surveys that were completed, 86% (24) responded that they would refer clients to cac, 96% (27) reported they would encourage other students to enroll in cac, and 86% (24) responded that they would encourage the courts to work with cac. further, over 90% of respondents reported that were expectations were met, exceeded, or greatly exceed regarding client interactions, legal experience, supervision, child welfare experience, and team building opportunities. 100% of respondents reported they understood and valued the different roles that lawyers and social workers play in the family court system. finally, 85% of alumni who responded to the survey felt competent that they could conduct a home visit and custody 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(1994). the integrated specialist: an interdisciplinary preservice training model. in l. adler & s. gardner (eds.), the politics of linking schools and social services: the 1993 yearbook of the politics of education association (pp. 161-164). farmer press. https://doi.org/10.1080/0268093930080513 author note: address correspondence to joe kozakiewicz, director, chance at childhood program, msu law clinic, po box 1570, east lansing, mi 48826. email: kozakiew@msu.edu https://doi.org/10.1016/j.childyouth.2005.06.006 https://doi.org/10.1080/0312407x.2018.1557232 https://doi.org/10.1080/0268093930080513 mailto:kozakiew@msu.edu _____________ tamara s. davis, phd, mssw, dean and professor, advances in social work, indiana university school of social work, indianapolis, in 46202, tamsdavi@iu.edu copyright © 2018 author, vol. 18 no. 4 (fall 2018), i, doi: 10.18060/22916 this work is licensed under a creative commons attribution 4.0 international license. message from the dean tamara s. davis as the new dean of the indiana university school of social work, i am pleased to welcome you to the fall 2018 issue of advances in social work. advances has provided our profession a peer-reviewed platform for sharing new ideas and best practices since 2000, and is a continued source of pride for the school. what a delight it is for me to serve as dean of a nationally recognized, forward-thinking school that provides our academic and practice communities with open access to thought-provoking discourse on relevant issues of today! our spring 2018 issue on immigrant and refugee populations garnered much interest. without a doubt, today’s national climate leaves us all searching for increased understanding of how to respond to the needs of the people and communities we serve. our authors in the current issue focus on innovations in research, teaching and practice. whether you seek to learn new strategies employed in research, alternative techniques for engaging students and instructors in the learning experience, or cutting edge approaches to practice, the array of subjects covered across these three domains is certain to provide something for everyone. i extend my thanks to the many contributors who ensure advances makes a meaningful contribution to our literature base with each issue. the dedication of dr. margaret adamek, the journal’s editor, the editorial board, and ms. valerie decker, assistant editor, allows us to produce a quality journal highlighting and disseminating new ideas and technologies in our profession. they, along with our guest editors and published authors, uphold these values and commitment to our readership without sacrificing the rigorous review process expected from a peer-review process, as the oldest school of social work continuously affiliated with a university (since 1911), and accredited since the council on social work education began accrediting programs, the iu school of social work enjoys a rich tradition of leadership in advancing the social work profession. our faculty are recognized for innovations in social work education and practice, with the most recent footprint in online education and practice technologies. headquartered in indianapolis alongside the largest medical school in the u.s., the school of social work actively partners with the iu school of medicine and iu’s health science disciplines to explore innovations in health care practice and education. we challenge ourselves and our students across bsw, msw and phd levels to tackle the issues of today while preparing to respond to the demands of tomorrow and beyond. we expect advances in social work to do the same. we hope you enjoy and are edified by the works published in our fall issue of advances. wishing you peace and prosperity in the work ahead. https://creativecommons.org/licenses/by/4.0/ _________ joshua r. gregory, a.m., doctoral student, school of social welfare and program in critical theory, university of california, berkeley ca. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 616-634, doi: 10.18060/24094 this work is licensed under a creative commons attribution 4.0 international license. toward a historically accountable critical whiteness curriculum for social work joshua r. gregory abstract: whiteness—distinct from individuals who identify as white—is a social construction; and social constructions, by definition, can be disassembled. whiteness is also wholly constituted by and inseparable from white supremacy, and thus exists purely as racial injustice. these are historical facts. consequently, racial justice demands that whiteness be dismantled and abolished. social work, as a profession committed to racial justice, is directly implicated in this imperative. yet, due to misunderstanding and unawareness, the above facts register with most social workers as exaggerated claims, baseless untruths, or ideological propaganda. social work requires a historically accountable critical whiteness curriculum in order to correct this pervasive misunderstanding and to facilitate informed participation in the pursuit of racial justice in a way that accurately apprehends the nature of whiteness. this curriculum, introduced here, explores the history and invention of whiteness in global, u.s., and social work contexts; examines the integral role of education in deploying and maintaining whiteness; and considers reconstruction and abolition as alternative modes of responding to whiteness as a social problem. the curriculum ultimately shows abolition to be the only historically and theoretically consistent response to whiteness, leading to a call for abolition as praxis and for further curricular development. keywords: whiteness, social work, history, curriculum, pedagogy this project originates from and speaks directly to one simple fact: whiteness is a social problem. white privilege (mcintosh, 1989) is not a social problem; white fragility (diangelo, 2018) is not a social problem; white silence (smalling, 2015) is not a social problem; but, more accurately, each is a symptom of one underlying social problem— namely, whiteness. this is not to deny that white privilege, fragility, and silence are pervasively and severely harmful, but to point out that to eradicate any or all of these will still leave intact whiteness as the root cause from which they stem. whiteness left intact— even absent privilege, fragility, or silence—will perpetuate racial oppression (nopper, 2010). that is because whiteness is, by definition, wholly constituted by and inseparable from white supremacy (ignatiev, 1997; ignatiev & garvey, 1996). or, as david r. roediger (1994) put it, “it is not merely that whiteness is oppressive and false; it is that whiteness is nothing but oppressive and false” (p. 13). whiteness is, therefore, not just a social problem, but a categorical social problem. social work’s orientation toward whiteness as a categorical social problem should be easily predictable and unwavering, but it is noti. other unambiguously harmful social problems make their way quickly onto social work agendas as injustices to which the profession stands unequivocally opposed and that legions of social workers rally fervently to combat. the normative course of action in such cases is never hesitant or partial, but imperative and absolute—total elimination, or, to use the popular language of rising social about:blank gregory/toward a historically accountable 617 work generations, abolition. social work has historically aimed to completely end categorical social problems like hunger, crime, violence and poverty (the notions of aspiring to alleviate most hunger or to prevent some violence would undoubtedly register with most social workers as falling short of their professional mandates and as abandonment of moral responsibility). further, growing numbers of prominent social work scholars, activists, and practitioners are pronouncing the need to abolish prisons (e.g., chandler, 2018; richie & martensen, 2020), and have recently taken to even more controversial abolition projects targeting the police (abrams & dettlaff, 2020) and the child welfare system (dettlaff et al., 2020), all of which are arguably more difficult to classify as categorical social problems than hunger, crime, violence, poverty, or whiteness. a burgeoning national social work collective and infrastructure has even recently progressed to the point of formal institutionalization as the network to advance abolitionist social work (naasw), focusing foremost on carcerality, but also promoting abolitionist social work praxis more broadly (see network to advance abolitionist social work, 2021). the historically consistent, socially just, and increasingly accepted position is thus for social work to commit, as it has in relation to other categorical social problems, to the abolition of whiteness. but social work has not embraced or even seriously entertained the abolition of whiteness, instead preoccupying itself with treating the aforementioned symptoms of whiteness rather than rooting out their cause (e.g., jeyasingham, 2012; lee & bhuyan, 2013; nylund, 2006), in effect thereby endorsing only half-measure solutions to the most insidious and impactful categorical social problem facing the united states today (see also de montigny, 2013; dominelli, 1989). setting aside for the time being whatever the reason might be that social work has so far proven either unwilling or unable to recognize the abolition of whiteness as crucial to racial justice, the mere fact that it has not yet come to this realization necessitates a historically accountable critical whiteness curriculum for social work. this curriculum, which will be introduced momentarily, meets social work where it is at (i.e., unaware that whiteness must be abolished or why) and gets it where it needs to go (i.e., committed to the abolition of whiteness).ii accordingly, this curriculum does not accommodate apologies for whiteness that attempt to reconstitute or misrepresent any part of whiteness as worth saving; which is to say that it sticks to historical-material fact. many will cast this pedagogical approach as ideological, when, in reality, it is that very objection which is ideological, given that it is only possible to see whiteness as anything other than oppressive and false through disconnection from historical-material fact. and this distinction is precisely the lesson the curriculum strives to impart to social work in pursuit of racial justice. mapping the critical whiteness curriculum this project uses an article format to introduce a historically accountable critical whiteness curriculum for social work. it is instructive, for what follows, to begin by unpacking the implications of that statement. first, this is an article about a curriculum. as such, it is neither fully an article nor entirely a curriculum, but a scaffold fusing elements of each in order to facilitate engagement that moves always from thinking in terms of the former toward elaborating the larger project of the latter. to that end, each section should advances in social work, summer 2021, 21(2/3) 618 be read as both describing to an external observer (i.e., reader) the topic and method of a given unit in the curriculum and exposing an internal participant (i.e., student) to the initial pedagogical encounter with that topic and method. second, it is the task of this project, vis-à-vis the curriculum, to introduce—introduce in the sense of positing a preliminary plan that is intended not as fixed or yet exhaustive, but which asserts what is estimated to be the best possible intervention at the present time with the knowledge available. the curriculum, as developed here, should endure as a moreor-less stable topical and methodological core to be amended, revised, and refined in response to the inevitable changes in and around whiteness, social work, and the ways in which they interact and intersect. third, the curriculum is historically accountable. this situates historical accountability, or accountability to history, as a necessary condition of any critical whiteness curriculum. in other words, without rigorous attention to the historical context that produces and is produced by whiteness, the curriculum cannot possibly meet its obligation to grapple with whiteness according to its etiology in lived experience. lack of historical accountability is exactly what leads to popular (bonilla-silva, 2003), academic (leonardo, 2009; matias, 2016), and legal-institutional (lópez, 2006) definitions of whiteness that are based more on myth and (often deliberate) misinterpretation than evidence and actuality. the resulting modes of ahistorical understanding fail to grasp whiteness for what it is (and is not). indeed, few social workers—or people in general, for that matter—can offer a historically informed definition of whiteness. fourth, this project sets upon building a critical whiteness curriculum. each unit of the curriculum, though unique in many ways, shares the common objective of contributing to a multifaceted, cohesive critique of whiteness as a historical-material fact, social construction, and lived reality. this description should not be taken to signify any affiliation with the formally institutionalized academic discipline of critical whiteness studies (see hartman, 2004; kincheloe & steinberg, 1998; niemonen, 2010; twine & gallagher, 2008), which, by aspiring to reconstruct rather than abolish whiteness, implicitly takes critique to be more of an end in itself than a means. lastly, the curriculum is for social work; it is not of, by, or in social work, in the sense that these alternative prepositions would suggest a self-produced social work curriculum or a curriculum assembled using tools and materials within social work. the curriculum addresses and caters to but originates outside of social work, drawing from topics and methods that social work does not traditionally engage in but which stand to immensely benefit social work’s overarching mission of social justice. the curriculum is also for social work in the sense that it is presented with the full intention that social work take possession of it, adapt it, and use it such that it may generate—and itself be regenerated by—novel forms of liberatory social work praxis. this historically accountable critical whiteness curriculum is delineated below in three sections which are designated as units of the curriculum, and that contain subsections corresponding to unit-specific lessons. unit one introduces the method of dialectical materialism and its application in capturing histories of whiteness based in global development, the u.s. nation state, and social work. unit two places the process of gregory/toward a historically accountable 619 education in reflective context to preemptively elucidate ways that whiteness might affect (or infect) the very modes of pedagogy upon which this and other curricula are forced to depend. unit three arrives at the present state of whiteness and considers theoretical and practical paradigms for responding to whiteness, ultimately demonstrating abolition to be the only treatment of whiteness that is supported by the information revealed over the course of the preceding curriculum, and that aligns, in practice, with social work’s ostensible devotion to racial justice. figure 1. a historically accountable critical whiteness curriculum for social work unit one: material histories and dialectical materialism in unit one, the essential content in which facilitators must possess proficiency and that students must internalize consists in understanding that whiteness has not always existed, that whiteness was and is (re)invented, maintained, and deployed by and in discrete individual, collective, and institutional actions prior to becoming a ubiquitous social construction; and that these processes penetrate global history, u.s. history, and social work history (see baldwin 1985; du bois, 1903/2014, 1935; morrison, 1970). this understanding is accessible through the analytical framework of dialectical materialism, which is most often attributed to marx (see marx & engels, 1932/1970), but is an extension of earlier philosophies that focused more exclusively on the material determinants of historical progress (e.g., feuerbach, 1893; ricoeur, 1986). what dialectical materialism contends, in short simplification, is what has just been stated regarding whiteness: social constructions (e.g., whiteness) first result from material conditions (e.g., colonialism and unit 1: material histories and dialectical materialism •lesson 1: whiteness in global history •lesson 2: whiteness in u.s. history •lesson 3: whiteness in social work history unit 2: education on education •lesson 1: whiteness and ideology •lesson 2: whiteness and pedagogy unit 3: beyond whiteness and whites •lesson 1: white(ness) •lesson 2: whiteness and reconstructionism •lesson 3: whiteness and neo-abolitionism advances in social work, summer 2021, 21(2/3) 620 capitalism), after which point the social and the material reciprocally influence and, indeed, form each other. this formative reciprocation is what is implied by the word “dialectical” in the name; that is, the social is formed in part by the material, and material is, in turn, formed in part by the social, each coming eventually to exist as a pure form of neither, but a mixture of both, and each with its respective namesake taking up the greater share of the form. the word “materialism” in the name indicates, however, that it is the material, not the social, which initiates and dominates this relationship—material change is more likely to force social change than vice versa. in unit one, dialectical materialism is just as important to facilitators and students as the contents concerning global, u.s., and social work history, each of which takes a turn as the critical object of this analytical framework. whiteness and global history. the first lesson topic in unit one is that whiteness did not used to exist—anywhere in the world (allen, 1994–1997; kendi, 2016). this does not mean that there were no human beings who might today be classified as white, but that the material fact of a pale phenotype was invested with no social significance. the prospect of white supremacy would have made about as much sense then as it would make today to predict that all of humankind will be organized into a hierarchical global society in which those with thick knuckle hair are presumed superior to their comparatively smooth-skinned counterparts and privileged accordingly. iii obviously, things have changed since then. dialectical materialism, by assuming some material antecedent for every social construction, compels a historical search for whatever impetus in materiality may have contributed to the global paradigm shift that gradually rendered whiteness (read: white supremacy) a thoroughly normalized fact of life. this search comprises the substance and process of the first lesson in unit one. here, the facilitator guides the student on an exploratory journey to excavate changes in historicalmaterial circumstance by which light color (and, by extension, light skin) was arbitrarily imbued with social desirability, and thus implicitly juxtaposed with dark color (and, by extension, dark skin) as socially undesirable (dyer, 1997; painter, 2010). these instances represent the seeds of nascent whiteness as a necessary developmental stage, for whiteness did not suddenly burst forth into the world in its recognized and dominating form. these incremental precursors represent inflection points that would eventually support and explain the full-fledged emergence of whiteness as an inherently oppressive, institutionally sanctioned, enveloping social relation, as it exists today. to note just one example, ibram x. kendi (2016) offers a generative starting point for this search in part i of his award-winning book, stamped from the beginning. the african slave-trade initiated by prince henry of portugal in 1415 eventually came to serve as a glorified model and historical touchstone for the future evolution of race and whiteness. interestingly, prince henry’s desire for material conquest was unmotivated by any conception of race or racism. it was, however, retrospectively rationalized and romanticized in terms of color (see de zurara, 1963; russell, 2000), laying the contrived intellectual foundation upon which subsequent slave-trading campaigns would build in order to justify the enslavement of persons with darker skin. kendi (2016) himself, ascertains the very point dialectical materialism hopes to capture in this first lesson of unit one, emphasizing that “inaugural racist ideas, in other words, were a product of, not a producer of, prince henry’s racist policies concerning african slave-trading” (p. 23). gregory/toward a historically accountable 621 whiteness and u.s. history. the second lesson topic in unit one is that the angloamerican colonies invented whiteness. given that the previous lesson reviews historicalmaterial events leading to but still predating the advent of whiteness, and considering the sadly common knowledge that the united states was founded upon a slave economy that subsisted on white supremacy and black dehumanization, it is logical to deduce that, by the seventeenth century, the pivotal historical-material turning point is imminent and likely an american domestic product. theodore w. allen (1994-1997) notes the following: “when the first africans arrived in virginia in 1619, there were no ‘white’ people there. nor, according to colonial records, would there be for another sixty years” (p. x). whiteness would soon become the single most consequential american invention and export in all of history, permanently altering the course of u.s. and global society. though the fact remains that, as already stated, whiteness did not simply appear instantaneously as a relational social identity, the dialectical materialist approach allows for the most precise approximation possible of the historical moment, broadly speaking, when certain people responded to material change in their environment by identifying for the first time as white. that historical moment was bacon’s rebellion in virginia, 1676. the rebellion created such destabilizing unrest that the small european landed aristocracy moved to devise a means by which to divide the two much larger populations of landless european peasants and enslaved africans from each other, preventing them from persisting in cooperative rebellion against class oppression (allen, 1994–1997; kendi, 2016). “the answer to the problem, obvious if unspoken and only gradually recognized, was racism, to separate dangerous free whites from dangerous slave blacks by a screen of racial contempt” (morgan, 1975, p. 328). and so in response to a threat to material class interest, the early anglo-american colonists invented whiteness, a social construct that they gradually reinforced with legal and institutional protections (hening 1823; neill, 1875; thandeka, 2000) in order to secure power and privilege at the direct expense of blackness (see also anderson, 2016, on whiteness and u.s. history). whiteness and social work history. the third lesson topic in unit one is that whiteness and social work have evolved in ways that have mutually affected each other; whiteness has informed what it means to be a social worker and to practice social work, while social work has influenced what it means to be identified and to identify as white (gregory, 2020a). as with the first lesson in this unit, which focused on white global history, this lesson, too, can be approached in an exploratory manner. reciprocity between whiteness and social work manifests in cases far too numerous to catalogue exhaustively (see dominelli, 1989; fox, 2012; goldberg, 2008; gustafson, 2009; katz, 1986; pimpare, 2007; piven & cloward, 1993), so various selections from the possible instances that serve as adequate examples can effectively demonstrate this symbiosis however the facilitator might like to contextualize the lesson in relation to geography, politics, culture, religion, etc. one recommended topic for making inroads to the substance of this lesson is the relationship between early social welfare and the first u.s. social sciences (e.g., anthropology). social welfare’s eager appropriation of social scientific methods—which relegated bipoc (black, indigenous, and people of color) to subhuman biological and social strata (gould, 1996)—summarily excluded bipoc from the socially constructed advances in social work, summer 2021, 21(2/3) 622 boundaries of “deservingness” that determined the selective distribution of aid (leiby, 1978). notwithstanding the gravity of every similar such occasion when social welfare—and eventually the formalized profession of social work—marginalized and mistreated bipoc by its very nature as a product and project of whiteness, the more serious implication of social welfare’s historical relationship with whiteness comes to bear upon the way that mainstream social work identifies itself as a profession today. stated plainly, through complicity in whiteness, social work systemically misunderstands and misrepresents itself at the individual, collective, and institutional levels as external and opposed to, rather than integral to, the historical development of racism and racial injustice. this is the overarching conclusion of lesson three, which synthesizes the essential takeaways from the previous lessons on whiteness in global and u.s. history and situates them in direct relation to social work. unit two: education on education in unit two, the essential content in which facilitators must possess proficiency and that students must internalize consists in understanding that the education system is enmeshed with whiteness and operates to (re)produce students as subjects who are legible according to the terms of whiteness. for the benefit of both the reader and the future student of this curriculum, it is and will be important to contextualize this unit in two ways. there is a chance that the topic of this unit (i.e., whiteness vis-à-vis education) might be perceived as peripheral or superfluous in comparison to the more direct connections to whiteness apparent in the other two units; and there is some risk that the lessons in this unit might be read in a way that is overdetermined, meaning more generalized and definitive in theory than turns out to be the case in practice. regarding the former concern, simply note the centrality of the education system as a mediator of any socioculturally transmitted influence (e.g., whiteness) on young persons, given the national out-of-school rate of roughly one percent (unesco institute for statistics, 2020) and the homeschooling rate of approximately three percent (national center for education statistics, 2018). note also the fact that professional social work depends on the education system for its very existence. as for the latter apprehension, it is a fair criticism that the theories discussed in this unit were originally presented by their authors as perhaps more explanatory than they really are. the theories should be taken as informative in every context, determinative in no context. this is important to clarify in order to leave room for the possibility of change that is necessary if there is to be hope for liberation from the oppression that is innate to contemporary life under the reign of whiteness. whiteness and ideology. the first lesson topic in unit two derives from french marxist philosopher louis althusser’s (1971) theory of ideological state apparatuses (isas) and interpellation. but before going any further, this necessitates an all-too-brief aside on the all-too-loosely applied concept of ideology. as developed most famously by marx, ideology is best understood in opposition to what one might colloquially refer to as that which is real or true (marx & engels, 1932/1970; see also ricoeur, 1986). thinking or acting ideologically, therefore, is for one to be guided not by that which is real or true gregory/toward a historically accountable 623 (again, in the informal sense), but by one’s idea of that which is real or true, which, of course, is subject to any and all sorts of subjective deviations. and it is a characteristic of ideology to substitute itself as that which is real or true rather than a subjective relation to it. this should sound readily familiar to u.s. social workers living amid the political climate of the year 2020, who likely encounter quite regularly the experience of a struggle to reach consensus with differently-minded others, not over opinions related to facts, but over facts themselves. this slippage in agreed-upon reality and truth depending upon subjective position is ideology at work. continuing now to althusser (1971), isas are those institutions (e.g., the school, the church, the family, etc.) that the state depends upon to disseminate its dominant ideology, but which are not always identified entirely with that function (i.e., the family is clearly more than just a state propaganda machine). althusser proposes that, in capitalist society, the school has surpassed the church as the primary isa. interpellation, he further asserts, is the process of recognition by which the dominant ideology constitutes individuals as “always-already subjects” (p. 176). though quite complex and impossible to elaborate in full within the constraints of introducing the curriculum at hand, this ideological corollary of interpellation essentially theorizes that by the mere fact of living in social contact with society as it is organized by the state, it is always the case that one can only be recognized by others and recognize oneself in terms already compatible with the dominant ideology.iv this abstract description will become clearer in the following summarizing example. the lesson is that, in the u.s. nation state, the isas—the school, first and foremost— facilitate the dominance of an ideology that is inextricably conditioned by whiteness (though it is, of course, also bound up with other determinants such as capitalism, nationalism, and heteronormativity). this ideology interpellates individuals as subjects assimilable to whiteness, meaning that individuals always recognize themselves and are recognized by others in terms of whiteness. since, again, whiteness is coextensive with white supremacy, these terms imply that recognition as white entails recognition as not bipoc, and recognition as bipoc entails recognition as not white, the former having the effect of ideological supremacy, the latter of ideological oppression. and these ideological relations exert material consequences. whiteness and pedagogy. the second lesson topic in unit two follows from french sociologist pierre bourdieu’s theories on pedagogy and cultural reproduction (bourdieu, 1991; bourdieu & passeron, 1990). if the dominant u.s. ideology is produced by and produces whiteness, and if this process depends largely upon schools and interpellation therein, there is still room to specify the mechanics of how students are continuously constituted and reconstituted as always-already subjects indissolubly related to whiteness. so far, the question of “how” has not been answered beyond it being located somewhere in the immersion of the student in the school environment. bourdieu goes further, explicating the roles of pedagogy and language in schools as means of reproducing subjects of the dominant ideology. here again, it is impossible, in an introduction to this curriculum, to do justice to the full scope and depth of the theoretical content. that task is reserved for curriculum implementation, sketching only an outline for now. in distilled form, bourdieu claims the following regarding pedagogy and language: the ideologically presumed, authoritative pedagogue (i.e., teacher) inculcates the student with understanding that advances in social work, summer 2021, 21(2/3) 624 comports with the dominant ideology; this understanding cultivates in the student a subjectivity that is dialectically related to the dominant ideology—neither purely individual nor ideological, but necessarily a synthesis of both, which bourdieu calls habitus; the habitus guides the student’s material practice in such a way as to guarantee the reproduction of the objective structures that, in the first place, secured the culture of the dominant ideology by which, among other things, the aforementioned pedagogue was presumed to be an authority. and this cultural, pedagogical reproduction of the dominant ideology and its subjects transpires in the medium of language—a sign system with the capacity to inflict what bourdieu calls the symbolic violence of assimilating an individual to the dominant ideology, even interpellating an individual as a subject of that dominant ideology, in direct contradiction with their best interest and autonomy (see also vološinov, 1986). the lesson, as it relates to whiteness, carries forward from the preceding lesson on isas and interpellation, but increases in specificity. beyond the “what” (i.e., schools traffic in the dominant ideology and constitute subjects accordingly), the “how” is now evident— students acquire the dominant ideology through pedagogy and as a product of language. and given the already established coincidence of whiteness with the dominant u.s. ideology, it follows that students in the united states are recruited as participants in whiteness through the content of the schooling they receive and the language of their lessons. this conclusion aligns with the growing body of evidence of the myriad ways that whiteness thoroughly pervades education (e.g., allen, 2004; applebaum, 2017; bonillasilva & zuberi, 2008; leonardo & manning, 2017). students are inscribed with the ideological imprimatur of whiteness not by diffuse absorption of something nebulous in the ether of the school environment, but by direct transfer of the very instructional substance that is part and parcel of the u.s. education system. unit three: beyond whiteness and whites in unit three, the essential content in which facilitators must possess proficiency and that students must internalize consists in understanding that the conflation of whiteness and whites has forestalled effective social and political action against whiteness; reconstructionism addresses symptoms but not causes of racial injustice vis-à-vis whiteness, thereby reifying whiteness through incorrectly framing the problem; and neoabolitionism represents the only response to whiteness that is historically consistent and practically aligned with the goal of racial justice. after two units spent solidifying the prerequisite familiarity with the history of whiteness and the primary means by which it is reinforced and spread, unit three finally turns toward the collective activity of responding to whiteness. this transition is imperative if the curriculum is to assist social work in moving beyond theory to a mode of praxis that directly addresses whiteness as a categorical social problem. white(ness). the first lesson topic in unit three is the rampant confusion regarding the conceptual boundary between whiteness and whites, along with the ways that this misinterpretation impedes and distracts social progress. the greatest accomplishment of whiteness has been to convince the world that whites, as such, exist. v today, any conceptual separation between whiteness and whites strikes most as mind-bendingly gregory/toward a historically accountable 625 difficult to fathom. even though biologically determined theories of race as an immutable trait have steadily declined over the better part of the last century (obasogie et al., 2015), few people have entertained the further prospect of letting go of whiteness as it is socially constructed. as many gain clarity around the fact of whiteness and white supremacy as the selfsame phenomenon, they paradoxically lament what they perceive to be the insurmountable challenge of whiteness as an ineradicable social construction, although it is precisely that which has been socially constructed that can be deconstructed and disposed. in spite of the unwilling reactionaries (e.g., gilbert, 2016) or the unwitting conformists (see hartmann et al., 2009), even those who critically engage the social problem of whiteness all too often orient themselves to intervention in ways that make an oxymoron out of whiteness as an allegedly irreversible social construction. this is because prevailing understanding conflates whiteness with whites. whiteness is a social construction; whites are individuals who positively identify or are affirmatively recognized in relation to whiteness. whether whiteness flourishes, decays, or disappears altogether, the individual does not change; but the relation of the individual to whiteness may change. it is only because the social construction of whiteness has, since its invention, subsumed nothing other than countless desires for the acquisition of capitalvi in various forms (e.g., social, cultural, economic, political) that it is systemically mistaken for something incorporated by and in the individual; it is something the individual has and is (see also harris, 1993; lipsitz, 1998). this erroneous attribution of whiteness as rather than to individuals has the effect of inhibiting social or political resistance to whiteness, given the much more precarious task for activists of combating people than an idea, as well as the more impassioned resistance elicited in defense of the self than a relation. put differently, the conflation of whiteness with whites is what leads people to take anti-racism as a personal affront; it is what compels donald trump and those in service to him, in the year 2020, to issue an executive memorandum condemning the concept of white privilege and the analytical paradigm of critical race theory as “divisive, false, and demeaning propaganda” (para. 5) and as “anti-american” (vought, 2020, para. 1), as if individuals, rather than social constructions, were under scrutiny. whiteness and reconstructionism. the second lesson topic in unit three is the reconstructionist response to whiteness. reconstructionism describes probably 95 percent of research, scholarship, and sociopolitical practice that responds directly to whiteness (see kincheloe et al., 1998, for the programmatic reconstructionist text; see also leonardo, 2009, pp. 61–74, on reconstructionism).vii it is a general, descriptive category, not a selfdesignation among those to whom it applies. the name is relatively transparent about what this mode of response to whiteness entails (i.e., the reconstruction of whiteness), but it is important to explicitly draw out the two implicit, definitive parameters that set the reconstructionist agenda. first, reconstructionism insists that whiteness change in a way that is decidedly antiracist. second, reconstructionism assumes the persistence of whiteness in some form, thus problematizing symptoms of whiteness, not its existence. reconstructionists diverge methodologically in both subtle and significant ways, but they are unified in the fact that they provide no justification for this second tenet, making it an assumption in the absolute sense. instead, when the subject is broached of a world without whiteness, advances in social work, summer 2021, 21(2/3) 626 reconstructionists characteristically make an argument about whites rather than whiteness. viii shannon sullivan (2014) is exemplary in this regard when she directly addresses the social movement for the abolition of whiteness, writing, “i object to its mission because it underestimates the significance of whiteness to many people’s identities and habits, and not just those who are avowed white supremacists” (p. 141). confronted by the abolition of whiteness as a hypothetical, sullivan says nothing about whether whiteness can be abolished, but weighs in on whether it should be abolished, claiming that, in fact, it should not, citing the “significance” of whiteness to whites. the signature of reconstructionism is any argument similar to sullivan’s, which answers questions about possibility with concerns about plausibility. every time, in whatever form, this amounts to an assertion that whiteness cannot be abolished because it would be too hard. whiteness and neo-abolitionism. the third lesson topic in unit three is the neoabolitionist response to whiteness. if the above estimate is accurate, then it follows that neo-abolitionism encompasses somewhere around five percent of the research, scholarship, and sociopolitical practice that responds directly to whiteness. the late harvard professor noel ignatiev and his collaborator john garvey founded the still-marginal neo-abolitionist movement in the late 1990s, publishing the sole explicitly neo-abolitionist text, race traitor, in 1996. the movement was also intellectually sustained by significant empirical and theoretical contributions from roediger (1991, 1994). these scholars are mentioned in text rather than parenthetically because, contrary to reconstructionism, neo-abolitionism is a program with which individuals do self-identify (though roediger has maintained a safe distance in practice despite his written pronouncements). and these three, collectively, set the terms of neo-abolitionism in their own words. ignatiev and garvey (1996) situate neoabolitionism as a theoretical possibility, contending “first, that the ‘white race’ is not a natural but a historical category; second, that what was historically constructed can be undone” (p. 35). roediger (1994) attempts to motivate the abolition of whiteness as a sociopolitical intervention, opining: we cannot afford to ignore the political implications of the mass questioning of whiteness as a trend and a possibility in the us. in a variety of settings . . . whites are confessing their confusion about whether it is really worth the effort to be white. we need to say that it is not worth it and that many of us do not want to do it. (p. 16) as ignatiev and garvey point out, neo-abolitionism is theoretically consistent with historical-material fact (which students will, by this point, realize based upon the first two units of the curriculum). it targets the abolition of whiteness as the unavoidable first step toward deconstructing the overarching social typology of race, which sustains racial inequity and injustice. zeus leonardo (2009) sums up the rationale for taking on whiteness directly as a necessary and efficacious strategy for dealing with the larger problem of race when he states that “without a privileged center, there can be no denigrated margin” (p. 71). but neo-abolitionism has never developed a means of praxis—theory-informed practice and practice-informed theory. in fact, neo-abolitionism has hardly begun to articulate any plan even for mere practice, save anecdotal evidence of white individuals giving their best ad hoc, subjective, inconsistent interpretations of what it might look like to embody and enact a new, chosen identity that they describe as a “race traitor” (see gregory/toward a historically accountable 627 ignatiev & garvey, 1996). while reconstructionism lacks a coherent theoretical foundation but proceeds nonetheless to practice, neo-abolitionism, conversely, begins from a theoretically sound point of departure without any plan for practical implementation. in their present forms, neither can offer a viable path to racial justice. but neo-abolitionism at least contains the potential to eventually, in a more mature form, break through the limitations of a human condition that is existentially constricted by whiteness and the social construction of race. conclusion: notes toward implementation the historically accountable critical whiteness curriculum for social work that is proposed here attempts to cover a lot of ground: global origins of color distinctions leading to colorism; the invention of whiteness and attendant racism; the formation of social work alongside of whiteness; state deployment of white ideology and the creation of subjects in relation to whiteness; schools and the uses of pedagogy and language in the cultural reproduction of white ideology and subjects in relation to whiteness; the relationship between whiteness and whites; the reconstruction of whiteness (reconstructionism); and the abolition of whiteness (neo-abolitionism). to teach these topics comprehensively over the course of a curriculum presents an immense challenge; to introduce these topics completely here is impossible. again, each section should be read as both describing to an external observer (i.e., reader) the topic and method of a given unit in the curriculum and exposing an internal participant (i.e., student) to the initial pedagogical encounter with that topic and method. what is written here should be taken as the beginning, not the entirety, of the curriculum content, along with clear indications of where to expand and suggestions for resources and strategies that will aid in fully bringing the curriculum to fruition. table 1 provides discussion questions designed to both deepen learning and to facilitate the further development of this curriculum, along with important resources related to each unit. these resources are valuable not only for their original content, but also for their references and footnotes, which, themselves, exponentially broaden the historical and theoretical terrain that may yield insights generative to the curriculum, its facilitators, and its participants. advances in social work, summer 2021, 21(2/3) 628 table 1. curriculum questions and resources unit discussion questions important resources material histories and dialectical materialism 1. when, where, why, and how did light color become socially valued over dark color? 2. when, where, why, and how was whiteness invented? 3. how has social work affected and been affected by whiteness? allen, 1994–1997; brodkin, 1998; hale, 1999; lópez, 2006; ignatiev, 1995; kendi, 2016; painter, 2010; roediger, 1991, 1994, 2005; thandeka, 2000 education on education 1. how is the education system related to ideologies of whiteness? 2. how does whiteness affect students, as learners and people, through education? 3. how does whiteness operate through language? althusser, 1971; bourdieu, 1991; bourdieu & passeron, 1990; bonillasilva & zuberi, 2008; hill, 2008; vološinov, 1986 whiteness, whites, and beyond 1. how is whiteness different from whites? 2. what is reconstructionism, how might one enact it, and to what effect(s)? 3. what is neo-abolitionism, how might one enact it, and to what effect(s)? ignatiev & garvey, 1996; gregory, 2020b; kincheloe et al., 1998; leonardo, 2009; roediger, 1994 in the course of proposing this curriculum, it has been stated on the one hand that these lessons will get social work from where it is at (i.e., unaware that whiteness must be abolished or why) to where it needs to go (i.e., committed to the abolition of whiteness). on the other hand, the curriculum does not include a plan for what the abolition of whiteness looks like as praxis. this is intentional. the commitment to the abolition of whiteness is as far as the curriculum intends to go, for now. it is one thing for the curriculum to review and interpret available facts, and even to draw a conclusion that suggests a particular response. it would be another thing altogether for the curriculum to prescribe the manner of that response, at this stage. neo-abolitionist social work praxis must grow from collective, participatory learning, and action. ironically, if it did not, it would simply reproduce ways of knowing and being that are historically characteristic of whiteness. this would quickly become self-defeating. the present discussion—this transitional step between an article and a curriculum—is neither a collective nor participatory intellectual product, but a single exercise in extending an invitation to the larger social work community to join in a collaborative movement in theory and practice toward the abolition of whiteness. as such, this alone cannot envision the steps from theory to practice in a way that is inclusive or sustainable. the possibility and shape of neo-abolitionist social work praxis can only be realized by first attempting to implement a historically accountable critical whiteness curriculum for social work. perhaps then, and only then, future iterations of the curriculum might include a plan for praxis. in a sense, the only way to finish is to begin. gregory/toward a historically accountable 629 i as one piece of highly public and commonly known evidence that clearly illustrates the lack of urgency displayed by social work toward racial justice issues in comparison to matters of social justice unrelated to race, simply consider that the goal of ending racism was included as a “grand challenge for social work” only in 2020, seven years after the so-called challenges were introduced as a social work guiding framework in 2013 (rao et al., 2021). ii hopefully the social worker that has already realized these truths will accept an apology, here, and understand that this necessary generalization is based upon and addressed to the overwhelming majority of social workers and prevailing social work institutions that have never considered the abolition of whiteness. iii jane elliott’s (2016) famous blue eyes/brown eyes experiment, originally conducted in 1968, represents perhaps the most classic case study on the observed effects of arbitrarily attaching social value to phenotypic traits, and illustrates the unnatural dissonance that social stratification must forcibly overcome in order to gain acceptance as a societal norm. iv paul ricoeur (1986) says the following in his own attempt to put the matter of interpellation succinctly, which might provide helpful additional context where my own introduction of this concept is necessarily abbreviated: “althusser’s interesting analysis of what he calls ‘interpellation’ demonstrates more specifically the relationship between ideology and the subject … we are constituted as subjects through a process of recognition. the use of the term ‘interpellation’ is an allusion to the theological concept of call, of being called by god. in its ability to interpellate subjects, ideology also constitutes them” (pp. 148–149). v baudelaire (1869/1970) originally wrote, “la plus belle des ruses du diable est de vous persuader qu’il n’existe pas,” or, roughly translated, “the most beautiful trick of the devil is to persuade you that he does not exist” (p. 61). vi capital has to be understood here in the strict sense of surplus value. vii reconstructionism’s ubiquity makes individual citations less meaningful as examples, but a few additional representative texts include alcoff, 2015; ellsworth, 1997; giroux, 1997; and feagin, 2013. viii the reconstructionist literature has never fully separated whiteness from whites, and has consequently yet to respond to roediger with a historical example of whiteness as anything other than oppressive and false. reconstructionists frequently cite examples of whites who are not oppressive and false, testifying to the individual but not the social construction. if there is any part of whiteness that is, or ever has been, inherently positive and independent from an implicit, negative relation to bipoc, reconstructionism has not identified it. gregory/toward a historically accountable 630 references abrams, l. s., & dettlaff, a. j. 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(2020). m-20-34: memorandum for the heads of executive departments and agencies: training in the federal government. executive office of the president: office of management and budget. https://www.whitehouse.gov/wpcontent/uploads/2020/09/m-20-34.pdf author note: address correspondence to joshua r. gregory, school of social welfare, university of california, haviland hall, berkeley, ca 94709. email: jrgregory@berkeley.edu http://data.uis.unesco.org/index.aspx https://www.whitehouse.gov/wp-content/uploads/2020/09/m-20-34.pdf https://www.whitehouse.gov/wp-content/uploads/2020/09/m-20-34.pdf mailto:jrgregory@berkeley.edu 20_gregory_24094_historisizing_swk_education 20_gregory_24094_historisizing_swk_education-references _________ december maxwell, msw, the university of texas at arlington, school of social work, arlington tx, 76019, december.maxwell@uta.edu & sarah r. robinson, lmsw, the university of texas at arlington, school of social work, arlington, tx 76019, sarah.robinson3@mavs.uta.edu copyright © 2019 author, vol. 19 no. 2 (spring 2019), 181-200, doi: 10.18060/22608 this work is licensed under a creative commons attribution 4.0 international license. safety for american indian women: an indigenous-focused policy analysis of violence against women act-title ix december maxwell sarah robinson abstract: american indian/native american (ai/na) women are disproportionately affected by intimate partner violence (ipv). the violence against women reauthorization act (vawa) of 2013 included new provisions under the title ix safety for indian women. this act created funding for the implementation of modern criminal justice structures allowing tribal governments to prosecute non-indian perpetrators. although this piece of legislation is meant to address the high prevalence of gender-based violence perpetrated against ai/na women, it has not been analyzed using indigenous or feminist perspectives. a policy analysis model was developed, incorporating indigenous values, feminist perspectives, tribal critical race theory, and social construction and historical contexts to examine title ix's goals, social values, and outcomes from an indigenous perspective. the analysis reveals the intentions of title ix to promote indigenous values of empowerment and interdependence but fails to account for the historical marginalization of ai/na people and the tendency of ai/na women to distrust law enforcement. although title ix did create cultural change and enhance acknowledgment of ipv improvements are needed to make a more indigenous-focused, feminist-based policy. these suggestions include providing access to culturally sensitive law enforcement approaches for ai/na women, accounting for historical factors, and creating a standardized pathway for prosecution, which incorporates feedback from tribal members. keywords: violence against women act; american indian; policy analysis; ipv congress initially passed the violence against women act (vawa) in 1994 after recognizing the prevalence of crimes related to intimate partner violence (ipv) such as stalking, harassment, and sexual assault that disproportionately affects women (breiding et al., 2014). in 2013, congress passed a reauthorization of vawa, which included updated provisions that protected specific groups of women including immigrants and women who are members of federally recognized “indian” tribes as they are named in the act (united states [us] congress, 2013). within these provisions, title ix safety for indian women sought to address tribal sovereignty and a criminal justice response to ipv. the new aspect of the policy allowed provisions for prosecuting crimes of ipv against american indian/native american (ai/na) women by non-tribal perpetrators (us congress, 2013). title ix created provisions for tribal governments to opt-in to prosecute non-tribal perpetrators of ipv who are affiliated with the tribe in some way, such as working or living on the reservation or being married to or in a relationship with a tribal member (us congress, 2013). mailto:december.maxwell@uta.edu mailto:sarah.robinson3@mavs.uta.edu https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(1) 182 prevalence rates of ipv are much higher among ai/na women than any other racial/ethnic group in the u.s. (houry et al., 2017). prosecution rates for ipv against ai/na women prior to title ix was disparate with attorneys refusing to prosecute (national congress of american indians, 2018). over half (52%) of violent crimes that occurred happened in indian country (67% of which are sexual violence cases; ncai policy research center, 2013). the reasons why these cases are not prosecuted are multitudinous, such as ambiguity about jurisdiction among tribal governments and which guarantees tribal courts must extend to defendants, such as legal representation (gross, 2016). additionally, there is a social construction of ai/na people as "other," in both personal and governmental framing, wherein ai/na people are painted as incapable of upholding laws or even unable to understand the law and ai/na women are considered meek or passive (sangster, 2016). these biases used in mainstream media and in government forums may also contribute to prosecutors choosing to not prosecute non-tribal members of violent crimes against ai/na women (sangster, 2016). continued unwillingness to formally prosecute non-tribal members of violent crimes against women perpetuates long-standing structural oppression against ai/na women. this continuing oppression is evident as crimes against ai/na women have historically been and are still largely ignored, including rape, sterilization, and ipv (amnesty international, 2007) and arguably continues the legacy of historical trauma (kirmayer, gone, & moses, 2014). five tribes participated in a pilot project which assessed the implementation of title ix by the department of justice before the official implementation date of march 7, 2015 (united states department of justice [us doj], 2015b). a five-year report on passage of title ix of vawa 2013 was released march 20, 2018, presenting prosecution statistics, profiles of each tribe participating, implementation strategies, and outcomes (national congress of american indians, 2018). although this report is a comprehensive analysis of the policy’s effectiveness, it does not discuss cultural implications or the values inherent to the policy (berney, 2015;national congress of american indians, 2018). in addition, reports do not contain an analytical framework that encompasses outcomes through the lens of gender or indigenous cultural values. the analysis in this article examined the policy using a framework that was developed to accurately assess policy outcomes applying indigenous values, gender issues, and social construction. this analysis addresses how shifting socially constructed norms of gender, gender-based violence, and feminism are relevant to this policy's outcomes as well as implicit and explicit objectives. the analysis also addresses culturally-related concepts such as: marginalization, wherein ai/na people have historically been treated as a peripheral group (dunbar-ortiz, 2014); "otherness," which is similar to marginalization but ai/na cultural practices are considered inferior to western-inspired approaches (sangster, 2016); colonization, which is the continued attempt to co-opt ways of knowing and doing of indigenous people and supplant it with western-inspired ways (tuhiwai smith, 1999); and indigenous goals of empowerment and interdependence, which promote working together and understanding the importance of all persons to exist and thrive (chino & debruyn, 2006). finally, this analysis focuses on the values that define the problems addressed by this policy and how these values can be used to evaluate policy outcomes. maxwell & robinson/safety for indian women 183 definition of terms defining the following terms is integral to understanding the interpretation of the policy within the subsequent analysis. definitions, as they are used in this analysis, are provided below. indigenous-focused. using writings and voices from indigenous leaders from around the world, indigenous-focused pertains to the use of indigenous scholars’ perspectives on the best ways to approach laws, research, and work with people belonging to indigenous groups (chino & debruyn, 2006). indigenous-focused makes no attempt to homogenize cultural practices or values of various global indigenous groups, but rather uses values that have been recognized as shared among contemporary indigenous groups such as interdependence (the value of working together), de-colonization (the ability of indigenous people to maintain or reclaim their own processes and ways of knowing and doing), and addressing global imperialism that has oppressed indigenous people. american indian/native american (ai/na) tribal members. this policy analysis encompassed members of federally recognized ai/na tribes or alaska natives. criteria for tribal membership is established by the tribe and it may be related to blood quantum or based on relationship to ancestors on official government documents (i.e., relatives registered on the dawes rolls; national archives, 2016). intimate partner violence. intimate partner violence (ipv) is defined as physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner (centers for disease control [cdc], 2017). ipv can also include control of sexual or reproductive health (houry et al., 2017). intimate partners can consist of boyfriends, girlfriends, dating partners, sexual partners, and current or former spouses (cdc, 2017). ipv can occur within same-sex couples as well as heterosexual couples, and sexual intimacy is not required for abuse to be considered ipv (houry et al., 2017). indian country and federally recognized tribe. indian country was officially defined by u.s. congress in 1948 to include "all land within the limits of an indian reservation under the jurisdiction of the united states government,…any dependent indian communities within the borders of the united states [and] all indian allotments, the indian titles to which have not been extinguished” (indian country defined, 18 u.s.c., § 1151, p. 321, 1948). the current definition of tribe within this policy is a federally recognized tribe. federally recognized tribes have a government-to-government relationship with the u.s. with responsibilities, powers, limitations, and obligations attached to that designation. federally recognized tribes are also eligible for funds and services from the bureau of indian affairs (2018). restorative justice. restorative justice is an approach to reducing crime wherein harmony and balance are sought between both perpetrator and victim as opposed to using punitive measures (hand, hankes, & house, 2012). further, the focus of restorative justice is on how harmony can be restored to an affected group and acknowledges that an entire community, not just an individual, are affected by acts which disrupt unity (hand et al., 2012). restorative justice has been used within indigenous communities long before advances in social work, fall 2019, 19(1) 184 european settlers arrived to the u.s. and operates in contrast to the criminal proceedings of the western world as it attempts to recognize the humanity in all people as well as the way a community can problem solve beyond mere punishment or retributive measures of an individual for a crime (hand et al., 2012). review of the literature the problem of intimate partner violence intimate partner violence (ipv) exists along a continuum of violent acts (hayes, mills, freilich, & chermak, 2018). intimate partner sexual violence, physical violence, and stalking are reported by 37% of women in the u.s. in their lifetime (houry et al., 2017). however, violence against women on tribal reservations far exceed any other group of women in the u.s. (women of color network, 2006). within their lifetime, 55% of ai/na women report experiencing ipv (national congress of american indians, 2018). those who report experiencing ipv also indicate that 90% of their perpetrators are non-tribal members. prosecution of violence from non-tribal members is difficult due to jurisdictional complexities arising from the federal government’s limitation of tribes to prosecute nontribal members (rosay, 2016). until the passage of title ix in 2013, tribes were not allowed prosecute non-tribal offenders, which led to ai/na women becoming targets of sexual crimes (rizzo, 2015). in an interview for vice magazine about an author’s book on the violence against indigenous women, casselman describes research that found that men in internet chat rooms discussed ai/na women as targets because rapists thought they could “get away with it” (rizzo, 2015). ipv affects public health in the u.s. in many ways. mental health disorders are associated with ipv among ai/in women, as those experiencing ipv are more likely to have more days with mental health problems than those who have not (harwell, moore, & spence, 2003). ai/in women have higher rates of anxiety, ptsd, and mood disorders relative to ipv experience (duran et al., 2009; evans-campbell, lindhorst, huang, & walters, 2006). in addition, there are numerous health consequences of ipv victimization such as increased likelihood of gastrointestinal issues, heart disease, high blood pressure, and chronic stress (bosch, weaver, arnold, & clark, 2017; dichter, cerulli, & bossarte, 2011; halpern et al., 2015, 2017). rosay (2016) reported that 41.3% of ai/na women were physically injured as a result of experiencing ipv. similarly, ai/an women ipv victims were 2.3% more likely to need medical care than other groups (rosay, 2016). risky sexual behaviors are also related to emotional trauma from ipv with more ai/na women contracting hiv due to unsafe sex (evans-campbell et al., 2006). the lasting health consequences of ipv for ai/na are far-reaching and requires intervention. the problem of prosecution in tribal communities tribes were sovereign before the immigration of europeans to the u.s. at the point of european contact, indigenous tribes made clear that they had inherent authority over their governments within what later became the borders of the u.s. (macklem, 1993). england and later, the us, engaged in treaties with ai/na tribes, establishing government-togovernment relationships. the us constitution created provisions for tribal sovereignty maxwell & robinson/safety for indian women 185 and future constitutional interpretations upheld by u.s. supreme court cases, including cherokee nation v. georgia (1831) and worcester v. georgia (1832) that continued to support tribal sovereignty. these supreme court rulings defined the us interpretation of legal sovereignty for tribes as they asserted that tribal governments retained jurisdiction over their affairs and the federal government was an overriding power in specific instances (macklem, 1993). currently, states with federally recognized tribes within their borders often have little to no power over tribal affairs (diamond, 2018). however, this varies from state to state. the specific instances in which the federal government claimed to have jurisdiction were defined by the indian appropriations act of 1871 (appropriation bill for indian affairs, 1871). the indian appropriations act posited that the federal government would interact with tribes through statutes rather than through previously arranged treaties, and that act also asserted that certain crimes, such as rape, murder, arson, and burglary, were under federal jurisdiction (macklem, 1993). even with the provisions that certain crimes were under federal oversight, tribal governments were mainly left to themselves (macklem, 1993). the unfortunate consequence of the way tribal sovereignty has been interpreted is that tribal governments could only prosecute tribal members, which meant that for crimes outlined by the indian appropriations act, tribal governments were not allowed to seek justice. in addition, tribal governments were not allowed to prosecute crimes committed by non-tribal members against tribal members on reservation land (national congress of american indians, 2018). the way that tribal sovereignty has been constructed stopped prosecution of non-tribal members when crimes were not under federal jurisdiction. such is the case with ipv. because ipv was not included in the original federal oversight, ipv perpetrated by a nontribal member not resulting in a homicide or rape, left tribal governments without legal jurisdiction (ncai policy research center, 2013). therefore, victims of ipv were left to either attempt to get local governments involved, or without any criminal justice options, seek restitution or punishment through other means (modi, palmer, & armstrong, 2014). vawa reauthorization of 2013, title ix because tribal governments were prohibited from prosecuting non-tribal members for crimes committed on reservations, ipv by non-tribal members against tribal members was not prosecuted (ncai policy research center, 2013; us doj, 2015a). due to the significant number of domestic and sexual violence cases, provisions specifically for ai/na peoples were included in the vawa 2013 reauthorization (berney, 2015; modi et al., 2014). title ix safety for indian women of vawa 2013 allowed tribes to “exercise their sovereign power to investigate, prosecute, convict, and sentence both indians and non-indians who assault indian spouses or dating partners, or violate a protection order in indian country” (us doj, 2015a, para. 2). beginning march 7, 2015, tribes could issue protection orders and start criminal prosecution of non-ai/na abusers. however, crimes between strangers, crimes committed by people who are not living on the reservation or tied to the tribe, crimes against a child, and crimes between two non-ai/na on the reservation were still not covered under title ix (us doj, 2015a). advances in social work, fall 2019, 19(1) 186 policy goals and objectives the primary goal of title ix of vawa 2013 was to reauthorize the vawa. a cultural shift surrounding gender-based violence was necessary due to the alarming rate of ipv, particularly against ai/na women. to meet this goal, tribal governments were able to prosecute non-ai/na perpetrators as long as they had some affiliation with the tribe (i.e., living on the reservation, married or related to tribal members, or worked on the reservation). other objectives were outlined through grant provisions which provided funds to develop prevention campaigns, increase awareness of services, and establish victim’s service centers. policy analysis framework the purpose of this article is to analyze the passage of vawa 2013’s title ix safety for indian women act using four existing policy analysis frameworks that focus on the rights and perspectives of ai/na women. as such, the analysis model incorporates aspects of a feminist policy analysis framework (mcphail, 2008), a values perspective framework (segal, 2007), a social construction policy analysis framework (ingram, schneider, & deleon, 2007), tribal critical theory (tribalcrit) (brayboy, 2005), and borrows from a policy capacity building framework that is ai/na peoples-informed and focuses on integrating ai/na values into policy (chino & debruyn, 2006). since ipv disproportionately affects women, outcomes that favor women within this policy are desired and therefore applying a feminist policy analysis framework was fitting. similarly, although the capacity-building framework was not initially intended for policy analysis use, values important to ai/na people such as empowerment and interdependence were integrated. furthermore, many scholars argue for interventions, such as policies like title ix, to be culturally competent and informed by ai/na values (yuan, belcourt-dittloff, schultz, packard, & duran, 2015). in addition, facets of the social construction framework were incorporated to apply cultural values and perspectives of ai/na people to the policy outcomes. tribal critical race theory addresses the ways laws may benefit the dominant culture at the expense of indigenous people, and therefore was included to add a lens evaluating how indigenous people are centered in title ix. finally, segments of segal’s (2007) values-perspective framework were included to address social values, belief systems, and inequities that may arise due to the policy. the following figure outlines the framework created for this analysis. first, the intentionality of the policy was discussed according to three existing frameworks of analysis: 1) ai/na first-perspective to determine if the policy promotes relationshipbuilding, empowerment, interdependence, and commitment, 2) social construction and historical contexts to determine how the policy addressed the allocation of benefits and power dynamics, as well as how ai/na women may have interpreted the policy, including its usefulness, 3) tribal critical race theory to evaluate how race/ethnicity of ai/na people specifically relates to development of u.s. policy, and 4) feminist aspects of the policy to determine the ways the policy addressed women and their lived experiences. finally, the contributions of the policy are analyzed using existing data and assessing feasibility and latent outcomes. see figure 1 for a visual representation of the analysis. maxwell & robinson/safety for indian women 187 figure 1. vawa 2013, title ix policy analysis model analysis intentionality of policy the intention of the original 1994 vawa was to increase empowerment of victims of ipv by providing legal pathways to prosecute abusers and funding for shelters, advocacy, awareness, and prevention (modi et al., 2014; whittier, 2016). title ix (us doj, 2015a) expanded these benefits to ai/na women who were victims of ipv which was perpetrated by ai/na or non-iai/na partners. it authorized tribal governments to become involved in the prosecution of ipv offenders. the following analyzes the values and historical contexts that contributed to the formation and intention of vawa title ix safety for indian women (2013). indigenous-focused perspective. because title ix (us doj, 2015a) supported voluntary participation to exercise special ipv criminal jurisdiction. the provision empowered tribes as it enabled them to prosecute additional crimes on their reservations. furthermore, the grant provisions included in title ix promoted the formation of tribal coalitions within tribes to address ipv, which aligns with multiple ai/na values such as skill-building, empowerment, relationship building, and interdependence (chino & debruyn, 2006). through coalitionbuilding, interdisciplinary input was used to create partnerships among and between tribes, tribal community services, health services, social services, and law enforcement. in this way, interdependence on one another was fostered as well as relationship-building. grant funding encouraged tribes to create interventions that were consistent with their communities’ goals and values, which increased tribal empowerment. several evaluative reports cited vital stakeholders within tribes and the national congress of american indians who stated that title ix had prompted updates to ipv laws and empowered tribal members to report ipv to law enforcement (fonseca, 2018; national congress of american indians, 2018; schilling, 2018). finally, title ix showed ai/na people a commitment by intentionality of the policy •native-first perspective •social construction & historical context •tribal critical race theory (tribalcrit) •feminist aspect policy contributions •feasibility •latent outcomes •evaluation of current data advances in social work, fall 2019, 19(1) 188 the federal government to protect ai/na people from gender-based violence by allocating funds and resources in addition to relinquishing prosecutorial power. however, robertson (2012) argued that the formation of title ix (2013) included ai/na voices only when their words were within the context of white supremacy and western-eurocentric ideals of legislation and tribal existence. for example, the legal term used for ai/na people in this and all legal documents is still indian, demonstrating that the us government still perpetrates colonization. although there were ai/na people on the coalition who helped form title ix, robertson (2012) stated that when their input encouraged decolonizing methods of violence prevention, such as allowing more tribal sovereignty by expanding the act to cover perpetrators not known to the tribe, robertson (2012) found that their input was often ignored and not included. in this way, title ix was informed by ai/na input, however, ai/na voices were not always incorporated. social construction and historical contexts. social constructionism espouses the theory that knowledge is constructed through shared experiences, meaning making, and how a population shares an understanding of reality (ingram et al., 2007). within policy analysis, social constructionism particularly evaluates how realities are formed through policies and politics that become a reality in the wake of policy implementation (ingram et al., 2007). the social construction of a population often contributes to the development of policies regarding such a population (ingram et al., 2007). because the media significantly impacts worldview, it is crucial to evaluate the media’s influence on the social construction of perceptions about people and policies. in a study on the impact of media on perceptions of title ix, sangster (2016) found that some media outlets argued that the added provision of title ix into the passage of vawa 2013 created special privileges for ai/na people because the existing act already encompassed all people. this framing of the issue as an “extra” provision allocated for ai/na people was a partisan issue drawn between democrats and republicans, signifying the social constructions surrounding oppression, intersectionality, and who is entitled to protection under the law. furthermore, otherness is often projected onto ai/na people in the u.s. through media portrayal, marginalization, and historical contexts which have shaped the discourse about title ix (meek, 2006). the u.s. has a history of genocide against ai/na people (madley, 2008); therefore, the power distribution of tribal sovereignty has not been balanced for ai/na people. crimes against ai/na people have been an issue throughout the history of the u.s. (anderson, 2016). despite attempts to present a softer narrative, historical relations between ai/na peoples and the u.s. government have been tenuous including mythical tales of pocahontas (hansford, 2000), relations between the us government and ai/na peoples regarding treaties broken by the us government (akers, 2014), implementation of the indian child welfare act (raia, 2017), and limitations on sovereignty as seen with the protests at standing rock (celeste, 2017). in addition, policing on reservations has reinforced western-imposed laws that did not always reflect the cultural values of the people on which the laws were being imposed by a governmental agent (redner-vera & galeste, 2015). as a result, ai/na people have long been distrustful of the colonizer-imposed government (redner-vera & galeste, 2015). even though acceptance towards policing on reservations may have improved in some maxwell & robinson/safety for indian women 189 locations, ai/na people retaining control of policing is still essential for both sovereignty and cultural maintenance (redner-vera & galeste, 2015). viewing title ix (2013) through a lens of historical maltreatment, the provision attempts to balance that distrust with more autonomy. by acknowledging the right of tribal governments to prosecute non-ai/na people for ipv crimes, the us government acknowledged that tribal governments are sovereign and supported their need to protect their citizens. furthermore, the voluntary nature of title ix allows tribes to opt in. also, title ix enables tribes to design culturally-relevant support systems and prevention efforts, acknowledging tribes’ freedom to interpret the provision and retain power over themselves. from a social construction perspective, title ix succeeds in integrating historical contexts and current marginalization to produce a policy that works for ai/na people. as mentioned above, however, the process of prosecution for ipv through title ix still fails to integrate decolonizing approaches which are informed by ai/na people who believe that is important. for example, prosecution does not incorporate a restorative justice approach. tribal critical race theory (tribalcrit). critical race theory (crt) is an approach to examining society which “exposes contradictions in law and illustrates the ways that laws create and maintain a hierarchical society” (brayboy, 2005, p. 428). in addition, crt insists that race is a critical piece of how our culture is developed, since race is tied to power hierarchy and treatment of groups of people (chandler, 2010). from crt, tribal critical race theory (tribalcrit) was developed to more adequately address colonization, tribal sovereignty, and tribal philosophies, customs, and beliefs as they relate to power imbalances in modern society and governments (brayboy, 2005). when applying tribalcrit to title ix, it is easy to see that although provisions in title ix allowing tribal governments to begin prosecuting non-tribal members for crimes perpetuated against tribal members aims to be empowering towards tribal sovereignty, it simultaneously imposes larger federal constitutional laws on the tribes (such as necessity of a jury of white peers), which forces additional assimilation. in addition, another tenant of tribalcrit is that tribal members exist in a liminal space, which is a space of transition wherein the tribal members cannot exist in their past identities as ai/na people, but also are not wanting to abandon traditional values and ways of life either (brayboy, 2005). further, this means that ai/na people are both a racial/ethnic group and a political/tribal group, and therefore, policies aimed at ai/na people need to address both facets of this identity. however, title ix only addresses the political/tribal aspect as it gives legal provisions for prosecution of non-tribal members, but largely ignores racial/ethnic historical legacies of ai/na distrust of federal government involvement in tribal affairs. that being said, according to tribalcrit, title ix does not adequately address prosecution of non-ai/na members in a way that decreases colonization and addresses the liminal space of which ai/na people occupy. this approach does not support the use of restorative justice, which has been effectively utilized for centuries by indigenous peoples when someone has been victimized as it fails to allow the entire community to evaluate the crime and focuses solely on punitive measures of justice (hand et al., 2012). feminist lens. even though title ix (2013) encompasses all genders experiencing ipv, the prevalence of ipv among women shows that the policy was developed to protect advances in social work, fall 2019, 19(1) 190 mostly ai/na women from ipv perpetrated by non-ai/na people. furthermore, the essence of the original vawa was framed as a gendered crime piece of legislation (whittier, 2016). in this way, title ix accounts for historical and political/legal contexts of women's lives because it provides a legal remedy for ai/na women who experience ipv through the prosecution of their abusers, if tribes choose to opt in. conversely, title ix does not provide specific access to assistance for victims. although the motivation for this deficiency is to allow tribes to retain sovereignty and cultural relevance, it is possible that victims may not be aware of changes to the law or have pathways to prosecute their abuser. however, there are ways which title ix fails to account for the historical, legal, social, political, and cultural contexts of both women and ai/na peoples. the historical legacy of tension between ai/na people and law enforcement in general means implementation of title ix may still be met with opposition, mainly from ai/na women. carceral feminism, for instance, argues that the criminal justice system and “control over women’s lives and bodies…is increasingly exercised at a cultural level through a gendered and ubiquitous ‘fear of crime’” (bernstein, 2012, pp. 234-235) which has numerous social implications. notably, some states have mandatory arrest laws which insist that at least one person be arrested when a domestic violence issue has warranted police response (hirschel, 2008). these laws may prevent victims who may fear being arrested from reporting the crime, and therefore inhibit women suffering abuse from reporting it. although these state laws do not impact tribal governments and tribal law enforcement, ai/na women who are victims may fear the implementation of such laws and the potential of such events occurring. moreover, from an intersectional standpoint, any intensified criminal justice interaction for ai/na women experiencing ipv may be met with three-fold opposition. first, even though tribes may have tribal members in their police force, ai/na woman may distrust western-imposed law enforcement regulations, which may limit their acceptance and participation in any new policy of prosecution (redner-vera & galeste, 2015). second, women’s distrust of patriarchal, paternalistic systems (podana, 2010) can influence use and access of new services provided under the umbrella of title ix. finally, women who are victims of gender-based violence may fear any individual or entity in a position of power which is male or belonging to a patriarchal system, including fear of losing their children (podana, 2010). therefore, even with funding for outreach and victim’s services, title ix fails to address the underlying systemic (patriarchal) causes and mediators of gender-based violence. in this way, title ix can empower victims by providing new pathways to prosecution against non-ai/na abusers. however, it lacks the more extensive systemic approach necessary to address the issue from a feminist perspective. meanwhile, the narrative surrounding title ix fails to address the historical context of sexism, racism, and oppression which have contributed to the high rates of ipv within ai/na communities. as illustrated in robertson's (2012) dissection of how title ix was developed and passed, even though the legislators heard voices of ai/na women, it is still legislation that seeks to continue a legacy of white supremacy and heteropatriarchy because it does not support the decolonization of society including ai/na people. further, robertson (2012) argues that title ix fails to incorporate ai/na voices as it "attempts to maxwell & robinson/safety for indian women 191 ‘include' women of color in a superficial and subordinating manner that further strengthens white supremacy and violence" (p. 41). a final point regarding the feminist analysis of title ix is that this policy had the potential of pathologizing native women as helpless victims who are incapable of personal empowerment. as tuhiwai-smith (1999) discussed in decolonizing methodologies, imperialism over the ai/na experience often creates the narrative that ai/na people are incapable of forming their own interventions or institutions. ramirez (2004) also discusses the historical narrative of ai/na women that perpetuated subservience of ai/na women and images of this were "degrading colonial representations" (p. 113). in this way, title ix is an imperialist-imposed government structure, the western constructed criminal justice system, which tribes can choose to use as a solution to ipv. for women, the government imposition of title ix (even though it is voluntary for tribes) may support a larger narrative that tribes and women, particularly ai/na women, are incapable of empowering themselves. policy contributions feasibility. even with the allocation of federal funds for implementation of opting into title ix, some smaller or poorer tribes cite financial costs as prohibitive (us doj, 2015a). furthermore, some tribes lack the organizational structure needed to implement this program (national congress of american indians, 2018). even with the funds allotted from title ix within vawa, some tribes still do not have the monetary resources to train law enforcement, recruit non-ai/na jury participants, pass and publish updated laws, and to pay for increased incarceration (national congress of american indians, 2018). other implementation barriers include costs related to detention (like health care for non-ai/na defendants) and an unwillingness to house non-ai/na defendants due to ambiguity of who funds housing and health care costs of the incarcerated individuals in the new provision (national congress of american indians, 2018). latent outcomes. many potential consequences are a result of title ix (2013). the cost for implementation may exceed the funds provided by the government to tribes. organizational structure and personnel resources might also prohibit tribes from implementing this policy. similarly, the voluntary nature of title ix means that victims who are members of different tribes may be impacted differently. other latent outcomes included the issue of prosecution for additional crimes. as the five-year report and some media articles noted, the perpetrators of ipv may also be committing drug-related crimes or commit other crimes during the arrest which cannot be prosecuted by tribal courts (fonseca, 2018; national congress of american indians, 2018). further, title ix does not cover abuse against children nor protect them if they are witnesses of ipv. notably, title ix does not include crimes perpetrated by strangers or those not affiliated with the tribe in some way, further endangering children and victims of internet-based crimes (national congress of american indians, 2018). title ix can potentially further colonize tribal people. although the policy provides legal pathways to prosecution, as well as funding for victim provisions, shelters, and social service implementation, it continues to address ipv through a patriarchal and settleradvances in social work, fall 2019, 19(1) 192 colonialism lens, which is a perspective that insists that cultural values of ai/na people be replaced with the more dominate, western approaches by omitting the historical context of oppression and cultural differences, title ix is not an indigenous-first policy, but rather a ai/na-informed policy that asks ai/na peoples to continue to subscribe to colonial methods and ideals of law enforcement, prosecution, and violence. evaluation. according to the report on vawa 2013 (national congress of american indians, 2018) released in april 2018, title ix had some success in increasing prosecutions of the non-ai/na perpetrators of violence against ai/na people. this report stated that 18 tribes have prosecuted non-ai/na perpetrators of violence. this report further indicated that, in the five years since the pilot project began, there were 74 convictions of non-ai/na offenders and half of those were sent to batterer-intervention programs or rehabilitation programs. the implementation of title ix has also illuminated the past prohibition of tribes to prosecute non-ai/na perpetrators because a majority of them were prosecuted since its enactment and have a previous criminal history (national congress of american indians, 2018). this policy has changed attitudes and behaviors toward ipv and prosecution according to a report by the national congress of american indians as well as some news reports (national congress of american indians, 2018). notably, despite historical hesitance to approach tribal police, some tribes report that since title ix has taken effect, women have slowly seen that the past barriers in the criminal justice system changed to provide more protection such as increased response to ipv calls and more ipv reports made to law enforcement (national congress of american indians, 2018). similarly, changes in collaboration among tribal leaders and law enforcement have altered the culture surrounding ipv and brought the issue to the forefront of advocacy in tribes (fonseca, 2018). discussion from an indigenous-focused and feminist perspective, the most salient point from analysis of title ix was the prevalence of non-ai/na perpetrators of ipv. these rates informed the creation of and response to title ix within vawa 2013. although the policy now encourages empowerment through access to prosecute a non-ai/na perpetrator of ipv, it fails to address the historical issues that contributed to the proliferation of not only ipv but of ipv committed by non-ai/na against ai/na women. the introduction of alcohol to indigenous tribes by european settlers has been cited as one cause of the high rate of ipv on tribal lands (women of color network, 2006). ipv against ai/na women is the imposition of european familial hierarchy on ai/na peoples (women of color network, 2006). even further, the imposition of domestication of ai/na women by white men could be related to the prevalence of non-ai/na perpetrated violence (ramirez, 2004). although title ix was meant to look like an ai/na-first policy, it failed to reflect the voices of ai/na women, which indicated the continuation of a legacy of non-ai/na imposition. title ix also does not address substance use, the attitude of non-ai/na entitlement to ai/na bodies, nor the perpetuation of colonizing policies. as ramirez (2004) noted, “[r]ecovering and encouraging native spiritual practices can also provide indian women with a means to nurture and heal…. [these cultural approaches] also maxwell & robinson/safety for indian women 193 demonstrate that native philosophy and points of view must inform our thinking so that we can one day decolonize a culture that has sanctioned violence against us” (p. 113). in addition, restorative justice, which is an approach to justice long used by indigenous peoples which does not focus on retribution but rather collective healing in the aftermath of a crime (hand et al., 2012) was not incorporated into the policy. therefore, title ix did not support ai/na women victims of non-ai/na abuse in a way that encouraged them to heal in culturally appropriate ways. limitations of analysis regardless of attempts to standardize crime data reported among tribal entities, there is still a lack of crime data and fragmented data collection (perry, 2015). also, tribal crime data available to the public is limited. as a result, evaluation of the prosecutorial effectiveness of title ix at this time is limited to the recently released five-year report (vawa 2013’s report, 2018). similarly, since the policy was implemented in 2015, the policy is still recent and therefore peer-reviewed research is limited as well. furthermore, the vawa 2013 report of 2018 which was heavily utilized in the outcome analysis of this policy was released by agencies invested in demonstrating the success of the policy. as a result, further investigation into the successes and failures of title ix both quantitatively and qualitatively is needed to fully ascertain the outcomes of the policy since its implementation. another critical limitation of this analysis is that it only pertains to vawa title ix in its current state. at the time the article was written, reauthorization of vawa is awaiting senate approval, amid controversy of an addition that would implement red-flag laws which would make it illegal for perpetrators of domestic violence with a misdemeanor to own a gun (dingell, 2019). as such, this analysis does not include any recent provisions or changes to the legislation, including any updates to title ix. however, the findings of this analysis strive to support future incarnations of the legislation. future research even though title ix allows for prosecution of non-ai/na abusers, it does not implement a standardized pathway for prosecution. although the impetus for this facet of the provision is to retain tribal sovereignty and culturally relevant implementation of title ix, the downside is that it guarantees only the ability to prosecute, not actual access to legal justice for the victims. therefore, future research focused on ease of use for victims, network path analysis on services, and evaluation of experiences of victims navigating the tribal court process against non-ai/na ipv abusers is needed. similarly, a comparison between tribes that have implemented title ix and those that have not, may illuminate the benefits and barriers of title ix from a uniquely ai/na perspective. even further, research that encompasses genuinely ai/na-created interventions for violence, such as restorative justice, and their efficacy would allow for any future provisions to be more relevant to ai/na people and tribal communities. advances in social work, fall 2019, 19(1) 194 implications for policy the many limitations of title ix, including crimes committed by strangers, crimes against children, and crimes co-occurring with violent crimes indicate there are many implications for future policy. indeed, at this writing, amendments are being proposed to allow tribes jurisdiction “over crimes of domestic violence, child violence, and violence against police officers” (mckie, 2018, para. 2). another proposed bill would allow tribal authority over domestic, dating, or sexual violence, sex trafficking, or stalking to close the gap on those offenders who are not affiliated with any tribe (mckie, 2018). both bills are still being discussed (smith, 2019; udall, 2017). this analysis posits another implication for policies focused on ai/na populations, i.e., that policies must always incorporate the input from various tribal members to ensure the cultural values of each tribe is reflected in the policy. furthermore, policymakers should pay particular attention to historical contexts that shaped tribal environments to account for potential outcomes arising from policy formation. as one news story reported, vawa as a whole "has significant flaws: it overlooks many proven causes of violence (substance abuse)…in some cases there is a reason to believe policies advanced in vawa have backfired on victims" (hays, 2018, para. 4). these flaws should influence future policies, and the reauthorization of vawa due in 2020, to incorporate voices of the victims, as well as focus on children involved in ipv cases. conversely, the voluntary nature of title ix, as well as the autonomous nature of implementation is a strength and a weakness of the policy that should inform future policies regarding tribal jurisdiction and sovereignty. policies focused on gender-based violence should learn from title ix and attempt to address the patriarchal nature of law enforcement and systemic oppression against women in their formation, moving away from carceral interventions that may harm women further. that said, evaluating the positive experiences of victims within tribes who elected to participate in prosecuting non-ai/na perpetrators of ipv, such as moments of empowerment, can highlight aspects of title ix which may be useful in future policy directed at gender-based violence reduction. conclusion title ix-safety for indian women of the violence against women act reauthorization of 2013 was described by evaluative reports as successful in changing cultural responses to intimate partner violence within tribes (vawa 2013’s report, 2018). the development of title ix was heralded as a change in the right direction towards addressing the issue of violence against ai/na women (robertson, 2012). yet, title ix has its flaws because it fails to address the intersection of historical colonial abuse against ai/na people and women and substance abuse on tribal land. in addition, it fails to recognize the gendered nature of ipv, and the impact law enforcement involvement may have on ai/na women who might distrust law enforcement due to its patriarchal and western foundation. to more fully understand the impact of title ix, further analysis of victim experiences and prosecution data is needed. additionally, comparison of tribes that did and did not implement title ix provisions would illuminate the strengths and barriers of title ix more clearly. to be more effective, title ix should implement provisions that maxwell & robinson/safety for indian women 195 address substance abuse; 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(2015). research agenda for violence against american indian and alaska native women: toward the development of strength-based and resilience interventions. psychology of violence, 5(4), 367-373. doi: https://doi.org/10.1037/a0038507 author note: address correspondence to: december maxwell, school of social work, the university of texas at arlington, arlington, tx 76019. e-mail: december.maxwell@uta.edu https://www.justice.gov/tribal/violence-against-women-act-vawa-reauthorization-2013-0 https://www.justice.gov/tribal/violence-against-women-act-vawa-reauthorization-2013-0 https://doi.org/10.1177/0891243216653381 https://www.doj.state.or.us/wp-content/uploads/2017/08/women_of_color_network_facts_domestic_violence_2006.pdf https://www.doj.state.or.us/wp-content/uploads/2017/08/women_of_color_network_facts_domestic_violence_2006.pdf https://www.doj.state.or.us/wp-content/uploads/2017/08/women_of_color_network_facts_domestic_violence_2006.pdf https://scholar.google.com/scholar_case?case=6938475705816460383&q=worcester+v.+georgia,&hl=en&as_sdt=6,37&as_vis=1 https://scholar.google.com/scholar_case?case=6938475705816460383&q=worcester+v.+georgia,&hl=en&as_sdt=6,37&as_vis=1 https://doi.org/10.1037/a0038507 mailto:december.maxwell@uta.edu _____________ patricia logan-greene phd, msw is an assistant professor, school of social work, suny university at buffalo, buffalo, ny 14260. mickey sperlich phd, msw, cpm is an assistant professor, school of social work, suny university at buffalo, buffalo, ny 14260. adair finucane msw is a research assistant, suny university at buffalo, buffalo, ny 14260. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1165-1186, doi: 10.18060/21620 this work is licensed under a creative commons attribution 4.0 international license. social work practice and gun safety in the united states: are we doing enough? patricia logan-greene mickey sperlich adair finucane abstract: public policy debate about guns continues in the united states, with many professional organizations taking strong stands in policy statements. moreover, many clinical organizations have provided recommendations for practitioners to use with clients to encourage gun safety in the home, particularly for vulnerable populations such as families with young children and those at risk of suicide. social workers are in an excellent position to encourage gun safety with some of the most at-risk populations; however, clinical guidelines and research on preventing gun violence has lagged in social work compared to other disciplines. in this article we examine the importance of gun safety for social work clients (with special attention to families with children, families experiencing violence, and individuals at risk of suicide), consider the recommendations made by other professional organizations, and provide some initial thoughts about how social workers might engage with the families they serve to reduce the incidence of gun violence. keywords: gun safety; firearms; violence prevention; suicide; social work in 2015, 36,252 persons in the united states died as result of firearms, which represented nearly 17% of all injury deaths recorded (centers for disease control and prevention [cdc], 2017). gun deaths in the united states are an outlier compared to other developed nations; a recent study demonstrated that us gun homicide rates were 25 times higher than our peer nations, and firearm-related suicides were 8 times higher (grinshteyn & hemenway, 2016). while firearm-related fatalities in the united states are high, it is estimated that two-thirds of those who are victims of firearm violence survive their injury, a phenomenon that has been described as a “hidden epidemic” (bernstein, 2017; kalesan et al., 2017). given the abiding concern about gun violence in the us, a public health social work perspective (keefe & jurkowksi, 2013; ruth, sisco, & marshall, 2016) that focuses on recognizing, preventing, and addressing the problem of gun violence is warranted (arp, gonzales, herstand, & wilson, 2017), and is consonant with gun policy responses from other sectors, including psychology, public health, psychiatry, nursing, pediatrics, and medicine (american academy of pediatrics, 2016; american medical association, 2016; american psychiatric association, 2014; american psychological association, 2017; cdc, 2014; pinals et al., 2015). in this paper, we use “firearm” interchangeably with the word “gun,” to be consistent with common usage in research and lay writing. however, the legal definition of “firearm” implies a shotgun, rifle, or long gun. public health social work is a framework that integrates public health with the values and techniques of social work (keefe & evans, 2013). the public health approach to https://creativecommons.org/licenses/by/4.0/ logan-greene et al./swk practice and gun safety 1166 violence prevention uses multidisciplinary data to address the problem, identify risk and protective factors, and design prevention strategies (cdc, 2015). the social work perspective complements the public health approach by bringing foci to nested levels of influence, including micro, mezzo, and macro practice. the purpose of this review is to assess the state of gun violence research, highlight the need for broader social work engagement, and to focus specifically on the ways in which social work practitioners can help keep their clients safe within a micro practice framework. for the purposes of this review, we focus on families with children, families experiencing domestic violence, and individuals at risk of suicide. the state of gun violence research a recent systematic review of clinician attitudes, screening practices, and firearm injury reduction interventions in the us found that the current literature in this area is not particularly high quality, and recommended more large-scale and adequately funded research (roszko, ameli, carter, cunningham, & ranney, 2016). of the 72 articles included in the review, social work scholarship was comparatively underrepresented; the majority of the research was undertaken by professionals in medical settings, predominately pediatrics, and only two articles covered research in social work settings (slovak & brewer, 2010; slovak, brewer, & carlson, 2008). this relative lack of social work scholarship on gun violence can been seen in other venues that highlight social work research, including our professional conferences. in a recent meeting of the society for social work and research, the number of abstracts that contain the words “firearm” or “gun” has been very low. between 2009 and 2016, there were no more than three per year; though the number has increased to six in 2017 and five in 2018, it still reflects a paucity of effort compared to other fields. moreover, in the four journals produced by the national association of social workers (children and schools, health and social work, social work, and social work research), only 35 articles have been published to date that contain either of those terms. this may be partially due to the fact that many social work researchers are working across sectors with other disciplines, and their scholarship may not be reflected in social work conference abstracts or in social work journals. some of this research has included firearm-related topics such as sociological autopsy of firearm suicide (slater, 2011), suicide ideation and intent (freedenthal, 2008), suicide among the geriatric community (adamek & kaplan, 1996; slovak, pope, & brewer, 2016), an editorial piece on gun violence following the virginia tech shootings (jenson, 2007), and an exploration of the etiology of school shootings (mongan, hatcher, & maschi, 2009). because gun violence is a multi-faceted problem, multi-faceted research is needed. however, research that directly impacts the micro practice role of social workers is particularly needed given the fact that social workers provide more direct mental health services to individuals than any other mental health profession. according to the united states department of labor bureau of labor statistics (n.d.), there were 682,100 individuals working as social workers in the us in 2017, versus 260,200 working as mental health counselors and 166,600 working as psychologists. as such, we would hope to see advances in social work, fall 2018, 18(4) 1167 more research specifically looking at screening for gun ownership and safety. to our knowledge, only one representative sample of social workers has ever been surveyed about knowledge, attitudes, and behaviors towards screening for guns (slovak & brewer, 2010; slovak et al., 2008). one possible reason for the paucity of studies has likely been the dearth of funding for firearm-related social science research, extending back to the 1990s. in 1993, an article published in the new england journal of medicine reported findings of a study funded by the cdc (kellermann et al., 1993). in an analytic review of 1,860 homicides, kellerman and colleagues found that the presence of a gun in the home was a strong and independent risk factor for homicide, controlling for illicit drug use, prior arrests, and domestic violence (see also kellermann, somes, rivara, lee, & banton, 1998). the researchers’ conclusion was that, rather than being an effective means of protection, guns instead posed a substantial threat to household members. these pronouncements from a federally-funded agency prompted the national rifle association (nra) to support the development of language in congress’s 1996 omnibus consolidated appropriations act (jamieson, 2013). this act mandated a prohibition on any funding by the national institutes of health (nih) that might pose a “restriction on any legal consumer product, including its sale or marketing, including but not limited to the advocacy or promotion of gun control.” an amendment introduced by u.s. house representative jay dickey (r-ar; the “dickey amendment”) further specified that “none of the funds made available for injury prevention and control at the centers for disease control may be used to advocate or promote gun control” [omnibus consolidated appropriations act of 1997, 110 stat. 3009, 3009-244 (1996) (this public law was not codified in the united states code)]. this policy has had a chilling effect on research directed toward understanding firearm injury in the us. the lack of research has stymied efforts to contextualize gun violence in the us, and has gone so far that dickey himself expressed regret at the situation. in an op-ed co-authored in 2012 with mark rosenberg, who was director of the cdc’s national center for injury prevention and control at the time the dickey amendment was enacted, dickey and rosenberg (2012) wrote: since the legislation passed in 1996, the united states has spent about $240 million a year on traffic safety research, but there has been almost no publicly funded research on firearm injuries. as a consequence, u.s. scientists cannot answer the most basic question: what works to prevent firearm injuries? (…) we were on opposite sides of the heated battle 16 years ago, but we are in strong agreement now that scientific research should be conducted into preventing firearm injuries and that ways to prevent firearm deaths can be found without encroaching on the rights of legitimate gun owners. the same evidence-based approach that is saving millions of lives from motor-vehicle crashes, as well as from smoking, cancer and hiv/aids, can help reduce the toll of deaths and injuries from gun violence. (paras. 12-15) in 2013, in the wake of the mass shooting at the sandy hook elementary school in newtown, connecticut, president obama issued an executive order that the cdc resume research into “the causes of gun violence and how to prevent it” (engaging in public health logan-greene et al./swk practice and gun safety 1168 research on the causes and prevention of gun violence, 2013, p.1). however, this has had little effect. a cdc spokesperson, courtney lenard, in a statement to the washington post in january 2015 noted that the cdc had possible research goals but lacked funding to pursue such goals. her statement outlined that it is “possible for us to conduct firearmrelated research within the context of our efforts to address youth violence, domestic violence, sexual violence, and suicide, but our resources are very limited” (frankel, 2015, para. 6). in march of 2018, a legislative report that accompanied the omnibus us spending bill included wording that read (reported by keneally for abc news, 2018): while appropriations language prohibits the cdc and other agencies from using appropriated funding to advocate or promote gun control, the secretary of health and human services has stated the cdc has the authority to conduct research on the causes of gun violence. (recent actions, but no changes section, para. 8) editorial comments following this announcement expressed pessimism that such a statement would increase research into gun violence due to the fact that: a) the original dickey amendment language is still in place, and b) no federal funding was appropriated for gun research in 2018 (e.g., greenfieldboyce, 2018; killough & walsh, 2018; weixel, 2018). in short, congress has not acted on calls to reverse the cdc funding freeze, despite public outcry following recent mass shootings like the orlando nightclub massacre (barry, 2016) or the school shooting at marjory stoneman douglas high school in parkland, florida (e.g., blaskey, 2018; cunningham, 2018). given that many social scientists use u.s. federal funding to conduct research, it is understandable that research has been limited in social work as well as other disciplines. indeed, the lack of good data for firearm violence is frequently lamented by policy-makers and researchers (e.g., bushman et al., 2016; foran, 2016), meaning that conclusions must be drawn from smaller or dated studies. however, there have been reports of impactful analyses despite the unavailability of federal support. for instance, research looking at the relationship between gun ownership and firearm homicide rates in the u.s. using publically available databases essentially replicated findings from the 1990s that demonstrated increased rates of firearm homicide in relation to increased rates of gun ownership (siegel, ross, & king, 2013). regardless of the disciplinary foci of the research in this area, it is clear that there are significant concerns that warrant social work attention to gun violence and gun safety. following, we briefly review the research on three vulnerable populations to illustrate how social workers in direct practice may work to prevent gun injury. children and firearm injury firearm deaths, whether from accident, homicide, or suicide, pose a serious threat to children in the united states. in 2009, 20 children were hospitalized every day for firearm injury, with the majority being males (leventhal, gaither, & sege, 2014). older children and adolescents (ages 13-17) may be more at risk for violent, intentional injuries by firearms, whereas younger children (10 and under) are more likely to sustain unintentional injuries (injuries occurred when a gun was accidently discharged during cleaning, hunting, playing with, or inspecting the weapon (perkins, scannell, brighton, seymour, & advances in social work, fall 2018, 18(4) 1169 vanderhave, 2016). moreover, in 2014 firearm suicide and firearm homicide, respectively, were the third and fourth leading causes of death in children ages 10-14. firearm homicide was the second leading cause of death for youth ages 15-24 (cdc, 2016a). high rates of firearm mortality and morbidity in the united states may be related to the number of guns owned and previous exposure to gun violence. one study found that 35% of homes with children below age 18 contained at least one gun, with 43% of those containing at least one unlocked firearm (schuster, franke, bastian, sors, & halfron, 2000). more recent data, focusing on parents of pre-school-aged children, showed that 21.6% of parents owned firearms, and only 68.6% stored them in a locked cabinet (prickett, martin-storey, & crosnoe, 2014). similarly, it has been shown that one in three homes in which adolescents are living have a gun that is either stored unlocked and/or loaded (simonetti, theis, rowhani-rahbar, ludman, & grossman, 2017). for adolescents exposed to firearm violence in their homes in chicago, illinois, propensity scoring analysis suggests that they have double the risk of perpetuating serious violence themselves over the subsequent two years from the date of their exposure (bingenheimer, brennan, & earls, 2005). there are also racial disparities in the likelihood of a child sustaining a firearm injury. an alabama study found that african american children were 2.5 times more likely than caucasian children to be victims of firearm injury (senger, keijzer, smith, & muensterer, 2011). firearm hospitalizations also increased for african american children between the years of 1998 and 2011 (kalesan, dabic, vasan, stylianos, & galea, 2016). in 2014, the cdc reported that homicide was the leading cause of death for african americans ages 10 to 24 (cdc, 2016b). given this reality, it is important to consider societal causes and social determinants for this disparity in risk among our youth. school mass shootings have brought the issue of youth violence and youth access to weapons to the fore. looking at the etiology of school shootings, mongan and colleagues (2009) suggested that risk factors for mass shooting perpetration among youth include marginalization, access to guns, and masculinity. they apply a stages-of-change model to the understanding of how a youth goes from pre-contemplation of school shooting through to the termination stage of carrying out violence. accessing weapons is part of the action stage of this model, and the majority of firearms (between 53% and 68%, depending on the study) used by youths in the commission of school mass shootings are acquired from their homes or from relatives (bushman et al., 2016). involving parents may be a critical component in light of research suggesting that parents of adolescents may be more likely to practice unsafe gun storage, which means adolescents may be able to access parents’ guns to commit crimes. in a national random sample of parents with firearms in the home, 42% stored their firearms unlocked, 26% stored their firearm loaded, and 10% stored their firearm unlocked and loaded (johnson, miller, vriniotis, azrael, & hemenway, 2006). for young children, morrissey (2017) used data from the childhood longitudinal study – birth cohort merged with the fbi’s active shooter incidents data to demonstrate that: 1) about one-fifth of young children lived in households with one or more guns, 2) only two-thirds of these homes stored all guns in locked cabinets, and 3) those parents living in closer proximity to recent active shooter logan-greene et al./swk practice and gun safety 1170 incidents were more likely to lock their guns properly. this suggests that heightened awareness about gun violence may prompt safer storage. in terms of clinical preparation of social workers for addressing youth violence, reports from the most recently available studies suggest that very few social workers (5%) received violence prevention training in their graduate programs (astor, meyer, & behre, 1999), yet many express desire for such training (astor, pitner, meyer, & vargas, 2000). social workers have noted a mismatch between their graduate training and the actual problems they confront related to violence, compounded by excessive caseloads that make preventively meeting client needs difficult (astor et al., 2000). intimate partner violence and firearms data from the national intimate partner and sexual violence survey (nisvs) in 2011 showed that in the course of their lifetime, approximately 33% of women and 28% of men experience physical violence by an intimate partner (breiding, chen, & black, 2014). intimate partner violence includes homicide, and is stratified by gender. female murder victims are six times more likely than males to be killed by an intimate partner (cooper & smith, 2011) and more likely to be murdered with a firearm than by all other means combined (petrosky et al., 2017). the presence of a firearm in the home has been shown to increase this risk eight-fold, even after controlling for a variety of individual-, relationshipand incident-level factors (campbell et al., 2003). firearms are also used to threaten and intimidate, as opposed to injure, in the context of intimate partner relationships. recent research has shown that this is the most frequent use of guns (69.1%) in relationships involving intimate partner violence (sorenson, 2017). a previous large study of men enrolled in certified batterer intervention programs found that this occurs in at least four ways – either by directly threatening to shoot, or by cleaning, holding or loading a gun while arguing, or by threatening to shoot loved ones or pets, or by actually firing a gun during an argument (rothman, hemenway, miller, & azrael, 2004). in a study of women residing in domestic violence shelters, it was reported that of the one-third of women who had previously resided in homes with firearms, the majority (71%) had been threatened with a gun (sorenson & wiebe, 2004). this use of guns to coerce and threaten has the effect of making women significantly more afraid of potential gun violence than other types of assaults (sorenson, 2017). addressing the issue of firearm involvement in intimate partner violence is complicated by the lack of research funding, and also by on-the-ground realities of limited or unavailable data on gun ownership. for instance, one social work researcher who set out to explore theorized relationships between domestic violence, rates of gun ownership, and parental educational attainment on aggression in children was stymied in analytic modeling by the inability to assess the number of registered firearms in the counties under study (sprinkle, 2007). although there is some evidence to suggest that restricting access to firearms for individuals under restraining orders for domestic violence reduces intimate partner homicide between 7% (vigdor & mercy, 2006) to 9.7% (díez et al., 2017), the relationship between domestic violence and firearms remains under-studied. advances in social work, fall 2018, 18(4) 1171 firearms and suicide the most common means of completed suicide in the us is death by firearm, accounting for approximately 50% of all suicides annually (cdc, 2016a). certain populations are at increased risk of attempting suicide, including veterans (kang, bullman, smolenski, skopp, gahm, & reger, 2015), older adults (conwell, 2013), and certain minority populations such as american indian/alaska natives (wyatt, ung, park, kwon, & trinh-shevrin, 2015), and lesbian, gay, bisexual, and transgender individuals (grant, mottet, tanis, harrison, herman, & keisling, 2011; king et al., 2008). anglemyer, horvath, and rutherford (2014) undertook a systematic review and meta-analysis across the professional and gray literatures in order to understand the association between firearm availability and suicide or homicide. the pooled data from 16 studies showed a three-fold risk for homicide, and a two-fold risk for suicide in homes with firearms; the risk for suicide was three-fold when only studies with interviews about firearms were considered. again, the authors note the difficulty of establishing firearm ownership due to inadequate data access and privacy and legality concerns. those who attempt suicide by firearm are largely successful – 91% of attempts are fatal, which is substantially more than any other method (miller, azrael, & hemenway, 2004). regardless of sex, using a firearm increases the risk of dying by 140 times when compared with other methods (bostwick, pabbati, geske, & mckean, 2016). efforts to reduce suicide have therefore centered on reducing access to lethal weapons for vulnerable individuals (“means restriction”; e.g., world health organization, 2014, p. 8). recent studies of the impact of state firearm regulations in the us show that restricting overall access to firearms through regulations such as permit and licensing requirements has been found to be associated with reduced suicide rates (alban et al., 2018; andrés & hempstead, 2011; fleegler, lee, monuteaux, hemenway, & mannix, 2013). the majority of individuals have some form of contact with mental health professionals prior to their death by suicide (luoma, martin, & pearson, 2002; stene-larsen & reneflot, 2017). assessment for suicide risk is a standard of care among many social workers; however, training to do such assessments may be lacking. in a national sample of social workers, less than 25% reported having received any such training; furthermore, a majority reported that they felt their training was inadequate (feldman & freedenthal, 2006). a national survey of msw deans and directors suggests that msw students received 4 or fewer hours of graduate school education on suicide (ruth, gianino, muroff, mclaughlin, & feldman, 2012). overall, a systematic review found that there has been very little evidence-based knowledge produced by the field since 1980, and concluded that this is a “neglected social work research agenda” (joe & niedermeier, 2008, p. 507). in a recent scoping review, maple, pearce, sanford, and cerel (2017) considered knowledge generation across 241 articles on suicide prevention, and found that only 7 of these were wholly authored by social workers, which in part underscores the inherent multidisciplinary nature of suicide prevention, but also suggests that reinforcing the importance of social work perspectives is also important. with inadequacy of training and evidence-based guidance, it is unclear how many social workers are adequately prepared to assess and respond to situations in which a suicidal client has access to a firearm. logan-greene et al./swk practice and gun safety 1172 responding to firearm injury risks from this focused literature review it is clear that these three populations (children, suicidal individuals, and those experiencing intimate partner violence) are vulnerable to firearm injury. evidence also suggests that small, individual interventions or changes (such as safely locking away or removing guns from a home) can substantially decrease the odds of accidental or impulsive firearm injury (e.g., barkin et al., 2008). social workers and other practitioners who work with vulnerable populations are well-positioned to educate and encourage families and individuals to take safety-increasing steps regarding guns in their homes. in the following section, we review and compare some of the public policy statements regarding firearm injury prevention from social work and peer disciplines. responses from other professional organizations several major professional organizations that represent health workers have made strong statements regarding national policy and offer specific suggestions for their frontline workers to reduce injuries for their clients. for example, the american psychological association (2013) convened a panel to review gun violence and produced a number of recommendations for policy and practice, including how psychologists can participate in the prevention of gun violence. the cdc (2014) has made recommendations including increasing youth connectedness at schools or with mentoring or caring adults and prosocial activities in the community. the american medical association (2016) recently declared that gun violence constitutes a public health crisis, calling for an end to barriers to quality research in addition to other stances they have taken with respect to gun violence policies. strong statements concerning practice and policy have also been made by others professional organizations including the american nurses association (pinals et al., 2015), the american psychiatric association (2014), and the american pediatric surgical association (nance, krummel, oldham, & trauma committee of the american pediatric surgical association, 2013). it is important to note that these recommendations have spanned both policy positions as well as recommendations to member clinicians about practical methods to keep patients and clients safe. the american academy of pediatrics (aap, 2016) has been exceptionally vocal on the threat of gun violence for children in the united states. in addition to strongly worded statements on the gun law debate (e.g., 2016), the aap provides guidance to pediatricians about how to prevent the health hazards of firearms. specifically, they recommend that the best way to keep children safe is to never have a gun in the home (dowd et al., 2012). they also provide advice for safe gun storage for families with children. moreover, all pediatricians are actively encouraged to discuss gun safety with patients’ families. these efforts have met with strong resistance is some areas. in florida, lawmakers passed the firearm owners’ privacy act (florida house of representatives, 2011), which prohibits physicians from intentionally soliciting information about firearms from their patients unless it was directly related to their care (and presumably could meet that standard in court). although given this minor latitude, doctors are unlikely to risk these questions, as the law stipulates that it could result in a fine of $10,000 and the loss of their medical license. this provision was challenged in court (wollschlaeger v. governor of the state of advances in social work, fall 2018, 18(4) 1173 florida, 2015) in a case commonly known as “docs versus glocks.” the 11th circuit of court of appeals struck down most provisions of the law in february 2017 (wollschlaeger v. governor of the state of florida, 2017), although other states are reportedly considering similar legislation (lithwick & west, 2016). thus, practitioners must remain aware of legislation that may curtail their ability to discuss gun safety with clients. response from the national association of social workers (nasw) the leadership of the nasw has grown more vocal regarding gun violence in recent years; however, they lag with specific recommendations to practitioners on how to prevent firearm injury. a social justice brief about gun violence was released in 2017 which on the whole promotes gun violence prevention laws, regulations, and policies (arp et al., 2017). on their website, the nasw has also praised specific actions, such as the executive actions president barack obama announced in january of 2016 (nasw, 2016a), and issued statements following mass shootings, such as the nightclub massacre in orlando in june of 2016 (nasw, 2016b). beyond these supportive statements regarding laws, regulations, and policies, the nasw has not yet elaborated clear and detailed guidelines on policy, practice and research toward preventing and controlling gun violence (similar to the aap positions), nor does this seemingly exist in the literature as a whole. the lack of detailed social work practice guidelines may have a number of causes. first, discussing guns may be uncomfortable for many social workers who, on the whole, are ideologically “left” of their client consumers on many social issues, are far less likely to be gun owners, and are more likely to support gun control initiatives (hodge, 2003). thus, many may be reluctant to broach the topic, either out of discomfort with what can be a hot-button issue, or perhaps out of a concern for their own safety. the relative lack of training noted earlier in terms of suicide and lethality assessment may be reinforcing the silence, in addition to the lack of training and knowledge on violence and guns in general (astor et al., 1999). nonetheless, the magnitude of the problem requires more specific attention from our discipline. recommendations for social workers in practice we respect social workers’ diversity in all domains, including their opinions on gun ownership and policies. in no way do we wish to say that social workers must take particular policy positions on gun control or any particular interpretation of the second amendment. we also do not encourage social workers to make strident statements about guns with clients with differing views; doing so may threaten the therapeutic alliance and thereby do harm. instead, we offer policy-neutral suggestions for practicing social workers that may help protect their clients from gun violence, either accidental or intentional. we encourage respectful engagement in such conversations with an emphasis on safety and preventing injury. discuss gun safety with clients. social workers in practice with families should be prepared to discuss the topic with their clients (slovak et al., 2008). this conversation would be different based on the nature of the family’s situation. for families with young children, the conversation should be about safe storage practices to prevent accidental logan-greene et al./swk practice and gun safety 1174 injury, as well as addressing safety concerns such as safe passage/travel to school programs. consideration should also be given to other homes that children spend time in, such as when they have playdates or visit other relatives. the asking saves kids (2016) campaign, created in collaboration with the aap, is designed to educate parents about the importance of asking about guns in other homes where their children play. they help parents prepare to ask what can be an awkward but important question: “is there an unlocked gun in your home?” this may be important even for older children, due to the vast differences in exposure to safe gun handling that youth may receive. for example, children raised in a home with guns may be taught to never handle a gun without an adult present, or to never point the gun at any person, even if they do not intend to fire it. a child with no prior exposure to guns will not necessarily know these basic safety precautions; therefore, they may be at higher risk of inflicting or experiencing injury with guns in the homes of their playmates. social workers who work with older youth should ask them if they or their friends have access to a gun and discuss ways to stay safe. social workers can also serve as links for individuals to resources for social protection, and act together with others through community building and local resource mobilization within their community, all of which are activities consistent with core values in the field of social work (douglas & bell, 2011). social workers with clients at risk for intimate partner violence and suicide risk should also stand ready to conduct lethality and suicidality assessments and to inquire about the clients’ access to means. individuals with suicidal ideation may be urged to remove guns from their homes to minimize the risk of impulsive lethal actions. this conversation could also be directed at the families of at-risk individuals. although research is sparse, there is some evidence that counseling on restricting access can reduce incidence of suicide as well as homicide in ipv relationships (barber & miller, 2014; vigdor & mercy, 2006). a recent study on an intervention designed to encourage parents to reduce access to guns for adolescents with suicide ideation found that 100% of parents with guns in the home had locked them away by follow up (runyan et al., 2016). despite encouraging findings, social workers may encounter some resistance from their clients to discussing guns. as evidenced by the now-defunct florida law that regulated patient conversations about guns, some proportion of the american public clearly feels that these conversations are an intrusion of their rights (parent, 2016). moreover, asking about some clients’ access to guns may be equivalent to asking whether they are disobeying the law, as some individuals with criminal records may be prohibited from possessing weapons. however, social workers are generally well-trained to discuss sensitive topics with hesitant clients while maintaining the therapeutic relationship, even with mandated clients (e.g., kemp, marcenko, hoagwood, & vesneski, 2009). know resources for gun safety and education. social workers in practice with vulnerable families should have knowledge about online and local resources to refer clients to learn more about safe gun handling and storage methods. good resources are readily available through the internet and in most communities within the united states. table 1 provides some online resources for gun safety information. these resources range from search engines for local educational resources to online safety tips, videos, and classes. in addition to online resources, most communities will have access to firearm dealerships that advances in social work, fall 2018, 18(4) 1175 can provide information, products, and classes on safe storage. social workers may consider encouraging vulnerable gun-owning clients to pursue educational options (which are often free) about gun safety. some of these resources, such as project child safe, will also provide free kits for children’s safety, including a cable-style gunlock (project child safe, 2018a). table 1. selected online resources for gun safety resource description website lock it up (2015) produced by the national crime prevention council. contains general information and resources about gun storage safety. http://safefirearmsstorage.org/ national rifle association training (2017) links to online courses and local resources to learn about shooting and gun safety. http://www.nrainstructors.org /search.aspx national shooting sports foundation (2018) provides information and videos on gun safety, primarily geared for hunters. http://www.nssf.org/safety/ba sics/ project child safe (2018b) a nonprofit organization developed to provide gun safety resources for firearms owners. http://www.projectchildsafe.o rg/safety/safety-resources know local gun laws. gun laws differ dramatically across states, with implications for client safety. as mentioned above, in some states all gun owners are required to take gun safety courses to be compliant with laws; however, other states have no such requirements. this can result in stark differences on gun safety knowledge among gun owners in different regions. some states also have provisions that allow family members or other concerned parties (including counselors) to request that an individuals’ access and possession of firearms be temporarily prohibited; preliminary evidence suggests these laws may be effective at reducing completed suicide (swanson et al., 2017). the law center to prevent gun violence (n.d.) provides an excellent database of state and federal laws that are searchable both by state and by topic. this resource makes it relatively easy for social workers and other clinicians to learn about local laws regarding firearm access, storage, and other ordinances. knowing state laws can facilitate social workers’ conversation with clients about salient issues. for example, conversations about safe storage practices for families with children will vary depending on state laws, as some states have requirements and others do not. reach out across disciplines. although social workers may lead the professions in terms of working directly with mental health clients, they cannot tackle the problem of gun violence alone. research from other disciplines might prove instructive and useful. for instance, a criminological meta-analysis of policies and programs to reduce firearm violence suggests effectiveness for community-based law enforcement initiatives (makarios & pratt, 2012), which could be applied across a variety of locations and social http://safefirearmsstorage.org/ http://www.nrainstructors.org/search.aspx http://www.nrainstructors.org/search.aspx http://www.nssf.org/safety/basics/ http://www.nssf.org/safety/basics/ http://www.projectchildsafe.org/safety/safety-resources http://www.projectchildsafe.org/safety/safety-resources logan-greene et al./swk practice and gun safety 1176 work settings. another meta-analysis coming out of the nursing profession (holly, porter, kamienski, & lim, 2018) suggests that gun safety programs do not improve outcomes for children when adequate supervision is not in place, and pointing to the need for more research to better understand how to increase gun safety for children. collaborations between nursing and social work might be able to elucidate knowledge gaps in this area. a review of research in the area of the prevention of school shootings (borum, cornell, modzeleski, & jimerson, 2010) pinpoints threat assessment as a promising strategy, and overviews the need for schools to develop crisis response plans. another study assessing attitudes of school personnel toward firearm violence identifies barriers including lack of expertise, time, and research in implementing violence prevention programs (price, khubchandani, payton, & thompson, 2016). social workers in school settings may be in a position to work together with educators to help with such efforts, given their preparation in lethality and suicidality assessment (assuming they received this, as noted above). similarly, researchers in pediatric primary care are researching the effect of firearms means restrictions for suicide prevention (wolk et al., 2017); hospital-based social workers may be able to collaborate on the development of such protocols. at the other end of the spectrum, research looking into high-risk management of older adults’ suicidal patients (brown, bruce, pearson, & prospect study group, 2001) points to the need for steppedup screening and assessment, which hospital-based social workers are well-suited to implement. these are only a few examples of ways in which working across disciplines may help to address the enormity of the problem of gun violence. conclusion this article is intended to spur action on the part of social workers – clinicians, researchers, and those involved with local and national advocacy – to address the problem of gun violence in the united states. clinicians should consider whether their client populations merit consideration of gun violence in initial assessments and in treatment planning, with particular attention to the vulnerable populations discussed in this article. clinicians whose client populations experience frequent gun violence and injury should take the steps outlined to be able to facilitate safe gun practices when indicated. moreover, social work educators must do a better job of preparing students to discuss firearms with diverse clients, including those at-risk of suicide (almeida, o’brien, gironda, & gross, 2017; joe & niedermeier, 2008; ruth et al., 2012) as well as other forms of gun violence (danis & lockhart, 2003; kelly et al., 2010). although current literature suggests that clinicians can encourage individual and family actions that can prevent gun violence, much more research is needed. social work researchers should specifically examine how well-prepared and willing practitioners are to engage with their clients regarding gun safety, in addition to how effective these actions are in preventing injuries. the public health social work paradigm, bringing together interdisciplinary scientific research with social work practices, may provide a helpful framework to engage in more effective safety planning. this will involve research and interventions that are cross-disciplinary in nature, and a commitment to promote social justice 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(2018, march 25). funding bill won't prompt new gun research, experts say. the hill. retrieved from http://thehill.com/policy/healthcare/380026-funding-billwont-prompt-new-cdc-gun-research-experts-say wolk, c. b., jager-hyman, s., marcus, s. c., ahmedani, b. k., zeber, j. e., fein, j. a., ...beidas, r. s. (2017). developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large us health systems: a study protocol for a mixed-methods implementation study. bmj open, 7(6), 1-9. doi: https://doi.org/10.1136/bmjopen-2016-014407 wollschlaeger vs. governor of fla, 814 f.3d 1159 (11th cir. 2015). wollschlaeger vs. governor of fla., no. 12-14009 (11th cir. feb. 16, 2017). world health organization. (2014). preventing suicide: a global imperative. geneva: world health organization. wyatt, l. c., ung, t., park, r., kwon, s. c., & trinh-shevrin, c. (2015). risk factors of suicide and depression among asian american, native hawaiian, and pacific islander youth: a systematic literature review. journal of health care for the poor and underserved, 26(2 supp), 191-237. doi: https://doi.org/10.1353/hpu.2015.0059 author note: address correspondence to: patricia logan-greene, phd, school of social work, suny university at buffalo, 630 baldy hall, buffalo, ny 14260. pblogang@buffalo.edu https://doi.org/10.1007/s10560-006-0071-8 https://doi.org/10.1177/1403494817746274 https://www.bls.gov/ooh/ https://doi.org/10.1177/0193841x06287307 http://thehill.com/policy/healthcare/380026-funding-bill-wont-prompt-new-cdc-gun-research-experts-say http://thehill.com/policy/healthcare/380026-funding-bill-wont-prompt-new-cdc-gun-research-experts-say https://doi.org/10.1136/bmjopen-2016-014407 https://doi.org/10.1353/hpu.2015.0059 _________ patrina duhaney, phd, assistant professor, and yahya el-lahib, phd, associate professor, faculty of social work, university of calgary, canada. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 421-437, doi: 10.18060/24471 this work is licensed under a creative commons attribution 4.0 international license. the politics of resistance from within: dismantling white supremacy in social work classrooms patrina duhaney yahya el-lahib abstract: everyday racism embedded in all facets of society, coupled with ongoing injustices against racialized people globally, have reignited an urgent action to turn the gaze within social work education. there is a need to challenge and resist white supremacy that continues to institutionalize systemic racism and justify state control of social and political processes. these current realities are in direct contradiction to the neoliberal push for state withdrawal from social programming and essential services. yet the interconnectedness between neoliberalism, white supremacy and fascist ideologies has gone undetected in social work circles resulting in a political and ideological vacuum in the profession. within the social work curricula, there is a lack of attention and involvement to effectively dismantle white supremacy and racism that are perpetuated within and through the profession. the social work classroom has been a natural place to incubate a new wave of resistance that has the potential of changing the face of the profession. considering the deleterious effects white supremacy has for racialized bodies within academic spaces, we assert the embodiments of resistance with a call to action for social work scholars, students, administrators and practitioners. these key actors must reject the legacy of white supremacy in our profession that acts as social control agents serving the state's interests and perpetuating its hegemony. we explore some of the ways in which we confront and disrupt white supremacy, which includes interrogating and dismantling dominant discourses, systemic and institutional academic racism (teaching, research and service), social work curriculum and priorities, and racist classroom dynamics that have been shaped by whiteness that continues to impact the interactions between racialized and white students and professors. we conclude with a call to infuse social work with practices and approaches that equip students with knowledge and tangible tools to enact change beyond academic spaces. keywords: white supremacy, racism, academia, social work education, whiteness, neoliberalism, racialization social work profession and education have a complex historical and contemporary legacy of advocating for social justice while simultaneously upholding dominant discourses that reinforce whiteness and white supremacy (gregory, 2021). indeed, a critical examination of social work theories, epistemologies, policies, practices, and pedagogies demonstrates that whiteness is rooted in the profession’s knowledge base in ways that construct white bodies and experiences as dominant norms. furthermore, social work curricula are imbued with whiteness. according to deepak and colleagues (2015), diversity content is diluted, minimized and “insufficiently infused throughout the curriculum,” and material used mostly represents the “white, upper class male norm” (pp. 116-117). similar patterns can be seen in the limitations of social work education to prepare students to be about:blank advances in social work, summer 2021, 21(2/3) 422 anti-racist social workers and address issues of racism, ableism, and sexism (richardsschuster et al., 2015). such assumed universality of whiteness acts as gatekeepers that not only maintain and facilitate white dominance, but also delegitimize the “racialized other” and render their experiences insignificant. a wide range of scholarship has questioned the dominance of whiteness within social work theories, epistemologies, and ontologies (e.g., dominelli, 1989; pewewardy & almeida, 2014; walter et al., 2011). the relationship between dominance and control also shapes the ways social work has been implicated in conceptualizing, facilitating and normalizing ableist and racist colonial policies, processes, and practices. indeed, chapman and withers (2019), el-lahib (2017, 2020), and joseph (2015) problematize the ways in which the social work profession not only facilitates states’ colonial, racist and ableist agendas, but also contributes to normalizing these practices that dissolve the state’s accountability. furthermore, the marriage between neoliberalism, dominant socio-political, economic relations of power and social work cannot be minimized or dismissed. as we write this article, people across the globe are raising awareness and supporting racial justice initiatives. in contrast, now former u.s. president donald trump made the headlines with a controversial executive order (cineas, 2020) to remove all diversity and anti-racism training from federally funded agencies and exclude concepts such as white privilege, unconscious bias, and critical race theory (crt) from any training material for federal employees (bbc news, 2020). for trump, these concepts are divisive and anti-america (guynn, 2020). failure to remove such content would result in the withdrawal of government contracts and funding. this move has created fear across government bodies and organizations as they scramble to meet trump’s directive (washington post, 2020). it appears that trump views white privilege and crt as two sides of the same coin. white privilege provides substantial benefits and opportunities to white people, whereas crt is an analytic that critiques white privilege and its effects on the social fabric of our societies. crt poses an existential threat to white supremacy, hence trump’s relentless tactics to protect and maintain this dominant ideology and affiliation with populist and neo-nazis practices. this example depicts the extent and insidious nature of whiteness and white supremacy. as social work and social workers are an essential part of government training, interventions and programs, it is essential to make institutional and systemic changes within and across governmental bodies to dismantle governments' controlling processes that thwart efforts to forefront knowledge and practices intended to empower marginalized groups. the social work profession continues to perpetuate oppression and facilitate racist, ableist and colonial practices (chapman & withers, 2019; el-lahib, 2020; humphries, 2004; siddiqui, 2011). social work educators and professionals have a moral and professional responsibility to address systemic racism and colonial practices and dismantle white supremacy on all levels (e.g., social, political, economic). however, the discrepancies between our professional values and the ways we operationalize social control create a great deal of uncertainties and tensions particularly for racialized and indigenous communities. therefore, the relationship between white supremacy, state duhaney & el-lahib/politics of resistance 423 control and social work need to be clearly articulated. social workers must advance a critical agenda for the profession that moves beyond the trendy notions of “activism performativity” and facilitates a meaningful process of resistance that emphasizes unlearning that activates social, economic and political consciousness. therefore, by interrogating, questioning and challenging dominant ideologies, we can begin the process of dismantling white supremacy. in this conceptual article, we explore some of the ways in which we disrupt white supremacy which includes interrogating and dismantling dominant discourses, systemic and institutional academic racism (teaching, research, and service), social work curriculum and priorities, and racist classroom dynamics that shape the interaction between racialized and white students and professors. we assert that dismantling white supremacy in social work is not a prescribed method that can be activated once a practitioner or educator decides to do so. it is in fact a process that requires not only divorcing social work from its own white, colonial and racist histories, but also engaging with various forms of anti-racist, anti-colonial resistance that allows us to dismantle white supremacy and challenge its assumed dominance and control. positionality before we delve deeper into unpacking the issues that shape our experiences, it is important to not only situate our own social subjectivities, but also validate our knowledge and experiences. the first author is a black female scholar, while the second author is a male scholar of bedouin arab descent. as racialized social work educators, we have worked predominantly in white institutions, faculties, and communities. as we combine our efforts and embark on interrogating white supremacy and its operation within and through the profession of social work, we are cautious of not essentializing our own identities or narrowing the issues that need to be questioned and challenged to dismantle white supremacy in social work. we highlight many shared experiences of marginalization and professional degradations; however, we do not assume that our experiences as black and arab individuals represent the experiences of all black and arab scholars in social work. our sharing is also not intended to over-victimize ourselves or villainize our own institution. in our daily lives, we grapple with the contradictory realities that shape our existence as racialized academics. these realities either valorize our identities or subject us and our bodies to tokenizing positions representing institutional performativity of diversity. examples of such valorizations and tokenization include being called upon to serve on university-level diversity committees or become a referral point to racialized students who need social, mental, and academic support, without any recognition of the added labour imposed on us with such requests. in addition, we interact with people who question the legitimacy of our knowledge and experiences within academic institutions and classrooms. as such, we embody many of the unchartered territories of resistance to whiteness and white supremacy in the ways we position ourselves within this context. as we grapple with these tensions and contradictions, our pride in our professional identities and commitments as anti-racist, anti-colonial, and critical social work scholars, we recognize the need to advances in social work, summer 2021, 21(2/3) 424 continue to hold social work accountable to its historical and contemporary practices. the social work profession continues to perpetuate oppression and facilitate racist, ableist and colonial practices (chapman & withers, 2019; humphries, 2004; siddiqui, 2011). indeed, scholars and educators embody various forms of resistance when they navigate the nuanced realities of academic and institutional racism. therefore, the accounts of our experiences are a form of discursive resistance that we hope shed light on the politics of subjectivities that racialized scholars face in their personal and professional interactions. discursive resistance refers to our intentional resistance to individual and systemic behaviours, actions, and discourses employed against our identities and subjectivities (anderson, 2008). for us, acts of discursive resistance speak to our efforts to reclaim and embody the complex “representation of power relations” by interrogating construction of our bodies and subjectivities as racialized academics within contemporary neoliberal dominant white academia (lessa, 2006, p. 285). it also allows us to engage in “practices that manage to break away from the hegemony of dominant discourses” (lessa, 2006, p. 286). as such, the process of discursive resistance for us begins with interrogating dominant discourses that shape our experiences and subjectivities within social workspaces (e.g., education, practice, scholarship, research), and we seek to disrupt these spaces by reclaiming our embodied subjectivities as racialized social work educators, practitioners and researchers through centering alternative discourses that represent our lived realities. thus, discursive resistance in this sense embodies other forms of resistance that reject professional conformity and enrich the knowledge base of social work in ways that account for diverse perspectives and lived realities beyond the assumed white universal subjectivities. as social work students, and now educators, it was common to be taught by just a few racialized instructors during our entire degree. these anecdotes are typical in many social work departments in canada where curricula about the “racialized other” are designed, constructed, and delivered mostly by white educators and scholars. our observations are not intended to dismiss or diminish these instructors and their educational efforts. instead, they are meant to offer an opportunity to discursively interrogate how the “racialized other,” their issues, and their experiences are negotiated, represented, and negated within social work curricula. we consider the various forms of oppositions and resistance we confront within institutional walls. we are also acutely aware of the ongoing challenges that exacerbate racialized faculty’s experiences in academia. structural inequalities within academic walls maintain and complicate their marginalized positionality. as such we must decide the extent to which we engage in overt and covert forms of resistance. we assert our multiple intersecting identities, discourses of resistance and subjectivities as guiding frameworks to interrogate whiteness and challenge its hegemonic domination. doing so is an important step to reclaim our positionalities and to establish the boundaries and requirements that will actively shape the process of dismantling white supremacy within social work. such discursive forms of resistance call for the need to think about social work education beyond the comfort of white academics and scholars; this is a call that occupies spaces, gives voices and embodied experiences to racialized and indigenous knowledges and realities beyond the imposed white subjectivities on these groups. duhaney & el-lahib/politics of resistance 425 terminology as a form of discursive resistance, we begin this section with a note on terminologies to highlight the importance of interrogating language and discourse and examine their ways of shaping power dynamics and relations. as such, we highlight several key terms, namely, black, indigenous, people of color (bipoc), racialized, whiteness and white supremacy to help to frame our political discussion and efforts of resistance. the myriad terms used to describe racialized bodies are fluid, some of which have been imposed by the dominant group. nonetheless, we recognize the significance in naming ourselves and our experiences. the concept of race is now widely recognized by social scientists and the broader academic community as a social construct. specifically, race has no biological significance. however, concepts of race have been used to differentiate racial groups based on physical features. while definitions of race are fluid and have evolved over time, the meanings attached to race contribute to differential treatment of racialized people and influence the ways in which they occupy and navigate space, their sense of belonging, accessing resources and services, and disparities in their experience on various levels of society. the term bipoc has received increased attention in recent months in academia and broader society following protests that stemmed from increased police brutality. bipoc is considered an umbrella term that refers to black, indigenous and people of color. the term is meant to reflect their histories of oppression and experiences of ongoing racism. however, we acknowledge that its usage may conflate and homogenize racialized people’s experiences. it creates a binary where bipoc are in opposition to white people, which inadvertently elevates whiteness and white superiority. in their seminal work where they conceptualized “coloniality of power” to interrogate experiences of colonialism in latin america, quijano (2000) asserts that indigenous peoples in latin america as well as people who were brought as slaves were ‘conquered’ only when they were stripped of their histories, languages and identities and became constructed as homogenized ‘indians,’ ‘negros or blacks’” (p. 219). for us, the term “people of color” is an active form of stripping racialized peoples and communities of their histories, identities, nationalities, cultures and hegemonically assign them one new identity. such active forms of coloniality of power not only eliminate our distinctive and unique characteristics, but also classify all of us (who are referred to as people of color) in ways that maintain white and whiteness while homogenizing racialized groups based on their skin color. as such, interrogating the term people of color for us is a form of discursive resistance to languages and discourses that seek to strip us of our identities and assign us new ones that fit with the dominance and control agenda. interrogating the centrality of white and whiteness as the dominant norm that all other racialized groups and communities are compared to and contrasted against is an important step to recognize the systemic and intentional erasure that these communities have been subjected to. we recognize that the various terms used to describe and classify racialized people remain contentious, however, we use the term racialized and indigenous to refer to the experiences of people who are not white. we argue that the term “racialized” is more politicized to reflect the systemic social construction that subjugates racialized groups and advances in social work, summer 2021, 21(2/3) 426 communities based on their racial identities as compared to the dominant white race. the notion of “racialized” in this sense is an active rejection of the assumed neutrality of the term race and asserts that racialized groups and communities have been marginalized based on interpretations and classifications of their racial identities as understood by the dominant white majority. as such, our rejection also is extended to the assumingly neutral term “people of color” that classifies all racialized people into one homogenous category based on skin color. the current climate of social movements and the calls to reclaim spaces within the struggles for justice by black, indigenous and racialized people are promising in many ways. yet there will be many stones to turn and terms to be explored before these struggles are able to reflect the pulse of the peoples and their desire to change. until then, and based on earlier discussion, we assert our claim and advance our arguments to use the political term “racialized” instead of the purely descriptive and problematic term “people of color.” it is important to note however that assuming a “racialized identity is possible only if its formation is seen as a dynamic process whereby similarities and differences are taken to be of equal importance” (britton, 1999, p. 40). thus, we recognize the multiplicities of our identities including gender and class and the ways in which they complicate our experiences. another term that is discussed is the concept of whiteness, which works in tandem with white supremacy. whiteness is defined as a “complex, hegemonic, dynamic [socioeconomic and political processes] that function to obscure the power, privilege, and practices of the dominant social elite” (lea & sims, 2008, pp. 1-2). it is an “invisible norm against which other races are judged in the construction of identity, representation, subjectivity, nationalism and the law” (moreton-robinson, 2004, p. vii). it “reproduces inequities, injustices, and inequalities within the educational system and wider society” (lea & sims, 2008, p. 2). these conceptualizations of whiteness shape understanding of identity and skin color as well as discourse, structures, location, broader social systems and subjectivities (duhaney, 2010; henry & tator, 2006; walter, et al., 2011). therefore, it is imperative to examine the ways that whiteness has imbedded itself within social work to shape the profession, its norms and how social work constructs racialized communities, groups and identities. for us, as racialized social work educators, grappling daily with these tensions is part of how we embody our professional identities as critical social workers. we deal with such tensions in our classrooms, on campus, with administrators at our institutions, community agencies we work with, and the broader communities we engage with. in fact, these tensions are present in every interaction we make as professional social work educators and scholars, and the impacts of these realities have lasting effects on our personal well-being and professional career advancements. related to whiteness is the concept of white supremacy, which is often used in conjunction with radical right-wing extremist hate groups who incite racist beliefs and promote violence. however, ansley (1989) asserts that it refers to: a political, economic and cultural system in which whites overwhelmingly control power and material resources, conscious and unconscious ideas of white superiority and entitlement are widespread, and relations of white dominance and non-white subordination are daily re-enacted across a broad array of institutions and social settings. (p. 1024) duhaney & el-lahib/politics of resistance 427 the prevalence of white supremacy is evident when we examine disparities in income, housing, education, and the overrepresentation of racialized people in the criminal justice system. finally, we recognize that neoliberalism is intertwined with whiteness and white supremacy to uphold dominant ideologies. in her seminal article, larner (2000) asserts that neoliberalism is a complex ideological phenomenon that can be defined by its focus on “new forms of political-economic governance” and offers three ways to understand and distinguish between various approaches to understanding neoliberalism and its operation. the author separates between “analysis that understands neoliberalism as a policy framework, those who portray neoliberalism as an ideology and those who conceptualize neoliberalism through the lens of governmentality” (p. 6). the foucauldian concept of governmentality, or the “art of government” (jessop, 2007, p. 37), refers to the ensemble formed by the institutions, procedures, analyses and reflections, the calculations and tactics that allow the exercise of this … complex form of power, which has its target population, as its principal form of knowledge political economy, and as its essential technical means of apparatuses of security. (foucault, 1991, p. 102) the correlation between neoliberalism and other means of social control through policies, ideologies and governance cannot be separated from the ways relations of power are conceptualized, perceived and operationalized within and through social work and the social working of marginalized social groups. as such, understanding and interrogating the current climate of neoliberalism in higher education using the lens of governmentality will be helpful to interrogate the process of control and discipline that continue to shape racialized faculty members and dictate their approaches to classroom management, access to research and scholarship as well as their chances of academic career advancement. contextualizing racialized people’s experiences in academia we acknowledge that some of the challenges (i.e., heavy teaching schedules, research and service demands, acquisition of external funding) that racialized faculty face are related to their jobs. these responsibilities are further complicated by their overcommitment on equity and diversity committees and student mentorship. we recognize the invisible labour that we expend to break down barriers and create spaces that are conducive to our growth. invisible labour refers to the disproportionate amount of time that racialized faculty spend on activities (i.e., advising students, sitting on various committees) which is often minimized and devalued (social sciences feminist network research interest group, 2017). these “processes take on increased and amplified weight for [racialized faculty] in predominantly white institutions” (caton, 2013, para. 6). recruiting and hiring practices are also exclusionary and often do not grant qualified racialized people equal access. even before they enter these homogenous spaces, their passage is marred with stereotypes that render them incompetent. simultaneously they are predisposed to increased scrutiny. students often publicly undermine their authority in the classroom and colleagues may question their legitimacy. many racialized faculties go to great lengths to establish credibility and legitimacy (kelly et al., 2017). advances in social work, summer 2021, 21(2/3) 428 resistance in academia resistance in academia takes many forms and shapes, and targets the ways institutionalized forms of racism, ableism and colonialism play out to maintain dominance and control. one of the most important areas that racialized educators interrogate and challenge is research. it is not surprising that many racialized faculty members can speak to missed opportunities of being overlooked for a research position in their institutions or being dismissed of a recognition for a scholarly achievement. the ways research funding is distributed continue to focus on priorities as set by dominant groups, forcing racialized researchers to either shift their research directions to fit with funders’ priorities or risk not being funded. the distribution of research funding and allocation of priorities are heavily influenced by neoliberalism and neoliberal ideologies (ramos & wijesingha, 2017). neoliberalism with its emphasis on productivity as a key measure of fund allocation combined with dominant and racist perceptions about racialized and indigenous scholars negatively affect their chances of tenure, promotion and securing research funding. in addition, some racialized scholars experience barriers developing robust research programs, and are misunderstood by grant reviewers or dismissed for political and ideological reasons rather than on the merit of their proposals. navigating hurdles and obstacles that we face to establish our research programs is also complicated by the ways our scholarship is viewed and evaluated. an example of this limitation is the current attacks by politicians like former us president donald trump on crt, or the current alberta premier, jason kenney, where he referred to intersectionality as a “kooky academic theory” (woods, 2020, para. 2). such political and ideological attacks on these theories need to be questioned and challenged. indeed, theories such as intersectionality and crt are premised on centering the lived experiences of oppression and marginalization as valid and legitimate sources of knowledge that honor peoples’ voice, experiences and lived realities. the experiences of rejecting knowledge that racialized scholars advance speaks to the delegitimization of the theories that they embody in their research and scholarship. recognizing the complexities of the knowledge production process and the scrutiny that scholarly publication goes through, our argument here is not to generalize these experiences or over-victimize racialized scholars and their research output. however, it is to demonstrate the interconnectedness between systemic racism, sexism, ableism and colonialism and the limited access to research funding as well as knowledge mobilizations as experienced by scholars from marginalized social groups (dolmage, 2017; ramos & wijesingha, 2017; savigny, 2014). in addition, resistance in academia is both gendered and racialized. although we are both racialized, we also recognize that our gendered identities may result in different realities. as a black woman, the first author navigates what hampton (2020) refers to as racially “demarcated spaces” (p. 3). her intersecting identities of race and gender complicate her experiences in academia, and influence, the way she navigates predominantly white spaces, her scholarly pursuits, the challenges she faces to gain legitimacy, the opportunities and supports available to her, and access to appropriate duhaney & el-lahib/politics of resistance 429 mentors. the ways in which her blackness is constructed in these spaces also inform her experiences in the classroom. similarly, as an arab man, the second author navigates his presence within the academic spaces he occupies with a great deal of caution and uncertainties due to the constant “orientalist” interpretations of him and what he brings to these spaces (said, 1978). his identity as an arab scholar gets to be “exoticized” when it is suitable and can be constructed as “terrorist” when necessary. these constructions and interpretations of his body, ethnicity, and identity shape many interactions he engages with and navigates his way through (mcqueeney, 2014; merskin, 2004; said, 1978). phrases like “your english is perfect, and your accent is adorable” are regular exoticizing occurrences in his classes and university committees he serves on. on the opposite extreme, he has been told by students that he “terrorizes” them and they “avoid [his] classes like the plague” because of his reputation as a hard marker, even though he is well recognized for his teaching excellence and the recipient of several teaching awards. such juxtaposition between being constructed as exotic and a terrorist makes navigating his positionality as an arab scholar an interesting endeavour that pushes beyond academic everyday interactions. indeed, our experiences within academia are ongoing sites of struggle riddled with significant emotional and physical labour. at times, we may be implicated in colluding with, embracing or conforming to white supremacy to validate our legitimacy. as such, we remain hyper aware of the decisions we make around how we navigate spaces that continue to disenfranchise us as a form of resistance. we embody our roles as scholar activists who attempt to advance knowledge and contest the politics within academia to provoke broader discussions around white supremacy. the first author provides an example of the ways in which hegemonic dominance of whiteness in social work is operationalized in the classroom. she interrogates the profession’s inherent white knowledge base by forefronting her experiences. my precarious and marginalized positionality in relation to my white colleagues influences the extent to which i confront and resist whiteness and white supremacy. to confront dominant structures in academic spaces, i highlight experiences i have had in the classroom to unravel my own process of discursive resistance. one semester, i decided to conduct an experiment in my graduate classes by asking students to not call me by my first name and instead refer to me as professor duhaney. my intention was to highlight the prevalence of dominant discourses and how these influenced the construction of identities. specifically, i was interested in better understanding the ways in which these processes maintain and reinforce ideological and cultural domination. on the first day of class as i was discussing the course outline, a student interrupted me and stated that she was curious why i was asking students to refer to me as prof. x and if i could let them know my background and work experience. despite my attempts to provide them with a rationale, they wanted more elaboration and i poignantly halted the discussion. i then made the following statements: why are we having this discussion? when i visit my family doctor, i refer to him as dr. x as a sign of respect. i also asked them to consider why this discussion was taking up so much time in class. i said, “if i were a white male, would we be having this conversation?” one student stated that they were surprised that i would claim the title of prof. especially in a social work classroom where everyone was advances in social work, summer 2021, 21(2/3) 430 assumed to be equal. at the end of class, one or two of these students were unhappy with the exchange they had with me and complained to administrators. in their attempts to villainize me, these students said i was “defensive and made them feel unsafe in the classroom.” one student continued to berate me in her written assignment. i was deeply disturbed at the extent to which students challenged me, undermined my authority and escalated the incident. it seemed that these exchanges were meant to remind me that i did not have the power to define myself or my experiences. it also reaffirmed that i must know my place and remain passive because i am not afforded the same privileges as my white colleagues. i was concerned that at the graduate level, some students believed that we are all equal and communicating on a first name basis assured this equality. during our second class together, i provided a more in-depth explanation to highlight the significance of titles for me. i shared the following with students, because of my experience of discrimination and oppression, holding the term professor or doctor does not carry claims to power and privilege that it may for a white man or white woman. although i have spent 23 years in higher education and have obtained four degrees during that time—i am reminded frequently when i navigate predominantly white spaces that i need to constantly prove my worth. claiming aspects of my identity holds so much more than a title that many people take for granted. it was not too long ago that black people did not have access to institutions occupied by white people. when they eventually gained access, they received substandard education. although they were just as smart or smarter, they had to work 10 times harder to get any recognition. i embrace the titles, professor duhaney and dr. duhaney because of the plight my ancestors have taken for me to be in this place. as i look around me, i see very few racialized professors and even fewer in leadership positions. some people claim aspects of their identities as a political act against intellectual colonization, which some scholars would refer to as discursive resistance. for me, asking students to refer to me as professor duhaney is not about elitism and power. it is a recognition of the ongoing struggles black people encounter as they navigate and reclaim space predominantly occupied by white bodies. it is also about legitimizing subjugated knowledge and experiences. it is countering hegemonic thinking and cultural norms. collins and moore (2004) further complicate the significance of titles by stating, “modes of address for african american families have historical, cultural, and psychological significance…white people did not address black people with the customary courtesy titles of respect. the standard protocol was to address blacks by their first names” (pp. 164-165). therefore, using the last name and appropriate titles with black people acknowledges their worth and value, and is a sign of respect. despite my detailed explanation, the student complainant was not satisfied. they escalated the issue further by making a complaint to a non-disclosure line; this complaint was also forwarded to the dean for further investigation. the allegations stated that i discriminated against minority students, feminized a person’s name and displayed micro-aggression in the classroom. the deleterious effects of these claims are long-lasting and the gravity and impact of the students’ accusations on my mental, physical and emotional well-being were significant. duhaney & el-lahib/politics of resistance 431 the emotional trauma that erupted following the accusations became unbearable and made it difficult for me to effectively do my job. during the investigation, i expressed concerns about the precedent this sets for other professors, particularly racialized professors who continue to experience hostility in the classroom. i also discussed the ways in which i was surveilled and treated as a suspect. although the events that occurred in my class were based on students’ perceptions, feelings and emotions, the onus was on me to prove that i was not culpable to vindicate myself. i went to great lengths to disprove these erroneous claims against me by providing emails from other students debunking what the other students shared as well as video recordings of the two classes in question. in the end, the accusations were deemed unsubstantiated; however, the harm was done. the second author’s experiences with knowledge delegitimization in the classroom takes similar directions. the theme for my first class was social work and diversity. i facilitated an ice-breaker activity and went through introductions. during the introductions, i listed my degrees and briefly discussed the focus of my research. however, a group of seven white female students stood up and “demanded that i prove my qualifications.” i was taken by surprise at the audacity of such a request and asked the class to take a break and that we would address this when they returned. after the break, i stated that i was unsettled by the request and called out the racist assumptions that made the students feel it was acceptable to “demand” that i prove my qualifications to them. i ended the tension by asserting the class agenda and schedule and offered those who were not happy with me to contact the dean, who hired me, for further information. such events are significant to how racialized bodies, minds and knowledges are subjugated, minimized, and discredited. in fact, these dynamics are not limited to classroom management, but extend further to official institutions and social work accrediting bodies. indeed, as a new hire at my current university, it was stipulated that i become a registered social worker. without delving into detail about the issues and problems with such approaches to social work conformity, i had to adhere to this condition on my job contract. so, i went ahead and started the process of becoming a registered social worker. i was shocked when i was “required” to complete my 3rd year bsw practicum hours because they expired. this is in the context of not having my 23 years of experience as a social worker, community organizer and disability activist recognized in canada. after i immigrated in 2005, i was forced to start my education from scratch with the bsw program. fast forward to finishing my bsw, msw and phd in canadian programs of social work and needing to become a registered social worker to maintain my job. when i contacted the alberta college of social workers to inquire about this unrealistic expectation, i politely shared my frustration with the person on the phone. i also stated that i had no choice but to accept that all my 23 years of experience were not recognized in canada, and asked, “now you also want to deny me my canadian experience?” the person on the phone interrupted me and said, “this is canada, and we are not selling hamburgers; this is canada, and we have higher standards.” this is where i realized the complex process of colonization and colonial practices and how whiteness and assumed white supremacy is deeply embedded in the minds and psyches of those controlling social work practice and institutions. indeed, one of the ways colonization operationalizes is through the delegitimization of the “other” knowledge base. the “civilization mission” of european advances in social work, summer 2021, 21(2/3) 432 settler colonizers is just an example of how the assumed superiority of the “canadian standards” constructed my 23 years of experience in five countries and two continents as useless and rendered my lifetime work as a process of “selling hamburgers.” these are not merely anecdotal experiences, the assumed superiority of white supremacy in social work runs deep in how the profession sees itself and facilitates its interactions. as the profession continues to see itself as the social justice knight and promotes its contributions to social transformation based on standards that fit its narratives, the discrepancy between the profession’s perception of itself, its reputation and what it really stands for will continue to deepen. the ways we embody our identities, experiences and knowledge as racialized social work educators, researchers and practitioners is a form of resistance to white supremacy and whiteness. our presence in academic spaces epitomizes a form of resistance, a statement that we are here, and we are not going anywhere, and social work must deal with these realities. the days that normalized stripping us out of our contributions to the profession are long gone and the current climate of political awareness in social work is something to embrace and build on. the question is, can social work truly embrace and support this transformative climate, embrace the challenges put forward to it, and activate the process of changing itself to be true to its value system as a social justice and transformation profession? implications for social work education, research and practice social work pedagogy has systematically contributed to the erasure of the racialized other. therefore, as racialized social work educators, researchers and practitioners, it is important to uphold our commitments to resistance in our classrooms and throughout our research and practice engagements. for paulo freire (1971), education is a practice of freedom, and as richard shaull further suggests in his foreword to freire’s book, there is no such thing as a neutral educational process. education either functions as an instrument that is used to facilitate the integration of the younger generation into the logic of the present system and bring about conformity to it, or it becomes ‘the practice of freedom.’ (freire, 1971, p. 34) therefore, resisting dominance and control and challenging social work’s epistemological and ontological knowledge bases and confronting notions of professional conformity is at the heart of our commitments to social justice principles. as such, diversifying the social work knowledge base is necessary and must include different ways of knowing and being to actively disrupt the heteronormativity of whiteness and white supremacy. one of the ways we can do this is to effectively equip social work students with social justice approaches that expose them to concrete opportunities to practice social justice skills throughout the curriculum and their practice environment (atteberry-ash et al., 2019; nicotera, 2019). moreover, given the challenges students face grappling with “social injustices and oppression in the real world” (richards-schuster et al., 2015, p. 380), accrediting bodies of social work must consider having designated courses that approach racism and other forms of oppression from wholistic perspectives that account for complex social positionalities and lived experiences. these may better duhaney & el-lahib/politics of resistance 433 equip social work students and practitioners with effective knowledge, skills and practices to do anti-racism and anti-oppressive work. dismantling white supremacy must move beyond the classroom and translate into research that accounts for other ways of knowing, and questions and challenges its dominant knowledge base, specifically, the profession’s epistemologies and ontologies that valorizes whiteness. we must recognize historically marginalized ways of knowing and being as valid sources of knowledge that would help advance theorizing. for example, within contemporary neoliberal systems and market-oriented approaches to research and knowledge production, there is an emphasis on research productivities that perpetuate entrepreneurial and consumerist approaches as research priorities at the expense of the lived experiences of racialized and marginalized communities. these dynamics shape the ways research agendas are structured and prioritized and how funding is allocated and distributed. within these broader socio-economic, political and ideological contexts, researchers from marginalized social groups and identities experience significant barriers securing funding and establishing research programs that respond to their communities’ realities. as such, to dismantle white supremacy within and through social work requires a critical examination of what constitutes research agendas and how they get to be actualized. the social work profession has been portrayed as social control agents (chapman & withers, 2019; margolin, 1997). dismantling white supremacy in social work requires an examination of our historical and contemporary practices that facilitate the control of marginalized social groups and communities. however, the process of dismantling white supremacy dictates that we question, challenge, and interrogate the mechanisms that place us as one of the states’ controlling hands like the police, the army and other governance institutions. it also means divorcing the profession from its white assumed universal subjectivities. starting on this journey of professional self-actualization for social work requires an active process of interrogating our role in facilitating oppression, marginalization and colonization, and owning the ways we operationalized racism within and through our practice. indeed, to dismantle white supremacy in social work means severing the profession’s relationship with the state and challenging the dominant ideologies that shape our knowledge and practice base. dismantling white supremacy calls for a critical look at the various processes that define our profession and the ways we have been implicated in upholding racist, ableist and heteronormative systems. this also means that social work needs to refrain from playing the role of the expert and reject its role as a hand of the state to control the marginalized and disenfranchised. such processes would move the profession away from its colonial and racist knowledge bases and center its political role as a profession that seeks to advance social justice and transformation, as we claim in all our professional codes of ethics and professional guidelines (canadian association of social workers, 2005a, 2005b; international federation of social workers, 2018; national association of social workers, 2017, 2018). conclusion in this article, we forefront our experiences in the classroom and beyond as a counternarrative to disrupt the dominant normativity of whiteness and white supremacy, advances in social work, summer 2021, 21(2/3) 434 which remain foundational elements of social work knowledge base. as we grapple with the dynamics of power that shape our interaction with social work institutions, pedagogies and practices, we are reminded of the need to reject professional conformity if we are to uphold critical consciousness and embody resistance. however, as racialized scholars, we recognize our precarious positionality in white institutions which creates ongoing tensions. these barriers and challenges simultaneously compound and diminish our capacity to resist white hegemony in academic spaces. therefore, the act of naming and calling out whiteness and white supremacy has the potential to place us into a perilous situation. the negative repercussions that may ensue for racialized scholars is enough of a deterrence. nonetheless, the issues discussed in this article are intended to create space for further dialogue about the state of the social work profession. conversations around whiteness and white supremacy should not be reactionary acts of performativity in response to current social events. indeed, we must have intentional conversations that propel us to look inward and interrogate the social work profession. we call on the profession to own its role in perpetuating racist, ableist and colonial practices and pedagogies, and be true to its value systems as a transformative profession. dismantling white supremacy in social work requires brave actions and sustainable solutions that not only acknowledge social work’s complicity in perpetuating racism but reclaim our role as agents of change to eradicate all forms of oppression. references anderson, g. 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(2020, september 24). jason kenny on throne speech: intersectionality a ‘kooky academic theory’. huffington post: politics. https://www.huffingtonpost.ca/entry/jason-kenney-intersectionality-thronespeech_ca_5f6d1f22c5b64deddeeb2130 author note: address correspondence to dr. patrina duhaney, faculty of social work, university of calgary, calgary, alberta, canada, t2n 1n4. email: patrina.duhaney@ucalgary.ca https://doi.org/10.1080/10437797.2019.1600443 https://doi.org/10.1177/0268580900015002005 https://doi.org/10.1080/10428232.2014.940485 https://doi.org/10.18060/18526 https://doi.org/10.1080/09540253.2014.970977 https://doi.org/10.4135/9781446269473.n2 https://digitalcommons.humboldt.edu/hjsr/vol1/iss39/21/ https://doi.org/10.1080/0312407x.2010.510892 https://www.washingtonpost.com/business/2020/09/30/trump-race-training/ https://www.huffingtonpost.ca/entry/jason-kenney-intersectionality-throne-speech_ca_5f6d1f22c5b64deddeeb2130 https://www.huffingtonpost.ca/entry/jason-kenney-intersectionality-throne-speech_ca_5f6d1f22c5b64deddeeb2130 mailto:alex.redcay@millersville _________ michael massey, phd, msw, m.ed., assistant professor, national catholic school of social service, catholic university of america, washington, dc. kynai johnson, phd, msw, senior director of diversity, equity, and inclusion, world resources institute, washington, dc. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 522-544, doi: 10.18060/24468 this work is licensed under a creative commons attribution 4.0 international license. social work educators as white allies? an integrative literature review michael massey kynai johnson abstract: white educators represent the majority of social work faculty. current research suggests that many white social work educators are not prepared to address racism in classroom discussions and model antiracist behavior. an integrative literature review was conducted by the co-authors—a white man and black woman, both social work educators—to examine how recent literature characterizes the “white ally” educator and explore concepts designed to prepare white faculty for purposive action to dismantle white supremacy. integrative review is a methodology used to summarize empirical/theoretical literature to provide a comprehensive understanding of a phenomenon. twenty-two articles met inclusion criteria for this review. the analysis involved two steps: first, a synthesis and integrative model of the literature on educators as white allies. second, an application of the critical race theory concepts interest convergence and anti-essentialism. the integrative model of the white ally educator suggests a white identity process; necessitating critical self-reflection and multi-level, antiracist action. critical examination of the literature troubles the concept of “white ally,” pointing to the potential re-centering of whiteness. further research is needed to help social work educators recognize racism in their work and prepare future social workers to engage in antiracist social work practice. keywords: white allies, social work education, anti-racism social work literature devotes significant attention to helping social work students become more culturally competent (bender et al., 2010; boyle & springer, 2001; bubar et al., 2016; council on social work education (cswe), 2015; johnson & munch, 2009). additional attention has been paid to preparing students to address racism in social work programs (abrams & moio, 2009; kindle & delavega, 2018; wagaman et al., 2019; wahler, 2012). much of this work presumes that social work educators are prepared to address racism in their classrooms and model antiracist behavior. little evidence supports this presumption. this is troubling considering that white educators represent the majority of social work faculty (cswe, 2020) and benefit from white supremacy. so, while it is no doubt helpful to explore educational strategies and pedagogies that facilitate student learning around white supremacy and racism, more attention is required to prepare faculty, particularly white faculty, to implement these approaches with commitment and fidelity. white supremacy is more than overt racial bigotry and discrimination. rather, as ansley (1997) states, white supremacy is a system in which “whites overwhelmingly control power and material resources, conscious and unconscious ideas of white superiority and entitlement are widespread, and relations of white dominance and non-white subordination are daily reenacted across a broad array of institutions and social settings” (p. 592). to understand how better to prepare white social work educators to address issues about:blank massey & johnson/swk educators as white allies? 523 of racism and dismantle white supremacy, we employed the methodology of an integrative literature review to conceptualize educators as “white allies.” though the concept is not new, “white ally” has become part of the popular vernacular through the work of white identity development scholarship (helms, 1990; sue, 2017; tatum, 1994), along with the growth of contemporary black-led activism movements such as the movement for black lives. that being said, white ally is difficult to define and remains a contested concept. white identity development scholarship focuses on how white people come to understand themselves as having a racialized identity, form a positive sense of self, and reconcile their unearned relationship to privilege and their capacity to utilize that power for antiracist social change (sue, 2017 tatum, 1994). in contemporary antiracist movements, the white ally is seen as someone who stands with black, indigenous, and people of color (bipoc) in resisting discrimination and fighting for racially equitable systems (dismantle collective, 2019). the purpose of this review was to synthesize recent literature on the white ally educator to inform the development of white social work educators ready to commit to racial justice. we also sought to explore the tensions and potential of the white ally educator identity. using critical race theory (crt) concepts of interest convergence and anti-essentialism, we critically examined the literature to identify areas for future research and ways that the concept may unintentionally center whiteness and reinforce white supremacy. background cswe position the council on social work education (cswe, 2015) mandates that schools of social work prepare students to “engage diversity and difference in practice” and to “advance human rights, social, economic, and environmental justice” (p. 7). further, cswe requires that social work programs create an inclusive environment that “models affirmation and respect for diversity and difference.” in light of recent events, cswe (2020) appears to be evolving from an emphasis on engaging diversity to one of racial justice, recently asserting that it is time to “honestly examine how social work curricula go beyond teaching an appreciation for physical or cultural diversity and empower the next generation of social work practitioners to dismantle institutional racism” (para. 6). role of white social work educators white faculty make up over 60% of full-time social work faculty members in the united states (cswe 2020), a share that is presumably higher at predominantly white universities (pwis). while we support a more diversified faculty composition, it is clear that white social work faculty have a critical role in dismantling racism in social work education. however, the current evidence points to several ways in which white social work educators are not prepared or resistant to taking up this challenge. advances in social work, summer 2021, 21(2/3) 524 in many cases, faculty identified as bipoc are overburdened with the responsibility for teaching courses focused on diversity and social justice (larke & larke, 2009; ledoux & montalvo, 1999). often, the majority of such content is relegated to one or two designated courses. this arrangement suggests that issues of racism, privilege, and oppression are the concern of only bipoc, and may marginalize this important content and the faculty teaching it (larke & larke, 2009; ledoux & montalvo, 1999). when white faculty are responsible for teaching diversity and oppression content, they may not be ready to do so effectively. deepak et al. (2015) contend that to effectively teach about racism, power, and privilege, instructors must be willing to “go there”—deeply explore uncomfortable issues, face student resistance, and reflect on their own status and positionality (p. 116). in many cases, white faculty members are resistant to doing so, perhaps due to personal or professional risk (deepak et al., 2015), internalized bias, and normative feelings of discomfort or guilt (cochran-smith, 1995; sue, 2017; tatum, 1994). even more concerning is that some white faculty may avoid addressing racism and oppression not because of discomfort, but because they think it unnecessary. in their qualitative study of u.s. social work educators who have taught cultural competency classes, feize and gonzales (2018) explore the ways that social work educators approach cultural competency, which is itself a highly contested concept (abrams & moio, 2009; azzopardi & mcneil, 2016; feize & gonzales, 2018). they distinguish between those who teach cultural competency through the lens of multiculturalism, which focuses on inclusion, tolerance, and cross-cultural perspectives, and those who teach through a critical lens, which directly addresses racism, privilege, and power and focuses on antiracist practice. they found that 11 of the 16 educators did not think it was necessary to teach about antiracism and discrimination, believing that “racism will diminish gradually on its own when minorities are fully included and embraced in society” (feize & gonzales, 2018, p. 484). only one of the five faculty members that did include antiracist and oppression content was white. of course, disrupting white hegemony in education requires extracurricular work as well. the cswe mandates that social work educators create inclusive and diverse programs actively engaged in dismantling oppression. to do so, educators must address institutional racism and the broader systems in which they are situated. again, the scholarship suggests much to be done and documents numerous ways that educational institutions, particularly pwis, are hostile to black and brown students and faculty alike (logan et al., 2017; mccoy, 2020; mills, 2020; von robertson & chaney, 2017). white educators have a crucial role in challenging these injustices. white identity development teachers must recognize—before challenging or complying with—systemic educational oppressions. a social-justice oriented approach demands acknowledgment of teaching’s inherent social responsibility, which includes challenging teaching’s neutrality, recognizing its inherent politics, and critically analyzing its systems by considering what counts as knowledge (cochran-smith, 1995). the question, then, is how do white massey & johnson/swk educators as white allies? 525 educators engage in such analysis, acknowledge their roles in upholding whiteness, and commit to dismantling it? exploring white identity development may provide insights. white identity development models according to giroux (1997), the visibility of whiteness as a racial identity emerged in the 1980s and ‘90s, largely through the consciousness raising of bipoc, including black and latina feminists. this broadened understanding of white as a race—rather than its absence—is reflected in helms’ six-stage model of white racial identity development (helms, 1997; tatum, 1994). according to helms (1997), racial neutrality reflects an early stage of white identity development. at the first stage’s onset, individuals see white culture as neutral and normative, and are unaware of their internalized prejudices and assumptions (tatum, 1994). however, helm’s (1997) model indicates that white people can move “from a racist identity to a positive white consciousness” (p. 211). in a parallel conceptualization, tatum (1994) outlines three common models of whiteness: (1) actively racist (embracing “white superiority”), (2) colorblind perspectives, and (3) the “guilty white model.” according to tatum, each model hinders development of a positive white identity resulting in anti-oppressive action. for instance, the latter model, characterized by “shame and embarrassment” as one develops an increased awareness of racism, leads either to immobilization or to over-sensitivity and selfindulgence, which is deeply frustrating to bipoc (p. 471). alternatively, tatum (1994) posits that the white ally model of “whites who have resisted the role of oppressor and who have been allies to people of color” provides the template for developing a “pro-active white identity” (pp. 471-472). for tatum, the white ally has moved past guilt to internalize a new vision of what it means to be white in a racist society. in sue’s (2017) configuration, the four elements of white identity include (a) active racists, (b) unintentional racists, (c) nonracists, and (d) antiracists. the fourth identity, the white ally identity, reflects white people who have moved beyond guilt toward social action to dismantle institutional racism. we sought to understand this identity as applied to educators. while there is ample popular and scholarly literature broadly addressing white allies (e.g., juarez, 2013; kivel, 2006; michael & conger, 2009; sue, 2017), there is significantly less about educators in this role. what exists, primarily in the discipline of education, focuses on training future white teachers to be white allies (e.g., lynch, 2018; page, 2009; tatum, 1994). however, as with comparable social work literature, much of this scholarship fails to examine current educators’ roles. we are attempting to start the process of filling the gap with this review. methods and sample integrative literature review an integrative literature review is a valuable form of secondary research (ganong, 1987; torracco, 2005; thomas & harden, 2008) contributing to a topic’s knowledge base advances in social work, summer 2021, 21(2/3) 526 by synthesizing known information regarding theory and practice (dixon-woods et al., 2006; souza et al., 2010; torracco, 2005; whittmore & knafl, 2005). through this process of review and critique, new understanding and frameworks are generated (dixon-woods et al., 2006; thomas & harden, 2008; torracco, 2005; whittmore & knafl, 2005). an integrative literature review can be applied to mature or emerging topics (torracco, 2005). for emerging topics, such as this one, integrative reviews often lead to an “initial or preliminary” conceptualization of known information, creating a clearer pathway for future research and scholarship (torracco, 2005, p. 357). translating key concepts and descriptive themes in extant scholarship is integral to this process (thomas & harden, 2008), as is addressing contradictory information (torracco, 2005). sample characteristics database searches of academic search complete, j-stor, google scholar, and google—using the search terms “white ally educators”, “white ally social work”, and “white allies” (including boolean combinations)—were conducted to identify articles for this review. in order to expand our literature base and allow for perspectives on the topic outside of academia, we reviewed peer-reviewed articles and monographs in addition to gray literature, which is inclusive of, but not limited to, unpublished reports, online journals, blogs, and white papers (conn et al., 2003; pappas & williams, 2011). to be included in the review, articles had to a) contain the term “ally” or closely related content, b) focus on k-12/university educators, and c) have a publication date between 2004-2019. exclusion criteria included books, dissertations, and articles focused solely on training future educators. since the social work literature on this specific topic is sparse, we searched across disciplines, with the hope that social work scholars will build on this to address social work education more specifically. similarly, we included literature on k-12 educators to expand our base and because college faculty have much to learn from those who teach younger students (quay et al., 2006). the time frame was selected to survey recent literature based upon the second-wave white identity research starting in 2004 (jupp et al., 2016). twenty-nine articles met our initial criterion. upon review, seven articles were deemed incompatible and excluded. of the twenty-two articles included in the final sample (table 1), thirteen were conceptual papers and nine were empirical publications, including one quantitative and eight qualitative analyses. qualitative analyses ranged from critical hermeneutic, narrative inquiry, critical interpretivist, semi-autoethnographic, and counterstorytelling methodologies. fourteen of the articles identified crt, including the subcategory of critical white studies (cws), as the theoretical perspective. fifteen of the articles came from the discipline of education, two from social work, one from a dual social work and teacher education perspective, and three from other disciplines. of the fifteen articles directly addressing the author’s racial identity, nine were from white authors, five were from bipoc, one who identified as a “latina with white skin privilege” (charbeneau, 2015, p. 661), and one was written by a person of color and a white person. massey & johnson/swk educators as white allies? 527 table 1. selected articles author and title theoretical perspective (if stated) conceptual (c) or empirical (e) racial identity of author(s) (if stated) akamine phillips et al. (2019) critical whiteness e aveling (2006) critical whiteness c white boucher (2016) critical race theory e white boutte & jackson (2014) critical race theory e bipoc (both) charbeneau (2015) critical whiteness e “latina w/white skin privilege” (p. 661) chiariello (2016) critical whiteness c white davis et al. (2015) c white (all three) de lissovoy & brown (2013) critical whiteness; decolonialism c denevi (2017) c white desnoyers-colas (2019) racial battle fatigue e bipoc diangelo (2012) c white gaffney (2016) c han & leonard (2017) critical race theory e bipoc martin (2008) white racial identity model e matias (2013) critical race theory; critical whiteness; black feminism c bipoc miller & harris (2018) critical race theory c white (first); second author not stated moss & singh (2015) critical race theory: relational cultural theory c patton & bondi (2015) critical race theory e bipoc (first); white (second) powell & kelly (2017) critical race theory; critical whiteness c white (both) reason & broido (2005) c spencer (2008) c bipoc utt & tochluk (2020) critical whiteness; white racial identity model e white (both) findings our findings will be presented in two main sections. the first, an integrative model of the white ally educator, synthesizes the literature’s common themes and offers a comprehensive picture of the major characteristics encompassing this identity. the second offers a critical analysis of the concept of the white ally educator through the lens of two ideas from crt—interest convergence and anti-essentialism. we will use these ideas to examine key tensions in the literature and problematize the white ally educator identity. integrative model of the literature an integrative reading of the literature suggests that being a white ally educator is an iterative identity process consisting of critical self-reflection and reflexive action in and advances in social work, summer 2021, 21(2/3) 528 out of the classroom (figure 1), represented by the figure’s curved arrows. because white supremacy exists at the intersection of mutually reinforcing micro and macro level processes, it requires attention to the continuum between interpersonal interactions and structures that reinforce and maintain oppression, represented by the “interpersonal” and “structural” boxes flanking the double-sided arrow. within this continuum lies the classroom and the institution, both of which should be seen as inherently political spaces. critical self-reflection for white educators includes but is not limited to self-education about white supremacy, self-recognition of racialized identity, redefinition of knowledge centering marginalized voices and experiential wisdom, and an interrogation of the educator’s traditional role. reflexive action takes place at multiple levels, including the interpersonal, classroom, and structural. in what follows, we will detail each aspect of the model, summarizing the literature’s recognition of educational institutions as inherently political spaces and the importance of understanding and attending to racism at multiple levels. next, we will provide more detailed explanations of the two major components of the white ally educator process: critical self-reflection and reflexive antiracist action. figure 1. integrative model of the white ally educator identity process massey & johnson/swk educators as white allies? 529 classrooms/institutions as political spaces one key aspect in the white ally process is to recognize that schools are not neutral spaces. institutional oppression and white privilege are often unnamed, therefore unaddressed. the literature suggested that white ally educators must identify and name them in order to upend them. working with black and brown students and faculty, white allies should “focus unwaveringly on how power and privilege function in the school environment and beyond” (gaffney, 2016, p. 36). educators who understand that teaching, research, and service are inherently political more clearly see how their actions, or lack thereof, contribute to or resist racism. micro/macro racism much of the literature warned that ally work cannot be focused on solely the micro or the macro level. many authors suggested that white educators often situate ally work predominantly at the interpersonal level, believing that supporting their black and brown students or colleagues is enough (miller & harris, 2018; patton & bondi, 2015). as a result, as de lissovoy and brown (2013) point out, many white educators fail to see that racism and its pernicious consequences will persist despite kind acts or good intentions: the consciousness of whiteness as a structural and global phenomenon can move the conversation of whiteness beyond the idea that white activism is an individualistic endeavor bound to a moralistic predilection to be an agent of change . . . white teachers must understand that whiteness entails much more than their individual privilege or their individual agency—a common theme in the educational literature about white teachers (bell 2002; johnson 2002; swartz, 1992). white activist-oriented teachers must understand that whiteness will operate whether they choose to act or not. (pp. 553-554) indeed, not only will whiteness continue to operate, but working only on an interpersonal level is “futile if efforts do not address overarching inequities” (patton & bondi, 2015, p. 505). critical self-reflection the white ally educator identity process is an “unending cycle of reflection-action and action-reflection” (martin, 2008, p. 166). ongoing critical self-reflection is the bulwark against action that marginalizes bipoc and reinforces whiteness. charbeneau (2015) asserts that implicit in any discussion of white educator allyship and antiracist action “is the requirement for white faculty to gain greater clarity about their own racial identity, their understanding of racial issues, and the role they themselves play in maintaining the racial structure – even as they may work to alter it” (p. 669). two themes, motivation and stamina, highlight the importance of the self-reflection process. motivation. when white educators involved with antiracist causes discuss diversity and oppression without ongoing critical self-reflection, they may not interrogate their motivations. being driven by superiority, guilt, or shame can undermine the work and leave advances in social work, summer 2021, 21(2/3) 530 bipoc to address the damage. many activists have experiences with self-determined allies who carry “romantic notions of oppressed folks they wish to ‘help.’ these are the ally saviors who see victims and tokens instead of people” (indigenous action media, 2015, as cited by powell & kelly, 2017, p. 46). motivation based on these essentializing notions of white superiority and racial hierarchy will be discussed in more detail in the antiessentialism section. in addition to being motivated by superiority, some white educators may be motivated by shame or guilt. utt and tochluk (2020) problematize this: the difficulty many white people have in conceiving of themselves in a positive way while also recognizing being entrenched within a system that privileges them leads many white people to simply reject association with white identity. this rejection, leading to a limited self-reflective process, results in less awareness of subconscious displays of privilege and the ways social conditioning regarding race penetrates white people’s psyches. (p. 133) boutte and jackson (2014), speaking from the perspective of black faculty members who have experienced frustration with so-called white faculty allies, observed that white faculty members who have not fully examined their own motivations often complain about “feeling attacked” (p. 626) or retreat into color-blind perspectives during difficult conversations about diversity and racism. akamine phillips et al. (2019) suggest that guiltmotivated white allies often seek affirmation from bipoc, which can put “undue pressure on a colleague of color to constantly affirm allyship” (p. 9). these actions protect white self-interest and deflect attention from dismantling white supremacy. stamina. the process of being a white ally educator is “ongoing, requiring continual reflection, and perseverance” (patton & bond, 2015, p. 489). han and leonard (2017) express the need to enter partnerships with white ally colleagues to make necessary changes promoting justice and equity. to facilitate this, white colleagues must establish themselves as persistent potential partners committed to antiracist work. reason and broido (2005) argue that education and self-reflection is key to developing the stamina to meaningfully engage in antiracist action. they point out that while a “critical understanding of one’s role as a member of one or more dominant groups” is not a requirement for action, it provides “the foundation on which sustainable ally identity and actions are built” (p. 82). similarly, matias (2013) reflects on her work with white teachers and those in training, observing “they are not aware of, nor [...] prepared for, how emotionally draining, mentally taxing, and vulnerable they must make themselves in order to be true white allies” (p. 73). reflexive action a recurring discussion in the literature centered around who determines if someone is an ally. not all authors agreed on this point: some highlighted self-identification as a catalyst for antiracist action, while others reflected upon the importance of oppressed groups identifying allies to establish partnership. collectively, the authors recognized that credibility in allyship is earned through consistent multi-level action that disrupts racism massey & johnson/swk educators as white allies? 531 and shares the risk of such disruption with bipoc. actions can include engaging in supportive relationships with marginalized students and faculty, making curriculum culturally responsive and representative of marginalized perspectives, pushing for policies that promote justice, and taking risks to challenge power structures. disruption. white ally educators must determine “how willing they are to personally disrupt the powers of whiteness in their jobs and lives in order to keep people of color safe from any form of abuse” (desnoyers-colas, 2019, p. 104). white educators have unique positionality to privilege that allows for the disruption of social order. denevi (2017) highlights that teaching is not a neutral endeavor. this identifies space to act by disrupting methods and curricula that reinforce white supremacy. ally educators model acknowledgement of privilege and complicity, disrupting the “invisibility” of white supremacy (davis et al., 2014). antiracist curriculums acknowledge identity within the classroom setting, ensuring the inclusion of white identity in analysis (denevi, 2017). antiracist practice requires moving beyond uplifting cultural and ethnic “variety,” critically analyzing power and equity (akamine phillips et al., 2019). this includes identifying “master narratives” within curricula aiming to justify subjugation (han & leonard, 2017, p. 117). additionally, identifying and interrupting microaggressions is a way of leveraging privilege (denevi, 2017). decentering whiteness includes creating space for personal narratives within the classroom. this approach creates space for cultural experiences and understandings (boucher, 2016). notably, classroom storytelling includes creating space for instructors themselves to “come out as white” (maxwell, 2004, as cited in charbeneau, 2015, p. 658). collectively, this moves beyond what freire (1968/1996) deems the banking model of education, to a liberationist practice (charbeneau, 2015). risk. though maintained through individual action, white supremacy is pervasively institutional. this necessitates social action beyond interpersonal engagement. “on the institutional level, this ‘hidden curriculum’ is often manifest in admissions criteria, curriculum requirements, graduation standards, residence hall arrangements, and other formal and informal policies and practices” (charbeneau, 2015, p. 656). institutional engagement occurs when white faculty publicly identify and denounce white supremacist practice, aiming to expose invisible structures that perpetuate and even strengthen white hegemony (akamine phillips et al., 2019). often, antiracist practices have social and professional repercussions. the literature consistently identified the racial threat directed toward black communities fighting for social equity. thus, the ability to leverage white privilege in pursuit of equity emphasizes the value of allyship. white educators engaged in social action are more likely to be praised for their efforts, whereas their colleagues of color are more likely to be denounced (patton & bondi, 2015). white educator allies can utilize this reality to shoulder the burden of the antiracist struggle in partnership with black and brown students and colleagues. despite their privilege, white allies are still likely to face social ostracism for their efforts especially when engaged in antiracist action within their own white communities (boutte, & jackson, 2014). taking this action, despite risk, is central to the white ally educator identity. advances in social work, summer 2021, 21(2/3) 532 critical analysis interest convergence: white ally motivation help or hindrance? scholars such as bell hooks (1989) note that due to pervasive, institutionalized white supremacy, white people have the power to invalidate and sacrifice the interest of bipoc. thus, vested interest in a social justice issue from those in power is crucial to change (miller & harris, 2018). from a crt lens, this vested interest is known as interest convergence, a term coined by scholar, and civil rights activist, derrick bell. interest convergence is defined as self and systemic-interest as a main source of motivation contributing to support of social justice and equity (milner, 2008). specifically, this concept acknowledges that white people will only support racial justice to the extent that it positively impacts white communities (akamine phillips et al., 2019; utt & tochluk, 2020). it is crucial to acknowledge that current policy, practice, research, and theory within educational institutions serve the interests of white communities (milner, 2008). utilizing interest convergence as an analytical tool, this section briefly explores the extent to which white allyship serves the white educator’s interests, ultimately reinforcing whiteness and white supremacy. we additionally explore the possibility for interest convergence to serve the mutual interests of white educators and bipoc, advancing the cause of antiracism. collectively, the literature acknowledged that lasting social change is not likely to occur without true engagement from white communities. de lissovoy & brown (2013) critique the attainability of effective “allyship,” pointing to centuries of oppression against black communities with minimal social change. school desegregation where some progressive white communities invested ideologically, and yet racial order was not transformed illustrates this tension. akamine phillips et al. (2019) liken ideology without action to “being an ally performer” (p. 15). moving beyond performance to disruption requires undermining pervasive, deeply embedded privileges of whiteness something many white educators may not be prepared to do. notably, tension emerged in the literature over the legitimacy of mutual benefits (boutte, & jackson, 2014). for example, han and leonard (2017) discuss how white homogeneity of school leadership in rural pwis creates an interest-convergence vacuum. in the absence of white communities engaging in equity work for their own edification, de facto racial segregation maintains white supremacy. charbeneau, (2015) highlights how racial equity necessitates significant sharing of status and power. this “sharing” can feel like a loss to white educators who have benefited from being privileged over other racial communities. interest convergence conveys “the belief that whites will tolerate and advance the interests of people of color only when they promote the self-interests of whites” (lopez, 2003, as cited in milner, 2008, p. 334). however, it may be possible to see interest convergence as a vehicle for positive change if we see self-interest beyond the win/lose binary (patton & bondi, 2015). for instance, self-liberation and the restoration of humanity is a fundamental element of self-interest (moss & singh, 2015). ally educators may see themselves answering a spiritual or moral calling (denevi, 2017), understanding that dismantling white supremacy benefits everyone. the approach of social action for “us” is massey & johnson/swk educators as white allies? 533 reflected in the work of paolo freire (1968/1996). the freirian approach creates space for authentic, humanizing relationships (utt & tochluk, 2020). collective action for collective benefit can also protect against motivations that are counterproductive to true allyship. anti-essentialism anti-essentialism, closely related to intersectionality, was initially conceptualized by critical race feminist scholars, who critiqued the feminist movement for emphasizing the experiences and aims of white women over those of women of color (grillo, 1995; harris, 1990; houh, 2005). they argued that feminists were ignoring the socially, historically, politically, and personally contingent nature of identity and the salience of multiple, intersecting group memberships. the realization by early black feminists that white feminist leaders “intended to take neither issues of racial oppression nor black women themselves seriously was instrumental in destroying or preventing political alliances between black and white women within the movement” (harris, 1990, pp. 586-587). like gender essentialism, racial essentialism ratifies the social construction of race as an objective and static biological or cultural characteristic—a construction created as a tool for oppression and social hierarchy. essentializing race ignores vast within-race diversity and the socially and historically contingent nature of race as a construct (lopez, 1994). an analysis of the literature on white ally educators through the lens of antiessentialism problematizes the white ally concept. when white educators see white ally as a fixed or essential identity status, they risk becoming inauthentic partners to bipoc and playing a counterproductive role in fighting against white supremacy, setting up white educators to see bipoc as objects of white good will rather than co-subjects in struggle. this tokenism can mask racism under the guise of good intent (greene, 1990). desnoyers-colas (2019) asserts that “today’s white allies seem to spend their time spouting ‘i am your savior’ banalities and equally meaningless mantras that they actually believe bring about a sufficient modicum of authentic social justice disruption” (p. 104). this critique represents a common concern: in positioning themselves as allies, many white educators reinforce the destructive helper/helpless binary that, grounded in good intentions, maintains white supremacy. this reifying dynamic, in which white allies construct themselves as saviors of the helpless other, has deep, historical roots. for instance, the relationship between frederick douglass and william lloyd garrison “illustrates a common narrative of black-white abolitionist alliances in which white elites often mobilized the meta-narrative of the hapless black slave to shape the political discourse of this time” (de lissovoy & brown, 2013, p. 543). de lissovoy and brown (2013) pose an important question: given the often exploitative and disappointing history of black/white alliances, “where is the impetus for african americans to be in solidarity with whites?” (p. 545) in response to this question, de lissovoy and brown (2013) suggest an urgent need for cross-racial solidarity projects to challenge white supremacy in education, suggesting that projects thus rooted undermine the essentialist white/black division crucial to upholding white supremacy. these projects are possible, they argue, in a space somewhere advances in social work, summer 2021, 21(2/3) 534 between the naive hope of re-forming white identities away from whiteness, and the hardened skepticism that white people can authentically engage in antiracist action. citing leonardo from 2009, utt and tochluk (2020) call this the “third space” (p. 127), in which white educators can see themselves “outside of the problematic, fixed construction of the ‘ally’ (boucher, 2016) and move past feelings of insurmountable guilt (tatum, 1994)” (p. 3). miller and harris (2018) also warn against the white “messiah syndrome” (p. 5), but see white allyship as the potential third space in which educators engage in authentic antiracist work. when white educators see themselves as works-in-progress, they can avoid essentialized binaries and self-congratulation: “rather than checking off a cultural competency list, we are transforming ourselves, our students, and the community around us” (p. 10). the lens of anti-essentialism brings focus to a tension in the white ally educator literature. the concept of a white ally identity is an attempt to conceptualize a way for white educators to dismantle whiteness while simultaneously being deeply implicated in it. as the literature points out, there are examples of cross-racial alliances, past and present, that have been undermined by white people’s inability to escape from essentialized notions of race and hierarchy that underpin white supremacy. for some, the white ally, particularly defined as an ongoing process, is the way to enter a space “beyond guilt and resentment” (aveling, 2006, p. 271) that pushes us beyond this conundrum and allows white educators to play a crucial role in dismantling racism in education. for others, the jury is still out. discussion the analysis and integrative conceptual model capture concepts and tools on how white educators can contribute to dismantling racist systems. moving beyond racial consciousness and good intentions, the model suggests an iterative white identity development approach, necessitating critical self-reflection, learning, and, most importantly, consistent multi-level, antiracist action. while much of the literature in this review did not specifically focus on social work educators, we hope it encourages more scholarship in this area. it is possible, though, to extrapolate from this review to inform the practice of social work educators right now. we will start our discussion by offering a few examples of work we are doing that seem to align with our integrative model. changing curriculum: i (michael) recently volunteered for the opportunity to take a leadership role in developing a new required msw foundation year course as part of our curriculum revision. i and two of my colleagues designed a course that builds upon the first semester diversity and oppression content to critically examine racism and oppression in past and current social work and apply antiracism and anti-oppressive lenses to assess and inform social work theory, research, and practice. we see this is a step towards more fully integrating antiracist and anti-oppressive perspectives throughout the curriculum. interrogating the role of educators: as a black woman who attended a pwi, i (kynai) can reflect on the many times a white instructor responded with defensiveness when i massey & johnson/swk educators as white allies? 535 brought up an alternative perspective in the classroom. as a social work educator, i encourage students to lean into discomfort, critique, and disruption. i reject an approach to teaching where i as the educator feel the need to be the universal “expert.” i see my role as a facilitator of discussion in the classroom—recognizing different types of expertise (personal, professional, and academic, for instance) and intentionally creating a space that values the exchange of diverse perspectives and critical thinking. taking antiracist action: as a white, early career social work educator, i (michael) am working to walk the walk and talk the talk. i still have a long way to go, but i have tried to be intentional about building in activism as part of my pedagogical approach. antiracist activism can take many forms. some examples include planning or attending political demonstrations with students, collaborating with students to write letters to local representatives or members of congress, and partnering with and/or supporting students/colleagues who are pushing schools of social work to be more inclusive and equitable. disrupting whiteness in the social work classroom: i (kynai) have seen the utility of addressing classroom dynamics and the manifestation or white supremacy and centering of whiteness that can occur in all spaces including the classroom setting. too often, discussions of cultural competency are externalized. educators and students talk about what we can do “out there” in our future social work practice. these discussions become more meaningful when we reflect on how we internalize and engage in white supremacy in the classroom. noticing and naming when a white student or educator cuts off or minimizes the comments of a student of color. naming and addressing microaggressions. noticing the racialized identities of the “experts” providing content for the course work. problematizing the white ally identity a critical examination of the literature identifies limitations of the concept of “white ally,” which include the potential re-centering of whiteness and the essentialization of racial identity and racial hierarchy. the concept of white ally, similar to the idea of being “woke”, may be problematic for ongoing development, since it suggests some sort of “threshold” to be crossed or credential to achieve. once the threshold is crossed or credential is achieved, the work is done. this point is reinforced by kendi’s (2019) conceptualization of racist and antiracist not as permanent labels, but as temporally bound descriptive terms. one can be an antiracist ally one day and a racist impediment the next, underscoring the point that white supremacy is most often enacted and reinforced by wellintentioned people rather than overt bigots. one “can only strive to be” antiracist, but there is no finish line (p. 23). identity and developmental scholars have taken pains to suggest that ally identity development is similarly iterative and processual, but thinking of identity in progressive stages nevertheless contributes to the idea that there is some sort of desirable end-point or ideal developmental pathway (rowe & atkinson, 1995). it is possible that conceiving of a positive, antiracist white identity is challenging because such an identity does not exist. from this perspective, because whiteness was constructed as a tool of oppression, then any white identity ultimately is rooted in hierarchy and inequality (garvey & ignatiev, 1996). according to garvey and ignatiev (1996), for advances in social work, summer 2021, 21(2/3) 536 white people to truly be part of the antiracist project, it would require the “ . . . unmaking of whiteness” (p. 107). this unmaking moves beyond thinking about individual identity and pushes us to “blow apart the social formation known as the white race, so that no one is ‘white’” (p. 106). to do this in education, leonardo (2015) calls for white teachers to be “epistemological traitors” who reject whiteness and “follow a pedagogy of racial disruption” (p. 96). these educators should not merely be an ally, but a “concrete subject of struggle” (leonardo, 2002, p. 46). while this is risky work for white educators, leonardo (2015) asserts that failing to do so puts them “at a different risk as they are dehumanized by racism” (p. 96). the common thread connecting these perspectives is that white educators have a profound responsibility to do more to dismantle white supremacy. the literature on educators as white allies provides an important contribution to understanding how white social work educators can be a persistent and authentic part of the antiracist struggle, in partnership with their black and brown colleagues and students. implications for social work this literature review suggests several implications for research and practice. first, we found only two articles from the social work discipline, suggesting a need for social work to examine the role of white social work educators in dismantling white supremacy and their readiness, or lack of, to do so. it is possible that the lack of social work research on this topic is due to a sense of complacency, assuming that social workers are already committed to and prepared to fight racism (corley & young, 2018). as we have noted, recent scholarship does not support such an assumption. additionally, most of the authors of the articles in our review identified as white. obviously, white social work educators are responsible for continued research and self-reflection in this area. however, the perspectives of black and brown scholars and educators adds a new level of depth and dimension. for instance, scholarship from the perspective of black and brown faculty’s experiences with white faculty can help clarify the distinction between “authentic” allies and “ally performers.” it is also important to note that much of the work on this topic is conceptual. further empirical research would help assess key concepts and illuminate the barriers and potentialities of the white educator ally model. for example, as we discussed in the section regarding motivation, much of the literature suggested that white guilt can undermine white educators’ antiracist efforts in a variety of ways. however, guilt mostly went undefined and was often conflated with shame, which is a related but different construct (miceli & castelfranchi, 2018). it would be useful to have more empirical work that could tease out the differences and offer more nuanced understanding of when guilt may be a useful motivator or when it might recenter whiteness (grzanka et al., 2020). more research is needed to understand how white social work educators reach a point where they are ready to engage in the reflection-action process that characterizes the integrated model. or, perhaps more importantly, if social work educators are not at this point, questions need to be asked about why. why, for instance, are social work schools hiring educators who are not ready to address issues of critical diversity and oppression in the classrooms, work in partnership with black and brown colleagues, and challenge massey & johnson/swk educators as white allies? 537 institutional racism? further, future research should seek to examine the dynamics of crossracial coalition building in education (de lissovoy & brown, 2013). indeed, the concept of the ally implies partnership and mutuality. a deeper understanding of the challenges to developing sustainable educational partnerships that decenter whiteness is needed (droogendyk et al., 2016). ultimately, social work educators are responsible for preparing future social work practitioners to live up to the values of the profession. as social work continues to grapple with its racist past and present (corley & young, 2018; craig de silva et al., 2007; dominelli, 1989), educators are called to interrogate themselves and their institutions and engage in educational practice that rejects white supremacy and equips future social workers with the tools to dismantle it. conclusions the obligation of anyone who thinks of himself as responsible is to examine society and try to change it and to fight it-at no matter what risk. this is the only hope society has. this is the only way societies change. (james baldwin, “a talk to teachers”, 1963/1998, p. 679) on one side of the most recent iteration of the culture war—where most social workers and social work schools reside—there is economic, political, and social capital to be gained by individuals or institutions who declare that “black lives matter”, appoint a diversity, equity, and inclusion task force, or label themselves an “ally.” on the other side, terms like “wokeism” and critical race theory have been weaponized in the fight to uphold the status quo and stoke racial resentment. in reality, the actual meaning and impact of these terms and labels varies greatly depending on who is using them and how they are acted upon. this analysis and integrated model suggest that to challenge and upend whiteness in social work education, white social work educators must move beyond labels and commit to intentional, disruptive action. social work educators are responsible for preparing future social work practitioners to live up to the values of the profession. as social work continues to grapple with its racist past and present (corley & young, 2018; craig de silva et al., 2007; dominelli, 1989), educators are called to interrogate themselves and their institutions and engage in educational practice that rejects white supremacy and equips future social workers with the tools to dismantle it. references abrams, l. s., & moio, j. a. 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(2005). the integrative review: updated methodology. journal of advanced nursing, 52(5), 546-553. https://doi.org/10.1111/j.13652648.2005.03621.x author note: address correspondence to michael massey, national catholic school of social service, catholic university of america, washington dc, 20064. email: masseymi@cua.edu https://digitalcommons.humboldt.edu/cgi/viewcontent.cgi?article=1015&context=hjsr https://digitalcommons.humboldt.edu/cgi/viewcontent.cgi?article=1015&context=hjsr https://doi.org/10.1080/10437797.2018.1513878 https://doi.org/10.1080/02615479.2011.616585 https://doi.org/10.1111/j.1365-2648.2005.03621.x https://doi.org/10.1111/j.1365-2648.2005.03621.x mailto:masseymi@cua.edu this work is licensed under a creative commons attribution 4.0 international license. new em@ncipatory landscapes? young people with intellectual disabilities, internet use, and identification processes martin molin emma sorbring lotta löfgren-mårtenson abstract: although research on young people’s identification processes on the internet is a growing field, few studies illustrate conditions for young people with intellectual disabilities (id). previous studies have shown that young people with id are worried about being marginalized, and that many in fact are lonelier than other young people. internet and social networking sites might be of vital importance as a space for exploring alternative and less stigmatized identities. this article reports findings from individual interviews with 27 young people with id in sweden. the transcribed interviews were analyzed using a thematic content analysis. a prominent finding concerned the informants being well aware of both risks and opportunities using internet and social networking sites. consequently, the more they interacted with nondisabled peers, the more they experienced negative consequences of internet use. these circumstances rather lead to downsizing than upsizing internet use, and less participation on social networking sites. the experiences of the informants are discussed in a conceptual framework of social identity, participation, and emancipation. we recommend that social work practitioners reflect upon the ways that support can be arranged in order to empower young people with id to participate on the internet. keywords: intellectual disability; internet use; participation; identification processes; social networking sites (sns) although research on young people’s identification processes on the internet is a growing field, there are few studies that illustrate conditions for young people with intellectual disabilities (id). previous studies show that young people with id are worried about being marginalized from other young people, and that many in fact report experiences of loneliness and living more isolated lives than others (mcvilly, stancliffe, parmenter, & burton-smith, 2006). internet and social media might be of vital importance as a space for exploring alternative and less stigmatized identities. however, scandinavian research has shown that a new generation of young people with id is emerging who have developed somewhat new ways of relating to issues of participation and identity (löfgren-mårtenson, 2005; 2008; mineur, 2013; molin, 2008). these strategies mainly concern the possibilities of expressing alternative selfpresentations, which are not necessarily connected to a specific functional impairment or a certain welfare institutional belonging (e.g., special need student or care user) (molin & gustavsson, 2009). one such strategy can concern attempts to, in an online setting, present a preferred identity (e.g., that of a hockey fan or a musician), which may differ from their disabled identity, which would be apparent in an offline setting. a swedish research project—particip@tion on internet? pupils with intellectual disabilities and identification processes on internet—aims to investigate these __________________________ martin molin, phd, associate professor of social work at the centre for child and youth studies at university west, se-461 86 trollhättan, sweden. +46520223746. emma sorbring, phd, professor of child and youth studies and research director at the centre for child and youth studies at university west, se-461 86 trollhättan, sweden. +46520223712. lotta löfgren-mårtenson, phd, professor of sexology and research director at the centre for sexology and sexuality studies at malmö university, se-205 06 malmö, sweden. +46406658672. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 645-662, doi: 10.18060/21428 https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2017, 18(2) 646 processes based on the perspectives of young people with id, school staff, and parents. the concept of intellectual disability can be used in different connotations across national affiliations. in this article we refer to intellectual disability in terms of the american association of intellectual and developmental disabilities (aaidd) put forward by schalock et al. (2010): “intellectual disability is characterized by significant limitations both in intellectual functioning and adaptive behaviour as expressed in conceptual, social and practical adaptive skills. this disability originates before age 18” (p. 1). in the context of swedish school legislation, an intellectual disability (utvecklingsstörning) along with an assessment of not being able to attain the regular knowledge goals is considered as a requirement for being enrolled in the special program schooling for pupils with id (särskola). the number of studies concerning young people’s use of the internet has radically increased in the last decade (boonaert & vettenburg, 2011). however, rather few studies include young people with disabilities in general and young people with id in particular. eu kids online—europe’s largest study of these issues—stresses the need for research focusing on groups that could be considered as extra vulnerable for content and consequences following internet use (livingstone & haddon, 2009; livingstone, haddon, & ólafsson, 2011). on this matter, chadwick, wesson, and fullwood (2013) concluded: more needs to be done to consider what proportion of individuals with an id actually can access the internet as well as the barriers which may preclude access. attitudinal barriers need much further consideration, with a view to altering negative attitudes. issues of safety, risk and protection online for people with id have yet to be adequately investigated and these currently serve as reasons given for hindering people from gaining online access. (pp. 390391) on the one hand, chadwick et al. (2013) describe an emerging digital divide in which some individuals and groups (e.g., elderly people with severe impairments) tend to be marginalized along with an increased and more advanced use of technology in society. on the other hand, there are indications exemplifying young people and young adults using internet and social networking sites (sns) for the purpose of exploring alternative self-presentations. in this study we define sns broadly as an overall concept including both social media platforms (e.g., facebook, twitter, instagram, snapchat) and other kinds of communicative platforms such as blogs, vlogs, online chat forums, discussion threads on youtube channels, etc. according to chadwick and colleagues (2013), there are several combined factors that influence whether people with id will gain access to the internet, such as individual functional variation, education/training, support and assistance, but also the broader political, economic and attitudinal climate. within these factors one could find both limitations and opportunities. in this regard thoreau (2006) concluded, “the reality of the internet may not be as emancipatory for disabled people as has been claimed” (p. 443). chadwick et al. (2013) stresses—with references to bowker and tuffin (2003)—”hiding id is likely to do little to reduce the stigma or increase the acceptance of people with id within society” (p. 386). managing and shaping social identities in different settings have been of vast interest for different disciplines over the years. the concept of social identity is often referred to as a sense of who a person is in relation to a group membership. jenkins (2007) put forward a distinction between a more static concept of identity towards a moli et al./new emanicpatory 647 more dynamic and negotiable concept of identification processes. too much contemporary writing about identity treats it as something that simply is […] indeed, identity can only be understood as process, as ’being’ or ’becoming’. one’s identity – one’s identities, indeed, for who we are is always singular and plural – is never a final or settled matter […] we should probably only talk about ’identification.’ (jenkins, 2007, p. 5) internet and sns could be considered as a prominent context in which these identification processes can take place. shpigelman and gill (2014) claim that “when using social networking sites disabled people have the opportunity to project a preferred identity to the online world which may differ from their disabled identity projected in the real world” (p. 1603). gustavsson and nyberg (2015) similarly argue that people with disabilities can choose to highlight, reject, or renegotiate their disability identity in different contexts. empowerment researchers have further suggested that people going from an excluded identity to a more included identity often display a civic identity (borland & ramcharan, 2000). in this sense, different sns on the internet could be of vital contextual importance for expressing these alternative civic identities in which, for instance, belonging to a special program or care user identity is not salient. beart, hardy, and buchan (2005) claim that people with id sometimes have problems understanding the terms that are used to categorise them, in particular, many people with id “experience the stigma of their social identity through their interactions with others” (p. 54). in a pilot study based on focus group interviews, we found that professionals expressed a concern that young people will get hurt and end up in undesirable situations (such as being cheated or abused), while parents mainly consider the internet as a possible future venue for the development of new and on-going social relations (löfgren-mårtenson, sorbring, & molin, 2015; molin, sorbring, & löfgrenmårtenson, 2015). another result from this pilot study was the informants’ emphasis on the internet as a tool that could promote both more and less participation in society. consequently, “the pendulum seems to strike higher in both directions” (molin et al., 2015, p. 27), as one of the informants claimed. drawing upon this background, the aim of this article is to describe and analyze how young people with id view risks and opportunities on the internet and, in addition, how they reflect upon emancipative strategies and issues of online and offline identification processes. of relevance for the disability perspective in social work, the voices of young people with id are put forward in order to shed light on both the individual’s limitations and opportunities and “how this interacts with supports to affect capability and subsequent agency in engaging with the online world” (chadwick et al., 2013, p. 391). previous research previous research on disability and the internet has often focused on limitations, risks, and shortcomings that people with id face when using the internet. for example, didden et al. (2009) discuss cyberbullying among pupils within special educational settings. furthermore, normand and sallafranque-st-louis (2016) have shown in a literature review that young people with intellectual or developmental disability (idd) run a greater risk for sexual solicitation. contributing risk factors like sexual and physical abuse, isolation, loneliness, depression, and chatting were found to be more advances in social work, fall 2017, 18(2) 648 prevalent within the target group compared with a general population (c.f., buijs, boot, shugar, fung, & bassett, 2016; priebe, mitchell, & finkelhor, 2013; wells & mitchell, 2014). notably, maïano, aimé, salvas, morin, and normand (2016) conclude in another systematic review that when youth with id were compared with other disabilities or so-called typically developed (td) youth, no clear differences of victimization were found. seale (2014) discusses issues of risk and safety in relation to the quality of technology access. the author argues that the concept of positive risktaking could be useful in order to understand how the relationship between supporters, technologies, and people with id is mediated by risk. positive risk-taking involves strategies for enabling people with id (among others) to have greater control over their lives. with reference to morgan (2004), it is generally about “managing risk not avoiding or ignoring it; taking positive risks because the potential benefits outweigh the potential harm” (seale, 2014, p. 228). shared decision-making (between support workers and people with id), possibility thinking (in terms of what happens if something goes right? rather than what happens if something goes wrong?) and resilience (achieving good outcomes in spite of various threats) are put forward as central dimensions of positive risk-taking. another common focus concerns topics of friendship and loneliness (emerson & mcvilly, 2004; mcvilly et al., 2006). sharabi and margalit (2011) compared how young people with and without id participate in online activities. the study revealed several similarities between the two groups in how they used the internet (c.f., shpigelman & gill, 2014). though, it was the motives for internet use that separated the groups. young people with id reported to a much higher extent that online activities were mostly a way to handle feelings of being lonely. another focus often highlighted in recent research concerns issues of accessibility (karreman, van der geest, & buusink, 2007). studies have investigated how the web could be made more accessible for people with id, in order to facilitate participation within the intellectual disability community (kennedy, evans, & thomas, 2011). even if people with id often use the internet in the same way as others, they also report challenges in handling privacy settings and literacy demands following a more technically advanced and online society (shpigelman & gill, 2014). several studies have shed light on how information and communication technology (ict) can be arranged in different settings, such as in daily activities and residential services (näslund & gardelli, 2012; parsons, daniels, porter, & robertson, 2006). parsons et al. (2006) concluded that ict promoted more accessible communication, but it was still linked to within-service activities rather than to those external to service provision. these findings could be related to molin and gustavsson’s (2009) discussion of how young adults with id sometimes ascribe self-expectations of being like others and sometimes self-expectations of being with others. studies examining ict use among people with id in special program schools and caring services show that professionals' commitment and curiosity in the area plays a crucial role in determining, for example, how the internet is used in different contexts. it is also noteworthy that the staff paying attention to students' own interests and experiences through ict contributed greatly to increasing user agency (näslund & gardelli, 2012). these findings could be linked with several studies stressing that young people with id and their internet use are greatly influenced by the attitude and support approach from the nearest parental and/or staff in their surroundings (chadwick et al., 2013; löfgren-mårtenson, 2005; molin et al., 2015; palmer, moli et al./new emanicpatory 649 wehmeyer, davies, & stock, 2012). finally, research on the internet, identification processes, and the role of support seems to have received less attention in comparison with the above-mentioned topics. though, there are a few exceptions (holmes & o’loughlin, 2012; johansson, 2014; mcclimens & gordon, 2009; salimkhan, manago, & greenfield, 2010). löfgrenmårtenson (2008) reports how young people with id handle issues of sexuality and social relations on the internet. the study describes internet and digital spaces as a new free zone for people with id where they can socialize with others in a unique way without insight from care staff and/or parents. these new meeting places create both risks and opportunities for the users, specifically when it comes to the development of alternative identities, which is not connected to otherwise ordinary experiences of stigmatization and alienation. however, seale (2001; 2007) has a specific interest in aspects of belonging and identification in relation to internet use among people with id. in an early study she analyzed how people with down syndrome manage their identities on their own personal websites. the study examined how the informants choose to present their self-images in relation to their disability, that is, to what extent they accept or deny a group membership for people with down syndrome. one result was that the websites give people the opportunity to express "multiple identities" in the sense that the informants’ identifications were both similar and different from other people with down syndrome. correspondingly, molin and gustavsson (2009) characterize the so-called new generation of integration, i.e., those who grew up during a time when reforms in a number of areas have been salient and they have also participated in various social arenas in a completely different way from previous generations. some representatives of this generation tend to strive for a "third way" between, on the one hand, reconciliation to a special program or care user affiliation (belonging) and on the other hand, trying to break free from the stigma and low-valued belongings. many also exhibit a strong belief in the right to be involved and participate (gustavsson, 1998). the literature shows a gap in knowledge regarding a more nuanced understanding of issues of participation and identification processes on the internet among young people with id. rather few studies have put forward young people’s own voices. we will argue that these voices are of vital importance in order to understand the complexity of internet use and intellectual disabilities. method participants this article reports findings from individual interviews with pupils in an upper secondary special program for pupils with id (n=27). altogether 15 adolescent boys and 12 adolescent girls were interviewed. their ages ranged between 16 and 20 with a mean of 17.2 years. the pupils and their parents were informed about the aim and method of the study in accessible writing and that their participation was voluntary. in connection with the interview, both oral and written information about the study was provided and written consent was collected. the individual interviews were conducted at two similar upper secondary special program schools for pupils with id in the western part of sweden. at the first school 9 interviews were held with 4 boys and 5 girls. at the second school 18 interviews (11 boys and 7 girls) were conducted. the experiences of the informants are presented with pseudonyms and age. advances in social work, fall 2017, 18(2) 650 upper secondary school for individuals with id in sweden is a four-year voluntary type of school that pupils can choose to attend once they have completed the nine-year compulsory school. it is divided into two programs. the individual program is primarily designed for pupils with a severe or moderate id. the national program is mainly designed for pupils with a mild id. there are in total nine national upper secondary school programs for pupils with id, spanning program-specific courses and assessed coursework. the interview participants were all enrolled within national programs such as the programme for health and care-providers, hotel, restaurant and bakery workers, vehicles mechanics, or media. procedure first, the principal of the special program school was contacted so that the researcher received approval to proceed with contacting the school’s teachers and pupils. in the next step, the teachers were contacted by written letter/mail and by telephone and in turn they informed parents and pupils of the study. pupils that were interested in participating in the study registered their interest with the teacher, who drew up a list of pupils that wanted to be enrolled in the interviews. the interviews were conducted by one of the authors in a quiet room located at the special program schools. the length of the interviews averaged 22 minutes. the ethical board of west sweden approved the project (dnr 048-15) and the study was adapted to comply with the swedish code of ethics concerning requirements of information, consent, usage of data, and confidentiality. measures and analysis the individual interviews were semi-structured following a pre-designed interview guide with the following themes: (1) the internet as an arena for identity formation, love and sexuality, (2) attitudes and experiences of young people’s self-presentations and internet relations, (3) the internet and its participative opportunities and (4) parents’ and professionals’ attitudes and coping strategies for how young people use the internet. these themes, with related questions, were influenced by the pilot study prior to this study (löfgren-mårtenson et al., 2015; molin, et al., 2015). all 27 interviews were recorded (in total, 9 hours and 51 minutes of recorded material). the transcribed interviews were analyzed using a thematic content analysis (braun & clarke, 2006). this is a method for identifying, analysing, and reporting patterns within data sets. in the first step the interviewing author read the transcribed material several times in order to “get to know the data” and to illuminate characteristic statements. the next step was to systematically code interesting features of the material in relation to the research aim and objectives. eleven main codes were then organized into different themes. the themes that emerged were designed to capture the content of the data set. in order to ensure this, the data were systematically reviewed and refined by all three authors, and empirically derived themes were then redefined in a dialectic process with the theoretical and conceptual framework of the study. this analytical step has generally been inspired by willis and trondman (2002) time-model— theoretically informed methodology for ethnography. the use of maxqda 12 (2015) assisted in the analysis. the analysis resulted in the following themes: 1) risk awareness and positive risktaking, 2) quest for authenticity, 3) participation like others or with others, and 4) the moli et al./new emanicpatory 651 role of support. excerpts from the data set were selected from the transcript in order to highlight characteristic experiences of the participants with regard to a specific theme. in the following phase of the analysis, three characteristic and categorical groups were identified in the material, namely: the consumers, the insiders, and the outwardly directed. in order to maintain confidentiality, no names or identifying information appear when presenting the results. results the findings in the study are structured according to four different themes: risk awareness and positive risk-taking, quest for authenticity, participation like others or with others, and the role of support. (1) risk awareness and positive risk-taking the theme of risk awareness and positive risk-taking is divided into two different sub-categories. the first sub-category contains experiences of the risk of being hurt or ending up in undesirable situations. most of the informants seemed to be well aware of the risks of internet use and they could articulate how to handle difficult situations (“bring someone with you if you are going to meet someone offline…”). i am very, very careful on the internet, because you never know if you will get into trouble […] i would rather not meet people on the internet because i’m afraid something bad will happen, e.g., me being abused by someone. there are those dating-sites…i have visited those sites, looked at them – but you have to be very careful visiting those sites! (mia, 17 years) several informants put forward the risks associated with gaming online and, especially, public chat forums linked to different types of online games. the second sub-category was represented by risk experiences of missing something or ending up lonely. several informants reported that they did not block unknown friend proposals on facebook (fb) immediately. either they intended to check out who it is or they would ask a friend who it might be. however, they would block unknown people if they behaved inappropriately. i’m not afraid of adding people, but if they behave badly i put them away (ninni, 18 years) well, if it’s a girl…i usually babble widely, but if it’s a guy i block him. take him away! (abeba, 17 years) even if it is a normal person, or a girl who looks nice i block them. i dare not. i added a girl once who looked fairly nice, but then she put up some sort of porn video and 56 other names – so – i blocked her right away. i manage. more and more people remove their facebook accounts, i hear (thommy, 19 years) some informants reported experiences of developing a romantic relationship with others through sns. either they had these experiences of their own or they knew people in their immediate surroundings who had became a couple on the internet. in some cases, the relationships have lasted for quite a long time. in other cases, the relationship only lasted for a short period. in both cases, the informants stressed that it was “worth trying,” but they made a point of saying that offline-based relations had better potential. advances in social work, fall 2017, 18(2) 652 i have been together with people i have met on the internet. but it didn’t last long…so i probably prefer meeting people in real life (laughter) (ninni, 18 years) (2) quest for authenticity one salient feature of the theme of self-presentations and internet relations was related to issues of authenticity and striving for greater honesty on the internet. one common experience was that people often exaggerated too much on the internet. in addition, that things taking place online were not ascribed as much importance as things happening offline. its important to be as clear as possible on the internet, and not to exaggerate […]…guys can be so crafty and wacky [...] i usually say that it is of great importance to bring things up face to face (ester, 18 years) you can make things up on the internet. it’s not always that serious… (sara, 18 years) some participants reported experiences of behaving differently online and offline. some informants stressed that they mainly wanted to have and maintain genuine, close relations on the internet and sns. they called for more honesty online. axel, anton and dragan illustrate this in the following excerpts: if you are a girl, don’t show yourself naked. don’t try to be tougher than you really are. try to be softer […] you can say nice things, but it is often too exaggerated on the internet (axel, 20 years) i just want to have people who really know me on facebook (anton, 17 years) on the internet you can fool around so to speak – like being cool…uploading pictures. but in real life – it’s only you. (dragan, 16 years) some informants had a skeptical approach to the presence of online conversations replacing the everyday offline relations. therefore, the content of the material shows a shared quest for authenticity both online and offline as illustrated by the following quotes: nowadays, people sitting next to me on the bench are sending me facebookmessages. hey, look! i’m sitting right in front of you! i mean, it’s crazy. we, i mean us young kids, we are so desperate for the internet. […] it was better in the old days – when internet was smaller…back then everybody was more “social” (patrick, 17 years) …most people live their lives on the internet, and they have the internet as their lives. unfortunately, they don’t live their lives! […] going out dancing, or whatever. if you meet someone at a dance, rather than meeting someone on the internet, that’s love for real. (thomas, 17 years) maybe it’s easier to say that you like somebody on the internet …rather than face-to-face. honestly, i think i have only used the internet to tell girls that i like them (laughter). you want to say it face-to-face, but it’s really hard… (thommy, 19 years) moli et al./new emanicpatory 653 (3) participation like others or with others informants stated that they predominantly have contacts in their immediate surroundings (peer mates from their school class, family members, relatives) on sns. other informants indicated that they have between 200-300 friends on facebook. having mostly contacts with peer group members was a general feature in the material. some respondents expressed that they wanted to use the internet and sns like everybody else, or so to say, participate like others. but some informants distinguished themselves from others by highlighting their everyday contacts with people outside their immediate peer group. one example came from peter who described himself as a “seeker” on the internet (“i like to dig deep into things that i find interesting on the internet”). though peter did not strive for participation like others on the internet, he was mainly aiming to establish new contacts with others in a wider context. it was peter’s gaming experiences that provided him with this opportunity. when i play an online game on the internet i chat with people from…all over the world. so, when i have chatted for a while i contact them…on social media rather than within the game…i speak english every day. actually, i don’t think i have one single swedish contact… (peter, 16 years) another example of participation with others outside the nearest peer group was reported from lovisa, who claimed that she received about ten new friend proposals on fb every day. i had a youtube-channel but i took it down…i had three very popular music videos…with a lot of views. […] …but i still work with my music. you never know, maybe i’ll bring it back someday…because it’s a bit hard to be famous – if you consider it. i remember when i had that youtube-channel and when i walked in the streets downtown. everybody said, ‘oh, it’s you!! please, make us another song!’ …and a lot of other stuff, so it can be too much sometimes – you have to set limits! (lovisa, 17 years) notably, those informants who were striving for participation in a wider society also reported experiences of hate comments, threats, and cyberbullying. patrick reported one example of this scenario. he had for many years developed great gaming skills and had recently become a participant on a gaming team competing at the international level. but patrick had ambivalent experiences with this situation: i am a member of the gaming team called [name] and there’s another team called [name]…and they have started to threaten me [on fb and in online chat forums]…saying ‘ if you win this match i will look you up and kill you’…it’s my everyday life so to say. getting hate comments. of course, you get both hate and cheering comments. but mostly hate i think. (patrick, 17 years) stefan, also a gamer, reported similar experiences: if i write (on fb) that i’m happy or something like that, it will be followed with a long discussion thread with quarrel. i just try to be nice. but such friends i have now deleted. i was almost up to 1000 friends on fb, but now i have deleted about 300. i’m pretty satisfied. now, only real friends left… […] don’t bully each other on the internet. otherwise life proceeds pretty advances in social work, fall 2017, 18(2) 654 well. don’t write stupid things about committing suicide and such crap. be kind, be gentle. behave! (stefan, 19 years) the more the pupils expressed experiences of interaction with peers outside the id community, the more vulnerability they experienced. as a consequence, they seem to avoid participation in a wider society. i’m not sitting by the computer so much lately. mostly i watch films nowadays…it’s more relaxing… (stefan, 19 years) (4) the role of support the theme of the role of support was divided into two sub-categories, namely technical support and moral and emotional support. most informants expressed little need for technical support. and if they needed that kind of support they knew whom to turn to: mostly siblings, cousins, or close friends. there were several reports of parents who still did not understand technical issues (e.g., safety adjustments, etc.). the vast majority of informants claimed that adults in general should increase their involvement, responsibility, and control of young people’s internet use, especially at younger ages. lovisa and ester came to similar conclusions on this issue: well, i have my brother’s daughter, she’s soon to be six years old, and she’s already started checking out bloggers and stuff. and i have told him that he has to keep an eye on her. because, in the end, it won’t turn out well. she’s gonna get addicted and perhaps forget her friends… (lovisa, 17 years) oh, yes!! some adults should take more notice of what young people do on the internet. of course, some adults take more notice than others… (ester, 18 years) participants noted difficulties in turning to parents, particularly when it came to handling cyberbullying tendencies. they think the situation could get even worse if their parents found out. even if there was a common trend in the material on the absence of parental discussions of internet use issues, there were several reports of parents willing to give advice on internet behaviour. i’m not the one who tells my mother about everything. let’s say something happened in school. she asks ‘how was school today, patrick?’ and i say ‘good!’ …but actually it wasn’t that good. so, i’m the one who keeps things inside so to say… (patrick, 17 years) from mum and dad i’ve got the advice that ‘don’t sit too much with the internet’ or ‘don’t upload so much from the internet, it would lead to less bullying’…so i have not uploaded so much the last couple of weeks – and nothing has happened! the world’s best advice, actually! (stefan, 19 years) nevertheless, some issues concerning sexuality and relationships could be easier to discuss with parents than with others. the majority of the informants stated that they had a girlfriend/boyfriend (often a peer pupil in the special program school), and sometimes there was a need for discussing certain eventualities. somehow, if my girlfriend got pregnant …what should i think about? what would happen? economy? will they (the parents) support me? well, questions like that… (jonny, 17 years) moli et al./new emanicpatory 655 discussion in the pilot study that preceded the youth interviews parents and school teachers put forward the perception that young people with id were often naive and had difficulties in understanding the consequences of internet and sns use. although some of the excerpts from the results above could be interpreted as a bit naive (e.g., ninni and abeba on risks and stefan on having just nearly 700 “real” facebook friends left after deleting those who behaved strangely) it is interesting to note the common awareness of potential risks when using the internet and sns. especially, when it comes to addressing the factor of so-called positive risk-taking (seale, 2014)—what happens if something goes right? the young people’s own voices in the study also stress the risk of being lonely, isolated and perhaps missing vital life experiences if you opt out of potential internet relations. on the one hand, it could be a methodological dilemma that the young informants’ awareness is basically a repeat of what the adults in their immediate surroundings have told them. then again, the material gives selfreflective examples of the informants having made risk-related choices, where they have learned something from the consequences of their actions (e.g., ninni and peter). identification processes and emancipation the main question this article poses concerns if and in what way the internet and sns could promote new emancipatory landscapes for young people with id. in order to answer that question, the informants could be divided into different categorical groups with certain characteristics, namely “the insiders”, “the consumers” and “the outwardly directed”. figure 1. three types of internet users among youth with id first, in general, those interviewed could be characterized as “the insiders” the vast majority of the interviewees reported daily use of the internet and sns. the purpose of their internet use was mainly for interacting with others in their immediate surroundings. consequently, they had their contact network predominantly within their peer group (e.g., fb friends from their own special program class, family members, and relatives) within the specific school setting (c.f., näslund & gardelli, 2012). they advances in social work, fall 2017, 18(2) 656 chose to immediately ignore new and unknown friend proposals on social media and the most common pattern was to first become friends in real life (irl) and then ask if someone wanted to be added as a friend on facebook, for instance. secondly, ”the consumers” (e.g., dragan, thomas, ester and sara) mainly use the internet for content-consuming purposes, e.g., watching funny youtube clips, checking out cool cars on e-bay, or checking out news or sports results. these kinds of activities seem to bring little harm to the informants. some of the informants within this categorical group reported that they also used social media (such as facebook, instagram, snapchat) but they hardly ever contributed anything. they were just following what others were doing. consequently, there were rather few negative experiences of internet use within these two categories. on the other hand, the internet and sns do not seem to promote new contacts and participation in a wider society for these groups. these findings are in line with sveningsson’s (2014) study on (mainstream) young swedes’ understandings of social media use for political discussion; they take part but they do not participate. another way of saying this is that these two groups participate on the internet like others (and not with others outside their peer group) but—thirdly—the last categorical group stood out compared to the other ones. this small third group could be designated as ”the outwardly directed”, namely the gamers (peter, patrick and stefan) and the vloger (lovisa). it could be argued that online gaming and vloging with open public access can promote both more and less participation. all of the informants within this group had a broad online network, widely—both nationally and internationally—spread outside their own peer group. in many ways it seems that they used the internet and sns as a “free zone” in which they could disclose so-called alternative identifications in relation to otherwise lowly valued and stigmatized identities as a special program pupil (c.f., löfgren-mårtenson, 2008). in terms of participation it could be stressed that they had high levels of involvement in everyday activities and, in contrast to the other two groups, they participated—not just like others but also—with others in the wider community. in return they also reported experiences of cyberbullying, harassment, and threats, as well as positive experiences of appreciation and high status within their peer group. as a consequence, several informants have chosen to tone down their internet involvement becoming “consumers” again (e.g., lovisa and stefan). moli et al./new emanicpatory 657 figure 2. types of internet users with id and their strategies for online participation. limitations of the study the analysis is based on a small sample and it is difficult to generalize. compared to studies of mainstream youth and their internet use, there are several similarities in how youth with id use the internet and sns (c.f., shpigelman & gill, 2014). young people with id could be considered more vulnerable to what the internet has to offer. in addition, there is also a possibility of so-called social desirability, namely that the informants’ answers are put forward in order to be viewed favourably by others (e.g., saying things they think the researcher wants to hear). implications and conclusions so, do the internet and sns promote new emancipatory landscapes for young people with id? mainly, no. maybe in a few cases it could be said that the internet and sns have helped them to stimulate emancipative strategies for alternative identifications. but in these cases they have chosen to downsize their involvement on sns due to experiences of cyberbullying and/or unwanted exposure. the result is partly in line with previous studies, which identify both positive and challenging dimensions of the use of social media for people with id (caton & chapman, 2016). recall that thoreau (2006) argued that the emancipatory possibilities of the internet may be overstated. the results of our study shed light on how the internet and sns can contribute to both more and less participation for young people with id. this could be viewed as a paradoxical development for young people with id when, as chadwick et al. (2013) point out, “in terms of self-expression, the internet affords an opportunity for people with disabilities, including id, to present themselves outside of their disability, having the option to disclose, or not, their disabled identity at will” (p. 385). one implication for social work practice is to be aware of the different meanings of participation experienced by young people with id rather than measuring social participation in terms of the number of social contacts (c.f., guillen, coromina, & saris, 2011). piškur and colleagues (2014) raise the crucial question: is more [participation] always better? another implication for the adult world in general and for social work practitioners in particular, is awareness and reflection upon how support can be advances in social work, fall 2017, 18(2) 658 arranged in order to empower young people with id to participate on the internet. adults’ lack of awareness of the online world and, as chadwick et al. (2013) point out, negative attitudes towards internet use and sns, commonly function as reasons for hindering people with disabilities from being digitally included. in social work practice there is a need for enhanced listening and understanding of the voices of young people with id: which possibilities can emerge in a space beyond potential problems and obstacles? in line with seale (2014)—empowering young people with id to use the internet is often about managing risks, not avoiding them. future research may further investigate identification processes on the internet for young people with id. a mixed method design or a netnographic approach could be useful in order to capture new dimensions of understanding—i.e., not only what informants state that they do or what their experiences are, but also what they actually do in everyday online settings. references beart, s., hardy, g., & buchan, l. 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(2002). manifesto for ethnography. cultural studies critical methodologies, 2, 394-402. doi: https://doi.org/10.1177/153270860200200309 author note: address correspondence to: martin molin, department of behavioral and social science, university west, trollhättan, se 461 86, sweden. +46520223746 martin.molin@hv.se acknowledgements: this research has been funded by the swedish research council for health, working life and welfare, project number 2014-0398. the authors would like to thank the participants and the school staff for their contributions to the study. https://doi.org/10.5817/cp2014-3-8 https://doi.org/10.1111/j.1083-6101.2006.00021.x https://doi.org/10.1177/0022466913479141 https://doi.org/10.1177/153270860200200309 mailto:martin.molin@hv.se _________________ jill m. chonody, phd, is an associate professor, school of social work, boise state university, boise, id 83725. barbra teater, phd, is a professor and msw program director, department of social work, college of staten island, city university of new york, staten island, ny 10314. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1237-1249, doi: 10.18060/22075 this work is licensed under a creative commons attribution 4.0 international license. exploring how practicing social workers define evidence-based practice: research note jill m. chonody barbra teater abstract: this research note presents findings from a study that sought to garner a better understanding of the way in which practicing social workers defined evidence-based practice (ebp). as part of a larger quantitative study, 137 social work practitioners provided a definition for ebp through an online survey and indicated the extent to which they: consider themselves an evidence-based practitioner; believe practitioners should apply ebp in social work; and were prepared through their social work education to use ebp. content analysis of the practitioners’ definitions of ebp revealed that the majority of respondents described ebp as an intervention or a product versus a process. regardless of the definition that was provided, descriptive statistics revealed practitioners reported on average that they identified somewhat as an evidence-based practitioner, believed that practitioners should apply ebp in practice moderately to always, and felt only moderately prepared by their social work education for ebp. the findings suggest an opportunity in social work education may exist to further reinforce the process of ebp to delineate it from the evidence-based interventions that may also be taught, especially in clinical programs. dissemination may also need to occur through mandated continuing education hours, much like ethics has been added as a requirement in some states. keywords: evidence-based practice; evidence-informed practice; social work practitioners; social work education evidence-based practice (ebp) in social work has been defined in various ways, but the most widely accepted definition originated from evidence-based medicine, which describes it as “the integration of best research evidence with clinical expertise and [client] values” (sackett, straus, richardson, rosenberg, & hayes, 2000, p. 1). in integrating ebp into social work, manuel, mullen, fang, bellamy, and bledsoe (2009) provide the following definition tailored specifically to social work practice: “a decision-making process integrating best research evidence, practitioner experience, and client or community characteristics, values, and preferences in a manner compatible with the organizational systems and context in which care delivery occurs” (p. 614). this definition of ebp considers three specific factors that should inform and guide the social work practice process: the best available research; social work practitioners’ knowledge and expertise; and clients’ wishes, values, and circumstances, yet also acknowledges that the extent to which ebp is integrated into practice will vary based on the organizational context in which the practice occurs. in defining ebp, it is important to note the difference between ebp as a process (or a verb) and ebp as a product (or a noun; mclaughlin & teater, 2017; williams & sherr, 2013). the definitions of ebp as provided above describe ebp as a process consisting of https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2018, 18(4) 1238 the social worker taking into account the best available evidence, the client’s values and wishes, and the practitioner’s experiences and knowledge through the work with the client. in this process, ebp is often described as consisting of five stages that the social worker works through (not necessarily in a linear fashion), which consists of the following: (a) formulate a well-structured answerable question to address a practice need; (b) search the best available evidence to answer the question; (c) critically assess and evaluate the evidence for its validity, impact, and applicability to the situation; (d) integrate the evidence with clinical expertise and judgment and client wishes, values, and circumstances; and (e) evaluate the process of conducting steps 1 – 4 as well as the outcome of the intervention (gibbs & gambrill, 2002; jayne, 2014; sackett et al., 2000). this process of engaging in ebp is different from ebp as a method or product, often referred to as empirically validated treatments, empirically supported treatments, or evidence-based interventions (ebi), which are specific interventions found to be effective, or “evidence-based,” and have established protocols for their implementation (mclaughlin & teater, 2017; tuten, morris-compton, abrefa-gyan, hwang, & harrington, 2016; williams & sherr, 2013). ebp as a five-step process considers ebis as one critical aspect of the process, but ebis are to be weighed against the social worker’s clinical expertise, the client’s wishes and values, and the organizational context (jayne, 2014). the delineation of ebp as a process instead of a product (i.e., treatment approach; intervention) is essential to ethical social work practice in that the role of the clients’ values and preferences should be weighed against empirical evidence. in addition, the clinical expertise of the social work practitioner in making decisions regarding treatment and in implementing the intervention is also a key component of the process. a practitioner can be knowledgeable and possess skills in a certain practice area, but still consider that particular approach for treatment with this client to be inappropriate or not applicable due to the client’s circumstances, values, and/or wishes. moreover, even if practitioners have access to the best available research, the integration into clinical practice can be a slow and challenging process as the extent to which practitioners engage and apply the process of ebp with their clients has been found to vary based on numerous factors, such as time to engage in research and the ebp process, access to research, outside political or insurance pressure, organizational support, knowledge and skills of the practitioner, and ongoing training, support, mentorship, and supervision (bellamy, bledsoe, & traube, 2006; bledsoe-mansori et al., 2013; gray, joy, plath, & webb, 2015; morago, 2010; tuten et al., 2016; wharton, 2010). for example, social workers need time to search for and appraise evidence as part of the ebp process, which requires organizations to acknowledge and support such activities through dedicated staff time as well as access to libraries and online databases of research evidence. yet such support and resources are often reported to be lacking in social service organizations (gray et al., 2015). additionally, lack of knowledge and skills of social workers in critically appraising research and applying findings to practice, due to lack of adequate training, has been identified as a barrier to integrating ebp (bellamy et al., 2006; gray et al., 2015; mullen & bacon, 2004). for example, parrish and rubin (2012) found only 38% of master’s level social workers in texas (n=688) read research evidence often or very often when making practice decisions, with only 28% reporting relying on research evidence as chonody & teater/research note 1239 the best guide for making practice decisions either often or very often. similarly, pope, rollins, chaumba, and risler (2011) found social work practitioners to have a moderate knowledge and use of ebp with nearly 30% disagreeing or somewhat disagreeing with the statement, “i am able to critically appraise/review professional literature” and 56% agreeing or somewhat agreeing to the statement, “i use relevant research to answer my clinical questions.” such findings point to the importance of integrating the necessary knowledge and skills to engage in ebp in social work education to assist future practitioners to engage in the process of ebp in their work with clients. thus, social work education can serve as the initial starting point for future practitioners to learn the skills in engaging in the ebp process, including the skills necessary for evaluating research evidence. education on the ebp process across the curriculum may help reinforce its components, and research indicates that the majority (73%) of social work faculty (n=973) reported being supportive of the inclusion of ebp into graduate social work curriculum (rubin & parrish, 2007). likewise, the majority (87%) of field instructors (n=283) indicated that ebp was useful for practice (edmond, megivern, williams, rochman, & howard, 2006). the council on social work education (cswe, 2015) specifies that social work students are to engage in research-informed practice and practice-informed research; yet it does not specifically refer to the inclusion of ebp in the explicit curriculum. in particular, students are to demonstrate competency in the following three areas: (a) “use practice experience and theory to inform scientific inquiry and research; (b) apply critical thinking to engage in analysis of quantitative and qualitative research methods and research findings; and (c) use and translate research evidence to inform and improve practice, policy, and service delivery” (cswe, 2015, p. 8). despite the enthusiasm for the inclusion of ebp into the curriculum by social work faculty (rubin & parrish, 2007) and field instructors (edmond et al., 2006), and the professional mandate by cswe to train social work students on how to be good consumers of research evidence (one aspect of the ebp process), it is not clear from the substantive literature exactly how ebp is being taught at the more than 770 accredited social work programs. despite the continual examination of the extent to which social work practitioners engage and apply the ebp process to their practice, there is a dearth of studies exploring how practitioners actually understand and define ebp. without a consensual definition of ebp, researchers and educators are limited in fully understanding how ebp is used and understood within social work practice, and how to most effectively modify and enhance social work education to more fully prepare future practitioners to engage in ebp. therefore, this study sought to further explore ebp among currently practicing social workers by asking them to provide their definition of ebp. an examination of social workers’ definitions can provide a greater understanding of how social workers conceptualize ebp and the extent to which their definitions are congruent with the definitions of ebp as a process, as defined by sackett et al. (2000) and manuel et al. (2009), versus a product. advances in social work, fall 2018, 18(4) 1240 method sample and setting data were collected from practicing social workers in the united states via an online survey, which included standardized instruments, demographic questions, and several open-ended questions. participation was completely anonymous, and participants were not asked about how they learned of the study. results of the quantitative findings exploring the factors that contributed to identifying as an evidence-based practitioner are reported elsewhere (teater & chonody, 2017). the current analysis is primarily focused on responses to an open-ended question regarding ebp. three quantitative single-items indicators were used descriptively to further contextualize the narrative findings. the electronic survey was distributed in 2016 to known social workers within the authors’ networks, including their university databases, which consisted of field placement supervisors and past social work students. the link to the survey was also posted on social media (e.g., facebook, twitter) and social work listservs (e.g., bpd, msw-ed). in addition, participants were encouraged to share the link with other practitioners who might be interested in completing the survey. given the use of a snowball sampling technique and the use of social media, the number of social workers who were exposed to our survey recruitment efforts is not known, and therefore, a response rate could not be calculated. approval for the research was obtained prior to data collection by the relevant institutional review boards (irb). before completing the survey, participants were provided with an overview of the study and were informed their participation was anonymous and voluntary. completion of the survey served as consent for participation in this study. a total of 152 social workers completed the survey, and 137 of these social workers are included in this research paper as they provided a response to the open-ended question. data collection to explore the research question: “how do social workers define ebp?” the participants were asked to provide their definition of ebp. the survey included demographic questions and work characteristics along with the following three single-item indicators, which were used to assess practitioners’ preparation and identification with ebp: (1) “to what extent do you consider yourself an evidence-based practitioner?” response options ranged on a likert-type scale from 0 (absolutely not an evidence-based practitioner) to 5 (somewhat an evidence-based practitioner) to 10 (absolutely an evidence-based practitioner); (2) “to what extent should practitioners apply the evidencebased practice process in social work?” response options ranged on a likert-type scale from 0 (should not apply at all) to 5 (should apply moderately) to 10 (should always apply); and (3) “to what extent did your social work education prepare you to use evidence-based practice in your practice?” response options ranged on a likert-type scale from 0 (not at all prepared) to 5 (moderately prepared) to 10 (greatly prepared). these three items as well as participants’ sociodemographic characteristics were used in this study for descriptive purposes only. chonody & teater/research note 1241 data analysis to code responses to the open-ended question, content analysis (lune & berg, 2017) was used whereby themes were generated based on participants’ definitions of ebp. in the initial stage, all responses (n=137) were read by both researchers to garner an overview of the data. during this stage, the authors examined the manifest content and independently found that the participants were defining ebp as either product-focused or process-focused with some definitions encapsulating aspects of both. during the next stage, the researchers reviewed the responses together to classify each response as to whether it was process or product focused. the guiding principle for this delineation was whether the participant primarily focused her/his response on an evidence-based intervention or focused the definition on the process whereby a client’s perspective is considered alongside empirical evidence and practitioner knowledge and/or expertise. then, the number of times a particular word (e.g., “empirical”) or phrase (e.g., “use of evidence”) occurred was noted and counted, and the independent counts were compared. any disparities that occurred were discussed and then resolved by comparing the respondent’s definition to the framework that was created for comparison. in the final step, the researchers worked together to create categories for the data by grouping words and phrases that represented similar ideas together to garner a representation of the findings from the data. spss statistics 24 was used to generate descriptive statistics. results demographics the sample was predominately female (85.6%) and white (86.1%) with an average age of nearly 42 years. most respondents held an msw degree (78.7%) and some type of social work licensure (80.2%). the average number of years in practice was approximately m=13 (sd=11.16), and their primary geographic setting was slightly more urban overall (38%). the largest percentage of participants worked in direct practice (59.7%) and in a nonprofit setting (30.1%). tables 1 and 2 provides further information on the characteristics of the sample. table 1. sociodemographic characteristics of the sample (n=137) variable mean (sd) na age 41.9 (13.59) 124 number of years in practice 13.4 (11.16) 126 consider self ebp 6.4 (1.85) 129 practitioners should apply ebp 7.2 (1.74) 128 education preparation for ebp 5.5 (2.94) 128 note: asample sizes are different on each variable due to missing data. advances in social work, fall 2018, 18(4) 1242 table 2. sociodemographic characteristics of the sample (n=137) variable n (%) gender (n=125) male 18 (14.4%) female 107 (85.6%) ethnicity/race (n=116) white/caucasian 105 (86.1%) african american/black british 3 (2.5%) biracial/multiracial 6 (4.9%) asian american 2 (1.6%) education (n=122) bsw/bssw 10 (8.2%) msw/mssw 96 (78.7%) phd 13 (10.7%) dsw 1 (0.8%) other 2 (1.6%) social work license (yes) 101 (80.2%) license type (n=99) lsw 11 (11.0%) lisw 4 (4.0%) lcsw 61 (61.6%) lmsw 14 (14.1%) other 9 (9.1%) practice setting (n=123) rural 24 (19.5%) suburban 20 (16.3%) mid-size city 34 (27.6%) urban 45 (36.6%) social work position (n=124) direct practice/frontline 74 (59.7%) supervisor/management 11 (8.9%) director 14 (11.3%) other 25 (20.2%) primary work environment (n=123) private practice/consulting 15 (12.2%) nonprofit 37 (30.1%) government 19 (15.4%) higher education 21 (17.1%) research institute 1 (0.8%) medical/palliative 16 (13%) other 14 (11.4%) note: asample sizes are different on each variable due to missing data. product versus process as figure 1 illustrates, participants overwhelmingly defined ebp as an intervention, or product, with 77.4% (n=106) using this as the basis for their description. only 14 participants (10.2%) defined ebp as a process that incorporates clinical judgment and chonody & teater/research note 1243 client wishes alongside research outcomes. the final 17 social workers (12.4%) provided a definition that fell slightly between these two definitions whereby they described ebp as “practice informed by research.” further analysis of the words that participants used within these definitions resulted in the following categories: research methods, outcomes, empirically-supported intervention, client needs/input, and clinical expertise. ebp as product. for the participants that defined ebp as an intervention, they mostly included either research methods or outcomes in their definition and occasionally they mentioned both. this response represents a typical definition within this grouping: “utilizing techniques/interventions that have been proven to be effective” or “practice [that] includes qualities/approaches to clinical work that hold research evidence to improve patient care.” other participants elaborated a bit further on this theme. for example, one participant stated, “the use of models and/or therapeutic approaches that have had a substantial amount of rigorous research over time to support their effectiveness in treating particular disorders/symptoms.” many respondents incorporated measurable outcomes, reliability, and/or validity into their responses, which positively reflects on the necessity to critically evaluate research studies before accepting the “evidence.” for some, ebis were provided as their definition of ebp, such as “motivational interviewing” or “cbt.” ebp as process. participants who described ebp as a process were more inclusive in their definition, which aligns more closely with the meaning of ebp within social work practice as indicated in the manuel et al. (2009) definition. one participant’s responses is quintessential: “[…] ebp is a process by which decisions for interventions are made based on the best available evidence that is compatible with the client’s values and preferences.” the following participant further extends this process to include how evidence is broadly defined and is used to generate a dialogue: “i think that it is using evidence to inform practice decisions. that evidence is research, experience of the practitioner, and client experience. ebp suggests that one is overt about the use of this evidence in conversation with the client.” this response demonstrates a clear understanding of the sackett et al. (2000) and manuel et al. (2009) definitions for ebp and incorporates each of the ebp as informed or guided by research (n=17) ebp as a process (n=14) ebp as an intervention (n=106) clinical expertise empirically supported intervention client input/ needs research methods outcomes product process figure 1. ebp as product versus process advances in social work, fall 2018, 18(4) 1244 components demarcated as important to the process. important distinctions found in these process-based definitions are the inclusion of keywords; that is, respondents explicitly highlighted the three key components of ebp—clinical expertise, client input/needs, and empirically-supported intervention. this participant concisely encapsulates the process of ebp when she defined it as “using research in tandem with clinical judgment and client input to guide treatment decisions.” very few social workers included the value base of social work as part of the ebp process, yet there were some exceptions, notably the response of one respondent who stated: “the combination of social work ethics, education, and skill applied with social work research to back up principles. this is used to gain a better understanding of social work practice and to make sure to provide best practice.” “informed by research.” this middle category for ebp definitions reflects the fact that participants did not completely limit their description to a product, but their definitions were also not process-based. most notably, these definitions lacked any mention of the role of client preference and clinical expertise; rather they tended to stick to ideas such as the way that “evidence [is] used to make decisions.” as such, these definitions predominantly focused on the way that research “guides” or “informs” practice. for example, one participant simply stated, “the use of evidence to guide treatment,” and another described it as “research-informed practice.” these short definitions reflect that research is used within practice but does seem to limit this idea solely to an intervention. a few participants in this category expounded on this notion a bit further, such as: “practice supported by sound research that shows adequate evidence, the methods utilized have shown to be effective.” what appears to be missing from such definitions is the integration of clients’ values and wishes in receiving interventions. demographic differences by definition to contextualize the responses, further analysis was conducted on the sample according to the type of ebp definition that was given. these results are included for descriptive purposes only and are not suggesting they are representative of social work practitioners; however, the overall patterns may warrant further investigation. most notable in these descriptive findings is that those practitioners who described ebp as a process (n=14) had on average more than twenty years of practice experience, while those in the other two categories had an average of 12-14 years. also, those practitioners in the process group had the lowest rating for educational preparation for ebp. table 3 provides the mean on these single-item indicators along with work-related descriptors. table 3. characteristics of practitioners by ebp definition variable product (n=106) between (n=17) process (n=14) age 40.31 (13.73) 44.0 (10.13) 50.92 (12.89) licensed (yes) 81.6% 80.0% 69.2% years practicing 12.23 (10.98) 14.20 (8.68) 21.46 (12.41) consider self ebp practitioner 6.28 (1.87) 6.93 (1.79) 6.77 (1.69) should use ebp 7.11 (1.78) 7.33 (1.59) 7.31 (1.75) education prepared for ebp 5.42 (3.00) 6.29 (2.73) 5.08 (2.75) chonody & teater/research note 1245 discussion this study found that the majority of the social work respondents described ebp as an intervention (or product) instead of a process that is inclusive of both the clinical expertise of the practitioner and the client’s values and preferences. defining ebp in this way may suggest that such social workers view ebp as the incorporation of an ebi in social work practice with clients, for example, integrating a specific evidence-based method (e.g., cognitive behavioral therapy) versus considering ebis as one part of ebp that is to be considered alongside the practitioners’ knowledge and expertise, and clients’ circumstances, values, and wishes. however, this does not suggest that this is necessarily the way that these practitioners actually practice. their definitions of ebp suggest a limited view consisting only of the integration of practice approaches or treatments found to be effective through research. in this sense, the practitioners are suggesting that social work practitioners who use ebp in their practice are using an intervention couched in evidence. if the social worker does not integrate ebis in their practice, then they are not evidencebased practitioners. this view could possibly be influenced by the increasing demands from government agencies and funding bodies for social services to demonstrate effectiveness and efficiency often through the adoption and use of ebis (pope et al., 2011). this is an important finding in light of the profession’s commitment to selfdetermination and practice that considers the client from a holistic perspective. presenting the client with treatment options while balancing this against the training and expertise of the practitioner and/or available referral resources within the community are essential to creating an ethical collaborative working relationship. moreover, this helps to ensure that clients are aware of practices grounded in research evidence and provided by practitioners who are skilled in its execution. interestingly, very few social workers included the value base of social work as part of the ebp process. evidence alone is not enough to warrant the use of a particular practice. for example, freud and krug (2002) posited that even if chain gangs had an evidence base for reducing recidivism, we would not support them as social workers because they violate human rights. future research should seek to further delineate how ebp is defined and how it is implemented across different practice settings. while further inferential statistical analysis was not possible in this study due to small cell sizes, the descriptive findings suggest future research should seek to investigate the way that practitioners are being educated about ebp. for this sample, practitioners who described ebp as a process (n=14) were in practice for more than 20 years, were older, were less likely to be licensed, were more likely to consider themselves an evidence-based practitioner when compared to those who defined ebp as a product, and were the least likely of the three groups to report being prepared through their social work education to practice ebp. such findings differ from previous research. for example, parrish and rubin (2012) found that social workers who had earned their msw degree within the past five years reported more positive attitudes towards ebp, whereas pope et al. (2011) found no statistically significant difference in knowledge and use of ebp based on years in practice, licensure type, year obtained social work degree, area of practice, or level of social work education, yet did find social workers in their 30s and 40s to have statistically significant higher levels of knowledge and use of ebp than other age groups. neither study asked the social workers to report their definitions of ebp. advances in social work, fall 2018, 18(4) 1246 while the findings from this study are only exploratory, it is counterintuitive given that ebp is a relatively newer element in social work education. some of the participants who provided a process definition were employed in higher education, and thus, they may teach this content or be exposed to it. however, it should be noted that many of these participants were still practicing, and other participants who were employed in higher education provided a product-based definition. these findings may suggest that practitioners in this study who reported ebp as a process have sought out (or have been required to gain) continuing education on ebp, and as such, they correctly identify ebp as a process. alternatively, it could be that those practitioners who report ebp as a product are learning ebis in their social work education and are then equating the use of ebis as the practice of ebp. this speculative conclusion should be explored in future research, which could identify educational methods and outlets and how they are related to the way practitioners define and practice from an ebp process. the findings are suggestive of a possible opportunity within social work education to create curriculum that further reinforces the ebp process to ensure that future practitioners are approaching practice from this perspective. jenson and howard (2013) argue, “a consistent definition of ebp and an educational commitment to the process steps required in ebp are critical at this juncture to prevent the misuse or misunderstanding of this new paradigm” (p. 1). social work education can respond to the need to strengthen the definition of ebp as a process and the promotion of social work students’ and future practitioners’ use of ebp through several activities and initiatives. first, social work programs can integrate ebp throughout the curriculum and, in particular, through field education where students are to apply the research evidence and theories learned in coursework in their field practice experience where they also consider their practice experience and knowledge and the client’s values and wishes. such practice can reinforce ebp as a process and as a routine part of their future social work practice. berger (2013) suggests this can be taught by breaking down the ebp process into manageable steps where students proceed through the stages deliberately while taking the time to process each step under supervision in their field education. second, social work programs can partner with social service agencies to provide training on ebp, research assistance, and access to ebp information and materials to encourage and support current practitioners to continually engage in the ebp process (bledsoe-mansori et al., 2013). finally, social work programs that provide continuing education to social work practitioners can ensure that the ebp process is integrated into the training to reinforce the use of ebp in the field. the results of this study should be considered in light of its limitations. first, the sample was small and cannot be considered representative of practicing social workers; thus, generalizability is limited. in addition, a self-selection bias may have occurred whereby those who felt most knowledgeable in ebp chose to participate in the study. nonetheless, their responses indicated that their definitions were not reflective of the process that ebp is meant to denote. second, the data for this study are based on an openended question that was part of a largely quantitative study, and as such, these definitions may be somewhat limited in their depth. future research should seek to conduct focus groups or interviews with practitioners to gain further insight into both their definitions of ebp and the way they practice using this process and how they differentiate it from ebis. chonody & teater/research note 1247 these findings add to the substantive literature on ebp in social work and also raise questions for future research. understanding how practitioners gain new knowledge about ebp and ebi are essential to strengthening the role that social workers play in mental health and health settings. social work education is a part of this process, but continuing education is also important. licensing bodies and social service agencies may want to consider ebp as part of their required educational standards for practice to help facilitate ongoing exposure to ebi and reinforcement of the ebp process. references bellamy, j. l., bledsoe, s. e., & traube, d. e. 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(2016). predictors of the use of evidence-based interventions among national association of social work (nasw) members. journal of evidence-informed social work, 13, 253262. doi: https://doi.org/10.1080/23761407.2015.1047109 http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-137?rskey=czm7kp&result=1 http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-137?rskey=czm7kp&result=1 https://doi.org/10.1177/1049731509335547 https://doi.org/10.1080/15433714.2010.494973 https://doi.org/10.1093/sw/sws016 https://www.tandfonline.com/doi/abs/10.1080/15433710903269149 https://doi.org/10.1177/1049731506293059 https://doi.org/10.1080/02615479.2017.1421161 https://doi.org/10.1080/23761407.2015.1047109 chonody & teater/research note 1249 wharton, t. c. (2010). exploring the uptake of evidence-based practice in social work. unpublished ph.d. dissertation, university of alabama. williams, n. j., & sherr, m. e. (2013). oh how i try to use evidence in my social work practice: efforts, successes, frustrations, and questions. journal of evidence-based social work, 10, 100-110. doi: https://doi.org/10.1080/15433714.2011.597299 author note: address correspondence to: jill m. chonody, phd, school of social work, boise state university, 1900 university dr., education bldg, room 717a, boise, id 83725. jillchonody@boisestate.edu https://doi.org/10.1080/15433714.2011.597299 mailto:jillchonody@boisestate.edu this work is licensed under a creative commons attribution 4.0 international license. midwestern service provider narratives of migrant experiences: legibility, vulnerability, and exploitation in human trafficking jennifer chappell deckert sherry warren hannah britton abstract: this exploratory study examined the vulnerability and exploitation of migrants from the perspective of service providers who work in social service organizations. researchers conducted 16 interviews and 1 focus group with service providers whose clientele had direct experience with migration. these service providers indicated that there is incongruence, even tension, between a welcoming local response to migrant populations and the state-level political rhetoric and policy initiatives, which are predominantly antiimmigration. this study demonstrates that there are contradictions and tensions related especially to exploitation in midwest migrant populations. service providers acknowledged complexity in the problems related to migrant vulnerability and exploitation and were interested in change. findings of this study highlight particular vulnerabilities of migrant populations, a lack of legibility of human trafficking in social service organizations, and a difference between political rhetoric and local responses to migrant populations. policies and practices in social service delivery need to reflect the subtleties of risk for exploitation and offer broad preventive support for migrant populations through education and advocacy. keywords: service providers; human trafficking; vulnerability; migrants; labor exploitation globalization and human mobility influence social service organizations across the world. in the united states of america and elsewhere, social workers interact with migrant populations soon, if not immediately, after their arrival. whether their role is directly or indirectly related to cultural adjustment and negotiation, social workers have the potential to play critical roles in migration. their “frontline” (lipsky, 2010) work intersects with migrants when they are looking for employment, enrolling in school, establishing a home, learning a new language or culture, and understanding new systems of social welfare (balgopal, 2000; chang-muy & congress, 2008; dominelli, 2010; furman, ackerman, loya, jones, & negi, 2012; nash, wong, & trlin, 2006; valtonen, 2001). increases in global migration influence many areas of society, including racial and ethnic diversity, religious diversity, family dynamics/inter-marriage, and public policy (national academy of sciences, 2015). these social workers and service providers can play an important role in the prevention of and identification of exploitation as they interact with migrant populations. ____________ jennifer chappell deckert, lmsw, university of kansas, school of social welfare. sherry warren, lmsw, university of kansas, school of social welfare. hannah britton, phd, university of kansas, department of political science, department of women, gender, and sexuality studies copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 887-910, doi: 10.18060/21657 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 888 as political, social, and economic forces shift over time, the terrain of social service delivery also shifts. contemporary social workers who work with migrant populations face many new and difficult challenges (ayón & becerra, 2013; chappell deckert, 2016; valtonen, 2001), and they have broadened their practice to focus not only on settlement but more keenly on integration and belonging (ben-david, 1995) as well as preventing the heightened risk for exploitation. these challenges are complicated by globalization, a rise in nativism (a political position that prioritizes citizens over new residents or migrants), the marginalization of migrants (del mar farina, 2013), restrictive policy decisions that impact social welfare institutions (ayón, 2016; romero & williams, 2013), and more flexible and transient patterns of human mobility (kim, 2009; sirojudin, 2009). as awareness of human trafficking improves nationally, social workers become more knowledgeable of the potential exploitation migrants face. social workers who work with migrant populations learn about human trafficking issues through changes in policy, interactions with clients, and public awareness campaigns. however, most of the information designed for social workers’ use in this area of practice has a bias toward sex trafficking and has neglected other areas of potential exploitation (alvarez & alessi, 2012). the goal of this research was to understand characteristics and behaviors associated with vulnerabilities to labor exploitation and human trafficking as expressed by midwestern service providers. using interviews and focus group methods, a research team from the university of kansas worked with regional service providers from a variety of perspectives and public forums to find answers to the over-arching question: how do midwestern service providers perceive migrant experiences related to vulnerability and exploitation? answering this question fills a gap in the literature on human trafficking risks and vulnerabilities, and, as we learned, raised awareness of signs of trafficking among area service providers likely to come into contact with trafficked persons. for the purposes of this paper, service providers include people who work or volunteer in positions that directly interact with clients by providing some kind of social service, including (but not limited to) education, healthcare and mental health services, occupational assistance/jobs/employment, legal services, social welfare, financial assistance, or community organization and advocacy. social workers are employed in many of these social service organizations, but they are not the only ones who provide direct service to people seeking their services (salett, 2006). therefore, the focus of this inquiry includes social workers and other service providers who are in direct contact with migrant populations while delivering some sort of social service. in these positions, they hear stories directly from clients who describe the risks of living in a precarious condition. the perspectives of service providers in mental health, education, medical care, housing, and employment in this study helped address the gaps in the scholarship around this precarity. their ability to work alongside clients through different challenges gives them unique knowledge that can assist researchers in understanding the potential for improved identification and response to risk (hodge & lietz, 2007; kelleher & mcgilloway, 2009). including service providers from varied sectors of social service (more than just social work) provided us with a richer and more descriptive understanding of the experiences of vulnerable migrants. chappell deckert et al./midwestern service 889 literature review there is much more scholarship related to vulnerability and exploitation of migrants in sex trafficking than there is in labor trafficking. this inquiry sought to understand this phenomenon through the perspective of service providers and the knowledge or assumptions they have surrounding trafficking. in order to do this, the research team considered the midwestern context, values, and politics, definitions of trafficking and the scope of the problem, and social service provision for exploited and marginalized populations as they pertain to trafficking awareness and intervention. midwestern context, values, and politics with the goal of stimulating economic growth, many midwestern states have recently embraced tax reduction policies in an effort to create smaller government and to become more “business-friendly.” consequently, many of our interview participants indicated that social service provisions have been significantly cut, resulting in higher caseloads and reduced resources for many of these institutions. this causes stress for the service providers in addition to reducing quality of services for clients (lipsky, 2010). privatization, a common means to reduce state-provided social services, leads to fewer social service programs overall and reduces states’ ability to track trafficking operations (peksen, blanton, & blanton, 2017). the geography and economy of the midwest make many areas prime locations for trafficking or exploitation to occur, and scholars have recently started to examine the midwest as a potential site for trafficking (heil & nichols, 2015; moser, 2015; williamson & prior, 2009). according to gleason et al. (2016), regional characteristics may increase human trafficking, including a high number of military bases, areas with large immigrant communities, and direct routes for interstate travel, all of which describe the midwestern context within this study. additionally, farming and meat-packing industries attract migrants to these states for employment (artz, 2012; martin, 2012). the agricultural base lends itself to keeping people in isolation, a tactic o’neill richard (1999) describes as both logistically savvy and emotionally cruel. defining trafficking and understanding the scope of the problem the u.s. defines severe forms of trafficking as “sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age” (u.s. department of state, 2017, p. 3). it also includes “the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery” (victims of trafficking and violence protection act of 2000, 2000) while both the victims of trafficking and violence protection act of 2000 (2000) and the palermo protocols (united nations office on drugs and crime, 2000) have a clear definition of labor trafficking in its many forms, global media attention, victim identification protocols, and survivor intervention services continue broadly to focus on sex trafficking. advances in social work, spring 2018, 18(3) 890 according to the u.s. department of state (2017), 66,520 survivors of sex trafficking and 17,465 labor trafficking survivors were identified in 2016 globally. of those identified, there were 14,897 prosecutions for sex trafficking, and only 1,038 prosecutions for labor trafficking cases. only 9,071 of the total number of cases led to convictions, and only 518 of those were labor trafficking. there were only 439 federal convictions of traffickers, and only an additional 387 cases at the state and local level (u.s. department of state, 2017). in this inquiry, exploitation includes the misuse and abuse of a person for economic gain. exploitation is broader in scope than these formal definitions of trafficking, and it may or may not lead to trafficking. since so much of the problem remains unidentified and hidden, the illicit nature of human trafficking presents countless methodological problems for researchers (brennan, 2005; weitzer, 2012, 2014; zhang, 2012). there is widespread belief that the scope of human trafficking is much larger than reflected in government reports. many trafficked persons are wary to come forward because they fear arrest, deportation, or retribution by traffickers on themselves or their families (schwarz & britton, 2015; zhang, spiller, finch, & qin, 2014). they may not even see themselves as trafficked (brennan, 2008; hoyle, bosworth, & dempsey, 2011; musto, 2013). similarly, law enforcement agencies may not have training or protocols in place to identify and assist trafficked persons (farrell, mcdevitt, & fahy, 2010) or conflate it with other forms of criminalized labor, such as sex work (musto, 2016). this is especially pronounced in labor trafficking cases, where there are competing understandings of what constitutes labor exploitation, illegal immigration, human smuggling, and labor trafficking. when issues of labor trafficking become conflated with smuggling, law enforcement may fail to identify or intervene in human trafficking cases, so much so that researchers have called for stand-alone training and research on labor trafficking to increase understanding and identification of the crime (barrick, lattimore, pitts, & zhang, 2014). in addition, much of the anti-trafficking discourse and rhetoric focuses on notions of an ideal victim, one who bears no culpability in their exploitation and who is deserving of protection and assistance (chapkis, 2003; hill, 2016; hoyle et al., 2011; musto, 2009; sassen, 2002; schwarz et al., 2016; schwarz & britton, 2015; srikantiah, 2007; stienstra, 1996). these narratives have real, material consequences for trafficking survivors and lead to missed opportunities to identify the broad range of exploited and vulnerable populations that may be trafficked. the construct of trafficking that solely involves passive women of color from the economically-struggling global south who are victims that need to be saved by a white, western legislative hero is one that enforces racism (baker, 2013; bromfield & capous-desyllas, 2012; capous-desyllas, 2007; jones, engstrom, hilliard & diaz, 2007; lutnick, 2016; mapp, 2016), diminishes individual agency, and limits prevention efforts that are concerned with trafficking outside of the realm of sex. as srikantiah (2007) writes, iconic victims originate from cultures in asia, latin america, or africa stereotyped as suppressing the individuality of women and girls and rendering them simple prey for manipulation by clever traffickers. the iconic victim concept chappell deckert et al./midwestern service 891 is thus consistent with stereotypes of foreign women and women of color as meek, helpless, and belonging to repressive male dominant cultures. (pp. 201-202) this stereotypical narrative of iconic victimhood perpetuates larger tropes about women of color and restricts the potential to identify and assist survivors whose identities complicate or resist this construction. social services for exploited and marginalized population globalization has contributed to increasingly complex issues in social service delivery including labor migration, new forms of labor exploitation, and new platforms that increase risk (i.e. digital) (agbényiga & huang, 2012; jones et al., 2007; salett, 2006). paired with free market models that encourage government downsizing through privatization, the demand for cheap or free labor is increasing dramatically (peksen et al., 2017). according to the trafficking in persons report (u.s. department of state, 2017), the global focus of investigations has been on sex trafficking, even while non-governmental organizations report serving higher numbers of labor trafficking survivors. unlike sex trafficking, labor trafficking has not been prioritized or widely recognized by law enforcement or social service agencies (barrick et al., 2014; owens et al., 2014). kaufka walts (2017) identifies three reasons for this gap, including minimal research on labor trafficking, lack of attention to labor trafficking in legislative or policy efforts, and the lack of training for service providers (p. 62). while the risk factors are often similar for both labor and sex trafficking, such as sexual assault and mental health concerns, labor trafficking is less frequently identified by service providers (schwarz, 2017). similarly, many of the risk factors identified in trafficking research (poverty, housing instability, health concerns, strict gender roles with male dominance, and lack of legal status) are also evident in the broader migrant populations. therefore, perspectives from service providers who attend to migrant populations can provide a window into the ways in which migrant vulnerability can lead to exploitation and trafficking. certainly, there is a need to expand conversations and research trends in human trafficking to include a deeper examination of labor trafficking and other forms of labor abuse, including the understanding that exploitation is the foundation of the abuse (hayes & unwin, 2016). this exploitation or result thereof may lead to some form of interaction with a social worker or other service provider in health care, child welfare, emergency shelters, or advocacy organizations (jones et al., 2007). still, social workers and other service providers are generally not trained to assess or intervene in the area of labor exploitation (alvarez & alessi, 2012; capous-desyllas, 2007). the national association of social workers (nasw) does promote materials about trafficking that include both forced labor and exploitation (abdus-shakur, 2016; nasw, 2015b; salett, 2006). however, the majority of materials that exist for social workers connected to human trafficking are related to sex. this is true in social work research as well (okech, choi, elkins, & burns, 2017). alvarez and alessi (2012) suggest social work adopt a broader definition of trafficking: “human trafficking encompasses the transportation and subjugation of persons for financial gain” (p. 142), which would include both labor and sex trafficking. we refine this definition further, since human trafficking advances in social work, spring 2018, 18(3) 892 does not have to include transportation, movement, or crossing borders. both international standards and us law agree that trafficking can, but does not have to, include such transportation. research suggests several indicators of trafficking that should be noted by social workers including debt bondage, unstable or overcrowded living spaces, hesitation to speak or seek services, lack of possession of key documents, inability or fear of moving, and poverty (salett, 2006). considering the midwestern context, politics, demand for labor, and increasingly restrictive social welfare policies, this study sought to better understand the issues from the perspectives of direct service providers who are on the frontlines of receiving and attending to people at risk by asking the following research question: how do midwestern service providers perceive migrant experiences related to vulnerability and exploitation? methods for this study, all interviews were conducted with the approval of the university of kansas’s institutional review board, and all the participants provided informed consent. in the spring of 2016, seven graduate student researchers conducted interviews with service providers in midwestern states whose clientele had direct experience with migrants. these organizations provided services in mental health, education, medical care, housing, and employment. interviews were chosen for inclusion based on the connection they had to the provision of social services. the sixteen (out of 19) interviews chosen for inclusion for this study capture a range of sectors: legal officials, state legislators, educators, and immigration advocates. additionally, they represented urban, rural, and suburban areas. three interviews were not included due to the peripheral nature of the role of the respondent. the research team worked collaboratively to develop interview protocols for different service providers including legal, advocacy, and social services. questions for each of the protocols were consistent thematically, but they also permitted adjustment based on the different disciplinary or organizational perspectives. this guide included key questions with follow-up prompts and allowed for flexibility during the interview process. interviews were designed to last approximately one hour. interviews ranged from 30 minutes to two hours, depending on the participants’ interest in the project and their time constraints. interviews were conducted in english by members of the research team, either individually or in pairs. in addition to these individual interviews, the same research team conducted a focus group with social work graduate students who had practicum placements in local social service agencies. the focus group was meant to provide additional information regarding perceptions of trafficking risk from a broader audience. some of these students were working explicitly with migrant populations. however, all of the clientele they served had direct experience with vulnerability through poverty, mental health issues, or lack of employment or housing. the focus group lasted for approximately one hour and was conducted in english. the individual interviews and focus group were digitally recorded and transcribed by the research team. these transcriptions were carefully de-identified and uploaded to a chappell deckert et al./midwestern service 893 secure network drive, only accessible by approved researchers for analysis. transcriptions were uploaded into a qualitative analysis software program (atlas.ti), and they were read/analyzed for general themes using inductive strategies rooted in grounded theory (glaser & strauss, 1967). in two separate working sessions, the research team collaboratively discussed the themes and developed a general coding scheme. from there, they designated team members to explore particular themes in all of the interview and focus group data. a second round of analysis included more focused coding related to each particular theme. findings through this project, contradictions and tensions related to labor trafficking in the midwest region became clear in three areas: migrant vulnerability to exploitation, legibility of human trafficking, and political rhetoric versus local response. the first two areas illustrated by this study are well established in the literature. however, they warrant inclusion because the emphasis of this research was to highlight perspectives from an understudied region and to illustrate the perspectives of service providers. the first area highlighted specific vulnerabilities to exploitation among migrant service-users from the perspective of service providers (see table 1). the second area highlighted a theme that human trafficking may not be legible from the perspective of service providers. the third area, which reflects a potentially novel contribution to the research, manifests the theme that state and national level political rhetoric about immigration is shaping policy decisions that do not necessarily align with local, organizational responses. migrant vulnerability to exploitation the first theme identified by service providers in this inquiry emphasized the importance of social support and social networks in reducing vulnerability of migrant populations. social networks serve as a cushion in an otherwise hostile environment. structural issues such as limited healthcare, transportation, housing, secure employment, and lack of community supports were all identified as barriers to helping migrant populations gain stability and reduce vulnerability to social ills. participants recognized these vulnerabilities but did not always make the clear connection to trafficking and exploitation. table 1 briefly introduces the themes of vulnerabilities that were identified by the service providers in our inquiry (in alphabetical order) and is followed by some descriptive examples from the data. advances in social work, spring 2018, 18(3) 894 table 1. vulnerability to exploitation of migrants as perceived by service providers vulnerability description documents withheld clients’ documents have been withheld by trafficker to limit power or ability to leave employment or income precarity income withheld by intimate partner or trafficker, or access denied english-only services not enough multilingual service providers and/or access to interpreters gender women are more vulnerable to trafficking history of trauma or abuse participants refer to migrants’ increased vulnerabilities due to generalized trauma, sexual and/or intimate partner violence, or substance abuse housing instability migrants experience instability in housing due to legal status, financial resources, or because it is provided by employer. immigration status whether the client has legal status to be in the united states isolation, physical and social being physically, culturally, or linguistically removed from social supports or networks. lack of supervision minors left without adult supervision migrants’ lack of understanding of english language and/or american culture inability to communicate in the dominant language and/or lack of familiarity with systems and institutions of the migrants’ new culture documents withheld. one common method of disempowering the persons being trafficked is to hinder their ability to move freely by withholding their documentation that identifies who they are and indicates their status as migrants. while some workers are sponsored into the usa on h-1b visas and feel beholden to the sponsor of the visa, those visa holders may work for multinational companies that provide them with a support network and resources to learn their surroundings. in contrast, some workers find themselves dwelling in inhumane conditions with their co-workers, allowed out only to go to work where they are supervised constantly in low-wage positions. they are powerless to leave because their identification documents are being kept from them, and they are terrified to report to authorities because they are unaware of their rights. one participant said of their interaction with this vulnerability: some labor recruiter went to india and told them they could get them green cards if they each spent about $20,000 to come to the united states and work in a ship yard. some of them borrowed money, some of them mortgaged houses, some of them had savings, so this whole group of people came, and the real hope was that if they got green cards they could then bring their families. so they are immediately locked up, and they are actually given h-2b visas, guest worker visas and forced to work under pretty deplorable, unhealthy conditions, living in unhealthy conditions. their passports were collected. they couldn't leave. and if they didn't keep working, they would lose the money, they would lose their houses, their fathers’ houses, whatever they had done to get the money together. chappell deckert et al./midwestern service 895 employment or income precarity. not only are workers vulnerable to having their “documents, their driver's licenses, their visas, their passports, whatever they might have with them” taken by their trafficker, as was indicated by yet another service provider, lack of access to their income also entraps vulnerable migrants and impedes their leaving. illegal, unethical, exploitative employment arrangements often mean very little income even though the migrant worker has fulfilled their work obligation. a participant reported: they are brought in by… gang leaders … as a gang of workers and the patrons, the leader is the one who gets paid, and he decides how much each person in the group makes. it is not a normal employment relationship. it's not a legal one. they just, they are like a subcontractor, and the dress it up by calling it a ‘subcontractor,’ but it's really a patron system, and if you screw up or piss off that person, you don't get paid. english-only services. providers recognized that their own inability to speak a language other than english as a barrier to serving migrants. representative of this theme is the following excerpt: we frequently advocate for interpreters at health appointments for our clients. sometimes we provide that interpretation service. sometimes we either are not able to for one reason or another or sometimes we just take the opportunity to advocate and say ‘the clinic really needs to provide it, and this is why’ kind of thing. it is really, sometimes it is very frustrating that this is still such a big barrier. it seems like it should be easier by now. gender. participants suggested that migrant women are particularly vulnerable to exploitation, which is congruent with the increased susceptibility of women to oppression that is recognized worldwide. whether it be because of gender roles and associated social norms differing from their home nation and the u. s., or because patriarchal underpinnings create a climate where women are considered subordinate, many women are at an increased disadvantage when they migrate. one service provider described this inequality within the refugee population they served: i think gender plays a huge impact, specifically working with refugees from certain countries. for instance, in burma the gender roles seem...very...strict and rigid at times. so even when i'm communicating with refugee clients--let's say it's a heterosexual couple--prolonged eye contact, for instance with the wife could suggest a whole number of things that you wouldn't think of. i think that when those strict gender roles carry over into a new culture, i think that can still leave you particularly vulnerable. migrating with one’s spouse who is likely from the same cultural milieu has its difficulties, but engaging in a relationship with someone from a different cultural background is also challenging when one person is put at a disadvantage because of perceived dominance or subordination. an example from the data that illustrates this imbalance: i think the final one i would say and again related to sexuality would be some exploitative situations or easily lend themselves to exploitative situations where advances in social work, spring 2018, 18(3) 896 you have an undocumented woman generally and an american man, and they enter into some sort of relationship…it so easily lends itself to exploitation. finally, the patriarchal construct of women as property of the male head of household undergirds this participant’s statement that “a lot of the women’s dads sell them to their husbands.” history of abuse or trauma. the prevalence with which people experience trauma and violence is alarming. whether it be domestic violence, child abuse, or past exploitation, often at the hands of a loved one, these factors increase vulnerability to further exploitation from the perspectives of many participants. having a history of trauma was mentioned numerous times, with domestic violence repeatedly identified as a risk factor for exploitation. these experiences were often combined with other risks for vulnerability as identified by a participant, “typically, there is substance abuse. there is history of trauma; they’re undocumented and typically indigenous. feeling very vulnerable, like they don’t have rights.” the perception that it is socially acceptable in some cultures, even normal, to experience abuse at the hands of an intimate partner was described by a participant in this way: the second area is domestic abuse and sexual violence, particularly prevalent in my experience…we helped people get visas, u visas because they're victims of sexual violence and domestic abuse…and in fact i think, maybe not sexual abuse, but domestic violence is culturally accepted in many ways. the logistics of migration itself create openings for trauma as well, as voiced by this participant: they’re a lot of things that happen before they come here which is why they’re here. or they happen when they were crossing the borders. i worked with a woman who was raped by a coyote. housing instability. one theme that emerged in the conversations with most participants addressed the instability many people face, and the nature of homelessness in the area. women appear particularly vulnerable when it comes to housing and financial disempowerment. they often have children they are trying to care for and keep safe, as illustrated by this participant: so housing is a huge thing. because obviously if you don’t have rental history, if you don’t have proof of income. like these are thing that are consistently demanded with u.s. housing. so we have established partnerships and relationships with the apartment complexes in [name of county]. … if they just don’t have any of these demanded documents or proof then they aren’t even considered. immigration status. it comes as no surprise that service providers recognize the stress experienced by migrants without legal documentation. not only does this status increase the hardship of securing gainful employment, it leads to increased vulnerability to exploitation due to the migrants’ perceptions that they have no rights, as indicated here: chappell deckert et al./midwestern service 897 there is still that underlying fear of not having papers …. i am using their terminology, ‘i don’t have any papers.’ having no papers and feeling very vulnerable, you have to put up with things that other people don’t have to put up with. additional support for this theme came from these participants who stated: “i have heard from my friends in [urban city 2], it was about 40% of their population is undocumented workers and undocumented kids. and they would be more apt to not report anything that might happen” as well as “probably helping the families find ways to be here legally without feeling like they have to keep a step ahead of being caught… it’s kinda a scary time in our country frankly, with the whole donald trump campaign.” physical and social isolation. the interview data clearly indicated that physical and social isolation increase vulnerabilities to exploitation and should be considered by service providers of migrant populations. service providers talked about the physical isolation that migrants face, including very limited transportation. they only go where their employers want to take them, and in rural areas often do not have the bus systems they need to get to services. social isolation was also identified as an area of vulnerability. for example: i think where you have problems is in places in more rural areas, how you get the networks to reach in those areas is going to be a challenge…i think you know, part of what [non-profit law firm 2] does…we have a migrant farm workers program that deal…workers who move from state to state or some sort of agricultural crop, and they face a whole variety of issues but their job and where they live is on site, and so if the employer doesn’t want someone on the property to talk with those people, you can’t get on the property to talk to those people. lack of supervision. participants identified a distinct difference between the vulnerabilities of migrant adults and minors, although there is a great deal of overlap in the characteristics that increase vulnerability to exploitation. children experience increased risks of exploitation simply because they rely on others for their care, transportation, and access to most services they would ever need. they are subordinate to (most) adults in that they are generally physically weaker, have less life-wisdom due to inexperience, and as is often the manner of youth, trusting and unaware that their situation puts them at risk. participants shared their concerns about young people being left unsupervised and the increase in vulnerability because of this: “we are concerned particularly for our teenage girls, particularly if they have a single parent and they are coming from a single parent household and maybe that parent is working second or third shift.” additionally, one indicated that they were …just worried about supervision, even though the child might be at an age where it is ok that they are home because they are 16 or 17 but just ensuring that they are safe and that they are not victimized. migrants’ lack of understanding english language and/or american culture. while one’s ethnicity or cultural background do not inherently increase vulnerability, immigrating from another country without a thorough understanding of american culture advances in social work, spring 2018, 18(3) 898 and/or english increase the risk of exploitation. tied directly to this theme is the vulnerability often felt by people who are at the mercy of smugglers when trying to immigrate to the us without going through legal channels to do so. many immigrants are just not prepared for the intricacies of american culture and the people who are more than happy to prey upon their ignorance. one respondent reflected: i think maybe also just not knowing the culture. for instance, we had one gentleman who found a job on his own and thankfully he continued to talk with his case manager about it, but it was not a positive situation. i mean the manager was quite verbally abusive, the pay was not what it should be, and so thankfully he was in communication with us, and we advised him that he needed to leave that job. another stated: … limited english proficient, coming from different places, not understanding the legal system at all, or people often don’t understand what rights they might have…and i think you know, access to quality education, i think affects people too, cause they feel like they don’t read or understand well when they’re faced with these legal documents that people give them, they just sign them, they don’t read them, and then they don’t understand what kind of debt they’re getting into that, that makes them, it makes it unsurmountable for them – payday loans, that people are frequently signing, they don’t understand how it works. legibility of human trafficking a second key theme identified by service providers relates to the legibility of human trafficking. schwarz and britton (2015) write, the defunding of social services and the welfare state continues to distance the members of society most vulnerable to trafficking from the institutions and structure they most need. in particular, the bodies and lives that are the least legible then become even more separated from the democracy that was intended to include them. (pp. 64-65) service providers negotiate the meaning of “human trafficking” in very different ways. service providers serve migrants who are also survivors of trauma on a daily basis, yet many providers may unintentionally fail to connect the actual lived experiences of their clients to trafficking policies and provisions that protect survivors (chapkis, 2003). this confusion, paired with anti-immigration rhetoric and restrictive social welfare policies, contributes to a climate in which individuals fail to read themselves into trafficking narratives. they are often not legible within the more common perceptions of what trafficking looks like. the data from these interviews indicated that there is a gap between what people perceive as trafficking and how it is defined or treated as a result of policy. most of the awareness campaigns and efforts toward prevention that these service providers discussed specifically highlighted young girls involved in sex trafficking and did not address labor exploitation or other forms of trafficking risk. additionally, anti-trafficking rhetoric that focuses on kidnapping and abduction ignores the possibilities that people could be coerced chappell deckert et al./midwestern service 899 or exploited in other ways. for example, several interview participants initially said they had no experience with trafficking and suggested we interview other people. however, when we explained the definition of trafficking from the victims of trafficking and violence protection act of 2000 (2000), they realized that the exploitation many of their clients faced could be identified as, or lead to, labor trafficking. for example, one service provider working with a migrant advocacy organization stated they see similarities in the work they do: …we deal with issues in the global economy that include migration. and while human trafficking isn't going to come up directly, there are so many similarities between the kinds of abuses you find that we call human trafficking and the kinds of working conditions that undocumented people face or people who are brought in—in the labor gangs. to me, the line is very fuzzy, between what’s human trafficking and what's just your standard abuse of workers who are undocumented. this service provider denied having a connection to trafficking and then, while answering, renegotiated its meaning. acknowledging a “fuzzy” line between trafficking and various working conditions not only makes identifying trafficking difficult, it means that providers and advocates may be dismissing the possibility that trafficking occurs to their organizations' clients outright. another participant who works with refugee resettlement in the united states pushed back on the idea that she was working with trafficked individuals. this social worker initially thought that only her former employment agency addressed trafficking, but she stopped and retracted: i guess i should back up and say that i am sure that we have, if you are talking about folks who have been trafficked prior to them coming to the us, then yes we have served them…so, i mean, it depends what your definition of trafficking is…but we have folks coming from situations where they have paid smugglers or traffickers for safe passage out of their home country or things like that that was not "safe passage." each of these examples considers the relationship individual service providers have with the definition of “human trafficking.” within the interview process itself, several participants became aware of their potential connections or interactions with clients who may be in fact be survivors of human trafficking. this is an interesting finding: that the very process of discussing trafficking with these service organizations helped clarify the ways in which their organization needed to address their work with potentially exploited clients12t.12t conversations within interviews themselves appeared epiphanic and perhaps transformative as indicated by reflections in the data. access to services/resources was critically important to these service providers. they expressed a desire to go to where the clients are and to take services to them, especially considering that these are populations that in some cases are hidden: “they are not out looking for social service organizations; they are not out.” there was also a desire to build collaborative services in an effort to increase access. service providers were committed to advances in social work, spring 2018, 18(3) 900 both quality and access in their care: “…even people without insurance deserve the best quality that they could get.” the majority of participants expressed that their organizations lacked training in human trafficking, lacked a protocol for identifying human trafficking, and lacked specific procedures for intervening and assisting survivors. most service organizations represented in the interviews did not have a working definition of trafficking. they were often apologetic about their lack of direct experience in trafficking. political rhetoric versus local response in addition to the legibility question, a third theme demonstrated that midwest service provider narratives illustrated a tension between national and state-level political rhetoric and local community responses to migrant populations in the midwest. service providers discussed their need to negotiate political and governmental approaches that restrict rights for migrant populations with a midwestern ethos of generosity and welcome. a service provider working with migrants in the midwest worried about anti-immigrant sentiment in political and governmental rhetoric: prior to [the paris attacks] i would say that families were very much welcomed, and i did not really have concerns about how they were being accepted or what it meant in the wider community. now, because of where things are at, and some of the thoughts and beliefs we hear about, i have greater concerns about whether the families coming to this area are being fully welcomed. the service provider also noted that they have seen an increase in support for the work of the organization: ...i see as a silver lining of things, is that i’ve had a lot more volunteers coming forward and saying ‘how can we support your agency?' and what you do. even one entity used the word--kind of i see this as our congregations’ resistance to what we are hearing [in the media]…a lot of people are saying, ‘no, we want to be welcoming. how can we get involved?' considering increased political restrictions on refugees and migrants, our research team also asked midwestern service providers for their perspectives on their motivation to continue to provide services. their responses reflected both individual and systemic issues that drive vulnerability and exploitation of migrant populations, and many used a specific lens of religion, ethos, and their self-described midwestern norms that motivated them to action. first, service providers identified areas of structural oppression and injustice that create difficulties for migrant populations and motivate the service providers to work for change. specifically, they highlighted poverty, gender inequality, anti-immigrant sentiment, corruption, healthcare access, trauma, and economic forces that contribute to problems of exploitation and vulnerability. these issues can layer one on top of another and create complicated and dense situations of vulnerability. chappell deckert et al./midwestern service 901 second, providers identified ways in which social policies (particularly related to welfare reform and immigration) increase the risk of exploitation. due to desperation, trauma, and lack of assistance, the people with whom they work are forced into compromising situations of employment. these injustices move service providers to action: “i just felt duty-bound to get involved and try to do something.” many of them mentioned strong desires for policy shifts and expanded supports and the expansion of social services. service providers listen to the experiences of migrants in their organizational contexts and try to translate those experiences into a call for social change. one service provider who provided education to migrants stated: “i want it [human slavery] to be disturbing for everyone involved. and to not let things go by the wayside. it should bother us.” these findings are reflective of previous research related to structural oppression and the risk of exploitation (berg, 2015; gleason et al., 2016; lutnick, 2016; schwarz & britton, 2015; todres, 2011). however, it highlights that in the midst of staunch political rhetoric that is anti-immigrant, anti-poor, and anti-assistance, there are voices that reflect a midwestern narrative that is welcoming, generous, and kind. finally, service providers encountered various legal and ethical issues in their work, most prominently mentioning issues of legal status and the risks associated when migrants are not authorized or undocumented: “…undocumented workers and undocumented kids…they would be more apt to not report anything that might happen.” the fear of talking and a lack of understanding basic rights inhibit the helping process. service providers appear to be motivated by a need for more integrated approaches and more legislative reform for protections. one provider stated, “i am really hoping that we can get something done legislatively…i just want to see it get strengthened.” in addition to identifying structures that needed to change, service providers also recognized that they could do more personally: “i feel trapped by my limited language ability,” and “i am sure there are times where we were working with clients, and we did not do a good enough job of explaining what’s going on…” this indicates a feeling of unpreparedness among service providers. discussion this study explored the perspectives of service provides related to the exploitation of migrant populations and their vulnerability to trafficking. findings indicate three main areas of emphasis which are discussed in the previous section: 1).vulnerabilities of migrant populations, 2). a lack of legibility of human trafficking in social service organizations, and 3). a difference between political rhetoric and local responses to migrant populations. in order to address the specific vulnerabilities to exploitation identified by our interview respondents, systemic and community issues that affect exploitation must be addressed. this includes access to services, social and economic inequality, citizenship status, transportation, and language, and is reflective in other literature related to trafficking risks as well (baker, 2013; berg, 2015; lutnick, 2016; okech et al., 2017; todres, 2011; warren, 2016). collaboration between service providers is also important. it was clear from these interviews that there are not enough resources to adequately support migrant populations and/or the motivation to improve these services at the regional level. the nasw, in the latest version of standards and indicators for cultural competence in social work practice (2015a), has addressed the expectation that services be provided advances in social work, spring 2018, 18(3) 902 in the “client’s preferred language with the proficiency required,” (p. 45) which could mean keeping professional interpreters on staff, certainly for commonly spoken languages represented by the migrant population in the geographic area. federally-funded entities are required to provide an interpreter, yet many migrants speak indigenous languages for which interpreters are rare. related to access and mobilization of resources for clients, social service interventions need to be formed around social networks (negi, michalopoulos, boyas, & overdorff, 2013). recognizing the importance of social networks, service providers were motivated to help link their clients into key relationships, connecting them to social networks so they can be a meaningful part of a community. they identified how healthy community and family connections can serve as a buffer against situations of exploitation. there is also a need to increase the knowledge base by educating social workers and other service providers about migration-related policy and trauma-informed care to improve their skills and understanding of vulnerability to exploitation and to expand research related to social networks. regarding legibility, social workers and other service providers need to broaden their understanding of trafficking to include narratives of exploitive practices so that they can successfully identify people being trafficked and help survivors navigate systems of assistance. a risk factor for labor exploitation identified by schwarz (2017) was prior (and unsuccessful) involvement with a social service provider. this indicates that survivors were seeking some sort of assistance, but their vulnerabilities for exploitation went unaddressed. for example, a client who seeks a health assessment may not be asked if they feel socially isolated or fear deportation. a holistic evaluation of individual cases will help identify risks earlier so that interventions are more effective (barrick et al., 2014; simmelink & shannon, 2012). helping providers understand the full range trafficking policy and intervention tools could help them identify and assist their clients who may be vulnerable to various forms of trafficking. educational and prevention programs to educate social service organization staff and advocacy groups on labor and trafficking practices as they relate to exploitation must increase in quality and frequency (hodge & lietz, 2007; salett, 2006). the “fuzzy” lines related to defining trafficking make it difficult for service providers to connect trafficking risks with more commonly understood social problems. when legibility among service providers is evident, that may filter to service-users as well. schwarz and britton (2015) argue that trafficking prevention is elusive without shifting structural factors such as gender, class, and sexuality inequalities. our data aligns with previous research that argues this connection needs to be strengthened. this study was conducted in a very politically conservative region of the country, where gubernatorial executive orders restrict services to migrant populations. still, it is important to note that these interviews were conducted in the early months of the 2016 presidential campaign, and since then the social and political divide regarding perceptions of migrants has deepened. regardless of political restrictions, local communities are stepping in and offering assistance and, in some cases, providing sanctuary for migrant populations. service providers need training in migration policy and public advocacy in chappell deckert et al./midwestern service 903 order to protect themselves, their agencies, and the people they are trying to help from unwelcome attention. it is also important for social workers and other service providers to pay attention to systemic issues such as lack of affordable housing, which is related to the vulnerability of precarious housing, power, privilege, and oppression (alvarez & alessi, 2012; okech et al., 2017). these systemic narratives are often omitted from interventions for trafficking. however, they are the perfect venues for identifying preventive strategies (schwarz & britton, 2015). migrants and others who live in a state of precarity need access to a safe place to live, sustainable and supportive employment, and quality health care and education. social workers are professionally positioned to do this work. increasing the training and support in community social welfare organizations is consistent with other recommendations in social work research (okech et al., 2017) and echoed across other sectors, such as law enforcement (farrell et al., 2010; owens et al., 2014) and medical providers (becker & bechtel, 2015; powell, dickins, & stoklosa, 2017). this area can be enhanced in social work practice across social institutions. social workers can fine tune assessment strategies and expand referral options for quality education, transportation, medical care, and mental health services. they can also advocate for policy changes to support migrant populations and create sustainable migration reform participants referred to assisting clients with obtaining u visas, which are available to survivors of violent crimes (including certain forms of trafficking) who work with law enforcement to investigate or prosecute offenders (warren, 2016), yet the t visa is another tool to assist immigrants. the t visa, which makes it possible for survivors of human trafficking to obtain legal residency if they cooperate with law enforcement to investigate or prosecute their traffickers, can be transformative for clients if social workers understand the procedure and collaborate to develop accessible processes in their communities. the t nonimmigrant status (t visa) provision was enacted, along with the u visa, under the victims of trafficking and violence protection act of 2000 (2000). the t visa has the potential to reframe victimization into a more positive opportunity by allowing trafficked survivors, who are in the united states as a result of being trafficked, to eventually gain legal residency, and then u.s. citizenship. as warren (2016) recommended with regard to the u visa, in order for the t visa to be fully realized, congress must mandate nationwide training to develop consistent procedures to enable clients to access these visas. social workers and other social service professionals cannot wait for a governmental revision to include the funding required to fill this need. they can fulfill an essential role in working with local and state law enforcement, labor divisions, and organizations that serve migrant populations to utilize both the t visa’s and u visa’s potential to identify and stop human trafficking. limitations while the intent of this study was to understand the perceptions of service providers, one drawback is that there are no direct voices of people with lived experience of migration themselves. this is a broader problem in migration literature, as talking with people who have recently experienced migration must be addressed with sensitivity. a second limitation of this study relates to the interview process for this study. even though the advances in social work, spring 2018, 18(3) 904 research team met together to develop interview questions and discuss interviewing strategies, the actual nuances of the interviews themselves may have varied. finally, only one interview was conducted with each service provider. multiple interactions may have provided more depth and detail to the interviews. recommendations and future research social work’s ecological perspective acknowledges a need for services across practice levels. social workers can offer this perspective to other service providers in helping to address trauma and interpersonal issues while simultaneously helping to navigate systemic issues that contribute to exploitation. social workers are poised to lead in collaboration with others to train community members in recognizing and intervening in suspected trafficking. their participation with local law enforcement and policy-makers is essential to challenging the structures and practices that enable predatory individuals to take advantage of vulnerable people. services need to include approaches that are not linear, are flexible/adaptable to client needs, and are interactive and client-driven (chappell deckert, 2016). service providers need to establish trusting relationships so the potential for deeper issues of exploitation to be uncovered readily exists (hayes & unwin, 2016). further inquiry is warranted for a more complete understanding about how conversations about trafficking and exploitation create changes in service provision. one principle of social work education is to develop professional resourcefulness and alliance with our clients. these skills put social workers in the forefront of the social services, assisting migrants who have left behind everything that they knew with regard to language, culture, and social systems either by choice or by force. as social workers, we are called by our ethical code and values to aid trafficking survivors with competent service that enhances dignity and well-being. this is a justice concern of utmost importance, and we must be prepared to act responsibly and with sensitivity. this study’s qualitative nature did not seek to quantify the increased effects of additional variables of vulnerability on one’s susceptibility to exploitation. knowing how much more vulnerable a person is because of the complexity of their life situation may awaken policy-makers to the needs of vulnerable and marginalized people, but it has failed thus far. more resources are needed in general: to get people to their services, to keep children safe, to teach parents the skills they need to be better parents, to help people feel less isolated and see themselves as worthy members of their communities, and to prosecute those who prey upon the many vulnerable people with whom we create a society. the three areas highlighted by this study (vulnerabilities of migrant populations, a lack of legibility of human trafficking in social service organizations, and a difference between political rhetoric and local responses to migrant populations) move the profession forward by illustrating key issues from the perspective of those who most directly interact with migrant populations through social services. addressing the vulnerabilities to exploitation can prevent further marginalization, bring the hidden parts of the problem to the forefront, and build networks of support across community agencies. responding to structural oppression and advocating for stronger social welfare policies, in addition to clarifying the “fuzzy line” identified by the respondents of what is/is not exploitive will help to improve chappell deckert et al./midwestern service 905 legibility and access to services. finally, understanding the incongruence, or tension of restrictive immigration and social welfare policies against the motivation of grassroots communities to respond in a welcoming and generous manner will help social workers feel empowered and hopeful as they create communities that can support and encourage these vulnerable populations. references abdus-shakur, a. 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(2014). estimating labor trafficking among unauthorized migrant workers in san diego. the annals of the american academy of political and social science, 653, 65-86. doi: 35thttps://doi.org/10.1177/000271621351923735t corresponding author: jennifer chappell deckert, department of social welfare, university of kansas, 1545 lilac lane, lawrence, ks, 66045. 35tjchappelld@ku.edu35t acknowledgements: dr. corinne schwarz, rachel scherzer denney, ryan louis, anna karpusheva, aminata seck, josephine kipgen, najmeh moradijan rizi, jamene brooks kieffer, tami albin, jason olenberger, university of kansas institute for policy & social research, university of kansas department of political science, university of kansas school of social welfare, university of kansas department of women, gender, and sexuality studies http://www.state.gov/documents/organization/10492.pdf https://doi.org/10.1080/15313204.2016.1187102 https://doi.org/10.1177/0002716214521562 https://doi.org/10.1080/19361520802702191 https://doi.org/10.1007/s10611-012-9393-y https://doi.org/10.1177/0002716213519237 mailto:jchappelld@ku.edu _________ *anaïs bailly, msw, lmsw, owner and founder, bm structured solutions, llc, lumberton, nj. benjamin p. brumley, phd, instructor, educational foundation and policy studies, megan a. infanti mraz, rn, phd, professor of nursing, benjamin s. morgan, associate director, student success center, gwenelle styles o'neal, msw, dsw, lsw, professor, graduate social work, brie radis, dsw, lcsw, mss, mlsp, is an assistant professor of social work, and susan r. wysor nguema, msw, phd, associate professor, social work, west chester university of pennsylvania, west chester, pa. colleen keeler, lsw, msw, medical social worker, main line health, west chester, pa. mia ocean, phd, lcsw, lmft, assistant professor, graduate social work, west chester university of pennsylvania, west chester, pa. erin spencer, lsw, msw, medical social worker for main line health, west chester, pa. *note: all authors in this manuscript are considered first authors. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 857-875, doi: 10.18060/24053 this work is licensed under a creative commons attribution 4.0 international license. anti-racism working group: exploring the results of an interdisciplinary partnership at a large public university anaïs bailly benjamin p. brumley megan a. mraz benjamin s. morgan gwenelle styles o'neal brie radis susan r. wysor nguema colleen keeler mia ocean erin n. spencer abstract: institutions of higher education fail to address ongoing systemic racism within their classrooms, boardrooms, and commons when university personnel and students are not prepared to discuss racism and structural inequalities that exist within the campus community. to address this at a public, predominantly white institution (pwi), a group of students, staff, and faculty developed an action-oriented community to increase awareness and advocacy efforts against systemic and micro-level racism. founded by faculty in the university’s bsw and msw programs, the anti-racism working group (arwg) is composed of faculty, staff, and students from multiple university departments. the goals of arwg include education and awareness, and dialogue about race, ethnicity, bias, power, and privilege; cultivating interdisciplinary faculty and student relationships, and inspiring anti-racist actions. this paper discusses and disseminates research about arwg’s inaugural year and early assessments of the program. data includes responses from students who attended arwg workshops and found them useful in their conceptualization and self-awareness around race, privilege, and taking anti-racist action. arwg members benefited around three themes including skill development, relationship building, and the increased awareness and ability to engage in productive discussions around race, power, and privilege. we share these results with other universities and organizations to encourage the creation of similar programs and to facilitate learning from our experiences. keywords: white supremacy, racism, advocacy, interdisciplinary, higher education west chester was founded in 1812 as a private, state-aided preparatory and teachertraining school, eventually becoming a state-owned teacher’s college in 1927 and joining the pennsylvania state system of higher education (passhe) in the 1980s. west chester is a predominantly white institution (pwi) at both the graduate and undergraduate levels (sinanan, 2016), and faculty and staff demographics are comparable to the student body: 83% white and 17% black, indigenous, and other people of color (national center for education statistics, 2019; west chester office of institutional research, 2020). like many other pwi’s, west chester ’s efforts to redress its latent institutional racism remain inchoate. while west chester has pledged responsibility for its complicated history of about:blank advances in social work, summer 2021, 21(2/3) 858 serving the common good while enacting systematic oppression (forde, 2008), the university has yet to create an environment in which students identifying as black, indigenous, people of color (bipoc) and those who identify as white complete their undergraduate degrees at equitable rates (robinson, 2020; west chester institutional research, 2020) — more work needs to be done. while university racial climate data acknowledges the challenges bipoc-identifying students experience at west chester, university personnel and students are often not prepared to dialogue about racism and structural inequalities in the campus community. universities have an institutional responsibility to prepare students, staff, and faculty with strategies and knowledge to reduce racism both directly and structurally to navigate challenging discussions and achieve institutional change (walls & hall, 2018). one such outcome of this commitment was the formation of the west chester’s anti-racism working group (arwg). arwg was founded in the spring of 2018 by social work faculty and funded through an innovation in diversity and inclusion forum grant from the west chester office of diversity, equity, and inclusion. the request for proposals sought programs to enhance west chester’s campus climate. initial arwg funds were used to organize a two-day intensive anti-racism training, which resulted in the creation of an action-oriented community. the group focuses on increasing awareness and advocacy to counter racism at our institution and in our related communities. arwg is composed of faculty, staff, and students from multiple university departments: counselor education, educational foundations & policy studies, english, graduate social work, management, the library, business college, nursing, and undergraduate social work, and includes a diverse range of participants in regard to markers of age, race, gender, and lgbtqia+ identities. to create an anti-racist learning community, to dialogue, and to practice a common language that can be shared among the working group members, students, and the greater college community (alejano‐steele et al., 2011), arwg convened for an initial 2-day intensive train-the-trainer workshop in august of 2019. the purpose of this workshop was to develop and build on the following goals: increase awareness of and the ability to engage in productive discussions related to race, ethnicity, bias, power, and privilege; cultivate interdisciplinary dialogue and encourage cross-campus professional faculty and student relationships; and inspire action and advocacy. this two-day time period was based on participant availability, grant funding (for food and an honorarium for the trainer), and also previous anti-racism training research demonstrating that trainings for a similar length resulted in changed attitudes and understanding around racism (abramovitz & blitz, 2015; singleton, 2012). this initial training was supplemented with monthly and quarterly meetings to review the progress and expectations set forth from the first training, which was intended to be the jumping off point as racial equity cannot be achieved through a week-long, two-hour, or two-day training (ajunwa, 2020). during the 2019-2020 academic year, arwg deployed across the university to host events to listen, educate, unsettle, and engage approximately 200 community members to take anti-racist action. arwg also met monthly to engage in discussion around logistics; review feedback from workshop trainees; refine and develop best practices for anti-racism bailly-mompoint et al./anti_racism working group 859 training for west chester students, faculty, and staff; create group advocacy goals and track progress towards meeting goals; and to support one another with encouragement and offer a safe space to debrief. this training for trainers attracts people (faculty, staff, and students) interested in examining their social political roles/identities and committing to having conversations about our history and the dynamics of racism, discrimination and inequality. this work involves the participants in learning content, analyzing the reactions of the participants, structuring and facilitating the content and subsequent discussions, and participating in developing strategies for outreach and policy improvements. following the completion of arwg’s first year of training and active engagement within the university setting, a survey was disseminated to all members of the working group and workshop evaluations were reviewed. in this paper, we detail arwg’s guiding theoretical frames of organizational change theory, specifically multicultural organizational development (mcod) and anti-racist social work pedagogy that is exemplified in critical race theory (crt), our research related to the lived experience of its working members, and our achievements, goals, and future plans for the group (crenshaw, 2003). literature review antiracism and theory within social work, anti-racism has been discussed broadly as a political perspective (keating, 2000), professional ethics (husband, 1995), and transformational practice (dominelli, 2017). its eclectic development can be traced through black activism, liberal multiculturalism, critical race theory (crt), marxism, feminism, post-colonialism, and post-structuralist frames (gillborn, 2006; ladhani & sitter, 2020). while difficult to define, the unifying purpose of anti-racism could be summarized as understanding and confronting contemporary racisms at the level of experience within the context of what foucault called the dispositif, the apparatus of discourses, institutions, and regulations immanent in oppressive systems (foucault & gordon, 1980). crt has been a productive lens through which this immanence can be understood in the united states, framing the ubiquity and normality of racism, especially anti-black racism, within the rubrics of intersectionality, a concept that seeks to understand how distinct identities create disparate and converging forms of oppression (crenshaw, 2003; crenshaw et al., 1995). with this in mind, antiracism is often understood as requiring active opposition to forces which seek to hide, elide, or reinterpret racisms in order to maintain the status quo and limit multidimensional interventions (corneau & stergiopoulos, 2012; dominelli, 2017; ladhani & sitter, 2020; svetaz et al., 2020). eliminating racism was only recently named a social work grand challenge for creating a just society (grand challenges of social work, 2020; uehara et al., 2017). while this acknowledgement is vital to the growth and efficacy of our profession, analyses of our literature reveal that we have inadequately addressed racism beyond the micro-level (corley & young, 2018; mcmahon & allen-meares, 1992). what the limited body of research does show is that effective antiracism work requires a focus on culturally advances in social work, summer 2021, 21(2/3) 860 responsive interventions as well as accountability and group organizing to counter the effects of racism across levels and systems. anti-racist projects must therefore seek communal understanding of local conditions and empower action to lead from below as “low-power actors” to redress racism for ourselves, our communities, and our collective futures (cohen & hyde, 2014; hyde, 2018, p. 1). antiracism in higher education institutions of higher education remain sites of “post-race” discourse, meritocratic mirage, and whiteness as organizational culture (tate & bagguley, 2017). similar to social service agencies, higher education institutions maintain and promote the status quo (i.e., white-supremacist distributions of power) through discriminatory hiring and admission practices, surface-level work focused on diversity through representation, and the creation and enforcement of professional standards and cultural norms (miller & garran, 2008). these standards and norms reveal an endemic feature of racism in higher education: institutions serve as gatekeepers and as brokers of resources, and restrict access to some communities of students, faculty, and staff more than others under the guise of merit, which always already operates within the rubrics of systemic racism and the intersectional convergence of identities and experiences (basham et al., 1997; figueroa & garcia, 2006; vaughn, 2008). to address these issues of institutional culture, our antiracism work has been informed by multicultural organizational development (hyde, 2004; jackson, 2006), a frame which posits the organization along a continuum of change, and prepares teams of change agents to plan, implement, assess, and renew actions across levels and subunits. as we are an interdisciplinary team in respects to tenured and untenured faculty, staff, and students across broad entities of the university, individual anti-racist leaders are dispersed across facets and realms of the university to act as change agents in various roles and departments (healy, 2014). fully developed multicultural organizations deploy diverse knowledge and perspectives from its members in developing functions, strategies, and values (hyde, 2018). while institutions of higher education are unique organizations and require a nuanced approach different from more common mcod analyses of human service organizations, some of the intentional techniques are transferable. for example, social justice change techniques such as utilizing collaboration across groups and campaigning for change, as well as incorporating social capital as a vehicle to empower change from below can all thrive in a university environment (cohen & hyde, 2014). while its organizational elite rarely advances anti-racist projects, educational institutions such as west chester university are characterized at low-power levels by the breadth of knowledge and diverse perspectives inherent to interdisciplinarity. interventions for social change can develop and succeed in collaborative learning organizational cultures (hyde, 2017). while universities are complicit in the forces of destructive neoliberalism, they also hold in escrow the knowledge, methodologies, and skillsets through which organizations may transform and anti-racist work may thrive. anti-racist group work: the undoing racism™ workshop bailly-mompoint et al./anti_racism working group 861 the undoing racism™ workshop developed by the people’s institute for survival and beyond (pisab) has been shown to effectively interrogate both the ubiquity and endemicity that allow racism to permeate our communities (abramovitz & blitz, 2015; hamilton-mason & schneider, 2018; pisab, 2018). this workshop model has been studied in social work classrooms (hamilton-mason & schneider, 2018) and education and human service institutional contexts (abramovitz & blitz, 2015). notable elements of the pisab framework include a deeper understanding of systemic inequality, the historical construction of race, the constitutive connection between race and class, as well as a general approach of critical self-analysis and accountability (lykes et al., 2018; pisab, 2018). undoing racism™ workshop attendees gained valuable knowledge of local institutional barriers which impede anti-racist work by exploring and discussing pisab’s anti-racist principles: analyzing institutional power, developing leadership, transformative gatekeeping, identifying and analyzing manifestations of racism, learning from history, accountability, sharing culture, and undoing internalized racial oppression (abramovitz & blitz, 2015; hamilton-mason & schneider, 2018; pisab, 2018). hamilton-mason and schneider (2018) discussed delivering the undoing racism™ workshop in a social work classroom and found that the model offered measurable benefit over standard anti-racism content delivery methods. the authors identified key elements of the workshop experience: activities to enhance learning, peer conversations about difference, discussing white privilege, language-focused approaches, and developing action plans. one of the key aspects to supporting arwg was to incorporate time to develop an action plan within the allotted training time. a focus on action-oriented approaches to addressing and redressing systemic inequality was also discussed by abramovitz and blitz (2015). their study of the workshop as a primer for larger institutional conversations is useful to our project in thinking through the ways that grassroots efforts are attenuated by the intricacies of organizational change and the many factors that limit or encourage efforts to build racial equity, such as funding limited to training, the institution’s racial equity progress and population, a participant’s personal engagement and attitude about race, and the racial composition of the organization’s leadership. research questions to evaluate the efficacy of our arwg workshops and group member’s experiences, this study utilized a pragmatic worldview and a qualitative mixed methods evaluation research design (creswell & plano clark, 2017; morse, 2010). the research questions were written to reflect the preliminary deductive qualitative strand (qual, participant feedback), the primary qualitative strand based on facilitator reflection (qual, facilitator feedback), and are ordered to match the proposed mixed methods design. they are listed as follows: • phase 1 (qual, participant feedback): how well does the anti-racist workshop reflect principles of anti-racist training? • phase 2 (qual, facilitator feedback): how do facilitators interpret their own experiences in the arwg and integrate the workshop in their own efforts towards anti-racist practice? advances in social work, summer 2021, 21(2/3) 862 methods a mixed methods evaluation design is often used to evaluate programs, organizations, or experimental trials using more than one methodological approach (creswell & plano clark, 2017). while typically mixed methods evaluation designs employ both quantitative and qualitative methods, following the developments by morse (2010) and creswell and plano-clark (2017), we utilized morse’s sequential qualitative mixed methods design whereby two qualitative methods are employed to triangulate study findings (little qual represented as qual and big qual represented as qual). we chose this qualitative mixed methods evaluation design because this type of study allows for both deductive (e.g., “hypothesis testing”) and inductive qualitative investigations (e.g., “emergent analysis”) using data from multiple stakeholders over an extended time (i.e., participants and facilitators across a year). while inductive and deductive approaches to research seem quite different, they can be rather complementary in a qualitative mixed methods evaluation design. researchers can plan for their research to include multiple components, one inductive and the other deductive and look for ways the findings “converge” or “diverge” depending on the analysis. this allows us to compare the end results and look for additional ways that mixing these two qualitative approaches adds value above and beyond the individual components (creswell & plano clark, 2017; glaser & strauss, 1967). therefore, we first used the deductive a priori coding in phase 1 to identify areas of success with implementing the principles of anti-racist training (qual). in phase 2, we inductively analyzed the survey results with the qualitative open text responses. this allowed us to connect the participant results from the workshop with the facilitator results to explain the anti-racist working group’s successes in its stated objectives (qual). we then compared these two approaches to identify areas of “convergence” and “divergence.” see table 1 to view the implementation matrix describing the strategy, sampling frame, goal, and analysis strategy for the two phases. ethical consent to address ethical considerations, internal review board approval was obtained (irb protocol number: 20200609b). data were kept under secure and confidential storage. all facilitators signed consent forms for study participation. workshop participants reflected on their experience post-workshop anonymously, and completion of their reflection provided implied consent. to protect workshop participant confidentiality during analysis, data were only used in non-identifying ways as per our university’s institutional review board’s guidance. we are in the second year of arwg, we continue to have irb approval even as our university’s operations have become remote. bailly-mompoint et al./anti_racism working group 863 table 1. implementation matrix describing the strategy, sampling frame, goal and analysis strategy for phase 1 and phase 2 strategy sampling frame goals analysis postworkshop surveys all participants in the workshop were given the survey assess efficacy of workshop training goals in meeting antiracist training objectives deductive qualitative analysis using a priori codes from santas (2000) open text response survey prompts to facilitators all continuing facilitators were invited to participate in end-of-year survey identify how these facilitators met principles of anti-racist training: e.g., did the workshop methods increase awareness of and ability to engage in productive discussions related to race, ethnicity, bias, power, and privilege? constant-comparative qualitative method (glaser & strauss, 1967). the specific approach to coding data includes open coding, axial coding, and selective coding. measures survey phase one (participant feedback: qual) approximately 200 attendees completed workshop evaluations anonymously via paper/pen at the conclusion of the arwg workshop. the evaluation included five likert scale items to rate the training and open-ended prompts documenting the trainee’s advocacy goal and allowing for additional feedback. if a trainee provided their email address, they received a post-workshop evaluation via qualtrics two weeks after they completed an arwg workshop. the survey consisted of open-ended questions asking trainees to assess the advocacy component of the training and share their success with their advocacy goal. survey phase two (facilitator feedback: qual) phase two involved a qualitative data collection through qualtrics survey software. for this phase, the facilitators were invited to complete a series of open-ended responses. the reflection logs consisted of open-ended questions asking about the facilitators’ understanding of and experiences with implementing the anti-racist working group plan over the past year. data analysis survey phase one (participant feedback: qual) for phase one, we implemented a confirmatory (“hypothesis-driven”) qualitative coding method (qual). this involved taking “a priori” qualitative codes from santas (2000) advances in social work, summer 2021, 21(2/3) 864 and looking for evidence of effective anti-racist training. a confirmatory, hypothesisdriven analysis such as this is guided by specific ideas or hypotheses the researcher wants to assess. the researcher may still closely read the data prior to analysis, but their analysis categories have been determined, a priori, without consideration of the data. santas (2000) developed an application of democratic and anti-racist educational principles in a college setting building from four key components of anti-racism utilizing existing educational theory (i.e., dewey, freire) and contemporary guidance from anti-racist organizations (santas, 2000). using this model, we applied these four principles as codes to the participant responses for phase 1. these codes included (1) defining and undoing racism: overcoming the trap of inevitability through analysis and recognition of historicity; (2) teaching the history of racism: historical stages of racism and the recognition of race as a social construct; (3) leadership development: overcoming the structure of domination by cultivating leadership and independence; and (4) accountability: overcoming domination by multidirectional accountability (santas, 2000). survey phase two (facilitator feedback: qual) the reflection logs in phase two collected in the summer of 2020 were then coded with a constant-comparative qualitative method (glaser & strauss, 1967). the specific approach to coding data includes open coding, axial coding, and selective coding. constant-comparative coding is appropriate when studying how concepts from an antiracist training were successfully implemented over the training year. this contrasts with the more deductive “a priori” coding methods implemented in phase one and allows for themes to emerge inductively (creswell & plano clark, 2017). results survey phase one (participant feedback: qual) participants (n=200) found the workshop to be meaningful and useful to their conceptualization and self-awareness around race and privilege. attendees of the workshops had a positive experience and wanted more students from diverse areas of study to have a similar opportunity. the main feedback focused on participants wanting the workshops to be longer and requesting access to more leadership possibilities and opportunities to continue the work. participants also wished they had mechanisms to remember their anti-racism actions developed at the end of the workshop. based on program evaluations, participants found the workshop to be meaningful and useful to their conceptualization and self-awareness around race and privilege. we found support for the four themes from the coded results from participants wanting to act on anti-racism. these included (1) defining and undoing racism: overcoming the trap of inevitability through analysis and recognition of historicity; (2) teaching the history of racism: historical stages of racism and the recognition of race as a social construct; (3) leadership development: overcoming the structure of domination by cultivating leadership and independence; and (4) accountability: overcoming domination by multi-directional bailly-mompoint et al./anti_racism working group 865 accountability (santas, 2000). selected quotes that supported these themes are included in table 2. table 2. a priori codes phase 1 and selected quotes theme selected quotes (1) defining and undoing racism: overcoming the trap of inevitability through analysis and recognition of historicity; • thinking practically about the challenges and opportunities to improve school systems and taking steps towards anti-racism. • i think a course on racism should be implemented with the curriculum. • have a class about race be part of general ed! i'm tired of hearing the word diversity thrown around. • also, make it a requirement for all educators at [the university] to have a training about dealing with race. (2) teaching the history of racism: historical stages of racism and the recognition of race as a social construct; • i enjoyed the history behind racism and the power of an individual class can completely destroy/ degrade another race. i like how you said this made them a ton of money coming out with stats that are random. i feel this still happens today. • the most beneficial part was discussing the 4 "oids". hearing people's opinions on these general stereotypes was thought provoking. (3) leadership development: overcoming the structure of domination by cultivating leadership and independence; • learning about the opportunities we can take to improve the ant[i] racist movement was beneficial. • the call to action! not just saying i am not a racist, but doing something to better the world. • being self-aware. reading articles and textbooks to increase my knowledge. (4) accountability: overcoming domination by multi-directional accountability. • i am going to be more proactive in the "it's just a joke" type of racism or the subtle racist remarks and bring it to attention. • correct individuals racial/ stereotypical comments in a respectful manner to raise awareness. • intervening when experiencing racist rhetoric/ actions. committing myself to understanding someone who has experienced racism personally. • i believe i committed to becoming more informed on racism and how it affects all populations. survey phase two (facilitator feedback: qual) we developed three themes based on facilitators’ survey responses (1) increased awareness and ability (2) success cultivating cross-discipline, cross-campus professional student, staff, and faculty relationships (3) developing skills to facilitate discussions on race. we detail each briefly. advances in social work, summer 2021, 21(2/3) 866 theme 1: facilitators indicated an increased awareness and ability to listen and integrate narratives and experiences related to race, ethnicity, bias, power, and privilege. facilitators and arwg group members (n=10) described how rich and meaningful it was hearing the perspectives and narratives of other workshop participants. these conversations promoted learning through introducing different viewpoints and opinions. dialogue became especially powerful when students and facilitators were asked to hear about the experiences of racism, and creating a culture of action and response without fear as in the following comment from a facilitator: i very much enjoyed my experience with arwg. i find that i am very insecure in speaking up on issues related to discrimination and racism because i am fearful of making a mistake. my experiences with arwg allowed me to explore opportunities of working towards a goal of inclusion and equality, identifying obstacles to these goals and presenting them in a way which fosters listening, growth, and change. another facilitator commented that these discussions even found their ways into the classroom discussions: i shared an anti-racism statement in my syllabus and integrated material about intersectional racism in all of my classes. i read several books and was more vocal and active with students and bipoc colleagues. generally, facilitators benefited from the ability to hear the thoughts and experiences of others, including admissions of power and privilege. the facilitators found these conversations productive, and emotionally moving. arwg members found the support to explore how they might make changes and increase accountability across their departments. theme 2: facilitators indicated they had success cultivating cross-discipline, crosscampus professional student, staff, and faculty relationships. the workshop, according to facilitators, created a sense of mutual support and community building. in addition to hearing new perspectives, facilitators left the initial arwg workshop with strategies for doing anti-racism work across departments and positions at the university. a prominent theme in facilitators' reactions on the last day of the workshop was the feeling that they were leaving with a plan of action for incorporating anti-racism into their work. one respondent spoke about integrating the material into their cross-department relationships: i had a positive experience. i most appreciated the safe space during the two-day training to learn and challenge each other. i have continued to build on those relationships throughout the year seeking consult, offer consult, etc. i really liked that the alliance we formed was across campuses, departments, roles, etc. bailly-mompoint et al./anti_racism working group 867 another commented that the group set up important processes for engaging with other parts of campus: we had a great training, and set up a system for sending trainers throughout campus. i was particularly impressed with the social work department's faculty and involvement. everyone however was open and willing to do this important difficult work. the ability to leave the workshop with concrete strategies and an action plan empowered the facilitators and may have additionally alleviated some of the distress that came with learning about the impact of racism. the inclusion of discussion action plans and concrete strategies also fits with the call-to-action component of anti-racism education described in the literature. theme 3: facilitators thought they developed skills, techniques, abilities to effectively facilitate discussions about race. despite experiences of discomfort, facilitators did indicate significant gains as a result of participating in the workshop, particularly through learning new skills and techniques for discussing race. respondents reported feeling they left the workshop with ways to speak about racism and power and privilege. one facilitator indicated that this commitment to discussion created greater capability for taking action, especially in the classroom and department meetings with faculty: it was amazing to be a part of a group of others working towards a common goal. it felt limited at times to make time and to not be more engaged or disjointed. but the involvement helped me to bring ideas up in my classroom and in my department meetings. learning working definitions of terms like race, racism, and prejudice and intentionally creating time for discussions left facilitators feeling empowered. intentionally making time for discussion creates a more inclusive campus community through increased faculty, staff, and student action. facilitators also shared that they learned new skills and ideas during the monthly and quarterly meetings to address racism and to collectively brainstorm and troubleshoot when there was a challenging situation either with a student, trainee, coworker, or policy. integration of findings we found areas of convergence between the reflections provided by participants and facilitators of the arwg. notably, we found that both facilitators and participants indicated an increased awareness of and ability to engage in productive discussions related to race, ethnicity, bias, power, and privilege. both groups, facilitators, and participants, thought they developed skills and techniques to effectively facilitate discussions about race. participants found that they could develop skills as evidenced by themes 3 and 4 (leadership development: overcoming the structure of domination by cultivating leadership and independence; and accountability: overcoming domination by multi-directional advances in social work, summer 2021, 21(2/3) 868 accountability) in phase 1. facilitators also thought they could engage productively with a new skill set to create anti-racist discussions in the classrooms and faculty meetings as evidenced by themes 1 and 3 (increased awareness and ability and developing skills to facilitate discussions on race) in phase 2. there were also areas of divergence between facilitators and participant feedback. one point of divergence between facilitators and participants was in their reflections on future anti-racist action. whereas workshop participants focused on individual actions towards anti-racist action (e.g., confronting racist comments or jokes made by peers, acting at a local protest, working on a new anti-racist policy or committee), facilitators had a more expansive view of thinking about cross-discipline, cross-campus professional relationships that could move forward anti-racist efforts at the university. this should be interpreted considering the positions of these two respective groups. facilitators tended to be employed at the university in faculty and staff roles and this featured prominently in their reflections, while workshop participants tended to be undergraduate and graduate students at the university. getting the perspective of both groups highlighted the benefits of this qualitative mixed methods evaluation approach. discussion as noted within the review of literature, the american academy of social work & social welfare’s grand challenges for social work include a call for creating a just society by eliminating racism in a way that focuses on culturally responsive prevention and interventions (grand challenges of social work, 2020). this call, and the action of arwg, is bolstered by the tenets of crt, which guide work in anti-racism through the lens of intersectionality, acknowledging that our socialization into racism, sexism, and classism naturally inhibits our ability to meet such challenges without intentionality (crenshaw, 2003). analysis of the data from both participants and facilitators during the inaugural year of the arwg would indicate that this call is being addressed and that we are headed in the right direction in meeting this challenge. the following discussion points elaborate on the working groups’ contributions to the anti-racism movement. in its inaugural year, arwg accomplished many tasks. it trained its first cohort of facilitators, held multiple workshops across campuses, developed and refined training materials, and began the process of collecting data for program analysis which is a central element of mcod to move towards more inclusion and integration to redefine our university (jackson, 2006). utilizing the mcod continuum, arwg members reviewed the placement of the larger institution as well as the group’s placement, assessing a developmental lag between the latter and the former (jackson, 2006). this difference was expected and is in line with mcod’s bottom-up approach to organizational change (hyde, 2017). we found areas of convergence between the reflections provided by participants and facilitators of the arwg. notably, we found that both facilitators and participants indicated an increased awareness of and ability to engage in productive discussions through the frame of crt related to race, ethnicity, history, experience, bias, power, and privilege. both groups, facilitators and participants, thought they developed skills and techniques to effectively facilitate discussions about race. bailly-mompoint et al./anti_racism working group 869 there were also areas of divergence between facilitators and participant feedback. one point of divergence between facilitators and participants was in their reflections on future anti-racist action. workshop participants focused on individual anti-racist action and facilitators focused on institutional anti-racist efforts. this should be interpreted considering the positions of these two respective groups. facilitators tended to be employed at the university in faculty and staff roles and this featured prominently in their reflections, while workshop participants tended to be undergraduate and graduate students at the university. getting the perspective of both groups highlighted the benefits of this qualitative mixed-methods approach, but these divergent responses also signaled the power dynamics at play. workshop participants, including student workers and graduate student administrators, bring valuable perspectives that can aid future antiracist collaborations beyond the micro level. moving forward, mcod’s consciousness raising training philosophy will be used to support workshop facilitators to include more mezzo and macro action-oriented content in their training and dialogue opportunities to better connect theory to practice, which is characteristic of later stages of mcod growth (jackson, 2006). evidenced in the results of our preliminary evaluations is a shared feeling that spaces are needed to talk about race, create shared understanding about history and the language we use to discuss racial injustice, and coordinate action. a key purpose of arwg is pushing beyond the boundaries of a typical diversity training. attending a workshop does not certify that a person is now anti-racist, a common challenge presented by one-off trainings (bezrukova et al., 2016). this commitment to action and next steps promotes the idea that none of us are ever “done” with anti-racism work. these ideas resonated with participants who left workshops eager to act and be held accountable in their anti-racist laboring. student enthusiasm for action and requests for opportunities to become leaders has expanded arwg’s focus for the future. students are especially motivated to engage with other students in discussions of race and inequity on campus. there is significant research to suggest that peer to peer dialogue about racial injustice can have a long-lasting impact on students’ decisions to become more actively involved in anti-racist action (alimo, 2012; nagda et al., 1999; rodriguez et al., 2018). this also further supports our efforts at mcod bottom-up activism and change (hyde, 2017). this inaugural year has assisted us in preparing for and working through disagreements, acknowledging that to grow, we must lean into discomfort and provide everyone the opportunity to work through intentional and unintentional contributions and reactions. limitations some limitations were noted for this study. this paper and findings take place during an inaugural and unusually challenging year of a group at one university. the global pandemic required a massive shift in university policies and practices, as staff, faculty, and students moved from primarily face to face instruction to remote learning. this impacted the ability for group members to stay involved and to be as focused on the work of the group while faced with other presenting challenges and demands such as work, homeschooling, and caregiving for both children and sick family members. our advances in social work, summer 2021, 21(2/3) 870 positionality as both white and bipoc identifying members who self-selected to engage in this working group may have impacted the study. while we are intentionally an interdisciplinary group, almost a quarter of us, including our lead facilitator and trainer, are social workers, which creates a focus on social work values and shared language. our second cohort has a diverse group across various roles and identities of staff, faculty, and students. one aspect of evaluation that has not yet matured in the inaugural year is an assessment of whether policies or practices within departments or student groups have shifted based on attendance in workshops or other arwg involvement. to meet our group’s founding goals, these policy and practice impacts must be assessed by the arwg in subsequent years. the implications of anti-racism work point to the interdisciplinary and macro, mezzo, and micro dimensions of social work as critical elements for social change. implications for social work the implications of this anti-racist work magnify the need for social work professional leadership in encouraging interdisciplinarity. moving forward, one goal is that through organizing and learning with faculty, staff, students, and citizens in the communities where we work, we will be better prepared to listen and speak to address and redress racism. this anti-racist work involves examining organizational and institutional policies that are rooted in the logics of the neoliberal university and other forces which obstruct access to the policy development process. the themes identified in the results section provide guidance for new workshop design and development, but also in the continuing evaluation of curricula and recruitment across disciplines, departments, and student groups. social work educators collaborating with faculty of various disciplines should advocate for curricula that include literature by diverse researchers and identify mentors, role models, and resources from diverse cultural groups. curriculum design should incorporate ways faculty may enhance their teaching to be flexible and inclusive, limit marginalizing or shaming students with different languages and abilities, and promote critical pedagogy and self-reflection. opportunities for students to share feedback should be increased. faculty development efforts and departmental protocols must include underrepresented faculty members in planning and decisionmaking. at west chester, this work builds on the institution’s strategic plan to become more accountable to the needs and strengths of students across demographic sectors. conclusion institutional oppression hides in the wicked plasticity of race, yet this past year clearly showed its indelible effects. we witnessed higher covid-19 mortality rates among minoritized racial and ethnic groups (centers for disease control and prevention, 2020), especially black and indigenous communities. we saw on display the circadian brutality of a racist criminal justice system in the murders of george floyd and breonna taylor, among many others. clearly, there is an urgent need for anti-racism work on a larger scale in our institutions. these recent events have shocked our university, like many others, into prioritizing engagement in anti-racism work (nwonka, 2020; sobo et al., 2020). we were approached multiple times in the summer 2020 by various departments and leadership bailly-mompoint et al./anti_racism working group 871 teams to partner together on training and programming, which led to a reexamination and redefining of not only our group’s goals but our capacity for sustainability and outreach. arwg has received funding from west chester’s diversity forum grant for a second year to continue our work to build a racially conscious and self-reflective community. we are working to broaden the group, inviting individuals from departments and university anti-oppression organizations who have not yet participated in the program and who bring unique strengths to arwg work. we are also building online training modules to support our work as we train with cohort 2 and add updated materials to meet the growing needs of our changing university environment. during the 2020-2021 year, arwg is offering a virtual workshop series which coincides with the university’s shift to remote learning during the pandemic. additionally, our work will continue to support our satellite campuses, as they can be omitted from important programming opportunities without purposeful actions of inclusion (groenwald, 2018). we continue to address the campus’s racial climate survey results and host a virtual workshop for faculty to increase opportunities for affirmation and anti-racist pedagogy in their classrooms. additionally, we will host a workshop showcasing faculty who have audited their classroom examples, readings, and syllabi to antiracist principles. looking to the future and our third cohort, we will seek to enhance and expand the arwg community within and outside of west chester’s “walls.” we hope to expand arwg by including community members who serve in supervisory roles for west chester students completing internships and service-learning projects. in addition 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(2020). retention and graduation rates for first time, full‐time, first year degree‐seeking student cohorts‐‐by race/ethnicity. https://www.wcupa.edu/viceprovost/institutionalresearch/documents/factbook%202 020.pdf author note: address correspondence to brie radis, department of undergraduate social work, west chester university of pennsylvania, west chester, pa, 19380. email: bradis@wcupa.edu https://doi.org/10.1016/j.jadohealth.2020.06.017 https://doi.org/10.1080/13613324.2016.1260227 https://doi.org/10.1086/690563 https://scholarworks.smith.edu/cgi/viewcontent.cgi?article=2347&context=theses https://doi.org/10.1080/13562517.2017.1359158 https://www.wcupa.edu/viceprovost/institutionalresearch/documents/factbook%202020.pdf https://www.wcupa.edu/viceprovost/institutionalresearch/documents/factbook%202020.pdf mailto:alex.redcay@millersville ______________ younghee lim phd, msw, is an associate professor, department of social work, university of mississippi, university, ms 38677. mi-youn yang, phd, msw, is an assistant professor, and elaine m. maccio, phd, msw, is an associate professor, at the school of social work, louisiana state university, baton rouge, la 70803; trey bickham, phd, msw, is a human resources coordinator, college of engineering, baton rouge, la 70803. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1187-1205, doi: 10.18060/22414 this work is licensed under a creative commons attribution 4.0 international license. engaging msw students in policy practice: evaluation of service-learning outcomes younghee lim mi-youn yang elaine m. maccio trey bickham abstract: social policy courses are a staple in social work curricula, particularly in graduate-level social work education. indeed, policy practice is among the nine social work competencies stipulated by the council on social work education. the purpose of the present study was to measure the effectiveness of service-learning compared to traditional-learning methods in achieving civic and course-learning outcomes. this study compared a purposive sample of 89 graduate-level social work students enrolled in advanced social policy courses (30 in a service-learning section, and 59 in traditional sections). employing a quasi-experimental design, we found that service-learning is associated with better civic and course-learning outcomes. service-learning may be used to enhance policy practice efficacy based on knowledge, skills, values, and competence. keywords: policy practice efficacy; service-learning outcomes; course-learning outcomes; competence social policy courses are a staple in graduate-level social work curricula. policy practice is an essential field of social work practice that can be used to address the dynamic nature of 12 pressing social issues, termed grand challenges (uehara et al., 2013). policy practice is included among the nine social work competencies stipulated by the council on social work education (cswe, 2015), the accrediting body of the profession. in the context of an uncertain and complex sociopolitical environment, the significance and need for competent social workers in policy practice has never been greater. however, policy courses are among those in which students have the least interest (anderson & harris, 2005; henman, 2012). social policy instructors must therefore find new and effective ways to hold students’ attention and foster their curiosity and interest in the subject matter. team-based learning (macke, taylor, & taylor, 2013), films (anderson, langer, furman, & bender, 2005), and tablet computers (young, 2014) have all been employed to promote student engagement in policy courses. another promising approach is the use of service-learning methods to engage master of social work (msw) students in social policy course material. https://creativecommons.org/licenses/by/4.0/ lim et al./engaging msw students 1188 literature review/background service-learning first introduced in the 1960s (stanton, giles, & cruz, 1999), service-learning is a form of school-based community service in which students engage with community members for mutual benefit. service-learning promotes civic engagement by demonstrating the impact students can have on their communities simply by becoming involved in meaningful ways. according to bringle and hatcher (1995), service-learning is most commonly defined as a course-based, credit-bearing educational experience in which students (a) participate in an organized service activity that meets identified community needs and (b) reflect on the service activity in such a way as to gain further understanding of course content, a broader appreciation of the discipline, and an enhanced sense of civic responsibility. (p. 112) to reiterate, the key features of service-learning are the community-identified need, which becomes the service, and the meaningful reflection in which students engage during and/or after the experience. service-learning is implemented in classrooms from kindergarten through college and is appropriate for learners of any age (kielsmeier, scales, roehlkepartain, & neal, 2004; lu & lambright, 2010). community partners can come from within or outside the immediate area (karasik & wallingford, 2007) and can come from the non-profit, forprofit, and public sectors (blouin & perry, 2009). service-learning is suitable for a variety of disciplines and has been applied in accounting, biology, environmental studies, nursing, psychology, and sociology (campus compact, n.d.). service-learning generally results in one of two end products: services or deliverables. services are activities that are typically performed on-location; performing the service is the end product in and of itself. examples of services are cleaning/restoration/beautification projects, reading/literacy/tutoring programs, and community organizing. deliverables are tangible products that may be completed on-site or off and are given to or left with the community partner. examples of deliverables are construction projects, written reports or white papers, and brochures/pamphlets/resource lists. service-learning in social work service-learning, with its philosophy of helping communities in need, finds itself at home in social work, whose emphasis is on serving vulnerable populations (byers & gray, 2012; cipolle, 2010; peterson, 2009). that the two are so close in their end goal may lead some faculty, and perhaps students as well, skeptical of the need for service-learning in social work and leaves them unable to differentiate the two (cronley, madden, davis, & prebele, 2014; madden, davis, & cronley, 2014). in addition to being complementary, however, there are, indeed, differences. advances in social work, fall 2018, 18(4) 1189 service-learning, the most common type of experiential learning (moore, 2010), is similar to other approaches such as cooperative education (i.e., paid work experience that coincides or alternates with academic coursework) and internships (tied to academic institutions; cooperative education and internship association, n.d.). however, service learning embodies several key differences. primary among them is their purpose. social work field education prepares students specifically for the profession and is guided by core competencies outlined by cswe. the purpose of field education is to develop these competencies through direct or indirect social work practice in a professional setting under the supervision of a licensed social worker. moreover, unlike service-learning, in which the service is driven by the community-identified need, social work field education is driven by the student’s need to gain professional experience. although the internship setting may benefit from the work performed by the student, that benefit is a byproduct and not the sole intent of the student’s placement. secondary is the academic credit awarded for the student’s participation in and successful completion of the activity. in servicelearning, students earn credit for a course in which service-learning is one part of the learning experience, in addition to, typically, classroom lecture, assigned reading, and graded assignments. in field education, students earn credit for the experience as a whole. service-learning has been used at both the undergraduate and graduate levels in social work education. gerontology (ames & diepstra, 2006; gutheil, chernesky, & sherratt, 2006), poverty (forte, 1997), research methods and statistics (wells, 2006), and special populations, such as burn survivors (williams, king, & koob, 2002), are just some of the topics in social work curricula taught using service-learning. social policy is among them, although to a lesser degree than other courses (anderson & harris, 2005; lim, maccio, bickham, & dabney, 2017) and with less known about this merger (droppa, 2007a). service-learning in social policy curriculum along with research methods, social policy courses are generally the least liked among social work students. students find the material dry and uninteresting (gordon, 1994), a perception that may interfere with learning. moreover, social work students who pursue direct-practice (i.e., microor mezzo-level) tracks find little relevance of macro-level social policy (kilbane, freire, hong, & pryce, 2014). however, policy is crucial to understand at any level of practice and is thus prescribed by cswe’s (2015) educational policy and accreditation standards. this requirement in the face of student disinterest and reluctance, then, places social work educators in an unenviable position. in an attempt to make the course more palatable and thus foster learning and acquisition of the material, instructors must find creative ways to expose students to the material and keep them engaged. servicelearning is an effective means of accomplishing that goal. there is some evidence of successful implementation of service-learning in social policy curriculum. for example, rocha (2000) compared experiential learning, including service-learning, to traditional learning on the variables of policy-related values, competency, and activity levels. the sample was comprised of 72 recent msw graduates, 39 (54.2%) of whom had taken a social policy course using an experiential learning method (30 using service-learning and 9 using another method) and 33 (45.8%) of whom had taken policy via traditional classroom-based instruction (rocha, 2000). students in the lim et al./engaging msw students 1190 experiential learning condition worked in small groups for several hours a week both inside and outside of the classroom (rocha, 2000), engaging in “planning change at the organization, community, and state levels; policy development and implementation of projects; and increasing public awareness of political issues” (rocha, 2000, p. 56). each of the three outcome variables—value of policy-related tasks, competency of performing policy-related tasks, and participation in political activity—was comprised of 8 indicators, each measured on a 5-point likert-type scale. data were analyzed using t-tests and multiple regression. findings revealed no significant differences between the experiential and traditional-learning groups on social policy-related values; however, students in the experiential learning group were more likely to perceive themselves as competent in the area of policy, which was associated with engaging in policy-related activities after graduation. service-learning thus assists social work educators in meeting the course goal of increasing competency in policy practice (rocha, 2000). service-learning not only increases students’ social policy comprehension (droppa, 2007b) but also improves their attitudes toward social policy (anderson, 2006; sather, carlson, & weitz, 2007). to the former point, 19 students enrolled in an undergraduate social policy course completed 16 different projects with 14 organizations (droppa, 2007b). although the research question was not clearly defined, the author’s goals were 1) for students to choose a partner organization from the community, 2) for students to “relate in a more intensive fashion to a community organization or entity” (droppa, 2007b, p. 86), and 3) for students to have “gained more knowledge, skills, and confidence in their ability to engage in policy practice and policy advocacy” (p. 86). data specific to the third goal, the most salient of the three, were captured through a focus group. the author used no formal method of qualitative analysis; however, according to the author, the students reported that the course and its infused policy project gave them a better understanding of course content, various levels of government, and advocacy; made them more marketable; and encouraged them to become involved in various policy activities. similarly, in a course involving a cultural immersion program, service-learning facilitated an understanding of the link between policy and advocacy (mercier, harold, johnson, & pond, 2016). twenty-eight undergraduate social work/pre-social work students over a period of three years participated in a week-long camp for lgbt-parent families. after working closely with these families, eight (29%) of those students remarked on the role that policy and advocacy play in social work practice. in an effort to promote positive attitudes toward social policy, anderson (2006), through an extensive literature review, makes the case for service-learning and communitybased research as means to better prepare students for policy analysis, promote civic engagement, and improve their collaboration with community members. sather et al. (2007) integrated service-learning into a research methods course and a macro practice course for senior undergraduates and came to a similar conclusion. the two courses, taught during the same semester and containing the same students, shared one service-learning project. although unclear how the data were collected, after engaging all semester with a homeless and housing services agency, 75% of the 24 students reported an increased interest in policy. advances in social work, fall 2018, 18(4) 1191 service-learning is not without its limitations, however. some colleges and universities fail, through various means, to support the community engagement of their faculty, despite touting institutional missions and values to the contrary (jaeger & thornton, 2006). research-intensive universities in particular may lack incentives and rewards for faculty who engage in service-learning and similar activities. these institutions prioritize research over teaching and service, two areas that service-learning taps into. in fact, engaging in service-learning may negatively impact faculty at institutions that offer little to no salary or tenure and promotion rewards for community engagement activities, leaving tenured faculty to discourage their tenure-track colleagues from such pursuits (jaeger & thornton, 2006). these factors and others were borne out in a study conducted by abes, jackson, and jones (2002) focused on service-learning motivators and deterrents. more than 500 (n = 518) service-learning and non-service-learning faculty in various disciplines from 29 institutions of higher education returned a survey regarding factors that motivate and/or deter them from engaging in service-learning. participants cited motivators such as encouragement from institutional administrators, the support they received in the form of advice from colleagues, and student learning outcomes. regarding deterrents, servicelearning faculty cited “time, logistics, and funding; student and community outcomes; reward structure; and comfort with ability to effectively use service-learning” (abes et al., 2002, p. 10) as factors that might make them less likely to continue using service-learning. among non-service-learning faculty, logistical challenges, lack of skill in using servicelearning, the perception of service-learning’s irrelevance, and the lack of time to prepare for service-learning courses served as the greatest deterrents. social work faculty report many of these same challenges. madden et al. (2014) surveyed 208 social work faculty and 68 criminal justice faculty on, among other variables, perceived barriers to using service-learning. social work faculty cited “lack of faculty reward” (73.1%), “logistically unfeasible” (71.2%), “unfamiliarity with the community” (69.7%), and “lack of teaching preparation time” (65.9%) as the top four barriers to implementing service-learning. despite these challenges, service-learning has repeatedly demonstrated positive outcomes in student learning across a number of domains in various undergraduate and graduate disciplines. this paper adds to the literature on the infusion of service-learning in graduate-level social policy courses in social work education. the present study builds on rocha’s (2000) work; however, it is different from rocha’s in several important regards. first, this study evaluated the effectiveness of service-learning pedagogy exclusively as compared to traditional-learning methods, whereas rocha evaluated the effectiveness of experiential learning methods, which included service-learning rather than traditional-learning methods. secondly, this study uniquely measured civic outcomes as well as course-learning outcomes that comprised both knowledge-oriented proficiency and advocacy(action-) oriented proficiency, whereas rocha measured three outcomes including value of policyrelated tasks, competency of performing policy-related tasks, and actual participation in political activity. thirdly, this study used a comparison group consisting of students who opted to enroll in the traditional (i.e., non-service-learning) course during the same semester (spring 2015). students in rocha’s comparison group were in two other policy lim et al./engaging msw students 1192 courses in another substantive area, whereas her service-learning course focused on child and family policy at five different times from spring 1995 to summer 1996. fourthly, this study administered a pretest at the beginning of the semester to identify any differences between the two groups in terms of values and attitudes toward community, social responsibility, and civic awareness before taking the advanced social policy course. rocha did not administer a pretest survey, which makes it impossible to gauge whether students who had opted to take the experiential-learning course would have been equivalent to their counterparts who had opted to take the traditional-learning course. lastly, this study measured the preand post-test differences between two groups to ascertain whether the service-learning approach produced a greater difference in both civic and course-learning outcomes, whereas rocha administered only a posttest survey after students had graduated. it is possible that factors other than the type of policy course taken could have affected post-graduation differences in values and competency in policy-related tasks and political activities. about the course three sections of an advanced social policy course were offered to advanced-year msw students: two traditional classroom-based sections and one service-learning section. service-learning was an obligatory rather than voluntary component of that section, and students were allowed to self-select into the section of their choice. the service-learning project was service in nature, namely serving lowand moderate-income individuals with tax preparation assistance and educating human service workers and clients at two social service agencies about the benefits of earned income tax credit (eitc) and volunteer income tax assistance (vita) as well as potential disadvantages of using refund anticipation loans and commercial tax preparers for the 2014 tax filing season. in tandem with the service-learning projects, course assignments included writing a paper analyzing state eitc policy to effect positive change. the purpose of this analytic paper was to “aid lawmakers who sponsor a bill that increases the state earned income tax credit (eitc) from the current rate of 3.5% to an increased rate of 7% (of the federal eitc amounts) during the 2015 legislative session” (lim, 2015, p. 6). additionally, in order to encourage critical reflection on their service-learning activities, the students were asked to compose five reflective journal entries to document their service-learning experiences throughout the semester. reflection topics included understanding the social problem of poverty; the working poor and the decline of the middle class; the contribution and limitations of the federal eitc, state eitc, and vita in reducing poverty; the rise of a fringe economy such as commercial tax preparation and refund anticipation loans (rals); and the implications their services have for the aforementioned social/community issues. together, the ultimate goal of this service-learning course was to learn and craft the best policy practices to present to the community partners and stakeholders for policy advocacy. once the service-learning project was selected and community partners were on board with the proposed project, the instructor of the course submitted a study proposal to the university’s institutional review board (irb) about a month prior to the spring 2015 semester. the irb approved the study proposal to measure the effectiveness of engaging msw students in policy practice that involves students as researchers, educators, and advances in social work, fall 2018, 18(4) 1193 practitioners in the lives of the individual clients, social service agencies, and the broader community. after reviewing the project details and signing consent forms, students were asked to voluntarily complete preand post-surveys. earned income tax credit (eitc). eitc is a tax credit for lowand moderateincome earners based on annual income, number of dependents, and filing status. for example, using 2015 tax year figures, an unmarried individual with no dependents, making less than $14,820 per year, would qualify for a tax credit of $503. at a maximum, a married couple filing jointly, with three or more dependents, making less than $53,267, would qualify for a credit of $6,242 (u.s. internal revenue service, 2015a). despite the benefits and relative ease of claiming this credit, nearly a quarter (24.7%) of claimants do not. the southeast region of the u.s., of which louisiana is a part, was tied for second-lowest eitc participation rates in 2005 (plueger, 2009). the failure to claim the credit may be due to taxpayers’ lack of awareness and understanding of and complexity surrounding eitc (bhargava & manoli, 2015). volunteer income tax assistance (vita). tax return preparation assistance is available free of charge for those who qualify at sites scattered throughout communities nationwide and staffed by volunteers certified by the united states internal revenue service. eligible participants are those “who generally make $54,000 or less, persons with disabilities, and limited english-speaking taxpayers” (u.s. internal revenue service, 2015b, para. 1). over one-quarter (25.5%) of baton rouge residents/residents in the city in which the university is located live in poverty, a rate far higher than that of the us (14.8%), state (19.8%), and parish (18.4%; u.s. census bureau, n.d.). this results in a considerable number of people eligible for vita. service-learning projects. a local association of nonprofit organizations, charity coalition, and credit union served as the community partners and identified the underutilization of vita sites as a concern within the community. therefore, the students in the service-learning section (1) became vita-certified volunteers after completing an 8-hour united way tax assistance training; (2) served lowand moderate-income individuals with tax preparation assistance for at least 20 hours; and (3) educated human service workers, clients, and community partners at two social service agencies on the benefits of the eitc and vita. one of the most critical components of the service-learning pedagogy for students was the five written reflections on their experiences as well as class discussions throughout the semester about the tax assistance services they provided. on one saturday at the beginning of the semester, students attended an 8-hour training offered by united way to become vita-certified. in exchange, students were to provide at least 20 hours of assistance with tax filing to residents from lowand moderate-income households who stopped by vita sites. these sites were funded and operated by united way during the 2014 tax year (2015 calendar year) beginning in february and lasting through april 10th. students also approached two social service agencies to educate workers and clients about eitc and vita. at the close of the semester, students presented their experiences with vita training, tax assistance, and the vita and eitc education campaign, as well as research findings on state eitc to stakeholders (i.e., the three community partners). the research on state eitc was based on a request from community lim et al./engaging msw students 1194 partners so they could use that information to lobby for the state eitc expansion during the legislative session in upcoming years. method sample service-learning pedagogy was incorporated into a required advanced social policy course during the spring 2015 semester at louisiana state university. students voluntarily registered for one of three sections. service-learning projects were mandatory for those who were enrolled in the service-learning section. thirty-one msw students were enrolled in the service-learning section, while 67 were enrolled in two traditional-learning sections. the final sample included 89 students who completed both surveys (n=30 for the servicelearning section; n=59 for the traditional-learning sections). student outcomes in the service-learning section were compared to those in the traditional-learning sections. instrumentation this study assessed two types of student outcomes: civic outcomes and course-learning outcomes. the virginia tech service-learning participant profile (virginia tech survey; see roemer [2000] for the instrument) served as the survey instrument to measure the five civic outcomes of personal social responsibility, importance of community service, civic awareness, self-oriented motives, and service-oriented motives (parker-gwin & mabry, 1998). personal social responsibility was assessed using a composite score of five items that measured the value that students placed on advocating for improving social justice issues that adversely impact vulnerable populations. the importance of community service was assessed using a composite score of five items that measured the value that students placed on community volunteerism. the civic awareness variable consisted of a composite score of seven items that measured the students’ self-evaluations of their competency in advocating for change for social justice issues. the self-oriented motives and serviceoriented motives consisted of composite scores of four and three items, respectively, that measured the students’ selfand service-oriented reasons for participating in community service and/or volunteer activities. the students could select from four response options for personal social responsibility (from 1 [not important] to 4 [essential]), five response options for importance of community service (from 1 [strongly disagree] to 5 [strongly agree]), five response options for civic awareness (from 1 [lowest] to 5 [highest]), and three response options for both self-oriented motives and service-oriented motives (from 1 [not important] to 3 [very important]). thus, higher composite scores indicate higher degrees of each dependent variable of interest (parker-gwin & mabry, 1998; roemer, 2000). cronbach’s alpha reliability coefficients ranged between 0.74 and 0.77 for the personal social responsibility variable, 0.77 and 0.83 for the importance of community service variable, 0.71 and 0.72 for the civic awareness variable, 0.68 and 0.79 for the self-oriented motives variable, and 0.77 and 0.80 for the service-oriented motives variable, suggesting that the virginia tech survey reliably measures these five dependent variables. advances in social work, fall 2018, 18(4) 1195 in addition to the civic outcomes, 12 learning objectives on the advanced social policy course syllabus were used to measure two dimensions of course-learning outcomes— knowledge-oriented proficiency and advocacy(action-) oriented proficiency. knowledgeoriented proficiency consisted of a summed composite score of six learning objectives such as “understanding dimensions and dynamics of social welfare policy,” while advocacy (action-) oriented proficiency consisted of a summed composite score of six learning objectives such as “understand and demonstrate policy practice skills.” the students could select from nine response options for each learning objective from 1 (extremely incompetent) to 9 (extremely competent), with the higher composite scores indicating higher competency levels. cronbach's alpha reliability coefficients were 0.91 for knowledge-oriented proficiency and 0.93 for advocacy(action-) oriented proficiency. the independent variable was dichotomous and indicated whether a student was enrolled in the service-learning class (coded as 1) or a traditional-learning class (coded as 0). the students’ participation in the study was voluntary, and their responses were collected confidentially at the beginning and end of the semester. to assure the voluntary nature and confidentiality of survey participation, each survey was numbered on the back according to the order of the students’ appearance on the class roster, for matching purposes only. additionally, students were asked not to write any identifying information on the surveys. data analysis a pretest-posttest comparison design was used to explore the impact of taking a service-learning course compared to taking traditional-learning courses. to compare group differences in demographic characteristics between students in the service-learning and traditional-learning courses, a chi-square test for nominal variables (i.e., race and gender) and a t-test for the continuous variable (i.e., age) were used. paired t-tests were used to compare pretest mean scores to posttest mean scores in civic and course-learning outcomes for students in the two course formats. in addition, independent samples t-tests were employed to compare mean differences in the civic and course-learning outcomes between students in the two course formats. although independent samples t-tests results show whether there are statistically significant mean differences between two groups, it does not tell the magnitude of a treatment effect (i.e., taking the service-learning class for this study). to test effect sizes (es) of taking a service-learning class compared to taking traditionallearning classes in the outcomes, cohen's (1988) d tests were utilized: es (𝑑𝑑) = (experimental group mean) – (comparison group mean) (pooled standard deviation) according to cohen (1988), d ≥ .2 is considered a small effect size, d ≥. 5 is a medium effect size, and d ≥ .8 is a large effect size. results table 1 displays descriptive statistics for the sample by course format. a majority of the students were white (77.3%) and female (87.5%), with an average age of 26.7 (sd = lim et al./engaging msw students 1196 6.92) years. the service-learning students were more likely to be white, female, and slightly younger than the traditional-learning students. however, chi-square and t-test result showed no significant group differences at the .05 level. table 1. student descriptive statistics by course type (n=89) service learning (n=30) traditional (n=59) all (n=89) race (%) white 80.0% 75.9% 77.3% black 13.3% 20.7% 18.2% other 6.7% 3.5% 4.6% female (%) 90.0% 86.2% 87.5% age (years) mean 26.0 27.1 26.7 sd 6.2 7.3 6.9 range 22—53 21—63 21—63 note. chi-square tests and a t-test showed no statistically significant difference at the 0.05 level between students in the service-learning course and students in the traditional course. table 2 shows the independent samples t-test results, which compare the mean differences in the civic outcomes between the service-learning and traditional-learning courses at pretest. although the mean scores for each of the five civic outcomes for the service-learning class were slightly higher than the scores for the traditional-learning classes, the results indicated that before taking the service-learning class, the servicelearning students did not differ significantly at the .05 level from the traditional-learning students. table 2. differences in civic outcomes between service-learning course and traditional course at pretest: independent samples t-test civic outcomes service learning (n=30) traditional (n=59) t m sd m sd personal social responsibility 17.93 1.62 17.42 2.08 -1.27 importance of community service 21.50 2.67 21.15 2.54 -0.59 civic awareness 27.00 2.85 26.88 2.91 -0.18 self-oriented motives 10.33 1.63 10.51 1.56 0.49 service-oriented motives 8.63 0.85 8.47 0.90 -0.82 note. no statistical significance was found at the 0.05 level. only civic outcomes are reported here because course-learning outcomes were measured only at posttest. table 3 reports the paired t-test results, which compare the mean differences in the five civic outcomes before and after taking the advanced social policy course for students in the service-learning and traditional courses. the service-learning students showed advances in social work, fall 2018, 18(4) 1197 significant increases in three of the civic outcomes: personal social responsibility, t(29) = -2.80, p = 0.005, importance of community service, t(29) = -3.44, p <.001, and civic awareness, t(29) = -4.63, p < 0.001. the traditional-learning students showed significant increases in two of the civic outcomes: importance of community service, t(58) = -2.07, p = 0.021, and civic awareness, t(58) = -3.17, p = 0.001. the results indicated that taking an advanced social policy class, regardless of the type of course, significantly increased students’ perceptions of the importance of community service and civic awareness. however, the increase in the two civic outcomes (importance of community service and civic awareness) was greater for students in the service-learning course. furthermore, a significant increase in students’ personal social responsibility between pretest and posttest was found only in the service-learning course. table 3. differences in civic outcomes between pretest and posttest for both servicelearning course and traditional course: paired sample t-test civic outcomes service learning (n=30) traditional (n=59) m (sd) m (sd) pre-test post-test t pre-test post-test t personal social responsibility 17.9 (1.62) 18.7 (1.17) -2.80** 17.4 (2.08) 17.9 (2.15) -1.48 importance of community service 21.5 (2.67) 23.0 (1.93) -3.44*** 21.2 (2.54) 22.1 (3.13) -2.07* civic awareness 27.0 (2.85) 29.1 (2.54) -4.63*** 26.9 (2.91) 28.4 (3.10) -3.17** self-oriented motives 10.3 (1.63) 10.6 (1.67) -0.95 10.5 (1.56) 10.8 (1.48) -1.43 service-oriented motives 8.6 (0.85) 8.9 (0.40) -1.49 8.5 (0.9) 8.6 (0.78) -1.47 note. *p<0.05. **p<.01. ***p<.001. only civic outcomes are reported here because course-learning outcomes were measured only at posttest. table 4 presents the independent samples t-test results, which compared the mean differences in the five types of civic outcomes and two types of course-learning outcomes between the service-learning class and the traditional-learning classes at posttest. there were no significant differences in civic awareness and self-oriented motives between the two groups. upon completion of the class, however, students in the service-learning class showed higher levels of personal social responsibility, t(86.47) = -2.47, p = 0.007, importance of community service, t(83.65) = -1.70, p = 0.047, and service-oriented motives t(86.95) = -1.91, p = 0.030, compared to students in the traditional-learning classes. regarding the degree of effectiveness in civic outcomes of the service-learning class, cohen’s d es results showed medium effect sizes for personal social responsibility (d = 0.50), importance of community service (d = 0.35), and service-oriented motives (d = 0.39). lim et al./engaging msw students 1198 table 4. mean differences and effect sizes in civic and course-learning outcomes between service-learning course and traditional course at posttest: independent samples t-test civic and course-learning outcomes m (sd) t cohen’s d es service learning (n=30) traditional (n=59) civic outcomes personal social responsibility 18.73 (1.17) 17.86 (2.15) -2.47 ** 0.50 importance of community service 23 (1.93) 22.08 (3.13) -1.70 * 0.35 civic awareness 29.1 (2.54) 28.39 (3.10) -1.16 0.25 self-oriented motives 10.63 (1.67) 10.83 (1.48) -0.55 0.13 service-oriented motives 8.9 (0.40) 8.66 (0.78) -1.91* 0.39 course-learning outcomes knowledge-oriented 44.97 (0.76) 42.62 (0.76) -2.18* 3.09 advocacy (action)-oriented 46.03 (0.64) 42.34 (0.82) -3.55*** 5.02 note. *p<0.05. **p<.01. ***p<.001. in addition, students in the service-learning section showed significantly higher average scores on course-learning outcomes than students in the traditional-learning sections including both knowledge-oriented, t(77.52)= -2.18, p = 0.016, and advocacy (action-) oriented, t(86.05) = -3.55, p < 0.001 outcomes. cohen's d results showed large effect sizes on both civic outcomes: knowledge-oriented (d = 3.09) and advocacy(action-) oriented (d = 5.02). discussion the purpose of this study was to measure the effectiveness of service-learning compared to a traditional-learning methods in an advanced social policy msw course. the study measured five civic outcomes and two course-learning outcomes. this study demonstrated the effectiveness of service-learning in enhancing students’ responsiveness to social problems, human rights, and social and economic justice issues. moreover, the service-learning version of the course boosted knowledgeand advocacy(action-) oriented proficiency (i.e., the course-learning goals). while this study did not use randomization, the absence of group differences at pretest provides a relative level of confidence that the group differences at posttest were a result of the different course formats (i.e., the service-learning course compared to the traditional-learning courses). the data revealed that, regardless of course format (either service-learning or traditional-learning), upon completion of an advanced social policy class, students' sense of personal social responsibility, importance of community service, and civic awareness increased. this is good news for all social work educators, irrespective of their teaching methods, who desire to effectively teach advanced policy in a way that will instill in students civic-minded attitudes toward community and social problems that lend to postgraduation involvement (rocha, 2000). however, the pretest/posttest differences for these civic outcomes were more pronounced for students in the service-learning course. social work educators may want to adopt service-learning when teaching graduate-level policy advances in social work, fall 2018, 18(4) 1199 courses to achieve better civic outcomes. consistent with conceptual articles about the positive effect of service-learning on cultivating students’ personal social responsibility (anderson, 2006; bringle & hatcher, 1996), the present study found that students’ attitudes toward responsibility increased significantly (lim et al., 2017). students in the servicelearning class may have “gained a deeper understanding of the social problem” (anderson, 2006, p. 13) of taxpayers’ failing to claim the eitc and underutilizing the vita sites, having worked with eitc-eligible individuals and social work agencies that assist low and moderate-income families. with “a deeper commitment to social action and change” (anderson, 2006, p. 13), the students’ sense of civic awareness also increased significantly. then, they would have wanted to implement individual, agency, and policy responses that address the issues (jansson, 2013) of under-utilization of social policies and services that would have helped economically vulnerable families if they avail themselves of the policies/services. this increase likely stemmed from the service-learning project and the course content, bolstered by critical reflections and in-class discussions of those reflections throughout the semester. second, and probably the most notable finding of this study, is that service-learning methods are effective not only in enhancing several civic outcomes (specifically, personal social responsibility, importance of community service, and service-oriented motives) but also in enhancing course-learning outcomes (both knowledge-oriented and advocacy [action-] oriented proficiency). effect size also showed that the group differences between service-learning and traditional-learning courses in the course-learning objectives appeared more substantial for the service-learning course, implying that service-learning is more likely to meet educational goals. this presents a great opportunity and a challenge for the social work profession, as knowledge-based policy advocacy skills may be becoming more indispensable to address the dynamic nature of the 12 grand challenges (uehara et al., 2013). thirdly, the self-oriented motives score was lower for service-learning students at both pretest and posttest, which is not surprising given that service-learning students more than traditional-learning students tend to want to give back to the community and are thus service-oriented (lim et al., 2017). given that service-learning students’ self-oriented motives were non-significant in both paired sample and independent samples t-test results, social work educators may want to consider ways to better market to students the personal benefits of service-learning policy courses. it may be interesting to investigate the motivations of students who opt to take a service-learning class: is it unbecoming to choose to take a service-learning class when motivated by self-oriented interests? can self-oriented motives complement other types of motivations for taking a service-learning class? social work educators who implement service-learning in social policy courses need to explore the reasons why the decreases in the self-oriented motives among students were not significant, and possible ways to increase those motives, if desired. limitations the present study has a number of limitations. first, while it instituted preand posttest surveys with a comparison group (and the two groups did not statistically differ on several characteristics), the study could not control for other possible participant lim et al./engaging msw students 1200 characteristics and, thus, could not establish causality. using a sample from a larger theoretical population and more rigorous research designs (i.e., longitudinal studies, experimental designs) may pose difficulties from an administrative standpoint (lim et al., 2017). doing so, however, does promise a next step up for pedagogical research that measures the effectiveness of service-learning methods. second, to run a paired samples ttest, the instructor recorded identifiers of survey participants to match preand post-test surveys. while it was explained to students that participation was voluntary, students might have felt pressure to participate and/or to respond in certain ways due to the identifiable responses between pretest and posttest. third, the present study used purposive sampling, and thus, findings are not generalizable to all msw students. fourth, a few or several students could have been previously or simultaneously enrolled in more than one servicelearning course. some of the change in students’ attitudes could have been ascribed to the additive effect of being enrolled in multiple service-learning courses. on the other hand, these students could have become fatigued with labor-intensive service-learning courses and projects, producing counter-intuitive changes in the direction opposite of the expected improvement in the outcomes. implications and conclusion a unique contribution of the present study is its engagement of students in servicelearning social policy courses that encompassed working directly with community members, campaigning for eitc policy and vita programs in the community, and interacting with macro-level stakeholders. this study demonstrates that service-learning fosters a sense of personal social responsibility, importance of community service, and civic awareness. moreover, service-learning in social policy courses is more effective than traditional methods in helping students increase both knowledgeand advocacy(action-) oriented social policy course goals. professional values and attitudes toward social personal responsibility and community services influence not only social workers’ perceptions of policy practice but also their actual involvement in advocacy activities (weiss-gal & gal, 2008). as rocha (2000) attested, students in the experiential learning courses, including service-learning, rate themselves as more efficacious policy practitioners, and consequently are more likely to perform policy-related activities. participation in service-learning promotes a sense of personal social responsibility (i.e., personal value systems) and, subsequently, encourages students to become more involved in their communities (importance of community service and service-oriented motives) as informed citizens and motivated social work practitioners (anderson, 2006). social work students often receive little or no exposure to macro-level systems (figueira-mcdonough, 1993; miller, tice, & harnek hall, 2008). servicelearning social policy courses help to fill that void. some universities like duke (2018) and purdue (2018) have a variety of excellent compendia of service-learning resources for faculty. the most important motivations for faculty members who adopt service-learning pedagogy are intrinsic—“passion and personal interests” for better student learning outcomes, “social commitment,” and “intangible rewards” (hou & wilder, 2015, pp. 3-4). by aligning intrinsic faculty values with extrinsic rewards such as institutional commitment to facilitate the integration of advances in social work, fall 2018, 18(4) 1201 faculty responsibilities (i.e., research, teaching, and service) in tenure and promotion (abes et al., 2002; hou & wilder, 2015), research-intensive universities can bolster civicallyengaged scholarship and promote the civic mission of higher education. references abes, e. s., jackson, g., & jones, 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(2002). social work students go to camp: the effects of service-learning on perceived self-efficacy. journal of teaching in social work, 22, 55-70. doi: https://doi.org/10.1300/j067v22n03_05 young, j. (2014). ipolicy: exploring and evaluating the use of ipads in a social welfare policy course. journal of technology in human services, 32(1/2), 39-53. doi: https://doi.org/10.1080/15228835.2013.860366 author note: address correspondence to: younghee lim, department of social work, university of mississippi, university, ms 38677-1848. youlim@olemiss.edu https://doi.org/10.1300/j067v22n03_05 https://doi.org/10.1080/15228835.2013.860366 mailto:youlim@olemiss.edu ____________ joan pittman, phd, clinical associate professor, and deborah gioia, phd, associate professor, university of maryland social of social work, baltimore, md 21201. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 446-462, doi: 10.18060/22899 this work is licensed under a creative commons attribution 4.0 international license. transformative learning and inclusion in a global social work course joan pittman deborah gioia abstract: as there are many types of global learning experiences for students, understanding best practices is critical in resource allocation and developing competencies. additionally, diversifying global education is essential in addressing unequal student access and improving cross-cultural competence. this paper describes a short-term international course with graduate students from social work, public health, and nursing. nine students participated in semi-structured interviews about the impact of the course on their lives. transformative learning theory emerged as an important pedagogical guide as students described transformations in lifestyle and perspectives that developed through experiential learning. recommendations for improving learning and increasing cultural and interprofessional learning include having guided group discussions on critical incidents, using a critical reflection process focused on cultural assumptions, and focusing on the psychological, convictional, and behavioral dimensions of learning. traditionally underrepresented students described barriers related to international study, further emphasizing the importance of encouraging underrepresented students to pursue global opportunities through mentoring, targeted marketing, and making international experiences affordable and logistically feasible. inclusion of students from different backgrounds in international courses is not only important in promoting social justice, but also enhances cross-cultural skill development and learning. keywords: transformative; global education; diversity; inclusion; interprofessional we work and live in a global world, and therefore it is essential for social workers to understand global social work to be effective practitioners in any community (healy, 2008). international educational experiences have the potential to broaden and challenge students’ worldview, strengthen professional identity, and deepen cultural sensitivity (bell & anscombe, 2013; dorsett, clark, & phadke, 2017; gilin & young, 2009; greenfield, davis, & fedor, 2012; roholt & fisher, 2013). global learning experiences can help students develop skills in all nine of the competencies outlined by the council on social work education (cswe, 2015), and can be particularly impactful in demonstrating professional identity and behavior (competency 1), increasing awareness and appreciation of difference (competency 2), and understanding “the global interconnections of oppression and human rights violations” (competency 3, p. 7). there are many ways to learn about global social work: on-campus courses, localglobal initiatives, service learning, semester study abroad coursework and/or field experiences, and short-term immersion courses (greenfield et al., 2012; tarrant, rubin, & stoner, 2013). short-term international experiences are the largest and fastest growing option because of convenience and affordability and can be effective in achieving learning outcomes (dorsett et al., 2017; roholt & fisher, 2013; tarrant et al., 2013). the experience of cultural immersion and being placed in the position of others often results in a deeper https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) 447 level of cultural humility and respect, a critical skill for all social workers (gilin & young, 2009; roholt & fisher, 2013). as healy (2008) describes, the goals of global social work education should include not only increased awareness of the global context but also professional action in being able to assist families, individuals, and communities from different countries, engage in problem-solving about global social problems, and assess the influence and interaction of regional, national, and international policies. this article describes a short-term international course with social work, public health, and nursing students in kerala, india, in 2017. the project adds to the literature on global education by using transformative learning theory (mezirow, 2000) as a guiding pedagogical framework. in particular, interviews with the students illuminated transformational aspects of the course as well as barriers and advantages of minority graduate student participation in global education. transformative learning theory global education experiences have the potential to be transformative, and several scholars have examined the use of transformative learning theory in understanding and improving learning in short-term immersion courses (dorsett et al., 2017; roholt & fisher, 2013; walters, charles, & bingham, 2017). transformative learning theory was originally developed through qualitative research methods to understand adult women returning to school for professional development (mezirow, 1991, 2000). the theory is built on the idea that adult learners have established frames of reference and assumptions, and a primary goal of education is to help adults challenge these assumptions through “disorienting” experiences, critical reflection and dialogue, and action (alfred, cherrstrom, robinson, & friday, 2012; kitchenham, 2008; mezirow, 1991, 2000). as merizow (2000) explains: transformative learning refers to the process by which we transform our takenfor-granted frames of reference (meaning perspectives, habits of mind, mind-sets) to make them more inclusive, discriminating, open, emotionally capable of change, and reflective so that they may generate beliefs and opinions that will prove more true or justified to guide action. (p. 7) mezirow’s qualitative research uncovered 10 possible phases of learning: a disorienting dilemma, self-examination with feelings, critical assessment of assumptions, recognition of shared experiences, exploration of new roles/relationships/actions, planning a course of action, acquiring new knowledge and skills, trying out new roles, building competence and confidence in new roles, and reintegration into one’s life with new perspectives (alfred et al., 2012; kitchenham, 2008; mezirow, 2000). much has been written in the transformative learning theory field about types of critical reflection and dialogue, and how to assess and promote these in adult learning (alfred et al., 2012; kitchenham, 2008; mezirow, 2000). additionally, there have been new developments and critiques of mezirow’s original theory that are important to consider in applying transformative learning theory to global education, including the impact of context, culture, and emotions in perspective transformation (alfred et al., 2012; nino, cuevas, & loya, 2011; walters et al., 2017). research looking specifically at context suggests that the process of perspective transformation may include three dimensions: psychological pittman & gioia/transformative learning 448 (changes in understanding of the self), convictional (revision of belief systems), and behavioral (changes in lifestyle; mezirow, 2000; nino et al., 2011). additionally, research suggests that a person’s cultural lens, emotions, and relationships may play a more central role in transformative learning than once understood (alfred et al., 2012; walters et al., 2017). immersive global educational courses may be experienced as disorienting events, potentially starting the “phases” of transformative learning that can lead to psychological, convictional, and behavioral changes. research on the theory has shown that disorienting experiences must be paired with critical reflection and dialogue to promote the process of cultural learning and perspective transformation. this framework provides guidance for faculty facilitating short-term global courses, highlighting the importance of individual reflection and group dialogue related to critical incidents, and continuing the learning by planning for future action and integration of experiences. diversifying global education international educational experiences are increasingly viewed as an important part of professional development and the number of students participating has more than tripled in the past two decades (institute of international education [iie], 2018). although statistics for study abroad students from the united states indicate continued improvement in racial and ethnic diversity, the 2015-2016 numbers still highlight significant disparities with 70.8% of students identified as white, 10.2% identified as hispanic or latino(a), and 6.1% as black or african-american (iie, 2018). these statistics are concerning, considering the increasing research indicating that global educational opportunities improve student academic outcomes and career opportunities (nafsa: association of international educators, 2018). several studies suggest that employers value study abroad experiences and the intercultural skills that students can develop (trooboff, vande berg, & rayman, 2008). given that international experiences may improve professional competence and expand career opportunities, it seems imperative that these opportunities are accessible to a more diverse student population. diversifying global learning opportunities may have benefits for increased learning and cultural sensitivity for minority and non-minority participants as well as the communities visited and the social work profession (acquaye & crewe, 2012; brux & fry, 2010). just as having more diverse classrooms and workplaces can increase our ability to see the world from different perspectives, having a diverse group of students and faculty participating in global learning provides more opportunities for examining cultural interactions from multiple perspectives. additionally, traveling to other countries as a diverse, representative group of students from the united states may help host communities have a broader view about american culture (brux & fry, 2010). in particular, in social work education, where our professional mission is to promote social justice, we have an obligation to address inequalities in our schools and communities, and advance inclusivity in all areas of our curriculum (acquaye & crewe, 2012). considering the substantial benefits of diversifying global education, it is important to understand and address the barriers to participation for underrepresented students. advances in social work, fall 2019, 19(2) 449 research in global education has outlined the following categories of barriers that may prevent underrepresented students from participation in global learning: finances, family concerns and attitudes, fear of racism and discrimination, historical patterns in education, disconnect with career goals, and institutional factors such as scheduling difficulties and marketing (acquaye & crewe, 2012; brux & frey, 2010). these barriers were highlighted by traditionally underrepresented participants in this study. course description the university of maryland, baltimore, school of social work (umb ssw) is a large, public master of social work program located on an urban interprofessional campus. umb ssw is committed to experiential global education initiatives and has a center for global education initiatives (cgei) which supports global interprofessional projects. this shortterm international course was developed with the aim of enhancing cultural sensitivity, interprofessional competence, and international perspectives on health and mental health issues. umb ssw has a well-established relationship with the rajagiri college of social sciences, school of social work (rcss ssw) in kerala, india, and has been offering a winter study abroad course in kerala since 1997. however, in 2016-2017 the course transitioned to new faculty leadership and was redesigned as an interdisciplinary course with enhanced coursework, assignments, and expectations. cgei helped to support the course by offsetting costs to students and faculty through a grant, assisting with selection of students, and providing resources and education to students about international travel. since 2014 there have been over 36 international trips sponsored by cgei to a wide array of global sites, yielding numerous presentations and publications. thirty-four students applied to participate in the international course and eighteen were selected based on academic standing, references, personal statement and essay, and an interview. cgei has established questions and structured procedures for students applying for international experiences. student applications included a personal statement and two essays that addressed their interest in the program, fit with their professional goals, and interest and experience in working interprofessionally. based on all components of the application, each student was rated in categories of interest, experience, professional goals, and quality of references by a member of the cgei staff and one of the faculty leading the trip. those ratings along with comments from the interview were compiled and reviewed by the faculty and cgei staff at a group meeting where applicants were ranked and selected. all of the 18 students chosen were in master’s programs at umb; 3 students were from the nursing program, one was in a dual degree public health/social work program, and 14 were in the social work program. all of the students identified as women. course content and structure this three credit master’s level course titled, interprofessional explorations of aging, health and mental health in a global context, consisted of 3 pre-travel classes in the fall semester, two weeks in india over the winter term (immersion), and one debriefing class and a campus presentation in the spring semester (post-travel). students selected for the pittman & gioia/transformative learning 450 course were given a detailed syllabus describing learning objectives, dates of classes, readings, assignments, and expectations. a core component of this course was participation in an international conference on healthy aging and mental health at rcss in kerala, india during the first week of travel. the course was led by two social work faculty members with experience and interest in global education and interprofessional practice. pre-travel. the goals of the pre-travel phase of the course were to form relationships, learn about different professions, learn about the history and culture of india, explore issues around aging in the united stated (us) and india, and discuss logistics of the travel portion of the course. we accomplished these goals through small group activities, guest lectures, readings, and assignments. students were placed in three groups of six students that were tasked with completing a research poster on an aging issue in india and the us. this assignment was instrumental in meeting the goals of forming relationships, learning about different disciplines, learning about the culture in india, and exploring aging issues in the us and india. the research posters were presented at the conference in india, providing an opportunity to engage with students and faculty from india and around the world. guest lecturers who were from kerala, former students who had participated in the course, and experts on indian culture were instrumental in facilitating learning about culture and global perspectives. an essential component of the success of the pre-travel classes was having the support from cgei. most students in the course had never been on an international education trip before, so having the center’s assistance with questions about visas, immunizations, and safety concerns was essential. immersion experience. the in-country immersion portion of the course took place during the two week winter break. the first part of the in-country experience involved participation in the dyuti 2017 international conference on healthy aging and mental health at rcss in kerala, india. students in the course attended conference presentations on aging and mental health topics, participated in social and cultural events, and formed relationships with students and faculty from india and other countries. the dyuti international conference is unique in that the masters of social work students from rcss plan and facilitate the conference activities and logistics. thus, students from umb and rcss ssw interacted frequently in both formal and informal ways, and this seemed to be one of the highlights of the program. for example, msw students from rcss created an interactive display of information about aging issues in kerala and umb students were able to engage with students and discuss the information presented. students interacted informally with students and faculty from india and other countries during daily tea breaks and lunches at the conference. umb students also had their research posters displayed and were able to engage with conference participants about their own projects. in addition to conference events, the group visited health and mental health agencies, cultural sites, workplaces, and a family’s home. during the conference and while traveling around kerala, students were required to write reflections in a journal, and take pictures of scenes that represented the course learning objectives of increasing cultural competence, interprofessional learning, and knowledge about health and mental health issues in india. additionally, faculty members led small and large group discussions about critical incidents that occurred on the trip, cultural issues, and health and mental health topics. advances in social work, fall 2019, 19(2) 451 post-travel. upon returning from the travel portion of the course, students were asked to review and reflect on their journal entries and photographs relevant to the key learning objectives, and attend the post-travel debriefing class to share ideas about learning themes from the course. for grading purposes, students were required to submit one journal entry and one photograph with a caption that captured important learning for the student. at the post-travel debriefing class, students shared themes, photographs, and journal entries, and worked to synthesize these into four common areas of learning: mental health and spirituality, cross-cultural relationships, women’s roles in the workplace, and health and mental health. students selected journal excerpts and photographs to showcase these themes at a campus event which included a gallery show featuring captioned photographs, research posters, and a brief presentation. choosing a caption for their photograph, a process derived from the photovoice method (wang & burris, 1997), was useful in enhancing the critical reflection process of the course. gaining funding and administrative support for global education can be challenging, thus sharing the positive impact of this course with deans and administrators, community members, and other students was a critical step in the process. additionally, having an end goal of sharing back to the larger community helped students synthesize and communicate what was valuable to them about the course, which seemed beneficial in the learning process. method participation in a post-course qualitative interview was voluntary. after grades were submitted for the course, an email was sent to all students asking for participation in a short open-ended qualitative interview about their experiences in the course. half of the students (n=9) agreed to participate in the interviews. although demographic information was not collected as part of gcei’s selection process, through exercises and conversations in the course the authors became aware of students’ ethnic and racial identification, age, and experience. forty percent of the students in the course identified as caucasian, while the remaining 60% of students identified as a non-caucasian race/ethnicity or mixed race/ethnicity which was the same percentage as those interviewed. four of the students interviewed identified as caucasian, three as hispanic, and two as african american. most of the students were in their 20s (n=7); one student was 34, and one was 64. only one student out of 9 had been on an international educational trip before this course. an interview guide (see table 1) was created by the authors; questions were framed to be descriptive and evaluative of student experiences on the trip. specific questions about cultural competence, interprofessional education, and barriers to participation were explored as these concepts were present in the literature and were learning objectives for the course. this paper highlights themes around transformative, cultural, and interprofessional learning which came up in response to many of the questions. additionally, the experiences of traditionally underrepresented students are highlighted because of the critical need to diversify global education. the experiences of barriers and benefits of having a diverse group of students participate in this course was notable. pittman & gioia/transformative learning 452 table 1. interview guide questions background/demographics: • age • advanced standing or not/ year in the program • race • have you been on other international educational trips? if yes how many? • have you traveled outside the country? if yes how many times? overall experience: • what did you get out of (learn from) this experience? • what did you learn that you think may help you in your profession? cultural competence: • do you feel this course increased your cultural competence? • is there an example from the course of how this improved? interprofessional education: • what did you learn about the roles and responsibilities of social work, nursing and/or public health professionals that you didn’t know before the experience? • do you think this ipe experience will help your career? explain barriers • what were the barriers to your participation in this global course? • were there health/mental health/financial/other concerns that could have preventing you from coming on the course? wrap up reflection question • was there an important (specific) event or experience that facilitated your learning? • looking back now, do you think taking this course was important in your professional career? how do you know this? what has happened that lets you know this was a good decision? a umb irb application was submitted for study approval, and the application was reviewed. however, the determination was that the study was low risk and did not require registration in the system as a formal study with oversight from the irb committee. in an effort to increase participation, faculty sent several emails to students inviting them to participate in interviews. on reflection, the time chosen for the interviews was at the end of the academic year and did not favor participation of all the students, especially since many students were graduating. however, it was necessary to wait until the grades were submitted before conducting the interviews, in order to decrease the risk of our dual relationships with the interviewees who were students of the interviewers. oral consent was given by the students who agreed to an interview and this was captured on the recording. interviews lasted roughly 15-20 minutes and all the interviews were digitally recorded and transcribed verbatim by the authors. in an effort to increase participation, students were given the option to participate by phone if they could not come in person. four of the interviews were conducted by phone and five were in person. no compensation was provided to the respondents. advances in social work, fall 2019, 19(2) 453 data analysis template analysis was used to develop an a priori set of codes that reflected the study aims (brooks & king, 2012). although a formal codebook was not used, the interviewers derived some agreed-upon codes, taken mainly from the interview guide to use in the coding. serendipitous comments were also weighed as to their relevance (padgett, 2016). due to the small number of interviews, no qualitative data software was used. each student interview was coded twice by hand, once by each interviewer, and then compared. a basic qualitative data analysis method was used (miles, huberman, & saldana, 2013) to aggregate the answers to the interview guide questions and compare and contrast the student responses during the second cycle of coding. a modified form of consensual qualitative research (cqr) (hill, 2012), characterized by small samples and open-ended questions, was used to understand the findings and to surface themes for discussion by the authors. in the cqr approach, a dialogue is employed by the research team to understand the data and make decisions about which quotes have density to put forward as themes. findings the interview data revealed four primary themes: transformative learning, cultural learning, interprofessional learning, and barriers for minority students. students were asked directly about cultural competence and interprofessional learning since these were course objectives, but as the findings show, when asked more general questions about what they gained from the experience nearly all students shared that cultural and interprofessional learning were an important part of the experience. students were not asked specifically about transformative learning, rather it arose spontaneously from students’ responses to questions about their overall experience. a question about barriers to participation was asked of all students; however there was a clear theme that students of color had barriers related to being a minority student that non-minority students did not report. transformative learning in response to questions in the interview guide, students described their experiences as transformative, causing adjustment of previously held assumptions and priorities and major life changes. five of the nine students interviewed gave specific examples of ways that this course changed their beliefs and behaviors both personally and professionally. these students described how the immersive experience of the international course resulted in changes in understanding of self (psychological), revision of belief systems (convictional), and lifestyle changes (behavioral; mezirow, 2000; nino et al., 2011). one example was a student who described how the course caused her to reevaluate her beliefs and behaviors around how to live her life and what was important, leading to lifestyles changes such as “turning off notifications on my devices” and “being present.” she further explained: we struggle as nurses with self-care because we take so much energy of ourselves into the care of other people. and i'm sure that that goes the same way for social work as well. and like nursing is so fraught with burnout and anxiety and all of pittman & gioia/transformative learning 454 these really negative things because we lack the capacity or the will to give of ourselves to ourselves. so as i've come back i've gotten really involved (in) the self-care group on the unit level and the hospital level. another student reported increased self-confidence and self-awareness, which could be categorized as psychological and convictional domains of perspective transformation, and changes in lifestyle (behavioral domain) as a result of participation in the course. when i came back home...just everything changed... i decided to quit my job and i just learned that i have to really do what i want to do, and just live life [more meaningfully], that's just how it felt. i also learned that, because i never thought that this trip would ever happen, [and then] it did. now i’m more convinced that whatever you want, if you try hard enough you can have it. another student echoed the increased self-confidence and perspective transformation resulting from the course. this is going to be something i'll take with me for the rest of my life…i guess the courage... just like even though i knew nobody, and i was not very familiar with social work. i’d never been to asia. despite all of those things having the courage to just like go for it, and it worked out so well, that yeah, i will take with me like a building block for more opportunities and seeking out more opportunities in the future. the experience solidified one student’s professional identity which could be described as psychological and convictional perspective changes, and allowed her to explore different areas of social work. i didn’t feel like a social worker until i went to the conference at rajagiri college. because i felt like a part of a bigger thing … after that (the course) i have been searching for careers in nursing homes. its opened an entire door of interest. critical reflection and dialogue were encouraged through daily journaling and facilitated group discussions. although most students did not specifically describe how journal reflections and group dialogues assisted in the learning process, students did describe critical incidents that occurred on the trip and these were incidents that were discussed in large and small groups and processed in their journals. in hindsight it would have been helpful to ask specifically about the impact of journaling and group dialogue and explore what was most helpful to students in facilitating critical reflection and learning. one student did describe the importance of guided group discussions in improving learning and integrating experiences and knowledge. one of my most favorite moments was the conversations that we had on the boat houses. i don’t want to speak for everyone else but it seemed that everyone had really rich conversation, and we had prompts [guiding questions] too. if there’s not guidance, it’s not like everyone is just going to organically get together and start talking. advances in social work, fall 2019, 19(2) 455 cultural learning all of the students interviewed except for one felt that the course increased their cultural competence. students described increased knowledge of indian culture, increased confidence in interacting with clients and families from different cultures, and increased cultural humility. gaining experience about cross-cultural communication seemed particularly impactful for several students. one example of this was when some students felt that the students from india were being rude or pushy, but after debriefing discussions and forming relationships, they began to understand the communication differently. i think there was this perception that the students (in india) were being pushy or a little bit aggressive in terms of what they wanted us to do. and then i think through our two weeks there we realized that they are not trying to be pushy or force these activities on us, it’s really that the end goal for them was for us to have a really great experience. another student described cultural learning that occurred as related to the diversity of our us student group interacting with the indian student group: as far as competency, we found out how they [indian social work students] act toward each other, things that you can’t do there, how they dress…we were really serious about learning their language and having conversations with people…they were surprised, because, number one, they did not see too many african americans, black people that travelled there…. culturally it was very important and i loved it. spending a day in the home village of an indian family was also a highlighted experience in student journals that seemed to increase cultural humility and understanding of norms and customs. interprofessional learning in response to the interview guide questions on interprofessional learning, seven of the students felt that interprofessional learning was a very important part of their experience and would improve their professional skills. one student did not feel that she learned new information or skills about the other professions because she had already participated in several in-depth interprofessional projects. another student shared that having more preparation and discussion about interprofessional concepts before visiting agencies while in india could have strengthened the learning. the seven students with positive comments about interprofessional learning described learning about different professional roles, values, and styles of working. these students felt that visits to health and mental health facilities in india were enhanced by having students from different professions present because questions were asked from multiple perspectives, and discussions after the visits included new multidisciplinary knowledge that provided a richer understanding of the issues. as one social work student explained: it made me appreciate the more medical side [of the social issue], and it made me see things differently than if they (nursing students) hadn’t been there. pittman & gioia/transformative learning 456 a nursing student explained that learning about the roles and education of social workers changed her professional behavior when she returned to working in a hospital: now since coming back i have had so many more ideas of how we can better utilize her (hospital social worker) … not just using her (hospital social worker) to get in touch with resources, but also using her as a resource. barriers for minority students based on the literature regarding underrepresentation of students of color in international education, a question was included that asked about barriers to participation in this course. four of the interviewed students identified as caucasian/white, three as hispanic, and two as african american. the four students that identified as caucasian described barriers of financial and work concerns, being drained from travel upon returning home, and difficulties with the process of obtaining a visa for india. one of the persons of color was accidentally not asked about barriers and one described barriers related to child care, but no specific cultural issues. three students that identified as african american or hispanic described barriers connected to their race/culture or family background. one student stated that she was not going to apply, but ended up submitting her application after encouragement from a former supervisor. when asked why she might not have applied, she responded, i don't know, i feel like, in my past experiences i haven't really seen study abroad opportunities offered so much to african-american students. and i don't know if i sort of internalized that, and felt that because i am african-american, maybe i won't be selected for this opportunity. one of the students of color talked about financial barriers and other values around obtaining vaccinations for travel. a lot of times in my culture they don’t take too many medicines or too many shots and they would use herbal remedies or teas. so getting the shots [vaccines] and the other things that were recommended for the trip – i was struggling with that too. so i don’t really like doing this, but i don’t want to get sick. so i had to kind of go against some things because i wanted to be okay on the trip. another student of color talked about how participation in international educational trips was not normative in her family. just me not thinking i was worthy enough to go on this trip. that was more of what it was. because i'm the first in my family to travel that far. you know it started off as kind of like a fantasy conversation and then it happened! i told my grandparents and they didn’t understand [and asked] what are you going to india for? why? by yourself? like they really didn’t get it. my parents were all for it. they were super supportive and they were really excited for it. but it's just one of those things, they themselves wouldn’t go to india. advances in social work, fall 2019, 19(2) 457 limitations as with any study, the findings must be considered in light of the limitations. the primary purpose of this exploratory study was to understand the students’ experiences on this international educational trip, and to identify areas that could be strengthened for future courses. although only a short period of time had passed when we conducted the interviews, it is possible that the study participants may have suffered from recollection bias, as well as the desire to please the interviewers, who were also the course instructors. these student experiences were tied to one class, from one graduate institution, potentially narrowing the applicability to other academic institutions and courses. as noted, only half of the students from the course participated in the interviews. the end of semester timing may have been a factor in the response rate. efforts were made to increase participation by sending multiple emails and offering students the option to participate by phone or in person. the interviews that were conducted by phone did not adequately give the interviewers a chance to observe reactions to questions and to probe more deeply. although students did speak freely about their experiences and were provided a variety of opportunities to provide positive and negative feedback, restrictions in critical comments may have been a function of the student/faculty power dynamic. both faculty were in social work and there were only a few nursing and public health students in the course and in the interviews, therefore, these findings may be skewed toward the social work student experience. discussion transformative learning although these nine interviews represent only half of the students from one course, the findings add to the growing literature that short-term international courses can be transformative learning opportunities (bell & anscombe, 2013; dorsett et al., 2017; gilin & young, 2009; roholt & fisher, 2013; walters et al., 2017). for many students, participating in a longer-term global immersion experience is not logically or financially possible, thus short-term immersion courses offer an obtainable option that may have lasting effects. using the 10 phases of transformative learning (i.e., disorienting dilemma, self-examination, critical reflection, planning for and integration of new roles and actions) as a guide to structure global courses may be helpful in promoting and extending the lessons learned (alfred et al., 2012; kitchenham, 2008). immersive international courses have the benefit of students and faculty being placed in the position of other and learning new skills and ideas experientially (dorsett et al., 2017; gilin & young, 2009; roholt & fisher, 2013). these immersive experiences can create critical incidents or “disorienting dilemmas,” the first phase of transformative learning. the main disorienting event for students in this course was first time travel to india. within the travel experience, other “culture shocks” arose in what they observed and experienced. faculty cannot always plan for what will be a disorienting event, or when these events will occur, but the goal of faculty facilitation is to stay alert for these opportunities, ready to help students reflect on their experiences. pittman & gioia/transformative learning 458 according to transformative learning theory, the next phases of learning include critical reflection and dialogue around assumptions, beliefs, emotions, relationships, and roles (alfred et al., 2012; kitchenham, 2008; mezirow, 2000). perhaps because students were not asked to elaborate on how they learned but instead what they learned, only one student interviewed highlighted the importance of guided group dialogues. however, faculty observations, anecdotal student comments, and prior research support the idea that group facilitated discussions are critical for integrating experiences and challenging assumptions (nino et al., 2011; roholt & fisher, 2013). it is often difficult, especially with large groups of students and intense travel schedules, to allow ample time for these periods of discussion and reflection. transformative learning theory outlines a critical reflection process as including identifying assumptions, challenging these assumptions based on experiences, integrating information to form new assumptions, and taking action based on the new integrated material (mezirow, 2000; roholt & fisher, 2013). an example of how this occurred in this course was when we had a large group debriefing about how students were interpreting non-verbal communication from students from other countries as “being rude.” after identifying and challenging the assumptions and integrating the new information, students were able to engage with students from other cultures in a different way. this example also highlights how the transformative learning process can improve intercultural skills and cultural competence. critical reflection processes outlined in transformative learning theory can contribute to increased cultural sensitivity by helping students examine biases, stereotypes, and understand the meaning that people give to events (askeland & fook, 2009). further research and practice on the use of transformative learning theory to improve cultural competence may be useful since they appeared to be interlocking concepts. student interviews touched on the different domains of perspective transformation (psychological, convictional, and behavioral), suggesting that global courses may improve learning outcomes if experiences and discussion questions are targeted to address these different elements. since these themes arose from the student data, we did not ask specific questions about the three domains of transformative learning. it would be helpful in future studies to gather more information on these domains including what facilitates changes in these areas. additionally, educators could extend learning by including course elements on the later transformative learning phases such as exploring new roles, beliefs, or behaviors that students would like to implement after the course and integrating learning and new perspectives. students in this course reported their intent to make significant personal and professional changes as a result of the experience. having post-travel discussions and a campus presentation appeared to help students integrate the experiences and new beliefs; however, faculty could have facilitated more targeted discussions and goal-setting around changes that students planned to make upon return. improved understanding and appreciation of different professions was an important learning outcome of this course, and transformative learning theory concepts may be helpful in expanding learning in this area. students shared how critical dialogue and reflection was enhanced by having different professional perspectives present, improving individual student learning and the potential for students to engage in interprofessional practice when returning to their professional roles. having a more balanced representation advances in social work, fall 2019, 19(2) 459 of different professions and including more post-trip elements on integration of new ideas and roles could enhance interprofessional learning. diversifying global courses student interviews post-travel provided further support to the growing literature on barriers for students of color and the need to increase access to international experiences (acquaye & crewe, 2012; brux & fry, 2010; iie, 2018). students of color, those who have come from low socioeconomic backgrounds, and students who have not had exposure to global experiences often do not apply for these programs, because they have not seen others like them apply, and are not convinced that they would be comfortable on these trips. student voices from this study further emphasize the importance of encouraging underrepresented students to pursue global opportunities through mentoring, targeted marketing, and making international experiences affordable and logistically feasible. learning was enhanced in this course because of the diverse cultures and experiences of the students participating. women of color had different experiences of being stared at, having questions about their hair, and concerns about being discriminated against. being able to discuss these cross-cultural experiences as a group enriched the learning experience and likely improved students’ cultural sensitivity. one of the possible reasons this course attracted a diverse group of students, most of whom had not previously participated in an international education experience, may have been because the course cost was reduced with grant support given by the gcei. one of the students interviewed shared how she was pleasantly surprised that she was not the only person of color in the course, and that made her feel more comfortable with her decision to participate. ensuring that marketing materials, student panels, and faculty teaching the courses are diverse may help students of color feel that they can apply and participate in these experiences. other suggestions from the literature on attracting diverse students include creating spaces to talk about safety and discrimination concerns, partnering with diverse student groups, and developing curricula that is responsive and inclusive of diverse points of view (acquaye & crewe, 2012; bruce, 2015). diversifying international opportunities supports the social work value of promoting social justice and enhances the experience for all participants, creating more opportunities for crosscultural dialogues and deeper critical thinking. future directions transformative learning theory, specifically the phases of learning, domains of perspective transformation, and types of reflection and dialogue, could be used to improve learning outcomes in short-term global courses by designing courses based on these concepts. future research could include a richer exploration of transformative learning theory concepts, and their connection to cultural and interprofessional learning. researchers could also use student interviews and a content analysis of journals. analysis of journal entries, coupled with retrospective interviews, would build on this qualitative study by triangulating different data sources, and serve to increase knowledge about transformative learning in graduate education. pittman & gioia/transformative learning 460 although many students reported psychological, convictional, and behavioral changes when interviewed a few months after the course, it is unknown if these changes were lasting or if they improved their professional competence. a second data collection point would help researchers understand the durability of these changes. additionally, as faculty teaching this course for the first time, there were many elements of the course that could be improved to promote learning including having more frequent group dialogues, having some groups facilitated by members of the host country (roholt & fisher, 2013), including faculty from other disciplines, and structuring journal prompts and discussions around transformative learning concepts. despite the exploratory nature of these qualitative interviews, and the fact that the data may give rise to multiple interpretations, these findings have generated some new ways of thinking about global coursework. in particular, the value of using transformative learning theory will improve global courses by tuning into disorienting events, bolstering critical reflection and dialogue, and providing 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(2013). expect the unexpected: international short-term study courses pedagogies and practices. journal of social work education, 49, 48-65. doi: https://doi.org/10.1080/10437797.2013.755416 tarrant, m. a., rubin, d. l., & stoner, l. (2013). the added value of study abroad: fostering a global citizenry. journal of studies in international education, 18(2), 141-161. doi: https://doi.org/10.1177/1028315313497589 trooboff, s., vande berg, m., & rayman, j. (2008). employer attitudes toward study abroad. frontiers: the interdisciplinary journal of study abroad, 15, 17-33. walters, c., charles, j., & bingham, s. (2017). impact of short-term study abroad experiences on transformative learning: a comparison of programs at 6 weeks. journal of transformative education, 15(2), 103-121. doi: https://doi.org/10.1177/1541344616670034 wang, c., & burris m. a. (1997). photovoice: concept, methodology and use for participatory needs assessment. health, education & behavior, 24(3), 369-387. doi: https://doi.org/10.1177/109019819702400309 author note: address correspondence to: dr. joan pittman, clinical associate professor, university of maryland school of social work, 525 w. redwood st., baltimore, md 21201. e-mail: jpittman@ssw.umaryland.edu. https://doi.org/10.1080/10437797.2013.755416 https://doi.org/10.1177/1028315313497589 https://doi.org/10.1177/1541344616670034 https://doi.org/10.1177/109019819702400309 mailto:jpittman@ssw.umaryland.edu transformative learning and inclusion in a global social work course joan pittman deborah gioia abstract: as there are many types of global learning experiences for students, understanding best practices is critical in resource allocation and developing competencies. additionally, diversifying global education is essential in addressing unequal ... keywords: transformative; global education; diversity; inclusion; interprofessional transformative learning theory diversifying global education course description course content and structure method data analysis findings the interview data revealed four primary themes: transformative learning, cultural learning, interprofessional learning, and barriers for minority students. students were asked directly about cultural competence and interprofessional learning since th... transformative learning cultural learning interprofessional learning in response to the interview guide questions on interprofessional learning, seven of the students felt that interprofessional learning was a very important part of their experience and would improve their professional skills. one student did not feel ... the seven students with positive comments about interprofessional learning described learning about different professional roles, values, and styles of working. these students felt that visits to health and mental health facilities in india were enhan... it made me appreciate the more medical side [of the social issue], and it made me see things differently than if they (nursing students) hadn’t been there. a nursing student explained that learning about the roles and education of social workers changed her professional behavior when she returned to working in a hospital: now since coming back i have had so many more ideas of how we can better utilize her (hospital social worker) … not just using her (hospital social worker) to get in touch with resources, but also using her as a resource. barriers for minority students limitations discussion references _________ rachel schwartz, msw, assistant professor of teaching, and laura curran, msw, phd, associate professor, school of social work, rutgers, the state university of new jersey, new brunswick, nj. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 163-177, doi: 10.18060/25210 this work is licensed under a creative commons attribution 4.0 international license. technical standards in social work education: what they are and why they matter rachel schwartz laura curran abstract: following larger developments within professional education, schools of social work have increasingly adopted technical standards as non-academic criteria for program admission and continuation. this paper examines the emergence of technical standards within schools of social work, articulates the distinction from and overlap with other forms of non-academic admissions and retention criteria, and considers their use in relation to the larger literature on gatekeeping in social work. drawing on select legal cases, this review paper contemplates possible challenges associated with the implementation of technical standards, including issues related to disability law and due process. we argue that the development and implementation of technical standards in social work education raises complex questions related to inclusion and equity and poses unique challenges and opportunities for a relational and behavioral profession grounded in interpersonal skill development. despite challenges, development of technical standards in schools of social work is worthwhile and can help manage the delicate and often difficult balance between serving as student-focused educators and professional gatekeepers. keywords: technical standards, social work education, gatekeeping, disability accommodations, professional behavior institutions of higher education have a legal and ethical responsibility for developing criteria and standards for admission and retention of students. standards help ensure inclusion, access, and opportunity for those seeking degrees and protect institutions and communities by ensuring that degree candidates and graduates are well-prepared to enter their fields of study. such standards and criteria typically include academic markers (such as gpa and test scores), but within many professional and health programs, they include non-academic criteria as well. technical standards have become an increasingly prominent means, particularly in professional fields such as law, pharmacy, nursing, medicine, and social work, to ensure that students and graduates meet non-academic criteria for program admission and continuation (kezar et al., 2019). originating out of disability law, the concept of technical standards includes the mental and physical qualifications and skills that are needed to learn and perform the essential requirements of the educational program with or without disability accommodations (blacklock & montgomery, 2016; ferro-lusk, 2017). despite the adoption of technical standards by many schools of social work (the exact number is not known), social work educators are often unfamiliar with this tool that both protects students’ rights and help programs to fulfill a gatekeeping function when standards cannot be upheld. the aims of this paper are to introduce the legal construct of technical standards, examine the meaning of technical standards within schools of social work, and about:blank advances in social work, spring 2022, 22(1) 164 explore the possible challenges associated with their development and implementation in the context of social work education. the first section will define technical standards, discuss their origins within disability law, and describe their emergence within professional schools across varying disciplines. we also examine the differences and intersections between technical standards and other common non-academic standards related to professional behavior or conduct which are often simultaneously evoked during gatekeeping processes. after reviewing this larger context, we will explore the adoption of technical standards specifically within social work education, including a more comprehensive look at gatekeeping concerns and their relation to technical standards. select relevant legal cases are reviewed, identifying issues for schools of social work to consider in implementing technical standards. finally, the discussion synthesizes salient areas for consideration in the development of technical standards. we argue that the development and implementation of technical standards in social work education pose unique challenges and opportunities for a relational profession grounded in interpersonal skill development and associated behaviors. in sum, this paper explores important ideas around the need for technical standards in social work education, and the complex questions related to gatekeeping, inclusion, and equity that schools of social work should deliberate as they become more engaged with employing technical standards as part of their professional programs. defining technical standards per federal guidance, technical standards in education refer to non-academic criteria, meaning mental and physical qualifications and skills, that are considered “essential” for a student to be admitted to and participate in the program (blacklock & montgomery, 2016; kezar et al., 2019; shannon, 1998; rehabilitation act, section 504, 1973). technical standards include the attitudes, experiences, and physical requirements needed to learn and perform the essential requirements of the educational program and are typically separated into five key areas: “perception/observation; motor/tactile; cognition; communication; and professionalism” (blacklock & montgomery, 2016, p. 7). for programs with clinical components (i.e., counseling/social work, nursing, medicine), these standards may need to be met at multiple points – at the time of admission to the program, when clinical experiences begin, and throughout program participation (babbitt & lee, 2016). the concept of technical standards originated within section 504 of the rehabilitation act of 1973 which prohibits discrimination on the basis of disability, including in educational settings. the federal regulations implementing section 504 define(s) a qualified individual [for an academic program] as one “who meets the academic and technical standards requisite to admission or participation in the [school’s] education program or activity” (34 c.f.r. § 104.3(l)(3) as cited in ferro-lusk, 2017, p. 7). collectively, protections under both the rehabilitation act, section 504 (1973) and the later americans with disabilities act of 1990 (ada) ensure that individuals with disabilities have access to education as well as “reasonable” accommodations that do not impose undue hardship to the educational institution providing the accommodation (ada, 1990). contemporary disability law thus mandates that “reasonable accommodations” schwartz & curran/technical standards in swk ed 165 must be extended to applicants and degree candidates when assessing their ability to meet technical standards. following federal guidance, accrediting bodies, whose mission is to ensure that programs are adhering to a set of standards in terms of curriculum and delivery of education, have increasingly encouraged programs to adopt technical standards. in 1979, the association of american medical college developed guidelines for technical standards for medical schools (kezar et al., 2019). since then, technical standards have become more prominent in professional educational programs to ensure that candidates are capable of educational and professional success; disability accommodations are met; individuals with disabilities who can meet these standards with accommodations are not excluded; and schools protect themselves from discrimination claims when an individual with a disability is denied admission or an accommodation or separated from a program (shannon, 1998). in 1997, the national council of state boards of nursing published a study entitled “functional abilities essential for nursing practice,” encouraging the adoption of technical standards. the accreditation council for pharmacy education (acpe, 2015) followed and required the development and use of technical standards for pharmacy school admissions in 2016. what technical standards are not as discussed earlier, technical standards are distinct from academic standards which usually include typical markers of academic achievement required for admission such as gpa and standardized test scores as well as standards which need to be maintained to continue in and graduate from the program (shannon, 1998). understanding technical standards further necessitates differentiating them from related sets of non-academic requirements and/standards, which are often confused. distinct from technical standards, meaning the apriori mental and physical qualifications and skills considered “essential” for a student to be admitted to and participate in the program, are the “essential requirements” of a program. often inappropriately used interchangeably, essential requirements refer to the skills and knowledge obtained as a result of participation in the program, which all students must demonstrate in order to graduate from a program and cannot be “fundamentally altered,” with or without reasonable accommodation (ada, 1990; blacklock & montgomery, 2016). educational competencies can be confused with technical standards given that they have may have a skills or behavioral component. increasingly prevalent in professional education programs such as social work, such competencies denote dynamic and synthesized learning outcomes comprised of multiple dimensions (in the case of social work, knowledge, values, skills and cognitive and behavioral processes and achieved thorough program participation) (cswe, 2015). finally, technical standards are sometimes confused with but distinct from essential functions. defined through disability law (including the rehabilitation act of 1973 section 504), essential functions are employment duties that employees must be able to perform, with or without accommodations (matt et al., 2015; rehabilitation act of 1973). advances in social work, spring 2022, 22(1) 166 technical standards, insofar as they address behaviors and attitudes, can also be confused with and intersect with student codes of conduct and professional codes of ethics. student codes articulate both student rights and responsibilities in relation to expected behaviors, while professional codes of ethics typically speak to both values and professional behaviors. professional schools typically expect adherence to professional codes at a level appropriate to a student (babbitt & lee, 2016). while technical standards are legally and administratively distinct from the related standards noted above, it is not uncommon to find conflation or concurrent presentation of these various standards and codes within a technical standards document (zerden et al., 2019). while this overlap is not inherently problematic, professional conduct and behavior concerns often arise in situations related to student dismissal, and schools need to ensure they are carefully articulating each set of standards and associated policies and procedures, including their distinction and potential overlaps, in order to effectively craft and communicate the necessary requirements for program participation. as we further discuss, this clear articulation protects both students’ rights and allows programs to fulfill a gatekeeping function when standards cannot be upheld. social work and technical standards in its 2015 educational policy and accreditation standards (epas), the council on social work education (cswe) specifies that programs are responsible for evaluating “academic and professional performance” and providing policies for advisement, retention, and termination within these areas (cswe, 2015). while social work’s accrediting body does not specifically use the term “technical standards,” cswe nonetheless requires schools of social work to articulate what they require of students at admission and for continuance and completion of the program from a professional or “non-academic” standpoint. despite the growing use of technical standards and the mandate to articulate non-academic criteria in the epas, there is a dearth of publications addressing technical standards in the social work literature. in one of three extant discussions of technical standards found in the social work literature, zerden et al. (2019) reviewed technical standards or related criteria for admissions and continuance at 14 u.s. schools of social work. their analysis identified a number of themes typically included in such standards, such as: “communication; physical and cognitive ability; emotional stability, management and regulation; self-awareness and reflective listening; respect for diversity and commitment to social justice; ethical conduct; interpersonal skills; and academic and professional standards” (zerden et al., 2019, p. 537). the prominence of communication skills, emotion management, and a commitment to social justice is predictable for social work educators but notable in comparison to technical standards in other professions, which may focus more on physical abilities (i.e., nursing and medicine that require a variety of motor skills and physical abilities). as zerden et al. (2019) acknowledge: “many of the tasks or skills needed for professional social work practice such as building empathic relationships and emotional regulation are difficult to articulate and objectively evaluate in the same ways a predetermined task or skill (e.g., lifting 20 pounds or using a device to detect a heartbeat)” (p. 535) that are more schwartz & curran/technical standards in swk ed 167 commonplace in health professions. the sometimes imprecise nature of these attributes and skills poses a unique set of challenges for social work. while the literature specific to technical standards in social work is extremely limited, many social work scholars have addressed the related concept of “gatekeeping” within social work programs – from the point of admissions through course work, field work, and graduation with a focus on professional behaviors (elpers & fitzgerald, 2013; hylton et al., 2017; sowbel & miller, 2015). a significant strand of this literature — although failing to address technical standards — nonetheless emphasizes the behavioral aspects of nonacademic criteria, such as communication skills, maturity, self-awareness, boundary setting, problem-solving skills, and emotional health/regulation (bogo et al., 2006; dillon, 2007; holmstrom, 2014; hylton et al., 2017; ryan et al., 2006; sowbel & miller, 2015). some attempts have been made to operationalize the aforementioned gatekeeping criteria (see, for example, hylton et al.’s [2017] consideration of the core competencies as behaviorally-specific gatekeeping criteria as well as tam and coleman’s [2009] professional suitability scale). yet this literature largely suffers from the same challenges as technical standards discussions: gatekeeping criteria are difficult to define and assess. many of the behavioral criteria used in social work, such as emotional regulation, implicitly speak to issues of behavioral health. the use of emotional well-being as a potential gatekeeping and technical standards criterion, which some recommend (huff & hodges, 2010), is potentially problematic from both a legal and ethical perspective if it results in bias and discrimination. the ada (1990) as well as the national association of social work’s (nasw, 2017) code of ethics promote inclusion and protect individuals with psychiatric disabilities and behavioral health conditions against discrimination (holley et al., 2020). the extant social work literature addresses the possible overrepresentation of students with behavioral health conditions in social work (regher et al., 2001; thomas, 2016). the existing literature also explores the potential ethical and educational challenges social work educators face in supporting these students (collins, 2004; dykes, 2011; glennmaye & bolin, 2007; mazza, 2015) when and if their behavioral health concerns interfere with successful program participation or when an “impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties…interferes with practice effectiveness” (nasw, code of ethics, section 2.08, 2017, para. 1). these concerns may arise in any professional program, but they constitute a particularly salient tension in social work given the centrality of relational skills to competent practice. moreover, the emphasis on a vague “professionalism” or “professional demeanor” or suitability in gatekeeping and technical standards criteria further complicates objective assessment, as this term is subject to significant variance, including cultural and racial norms and biases, in interpretation (davis, 2016; hylton et al., 2017; marom, 2019). collectively, these complexities reinforce the import of articulating clearly defined behavioral standards to protect students from nebulous or discriminatory claims while assisting educators in upholding gatekeeping standards to ensure competent professional practice. the legal cases discussed below further elucidate these dynamics, including the responsibilities of professional schools and the role of technical standards and related behavioral standards in navigating these complex issues. advances in social work, spring 2022, 22(1) 168 legal background technical standards are a legal construct, originating out of and codified within federal law. both challenges to their definition and questions of their application occur within the courts. while we do not present an exhaustive review of legal challenges to technical and related behavioral standards, we have selected oft-cited and/or precedentsetting cases or those particularly relevant to social work programs. an exhaustive count of cases related to technical standards within social work or other disciplines is not known as many cases may be dismissed or turned back to the school for administrative decisionmaking at various points within the judicial process. one of the first cases to set a precedent for the use of technical standards in health professional programs was southeastern community college v. davis (1979). the first judicial interpretation of section 504, this case considered the imposition of “reasonable physical qualifications” and in what instances a university can impose such requirements. davis, who was an applicant with a hearing impairment, sought admissions to a nursing program, but due to the nature and fast pace of the clinical program, her participation was deemed to be a safety risk to her patients even with potential accommodations (southeastern community college v. davis, 1979). in this landmark case that helped define the meaning of reasonable accommodations under section 504 of the rehabilitation act of 1973 (babbitt & lee, 2016), the court upheld the nursing school’s denial of admissions and thus set a precedent for the use of technical standards. it set the stage for later cases to address the behavioral aspects of technical standards or related behavioral and professional codes that social work programs grapple with. halpern v. wake forest university health sciences (2012) demonstrated the salience of well-defined non-academic criteria and a well-articulated standard “professionalism” in particular. in this case, a student in wake forest’s medical school brought claims against the school after he was dismissed, arguing his dismissal violated the ada and the rehabilitation act. the student, halpern, acted in a very abusive manner – behaviors that violated a “fundamental educational goal” of the medical school’s curriculum and were outlined for students in the medical school’s student bulletin. prior to his clinical rotations, halpern exhibited unprofessional conduct with faculty and staff and had attendance issues – which he attributed to side effects of the medication he was on at the time. after starting his clinical rotations, halpern continued to exhibit problems (i.e., rejected feedback, lacked interpersonal skills, and was frequently absent), though he did pass several rotations, but still found himself before the school’s student progress and promotions committee which dismissed him. the united states district court for the middle district of north carolina granted summary judgement in favor of the university. the student appealed the ruling and the fourth circuit court of appeals rejected halpern’s argument and held that the student’s unprofessional behavior deemed him as “not otherwise qualified” to participate in the program, and his requested accommodations were unreasonable (halpern v. wake forest university health sciences, 2012). in its consideration of how to uphold professional behavior standards, the court noted that it would defer to the university in this case and found that the school clearly outlined “professionalism” as an essential requirement of the program – one that halpern could not schwartz & curran/technical standards in swk ed 169 meet, regardless of accommodations (halpern v. wake forest university health sciences, 2012). lee v. seton hill university (2017) similarly supports the import of transparent and well-disseminated non-academic standards and procedural fidelity. here, the plaintiff, lee, filed breach of contract due to his dismissal from seton hill’s physician assistant program. the federal district court for western philadelphia dismissed lee’s claims, as he was unable to show clearly what terms of the contract were breached. seton hill, a private university in pennsylvania, provides students with a “technical standards form” upon admission to the physician’s assistant program. this form outlines the factors in which admissions and retention decisions are made, and outlines both academic achievement and non-academic factors as playing a role in students’ retention in the program. the technical standards for this program articulate the differences between academic standards (i.e., grade point average) and technical standards, specifically bringing in professional qualities required for the field. the standards policy also notes that students may be dismissed from the program for failing to maintain “technical standards” or for violating the profession’s ethical standards and provides opportunity for appeal and challenge to disciplinary action such as suspension or dismissal. while lee met academic standards in terms of his gpa, faculty raised concerns around a number of inappropriate professional behaviors, including absenteeism and lack of participation. lee was placed on academic probation, but he did not improve his behavior and the university provided notice of his dismissal. lee claimed he was not given appropriate notice to remediate his behaviors. however, letters provided to him by faculty and administration (between may 2015 – may 2016) refute this, along with the technical standards form that he signed upon admission. in a letter from the dean and provost in may 2015, lee was informed of faculty concerns related to inappropriate professional behavior that included falling asleep in class, being absent/missing class, missing an exam, failure to participate in labs, and not following up with faculty and advisors. the student was then placed on academic probation and clinical rotations were delayed until a future semester. a few months after he was removed from probation, concerns were expressed about “several inappropriate/adverse events,” and it was recommended that lee be dismissed from the program (lee v. seton hill university, 2017). this case illustrates the need for well-articulated non-academic standards and effective dissemination and written documentation around remediation efforts. in another case that elucidates the importance of compliance with due process procedures, in warters v. laura et al. (2013), the plaintiff, jessica warters, claimed that she was deprived “due process of law” after she was dismissed from a master’s of social work program for failing the field instruction course. just prior to starting her field instruction course, warters was involved in a car accident in which she sustained serious neck, back, and eye injuries (warters v. laura et al., 2013). after receiving a mid-term evaluation from her field instructor that indicated she was doing “satisfactory” in her field work, warters began having difficulty meeting field hour requirements and she received notice from her field instructor and faculty field liaison (who was also the director of field education) that her performance fell below satisfactory. the school suggested that she take a medical leave of absence, which warters declined. at the next evaluation period she received a score of “needs improvement.” a few months later the field instructor informed advances in social work, spring 2022, 22(1) 170 warters to not return to her field placement and that she would receive a failing grade. the director of field education then informed warters that she was terminated from the msw program. warters then filed three unsuccessful appeals to the director of field education, an ad hoc hearing committee, and to the college grievance committee, to overturn her grade/dismissal. after these appeals, an associate dean of the graduate school decided (against the recommendation of these committees) that warters’ grade should be changed to an incomplete and she should be given an opportunity complete the course requirements, resulting in a change of her grade to an incomplete. the school determined it did not appropriately follow its own disciplinary procedures and provide due process to the student, hence the grade change. in providing a “second chance” for warters, an advancement committee convened and determined that she would be provided with another opportunity to complete her internship, but that her continuation in the program also relied on her maintaining better communication with the school. as the school set up a new opportunity for her, warters failed to meet the requirements, as she did not communicate properly with the school, arrived late for her interview, and did not attend required orientation sessions. as a result of her actions, the university decided that warters should in fact be given a failing grade for the course she had previously grieved (and given an incomplete in), and was dismissed from the program. the school ultimately allowed warters to apply for a retroactive medical withdrawal, which would allow her to reapply to this or other programs. in reviewing her claims, the u.s district court for the northern district of new york found that warters continually did not meet the academic performance and professional expectations of the msw program and that the decision made to dismiss her was sound (warters v. laura et al., 2013). professional and technical standards are further complicated when students present with behavioral health issues that are potentially addressed through disability law, creating tensions between program standards and disability claims. in neal v. university of north carolina and east carolina university (2018), the student’s behaviors led to her dismissal from her professional program. here, the plaintiff (olivia neal), a young woman with bipolar disorder, claimed that her dismissal from an msw program violated the ada and the rehabilitation act, as well as a breach of contract claim under state law. neal further argued that her dismissal resulted in economic damages due to her inability to find employment, as well as non-economic damages related to the emotional distress and embarrassment she suffered as a result of her dismissal from the msw program. importantly, and unique to most of these cases, is that the court did find viability in some of the plaintiff’s claims. in this case, faculty and a field instructor raised concerns about neal’s behaviors and mental health, including her ability to complete the program successfully, as they witnessed manic episodes. during an interaction with a professor, it was noted that neal “experienced a degree of mania, and her communications were dissociative and garrulous” (neal v. university of north carolina and east carolina university, 2018). the defendants did not claim that her psychiatric disability played a role in her dismissal, but rather, her unprofessional conduct. however, the federal court for the eastern district of north carolina ruled in favor of the plaintiff and found that the school considered the plaintiff’s mental health status as a “motivating factor” in the decision to dismiss her from the schwartz & curran/technical standards in swk ed 171 program. the defendants claimed that they dismissed neal because of her unprofessional conduct, not her disability. faculty correspondence in this case revealed that neal’s mental health concerns were one of the reasons for her dismissal, and that faculty who shared similar concerns about students without documented mental health issues would not necessarily dismiss those students (for the same behavioral reasons). the court ruled for the plaintiff and determined that based on feedback neal received from both her field placement and others within the school of social work, that she could meet the school’s expectations for professionalism. the court also agreed with neal’s claim that her rights under ada may have been violated and did not dismiss these claims, as the plaintiff was able to return to both her field placement and courses without relapse or any other incidents after being diagnosed with and receiving treatment for bipolar disorder. finally, the court also permitted neal’s breach of contract claim, but specifically focused on the processes that should have been followed (and were not) by the academic and retention committee (neal v. university of north carolina and east carolina university, 2018). this demonstrates that schools must ensure that standards have clear associated policies and procedures outlined and implemented with fidelity, including due process for students. discussion collectively, the above cases as well as extant discussions of technical standards demonstrate the need for: 1) appropriate and legally sound and behaviorally focused standards; 2) effective dissemination of and fidelity to clearly articulated procedures around admittance and dismissal, which include the procedural due process rights of appropriate notice, the opportunity to be heard, and decision-making by a neutral body (wayne, 2004); and 3) the provision of reasonable accommodations when appropriate. in their review of challenges and strategies for accommodating students in professional clinical programs, babbitt and lee (2016) argue that programs should include behavioral components in their academic and technical standards. this involves both training students in the professional and ethical behaviors required for certain professions, as well as assessing that such behavioral standards are met (babbitt & lee, 2016). as described in the neal case, the school focused on the student’s mental health and psychiatric disability, rather than on problematic behaviors, leading to upheld discrimination claims. hylton et al. (2017) emphasize that the focus of a remediation plan/process for students must be on the identified performance or behavioral issue – not necessarily the “cause” or reason for the behavior (i.e., not an underlying mental health condition). as previously discussed, technical standards in social work typically encompass behaviors, such as emotional management, or professional communication, or commitment to social justice that are difficult to operationalize; yet in order to protect due process and guard against bias due to mental health (holley et al., 2020) and other forms of bias and predictive thinking, operationalization of concrete and specific behaviors is key. these are essential to upholding professional ethics, including the profession’s commitment to social justice. ensuring procedural fidelity which helps ensure due process (i.e., notice, the right to be heard, and decision-making by a neutral party) for students is critical for the successful advances in social work, spring 2022, 22(1) 172 implementation of technical standards in professional programs including social work. in many of the cases discussed above, some level of committee or administrative review was present and claims emerged charging schools with failure to follow their own internal process particularly when faced with remediation steps or program dismissal. social work’s professional focus on individualization, including the individualization of student needs, can inadvertently undermine due process procedures. recognizing distinctions between technical standards,professional codes of ethics, professional standards, and other student codes of conduct also need to be considered. while technical standards are the nonacademic criteria needed for a student to participate in a program (blacklock & montgomery, 2016), there still seems to be some level of disagreement regarding what other components might be referenced within a technical standards document, and when each may be applied. as seen in the cases above, professional conduct and behavior often arise in situations related to student dismissal. schools of social work need to ensure they are carefully crafting the necessary requirements for participation in programs – with a clear process for what occurs when various standards are not met. staff/faculty training as well as the designation of an internal monitor can help ensure procedural fidelity and due process. effective and consistent dissemination of policies and related procedures are also fundamental to due process and for the protection of students’ rights (wayne, 2004). for example, students might acknowledge standards upon admission, prior to the start of clinical components, and at varying points in the program through orientation, student handbooks, website content, and other communication channels. administrators tasked with developing technical standards, policies, and processes should consult with university legal, disability services offices, and other clinical schools within the university to ensure development and implementation of such processes is sound (babbitt & lee, 2016). as educational institutions and social work programs seek to be inclusive, they will need to closely consider both the legal and ethical implications of developing technical standards that may exclude classes of individuals, particularly those with disabilities. in their review of existing technical standards in nursing programs, ailey and marks (2016) argue that technical standards may create barriers for individuals with disabilities. they propose a new model of technical standards for nursing education, focusing on diversifying applicant pools to consider students with disabilities and their role in rehabilitative nursing. looking at technical standards in allied health professions, ferro-lusk (2017) and kezar et al. (2019) similarly argue for inclusive language that is welcoming to students with disabilities. gonzalez and hsiao (2020) explore how one nursing program, in consultation with disability experts, adapted their technical standards for admission to the program, focusing more on standards of performance that focus on the skills needed to practice nursing safely, rather than individual physical or mental qualifications. they also identify several nursing settings where those with disabilities could meet standards, arguing that nursing programs need to think more broadly about who can be awarded admission, and the different settings they may thrive in with appropriate accommodations (gonzalez & hsiao, 2020). schools of social work may ask themselves similar questions: should technical standards and associated qualifications be the same across settings or might they schwartz & curran/technical standards in swk ed 173 differ, perhaps, across different settings (for instance, micro/clinical vs. macro field education settings). insofar as social work technical standards address interpersonal relations and skills, standards need to refrain from invoking reference to vague concepts such as “emotional well-being” that may serve as a euphemism for a behavioral health diagnosis and instead articulate observable behaviors. todd et al.’s (2019) review of social work educators’ response to students with behavioral health disabilities employs a critical disability studies framework. arguing that us social work programs are overly reliant on a medical model of disability and overly reactive in their response to students’ mental health issues, they advocate for a set of inclusive practices, beginning at admissions, that can uphold the rights of students with mental health disabilities and support them while balancing program’s gatekeeping functions. however, the authors fail to address technical standards policies in their critique. we believe technical standards policies, when well-crafted and appropriately implemented, can fulfill social work programs’ gatekeeping role while simultaneously reflect the profession’s commitment to inclusivity and social justice. finally, as alluded to earlier, there is also a critique of professionalism that suggests arguing that cultural, gendered, and racial power relations underscore this construct (cheney & ashcraft, 2007). a recent well-publicized case surrounding the (eventually reversed) dismissal of a doctoral student at the university of tennessee’s health sciences center’s college of pharmacy due to personal social media posts unrelated to her program participation raised a national conversation as to whether black and white students are held to differential standards of professionalism and whether a white, female student would have faced dismissal for similar actions (anderson, 2021). carefully developed standards that are vetted and implemented by a diverse group of faculty and administrators and define professionalism through concrete, observable behaviors can potentially guard against racial and other forms of biases and enhance equity and inclusion. moving forward, additional research can more systematically examine the presence and use of technical standards at schools of social work, including common challenges around their development and implementation. further discussion and examination of “professionalism” and the term’s operationalization within social work is also needed to ensure transparent technical standards. while cswe currently requires schools to articulate policies and procedures for evaluating and terminating students based on professional performance (cswe, 2015), it does not explicitly require or recommend that programs develop technical standards. given the salience of technical standards in upholding non-academic criteria and protecting students’ rights to reasonable accommodations, cswe may also want to consider requiring technical standards like some other accreditation bodies in health professions or through providing more explicit guidance. the development of technical standards is surely a challenging and complex task that involves many layers of higher education administration. investment in their development is, however, likely worthwhile. technical standards are one of the most important tools that social work educators can draw on to manage the delicate and often difficult balance between serving as student-focused educators and professional gatekeepers. advances in social work, spring 2022, 22(1) 174 references accreditation council for pharmacy education. 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(2019). responding to student mental health concerns in social work education: reflective questions for social work educators. social work education, 38(6), 779-796. https://doi.org/10.1080/02615479.2018.1563591 warters v. laura et al., no. 3:10-cv-850 (gls/dep), 2013 wl 371661 (n.d.n.y. jan. 29, 2013). wayne, r. h. (2004). legal guidelines for dismissing students because of poor performance in the field. journal of social work education, 40(3), 403-414. https://doig.org/10.1080/10437797.2004.10672296 zerden, l. d. s., naylor, s. m., thomas, s., brigham, r. b., & bailey, t. (2019). defining the minimum expectation of msw students: implementation and application of technical standards. journal of social work education, 57(3), 534-544. https://doi.org/10.1080/10437797.2019.1671269 author note: address correspondence to rachel schwartz, school of social work, rutgers, the state university of new jersey, 120 albany street, tower one, suite 200, new brunswick, nj, 08901. email: rschwartz@ssw.rutgers.edu acknowledgments: thank you to barbara lee and michael klein for their feedback and legal expertise. https://doi.org/10.1080/02615479.2018.1563591 https://doig.org/10.1080/10437797.2004.10672296 https://doi.org/10.1080/10437797.2019.1671269 mailto:rschwartz@ssw.rutgers.edu technical standards in social work education: what they are and why they matter rachel schwartz laura curran abstract: following larger developments within professional education, schools of social work have increasingly adopted technical standards as non-academic criteria for program admission and continuation. this paper examines the emergence of technical... keywords: technical standards, social work education, gatekeeping, disability accommodations, professional behavior defining technical standards what technical standards are not moving forward, additional research can more systematically examine the presence and use of technical standards at schools of social work, including common challenges around their development and implementation. further discussion and examination of “... references _________ jeremiah w. jaggers, phd, msw, assistant professor, aurene wilford, research analyst, ileana anderson, student, and jaonna bettman phd, lcsw professor, college of social work the university of utah, salt lake city, ut. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 100-115, doi: 10.18060/24249 this work is licensed under a creative commons attribution 4.0 international license. perceived effectiveness of parent representation social workers by legal professionals involved with indigent defendants jeremiah w. jaggers aurene wilford ileana anderson joanna bettmann abstract: the total number of children in the u.s. foster care system exceeds 428,000. previous research indicates that when social workers and legal professionals work together, children and their families benefit significantly. parents who effectively engage in the child welfare system are more likely to benefit from services and reunify with their children. the present study employed a phenomenological approach to explore how a parent representation pilot, which paired social workers with public defenders to better represent the needs of families in the child welfare system, was experienced by legal professionals. judges and family court attorneys (n = 9) found the program to be helpful in reunifying families. public defenders were able to leverage the social worker’s skills and experience to facilitate more positive outcomes, while reducing case burden. challenges were also identified and included a lack of interdisciplinary training, potential overlap in ethical responsibilities, and role confusion. structured intervention programs that encourage collaboration between social workers and legal professionals may improve case outcomes for indigent families involved in the child welfare system. it is advised that social work undertake a formal multidisciplinary approach in support of public defenders, which may serve to encourage positive case outcomes. keywords: child welfare; parent representation; social work; indigent defendants; foster care the total number of children under the age of 18 in the u.s. foster care system exceeds 428,000 (annie e. casey foundation, kids count data center, 2019). national data indicates there were 4.1 million reports of child maltreatment in 2017 involving 7.5 million children; of those, 2.3 million reports had sufficient evidence and needed further investigation (u.s. department of health and human services, 2017). such cases entail the whole family becoming involved in social services and the child welfare system. in an effort to reduce the number of youth in out-of-home placements, states like utah have employed innovative strategies like the parent representation program (prp) pilot, which partners social workers with legal professionals (e.g., prosecuting attorneys, judges) in the child welfare system. the collaboration between the two professional fields is considered essential to successful outcomes for families (buchanan & orme, 2018; carnochan et al., 2007; han et al., 2007; pott, 2017). previous research indicates that when social workers and legal professionals work together, children and their families benefit significantly (pott, 2017). the improved outcomes may be due, in part, to social workers’ specific skill set (carnochan et al., 2007; geurin et al., 2013; han et al., 2007; pott, 2017). rather than focusing on legal processes, social workers focus on helping each child to achieve the best about:blank jaggers et al./perceived effectiveness of prp 101 possible outcome (geurin et al., 2013; pott, 2017). it is vital for parents to have legal representation and guidance in court hearings as they often do not have a comprehensive understanding of the juvenile dependency system. parents frequently face informational and cultural barriers, which may contribute to parents feeling alienated and disempowered in the legal process (barsky, 1996). without proper guidance, parents cannot best advocate for themselves in court proceedings (wood et al., 2016). social workers working alongside parents can help them bridge this gap and navigate the complicated court system. literature review child welfare case outcomes have been shown to improve when a multidisciplinary team (mdt) is involved in the case (bracewell, 2018; pott, 2017). although the team members included in each mdt vary, the team typically includes a social worker as well as a legal representative who collaborate on each child welfare case (bracewell, 2018; pott, 2017). studies of mdts found that when social workers and legal professionals collaborate as a team, the likelihood of family reunification and case resolution increases, while the likelihood of prosecution and out-of-home placements decreases (bracewell, 2018; courtney & hook, 2011). when there is a strong relationship between professionals on the mdt, children are more likely to be placed with relatives when they must be removed from the home. several studies demonstrate that children who remain in kinship care placements have lower incidents of behavioral issues compared to children who enter the foster care system (e.g., rubin et al., 2008; ryan et al., 2010). parents who effectively engage in the child welfare system are more likely to benefit from services and reunify with their children. hence, the utah indigent defense commission (idc) prp pilot was developed with three main goals: 1. to increase the capacity and efficiency of parental defense attorneys by including social workers on child welfare cases, 2. to achieve better outcomes by connecting court-involved children and their families to services and treatments, and 3. to achieve faster case resolutions and reduce the need for attorney continuances. a pilot study conducted in washington found that when indigent parents received enhanced parental representation, the rate of family reunification increased significantly to 68% (courtney & hook, 2012). the same study also found that prp pilot implementation resulted in an expedited judicial process regarding permanency placements for children in state care. in cases where family reunification was not possible, the prp social worker's involvement increased the likelihood that the parents would agree to an out-of-home placement more quickly. although the literature suggests that when social workers and legal professionals collaborate child welfare cases have more favorable outcomes, there is a well-documented history of conflict and strained relationships between legal professionals and social workers within the child welfare system (buchanan & orme, 2018; carnochan et al., 2007; courtney & hook, 2012; geurin et al., 2013; han et al., 2007; pott, 2017). although many advances in social work, spring 2021, 21(1) 102 studies document the existence of conflict between the two professional fields, to date, there have only been a few studies which examined this conflict’s origins (han et al., 2007). several factors contribute to the conflict and poor relationships between social workers and legal professionals, including cultural differences between the two professions, low pay and professional status in both professions, and lack of interdisciplinary training and role definition (carnochan et al., 2007; han et al., 2007; johnson & cahn, 1995; pott, 2017). these factors can lead to a lack of respect and trust between the two professional groups, as well as poor communication and information flow (carnochan et al., 2007; han et al., 2007). cultural differences cultural differences between the two professional fields can lead to strained relationships between legal professionals and social workers (carnochan et al., 2007; han et al., 2007; pott, 2017; steen, 2020). the cultural differences originate from a difference in perspectives, professional expectations, and mandates. while social workers typically emphasize a collaborative approach, the legal profession exists in an inherently adversarial setting (carnochan et al., 2007; han et al., 2007). social workers view clients from an ecological perspective, viewing each client within their particular social, political, and cultural contexts and systems. systems theory informs this social work perspective, viewing clients’ behaviors as embedded within their contexts and impacted by multiple systems (greene, 2017). by contrast, legal professionals tend to focus on clients’ individual rights and view the actions of an individual apart from their environment (carnochan et al., 2007). according to the american bar association's model rules of professional conduct, lawyers are responsible for upholding the quality of justice (american bar association [aba], center for professional responsibility, 2019). legal professionals’ conduct must conform to the law and demonstrate respect for the legal system. as the legal representative, the lawyer is expected to be competent, timely, and thorough. lawyers are expected to improve the law as well as improve access to the legal system for all citizens. additionally, lawyers must adhere to the profession's ideals of public service and the promotion of justice. legal professionals are relatively autonomous, and thus have the responsibility of self-regulation and self-governance in the public interest (aba, center for professional responsibility, 2019). the social work profession similarly has a code of professional conduct to which all social workers are expected to adhere (national association of social workers [nasw], 2017, preamble). however, the primary mission of the social work profession is to promote the well-being of all people, particularly the most vulnerable populations. social workers are expected to promote social justice and social change. the nasw code of ethics requires social workers in the child welfare system to understand the legal profession (carnochan et al., 2007). according to the nasw code of ethics, social workers are expected to practice with competence and be knowledgeable in their area of focus (nasw, 2017). although legal standards do not require lawyers to have familiarity with the social work perspective, the aba's model rules similarly promote competence (aba, center for jaggers et al./perceived effectiveness of prp 103 professional responsibility, 2019; carnochan et al., 2007). lawyers who work with child abuse victims must consider the emotional and physical factors that contribute to each case, even though such factors may not necessarily align with broader legal culture and education. pay and professional status family court is often perceived as a low-status setting in the legal system (carnochan et al., 2007; han et al., 2007). lawyers and judges in family court cycle through the court quickly; this pattern is similar to the social work profession where there is also a high turnover rate, especially among child welfare workers (carnochan et al., 2007; han et al., 2007; lizano & mor barak, 2015; travis et al., 2016; willis et al., 2016). an exploratory study found that the high turnover of legal professionals and social workers is a strong predictor of the effectiveness of inter-professional communication and collaboration (han et al., 2007). when communication is interrupted, child welfare professionals perceive cases to be more difficult. the high turnover rates of social workers and legal professionals in the child welfare system makes it challenging for social workers and legal professionals to develop strong relationships, often resulting in overrepresentation of inexperienced staff within the child welfare system (carnochan et al., 2007; han et al., 2007). there is a substantial lack of resources for both public defenders and social workers working in the child welfare system. social workers in the child welfare system and public defenders are overburdened and underpaid, leading to the perception that they are at the bottom of the court hierarchy (boyas & wind, 2010; carnochan et al., 2007; depanfilis & zlotnik, 2008; han et al., 2007; lizano & mor barak, 2015; porter, 2017; travis et al., 2016). lack of interdisciplinary training and role definition the lack of interdisciplinary training is another factor contributing to the conflict between legal professionals and social workers (carnochan et al., 2007; han et al., 2007; johnson & cahn, 1995). there is a substantial lack of understanding of the other profession’s role in the child welfare system (carnochan et al., 2007; han et al., 2007; johnson & cahn, 1995). lawyers surveyed in several studies report that social workers would benefit from more training on the adversarial process, including gaining a better understanding of legal definitions and the legal process (carnochan et al., 2007; johnson & cahn, 1995). similarly, social workers surveyed recommended that legal professionals would benefit from more training on social work values and principles (carnochan et al., 2007; johnson & cahn, 1995). one study found that attorneys want social workers to be more objective and that social workers want attorneys to be less adversarial and allow more time for counseling (carnochan et al., 2007). notably, research shows that when social workers and legal professionals receive interdisciplinary training, the friction between the two professions decreases (bracewell, 2018). the existing research suggests that inter-professional collaboration between legal professionals and social workers correlates to positive case outcomes in the child welfare advances in social work, spring 2021, 21(1) 104 system (bracewell, 2018; carnochan et al., 2007; courtney & hook, 2012; geurin et al., 2013; han et al., 2007; pott, 2017). thus, the present study sought to explore how a program which paired social workers with public defenders to better represent the needs of families in the child welfare system was perceived by legal professionals. since these types of programs are relatively new, there is a dearth of research on this topic, especially as it relates to multidisciplinary collaboration. method setting the primary aim of this study was to evaluate legal professionals’ (judges and attorneys) perceived effectiveness of the prp pilot and to inform future expansion of the program, including additional needs related to training and policy. a process evaluation was conducted to ascertain how the social worker was utilized, what role they took in court proceedings, and to explore the perceived efficacy of having social workers collaborate with public defenders who represent parents in child welfare cases. for simplicity, we refer to the “social worker” as the individual working with the public defender, while “child welfare worker” refers to state employees charged with overseeing the safety of children who are involved with the child welfare system. the utah indigent defense commission (idc) was established in 2016 to provide oversight and direction to the state’s public defense agencies. one of the newly created agency’s initiatives is to enhance the representation of indigent parents alleged to have committed abuse or neglect (utah idc office, 2017). to this end, the prp pilot paired social workers with public defenders to better represent parents and enhance services already provided by the utah division of child & family services (dcfs), the state’s child welfare agency. ethics appropriate materials were submitted to the university of utah institutional review board. a waiver was provided by the overseeing committee since the research was considered program evaluation. sampling procedures and justification recruitment occurred through collaboration with court administration. study information, including informational flyers were provided to the court administrator and the director of the public defenders’ office. information was then disseminated to potential participants, which included public defenders, attorneys general, and judges. interested participants notified the court administrator, the public defender’s office, or members of the research team. as part of the prp pilot evaluation, nine individual interviews were conducted. interviews were conducted with all juvenile court judges (n = 3), all assistant attorneys general (aag; n = 3), and approximately three-quarters of public defenders (n = 3) in the region. given the limited sampling frame and the potential threats to anonymity, additional information on the participants has been excluded. jaggers et al./perceived effectiveness of prp 105 the final sample size was adequate for addressing the study’s aim. several researchers have suggested that fewer than 10 participants is necessary when conducting qualitative inquiry (creswell, 1998; moser & korstjens, 2018). others have argued that saturation, not specific a priori recruitment goals, should be used to determine a final posterior sample size (vasileiou et al., 2018). saturation is defined as the point at which the data no longer offer any new or related information (dworkin, 2012). simply put, “when gathering fresh data no longer sparks new theoretical insights, nor reveals new properties of your core theoretical categories” you have reached saturation (charmaz, 2006, p. 113). while endorsing this approach, smith and osborne (2003) emphasize that, in cases where the topic being researched is limited, such as pilot studies, sampling guidelines may not be applicable (c.f. smith et al., 2009). since almost all legal professionals involved in indigent cases within this region were interviewed, saturation was achieved. design and analytic approach after consultation with idc personnel, the research team determined that a qualitative descriptive approach was most appropriate. using a qualitative approach and through semistructured interviews, the researchers aimed to understand individuals’ perceptions of the prp pilot. this was an iterative process where codes and themes were identified, across all interviews, using thematic analysis (braun & clarke, 2006). this process required familiarization with the data and listing peoples’ ideas, beliefs, or experiences as codes. further, sorting the data and organizing the data into themes and sub-themes, then consensus coding with other analysts occurred. semi-structured interviews were used to collect data from individual participants. this afforded researchers the opportunity to focus on collecting data about specific topics, while permitting the flexibility to explore other relevant areas that arose during the interview. a priori topics of interest included in the interview were questions of process (e.g., “how are clients referred?”; “what information is shared with the dcfs case worker?”), legal ethics, and multi-disciplinary collaboration. the establishment of rapport and empathy is essential to gaining depth of information, particularly when investigating issues where the participant has a strong personal stake (gorden, 1969; measor, 1985; plummer, 1983). thus, interviews began with a brief discussion about the participant’s role in child welfare cases and their specific responsibilities. participants were then asked about their involvement with the prp pilot, specifically as it pertained to involvement with the prp social worker. each individual interview was recorded and transcribed using dragon speech recognition software v15 (nuance, n.d.). researchers then manually reviewed each document to correct errors in transcription, and when necessary, to highlight areas emphasized by the participant. then, researchers coded each transcript independently. specifically, researchers focused on identifying themes relevant to each individual’s experience with the prp pilot. after individual coding, research staff met and engaged in a consensus coding process. the purpose of the consensus coding was twofold. first, it was necessary to identify areas of overlap. second, the researchers engaged in a decisionmaking process based upon their areas of methodological and substantive expertise (c.f. advances in social work, spring 2021, 21(1) 106 elliott, 2018). subsequent to this process, the researchers finalized codes for each constituent group. data were triangulated using two approaches: source triangulation and analyst triangulation (denzin, 1978; patton, 1999). first, a comparison was made among people with potentially differing views of the program, namely judges, assistant attorneys general, and public defenders. each group was found to have a unique perspective on the program, with limited convergence. excessive convergence is a limitation to qualitative research trustworthiness (heale & forbes, 2013). in this instance, the limited convergence was deemed to be appropriate since all three groups work in a similar environment (the court system) and were trained in an identical fashion (all were lawyers). second, analyst triangulation was used as part of the consensus coding process. analyst triangulation entails using multiple analysts to review the findings of others involved in coding the raw data (patton, 1999). in the current study, three analysts were responsible for coding the data individually and independently. during the consensus process, each analyst was given the opportunity to review and critique the results of other analysts. the consensus process yielded a set of structured codes that originated from the repeated individual codes provided by all three analysts. results for the prp pilot, nine legal professionals were recruited; interviews were conducted with juvenile court judges (n = 3), assistant attorneys general (aag; n = 3), and public defenders (n = 3). it should be noted that not all sub-themes applied to each group equally. we have contextualized the findings based not only on the program, but how each group viewed the prp pilot to emphasize individual and collective experience. what follows is a description of the findings, with sample quotes provided. in the following sample quotes, the social worker’s name has been removed and replaced with “[the social worker]” where necessary. expertise, the court process, and contextualization judges expressed confidence in the social worker’s abilities to represent the parents. this was, in part, due to the social worker’s long-time exposure and experience with the child welfare system. one judge stated: …i have a lot of trust in her because i know her work is done well and i think she has the ability to work well with clients to provide them the help they need to better understand the process. judges also recognized the social worker’s role in advocating for the parents and in guiding them through the court process. one judge expressed concern about expanding the program, saying this social worker had “unique skills, and may be extraordinary among social workers.” in addition, the judges perceived the social worker to have a positive impact on case outcomes, with one judge stating: jaggers et al./perceived effectiveness of prp 107 …so i think the cases she is assigned to, the parents are more engaged in the services and there are more positive outcomes. a second judge echoed this by saying: [the social worker] provides another piece of information. the more information i have, the better decisions that i make, so anytime i have a social worker that is able to provide additional information, it’s going to have an impact on my decisions. in general, the judges saw the social worker as having a positive impact on case outcomes. the judges reported that the social worker was able to provide additional context and support to the parents, which was seen as a critical part of their role in the process. role confusion and conflict this section includes information provided by the assistant attorneys general (aags) when asked about the prp pilot. the court system has a well-established hierarchy that has existed for generations. inserting a social worker into the naturally adversarial environment common in the court system resulted in a tension that did not exist prior to the prp pilot. that tension was obvious in the interviews, as aags often expressed frustration around the social worker’s role in the process. one attorney said: the challenge for me is i don’t know the exact outline of what that particular role [the social worker’s role], how it overlaps with the dcfs [the division of child & family services] case worker, what [social workers] can and cannot do. so it was never explained to me. in addition, aags expressed confusion about attorney-client privilege and the social worker’s ethical obligations. clients can share information with their attorney, but does the confidentiality associated with those exchanges extend to the social worker who must follow state laws and nasw ethical guidelines? one aag summarized the concern by saying: i think that the public defender would not want [the social worker] to be identified as a paralegal who is assisting in the legal process. they might not want her to be identified as a therapist because there are some protections for therapeutic roles… still, they saw the social worker as having a significant influence on case outcomes. one aag said: [the social worker] does a fantastic job of assisting parents through the system… but there is often an oppositional position between the state and the parents we are trying to help. in speaking of the social worker as an advocate, the aag continued by saying: we have some parents [pause] who need extra explanation, or they are not very literate, and having someone else there to assist them can be helpful – giving extra guidance to the parent. advances in social work, spring 2021, 21(1) 108 overall, the aags felt the social worker was helpful to parents, but were uncertain about the social worker’s role in the legal system’s ethical and practical infrastructure. social worker utility this section includes information provided by the public defenders (pds) who work directly with the social worker in representing the interests of the parents. most of those interviewed had never worked directly with a social worker before. in fact, many had only engaged with dcfs case managers within the courtroom. thus, the utility of the social worker was a major point of discussion. in an excited tone, one pd summed up the social worker’s importance by saying: if we had the resources i would recommend a social worker on every case. [the social worker] is so helpful. first of all, [the social worker] helps them [clients] understand the process. second of all, [the social worker] helps them understand the [dcfs] case worker and her particular case. this is what we need to focus on. ‘here's what the caseworkers looking at. here's what you need to do based on the adjudication you know, based on these services you have gotta focus on right?’ and finally she's just a person who is available more often, i hate to say, than the [dcfs] attorney. she is someone you can always call, you know. she can talk to me, the attorney, and be liaison between all that, and, you know i do not know what i would've done without her in several cases now. another pd echoed this sentiment by saying: i would say it is her more frequent visits with the clients than the attorneys have…she gets to know them better and she can relay pertinent information to the attorneys and they can deal with it on the legal side. one point raised by the pds was the social worker’s role in reviewing cases and preparing court reports, which substantially relieved part of the pds work in any given case. enthusiastically, one pd said: [the social worker] is a documenter, she is able to say ‘hey you know what, yes, i was there when your attorney told you this, that, that and i heard it, and i know it, and i told you the same things’ with those clients, i’m so glad she's involved with those cases. she is the third person who documents everything. while there was some concern that the social worker is another moving part of an already complicated, adversarial system, they were more often regarded as playing an integral and positive role in helping families navigate the court process. the pds expressed admiration and support for the social worker’s role, even suggesting that the program be expanded into additional regions within the state. the social worker was able to provide in-depth services that the pds did not have the time to provide themselves. the pds reported that they relied on social workers to connect with families on a regular basis, and to provide any additional information that they needed to know. jaggers et al./perceived effectiveness of prp 109 discussion the present study aimed to evaluate how legal professionals perceived the effectiveness of the prp pilot to inform future expansion of the program. the prp pilot paired social workers with public defenders. any mention of social workers reflects those social workers who collaborated with legal professionals. this study focused on how legal professionals perceived the social workers’ involvement in child welfare cases. overall, results demonstrate that legal professionals perceived that social workers positively influenced case outcomes. family court judges observed that cases with an assigned social worker had more positive outcomes compared to cases without an assigned social worker. this finding was echoed by one judge who indicated that social workers were able to provide additional information relevant to the case, further enhancing their decision-making capacity. judges highlighted trust as a major component of social workers’ contributions. on multiple occasions, the judges reported being able to trust the prp social workers due to their skills and expertise. however, the judges also expressed hesitation about the expansion of the prp pilot, since other judges may have to rely on less experienced social workers. public defenders similarly expressed support for the social worker’s role in cases and suggested that the program be expanded into additional regions within the state. the pds also suggested that the social worker’s assistance in reviewing cases and preparing court reports significantly lightened their workload. these findings build upon existing studies (bracewell, 2018; carnochan et al., 2007; geurin et al., 2013; han et al., 2007; pott, 2017), which found that collaboration between legal professionals and social workers correlates with positive outcomes in child welfare cases. the aags also cited social workers as helpful and having a significant influence on child welfare case outcomes. the aags, however, were concerned with role confusion between legal professionals and social workers. they expressed confusion about attorneyclient privilege and the social worker’s ethical obligations regarding confidentiality. specifically, the pds’ ability to withhold privileged information is not shared by social workers who must report suspicions about child maltreatment. this finding is consistent with previous research that role confusion and a lack of understanding of the other profession’s role in the system was an important issue in professional collaboration (carnochan et al., 2007; han et al., 2007; johnson & cahn, 1995). the aags in this study perceived tension between social workers and pds which initially arose when social workers joined the public defense team. this finding is supported by previous studies that point to professional tension attributable to the court’s hierarchy and adversarial environment (carnochan et al., 2007; lizano & mor barak, 2015; travis et al., 2016). pds expressed a great deal of gratitude for the social workers’ support. this finding may indicate that, while there was strong collaboration between pds and social workers, tension and conflict extended into the courtroom. a lack of interdisciplinary training may contribute to strained relationships. notably, social workers often frame client behaviors using the lens of systems theory (greene, 2017), while legal professionals rely on the framework of the law. these diverse theoretical orientations, as advances in social work, spring 2021, 21(1) 110 well as differences in professional training and orientation, may account for some of the tension between workers from these two professions. therefore, social workers involved in the child welfare system would likely benefit from additional legal training (bracewell, 2018; carnochan et al., 2007; han et al., 2007; johnson & cahn, 1995), and legal professionals may benefit from training on social workers’ specific roles, theoretical orientation, and obligations. notably, the present study did not find a perception of cultural differences between the two professional groups as a cause for tension in those relationships. this finding differs from other research (carnochan et al., 2007; han et al., 2007; pott, 2017) which found cultural differences between the two professional groups can lead to strained relationships. it is possible that the nature of the child welfare cases may be a consideration here. both social workers and public defenders serve to support individuals in poverty. in this specific instance, those impoverished individuals are facing significant legal challenges. incorporation of a social worker into the public defense team may serve to enhance the public defender’s effectiveness, thus mitigating cultural differences. the present study bolsters the argument for further integration of public defense social workers in child welfare cases (bracewell, 2018; carnochan et al., 2007; geurin et al., 2013; han et al., 2007; pott, 2017). this multi-disciplinary team approach appears to produce more positive case outcomes. additional research is needed to understand the child welfare outcomes of the prp pilot. collaboration between social workers and legal professionals is necessary for the child welfare system to function effectively. likewise, improved inter-professional collaboration is essential to the child welfare system’s success. the present study similarly found that collaboration between social workers and legal professionals appears to improve child welfare case outcomes and thus should be expanded. limitations the present study carries several important limitations. the small sample size for the study poses one limitation. thus, the results should not be generalized to all populations. additionally, this study was conducted in one urban area in a large western state; the interpretation of the data should not be generalized across all states, or across regions within the state. the present study should be replicated in a range of states with different demographics to identify region-specific issues. in addition, it is important determine the efficacy of the prp pilot. the present study focused on process and perception of efficacy, but future quantitative approaches are advisable. future research is also needed to determine the specific training needs for social workers in these roles. implications for practice this study supports the notion that policy changes, such as requirements for mdts to include a parent social worker, and multi-disciplinary training can have a significant positive impact on the child welfare system. collaboration between social workers and legal professionals is linked to positive case outcomes. the social workers’ assistance with jaggers et al./perceived effectiveness of prp 111 the pds’ workload may be one contributing factor; overwhelmed pds may have more time to dedicate to each case when they collaborate closely with social workers. attention should be given to the divergent responsibilities and ethics of each profession. social workers involved in the child welfare system should receive legal training so they are better prepared to support clients through the legal process. similarly, legal professionals involved in child welfare cases could benefit by receiving training on social work principles and ethics, so they are likewise better prepared to support the clients in cases with embedded social workers. the social work profession’s focus on liberating people in poverty from social programs and policies that have a disparate, negative impact on them is a seminal component of social work practice and aligns well with the role of pds. the public defender system is designed to provide legal representation to individuals who cannot afford an attorney—most often those clients live in poverty (c.f. gideon v. wainwright, 1963). legal representation of impoverished individuals and families may not be as effective given the extraordinary case burdens of pds. through collaboration with social workers, parental representation could be more effective, reduce case duration, and improve child welfare case outcomes. expansion of the prp pilot and other similar collaborative programs would likely result in a significant structural shift. historically, the child welfare system has not appointed non-agency social workers to work directly with individuals in collaboration with assigned legal representatives (pott, 2017). child welfare workers are almost always the only individual responsible for guiding parents through the court process. a focused effort on expanding prps is likely to provide additional support to parents who may not trust or want to work with child welfare workers in what is frequently an adversarial relationship (pinkney, 2013). such structural changes will not arise in a progressive and natural fashion. social work’s mission can extend into the courtroom by incorporating multi-disciplinary training. such trainings could enhance the partnership between lawyers and social workers. similarly, social workers should advocate for policy change such as additional funding to hire and train social workers to work alongside public defenders. such funding could expand available social work resources to parents and courts, thereby increasing the odds of successful family reunification. incorporating parent representation social workers in all indigent defense cases would likely increase the opportunity to enhance child well-being and family reunification. references american bar association, center for professional responsibility. 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(2016). legal representation in the juvenile dependency system: travis county, texas’ parent representation pilot project. family court review, 54(2), 277-287. https://doi.org/10.1111/fcre.12218 author note: address correspondence to jeremiah w. jaggers, college of social work, university of utah, salt lake city, ut 84112. email: jeremiah.jaggers@utah.edu https://doi.org/10.1111/fcre.12218 mailto:jeremiah.jaggers@utah.edu _______ m. sebrena jackson, phd, msw, assistant professor, university of alabama school of social work, tuscaloosa, al. alex d. colvin, phd, msw, assistant professor, texas woman’s university, denton, tx. angela n. bullock, phd, msw, associate professor, university of the district of columbia, washington, dc. qingyi li, phd, university of alabama school of social work, tuscaloosa, al. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 172-183, 10.18060/23614 this work is licensed under a creative commons attribution 4.0 international license. teaching practice skills to online msw students: the blended skills lab model m. sebrena jackson alex d. colvin angela n. bullock qingyi li abstract: as social work considers teaching practice in a fully online environment, more consideration should be given to blended or hybrid learning formats for practice course delivery. there is a dearth of literature on the use of skills labs for teaching social work practice courses, particularly using a blended or hybrid approach. using carman’s five key constructs of blended learning (live events, online content, collaboration, assessment, and reference materials), this study examined the use of a blended skills lab to teach social work practice skills online to msw students. as the number of online programs continues to expand in social work education, the blended skills lab model is examined as a case study, offering implications for others to consider as they formulate alternative models for online msw students. a blended skills lab model takes full advantage of the benefits of each platform--online and face-to-face--in order to provide an educational opportunity that can promote student learning better than either platform alone. keywords: blended learning; hybrid learning; skills labs; practice skills; social work; online education online education in social work has significantly expanded over the last two decades. several factors have contributed to the growth of online education in social work, including the availability and use of new technologies, a changing student population, an increased societal focus on lifelong learning, and growing educational requirements for professional licensing and career advancement (coe regan, 2016; hitchcock et al., 2019). covid-19 has further contributed to the growth in online education as many programs had to make a sudden shift to using digital platforms as campuses shut down around the world. research suggests that online learning has been shown to increase retention of information, and take less time, so the changes coronavirus have caused might be here to stay (li & lalani, 2020). online courses provide opportunities for widening and expanding access to social work education (kurzman, 2013). this growth of online education within social work can also be seen as an effective response to the need for an increased workforce of social work professionals. according to the bureau of labor statistics (2018), overall employment of social workers is projected to grow 16% from 2016 to 2026. according to the council on social work education (cswe) annual survey of social work programs (hitchcock et al., 2019), 22.9% of respondents indicated that their entire msw program was available online, 42% responded that part of the msw program was available online, and 13.9% stated that they were either developing online courses or would https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2020, 20(1) 173 have courses in operation the following year. just twelve years prior, a question regarding online programs was not even a part of the 2007 statistics on social work education report (cswe, 2008). despite the growth of online education in social work, social workers and social work educators alike continue to express concerns regarding the effectiveness of online courses (groshong et al., 2013; jones, 2015; vernon et al., 2009). concerns regarding online social work education are especially raised around the teaching of practice courses online. specifically, social work educators have expressed concerns about the effectiveness of learning practice skills solely in an online format (jones, 2015). the clinical social work association (cswa) questioned the effectiveness of online social work education to prepare social work practitioners without face-to-face instruction. concerns were raised that the relational skills and integrative knowledge essential in social work practice are difficult, if not impossible, to convey in online education formats where there is little or no in-person dialogue between faculty and students (groshong et al., 2013). these worries were also clearly expressed in a survey study by vernon et al. (2009), where a number of student respondents expressed views such as “i firmly believe practice courses should never be online” and “distance learning works best with courses that are primarily didactic; does not work well with practice” (pp. 272-273). nevertheless, a growing body of research literature confirms the effectiveness of teaching practice online (collins, 2008; cummings et al., 2015; cummings et al., 2013; jones, 2015; petracchi et al., 2005; siebert et al., 2006). collins (2008) asserted that an online format may enhance social work students’ ability to practice assessment and interviewing skills, since this technology allows students the benefit of performing in a less stressful environment. cummings et al. (2013) compared the learning outcomes of students who participated in an online graduate level evidence-based class to students who selected the traditional face-to-face class. evidence showed that online education was an effective tool for teaching social work practice skills and produced outcomes equivalent to face-toface courses. forgey and ortega-williams (2016) found no significant differences in learning outcomes of students in an online generalist practice course versus those in a faceto-face generalist practice course taught by the same instructor. as social work educators consider teaching practice in a fully online environment, more consideration may need to be given to blended or hybrid learning formats for practice course delivery. although social work programs are teaching practice skills using simulations and standardized clients (kourgiantakis et al., 2019; logie et al., 2013), there remains a dearth of literature on the use of skills labs for teaching social work practice courses, particularly using a blended or hybrid approach. the purpose of this study was to examine the use of a blended skills lab model for teaching social work practice skills to online msw students. as the number of online programs continues to expand in social work education, the blended skills lab model offers a case study that may have implications for other social work education programs to consider as they formulate new models for online students. jackson et al./teaching practice skills 174 overview of blended education courses and programs that combine internet-based and traditional face-to-face education components are often referred to as hybrid, web-enhanced, mixed mode, or blended (miller & king, 2003). the online learning consortium’s (2016) definition of blended (hybrid) online courses is one where most course activity is completed online, but there are some required face-to-face instructional activities such as lectures, discussions, labs, or other in-person learning activities. for purposes of this paper, the terms “blended” and “hybrid” are used interchangeably. blended or hybrid courses are offered by nearly four out of five (79%) public institutions of higher education in the u.s. (mcgee & reis, 2012). research suggests that blended courses can have a positive impact on efficiency, convenience, and learning outcomes (stein & graham, 2014). blended courses may enhance student satisfaction and engagement (kuo et al., 2014). when properly implemented, blended learning can result in improved student success, satisfaction, and retention (university of central florida, 2018). blended courses have proven to be popular choices for students because they allow students opportunities to have the best of both worlds, the flexibility of an online course and the benefits of the face-to-face classroom (drysdale et al., 2013). jared m. carman, a leader in instructional technology, developed an instructional design model for blended learning. applying the learning theories of keller (1987), gagné (1985), bloom (1956), merrill (2002), clark (2002), and gery (2002), carman’s framework proposes five constructs (live events, self-paced learning, collaboration, assessment, and reference materials) that are important elements of a blended learning process. live events are instructor-led learning events in which all learners participate at the same time, such as in a live virtual classroom. self-paced learning addresses learning experiences that the learner completes individually, at their own speed and on their own time, such as interactive weekly assignments, internet-based training, as well as synchronous activities, such as discussion boards, reading assignments, and quizzes. collaborations involve engagement with peers to develop problem-solving skills (carman, 2005). assessment, the fourth component of the carman model, is a measure of the learners’ knowledge and includes measurements of whether or to what extent learning has taken place. finally, reference materials or performance support materials allow students to access reference materials that enhance learning retention and transfer. this includes online videos and optional content that is not covered in a traditional class due to time constraints, such as pda downloads and pdfs. carman’s (2005) five key ingredients should be considered by social work programs in the development of blended learning courses. these ingredients may be especially helpful when developing blended skills labs to teach practice content to online msw students. in the next section, we describe how we used the key ingredients of carman’s model to build a blended skills lab. the large southern university: online msw program the university of alabama is a large, public, research university located in tuscaloosa, alabama. the school of social work (ssw) recently celebrated its 50th anniversary. the advances in social work, spring 2020, 20(1) 175 ssw offers a full spectrum of social work education: bsw, msw, dsw, and phd programs. the msw program, ranked 44th nationally by us news & world report, has nearly 500 students (us news & world report, 2019). online students comprise approximately 75-80% of the student population. students are located all over the us, with the largest numbers of students in the southeast (alabama, mississippi, tennessee, georgia). the program offers two concentrations: children, adolescents, & families (caf) and adults & families (af). blended skills lab model the online msw program is advertised as a primarily online program. students are able to complete most coursework in an asynchronous format. practice courses (2 credit hours) are offered asynchronously and require concurrent enrollment in a practice skills lab (1 credit hour). students are required to complete 3 foundation practice courses (social work practice with individuals and families, social work practice with groups, social work practice with communities) and 2 concentration practice courses (social work practice with adults mental health and models & methods of gerontological social work practice or social work practice with child/adolescent mental health and models and methods of child welfare & family services). students are registered concurrently for a practice skills lab with each practice course. the skills labs are held at regionally convenient locations around the state of alabama. skills labs are held on college campuses in each city. students are able to register for the skills lab that is most convenient for travel. the labs are held on 4 saturdays once a month from 8:00am-12noon or 1:00-5:00pm, allowing students to complete 2 skills lab courses in one day. students register for no more than 2 practice courses in the semester, therefore requiring registration for only 2 skills labs in any given semester. at most, students are required to spend one full saturday a month in skills labs. for example, students may enroll in social work practice with adults mental health skills lab from 8:00am-12noon and models & methods of gerontological social work practice skills lab from 1:00-5:00pm. practice courses are primarily taught by full-time faculty and skills labs are primarily taught by adjunct faculty. full-time faculty develop the content for both the practice courses and skills labs to ensure that the courses are in sync. instructor meetings are held at the beginning of each semester to ensure that full-time faculty and adjunct faculty are on the same page with content delivery. practice course content focuses on knowledge and theory development while skills lab content focuses on applying the knowledge and theory to practice through the demonstration of specific skills. practice course enrollment is capped at 25 students, while skills lab enrollment is capped at 15 students. in order to expand the national reach of the msw online program, a new blended skills lab model was introduced for atlanta, georgia and jackson, mississippi. the new blended skills lab model requires travel to the skills lab site only 2 saturdays during the semester. skills labs 1 (beginning of semester) and 4 (end of semester) are offered face-to-face, while skills labs 2 and 3 are held virtually. skills labs 1 and 4 follow a similar format as the alabama labs, 8:00am-12noon or 1:00-5:00pm. the virtual skills labs use a blended approach, with both asynchronous and synchronous components. the skills lab content is jackson et al./teaching practice skills 176 separated by pre-lab work, lab work, and post-lab work. the pre-lab and post-lab assignments are completed asynchronously while the lab work is done synchronously, using video conferencing software, on saturdays from 9:00am-11:30am or 1:00-3:30pm. students are expected to complete the pre-lab assignment one week prior to the synchronous lab and the post-lab assignment one week after attending the synchronous lab. students who attend the atlanta and jackson labs are also concurrently enrolled in an asynchronous practice course, similar to students attending labs in alabama. collaboration. pre-lab work gives students opportunities to collaborate peer-to-peer, which is a strength of a blended learning model (carman, 2005). for example, in the social work practice with individuals and families skills lab, students work in pairs to complete an interview assignment. students work together to identify an interview time and use video conferencing software to record the interviews. the interviews are uploaded into a cloud-based program for the instructor to review and give feedback. live events. live synchronous, instructor-led events are also an important ingredient of a blended learning model (carman, 2005). the blended skills lab model uses a live synchronous approach during virtual labs 2 and 3. during the live synchronous labs, the instructor reviews any required content completed for pre-lab work. the instructor may also divide students into groups to practice their interview skills. for example, using the video conferencing software, the instructor may move students into virtual breakout rooms to watch them demonstrate assessment skills. students can record the breakout sessions during the live synchronous lab. the instructor can give feedback as students are demonstrating the skills (instructor-student collaboration) or offer direct feedback to students by email or through the learning management system. self-paced learning. the blended skills lab model allows students to complete work online at their own pace. self-paced learning is another component of an effective blended learning model (carman, 2005). the self-paced learning is accomplished through the use of a learning management system (lms) to deliver online content to students. students are assigned asynchronous pre-lab work such as case study reviews, review of content from the practice course, or sample assessments. self-paced post-lab work may include selfreflections on the video recording of the student demonstrating a skill or reflections on skills demonstrated during the synchronous lab session. assessment. assessments are the measures taken to ensure that students successfully understand the content presented. carman (2005) sees this as a critical ingredient of learning. in this blended skills lab model, students are assessed on their ability to demonstrate specific practice skills. students can earn up to 25 points per lab. pre-lab work, such as discussion posts or video recordings of interviewing skills, is submitted for grading and instructor feedback. student skills are also assessed and graded during the synchronous lab session. post-lab work, including self-reflections on overall skill development for each lab, is also submitted for assessment. students also have opportunities to give feedback to their partner after specific skill-building exercises such as roleplays. this peer feedback is not graded. performance support. the fifth and final ingredient of carman’s blended learning model is performance support material. students have access to reference materials that advances in social work, spring 2020, 20(1) 177 enhance learning retention and transfer. within the learning management system used for this blended skills lab model, students can access additional resources such as case studies, video content, sample assessments, and other resources to support continued practice skill growth and development. students can refer back to this material at any time. students who desire additional readings or content may access additional information that the instructor is unable to cover during the synchronous sessions or face-to-face sessions. challenges of blended skills lab model implementation based on our experiences implementing a blended skills lab, we describe some of the challenges and opportunities we encountered and offer some recommendations regarding areas to consider when developing a similar blended skills lab for online msw students. although all msw online programs are different, the lessons learned may offer important implications, regardless of program size. when implementing a blended skills lab model for online msw students, multiple challenges arose, such as developing course content, identifying skills lab locations, training skills lab instructors and students to use technology, and identifying adjunct faculty to teach the skills labs. course development the first challenge was the development of the skills lab course. the blended skills lab course was developed as part of a special innovation project with the college of continuing studies (ccs). the innovation team consisted of the msw program director, the social work adjunct instructor who had taught the traditional campus-based skills labs, the ssw distance coordinator, and members of the ccs innovation team. both members of the innovation team had backgrounds in instructional technology and online education. one of the greatest challenges with course development was identifying ways to deliver the same content that was offered to students in alabama. although the method of delivery would change, faculty wanted to ensure that all students enrolled in the skills labs, regardless of location, were receiving the same curriculum content. the team reviewed each skills lab manual to determine what content from labs 2 and 3 would be best offered in an asynchronous format and what content would be best delivered during the synchronous session. this step took quite a bit of time and processing. the team also identified the best tools to use to deliver different aspects of the course content. for example, the team determined that flipgrid, a social learning platform, would be used for discussions during the asynchronous portion of the course instead of traditional discussion boards. after the first blended skills lab was developed, the course was piloted in tuscaloosa, which is where the main campus is located. the blended skills lab model was later expanded to atlanta and jackson and is only offered in these two locations. skills lab locations a second challenge in using a blended skills lab model is identifying locations for the skills labs to be held on saturdays. initially, skills labs were held in hotel conference rooms. this proved to be very expensive and did not seem to be the best educational environment for students. the decision was made to reach out to colleges/universities in atlanta and jackson regarding contracts for classrooms. the ssw distance program manager is jackson et al./teaching practice skills 178 responsible for reaching out to sites and securing contracts. the distance program manager works with event planners on each campus to coordinate contracts. the college of continuing studies pays for the rental of the classrooms as a part of an agreement with the ssw. the msw program assistant is then responsible for assigning rooms and creating a skills lab information sheet for faculty and students. the skills lab information sheet contains detailed information, such as skills lab dates and times, names and addresses of the locations, room numbers, campus contact persons, and information on faculty members teaching the skills lab. this information is emailed to faculty and students and posted in the lms. training skills lab instructors and students to use technology a third challenge in offering a blended skills lab model is ensuring that adjunct faculty and students are trained to use the technology needed to deliver the content for both asynchronous activities and the synchronous sessions. adjunct faculty and students had to be trained to use tools such as flipgrid (video discussions program) and zoom (video meeting program). the innovation team initially scheduled meetings with adjunct faculty and students to introduce the tools prior to the start of the semester. faculty especially had challenges with teaching the required content and simultaneously navigating the technology. for example, during the synchronous sessions, faculty are required to move students into breakout rooms to conduct skill-building exercises. faculty have to move in and out of the rooms virtually to observe student interactions. they ensure that students record the sessions and then move students back into the main room for full group discussions. as the number of sections of skills lab courses expanded, it became no longer feasible to offer these trainings each semester. resource materials were created for faculty and students, and posted in the lms, offering a step-by-step guide for using each tool. technical support is available for questions that arise during the semester, including the days of the synchronous sessions. the two most common technology issues include challenges with rural students accessing wi-fi to support the video conferencing software during the synchronous class session, and students not understanding instructions on how to record sessions and upload videos. to address these challenges prior to future sessions, students are encouraged to meet individually with technology specialists to test the software on available wi-fi networks. students could also receive individual assistance on recording and uploading videos. identifying adjunct faculty to teach the skills labs identifying adjuncts in atlanta and jackson to teach the blended skills labs was the fourth challenge. both locations are over 200 miles from the main campus in tuscaloosa so it was not a feasible option to have local adjuncts travel to these sites. the msw program director reached out to the director of field to identify field instructors in both communities. msw program graduates were also identified as prospective instructors. having field instructors and graduates of the program to serve as adjunct instructors at these sites has proven to be very beneficial for both. students have an opportunity to meet program graduates and learn of their post-graduate practice experiences and program graduates enjoy meeting new students and giving back to the program. advances in social work, spring 2020, 20(1) 179 opportunities of blended skills lab model implementation despite the challenges experienced implementing the blended skills lab, several opportunities with model implementation were identified. the ability to integrate both modes of learning, asynchronous and synchronous, often enhances the online learning experience (farrel et al., 2018) for students. one student shared, “i enjoyed the fact that we had two onsite labs because i enjoyed meeting my peers and instructor in person and also being on campus. i also enjoyed doing the two middle labs virtually. it saved on time traveling and money.” another student shared, “the ability to avoid travel from neighboring states was a great benefit. additionally, the online interaction was equally as beneficial in terms of learning as were the onsite meetings. it was a great joy to work together as a group and our instructor was excellent!” integrating both modes of learning in the blended skills lab model allowed the expansion of the msw program to a national audience. the large international airport in atlanta makes travel two times in the semester very affordable for students. students have the option to select from multiple airlines that fly into the atlanta airport. this approach has allowed the program to attract students from states such as california, new york, and north carolina, and has increased enrollment in georgia. one student shared, “i live in oklahoma and without this setup i would not have been able to fully participate in the course. this provided me with an opportunity to be part of an amazing school!” another opportunity of the blended skills lab model is the engagement of msw program graduates in atlanta and jackson. many of the graduates had not been actively involved with the program since graduation and were excited about the opportunity to reconnect with the program. a final opportunity of the blended skills lab model was the introduction of new technology to faculty and students. these tools can be used in practice settings for meetings and assist students in other courses with group assignments. at the end of the course , one student stated, “the virtual skills lab most definitely took me out of my comfort zone and challenged me as it relates to this type of technology. initially, it was frustrating, not from the technology standpoint, but me navigating through the assignments. as time progressed, i was able to navigate with ease. i look forward to more virtual labs as i progress in this program.” implications and conclusions in the new standards for technology in social work practice, those who deliver social work education are challenged to “use student-centered instructional strategies that are connected to real-world practice applications to engage students in learning, such as peerbased learning, inquiry-based activities, collaborative learning, discussion groups, selfdirected learning, case studies, small group work, and guided design” (nasw et al., 2017, p. 45). a blended skills lab model approach presents a unique opportunity to use technology that allows students to engage in these kinds of practice opportunities. further, “social workers who develop, design, and deliver education and training programs using technology” should also “use a range of existing and emerging technologies that effectively support student learning and engagement in the online environment” (nasw et al., 2017, jackson et al./teaching practice skills 180 p. 46). a blended skills lab model uses technology to support the development of student practice skills in an online environment. as the number of social work programs offering distance programs continues to expand, more consideration to blended or hybrid learning formats for practice course delivery is suggested. a blended skills lab model takes full advantage of the benefits of each platform--online and face-to-face--in order to provide an educational opportunity that can promote student learning better than either platform alone. further research should be conducted on this blended 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(2019). best schools for social work. https://www.usnews.com/best-graduate-schools/top-health-schools/social-workrankings https://doi.org/10.1080/01587919.2015.955265 https://www.weforum.org/agenda/2020/04/coronavirus-education-global-covid19-online-digital-learning/ https://www.weforum.org/agenda/2020/04/coronavirus-education-global-covid19-online-digital-learning/ https://doi.org/10.1080/10437797.2013.755377 https://doi.org/10.1080/1360312032000118225 https://www.socialworkers.org/linkclick.aspx?fileticket=lctcdshucng%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=lctcdshucng%3d&portalid=0 https://doi.org/10.1300/j017v23n03_09 https://onlinelearningconsortium.org/news_item/negotiating-many-definitions-hybrid-online-classes/ https://onlinelearningconsortium.org/news_item/negotiating-many-definitions-hybrid-online-classes/ https://doi.org/10.5175/jswe.2006.200404103 https://blended.online.ucf.edu/about/benefits-of-blended-learning/ https://www.usnews.com/best-graduate-schools/top-health-schools/social-work-rankings https://www.usnews.com/best-graduate-schools/top-health-schools/social-work-rankings advances in social work, spring 2020, 20(1) 183 vernon, r., vakalahi, h., pierce, d., pittman-munke, p., & adkins, l. f. (2009). distance education programs in social work: current and emerging trends. journal of social work education, 45(2), 263-275. https://doi.org/10.5175/jswe.2009.200700081 author note: address correspondence to dr. m. sebrena jackson, school of social work, university of alabama, box 870314, tuscaloosa, al 35487. e-mail: msjackson5@ua.edu https://doi.org/10.5175/jswe.2009.200700081 mailto:msjackson5@ua.edu teaching practice skills to online msw students: the blended skills lab model m. sebrena jackson alex d. colvin angela n. bullock qingyi li online education in social work has significantly expanded over the last two decades. several factors have contributed to the growth of online education in social work, including the availability and use of new technologies, a changing student populat... overview of blended education the large southern university: online msw program the university of alabama is a large, public, research university located in tuscaloosa, alabama. the school of social work (ssw) recently celebrated its 50th anniversary. the ssw offers a full spectrum of social work education: bsw, msw, dsw, and phd... blended skills lab model the online msw program is advertised as a primarily online program. students are able to complete most coursework in an asynchronous format. practice courses (2 credit hours) are offered asynchronously and require concurrent enrollment in a practice s... ________ alex redcay, phd, lcsw, is an assistant professor in the department of social work at millersville university in lancaster, pa. wade luquet, phd, lcsw, is bsw program director and professor of social work at gwynedd mercy university, gwynedd valley, pa. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 515-531, doi: 10.18060/23436 this work is licensed under a creative commons attribution 4.0 international license. institutional change and transgender employment alex redcay wade luquet abstract: the purpose of this paper is to recommend non-discriminatory policies and practices regarding transgender individuals in the workplace. this paper will summarize workplace discrimination legal cases involving transgender individuals. specifically, employers can be held financially responsible if they fire or discriminate against transgender individuals on the basis of gender identity and gender expression and can be required to use affirmed pronouns, revise policies, and provide training to employees regarding non-discrimination. employers cannot discriminate against transgender individuals for transitioning, cannot prevent transgender individuals from using a particular bathroom or locker room, and cannot require employees to medically transition prior to gender identity recognition. employers can be required to allow medical services related to transgender care. finally, transgender individuals are a protected class under title vii. this paper discusses the historical and current legal cases that prevent employment discrimination and proposes policies and practices. recommendations for social workers include creating a sufficient non-discrimination policy, consulting with experts, becoming recognized on an equality index, educating others by not shaming them, and following the social work code of ethics. keywords: transgender, workplace discrimination, advocacy in the united states, more than 11 million adults identify as lesbian, gay, bisexual, or transgender (lgbt, newport, 2018). lgbt workers have faced a long and pervasive history of employment discrimination, yet little research has focused on the workplace experiences of transgender employees. either these individuals are not included in such studies, or they are lumped together with non-heterosexual individuals and viewed similarly (law et al., 2011). transgender individuals can identify as heterosexual or as lgb since gender identity is distinctly different from sexual orientation. while there is evidence that transgender and lgb individuals both experience discrimination, the experiences differ greatly. due to these considerable differences, transgender people facing employment discrimination need more specific legal protections as well as distinct and particular resource supports. several of the legal cases discussed in this paper involve employers firing transgender individuals because they were transitioning. transition can involve three types: social (i.e., gender expression, pronoun, name), legal (i.e., identification), and medical (i.e., hormones, surgery). social transition generally occurs first and legal or medical are not required before employers are required to honor gender identity, pronouns, or a name change (lambda legal, 2021). title vii of the civil rights act of 1964 prohibits discrimination “because of…sex” (section 701, k). despite this, the act previously failed to support transgender plaintiffs in discrimination cases. the obama administration broadened protected classes under an executive order to include lgbt persons, but that was weakened in a series of orders in about:blank advances in social work, fall 2020, 20(3) 516 2019 during the trump administration. however, in june of 2020, the supreme court (2020) ruled that the phrase “because of sex” also included gender identity and sexual orientation (bostock v. clayton county). public support for protections had increased steadily over the years prior to the ruling; businesses have voluntarily adopted policies prohibiting discrimination against lgbt employees, and states and local governments have added sexual orientation and/or gender identity to their nondiscrimination laws and policies (pizer et al., 2011). now that protections are inscribed in the law, one might expect major changes in employment discrimination for transgender employees; however, like civil rights laws before this, the change will take time, education, support, and continued legal action. unfortunately, most discrimination is never legally challenged (pizer et al., 2011) leaving many discriminatory practices such as loss of job, promotion, income, and bullying by individual companies intact, causing undue hardship for the transgender employee. social workers are in a unique position to assist in ending discrimination against transgender employees through education and advocacy. because of our person-inenvironment education model, we are acutely aware that the environment a person lives and works in has a direct influence on performance and emotional well-being. an environment of acceptance and inclusion can help reduce the dysphoria often experienced by transgender persons as they go through their transition and their own self-acceptance (apeiranthitou et al., 2019). yet, work environments are often hostile or unaccepting of transgender employees, resulting in their being ostracized or terminated by the company (tebbe et al., 2019). this paper reviews current case law that has shaped the present day work environment for transgender employees and makes several recommendations that can be undertaken by social workers working within the work environment or hired as consultants to assist with the culture change necessary for work environments to become safe and affirming for transgender employees and colleagues. impact of discrimination members of the lgbt community experience higher rates of discrimination based on sexual orientation and gender identity than their heterosexual and cisgender counterparts (kattari et al., 2016). research suggests that discrimination against this community may not occur equally across all members and that transgender individuals experience an even higher frequency of discrimination. a national survey of 6,500 transgender individuals acknowledged that an adverse employment action, denial of a job or promotion, or termination as a result of their transgender status contributed to elevated symptoms of depression, anxiety, and suicidality (mizock & mueser, 2014; national center for transgender equality [ncte], 2015). further, those who lose their job due to workplace bias are six times as likely as the general u.s. population to be living on a household income under $10,000 per year and four times as likely to experience homelessness (ncte, 2015). employment discrimination against transgender people creates a wide range of negative effects. transgender employees consistently report having experienced or witnessed discrimination based on sexual orientation or gender identity. in the largest survey of transgender people to date (n = 7,500; grant et al., 2011), 90% of respondents redcay & luquet/institutional change 517 reported having experienced harassment or mistreatment at work or have taken action to avoid it. in the same survey, 47% reported having been discriminated against in hiring, promotion, or job retention because of their gender identity. despite having attended college or gained an academic degree at 1.74 times the rate of the general population (47% vs 27%), respondents revealed brutal impacts of discrimination including experiencing unemployment at twice the rate and living in extreme poverty at four times the rate of the general population. forty-one percent reported attempted suicide (harrison et al., 2012). the intersectionality (crenshaw, 1989) of gender, race, disabilities, and other axes of oppression should be considered as additional levels of discrimination for the transgender person. each of these layers of discrimination adds additional hardships for the person in transition. for example, although the unemployment rate of transgender persons is double that of the general population, the unemployment rate of transgender people of color is four times that of the general population (grant et al., 2011). for transgender women of color, loss of employment often means an increase in depression (jefferson et al., 2013) and higher levels of entry into sex work for income. sex work may also contribute to an increase in arrest (nadal et al., 2014) and in the homicide rates of transgender persons of color (balzer et al., 2012). numerous high-profile murders of transgender women of color have highlighted significant concerns for this population (human rights campaign [hrc], 2020). for the social worker using the person-in-environment model and working with transgender persons, it is best to keep in mind that discrimination mostly occurs, and is intensified by, multiple, intersectional levels of oppression and all must be recognized and addressed for any social change to be successful. supporting the scope of negative workplace experiences, brewster et al. (2014) conducted a qualitative study with 139 transgender-identified individuals who were employed at the time asked participants open-ended questions related to their experiences transitioning at work. using a thematic content analysis informed by grounded theory, participants’ responses were coded into four main domains: (a) interpersonal issues, (b) intrapersonal factors, (c) systemic and organizational issues, and (d) logistics and planning. findings highlighted the universality of key areas of stress (e.g., hostile coworkers, gendered spaces, no employee protection policies) and strategies for preparing to transition at work (e.g., informing human resources, identifying allies). in addition, the study highlighted positive aspects of the work environment including supportive co-workers who made the transition easier than expected. several respondents also reported a positive aspect of becoming advocates for workplace changes at their companies by changing policies for transgender employees and having the opportunity to educate co-workers on transition issues (brewster et al., 2014). studies such as these can help businesses and those working to change employment environments understand the effects of negative workplace experiences while understanding positive aspects that can be enhanced to support and empower transgender employees. why advocacy is needed until the june 2020 supreme court decision, there was no comprehensive, federal nondiscrimination law that included gender identity. until this decision, it was difficult to advocate because the ambiguity of the law allowed states to make their own decisions advances in social work, fall 2020, 20(3) 518 whether transgender was a protected class in employment decisions. according to the 2017 state equality index (hrc, 2017), 20 states and the district of columbia prohibited employment and housing discrimination against transgender people based on gender identity. at the same time, state legislatures are debating and, in some cases, passing legislation designed to prohibit transgender people from accessing public bathrooms that correspond with their gender identity or to create exemptions based on religious beliefs that would allow discrimination against transgender people. the lack of legal protections for transgender individuals produced drastic increases in unemployment and poverty. the national transgender discrimination survey found that 15% of respondents were living in severe poverty (household income of less than $10,000/year; james et al., 2016). the unemployment rate among respondents (15%) was three times higher than the national unemployment rate (5%) (james et al., 2016). being unable to afford basic living necessities can result in homelessness or lead to engagement in underground economies like drug sales or survival sex work, ultimately resulting in an increased risk for violence and/or health complications (ncte, 2015). with the supreme court now ruling on the side of employees and advocates, strides can be made in acquiring equal protection and transgender employment rights potentially resulting in equal pay, a decrease in hostile work conditions, and a decrease in stress for the transgender employee due to concerns related to job loss. however, individuals who are transgender can still be discriminated against by employers with fewer than 15 employees and in venues outside of employment such as housing or public accommodation. legal framework title vii of the civil rights act of 1964 specifically prohibits employers from discriminating on the basis of sex, race, color, national origin, and religion, and is considered a landmark civil rights and u.s. labor law triumph. the act generally applies to employers with 15 or more employees, including federal, state, and local governments. in 2012, the u.s. equal employment opportunity commission (eeoc) ruled that employment discrimination on the basis of gender identity or transgender status is prohibited under title vii. this decision defines “sex” discrimination to include sex stereotyping and discomfort with the fact of an individual’s transition or with the perceived change in an individual’s sex. in 2014, attorney general eric holder and the department of justice adopted a position aligning with the eeoc (us doj, 2014). in 2017, attorney general jeff sessions issued a directive withdrawing holder’s position and stating that title vii should be narrowly interpreted to cover discrimination between “men and women,” stating, “title vii does not prohibit discrimination based on gender identity per se” (sessions, 2017). the u.s constitution does not directly address employment discrimination; however, both the fifth and fourteenth amendments limit the discriminatory power of federal and state governments. the fifth amendment explicitly bars depriving individuals of “life, liberty or property” without due process of law. the fourteenth amendment prohibits states from violating an individual’s rights of due process and equal protection. in the context of employment, these federal constitutional provisions limit the power of the state and federal government to discriminate through unequal treatment of employees, former redcay & luquet/institutional change 519 employees, or job applicants based on membership in a group (i.e., race or sex). historically, the structural relationship between the u.s. constitution and states’ constitutions’ civil rights provisions are based on what is called the supremacy clause. simplistically, this clause asserts that state constitutions are only allowed to provide more civil liberties than the federal constitution provides. in practice, legislating civil rights is more complicated, often falling prey to prevailing political parties holding offices and the ideologies of their constituents. even though, in some states, specific anti-discrimination laws have not yet been enacted, and employment discrimination or harassment is not technically prohibited, legal progress is being made toward extension of those civil rights. owing to the unceasing efforts of both individuals and advocacy groups, 20 states, plus d.c., have enacted transgender employment protections. thus, most states have not enacted such protections. transgender employment cases historic rulings in price waterhouse v. hopkins (1989), the supreme court recognized that employment discrimination based on sex stereotypes (e.g., assumptions and/or expectations about how persons of a certain sex should dress, behave, etc.) is unlawful sex discrimination under title vii. for the first time, the supreme court legally established that gender stereotyping is illegal as sex discrimination for cisgender and transgender individuals. since that ruling, there have been many legal victories for transgender individuals against employers or other organizations who have discriminated against them based on gender identity or gender expression even for children and youth (broussard v. first tower loan llc, 2015; department of fair employment and housing v. american pacific corporation, 2014; eeoc v. bojangles restaurants, inc., 2016; eeoc v. deluxe financial services corp., 2015; eeoc, 2015; eeoc v. lakeland eye clinic, p.a., 2015; eeoc v. r.g. & g.r. harris funeral homes, 2014; lusardi v. department of the army, 2015; lambda legal, mccreery v. don’s valley market, 2013; tudor v. southeastern oklahoma state university [sosu], 2017; vroegh v. iowa department of corrections, 2017). gender identity, expression, and pronouns employers can be held financially responsible if they fire or discriminate against transgender individuals on the basis of gender identity or gender expression and can be required to use affirmed pronouns, revise policies, and provide training to employees regarding non-discrimination (broussard v. first tower loan llc, 2015; eeoc v. bojangles restaurants, inc., 2016; tudor v. sosu, 2017). in broussard v. first tower loan llc (2015), first tower's vice president informed tristan broussard, a transgender male, that he must dress and act as a female in the workplace because his driver’s license indicated an “f” for female (united states equal employment opportunity commission [eeoc], 2017). first tower also required broussard to sign a statement agreeing to act and be treated as a female rather than a male while working for first tower loan. when broussard refused, first tower fired him. in 2015, broussard was awarded $53,000 in advances in social work, fall 2020, 20(3) 520 damages, and in 2016, first tower loan agreed to settle the lawsuit and to implement gender identity protections in the workplace. this decision established that employers should honor the gender identity and expression of the employee regardless of the gender listed on identification (eeoc, 2017). in a similar case, the employer was required to provide training to employees, enter a two-year consent degree, and to change policies regarding gender identity/expression and transgender individuals (eeoc v. bojangles restaurants, inc., 2016). in a third case, southeastern oklahoma state university (sosu) administrators continually used male pronouns when talking to dr. rachel tudor, who identified as female. she was harassed by her colleagues, was told how to dress and what makeup to wear, and was warned that she should take safety precautions as many people were hostile toward transgender individuals. despite a positive review from her department committee, sosu denied her tenure several times. tudor was the first professor in her department to be denied tenure. she filed a complaint with the eeoc and was subsequently fired by sosu. in 2017, a federal district court in oklahoma found that sosu retaliated against her for the eeoc complaint and that sosu discriminated against her on the basis of gender identity. tudor was awarded $1,165,000 in damages which is the largest award ever received for transgender employment discrimination. significantly, this case was one of the first in which gender identity was established as a protected class under title vii, with the federal courts upholding title vii’s prohibition of discrimination based on sex as also applying to gender identity discrimination. in the past, title vii cases had historically gone to settlement rather than determining federal questions. tudor v. sosu was a substantial win for the transgender community, as it set precedent for future gender identity discrimination cases. social transition individuals who are transgender are a protected class under title vii so employers cannot discriminate against them for transitioning (department of fair employment and housing v. american pacific corporation, 2014; eeoc, 2015; eeoc v. lakeland eye clinic, p.a., 2015; eeoc v. r.g. & g.r. harris funeral homes, 2014; lambda legal., n.d.-b). aimee stephens, a transgender female employed by harris funeral homes, was fired after disclosing her plans to transition from male to female. in 2014, the eeoc sued harris funeral homes, alleging that her firing was in violation of title vii because harris funeral home expected stephens to conform to sex stereotypes. the district court ruled that transgender status was not a protected class under title vii but after an appeal, the 6th court ruled that title vii did include transgender individuals. in response, harris funeral homes petitioned the u.s. supreme court to determine whether title vii’s term “sex” includes gender identity. on june 15, 2020, the u.s. supreme court ruled that both lgb and transgender individuals are protected under title vii which is the most significant supreme court ruling for transgender individuals ever (supreme court of the united states [scotus], 2020; scotus blog, 2019). redcay & luquet/institutional change 521 restrooms and medical transition employers can be held financially responsible if they mandate or prevent transgender individuals from using a particular bathroom or locker room (department of fair employment and housing v. american pacific corporation, 2014; eeoc v. deluxe financial services corp., 2015; lusardi v. department of the army, 2015; vroegh v. iowa department of corrections, 2017). the army prevented tamara lusardi, a transgender woman and civilian employee, from using the same restroom as all other female employees and her supervisors continued to use male names and pronouns (eeoc, n.d.; lusardi v. department of the army, 2015). lusardi filed a formal complaint with the department of the army who concluded lusardi failed to prove any of her claims. lusardi filed an appeal of that decision with the eeoc and this decision was reversed. the army was required to grant equal and full access to common female facilities, cease and desist from all discriminatory and harassing conduct, pay $50,000 in compensatory damages, provide eeo training to all civilian personnel and contractors working at the agency, provide inperson eeo training to all management officials, and consider appropriate disciplinary action against leaders that discriminated against and/or harassed lusardi (eeoc, n.d.) this was a precedent-setting decision, in that it is binding on all federal agencies, federal contractors, state and local government employers, as well as all private sector employers with 15 or more employees, as the eeoc’s interpretation of title vii affects all future transgender employee discrimination claims (eeoc, n.d.). since 2015, there have been several more cases related to transgender individuals in the military that are beyond the scope of this paper. for more information on transgender individuals in the military, see redcay et al. (2020). employers are required to recognize the gender identity of all employees and cannot require employees to medically transition prior to gender identity recognition (transgender law center, 2014). in the case of department of fair employment and housing v. american pacific corporation, 2014, nick lozano, a transgender male, applied for, and accepted, a position as operations technician at ampac, a pharmaceutical ingredients manufacturer (transgender law center, 2014). prior to starting the job, lozano disclosed his transgender status and that he would be undergoing gender affirmation surgery. the original source used the term “sex reassignment surgery.” the more appropriate term today is “gender affirmation surgery.” ampac reacted by requiring lozano to use the women’s restroom until he completed his surgery. lozano subsequently declined the job offer. in 2014, the department of fair employment and housing (dfeh) filed a complaint in california superior court on lozano’s behalf, alleging discrimination on the basis of gender identity. having reached a settlement, the california dfeh issued new guidance in 2016 for california employers indicating that employers cannot require a gender affirmation surgery as a prerequisite to the employer recognizing the employees' gender identity. sacramento superior court held that california’s fair employment and housing act (feha) prohibits employers from requiring transgender workers to use restrooms and locker rooms based on their assigned sex at birth (transgender law center, 2014). advances in social work, fall 2020, 20(3) 522 medical services and hormones employers can be required to cover medical services related to transgender care (department of fair employment and housing v. american pacific corporation, 2014; eeoc v. deluxe financial services corp., 2015; vroegh v. iowa department of corrections, 2017). in two similar cases, the employer was prohibited from denying transgender adults from receiving medical care that is normally provided to cisgender individuals. both employees faced discrimination and harassment based on gender identity/expression and bathroom use. the first employee, britney austin with the legal assistance of the eeoc won a settlement agreement which required the employer to pay austin $115,000 in damages due to discrimination but also required a three-year consent provision that deluxe will not make exclusions in their healthcare benefits plan for medically necessary care based on transgender status (eeoc v. deluxe financial services corp., 2015). in a second similar case, jesse vroegh, a transgender male nurse at the iowa correctional institution for women (iciw), alleged that iciw denied necessary medical treatment because he is transgender (vroegh v. iowa department of corrections, 2017). wellmark blue cross, vroegh’s employer-sponsored medical insurance provider, denied him health care coverage for medically necessary surgery even though it provides coverage for similar procedures for non-transgender employees. the aclu of iowa filed a complaint with the iowa civil rights commission (icrc) and in february 2019, vroegh was awarded $120,000 because they found that he was denied insurance coverage for medically necessary surgery solely because he was transgender. this decision established that employers or their insurance companies are not permitted to deny medically necessary medical care, including surgery, for transgender individuals. in another case, (lawrence v. office of personnel), marc lawrence, a transgender male retiree of the federal bureau of prisons, was denied health coverage for hormone-related care, including hormone prescriptions and visits to an endocrinologist, despite such care being routinely covered for cisgender employees and retirees (lambda legal., n.d.-a). citing a blanket health plan exclusion refusing coverage for all care related to gender affirmation transition, lawrence’s care was denied. in 2014, lambda legal filed a complaint with the eeoc on behalf of lawrence, arguing that the opm’s health plan’s exclusion violates title vii protections against discrimination based on sex. the judge issued a tentative ruling in favor of lawrence, and lambda legal requested a final agency decision (fad) from opm. opm found in its own favor, rejecting lawrence’s claims. in june 2016, lambda legal filed an appeal with the eeoc. the case remains open. action recommendations without a doubt, the workplace has changed for employees who are transgender. it is now increasingly hospitable because of greater societal understanding and at the same time increasingly hostile from those who fear the change and do not know how to react or treat their transgender colleagues and employees. certain groups are at higher risk for difficulty. transgender women of color have significantly higher rates of harassment, bullying and even murder due to the intersectionality of race and gender identity (hrc, 2020). in spite of forward progress and regressive reactions, case law and inclusive employee policies are moving the arc of justice increasingly toward protection against discrimination for redcay & luquet/institutional change 523 transgender persons in the workplace. and now that the supreme court has weighed in to protect transgender persons from work discrimination, the door is opened for definitive actions by companies and transgender advocates, including social workers. the real shift toward non-discrimination will take a work culture change that not only accepts but affirms the right of the transgender person to work in a safe environment. revise non-discrimination policies many organizations have a non-discrimination policy as part of their employee handbooks, but many do not include gender identity and expression. in addition, organizations are unaware of their requirements to honor the gender identity, affirmed pronoun, and name of all employees regardless of the status of transition. the majority of states (n=31) fail to have sufficient non-discrimination laws for transgender individuals, so employer policies are important to address the gap in protection (movement advancement project, 2017). employers are also required to permit medical services and bathroom use regardless of transgender status. organizations choosing to address these issues could draft a non-discrimination policy that is inclusive and reflective of the current state of the legal environment. an example of an inclusive non-discrimination policy might be: this organization is an equal opportunity employer and does not practice, condone, tolerate, facilitate, or collaborate with any discrimination on the basis of race, color, age, ethnicity, sex, gender identity, gender expression, pregnancy, religion, creed, sexual orientation, marriage or partner status, national origin, ancestry, citizenship status, disability, military service or affiliation, financial status, or genetic information. this organization acts to prevent and eliminate discrimination in policies, practices, work assignments, hiring or firing of staff, compensation, selection of volunteers, vendors, and provision of services. we are committed to providing an inclusive and welcoming environment for all staff, clients, volunteers, subcontractors, and vendors. there is little proof that a non-discrimination policy will by itself change a work culture and may in fact increase discrimination during the hiring phase (valfort, 2018). however, an inclusive non-discrimination policy is a good start and is a statement that will lead the change as a company mission statement. definitive action is needed to meet the workplace mission of non-discrimination toward transgender employees. these policies require actions and enforcements to counter prejudices and bias toward targeted groups (valfort, 2018). consult with experts one way of moving a policy toward implementation is by consulting with experts trained to facilitate organizational change. organizations that are responsive to the changing culture can work with experts to update and assist them with education of employees and understanding of legal policies. organizations that fail to learn and practice non-discriminatory actions may be engaged in lawsuits, engendering negative publicity, a tremendous amount of wasted time, and exorbitant legal fees. many national organizations, including the national center for transgender equality, transgender law center, american civil liberties union, lambda legal, and the equal employment opportunity advances in social work, fall 2020, 20(3) 524 commission provide advice regarding employment non-discrimination policies and practices. all websites are free to review and generally provide examples and helpful advice. become recognized one place to begin is to work toward meeting the criteria for and becoming recognized by the hrc effort for safe and non-discriminatory workplaces for the lgbt community. the healthcare equality index, campus pride index, and the corporate equality index are just a few rating systems set up by hrc that share a similar goal to identify organizations that recognize and respect lgbt individuals. each index provides an assessment for organizations to review their policies and procedures to ensure best practices. for example, healthcare organizations would be expected to meet the specific criteria in the following areas: non-discrimination and staff training, patient services and support, employee benefits and policies, patient and community engagement, and responsible citizenship. to meet these criteria, health care organizations would have to hold regular trainings for employees on lgbt issues, provide equal health care benefits for employees including transition benefits for transgender employees, train staff to work with lgbt patients, hold events supporting the lgbt community, and allocate resources to lgbt advocacy groups, as well as other criteria described on their web site (hrc, n.d.-b). for corporations to receive a high score in the corporate equity index, employers must offer parity between differentand same-sex spouses and have coverage available for domestic partners of enrollees, must remove transgender exclusions from all benefits plans, and must include lgbt suppliers as part of their supplier diversity program (if such a program is in existence; hrc, n.d.-a). these indexes and the criteria established for inclusion as a safe workplace for lgbt employees can offer employers an outline of the changes needed in their corporate culture to protect the rights of their transgender employees. advocate by educating, not shaming culture change in the workplace is often filled with anxiety and fear until the change become ordinary and part of the organizations story (burk, 2019). for some, especially those coming from more conservative backgrounds, the change and accompanying anxiety toward inclusivity can induce adverse reactions resulting in discriminatory behavior. rather than shame those who are fearful of what they do not know, it is more prudent to educate them. it is often said that fear of the “other” is rooted in the ignorance of the “other.” getting to know the other lessens fear. this might start as an educational program as advocated by the hrc and then lead to exposure to the transgender person through trans advocates who can come into the workplace to meet those who would like to know more. a simple internet search will reveal multiple agencies and universities that provide workplace transgender equity training. one example in the philadelphia area is the mazzoni center, a comprehensive center that offers multiple services for transgender individuals including trainings for the workplace (mazzoni center, 2021). redcay & luquet/institutional change 525 there are plenty of ill-informed ideas people hold, including that someone who is transgender is mentally ill, a cross dresser who likes to wear men’s or women’s clothing, or wants to get into the bathroom of the others. employees can be enlightened by exposure to transgender individuals who can speak their truth and expose anxious employees to the reality that their desire to live their gender identity is as natural as each of them living their gender identity. many persons hold the false idea that being transgender is a mental illness because of the recent addition in the dsm 5 of gender dysphoria (american psychological association, 2013), a diagnosis added to describe the stress transgender persons experience during their transition from the change and non-acceptance of others. in an inclusive and accepting environment, gender dysphoria is lessened (martinez et al., 2017). a safe workplace for transgender individuals is part of the overall solution to the depression and anxiety transgender individuals experience during transition. ethical implications for social workers in alignment with their code of ethics (coe), members of the national association of social workers (nasw, 2017) are tasked with exerting all effort toward meeting basic human needs, with a specific focus on those who are threatened, unprotected, and persecuted. building and fostering social justice and change on behalf of the oppressed is virtually mandated for those in the service of social work. for the transgender community, obstacles to human rights, including employment barriers, far exceed the criteria for the definition of a vulnerable and often brutally oppressed population. at the macro level, social workers are called upon in the coe standard 6.04 (a) (nasw, 2017) to take social and political action: social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully. fortunately, nasw, representing 120,000 social workers, joined other advocacy agencies in filing an amici curiae (friend of the court) brief (brief for southern poverty law center et al. as amici curiae supporting respondents bostock v. clayton county, 2019) to the supreme court for the bostock v. clayton county case that resulted in the historic june 2020 decisions recognizing that “on the basis of sex” also included sexual orientation and gender identity. the brief is a comprehensive document backed by peer-reviewed research and case law that outlines the dangers of workplace discrimination. friends of the court briefs are one way the profession of social work can with other organizations to advocate at the macro level for fairness in the legal system for transgender persons. nasw responded to this case in a manner in keeping with the coe which states in standard 6.04(b) (nasw, 2017): (b) social workers should act to expand choice and opportunity for all people, with special regard for vulnerable, disadvantaged, oppressed, and exploited people and groups. at the mezzo level of practice, social workers and social work administrators must assure that their own organizations and agencies are practicing non-discriminatory hiring practices. a formal non-discrimination policy that includes gender identity as a category advances in social work, fall 2020, 20(3) 526 should be on file and presented to new and existing employees. this would be in alignment with standard 3.07(d) (nasw, 2017): social work administrators should take reasonable steps to ensure that the working environment for which they are responsible is consistent with and encourages compliance with the nasw code of ethics. social work administrators should take reasonable steps to eliminate any conditions in their organizations that violate, interfere with, or discourage compliance with the code. at the micro level, social workers are ethically obligated to promote the well-being of their client. standard 1.01 (a) (nasw, 2017) states “social workers' primary responsibility is to promote the well-being of clients. in general, clients' interests are primary.” when clients find themselves in job situations where they are being harassed, demoted, passed over for promotion, or terminated based on their gender identity, their well-being is diminished and there is an obligation for the social worker to intervene or advocate. it may not be appropriate for the social worker to intervene or advocate personally because of confidentiality, self-determination or self-efficacy reasons, so support, encouragement, and information may be the best course of action for the social worker. encouraging the client to initially follow job protocols, talking to the offending person, or going to the human resources administrator, may be the first steps. should the situation not be satisfied, the social worker can help the client take the matter to the next level by helping the aggrieved employee build a case to take to the equal employment opportunity commission (eeoc). this is a necessary step prior to a lawsuit with the eeoc acting as a mediator to settle the dispute prior to any lawsuit. with the law now on the side of the transgender person, the person can step forward to file a complaint with less fear of losing a job. for employers who choose to disregard the law and terminate the transgender person from their job, the social worker has an obligation to assist the person to find legal help, including low-cost legal help for those who cannot afford a lawyer. the social worker should advocate not only to foster the culture change that will be gradual since the 2020 ruling, but also because transgender persons who lose their jobs, are not promoted, or are not hired because of their gender identity lose income that can serve as their bridge out of poverty. the social worker should advocate for legal protection related to transition, harassment issues, job security, promotion opportunities, and bathroom access. beginning with the end in mind (covey, 2004), the goal should be equal job opportunities, equal promotion opportunities, equal job security, and an opportunity for a livable wage for transgender clients. conclusion violence, poverty, stigma, harassment, the lack of legal protections, and other roadblocks to public resources faced by the transgender community are conditions that the social work community must endeavor to remedy. along with the implementation of gender-affirming counseling, social workers’ advocacy for diversity and inclusion in the workplace could ensure these ideals become foundational to a company’s core values. moreover, creating inclusive policies could help retain valuable employees and affirm them as respected members of their workplace community. according to the national redcay & luquet/institutional change 527 lgbt task force, transgender individuals who come out in a supportive workplace not only reduce the stress of having to hide their true selves, but are more productive, have higher self-esteem, have authentic and close relationships with their colleagues, customers and clients, and are ultimately better able to live genuine and whole lives (james et al., 2016). although more than half a century has passed since the civil rights act was enacted, employment discrimination persists. this article raises and addresses critical issues regarding the unanswered question of how social workers and organizational researchers and practitioners can contribute to eradicating employment discrimination toward transgender employees. this article considers discrimination reduction tactics through discussing current legal strategies aimed at reducing discrimination beyond racial, ethnic, and gender differences. education and advocacy by social workers will be an integral part of the change to eliminate employment discrimination for transgender persons. the law has only recently evolved to include all rights of transgender individuals in the workplace. advocating for their civil and human rights is the responsibility of our society, and social workers are well-positioned to advocate at both the micro, mezzo, and macro levels. this includes eliminating barriers that allow discrimination in the workplace and other areas of public life; creating systems of support at the municipal, state, and federal levels that meet the needs of transgender people; and changing federal, state and local laws to acknowledge the humanity and, subsequently, the equal rights of transgender people. for the transgender community to continue to evolve, public education, understanding, and acceptance of this community are crucial. references american psychological association. 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(no. lacl138797) author note: address correspondence to alex redcay, department of social work, millersville university, millersville, pa, 17551. email: alex.redcay@millersville https://www.laborandemploymentlawcounsel.com/wp-content/uploads/sites/224/2017/11/tudor-v-se-oklahoma-state-u-no-15-324-c-wd-ok-10-26-2017.pdf https://www.laborandemploymentlawcounsel.com/wp-content/uploads/sites/224/2017/11/tudor-v-se-oklahoma-state-u-no-15-324-c-wd-ok-10-26-2017.pdf about:blank about:blank about:blank about:blank mailto:alex.redcay@millersville at the macro level, social workers are called upon in the coe standard 6.04 (a) (nasw, 2017) to take social and political action: this work is licensed under a creative commons attribution 4.0 international license. title iv-e child welfare training and university partnerships: transforming state child protection services into a trauma-informed system robin hernandez-mekonnen dawn konrady abstract: children who are involved in the child welfare system have experienced trauma, and research indicates that parents of those children also frequently grapple with their own unresolved trauma. in addition, child welfare workers face high rates of secondary traumatic stress. federal legislation from 2011 requires states to conduct universal trauma screening on children in foster care. the administration on children and families (acf) urges state child protection agencies (cps) to become trauma-informed, however, many states still struggle to integrate a trauma focused practice model. this article describes the outcomes of a national, empirically driven, core concepts in child trauma for child welfare curriculum utilized in a title iv-e university partnership program to teach graduate level child welfare agency supervisors. findings suggest that the graduate trauma course demonstrates statistically significant gains in confidence, and also has a profound impact on the agency’s transformation into a trauma-informed system. keywords: title iv-e; child welfare; trauma; secondary traumatic stress; social work education there is a significant body of research indicating the importance of using a traumainformed approach in working with maltreated children, yet not all states and jurisdictions have fully engaged in the process of identifying or adapting a model or framework by which they will approach trauma–informed practice (ai, foster, pecora, delaney, & rodriguez, 2013; hanson & lang, 2016; klain & white, 2013). as states transition to a trauma-informed approach, there is a need for high caliber evidence based curricula. this study investigates the impact of a statewide title iv-e msw consortium utilizing an empirically based trauma curriculum in aiding the early transition into a trauma-informed child protection system. child maltreatment research has grown exponentially in the number of studies investigating the nature and prevalence of trauma experienced by the children involved in the child welfare system (kisiel, fehrenbach, small, & lyons, 2009; miller, green, fettes, & aarons, 2011). in addition to learning about the trauma experienced by children, we have gained insight into the unresolved trauma histories of caregivers, and the secondary traumatic stress experienced by the child welfare workforce (bride, jones, & macmaster, 2007; nelson-gardell & harris, 2003). in 2011, president obama enacted the child and family services improvement and innovation act (2011) which amended language to require states to include a description of how they will screen for, and treat, emotional trauma associated with maltreatment and removal, in the health oversight plan. while the requirement specifies children in foster care, the administration on children families ______________________ robin hernandez-mekonnen, phd, msw is associate professor of social work, school of social and behavioral sciences, stockton university, galloway, nj 08205. dawn konrady, edd, mba, ma, is director of the child welfare education institute, stockton university, galloway, nj 08205. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 235-249, doi: 10.18060/21323 https://creativecommons.org/licenses/by/4.0/ hernandez-mekonnen & konrady/title ive 236 (acf) issued an information memorandum (im) to states, tribes, and territories suggesting that they integrate trauma screening into the regular developmental screening activities (under early periodic diagnosis and treatment: epsdt) in order to meet the new requirement (acf, 2012). as such, child protection agencies are compelled to seek strategies to become trauma-informed, including specific trauma-informed screening and assessment protocols, and creating access to trauma-informed treatment. since 1980, title iv-e of the social security act has supported the development and implementation of formalized child welfare education programs to increase the number of prepared candidates for careers in child welfare (zlotnik, 2003). there are currently approximately 40 states receiving title iv-e funding for education, and nearly all of those states are engaged in university partnerships with academic degree programs (zlotnik, strand, & anderson, 2009). the range of supports students receive in these programs is notable, some receiving book stipends and others receiving full tuition benefits and salary. however, research indicates iv-e programs are effective in improving child protective services (cps) worker retention (o'donnell & kirkner, 2009; zlotnik, 2003; zlotnik & pryce, 2013). social work programs are charged with educating iv-e students. both undergraduate (bachelor of social work bsw) and graduate (master of social work msw) programs serving iv-e students vary in their offerings of courses, or electives that are related to child welfare. this paper discusses the implementation and impact of an evidence-based msw elective in trauma-informed child welfare practice in a title iv-e university partnership to aid in the transformation of a state based child welfare system to a trauma-informed system. child traumatic stress scientific advances in the study of the brain have enhanced the ability to detect the neurological and cognitive impact of childhood trauma on the development of children (perry, 2009; watts-english, fortson, giblet, hooper, & debellis, 2006). traumatic experiences have both short-term and long-term effects upon children, often lasting into their transition into adulthood. research indicates a clear pathway between childhood trauma and both acute and chronic manifestations of cognitive, emotional, psychiatric, relationship, social, and health outcomes (richardson, henry, black-pond & sloane, 2008). the centers for disease control and prevention has conducted decades of research investigating the public health repercussions of adverse childhood experiences (feletti & anda, 2014). a multitude of studies reveals the effects of trauma upon long term outcomes, including an array of emotional, behavioral, cognitive, and social, cognitive, emotional and behavioral impairments (ai et al., 2013; feletti & anda, 2014; felitti et al., 1998). according to the new jersey department of children and families (dcf) commissioner’s monthly report, in september 2016, approximately 45,823 children were under the division of child protection and permanency’s supervision, 6,698 were in outof-care settings, with approximately 11,500 new cases of child maltreatment substantiated and opened in the past year (blake, 2016). by the very nature of coming to the attention of the child protection system, particularly after an investigation has concluded that there is merit for involvement, children have experienced some form of trauma (ko et al.,2008). advances in social work, spring 2017, 18(1) 237 while the manifestations of trauma are varied, depending on age, trauma type, and the supports the child may receive (ko et al., 2008), cps agencies have lacked sufficient resources to adequately address the needs of traumatized children, despite the 2011 law. the resources to address the needs of children experiencing trauma include universal and routine screening of children for symptoms of traumatic stress, access to trauma focused and evidence based interventions, and access to trauma-informed systems of care (acf, 2012). trauma-informed child welfare practice, along with quality and trauma focused clinical interventions are crucial components addressing traumatic stress (acf, 2012). caregiver traumatic stress cps agencies have undergone decades of reform efforts, often lead by litigation, and class action suits resulting in consent decrees (noonan, sabel, & simon, 2009). despite the mandate of the 2011 legislation, the movement toward integrating a social work perspective, accompanied by a trauma-informed focus, is only a recent undertaking by a handful of state child welfare systems. as cps workers and clinicians begin to align their approaches with a trauma-informed lens, it becomes increasingly evident that the caregivers or parents of the children being screened for trauma, are experiencing parenting deficits, at least in part, due to their own unresolved trauma (walker, 2007). in fact, many systems still do not conduct universal trauma screening for child victims, so performing trauma screening with birth parents or other caregivers is even more unlikely. yet, there is a growing body of research linking the experience of child maltreatment (as indicated by cps involvement) in later childhood or adolescence to the increased likelihood of involvement as a parent in cps (thornberry & henry, 2013). most recent data from california indicates at least a 44% increased likelihood that a mother who conceives between the ages of 15-19 will be reported for child maltreatment before her child reaches five years of age (putnam-hornstein, cederbaum, king, eastman, & trickett, 2015). while the debate of whether “maltreatment begets maltreatment” continues (thornberry, knight, & lovegrove, 2012, p.135), research is being done to explore the intergenerational effects of maltreatment upon parenting styles and attachment of adults with their children (berthelot et al., 2015; kim, fonagy, allen, & strathearn, 2014; schwerdtfeger, larzelere, werner, peters, & oliver, 2013). the empirical evidence thus far suggests there are indeed correlations, and cps professionals in the field struggle with addressing prior trauma histories on cases where perhaps there was a missed opportunity by the system when the caregiver was a child. in states like new jersey, where the child protection system has a history of failings, cases where parents were former clients as children, are relatively common. as workers learn about case level caregiver trauma and continue to trace history of cases, there is a disheartening realization that that the system failed to adequately address their childhood trauma, and as parents, these former clients still struggle to overcome the effects of unresolved trauma (kim et al., 2014; national child traumatic stress network [nctsn], 2011; walker, 2007). cps supervisors find themselves frustrated that the cps system had an opportunity to intervene, and had a trauma focus been part of the service delivery a decade ago, these children may have had better chances to become healthy adults and parents. additionally, the level of trust these parents, former clients, have for the cps system is limited (nctsn, 2011; walker, 2007). hernandez-mekonnen & konrady/title ive 238 a lack of trust due to failure of the system on their own behalf creates a difficult dynamic for effective engagement by cps workers. secondary traumatic stress in cps workers the child welfare workforce is another important consideration in becoming a traumainformed organization. there is a significant body of literature that captures the prevalence and impact of secondary traumatic stress in the human service professions. there are fewer studies that parse out the effects of secondary traumatic stress upon the cps workforce. figley (1995) pioneered the term secondary traumatic stress (sts), which he defined as “the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other” (1995, as cited in pryce, shackelford, & pryce, 2007, p. 13). he contends that while the causes of sts are different from post-traumatic stress disorder (ptsd), the reactions are equivalent. figley also identified four criteria that increase one’s vulnerability for sts: the actual child’s trauma, unresolved personal trauma, any personal trauma history, and one’s level of empathy (pryce et al., 2007). cps workers experiencing sts are more likely to leave their positions, creating significant cost to the organization and to clients (o'donnell & kirkner, 2009). recruiting, training and retaining child welfare workers is a significant fiscal burden, and is also costly to their clients in terms of stability and trust (strolin-goltzman, kollar, & trinkle, 2010). cps organizations and clients benefit from taking stock of their current staff and cultivating resources to monitor and support workers who are at an elevated risk for sts (pryce et al., 2007). title iv-e master of social work and the masters child welfare education program (mcwep) university partnership the new jersey iv-e partnership is an innovative model to cps workforce training. after a sordid history of failure in child protection, combined with high profile media exposure and a class action law suit, the new jersey department of children and families entered a consent decree, a modified settlement agreement, and is currently developing an exit strategy. under the consent decree, aggressive measures were initiated to recruit hundreds of cps workers (lipka & graham, 2004). funds were harnessed for this recruitment effort, as well as training and retention. a state of the art training academy, in collaboration with the mcwep program, is a key component in the agency’s strides in professionalization and retention (guzkowski, 2015). mcwep is a statewide university partnership consortium, including four of the state’s accredited msw programs, initiated in 2012. the mcwep project developed as a partnership based upon the current consortium model used in the baccalaureate iv-e educational consortium for the state, the baccalaureate child welfare education program (bcwep), in which seven of the state’s public and private universities with bsw programs are members. a unique facet of both the bcwep and mcwep is the use of learning communities. the learning community consists of quarterly daylong meetings of all msw iv-e students from all four partnering universities. students meet as cohorts based upon year of study advances in social work, spring 2017, 18(1) 239 (the program typically takes 3-4 years as part-time study only), and also as a large group. learning communities provide the opportunity to synthesize the students’ msw curriculum, field placement experiences, cps agency integration, and to infuse critical thinking exercises, with self-care and leadership development. the learning communities provide an enhanced learning environment for students, who are mid-level supervisors, to establish a support network among colleagues and faculty, and cultivate innovation in their ideas and strategies to support ongoing reform efforts within the agency. in addition to the learning communities, mcwep students are required to take two courses based upon national models of evidence-based curriculum. one course focuses on leadership and supervision in child welfare; the other is trauma-informed child welfare practice (ticwp), which is the focus of this analysis. the ticwp course was adopted from the nctsn’s core curriculum for childhood trauma (ccct; layne et al., 2011). students receiving the trauma course through the mcwep program, take the course with an nctsn certified instructor, and are subjects in the national data collection. both fordham university and stockton university’s institutional review boards have approved the research, and students were provided with informed consents for each respective data collection effort. national child traumatic stress network core curriculum the nctsn was established in 2000 under the children’s health act (2000), and has developed a comprehensive empirically-based national model for addressing trauma. over the past decade, nctsn has cultivated workgroups through networks of professionals and academics from across the country to formulate an evidence driven curriculum. the national center for social work trauma education and workforce development, a member of the samhsa-funded nctsn, developed the ccct for child welfare with the goal of creating a high caliber and evidence informed trauma curricula for dissemination in social work education. there have been 55 ccct social work professors certified through the yearlong learning collaborative (over 6 years), open for ongoing participation to maintain fidelity to the teaching framework and structure of the course. once certified, faculty have some flexibility to tailor content or style within reason. for example, in the mcwep program some adaptation was necessary since our students are acting supervisors within the organization, occupying slightly different roles than those for which the course content was designed. since most mcwep students/supervisors have over a decade of experience in the new jersey state child welfare system, some organization of the materials was altered to emphasize the importance of their supervisory roles. in addition, because they are well positioned to catalyze agency change in practice, additional depth underscoring the effort toward a trauma-informed agency and developing trauma-informed systems of care is included. the center’s technical report details the findings from data (2010-2016), from 55 faculty teaching at 36 schools, with 79 separate offerings of the course, and 985 matched (using participant designed unique identifiers) preand posttest student surveys (popescu, richards, strand, & abramowitz, 2016b). the evaluation of the ccct over six years hernandez-mekonnen & konrady/title ive 240 resulted in ongoing revising of course content and delivery, for overall improvement and enhancement. the main objectives of the course as identified in the technical report are “to increase the students’ trauma knowledge, skills, and confidence in relation to the 12 core concepts of trauma” (popescu et al., 2016a, p. 106). the main measure of these indicators comes from the core concept confidence scale (designed by popescu & moller, 2010; revised in 2012), in addition to general demographics and student learning objective questionnaires. in the national cohort, researchers at the center found a statistically significant increase in student confidence, indicating a significant gain in confidence applying the core concepts of trauma (in the national aggregate data, there was an increasing trend in post test scores from year to year, indicating that the ongoing adjustment and integration of course feedback was useful in improving the course outcomes over time (popescu et al., 2016a). findings from the national center for social work trauma education and workforce development report: mcwep data. in addition to national aggregate data report on learning and course outcomes, collected by class, the center provides an individualized technical report for each individual institution based upon the pre and posttest data collected each semester. the individualized data report is produced so each instructor can assess the outcomes of their specific class at their institution. mcwep data provided to the center for 2015 and 2016 cohorts indicate improvement between preand posttest, measured using a matched t-test for each of the 2015 and 2016 classes (table 1). table 1. mcwep ticwp overall student confidence in core concepts of trauma year pretest mean posttest mean t-test wilcoxon signed ranks 2015 (n=11) 6.13 7.68 p = .013 p = .043 2016 (n=18) 5.12 8.39 p = .001 p = .018 scale 1-9, 1 = not confident at all, 9 = completely confident mirroring the national aggregate data, the data for the mcwep specific classes indicates an increase in the primary objective of the course, student confidence in applying the core concepts of trauma (popescu et al., 2015; 2016b). while the sample size for each analysis is small, which limits the generalizability of these findings, the mcwep data reflect a trend similar to the national data, and provide a class by class assessment of student confidence for longitudinal consideration; akin to how one might use course evaluation data in teaching. outcomes of the mcwep trauma-informed child welfare course methods. in order to assess the impact of the ticwp course in increasing the knowledge of supervisors with regard to trauma, and their ability to apply the concept to their work, including integrating their knowledge, mcwep has collected independent data through three different formats; self-efficacy surveys, overall mcwep survey, and an exit survey. the data collected by mcwep is intended to compliment and supplement the reports generated from the pre and posttest data collected and compiled by the center (popescu et al., 2015; 2016b). advances in social work, spring 2017, 18(1) 241 the first source of program evaluation data supplemental data is the self-efficacy survey given to each student at the end of each semester to capture their perceptions of their learning and ability to apply their knowledge. the second is the overall mcwep program survey which is sent each year to all current students, and the third is the exit survey, which is sent to students who are graduating. table 2. self-efficacy of ticwp students with identified trauma practice behaviors (n=54) trauma competency/practice behavior min max % rating 4 or 5 mean st. dev. 1. i am able to integrate the concept of “child traumatic stress” in case practice and supervision by knowing what types of experiences constitute childhood trauma and utilize a traumainformed lens to manage child welfare cases. 4 5 100 4.8 0.42 2. i am able to apply knowledge of how traumatic experiences affect brain development and memory and understand the relationship between a child’s lifetime trauma history and his or her responses through comprehensive case planning. 3 5 98 4.5 0.54 3. i can articulate how trauma has an impact on the behavior of children over the course of childhood and how child traumatic stress is exacerbated over time by ongoing stressors (including separation from/loss of caregivers, and/or foster placement) in a child’s environment and within the child welfare system. 4 5 100 4.6 0.50 4. i am able to identify and promote the utilization of traumasensitive interventions such as strategic referrals to timely, quality, and effective trauma-focused interventions and traumainformed case planning with multi-disciplinary teams. 3 5 96 4.5 0.57 5. i can articulate how the impact of traumatic stress can be prevented and/or mitigated by trauma-informed responses of child welfare workers and child welfare systems. 3 5 94 4.5 0.61 6. i am able to consider how cultural factors influence the manner by which children may identify, interpret, and respond to traumatic events during the case practice process. 3 5 98 4.5 0.54 7. i am able to identify the impact of secondary traumatic stress (sts) on child welfare workers and employ appropriate interventions. 3 5 96 4.4 0.57 8. i support child and family services review (cfsr) goals of safety, permanency, and well-being by increasing skills to effectively serve children and families (biological and resource) in the child welfare system that have experienced traumatic stress. 4 5 100 4.5 0.50 note. (five-point likert scale, from 1 (very much disagree) to 5 (very much agree). self-efficacy surveys ask students to rate the degree to which they agree with statements regarding trauma-informed child welfare competencies and practice behaviors. these data were collected over four class cohorts (2013-2016). responses were based on a five-point likert scale from 1 (very much disagree) to 5 (very much agree). means on individual items range from 4.44 to 4.78. students consider themselves capable hernandez-mekonnen & konrady/title ive 242 in all eight categories in the ccct ticwp competencies. the 2016 (not shown) cohort has the highest overall self-assessment means, indicating that improvements in course structure, instruction, and student perceptions of self-efficacy in the competencies are occurring. perhaps the most significant indicator of the magnitude of the impact of the ticwp course in the mcwep program upon the new jersey state cps agency comes from the overall qualitative program assessment surveys students complete annually. a thematic analysis was conducted by study authors, once consensus on coding was reached, and ambiguities resolved. a priori categories, anchored in the overarching questions, were considered the guiding framework for coding and developing themes in the analysis, based upon grounded theory techniques (corbin & strauss, 2007). in the analysis, responses from three questions included repeated thematic comments around the impact of the ticwp course. they are: 1) what are the strengths of mcwep (table 3); 2) how well do you think mcwep is preparing you to be a more impactful supervisor at dcpp (table 4); 3) do you feel you are being prepared to play a role in the transformation of new jersey’s public child welfare system? five themes emerged across the three questions as described in tables 3 and 4 below: supervision secondary traumatic stress change in language change in perspective/thinking/understanding importance of trauma history table 3. program strengths theme common code in their voice supervision strengthen skills and incorporate more clinical supervision “the program has strengthened my supervisory skills by helping me to help my workers and supervisors understand the impact of trauma on the families we serve.” secondary traumatic stress recognition “importance of recognizing sts and burnout is something i am constantly on the lookout for now.” when asked about feeling prepared to play a role in the transformation of new jersey’s public child welfare system, there was a strong consensus that students, indeed, feel prepared. in fact, 88% (44/50) respondents indicated they felt they are more prepared to play a role in the agency’s transformation. despite the majority of students affirming, many acknowledged that they experienced some tentativeness about the pace of the agency, and concern for the readiness of the agency to accommodate the transformation, for example: i do feel that i am prepared, but i don’t think new jersey is prepared. we learn about different things our families need to be successful but they are not available for us to implement. an example of this is more trauma-informed services. advances in social work, spring 2017, 18(1) 243 table 4. supervisor preparation theme common code in their voice supervision strengthening skills “it teaches what supervisors need to know and equip themselves for working in the field.” access to tools “..continue using the theories and information in my day-to-day work during case consultation.” change in delivery “i have already seen a change in my supervision.” “the course was extremely useful to my case practice.” “it has definitely changed my way of thinking when providing supervision on case.” secondary traumatic stress acknowledgement of existence “i remind my workers and supervisors that they are incapable of providing effective intervention if their own baggage is too heavy.” “beyond speaking, i am able to step back and focus on what trauma exposure has done to my children and staff.” change in language adaptation of trauma focus lens “these classes provide the language necessary to invoke change in how we deal with families as well as how to effectively supervise.” “the class has changed my dialect. i speak about terms that are foreign to the workforce and it makes them want to learn more about it.” change in perspective knowledge acquisition “the ticwp elective was so informative that i will be able to use all i learned in that class to continue to service my clients in a more sufficient way when dealing with trauma.” “the eye opening moments i had in trauma in child welfare will stay with me throughout my career.” “the fact that we were exposed to trauma focus speaks volumes. at dcpp we are not exposed to this type of training.” additional tools and resources “..continue using the theories and information in my day-to-day work during case consultation.” understanding of trauma “i understand trauma now, clinical trauma, i also understand how important it is to provide the correct services for families.” “i am now aware of the importance of reviewing cases with a trauma focused lens.” hernandez-mekonnen & konrady/title ive 244 table 4. supervisor preparation theme common code in their voice “i do think from a more trauma focused/critical thinking perspective.” need for change “it makes no sense to have a child welfare agency staff that is not first and foremost educated in the long lasting impact and effects of child trauma and complex trauma.” importance of trauma history data collection “the trauma class made me realize how important it is to gather a trauma history with our children and parents.” “we should be making all decisions with the consideration of past, present, and possibility of future trauma.” informing the work “i feel that making my supervisees aware of social justice concerns and impacts their work. i share with them the impact of trauma and the importance of history informing their work. frustrations with the bureaucratic pace of change that cps supervisors are encountering as they become trauma-informed create challenges in remaining invigorated as change agents. students voice the personal preparation, feeling armed with knowledge to make a difference within their agency, but are tentative since they do not know how to begin. students are encouraged to take active advocacy roles within the agency to increase change within the organization; and there is opportunity to develop creative strategies to pursue this goal. as the number of graduates completing the program increases, there will be greater dissemination of this empirically driven ccct in child welfare, and thus greater the impact on the agency’s internal momentum toward becoming a trauma-informed agency. discussion and limitations when considering the compelling evidence to suggest that children, caregivers, and workers in the child welfare system all contend with the adversity and suffering that traumatic experiences bring, it seems obvious that cps agencies should embrace a trauma focused approach to benefit all those involved. acf released a detailed information memorandum, in response to the 2011 legislative amendments, to provide guidance in both scope and comprehensiveness of how trauma-informed child welfare systems should approach the issue of trauma (acf, 2012). however, the reality of transforming large bureaucratic child welfare organizations, whether it is at the county or the state level, is a daunting task. the trauma-informed child welfare practice course, from the nctsn, the learning communities, and the overall mcwep program, have initiated a comprehensive approach to move the agency in the direction of transformation. the mcwep program strategically educates mid-level supervisors, who are in positions to impact potentially advances in social work, spring 2017, 18(1) 245 thousands of cps cases around the state, and at the same time mitigate secondary traumatic stress among their workers. additionally, these supervisors are located in the ranks that will likely vie for leadership positions in the long term. in a recent initiative, spawning from the mcwep program, students and alumni have formed task groups to inform and assist the agency’s policy unit on revising specific policies to be more trauma-informed. the group has been asked by administration to conduct presentations to key leaders around secondary traumatic stress in the work force. students and alumni have indicated this is a significant stride in having an engaged and open agency. there are several limitations of the assessment methods that should be considered. first, this study is a small-scale case study. while it can be replicated, the findings cannot be generalized. the ticwp/ccct classes have had 20 or fewer students in each cohort, and in the first two years (2012, 2013), data was collected and reported from only two of the three msw programs participating in the mcwep course, making the n for the course only 11. also, the technical reports that provide the statistical analysis of the data sent to the national center for social work trauma education and workforce development were only available for the two most recent course years (popescu et al., 2015, 2016b), with low rates of matched data, limiting our ability to assess the statistical efficacy of the course in the earliest sections, and longitudinally. due to ending of the nctsn contract with the center, there will be no future reports unless mcwep continues to replicate the analysis without the assistance of the center. the mcwep self efficacy questionnaire uses questions designed to capture not only the transfer of knowledge, but also a student’s capacity to apply the knowledge in their case practices. as such, the eight questions may be considered double barreled, and may not elicit full responses. finally, additional longitudinal data related to retention and employment satisfaction of mcwep students is needed to better assess type of supervisors the program draws in its applicants and participants. the self-selection process may be creating the impression that agency supervisors are generally highly motivated and engaged, which may not be the case across the agency. conclusion the trauma-informed child welfare course is an effective academic course in educating students in the tenets of trauma-informed child welfare practice and when coupled with the learning communities as part of a title iv-e msw program, is likely to have a significant impact on the overall direction of the new jersey state child welfare transformation. in fact, it may be the leading initiative at this point in time, in terms of driving the change from within, particularly with regard to the recommendations of acf. in addition to informing case practice and supervisory roles, the course and program are cultivating leaders and advocates within the ranks, who will play key roles in the success of the 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(2003). the use of title iv-e training funds in social work education: an historical perspective. journal of human behavior in the social environment, 7(1/2), 5-20. doi: https://doi.org/10.1300/j137v07n01_02 zlotnik, j. l., & pryce, j. a. (2013). status of the use of title iv-e funding in bsw and msw programs. journal of public child welfare, 7(4), 430-446. doi: https://doi.org/10.1080/15548732.2013.806278 zlotnik, j. l., strand, v. c., & anderson, g. r. (2009). introduction: achieving positive outcomes for children and families: recruiting and retaining a competent child welfare workforce. child welfare, 88(5), 7-21. author note: address correspondence to: robin hernandez-mekonnen, department of social work, school of social and behavioral sciences, stockton university, 101 vera king farris drive, galloway, nj 08205, 609-626-5530, robin.hernandez-mekonnen@stockton.edu. https://doi.org/10.1007/s10802-012-9697-5 https://doi.org/10.1177/1524838012447697 https://doi.org/10.1080/02650530601173656 https://doi.org/10.1111/j.1540-4560.2006.00484.x https://doi.org/10.1300/j137v07n01_02 https://doi.org/10.1080/15548732.2013.806278 mailto:robin.hernandez-mekonnen@stockton.edu _________________ tonia stott, phd, msw, is the coordinator for the bsw child welfare education program in the school of social work at arizona state university, 411 n. central ave., ste. #800, phoenix, az 85004. ann maceachron, phd, msw, is a professor at the school of social work at arizona state university. nora gustavsson († deceased), phd, msw, was an associate professor at the school of social work at arizona state university. copyright © 2016 authors vol. 17 no. 2 (fall 2016), 221-234, doi:10.18060/21263 social media and child welfare: policy, training, and the risks and benefits from the administrator’s perspective tonia c. stott ann maceachron nora gustavsson† abstract: the field of public child welfare faces special challenges as it interweaves the use of social media into practice. social media can assist agencies in meeting demands of practice such as communication, preservation of important family connections, identification of kin, and service coordination with caretakers and community partners. it also presents risks with respect to privacy, confidentiality, and safety. to look at the role of social media in child welfare practice, we began by examining the literature on social media use and how agencies are responding to the risks and benefits of this technology. we then report the findings from an exploratory national survey of training administrators (n=14) that suggests states vary in both policy development and training with respect to social media in child welfare work. we further report on state training administrators’ views of the perceived risks vs. benefits of the use of social media in various case management tasks and in enhancing the well-being of youth in out-of-home care. agencies would reduce their liability risks and at the same time benefit their staff and clients by developing policies that offer guidelines to protect agency and staff privacy and safety, as well as client privacy and safety. agencies may also promote the well-being of youth in out-of-home care by providing adequate information to staff and care-givers regarding the safe use of social media to create and maintain appropriate connections. keywords: foster care; social media; technology; case management social media and other digitally-based technologies are increasingly becoming commonplace platforms for both communication and connection. in the field of public child welfare, social media can pose a complex mix of risks and benefits. its benefits include expediting such case management tasks as client contact and communication, keeping children and youth connected to siblings and family, mining for potential family and relative connections for children in out-of-home care, finding missing parents and/or runaway youth, and coordination among care-givers. despite its many potential uses in supporting case management tasks, social media also has risks that include breached confidentiality, invasion of privacy, and inadequate protection of child, family, and worker information. yet, there is little information in the empirical literature about either the employment of social media in public child welfare or its ethical, effective, and safe use. we undertook an exploratory study of state child welfare training administrators to examine the use, policy context, staff training, and perceived risks and benefits of social media in public child welfare. stott et al./social media and child welfare 222 literature review social media use in human services the helping professions have begun to give increased attention to how digital technology can be used to support and enhance client well-being (denby-brinson, gomez, & alford, 2015). the fields of nursing, public health, and medicine have not only recognized the challenges of social media use in health care but have also begun capitalizing upon the potential assets inherent in those communication platforms. various health care organizations have developed programs to incorporate social media in their efforts to support patients. these organizations have been using social media to work with health issues such as diabetes, obesity, smoking cessation, and medication compliance (hall, cole-lewis, & bernhardt, 2015). the mental health field has also capitalized on people’s increased use of electronic communication and social networking. cognitive behavioral therapy appears to be well-suited for adaptation in e-mental health (musiat & tarrier, 2014). furthermore, social media has been used in the treatment of substance abuse, anxiety, and mood disorders (berman, wennberg & sinadinovic, 2015; mewton, wong, & andrews, 2012; newby, mewton, williams, & andrews, 2014; parikh & huniewicz, 2015). organizations serving youth have recognized the pervasive use of social media among the populations they serve, and many have responded by using these technologies while trying to minimize the risks associated with the use of social media (schwartz et al., 2014). populations that present particular engagement challenges, such as homeless youth, use social media to communicate with service providers, kin, employers, and friends (rice & barman-adhikari, 2014). organizations concerned with youth mental health are using social media for prevention programming (clark, kuosmanen, & barry, 2015). software programs have been developed in child welfare to facilitate communication and information exchange between case managers and care providers (dodsworth et al., 2013). real-time video technologies such as skype and facetime have been used to support visitation between children and parents (quinn, sage, & tunseth, 2015). the use of the internet in various aspects of service delivery can extend the availability of services and help clients avoid the stigma associated with going to an agency (ramsey & montgomery, 2014). social work as a field, however, has approached social media with caution (baker, warburton, hodgkin, & pascal, 2014). social media in child welfare practice the use of social media in child welfare has been a topic of on-going discussion in practice publications (e.g., center for advanced studies in child welfare, 2011), and at child welfare conferences, the children’s bureau (e.g., smith & fitch, 2012), and the national resource center for child welfare and technology (2012). three studies have been published in the empirical literature documenting that front-line workers are using social media in their child welfare work (breyette & hill, 2015; mcroy, 2010; sage & sage, 2016). however, there is little in the empirical literature that addresses the extent of policy development around social media in professional child welfare, training available advances in social work, fall 2016, 17(2) 223 to staff from the training administrator’s perspective, or the risks and benefits of the use of social media from administrators’ perspectives. sage and sage (2016) used a snowball sampling technique of child welfare workers across several states to explore how they engaged in social media. most child welfare workers in their study reported using social media in their work but also reported challenges as well as benefits of its use (sage & sage, 2016). the literature in allied professions also suggests multiple ways social media may be integrated into professional practice. friend lists of youth and their parents can be mined to identify kin and natural mentors who could provide connections to children and youth in out-of-home care and to communicate with people who could be potential permanency options. when a parent’s whereabouts are unknown or a youth runs away, social media postings can provide clues to their location and an avenue for communication. when parents are transient, or their phone numbers frequently change, social media may prove to be a more reliable way than traditional phone contact of staying in touch with them and communicating about appointments. finally, for parents or kin who do not have phones, but can access the internet through friends’ phones or public venues (e.g., libraries), they may be more responsive to social media site messages from child welfare staff than other forms of communication. most notably, social media can be integrated into child welfare practice with respect to work with youth. youth in out-of-home care are highly vulnerable to becoming disconnected, socially and emotionally, due both to their removal from their original friendship and natural belonging groups and the continual disruption of their friendships and connections through placement instability. a potential advantage of social media use by youth in out-of-home care is that they can remain connected to friends and networks or groups of others who share their experiences. a recent study of smartphone use by foster youth reported the technology was viewed as important and helpful by the youth (denby, gomez, & alford, 2016). smartphones can also serve to support youth empowerment by giving them a voice in their service planning in addition to facilitating emotional connections (denby-brinson et al., 2015). these connections could be significant sources of resilience and emotional and social development (amichai-hamburger, 2013; best, manktelow, & taylor, 2014; fitton, ahmedami, harold, & shifflet, 2013). providing youth with access to internet technologies can also increase their e-literacy and reduce the digital divide they may otherwise experience in their transition to young adulthood. concerns about the use of social media in social service delivery concerns about social media use in social services have focused on access to the technology, confidentiality, privacy, boundaries, informed consent, documentation, and practitioner competence in the use of the technology (dombo, kays, & weller, 2014). a 2012 study by the national association of state chief information officers (nascio, 2013) found that all reporting states use social media and rated the future use of social media as essential. however, only half of the states had policies and procedures to guide the use of social media to meet job responsibilities. these policies typically provided for “confidentiality, ethical conduct, security and privacy, personal use, public commenting, and transparency” (p. 2). stott et al./social media and child welfare 224 the context of public services to children, youth, and families often demands additional but unique policy requirements. an initial recognition of this need occurred about ten years ago when the national association of social workers (nasw, 2005) developed standards for technology and social work practice. the standards represent an attempt to deal with the multiple challenges of the ever-increasing complexity and availability of social media as understood at that time. recently, nasw and three other nationally-based social work organizations drafted standards for the use of technology in social work practice (association of social work boards international technology task force, 2015). these standards are expected to be published by early 2017. it is unclear how well schools of social work are preparing practitioners for the digital component of contemporary practice (young, 2015). clear guidance on how to use social media with clients is thus still evolving. for example, clients may request to have an online relationship through social networking sites such as linkedin or facebook and may want to use text and email to communicate with their social worker. these common practices can present ethical challenges (reamer, 2015). for example, it is unclear how social workers should respond to friend requests from clients. boundaries can be further tested by texting (dejong & gorrindo, 2014). texting can be used multiple times a day, every day. the mixing of personal and professional social media is another area of risk (kimball & kim, 2013). guidelines on when and how to use social media to seek information on clients who may not have consented to such searches are still in development. furthermore, practitioners may not realize how their searches of clients can make their social media profiles or account names visible to those clients through anti-cyber stalking programs. in child welfare, specifically, social media can pose multiple dilemmas. millennials, generation z youth, and young adults may be more comfortable communicating via text message than through the phone. thus, the most efficient method of communicating with young parents may be lost to child welfare staff who are not comfortable using text messages or do not have a business line that is text-compatible. concerns for child safety can also be amplified. out-of-home care providers and case managers who do not understand social media, or the ease with which pseudonym accounts can be created, may miss opportunities to have discussions with youth about their social networking and safety online. even youth who do not have access to the internet at their placements can be communicating with family and others on their social media accounts through public computers or the smartphones of peers at school. children and youth may unwittingly reveal their address or school name on social media sites or even post pictures with gps coordinates embedded in them, revealing their location to dangerous parents or others who are barred from contact with them. additionally, foster youth may be especially vulnerable to child predators and traffickers who use social media sites to look for disconnected and desperate youth. mining parents’ friend lists for kin and viewing information posted on social media sites can also pose ethical and legal dilemmas in child welfare. it is unclear how information procured through a search of a parent’s social media site can be used in dependency hearings or the assessment of safety. researchers continue to try to understand how social media can be used to benefit which clients with what types of challenges. the advances in social work, fall 2016, 17(2) 225 unanswered questions on effectiveness can lead to reluctance to embrace the technology (harris & birnbaum, 2015). however, social media is omnipresent and has become a component of contemporary practice (mishna, bogo, root, & fantus, 2014). the ubiquity of social media suggests that child welfare agencies must negotiate the use of social media if only because child welfare staff, families, care providers, and youth may use it even without input, guidance, or direction from the organization. the professionally appropriate, safe, and ethical use of this technology is necessary, both to manage the risks social media poses and simultaneously offer templates for practice in environments saturated by social media and technological innovation. it is in this context that we undertook an exploratory study of training administrators of state child welfare agencies to examine whether public child welfare agencies: a) are using social media in practice, b) are guided by policies regarding the use of social media in child welfare, and c) provide staff training to promote competence in appropriate, safe, and ethical use of social media technology. we also explored how training administrators view the balance of risks versus benefits of social media use by child welfare workers and youth to meet child welfare goals. methods participants internet searches were performed to garner the name of the state-level department or division responsible for child welfare in each state. further searches were performed to attempt to ascertain email addresses or general phone numbers for the state-wide training departments in each state. if email addresses were not publicly available, phone calls were made to inquire about the person and/or specific agency responsible for the oversight of state-wide training and the email addresses of contact people. further searches and inquiries were conducted until names and email addresses of state-wide administrators, directors, and/or managers were collected. an email was sent to the identified person in all 50 states describing the purpose of the survey and asking if she/he would be the person most suitable to respond to a survey about the extent to which training was available to the child welfare workforce in that state on the subject of social media. correspondence including both phone calls and emails continued until all means were exhausted to identify state-wide training administrators, directors, and/or managers or their nominated representatives along with a confirmed email address for each state. these iterative search processes were used to ensure that our survey targeted state-level personnel involved in state-wide training or its oversight. although a number of states use counties to manage and train for child welfare work, state-level administrators receive and manage federal child welfare funds. from among the 50 states, we identified 49 people with a confirmed email address who had a role as a state-level training administrator, or as a director, manager, contracted provider, university partner, or a nominated representative of the state level training administrator. we sent an invitation by email to these 49 training representatives to participate in our electronic survey. data collection took place from august 2014 through stott et al./social media and child welfare 226 december 2014. the survey included an option for the participants to provide link(s) to their state or county policies relevant to social media use in child welfare and/or to provide additional information about procedures and protocols concerning social media. from among the 49 potential respondents, 17 responses were received; however, 3 responses were entirely blank. the response rate was 28% (n = 14). of these, 2 participants provided state-level links to their policies. the research protocol was approved by the irb and permission to proceed was authorized. measures training administrators or their designees responded to an on-line qualtrics survey. the survey questions aimed to assess the extent to which child welfare staff were using social media for work-related purposes and the extent to which policy was in effect concerning the professional use of social media. survey items further assessed the extent to which staff participated in training about social media in child welfare work across three case management topic areas, namely: a) searching for clients on the internet or communicating with clients through social media, b) privacy and protection of staff, and c) talking with youth in out-of-home care about their use of social media. if trainings were offered, participants were asked to identify the typical content of each training area. additionally, the relative risks and benefits of using the internet and social media was assessed by child welfare administrators on a 10-point scale ranging from: 1 to 3 (extremely risky with minimal benefits), 4 to 7 (moderate benefits with moderate risks), and 8 to 10 (extremely beneficial with minimum risks). one area of interest was the perceived risk/benefits of child welfare staff using social media to search for missing children, extended family and fictive kin, and parents. a second area of interest was the risk/benefits of child welfare staff using social media to communicate with youth in out-of-home care, parents, extended family and fictive kin, and out-of-home care providers. a third area was the perceived risks/benefits of youth in out-of-home-care using the internet and social media to search for their family and friends, communicate with family and friends, and search for educational resources, jobs, and health information. analysis we employed univariate descriptive statistics. the number/percent of respondents as well as means and standard deviations are shown in tables 1 and 2. the small sample size limited further analysis. results use of social media and policy development our initial research question was whether public child welfare agencies and staff use social media in their work, and specifically, in the case management areas of searching for and communicating with clients. as shown in table 1, 10 (71%) of the 14 training administrators in our sample indicated that their agencies allow child welfare staff to use social media to search for missing children, missing parents, or family members in the advances in social work, fall 2016, 17(2) 227 friend lists of their clients. half (50%) of the training administrators reported that their agencies allow child welfare staff to use social media to communicate with family and friends of children and youth in out-of-home care. thus, the majority of the reporting states use social media to search for and communicate with their clients. table 1. social media use, policy development, and child welfare staff training (n=14) n (%) agency allows use of internet and social media for: searching for missing children, for missing parents or for family members in “friend” lists of children or parents 10 (71%) communicating with family/connections of children and youth in out-of-home care 7 (50%) there is agency policy about the use of the internet and social media in child welfare work: no, no policy 5 (36%) no, but we are developing a policy 6 (43%) yes, some specific policies 3 (21%) yes, a comprehensive policy 0 (0%) training topic areas covered: searching for clients and/or communicating with clients through social media 9 (64%) privacy and protection of personal internet and social media accounts 8 (57%) talking with youth in out-of-home care about social media 5 (36%) a related research question was whether there was agency policy on child welfare staff’s use of social media for case management duties. only 3 states (21%) reported having at least one specific policy while no state reported having a comprehensive policy in place. one of these states emphasized the official use of social networking and social media for public education regarding the agency’s mission, official interaction with the public, connection with agencies and public “in times of crisis,” and/or to “assist with emergency, disaster, or crisis communications” (oklahoma department of human services, n.d.). this state also included a link to the ethics and expected code of conduct for using official social networking and social media. in another state, while there was no official section in their policy manual that addressed the use of social media by staff, a directive was sent via email to staff stating that social media could be used only with agency permission and in accordance with the following parameters: a) the social media account had to be separate from the staff person’s personal account, b) the account had to reflect the professional identity of the worker, c) the email address associated with the account could not be the staff member’s state or personal email address, and d) they could not reveal confidential information through social media communication. this approach offers guidelines regarding the access and use of technology for social media in social work practice, though the guidelines are not set forth in official policy. in the policy manual for this state, the term “social media” appears once. in the section on identifying family and connections for older youth with a case plan goal of appla (another planned permanent living arrangement), the policy states that there should be documented efforts to find family including through the use of search technologies and social media. this approach seems to recognize a benefit of using social stott et al./social media and child welfare 228 media in child welfare work, though standards for ethical conduct in carrying out social media searches were not simultaneously addressed. despite the examples of these two states, the majority of responding states reported having no policy (5 or 36%) or being in the process of developing policy (6 or 43%). these results suggest that policy development is loosely tied, at this time period, to the use of social media in accomplishing child welfare case management search and communication tasks. training the third research question explored whether agencies provide staff training regarding the use of social media to accomplish child welfare case management tasks, and if so, to identify incorporated topics. nine (64%) states provide agency-based trainings. this is consistent with the previous finding that the majority of responding states employ social media in child welfare case management with clients. the training content that these nine states are most likely to incorporate includes searching for client information online and online communication with clients. featured topics were the ethics of searching for personal information about clients and how information gleaned from social media accounts can be used in child welfare decisionmaking. the next most likely topics were the circumstances under which staff can communicate with clients via social media (e.g., only in emergency circumstances like an abducted or runaway child) and how staff are to represent themselves when communicating with clients or the families of clients through social media (e.g., does the worker’s professional profile need to make it apparent that the person represents a child welfare organization). eight (57%) states incorporate training content about the privacy and protection of staff members’ personal accounts. the most likely topics included were importance and/or meaning of password protections, privacy settings, guidelines on posting pictures, and how to respond to client requests to friend or follow them. only 2 states mentioned inclusion of information on how to respond to cyber-stalking or cyber-harassment from clients or colleagues. with respect to training content about talking with youth in out-of-home care about their social media use, only 4 (29%) of the responding states provide training on this topic. these states were most likely to focus on the importance of talking with youth about safety issues related to posting pictures online and about who is on the youth’s friend lists. risks vs. benefits of social media the last survey question asked training administrators their opinion about the risks versus benefits of: a) child welfare workers using social media to engage in case management activities related to the permanency and well-being of children, and b) of youth in out-of-care using social media. as shown in table 2, training administrators believe that more benefits than risks exist in both realms advances in social work, fall 2016, 17(2) 229 table 2. perceived risk/benefit of using social media in child welfare work child welfare workers’ use of social media mean (sd) range of scores to search for: missing children 8.1 (1.8) 5 10 extended family/fictive kin 6.3 (2.1) 4 10 parents 6.1 (2.2) 2 9 to communicate with: youth in out-of-home care 8.1 (1.8) 5 10 parents 7.2 (1.9) 5 10 extended family/fictive kin 6.4 (2.4) 2 9 out-of-home care providers 5.9 (2.9) 2 10 foster care youths’ use to search for: educational resources/programs 7.7 (2) 5 10 jobs 7.6 (1.5) 5 10 health information 6.6 (1.9) 4 10 family 5.5 (0.9) 4 7 friends from their past 5.5 (2.2) 2 10 foster care youths’ use to communicate with: family 5.9 (1.2) 4 8 friends 5.8 (1.5) 3 8 note. n = 14. the risk benefit scale ranges from 1 (extremely risky with minimal benefits) to 10 (extremely beneficial with minimum risks). low benefit/high risk scores range from 1 to 3, moderate benefit and risk scores range from 4 to 7, and high benefit and low risk scores range from 8 to 10. in the child welfare task of searching for child and family information, the greatest perceived benefit versus risk was for finding missing children, followed by the more moderate benefit of finding missing parents or extended family. in the child welfare task of communication, the greatest benefit versus risk was for communicating with children in out-of-home care, followed by the more moderate benefit of communicating with parents, extended family, and out-of-home care providers. in the realm of out-of-home youth using the internet and social media, the greatest but still moderately perceived benefit versus risk related to youth searching for information about educational resources, jobs, and health. other moderate perceived benefits were for youth to find and communicate with family and friends. discussion the results of this study indicate that of the states participating in the survey, most allow child welfare workers to use social media in their work and that respondents believed, overall, that the benefits of social media use by staff outweigh the risks. however, a limited number of states who responded to the survey have policies concerning social media use in child welfare. furthermore, few respondents noted providing training on how child welfare professionals can protect themselves when searching for and communicating with clients through social media, ethically search for client information, safely and ethically communicate with clients, or the importance of talking with older children and youth about stott et al./social media and child welfare 230 their social media posts, tags, and discussions. these state-level results are congruent with the sage and sage study (2016) where workers in three states reported being unlikely to have practice and/or case management guidance in the use of social media by either clear agency policy or through agency training. given the ubiquity of individual smartphones, the ease of access to social media by staff and clients, and the rapidity of change in digital technology, states may be reluctant to develop specific policies for worker use of social media in favor of more universal concerns for the ethical and safe use of social media through employee training. the primary limitations of this study are two-fold: the small sample size of the statelevel training administrators and an unknown generalizability of results. although the sample size was small, the response rate of 28% is not atypical of online surveys (nulty, 2008; pedersen & nielsen, 2016). given the paucity of literature on the subject of social media in child welfare work, these initial results serve not as generalizable population parameters but rather as an important genesis for discussions of this developing topic at the macro level of child welfare policy and training. our ongoing research involves phone interviews with state-level administrators to deepen the understanding of the barriers to policy development and training related to social media use at both the state level and, where applicable, at the county level. secondly, we plan to use skype to conduct focus groups about the challenges in policy development and training for case management uses of social media. implications social media use in child welfare work has risks, and there are risks to older children and youth accessing the internet and having social media accounts. there are also considerable benefits. the risks can be reduced by some degree with training, open discussion, and information-sharing. there is a gap, however, between acceptance of risks in the use of social media in public child welfare and the congruent policy and staff training offered to ensure practitioner competence in engaging online ethically, safely, and confidentially. sage and sage (2016) suggest that agencies provide guidance on the ethical use of social media. social media use, as revealed in this study, provides an example of how realities on the ground can result in practices before formal comprehensive policies are developed. on a daily basis, child welfare staff deal with the pervasiveness of social media in the lives of their clients. their own use of social media is often added to the mix. guidelines on how staff should respond to these realities may be developed on a caseby-case, idiosyncratic basis such that practice precedes policy. agencies would reduce their liability risks and benefit their staff and clients by developing policies that offer guidelines to protect agency and staff privacy and safety, as well as client privacy and safety. the nascio report (2013) strongly recommends that state governments develop such “comprehensive social media participation policies” (p. 4) and offers a checklist of issues to include. the 2005 national association of social workers’ and the 2015 association of social work board’s publications on professional practice standards include helpful checklists and highlight important principles to guide policy development in the use of social media technologies. an appropriate starting point for the development of these guidelines is an understanding of the risks and benefits, the capability of the technology to advances in social work, fall 2016, 17(2) 231 be misused and misunderstood, and the involvement of the many stakeholders in child welfare. care providers, attorneys, juvenile courts, service providers, and case managers have a vested interest in the technology. however, foster children and youth may 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(2015). assessing new media illiteracies in social work education: the development and validation of a comprehensive assessment instrument. journal of technology in human services, 33, 72-86. doi:https://doi.org/10.1080/15228835.2014.998577 author note: address correspondence to: tonia stott, school of social work, arizona state university, 411 n. central ave., ste. #800, phoenix, az 85004, 602-496-0077, tonia.stott@asu.edu https://doi.org/10.1016/j.childyouth.2014.09.004 https://cb100.acf.hhs.gov/downloads/friendingyourclientsonfacebook_transcript.pdf https://cb100.acf.hhs.gov/downloads/friendingyourclientsonfacebook_transcript.pdf https://doi.org/10.1080/15228835.2014.998577 mailto:tonia.stott@asu.edu _________ carolyn mak, phd, msw, rsw, adjunct assistant professor, school for social work, smith college, northampton, ma. mandeep kaur mucina, msw, phd, assistant professor, school of child and youth care, university of victoria in victoria, british columbia. renée nichole ferguson, msw, pmp, phd candidate, policy studies, ryerson university toronto, ontario. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 545-565, doi: 10.18060/24082 this work is licensed under a creative commons attribution 4.0 international license. wrestling the elephant: teaching as a racialized body in the social work classroom carolyn mak mandeep kaur mucina renée nichole ferguson abstract: white supremacist ideology is the elephant in the social work classroom, negatively impacting educators’ abilities to facilitate discussion and learning. one of the most effective ways to dismantle and organize against white supremacy is to politicize the seemingly benign moments that occur in the classroom that can create discomfort for students and instructors. politicization includes identifying and addressing both the racial (micro-) aggressions that occur in the classroom and the processes and institutional policies that create complacency and lull us to sleep. in this conceptual piece, we use a critical race theory (crt) framework to understand how white supremacy perpetuates itself in the classroom, with a particular focus on whiteness as property. as well, we explore what it means to decolonize the classroom. using a vignette based on our teaching experiences, we use these two frameworks to analyze classroom dynamics and interactions, and discuss how implications for social work education include waking from the metaphorical sleep to recognize the pernicious effects of whiteness and white supremacy. included are practical individual teaching, relational, and systemic suggestions to enact change. keywords: dismantling white supremacy, social work classroom, critical race theory, decolonization, racialized identities as social work educators, we focus on theory and practice, while weaving in stories from the field whether they are personal or emerge from the plethora of examples found in the news, podcasts, public radio, or from social media. how students take up and digest these stories is completely out of the control of the educator; however, the hope is that students emerge with a deeper understanding of the world we live in and how it shapes, constructs and impacts the people with whom we work. what happens when white supremacy, the large, stubborn, and ubiquitous elephant, makes itself visible in the social work classroom? what does the battle to wrestle the elephant look like for a racialized social work instructor? we use the term “racialized” or “racialization” to refer to the active process of being seen as a body belonging to a particular race, as a result being subjected to unequal treatment because of the color of one’s skin. as dalal (2002) effectively articulates, “racialization is the process of manufacturing and utilizing the notion of race in any capacity” (p. 27). while all people are racialized, white people are often seen to be exempt from being racialized, maintaining whiteness as the norm that all other races are compared to, giving whiteness a tremendous amount of power, socially and politically. for the aforementioned reasons, we have followed laws (2020) and miller (2020), and elected not to capitalize “white.” about:blank advances in social work, summer 2021, 21(2/3) 546 white supremacy is not a new concept, but it has only now become more commonplace in mainstream conversations, compared to early contexts which bell hooks names “white supremacist capitalist patriarchy” (hooks, 2006). what hooks offered was a shift in conversation, where white supremacy was not simply a far-right ideology that was reserved for klan and nazi activity, but part of unnamed culturally normative practices and relationships that racialize and negatively impact black, indigenous, people of color (bipoc); while for white people, white supremacy is upheld in individual attitudes and structural inequalities. postsecondary social work classrooms are not immune to white supremacist thinking or indoctrination; as in society, white supremacy needs to be dismantled in the academy (henry et al., 2017; mohamed & beagan, 2019). fraught moments of discomfort and their ensuing dynamics are reflective of and are a result of white supremacy. as we will demonstrate in this paper, critical moments in the classroom serve as examples of how social work postsecondary classrooms are not designed to reflect or support the diversity of the learners and instructors who inhabit them. as educators who work in postsecondary social work programs that focus on social and racial justice and action, we know that even with increasing diversity of social identities and locations in classrooms, white supremacy continues to present itself. in other words, “increasing diversity” does not preclude white supremacy; activity and action are needed to uproot it. one of the most effective ways to dismantle and organize against white supremacy is to politicize the seemingly benign moments that occur in the classroom that can create discomfort for students and even instructors. alternately, it is incumbent on social work educators to also politicize challenging dynamics by making white supremacist and racist undertones more visible in the classroom. by “politicize,” we intend to identify and address both the racial (micro-) aggressions that occur in the classroom as well as the processes and policies that create complacency and lull us to sleep. we recognise this sleep as dangerous because it offers a false sense of security within the current racially unsafe landscape; it requires complicity in our own oppression as well as the oppression of others. without the critical tools to politicize both micro-level and macro-level interactions (e.g., individual conversations and policies, respectively), we might easily believe in a “racialized innocence” or a false sense of safety and security. through the politicization of the benign, we are shaken awake and believe that these awakenings offer opportunities for resistance and action against the status quo, and are necessary for progress to be made. this paper aims to identify and document our processes of awakening. we first examine the concept of white supremacy and its impact on postsecondary classrooms, including how racial microaggressions present themselves to do the work of white supremacy. by “classrooms” we take into consideration the people (students and instructors), the physical environment (classroom set up, materials displayed) and its construction (the building in which the classroom is housed, the land on which the institution operates). we recognize that well before more recent contemporary discussions of white supremacy have occurred, black feminists and critical race scholars have been using this terminology. we use a critical race theory (crt) framework to understand how white supremacist ideology and racism affect both students and faculty alike, and further examine what it means to “decolonize our curriculum and education” to help us mak et al./wrestling the elephant 547 understand the politics of identity, power and privilege that are at play in the classroom. by examining our awakenings, the ways that whiteness behaves perniciously in institutions and how we want and work to de-center this perspective, we hope to add to strategies that educators can use to make more critical and informed decisions about their teaching practices. in particular, we will call attention to the “invisible contracts” that are constantly being negotiated by racialized instructors; namely, how occupying this space can be lonely, can engender self-doubt, and necessitates emotional labor often not shared by white colleagues. overall, we aim to empower educators to recognize and voice how white supremacy takes shape in their own institutions, to be able to organize in both individual and systemic ways to dismantle it. with an established framework of crt and decolonization, in the latter part of this paper we analyze a vignette that illustrates how white supremacy creeps into the classroom. to model and practice self-reflexivity, we first briefly discuss how each of us comes to this work. self-reflexivity and coming to the work we are three women-identified, racialized educators who personally encounter the continual effects of white supremacy in the postsecondary classroom. for us, the body one inhabits can constrain choices in education; for indigenous and racialized faculty, implicit bias and racism (both from students and that which is internalized) negatively impact our ability to teach, grow and advance. it is vital to position ourselves to the readers in order to contextualize what informs our teaching and why we persist in the dismantling of white supremacy. renée. black canadian feminist theorist njoki wane (2011) raises important ideas about the use of the spiritual self, collectivism and relationship for black feminist theory. using her own personal narrative, wane argues that we cannot tell the stories of our lives without finding a context for these narratives. for black feminists in particular, our context is rooted in a collective consciousness of gendered racialization; it is grown out of histories of colonialism, slavery, imperialism and neocolonialism. emerging from this, we form cultures of resistance against what bell hooks (2006) calls an ethic of domination, and a commitment to global practices of freedom in recognition that our own liberation is irrevocably linked to the global community. as a descendent of peoples who survived the transatlantic slave trade, with nearly ten years of teaching experience in the university classroom on the traditional territories of the mississaugas of the credit, the anishnabeg, the chippewa, the haudenosaunee and the wendat peoples, my work is grounded in this particular milieu of black feminist thought. my visceral experience and witnessing of racism buried within interactional and contextual rules of the classroom leaves me thinking about relationships of power and domination that i participate in and witness in the classroom. i draw on the work of my black feminist foremothers to illuminate the complex and messy relationships of value incongruency and power that exist in the classroom between me, as the educator, the university and students. advances in social work, summer 2021, 21(2/3) 548 carolyn. like renée, i have also been in the postsecondary classroom as a part-time, adjunct/sessional faculty for approximately 10 years. born in canada to chinese immigrant parents, i only “discovered” social work in my early twenties. i grew up and was educated in white spaces, thus becoming very skilled at performing whiteness, in hindsight, seeing it as a way of acceptance and a method to excel. particularly resonant is liu and colleagues’ (2019) notion of being “racially innocuous,” that one might “thrive” in white spaces or that “becoming racially innocuous may come with rewards such as proximity privilege” (p. 149). for many years, i strove to be more white and to fit into predominantly white educational and work spaces. it was through my professional employment experiences as a social worker early in my career working with chinese immigrants and through further doctoral studies that i began to understand my own identity as a racialized person. the realization that i was not indeed white, and that i could come to embrace my racialized identity was trying, painful, and humbling, but ultimately a journey that was worth taking. concerns over race-based conflict and discomfort, and white performativity, still affect my teaching today; i often worry about offending white students when attempting to confront whiteness, and also simultaneously fear not doing my racialized students justice when not centering needed conversations on race, ethnicity, culture, power and privilege. trying to meet the needs of all students, while recognizing the societal marginalization of some, while also trying to avoid being one of the marginalizing forces as a teacher with power in the classroom, continues to be a fine and tricky balancing act. mandeep. i am a second-generation punjabi sikh cisgender woman born on unceded land of indigenous peoples, in a nation that we collectively call and know as canada. as an uninvited perpetual visitor and second-generation immigrant, my physical occupation of this land comes at the expense of the quw’utsun people, and the songhees, esquimalt, and wsáneć peoples who never ceded their territories to colonial canada. i strive towards being a responsible visitor on these territories, while also being loud and vocal about the constructed injustices that continue subjugating and marginalizing historically targeted bipoc communities. in everyday acts of resistance towards colonization, i resist the allure of calling this land home and work towards undoing colonialism and its impact on the diversity of communities that live on these lands. in the process of decolonizing my scholarship, teaching and service, i start by speaking out loud about the colonial roots and ongoing structures of colonialism in our discipline. i also critically reflect on how my research may be contributing to, or benefiting from, these colonial roots and work towards actively dismantling these patterns. i often begin my classes by sharing powerful words of bell hooks, who describes how she came to theory as a place of healing and liberation. these words ring true for my own life journey, especially in formal educational settings. as a racialized woman, i have encountered and navigated painful experiences. in these moments i turn to books and theory as a way of understanding and critically thinking through my experiences. education has been a liberation for me and through it, i gained freedom (hooks, 1994), yet to get to where i am today, i have endured racism, sexism, and multiple forms of rejection. i remind my students that the university has not always imagined particular bodies inhabiting these spaces and roles. in my teaching, i also spend time situating the kind of practice i have had the privilege of doing over 15 years in the human service field. as a practitioner and as an mak et al./wrestling the elephant 549 educator, i have worked in multiple sectors including child and youth care, social work, adult education and community development. these disciplines show up in my teaching, particularly when i provide students with strategies to transgress the social systems they will be working in, in an effort to uphold social justice. white supremacy and the postsecondary classroom institutions are imagined with particular bodies, orientations, and ethics in mind, ones that center western philosophical epistemologies and ontologies. in recognizing the foundation on which we stand when teaching, asking students to consider how social systems are constructed to stratify who has the privilege of teaching and learning in these spaces becomes essential. we recognize that “we are all implicated in systems of oppression that profoundly structure our understanding of one another” (razack, 1998, p. 10). every student, regardless of their social location, has come to the university with some level of privilege, and yet there remain those of us who are marked for marginalization because of our differences. as racialized instructors, our encounters with education are often painfully isolating. working within these institutions as racialized instructors, we recognize that they are built on an already imagined idea of a professor and student, who were white cisgender able-bodied males with middle to upper class privilege. to embody anything beyond this means shifting a system with deep histories and norms. learning is often uncomfortable, yet we emerge transformed when we are able to think critically about knowledge, its production and our adoption of it, as well as the contradictions embedded in our socially constructed world. in these complex times, we resist the simplistic mandate to manage encounters between dominant and subordinate groups with cultural, racial, or gender sensitivity (razack, 1998), which leads into the imperialist belief that if one possesses sensitivity to people’s differences, we can overcome divisions by predicting future behavior. as sherene razack (1998) effectively argues, “without an understanding of how responses to subordinate groups are socially organized to sustain existing power arrangements, we cannot hope either to communicate across social hierarchies or to work to eliminate them” (p. 8). as instructors, we need to listen carefully, openly and deeply discuss power, privilege and oppression, encouraging this critical reflection in our students as well; consensus or harmony is not the ultimate goal, but rather meaningful discourse that deepens learning. these pedagogical directions center what bell hooks (1994) calls “education as the practice of freedom” (p. 4)—a standpoint that honors the sacred role we play in students’ learning. we value the journey each student has walked into the classroom and into their work, and hold space to witness their stories as their instructor. discussing white supremacy in the academy is challenging and uncomfortable in part because it disrupts the notion that universities and postsecondary institutions are “postracial” and are places where there is a free exchange of (sometimes controversial) ideas. instead, what scholars are beginning to document and research are the ways in which institutions produce, protect and cater to “white comfort”: …the constitution of who is made to be or expected to be uncomfortable and what kinds of difficult conversations are protected by [freedoms such as free speech] advances in social work, summer 2021, 21(2/3) 550 often reflects institutional practices designed to tend to white guilt and comfort. these projects of innocence making, reconciliation and absolution persist, while hatred and bigotry are left to make already marginalized groups (re) experience intergenerational forms of systemic ‘discomfort’ through race erasure, institutional silencing and invalidation, which often occurs specifically for the learning of dominant groups in the university. (joseph et al., 2019, p. 169) dismantling pre-existing narratives and ideologies that exist in the classroom before we arrive creates classrooms that resist these dominant narratives. by de-centering whiteness we can create space for students who have not always been imagined in these spaces. to begin the process of dismantling white supremacy, there needs to be an understanding of how to de-center whiteness. even before the 2020 uprising in support of racial justice in the united states, sparked by the murder of george floyd at the hands of police, and the renewal of interest and focus on anti-black racism, scholars were calling out and recognizing the pernicious nature of whiteness. this includes the notion that white leaders and allies will need re-education to understand the impact of whiteness, power and privilege (as opposed to simply increasing tolerance, inclusivity or diversity) (ash et al., 2020). studies highlight the experiences of black, indigenous and other people of color in predominantly white spaces in the academy (e.g., ash et al., 2020; decuir-gunby et al., 2020; joseph et al., 2020; joseph-salisbury, 2019; louis et al., 2016; mohamed & beagan, 2019). what these scholars have in common is a call to bring awareness to how whiteness dominates the postsecondary world. however, awareness is not enough. awakening, should be followed by action, and for too long, the onus has been on bipoc to accommodate and do the required labor. one of the ways in which white supremacy manifests in the classroom is through racial microaggressions; this phenomenon has been increasingly studied in education, psychological and social work scholarship, and it impacts students and faculty alike (e.g., decuir-gunby et al., 2020; louis et al., 2016; nadal et al., 2014). often, microaggressions take the form of something that seems innocent or unintended (e.g., such as playing “devil’s advocate” in a discussion), but are actually ways that the speaker unconsciously or consciously communicates racist stereotypes. since higher education encourages “diverse” ideas, this notion of devil’s advocate appears pseudo-intellectual, when in fact, it (sometimes thinly) disguises bias. racial microaggressions “are brief and commonplace daily verbal, behavioral, and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults to the target person or group” (sue et al., 2007, p. 273). the term “microaggression” is widely used but almost a misnomer since there is nothing “micro” about the cumulative effects of these acts. studies have shown that beyond the negative psychological impact on bipoc, microaggressions also significantly impact physical health (nadal et al., 2017). in our collective experience, we know when microaggressions have occurred in the classroom because there is often a discomfort experienced by members of the class, with the ubiquitous elephant sitting beside mak et al./wrestling the elephant 551 the instructor. it is in these moments when the elephant is most apparent; yet, no one is able or seems willing to name it. theoretical perspective: critical race theory (crt) since the 1980s and 1990s, crt has provided a valid framework for understanding racial injustice. scholars, activists and thinkers like dr. martin luther king jr., w.e.b. dubois, malcom x, and frantz fanon have laid the foundation for thinking about race, critically. with these historical roots and voices, we see this concept growing as legal scholars and activists (bell, 1995; crenshaw, 1988; delgado, 1988; harris, 1993; harris, 1994; matsuda, 1987; williams, 1991) who wanted to understand why, nearly two decades later, key legislative promises of the american civil rights era remained unfulfilled. in one foundational essay, kimberlé crenshaw (1988), comments on the commencement of martin luther king day: although king's birthday had come to symbolize the massive social movement that grew out of efforts of african-americans to end the long history of racial oppression in america, the first official observance of the holiday would take place in the face of at least two disturbing obstacles: first, a constant, if not increasing, socioeconomic disparity between the races, and second, a hostile administration devoted to changing the path of civil rights reforms that some believe responsible for most of the movement's progress. a focus on the continuing disparities between blacks and whites might call, not for celebration, but for strident criticism of america's failure to make good on its promise of racial equality. (pp. 1332-1333) the critical race response to the sliding back of racial progress takes its analytical cue from the critical legal tradition; a tradition that recognises the legal system as a key player in the creation and legitimization of unjust social structures in the u.s. however, critical race scholars argued that this arm of legal discourse should be bolstered with racial formation and systemic racism analysis, so that it can address the indiscernible ways that the law maintains racialized relationships of power. in other words, with meticulous attention to race coupled with a mapping of where law is assumed race-neutral, critical race theorists could make visible the ways that race and racism create law and are created by law. since its emergence, critical race theory’s intentional race consciousness and scholarly resistance has expanded out of american legal studies, crossing both discipline (ford & airhihenbuwa, 2010; kolivoski et al., 2014; ladson-billings & tate, 2006) and geographical borders (pon et al., 2011; tate, 2016; yee, 2005). specifically, over the past two decades, scholars have frequently engaged with crt as a way to highlight the systemic racial injustices in higher education, including the racial injustices of teaching and researching (bernal & villalpando, 2002; croom & patton, 2011; griffin et al., 2014; harper, 2012; hughes & giles, 2010; mccoy & rodricks, 2015; patton, 2016; patton & catching, 2009). this work is important because it illuminates a system at the behest of white supremacy. it does so by highlighting a system of segregated knowledge production (bernal & villalpando, 2002), by critiquing a system readily engaged with race whilst erasing racism, colonialism and white supremacy (harper, 2012; patton, 2016); by advances in social work, summer 2021, 21(2/3) 552 validating the racial profiling experiences of postsecondary faculty (patton & catching, 2009); and by proposing practical and community-based applications of crt within postsecondary contexts (hughes & giles, 2010). although the above mentioned do not capture the entire breadth and depth of crt interventions into postsecondary spaces, we believe that the intentional race consciousness and structural determinism of critical race theory represents an ideal method for analyzing the relationship between race, racism, and power in the classroom. we believe this for several reasons. first, it is an ideal fit because we have seen how it successfully provides a framework for critiquing liberal ideas of equity and reform within the academy (ladsonbillings, 1998). second, we appreciate its use and validation of voice by communicating real life experiences of racialized peoples (griffin et al., 2014; solórzano & yosso, 2001). finally, the critical race tenets are useful for providing a means of systematically studying contemporary race relations within institutions (see delgado & stefancic, 2017). in our own work, we draw from two specific crt tenets for this paper. first, by way of harris (1993), we make use of whiteness as property and harris’ argument that laws and policies legitimize the value of whiteness by structuring benefits to citizens because of whiteness. we apply this to a postsecondary context by exploring the hidden and not-sohidden ways that the academy bestows benefits to whiteness and white adjacency, marks resistance as risky and undermines claims for racial justice. second, we use the tradition of storytelling and counter-storytelling (delgado & stefancic, 2017) to make visible the oftencomplicated classroom experiences of racialized faculty that are frequently ignored or consumed by narratives of progress. we hope these stories in the form of our case vignette will resonate with and validate racialized readers. while we are excited to explore crt interventions in the academy, we recognise that critical race tradition is not without critique. in particular, we note the critique of crt emphasis of a black-white or people of color-white binary (ray et al., 2017). this point of bifurcation has meant that crt has been slow to take up distinct yet linked histories of racial formation of different racialized groups as well as the material consequences that arise vis-a-vis white supremacy. for example, while crt developed out of the experiences of black americans, there is no theorization of blackness or antiblackness (dumas & ross, 2016). the significance of this absence lies in the deeply anti-black logic embedded in social, cultural and economic norms embedded in postsecondary institutions (see walcott, 2014). recognizing this, dumas and ross (2016) argue that in crt, whereas black people’s experiences with race become default and generalizable, whereas other specifically named critical race sub-theories, also known as “crits,” “...offer and benefit from more detailed, nuanced, historicized, and embodied theorizations of their lived racial conditions under specific formations of racial oppression” (p. 417). a second, related critique of crt comes from gaps in its explanation of racial formation, particularly at the hands of non-indigenous thinkers, who have said very little about the perceived permanence of the settler state, its use of citizenship and rights, and sovereign indigenous nationhood, these playing a role in racial formation. instead, under crt, indigeneity has mostly become subsumed under the issue of race, with no connection to political and legal issues around sovereignty, indigenous nationhood and the colonial mak et al./wrestling the elephant 553 legacy of settler law (smith, 2006). we take both of these critiques seriously because we recognize that anti-blackness and settler colonization play roles in the academy and are built on anti-black and settler colonization projects. this most certainly shapes how students and faculty experience and live within the academy. we understand that even at a time when liberal democratic states point to an end of formal colonialism and slavery, the ways of viewing land and race along with the rules governing racial relationships that grew out of colonialism and racism are carried forward into current institutions and ways of being. their logics are still present and alive. decolonization and the classroom in situating our discussion on decolonization, it is important to acknowledge and recognize scholarship that has emerged in the past decade addressing decolonization and more specifically, decolonizing social work education (e.g., absolon & absolonwinchester, 2016; baikie, 2009; baskin, 2011; baskin & sinclair, 2015; bruyere, 1999; clark & drolet, 2014; gray et al., 2013; hart, 2009; sinclair, 2004; sinclair et al., 2009; tamburro, 2013; weaver, 2004; yellow bird, 2008). two widely recognized scholars to contribute to the field are eve tuck and wayne yang (2012) with their article decolonization is not a metaphor, which articulates the crux of decolonizing education. the authors bring attention to the superficial adoption of decolonization language into educational spheres that erases possibilities of talking about the essential project that decolonization calls for: the repatriation of indigenous land and life. to decolonize education, social work practice, and policies, we must acknowledge how settler colonialism operates through multiple pillars, relying on racial capitalism and white supremacy as its foundation (smith, 2016). through resource extraction and exportation, settler colonialism works to “build the wealth, privilege, or feed the appetites of the colonizers, who get marked as the first world” (tuck & yang, 2012, p. 4). settler colonialism functions on managing indigenous people, land and waters through “modes of control, imprisonment, and involuntary transport” (tuck & yang, 2021, p. 4). recognizing that the americas are settler colonial nations, the current structures of governance we understand and operate under are imagined through prisms of white supremacy and settler dreams of making this land home and never leaving. settler colonialism requires land, resources, and ripping away any recognition of indigenous peoples’ sovereignty and culture (tuck & yang, 2012). this intricate organization of settler nations relies on the genocide of indigenous peoples, erasing traces of indigenous existence, a long and bloody history of slavery, and the displacement/migration of low-wage labor (lawrence & dua, 2005; smith, 2016; tuck & yang, 2012). racialized scholars are making connections between critical race theory and decolonization, while attending to the specific relationships that hold up the settler state, settler law and settlerhood and, in the process, speaking to what binds us together (e.g., dhamoon, 2015; hackett, 2019; moreno & mucina, 2019; sharma & wright, 2008). questions of who is a settler within these settler nations shape these discourses and force indigenous, black and people of color to reflect on our relationship to land, to each other, and to our futurities as communities of color impacted differently by settler colonialism. advances in social work, summer 2021, 21(2/3) 554 yet the questions of who is defined as a settler and who is impacted differently by settler colonialism need ongoing discussion and unpacking. we often confront these questions when we have black and racialized students in the classroom who ask pertinent questions about their position and role in decolonizing their selves and their practice. when we consider a critical race perspective that comes from anti-colonial foundations, we recognize that it is not only about analyzing race, racism and power, but locating these relationships at the center of a project that normalizes racial capitalism and harmful relationships between indigenous and black people and people of color. in this sense, social work education is critical race work. this requires recognition of both global and local understandings of indigenous and colonial histories, with specific understanding and appreciation of the land on which we live, teach and practice (allan et al., 2019). social work scholars allan and colleagues (2019) call for an imagining of decolonial futurities in social work education that go beyond territorial acknowledgments and seek a new relationship beyond colonial frames; they write: we must also attend to our relationships and accountabilities to the indigenous peoples and traditional teachings of the spaces we occupy in order to learn how to be good (decolonial) relatives and to transform the legacy of social work with communities and nations who have been on the receiving end of colonial violence. (p. 2) to attend to the call for decolonization as social work educators, we must ask ourselves how are we contributing or supporting indigenous peoples’ fight for repatriation of land/water and life? how do we recognize, name and acknowledge the impact of slavery and displacement that continues to encounter a governance system that polices, punishes and persecutes black bodies and indigenous communities? the complexities of race and intersecting histories of colonization affect each of our entry points to this conversation, while shaping how we define our selves in the classroom. social work education as a discipline is largely practice oriented, which pushes educators to make the connection between policy, theory and practice, engaging in how theories come to life in the field. moreover, our engagement with decolonization in the classroom pushes students to consider how normalizing discourses created by settler colonialism and so much of what we practice is embedded in prisms of white supremacy, capitalism and settler colonialism. in a decolonial classroom, students are pushed to consider how they will take up this work in their practice outside of the classroom, which is the space for tangible transformative social justice change that considers decolonizing social work spaces. we recognize that these are beginning entry points to discussing the theoretical foundations offering insights on how racialized educators can recognize and begin to wrestle with white supremacy in the classroom. this is not an exhaustive literature review and the theories offer particular entry points to the remainder of the paper where we move to illustrate the impact of white supremacy in the classroom by examining a vignette based on our teaching experiences; the vignette is analyzed using the theoretical frameworks above, followed by a discussion of the implications for social work education. mak et al./wrestling the elephant 555 table 1. case i in a class of 45 second-year bsw students, who represent a mix of diverse races and ethnicities, students listened to a podcast segment (balkissoon & sung, 2016) that illustrates an example of white fragility; a white male podcast host named ian power invites a racialized female journalist, denise balkissoon, to speak about racial issues. power refers to a recent poll indicating that “minorities” are “insular,” and talks about his own experience feeling excluded by them. balkissoon disagrees that minorities are insular, and points out his assumption that all visible minorities are immigrants (as opposed to naturalized citizens or permanent residents). the conversation devolves from there, with the host eventually ending the interview abruptly, stating that he feels the guest is calling him a racist. in the classroom, students shift uncomfortably and many comment that they feel power was indeed being racist by stereotyping “minorities” and the behaviors of racialized communities. as the instructor, i try to note how quickly some conversations can transform and move away from the original intent, how even with good intentions to speak about racial issues, these can easily be brushed aside. a racialized student immediately puts up her hand and says, “i don’t think he had good intentions—why are you defending the white man?” analysis teaching and learning can create uncomfortable moments and this vignette brings back the discomfort, as well as the awkwardness of the learning situation. it is clear that whiteness has entered both the room (and arguably, was always there) as well as the instructor’s teaching and unconscious. as a racialized instructor, the teacher has tried to assuage the white fragility and guilt that white students are likely experiencing by noting aloud that the host of the podcast had “good intentions.” this further illustrates the effects of white supremacist thinking — that attending to white fragility and guilt are prioritized, that the comfort of white students is more important than the comfort of bipoc students. using a critical race theory framework encourages us to consider what might have been happening for the instructor and students. while it was not within the instructor’s conscious intent, it is clear that the crt tenet of whiteness as ultimate property was at play. kolivoski and colleagues (2014) write that “crt asserts that whiteness is the ultimate property value, leveraged to perpetuate advantages and privileges among whites” (p. 270). the authors further draw from harris (1995) when they write that “whiteness can be transferred by rewarding people of color for conformity to white norms or sanctioning cultural practices that violate white norms” (as cited in kolivoski, 2014, p. 270). this notion of conformity is demonstrated in the instructor as she weakly attempts to normalize the racist statements made by the podcast host and demonstrates her own (unconscious) attempts to approximate towards whiteness. harris (1993) posits that “whiteness shares the critical characteristics of property even as the meaning of property has changed over time. in particular, whiteness and property share a common premise – a conceptual nucleus – a right to exclude” (p. 1714). the notion advances in social work, summer 2021, 21(2/3) 556 of the right to exclude further brings up the idea that the instructor is hoping to be included, to feel safe; her efforts to assuage the upset and discomfort in the class may be interpreted as a way of seeking inclusion. while there is nothing inherently wrong with wanting to be included (which can include things such as job security and positive regard from students and faculty colleagues), this also makes the racialized instructor side with whiteness, which ironically supports her own oppression and the oppression of racialized others. the racialized student who wondered aloud and demanded to understand why the instructor came to the defense of the white man in the podcast may have sensed this, and in her own way, was politicizing or making known that defense of racism is wrong. the instructor is fortunate that this student was particularly awake, not asleep and lulled into whiteness as property, and that the class climate was one where she felt she could and should speak out. by trying to accommodate the white students, the instructor has missed an important opportunity to open the discussion about how white supremacist thinking, white fragility, and tenets of crt are playing out right in front of them, and are evident in the interaction that students heard in the podcast. it is regrettable that a student interpreted the instructor’s comments as a “defense of the white man” but is also completely understandable. for the students, particularly the racialized students in the room, there is a confusing message being communicated: is a teacher – no less, a social worker – not supposed to call out racism when it is seen, heard or experienced? is the (micro-) aggressive dialogue between the podcast host and his guest not meant to be explored and further understood? racialized instructors are constantly negotiating these invisible “racial contracts” when they enter the academy, which was not built or imagined with them in mind. the instructor in this vignette not only needs to contend with how to teach the curriculum and manage the class, but also, has the additional pressures of “representing” racialized peoples. this representation is both a privilege as well as a source of additional racially-related challenges that white instructors do not necessarily experience. while this vignette speaks specifically to racial issues, let us also not forget how a decolonizing framework can help us understand how white supremacy has infiltrated the classroom. in this case, issues of colonization are not made visible in the room at all. while the content of the podcast certainly speaks to white supremacist thinking (i.e., “othering” non-whites), the instructor’s comments following the discomfort having listened to the podcast also further colonizes the classroom by normalizing a white perspective. to decolonize would have meant to deconstruct the worldviews that lead to both the reactions and spoken sentiments of the students and the instructor. any conversation or engagement of minority communities or immigrant assimilation is a conversation about people of color who are expected to melt or integrate into a national identity. this national identity is imagined by and for settlers who embody whiteness and have invested in the extraction of resources in order to build this national identity, resorting to the genocide of indigenous people, their land and waters, and the slavery of black people who are continually shaped by these narratives. yet in the podcast and in the classroom, there is a disavowal of what it means to even begin to have a conversation about nationalism, assimilation or “canadian values”; the implication is that people of color approximate towards whiteness and contribute to the colonial machinery. the colonial machinery relies on national ideas that are intertwined with capitalist ideals that rely on the mak et al./wrestling the elephant 557 resources deeply embedded in the land and waters of this nation. this machinery homogenizes who is and can be canadian, all the while removing indigenous sovereignty from the picture and the history of transatlantic and indentured slavery, exploiting and banking on black and racialized bodies to produce the labor to continue making the west rich. the instructor’s behavior is also informed by the fact that postsecondary institutions often depend on positive student evaluations to invite adjunct or sessional instructors to return and continue teaching. women and people from marginalized identities often receive lower student evaluations, which negatively impact their ability to be retained and promoted (evans-winter & twyman hoff, 2011; lazos, 2012; stanley, 2006). research demonstrates psychological bias by students and negative misattributions towards instructors in postsecondary student evaluations (coren, 1998). educators who dare to bring up issues of race and racism may be judged harshly by students who resist learning about these issues; evans-winter and twyman hoff (2011) go so far as to say that student evaluations can be used “as weapons to speak back to and against, not only to anti-racist philosophies, but counter-hegemonic narratives that represent the diversity of their future teaching experiences” (p. 461). learning and discomfort are not mutually exclusive and yet, with the pressures of delivering curriculum while also trying to embody social work values, social work educators are often in a position where they do not want their students to be too uncomfortable. teaching in a racialized body, coupled with the aforementioned desire for inclusivity and safety, can lead to hidden spots and surface-level teaching. for example, in this vignette, the instructor attempted to introduce content about race, racism and white supremacy into the classroom but had not anticipated the myriad of other factors outlined above that led to her own reactions in the classroom. this demonstrates the essentiality of self-reflexivity, good teaching mentorship, and the ability to analyze and debrief with trusted colleagues. implications for social work education the vignette illustrates both how subtle white supremacy can creep or explode into a classroom, as well as why it is essential that white supremacy be dismantled in academe. whiteness has been internalized by the instructor, which speaks to the systemic ways it is normalized in our society and our institutions. as previously stated, awareness of these dynamics is not enough: action and activation are needed to dismantle what has been so long entrenched. politicizing and not letting go of what can seem to be benign classroom moments, practices, and policies, is one way to take such action. from a teaching perspective, the instructor might have felt compelled from the difficult moments in the classroom to be able to discuss openly with her students the dynamics that were noticed, or the “stuck” feelings they might have experienced. the instructor might have been able to enrich student learning by opening up a dialogue and discussion about the discomfort in the room, making an overt connection to the ways her comment reflected a white lens, arguably also a colonial lens, influenced by her own experience with whiteness. perhaps not all instructors are comfortable with this level of self-disclosure; in advances in social work, summer 2021, 21(2/3) 558 that case, it might simply be enough to begin a dialogue by proposing to students that whiteness had become centered in the room, and to ask them to discuss what they noticed, experientially, in small groups. giving a name to that racial discomfort that is expected in the classroom when these moments become exploited would be another strategy to encourage student engagement. further, the instructors might rely on trusted colleagues to debrief the interactions in the classroom, particularly for the instructor who needs to increase her own awareness of how she has used proximity to whiteness as a survival skill. one may wonder, how and why do these moments occur, even in supposedly progressive spaces? the answer: because white supremacy has been given permission to take the focus back to what a number of scholars call a race to innocence (fellows & razack, 1998; tuck & yang, 2012). as racialized educators, we are expected to demonstrate respectability in the face of white privilege and colonial attitudes that center whiteness and innocence from the legacy of white privilege that comes from being a settler on stolen land. by taking up the position of educator or instructor as people of color, we are often asked to invest emotional labor in breaking down racism into edible and easy to digest pieces so that “well intentioned” white settler students can understand and in particular within social work, engage in social work practices with the racialized or indigenous other ethically. from a systemic perspective, instructors, particularly those in racialized bodies, need to question and stay awake to how institutional policies around evaluation, recruitment, retention and promotion are not at all neutral. it is we black, indigenous, people of color who are tacitly agreeing to the “invisible contracts,” the invisible emotional labor attached to teaching in a racialized body, to continue to pursue social work teaching positions. teaching in a racialized body often means being keenly aware of how being racialized affects teaching abilities, emotional capacities and the energy it takes to continue the pursuit of equity and justice. for white allies, it is just as important to recognize, acknowledge and politicize how classroom dynamics can stay hidden and policies tacitly create benefits for some but not all.. if you are a white ally, consider these questions: on a colleague-to-colleague level, are you noticing and actively listening to how your racialized colleagues are doing? do you integrate anti-racism content into your own teaching? do you broach and denounce the construct of white supremacy and its many forms? do you take on the necessary labor to dismantle white supremacy? how are you recognizing the land you stand and teach on and the history of displacement, genocide, and violence that sits below the classroom? how do we stay awake in the face of colonization and capitalist white supremacy? conclusion this paper challenges all social work educators to politicize and make known how white supremacy comes into the classroom, and can take the form of microaggressions, covert racist undertones, benign interactions or awkward moments. we have used two main metaphors to highlight the challenges of teaching in a racialized body: first, the metaphor of wrestling the elephant that is white supremacy, that which does not want to be named or identified; and second, the metaphor of being lulled to sleep. it is imperative that we rise mak et al./wrestling the elephant 559 from our slumber, when we have been lulled into false senses of safety and inclusion. we are not indicting the institutions where we teach; instead, we are calling attention to how postsecondary institutions have never been imagined with racialized bodies in mind, and are built on foundations of colonial and colorblind tenets. critical race theory and decolonizing frameworks have also helped in the analysis of a teaching encounter that is presented in the form of a vignette. in particular, whiteness as property is explored as a way to understand how the instructor responded to white supremacy showing up in her classroom. if you are a racialized social work educator, we encourage you to continue to stay awake to what student-to-student, student-to-instructor, and instructor-within-institution dynamics and policies surround you. one of the questions we have wrestled with as a group of racialized instructors is what it might mean to be a truly “free” educator – to be able to fully express ourselves, without the specter of white supremacy overshadowing us, and where we are empowered at individual, organizational and systemic levels to continue to combat the dominance of whiteness. our sincere hope is that by using crt and decolonizing lenses, we will be better equipped to fulfill the invisible contracts that are part of teaching as a racialized body, with a greater sense of clarity and purpose for our future teaching experiences. references absolon, k. e., & absolon-winchester, a. e. 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(2008). postscript—terms of endearment: a brief dictionary for decolonizing social work with indigenous peoples. in m. gray, j. coates, & m. yellow bird (eds.), indigenous social work around the world: towards culturally relevant education and practice (pp. 275-292). ashgate. author note: address correspondence to mandeep kaur mucina, faculty of human and social development, school of child and youth care, po box 1700, stn csc, victoria, british columbia v8w 2y2. email: mmucina@uvic.ca https://d.docs.live.net/0b35692bdfca311b/documents/5%20-%20aisw%20article%20prep/copy%20edting/mmucina@uvic.ca _____________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2017 author vol. 18 no.2 (fall 2017), i-iii, doi: 10.18060/22166 editorial: the march of scientific knowledge in social work margaret e. adamek in the fall 2017 issue of advances in social work we are pleased to present 15 manuscripts--12 empirical, three conceptual--written by authors hailing from 15 states, the district of columbia, and four countries. seven papers address various aspects of social work education, including three on research issues, two on child welfare curriculum, one on macro social work, and one on combined public health/social work programs. the remaining papers include three conceptual offerings and five empirical studies conducted in the field. mirick, davis and wladkowski surveyed over 200 graduates of phd programs in social work about their experiences with recruiting and sampling participants for their dissertation research. since many social work dissertations focus on hard-to-reach, vulnerable, or marginalized populations, the input of dissertation committee members and connections to community contacts proved pivotal to the sampling process. davis and mirick partnered again in a second study comparing the outcomes for msw students taking statistics as a non-credit option and those who took a regular for-credit statistics course. this exploratory study offers preliminary support for replacing the stats requirement with a brief, non-credit class as a less costly and time-consuming approach. deck, connor, and cambro explored the perceptions of 70 masters-level social work students enrolled in an advanced research course that included a significant service learning component, i.e., a pro bono program evaluation of a shelter serving homeless men. in addition to reinforcing the importance and relevance of research to social work practice, as a bonus outcome, students also changed their thinking about homelessness in positive ways. using mixed methods, greeno, fedina, rushovich, burry, linsenmeyer and wirt evaluated the impact of title iv-e training on the skills of 224 msw students. improvements were found across all practice content areas with the largest gains in working with the courts and conducting assessments. multiple focus groups assessed students’ perceptions of competency to practice in child welfare. a second study of child welfare students by pierce and park involved three cohorts of bsw and msw students who were educated using a competency-based curriculum and field placements in child welfare. based on pre and post field placement surveys, statistically significant change was demonstrated for most competencies. key strategies recommended to support bsw and msw graduates in child welfare agencies include transition-to-work initiatives in schools and mentoring programs in agencies. two studies illustrate how alumni surveys may provide helpful insights for enhancing educational programs. using electronic surveys, salm ward and reeves examined the perceptions and experiences of alumni and field instructors from an msw/mph program. alumni reported satisfaction with their dual degree program and with the application of both social work and public health skills in the workplace. field instructors underscored the complementary skill sets of dually-trained students and noted the added value of msw/mph professionals in their agencies. based on an online survey, hill, erickson, advances in social work, fall 2017, 18(2) ii ferguson, fogel, and donaldson examined perceptions of macro social work educators and practitioners nationally about macro education and the influence of larger societal forces such as licensure regulations. while there remains a consistent level of support for macro social work within msw programs, macro practitioners recalled negative perceptions of macro social work during their msw education. the authors recommend that social work programs seek out opportunities to integrate macro practice content and field experiences into their curriculum so that students can be better equipped to respond to the complex systemic challenges they will encounter while in professional practice. moving on to the conceptual papers in this issue, scanlon and sanders promote financial capability and asset building (fcab) as an important professional activity for social work. the authors propose a person-environment-centered process model for use in fcab. the authors assert that attention to behavioral, cognitive, emotional, and policy feedback processes may help provide the missing link between individual financial behavior and the institutional opportunities offered by fcab programs. in an epistemological analysis, iacono argues that the nature of marginalization experienced by bisexual individuals is unique among lgbtq individuals. seeing an opportunity for social work, iacono calls for research that is inclusive of sub-populations within sexual minority groups. boys and walsh point out that social work literature on working with families affected by infertility has not kept up with medical technology that frequently results in excess embryos. persons receiving care through assisted reproductive technology (art) need to be prepared for the difficult moral questions raised when ivf procedures result in more embryos than intended. boys and walsh outline the pros and cons of each disposition option that social workers need to explore with ivf clients. moving on to studies conducted in the field, bruno, brown and holloway used a mixed methods approach to examine outcomes of a worksite wellness program. the contingencybased program bases individual employee health insurance discounts on each participant achieving bio-metric goals. while over half of the nearly 400 employees met their health goals, focus groups revealed that employees were stressed by contingency approaches that tie financial incentives to achieving specified benchmarks. as worksite wellness programs proliferate, social workers in healthcare and administration need to advocate for programs that promote human dignity and avoid discriminating based on employee health status. the availability of evidence-based practices does not necessarily equate to their implementation in the field. thus, edmond and voth schrag examined the attitudes of 76 rape crisis counselors toward evidence-based practices for addressing trauma in rape survivors. in particular, they examined counselors’ perceptions of prolonged exposure (pe), cognitive processing therapy (cpt), and emdr therapy. results from a statewide survey in texas suggest that efforts are needed within rape crisis centers to advance the uptake of empirically-supported treatments (est). recognizing that combat veterans may have some attributes of differentness that may cause others to create stigmatized perceptions and devalue their skills, kranke, gin, saia, schmitz, and dobalian conducted qualitative interviews with combat veterans who work side-by-side with civilians in disaster relief projects. modified labeling theory (mlt) was proposed to help understand the stigma and labeling experience of combat veterans volunteering in disasters settings. the interviews with combat veterans produced some hopeful results. molin, sorbring, and löfgren-mårtenson interviewed 27 young people with intellectual disabilities (id) in sweden about their internet use. a thematic analysis revealed that study participants were well aware of both the risks and opportunities in using the internet and social networking sites. nevertheless, the more they interacted with non-disabled peers online, the more they experienced negative consequences of internet use. the authors recommend that social workers reflect upon ways that young people with id can be empowered to participate positively on the internet. concerned with the socio-cultural and historical context where african americans are seen as a strong people, able to deal with anything, and not affected by depression, campbell conducted qualitative interviews with african american adults experiencing depression. her analysis revealed that african americans may go through a process of reconciling being depressed with certain aspects of their cultural identity as they strive to better understand themselves, their illness, and options to help alleviate their symptoms. campbell’s results raise questions about whether racial identity and cultural expectations may interfere with help-seeking among african americans. we are delighted to present this eclectic mix of empirical and conceptual papers as a contribution to the forward march of scientific knowledge in social work. microsoft word 12_evans_et_al_24428_advancing_child_trauma_screening _________ kylie e. evans, msw, lsw, doctoral candidate in social welfare, jennifer a. king, dsw, lisw, assistant professor and co-director of the center of trauma & adversity, and megan r. holmes, phd, msw, lisw-s, associate professor and co-director of the center on trauma & adversity at msass at case western reserve university, cleveland, oh. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1261-1279, doi: 10.18060/24428 this work is licensed under a creative commons attribution 4.0 international license. advancing child trauma screening practices: an evidence-informed framework for a pictorial child trauma screening tool kylie e. evans jennifer a. king megan r. holmes abstract: child trauma screening practices have advanced considerably as child-serving systems have increasingly incorporated early identification and intervention into traumainformed models of care. while research points to the necessity of screening practices that attend to a child’s developmental capacities, cultural background, relational strengths, contextual details surrounding the traumatic experience, and complex trauma considerations, many of these features remain absent in common brief screening measures used in practice. pictorial screening measures may offer an innovative opportunity to address attentional concerns and developmental capacities of young and complexly traumatized children, yet are understudied in this area. the purpose of this paper is threefold: 1) highlight areas for expansion within current brief trauma screening models, 2) propose an evidence-informed framework for a pictorial complex trauma screening tool for children, and 3) offer implementation considerations for piloting the proposed screening tool. piloting and implementation considerations address the importance of cognitive interviewing, cultural sensitivity, development of a companion response and referral protocol, and embedding principles of trauma-informed care in the training and implementation process. keywords: child trauma; trauma screening; complex trauma; child trauma measurement child trauma exposure has been identified as a public health crisis, with lifetime victimization/exposure rates for children ages birth to 18 years ranging from 9% to over 50%, depending on the type of victimization (finkelhor et al., 2013). the substance abuse and mental health services administration (samhsa, 2014) defines individual trauma as an event or series of events that one perceives as harmful or life-threatening, and has persistent effects on one’s physical, socio-emotional, and/or psychological well-being. types of traumatic events experienced by children are wide-ranging and can occur across levels of the child’s ecology, including interpersonal victimization (maltreatment, neglect, peer victimization), intimate partner violence (ipv) exposure, community violence exposure, terrorism, refugee trauma, natural disasters, medical trauma, and traumatic grief, among others (greeson et al., 2014). childhood trauma has been linked with a variety of adverse outcomes across the lifespan, including cognitive, physical, behavioral, socio-emotional, and neurodevelopmental challenges, many of which can persist into adulthood if left untreated (dye, 2018). traumatic victimization also increases children’s risk of subsequent traumatic exposures across different settings and perpetrators, a phenomenon referred to as polyvictimization (turner et al., 2016). a dose-response relationship between exposure advances in social work, fall 2021, 21(4) 1262 and outcomes indicates that the more traumatic exposures a child experiences, the higher their likelihood of experiencing maladaptive outcomes across the lifespan (ballard et al., 2015; copeland et al., 2018). for example, among child welfare populations, evidence has shown a 41% increase in trauma symptoms and a 34% increase in other mental health symptoms for each additional traumatic exposure a child reports (griffin et al., 2011). the rapidly growing body of research on child trauma points to important areas for expansion to better identify and treat child traumatic exposure and sequelae. accurate identification and treatment of child trauma symptoms requires screening and assessment tools that are not only developmentallyand culturally-sensitive, but also tap into a range of diverse reactions to child trauma. failure to attend to both of these considerations places children at risk for misdiagnosis, poor treatment planning, and inadequate intervention. the past two decades have brought substantial gains in the development of reliable and valid measures of child trauma exposure and symptomology. the national child traumatic stress network (nctsn) maintains a robust database of trauma screening and assessment measures, providing an accessible repository for practitioners and clear information about target population, scoring, format, and administrative requirements (nctsn, 2021). distinctions are also made between screening and assessment tools, thus providing practitioners with a range of options depending on their practice setting, level of clinical training, and time limitations. while assessments typically require training in evaluation and scoring, trauma screening tools provide initial indicators as to whether an individual has been exposed to trauma and, if so, if he/she presents with trauma symptoms. (conradi et al., 2011; kerig et al., 2014; samhsa, 2009). systematic literature reviews have also sought to catalog and summarize instrument properties (e.g., choi & graham-bermann, 2018; eklund et al., 2018; oh et al., 2018; stover & berkowitz, 2005; whitt-woosley, 2020), finding that child trauma measures are wide-ranging in their scope, depth, provider accessibility, and training requirements for administrators. while brief screening instruments like the child trauma screen (lang & connell, 2017), young child posttraumatic stress disorder screen (ycp-screen; fraser et al., 2019), and the trauma symptom checklist for children—short form (tscc; briere, 1996) offer the benefits of time efficiency, swift identification, and broader accessibility to a range of providers, more extensive assessments like the clinician administered posttraumatic stress disorder scale for children and adolescents (caps-ca; nader et al., 1996) and child and adolescent needs and strengths—trauma (cans-trauma; kisiel et al., 2018) can provide salient details about the child’s context, clinical diagnoses, and resources/supports. despite the burgeoning body of literature on child trauma measurement, persistent gaps exist between the state of knowledge of children’s developmental capacities, the complicated presentation of traumatic symptoms in young populations, and the translation of measures with strong research utility to practitioner-friendly tools that are well-suited for a range of practice contexts (leigh et al., 2016; strand et al., 2005). thus, guided by contemporary research on child trauma exposure and measurement practices with children, this paper seeks to: 1) highlight areas for expansion within current brief trauma screening models. evans et al./advancing child trauma screening 1263 2) propose an evidence-informed framework for a pictorial complex trauma screening tool for children ages 5 – 12 years. 3) offer implementation considerations for piloting the proposed screening tool. screening for child trauma: areas of expansion considerations around complex trauma trauma screening measures that account for the unique and variable symptom presentation associated with complex trauma in children—rather than those defined only by post-traumatic stress disorder (ptsd) diagnostic symptom clusters—may offer a more comprehensive understanding of children’s traumatic reactions. complex trauma exposure is characterized by chronic, ongoing, or repetitive traumatic events that are often of an invasive, interpersonal nature, including experiences such as child neglect, exposure to intimate partner violence (ipv), and physical, sexual, and psychological abuse (d’andrea et al., 2012). complex traumatic reactions extend beyond criteria for ptsd, and manifest across symptom clusters including attachment, biology, affect regulation, dissociation, behavioral regulation, cognition, and self-concept (cook et al., 2017; van der kolk, 2017). although the most recent edition of the diagnostic and statistical manual of mental disorders (5th ed., dsm-5, american psychiatric association, 2013) provides an updated and broadened definition of child ptsd, clinical concern has been raised that the expanded ptsd criteria still do not account for the disruptions to neurodevelopment—and subsequent regulatory challenges and developmental sequelae—that are linked to early and chronic traumatic stress (debellis & zisk, 2014; depierro et al., 2019; ford, 2011). child trauma measures that screen for symptoms defined by dsm-5 ptsd diagnostic criteria may fail to tap broader developmental indicators of complex trauma, including relational dysregulation, attachment difficulties, and physical and somatic complaints, and thus risk under-identification and missed opportunities for intervention (ford, 2011). recent systematic reviews of child trauma screening measures used with child welfare populations (whitt-woosley, 2020) and in school settings (eklund et al., 2018) found that the majority of included measures use ptsd symptom clusters as evidence of traumatic stress. examples included the university of california at los angeles ptsd reaction index (ucla ptsd-ri; steinberg et al., 2013), the child trauma screen (cts; lang & connell, 2017), the child ptsd symptom scale (foa et al., 2018), and the child and adolescent trauma screen (sachser et al., 2017). despite the important benefits these tools offer, their emphasis on ptsd criteria may present identification challenges when working with child welfare populations, which have high rates of complexly traumatized children. greeson et al. (2011) found 70% of their sample of 2,251 foster children and teens had experienced two or more types of interpersonal trauma that constitute complex traumatic stress. if measurement tools lack the nuance necessary to detect the diversity of complex traumatic reactions, children can be inadequately diagnosed, subjected to faulty treatment decisions, or may not be identified for services at all (mcmillen et al., 2007; whittwoosley, 2020). advances in social work, fall 2021, 21(4) 1264 relational health and resilience relational health, defined as one’s connectedness to attuned, supportive, and caring adults, has demonstrated significant protective effects among trauma-exposed youth, promoting resilient functioning across cognitive, behavioral, and emotional domains (hambrick et al., 2019). clinical researchers have recently found that high levels of relational health can disrupt the dose-response relationship between exposures and outcomes and buffer children from the detrimental effects of increasingly high levels of trauma (bartlett, 2020). in a study of children ages 6 – 13 years of age with histories of severe trauma and/or maltreatment, hambrick and colleagues (2019) found that participants’ current relational health was the strongest predictor of children’s physiological, behavioral, and social-emotional functioning. similar findings have been reported among child welfare-involved samples (hambrick et al., 2018). these studies assert that relational health holds a more powerful association to child outcomes than a cumulative traumatic exposure score, yet relational health remains absent among brief trauma screening tools. while some lengthier assessments include measures of relational support, such as the cans trauma (kisiel et al., 2018), the time requirements (45 minutes) and clinician-report format preclude such measures from being used as a brief screening instrument across a variety of practice settings. embedding relational health screening within brief child trauma screeners will offer a more balanced picture of the child’s context, highlighting concern for children in relationally impoverished environments, and calling attention to interpersonal resources for those who are relationally healthy. culture and trauma culture can influence how a child experiences trauma, their appraisal and perception of traumatic experiences, and their responses and reactions (perry et al., 2019). a child’s culture can shape their belief systems, familial relationships and attachment patterns, and coping skills, all of which can influence a child’s interpretation of a traumatic event and their expression and communication about the experience (nader, 2007). cultural differences in the conceptualization of trauma symptoms have been identified, such as the western method of dichotomizing physical and mental health symptoms, which differs from eastern medical models that use a more integrated and holistic approach to mindbody connection when framing traumatic reactions (zheng & gray, 2015). cross-cultural differences have also been noted in symptoms related to avoidance, hyperarousal, and cognitive structures related to self-blame (perry et al., 2019). moreover, belonging to a collectivist versus individualist culture has also been linked with differences in disclosure, perceptions, interpretations, and healing from trauma (engelbrecht & jobson, 2016). despite this evidence, cultural differences are rarely accounted for in many trauma screening tools (bartlett, 2020), and little is known about their validity in diverse cultural contexts, particularly among children from non-western cultures (perry et al., 2019). adding to concerns around the use of dsm-v ptsd criteria, perry and colleagues (2019) note that when ptsd criteria are used as the gold standard by which to establish validity evans et al./advancing child trauma screening 1265 in new screening tools, we may fail to capture cultural differences in trauma symptoms. enhanced cultural sensitivity in screening tool design, piloting, and implementation is necessary for accurate identification of trauma exposure and reactions among children from diverse cultural backgrounds. sensitivity to developmental age and stage practitioners and researchers working within child-serving systems have called significant attention to the importance of using developmentally-sensitive trauma screening practices (bartlett, 2020; fraser et al., 2019; scheeringa, 2019; scheeringa et al., 2011). it is well-established that children’s information processing skills, verbal and communicative abilities, and presenting symptoms can vary by developmental age and stage, and age-appropriate screening tools must be developed with this in mind. evidence of such developmental sensitivity is increasingly found in child screening practices, such as with the massachusetts child trauma project’s use of the aforementioned brief ycpscreen (scheeringa, 2019) with its young child welfare population (fraser et al., 2019). similarly, new hampshire’s child welfare department developed a mental health screening tool (mhst; butcher et al., 2020) that includes varying measures based on a child’s age, including the young child ptsd checklist (ycpc; scheeringa, 2013) and the ucla ptsd-ri (steinberg et al., 2013), among other measures. as technology advances, options for measure formatting have also expanded to address children’s developmental needs, such as the use of a tablet-based computer interface for trauma screening among youth with autism spectrum disorders (hoover & romero, 2019). even with these advances, the majority of brief child-report trauma screeners still rely on verbal or written formats, which may present comprehension challenges for young and/or complexly traumatized children. growing knowledge about the power of visual working memory (constantinidou et al., 2011) and challenges with attentional capacity among complexly traumatized children (d’andrea et al., 2012; ford, 2011) offer a promising opportunity for the addition of pictures to enhance child comprehension of trauma screening questions. in current systematic reviews of child trauma screening measures, the angie/andy cartoon trauma scale (praver et al., 2000) is one of the only pictorial-based child trauma screening measures identified (eklund et al., 2018), and some reviews do not identify any pictorial measures (gadeberg et al., 2017; whitt-woosley, 2020). while the angie/andy scale has demonstrated adequate reliability and validity among children ages 6 – 12 years, there has been a dearth of follow-up innovations in pictorial screeners since its development, and the scale’s lengthy assessment format makes it inaccessible to a wide range of practitioners and for brief screening purposes. such challenges highlight an opportunity for innovation in pictorial child trauma screening. closing the gaps on measurement of complex trauma in children knowledge and measurement practices around child trauma have made significant gains in recent decades, much of which is evidenced by the database of screening and assessment measures available through the nctsn (2021). despite these advances, important gaps still exist in child trauma brief screening tools and practices. building from advances in social work, fall 2021, 21(4) 1266 the contemporary body of research on complex trauma screening and identification, we propose a framework for the development of a pictorial child trauma screening tool. seven key measurement priorities are highlighted to address the aforementioned gaps and enhance usability for a range of practitioners (see table 1 for a summary). table 1. considerations for development of a brief pictorial child trauma screening tool 1. a screening tool, rather than an assessment or formal interview, permits administration by a range of trained child-serving system professionals. 2. a self-report format ensures that data are obtained from the source closest to the traumatic incident(s): the child. 3. a child’s relational health should be accounted for in brief child trauma screening tools. 4. screening tools must attend to the developmental capacity of traumatized children under age 12, including language ability, attention and engagement, and memory. 5. a single self-report measure for children ideally screens for both exposure to traumatic events and traumatic reactions/symptoms. 6. interpersonal proximity in the victim-perpetrator relationship is an important consideration when measuring child trauma exposure and symptoms. 7. pictorial self-report measures offer potential for addressing measurement concerns related to children’s developmental levels, including attention and engagement, expressive capabilities, and reading comprehension. an evidence-informed framework for the pictorial child trauma victimization tool 1. a screening tool, rather than an assessment or formal interview, can be administered by a range of child-serving system professionals. in addition to the mental health expertise and/or graduate-level training often required for assessment administration (conradi et al., 2011; kerig et al., 2014; samhsa, 2009), assessments also tend to be more comprehensive compared to screening tools. assessments are designed to provide clinicians with detailed information about client functioning in multiple domains, and, in some cases, serve as diagnostic measures for clinical diagnoses (lanktree et al., 2008). in contrast, trauma screening tools provide initial indicators of trauma exposure and symptoms. results of the screener inform whether or not a child needs referral for a more comprehensive assessment (conradi et al., 2011; kerig et al., 2014). a primary benefit of the screening tool format is its accessibility to a range of trained workers in child-serving systems. by not restricting screening tool administration to trained clinicians and mental health professionals, the spectrum of professionals who can screen and refer children for traumatic exposure expands significantly (samhsa, 2009), which has important implications for identifying children impacted by trauma, regardless of their entry point into the system or their involvement with child welfare. evans et al./advancing child trauma screening 1267 2. a self-report format ensures that data are obtained from the source closest to the traumatic incident(s): the child. research has shown that children tend to report higher levels of traumatic exposure than caregiver reports on their behalf (meiser-stedman et al., 2007; schreier et al., 2005; stover et al., 2010; tingskull et al., 2015). discrepancies also exist with children’s trauma symptomatology, with some studies showing parental under-report of child post-traumatic stress symptoms (humphreys et al., 2017; lanktree et al., 2008). adult under-reporting of children’s trauma exposure can have dire consequences for youth, including potential risk of ongoing exposure to traumatic incidents and failure to receive the treatment they need to heal. furthermore, there are limitations to gathering trauma exposure and symptom information from a single source. although the nctsn has advised integration of symptom observations from caregivers, teachers, clinicians, and children (nctsn, 2018), all of the brief trauma screening measures included in whitt-woosley’s (2020) review use only a single reporting source. triangulation of multiple perspectives in brief trauma screeners may offer an area for future expansion in screening tool development. perhaps most importantly, increasing attention has been directed toward child-centered measurement, whereby children’s insight into their own experience is prioritized (berliner et al., 2020; deighton et al., 2014; sidebotham, 2015; valla et al., 2000). evidence indicates that children are capable of providing accurate, reliable, and valid self-reports of their own mental and behavioral health symptoms (berliner et al., 2020; sturgess et al., 2002; valla et al., 2000), thus illustrating the value of centering their voices in the screening process. 3. a child’s relational health should be accounted for in brief child trauma screening tools. as previously discussed, studies have increasingly pointed to the role of consistent, caring adults as a protective buffer against the negative outcomes associated with child trauma exposure, with evidence supporting these protective effects across the lifespan (brown & shillington, 2017; hambrick et al., 2018, 2019; southwick et al., 2007). consequently, indicators of child victimization and traumatic reactions cannot be understood independent of a child’s relational context. while a variety of well-validated measures exist to assess children’s relational health and social connectedness, this construct is largely absent within commonly used brief trauma screening tools, such as the cts (lang & connell, 2017), ucla ptsd-ri (steinberg et al., 2013), and the child and adolescent trauma screen (sachser et al., 2017). given current research on the powerful buffering effects of relational health, it would be prudent to embed relational connection screening within measures of trauma exposure. 4. screening tools must attend to the developmental capacity of traumatized children under age 12, including language ability, attention and engagement, and memory. advances in social work, fall 2021, 21(4) 1268 language ability. empirical studies have documented a well-established link between child maltreatment and/or violence exposure, and poorer literacy and language skills in school-age children (coohey et al., 2011; de leeuw, 2011; perkins & graham-bermann, 2012; thompson & whimper, 2010). the potential for child difficulties with reading and language-processing presents challenges for practitioners who must administer self-report measures for traumatic exposure and symptoms. this highlights the importance of administering measures that are simple for children to process and interpret, and are not reliant upon reading skills, when working with complexly traumatized children. attention and engagement. children exposed to complex trauma often have difficulties with attention span, concentration, impulse control, and problem-solving (cook et al., 2017; d’andrea et al., 2012; van der kolk, 2017). questions pertaining to vague or abstract content can also present attention challenges as children under the age of 12 rely on concrete language to understand others and to express themselves (de leeuw, 2011). taken together, these factors can result in child disengagement and lower response rates (denton et al., 2017). memory. effective screening requires that children recall and report their experience with traumatic events. activation of children’s visual working memory has been suggested to promote accurate recall (hitch et al., 1988), and studies have shown that children both with and without mental health symptoms perform significantly better on memory and processing tasks when information is presented pictorially, rather than verbally (constantinidou et al., 2011). 5. a single self-report measure for children ideally screens for both exposure to traumatic events and traumatic reactions/symptoms. the nctsn recommends that child trauma evaluations screen for both exposure and symptoms in seven domains of functioning affected by complex trauma: attachment, biology, affect regulation, dissociation, behavioral regulation, cognition, and self-concept (cook et al., 2017). incorporating both exposure and symptom screening into a single tool reduces the administrative and scoring burden of multiple screeners. furthermore, individual responses to trauma can vary widely based on a child’s cultural background, previous victimizations, personal coping skills, and supportive connections. screening for traumatic exposure only, without tapping into a child’s traumatic reactions, provides an incomplete picture of their coping response and needs (bartlett, 2020). screening for a wide range of traumatic reactions in these seven domains also expands our identification of children affected by trauma who may not meet criteria for ptsd, and ensures that each child’s unique constellation of symptoms is captured within a broader complex trauma framework. 6. interpersonal proximity in the victim-perpetrator relationship is an important consideration when measuring child trauma exposure and symptoms. a child’s interpersonal proximity to their perpetrator can significantly impact the severity of their traumatic reactions. research has shown that the closer a child’s evans et al./advancing child trauma screening 1269 relationship is to his/her perpetrator, the more likely the child is to experience feelings of betrayal and exhibit higher levels of traumatic symptoms (kisiel et al., 2009; price et al., 2013). such close interpersonal proximity in the victim-perpetrator relationship is one of the defining features of complex trauma, as broken trust in these relationships may have lasting effects on attachment and biopsychosocial functioning (cook et al., 2017; john et al., 2019; van der kolk, 2017). when measuring child trauma exposure and reactions, attention to such nuance in the child-perpetrator relationship is necessary for the clinician to contextualize the child’s experience, and garner a clearer understanding of the level of betrayal implicated by the trauma. 7. pictorial self-report measures offer potential for addressing measurement concerns related to children’s developmental levels, including attention and engagement, expressive capabilities, and reading comprehension. conveying survey content through pictures has been offered as one solution to address child attention span, engagement, and reliance on concrete stimuli (de leeuw, 2011; valla et al., 2000). considering the broad spectrum of developmental levels represented by children ages 5–12, pictures have the capacity to engage a child’s attention with visual stimuli and overcome reading comprehension challenges. research on early childhood social-emotional skills highlights children’s ability to recognize and relate to experiences depicted in pictorial images before they are capable of verbally articulating their feelings or experiences (reid et al., 2013). consistent with such findings, pictorial screening tools for other childhood experiences have shown to be both reliable and valid, including mental health diagnoses (valla et al., 2000), parent aggression (cecil et al., 2016), and child fearfulness (muris et al., 2003). there is also some evidence of success with pictorial assessment for child trauma, including a computer-based screener for children with autism (hoover & romero, 2019), and the andy/angie cartoon scale (praver et al., 2000). the cameron complex trauma interview (ccti) has also provided innovation in pictorial child trauma screening and preliminary evidence of internal consistency and convergent validity, though further piloting is needed in order to establish more robust psychometric properties (king et al., 2017). given the limitations of these pictorial measures with regard to length and time requirements, psychometric properties, and the lack of information about cultural validity, there is room for expansion, innovation, and further research. conclusions and implementation considerations this paper seeks to advance an innovative, pictorial approach to complex trauma screening, consistent with contemporary research on child development and the neurobiological impact of trauma. however, screening alone is an insufficient solution to the current challenges in child trauma screening. several considerations around screening tool piloting, cultural sensitivity, and trauma-informed implementation must be embedded in the development process. advances in social work, fall 2021, 21(4) 1270 piloting process and cognitive interviewing cognitive interviewing has been identified as an important step in the design of questionnaires, particularly for children (lapietra et al., 2020), yet the process is rarely mentioned in published studies describing the development of common child trauma screening tools. cognitive interviewing reveals how question items are interpreted from the perspective of the respondent, and can enhance content and response validity by highlighting problematic questions, confusing wording, and areas that may contribute to response error (drennan, 2003). best practices suggest that piloting of the proposed pictorial screener should include at least one round of cognitive interviewing to gather data on items and pictures children found confusing or unclear, and items that had high rates of non-response in the initial pilot. feedback from cognitive interviewing could be used to adjust item wording and illustrations before re-piloting the measure. cultural sensitivity as noted in the aforementioned framework, the traumatic symptom portion of a screener should address all seven domains of functioning for complex trauma (biology, self-concept, affect regulation, behavioral regulation, dissociation, cognition, and attachment; nctsn, 2018; van der kolk, 2017). this taps a broader range of symptoms than those defined by dsm-v diagnostic criteria and attends to one of the concerns that have been raised regarding cultural differences in the conceptualization and presenting symptoms of “posttraumatic stress” (perry et al., 2019). for a pictorial screener, the images that accompany each question must be developed with input from a diverse, multicultural team of researchers, practitioners, and survivors. each phase of piloting and cognitive interviewing must also include culturally and socioeconomically diverse child samples. cultural background may influence children’s interpretation of images, language, and traumatic experiences; ensuring that items and images are consistently understood across groups will enhance the tool’s cultural and developmental validity. response and referral protocol screening for trauma is irresponsible in the absence of a clearly-delineated protocol for referral and resource linkage to proximal services that have demonstrated effectiveness with complexly traumatized children (finkelhor, 2018). for this reason, the proposed pictorial child trauma screener must be developed in tandem with a culturally-sensitive response and referral protocol for practitioners. the response and referral protocol should include recommendations and guidelines for determining families’ cultural needs and preferences, collaborative engagement of youth and families in the referral process, logistical issues for the family (e.g., transportation, childcare, work schedule), steps for making a referral, and suggestions for post-referral follow-up. the virginia heals (2019) project offers one such example of a trauma-informed protocol to accompany child trauma screening, including additional details about rapport-building, obtaining consent, and emphasizing the “warm handoff” referral process for trauma-informed systems. alongside the response and referral protocol, service providers administering the screening tool must evans et al./advancing child trauma screening 1271 have access to a local service and resource directory. while screening is a critical first step, equally as important is working with families to identify local agencies that are both accessible and the best-equipped to meet the unique needs of each child and their family circumstances. trauma-informed model of care the sensitive and personal nature of questions about traumatic exposure and reactions requires thoughtful implementation procedures that attend to all levels of the samhsa’s (2014) key assumptions of a trauma-informed approach, with special attention to the need to resist retraumatization. the proposed screening tool must be developed with companion training materials on core principles of trauma-informed care (tic) and concrete examples of how these principles are enacted in practice. examples of system-wide implementation of tic principles can be found for schools (perry & daniels, 2016; von der embse et al., 2019), juvenile justice systems (branson et al., 2017), and child welfare (akin et al., 2017). comprehensive training materials may include guidance for engaging children and families in collaborative relationships, establishing and maintaining trust, and practicing cultural humility and sensitivity throughout the screening and referral process. conclusion practitioners, clinicians, and social work educators are rapidly working to integrate contemporary findings on complex trauma and neurodevelopment, historical and systemic trauma, and relational health, into our direct practice work and student instruction. paramount to this process is ensuring that complexly traumatized children are accurately screened and identified. accurate identification of complex trauma permits a deeper understanding of child behavior, more focused treatment planning, and may prevent misdiagnosis, overmedication, and inadequate intervention with children improperly labelled with several social, emotional, and behavioral disorders. as we work to innovate and advance child trauma screening practices, this process must prioritize both clinical utility and embedding screening in a broader system of trauma-informed care. references akin, b. a., strolin-goltzman, j., & collins-camargo, c. 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(2015). posttraumatic coping and distress: an evaluation of western conceptualization of trauma and its applicability to chinese culture. journal of cross-cultural psychology, 46(5), 723-736. https://doi.org/10.1177/0022022115580848 author note: address correspondence to dr. jennifer a. king, mandel school of applied social sciences, case western reserve university, 11235 bellflower road, cleveland, oh, 44106. email: jak292@case.edu this work is licensed under a creative commons attribution 4.0 international license. creating a trauma-informed community through university-community partnerships: an institute agenda john m. keesler susan a. green thomas h. nochajski abstract: the impact of trauma on wellness has been identified as a community health crisis. the alliance of universities and communities is a plausible response to address the scope of the problem given their wealth of resources. the institute on trauma and traumainformed care (ittic) is an exemplar of a university-community partnership and unique approach that has fostered a common language within and between organizations to foster at the community level an awareness and understanding of trauma. the present article provides an overview of university-community partnerships and their importance to social work practice. it describes the formation of the institute and discusses its model and contributions to the local community and abroad. the implications of ittic for the school, university and community are discussed. an iterative process that includes active engagement, evaluation, and reflection, is recommended for the integration and advancement of trauma-informed care through university-community partnerships. keywords: university-community partnerships; trauma; trauma-informed care universities are uniquely situated to address the social needs of their surrounding communities, due, in part, to their civic engagement as well as the intersection of teaching, research, and service (buys & bursnall, 2007; maurrasse, 2002). university-community partnerships are one way in which academic institutions can fulfill this responsibility. the present article provides an overview of university-community partnerships as represented in the literature and highlights their relevance to social work. the institute on trauma and trauma-informed care at the university at buffalo, new york, is then described as an exemplar for university-community partnerships, particularly as it addresses the community’s need to become trauma-informed. the development of the institute, as well as its efforts, contributions, and future directions are discussed. university-community partnerships university-community partnerships foster the development of relationships across systems and the mobilization of pooled resources through collaborative initiatives. while universities provide excellence in research and education, community partners provide practice knowledge and a natural setting with community members. together, these partnerships can “advance practice to research and research to practice” (dulmus & cristalli, 2012, p.195) as they bridge the gaps between research and practice, and, the classroom and real-world practice (institute of medicine, 2001; mccaslin & barnstable, 2008; mullen, bledsoe, & bellamy, 2007). further, the information exchanged between ______________________ john m. keesler, phd, lmsw, is assistant professor, school of social work, indiana university, bloomington, in, 47401. susan a. green, lcsw, is clinical associate professor, school of social work, university at buffalo, buffalo, ny 14214. thomas h. nochajski, phd, is research professor, school of social work, university at buffalo, buffalo, ny 14214. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 39-52, doi: 10.18060/21298 https://creativecommons.org/licenses/by/4.0/ kessler et al./creating trauma-informed community 40 the academy and the social service sector can: (a) promote professional development; (b) establish and strengthen meaningful relationships; (c) foster social change efforts; and, (d) enable better client outcomes (allen-meares, 2008; miller & hafner, 2008; van de ven & johnson, 2006). university-community partnerships represent diverse collaborations with a range of activities and levels of engagement (strier, 2014). the diversity is highlighted in the literature which includes partnerships aimed at: social work curriculum development (lewis, kusmaul, elze, & butler, 2016), low-income senior housing (perry et al., 2015); homelessness (patterson, cronley, west, & lantz, 2014), nonprofit capacity building (kindred & petrescu, 2015); child protection and family violence (fantuzzo, mohr, & noone, 2000), and the advancement of research in human service organizations (dulmus & cristalli, 2012). university-community partnerships can be vulnerable to various challenges given the potential for an imbalance of power and differences in expectations (dempsey, 2010; kindred & petrescu, 2015). however, such challenges can be minimized through shared decision-making, clearly defined roles, and the articulation of specific goals (miller & hafner, 2008). in addition, transparency and the desire to learn from each other can foster trust, collaboration, and a shared sense of capacity and influence (miller & hafner, 2008). these characteristics, centered on personal relationships, can lead to successful partnerships (bringle & hatchner, 2002; mccaslin & barnstable, 2008). university-community partnerships, social work & trauma university-community partnerships can be integral to social work practice, education, and research (dentato, craig, & smith, 2010; lewis et al., 2016). according to the preamble of the national association of social workers’ (nasw) code of ethics: the primary mission of the social work profession is to enhance human wellbeing…with particular attention to [those]…who are vulnerable, oppressed, and living in poverty. a historic and defining feature of social work is the profession’s focus on individual well-being in a social context and the well-being of society. fundamental to social work is attention to the environmental forces that create, contribute to, and address problems in living…. social workers also seek to promote the responsiveness of organizations, communities, and other social institutions to individuals’ needs and social problems. (nasw, 2008, para. 1-2) trauma, although not explicitly noted in the preamble, is often at the intersection of vulnerability, oppression and poverty – dimensions of the human experience that are critical to social work. over the past two decades, the complexities of trauma and potentially traumatic events have been illuminated, particularly given their association with health-compromising behaviors, disease, and what has been identified as a “health crisis” (larkin, felitti, & anda, 2014). trauma-informed care has emerged as a systems-based response to trauma and trauma sequelae in order to create organizational environments that recognize the impact of trauma, promote healing, and avoid retraumatization (butler, critelli, & rinfrette, 2011; harris & fallot, 2001). the institute on trauma and traumainformed care is an exemplar for how university-community partnerships can embrace the advances in social work, spring 2017, 18(1) 41 mission of social work with a particular focus on a community’s need to become traumainformed. the institute on trauma and trauma-informed care: conceptualization and inception the institute on trauma and trauma-informed care (ittic) was established in 2011 by a clinical professor and a research professor in the school of social work at the university at buffalo as a center for university-community partnerships that focus on consultation, collaboration, training, evaluation and research. the institute developed in response to an advancing global awareness of the prevalence and impact of trauma (mills et al., 2011) and the needs of the surrounding community. the foundation of ittic is comprised of the five principles of traumainformed care: choice, collaboration, empowerment, safety, and trustworthiness (harris & fallot, 2001). the mission of ittic is to foster a community-wide understanding of “what it means to be…trauma-informed…, [to] identify [and address] the need for trauma-informed change…, and [to] take necessary steps to integrate and sustain these changes over the long term” (richardson, coryn, henry, black-pond, & unrau, 2012, p.179). the institute is housed within the buffalo center for social research (bcsr) and complements the school’s trauma-informed and human rights curriculum. a community in need. ittic is nestled in a university campus that is situated in a community of approximately 264,000 residents that is marked by poverty, increasing violence, and changing demographics. approximately 39% of the population is african american and 11% is hispanic/latino (u.s. census bureau, 2010). about half of all residents are “doing poorly or struggling economically” with 43% of individuals having an income of $25,000 or less and about 43% of children living in poverty (university at buffalo regional institute, 2014a, 2014b, p.4). poverty rates are influenced by regional job loss; for example, 20,000 jobs were lost between 2008 to 2009. in addition, 1 out of every 100 individuals in the community is a victim of a violent crime (not including theft or breaking and entering) and the rate of crime continues to increase. the needs of the community are compounded by gaps in psychiatric and medical services as well as changing demographics, including the annual resettlement of approximately 1,500 refugees (university at buffalo regional institute, 2014a, 2014b). low-income urban areas, like the respective community, have been associated with increased risk for trauma due to violence, drug activity, incarceration, and victimization. african americans are disproportionately at increased risk for lifetime exposure to trauma (kiser, donohue, hodgkinson, medoff & black, 2010). as a social work institute focused on community collaboration, the placement and mission of ittic are most appropriate. toward the creation of a trauma-informed community ittic was established in a time and environment that was “ready for it.” across the united states, initiatives and policies to support trauma-informed practices were well underway (cooper, masi, dababnah, aratani, & knitzer, 2007). for example, as early as 2005, illinois, massachusetts, and oklahoma had passed legislation and implemented collaborative efforts to foster the integration of trauma-informed practices in child welfare kessler et al./creating trauma-informed community 42 systems, schools, and behavioral health. similarly, efforts were underway within new york state through the community health care association of new york state and in collaboration with the national traumatic stress network, to promote trauma-informed care within various medical centers, family and children’s services, and through training institutes. more proximally, the university of buffalo school of social work, with which ittic is affiliated, was pursuing its re-accreditation. as the school engaged in this process, it considered the needs of the community and the status of tic within the surrounding community-based organizations. the founding co-directors of the institute assisted the school in developing an assessment tool that would facilitate a community evaluation. the school had a strong presence in the community through well-established field placements and numerous alumni working in the community. this presence fostered openness among community organizations to the administration of the measure. the school gathered and analyzed the data, and subsequently disseminated their findings to the community, which sparked an interest among organizations for more information on tic. concurrently, as the school established a new trauma-informed curriculum, the community started a trauma coalition in which one of the institute’s co-directors played an integral role. in response to the community’s desire for more knowledge and training, ittic was created. among the first initiatives of the new institute was the procurement of a substance abuse and mental health services administration (samhsa) train-thetrainer grant. as information about the training and ittic spread, the institute began to receive requests from organizations for training. such requests were, in part, influenced by current students in their field placements and a strong presence of school alumni, many of whom were among the first to request training. notably, although the institute initially had few resources, many of the early trainings and consultations were provided free-of-charge. pro bono work further fostered relationships between the ittic and the community. it became evident that the institute was committed to its work and invested in the community. ittic used a formative process during its development, beginning with the support of the school’s dean, including the allocation of physical space in the school’s research center. the first year for the institute was critical to establishing a community presence and involved strategic tasks such as developing an online presence; establishing an advisory council of local, national and international expertise; crafting a strategic plan; creating a field placement for msw interns; and generating initial revenue (e.g., samhsa training grant). as the work of the institute continued to expand, the co-directors sought consultation from top administrators in local agencies to help create a strategic plan. similarly, ittic established an expert advisory panel of lead experts in the field of trauma and tic to provide the institute with advisement. over the first year, the co-directors met biweekly, and had monthly meetings with the director of the bcsr. in addition, bimonthly meetings were held with various community members and recent graduates to help inform the institute around priorities for engaging with the community. ittic shared information and literature (e.g. impact of trauma, understanding tic, etc.) with community members and encouraged them to pass it along to others. advances in social work, spring 2017, 18(1) 43 collaboration: a key principle of tic and ittic’s operation ittic embraces a total approach when working with community partners. the institute assists organizations with the adoption and integration of trauma-informed care by working with them to identify their readiness for change, while assessing their resources (e.g., clinical sophistication) and supporting the development of sustainable strategies to foster change at the organizational level (brown, baker, & wilcox, 2012; hummer, dollard, robst, & armstrong, 2010). the principles of trauma-informed care are enacted within the institute’s daily operations and its collaborations such that engagements with community partners become exemplars of trauma-informed practices. by “modeling the model,” members from ittic initiate a relationship with organizations that is based on trustworthiness and fosters emotional safety. members extend themselves to the organizations by their willingness to meet with them in person, visiting the agency, and making themselves available for ongoing consultation via phone and/or in person. during the initial phases of partnership, it is not uncommon for ittic to provide the organization with references from previous partners. in addition, materials, resources and information (e.g., infographics, impact of trauma, etc.) are provided to the organization to help them make informed decisions about what makes most sense for them and how they would like to proceed. partnerships begin with open dialogue regarding what the organization is looking for and different options that the institute can provide to them depending on what makes most sense for the organization. together, the organization and ittic work together to develop a strategic plan that is tailored to the organization’s goals and the resources that they have available to them. through ongoing communication and routine contact with a point person(s) at the organization, members of the institute provide updates, have team meetings to monitor progress on the work plan/timeline, and maintain flexibility to feedback throughout the process. while ittic acknowledges its expertise in trauma and tic, it also recognizes and upholds the expertise of agency staff regardless of their position or experience. the institute maintains a stance of not telling organizations what to do, but rather, working with the organizational team to operationalize what tic looks like in their role and in their agency. the process for organizations to become trauma-informed involves a cultural shift “structured around the presumption that everyone in the agency (from clients through agency management) may have been directly or indirectly exposed to trauma” (wolf, green, nochajski, mendel, & kusmaul, 2014, p.111). thus, the institute seeks to ensure that an organization, from executive management to clients, as well as all policies, practices and procedures, are trauma-informed (harris & fallot, 2001). the inclusion of employees is critical – they translate policies into practices with clients – yet they are often overlooked regarding trauma-informed care (bowen, privitera, & bowie, 2011; keesler, 2016; wolf et al., 2014). ittic also explores the ways in which organizations already exemplify trauma-informed practices with clients as trauma-informed practices are frequently used yet rarely identified as such (wolf et al., 2014). training – a critical element training is central to ittic’s mission as it is a critical component for agencies seeking kessler et al./creating trauma-informed community 44 to implement trauma-informed care (brown et al., 2012). although many trauma-informed initiatives “lack theory-based comprehensive staff trauma training models that agencies can adopt system-wide as a way to implement tic” (brown et al., 2012, p.508), the institute uses a user-friendly training curriculum comprised of fundamental trauma knowledge (e.g., definition of trauma and its biopsychosocial implications, triggers, retraumatization, vicarious traumatization) and the principles of trauma-informed care (e.g., conceptualization of principles, their importance, and their implementation). the training fosters a perceptual and attitudinal shift as participants are taught to approach trauma as a universal precaution (i.e., each person is interacted with as if they have experienced trauma) and to ask clients “what has happened to you?” rather than “what is wrong with you?” (bloom, 1994). the structure and content of the training is malleable to organization-specific wants and needs, and is often influenced by a reciprocal process of evaluation and training, largely consistent with translational research (rubio et al., 2010). the institute works with community partners based upon their needs and resources, and considers what makes most sense at that time. thus, agencies get support (i.e., consultation/training/evaluation) that is personalized. in addition, baseline evaluations provide a critical understanding of an organization’s current functioning from which the institute can tailor the initiative and ascertain the initiative’s impact through pre-/post-assessments and analyses (hummer et al., 2010). this approach fosters the likelihood that the community partner will find the support useful and relevant, while increasing buy-in from those involved. in addition, ittic assists organizations in identifying and training “trauma champions” as a means of fostering the integration of trauma-informed care through a train-the-trainer model and as an ongoing internal support (brown et al., 2012; brown, harris, & fallot, 2013; henry et al., 2011). growth and advancement over the course of five years, ittic has expanded its assets and impact in various ways. in addition to augmenting its advisory panel with national experts and pool of affiliates, the institute has established an operating budget of self-sufficiency, expanded its capacity as a designated field placement for msw students, as well as independent studies and research internships for phd students. ittic has created a well-established presence within the community and demonstrated the versatility of trauma-informed care through its work with more than 20 local agencies and organizations in children’s mental health and residential services; adult behavioral health; crisis services; refugee, asylee and immigrant services; military veteran services; and, the criminal justice system (bloom & sreedhar, 2008). in addition, more than 10 students have completed field placements at ittic where they have been immersed in trauma-informed care. as students graduate and become employees within community organizations, they have the potential to further the work and connections of the institute while promoting trauma-informed care. advances in social work, spring 2017, 18(1) 45 ittic has expanded its community influence through local think-tanks around trauma and trauma-informed care. in addition, it provides leadership and administrative support to the trauma-informed community initiative of western new york (tici). together, they developed a community action plan to “lead and assist organizations, individuals, and communities through the mobilization of resources in education, prevention, and response to the multi-dimensional aspects of trauma as a root cause of our growing public health crisis” (university at buffalo school of social work, 2016, para. 1). grand rounds are hosted throughout the year to provide regional trainings and presentations on topics related to trauma and trauma-informed care. the institute has extended its influence beyond the local community to the state, national, and international levels. through funded collaborations with the state department of health aids institute and the state office of alcohol and substance abuse services, ittic has engaged in partnerships focused on training individuals who will serve as champions across the state. the institute has developed trauma talks, an online podcast series of interviews with service providers and survivors about strength, resilience, and trauma-informed approaches in the healing process for trauma. in addition, ittic and its affiliates continually present at agencies and universities, as well as national and international conferences such as the society for social work research, the council on social work education, and the international congress on law and mental health (e.g. heagle, green, & peek, 2016; keesler & green, 2014; keesler & nochajski, 2016; nochajski & hales, 2015). the institute’s use of harris and fallot’s principle-based model has afforded opportunities for the development and validation of an instrument to measure traumainformed care within organizational culture which has largely been lacking (brown et al., 2013; clark et al., 2008; hendricks, conradi, & wilson, 2011; kusmaul, wilson, & nochajski, 2015). the development of such a measure presents the opportunity for comparative analyses within and among organizations, and the foundation for future work, for example, associations between trauma-informed care and agency/client outcomes (e.g., behavioral and psychiatric progress, injuries, staff retention). such research is a critical next step in advancing trauma-informed practices (brown et al., 2012). emergent and critical research surrounding tic has come forth through the work of the institute and its affiliates. kusmaul et al. (2015) identified a high correlation among the five principles of tic (harris & fallot, 2001) thus suggesting the integral interrelationship between the principles as well as the possibility of a unidimensional construct. in addition, they noted an association between employees’ education and position within an organization with their perceptions of tic . higher education and higher ranked personnel (e.g., administration) were associated with more favorable ratings of tic. keesler and isham (2017) identified the feasibility of integrating tic within the context of services for individuals with intellectual and developmental disabilities. findings suggested a positive association between tic and staff satisfaction, restraint reduction, and behavioral improvement among individuals with disabilities. this research was the first study of its kind within the peer-reviewed body of literature on intellectual and developmental disabilities. subsequent research has identified a positive association between tic training and increased satisfaction among human service staff (hales et al., 2016). following an kessler et al./creating trauma-informed community 46 agency-wide initiative to integrate tic, post-test results identified approximately 10% to 16% increases in staff satisfaction with delivery of services, relationships with management, and connections and satisfaction with the workplace (hales et al., 2016). in addition, keesler (2016) noted the predictive nature of tic and staff members’ professional quality of life. organizational environments that demonstrated greater presence of choice, collaboration, empowerment, safety, and trustworthiness, predicted greater satisfaction and lower burnout among workers. it is the authors’ understanding that this is the first time tic has been directly linked with staff outcomes. differentiating levels of trauma services through its work, ittic has also identified and differentiated three levels of trauma services: (1) trauma-informed, (2) trauma-sensitive, and (3) trauma-specific. this perspective mirrors prevention and health promotion models that recognize universal, secondary, and tertiary levels of intervention (skybo & polivka, 2007). in addition, the trilevel perspective provides clarity for providers and appropriately frames the primary work of the institute in relation to other possibilities for the care and treatment of individuals who have experienced trauma. at the first level, trauma-informed practices are anchored in choice, collaboration, empowerment, safety, and trustworthiness for everyone (harris & fallot, 2001). being trauma-informed considers: (a) where and when services are offered; (b) attentiveness to signs of discomfort among clients and staff; (c) perception of discomfort in a traumainformed way; (d) providing clear information about what will be done, by whom, when, why, and under what circumstances; (e) provision of clear and appropriate messages regarding rights and responsibilities to clients and staff; (f) cultivating an atmosphere of working “with” rather than doing “to” or “for”; (g) providing an atmosphere that allows people to feel validated and affirmed with each and every contact at the agency; (h) paying attention to what works and what does not; and, (i) a deliberate use of non-problem focused language. trauma-sensitive is the second level of trauma services. being trauma-sensitive involves the decision to address trauma and is exemplified through the use of trauma screening tools/evaluations and considers the procedures and process of providing services to clients. a deliberate effort is made in allocating time to: (a) witness the impact the work may have on staff; (b) promote self-care practices (e.g., having a venue for staff to decompress, debrief, and rebuild); and, (c) modifying intake, supervisory sessions, and procedures that may be intrusive. the third level of trauma services is trauma-specific. trauma-specific refers to trauma treatments that have been researched and are evidenced-based or, at least, promising practices. such interventions are conducted by clinicians trained in the specific modality. trauma-specific interventions include cognitive processing therapy, trauma-focused cognitive behavior therapy, crisis intervention stress debriefing (cisd), eye movement desentization reprocessing (emdr), and prolonged exposure (pe). most of the treatments for trauma that have been categorized as evidence-based or promising have specifically treated ptsd. advances in social work, spring 2017, 18(1) 47 impact of institute on school of social work ittic has had a notable impact on the university of buffalo school of social work within a relatively brief period of time. first, the institute has served as a champion of and consultant on the trauma-informed perspective for the school. the directors of ittic have helped to train the school’s faculty and staff on trauma-informed care and have facilitated changes within the school toward more trauma-informed practices. secondly, the institute has strengthened the school’s portfolio. through service, teaching and evaluation, ittic has generated additional revenue for the school, has made contributions to the literature through its emerging publications, and has helped faculty to define their roles within the school as leaders. thirdly, the school has become more prominent in the community. as trauma-informed care has become a “hot topic” locally, regionally, and nationally, ittic’s work has helped strengthen community relations and position the school as a strong partner for collaboration. fourthly, ittic has become a model for the perspective of an institute within the university. because of the distinguished identity of the ittic in the community, the university has begun to look to the institute and the school for leadership in institute development. lastly, ittic has helped the school with recruitment of students and faculty. with trauma and trauma-informed care at the forefront of behavioral health, the institute has attracted not only students who seek to learn more about trauma and trauma-informed care through applied experience, but also faculty members who seek to partner on grants and research opportunities given the well-established community relationships between ittic and the community. directions for future work as ittic continues to envision a trauma-informed community, it strives to increase its influence and sustainability through an expansion of community partnerships, presentations, publications, and funding. the directors and affiliates continue to learn about the process of becoming trauma-informed from each community partner and about the nuances of trauma-informed care with specialized populations. the need to better understand how tic is implemented within an organization and viewed by service providers is recognized by the institute and is supported by research (kusmaul et al., 2015). conclusion university-community partnerships can be seen as “joint ventures [with] opportunities to achieve different goals” (strier, 2014, p.155). however, for ittic and its community partners, the goal has been mutual: to infuse trauma-informed care within service delivery. this is a unique consideration that has strengthened the institute as a visible and viable resource for the community, school, and university. good relationship-building and its components are inherent in trauma-informed care. as such, the product has become much of the process for the institute. kindred and petrescu (2015) noted: communication and relationship building [are] an important aspect to community collaborations, and to understanding and potentially improving the process is just as important as delivering outcomes. paying attention to process and relationship building will ultimately impact future community collaboration efforts between kessler et al./creating trauma-informed community 48 universities and nonprofits and may potentially lead to even better outcomes than participants initially expect. (p. 840) the directors and affiliates of the institute continue to learn about what it means to be trauma-informed and the process of becoming trauma-informed as it evolves through their work. while many people experience trauma and potentially traumatic events, far fewer are ever diagnosed with post-traumatic stress disorder (ptsd; kessler, sonnega, bromet, hughes, & nelson, 1995). however, the need to consider those who have not been diagnosed with ptsd yet have trauma symptoms remains, and a general awareness and understanding of trauma is warranted, thereby justifying the need to be trauma-informed. thus, the establishment of a trauma-informed community through the adoption of a common language within and between organizations continues through the work of ittic, grounded in university-community partnerships. references allen-meares, p. 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(2006). knowledge for theory and practice. academy of management review, 31(4), 802-821. https://doi.org/10.5465/amr.2006.22527385 wolf, m. r., green, s. a., nochajski, t. h., mendel, w. e., & kusmaul, n. s. (2014). ‘we’re civil servants’: the status of trauma informed care in the community. journal of social service research, 40(1), 111-120. doi: https://doi.org/10.1080/01488376.2013.845131 author note: address correspondence to: john m. keesler, phd, lmsw, school of social work, indiana university, 1127 e. atwater ave., bloomington, in, 47401, 812855-2580, jkeesler@iu.edu https://doi.org/10.1007/s10734-013-9698-5 http://www.census.gov/quickfacts/table/pst045215/3611000 http://ubwp.buffalo.edu/ubri/wp-content/uploads/sites/3/2014/06/strengthening-wnys-safety-net-buffalo-west.pdf http://ubwp.buffalo.edu/ubri/wp-content/uploads/sites/3/2014/06/strengthening-wnys-safety-net-buffalo-west.pdf http://ubwp.buffalo.edu/ubri/wp-content/uploads/sites/3/2014/06/strengthening-wnys-safety-net-buffalo-east.pdf http://ubwp.buffalo.edu/ubri/wp-content/uploads/sites/3/2014/06/strengthening-wnys-safety-net-buffalo-east.pdf https://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/community-partnerships-initiatives/trauma-informed-community-initiative.html https://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/community-partnerships-initiatives/trauma-informed-community-initiative.html https://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/community-partnerships-initiatives/trauma-informed-community-initiative.html https://doi.org/10.5465/amr.2006.22527385 https://doi.org/10.1080/01488376.2013.845131 mailto:jkeesler@iu.edu __________ abigail a. mills, phd, lecturer, department of social work, university of ghana, legon, aamills@ug.edu.gh copyright © 2019 author, vol. 19 no. 2 (fall 2019), 329-348, doi: 10.18060/22539 this work is licensed under a creative commons attribution 4.0 international license. inclusive education for children with intellectual disability (id) in ghana: challenges and implications for social work abigail adubea mills abstract: inclusive education in ghana is in its infancy. due to the wide array of challenges that may be encountered in the effort to implement inclusive education, programs are needed that involve a cross-section of professionals including social workers. in this study, in-depth face-to-face interviews were used to collect data from 15 educators and social workers about the challenges associated with inclusive education for children with intellectual disability (id) in ghana and the implications that these challenges have for social work practice in the education system. some key roles that social workers can play in inclusive education in ghana include intensifying public awareness to curb misconceptions about ids, and serving as liaisons between the school, home, and community. a system is needed that fosters effective collaboration between educators and social workers to enhance educational outcomes for children with id in inclusive school settings in ghana. keywords: inclusive education; children with intellectual disability; social workers; ghana the implementation of inclusive education has its attendant challenges in different socio-cultural settings (agbenyega & deku, 2011; ametepee & anastasiou, 2015; tchintcharauli & javakhishvili, 2017; yekple, 2012), necessitating a multi-disciplinary approach to address the issues that may emerge (damyanov, 2010; suc, bukovec, & karpljuk, 2017; von ahlefeld nisser, 2017). across different parts of north america and europe, social workers are recognized as a core part of the multidisciplinary or multi-professional team that facilitates the implementation of inclusive education (altshuler & kopels, 2003; damyanov, 2010; pryor, kent, mcgunn, leroy, 1996; united nations children's fund [unicef], 2012, 2013). given the socio-economic constraints and diverse socio-cultural characteristics of the ghanaian populace, there are unique challenges that arise in efforts to include children with intellectual disability (id) in regular community schools. furthermore, there is little to no structure in the education system within which professional social workers can offer their services. the main objectives of this study were to: a) examine the challenges associated with inclusive education for children with id in ghana from the perspectives of educators and social workers; and b) highlight the roles that social workers can play in helping to address the identified challenges. literature review intellectual disability and the ghanaian society intellectual disability, previously referred to as mental retardation, is characterized by significant limitations both in intellectual functioning and in adaptive behavior, with the onset before age 18 years (american association on intellectual and developmental disabilities [aaidd], 2013; schalock et al., 2007). the differences are typically observed along three main skill domains: conceptual, social, and practical (tassé, 2009). global estimates of the prevalence of id hover between one and three mailto:aamills@ug.edu.gh https://creativecommons.org/licenses/by/4.0/ mills/inclusive education 330 percent (harris, 2006; world health organization [who], 2001). it is however difficult to get reliable statistics on disability prevalence in many developing countries, including ghana (inclusion ghana, 2013; who, 2011). the first time an attempt was made in ghana to obtain a national estimate of disability prevalence was during the last population and housing census conducted in 2010. the results of that census indicated that three percent of the population (i.e., 737,743 out of 24 million at the time) had a disability, out of which 15.1% constituted intellectual disability (ghana statistical service, 2012). however, global estimates of 10-15 percent disability rate suggest that the ghanaian census figures may be under-estimated. definitional issues and nonreportage due to stigmatization are some of the factors underlying this potential underestimation of disability prevalence in ghana (inclusion ghana, 2011). some types of intellectual disabilities include down syndrome, fragile x syndrome, and other developmental delays which may remain undiagnosed or whose causes may be unknown. while in some cases the cause of id is unknown, research establishes a myriad of causal/predisposing factors including: biomedical causes, nutritional deficiencies, developmental brain abnormality, behavioral issues during pregnancy, infections during pregnancy, problems at birth, social factors, as well as educational deficiencies (de la rocha, 2011). in ghana, regardless of whether the cause of disability is known or not, there are cultural and superstitious beliefs which influence people’s perceptions about the disability (agbenyega, 2003, 2007; anthony, 2009a; avoke, 2002; botts & evans, 2010; botts & owusu, 2013; naami & hayashi, 2012; reynolds, 2010; yekple, 2012). for example, naami and hayashi (2012) reported that many ghanaians believe that “disability is a curse from the gods for sins committed by a parent or some ancestors” (p. 101). id is believed to be the most stigmatized of all the disabilities in ghana (inclusion ghana, 2011). according to the united nations development programme (undp; 2007), due to erroneous beliefs and perceptions held by a society, children with id may find their basic rights violated despite opportunities that may be provided for social interaction, medical care, and education. special residential schools currently remain the main avenue for educating children with id in ghana, while efforts are ongoing to create more inclusive schools. inclusive education for children with intellectual disability inclusive education generally connotes that all children, irrespective of their unique characteristics, should be able to attend their regular community schools (united nations educational, scientific and cultural organization [unesco], 1994). there is a greater probability that children (with or without disabilities) who attend regular schools would complete school, pursue further education and/or training, secure employment, earn decent incomes, and actively participate in their communities (united nations [un], 2007). comparatively, children with disabilities who do not get the opportunity to attend school are more likely to become illiterate, leading to lesser chances for them to obtain decent employment as adults, and further resulting in poverty (un, 2007). whereas a significant number of children with various disabilities continue to be educated in specialized settings in ghana, considerations about enrolling them in regular schools depend largely on the type and severity of the disability (hooker, 2007). to some appreciable level, the educational system in ghana has successfully integrated persons with physical, hearing, and visual disabilities at different levels of education in mainstream schools (hooker, 2007). however, until advances in social work, fall 2019, 19(2) 331 about a decade and a half ago, children with id were largely educated in special educational institutions in ghana (anthony, 2009a; hooker, 2007). undeniably, id presents challenges that influence learning, but research supports the fact that children with id have the capacity to learn (maul & singer, 2009; porter & smith, 2011; reiter & vitani, 2007). with continuous calls from the international community (such as unesco and unicef), the provision of inclusive education for children with disabilities has been on the agenda of a cross-section of stakeholders in ghana (botts & owusu, 2013; inclusion ghana, 2011; ministry of education, 2003, 2012). the special education division (sped) of the ghana education service (ges) began initiatives in the 2003/2004 academic year aimed at providing inclusive education by piloting six models of inclusive education for children with disabilities, including those with id, in three regions of the country (ghana education service, 2007), and has since spread to other regions. these efforts have, however, not been without challenges. some of the challenges stem from insufficient resources and stigmatization (adera & asimeng-boahene, 2011; obi, mamah, & avoke, 2007; ocloo & subbey, 2008), reflecting an urgent need for advocacy for children with id and their families. social workers in inclusive education apart from educators and policy makers, who are obvious stakeholders in inclusive education, there are other categories of stakeholders, including social workers, who are recognized as key players in the inclusive education agenda (agbenyega, 2007; gyimah, sugden, & pearson, 2009; inclusion ghana, 2011). however, literature regarding how social workers can effectively participate in the implementation of inclusive education in ghana is relatively scant. the main goal of any formal educational institution is to train and impart knowledge, and naturally, teachers constitute the primary workforce of any educational setting. however, there are several stakeholders involved in the school system, such as children, teachers, administrators, parents, and community members, who interact in both organized and casual ways to create an appropriate atmosphere for learners (price-mitchell, 2009). furthermore, the presence of other professionals in the school environment, such as social workers, helps to improve the educational experience of students (gallagher, malone, & ladner, 2009). for example, in inclusive education settings, social workers can function as liaisons between the school, the home, and the community and connect all relevant stakeholders to resolve problems that students may be facing in school (mittler, jackson, & sebba, 2002). based on their study in pacific island schools, sharma, loreman, and macanawai (2016) concluded that issues in the society that affect the school environment – for example, culture, communities, and religion – could be either limiting or helpful to the implementation of inclusive education. they further noted that change in the negative attitudes of members of the school community, engagement with local communities, collaboration with families, and adjustment in curriculum could all help to meet the goals of inclusive education (sharma et al., 2016). the challenges and recommendations presented by sharma et al. (2016) point to several areas of inclusive education where social workers can enhance implementation. examples of such areas of involvement by social workers include public education, community outreach, and family engagement. mills/inclusive education 332 with specific reference to id, bigby and frawley (2010) assert that just like in any other field of social work practice, “there are multiple ways to work, both at the individual and structural levels to redress disadvantage, improve quality of life, and bring about social change to reduce discrimination and oppression that result from the ‘social problem’ of intellectual disability” (p. 1). the primary functions of school social workers include: the development of specialized programs for students in conjunction with other professionals; carrying out interventions with children and their families either in group or individual sessions; and participating in the design and development of programs in the educational setup (openshaw, 2008). one of the specific roles that school social workers often play, which is germane to this study, is the work they do both independently and as part of a team to ensure that children with disabilities successfully achieve learning objectives at school. the social worker can collaborate with multi-disciplinary teams to ensure that schools provide students with id with opportunities to experience meaningful social encounters with students without disabilities (reiter & vitani, 2007). school social workers also need to be engaged in designing public policy initiatives and practice interventions for working with different student populations (teasley, 2004) such as children with id. context of the study ges started piloting six models of inclusive education for children with disabilities in the 2003/2004 academic year. one out of the six models was specifically for children with id. in this model, a classroom block, called a unit school is constructed on the premises of a cluster of regular public schools to provide separate classrooms for children with id. the children are taught by special educators referred to as resource teachers, and they interact with their peers from the regular schools during break periods and other co-curricular activities such as sports. occasionally, and based on the assessment of the resource teachers, some children in the unit school may be sent to participate in the regular classes of their age peers for certain periods during the school day. the regular classroom teacher is expected to involve the child with id in the classroom with the assistance of the resource teacher. at the time this study was being conducted, there were three of these unit schools in three different communities in the greater accra region, which is one of the sixteen administrative regions of ghana. this model served as a key context for the exploration of inclusive education for children with id in ghana. the greater accra region was selected because it hosts the national capital accra, where the headquarters of various government ministries, departments, and agencies are located. due to this unique feature, it is usually expected that government policies, such as that of inclusive education, would be best implemented in the capital region for the other administrative regions to emulate. the purpose of this study was to highlight some of the challenges associated with providing inclusive education for children with id in ghana, as well as examine how social workers can contribute to resolving the identified challenges. methods the data for this paper were obtained from a broader study which examined various stakeholders’ perspectives on inclusive education for children with id and the implications for social work practice in ghana. data were collected between october 2012 and april 2013. although it has been a while since the data were collected, the advances in social work, fall 2019, 19(2) 333 findings of this study remain relevant in ghana today because not much has changed regarding the involvement of social workers in the inclusive education agenda in ghana. there remains a huge vacuum regarding public education and sensitization about the inclusion of children with id in regular schools. this study examined data gathered through in-depth face-to-face interviews with 15 participants (nine educators and six social workers). this approach to data collection has the advantage of eliciting detailed views of individual participants about the problem being investigated (creswell, 2010). the issues explored with the educators and social workers were inclusive education in ghana, the challenges with implementation, especially for children with id, whether social workers were considered relevant in the inclusive education discourse, and how social workers could be involved. the specific research questions were: 1. what are the challenges associated with inclusive education for children with id in ghana? 2. how can social workers contribute to overcoming the identified challenges associated with inclusive education for children with intellectual disabilities in ghana? sampling and data collection study participants comprised nine educators and six social workers who were purposively selected based on the criteria of having relevant knowledge and/or experience regarding inclusive education, id, and the social work profession in ghana. specifically, the educators were made up of five special education resource teachers (who worked in selected “inclusive schools” for children with id); two special education coordinators (one municipal, one regional); and two teacher educators (lecturers at a special education department of a public university in ghana). the five resource teachers had training in special education in a recognized university in ghana and had teaching experience in the regular classroom before moving into special education. the two teacher educators, who were both phd holders, were seasoned lecturers in special education and had a wealth of knowledge about id and disability issues in general. both special education coordinators had at least ten years of professional teaching experience, prior to their assumption of office as coordinators of special education within the ghana education service. there were three professional social workers, all of whom had both bachelor’s and master’s degrees in social work, and worked at the department of social welfare (dsw), which is the main governmental institution in ghana where a majority of social workers are employed. they were recruited based on the experience they had working with children with disabilities in the course of their professional practice. the remaining three participants were labelled as “paraprofessional social workers” because they were educators who self-identified as school social workers, despite not having social work degrees. these participants had been delegated to carry out aspects of professional social work tasks that they did not have the requisite (social work) qualification for. some of the titles designated to these educators within public schools in ghana include: school welfare officers, special education officers, school health education programme officers, girl-child education officers and guidance and counselling officers— all of which are recognized within the ges. these educators have an association called the school social workers association of ghana (sswag; mills/inclusive education 334 n.d.). in this study they were identified as paraprofessional social workers. one of the three paraprofessionals in this study was a retired teacher who had spent many of her 35 years of active employment working to integrate social work practice into the school system both within and outside ghana. the remaining two were in active service, one as a regular teacher (appointed as a welfare officer) and the other as a special educator. they had an average of fifteen years teaching experience but four and six years respectively in their paraprofessional roles. table 1 provides a summary of the sample demographics. table 1. sample demographics (n=15) variables gender level of education length of professional experience all 6 (40%) ♂ 9 (60%) ♀ bachelor’s, master’s and phd 4 to 35 years resource teachers (n=5, 33.3%) 1 (6.7%) ♂ 4 (26.7%) ♀ master’s and bachelor’s degree > 10 years teacher educators (n=2, 13.3%) 2 (13.3%) ♂ 0 (0%) ♀ phd >20years special education coordinators (n=2, 13.3%) 1 (6.7%) ♂ 1 (6.7%) ♀ master’s and bachelor’s degree > 10 years social workers (n=3, 20%) 1 (6.7%) ♂ 2 (13.3%) ♀ master’s and bachelor’s degree >20 paraprofessional social workers (n=3, 20%) 1 (6.7%) ♂ 2 (13.3%) ♀ master’s and bachelor’s degree 4 35 years a semi-structured interview guide was developed by the primary researcher to collect data. the interview guide was in english, and the same language was used in conducting the interviews. although guided by some general literature in the research area, there was no known study in ghana which focused on the issues that were of interest. thus, the interview guide was designed specifically to respond to the objectives of this study. interviews lasted between 35 and 90 minutes. except for one interview in which the participant declined permission to be audio-recorded, all interviews were audio-recorded with prior permission from the participants. detailed notes were taken during the interview with the participant who did not permit the audiorecording, and these were typed out by the primary researcher afterwards. the audiorecorded interviews were also transcribed by the primary researcher and a trained graduate student. member checking was adopted to ensure trustworthiness in the study. participants were provided with copies of their interviews so that they could verify the information they had shared. all participants validated the transcripts as a reflection of the interviews they granted. data analysis all transcriptions were checked with the corresponding audio files to ensure accuracy. the researcher followed the six guidelines of thematic analysis provided by braun and clarke (2006) to arrive at the findings. first, the researcher read and re-read the transcripts to become familiar with the data. the thorough reading led to the development of initial analytical thoughts. following this, initial codes were generated from the data. the initial codes reflected some catchwords or phrases that participants used to express their thoughts about key issues such as challenges (e.g., “stigma,” “lack advances in social work, fall 2019, 19(2) 335 of resources,” “parents withdrawing their children without disabilities”); inclusive education (e.g., “mainstreaming”, integration); intellectual disability (e.g., “mental retardation,” “degree of disability mild, moderate, severe, profound,” “stigma); and social workers’ roles (e.g., “public education to change attitudes,” “liaising between school, home and community”,” “referrals”). the third step in the thematic analysis involved searching for themes, which essentially were derived from combining different codes to reflect a central perspective or idea (theme). for example, the researcher tried to make meaning out of the views that participants had about children with id being included in regular schools by reexamining the codes generated in the previous phase. thus, an example of an initial theme that captured the overall essence of what emerged from the data was “perceived outcomes of inclusive education for children with id.” another example that connected the initial codes generated about social work roles was “anticipated roles of social workers in inclusive education for children with id.” under phase four, the initial themes were reviewed bearing in mind the overall objectives of the study. some of the initial themes were submerged under broader themes while others remained as initially thought out. this process wove into the fifth stage where the specific themes that emerged from the data were better defined to capture the essence of what the data were telling, and ultimately, the final report was written up. this article reflects the two broad themes that resulted from the analysis. figure 1 shows the final thematic map, reflecting the two major themes and the corresponding sub-themes. figure 1. final thematic map to help link participants’ voices with their respective backgrounds, they are described by the specific sub-category they belong to and a number designation for differentiation. for example, ‘resource teacher 1’, ‘special education coordinator 2’, ‘teacher educator 1’, ‘social worker 2’, and ‘paraprofessional social worker 3, et cetera. mills/inclusive education 336 findings challenges associated with including children with id in regular schools participants talked openly about several challenges that were associated with the idea and practice of including children with id in regular schools in ghana. these challenges were societal stigma, inadequate human and material resources, and ambivalence about the relevance of inclusive education to children with id. societal stigma one of the major concerns shared by participants regarding the concept of inclusive education for children with id was in relation to stigma and negative perceptions held about id. participants explained that id continues to be perceived as a curse, or punishment on the family. some parents try to avoid situations in which they will be noted as having children with an id. others simply view children with id as inferior. society sees it [id] as bad luck, a punishment or a curse. they label and make fun of them [children with id]. and sometimes they say it is either the fault of the child, parent or family. it is demoralizing… the stigma continues to exist to some extent. (resource teacher 4) sometimes, you realize that you call for meetings and parents will not come. sometimes instead of the biological parents to come for you to discuss issues with them, they will prefer to send somebody, because they know that when they come, ..people will start to associate the children [with id] with them [the parents], and for that matter, some [parents] will not even come.… (paraprofessional social worker 1) the idea of inclusion is to do away with the stigma … some of the ‘normal’ people don’t want to mingle with [children with id], and so they make them look very inferior... (resource teacher 2) resource teachers and special education coordinators pointed out that they are at the receiving end of the stigmatization as well because they work with children with id. for example, resource teacher 2 lamented that most of the regular teachers at the school compound do not extend the necessary courtesies to the resource teachers in the unit school because of the children with id. one special education coordinator also commented that “even fellow teachers stigmatize those in special education. they think we deal with mental illness…” (special education coordinator 1). this wrong perception about id and the associated stigma points to the need for targeted community education. inadequate resources (human and material) another issue raised by most participants was the inadequacy of the human and material resources required to ensure the successful implementation of inclusive education for children with id. specifically, participants emphasized the need for teaching and learning materials as well as sufficiently trained personnel to enhance inclusive education programs. advances in social work, fall 2019, 19(2) 337 it is hypocritical to assume that without adequate and appropriate provisions within the regular schools, children with intellectual difficulties would be properly included. (teacher educator 2) we should not only bring them [children with and without disabilities] together per se but provide every resource to cater for them.… i believe without that, the inclusiveness will not work. (resource teacher 1) we [as a country] should try and make sure that we give the teachers the necessary training that will help them take good care of children with special needs in their classrooms. (social worker 1) the above excerpts reflect the varied ways in which participants registered their concern about the need for appropriate resources for inclusive education. ambivalence about the goals of inclusive education for children with id while study participants appreciated the idea of inclusive education, the summary of their perspectives pointed to the fact that not all children with id can have their educational goals met in that system. most participants thought that children with mild to moderate id could be accommodated in regular schools, or even in the regular classroom at certain points. however, they could not envisage how children with severe to profound id could be accommodated in the regular school or classroom. questions were raised about the objectives for placing children with id in inclusive schools, as to whether the emphasis would be on academic gains or otherwise. for instance, teacher educator 2 posed the following questions: “what is the nature of the curriculum? why are you including them [children with id]? what are the basic objectives?” in response to his own questions, he continued: the learning and behavior needs of some children [with id] will still require that additional support is given them in alternative settings beyond inclusion. if, however, you are thinking that some group of children with id could be included, yes! ... we can look at the mild category; those that are sufficiently mild. (teacher educator 2) additional perspectives shared by other participants are as follows: for mental retardation (id), …you see, there are groups. for the mild and the moderate, they can be taught and trained, and can improve behaviorally; but those with severe and profound disabilities…for them, academic work is out! you could only focus on teaching them daily living skills. (resource teacher 1) you see, in inclusive setting, we have what we call, iep [individualized educational plan], so for such children [with id], we develop such a document for them which we use to address their interests and needs.… so that is why we develop iep. we look at their interest areas and their needs, and then make sure we tailor their learning experiences … to satisfy those needs and interests. (paraprofessional social worker 3) id needs to be given some special attention … how we grade them as being good or bad, or being intellectually high or low… because the fact that somebody cannot read or write well does not mean the person is stupid; or that the person cannot do any good thing in life. (social worker 1) mills/inclusive education 338 in general, participants were wary of the limitations associated with the practical aspects of inclusive education. the awareness of these limitations can influence the extent to which full inclusion of children with id in regular school/classroom settings will be supported. most of the educators suggested that the inclusive education model where children with id are in the same regular school but in separate classrooms is a more practical arrangement because the curriculum content could be presented to children with id at a much slower pace. social workers in inclusive education most of the participants acknowledged that social workers are relevant in the implementation of inclusive education for children with disabilities in general, especially those with id. these participants shared ideas about what social workers could do as part of multidisciplinary teams in the education system. some participants were however uncertain about what particular roles social workers would play that special educators could not fill. these issues are presented under two sub-themes as follows. roles that social workers can play in inclusive education specific roles of social workers that were mentioned by participants included: providing public awareness-raising about id; liaising between the school, family and community to address the needs of the children with id; advocating for the rights of children with special needs; contributing to the preparation of iep; and being involved in transition planning for children with id. social workers can also go to the communities, organize community programs and then educate … through the media… (social worker 2) the social worker is there to advocate for the children with special needs. they champion the cause of such children in terms of their welfare. so sometimes, when we [special educators] are preparing our iep, we even need them to be at our meeting, but you know such people are scarce. we need their inputs as well…. so, the social workers, we need to work with them. where the child’s rights are being trampled upon, it is the social worker who has to intervene… even though we [special educators] are there to provide their educational interventions for them, when you talk of the championing the rights of the special needs child, it is basically the function of the social worker… (paraprofessional social worker 1) just like we have sanitation or agricultural extension officers, the services of social workers can be extended to go between the school and the community (resource teacher 4) apart from the specific roles highlighted, some of the educators stressed the fact that teachers cannot handle everything that concerns children in school. it is for this reason that social workers are needed to assist in the schools. the teacher’s duty is to teach the child. other factors that are preventing the child from learning should be taken care of by other experts. we don't do that in ghana… these [children with id] are kids who have needs, social needs.… so, some of these things should be investigated and worked on by the school social worker, not the teacher. (teacher educator 1) advances in social work, fall 2019, 19(2) 339 we realize that children’s problems are multi-faceted, in the sense that you have a child who has emotional problems, and may have some hidden problem with maybe health, may have issues with disabilities, a whole lot! of course, we have realized that we are limited in the sense that we can’t go beyond the school system…and that is why those who have been trained in social work proceed from that level. (special education coordinator 2) educators recognized the need to have professional social workers in the schools to pursue cases that go beyond the capacity of the teachers. this need was based on the recognition of differences in training for teachers and social workers. policy and practice implications despite the preceding views on the relevance of social workers to inclusive education, some concerns were raised in connection with the policy and practice implications of having professional social workers in the education system. some of the educators felt that there could be some overlap between the roles that social workers and special educators play in inclusive education programs. an example of such a perception was expressed by one paraprofessional social worker: the work of the special educator is almost the same as the social worker, so we are all school social workers… (paraprofessional social worker 1) there were some educators whose disquiet had to do with having the social workers as core staff of the school, and the budgetary implications that this would have for the education service. in special education, there is something we call multi-disciplinary team. we have the special educator, the audiologist, ophthalmologist, occupational therapist, social worker, clinical psychologist, psychiatrist, et cetera. all these people are not in the school, they are outside, so we collaborate with them, we team up with them, when we do our work. so, i think the same structure should be maintained for social workers too. if not, the moment we bring the social worker in, it means we have to bring in the ophthalmologist, the audiologist, the psychiatrist, et cetera … (paraprofessional social worker 2) another issue raised by special education coordinator 1 had to do with the education budget. according to this respondent, the more other professionals are supported by the country’s education budget, the more the budget will swell, which would lead policy makers to complain about “putting all [the country’s] money into education.” this concern has implications for inclusive education policy because social workers could ideally be part of the daily functioning of schools rather than being called upon in isolated situations. other study participants asserted that the roles of social workers and special educators do not overlap per se but are rather complementary. [special educators] may be playing roles that are akin to social work roles, but they are not social workers. a few of them may try to exaggerate their expertise even though they are not trained for those roles. but what i also know is that there is a lot of interplay between educational social work and special education. sometimes you think that it’s almost undefined. they [special educators] would play some of those roles even though professionally they are not mandated to play those roles. in circumstances where you do not have a social worker, this is how it plays out, but i am not an apostle of people who mills/inclusive education 340 try to exaggerate their expertise. my belief is that they should be content with what they are trained to do. but in the unlikely event that sometimes you don’t have them [social workers], you would be playing that role rather in an unprofessional manner. (teacher educator 2) teacher educator 1 proposed how social workers can carry out their roles in the education sector without being redundant: we [educators] are not saying every school should get one social worker... no! they will be redundant. but if you can get a cluster of schools and you put a social worker with a very defined prescription or description, that will help us a lot, because at the end of the day when you need to work with parents as we do, there should be a third person who understands the dynamics, and who can make that relationship cemented for things to flow. if you don't have that person, how often can the teacher meet the parents to talk about the child? (teacher educator 1) additional views were expressed by participants about how collaboration between educators and social workers can be facilitated since the governmental ministries that recruit the respective professionals are separate entities. one special education coordinator anticipated that an inclusive education policy would be very useful in addressing such details. generally, what i will say is that everything will boil down to policy. it is the policy that will give us the kind of strength that we need to do this kind of inclusive education in which the role of the school social worker is very crucial. so, all boils down to a policy…. we see the role of the social services to be very crucial…. because you need them … to assist the teachers to understand the students and how to treat and deal with the students at different levels depending on the child’s ability. (special education coordinator 2) the formulation of a working policy which provides for the incorporation of social workers in the inclusive education framework was noted as a necessary step toward the realization of inclusive education in ghana. participants asserted that if the educational system in ghana is well-structured, there will not be duplication of roles between social workers and educators. rather the collaboration between social workers and educators (whether with general or special education training) would strengthen inclusive education efforts. discussion study findings reveal three key challenges associated with inclusive education for children with id in ghana: stigma, inadequate resources; and ambivalence regarding the benefits children with id derive from inclusive education. in addition, the findings affirm the need for social workers to be active participants in the inclusive education efforts in ghana. loreman (2007) noted that although there is abundant literature substantiating why inclusive education is the preferred approach to education, it is equally important to direct attention to the essential background conditions that are required to ensure “effective inclusive education practices” (loreman, 2007, p. 23). it is important for educators, social workers, and other relevant professionals to factor the prevailing beliefs about id in the ghanaian society in inclusive education endeavors since these are the roots of the stigmatization meted out to the children, their advances in social work, fall 2019, 19(2) 341 families, and even their teachers. in one of the few studies in ghana that recognizes the roles of social workers in inclusive education, agbenyega (2007) reveals that the ges had collaborated with the british non-governmental organization, voluntary services overseas (vso), to involve the department of social welfare and health professionals in the sensitization of selected communities prior to piloting the inclusive school system. however, there was little from this study to suggest that such an initiative was being sustained in the inclusive education pilots. a primary social work role which study participants highlighted was that of providing public awareness-raising and sensitization programs about id. for example, the finding that some sections of the ghanaian society confuse id with mental illness, which leads to the stigmatization of the professionals who work with children with id in the schools is an issue that ought to be addressed through public education. furthermore, considering stigma can lead to formulating community education programs to dispel the beliefs that foment negative attitudes, while affirming positive perspectives about id. this would insure the transmission of more positive perceptions about id to the wider society, an endeavor social workers can contribute effectively to. additionally, social workers could serve as liaisons between the school, home, and the community to address issues that affect the child with id within and outside the school environment. the role of the social worker as a home-school liaison was emphasized by mittler et al. (2002), who encourage teachers and social workers to work collaboratively. one way of collaborating would be for social workers to conduct assessments of the child’s family and community backgrounds and share relevant information with the teachers to help them understand the social background of the child. the information provided by the social worker can also help the teacher design class lessons with examples that are germane to the child. furthermore, appropriate home-school linkages can help identify multi-faceted problems that the child with id may be facing at any given time (for example, health and/or emotional problems) so that targeted interventions can be provided. the social work profession has long operated from an ecological perspective, which recognizes that the interactions in a client’s environment go a long way to affect interventions (cummins, sevel, & pedrick, 2006). guided by the “person-in-environment” concept, professional social workers are skilled to navigate the environment of the child with id from the micro to the macro level. in an early study that examined the roles of social workers in inclusive education, pryor et al. (1996) reported that when inclusion became the goal of the u.s. department of education’s systems change efforts in 1989, school social workers were identified as integral members of inclusive education teams in each school district. social workers were trained in “inclusive education philosophy, programme models, student planning, curricular and instructional accommodations, and socialization” (pryor et al., 1996, p. 669). these are relevant issues in inclusive education, and of much significance to school social workers globally, including those in ghana. social workers can facilitate training sessions in schools to help regular teachers appreciate disability issues and work more effectively with their colleagues in special education. a common understanding of disability issues will also encourage better collaborative working relationships between social workers and educators in inclusive school settings. bean (2011) strongly asserts that social workers have a unique role to ensure proper assessments through attending iep meetings and conducting home visits, among mills/inclusive education 342 others. this draws attention to the multi-faceted contributions that social workers can make in the lives of students when they are given proper mandate to work in schools. pryor et al. (1996) list a variety of strategies used by social workers to promote success of inclusion in schools, including: preparing students for human differences; facilitating the transition process for newly included students; consulting collaboratively with teachers; revising the school curriculum to address social and emotional needs; providing services to students in general education settings; and expanding inclusive education concepts throughout a school. (p. 670) the perception that children with id would not benefit from the curriculum used in the regular classroom was prevalent in this study. study participants did not expect children with id to be assessed in the same way as their peers in the regular school, especially in terms of the transitional examinations taken at the end of the junior high and senior high schools in ghana. alternate trajectories of education, leading to the acquisition of vocational skills which could help children with id earn a living in adulthood, was proposed as a more realistic option. lee, soukup, little, and wehmeyer (2009) articulate that one of the ways to promote access to the curriculum by students with intellectual and developmental disabilities is to focus on the ways in which the content is delivered, which can be achieved by using technology to develop instructional materials designed for all learners. clark (2007) established that the social worker is needed as a facilitator to provide specialized support for learners with disabilities in the regular school. it is therefore important that tailor-made educational resources be made available for inclusive education as they facilitate teaching and learning for both teachers and students. most study participants affirmed that social workers are trained professionals who could use their skills to harness family and community resources to support inclusive education efforts, a task that regular or resource teachers might struggle to accomplish due to lack of requisite skills. some study participants disclosed that in times past, the department of social welfare in ghana was responsible for supplying school social workers to various public schools to address any issues that may be affecting students and/or staff of the school. however, as time went on, the ges decided to train their own school social workers. this action resulted in the loss of mandate by the department of social welfare to assign trained social workers to public schools, even though the department continues to have responsibilities toward educational placement and referrals of children with disabilities (anthony, 2009b). writing on inclusive education for children with special needs in ghana, gyimah et al. (2009) point out that: though the departments of social welfare and health are required to assist in assessing children, collaboration is little or non-existent. assessment is usually not multidisciplinary to allow for the involvement of professionals in fields such as health, social welfare and education, and the needs of the child are not comprehensively assessed. (p. 790) social workers can facilitate effective collaboration among all relevant stakeholders in inclusive education programs. they can also coordinate and facilitate iep meetings among teachers, parents, and significant others in the child’s life, which would go a long way to enhance the child’s educational process and experience. advances in social work, fall 2019, 19(2) 343 limitations of the study being the primary analyst of the data, there was the tendency for some level of bias in relation to seeking to validate specific themes and/or failing to recognize possible themes from other perspectives. being conscious of this, the researcher involved two colleagues who were doctoral candidates in the analytical processes. the initial codes and themes were presented to these colleagues, who in turn checked with portions of the data to ascertain whether the codes and themes reflected the narrative data. where there was the need for revisions, the codes were modified accordingly. the researcher also worked closely with the supervisory committee, who thoroughly examined the analytical processes and gave input before the final themes were arrived at. all these engagements strengthened the analysis and significantly reduced the bias that could have resulted from the researcher’s independent analysis. secondly, a topic of this nature could have benefited from a larger sample recruited from various parts of ghana. it is important to note that the researcher had no prior relationship with the schools or communities from which the sample was taken. however, having conducted this study in one administrative region, there are possibly some issues that may not have come up in the findings. for example, regional differences pertaining to cultural beliefs about id and availability of trained professionals (both teachers and social workers) in other regions could lead to variations. however, the findings of this paper remain relevant, as they contribute to filling a wide gap in the literature pertaining to the involvement of social workers in inclusive education efforts in ghana. it is anticipated that studies such as this one would stimulate other researchers and stakeholders to conduct further studies to inform the implementation of inclusive education in ghana. conclusion this paper contributes to the body of knowledge on inclusive education in ghana by highlighting some challenges on the ground and providing ideas on how social workers can get involved in promoting the inclusive education agenda in ghana. while resources need to be made available to fully implement inclusive education, it is important to recognize other critical factors such as stigma associated with id. this paper has established that social workers in ghana can play diverse roles such as: facilitating public awareness-raising to reduce stigma related to id; serving as homeschool-community liaisons; and helping to design policy and practice frameworks that guide social work practice in the inclusive school system. through planned educational and recreational programs, social workers can help foster healthy interactions between all members of the school community. school social workers can also help students with id adjust to the inclusive school through their role as home-school-community liaisons. furthermore, given the reluctance of some parents to acknowledge their own child’s id, social workers can also facilitate (or make referrals to) parent support groups to help such parents. it is recommended that stakeholders from the department of social welfare, the ghana education service, and the universities re-visit the incorporation of social workers in ghana’s inclusive education efforts and the education system in general. a policy and practice framework that guides social workers in their work within the school system will help to direct their involvement in inclusive education in ghana. beyond ghana, the findings of this study can inform other audiences, particularly mills/inclusive education 344 developing countries where similar challenges such as stigmatization of id, and disability in general, is prevalent. this paper can also guide relevant stakeholders to rethink efforts being put into launching inclusive education programs, especially regarding the integration of social workers in such programs. references adera, b. a., & asimeng-boahene, l. 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(2012). access and enrollment of children with intellectual disability in selected special schools in ghana: the influence of parental economic status. international journal of african & african-american studies, 8(1), 41-50. author note: address correspondence to dr. abigail a. mills, department of social work, university of ghana, legon. e-mail: aamills@ug.edu.gh http://hdr.undp.org/sites/default/files/nhdr_2007_ghana.pdf http://www.unesco.org/education/pdf/salama_e.pdf https://www.unicef.org/disabilities/files/unicef_right_to_education_children_disabilities_en_web.pdf https://www.unicef.org/disabilities/files/unicef_right_to_education_children_disabilities_en_web.pdf https://www.unicef.org/sowc2013/files/swcr2013_eng_lo_res_24_apr_2013.pdf https://www.unicef.org/sowc2013/files/swcr2013_eng_lo_res_24_apr_2013.pdf https://www.un.org/disabilities/documents/toolaction/ipuhb.pdf http://www.iier.org.au/iier27/von-ahlefeld-nisser.pdf https://www.who.int/whr/2001/media_centre/en/whr01_fact_sheet1_en.pdf?ua=1 this work is licensed under a creative commons attribution 4.0 international license. using structural social work theory to drive anti-oppressive practice with latino immigrants arturo carrillo caitlin l. o'grady abstract: social work practice with marginalized populations not only requires intervention to address individuals’ immediate service needs, but also requires intervention to address the larger structural context that impacts well-being. critical theoretical frameworks, such as structural social work (ssw) theory, are essential in helping social workers to develop a comprehensive understanding of the manner in which social systems are intentionally designed to oppress marginalized populations, including immigrant and refugee communities. ssw serves to both understand how society’s structure causes social problems and to identify how these structures must be changed in order to alleviate harm. focusing specifically on latino immigrants, this article presents an overview of ssw theory and discusses its relevance to social work practitioners. this ssw framework will then be applied to analyze two u.s. social systems, the labor regulatory and mental health systems, that are integrally connected to latino immigrant well-being. finally, drawing from two case examples of research conducted in chicago, alternative models of practice in the realms of labor and mental health are presented. findings from these case examples illustrate how social workers can engage in antioppressive practice when they implement interventions that promote personal healing while simultaneously challenging oppressive elements of social systems. keywords: structural social work theory; labor; mental health; latino immigrants; antioppressive practice hide nothing from the masses of our people. tell no lies. expose lies whenever they are told. mask no difficulties, mistakes, failures. claim no easy victories… (cabral, 1970, p. 89) these words of amilcar cabral (1970) remind us of the necessity to engage in a genuine way with those with whom we seek to work. as social workers, if we are truly to work for the emancipation and empowerment of those we serve, we must be cognizant of the challenges we are faced with in practice, including both the realities of the “client” and that of the profession. in the same way that amilcar cabral used his professional training to support the struggle for liberation of the people of bissau-guinean and cape verde from the colonization of portugal, as social workers we are positioned to engage in the complex and at times turbulent work of anti-oppressive practice. anti-oppressive practice requires that we recognize how individual well-being is integrally connected to larger social institutions. considering that social institutions in the u.s. perpetuate systems of power, privilege, unequal access, and oppression, anti-oppressive practice intends to alleviate the negative impacts of oppressive social systems on individuals while simultaneously transforming these social structures that perpetuate oppression (mullaly, 2007). as ____________ arturo carrillo, phd, lcsw, saint anthony hospital: community wellness program. caitlin l. o’grady, phd, lcsw, saint anthony hospital: community wellness program. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 704-726, doi: 10.18060/21663 https://creativecommons.org/licenses/by/4.0/ carrillo & o’grady/using structural social work 705 amilcar cabral pushes us to understand through his words, we must be honest in the complexities of engaging in anti-oppressive practice and must not claim easy victories that fall short of structural transformation. social work with immigrants and refugees presents an important space to engage in anti-oppressive practice. immigrants and refugees enter a u.s. sociopolitical context where nativist sentiment and rhetoric is pervasive (ayón, 2014; collinson & diamond, 2016; salas, ayón, & gurrola, 2013). members of these populations commonly experience multiple forms of oppression, including exploitation, marginalization, exclusion from social and civic spaces (i.e., powerlessness), pressure to assimilate to dominant cultural norms (i.e., cultural imperialism), and violence (young, 2013). these experiences of oppression are manifested in both their interactions with u.s. social structures and in their daily interpersonal interactions (aguilar-gaxiola et al., 2012; garcini et al., 2016; raymond-flesch, siemons, pourat, jacobs, & brindis, 2014). the labeling of the immigrant population in reference to categories of legality and illegality is used to legitimize oppressive acts (menjívar, 2016). considering that experiences of oppression are central to the experiences of immigrants and refugees in the u.s., it is essential that social workers are prepared to assess the impact of oppressive structural contexts on wellbeing and to challenge oppressive social structures in their daily practice. focusing specifically on latino immigrants, this article will introduce structural social work, a critical social work theory. following this theoretical overview, we will use a structural social work lens to analyze the u.s. labor regulatory and mental health systems, two systems that are integrally connected to the well-being of this population. as part of this analysis, we will discuss how these systems are intentionally designed to perpetuate oppression. finally, drawing from two case examples of research that the authors conducted in chicago (carrillo, 2017; o’grady, 2017), we will discuss how social workers can practice outside of oppressive systems. recognizing how oppressive interactions with social systems negatively impact well-being, the highlighted practice models in the realms of mental health and labor organizing are intentionally designed to promote alternative patterns of interaction. these spaces serve as refuges where community members are supported in reframing their understanding of themselves and their environments, with the aim of empowering them to advocate for structural change in their communities. after highlighting how these alternative practice models both promote personal healing and cultivate spaces of resistance, we will discuss the implications of these local level practices for the social work profession. structural social work theory and the role of critical frameworks in practice critical theoretical frameworks provide an important foundation for guiding social work practice grounded in principles of social justice. critical theoretical frameworks assist social workers in developing a comprehensive understanding of the structural context that impacts the immigrant population and provide a lens for identifying practice solutions that challenge this context. attending to the larger structural context ensures that individuals, families, and communities are not pathologized for the challenges that they experience. a advances in social work, spring 2018, 18(3) 706 structural social work (ssw) critical theoretical framework is of particular relevance for informing anti-oppressive practice with the latino immigrant population. first, ssw theory provides a descriptive understanding of how oppressive dominant ideologies inform political, economic, and social systems and patterns of interpersonal interactions. second, ssw offers a prescriptive approach for supporting individuals who have been harmed by social systems and challenging these oppressive social systems and underlying ideologies that cause harm (mullaly, 2007). while we recognize the breadth of scholars contributing to the body of critical social work literature, we focus primarily on mullaly’s (2007) work in our overview due to the fact that mullaly’s (2007) bridge model of society is central to our subsequent analysis of both the u.s. labor regulatory and mental health systems and the presented alternative practice models. structural social work theory ssw, as first postulated by maurice moreau in canada in 1979, was created in reaction to the "medical and disease model" which seeks to work with people in a dependent position, emphasizing change at the individual rather than the sociopolitical level. ssw seeks to focus the intervention on the direct interactions between individuals and social, political, and economic systems (moreau, 1979). stemming from radical social work, which is grounded in socialist ideologies, ssw criticizes conventional social work for a lack of critical self-awareness and pathologizing the oppressed by opting for individual diagnosis at the expense of addressing large social problems (mullaly, 2007). even with the attention given to societal level concepts, ssw is meant to be a generalist model of practice for social work with individuals, families, groups, and communities, while not losing sight of the interaction between the personal and larger cultural and political forces (mullaly, 2007). as conceptualized by ssw, society is envisioned as a bridge structure, whereby the bedrock, or substructure, on which the bridge is erected is the ideology that underpins society. the foundation of a bridge is not visible, yet it is essential to support the structure on which it is built. the ideologies of society provide a similar foundation. the pillars holding up the bridge platform are the various social institutions created to manage society’s primary functions, including but not limited to economic, political, social welfare, labor regulatory, educational, and health systems. the platform of the bridge on which the general population exists and interacts is largely defined by the lower portions of the structure. as mullaly (2007) explains, "the substructures or foundation of society consists of a dominant ideology, which is transmitted to all members of society through the process of socialization and determines the nature of a society's institutions and the relations among its people" (p. 245). to achieve social transformation, change must happen at all levels and social workers must be ready to navigate throughout the three levels as outlined by the ssw model. mullaly’s (2007) bridge model is displayed below. at its core, ssw is meant to be both descriptive and prescriptive. the model serves to both understand how society’s structure causes social problems and to identify how these structures must be changed in order to alleviate harm. to achieve this goal, an immediate focus on relief must also be accompanied by a long-term focus on structural and institutional change. utilizing a dialectical understanding, ssw understands that social carrillo & o’grady/using structural social work 707 welfare and social work contain opposing forces of social care and social control. given this understanding, the focus of practice is meant to “maximize the emancipatory potential of social welfare and social work and to neutralize or minimize the repressive elements” (mullaly, 2007, p. 238). figure 1. mullaly’s structural view of society (bridge model) reproduced with permission from mullaly (2007, p. 246) recognizing that critical analysis of social systems is central to ssw, in the following section we will analyze two u.s. social systems through a structural lens. in particular, we will analyze both the u.s. labor regulatory and mental health systems. based on our synthesis of the literature, we contend that not only does the latino immigrant population have unmet needs in the realms of labor and mental health, but also that these systems are designed to perpetuate structural oppression rather than to address unmet needs. u.s. social systems through a structural lens u.s. labor regulatory system the labor regulatory system falls within the economic system of our society. it is intended to be the mechanism that checks the detrimental impacts of exploitation on workers by employers in their pursuit of profit and efficiency within the capitalist economic system. the labor regulatory system encompasses laws and policies that regulate workplace standards, the state and federal worker protection agencies established to enforce workplace policies (including among others, the department of labor, equal employment opportunity commission), and collective bargaining agreements set by labor unions. in order to understand the structural causes of the workplace exploitation on lowwage immigrant workers, an analysis of the u.s. labor system must be contextualized in relation to both the u.s. labor regulatory system and the immigration system. advances in social work, spring 2018, 18(3) 708 the immigration system and labor regulatory system: the connection between “illegality” and substandard working conditions. the literature has long emphasized the role of immigration policy in regulating the flow of foreign labor into the united states (borjas, 1989; de genova, 2005; gomberg-muñoz, 2011; massey, durand, & malone, 2002; sassen-koob, 1981). decades of increasingly restrictive u.s. immigration policy, culminating with the passage of the immigration reform and control act of 1986, established a present day political reality in which 11.1 million people live in the united states without legal status (passel & cohn, 2016). the political creation of “illegality” establishes a vulnerable and “temporary” population that is often exploited in the workplace and made to live in fear within their communities (gleeson, 2010). the mexican migrant community has for generations served as a continued and expendable pool of labor for the united states (de genova, 2004). by creating a system of deportation targeting undocumented workers, the nation creates what is essentially a disposable commodity (de genova, 2002). even though undocumented immigrant workers maintain many of the same legal protections as documented workers in the workplace, their undocumented status places them in a relatively powerless position. various studies have identified that undocumented workers face a higher likelihood of experiencing wage theft (bernhardt et al., 2009; fussell, 2011), wage disparities (hall, greenman, & farkas, 2010; rivera-batiz, 1999), unsafe workplace conditions (mehta, theodore, mora, & wade, 2002), and workplace injuries and fatalities (orrenius & zavodny, 2009; sanchez, delgado, & saavedra, 2011). substandard wages and workplace conditions plague entire industries and communities that employ a high percentage of immigrant workers (bernhardt et al., 2009; levin & ginsburg, 2000). among the most pervasive experiences of immigrant workers is the loss of owed wages. violations of wage and hourly laws are commonly referred to as wage theft (bobo, 2009). it occurs through various forms including: failure to pay minimum wage, failure to pay overtime (i.e., paid less than 1.5 times the regular rate of pay for all hours over 40 per week), “off-the-clock violations” (i.e., work not compensated before or after regular shift), meal break violations (i.e., work during break without compensation), or illegal deductions taken from workers' pay. a study by bernhardt et al. (2009) of 4,387 workers in the three largest cities in the u.s., new york, chicago, and los angeles, identified the industries with the highest rates of wage theft, as measured solely by minimum wage violations. these industries included apparel and textile manufacturing (42.6% violation rate), personal and repair services (42.3%), private households (41.5%), retail and drug stores (25.7%), grocery stores (23.5%), security, building and ground service (22.3%), food and furniture manufacturing, transportation and warehousing (18.5%), restaurants and hotels (18.2%), residential construction (12.7%), home health care (12.4%), and social assistance and education (11.8%). the same analysis of minimum wage violations by demographics identifies undocumented immigrants as reporting the highest percentage of wage violations. within this demographic, there is a marked difference by gender; nearly half (47%) of undocumented female respondents reported minimum wage violations compared to 30% of undocumented men, by far the highest rate among workers interviewed. carrillo & o’grady/using structural social work 709 the need for and limitations of federal and state labor enforcement agencies. the relatively powerless position of vulnerable workers makes them less likely to report substandard work conditions (fussell, 2011). as a result, there is a considerable role for federal and state regulatory agencies to ensure compliance of wage and hourly laws for all workers, including undocumented workers. at the federal level, the department of labor is tasked with, among other responsibilities, regulating workplace conditions. specifically, the wage and hourly division (whd) “enforces federal minimum wage, overtime pay, recordkeeping, and child labor requirements of the fair labor standards act” (u.s. department of labor, n.d.). however, analysis of the whd has shown continued reductions in the investigative staff since its inception. in 1941 when it was first created, the whd employed 1,769 investigators, compared to 1,544 in 1962 and 750 in 2007. investigators have decreased despite the fact that the number of businesses covered by the whd has seen a dramatic increase from 360,000 to 1.1 million to 7 million in the respective years (bobo, 2009). separate analyses demonstrate similar findings; between the years of 1975 and 2004 the number of investigators decreased by 14% from 921 to 788, while the number of workers covered increased by 55% and the number of businesses covered increased by 112% (bernhardt & mcgrath, 2005). the limited availability of investigators has led the whd to be a worker-initiated complaint driven agency instead of one designed to conduct proactive investigations (weil, 2008). beyond the federal labor regulatory agencies, states can establish their own labor protection agencies in order to increase the level of protections for workers. however, the enforcement capacity and role of each state agency varies widely throughout the country (meyer & greenleaf, 2011). the absence of labor unions. the erosion of union density in the private sector over the last 50 years is striking (bui, 2015). this has had a marked impact on working standards within the united states labor market. without union representation, workers lose the ability to use collective bargaining to increase wages, benefits, and improve working conditions. as a result, in a 44 year span the share of the nation’s income taken home by the middle class has declined, with the aggregate household income having shifted from middle-income households, 62% in 1970 to 43% in 2014, to upper-income households, 29% in 1970 compared to 49% in 2014 (pew research center, 2015). the decline in union membership accounts for 35% of the falling share of workers within the middle class and explains nearly half when adding in the union equality effect (freeman, han, madland & duke, 2015). it has also played a role in limiting upward mobility among low-income children, especially when parents are low-skilled workers (freeman, han, duke, & madland, 2016). within the current labor regulatory system, various factors make it unfeasible for labor unions to organize low-wage workers. mehta and theodore (2005) identify the obstacles that employees and organizers commonly experience during their efforts to organize labor unions. findings from their analysis of 25 union organizing campaigns indicated that companies engaged in a variety of legal and illegal tactics to discourage union organizing (mehta & theodore, 2005). while legislative solutions such as the employee free choice act would serve to lower the hurdles for workers to unionize and would increase opportunities for collective bargaining in more workplaces, more and more states adapt “right to work” legislation, which purpose is to weaken union membership by making advances in social work, spring 2018, 18(3) 710 union dues optional by union members and prohibits union membership as a condition of employment. the limited support that unions are able to offer to low-wage immigrant workers, coupled with the shortcomings of federal and state labor regulatory agencies, point to the ineffectiveness of the u.s. labor regulatory system in protecting immigrant low-wage workers from workplace exploitation. the psychological harm of the labor regulatory system’s failings. not only do immigrant workers have unmet needs in the realm of labor protections, but experiences of workplace exploitation have also been found to negatively impact emotional well-being. lesniewski and drucker (2017) conducted a mixed-methods research project that explored the psychosocial impact of wage theft on low-wage immigrant workers. findings revealed that two-thirds of respondents were likely or highly likely to suffer from depression. immigrant workers who took part in this study reported that they often had to take on additional jobs to compensate for lost wages and experienced psychological distress, family conflict, and nutrition and health issues as a result of working long hours and coping with financial hardships and housing instability (lesniewski & drucker, 2017). synthesizing the literature on the labor regulatory system, it is not only evident that the system fails to address the needs of immigrant workers coping with workplace exploitation, but it is also evident that the system intentionally creates an expendable workforce who is vulnerable to exploitation. furthermore, these experiences of workplace exploitation negatively impact immigrant workers’ mental health. u.s. mental health system the negative impact of workplace exploitation on emotional well-being is part of a growing body of literature exploring the effects of structural oppression on the mental health of latino immigrants. for example, research has attributed living in a hostile, antiimmigrant political climate to mental health challenges including depression, anxiety, and chronic trauma among mexican immigrant adults and their children in arizona (salas et al., 2013). similarly, flores et al. (2008) found that experiences of interpersonal discrimination were associated with depression among mexican immigrant adults in california. evidence also indicates that the experience of being undocumented in the oppressive structural context of the u.s. negatively impacts mental health. research cites specific examples of experiences that are associated with mental health symptoms, including limited access to employment, education, healthcare, and social services; living in constant fear of deportation; and exposure to negative stereotypes about undocumented immigrants (garcini et al., 2016; raymond-flesch et al., 2014). a structural analysis of the u.s. mental health system not only indicates that oppressive social systems and discriminatory patterns of interpersonal interactions negatively impact mental health, but also that the system is intentionally designed to limit access to mental health services and inadequately address the mental health needs of latino immigrants. in accordance with mullaly’s (2007) bridge model of society, underlying capitalist ideologies inform the development of a mental health system that ignores the impact of structural oppression on well-being and limits access to services based on an individual’s ability to pay. first, the limited attention paid to the impact of structural oppression on well-being is reflected in the dominance of what saleebey (2005) describes as the “medicalcarrillo & o’grady/using structural social work 711 psychiatric/pharmaceutical/insurance cartel” (p. 23) model of mental health. saleebey (2005) defines this model as one in which “a group of institutions…control a particular market or social sector through a melding of their interests and exercising of their social power” (p. 23). by framing mental health in relation to biochemical responses, illness, deficits, and pathology, this biomedical model of mental health service delivery advances the interests of psychopharmaceutical companies while failing to address the structural context that impacts well-being (saleebey, 2005). second, according to rylko-bauer and farmer (2002), the mental health system is part of the larger …market-based [healthcare] system shaped by forces of competition, commercialization, and corporatization...the orientation is increasingly one of selling ‘product’ rather than providing care, to ‘consumers’ and ‘clients’ rather than to patients, with a reliance on competition to control costs and encourage ‘efficiencies’. (pp. 478-479) for underinsured and uninsured individuals who are unable to pay out of pocket for mental health services, treatment options are limited. the structure of the mental health system results in disparate rates of mental health service access and lower quality services for latino immigrants. there is a well-established body of literature identifying cost and lack of insurance coverage as barriers to service access (bridges, andrews, & deen, 2012; cabassa, lester, & zayas, 2007; santiagorivera et al., 2011). these access barriers translate to lower rates of service utilization among latino immigrants in comparison to both non-latino whites and u.s.-born latinos (cabassa, zayas, & hansen, 2006). in addition, evidence indicates that immigrant and u.s.-born latinos are less likely than non-latino whites to receive depression treatment in accordance with established care guidelines, thus pointing to disparities in treatment quality (lagomasino et al., 2005). horton (2006) further illustrates the negative impact of the market-based care system on service quality in her case study of a mental health clinic serving primarily uninsured and medicaid insured latino immigrants in the northwestern u.s. because the mental health clinic’s parent hospital was facing budget difficulties due to limited reimbursement for the provision of charity care to the uninsured, the hospital placed increased demands on clinician “productivity” (i.e., meeting specified billable hours quota). in order to meet these demands, clinicians were pressured to implement practices including shortening appointment times, limiting or denying services to uninsured individuals, double booking appointments, and stopping service provision to program participants who “no showed” three appointments, meaning that they missed appointments without providing 24-hour notice (horton, 2006). clinicians identified these practices as conflicting with their beliefs about high quality service provision (horton, 2006). within the city of chicago, the site of the case studies highlighted in this article, research has documented similar disparities in mental health service access and quality for latino immigrants. over the past decade, there has been a disinvestment in publicly funded mental health services throughout the city. while there were 12 free mental health clinics operated by the chicago department of public health (cdph) in the year 2011 (at one point 19), the number has been reduced to five currently operating clinics (coalition to save our mental health, n.d; lowe, 2015; spielman, 2017). the only two bilingual advances in social work, spring 2018, 18(3) 712 english and spanish cdph clinics were among those that closed (fecile, 2012). furthermore, a mixed methods study surveying 2,859 primarily latino community residents on chicago’s southwest side found that 57% of respondents identified cost, 38% identified lack of insurance coverage, and 34% identified a lack of services in close geographic proximity as posing service access barriers. stigma, by comparison, was reported by only 11% of those surveyed (collaborative for community wellness, 2018). in addition, qualitative data from this same study indicated that when service providers do not consider the impact of structural context on well-being, they are limited in the extent to which they can truly address community residents’ mental health needs (collaborative for community wellness, 2018). at both the national and local levels, the mental health system contributes to and reinforces latino immigrants’ experiences of structural oppression by systematically denying access to high quality services. challenging structural oppression in practice: empirical case examples ssw not only emphasizes the importance of assessing social systems from a critical perspective, but it also highlights the importance of challenging structural oppression. the following section will present two empirical examples of practice approaches that challenge oppressive structural contexts based on the authors’ research in chicago. the section will begin with a description of carrillo’s (2017) empirical analysis of innovative practice approaches in the labor realm and a summary of key findings from this analysis. the section will then provide an overview of o’grady’s (2017) case study of a mental health program and highlight findings pertaining to the program’s anti-oppressive practice approach. alternative practice model: labor the emergence of the worker center movement has served as a novel approach to organizing workers in the low-wage labor sector who are largely excluded by organized labor. it is in this space that innovative strategies have developed to organize the "unorganizable." study methodology. the study by carrillo (2017) was conducted as research for a doctoral dissertation, with irb approval. the research focused on the following two research questions: 1) how are the various factors present in the lives of low-wage immigrant workers, excluded workers, and the excluded workforce, in particular, elements of personal, cultural, and structural oppression understood by the worker center organizers? 2) how does this understanding shape and determine the interventions of the worker center organizer and the maturing worker center movement in the chicagoland area at the three different levels of society; superstructure (interpersonal), structural (social institutions) and substructural (ideologies) in support of this vulnerable workforce? carrillo (2017) contributes to the literature by examining and developing a conceptual understanding of this organizing process through in-depth, semi-structured interviews with 18 worker center organizers at eight worker centers in the chicago metropolitan area. data were analyzed by the author using a modified grounded theory approach to understand the dimensions, properties, context, actions and their consequences related to the process of organizing carrillo & o’grady/using structural social work 713 vulnerable workers across a variety of low-wage industries and throughout distinct communities in the chicagoland region. study findings. interviews with the organizers provided space for an examination of the structural elements that are perceived as oppressive in the lives of the workers. the following structures are listed in the order of mentions received within the interviews: labor regulatory (governmental regulatory and enforcement agencies, labor unions, labor policy), immigration (lack of immigration reform, threat of deportation), economic (neoliberal capitalism, the fissured workplace, temp staffing agencies, the informal economy), criminal justice (incarceration, lack of rights for ex-offenders), housing (lack of housing assistance, limited affordable housing options), political (established political parties), educational (school system), welfare (social safety net programs), and health care (access to health care). many of these structural elements were not only understood through their interconnections, which increase vulnerability to exploitation, but also added to contentious relationships of workers often along racial lines. one respondent captured this notion in the following way: latino workers, immigrant undocumented workers, are the preferred group for many of these factory owners. they do not… and if you think about why right. it is not knowing regulations, it is not knowing laws, it is like a very obedient workforce that does not cause problems for the boss. people do what they are told right. and it because a fear of retaliation right, fear of deportation, a fear of, if you lose your job you do not have a safety net. you cannot file for unemployment right. so, on the other end, native-born people, if they lose if they are at a place for you know a certain amount of days then they can file for unemployment right. and then the unemployment insurance goes up for the temp agency right. and then you get the factory owners and just say i don’t want any black people i want mexicans, you know. although each worker center organization is unique, common features exist. worker centers are often hybrid organizations that take on various functions, including service provisions, advocacy, organizing and formation. the organizations do not exclusively focus on workers from only one company but instead are place-based and work with employees from different employers. these are often democratic organizations, rooted in latin american liberation movements, which employ elements of popular education. worker centers often employ a broad agenda that involves causes outside of labor, such as education, tenant rights, and immigration-related issues, among others. they may also involve international issues and transnational work. the centers often have a small but dedicated membership that supports different functions of the organization (fine, 2006). even though worker centers may be varied in their origin and function, they all are grounded in the need to organize alternative local solutions where little else exists in an effort to address the challenges faced by low-wage workers. as a result, organizers have developed strategies to address the issue of workplace exploitation throughout entire sectors of the labor market and within specific communities. these organizers employ a variety of approaches, including direct action, legal action, policy initiatives, partnerships advances in social work, spring 2018, 18(3) 714 with state enforcement agencies, collaborations with ally organizations, and promotion of higher workplace standards among the business community. understanding the function of the worker center through a structural social work lens proved to be a fruitful endeavor. as a tool to examine oppression in the lives of low-wage workers and prescriptive functions of assessing opportunities for intervention, the model resonated with the worker center organizers in this study. the findings allowed for a detailed understanding of the function that the worker center served as a space for supporting individual workers, organizing for structural change, and engaging in the ideological realm. worker centers serve as a focal point of activity by workers who seek support on workplace related injustice. however, for workers engaging with the worker center, it also gives them access to many other types of support and possibilities for development. worker center organizers shared their understanding of the work through the various roles and functions they serve. at an interpersonal level, the function of the worker center is not only to provide support and attempt to offer relief for the worker, but to also conduct an assessment of other issues present in their lives so that the worker can be connected with other resources and understand how their personal experience is linked to structural oppression. the following respondent highlights an example of the understanding of structural violence as the compounding effect of various oppressive systems: so, i know a worker who has cancer and obviously can't get obamacare because he is undocumented, and we worked really hard to figure out what to do with him and how to get him what he needed. before obamacare even existed, it was more of a question of language access and like if he was trying to get special treatment, could he find the clinic to go to… all of that sort of stuff. so, i think one area of that, is access to services. another is, and super prevalent one, is contact with the criminal justice system. whether that is the dui and in chicago dui checkpoints are almost all in black and brown neighborhoods. whether that is the ways that individual crises mix with poverty to create criminalized communities. you know, like i grew up in an alcoholic household and i also grew up in the suburbs, so you did not see police on a regular basis. so, the ways individual crises and class intersect often leads to calls to the police because there is a fight or duis or drinking in public, all of that sort of stuff. not to mention the direct attack on the workers and the direct racialized policing and that sort of stuff that you know… you are on your way home and a cop forces you up against a wall just for no reason. you know with day laborers a lot of them were living in homeless shelters and a lot of those shelters were getting closed down too. understanding the ties between the personal and the structural, the worker center organizer can engage with the worker in active capacity building and leadership development. the constant presence of the worker center within the marginalized communities they serve also provides the worker center with an opportunity to become the content experts on worker exploitation, and together with the worker engage in developing solutions. carrillo & o’grady/using structural social work 715 engaging in the process of structural reform was at the heart of the worker center model, in spite of every challenge present in this undertaking. it is clear however that seeking structural reform requires the development of power. the respondents were all aware of the necessity to develop worker power and would activate their membership base in order to challenge employers and labor regulatory institutions and to reshape policy in favor of the vulnerable worker. worker center organizers attempt to navigate three essential elements of power: social, economic, and political. for us [in the mexican labor movement] it was important [to understand] organizing socially, the economically, and the politically, if you handle all three, you move where you want, and you have power. if you do not handle all three you will not have power as an organization. and here [in the american labor movement] there is no power. the unions have the economic power but not political or social because in the political they are dominated. in the social, they do not do work, they do not care. even though challenges and limitations exist in the three areas, respondents were optimistic of the potential for a recently established coalition of worker centers to increase their organizational capacity, as well as to amplify their ability to engage in structural reform. utilizing the popular organizing axiom, “understanding the world as it is and working towards the world as it should be,” worker center organizers must be innovative, creative, resourceful, and above all, not lose sight of what is possible in order to actively support the vulnerable workers. one excellent example of this is the development of the worker cooperative as an alternative economic model, that places people before capital. although this study was not meant to be a thorough exploration of all the ideological elements influencing the experiences of the vulnerable worker, capitalism and/or a critique of capitalism was found to be a central ideology in the findings. as this respondent articulates: i view my goal is developing politically conscious working class leaders and that really only happens through struggle and through struggle in a particular way that is democratic, that is where workers own the struggle and they have to kind of come to grips with the consequences of their actions, they have to come to grips with the strategy themselves and through that process become aware and conscious of capitalism, of racism of the forms of oppression that they are facing and develop leadership over time. furthermore, some respondents were keen to understand the dangers of organizing without a deep ideological grounding, as referenced in their critique of alinsky-style organizing and the u.s. labor movement. quotes from two different respondents capture this understanding: so many problems with alinsky in terms of race and gender and stuff like that. but the biggest critique i have is the whole like leave your ideology at the door and i think, when you do leave your ideology your values your beliefs at the door you get into a situation where, what happened with alinsky where you organized a bunch of people to like discriminate against another set of minorities. which you advances in social work, spring 2018, 18(3) 716 know, the organizing he did in the back of the yards, basically he does organizing to exclude black people from the area. [the] u.s. labor movement because it has no explicit ideology, you know gets led down all these paths and that is part of the reason why we are where we are. although the respondents understood the necessity of grounding their organizing efforts in the ideological space of what a different world could look like, they presented a list of challenges to doing so. challenges notwithstanding, both the potential and desire to develop an articulation of the ideological grounding exists within the worker center movement in chicago. alternative practice model: mental health o’grady (2017) used a case study design to explore a branch of saint anthony hospital’s community wellness program (cwp), located in chicago, that offers mental health services exclusively to uninsured latino immigrant adults. operating under the purview of a community hospital and funded through the hospital’s operating budget, the cwp offers mental health services in community-based satellite locations. mental health services are offered in conjunction with a range of supportive services including family support, health education, and public benefits assistance. the branch of the cwp that was examined is located in a neighborhood with a predominantly mexican immigrant population, and its unique focus on mental health service delivery with uninsured latino immigrants provides an important opportunity to explore how the structural context impacting this population is addressed in practice. study methodology. o’grady (2017) conducted a case study of the aforementioned branch of the cwp for her doctoral dissertation research. this case study was informed by the following research questions: 1) how do service providers and service participants describe the services that are delivered at the cwp? 2) how do service providers and service participants experience service delivery at the cwp? and 3) how does the program address the mental health needs of community residents? using a transcendental phenomenological qualitative approach, o’grady (2017) conducted 21 semi-structured individual interviews with service providers and mental health program participants; observed routine program activities; and collected 17 agency documents. o’grady (2017) analyzed all data independently using an inductive open coding process to identify salient themes. of the 10 interviews conducted with service providers, nine were conducted in english and one was conducted in spanish, while all 11 interviews with program participants were conducted in spanish. irb approval was received prior to beginning research activities. findings from this case study led to the development of a new empirical model for conceptualizing culturally competent service delivery (o’grady, 2017). the section below will present data demonstrating how the cwp addresses community members’ mental health needs through its anti-oppressive practice strategies, which is one element of the larger empirical model. due to space limitations, only the english translation is presented for quotes from spanish-language interviews with program participants. the second author translated all quotes from spanish to english. carrillo & o’grady/using structural social work 717 study findings. data indicated that at both the level of the organization and the level of individual providers, mental health practice at the cwp challenges the oppressive structural context in which latino immigrants are situated. at the organizational level, the cwp is intentionally designed to create an alternative space outside of the biomedical model of mental health service delivery. within this alternative space, mental health services are free and time-unlimited; program participants may start, stop, and reinitiate services without penalty; and program participants are not assigned a dsm-v diagnosis. service providers explicitly describe their alternative practice model as challenging structural oppression. services are free and time-unlimited because community members have traditionally been denied access to long-term mental health services when they are unable to pay the out of pocket cost. similarly, recognizing that program participants have commonly experienced multiple traumas that they may not be ready to explore immediately upon initiating services, the cwp’s model provides the flexibility for program participants to process past trauma at a pace that feels comfortable without facing penalties for “no showing” appointments. service providers also intentionally do not assign dsmv diagnoses to avoid pathologizing program participants. as one service provider stated: when you're dealing with communities that have been oppressed, marginalized, a lot of this internalized oppression, you know, going to a clinical setting that then reinforces that by giving them diagnoses and reinforcing that yes, they need to be treated for whatever they're dealing with is very, very reinforcing of this oppressive nature. another service provider described that, by framing mental health challenges in the context of environmental conditions rather than in the context of symptomology, this alternative model conveys that: “we are products of our environments, not just products of our pathology.” the alternative practice model at the cwp offers service providers the flexibility to deliver services in a manner that aligns with their ideals about what high quality mental health service delivery entails: we can meet our clients as we see absolutely fit. that means absolutely minimal paperwork. it's just a true devotion to the work being almost entirely relational, not planned out and boxed in and meeting milestones and meeting have you met your goals yet. no. that to me stands out. as this quote illustrates, the alternative space that has been created at the cwp is largely defined by alternative patterns of interaction that challenge both traditional service interactions within the biomedical model and patterns of discriminatory interpersonal interactions within society at large. through these alternative patterns of interaction, service providers dismantle power differentials in the therapeutic relationship; affirm individuals’ strengths and provide a space where they may reclaim their self-worth; and collaboratively work with program participants to reframe the meaning attributed to past traumatic experiences. service providers described the practice of dismantling power differentials as one in which they convey that program participants enter the therapeutic space with a set of advances in social work, spring 2018, 18(3) 718 strengths and expertise. this practice of dismantling power differentials is thus integrally connected to the practice of affirming individuals’ strengths and providing a space to reclaim one’s self-worth. in accordance with this practice of affirming individuals’ strengths, one service provider stated: i am like the mirror. i'm just reflecting back to you what–who you are, and sometimes i might shift the mirror a little to the side, and have you see a different perspective of something, but it's still you, and that strength and that wisdom that you have within yourself that's coming through. recognizing that program participants are systematically denied access to social spaces, service providers described their role as offering a space where individuals can find the answers within themselves, and in so doing can reclaim their voice and self-worth that are silenced and denied within society at large. as program participants feel safe and empowered within the therapeutic space, they explore and reframe past traumatic experiences in collaboration with service providers. central to this process is contextualizing traumatic experiences in relation to oppressive environmental conditions: what it looks like is… starting to slowly, respectfully, question those narratives with curiosity, not defiantly, but sort of really start to explore the validity of those narratives and see if there are spaces in it where rather than taking a sort of oppression bound take on things that you can sort of insert strengths instead and say well is it that you are truly just a useless person who can't take matters into her own hands. is that really true? or is it that that has been imposed on you over the course of your entire life? how much of a choice did you really have in that matter and how much of a choice do you have now to start pushing back?...then saying maybe then you didn't have a choice to push back, but maybe now you do. mental health program participants described the cwp’s alternative practice model, and the alternative patterns of interaction that took place within that space, as promoting positive mental health outcomes. program participants who had prior experiences with mental health services described the cwp as being different from other places where they had sought services: so, my experience here in the program is that i first entered, and it wasn’t like the others. they let me talk, or it was what i was looking for. so that caught my attention, it wasn’t like the others where they say, and why did you come? no, they listened to me, they said, well, what can we talk about? or rather they didn’t demand that i talk about certain things, or about why i’m depressed, or something like that. no, with them, what do you want to begin talking about? within the context of this space where they felt the safety and freedom to explore the answers within themselves and process past traumatic experiences, program participants felt an enhanced sense of self-worth: …it has helped me a lot, it is helping me a lot, because before i was, why are these things happening to me? and i didn’t know why. but now i am understanding, seeing, that i had always blamed myself, that it must be something that i am doing carrillo & o’grady/using structural social work 719 wrong, or something like that. but with the passage of time…they are helping me to understand that things happen for some reason and that it is not always my fault. program participants also explained that as they processed past traumatic experiences and redefined how they viewed themselves, they became increasingly aware of the need to advocate for their rights within other social systems: so, the program hasn’t told me you have to do this, right, but rather in the way that they go about orienting you, you realize as a parent and as a member of the community what rights you have and what rights you don’t have. so, i have learned so much. i have learned so much about everything, that i have rights, what i am able to do. and there are many parents that don’t know that. lastly, program participants described how their personal transformation and their desire to affect change in their communities led to their involvement in community organizing initiatives. one service participant described how they became involved in community level efforts to increase latino immigrants’ access to mental health services: …i have seen a radical change that has happened in my life, so radical. so, i said that i could continue with these steps and involve myself with helping people so that they become acquainted with [these services], so that they go and can solve their problems without having a big disruption or having more serious problems… if i saw this change in myself, i think that a thousand people are going to make this change that they so desire. program participants thus identified that as they integrated new understandings of themselves and their environments, this growing sense of critical consciousness empowered them to advocate for structural change in their communities. implications implications for social work practice from a ssw perspective, the examples of the chicago worker centers and the cwp are illustrative of practice models that are situated between and span across the systemic and relational elements of mullaly’s (2007) bridge model (see figure 2 below). both practice models are informed by an understanding of how oppressive systemic and interpersonal interactions negatively impact the well-being of latino immigrants in chicago. in addition, both models have created alternative spaces that promote personal and structural transformation. at the personal level, the alternative patterns of interaction promoted within these spaces lead community members to integrate new understandings of themselves and their environments, which ultimately allows them to reclaim their selfworth. in the context of worker centers, immigrant workers are provided with a space to assert their rights in their place of employment, which in turn allows them to recover a sense of self-worth that was challenged as a result of workplace exploitation. similarly, as program participants at the cwp engage in therapeutic encounters where their strengths and expertise are affirmed and where traumatic experiences are understood in the context of structural oppression, they redefine how they see themselves. advances in social work, spring 2018, 18(3) 720 this personal transformation is connected to social justice movement work focused on transforming structural contexts. at worker centers, personal healing is connected to efforts to improve workplace conditions and advocate for labor system regulatory changes through changes in policy. at the cwp, new understandings of how individuals view themselves in relation to their environment inform new ways of interacting with their communities and social systems. as community residents advocate for their rights and become involved in community organizing initiatives, these new patterns of interaction are linked to structural transformation. not only do immigrant workers and cwp program participants become involved in structural change efforts, but the organizations themselves also challenge oppressive social systems through the infrastructure that they have developed to implement these alternative models. figure 2. the bridge model as applied to worker centers and the cwp adapted from mullaly (2007, p. 246) while the case examples highlighted in this article demonstrate the potential for alternative practice models to simultaneously promote personal and structural transformation, this is not to say that these models are free of challenges. worker center organizers are aware of the enormity of the task, given the size of their organizations compared to the industries that they are looking to challenge. the largest worker center in chicago at the time of the study only employed six organizers. their limited organizing capacity does not allow worker centers to build the economic power necessary to effectively challenge the labor sectors they are targeting. in addition, at the cwp, the mental health program has a waiting list of approximately eight months, demonstrating that the program cannot keep pace with the demand for services. although it is important to acknowledge these challenges, they should not be viewed as deterrents for creating alternative practice models. recognizing that resource limitations pose challenges to the carrillo & o’grady/using structural social work 721 scope of the intervention in each of the case examples, increased investment in the creation of alternative spaces at the local level is critical for far-reaching structural transformation. social work practitioners can play an invaluable role in advocating for the creation of these alternative spaces. furthermore, across organizational contexts, social workers can promote personal and structural transformation by integrating into their practice an understanding of the impact of the structural context on well-being and interacting with program participants in a manner that challenges oppressive systemic and interpersonal interactions. implications for social work research the presented case examples highlight the importance of conducting research with marginalized populations, including the latino immigrant population, from a ssw perspective. for the latino immigrant population in particular, there is a growing body of literature documenting the ways in which latino immigrants experience oppression within u.s. society. research that fails to take into account the oppressive structural context in which latino immigrants are situated runs the risk of pathologizing individuals, families, and communities for the challenges that they experience. in addition, research that explores how programs and organizations engage with and push back against oppressive structural contexts allows for the identification of innovative practices across realms connected to well-being. engaging in anti-oppressive practice that promotes personal and structural transformation requires research highlighting innovative strategies for achieving this aim. conclusion in this article, we have discussed the relevance of a ssw framework for understanding latino immigrants’ experiences of structural oppression. we have additionally used a ssw lens to examine how dominant ideologies inform the development of social systems that intentionally perpetuate structural oppression. finally, we presented alternative models of practice in the realms of labor and mental health that connect interventions at the personal and structural levels. these spaces contribute to personal healing by promoting alternative patterns of interaction that support latino immigrants in redefining how they see themselves and reclaiming their self-worth. at the same time, these interventions at the personal level empower community residents to become involved in advocacy and community organizing initiatives, which in turn promotes structural transformation. findings suggest that when social workers are intentional in implementing interventions that both promote personal healing and challenge oppressive social systems and underlying ideologies, their efforts to change local 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(2013). five faces of oppression. in m. adams, w. j. blumenfield, c. castañeda, h. w. hackman, m. l. peters, & x. zúñiga (eds.), readings for diversity and social justice (3rd ed., pp. 35-44). new york, ny: routledge. author note: address correspondence to: arturo carrillo, phd, lcsw, saint anthony hospital: community wellness program, 2826 w. cermak road, chicago, il 60623. email: arturocarrillojr@gmail.com _______ marietta anne barretti, dsw, is emeritus faculty, liu post, brookville, ny 11548. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 39-61, doi: 10.18060/22603 this work is licensed under a creative commons attribution 4.0 international license. same problem, different policies: a framework for examining social problem constructions over time marietta anne barretti abstract: educators teaching policy analysis can choose from many available frameworks, varying in purpose and approach. these frameworks typically advise students to view policies as transient and context-sensitive, but to view the problems activating the policies as objective and static conditions. how problems are variably framed in policy relative to how students are advised to analyze them has not captured the profession’s interest. this article presents 1) an overview of policy analysis frameworks; 2) a summary of findings from a recent study investigating how social policy texts advise students to analyze problems and; 3) a social constructionist framework (matrix) that provides an historical and contextual view of social problems and policy responses. this problem-to-policy framework corrects the omissions in most frameworks by including the forces that contributed to a problem’s discovery and construction, while also identifying periods of silence when the problem endured yet faded from view. the author argues that this framework bolsters policy practice by 1) emphasizing those problem frames and contexts that historically led to progressive policies and 2) underscores the urgency for social workers to engage with affected populations in the initial (re)claiming and (re)framing of problems, rather than during the later policy-making stages when constructions have already presaged policy responses. keywords: social problem analysis; policy analysis; social constructionism social work educators faced with the daunting task of teaching policy analysis can choose from many readily available policy analysis frameworks. these frameworks reflect varying purposes and approaches (popple & leighninger, 2015), posing a challenge for educators to assess their comparative utility. although many frameworks advise students to view policies as transient, context-sensitive, and shaped by a multitude of interests, they largely instruct students to view the social problems activating policies as fixed and objective conditions, impervious to political influences and social context (barretti, 2016). while scholars agree that the first critical step in policy analysis (pal, 2006) and in most frameworks (popple & leighninger, 2015) is defining the problem, how problems are variably framed in policy relative to how students are advised to analyze them in policy analysis frameworks has not captured the interest of social work scholars and educators (barretti, 2016). this article presents 1) a descriptive overview of policy analysis frameworks, 2) a summary of findings from a recent study (barretti, 2016) that investigated how social policy texts advise students to analyze problems in policy analysis frameworks, and 3) an alternative social constructionist framework (or matrix) that provides a historical and contextual view of social problems and strengthens their connection to resultant policies. developed by the author and taught to successive classes of undergraduate social work policy students for almost two decades, the matrix and broader midterm assignment advances in social work, spring 2019, 19(1) 40 augment current frameworks by providing a longitudinal view of social problems in their respective environments. this approach deviates from the traditional approach of treating problem definitions separately from the policy under analysis, instead examining the problem-to-policy from the vantage point of the period in which it emerged and was consequently framed and addressed. this approach challenges the prevailing view in most policy analysis frameworks that problems are objective, static conditions that should be analyzed using expert, rational methods that isolate and decontextualize them (barretti, 2016), positing instead that problem-making is as organic, discursive, and contextually messy as policy-making (chapin, 2014). perhaps most critically, when completed, the problem-to-policy matrix reveals not only the ideological and contextual forces that contribute to a problem’s construction, but also exposes periods of policy silence when the problem objectively endured yet faded from view. it includes the role of claimsmakers (best, 1995) and social movements (stakeholders that draw attention to and frame the problem), and how policies generate new problem constructions that become the subject of renewed claims (spector & kituse, 2001). finally, the author argues that using a social constructionist perspective in policy analysis bolsters the timing and efficacy of policy practice by 1) emphasizing those problem frames and contexts that historically led to progressive policies; and, 2) underscoring the urgency for social workers to engage with affected populations in the initial (re)claiming and (re)framing of problems, rather than during the later policy-making stages when established constructions have already presaged policy responses. further, adopting a discursive view of problem construction as a negotiated process empowers affected populations to more fully participate in calling attention to their needs and interests, in their own voice and language. the social constructionist perspective relegating social phenomena to the status of social problems is a complex process with a sturdy social science literature. the traditional rationalist view of social problems suggests that problems are objective social conditions that are found to be harmful to individuals or society and that affect large numbers of people (blumer, 1971). alternatively, social constructionism argues that social problems are not conditions or products, but instead interpretive and dynamic processes. accordingly, social problems are defined as “the activities of individuals or groups making assertions of grievances and claims with respect to some putative conditions” (spector & kituse, 2001, p. 75), where problems remain inseparable from their constructions (berger & luckmann, 1967). this view accounts for the fact that phenomena are not inherently problematic or troublesome, but come to be defined as such through an interactive, discursive process entailing a complex series of activities called typification, in which interested individuals and groups, known as claimsmakers engage and interact (best, 1995). creating an issue, dramatizing it, calling attention to it, and pressuring policymakers to address it are all tactics used by claimsmakers to construct a problem. as opposed to a rationalist perspective that interrogates the objective aspects of the problem such as its extent and origin and how many people it affects and how, social constructionists ask how and why some conditions obtain the status of a social problem barretti/same problem, different policies 41 and others do not, and why a particular problem emerges or reemerges at a particular point and place in time. constructionists note that what is collectively considered a social problem and what should be done about it shifts over time (spector & kituse, 2001) as troubling societal conditions are not always defined as problems and thus never get on the agenda of policymakers. additionally, social constructionism assumes a continually dynamic social context where perceptions, frames, and explanations of a given social problem change over time (best, 1995; conrad & schneider, 1980) and in turn, trigger varying and oftentimes conflicting policies. for example, best (1995) makes the case that the problem of “unwed motherhood” may be viewed and constructed as a moral problem, an educational problem, as a young woman’s lost chances, a problem stemming from a patriarchal society, baby as victim, or, in terms of exacting social costs. a scan of the policy history addressing unwed motherhood over time would arguably find policy responses corresponding with many of these varied interpretations. sociologists have analyzed various social problems and their policy responses using a social constructionist perspective, integrating the effect of historical, theoretical, and ideological forces on the ways in which social problems are understood and framed. schneider (1978) and conrad and schneider (1980) traced the construction of “drunken excess” as a sin in the puritan period through the present-day typification of “alcoholism” as a disease. they argued that although the objective nature of drunkenness has not changed much over time; this deviant behavior, once defined as immoral, sinful, and criminal now assumes medical meaning, symbolizing the decline of religious authority and the rise of the therapeutic state. edelman (1988) too points out that a range of troubling social conditions fail to achieve the status of a social problem or only achieve this status at particular times. “(s)egregated restaurants, hotels, schools and toilets in the south existed for many years without being constituted as social problems” (pp. 13-14). though not an exhaustive list, a social constructionist analysis has been applied to alcoholism (levine, 2012; mcvinney, 2004; schneider, 1978), battered women (davis, 1987), child abuse (olafson, corwin, & summit, 1993; pfohl, 1977), crime (rafter, 1990), illness and disability (brown, 1995; brzuzy, 1997; erchak & rosenfeld, 1989), delinquency (empey, hay, & stafford, 1999), homelessness (cronley, 2010; loseke, 1995), and hunger (poppendeick, 1995). though the social constructionist view has been embraced by some social work scholars (e.g., chapin, 2014; danto, 2008; dean, 1993; dybicz, 2011; laird, 1993; mildred, 2003; sahin, 2006; weick, 1992, 1993) over time, albeit unevenly, in other sectors of the professional curriculum (see barretti, 2016 for a more in-depth discussion), it has not been vigorously or consistently championed in social policy. public policy more readily embraces aspects of social constructionism and boasts an established history in the concept of framing and frame analysis (van hulst & yanow, 2016). mcbeth, jones, and shanahan (2014) identify the social construction of public policy processes as the first core assumption of their narrative policy framework, asserting that “socially constructed realities are captured within policy narratives, which are at least partially strategic and/ or rooted in belief systems” (p. 249). schneider and ingram (1993) argue that how target populations are socially constructed profoundly influences the “policy agenda, the selection of policy tools as well as the rationales that legitimate policy choices” (p. 334). schneider, ingram, and deleon (2014) further examine advances in social work, spring 2019, 19(1) 42 how these constructions “interact with political power resources to create a typology of target populations, and how policymakers respond to these different ‘types’ of target populations in their allocation of benefits and burdens” (p. 109). pierce et al. (2014) found a significant body of empirical literature incorporating schneider et al.’s (2014) propositions. though schneider and ingram’s (1993) work on the social construction of target populations is sporadically cited in social work publications (e.g., segal, 2013), social work journals were not well-represented in an extensive list of policy areas where schneider et al.’s (2014) framework was applied in scholarly works from 1993-2013. in a reference list of 5 pages and 103 peer-reviewed publications compiled by pierce et al. (2014), only one article was cited in a social work journal, administration and social work (hasenfeld, 2010), and two in an allied journal, the journal of sociology and social welfare (kissane, 2003; patterson & keefe, 2008), despite a comprehensive inclusion of policy areas of interest to social work: children, criminal justice, disability, disasters, drugs, economic reform, education, elderly, environment, health, homelessness, housing, hunger, immigration, mental illness, non-profits, poverty, race, affirmative action, welfare and women (pierce et al., 2014, pp. 132-136). judging by the paucity of social work journals represented in the authors’ reference list, social work has not yet extensively applied schneider et al.’s (2014) social constructionist framework. the exchange between social work and theoretical developments in public policy appears limited (almog-bar, weissgal, & gal, 2015). although this article is concerned with how social problems are constructed over time in policy analysis frameworks, the author qualifies that the construction of social problems cannot be disentangled from (the constructions of) the target populations affected by them. chapin (2014) alludes to the inability to separate the two when advising students to examine “the definitions of problems that laid the foundation for policy” in order to “uncover the assumptions that were made about the people the policy is designed to serve” (p. 175). a cursory scan of the social work literature over the past several years indicates some initial attention to the significance of problem framing for vulnerable populations including: the “child at risk” in social work reports (roets, roose, dewilde, & vanobbergen, 2017), child health inequality (hernandez, montana, & clarke, 2010), immigrant communities (valtonen, 2016), and citizens returning to the community after incarceration (van sluytman, torres, mcleod, & coleman, 2018). overview of policy analysis frameworks in social work pal (2006) defines policy analysis as “the disciplined application of intellect to the study of collective responses to public problems” (p. 14), and as such, a policy framework typically serves as “one of the major tools used by the policy researcher…a systematic model for examining a specific social welfare policy or a series of policies” while also guiding the analysis and evaluation of policy proposals (karger & stoesz, 2014, p. 26). many policy analysis frameworks exist both within and outside of social work. despite the fact that policy analysis is one of six major content areas frequently included in social policy-related syllabi in social work (pawar, 2004), currently, there is no agreement in social work on what a policy analysis framework should accomplish (o’connor & netting, barretti/same problem, different policies 43 2008) or on a correct (barusch, 2015) or “best” way to analyze policies (ginsburg & millercribs, 2005; haynes & mickelson, 2010). some authors contend that one framework cannot do it all, and a framework should be selected depending on the purpose of the analysis (e.g., karger & stoesz, 2014; o’connor & netting, 2008) and sometimes, the ideological orientation of the analyst (barusch, 2015). many social work scholars have categorized policy analysis frameworks. cummins, byers, and pedrick (2011, p. 229) reviewed the many policy analysis frameworks in social work and explained that they vary by the depth and breadth of their emphasis on products (the policy and its contents that result from the policy process), processes (the sociopolitical dynamics of policy formulation), outcomes or performance (the evaluation of the outcomes of an implemented policy; gilbert & terrell, 2005) and; choices and values. kanenberg (2013) instead divided them by: the rational or behavioral approach (e.g., dinitto, 2011; jansson, 2008; karger & stoesz, 2006), incremental policy analysis (e.g., van wormer, 2004), choice analysis (e.g., gilbert & terrell, 2005), the cause and consequence approach (e.g., mcinnis-dittrich, 1994), criteria or value-based analyses (e.g., chambers & wedel, 2005; gil, 1998) and feminist policy analysis (e.g., hyde, 2000; mcphail, 2003). additionally, ginsburg and miller-cribbs (2005) divided social work policy analysis frameworks into descriptive, process, evaluation, and hybrid models. policy analysis frameworks were also categorized on the basis of their conflicting ideological assumptions and worldviews (o’connor & netting, 2008). o’connor and netting (2008) divided policy analysis frameworks into three categories: rational, interpretive, and progressive (radical). the authors discovered that the rationalist view espousing that policies should be addressed by predetermined goals is so dominant that the developers of rational frameworks “have little need to explain the position on which the framework is based” (o’connor & netting, 2008, p. 169). the rationalist orientation adheres to the view that there is one objective reality that can be measured, described and analyzed (blumer, 1971), and when applied to policy-making, can be ordered into clearcut stages of formulation, implementation, and evaluation. another assumption inherent in this view is that when a readily identifiable problem emerges, policy makers will converge to address the problem rationally and come up with a “best” solution in terms of any of a number of contextual constraints (lindblom, 1980). alternatively, interpretive frameworks entail taking a political approach to the policy process. guided by metaphors and images, and focusing on context and subjective meanings, these frameworks examine pluralistic forces, such as interest groups, that compete over discourse and policy proposals (barusch, 2015). finally, radical or critical frameworks focus on the critique of social policy in serving the existing social order, using analysis as a tool for accomplishing fundamental social change; a framework for which o’connor and netting (2008) could not find evidence in the social work literature. in sum, as mentioned earlier, the researchers found that most of the frameworks investigated were rationalist, and some interpretive in their orientation. however, none of the interpretive frameworks cited in o’connor and netting’s (2008) article were located in social work texts, arguably making them less accessible to educators and students. advances in social work, spring 2019, 19(1) 44 the findings of a review (barretti, 2016) of seven of the most frequently used social work policy texts (based on largest quantity textbook orders as collected by the mbs textbook exchange, inc. from roughly 3600 bookstores across the country and in canada) (faculty center network, 2015), concurred with the previous reviews that the policy analysis frameworks found in social work policy textbooks vary in their self-identified theoretical orientation. with the exception of a small cluster of rationalist frameworks, there was otherwise no uniformity in theoretical orientation among the seven texts examined and no justification offered explaining why one author’s preferred theoretical orientation was more effective or useful than another. for example, barusch (2015) advises students to choose their own approach to policy analysis based on o’connor and netting’s (2008) typology of rational, interpretive, and critical frameworks described above. blau and abramovitz (2014) propose a social change approach based on evolutionism, cyclical theories, and historical materialism. chapin’s (2014) framework is based on the strengths perspective, reflecting a social constructionist approach. popple and leighninger (2015) identify their framework as practitioner policy analysis which may apply to specific policies or policy areas. segal (2013) offers a critical analysis model which combines deconstruction, self-reflection, and praxis or social action. also, as o’connor and netting found (2008), many frameworks explicitly urge a rational or scientific approach to policy analysis (e.g., dinitto & johnson, 2012; jansson, 2008; karger & stoesz, 2014), which views policy principally as a process of problem-solving. barretti (2016) also found that despite the many assertions by social work authors in the narrative of their textbooks that social problems are invented or constructed (barusch, 2015; popple & leighninger, 2015; segal, 2013), the majority of the authors did not transfer this perspective of the problem into the problem analysis sections of their policy analysis frameworks. problems were instead treated and analyzed as objective phenomena whose definitions do not change over time or in the policies that address them. questions comprising the objective aspects of the problem (e.g., what is the nature or cause of the problem; how widespread is it, how many people are affected by it and how, and what are the causes or theoretical explanations of the problem) were found in five of the seven frameworks (barusch, 2015; dinitto & johnson, 2012; karger & stoesz, 2014; popple & leighninger, 2015; segal, 2013). these “problem analysis” subsections within the five policy analysis frameworks above were frequently limited to a battery of questions usually placed at the beginning of the framework (e.g., dinitto & johnson, 2012; karger & stoesz, 2014) and then forgotten about until the latter stages of analysis (e.g., segal, 2013), or if sequestered in separate chapters (e.g., barusch, 2015), were fractured historically, socially, and politically from the policies that succeeded them. in short, barretti (2016) could not find evidence in the above frameworks that the problem was inextricably linked to the policy under analysis, concluding that when the framework was completed, it rendered the false impression that 1) the problem remains disparate from the resulting policy, and 2) an ideologically-driven policy is the response to an objectively-defined problem. two frameworks in barretti’s (2016) study self-identified as espousing a social constructionist perspective in the analysis of problems. the questions posed by blau and abramovitz (2014) stand in sharp contrast to the questions posed in the five other frameworks. 1) “how do social problems get constructed? 2) who gets to construct them? barretti/same problem, different policies 45 3) how does the construction of a social problem help to create a social policy that shapes what social workers do? 4) how do social policies change over time?” the authors cite specific examples where “a new definition of the problem changed both the social policy and the social work practice that it embodied” (p. 5). probably the strongest carryover of social constructionism to policy analysis was found in chapin (2014) who, early on in the narrative, establishes social constructionism’s place in the strengths perspective (p. 170) and clearly stipulates that the values, ideologies, and self-interests that shape problem definitions transfer directly into policy responses (pp. 179-182). unlike other policy textbooks, chapin (2014) makes explicit references to claimsmaking, which “connects the social problem or needs assessment and the resulting social policy” (p. 182). though the formal definition conceptualizes claimsmaking as a largely policy-making rather than problem-making activity (p. i-6), chapin’s consistent reinforcement of the need for social workers to draw attention to needs/ problems and to be claimsmakers for strengths-based policies is a significant contribution to a constructionist approach in policy analysis and policy practice. most of the seven authors in barretti’s (2016) study also advised that the expert and/ or the expert literature defines social problems (e.g., barusch, 2015; dinitto & johnson, 2012; karger & stoesz, 2014; popple & leighninger, 2015; segal, 2013), despite the fact that experts are rarely responsible for discovering social problems or for calling attention to them in such a compelling way that they garner policy attention (blumer, 1971). also, though policy text authors may advise students in the narrative of their texts to consider how the problem was defined at the point of time in which the policy was developed (e.g., barusch, 2015), to deconstruct language to understand what it means to different people (e.g., segal, 2013), and to view policies as a consequence of historical and economic events (e.g., karger & stoesz, 2014; popple & leighninger, 2015), the problem analysis sections of their policy analysis frameworks often did not incorporate these considerations. an alternative social constructionist problem analysis the problem-to-policy matrix and attending midterm assignment questions presented in figure 1 of this article were designed by the author to address the limitations of an objectivist problem analysis found within policy analysis frameworks in social work policy texts (barretti, 2016). the assignment 1) strengthens the connection between problem construction and resultant policy, 2) avoids expert, objectivist problem definitions, 3) includes the role of context and claimsmakers in problem-making, and 4) provides a continuing historical thread between the periods when problem constructions and policy responses changed. the assignment was heuristically designed to allow students to explore the forces that contribute to changing problem frames over time and then consider the efficacy of those frames for policy. the assignment is theoretically guided and inspired by berger and luckman’s (1967) work on social constructionism and the policy models of bacchi (2007) and stone (1988). bacchi (2007) contends that every problem definition is both an “interpretation and an intervention, as definitions invariably predict and predestine policy responses by how they represent what is problematic (and unproblematic through gaps and omissions) in the representation of the problem” (p. 153.) both authors contend that policy analysts must pay closer attention to problem representations (bacchi, 2007, p. advances in social work, spring 2019, 19(1) 46 21), and the “strategic representation of situations…constructed to win the most people to one side and the most leverage over one’s opponents” (stone as cited in bacchi, 2007, pp. 106-107). no mention of bacchi’s (2007) or stone’s (1988) work was evidenced in barretti’s (2016) analysis of social work policy frameworks. based on the social constructionist orientation guiding the problem-to-policy matrix and assignment in figure 1, the following questions were crafted to replace the objectivist questions found in most policy analysis frameworks: • why did the problem emerge or re-emerge at this point in time? • why did it fade at others? • how was the problem represented/ constructed at various times? • what person or group brought the problem to the public’s attention or made a claim about the issue at each point in time? • did this issue [or claimsmaker] occupy a privileged position in society or in the process? • what were the implications of the varying claims for policy in each period? strengths and limitations of the problem-to-policy matrix the reader will note the characteristics and categories of the matrix that were, as noted above, designed to address the omissions and limitations found in the objectivist problem analysis sections of many policy analysis frameworks. first, and most importantly, the matrix maintains a connection between problem frames and resultant policies. as schwartz (1969) argued for social work to adopt interventions that incorporated a case-to-cause model, integrating micro and macro so as to make them inseparable, the author similarly argues for a policy model that inextricably links problem to policy, contending that there can be no choice or division between one and the other or in this case, between problem and policy. second, unlike an objectivist problem analysis that assumes that problems are impervious to context, the matrix critically incorporates contextual forces that influence how the problem is viewed and defined. when completed, the matrix underscores at a glance that social problem constructions change in different contexts during different periods and that, upon further examination, problems assume different shapes with respect to the target population under analysis. a contextual view elucidates, for example, why the confluence of social, political, and economic forces were advantageous for the successful passage of the social security act in the 1930s, but not the 1920s, or the civil rights movement in the 1960s, but not the 1950s. it may also account for why an issue may be problematized in one setting but not in another or why one version of a problem appears in one place or among one population and may either be absent or take on other forms elsewhere or among other populations (bacchi, 2007). third, instead of ignoring time frames and viewing problems statically, the matrix provides a longitudinal view that underscores when a problem fades from policy attention and how and when a change in typification results in a change in policy. using time periods allows students to quickly ascertain when changes in frames result in changes in policy, and enables them to identify periods when the problem persisted but there was no formal barretti/same problem, different policies 47 attention to addressing it. though dividing history into general periods may lead to some bias, “the creation of generalities and to the reification of time segments” (mcvinney, 2004, p. 7), many disciplines, including social work, frequently use broad periodization when comparing competing trends or patterns in problem and policy constructions over time (e.g., davis, 1987; poppendeick, 1995). fourth, the matrix highlights what most objectivist problem analyses sections ignore; language is extremely important in establishing initial perceptions and orientations for a specific problem and for those target populations affected by that problem. in the process of interpreting and defining a problem, boundaries are set around what is believed to be the problem’s nature and important aspects, what stone (2012) refers to as “border wars waiting to happen” (p. 384), that are in turn claimed and housed within a domain of inquiry (e.g., psychology, sociology, science, medicine). domains of inquiry select the problems and aspects of problems they will own and address while implicitly or explicitly excluding others. taken together, domain-specific concepts, jargon, conceptual frameworks, and theories contribute to a certain perspective or societal view of the problem at hand. theories may be descriptive or prescriptive (hardcastle, powers, & wenocour, 2004) in providing explanations for conditions and behavior, but they not only have strong ideological components, they are ideology (kuhn, 1970). since problems are not only framed differently for different target populations, but also variably experienced by them (e.g., consider the more sympathetic view toward populations addicted to opioids now versus the view of populations addicted to crack cocaine decades earlier), the matrix allows for a specifically-affected population to remain front and center in the analysis. as noted earlier, how target populations are constructed cannot be disentangled from problem construction and policy (schneider & ingram, 1993). some examples (provided by former students) include examination of the historical constructions of and policy responses to rape and police brutality in the african american community; child (sexual) abuse in a specific latino community, bride-burning and dowry murders in rural india; deviant drinking in urban ireland, and many others. adopting the standpoint of an affected population yields a richer analysis that may include how that population was portrayed, if it was included or excluded from the claimsmaking and from the political process, and the implications of the aforementioned for resultant policies. one caveat is that literature written about or from the perspective of special populations may be harder to obtain. fifth, the assignment accentuates that over time problems are not defined by experts, but through discourse by competing claimsmakers. the attending questions in the assignment underscore the dynamic, fluid role of claimsmakers who compete to control language and problem perception, using theories and theoretical orientations to serve their political ends. political interests and mixed motives are characteristic of claimsmakers and interest groups who are seldom driven by the needs of the populations most adversely affected by the problem they are claiming and framing. framing, by its nature, “includes selecting and highlighting some features of reality while omitting others” (entman, 1991, p. 53). hence, claimsmakers use framing strategically to fashion policy debates and proposals of benefit to themselves (heike & mahoney, 2015). though the matrix cannot capture, on a micro-analytical level, the entire landscape of rising and ebbing claims and advances in social work, spring 2019, 19(1) 48 frames throughout each period, the additional claimsmaking question addresses the political dynamic. this includes how claimsmakers use theories to identify and typify who or what is to blame for the problem. since problem location implies policy location, the assignment allows students to explore the implications of problems located in the individual, family, or social structure. ideologically, conservatives prefer policies that locate the causes of social problems in individuals, while liberals and their policies place more emphasis on environmental factors (jansson, 2014, p. 48). students may discover that victim-blaming frames and policies may dominate for one period, only for the pendulum to swing back in the following period, revealing an emergence or resurgence of socially empowering frames and policies. however, conservatively oriented claims still abide in the liberally oriented periods and vice versa. the matrix provides an opportunity to consider the implications of evolving individual or structural explanations and how they entangle with ideological policy agendas. sixth, the matrix is designed to include new problems that result from policy interventions. it bears mentioning that claims do not just periodically emerge and recede but also evolve and change shape and course through multiple generations of new activities (spector & kituse, 2001). this usually occurs after initial responses to claims are deemed inadequate, and solutions then become the basis for renewed claims and demands. for example, when the initial governmental response to the early years of the aids epidemic was deemed inadequate, claimsmakers engaged in a second generation of more confrontational activities to gain public attention, research, and resources to address the problem (shilts, 1987). the final column in the matrix was added to allow for the identification of a second generation of problems (spector & kituse, 2001) resulting from the original policy, which then triggers the problem typification process anew. there are a few limitations and advisories when using the matrix. first, whenever a context is academically deconstructed into its components as in the columns of the matrix, (e.g., claimsmaking activities, theories, social and economic forces), it is not always possible to account for the intersections between components (or columns). relatedly, although the matrix uses clear dividing lines distinguishing one period’s typification from another for academic purposes, in reality there is no clear dividing line in public discourse between the beginning of one frame or public perception of a problem and another. second, as an analytical tool, the structure of the matrix imposes a false linearity on the problem-to-policy process, positioning the problem construction as always preceding the policy when history instructs that in “wag the dog” situations, the policy sometimes drives the problem construction. in these situations, stakeholders lead with the desired policy at the forefront of their claimsmaking and then work backwards to the problem construction in order to justify the policy’s implementation. for example, during the war on drugs (1986-1992), the bush administration depicted crack use as an “epidemic” or “plague” in order to escalate and reinforce law and order policies and deflect attention from the economy, despite the fact that statistics during this period actually indicated declining rates of crack use (reinarman & levine, 1995). in such cases, and if the student is so inclined, the frame/ typification column and policy response columns in the matrix can be reversed, allowing the policy to drive the analysis and the other aspects of the analysis to remain relevant and intact. barretti/same problem, different policies 49 figure 1. the problem-to-policy matrix and assignment in this assignment, the unit of analysis is a social problem. you may wish to identify a specific affected population or location to focus your analysis. you may choose a domestic or international social problem. it is recommended that you choose a specific population affected by your chosen problem, though it may be more difficult to find specific literature on this. below are some examples of recognized social problems. the list is not exhaustive. you may wish to choose an issue that is not yet commonly recognized as a problem. • aids/ hiv • crime • gambling • mental illness • human/ sex trafficking • poverty/ unemployment • homelessness • alcohol/substance abuse • incarceration • sexual harassment • hunger • environmental illness • immigration • intimate partner violence • child abuse/ child sexual abuse • elder abuse • pay equity/discrimination • rape a) the completion of the problem-to-policy matrix below will include two to three distinct periods in history (a row for each period) when the problem of your choice (re)emerged in society and was explained and addressed in some way. the matrix answers: • how was the problem constructed (framed) during each of these periods? • what claims were made and who was making them? • what prevailing social, economic and political forces were present at each period? • how was the problem explained (which theories/ explanations dominated)? • what policies or interventions were generated to address the problem during each of these periods? • what new problems did these policies generate? *b). essay on claimsmaking: choose one time period in your matrix and discuss in greater detail the claimsmakers and/ or social movements that were particularly influential in raising consciousness about the problem or advocating for a specific policy during that time period. you may wish to include some of the following bullets: • what interest(s) did these groups have in the issue; what did they hope to gain through their claims? where did they locate the problem and how did they explain it? • how was the target population depicted? what groups were included or excluded from their claims (either explicitly or implicitly)? that is, did the claimsmakers advocate equally for all sectors of the population experiencing this problem or were they selective with regard to who they represented and how they were depicted? • what was the ideological orientation of the claimsmakers? • did the claimsmakers occupy a powerful or privileged position in society (e.g., celebrities, pacs, or elected officials)? • ultimately, how successful were they in reframing the issue and gaining needed policy attention? remember that though claimsmakers are not always successful in winning the policy responses they seek, they may succeed in raising or changing public awareness. finally, as you see it, what gains and losses occurred during the period selected for those populations affected by the problem? what gains and losses were incurred in terms of changing the status of the problem in society (moving it front or back or up or down in importance)? barretti/same problem, different policies 50 table 1. problem-to-policy matrix period: identify three or more periods in time in which major shifts occurred in the definitions of the problem you are writing about. 1.____ 2.____ 3.____ frame/ typification: what was the dominant typification or name assigned to the problem during these 3 periods? 1.____ 2.____ 3.____ were there variations in the typification for people of color, the poor, immigrants, lgbt, etc.? political, social & economic context: what were the prevailing social, economic and political arrangements in society at the time? *claimsmakers policy activities: what individuals/ groups drew attention to this problem during each period? were they selfidentifiably conservative, liberal, radical, feminist? what (types of) actions did these claimsmakers take? what social movements were occurring at each time? ideological explanations/ theories: what were the prevailing ideological explanations and/ or sociological/ psychological theories supporting these typifications? where was the problem located? [individual, family, society?] policy response: what types of policies emerged as a response to the (re)constructed definition? how was the problem addressed or not addressed at each time period? [were they formal policies that had a name?] new problems: what new problems arose out of each of these policies? barretti/same problem, different policies 51 illustration: the problem-to-policy matrix applied to a social problem due to space limitations, table 2 is an abbreviated version of the matrix presented in table 1 and is intended as a starting point or thumbnail example of a social problem’s history. it provides a broad scan of the temporal nature of competing constructions of the problem and its resultant policies over time. the example lacks the third (political, social and economic context) and final (new problems) columns of table 1. (the instructor may choose to assign the simplified version of the matrix illustrated in table 2 or the more detailed option containing all seven columns. the matrix of the problem example with the two additional columns intact is available upon request.) the instructor may also choose to read aloud the narrative below before presenting table 2 to determine if students can correctly guess the problem so described: in mid-17th century america, it was considered a sin, a dishonor to god and self, and referred to as “wicked carriage.” the unofficial yet relatively effective policy for confronting it was “holy watching.” the community was held responsible for the surveillance of immoral behavior and for publicly shaming wrongdoers. in the early to mid-19th century, it was not considered a distinct social problem, but rather one of the evil consequences of alcohol. the temperance movement, which included women activists advocating for prohibition, started to champion women’s rights, including the right to divorce on the grounds of drunkenness. during the 1930s, women were held responsible for provoking it; as they were regarded as masochistic by the psychiatry movement. therapy was viewed as the solution and psychiatric social workers, in the hope of elevating their professional status, were complicit in perpetuating victim-blaming theories and therapies that resulted (pleck, 2004). it was framed as a problem of patriarchy though it went relatively unnoticed in the early years of the women’s movement until “discovered” by grassroots organizations and feminist scholars who documented and publicized the issue (fagan, 1990). in the 1990s, it was framed as a violation of a victim’s civil rights, a failure of a coordinated criminal/ community response. as a law and order issue backed by a comprehensive response from the federal government, the legislation to address the problem was deemed successful. elaboration on the problem example in table 2 as revealed by the matrix, the “it” the author refers to is wife abuse (dobash & dobash, 1979). (the author will hereinafter refer to the problem in table 2 as “wife abuse” following the argument of dobash and dobash (1979) that “(i)f the issue being addressed is violence by men against their wives or cohabitants, that should be made clear by naming it wife or woman abuse” (p. 109).) many different terms have historically been used to describe the brutalization of women by the men with whom they share an intimate relationship. though its nature and incidence have remained relatively constant from the pre-victorian era to the age of technology (gordon, 1988), through time it has changed not just its name but how it has been perceived, explained, and addressed. in colonial times, it was referred to as wicked carriage, in the nineteenth century, wife-beating, in the 1970s, battered women and shortly thereafter, the more generic term, domestic violence. presently, the problem is more commonly referred to as intimate partner violence. other terms advances in social work, spring 2019, 19(1) 52 including spousal abuse, marital abuse, and family violence have also been employed over time (gelles, 1993). critics have noted how some problem referents such as spousal abuse or domestic violence depoliticize and genderneutralize the problem, allowing it to become easily appropriated as a mental health or criminal justice problem, while avoiding addressing the “power dynamics between men and women in a sexist society” (schecter, as cited in walker, 1990, p. 85). interestingly, gordon (1988) asserts that “the modern history of family violence is not the story of changing responses to a constant problem but, in large part, of redefinition of the problem itself” (pp. 27-28). despite its persistence over time, inattention to wife abuse lasted from about 1680 to 1874, and from 1890-1960 (pleck, 2004). like any other social problem, the discovery, visibility and urgency of wife abuse as a problem fluctuated depending on the activities and interactions of groups making claims about the issue (spector & kituse, 2001) rather than on any objectively documented statistical increase or worsening conditions (gordon, 1988). religious institutions played a formidable role in influencing definitions of and responses to wife abuse in the first few periods of the matrix, only to be supplanted by the rising hegemony of psychiatry in the period thereafter. feminists from the free speech, civil rights, antiwar and gay rights movements of the 1960s transferred over to the fight for women’s political freedom, and were instrumental in rediscovering, publicizing and documenting the problem of wife abuse in the 1970s (pleck, 2004). in each period in table 2, the problem construction and the response to it reflected the predominant forces at work around the issue at that time and the images and explanations adopted by the groups, which in turn, served competing interests for the groups making claims. puritans were motivated by the desire to divinely protect their settlements from disruptive influences, and the 1870s temperance women’s motives included controlling dangerous and violent lower-class men. the battered women’s movement of the 1970s sought to express the importance of feminist ideas in addition to aiding its victims. the desire to deter and prevent crime continues to serve as one rationale for the violence against women act of 1994 and its many reauthorizations (pleck, 2004). three causal models of wife abuse supported these competing views: individual models (psychological), sociological models (sociopsychological), or social-structural models (feminist; gelles, 1993). theories that ascribe the problem to individuals can only lead either backward to a consideration of antecedents attributed to the individual or forward to solutions that can only reside in the individual (dobash & dobash, 1990). similarly, theories that locate problems in institutions will find only antecedents and solutions within these boundaries as well. for example, when wife abuse was characterized as a problem of “masochistic women and violent-prone men” in the third period, the only logical policy was therapy. when wife abuse was identified as a sociostructural problem in the 1970s, then the remedy included some institutional changes and social supports that empower women. when the problem was typified as a failure of the criminal justice system in the 1990s, then the resultant policy was to improve the overall institutional response. barretti/same problem, different policies 53 table 2. the problem-to-policy matrix applied to a social problem period frame/typification claims/claimsmakers ideology/ theory policy mid 1600s (public matter) wicked carriage a sin, dishonor to god & self, a public concern puritans & christianity the state must punish sin so god could protect community from fires, plagues, disease etc. holy watching. 1641 ma body of liberties. community responsible for surveillance, meddling, shaming mid to late 19th century evil consequence of alcohol/ public harm “wife-beating” coined in 1856 england. violated christian ideals & seen as destroying female virtue/ purity the temperance movement/ first wave of feminism christian values of obedience, modesty, purity & self-sacrifice must be preserved prohibition/ divorce on grounds of drunkenness 1853: some states punished as misdemeanor. late 1920s1940s (private matter) masochistic women & violent-prone men women have an unconscious need to be subjugated & men have an angercontrol problem freud; deutsch. psychiatric social workers seeking elevated status women have a disease & men can’t control anger. individualized & depoliticized problem. medicalization of batterer & battered. therapy (locates problem & solution in individual) mid-1960s1970s (public matter) rediscovery of problem problem of patriarchy “battered women” “domestic violence” coined in 1979. “we will not be beaten!” women are not men’s property. feminist/ battered women’s movement feminist. wife abuse is an extension of male domination/ consequence of patriarchy that permits violence against women. 1976: first state laws were passed. services established; shelter funding, improved reporting, hotlines, arrest of wife beaters, social services, transportation, legal assistance, employment, child care mid 1990s2013 a violation of a victim’s civil rights. “intimate partner violence” “domestic violence is everybody’s business & there’s no excuse for it.” the family violence prevention fund, broad coalition of advocacy groups, feminist lawyers, female legislators, male democratic senators, joe biden became major sponsors of legislation. a law & order issue. failure of a system-wide, coordinated criminal/ community response to problem. problem located in crj system response to domestic violence. violence against women act (vawa) of 1994, (2000, 2005, 2013): provided funding for battered women’s shelters, more prosecutors & training hospital personnel, special police units & judges. advances in social work, spring 2019, 19(1) 54 even in the current climate, it is clear that victim-blaming theories of wife abuse may lie dormant but are never extinct, but will reemerge, recirculate and recycle, gaining traction in policy proposals when the timing and ideological conditions are ripe. a historical view of the problem over time distinguishes those claims that were successful in empowering affected populations from those that (further) victimized them at various points in time. history arguably provides an informed starting point for change and for change agents. discussion the assignment presented in this article was developed to address the limitations of a widely prescribed objectivist problem analysis found within policy analysis frameworks in the most frequently adopted social work policy texts. objectivist criteria that fracture and decontextualize problems from the policies under analysis stubbornly prevail despite the fact that they rarely apply when society and policymakers “decide” what is and what is not a problem. if society “worked” according to the rationalist view, and only those conditions that affected significant numbers of the population and caused emotional and economic suffering were considered problems, then surely poverty would be positioned at the top of the policy agenda for attention. if objectivist criteria for problems determined policy attention, then aids would have been recognized and addressed during the earliest years of the epidemic when thousands of men died, yet the federal government did essentially nothing (shilts, 1987). “the actual size and seriousness of a problem does not determine whether public concern rises to the point of action” (chapin, 2014, p. 168). history continually instructs that the issues that make it to the policy arena are those that are the results of large social movements (blau & abramovitz, 2014) or that are constructed by influential claimsmakers (mildred, 2003) in the hierarchy of credibility (becker, 1967). when policies change over time, as they continually do, it is usually because the perception and construction of the problem has changed, not the nature of the problem itself. if not for celebrity claimsmakers with a personal stake in a disease or issue, many social causes would have fallen off the table. for example, the sexual harassment of women has only recently gained traction as a bona fide problem, thanks in part to influential actresses who piggy-backed on a movement started in 2006, but until then lacked critical visibility. sexual harassment’s emergence as a legitimate issue begs the questions posed earlier regarding what confluence of forces successfully converged at this time, but not in previous years or even in 2006 when #metoo was first started by tarana burke (garcia, 2017). thus, defying the rationalist view, the business of problem-making is as dynamic as that of policy-making, ever transitory and fugitive. the matrix and assignment presented here are intended to inspire an analysis of dynamics, where problem-making is more than just a presentation of differing ideas but more often a brutal contest of and for language. every definition, designation, diagnosis, or paradigm chosen constitutes a political act. political dynamics are starkly evident in many current debates where competing typifications lead to competing explanations, locations, and responses to the problem: wife abuse versus domestic violence; vagrancy versus homelessness; prostitution versus sex work; drunkenness versus alcoholism; partial birth abortion versus third trimester abortion; death panels versus end-of-life counseling; tax relief versus tax cuts for the wealthy; hunger barretti/same problem, different policies 55 versus food insecurity; grief versus mental illness; gambling versus gaming; enhanced interrogation versus torture; undocumented persons versus illegal aliens; chain migration versus family reunification; voter fraud versus voter suppression; inappropriate contact versus rape. since most problems “are rarely solved except in the sense that they are occasionally purged from common discourse or discussed in changed legal, social, or political terms as though they were different problems” (edelman, 1988, p. 16), social workers are wellpositioned to publicize and reframe the unpopular and intractable problems that habitually fade from view. as shoestring claimsmakers advocating for the disenfranchised, the profession’s currency lies in the power of dialogue, the conversation, the democratizing discourse that recrafts, reframes, and creates new meanings. “if indeed all policies are framed by values and beliefs reinforced by dominant groups, then we have the power to change the way issues are viewed and hence change policy” (segal, 2013, p. 72). since discourse contains “multiple and internally contradictory” claims, incorporating “elements of what it opposes and aims to replace” (cameron, 1990, p. 22), social work and by extension, the expressed power of its value base already possess the tools needed to effectively: 1) address the limits on what can be said and who can say it; and 2) replace oppressive language assigned to target populations by dominant groups with language elected by those populations to better represent their own histories, interests, and needs. the starting point for policy practice must be in meeting affected populations where they live, and engaging, assembling, and educating them in the nuances of discourse and framing so that as future claimsmakers for their own issue, they can most effectively represent their realities in their own voice. mobilization includes exploring alternative problem frames with clients, arguing their efficacy and capacity for social justice, and then considering the implications (mcphee & bronstein, 2002), that is, how policy outcomes could be different if problem constructions were different. thus, in policy practice as in policy analysis, emphasis must be placed not only on evaluating policy outcomes, but on interrogating and influencing the typifications that generated those outcomes. however, in order for students to effectively mobilize others, they first need to be armed with a range of possible problem constructions, and to distinguish previously successful claims from those that were unsuccessful or harmful. arguably, an examination of problem history positions them far better for this task than merely examining the issue’s policy history. walking policy proposals backward to the problem framing prepares students to join the debate, get out in front of (re)discovered social issues, and compete for the narrative before competitors step in, before the climate recalls and acclimates to historically-entrenched, well-worn frames that serve the status quo and resist change. a more pronounced role for our future policy practitioners in current political discourse is now more critical than ever when lies are contorted, distorted, and framed as truths, when oppressive policies are repackaged and recycled, and when timing is of the essence in gaining public recognition of ever-expanding human rights abuses promoted by those in power. never in the history of our country or perhaps our world, has it been more imperative to deconstruct and catechize issue typifications and expose insidious policy goals, propped up by pernicious theories and rhetoric that would serve the ends of those exploiting the disenfranchised. advances in social work, spring 2019, 19(1) 56 words are important. what we call things, what we consider problems and how we frame them, ultimately determines our reality and how we intervene in it. if using the problem-to-policy matrix and assignment presented in this article only serves to intensify student awareness and stir more thoughtful consideration of the impact of words and frames in our discourse, then it has fulfilled its purpose and justified its place in policy classes. references almog-bar, m., weiss-gal, i., & gal, j. 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(1993). reconstructing social work education. journal of teaching in social work, 8(1/2), 11-30. author note: address correspondence to: marietta anne barretti, emeritus faculty, liu post. e-mail: marietta.barretti@liu.edu https://doi.org/10.2307/2939044 https://doi.org/10.1177/0275074014533142 https://doi.org/10.1007/s41134-018-0070-7 mailto:marietta.barretti@liu.edu *claimsmakers _________ brian hansen, ma, recent mph graduate from the school of public health & social policy, faculty of human and social development, university of victoria, b.c. lana wells, msw, rsw, is the brenda strafford chair in the prevention of domestic violence and an associate professor in the faculty of social work and caroline claussen, phd, is a postdoctoral scholar in the department of psychology in the faculty of arts at the university of calgary, ab. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 199-216, doi: 10.18060/24458 this work is licensed under a creative commons attribution 4.0 international license. engaging men across the violence prevention continuum: an exploratory study brian hansen lana wells caroline claussen abstract: men have a role to play in the prevention of violence against women; however, there is increasing awareness that the social service sector has failed to adequately engage men in violence prevention programming and advocacy. this study used semi-structured interviews to explore the challenges that a sample of canadian violence prevention practitioners and organizations face in engaging men in preventing violence and generating practice recommendations for what is needed to better equip practitioners. at an organizational level, findings indicate that more capacity-building around emerging research, strategies, and tools in working with and engaging men in the prevention of violence is required. challenges around recruiting male staff, in what is primarily considered a female-dominated profession, were also noted. practitioners also discussed the role of masculine gender norms as barriers to men’s help-seeking and engagement in violence prevention advocacy. recommendations include expanding social work curriculum and training to include information and resources on working with men, as well as increased research on best and promising practices to support organizations and practitioners in their engagement efforts. keywords: violence prevention; men and masculinity; social work training, intimate partner violence through the highly visible movements such as #metoo and #timesup, there is increased public awareness of the prevalence of violence against women as well as the role men can play across the violence prevention continuum. this continuum spans from primary prevention, focused on the promotion of healthy and positive constructs of masculinity, through crisis intervention and re-building lives, where the focus is on working with perpetrators and supporting victims in long-term healing and well-being (flood, 2019; wolfe & jaffe, 1999). engaging men in violence prevention efforts can have positive and transformational impacts not only in the lives of women and girls, but also in the lives of men and boys by freeing them from harmful and rigid aspects of traditional masculinities (casey et al., 2013; flood, 2019; minerson et al., 2011) that reinforce violence and sexism (harvey et al., 2007; kaufman, 2001). while the “why” of engaging men across the violence prevention continuum is abundantly clear, less is known about “how” to do this work in ways that are meaningful and effective (casey et al., 2018; chovanec, 2012; donovan & griffiths, 2015; wells et al., 2015). research indicates that men are less likely than women to engage in helpseeking behaviors and/or structured social supports and services (buston, 2018; douglas & hines, 2011; drapeau et al., 2009; meyer, 2019; pfitzner et al., 2017). this tendency about:blank advances in social work, spring 2021, 21(1) 200 may explain why male recruitment for, and participation in violence prevention supports and services can be challenging (donovan & griffiths, 2015; kosberg, 2002). masculine gender norms that emphasize self-reliance, toughness, and autonomy (levant et al., 2012) have been identified as variables that negatively affect men’s decisions to engage with prevention supports and services (messing et al., 2015; meyer, 2019; shafer & wendt, 2015). nevertheless, there is increasing awareness that the social service sector has failed to develop supports and services that adequately meet the needs of men (baum, 2016; donovan & griffiths, 2015; kosberg, 2002). while there is some research examining men’s reasons for not seeking out or using violence prevention supports and services (cheung et al., 2009; donovan & griffiths, 2015; douglas & hines, 2011; machado et al., 2017; tsui, 2014; tsui et al., 2010), little research has focused on the challenges faced by social service practitioners and organizations in offering and developing gender-responsive services for men across the prevention continuum (kosberg, 2002). this paper presents findings from an exploratory study focused on understanding the challenges that a canadian sample of violence prevention practitioners and organizations face in meeting the needs of men in the area of violence prevention and intervention supports and services. potential opportunities for developing or enhancing prevention and intervention supports and services to better support men’s needs are discussed, and recommendations for social work practice, policy, and research are offered. domestic and sexual violence supports and services male perpetrators of violence while a multi-pronged approach that includes the engagement of men across the prevention continuum through the promotion of healthy and positive constructs of masculinity has been called for (flood, 2019; katz, 1995; kaufman, 2001), much of the research, services, and supports have been directed towards men as perpetrators of violence (as opposed to victims, allies, leaders, and violence disrupters) (baum, 2016; kosberg, 2002). batterer intervention programs (bips) have generally been the most developed support for helping men end abusive behaviors, with the majority of men who participate being court-mandated to do so (carter, 2010; messing et al., 2015). despite their proliferation, however, there remains varying evidence of their effectiveness (arias et al., 2013; babcook et al., 2004; feder & wilson, 2005; gondolf, 2012). research in this area hypothesizes that failure to tailor services to meet the clients’ specific needs, such as addressing substance misuse, psychological problems, or both, may influence program effectiveness (messing et al., 2015; stuart, 2005; stuart et al., 2007). research also suggests that high non-completion rates may be due to the fact that many supports and services treat men as a homogenous group, as opposed to individuals with unique issues and experiences that vary across the lifespan (lehmann & simmons, 2009; messing et al., 2015; stuart, 2005). for example, gondolf (2012) suggests that treatment may be more effective when practitioners and program participants share similarities, such as language, race, and/or ethnicity. stuart (2005) suggests that practitioners should develop a range of services that balances treatment with individual contexts and variability. hansen et al./engaging men 201 male victims of violence there has been some attention paid by scholars to how male victims of domestic and sexual violence use services and how helpful men perceive those services to be. victimization of males, however, generally continues to be overlooked (elkins et al., 2017) resulting in limited availability of supports and services (cheung et al., 2009; douglas & hines, 2011; machado et al., 2017; tsui et al., 2010). studies repeatedly show the difficulties faced by male victims in accessing domestic and sexual violence supports and services (cheung et al., 2009; douglas & hines, 2011; elkins et al., 2017; machado et al., 2017; tsui, 2014; tsui et al., 2010). in a cross-sectional study on the helpfulness of domestic violence services, male victims overwhelmingly ranked the existing services as not helpful, with those specifically offered by shelters being ranked the least helpful among all supports and services (i.e., counseling, legal, medical, helplines, services related to substance abuse, shelter, and other services; tsui, 2014). in a 2011 study conducted by douglas and hines in the u.s., findings showed that men who seek help for domestic violence victimization have the least positive experiences with service providers in the domestic violence service system. the authors recommended increased training for domestic violence system practitioners about the diversity of domestic violence victims and advocated for re-examining family violence curricula in social work education (douglas & hines, 2011). like the research on bips, there appears to be very limited research from the perspective of practitioners who do work with male victims of violence. tsui et al. (2010) conducted a study of domestic violence service organizations to understand what service providers identify as the reasons that male victims do not access social services provided by the community. findings showed that most domestic violence services targeted female clients, and there was an acknowledgement of limited appropriate services for male victims. in their qualitative study of practitioners working with male victims, hogan et al. (2012) concluded that aside from therapy, there is a lack of supports and services for male victims. the study participants were unaware of specific programs to refer their clients to, demonstrating a need for the development of more services for this population (hogan et al., 2012). as with perpetrators of violence, male victims are not a homogenous group and there is a need to develop a range of appropriate supports that recognize the heterogeneity of male victims. male allies, leaders, bystanders, and disrupters violence prevention practice has evolved from approaches tailored just for women to approaches that aim to transform relations, social norms, and systems to promote and uphold gender inequality and violence (jewkes et al., 2015). across the globe, engaging men in violence prevention work has become a priority in government and community prevention efforts (casey et al., 2013; flood, 2019; wells et al., 2015; wells & fotheringham, 2021). in many cases, these approaches work to build a critical consciousness among men about the prevalence and impact of violence against women, as well as supporting men to understand the links between the embodiment of traditional forms of masculinity, male privilege, and violence perpetration. such efforts aim to advances in social work, spring 2021, 21(1) 202 highlight the positive role men can play in addressing and disrupting other men’s abusive behavior (casey, 2010). organizations are increasingly using a variety of approaches and strategies to engage men as allies and bystanders through group education, community outreach, and community mobilization initiatives (carlson et al., 2015; wells et al., 2015; wells & fotheringham, 2021). despite this increased focus on engaging men, there is limited research on the different strategies used by organizations in their work, and on the challenges that organizations face in engaging men in violence prevention efforts (carlson et al., 2015; casey, 2010; casey et al., 2013). casey (2010) identified several challenges related to engaging men in violence prevention efforts, such as (1) using non-personalized approaches (flyers, posters, and other non-individualized invitations); (2) not identifying with the messenger (perceived identity and/or age of violence prevention messengers may impact the ability to engage men); and, (3) lack of available and accessible violence prevention groups in some communities. in their study of organizations doing this work across the globe, casey et al., (2013) found fragmented support and services and limited or narrow models for effectively engaging men in violence prevention. the authors also conclude that developing or tailoring existing services to be culturally and contextually appropriate while still meeting funding expectations of evidence and rigor can be challenging (casey et al., 2013). study purpose while the research base examining the engagement of men across the violence prevention continuum is emerging, few studies have focused on how to design appropriate programs for men or on understanding how to create organizational cultures and strategies that engage men effectively. to this end, this study examined narrative data from interviews with key representatives from the domestic and sexual violence sector in calgary, alberta to better understand these challenges and to identify possible solutions to more effectively engage and support men across the violence prevention continuum. specifically, this study aimed to (a) describe the primary challenges experienced by service providers in designing strategies and programs for men, (b) identify the organizational strategies and cultures that engage men in violence prevention work, and (c) examine the opportunities for social workers and the human services sector to better serve men across the prevention continuum. this study was approved by the university of calgary conjoint faculties research board. method in late 2017, representatives from agencies and institutions throughout the violence prevention sector in calgary, alberta approached a member of the faculty of social work explaining they were experiencing more men trying to access local domestic and sexual violence supports and services. representatives also shared that they were experiencing challenges with (a) how to design and offer programs and supports for men, (b) how to create strategies within their organizations to engage and work with men, and (c) how to curate organizational cultures that integrate men into workplaces traditionally dominated hansen et al./engaging men 203 by women. in response to this issue, shift: the project to end domestic violence launched a research project to collect information to help identify high-priority and emergent service and capacity gaps related to men’s violence prevention needs with the hope of mobilizing government and community partners to more effectively address these gaps. the first author undertook a series of interviews with key individuals working in calgary’s domestic and sexual violence sector to better understand these challenges and to identify possible solutions to more effectively support men across the violence prevention continuum (men as victims, perpetrators, allies, leaders, and violence disrupters). the interviews were designed to answer the following research questions: 1. what are the primary challenges experienced by service providers in designing strategies and programs for men? 2. what are the primary challenges experienced by service providers responding to men as clients? 3. what are examples of promising practices, emergent approaches, or identified successes in responding to men as clients? 4. what future initiatives are planned that target survivors, perpetrators, or violence disrupters who are men? an e-mail invitation was sent out to the calgary domestic violence collective – a local voluntary initiative that has over 70 partners from multiple sectors. in total, 16 individuals from 13 organizations responded to the invitation to participate. interview participants were provided with an informed consent form which was signed and returned prior to participation. participants were also provided with the interview guide in advance so that they could consider the questions in greater detail and retrieve any relevant agency data in advance of the interview. thirteen interviews with 16 individuals took place. ten interviews were conducted one-on-one, and three interviews each included two participants. interviews ranged from 25 to 55 minutes, with an average length of 40 minutes. all interviews were conducted by phone and followed the semi-structured interview guide found in table 1. interviews were audio-recorded, transcribed verbatim, and subsequently analyzed using nvivo11. the 13 organizations who participated all serve men who occupy at least one of the roles along the violence prevention continuum–perpetrators, victims, allies, leaders, and/or violence disrupters. out of 16 participants who participated in the interviews, 50% were directors (n=8, including seven directors of programs/services and one executive director), 25% were coordinators or managers (n=4, including three coordinators and one manager), and 25% were frontline staff (n=4, including two counsellors, one specialist, and one practitioner). almost all of the participants (n=12) were women. this sample is congruent with studies showing that social work as a profession is predominantly female (salsberg et al., 2017), and that the nonprofit sector overall is comprised of a female-majority workforce (ontario nonprofit network, 2018). thematic analysis was used to make sense of and interpret the data. thematic analysis is a flexible analytic method that operates independent of theory yet provides rich and detailed accounts of data (braun & clarke, 2006). for this project, the data were reviewed advances in social work, spring 2021, 21(1) 204 several times by the first two authors to gain a general understanding of the scope and contexts of the data and how they relate to the study questions (braun & clarke, 2006). following this, an initial structural coding frame was established by the first two authors. structural coding is a first cycle coding method that follows the layout of the interview questionnaire, designating question-based codes that allow data to be analyzed in relation to the question from which they were collected (namey et al., 2008). once all of the data were sufficiently coded in this manner, the first author conducted a second cycle of coding focused on developing descriptive codes that summarized the primary topic of the data excerpts (saldana, 2009). in some instances, this involved applying more than one code to a segment of data and reconfiguring codes where necessary. this resulted in a final coding frame being applied to the full dataset. at this point, the second author reviewed how the final coding frame had been applied to all of the transcripts. once coded, the dataset was analyzed for semantic themes. semantic thematic analysis looks at the “explicit or surface meanings of the data” (braun & clarke, 2006, p. 84) and aims to move beyond pure description of the data into interpretation. themes were determined based on their richness and relevance to the data and the project purposes, as well as their applicability to the dataset as a whole. the first and second author reviewed each of the themes together to ensure agreement. a report was completed and sent out to all participants to provide any clarifications on the presentation of quotes and subsequent findings. findings in the following section, findings from the interviews are presented. the section is organized according to the respective research question, with an exploration of key themes that correspond to each question. primary challenges experienced by service providers agencies in the violence prevention sector experience several challenges designing supports and services for men. overall, most organizations feel like they are doing a good job at meeting the needs of their clients, including those clients who are men; however, there was a general sentiment amongst the interview participants that there are opportunities for growth and improvement. as one individual said, their agency is focusing on “not bigger, not broader, but better,” highlighting how they intend to take the solid foundation of their service offerings and enhance them to better serve all genders. the participants did, however, highlight some of their agencies’ needs that would help serve this purpose. capacities to do this work. many of the agencies identified an ongoing need for training, saying that the violence prevention sector has typically focused on women; men are a relatively recent target for programs and services in this field. as such, there was a sense that new research, strategies, and tools are increasingly emerging and there was a desire to stay on top of these new, promising, and best practices. one participant commented: hansen et al./engaging men 205 i think just everybody should be in ongoing training so it is continuous, and especially in this kind of work where you are talking about violence. every year we should be updating our practices. so, if five years from now i am still doing the same thing i did five years ago i am in trouble; i haven’t evolved. this was affirmed by other participants, one of whom said that their staff need “specific education or tools around working with men,” while a participant from a different agency commented that, “i think that moving forwards, we are needing and wanting some more of those specific, in-depth tools to deal with some of these things.” it was not always clear from the interviews what this education or these tools may target, and one program coordinator commented that she would be curious to know “the breadth” or “option menu of how to start to meet [men’s] needs.” access to knowledge. in line with the need for capacity building, some participants highlighted their lack of access to new knowledge, particularly contemporary research related to the best practices for supporting men, as a challenge to designing services for men. most organizations hire staff whose skills are tailored to working with clients in front line roles and not necessarily to reviewing, interpreting, synthesizing, and incorporating research into programs. as one program manager said, “it is tough because i think we do the best we can and when we have male clients we try and keep up-to-date on the literature and the resources, and there are more programs popping up….” another program manager commented that: a product coming out of this [research] that we could benefit greatly from is a vetted resource list. a resource list of places we can send people where we know those people have met some kind of criteria, and the development of what that criteria should be. like what do people have to have in order to support people who need support? a similar request was made for “any information or resources or research we can get around other places who are doing similar work.” several participants commented about engaging with contemporary research or the desire to engage with evidence; however, it was evident that there is a need for support around synthesizing, disseminating, and integrating new knowledge into practice as it becomes available. engaging men in violence prevention activities. many of the participants highlighted the challenge of engaging men across the continuum of violence prevention work. there are conflicting and uncertain views amongst service providers about the best approach to engage men as clients and whether agencies need to have materials tailored for men. in some instances, service providers said that men need specific programming, messaging, materials, and approaches that have been designed to cater to men. this uncertainty around targeting men was highlighted by one program coordinator who stated: we recognize – and maybe we are wrong in this, so part of what we need to know is if our assumptions are wrong – our assumption right now is that men aren’t going to access programming in the same way our female-identified clients are. what we need to know is, we need to be able to test that assumption to say, is that advances in social work, spring 2021, 21(1) 206 in fact true? will male-identified clients access programming differently, and if so, how? what does that difference look like? in other instances, service providers stated that presenting gender-neutral messages and materials is sufficient to engage men: “i think we target men. when you look at our website it doesn’t have women on it.” although some agencies are taking purposeful action to engage men, most are unsure about the effectiveness of those actions beyond anecdotes. one participant mentioned that they are interested in better understanding: some of the longer-term engagement stuff – like how [men] come in; what keeps them there; how to know that, because of what [services] they are engaged in, they are doing better. like, some of those things are so unclear to me because it is kind of new. beyond finding useful mechanisms to disseminate information about engaging men, it would be helpful to support agencies to better evaluate and collect data about the effectiveness of their efforts so that those efforts can be enhanced or adjusted if necessary. recruiting men as staff. engaging men in violence prevention work across the continuum is about more than just the clients; effective staffing is also critical. for example, some service providers suggested that men may respond better to services delivered by men. in more than one instance, the interview participants highlighted this as a specific question they would like answered: “that is one of the questions, you know, do you really have a female running that [program] or does it need to be a man?” a number of participants reported that their agency is struggling to hire and retain men as staff. the notion of a sector dominated by women was often mentioned, and this poses problems when some service providers believe that clients who are men should be served by staff who are men. one participant stated, “can we find a man with the right qualifications because there are fewer of them in the field… and then the assumption is, whether it is true or not, that men should be working with men.” similarly, another participant said, if we were to get into programming [for men], one of the first steps that we would need to look at is bringing on a coordinator that is male-identified for any direct service work that we are doing. just the same as we have the rule that, [for] any direct service work for female-identified individuals, we have a female-identified coordinator, and i would want to have the same thing when we start to do men’s programming. the difficulty in recruiting men was further affirmed by other participants: “our shortage of male staff is not a principle-based thing, it is a circumstantial thing. a high percentage of social workers are not men.” thus, for agencies who seek to match the gender of their staff with the gender of their clients, finding qualified gender-matched service providers can be difficult. responding to diversity among men. one of the recurring challenges experienced by many agencies is their ability to respond to men who come from hansen et al./engaging men 207 diverse backgrounds, specifically racially and ethnoculturally diverse communities. this was emphasized not only by those agencies who primarily serve ethno-cultural communities, but also by agencies who serve a more general population as well. for example, one participant stated: “…we are all primarily english speakers so that rules out a whole bunch of people right there as patients and clients.” beyond language, there are cultural nuances related to the constructions of masculinity (and masculinities) in non-canadian cultures that may present challenges for service providers who lack familiarity. in one interview, for example, the participant recounted cases of a client whose experiences of victimization were linked with their role reversal when immigrating to canada, whereby the man’s wife had greater autonomy and access to financial resources. in this instance, the wife used financial control as a form of violence against the man, who experienced vulnerability from his inability to find employment upon resettlement. for organizations that do not have the language skills, cultural knowledge, or understanding of the struggles related to immigration, the ability to support ethno-culturally diverse men may be diminished. primary challenges responding to men as clients work in the violence prevention sector is complex and often involves supporting clients in crisis who have experienced, or are experiencing, trauma. the work, by nature, also places tension between individuals, evidenced in the oppositional labeling of persons as “victims” or “offenders.” service providers work with these persons as they occupy these roles, responding to their client as a victim of another, or as someone who has offended another. in this work, service providers experience challenges responding to male clients who are victims, perpetrators, allies, and violence disrupters. acknowledging trauma and the impact on practice. many practitioners and their supervisors acknowledged that the violence prevention sector has traditionally employed women to serve clients who are women and whose need for services have often been precipitated by experiences of victimization by men. as a result, some service providers may experience challenges working with men on subjects related to violence because of the inherited trauma from working with their clients who are women or, in some instances, from trauma related to their own experiences of violence. one program coordinator stated, as a woman engaged in this work, you know, most women have been impacted by violence, on some scale or another. some are further away from it than others, and being able to kind of recognize your ability to wade into this work with that and knowing what you need to do to protect yourself is huge, right? this comment is affirmed by other participants, who shared that, “it can be triggering for people working with men who are quote unquote ‘violent’ as we are a female-dominated field” and “… you often have to have worked through your own stuff a little bit otherwise you get triggered and perhaps bring stuff into the room that isn’t about the patient.” thus, people working in the violence prevention sector, and particularly those who are women, acknowledge the role that trauma plays in their own lives as service providers, thereby underpinning both the need for self-care, but also the need for reflexive practice so as to prevent that trauma from impacting the support provided to clients who are men. advances in social work, spring 2021, 21(1) 208 need for greater examination of individual biases. most of the interviews touched on the importance of recognizing, reflecting upon, and unpacking individual biases related to working with men. these biases are intimately connected to individual and inherited trauma and may present challenges for service providers who work with men as clients. a number of participants, however, highlighted how they have engaged in the personal reflexive work to unpack these biases and, in at least one instance, the participant highlighted how being given the space and support to do this reflexive work was a strength of her organization that enabled her to better support her clients. one front line provider said, i had to work on my own bias and think about, ‘what bias do i have about men?’ in case i need to work with this. i identified a couple of things you know. i am very good at connecting with women, single women, because part of my own history of domestic violence. another program manager highlighted how critical it is that service providers undertake reflexive practice, noting that: if you have not done your unlearning work around what it takes to be a man or a woman in this work you are going to do harm, so don’t do it. people don’t like hearing that, but i think it actually requires a ton of emotional labor and work for [service providers] to do this without possibly screwing shit up worse than it already is. one thing that is evident from the interviews is that many service providers felt supported in working through their biases, although how that support is manifested remains unclear. stigma related to masculine gender norms. one of the challenges service providers face in supporting men across the violence prevention continuum is addressing the stigma men experience related to their masculinities. many of the participants commented on this notion of masculine gender norms. in particular, participants discussed how men do not necessarily access services presenting with “violence” as their primary need. in some instances, men may present with other concerns or emotions, which one service provider referred to as an “iceberg” – giving the sense that what is easily apparent with men may conceal the larger, underlying body of needs. other participants discussed how men who access services may face stigma associated with exposing vulnerabilities or with failing to provide for their families, both of which may be considered traditionally emasculating. this dynamic may be connected to the shame and embarrassment that participants cited as common emotions displayed amongst clients who are men. one participant commented that, [men] are not unaware that violence is part of the package, but that is not necessarily their primary concern. i wonder if that is because it is so stigmatized to talk about violence? you know, even the men who are forced to come talk about it, they will say they are very embarrassed about this. another participant shared, “you know, my experience is that the men are far more ashamed of their own behavior than people ever give them credit for,” acknowledging the centrality of shame in men’s experiences of violence. service providers connected this hansen et al./engaging men 209 stigma, or stigmas, to men who have offended as well as to men who have been victimized. as another participant shared, i think, definitely, there is a lot of stigma around men; how are men victims of domestic violence? a lot of people still view domestic violence as something that is physical and the way the domestic violence has been portrayed in the past is as battered women, and i don’t think people really fully recognize yet that domestic violence can come in the form of financial abuse, using the kids against them, it can be emotional abuse, it can be withholding sex, there are so many different aspects that affect men that are not necessarily physical, and then yes, of course, there are physical instances as well. for service providers working with men, understanding, and having the tools to navigate stigma and attendant feelings of shame and embarrassment can be challenging. understanding how men seek services. part of engaging men in violence prevention is understanding the nuances in how men seek out and access services and the coded language men use to articulate the struggles they are experiencing. there was disagreement in the interviews, however, on the extent to which men exhibit helpseeking attitudes and behaviors related to violence. some participants mentioned that men are more inclined to ask for general help than they are to ask for a specific service or type of help. as one participant said: “they are not that specific, they really just say – the most common thing that somebody will ask me is ‘can you help me figure out why i did this?’… that is their primary question and that is what they are asking for.” another participant similarly commented, “[men] won’t state what it is they want initially… they don’t state that from the get-go.” on the other hand, one participant stated that, “[men] ask really, from their understanding, they ask for help to not do it again.” decoding men’s help-seeking language is one of the challenges providers face in determining what type of support men require. according to the majority of participants, men present for services because of a number of motivating factors, ranging from personal motivations, to being requested (with varying degrees of consequence) by partners, to being mandated by courts or social systems (e.g., child and family services). from the perspective of the interview participants, men who seek services are generally already at a place of crisis, either having offended or, as one participant said, being at a point in their relationship “where things are really tough… they want to fix a situation that has been a concern for many years or for a long period of time.” as another participant said, “often this is their last opportunity to kind of change and save their relationship.” there are men, however, who seek services preventively, or who access services to become a better ally or bystander. some participants shared accounts of men who, in seeking to become a better ally, recognize they are on the spectrum of violence as an offender or victim and thus they also experience a shift in how they understand their own experiences with violence. for some service providers, this can prove challenging as the support required by clients evolves after support has been initiated. the services accessed may no longer be appropriate and, in some cases, the agency may no longer be suitable (for advances in social work, spring 2021, 21(1) 210 example, agencies that do not take men on as clients if they have been convicted of perpetrating violence). examples of promising practices and emergent approaches leveraging informal supports. the concept of informal or natural supports was mentioned numerous times by participants as an emergent area in which they are focusing their resources and attention. many said that their programming encourages men to look at their informal contacts (friends, families, colleagues, neighbors, etc.) for further support, both while participating in services and after exiting them. for example, one provider stated that, “we often refer [clients] after individual counselling to look for their natural supports if they need further support.” some service providers are actively working to enhance informal supports by working with those supporters and building their capacity to respond to disclosures of violence, while a few agencies identified this as an area of growth that they would like to develop. creating cultures of learning. many participants commented about cultures of learning within their agencies, whether explicitly acknowledging ongoing training and education, or subtly commenting on the desire for enhanced trainings and development. in most cases, participants are eager for new information so that they can improve their own practice. one participant commented, “if you are an organization that believes that you actually don’t know everything and if there is space to be able to understand that, and to be able to recognize that, it will have impact.” by recognizing existing cultures of learning and working with this momentum, there may be greater potential to embed best and promising practices within organizations that have expressed an interest to grow in this area. discussion and implications for engaging men across the violence prevention continuum given the emerging research examining the challenges faced by violence prevention practitioners and organizations in meeting the needs of men in violence prevention programs and services, this study offers important insights for developing or enhancing services to better support the needs of men. based on the findings, we offer practice, organizational, and research implications that may impact social work education and practice. social work practitioner and organizational capacity based on interview data, it appears that capacity is a significant challenge in being able to engage men across the violence prevention continuum. practitioners pointed to the lack of education, tools, and resources in relation to working with men, a finding supported by several scholars in the social work literature (baum, 2016; douglas & hines, 2011; kosberg, 2002; shafer & wendt, 2015). expanding social work curriculum and training to include information and resources related to working with men is critical to enhancing prevention and intervention services (douglas & hines, 2011; kosberg, 2002; machado et hansen et al./engaging men 211 al., 2017). incorporating topics such as men and masculinity, stigma related to help-seeking and masculine norms (baum, 2016; cheung et al., 2009), and ways to engage effectively with men in the beginning stages of support may be particularly important in better serving men across the violence prevention continuum. supporting processes that encourage the recognition, reflection, and unpacking of individual biases in relation to serving men is critical to ensuring practitioners engage meaningfully and effectively with clients who are men. as stated by bellamy (2009), good social work practice with men not only affects individuals, but can produce positive systemic effects, given that the well-being of men is inherently connected with the wellbeing of women and children. working with practitioners to acknowledge their own trauma history and responses, as well as how their experiences contribute to biases in relation to serving men, is essential to ensuring practitioners provide services and supports that uphold the dignity and worth of each individual, regardless of gender (shafer & wendt, 2015). organizationally, capacity-building efforts should be directed at building tools, programs, and resources for supporting ethno-culturally diverse men. broader research consistently points to the fact that many programs and supports treat men as a homogenous group, as opposed to recognizing the diversity within and across groups of men (douglas & hines, 2011; hogan et al., 2012; lehmann & simmons, 2009; messing et al., 2015). our interview participants corroborate this finding, suggesting that many agencies struggle to fully support men from diverse cultures and backgrounds. examining the potential for partnerships with agencies that have expertise in serving ethno-cultural communities may be a way in which domestic and sexual violence organizations can better address the needs of men across the prevention continuum. organizational staffing and structure the social work sector has long been a field dominated by women (baum, 2016; kosberg, 2002; shafer & wendt, 2015). our findings support this view, with interview participants pointing to the challenges of recruiting men to their staff, and the desire to gender-match service providers with their clients. in addition to working with postsecondary institutions around recruitment of men to social work programs, organizations could work with other post-secondary programs that produce graduates with skills desirable for employment in the human services sector. research in engaging and supporting men leveraging informal supports to support and engage men appears to be an emerging area of work for local domestic and sexual violence organizations. this finding contributes new knowledge to the scholarly body of work around engaging men across the violence continuum. further research should be conducted to understand the work being done in the domestic and sexual violence sector that is specific to activating and leveraging informal supports for men. our findings clearly show a need and desire for current social work research on best and promising practices in relation to engaging men across the violence prevention continuum. understanding the best approach to engaging men as clients, and what advances in social work, spring 2021, 21(1) 212 resources, tools, and techniques are needed to keep them engaged was referred to by our participants. literature is starting to build in this area, as is seen in research focused on fatherhood to engage men in preventing violence (baum, 2016; dozois et al., 2016; pfitzner et al., 2017; scourfield et al., 2012); however, more work is needed to support organizations in their efforts. limitations the findings of this study are based on a relatively small, self-selected sample from one jurisdiction in canada. while our exploratory research does correspond to and support other scholarly work published in the area of engaging men in violence prevention, it would be valuable to conduct research with a broad range of domestic and sexual violence representatives from multiple jurisdictions in order to expand knowledge in this area. although the paucity of men working in this area may pose a barrier, future studies should dedicate increased effort to recruiting men working in the area of violence prevention. lastly, while our study participants did not speak specifically to the needs of sexually and gender-diverse men in relation to interpersonal violence (ipv) services and supports, we believe this to be an area where more research is needed. understanding the needs of gender and sexually diverse individuals will ensure their needs are being met and will support their engagement in violence prevention efforts. conclusion men are important stakeholders and co-beneficiaries of ending violence and, for this reason, understanding how to engage them in ways that are meaningful and effective is critically important. participants in this study identified several challenges they face as practitioners and organizations in engaging men across the violence prevention continuum. however, they also 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(1999). emerging strategies in the prevention of domestic violence. future of children, 9(3), 133-144. https://doi.org/10.2307/1602787 author note: address correspondence to caroline claussen, department of psychology, university of calgary, calgary, ab. email ccclauss@ucalgary.ca https://doi.org/10.1093/sw/swu061 https://doi.org/10.1037/0735-7028.36.3.254 https://doi.org/10.1037/0735-7028.36.3.254 https://doi.org/10.1001/jama.298.5.560 https://doi.org/10.1093/sw/swu007 https://doi.org/10.1002/jcop.20394 https://preventdomesticviolence.ca/wp-content/uploads/2017/07/goaengagingmenandboysinalbertadec2015.pdf https://preventdomesticviolence.ca/wp-content/uploads/2017/07/goaengagingmenandboysinalbertadec2015.pdf https://doi.org/10.1177%2f0020872820963430 https://doi.org/10.2307/1602787 mailto:ccclauss@ucalgary.ca capacities to do this work. many of the agencies identified an ongoing need for training, saying that the violence prevention sector has typically focused on women; men are a relatively recent target for programs and services in this field. as such, t... access to knowledge. in line with the need for capacity building, some participants highlighted their lack of access to new knowledge, particularly contemporary research related to the best practices for supporting men, as a challenge to designing ser... engaging men in violence prevention activities. many of the participants highlighted the challenge of engaging men across the continuum of violence prevention work. there are conflicting and uncertain views amongst service providers about the best app... recruiting men as staff. engaging men in violence prevention work across the continuum is about more than just the clients; effective staffing is also critical. for example, some service providers suggested that men may respond better to services deli... responding to diversity among men. one of the recurring challenges experienced by many agencies is their ability to respond to men who come from diverse backgrounds, specifically racially and ethnoculturally diverse communities. this was emphasized no... primary challenges responding to men as clients acknowledging trauma and the impact on practice. many practitioners and their supervisors acknowledged that the violence prevention sector has traditionally employed women to serve clients who are women and whose need for services have often been prec... need for greater examination of individual biases. most of the interviews touched on the importance of recognizing, reflecting upon, and unpacking individual biases related to working with men. these biases are intimately connected to individual and i... stigma related to masculine gender norms. one of the challenges service providers face in supporting men across the violence prevention continuum is addressing the stigma men experience related to their masculinities. many of the participants commente... understanding how men seek services. part of engaging men in violence prevention is understanding the nuances in how men seek out and access services and the coded language men use to articulate the struggles they are experiencing. there was disagreem... examples of promising practices and emergent approaches leveraging informal supports. the concept of informal or natural supports was mentioned numerous times by participants as an emergent area in which they are focusing their resources and attention. many said that their programming encourages men to loo... creating cultures of learning. many participants commented about cultures of learning within their agencies, whether explicitly acknowledging ongoing training and education, or subtly commenting on the desire for enhanced trainings and development. in... _____________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2020 author, vol. 20 no. 1 (spring 2020), i-iii, doi: 10.18060/24257 this work is licensed under a creative commons attribution 4.0 international license. editorial celebrating our 20th anniversary! margaret e. adamek this past year advances in social work hit its 20th anniversary! we are proud of our legacy of being one of the first, if not the first, open access journals in social work. looking back over our first 20 years, it is evident that we ramped up our productivity as a scholarly journal over time. in our first decade (2000-2009), we published 142 papers and offered 3 special issues. in our second decade (2010-2019), we more than doubled the number of papers published to 307 and tripled the number of special issues (n=10). our first decade relied on the efforts of three consecutive editors (cournoyer, daley, barton) and two guest editors (adamek, vernon). our second decade saw the addition of an assistant editor (valerie decker), an open access technical expert (ted polley), a statistical consultant (jieru bai), and the contributions of 16 guest editors. we grew from 33 reviewers evaluating manuscripts in 2000 to 189 individuals from over 100 universities and institutions in 7 countries, 1 territory, and 43 states serving as reviewers in 2019. the work of advances in social work is ably guided by our editorial board. this fall we are pleased to welcome two new editorial board members: dr. lauri goldkind from fordham university and dr. lisa zerden from the university of north carolina at chapel hill. we are looking forward to their contributions as we head into our third decade. in this issue of advances in social work we are pleased to present 10 empirical papers authored by 35 scholars who are geographically dispersed across 15 states in the u.s., washington, dc, and canada. four papers touch upon various aspects of violence prevention or intervention, two papers address social work management issues, three papers focus on diversity and/or advocacy for particular populations, and the final paper shares an efficacious approach for teaching practice skills to online students. violence prevention and intervention in an effort to learn how best to facilitate survivor-centered services, wood, clark, cook heffron, & voth schrag interviewed 25 survivors of domestic violence who received services in shelters or transitional housing programs in two states. from the survivors’ perspective, the most effective advocacy approaches emphasize safety, mutuality, and connection/collaboration. providing adequate time and space for survivors to share their stories and being available are two critical approaches that help survivors to feel supported and empowered to achieve their goals. focusing on the college population, cho, seon, choi, an, kwon, choi, hong, lee, son, & yun used survey data collected from over 3,000 students at six universities across the u.s. their analysis focused on gender differences in ipv, help-seeking, and outcomes. the analyses revealed that female students who were victims of ipv had poorer health status, higher levels of depression, and greater physical/mental health and social https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2020, 20(1) ii challenges. females also used formal help more so than males. cho and colleagues recommend that social workers provide services tailored by gender for ipv survivors. robinson, elias-lambert, casiano, & ward assessed faculty members’ perceptions of their role in the prevention of sexual violence on campus. the researchers call on social work faculty to use their unique skillset to raise awareness among their faculty colleagues about the need for bystander intervention training for all faculty in order to change cultural norms around sexual violence on university campuses. in light of the ubiquity of school bullying, yet another form of violence, karikari, brown, ashirifi, & storms examined the perspectives of various stakeholders, namely, principals, school social workers, bus drivers, and parents from an urban midwest school district. focus groups unveiled both implicit and explicit challenges associated with bullying prevention efforts. stakeholders tend to view bullying through the prism of their own experiences, and due to different positions some perspectives may not be taken into account. karikari and colleagues recommend a more open system of dialogue among different stakeholders to promote inclusion in efforts to prevent and address bullying. social work management issues another study revealing unheard voices also involved a focus group approach—in this case to document the perspectives of case managers regarding issues impacting their job satisfaction and retention. through a process of inductive coding, steen identified the suppression of case managers’ voices as a prominent theme. case managers described the suppression of their voices during decision-making in foster care cases by five types of stakeholders. based on these findings, steen calls for more inter-professional training in the foster care field so that all voices can be considered. to promote effective fund-raising and financial management, kim & lee conducted the first pilot study of crowding-out effects at 410 chinese, korean, and japaneseamerican nonprofits in new york and new jersey. using a panel analysis, they found a significant crowding-in effect for donations to east asian-american nonprofits (p < .01). the effects of government grants on private giving by each of the east asian countries were explicated based on each country’s unique social, political, and cultural background. kim & lee point out that social work managers in ethnic nonprofit organizations may need to establish different strategies to help shape donor giving patterns according to the effect of government grants. advocacy and diversity makki alamdari investigated civic attitudes and civic engagement among 145 immigrants and refugees from the middle east and north africa living in the midwest. using linear regression models, the results show that health and english language proficiency significantly predict civic attitudes among this group. attitudes also mediated between health status and level of civic engagement. promoting understanding of the civic engagement of immigrants and refugees from the middle east and north africa could possibly help to counter the negative images of muslims in the u.s. adamek/editorial iii constance-huggins, davis, & yang assessed color-blind racial attitudes and attributions of poverty among 41 bsw students and 128 msw students. in contrast to the hypothesized predictions, bsw students had fewer negative attitudes toward race and endorsed more structural causes of poverty than msw students. to ensure that social work students recognize systemic racism and its connection to poverty, the researchers recommend using an anti-oppression approach to diversity education. given the precarious nature of employment experienced by many young workers, allmang & franke used a nationally-representative longitudinal dataset to assess gender differences in precarious employment trajectories in the u.s. findings revealed significant differences by gender with higher percentages of females than males remaining in semiprecarious employment over time. these findings challenge the common assumption that young people generally move out of low-wage or otherwise “bad” jobs over time. allmang & franke call for social workers to join labor advocates in bringing attention to gendered patterns in job quality among young people. social work education jackson, colvin, bullock, & li cogently argue that as schools of social work consider teaching practice in a fully online environment, more consideration should be given to blended or hybrid learning formats for practice course delivery. the blended skills lab at the university of alabama is examined as a case study, offering implications for others to consider as they formulate alternative online models. a blended skills lab model takes full advantage of the benefits of each platform--online and face-to-face--in order to provide an educational opportunity that can promote student learning better than either platform alone. while celebrating our first 20 years, we continue to look to the future. we are grateful for the ongoing support of dean tamara davis as we endeavor to document and share emerging knowledge in the field of social work in a fully open access format. advances in social work was accepted into scopus for indexing and is fully indexed with socindex with fulltext (ebsco), social work abstracts (ebsco), and social services abstracts (proquest). as we forge ahead into our third decade, we commit to publishing the latest works from social work scholars around the world, addressing contemporary issues of the utmost importance to the communities we all serve. we look forward to bringing you upcoming issues of advances in social work highlighting interprofessional practice and education (summer 2020), gender inequity in the workforce (fall 2020), and anti-racist education (spring 2021). we welcome your suggestions for special issue topics that will help to advance social work and our causes around the globe. margaret e. adamek, editor madamek@iupui.edu mailto:madamek@iupui.edu _________ janeen cross, dsw, licsw, assistant professor, school of social work, howard university washington, dc. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 1162-1173, doi: 10.18060/25613 this work is licensed under a creative commons attribution 4.0 international license. maltreatment and nicu infants: social work’s role in promoting breastfeeding as a protective factor janeen cross abstract: child maltreatment is a concern for nicu infants who have special care needs at discharge. improving mother-infant attachment through breastfeeding in a nicu environment may reduce maltreatment for this high-risk, vulnerable population. breastfeeding an infant in the nicu is a complicated caretaking task yet provides an opportunity to overcome parenting challenges associated with a medically fragile infant by promoting the development of the maternal-infant attachment bond. breastfeeding can serve as a prevention strategy for child maltreatment by improving attachment and bonding that is oftentimes disrupted between the nicu infant and mother due to the hospitalization. social workers serve a pivotal role in preventing child maltreatment through education, promotion, and support of breastfeeding policies. this article highlights the role of social work in enhancing mother-infant attachment and advocating for nicu policies that support attachment therefore preventing maltreatment. keywords: maltreatment, nicu infants, attachment, breastfeeding child maltreatment is a public health concern (department of health and human services [dhhs], 2019). child maltreatment statistical reports do not stratify the prevalence of abuse/neglect specifically for nicu graduates. however, child maltreatment groups are identified by age with infants representing the highest risk group. the maltreatment rate for infants (under 1 year of age) is the highest in the nation at 25.3 per 1,000 (dhhs, 2019). infants also have the highest abuse fatality rate (dhhs, 2019). infants die from abuse and neglect at a rate of 21.9 per 1,000 children, which is three times the death rate for children over the age of one (dhhs, 2019). annually, child maltreatment costs in the united states (u.s.) are estimated at $80 billion (gelles & perlman, 2012). there is heightened concern for medically vulnerable and fragile infants from the newborn intensive care unit (nicu) as they are represented in the highest abuse rate and fatality group (dhhs, 2019). owora and colleagues (2016) examined the demographic and clinical characteristics of maltreated nicu graduates to understand the probability of risk. in this group of nicu graduates, 22% were admitted to the nicu for prematurity and 32% for very low birthweight (owora et al., 2016). in addition, 84% of these infants had a prolonged nicu duration and 55% had high caregiving burdens (owora et al., 2016). in terms of maternal characteristics, 32% of mothers who maltreated nicu infants were young (less than 21 years of age), 39% were first-time parents, 58% had low income (medicaid eligible), and 32% had prior histories with child protective services. maltreatment probability risk factors increase with nicu duration and caregiving burden poses the highest risk factors, regardless of parenting experience (owora et al., 2016; risch et al., 2014). both high risk infants of first-time and experienced parents have about:blank cross/maltreatment & nicu infants 1163 the highest probability of risk along with infants that have longer nicu stays. unique risk factors present parenting challenges that lead to maltreatment of nicu infants. early intervention programs focusing on parenting education and skills training are recommended in the first year of life (risch et al., 2014) along with enhanced awareness of maltreatment awareness by nicu providers (owora et al., 2016). this article adds to the knowledge base by increasing the awareness of maltreatment of nicu infants as a high-risk child maltreatment subgroup. it also highlights breastfeeding as a key area of parenting education and skills training to prevent maltreatment. breastfeeding is recommended as an intervention to enhance mother-child bonding and attachment prior to discharge improving child maltreatment outcomes. breastfeeding, as a protective factor against child maltreatment, has special implications for this population based on the context of the nicu that leads to disrupted caregiving and attachment, challenges to parental caregiving, the complexity involved in the provision of human milk to nicu infants, and lack of uniform nicu policies and standards for breastfeeding. attachment theory attachment theory promotes the development and safety of infants through maternalinfant attachment. attachment theory is integrated in this discussion to conceptualize the maternal and infant bonding process in the nicu and subsequent maltreatment outcomes. child maltreatment of nicu infants occur due to disrupted attachments that may start in the nicu environment. factors unique to the nicu environment serve to complicate parenting and thus increase infant risk. although nicu providers transfer medical care at discharge to primary care providers, infant care challenges during the nicu course may create unintentional barriers to maternal-infant bonding leading to negative parenting trajectories that persist post-discharge. for this reason, nicu providers, including social workers, need to adopt heightened awareness of child maltreatment risks during the nicu course and promote care practices that reinforce maternal-infant bonding. understanding the association between an infant’s early attachment experiences and the subsequent impact on physical, social, and emotional risks to well-being is critical. the attachment relationship between infant and caregiver is critical in determining risk and the capacity for resiliency during infancy and all stages of development. children with attachment experiences characterized by separation, loss, and inconsistent, neglectful, or abusive caregiving often find their way into the child welfare, medical, and mental health systems (applegate & shapiro, 2005). attachment involves the parent’s capacity to exercise compassion, understanding, warmth, and sympathy in response to the infant’s needs (berzoff et al., 2011). when parents are not able to mirror an infant’s emotions optimally, “misattunement” occurs potentially leading to disruption in the attachment/bonding process (schore, 2012). a mother’s “misattunement” (i.e., inappropriate responses and contradicting communications) results in a disorganized attachment (alexander, 2013). mothers who do not attune to their infant offer reduced protection to their infants, and this heightens the potential for subsequent trauma (alexander, 2013). in addition, a maternal history of advances in social work, spring 2022, 22(1) 1164 trauma and loss, helplessness, and aggressive parenting are additional risk factors for child maltreatment (alexander, 2013). the nicu setting itself can disrupt attachments for the mother and infant (lasiuk et al., 2013). it is difficult for women to learn how to provide optimal nutrition to a medically compromised infant in a stressful environment. this challenge is multiplied when the mother must physically and mentally recover from the delivery process and simultaneously adjust to the nicu setting to successfully provide her own breastmilk to her infant (hurst et al., 2013; parker et al., 2013). the position of this paper is that the provision of human milk is a maternal parenting skill that can be developed during the nicu duration. according to the centers for disease control (cdc, 2020), breastfeeding rates are increasing with 84% of women attempting to breastfeed. conversely, at 3 months and 6 months, the breastfeeding rates for women who exclusively breastfeed declines significantly to 46.9% and 25.6% respectively (cdc, 2020). the breastfeeding initiation rates for extremely premature, premature, and late preterm infants are lower than term infants at 71.3%, 76.0%, and 77.3% (chiang et al., 2019). one factor that impacts breastfeeding choices and health decision is the mother’s attachment orientation. women who initiate breastfeeding are more likely to have an attachment-approach orientation and those who do not breastfeed are more likely to have an attachment-avoidance orientation (scharfe, 2012). women with either type of attachment orientation equally cited latching, demanding infant, work, and personal health issues as challenges to breastfeeding (scharfe, 2012). women who have an approach-orientation are more likely to continue with a caregiving task (breastfeeding) while coping with interpersonal challenges (demanding infant), environmental challenges (work), and medical challenges (scharfe, 2012). subsequently, maternal attachment styles may help predict mothers who are more likely to continue caregiving tasks post discharge while coping with similar challenges. attachment style may provide an indicator for child maltreatment risk post-nicu discharge. breastfeeding can serve as a marker to assess attachment and care-giving ability in the nicu. breastfeeding serves as an in-vivo situation where mothers are supported while coping with high levels of stress and developing parenting skills. social workers play an important role in understanding the impact of attachment on caregiving outcomes. the national association of perinatal social workers (napsw, 2007) standards for social work services includes that each family with an infant in the nicu should receive social work services. in addition, social work services need to foster information-sharing that is focused on the unique stressors and family’s adaptation to the nicu environment (napsw, 2007). furthermore, nicu social work services aim to enhance parenting skills to prevent risk factors (i.e., child maltreatment, failure to thrive) associated with parental separation from the infant (napsw, 2007). the key protective factor this article asserts that breastfeeding is an important intervention that may help to prevent maltreatment of nicu infants. the provision of a mother’s own milk may improve both mother-infant interactions, enhance maternal mental health, and decrease child maltreatment (callen & pinelli, 2005). breastfeeding and the provision of human milk is a cross/maltreatment & nicu infants 1165 caregiving task that fosters attachment and bonding between the mother-infant dyad, fulfills a biological and physiological need (hurst et al., 2013), and emphasizes mutuality. in a relationship of mutuality, the mother physiologically responds to infant cues and the infant responds to physiological gratification. the strength of this intervention is its ability to provide positive reinforcement of the relationship between the mother and her infant (hurst et al., 2013). subsequently, the provision of human milk and breastfeeding strengthens mother-infant attachment. breastfeeding and parenting breastfeeding in the nicu is a challenging process for mothers and their infants (black, 2012). breastfeeding is defined as feeding at the breast and the methods used to facilitate the provision of human milk to the infant (aap, 2012). also, breastfeeding in the nicu includes the expression of human milk and the use of donor human milk (davanzo et al., 2012). the clinical instability of the nicu infant hinders the ability to achieve an adequate latch to initiate breastfeeding (black, 2012). conversely, healthy full-term infants are better able to latch onto their mother’s breast immediately after birth (black, 2012). there are also biopsychosocial challenges to breastfeeding. nicu mothers often cite stress, low milk supply (a potential byproduct of stress) and return to work as common reasons for discontinuing pumping and breastfeeding (rossman et al., 2013). there is a negative association between psychological stress and initiation of lactation, milk volume, and frequency and duration of first feeding (doulougeri et al., 2013). maternal stress postpones and compromises the establishment of breastfeeding (doulougeri et al., 2013). subsequently, the maternal protective role is altered and benefits to the child are reduced (doulougeri et al., 2013). stress and other mental health challenges can disrupt bonding through breastfeeding and ultimately attachment. through breastfeeding, nicu mothers expressed increased motivation at seeing the result of weight gain and infant stability (rossman et al., 2013). breastfeeding helps develop parenting skills, increases confidence in parenting skills, and supports maternal mental health (rossman et al., 2013). similarly, mothers in rossman and colleagues’ (2013) study expressed feelings of reward in helping their infants grow and heal. these mothers could not maintain sufficient milk volume yet continued pumping because they had faith that their infants were healing with the breast milk that they could provide. these positive infant outcomes reinforced the maternal nurturing role, supported bonding, and helped the mothers heal from the trauma of delivery (rossman et al., 2013). breastfeeding equally reinforces improved parenting behaviors while improving parenting skills. martino et al. (2015) credit maternal resiliency, commitment to a demanding pumping regimen, and overcoming hurdles as reasons for increased rates of breastfeeding when medically fragile infants are hospitalized. nicu infants may refuse the breast, present with fussy and hungry behavior, and have a weak suck response (black, 2012; callen & pinelli, 2005). to breastfeed, infants must be at the appropriate gestational age and be developmentally ready to feed and master anatomic and physiologic barriers, using muscles to coordinate sucking, swallowing, and breathing (callen & pinelli, 2005; sakalidis & geddes, 2016). they often need to advances in social work, spring 2022, 22(1) 1166 overcome the challenges of transitioning from gavage (tube) feeding to breast initiation (ziadi et al., 2016). nicu infants must correctly apply oral latching techniques and sucking patterns to successfully breastfeed and avoid nipple confusion (callen & pinelli, 2005). there are challenges to breastfeeding and providing human milk to premature infants, as they are often not able to breastfeed immediately and must learn to breastfeed when they progress to a more physiologically and medically stable level (maastrup et al., 2012). feeding at the breast for preterm nicu infants is further complicated by the medical need of infants during hospitalization. preterm infants are highly susceptible to health conditions that can impede proper breastfeeding (greene et al., 2013; sakalidis & geedes, 2016). preterm infants often have comorbidities (i.e., respiratory difficulties, infections, neurological impairments) that significantly reduce their capabilities (greene et al., 2013; maastrup et al., 2012). in addition, mechanical devices (extended intubation with nasal or tracheal devices) may lead to the development of feeding aversion in preterm infants (greene et al., 2013; sakalidis & geedes, 2016). as there are safety concerns related to premature infants, greene et al. (2013) discuss the need to explore breastfeeding methods that focus on the preparedness (i.e., weight, gestational age, oral motor skills, and feeding techniques and experience) of infants to safely feed orally. the maternal challenges in the nicu environment also complicate successful strategies for breastfeeding. the nicu environment is particularly challenging as it does not always offer privacy for mothers attempting to bond with their infants and initiate breastfeeding (castrucci et al., 2007). new mothers must bond and maintain lactation progress under the noise and stress of the nicu (brier et al., 2014). similarly, maintaining a milk supply during the postpartum period when the health and strength of the mother and infant have been compromised provides an additional physical health barrier (parker et al., 2013). strathearn et al. (2009) examined the association between breastfeeding and child maltreatment reports. they found that 60% of cases (approximately 512 children) with substantiated child abuse reports experienced at least one or more incident of maternalperpetrated abuse or neglect. an inverse relationship between maltreatment and breastfeeding duration was reported demonstrating an increase in maternal maltreatment with a decrease in breastfeeding duration (strathearn et al., 2009). in addition, nonbreastfed children were 4.8 times more likely to experience child maltreatment than children breastfed for 4 or more months (strathearn et al., 2009). maternal neglect was independently associated with breastfeeding duration and increased four-fold for nonbreastfed children compared to those breastfed for four months or longer (strathearn et al., 2009). this study supports the protective factor of breastfeeding duration as it relates to maternal maltreatment. kremer and kremer (2018) conducted a quantitative, longitudinal study examining the odds of child maltreatment by subtypes comparing adolescents who were breastfed to those who were not breastfed. the findings report that adolescents who were breastfed for 9 months or longer have reduced odds of experiencing neglect and sexual abuse (kremer & kremer, 2018). in addition, breastfeeding duration is also associated with decreased childhood neglect and sexual abuse (kremer & kremer, 2018). while breastfeeding is a cross/maltreatment & nicu infants 1167 significant consideration for examining the risk of child maltreatment, more research is needed to establish a causal relationship between breastfeeding and the reduction of maltreatment (kremer & kremer, 2018). nicu challenges postpartum depression is another concern that can compromise bonding and attachment. mothers of infants who are in the nicu are at significant risk of developing postpartum depression due to feelings of failure and guilt for having a premature infant (hynan et al., 2015; rossman et al., 2013). these mental health risks are increased for adolescent mothers (hodgkinson et al., 2014). there is an association between untreated maternal depression and diminished parenting skills, difficult maternal-infant attachment, and behavioral difficulties that develop during childhood (hodgkinson et al., 2014). breastfeeding may reduce the risk of postpartum depression and improve infant well-being (aap, 2012). breastfeeding women also have lower anxiety scores and improved confidence with interpersonal relationships (scharfe, 2012). conversely, women who do not breastfeed or who wean their infants prematurely have increased risk of postpartum depression and an increased rate of abuse and neglect of their infant (aap, 2012). implications for social work breastfeeding aligns with the core ethical values of social work (hurst et al., 2018). health equity and promotion are part of social work’s historic roots and is a core value of social work service (hurst et al., 2018). breastfeeding is a reproductive right and justice concern for all women (smith, 2018). however, there are persistent disparities in breastfeeding rates among low-income, african american women (hurst et al., 2018) therefore improving breastfeeding rates aligns with the social work value of social justice. similarly, the overrepresentation of infants in child maltreatment rates, and particularly nicu infants, present a public health disparity. the importance of human relationships is a value that is promoted through the bonding and attachment process of breastfeeding (hurst et al., 2018). the breastfeeding process provides social workers with the opportunity to exemplify the value of dignity and worth of persons through inclusion of breastfeeding practices and breastfeeding choices (hurst et al., 2018). the ethical value of competence reflects the social workers’ need to be educated and familiar with current breastfeeding recommendations and guidelines (hurst et al., 2018) and to act with integrity as it relates to honest and truthful support of breastfeeding women, especially those with substance use challenges to promote optimal recovery, (hurst et al., 2018; trainor, 2022) and advocate for maternal/infant soothing and bonding. as nicu graduates are represented in the high-risk maltreatment group, it is important that social workers understand that they can influence mother-infant attachment through breastfeeding in the nicu. lactation support models can help reinforce breastfeeding strategies and support mothers’ feeding efforts (greene et al., 2013). social workers in the nicu assess mental health needs, child maltreatment risk factors, and social support needs. they also evaluate ongoing mental health needs and provide mental health support and referrals. in addition, social workers motivate and encourage maternalinfant interaction advances in social work, spring 2022, 22(1) 1168 and bonding. by improving attachment systems between mothers and infants, social workers improve protection against child maltreatment. social workers encourage parent education and communication by scheduling regular family meetings with nicu providers and endorsing family support policies. family-centered care (fcc) is a quality-of-care model that promotes mutually beneficial partnerships between providers and families for the delivery of health care (kokorelias et al., 2019). the fcc model also encourages full parental access to infants and medical information through family-centered policies and practices (gooding et al., 2011; kokorelias et al., 2019). the fcc model urges nicu staff to partner with families and schedule infant care around the parents’ schedules to improve parental participation (gooding et al., 2011). fcc is a model of care that can help reduce a parent’s anxiety in the nicu and increase parental competence through involvement in infant care and participation in the decision-making process (croft, 2012; gooding et al., 2011). fcc is included in the recommendation for nicu staff education (hall et al., 2015). in a study of 59 nicu mothers, sheeran and colleagues (2013) found that mothers felt that their individual infant’s needs were not met based on nursing workflow and assignments in the nicu. mothers believed that they were not provided with complete, comprehensible, and consistent information about their infants, considered nicu policies and procedures restrictive, and perceived that they were often excluded from the decisionmaking process (sheeran et al., 2013). the findings from this study support that nicu nursing behaviors and lack of fcc policies can restrict the ability of parents to provide care to their infants (sheeran et al., 2013). policies are needed that promote lactation practices and remove barriers and constraints to daily activities, opportunity, and location of breastfeeding (smith, 2018). the fcc model can be used to address nicu parenting concerns and support the unique needs of parents with infants in the nicu (joint commission, 2010). family-centered developmental care (fcdc) extends fcc by involving the family as the necessary contributor of customized, developmentally supportive care of their infants (craig et al., 2015). fcdc focuses on developing long-term relationships between parents and infants through optimizing physical, cognitive, and psychosocial development and mitigates the negative impact that an infant’s illness may have on parent-infant interactions (craig et al., 2015). although it is not known how widespread fcc and fcdc policies are implemented in nicu settings, fcdc is recommended as best practice standards with accompanying competencies for interdisciplinary nicu providers (browne et al., 2020). fcdc is an interprofessional model, however, the emphasis on targeting the psychosocial needs of families in a stressful nicu environment through enhancing individual strengths (browne et al., 2020) highlights the unique role for social work. overall, fcdc policies center care around the needs of the family. fcc policies are also endorsed by the american academy of pediatrics (aap) and other health organizations as a method for standardizing practices and developing nicu environments that support attachment and bonding (aap, 2012). in addition, the fcc model of practice supports parental involvement in care rounds, which promotes their inclusion in the feedback loop and care planning (gooding et al., 2011; joint commission, cross/maltreatment & nicu infants 1169 2010). fcc initiatives also support parental needs at discharge to improve their success with caregiving tasks once the baby is discharged (gooding et al., 2011). social workers play a key role in educating nicu staff in efforts to improve maternal bonding experiences for healthy development and to reduce child maltreatment risks. nicu providers can facilitate the necessary skills and techniques to create a clinical environment that supports brain development and aids the infant’s brain wiring system (bader, 2012). skin-to-skin contact (kangaroo care), infant touch, and oral feeding experiences are recommended options that promote healthy nicu infant development (craig et al., 2015). fcc is vital in standardizing the optimization of infant development and enhancing the family’s long-term relationship with the child (craig et al., 2015). social workers can review nicu policies to address the unique environmental circumstances that compromise attachment and bonding and increase the risk of child maltreatment. in promoting mother-infant attachment, nicu policies and practices should require parenting support efforts by health care providers. health care practices should center around the needs of the maternal-infant dyad and family. similarly, opportunities for teaching parenting skills that enhance infant development and bonding can improve the health and safety of nicu infants. nicu staff must emphasize the parental role in all aspects of care to help mothers develop the necessary parenting skills and behaviors to protect and care for their nicu infant during the hospital course and post-discharge. conclusion the unique challenges of parenting and breastfeeding in the nicu provides a support opportunity to build attachment bonds. nicu mothers must be supported in overcoming the challenges of breastfeeding in the nicu environment to successfully deliver needed nutrition to their infants. mothers who overcome these challenges demonstrate improved attachment and parenting skills. opportunities are present for social workers to support new mothers facing parenting challenges in the nicu, thus creating a positive parenting interaction and outcome post-discharge. during the nicu course, maintaining the health of infants is paramount; however, from a child maltreatment perspective, it is equally important to maintain and develop babies’ attachment and bond with their mothers. emphasis on maternal-infant bonding and attachment will improve the maternal protective capacity and avoid contributing to poor parenting trajectories that increase risk for maltreatment. more research is recommended to examine child maltreatment outcomes and interventions for this vulnerable, high-risk population. it is important that nicu providers remain aware and vigilant of child maltreatment and fatality risks for nicu graduates. social workers can play a pivotal role in supporting positive parenting trajectories during the nicu course to prevent maltreatment outcomes. advances in social work, spring 2022, 22(1) 1170 references alexander, p. 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(2016). a critical review of interventions supporting transition from gavage to direct breastfeeding in hospitalized preterm infants. newborn & infant nursing reviews, 16(2), 78-91. https://doi.org/10.1053/j.nainr.2016.03.013 author note: address correspondence to janeen cross, school of social work, howard university, washington, dc, 20059. email: janeen.cross@howard.edu https://doi.org/10.1177/0890334415601093 https://doi.org/10.1177/0890334411429111 https://doi.org/10.1016/j.jnn.2013.01.006 https://doi.org/10.1177/0890334418758660 https://doi.org/10.1542/peds.2007-3546 https://doi.org/10.18060/24282 https://doi.org/10.1053/j.nainr.2016.03.013 mailto:janeen.cross@howard.edu%20e _________ allison buzard, dsw, msw, mssw, program director and associate professor of practice, college of social work, university of tennessee knoxville, knoxville, tn. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 295-316, doi: 10.18060/27152 this work is licensed under a creative commons attribution 4.0 international license. conceptualizing anti-racist social work pedagogy: practical ideas for increasing faculty capacity, reflexivity, and ability allison buzard abstract: studies have suggested that faculty in higher education lack the preparation, training, tools, and collaboration to be effective anti-racist educators. this conceptual paper presents a new framework for social work faculty to consider as they evolve their anti-racist pedagogy. the history of the priorities and professionalization of social work is explored along with the origins and theoretical influences of social work education and accreditation, the inequitable system and structure of higher education, and the racial identity, lived experience, and education of individual educators. the proposed conceptual framework centers on practical strategies for increasing faculty capacity, building faculty reflexivity, and scaffolding faculty ability for social work anti-racist pedagogy. strategies for increasing faculty capacity include professional development and training, places to process, and policy and support. strategies for building faculty reflexivity focus on applying racial consciousness, assessing values, and adopting humility. strategies for anti-racist pedagogy skills include building intentional class culture, braving collaborative learning, and banking on resistance. this paper concludes with discussions about anti-racist capacity-building for social work educators and broader implications for social work education in the united states. keywords: anti-racism, social work, social work education, pedagogy studies have suggested that faculty in higher education lack the preparation, training, tools, and collaboration to be effective anti-racist educators (diggles, 2014; kishimoto, 2018). a growing body of research indicates social work education has a similar dearth (deepak et al., 2015; haynes, 2017; hollinrake et al., 2019; olcón et al., 2020; varghese, 2016; werman et al., 2019). the 2022 council on social work education (cswe, 2022) educational policy and accreditation standards (epas) require that accredited social work programs in the united states prepare students to have the “knowledge, awareness, and skills necessary to engage in anti-racist practice” (p. 9). if social work faculty are charged with raising student anti-racist knowledge, awareness, and skills, then it is essential for social work faculty to first raise their own anti-racist knowledge, awareness, and skills. the purpose of this paper is to present a new framework with practical ideas, rooted in theory, for building faculty capacity, reflexivity, and ability in anti-racist social work pedagogy. since 1952, cswe’s accreditation competencies have ensured that social work education produces social workers across the united states with a shared knowledge base. the majority of current social work faculty in the united states have been trained with this shared knowledge base. unfortunately, the profession’s wavering history with cultural competence, multicultural, and diversity frameworks may have produced social work faculty with little or inconsistent anti-racist frameworks. findings from numerous studies and reports confirm that many social work faculty had not received adequate education about oppression, race, racism, and anti-racism, nor have many received training on how about:blank advances in social work, summer/fall 2023, 23(2) 296 to teach constructively about oppression, race, racism, and anti-racism (diggles, 2014; haynes, 2017; hollinrake et al., 2019; knowles & hawkman, 2019; nicotera & kang, 2009; olcón et al., 2020; perez, 2021; werman et al., 2019). the social work profession’s mission contains a commitment to social justice and a pledge to “strive to end discrimination, oppression, poverty, and other forms of social injustice” (national association of social workers [nasw], 2021, preamble). since the profession’s birth, social work has strived toward this mission, with good intentions that have produced some healing and some harmful impacts. as with social work clients, the social work profession exists within a social environment, and as such, the white supremacy, racism, and other injustices that are ubiquitous in the united states also exist within the social work profession (cannon yearwood et al., 2021; king-jordan & gil, 2021). glaring racial disparities, disproportionalities, and inequities persist in nearly all of the systems in which social workers practice—child welfare, criminal justice, education, gerontology, healthcare, and poverty reduction (alexander, 2010; mcghee, 2022; morris, 2018; roberts, 2022; washington, 2008). many in our society are opposed to social justice, especially racial justice and so, preparing anti-racist social workers is central to our mission of ending discrimination, oppression, poverty, and other forms of injustice. all social workers are formally trained through social work education and social work educators are central to the structure of this training. as a fellow social work educator, i believe that if we, as social work faculty, are responsible for raising student anti-racist knowledge, awareness, and skills, then it is essential for us to first raise our own so that we can achieve our mission as a profession and more, so that we can eradicate the injustice of racism. author positionality i approach the topic of anti-racist social work pedagogy from my own identities, paradigms, values, beliefs, and curiosity. i am a white social work professor who contains a number of other dominant group identities and also several oppressed group identities. my theoretical frameworks, rooted in anti-oppressive theory, critical race theory (crt), and critical whiteness studies (cws), suggest that my social positionality as a white person impacts other aspects of my identity, experiences, teaching, and research. it also causes me to pause and reflect on the tension of how i might be inappropriately centering my voice in this critical dialogue and also how i might use the platforms that my privilege extends in order to share this research. the literature, conceptual framework, and discussion contained in this paper are intended to join the voices of many social work educators who have been, are currently, and will be evolving their anti-racist pedagogy. literature review the literature reveals several historical and present-day influences on anti-racist pedagogy in social work education including: the history of the priorities and buzard/anti-racist sw pedagogy 297 professionalization of social work, the origins and theoretical influences of social work education and accreditation, the inequitable system and structure of higher education, and the racial identity, lived experience, and education of individual educators. the lack of shared knowledge about anti-racism and anti-racist pedagogy is also apparent in the literature, thus, for clarity, a glossary of applicable key terms as defined by current literature can be found in table 1. table 1. key terms and definitions key concepts embedded in this framework as defined by anti-racist thought leaders: • anti-racism: to actively work against racism and the forces of white supremacy or “supporting antiracist policy through actions or expressing antiracist ideas” (kendi, 2019, p. 13). • anti-racist pedagogy: a method of teaching, framed by critical race theory (crt) tenets, that offers an explicit exploration of race, racism, white supremacy, power, privilege, oppression, positionality, and social location to reorient consciousness, ideas, policies, and practice. anti-racist pedagogy extends beyond content and into course construction, implementation, and assessment (abrams & gibson, 2007; chew et al., n.d.; deepak, 2015; hollinrake et al., 2009; kandaswamy, 2007; kishimoto, 2018 singh, 2019; taylor et al., 2019; wagner, 2005). • race: “the socially constructed meaning attached to a variety of physical attributes including but not limited to the skin and eye color, hair texture, and bone structure of people in the united states and elsewhere” (singleton, 2015, p. 50). • racism: “racial prejudice when combined with social power – access to social, cultural, and economic resources and decision-making – leads to institutionalization of racist policies and practices” (tatum, 1997, p. 66). • white supremacy: “a set of conscious or unconscious beliefs, practices, or ideologies which support, perpetuate, or fail to challenge the social, political, historical, economic, or institutional dominance and assumed superiority of persons socially identified as white” (bryant & kolivoski, 2021, p. 485). • whiteness – “a phenomenon of being unmarked yet racially dominant” (jeffery, 2005, p. 411). “a set of social practices, systems, and values” (jeffery, 2005, p. 419). and, “in north america, the concept of whiteness is a fluid, dynamic, and situationally specific social and cultural process that positions those who are white, in terms of skin color, into a place of power and privilege” (ying yee, 2015, p. 569). history of the priorities and professionalization of social work according to the dominant narrative, the two philanthropic organizations that had the most significant influence on the development of the social work profession in the united states were charity organization societies (cos) founded by mary richmond and settlement houses most famously led by jane addams (trattner, 1994). addams and richmond, who had privilege and platforms from which to share their vision and work, dedicated their lives to exemplary service and social justice, and yet, they were not exempt advances in social work, summer/fall 2023, 23(2) 298 from the social environment in which they matured and worked (wright et al., 2021; ying yee, 2015). during the late nineteenth and early twentieth centuries, the united states experienced significant racialized movements such as the post-civil war reconstruction efforts including the premature termination of the freedman’s bureau, the rise of the jim crow era including legalized segregation, the lynching of thousands of black americans, and the great migration (equal justice initiative, 2017; wilkerson, 2010). coinciding with the emancipation of formerly enslaved black people, a boom of european immigrants arrived in the u.s., compelling those in power to attach definitions, meaning, and rights to racial identity over ethnic identity (sensoy & diangelo, 2017). all of these events perpetuated continued racial segregation in the united states and impacted all areas of industry and professionalization including the budding profession of social work (pewewardy & almeida, 2014). cos worked exclusively with impoverished white clients, believing impoverished black people to have a moral deficit (segal et al., 2019). the settlement houses initially served only white people, including white immigrants, and later, black settlement houses were organized in order to maintain a separate but equal service model reminiscent of the jim crow era in which they originated (lasch-quinn, 1993). ying yee (2015), summarizes, “both the cos movement and settlement house practices of intervention were aligned with the dominant values of society, that is, whiteness” (p. 569). origins of social work education and accreditation the quest for the professionalization of social work followed the pattern of other professions during the progressive era. the professional training for this newly established field was issued through the development of schools of social work within higher education (olson, 2007; varghese, 2016; ying yee, 2015). after the initial school of social work foundings, schools of social work arose rapidly throughout the united states. as a result of the boom, the cswe was established in 1952 with the goal of unifying social work education efforts, generating educational policy, and developing a cohesive social work education accreditation system for programs in the united states (wenocur & reisch, 2001). in response to advocacy efforts by the national association of black social workers (nabsw) and other workgroups mainly comprised of social workers of color, cswe voted in 1968 to incorporate its first diversity standards (bell, 2014; gutierrez et al., 1999). the 1980’s, 1990’s, and early 2000’s experienced cswe diversity education standards language shifting with cultural trends like multiculturalism and cultural competence (singleton, 1994; tolliver et al., 2016). since cswe’s founding, there has been substantial critique about the lack of clear stance, definitions, theoretical frameworks, and strategies for cswe diversity education standards (bell, 2014; gutierrez et al., 1999; hollinrake et al., 2019; olcón et al., 2020; ortiz & jani, 2010; tolliver et al., 2016). after the murder of george floyd in the spring of 2020, a growing mass of social workers, social work students, and social work educators joined the decades-long call for cswe to adopt clear anti-racist guidelines. buzard/anti-racist sw pedagogy 299 in response to these calls to strengthen social work preparation with explicit antiracism efforts, cswe published its newest educational policy and accreditation standards (epas) in july of 2022, which contained significant diversity guideline shifts from the 2015 guidelines which termed diversity education as “diversity and difference” (cswe, 2015) to the 2022 guidelines which address “anti-racism, diversity, equity, and inclusion (adei)” (cswe, 2022). the 2022 standards state: “social workers understand the pervasive impact of white supremacy and privilege and use their knowledge, awareness, and skills necessary to engage in anti-racist practice” (cswe, 2022, p. 10). theoretical frameworks influencing social work education and accreditation some literature suggests that social work’s early quest for professionalization and professional acceptance from the wider public may have superseded the profession’s mission of social justice and as such, social work education may have adopted a cultural competence theoretical framework rather than an anti-oppressive one (gregory, 2021; jeffery, 2005; mehrotra et al., 2018; olson, 2007). jeffery (2005) writes, “as long as social work practice is synonymous with diversity management and the development of competencies, we will remain unable to reconcile being a “good” social worker with antiracist practice” (p. 409). definitions and critiques of the varied theoretical frameworks that have informed social work education in the last 75 years are central to an analysis of the current state of anti-racist pedagogy. cultural competency and multiculturalism. cultural competence theory focuses on micro-level viewpoints and promotes the ideals of cultural awareness, tolerance, and culturally relevant interventions (abrams & moio, 2009; ortiz & jani, 2010; perez, 2021). some of the critiques of cultural competence and multiculturalism frameworks are that they are “safe” frameworks that do not explore systemic conditions of oppression, and at times, they perpetuate more biases than they interrupt (crudup et al., 2021; diggles, 2014; franco, 2020; grosland, 2011; gutierrez et al., 1999; park, 2005; pewewardy & almeida, 2014). kishimoto (2018) suggests that multiculturalism assumes that diverse groups of people exist within an equal society and fails to recognize the power and oppression that exist between those diverse groups of people, thus erasing the idea of racism. anti-oppressive theory. anti-oppressive theory exposes systems of interlocking oppressions among dominant and oppressed groups in societies. some of the central goals of anti-oppressive theory are equity, empowerment, and community, which the social work profession establishes as its core values (campbell, 2003; mehrotra et al., 2018). antioppressive theory is an umbrella theory under which many other anti-oppressive frameworks exist, such as critical race theory and critical whiteness studies. critical race theory (crt). crt was developed in the mid-1970’s as legal oppositional scholarship focused on the stalled progress of social reform on the heels of the civil rights movement (ladson-billings, 1998; taylor, 1998). social work scholars began to push for theoretical incorporation of crt into social work education in the early 2000’s (ortiz & jani, 2010; razack & jeffery, 2002). some of the key themes of crt in the literature that resonate with social work’s mission of social justice are: endemic racism, advances in social work, summer/fall 2023, 23(2) 300 the myth of meritocracy, the problem of colorblindness, the reality of intersectionality, and the importance of centering voices of color through scholarship and storytelling. endemic racism is the idea that racism is embedded in american culture as a result of structural racial hegemony and white supremacy, and that the current realities are the direct result of historical conditions (delgado & stefancic, 1993; razack & jeffery, 2002). the myth of meritocracy debunks the idea that in the united states, if one works hard enough, they can pull themselves up by their bootstrap because racism’s systemic legacy has impacted equal access and opportunity (delgado & stefancic, 1993; taylor, 1998). the problem of colorblindness denotes that humans do see racial and cultural differences and suggests that since all humans have not been treated equally by law in the united states, the idea of colorblindness perpetuates oppression (taylor, 1998). the idea of intersectionality explores the unique intersections of multiple oppressed identities, particularly how race intersects with other identities such as gender and socioeconomic status (crenshaw, 1991; delgado & stefancic, 1993; mehrotra, 2010; ortiz & jani, 2010). lastly, a key concept found in most crt research explores centering voices of color through scholarship and storytelling, affirming that lived experience is a valuable source of knowledge which challenges the idea of whiteness that positions itself as the standard or expert (abrams & moio, 2009; delgado & stefancic, 1993; hartlep, 2009; razack & jeffery, 2002; taylor, 1998). critical whiteness studies (cws). cws traces its roots to essays written in the early to mid1900’s by w.e.b. dubois and james baldwin and re-emerged as its own field of study at the turn of this century. “cws is a growing field of scholarship whose aim is to reveal the invisible structures that produce and reproduce white supremacy and privilege” (applebaum, 2016, p. 1). cws seeks to uncover the hegemony of whiteness in the united states by exposing the myth of invisibility, which posits white as “raceless” or “normal” and other racial categories as “diverse,” and the reality of white privilege; the access and opportunity that are supposed to be shared by all but are only consistently available to persons socially identified as white (beck, 2019; diangelo, 2012; jeyasingham, 2012). inequitable system and structure of higher education another key theme that emerged in the literature as a significant influence upon anti-racist pedagogy is the inequity within the system and structure of higher education itself, in which social work education exists. “all institutions are inevitably shaped by the society in which they operate, american academia was originally designed to expand the minds and the ideas of white men only, while excluding everyone else” (kingjordan & gil, 2021, p. 375). literature suggests that the design of the united states’ education system was rooted in structures and practices that replicated colonization, oppression, and white supremacy in order to maintain the power structures of dominance and oppression in the united states and that those structures and practices have been adopted as academic structure (crudup et al., 2021; kishimoto, 2018; perez, 2021). abrams and moio (2009) suggest that the inequitable power structure within higher education may be invisible to some, because racism is “ordinary and embedded, it’s structural functions affect our ways of thinking are often invisible, particularly to buzard/anti-racist sw pedagogy 301 people holding racial privilege” (p. 251). the literature suggests that the legacy of systemic racism in the united states, in higher education, and within social work education have created present-day inequities within social work education (davis & livingstone, 2016; massey & johnson, 2021; stanley & mobley, 2020). racial identity, lived experience, and education of individual educators just as the history and structure of higher education, social work education, and social work education accreditation is central to social work pedagogy, so are the racial identity and lived experiences of social work faculty. several studies indicate that faculty racial identities and personal racial identity development are significant to their ability to teach anti-racist pedagogy and content (deepak et al., 2015; haynes, 2017; perez, 2021; wagner, 2005). “the classroom is not a space outside of society, and students and teachers do not check their histories at the door when they enter it” (kandaswamy, 2007, p. 7). wagner (2005) asserts that there are benefits and drawbacks to both black, indigenous, people of color (bipoc) and white faculty teaching about anti-racism. deepak et al. (2015) echo that often in academia, white faculty members are perceived as non-credible faculty to explore issues of race because of the false belief that whiteness is not racial identity, and bipoc faculty are often perceived as “too close” to the issue of race to teach with objectivity and expertise. several studies propose that faculty of all races engage their own racial identity as part of anti-racist commitment and pedagogy (deepak et al., 2015; haynes, 2017; wagner, 2005). the history of the priorities and professionalization of social work, the origins and theoretical influences of social work education and accreditation, and the inequitable system and structure of higher education, and the racial identity, lived experience, and education of individual educators are all significant to anti-racist social work pedagogy. conceptual framework table 2. a framework for anti-racist social work pedagogy increasing faculty capacity building faculty reflexivity anti-racist skills scaffolding faculty abilities professional development & training apply racial consciousness, selfawareness, & reflection • build intentional class culture & structure • engage students authentically • elevate safety • embrace the process • establish academic legitimacy places to process assess values • brave collaborative learning • facilitate, don’t dictate • focus on narratives policy & support adopt humility • bank on resistance • expect emotions • engage difficult conversations • encourage cognitive dissonance advances in social work, summer/fall 2023, 23(2) 302 studies suggest that faculty must be equipped with knowledge, prepared with skills, and become self-aware of values to be effective anti-racist educators (deepak et al., 2015; singleton, 1994). this conceptual framework centers around increasing faculty capacity with knowledge, building reflexivity with awareness, and scaffolding faculty abilities with skills (see table 2). the goal of anti-racist social work education, according to singh (2019), is to prepare future social workers to identify and name racism, assess racial inequity, oppression, marginalization, and exclusion in society, raise consciousness of personal prejudices, stereotypes, and biases, de-center whiteness and white supremacy, and transform inequities on the micro, mezzo, and macro levels. “effective infusion of content on diversity and societal oppression requires faculty who have the knowledge, values, and skills to teach this content” (gutierrez et al., 1999, p. 418). anti-racist knowledge – increasing faculty capacity many faculty members confess that their formal terminal education coursework focused strictly on their area of discipline and scholarship and not on pedagogical strategies (funge, 2011). because of the dearth of pedagogical strategy in doctoral and master’s programs, many faculty have never been exposed to specific pedagogical lenses, including anti-racism (perez, 2021). crudup et al. (2021) implore social work educators to “learn to recognize and confront problematic ways in which we perpetuate educational models that are anti-black and center whiteness” (p. 663). sixty-six percent of social work faculty participants in the werman et al. (2019) study report being unprepared to teach a course about critical race theory (crt), and 3% have never heard of crt. several studies reveal that bipoc students are often called upon by white faculty to “be race experts” in class and argue that professors should have knowledge about race, racism, and oppression rather than rely on the emotional labor of bipoc students to inform classes from their lived experience (grosland, 2011; hollinrake et al., 2019). some faculty, depending on their own formal education, lived experience, and ongoing learning, may need to remedy a gap in their knowledge of non-eurocentric theories and ways of knowing as well as social work and united states history (cannon yearwood et al., 2021; wright et al., 2021). wright et al. (2021) advocates for social work faculty to critically analyze the behaviors of the pillars of social work that the profession holds up such as jane addams, mary richmond, and their respective organizations and instead, hold up practitioners and organizations who have evidenced anti-racist practices such as w.e.b. dubois, birdye henrietta hanes, the urban league, and the national association of black social workers (nabsw). if the majority of current social work faculty in the united states studied within the cultural competence era of social work education, then many social work educators may need to build their anti-racism knowledge-base through professional development and training, through intentional conversations with colleagues, and with organizational and policy supports. professional training the need and desire for ongoing, relevant, anti-racist pedagogy-specific training for social work faculty is evident in the literature (perez, 2021). professional development buzard/anti-racist sw pedagogy 303 training topics that can foster anti-racist pedagogy are: classroom conflict management, identifying microaggressions, establishing effective community agreements, group processes and dynamics, race impacts on group processes and dynamics, and racial identity development models (abrams & moio, 2009; deepak et al., 2015; hollinrake et al., 2019; singleton, 2015; wagner, 2005). professional training can take place at conferences, in virtual or in-person workshops, through articles, books, podcasts, and through intentional mentoring. places to process effective professional development does not always take place in formal trainings, nor through established protocols. some of the most effective professional development for adults takes place through discussion, debriefing, and brainstorming. faculty collaboration, support, and mutual aid are needed for increasing the capacity of anti-racist teaching to process the challenges of teaching complex ideas in complex ways (abrams & gibson, 2007; funge, 2011; garran et al., 2014). processing can happen through formally established curriculum mapping processes, staff meetings, book studies, and through informal discussions in hallways. it can take place within departments or schools, and it can also take place across schools of social work and disciplines through virtual groups (garran et al., 2014; gutierrez et al., 1999). policy and support in addition to professional development and places to process, the literature is clear that faculty need institutional support and structures to increase their anti-racist knowledge capacity. many of the structures, traditions, and norms within higher education’s systems and structures, which king-jordan and gil (2021) suggest are rooted in white supremacy, such as faculty rank, tenure track, and academic freedom, inhibit faculty’s engagement with anti-racism content and pedagogy (haynes, 2017). higher education’s reliance on student evaluations to measure professor’s rank is a barrier for anti-racist pedagogy— particularly for bipoc faculty and faculty from other marginalized identities who are more likely to be assigned to teach courses with explicit content on race and racism (abrams & moio, 2009; funge, 2011; gutierrez et al., 1999; haynes, 2017; kishimoto, 2018; singleton, 1994; werman et al., 2019). these studies indicate that students are more likely to rate faculty of color less favorably; particularly when those faculty teach about race and racism which can negatively affect the career trajectories of faculty of color. institutional policies and support for anti-racist pedagogy include intentional hiring practices, faculty support, course assignments, funding and support for professional development, and annual evaluations. anti-racist awareness – building faculty reflexivity several studies indicate that one of the central reasons that race, racism, and oppression are omitted from some social work curricula is faculty discomfort with the issues themselves (loya, 2011; perez, 2021; singleton, 1994). laszloffy and hardy (as cited in advances in social work, summer/fall 2023, 23(2) 304 diggles, 2014) define racial awareness as “a person’s ability to recognize that race exists and that it shapes realities in inequitable and unjust ways” (p. 32). haynes (2017) observes that faculty with low racial identity awareness view race as “bad” or uncomfortable. franco (2020) and perez (2021) note that faculty with high racial identity awareness practice racial consciousness through self-exploration of their own social location and biases. according to several studies, cultivating the anti-racist self is the prerequisite to building an anti-racist pedagogy (chew et al., n.d.; haynes, 2017; nicotera & kang, 2009). social work faculty often ask students to practice the skills of reflectivity and reflexivity throughout their social work studies. “reflexivity refers to the process of locating the self in relation to the community serviced, while reflectivity engages the individual in critical thinking about one’s practice” (franco, 2020, p. 528). massey and johnson (2021) suggest that faculty practice their own anti-racist reflectivity and reflexivity before asking students to engage in anti-racist reflectivity and reflexivity. apply racial consciousness, self-awareness, and reflection an anti-racist framework invites individuals to explore their positionality, socialization, and society, and anti-racist teaching invites faculty to explore the ways that their own identities impact their classrooms, research, and university work (deepak et al., 2015; kishimoto, 2018). some faculty use the many racial identity development models established by cross, helms, sue, and others for their own self-awareness (massey & johnson, 2021; tatum, 1997). “anti-racist pedagogy is not a ready-made product that professors can simply apply to their courses, but rather it is a process that begins with faculty as individuals” (kishimoto, 2018, p. 543). massey and johnson (2021) posit that racial identity development and an understanding of racial identity within the socio-historical realm, particularly for white faculty, is instrumental to anti-racist pedagogy. haynes’ (2017) research suggests that racial identity formation and racial consciousness-raising often occur simultaneously. nicotera and kang (2009) describe this reflectivity and reflexivity as doing “heart work” (p. 192). according to deepak et al. (2015), faculty can engage in this heart work by exploring how their identities, biases, triggers, self-doubts, anxiety, desire for competence, and need for student approval intersect with the institution and students. chew et al. (n.d.) suggest that self-reflection begins with asking questions such as: “am i ready to engage in uncomfortable work?” “have i engaged in my own independent learning?” “am i open to facilitating rather than lecturing? how have i prepared for managing challenging classroom dynamics?” (pp. 11-13). assess values value assessment is another valuable reflexive practice for faculty. singleton (1994) suggests that faculty members’ personal values and views on racial oppression impact the volume and quality of their teaching on the subject. when a faculty member believes an issue is beneficial to student education, they teach the subject often and well (singleton, 1994). mehrorta et al. (2018) lament more broadly that the social work profession has minimized its value of social justice in the quest for the validation of professionalization. buzard/anti-racist sw pedagogy 305 if social work has lost its focus on the value of social justice, social work education may need to reckon with its accreditation standards, textbooks, and curriculum in order to align with a social justice focus on anti-racism. the values of the profession impact the values of social work education which impacts both students and faculty members. adopt humility one of the final pieces to building faculty reflexivity is that of adopting humility. academic culture elevates hierarchy, expertise, and objectivity, while anti-racist culture depends upon humility (crudup et al., 2021; kishimoto, 2018; perez, 2021). chew et al. (n.d.) suggest that faculty practicing anti-racist teaching practices may need to actively monitor their own sense of expertise, accept a growth mindset, be teachable, and be willing to admit mistakes to students. kishimoto (2018) counsels that faculty anti-racist awareness requires a continuous, lifelong commitment to self-reflection, and vulnerability which are the hallmarks of cultural humility (tervalon & murray-garcia, 1998). anti-racist skills – scaffolding faculty ability while some studies show gaps in social work faculty’s anti-racist knowledge and awareness, more studies indicated that many social work educators lacked anti-racist pedagogical skills. study findings suggest that terminal educational programs often lack sufficient faculty preparation and teaching methods, including anti-racist teaching methods (abrams & moio, 2009; deepak, 2015; funge, 2011; garran et al., 2014; gutierrez et al., 1999; perez, 2021). perhaps as a result of the lack of formal preparation, numerous studies reveal that social work faculty report being uncomfortable and feeling unprepared to facilitate conversations about race, racism, anti-racism, and white supremacy (abrams & gibson, 2007; abrams & moio, 2009; davis & livingstone, 2016; deepak et al., 2015; haynes, 2017; loya, 2011; olcon et al., 2019; perez, 2021; singleton, 1994; varghese, 2016). according to findings from the werman et al. (2019) study, faculty report great openness to receive more training about how to facilitate effective classroom conversations about oppression, racism, and anti-racism. hollinrake and colleagues’ (2019) qualitative study of social work students’ experiences in the academy reveal that many bipoc students want faculty to address and challenge oppressive and problematic classroom dynamics that they report are typically perpetuated by white students. werman et al. (2019) confirm this idea, reporting that social work students lack confidence in faculties’ abilities to lead difficult conversations about oppression, racism, and other “isms.” kishimoto (2018) suggests that social work faculty need to build skills to effectively facilitate anti-racist discussions, including practicing decentering dominant narratives. according to a recent cswe (2020) report, statistically speaking, that implies that many social work faculty require skills in decentering their own voice at times. hollinrake et al. (2019) agrees, suggesting that some white social work faculty may need specific training to address white guilt, shame, fragility, and conflict in themselves and their students. studies reveal that when faculty lack the skills to manage conflict and address oppressive classroom dynamics, they often put student safety at risk, especially students from marginalized identities (haynes, 2017; kandaswamy, 2007; advances in social work, summer/fall 2023, 23(2) 306 wagner, 2005). some anti-racist pedagogical skills that emerged in the literature centered around building intentional class culture and structure, braving collaborative learning, and banking on resistance. build intentional class culture and structure according to scholars, building intentional classroom culture and structure is an essential component of anti-racist pedagogy (hollinrake et al., 2019; phan et al., 2009; wagner, 2005; werman et al., 2019). to construct an anti-racist course structure, faculty can start by exploring how eurocentricity, ethnocentricity, and power, all structures found in the inequitable system and structure of higher education, might exist in their course design and instead, faculty can design their courses through anti-oppressive theoretical frameworks (kandaswamy, 2007; kishimoto, 2018; okun, n.d; singh, 2019; taylor et al., 2019; wagner, 2005). according to scholars, anti-racist course design is rich with learning activities, storytelling, discussion, and experiences outside of the classroom (diggles, 2014; hollinrake et al., 2019; kishimoto, 2018; phan et al., 2009). the literature contains many ideas for how faculty can build intentional class culture and structure and several key themes emerged repeatedly, which were: engage students authentically, elevate safety, embrace the process, and establish academic legitimacy. engage students authentically. bolstering faculty knowledge of students, their identities, and how those identities may intersect in a classroom is a major step to building intentional class culture and structure (chew et al., n.d.). establishing community culture through norms or agreements is another essential anti-racist pedagogical strategy (hollinrake et al., 2019; phan et al., 2009; singleton, 2015; wagner, 2005; werman et al., 2019). chew et al. (n.d.) suggest adopting and publishing communication guidelines that help to hold class members accountable to class norms and agreements such as: “name the discomfort; your impact is everything, keep a learner’s mindset, use sound [academic] arguments, use appropriate language, and make all voices heard” (p. 20). taylor et al. (2019) suggest that the syllabus can be an intentional centerpiece to class culture with intentional language, strategic course objectives, and insightful assessments. wagner (2005) and chew et al. (n.d.) encourage faculty to foster student success by setting clear course intentions and naming that which may be difficult for both students and faculty at the outset of the course. elevate safety. safety is a critical consideration to intentional anti-racist class culture and structure. several studies appeal for faculty to create safety in the classroom, while other studies also caution that the idea of “safety” is complicated within anti-racist teaching; especially when students from oppressed and privileged racial groups are learning together (chew et al., n.d.; nicotera & kang, 2009). wagner (2005) suggests that faculty ask the question: “safe for whom?” as they are establishing the idea of emotional safety in the classroom. anti-racist pedagogy recognizes that discomfort for students in privileged racial groups is not a safety issue. lack of class norms, structures, and boundaries that put the burden of racial education on students from marginalized racial identities, however, is a safety issue (hollinrake et al., 2019). wagner (2005) pushes faculty to explicitly explore these dynamics with students and contract together for a “safer space” for the class buzard/anti-racist sw pedagogy 307 community. phan et al. (2009) explore this idea with different terminology, calling for faculty to note the tension between an academic space, a safe space, and a transformational space. faculty create and hold transformational space when fostering “openness, approachability, fairness, and safety” in the classroom (p. 328). embrace the process. anti-racist pedagogy is a unique reflexive and transformational approach that runs counter to the larger academic culture and society that values objectives, goals, and outcomes resonant with eurocentric ideals. wagner (2005) suggests that the process of learning and unlearning that happens within an anti-racist framework is the most essential learning that can occur within classrooms. gutierrez et al. (1999) assert that deep learning and growth occur with a shift from learning information to personal transformation and taylor et al. (2019) recommend that teaching students to adopt a growth mindset versus a fixed mindset, which can help orient students to the process of learning. establish academic legitimacy. because anti-racist pedagogy stands in contrast to traditional western ideologies, establishing that anti-racism is an academic field of study and a theoretical approach is critical for student learning (diggles, 2014; phan et al., 2009). critics of anti-racism seek to invalidate its legitimacy claiming that the subject is political, subjective, and biased (wagner, 2005). faculty can establish academic legitimacy by rooting learning in theory, history, and many perspectives (sensoy & diangelo, 2017). the materials selected for courses are a significant part of anti-racist curriculum design, and faculty can carefully consider the central and supplemental texts they assign while exploring the social location and perspectives of the authors (abrams & gibson, 2007; chew et al., n.d.; diggles, 2014; kishimoto, 2018). brave collaborative learning learning in an anti-racist classroom is a collaborative process. anti-racist educators believe that students and educators teach and learn from one another. mutual learning is countercultural to western education methods and anti-racist educators can learn skills that can help them implement this countercultural strategy, such as: facilitate rather than dictate and focus on centering often marginalized narratives, and de-center often dominant narratives. facilitate, don’t dictate. anti-racist educators facilitate learning more than they dictate information (chew et al., n.d.; taylor et al., 2019). instructors who successfully foster anti-racist classroom communities demonstrate self-disclosure, reflexivity, openness, vulnerability, humility, and a willingness to challenge and be challenged (chew et al., n.d; kishimoto, 2018; knowles & hawkman, 2019; phan et al., 2009). werman et al. (2019) suggest that faculty who facilitate difficult conversations feel secure in taking risks and promoting student reflexive identity exploration. anti-racist educators welcome storytelling, reflective writing, and creative assignments while de-centering the conventional teacher-as-authority dynamic (diggles, 2014; kishimoto, 2018; taylor et al., 2019). focus on de-centering and centering narratives. anti-racism acknowledges that the racial hierarchy established and upheld by white supremacy centers white narratives advances in social work, summer/fall 2023, 23(2) 308 and voices as “normal” or “right” and de-centers bipoc narrative and voice as “diverse” or “unique” (crudup et al., 2021). currently, students of color represent 35% of bachelor’s of social work (bsw) program enrollments, and white students represent 65%. students of color represent 31% of master’s of social work (msw) program enrollment, and white students represent 69% in the united states (olcón et al., 2020). these statistics are similar for social work practice and social work faculty. the disproportionate representation of white social workers, faculty, and students in the united states combined with the white supremacy culture in the united states means that the dominant narrative and voice within the social work profession is white (crudup et al., 2021). anti-racist educators acknowledge this and seek to embody our profession’s mission by de-centering the often-dominant voices and centering marginalized narratives and voices (diggles, 2014; nicotera & kang, 2009; wagner, 2005). anti-racist pedagogy does not just require faculty to de-center dominant narratives and voices, but also, it requires that faculty center often marginalized narratives and voices; welcoming the complexity of their identities that contain oppression, privilege, and resilience (wright et al., 2021). hollinrake et al. (2019) describe this as a “sensitive and balanced” approach to teaching about oppressed and marginalized communities stressing that counter-narratives of transcendence and resilience are critical to an anti-racism approach. providing space for students to share stories with one another, exploring bipoc history, and inviting guest lecturers to share about their experiences fosters empathetic and empowering learning opportunities for students (phan et al., 2009). bank on resistance resistance is a common reaction to the confrontation of power and socialization. studies suggest that resistance from students, particularly white students, can disrupt the learning environment if not addressed (abrams & moio, 2009; deepak et al., 2015; singh, 2019; wagner, 2005). kandaswamy (2007) suggests that when confronted with white resistance, faculty should briefly address the resistance, but cautions faculty to avoid catering to white privilege by focusing the attention on convincing and comforting white students. instead, they suggest that faculty design courses for students from often marginalized identities, considering what students from marginalized identities would take from the class (kandaswamy, 2007). jeyasingham (2012) agrees with this idea, offering a critical analysis of whiteness studies cautioning instructors to carefully navigate how whiteness is addressed as to not reinforce privilege and hegemony. according to the literature, faculty can engage student resistance well by expecting emotions to arise, being willing to engage in difficult conversations, and by encouraging cognitive dissonance. expect emotions. it is rare for people to have inter-racial conversations about race and amongst some groups, it is rare to have intra-racial discussions about race (singleton, 2015). as such, teaching from an anti-racist framework and facilitating dialogues about anti-racism may elicit strong emotions from students such as anger, avoidance, disgust, fear, and resistance (chew et al., n.d.; wagner, 2005). faculty response to these emotions such as avoiding conflict, fearing emotions, demanding polite interactions, and deflecting discussions inhibits the class from the ability to learn and to grow from the process (wagner, buzard/anti-racist sw pedagogy 309 2005). abrams and gibson (2007) write that when teaching about anti-racist concepts like white privilege, that it will be emotional, it will be uncomfortable, there will be resistance, and that resistance can be a teaching tool if the faculty have the awareness, knowledge, and skills needed. engage difficult conversations. kishimoto (2018) suggests that when difficult conversations emerge, effective faculty do not shut down the conversations, but rather, they engage the conversations, allowing for learning to happen throughout the process. deepak et al. (2015) finds that students need faculty who will “go there” with difficult conversations. when faculty do not engage in potentially difficult conversations such as addressing subtle racism and microaggressions within the classroom, nor engage university and community oppression outside of the classroom, the effects are harmful to the perceived safety and equity of the learning environment (hollinrake et al., 2019; kandaswamy, 2007). encourage cognitive dissonance. in the face of resistance, skilled faculty can encourage cognitive dissonance. van soest (1996) writes that faculty can become prepared with skills to welcome and meet cognitive dissonance. kandaswamy (2007) suggests that the anti-racist educator plans to create critical analyses of power amongst students, which will, undoubtedly, produce cognitive dissonance. singleton (2015) recommends “experience discomfort” and “expect and accept non-closure” as norms for anti-racist dialogue so that students and faculty alike can be prepared for the cognitive dissonance that is central within anti-racist pedagogy (p. 59). recommendations for social work the 2022 council on social work education’s (cswe) educational policy and accreditation standards’ (epas) adoption of anti-racism, diversity, equity, and inclusion (adei) standards for social work programs across the united states creates a significant shift in social work education. lived experiences, personal racial identity, and personal and professional growth may have shaped individual social workers and social work educators’ understandings of anti-racism in social work, however, schools of social work were not required to teach about anti-racism or anti-racist practice before the release of the 2022 epas. research suggests that many social work faculty do not feel adequately prepared with knowledge, awareness, and skills to teach anti-racism to their students because they were not taught about this in their own social work education. after exploring the literature and presenting a practical conceptual framework, i propose the following recommendations to social work education focused on: increasing faulty knowledge capacity, awareness through reflexivity, and skills and ability. increasing knowledge capacity while some studies have explored social work faculty perceptions and engagement with anti-racism, many of those studies were conducted prior to the release of the 2022 epas. further research is needed to understand how current social work faculty in the united states understand the concepts of race, racism, white supremacy, whiteness, advances in social work, summer/fall 2023, 23(2) 310 and anti-racism. additionally, studies focused on social work students’ experiences of faculty knowledge of race, racism, and anti-racism should be explored with particular attention to bipoc student experiences of this. since the release of the 2022 epas draft in 2021, the council on social work education has been transparent about their antiracism task force and has regularly distributed practical ideas to social work faculty from their center for diversity in an effort to increase faculty capacity in accredited social work programs. research exploring the volume of interaction between faculty and the cswe’s informational websites should be explored as well as assessed for impact. various universities, colleges, and schools of social work may be building the capacity of their own faculty, and this could be researched for its effectiveness as well. as explored in this article, faculty have varied experiences with anti-racism and faculty at smaller and larger institutions have different access to resources, and as such, varied types of capacity-building efforts are warranted within the social work community. social work education is shaped outside of the classroom. as cswe has designated practicum placements as the signature pedagogy in social work education, social work programs might also consider how they build the anti-racism capacity of practicum supervisors, as these individuals may lack the same anti-racism training that current social work faculty lack. social work doctoral programs, both phd and dsw, might consider emerging scholarship about anti-racist capacity-building for doctoral candidates that builds knowledge, awareness, and skills so that future social work educators do have the knowledge, awareness, and skills as both faculty and students report that content lacking from doctoral education. increasing awareness through reflexivity because social work faculty have varied personal and professional experiences with race, racism, and anti-racism, resources for growth and reflexive experiences should be vast and layered. some social work faculty may have lived and research experience in racism and be willing to lead professional learning opportunities, while other social work faculty may not believe that racism is real, nor is anti-racism a needed standard in social work education. further research about faculty beliefs, awareness, and values might help the cswe and nasw to develop professional learning and places to process that would be vast and layered to meet varied gaps in faculty racial awareness. these resources could be tailored and offered to practicum supervisors and social work doctoral students, as well. increasing skills and ability more research is needed to understand faculty’s skill gap from both faculty and student perspectives so that resources can be developed. social work faculty at some institutions may have more resources or collaboration and the cswe might want to consider how to support faculty at resource-scant institutions, perhaps through the sharing of resources. additionally, the challenge of how to build the capacity of resistant faculty should be considered both at the programmatic and cswe-levels. faculty buzard/anti-racist sw pedagogy 311 capacity, reflexivity, and ability should be assessed regularly to understand what interventions and support are helping and what can be strengthened. conclusion if social work faculty are to raise student anti-racist knowledge, awareness, and skills, we must first and continually raise our own anti-racist knowledge, awareness, and skills. studies indicate that social work faculty in the united states have not received adequate education or preparation for anti-racist pedagogy and studies also reveal that social work faculty are eager to receive professional training in this area. with the recent publication of the 2022 cswe epas and the incorporation of adei standards, anti-racist pedagogy will become expected rather than optional in social work education. the conceptual framework presented in this paper offers a practical structure for faculty to consider as they evolve their anti-racist pedagogy. i am grateful to be on the journey with other social work educators who are building our capacity, reflexivity, and ability to embrace anti-racist social work pedagogy. 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(2015). whiteness and white supremacy. international encyclopedia of the social and behavioral sciences, 2(25), 569-574. author note: address correspondence to allison buzard, college of social work, university of tennessee, knoxville, nashville campus: 193 polk ave, suite e. nashville, tn 37210. email: abuzard@utk.edu https://doi.org/10.1080/13613320500174333 https://doi.org/10.1080/13613320500174333 https://doi.org/10.1080/10437797.2018.1520665 https://doi.org/10.1080/10437797.2018.1520665 https://doi.org/10.18060/23946 https://doi.org/10.18060/23946 https://doi.org/10.18060/23946 https://doi.org/10.1016/b978-0-08-097086-8.28099-9 mailto:abuzard@utk.edu author positionality literature review history of the priorities and professionalization of social work origins of social work education and accreditation theoretical frameworks influencing social work education and accreditation inequitable system and structure of higher education racial identity, lived experience, and education of individual educators conceptual framework table 2. a framework for anti-racist social work pedagogy anti-racist knowledge – increasing faculty capacity professional training places to process policy and support anti-racist awareness – building faculty reflexivity apply racial consciousness, self-awareness, and reflection assess values adopt humility anti-racist skills – scaffolding faculty ability build intentional class culture and structure brave collaborative learning bank on resistance recommendations for social work increasing knowledge capacity increasing awareness through reflexivity increasing skills and ability _______ nora padykula, ph.d., licsw, professor and terri haven, msw, licsw, field education director, department of social work, westfield state university, westfield, ma. julie berrett-abebe, ph.d., licsw, assistant professor, fairfield university, fairfield, ct copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 266-282, doi: 10.18060/23658 this work is licensed under a creative commons attribution 4.0 international license. helping community partners build capacity within integrated behavioral health: a call to action for social work education nora padykula julie berrett-abebe terri haven abstract: social workers are recent additions to integrated health care teams; therefore, there is emerging literature about the work experiences and training needs of social workers in integrated settings. after receiving a health resources services administration-behavioral health workforce education and training (hrsa-bhwet) integrated behavioral health (ibh) grant, our social work program conducted a survey among our social work field education sites to determine training needs. results of the needs assessment revealed that a lack of clarity exists about what is meant by integrated behavioral health as well as ways to measure and interpret levels of integration within social work field education sites. barriers to collaboration and areas of needed training revealed gaps in knowledge and workforce readiness for providing integrated care. recommendations include using a bidirectional level of integration conceptual framework to support greater participation of social workers and social service agencies in integrated care, in addition to specific curricular and continuing education training opportunities. social work educators are afforded a unique opportunity to support our field education partners in reviewing and enhancing their systems of care as they continue to train future social workers. keywords: integrated behavioral health; training needs; social work; interprofessional team in 2017, our social work department, within a mid-sized public university in the northeast, received a four-year health resources services administration behavioral health workforce education and training (hrsa-bhwet) grant to train social work students to practice in integrated behavioral health (ibh) settings. given the importance of field education to these efforts, the grant work began with a focus on determining the current practice configurations, knowledge and skills within our social work field education training sites, as well as soliciting information about training needs. many of our community partners were traditional social service agencies, although others were within medical settings; most were in the beginning stages of practice within integrated behavioral health. an online needs assessment was conducted to better understand self-reported levels of integration, practices used to support integrated care, and training needs of our community partners. https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 267 literature review the rapid evolution of integrated health care for social work integrated health care is patient-centered care delivered by a team of primary care and behavioral health clinicians using a systematic and cost-effective approach (berwick et al., 2008). while integrated services do not have to be delivered in the same location to be considered integrated care (peek & the national integration academy council [niac], 2013), the highest levels of integration that include fully merged practices have been identified as a best practice method to fulfill the quadruple aim of reducing cost, improving patient safety, improving the patient experience, and reducing burnout among providers (bodenheimer & sinsky, 2014; brandt et al., 2014). social work, as a profession, has been involved in public health for over a century. the formation of the american association of hospital social workers dates back to 1918 (ruth & marshall, 2017), yet there has been historical difficulty in articulating the role and value of a social worker within the evolution of the complex health care systems within the unites states. the twentieth century saw a splintering of medical and psychiatric health care, and social work became more easily defined within therapeutic settings addressing the latter. the mental health parity and addiction equity act (mhpaea) of 2008 mandated that comparable mental health and addiction treatment to that of medical services must be covered by insurance. the paradigm shift in health care systems that began with the mhpaea set the stage for the passage of the patient protection and affordable care act (aca) of 2010, and the creation of systemic integration (beronio et al., 2013). spearheaded by the passage of the aca, reform efforts of the u.s. health care system include: better coordination of inpatient and outpatient health services, integration of behavioral and medical health services, and changes to payment structures to favor comprehensive, efficient care (andrews et al., 2013). herein, the profession of social work has been fiscally mandated to join modern day integrated health care efforts in creating models of practice, policies, special committees, and taskforces (stanhope & straussner, 2018). the council on social work education (cswe) has made a concerted effort to advance the role of the social worker within integrated health care teams. cswe has increased education and training expectations for working with other professions, and has shifted from using the terms working in multidisciplinary or interdisciplinary teams to interprofessional collaboration. the social work competencies outlined in the 2015 educational policy and accreditation standards (epas) identify the ability to use interprofessional collaboration as a new component behavior within the core competencies. in 2016, cswe highlighted the concept through the annual program meeting theme advancing collaborative practice through social work education. that same year, cswe joined the interprofessional education collaborative whose membership is comprised of 21 discipline associations related to health professions and was responsible for setting the interprofessional competency standards. most recently, several social workers were included members of the national academies of science, engineering, and medicine’s (nasem) committee that produced padykula et al./helping commuinity partners 268 the consensus study report on integrating social care into the delivery of health care (2019). the report concurs with literature recommending the inclusion of social work and identifies the integral role that social workers play in achieving the goal of better health outcomes through their specialized skills for addressing social determinants of health (fraser et al., 2018; nasem, 2019). the nasem report also introduces a new concept within the united states. the 2019 nasem committee defines social care as “activities that address health-related social risk factors and social needs” (p. 28). this concept is widely used in in other parts of the world (great britain department of health, 1989) as an umbrella term for services provided to enable people of all ages, with a range of needs, to live their lives to the fullest and spans across traditional social work settings from services provided within the child welfare system to work with older adults to health care settings (the kings fund, 2017). specific skill-based competencies that would be included in the broader concept of social care include “collaborate in cross-professional settings, contribute to team-based decision making, administer screening instruments, engage in practice-based learning, use medical informatics, and provide behavioral health intervention” (zerden, lombardi et al., 2018, p. 72). gaining these competencies prepare social workers for completing a range of functions performed in integrated settings, such as: performing standardized assessments such as the screening brief intervention referral and treatment (sbirt) and functional assessment, providing training in relaxation, applying cognitive behavioral therapy (cbt), problem solving therapy (pst), motivational interviewing, behavioral activation, and psychoeducation. social workers also use techniques to ensure cultural competence and inclusivity, address social determinants of health, and contribute to care plans, team-based care. tasks fulfilled by social workers are also related to patient education and navigation, medication and care management, and in providing consultations to other team members. finally, social workers serve as a link with resources in the community (fraher et al., 2018; fraser et. al., 2018). given this context, incorporating material on integrated care across the curriculum for coursework and field experiences is needed (mattison et al., 2017; smith-osborne & daniel, 2017). what is integrated behavioral health care? due to the diversity and breadth of roles and services provided by social workers, the concept of integrated behavioral health care has been complex for the profession (rishel & hartnett, 2018; sankar, 2014). when introducing the ibh focus of the grant to field education sites, the vernacular surrounding the concepts of integrated care, team-based care, and collaborative care, were often viewed as synonymous with ibh, despite their different meanings (peek & niac, 2013). the traditional roles of a social worker – advocate, case manager, educator, facilitator, broker are naturally collaborative with other disciplines. many social workers ask how is integrated behavioral health any different than social work as usual. integrated behavioral health care is generally defined as infusing behavioral health (mental health and substance abuse services) into primary care settings although the integration can be bidirectional (mauer & jarvis, 2010) whereby physical health is addressed in a behavioral health setting. by integrating services, medical health and behavioral health care needs will be streamlined and provide better outcomes, advances in social work, summer 2020, 20(2) 269 especially for those with chronic physical, mental health, and addiction related issues (crowley & kirschner, 2015). through the substance abuse and mental health services administration (samhsa) -hrsa center for integrated health solutions (cihs), integration of health care is further conceptualized along a continuum (levels 1-6), with lower levels characterized as having coordinated integration due to minimal collaboration (level 1) or basic collaboration at a distance (level 2). at these levels, providers communicate in order to address provider and/or patient needs. mid-level integration is co-located where there is basic collaboration onsite (level 3) or close collaboration with some system integration (level 4) due to the closer physical proximity of providers. the higher levels, considered integrated indicate a change in the practice noted by “close collaboration approaching an integrated practice” (level 5) to a full collaboration in a merged practice (level 6). each level of integration is further described by examining the physical proximity of providers, ways in which clinical services are delivered, what the patient experiences, levels of coordination within the practice or organization, and finally, ways in which the business model provides the infrastructure to facilitate integrated care (heath et al., 2013). the influence of ibh on social work field education considered by cswe as the signature pedagogy, field education is of equal importance within the curriculum as classroom learning and serves to integrate the theoretical and conceptual contribution of the classroom with the practical world of the practice setting (cswe, 2015). the top five msw field education placements reported by cswe are: 1) community mental health, 2) health and mental health, 3) school social work, 4) child welfare, and 5) family services (cswe, 2017). within these placements social work students routinely work with other professionals providing social care. additionally, field education training sites increasingly exist within varying levels of integration. given these changes, field education has experienced a shift in how training sites are perceived. traditionally, a social work setting that exclusively provided social services was identified as a primary social work setting, and a distinction of a secondary social work setting was where social workers’ main role was to support the central goal of the institution/organization (suppes & wells, 2018). now, many training sites are viewed within the lens of integrated care/ interprofessional teaming. within the interprofessional team, a hallmark of higher-level integration is the notion that each representative from the different disciplines on the team is an integral member to meeting the overall goals of the quadruple aim (nester, 2016). while the concept evolved from health settings, an interprofessional organizational approach changes how we understand ways that field education settings function, what type of social work training is expected, and requires consistency across social work curriculums, field supervisor trainings, and continuing education offerings for social workers in the field. furthermore, because the discipline of social work entered the integrated care conversation later than other disciplines, several current challenges arise in field education for integrated behavioral health training programs (zerden, kanfer et al., 2018). one challenge is the limited number of placements at training sites considered integrated through the samhsa-hrsa cihs definition that are available to social workers. when padykula et al./helping commuinity partners 270 entering the field of integrated care from the end of the continuum that is predominantly behavioral health services, the majority of social work settings do not fit seamlessly within the levels of integration framework (heath et al., 2013). limited access results in the need to diffuse training opportunities across settings that are attempting to integrate care in new ways (e.g., outpatient mental health and schools; smith-osborne & daniel, 2018; zerden et al., 2017). although using a range of training sites can bring diversity and richness, it also means that field instructors and students have greatly varied lived experiences of integration in the field. lack of a clearly defined role, overlap with other interprofessional team members, and difficulty in identifying functions served within the social work activity is also an area of need in curricula, with field supervisors, and as continuing education opportunities (foster & clark, 2015). as field education sites are comprised of various levels of systemic integration, social work programs must work closely with community stakeholders to determine the range of opportunities for their students to gain the knowledge and skills necessary to work within integrated health and social care settings. an additional challenge related to gaining applied knowledge is the lack of clarity among and across field instructors, faculty field liaisons, and students about integrated care language and interprofessional training expectations and experiences (putney et al., 2017). moreover, generational differences have been shown to exist between students receiving the current social work curricula and for seasoned supervisors in the field who may have continuing education needs related to more recent expectations for social workers in gaining competence in evidence-based practices such as sbirt (fraher et al., 2018). in order to better understand the self-reported levels of integration and training needs of our community partners, we conducted a needs assessment with the agencies at which our first group of hrsa-bhwet ibh msw students were placed. this needs assessment was the first step in developing systematic efforts to support agencies’ efforts at integration, and thereby provide high quality field education training experiences for our msw students. methods needs assessments are commonly used in the field of social work to gather information about gaps and priorities for program development and service delivery (royse & badger, 2015). for efficiency and ease of participant response, we developed an online survey for our needs assessment. following irb approval, the needs assessment was disseminated via survey monkey to the 15 field education training sites that were hosting our hrsabhwet ibh msw students. in our university, advanced msw students spend 20 hours per week for an academic year receiving field education training within local community organizations under the supervision of an experienced social work clinician. a setting was considered to have a degree of integration if at least two health care disciplines were present. there was a range of settings, from traditional outpatient behavioral health clinics, to full service medical centers, to settings whose primary purpose was to provide integrated health services. the survey was sent to the organization’s executives with a request that it be forwarded to whomever they felt was best able to complete an integrated behavioral health needs assessment for the social work field education training site. all executives advances in social work, summer 2020, 20(2) 271 identified the field supervisor as the respondent. during the data collection process, three reminder emails were sent directly to the field supervisors to maximize the response rate. guiding the formulation of the needs assessment questions was the sustaining integrated behavioral health services: a step-by-step guide part ii (samsha, 2018). this resulted in five sections: 1) demographics, 2) assessing the settings level of integration, 3) organizational communication, 4) barriers to collaboration, and 5) workforce training needs. in total, there were 46 questions with a combination of multiple choices, open-ended, and preference ratings for training needs. questions aimed at assessing the level of integration within the setting included those that identified the various disciplines at the setting, the physical locations, and proximity of the various disciplines. organizational communication questions were multiple choice that focused on the infrastructure that supported or impeded communication such as the presence of shared electronic medical records (emr) or daily huddles. multiple choice questions where respondents chose all that applied were aimed at gathering the barriers to collaboration that were described in the literature including: not part of the agency culture, emrs not accessible by all team members, not enough time, lack of knowledge about other professions, lack of interest from other disciplines, collaboration not billable/counted towards productivity, release of information issues, and an open response to gather information not listed. questions about workforce training need questions were adapted from the needs assessment described in horevitz and manoleas (2013) and specifically focused on knowledge of interprofessional competencies, training in evidence-based clinical practices, techniques used in integrated care such as warm handoff, and service delivery models used in treatment planning and evaluation. each field education training site also completed the integrated practice assessment tool (ipat), a standardized tool based on the samhsa-hrsa cihs levels of integrated healthcare, that determines the organization’s perception of their baseline level of integration (heath et al., 2013). lastly, throughout each section of the needs assessment, questions addressed access to and barriers impeding further integration, readiness to make changes, and type of workforce development that would help the agency achieve their integrated behavioral healthcare goals. results demographics of the 15 field education training sites surveyed, 13 responded providing us with a robust 80% response rate (where questions were not answered missing data is noted). the majority of respondents identified as female (92%), white (100%), all had their msw degree (100%), and the majority held an independent social work license (83%). experience in the profession ranged from 7-30 years with a median range of 11-15 years. all respondents also served multiple roles within the agency (e.g., supervisor [75%], clinician [58%], field education supervisor [58%], administrator [50%]). the respondent agencies represented a range of settings, falling into 3 broad categories, 38% (n=5) were community behavioral health clinics, 38% were (n=5) integrated padykula et al./helping commuinity partners 272 healthcare agencies, and 23% (n=3) were medical centers. the majority of respondents reported providing integrative health services (75%), addressed substance use disorders (67%), mental health needs (67%), issues related to aging (58%), and homelessness (58%). all of the agencies provided services to adults and elders, and 75% of agencies also served children and adolescents. by way of federal designation, 100% of the sites served medically underserved areas/ populations. a variety of healthcare professions worked within each agency setting, with 5 disciplines minimally represented (see table 1 for the specific healthcare disciplines represented at the field education training site and the disciplines collaborated with outside of the setting). table 1. healthcare professions represented during field education training (n=12) setting n (%)* healthcare discipline field education outside social worker 12 (100%) 9 (75%) advanced nurse practitioner 11 (91.7%) 5 (41.7%) mental health counselor 10 (83.3%) 7 (58.3%) registered nurse 10 (83.3%) 4 (33.3%) direct care staff 9 (75%) 7 (58.3%) medical doctor (psychiatry) 9 (75%) 4 (33.3%) addiction counselor 8 (66.7%) 4 (33.3%) medical doctor (physical health) 7 (58.3%) 10 (83.3%) physician assistant 7 (58.3%) 5 (41.7%) nutritionist 6 (50%) 3 (25%) occupational therapist 6 (50%) 2 (16.7%) psychologist 5 (41.7%) 3 (25%) physical therapist 5 (41.7%) 2 (16.7%) chaplain 4 (33.3%) 1 (8.3%) community health worker 2 (16.7%) 1 (8.3%) school personnel 0 (0%) 1 (8.3%) *presented by highest % of field education followed by outside setting levels of integration the integrated practice assessment tool (ipat) was used to assess level of integration. of the field education training sites, 23% (n=3) identified being at a coordinated level of integration, 16% (n=2) were co-located, and 61% (n=8) were integrated. as seen in table 2, the needs assessment data from questions that addressed the domains associated with integrated care (proximity of healthcare providers, organizational readiness, and business model) are compared to results from the ipat showing the discrepancies. for example, when asked specific questions about proximity to other healthcare providers, organizational structures that promote collaboration, and aspects of their business model that support collaborative work, only 8% (n=1) reported that their setting was integrated at the coordinated level; yet, according to the ipat, 23% (n=3) of respondents were identified at the coordinated level. as table 2 illustrates, there are inconsistencies throughout. advances in social work, summer 2020, 20(2) 273 table 2. center for integrative health solutions levels of integration (n=13) integration level collaboration ipat results n (%) domain n (%) behavioral & other healthcare prov. proximity practice/ organizational structures business model coordinated 1 minimal 3 (23.1%) 2 basic 1 (7.7%) 1 (7.7%) 1 (7.7%) co-located 3 basic at a distance 2 (15.4%) 3 (23.1%) 2 (15.4%) 2 (15.4%) 4 close, onsite w/some system integration 3 (23.1%) 4 (30.8%) 4 (30.8%) integrated 5 close, approaching integrated practice 8 (61.5%) 3 (23.1%) 3 (23.1%) 3 (23.1%) 6 full, in transformed/ merged integrated practice 3 (23.1%) 3 (23.1%) 3 (23.1%) organizational communication readiness for integrated care relates the day-to-day practices within the team-based communication system within the organization (samhsa, n.d.). these internal processes inform the culture of the setting, as well as opportunities and/or barriers as it relates to readiness for integrated care. all of the respondents reported a business plan that included language about integrated/patient centered care teams, and 67% (n=8) knew that their mission statement was in alignment. communication systems varied, with 75% (n=9) of the settings using electronic medical records to communicate across all disciplines, but 15% (n=2) had discipline restrictions to access, and 8% (n=1) had limited communication through a mix of electronic and paper medical records. additionally, agencies used a variety of methods to communicate between team members, from weekly interdisciplinary meetings to daily huddles and warm handoffs (see table 3). of the settings, 92% (n=11) reported already engaging in agency-wide reviews of communication strategies on patient centered care teams, and 83% (n=10) wanted consultation to review their communication systems. table 3. ibh communication strategies endorsed (n = 12) communication strategies n (%) email 12 (100%) warm hand offs 10 (83.3%) weekly interdisciplinary team meetings 8 (66.7%) daily team meetings or huddles 7 (58.3%) text 7 (58.3%) bi-weekly interdisciplinary team 1 (8.3%) barriers to collaboration regarding barriers to collaboration with other professions within their respective settings, 64% (n=7) of respondents identified lack of time, 45% (n=5) noted a misunderstanding of other disciplines’ expertise, 36% (n=4) cited lack of interest from other disciplines. billing or productivity issues accounted for 23% (n=3), inaccessible padykula et al./helping commuinity partners 274 electronic medical records 18% (n=2), and 8% (n=1) identified lack of proximity as a barrier to collaboration. no respondents identified agency culture as a barrier to collaboration. when trying to collaborate with healthcare professionals outside of the field education training site, lack of time 73% (n=8), misunderstanding other disciplines’ expertise 45% (n=5), and release of information issues 36% (n=4) were the top three barriers, see table 4 for the complete list. table 4. barriers to collaboration between healthcare professionals (n=11) barriers to collaboration setting within outside lack of time 7 (63.6%) 8 (72.7%) misunderstanding of other disciplines’ expertise 5 (45.5%) 5 (45.5%) lack of interest from other disciplines 4 (36.4%) 4 (36.4%) billing or productivity issues 3 (27.3%) 2 (18.2%) inaccessible electronic medical records 2 (18.2%) 3 (27.3%) release of information issues 1 (9.1%) 4 (36.4%) lack of proximity not allowing in person collaborations 1 (9.1%) 0 (0%) not part of agency culture 0 (0%) 1 (9.1%) knowledge and clinical workforce training needs due to the relative infancy of integrated healthcare within traditional social work settings, it was necessary to gather baseline data on training that respondents from field education sites had received. agency respondents also identified the integrated care practice methods employed within their setting, and finally, methods they would like training in. to begin, 27% (n=3) were trained in the interprofessional educational practice (ipec) competencies and 64% (n=7) were trained in integrated healthcare service delivery models. regarding future training in these areas, 55% (n=6) of respondents wanted more training on both topics for themselves and their staff, and 45% (n=5) felt higher level administrators would benefit from training. in terms of specific practice-oriented training needs, the top five were psychosocial implications and management of chronic physical conditions with 75% (n=9), ebp tools for alcohol and other drugs at 67% (n=8), traumainformed care at 58% (n=7), ebp tools for depression, motivational interviewing, ebp tools for physical health assessment, and psychotropic medications all were endorsed at 50% (n=6). see table 5 for the full list. advances in social work, summer 2020, 20(2) 275 table 5. integrated behavioral health training needs (n=12) training needs n (%) psychosocial implications & management of chronic physical conditions 9 (75.0%) alcohol and other drugs ebp prevention, screening, & assessment tools 8 (66.7%) trauma-informed care 7 (58.3%) depression and risk prevention ebp screening & assessment tools 6 (50.0%) motivational interviewing 6 (50.0%) physical health ebp prevention and screening tools 6 (50.0%) psychotropic medications 6 (50.0%) functional assessment tools 5 (41.7%) curbside consultation 4 (33.3%) self-care & burnout prevention 4 (33.3%) stress management & relaxation techniques 4 (33.3%) understanding role of poverty & culture in health disparities 4 (33.3%) warm hand off 3 (25.0%) psychoeducation 2 (16.7%) team-based care 2 (16.7%) interprofessional education models 1 (8.3%) case management discussion the needs assessment was completed by social work field supervisors within a diverse group of community agencies that provided training for masters level social work students. results provide a better understanding of levels of integration, practices that support integrated care, and identified training needs of our community partners. levels of integration discrepancies between levels of integration identified on the ipat and responses on cihs framework suggest that identifying levels of integration is subjective and there might be a lack of clarity about how to appropriately identify levels of integration. for example, according to the ipat, over half the settings (n=8) were functioning at the level of integrated (levels 5-6) whereas answers on specific domain questions (e.g., provider proximity, business model, and organization structures) suggested that only six were at this level. similarly, the ipat scored two organizations at co-located (levels 3-4) but answers on specific domain questions suggested that six organizations were at this level. we believe that domain related questions about collaboration were a better indicator of the levels of integration because they operationalized integration in a more specific way for respondents. therefore, we view the levels of integration within our sample as: one coordinated (one behavioral health clinic), six co-located (four behavioral health clinics, two medical centers), and six integrated (one medical center, five integrated health agencies). when applying systemic integration concepts to field education training sites in social work, it is important to recognize the historical context and consequences of having vast separation between medical and mental health care in the united states. this separation has resulted in two unequal systems that have provided suboptimal care (compton-phillips padykula et al./helping commuinity partners 276 & mohta, 2018). within these two systems, both mental health and physical health providers routinely work with other health care professionals. social workers are currently the largest group of mental health care providers in the u.s. (heisler, 2018) and have been practicing collaboratively for over a century in the mental health system (vourlekis et al., 1998). with the passage of the mental health parity and addiction equity act of 2008, mental health was legislated to be as equally important as physical health. however, this legislation alone did not create the systemic change necessary to reduce the barriers for accessing mental health services (gertner et al., 2018). as we see the growing efforts to increase access to mental health care through creating a more integrated system of care, vis-à-vis the aca mandates, we would suggest that an unintended consequence is that social work has only recently joined the integrated care discussion. consequentially, the conceptualization of integration was crafted from the vantage point of a single system, the physical health system. this conceptualization does not fit as seamlessly in the systemic practice of mental health care, more recently referred to as behavioral health care. behavioral health providers routinely collaborate with other disciplines to provide more comprehensive behavioral health services (e.g., social workers collaborating with nurse practitioners or psychiatrists who are the medication providers for their patients). in this way they are indeed engaging in integrated care through an interprofessional team. while they may not be in a traditional medical setting, the care may be coordinated or colocated. our medical counterparts are doing the same, providers within the physical health care system also routinely collaborate along the continuum of integration with other disciplines (e.g., doctors of family medicine, or pediatrics collaborating with nurses, phlebotomists or radiologists) to provide comprehensive care. one critique of the movement to fix these broken systems through integrated primary care is that it is layering services on top in a “cookie-cutter manner” (compton-phillips & mohta, 2018, p. 2). integrated systems guided by community health needs assessments allow for care redesign that is responsive to the specific health needs of the community that is served. social work has long operated from the perspective of starting where the client is at; applied here, it is joining the integrated movement starting where the system is at. social work education is in a unique position to contribute to the integrated movement by advocating for a more inclusive understanding of the concepts surrounding levels of integration. an alternative is the bidirectional levels of integration conceptual framework. the term has been formerly used to describe the business design along the continuum of integration (mauer & jarvis, 2010). figure 1 illustrates this framework applied to the ways in which behavioral health and medical health services are delivered. if not fully integrated, both systems are simultaneously engaged in their own version of coordinated and colocated integration efforts. a bidirectional framework allows for the inclusion of social work that recognizes the long history of interdisciplinary collaboration, responsiveness to community health needs, and validates the full spectrum of health care delivery. advances in social work, summer 2020, 20(2) 277 figure 1. bidirectional levels of integration conceptual framework interprofessional collaboration and communication data on collaboration and communication were more consistent, and support the aforementioned bidirectional framework. each of these settings identified the same top 5 disciplines (social work, mental health counseling, prescribers that included psychiatrists, physician assistants, advanced practice registered nurses, and registered nurses) that they worked with which were predominantly behavioral health focused. this persisted regardless of level of integration and whether their collaboration was within or outside their setting (with the exception of more primary care doctors outside of their setting). in terms of ways in which social workers collaborated with other disciplines, 67% engaged in weekly ibh meetings while 58% met daily for meetings or huddles, and 83% endorsed using warm handoffs. when reporting barriers to collaboration, the three highest to be endorsed were the same regardless of the location (within or outside the setting): lack of time, a misunderstanding of each other’s discipline, and a perceived lack of interest from other disciplines. two-thirds of the sample reported having weekly interdisciplinary meetings, while just over half have daily “huddles.” encouragingly, very few respondents identified “billing” as a barrier to collaboration, suggesting that fee for service models of care may be shifting in behavioral health. when asked where they would like to be in one year in relation to overcoming barriers, 82% of the agencies identified wanting organizational structures in place to promote deeper collaboration, yet only 18% endorsed wanting strategies for achieving operational and administrative readiness. similarly, 73% wanted greater physical proximity to collaborate with other healthcare providers, but only 9% wanted consultation to realize this goal. with the elements of integrated care still in its infancy within social work, it is difficult to ascertain the meaning related to these results, overall organizational culture and the capacity for self-assessment about training needs in these areas. training needs the training needs most frequently identified included: psychosocial implications of chronic health conditions, evidence-based screening and assessment tools for alcohol and drug use, depression, and physical health issues. trauma informed care, motivational interviewing, and psychotropic medications were also at the top of the list. these training topics seem to be in line with the literature about the newness of integrated care and related practices expected of social workers, particularly as evidenced by the knowledge gap coordinated co-located co-located coordinated behavioral health care medical health care integrated behavioral & medical care padykula et al./helping commuinity partners 278 experienced by our respondent group of seasoned field supervisors (fraher et al., 2018; putney et al., 2017). recommendations for social work educators our findings suggest that there is lack of clarity in the field about what integrated care is and how agencies that have traditionally focused on behavioral health exclusively can better align with new models of care that are responsive to their community health needs. helping to educate stakeholders (students, faculty, field supervisors, practicing social workers, other behavioral health disciplines) about integrated care, potentially through a framework such as the bidirectional level of integration, can help by providing clarifying information in this new field. educators are being called on not only to educate the new generation of social workers to practice in integrated care models, but also to orient our profession to this new reality and work closely with field sites to identify and further develop integrated care internship opportunities. educators can do this by providing continuing education opportunities for practitioners in the field. for example, our grant team currently provides and tracks usage by organization of our online training modules (with free continuing education credit) on topics related to integrated behavioral health care in order to support workforce development in this area. field education is the signature pedagogy of social work and it is of fundamental importance that agencies that host social work students for training receive the resources necessary to align with cswe competencies and best practices/models of care. this could be accomplished through site-specific consultation on integration as well as targeted educational information to leadership, administrators, and supervisors. finally, as social work educators, we are being called upon to implement cswe guidelines for preparing social workers to practice on interprofessional teams. this entails changing traditional curricula to focus on such topics as interprofessional communication and evidence-based practice in integrated care settings. given that cswe is also a member of ipec and committed to the value of interprofessional education, social work programs could also consider developing and/or joining interprofessional education efforts at their institutions as well as within their communities. these efforts could be as small as a one-hour educational seminar, or as large as shared field experiences or interprofessional courses (zerden et al., 2017; zerden, lombardi et al., 2018). limitations our study sample was small and homogenous. we also only surveyed one geographical region although issues raised by this needs assessment are in line with national literature. we sent a link to the online needs assessment to executive-level administrators, asking that they determine the person in their agency who was best situated to complete the needs assessment. based on respondent information, the executive-level administrators did not complete the survey themselves but rather asked front-line field supervisors to do so. these supervisors likely understand agency culture and training needs but are less likely to have knowledge about administrative tasks and their organization’s vision for the future. future needs assessment might target both administrators and supervisors in an effort to gain more robust organizational information. in addition, we did not seek information from the other advances in social work, summer 2020, 20(2) 279 disciplines present within the settings, nor did we seek the perspective of the patients receiving services. information from these constituents would have provided an understanding inclusive of the members within integrated teams, and is a suggestion for future research. conclusion this needs assessment was the first step in supporting community partners’ efforts at integration and thereby provide high quality field education training experiences. as the field is new to the integrated care movement, social work educators have an opportunity to help shape views on integrated systems of care that is inclusive of social work and the systems in which we work. this study demonstrated that despite momentum in embracing integrated care, a lack of clarity remains; 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(2018). recruiting, maintaining, and sustaining integrated behavioral health sites for field education. the field educator, 8.2, 1-17. http://fieldeducator.simmons.edu/article/innovations-infield-education-to-improve-integrated-care-for-young-people-and-their-families/ zerden, l. d. s., lombardi, b. m., fraser, m., jones, a., & garcia rico, y. (2018). social work: integral to interprofessional education and integrated practice. journal of interprofessional education and practice, 10, 67-75. https://doi.org/10.1016/j.xjep.2017.12.011 author note: address correspondence to nora padykula, department of social work, westfield state university, 577 western avenue, westfield, ma 01085. email: npadykula@westfield.ma.edu https://doi.org/10.1080/00981389.2015.1025122 https://www.kingsfund.org.uk/blog/2017/05/social-care-whats-name https://doi.org/10.1093/sw/43.6.567 https://doi.org/10.1080/10437797.2017.1288595 http://fieldeducator.simmons.edu/article/innovations-in-field-education-to-improve-integrated-care-for-young-people-and-their-families/ http://fieldeducator.simmons.edu/article/innovations-in-field-education-to-improve-integrated-care-for-young-people-and-their-families/ https://doi.org/10.1016/j.xjep.2017.12.011 mailto:npadykula@westfield.ma.edu _________ sameena azhar, phd, lcsw, mph, assistant professor, graduate school of social service, fordham university, new york, ny. kendra p. deloach mccutcheon, phd, lmsw, assistant professor, school of social work at syracuse university, syracuse, ny. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 396-420, doi: 10.18060/24118 this work is licensed under a creative commons attribution 4.0 international license. how racism against bipoc women faculty operates in social work academia sameena azhar kendra p. deloach mccutcheon abstract: in this article, we seek to highlight the ways in which we, as two female social work faculty members whose racial/ethnic identities fall into the categories of black, indigenous, and other people of color (bipoc), have experienced racism and white supremacy within predominantly white institutions in the united states. we seek to clarify that these experiences are not unique to any particular institution or university, but rather reflect systemic racism and the upholding of white supremacy in higher education in social work throughout the united states. we highlight the differential vulnerability faced by bipoc women in academia, which are often unaddressed in the pursuit of what is seen to be an egalitarian or colorblind merit review. bearing in mind our reflexivity on our positionalities, we share personal narratives regarding our own marginalization within white spaces and the emotional labor that we are often asked to carry for the institutions within which we work. we will elucidate experiences of tokenization or assumed intellectual inferiority by our peers. given the current sociopolitical moment and the heightened awareness of diversity, equity and inclusion efforts within universities, we also reflect on how institutions of higher education, and particularly schools of social work, can move beyond simply hiring more people of color or conducting diversity trainings to ensuring that bipoc women are more fully included in their roles within universities as faculty, administrators, staff and students. keywords: racism, social work, academia, faculty, women of color disparities regarding the treatment and pay of women have been well documented in scholarship on higher education in the united states (u.s.; burke et al., 2005; johnson & stafford, 1974; porter et al., 2008; renzulli et al., 2006). campuses have been depicted as having a “chilly professional climate” for women (sandler & hall, 1986, p. 3). women are less likely to be tenured or promoted compared to male faculty; and women faculty earn less than their male colleagues (winkler, 2000). men are more likely to hold higher academic ranks and administrative posts and will therefore occupy positions that evaluate, reward, and punish women (barbezat & hughes, 2005; bellas, 1999). similarly, black, indigenous, and other people of color (bipoc) faculty also have experienced hardships in recruitment, hiring, tenure, and promotion within universities (arnold et al., 2016; garrison-wade et al., 2012; ware, 2000; williams & williams, 2006). systemic racism entails recurring and unequal relationships within institutions (feagin, 2013). political agendas within institutions may engage black and brown bodies implicitly as property, enforcing what has been called “a direct model of plantation politics” (dancy et al., 2018, p. 187). about:blank azhar & deloach mccutcheon/how racism against bipoc women 397 university administrators may claim that the lack of diversity within faculty is caused by a dearth of qualified minority candidates. yet, according to the national science foundation (2015), in the past decade enrollment in doctoral education by u.s. citizens or permanent residents who are black has increased by 31% and enrollment by those who are latinx has increased by 71%. as gasman (2016) noted, “the reason we don’t have more faculty of color among college faculty is that we don’t want them. we simply don’t want them” (p. 1). higher education in america is largely reflective of a deep commitment to the degradation of people of color as fundamental to the maintenance of a colonial or imperial order (dancy et al., 2018). as dancy et al. (2018) argue: anti-blackness as a framework also extends beyond the construction of the black body as property. the notion of black fungibility describes the ways in which settler colonialists use black bodies as symbols, signifiers, and means to settle space and expand territories. the space-making practices of settler colonialism require the production of the black body as a fungible (exchangeable or replaceable) form of property. (p. 181) notably, universities in the u.s. were initially created to educate the offspring of colonizers and may implicitly still serve to recreate the settler colonial state (thelin, 2004). black and brown faculty are more likely to be treated unfairly in the areas of promotion and training opportunities; are more likely to be targets of workplace discrimination; and are more likely to have difficulty in accessing informal professional networks (durr & wingfield, 2011; phinney, 1990). these connections and social networks help to shape, fund, and advance scholarship, making it easier for some faculty to navigate and succeed in academia. bipoc women faculty within predominantly white institutions (pwi) experience additional tensions in academe (menges & exum, 1983; rideau, 2019) as oppression is based on both axes of race and gender (turner, 2008). while the overall number of female faculty has increased within institutions of higher education, the number of bipoc female faculty has remained a small proportion (national research council, 2013). bipoc women account for only about a tenth of faculty members at four-year institutions (national center for education statistics, 2018). even bipoc women who come from socioeconomic privilege or wealth experience the detrimental mental health impacts of being in work settings that may be unwelcoming to them. implicit assumptions of superior intellectual and professional competency are automatically assigned to white men and women (turner & gonzales, 2011), disadvantaging bipoc women faculty in multiple spheres of academic mobility. bipoc women faculty are the lowest paid demographic among faculty, earning less per dollar than white men (67 cents), white women (81 cents), and bipoc men (72 cents; mcchesney, 2018). according to the council on social work education (cswe, 2017), women constitute the majority of students at the bachelor of social work (bsw, 83.5%), master of social work (msw, 80.3%), doctorate of social work (dsw, 87.4%), and doctorate of philosophy in social work (phd, 75.7%) levels. similarly, 75.2% of social work faculty advances in social work, summer 2021, 21(2/3) 398 members are women. in terms of race/ethnicity, at the bsw level, 44.9% of full-time students are bipoc; part-time bsw programs had an even greater proportion of bipoc students (48.6%; cswe, 2017). at the msw level, proportions of bipoc students are slightly lower (39.7%). at the dsw level, 50.0% are bipoc students, and at the phd level, 45.6% are bipoc students. although almost half of all social work doctoral students are of color, only 33.1% of full-time social work faculty members are of color (cswe, 2017). drawing from crenshaw (1991) and collins’ (2012) theoretical framework on intersectionality, we analyze how positionalities of race, class, and gender shape multiple dimensions of lived experience for bipoc women who are social work faculty in the u.s. we draw from one of the central tenets of critical race theory (crt), which argues that racism is an everyday american experience (razack & jeffery, 2002). as bell (1995) argues, crt recognizes that revolutionizing a culture begins with a radical assessment of it. however, the development of critical consciousness regarding the role of race in social work academia is hampered by the politicization of these ideas. in a sept. 4, 2020 memorandum to the heads of federal executive departments and agencies, the executive office of the president of the u.s. (2020) outlined that all federal agencies were banned from engaging in training related to crt or white privilege. such attempts at educational censorship effectively reinforce the notion that americans, and white americans in particular, should not critically assess the ways in which race and racism play fundamental roles in this country, but should instead continue to deny the very existence of american racism at all. under such a view, to engage in these discussions is not the realm of intellectuals and social change agents, but rather becomes the “divisive, false, and demeaning propaganda of the critical race theory movement” (executive office of the president of the u.s., 2020, p. 2). multiple states have passed laws that seek to ban the teaching of crt in public education. in tennessee, for example, republican state representatives advanced legislation in may 2021 that sought to bar teaching critical race theory in public schools and universities (folley, 2021). similarly in idaho, governor brad little signed house bill 377, which states that “the idaho legislature finds that the tenets… often found in ‘critical race theory’… exacerbate and inflame divisions on the basis of sex, race, ethnicity, religion, color, national origin, or other criteria in a way contrary to the unity of the nation and the well-being of the state of idaho and its citizens” (dewitt, 2021, para. 3). clearly then, overcoming the politicization of crt in the current sociopolitical environment remains an ongoing obstacle to the greater recognition of the role that racism plays in american life at large and american academia in particular. bipoc women carry the university’s emotional labor there are several ways in which bipoc women carry additional emotional labor for the university. bipoc women professionals have reported feeling that they must transform themselves to be welcomed and accepted in the workplace; additionally, they may feel perpetually judged for their appearance, personal decorum, communication skills, and emotional regulation (durr & wingfield, 2011). bipoc women often suffer from “race fatigue” (harley, 2008, p. 19) as a result of being overextended and undervalued in the azhar & deloach mccutcheon/how racism against bipoc women 399 areas of teaching, research, and particularly service (thomas & hollenshead, 2001). bipoc women are sought out by administrators as instructors, mentors, and stars for diversity brochures. padilla (1994) refers to this phenomenon as cultural taxation, or the additional service that falls upon bipoc women faculty to serve their institution’s needs. faculty of color often spend more time than their white colleagues in mentoring students (rideau, 2019). teaching and service generally entail substantial amounts of emotional labor, but this labor is not seen to be a valued skill and is therefore poorly rewarded by the academic merit system (bellas, 1999). students of color also seek out bipoc women faculty for advising and educational/career counseling. while bipoc women faculty are often strongly committed to supporting students of color, caring for marginalized students is another method by which we experience identity taxation (rideau, 2019). while women of color faculty take pride and responsibility in supporting younger colleagues, these added mentorship expectations can be time-consuming and emotionally draining. the added burden of supporting marginalized students can also entail assuming adding risks (rideau, 2019) within university systems. additionally, women often bear the brunt of family caregiving responsibilities, both for children and for aging family members (neufeld & harrison, 2003). women faculty, and particularly women of color faculty, are no exception to this gendered norm (bingham & nix, 2010; carr et al., 1998; gunter & stambach, 2003; hart, 2016). prior to and through the covid-19 pandemic, many bipoc women faculty have been responsible for childcare, homeschooling of children, or caretaking of aging family members, a responsibility that differentially impacts the productivity of women over men (breuning et al., 2021; cress & hart, 2009; krukowski et al., 2021). throughout the pandemic, distinctions between work life and home life have been blurred (shillington et al., 2020) as faculty offer online zoom classes and participate in service committees from their living rooms, sometimes while also providing care for family members or coordinating their children’s online schooling at home. interestingly, even in those instances where women of color faculty may begrudgingly take on additional service responsibilities through peer or institutional pressure, the narrative of the interaction may be recreated to portray women as naturally more giving, more altruistic, less concerned with their own career advancement, and more committed to collectivistic causes. these reductionist renderings of gendered roles and racialized expectations equate bipoc women to be the mammies (collins, 2000) of their universities, upholding moral virtuousness, but not necessarily demonstrating academic prowess. reflexivity regarding our own positionalities it may be helpful to first define how we are using the acronym bipoc. we have explicitly chosen to use this acronym in this paper as it both refers to a wide swath of people of color, yet also keeps the experiences of black and indigenous people at the forefront of our consciousness. to be fully transparent about the ways in which our own identities may contribute to how we view social constructs regarding race, class and gender, we also wish to explain our own positionalities. advances in social work, summer 2021, 21(2/3) 400 the first author identifies as an indian, muslim american woman, who has primarily worked in social policy and clinical social work practice pertaining to hiv, mental health and addiction treatment, as well as for city and state public health departments, in oakland/san francisco, delhi, philadelphia, chicago, hyderabad, and new york city. the second author identifies as a southern african american/black christian woman, wife, and mother who has practiced in the following areas: medical social work in rural and urban communities, counseling in a psychiatric hospital within the department of corrections, investigations with child protective services, evaluation of mental health system of care services, clinical counseling with sexual trauma services, as well as teaching in a few universities in both the northeast and southeast of the u.s. while the two of us differ in our racial/ethnic identities, household compositions, religions, and institutional affiliations, our experiences as bipoc women social work faculty remain unquestionably similar. we dissect these similarities and differences in our experiences as women of color in this paper. we do not seek to analyze these experiences from a deficit-based model that solely envisions people of color as being perpetually at a disadvantage. instead we argue that operating from a bicultural perspective may equip women of color with skills that aid them in critically examining their institutions and moving beyond white-dominant notions of educational leadership to more culturally responsive approaches (martinez & welton, 2015). bipoc women are tokenized a common thread for women of color faculty is the awareness of working within contexts that explicitly or implicitly promote the socially constructed myths of white male superiority. as anderson (2015) noted, some spaces, including much of american academia, are perceived to be white spaces, which are informally off limits for bipoc people, and even more so for bipoc women. when a bipoc woman enters a white space, others try to make sense of her, to determine whether they need to be concerned (anderson, 2015) or threatened. without regular contact with communities of color, stereotypes regarding bipoc women become the norm, estranging us from our work settings and from our peers. others describe us as hostile, aggressive, confrontational, entitled, argumentative, angry. yet we do not notice the same critiques made of even our most outspoken white peers. both authors have experienced exclusion from networks that not only teach unwritten cultural rules, but also help faculty build connections with other colleagues, university administrators, funders, and community members. often we, as women of color faculty, agree to take on additional mentoring roles (and their associated risks) as we see it to be “paying it forward” for those mentors who helped us navigate our own way. since the pandemic, bipoc pre-tenure faculty have carried additional emotional burdens from supporting students of color who are distressed, honoring requests for guest lectures, and providing consultations regarding current events (shillington et al., 2020). but of course, that added labor goes unreflected in our annual merit reviews and remains unrewarded by tenure and promotion processes. there is also no way to quantify the pain we feel when hearing about the struggles of our students who are women of color because often those struggles are our own. advocating for these azhar & deloach mccutcheon/how racism against bipoc women 401 students of color often involves the kind of advocacy we wish we had received ourselves as graduate students. while women of color faculty are often asked to “step up” to support marginalized students, we may need to “step back” to ensure that we are able to meet our own research, teaching and service obligations at the university (ventura & wong, 2020). an implicit bias permeates our interactions within university settings, depicting us as perpetually threatening or foreign to the existing social order. both authors have been mistaken for secretaries and been asked to make photocopies for other professors. the second author has walked into academic spaces and been mistaken for a custodian and asked to dump the trash. both authors have been told by multiple people, with genuine surprise in their eyes, how articulate we are or how well we speak english. both authors have experienced moments when students are surprised to find that we are their instructors. a student has tersely told the second author to move her belongings on the front desk in the classroom to a different location to make way for the professor, only to be surprised to find that she was already speaking to the professor. the second author has had several incidents of students being taken aback with referring to her by the title of “dr.”, while the same students do not express issue with referring to white faculty in the same manner. the first author has experienced multiple instances of sexual harassment at academic conferences, where senior faculty and search committee chairs wave job openings at their institutions as proverbial carrots on sticks for their unwelcome sexual forwardness. the first author has also had other scholars refer to her research as “exotic,” reflecting the perpetual orientalization and fetishization that often permeates studies conducted in asian contexts and particularly those involving women (azhar et al., 2021; said, 1979). women of color are also disproportionately asked to serve on committees (bellas, 1999) and assigned greater clerical or administrative tasks within those committees. committee service entails the need for communication skills and interpersonal skills, which often promote an emotionless notion of professionalism. particularly when serving on diversity and inclusion committees for our institutions, we became painfully aware of how we may be perceived by others and may need to soften our criticisms of systemic flaws, lest they be misconstrued as entitled, privileged, or ungrateful. faculty, administrators and staff who are women of color are often interrupted, ignored or unrecognized in meetings. our education and current income may lessen how our white peers understand the ways that we too experience racism and sexism simultaneously. over time, this may lead women of color who choose to remain in academia to either move from one academic institution to another to avoid systemic discrimination or resign themselves to dysfunctional racialized and gendered dynamics among university faculty and employees at multiple institutions. if they do remain at institutions for the longer term, they may continue to be shut down and their actions may be minimized by their white colleagues. bipoc women are seen as complainers bipoc women are discouraged from speaking out about these instances for fear of retaliation from faculty at their current institutions or from being blacklisted from potential employers at other institutions. “this will ruin your career” and “it’s a small world in academia” are mantras that have been used to instill fear and encourage silence in voicing advances in social work, summer 2021, 21(2/3) 402 a complaint. the fear of an unknown future is used to justify uncomfortable working conditions. when women of color do in fact make a complaint or vocalize a grievance about inequitable treatment, their issues are often dismissed and demeaned. as sara ahmed (2020) notes: a complaint that you do not belong can be used as evidence that you do not belong. the more you are treated as a stranger, not from here, not really from here, the harder it is to complain. and the harder it is to complain the more vulnerable you become. (para. 2) affirmation bias permeates the social structure of the work environment for faculty who are women of color. formal complaints by women of color are likely to be deemed irrational, hypersensitive, and emotional. bipoc women faculty are subtly reminded that we should just be happy to have “a seat at the table,” but refrain from desiring full inclusion. our justified emotions of frustration are heralded as the hostile and aggressive rants of angry women of color (duncan, 2014), reinforcing old and damaging tropes. this leads to the upholding of white supremacy as people in positions of power often do not like to be made uncomfortable through the recognition of their own privilege. defensiveness may also ensue as faculty members and administrators assume that by making a critique of systemic oppression, we are individually accusing them of racism. a lack of differentiation, indeed the ecological fallacy at play, is made between saying, “this university system is racist” and “you, individual white faculty member, are racist.” beyond explicit discrimination, our more common experiences with racism are everyday microaggressions at the workplace. microaggressions are defined as race-specific interactions with themes of criminality and incompetence directed toward african americans and themes of perpetual foreignness and invisibility directed toward asian americans (sue et al., 2008). among a racially diverse sample of color, a greater frequency of racial microaggressions was significantly associated with greater traumatic stress symptoms; further, school or workplace microaggressions were the type of microaggressions most associated with traumatic symptoms (nadal et al., 2019). in academic settings, microaggressions may take the form of white faculty confusing the few women of color faculty or students with one another through seemingly naïve comments like, “you look just like [insert name of the other woman of color in the department].” it is demonstrated when the achievements of bipoc women are intentionally or unintentionally absent from group recognition. even the very usage of the term microagression may serve to minimize the scale and impact of these perpetual insults against us because the usage of the prefix “micro” may be misinterpreted to refer to the magnitude of the interaction, rather than the frequency and routineness with which these insults occur. during moments of crisis, like the current pandemic, inequitable service expectations are also often conferred on bipoc women faculty. refusing to accommodate these service requests can be misconstrued as a lack of desire to be a “team player” or to be seen as ungrateful for one’s privileged place as a faculty member of color in a pwi. as audre lorde (1984) poignantly stated in 1979: azhar & deloach mccutcheon/how racism against bipoc women 403 it is a particular academic arrogance to assume any discussion of feminist theory in this time and in this place without examining our many differences, and without a significant input from poor women, black and third world women, and lesbians. and yet, i stand here as a black, lesbian feminist, having been invited to comment within the only panel at this conference where the input of black feminists and lesbians is represented. (p. 10) audre lorde’s experience summarizes well how many women of color within academia are treated—both as tokens and as ignorable members. some 40 years after lourde’s poignant statement, the state of racism and bias within american academia remains essentially the same. diversity, equity and inclusion trainings are increasingly popular in the current moment, but typically only occur in one time and at one place, serving as the implicit justification for ongoing acts of systemic racism that permeate institutional structures. more importantly, these trainings have largely been proven to be ineffective at changing racial attitudes and behaviors within institutions in the long term (anand & winters, 2008; cocchiara et al., 2010; holladay & quiñones, 2005). their presence is more likely to serve institutional interests in protecting liability from workplace discrimination than actually fostering an environment that promotes race and gender equity. additionally, many institutions of higher education have created what have been termed “safe spaces” or “brave spaces” (arao & clemens, 2013; palfrey, 2017) for people of color to more freely discuss those issues that impact them. but a rebranding of the name of the space does not make it any safer nor braver. indeed these spaces can serve as a refuge for students of color in an environment that can be perpetually hostile. but as ahmed (2012) notes, the very creation of these relegated spaces serves as the rebuttal for the fact that social exclusion and marginalization permeate all other social interactions for people of color. indeed the creation of an anti-racism task force is the validation that systemic racism does in fact exist within the university. social workers’ complicity with white supremacy social workers have had a long history of being complicit in structures that have ultimately served to promote white supremacy. a notable critique of child welfare social workers is their involvement in systems that have historically served to separate families of color and punish poor women of color for social conditions that have been caused by centuries of slavery, colonization, and social exclusion. social workers have an equally disdainful past with indigenous communities. from the 1880s to the 1950s, child welfare workers removed american indian children from their families and placed them into government boarding schools and christian missionary programs that were meant to assimilate them into white culture, labeling native american families as savages (george, 1997). these histories are often ignored or minimized in american social work education. our profession needs to be held accountable to both its past and present horrors. following the recent widespread protests regarding the murder of george floyd at the hands of minnesota police over the summer of 2020, institutions across the country—from police departments to schools to prisons—have been forced to recognize the multiple forms advances in social work, summer 2021, 21(2/3) 404 of systemic racism that they have historically sanctioned. women of color who are clinical social workers must deal with both the psychological effects of powerlessness and the concrete problems in their clients’ lives (gutierrez, 1990). as we begin to conceive of social work services, social work departments, universities, and institutions that are more inclusive of bipoc women faculty, social workers, staff and students, we have a few insights and recommendations for meaningful social change. recommendations to address racism in social work academia in the final section of this paper, we provide recommendations for meaningful social change in social work academia and provide action-oriented suggestions for how to work towards accomplishing these goals. table 1. recommendations to address racism in social work academia  reaffirm social work’s commitment to addressing racism  infuse anti-racist content into social work curricula  recognize the role of white supremacy in academia  assess the institutional climate  encourage critical reflection and counter-storytelling  critique how racial/ethnic minority populations have been pathologized by social workers and psychologists  encourage institutional support and mentorship of bipoc faculty and students  reconsider faculty workloads and tenure expectations  give space for bipoc women faculty, students and staff to grieve and recover  appreciate that the pursuit of social justice is the hallmark of our profession reaffirm social work’s commitment to addressing racism compared to other disciplines and professions, social work has a unique commitment to address issues of racism. the national association of social workers’ (nasw, 2017) code of ethics explicitly states that social workers respect the inherent dignity and worth of the person. the nasw code of ethics mandates that social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity. social workers are responsible for having a knowledge base of their clients’ cultures and to be able to demonstrate competence in service provision that indoctrinates cultural humility. we are expected to seek understanding of the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity, gender expression, age, and other social identity markers. a noteworthy consideration in anti-racist work within our profession is the very realization that social workers themselves have historically contributed to mechanisms of social control that have served to punish communities of color for their poverty and social marginalization. these social hierarchies stem from the portrayal of the histories of some of the first american social workers, who were white, affluent, “friendly visitors” and settlement house workers, largely providing “charity” to ethnic minority immigrants and azhar & deloach mccutcheon/how racism against bipoc women 405 working class families in urban centers (lasch-quinn, 2017). an ahistorical representation of the contributions of social work reformers and progressives as only white women is also evidence of the centering of whiteness in social work history (hounmenou, 2012) and the linchpin to the centering of whiteness throughout social work education. addressing ahistoricism in social work education is one approach in decentering whiteness, dismantling white hegemony, and addressing racism throughout the curricula. to address racism, the profession must first promote a historicity that is robust, comprehensive, and punctilious, one which would need to include counternarratives of bipoc social workers, advocates, activists, and community organizers, such as willie gertrude brown, janie porter barrett, w. e. b. du bois, fred korematsu, fannie lou hamer, and sojourner truth, alongside the conventional narratives of social work reformers and progressives, such as jane addams, helen gates starr, mary richmond, helen h. pearlman, and edith abbott. the inclusion of counternarratives would facilitate dialogue on the ways racism has historically impacted the field of social work. the profession should be resolute in including these counternarratives, given the deference given to the social work code of ethics that governs practice and professional interpersonal behavior for social workers (nasw, 2017). by addressing the centering of whiteness throughout social work education, we examine the assumptions buttressing these narratives, the lack of critical analysis regarding the ahistoricism of social work history, the ways that white supremacy has infiltrated the profession (deloach mccutcheon, 2019), and the marginalization and omission of the contributions of women of color in social work education (spanierman & soble, 2010). this process would lend itself to substantive discussions regarding the longterm, systemic effects of racism, and its pervasiveness throughout formal and informal institutions in the social work profession. social work advocacy organizations are increasingly recognizing the importance of the development of future social workers who embrace diversity and difference within their practice (cswe; 2015) and who are culturally competent (nasw, 2017). infuse anti-racist content into social work curricula currently, much of what is examined in social work education consists of generalized knowledge of different westernized cultural group customs, norms, and experiences (adams et al., 2007) with a focus on “multiculturalism.” however, multiculturalism, in the absence of collective anti-racist struggles, can reproduce the ontologies, epistemologies, and practices of white supremacy (bery, 2014). while cultural competence and cultural humility are current buzz words in our profession, rarely do these perspectives involve the analysis of whiteness; the systemic effects of the legacy of genocide and massive deportation of indigenous people in the settling of the u.s.; the chattel slavery of africans in the u.s. circa august 1619; the recruitment of chinese immigrants as indentured laborers on cotton plantations and railroad projects; the denigrating practices of sharecropping for black farmers in the mississippi delta post-civil war; the internment of japanese people during world war ii; the clandestine, forced sterilization of puerto rican women factory workers in the 1950s; the growing attacks on muslims in the u.s. post9/11; the continued colonization of the u.s. territories of american samoa, guam, advances in social work, summer 2021, 21(2/3) 406 the northern mariana islands, puerto rico, and the u.s. virgin islands; ongoing american military intervention in afghanistan, syria, and iraq; the periodic attacks on black churches and synagogues by white supremacists; the killing of unarmed black and latinx individuals at the hands of police; and numerous other atrocities committed against people of color, including redlining, racial profiling, and predatory lending. incendiary acts of modern-day racism need to be examined through a critical theoretical lens in social work education. without such an approach, this lack of knowledge leaves clinical social workers ill-equipped to engage in therapeutic treatments that address the biopsychosocial functioning of client systems, who continue to face the by-products of these atrocities. similarly, this lack of knowledge leaves macro-practice social workers unprepared to engage in social activism, community organizing, and policy-making that promotes the changes necessary to dismantle the effects of these human rights violations and prevent their recurrence. to develop culturally competent social workers, counter-narratives must be added with intentionality, accuracy, and purpose within social work education. social work educators must therefore accept that whiteness and all of its effects pervade social work education, institutions of higher education, human service agencies, and social and economic institutions. recognizing and holding the field accountable for these racist histories and ongoing tensions is an important first step to creating more equitable spaces within social work. while calls for “decolonizing the curriculum” have been widespread, social work education in particular needs to include more content related to anti-racism and antioppressive social work practice, including readings from bipoc scholars. emerging research shows that diversity coursework has an overall small but positive association on behavior, behavioral intent, affect, cognition, and diversity (denson et al., 2020). by examining the curricula to assess the content and the extent to which whiteness is centered explicitly and implicitly, we can broaden curricula to include counter-storytelling (ortega & feagin, 2016). an assessment of the curriculum would help identify the contributions of people of color within social work syllabi (hikido & murray, 2016) and develop strategies for centering missing contributions of people of color to create a more holistic teaching paradigm. although it is not universally mandated, some schools of social work have required anti-racism courses during the first year of graduate study for master of social work students. however, this practice is by no means standardized. one way to address this lack of uniformity in social work education is for cswe, the body which maintains standards for accreditation for schools of social work in the u.s., to establish anti-racist curricula as a national requirement for competencies of graduating social work students. there are multiple letters and online petitions that are currently being circulated to cswe to broaden the second competency for social work that addresses diversity to explicitly require the instruction of anti-racist content. this would be a strong move in the right direction. for the training of students intending to focus on clinical social work, counseling competencies that are not ethnocentric in nature can help social workers integrate structural issues of inclusion into their interactions with racial/ethnic minority clients (vera & azhar & deloach mccutcheon/how racism against bipoc women 407 speight, 2003). moving in this direction, the national association of deans and directors of schools of social work (nadd; 2020) recently signed a statement, denouncing racism and structural oppression that allow violence, hatred, and brutality to persist. further they have committed to stop racism and injustice as they see these to be the cause of disparities in health and wealth, mass incarceration, political disenfranchisement, and multigenerational trauma (nadd, 2020). while the nadd reflects a commitment to creating more equitable social work education, their future steps for action are somewhat vague and speak broadly to the importance of self-reflection, providing anti-racist professional education, and partnering with national social work advocacy organizations. to truly move anti-racist initiatives forward in social work schools, specific, outcome-oriented plans need to be made at the national, state, local and institutional levels. recognize the role of white supremacy in academia an emerging group of activists within our profession are working to educate social workers on the recognition that white supremacy has been a historical component of social work. the social work coalition for anti-racist educators (swcares), is an organization created by a group of social work educators who seek to actively dismantle the systemic racism and oppression created by white supremacy culture (swcares, 2020). one of their main activities is compiling resources for anti-racist education within social work classrooms. swcares seeks to identify and acknowledge the ways in which white supremacy culture exists in social work education, including hiring practices, leadership, competencies, implicit curriculum, accreditation requirements, funding, ethical principles, and gaps in equity (swcares, 2020). similarly, the organization swhelper (2020), held a two-day virtual summit in september 2020 to address ways in which social workers can more actively engage in anti-racist practice. another group of social workers connected via twitter using the hashtag #sweduacts. the hashtag was created in response to a call for social work educators to collaborate on anti-racist efforts. the collective held a national social work teach-in online october 2020, addressing issues of police brutality and structural racism (stoelker, 2020). more widespread approaches like these should be adopted by social work schools to address the multiple facets in which racism permeates social work education and practice. assess the institutional climate in order to analyze the psychosocial, environmental, economic, cultural, and structural conventions that uphold white supremacy and marginalize faculty, staff and students of color (cabrera et al., 2016), social work departments, schools, and universities need to conduct an assessment of their institutional climate. part of this critical assessment would require examining recruitment, hiring, mentoring, retention and promotion efforts, and the extent to which these efforts include bipoc students and faculty members (kaplan et al., 2017). such assessments must also involve honest evaluations of leadership and the ways in which institutional management has potentially contributed to the maintenance of white supremacy. for social work departments/schools, some forms of this work may have already been conducted during the cswe accreditation self-study, so departments/schools advances in social work, summer 2021, 21(2/3) 408 may expound on this existing work to delve deeper into these issues. during the climate assessment, questions that focus on social conventions, processes, supports, resources, attitudes, interactions, and organizational culture may reveal findings that would otherwise go unnoticed. following an assessment, the next steps would include examining how whiteness plays out in the school’s strategies for program marketing, admission criteria, and graduation trends for students of color (russell et al., 2019). encourage critical reflection and counter-storytelling a function of social work education is to promote critical thinking, which should include efforts to decenter whiteness within institutions in order to promote diversity, difference, and inclusivity. given the cardinal values of social work and the ethical underpinnings of the profession, one might question what has prevented the profession from having already engaged in such decentering efforts. the american academy of social work and social welfare (aaswsw, 2020) only recently added eliminating racism as the 13th grand challenge to the profession, following criticism regarding its absence. a possible explanation for social work’s relatively slow adoption of anti-racist principles may be what bourdieu (1986) termed miscognition, or the active set of social processes that anchor accepted assumptions in social and cultural life. this anchoring creates a collective false consciousness based on routinely unnoticed and unchallenged conditions, in this case, the pervasiveness of whiteness throughout social work education, policy and practice (feagin, 2020). this false consciousness may be attributed to pushing the contributions of women of color to the sidelines, not only within the social work profession, but throughout society. the inclusion of counternarratives may begin to correct this false consciousness and begin the process of establishing a new perception of reality. the adoption of counter-storytelling, or the practice of using alternative stories regarding communities of color, can also be an effective tool to challenging dominant narratives among faculty (solórzano & yosso, 2001). a diverse faculty strengthens any institution through the adoption of a richer curriculum and deeper engagement on race and gender in faculty committees and meetings (gasman, 2016). a diverse faculty can hold the university accountable in ways that uplift people of color (gasman, 2016) and decenter whiteness. people of color are often told that their perceptions regarding racism are incorrect and that their assertions lack empirical validity (sue et al., 2008). university leaders need to critically examine how racism, sexism, and gender-based oppression are reproduced within institutions (patton, 2016) and have often been the historical precedents to the very creation of these institutions. critique how racial/ethnic minority populations have been pathologized by social workers and psychologists anti-oppressive approaches towards social work education should include the widening of our lens to include minoritized voices not only within the u.s. context, but also across global contexts (azhar et al., 2020; aziz & azhar, 2019). american imperialism within the field of clinical social work, stemming from the profession’s azhar & deloach mccutcheon/how racism against bipoc women 409 dependence on validation from the culturally biased diagnostic and statistical manual (dsm; american psychiatric association, 2013), continues to remain largely unquestioned. the reliance on criterion-construct validity of mental illness categorizations is highly problematic given the dominant-majority group influence on determining which behaviors, attitudes, thoughts, and emotions constitute normalcy and which constitute pathology (kaufman, 2006). research has documented the limitations of clinical utility and construct validity of criteria from the dsm-5 diagnostic categories of somatic symptom disorder (ssd; häuser et al., 2015), schizoid personality disorder (hummelen et al., 2015), and pediatric bipolar disorder (galanter et al., 2012). even after controlling for symptoms, people of color, and in particular black men, are more likely to be diagnosed with schizophrenia and antisocial personality disorder (feisthamel & schwartz, 2006). similarly, black children and adolescents are more likely to be diagnosed with oppositional defiant disorder and conduct disorder, reflecting implicit biases regarding the perceived psychology and behavior of people of color (atkins-loria et al., 2015) who are assumed to be more aggressive, violent or resistant to authority. encourage institutional support and mentorship of bipoc faculty and students bipoc women faculty need unique support and resources that are designed to address the isolating effects of being the only person of the color in the room, on the committee, or in the department (hitchcock & sage, 2020). providing support to bipoc faculty and students also requires an appreciation for mental health disparities among racial/ethnic minority students. recent research has shown that people of color are at increased risk for both experiencing discrimination and experiencing mental health issues (cdc, 2020; ruiz et al., 2020). black and latinx people report higher rates of depression, anxiety, and trauma-related symptoms as a result of the pandemic than white people (cdc, 2020). moreover, greater than 30% of asian-american adults say they have experienced interpersonal racism since the pandemic began (ruiz et al., 2020). similar trends impacting racial/ethnic minorities have existed long before the pandemic. students of color are more likely to report feeling overwhelmed at college, yet keep these concerns to themselves (lipson et al., 2018). in a 2018 study involving in-depth interviews and focus groups with a convenience sample of black college students at a pwi in south carolina, students reported experiences with everyday racial discrimination that contributed to feelings of anger, loneliness, social isolation, and invisibility (lewis, 2018). bipoc students are also less likely to seek out mental health care. in one study of university students, 23% of asian-american students, 26% of black students, and 33% of latino students with mental health problems sought treatment vs. 46% of white students (lipson et al., 2018). students have also revealed that they perceived their university’s approach to diversity and inclusion to be superficial, ultimately benefiting white students while continuing to marginalize black students (lewis, 2018). to address these disparities within social work departments and schools, we must make greater efforts to conduct mental health outreach to racial/ethnic minority students, including doctoral students. these students must also be provided opportunities to be actively involved in the design and change of school policies advances in social work, summer 2021, 21(2/3) 410 that directly impact them. a focus on systemic discrimination is important to develop a deep understanding of the holistic mental health needs of minority students (the steve fund, 2020). reconsider faculty workloads and tenure expectations expectations for bi-annual and tenure/promotion reviews must consider structural inequities by gender and race/ethnicity (shillington et al., 2020). recent discussions regarding one or two year extensions to the tenure clock acknowledge the challenges to productivity elicited by the pandemic, but only do so by delaying the decision of when faculty will be evaluated for tenure. these extensions may provide extra time to adjust research efforts, but may affect faculty and administrator perceptions of whether pre-tenure faculty members are “on track” for academic success (shillington et al., 2020). ultimately, the standards by which faculty are assessed for tenure and promotion decisions remain the same, albeit delayed. if faculty take the additional year in their tenure review, this essentially equates to a pay cut as junior faculty are prevented from assuming the salary increase associated with receiving tenure and being promoted to the level of associate professor, which typically follows the seventh year of university service. this too may arguably serve to maintain standards that ultimately uphold white male supremacy as universities are unable to adequately respond to the differential burdens that the pandemic has placed on bipoc women, and in particular bipoc women who serve are caregivers. additionally, several universities do not offer affordable childcare services to faculty, staff and students, again creating a greater burden on women who are parents, particularly of young children. perhaps a better way to adjust work expectations is to adjust tenure expectations by a year, such that women can still be promoted on time and without being forced to sacrifice a promotional salary increase. efforts can also be made to identify and reduce pay disparities across faculty rank by race and gender. give space for bipoc women faculty, students and staff to grieve and recover in the midst of one of the most tumultuous political years of our lives, it is important for university faculty and administrators to give women of color faculty, students and staff opportunities to grieve, rest, recover, rejoice. experiencing joy is an act of resistance against the narratives that tell us that we are destined to fail, fated to be oppressed, and condemned to subjugation. allow for the expression of joy in the classroom, joy in the field, even joy in the committee meeting. this is not to say that we simply smile and withstand our agony. but we “must include feelings of pleasure such as laughing and experiences of joy even within the traumatic existence of exploitation” (shimizu, 2016., p.319). appreciate that the pursuit of social justice is the hallmark of our profession ultimately, as social work faculty members, we are deeply committed to the pursuit of social justice, which we define here to be equity and fairness in the distribution of social resources (fouad et al., 2006). social justice refers to how advantages and disadvantages azhar & deloach mccutcheon/how racism against bipoc women 411 are distributed to individuals in society (miller, 1999). operating from a perspective of social justice emphasizes structural issues, namely equity, interdependence, and social responsibility (bell, 1997). given that the notions of equity and fairness are highly subjective within institutional settings, operationalizing these terms can be challenging. but we must stand ready for this challenge. and we must stand ready to face the institutional obstacles and risks that advocating for these changes will inevitably entail. as we have already outlined, one of the fundamental ways to help create a paradigm shift is the development of critical consciousness amongst our faculty, staff and students regarding the nature of power relationships within society and how these dynamics shape individual perceptions and biases (gutierrez & lewis, 1999) within university settings. it would be irresponsible for social workers to ignore the ways in which we may act as agents of social control, rather than agents of social change (saugeres, 2000). social workers working in mental health, criminal justice, and child welfare settings need to confront the ways in which juvenile justice systems, jails, prisons, psychiatric hospitals, homeless shelters, and foster care systems have contributed to racial disparities in health, education, housing, and employment. we need to move beyond giving credit for our good intentions to acknowledging our bad consequences. in order for us to engage in meaningful and lasting social change, social workers must come to terms with the ways in which our profession has participated in historical systems that have normalized and institutionalized racism and white supremacy, often blaming racial/ethnic minority groups for their own poverty and social marginalization. our commitment as social workers has always been to the most vulnerable within society. 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(2000). faculty reappointment, tenure, and promotion: barriers for women. the professional geographer, 52(4), 737-750. https://doi.org/10.1111/00330124.00262 author note: address correspondence to sameena azhar, phd, lcsw, mph, assistant professor, fordham university, graduate school of social service, 113 w. 60th st., new york, ny 10023. email: sazhar@fordham.edu https://doi.org/10.1111/j.1467-9620.2006.00649.x https://doi.org/10.1111/0033-0124.00262 https://doi.org/10.1111/0033-0124.00262 mailto:sazhar@fordham.edu _______________ ninive sanchez, phd, msw, ms is an assistant professor. megan corbin, msw, was a graduate student and alexander norka, bsw, an undergraduate student at the time of this project. school of social work, university of missouri, columbia, mo, 65211. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 463-477, doi: 10.18060/22428 this work is licensed under a creative commons attribution 4.0 international license. use of “comment bubbles” in a writing-intensive, social and economic justice course: a novel approach to engage students in thinking about their writing choices ninive sanchez megan corbin alexander norka abstract: a central question among instructors teaching writing-intensive courses is how to best respond to student writing. this study posits that the margin of the essay should not be reserved for instructor feedback only, and that allowing students to comment on their writing choices in this space has pedagogical aims. this study examined the use of “comment bubbles” to engage students in thinking about their writing choices in argumentative writing in an undergraduate social and economic justice course. comment bubbles are comments and questions students inserted in the margin of their essays using the comment function in microsoft word. the margin of student essays was framed as a safe writing environment to encourage student self-expression beyond that already expressed in the essay. a thematic analysis of student comment bubbles found that students used the comment bubbles to react to research they read in journal articles, elaborate on their writing choices, share their personal experiences, and reflect on their future career interests. allowing students to comment on their writing choices in this space facilitates student self-expression, self-reflection, and critical thinking. keywords: argumentative writing; social work; social and economic justice; writing intensive; undergraduate students social work instructors across the country are tasked with teaching writing-intensive (wi) courses informed by writing across the curriculum (wac) pedagogy (horton & diaz, 2011; kolb, 2013; wiener, 2012). writing-intensive courses are taught using a “writingto-learn” and “learning-to-write” approach that incorporates writing as a mode of learning about course content and develops students’ writing skills within discipline-specific genres (bean, 2011). for instance, wi courses in social work incorporate writing activities that teach person-in-environment perspectives and the provision of social welfare services, boundaries between social workers and clients (horton & diaz, 2011), and gerontology practice and theories of aging (kolb, 2013). writing-intensive courses, such as the one discussed in this study, offer a combination of low stakes, non-graded writing assignments and high stakes graded writing assignments (kolb, 2013), writing consultations with instructors, revision, and peer-review (horton & diaz, 2011). additionally, at the institution where the current study took place, undergraduate students must complete two wi courses, one in any discipline and one upper-level course in the major. in wi courses, at least 20 double-spaced pages of writing are completed and writing assignments comprise a major part of the course grade. the campus writing program provides support services for all wi instructors and the campus writing center provides tutoring for students in wi courses. https://creativecommons.org/licenses/by/4.0/ sanchez et al./use of “comment bubbles” 464 a central question among instructors of wi courses is how best to respond to student writing (bean, 2011). instructors must consider how to provide appropriate guidance and motivate writers, rather than simply diagnose problems (weaver, 2006), and reduce confusion and misunderstandings their feedback may communicate to students (hyland & hyland, 2001). students value written feedback, develop perceptions of the instructor’s engagement with their writing, and respond emotionally to the feedback they receive (lizzio & wilson, 2008; mahfoodh, 2017). purpose in this study, students enrolled in a social and economic justice course designated as wi wrote an argumentative essay in which they were asked to pick a topic of their choice and argue how the issue is associated with discrimination and the forms of oppression covered in the course. for instance, students chose topics such as food insecurity and poverty, racism and community violence, immigration and marginalization, and sexism and the gender wage gap. additionally, students were asked to discuss previous and current advocacy to address the issue and their thoughts on future directions to address the issue. students were also required to write a thesis statement, use peer-reviewed journal articles to support their arguments, and include at least one counterargument. the essay was 8-11 pages in length, double-spaced, with apa-style formatting. this essay was one of two high-stakes writing assignments in the course. to facilitate the writing process, the essay was divided into three parts--a draft of the thesis statement and description of the nature of the issue, a full draft for peer-review, and the final paper due at the end of the semester. the instructor and a graduate teaching assistant provided feedback on the initial drafts. furthermore, writing workshops were held in class to teach students how to write a thesis statement, counterarguments and rebuttals, and retrieve relevant peer-reviewed journal articles to support claims. the instructor and graduate teaching assistant also worked with students individually during in-class writing consultations before each of the sections were due to answer student questions and provide additional feedback. this assignment was designed to integrate writing and critical thinking using approaches recommended by bean (2011). argumentative essays engage students in critical thinking because they require students to develop a thesis, consider different interpretations of a problem, reason, and use evidence to support arguments. writing activities (such as the current assignment) that present students with complex problems motivate students’ curiosity and inquiry, and challenge those students to actively engage with the problem and grapple with ideas (bean, 2011). instructors typically use the margin of the essay to comment on student essays and provide feedback to encourage students to think about ideas more fully (institute for writing and rhetoric, 2016). this study posits that the margin of the essay should not be reserved for instructor feedback only, and that allowing students to comment on their own writing choices in this space can have pedagogical aims. allowing students to comment on their writing choices is a student-centered approach that communicates to students that their comments are valued and not lesser than those of the instructor (sanchez, norka, corbin, & peters, 2019). advances in social work, fall 2019, 19(2) 465 in this course, the margin of student essays was framed as a safe writing environment to encourage student self-expression beyond that already expressed in the essay. this approach was informed by prior literature indicating that students tend to restrict selfexpression when they fear voicing perspectives that may be perceived as politically incorrect (waller, carroll, & roemer, 1996). additionally, student embarrassment and lack of confidence about their perceived writing skills can inhibit help-seeking to improve writing (nelson & weatherald, 2014). conversations on creating safe learning environments have traditionally focused on creating such climates in the classroom. the need to create safe writing environments outside of the classroom tends to be overlooked. to address these challenges, students in the course were asked to insert at least two “comment bubbles” in their essays during the writing process. comment bubbles are questions and comments students inserted in the margin of the essay using the comment function in microsoft word (see sample comment bubble in figure 1). students were told that the margin served as a space for them to write any questions or comments they did not want to write in the essay itself or that they felt did not fit within the conventions of the essay. students were not provided with specific instructions on what to write. figure 1. sample comment bubble. sample comment bubble a student inserted in the argumentative essay. comment bubbles were also used as a strategy to engage students in metacognition, a deliberate awareness of one’s cognitions. metacognition is higher-order thinking necessary for effective professional writing for social work because it allows one to stand back, examine one’s cognitions, and engage in critical thinking necessary to become effective thinkers and writers (weisman & zornado, 2018). educational psychologists argue that metacognition is not something students tend to learn on their own and that instructors need to use strategies to develop students’ metacognition (national research council, 1999; silver, 2013). this conscious, deliberate awareness of one’s cognitions during the writing process paves way for the development of mindfulness among writers (mcdonald, boddy, o’callaghan, & chester, 2015). one way in which social work instructors teaching wi courses have helped undergraduate students become conscious of their writing choices is sanchez et al./use of “comment bubbles” 466 by asking them to use the margin of the paper to identify claims in their argumentative essays (horton & diaz, 2011). the purpose of this study was to examine what students wrote in their comment bubbles to understand what they reflected on during the writing process. that is, what kinds of questions and comments did students insert in the margins of their essays? the findings can help instructors teaching wi courses better understand students’ writing choices and inform the way they engage with students in the writing process to prepare students to be critical thinkers and skilled writers. method participants participants in this study were students enrolled in a social and economic justice course in spring 2016 offered by the school of social work and cross-listed with peace studies at a midwestern, public university in the united states. the course is taught using a social justice framework that addresses forms of oppression (e.g., violence, exploitation), discrimination (e.g., racism), intersectionality, privilege, power, and advocacy. the course is designated as wi by the campus writing program and is open to students of all majors in an effort to develop a curriculum that emphasizes the significance of diversity and social and economic justice issues across the disciplines. additionally, this is a required course for all new social work students and counts as a requirement for the university’s minor in social justice and the multicultural certificate. a master of social work research assistant attended the course at the start of the spring 2016 semester and described the study to students, answered questions about participation, and informed students that their participation in this research, or a decision to withdraw from it, would not affect their grade in the course. the course instructor and teaching assistant stepped out of the classroom during the informed consent process. of 87 students enrolled in two sections of the course, 64% (n = 56) provided informed consent to take part in this study allowing the research team to use their argumentative essays and comment bubbles for research purposes. of these 56 students, 25 provided demographic information. nearly all students were female (n=24), with an average age of 21 years (sd=1.5). most students identified as white (n=16), with fewer identifying as black (n=2), chineseamerican (n=1), and native-american and german (n=1). five students identified as being first-generation college students, and 12 students reported taking the course to fulfill the university’s writing intensive requirement. table 1 lists students’ year in school and major. the principal investigator de-identified student essays by removing student names and replacing them with identification numbers. student essays were stored in a secure, webbased storage site managed and approved by the university. this study was approved by the institutional review board at the researchers’ institution. advances in social work, fall 2019, 19(2) 467 table 1. participants’ year in school and major (n = 56) student characteristics n % year in school freshman 6 10.7% sophomore 24 42.9% junior 13 23.2% senior 13 23.2% major social work 21 37.5% psychology 10 17.9% undeclared 6 10.7% pre-health professions 5 8.9% nutritional sciences 2 3.6% pre-nutritional sciences 2 3.6% business administration 1 1.8% communication 1 1.8% general studies 1 1.8% health science 1 1.8% interdisciplinary studies 1 1.8% mathematics 1 1.8% philosophy 1 1.8% political science 1 1.8% pre-communication 1 1.8% pre-personal financial planning 1 1.8% research team the research team consisted of the course instructor, a master of social work (msw) student, and a senior bachelor of social work (bsw) student. the bsw student was enrolled in the course the previous year as a junior; however, the particular instructor for their section of the course did not use comment bubbles as part of the class. the researchers practiced reflexivity through reflection, memoing, and peer-debriefings. reflexivity refers to the process by which researchers recognize they play a role in the creation of knowledge and continuously evaluate how their intersecting identities, assumptions, beliefs, biases, and experiences affect the research process and outcomes (berger, 2015; creswell & miller, 2000). additionally, the researchers employed investigator triangulation, which refers to the use of multiple observers of the same data to reduce bias from a single person and ensure greater reliability in observations (denzin, 1978). during peer debriefings, the researchers compared coding, asked each other questions to understand and challenge each other’s interpretations of the data, integrate categories, and refine the codebook. researcher reflexivity and peer debriefings are methodological strengths that increase a study’s validity (creswell & miller, 2000). sanchez et al./use of “comment bubbles” 468 thematic analysis the first step in data analysis was a thorough review of the assignment guidelines by the research team. then, each team member read the anonymized student essays and the comment bubbles to familiarize themselves with the data. student essays and comment bubbles were examined as student artifacts, as texts constructed by students and situated in a place and time (castelló & iñesta, 2012). student essays were also considered classroom artifacts because writing assignments reflect the goals and values of a course and its discipline (melzer, 2009). the units of analysis were the comment bubbles. the text associated with the comment bubbles provided context for understanding the comment bubbles. the researchers conducted a thematic analysis of 90 comment bubbles. theoretical thematic analysis was used to identify themes. theoretical thematic analysis refers to identifying themes that answer a specific research question, as opposed to inductive analysis which is more data-driven, and has some similarity to grounded theory (braun & clarke, 2006). coding began with provisional coding, which refers to an initial list of codes that can be revised, deleted, or expanded to include new codes as data are collected, coded, and analyzed (saldaña, 2016). the course instructor, also the principal investigator, requested a copy of the coding scheme developed by lavaque-manty and evans (2013). this coding scheme was based on a thematic analysis of the comment bubbles that undergraduate students in evans’ wi psychology class inserted in their papers. this coding scheme was selected because it was the only available framework for analyzing comment bubbles inserted in papers written by undergraduate students in a social science course. the initial coding scheme contained categories and quotes from student comment bubbles representative of the categories. a sample quote was, “i tried to add to the introduction and to follow the guidelines. i am not sure that i mastered the concept fully and was still a little lost as to how to begin the introduction and what to include in the introduction.” this quote was associated with the category “reflections on own writing.” in the current study, the research team used this initial coding scheme to do a first cycle of coding of students’ comment bubbles in the argumentative essay. in the second and consecutive cycles of coding, the research team identified new categories they observed in the data and deleted categories from the initial coding scheme that they did not observe in these data. for instance, a category that the researchers observed in the data that was not in the initial coding scheme was “personal experiences associated with content.” in consecutive cycles of coding, the research team continued organizing the data, defining and naming categories, refining the codebook, and identifying repeated patterns that emerged from the data that could be potential themes. findings the following four themes emerged from the data: (1) reactions to research, (2) elaboration on one’s writing choices, (3) personal experiences, and (4) future career interests. these themes are illustrated below with representative quotes. the corresponding writer’s major and year in school appear in parentheses. advances in social work, fall 2019, 19(2) 469 reactions to research the majority of comment bubbles were student reactions to research. these comments were characterized as student reactions to information in peer-reviewed journal articles that students cited in their essays as evidence to support their arguments. students shared primarily positive and emotional reactions to the information they read. students shared their enthusiasm for articles that discussed advocacy efforts to address the needs of vulnerable populations. for instance, one student cited an article on how a public library started a campaign to promote awareness of human trafficking after learning that the library was becoming a safe haven for victims of human trafficking: “it was amazing to read this article. to know that one girl/victim was saved and then an amazing program started because of it” (social work, junior). similarly, another student who wrote an essay on ableism commented on the wage and employment effects of the americans with disabilities act: this paper was really interesting for me and i really enjoyed researching this topic. it is a huge passion for me and one thing i enjoy about this field is being able to find ways to make changes and better help the community in understanding different populations. this paper helped me understand how important research is and how research helps you see what things have been done or not done to make a change and the effectiveness of change. (social work, senior) students also expressed enthusiasm at finding articles to support their claims. for instance, a student who cited an article about racial disparities in the criminal justice system wrote: i’m so glad that i found this article. not only does it show that black ex-felons are more disadvantaged than white ex-felons but that black individuals who don’t even have a criminal record will find it harder to find a job than a white person with a criminal record. (social work, sophomore) in some instances, students reacted to the language used in journal articles and the messages these conveyed: one of the articles i read only referred to the survivors of assault and rape as victims. although the article was advocating for them it seemed odd to use such a negative word. instead of promoting their strength, it just made me think of how important our word choice is. (nutritional sciences, sophomore) this comment suggests the student recognized the values and assumptions behind the use of the term “victims” versus “survivors.” this may be due to the course emphasizing use of person-first language and language that is sensitive to diverse groups of people and the conditions they live in. students also reacted to the statistics they read in journal articles. one student commented on the percentage of school children from low-income families attending public schools: “i think this statistic is very shocking and eye-opening. i had no clue that so many families were low-income” (undeclared, sophomore). sanchez et al./use of “comment bubbles” 470 elaboration on one’s writing choices some students inserted comment bubbles that elaborated on or clarified their word choices, writing strategies, and expressions of writing difficulty. for example, one student commented on the use of the wording “a person with a disability” versus “disabled”: “after this class, i am aware now to use this terminology instead of ‘a disabled person,’ because this puts the disability as the defining quality of someone. i did not know this before” (prepersonal financial planning, junior). students commented on the writing strategies they could have used to communicate their ideas better: “i think i could have gone into more detail about childcare and how a large portion of a low-income family’s money goes towards childcare while these parents are working long hours or night shifts” (psychology, sophomore). expressions of difficulty were comments in which students shared their uncertainty or difficulty conveying meaning and questioned their control of the ideas they wanted to express. for instance, here a student expresses uncertainty about whether the use of “tightly bonded” conveys a family structure that challenges the traditional family structure: “i do not know if “tightly bonded” is a way to word that. i wanted to express that their families were not ‘normal.’ normal being defined as having a mother and father in the home together” (psychology, junior). students also expressed difficulty paraphrasing and quoting such as, “i know this is a really long quote but i didn’t see any other way to paraphrase it. i just thought it was written too well!” (social work, senior). the student had this concern because students were asked to paraphrase as much as possible and quote minimally only when quoting an important document such as policy or an influential orator. students also asked questions to elicit help from the reader such as: “it was very hard for me to find a statistic of the rate of african americans that lose their jobs because of an illness. do you have any recommendations on where to look for this information in the future?” (social work, senior). the use of questions suggests that students want to engage the reader and are looking for feedback that will help them find resources to support their arguments. personal experiences to a lesser extent, students used the comment bubbles to share their personal experiences with the reader. personal experiences were characterized by the use of “i” and “me” and the sharing of one’s lived experiences. for instance, one student wrote about racial disparities between school districts and shared this observation: “i have worked with a high poverty school and you can really see the differences in race within the school” (political science, sophomore). another student who wrote an essay on educational disparities shared a personal experience about the challenges of pursuing a college degree. this comment bubble was associated with a part of the essay that discussed lack of family support among firstgeneration college students, compared to second-generation college students: advances in social work, fall 2019, 19(2) 471 this statistic was very impactful to me because as a first-generation college student i know that this is true in most cases. my parents do not understand why i wanted to go to college and are not very supportive of my decision. i had no idea that statistically this can create a big impact on if i obtain a degree or not. (social work, junior) the student shared his identity and experience as a first-generation college student and his relationship with family. he also reacted strongly to the information in the journal article because he personally related to the information. a student who wrote an essay on women and sexism cited an article that discussed how women organize their lives and behavior to minimize their risk of sexual assault and what she did personally to reduce her risk of sexual assault: it is very unfair that women have to live their lives in constant fear that they could be sexually assaulted. i know that i plan out things so that i don’t put myself in risky situations, such as never walking alone at night or always watching my drink at a party. (social work, freshman) the comment suggests that the student is aware that women are at risk of sexual assault because of their sex and gender. the comment also reflects the narrative of personal responsibility and victim-blaming, that is, the perception that women are responsible for or are the ones to blame for sexual assault because of their behavior such as walking alone at night or drinking. future career interests in a few cases, students used the comment bubbles to relate content in their essays to their future career in social work and populations of interest. for instance, a student who wrote about ethnic/racial disparities in standardized test scores, academic achievement, and the quality of education inserted the following: “i loved writing this paper. i became emotional during it because it truly is unfair for individuals suffering from classism and/or racism. i hope as a future social worker to help change some of this.” (psychology, senior). the student reflected on how she felt during the writing process. the student’s use of “unfair” and “suffering” suggest the student empathized with people who experience classism and racism, motivating the student to address educational inequalities as a future social worker. another student used the comment bubbles to reflect on visible and invisible disabilities and express motivation to work with veterans with mental health needs: this is something that is very important to me, and one of the main reasons that i want to work with veterans when i graduate. i feel like because you cannot see a mental illness like you can a physical disability, these men and women do not get the help they need. (social work, freshman) sanchez et al./use of “comment bubbles” 472 discussion the purpose of this study was to understand what students wrote in comment bubbles they inserted in an argumentative essay in a writing-intensive, social and economic justice course. comment bubbles were a pedagogical approach used to engage students in reflection on their writing choices during the writing process. students used the comment bubbles to react to research, elaborate on their writing choices, and reflect on their personal experiences and future career interests. existing literature indicates that college students tend to be resistant to reading journal articles when they are disinterested in the material and lack self-confidence in their reading comprehension skills (lei, bartlett, gorney, & herschbach, 2010). in contrast, this study’s findings suggest that undergraduate students express enthusiasm when reading research on advocacy efforts to meet the needs of vulnerable populations and research that supports their claims. this may be because students searched for journal articles on a topic of their choice and comprehended the journal articles enough to use them as evidence in their essays. the positive reaction to journal articles is consistent with research suggesting that students develop confidence when they learn to gather relevant information and communicate their findings effectively (freeman & lynd-balta, 2010). students used the comment bubbles to elaborate on their word choices and writing strategies. this suggests that students were aware of their audience and were concerned about their ability to communicate effectively. audience awareness refers to actively keeping one’s audience in mind and allowing this awareness to influence one’s writing process such as planning ideas and formulating sentences (wong, 2005). students also shared expressions of writing difficulty in their comment bubbles to elicit feedback from readers, who were the course instructor and graduate teaching assistant. this is consistent with research that college students tend to value teacher feedback on writing assignments when they perceive teachers to have a greater command of language and word choice than they do (zacharias, 2007). this study also found that students used the comment bubbles to share their personal experiences with the reader. the findings are consistent with research that social work students and first-year undergraduate students tend to rely on their personal experiences to write papers (aull, 2015; jani & mellinger, 2015). however, this study’s findings counter results that students fail to link their personal experiences to larger conceptual issues (jani & mellinger, 2015). in this study, students connected their personal experiences to content they read in journal articles such as educational disparities and risk of sexual assault. the findings are consistent with research that students tend to assimilate new concepts by connecting course concepts to personal experiences and information they already know (bean, 2011). finally, to a lesser extent, students used the comment bubbles to reflect on their future career interests. research on undergraduate student writing has found that expressive, creative, and reflective writing used in career-writing courses facilitate development of career identity (lengelle, meijers, poell, & post, 2013; 2014). similarly, this study’s findings suggest that argumentative writing, with the use of comment bubbles, can facilitate reflection on one’s career. although students were not asked to write about their advances in social work, fall 2019, 19(2) 473 future career in this essay, students may have used the comment bubbles to do so because they wrote the argumentative essay on a topic of their choice. indeed, when students are given autonomy to choose their own topics, they tend to be more invested in an assignment because they can pursue their own passions and interests (bean, 2011). limitations this study had limitations. first, this study is drawn from two sections of one course conducted at one university with one instructor in one semester, and therefore, there are limitations to generalizing the findings to students at other campuses. second, student interactions with the instructor and graduate teaching assistant likely influenced students’ comfort level to comment, share their personal experiences, and ask questions in the comment bubbles, and this study did not account for these influences. additionally, this study did not assess student confidence or self-efficacy with regard to academic writing. future research future research will need to examine the extent to which students feel the margin of the paper served as a safe writing environment in which they could express themselves honestly using comment bubbles. student comfort level can vary depending on the type of and level of engagement with instructors and graduate teaching assistants, and this can influence what students write in their comment bubbles. additionally, future research will also need to examine how instructors and teaching assistants respond to student comment bubbles, student perceptions of this feedback, and the extent to which students benefit from the feedback, depending on the goals of the assignment. future research can also consider the impact of using comment bubbles on the nature and effectiveness of peer-review and assess the impact of comment bubbles on students’ critical thinking. implications for social work education the use of comment bubbles as a pedagogical approach that allows students to reflect on their writing has implications for social work education. research has found that when students take part in experiential learning activities and then reflect on these experiences in their writing, they use comment bubbles to examine their emotions, seek understanding of self and others, and recognize their privilege (sanchez et al., 2019). and as the current study finds, when engaged in argumentative writing, students use comment bubbles to react to research they read in journal articles, elaborate on their writing choices, share their personal experiences, and reflect on their future career. clearly, use of comment bubbles can have different pedagogical aims depending on the purpose of the writing assignment, and instructors need to consider how best to use comment bubbles to meet student learning goals. thesis-based argumentative writing assignments such as the one discussed in this study, engage students in complex thinking about debatable issues that can be approached from multiple perspectives (bean, 2011). social work instructors and instructors teaching writing-intensive courses can supplement argumentative writing with comment bubbles to further prepare students to be critical thinkers and skilled writers. for instance, student sanchez et al./use of “comment bubbles” 474 reflections on research can help instructors assess whether students are retrieving relevant information and communicating their findings effectively, particularly in a class such as this one with students ranging from freshmen to seniors with varying degrees of literacy working with peer-reviewed journal articles. student reflections on their writing strategies and expressions of difficulty can help instructors identify areas where students need assistance, be it help writing coherent arguments or paraphrasing quotations, and aid instructors in providing revision-oriented feedback tailored to student comments. this can help students develop their writing skills, particularly students concerned with their writing abilities who may be hesitant to meet with the instructor in person. comment bubbles can help engage students in the writing process however this should not take the place of student-teacher consultations. instructors might also consider inserting their own comment bubbles to engage students with opposing points of view and 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(2007). teacher and student attitudes toward teacher feedback. regional language centre journal, 38(1), 38-52. doi: https://doi.org/10.1177/0033688206076157 author note: address correspondence to: dr. ninive sanchez, assistant professor, school of social work, university of missouri, 712 clark hall, columbia, mo 65211. email: sanchezni@missouri.edu https://doi.org/10.1177/0033688206076157 mailto:sanchezni@missouri.edu _________ phillipe copeland, phd, clinical assistant professor, school of social work, boston university, boston, ma. abigail m. ross, licsw, mph, phd, assistant professor, graduate school of social service, fordham university, new york, ny. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 766-778, doi: 10.18060/24139 this work is licensed under a creative commons attribution 4.0 international license. assessing antiracism as a learning outcome in social work education: a systematic review phillipe copeland abigail ross abstract: the current political climate and reversals of gains made during the civil rights movement underscore the urgent need for preparing emerging social workers to effectively address white supremacy in social work practice. antiracism education in social work aims to ensure competent antiracist social work practice towards the goal of eradicating white supremacy in all its forms. given the widening racial disparities evident in income, health and educational outcomes, it is essential to examine the degree to which social work education adequately prepares emerging social work practitioners to engage in antiracist social work practice. this paper presents findings of a systematic review of social work research assessing antiracism as a learning outcome. after reviewing more than 150 studies published between 2008 and 2018, none of them focused on assessing antiracism as a learning outcome. our review demonstrates that despite the importance of antiracist social work practice, published research on assessment of antiracism as a learning outcome is sparse and is not antiracism-focused as much as it is antiracism-inclusive. more attention to identifying and disseminating best practices for assessing student competence in antiracism practice is required to defeat white supremacy. keywords: white supremacy, antiracism, racism, social work education how do we know that learning has occurred? the simple answer is that we look to see if there has been some kind of change in what a student can do. (wehlburg, 2010, p. 45) white supremacy is an historically based system of exploitation and oppression that generates and concentrates wealth, power, and privilege among white people at the expense of non-white people. this system is perpetuated through culture, beliefs, ideas, policies, laws and institutions that make it appear to be rational and/or ethical. culture, beliefs, policies, laws and institutions also work together to obscure the existence of white supremacy, how it operates, its impact, and who benefits from it (copeland et al., 2019). antiracist social work practice is activism to resist and ultimately eliminate white supremacy, empowered by recognizing it accurately and thinking critically about white supremacy’s origins, manifestations, and impact. antiracism education in social work aims to ensure competent antiracist social work practice. it is comprised of knowledge, values, skills, and cognitive and affective processes (gollan & o’leary, 2009; miller & garran, 2017; o’neil & miller, 2015; tisman & clarendon, 2018). in recent years, white nationalism has emerged as a disturbing feature of political life (birkhold, 2019). white supremacist ideas are openly expressed and rationalized as free speech, science, or differences of opinion (beauchamp, 2019). specifically, harassment, hate crimes, and domestic terrorism are on the rise (beckett, 2019; carasquillo, 2019; williamson & gelfand, 2019); a 2018 report by the southern poverty law center indicates that the about:blank copeland & ross/assessing antiracism 767 number of known hate groups in the united states rose to an all-time high in 2018, up 30% in the three year period ending in 2017. hard won gains like voting rights are being undermined through systematic and governmentally-sanctioned voter suppression efforts targeting black and brown communities (mccarthy, 2019). human rights are being violated at national borders (gumbel, 2019), on indigenous lands (serpe, 2019), and within impoverished communities (alcorn, 2019). the current sociopolitical climate underscores the danger posed by white supremacy and the urgency of educating social workers who can competently practice antiracism to defeat it. background antiracism education in social work antiracism education in social work seeks to develop practitioners who can effectively counter racism and white supremacy. it is comprised of knowledge, values, skills and cognitive and affective processes involved in recognition, critical thinking, and activism. both inwardly and outwardly directed, recognition requires students to develop capacities for self-awareness and reflection about their personal racial identities (gollan & o’leary, 2009; o’neil & miller, 2015; simmons et al., 2008). emerging social workers should also be attentive to the ways clients self-identify (butler et al., 2003), recognize the various ways in which racism permeates society (miller & garran, 2017; tisman & clarendon, 2018), and the role of history in the creation and perpetuation of racism (miller & garran, 2017; o’neil & miller, 2015; tisman & clarendon, 2018). recognition is complemented by critical thinking about racism as a structural issue that impacts white people and people of color differently (gollan & o’leary, 2009; simmons et al., 2008; tisman & clarendon, 2018). some authors emphasize analysis of white identity and/or differential tasks for white people and people of color as necessary for antiracism (kivel, 2006, as cited in deepak & garcia biggs, 2011; gollan & o’leary, 2009; simmons et al., 2008; tisman & clarendon, 2018). gollan and o’leary (2009) refer to this analysis as accountability, which requires white people to understand their social position and cultural identity, how power through racial domination shapes relationships, the invisible nature of whiteness and institutional racism, and how these factors can play out relationships with clients/communities. in addition, recognition requires a focus on the experiences of those living with racism versus the intentions or feelings of those in the dominant group. while all individuals are living with racism in some form, all social work students must learn to recognize and be sensitive to the impact of racism and oppression— and the ways in which oppressive ideas can be transferred across targeted identities and groups. social work students must also learn to demonstrate the ability to apply diverse sources of literature reflecting a range of perspectives on practice and the multiethnic nature of the profession (butler et al., 2003). the ability to comprehend and critically engage the historical development of racism is also essential (tisman & clarendon, 2018). antiracism applies recognition and critical thinking to activism at multiple levels, from the personal to the structural (werkmeister rozas & miller, 2009). for example, it is not sufficient to recognize or think critically about one’s racist ideas or beliefs; they must also advances in social work, summer 2021, 21(2/3) 768 be resisted and changed (werkmeister rozas & miller, 2009). kivel (2006, as cited in deepak & garcia biggs, 2011) argues that white people must acknowledge their active and passive participation in racism as well as actively commit to interrupting racism and becoming allies with people of color. antiracism also promotes connection and solidarity (o’neil & miller, 2015; werkmeister rozas & miller, 2009), which includes developing authenticity, empathy, and mutuality (davis, 2016). although antiracism underscores the importance of structural analysis and social change through policy advocacy, it must also be used in clinical practice with individuals, groups and families (butler et al., 2003; hamilton-mason & schneider, 2018; o’neil & miller, 2015; tisman & clarendon, 2018). in light of the emphasis on competency-based education in social work (council on social work education [cswe], 2008, 2015), antiracism education can be understood as focused on developing competency in antiracist social work practice. specifically, antiracist social work practice is activism to resist and ultimately eliminate white supremacy, empowered by recognizing it accurately and thinking critically about white supremacy’s origins, manifestations, and impact. in the current structure, antiracism could be conceptualized within competency #3: advancing human rights and social, economic, and environmental justice. a competency-based approach to assessment of antiracism learning outcomes in social work is critical not only for policy and community practitioners, but also for clinicians (goggin et al., 2016; varghese, 2016). assessing learning competency-based education is focused on learning outcomes (cswe, 2008, 2015). this can be understood as a “value-added” approach, defined as what the learner gains from a course of study (department of education, 2006 as cited in drisko, 2014), as opposed to the experiences a student has or the processes through which they learn. optimal measures of competence are based in real-world performance, address open, dynamic, and complex practice situations and require learners to make considered judgments in specific contexts while incorporating professional values (drisko, 2014). social work education assessment metrics should also evaluate the multiple dimensions of competence including knowledge, values, skills, and cognitive and affective processes (cswe, 2015). recommendations for assessing competence include course assignments or graded tests with rubrics directly linked to identified competencies or the use of standardized measures (drisko, 2014; poulin & matis, 2015). practice assessment in student field placements is another approach (drisko, 2014; poulin & matis, 2015). while assessment methods, such as self-efficacy measures, student self-evaluations, alumni surveys, and course evaluations may be commonplace, they present a host of limitations when used in isolation. self-reported measures of self-efficacy may capture readiness and confidence, but not actual practice ability. alumni surveys fail to address the ways in which experiences beyond the program threaten internal validity. course evaluations are typically designed to evaluate course content or instructor performance, rarely assessing student competency; in addition, they may be subject to attribution bias and questions of validity (drisko, 2014). feedback questionnaires administered at the end of a course or program are limited due to copeland & ross/assessing antiracism 769 the lack of baseline data. without comparison or control groups, observed changes cannot be attributed exclusively to an educational intervention (carpenter, 2011). the present study given the necessity of competent social work antiracist practice, social work educators must know if they are adequately preparing students to engage in it. this requires assessing antiracism as a learning outcome. to effectively assess antiracism as a learning outcome involves determining if a student has demonstrated the knowledge, values, skills, and cognitive and affective processes required for antiracist social work practice. the goal of the present study was to critically review the research literature on antiracism education in social work and the manner in which learning is assessed. to our knowledge, this is the first systematic review of such research. study aims: • to examine the extent to which antiracism is assessed as a learning outcome in social work education; • to consider, identify, and evaluate the different approaches to assessing antiracism as a learning outcome. methods the systematic review was designed, conducted, and reported according to guidelines provided by the social care institute of excellence (rutter et al., 2010). refer to figure 1 for specific database search terms. search strategy to achieve specificity, use of these search terms was limited to titles and abstracts. the authors chose to limit inclusion of studies to those published between 2008 and 2018, as competency-based education guided by specific criteria has been a focus of social work education since 2008 (cswe, 2008). the authors employed a double-search and screening strategy to increase reliability (rutter et al., 2010) that was divided into three phases. in phase 1, inclusion criteria were applied to titles retrieved through the search strategy to determine relevance. specifically, only titles with all three of the primary review concepts/keywords were retained for additional screening. these included “racial justice” or “antiracism”, “education”, and “social work”. in phase 2, each abstract for the included titles was reviewed and retained for inclusion in phase 3 if it met the following criteria a) contained an empirical assessment of student learning outcomes, b) referenced explicit assessment of student learning outcomes related to racism, c) examined a sample comprised of social work students, d) was peer-reviewed and e) published in english. phase 3 involved full text review of articles retrieved during phase 2. during each phase of the review process, each author independently assessed all studies to ensure they met inclusion criteria; disagreements were resolved through discussion and consensus. advances in social work, summer 2021, 21(2/3) 770 included studies were subsequently categorized as either antiracism-inclusive or antiracism-focused. studies were classified as antiracism-inclusive if they did not explicitly assess antiracism as a learning outcome, but did assess aspects of antiracism education described in the literature that served as the background for this study. examples included: 1. the ability to identify forms of oppression at individual, institutional and societal levels; 2. the ability to attribute racial inequality to structural vs. individual causes; 3. the ability to understand racism as an experience of oppression and marginalization; 4. the ability to understand white privilege. alternatively, studies were classified as antiracism-focused if the explicit purpose of the study was to assess antiracism as a learning outcome. figure 1. study databases and search terms databases academic search premier, psycinfo, psycarticles, psycbooks, education index, social-science full text, social service abstracts, sociological abstracts, assia, eric, web of science, project muse concept 1: racial justice “racial justice” or “antiracism” or “cultural competence” or “racism” or “race” or “racial inequality” or “racial discrimination” or “social justice” or “race relations” or “intersectionality” or “microaggressions” or “racial equity” or “critical race theory” or “ethnicity” or “color” or “tribal” concept 2: social work “social work” or “social services” or “social care” concept 3: swk education education or teaching or pedagogy or training or “social work education” or “social work curriculum” or “competency” use a table or info graphic copeland & ross/assessing antiracism 771 results the search yielded 150 unique records published in english between january 1, 2008 and september 1, 2018. of these, 23 abstracts (15.3%) met inclusion criteria. full text review eliminated 20 articles that lacked the required information. the final sample contained three (2.0%) unique studies that met all inclusion criteria, with publication dates ranging from 2016-2018. despite the international scope of the search parameters, all studies meeting inclusion criteria were conducted in the united states. based on the aforementioned criteria, all studies were classified as antiracism-inclusive. study characteristics all included studies drew from samples of masters (dessel & rodenborg, 2017; pitner et al., 2018) and bachelor-level (block et al., 2016) social work students, with sample sizes ranging from 126 to 286 subjects. all studies were longitudinal in nature, evaluated structured learning activities that were required (not optional), and used student surveys administered at pretest (prior to commencement of learning activities) and posttest (near the end or after completing the learning experience) as methods of evaluation. all data were collected via self-report. two studies utilized single group pretest-posttest designs; each of these studies evaluated student participation in a class required of all students enrolled in their respective social work programs. block and colleagues (2016) examined student learning outcomes of a bachelor in social work (bsw) course that focused on exploration of students’ cultural awareness, bias and competence, as well as skills of understanding and empathizing with the experiences of diverse populations. dessel and rodenborg (2017) evaluated student learning outcomes of a course using inter group dialogue (igd) pedagogy, which involved structured, facilitated interactions between students with different social identities designed to build relationships across difference, increase understanding of the experiences of those different than themselves, and promote social justice. the third study utilized a quasi-experimental design to examine the utility of two strategies designed to enhance social work student learning outcomes. specifically, pitner and colleagues (2018) examined whether student learning outcomes differed across students assigned to a dedicated diversity course (n=83), or those who participated in a more general infusion model employed in their social work program of study (n=107). the researchers also included a group of psychology undergraduate students (n=106) as a null comparison group, as they were not exposed to either pedagogical strategy. competency assessment tools and target domains each of the three studies referenced the council on social work education educational policy and accreditation standards (cswe epas) (2015) competencies as their basis and either utilized validated instruments or developed project-specific measures to assess a) attitudes and perceptions, b) acquisition of knowledge and skills, or c) changes in behavior. advances in social work, summer 2021, 21(2/3) 772 block and colleagues (2016) used the california brief multicultural competence scale (der-karabetian et al., 2008) to assess cultural competence. dessel and rodenborg (2017) created the multi-university igd research project scale that examined student target outcomes of social awareness, knowledge about inequality, confidence in specific use of micro/macro skills, and confidence in capacity to engage in social justice action. the posttest also included a question about student behavior since course inception, inquiring about the degree to which social justice action engagement had occurred (university of michigan, n.d.). pitner and colleagues (2018) adapted a variety of validated instruments, including the transcultural self-efficacy tool (jeffreys & smodlaka, 1996, 1998), the multicultural awareness, skills and knowledge survey (andrea et al., n.d.), the survey of graduate students’ experiences with diversity (talbot, 1992), the social work competencies self-assessment pretest (lum, 2010) and social work cultural competencies with culturally diverse groups and social and economic justice pretest (lum, 2010). all instruments were administered via survey and relied on student selfreport. study findings the majority of students were white, female, and young adults; findings from all studies showed that social work educational initiatives did in fact improve student learning outcomes. specifically, findings from block et al (2016) show that students self-reported levels of multicultural competency increased significantly after completing a required bsw course in cultural diversity. similarly, dessel and rodenborg’s (2017) evaluation of igd found that at post-test, students reported significant increases in self-awareness as pertaining to membership of social identity groups, knowledge about structural group inequality, and both confidence in and motivation to bridge differences and take action to address prejudice, discrimination, and injustice. further analyses showed that participant race and social contact did not predict change in confidence in and frequency of taking social justice action; similarly, baseline levels of knowledge about racial inequality and motivation to bridge differences did not predict change in action at posttest. the results of pitner and colleagues (2018) showed that both the dedicated diversity course and the infusion groups outperformed the non-exposed comparison group on four of five outcomes of 1) awareness of cultural background influences, 2) identifying forms and 3) identifying levels of oppression, and 4) cultural responsiveness. the authors note that there were no between-group differences observed on the fifth outcome of awareness of beliefs and biases across any exposed or non-exposed group. students participating in the dedicated diversity course also scored significantly higher on outcomes of identifying levels and forms of oppression and cultural responsiveness when compared to the students exposed to the infusion model. discussion and implications this systematic review sought to identify and evaluate empirical social work literature assessing antiracism as a learning outcome. the primary finding was that no antiracismfocused literature meeting inclusion criteria were identified. thus, such literature could not copeland & ross/assessing antiracism 773 be evaluated. this finding is remarkable, given the emphasis placed on antiracism education in social work (blitz et al., 2014; kivel, 2006, as cited in deepak & garcia biggs, 2011; miller & garran, 2017; o’neill & miller, 2015; werkmeister rozas & miller, 2009). a possible explanation is current epas standards (cswe, 2008, 2015) do not explicitly specify antiracism as a competency to be taught, learned, or assessed. the search strategy yielded three studies characterized as antiracism-inclusive (2.0%). methods used to assess race and racism involved learning activities aligned with the epas (cswe, 2015, p. 7) framework, wherein outcomes were included explicitly or implicitly under “engaging diversity and difference” (block et al., 2016; dessel & rodenborg, 2017; pitner et al., 2018). included studies primarily assessed the knowledge and cognitive processes dimensions of learning (carpenter, 2011; drisko, 2014, 2015; poulin & matis, 2015), with only one study (pitner et al., 2018) including a question about behavior (selfreport). in general, study findings offered little insight about changes in affective processes, values, or skills, much less practice behaviors. in addition, the absence of randomized trials makes it challenging to draw conclusions about the efficacy of particular teaching methods, courses, or pedagogies. future studies should include more rigorous study designs that employ observational measures and explicitly link the competency domains to learning outcomes, while addressing all of the domains rather than just some of them. it is possible that the paucity of studies meeting inclusion criteria may not accurately reflect the current state of social work education with regard to antiracism. interestingly, none of these studies included an evaluation of field education, the signature pedagogy of social work and arguably the domain in which observation could effectively occur. all accredited schools of social work require field education evaluations by supervisors; these could provide a rich source of information about antiracist practice competencies. in addition, classroom-based social work educators may in fact be teaching antiracism, but choose not to conduct research on student learning outcomes or disseminate findings through peer-reviewed journals. the absence of reliable and valid measures that assess antiracist student competencies may also interfere with assessment capacity and hinder dissemination activities. future research should include development of psychometrically sound metrics for assessing student competency in antiracist practice. this systematic review suggests a number of implications for social work education and research. first, more research that specifically assesses antiracism as a learning outcome must be conducted. it is critical to examine whether students are learning antiracist social work practice and which teaching methods are most effective for accomplishing this goal. for example, findings from pitner and colleagues (2018) showed that while both dedicated and infusion course models yield positive outcomes, the dedicated diversity course outperformed the infusion model. although findings are not generalizable to all social work student populations, more research is needed to evaluate various models of delivering antiracism education. ultimately, including antiracismrelated items within explorations of diversity or cultural competency is simply not sufficient. such concepts fail to adequately address the nature of the problems that racism and white supremacy represent, or provide solutions to them (abrams & moio, 2013). advances in social work, summer 2021, 21(2/3) 774 review findings also raise important questions. specifically, while all included studies were characterized as antiracism-inclusive, further investigation of specific content – and whether it is antiracist – is warranted. although social work education typically includes the concept of microaggressions, a term first coined by chester pierce in 1970 that to describe subtle racial putdowns that degrade health over a lifetime (pierce, 1970), dr. ibram kendi maintains that these instances are not at all “micro” and are more aptly termed “racial abuse” (kendi, 2019, p. 47). given that results showed that epas (cswe, 2015) competency definitions appeared to drive assessment orientation and competency conceptualization, it is possible that, if future revisions of epas were to make antiracism an explicit and discrete competency, more studies examining antiracism as a social work student learning outcome would be conducted. what impact might this have on teaching, learning, assessment, and dissemination of antiracist concepts and practice in social work education? how might this empower social work education to better prepare student to resist and ultimately eliminate white supremacy? study limitations these results must be considered in light of study limitations. while applying rigorous review methods, it did not include sources beyond peer-reviewed journal articles. it was also restricted to a ten year period and english language sources. thus, it is possible that relevant studies may have been missed. given what was noted previously about the internally-focused nature of some assessment work, reviewing publications may have also limited what could be learned about the quantity, methods, and quality of assessments being conducted. conclusion eradicating white supremacy must be an urgent priority in social work practice. as such, developing the knowledge, values, and skills necessary for antiracism practice must be a priority for social work education. this systematic review sought to explore literature focused on assessing antiracism as a learning outcome, yielding a paucity of literature on the topic. more attention to assessing antiracism, evaluating and developing assessment methods, and disseminating best practices in social work education is necessary. references abrams, l. s., & moio, j. a. 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(2019, august 14). trump and racism: what do the data say? brookings institute. https://www.brookings.edu/blog/fixgov/2019/08/14/trumpand-racism-what-do-the-data-say/ author note: address correspondence to phillipe copeland, phd, school of social work, boston university, boston, ma. email: copelanp@bu.edu https://doi.org/10.1002/tl.408 https://doi.org/10.1080/15313200902874953 https://www.brookings.edu/blog/fixgov/2019/08/14/trump-and-racism-what-do-the-data-say/ https://www.brookings.edu/blog/fixgov/2019/08/14/trump-and-racism-what-do-the-data-say/ mailto:copelanp@bu.edu this work is licensed under a creative commons attribution 4.0 international license. seeking refuge: an exploration of unaccompanied minors and women from somalia and pakistan experiences of services in bangkok, thailand aster s. tecle kara byrne kimberly schmit mary beth vogel-ferguson naima mohamed abdulkhaliq mohamed rosemarie hunter abstract: the number of unprotected urban refugees in bangkok has grown over the past few years with new migrations of young women, men and families from somalia and pakistan. an urban environment can mean opportunity for some but for many the environment can increase vulnerability to exploitation and detention. this study aimed to explore refugees’ experiences in bangkok, assess agencies’ service delivery models, and strengthen their capabilities to address service gaps. participants were recruited using purposeful sampling and snowball. using cbpr, focus groups discussion with somali and pakistani refugees (n=63) and individual interviews (n=42) were conducted. agencies’ staff (n=23) were interviewed regarding challenges in providing services to refugees. qualitative data analysis revealed four major themes: lack of basic need, problems with legal services, agencies revealed urgent need for shifting from emergency services towards long-term strategies given the protracted immigration status of urban refugees, and the need for a collaborative approach in service provision emerged as an urgent call. implications to social work practice with urban refugees focusing on potentials for innovative service provision and collective agency responses are discussed. keywords: refugees; urban refugees; asylum-seekers; refugee services; community-based research; partnerships while bangkok has always been a well-known destination for refugees and asylumseekers, something is different today. over the past few years, bangkok has experienced new waves of migration including women, children, and families from somalia and pakistan. with over 9,000 new refugees and asylum-seekers coming into the city from 1996 to 2015 the new migration phenomenon is challenging current resources and knowledge, putting into question the relevance of existing service delivery models and organizational policies (un high commissioner for refugees [unhcr], 2015b). while an urban environment can mean opportunity for some, for many more this urban environment can increase vulnerability to being exploited, arrested, or detained (unhcr, 2017b). thailand is unique. the nation has not signed onto the 1951 un refugee convention and does not have a legal framework in place to support asylum-seekers and _________________ aster tecle, phd, is an assistant professor, college of social work, university of utah, salt lake city, utah 84112 (uu csw). kara byrne is a research assistant professor, social research institute, uu csw. kimberly schmit is the project coordinator for bridging borders, community organizer and artist, uu csw. mary beth vogel-ferguson is a research associate professor, social research institute, university of utah. naima mohamed is a social worker with the department of workforce services, salt lake city, utah. abdulkhaliq mohamed is a partnership manager, university neighborhood partners, university of utah. rosemarie hunter, associate professor, uu csw. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 1005-1022, doi: 10.18060/21639 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 1006 refugees. with the emergence of the syrian refugee crisis, and already scarce resources, crucial attention has been diverted away from bangkok, even as the numbers of unprotected urban refugees has grown (potter, 2014). the context: seeking refuge and finding fear the united nation’s convention relating to the status of refugees, adopted in 1951, lays the foundation for international human rights relating to refugees and asylum-seekers. the convention offers the widely accepted definition for the term “refugee” and creates the framework for states to recognize rights to protect refugees. article 1(a)(2) of the 1951 convention defines a refugee as a person who, “as a result of events occurring before 1 january 1951 and owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable, or owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it” (un, 2011, p. 16). oftentimes, when there is an influx of migrants fleeing into a country, it is impossible to process every individual for formal refugee status. in these circumstances, people may be referred to as an asylumseeker, or “someone whose request for sanctuary has yet to be processed” (unhcr, 2017a). globally speaking, the unhcr serves as the guardian for the 1951 refugee convention (unhcr, 2011). this convention is an instrument for states to develop their legal framework and stemming from the un declaration of human rights, has a foundation in non-discrimination, non-penalization, and non-refoulement (unhcr, 2011). specifically, the convention sets standards that give refugees access to education, work, and courts (unhcr, 2011). unfortunately, thailand is not one of the states who has signed onto the 1951 convention, leaving many asylum-seekers who have fled to this country in an extremely vulnerable situation (unhcr, 2015b). the 145 nations that have signed onto the convention have made a commitment to significantly increase protections and overall well-being for refugees who flee to their homeland. without signing onto the 1951 convention and without a legal framework for handling refugees and asylum-seekers, thailand is left with few options for handling an estimated 130,000 individuals who are asylum-seekers and refugees (unhcr, 2016; universal periodic review [upr], 2015). moreover, according to unhcr, by 2009 more than half of the world’s refugees resided in cities and towns, compared to one third who live in camps. in recognition of the changes in the size and composition of the urban refugee population, as well as the protection risks facing these refugees, unhcr released a comprehensively revised policy on refugees in urban areas in 2009. the policy has two principal objectives: (1) to ensure that cities are recognized as legitimate places for refugees to reside and exercise the rights to which they are entitled; and, (2) to maximize the protection space available to urban refugees and the humanitarian organizations that support them (unhcr, 2009). this approach is a significant departure from the previous policy of giving primary attention to refugees in camps, and an acknowledgement that movement to urban areas can be a tecle et al./seeking refuge 1007 legitimate response to lack of access to livelihoods, education, and even physical and material security in some camps” (unhcr, 2009). while thailand has not signed onto the convention, the state is bound to international human rights standards, which include basic human rights along with a non-refoulement policy that dissuades a state from sending asylum-seekers back to the country from which they have fled. this has created an anomalous life experience in thai refugee camps and urban settings. the refugee camps are an organized response to asylum-seekers; however they are deeply confining. thailand has responded to the influx of asylum-seekers in the creation and management of nine refugee camps along the thai-burma (myanmar) border. these camps house approximately 106,321 refugees from burma (myanmar), with a large portion of assistance coming from non-governmental organizations such as jesuit refugee services (jrs) and the international rescue committee (irc) (unhcr, 2016). while the camps meet basic needs (albeit in a volatile manner), without legal rights in the country, a refugee living in a camp is restricted in their ability to come and go from the camp as they please. camps have been the most formalized response to asylum-seekers in thailand, but a legal framework and response is lacking for the urban asylum-seekers and refugees arriving from nations other than burma (myanmar) (unhcr, 2016; upr, 2015). this urban population of bangkok’s refugees is changing with the emergence of pakistani and somali refugees in the past few year. these new populations have presented unique challenges for the agencies that serve urban refugees and are the focus of our article. individuals seeking refuge arrive in bangkok and initially link to services through informal networks and wordof-mouth referrals through peers. while a dense urban population makes the word-ofmouth referrals possible, this is not a sustainable or consistent mechanism for linking refugees to resources. while struggling to obtain basic needs, individuals are simultaneously working with unhcr to register, secure an interview, and receive determination on their migration status. while lack of a legal framework leads to a shaky foundation for these individuals seeking refuge, unhcr continues to process these applications, perhaps in hopes that a refugee status determination will lead to increased access to resources, resettlement, or the adoption of a legal framework that will open up opportunities. with continued conflict in their countries of origin, repatriation is not an option for these individuals. at this point, however, refugee status determination simply leads to the very slim chance at resettlement. the initial interview and determination process takes time and while experience and expertise is high within unhcr, with constrained resources towards refugee services, capacity to process asylum-seekers and refugee determination is limited. in bangkok, individuals seeking refuge are currently waiting an average of 4 years before their refugee status claims are heard (upr, 2015). during the course of the study, unhcr increased the number of staff processing claims and progress was being made on the backlog of cases. due to the lack of national legal framework for integrating asylum-seekers and refugees, in conjunction with the lengthy wait time to begin the unhcr determination process, asylum-seekers and refugees are vulnerable to many human rights violations. without legal status, they are at risk for arbitrary arrest, detention, and exploitation. the advances in social work, spring 2018, 18(3) 1008 upr (2015), a tool used by un states to assess human rights, lists the top five human rights concerns in thailand as arbitrary detention, lack of basic needs (e.g., shelter, food), education, refoulement, and healthcare. lack of legal status puts asylum-seekers at risk of being stopped and arrested anywhere in thailand, including in their homes but the dense population in bangkok makes the risk of detention even higher. as people travel to and from their homes, via bus, long walks, or taxi, their risks for arrest increase. being arrested is a traumatic experience, leading to detention and division of families. the bangkok detention center has received negative international attention for keeping people in foul, confined conditions (global detention project, 2017). many refugees and asylum-seekers fear leaving their home with the looming threat of detention at their doorstep. as a result, the unique urban context of bangkok, thailand has led to an isolating and dangerous life for urban asylum-seekers and refugees. bangkok urban asylum: the journey to limbo somali and pakistani asylum-seekers are fleeing complicated and traumatic environments. asylum-seekers from somalia are fleeing decades-long civil war and sexual and gender-based violence (sgbv) (pickering, 2011). in bangkok, the majority of the asylum-seekers from somalia tend to be women and men in their early 20’s, many who arrived in bangkok as unaccompanied minors and single mothers. the pakistani community in bangkok is made up of christians and hammadi muslims fleeing religious persecution. they fled as families and are living together in bangkok. the journey to thailand across the somalis and pakistanis varies; some are smuggled, others arrive by boat, travel by bus from malaysia, all to seek refuge in the thai capital, bangkok. consistent with the interviews in this study, pickering (2011) describes the specific terror that many women face as they travel towards asylum. the violence towards women does not end after crossing state borders but continues along the journey. upon arriving in crowded international bus terminals in bangkok, some seem confused on where they are, having paid for travel to a transition country as asylum-seekers and then abandoned in bangkok (potter, 2014). service providers have expressed concerns over increased risk of abuse of asylum-seekers because of misinformation regarding the migration process (unhcr, 2015b). the lack of formal infrastructure or response has led to significant misinformation, which may exacerbate migration to cities such as thailand, without the resources to support the influx. families move or push their children towards a perceived better life, but that is not the case for the somalis and pakistanis in bangkok (oppedal & idsoe, 2015; vervliet, vanobbergen, broekaert, & derluyn, 2014). the realities of surviving in bangkok lies in stark contrast to their hopes of a new life (jesuit refugee services, 2015). thailand does not have a formal asylum framework and receiving official refugee status is a long process with no assurances (unhcr, 2015b). while people wait for a chance at refugee determination and the small chance of resettlement, there is the present-day reality in limbo. in countries without effective protection measures, such as thailand, asylumseekers are more susceptible to experience abuse from employers (migration policy institute, 2015). as a result, many are unemployed or in illegal employment and risky tecle et al./seeking refuge 1009 circumstances. additionally, with no documentation or work papers, bangkok’s refugee community remains vulnerable to arrest and myriad forms of exploitation and abuse (migration policy institute, 2015; unhcr, 2015a). without a job, within weeks, somali and pakistani refugees find their savings depleted, languishing in a small apartment with little food, let alone hope for employment (steele, 2014). an asylum seeker's journey is often leaden with trauma. studies have uncovered the trauma that women with refugee status have witnessed or experienced in their journeys away from violence, although additional research is needed to continually assess the unique needs of women in bangkok and develop culturally relevant treatment approaches (holt, 2013; robertson et al., 2006; schmidt, kravic, & ehlert, 2008). women may be survivors of rape, sexual and other forms of gender based violence (sgbv), or domestic violence and may not be initially equipped to cope with trauma (jesuit refugee services, 2015). methods in response to the drastic shift in the needs of asylum-seekers in bangkok, jesuit refugee services (jrs) in thailand collaborated with faculty and students from the university of utah, college of social work in the implementation of a community-based participatory research (cbpr) project. the focus was on the evaluation and improvement of the current service delivery model and examining the potential of a collective agency response to address challenges and gaps. the research team consists of staff from a local ngo, faculty, and students from the college of social work. researchers conducted 42 interviews with 63 individuals representing refugee and asylum-seekers from somalia and pakistan the team began this project with two aims in mind: (1) exploring the experiences of somalis and pakistanis residing in bangkok as urban refugees and/or asylum-seekers to assess and better understand formal and informal networks for accessing services, as well as gaps and challenges for obtaining services. (2) strengthening partners’ capacity by providing trainings on case management and community practice based on local demands. jesuit refugee services and the university of utah, college of social work have partnered on a variety of projects, including bridging borders, a community-university partnership with camp and migrant communities along the thai/burma (myanmar) border since 2012. both university and community partners expect the partnership to continue and evolve as a long-term applied research, teaching and practice collaborative with the aim of investigating and responding to refugee issues in urban settings in the asia pacific region. within a community-based participatory research (cbpr) framework, ngo partners identified the following goals for the research: a) to assess and better understand challenges accessing services; and b) to develop jrs’s capacity to address service gaps. the longterm aim was to gather information that will increase case managers’ understanding of diversity in the community and inform development of innovative treatment and practice aimed at working with asylum-seekers’ strengths and needs. advances in social work, spring 2018, 18(3) 1010 working to change the pervasive narrative of refugees as needy and refugees as consumers of services to refugees as strong and co-creators of services, a community development and asset-based approach were utilized in the development, implementation, and thematic analysis of the data. according to community development exchange, “a community development approach’s key purpose is to build communities based on justice, equality and mutual respect. community development involves changing the relationships between ordinary people and people in positions of power, so that everyone can take part in the issues that affect their lives. it starts from the principle that within any community there is a wealth of knowledge and experience which, if used in creative ways, can be channeled into collective action to achieve the communities' desired goals” (2008). community based participatory research (cbpr) is another way of collaborating with communities to explore and better understand social phenomena communities are experiencing. cbpr is a process of learning and knowing based on communities’ own terms (minkler & wallerson, 2003; strand, 2000). communities identify, describe, assess and plan ways of addressing social issues of concern with research experts engaging as partners or collaborators (anderson, 2006; strand, 2000). one of the unique characteristics of cbpr as a methodology and method is that cbpr is based on the premise that communities’ ways of knowing are central and equally legitimate as any other centered knowledge, in research and that cbpr is action oriented towards social transformation (strand, 2000). communities take charge of their own affairs in terms of design, implementation and follow-up, which ensures sustainability, together with mutual and equally shared partnerships with external partners. the goal of such an interpretive research was to better understand a phenomena for the researchers and those impacted by the social phenomenon so that both of them can explore alternatives or other possibilities (yanow, 2000). social work practice being inherently pedagogical (freire, 1990), using cbpr and field observation to explore immigrants experiences in bangkok was central as a colearning process and building relationships during the study period. utilizing these paradigms, the research team made up of lead individuals from jrs and the csw codeveloped the research topics and questions, research methods, and identified key community, agency, and community based organization stakeholders to be interviewed. the following sections include the interview, study participants and emerging themes from the study followed by discussion and future plans. the interviews in order to develop a comprehensive service delivery and advocacy response supporting urban refugees and asylum-seekers from somalia and pakistan, interview guides gathered information on: the experiences in accessing services and the challenges of newly arriving communities to better understand existing gaps in services and inform practice. as summarized in table 1, 42 interviews were conducted with 23 ngos and cbo’s staff who served and advocated for the refugee communities, and with 63 refugees and asylum-seekers from somalia and pakistan. the research team included faculty (4), students (2) and community partners (2) who conducted the interviews. through a purposeful sampling technique, service providing agencies identified refugees and asylumtecle et al./seeking refuge 1011 seekers and recruited those who were willing to participate in the study. a snowball method also occurred, sometimes with interviewees mentioning another person to interview and sometimes the translator. all of the interviews happened in the interviewees’ apartments or a neighbor’s apartment. conversations with staff from jrs, other agencies and community based organizations happened at their respective places of work. participants from agencies and cbos were mainly staff selected randomly. table 1. number of participants and interviews participants # of interviews # of people interviewed agency staff 9 17 community based organizations 4 6 somali community members 21 23 (16 ♀, 7 ♂) pakistani community members 9 17 (13 ♀, 4 ♂) total 42 63 jesuit resettlement services (jrs) provided somali and pakistani translators for the relevant interviews. the translators received training by college of social work (csw) researcher team. the research team also included members with refugee and/or asylum seeking backgrounds now residing in the united states. for example, one researcher, a us citizen originally resettled from somalia and was extremely valuable to the team in developing trust with the somali community in bangkok, as well as providing other team members with cultural context. it is important to mention that the interviews were conducted the week following a raid in the communities where some of the interviews took place. jrs and interviewees reported that between 40-65 asylum seekers and refugees were arrested including 25 children. the partnership relied heavily on community-based interpreters of refugee background, not only to translate interviews but also serving as guides in the community, community liaisons, and connecting with potential participants. the research team came to develop important professional relationships with the translators, filled with trust and deep respect. the interviews took place in neighborhoods across bangkok where the somalis and pakistanis were living, and at agencies’ offices. an irb application was approved by the university of utah. it is important to note that the research team made explicit decision not to ask interviewees about the reasons for immigrating to bangkok from somalia and pakistan, nor about their migration stories. this was to avoid re-traumatizing the individual, as well as to move away from the dominant, and disempowering, approaches to refugee narrative that focus mostly on trauma stories. however, participants shared their stories, which could be due to power differentials, or the possibility that comes with telling one’s story, or simply the familiarity that comes with sharing one’s life story with interviewers. the research team embraced the stories as potentially therapeutic and a natural opportunity of listening to support healing. collected information was transcribed, reread and discussed by team members. together with partners’ contributions, shared identification of major themes revealed recurring events and experiences participants reiterated during the interview. the results section details what emerged from the conversations. advances in social work, spring 2018, 18(3) 1012 results with the exception of one female, somali interviewee, individuals reported leaving somalia when they were between the ages of 13 and 16, with age 15 as the most common. 68% interviewed had been in bangkok since 2014 (2 years at the time of the research), 21% after 2014 (less than 2 years), and 11% before 2014 (more than 2 years). the next section presents three major themes from the findings of this study, (1) services and support in bangkok, (2) legal services and (3) shifting towards a collective response. examples of each theme can be found in table 2. themes table 2. major themes themes examples basic needs and referrals “i went agency 1, but they send me back to agency 2. when i go to agency 2 then they send me back again to agency 1.” legal services “agencies collaborate but refugees don’t know” shifting to a collective response “scattered resource locations won’t work” basic needs and referrals while agencies who provide services to urban refugees provide information about their services, study participants shared that there is a lack of information regarding what services exist for asylum-seekers, how to access these services, and an understanding of how the systems work in bangkok. unhcr provides a booklet with information about all the ngos and their services to individuals who visit their offices. nevertheless, individuals who participated in the interviews indicated that the primary way to contact service providing agencies (community-based organizations [cbos], faith-based institutions [fbis] and non-governmental organizations [ngos] is through word of mouth from their respective communities, informal connections with other communities, and referral to these agencies. many study participants shared a similar story of being lost and isolated when arriving in bangkok, often not knowing where they were or who and how to connect to resources in the community. resources are scattered around the city and transportation into the heart of the city felt like navigating a maze. a female, 17 years old participant recounts his arrival to bangkok: so the thing is, when i first arrived here, i took a cab to drive me to the town but i had no clue where to go or if there were some somali people around this area, so i was taking the cab and i’ve been in the cab for a long time, but when i was passing here i have seen 2 somali passing by and i recognized their face and their color and i told the cab driver to just stop and leave me. i get off the taxi and i talk to the guys and they ask me, ‘are you somali too?’ i said, ‘yes.’ then the 2 somali men took me to where 3 somali men were living in a room and they told them about my situation that i just got off the taxi and i don’t know any person here so they told them that i should at least stay with them for a while until i know places. tecle et al./seeking refuge 1013 representatives of participating agencies indicated that the process to gaining access to services ideally starts with the unhcr. this process includes registration with the unhcr to gain refugee status in thailand based on the credibility of each case. when unhcr legally validates asylum-seekers’ cases for refugee status, they get a card from unhcr implying that they have status as a refugee but not legal status in thailand. additionally, not all asylum-seekers obtain the unhcr card because they do not meet the criteria or because of the prolonged waiting period to meet with unhcr since arrival in bangkok. according to participants, the unhcr’s card facilitates access to services, but does not protect them from thai immigration officers’ random detentions. the acknowledgement of status from unhcr allows asylum-seekers to follow-up on referrals to services provided by cbos, fbis and ngos in bangkok. the types of services cbos, fbis, and ngos provide are primarily basic human needs including food, healthcare, education, and housing. the services vary in terms of quality and permanency. asylumseekers noted that they get confused regarding who is providing what type of services and for how long. the agencies keep on referring them from one agency to another. they may also roam around based on word-of-mouth and lose hope and trust in the agencies. given the lack of a national legal framework, the access to referrals can be random and happenstance. individuals resettle themselves around the city and find unhcr, asylum access thailand (aat), or other international ngos rather haphazardly. when i was first registering at the unhcr, i’ve been told that there are some organizations that help the people and later on i also ask the somali people to show me those places that i can ask help from. in addition to the location of organizations being scattered around the city, the provision of services was assorted. for example, some cbos, fbis and ngos focus on provision of food, while others provide health care services, education, or shelter. some agencies provide two or more types of services. fbis, for instance, focus on providing food, more often than not based on those who register with them and attend church services and activities. other well-established churches provide services to all asylum-seekers, asylees and refugees in bangkok regardless of their membership in that specific church. for example, calvary church conducts home visits to protect recipients from the risk of random detention in the streets. however, as time goes by and asylum-seekers do not hear from the unhcr, they start losing hope. as one female participant shared, we are here for long time and we still don’t know really that we have the results, if they are going to reject us, if they are going to refuse us, or what they are going to do, we don’t know. every day is a different day and we don’t know each day what is going to be happening. while there are several ngos providing a variety of services, in our interviews, we found that there are three well-known agencies that seem to be focal points for providing for meeting basic human needs: jrs, bangkok refugee center, and yateem tv. jrs is an international catholic non-profit organization established to serve and advocate for refugees and internally displaced populations worldwide. the organization has regional offices around the world, including south asia. in thailand, jrs typically provides advances in social work, spring 2018, 18(3) 1014 psychosocial counseling, financial assistance, and material resources for asylum-seekers. jrs provides basic services to newly arriving asylum-seekers for six months based on aat referrals for psychosocial counseling and will then refer out for medical services. according to one of the representatives, the support is short-term due to lack of funding. in addition to short-term monetary support, jrs also provides training for parents and children, including english and thai language courses, mainly to train people in skills that would serve them locally and when resettled in a third country. jrs also refers asylumseekers and refugees to the bangkok refugee center (brc), an arm of unhcr, for services they do not provide. bangkok refugee center (brc) is the branch of unhcr that provides on-the-ground assistance, including medical screening for newly arriving asylum-seekers. the brc is located in a residential area of bangkok and receives walk-ins, unlike the unhcr office, which is closed to the public, requires an appointment, and includes extensive security clearance for entry. brc, on the hand, is a setting where individuals can attend classes, receive assessments for other services, referrals to other agencies, and additional social services. brc has a bridge school at the center where refugees’ children learn thai for six months to help them transfer to thai public schools. this center also provides health services even though, according to representatives of the agencies, access to medical treatment is not guaranteed for asylum-seekers and refugees. the brc and jrs are two agencies that provide resources and services to the urban asylum-seekers. one agency, yateem tv, is unique, in that they are focused on providing actual housing for the urban asylum-seekers in addition to a variety of services. yateem tv is a bangkok ngo led and run by a local muslim addressed as sheikh. the agency provides varied services not only to asylum-seekers but also to the poor and low income in bangkok. local thai businessmen, leaders of the muslim community appointed by the king, and the thai muslim center support yateem tv. at the center, there are faith-based services, large spaces for gathering, and space whereby volunteers cook food for anyone who cannot afford to feed him or herself in the city. participants admitted that yateem tv is a welcoming space for urban refugees and asylum seekers in bangkok. furthermore, the agency gives adults financial incentives to learn english and pays for school transportation for youth. given the dispersed population of asylum-seekers and resources, access to transportation is of vital importance. yateem tv is well-known for providing asylum-seekers and refugees with free of charge apartments and/or paying for their rent. according to yateem tv representatives, bringing together asylum-seekers and refugees across various communities has been key to the communities’ ability to support each other. still, as important and accessible as this organization is for the somali community, during our interviews we found some young women who did not know of yateem and described a sense of fear about going outside of their apartment buildings, as there was no place for a somali woman to hide from police and avoid the risk of detention. as a 16 years old female somali participant shared, i’ve been staying in the room without going to the unhcr and registering myself in the unhcr 14 days because i was afraid if i go out i will be arrested. but you know, i couldn’t just keep myself in the room and i went out one day and i registered in the unhcr but after a while, i, as i went to the bcp office and tecle et al./seeking refuge 1015 registered in that office as a minor an unaccompanied minor, i went to back to my home and when i arrived at my home, i entered the room, a knock at the door. i didn’t know them, they just entered the room and we were captured and we have been taken to the idc, to the prison. asylum-seekers who migrated from africa in particular, their skin color exposes them to racist attitudes they have to endure every day of their lives, and that would also make them easy targets of immigration officers who roam around their neighborhoods. moreover, as service users, they have to take public transportation or a taxi to visit these agencies for services. the drive can take two hours to get to the agencies depending on the traffic. the financial resources they need to take a taxi or public transportation, and the long hours drive to go back and forth to visit the agencies, not to mention during emergency, puts them at great risk of being questioned and detained. yet they have no other choice but to take the risk. when meeting with a family of four from pakistan, the father said, there is one church….. there is one indian lady and she got care from the church. they are providing food for the people. nobody help for the rent, only jrs they do help. jrs also have limited sources, they will help you in emergency cases. ... i have a son and he is not normal and he is not taking a normal food as well. what i have to give to him is always i have to spend money. he have a very heavy medicine and if i don’t choose the milk, if i give him the medicine without milk, then he have starting to have motions, and we have to buy the pampers for him. there is not any organization that is helping to us that we can live here easily. especially, the people like me, who have children for special needs or have some medical issues, it is really difficult for these type of people to stay here. in addition to security issues, nothing seems to be enough and/or there is no one to fill in the gaps when lack of basic needs is the main issue. legal services unhcr and asylum access thailand (aat) are the primary agencies that provide legal services for urban refugees and asylum-seekers in bangkok. idc issues. in addition to processing status applications, unhcr works with the government on system level issues and with the local thai police. their role is to educate local police about what the unhcr card means and provide a context for migration and the people seeking refuge in bangkok. in this way, unhcr strives to assist the police with considering the priorities around crime in the city and to deter them from arresting people whose only violation is their status. unhcr staff will go out into the community to meet with police and military groups to provide education about refugees and asylum-seekers and to discuss bailout programs for individuals who have been arrested and are in detention. in addition to providing legal services, aat also works with refugees and asylumseekers to assist them “to organize and assert their rights.” aat works with identified community leaders and supports them in developing the capacity of the community to develop advocacy and action efforts. for example, in bangkok, aat is active in supporting advances in social work, spring 2018, 18(3) 1016 somali and pakistani communities with forming and running democratic collective action groups. these groups are initiated and run by the urban refugees. another example is the community paralegal program. aat has also developed formal public/private partnerships, such as partnering a private law firm with the international refugee assistance project (irap). additionally they have been successful in engaging a corporate law firm with providing pro bono legal aid and developing legal briefs for advocacy and policy work. these public/private partnerships have also supported the work of unhcr. by working with community leaders, aat learned that these direct connections to the community are the most beneficial way to get and share information and to support organizing efforts, as well as to get legal and human rights assistance directly to urban refugees. however, the fears of one’s apartment been raided, picked up from the streets and detained remains to be threatening refugees who hesitate between taking the risks or not even for the sake of feeding their children and/or going to clinics. one female somali participant describes her sense of living in constant fear. i’m always afraid if i am going out or if i am staying inside, if i accompany my daughter to the school, if i try to pick up her from the school, i always, i’m always afraid about it. as people travel to and from their homes, via bus, long walks, or taxi, their risks for arrest increase. as a young 16 years old somali male shared, when i came to bangkok, i didn’t have any information about it. i didn’t know the name of the city. i didn’t even know there were somalis in bangkok. but when i arrived here and i met somali people they told me that the people are arrested for being illegal immigrants here. and they frightened me. i’ve been staying in the room without going to the unhcr and registering myself in the unhcr 14 days because i was afraid if i go out i will be arrested. but you know, i couldn’t just keep myself in the room and i went out one day and i registered in the unhcr but after a while, i, as i went to the bcp office and registered in that office as a minor an unaccompanied minor, i went to back to my home and when i arrived at my home, i entered the room, a knock at the door. i didn’t know them, they just entered the room and we were captured and we have been taken to the idc [immigration detention center], to the prison. despite the efforts of legal experts, the lack of information about legal services, lack of transportation and fears of leaving their homes have left urban refugees in bangkok isolated and insecure. six of the somali interviewees (three female and three male) had been in idc themselves and 50% of those report having been beaten or tortured during their time there. the amount of time spent in idc varied greatly—between 12 days and 2 years. conditions were described as “awful and difficult”. concerns within idc include: cramped quarters (200 men in one room), the spread of disease (i.e. tb), lack of water, children being born inside and “being impossible to provide for”, corruption and discrimination amongst idc staff, unpredictable and inequitable system for getting out and bailout being open, etc. they also discussed how once someone is in idc it is very hard to build their resources again. tecle et al./seeking refuge 1017 usually when they are arrested, all the work that we have done build them up and helping them achieve goals, sustainable, and mental health, and well-being, all of that just falls apart, so it is a constant challenge for us to help people in this environment where they are so subject to these risks of arrest....everything falls apart. as the agencies indicated, urban refugees’ illegal status leaves them vulnerable to their employers and residential property owners. hence, the need for coordinated and geographically accessible legal service sites essential for refugees. shifting to a collective response overall, while both service providers and asylum-seekers claim availability of varied services, the services are not enough in terms of quality, longevity, and types of services. for instance, according to a representative of an ngo, “unhcr resources are draining due to the global focus on the middle east, mainly the syrians.” some agency representatives indicate that many of the ngos do not have enough resources to provide services until asylum-seekers are resettled in a third country because of financial, human, and material resources. an ngo male staff member who has been working in the areas of case management with urban refugees explains the situation. we are struggling in all the social sectors. there are not enough resources, basic needs are not met,,.nowhere for single people to live, and there are limited health services. while the agencies are dispersed around bangkok and services are varied, there has been a growing trend to collaborate and work towards a collective response to the influx of urban asylum-seekers and refugees. each agency may also be providing two or more types of services, which has led to the need for networking and coordination of services to maximize resources and have greater impact on the individuals and families they serve. for example, the tzu chi clinic (an indian community-based clinic), has organized with brc, unhcr and muslim communities to support christian churches in emergency times. this community-based clinic provides free services including medical tests, x-rays, dental services, and medications at no cost. the clinic itself is a collective of pro-bono doctors and nurses providing free services for those seeking refuge in bangkok. at the time, they reported serving 700 to 800 patients every month. study participants repeatedly acknowledged the importance of these agencies for urban refugees in bangkok. a 20-yearold somali female stated it this way. the country doesn’t recognize the refugees and there’s no one who helps the refugees so deep down in my heart, i believe that it’s only the unhcr, brc, jrs and bcp that can help the refugees. there are a number of advocacy collectives that come together to assess and respond to the growing needs of refugees and asylum-seekers in bangkok. the core urban refugee network meeting is an example of one of these collaborative efforts. they meet once every two months among the ngos serving these communities. the bangkok asylum seeker and refugee assistance network (basran) is another form of network holding open advances in social work, spring 2018, 18(3) 1018 meetings whereby unhcr and the american embassy staff can attend. the basran group breaks up into interest groups (i.e., health, education, etc.) so that each one of the sub-groups can concentrate on their expertise. during our interviews with agency representatives, we found strong desire across ngos, community based organizations (cbos), faith based institutions (fbis) and unhcr to increase their networking and coordination of services. indeed, it was the desire on the part of jrs for an increase in understanding of the community networks, both formal and informal, that sparked this research. as the spectrum of organizations who support these communities are increasingly stretched with higher numbers and shrinking resources, they are searching for a collective response that can maximize the resources. university of utah, csw and jrs partners are using the information gained from this study to inform a process that will enable interested partners to shift from an emergency service provision model to sustainable, and long-term solutions. the partnership aims to strengthen jrs and university of utah partnership for further research that will inform larger practice and advocacy frameworks related to refugee and immigrant services to address misperceptions, misinformation, and acts of exploitation of migrant communities, and formulate a plan for improving services through a collective response. discussion service-providing agencies for urban asylum-seekers and refugees in bangkok are doing their best with available resources. efforts to move beyond conventional approaches to service users and working independently despite the overlaps of the service demands has led agencies to engaging in dialogues around collaborations. such collaborative efforts would not only maximize agencies’ resources but also minimize service users’ efforts to seek support. considerations of advocacy and systems level changes, as well as jrs’ initiative of shifting their approach from an emergency to long-term and sustainable interventions, and expanding the initiative to other agencies, are underway. such efforts would also address the main challenges asylum-seekers are facing including the lack of sufficient resources and information, length of time for interviews, and risk of arrest and detention. investing in sustainable skills is strategic and will have long term effects that would also be reflected when asylees and refugees get resettled in a third country. asylum-seekers are often trapped and deserted in the poor sides of the city, with poor infrastructure and environmentally unhealthy neighborhoods. for those who migrated from africa in particular, their skin color exposes them to racist attitudes they have to endure every day of their lives, and that would also make them easy targets to immigration officers who roam around their neighborhoods or the agencies they visit for services. there is a felt need for a national framework that would reconsider the basic rights of asylum-seekers, their immigration status, and access to basic social services including employment rights and security from random detentions so that they can sustain their life until decisions are made regarding their resettlement process. tecle et al./seeking refuge 1019 study limitations this study could have been stronger if study participants were identified through a random selection based on neighborhoods where asylum-seekers and urban refugees reside. having research team members who could speak languages spoken by all study participants would also have strengthened the discussions. moreover, since the translators were also urban refugees and/or asylum-seekers, safety concerns limited their mobility to interview sites. the team shared some incentives with study participants. however, the basic needs were beyond the incentives and created discomfort and uneasiness among team members. bringing all study participants—refugees, asylum-seekers and staff from agencies and cbos—to focus group discussions would have yielded powerful conversations around their basic needs, legal services, and the future. remarks for the future the findings from this research are not meant to be conclusive of either all somali and pakistani urban refugees in bangkok or the agencies and community-based organizations working with them. more so, it is meant to provide a snapshot, highlighting the voices of those interviewed. this study was a starting point to explore the experiences of urban refugees and asylum-seekers in countries whereby legalized protection does not exist. the findings have serious implications for social work practice with urban refugees and asylum-seekers in such contexts including cultural sensitivity during practice with diverse communities, having information regarding sources of resources easily available and in different languages, having systems in place rather than responding to emergency calls from newly arriving refugees and asylum seekers, and coming up with innovative approaches to service with communities in danger such as living and/or providing services within communities’ apartment buildings and neighborhoods. overall, while service providing agencies’ and cbos’ initiatives are hopeful there is a prerequisite for a political commitment and will of the agencies to ensure that a national framework is in place, and collaborative approaches to protect and serve asylum-seekers are strengthened and translated into action. exploring formal and informal networks is essential to help asylum-seekers realize their potential to support themselves. the research team is aware of the power differentials involved in outside researchers coming into communities for short periods and believe the role of the community translators was paramount in the success of the conversations. our sincerest thanks is extended to them, both for the wisdom they offered as well as the risks that they took in creating access to their communities. finally, sharing and disseminating what partners have learned from this study at different venues and through varied means (publications, conferences, community events, etc.) is essential. getting informed and learning from other models of working with asylumseekers including university of utah model of serving refugees in their residential areas, including inside apartment complexes, to meet unsecured asylum-seekers and refugees where they feel comfortable and safe is critical. an important aspect of the cbpr framework is the value of research findings as community owned. there is a commitment advances in social work, spring 2018, 18(3) 1020 to provide the findings directly to those who participated in the study and those most affected by the issues. references anderson, d. k. 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(2017b). urban refugees. retrieved from http://www.unhcr.org/en-us/urbanrefugees.html universal periodic review. (2015). kingdom of thailand: universal periodic review 2nd cycle. kingdom of thailand. submitted 21 september 2015 on behalf of asia pacific refugee rights, asylum access, human rights development foundation, jesuit refugee services, migrant working group, and people’s empowerment foundation. unterhitzenberger, j., eberle-sejari, r., rassenhofer, m., sukale, t., rosener, r., & goldbeck, l. (2015). trauma-focused cognitive behavioral therapy with unaccompanied refugee minors: a case series. bmc psychiatry, 15, 260-273. doi: https://doi.org/10.1186/s12888-015-0645-0 vervliet, m., vanobbergen, b., broekart, e., & derluyn, i. (2014). the aspirations of afghan unaccompanied refugee minors before departure and at arrival in the host country. childhood: a global journal of child research, 22(3), 330-345. doi: https://doi.org/10.1177/0907568214533976 yanow, d. (2000). conducting interpretive policy analysis. thousand oaks, ca: sage publications. doi: https://doi.org/10.4135/9781412983747 author note: address correspondence to: aster s. tecle, phd, college of social work, university of utah, 395 s 1500 east. salt lake city, ut 84112. e-mail: aster.tecle@utah.edu http://www.ucanews.com/news/pakistan-catholics-flee-to-seek-refuge-in-bangkok/70855 http://www.ucanews.com/news/pakistan-catholics-flee-to-seek-refuge-in-bangkok/70855 http://www.ucanews.com/news/pakistan-catholics-flee-to-seek-refuge-in-bangkok/70855 http://www.unhcr.org/refworld/docid/4ab8e7f72.html http://www.unhcr.org/5461e60b17.html http://www.unhcr.org/5461e60b17.html http://www.unhcr.org/5461e60b17.html http://www.unhcr.org/5461e60b17.html http://www.unhcr.org/pages/49e489646.html http://www.unhcr.org/en-us/asylum-seekers.html http://www.unhcr.org/en-us/asylum-seekers.html http://www.unhcr.org/en-us/urban-refugees.html http://www.unhcr.org/en-us/urban-refugees.html https://doi.org/10.1186/s12888-015-0645-0 https://doi.org/10.1177/0907568214533976 https://doi.org/10.4135/9781412983747 mailto:aster.tecle@utah.edu advances in social work, spring 2018, 18(3) 1022 acknowledgements: we are very grateful for the contributions of individuals seeking refuge for their participation in this project. their willingness to meet with the research team and their openness with sharing their stories and experiences has extended our understanding of their lived experiences and provide much needed information to community partners and organizations who serve and advocate for and with these communities. additionally, we appreciate the time and participation of the many community partners and agencies located in bangkok who provide support to these communities. our special thanks to the staff and administration of jesuit refugee service, thailand for their vision and leadership in requesting this study and partnering at all stages of the work to develop a partnership focused on assisting communities in forced migration and improving the systems that serve these communities. _________ laurel iverson hitchcock, phd, mph, licsw, associate professor, department of social work, college of arts & sciences; allison shorten phd, rn, facm, faan, professor and department chair, school of nursing and director, office of interprofessional curriculum [oipc], center for interprofessional education and simulation [cipes]; peter bosworth, mba, program director, oipc, cipes; shawn galin, phd, associate professor of medicine, department of medicine, division of pulmonary and critical care medicine, and director, office of standardized patient education [ospe], cipes; tara edmonds, phd, director of assessment, ospe, cipes; and caroline harada, md, associate professor of medicine, department of medicine, division of gerontology, geriatrics, & palliative care and assistant dean for community-engaged scholarship, school of medicine, university of alabama at birmingham, birmingham, al. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 355-370, 10.18060/23664 this work is licensed under a creative commons attribution 4.0 international license. using a standardized patient model for interprofessional team training in social work laurel iverson hitchcock allison shorten peter bosworth shawn galin tara edmonds caroline harada abstract: the purpose of this article is to describe the development of a single-session interprofessional team (ipt) training that incorporates the practice of interprofessional teamwork using a health care case study. we will share how a large-scale training that requires interprofessional teams of students to create a treatment plan of care for a standardized patient developed over time and how this experiential learning activity affects learning outcomes for social work students related to interprofessional awareness and teamwork skills. additionally, we will explore the use of video technology as a pedagogical approach to presenting standardized patients to students. student responses from three ipt training sessions provided the data discussed in this article. while overall results are mixed about students’ learning outcomes, trends in the data show this single-session, interprofessional training involving a standardized patient as a promising practice. lessons learned for social work education are also discussed. the present study advances the field of interprofessional simulation by contributing to our understanding of how a team-based training combined with a standardized patient can be used to increase social work students’ professional awareness about interprofessional teamwork. keywords: standardized patient, interprofessional education, technology-mediated as defined by the world health organization (2010), interprofessional education (ipe) occurs when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes for individuals and communities. ipe is now considered an essential part of the curricula in us colleges and universities that are educating the next generation of health care professionals, including social work education (council on social work education [cswe], 2015; interprofessional education collaborative [ipec], 2019). while ipec (2016) offers guidance for key competencies needed by students graduating from health care degree programs, the questions of how and when to incorporate ipe learning activities into curricula is a challenge for educators across all healthcare professions. in this article, we explore the development, implementation, and evaluation of an ipe learning activity at one university that uses a standardized patient https://creativecommons.org/licenses/by/4.0/ hitchcock et al./using a standardized patient model 356 model with large groups of students from nine professions including social work, nursing, and medicine, and report on how this activity affects social work students’ perceptions of interprofessional collaboration. benefits and challenges of ipe innovative interprofessional curriculum is critical for preparing a future healthcare workforce in the us that is capable of serving the increasingly complex needs of patients living in our community. optimizing patient experiences, improving population health, and bettering the working lives of healthcare providers, while simultaneously reducing costs, known as the quadruple aim of healthcare delivery, necessitates working in highly functional interprofessional teams (bodenheimer & sinsky, 2014). effective interprofessional communication, role clarity and teamwork are critical for patient safety. higher team functioning in the context of interprofessional models of care is associated with lower mortality rates and better health outcomes for patients (wu et al., 2018). interprofessional healthcare teams, working within coordinated models of care, can reduce patient length of stay, improve patient health and health literacy and prevent readmission to hospital (berwick & hackbarth, 2012; blewett et al., 2010). students in healthcare professions must be trained in effective, meaningful participation in interprofessional teamwork in order to provide them with the skills necessary to succeed in our current and future healthcare systems. purposefully designed, interprofessional, team-based learning experiences, have demonstrated potential to improve student attitudes and skills in working with other professional groups (kaminetzky et al., 2017; white et al., 2013; wu et al., 2018). additionally, high quality interprofessional educational experiences for interprofessional learners include a clear rationale, outcome-based goals, deliberate design, and coordinated assessment and evaluation (health professions accreditors collaborative, 2019). educational experiences are capable of breaking down the traditional barriers to build mutual respect, appreciation for shared knowledge and shared experiences, while helping students to appreciate the roles and responsibilities each profession brings to the healthcare team (homeyer et al., 2018). educators tasked with preparing students for the interprofessional healthcare workforce of the future, require resources and willingness to step outside traditional professional silos with the explicit goal of helping students learn from, with, and about other professions in the healthcare team. logistic challenges can be significant and are often reported as key barriers limiting widespread use of interprofessional education across u.s. college campuses. barriers to interprofessional education include lack of designated funding for activities, high volume of learners, space and time limitations, and diverse program curricula requirements (freeth & reeves, 2004). interprofessional education programs should therefore be designed with the intent of overcoming known barriers and promoting enablers to developing skills in effective interprofessional teamwork and communication. in this paper, we share how a large-scale training that requires interprofessional teams of students to create a treatment plan of care for a standardized patient developed over time to address many of these common logistical challenges. advances in social work, summer 2020, 20(2) 357 ipe in social work education the social work profession has long articulated the need for interprofessional education, especially for social workers practicing in settings where social work is not the dominant profession such as hospitals and schools. at the annual meeting of the council on social work education (cswe) in 1968, dana, along with colleague dr. sheps noted that “the successful outcome of new educational ventures into interprofessionalism will be dependent upon the degree to which professional schools themselves demonstrate the principles of interprofessional behavior in designing and implementing new ways for students to learn together” (dana & sheps, 1968, p. 41). more recently, this call to action has been operationalized by the cswe’s membership in the interprofessional education collaborative (ipec) in 2016 as well as cswe’s 2018 annual conference being devoted to the theme of interprofessional education. further, current leaders in social work education have been calling for more emphasis on practical and meaningful educational experiences where social work students are at the same table as students from other professions, learning about other professions’ roles as well as effective collaborative processes (jones & phillips, 2016; rubin et al., 2018) among social work curricula, ipe has been a growing area of educational innovation. recent studies of various ipe activities with social work students have shown positive student learning outcomes associated with attitudes and beliefs toward interprofessional collaboration. for example, wharton and burg (2017) found that working with medical and pharmacy students on health-related cases increased social work students’ confidence in their role on an interprofessional healthcare team. others have found that social work students can learn about how poverty affects health outcomes by participating in a teambased poverty simulation with other professions such as nursing and occupational therapy (hitchcock et al., 2018; vandsburger et al., 2010). additionally, the social work profession has demonstrated diversity in ipe by working with disciplines such as k-12 education, business, and social innovation as well as the traditional health care professions (archibald et al., 2016; lopez et al., 1998). as more social work educational programs expand their curricular efforts to incorporate interprofessional skills for teamwork, faculty will need to develop evidence-informed practices that promote positive student learning outcomes across a variety of educational activities. standardized patient model in ipe one important modality of interprofessional education involves the use of standardized patients (sps). sp methodology provides a gold standard for education and assessment of learner performance in a clinical health care setting (palaganas et al., 2014). sps are individuals who have been trained to portray a patient in a scripted case scenario and are able to consistently deliver a standardized performance when interacting with different students or groups of students. the use of sp methodology in formative educational activities and high stakes summative assessment has been extensively documented and its ability to bring the human touch to simulation is undeniable (kaplonyi et al., 2017). the use of sp methodology in ipe allows students to practice acquired skills and behaviors around patient care while gaining knowledge from the nuances associated with hitchcock et al./using a standardized patient model 358 human interaction. in ipe, working with an sp while simultaneously interacting with other health professional students can foster insight and understanding into individual roles and tasks within the healthcare team (wamsley et al., 2012). in addition, education around communication skills is a hallmark of sp methodology. it has been shown that practicing interpersonal communication with sps results in better communication skill acquisition than practice with peers (schlegel et al., 2012). while the use of sps to enhance interprofessional communication and teamwork has been reported, this has commonly been done in small group settings (bays et al., 2014; foronda et al., 2016). small group settings do aid in recreating the healthcare team approach by selectively limiting number and types of participants. however, small group formats do raise certain curricular design challenges when dealing with large numbers of students representing many schools. designing large group interprofessional activities, particularly those involving considerable student cohorts, often come with logistical and financial challenges. the use of virtual patients or web-based sp encounters can provide a platform to assure learners are provided equal opportunity often at a lower cost to stakeholders (lempicki & holland, 2018; reis et al., 2015). here, we will report the use of videotaped patient interviews using a sp that combines patient history acquisition with continuum of care. standardized patients in social work education scholarship about the use of standardized patients or clients in social work education primarily follows two models a formative sp-based learning experience, and summative encounters (e.g., objective structured clinical exams). the formative learning experience typically involves an actor or theatre student in the role of a client who is based on a case study developed by a faculty member with the goal of improving student skills and competency related to specific course content (badger & macneil, 2002; mooradian, 2008). research on these learning experiences has found that the use of sp methodology can increase interviewing and assessment skills as well as their knowledge about specific clinical situations such as domestic violence or adolescent sexuality (forgey et al., 2013; logie et al., 2015). other examples of the formative use of a standardized patient model in social work includes virtual patients to increase knowledge about brief assessment skills in medical settings (hitchcock et al., 2019; washburn & zhou, 2018), and live patients to practice interprofessional communication skills among a team of health care students (wharton & burg, 2017). this article describes the development, implementation, and evaluation of a singlesession training that incorporates the practice of interprofessional teamwork using a sp health-based case. the authors will meet this aim in two ways. first, we will describe the large-scale training that requires interprofessional teams of students to create a treatment plan of care for a sp which has been developed over time and how this experiential learning activity affects learning outcomes for social work students related to interprofessional awareness and teamwork skills. we will also explore the use of video technology as a pedagogical approach to presenting standardized patients to students, which can provide efficiency in educational delivery and mitigate the need for multiple spaces and extensive human resources when providing valuable ipe content to hundreds of learners from multiple health professional schools. second, we will share data about student responses advances in social work, summer 2020, 20(2) 359 from three interprofessional team training (iptt) sessions, providing a combination of quantitative and qualitative data that informs student learning. lessons learned from iptt are discussed for ipe generally and for social work education specifically. method description of interprofessional team (ipt) training activity the university of alabama at birmingham (uab) iptt was originally conceived and designed in 2009 as a part of the health resources and services administration-funded uab geriatrics education center (uab gec) to provide an opportunity for health professions students to experience interprofessional team-based care (rothrock et al., 2013). in its earliest iterations, large groups of 300-350 students from nine health professions (social work, nursing, medicine, pharmacy, dentistry, occupational therapy, physical therapy, optometry and nutrition) gathered in a lecture hall for a 60minute presentation. after a brief introduction to interprofessional teamwork, a real patient was interviewed sequentially by a professional, typically a faculty member, from each of the nine different health professions, and students were tasked to take notes. each professional had approximately 5-minutes to ask questions to complete their assessment and were asked to focus their questions on specific aspects of their scope of practice. for example, the social work faculty frequently asked questions of the real patient about family involvement and financial resources. students then divided into smaller interprofessional groups for a 75-minute discussion to debrief the interview and develop an interprofessional care plan, facilitated by a proctor who was a faculty or staff member accustomed to working in interprofessional teams. this activity continues to be conducted twice a year in the fall and spring semesters, although it has been modified considerably over the years due to several challenges inherent in the original model. first, using real patients meant that sometimes the interview would take off in unexpected directions, and some patients did not bring up issues that provided content to engage students from each of the health professions participating in the training. second, the session had to be held on a friday afternoon because of scheduling constraints, and usually took about three hours, resulting in frequent complaints from students about the timing. third, while students usually became quite engaged during the interprofessional team small group discussion, they sometimes found the introductory lecture and interview demonstration to be long and tedious. fourth, the session often lost momentum during the transition from large lecture hall into small group meetings, as simply getting that many students up the stairs or elevators to the small group rooms took about fifteen minutes. because of these persistent challenges, the experience was eventually re-designed in two phases. table 1 shows an overview of how the training changed over time. in the 2017 revision, we moved to using a standardized patient in place of a real patient. the standardized patient approach allowed us to craft a clinical case with features to engage learners from a wide variety of participating professions, and teaching points could be prepared in advance. at this time, the activity name was changed to ipt training to better illustrate the learning goals. to address remaining challenges, in 2018 we undertook a second revision in which we eliminated the large group session altogether and moved to a hitchcock et al./using a standardized patient model 360 distributed model. in this model, students reported to small group rooms at the start of the activity. the patient interview was replaced by a 4-minute video of a standardized patient talking about his various health-related problems. table 1 provides a summary of the different models of this training for the following elements: 1) amount of time allotted for the training; 2) predictability of the standardized patient; 3) physical space requirements; and 4) proctor requirements. table 1. summary of the three ipt training models element model real patient (2009-2016) live standardized patient (2017) distributed (2018 to present) time required 2.5 hours ▪ 15 min lecture ▪ 45 min patient interview ▪ 15 min room transition ▪ 75 min small group discussion 2.5 hours ▪ 15 min lecture ▪ 45 min patient interview ▪ 15 min room transition ▪ 75 min group discussion 1.5 hours ▪ 4 min video ▪ 86 min small group discussion predictability low moderate to high high physical space requirements large lecture room, followed by multiple small group rooms large lecture room, followed by multiple small group rooms multiple small group rooms only faculty proctor requirements ▪ 1 lecturer ▪ 1 patient interviewer from each profession ▪ 1 facilitator for each small group ▪ 1 lecturer ▪ 1 patient interviewer from each profession ▪ 1 facilitator for each small group ▪ 1 facilitator for each small group an overview of the distributed model for the ipt training can be found in table 2, from start to finish. the training starts with some preparatory information which is sent to students via email. they are given their group room assignments and are directed to resources to help them craft their “elevator speech”. on the day of the event, students arrive directly to their assigned room. the faculty preceptor screens the video, and then students break into pairs to give a 30-second summary outlining their profession’s scope of practice. the next part of the training is an interactive group discussion. students then discuss the case in detail, and work as an interprofessional team to develop their own care plan for the patient. this new model takes about 90 minutes to complete, which considerably improved student satisfaction on a friday afternoon and eliminated both the long-observed interview component, and the cumbersome transition times seen with the previous model. faculty preceptors for the small groups are recruited from a large pool of experienced faculty, many of whom have been with this activity since the beginning. using a “train-the -trainer” approach to maintain quality and consistency, new faculty volunteers are paired with an experienced preceptor the first time they participate to get a realistic preview before they facilitate a small group on their own. the focus on preceptor training is to provide strategies that will enable preceptors to create opportunities for students to practice effective interprofessional communication and teamwork regardless of the mix of professions within the group. advances in social work, summer 2020, 20(2) 361 table 2. elements of distributed model of ipt training activity duration/timing activity pre-work learners are emailed resources to help them prepare a 30 second “elevator speech” outlining their scope of practice and “myths” about their profession. 30 min. prior to session preceptors gather for lunch and briefing. learning goals, session flow and expectations are communicated. new preceptors are paired with experienced faculty. 10 min. learners watch standardized patient video 15 min. introductions, aims, elevator speeches, review patient information, preactivity attitudes/skills evaluation 5 min. intraprofessional discussion for each group of professional students 5 min. consider what additional information might be needed. reflect on role overlaps/differences 40 min. learners prioritize goals for patient care and develop a care plan 15 min. reflection: role similarities/differences, cross profession interaction, “takeaways” 10 days after activity learners sent link to postactivity attitudes/skills evaluation standardized patient because the original ipt training was developed by the geriatrics education center at (de-identified), the sp is an older adult with multiple health care problems. along with watching the video of the patient talking about their health concerns, the students are provided with a two-page handout that includes: 1) past medical, surgical, vision and dental history; 2) a medication list and lab results; and 3) a social history. table 3 provides some examples of the standardized patient’s health concerns. table 3. clinical case details of geriatric standardized patient from ipt training component of the patient’s story examples patient complaints “i have a gum boil that keeps draining” past medical history congestive heart failure, diabetes, glaucoma, bilateral hip replacements allergies sulfa causes anaphylaxis medications insulin aspart, furosemide social history former smoker, widowed, lives alone in a rural area, four adult children, retired steel mill worker, on a fixed income from social security, has medicare parts a and b mobility & function uses a cane, four falls in the past year vision s/p cataract surgery, last saw eye doctor three years ago dental last saw a dentist four years ago hitchcock et al./using a standardized patient model 362 participants and setting the office of interprofessional curriculum at the university of alabama at birmingham hosted three ipt trainings over three semesters during 2018 and 2019. during the spring 2018, fall 2018, and spring 2019 semesters, a total of 1,015) from nine professional health care programs at uab and samford university were invited and participated in the ipt training. these disciplines included dentistry, medicine, nursing, nutrition, optometry, occupational therapy, pharmacy, physical therapy, and social work. a total of 287 participants completed both the preand post-event surveys for a response rate of 28%. there were 77 social work participants and all of these students completed the pre-event survey, and only 20 students completed both the preand post-event surveys for a response rate of 26%. for this activity, small group rooms were used to comfortably accommodate groups ranging from 12 to 25 learners. the size of the small groups varies depending on the number of available preceptors and the number of students from each profession. rooms were equipped with the necessary audio/visual systems. design the irb at the university of alabama at birmingham granted exemption for the study, “effect of an interprofessional team training exercise on attitudes towards interprofessional teams among students in health professions” (irb_300000478). a pre and post-event survey design was used to collect data from the participants. a paper version of the survey was distributed to all participants at the beginning of the ipt training, and they were asked to complete the survey before the event started. post-event surveys were collected using qualtrics, a digital survey tool, and were sent electronically to all participants via email approximately one week after the experience. preand post-event responses were collected from 287 participants. measurements demographics and health profession major were collected from each participant. quantitative measures were used to assess changes in student attitudes towards interprofessional teamwork. the revised version of dow’s ipec competency selfassessment tool was used to assess overall attitudes toward interprofessional teamwork (dow et al., 2014; lockeman et al, 2019). the original version of this assessment tool consisted of a 42-item self-assessment questionnaire. the dow team revised the tool in 2015 and revalidated this version 3 in 2016. it now consists of 16 items assessed on a 5point likert scale. the tool that was used consists of two domains, one to assess attitudes toward interprofessional interaction and one to assess interprofessional values. additionally, three items were included to assess the participants overall satisfaction with the learning experience. the items were as follows: a) “this was a valuable learning experience;” b) “the preceptor was well prepared;” and c) “the preceptor effectively led the activity.” these items were rated on a 5-point likert-type scale (1= strongly disagree to 5= strongly agree). the participants were also given the opportunity to provide comments at the end of the survey using an open-ended prompt. advances in social work, summer 2020, 20(2) 363 analyses analyses were conducted using ibm spss statistical software (version no. 25). the authors conducted univariate analyses to generate means, frequencies and proportions for the demographic and outcome variables. because the data could not be matched by participant between preand post-event, to look at differences between the social work students’ preand post-event scores, cross tabulations and t-tests for unequal variances were conducted. the analyses used an alpha level of .05 for all statistical tests. because of the low number of qualitative comments, no thematic analysis could be completed, but representative comments are provided in the results section for context. results while students from multiple professions participated in this event, we were interested in how the social work students’ attitudes toward interprofessional teamwork changed due to this training. table 4 provides demographic information of all the student participants who completed both the preand post-event survey, specifically, in terms of race, gender and major. most of the participants identified as female (69%), white (54%), and between the ages of 20-29 years (93%). additionally, table 4 shows the demographic information for all social work students who completed both the preand post-event survey and the just the pre-event survey. table 4. demographics of students completing ipt training, 2018-2019 demographics n (%) pre & post preonly all (n= 287) non-swk (n= 267) swk* (n = 20) swk* (n= 77) gender female 199 (69%) 180 (67%) 19 (95%) 65 (84%) male 86 (30%) 85 (32%) 1 (5%) 10 (13%) missing 2 (< 1%) 2 (< 1%) 2 (3%) age (years) 20-29 268 (93%) 256 (96%) 12 (60%) 54 (70%) 30-39 8 (3%) 7 (3%) 1 (5%) 9 (12%) 40 49 7 (2%) 2 (< 1%) 5 (25%) 7 (9%) 50-59 2 (< 1%) 2 (10%) 4 (5%) missing 2 (< 1%) 3 (4%) race black 16 (6%) 7 (3%) 9 (45%) 31 (40%) white 156 (54%) 150 (56%) 6 (30%) 42 (55%) hispanic 1 (5%) 2 (3%) asian 15 (5%) 15 (6%) native american 6 (2%) 2 (< 1%) 4 (20%) 1 (1%) other 4 (1%) 4 (1%) missing 90 (31%) 90 (33%) 1 (1%) *swk=social work hitchcock et al./using a standardized patient model 364 among all students participating in the ipt training, a majority (78%) rated it a valuable learning experience. in figure 1, 65% of social work students “strongly agreed” whereas only 32% of total participants “strongly agreed” the training was a valuable learning experience. one caveat is that the social work student data is included in the total participant data, thereby positively influencing the response pattern of the group. when social work students were excluded from all participants, only 30% of all participants found the event to be a valuable learning experience. figure 1. reported ratings of that ipt training provided a valuable learning experience in terms of specific learning outcomes, table 5 shows the mean scores and standard deviations for preand post-event measures for the social work students for the interprofessional competency scale and each of the domains assessed within the tool. these means were compared using independentsample t tests (alpha value of 0.05), and results found no differences between students’ attitudes on interprofessional teamwork for the full scale as well as the two domains, interprofessional interaction and interprofessional values. table 5. effects of iptt training on social work students’ attitudes about interprofessional teamwork scales m (sd) t (df) sig. before iptt (n=77) after iptt (n=20) full scale 4.5 (0.38) 4.5 (0.42) .095 (95) 0.924 interprofessional interaction 4.4 (0.48) 4.4 (0.50) -0.378 (95) 0.700 interprofessional values 4.7 (0.35) 4.6 (0.39) 0.750 (95) 0.455 6% 6% 5% 5% 5% 11% 10% 30% 48% 46% 65% 30% 32% 0% 25% 50% 75% 100% swk (n=20) non-swk (n=267) all (n=287) strongly disagree disagree neutral agree strongly agree advances in social work, summer 2020, 20(2) 365 a small number of all the participants (10%) provided written comments about their experience with the ipt training, and while the number does not reflect generalizable qualitative results, they do inform future topics for further exploration for similar interprofessional activities. table 6 shows representative comments from the social work participants, mapped with possible themes for future exploration based on the interprofessional education collaborative’s core competencies for interprofessional collaborative practice (ipec, 2016). for example, quote #1 from a social work student could represent that the social work student was apprehensive about working with interprofessional teams or that they embrace commonly held stereotypes about other health care professionals. similarly, quote #2, from another social work student, could reflect that the student had difficulty engaging with students from other health professions or perhaps is unclear about the role of social workers in medical settings. while these quotes are not generalizable, they suggest that rich learning can take place during the ipt training. additionally, there is a need for more mixed methodology when assessing student learning with interprofessional activities. table 6. sample student comments and corresponding themes sample quotes possible themes for future qualitative exploration based on ipec competencies (ipec, 2016) quote #1 social work student i was worried that other health care professionals would speak over me because i am not a traditional field of health care, but everyone was very respectful! competency #1 values and ethics for interprofessional practice ▪ embrace the cultural diversity and individual differences that characterize patients, populations and the health care team (sub-competency ve3) ▪ maintain competence in one’s own profession appropriate to scope of practice (sub-competency ve10) quote #2 social work student i think it would be helpful if the client did not have as many health conditions. i felt like his medical issues were at the center of the conversation which made it difficult for the students in more medical disciplines to focus on other aspects of the clients life that were also of concern. competency #4 team and teamwork ▪ engage health and other professionals in shared patient-centered and population-focused problemsolving (sub-competency tt3) ▪ reflect on individual and team performance for individual, as well as team, performance improvement (sub-competency tt8) ▪ perform effectively on teams in different team roles in a variety of settings (sub-competency tt11) discussion the present study advances the field of interprofessional education in two ways. first, this innovative program, using a video-based standardized patient, offers a viable interprofessional education experience for health care professions, including social work students, which could be replicated by other institutions. second, it contributes to our understanding of how an assessment on the effectiveness of team-based interprofessional trainings need to be structured, especially to assess social work students’ professional awareness about interprofessional teamwork. hitchcock et al./using a standardized patient model 366 while social work students did not demonstrate an improvement in attitudes towards interprofessional teamwork, we suspect this was due to the very positive attitudes students reported on our survey instrument before they began the training, possibly due to confidence in their knowledge and skills or wanting to provide socially desirable responses. additionally, this lack of significant change in attitudes toward interprofessionalism between may be because of the low sample size for social work students. future assessment of the effectiveness of the program will account for these limitations. but written comments suggest that this experience may influence students’ understanding of specific ipec competencies and sub-competencies, and this worthy of further investigation. combined, these data suggest that current scales to assess attitudes toward interprofessional teamwork may be too blunt to assess the complexity of interprofessional competencies across multiple professions. to further assess, in fall 2019, the team is testing a different instrument, the interprofessional collaborative competency attainment survey (archibald et al., 2014), which uses a post-pre and post-activity methodology. additionally, post-retrospective research designs may better compensate for the natural tendency of learners to rate themselves higher on attitudes and knowledge related to interprofessional competencies prior to an interprofessional learning activity. future research studies should address these limitations. another interesting finding is the marked difference in the reported value of the ipt training as a learning experience between social work students and all other health professional students, with a higher percentage of social work students reporting the ipt training as a valuable learning experience. while this is an area for future exploration, one possible explanation for these differences is that social work students at uab participate in fewer ipe events than the other health care students due to curricula differences and location of the program within the university’s administrative structure. social work students’ higher satisfactions scores may be because ipe events are more novel for them. adding questions about students’ prior experience with ipe combined with an open-ended survey question could uncover reasons for this difference in satisfaction with the training. lessons learned this study offers many lessons learned for social work and other health care educators interested in designing and implementing ipe activities. first, the use of a standardized patient model offers several advantages, such as: allowing for a more consistent and inclusive educational experience for this diverse group of learners; and providing a more condensed and efficient version of the training. second, the transition to the video interview was a welcome change from the point of view of the standardized patient, who appreciated the improvement in role clarity. the individual in the role of the standardized patient reported it was challenging to prepare for the live interviews because of the diversity of clinical information they had to memorize, as well as the potential that they would be asked questions for which they were unprepared. third, instruments designed to assess attitudes toward interprofessional teamwork are often not adequate to detect a change in attitudes or understanding. research shows that students often overrate their abilities, thus, when using some pretest instruments they will rate themselves at the high end of the scale leaving little or no room for an increase to be measured post activity (national association of colleges advances in social work, summer 2020, 20(2) 367 and employers [nace], 2018). more collection of qualitative data may be needed to better understand the social work student experience in a large interprofessional training program. finally, one potential area for further research is to assess if differences among the small group faculty preceptors have any 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(2010). framework for action on interprofessional education and collaborative practice. author. https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng. pdf;jsessionid=17e9af821ccecc269a55481eb89e8a27?sequence=1 wu, f. m., rubenstein, l. v., & yoon, j. (2018). team functioning as a predictor of patient outcomes in early medical home implementation. health care management review, 43(3), 238-248. https://doi.org/10.1097/hmr.0000000000000196 author note: address correspondence to laurel iverson hitchcock, department of social work, university of alabama at birmingham, uh 3148, 1720 2nd ave south, birmingham, al 35294. email: lihitch@uab.edu acknowledgements: we gratefully acknowledge drs. christine ritchie, cynthia j. brown, and angela rothrock who developed and implemented the original version of the program supported by in part by funds from the bureau of health professions, health resources and services administration, department of health and human services. we also owe gratitude to danny andrews, our standardized patient who participated in all live and video versions of the program. https://doi.org/10.3928/01484834-20111116-02 https://doi.org/10.3928/01484834-20111116-02 https://doi.org/10.3928/01484834-20111116-02 https://doi.org/10.1080/08841233.2010.497129 https://doi.org/10.1080/08841233.2010.497129 https://doi.org/10.1080/08841233.2010.497129 https://doi.org/10.3109/13561820.2011.628425 https://doi.org/10.1080/10437797.2017.1404519 https://doi.org/10.1080/10437797.2017.1404519 https://doi.org/10.1080/10437797.2017.1404519 https://doi.org/10.1080/10437797.2017.1288592 https://doi.org/10.1080/10437797.2017.1288592 https://doi.org/10.1080/10437797.2017.1288592 https://doi.org/10.1002/rnj.75 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessionid=17e9af821ccecc269a55481eb89e8a27?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessionid=17e9af821ccecc269a55481eb89e8a27?sequence=1 https://doi.org/10.1097/hmr.0000000000000196 https://doi.org/10.1097/hmr.0000000000000196 mailto:lihitch@uab.edu _________ travis albritton, phd, msw, associate dean for diversity, equity, and inclusion, university of north carolina (unc)chapel hill school of social work, chapel hill, nc. charity s. watkins, phd, msw, assistant professor, department of social work, north carolina central university, durham, nc. allison de marco, phd, msw, advanced research scientist, frank porter graham child development institute and adjunct faculty, unc school of social work. jp przewoznik, msw, clinical assistant professor, unc-chapel hill school of social work, chapel hill, nc. andrew heil, lcsw, is a senior behavioral wellness manager, avance care, durham, nc. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 934-953, doi: 10.18060/24105 this work is licensed under a creative commons attribution 4.0 international license. social work education in the shadow of confederate statues and the specter of white supremacy travis albritton charity s. watkins allison de marco jp przewoznik andrew heil abstract: driven by our code of ethics and our call to reckon with our embeddedness within a white supremacist institution in the us south, the unc-chapel hill school of social work re-visioned our approach to the msw curriculum. using case study methods, we trace our history and on-going work through interviews, document review, and community conversations, centering student voices. students interviewed spoke about activism prompted by racist events on campus and nationally, and the inadequate response from the administration. their efforts led to school-wide initiatives including curriculum shifts and accountability and action. the first-year generalist course, confronting oppression and institutional discrimination was restructured and resituated. critical race theory was infused across the coursework. two new working groups were created: the anti-racism task force and reconciliation standing committee. efforts to address racism and white supremacy in academic spaces require sustained activism to expose how racism is embedded within our institutions. while much work remains in the practice of becoming an antiracist institution, this model can serve as a prototype for others as they work to create programs that are site-specific and universally reflective of the institutional changes we need. keywords: racial justice, social work education, oppression, white supremacy in keeping with our commitment to anti-oppressive social justice education and practice, and in the shadow of confederate statues and the specter of white supremacy within the ivory tower, the school of social work (ssw) at university of north carolina (unc)-chapel hill embarked on a process to re-vision the way we approach generalist practice in our msw program. our national association of social workers (nasw) code of ethics calls on all social workers to work for racial justice and equity (nasw, 2017). this appears in tenet 1.05, cultural competence and social diversity: social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability. (nasw, 2017, para. 22) about:blank albritton et al./social work in the shadow 935 social and political action is addressed in tenet 6.04: social workers should act to prevent and eliminate domination or, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability. (nasw, 2017, para. 173) in 2005, the social work congress developed 12 imperatives to guide the profession over the next decade, which include (clark et al., 2006): ● addressing racism, other forms of oppression, social injustice, and other human rights violations through social work education and practice. ● continuously acknowledging, recognizing, confronting, and addressing racism within social work practice at the individual, agency, and institutional levels. our goal is to live into the values of our nasw code of ethics and our educational charges from the council on social work education (cswe), in which we are called to prepare students to engage diversity and difference in practice and advance human rights, and social, economic, and environmental justice. this work is in service to the vital role that social workers must play in challenging systems of oppression and disrupting white supremacy in our institutions. this article traces the school’s re-visioning process, highlighting leadership from students to keep racial and social justice at the forefront, and initiatives to disrupt manifestations of white supremacy culture in our climate and curriculum. initiatives have targeted all levels of our school community, including sswwide community conversations, faculty trainings, an all-chool retreat, the creation of the assistant dean of diversity, equity, and inclusion position, and a faculty and staff book read of how to be an antiracist by ibram x. kendi (kendi, 2019). our hallmark educational offerings for students have included an on-line history of oppression course leading into the generalist year and our first-year generalist course, confronting oppression and institutional discrimination. the school uses critical race theory, along with other seminal critical theories, to frame students’ educational journeys and their prospective practice as social workers. this content is introduced in the confronting oppression course, which examines institutionalized oppression and implications for practice at all levels, emphasizing the consequences of social inequality and the social worker’s responsibilities to interrogate oppression in policy and practice. background and significance since the late 1960s, the cswe has used educational policy and accreditation standards (epas) to establish guidelines that ensure students in social work programs receive instruction in nine core competencies (cswe, 2015). the development of epas closely mirrors how conversations about issues related to race and diversity have changed over the past 50 years. jani et al. (2011) point out that as the united states has undergone demographic shifts, cswe has tried with each new iteration of epas to ensure that social work programs remain relevant in their attempts to address issues of diversity and advances in social work, summer 2021, 21(2/3) 936 difference. specifically, in 2008 cswe instituted epas competency 2 which mandates that social work curricula ensure students have opportunities to “engage in diversity and difference in practice” (cswe, 2015, p. 7). efforts to fulfill the mandate set forth by epas competency 2 require social work programs to be intentional about instruction in both the explicit and implicit curriculum. the explicit curriculum refers to “the program’s formal educational structure and [includes] the courses and field education used for each of its program options” (cswe, 2015, p. 11). the implicit curriculum refers “to the learning environment in which the explicit curriculum is presented” (cswe, 2015, p. 14). historically, social work education has sought to fulfill such calls for instruction about diversity by exposing students to cultural competency frameworks (adams et al., 2009; dreschler et al., 2019; jani et al., 2011). this emphasis on cultural competence has often been at the expense of more critical models that offer nuanced and expansive approaches to thinking about and understanding issues of diversity, especially with respect to race. as abrams and moio (2009) point out, cultural competency frameworks’ broad lens with respect to diversity “tend to downplay racism’s persistent legacy and leaves social workers unprepared to deal with the realities of racism both systematically and interpersonally” (p. 249). the decades-long work of students, faculty, and staff within the unc ssw has led us to a vital moment of reckoning and transition. members of the ssw community are heeding the call of the current moment while acknowledging that our collective action is far past due, that to be a social worker committed to change in this moment means to acknowledge our decades of complicity and to work against reproducing harm by committing intentionally and sustainably to action. as a site for social work education, we ask ourselves how we affect change from both the inside and outside through our dual charges of acting as social workers in our own right while training up social workers of the future. this article discusses how one school of social work, when faced with calls from students for more deliberate conversations about the impact of white supremacy in both the school’s implicit and explicit curriculum, sought to re-vision the way the school approached generalist practice in the msw program. in so doing, the authors center student voices to highlight advocacy efforts by students enrolled in the program and discuss how the re-visioning process involved the restructuring of generalist courses, the inclusion of more critical theory in the generalist year, the institution of a summer reading program for newly admitted students, and the creation of an anti-racism task force. method using case study methods, this article traces the school’s historical underpinnings and its re-visioning process through interviews, document review, summaries of community conversations, the school’s strategic planning process, and initiatives implemented to disrupt manifestations of white supremacy culture in both the climate and curriculum. a case study research approach was selected to enable us to provide an “in-depth understanding of a single or small number of ‘cases,’ set in their real-world contexts” (e.g., bromley, 1986, p. 39), here for one school of social work. the goal is to provide a deep albritton et al./social work in the shadow 937 understanding by describing through various sources the historical and current work to dismantle white supremacy (yin, 2012). to help frame the history of student activism at the school, we interviewed three former students who were leaders in organizing at the height of this institutional work to highlight their efforts to address issues of racial and social justice, and demands for accountability from the administration and faculty. semistructured interviews were conducted using virtual conferencing software and lasted about 60 minutes (see table 1). questions included perspectives on the school’s history of antiblack racism, students’ role in addressing anti-black racism, impetus for activism, barriers to change during their time as a student activist, wins experienced, and hopes for the future. interviews were audiotaped and notes taken of key points. interviews were then transcribed and summarized for key themes. in addition to these key interviews, we reviewed literature from articles written about the school’s history, meeting notes, and documents produced during the 2019 2020 strategic planning process. table 1. interview guide questions 1. [for background] what was/is your role at the school? what years? 2. from your perspective, what is the school’s history of anti-black racism? 3. what was your role in addressing anti-black racism in the school? 4. what prompted your activism? 5. what were the barriers to change during your time as a student activist? 6. what wins (if any) did you experience? 7. how would you like to see your activism reflected in the school (e.g., student admissions, staff and faculty hiring, acknowledgement of anti-black racism within the school)? 8. what do you hope for future students of color in the school of social work? a recent history of anti-black racism the history of unc-chapel hill’s school of social work’s anti-black racism can be explored through the lens of what can be viewed as the difference between the externalfacing and internal-facing stances of the school on issues of racism. the public, externalfacing stance of the school includes being the first department or school at the university to hire an african american faculty member, professor hortense mcclinton in 1966 (graham, 2016); and the naming of the ssw building to include dr. john b. turner, the first african american dean at unc chapel hill and dean of the school from 1981 to 1992 (outlaw, 2009). the more private, internal-facing stance includes the underlying evidence of anti-racism that leads to these public demonstrations of racial “wokeness.” such internal-facing illustrations of anti-black racism includes very little record and recognition of the historic hiring of professor mcclinton (graham, 2016); a lack of racial diversity among tenured and tenure-track faculty; an extreme lack of representation of people of color among school administration, including dr. turner being the first and only black dean or dean of color within the school's 100-year history; a limited presence of black students in the school's msw and phd programs; and the creation of diversity and inclusion initiatives generally in response to national racial injustices and the racially unjust advances in social work, summer 2021, 21(2/3) 938 reactions by ssw leadership. in august 2021, dr. ramona denby-brinson joined the unc school of social work as the first black female dean of the school. by exploring the external and internal face of the school on issues of racial equity and justice, a publicprivate disparity in the school’s promotion of diversity and inclusion are revealed. the external face celebrated as the oldest public university in the country, unc-chapel hill first opened its doors to students in 1795, becoming the first and only institution to graduate students in the 18th century (unc-chapel hill, 2020). however, with north carolina fighting to maintain the right to enslave african people in the civil war, extending the exploitation of african people and their descendants under the protection of the 13th amendment during reconstruction, and continuing the violent oppression of african americans under the black codes and jim crow laws, admission to the university was not extended to african americans until 1951–more than 150 years after hinton james, unc-chapel hill’s first student, stepped foot on campus. under court order, unc school of law and medical school admitted the first black male students in 1951, followed by the admission of the first undergraduate black men in 1955, and the first black woman in 1963 (unc-chapel hill, 2020). although black students were enrolled at unc beginning in the 1950s, the racial climate on campus was slow to change. in response to a lag in continued admission of black students and a lack of representation within curricula, faculty, and student support services, the black student movement (bsm) was formed in the fall of 1967 (the black student movement, n.d.). within the first two years after its inception, bsm began using activism to shift the campus climate for not only students, but also for staff. in december 1968, bsm presented the chancellor with 23 demands to improve the experiences of black students on campus including a call for an african american studies department, a campus office centered on addressing the needs of black students, and equitable admissions policies dependent on grades rather than sat scores (the carolina story: a virtual museum of university history, 2019a). a few months later, bsm supported food workers in their month-long strike for fair labor practices by first holding a sit-in at lenoir dining hall followed by more direct student-led action and the walkout of food workers (the carolina story: a virtual museum of university history, 2019b). bsm’s efforts to improve the racial climate of unc continued in the following decades including: participation in a second food workers’ strike near the end of 1969; the protest against the use of student fees to host david duke–founder of the knights of the ku klux klan– for an on-campus speaking engagement in 1975; a sit-in at the south building in 1979 to protest the denial of tenure for dr. sonja haynes, who was the head of african and afroamerican studies; a teach-in in october 1990 in protest of the “student body” sculpture that portrayed a black male and female student as stereotypical images (i.e., black women carrying books on her head, black man spinning a basketball on his finger); and advocacy for physical space dedicated to black students on campus including the sonja haynes stone black culture center that opened in 2004 and the rededication of the upendo lounge in 2016 as a reserved space for bsm (the carolina story: a virtual museum of university history, 2019c). albritton et al./social work in the shadow 939 while long struggling with the legacy of white supremacy as part of the predominately white unc-chapel hill institution, the ssw was leading early on. in 1966, the school hired hortense mcclinton, the first black faculty member hired at unc (graham, 2016). mcclinton taught at the school for 20 years, creating and implementing a course on institutional racism in 1972 as well as serving on numerous school and university-wide committees until her retirement in 1984 (graham, 2016; moss, 2015). in an interview with unc’s university archivist, mrs. mcclinton related, “i finally decided, well, if you’ve been taught a certain thing all your life, you have to learn to know something different. that’s when i started the class in institutional racism.” mrs. mcclinton also shared that she was tapped to serve on 11 different committees at the same time because “they wanted a black voice, and she was it” (moss, 2015). another african american faculty member was not hired by unc chapel hill for another three years; evidence that the ssw was spearheading efforts to desegregate the university beyond student admission (moss, 2015). the hiring of black pioneers on unc-chapel hill’s campus continued with the appointment of dr. john b. turner as dean in 1981. a tuskegee airman during world war ii, dr. turner became the first black dean at unc. during his 11-year tenure, dr. turner provided the foundation for the school to become a leader in the field, including the establishment of the school’s first development office, advocating for the development of the doctoral program–the first social work phd program in north carolina–and raising the $10 million that allowed the ssw to move from five different buildings on the edge of campus to a modern building close to main campus (outlaw, 2009). the literal groundbreaking of the ssw became groundbreaking history as the tate-turner-kuralt building became the first academic building on unc’s campus to bear the name of a black person (outlaw, 2009). the public and historical examples of the school of social work’s inclusion of black people from students to administration are evidence of a foundational commitment to diversity and the continued presence of individuals from diverse backgrounds within the school; however, history and publicized images of diversity and inclusion have not translated to the present institutional structure, resulting in anti-black racism being exemplified within the current, student-facing stance of the ssw. the internal face as with any institution, the public representation of the ssw differs from its daily, inner workings; however, when an institution’s image of diversity and inclusion runs counter to its private, internal commitment to racial equity, tension can arise and overflow into the public eye. two examples of this public-private disparity at the ssw exist within the very same historical markers of the school’s promotion of racial equality: the hiring of mrs. mcclinton and the deanship of dr. john b. turner. according to graham (2016), mrs. mcclinton’s hiring at the ssw appeared to be unpublicized with little to no record of her hiring within unc archives. graham (2016) went on to state that mrs. mcclinton’s notable employment as the first african american faculty member at unc had very little coverage in comparison to the admission of the first black undergraduate and graduate students in the 1950s “which came after lengthy court battles and were well covered in the advances in social work, summer 2021, 21(2/3) 940 local media” as well as when unc hired english professor, dr. blyden jackson, as the first black full professor in 1969, “[who] was the subject of a feature story in the daily tar heel” (para. 6). it should also be noted that recognition by the university of mrs. mcclinton’s role in desegregating unc did not take place until 2016–32 years after her retirement–in the form of a scholarship in her name and coverage of her story (graham, 2016). on the other hand, the historic appointment of dr. john b. turner as the first black dean at unc is well documented, including in the naming of the ssw’s building, yet a public-private disparity in racial equity is evident in the extreme lack of racial diversity among the school’s leadership since dr. turner’s retirement in 1992. within the school’s 100-year history, dr. turner is both the first and only black dean or dean of color in the ssw. the internal-facing stance of the school also reveals a lack of racial diversity and, to a greater degree, instances of anti-black racism experienced among students, staff, and faculty. a lack of racial diversity is evident in the underrepresentation of black people among the student body and faculty, including tenured professors; homogenous racial identities of the authors of assigned textbooks and readings; a dearth of racially diverse guest speakers; and limited course curricula dedicated to racial justice and the study of communities of color using a strengths-based perspective. as the lack of racial diversity in the school is evident through the absence of black representation, anti-black racism has become evident through the presence of racist interactions among students, between students and faculty, and, in particular, within interactions between students and administration. the interviews conducted with former student activists in the school for this article provide context for unc's ssw recent history and current occurrences of antiblack racism in the face of a public assertion that the school “value[s] the individual differences and perspectives of each person…[and] respect and honor the lived experiences within our community” (unc school of social work, 2021a, para. 2). centering student voices in this section, we center voices of msw and doctoral students whose activism and commitment served to greatly advance the anti-racism development of the school. one interview was conducted with “peter,” a white male msw program alum who actively helped lead social activism efforts within the school during his time as a student from 2013 to 2015. peter, who also attended unc-chapel hill as an undergraduate student from fall 2009 to spring 2013, described the institution as “not being new” to him as his initial activism began with the student-led protests against silent sam–a monument erected on the campus of unc-chapel hill in conjunction with the daughters of the confederacy in 1913 (nearly 50 years after the end of the civil war) to recognize students who left the institution to fight for the confederacy. a second interview was conducted with “leslie,” a black, female msw alum from 2018-2020. she was also an undergraduate at unc and spoke a lot about the anti-black history of the university from its very foundations: “black students were not admitted, not welcomed, barred from being on campus, our very foundation, because the school of social work is part of unc, embedded in anti-black narrative.” leslie’s work started internally albritton et al./social work in the shadow 941 facing with conversations in classrooms. she described how it was first uncomfortable to name what this is (anti-black racism) but then other students started speaking up, saying “we also need to name what it is.” she talked about how “we always tip toe around to be sensitive to white feelings, but this is happening.” additional insights about the school’s anti-black racism were provided by a coauthor, who was a student activist during her time in the doctoral program from 2012 to 2019 following the completion of her master’s degree at the school. similar to peter and leslie, the co-author attended unc as an undergraduate and graduate student, which provided her with perspective on the externaland internal-facing stances of both the ssw and the larger university on issues of race and racism. the added role as a doctoral student extended her time in the school and, in turn, her participation in activism efforts, providing a bridge between peter and leslie’s periods of enrollment. ferguson, silent sam, and deans’ responses both alums talked about their activism in relation to social movements against antiblack racism, and dean and administration failures of leadership in response to those social movements. after completing his undergraduate degree and entering the msw program, peter cited that his participation in student activism, and more specifically, student organizing against anti-black racism at the ssw, was incited by two events in august 2014: the shooting murder of 18-year-old michael brown jr. in ferguson, missouri; and the email response to the nationwide coverage of the shooting from the dean at unc chapel hill’s ssw. first, national outrage was ignited after michael brown, an unarmed black teenager, was killed and left in the street for four hours after being shot in the back by white police officer, darren wilson, on august 9, 2014 (associated press news, 2019). local and national protests followed michael brown’s killing as demands for justice were made across the country, including among students at unc-chapel hill. as peter reflected on how “we had ferguson,” he described the context in which his activism took place in the ssw: “ [it was ] a remix of white supremacy and violence and reflecting like, it was the obama administration, it wasn’t the trump administration. it wasn’t amadou diallo. that was a couple generations before, but again, it was this reframe but it was there.” in efforts to quell the growing sense of unrest at the ssw, the dean sent out an email to students, staff, and faculty that stressed “tempered” responses, a need to “provide legal due process and appropriate investigation,” and likened the shooting of michael brown to a prior high-profile racially-charged investigation that involved the duke university lacrosse team, in which the “‘facts’ turned out not to be ‘fact’.” in addition to these statements, the dean also called for recipients to “focus on the institutional and structural issues of racism, poverty, lack of opportunity, and exclusion” rather than on the “immediate injustice of the shooting death of mr. brown.” the dean then ended his email reminding students, staff, and faculty that there are other issues of oppression occurring across our country, including “dramatically increasing anti-semitism” (j. richman, personal communication, august 19, 2014). as peter recalled the dean’s email, he remembered it being a “microaggression” and perceived the dean as displaying the notion of “friend of all is a friend of none.” peter also advances in social work, summer 2021, 21(2/3) 942 recounted the response of other students including the co-author, who reacted by sending an email to the dean and coordinating a meeting with the dean and her faculty advisor to discuss the harm the dean’s email inflicted on black students. they also posed some next steps to move towards reconciliation and healing within the school, including a follow-up email (crafted with help from the co-author), a community dialogue within the school, and racial equity training for faculty, staff, and students: “the email came out and [co-author is] like ‘hey, that hurt, what can we do?’ like from a position of togetherness.” peter went on to further reflect on the dean’s response to students’ responses to his email: the dean, at that point, had sparked a broader community response, like ‘wait a minute, he’s digging in’…the digging in around that led to this broader activation of the community of students about what the institutional racism at unc-chapel hill broadly and at the school of social work was. national demonstrations of racial violence against black people and inadequate responses from the school’s leadership continued to spark student advocacy and activism in the following years with later cohorts of social work students. leslie was an msw student during a heavy period of student and community activism to remove the confederate statue from campus. while ostensibly erected to honor the students who served in the civil war, the statue, known as silent sam, was not erected until 1913 in an effort to reinforce jim crow segregation and terror (killgrove, 2018). protests against the statue began in the 1950s when black students were first admitted to the university. this activism led to the statue finally coming down just before school started in august 2018 (stancil, 2018). this led to additional organizing and activism around the disposition of the statue, including a recommendation from the university's board of trustees (bot) to create a place for it in a campus location historically home to black students (harris, 2018). in leslie’s words, the school held a meeting to: talk about how we were going to wait and see, partner with them, help shape the narrative, acknowledge the truth, i got worked up, really, we are going to wait and see? i asked the dean if he would make a statement against this. and he said no because he was speaking not just for himself but for the whole school. but wait, why are you a social worker? aren’t we against racism? student activism and leadership as evident in peter and leslie’s descriptions, racist events happening on campus and beyond motivated students’ activism. leslie related: [before school started] i did the summer bridge class for black and brown students – they mentioned silent sam and students were like really, that’s here? i learned early on at unc, having been at protests, not feeling protected at all, police were protecting the kkk and not students. people came with bats and police did nothing. friends having experiences with silent sam – and being in the school of social work with a wait and see attitude – we are just going to have to do this ourselves. some faculty offered and asked how they could help…[two other black, albritton et al./social work in the shadow 943 female students] also wrote a letter addressing the things they saw in the school that they thought weren’t going well. seems like some of that is being addressed. similar to leslie, peter also described his call to participate in student activism as a responsibility to merge those internal and external faces of the school and embody the guiding values of social work: “i don’t think we would have done what we did as a trio, as a larger group of students, as a school, if the institutional defensiveness hadn’t reared its ugly head.” additionally, peter explained, ...we come in with a social justice mantra, we have classes that talk about the history of oppression and liberation, we’re in field placements where if you don’t have an analysis of race and racism, or sex and sexism, or class and classism, you’re going to be missing a lot. in the 2014-2015 academic year, a coalition of concerned students from various racial and ethnic backgrounds, ages, and institutional positions (i.e., advanced standing, twoyear, three-year, phd) led and facilitated student activism, which culminated in partnerships with other campus offices for the planning and implementation of two community dialogue events, several debriefs, and the presentation of student-formulated measurable steps toward racial equity at a faculty meeting. student activism was impacting the school’s climate, however the push for racial equity did not come without pushback and obstacles. barriers. leslie identified two primary barriers to change during her time at the school: communication and transparency. there have long been challenges in communicating across groups at the school, which creates a disconnect between who has information and who doesn’t, who is included and who isn’t. leslie shared that “the engagement piece is hard – black and brown students are just tired. i have to go and bare my soul and hope that you have compassion; that is mentally exhausting.” in addition, with students doing so much of the labor to disrupt white supremacy and demand accountability, institutional memory becomes a barrier with most students only in residence for 1-3 years. leslie related some of her and her colleagues' efforts, in the black student caucus we were trying to gather and save information. we need a remembrance space to keep these memories. then covid-19 happened and our time present was cut short. phd students are even more not a part of the loop. the major barriers identified by peter centered on power imbalances within institutional positions. first, peter pointed to demanding student schedules functioning to dissuade student activism. with limited time to engage in the strenuous work of activism, students who may have been concerned about anti-black racism among the school’s leadership had to decide if they wanted to actively participate in the fight for racial equity. this decision led to the designation of leaders among the student body who represented the interests and voice of students among school administration. peter shared the pressure he felt from other students while leading activism efforts in the school: there’s some pressures, there’s some barriers to organizing because you have a lot of demands from family, from your work life, from your field life, from the advances in social work, summer 2021, 21(2/3) 944 academic rigor of that program. … [t]here [were] three of us...and we became like the representatives of that group. so, you have the huge student population, our group of concerned students didn’t speak for everybody or was a subset, and then we became a subset of the subset but at least from that meeting, it really was, ‘hey, we’re concerned, yea we trust you, and y’all can do it’….it was a sense of, at least for me, basic duty. it was like….you need to step up. people are asking someone to step up. peter went on to describe the power imbalance among staff and faculty as those without tenure had an inability to publicly support students and participate in social activism. peter stated that some staff and faculty who may have been committed to anti-racism work were unable to stand with students because “they’re not tenured, we’re an at-will [employment] state” and some of those faculty and administrators in the school who had more power “closed ranks” around the dean, demonstrated similar defensiveness, and, in turn, decided “we’re not listening to students.” peter also acknowledged the surveillance faced by faculty at a public institution, recalling previous threats from north carolina’s general assembly following the publication of the school newsletter displaying pictures of social work faculty at a moral monday protest. therefore, one’s ability and desire to promote racial equity in the school greatly depended on one’s position of power, which peter related to social workers’ professional relationship with clients: i think of the power dynamics: social worker, client. social workers are gonna have power—you need to be listening to and centering the client. school of social work: a lot of power in the institution, like hierarchies of staff are different. and students. there’s this interesting view that like ‘well students have all the power, you just see them as customers, and the customer is always right’. we don’t have power compared to the people who award degrees. i think there’s almost this dual perspective that the other side had more power. structurally, we weren’t talking about power. there may have been more freedom to say or do certain things but in a power analysis, we were the clients. unlike peter and other msw students, the co-author, who also participated in student activism, was a doctoral student with a longer period of time to engage in advocacy efforts and, in turn, a longer period of time to encounter barriers to the promotion of racial equity and justice in the school. one barrier faced by the co-author was discontinuity in coalitions as students cycled in and out of the msw program throughout her enrollment. because of the vast difference in the lengths of matriculation between msw (e.g., 1-3 years) and doctoral students (e.g., 5-6 years; cswe, 2018) , the co-author was unable to coordinate with a consistent group of student advocates in the msw program, leading to a rehash of issues identified by previous students; a halt to activism efforts with the graduation of msw student advocates; and, a lack of follow-through with administration to ensure accountability to commitments made to students as well as to staff and faculty. this lack of continuity in student presence contributed to the co-author, at times, leading individually on issues of anti-black racism particularly within the doctoral program, including publicizing the lack of black student enrollment, dearth of doctoral curriculum focused on race and racism, and the absence of black faculty teaching in the phd program (watkins, 2017). albritton et al./social work in the shadow 945 the role of being a doctoral student also presented various barriers to activism for the co-author. first, as indicated by peter, student activism requires a substantial time commitment. this commitment may be particularly taxing for doctoral students, who tend to be older than msw students with more family and financial obligations (cswe, 2018). second, because support from faculty and positive interactions within the departmental environment are significant predictors for successful dissertation completion, student activism can carry heavy consequences for doctoral students (liechty et al., 2009). by challenging the structure and critically analyzing the racial climate of the school, the coauthor’s relationships with administration and some faculty were negatively impacted, potentially hindering her progression in the program. last, activism within one’s academic institution as a doctoral student may negatively influence postdoctoral employment as challenging racially unjust program policies and practices may be perceived as the breaking of the “unwritten rules of graduate school” (jones et al., 2013, p. 327). by breaking those unspoken rules, doctoral student activists who are on the job market may be viewed as difficult troublemakers with a propensity for conflict–characteristics that are not typically sought in candidates for employment. despite these barriers and challenges, the co-author and the interviewees were able to identify some wins that sprouted from their advocacy efforts. wins. in the face of the challenges he experienced while leading students in efforts to promote racial equity, peter was able to report both immediate and distal wins. first, peter considered gaining entry into a faculty meeting to present students’ proposals for social change as an immediate fruit of his labor. peter described that experience and the resulting sense of self-efficacy in the following way: i imagine that there’s a process. i don’t know how often students get to do that. so that idea of a self-empowerment tradition in social work….we did something that wasn’t a part of the structure, we organized ourselves, and we demonstrated selfefficacy. so, our own sense of self, and sort of being paralyzed like ‘oh my god, the news, there’s tanks in the streets, there’s people getting killed’. well you can do something about it. so, there was that internal win. peter also considered the relationships he developed with fellow student activists as a win. as he reflected on the students he developed relationships with as a result of their shared commitment to countering anti-black racism, peter described “forg[ing] this fire around anti-racism across gender, and across race, and across professions,” in which the very principle of valuing human relationships was modeled and practiced. despite being disconnected from the school since his graduation in 2015, peter has been able to witness more distal wins through his connections with current students and their activism around other social injustices. peter highlighted the anti-oppressive advocacy students demonstrated in the school around the passing of hb2 by the north carolina legislature, which required individuals to use bathrooms and locker rooms that corresponded with the sex one was assigned at birth, discriminating against transgender and gender nonbinary individuals (pbs, 2017). peter also cited the school’s recent response to the murder of george floyd as a distal win stemming from the activism of students in response to the murder of michael brown: advances in social work, summer 2021, 21(2/3) 946 i don’t know if [the dean’s] email would have looked like how it looked like with george floyd and this administration, in this resurgence of white supremacist violence. it’s almost like this spiritual win. we as students made a commitment to values and did what we needed to do at that time because now there’s this time. the biggest win that peter mentioned was being remembered and the implications it has for the social issues he was fighting against and those that are being fought for now: we are connected to our ancestors of students….if our pressure hadn’t been applied in the way it did. institutional knowledge includes institutional memory of ‘oh yea, those students in 2014-2015; remember what happened then? maybe we should ask these questions.’ i think the institution remembers us, and that’s a win. which means they remember ferguson. they remember mike brown. so, i think breonna taylor is going to be remembered this time around. ahmaud arbery. leslie described a number of positive changes at the school as a result of student organizing, many very recent. she shared a lot about the move of the confronting oppression course (501) from the spring semester to the fall semester: hearing about all the changes this upcoming year [was a win]. especially how the 501 class is moved to the fall – some people may not have been exposed to this [content – confronting oppression and institutional discrimination] before. black students come in with hope and then by the 2nd semester mourning not getting what they expected. [there is a] dance that has to be taken – who is teaching these classes? what are my options? where are the other black students going to be? 501 is not a class where you want to be the only black student. i shouldn’t have to be the teacher in that class. she also described other ways that explicitly anti-racism content has been infused into the school’s curriculum, including embedding critical race theory across the curriculum and an all-school read of jonathan metzl’s dying of whiteness “those pushes were because of student activism!” hopes for the future the materialization of social activism into actual change may be delayed or denied; however, activists continue to engage in the work. peter and leslie both expressed hopes that their activism will eventually contribute to institutional change at the ssw. peter voiced that he hoped his advocacy efforts would contribute to “institutional transformation” in the form of racial equity being evident among students, faculty, and administration. first, peter hoped that students of color could move from surviving to thriving in the ssw environment: i want students of color, in particular, to feel like they have a voice and their degree isn’t just like ‘shit, i gotta come in here and survive in this predominantly white institution, survive the racism, and get out with the least amount of scratches i can. albritton et al./social work in the shadow 947 additionally, peter stated that he hoped for greater levels of allyship among white students in order to reduce the psychic and physical trauma experienced by students of color through frontline advocacy and taking on the burden of addressing anti-black racism in the school. next, peter shared that he hoped that both faculty of color and scholarship around issues of race, racism, and anti-racism practices would become more present in the school. this promotion of racial equity in both the presence and substance of faculty would then contribute to racially equitable curricula, diversification of school leadership, and increased efforts to connect with historically black colleges and universities (hbcus) in the area rather than partnerships primarily being sought with the nearby historically white private institutions. overall, peter expressed a hope for the school’s private face to more closely align with its public face. peter voiced a desire for the school to model and integrate its mission within its policies and practices, including hiring practices, policies on engagement in social activism, and admissions processes. there is also hope for efforts to repair the harm caused to students, staff, and faculty of color by first acknowledging the harm and then implementing safeguards to prevent those harms from happening in the future. our second msw graduate expressed the hope that future students of color won’t have to experience what she experienced. she also found that some white students in her cohort talked about holding each other accountable: “what they need to do to increase their own learning – hope this learning/approach continues – accountability for white students, faculty, too.” leslie also shared her hope that the administration be fully involved and integrated, which has to happen to move us forward. we need to be loudly transparent – we come off as elitist and hypocritical. how can we say, “you need to do this,” if we need to do that? get to the place of what are we going to say, not if…example for students to follow – how can i respond as a social worker to support my clients, community, model responding compassionately and quickly. where we are now multiple action steps have been taken over the past year that have carried forward work conducted by those students, faculty, and staff who have come before us, detailed above, and also ushered in new ideas that have been born out of the ssw, as well as the institutional, state, and national landscapes. community members within the unc ssw envision this work as needing to happen at multiple levels simultaneously. over the past year many members of the ssw community involved in planning and action in the school have begun to refer to these work levels as “buckets.” the three distinct, yet related buckets we are using as a framework are: 1) work within the ssw. this work entails actions and strategies taken in the ssw to integrate antiracist practice to effect change in teaching, research, school culture, interpersonal relationships, infrastructure and policy; 2) work that ssw community members engage in at the university level. this work includes actions and strategies taken by ssw faculty, staff, and students as we interface with the larger university to integrate antiracist practice to effect change in teaching, research, advances in social work, summer 2021, 21(2/3) 948 school culture, interpersonal relationships, infrastructure and policy; and 3) work with the external community. this work looks like taking part in opportunities to connect the school community to advocacy and actions outside of the ssw and the university, including local, state, national, and international work. this would be building on what is already being done in the community and finding ways to connect, collaborate, amplify, and utilize our resources and person-power. the vision among members of the ssw community actively working on these efforts is that the ssw embarks on a process of self-reflexivity, truthtelling, and action that starts within our own walls, keeping our own journey toward antiracist practice central to all of our efforts. here we will focus on two aspects of our internal work as a school community: curriculum shifts, which was described briefly above in the student voices section, and internal calls for accountability and action. curriculum shifts an important star in the constellation of change within the ssw, couched within the bucket of our internal work, has been an overhaul of one of our generalist courses: confronting oppression and institutional discrimination. this course meets cswe requirements related to understanding how systems of oppression marginalize vulnerable populations and how social workers can act to interrupt discrimination. prior to this academic year, confronting oppression had been a required course in the second semester of the first msw year. the strategic re-envisioning of this course to ensure that it both sets a practical stage for curricular content throughout the program and sends a clear message early about the priorities of the ssw included moving the course to the first semester first year. this course works to introduce students to theoretical frameworks to prepare them for two years of antiracist and anti-oppressive pedagogy and situates itself as a way to use theory to excavate the challenges and possible solutions to societal inequities. critical race theory (crt; bell, 1995) is a springboard to explore the multi-faceted, complex, and urgent realities of how identities impact one’s lived experience. the course moves through a critical assemblage of topics, including disability studies, queer theory, freirean dialogic, and environmental justice, to interrogate the intersectional relationships between race and other forms of oppression. as a curricular companion and as a community-building activity, the ssw instituted a summer reading initiative. the selected book is intentionally woven throughout course content for both 1st and 2nd year msw students and is the centerpiece of a faculty and staff book discussion group. additionally, a future plan is to create year-long events that also directly connect to the chosen reading. the summer reading for 2020 was dying of whiteness by jonathan metzl. metzl’s book provides a helpful framework for faculty, staff, and students to together explore the ways that white supremacy gets enacted through institutions, public policy, and human behavior. specifically, dying of whiteness provides the ssw with a lens through which to view and interrogate the insidious nature of white supremacy, a theme that we can then explore in courses ranging from policy to research methods to human development. albritton et al./social work in the shadow 949 internal calls for accountability and action while the explicit curricular changes mentioned above speak to an evolution in praxis, these shifts are inextricably connected to internal calls for accountability and action made by multiple sub-groups within the ssw community over many years. in an effort to share a snapshot of the most recent actions that have propelled change, we focus on two open letters addressed to the ssw and beyond: one from students and one from faculty. in november of 2019, msw candidates wrote an open letter to deans of the ssw asking for leadership from the school in taking action against anti-black racism in the school, the university, the profession, and the country. one of the driving forces behind this open letter was the toppling of the confederate statue known as silent sam, and the ensuing legal battle that included an initial payout of $74,999. and the creation of a $2.5 million trust from the unc board of governors to the north carolina sons of confederate veterans, a neo-confederate group headquartered in tennessee. the initial payout by the unc system to this group to take possession of the statue ignited strong opposition from faculty, staff, and students on campus (sheehey, 2020). among other things, the open letter from msw students urged leadership within the ssw to step more fully into the vocal resistance movement building on campus. this letter prompted the creation of a series of working groups called community conversations, now partially rolled into the work of the pre-existing, student-led social justice action collaborative (sjac). the sjac collaborative is an open working group of faculty, staff, and students committed to working toward social justice in the ssw in both the explicit and implicit curriculum through events, actions, and collaborations. in june of 2020, four black-identified full professors in the ssw penned a joint statement to the entire ssw community detailing the historical and current racist harms committed by both the ssw and the academy as a whole. the statement included a sixpoint plan as a starting point to uprooting racism in the ssw and introduced the creation of two new working groups in the school: the anti-racism task force and reconciliation standing committee. the task force will coordinate with ongoing efforts and activities in the school while the reconciliation standing committee will serve as a sounding board and potential advocacy group for faculty, staff, and msw/phd students who experience racism in the school. these two groups will provide much needed leadership, oversight, and accountability for the many co-occurring projects, curricular changes, and efforts going on with the school. conclusion efforts to address racism and white supremacy in academic spaces require sustained activism that seeks to expose how racism is embedded within the fabric of our institutions. the work to address white supremacy carried out in the aforementioned school of social work required individuals at the administrative, faculty, staff, and student levels to take seriously the need for intentional dialogue and action designed to call attention to the ways in which members of the school community failed to demonstrate a commitment to antiracism. furthermore, student activism played an essential role in holding the school’s advances in social work, summer 2021, 21(2/3) 950 administration accountable for developing a plan aimed at centering anti-racism. the collective effort of students across multiple cohorts coupled with consistent advocacy from numerous faculty laid the groundwork for our school community to take tangible steps toward building and maintaining an antiracist program of action. going forward, we will implement a process evaluation to better understand how the past and current antiracist leadership of students, staff, and faculty have led to changes in reputation, enrollment, and on-going anti-racism progress. any efforts to address institutional racism must insist on a multifaceted approach; one that asks the entire school community to make a commitment to behaviors and actions that center anti-racism. social work programs committed to anti-racism must interrogate why so many voices of the past were not ceded to in their calls for justice both in their schools and in the profession. to answer this with integrity, faculty and administrators must name the role that white supremacy as a system plays in the academy and in the social work profession. additionally, those in the highest positions of power must be earnestly willing to center the voices and experiences of minoritized students who have been actively harmed by the school environment by creating participatory change processes. author and activist tema okun (1999), writing for the organization dismantling racism works, writes, “culture is powerful precisely because it is so present and at the same time so very difficult to name or identify” (p. 1). the dismantling of deeply embedded ways of knowing and acting is difficult yet urgent work. we have seen a culture of white supremacy creep into the very work discussed in this article, centering whiteness and unwittingly reproducing anti-blackness due to the strength and compulsion of dominant culture to become the default without careful attention to this toxic pattern. our school’s current mission, “advancing equity, transforming systems, improving lives,” provides a mutually agreed upon springboard for this vital work moving forward as both a school and a profession (unc school of social work, 2021b). the primary limitation of this article is that case study methods are not generalizable to other contexts. this paper addresses only one school’s experience in the us south, as well as centering the experiences of former students who were integral in affecting change at the school, in an effort to elucidate the historical context of our journey and to shed light on the very real fact that doing this work with integrity is a marathon and not a sprint. schools committed to combating white supremacy must build their own springboards, doing so with a recognition that the work never ends and will never be perfect. to be clear, the goal should not be perfection but rather an unwavering commitment to ensuring that anti-racism permeates every aspect of the institution's practice. anti-racism must become more than a mission statement, a committee, a task force, or a reaction to a national event; it must become who you are and who you seek to become as an institution for those who are currently a part of your school community and for those to come. so, we pose the following question to you: are you truly committed to anti-racism? references abrams, l. s., & moio, j. 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(2012). a (very) brief refresher on the case study method. in applications of case study research (3rd ed., pp. 3-20). sage. https://www.sagepub.com/sites/default/files/upm-binaries/41407_1.pdf author note: address correspondence to travis albritton, unc school of social work, 325 pittsboro st., cb#3550, chapel hill, nc 27599-3550. email: talbritt@email.unc.edu acknowledgements: we are grateful to current and former students, including andrew heil and treasure williams, for their long-term work to push us in the direction of antiracism and sharing their experiences in the school. we also want to acknowledge the ongoing leadership from black faculty who have maintained a focus on racial justice and worked to hold our institution accountable for dismantling systems of oppression. https://ssw.unc.edu/about/our-foundation/mission-and-vision/ https://www.dailytarheel.com/article/2017/08/letter-uncs-racism-includes-school-of-social-work https://www.dailytarheel.com/article/2017/08/letter-uncs-racism-includes-school-of-social-work https://www.sagepub.com/sites/default/files/upm-binaries/41407_1.pdf implementing trauma-informed care: recommendations on the process diane k. yatchmenoff stephanie a. sundborg mildred a. davis abstract: the importance of trauma-informed care (tic) is now recognized across most health and human service systems. providers are calling for concrete examples of what tic means in practice and how to create more trauma-informed organizations. however, much of the current understanding about implementation rests on principles and values rather than specific recommendations for action. this paper addresses this gap based on observations during the provision of technical assistance over the past decade in fields like mental health and addictions, juvenile justice, child welfare, healthcare, housing, and education. focusing on the infrastructure for making change (the tic workgroup), assessment and planning, and the early stages of implementation, the authors discuss barriers and challenges that are commonly encountered, strategies that have proven effective in addressing barriers, and specific action steps that can help sustain momentum for the longer term. keywords: trauma-informed care; implementation; health and human services rates of past and current trauma are known to be high among service recipients involved in many health and human service systems (hopper, bassuk, & olivet, 2010; ko et al., 2008; salazar, keller, gowen, & courtney, 2013), in the social service workforce (berger et al., 2012; elliott, bjelajac, fallot, markoff, & reed, 2005), and in the general population (dube et al., 2005; green et al., 2010; huang, schwandt, ramchandani, george, & heilig, 2012; mclaughlin et al., 2010). moreover, service providers recognize that not only are our public systems populated with trauma survivors but that many service settings, programs, and processes can be re-traumatizing (bloom & farragher, 2011; substance abuse mental health services administration [samhsa], 2014a). trauma-informed care (tic) takes this understanding into account, based on the premise that when services feel safe, empowering, and welcoming for those affected by trauma, service recipients are more likely to engage in and benefit from care. tic is not an evidence-based intervention with fidelity measures and clearly outlined strategies, nor is there a single definition (hopper et al., 2010). experts agree, however, that essential components of tic include awareness of the prevalence of trauma, understanding about the impact on service utilization and engagement, and commitment to incorporating those understandings in policy, procedure, and practice (guarino, soares, konnath, clervil, & bassuk, 2009; hopper et al., 2010; samhsa, 2014a). in recent years, efforts to define tic, outline its principles, and generate buy-in have turned to a focus on implementation (miller & najavits, 2012; morrissey et al., 2014). service providers are calling for concrete examples of what it means in practice and the most effective strategies at the organizational level to make the needed changes. however, ______________________ diane k. yatchmenoff, phd, former director of trauma informed oregon, adjunct faculty at the school of social work, portland state university; stephanie a. sundborg, phd, research and evaluation coordinator for trauma informed oregon, portland state university; mildred a. davis, lcsw, phd, director of trauma informed oregon, associate professor of practice at the school of social work, portland state university. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 167-185, doi: 10.18060/21311 this work is licensed under a creative commons attribution 4.0 international license. yatchmenoff et al./implementing tic 168 despite a proliferation of national centers, conferences, proprietary models, web-based resources, training opportunities, and experts offering technical assistance or consultation, much of the dialogue about implementation remains academic, resting on principles and general guidelines (baker, brown, wilcox, overstreet, & arora, 2015). in some cases, creating a more trauma-informed service system may be easy and intuitive. however, for many organizations, adoption of tic is slow to take off and hard to sustain, despite deeply held interest and commitment (hodgdon, kinniburgh, gabowitz, blaustein, & spinazzola, 2013; hopper et al., 2010). what is missing from the literature is detailed and concrete information about what commonly happens in the implementation process, the barriers that are encountered, factors that can facilitate the process, and how organizations are effectively moving forward despite significant challenges. this paper addresses this gap, presenting observations from the provision of technical assistance over the past decade in fields like mental health and addictions, criminal justice, juvenile justice, child welfare, healthcare, housing, criminal justice, and education. the authors have consulted and/or facilitated a tic change process for individual agencies, larger organizations, and inter-agency or cross-system initiatives. while these settings are all different and each organization within them is a unique entity, our experience suggests that too much has been made of these differences, while the reality is that there are significant common dimensions to the work, common obstacles that are encountered, and a common set of strategies that can facilitate progress. the overarching process for the implementation of tic (see, for example, trauma informed oregon, 2016a) will be familiar to anyone who has used organizational planning tools in the past, such as the well-known plan-do-study-act (pdsa) model of iterative change (institute for healthcare improvement, 2003). the pdsa cycle includes introducing the idea of change, forming a team, setting aims, establishing measures, selecting changes, testing and implementing changes, and then spreading changes. similarly, for the trauma-informed care initiative in an organization, early steps include acquiring foundational knowledge, generating buy-in (guarino et al., 2009; hendricks, conradi, & wilson, 2011; institute for health and recovery, 2012; samhsa, 2014b), and ensuring other elements of readiness (armenakis & harris, 2009) as a precursor to the assessment and planning phase. in this paper, we focus primarily on infrastructure (forming a team), assessment, and early steps in implementation, where difficulties most frequently arise and successes can mean the most. brief examples of action steps that organizations have taken to reflect the principles of trauma-informed care are mentioned in various sections below, but the overarching purpose of the paper is to provide support for the process of assessment, planning, and implementation rather than to detail specific trauma-informed practices that have been adopted. infrastructure for change: the tic workgroup although we have seen some success with individual champions or small grassroots efforts that create a ripple effect in organizations, most successful tic implementation initiatives begin with foundational training and subsequently the establishment of a advances in social work, spring 2017, 18(1) 169 workgroup that is charged with leading the implementation effort. ideally, staff at all levels and from all roles in an organization receive training in the core knowledge areas: the nature of trauma; the impact of trauma on brain development and functioning; how trauma shows up in service systems; how systems may inadvertently re-traumatize or activate a trauma response; secondary and vicarious trauma in the workforce; and the definition and principles of trauma-informed care, including care of the workforce as well as the population seeking or using services. a tic workgroup is usually established soon after initial training. it has not worked particularly well, in our experience, when organizations have put this responsibility into existing structures such as quality improvement or safety committees. a team that is created specifically for this purpose has been more effective. the job of the workgroup (guarino et al., 2009; samhsa, 2014b) includes:  gathering information to identify strengths and challenges;  recommending priorities for change;  developing solutions or action steps in priority areas;  monitoring results; and  proposing additions or changes to agency policy to institutionalize traumainformed practices. these primary purposes are generally well understood. what is sometimes overlooked is the role of the workgroup to sustain momentum across the organization and to model trauma-informed practice. for instance, if a workgroup forms and begins to meet but is not heard from again for six months, the opportunity to build on and enhance the initial impact of training is missed and staff buy-in may be lost. moreover, even if the workgroup comes up with recommendations for changes and is successful in getting them instituted by management, the opportunity to demonstrate transparency and inclusiveness is missed if other staff feel unheard. the most successful workgroups send out regular updates about membership, process, activities, priorities, and proposed recommendations, along with information about trauma or tic (articles, video clips, fact sheets, etc.). these missives are also an opportunity to recognize exemplary practices observed in the workplace and to disseminate new ideas or concrete examples that staff can use. some of our favorite workgroup communication tools have been electronic newsletters, but a simple email will suffice so long as it is regular, informative, and invites feedback. to encourage staff input, it can be helpful to create an email address for the workgroup. this serves the dual purpose of institutionalizing the group and ensuring that no one person is solely identified with the effort. forming the workgroup workgroups can be challenging to manage and sustain. some of the difficulties are preventable by considering the following as the initial team comes together. membership. it is axiomatic that workgroups represent different roles and different levels of authority in the organization (guarino et al., 2009), but issues of relationship and power inevitably come into play. in large complex organizations, individuals will not yatchmenoff et al./implementing tic 170 necessarily know one another. one technician in a residential setting gently pointed this out when his expert outside consultant was confused by the awkward silences in the room. it helps to know ahead of time that the work of the first few months may progress slowly until relationships form. more challenging are inevitable power differences if management or senior management is represented along with line staff, facilities staff, front office staff, etc. the advantages to including senior managers are manifold. their direct involvement sends a message that tic is valued at the highest levels. moreover, the authority to make changes happen is also present; without that, workgroups can spin their wheels coming up with ideas and priorities that are subsequently ignored or rejected by the leadership or governance body. in some instances, we have seen strong resistance to including senior management because of significant trust issues. however, the workgroup is the place where some of these divisions can begin to be breached; sustaining factions only contributes to the problem and undercuts the effort. it is helpful if workgroups include individuals with lived experience of trauma and of the organization or service system. in our experience, this rarely happens. more successfully, we have seen peer support personnel added to workgroups and consumer advisory groups involved in helping with the assessment and planning process (e.g., walking through the lobby or waiting areas; reviewing signage; providing perspective on what feels safe, welcoming, or otherwise in the agency’s practices). considering the discussion and tasks involved, the optimal group is comprised of eight to ten members. however, workgroups may need to be larger to represent constituencies in the organization and to ensure reasonable attendance at meetings. if the group is larger, and attendance remains high, sub-committees can form for different tasks. recruitment and length of service. we have seen three approaches to recruitment: (a) the open invitation (anyone is welcome to join) which honors interest but may not achieve representation across the organization and may also result in an overly homogenous group with respect to views; (b) appointment by a senior manager or supervisors in different programs, which gains representation but could be perceived as favoritism and may not be representative of different perspectives; and (c) a slot-based application process with openings for representatives from different roles and levels, asking interested staff why they want to participate and what they bring to the process. in whatever way recruitment occurs, it is important to think through, ahead of time, the consequences and to have a process that is as transparent as possible. it has also been helpful to form the workgroup with a limited duration (six–eight months works well), at which point the group can revisit the structure, membership, and process. the tic initiative will be ongoing (we have worked with organizations over four–five years in some cases) but membership in the workgroup need not be a long-term commitment. in fact, some organizations rotate membership regularly to give more staff a chance to participate, bring new ideas, and reduce the burden for individuals. it is important to have some continuity in the group, however, and a set of priorities to work from, so that it does not feel like starting over as the membership changes. advances in social work, spring 2017, 18(1) 171 facilitation and technical assistance. many workgroups find it helpful to have support, at least initially, from outside the organization. this can increase credibility in the early planning stages as well as help with structure and manage power differences or conflict. in small organizations or in those with knowledgeable staff, outside technical assistance may not be necessary. in the end, sustainability rests on internalizing the process. ideally, an outside facilitator phases out as soon as possible, providing any additional consultation only periodically. even with outside assistance, someone in the organization will need to set up meetings, send out reminders, write agendas, facilitate the meetings, take minutes, etc. management’s commitment of staff time for a designated point person is important. this role can rotate, but we have found it works best when the point person is a committed champion for traumainformed care, is relatively well-versed in the concepts, has the ear of leadership, and is respected by colleagues. the workgroup process forming the workgroup carefully may help avoid some of the common challenges to the process, but will not prevent others, especially those related to long-standing undercurrents in organizations with a history of trauma and oppressive practices. the condition of organizational trauma and its long-term impact has been described in detail (bloom, 2010; bloom & farragher, 2011). briefly, this occurs when a system becomes fundamentally and unconsciously organized around the impact of chronic and toxic stress, such that the essential mission of the system is undermined. we find this phenomenon sometimes reflected in workgroup dynamics (vivian & hormann, 2013). it is likely that any change process or introduction of innovation would run into the challenges related to organizational trauma, but the explicit focus on tic (especially the open acknowledgment, often for the first time, of toxic stress and/or vicarious trauma in the workforce) almost certainly heightens its likelihood. this can show up in a variety of ways. in systems like housing, child welfare, juvenile justice, community mental health, and others, there may be members of the workgroup who bring long-standing frustration with management or deeply held anger about perceived past wrongs; others may need to share their sense of being overwhelmed with the work itself or of not feeling seen, heard, and supported by managers or colleagues. for example, in a large complex public system, early successes with implementation were dismissed by one powerful workgroup member as not really addressing the important issues. this may have reflected a lack of shared vision and goals, but it also reflected deeper underlying issues. in one community mental health program, the tic workgroup hung on through a very difficult phase (the facilitator said it felt like six months of group therapy) before they were ready to start work in earnest. if the workgroup cannot move past those feelings, however, the process breaks down. in some cases, it has been necessary to revisit group membership, goals, and expectations in order to restart processes that stalled out. if there is a history of mistrust or finger pointing between different parts of the organization either across departments/programs or between line staff and management, this may show up as well. silence in workgroup meetings can signal merely a lack of yatchmenoff et al./implementing tic 172 confidence or uncertainty about how to proceed but it may also reflect a lack of safety or strong resistance to working together. in some organizations, there can also be a sense of hopelessness or a lack of belief that anything will be different (a felt sense that initiatives come and go, are billed as promising but do not change anything). all of this takes time to overcome and may sometimes be impossible (bloom, 2012; burnes, 2011), at least in the short run. in fact, there is probably a case to be made for holding off on a tic initiative in some instances. however, we have seen tic efforts in agencies struggle through ups and downs over a period of years, experience frustration and confusion in meetings, see changes in membership of the workgroup, have periods of inactivity, and still move forward. organizations persist through these challenges when there is a commitment of key staff and leadership, understanding that it is a long haul process, solid relationships that exist or are built during the process, and—on a practical note—have strong facilitation skills available to the group. a set of guidelines for the workgroup (see, for example, trauma informed oregon, 2016b) may help steer the process if the guidelines are reviewed, adapted as necessary, endorsed by the membership, and used regularly during meetings. the planning process the map of trauma-informed care is huge and without distinct boundaries. it can be confusing to know what is most important or even where to start. we have watched groups approach planning in a variety of ways over the years and based on some of their experiences, we recommend a hybrid approach that involves both responding to urgent/immediate felt concerns and simultaneously (or nearly simultaneously) using a more structured self-assessment process to provide an overall framework for the work. we discuss each of these approaches in turn. dealing with the immediate based on our observations working with organizations over time, individuals join the tic workgroup because there is something about trauma-informed care that resonates with them, either in their own experience personally (on or off the job) and/or in their experiences with the individuals they encounter in their work. it is important to honor, capture, and use this immediate sense of what is important. we often start the first workgroup by asking participants why they want to be in the workgroup and what they believe the organization can do to be more trauma-informed for both the workforce and individuals seeking or receiving services. typically, we get enough material from this initial conversation to drive priorities for the first six months. however, it is also important to be sure that other staff have an opportunity to feed into the list of immediate issues, either during brainstorming sessions as part of training or in their teams, staff meetings, or focus/discussion groups convened for this purpose. in order for this to be useful, all staff need to have the basic language and ideas about trauma and trauma-informed care; foundational training is a prerequisite (fallot & harris, 2009; guarino et al., 2009). in our experience, the issues that surface first are surprisingly similar across a wide range of organizations: advances in social work, spring 2017, 18(1) 173  activated clients (in the waiting room, on the phone, in a confined office, or exam room) and the need for training in an effective and traumainformed response;  lack of protocols for dealing with crisis situations (an incident of violence, a death, or police intervention) that in themselves can be extremely destabilizing to staff, individuals involved, bystanders; and  the need for care of all concerned following such a crisis. other physical safety issues that affect staff (and sometimes clients) are also easy to elicit: simple things like poor lighting, or malfunctioning locks, or challenges accessing crisis services when the need arises. in complex organizations, issues also typically emerge related to communication and power dynamics within the system: lack of transparency in decision-making, personnel practices that generate anxiety, lack of communication and a sense of respect or mutuality between different programs or divisions within the organization, and lack of teamwork. by acknowledging and working with the experience of the workforce immediately, the tic initiative can gain buy-in. this is particularly true if there are simple steps that can be taken to resolve concerns that surface. often these opportunities relate to physical safety. one primary healthcare clinic in an urban setting, for example, made immediate converts among the workforce by adding a combination lock and motion sensor light to the bike shed (located in a dark corner of the parking lot) and by creating a buddy system for individuals leaving the building at night to walk several blocks to their cars. in another case, a list of emergency numbers, printed and laminated, made staff feel safer. we call these high impact/low cost results. they are usually simple, inexpensive, and easy to accomplish, but they can make a big difference by sending a message that staff concerns are being heard. the tic worksheet. a worksheet of initial priorities can be helpful, especially if it includes a column for workforce hot spots and a column for circumstances that may activate those seeking or receiving services. if this document also notes how each issue relates to trauma (e.g., why it would be particularly activating for a trauma survivor, or what principle of trauma-informed care is involved), it can help keep the workgroup on topic. often these two columns line up with the same activating circumstances affecting both populations. for example, an incident that happens in the lobby with a patient yelling or threatening the front office staff will have an impact on the staff but also on other patients who witness the event or hear about it later. likewise, unexpected staff turnover or sudden changes in policy without warning may equally destabilize anxious workers and anxious patients/clients. this alignment can make it easier to advocate for a specific recommendation to senior management because it affects both populations and maintains a balance in priorities between the workforce and the people walking in the door for help. the worksheet is also a handy tool to come back to when discussion strays. structured assessment and planning a systematic framework for assessment and planning provides a map of tic that is recognizable and describable. by linking immediate concerns with longer-range goals, it yatchmenoff et al./implementing tic 174 is possible to connect an individual organization’s efforts with those that are occurring across the system of care in the wider community. a structured framework makes it easy to communicate with stakeholders, including governance boards, staff, advisory groups, funders, etc., about what you are doing and where you are in the implementation effort. it can also help reassure even workgroup members that small steps are part of a bigger picture as well as providing an organized parking lot for the many ideas that are likely to surface. pioneer efforts by harris and fallot (2001), jennings (2004), and others were followed by the development of formal guidelines and planning toolkits for organizations, frequently but not always focusing on particular service systems. they cover much the same territory and vary primarily with respect to their level of detail and the amount of emphasis on clinical practice versus a systems perspective. fallot, harris, and colleagues at community connections created one of the first and most comprehensive self-assessment and planning processes (fallot & harris, 2006). the center for family homelessness, likewise, created the trauma-informed organizational toolkit for homeless service (guarino et al., 2009) that includes an assessment instrument. tip 57 published by samhsa (2014b) is another comprehensive resource. organizations all over the country presumably have been working with these or other tools for some time, with or without guidance from the authors or technical assistance from outside consultants. however, there is little in the literature about the experience or results from using these assessment tools. trade-offs with formal planning tools. in our early work with organizations, we often recommended either the planning tools developed by community connections or the toolkit available from the national center for family homelessness. both are excellent; they can scarcely be improved on, with the exception of newer emphases that have emerged related to historical/cultural considerations, collective oppression/trauma, and the centrality of peer support. we and our organizational partners have had mixed results. we found that the agencies that had turned to us for help or advice did not always have the capacity to take this route very effectively. first, the tic effort is frequently led by a supervisor, a clinician who is passionately committed, or a behavioral health manager. generally speaking, these individuals are working under tremendous pressure and, more important, come to the table with a sense of urgency and a helping perspective that can make the longer and more conceptual manuals or toolkits feel both daunting and not well-aligned with their immediate concerns. given lack of confidence, lack of time, and limited support, the systems perspective was often not a good fit. consequently, we had trouble getting workgroups to complete the longer manuals or toolkits. the specific assessment instruments were more easily adopted since our partners recognized the need to gather information from staff and in some cases from volunteers and/or individuals receiving services. a number of organizations constructed surveys out of these tools, in some cases administering them to a large number of individuals. the process was lengthy and required substantial staff time in the development of the surveys to suit the context. the bigger difficulty was in the output. these instruments yield huge amounts of information particularly if you tap into multiple sources, and it can be a long, arduous, and advances in social work, spring 2017, 18(1) 175 confusing process to sort through, report out, and use the data to guide priorities. moreover, survey data usually resulted in numerical ratings. average or summary scores can be hard to work with and give little help in determining what to do next. finally, as agencies began to act on identified priorities and to make changes, they could report out on what they had accomplished, but they had no framework against which to gauge or report on their overall progress in a way that lined up with what other organizations might be doing. another challenge needs mentioning here as well. when an agency’s service population are included in a large survey process, the intention is admirable but the data can be misleading. consumer satisfaction surveys are known to have a strong positive response bias in most cases (fowler, 2013; patwardhan & spencer, 2012). more important, it is difficult to get reliable or valid data in a written survey from vulnerable individuals and especially if the population is diverse, potentially using english as a second language (or not at all), and without support and guidance around what is being asked and whether it is safe to answer honestly. it is a weak methodology at best. as a result, we have taken to discouraging our partners from starting their assessment process with a survey unless it is highly targeted and based on at least a preliminary understanding about the current status. we also recommend that any survey should include open-ended questions inviting a qualitative response either in addition to or in instead of a set of ratings. if open-ended questions are not included or do not yield sufficiently useful information (it can sometimes be difficult to get participants to articulate their thoughts in text), following up with small group discussions to help interpret the results can be helpful. at the other end of the spectrum are a number of checklists for tic that can also be found online, and are often focused on general concepts (“our agency is committed to trauma-informed care”) rather than concrete steps that have been taken. see, for example, national council for behavioral health (2013) or u.s. department of health & human services, office of adolescent health (2015). these resources may be useful to stimulate thinking but they are necessarily crude and will rarely yield enough information to be useful in planning (or credible with stakeholders, since they are generally not wellanchored in specific or concrete detail and thus highly subjective). the principles of tic as framework. another approach is to build the planning/assessment process around the principles of trauma-informed care. again, despite differences in the language and the number of principles that are listed, there is strong congruence across the literature about the core principles. samhsa (2014a) now uses six principles; some of the original proponents outlined six or seven (see hopper et al., 2010 for a review). new principles related to peer supports and to the critical importance of cultural responsiveness and sensitivity to gender issues have fleshed out areas that were underplayed in earlier work. fallot and harris (2009) modified their original highly detailed “trauma-informed self-assessment and planning protocol” (2006) to produce “creating cultures of trauma-informed care (cctic): a self-assessment and planning protocol,” organized around tic principles, which we have seen used very effectively by small agencies with cohesive and like-minded staff. in our work, it has been useful to collapse the principles of tic into three major domains: safety, power, and self-worth. we base this framework on the understanding that yatchmenoff et al./implementing tic 176 traumatic experiences that have a lasting impact are those events that induce overwhelming fear, powerlessness, and, depending on the nature of the trauma, a sense of worthlessness. in light of this, the fundamental commitment of trauma-informed care is to avoid reinducing those experiences and instead to establish policies, practices, and procedures that, insofar as possible, create a safe context, restore power, and support self-worth. as reflected in table 1, we find that larger sets of tic principles fit readily into these areas, sometimes arguably into more than one. table 1. principles of trauma-informed care: agencies demonstrate trauma-informed care through practices, policies, and procedures restore power through: create safe context through: build self-worth through:  choice  physical safety  relationship  empowerment  trustworthiness  respect  strengths perspective  choice  compassion  skill building  transparency  mutuality  predictability  collaboration  clear and consistent boundaries  acceptance and nonjudgment it is possible to use these domains for assessment as well. physical safety has proven to be a good place to start. this domain is easily understood by workgroup members, and it is usually fairly concrete. agencies are often doing a reasonably good job already regarding safety, so it is possible to highlight strengths as a starting point. quite often, moreover, small fixes can make a big difference as noted earlier in the light on the bike shed example. moving beyond physical safety, however has been more difficult. defining emotional safety can prove to be a stumbling block and is subject to highly individual interpretation. issues of power and especially relationship, respect, mutuality, and so forth that constitute the self-worth domain can take a group into challenging areas, particularly in traumatized organizations with a particularly vulnerable workforce. nonetheless, some agencies have worked successfully with the principles. sample action steps based on this approach appear in table 2. for some organizations, a narrative approach (clandinin & huber, 2010) can be appealing. in essence, workgroup members walk through the experience of a client from the moment the service need arises: the referral or self-referral, initial contact, appointment scheduling, entry and intake, the waiting room, location of bathrooms, signage, and so forth—all the way to exiting services. the idea is to look at each step along that path for conditions that might activate a trauma response, fail to activate a trauma response, or in fact may be welcoming/healing. this approach appeals especially to direct service staff because it is concrete rather than abstract and contains within it the experiences that clients may have shared with them. in contrast to more abstract assessment, the narrative approach lends itself easily and effectively to direct involvement from individuals with lived experience of trauma and of the service system in question. it can be useful, for example, for gathering information from consumer advisory groups or in listening sessions with service recipients. advances in social work, spring 2017, 18(1) 177 table 2. action steps for implementation based on key principles of trauma-informed care create safe physical context  crisis protocols in place & practiced for critical incidents.  buddy system instituted for after-hours parking concerns.  lighting reviewed & improved inside & outside building.  de-escalation training provided for all staff.  emergency numbers posted at every workstation. create safe emotional context  intake forms reviewed & revised to be less activating/intrusive.  front office staff, security, custodial staff, & direct service staff are taught how to recognize & respond to signs of trauma response in waiting room, office, lab, & exam room. scripts created & practiced that are respectful & de-stigmatizing.  client handbook includes section about relationship between clinician & client, explaining boundaries in a supportive & informative way.  clients provided clear & concrete information about what to expect at every juncture. a what you need to know document created & available.  signage reviewed & improved to be more welcoming & clear.  restroom closed when mandatory tests (urinalysis) are underway.  gender inclusion signs posted.  staff debrief process created for critical incidents. offer/restore power  individuals provided whatever choices are available with respect to service options, scheduling, etc.  individuals asked at first appointment about their prior experience with the system & their current needs.  staff & clients regularly asked for feedback & they also receive a report on what they said & how it was addressed.  staff offered flexibility in work schedules.  peer support available & offered. support self-worth  service recipients offered coffee or water (especially if staff are enjoying them).  observation & appreciation of colleagues’ trauma-informed work is routine.  self-care plans institutionalized as regular part of supervision.  staff can acknowledge strengths & recognize the why behind behaviors, even if they are unacceptable; staff are able to connect the dots for clients about how trauma has impacted them.  diverse staff are hired to represent population served. the middle way: benchmarks. in recent years, new resources have been developed that fall somewhere between a crude checklist and the detailed set of highly individual issues that came out of the earlier assessment tools. “samhsa’s concept of trauma and guidance for a trauma-informed approach” (samhsa, 2014a) falls into this category, reducing the content of “tip 57” (samhsa, 2014b) to a 19-page document that includes questions or prompts for action that are organized into a set of ten implementation domains. trauma informed oregon’s “standards of practice for trauma-informed care” (trauma informed oregon, 2015) is another example of a benchmark approach, or the organizational self-assessment for youth residential programs developed at the university of south florida (hummer & dollard, 2010). others combine elements in slightly different ways or in larger or smaller clusters, but the content is virtually identical. in each case, domains of concern typically include multiple organizational functions: governance, operations, human resources, physical environment, workforce development, service yatchmenoff et al./implementing tic 178 delivery, and program improvement/evaluation. when used appropriately, benchmarks can support a mezzo-level approach for management, guiding planning at a structural level while the workgroup continues to focus on specific micro-level concerns. moreover, a set of specific standards or benchmarks can be used to highlight and communicate progress over time against a framework that is common across organizations. sample benchmarks (trauma informed oregon, 2015) are illustrated further in table 3. table 3. benchmarks for trauma-informed care: organized by five domains common across systems governance & leadership  board & executive team attend training or information sessions to learn about trauma & trauma-informed care (tic).  agencywide trauma policy is in place.  regular feedback from workforce & service population is solicited & used to improve practice.  resources are set aside to support mental & physical health of staff & to attend to vicarious or secondary trauma.  policy decisions are communicated with as much transparency as possible & with a demonstrated understanding of the impact on staff. physical environment & safety  physical environment has been reviewed & modified to be as welcoming & safe as possible (art work, signage, common areas, hallways, bathrooms); individuals with lived experience were part of that process.  crisis protocols in place; provision is made to ensure that no staff member is alone in the building.  there is a designated space for staff to go when self-care or a time-out would be helpful. workforce development  initial & ongoing training about trauma & trauma-informed care are institutionalized.  hiring practices (job descriptions, resume review, interview questions, etc.) reflect a commitment to traumainformed care.  on boarding includes orientation to trauma-informed care & the organization’s commitment to it.  supervision & performance reviews include expectation of ongoing learning & application of tic principles. service delivery  required intake forms & processes have been reviewed & modified to reduce unnecessary detail or questions that could be activating for survivors.  easy-to-read materials are available that explain core services, key rules & policies, & procedure for questions, concerns, or complaints.  [in direct service organizations], screening for trauma is routine & trauma specific services are available.  all staff understand heightened risk of suicide & are able to respond effectively or get appropriate help. ongoing systems change  infrastructure is in place to sustain ongoing assessment, planning, implementation, & feedback.  staff time has been set aside to participate, including designated fte for coordination.  clinic policies (new & existing) are reviewed regularly for trauma-informed language & content.  regular mechanism has been established to report out to entire organization about tic practices & the change process. benchmarks also may serve as a step towards accountability measures. more and more states are creating policies that require behavioral health or other entities to demonstrate that they are meeting minimum sufficient standards for tic or are working towards them (see, for example, oregon health authority, 2014). standards or benchmarks are proving useful in demonstrating adherence to policy stipulations. in the long run, this work may also move us towards fidelity measures that would allow researchers to examine the impact of trauma-informed care (or “trauma-informed approach” as it is being rebranded) on the advances in social work, spring 2017, 18(1) 179 experiences and outcomes for the workforce and for individuals and families receiving services. implementation and the feedback loop setting priorities and agreeing on action steps may be the most time consuming and complex aspect of the work, but as organizations begin to implement specific changes, a number of new challenges frequently appear. trauma-informed rollout even the most well-conceived efforts to create a more trauma-informed organization can have unintended negative consequences if they are not carried out with skill and sensitivity. a new intake procedure, for example—one that slows the process down, eliminates unnecessarily triggering questions, provides more transparency and opportunity for clients to connect and engage—may be exemplary. however, it will feel anything but trauma-informed to staff if it is rolled out as a new policy that requires changes in the dayto-day work of already-stressed employees without warning, without providing enough time to adjust, or enough support for the potential impact on the workload. considering context. along the same lines, if a trauma-informed policy fails to consider the context and realities of the workforce (or clients), it may result in a backlash. schools are currently in the cross-hairs of the movement towards trauma awareness and improved practices. many districts are seeking to change disciplinary policies and procedures to support students more humanely and effectively, recognizing that adverse experiences, past and present, are likely driving much student conduct. however, schools of education are not yet equipping teachers with the tools to de-escalate activated students or to manage their classrooms in new ways. if we ask teachers to respond differently, we need to have a strategy in place for when the child responds to “what happened to you?” rather than “what’s wrong with you?” by throwing a chair across the room. the needed skill set. likewise, our human services field is famous for initiating promising new practices, putting them into policy, and failing to account for the skills and support needed to make these practices work as they are intended. screening for adverse childhood experiences or a history of trauma is only one of many examples where some workers will be able to do it well initially, others may never have the skills, and some will need coaching and support over time. in our rush to implement tic, we sometimes forget that there is a steep learning curve for many, even those that are enthusiastic about the ideas in the abstract. shared understanding of the concepts. trauma-informed care relies on the operationalization of a set of principles rather than a manual with specific and well-defined action steps. this can lead to confusion. concepts like transparency, for example, are easily misinterpreted. does it mean telling a client everything you know or everything that has been said? this is a serious problem, and most organizations are not yet equipped to carry out the detailed discussions to ensure that everyone is on the same page about what is being asked of them. some office staff in a juvenile detention facility in wisconsin, for example, blamed trauma-informed care for an incident of violence and harm (hall, 2016). since yatchmenoff et al./implementing tic 180 physical safety is the first principle of tic, on the face of it there was likely a misinterpretation (or over-interpretation) of one of the other principles. follow up. in small or very cohesive organizations, planning may lead directly and visibly to action, but in larger, more complex organizations, best laid plans do not always result in change. the workgroup may present a recommendation to management; there may even have been the opportunity for all staff to review or provide input about the draft protocol. the proposed solution may be put into policy and shared at an all-staff meeting. there is no guarantee, however, that it will be widely adopted across the organization. one mental health organization initiated a large number of changes over a period of about three years based on recommendations from the tic workgroup. the steps ranged widely and included creating an agency wide trauma policy, installing new and more welcoming signs in the lobby, involving clients in designing a planned remodel, requiring that staff self-care plans be included in supervision and reviewed annually, adding a section in the client handbook about boundaries so that clinicians could go over it with new clients together, initiating lunch and listen sessions where clients could bring ideas, concerns or grievances, and so on. in a follow-up survey of staff, we learned that the required self-care reviews were only being used by about a third of the supervisors. some of the newer staff had never heard of the policy. this is not because the organization failed in its efforts; it reflects only that culture change takes a long time, requiring vigilance and follow through. in other cases, laudable efforts may simply not be as visible to a busy and overworked staff. if there is a new crisis protocol that is brilliantly conceived, but staff do not know how to get to it easily when they need it, the impact will be minimal. impact. assuming that a change actually occurred, there is no way to know without asking whether it makes a difference. at one of our partner agencies, for example, the leadership instituted a policy that every unit, department, team, or staff meeting across the entire multi-site system would start with appreciations, to set a positive tone and build community. in a follow up survey, we learned that although some teams seemed to do this well and some of the workforce told us it made a difference in their experience, a significant number of staff said it felt artificial, did not make a difference, or made things worse. this was important information for the workgroup to address. moving with resistance. no matter how solid the work, how well-intentioned, and how thoughtful the planning and implementation, there will be resistance to change (choi, 2011; oreg, vakola, & armenakis, 2011). not everyone gets it, not everyone will. even when they do, it is challenging and stressful to be asked to do things differently. if organizations were to wait for 100% buy-in before they committed to an implementation process, nothing would happen. the most experienced advocates and consultants in the field (ace interface, 2014) recognize the importance of persistence—the capacity to move around resistance and continue to work with folks that are ready and available (family resources, 2013). we would add that it is necessary for leadership to support the process from the top—setting direction and even mandates. it is also necessary to include and involve every layer in the organization. but it still will not eliminate resistance—at least not entirely. you just keep going. advances in social work, spring 2017, 18(1) 181 down the road as organizations begin to move further along this journey, we would like to see better documentation of the process and the results. disseminating this information is useful in that it normalizes the challenges inherent in the work (and the time involved) and sparks ideas for other changes that can be made. we are also committed to developing evaluation resources and supports for organizations. the core questions are, first, what did we do and what happened? (the documentation piece); and then, if changes were implemented, what if any difference did it make to the experience of the workforce or those receiving services? for example, attention to trauma-informed care of the workforce might be reflected in reduced absenteeism, reduced turnover, greater sense of competence and confidence, and increased job satisfaction. likewise, for those receiving services, trauma-informed policies, procedures, and practices could help improve, among other things, client/patient engagement and retention in services, rates of follow-through on appointments, buy-in with service plans, adherence to plan provisions, and reduced non-indicated use of emergency services. these are merely examples of the kinds of outcomes that might appear on a logic model for evaluation of trauma-informed care. research is stymied for the moment by the lack of a fidelity measure for trauma-informed care, a way to measure dosage (what changes, how many changes, what type of changes would influence these or other outcomes) and experience with the time element (how long it should take for outcomes to be realized). these are not simple questions and the answers are not going to come quickly. what is possible at this stage is documentation of our work—tracking the process, the outputs, and any difference we can detect both in terms of reported experiences of staff and clients and agency-level indicators of staff and client engagement. careful documentation will pave the way for more rigorous research efforts aimed at demonstrating how the significant changes that are occurring across many service systems may be improving outcomes for children, adults, and families in our communities. references ace interface. 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(2013). organizational trauma and healing. north charleston, sc: create space. address correspondence to: diane yatchmenoff, portland state university, regional research institute, 1600 sw fourth ave., suite 900, portland, or 97201, yatchmd@pdx.edu http://store.samhsa.gov/shin/content/sma14-4884/sma14-4884.pdf https://store.samhsa.gov/shin/content/sma14-4816/sma14-4816.pdf http://traumainformedoregon.org/standards-practice-trauma-informed-care/ http://traumainformedoregon.org/standards-practice-trauma-informed-care/ https://traumainformedoregon.org/roadmap-trauma-informed-care/ https://traumainformedoregon.org/wp-content/uploads/2016/01/trauma-informed-care-workgroup-meeting-guidelines.pdf https://traumainformedoregon.org/wp-content/uploads/2016/01/trauma-informed-care-workgroup-meeting-guidelines.pdf https://traumainformedoregon.org/wp-content/uploads/2016/01/trauma-informed-care-workgroup-meeting-guidelines.pdf https://www.hhs.gov/ash/oah/sites/default/files/traumainformed-checklist.pdf mailto:yatchmd@pdx.edu _______ ann curry-stevens, associate professor, faculty of social work, wilfrid laurier university, kitchener, on. lisa hawash, associate professor of practice and msw online option coordinator and sarah bradley, associate professor of practice and msw program director, school of social work, portland state university, portland, or. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 62-85, doi: 10.18060/22642 this work is licensed under a creative commons attribution 4.0 international license. learned lessons: growing social workers’ preparation for upstream policy practice ann curry-stevens lisa hawash sarah bradley abstract: over the last 10 years, the msw program at portland state university has gone from graduating 15% of its students in the macro concentration to 32%, while the national average is at 13.2%, among students who have declared specializations. this article traces that experience through a historically-grounded narrative line, administrative datasets, program surveys and the results of a world cafe, and extracts lessons that are potentially relevant for the profession. although a range of factors, both intentional and unintentional, are perceived as important for this growth, key factors are discerned to be sequencing of the curriculum to ensure students get exposure to macro practice prior to selecting their concentrations, relationships with faculty who hold secure positions and are engaged in local practice, curriculum design and practice that ensures horizontal and vertical integration, student and community influence in the curriculum, and scheduling that ensures advanced year faculty teach in the first year and teach some of the field seminar courses. insights including faculty stabilization, strong vertical and horizontal curriculum integration, early introduction to macro content, high levels of student choice and faculty’s community engagement are shared. the article also includes tensions that emerged during the development process with potential to derail the effort. keywords: macro practice; advocacy; equity; policy; organizational change; leadership the special commission to advance macro practice in social work has called for “20% by 2020” (acosa, 2017), meaning they aim for schools of social work in the us to graduate, on average, 20% of students with a macro specialization. although the national association of social workers’ (nasw, 2017) code of ethics confirms all social workers have responsibilities in macro practice, emphasizing social work’s need to address social problems, to challenge social injustice, and “act to expand choice and opportunity for all people, with special regard for vulnerable, disadvantaged, oppressed and exploited people” (p. 24), there is uneven capacity within higher education. the limited numbers of those specializing in macro practice calls into question the commitment to achieve a more equitable balance. credentialing processes within the council on social work education (cswe) identify that social work’s purpose is to advance “social and economic justice, the prevention of conditions that limit human rights, the elimination of poverty and the advancement of the quality of life for all persons” (cswe, 2015, p. 5). msw programs across the usa, however, are persistently stuck at levels just over single digits, graduating on average about nine micro specialized practitioners for every macro specialized practitioner. this lack of balance is not only a matter of student choice, but also the result of program availability, as well as a number of longstanding barriers identified comprehensively by rothman (2013). https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2019, 19(1) 63 even for programs that want to promote a stronger balance, the current literature is elusive about strategies for attracting more students to macro practice. this article describes the journey of one msw program’s efforts to strengthen the macro concentration. it has been a journey shared by the three authors, and these insights are the result of dialogue and a combination of individual and shared reflection on the events of the last ten years in the program. additional information on student numbers and course offerings were identified in administrative databases, a world café event to assist in curriculum restructuring, and the results of surveys conducted with students, community members, and field instructors. the authors are three organizational leaders: the 8-year lead of the macro concentration, the current lead of the concentration, and the msw program director. this allows us to identify long-term patterns and bring forward details that are the purview of those in administrative roles. the umbrella term we use in this paper is macro practice. we draw from netting’s (2013) definition: macro social work practice includes those activities performed in organizational, community, and policy arenas. macro practice has a diverse history that reveals conflicting ideologies and multiple theoretical perspectives. programmatic, organizational, community, and policy dimensions of macro practice underscore the social work profession's emphasis on using a person-in-environment perspective. (para. 1) at portland state university (psu), in the school of social work (ssw), we have grown the macro concentration from 15% to 32% of our graduate population, surpassing the historically low numbers of 3% in 2000 (de saxe zerden, sheely, & despard, 2016) and the current national average of 13.2% among students with a declared concentration (cswe, 2017), up from 9% in 2014 (reisch, 2016). this does not include students in an advanced generalist concentration, as the degree of macro integration cannot be discerned at this time. in a school that has almost triple the national level of macro students, we anticipate that our experience holds insights that are likely relevant for other schools aiming to heed the call for 20% by 2020. the ssw is a well-established program within the pacific northwest. established in 1961, the psu school of social work is among the top 20% (33rd in the nation) of schools of social work based on its ranking by u.s. news & world report (2019). over the last ten years, we have grown this concentration from fewer than 25 students to approximately 90 students who specialize in macro practice each year. this paper focuses on the efforts made to strengthen the program, which in turn widened its appeal for students, attracting more students into the macro specialization. in addition to the curricular efforts implemented across the last ten years, we also detail the ways in which students in the region have been drawn to macro social work and the ways the ssw has positioned itself to be attractive. in the spirit of transparency, we also include issues that held potential to derail these efforts and conclude with the activities we perceive to be replicable for other universities to similarly grow their macro concentrations. first, we set the context by describing our program. curry-stevens et al./lessons learned 64 the ssw holds a distinctly social justice orientation. its mission reads: …[to] educate students for advanced leadership and practice that recognizes and dismantles systems of oppression; builds racial equity and social, political, and economic justice; and advances the well-being of diverse individuals, families, groups, organizations, communities, and tribal nations. we endeavor to deliver a social work education that is critically informed, theoretically driven, empirically supported, reflexive, ethical, vigilant and resistive to colonial, heteropatriarchal, classist, and white supremacist agendas. (psu ssw, 2017) the critical emphasis continues in the curriculum, which is formally grounded in principles of equity, social justice, and anti-oppressive practice. educational content includes values, principles, and skill development for culturally responsive practice that enable students to gain skills to work effectively, cross-culturally, and innovatively. in addition, the school prioritizes research and scholarship that focuses on understanding, preventing, and ameliorating social problems (psu msw program, 2018). the ssw has also developed a strategic plan that includes diversity and equity, and community and policy impact. among larger goals of teaching and research excellence, these two elements reflect what we perceive to be the forte of the macro concentration. with this commitment to social justice and equity formally embedded in the ssw, the school has largely welcomed growth of the macro concentration. working upstream to address the causes of downstream distress is a valued focus in psu’s ssw. we recognize that not all social work programs are oriented to this perspective which might be a limiting factor for other programs seeking to grow their macro concentrations. we begin by introducing a few necessary contextual elements. psu’s msw program is the only cswe-accredited public university in the state of oregon. it has had the advantage of a non-competitive environment, which is beginning to be challenged as two private universities are now delivering msw programs. the program has developed five key offerings: regular and part-time campus programs, distance delivery in four regional sites, an online program, and an advanced standing program, that admits students with bsws into the second year of the curriculum. annual admission numbers are sizable: 180 on campus, 40 students online, and 30 in the distance program. the vast majority (87%) of the 530 enrolled students are from oregon. over the past six years, 30% have been students of color, which is equivalent to the local urban region, and higher than the state of oregon itself (at 24% people of color). the macro concentration is called “practice and leadership with communities and organizations” (plco). it includes policy practice within the system as well as advocacy practice to influence policy from outside the system. through a combination of instruction, assignments and field practice, we prepare students for a wide range of macro roles, ranging from community organizing to leading not-for-profit organizations, to running for public office, and just about everything in-between. practice skills emphasize partnership work with marginalized communities and building the power of vulnerable communities to durably influence organizations, coalitions, research, policy, and public discourse. overall, the program emphasizes a principles-led approach to practice, establishing values that drive practice regardless of but sensitive to the context. examples include “nothing about us advances in social work, spring 2019, 19(1) 65 without us” drawn from the disability rights movement, and “walk your talk” that aims for integrity of values and practice across the range of roles practitioners hold. an achievement occurred this past year when two recent msw graduates were elected to the state legislature. literature review important scholarship has centered on the necessity of macro practice for the profession of social work as well as the wellbeing of society, and on the problems facing macro practice. a smaller body of literature focuses on content that is needed in the curriculum, both from cswe (2015, 2018) and from individual scholars. supplementing these directives are the generalist textbooks that continue to affirm the importance of both macro analysis and macro practice skills to affect change, addressing the upstream factors of downstream distress. new work addresses the journeys of macro faculty in how they have been influenced institutionally, in terms of the issues they have faced in being macro instructors in a predominantly micro faculty. each challenge will be addressed in turn. reisch (2016, 2017) leads the current efforts to define the benefits of macro practice in the profession. positioning macro practice as a key feature for manifesting social justice in the field, he recounts the history of macro social workers in social movements and in influencing the policy evolution from residual to institutional models of welfare in the era of the welfare state (circa 1945 to 1975). social workers were instrumental in building the welfare state, although rarely afforded recognition. today, this influence is much reduced, and we see a corresponding decline of macro practitioners in public policy and institutional influence. neoliberalism has undermined the welfare state and its rugged individualist discourses and merit beliefs devalue the importance of social programs and systems change to support marginalized communities (aronowitz, 2003; korten, 1995; stanford, 2008). this larger ideological context narrows the attractiveness of macro practice. the “market compliance” ideology observed among those dependent on social programs (schram, soss, & fording, 2014, p. 379) cannot help but stretch to potential social workers. pushing for a revitalization of the macro specialization is at the heart of the special commission to advance macro practice in social work and their call for “20% by 2020.” deeming macro practice as essential for advancing social justice, adhering to the code of ethics, infusing public policy debates, and ensuring that social services are led by social workers, the special commission has embarked on a campaign based in the belief that critically-oriented macro practitioners hold potential to address a range of “isms” that threaten the wellbeing of a range of communities. a thread in the literature urges caution in a universal approach to social work that integrates macro and micro practice with established theories, content, and pedagogy. grey and fook (2004) suggest that the push for an established balance of macro and micro is prone to being unresponsive to local conditions, and to becoming a western-infused curriculum. although their focus is on international social work, their messages are worthy in american schools of social work. local contexts need to be centered in the curriculum, and scholars will be most relevant when they are steeped in local issues. social work is primarily place-based, and needs to hold local issues in the foreground of the curriculum. curry-stevens et al./lessons learned 66 later in this paper, we argue that local priorities of racial equity, poverty and homelessness, and the campaign of “disarm psu” need to be integrated in the curriculum. mcbeath (2016) reinforces this approach. while defining key content for the macro curriculum, he simultaneously identifies a range of desirable practices to ensure that the program is responsive to local issues, and emerging community priorities, and is led by professionals who are in deep partnerships (research and advocacy) with community groups. netting et al. (2016) share an invigorating journey into the lives of macro educators and the types of challenges that have served to limit the presence of macro practice in their schools of social work. the limits are pronounced and reinforced by personalities, funding patterns, subject positions, and professional investments, enacted by other faculty and discourses about the field as a whole. also implicated is the ambivalence that the field has had about the type of leadership roles we envision for students and for the profession itself – and whether we prepare students for top leadership roles or for management functions. we also note the often-conflicting choices faced by macro scholars in their careers, such as choosing between grant writing and solidarity action with communities in distress. heightened awareness to the multitude of social justice issues makes academic life difficult. in addition to the plurality of sites to which we are drawn to practice, cochranesmith (2000) issued a stark missive for higher education when she surfaced the consequences of not working as an ally with students within one’s own department; the students subsequently perceived her educational work as irrelevant. she highlights the need to ensure our roles do not end at the classroom door. the literature provides us with glimpses of relevant knowledge about history and current experience that helps us to name some of the patterns that align with and diverge from the experiences of others. it does not provide us with narratives of how programs have addressed challenges and built stronger msw macro programs. we hope this contribution catalyzes more programs to share their stories and deepen our understanding of what has been effective elsewhere. for now, we share the story of the macro concentration at psu’s ssw. this article conducts a historic review of efforts undertaken to strengthen the concentration, which subsequently expanded its appeal. history four periods of growth have occurred in the program (see table 1). the first was the intentional quality improvement effort to the community-based practice concentration that occurred from 2006 to 2010. the second was the curriculum revision process associated with re-accreditation, and the third was the development of the online program. fourth, and ongoing, is a renewed curriculum development process that is infused with the faculty’s capacity to assess horizontal and vertical integration that aims to ensure that courses in the curriculum are both comprehensive and logically sequenced, with minimal overlap or omissions. each period of growth is described. table 1 has some overlapping time frames as some phases continued as others began. advances in social work, spring 2019, 19(1) 67 table 1. periods of program growth at psw ssw phase brief description time frame i hiring and curriculum improvements 2007 to 2011 ii reaccreditation opportunities 2011 to 2015 iii online innovation launched in 2014 iv longer term influence of horizontal and vertical integration 2015 to present day phase i: hiring and curriculum improvements the first phase began in 2007 and continued until the start of the formal reaccreditation process in 2011. hiring to build and stabilize the tenure-stream base for the macro concentration was a key part of this effort. the decision to expand the macro track was made by the dean, with agreement from the msw committee. existing faculty were “all but dissertation” (abd) status and the school recognized that this placed the concentration out of balance with other concentrations. without tenure, faculty were unable to advocate and take risks in bringing contentious issues forward, such as the thin focus on macro practice within the first year of the curriculum. it is this type of marginalization of nontenure faculty that contributes to what netting et al. (2016) suggest is a more widespread pattern among their faculties who are less informed about macro practice. although these authors’ more global portrayal of disregard for macro practice was not experienced at psu, the features noted above signal a power imbalance among the faculty. these hirings occurred without conflict, coinciding with the appointment of a dean who aligned with macro practice. as well, the ssw had (and largely continues to have) cultural valuation of macro practice. when assessing why this culture exists, the authors perceive that it is partly a function of “portland nice” which refers to a cultural norm that defaults to “let’s all just get along” (gragg, 2012, para. 2,). it is also due to a relatively conflict avoidant culture within the faculty, which is female-dominated, university-based, middle class, and relationship-valuing, all factors linked to conflict avoidance (barsky & wood, 2005). we also believe this culture exists due to macro practitioners being “heavy lifters” within the ssw, with a reputation of shouldering significant administrative and service activities. faculty are more likely to agree with those on whom they routinely depend. it is also likely a function of the long-term hiring practices of the ssw, with macrorelated questions being embedded in faculty hiring, and active participation of most faculty in hiring decisions. candidates who communicated exclusivity about their professional orientation were unlikely to be hired. ensuring that all faculty have voice in hiring practices assists in promoting this culture. it has also been helpful that psu had macro-oriented deans for ten of the last twelve years who supported macro tenure lines and the hiring culture noted above. faculty hiring of macro scholars prioritized community-based engagement, emphasizing those who were activist/advocate scholars and who were deeply steeped in local community research and advocacy. the benefits were to advance the school’s reputation and regard in the community; imbue the curriculum with real life examples of applications to practice, which for students excites possibilities for their own future practice; and help students make sense of the relevance of what they are learning. curry-stevens et al./lessons learned 68 this era’s curriculum included the following required 1st year courses: a 3-course generalist practice sequence, a policy history course, and a macro theory course. within generalist practice, one term was macro practice (in theory) but few instructors were steeped in such practice and often narrowed this content. in response to this shortcoming plus the arrival of two new tenure stream faculty who were eager to strengthen the concentration, we assessed the concentration and revised the three-term advanced (second year) macro practice curriculum. input was gathered from students, graduates, field instructors, and faculty. at the time, input was not directly sought from members of communities served by social workers. since then, faculty have established these stakeholder commitments, although have yet to formalize methods for gathering such input. students are taught approaches to involve service users in service delivery, the ssw does not operationalize this commitment. our primary service users are defined as students, their field placements, employers, and community partners. service users and community members whose lives are more directly affected by the quality of social work services and supports have yet to be involved. such an initiative could be rooted in a research study of the valuation of macro education by service users, as a vehicle to ensure that service users’ insights are respected and shared more widely. resultant curricular improvements included updating relevant research and theory, and more importantly, adopting stakeholder commitments that have been retained to this date. curricular priorities are to more holistically prepare students for macro practice, even when it stretched beyond the forte of existing faculty. we decided that should faculty be unable to deliver sections of the curriculum, we would adapt teaching practices such as coinstruction, guest presenters, and shifting away from the traditional 3-term instructor consistency, flexing instruction to curriculum needs. we also decided to integrate micro practice within the 3-term advanced practice curriculum. many students were drawn to upstream macro practice yet were similarly drawn to organizations where these roles were blended with micro interventions. to neglect preparing students for micro practice would invalidate their micro interests, as well as render numerous community practice settings ineligible for our macro students. we shaped this part of the curriculum within antioppressive practice and critical social work traditions such as feminist, structural and radical micro practices. as emphasized by reisch (2017), “macro social work is not indirect practice… all social workers work with people...” (p. 7). being able to say, “and we also support students who have micro roles with clients” makes the choice easier to make. this inclusion is retained today. we also began to listen more deeply to students and their priorities for their own learning. stretching beyond conventional approaches to grading, faculty established much greater flexibility in assignments. the major assignment in the second and third term was open to the preferences of students, and they identified their own project, including the ways they wanted their work to be graded. this took many different shapes over the years. sometimes it was an intervention project that they engaged in at their practicum, including an evaluation of its effectiveness. other times, it was a conference presentation, or an artsinformed reflection of a current social justice issue. students did this alone, in pairs, or in larger groups. it was not without some anxiety for students as self-directed learning is countercultural in higher education. we provided students with an alternate assignment advances in social work, spring 2019, 19(1) 69 which was to identify a job they wanted to apply for, and customize their resume for the position, prepare a cover letter, and prepare written versions of how they were going to respond to a few interview questions, such as:  how has your recent education (your msw, with a macro concentration) contributed to your skills and capacities for this position?  we understand that the school of social work has been expanding student exposure to “anti-oppressive practice.” please describe what this is, and how you anticipate that we will benefit from this approach to social work practice. please make sure your answer to the second part of this question is rooted in the activities of our organization. in most cases, students actually submitted their application for available positions. after one year of curriculum improvements, instructors began to include students in customizing the curriculum. in the middle of the first term of the advanced practice year, a survey was administered to all students in the concentration (n=23). the framing of this was to both honor the existing curriculum and elicit student input. the survey asked students to identify the degree to which learning about specific topics was relevant to their professional and personal goals. by the time they took the survey, they had been in practicum for about 6-8 weeks, allowing them to discern relevant practices. response rates were above 80% and responses helped instructors shape and balance the curriculum. we also asked students about their preference for assignments, identifying what was traditionally used and offering open-ended questions to elicit their ideas for strengthening the curriculum. typically, students affirmed the planned content, with one exception which has been responded to: a desire for more content on how to advance racial equity relationally, structurally, and institutionally. this survey practice continues and keeps faculty grounded in local priorities, builds student voice and influence, and heightens expectations for our responsiveness. our final innovation was to hold a regional macro conference to showcase student projects developed through the three-term advanced practice course. it was also an opportunity to add faculty presentations, as well as community presentations. the purpose was not just to profile these projects, but also to promote awareness of macro roles in social work and create a network of macro social workers in the region. the workload was considerable, and faculty partnerships with oregon’s nasw, the portland chapter of the social welfare action alliance, and with students (a student coordinating committee) did not diminish the work, although the conference attendance increased. after four years, faculty were unable to sustain the effort and while the idea remains a good one, it is not viable with current workloads. the results of this phase of growth efforts was to increase enrollment in the macro concentration from less than 25 students a year to approximately 40 students a year. phase ii: reaccreditation opportunities the second phase of our growth of macro practice occurred in the re-accreditation process that began in 2011, integrating broad and deep engagement practices with the curry-stevens et al./lessons learned 70 community, and emphasized more effective preparation of students for practice. three major input processes occurred in re-accreditation: a survey of 116 current and prior students, field instructors, and allies of the program; a “world café” engagement process with 85 community partners who spent the day surfacing community priorities and advice for the ssw; and a series of working groups (comprised of faculty, students and interested allies) that created proposals for consideration. community input included research partners, grassroots coalition members, alumni, employers, and field instructors. in this design process, we shaped and differentiated the content that needed to be available to all students (and thus within the first year of the program) and that which should be available at the advanced level. overall, macro faculty were instrumental in moving more macro practice content into the first year, drawing from their learning in phase i. here were key decisions: first year foundation o the first-year policy course was revised to be more practice-oriented, integrating policy practice into what had been a social welfare history course. its focus has served to help build capacity among students in public policy engagement, and has enlivened interest in macro practice; o a three-term generalist sequence was eliminated, letting us refine macro courses and better integrate macro instructors in one-term courses; o while there had been a macro theory course, we needed to add macro practice. broad social theories, political theory and social change theory were reduced in number although we retained broad social theories (deferring more to second year), and macro practice was added to both the social welfare policy and communities and organizations courses. content was revised to ensure key macro theories were kept in courses that all students needed. more specialized theories were moved to the advanced year for the macro concentration. we have tried to keep these courses early in the first year of the msw but had limited success: faculty prefer their courses to come early in the curriculum. these courses pique student interest in macro practice, and would ideally be scheduled early enough to influence concentration choice (which occurs in february); o a new required first-year course was created called “advocacy and empowerment” that included a range of practices: case advocacy skills, use of self in advocacy, empowerment-based practice across levels, and service user voice. this course, more than any (we believe), has strengthened micro-level practitioners’ engagement in advocacy, particularly in the area of service user voice, as a vehicle for organizational accountability, empowerment for clients and systems improvements. while not directly serving to “grow” the macro concentration (as it is scheduled after selection of concentrations has occurred), it is still an influence in strengthening macro engagement among micro practitioners, which in turn strengthens the school’s culture of support for macro practice. advances in social work, spring 2019, 19(1) 71 second year advanced concentration o two macro-focused concentrations (“community-based practice” and “social service administration and leadership”) were collapsed into one, renamed “practice and leadership with communities and organizations” (plco). content included the strengths of each prior concentration, with the benefit that each group of students gained key advantages that broadened their skill acquisition and subsequently their employability. community practice students gained organizational operations content (including budgets, human resources, and fundraising), and administration students gained a more astute critical and social justice perspective. students now consider a wider array of jobs, as observed in an assignment where students identify and apply for a job of interest to them; o in response to community and student priorities, we added content on advancing racial equity in organizations, and students have an assignment oriented to supporting their practicum sites in doing an equity assessment; o students have been given more flexibility to build a program that reflects their interests with six electives taken in the advanced year. this has allowed macro students the ability to build micro skills or to widen their macro skills. greater responsiveness is useful for higher student satisfaction (which is also relevant for micro students); o the plco concentration, like other concentrations, is three terms long. in plco, we allow students outside the concentration to enroll for just one term, expanding options for learning macro content, although such figures do not show up in our specialization numbers. we still consider it a success to attract micro students into macro courses. one year we had a decline in student enrollment in macro; we noticed that macro faculty were no longer teaching in the first year of the program, and their reputation among incoming students who had still to decide their concentration diminished. in subsequent years, the faculty made sure that the instructors of the advanced macro courses also taught at least one first year course. the success of these revisions was to grow student enrollment numbers in macro practice to two large sections, at about 50 annually. phase iii: online innovation the third phase of change efforts in macro practice created the largest increase in student numbers, growing from 50 to 90 students annually. our online msw program was created in 2014 and its sole specialization was macro practice (the plco concentration). while the reason was idiosyncratic in nature (as the leads of the creation of the online course were both the lead macro faculty and director of the msw program), it was a curriculum focus that aligned well, given broader faculty reticence about online education. numerous faculty had difficulty envisioning how clinical practices could be adapted online, and thus this choice did not activate as much resistance. a niche also existed for this specialization, as less than 18% of 74 online programs in the usa include such a concentration (cswe, 2019). curry-stevens et al./lessons learned 72 the online program has been vastly successful, with 40 students accepted into the program annually and all of them specializing in macro practice. retention rates have been steady at 97%. two new features are now on the horizon: adding a specialization in health care and admitting advanced standing students. access to oregon’s only public university and continuing to specialize in macro practice retains considerable appeal and we are resourcing students in rural areas and supporting non-traditional students to better access higher education. the process for developing the online curriculum included two weeklong retreats for faculty who were participating in course design, led by the two lead faculty for the initiative and supported by a range of staff who provided expertise on instructional design, americans with disabilities act (ada) compliance, accessibility considerations, copyright legalities, and online technologies. a significant dimension of these retreats was to develop horizontal and vertical integration of the curriculum. the program was designed to maximize the student experience by ensuring that the parts of the curriculum “hang together” and are understood as a larger, integrated education about social work (horizontal integration). this approach strengthened the inclusion of macro content in the first year. we also committed to student skill development so that students, became increasingly capable and advanced practitioners as they moved through the program, with content sequenced intentionally to eliminate gaps and repetition (vertical integration). we also found that the rigors of online course design (as required by the instructional design faculty) transferred into the campus program. an example here is the grounding of each curriculum element in measurable objectives. the ongoing benefit of this process is that faculty can now view their courses as interrelated with other courses, and they continue to prioritize such alignment. a related dimension of this online focus (although it did not align with this phase of the work) was dialogue about the number of students coming into the advanced standing program. over the years, many faculty revealed concern about the advanced standing program believing that students were not as well prepared for clinical practice coming out of bsw programs. the macro faculty participating in these dialogues did not feel the same way and had experienced advanced standing students as well-prepared for the advanced macro curriculum. this holds potential for increasing the size of the macro concentration. we have yet to stratify incoming students in this way, but identify it as a possible option for growth. phase iv: longer term influence of horizontal and vertical integration the fourth and final development period for strengthening and growing macro practice occurred after the online macro specialization was developed, and the residual capacity for vertical and horizontal integration remained in the foreground of our curriculum insights. since 2015, we have seen the evidence of horizontal and vertical design capacity in pathways to strengthening the entire curriculum, with two examples provided below. the advanced standing program requires students to have a “bridge course” that they take in the summer before they join the advanced year. the course had been taught by many different instructors, each with their own priorities. in 2018, the course was led by advances in social work, spring 2019, 19(1) 73 two instructors steeped in awareness of the entire curriculum and with experience in understanding vertical and horizontal integration. these principles were forwarded in the new course design, with an emphasis on applications of theories to practice, and the consequences for practice of different theoretical perspectives. in this way, students built understanding of the intersections of various fields of study and an appreciation for their full relevance to practice. in a second example, it became clear that in a required course on groups, the instructional faculty were omitting non-clinical, macro-oriented group practices, such as coalitions and popular education. after advocacy efforts for inclusion did not work, the macro practice faculty successfully moved popular education into a different first year course, while additional elements were moved into the advanced year macro courses. being aware of the importance of the entire curriculum (achieved through engaging with horizontal and vertical integration in phase 3), strong relationships across faculty allowed for macro faculty to adjust to these conditions. that said, losing this content from the required groups course is, indeed, a loss for the broader student body as non-macro students do not gain broader exposure to macro groups elements. this fourth period has not resulted in more students entering the macro concentration. in fact, numbers have declined a little. such a shift, we believe, is the result of greater choice in the online program (whereby students can now take a concentration in health, which is primarily micro practice) and some reduction in student support for macro practice due to various staffing changes (e.g., one senior macro faculty left the university, a second was on medical leave last year, and a third reduced their presence on campus due to a significant residential move). this aligns with earlier insights when we learned (or rather, hypothesized) that macro faculty presence on campus (e.g., engaging in advocacy practice or instructing first year macro courses) served to attract more students into the macro concentration. while there is an incoming stream of tenure-track faculty into the macro concentration, the importance of having faculty known by students in the first year needs to be consistent. we have come to believe that students are primarily relational, and make decisions with attention to both the ways they are being equipped for professional practice and their confidence in those instructors who will lead their education. proactive succession planning holds potential to reduce the vulnerabilities of faculty transitions. future options we identify five opportunities to expand growth of the specialization. most are related to building awareness about the possibilities for macro practice. first, incoming students and potential applicants are rarely aware of the macro dimension of social work. communication efforts that detail skill development, impact possibilities, job opportunities and career trajectories (such as the high likelihood of being involved in macro social work upon graduation) can be developed. recent research highlights the importance of macro skills training for all students. de saxe zerden et al. (2016) identify the need for micro students to learn macro skills as their movement into administrative positions comes with weaker management skills. we have the potential to better market taking a single advanced course in macro practice. students are able to take just one of the advanced three-term sequence but very few do this. given we have a facilitative structure for this, curry-stevens et al./lessons learned 74 communicating it more effectively could increase the number of students prepared for macro practice even if they do not take the whole curriculum. second, to attract students who are more likely to want to concentrate in macro practice, we will market the msw to sociology, public health, women’s studies, cultural studies, and political science students, many of whom may be eager for professions (and their related credentials) that help them establish pipelines towards engaged policy and systems reform practice. the macro msw holds this potential. third, we have learned that introducing first year students to macro practice is essential, and where these courses are positioned in the curriculum is very important. ideally, such course work would occur early enough to inform specialization decisions. fourth, we have just identified the importance of ensuring that those who teach field seminars in the first year include macro practitioners, or practitioners with strong macro orientations. such instructors are more likely to support serious exploration of the macro specialization and infuse reflections on practice from an upstream orientation. without this, students have limited integration of macro practice connections to their field experiences. in our opinion, omitting macro capacity of such instructors is a mistake. the field seminar is an important course to influence students’ choice for their msw specialization, and while clinical savvy is needed for such instructors (as micro practice is expected of first year practicum experiences), the opportunity to also integrate macro dimensions of practice diminishes both the imperatives of the nasw code of ethics and the upstream dimensions of the social justice dimensions of the psu msw mission statement. fifth, we could stratify entrance selection based on students’ anticipated desires for their concentration. if concentration preferences were a part of the application process, we could bring in more macro-oriented students. this would require agreement within the faculty body which could potentially be gained through dialogues about how we want to see the field develop. providing students with a range of online resources to better explain the concentration, as well as having macro instructors host information sessions, would assist students in making this a well-informed decision. this would be a radical shift among schools of social work which typically do not stratify according to concentration preferences. doing so would necessitate a shift in discourse that prioritizes faculty interpretation of what the field needs over student preferences. emergent tensions tensions emerged during this evolution that held potential to derail progress. literature suggests that some of these challenges were not uncommon, and thus might have relevance beyond psu. the first is a version of the historic divide between micro and macro practice. social workers have long been writing about the emphasis that clinical practice has in the field, and the limited exposure students have to macro practice (rothman & mizrahi, 2014; specht & courtney, 1994). newer contributions highlight the marginalization that macro instructors experience in faculties of social work (netting et al., 2016). missing as yet is literature on what this means for macro students in predominantly micro-focused msw programs. our experience identifies challenges including reduced curriculum options, isolation within micro classes, lack of instructor capacities to support their interests, and advances in social work, spring 2019, 19(1) 75 weaker capacities to explore field challenges and areas for growth. at the phd level, rothman (2013) highlights this influence in directing students away from macro dissertations due to a shortfall in macro faculty. greater exploration has been limited; our experience may begin to shed light on this tension and possible solutions. we all know that there can be a zealotry of converts and anticipate the energy that can be released through transformative learning practices (mezirow, 1991). our experience was that students in macro practice were enthusiastic about experiencing a welcoming and affirming “home” environment within the msw program. the combination of their zeal and a place of belonging (in the macro classrooms) showed up as arrogance of being the “better” social worker when compared to micro practitioners. from students’ perspectives, their positionality of being a macro practitioner was tied to one of superiority for doing “real” social change and social justice practice. instructors generally supported this emphasis for how they envisioned their role, and initially did not try to minimize this divide. two problems existed with this issue: the first is that it was associated with a professional identity that rendered one “innocent” of being complicit with oppression (rossiter, 2001) because one was a macro student. it is relatively easy to criticize the profession as being satisfied with putting band aids on problems that should be addressed at their roots, and to reason that if one endeavors to work at root cause levels, then one is doing “better” social work. but the macro practitioner can be just as culpable as micro practitioners. macro practice can be just as expert-infused, disempowering, silencing, and marginalizing of those who experience distress. shragge (2007) identifies the equivalent need to address power relationships between social workers and the communities with which we work, and that the work of rebalancing power is essential to minimizing the oppressive relationships that appear within macro practice. fay (2003) ventures into similar territory, highlighting how the post-modern era in organizing addressed power and stature among coalition members. the second tension emerged not from macro content but from the social justice content that has sharpened student analyses of power. this lens, while aiming for students to bring it into their practice with clients and communities, became targeted at the operations of the ssw itself. faculty and administrators learned the hard way that a social justice lens cannot be limited to engagement outside the ssw, and expectations for the school to “walk its talk” were raised. while this was an early learning (circa 2007), it continues to manifest among students and there is a perpetual critique of our actions and inactions, particularly enlivened by the principles-based teaching that flows from macro-oriented courses including principles such as “walk your talk,” “nothing about us without us” and “power sharing.” falling short on consistently practicing social justice in the department remains a source of discomfort within the faculty, although it is ideologically embraced among administrators as an important source of growth for the ssw and the university itself. it is simply hard to become the focus of change efforts of students who find aspects of our work unacceptable. in response to these raised expectations, the ssw has created the “student inclusion coordinator” position that aims to improve the educational experiences facing students from marginalized communities. in addition, an equity assessment and action plan has been implemented along with, an ongoing committee to address equity issues, and a curry-stevens et al./lessons learned 76 student-led “student of color caucus” that has agitated for reform. universities are notoriously difficult to change, but movement is occurring and it is essential that the ssw remain both responsive and accountable to the importance of equity and inclusion. the third tension was that the traditional marginality facing macro practitioners within the school of social work was being challenged as the macro numbers increased. while clinically-oriented students had definitely been the majority, and were reflected in dominant discourses about social work, their dominance was being challenged. at this time, macro practice had grown to three sections of students, and both a greater visibility in the school, as well as influence to support more macro electives, correlated with narrowing electives for micro practice. to some degree, this was cause for celebration and energizing for the concentration as it moved out of the shadows, and the influence of clinical students was diminished. the celebratory dimension was short-lived. fracturing of the faculty emerged, and some open hostility towards macro students and faculty occurred. this was painful, and the common interpretation was that macro students were in the wrong for being arrogant in their positioning as the “better” social worker. tensions also reflect diminished centrality for clinical students, but it was more readily construed as the arrogance of the macro practitioner. once the dialogue began to consolidate around this framing, we took action. this took two forms: the first was to share back with students how others perceived their attitude of superiority and defend the importance of micro practice, particularly when undertaken within an anti-colonial, anti-oppressive, critically-infused approach. second, we added content on the complicity of the macro practitioner with relations of domination. explicit attention in the curriculum was etched out to pay greater attention to how power arrangements were embedded in macro practice. curriculum adjustments included more content on power-sharing partnership practices within community and policy practice, deeper “troubling” of the profession (with this concept drawing from kumashiro, 2001), and critical reflexivity which were approached through focusing on identities, biases, and professional positionality. a core message was the ongoing need to implicate oneself as a professional with considerable privilege, even when one shoulders additional marginalized identities. this stance has enhanced the capacity of macro students to practice with greater attention to power and to identify pathways that build the power of clients and communities and integrate organizational changes that raise the power and influence of the communities being served. the negative attributions by clinical faculty to macro faculty and students diminished considerably, although they are still present from time-to-time. macro students demonstrate greater humility and stop themselves from criticizing micro students for their concentration choice. reflecting back on these years, we wonder if this action–of responding by taking actions that induced greater humility and awareness among the macro students – was an incomplete response. in essence, we interfered with both the transformational learning of students, and may have diminished the pride they held as macro practitioners, through adding curriculum that caused them to be more self-aware of privilege, identifying pathways to power-sharing with the clients and communities with whom they work. going forward, we wonder three things: was this an act of disloyalty to macro students who were rejecting the discourses that kept them (and continue to keep them) in the margins of the advances in social work, spring 2019, 19(1) 77 profession? in the interests of minimizing the fracturing among faculty, did we sidestep an important conflict about the ways the faculty reinforce the primacy of micro practice, and the ways in which macro shows up in the school? third, we missed the opportunity for non-macro students and faculty to learn about the alienating features of the marginalization of macro students in the field, and the attribution to oppressed groups as being the cause of this disharmony. this connects to the tensions that netting et al. (2016) suggest: … it seems we need to be crossing curricular boundaries and engaging in dialogue with colleagues who are equally passionate about the micro aspects of social work education… social work has always housed diverse interests… and these tensions have been replete with challenges related to control and dominance. (p. 168) the authors of this article have used this experience in teaching as a case study of institutional power arrangements. shared are the critical reflections on how power relationships were addressed within the macro program, alongside our omission in bringing this issue to the faculty more widely. we have learned the incompleteness of our response as only macro students learned more deeply about power and how macro students were perceived as responsible for this disharmony, instead of implicating the conventional clinical/macro power relationships. currently, the cohesion of the faculty is stronger than in the earlier era, although the decision to sidestep this tension was potentially a form of conflict avoidance. on the other hand, it could be interpreted as an effort to articulate a boundary-crossing understanding of the importance of all levels of social work, provided they were steeped in effective responses to power hierarchies. faculty and students in the advanced year of the macro practice concentration shouldered responsibility to mend the fractures within the student and faculty body. it is unclear if it was matched by similar accommodations within the micro-oriented streams. analysis: who is drawn to macro practice and why? the history section describes the efforts that faculty engaged in to make the concentration more accessible, responsive and appealing to students. at the same time, there have been important regional and professional dynamics that also make macro more appealing. this section documents the authors’ understanding of this pattern, building possible explanations for the increased appeal of macro practice. at first glance, the dimensions are beyond our control, as local dynamics shift across time, sometimes yearly, as political patterns emerge from crises, historic events, and electoral politics. our macro concentration now includes more enduring content on administration, leadership and partnership practices, and we have reduced available curriculum space to respond to contemporary issues. that said, we are committed to responding to student priorities, emerging community and regional conditions, and our curriculum process attends to these. local dynamics include heightened attention to racial equity, borne of the strategic research and advocacy agenda led by the coalition of communities of color, including a seven-year research and advocacy partnership with the lead author of this article. also prevalent is environmental advocacy, which several in social work have endeavored to stretch to include social sustainability (dujon, dillard, & curry-stevens et al./lessons learned 78 brennan, 2013). in response, how to conduct a racial equity assessment is included in the curriculum, and environmental analysis and advocacy is included as an option for assignments. greater choice in assignments also allows students to follow their passions. we have identified the types of students who are drawn to the program, noting a few patterns that might be relevant for other universities. in our situation, more advanced standing students are drawn to the plco concentration than regular two-year students. we think this is because they are already steeped in bsw curriculum that tends to retain its generalist orientation, gaining more macro content. when students take between one and four years of bsw studies (and abundant numbers of courses), there is greater likelihood of exposure to macro content. while we do not have data to support this, we find advanced standing students are well-prepared for macro practice. this may be a regional attribute and suggest others shore up their bsw macro content and delivery. we also have tracked the portion of students who select the macro concentration, comparing those who are part-time to those who are full-time. our part-time students take three macro-oriented first year courses before making their concentration selection, while full-time students have only one such course prior to the selection. we analyzed the current cohort and found wide variations in the numbers of students who had different levels of exposure: part-time students have triple the level of enrollment in the macro concentration at 20.4% compared with 6.7% of full-time students. this does not include our online students who only have the macro option. this is important for other universities: in our experience reviewing transfer requests, we know that it is rare for first year msw curriculum to include macro content. this is a lost opportunity, suggesting potential for improvement. the macro concentration tends to appeal to more experienced students. in 2017-2018, students who selected macro practice had an average of four years of prior experience, compared to the micro students who tend to have closer to a two-year average. while we were unable to disaggregate our data in this way, we used a proxy measure of advanced standing students: 30.3% of advanced standing students enrolled in macro practice, while (as noted above, again omitting online students) only 6.7% of regular students made this selection. our shared experience in teaching such students shows they have become disillusioned with solely micro-levels of intervention and are eager to engage in systemiclevel change. their priorities tend to be focused on how to improve institutions and public policy. we continue to attract students who are activist-oriented, who aim to learn skills and gain experience in advocating for social justice. for most, the inclusion of “community practice” within the name of the concentration tends to organically suggest we are focusing on social change, alongside the ssw’s mission statement which is clearly oriented to social justice. these students are mostly identifying as such when they enter the program, although there is growth of such students as they engage with the critical orientation of the program and its focus on how power works to create and sustain marginalization of an array of communities and populations. they often critique a solely micro orientation to social problems, and practitioners who disengage from the macro context of the micro advances in social work, spring 2019, 19(1) 79 experience. for these students, “light bulbs go on” when instructors name the macro dimensions of client issues, gaining motivation to work upstream. the regional dynamics of this ten-year period of macro growth is not one with heightened social movement and social change. few movements have been pronounced – certainly in comparison with the 1960s and 1970s. the election of president obama with his community organizing history did not seem to build our numbers, although it gave us much to explore within the macro curriculum. the new era of black activism, alongside the black lives matter movement, and the opposition to president trump’s incarceration of undocumented children (among other actions), hold potential for more activist-oriented students to be drawn to the ssw. for this to materialize, faculty would need to be embedded in these struggles, working as academic activists in partnership with community groups. this involvement exists but it is not consolidating in a reputation, as yet. students are drawn to the reputation of those leading the macro concentration. when we examine the appeal of macro faculty, we discern that holding community leadership positions attracts students. community leadership emphasizes leadership that focuses on building community power and influence, and works through strategies of building social capital and civic engagement within communities (doherty, 2003; kirk & shutte, 2004). first author curry-stevens built a considerable profile from working with racialized communities and her combination of research, advocacy, and organizational equity work is widely known (among them are curry-stevens, 2012a and 2012b; curry-stevens, crosshemmer, & coalition of communities of color, 2010; curry-stevens, reyes, & coalition of communities of color, 2014; har, 2010). integrating this content into the curriculum has occurred and so too for second author hawash. hawash has longstanding local and community-based anti-poverty work, including research and project work alongside her consulting work that prioritizes socially-just fundraising and grant writing, all of which now feature in the curriculum. she is also a leader in “disarm psu” that emerged after the recent administrative decision to arm the security staff, and their subsequent 2018 killing of jason washington, a black man and non-violent bystander trying to defuse the conflict. students are leading this campaign, and faculty are supporting this leadership. these advocacy efforts seem to inspire students to be drawn into the ssw and its macro concentration, as several routinely seek additional engagement with these activities, as demonstrated through seeking practicums in these efforts, independent study requests, and enthusiasm for classroom teaching and assignments that relate to these activities. additional instructors hold a mix of scholarship in the area of macro practice and wellrecognized practice in the local community. we also believe that if social work faculty are to maximize awareness of our contributions, we need to move into advocacy-based scholarship so our work has relevance, visibility, local credibility, and the possibility to generate resources that are more accessible than journal articles. we are coming to understand that community leadership also emphasizes the principle of “walking our talk” which is essential to demonstrate to students. students are drawn to leaders they respect. being advocates in local struggles demonstrates to students that their faculty are “walking their talk,” taking social justice beyond the classroom into the lives of marginalized communities. for the macro concentration, students seem more interested in local engagement than national and international reputations. they might have become curry-stevens et al./lessons learned 80 familiar with instructors’ reputations before entering the program, and respond enthusiastically when these experiences are brought into classroom teaching and assignments are offered that can support these advocacy goals. in one example, macro students participated in outreach for the annual homelessness count. in another example, students reviewed racial equity policies globally to identify common features that local organizations could draw from. whatever the local context, engaged instructors demonstrate the type of community leadership to which students are drawn. there is simultaneous emphasis on being advocates for students within the university. a brief note about practicum opportunities is needed. the requirement by cswe to have an msw-credentialled supervisor limits the range of options for students. many vibrant and exciting settings (advocacy coalitions, networks and small organizations) do not have this capacity, and while our field team endeavors to find a process supervisor to supplement a non-msw task supervisor, this is often not possible. innovations to support a broader range of possibilities and reduce this cswe requirement are recommended. in summary, the macro concentration at psu ssw has grown from less than 25 to approximately 90 students a year. four broad factors are responsible: (a) macro faculty leaders have been intentionally working to improve its quality; (b) faculty themselves are committed to engaged community practice and “walking their talk”; (c) an array of initiatives were adopted to introduce students to macro practice in the first year, and (d) the online program was created with macro as its sole concentration, adding 40 students to the program. in our estimation, half of this growth is due to the first three factors, and half is due to the creation of the online program. we also have tapped into the natural orientation of advocacy-infused msw students to draw them into the program. our credibility as activist-oriented scholars and educators has been strong, maintaining reputations for meaningful engagement with community partners. we were challenged by an array of tensions which have been, so far, navigated with some success, and adversity was transformed into a series of discomforting events, difficult but possible to address. recommendations we have grown the macro concentration from an average of 15% to 32% of our student body, standing at roughly triple the national average. significant features have been identified, as we reflect on the last ten years of the school of social work at portland state university. highlighted are the domains of innovation and responsiveness that we have found key to this development: • faculty stability and tenure, insuring the availability for service roles; • faculty who are actively engaged in the community, with various advocacy and research endeavors that inform the priorities that faculty bring into teaching; • faculty who enact leadership in the university to advance social justice, and ally practices that support students inside and outside the classroom; • student relationships with macro faculty, highlighting access, respect, responsiveness and active attention to the macro context of the micro experience; advances in social work, spring 2019, 19(1) 81 • sequencing curriculum so students are exposed to macro practice early; • flexibility and choice in the curriculum, supporting students to respond to their passions; • attention to growth opportunities, such as online development where the macro concentration was not resisted by faculty; • curriculum development that is firmly rooted in horizontal and vertical integration, and ongoing awareness of this importance outside of formal assessment processes; • adaptable curriculum to integrate current issues and local dynamics; • collegial relationships that are respectful, depicted by humility and remedy for missteps, heavy lifting in service roles, and willingness to compromise; • student and human service professionals influence in the curriculum to ensure that curriculum reflects local priorities and links students to macro practice networks outside the university; • culture that respects the contributions of all levels of practice; • recruitment of students from fields of undergraduate studies that are more likely interested in macro practice (for example, sociology and political science students); • monitoring the number of students selecting macro practice and identifying factors that are influencing the numbers so early intervention is possible. our final note is one of advice to other programs and to the profession at large: it is in all our interests to legitimize and raise the number and importance of macro practitioners in the field of social work as a whole. when social workers lose their focus on the upstream causes of the downstream distress of clients and their communities, we risk de-socializing this distress, and implicitly support framing distress in terms of pathology and illness. when we ignore the deficiencies of the market to generate enough well-paid jobs, and the discourses that continue to diminish the integrity of and respect for communities of color, and when we fail to invigorate resistance to injustice, and neglect the urgency of reforms needed to address institutional racism and the multitude of other “isms,” we put all of society’s wellbeing at risk. when we have this upstream focus, actions that invigorate resistance and promote opportunity, social justice and human rights expand. if civil society is enlivened, we could expect our political leaders to value social wellbeing and work more effectively for the collective good. the empowerment of marginalized communities increases, and the institutions that provide services become more responsive and useful. critically-oriented macro practitioners are steeped in these skills, understanding the 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https://www.usnews.com/best-graduate-schools/top-health-schools/social-work-rankings advances in social work, spring 2019, 19(1) 85 author note: address correspondence to: dr. ann curry-stevens, associate professor, faculty of social work, wilfrid laurier university, 120 duke street, kitchener, on n2h 1p9. e-mail: acurrystevens@wlu.ca mailto:acurrystevens@wlu.ca this work is licensed under a creative commons attribution 4. 0 international license. a worthy reception? ambivalences in social work with refugees and migrants in sweden kristina gustafsson jesper johansson abstract: the purpose of this article is to analyze how reception practices and the meaning of a “worthy” reception of refugees and migrants are negotiated in encounters between various receiving actors in times of shifting swedish migration policies. the analysis is grounded in ethnographic methodology and draws on data collected in 2016. the aim of the study was to document experiences of the so-called “refugee crisis” in europe and scandinavia from a bottom-up perspective among professionals and volunteers narrated during reference group meetings. the reference groups consisted of representatives from state and municipal agencies, the private sector, and civil society organizations. the actors represented in the mixed reference groups were diverse, but all were involved in reception activities. in the analysis we have combined political philosophy about willingness versus ability to receive refugees and migrants with postcolonial theoretical perspectives on concurrent claims and voices. we identified three themes that are central in the negotiation of the practice and meaning of a “worthy reception”: first, the overlooked existential needs of refugees and migrants; second, the lack of genderand diversity-sensitive reception practices; and third, ambivalences in relation to various refugees groups in times of shifting migration policies. we recommend that in order to promote a worthy reception of refugees and migrants, existential needs must be taken care of and genderand diversity-sensitive practices must be developed. another recommendation is to recognize how migration policy limits a society’s ability to receive refugees and migrants, but also affects the willingness among those actors who receive. keywords: migrants; refugees; reception; social work today, migration policies in liberal democracies are marked by an ambivalence between seemingly contradictory jurisdictions and claims (andersson, 2014; gibney, 2004). this ambivalence can be seen in the public debate, with themes such as human rights versus national security and the rights of refugees versus the right to protect national welfare state institutions. in sweden, such contradictions manifested themselves with the implementation of a new law in 2016 which restricted the possibilities for permanent residency and family reunion for asylum seekers (sfs 2016:752). political leaders justified the law by referring to the pressure that an increased influx of refugees in 2015 put on migration agencies, social services, schools, health and medical care and so on. the “refugee crisis” of 2015 was thus framed as a crisis for the receiving country rather than a crisis for the people seeking protection (sou 2017:12). thus, the “refugee crisis” was framed and re-framed in similar ways in several european countries. in some countries, like sweden and germany, the rhetorical reactions of leading politicians in 2014 and 2015 concerning the increased numbers of arriving asylum seekers were marked by solidarity and empathy. in a speech in the summer of 2014, then swedish prime minister fredrik reinfeldt, who lead a center_________________ kristina gustafsson, phd, is an associate professor, department of social work, linnaeus university, 351 95 växjö, sweden. jesper johansson, phd, is an assistant professor, department of social work, linnaeus university, 351 95 växjö, sweden. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 983-1004, doi: 10. 18060/21656 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 984 right coalition government, exhorted the swedish people to “open your hearts” towards asylum seekers fleeing war-torn regions. furthermore, conservative german chancellor angela merkel commented on the increased numbers of received asylum seekers in germany in autumn 2015 with the words “wir schaffen das” (“we will make it”), addressing a symbolic message to the german people to have trust in the german society’s ability and willingness to receive refugees. in contrast, other countries like poland, hungary and slovakia consistently turned away asylum seekers and refugees. nevertheless, even in countries like sweden and germany, the political atmosphere concerning migration policies changed radically during late autumn 2015 and the following years. new regulations and strict border controls were implemented not only around the external borders of the eu but also (temporarily) between eu countries to limit migration movements. one of the main arguments for these increasingly strict measures in european countries was the fact that there was, and still is in 2018, a split among eu countries. several eastern and central european countries did not want to receive asylum seekers and refugees at all. others, mainly south european countries close to the mediterranean sea where large numbers of migrants first arrived, as well as germany and sweden as the largest receiving countries, preferred to establish a redistribution system leading to an obligation of all eu-countries to receive a “fair” share of asylum seekers and refugees migrating to the eu (gibney, 2015; regeringens skrivelse, 2016; svensson, 2017, pp. 20-21). in sweden the new law about restrictions on permanent residency and family reunification can be described as a turning point in swedish migration policy (johansson, 2005), which has had a significant impact on everyday social work connected to the reception of refugees and migrants. on the one hand, professionals and volunteers have been obliged to act in accordance with the new restrictive legislation. on the other hand, they are endeavoring to provide a welcoming and “worthy” reception in line with professional ethics and the ambitions of a social democratic welfare regime (esping-andersen, 1990; international federation of social workers [ifsw], 2012/2004). in this way, the reception of refugees and migrants is practiced and produced on the front line between divergent but concurrent demands in contemporary sweden. the purpose of this article is to analyze how reception practices and the meaning of a “worthy” reception of refugees and migrants are negotiated in encounters between various receiving actors in times of shifting swedish migration policies. our primary research question is: how is the meaning of a “worthy” reception negotiated in personal narratives by different professionals and volunteers? the study is based on data collected in the fall of 2016 from eight recorded reference group meetings with three mixed groups consisting of both professionals and volunteers involved in the reception of migrants and refugees. in our analysis, we combine political theory about a society’s ability and/or the willingness to receive refugees and migrants with postcolonial perspectives on concurrences in cultural encounters. research perspectives on swedish refugee and migrant reception this study intersects research in social work, migration studies, and cultural sciences. we employed a broad definition of social work, which includes professionals and civil society volunteers involved in the asylum process and the reception of asylum seekers. social work has a given function in civil society organizations. civil society involves individual commitment, which has been clarified in reception activities of gustafsson & johansson/a worthy reception? 985 refugees and migrants during the last several years. for instance, civil society volunteers organize a variety of relief efforts, such as serving food, collecting and distributing clothes and arranging temporary housing for refugees and migrants. in sweden, civil society organizations have sometimes taken the place of state or municipal authorities in providing social services for refugees and migrants when these public actors have failed or ceased to act. furthermore, professional social workers in public organizations have also cooperated with civil society organizations, sometimes using civil society as an arena to support the public authorities’ efforts (turunen & weinryb, 2017). in scandinavia several studies have been conducted on workers at the swedish migration agency (brekke, 2004; hedlund, 2016; ottosson & lundberg, 2013; valenta & berg, 2010), those who work with newly arrived children in the swedish school system (bunar, 2015; nilsson folke, 2017), in social services (montesino & righard, 2015), within health care services (safipour, hadziabdic, hultsjö, & bachrach-lindström, 2017) and at the swedish public employment agency or the national social security agency (schierenbeck, 2003; soydan, 1995). a great deal of previous research has focused on how swedish receiving sectors deal with integration and issues of promoting resilience, health and identity, as well as how they are marked by racism and structural discrimination (andersson, ascher, björnberg, & eastmond, 2010; eliassi, 2015). although these studies are relevant for the present study, they all focus on the reception measures of one specific welfare sector or authority separately. in order to understand the reception of refugees and migrants as the sum total of many different agents and institutions in the welfare state, a comprehensive and inclusive perspective on reception is necessary (gustafsson, 2015). within the field of migration research there is a growing critique of the tendency to focus on the migrants’ backgrounds and experiences rather than the contexts, structures, and actors forming the conditions of migration. in the field of social work, “cultural differences” or “otherness” is often framed as the “problem” explaining migrants’ weak structural integration. migrants’ “otherness” is often targeted in specific interventions (ahmadi, 1998/2003; hessle, 1988). such social interventions are often focused on migrants’ ability and willingness to adapt to swedish society instead of the surrounding advantageous or disadvantageous conditions that exist concerning migrant’s integration montesino & righard, 2015, pp. 11-12). one consequence of such a perspective is that the migrant becomes the “problem,” or the one who needs to change in order to integrate. this is known as the “minority model” (pripp, 2005). this critique is also present among scholars influenced by postcolonial theories that suggest a shift in focus to the surrounding society in order to understand the conditions for migrants and migration (andersson, 2014). this suggestion is supported by several studies within the fields of migration studies and social work or social policy that show that the character of social policy and immigration policy regimes strongly influences refugees’ and migrants’ level of control over their own empowerment, participation, and well-being (castles & miller, 2011; montesino & righard, 2015; sainsbury, 2012). in contrast, however, other studies show that reception measures take their point of departure from the needs of the host society, rather than the needs of the migrant. this leads to an ambivalent position of the migrant who is offered reception measures that might be empowering. at the same time, it is not measures that the migrant can choose or suggest themselves. in that sense, the migrant has relatively less advances in social work, spring 2018, 18(3) 986 power (andersson, 2014; gibney, 2015; gustafsson, fioretos, & norström, 2012; larsen, 2011). these concerns are central to the perspectives of the present study. the surrounding society, here primarily represented by different welfare state professionals and civil society volunteers, and its reception measures are regarded as central for understanding the challenges of migration and the resettlement of migrants (castles & miller, 2011; johansson, 2008). theory and concepts zetterqvist nelson and hagström (2016) use the concept of “reception structure” to characterize the swedish reception of refugees and migrants. according to zetterqvist nelson and hagström (2016), the concept clarifies how swedish reception involves different sectors and agencies, each of them governed by their own laws and regulations (pp. 11-12). these sectors and agencies operate largely independently of each other rather than in close collaboration. accordingly, sweden’s reception of refugees and migrants is not a “system” governed by one general law or regulation, but a complex “reception structure” consisting of different sectors and agencies such as the police, the migration agency, municipal institutions such as schools and social services, regional health care, civil society, and private companies. the private sector is part of the reception structure since parts of the public welfare include contracted services from the private sector. residential care homes for unaccompanied children and accommodations for asylum seeker families are often run by private companies (zetterqvist nelson & hagström, 2016, p. 12). the concept of “reception” refers to a broad and complex arena of actions surrounding refugees and migrants (andersson, 2014). as a consequence, many of the actors included are not specialized in reception in the administrative or legal sense, but work as teachers in schools, public officials or social workers and encounter refugees and migrants in their everyday work as a consequence of migration. they all have an impact on the refugees’ and migrants’ lives, but how they operate and intersect, as well as the joint outcome of their work, is difficult to understand if their agency and professional practices are not analyzed together (andersson, 2014; gustafsson, 2015; zetterqvist nelson & hagström, 2016). encounters taking place in the reception of refugees and migrants are theoretically framed by the concept of “cultural encounters.” this concept is contested, first and foremost, in how it has been used by researchers to describe and evaluate differences between people based on ethnicity and nationality, often in hierarchal, stereotypical and oppressive ways (hall, 1997; hastrup, 2010). in present postcolonial research, however, the concept is still used both to understand encounters between colonizers and colonized peoples and to investigate how different knowledge-producing groups give voice to concurrent perspectives and interpretations of the world (brydon, forsgren, & fur, 2017). the concept of “concurrences” refers to simultaneous but contradictory process of meaning-making for example, agreement, competition, entanglement and incompatibility (fur, 2017, p. 45). used in research on colonial asymmetries, indigenous people or, as in this case, migration, the concept of concurrences opens up for a respect for pluralism and entanglements rather than singling out dominant perspectives and separate claims and jurisdictions. fur (2017) notes, “it is not a multiplicity of histories per se that interests me, but the way in which they become entangled, ensnared by their competing jurisdictions” (p. 51). a challenge for researchers is to acknowledge and handle such a plurality of knowledge regimes gustafsson & johansson/a worthy reception? 987 and how they are concurrent but also given disparate authority and power to dominate and silence each other (fur, 2017, p. 42). departing from this perspective, we consider the cultural encounter as a fruitful description of the encounters of those involved in the reception. the actors involved work for state and municipal agencies, private enterprises, and civil society organizations. they operate in organizations that have different jurisdictions and mandates depending on their assignment. for example, a social worker or a teacher working at the municipal level is involved in reception work but on different terms than an actor working at the state level for the swedish migration agency or for a civil society organization. we consider the actors involved in reception work as representing different knowledge-producing groups. they work as professionals and volunteers under different jurisdictions and give voice to different claims that sometimes exist in parallel to each other and at other times converge. taken together, they are involved in processes of negotiation that produce the meaning of a worthy reception. in this study, political philosophy theories about the reception of refugees and justice between states are used in order to analyze the notion of worthiness. these theories are explored and advanced by political scientist gibney (2004, 2015), who writes about the obligation of liberal democracies to receive refugees and offer resettlement. gibney investigates the need for justice and standards for an equitable division between states of the responsibilities for refugees. in connection to a fair distribution based on statistical data, population, gdp etc., gibney (2015) also discusses the relation between the ability and the willingness of a state to receive refugees. he suggests that the ability of a state to accept refugees might be influenced by the level of racism amongst the populace, its previous experience of integrating noncitizens and community preferences for particular types of refugees. he concludes that such factors say more about the willingness of a state to take refugees than its actual ability to do so (gibney, 2015, pp. 456-457). we use the terms ability and willingness in the analysis of a worthy reception. ability frames the way participants in the reference groups identify and explain their assignment to receive refugees and migrants. their assignment is controlled by legislation and limited by their mandate, resources and competence. in these ways, the ability to receive is in certain respects restricted. to fulfill reception work within these limits could be considered as a minimum for a worthy reception. as gibney (2015) states, the willingness to receive refugees and migrants is restricted by more subjective considerations and non-measurable factors. in a qualitative study such as this one, subjective perspectives and meanings were what we are actually looking for. although ability and willingness are difficult to quantify, they still have a significant impact on reception. a society’s willingness to receive refugees and migrants can be stronger or weaker than its ability to do so. for example, in contemporary sweden, more and more professionals in social services engage in volunteer work with refugees and migrants in their spare time in order to be able to do everything they want to do, not only what they can do within the framework of their professional work. methods this study is part of a regional project in southern sweden which documented professional and volunteer experiences from the reception of refugees and migrants in 2015 and 2016. the project was conducted in 2016 as a collaboration between four advances in social work, spring 2018, 18(3) 988 scholars in social work and cultural sciences, two curators at regional museums, and two regional public officials. the documentation of professional and volunteer experiences and voices was implemented using reference groups and individual interviews. we divided 15 selected professionals and volunteers into three reference groups who met for three sessions of three hours each during the fall of 2016. the participants represented state agencies: the public employment agency, the migration agency and the police; municipal agencies: social services, schools and group residences for unaccompanied minors; private entrepreneurs running refugee accommodations and civil society organizations: the red cross, the church of sweden and fryshuset (the freezer house). following the last meeting, eight participants were interviewed individually by students at the university. through our method of gathering these representatives in mixed groups, we included different perspectives from various knowledge-producing groups in an open dialogue with each other. in the dialogue, they describe their experiences in narratives, explore their own claims and jurisdictions, and compare and negotiate with the others. participants explored how their perspectives and functions in the reception of refugees and migrants are entangled and concurrent. each meeting with the three reference groups was recorded. in total, the data consists of 16 hours of recorded narratives and discussions from reference group meetings and eight individual interviews. in all three groups, the group leaders (the researchers) endeavored to give space for all participants to present themselves, their organization, and their experiences and perspectives on the reception of migrants and refugees from the fall of 2015 to the fall of 2016. the analytical work of coding and finding central themes in the data started during the period of data collection. after the first meeting with the three reference groups, central themes in the data that could be discussed at the second meeting were isolated. four themes came forward in the coding of the first meetings: the elusive concept of integration, the overlooked existential needs of refugees and migrants in reception work, the problem of non-gender-sensitive reception, and the problem of a reception that makes the received refugees and migrants passive. these themes were further discussed in the second and third meetings. after finishing the data collection, we repeated the coding of the data and in this process three main themes emerged. two themes overlapped with those discussed at the second and third meetings: the overlooked existential needs of refugees and migrants in the reception work (particularly the existential vulnerability and uncertainty of asylum seekers, the lack of meaningful everyday activities and existential life beliefs) and genderand diversityinsensitive practices. a third theme was not discussed in the reference groups, nor in the individual interviews, but seems fundamental in the negotiation of a worthy reception, namely, ambivalences towards different groups of refugees and migrants in times of shifting migration policies. the swedish reception of refugees and migrants according to current legislation, the swedish migration agency has the general responsibility not only for the asylum procedure but also for the reception of asylum seekers (sfs 1994:137). the latter is organized in collaboration with regional and municipal authorities. for unaccompanied children the legislation is different, and according to the social service act (sfs 2001:453), municipalities have the responsibility for reception measures while the migration agency is responsible for administering the asylum procedure (gustafsson, 2015). gustafsson & johansson/a worthy reception? 989 after asylum seekers receive a residence permit, they also get a specific municipality placement and the responsibility concerning refugees’ and migrants’ resettlement is divided between different state and municipal agencies. municipalities are responsible for housing (sfs 2016:38). according to a 2010 law about resettlement activities (sfs 2010:197), refugees and asylum seekers with a residence permit are entitled to a resettlement plan formed in consultation with the concerned individual and managed by the public employment agency in collaboration with municipalities, authorities, companies, and civil society organizations. before 2010, this was a municipal responsibility. however, municipalities are still responsible for providing swedish-language training and social information about laws, regulations, and civic instructions. the national social security agency is responsible for paying a resettlement benefit to the refugee or asylum seeker when he or she has been given a resettlement plan by the public employment agency. looking back on the swedish migration agency’s statistics, family reunification was the most common reason for migration to sweden. besides asylum-seeking and family reunification, sweden has granted quota refugees permits registered by the unhcr since the 1950s. other bases for obtaining a residence permit include work or study in sweden. citizens of the european union/european economic area eu/eea-member countries are also eligible to relocate to sweden and receive a residence permit (migrationsverket, 2017). in 2013 and 2014, sweden experienced a major increase in the influx of refugees and migrants when around 54,000 people in 2013 and over 81,000 people in 2014 applied for asylum. however, in the fall of 2015, most municipalities were still quite unprepared for the more than 160,000 asylum seekers that entered sweden within the space of a few months (migrationsverket, 2017). in relation to sweden’s total population of around 10 million people, these were remarkable immigration figures. the reception of people seeking asylum has also been an international and european matter of concern during the last decades (europeiska unionen, 2010). the european union’s directive of asylum reception from 2013 aimed to harmonize policies between member states and set up minimum standards about asylum reception. the directive states that the reception should be conducted with respect for human dignity (§35), but that the member states nonetheless have the right to treat asylum seekers less favourably than their own citizens (§24) (europeiska unionen, 2013). these contradictory objectives have created tensions and triggered conflicts between member states in the european union, where some states have received large numbers of asylum seekers while other states have received very few. furthermore, these contradictory objectives give nation states latitude to radically alter the terms and conditions of reception at short notice, for example, by reducing the standards of accommodation, language training, social activities, and other services offered to refugees and migrants. as noted in the introduction, sweden went through a shift in migration policy in 2016. restrictive border controls in november 2015 and personal id controls on trains, ferries, and buses were implemented in january 2016 followed by temporary changes in the migration law in july 2016. these changes in law and practice were implemented in order to restrict the increased influx of asylum seekers. before july 2016, successful asylum seekers were offered permanent residence permits. since the implementation of the new law, asylum seekers can only receive temporary residence permits from 13 months up to three years. since july 2016, only those with refugee status according to the un refugee convention have the right to family reunion (sfs 2016:752). before advances in social work, spring 2018, 18(3) 990 the new law was implemented family reunion was a fundamental social right for an immigrated person with a residence permit, regardless if the person was given a residence permit based on refugee status, subsidiary protection or labor market reasons. with increased legal restrictions, sweden downsized its reception of asylum seekers to a minimum standard compared to european union standards (regeringens skrivelse, 2016). due to changes in the law and agreements made between turkey and the eu, the influx of asylum seekers has decreased in recent years. in 2016, sweden received less than 29,000 applicants. asylum seekers in the last few years have come from syria, afghanistan, iraq, somalia, iran and eritrea or were stateless. war and conflicts are the main reason for leaving these countries of origin. in 2016, 111,979 persons received a decision and 69,682 received a residence permit (77%), but only 17,000 were recognized as refugees. the rest were regarded eligible for subsidiary protection (migrationsverket, 2017). results overlooked existential needs the first central theme identified during the coding process of the interview data was that refugees’ and migrants’ existential needs were partly overlooked during their reception. we have structured the findings around this theme following three different perspectives discussed in the reference group meetings: the existential vulnerability and uncertainty of asylum seekers, the lack of meaningful everyday activities, and existential life beliefs. one case worker at the migration agency told a story about her personal experiences of working in an asylum unit, where she encountered asylum seekers who felt frustrated about their situation and the long waiting time of more than one year for asylum applications. she described the atmosphere in the waiting hall of the asylum unit as characterized by despair and agony. the case worker’s story was followed by a discussion about the poor situation of asylum seekers waiting for a decision. the process takes time and it is well-documented in research that such a waiting period can completely break down applicants’ self-confidence and hope (brekke, 2004; valenta & berg, 2010). the main problem is of course the time; it takes too long to receive a decision. but another problem is that the asylum seekers often become extremely passivized. language training, workforce trainee programs, and other kinds of activities are not always offered or permitted before applicants have received a decision. actually, the right to education for children is the only welfare service that is offered that constitutes a “normal” everyday life situation for those awaiting a decision (svensson, 2013). for adults there is no similar occupation offered although these circumstances have gradually changed since we did the reference-group interviews with professionals and volunteers in autumn 2016. from january 2017, the county administrative boards in sweden are in charge of coordinating and funding early interventions for asylum seekers or persons with residence permits living in the migration agency’s accommodations and waiting to be allocated a municipality placement. these early interventions aims to hasten the resettlement process and help to make the waiting time, when the asylum application is being processed, more meaningful. supported by funding from the county administrative boards, civil society organizations then in practice often provide swedish language training, social gustafsson & johansson/a worthy reception? 991 information and social activities for asylum seekers in the local association sphere (länsstyrelsen, 2017). each person in the reference groups was asked about their contribution to the existential and normal everyday life of asylum seekers. the answers differed, of course, but a main difference was between actors working for public authorities and actors working for civil society organizations. actors working for public authorities, such as social services, schools and the migration agency, had a mandate to receive asylum seekers and to give opportunities for a normal life by offering housing, basic economic assistance, and help with the procedures of the formalities of the asylum process (lma card, address, filling in formulations, etc.). they stated that they did not really have a mandate to intervene in the existential quality of the refugees’ lives. one social worker simply stated: we should offer basic support according to legislation, but nothing more. social life, integration and existential issues are things that the asylum seekers have to take care of themselves. we cannot do that. still, despite this narrow view of social work, the same person was very critical of the passivizing situation most asylum seekers ended up in. he discussed how it takes too long to get the decision about acceptance or rejection regarding the asylum application, and during that time many asylum seekers are broken down. i wonder, he said, “what would happen if we said: here is your permit, now you have three months to establish yourself. people would manage, i am sure of it. instead they have to wait, and wait and wait.” professionals or volunteers working for civil society organizations answered differently. they saw it as their task to fulfill existential needs and create possibilities for normal social life. they also expressed criticism in line with the social worker above. their main challenge was that they worked on a volunteer basis, had few resources and experienced difficulties in gaining access to the asylum seekers. one woman working locally for the red cross noted that it takes time to meet, talk and listen to people’s existential problems, which is a demanding but extremely important task. furthermore, she criticized the lack of information and communication from public authorities regarding the use of civil society organizations as a resource for meeting people’s need for meaningful activities. according to a priest from the swedish church, religious organizations naturally feel a responsibility to deal with people’s existential needs. she expressed her view that is was healing to let people talk about their problems in front of a non-authority person, who does not share the same troublesome experiences, but who provides a sounding board for people’s mental stress and worries. her experience was also that the preconditions for taking care of people’s existential needs at the migration agency’s accommodations for asylum seekers were inadequate. the focus at these accommodations was instead, providing food and shelter. in relation to the question put to participants in the reference groups about who is responsible for refugees’ and migrants’ existential needs, we have noticed a negotiation among the group participants as to whether this is actually an issue of significance. actors in the reference groups working for public authorities such as the migration agency, the public employment agency, the police and social services said that these existential needs were not their professional responsibility. they took the stance that the individual refugee or migrant is more or less responsible for taking care of themselves in fulfilling these needs. one social worker’s narrative quoted above, that advances in social work, spring 2018, 18(3) 992 social services should offer basic support according to legislation, nothing more, is one illustration of these standpoints. the caseworker from the migration agency argued in the same direction, “the individual has to search for different activities by himor herself. to show curiosity and a will to do something with his/her life.” the same social worker quoted above declared, “we ought to put the largest responsibility where it belongs, on the individual, instead of giving state and municipal officials too much responsibility.” most public actors felt that it was first and foremost the individual’s responsibility to tackle any existential problems. they expressed a common feeling that public officials should treat all clients politely, objectively, and with the same kind of treatment and respect. however, in different ways they all expressed a lack of professional responsibility to involve themselves in people’s existential worries or anxiety. accordingly, these public officials claimed that their ability to involve themselves was restricted by the law (i. e., the migration law, the social services act, the regulation on labor market policy, etc.). the responsibility for engaging existential needs and problems was left to the individual refugee or migrant. in contrast, the teachers working with introducing refugees and migrants into society as well as employees from civil society organizations such as the swedish church, the red cross and fryshuset (the freezer house) expressed a willingness to develop the existential support available to refugees and migrants. one male teacher working with social information courses at a local training center argued that by really seeing and listening to a person’s life story, one becomes better prepared to understand and handle that person’s feelings of misery and frustration. a red cross employee said that she meets people on a daily basis who are frustrated over their situation as asylum seekers, i.e., the new migration law preventing family reunion, the long waiting time, and being forced to live in uncertainty about whether they can stay in sweden or will be deported. “we try to fulfill their existential needs, give support and we also work with different activities.” one improvement of the reception which she desired was to introduce official information about the procedures in the asylum process and about residence permits as soon as people arrive in sweden as asylum seekers. such improvements could ease some of the stress and uncertainty of asylum seekers. she was critical of the fact that most official information is provided only after people have been given a residence permit and municipality placement. in contrast to public actors, actors working for civil society organizations expressed a stronger willingness to engage themselves in people’s existential needs and everyday social activities. ironically, however, despite their willingness, their efforts are sometimes hampered by their organization’s limited economic and staff resources or limited access to the target groups for which their social activities are intended. the limited access was the result of public regulations or weak multisectoral cooperation. negotiated stereotypes on gender a second theme that became apparent in the analysis of the data was gender. in all groups and at every meeting the issue of “refugee and migrant women” was discussed. it is important to note that the notion of “refugee and migrant women” tend to be stereotyped and oversimplified in public debate and policymaking instead of recognizing the need for understanding migration as a gendered process involving different conditions for men and women in relation to other aspects, for instance gustafsson & johansson/a worthy reception? 993 education, class, and so on (akman, 2014). in order to analyze how the perceived problem of “refugee and migrant women” was negotiated, we will proceed from a discussion in one of the reference groups where the challenges of women came up when the theme of integration was discussed. a private entrepreneur running a refugee accommodation said that she had noted that the refugee women living at her place always stayed in their rooms. they did not take part in activities at the center and did not even go out to buy groceries. she declared that females in their culture (vaguely defined as arabic) stick to themselves and their goal is to become housewives. several of them have a high level of education, she stated, but still education is only a hobby, not a means to become a professional but a rather talented housewife who is financially supported by her husband. the entrepreneur emphasized her experiences of cultural differences by adding a story about how men with migrant backgrounds “imported” a wife from their home country rather than marrying a swede. she had witnessed this practice on several occasions and was disappointed about it. in her opinion these “marriage arrangements” were a loss for swedish society; e.g., she could not imagine a better way to integrate than through mixed marriages. she added, “it is also a loss for these women, who often get extremely alienated when they arrive in sweden.” the private entrepreneur touched upon two well-established ideas in many european countries about the “flaws” of arranged marriages among migrants and the “strength” of integration through marriage between natives and migrants. these ideas have influenced laws and regulations concerning international marriages in several european countries. the most prominent example is probably the danish legislation from 2002 on family reunification. the legislation was introduced to stop arranged international marriages, primarily among pakistani migrants in denmark, but in fact had a greater effect on stopping native danes’ international marriages (rytter, 2013). one of the other participants, an activist who arranged meetings for women with migration experiences, added to the discussion of the private entrepreneur with further common (although equally simplified) ideas about “refugee and migrant women.” she stated that the combination of culture, patriarchal structures, and the swedish reception of refugees and migrants was devastating for women. “many women who have lived in sweden for a long time are depressed, isolated and need medical treatment.” she thought that the reception of migrants and refugees in sweden took away all sense of self-responsibility and made people passive. she added, “if it is a recognized problem that asylum seekers [as a total] get passive and depressed, the situation is even worse among women.” a third person then entered the conversation and declared that he found the previous statements about refugee and migrant women too generalized and stereotyped. the private entrepreneur immediately defended herself and received support from a representative of the red cross who said, “it is not so dramatic to talk about these things; we had the same situation in sweden 100 years ago.” the other participants in the reference group then declared their ambivalence towards the description of the situation of migrant women on one hand and towards the stereotyped image of “refugee and migrant women” on the other hand. they agreed that it is dangerous to be too stereotyped and general in their descriptions. at the same time, they concluded that they should not overdramatize this problem since they all recognized the description of the situation of refugee and migrant women as accurate and problematic. advances in social work, spring 2018, 18(3) 994 in this reference group, as well as in the other groups, the perceived problem of “refugee and migrant women” was discussed from different perspectives. firstly, the participants discussed gender in terms of culture. several participants, as in the example above with the private entrepreneur, described the cultural differences they experienced in encounters with refugee and migrant men and women. an interesting finding, though, is that narratives about gender issues were almost the only topic that also led to cultural explanations for refugee and migrant behavior. the example above shows how the participants in the reference groups negotiated how to formulate the perceived problem of “refugee and migrant women” without being prejudiced. some of them preferred to explain perceived differences in terms of culture. others were more sensitive about the idea of culture. they balanced the conversations by interrupting those whom they found too stereotyped in their descriptions. in this way, several of the participants showed an awareness of the difficulties that are related to the concept of culture, for example the risk of culturalization, othering and essentialism (eliassi, 2015; gustafsson, 2015). in this sense they struggled with the dilemma of how to address perceived differences between themselves and the refugees and migrants that they meet in the reception. another example came up in relation to the courses on social information about swedish society. these courses are offered to asylum seekers with a residence permit in sweden and consist of at least 60 hours of information and education about swedish society. the teacher of these courses, supported by a social worker working with families and children at a place called “landningsbanan” (“the landing strip”), discussed the need to recognize differences in culture and fundamental values. the oppression of women or the value of equality between men and women were topics that were raised in the information courses. both the teacher and the social worker in the group concluded that there is a huge need among refugees and migrants (course participants) to understand and reflect upon these topics, especially in their mother tongue. in that sense, they supported a genderand diversity-sensitive approach in the reception of refugees and migrants. at the same time, their hope to understand cultural differences also reflected a more normative perspective. the aim of the information presented in the courses was to change the ideas among the refugees and migrants rather than creating dialogue and mutual understanding between different values. this kind of normative perspective surfaced at almost all the meetings and in all of the reference groups. the perceived problem of women being too passive was mainly framed as a consequence of an oppressive (male) culture and the solution was that those women should be “forced” to take responsibility for their integration through education and finding a job. one of the social workers stated that the refugees and migrants must get to know that in sweden “you have to work. both partners in the family have to work in order to manage and support the family.” hence the demand to join labor market activities was also discussed in terms of gender equality. in addition to this normative perspective on gender equality and the passion for work activation, the perceived problem of women and their situation was also discussed from a more existential perspective. in the reference-group discussion summarized above, the activist described how the existential situation is difficult for all refugees and migrants, but was worse for women than for men. she then touched upon the problem that in the daily debate in the media, politicians, professionals, and others tend to talk about asylum seekers as one homogeneous category without recognizing gender and diversity. the solution to this existentially poor situation and environment from gustafsson & johansson/a worthy reception? 995 the perspective of the activist was the same as the one formulated above: to take part in education and work would lead to independence, self-responsibility and gender equality. but in order to do that, gender differences would have to be recognized in the reception structure. this led to another aspect of the way the idea of a genderand diversity-sensitive reception was discussed. again, the teacher of the social information courses provided an example. he told the other participants about how he came to sweden from syria four years ago and received a residence permit within a few months. he began his university studies and has since finished a master’s degree. at the time of the meeting, he was a full-time employee at the training center and he declared that: i see myself in the line. i am not the one sitting behind the desk. i understand when someone comes forward and is angry, frustrated, and yells at me. when i came to sweden, i knew english, so i could manage quite well. but imagine a 55-year-old somali woman who only speaks (but does not read) somali. it is not easy to learn swedish and to understand a new language. people must have more patience. […] i was privileged and came from a well-educated family. and no, a 55-year-old somali woman cannot manage as well as i could. the problem is that the system does not understand this. the system treats everybody the same and with the same expectations. in his narrative, reception work does not meet the needs of individuals and he reiterated the earlier idea that reception measures proceed from the needs of the host society, rather than the perspective of the migrant, leaving the latter in an ambivalent position of being both empowered and powerless (andersson, 2014; gibney, 2015; gustafsson et al., 2012; larsen, 2011). the teacher also presented another perspective on the perceived problem of “migrant women.” his suggestion was that instead of viewing the 55-year-old somali woman (or any migrant woman) as a problem, swedish authorities must investigate problems inherent in their own systems and practices. he then argued in line with the aforementioned critique of minority model thinking as presented in research literature. we identified a consensus in the reference groups’ discussions concerning views about the problem of “refugee and migrant women.” the main perceived problem was that they lived in culturally different contexts that expected them to stay at home and not pursue education or work. this, in turn, undermined the virtue of gender equality that was embraced among the participants, and was considered as a non-negotiable value in swedish society and by swedish authorities. this theme of negotiated stereotypes on gender is reflected in previous research and government inquiries where swedish welfare benefits, such as paid parental leave, seem to cement migrant women’s marginalization (länsstyrelsen, 2017; sou 2006:37; sou 2012:9). larsen explored how the scandinavian welfare state intervenes in family lives in order to create “good citizens,” sharing “danish” values of gender equality and emancipation (larsen, 2011). however, the strong focus on labor market activation and education in integration policies ignores the experiences of the women themselves as mothers and family members. in contrast to these officially-sanctioned values of gender equality and labor market activation policies, a more critical discussion came up in the reference groups as they talked about the need to recognize cultural differences. thus, according to the participants in the reference groups, reception in contemporary sweden is not gender advances in social work, spring 2018, 18(3) 996 and diversity-sensitive. the current reception approach is not able to solve differences between men and women, nor between individual circumstances. participants expressed a willingness to do more in this area. on the one hand, those active in reception work desire to uphold the normative idea of gender equality, promote labor market activation, and change the way they perceive that many refugee and migrant women live their lives. on the other hand, there is a willingness to be more openminded, to find ways to talk about cultural differences in various languages, and to find ways to meet the individual needs of particular women or men instead of offering standardized support that is more in line with the officially proclaimed needs of society. ambivalences towards various refugee groups the third theme encompasses the dilemma of receiving different categories of refugees and migrants and the present changes in the migration policies in sweden. we will start out with a narrative which frames both of these dilemmas and how they intersect. at the first meeting, a police officer in one of the reference groups described his experiences of receiving refugees in a huge parking lot outside a shopping mall situated close to the danish/swedish border in november 2015. there were hundreds of people waiting from all over the world. buses came to pick them up and take them to municipalities all around sweden that had prepared housing for them. before they entered the buses, the caseworkers from the migration agency registered their names and nationality. our job as police officers was to check that no person entered a bus without being registered. the first evening, the lights went out when the shopping mall closed. it was completely dark and i noted that many people never came forward and registered. we had absolutely no idea of who they were or where they went. it was completely out of control and people were desperate. […] i think we have to pay a high price for this today, both in relation to those who we received and are now waiting for residence permit, and those who were never registered at all. from my perspective, of course, sweden should receive refugees, those who come from war zones in syria. but we also received all other kinds of migrants and travelers, and many of them entered sweden without permission and were never registered. in this narrative, the police officer frames the complex of different laws and values, and how human rights are challenged by the need for national security (gibney, 2004). this negotiation has an effect on his everyday professional work, perhaps even more than the other participants in the reference groups, since his function as a police officer is to uphold the law, maintain order, and assure the security of the nation and its citizens. his views on whether sweden should receive all kinds of people, categorized as “refugees from war zones” in contrast to “all kinds of other migrants and travelers,” could be interpreted as representing a welfare-nationalistic position. this position stresses the importance of regulating the influx of refugees and migrants due to a fear of losing control of the national welfare state’s resources, capabilities and its task to secure the order and well-being of its citizens (gibney, 2004; johansson, 2005; johansson, 2008). the narrative also opens up for negotiation over who is a worthy receiver. the police officer suggests that not everybody who arrived at the parking lot was worthy of reception in sweden. his suggestions frame a current feature in studies about refugees gustafsson & johansson/a worthy reception? 997 and migrants, namely, the dilemma of who is a true refugee and who is not. gibney (2004) describes how the un refugee convention, in combination with the national migration law, regulates the categorization of migrants and divides them into three main categories: asylum seekers, economic migrants, and family migrants. all three categories have different legally legitimate claims for entry into sweden based on the reason for the migration. a legitimate claim for a refugee and an asylum seeker would be, “grant me asylum for, if you do not, i will be persecuted or face life-threatening danger” while an economic migrant would claim “take me, or i and my family shall be condemned to a life of great poverty” (gibney, 2004, pp. 9-12). in his analysis, gibney (2004) denies that states have a responsibility for economic migrants. the sociologist sassen (2016), in contrast, concludes that most refugees of today have “economic claims” and she describes how they are victims of a complex mix of conditions, wars, dead land and expulsions. her main point is that liberal democracies all over the world have to recognize these refugees and include their claims for asylum among other legitimate claims (sassen, 2016). when it comes to family migrants, gibney refers to a double claim. on one hand, the claim is universal, “take me in because families should be together” and on the other hand particular, “you owe it to me as a citizen to allow my cousin, daughter or spouse to enter” (gibney, 2004, p. 14). the legitimacy of the claims for asylum is not only crucial for receiving a positive decision about asylum, but also for subsequent reception measures, residency status, and the possibilities for a future residence permit, citizenship, and family reunification (hedlund, 2016). the ambivalence among the professionals and volunteers in the reference groups about the assessment of who is a true refugee and who is not led to negotiations about the swedish society’s ability and willingness to receive refugees and migrants and to provide a worthy reception. the changes in swedish migration policies were also discussed and negotiated. for example, the social worker at the landing strip stated, “we have a fantastic and generous reception, but we cannot receive everybody.” in contrast, a teacher at the social information courses declared: to me, the restrictive legislation breaks my heart. i’d rather have a crisis situation and work hard under stress and receive everybody than close the borders and have this restrictive legislation. the social worker defended the changes in the migration policies while the teacher was critical. in another reference group, the participants shared their perspective on how the changes in legislation in 2016 had a direct impact on their work. an employee at the red cross described how friends had quit their jobs at the migration agency. they could not stand the changes in the legislation with temporary permits. they felt that human rights were set aside in favor of the security of the nation in a way that did not fit with their values and ethics. she also noticed that there was much less interest among people in general in offering their support or working as volunteers than a year ago. a public service officer at the public employment agency explained: the changes in the law in 2016 have led to changes in the openness among people and those who work with reception. in 2015 the politicians said that “we should open our hearts” and “wir schaffen das” about the refugees crisis. in 2016 they said the opposite, and the crisis became the crisis of swedish [and european] welfare institutions and welfare officers instead of a crisis for refugees and migrants. the government wanted to send a signal advances in social work, spring 2018, 18(3) 998 internationally and to countries that produce refugees and migrants, telling them that they are not welcome to sweden. instead, they have sent an internal signal to the nation of sweden. i believe that the changes in legislation have had more impact on our willingness to receive refugees and migrants than on the willingness of refugees and migrants to come to sweden. now, we are used to not wanting to receive refugees and migrants. he gives an example from his own work. he is supposed to create a resettlement plan for those who have received a permit to stay. but since it is a temporary residence permit it is almost impossible to create such a plan. at the same time, to find a job and prove that you can support yourself is vital to obtaining a permanent permit. the participants in the reference groups working for the swedish church and the red cross explained that they met more and more desperate former and denied asylum seekers who did not know how to survive. the priest from the swedish church explained that they took care of and supported these people, or if we use the vocabulary above, these “false” refugees. she did not want to provide details about this support in the reference group since representatives from both the migration agency and social services were present. a problem she had encountered and wanted to discuss, though, was that various groups were placed in opposition to each other. she and her colleagues as well as the volunteers from the red cross had received much criticism from the surrounding society because of their support for denied asylum seekers. in the critique, various vulnerable groups were juxtaposed. a common idea was, for example, that homeless people and people suffering from mental illness were suffering more now when asylum seekers took most or all of the available resources. the priest concluded that the juxtaposition of disadvantaged groups exposed them to hate and feelings of xenophobia or racism that were difficult to handle. one of the social workers added that he had met the same kind of argumentation among his colleagues at the social services. they had their own idea of a hierarchy of who was the most vulnerable and who was most in need. he argued that in this evaluation, it was too easy to rely on the idea discussed above, about “true” and “false” refugees and migrants. in short, volunteers and professionals could justify a less ambitious treatment of some groups with the argument that many among the group of refugees and migrants were not worthy of support and social services since they were not “true” refugees. in this way, the insiders and the outsiders of a worthy reception were defined, negotiated and discussed in the different reference groups. conclusions initially, we framed the reference groups as cultural encounters between representatives of different knowledge-producing groups working under different jurisdictions and conditions. in addition, by referring to the concept of concurrences, our ambition was to emphasize different voices and claims and how they were performed or narrated in relation to and in negotiation with each other. negotiation became possible within the framework of the research design during the reference group meetings. the design with mixed reference groups made it possible to frame the reception of refugees and migrants as a joint responsibility with shared problems and challenges. this kind of conversation and exchange of experiences is not taking place in the receiving actors’ everyday work within the reception structure. as outlined above, the gustafsson & johansson/a worthy reception? 999 swedish reception of refugees and migrants is not a “system” governed by one general law or regulation, but a complex “reception structure” consisting of different sectors and agencies that act independently of each other and rarely collaborate. they all have an impact on the refugees’ and migrants’ lives, but how they operate and intersect, as well as the joint outcome of their work, is difficult to understand if their agency and professional practices are not analyzed together (andersson, 2014; gustafsson, 2015; zetterqvist nelson & hagström, 2016). the refugee situation in 2015 temporarily changed the “structure” of reception and for a few months during the autumn, collaboration became necessary in order to solve the emergent situation. the receiving actors participating in our reference group meetings told of their personal experiences from both the fall of 2015 and the impact of the subsequent restrictive policy changes in 2016. different events and procedures were highlighted as examples of how the challenging situation in the fall of 2015 required multisectoral cooperation and new, flexible solutions. one female social worker said with reference to a representative from the red cross: “you did a fantastic job. but even different municipal administrations did a fantastic job. everyone took part and adjusted. everyone came together.” one benefit of this research approach is that we can reach a comprehensive narrative of the reception of refugees and migrants in contemporary sweden, but also highlight issues and challenges that the representatives of different knowledgeproducing groups have in common – problems that could be better addressed through cooperation. this does not mean that different actors have the same relation to or solution to these issues. we have, for example, analyzed the difference between the ability and willingness to deal with existential needs, gender and diversity and ambivalences towards what are perceived as “true” and “false” refugees and towards changes in migration policy. the most obvious, but perhaps unsurprising, differences could be seen between those who work for public authorities and those who work for civil society organizations. the former are limited by the ability of their authorities which are regulated and financed in relation to specific mandates and assignments. the latter can work more in accordance with willingness but are limited by their ability in terms of time and resources. in relation to the first theme, we found that no matter which organization they belonged to, reference group participants agreed on the problem of overlooking refugees’ and migrants’ existential needs. those working for public authorities believed that it was not their problem to deal with. they claimed that it was foremost an individual responsibility for the refugee or migrant. those working for civil society organizations were prepared to take on larger responsibility and to act as sounding boards for fellow humans. while the analysis showed that the actors taking part in the reception structure became aware of overlooked existential needs, who is best equipped to address the unmet needs has not yet been resolved. reception work actors are confronted with the risk that if overlooked needs are not dealt with anywhere in the reception structure, it could lead to severe consequences for the physical and mental health of refugees and migrants, which also has consequences for their long-term resettlement in the new country (valenta & berg, 2010). for these reasons, the responsibility for taking care of existential needs must be communicated and undertaken by the receiving actors in a collaborative dialogue with each other and with refugee and migrant groups and individuals that require some kind of existential support (beresford & croft, 2004). advances in social work, spring 2018, 18(3) 1000 when it came to the second theme, negotiated stereotypes on gender, we saw in the analysis that all participants agreed upon the need for recognizing gender differences and especially the situation for women who migrate. there were, however, differences in how the “problem” was perceived and formulated. those working for public authorities focused on the normative perspective of promoting gender equality through education and working activation for women. those working in civil society organizations and in close relation to refugees and migrants through their position as grass-root social workers and teachers had a larger engagement in finding ways to promote mutual understanding of cultural differences. they also recognized the need for a genderand diversity-sensitive reception. one lesson that can be learned is how the reference groups negotiate and formulate the problem of gender and diversity and how to avoid using a stereotypical and othering discourse. in the third theme about ambivalences towards who are perceived as “worthy”, “true” and “false” refugees, the main difference was that civil society organizations helped everyone who came to them regardless of legal status, while public authorities were only allowed to support those who were still asylum seekers or had received a permit to stay. this third theme highlights the impact of legislation and the conditions for those who work and are involved in the reception structure. migration policy limits a country’s ability to receive refugees and migrants, but also affects the willingness among those actors who receive. in times of shifting migration policies, the issue of who is a worthy receiver is negotiated. hence, an ethical dilemma that affects the everyday work of social workers and other welfare state professional groups was raised and contested in the reference groups. as stated by one participant, the legal changes in sweden in 2016 towards a european minimum standard sent signals to refugees and migrants not to come to sweden. he suggested that they also sent internal signals to actors in the reception structure that they should not welcome refugees and migrants. his statement created a dialogue in the reference group about the direct impact of law and regulation on the participants’ daily work. the statement and the resulting dialogue demonstrates how the ability to receive refugees and migrants is intertwined or sometimes supported by the willingness of reception actors. this has an impact on how social work responds to the needs of refugees and migrants in different political climates. the division that emerged in the interviews, between who was defined as a “true” refugee and who was not, was shaped by the participants’ different knowledgeproducing groups and different levels of authority. the division was supported by contemporary restrictive legislation that gives more authority to border controls, security issues, and police forces than to human rights and social work values (jönsson & heggem kojan, 2017; lundqvist & mulinari, 2016). such a focus on social control also affects contemporary debates about migration in sweden and other european countries. an implication is that social workers need to be more actively involved in debates on migration so that the importance of responding to human suffering and inequality is not lost to the dominant perspective on control and security. this conclusion about the dominance of control and security over human rights and social work values can also be situated in the wider context of contemporary europe and sweden’s role in negotiating general standards for the asylum process and for receiving a “fair share” of refugees and migrants between countries in europe (gibney, 2015). the changes in swedish migration policy sent signals to other european countries that a minimum standard was enough instead of higher demands on a “worthy reception.” where 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[on the limits of the welfare and conditional citizenship]. stockholm: fritzes offentliga publikationer. sou 2012:9. förmån eller fälla: nyanländas uttag av föräldrapenning. [benefit or failure: newly arriver’s withdrawal of parental allowance]. stockholm: fritzes offentliga publikationer. sou 2017:12. att ta emot människor på flykt. sverige hösten 2015 [to receive people on flight. sweden autumn 2015]. stockholm: fritzes offentliga publikationer. soydan, h. (1995). försäkringskassan och invandrarna [the social insurance agency and immigrants]. malmö: bokbox förlag. svensson, m. (2013). betwixt and between: hope and the meaning of school for asylum-seeking children in sweden. nordic journal of migration research, 3(3), 162-170. doi: 27thttps://doi.org/10.2478/njmr-2013-000727t svensson, m. (2017). hoppet om en framtidsplats. asylsökande barn i den svenska skolan [hoping for a future home. asylum-seeking children attending swedish school, no. 402]. göteborg: gothenburg studies in educational sciences. turunen, j., & weinryb, n. (2017). volontärer i välfärdsstaten – socialt arbete med transitflyktingar som politisk handling [volunteers in the welfare state social work with trans-refugees as political action]. in s. linde & r. scaramuzzino (eds.), socialt arbete i civilsamhället – aktörer, former och funktioner [social work in civil society: actors, shapes and functions] (pp. 175-200). lund: studentlitteratur. valenta, m., & berg, b. (2010). user involvement and empowerment among asylum seekers in norwegian reception centres. european journal of social work, 13(4), 483-501. doi: 27thttps://doi.org/10.1080/1369145100360340627t zetterqvist nelson, k., & hagström, m. (2016). nyanlända barn och den svenska mottagningsstrukturen. röster om hösten 2015 och en kunskapsöversikt [new arrivals and swedish reception structure. voices on autumn 2015 and a research overview]. stockholm: forte (forskningsrådet för hälsa, arbetsliv och välfärd). author note: 27tkristina gustafsson, phd, department of social work, linnaeus university, 351 95 växjö, sweden. kristina.gustafsson@lnu.se. jesper johansson phd, department of social work, linnaeus university 351 95 växjö. sweden. jesper.johansson@lnu.se https://doi.org/10.2478/njmr-2013-0007 https://doi.org/10.1080/13691451003603406 mailto:kristina.gustafsson@lnu.se mailto:jesper.johansson@lnu.se a worthy reception? ambivalences in social work with refugees and migrants in sweden abstract: the purpose of this article is to analyze how reception practices and the meaning of a “worthy” reception of refugees and migrants are negotiated in encounters between various receiving actors in times of shifting swedish migration policies.... keywords: migrants; refugees; reception; social work negotiated stereotypes on gender ambivalences towards various refugee groups conclusions references migrationsverket. (2017). översikter och statistik från tidigare år [overview and time series]. retrieved from https://www.migrationsverket.se/om-migrationsverket/statistik/oversikter-och-statistik-fran-tidigare-ar.html ____________ katie richards-schuster, phd, associate professor and director of undergraduate minor programs, ruffolo, phd, rosemary sarri collegiate professor and associate dean for educational programs, change kwesele, phd student, and charity hoffman, phd, university of michigan school of social work, ann arbor, mi 48109. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 430-445, doi: 10.18060/22440 this work is licensed under a creative commons attribution 4.0 international license. the global reach of social work: exploring motivations and participation in a social work mooc katie richards-schuster mary ruffolo change kwesele charity hoffman abstract: technological innovations in social work education support efforts to expand the global reach of social work education. massive open online courses (moocs) represent one type of innovation; however, little is known about their potential for promoting global social work. in 2015, our school of social work developed the first known social work mooc using the edx platform. in this paper, we explore the initial voluntary survey data from registrants (n=992) to determine participation patterns and motivations. our data indicates that the mooc engaged participants from over 180 countries, with over one-third (35%) from the united states. over 40% of participants rated themselves as novices with social work content. thematic analysis of open-ended responses suggests that many participants were working in organizations or ngos and wanted information about how to be more effective as a worker in these settings. their participation in the mooc allowed for exploration of a social work educational program. further analysis of demographic trends, motivations, and participation levels suggests that moocs can be a platform for extending the reach of social work education to global social work settings. more research is needed to fully explore the potential of this educational platform for expanding the reach of social work education globally. keywords: global social work; web-based learning; massive online open courses; social work education social work’s global reach is expanding. from 2000 to 2010 the number of degree programs in social work increased by 50%; hundreds more programs have taken root since 2010 (barretta-herman, leung, littlechild, parada, & wairire, 2016). globally, there is an untapped growth in social work education that could address the changing demands of contemporary societies including rapid economic shifts, urbanization, rising inequality, migration, and human trafficking, all impacting human rights. online coursework, continuing education, and distance education approaches within social work education are on the rise. a survey of 137 schools of social work in the united states showed that 72% of bsw and 56% of msw programs offered instruction via the internet, 9% and 32% offered television-based instruction, and 19% and 12% featured combined approaches (vernon, vakalahi, pierce, pittman-munke, & adkins, 2009). there is a need and desire for social work education to keep pace with trends in student learning. rapidly expanding technologies offer opportunities for social work education to expand innovative practice with digital tools that increase the reach of social work to audiences that have had limited exposure or are geographically distant from existing programs (coe regan & youn, 2008; wretman & macy, 2016). indeed, an increasing number of social https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) 431 work schools are offering online or hybrid programs and many now offer accredited fully online programs. according to the council on social work education’s (cswe) 2015 report on social work education, 60% of msw programs had some component of online or hybrid education. cswe (2019) lists 27 bsw and 79 msw part-time or fully online accredited programs. this paper examines the response to a massive online open course (moocs) within our school of social work. moocs are open learning educational courses. they contrast with the more traditional forms of online courses, such as distance learning or online education programs, in that they are generally free courses open and available to anyone with a connection to the internet. they do not require acceptance or application to enroll in the course. once learners enroll, they are often in control of the process given that most are offered as self-paced courses with no penalty for not finishing. the university of michigan school of social work is at a large public university in the midwestern united states. in 2016, we worked with our university’s academic innovation office to develop and launch a mooc on the edx platform. the mooc focused broadly on the field of social work through a u.s. perspective by exploring the foundations of the field, core frameworks, history and policy issues, and providing opportunities for critical reflection on social justice, power, and privilege within the context of social work practice. this was the first mooc specifically focused on the field of social work on the edx platform. the mooc was initially developed for the purpose of supporting our school’s incoming master’s-level students and offering a resource for workforce development within the u.s. social work field on an ongoing basis. however, because moocs are available globally through the web-based platform, we quickly learned that many learners from across the world were enrolled in the introductory social work course. since its launch in 2016, over 9,000 participants from across the world have enrolled in the course. this sparked our interest in understanding the potential of the mooc for social work and the implications for social work education in a global context. since this initial mooc, we have since launched five additional moocs. these moocs are: (a) social work practice with individuals, families, and small groups; (b) diversity and social justice in social work; (c) social work practice in community organization, management, and policy/evaluation; (d) social work research; and (e) social welfare policy and services. this paper focuses on our experience with the initial mooc. drawing from our learning about the broad range of students who enrolled in the initial mooc, we discuss the implications and the potential of moocs within the field of social work. while we are not advocating that moocs in any way replace standard accredited social work education, we do believe they can offer some opportunities to introduce social work to a broad audience, to share examples in a broader and more accessible way, and to support workforce development to further the field. background of moocs social work is positioned for innovation and engaging new technologies as a way to promote social work education and workforce development (gates & walters, 2015). richards-shuster et al./the global reach 432 many scholars argue that technology expansion aligns directly with the values of the social work profession, i.e. to promote social justice and empowerment (coe regan & youn, 2008; gates & walters, 2015; maidment, 2005; wretman & macy, 2016). for example, kurzman (2013) notes that “the online revolution offers intriguing opportunities for broadening and extending access to social work education” (p. 336). more recently, there is increasing interest among scholars, including those who are part of the american academy of social work and social welfare’s grand challenges, to understand methods to “harness technological advancements and leverage digital advances for social good” (berzin, singer, & chan, 2015, p. 3). this call for innovation and engagement presents a platform for exploring additional types of technological advances, such as moocs. moocs were first known to be offered in 2011 by stanford university (gates & walters, 2015; kurzman, 2013). since that time, educational platforms including coursera (2019) and edx (2019) have served as a home to hundreds of moocs on topics that range from business management to the history of art. indeed, many other fields of education, including schools of education, business, information, engineering, and systems management, have been leading proponents of the use of moocs due to their open platform and availability as a free resource to any interested learner with access to internet and technology (alexander, 2014; liyanagunawardena, adams, & williams, 2013; yuan & powell, 2013). despite the potential, most of the research around moocs has emerged in other fields such as education, business, and information, with generally less scholarship and understanding about these potentials within social work (richards-schuster, ruffolo & hiltz, 2019, gates & walters, 2015). most of the work to date has examined questions about audience, motivations, and outcomes. for example, studies suggest that moocs attract a diverse global audience from many countries, cultural backgrounds, and ages. in addition, the research suggests that the majority of these learners tend to be those with college degrees who are looking to gain additional educational and career benefits, such as mobility or workforce advancement (jung, 2016; stich & reeves, 2017; zhenghao et al., 2015). other studies have looked at learner motivation, finding that intrinsic motivation, a desire to solve problems, and self-determination were critical factors to completing moocs (barak, watted, & haick, 2016; hew & cheung, 2014). some scholars raise questions about the ability of moocs to retain learners, recognizing that overall completion rates for moocs hover at 10% of those who enroll (hone & said, 2016). in addition to retention, scholars have also been critical of moocs, in that they can heighten divides due to non-universal technology access, that most moocs have been created in english, making them difficult to access for non-english language learners, and that moocs may further push a western, neo-colonialist framework for understanding issues (altbach, 2014; finardi & tyler, 2015; gates & walters, 2015; literat, 2015). others question the rigor, quality, and legitimacy of moocs as platforms for education (daniel, 2012). ma and lee (2018) argue that despite the promise of promoting equity and access, developing countries face barriers due to lack of internet access, perception of their value, and the traditional expectation of education as being in the classroom rather than in an internet format. advances in social work, fall 2019, 19(2) 433 while these are all important critiques, there is also opportunity to see and explore the potential of moocs within social work. while there has been some interest in exploring the role of moocs within the field, there has been little research on the particular role of moocs within social work (barretta et al., 2016; berzin et al., 2015, gates & walters, 2015; hawkins, martin, mckay, & pattanayak, 2017). within the existing literature on moocs in social work, scholars have considered the potential of moocs or examined moocs within a larger understanding of the role of technology within social work education, such as distance learning or online courses. for example, gates and walters (2015) speak to the potential importance of moocs within social work, arguing that “each mooc has the potential for reaching hundreds of thousands of students globally. any person with an internet connection could access swe (social work education) via a mooc” (p. 189). gates and walters (2015) further suggest that moocs could play a significant role in supporting educational development in the expanding global social work field and contribute to promoting social work’s social justice mission. in particular, these scholars state that moocs could help promote baseline knowledge about the field, eliminate disparities around access to evidence-based approaches, and could “have significant impact for social justice workers in developing or underdeveloped economies” (gates & walters, 2015, p. 189). these possibilities warrant further investigation into the efficacy of moocs as a tool for promoting professional development, providing support in addressing issues of injustice and human rights, and promoting human well-being. more research, however, is needed to understand the value of moocs within social work, and in particular to understand the motivations and implications for students, from around the globe, to enroll in a us-based social work mooc. while these are important questions, for the purpose of this paper we focus on understanding who enrolls and their motivation for enrolling. thus, we used data from the school’s first mooc to explore two key questions: what are the demographic characteristics of those who enroll in a social work mooc and how do they participate? what motivations drive people to enroll? background of social work mooc our school of social work is part of a large public university located in the midwest and offers a master’s of social work (msw), and an advanced placement program for students with a bachelor’s of social work (bsw), with an annual enrollment of approximately 350–400 students. the msw program is full-time with no option for a parttime program. our school also has an undergraduate minor focused on social justice, and a phd program that is jointly offered with five social science doctoral programs. for many years, our school has offered multiple online continuing education programs and certificates, and some faculty engaged in hybrid or flipped classroom experiences. however, our school did not have an online program or mooc-like course prior to 2016. in 2016, we launched a mooc entitled “social work: advocating social justice and change.” the mooc engaged much of the school’s faculty and teams of students and alumni to develop a comprehensive course aimed at introducing participants to social work as a profession and exploring social work’s contributions to work with individuals, richards-shuster et al./the global reach 434 families, communities, and organizations, and in policy-making arenas within the united states. the mooc includes five modules as described in table 1. table 1. social work: advocating social justice and change mooc modules module description 1. introduction to social work explores the field of social work and the roles that social workers play in society. 2. major social work frameworks and concepts covers major frameworks and social work concepts that inform practice. 3. history of social work highlights the history of the field and the scope of policy issues within social work research and practice. 4. power, privilege, and diversity details the importance of power, privilege, diversity, and social justice for social work as a field. 5. msw education provides an overview of msw education, specifically in our school’s program, and key advice for incoming students. each module included a range of engaged learning techniques, including videos, timelines, discussions, expert lectures, and case studies. in total, the mooc included approximately eight hours of interactive content. the mooc was piloted to the incoming msw class in the summer of 2016. the pilot allowed us to evaluate the effectiveness of a mooc as a tool to prepare students for entering a graduate program in social work. after the beta-test and a few tweaks to the content, the mooc was launched publicly on the edx platform in fall 2016. anyone with access to a computer and the internet could enroll in the course at no cost. the mooc was launched as a self-paced course, meaning that anyone could enroll in the course at any point and that the course could be completed on user’s own timeline. those who completed the mooc were eligible to pay for a certificate of completion that could be used to verify their participation. the certificate, offered through edx, costs roughly $100. while we knew that there would be a captive audience amongst our students who would be strongly encouraged as part of their orientation to take the mooc prior to entering the program, we were unsure about the broader audience and why people would enroll in a social work mooc. this paper provides the initial evaluation of the first year’s enrollment in the mooc. methods the course evaluation was based on general enrollment data from the first year of the mooc, a voluntary participant survey at the start of the course, and tracking of engagement in modules completed by participants. this paper tracks participants who enrolled in the mooc from september 2016–september 2017. over this 13-month period, there were 9,120 participants. a total of 992 participants (11%) completed the voluntary participant survey at the start of the course. all 9,120 participants were tracked using engagement measures within the edx platform. demographic data was self-reported by participants (n=9,120) and included information on age, country/geographic location, gender, and educational background. the advances in social work, fall 2019, 19(2) 435 tracking of all participants involved using edx statistics to monitor how many modules were completed in the mooc, including the number of quizzes taken, responses to activities, number of activities completed, and number of videos watched. additional data is drawn from edx’s course participant survey. this survey is offered to participants at the beginning of each specific course. participation in the survey is voluntary and anonymous. the edx platform developed survey questions that captured information about participant motivations, including interest in taking the mooc, previous experiences with moocs, motivation for completing the mooc, and participant goals and expected outcomes. we used a two-stage approach to analyze the data for this paper. first, we explored the edx enrollment data, drawing largely on descriptive statistics to analyze participant enrollment characteristics and participation levels. second, we used thematic analysis to explore participant motivations as reported as part of the survey data and in the mooc activity responses. themes were also identified based on responses to open-ended questions in enrollment data using nvivo. team members reviewed the themes independently as well as in meetings. . disagreements were discussed until u a consensus was reached. because we approached the thematic review in this way, we did not calculate inter-rater reliability. there were some limitations. most importantly, we were limited by the data categories that edx collected. we were also limited by the survey questions provided by the edx platform and the voluntary nature of their survey. as a result, our analyses were limited to general themes and descriptive statistics. in addition, we provide quotes from the survey but the way the data was collected by edx it is impossible for us to link quotes to individual respondents. however, given the exploratory nature of this pilot study, we feel that the data is important to report despite these shortcomings. specific limitations are included as they relate to findings in the following section. results in this section, we first describe participant demographics of those enrolled in the course and the findings related to their participation in the course. secondly, we share the findings related to the interests and motivations of enrolled learners. the results draw on both descriptive and narrative data. participant demographics participants in this course represent a global community. drawing on the enrollment data, participants came from over 184 countries and regions. participants from the united states comprised 35% (n=3,286) of the learners. other than the united states, nations represented by more than 100 participants included canada, india, united kingdom, australia, germany, nigeria, brazil, china, turkey, pakistan, singapore, indonesia, and mexico. the following countries had between 50 and 100 participants: spain, colombia, france, south africa, south korea, philippines, greece, netherlands, hong kong, japan, vietnam, kenya, russia, egypt, peru, trinidad and tobago, and romania. richards-shuster et al./the global reach 436 of the 9,120 participants, the median age was 30 years. approximately 52% were between the ages of 26 and 40 years. the next-largest group of learners (29%) were under 25 years. over 48% of the participants had a college degree and 25% had advanced degrees. in terms of gender, 63% identified as female and 35% as male. the edx survey did not request information about race/ethnicity, nor did it provide more robust categories for gender identity beyond a binary male/female. on average, approximately 120 participants engaged with the mooc each week. for these participants, in a typical week, about 50 watched a video, 15 tried an activity or problem, and 20 participated in discussions. the mooc has five modules and between 79% and 88% of the videos in the modules were completed by participants. participant interests, motivations, and learning of those who took the voluntary survey (n=992), more than half of the participants (55%) had never taken a mooc before enrolling in this course. of those participants who had taken a mooc before, 70% had taken between one and three moocs prior to this course. when asked to rate their level of knowledge regarding the focus of the mooc prior to taking the course, 44% reported that they were new to the material (novices), 15% felt that they were proficient, and 30% indicated that they felt competent in this particular knowledge area. of the 992 survey respondents, 335 expected to earn a certificate, 397 planned to complete all the course requirements, and 149 expected to mainly peruse the course content. for first-time mooc participants, 35% thought that they would earn a certificate and 42% expected to complete all of the course requirements. over one-third of the participants who enrolled in the mooc thought that taking it would help them progress in school, another third reported that the content areas interested them, and another third viewed the information in this mooc as helping them in their job. while difficult to ascertain participant motivation, there were questions in both the enrollment data and the voluntary survey that spoke to participant interest in enrolling in the mooc and that requested their thoughts about its value. in the enrollment survey, participants were asked to share their main reason for enrolling in the mooc. although there was a range of responses, a few key themes emerged. one key theme was participants’ interest in furthering their knowledge or education. in some instances, there was a specific interest in social work, and in others, participants’ interest was in learning more generally. for example, participants who specifically articulated an interest in gaining knowledge of social work stated: to increase my knowledge in different fields and my critical thinking as a law student, also to take advantage of the interaction with other students and prestigious teachers around the world. i have chaired a human rights ngo for women and children in crisis using the universal human rights provision to defend them in their situation. yet, many things are unclear to me about the implementation of those rights by those who created them. it has become too many conventions without judicial remedy. so i advances in social work, fall 2019, 19(2) 437 would like to deepen my knowledge of human rights and in cases of noncompliance what remedies are available? what legal body provide the conventions a cause of action? it is my dream to fulfill my passion to educate children in the rural communities about the importance of health issues and more. others spoke of their love of learning and their interest in growing personally and professionally through lifelong learning opportunities: i love learning and miss the interactivity of an academic environment. i hope to keep my mind sharp. i'm an advocate for promoting greater (free) access to higher education and the wonderful possibilities of mooc. simply, i miss learning. my life has come to a place in which fresh ideas are absent. i want the new perspectives and better understanding afforded by education. some of the participants mentioned the convenience of learning or cost as a prime motivator for taking the course. for example, a few of these participants mentioned, “it is self-paced and convenient,” and “i can't attend or afford college anymore…but i want to keep learning.” an interesting, although not surprising finding, was that a portion of the participants joined to improve their english skills. for example, “i am in need to learn english as i am becoming aware of its importance in my country as well as in the region and all over the world. english is a very useful tool of communication that can serve everyone in his life.” for these students, it was unclear how much the content mattered to them. once participants began the mooc, when asked to introduce themselves and their reason for joining in a class chat board, about one-third indicated that they wanted to explore what social work is and how social work makes a difference in the world. they also frequently indicated that they were taking this course to explore starting a degree in social work. some shared that they are community activists and wanted to learn theories and skills about how to empower others. in their introduction of themselves almost all participants indicated a desire to further their understanding of social justice and advocacy. these responses echoed many of those given in the initial enrollment registration and focused on participants’ interest in gaining more knowledge about the field of social work, either as a way to further their existing knowledge or as a way to gain some basic understanding about the field of social work. for example, some illustrative quotes from participants about their reasons for taking the mooc included: i am looking to expand my knowledge of the social work field. i have been interested in learning more about the field of social work to see if it could be a good fit for me to pursue. i opted to take this course as i want to further my knowledge in the social justice field. i've worked in homeless shelters and food banks for several years. now hoping to gain more skills to advance my abilities in the field of social work. richards-shuster et al./the global reach 438 a few participants specifically discussed their participation in the mooc in relation to their interest in an msw degree: i'm here to gain knowledge as i believe it will benefit me when i hopefully get accepted into one of my five choices of university. i'm applying to social work masters programs, and i want to learn a little bit more about the field of social work before i apply. possibly the most meaningful narrative data about participant motivations and learning comes from some of the responses of mooc participants related to their understanding about the value of the mooc with respect to their own interests. in these cases, participants shared key takeaways for them as individuals and mainly reflect their interest in further developing skills and understanding about social work. for example, one participant stated: this mooc has provided a good reminder of the importance of approaching situations with humility and self-awareness, so as to try to avoid perpetuating forms of oppression unconsciously…i also think, along with the humility comes a calling to be curious. if i am going to gain an understanding of people whose lives are quite different from my own, i have to be curious to know more about their experiences and worldview…as a social worker i would hope to cultivate both deep and broad knowledge of possible interventions from which i and a client could draw together. others reflected on the social justice components of the mooc and the ways in which the mooc helped empower them to advocate for change in their own community. for example: to me, the social justice component is very important, and it ties in with the difference between providing (charity) and empowering (justice). because advocating for social justice is, at its heart, about empowering people who may not have a lot of power, it is more controversial than charity. dom helder camara, a brazilian archbishop, captured this dynamic when he said, “when i feed the hungry, they call me a saint. when i ask why people are hungry, they call me a communist.” still another noted: watching these videos is like looking at my values in a mirror. it is the direction i wish to go with what i currently do within the community. caring about others, supporting others, advocating for others. for others, the mooc provided an example of how to connect social workers and social change agents, who have limited access to social work-specific knowledge or content, and become empowered to work for social justice in their home community. these quotes illuminate the ability of social work moocs to have a broader reach beyond delivering specific educational content. for example, one participant noted: i come from a community that is marginalized, no electricity, no potable water (drink from stream), no access road, we have to walk for 5 km to access a health advances in social work, fall 2019, 19(2) 439 facility that has only a nurse assistance, and no primary nor secondary school. we have a population of about 4800 inhabitants there. with the knowledge i have gained from this course, i am better equipped now to go to the village and hold a rally to see how the village can come up with programs that will benefit them based on their resources. another specifically spoke to the importance of social work: homelessness had been alien to my country until the recent craze of rural folks to get into the urban centers. prior to urbanization, the extended family system practiced in most parts of the country ensured that each and every person was housed. urbanization has however drawn so many young people into the cities without a plan. building affordable housing…has been a goal for almost every government for the past 12 years however this goal has not been very easy to achieve. looking at all these issues and the role social workers play to get all these social problems solved, it brings me to the conclusion that social workers are becoming indispensable in our modern-day societies. still another: as a development practitioner in a developing country, the first grand challenge to look into the ways of reducing economic inequalities grabbed my attention and as a student of environment sciences who led its social interest by doing masters in environment and development,; i found that creating social response to a changing environment is what i am seeking to do in my development/ social work practice…one of the important take away messages for me is that policy level advocacy is a must in order to seek change or to improve any situation. an integrated policy framework is required in order to move things in a more impactful and sustainable manner. discussion the findings confirm what the emerging literature on moocs has indicated related to who takes moocs and their motivations for taking a mooc. other studies similarly reported that participants represented a global community, most had college degrees, and many viewed the mooc as a way to enhance work functioning (gates & walters, 2015; jung, 2016; stich & reeves, 2017). the broad, global reach of this mooc (over 184 countries/regions) reflected participants’ strong interest in learning more about social work and social justice. the motivations for taking this course (including personal growth, time constraints, financial constraints, and increasing knowledge) are also consistent with findings from other studies (barak et al., 2016; hew & cheung, 2014). the findings extend what we know about the interest that the global community has in learning more about social work even if from a united states perspective. from the themes that emerged, many of these participants shared that they were working in organizations or ngos and felt a need for more information about how to be more effective as a worker in these settings. the mooc also helped provide an introduction to graduate education in social work for participants who might apply at a later point to a social work program. richards-shuster et al./the global reach 440 the level of engagement in the mooc was impressive. the takeaway messages that participants shared about the learning with respect to social work key values and theories that occurred in the mooc illustrates the value of this type of platform for helping participants to apply their learning to real-world settings. it is critical to note that while moocs show promise as a tool for raising awareness about social work as a field, empowering individuals within communities, providing support for workforce development, and supporting educational practices, they cannot be viewed as a global graduate degree. at a minimum, educational practices must fit specific global needs, both from accreditation and competency perspectives, and as a practiceengaged field, it is essential to remember that mooc coursework can provide only a small fraction of what is needed for a master’s of social work degree. as a field we must examine new technologies and innovations for workforce development and education that enable schools of social work and global associations to work in innovative ways to promote a new vision for the field (gates & walters, 2015; hawkins et al., 2017; robbins, coe regan, williams, smyth, & bogo, 2016). implications and recommendations in this paper, we explored the initial evaluation of our social work mooc to understand who enrolled and their motivations for enrollment. based on the findings and discussion, there are several potential implications for consideration by the broader field of social work practitioners, researchers, and educators. first, the preliminary evaluation of our mooc suggests that there is global interest in social work. thus, more innovation should be occurring with the global online space to promote the value of social work as a tool for workforce development and for empowering individuals to address injustices and build the capacity for social work in various settings. while more research is needed, the findings suggest that moocs can help expand social work in multiple ways, including to those who do not have access to schools of social work in their own communities and to those who are unsure about whether social work is a field they want to pursue. second, we have learned from our own internal work and pilot that moocs can be helpful for providing baseline content knowledge about the field as a way to prepare incoming msw students for graduate study. in addition, in our own school we are exploring innovative ways to use moocs in a hybrid classroom experience as a way to accelerate coursework and allow for more discussion and experiential learning. we also know, because of the no-cost nature of moocs, that other universities, especially universities outside of the united states, are using aspects of this mooc to highlight social work within a united states context. especially because they are free and not tied to online distance learning credit programs, moocs offer opportunities to be innovative and creative in looking at cross-cultural exchanges of information and learning. moocs also can be a platform in which multiple universities can collaborate on versions of a course to be offered in multiple countries or with multiple perspectives (chingos, griffiths, mulhern, & spies, 2017). indeed, we are currently working on such a collaboration with schools of social work in norway, chile, and singapore to develop a course focused on global child advances in social work, fall 2019, 19(2) 441 welfare practices. this type of learning relates to what hawkins et al. (2017) described as the potential for global mooc communities. while innovative in nature, we recognize that this approach would need further exploration to examine any accreditation issues that would emerge. third, moocs should be explored further as a tool for workforce development. this new platform enables social work educators to expand their connection to various employment sectors, such as law enforcement or health care, for which there are social work implications but potentially fewer shared education programs. given the motivations expressed by the students who enrolled in this mooc, there is also interest by those in other countries who plan to get a social work credential but do not have access to formal social work education courses. fourth, moocs can be an opportunity to share the concept and practices of social work to a global audience. whether this audience seeks out social work courses or finds the course when exploring options, a mooc offers a no-cost opportunity to explore our field, values, and approaches. for our school, the initial evaluation suggests the global potential for moocs and opens up the possibilities for re-thinking our engagement outside of the classroom. based on this mooc, our school initiated a pilot of a micromasters program, a series of related moocs on social work foundational content (research, interpersonal practice, macro practice, social justice, and social welfare policy) that when taken along with a set of credentials and exams, could be used to help advance a student’s academic program or be leveraged as a workforce credential. this micromasters program launched in 2018 and over time it will undoubtedly raise future questions for research. in addition, we continue to evaluate the impact of the mooc on our own master’s students to explore the long-term impact of moocs on classroom learning. all of these potential implications, however, must be weighed against the potential ethical issues and the value of learners using moocs to engage in social work. for example, our mooc was about u.s. social work specifically, and did not engage with exploration of social work in other contexts. we must grapple with the balance between introducing and empowering learners to engage with social work and social justice concepts and the understanding about the ethical issues of new learners feeling as though they are able to practice social work in any practical way. furthermore, given that our mooc was specifically based in a u.s. context, there is also need to critique the limitations of a u.s. framework for global social work. our experience suggests that there is need for discussions about the ethical issues of moocs and the global development of moocs for the social work field. presentations such as those at the hustita (human service information technology association) strand of the joint world congress of social work and social development global conference offer opportunities to introduce ideas and critique content across schools of social work globally. more opportunity to weigh the promise alongside the ethical issues is needed as educational technology emerges. moocs in social work raise many questions for future research and discussion. for example, more information is needed on the impact of participation in moocs as well as the potential liabilities of engagement in moocs. future research should examine how open-platform programs impact an educator’s ability to properly follow-up or engage richards-shuster et al./the global reach 442 participants in ongoing education. an additional area of scholarship should attend to the ethical implications of learning social work in an online space, especially of learning social work from moocs produced in the us. scholars should explore the ethical issues in moocs, the underlying values in moocs, and if u.s.-produced moocs are sensitive to a global context. finally, social work research should examine if moocs expand access to social work education, and if so, for whom. a major limitation of this study is that, while we were only able to capture data on who enrolled and their motivations, we had much more limited information on who completed the mooc and what they gained from their engagement. additional research should explore the impact of participation on global learners: how does this shape their understanding and, potentially more interesting, how does a global perspective challenge u.s.-centric perspective (literat, 2015)? an additional limitation is that the survey did not capture certain demographic questions (e.g., race/ethnicity) that are important to understand. future research should ensure that these questions are added to understand the participant profile more thoroughly. as the potential for this type of educational technology emerges, there is a need to track and understand the impact of moocs on traditional forms of social work education. issues such as the impact of moocs on social work education, the value of mooc credentials in the workplace, and the true costs and benefits of moocs are all important topics that deserve attention as other schools of social work engage in moocs. in closing, moocs represent a new frontier for social work research, education, and practice and as such require schools to consider this innovation (robbins et al., 2016). there are many questions to be answered and much more research is needed on the role of moocs within social work. however, while there are many unknowns, we are excited about the promise and potential impact of moocs, as well as their global reach. as we as a field continue to explore the use of technology innovations, we have the potential to unlock and harness new ways to conceptualize social work and to provide opportunities for new forms of learning for enhancing the field. references alexander, p. c. 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(2015, september 10). who’s benefiting from moocs, and why? harvard business review. retrieved from https://hbr.org/2015/09/whos-benefiting-from-moocs-andwhy author note: address correspondence to: dr. katie richards-schuster, associate professor, university of michigan school of social work, 1080 s. university, ann arbor, mi 48109. e-mail: kers@umich.edu https://doi.org/10.1080/10437797.2016.1198293 https://doi.org/10.5175/jswe.2009.200700081 http://publications.cetis.org.uk/wp-content/uploads/2013/03/moocs-and-open-education.pdf http://publications.cetis.org.uk/wp-content/uploads/2013/03/moocs-and-open-education.pdf https://hbr.org/2015/09/whos-benefiting-from-moocs-and-why https://hbr.org/2015/09/whos-benefiting-from-moocs-and-why mailto:sinha.sunny@marywood.edu the global reach of social work: exploring motivations and participation in a social work mooc abstract: technological innovations in social work education support efforts to expand the global reach of social work education. massive open online courses (moocs) represent one type of innovation; however, little is known about their potential for ... background of social work mooc methods results in this section, we first describe participant demographics of those enrolled in the course and the findings related to their participation in the course. secondly, we share the findings related to the interests and motivations of enrolled learners. t... participant demographics discussion implications and recommendations references _________ samantha n. wolfe-taylor, msw, lcsw, cth, associate director of the office of e-social work education and practice and clinical assistant professor, khadija khaja, phd, associate professor, david wilkerson, phd, director of the office of e-social work education and practice and associate professor, and christian k. deck, msw, lcsw, cth, lecturer, indiana university school of social work, indianapolis, in. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 287-302, doi: 10.18060/24912 this work is licensed under a creative commons attribution 4.0 international license. the future of social work education: a guide to developing, implementing, and assessing e-simulations samantha n. wolfe-taylor khadija khaja david wilkerson christian k. deck abstract: advances in technology, an increase in non-traditional students, a new generation of e-learners, the covid-19 pandemic’s impact on education and practice, and the emergence of greater practitioner and client adoption of telebehavioral health present opportunities and challenges for curricular innovation in schools of social work. e-simulations are reliable, valid, authentic high impact practices that address these challenges and prepare students for a future where social workers are called upon to adopt telebehavioral practice. although there is literature on the development, implementation, and assessment of simulation-based learning in social work education, much of the literature explores the use of simulations in face-to-face social work education. provided is a guide for educators and administrators on developing, implementing, and assessing online simulations (e-simulations) in social work education. keywords: e-simulations, high impact practices, social work education, telebehavioral health training the american academy of social work and social welfare’s [aaswsw] (2015) grand challenge to harness technology for social good calls for social work educators to reexamine their role in technology-innovated education, tools, and practices (berzin et al., 2016). there are a variety of challenges and opportunities for innovation to the curricula of schools of social work. these include advances in technology, increasing numbers of non-traditional students, growth of a new generation of e-learners, pandemic impact on education and practice, and the emergence of greater practitioner and client adoption of telebehavioral health services. the audience for these challenges and opportunities in the united states is not limited to online undergraduate or graduate schools and programs, but all 539 baccalaureate programs and 303 master’s programs accredited by the council on social work education (cswe, 2021). the covid-19 pandemic and the acceleration of telebehavioral practice challenge schools of social work to reevaluate their curricula and make room for training in technology-mediated social work practice. the fact that over 60% of mental health practitioners are social workers (national association of social workers, n.d.) adds urgency to this challenge. although the number of covid cases are decreasing in the united states, schools of social work must support students facing an uncertain future where community lockdowns may once again disrupt traditional educational experiences and social services delivery. due to the covid-19 pandemic, an urgency has been placed on social work education to reimagine practice skills assessment (keeney et al., 2021). about:blank advances in social work, summer 2022, 22(2) 288 morley and clark (2020) identified that since the start of the covid-19 pandemic, substantial changes have been made to social work education as it relates to the acceptance of technology-based supervision and engagement with clients for students in the field, but literature is limited on the impact these changes have made to assessment of practice in social work education. additionally, “social work educators have for the most part been inactive in developing curricula that support student knowledge, training, and decisionmaking on the adoption of technology for practice” (wilkerson et al., 2020, p. 1), slow to embrace distance learning (smoyer et al., 2020), and late in the development of online high-impact practices (hip). smoyer and colleagues (2020) explored this further in their study on bsw students’ experiences in distance education during the covid-19 pandemic and found that when students were unexpectedly thrust into online learning platforms due to the covid-19 pandemic, most were able to learn online; however, substantive interactivity and synchronous engagement were factors that were necessary to maintain student overall satisfaction in the distance learning environment. additionally, they point out the “the need for interactive technology in online social work classrooms to simulate the human interaction that is essential to student learning and practice” (smoyer et al., 2020, p. 653). in the cswe’s (2015) educational policy and accreditation standards (epas), they identify assessment as being most fruitful when students engage in activities that reflect authentic practice skills and tasks that they will need or complete in practice in the field. to address the need for authenticity, social work educators have used role-playing: a single station where a student interviews a standardized client (often a classmate) while being observed, but for training purposes only. a multitude of informative and formative practice skills assessment tools and checklists have been used to assess social work students’ competency in practice (baez, 2005; bogo et al., 2014; crisps & lister, 2002; kealey, 2010). however, researchers have found these methods lack authenticity, for they do not provide students with opportunities to engage with clients in similar ways as they would upon entering the field to practice (baez, 2005; bogo et al., 2014). for social work educators teaching online, an additional concern is that they do not engage the learner in a way that allows for sufficient levels of interactivity with others. e-simulations can provide students with the opportunity to practice competency prior to entering practicum settings or the field. e-simulations are a high-impact innovation that address the challenges of enhancing online social work practice courses and prepare students for a future that includes telebehavioral practice. high-impact practices in education in 2008, george kuh identified high-impact practice (hip) as a purposefully developed, evidence-based educational activity that seeks to engage students, directly and indirectly, in the learning process, while using various measures to assess learning outcomes (buck, 2020). kuh identified 11 hips for education: • first-year experiences • common intellectual experiences wolfe-taylor et al./future of online swk 289 • learning communities • writing-intensive courses • collaborative assignments and projects • undergraduate research • diversity/global learning • eportfolios • service learning, community-based learning • internships • capstone courses and projects. the implementation of hips has been identified as a fundamental strategy to increase student engagement and academic success, create more authentic learning experiences, and improve campus culture (linder & mattison hayes, 2018). educators employ hips in the classroom with the goal of keeping students engaged in the course material and developing skills they can apply in other courses and beyond the classroom (kuh, 2008; linder & mattison hayes, 2018). however, most of the literature on implementing hips in education focuses on traditional, face-to-face education (linder & mattison hayes, 2018). in 2018, the first book was published on how to implement hips into online education. it provides educators with the foundational background on the use of hips in online education and a multitude of studies exploring the outcomes from implementing the 11 hips in different ways and areas of practice (linder & mattison hayes, 2018). hips in social work online education can further expand upon this literature and knowledge, but how do educators effectively do this in the online environment? online simulation-based learning is one way in which social work faculty can offer hip opportunities for face-to-face and online students to practice and demonstrate complex skills, all while creating space for implementing different types of scaffolding to facilitate effective learning (chernikova et al., 2020). e-simulations in social work education a primary goal of social work education programs is to ensure that their graduates can contribute to social work’s mission of enhancing human well-being (cswe, 2021). esimulations can provide students with the opportunity to practice competency prior to entering practicum settings or the field. e-simulations are an innovation that address the challenges of enhancing distance education’s social work practice courses and prepare students for a future that includes telebehavioral practice. “it is a technique (not a technology) to replace and amplify real experiences with guided ones, often ‘immersive’ in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion” (lateef, 2010, para. 1). simulations train students in a humanistic and competency-based method of practice that is reliable, valid, and authentically reflective of practice in the field (bogo et al., 2014). in addition, simulations offer opportunities for students to practice and demonstrate complex skills while creating space for implementing different types of scaffolding to facilitate effective learning (chernikova et al., 2020). in their study on student self-efficacy and practice readiness upon completion of simulationbased learning, carter et al. (2018) discovered that simulation-based learning helps improve key social work practice skills, increases students’ recognition of diversity in advances in social work, summer 2022, 22(2) 290 practice, and students reported an increase in interviewing, managing emotions, and engaging in culturally competent practice skills. e-simulations can come in the form of asynchronous case scenario, practice decision making trees, and synchronous online interview sessions with a mock client/patient simulating real-life (bogo et al., 2012, 2014; chiniara & riviere, 2019). e-simulations can also come in the forms of gamification, augmented reality (ar), e-objective structured clinical examination (e-osce), virtual reality (vr), etcetera (bogo et al., 2012, 2014; chiniara & riviere, 2019). social work educators have only just begun scratching the surface of using online simulations to create hip opportunities in an online educational environment. since the start of the covid-19 pandemic, publications on simulations and simulation-based learning have increased significantly in the fields of social work and distance education, but the literature lacks guidance and research on the development of online simulations in social work education practice courses. huttar and brintzenhofeszoc (2020) recently conducted a systematic review of the literature and only found seven scholarly pieces that met their criteria for virtual reality and computer simulations in social work education. to address the gap in knowledge about the application of e-simulations as hip for training students in technology-mediated practice, the following is a guide for social work administrators and faculty with the tools and considerations for developing, implementing, and assessing e-simulations in practice skills training of social work students. developing e-simulations the planning and designing of e-simulations for social work practice education requires time, strategic planning, and creativity. it takes reflexivity, critical evaluation, open-mindedness, and collaboration of faculty, administrators, students, it professionals, course designers, and social work practitioners. a framework for developing, implementing, and assessing the e-simulations is key to its continued success. due to the nature of these simulations being online and using technology, a framework like assessment technology adoption framework (ataf) should be considered. ataf is a set of practices to “enable a technology solution for program and institutional assessment that combines people, roles, and practices with the process of adoption in order to execute a shared vision for effectively implementing a technology to assist with evaluating outcomes to improve learning and learner success” (newberry et al., 2021, p. 220). ataf recognizes the importance of collaborative efforts amongst faculty, administration, and the technology, and looks to move beyond simply implementing a form of educational technology, but to achieve sustainable and broad adoption of the technology (newberry et al., 2021). assessing the organization’s culture and climate although an organization’s culture and climate are important components in determining the quality and health of the school, they are often overlooked components of school improvement (bustamante, 2005; freiberg, 1998; peterson & deal, 1998). the concept of a school’s culture and climate are further complicated by the multiplicity of racial/ethnic cultures (lindsey et al., 2003); institutional, administration, faculty, and wolfe-taylor et al./future of online swk 291 staff’s adoption and use of technology for learning; and pedagogical stances of faculty surrounding teaching social work practice in an online setting. nissen (2014) discusses the gap in literature on schools of social works’ readiness for change created in 2008 by the cswe educational policy and accreditation (epas). the release of the 2008 epas created a shift in standards from retention and reiteration of educational materials to application in social work education. also, distance education and telebehavioral health practices have created a new shift in social work pedagogy and best practices. additionally, the 2022 cswe epas will play a significant role in the future of social work education standards, with new focuses and an emphasis on anti-racism, diversity, equity, and inclusion information (adei). due to the increased desire by students to complete their education online, the covid-19 pandemic impacting how higher education is provided, the changing landscape of higher education, and the influx in social workers using technology in practice, it is not surprising that higher education institutions and social work faculty may feel overwhelmed, apprehensive, or behind in catching up to the challenges and needs of the students of today and tomorrow. for this reason, organizational culture and climate assessments are essential to ensuring the school is ready to explore the use of e-simulations as hips for social work practice education. evaluating the school’s capacity and need following the assessment of the school’s culture and climate, schools of social work need to evaluate their ability to implement and sustain e-simulated learning opportunities in their curriculum. in addition, schools of social work should evaluate the need and benefits of e-simulations. surveying the school’s interest, support, and understanding of simulation-based learning provides e-simulation developers, faculty members, and administrators a foundation for an action plan. an action plan may have to start with educational and learning opportunities if faculty, students, and administrators are unaware of or are apprehensive about implementing e-simulations prior to developing and implementing an e-simulation. determining goodness of fit there are an array of online simulated environments and types of e-simulations available for consideration. these include but are not limited to operational simulations (procedural, looking at proper steps to completing a task), principal based-soft-skills demonstration, and problem-solving simulations (designing digitally, 2017; kincaid & westerlund, 2009). these can come in the form of asynchronous e-simulations (e.g., branching scenarios and conversation scenarios) and synchronous e-simulations (e.g., online role-playing simulations and chat room/discussion board case-based dialogue). gamification and virtual reality simulations can be categorized as asynchronous or synchronous, depending upon the design and requirements of the e-simulation. alignment and appropriateness of course content, technology tools, and practice activities throughout the course are necessary for successful implementation and evaluation of the selected esimulation(s). in addition, the selected e-simulation should complement the course content, technology used, practice competencies, and learning outcomes. if e-simulations are advances in social work, summer 2022, 22(2) 292 identified as an appropriate learning opportunity within your institution, identification of resources becomes necessary. funding and budget funding for an e-simulations program will all be dependent upon the school’s budget and interest in creating the e-simulations “in-house” or to contract out for these services. it will also be dependent upon the number of faculty and staff involved in the development, implementation, and assessment for the e-simulations. due to the covid-19 pandemic, there has been an influx in external funding opportunities on technology innovations for mental health services, ai, and online, simulated learning for universities and schools to consider as a funding option. however, internal funding should be prioritized for sustainability and continuation of the e-simulation once grant funding is no longer available. internal funding sources to consider are small course development grants, educational practice research funds, and lab fees for the e-simulation services. schools of social work have also become creative in decreasing the cost of simulations by collaborating and sharing the cost with other fields by developing a multi-disciplinary simulation. some budgetary items and positions to consider including are: • course(s) buyout for faculty involved in the design of the course content and esimulations • part-time actors/actresses involved in the e-simulations • part-time employee work-study student or intern in online simulations development, software, and/or web development • a full-time e-simulations coordinator position • part-time course designer to assist with accessibility adherence and course development • external software, databases, and/or online simulations lab services • cameras, lighting, and noise-cancelling microphones and headsets • studio or recording room. staffing staffing could be split into two categories: short-term staffing and long-term staffing and should represent the types (asynchronous versus synchronous) of e-simulations being implemented. for example, if your institution selects an outside vendor to supply asynchronous e-simulations through proprietary software, the need for web developers, esimulations designers, and proctors would not be necessary, as the outside vendor will provide software updates, address design and implementation issues, and manage the simulations in collaboration with the administration and faculty. however, if your institution desires to offer synchronous e-simulations that are designed “in house” then the staffing needs would likely include course designers, web and software developers, esimulation designer(s), proctors, actors/actresses to role-play in real-time as clients, and faculty. some questions to consider when determining staffing needs for the e-simulations should include: wolfe-taylor et al./future of online swk 293 • if developing the e-simulations (asynchronously or synchronously) “in-house” should the web and software developers create an online simulation platform, database, app, and/or software that can be edited and updated by faculty or is more complex coding required for maintenance and edits by developers only? • who will have access to the e-simulations and what type of access should be granted to faculty and staff? • if data are collected on the outcomes and assessments, will there be a database that contains this information and is this database controlled by a faculty member(s) and/or staff? • if using actors/actresses to develop the e-simulations, do you desire to have social workers, acting students, or professional actors/actresses participating in the development processes? • if using actors/actresses in the synchronous e-simulations, do you desire to use practicing social workers, professional actors/actresses, or acting students to role-play as the client? how much will they be paid for their time/services? are they representative of diverse groups in society? table 1. e-simulations staffing considerations roles responsibilities e-simulations coordinator oversees the development, implementation, and evaluation of the esimulations (asynchronous or synchronous). proctors the synchronous esimulations and manages scheduling for synchronous e-simulations. recruits, hires, trains, and manages the simulated patients. faculty assist in the course design and content development processes and ensure the alignment of the e-simulations and assessments with the course objectives and learning outcomes. teach the course(s) with the e-simulations and prepares students for the expectations of the e-simulations. provide debriefings with the students upon completion of the e-simulation. collaborate with the esimulations coordinator on scheduling of synchronous e-simulations. students (nonparticipatory) assist in web developing, graphic design work, software development, and content development as interns or work study students. students (participatory) complete the e-simulations as part of their social work practice education, complete assessments of their and a peer’s practice skills, participate in the debriefing with the standardized patient(s) and instructor, complete a reflection paper on the process, provide feedback on the experience. web developer assist with database development for management of the schedules, assessments, and data that are collected. course designer assist with course alignment, accessibility, and ensure the e-simulations can embed into the learning management system (lms). graphics designer assists in the development of the asynchronous e-simulations. social work practitioners participate in the development of the case scenarios and assessments. may role-play as the standardized patient(s). standardized patients role-play as the client(s) in the e-simulations developed. participate in the debriefing session with the students. participate in the assessment of the student’s practice skills demonstration if it is a social work practitioner participating as the standardized patient. advances in social work, summer 2022, 22(2) 294 the selection of educators, practitioners, and students reviewing and developing the case scenarios and assessment tools should come from diverse personal (age, gender identification, race, etc.), educational (bsw, msw, and phd levels), and professional backgrounds (health, mental health, family services, policy, private practice, education, etc.) as well. provided in table 1 is a more detailed exploration of the staffing considerations for e-simulations and the roles/responsibilities of those individuals involved in the process. technology considering the different types of technology, whether the school should develop its own platform versus paying for an app or software and identifying if the technology being used meets accessibility standards is key. the longevity and malleability of the different technological resources and services should be compared. additionally, the costeffectiveness and number of users allowable to create, change, and monitor the esimulations should be compared as well. reviewing the design methods of the technology developed is important. what ethical standards do the developers use during the design and management processes of the e-simulations? were coded biases identified and addressed in the software app, platforms, or ai being used? how were they addressed? was accessibility a priority in the development? does the software meet accessibility standards and university guidelines for accessibility? how often is the software reviewed and updated? if purchasing an outside app or software for the e-simulations, is it conducive to the learning management system (lms) used by your school? is the software or technology easy to be trained on and to navigate? what supportive services are in place if there is an issue with the technology? does the software or app meet family educational rights and privacy act (ferpa) guidelines? if schools are interested in developing these tools “inhouse” consider the following questions regarding the technology: • which staff and faculty will be involved in the developmental and management processes of the e-simulations, technology, and databases developed? • what type of equipment (software, video cameras, microphones, video editing software, lighting, computers, etc.) will be needed to develop an asynchronous e-simulation? • can the e-simulation be embedded into the learning management system (lms)? • how bias in the coding will be evaluated, identified, and addressed? • how will the school ensure accessibility standards and guidelines are being met? zoom, kaltura, signup genius, otter assistant (otter.ai), and adobe captivate are a few no to low-cost external software or application tools to consider using for the design and implementation of synchronous e-simulations. asynchronous e-simulations are more involved in the developmental process than the implementation process. once the software or database is designed it is crucial to conduct beta testing before the e-simulation “goes live”. requesting faculty, students, course designers, and accessibility specialists to evaluate the software or databases performance ensures that 1) accessibility standards are being met, 2) the technology developed for the wolfe-taylor et al./future of online swk 295 asynchronous e-simulation is appropriate and not too complex to navigate, 3) there are no technology glitches or bugs that need to be addressed, and 4) that the asynchronous esimulation aligns and explores the content and practice competencies for that specific course effectively and thoroughly. ispring suite max, branchtrack, itystudio, and uptale are a few external esimulations software and applications to consider as well, but these are not as cost-effective and do not provide as much access and freedom for multiple developers to make significant changes without substantial cost increases in contracted services. additionally, if an asynchronous e-simulation is being implemented, the institution could develop software or a database with pre-recorded potential responses that either allows the student to proceed forward in the e-simulation or electronically guides the student back to the course content and materials for further learning. implementing synchronous e-simulations the implementation of synchronous e-simulations is an involved process for the instructor with a multitude of moving parts that present both strengths and challenges within the overall experience. executing a seamless synchronous e-simulation requires instructor attention in the time leading up to the e-simulation as well as on the day of. factors that must be considered include confirming the technical aspects of facilitation are optimized, ensuring the authenticity of the experience for the student, and engaging the student in dialogue before for preparation and after for a debriefing and evaluation of the student’s completion of the e-simulation. in preparation for implementation, it is vital for the instructor to create a schedule of available time slots for students to sign up. this is to ensure instructor availability to facilitate and monitor each simulation, and to secure actor/actress availability far in advance. this also allows the actors/actresses ample time to familiarize themselves with the client character that they will portray for the student. once students have signed up for their e-simulation, the instructor can make the necessary technical adjustments within their course site for implementation, such as creating unlock times for case scenarios that correspond with individual sign-up times, testing video meeting room ids and passcodes, and corresponding with all individuals involved regarding the optimization of audio/video equipment. at the time of implementation, the student, instructor, and actor/actress will converge in the designated video meeting room. after ensuring the student reviewed their case scenario and that the audio/video components of all involved parties are functioning properly, the instructor should provide a short overview of the e-simulation process to ensure the student understands their role and the expectations for the experience. this short dialogue can consist of the following talking points: • the student will have a set amount of time to complete the e-simulation. the instructor will keep track of time for the student, but they are welcome to do this on their own as well. advances in social work, summer 2022, 22(2) 296 • the instructor will turn off their video and microphone so that they are not a distraction to the student or actor. • the only time the instructor will communicate with the student is to let the student know when five minutes remain in the synchronous e-simulation and when time has expired if the student does not end the session prior to the time allotted. • upon completion of the synchronous e-simulation there will be a debriefing where the student will be provided feedback from both the instructor and actor. once this dialogue has concluded, and any logistical questions have been answered, the instructor will transition to an observer by turning off their video and microphone. the student will begin recording and will then proceed to engage the client for the purpose of demonstrating competency in their practice skills. it could be considered best practice for the instructor to have the student’s rubric on hand while they take notes throughout the esimulation. instructors should approach this time as an opportunity to observe not only the student in the moment for the purpose of assessment, but also be mindful of any identified areas of growth throughout the term. a strength of this implementation process is the collaborative approach to feedback provided at the end of the experience. debriefing with the student is vital to the learning process and is the final step of implementation before assessment. this is an opportune time for the instructor to celebrate the conclusion of the e-simulation and congratulate the student. a moment of mindful reflection on the experience may be beneficial for the student before the instructor and actor/actress provide their observations and feedback. an instructor’s approach to providing feedback can be at their discretion; however, highlighting areas of growth and specific moments within the e-simulation where competency was displayed is recommended. common issues that may manifest during the implementation are largely technical, due to the high-level of technical integration within the synchronous e-simulation process. however, these can be avoided when instructors are prepared to troubleshoot. day-of issues with software and audio/video equipment are common. if students are willing to provide a phone number to their instructor, it may prove helpful for real-time communication when troubleshooting. variances in time zones for involved parties is common, it is vital that this is communicated during the scheduling phase of implementation. it could be considered best practice for all involved parties to confirm their operating system does not have a pending update installation which could restart their computer during the e-simulation, test the input and output of their audio, and ensure the recording is captured in gallery view so that all participants are visible during the esimulation. implementing asynchronous e-simulations once the beta testing of the asynchronous e-simulation has occurred and all technological issues resolved, implementing the asynchronous e-simulation involves embedding the software or database into the online course shell and ensuring the wolfe-taylor et al./future of online swk 297 designation of the software or database appropriately aligns with the course content and learning objectives. additionally, the developers need to ensure that faculty and students are trained to use the technology that is necessary for the successful implementation of the asynchronous e-simulation. assessing e-simulations a multi-dimensional assessment strategy is recommended to assess the design and implementation of the e-simulation. these should include assessing: the learning materials developed, the technology created and used, the case scenarios, the goodness of fit of the assessment tool developed, and the experience for the student, faculty, and actors. assessors can include instructional designers, web developers, administrators, faculty content leads, students, actors, and beta testers of the technology. feedback forms are crucial and can provide continual data and information on the accessibility, usability, relevance, and impact of the e-simulation on student learning. depending upon what is being measured and the type of e-simulations being implemented, an institution should also include assessments of learning, practice competency, and skills demonstrated by the students. diagnostic, interim, formative, and summative assessments should be developed to assess the students’ practice competency. these assessments should be based upon the course objectives and outcomes, learning competencies, assignment requirements, and course content/topic. these forms of assessment can be created as electronic rubrics, competency-based assessment scales, reflective papers/videos/audio recordings, etcetera. provided in table 2 is an example of assessment criteria developed for a practice competencies assessment for a synchronous e-simulation. the criteria were developed by social work practitioners, faculty, and students. the sample criteria are tailored to capture and evaluate the demonstrable skills and competencies specific to a graduate-level generalist theory and practice course that implemented a type of e-simulation called an online objective structured clinical examination (e-osce). the scale is identified as the social work post-osce practice competency rating scale (swp-opcrs). advances in social work, summer 2022, 22(2) 298 table 2. sample criteria from the swp-opcrs criteria description ratings for practice skills demonstration at the msw level points feedback exceptional 5 to 4.5 pts (100%-90%) satisfactory 4.49 to 4 pts (89%-80%) marginal 3.99 to 3.65 pts (79%-73%) unsatisfactory 3.64 to 0 pts (72% or less) student’s use of questions primary use of open-ended questions. as appropriate, judicious use of closed-ended questions. avoids the use of multiple questions at one time, questions as statements, & “why” questions. student’s exploration of client’s needs works in collaboration with the client to explore & identify the client’s current needs. collaborative goal setting invites the client into the goal-setting process, works in collaboration with the client in identifying goals, & helps guide the client’s ideas into a realistic, attainable plan that the student creates in collaboration with the client. intervention selects intervention(s) that match the client’s goals from appropriate pie frameworks. assists the client in narrowing of intervention to a reasonable expectation of 1-2 interventions to implement before next session. total points received wolfe-taylor et al./future of online swk 299 limitations and considerations although there are several benefits to using e-simulations in education, it is important to recognize their limitations. the financial cost of designing and implementing a face-toface simulation can be rather cumbersome (savoldelli et al., 2005) and has left some universities and programs with an inability to continue face-to-face simulations if significant funding resources are not provided. although there is an alternative through esimulation, it is important to recognize that there is still a cost to implementing an online simulation. the amount of time required to construct, proctor, review, and/or improve a simulation can also be identified as a limitation for smaller universities and programs that may have limited faculty and staff or that have a limited number of faculty available to manage all that e-simulation entails (mccoy & merrick, 2001; savoldelli et al., 2005). there are concerns regarding educators’ ability to integrate the e-simulations within the curriculum in the appropriate manner to ensure it meets the course learning objectives. it is also important to recognize that the e-simulation may be stress inducing for students and cause anxiety. additionally, despite efforts to ensure standardization of clients through actor and case scenario preparation, there is still the possibility for different experiences with the client given the context, dialogue, and assessment at hand. finally, when considering implementation of an e-simulation in social work practice education, it can be more difficult to assess the change process intervention depending upon the time limits allotted for each synchronous simulated experience (bogo et al., 2014). futures of e-simulations and technology in social work ethical designs in educational tech, online simulations, and using technology to create high levels of interactivity and engagement in education are not new ideas or educational experiences; however, social work has been hesitant and at times resistant to engaging in futures-thinking in relation to using technology in social work education and practices. online education and technology use in social work are here, growing, and advancing. the field of social work needs to further explore its role, responsibility, and ability to be at the forefront of technology innovation for distance education and social work practices. covid-19 may have been the catalyst for some schools of social work in adopting technology and distance education, but social work has the opportunity and calling to change the future of tech, tech in social work education and practices, and tech's impact on social determinants. social work will need to prioritize the call to harness technology for social good to create such changes in the profession and how it uses technology to prepare students for practice. references american academy of social work and social welfare [aaswsw]. 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(2020). lessons learned from covid-19: being known in online social work classrooms. international social work, 63(5), 651–654. https://doi.org/10.1177/0020872820940021 wilkerson, d. a., wolfe-taylor, s. n., & deck, c. k., wahler, b. e. & davis, t. s. (2020). telebehavioral health practice basics for social work educators and clinicians responding to covid-19. journal of social work education, 39(8), 1137-1145. https://doi.org/10.1080/02615479.2020.1807926 author note: address correspondence to samantha wolfe-taylor, indiana university school of social work, of social work, ad 2020n, 301 university blvd., indianapolis, in, 46202. email: swt@iu.edu https://doi.org/10.1080/10437797.2014.856223 https://files.ascd.org/staticfiles/ascd/pdf/journals/ed_lead/el199809_peterson.pdf https://doi.org/10.1007/bf03022056 https://doi.org/10.1177/0020872820940021 https://doi.org/10.1080/02615479.2020.1807926 mailto:swt@iu.edu this work is licensed under a creative commons attribution 4.0 international license. challenges to family unity and opportunities for promoting child welfare in an increasingly punitive immigration landscape megan finno-velasquez alan j. dettlaff abstract: this paper describes specific challenges to family unity and child welfare among children in immigrant families resulting from immigration enforcement. surges in immigration activity over the past decade have resulted in family economic hardship, psychological trauma to children, and difficulty accessing social services. children whose parents are detained/deported are at risk of unnecessarily entering the child welfare system, and encounter significant barriers to family reunification. in recent months, the scope of enforcement priorities that previously safeguarded many parents now target a much larger group of immigrants for deportation, increasingly disregarding the needs of children. immigration raids have terrorized communities across the country, and repercussions are being felt by the child welfare system and social service providers. within an anti-immigrant political climate, there is a desperate need for social workers to lead initiatives to respond to immigrants’ needs. strategies include: (1) development of social work expertise in working with immigrants; (2) cross-systems and cross-disciplinary collaborations; (3) leveraging existing resources and supports; (4) documentation/collection of data; and (5) focused advocacy efforts. keywords: children of immigrants; child welfare; social work the number of children in immigrant families in the u.s. has risen for the past several decades. by 2015, a full quarter of children in the u.s. were from immigrant families (clarke, turner, & guzman, 2017). numbers of unaccompanied children arriving to the u.s. have also spiked in recent years (rosenblum & ball, 2016). in 2016 alone, nearly 250,000 immigrants were deported (u.s. immigration and customs enforcement, 2016). thousands of unaccompanied children were placed in federal foster care or released to sponsors while awaiting asylum claims. surges in immigration activity have resulted in family economic hardship, psychological trauma to children, and difficulty accessing social services. children whose parents have been detained or deported have been at risk of unnecessarily entering the child welfare system, and encounter significant barriers to reunification with their parents. unprecedented numbers of unaccompanied migrant children arriving to the u.s. in recent years have posed significant challenges for the child welfare system. once children in immigrant families come to the attention of the child welfare system, they face considerable barriers to achieving positive outcomes. during the obama administration, some efforts were made to reduce the risk of collateral consequences of immigration on children. for example, the 2013 ice parental interests directive protects immigrants' parental rights and responsibilities by increasing detained parent's ability to be involved in child welfare proceedings and arrangement of _________________ megan finno-velasquez, phd, lmsw, is an assistant professor and director of the center on immigration and child welfare, school of social work, new mexico state university, albuquerque, nm 87111. alan j. dettlaff, phd, is dean and maconda brown o’connor endowed dean’s chair for the graduate college of social work at the university of houston, houston, tx, 77204. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 727-744, doi: 10.18060/21716 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 728 care for their children (u.s. immigration and customs enforcement [ice], 2013). in recent months, however, the scope of enforcement priorities that previously safeguarded many parents now target a much larger group of immigrants for deportation, increasingly disregarding the needs of children. immigration raids have terrorized communities across the country, and repercussions are being felt by the child welfare system and social service providers throughout the country. this article describes specific challenges to family unity and child well-being among immigrant children or u.s. citizen children in immigrant families resulting from immigration policy and enforcement activities. within an anti-immigrant political climate, this paper identifies opportunities for social workers to lead initiatives to respond to this problem, with strategies that include: (1) development of social work expertise in working with immigrants; (2) cross-systems and cross-disciplinary collaborations; (3) leveraging existing resources and supports; (4) documentation/collection of data; and (5) focused advocacy efforts. children of immigrants in the u.s. changes in immigration patterns and trends over the past two decades have considerably shifted the demographic profile of the united states (grieco et al., 2012). the number of foreign-born immigrants living in the united states has increased, and the proportion of children in the u.s. living in immigrant families has been rising for the past several decades. in 1990, just 8.3% of children in the u.s were in immigrant families, but by 2015, a full quarter of children were from immigrant families (annie e. casey foundation, 2018). approximately 20 percent of children with two parents live with two foreign-born parents, and 10 percent of children live in families of mixed-status parents, or families with one foreign-born and one native-born parent (u.s. census bureau, 2017). almost a third (30%) of children of immigrants have at least one undocumented parent (capps, fix, & zong, 2016), while 90% of children in immigrant families are themselves u.s. citizens (annie e. casey foundation, 2017). more than half (55%) of immigrant children are of hispanic origin, followed by sixteen percent non-hispanic white, seventeen percent nonhispanic asian, and nine percent non-hispanic black (child trends data book, 2014). although children of immigrants reside throughout the country, half of children in immigrant families live in 4 states: california, texas, new york, and florida annie e. casey foundation, 2017). rates of children in immigrant families vary widely by state, ranging from 3% in west virginia to 48% in california . the numbers of unaccompanied children arriving to the u.s. have also spiked in recent years, peaking in 2014 and rising again in 2016 with nearly 60,000 arrivals that year (u.s. customs and border protection, 2016). the greatest numbers of children encountered by u.s. customs and border patrol are arriving from guatemala, honduras, and el salvador, known as the northern triangle region of central america (chishti & hipsman, 2016). the vast majority of unaccompanied children released to approved sponsors are in california, texas, new york, and florida. finno-velasquez & dettlaff/challenges to family 729 challenges to family unity & child well-being immigration enforcement and child well-being. immigration enforcement activities conducted by immigration and customs enforcement (ice) have resulted in an unprecedented number of deportations over the past decade. the period between 2005 and 2008 was characterized by a large increase in enforcement efforts, most notably with several highly publicized worksite enforcement operations (dettlaff & finno-velasquez, 2013). major worksite enforcement operations were mostly halted in 2008 with a changing administration and harsh criticism by child advocates. as a result of the attention generated by these raids, ice developed a set of humanitarian guidelines that applied to enforcement actions involving more than 150 arrests, which was later reduced to actions involving more than 25 arrests (dettlaff, 2012). those guidelines encouraged the identification of individuals who are the sole caregivers of minor children or who have other humanitarian concerns, including individuals with serious medical conditions, nursing mothers, pregnant women, or caregivers of spouses or relatives with serious medical conditions. evidence suggests that when administered appropriately, those guidelines have been effective in preventing or minimizing parent-child separations (chaudry et al., 2010). the limitation is that those guidelines do not apply to enforcement actions targeting individuals or small groups, including home raids and other small criminal justice operations. although worksite raids were suspended under the obama administration, the obama administration oversaw the highest number of deportations in recent history. between 2009 and 2013, almost half a million parents were deported from the united states (american immigration council, 2017). in fiscal year 2016 alone, almost a quarter million immigrants were deported (lópez & bialik, 2017). the leading countries of origin for deportations were mexico, honduras, guatemala, and el salvador (batalova & lesser, 2017). documented impacts of worksite raids include family economic hardship, psychological trauma to children, difficulty accessing social services because of language barriers, difficulty documenting eligibility, mistrust and fear, and family separation (campetella et al., 2015). there are several reasons for this increase in detention and deportation, all of which are associated with interior enforcement operations, such as fugitive operations, small worksite raids, customs and border patrol traffic stops, and increased cooperation between local law enforcement and the department of homeland security (dhs). in 2007, a strategy was adopted to prioritize the apprehension of immigrants who have committed criminal offenses, which resulted in the merging of several programs under the ice agreements of cooperation in communities to enhance safety and security (access) initiative. one of the most well-known of these is the 287(g) program, which established collaborations between ice and local officials that allow local police to be deputized to enforce immigration laws. currently ice has 287(g) agreements with 60 law enforcement agencies in 18 states, and ice officers have certified more than 1,800 local officers to enforce immigration law (u.s. department of homeland security, 2017). a related program, secure communities, uses local jails to identify immigrants for deportation by forwarding fingerprint data from the fbi to ice, which determines the arrested person’s immigration status. if the arrested person is identified as a non-citizen, ice can request that advances in social work, spring 2018, 18(3) 730 local authorities detain that person until ice moves him or her to an immigration detention center. although the stated goal of these programs is the removal of individuals who pose a threat to national security and public safety by prioritizing those with an aggravated felony conviction or multiple felonies, secure communities has resulted in the deportation of thousands of immigrants who do not have criminal convictions at all, or whose only crimes are simple misdemeanors such as driving without a license (american immigration lawyers association [aila], 2011). secure communities operates as a partnership between local law enforcement and ice and is still implemented throughout the country. in addition to these federal enforcement programs, a number of state and local immigration enforcement initiatives have been fueld by anti-immigrant sentiment, such arizona's senate bill 1070 and other copycat laws. arizona senate bill 1070 (support our law enforcement and safe neighbors act, 2010) imposed penalties on immigrants who failed to provide immigration documentation and allowed law enforcement to ask suspected undocumented immigrants about their immigration legal status. following the adoption of arizona's law, many other states considered copycat laws while utah, georgia, indiana, alabama, and south carolina passed sb1070-style legislation (lacayo, 2011). however, arizona's sb1070 (and others) have since been challenged in court. in 2012 the supreme court blocked three of four provisions in the bill as well as in other copycat laws (liptak, 2012). despite the ramping up of enforcement during the obama administration, some efforts were made to reduce the risk of collateral consequences on children. advocacy by immigrant rights and child protection groups led to an increased use of prosecutorial discretion to release parents in deportation cases. this resulted in a decrease in removals of parents of children legally present in the u.s. (trevizo, 2016). in 2011, ice created policy that directs ice personnel to avoid arresting individuals at certain “sensitive locations” including churches, schools, and childcare programs (morton, 2011). arguably, the largest win for children during the obama administration was ice’s 2013 parental interests directive, created with the aim of helping ice balance the enforcement of immigration laws with respect for a parent's/guardian's rights and responsibilities. the parental interests directive contains specific guidelines for the handling of cases involving primary caretakers, parents or legal guardians of minor children, and particularly those involved in family court or child welfare proceedings. it promotes better tracking of immigration cases involving parents, legal guardians, and primary caretakers of minor children. this directive encourages taking children into account when determining detention placement locations, needs for court participation, and allowing for parent-child visitation. as a result, it also increased the ability of detained parents to make decisions for the care of their children and participate in child welfare proceedings. with the implementation of the parental interests directive, while families continued to be separated by immigration enforcement, the chances that a family would become involved with the child welfare system as a result of immigration enforcement decreased. however, harsh enforcement strategies were again elevated along the border in 2014 when unaccompanied immigrant children began to flee to the united states in large finno-velasquez & dettlaff/challenges to family 731 numbers to escape violence and persecution in their countries of origin (kandel, 2017). as a result, the obama administration publicly committed to an aggressive deterrence strategy which resulted in increased apprehensions of children and individuals seeking asylum from mexico and other central american countries (the white house, office of the press secretary [wh ops], 2014). this surge resulted in an expansion of immigrant detention, including the detention of children and mothers, and increases in the separation of children from their parents when crossing the border (detention watch network, n.d.). through the office of refugee resettlement, many thousand unaccompanied children are released to parents or relatives willing to sponsor the children while they are waiting for decisions in their immigration cases. as currently funded, the orr licensing and monitoring process for unaccompanied minor sponsor cases is generally less stringent than the regulation and oversight of state foster care licensing. in most cases, federal protective jurisdiction of unaccompanied children ends after a short home study and release to sponsors. once released to sponsors, these placements are not subject to any oversight or monitoring, and the children do not have access to health insurance, public assistance, or any health or support services normally afforded to children in state foster care, leaving the placements at risk of disruption, exploitation, and maltreatment. impact of immigration enforcement on children and families. research documenting the impact of immigration enforcement activities over the past decade suggests that parental detention and deportation results in child trauma and mental health problems, increased family instability, and heightened risk that a family will become involved with the state child welfare system, especially when parents lose their parental rights (koball et al., 2015). u.s.-citizen children of detained and deported parents experience a greater amount of psychological distress, trauma, and ptsd symptoms than their counterparts with parents who have not been impacted by immigration enforcement (rojas-flores, clements, koo, & london, 2017). children affected by parental detention and deporation also demonstrate higher levels of depression and anxiety, lower academic performance, and greater behavioral problems (rojas-flores et al., 2017). furthermore, dreby (2012) found that children in latino immigrant families experience significant negative outcomes not only due to the fear of immigration enforcement, but also because of ethnic identity challenges and stigma and conflation of ice with law enforcement. not only does immigration enforcement negatively affect children, but it also affects the entire family system. in one study, spouses and partners reported increased feelings of depression and social isolation, which is associated with negative cognitive and behavioral outcomes in children (koball et al., 2015). the loss of income from a detained or deported family member contributes to family financial insecurity, housing and related food insecurity, and lack of access to social services due to fear of interacting with government officials (brabeck, sibley, & lykes, 2016; dreby, 2012). the many burdens of immigration enforcement including financial distress, stressful events, and social isolation, are factors associated with child maltreatment and involvement with the child welfare system (dettlaff & finno-velasquez, 2013). the current climate. the concerns for children resulting from family separation and immigration enforcement have escalated since the 2016 presidential election. in recent months, the scope of enforcement priorities that previously safeguarded many parents now advances in social work, spring 2018, 18(3) 732 target a much larger group of immigrants for deportation, increasingly disregarding the needs of children. shortly after taking office, the trump administration issued two executive orders that authorized a new list of immigration enforcement priorities expanding removability to include anyone who has committed an act constituting a chargeable offense, such as entering the country illegally, which placed nearly 11 million undocumented individuals and many legal permanent residents at risk of deportation (wh ops, 2017). since that time, the nation has seen ramped up activity by ice in communities across the country. in 2017, the trump administration proposed a new deterrence strategy that included systematically separating children crossing borders from their parents and placing them into foster care (ainsely, 2017). public outcry put a stop to this border deterrence initiative, but the impacts of ramped up enforcement are still felt (foley & planas, 2017). in fact, although it has not received much press, the separation of children and parents at the border has occurred to some degree since the obama administration (aila, 2016). with very limited options for family detention, parents and children are often held in separate facilities (barrick, 2016). reports have also surfaced of pregnant women seeking asylum being held in detention with risks to their unborn children’s health, in violation of ice’s own policy (bogado, 2014). asylum claims by people fleeing violence and persecution in mexico and other central american countries are no longer being granted (dickerson & jordan, 2017). reports of suicidal ideation and attempt among detained women and their children have emerged. in july of 2017, the trump administration also announced that it will begin arresting and deporting undocumented parents, guardians, and relative sponsors of unaccompanied children (burke, 2017). the effects of this policy exacerbate the chances that unaccompanied children will be placed in state child welfare custody. not only does this policy punish individuals who have in good faith come forward to care for unaccompanied children, but it will also leave children with fewer relative and kin options for sponsors, placing them at higher risk of disruption in placement and increased risk for entry into state foster care. immigration enforcement and risk for child welfare involvement. although an emerging body of research has begun to shed some light on the involvement of immigrant children and families in the child welfare system, the extent to which immigration enforcement activities have contributed to child welfare system involvement remains unknown. one study estimated that in 2011 as many 5,100 children currently in foster care have parents who have been either detained or deported (wessler, 2011). although that study could not determine whether these children entered foster care as a direct result of their parents’ detention or deportation, anecdotal information suggests that this problem is likely to grow as a result of recent changes to immigration enforcement policies. although the exact number of children who become involved in the child welfare system as a result of immigration enforcement is unknown, it is clear that children have been impacted by these efforts. statistics made available from dhs in late 2012 showed that between july 1, 2010, and september 30, 2012, dhs removed 204,816 parents of u.s. citizen children from the united states (u.s. department of homeland security, 2012) in finno-velasquez & dettlaff/challenges to family 733 2013, ice conducted 72,410 removals of parents with at least one u.s. citizen child (foley, 2014). no data have been made public on the whereabouts of the children from these families or the consequences they faced as a result of their parents’ deportation. the challenges of cases involving children who enter the child welfare system due solely to an immigrant parent’s arrest or apprehension are far-reaching. although courts that handle child welfare cases operate under statutes requiring that children's best interests be considered in decisions regarding their custody and placement (child welfare information gateway, 2010), there are wide variations across juvenile courts in what is interpreted to be in children’s best interest when parents are deported. immigration law does not recognize children’s interests as a valid factor in the immigration decisions concerning their parents, which can lead to profound implications for families with mixed immigration statuses. children may remain in the united states and be permanently separated from their parents – or they can leave their home and all they have known to move to an unfamiliar country to remain with their family. although this has been described as a “choiceless choice” for immigrant parents (thronson, 2006), best practice calls for deported parents’ decisions regarding their children to be honored when maltreatment is absent. however, the extent to which parents’ and children’s voices are heard in juvenile court decisions remains unknown. parents detained in immigration facilities may be prevented from meaningfully participating in a court plan for reunification. in some cases, child welfare staff are unable to locate parents, reducing their chances of participation in decisions concerning their children, including court proceedings related to their children’s care and custody. deportation proceedings and decisions often last longer than the timeframes under which child welfare agencies must make decisions about children’s permanency, further complicating the agencies’ ability to act in children’s best interests (cervantes & lincroft, 2010). child welfare system challenges. regardless of how or when children of immigrants come into contact with the child welfare system, social workers face complex challenges to responding to their needs and facilitating positive outcomes related to their safety, permanence, and well-being. research has shown that children with immigrant parents who become involved with child welfare systems have lower access to mental health services than children with u.s. citizen parents (dettlaff & cardoso, 2010; finnovelasquez, cardoso, dettlaff & hulburt, 2015). immigrant parents who become involved with the child welfare system also have less access than non-immigrant parents to needed substance abuse services and concrete supports that can prevent entry of their children into foster care (finno-velasquez, 2013; finno-velasquez, seay & he, 2016). once children enter foster care, immigration status can create additional delays or barriers to reunification, as non-citizen parents may be unable to obtain employment or participate in certain mandated services or supportive services that could facilitate reunification (dettlaff & fong, 2016). language barriers can result in miscommunication and misunderstandings, and delays in service delivery, which can affect parents’ abilities to complete required services and place them at risk for termination of parental rights due advances in social work, spring 2018, 18(3) 734 to the timeframes mandated by the adoption and safe families act (asfa) of 1997 (ayón, 2009; committee for hispanic children and families, 2003). child welfare workers may also encounter challenges in the placement of children of immigrants. in many states, undocumented immigrant family members do not qualify to serve as foster parents for children because of their legal status (ayón, aisenberg, & cimino, 2013; wessler, 2011). child welfare workers must also attempt to locate relatives residing in other countries to notify and screen for potential placement. sometimes, when parents reside in other countries, reunification plans must cross transnational borders, requiring coordination of home studies and services with foreign governments (lincroft & borelli, 2009; reed & karpilow, 2009). many children and their family members involved with child welfare agencies also qualify for some form of immigration relief, and their ability to obtain legal status depends on the child welfare system’s capacity to adequately screen for eligibility and navigate the immigration system, ideally in collaboration with immigration experts (finno & bearzi, 2010). some child welfare agencies across the country have solid partnerships and policies in place to provide those assessments and ensure that immigrant children and families receive due process, but many still do not (lincroft, 2013). another challenge is the lack of expertise within the child welfare workforce about the unique needs of immigrant families that result from their experiences with immigration and acculturation. achieving reunification with parents largely depends on the child welfare system’s ability to provide family services that effectively address the issues that led to this placement, as well as the parents’ participation and engagement in these services (dettlaff & fong, 2016). given these barriers, immigrant families may be at a disadvantage in meeting case requirements and reunifying children with family members, thus placing them at greater risk for termination of parental rights. since the beginning of the trump administration, immigration policy has taken a strikingly different direction, with almost unilateral disregard for the well-being of children. the scope of enforcement priorities that previously safeguarded many parents and long-time residents whose only violation was living in the country without documentation now target a much larger group of immigrants for deportation. immigration raids have taken place in communities across the country, and its consequences are being felt by social workers and their immigrant clients throughout the country. the impact of enforcement activities on child welfare systems is not yet known, but it is widely feared that children’s well-being and stability continue to be compromised. directions for social work the following are approaches that the profession of social work can take to respond to immigrants’ needs: (1) development of social work expertise in working with immigrants; (2) cross-systems and cross-disciplinary collaborations; (3) leveraging existing resources and supports; (4) documentation/collection of data; and (5) focused advocacy efforts. development of social work expertise in immigration. first, the profession of social work must develop specific expertise in practice with immigrants. in addition to competence in working with ethnically and culturally diverse groups, as professionals who finno-velasquez & dettlaff/challenges to family 735 work across disciplines, various aspects of the immigration system and immigration law that affect families’ lives should be seamlessly integrated into required social work training curricula. training is needed that provides information to social workers, especially those working in the child welfare field, on the experiences of immigrant children and families to improve cultural responsiveness and reduce the potential for bias. to conduct adequate assessments and provide interventions that respond to their needs, child welfare professionals need to understand the effects of immigration and acculturation on immigrant family systems. once children in immigrant families become involved in the child welfare system, social workers need to be familiar with resources and programs available for immigrant children and families to provide comprehensive services that meet their needs. practitioners also need to be familiar with federal and state policies that affect immigrant and refugee children and families and understand how those policies may affect service delivery. within child welfare systems especially, it is important to develop, recruit, and train social workers who are bilingual and bicultural in order to respond more appropriately to children and families from diverse cultures. bridging refugee youth and children's services (brycs) offers a number of training tools and webinars on their website that can assist social workers working wtih refugee families, and specifically, refugee children and adolescents, on a number of issues (i.e., trauma, accessing resources, navigating the legal system, etc.). the website for the immigration legal resource center offers multiple trainings relevant to social workers that are specific to immigration laws. the nasw california chapter offers multiple low-cost courses on their website, including one specific to immigration and child welfare issues. both courses are designed to provide social workers with information about current u.s. immigration laws and the impact of immigration enforcement on children and families. improved understanding of immigration policy and culture can lead to improved engagement, more thorough assessments, and more effective service delivery. cross systems and cross-disciplinary collaborations. effective social work practice with immigrant children and families cannot be achieved in isolation. many immigrant families are likely to intersect with multiple systems, and a coordinated community response is necessary to promote their overall well-being. within the current environment over the past several months, many grass-roots initiatives have begun in various states and localities around the country to protect immigrant children and families. these include rapid response teams and networks in many states including california, colorado, massachusetts, and virginia that are composed of social workers, attorneys, advocates, and community organizers who offer support particularly in the wake of immigration raids, which often leave children behind (spivack, 2017). social workers are the ideal professionals to engage with various systems and ensure all key stakeholders have a place at the table, as issues around immigration and child welfare are complicated, and if successful, will have multiple layers to any response. collaborations should include foreign consulates and child welfare agencies, legal professionals, public policy and child development experts, courts, schools, health and mental health systems, along with natural supports like churches and faith groups, and academics/research scientists. given concerns resulting from ongoing immigration enforcement efforts, social work professionals, and child welfare agencies in particular, need to develop and strengthen advances in social work, spring 2018, 18(3) 736 relationships within immigrant communities to create a climate where families feel safe accessing services and the reporting of maltreatment can take place without fear of deportation or other negative consequences to families. child welfare agencies in particular should develop collaborations with community-based social service providers in immigrant communities to facilitate education about cultural norms related to maltreatment and to dispel fears about reporting. leverage existing resources and supports. for social work professionals and agencies struggling with how to respond, many resources already exist. advocacy groups around the country have been quick to respond in creating toolkits and legal guides, such as family safety planning and trauma response resources, in response to immigration policy changes. many such resources are highlighted and can be accessed on the webpage of the center on immigration and child welfare (2017). two timely and relevant resources include appleseed’s (2017) updated protecting assets and child custody in the face of deportation: a guide for practitioners assisting immigrant families and the institute for women in migration’s (imumi; 2017) a brief guide for families, organizations, and public officials: resources to inform, support, and prepare families for a possible return to mexico. for social workers working in macro settings, energy should focus on translating and disseminating the newest and most relevant research and resources into practice settings, and developing tools and workshops for front-line workers requesting guidance on working with immigrant children and families in the current climate. plans should focus on using existing training opportunities to increase capacity and skill in working on immigration issues, such as title iv-e training for child welfare workers, creating a natural platform for disseminating current knowledge into relevant practice. documentation and collection of data. in the modern era of data-driven decisionmaking, one of the greatest challenges to proposing solutions is that there is no accurate data on the number of immigrant children and families impacted by deportation and at risk for child welfare system involvement. nativity and citizenship status has never been uniformly collected across child welfare systems in the u.s., and the department of homeland security does not collect (or publicly release) information on the children of immigrants who are detained and deported. congressional members have demanded that homeland security begin to release this information (gillibrand et al., 2017). social workers should continue to push this issue with legislators to continue this pressure. immigration information is not required for national child abuse and neglect data collection and reporting, and is thus not collected in a consistent manner across the country. there are rightly confidentiality concerns and apprehension about how such information would be used by federal agencies if it were required. however, without a requirement for collecting immigration information, child welfare agencies do not have a way to ensure that immigrant children and families receive the services they need. with no guidance on how to track children in immigrant families, child welfare agencies also grapple with the most sensitive ways to retrieve and record that information from families. clear protocols should be developed to dictate how to collect sensitive identifying information from immigrants while ensuring the utmost confidentiality of that information for use within the child protection system only. as it currently stands, without official data identifying immigrant families impacted by deportation and involved with the child welfare system, finno-velasquez & dettlaff/challenges to family 737 efforts to document immigrant family experiences and needs through rigorous research, data collection, community needs assessments, and service evaluations are sorely lacking. much additional research is also needed to facilitate the provision of culturally responsive child welfare services. although some research has begun to identify the presence of immigrant children and families in the child welfare system (wessler, 2011), specific studies are needed that provide information on interventions that facilitate positive outcomes of safety, permanency, and well-being for immigrant children and families. interventions that have historically been used with non-immigrant populations may not be effective with immigrant children and families due to their cultural differences, as well as differences in the underlying issues that brought them to the attention of this system. in order to facilitate positive outcomes, interventions need to consider the cultural influences and experiences in immigrant families and how these influences affect service delivery. focused advocacy efforts. advocacy is a primary skill of social work practitioners, but now more than ever, all social workers who work with immigrant families, whether in clinical settings, in legal or policy settings, or in research, must include advocacy as part of their responsibilities. advocacy efforts should focus on electing candidates who support pro-immigrant integration policies, in contrast to restrictive immigration policies, and may include forming local coalitions to respond to community-specific needs and issues. social workers have an ethical responsibility to understand current policy and report cases of noncompliance with immigration policies to appropriate authorities. immigrants involved in legal immigration proceedings do not have the right to an attorney, and if they do not have representation, the court will likely not rule in their favor. as part of these advocacy efforts, social workers can help obtain legal representation for immigrant. multidisciplinary rapid response teams and networks can help provide coordinated and comprehensive responses to immigration raids and other emergency immigration situations (national immigration law center, 2007). safety and contingency planning resources and trainings in relevant languages are also crucial for immigrant families in order to make practical and legal arrangements in the case of parental detention or deportation (immigrant legal resource center, 2017). in the current political climate where comprehensive immigration reform remains unlikely, state and local level policy change presents greater promise. several effective models already exist, such as california’s sb 1064 and other collaborative efforts along with border region involving agencies on the u.s. and mexico sides of the border (finno & bearzi, 2010; lincroft, 2013). finally, the narrative around immigration and immigrants in this country has always ebbed and flowed around dominant u.s. values, morals, and who is considered to be deserving and undeserving. as professional social workers, we must use our voices to contribute to framing the public narrative around immigration enforcement as a humanitarian crisis characterized by egregious violations to women’s and children’s rights. conclusion with the scope of immigration policy placing the well-being of our children at an unprecedented crossroads, social workers have an ethical obligation to step up and do everything within their power to mitigate or alleviate the traumatic threats and potentially irreparable damage to child well-being imposed by our immigration system. efforts to advances in social work, spring 2018, 18(3) 738 increase the capacity of social workers to address the unique needs of this population, as well as cross-systems collaborations, and focused advocacy efforts are essential components of this response to facilitate positive outcomes of safety, permanency, and well-being. specific training on immigration policy and culturally informed, traumasensitive practice with immigrants needs to be prioritized in social work 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(2011). shattered families: the perilous intersection of immigration enforcement and the child welfare system. applied research center. retrieved from file:///c:/users/vdecker/downloads/arc_report_shattered_families_full_repo rt_nov2011release.pdf white house, office of the press secretary [wh ops]. (2017, january 25). executive order: enhancing public safety in the interior of the united states [press release]. retrieved from https://www.whitehouse.gov/the-pressoffice/2017/01/25/presidential-executive-order-enhancing-public-safety-interiorunited wh ops. (2014). letter from the president -efforts to address the humanitarian situation in the rio grande valley areas of our nation’s southwest border [press release]. retrieved from https://obamawhitehouse.archives.gov/the-pressoffice/2014/06/30/letter-president-efforts-address-humanitarian-situation-rio-grandevalle author note: address correspondence to: megan finno-velasquez phd, school of social work, new mexico state university, 11024 montgomery blvd. ne, pmb #300, albuquerque, nm 87111. email: mfv@nmsu.edu file:///c:/users/vdecker/downloads/arc_report_shattered_families_full_report_nov2011release.pdf file:///c:/users/vdecker/downloads/arc_report_shattered_families_full_report_nov2011release.pdf https://www.whitehouse.gov/the-press-office/2017/01/25/presidential-executive-order-enhancing-public-safety-interior-united https://www.whitehouse.gov/the-press-office/2017/01/25/presidential-executive-order-enhancing-public-safety-interior-united https://www.whitehouse.gov/the-press-office/2017/01/25/presidential-executive-order-enhancing-public-safety-interior-united https://obamawhitehouse.archives.gov/the-press-office/2014/06/30/letter-president-efforts-address-humanitarian-situation-rio-grande-valle https://obamawhitehouse.archives.gov/the-press-office/2014/06/30/letter-president-efforts-address-humanitarian-situation-rio-grande-valle https://obamawhitehouse.archives.gov/the-press-office/2014/06/30/letter-president-efforts-address-humanitarian-situation-rio-grande-valle ______________________________________ cristina mogro-wilson, phd, msw is an associate professor, alysse m. loomis, lcsw and crystal hayes, msw, are doctoral candidates, school of social work, university of connecticut, hartford, ct. aubri drake is clinical research administrative coordinator, baystate state health system, springfield, ma. melanie martin-peele is at the health disparities institute, st. francis health care, hartford, ct. judith fifield is at the health disparities institute, university of connecticut health center, farmington, ct. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1068-1084, doi: 10.18060/22293 this work is licensed under a creative commons attribution 4.0 international license. supporting recruitment and retention of young african-american and hispanic fathers in community-based parenting interventions research cristina mogro-wilson alysse m. loomis crystal hayes aubri drake melanie martin-peele judith fifield abstract: few studies to date have provided strategies for maintaining low rates of attrition when conducting longitudinal, epidemiological, or community-based research with young, minority, urban fathers. this paper highlights lessons learned from a 5-year randomized controlled trial of a fatherhood intervention that designed and implemented state-of-the-art and culturally relevant recruitment and retention methods with 348 young fathers ages 15 to 25. qualitative findings are drawn from interviews with fathers who had been enrolled in the fatherhood intervention (n=10). while traditional recruitment and retention methods, such as incentives, were employed in this study, non-traditional methods were used as well, such as intensive community outreach, staff relationship development, recruiting specialists, and flexible contact methods. these methods were found to be helpful to young fathers in the study. future research should incorporate, and further study, such non-traditional methods for recruiting young, minority, urban fathers into studies of parenting programs, including randomized control trials, to improve services for this underserved population. keywords: fathers; community-based research; recruitment; parenting including fathers in parenting interventions is important to children’s well-being. fathers play an important role in children’s development and competence (dubowitz et al., 2001), and interventions that include both parents have more positive impacts on parenting practices and children’s outcomes (lundahl, tollefson, risser, & lovejoy, 2004). twentyfive percent of african american males, and 19% of hispanic males father children before the age of 20 (martinez, chandra, abma, jones, & mosher, 2006). young fathers, who have children as adolescents or young adults, are particularly important to engage in parenting programs, as they are at higher risk for future unintended pregnancy and other health risk behaviors compared to older fathers (khurana & gavazzi, 2011). despite the risks associated with early fatherhood, there are limited pregnancy prevention and parenting programs targeted at young fathers (aggleton & campbell, 2000; lewin, mitchell, burrell, beers, & duggan, 2011). for those programs that do exist, there is a need for research examining recruitment and retention, particularly for minority young fathers (trivedi, brooks, bunn, & graham, 2009) who have consistently higher birth rates compared to white fathers ages 15-25 years of age (hamilton, martin, & osterman, 2016). https://creativecommons.org/licenses/by/4.0/ mogro-wilson et al./supporting recruitment & retention 1069 the parenting challenges that young minority fathers face highlight the need to focus on ways to improve recruitment and retention of these fathers into pregnancy prevention and other parenting programs. young, low-income, minority fathers young fathers are at increased risk for additional unintended pregnancy compared to young men the same age who are not fathers (burrus, 2018; centers for disease control, 2013). young fathers are also at higher risk for participating in sexually risky behaviors, such as not using condoms that could lead to subsequent pregnancies and hiv/aids or other sexually transmitted diseases (bronte-tinkew, burkhauser, & metz, 2007; mogrowilson et al., 2018). young men who become fathers in their teens are more likely to live in poverty, encounter school hardships, leave school prior to graduation, and other negative consequences compared to their peers who are not fathers (xie, cairns, & cairns, 2001). however, research shows that some of the negative consequences for young fathers can be tempered by parenting programs that help fathers become positively involved in their children’s lives and well-being (buston, parkes, thomson, wight, & fenton, 2012; carlson & magnuson, 2011; jeynes, 2015; milkie & denny, 2014; palm & fagan, 2008). parenting programs with fathers although parenting programs benefit fathers and their children, recruitment of fathers into such programs remains a challenge for fatherhood program providers. studies on rates of father participation reflect this difficulty. a meta-analysis of the parenting program triple p, which targets both fathers and mothers, analyzed randomized controlled trials of triple p that either specifically targeted fathers or included fathers (fletcher, freeman, & matthey, 2011). this analysis found that out of 4,959 participants in 21 studies across several countries, only 20% of the participants were fathers. furthermore, a systematic review of father participation in child maltreatment prevention programs, all of which involved a parenting education component, found father participation rates to be less than 30% (smith, duggan, bair-merritt, & cox, 2012). in a study of providers of parenting programs, one-third of providers reported that fathers rarely attended programs (tully et al., 2018). these studies reviewed father participation without differentiating between races and ethnic groups. while data on rates of african american and latinx father participation in parenting programs are scant, there is sufficient evidence that participation rates among minority parents may be lower than among other groups (caldwell, bell, brooks, ward, & jennings, 2011). a few studies have suggested strategies for maintaining low rates of attrition when conducting longitudinal, epidemiological, or community-based research among fathers (anderson, kohler, & letiecq, 2002; caldwell et al., 2011; gordon et al., 2012; mogrowilson & fifield, 2018). barriers to engaging in parenting interventions identified by fathers include fear of opening up to other men in groups, difficulty balancing employment and parenting programs, and a lack of tangible social supports within parenting programs that can alleviate financial stressors (anderson et al., 2002). provider experience and organizational support, such as emphasizing the inclusion of fathers in program materials, are predictive of increased father engagement in parenting interventions (tully et al., advances in social work, fall 2018, 18(4) 1070 2018). in focus groups of providers and african-american fathers not currently participating in parenting programs, providers identified that word-of-mouth, where participants tell other potential participants about the parenting programs, and targeted recruitment, where individuals are sought out for participation based on key characteristics or relationships with agencies, are effective recruitment strategies for fathers (stahlschmidt, threlfall, seay, lewis, & kohl, 2013). in these focus groups, fathers identified increased advertising (not only targeted) and tangible incentives, such as transportation were also key to overcoming barriers to engaging fathers in parenting programs. recruitment strategies have been sought out from urban african-american fathers not currently engaged in a parenting program (stahlschmidt et al., 2013) and fathers involved in parenting programs (rather than fatherhood programs specifically; anderson et al., 2002; fletcher et al., 2011). however, no information is currently available specific to the recruitment and retention of young urban minority fathers in pregnancy prevention and parenting programs. therefore, there is little systematic discussion on how to successfully implement parenting and prevention strategies among young urban fathers. an assessment of methodological strategies for conducting longitudinal prevention research with young fathers is necessary to advance the science of pregnancy prevention and fatherhood and address the risks uniquely associated with early parenting. importance of retention in parenting programs agencies offering parenting programs to young parents have increasingly been challenged to create evidence-based practices in their settings. in order to establish evidence for an intervention, agencies are often expected to use randomized controlled designs that collect longitudinal data with a focus on retention into such trials. much of the research on participant retention has focused on randomized controlled trials of diseases such as diabetes, heart disease, and cancer (bailey, bieniasz, kmak, brenner, & ruffin, 2004; froelicher et al., 2003; katz et al., 2001; parra-medina et al., 2004) with less of an emphasis on exploring participant enrollment and retention in prevention studies. however, retention rates in pregnancy prevention studies range from 24-76% (corcoran & pillai, 2007), a stark difference from retention rates of 59-99% common in clinical studies (robinson, dennison, wayman, pronovost, & needham, 2007). the difference in retention rates may reflect a difference in motivation for study participation. for example, study participants in health care research are often recruited from clinical settings in institutions where they are patients and thus highly accessible. in conventional clinical studies, a patient may continue their participation on the basis of anticipated health benefits. in contrast, in prevention intervention studies, participants may be less likely to see an immediate need for the program, and program benefits may be less clear or take longer to emerge (becker, hogue, & liddle, 2002; spoth & redmond, 2000). motivations and benefits for young urban fathers in longitudinal prevention intervention studies are unclear and often confounded by issues of income, education, race, and social capital. there is a legacy of distrust, bias, negative perceptions, and poor communication for african american and latinx communities when it comes to interacting with health care service providers (corbie-smith, thomas, & st. george, 2002). some mogro-wilson et al./supporting recruitment & retention 1071 african americans have reported they do not feel respected by providers, often leading to mistrust of anyone related to health care services or research (gordon et al., 2006). there is also a documented lack of communication between minority communities and their providers, which further contributes to mistrust of services being offered, ultimately leading to underutilization of those services (travaline, ruchinskas, & d'alonzo, 2005). for community-based programs, challenges around mistrust must be overcome in order to build public health studies that will lead to better services and improved outcomes within low-income minority communities. this is particularly important given that government funding agencies are requiring treatment and prevention grantees to have retention rates of at least 80% for their projects to be considered “successful.” research on recruitment and enrollment must address the value of multicultural community organizing and engagement. for example, events should involve opportunities for community celebration with families as a medium for community collaboration and outreach.. these strategies may result in higher retention rates, and thus more valid research and better opportunities for care within marginalized communities. current study longitudinal studies of young adult pregnancy prevention programs generally have been associated with prevention in school-based settings, where the targeted youth are a captured population, enrolled and attending school. additionally, such studies have typically primarily focused on females (aggleton & campbell, 2000; trivedi, bunn, graham, & wentz, 2007). longitudinal studies of hidden and hard-to-reach populations, such as young fathers, are less common. longitudinal studies among these subpopulations require the use of multiple innovative retention techniques. these techniques are specific to each subgroup and their respective contexts. this paper seeks to add to the scant literature base regarding recruitment, enrollment, and retention in studies with young, minority fathers using the experience and lessons learned in a five-year rct of a parenting intervention implemented with low-income minority fathers that designed and implemented novel recruitment methods. methods intervention design the current study reports on experiences and findings from a larger collaborative study designed and undertaken by a university-agency partnership in connecticut. agency staff recruited and randomized participants, conducted the intervention, and collected data with training. the university partner provided scientific quality control monitoring, data management, and data analytics. between 2011 and 2016, 348 fathers aged 15-25 were enrolled from a city in the northeastern united states, in a highly dense low-income area. eligible participants were males ages 15-25 who had fathered one or more children with a female under the age of 21 at the time of enrollment. approximately 62% (n=215) were hispanic, 38% (n=132) were african-american or black, 5% (n=17) were white, 2% (n=7) were american indian or alaska native. at the start of the study, 35% (n=121) had a high school diploma, and 38% (n=132) were still in school and all were unmarried. fathers were advances in social work, fall 2018, 18(4) 1072 randomized by enrollment wave into the intervention condition, fatherworks, or to the control condition, the standard-of-care program 24/7 dads. the intervention condition, fatherworks, was comprised of five components: 1) a 15-session parenting intervention, supporting father involvement (sfi) group (cowan, cowan, pruett, pruett, & wong, 2009); 2) a 13-session employment class, supported employment (se; farr & pavlicko, 2006); 3) access to a 120-hour paid internship; 4) biweekly case management; and 5) access to behavioral health services. the supporting father involvement (sfi) parenting intervention met once a week with 120 minutes of group (cowan et al., 2009). the supportive employment (se) classes met once a week with 120 minutes of group (farr & pavlicko, 2006). individual case management occurred biweekly for 60 minutes. the control condition, 24/7 dads, is comprised of three components: 1) a 15 session parenting education class (24/7 dads) (chacon, patterson, brown, & bavolek, 2003); 2) problemfocused case management; and 3) outside referrals to other services, including behavioral health, if desired. the 24/7 dads parenting education classes are based on the 24/7 dads am curriculum (chacon et al., 2003). the 24/7 dads parenting education classes occurred once a week with 120 minutes of group. problem-focused case management was available on an emergency basis. survey data on demographics, safe sex practices, and parenting attitudes/behaviors was collected at pre-intervention, at post-intervention (14 weeks), and four, eight and 12 months after intervention. participants were given gift cards of $10, $15, $20, $30, and $50 for each completed data collection point. process evaluation data and interview groups. information was gathered from study participants in the fatherworks group regarding successful strategies, additional barriers, and future suggestions to increase recruitment, enrollment, and retention of young, urban, minority fathers into the identified prevention programs. interviews of two fathers per group were conducted by the university partner to explore fathers’ perceptions about the parenting programs and strategies to engage fathers in these programs. these interviews were conducted during the second through fourth year of the five-year implementation period and recruited fathers who were close to completion of the fatherworks program. prospective participants were recruited via flyers posted and distributed at the community agency’s parenting programs. to make attendance easier, interviews were scheduled directly after the day’s parenting group. a semi-structured guide was used to discuss the fatherworks program. questions covered topics ranging from issues related to parenting and co-parenting to services provided by fatherworks, from what they believed went well to what they believe did not go well in the program (see table 1 for the full list of questions). specifically, the interview guide sought to elicit information about the father’s access and barriers to services to determine: 1) how the participant became aware of the program (recruitment), 2) perception of preliminary contacts with program staff (enrollment), 3) overall experience with the program, 4) successful strategies and barriers to continued attendance (retention), and 5) suggestions for ways to engage fathers in the programs (suggestions for future recruitment, enrollment, and retention). mogro-wilson et al./supporting recruitment & retention 1073 table 1. group interview questions 1. how did you first learn about the fatherworks program? 2. what was it like for you the first time you talked with a fatherworks staff person about the program? 3. what information did the staff person give you, like the reasons you might be eligible to be in the study, when the program would be starting, what you would get out of it, etc.? 4. what services have you used in the program? 5. what was your experience with the program staff, like case managers and group leaders? 6. what do you think were the strengths of the services offered by the program? 7. what do you think were the weaknesses of the services offered by the program? 8. what were your experiences with feeling understood or accepted, or not, by the program staff? 9. what made coming to group easier for you? 10. what made coming to group difficult for you? 11. would you recommend the program to someone who’s a young dad? why or why not? 12. do you think your parenting has changed since you started the program? if so, in what ways? 13. in one of the survey questions, the respondent is asked the number of times they’ve had sex in the past 3 months (90 days). quite a few people answered “a lot.” what number seems like “a lot” to you? if you’re willing to share that number with us, please write it down on the piece of paper. don’t write anything else on the paper; we want it to be anonymous. 14. is there anything else you’d like to tell us about? all interview group facilitators received comprehensive training in qualitative interview methodology. training included strategies for reducing threats to the trustworthiness of qualitative data, including strategies for reducing research and respondent bias (padgett, 2008). five interview groups containing 2 participants each (small group size due to the volume of their answers and length of interviews) were held at varying times and days at the community-based agency providing the support services to fathers. interviews were approximately 90-110 minutes in duration. the participants (n=10) were each given a $15 gift card from walgreens or walmart. the fathers were informed that there were no right or wrong answers and to feel free to speak as openly and honestly as possible. fathers in need of transportation assistance were provided with transportation to and from the agency. interviews were audio-recorded, transcribed, and coded using thematic analysis. this study was approved by the university of connecticut’s irb (#ie-12-018so-2), and participants were consented using irb-approved procedures. data analysis. a database was developed consisting of the interview narratives. the process evaluation field notes were used to triangulate the analysis of the data to develop a comprehensive understanding of the context of fathers’ experiences in the parenting program. analysis was guided by social ecology theory (bookchin, 2005) and used nvivo, a qualitative data analysis software. data analysis was comprised of four inductive strategies (miles, huberman, & saldana, 2013). the first strategy, item level analysis, involved careful line-by-line reading of the narrative data (text files) and unrestricted initial coding. items and categories were developed through the process of constant comparison (miles et al., 2013). specifically, the research team comprised of a faculty member, a doctoral student, and an msw student, compared categories and classifications across the data. in this process, more general categories emerged. during this initial process, item codes were considered tentative and so were further explored in the next step. the second advances in social work, fall 2018, 18(4) 1074 strategy, a pattern level of analysis, established linkages among the coded items, categories, and classifications in order to develop potential taxonomies or domains (miles et al., 2013). item codes that were not considered by the research team to have utility to the research aims were excluded. based upon continuous dialogue with research members, selected codes were further collapsed or dropped from the analysis. the third strategy, the structural level of analysis, organized the relationships among the elucidated patterns of the data (taxonomies or domains) into structures. the fourth strategy, interpretation, allowed for wider theoretical meaning to structures within the theoretical framework of social ecology. all members of the research team were involved in data analysis by coding data first separately and then jointly. emergent codes were based upon consensus and those that did not reach consensus were discussed at length. on a few occasions when consensus was not reached regarding specific codes, a fourth party was consulted. this process continued until the coders reached a consistent level of coding that was monitored by the faculty member. results community involvement, staff characteristics and relationships, frequent and flexible communication, and tangible program elements emerged as key themes related to supporting recruitment and retention with the fathers in this study. key recruitment strategies included community outreach, social media campaigns, a designated recruitment specialist, and non-traditional recruitment strategies such as peer-to-peer recruiting. successful retention strategies included helpful program elements, flexible methods of communication, and relationships with program staff. suggestions were identified by fathers to address ongoing challenges to recruitment and retention in the study. recruitment and enrollment the recruitment-retention protocol developed for the study aimed to fuse evidencebased strategies with principles of social marketing. the study design called for stringent eligibility criteria due in part to funding requirements (e.g., money must be used to fund programs designed to reduce youth pregnancy). as restrictive eligibility criteria have been implicated as one of the main causes of nonparticipation in randomized controlled trials, an outreach plan was developed to recruit potential participants through three primary methods: (1) engagement of the community; (2) strategies to locate hard-to-reach populations; and (3) using culturally relevant materials. the strategies identified by program staff and participants that supported recruitment included intensive community outreach, identified staff roles for recruitment, and non-traditional recruitment methods, such as peer-to-peer recruiting. community outreach. the community-based agency conducted extensive community outreach, through support of a variety of events in the community, including a bbq and a picnic, in attempts to be more involved within the community. these events provided the community with food, music, and entertainment as well as a platform to dispense recruitment materials for the study. clinical staff were present to describe different services the agency provided. in addition, community collaborations with agencies allowed for informative presentations and referral information to be given to various organizations that provide services to youth and young adults (such as the state of mogro-wilson et al./supporting recruitment & retention 1075 connecticut department of children and families, family court, and other social service agencies). as part of a wider media and marketing campaign advertising its fatherhood services in general, the study site also conducted outreach about the fatherworks program through a variety of media activities including: appearances on radio and television shows; online radio/tv shows; podcasts; in-person interviews; live streaming interviews; inperson gatherings of young fathers, their family members and friends, and those who provide services to and/or educate them; and social media such as facebook, twitter, instagram, the agency’s website, and other applicable websites. these recruitment strategies reflected a culturally relevant method of engaging young fathers. identified staff roles for recruitment and enrollment. the presence of a recruitment specialist, typically a graduate from the program, and the use of street teams, which included peer-to-peer referrals, assisted with community-level recruitment. the recruitment specialist was able to dedicate the majority of their time to locating potential participants. recruitment staff spent hours getting names and contact information, following leads, calling and recalling numbers for months, going to locations where participants may frequent such as basketball courts, schools, hospitals, eateries, and so on. graduate interns and street teams engaged in the community were able to provide referrals to the recruitment specialist. recruitment messages in the study often emphasized four themes: 1) the value of the participant’s own story; 2) confidentiality of collected information; 3) the potential positive impact of the program on their lives, and 4) the importance of the study data in evaluating how fathers matter in their children’s lives. staff worked hard to meet with fathers on their own terms, taking the time necessary to build relationships with them. one participant noted the benefits of a dedicated recruitment specialist who was able to connect personally with the individual, noting: you know, it wasn’t really like he was telling me about the program. he was, but at the same time, he was trying to like kinda get to know me too, and not make it so professional. you know what i mean? like he’s tryna sell me a program. you know what i’m saying? like he’s tryna, how you doing man you know, i hear you got a kid coming and stuff like that, you know what i mean? like tryna get to know me, and i respected that. you know, ‘cause not a lot of people have the ability to do that, you know. make a job more than a job, so. and i respected that. building relationships with potential study participants both assisted in increasing buy-in for the community program and providing fathers with an outlet to voice their own goals and needs for the program. enlisting staff with similar characteristics as the fathers in the study were identified as a strength in building relationships and supporting study recruitment and enrollment. as one young father shared, being able to identify with staff helped him connect with the program and also helped him succeed as a dad: it’s been pretty good, cause well, like, they’re here to show us things, but like one of the staffs, he’s 20 something. he’s like almost our age, i think. so he talks about his experience too. the other two staffs, they’re like in their 40’s, so they also talk about they…when they was young, they like, how they was like, how we think we’re crazy, when they was young they did crazier things as us too. they was like, everybody grows up almost the same. so then they start[ed] talking about they advances in social work, fall 2018, 18(4) 1076 feelings. they start talking ‘bout how they raised their kids, so, like, we all bond together. while recruitment specialists, street-level recruitment, and taking time to build relationships may be time-consuming, these strategies were identified as positive and effective by fathers in this study. another successful recruitment strategy was the support of peer-to-peer referrals. the use of peers and street teams helped to ease fears about participating in a research study. retention successful retention strategies included program elements, relationships with program staff, and flexible methods of communication. program elements. several fathers expressed their appreciation for program elements in helping them set goals and meet their responsibilities as parents as a huge motivation for maintaining their enrollment with the program. one father said,“i kinda liked it. i came in... and me and him had a connection, ‘cause, um, we was talking ‘bout goals i should have, plans for the baby, and i told him all these plans i have.” in addition to supporting fathers to meet their own identified goals, fathers discussed that the tangible benefits and incentives of the program, namely the participant incentives, employment training, and supportive case management referral services, allowed them to tangibly meet goals during the course of the program. one participant noted the way to recruit other fathers into the program was to highlight the tangible study elements: um, just letting them know, just flat out, like, listen, if you do this program, you can get some money in your pocket. it could give you a decent job to put some money in your pocket so you can support yourself and your family. if you need help dealing with school, we got you. if you need, what’s the word i’m looking for, i don’t know, but if you need help in school, we got you. if you need someone to talk to, we got you. if you hungry, we got you, you know what i mean? so, that’s all of it right there. like you get fed, you get paid, you get a higher sense of being, and that’s basically it. like what else can you really ask for? what else can you really ask for? program characteristics that allowed participants to meet personal, tangible goals were identified as helpful in supporting fathers to continue in the program, even after the program had concluded. incentives for participations were also identified as positive strategies to support retention. staff relationships. just as staff trust and relationships were identified by participants as a positive strategy for recruitment in this study, positive staff characteristics were identified by fathers as a support for remaining in the study, particularly once the program ended and participants were in long-term follow-up. for example, two fathers recount their relationship with staff members as supportive and distinct to their experience in the program. so you know, yeah it was the help that came behind the free food and it’s like, it’s like, you know, it’s actually people that want to see you succeed. they’re not just mogro-wilson et al./supporting recruitment & retention 1077 doing their job. they’re people that’s really sitting there behind you, hey did you go to that interview? do you need a ride to that interview? do you need clothes for that interview? staff relationships were identified as important to fathers throughout the study, and may be underemphasized in traditional literature on enrolling and retaining low-income fathers in longitudinal prevention research. flexible communications. multiple methods of communication were used to support participant retention, including texting, calling, and in-person visits. one father explained that using text messages to confirm appointments was one way he was able to stay connected with the program, saying “so, me and the instructors, we kinda close. like, before program starts, i either text him or call him to check if there’s a program.” in addition to flexible communication, staff also made efforts to have contact information and permission for other potential points of contact for each father in the study. this assisted with contacting participants for data follow-ups once the 15-week program had ended. staff used various points of contact, such as family or friends, in order to support retention. upon obtaining informed consent at the time of the baseline interview, outreach specialists asked respondents to provide detailed information so that they could be contacted for follow-up visits and data collection. information collected on the form included the individual’s most current phone number(s), email, current address, and usual hangout. most importantly, contact information was collected for at least one friend or relative of the respondent. this person would be someone who would serve as a contact person in case staff needed to locate the respondent and could not find them using their own contact information. this latter data proved to be strategically significant given the sample was highly mobile during the course of the study. project staff made sure that the participant understood the importance of follow-up data collection being essential and integral to the research, a point that was highlighted in the informed consent procedure. when the above strategies did not yield results, research and outreach staff made phone calls and personal visits to homes. phone calls were used in two ways. first, the day before the scheduled follow-up data collection, outreach specialists would make reminder phone calls with those with valid numbers. phone calls were also used as a way to maintain contact with respondents between follow-ups. this was especially the case for those that had valid phone numbers and contributed to maintaining the staff-participant relationship. staff members also made personal visits to participants’ homes. one father recounts his experience with a staff member working to re-engage him in the study: one way that i felt accepted, or one experience, um, that happened, where i felt accepted was when i wasn’t really buying into the program and one of the staff members just basically kept like, kept trying to get me involved. you know what i’m saying? like, he showed up at the house, he called me...you know, he told me something and it was, it was crazy, ‘cause it was like, i never really heard nobody, it’s one of the reasons why i’m here today, to be honest with you. it’s, he told me, he said i’m never gone give up on you. he said there’s too many of that going on, there’s too much of that going on right now. advances in social work, fall 2018, 18(4) 1078 these home visits further contributed to the research team’s “street presence.” this street presence facilitated the process of maintaining trust and rapport with the participants. additionally, the location of the field office within the same geographic area where recruitment was taking place contributed to the interaction of staff and respondents on a regular basis. the home-visiting strategy was particularly critical during the months in between follow-ups, when participant retention and communication was more likely to drop off. identified barriers and solutions recruitment. participants identified further community outreach strategies that could be used to support recruitment for the study, including more street-level outreach that demonstrated community involvement and investment. participants suggested that getting involved in local basketball games and speaking on popular radio stations may boost enrollment. in addition, participants suggested more outreach attempts on social media sites. one father noted that this was a way to reach out to the generation of young men and fathers. “well you know, kids my generation, you know like to facebook, to twitter, and you know, i think that if they can create like social sites.” participants also suggested onetime information sessions for fathers, providing concrete parenting information and serving as gateways to the larger program. retention. despite the extensive efforts to support recruitment and retention in this study, there were still relatively high rates of attrition, with only 41% of participants responding to the 16-month follow-up survey. however, these rates were consistent with other recent longitudinal studies of pregnancy prevention (corcoran & pillai, 2007). study participants noted transportation and weather were strong barriers to retention for participants. “transportation and the weather. that’s the only thing i can say, cause if it’s raining i will not show up. knowing that i gotta take the bus from my house here, i won’t show up.” one father suggested providing transportation to participants as a strategy to overcome the transportation barrier. future studies may provide bus passes, or a central van pick-up location at key city spots, as strategies to enhance retention. follow-up visits, home visits for data collection, or data collection at central community locations may be more practical and feasible, and may eliminate transportation barriers for longitudinal follow-ups. employment, and most specifically work schedules, were also identified as a barrier to program completion. fathers noted program times would conflict with work schedules, causing them to miss group and potentially leave the program. one father discussed the challenges of balancing the program with a third shift position. “...i work third shift and the mornings were like, i’m dead (laughing). you know what i’m saying? so, yeah that was hard.” although not directly noted by participants, flexible program hours such as morning or evening sessions may be a strategy to overcoming this barrier. discussion this study builds upon the existing literature by including perspectives from young minority fathers and providers engaged in a randomized control trial of an early fatherhood mogro-wilson et al./supporting recruitment & retention 1079 prevention programs to the existing literature base. recruitment strategies such as advertisement and incentives identified by other fathers (stahlschmidt et al., 2013) were also identified as helpful by the fathers in this study. advertisement and outreach was a major recruitment strength identified by participants. in fact, fathers suggested even broader community outreach, such as engagement through social media and informal community activities, such as basketball games. this type of extensive recruitment and outreach may be particularly developmentally appropriate for young fathers. additionally, fathers noted that financial incentives and job training were incentives for both recruitment and retention in the program. some recruitment strategies identified by the fathers in this study that have not been identified in the broader research are using flexible communication and the importance of the relationship with staff. participants identified that being able to text or call a program staff member was particularly helpful to supporting retention in the program. participants also identified the importance of having a relationship with the staff; fathers reported that they felt supported by the caring relationships with staff. the importance of relationships may be of particular significance for young fathers who may not have informal support networks in their role as fathers. participants noted feeling heard and understood by program staff, and identified this relationship and communication as central to retention. this is an important finding in terms of program development in community-based programs, where staff turnover may be a barrier to continued relationship development and support of clients and participants. other research on enhancing father engagement indicates that fathers use humor and personal stories more in parenting groups and this may be helpful in further program development (frank, keown, & sanders, 2015). another successful strategy employed in this study was adopting community-organizing ideologies and strategies. these community-organizing events not only helped to build an alliance and a bridge between fathers, services, research, and the community, but they also helped to encourage behaviors that lead to more interaction with community services and programs. by adopting community-organizing tools and strategies, along with successfully incorporating social media, and other flexible communication techniques, we can increase participation of groups and communities by rebuilding that trust and through renegotiating relationships that are rooted in mutual respect and trust. over the past decade there has been increasing interest in understanding the role of the young father in condom negotiation and partner communication to decrease future pregnancies (horn, 2003; mcbride & lutz, 2004; mogro-wilson et al., 2018). despite this progress, there remain many methodological challenges in conducting studies with fathers. this paper highlighted several methodological barriers and strategies for how this project overcame these barriers, including recruitment strategies, enrollment and retention barriers, and those overarching issues that have persisted throughout the project. while traditional recruitment and retention methods, such as incentives, were employed in this study, nontraditional methods were used as well, such as intensive community outreach, staff relationship development, recruiting specialists, and flexible contact methods. although limited through a small sample size, this study gives conceptual backing for future adaptations to interventions to support hard-to-reach young fathers. the use of culturally adapted social work interventions has also been touted as a responsive way to support equal advances in social work, fall 2018, 18(4) 1080 opportunity and justice for latino/as in the 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(2018). examining practitioner competencies, organizational support and barriers to engaging fathers in parenting interventions. child psychiatry & human development, 49(1), 109-122. doi: https://doi.org/10.1007/s10578-017-07330 xie, h., cairns, b. d, & cairns, r. b. (2001). predicting teen motherhood and teen fatherhood: individual characteristics and peer affiliations. social development, 10(4), 488-511. doi: https://doi.org/10.1111/1467-9507.00177 author note: address correspondence to: cristina mogro-wilson, phd, msw, school of social work, university of connecticut, 38 prospect street, hartford, ct 06103. cristina.wilson@uconn.edu https://doi.org/10.1093/her/cyp025 https://doi.org/10.1007/s10578-017-0733-0 https://doi.org/10.1007/s10578-017-0733-0 https://doi.org/10.1111/1467-9507.00177 mailto:cristina.wilson@uconn.edu keywords: fathers; community-based research; recruitment; parenting current study methods intervention design table 1. group interview questions results recruitment and enrollment retention identified barriers and solutions discussion references _________ fredi giesler, msw, ph.d., msw program director, department of sociology, social work and criminology; robert rieske, ph.d., assistant professor, department of psychology; lacey wuthrich, lmsw, msw, clinician at idaho department of health and welfare, adult mental health act team; tara ashley msw, lcsw, msw/bsw field director/instructor, department of sociology, social work and criminology, idaho state, university, pocatello id. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 236-251, doi: 10.18060/23678 this work is licensed under a creative commons attribution 4.0 international license. meeting the grand challenges in a rural community: an ipe case study fredi giesler robert rieske lacey wuthrich tara ashley abstract: three of the grand challenges identified by the social work profession are specifically related to health care: healthy youth development, closing the health care gap, and advancing long and productive lives. idaho state university (isu) initiated a collaborative interprofessional health education project (iet) over 30 years ago. this collaborative includes ten health care disciplines across five colleges and provides indepth assessment and referral to three families annually. this study describes the development of a collaborative, high impact, teaching exemplar, and examines the knowledge, perceptions, and competency of participating students using the framework of the ipec competencies and the cswe practice competencies for social work education. results are derived from a pre-post survey administered during the previous two years. the project includes two groups of students: those that engaged in a hands-on experience with a client and those that only observed clients. the observation-only group completed the spice-r2 and the ieps. students that had direct interaction with clients completed the ieps (pre-post engagement with clients) as well as the iccas. attitudes, perceptions, and perceived competency improved amongst students participating in the iet course from pre-assessment to post-assessment with moderate to large effects being observed. keywords: grand challenges, interprofessional education, health professionals since the days of jane addams and mary richmond, social work services have been provided within an interdisciplinary service delivery context; although not always interprofessional. in rural communities interprofessional practice is a necessity because services are offered on a limited basis and providers often have dual roles. rural social workers routinely collaborate with health care providers, law enforcement, mental health specialists, educators, policy makers, clergy, and community leaders (scales & streeter, 2004). interprofessional collaborative practice is defined as: the professional practice of two or more health/social care workers from different professional backgrounds working together with patients, their families, care providers and the community to deliver the highest quality care (center for the advancement of interprofessional education [caipe], 2019; gilbert et al., 2010). to facilitate interprofessional collaborative practice, the service providers must be well prepared through their education to deliver high quality, interprofessional care (gilbert et al., 2010). in 2010, the world health organization (who) recognized the necessity for effective interprofessional practice to meet the world’s health care needs. a framework for interprofessional practice was created, which defined interprofessional education as https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 237 education that “occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (gilbert et al., 2010, p. 7). in 2011 interprofessional education collaborative (ipec) published a set of core values and practice competencies for interprofessional practice; these standards were updated in 2016 (ipec, 2016). the ipec values and competencies are consistent with social work values and education standards (council on social work education [cswe], 2015; national association of social workers [nasw], 2018). the ipec values focus on patient and family-centered care, and a practice orientation toward community and populations (ipec, 2016). there are four core interprofessional practice competencies: a) work with individuals of other professions to maintain a climate of mutual respect and shared values; b) use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations; c) communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease; and d) apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable (ipec, 2016, p. 10). the need for interprofessional practice in 2010 the who recognized a shortage of well qualified health care workers worldwide and identified interprofessional practice education as a mechanism to mitigate this crisis (gilbert et al., 2010). in 2017 social work policy makers, practitioners, educators and leaders identified 12 grand challenges for social work practice (nurius et al., 2017). three of these grand challenges are especially important to rural, interprofessional practice: a) ensuring healthy development for all youth; b) closing the health gap; and c) advancing long and productive lives (nurius et al., 2017). routine and specialized health care services, like pediatrics and associated children’s specialists, are limited in rural communities (moore & sapien, 2012). rural community members also lack access to follow-up health treatment required for successful recovery from injury or illness and the wait times for emergency services are much longer than for urban communities (buzza et al., 2011). people living in rural communities are at greater risk for poor health outcomes due to disparities in access to health care services (goins et al., 2010; lutfiyya et al., 2009). rural hospitals often do not meet national accreditation standards (lutfiyya et al., 2009). facilitating the development of competent interprofessional health/social care providers can effectively address these challenges and meet the needs of rural communities. practice competency the evidence for the need for competent social and health care providers in rural communities is clear. social work education, like most health care professional education programs, is facilitated by a set of nine practice competencies that are monitored through the cswe (2015) accreditation policy standards. these competency categories include: 1) professional identity, 2) diversity, 3) social justice and human rights, 4) research, 5) giesler et al./meeting the grand challenges 238 policy, 6) client engagement, 7) client assessment, 8) intervention, and 9) evaluation (cswe, 2015). while all areas of practice competency are important, a specific few are critical for competent interprofessional practice, including those related to professional identity, client engagement and assessment, intervention, and evaluation. in this context, social workers must understand their role and responsibility in connection with other provider partners and value this partnership (ipec, 2016). social workers must develop effective interprofessional skills to competently deliver services and meet the client/patient’s needs (cswe, 2015). competent social workers reflect on their interprofessional practice, acknowledge the strengths and talents of partners, and consider opportunities in order to better meet community needs (cswe, 2015; ipec, 2016). effective rural social workers have a broad base of practice knowledge and skill, and they respect the expertise of their collaborators in order to engage with clients, and assess their needs (scales & streeter, 2004). interprofessional practice increases client access to appropriate interventions and treatments and encourages interprofessional dialogue on best practices, outcome evaluation and application of evidence-based practice (fitzgerald et al., 2018). this approach stretches the available resources to best meet the health and welfare needs of rural communities (ipec, 2016). needs in southeast idaho in general, idaho is a rural state with 35 of idaho’s 44 counties considered to be rural by the idaho department of commerce (salant & porter, 2005). not surprisingly, idaho is ranked 46th out of the 50 states for access to a primary care physician (idaho department of health and welfare & division of public health [idhw & dph], 2019). idaho is experiencing a shortage of caregivers and health care providers to meet the needs of a growing aging population (cooper, 2018). additionally, there is a serious lack of dental care for low-income families in idaho (cooper, 2018). in 2018 access to dental health was the leading health concern in idaho statewide (idhw & dph, 2019). these needs are reflective of the “grand challenges” facing rural communities (nurius et al., 2017). rural idahoans are experiencing a number of “grand challenges” (nurius et al., 2017). compared to the national average, idaho has a low per capita income, with nearly half of the university community considered low income (census bureau, 2017; cooper, 2018; get healthy idaho, 2019). young families with children and older adults experienced decreasing wealth between 2010 and 2016 (cooper, 2018). additionally, the cost of health care in idaho is on the rise (cooper, 2018). decreasing access to resources makes collaborative, interprofessional practice a necessity. university services and professional education programs can help to fill the gap in rural, under-served communities. idaho state university (isu) is a key player in meeting the need for increased access to primary care providers (idhw & dph, 2019). the isu interdisciplinary evaluation team (iet) has provided access to specialized assessment for many families and children in rural southeast idaho for over 30 years. this collaborative is an interprofessional practice education exemplar. details about iet are discussed below. advances in social work, summer 2020, 20(2) 239 interprofessional training at idaho state university the isu interdisciplinary evaluation team (iet) offers an example of best practices in professional collaboration. this project was originally conceived in 1987 as the multidisciplinary evaluation team (met) and was comprised of faculty from audiology, nursing, psychology, social work, special education, and speech pathology. initially eight graduate students worked collaboratively with the faculty to evaluate the needs of children referred for assessment. a one-credit course was developed in 1992 with 20 students enrolled. this course functioned as a clinical team meeting with each discipline sharing their assessment findings. in the late 1990’s the project was renamed the interdisciplinary evaluation team (iet) and began to add additional health care disciplines. the iet is currently comprised of ten healthcare disciplines housed in five different colleges. the disciplines include: audiology, dental hygiene, dietetics, nursing, occupational therapy, physical therapy, psychology, social work, special education, and speech and language pathology. in 2016 the project modified some of the assessment procedures to be more consistent with ipec standards. annually, three families volunteer to be served by the team. families often refer themselves to the iet or are on a university waiting list for other isu clinic services. the interdisciplinary evaluation team facilitates a one-credit (50-minute) weekly course each spring semester. broad course objectives are centered around introducing students to the various models of team assessment processes, identifying assessment goals and procedures across disciplines, recognizing the overlap between disciplines, integrating information across disciplines, and providing interprofessional training opportunities for advanced students. course assignments include weekly in-class assessment activities, discipline assigned assessments and online reading/viewing assignments. for example, social work students use the person-in-environment (pie) assessment and the students in the class learn about the efficacy of this tool (karls & wandrei, 1998). in-class activities involve the challenging of myths and misconceptions across disciplines, more fully defining the roles of various disciplines and the language they use, and learning how to integrate information across disciplines. the course uses a “flipped classroom” approach where students access course content on moodle (learning management system) and then apply it during the class session, which is facilitated by one or two of the project faculty (cheng et al., 2019). there are approximately 60-70 students enrolled in the course annually from all ten disciplines. both undergraduate and graduate students can enroll in the class and may choose to observe the interprofessional team, or work directly with the client family, dependent on the expectations of the student’s educational discipline. all students enrolled in the iet course are required to view an online lecture as part of the “flipped learning” curriculum for each discipline throughout the semester. once the online lecture has been viewed, students have two hours to take an online quiz. the online learning portion must be completed before the discipline’s in-class session. students are asked to meet specific objectives during the iet course. these objectives include: gaining knowledge about entry level information from each discipline, identifying assessment goals and procedures associated with each discipline, having the ability to giesler et al./meeting the grand challenges 240 describe the various disciplines associated with the course, and integrating information learned into their own professional discipline. student competency is evaluated by participation in in-class interprofessional activities, completion of online assignments and knowledge on exams. in-class sessions are scheduled once a week for 50 minutes and include interprofessional interactions and activities to engage students and faculty. students complete a final exam that is worth 20% of the student’s total grade. every student enrolled in the iet course is required to observe at least one case from beginning (intake and social history appointment) to end (case review and feedback session) and many of the students are required to observe the evaluation process for all three cases. students also observe all client assessments from each discipline, for one identified client. these observations include attending the client evaluation, and meeting either through the observation room or via video conferencing. the only students in the room with the family are those individuals that completed the evaluations. this course is required for both graduate and undergraduate students in the speech and language pathology program. the role of the faculty facilitators is to model effective interprofessional practice and teach students how to effectively collaborate for the benefit of the client. disciplines generally work in teams to complete the client assessments. social work teams with psychology for the bio-psycho-social and spiritual elements of the assessment. dental hygiene and dietetics team to examine nutritional wellbeing and oral health. occupational therapy and speech and language pathology team to examine communication and oralmotor challenges. nursing and physical therapy team up to examine medical and physical challenges. special education teams with psychology in order to complete psychoeducational assessments. due to the technology required for the audiology assessment, this discipline provides an independent hearing assessment. these pairings allow students to observe clinicians (via video feed) working together to meet the client’s needs. through the iet collaborative process assessments have resulted in identifying the source of a problem that would not otherwise have been detected (e.g., one child had a serious problem with a tooth that was eliciting a problematic behavioral response and an adolescent was diagnosed with early symptoms of schizophrenia). without the team approach these problems had been overlooked in earlier evaluations. the administrative structure of the iet is informal (i.e., based on consensus decisionmaking, voluntary participation and subject to professional interest). leadership has been relatively stable since 1987. the third and current leader is a faculty member in communication sciences and disorders who assumed the position in 2018. each participating department contributes to the funding of the iet through faculty teaching assignments, and the cost of assessment materials. families are not charged for services and student tuition and public financing cover the costs associated with the iet course. the iet has produced annual reports since 2011 and these are submitted to the deans of the participating colleges. these reports detail the services provided, the costs, and the activities of the participating faculty and students. the annual reports allow the iet to reflect on strengths, progress, challenges, needs, and improvements. advances in social work, summer 2020, 20(2) 241 the previous iet leader identified three primary challenges for the iet: 1) coordinating all 10 disciplines in order to minimize redundancies and inefficiencies; 2) strengthening professional trust in order to decrease the need for “turf” protection; and 3) attending to patient outcomes and follow-up treatment (j. holst, personal communication, september 19, 2019). future program evaluation will focus on defining the diagnostic process and the impact on professional development for participating students. these goals and challenges will continue to be explored by the team and addressed as time and resources become available. this paper describes a long-standing model for interprofessional education in a rural region of the united states and presents the results of an evaluation of student attitudes related to interprofessional practice. data were collected for spring 2018 and spring 2019 and answers the question: is the iet course effectively improving student interprofessional practice competency? method research design during the spring semester students enrolled in the iet courses are invited to participate in a program evaluation of the iet process using an anonymous online survey. the iet course is offered annually, during the spring semester at a public university in southern idaho. the course is open to both undergraduate and graduate students. survey participants complete two or three standardized assessments and answer an open-ended question about the impact of the course on their values and attitudes related to interprofessional practice. participation in the evaluation is voluntary and the procedures have been approved by the university institutional review board. study participants are divided into two groups: 1) observation only and 2) direct interaction. students in the observation only group viewed the client assessment process and did not interact with client families. students in the direct interaction group conducted the assessments with families and interacted with interprofessional peers in the assessment process. survey participants of the 109 students that completed the survey, 42 (38.5%) fully completed both the preand post-surveys and were included in the current analyses. students in the direct interaction group met the following criteria: 1) the students were assessed by faculty to be professionally ready to perform the iet evaluations and were directed to actively participate in the client assessment; 2) students were involved in conducting the evaluations, presenting oral summaries at the final case review, participating in the parent interpretations, writing collaborative interprofessional reports, and assisting the case manager in follow-up activities. of the 42 participants, 18 were from the observation only group and 24 were from the direct interaction group. see table 1 for further participant demographics. giesler et al./meeting the grand challenges 242 description of the clients served by iet families, foster families, idaho state university professors, or other professionals in the southeast idaho region can make referrals or can inquire about possible participation for clients. the largest number of referrals are made due to a youth having challenges that have either not been identified or clarified, or that were identified, and the current course of treatment is not resulting in a significant improvement for the child. clients who have been served by the iet are children or adolescents who have demonstrated problems with hearing, speech, generalized development, attention, sleeping, eating, unusual behaviors, scholastic retention, self-stimulation, gaps in cognition, and/or issues related to attachment. table 1. participant demographics (n=42) n (%) observers (n=18) direct interaction (n=24) all (n=42) age (in years) 18-24 8 (44.4%) 6 (25.0%) 14 (33.3%) 25-34 6 (33.3%) 16 (66.7%) 22 (52.4%) 35-44 3 (16.7%) 2 (8.3%) 5 (11.9%) 45-54 1 (5.6%) 1 (2.4%) gender female 18 (100.0%) 20 (83.3%) 38 (90.5%) male 4 (16.7%) 4 (9.5%) race/ethnicity caucasian 17 (94.4%) 21 (87.5%) 38 (90.5%) hispanic/latinx 1 (5.6%) 2 (8.3%) 3 (7.1%) native/american indian 1 (4.2%) 1 (2.4%) completed education some college 6 (33.3%) 6 (25.0%) 12 (28.6%) associate’s degree 2 (11.1%) 3 (12.5%) 5 (11.9%) bachelor’s degree 8 (44.4%) 7 (29.2%) 15 (35.7%) master’s degree 2 (11.1%) 8 (33.3%) 10 (23.8%) student status undergraduate 13 (72.2%) 11 (45.8%) 24 (57.1%) graduate 5 (27.8%) 13 (54.2%) 18 (42.9%) previous ipe experience yes 2 (11.1%) 17 (70.8%) 19 (45.2%) no 16 (88.9%) 7 (29.2%) 23 (54.8%) identified clients are children and adolescents that range from age three years to 18 years. a parent and/or significant caregiver brings the youth to idaho state university for each assessment during a two-week time period in the spring semester and is often actively involved in the assessment process. assessments are concentrated into a two-week period advances in social work, summer 2020, 20(2) 243 in order to ensure a timely assessment for families. students conduct all assessments under the supervision of the iet faculty. a social history of the family is conducted first by the social work and psychology team in order to provide the evaluating team a picture of the child in their familial environment. most assessments outside of the social history are conducted with the child alone, unless there is an extenuating circumstance to have a caregiver present. exceptions to this might include when the child is pre-verbal or the assessor/assessment indicates caregiver input. upon completion of assessments, the family of the identified client meet with the iet to review assessment results and/or diagnoses as well as recommendations for treatment. measures of interprofessional practice participants in the observation only group completed assessments related to their attitudes and perceptions, specifically the student perceptions of interprofessional clinical education-revised (spice-r2; zorek et al., 2016) and the interdisciplinary education perception scale (ieps; mcfadyen et al., 2007). this tool is limited to measuring attitudes and values since these students did not deliver any direct services to the clients. the spice assessment tool was originally validated in 2013 with medical and pharmacy students, and the 10-item, five-point, likert-type measure was found to accurately measure student perceptions of teamwork, roles/responsibilities of collaborative practice, and patient outcomes resulting from collaborative practice (fike et al., 2013). the spice-r2 was created to measure the same factors for student perceptions and attitudes of students participating in a broader interprofessional team (zorek et al., 2016). this measure includes subscales of interprofessional teamwork and team-based practice, roles/responsibilities for collaborative practice, and patient outcomes from collaborative practice (zorek et al., 2016). this measure has been used in large assessments of student change in perceptions in the interprofessional classroom settings (lockeman et al., 2017) and has been well validated by a multi-site study (zorek et al., 2017). the ieps is a 12-item, six-point, likerttype assessment that measures perceptions and attitudes about competency and autonomy, the need for cooperation, and the actual application of cooperation (mcfadyen et al., 2007). this measure was originally developed in 1990 by luecht and colleagues, and the later version was shown to have greater validity and reliability than the original measure (mcfadyen et al., 2007). both groups completed the ieps. participants in the direct interaction group also completed the interprofessional collaborative competency attainment survey (iccas) to assess their perceived competency (archibald et al., 2014). the iccas is a 20-item, seven-point, likert-type, retrospective pre-post assessment of interprofessional competency developed for practitioners who have engaged in interprofessional education interventions (archibald et al., 2014). this measure of perceived interprofessional practice competency has been found to be a reliable measure of self-assessment of collaborative professional practice (archibald et al., 2014). analysis plan paired-samples t-tests were completed to assess preand post-improvement in attitudes, perceptions, and competency amongst the two groups and their respective giesler et al./meeting the grand challenges 244 subscales. this analysis of student outcomes examined the overall impact from pre-test (the beginning of the course) to post-test (end of the course) that the course had on improving attitudes, perceptions, and perceived competency. additional post-hoc analyses were completed to assess change within each of the subscales of the administered measures and a bonferroni correction was applied to address family wise error. a repeated-measures anova was also planned with each assessment in order to assess the potential role of other variables such as age, gender, ethnicity, previous ipe experience, and student status (graduate or undergraduate). results data was collected on 42 student participants who completed both the pre and post surveys. just under half (n=18) of the students observed the interprofessional practice process and 24 students provided direct assessment services to clients. all of the observers were female students and 20 of the direct interaction students were female. four of the participants were students of color. just over half (n=13) of the direct interaction participants were graduate students and nearly one third (n=5) of the observers were graduate students. most (n=15) of the study participants were from the speech and language pathology program. other participants represented include: psychology (n=8), dental hygiene (n=8), audiology (n=3), dietetics (n=3), and physical therapy (n=1). over half (n=24) of the study participants had prior experience in providing direct care to clients through internships or employment. lack of variance in the sample precluded the ability to assess age, gender, and ethnicity as potential factors in the relationship between the course and variables of interest as well as previous ipe experience in the observation only group (i.e., only 11% had previous ipe experience). perceptions and attitudes table 2 details the results of the ieps and the spice-r2 assessments of student attitudes. the total ieps score indicated that positive perceptions of interprofessional practice improved significantly from preto post-assessment among both observers [t(17) = -2.584, p=0.010)] and direct interaction [t(23) = -2.549, p=0.009)] participants, with each showing a moderate effect (d= -0.620 and -0.604, respectively). observers (n=18) completed the spice-r2 at the beginning and end of the course to measure attitudes relevant to interprofessional practice. the spice-r2 total score indicated that these attitudes improved significantly [t(17) = -3.081, p=0.004] by the end of the course with a moderate-to-large effect (d= -0.729). roles/responsibilities was the only subscale of the spice-r2 that indicated significant change (at the p=.017 level after bonferroni correction). the roles/responsibility subscale improved significantly [t(17) = -2.75, p=0.007] with a moderate effect (d= -0.653). additionally, there was no significant difference in observer perceptions [f(1, 15) = 0.249, p=0.313] or attitude [f(1, 16) = 0.013, p=0.455) change between graduate (n=5) and undergraduate (n=13) students in the observation only group, suggesting the course was equally effective in improving collaborative competencies across education levels. there was a significant interaction between student level (graduate=13 and undergraduate=11) and change in perception on the ieps (wilks’ lambda = .80 f (1, 22) advances in social work, summer 2020, 20(2) 245 = 5.59, p=0.014, partial η² =.203) for those in the direct interaction group, suggesting that undergraduate perceptions (mean change of 0.52) may have changed more drastically than graduate student perceptions (mean change of 0.06). there was no significant difference [f (1,22) = 0.037, p=0.424] in perception change based on previous ipe activities (n=17) versus those participants with no previous ipe experience (n=7). this suggests that the course was equally effective in improving perceptions across previous ipe experience levels. table 2. perception/attitude assessments measure observers (n=18) direct interaction (n=24) m (sd) t (d) m (sd) t (d) pre-test post-test pre-test post-test ieps 4.71 (0.41) 5.05 (0.54) -2.58* (-0.620) 4.99 (0.56) 5.26 (0.44) -2.55* (-0.531) spice-r2 3.91 (0.46) 4.25 (0.51) -3.08 (-0.729) *one-tailed, p<.01; d represents the effect size competency collaborative competencies were measured by the iccas total score for study participants who had direct interaction with clients. competency for direct interaction students improved significantly through the course from pre-test (m=6.04, sd=1.33) to post-test (m=6.67, sd=0.28); t (23) =2.37, p=0.014, d=-0.604. there was no significant difference [f(1,22) = 0.344, p=0.282] in change between graduate (n=13) and undergraduate (n=11) students, suggesting the course was equally effective in improving collaborative competencies across education levels. the roles and responsibility subscale [t(23) = -2.669, p=.007] of the iccas was the only subscale that showed a significant change (at the p<.01 level after bonferroni correction), although the communication subscale of iccas approached significance [t(23) = -2.413, p=0.012]. these results are consistent with changes in attitude and suggest that students improved their ability to carry out collaborative roles and responsibilities and to effectively communicate with their interprofessional colleagues. there was not enough variance to make comparisons based on age, gender, or ethnicity. there was no significant difference [f(1,22) = 0.749, p=0.198] in change of perceived competency based on previous ipe activities (n=17) versus those students with no previous ipe experience (n=7), suggesting the course was equally effective in improving collaborative competencies across previous ipe experience levels. student self-assessment of collaborative competency students in the observer group were asked: “how has this interprofessional experience changed your attitude and/or perceptions towards other professions?” student observers who perceived that their ability to collaborate had improved stated the following: the only profession i didn't know about as part of the team was dental hygiene. that was good to learn, since in our class we just say make referrals to the dentist. i already had a very high positive attitude towards inter-professional collaboration before this class so i would not say that it has changed much. i also already knew a bit about pt, ot, psych, and sped since i was a para in an giesler et al./meeting the grand challenges 246 extended resource room and saw a very system of interprofessional collaboration and assisted in the testing of a student who used an alternative augmentative communication device so my background already gave me a lot of respect and insight into what some of the other professions actually do. i have learned much more about specific responsibilities and ways that healthcare professions can sometimes overlap but still cooperate on a team. it has made me more aware of the scope of practice for the related professions, which may make me more likely to collaborate or refer clients to them. interestingly, students who did not perceive that their ability to collaborate had improved, identified areas where their knowledge had improved: i have just learned more about the other professions. i have a better understanding of what the related disciplines do and how the work can be coordinated. i came into the class thinking that interprofessional collaboration was important, and that hasn't changed. i do have a much better idea of the mechanics of working through a case with a team. students in the direct interaction group were asked: “how has this interprofessional experience changed your attitude and/or perceptions towards other professions?” students with direct interaction who perceived that their ability to collaborate had improved stated the following: this experience has increased my respect for other professions. i was largely unaware of the areas of overlap between my profession and others; since being exposed to the assessment and treatment that other disciplines offer, i have come to value the contributions that other team members may offer. this course allowed me to learn more about the other professions and when would be appropriate to refer to them. i thought this course was informative to give an in-depth look at the contributions and overlap other fields can provide and how they can even help inform an assessment in my profession. i highly respect other professions and what they have to offer patients within their care. i was surprised that i felt like i actually had something to contribute and that others were interested in our assessment findings. discussion the results of this study indicate that the iet course helps students to develop prointerprofessional attitudes regarding engaging with other professionals for the benefit of clients. most study participants indicated that the course positively changed their attitude about interprofessional practice and students who had experience with interprofessional practice affirmed their positive regard for this approach to practice. students clearly articulated how this experience improved their practice competency, while at the same time a valuable service is provided to the clients. these students have learned to be sensitive to advances in social work, summer 2020, 20(2) 247 the specific needs of their clients, as well as the benefit of the particular expertise that collaborative, interprofessional practice brings to bear on complex client needs. the educational strategies employed in this course are consistent with best practices outlined by the who (gilbert et al., 2010). the students in the iet class are prepared to competently engage in collaborative practice upon joining the health and social care workforce and can further the aims of the who framework for action on interprofessional education and collaborative practice (gilbert et al., 2010). according to pockett (2010), “teamwork has been given a renewed emphasis in practice” (p. 208). specifically, interprofessional practice, teamwork, and communication skills are necessities for social workers in working with individuals and families in rural communities (pockett, 2010). providers often have a duality in roles in rural communities because of a lack of resources. appreciating partnering disciplines is an integral part of working with and accepting the unique challenges that rural practitioners face (smalley et al., 2010). the pro-interprofessional attitude exhibited by the students in the iet class is particularly important for effective practice in rural communities where access to physical and behavioral health care services are limited (buzza et al., 2011). students engaged in the iet course gained increased awareness of the limited resources available to families in rural communities and how interprofessional education can extend these resources. the iet course provides an opportunity to ensure the healthy development of youth and to close the health gap for local families who have run out of options for their children’s health and social care needs (nurius et al., 2017). this project is an exemplar of how interprofessional practice is situated to address the “grand challenges” of health care practice in a rural community (gilbert et al., 2010; nurius et al., 2017). implications for iep social work education social workers follow a generalist practice model and assume a wide range of roles within the profession as a whole (cswe, 2015). these roles include: counselor, educator, broker, case manager, mobilizer, mediator, negotiator, facilitator, and advocate (kirstashman, 2013). as a generalist practitioner, it is imperative that the social work professional has a broad knowledge of interprofessional roles and how collaboration is key to client health and overall client outcomes (fitzgerald et al., 2018). the iet course provides an opportunity for students from ten different physical and behavioral health disciplines to learn together in a safe and controlled environment, while at the same time providing a valuable and rare service to a family in need. this course effectively prepares students for practice in rural communities, where interprofessional practice is essential. opportunities for enhancement/expansion the iet course at isu has been a major asset for students who have completed the requirements, as evidenced by the outcome results of this study. however, there is room for enhancement and expansion. students might benefit from a brief introductory module focused on the intent, values, and evidence regarding interprofessional practice. such an giesler et al./meeting the grand challenges 248 introduction would provide a foundational motivation of participating in the course beyond being a program requirement. there are also specific opportunities for this course to enhance social work education. this course is offered as a one credit course at isu to both undergraduate and graduate students. the newly developed isu master of social work (msw) program offers a course titled: interdisciplinary practice with children and families. if the iet course was paired with the msw elective, msw students would have greater opportunity to develop competent interprofessional practice skills in a rich and supportive educational environment. this opportunity is being offered by the msw program in spring, 2021. additionally, msw elective courses are open to graduate students in other disciplines, providing opportunities to create a truly interprofessional course in the msw program. limitations this case example may be unique to this institution, thus making it difficult to replicate in other universities based in a rural location. this study has several limitations including the fact that the researchers were not able to compare these results to a comparison group of professional health care students who were not enrolled in the iet course. it is worth noting that the study sample is small, especially compared to the number of students enrolled in these ten disciplines. students participated in this study on a voluntary basis. these limitations offer opportunities for continued research and evaluation of iet, as well as room for growth in the course throughout the participating disciplines. next steps there are two distinct areas for continued research and evaluation related to the iet. the iet leadership has noted that collaborative assessment procedures could be further streamlined to reduce redundancy and improve efficiency for providers and clients. the iet faculty and students have an opportunity to analyze all of the elements of the assessment process and identify these redundancies to then clarify who will take the lead where there is overlap in procedures. it would be worth exploring the possibility of creating a course assignment that would take advantage of this opportunity. for the sake of the wellbeing of clients, the results of such an analysis might require collaborators to relinquish “turf” boundaries and develop genuine trust in their colleagues. ambrose-miller and ashcroft (2016) suggest that successful interprofessional practitioners have a clear definition of professional roles, the specific scope of practice, and the organizational structure. attention to these factors will minimize problematic power differentials (ambrose-miller & ashcroft, 2016). having the ability to collaborate and communicate as an interprofessional team is imperative in continuing a culture of collaborative consultation in educational settings (ambrose-miller & ashcroft, 2016; gilbert et al., 2010). the second area for further research development is to follow-up with exploring client perceptions of the assessment process and the outcomes patients and their families experience. this line of research will facilitate a better understanding of the effectiveness of interprofessional education. a systematic procedure needs to be developed to effectively track families who participate in the iet and understand the impact of the assessment advances in social work, summer 2020, 20(2) 249 process. this can be an expensive process and requires that professionals integrate this procedure from the beginning of the assessment process to ensure future access to clients. since this course is offered annually, tracking family outcomes may be included as a course assignment in the class. the current iet coordinator has a strong interest in this area of research and is poised to facilitate these next steps. documenting client outcomes is an important factor in identifying the strengths and areas for growth of the interprofessional evaluation team 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(2016, april). student perceptions of interprofessional clinical education-revised instrument, version 2 (spice-r 2): instrument validation. paper presented at the university of wisconsin-madison interprofessional health summit 2016: impact of interprofessional care on chronic conditions, madison, wi. zorek, j. a., lockeman, k. s., eickhoff, j. c, & gunaldo, t. p. (2017, october). multiinstitutional validation of the student perceptions of interprofessional clinical education-revised instrument, version 2 (spice-r2). poster session presented at the collaborating across borders conference, alberta, canada. author note: address correspondence to fredi giesler, department of sociology, social work and criminology, idaho state university, 921 s. 8th ave, ms 8114, pocatello, id 83209. email: giesedna@isu.edu https://doi.org/10.1086/690562 https://doi.org/10.1080/03124070903060059 http://irp.idaho.gov/documents%2520and%2520settings/14/site%2520documents/site%2520media/rural%2520profile/profile%2520of%2520rural%2520idaho.pdf http://irp.idaho.gov/documents%2520and%2520settings/14/site%2520documents/site%2520media/rural%2520profile/profile%2520of%2520rural%2520idaho.pdf https://doi.org/10.1002/jclp.20688 mailto:giesedna@isu.edu __________ stephanie k. boys, phd, jd, associate professor, and evan m. harris, phd, indiana university school of social work, indianapolis, in, 46202. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 518-533, doi: 10.18060/22629 this work is licensed under a creative commons attribution 4.0 international license. ivf and the anti-abortion movement: considerations for advocacy against overturning roe v. wade stephanie k. boys evan m. harris abstract: as the anti-abortion movement gains ground in the united states, it is important to explore the potential impact of overturning roe v. wade (1973) on the practice of ivf (in vitro fertilization). if the united states supreme court abandoned the legal right to early pregnancy terminations, it would open the door for states to enforce laws defining life to begin at conception. in all likelihood, legally establishing life to begin at conception may make ivf far less likely to be successful, significantly more expensive, more likely to result in high risk pregnancies with multiples, and more medically invasive. as the prevalence of ivf grows, this is a practice that should no longer be ignored in the political discourse on abortion. instead, the unintended consequences of life at conception bills on the cost, availability, safety, and success rates of ivf can provide a strong argument in the toolbox of strategies for social workers lobbying against anti-abortion legislation. keywords: in vitro fertilization (ivf), policy advocacy, abortion, roe v. wade, life at conception laws the 2018 nasw policy statements specifically call on social workers to oppose the repeal of roe v. wade (1973). as the united states swings toward a more conservative supreme court with a president who has committed to appointing justices willing to overturn the case, social work advocates need to be armed with as many arguments against anti-abortion legislation as possible. roe v. wade (1973) is the united states supreme court case which stands as precedent for a privacy right that includes the ability to terminate early pregnancies. in order to prepare social workers for the impending challenges to abortion, a brief history of abortion regulations will be provided. the history requires an explanation of the right to privacy, which birthed the right to abortion in a very precarious manner. attention will then turn to the process of in vitro fertilization (ivf), and the potential impact of overturning roe v. wade (1973) on the practice of ivf. if american law were to evolve to legally define life as beginning at conception, it is unclear whether the practice of ivf would be outlawed due to conceiving embryos in a petri dish with no guarantee that they will ever be placed in a human body to continue their growth. it is possible ivf could be banned, but more likely that the procedure would instead become far more expensive, more medically invasive for patients, less likely to be successful, and more unsafe for mother and child with an increased risk of multiples. the serious potential negative consequences to ivf practice are rarely contemplated in the current public discourse surrounding abortion. however, demonstrating the potential unintended and negative consequences, primarily related to the increased inaccessibility and decreased success rates, can be another tool in social work advocates’ battle against the onslaught of new abortion regulations. https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) 519 brief history of abortion although historical literature documents that abortion has been practiced during all of recorded history, the legality of purposely terminating pregnancies has varied greatly throughout human history. in classical greece, abortion was legal as long as the father was informed (costa, 1996). some of the earliest writings about controlling pregnancies can be traced to philosopher plato. he was a proponent of state involvement in mating practices that today would be coined a eugenics program. as part of his suggestions for improving the rate of healthy births, he stated that women who became pregnant over the age of 40 should be required to have an abortion (costa, 1996). plato’s student, aristotle, furthered his ideas by proposing that the state should regulate how many children a married couple may bear, and that abortion be compelled after the maximum number of children had been reached. aristotle hypothesized that a fetus had a vegetable soul that evolved from animal to human soul over the course of a pregnancy; thus, he did not feel early abortions were ethically problematic (costa, 1996). yet even in early times, views on abortion differed within cultures (carrick, 1995). hippocrates felt abortion was immoral, leading him to incorporate a clause against abortion in his medical oath (costa, 1996). abortion continued to be a source of controversy into modern times. when the united states was founded, abortion before quickening, or noticeable movement of the fetus, was generally unregulated in most areas (engelman, 2011) and was often performed by laypersons or midwives. however, the american medical association (ama) was founded in 1847 with a strong agenda of gaining more control over the medical field for professionally trained doctors (costa, 1996). by 1859, the ama passed a resolution “condemning induced abortion, including those performed before quickening, and urging state legislatures to pass laws forbidding it” (costa, 1996, p. 7). many argue this stance, although publicly based on the rights of fetuses and a fear of declining birth rates among white protestants, was premised on reducing the legitimacy of midwives and others practicing medicine without a physician’s license (costa, 1996; nossiff, 2001). in 1873, the u.s. congress passed a comstock law that outlawed sending information about how to obtain or perform an abortion through federal mail (engelman, 2011). by 1900, antiabortion legislation had been passed in nearly every state and territory (nossiff, 2001). despite the illegality of abortion during nearly the first three-quarters of the twentieth century, abortions continued to be performed by physicians and non-physicians, often in an unsafe and unsterile manner (ferree, gamson, gerhards, & rucht, 2002). as the women’s movement grew stronger through the 1960s, so did the public outcry for abortion rights (engelman, 2011). several catalysts for change culminated in 1969 with planned parenthood coming “out in support of abortion rights, reversing its long-standing position against abortion” (costa, 1996, p. 18), the establishment of the national association for the repeal of abortion laws (naral; ferree et al., 2002), identification of the woman who would serve as the plaintiff known as “jane roe” (costa, 1996), and the start of the illegal abortion collective called jane (ferree et al., 2002). developing through an underground network at the university of chicago, jane counseled, referred, and eventually performed abortions. it is estimated jane performed over 11,000 abortions during its four years of existence (costa, 1996). boys & harris/ifv & the anti-abortion movement 520 development of the right to privacy once a plaintiff had been identified for the courtroom battle to legalize abortion nationwide, public attention to the issue rose as her case made its way through the lower courts toward the supreme court, where it was ultimately decided in 1973 (roe v. wade). between 1965 and 1972, a few states had begun to loosen their abortion laws. thirteen altered their laws to allow abortion in certain circumstances, such as rape, incest, or health of the mother (nossiff, 2001). importantly, four states permitted abortions for residents (nossiff, 2001), including new york where abortions for non-residents were also allowable (ferree et al., 2002). as the state laws began to cause chaos with persons traveling to states where abortion was more permissible and as public focus on abortion heightened, the supreme court agreed to hear the roe v. wade case in order to establish a common framework for state laws. in 1973, the supreme court penned the landmark decision roe v. wade, which placed abortion among the protected privacy rights in the due process clause of the 14th amendment. many advocates overestimate roe’s solidity within constitutional precedent. the right to privacy is not formally granted by the u.s. constitution. instead, it was first explicitly stated by the supreme court in the majority opinion of griswold v. connecticut (1965), a case challenging the constitutionality of a connecticut comstock law that banned birth control in virtually all forms. in a complex legal analysis, the court asserted that each individual right in the bill of rights works in concert to form a penumbra of rights that constitute a privacy right (griswold v. connecticut, 1965). in the griswold case, the supreme court granted the right to use birth control only to married couples. the right was later extended to non-married couples in 1972 (eisenstadt v. baird). next, the supreme court extended the privacy right to include early pregnancy abortions in roe v. wade (1973). later, in 2003, the supreme court utilized the privacy right to strike down sodomy laws being used to prosecute homosexual men, arguing again that the right to privacy extends into the bedroom (lawrence v. texas). although the privacy right has been used as precedent in several cases, the fact that privacy is not an explicit right in the constitution leaves it on precarious ground and vulnerable to solid legal arguments for overturning roe v. wade. roe v. wade stood as a block on state laws regulating abortion in the first trimester for almost two decades, but in 1992, the supreme court began a loosening of roe that increased state authority to regulate abortion in planned parenthood v. casey. casey (1992) altered the roe precedent by scrapping the trimester system for determining when abortion can be regulated and replacing it with the holding that states can regulate abortion for the safety of the mother or fetus prior to fetal viability (including viability achieved by medical intervention, which is pushing viability ever earlier in pregnancy), as long as it does not place an undue burden upon the mother’s right to an abortion. the case clearly begs the question of “what is an undue burden?” the casey case explored four examples of regulations in a pennsylvania law. the supreme court decided three of the regulations were not undue burdens: requiring doctors provide patients with informed consent, requiring women to wait 24 hours to receive the abortion after receiving informed consent, and requiring minors to inform their parents or seek a judge’s permission for the abortion. however, the court did declare requiring women to inform their husbands prior to an advances in social work, fall 2019, 19(2) 521 abortion to be an undue burden, primarily because the situation might induce domestic violence (planned parenthood v. casey, 1992). since casey’s establishment of an undue burden standard, states have added ever more abortion regulations (phillips, 2016). the majority of regulations challenged at the supreme court have been upheld, until 2016, when the supreme court decided whole woman’s health v. hellerstedt. the case challenged a texas law that required abortion providers to have admitting privileges at a hospital within 30 miles and abortion clinics to upgrade their facilities to those legally required of surgical centers. the supreme court called both restrictions undue burdens due to the cost associated with compliance. the court reasoned that the regulations were clearly about limiting abortion access as they forced many clinics to close due to the expense. the court balanced the state’s right to protect health against a woman’s right to an abortion, and concluded the restrictions did little to promote health and had a devastating effect on the number of abortion providers in texas; hence, the regulations posed an undue burden (whole woman’s health v. hellerstedt, 2016). recent limitations on abortion rights although abortion has stood as a fundamental right for nearly 50 years, it is currently resting on precarious ground. the number of regulations introduced and passed in state legislatures has been on the rise over the past few years. nearly a quarter of all abortion regulations passed since 1973 have been enacted since 2011 (phillips, 2016). in 2016 alone, 14 states passed 30 laws that made it more difficult for women to obtain abortions (phillips, 2016). additionally, many more laws were considered by state legislatures. as of september 15, 2019, 22 states had introduced 62 bills aimed at either completely banning, or banning with limited exceptions, all abortions (guttmacher institute, 2019). of the 11 enacted laws, four will only go into effect should roe be overturned (guttmacher institute, 2019). additionally, laws banning abortion once a fetal heartbeat has been detected are temporarily blocked due to pending litigation in kentucky, louisiana, mississippi, ohio, and missouri (guttmacher institute, 2019). similarly, the american civil liberties union (aclu) has already filed court cases challenging abortion bans recently signed into law in alabama and georgia (aclu of alabama, 2019; aclu of georgia, 2019). bills completely outlawing abortion are clearly unconstitutional under current case law, which explains why it is still legal in all 50 states despite legislative attempts to ban abortion (aclu of alabama, 2019; aclu of georgia, 2019). still, the anti-abortion movement has been gaining ground in limiting access to abortions. often the discourse surrounding the complete ban of abortion typically includes language defining life to begin at conception. such language is present in recently passed states laws that immediately go into effect should roe be overturned. for example, the arkansas human life protection act (2019) defines abortion as an act terminating the pregnancy of a woman and causing the death of an unborn child. the act goes on to define an unborn child as an individual human organism from fertilization up through live birth. however, since the act fails to explicitly define pregnancy, there is potential room for interpretation regarding whether the fertilization and embryonic development must occur within the body. boys & harris/ifv & the anti-abortion movement 522 the 2016 presidential election was significant for the movement with the election of a president who purports to be supportive of limiting abortion and a majority republican congress. beyond the president’s words, he has already shown commitment to appointing supreme court justices who are open to overturning roe v. wade with the appointments of neil gorsuch and brett kavanaugh (center for reproductive rights, 2018; taylor, 2017). in anticipation of a supreme court willing to hear a case on the sanctity of life, craddock (2017) argues that states not be given leeway to regulate abortion. instead, he uses an originalist theory of constitutional interpretation to argue that the equal protection clause of the 14th amendment applies to all persons regardless of birth status. he further argues, “certainly the framers of the amendment did not promote an understanding of ‘legal personhood’ separate from biological humanity” (craddock, 2017, p. 561). if more originalists are appointed to the supreme court as the current president has vowed, it is likely the right to abortion will be under serious threat. as of the time of writing, the 11th circuit court of appeals has set the stage for overturning roe v. wade by issuing an opinion highly critical of the right to privacy. in the opening paragraph of the opinion, chief justice ed carnes calls abortion law an “aberration of constitutional law” and goes on to accuse the roe court of discovering the right to privacy (west alabama women’s center v. williamson, 2018, p. 2). the opinion strikes down alabama’s ban on dilation and evacuation (d & e) abortions based on the reasoning that supreme court precedent must be followed by lower courts; however, the language demonstrates strong distaste for the procedure by often referring to the procedure as dismemberment abortion because, as the court holds, “that name is more accurate because the method involves tearing apart and extracting piece-by-piece from the uterus what was until then a living unborn child” (west alabama women’s center v. williamson, 2018, p. 3). the opinion’s language essentially begs for the ruling to be overturned by the supreme court on appeal. the process of ivf and related ethical dilemmas as with most potential legislation, there are unintended consequences ignored in the debate over abortion. if life is defined as beginning with conception, what will become of the growing field of assisted reproductive technologies (art)? the united states center for disease control and prevention (cdc; 2017) estimates 6% of married couples experience infertility each year, and this has prompted the cdc to classify infertility as an emerging public health concern. while many people may not talk about their experiences with art due to stigma and emotional distress, the use of art, and in vitro fertilization (ivf) more specifically, has been growing (cdc, 2017). in 1978, five years after roe v. wade (1973) legalized abortion across the united states, the first baby was born via ivf in england. her name is louise brown but she has historically been referred to as the “first test tube baby,” a name that sparks controversy for those concerned about scientific interference in reproductive matters (baron & bazzell, 2014). ivf has continued to become more common since its development. the prevalence of ivf in the united states doubled between 2000 and 2010 (cdc, 2011), and the cdc (2017) estimates that approximately 1.6% of all babies born in the united states in 2015 were products of ivf. advances in social work, fall 2019, 19(2) 523 irrespective of legislative changes, ivf is already a time-consuming, expensive, and medically-invasive process. typical medical protocols require the woman developing the eggs to take a course of oral and injection medications several times a day for a few weeks to encourage the body to create more than the single egg typically matured during a single menstrual cycle (o’brien, 2010). the eggs are then retrieved prior to ovulation in a procedure generally requiring light anesthesia. next, the eggs are fertilized with sperm in a laboratory and allowed to grow for 3-6 days before being transferred to a uterus (o’brien, 2010). the newly pregnant person is required to again undergo a few months of medications, some oral and some injection (o’brien, 2010). each of these ivf cycles costs on average $8,000 for the medical procedures, in addition to $3,000-$5,000 for the required medications (johnston & gusmano, 2013). despite the time-consuming, expensive, and invasive nature of ivf, the success rate per ivf cycle in the united states for those using their own eggs is currently 42.4% (cdc, 2019). very unlike natural reproduction in which embryos are created within the human body, embryos developed through ivf procedures result from egg and sperm being retrieved from the body and combined in a petri dish. a unique, but extremely important legal dilemma resides here for ivf professionals and patients. if life is defined as beginning at conception, do embryos created in a petri dish have rights? these embryos will fail to thrive if not purposefully placed in a human, female body within approximately seven days (shahbazi et al., 2016). do they have a right to be transferred to a human uterus? if so, keeping in mind that eggs may have been donated to a potential mother, to whose uterus do they hold rights? a further dilemma arises from the common practice of freezing unused embryos after a fresh ivf cycle. originally, typical ivf practice was to transfer all embryos that were created each cycle to a uterus; however, this sometimes resulted in high order pregnancies, which can be dangerous for mother and babies (mastenbroek et al., 2011). patients were loath to “waste” created embryos after the effort and cost of the process, thus, in the mid1980s, cryopreservation technology was applied to ivf practices (murphy, 2013). cryopreservation allowed for the desired number of embryos to be transferred in a given cycle, accounting for the patient’s age to improve likelihood of success, but decreased the risk of a multiples pregnancy (murphy, 2013). unused embryos are frozen for future use if the cycle is unsuccessful or for a time when more children are desired (mastenbroek et al., 2011). however, many circumstances can change after embryos are frozen: a couple may divorce, one or both partners may die, or a couple may have completed their desired family size and have no use for the frozen embryos (boys & walsh, 2017). an estimated 600,000 embryos are currently being stored in cryopreservation banks in the united states, and this number is certain to climb as the prevalence of ivf continues to grow (crockin & debele, 2014; tucker, 2014; u.s. department of health and human services (hhs), 2017). up to 25% of embryos are abandoned as “parents stop paying the storage fee, they move away, or they divorce and forget about their frozen embryos” (o’brien, 2010, p. 172). do these embryos have rights if life began when their sperm and egg met? how would the united states handle the embryos under these potential “life at conception” laws? boys & harris/ifv & the anti-abortion movement 524 the possible impact of life at conception bills on ivf what will become of ivf if roe v. wade is overturned, opening the doors for states to enforce and pass additional laws defining life as beginning at conception? some editorials have been published with the alarming message that ivf could be banned in the united states. opponents of mississippi’s proposed initiative 26, to define life as beginning at fertilization, cited concerns of halting ivf should the state constitutional amendment have passed (seelye, 2011). beyond outlawing abortions and certain forms of birth control, initiative 26 would have banned the disposal of fertilized eggs (eckholm, 2011). reaching beyond that of state and federal legislation, paulk (2014) concludes that if embryos were granted personhood, then ivf procedures would significantly challenge international human rights laws. either by way of the disposal of unused embryos being equivalent to murder or their freezing being seen as cryogenics, ivf could violate existing human rights treaties (paulk, 2014). given the decreasing viability of frozen embryos, browne and hynes (1990) argue indefinite freezing ultimately destroys the embryo and therefore is equivalent to disposal. echoing the above, davis (2014) questions the continued legality of ivf and infers, “logically, if an embryo is considered a legal person, the destruction of the embryo in any manner is tantamount to murder” (p. 316). the consequences of life at conception laws in the united states is purely speculative at this time. however, while it is possible to argue that ivf could be interpreted as completely unconstitutional, there is much more leeway in constitutional interpretation, which would be strongly lobbied for by the lucrative art community and the pharmaceutical companies that provide the very expensive medications that make ivf possible. according to the center for responsive politics (2018), the majority of ivfrelated lobbying is supported by organizations such as the american society for reproductive medicine (arsm), american academy of adoption & assisted reproduction attorneys, family research council, and ferring pharmaceuticals (a relatively small pharmaceutical company based out of switzerland). market research suggests the ivf services industry in the united states will see a 10.6% compound annual growth rate over the next couple of years, moving the market value from $2,213.1 million in 2015 up to an estimated $4,472.2 million by 2022 (jaiswal, 2017). the aforementioned organizations have a vested interest in ensuring the future of ivf in america and therefore invest significant amounts of money in lobbying. with this intense lobbying, in lieu of a complete ban on ivf, interpretation of life at conception bills would more likely strike a balance between valuing life at conception and continued support for infertility treatments. italian policymakers recently undertook a similar debate. in 2004, the italian parliament debated regulation of ivf in response to the vatican’s position that procreation is immoral outside of sexual activity (boggio, 2005). the regulations placed upon ivf in italy were based on a balance between arguments for reproductive access and arguments to value the sanctity of life (boggio, 2005). the legislation passed with three primary limitations on ivf (benagiano & gianaroli, 2004). first, the law limited the number of embryos that could be created each cycle to three. second, the law required all embryos be transferred each cycle, hence the cap at three to reduce the risk of multiples in the pregnancy. third, the law banned cryopreservation, or freezing, of embryos for future use. much of the law in italy has been dismantled in recent advances in social work, fall 2019, 19(2) 525 years (riezzo, neri, bello, pomara, & turillazzi, 2016); however, the impact of the law provides a speculative window into what ivf practices in the united states could look like if life is defined as beginning at conception and a balance between embryo rights and reproductive justice is required. while ivf might still be legal, there are a multitude of negative consequences of limiting embryo creation, requiring embryo transfer, and outlawing cryopreservation. under a legislative framework similar to italy’s former legislation, ivf success rates could be significantly lower, ivf could become even more expensive, there may be an increased rate of risky multiples pregnancies, and more medically-invasive procedures may be necessary for most persons using ivf to potentially grow their families. lower ivf success rates of initial concern is that ivf fresh cycles are far less likely to be successful if only a limited number of eggs can be united with sperm. under u.s. current standards approximately 10 eggs are retrieved during the ivf process (mcavey, zapantis, jindal, lieman, & polotsky, 2011). this number is based on attempting to mature as many eggs as possible without invoking the side effects that can arise from hyper-stimulating the ovaries (mcavery et al., 2011). since it is impossible to tell which mature eggs are most likely to result in a pregnancy, fertilization by sperm is generally attempted with all retrieved eggs. even when starting with an average of 10 eggs, the live birth success rate per ivf nondonor cycle is only 42.4% (cdc, 2019). if the number of eggs with which fertilization is attempted is legally reduced from an average of 10 to a maximum of three, the likelihood of experiencing a failed cycle would increase far beyond the current rate of nearly 6 out of 10. finally, the rate of success will further decrease as time necessary for each cycle allows aging of patients for whom age was already a factor in infertility. higher ivf cost along with lower success rates comes increased expense as more cycles would be necessary to result in a live birth. the cost of ivf per fresh cycle averages $12,000 in the united states, and the procedure is rarely covered by insurance (johnston & gusmano, 2013). in order to achieve pregnancy given reduced odds of success, ivf patients will likely have to go through more and more cycles at increasing cost. additionally, if life at conception bills outlawed cryopreservation, patients would be unable to reap the benefits of freezing embryos for a much cheaper second attempt at a live birth. the cost of an ivf cycle when cryopreserved embryos are used could be one-quarter the cost of a fresh cycle as egg retrieval and the associated costs are unnecessary in frozen cycles (van voorhis, syrop, allen, sparks, & stovall, 1995). taking cryopreservation technology out of the cost equation could take the possibility of pregnancy away from many americans for financial reasons. more multiples pregnancies if cryopreservation is not available but three embryos are created, patients will be loath to waste embryos. further, if a life at conception bill mandated the implantation of all fertilized embryos, patients may not have an option to waste embryos. yet, the american boys & harris/ifv & the anti-abortion movement 526 society for reproductive medicine (asrm, 2017) recently released guidelines encouraging doctors and patients to transfer only one embryo per cycle in the majority of cases. the organization reduced the number of suggested embryos in 2017 to reduce the risk of a pregnancy with multiple fetuses. pregnancy with multiples poses serious health risks to both mothers and babies, and greatly increases the cost of pregnancies and raising children if the children are born with special needs (asrm, 2017). if embryos could not be cryopreserved and further cycles would have to start from scratch, patients would be highly likely (or potentially legally required) to transfer all embryos created, thus increasing the risk of pregnancy with multiples. more medically-invasive procedures another potential consequence of life at conception bills is that additional invasive medical procedures and medication would be necessary for multiple ivf cycles. if each cycle must be a fresh (not cryopreserved) cycle and more cycles are necessary for success, patients will likely have to undergo the procedures and medication protocols many more times before achieving a live birth. the full risk of ivf medications are not known, but the stress of the cycles certainly has an emotional toll on individuals and couples (ockhuijsen, van den hoogen, eijkemans, macklon, & boivin, 2014). social work advocates can use ivf to argue against abortion restrictions the most recent policy statements from the national association of social workers (nasw, 2018a) proclaim, “women’s bodies have become the battlegrounds on which ideological battles are waged” (p. 265). in response, nasw (2018a) has expanded the issue of choice surrounding abortion to a more inclusive lens of reproductive justice, which includes among other issues, access to infertility treatments and assisted reproductive technologies. the nasw policy statement on reproductive justice specifically includes “opposing the repeal of roe v. wade” (p. 272). in reaching the position, nasw speaks draws upon the nasw code of ethic’s focus on self-determination and espouses: self-determination related to reproductive health means that without government interference or reproductive coercion….people should make their own decisions about sexuality and reproduction. as social workers, we support the right of individuals to decide for themselves, without duress and according to their own personal beliefs and convictions, when they want to become parents, and if they want to become parents. (p. 271) as bans on abortion expand, the profession of social work calls upon members to advocate for reproductive choice, including affordable access to both abortions and infertility interventions (nasw, 2018a). further, as outlined by our code of ethics, social workers are tasked to challenge social injustice (nasw, 2018b). denying individuals access to effective, minimally-invasive medical resources to grow their families is an oppressive act that disproportionately impacts already vulnerable populations, such as those already struggling to afford ivf, advances in social work, fall 2019, 19(2) 527 certain same-sex couples or surrogacy situations, and those with medical conditions that may make ivf a necessary option for producing biological children. political discourse surrounding abortion regulations typically focuses on fetuses developed several weeks into pregnancy. the impact upon embryos created through ivf is often left out of the discussion and debate on policy action on abortion. limiting access to and increasing the medical risks of ivf may be a serious unintended consequence for many supporters of life at conception bills. thus, social workers can leverage the potential negative impact of overturning roe v. wade on ivf in their advocacy toolbox in the upcoming years to better inform judges, politicians, and the public. for example, a common advocacy practice social workers can use to present social science research to the courts is to submit an amicus curiae brief. the briefs are intended to help judges make decisions. they provide information to the court regarding the impact of a potential court decision beyond just the facts involved in the immediate case (boys, 2010). hence, submission of an amicus curiae brief regarding ivf could be extremely beneficial for a judge or justice contemplating the unintended consequences of a law defining life to begin at conception. application of merton’s five barriers merton (1936) identified five barriers to correctly anticipating the potential for unintended outcomes of social action: ignorance, error, immediate interest, basic values, and impacts of predictions. social work advocates can apply these barriers as a framework for discussing the unintended consequences of life at conception bills on ivf. ignorance first, merton (1936) identifies ignorance, the “lack of adequate knowledge” (p. 898), as the “most obvious” and occasionally the “sole barrier to correct anticipation” (p. 898). in regard to overturning roe v. wade, much of the public may not even contemplate ivf and infertility treatment as they advocate against the abortion of a developing fetus. education regarding all aspects of reproductive health for advocates may need to begin within social work classrooms, as the council on social work education’s (cswe) 2015 educational and practice standards (epas) do not require schools of social work to incorporate sexual health or reproductive health within their curriculum (winter, kattari, begun & mckay, 2016). the most recent nasw (2018a) policy statements, however, do suggest including the reproductive justice paradigm in social work curriculums. support for reproductive health education is evidenced by a survey of social work students at a large, public university that found 41% of those surveyed did not even know if abortion was legal in their state (ely, flaherty, akers, & noland, 2012). once education is provided, trained advocates can include the aforementioned statistics on the growing prevalence of ivf in testimony, amicus curiae briefs, letters, and countless other forms of educational advocacy. advocates can expand upon the negative consequences to the many americans trying to procreate healthy families through the use of ivf, and how life at conception bills could actually hinder the ability of prospective parents to conceive biological children. boys & harris/ifv & the anti-abortion movement 528 error error goes beyond mere ignorance to include misjudgments based on assumptions, habits, or failure (willfully or otherwise) to consider all aspects of the scenario (merton, 1936). persons who have never experienced infertility may not understand how the process of ivf works. social work advocates can again use advocacy tools to provide information regarding how many embryos are typically created and why cryopreservation is beneficial. without understanding the process, policy makers may not fully comprehend how cryopreservation can make ivf less expensive, more successful, and less risky. immediate interest having a myopic focus on the immediate interest and taking action without sufficient consideration of alternative or secondary outcomes is a third barrier (merton, 1936). with a focus solely on protecting the life of developing fetuses, the rights and interests of those hoping to grow a family through development of embryos is ignored. social workers must expand the discussion of life at conception bills beyond abortion to the potential infringement on rights of those trying to create a biological family. basic values politicians sometimes espouse campaign rhetoric premised on the fourth barrier, basic values. this barrier to anticipating unintended consequences places focus on fundamental values with reduced regard for “the objective consequences of these actions but only with the subjective satisfaction of duty well performed” (merton, 1936, p. 903). enacting antiabortion legislation may allow some legislators to fulfill campaign promises and secure reelection (byrnes & segers, 1992). as such, it is critical that advocates not only open politicians’ eyes, but also educate their constituency to the wide impact their value of life might have, including preventing the development of families for persons desperately desiring to bear biological children. impact of predictions finally, merton (1936) acknowledges the ability of public predictions to fundamentally change a situation and produce an opposite outcome when human conduct is involved. for example, consider election predictions that suggest one candidate will win by a landslide. as a result of that prediction, supporters of that candidate may feel secure in a victory and become lax in their voting whereas opponents may ramp up efforts to motivate their base to increase voter turnout. though social workers cannot fully account for the impact of predictions, risks may be lessened through continued engagement, education, and action to otherwise reduce the likelihood of unintended outcomes of social actions. social work advocacy throughout the legislative process has the potential to positively impact barriers to correctly anticipate outcomes of social policy. social workers providing legislators with access to empirical research and quality information can help reduce ignorance, error, and immediate interest. providing legislators with outcomes of similar legislation in other places can increase knowledge, address assumptions, and present additional potential outcomes. smith (2017) specifically notes that there is currently a advances in social work, fall 2019, 19(2) 529 “policy window” for social work advocates to fight for reproductive justice while the issue is in the political forefront (p. 221). conclusion life at conception bills would be unlikely to outlaw ivf, but they could have a detrimental and unintended impact on ivf services and those experiencing infertility. with the potential of lower success rates, increased costs, increased chance of multiples, and more invasive procedures, ivf may no longer be a safe, viable option for individuals who need assistance to start or expand their biological families. in wake of the president’s commitment to appointing justices willing to overturn roe v. wade, and the nature of the precarious ground it rests upon, it is critical that social workers be informed and engaged in advocacy to protect rights of clients wishing to grow their families through ivf. references aclu 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(2017). embryo adoption. retrieved from https://www.hhs.gov/opa/about-opa-andinitiatives/embryo-adoption/index.html van voorhis, b. j., syrop, c. h., allen, b. d., sparks, a. e. t., & stovall, d. w. (1995). the efficacy and cost effectiveness of embryo cryopreservation compared with other assisted reproductive techniques. fertility and sterility, 64(3), 647-650. doi: https://doi.org/10.1016/s0015-0282(16)57808-x west alabama women’s center v. williamson. no. 17-15208, 2018 u.s. app. lexis 23556 (11th cir. aug. 22, 2018). winter, v. r., kattari, s. k., begun, s., & mckay, k. (2016). personal and professional values: relationships between social workers’ reproductive health knowledge, attitudes, and ethical decision-making. journal of social work values and ethics, 13(2), 35-46. whole woman’s health v. hellerstedt, 136 s. ct. 2292, 2354 (2016). author note: address correspondence to: stephanie k. boys, phd, jd, associate professor, indiana university school of social work, indianapolis, in 46202; email: sboys@indiana.edu https://www.hhs.gov/opa/about-opa-and-initiatives/embryo-adoption/index.html https://www.hhs.gov/opa/about-opa-and-initiatives/embryo-adoption/index.html https://doi.org/10.1016/s0015-0282(16)57808-x mailto:sboys@indiana.edu _________ taniko king-jordan, dsw, lmsw, former bsw program director and assistant professor, phyllis lan lin department of social work, university of indianapolis, indianapolis, in. karina gil, phd, msw, associate professor, worden school of social service, our lady of the lake university, san antonio, tx. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 374-395, doi: 10.18060/24088 this work is licensed under a creative commons attribution 4.0 international license. dismantling privilege and white supremacy in social work education taniko king-jordan karina gil abstract: the primary aim of social work is eliminating social inequalities by advocating for racial, social, and economic justice for individuals, families, groups, organizations, and communities. this commitment and promise starts in the classroom by providing opportunities for students and faculty to interact with each other and promote the core tenets of the profession. as the social work practices are shaped by the values promoted by the mainstream society, many argue that the profession is biased and does not meet the needs of black, indigenous people of color (bipoc). this issue is explored in the present study by interviewing six black female social work faculty, aiming to elucidate their experiences in academia and the social work educational environment when interacting with their white counterparts, their students, and the administration. the findings yielded by this investigation have implications for academia, as well as social work education programs and their leadership. keywords: social work, white supremacy, female faculty of color, african american, bipoc the primary aim of social work is eliminating social inequalities by advocating for equality for all individuals irrespective of their color, race, socio-demographic background, or any other characteristics. this commitment is reflected in the educational curricula and is further reinforced in the interactions among students and faculty in the classroom. in the united states, the council on social work education (cswe) serves as the national association charged with advancing the quality of social work education and is recognized by the council for higher education as the sole accrediting agency for the entire country (cswe, 2021). however, as social workers make the transition from practitioners to faculty, the ideals of the profession often become skewed or disconnected as issues of race and ethnicity are exacerbated in the academic environment, where individuals are measured by the attributes dictated by the academic institution, such as academic pedigree (where they graduated), publications and impact factors, and the number of grant dollars they can secure. in this new framework, the richness of experience that social workers bring from their previous career, and their commitment to educating and inspiring students through pedagogy, or enhancing diversity and differences, no longer seem to matter. this skewed value system is particularly damaging for faculty of color, as they must grapple with different expectations and subjective judgments of their contributions. an ample body of evidence indicates that faculty of color experience devaluation of their research agendas, while being required to engage in additional activities in the areas of service to the college, department, and university (holosko et al., 2017; jayakumar et al., 2009). as a result, these faculty members have limited time to mentor students that come from the same cultural, racial, or ethnic background. this is particularly problematic, given that academic about:blank king-jordan & gil/dismantalng privilidge 375 institutions are still predominantly white and bipoc (students) would benefit from more diverse role models. these issues have motivated the present study, the aim of which is to gain insight into the experiences of six black female social work faculty members. using a narrativeidentity approach, underpinned by critical race theory (crt) and intersectionality, their shared experiences in academia and their social work educational environment when interacting with their white counterparts, students, and administration are analyzed. history of academia academic institutions are generally perceived as safe spaces where those with inquisitive minds come to exchange their ideas and learn about philosophy, arts, and science from experts in the field. as such, academia has been celebrated as a means of advancing social mobility (sanders, 2019). however, as all institutions are inevitably shaped by the society in which they operate, american academia was originally designed to expand the minds and the ideas of white men only, while excluding everyone else (wilder, 2014). thus, as patton (2016) argued, to fully understand the present context of racism and white supremacy in higher education, it is important to acknowledge its violent, imperialistic, and oppressive past. in the same vain, kendi (2016) used the term “uplift suasion,” (p. 505) to describe the challenging position of black people in the u.s., as they are expected to take the sole responsibility for ameliorating the negative stereotypes about race and thus minimize racism reinforced by those with power. american academic institutions have a long history of racism and discrimination that dates back to their founding (harris, 2015; thelin, 2004). in the colonial area, u.s. colleges and universities financially benefitted from the slave trade, and, in order to secure further investments created curricula and conducted research that supported the enslavement of africans (harris, 2015). to justify such intentional perpetuation of white supremacy and power, scholars created theories and methodological approaches in favor of the racial inferiority of individuals of african descent and argued that keeping the institution of slavery was central to the nation’s economic success. to make this stance morally right, they purported that enslavement would bring members of the african diaspora closer to christian salvation (harris, 2015; wilder, 2014). coursework in history, religion, and other subjects was also aligned with these moral, economic, and political arguments (harris, 2015). harris (2015) found that many college campuses used or owned enslaved blacks: who erected, and maintain the buildings and grounds, and served faculty, students, and administrators. at many schools, students, faculty, and administrators brought their slaves with them . . . most students who came to these schools from all over the united states, were supporters of slavery, and some were wealthy slave owners themselves. (para. 10) at the time, exclusion was not limited to race only, as prior to the 19th century, white women were not accepted into higher education in the u.s. (chamberlain & russell sage foundation, 1988). towards the end of the civil war, faith-based religious institutions advances in social work, summer 2021, 21(2/3) 376 began to create co-educational spaces to expand higher education opportunities for women (chamberlain & russell sage foundation, 1988). however, even after the civil war, white colleges continued to limit or prevent the enrollment of students of color. in the south, legal segregation prohibited the attendance of african americans while in the north, a limited quota system was established. at the end of the civil war, the revisions to the morrill act of 1862 granted 30,000 acres of land that could be disseminated on federal land towards building an infrastructure for the education of black indigenous people of color (bipoc; bracey, 2017; dyson & smith brice, 2016). in the early 1900s, bipoc students were allowed to gain postsecondary degrees at these institutions (u.s. department of education, 1991). even though after hard-fought court cases, such as sweatt v. painter in 1950 and brown v. board of education in 1954, access was expanded, in the south, black students continued to be segregated from their white counterparts. racial segregation in educational institutions still persists and is enacted through different means such as lack of economic mobility, lack of appropriate school funding, and housing discrimination. consequently, social mobility as the main objective of higher education remains an elusive dream for many black americans (shotwell, 2016; walcott, 2014). indeed, as argued by many authors, higher education continues to perpetuate white supremacy (corley & young, 2018; mcmahon & allen-meares, 1992). in fact, nidiffer (1999) suggests that the experiences of marginalized populations in higher education generally fall within one of five categories or a combination of these: “traditional/omission, increased inclusion, center of analysis, issue-specific, or broader social analysis” (p. 323). as a result, attempts at greater inclusion are often presented as an afterthought, rather than being guided by a broader social analysis (mustaffa, 2017; nicolazzo & marine, 2016). consequently, the perspectives of white, male, middle/upper class individuals continue to shape the educational landscape and are promoted as the universal point of view. these same arguments apply to social work education as well as the profession. this is aptly conveyed by mcmahon and allen-meares (1991), who conducted a comprehensive review of pertinent literature focusing on the social work with asian americans, african americans, hispanic americans, and native americans. their analysis of 117 articles revealed that most of the research involving people of color is naïve and superficial. similar conclusions were reached by billingsley and giovanni (1972), solomon (1976), gruber (1980), and olsen (1982), who found that racial and ethnic minorities received differential treatment within the social welfare system. the consequences of these discriminatory practices are felt in academia, as faculty of color are made to carry a heavier burden than their white counterparts (fields, 2007). given that cultural competence and expertise in interpersonal relationships are key skills for a social worker, the fact that this does not seem to apply to social workers in academia is problematic. the daily interactions of social workers, their role within the community, and their actions have lasting impacts on individuals, families, groups, communities, and organizations they purport to serve as this becomes part of the social contract, the rights, and benefits we forgo for the betterment of others (palmer, 2010). king-jordan & gil/dismantalng privilidge 377 consequently, the discrepancy in higher education that delineates these tenets and values for faculty of color must be urgently addressed. a review of social work discriminatory practices in academia social work is a profession that seeks to enhance human well-being and helps meet the basic needs of all individuals (national association of social workers [nasw], 2017). as a profession embedded in a society with historical and ever-present ties to racism and oppression, its practices and the institutions charged with educating and cultivating future generations of social workers reflect these societal trends and struggles. for example, throughout the history of social work, the profession has often been criticized for failing to meet the needs of people of color (corley & young, 2018; sakamoto, 2007). according to schiele (2007), the evolution of social work practice and education can be segregated into four waves, the first of which spanned the 1965−1974 period and focused on the emerging concepts of race and ethnicity. in the second wave, relating to 1975−1984, focus was given to gender and race, as it coincided with the feminist movement. the third wave, spanning the 1985−1996 period, corresponded to the lgbtqi movement, championing equal rights for all people irrespective of their sexual orientation. the last wave, which commenced in 1995 and continues to the present, has a much broader focus, as it addresses the intersection of race, ethnicity, sexual orientation, physical and mental abilities, and social class (schiele, 2007). a close look at these waves reveals that the issues affecting bipoc and other minority groups have been neglected in social work research and practice. yet, despite these evident blind spots, throughout the 20th century social workers have strived to promote their professional status by demonstrating that goodwill and intentions did not necessarily translate to good social work practice, augmenting their knowledge and skills, advancing their educational curricula, establishing professional organizations vested in social justice, publishing books linking practice and theoretical social work frameworks, creating professional journals, and identifying core values all social workers should uphold (baker gary & gary, 1994). however, as a part of this initiative, the roles and contributions of black social workers, and other racial and ethnic groups of color who played a significant role in establishing the professional status of social work, were erased (baker gary & gary, 1994). according to gregory (2021), this practice can be attributed to the profession being predominantly white and lacking any accountability to its commitment towards social justice. as a result, academic social work continues to perpetuate racists practices (corley & young, 2018; mcmahon & allen-meares, 1992). these issues are further exacerbated by the fact that, for a long time, african americans interested in pursuing specialized social work training and internships were denied access, especially in southern states (baker gary & gary, 1994). as a response to this discrimination, certain institutes sponsored short training programs to help these individuals gain the requisite knowledge, skills, and values (baker gary & gary, 1994). as these measures were clearly inadequate, in 1911, the first social work training program for blacks was established at fisk university (baker gary & gary, 1994). advances in social work, summer 2021, 21(2/3) 378 in the decades that followed, black social workers significantly contributed to the profession by not only creating programs to educate the community and other social workers but also through delivery of services that had previously been neglected. in their efforts, they leveraged black churches and other organizations, participated in mutual aid, and strategically partnered with the community to combat social problems. some notable pioneers, such as eva d. bowles, eugene knickle jones, forrester b. washington, e. franklin frazier, and george e. hayes, spearheaded the profession of social work and made it a desirable profession for african americans, yet their leadership efforts are absent from the social work history (baker gary & gary, 1994; national association of black social workers [nabsw], n.d.). in recognition of these shortcomings, the cswe took the initiative to spearhead the development and re-imagining of the core tenets of the profession. with the aim of promoting social, economic, and environmental justice more effectively, in 2005, a social work congress convened by the nasw, the council of social work education, and the national association of deans and directors, addressed racism as a part of 12 imperatives to work on over the next decade. to aid with this initiative, in 2006, nasw issued a detailed update to their statement on racism, calling upon all social workers to continuously acknowledge, recognize, and confront all forms of racism within all the institutions that are relevant to social work (nasw, 2007). despite these efforts, the profession of social work continues to be impacted by racist ideologies (mccoy, 2020). while the field of social work has benefited from anti-blackness, violence, and institutional racism, academia still suffers from “apartheid” on knowledge, given that a large number of publications on people of color and by people of color are rejected by peer-reviewed journals (bernal & villalpando, 2002). this practice has led many authors to conclude that research on racerelated themes is not valued or considered good scholarship (bernal & villalpando, 2002; holosko et al., 2017; jayakumar et al., 2009). this evident lack of attention and inaction on issues related to social justice brings the profession’s true commitment to ending all forms of oppression into question (bowles & hopps, 2014; briggs et al., 2018; schiele & hopps, 2009). the lack of social work leadership in this area has not gone unnoticed, and its silence has been categorized as “discomforting” (allen-meares & burman, 1995, p. 271) and “unnatural” (holosko, et al., 2017, p. 273). many authors argue that these issues stem from white ideology that neglects the experiences of people of color by adopting inappropriate research methodologies (sakamoto, 2007; smith, 2012; strier, 2007) but also by failing to recognize the specifics of minority groups (mokuau et al., 2008; pelczarski & kemp, 2006), and by ignoring the contributions of scholars of color (bernal & villalpando, 2002; holosko et al., 2017; jayakumar et al., 2009). according to the available records, in 2016, 680,000 social workers were employed throughout the united states and this number is projected to increase by 100,000 in 2026 (torpey, 2018). however, while a large percentage of these individuals are women and racial minorities, and the clients they serve are increasingly diverse, the number of social work faculty of color is very limited. according to the cswe 2017 statistics on social work education in the united states, in 2017, 914 (15.7%) full-time faculty identified as african american or black, with only 170 (3.1%) as other latino or hispanic, 84 (1.8%) king-jordan & gil/dismantalng privilidge 379 as chicano r mexican american, 66 (1.2%) as puerto rican, 53 (1%) as american indian/native american, 390 (7.1%) as asian or other asian, and 19 (0.3%) self-identified as pacific islander, respectively, compared with 3,474 (63.6%) who identified as white, non-hispanic (cswe, 2017). aside from the evident scarcity of bipoc in social work departments, those that have secured their positions in academia usually tend to be in the lower echelons of the labor hierarchy (aparicio, 2013; charity et al., 2020; rooney, 1987). faculty of color although gender disparity in academia has been addressed to an extent, bipoc faculty are still in a significant minority (alleman et al., 2017). as a result, they are subjected to the same types of discriminatory behaviors that their communities experience daily, even if these are more subtle. as many carry the burden of being viewed as affirmative action hires (fields, 2007), bipoc faculty are expected to be twice as good at their jobs as their white counterparts (white, 2015). they are also often asked to serve on more committees and mentor students at a much higher rate, but their efforts are not recognized when it comes to promotions, evaluations, or hiring (fields, 2007). faculty of color must also constantly deal with disrespectful actions from students, faculty, and staff. ample body of evidence indicates that bipoc, especially women, are consistently given less respect in the classroom where their expertise is commonly questioned, receive negative student evaluations and feedback, and earn lower salaries (fields, 2007). these issues are further exacerbated for bipoc teaching courses on diversity or issues facing people of color (fields, 2007). furthermore, emails sent by bipoc are less likely to receive a response if the name of the faculty sounds non-white and/or female (jaschik, 2014). as a result of these discriminatory practices, for many bipoc, and specifically for women of color, race as a social construct remains a predictor for poorer outcomes (williams, 2018). women of color in academia lack the freedom to be authentically present and visible, as they are forced to repeatedly assert their competence and ability. according to di’angelo (2018), in many workplaces, there is a racial discomfort which is used to purport white sense of entitlement. this often gives rise to conscious or unconscious manipulative interactions, denoted as racelighting (luke wood & harris, 2021). racelighting continues to have lasting implications for bipoc because it invalidates their racialized lived experiences, forcing them to reconsider traumatic and harmful events and second-guess their experiences of it (luke wood & harris, 2021). anderson (2017) used the term “kindling” (p. 3) to describe subtle and less visible forms of violence targeting bipoc, which are particularly prominent in employment practices, housing discrimination, education, health care, and even the criminal justice system. for many bipoc in academia, these persistent experiences are exhausting. given the complex nature of issues bipoc face in all contexts, they should be viewed in relation to the intersections of their identities and experiences. for this reason, this research focuses on black female social work faculty and their interactions with their white counterparts. it is worth noting that, in the history of social work, the concept of intersectionality was neither acknowledged nor explored prior to 1995 (schiele, 2007). advances in social work, summer 2021, 21(2/3) 380 this delay in embracing this concept has had a severe impact on understanding the experiences of bipoc individuals (crenshaw, 1989). the intersectionality lens can also be applied to the bipoc experiences in the united states. according to gil and king-jordan (2020), intersectionality encompasses multiple identities an individual may hold that must be considered in tandem to fully understand this person’s lived experience. during a presentation kimberlé crenshaw shared her perspective with southbank centre (southbank centre, 2016) and concurred with this view, adding that intersectionality also requires consideration of the structures that strengthen the experiences of black women and how their narratives have been shaped by white women and black men. for these reasons, economic, political, and social intersectionality was chosen in the present study to explore the barriers encountered by women of color. african american women consistently contend with a plethora of racial bias that place added stressors to their ability to establish wellness (guerra, 2013). this is especially evident in their efforts to navigate higher education. being a female faculty of color requires that they be strong with thick skin, never showing emotion or any signs of weakness, to be assertive, but without asking too many questions. these women must perform and execute tasks at 100% all the time, and be present for every meeting, and be sure to gauge the pulse of the room as they might get called on to speak for all people of color (sanders, 2019; walter et al., 2011). thus, to better understand the experiences of black women in academia, we must recognize race as a social construct that is embedded across structures and institutions (mccoy & rodrick, 2015). crt provides a framework for understanding the experiences of bipoc and how racial inequality is perpetuated and normalized throughout the mainstream culture (mccoy & rodrick, 2015). it was initially developed to address racism and as a response to structural violence occurring in the educational space following the civil rights movement (mccoy & rodrick, 2015). in academic research, crt is extensively used to examine how race is viewed in education and how it should be used to embrace discourse and conversations around the idea of normalizing whiteness (matias et al., 2014). therefore, it can be adopted for examining the insidiousness of white supremacy throughout the educational systems in the u.s. (patton, 2016). the ultimate aim is prompting social work educational institutions to enact significant changes in their policies, processes, and systems to eliminate any barriers based on race. method this qualitative research is a part of a larger study exploring the experiences of black female faculty at different u.s. universities. the data for meeting its objectives was obtained from six social work faculty members that, coincidentally belonged to the same racial group (five self-identified as african american and one as of african origin). when analyzing the data, the narrative-identity approach was adopted, as proposed by mcadams (2008) who defined it as: king-jordan & gil/dismantalng privilidge 381 stories we construct to make sense of our lives are fundamentally about our struggle to reconcile who we imagine we were, are, and might be in our heads and bodies with who we were, are, and might be in the social contexts of family, community, the workplace, ethnicity, religion, gender, social class, and culture. (p. 242) this data collection and analysis method was chosen, as participants were asked to share their experiences by responding in writing to an online survey, thus allowing them to consider their responses carefully and complete the survey at their own pace. moreover, they could be assured of the confidentiality, and were thus more likely to respond truthfully. survey participants were recruited through social networking sites focusing on faculty of color and through linkedin. the online survey commenced with demographic questions, followed by 13 open-ended questions focusing on experiences in academia and social work. participants as previously noted, six female social work faculty took part in this study, five of whom identified as african american and one identified as an immigrant belonging to the african diaspora. the mean age of participants was 43.2. four participants held a doctoral degree, one selected jd/md, and one had an msw degree. four respondents held the rank of tenure-track assistant professor and the remaining two were non-tenured track adjunct professors. their teaching experience was diverse, ranging from 0−2 years (two individuals), to 10−15 (four participants), with one person having more than 10 years of teaching experience. four participants taught at teaching institutions and two at research institutions. finally, four participants were employed by public and two by non-profit universities. see table 1 for a profile of each participant and their institution. analytical approach as the responses participants provided to the survey were in digital format, they were transcribed and saved as ms word files before being analyzed using the narrative-identity thematic approach. the analysis commenced with the organization and preparation of the data in order to obtain a general sense of the information and to facilitate the coding process, giving rise to the categories or themes that were interpreted using excerpts from participants’ responses. next, the data were imported into the visual qualitative data management software (nvivo) and the process described above was repeated. therefore, the data was first coded manually before using the nvivo software. close readings of transcripts and the identification of key phrases led to further revision of generated codes, allowing themes that applied to majority of participants to emerge (berg, 2009; ryan & bernard, 2003). the following main themes were yielded by this process: “diversity of experience,” “racism,” “support,” “superficial relationships,” “sharing their pain,” and “strength.” thus, findings reported in this article relate to these themes and are supported by excerpts from participants’ narratives (attride-stirling, 2001; maxwell, 1996; ryan & bernard, 2003). king-jordan & gil/ privilidge 382 table 1. participants profile pseudonym age (years) terminal degree rank administrative position teaching experience (years) institution public/ private institution participant 1 n/a jd, md* tenure-track assistant professor program director 5-10 years teaching private-nonprofit participant 2** 37 ph.d. adjunct instructor no 0-5 years research public participant 3 31 ph.d. tenure-track assistant professor no 0-5 years teaching private-nonprofit participant 4 59 ph.d. tenure-track assistant professor no 5-10 years teaching public participant 5 49 ph.d. tenure-track assistant professor msw program director 10-15 years research public participant 6 40 msw adjunct instructor oversight of student success 0-5 years teaching public *teaches in the social work department **immigrant belonging to the african diaspora advances in social work, summer 2021, 21(2) 383 data verification and validation to ensure the accuracy of study findings, as recommended by creswell (2013), all transcripts were member-checked and were coded manually before using the nvivo software. member-checking was conducted by sharing the results with an african american social work faculty member who did not participate in the survey and who has expertise on the subject matter. only the results that were retained at the end of this process are reported below. results “why should my experiences in academia be any different from my everyday experiences of being black in america?” − participant 1 the analysis of the survey responses provided by the six participants yielded six main themes: experience with diversity, racism, support, superficial relationship, sharing the pain, and strengths. three of these main themes were also related to sub-themes. see table 2 for a breakdown of themes and corresponding sub-themes. table 2. themes and sub-themes experience with diversity o ineffective o inconsistent racism o hostility and differential treatment support superficial relationships sharing the pain strengths o community o self-talk o reframing o skills experience with diversity as participants were encouraged to describe their personal experiences with racism at their institutions, diversity was frequently discussed, often in negative terms, as strategies put in place were found to be ineffective and inconsistent. those that labelled their institutions’ efforts at promoting diversity ineffective claimed that this was perceived as mere rubber-stamping rather than a concerted effort at enacting change or making faculty of color feel welcome. similarly, mechanisms aimed at enhancing diversity were often found inconsistent, as they focused on students and academic staff, while neglecting those in the administrative functions. advances in social work, summer 2021, 21(2/3) 384 ineffective when describing their institutions’ efforts at promoting diversity, three participants indicated that, despite having diversity and inclusion offices or committees and offering training, they seemed incapable of establishing any real or significant changes. one individual shared, “the university has a diversity and inclusion office that is administered at the highest level of the administrative structure. however, the office does not appear to set its agenda to make the needed changes at the university.” this lack of connection to the real needs of the institution seemed to be a common experience, as indicated by another participant: i noticed my university works to offer opportunities that are diverse for students, staff, and faculty to attend. however, the diversity could expand more to encompass other groups and identities. there is no training offered on diverse groups or experiences and i believe this will be helpful for more awareness and support for faculty and students. – participant 3 inconsistent the institutions’ efforts were also deemed inconsistent, as there was evident incongruity between the racial and ethnic realities of the campus and the racial composition of those who held positions of power. several participants stated that, even though student population was racially and ethnically diverse, those who held leadership and administrative positions were predominantly white. on this issue, one participant noted: the challenge comes in with diversity in leadership and i think that impacts recruitment and retention of bipoc students and faculty. most who are chairs or heads of departments are white men or women. – participant 2 only one participant described her experiences with diversity as positive, which was ascribed to her institution being a historically black university. racism when asked to describe their experience with racism at their institutions, five participants reported racial discrimination by students, administrators, and/or colleagues. the racism experienced by these participants ranged from microaggressions to more overt types of discrimination, but was always interpreted as hostility and differential treatment. hostility and differential treatment when recounting their racial experiences, participants reported a variety of hostile and differential treatments. one participant described her interaction with students from rural settings as very hostile, attributing these attitudes to the absence of “any real individual experiences with people who do not look like them.” she also shared that “many, not all, have challenged my knowledge of course content, refused to engage in the classroom, and [have] been outwardly hostile when they are challenged by me in the classroom.” king-jordan & gil/dismantalng privilidge 385 several participants expressed that they had been treated differently by the university staff compared to their white counterparts, stating, “the standard i was held to was different so [by] the students as well as the chair;” reporting “microaggressions and micro assaults by faculty members and staff;” and, recounting experiences “primarily revolv[ing] around racism, discrimination, microaggressions, white supremacy in the reflection of treatment from colleagues, administration, and even students.” one participant indicated that her questions or feedback have earned her a label of “difficult” as she was held to different standards compared to her white counterparts. she elaborated on this view by stating, “the rules are different, the tolerance for questions and push back is less and [i am] seen in some ways as being ‘angry,’ the expectations of students as well as colleagues are different.” support the theme of support (or lack thereof) by peers, their department, and their university, featured very prominently in the responses participants provided. one participant indicated: [i] felt dismissed and ignored by the institution when i made overt gestures to create policies and recommendations to increase diversity awareness and practices that increased the university’s intent to demonstrate equity in action. – participant 6 as those who hold leadership positions have a significant impact on whether faculty feel supported or not, it is not surprising that one participant “initially felt supported as a faculty of color but that changed when leadership changed.” some participants felt supported in their academic units, but the support was inconsistent, as indicated by the following account: i have felt supported in my academic unit by others similarly situated to me. however, that support does not extend to the larger university community. the university has a conservative, anglo-saxon, patriarchally-led, and supported culture that does not support those who do not conform to its beliefs, values, language, and culture. – participant 1 another participant recalled having her lessons constantly revised by the chair when she started teaching a new course. as she was forced to seek help and clarification, she could sense “annoyance” in the way her requests were handled. she shared, “i would ask for meetings but there was a lack of flexibility and sometimes response, and then, of course, complaints were made about me.” another participant revealed how challenging it is to find colleagues that will collaborate on scholarship with her, explaining “i see this happen all the time with white assistant professors but don't see this as much with black assistant professors. black assistant professors are often left to "fend for themselves" as they navigate the academic ladder.” two participants, however, felt supported. in one case, this was ascribed to her faculty status at a historically black college. however, the other participant also noted that she advances in social work, summer 2021, 21(2/3) 386 felt supported by faculty and staff of color only, which has resulted in collaboration and co-teaching. superficial relationships participants also described their relationships with their white social work colleagues as superficial or lacking depth. the five participants who referred to their relationship as “surface level” used the terms such as “no genuine connections,” “non-existing,” “very surface,” and “hello, how are you [that] happens in passing or while sharing the same physical space, nothing substantial.” one participant stated that she had to “manage [her] own expectations about [her] experiences with them.” another participant ascribed these superficial relationships to the sense of white privilege that is rooted in racism, explaining: many of these colleagues do not operate from a lens of change and believe that we have recruited both staff and students who are “not a good fit.” this becomes a bias statement that simply reflects the predominant culture's perspective of an 'us and them' environment. – participant 6 sharing the pain several participants indicated having a “need” or “want” to share their lived experiences with their white colleagues, as they lack the understanding of the obstacles their black counterparts encounter as they navigate the academic environment. one participant expressed that she would like to tell her colleagues to “check their privilege,” while another wanted to remind her colleagues that “the reality that the ivory tower was not built for someone like me to climb to the top” and that it brings “differences in expectations and treatment” to someone like her. one participant expressed, “[i am tired] of my trauma being used as a voyeuristic process for colleagues and my experiences being challenged as ‘maybe they did not mean it that way or you're looking into it too much’.” strengths participants spoke at length about the strength and resilience needed to survive and coexist in the social work academia. they drew upon the support of their community, as well as relied on self-talk, reframing, and other skills. community for all participants, communities of support were essential in coping with institutional racism, as they were a source of strength, encouragement, and connection. in most cases, such support was offered by individuals outside of their departments and institutions, who could “validate [their] humanity and experiences.” one participant shared how she has created “a unique group of friends who share ideas and opportunities to connect.” she added that she also relied on several social media groups for forging such supportive partnerships. king-jordan & gil/dismantalng privilidge 387 several participants highlighted the importance of maintaining relationships with their mentors to help them cope and navigate academic life. one participant shared that she engages in “frequent conversations with her assigned mentor” who helps her manage uncomfortable emotions. another individual noted that connecting with those who came before her “and successfully navigated these waters” was particularly beneficial for her. self-talk several participants engaged in motivational self-talk to help them find strength needed to navigate and survive academia. one participant shared that she often tells herself to stop being emotional and start being more logical about her environment, as this helps her “anticipate moves from those that are hostile” towards her. another participant is more inward-oriented, as she considers “how can i make a reasoned counter move to your move if i’m blinded by the transaction.” reframing participants also found changing the way they view or think about their experiences helpful. this reframing process is an important survival skill, as it allows them to operate more effectively in academia. for example, one participant shared that she re-tooled the word “privilege” to empower her to see being african american as a privilege that allowed her to embrace her “grit and determination to succeed in the academic environment.” another participant reported that she developed “awareness that the academic ladder may not even be equipped for someone” like her, adding that it is ok to “recognize [that] your strengths can be invested in [a] different setting.” one participant stated that she just stopped “expecting fair treatment,” while another opined that her “uncomfortability has become routine.” skills all participants developed the skills they felt they needed to cope with academia, most notably resilience, strength, and management of expectations. some participants found their voice to speak out while others learned to be more strategic and to operate with a plan. in addition, participants shared that all together, they found the “strength to persevere” and to “remain resilient against adversity.” discussion based on the tenets of the social work profession, it is easy to have an idealized view of the way faculty from bipoc communities are treated by their white colleagues. at a minimum, academic social work departments should provide an environment that ensures the well-being of all. however, the six individuals that participated in the present study had been subjected to discrimination and racism not only within their wider academic institutions but also within their social work departments. these findings corroborate the results reported by other authors (corley & young, 2018; mcmahon & allen-meares, advances in social work, summer 2021, 21(2/3) 388 1992). therefore, even if racial practices may have morphed to be less evident or overt, social work academia as an institution continues to hold and perpetuate racial inequality. however, this still constitutes racism that must be eradicated more effectively and systematically. most participants in this study were of view that the way that their academic institutions have been addressing the issues of diversity and inclusion is ineffective and inconsistent. social work departments, as a part of large institutions and reflective of the general society, do not seem to fare any better. according to the current study participants, collegial relationships with white social work faculty seem to be plagued by microaggressive and racist practices. this finding is in line with the crt postulates, as it acknowledges that racism is alive and well in the american society, and that the history of slavery and racism in which the academic institutions were founded persists to this day, and social work is not protected from it. a brief overview of the history of social work confirms that the white perspective has dominated the profession. schiele (2007) described the history of the profession in terms of four waves, indicating that the concepts of race and ethnicity were absent from the social work prior to 1965, which coincided with the emergence of the civil rights movement. the three subsequent waves similarly responded to the changing social landscape, and thus explored and integrated the concepts ascribed to intersectionality, and included race, ethnicity, sexual orientation, physical and mental abilities, and social class (schiele, 2007). the framework of intersectionality was not fully conceptualized until the fourth wave which commenced in 1995 due to the constant denial of the pervasiveness of racism and oppression in social work. as such, prominent white authors who attest to the call for social justice leveraged their power and privilege to narrate and interpret a critique on the experiences of bipoc to make information sharing more palpable for their counterparts (gregory, 2021). these overt acts constitute an “absent presence of whiteness” and can be viewed as a pattern of structural violence (gregory, 2021). this research sheds light on the lived experiences of six black female social work faculty as they navigate academia and interact with their white counterparts. their accounts demonstrate that, despite having the skills and training to develop meaningful relationships with individuals from diverse groups, white social work faculty are not utilizing those skills to forge more cordial relationships with their colleagues of different race or ethnicity. this finding speaks to the realities of the social work curriculum that usually includes surface education on diversity and inclusivity. yet, extant research on this issue remains scant. participants in this study described several strategies they employed to survive and navigate this hostile environment. they created plans, found social support outside of their departments and institutions, shifted their thoughts through self-talk, and developed resilience skills. in their recent study, gil and king-jordan (2020) examined female bipoc’s access to power and leadership, reporting that women of color who successfully secured leadership roles identified creative strategies to overcome fear that could impede their capacity to advance and progress in their respective fields. king-jordan & gil/dismantalng privilidge 389 as expressed by the six social work faculty that contributed to this research, to live up to the values and ethics of the profession, social work departments, white faculty, and students have a lot of work to do to dismantle racism and white supremacy in social work education, which starts by recognizing that these issues exist. moreover, to truly engender change, social work departments must be intentional in addressing this situation and must adopt strategies that are measurable, include accountability, and change culture. if such steps are not taken, the contributions of bipoc social work faculty will continue to be measured against different standards compared to their white peers and their place in the realm of academia will continue to be questioned by students and faculty alike (bernal & villalpando, 2002; fields, 2007; holosko et al., 2017; jayakumar et al., 2009). therefore, until a systematic change takes place and their departments provide a safe space for all, they will continue to build support networks elsewhere. they will also draw upon their emotional intelligence, positive self-talk, and self-control in the face of adversity with the hope of securing their rightful place at the proverbial table. maybe in time these amazing individuals and the obstacles they had to overcome to obtain positions that seem to come easily to their white counterparts with the same experience and education will not only be recognized fully, but championed and admired for their accomplishments. limitations all studies are subject to certain limitations and this research is no exception. the main shortcoming of this investigation is a small sample of female bipoc faculty. thus, in future research, it would be beneficial to seek the perspectives of male bipoc members of academia, as well as expand the sample by including social work faculty (and faculty specializing in other disciplines) from a variety of academic institutions across the country. additionally, other research methodologies, such as ethnographies, focus groups, or faceto-face interviews, should be considered to expand upon the perspectives shared here. implications for social work educational environment social work strives to advance social and economic justice and to address issues of oppression and racism. however, the foundational practices of social work in academia have some clear racist roots and bipoc are dealing with the consequences. whiteness continues to permeate the field of social work, without any measures of accountability or critical self-reflection, which are clearly necessary to authentically understand the core values of social work (gregory, 2021). the profession of social work must commit to cultivating the knowledge and skills on the intricacies of oppression and the intersections of race for bipoc to transform and fulfill its mission of social justice (gregory, 2021). the social work profession must do a better job with dismantling white supremacy in order to live up to its mission and honor its code of ethics. as a profession that shares a commitment to culturally competent practice, there should be an intentional emphasis on the work conducted by social justice advocates of color. systematic exclusion of bipoc from academia has been normalized and social work as an academic institution must own its responsibility and rise to its mandate to ensure the advances in social work, summer 2021, 21(2/3) 390 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(2018). race and poverty: growth areas for social work research agenda. social work research, 42(2), 67-70. https://doi.org/10.1093/swr/svy009 author note: address correspondence to taniko king-jordan, phyllis lan lin department of social work. 1400 e. hannah ave., indianapolis, in. 46227. email: kingjordant@uindy.edu or karina gil, worden school of social service, our lady of the lake university, 411 s. w. 24th st, san antonio, tx 78207. email: kegil@ollusa.edu https://doi.org/10.1093/swr/svy009 mailto:kingjordant@uindy.edu mailto:kegil@ollusa.edu _______ dasha j. rhodes, lmsw, phd candidate, and davida l. robinson, lcsw-c, cctp, phd candidate, morgan state university school of social work, baltimore, md 21251. paul c. archibald, drph, lcsw-c, assistant professor, morgan state university school of social work, baltimore, md 21251. laurens van sluytman, phd, lcsw, associate professor, morgan state university school of social work, baltimore, md 21251. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 217-238, doi: 10.18060/22599 this work is licensed under a creative commons attribution 4.0 international license. a decade's tale: consent decrees and police use of disproportionate excessive force with communities of color dasha j. rhodes davida l. robinson paul c. archibald laurens van sluytman abstract: according to the u.s. department of justice (us doj, 2016), african americans have experienced disproportionate instances of police use of excessive force as a result of discriminatory practices and insufficient training. officers are permitted to use appropriate force in specific situations; however, when force is excessive and deemed unnecessary, it then becomes an issue of concern. the u.s. department of justice was invited to investigate police departments that participated in the use of excessive force and a consent decree was developed with those departments to remedy the doj's findings. the researchers conducted a consent decree analysis examining government investigations of police practices throughout the u.s. between 2008 and 2018 comprising the following terms: police reform, consent decrees, settlement agreement, investigation reports, use-offorce, and policy to determine how prevalent excessive force was used towards african americans. findings indicated that within the decade, 14 cities were investigated, 12 were identified as using excessive force, with nine having their use-of-force policies available, and four municipalities using excessive force against african americans. social work values, advocacy, and cultural training were also identified to aid in the decrease of excessive force complaints. keywords: african americans; police; excessive force; policy; consent decree the use-of-force is a common and sometimes appropriate practice that occurs throughout the daily duties of law enforcement. officers are initially trained and authorized to perform forceful tactics in specified situations (u.s. department of justice [us doj], 1999); however, it becomes troublesome when wrongful use of excessive force— unnecessary force that exceeds reasonable and lawful responses—is practiced and leads to either physical harm or death (bureau of justice statistics, n.d.; danilina, n.d.; dibattista, 2017; police brutality, 2003). to give historical context, consent decrees were pioneered in 1994 under the clinton administration (stolberg, 2017). prior to 2008, six cities entered a consent decree agreement (upper marlboro, md; detroit, mi; los angeles, ca; newark, nj; steubenville, oh; and pittsburgh, pa) and three were found to engage in excessive force practices (los angeles, pittsburgh, and steubenville) (us doj, 2017). studies from these cities have reported more effective policing as a result of the consent decree; although limitations existed (davis, henderson, mandelstam, ortiz, & miller, 2002; powell, meitl, & worrall, 2017; stone, foglesong, & cole, 2009). heightened awareness of police use of excessive force has occurred within the last decade as the u.s. department of justice (doj) conducted several investigations regarding advances in social work, spring 2019, 19(1) 218 police practices across the united states. discriminatory practices and unnecessary force, specifically toward african americans, were identified in some of the investigations due to lack of training, which led agencies to enter a consent decree or settlement agreement (us doj, 2016). swift (2004) indicated that a consent decree is an agreement between parties to remedy and resolve a query pertaining to a complaint or concern without either party admitting fault or guilt. in 2016, the center for policing equity conducted a study involving 12 agencies with approximately 600,000 city residents across the mid-atlantic, midwest, south, and west regions of the united states (goff, lloyd, geller, raphael, & glaser, 2016). their findings indicated that, on average, for every 100,000 residents, excessive force was used on 108 individuals; however, the mean for whites was 76 per 100,000, while the mean for african american residents was 273 per 100,000—a rate 2.5 times higher than the overall average and 3.6 times higher than whites (goff et al., 2016). additionally, police shootings occur at a higher rate in disadvantaged, minority neighborhoods as well as cities with higher racial inequality (correll et al., 2007; mcelvain & kposowa, 2008). debates concerning the reasons for these disparities vary. for example, several researchers (macdonald & stokes, 2006; meese & malcolm, 2017) suggest that african american individuals are more likely to reside in neighborhoods with limited resources where crime is high, increasing the need for police presence, potentially increasing the likelihood of policeresident contact. others have also suggested that police expansion occurred as a result of revitalization projects that attempted to rebuild those same neighborhoods as investors sought to protect their investment, the newly arriving consumers/residents, and their business partners, which granted more contact with officers as the frequency of police patrols were increased to protect the community (van sluytman, 2017). still others have argued that both neo-conservative and neo-liberal ideological forces have engineered crime prevention as a vehicle to achieve individual responsibility and social welfare dependence deterrence in resource-poor communities (gilling & barton, 1997). these systems of policing have social and economic implications. families and communities experience adverse outcomes including a decrease in crime reporting out of fear, posttraumatic stress disorder, substance abuse, and other negative ailments that affect the health and behaviors of others (lacoe & stein, 2018). further, when death occurs, human capital or individual sustainability, known as individual qualities, that aid in personal productivity is lost. individuals are unable to work due to police-inflicted injuries and cannot contribute to the economic development of the community (leibson hawkins, 2005). taxpayers are also subject to bear the payments of victims who experienced excessive use-of-force lawsuits and the city’s legal fees due to frequent accusation of misuse of police force (kelly, childress, & rich, 2015) therefore, potentially diverting funds from other city projects and budgets (broadwater, 2017). the findings of multiple consent decrees impacted the growth of scholarly interest involving police officers and the african american community (carter & corra, 2016). advocacy, the value of human dignity, and engagement in social and criminal justice are core principles driving social work practice and scholarship (national association of social workers [nasw], 2016b, 2017). accordingly, social workers and the nasw called for police reform that does not compromise public safety but gains public trust (wilson, 2015). rhodes et al./ consent decrees 219 recommendations were suggested to the doj to have national uniform standards and protocols on training models for use-of-force (nasw, 2016a). the importance of use-of-force policies policy is a systematic way of addressing complicated issues that help individuals and groups to act in accordance with a set agenda or practice (colebatch, 2009). effective policy aids in overturning a system of inequity, systemic discrimination, and structural violence (gupta, 2013; hirschfeld, 2017). policy builds on existing procedures to either heighten, replace, or specify evolving needs (van engen, tummers, bekkers, & steijn, 2016). community involvement is essential to constructing effective policy. the consent decrees propose structural reform through the identification of problematic practices (excessive force) and offer a remedy to overturn or adjust these issues through policy revision or development while mindful of the community most affected (swift, 2004). as cities undergo a consent decree, the public is often invited to provide feedback and suggestions during the development or amending of policies that directly affect their community prior to implementation (davis, 2017). additionally, by having policies in place to reduce the number of incidents that lead to police brutality (klinger, 2012), increased community involvement may be instrumental to demonstrate governing bodies’ commitment to correct practices that disproportionately target disadvantaged communities with excessive use-of-force (chindarkar, howlett, & ramesh, 2017). policy also serves as an important guideline for achieving social justice and increasing accountability; it can be legally binding by guiding police officers’ use-of-force practices (us doj, 2003). research aim the current research explored existing use-of-force policies among municipalities across the u.s. that are facing scrutiny for excessive force practices. african americans and other targeted groups are discussed along with the difference in policies, cost, and effectiveness. the intent of this analysis is to inform future social work practice and promote advocacy for reduced use-of-force against communities of color. first, we examined various documents that included investigation and consent decree reports that highlighted cities that engaged in excessive force practices. next, we identified variations in the mentioned reports and identified the targeted populations along with police agencies use-of-force policies. further examination then determined the cities that applied levels of force standards to their policy and demonstrated a decrease in complaints. third, we explored the implications of these findings for marginalized communities and social work practice. finally, we discuss recommendations for future social work advocacy and involvement within the community in relation to use-of-force policies. consent decree analysis definition of policy documents policy is defined as formal procedures based on ideologies of a governing body or organization that alters or homogenizes behavior and performance of individuals (chindarkar et al., 2017; lomotey et al., 2016). policy development is the outcome of advances in social work, spring 2019, 19(1) 220 evaluation prefaced by a response to an event or crisis (boehmke, matthews rury, desmarais, & harden, 2017; gilbert, ahrweiler, barbrook-johnson, narasimhan, & wilkinson, 2018). for this analysis, reviewed documents included use-of-force policies that resulted from a consent decree or settlement agreement with the doj—both referred to as "agreement" in their reports. the primary analysis focused on the documents administered by the identified police departments and doj. collection of documents police brutality or maltreatment against african americans has been discussed nationally and internationally (deberry, 2016; epp, maynard-moody, & haidermarkel, 2016; llana, 2015; shane, lawton, & swenson, 2017). doj investigative reports were obtained for analysis. further methods included an internet-based search on the doj website for documents that referenced consent decrees or settlement agreements, investigation reports, and police reform (us doj, 2017). a list of cities with consent decrees was created, with attention given to cities that entered an agreement between 2008 and 2018. a specific web search of each listed police agency was conducted including a direct search for their respective consent decree monitor's web page to examine their site for records of "policy" or "use-of-force." additionally, the following key terms were used on the "google" search engine: investigation reports, consent decree, consent decree costs, and excessive force. to retrieve the most accurate and reliable information, and to avoid the collection of documents from opinionated sites or blogs, the researchers reviewed only documents from police agencies, the doj, and national or local news sources. analysis of the policy documents the analysis began by identifying cities and u.s. territories that entered a doj agreement. the researchers screened those cities by reviewing reports to determine the causes for a doj agreement. if excessive force was a factor, then further review was expended to determine if a target population was identified. once police agencies who met the search criteria were recognized, a use-of-force policy search was then generated creating the content for this analysis. development of a grid for deconstructing consent decrees an analysis grid was created to facilitate a comparison between agencies that had alleged patterns or practices of excessive force. the researchers developed the indicators used in the analysis grid from the consent decrees or settlement agreements, proposed useof-force policies, community interest, cost of reform, and policy effectiveness. the following six characteristics were used for comparison: • municipalities and territories: locations identified to have violated the constitution and undergone an agreement to govern actions to protect citizens. all locations were identified in the u.s. and its territories. • application plan: further development of concepts that were identified during examination of all eligible consent decrees for analysis by the authors. • publication date: describes the timeframe of events mentioned throughout this analysis, such as the start of the doj investigation, the entering of the agreement, and the year of the published use-of-force policy. rhodes et al./ consent decrees 221 • goals and purpose: statements that mentioned the sanctity and value of human life as part of their decision-making for execution of force or the purpose of policy. • application process: involves the development of use-of-force policy and its effectiveness within each department. • budget: officially approved budgets were not always available for review under the abovementioned search methods. therefore, the study employed reported, proposed, or estimated city budgets. • evaluation: annual assessments either by the doj and/or police department's own record-keeping of claims. statements of decrease or increase in excessive use-offorce complaints were determined via official reports or documents. table 1. overview of the 14 identified cities with consent decrees between 2008-2018 location year patterns of excessive force force used against use-of-force policy u.s. virgin island 2009 x general warren, ohio 2012 x general east haven, connecticut 2012 x latinos x seattle, washington 2012 x general x new orleans, louisiana 2013 x african americans x puerto rico 2013 x african americans and dominicans portland, oregon 2014 x mentally ill x antelope valley l.a. county sheriff's department 2015 albuquerque, new mexico 2015 x general x cleveland, ohio 2015 x mental health crisis x maricopa county, arizona 2015 x latinos x ferguson, missouri 2016 x african americans x newark, new jersey 2016 baltimore, maryland 2017 x african americans x overview of collected policy documents between 2008 and 2018, the authors identified 14 consent decrees or settlement agreements that met the search criteria. of those, two cities (antelope valley and newark) did not meet the criteria for this analysis because their investigation revealed violation of the fair housing act and discriminatory stop-and-frisk and arrest practices, respectively (national council on crime & delinquency, n.d.; u.s. department of justice civil rights division [doj-crd], 2014b). the remaining 12 cities were identified to have alleged patterns or practices of excessive force. of those 12, only nine policies were available that met the criteria for excessive use-of-force for the analysis; however, three cities (baltimore, ferguson, and new orleans) and one u.s. territory (puerto rico) acknowledged using excessive force against african americans (american civil liberties union, 2012; dojcrd, 2015, 2016; new orleans police department [nopd] consent decree monitor, 2017). puerto rico’s policy was not considered for additional inquiry due to the language barrier and the policy being published in spanish. all other policies met the criteria to be examined for the consent decree analysis (see figure 1). table 1 provides an overview of advances in social work, spring 2019, 19(1) 222 cities with consent decrees, the targeted population, and the availability of use-of-force policies. figure 1. flow chart of collected documents available for analysis findings of the consent decree analysis municipalities and territories. the u.s. cities and territories that were identified allegedly engaged in excessive force. force was either used towards the general population, those with mental illness or in crisis, latinos, or african americans. specifically, findings of the doj reports indicated that african americans were disproportionately represented among those who experienced excessive force. in baltimore, african americans were victims of excessive force in 90% of cases although they comprised 63% of the city’s population (doj-crd, 2016). in ferguson, 90% of reported excessive force incidences were against african americans, although they comprised 67% of the population (dojcrd, 2015). in new orleans, a reported 83% of excessive force cases were against african americans, with no mention of their percent within the population (adelson, 2017; dojcrd, 2011). additionally, there was no mention of the characteristics of the alleged officers involved in excessive use-of-force; the reports only provided a review of the victims involved in such instances. however, police officers who are involved in excessive use-of-force tend to be white (mcelvain & kposowa, 2008), younger, and less experienced (harris, 2010). application plan. the outline for the analysis was established by the researchers based on the doj’s suggestions listed in each city’s consent decree use-of-force policy. during each read of the consent decree, the researchers continuously recorded the suggestions to identify any differences and overlapping concepts among each city. once all of the documents were read, a comparison of the noted similarities and disparities was made leading to the 13 concepts for the analysis beginning with the timeframe that each city entered the consent decree and ending with reported evaluation as presented in table 2. since much attention was given to excessive force, a generalization of requirements by the doj gave cities freedom and the option to construct their own levels of reportable force and state what is permitted and prohibited regarding overall force. furthermore, regardless of the differences in policy content, each document reported their goals or purpose and included the requirement to give a verbal warning before using force when appropriate and possible. all other application concepts such as budget, definitions, and training among other listed items varied with each policy (see table 2). rhodes et al./ consent decrees 223 table 2. overview of policies included in consent decree analysis albuquerque baltimore cleveland east haven ferguson maricopa county new orleans portland seattle timeframe 2015 2017 2015 2012-2017 2016 2015 2013 2014 2012 budget in millions 2.3** 10.0 11.0 no report 5.8-9.8* 13.2** 6.28 3.86 13.3* cost in dollars per 1,000 residents 4,105 16,597 28,661 279,787472,744 2,992 16,070 5,910 17,853 goals x x x x x x x x x definition of force x x x x x x x definition of other terms x x x x x x x incorporates use-of-force model x x x x x prohibits chokehold unless authorized x x x x x x x x expectation to perform deescalation techniques x x x x x x x aerosol irritant-oleoresin capsicum x x x x x x x x give verbal warning for lethal force x x x x x x x x x annual use-of-force training requirement x x x evaluation effective effective completed effective effective effective note. *estimated budget ** proposed budget. budgets reported from broadwater, 2017; bush & gallagher 2014; city of albuquerque, 2018; cleveland city council, 2016; kiefer 2016; madhani, 2016; nopd, 2018; portland police bureau [ppb], 2015 advances in social work, spring 2019, 19(1) 224 publication date. table 3 summarizes the dates of the sample including the start of the doj investigation, the entrance of consent decree, and the year of the use-of-force policy implementation. this shows the length of time taken before policies are updated after a city enters a consent decree. six of the cities updated their policy within a two to three-year timespan from inception of a consent decree except for ferguson, baltimore, and maricopa county. ferguson held the oldest use-of-force policy that was in effect before the entry of an agreement compared to the other cities that updated their policy either during the doj investigation or after entering an agreement. however, at the start of 2019, the city was awaiting public feedback on a draft updated policy for final implementation (city of ferguson, n.d.). baltimore updated their policy during the doj investigation before entering a consent decree and maricopa county revised their use-offorce policy one-year after the consent decree agreement. table 3. timeframe of updated use-of-force policies city start of investigation enter consent decree effective policy date albuquerque 2012 2015 june 2017 baltimore 2015 2017 july 2016 cleveland 2014 2015 january 2018 east haven 2011 2012 december 2015 ferguson 2014 2016 july 2010 maricopa county 2011 2015 february 2016 new orleans 2010 2013 december 2015 portland 2012 2014 august 2017 seattle 2011 2012 september 2015 goals and purpose. each policy discussed the value, protection, and sanctity of human life including an emphasis on de-escalation techniques and methods that can be applied to ensure the safety of officers while protecting the public welfare (albuquerque police department [apd], 2017; baltimore police department [bpd], 2018; city of ferguson, 2010; city of portland, oregon, 2017; cleveland division of police, 2018; east haven police department [ehpd], 2014; maricopa county sheriff’s office, 2017; nopd, 2015; seattle police department [spd] manual, 2017). however, none of the documents contained quantifiable goals regarding excessive use-of-force. for instance, none of the policies suggested to decrease use-of-force complaints or cases by a certain percentage within a specific timeframe. all but three departments clearly identified the purpose of the policy at the start of the document. the police departments described their use-of-force policy as a guideline and expectation for officers to follow concerning all types of force—lethal and less lethal (apd, 2017; city of ferguson, 2010; cleveland division of police, 2018; ehpd, 2014; maricopa county sheriff’s office, 2017; nopd, 2015) . baltimore and portland did not have a distinguished “purpose” section within their policy compared to the others but shared the same purpose in the general content. seattle was the only department that did not clearly identify the purpose of its policy. rhodes et al./ consent decrees 225 application process. the policy documents were examined to ascertain the influence of the doj agreements, policy formation, and their effectiveness. in this analysis, effectiveness was determined by whether there was a decrease in the number of excessive force complaints or cases that involved force according to the police, doj reports, or the city’s local news. five cities reported a decrease in excessive force complaints. according to both new orleans’ and albuquerque’s monitor reports, there was a decrease in the number of excessive force complaints; however, the cities reported that officers were not fully compliant with reporting such instances (ginger, 2017; nopd consent decree monitor, 2017, 2018). specifically, new orleans reported a decrease in complaints from 413 to 203 (51%) between 2014 and 2015 (nopd consent decree monitor, 2017). albuquerque saw a nearly 64% decrease in complaints from 756 in 2014 to 274 in 2015 (ginger, 2017). baltimore’s commissioner reported a 36% decrease in complaints from 146 in 2015 to 93 in 2016 (davis, 2017). seattle police department (spd, 2019) provided a detailed report of complaints by force levels. from 2017 to 2018, there was an increase of level 1 force (1,272 to 1,818) that was attributed to the increased complaints of pain and discomfort with handcuffs (spd, 2019). however, spd (2019) reported a decrease in force levels 2 and 3 force including officer-involved shootings (358 to 348 and 33 to 25, respectively) within the same time period. portland (ppb, 2017; 2018) did not report the number of complaints, but rather the number of cases that involved force. the annual reports from 2016 and 2017 indicated that ppb saw a decrease in cases involving force from 755 to 721 (ppb, 2017; 2018). east haven was the only city that terminated its consent decree due to full compliance, deeming its use-of-force policy to be effective (east haven police, n.d.). conversely, three cities were not assessed for effectiveness. cleveland, ferguson, and maricopa county city officials, local news, and affiliates did not report or provide information to the public indicating their use-of-force policy’s impact, or number of excessive force complaints at the time of analysis; hence, the effectiveness of their policy’s outcomes was undetermined. however, a consistent and stark difference among the three cities was the lack of incorporated use-of-force models. although east haven police did not incorporate a use-of-model, they met the requirements to end the consent decree. most of the cities that remain in a consent decree and have reported a decrease in use-of-force complaints or cases have similar content in their policies. the exceptions are albuquerque, which does not define force and affiliated terms, new orleans, which does not use an aerosol irritant, and portland, which does not prohibit the chokehold. only albuquerque, baltimore, and cleveland require annual use-of-force training, though cleveland did not provide any record of effectiveness. a summary of the policies’ similarities and differences are presented in table 2. for the cities that demonstrated a decrease in excessive force complaints and cases, a closer examination of their use-of-force policy model was assessed. the level/type of force model is used as a tool for investigative purposes, police documentation, and reporting data. the researchers assessed the types of reportable force at each city's level (n = 5; see table 4). the remaining four cities have not adopted this model, nor published their updated policy for public review. however, ferguson did agree to commit to a use-of-force advances in social work, spring 2019, 19(1) 226 model according to their agreement with the doj (united states of america v. the city of ferguson, 2016). albuquerque, baltimore, new orleans, and seattle identified their lowest level of force as level/type one. as the use-of-force increased so did the categorization of force—levels coincide with the amount of force used. portland’s model used reversed numbering for the type of force used. for example, their lowest amount of force is categorized as level-4 and the most extreme use-of-force is considered level-1. new orleans and portland have four levels of force while the other cities have three. except for portland, each city’s level-1 of reportable force included soft takedowns and/or a threatening police presence. level-2 essentially used more physical force with non-lethal weapons that may or may not result in injury. further, the top-tier level for most of the cities (level-4 for new orleans) included discharge of weapon and lethal force. budgets. litigation regarding police misconduct often leads to payouts that can range from several hundred thousand to several million dollars for one individual and can total to hundreds of millions overtime for multiple victims (avila & marshall, 2014). the cost to fully implement the recommendations by the doj in a consent decree varied widely by city. the needs and resources of cities were not universal; therefore, each city indicated a budget that included doj recommendations, associated special projects, equipment, maintenance of data for police practices and policies, and any other federally mandated programs to bring cities into compliance (anderson, 2018; broadwater, 2017; madhani, 2016; nopd consent decree monitor, 2017). budgets ranged based on the needs and improvements of the departments including use-of-force initiatives and other programs and could fluctuate between $1 million and $13 million. table 2 displays the cost for each city and cost per 1,000 residents based on the u.s. census bureau 2018 population estimates for each city (u.s. census bureau, 2019). ferguson had a notably higher cost per 1,000 residents since its estimated population was 20,730 compared to the other cities whose population ranged from over 300,000 to over 4.4 million (u.s. census bureau, 2019). evaluation. overall, all policies emphasized the importance of accurate recordkeeping for use-of-force incidents to monitor the number of occurrences and determine additional training needs and levels (apd, 2017; bpd, 2018; city of ferguson, 2010; city of portland, oregon, 2017; cleveland division of police, 2018; maricopa county sheriff’s office, 2017; nopd, 2015; seattle police, 2018). since each city, apart from east haven, is currently in partnership with the doj, cities are continuously evaluated for their policy compliance, its effectiveness, and areas of improvement. a noticeable trend in this analysis was the decreased counts of use-of-force complaints and cases with cities that used a levelof-force model, aside from cleveland. although use-of-force complaints and cases have decreased in most reported police departments, cities are bound to a consent decree until all concerns are resolved including issues outside of excessive force (i.e., technology updates). rhodes et al./ consent decrees 227 table 4. comparison of use-of-force models among cities with consent decrees city* levels of force level 1 level 2 level 3 level 4 a lb uq ue rq ue 1. low-level control tactics. 2. officer presence. 3. verbal communication to deescalate situations. 4. escort techniques. 5. application of handcuffs or any other approved restraints. 6. show of force. 1. intermediate force. 2. empty hand tactics. strikes, grabs, kicks, takedowns, distraction techniques & proper arrest techniques to control subject. 3. use of leg sweeps, arm-bar takedowns, or prone restraints to prevent imminent bodily harm, overcome active or passive resistance. 4. oleoresin capsicum (oc) spray. 5. baton or impact weapons using jabs or strikes. 6. electronic control weapon. 7. less than lethal impact munition. 1. lethal force. 2. discharge of firearm. 3. strike to neck, head, or throat with hard object. 4. when lethal force is objectively reasonable & necessary to protect the lives of officers or others, officers may use any tactics or weapons available. 5. neck holds are prohibited except when lethal force is authorized. n/a b al tim or e 1. physical force used to gain control of person demonstrating active resistance or aggressive behaviors that does not result in actual or perceived injury. 2. pointing a firearm or conducted electrical weapon (cew). 3. “cycling” a cew as a form of warning. 4. forcible takedowns without apparent injury or allegation of injury. 1. physical contact that results in injury or complaint of injury with a suspect or arrestee. 2. three or fewer cew cycles during a single encounter or operation of cew in drive stun mode. 3. any application of oc spray or other chemical weapons. 4. discharge of less-lethal launcher or munition. 5. inflicted injury caused by canine. 6. any strike, other than an intentional strike to head, neck, sternum, spine, groin, or kidney area with an impact weapon. 7. intentional striking of vehicle or subject with a vehicle. 1. deadly force or death of a person while in custody. 2. intentional & unintentional discharge of firearm. 3. any force that caused great bodily injury including injury resulting in hospital admission, loss of consciousness, or broken bone. 4. strike to the head, neck, sternum, spine, groin, or kidney with impact. 5. more than three cew cycles during a single encounter with individual. 6. significant officer misconduct in the useof-force. n/a n ew o rle an s 1. pointing a firearm or cew. 2. hand control or escort techniques used as pressure point compliance techniques that result in injury or complaint of injury. 1. use of cew including missed attempts. 2. use of impact weapon to strike individual but no contact was made. 3. use of baton for non-striking purposes. 4. weaponless defense techniques. 1. strike to the head except with an impact weapon. 2. use of impact weapon with contact except to the head regardless of injury. 3. destruction of animal. 1. use of lethal force. 2. critical firearm discharge. 3. force resulting in serious physical injury or hospitalization. 4. neck holds. 5. force resulting in loss of consciousness. 6. canine bites. 7. more than two applications of cew in an encounter or more than 15 seconds. 8. any strike, blow, kick, cew use, or similar force against handcuffed subject. 9. vehicle pursuit resulting in death, serious physical injury, or injuries requiring hospitalization. advances in social work, spring 2019, 19(1) 228 table 4. comparison of use-of-force models among cities with consent decrees city* levels of force level 1 level 2 level 3 level 4 po rtl an d* * 1. force that is intended to establish control of a restrained subject, though not intended or reasonably likely to cause persistent pain or physical injury. 2. non-striking use of baton. 3. takedown performed in a controlled manner with no injury. 4. handcuffing against restraint. 5. pointing of firearm. 6. use of hobble restraint. 7. firearm discharge to end suffering of badly injured animal. 8. boxing-in maneuver as a vehicle intervention strategy. 1. force that is reasonably likely to cause nonenduring: pain, disorientation, physical injury, or complaint of pain. 2. cew deployment of 1 or 2 applications. 3. use of aerosol restraints. 4. chemical agents used by special emergency response team (sert). 5. use of impact without injury. 6. complaint of improper force. 7. cew & launched impact munition without contact. 8. takedown. 9. strikes with hands or feet. 10. pursuit intervention techniques (pit) maneuver as a vehicle intervention strategy. 1. force resulting in hospital admission or serious injury. 2. more than one simultaneous intentional cew application. 3. three or more cew applications on one person. 4. cew deployment on restricted persons. 5. cew deployment on those with actual or perceived mental illness or crisis. 6. launched impact munition with contact. 7. impact weapon with injury. 8. firearm discharge to stop aggressive animal. 9. canine bites. 10. takedowns that cause injury requiring hospital treatment. 11. riot control agents. 12. force used on juveniles under 15. 13. force used on pregnant individuals. 14. force resulting in loss of consciousness. 15. any strike, blow, kick, or similar force against handcuffed or retained subject with or without injury. 16. ramming as a vehicle intervention strategy. 1. deadly force. 2. all firearms discharged except when necessary with animals. 3. in-custody deaths. 4. death caused by force. 5. carotid neck holds. 6. intentional head, neck, throat strikes with or against a hard object. se at tle 1. actions which cause transitory pain, disorientation, or intentional pointing of firearm or bean bag shotgun. 2. used to control a person resisting commands. 3. soft takedowns, strike with force to cause pain, or open hand technique. 1. force that causes or is reasonable expected to cause physical injury. 2. hard takedowns. 3. use of cew, oc spray, impact weapon, beanbag shotgun, deployment of k-9 with injury or complaint of injury, vehicle & hobble restraint. 1. force that cause great or substantial bodily harm, loss of consciousness, or death. motorcycles, & impact weapon strikes to the head. 2. use of neck & carotid holds; stop sticks against motorcycles. n/a *note. adapted from apb (2017); bpd (2018); city of portland, oregon (2017); nopd (2015); spd manual (2017). **levels 1-4 were reverse coded for comparison. rhodes et al./ consent decrees 229 discussion one-third of cities identified in the consent decree analysis used excessive force against african americans and five used force against people of color. african americans are documented to live disproportionately in poor, high crime communities with a particular vulnerability to police brutality (brown, 2010; brunson & miller, 2006; lawson, 2013). as social workers, it is our duty to participate in social justice initiatives and promote social change through policy examination and provide preventative fundamental solutions such as advocacy and training (reisch, 2016). social work values include being mindful, sensitive, and knowledgeable of cultural and ethnic diversity, individual differences and oppressions; discourage discrimination through change efforts; and acknowledge the importance of partnerships with others to drive change (nasw, 2017). by examining the use-of-force policies, social workers uphold their commitment to enhance their knowledge (nasw, 2017) and engage in effective interventions with the community they serve (hill, fogel, donaldson, & erickson, 2017). for example, social workers archibald, daniels, and sinclair (2017) hosted a training session regarding cultural competency with their local police department that was under a doj investigation for excessive force, and subsequently held a conference with community members to inform them of the policing agenda where both groups believed in the necessity of cultural competency training. with these values in mind, the intent of this analysis on police departments’ use-of-force policies was to inform social workers of the targeted populations, with attention given towards african americans, along with the current policies and their outcomes. findings from this analysis encourage social workers to advocate and demand police departments to become and remain transparent with reports and use-of-force cases as a form of accountability with reform and consent decree adherence. knowing that reform is initiated from unconstitutional practices as evidenced by the finding of the doj investigations, social workers who engage in community work can empower individuals to report incidents of perceived misconduct. additionally, to bridge the trust between community and police, social workers must garner innovative approaches that work towards eliminating implicit bias from both the community and police. examples include working in partnership with police to host community and social events, focus groups, and solution forums that require both parties to work together to find a solution to a pressing issue or concern in their community. proactive measures are necessary since the doj intervention is not guaranteed depending on the criminal justice attitudes of a particular presidential administration. like previous studies, the use-of-force policies in this analysis shared many commonalities; however, differences remained and there were some limitations in the study approach. for instance, each agency offered statements of commitment to value and protect human life in addition to a verbal warning before lethal force is used. baltimore city, albuquerque, and cleveland have further demonstrated their commitment to addressing use-of-force concerns by adopting the requirements of annual de-escalation training in their use-of-force policy (apd, 2017; bpd, 2018; cleveland division of police, 2018). also, this analysis implies that not all policies followed the recommendation of the doj to apply a use-of-force model. coincidentally, the cities that did not implement the model also did not present any indication of reported effectiveness except for east haven advances in social work, spring 2019, 19(1) 230 which successfully fulfilled their agreement requirements. some policies also did not define force and their associated terms, prohibit chokehold when authorized, encourage officers to perform de-escalation techniques, or allow aerosol irritant which promotes the ongoing use-of-force and ambiguity. another difference included the cost variations between cities. several cities announced the amount for a consent decree monitor while other cities either shared their proposed or approved annual budget of total reform costs that included training, salaries, audits, or equipment. as a result, this analysis was unable to conduct a thorough cost evaluation because all agencies did not provide final budgets for consent decree reform. other limitations included the sample size of the analysis and the ongoing agreements. as cities attempt to comply with the doj agreement fully, there are continuous changes that affect the outcome and alter the components of the analysis. moreover, future implications should consider re-examining the nine use-of-force policies two years post-compliance for effectiveness measured by decreased complaints and costs in lawsuits derived from police use-of-force. a closer examination ought to investigate additional factors that may cause excessive rates of police use-of-force. these additional factors could include considering underlying or additional social problems, like available resources or the lack thereof, economic concerns, or untreated mental health issues in affected neighborhoods that contribute to increased interactions with police. social workers should continue to support the nasw (2016a) agenda to encourage the doj to promote uniform standards and protocol for use-of-force and cultural competency training. conclusion this review of nine use-of-force policy documents demonstrates the diligence and consideration of both the doj and respective police departments to amend the inappropriate practices identified during their investigation. the development of the useof-force policies starts the breakdown of systemic discrimination and structural violence. not only do the policies detail force and its use, but it also holds individuals accountable by providing an outline of appropriate behavior with an expectation to follow such procedures that are legally binding. although not clearly reflected within the policies, but noted in the investigation reports and consent decrees, african americans believed they were specifically targeted because of their race and reported negative experiences with police officers throughout the community (doj-crd, 2011, 2014a, 2015, 2016). this information apprises social work practice by demonstrating the continuing need to construct a bridge between the two groups. thus far, cities in agreement with the doj saw more than 20% reduction in filed civil rights lawsuits that involved police use of excessive force (powell et al., 2017). although there was not an immediate policy change after cities entered an agreement, cities are continuously working to improve their behavior and results. cities could potentially mitigate their lawsuit costs by using more effective policing that improves police practices and police-community relations. based on these policies and the content in the doj reports, social workers should demand a presence in the reform process and provide training to officers given their unique holistic approach and understanding of interpersonal relationships, communities, and rhodes et al./ consent decrees 231 culture. social workers should also take the initiative to include the affected community's concern and input when hosting training sessions and serve as a liaison between agency 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(2017). oh baltimore: incarceration and re-entry in marginalized communities. critical social work, 18(1), 25-45. http://assets.lapdonline.org/assets/pdf/harvard-lapd%20study.pdf https://www.census.gov/topics/population.html https://www.bjs.gov/content/pub/pdf/ndcopuof.pdf https://www.justice.gov/archive/crs/pubs/principlesofgoodpolicingfinal092003.htm https://www.justice.gov/crt/page/file/922456/download https://www.justice.gov/sites/default/files/crt/legacy/2011/03/17/nopd_report.pdf https://www.justice.gov/sites/default/files/opa/press-releases/attachments/2014/12/04/cleveland_division_of_police_findings_letter.pdf https://www.justice.gov/sites/default/files/opa/press-releases/attachments/2014/12/04/cleveland_division_of_police_findings_letter.pdf https://www.justice.gov/sites/default/files/crt/legacy/2014/07/22/newark_findings_7-22-14.pdf https://www.justice.gov/sites/default/files/crt/legacy/2014/07/22/newark_findings_7-22-14.pdf https://www.justice.gov/sites/default/files/opa/press-releases/attachments/2015/03/04/ferguson_police_department_report.pdf https://www.justice.gov/sites/default/files/opa/press-releases/attachments/2015/03/04/ferguson_police_department_report.pdf https://www.justice.gov/crt/file/883296/download https://doi.org/10.1080/14719037.2015.1088568 advances in social work, spring 2019, 19(1) 238 wilson, m. h. (2015). the role of racial profiling in encounters with law enforcement. retrieved from http://www.socialworkblog.org/wp-content/uploads/the-role-ofracial-profiling-in-encounters-with-law-enforcement.pdf author note: address correspondence to: dasha rhodes, lmsw, school of social work, morgan state university, 1700 e. cold spring ln, rm 344 baltimore, md 21251. e-mail: daeva14@morgan.edu http://www.socialworkblog.org/wp-content/uploads/the-role-of-racial-profiling-in-encounters-with-law-enforcement.pdf http://www.socialworkblog.org/wp-content/uploads/the-role-of-racial-profiling-in-encounters-with-law-enforcement.pdf mailto:daeva14@morgan.edu the importance of use-of-force policies research aim consent decree analysis definition of policy documents analysis of the policy documents development of a grid for deconstructing consent decrees overview of collected policy documents _________ emily tillotson, dsw, licsw, associate professor, susan smith, phd, licsw, professor, and cheris current, phd, professor, social work and sociology, walla walla university, college place, wa. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 841-856, doi: 10.18060/24064 this work is licensed under a creative commons attribution 4.0 international license. we are what we read: assessing bias in the implicit curriculum of a social work program emily tillotson susan smith cheris brewer current abstract: a school of social work devised a process to assess the implicit curriculum by auditing the required readings to identify the race and gender of the authors. as a profession, we espouse a strong commitment to social justice and diversity. yet we know that there are limitations to our objectivity and that auditing is a valuable tool that can reveal biases. the concrete data provided by an audit can help reveal and disrupt entrenched patterns. the audit was conducted by reviewing the syllabi for required bsw and msw courses. for each text, we collected the names, gender, and race for each author. across all programs, authors were disproportionately white as compared to the general u.s. population, professional authors, professional social workers, and students in the programs. similarly, men were over-represented as compared to all of the benchmarks, except for the authors in the bsw program, which was more feminized as compared to the u.s. population. this assessment process adds to the existing toolset by measuring current levels of representation—including over and underrepresentation. it is hoped that auditing will prove an effective tool for doing antiracist and anti-oppressive assessment, however an audit can only reveal where work is needed. keywords: implicit curriculum, assessment, diversity, race, gender the best elements of social work's legacy are the values of social justice and human rights (murdach, 2011). today these values are still found in the profession's foundational documents. however, a history of strong activist leadership is not enough; higher education, and social work specifically, is not part of the vanguard of contemporary social justice movements (healy, 2008). social work, as a profession and in the academy, often fails to confront inequality and instead aligns in practice with neoliberalism, individualism, and corporate entities while providing lip service to the values of social justice and equity (corley & young, 2018). higher education offers a lot of symbolic talk about commitment to diversity, but the literature suggests there is a gap between rhetoric and practice (bonillasilva & baiocchi, 2001; harper, 2012; shapiro et al., 2017). this gap creates a tension between social work values and actions, and may fail to produce professionals that are prepared to work in a diverse society or challenge inequalities (mehrotra et al., 2017). this paper follows one program's assessment process, attempting to identify aspects of their implicit curriculum—specifically the race and gender of assigned textbook authors. the authors are cognizant of the legacy of inequality and, in particular, white supremacy and patriarchy that are endemic to american culture. accordingly, we thus hypothesize that despite a commitment to social justice, social work educators will disproportionately select textbooks written by authors with dominant racial and gender identities. about:blank tillotson et al./we are what we read 842 literature review addressing the challenge of achieving equal opportunity and justice is difficult to imagine without also considering how inequalities are maintained within higher education. most campus norms currently support elective opportunities for those seeking antioppressive and antiracist coursework. yet, few places require anti-bias classes or cocurricular programs (hart research associates, 2015). underneath the commitment to diversity messaging, there seems to be an even greater commitment to guarding tradition and business as usual. some professions, like social work, do mandate that students demonstrate competency in “diversity and difference” although they fall shy of requiring a discrete class. nor is there currently a mandate calling specifically for antiracist, antioppressive curriculum. instead accreditors continue to use the concepts “diversity and difference” which does not explicitly call for the dismantling of white supremacy and systems of oppression. the accrediting body, the council on social work education (cswe; 2015) defines diversity as the following: the dimensions of diversity are understood as the intersectionality of multiple factors including but not limited to age, class, color, culture, disability and ability, ethnicity, gender, gender identity and expression, immigration status, marital status, political ideology, race, religion/spirituality, sex, sexual orientation, and tribal sovereign status. (p. 7) while social work may be more robust in their requirements than other disciplines, scholars, social workers, students, and critics are vocally demanding reform and a more significant commitment to anti-oppressive work (abrams & moio, 2009). the cswe annual survey of accredited programs reports that the united states has more than 800 accredited social work programs (cswe, 2017). social work scholars have cited the need for stronger anti-bias standards and measurement tools appropriate for accreditation and program evaluation (abrams & moio, 2009; brown, 2016; carnevale et al., 2018). while these calls for change and awareness from scholars are encouraging, systemic inequality in higher education outcomes remains (espinosa et al., 2019; jack, 2019). the lack of exposure to antiracist and anti-bias content is, in part, due to the historic inequalities built into the system of higher education (jack, 2019; yee, 2016). the landscape is full of aging institutions with generations of experience with the status quo. the history of disparity, discrimination, marginalization, and oppression within higher education is substantial (byrd, 2017; jack, 2019; warikoo, 2016). the profession of social work and social work education have historically held a certain discomfort towards the academy, remaining wary of the elitism and inequality built into the system and a nervousness about being co-opted, yet also struggling for professional acceptance (healy, 2008; olson, 2008). these tensions are located around the values of social justice and a more radical vision of a just society versus those who have sought to build a credentialed profession with similar structures and hierarchies found within the larger adjacent system of health care (olson, 2008). some scholars have written that this trend towards the clinical has led the profession away from its social justice roots (specht & courtney, 1994). others suggest that debate continues to exist within social work about advances in social work, summer 2021, 21(2/3) 843 whether the profession serves the more social justice-oriented human rights agenda or the micro practice-oriented, human needs agenda (murdach, 2011). institutions are tasked with providing the next workforce, and colleges and universities are eager to demonstrate their commitment to diversity in response to changes at the grassroots level. social work education, like higher education in general, is moving quickly to address the call for anti-racism initiatives—at least in rhetorical terms. however, the toolset remains undefined and limited (bogo & wayne, 2013; grady et al., 2011; peterson et al., 2014). universities and social work educators need new and better ways of measuring equity work, including finding common definitions and reliable ways to quantify this work (abrams & moio, 2009; bell & hartmann, 2007). at the same time, accreditors are increasingly demanding detailed reports. auditing readings offers a new and useful tool for assessment writers to respond to these demands. a primary stakeholder in this discussion, cswe, has a robust interest in understanding inequality, including a center for diversity and social justice. as an accrediting body, they also include diversity within accreditation standards and competencies but fall short of clearly articulating these goals in ways that align with anti-oppressive scholarship and best practices. currently, social work educators can use any approach to teach this content, including outdated modes, in part because the competencies are so ill-defined. programs are also asked to address the implicit curriculum, but diversity is just one of many means of completing this requirement, and this too is a liminal area without clear standards or measurements (bogo & wayne, 2013). unlike the practice content, each school is largely left to its own devices concerning the qualifications of the instructors charged with teaching diversity and inclusion material, and there is too little research about these courses (mehrotra et al., 2017). still, other programs offer electives, but students can easily miss this so-called "elective" content. students themselves recognize the value of diversity skills and content (larson & bradshaw, 2017). recently columbia university's msw program experienced student protests demanding stronger anti-oppressive curriculum (williams & reidel, 2018). this highlights the important role that cswe plays as a critical leader in setting standards and preparing the next generation of social workers. a case for auditing within the higher education landscape, the diversity lens used by cswe is commonplace. the current landscape for diversity work on campuses includes a variety of tools and vendors. there are consultants, climate surveys, trainings, and workshops, among other options for schools to choose from. auditing does exist in this context. one mainstream example, from the annenberg inclusion initiative’s audit of recent topgrossing films, revealed substantial underrepresentation of women and received national press attention (smith et al., 2018). still, audits are not regularly included as mainstream tools, and accreditors have yet to embrace the practice as part of the diversity assessment in cyclical reports. the existing tools are helpful and should continue to be used. still, they do not provide the baseline information of an auditing process. many current measurements look at specific diversity offerings and talk about campus climate, but more normative aspects of the implicit curriculum are less scrutinized. this greater campus climate—which tillotson et al./we are what we read 844 is considered a combination of environmental factors and social relations—is directly related to the implicit curriculum. relying solely on climate surveys to assess the implicit curriculum can inadvertently produce a misreading of the campus climate, leading administrators to believe the climate is more positive and inclusive than it is (hurtado et al., 2008). while there are several definitions of the implicit curriculum, long-time education scholar, eric eisner, provides a succinct description, "the implicit curriculum of the school is what it teaches because of the kind of place it is" (bogo & wayne, 2013, p. 5). the hidden or implicit curriculum is a challenging area of campus assessment, yet accreditors, including cswe, are beginning to direct programs to address it (bogo & wayne, 2013). however, this direction has not arrived with clear standards or measurement tools despite calls from the literature (grady et al., 2011; peterson et al., 2014). the auditing process can help schools and programs examine the implicit curriculum and measure their learning environments from various vantage points. this paper proposes building on the concept of implicit bias auditing to gather information specifically about the organization (milkman et al., 2012). implicit bias auditing is the process of examining the social and media choices at the personal level to reveal patterns of self-segregation in a variety of categories. the auditing process relocates and expands this idea for use at the organizational level. however, the basic premise of auditing remains the same—to make the invisible and hidden clear and discernable. in this study, we consider textbook author identity and representation as a significant element of what has been called the hidden or implicit curriculum (bogo & wayne, 2013). we did not analyze the content of the texts—the explicit academic content—but instead the race, gender, and discipline of the authors. our analysis is not concerned with the topics, theories, or content of the required readings as we understand that this is part of the explicit curriculum. in the same way that the diversity of the faculty contributes to the implicit curriculum, the diversity of the authors contributes to the implicit curriculum. creating standards and measurement techniques that make it easier to identify disparities aligns with social work's earliest values (murdach, 2011). for social work educators, scrutinizing how to best prepare students for the field is regular work. professional schools with predictable accreditation cycles are uniquely well-positioned to engage in meaningful assessments that will help them see and address these often hidden and damaging patterns of white supremacy, patriarchy, and other systems of oppression. it is clear that believing in diversity and social justice are not enough to create equitable learning environments. critical self-reflection and tangible measures are needed at the teacher, program, and college-level, to reduce inequalities in the implicit and explicit curriculum. producing an accurate picture of the implicit curriculum, that can be used repeatedly to measure current program performance and change over time, is an important tool for program renewal and creating truly anti-oppressive learning environments. theoretical research framework by focusing on outcomes of behavior, auditing provides a countermeasure to methods that seek to understand psychological or interpersonal expressions of racism and sexism that center on intentionality. a growing body of scholarship argues that we should eschew advances in social work, summer 2021, 21(2/3) 845 focusing on motivations or intentions but instead on the behaviors and artifacts themselves—policies, structures, and practices that, intentionally or not, reproduce inequalities by implicitly or explicitly centering on the best interests of those in power (kendi, 2019). this disregard for intentions or the implicit vs. explicit nature of inequality replication is particularly useful in measuring the actual behaviors of neoliberals who claim a post-inequality frame and for espoused adherents to social justice, like social workers, who claim to have an anti-inequality agenda (roberts, 2002). instead, we rely on quantcrit or quantitative inquiry that is grounded in critical race theory (crt) and assumes that racism is pervasive and impacts structural and individual behaviors (garcia et al., 2018). originating in legal studies, crt historically used qualitative methods, including narratives, storytelling, and content analysis, to identify the subtle ways that white supremacy is replicated in the post-civil rights era. crt's rejection of objectivity within our racist society makes the use of seemingly positivist quantitative methods an unlikely tool of inquiry. scientists, and of particular import to our work, social scientists, have long used the purported objectivity of science and quantitative research to demonstrate the racial unfitness of people of color and to naturalize the domination of whites. because of this history and its continuance by contemporary researchers, a postpositivist approach to quantitative research that focuses on the structural, historical, and personal liminality of objectivity is the only way to integrate crt and quantitative research (crawford, 2019). auditing the selection of textbooks aligns with crt as it attempts to understand the subtle everyday behaviors that reinforce white supremacy and the emerging subfield of quantcrit scholarship. the tenets of quantcrit are laid out by gillborn and colleagues (2018) who identify: 1. the centrality of racism as a complex and deeply rooted aspect of society that is not readily amenable to quantification; 2. the acknowledgment that numbers are not neutral and they should be interrogated for their role in promoting deficit analyses that serve white racial interests; 3. the reality that categories are neither “natural” nor given and so the units and forms of analysis must be critically evaluated; 4. the recognition that voice and insight are vital: data cannot “speak for itself” and critical analyses should be informed by the experiential knowledge of marginalized groups; 5. the understanding that statistical analyses have no inherent value but they can play a role in struggles for social justice. (p. 158) this evaluation of assigned readings in one social work program's curriculum is grounded in self-reflexivity and its liminalities, because we teach within the program we are auditing. we do not trust that our own antiracist and feminist ideologies are producing reading lists that center people of color and women. using a measurement tool, rather than relying on our perceptions, accomplishes the goal of challenging the taken for granted ways that inequalities are replicated through daily choices within the academy. focusing on who gets to contribute to the chorus of voices in the classroom by auditing and strategically making tillotson et al./we are what we read 846 new textbook selections to include more diverse authors also aligns with the crt goal of questioning dominant ideologies and utilizing counternarratives (solórzano, 1997). the process of auditing ensures these notions are tested and makes space for counternarratives. method during the 2017-2018 school year, an audit was conducted of all of the required readings in one social work department that offered both bsw and msw programs. the bsw program is a residential program located in the rural western u.s. the msw program consists of a two-year program made up of a generalist year and clinical year. the clinical year of the program is also taken as a one-year advanced standing clinical program for entrants who have strong grade point averages and graduated with bsw degrees from cswe accredited programs. the msw programs, both the one and two-year programs, are taught in three different locations (sites a, b, and c) in two states in the rural western u.s. to account for the two programs and three sites, we assessed each program option and each location separately to identify the particularities of each year of the program and on each campus. syllabi for every required course were included in the sample. the syllabi follow a singular format, with one section labeled "required texts." all books listed in this section of the syllabi were included in the sample. arguably, this did not represent every book and article required for a class, but it did capture those readings deemed important enough to name in the "required texts" portion of the syllabus. the bsw program included 30 books written by 52 authors over four years of the curriculum. the first year of the msw program at site a had 19 books by 33 authors, the second year at site a had 18 books by 29 authors. at site b the first year courses required 25 books by 39 authors, and the second year at site b had 31 books written by 53 authors. the first year at site c had 15 books authored by 22 authors, and the second year at site c had 27 books and 41 authors. all of the titles and author names were recorded in an excel spreadsheet. next, a researcher identified each author and assigned each a gender and race. we intended to collect information about the sexuality, religion, ability, and other elements of identity for each writer, but found it too difficult to consistently locate this information for many of the authors. the invisible nature of some of these elements of identity made it impossible to infer their identity with any reliability. assigning gender and race information to each author followed this multi-step process. researchers first visited the publishers' and authors' personal webpages to determine gender and race. gender was determined by first looking for clear statements in author biographies, the use of pronouns, and lastly, photographs of the authors. all of the authors identified as either male or female. the same process was followed for race, where explicit self-identifications were sought out, followed by using photos to assign race to the authors. in a few cases, biographical information did not specifically name an author's race, and photos were unavailable. in these instances, we used contextual clues to assign their race. for these individuals, their race was often inferred as white because they attended traditionally white universities in the mid-twentieth century (or before), their biographies and often obituaries did not contain any information that would mark them as anything other than white. the advances in social work, summer 2021, 21(2/3) 847 unmarked nature of whiteness means that it is often not explicitly named as part of one's biography or identity (mcintosh, 1988). the authors included in the study were assigned one of the following races: white, black, asian american, latinx, native american. a multi-racial or other category was not used, so authors like malcolm gladwell, who has a white parent and a black parent, is identified as black in our assessment. our assessment revealed only one multi-racial individual, so we chose not to create a dedicated category for a single person. results bachelor of social work program in the bsw program, most of the books were authored by women; 55.77% of authors were women, while 44.23% were men (see table 1). the majority of the authors of the required readings were white. in our sample, 84.62% of all authors were white, 5.77% were latinx, 5.77% were black, 1.92% were asian american, and 1.92% were native american (see table 2). master of social work programs table 1 shows the genders of authors from the required readings across programs and program sites. at site a, in the generalist year, 51.52% of books are authored by women and 48.48% by men, and in the clinical year, 44.83% of authors were women, and 55.17% were men. at site b, in the generalist year, 33.33% of authors were women, and 67.67% were men. in the clinical year, 35.85% of authors were women, and 64.15% were men. women authors were much more underrepresented in the authors of books at site b. at site c, 22.73% of authors in the generalist year were women, and 77.27% were male; in the clinical year, 43.90% were women, and 56.10% were men. the race of the authors varied across sites and program concentrations (see table 2). at site a, in the generalist year, the authors' races were as follows: 87.88% white, 6.06% latinx, 6.06% black, 0% asian american, 0% native american. in the clinical year at site a, 92.86% were white, 7.14% latinx. zero authors were identified as black, asian american, or native american. in the generalist year at site b, 97.44% of authors were white, 0% latinx, 0% black, 2.56% asian american, and 0% native american. at site b, in the clinical year, 90.57% of the authors were white, 1.89% latinx, 1.89% black, 5.66% asian american, 0% native american. at site c, in the generalist year, 95.45% were white, 4.55% latinx, 0% black, 0% asian american, 0% native american. at the same site in the clinical year, 95.12% of authors were white, 4.88% were latinx, 0% black, 0% asian american, and 0% native american. advances in social work, summer 2021, 21(2/3) 848 table 1. gender of required reading authors compared to graduates for each program and site program/site graduates authors generalist year clinical year female male female male female male bsw 79 (85.0%) 14 (15.1%) 29 (55.8%) 23 (44.2%) na na msw, site a 238 (83.5%) 47 (16.5%) 17 (51.5%) 16 (48.5%) 13 (44.8%) 16 (55.2%) msw, site b 231 (82.5%) 49 (17.5%) 13 (33.3%) 26 (66.7%) 19 (35.9%) 34 (64.2%) msw, site c 110 (84.0%) 21 (16.0%) 5 (22.7%) 17 (77.3%) 18 (43.9%) 23 (56.1%) note. graduate data are from 2012-2018. students self-reported gender at admission. table 2. race of required reading authors compared to graduates for each program and site race bsw msw, site a msw, site b msw, site c all graduates authors graduates generalist clinical graduates generalist clinical graduates generalist clinical graduates authors white 62 (66.7%) 44 (84.6%) 200 (70.2%) 29 (87.9%) 26 (92.9%) 222 (79.3%) 38 (97.4%) 48 (90.6%) 113 (86.3%) 21 (95.5%) 39 (95.1%) 597 (75.7%) 245 (91.4%) latinx 25 (26.9%) 3 (5.8%) 48 (16.8%) 2 (6.1%) 2 (7.1%) 10 (3.6%) 0 (0%) 1 (1.9%) 4 (3.1%) 1 (4.6%) 2 (4.9%) 87 (11%) 11 (4.1%) black 2 (2.2%) 3 (5.8%) 11 (3.9%) 2 (6.1%) 0 (0%) 0 (0%) 0 (0%) 1 (1.9%) 0 (0%) 0 (0%) 0 (0%) 13 (1.7%) 6 (2.2%) asian american 1 (1.1%) 1 (1.9%) 8 (2.8%) 0 (0%) 0 (0%) 5 (1.8%) 1 (2.6%) 3 (5.7%) 3 (2.3%) 0 (0%) 0 (0%) 17 (2.2%) 5 (1.9%) native american 2 (2.2%) 1 (1.9%) 9 (3.2%) 0 (0%) 0 (0%) 35 (12.5%) 0 (0%) 0 (0%) 4 (3.1%) 0 (0%) 0 (0%) 50 (6.3%) 1 (0.4%) multi-racial 1 (1.1%) 0 (0%) 1 (0.4%) 0 (0%) 2 (0.3%) not specified 0 (0%) 9 (3.2%) 7 (2.5%) 7 (5.3%) 23 (2.9%) note. graduate data are from 2012-2018. students self-reported race at admission. -data not collected for authors. advances in social work, summer 2021, 21(2/3) 849 discussion representation of dominant identities in textbook selection the ongoing racial justice and #metoo movements have made clear that americans need to do better at understanding the insidious functions of white supremacy and patriarchy. evaluations of institutionalized, structured power are necessary before justice can be sought out. we believe that this auditing assessment is a substantial aid in understanding patterns of white supremacy and patriarchy as it quantifies the sum of our choices and moves them from implicit to the realm of explicit—where they can fundamentally be addressed. this paper examined the program assessment of the implicit curriculum at a multicampus social work program. the hypothesis was supported as educators did disproportionately select books written by authors who were male and white. the proportionality was measured based on the demographics of students in the programs as self-reported at admission, the social work profession, the general u.s. population, and those who identify their profession as author or writer on the u.s. census. race the study supports the hypothesis regarding race, finding that across all programs and sites, there was an overrepresentation of white authors as compared to u.s. census data on national and professional author demographics, professional social workers, and the racial demographics of the students enrolled in the bsw and msw programs. in our sample, the racial diversity of the authors of the required readings are very white, at 84.62% of all authors in the bsw program and 93.06% in the combined msw programs. latinx authors were included in the bsw required readings at a much higher rate compared to the combined msw programs at 5.77% and 3.70%, respectively. black and asian american authorship was low at the bachelor and master levels. three black authors and one asian american author were assigned as required texts in the bsw program. of the 216 authors assigned in the combined msw programs, only four were black, and three were asian american. one of the msw sites did not assign any required readings by black or asian authors. bsw students had merely one book authored by a native american. native american authors were not represented at all in the msw program. despite native american enrollment in all the programs on each campus. of note, native americans represented 12.5% of student enrollment on one of the campuses. this overrepresentation of white authors is mirrored in the national data from the census bureau, which indicates that 86% of all authors are white, 5.7% are black, 4.5% are asian american, and .4% are native american (data usa, 2018). this census data on authors only includes race and not ethnicity, so latinx individuals are included in this data based on their racial identities. this makes for a difficult comparison of data. the racial demographics of the u.s. in 2018 are as follows: 60.7% white, 18.1% latinx, 13.4% black, 5.8% asian american and, .2% native american (u.s. census, 2019). tillotson et al./we are what we read 850 among active social workers with bachelor's degrees at the national level, 67.5% are white, 25.7% are black, 1.8% are asian american, 1.2% are native american, 1.9% are another race, and 2.1% are two or more races (salsberg et al., 2017). among this group of bsw-prepared social workers, 89.3% identified as not spanish, hispanic, or latino, and 10.7% designated that they were spanish, hispanic, or latino. the racial demographics for active social workers with a master's degree or greater are 72.6% white, 19.1% black, 3.3% were asian american, .5% were native american, 2.0% were some other race, and 2.5% were two or more races. among the social workers with at least a master's degree, 9.5% identified as spanish, hispanic, or latino (salsberg et al., 2017). as table 2 shows, in the combined bsw and msw programs, 75.67% of graduates were white, 11.03% were latinx, 1.65% were black, 2.15% were asian american, 6.34% were native american, .25% identified as multiracial, and 2.91% of graduates did not specify a racial or ethnic group. across all programs and sites, white authors were selected 91.42%, compared to 4.1% latinx, 2.24% black, 1.87% asian, and .37% native american authors. races of authors are compared to the races of graduates on a given campus, revealing noteworthy gaps in representation. in the bsw program, 26.88% of graduates were latinx; however, only 5.77% of authors were latinx. at site a, 16.84% of graduates were latinx, while only 6.06% of generalist text authors and 7.14% of clinical year authors were latinx. we see a similar disparity at site b, where 12.5% of our graduates were native american, and there were no native american authors in the sample. using all four measures—students, professional writers, professional social workers, or the general us population—the textbooks in this sample all exceeded proportionality in the assignment of white authors except for one data point. the 84.62% white authors assigned in the bsw program is lower than the percentage of white professional authors at 86% (data usa, 2018). the authors are more white than the student body, across all programs. this varies by site and year, with the authors in the first year of site b almost exclusively white, with only one asian american author in the sample (see table 2). examining the race of authors provides a singular but important piece of data about who has the authority to construct knowledge within a course. it is acknowledged that some of the authors included in the reading list are committed white antiracists and their books focus on issues of diversity and equity. their voices are important too, particularly for our white students who need antiracist white role models. that said, we align ourselves with crt and believe that people of color and other oppressed individuals should be able to tell their own stories (solórzano, 1997). we need to address this disproportionality. students should be able to see themselves reflected in the curriculum. this is happening for our white students, but not our students of color. gender when examining the authors' gender identity, the study found that the majority of the authors for the combined msw programs were men at 60.83%. the bsw program audit found that most of the authors were women at 55.77%. the percentage of women authors in the bsw program does exceed the national population estimates for 2019, which indicated that 50.8% of people in the u.s. were female (u.s. census, 2019). additionally, advances in social work, summer 2021, 21(2/3) 851 the census bureau also indicated that 61% of all authors in 2016 were women (data usa, 2018). in total, across all programs and sites, males composed 57.62% of all authors. this is an overrepresentation of men as compared to the national demographics of the profession which indicate that 83.3% of professional social workers were women in 2017 (salsberg et al., 2017). the gendered representation of our students aligns with the national data as 84.95% of bsw students are women, and 83.19% of all msw students are also women. using these benchmarks, only the bsw program exceeded proportionality in just one of the four measures—as compared to the u.s. population. therefore, we concluded that the outcome supported the hypothesis that a preference for men existed in the book selection process for both the bsw and msw programs. implications and limitations the reading audit harvested institutional information to give course decision-makers a richer understanding of the program and their individual choices as teachers. often privileged voices are accepted without question or understood as neutral (phillips & lowery, 2018). the audit of assigned readings tells a story about whose voices matter to teachers and in constructing their students' understanding of content and the world around them. students spend hours throughout their education reading the books assigned by their professors. the authors assigned telegraph to students, and the campus community, who is worthy of an audience and who gets to be a creator of knowledge. the practice of auditing for race and gender will help decision-makers confront choices and see who is getting too much time at the proverbial mic and who has been neglected. while many decisions about texts are made one at a time over the course of the year, the audit aggregates these decisions to make representational patterns clearer and easier to see–across courses and programs of study. for assessment and accreditation, additional areas can be included in an audit of textbooks, such as author discipline. in an interdisciplinary field like social work, this can be very helpful in understanding what views the program may be intentionally or unintentionally emphasizing. faculty members are often completely unaware of their peers' course material selection or the overall implicit messaging of their department until an audit is completed. although the auditing tool was designed to measure social work programs, it is possible to imagine other useful applications. colleges could elect to audit their general education programs as part of an internal review or accreditation. these audits could be completed by external researchers as schools use websites as an archival repository for syllabi, making auditing from a distance more feasible. similarly, an audit of authors of the most commonly used textbook publishers could reveal needed information about the demographics of current authorship. audits can highlight patterns and trends that were there all along, but so normative, they went unnoticed (smith et al., 2018). while this is useful to disrupt norms, there are a few potential negative effects to consider. first, using auditing to achieve better representation is a goal of the auditing process. improved representation, measured in numbers, may not achieve deeper goals like adopting an antiracist perspective or an awareness of toxic masculinity. some may view simply getting the numbers right as the tillotson et al./we are what we read 852 whole picture, instead of a part of the picture. this kind of approach could lead to another negative consequence, manipulating the numbers to appear to be achieving race and gender representation while preserving the status quo. social workers are ethically driven by the national association of social workers code of ethics (nasw, 2017) to empower and advocate for oppressed groups, but not all in higher education have a code of ethics requiring this commitment. organizations may prefer not to know what the performance of the institution is in terms of representation. some research suggests that the dominant group is often invested in ignorance or maintaining "racial innocence" as a form of plausible deniability and to maintain existing privileges (phillips & lowery, 2018). norms are durable and resistant to change. as social phenomena, racism and sexism are responsive to changing social standards and adapt quickly (berdahl et al., 2018; bonilla-silva, 2006). secondly, accreditors may decide to select other mechanisms for measuring the implicit curriculum. ideally, the auditing tool would become an accepted process of accreditation assessment. auditing is a straightforward process, but assigning gender and race to individuals who do not explicitly identify themselves is an instance where the researchers' decisions impact the results. using a gender binary with only male or female as an option should be addressed in future audits. similarly, not using a multi-racial category produced results that emphasized one element of racial identity over others. this was true in racializing malcolm gladwell as black and not multi-racial. lastly, as researchers and program administrators, we elected to study our own four programs and to pilot the auditing process on our courses and faculty. this certainly is a limitation that impacts our ability to approach the work with neutrality. yet, as discussed above, we take a postpositivist theoretical approach that begins without an expectation of objectivity. we do not know if these findings hold beyond our program. virtually nothing is known about the diversity, or lack of, among textbook authors in the academy or specifically social work education. we believe that the process was useful for our critical self-reflection, particularly the ability to name our biases, and for targeted program renewal by consciously selecting textbooks written by authors with a broader array of social identities. conclusion the world of higher education was already facing substantial pressures, including higher costs to provide education and smaller pools of potential applicants before covid19 forced institutions to send their students home and complete the school year entirely online. at the same time, the nation has finally woken to the truth of structural racism across the country. in particular, the murders of breonna taylor, ahmaud arbery, and george floyd have inspired protests, rallies, and national soul-searching that has been compared to the civil rights era (berry, 2020). the black lives matter movement was launched in response to the death of michael brown in ferguson, missouri, in 2014, yet, early public opinion polls and reports indicated that most americans did not align themselves with the movement until recently. in the run-up to the 2020 u.s. presidential election, polls suggested that opinion has changed dramatically, especially among political advances in social work, summer 2021, 21(2/3) 853 progressives and liberals (yglesias, 2019). as the national conversation around racial justice may wax and wane, the current context within academia appears supportive and eager for new tools with the potential to answer the harder and more critical questions students, alumni, and accreditors are sure to be asking soon. much more work is needed within higher education to break down the deeply entrenched norms of patriarchy and white supremacy. even forty years after the civil rights movement and the passage of critical pieces of legislation, there is evidence that access to higher education—especially elite higher education—may have decreased for students of color in recent decades (espinosa et al., 2019). moreover, students are aware that they need skillsets for working with diversity and difference in their future workplaces and are demanding more preparation (larson & bradshaw, 2017; warikoo, 2016). social work education has made a start by developing a stand-alone competency for diversity and requiring programs to specifically address diversity in their self-assessments. if schools want to close the divide between rhetoric and practice and embrace diversity, equity, and inclusion as an integral part of the implicit and explicit curriculum, additional tools and approaches are needed. the hope is that the audit will help to uncover the unconscious biases of faculty, stimulate further research, and facilitate meaningful course and program level change that is grounded in creating more just educational programs that reflect the intersectional diversity of our students. references abrams, l. s., & moio, j. a. 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(2019, april 1). the great awokening: a hidden shift is revolutionizing american racial politics—and could transform the future of the democratic party. vox. https://www.vox.com/2019/3/22/18259865/great-awokening-white-liberalsrace-polling-trump-2020 author note: address correspondence to emily tillotson, department of social work and sociology, walla walla university, 204 s. college ave, college place, wa, 99324. email: emily.tillotson@wallawalla.edu. https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1015&context=sphhs_policy_workforce_facpubs https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1015&context=sphhs_policy_workforce_facpubs http://nscresearchcenter.org/wp-content/uploads/signaturereport12.pdf http://nscresearchcenter.org/wp-content/uploads/signaturereport12.pdf http://assets.uscannenberg.org/docs/inequality-in-1100-popular-films.pdf https://doi.org/10.1093/sw/40.1.134 https://www.census.gov/quickfacts/fact/table/us/sex255219 https://doi.org/10.4000/sdt.8570 https://doi.org/10.1080/02615479.2016.1170113 https://www.vox.com/2019/3/22/18259865/great-awokening-white-liberals-race-polling-trump-2020 https://www.vox.com/2019/3/22/18259865/great-awokening-white-liberals-race-polling-trump-2020 mailto:emily.tillotson@wallawalla.edu _________ hanna kirjavainen, ms, senior lecturer, turku university of applied sciences, finland. harri jalonen, phd, professor, university of vaasa, finland. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 109-131, doi: 10.18060/26067 this work is licensed under a creative commons attribution 4.0 international license. “one’s social skills go to the dogs”: the potential of social media to elicit information on socially withdrawn youths in finland hanna kirjavainen harri jalonen abstract: youths who are socially isolated are largely inaccessible to social work professionals; nevertheless, most are active on social media. feeling they have been let down by society, many such youths seek comfort in imageboards, where the idea of being anti-social is cherished and where even extremism and hate speech is tolerated. this study relies on a thematic analysis of 323 imageboard messages to identify the challenges socially withdrawn youths perceive as excluding them from society. we use the capability approach as our viewpoint, emphasizing the youths’ actual capabilities to join in, as opposed to the opportunities seemingly provided by society. our results resonate with the earlier research: many members of the group labeled ‘withdrawn youth’ suffer from neuropsychological and mental health problems, fear social situations, experience a sense of shame and failure, and harbor bitterness toward society. they consider issues including unsuitable services, the onerous demands imposed by working life, and the hard values prevalent in society to restrict their opportunities to participate in that society and undermine their self-respect. fear and negative experiences prevent socially withdrawn people from approaching social workers. accordingly, we recommend social services keep an open mind on using digital options to reach people beyond the conventional service system. keywords: social withdrawal, social media, social work, youth, finland the advances in digitalization present more opportunities than ever before for people to be connected. paradoxically, feelings of loneliness and isolation have grown in recent decades, and social isolation has been recognized as an important global threat that affects all age groups (lubben et al., 2015). in the capability approach, exclusion and the inability to relate to others have been recognized as impoverishment as well as a source of further loss (sen, 2000). the situation also challenges the care professions, especially social workers, who are centrally positioned to help counter loneliness by developing and piloting interventions (bessaha et al., 2020). in finland, social media forms a remarkable part of young people’s lives: in 2020, 84% of 16-24 years old used social media every day (statistics finland, 2020). young men recorded almost 20% more screen time than young women (gracia et al., 2022). despite embracing technological opportunities when forming and maintaining social contacts, young adults report regularly feeling lonely and socially isolated (smith et al., 2021). one of the reasons for loneliness is not being in education or employment (husu & välimäki, 2017). the number of such youths has remained high for decades in the developed world. the situation has led to a growing phenomenon in developed societies called social withdrawal, typified by the group feeling confined to their homes and avoiding social about:blank advances in social work, spring 2023, 23(1) 110 contact (rubin et al., 2009). consequently, social workers and other caring professionals face challenges in reaching this section of youths (ayoub et al., 2021). it seems that the existing services do not meet the group's needs and that there is a lack of understanding of which methods might work more efficiently (e.g., ayoub et al., 2021; li et al., 2017). social withdrawal is a well-theorized and researched phenomenon (e.g., bowker et al., 2016). nevertheless, there is a lack of research focusing on practices (li & wong, 2015a) and technologies (lember et al., 2019) that could encourage young people who are socially withdrawn to engage with public services. the idea of service users working alongside professionals to design, create, and deliver services (voorberg et al., 2015) does not fit those who are not interested in attending, distrust the system, or are unreachable through traditional means. the shortcomings of the social care system lead to a constant bias against and exclusion of vulnerable groups (brandsen, 2021). with more information about socially withdrawn youth, social workers and other service providers could start developing new kinds of support services that reflect the needs of different customer groups (e.g., bullock & colvin, 2015; li et al., 2017). online communication is a primary means of social interaction among youths in the developed world, and the vast majority use social media platforms regularly (e.g., smith et al., 2021). digital options are thus suitable means to reach young generations. however, the potential of digital technologies to aid service provision is hindered by a lack of empirical evidence on how vulnerable groups can be reached through digital means (bonevski et al., 2014; jalonen et al., 2021). this paper fills these gaps by providing findings from a case study on how social media discussion forums can be used to ensure the voices of socially withdrawn youths are heard. the primary aim of this article is to address how youths who are socially withdrawn perceive their situation and to suggest what forms of support would help them in response to the lack of understanding of their worldview (ayoub et al., 2021; bonevski et al., 2014). the study specifically concentrates on the service-system level and the societal obstacles young people believe prevent them from participating in society. the article’s second aim is to explore how digital technologies could assist in bridging the gap between socially withdrawn youths and social workers and other caring professionals. we used finnish discussion board posts as our data source to illuminate the potential of social media as a source of otherwise unattainable information. the capability approach (sen, 1985) is used as a framework to understand how the capabilities of socially withdrawn youths enable them to access finnish society’s opportunities. theoretical framework social withdrawal and hikikomori syndrome social withdrawal is an umbrella term that refers to individuals isolating themselves from familiar and/or unfamiliar others voluntarily and permanently (rubin et al., 2009). the process often starts in childhood (li & wong, 2015b), but it seems that many young people do not even recognize withdrawing initially, and once they have, their condition may already be quite severe (li et al., 2017). social withdrawal has been linked to mental kirjavainen & jalonen/social media & finnish youth 111 health problems (lubben et al., 2015), internet and gaming addictions (dong et al., 2022), suicide (haasio & salminen-tuomaala, 2020), and school shootings (bogerts, 2021). the phenomenon emerges from both psychological and societal factors. bowker et al. (2016) listed several correlating factors, such as parental relationships, disposition, peer rejection, poor self-image, a tendency to internalize problems, and being male. husu and välimäki (2017), in turn, identified the following three factors as contributors to social withdrawal: excessively high expectations on the part of society and the impossibility of non-educated youths attaining status, income, and social capital; mental health problems and lack of social skills; and life-changing events beyond the individual’s control. li and wong (2015b) explain social withdrawal with reference to micro-level social and psychiatric issues such as family dynamics, bullying, and negative experiences of the education system, while also stating that the phenomenon is strongly influenced by sociotechnological factors, such as unemployment, reduced or suspended social mobility, a rigid educational system, and the extensive use of the internet and online gaming. research shows that social withdrawal is also somewhat culturally specific (norasakkunkit et al., 2017), being particularly associated with individualistic cultures (dieckhoff & gash, 2015; välimäki et al., 2019). being out of the education and employment spheres correlates with being socially excluded (li & wong, 2015b) and, as a rule, those not in education, employment, or training feel lonelier than those who are. feelings of loneliness might be attributable not only to having fewer contacts but also to a lack of money, the presence of psychological strain, stigma, and a sense of shame (dieckhoff & gash, 2015; välimäki et al., 2019). one extreme representation of social withdrawal is hikikomori syndrome, which originated in japan but is now a worldwide phenomenon (li & wong, 2015a; tan et al., 2020) alongside the growth of industrialization and individualism (bowker et al., 2016) and the constant use of technology and social media (li & wong, 2015b). based on a systematic review, nonaka et al. (2022) concluded that the elements characterizing hikikomori syndrome are not working or attending school, a person not socializing outside their home, and the condition lasting over six months. currently, however, there is no overarching definition of hikikomori syndrome (tan et al., 2020). some researchers include among those affected, people who maintain few relationships, leave their homes infrequently, or have withdrawn for a short period (nonaka et al., 2022; tan et al., 2020). there is also some debate over whether hikikomori is merely a symptom or a primary mental disorder (pozza et al., 2019). it has been suggested (pozza et al., 2019) that hikikomori syndrome should be added to the diagnostic and statistical manual of mental disorders (dsm) as a psychiatric disorder. the diagnostic criteria would include the following components: a person spending most of the day, and nearly every day, at home; clearly and long-lastingly avoiding social interaction; the situation interfering with the person’s life; and the syndrome being unexplainable by other mental disorders (pozza et al., 2019). while social withdrawal certainly causes problems at the individual and societal level, it is necessary to acknowledge that the concern over this phenomenon and its labelling has also been suggested to reflect a moral judgment on the part of the dominant socio-economic advances in social work, spring 2023, 23(1) 112 section of society (chan, 2017). withdrawing has also been presented as a lifestyle choice (norasakkunkit et al., 2017). it is important to ask if professionals and researchers are aware of and able to reflect on their own cultural conventions and values and accept fundamentally different worldviews. moreover, a narrow understanding of this phenomenon may lead to a generalization of youths being targets of various (more or less one-way) activation practices—meaning state policies aiming to push unemployed people into employment or education backed by the threat of sanctions to their social benefits. in other words, there is a risk of narrow-mindedness dominating thinking on the issue, which does not leave room to acknowledge youths who have decided to live differently, such as in a socially withdrawn manner. the paradox of social media early depictions of social media promised an innocent arena for sharing information and interacting socially. however, as social media matured and became ubiquitous, its value as an empowering technology came to be questioned. the penetration of social media usage, combined with the rapid development of artificial intelligence and machine learning techniques, uncovered the ambivalence of social media. concerns have been raised over issues such as deep social polarization, the rapid diffusion of misinformation and disinformation, privacy breaches, and data surveillance (e.g., mckay & tenove, 2021; zuboff, 2019). to put it in a somewhat simplified way, what was once thought to be a remedy has become the disease. there is extensive research on how youths use social media, and the findings indicate several purposes and consequences. numerous advantages and disadvantages can be identified. benefits reported in studies include enhancing social contact, independence, and communication (valkenburg & peter, 2007), developing a sense of connection with others (wong, 2020), fostering of individual identity and expressing identity (boyd, 2008), reducing loneliness (kivijärvi et al., 2019), increasing quality of friendships (valkenburg & peter, 2007), gaining informational and educational benefits (boyd, 2008), health advice and peer support (robinson et al., 2016) actualizing citizenship through political expression (weinstein, 2014). on the negative side, studies have identified several concerns: social media addiction (davila et al., 2009), online meanness and cyberbullying, misunderstandings, unwanted contact and unintentional disclosures (christofides et al., 2012), a detrimental impact on cognitive and emotional well-being (kross et al., 2013), increased risk of depression (jelenchick et al., 2013), limited self-regulation and susceptibility to pressure from peers (o’keeffe & clarke-pearson, 2011), fear of missing out (oberst et al., 2017), polarizing political engagement (keating & melis, 2017), and inspiring and worsening psychopathologic behaviors (vainikka, 2020). the paradox of social media is palpable (jalonen, 2014). social media sites allow youths to accomplish many things online that are important to them. sites can help maintain connections with friends and family, make new friends, create and express identities, exchange ideas, and give and receive emotional and informational support. however, social media brings new risks, such as peer-to-peer misbehavior, inappropriate and kirjavainen & jalonen/social media & finnish youth 113 insulting content diminishing self-confidence, self-respect, and self-esteem, and the threat of data leakage and connected privacy breaches. social media lends itself to acts of selfexpression and identity management and engaging with others. social media has also acquired a prominent role in social welfare practices (dolinsky & helbig, 2015), an effect heightened owing to the recent pandemic (e.g., misha et al., 2021). social media can offer a social worker, for example, a way to reach existing and prospective clients (bullock & colvin, 2015) or a method to assess service needs, conduct interventions, and evaluate service quality (chan, 2016). it can be a tool to support case assessment (sage & sage, 2016) and working with communities (sitter & curnow, 2016). social media also offers a window into the lives of the youth and, in so doing, provides social workers with new ways to understand the experiences and perspectives of youth. the capability approach to social withdrawal the capability approach has become an important framework for the evaluation and assessment of well-being, social arrangements, and policies. amartya sen (1985) and martha nussbaum (1988) are among the key developers of this framework, focusing on the quality of life that individuals are able to achieve. according to sen (1985), this should be analyzed in terms of people’s capabilities to function, meaning their opportunities to undertake activities they want and to be who they wish to be. sen calls these valuable achievements functionings, which include, for example, working, resting, being healthy, and being part of a community. the crucial point is the freedom and actual opportunities people have to live the life they want and be the person they aspire to be, referred to as their capabilities (sen, 1985). these aspects are strongly affected by economic and social opportunities, political and civil rights, and enabling conditions such as health, education, and encouragement (kjellberg & jansson, 2022). another important element is individuals’ “agency” (i.e., individual abilities to pursue and realize their goals; alkire, 2016; sen, 1985). the capability approach offers alternatives to traditional well-being measures such as income (sen, 1985) and challenges the dominance of the neo-liberal ideology (kjellberg & jansson, 2022). analyzing the roots of capabilities is important, as is understanding exactly how individual traits and social structures manifest in a person’s situation (naz, 2016). sen (2000) speaks of the multidimensionality of poverty, addressing it as a deprivation of certain crucial capabilities—not merely physical ones but also more elaborate social achievements, such as participation in a community or being able to appear in public without experiencing a sense of shame. exclusion may take an active or a passive form, the latter arising through societal processes without actual intention. sen (2000) claims that unemployment is the most important factor and a major cause of social exclusion in europe. the effects of unemployment are not confined to having a low income but include several other personal and society-level losses. these include deterioration of skills, confidence, and sense of control; lack of freedom, psychological and physical harm, disruptions to social relations, passivity and lack of motivation, and at the societal level, underutilization of productive power, increasing inequality and weakened social values and social cohesion fostered by advances in social work, spring 2023, 23(1) 114 cynicism and hostile attitudes to society (e.g., mathers & schofield 1998; weckström 2012; karsten et al. 2018). the main principles of the capability approach align with the core of social work values, as the approach focuses on evaluating individual well-being and advancing social justice (den braber, 2013; kjellberg & jansson, 2022). den braber (2013) differentiates three main ways to connect the capability approach with social work strategies and programs—the theory of action for professionals, a normative framework for legitimatizing strategies and tools, and an evaluative instrument for social policies and actions. kjellberg and jansson’s (2022) scoping review revealed that the capability approach was used in social work research in several ways: as a method for investigating the sense of well-being, as a tool for social workers to conceptualize, understand, and support their clients, and in addressing structural inequalities and evaluating social practices. sen (2004) opted not to specify the list of capabilities owing to the list being dependent on context. this vagueness has led to capabilities being operationalized in a variety of ways. burchardt and vizard (2011) defined ten domains of the most important capabilities connected with inequality: life, physical security, legal security, health, education and learning, standard of living, productive and valued activities, participation and influence, social life, identity and respect. peruzzi (2014) distinguished capabilities based on domains of social exclusion, including physical health, mental well-being, enjoyment of relationships, participation in political life, standard of living, access to social services, and engagement in productive and valued activities. today, several of those capabilities manifest themselves online, especially with young people through virtual learning, social media influencing, and forming and maintaining relationships. however, online options may also reduce the readiness to engage in face-to-face activity and have created situations in which some people interact with others only through digital means. we aimed to explore how youth who are socially withdrawn 1) perceive their situation, and especially which kind of service-system level and societal obstacles they feel exclude them from society, 2) what kind of supports could benefit them, and 3) how digital technologies could assist social workers in reaching these youths. this topic is important, as the poisonous atmosphere of imageboards allure especially young men who feel mistreated and excluded (vainikka, 2020). we do not truly understand their reality (ayoub et al., 2021; bonevski et al., 2014). data the empirical data were gathered from ylilauta.org, one of finland’s most popular imageboards, particularly among young people. ylilauta emerged in 2011 and is a finnish representative of an imageboard: an online forum focusing on posting images alongside text and discussion (ylilauta n.d.a). it is not owned by media companies but by a private individual, who is also the main administrator. the forum is moderated by volunteers and, according to the ministry of justice, the main platform for finnish hate speech (kettunen & paukkeri, 2021). ylilauta describes itself as “a privacy-oriented anonymous discussion board where you are free to discuss almost anythin.” (ylilauta n.d.b). kirjavainen & jalonen/social media & finnish youth 115 one of the discussion forums in ylilauta is called hikikomero, which consists of young adults who describe themselves as having no or few social relationships (husu & välimäki 2017). the forum’s name is based on hikikomori syndrome but is also wordplay, as in the finnish language, hiki means sweat, and komero means a closet. users refer to their limited sphere of life and breaking out in a cold sweat if forced to go out in public. both sympathetic advice and anti-social behavior toward others co-exist on this forum, and it creates a sub-culture and a community of its own, marked by participants distancing themselves from society and using negative characterizations of other people. hateful comments, lack of empathy, and misogynous views abound, which is common in online imageboards, such as 4chan and 8chan (vainikka, 2020). hikikomero syndrome has been studied from various perspectives, including the differences between the information needs of finnish and japanese socially withdrawn people (haasio & naka, 2019), the participants’ reasons for their withdrawal (husu & välimäki, 2017), and the forum’s relationship with social exclusion and anti-social behavior (vainikka, 2020). we chose this forum as our data source because of its popularity. although the participants do not expressly represent the hikikomori phenomenon, they spend much of their time online and mainly form their social contacts in that space. mental health problems seem common, and the participants’ everyday lives are characterized by fear of social situations and loneliness (husu & välimäki, 2017; vainikka, 2020). while the forum permits anonymity, surveys reveal that its users are mostly male and aged between 20 and 30 (haasio & naka, 2019; husu & välimäki, 2017). the forum does not offer a representative sample of young finnish people as a whole but does offer a lens on the reality of young men who are lonely and withdrawn. method the empirical data consist of messages published during 2018 and 2019 on the hikikomero discussion forum; a total of 78,095 messages. these messages were downloaded on march 2020 from a database owned by a company that each day gathers social media messages written in finnish and published on different social media platforms. the study builds on research investigating social withdrawal and the capability approach to provide insights into the world of socially isolated youths. the data helped unveil which service-system level and societal challenges withdrawn youths feel prevent them from taking part in society and living the life they desire. we were particularly interested in working life, studying, employment services, and social services. choices motivated by employment and education play a significant role in the lives of young people, and in finland, those unable to access them consume employment and social services provided by the state. the provision of those services carries a threat of sanctions to the welfare benefits of those who refuse to take up proffered activities, such as training or work experience placement. to avoid the moral judgment of the dominant socioeconomic class (chan, 2017), we concentrated on messages posted by people expressing dissatisfaction with their situation and who were unable to achieve their desired outcomes. advances in social work, spring 2023, 23(1) 116 figure 1. the data analysis process we deployed thematic analysis in line with our research purposes, informed by the capability approach and prior research on social withdrawal. our thematic analysis followed the five steps outlined by braun and clarke (2006). (1) familiarization with the data. both authors explored the messages with a tailored digital tool. the main author carried out a trial search with the finnish words osallistua (take part, participate, attend, engage in, be involved) and este (obstacle, barrier, hindrance, impediment). the results obtained seemed rather limited, so the main author investigated the messages on services, working life, and studying and found they contained information about the participants’ capabilities and the obstacles to attendance they faced. the authors discussed this and decided to include commonly used words related to these themes to ensure data quality. the words were lemmatized in that they were sorted in a corpus to group with all their variant and inflected forms (table 1). (2) generating the initial codes. the authors made independent trial codings from a sample of 100 messages of the 7785 posts identified. the differences between researchers’ trial codes were discussed, and further work principles were agreed upon. the researchers gathered the posts in excel files and sorted the messages under suitable headings. both researchers collated the messages under initial codes, chosen according to the research question, trial codings, and previous research on capability sets and social withdrawal. many messages could be assigned to several codes and themes. the initial codes the researchers agreed on were: seeking work; studying (only posts related to university or vocational school study were collated as the research focus was on the present); employment services; society; requirements of working life; relationships; inability to pursue ambitions; attitudes of professionals; mental health; practical hindrances and obstacles; proposals and suggestions. kirjavainen & jalonen/social media & finnish youth 117 table 1. search words and examples topic search word(s) messages text example workrelated “työ”, “ammatti”, “palkka”, “duuni” (work/job, profession, salary) 6865 i graduated with a professional qualification, worked in my specialist field for a while, then got sacked as “i didn’t fit into the group.” educationrelated “opiskelu”, “koulutus”, “yliopisto”, “amk”, “ammattikorkea” (education, study, university, university of applied sciences) 443 i don’t get bullied at university, but i am excluded from everything. employment services “työtoiminta”, “työkokeilu”, “kurssi”, “harjoittelu” (rehabilitative work activity, work experience placement, course, labor market training) 174 i was first in the rehabilitative work activity in, 2005 and then all the clients were junkies, alkies, people with mental health problems, and those who were otherwise really deeply marginalized, the long-term unemployed. public services “sosiaalitoimisto”, “kela1”, “sossu” (social office, “kela1”) 174 when i was still able to manage my affairs with the social, it was more human. with kela1, there is no humanity. they just try to figure out reasons to cut your support and delay the decisions. engagement “osallistua”, “osallistuminen” (take part, participate, engage in, be involved) 131 in the closet2, one’s social skills go to the dogs. you then cannot join in a conversation. barriers “este”, “rajoite”, “haitta”, “epäonnistuminen” (obstacle, barrier, hindrance, impediment, failure) 104 in theory, age isn’t an obstacle, but preferring to cube [meaning the withdrawal process] is; because it means that you lose your grip on so-called real life. notes. 1 the social insurance institution of finland, which pays income support, sickness benefits, pensions, and labor market support for those who don’t belong to trade unions or have insufficient work experience to qualify for trade union unemployment benefits. 2 in finland, ‘being in the closet’ usually refers to people hiding their sexual orientation. however, the participants in this forum use it to refer to being confined to their homes. (3) searching for themes: the main author examined all the collated messages, combining suitable codes to simplify the data, addressing the issue of some initial codes representing only a few messages, and searching for themes present in several or all of the codes. the authors discussed the findings and agreed upon seven themes among the messages, which seemed to play a part in excluding people who are socially withdrawn from social services and society. these themes were: personal fears and shame; negative service experiences; neuropsychological and mental health problems; problems with interaction and communication; bitterness and hostility toward other people and society; advances in social work, spring 2023, 23(1) 118 the importance of paid work; and complicated-intertwined problems that had developed over a long period. (4) reviewing the themes: the main author read the messages once more, marking them according to how they contributed to the research question: whether they related specifically to the service system or society in general. it became clear that some refinement and combining would be necessary, as the distinctions between themes were unclear. it is worth noting that there is still some overlap. (5) defining and naming themes. the researchers had a final discussion about the data, the analysis process, and the themes found. seven identified themes were condensed into two overarching themes, which relate to the unsuitability of services and the role of society in exclusion. the former encompasses the forum participants’ extreme reluctance to access services, the attitude of service professionals, the wrong kind of services, and bureaucracy. the latter relates to loneliness, hard values, and the demands of working life. figure 2. service-system level and societal obstacles that youths who are withdrawn consider prevent them from participating in society kirjavainen & jalonen/social media & finnish youth 119 findings the current study aimed to determine what service-system-level or societal obstacles socially withdrawn youths feel prevent them from participating in society. the results of our thematic analysis resonate with earlier research on social withdrawal, as well as sen’s (2000) listing of the effects of unemployment and peruzzi’s (2014) dimensions with the focus being on mental well-being, enjoyment of social relationships, access to public services (social, health, employment, and youth-oriented), and engagement in productive and valued activities. we present our key findings below with examples of the messages on the hikikomero forum to exemplify the final themes. the messages were translated from finnish to english by the authors, who aimed to be cognizant of the benefit of retaining the spirit of the forum. the meaning of the messages was also checked with an english native, who also speaks finnish fluently. overall, the messages were well-written, but the syntax of the posts was sometimes untypical. the use of the forum’s own argot was common, which often included fabricated words and terms used in non-standard ways. using an online forum to harvest data raises ethical considerations (convery & cox, 2012), as participants have not been able to give consent to the use of their posts. however, the forum hosted on ylilauta is anonymous and public and includes a disclaimer that the posts may be used as research material. some of the participants might not realize that this is the case, as the boundaries between private and public tend not to be explicit in online contexts (convery & cox, 2012). we have respected the participants’ privacy; we do not individualize any writers or provide any information that could identify them. the fact that the text extracts were translated from finnish into english means that the data do not exist in the same format on the internet as in this article. we avoided bias by approaching the data openly, eliciting the obstacles from the messages. however, it must be admitted that the research team created the initial categories in advance of data gathering, and therefore, those categories reflect the team’s values, such as participation in society being a worthwhile goal. the negative connotation of social withdrawal could and should be questioned as it can also be seen as a personal choice (chan, 2017; norasakkunkit et al., 2017). however, our data make it clear that although some expressed contentment, the majority of posts revealed dissatisfaction. our findings emerged following a thorough familiarization process with our data that involved two researchers reading the posts three times after the selection phase. unsuitable services participants reported factors contributing to their sometimes extreme reluctance to access services. those factors included experiences of exclusion and rejection from workplaces, schools, and society in general, and also a lack of comprehension on the part of service providers and those service providers sometimes belittling their clients. many of those posting had accessed different forms of social and health services (albeit in many cases only briefly) and found them unhelpful or unsuitable: “i know the low-threshold meeting places and have visited one, but the crowd there seems to be of a different age, and i do not seem to adapt to that place.” lack of money or material resources did not come advances in social work, spring 2023, 23(1) 120 up as a major challenge, confirming sen’s (1990) idea about material resources as a means but not an end to achieving well-being. unemployment in particular cannot be countered simply by providing social security, as it is related to so many other negative effects (sen, 2000). many forum users professed their dissatisfaction with the help available from the service system or stated none was available. the feeling that professionals did not understand their problems or questioned and diminished them was common, as seen in writer 1’s post: that is why one should never ask advice from normal people about one’s life because the only responses are like the best lines from donald duck. even qualified doctors, psychologists, and nurses offer this verse advice for real, despite knowing very well that you cannot fix neurological disabilities by going to a school, for a walk, or to a rehabilitative workplace to carve wooden dildos. the participants also stated that service professionals patronized them and did not appreciate their achievements and skills if they did not fit the predetermined standards; for example, if a young person had taught themselves coding but did not have recognized qualifications. access to the services listed by peruzzi (2014) is not enough if the contact person for that service has a negative attitude or insufficient knowledge of the customer’s situation. the forum users commonly expressed how they found applying for and dependence on benefits humiliating. employment services, an integral part of social work with young adults in finland, were a popular topic. many participants felt that rehabilitative work activities were the only service offered to them, and in the service professionals’ opinion, work was a cure for all illnesses as well as a remedy for exclusion. as demonstrated in writer 2’s example, these services were generally seen as exploitative and not a valued activity as such. the evident frustration was remarkably intense. many participants referred to the employment services as slavery and voiced very strong opinions about them; however, some considered them appropriate and valuable. i have even been bullied on employment office training schemes, where in practice, one works without pay in some company for several months. …this is a good help for years of poverty and marginalization as one has to go to get bullied for eight hours five days a week for several months or risk sanctions. some participants shared their experience of the problems with finnish bureaucracy and wished the system were more flexible. many felt managing the triad of the employment office, kela (the social insurance institution of finland), and the social office was very stressful. the employment service and kela professionals were considered mainly to be unsympathetic bureaucrats, whereas social workers appeared more humane. writer 3’s post relates to the change when responsibility for the payment of income support was transferred from the municipalities to the state-led kela in 2017. here as well, when one could deal with the social services, there was humanity. in addition, they truly tried to help us to move on with our life. sometimes they paid full support just to encourage a hobby and buy clothes etc., so we don’t only get stuck kirjavainen & jalonen/social media & finnish youth 121 within four walls the whole time. kela doesn’t have any kind of humanity. they are just trying to figure out reasons to cut support and delay decisions. probably decisions are made like a conveyor belt, which adds even more errors and isolates the customer [from them]. the fear of sanctions applied to their unemployment benefit and income support was a pronounced topic. and even though the disability pension was seen as a lucrative target, it was also claimed that young claimants are forgotten by society, and then loneliness becomes even more difficult to handle, as demonstrated in writer 4’s post: i have ruined everything in my life and grandly. nobody offers help anymore: not healthcare, not the social office, or any other place. (…) they kicked me out of public health care as i got a disability pension a couple of years ago. i have nothing, absolutely nothing anymore. fear and regret stayed as a friend. go to school, go to work. go to those uncomfortable situations. catch those opportunities. i didn’t, i didn’t dare, and in the end, nothing was left. the exclusive society this theme consisted of complex, entrenched entities revolving around how other people and society contribute to the withdrawal phenomenon in finland. the withdrawing process often begins in childhood, when some children are bullied or ostracized, which is visible in writer 5’s text: i cannot help my autism. i would have wanted to be normal, but this is the result of exclusion as they push one into the closet. i have my own shit in the background already (traumas and becoming the target of bullying), and then, as an adult, i still have to try to adapt to society somehow. i don’t anymore. i’ll tell this whole bustle where to get off and live as a rat [meaning living on benefits] for the rest of my life then. the loneliness in the posts was palpable, even though some claimed to no longer need the company of other people and felt being sociable was burdensome. the sociability aspect raises the question of whether social relationships are a valuable goal for the participants—a prerequisite of “functionings” under the capability approach (alkire, 2016)—and whether withdrawal is more like a lifestyle choice (norasakkunkit et al., 2017). this finding might partially reflect young people’s social connectedness in the digital age (wong, 2020). however, in light of the forum participants’ bitterness, it also appears to be a response to a lifetime of exclusion and bullying, which were commonly claimed. in addition to active bullying, passive forms included being left out, staring, laughing, whispering, and teasing from classmates or co-workers, to which the participants were unable to retaliate. many participants simply did not know how to make friends. writer 6 elucidates the participants’ attitudes to socializing, as well as their tendency to internalize their problems, as noted in earlier research (bowker et al., 2016): i have mainly bad experiences from university. illusory freedom of choice makes the useless but obligatory [studies] feel even more impossible. another thing i have noticed is so-called low-intensity bullying. i do not want to reveal my subject but advances in social work, spring 2023, 23(1) 122 in this field, a remarkable portion of students are unauthentic popinjays. for me, it started little by little with long stares and laughter, “hey, nn is here” style comments started to be audible sometimes. well, there are reasons due to certain mental health problems. well, consciously i don’t care about any drama shit, but a decent amount of anxiety from which is almost impossible to get rid of is left and friends…zero for sure. problems with mental health and neuropsychological disorders, especially asperger’s syndrome and autism, were expressed as obstacles to participating in valued activities and seemed to make the participants feel they were undervalued by society, as also showcased in the research results of molin et al. (2017). there were many mentions of shame, which sen (2000) offers as a good example of social-exclusion-shaped capability deprivation. the participants feared they would fail or humiliate themselves. in many cases, this was linked to negative experiences. many participants also seemed to lack motivation; they had possessed it once, but their life experiences had diluted it, and a feeling of being stuck in the home stymied their ability to act. some lacked interest in anything and had no dreams or ambitions, while some appreciated the freedom and stress-free life, coping with only a little money. they made comments like “as i don’t have a life anyway,” and some criticized the current exaltation of materialism. the participants found society lacking in many ways. many felt hard values, such as competitiveness and productivity, had assumed too much importance. employment in finnish society was considered hugely important, almost to the point of being a prerequisite for having dignity, a perception that aligns with sen’s (2000) findings on the link between unemployment and social exclusion. the participants felt they were blamed for their situation in public discussions and in their relationship spheres. much discussion revolved around participation in productive activities, and work, in particular, was considered a valued activity, as the capability approach anticipates. access to working life was considered challenging for a variety of reasons, most of them internalized, such as having the wrong demeanor, gaps in the curriculum vitae, too long spent studying, a lack of experience or education, and, in contrast, being overqualified. moreover, competition for jobs was seen as extremely rigorous because “normal” people were also unemployed. however, many reported having work experience; albeit portraying it as mainly negative. bullying and burnouts were common, with participants claiming they were unable to work the full hours expected in modern working life, especially if the job was unsatisfactory or if life did not offer anything positive to counter working life. adjustments to working life were considered important. several forum participants expressed bitterness that merely working is no longer sufficient in current society as there was an expectation that staff would socialize together too, even if the job mainly required solitary work. the frustration and disappointment relating to employment seemed to lead to resentment and even misanthropy, thus confirming sen’s (2000) findings of enhanced cynicism, a sense of exclusion, and grievances against society among the long-term unemployed. wong (2020) suggests that withdrawal can also be seen as a response to the precarious nature of work in the twentyfirst century, reflecting the agency of young people in the face of structural barriers. kirjavainen & jalonen/social media & finnish youth 123 negative experiences, bitterness, and the participants’ personalities create a kind of downward spiral, where encounters with other people are interpreted negatively, at some point completely blocking the participants’ attempts to normalize, as they put it. the attitude to “normal” people was usually hostile; the inability to relate to others was a deprivation in itself and something that indirectly exacerbated other forms of deprivation (sen, 2000). the forum participants had had plenty of time to ruminate on past injustices, and the hikikomero forum offers peer support for that kind of attitude and may even amplify it. the situation highlights the paradox of social media (jalonen, 2014) as the forum discussions offer peer support and exemplify pro-social behavior while simultaneously giving prominence to hateful comments and to those displaying no empathy. the forum may thus work against the participants, deepening their feelings of exclusion (see also vainikka, 2020), as the post by writer 7 shows: unknown people are just the group of normal people you don’t belong to and by whom you have been discriminated against. they talk about marginalized but the correct term is discriminated, but they don’t use this because it would be inculpatory. some random employee might not have discriminated against you but might have been discriminating against some other ‘hikky’ [a person who is socially withdrawn] or just allowed it to happen by standing back. discussion and implications loneliness is a worldwide phenomenon, threatening people’s well-being, especially in the developed world, and is recognized among the grand challenges that social work champions (lubben et al., 2015). the posts to the hikikomero forum provided a unique glimpse into the lives of youths who are socially withdrawn, the obstacles they identify as preventing them from participating in society, and the outcomes they deem important. the forum participants seem to have access to numerous options geared around finland’s university education being free at the point of delivery and its guaranteed basic income for all. however, in practice, the forum participants lack the actual capabilities to lead the lives they want (see sen 1985, 2000) and are constrained from attaining the outcomes they value by various intertwined forms of passive exclusion caused by the demands of working life, other people, and an unaccepting society. additional hurdles include mental health and neuropsychology issues, a sense of shame, and a fear of social situations. social work with adults in finland is closely connected to employability and employment services. it is therefore important to discuss which employment services cater to the needs of the members of society who are socially withdrawn. the current policy is that one size should fit all. that policy results in a situation exemplified in one of the posts where clients of the social rehabilitation service were described as including “alkies, junkies, people with mental health problems and those who were otherwise really deeply marginalized…long-term unemployed.” the jobs assigned to participants were often monotonous and thus not suited to those who are, as one participant put it, “intelligent but retarded.” that description would, for example, encompass highly intelligent people whose potential is constrained by their suffering from a neurological disorder such as autism or asperger’s syndrome. advances in social work, spring 2023, 23(1) 124 another implication of the current system in finland and other developed countries is that they should enable opportunities for anonymous and faceless interaction, as social anxieties and shame hinder traditional face-to-face contact. menon and miller-cribbs (2002) state that online counseling may suit those unwilling to seek traditional counseling. anonymity confers advantages such as an opportunity for intimacy and to manage feelings of being stigmatized. one option could be exploring different social media arenas where previously unreachable groups might be found, as social media seems to provide spaces where peer support (kivijärvi et al., 2019) and professional help (chan, 2016, 2018) are sought and received. this is true of the hikikomero forum, although the probable contagion of the hostile atmosphere can also be considered a negative effect (vainikka, 2020). the atmosphere resonates with the compatibility pressures described in the form of groupthink (janis, 1971), meaning that members do not wish to express ideas perceived to be unpopular. overall, the strict division between the face-to-face and online worlds seems to no longer be relevant to the younger generations. virtual opportunities should be regarded as complementing traditional ones, as some previously unreachable groups might be accessible with online methods (liu et al., 2018). however, the feeling of loneliness was clearly evident on the forum, and the extensive use of social media has been linked to social withdrawal (li & wong, 2015b). one example based on information and communication technologies, with the potential to tackle loneliness, is the moderated online group, in which the presence of a professional ensures a positive atmosphere. the results show that a moderated group can particularly benefit lonely youths who find attending groups in person challenging (kivijärvi et al., 2019). some kind of professional facilitator would be needed in such groups, for example, to counter the participants’ limited social skills, as exemplified in this hikikomori forum entry, “if your social skills (in the best case) were left in high school, it is extremely difficult to start creating new relationships.” accordingly, social workers should not shy away from the professional use of social media but embrace it, especially with youths, a group for whom it has proved to have several advantages (e.g., stott et al., 2016). social media should be seen not only as a way to reach people and maintain connections but also as a source of unfiltered information on people’s situations and needs (jalonen et al., 2021). this approach would counteract the lure of “tamed” and neutral experiences, often present in the service user involvement where participants can find themselves constrained by conditions determining how they should work and present their story (meriluoto, 2017). the posts examined suggest service professionals would benefit from a greater understanding of their clients’ secluded lifestyle and neuropsychiatric problems and also of the paths that led them to withdraw. such understanding is essential for the early identification and assistance of young people who are not yet isolated but at risk of becoming so, as withdrawal is a process (li et al., 2017). conclusion this study explored the potential of social media to elicit information on how youths in finland who are socially withdrawn perceive the social services system and why they believe society excludes them. in a way, they are seen as experts-by-experience facing kirjavainen & jalonen/social media & finnish youth 125 difficulties and/or care services in the past, sharing their experiences of social welfare and healthcare organizations (mclaughlin, 2009). in practice, however, it has been found that the experts-by-experience approach is used to justify an existing rationale. consequently, collaborative individuals intent on seeking consensus are sought for such roles (meriluoto, 2017). the practice raises an important question of whether we are willing to hear critics of the service system or society in general and ready to rethink the status quo instead of merely fine-tuning existing services. there are a few limitations to this research. the sample was collected from one finnish discussion board. in addition, using the internet as a data source might risk the contributors being unrepresentative of the target group. social withdrawal is such a complex phenomenon that it will never be completely understood by analyzing social media messages. however, hikikomero and similar social media platforms can provide a unique window into the lives of youths who are socially withdrawn. anonymity may foster honest discussion about painful and stigmatizing themes. however, group dynamics often lead to complaints being exaggerated, and the possibility of social media bots manipulating conversations and spreading fake news is a real one. the qualitative form of research makes it possible to explore the obstacles to the target group’s participation and also examine what motivates them to become involved. one possible avenue for further research would be to explore exploiting social media to empower the persons who are socially withdrawn on their own terms and to clarify what those terms would be. it is also necessary to focus on public service providers’ willingness to cross the portal opened by social media. gathering information about the situations and challenges faced by youths who are socially withdrawn will remain worthless unless it is transformed into new approaches to 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(2019). the age of surveillance capitalism. the fight for a human at the new frontier of power. profile books. author note: address correspondence to hanna kirjavainen, turku university of applied sciences, finland. email: hanna.kirjavainen@turkuamk.fi https://doi.org/10.1177/1367549418810075 https://doi.org/10.1037/0012-1649.43.2.267 https://doi.org/10.1080/14719037.2014.930505 https://doi.org/10.1080/146498805200034266 https://doi.org/10.1111/j.1468-2397.2011.00829.x https://ijoc.org/index.php/ijoc/article/view/2381/1066 https://doi.org/10.1177/1461444820912530 https://ylilauta.org/info/en_us/about https://ylilauta.org/ mailto:hanna.kirjavainen@turkuamk.fi theoretical framework social withdrawal and hikikomori syndrome the paradox of social media the capability approach to social withdrawal data method findings unsuitable services the exclusive society discussion and implications conclusion references this work is licensed under a creative commons attribution 4.0 international license. participants’ perspectives of a worksite wellness program using an outcome-based contingency approach david gerard bruno james r. brown evan d. holloway abstract: worksite wellness programs in the u.s. are increasingly common. social workers in healthcare and administration should familiarize themselves with the various wellness programs and the impact they have on workers and organizations. this study examined a worksite wellness outcome-based contingency approach (wwoca). this approach bases individual employee health insurance discounts on each participant achieving biometric goals. a mixed-method explanatory approach was used. quantitative health measures of participants (n = 397) and six focus group discussions (n = 45) were conducted using a convenience sample. results indicate that over half of the participants met their work-based health goals (i.e., body measurements at the average or excellent rankings) with increases from 56% in year one to 87% in year two and 90% by year three. however, focus group participants expressed a high sense of failure in relation to health goal attainment, frustration with loss of the financial incentive, and stress and anxiety linked to negative feedback about their body measurements. these results suggest that many participants’ self-worth was negatively impacted when participants had difficulty conforming to worksite wellness standards. social workers in healthcare and administration will need to advocate for worksite wellness programs that promote human dignity and avoid discriminating based on employee health status. keywords: employee wellness; weight loss; workforce health; worksite wellness health contingent programs over the last several decades, health experts and researchers in the united states have become more aware that there are a variety of lifestyle challenges, such as physical inactivity and excessive stress that have been linked to resultant health problems (arena et al., 2013; hill-mey, merrill, kumpfer, reel, & hyatt-neville, 2013; mattke et al., 2013; murray & frenk, 2010; task force on community preventive services, 2010). as a response to these lifestyle challenges, many organizations in the u.s. and elsewhere have developed worksite wellness programs as a core strategy for health promotion, employee self-care, and prevention of disease (hepworth, rooney, rooney, & strom-gottfried, 2017; pronk, 2009; van berkel et al., 2014). research in the area of worksite wellness is fairly new. initial results indicate that, when properly designed, these programs can increase employees’ health and productivity (goetzel & ozminkowski, 2008). however, many questions remain unanswered. for example, what exactly constitutes a successful worksite wellness intervention? also, do worksite participants differ in their opinions of their role in the organization, whether they _________________ david bruno, phd, ma, msw is an assistant professor, department of social work, valdosta state university, valdosta, ga, 31698. james r. brown, phd, msw is an assistant professor, school of social work, indiana university, bloomington, in, 47401. evan d. holloway, ma is a doctoral candidate in clinical psychology, department of psychology, fordham university, bronx, ny, 10458. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 595-610, doi: 10.18060/21624 https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2017, 18(2) 596 are ground-level staff or high-level administrators? in general, there has been very little information available on the opinions of mainstream employees involved in worksite wellness programs (gabel, et al. 2009; robroek, van de vathorst, hilhorst, &, burdord, 2012; van berkel et al., 2014). this study examined participant involvement in a specific type of worksite wellness program that used an outcome-based contingency approach (wwoca) in which participants received an approximate 30% discount on their monthly health insurance premium as long as they achieved their health goal set by a professional trainer. the researchers had three aims: first, to document the level of employee participation in the wwoca over a three year period; second, to assess the effectiveness of the wwoca in helping participants achieve their health goals over three years; and, third, to explore (primarily) frontline employees’ perception of their involvement in their wwoca program. worksite wellness programs as of 2013, approximately half of large employers in the u.s. offer some form of wellness promotion initiative (horwitz, kelly, & dinardo, 2013; mattke et al., 2013). however, since worksite wellness programs are a relatively new phenomenon, there is wide variation in these programs and a lack of standardization (lerner, rodday, cohen, & rogers, 2013). for example, a worksite wellness program can vary from a relatively small once per year health screening measure with no rewards for employee participation, to a large, more comprehensive program that offers the employee and their dependent partner the opportunity for physical exercise, yoga, nutritional workshops, personal trainers, and monthly insurance premium discounts, all within the workplace environment. according to the u.s. centers for medicare and medicaid services (2017) a worksite wellness program is an employment-centered activity or employer-sponsored benefit promoting health-related behaviors. wellness programs make available the opportunity for employees to improve or maintain health-related behaviors, and may also benefit the organization’s bottom line via improved worker productivity (berry, mirabito, & baun, 2010; goetzel & ozminkowski, 2008; mattke, schnyer, & van busum, 2012). although a wellness program is generally defined as a program offered by an employer designed to promote health or prevent disease (mattke et al., 2012), a more specific definition of a worksite wellness program has not yet been established due to the novelty and apparent heterogeneity of worksite wellness programs. according to health reform researchers in the united states, there are two main categories of such wellness programs: worksite wellness participatory programs and worksite wellness health contingent programs (mattke et al., 2012). worksite wellness participation programs provide employees the opportunity to participate in a health screening and employees may have access to a fitness activity program. hence, in a worksite wellness participation program, the employee only needs to partake in an intermittent health screen test with no specific resultant outcomes required in order for the worker to continue in this type of wellness plan. the second category of worksite wellness program is based on health contingent factors for organizational employees. this means that the employee is required to engage in some specific type of health intervention in order to obtain a reward from their employer. bruno et al./participants perspectives 597 rewards can vary a great deal (e.g., a free plastic water bottle or a 30% reduction in participants’ monthly health insurance premium) depending on the specific organization and the type of health insurance plan. in this type of wellness program, the employees’ reward is contingent upon their engaging in some kind of agreed-upon health behavior with their employer (e.g., a six-week exercise class). further, worksite wellness health contingent programs are subdivided into two subtypes: worksite wellness contingent activity-only program, and worksite wellness outcomebased contingency approach (or wwoca). in the former program, the employee only needs to perform a particular health activity in order to obtain a reward, whereas, in the latter, the employee is required to attain or maintain a specific health outcome that requires a variety of physical health measurements of the body in order to receive their reward. in some of these types of wwoca programs, each employee develops individualized health goals based on the worker and a licensed professional trainer (mattke et al., 2013). the current study evaluated the implementation of a wwoca program in which employee participants received ongoing physical health measurements taken by a licensed trainer in order to receive or maintain a 30% reduction of their monthly health insurance premiums. however, if a participant did not meet quarterly or annual physical health goals, the participant lost their 30% monthly discount. these health outcome goals were established via an individualized agreement between a licensed trainer and the participant, with the trainer following a relaxed version of the guidelines established by the american college of sports medicine (pronk, 2009). the first aim of this study was to document the level of employee participation in the wwoca over a three-year period. the second aim was to assess health outcomes achieved by participants in the wwoca program in which employees received a reduced monthly health insurance premium contingent upon their achieving a previously-identified physical health goal set by a licensed trainer. the third aim was to explore participant perspectives on the benefits and challenges related to participating in the wwoca program at their workplace. in general, there is a dearth of research about current organization knowledge regarding how non-managerial employees experience their worksite wellness programs (gates, brehm, hutton, singler, & poeppelman, 2006; makrides, heath, farquharson, & veinot, 2007; wood & jacobson, 2005). methods study design researchers used a sequential mixed methods approach consisting of a two-phase data collection procedure. first, licensed health trainers measured participants’ ongoing health outcomes, and second, subsequent focus group data were evaluated to understand participants’ experience in the wwoca program (creswell & plano-clark, 2011; johnson & turner, 2003; rubin & babbie, 2013). during phase one of this study, ongoing quantitative health measures were gathered from participants involved in the worksite wellness intervention in order to evaluate whether a participant was onor off-track to meet their previously agreed-upon individual advances in social work, fall 2017, 18(2) 598 health goal. a licensed trainer conducted physiological measurements, typically on a quarterly and/or annual basis. participants who achieved an excellent health outcome score were assessed only once annually. the licensed trainer decided whether participants attained their health goals. data collected in phase one addressed the first and second aims of the study regarding the level of employee participation and the effectiveness of the wwoca in producing health benefits. in phase two, multiple focus groups were used to understand participant perceptions of their involvement in the wwoca (stewart, shamdasani, & rook, 2007). sample the phase one study sample consisted of all medical center employee participants (and dependent spouses) in this midwestern facility who were enrolled in the worksite wellness program for a minimum of three months during the period from january, 2010 until december, 2012. the program was available to all employees and their spouses/domestic partners. a total of 397 participants met criteria and were enrolled in the wwoca program. this study was approved by the university of wisconsin-oshkosh irb. phase one data was collected by the employer, which occurred before irb approval. the research team became involved prior to phase two and initiated the irb process. in phase two of the study, a subset of the phase one participants (n = 45) were selected by researchers using a convenience sampling procedure (two participants were managers at the medical facility, all other focus group members were non-managerial participants; four participants were dependent spouses). these 45 participants attended one of six focus groups, which were conducted in late 2012 (creswell & plano-clark, 2011; ivankova, creswell, & stick, 2006). participants were recruited using brochures with help from the human resources department. participants chose either a $20 company café gift card or thirty-minute personal trainer session ($25 value) as compensation for their time. collection and analysis of quantitative data for the quantitative phase, physical health outcome measures were used to record participant health indicators on an ongoing basis from january, 2010 to december, 2012 for the following measures: body composition, cardiovascular functioning, and strength and flexibility. body composition was determined by a combination of body mass index (bmi), waist-to-hip ratio, and body fat measurements. the cardiovascular score was a result of either the step test or the treadmill test (licensed trainer and participant would agree to one of the latter measures). the strength and flexibility score was a result of combining the best three measures (i.e., highest scores) into one score on the following five tests: grip strength, sit and reach, sit-ups, push-ups, and squats. the three health assessment scores (i.e., body composition, cardiovascular, strength and flexibility) were then formulated into an overall outcome score for each participant, which resulted in a final categorization of excellent, average, or below average. in calculating the overall outcome score for each participant, licensed trainers used a relaxed version of health guidelines established by the american college of sports medicine (pronk, 2009). a licensed trainer bruno et al./participants perspectives 599 individually assessed whether participants achieved their previously agreed-upon physical health goal. participants who achieved their overall goal were allowed to continue their monthly discount on their health insurance premium (approximately 30% per family). participants who did not meet their original health goal could no longer receive their monthly premium rate discount. however, these participants could re-enter the worksite wellness program after a two-week waiting period for an additional $50 fee. descriptive statistical procedures were conducted using microsoft excel and spss 22 (ibm corp, 2013) to analyze demographic and health information for the employees who participated in the wellness program. aggregate data included the number of participants involved per quarter as well as their resultant health composite rank per quarter (i.e., excellent, average, or below average). the aggregate rankings were viewed as indicators of the overall effectiveness of the wwoca program. focus groups in order to help focus group participants feel empowered to discuss their opinions freely at the medical facility, medical center physicians and their family members were excluded from focus group meetings. with the exception of two middle managers, focus groups consisted of lower level employee participants and/or their spouses (four participants were dependent spouses of employees). focus group interviews allow for collaborative and empowering discourse in which members within the group were invited to share personal experiences throughout the session. focus groups are also used as a method of obtaining important group feedback concerning organizational culture and have the potential to elicit unanticipated and in-depth information (ferguson & islam, 2008; madriz, 2000; padgett, 2004; patton, 2002; stewart et al., 2007). a semi-structured interview guide was used for all six focus groups. each focus group had the same moderator and was conducted at the participants’ worksite. focus group meetings were held in a secluded area of the medical complex that was not in close proximity to the exercise rooms. just prior to each meeting, focus group members were identified by a human resource employee and the moderator. the human resource person was not present during focus group meetings. focus group participants were a subset of the phase one participants (creswell & plano-clark, 2011; ivankova et al., 2006). each focus group meeting lasted 90 minutes. the focus group participants were white (100%) and primarily female (93%). all focus group discussions were audiotaped and transcribed verbatim. analysis of narrative data two researchers first reviewed transcripts for each of the six focus groups independently and then as a dyad. a thematic analysis was used which involved the five steps outlined by qualitative experts (braun & clarke, 2006; santos, hayward, & ramos, 2012): first, become familiar with the text (mainly through transcription and repeated reading); second, generate initial codes (systematically identifying and coding of group dialogue based on the intensity and/or frequency of participant comments across the six focus groups); third, search for themes (grouping codes together with provisional names); advances in social work, fall 2017, 18(2) 600 fourth, review themes (checking above themes in relation to the full transcripts and initial codes); and, finally, name conceptual themes. maxqda (2014) qualitative computer software was used for data analysis. several steps were taken to enhance the trustworthiness of the study. the two researchers completed steps one and two independently, and then met together to discuss specific focus group dialogue segments concerning codes and emerging themes. participant quotes are used to illustrate each identified theme (ayon, 2014; charmaz, 2006; strauss & corbin, 1998). results participant involvement in the wwoca program collection of participants’ quarterly health assessment data in the worksite wellness program began in january 2010 (see table 1). this was the initial start-up year for the wwoca program. during the first quarter of 2010, 397 of 458 eligible employees (87%) participated in the wwoca program, representing a high rate of participation. all participants received an automatic monthly health insurance premium reduction rate of approximately 30% for enrolling during the initial sign-up period. participant employees had to meet their quarterly (or, in some cases annual) wellness goals in order to maintain the 30% discount. trainers were advised by medical center administrators to ease participants into the program as they set their initial health goals. as the year progressed, many of these initial participants left the program. by the fourth quarter of 2010 the number of participants decreased to 300. hence, from january 2010 to december 2010, 97 participants (or 24%) dropped out. this rate of attrition indicates that participation was relatively unstable in year one, with a mean number of 350 participants (sd = 44) across all four quarters. however, during years two and three of the program, the number of participants stabilized. the mean number of participants for 2011 was 319 while the standard deviation was substantially smaller (sd = 5.7). the mean number of participants in 2012 was 295 with similar variability as 2011 (sd = 4.7). thus, there was increased stability in participation (i.e., small dropout rate) in the second and third years of the wwoca program. participant health outcomes in the wwoca program at this medical facility, average and excellent ranks of overall physical health were grouped together as a practical measure (see bottom row in table 1). in 2010, participant health outcomes at the average or excellent levels were initially low, but gradually improved: 1st quarter 37%; 2nd quarter 51%; 3rd quarter 61%; and 4th quarter 75% (m = 56%; see table 1). in 2011, participant health outcomes at the average or excellent levels were quite high and increased over time: 1st quarter 82%; 2nd quarter 87%; 3rd quarter 87%; and 4th quarter 92% (m = 87%). this trend continued in 2012: 1st quarter 84%; 2nd quarter 91%; 3rd quarter 91%, and 4th quarter 93% (m = 90%). thus, during the initial start-up year, an average of 56% of participants reached their health goals at the average or excellent levels compared to 87% in 2011 and 90% in 2012. therefore, the program appeared to be effective in helping participants achieve individualized biometric health outcomes. bruno et al./participants perspectives 601 table 1. participant quarterly health outcomes-2010 to 2012 2010 1st 2nd 3rd 4th n=397 n=375 n=326 n=300 outcome-excellent 88 (22%) 127 (33%) 153 (47%) 170 (57%) outcome-average 57 (15%) 66 (18%) 46 (14%) 55 (18%) outcome-below avg. 245 (62%) 174 (47%) 117 (36%) 65 (22%) medically exempt 2 (1%) 3 (1%) 5 (2%) 4 (1%) pregnant 5 (1%) 5 (1%) 4 (1%) 6 (2%) % excellent + avg. 145 (37%) 193 (51%) 199 (61%) 225 (75%) 2011 1st 2nd 3rd 4th n=315 n=322 n=325 n=313 outcome-excellent 172 (55%) 222 (69%) 248 (76%) 263 (84%) outcome-average 85 (27%) 59 (18%) 36 (11%) 25 (8%) outcome-below avg. 46 (15%) 33 (10%) 35 (11%) 24 (8%) medically exempt 5 (2%) 4 (1%) 4 (1%) pregnant 7 (2%) 4 (1%) 2 (1%) 1 (0%) % excellent + avg. 257 (82%) 281 (87%) 284 (87%) 288 (92%) 2012 1st 2nd 3rd 4th n=295 n=235 n=298 n=298 outcome-excellent 208 (71%) 235 (82%) 246 (83%) 253 (85%) outcome-average 40 (14%) 27 (9%) 25 (8%) 25 (8%) outcome-below avg. 37 (13%) 21 (7%) 21 (7%) 16 (5%) medically exempt 4 (1%) 3 (1%) 4 (1%) 2 (1%) pregnant 6 (2%) 2 (1%) 2 (1%) 2 (1%) % excellent + avg. 248 (84%) 262 (91%) 271 (91%) 278 (93%) note. occasionally, subcategories are slightly more than total n when a new participant employee was hired during a specific quarter or slightly less than total n due to a participant employee changing insurance plans or no longer being employed. focus group results a focus group approach was used to elicit participants’ perceptions of their involvement in the wwoca. participant responses from the six focus groups fell into four major categories: personal self, social self-context, personal trainer, and organization and mainstream culture. although quantitative health outcomes were quite positive as most members achieved their physical health goals in year three at the average or excellent levels (m = 90%), focus group members provided a less positive opinion of their experience in the program. personal self. the majority of focus group comments under the personal self category were critical of the program, and were often expressed with sad or frustrated affect. in this category, out of a total 128 coded group dialogue segments from the six focus group discussions, the most frequent comments were as follows: personal sense of failure (f=26); frustration with losing the health insurance discount (f=25); negative feedback about body measurement (f=21); and, stress and anxiety linked to health goal attainment (f=15). advances in social work, fall 2017, 18(2) 602 in general, the subcode personal sense of failure generated strong feelings among focus group participants when they did not meet their expected health goal (all participant names are pseudonyms). mary: …but there are some people that have weight problems in their family and you know, they don't come from the skinny genes and there are different things. i mean, i have sat in my car, i mean, and cried for a half an hour because i failed. this sense of personal failure was commonly expressed among group members who shared strong feelings of embarrassment and/or shame. however, participants were relatively supportive of one another regarding their feelings of disappointment for not achieving their contingency-based health goal. many participants expressed financial frustration and stress about the possibility of losing their monthly premium discount (an approximately 30% discount) after not meeting their expected health goal. this discussion was subcoded frustration with loss of health insurance discount. the following statement from rebecca, a frontline staff worker at the medical center, illustrates her sense of frustration: i think it would be a lot of people, and not everybody, but a lot of people see it as being a punishment. you know, yes you are told that you are not forced to do this, this is really of your own freewill and whatever and that you get the reduced premium if you do the program and whatever, but the flip side of that is that….you do not [want to use] laxatives and diuretics before weighing in. it is just crazy what people are going through before their assessments. so, could we make it more of a reward program versus a punitive thing, i don't know. group moderator: but it is a reward and that is what i'm wondering where that is coming from. rebecca: it is but somehow with the way the assessments are done and the way it is gauged, too often i think people are feeling it to be a negative experience… this member expressed that she experienced the threat of losing the monthly premium discount as a “punitive thing” because of her ongoing stress and fear of not meeting her future quarterly health goals. hence, even though the member’s monthly health insurance premium would only return to the normal rate, it is clear that rebecca (and many other participants) experienced this fear of losing their premium discount. in general, the latter two subcodes sense of failure and frustration with loss of health insurance discount emerged as a consistent pattern. members often commented on this pattern in the following manner: first, they would state how upset they were about not meeting their health goal and second, participants would express frustration about their monthly health insurance premium returning to its normal rate (i.e., loss of discounted health insurance). on the other hand, within the personal self category, positive discourse about participant involvement in the wwoca program did occur within focus groups although with much less frequency. in this example, which was coded desire to have a healthier bruno et al./participants perspectives 603 lifestyle, one male group participant, who was the spouse of a medical center employee, expressed how his high level of self-motivation was important for him: mark: …first of all the person’s got to want to do it and you have to go into it with that mindset and then when you start doing it, i wanted to do it, i wanted to do it for myself. you have to build that habit…i had tons of weight to lose and i had that body fat thing too and it is hard to judge and it is frustrating but it’s got to be that desire…i try to inspire, you know, whomever i talk to to say, 'yeah you can do it but first you have got to want to do it.' another example of positive discourse within the personal self category coded satisfaction with ongoing exercising lifestyle was articulated by laura: i had already started on my journey…i was real hesitant and wasn't too sure and pretty much kept…to myself…but today, i would have to say thank you for the mere fact that it did help me. it got me going down the right track and i feel so much better as a person today, you know… more confident in that and i will keep going. i do not want to go back to there. you know, i lost 60 pounds... thus, these two participants expressed that they felt quite positive about their involvement in the program and indicated that they benefited greatly from the wwoca program. social self context. a social self theme emerged from participants’ attributions concerning their interpersonal and family relationship experiences. the most frequent comments related to group members feeling overwhelmed due to struggles with trying to balance exercise time with parental responsibilities. this was coded as schedule conflict. often, group members, most of whom were women, mentioned that they would like to increase their attendance at worksite exercise sessions (especially immediately after work) but due to a multitude of family responsibilities and a lack of accessible daycare, they return home right after work. brandi: daycare is huge for me and that would help me as well. my husband has lost like 40 pounds on the program and he has had access to the trainers…but i have been the one staying home so he can work out, so he can meet his goals. tina: you go to work at 7:00 in the morning and you get home at 5:30/6:00 or later and you get supper, you get the kids where they gotta go, go pick up, you know drop off, laundry, housework, whatever. by the time you are able to sit down, it's already 8:30. i mean, you have no time for yourself because everybody else is put first. joanna described her family caregiving responsibilities and how they contributed to stress: i'm very grateful to have this program… for the prescription for fitness even though i haven't been able to qualify and i haven't found the time yet to do it again, i know it's there. i want to get into it but i've had to put my father into a nursing home, my mom's dealing with issues with separation and my daughter is pregnant with a baby with spina bifida and i've got all these things on my plate that my mind is just too much. i can't focus on – advances in social work, fall 2017, 18(2) 604 this social self category also documented a fair amount of positive comments from about half of participants. one participant shared that during her involvement in many of the worksite wellness activities, she and her co-participants formed a “close knit group,” which she felt increased the level of motivation for ongoing health behaviors within her group. jacqueline: they [her peer participants]…motivate one another and i think that that is what it is. they are a very close knit group, they really are. i do not think they all see one another on the weekends or anything but they enjoy being with one another during the day…. group moderator: so, there is a culture of investment or what? that we are in this together and there is... jacqueline: i mean, we all get along…there is that respect level that they treat one another like sisters… it's like they look out for one another... notice that this concept of a “close knit group” relates to greater group cohesion and interpersonal support, which has been shown in previous research on group dynamics to be associated with positive group outcomes (corey, corey, & corey, 2014; yalom, 2005). personal health trainer. participant comments about their experience with their licensed trainer were also mixed. focus group dialogue typically had either a critical or positive narrative. most of the critical comments were related to the perception that the trainers varied too much in how they assessed members on their health goals. other comments made during group discussions were as follows: the trainers did not take into consideration the developmental ages of older participants in meeting their health goals and a desire for trainers to be more empathic to the measurement apprehension (i.e., some members felt demeaned) of the participant. for example, one participant mentioned, “i am offended that i might have my flabs measured and i am 61. i don't think i should have to do that.” for some participants, it was difficult to schedule with the same trainer throughout the year. in contrast, a similar number of participants in the wwoca program made upbeat comments about their experience with their trainer. for example, jasmine shared: i was so fortunate that they ended up just putting me with the trainer they did, because we actually started a life journey together. we're still friends to this day. organizational and mainstream culture. although the worksite wellness program was voluntary, many focus group participants expressed criticism that the wwoca program was too top-down and rigid. focus group participants expressed a great deal of frustration and dissatisfaction about their perception of health goal inflexibility. often, they inferred that this rigidity went beyond the worksite wellness program to the overall social and organizational culture of the company. for example, one participant complained that although she met almost every health goal, with the exception of the body fat measure, which was 1% below the goal, she was assessed as not meeting her overall health goal. lydia: you know, i think it also seems like we are just kind of dictated down from the top. there is not a lot of collaboration. you know, there hasn't been any of these, ‘what could we do to help?’ it's just, ‘this is how it is.’ bruno et al./participants perspectives 605 group moderator: you want to see input from within? lydia: yes. group moderator: and would you think that that would help build the sense of community, camaraderie...? lydia: yes, because i think right now everybody feels like if you go to talk to someone who is in the, shall we say power position, about your concerns you are just shot down immediately, that there isn't, you know, nobody really listens to the fact like, ‘hey, try to engage us here and include us and you might have a more positive response.’ some participants also made critical comments about how they felt demeaned by the assessment procedure and also stated that they felt the health goals were unrealistic. one participant questioned the health standards that reflected dominant cultural ideals of health. michelle: that people just got frustrated with having to go and it is kind of demeaning when you have your assessment to get pinched and be told that you are not meeting certain standards which, you know, where did these standards come from and who, you know, it seems kind of one-sided sometimes and it is just like we all have to meet some person’s ideal and, or global, [standard]… group moderator: almost like it is arbitrarily set? michelle: yeah, and like why keep trying… participants also made statements that praised how their workplace organization is helpful to their employees, especially how convenient it is for participants to be able to engage in activities such as yoga, zumba dance fitness, and physical exercise while in the workplace. participant recommendations can be summarized as follows: 1) base the assessment of health goal achievement and subsequent monthly premium discount on the percentage of biometric criteria attained by the participant (rather than current all-or-nothing criteria); 2) enhance access to trainers and dietitians; and, 3) form a worksite wellness committee with representation of front-line staff. discussion the first aim of this study was to document the level of employee participation in the wwoca over a three-year period. during the initial start-up year of 2010, approximately one-fourth of participants left the program; however, this drop-out rate was greatly reduced during years 2011 and 2012. further, in 2010 approximately 56% (the mean of the four quarters) of participants achieved their health goal at the average or excellent levels. in 2011, 87% of participants attained average or excellent ranks; and, in 2012, 90% achieved average or excellent health ranks. these findings provide compelling evidence that this wwoca program was effective in helping participants achieve their health goals, especially in years two and three when the dropout rate was low. advances in social work, fall 2017, 18(2) 606 the reasons that approximately one-fourth of participants dropped out during the first year are not yet understood, although one possibility is that these individuals left the program because they were unable to meet their health goals and/or were uncomfortable with the wwoca program. another possible explanation for the high member exodus was that participants exercised because they feared losing their monthly 30% discount, which serves as a negative reinforcement. in general, people do not like to be motivated by fear (sidman, 1989). participant perceptions of the benefits and challenges of their involvement in the contingency-based worksite wellness program were explored. one unique feature of the wellness program, the participant monthly health insurance premium discount (approximately 30%), was contingent on the member achieving their physical health goal. this contingency-based factor was often mentioned by focus group members with strong feelings of embarrassment, shame, and frustration when they did not achieve their health goal, often linked to members’ concern about paying more for their health insurance. this was evidenced by the frequent mention of personal sense of failure (26 instances) along with frustration with losing the health insurance discount (25 instances) when members did not achieve their personal health goals. many focus group members expressed personal stress, some anxiety, and evaluation apprehension in the days and weeks prior to their quarterly or annual health assessments. participants were concerned that if they failed to achieve their health goal their monthly health insurance premium would return to the standard non-discounted rate plus a $50 reentry fee. in general, participants’ feelings of embarrassment, shame, and frustration were not aligned with more holistic definitions of wellness (clark et al., 2013; dale, smith, chess, & norlin, 2006). in contrast, a small portion of focus group members made positive statements; however, such statements were less frequent than group criticisms. positive comments included the following: wwoca program tends to work for persons who have a high level of intrinsic motivation (as evidenced by results section personal self category, coded as desire to have a healthier lifestyle); and second, some members experienced a greater sense of group cohesiveness, which they felt increased their level of motivation to achieve their health goals; and third, members praised the medical organization for allowing them to have the convenience of engaging in healthy activities such as yoga, zumba dance, and physical exercise in the workplace. given that many members were able to meet their physical health goals, this study provides evidence of an effective worksite wellness program. however, results identified criticism by focus group members concerning having to achieve their personal physical health goals in order to maintain their premium discount. the contingency aspect of having to maintain and/or achieve an actual physical health goal on an ongoing basis seemed to contribute to stress, frustration, and a personal sense of failure for some participants, especially those who were having difficulty achieving their health goals. themes that emerged from the focus groups suggest that this type of wwoca may be perceived as disrespectful to the inherent dignity and worth of the person (national association of social work, 2006). further, horwitz and colleagues (2013) mention that health contingent bruno et al./participants perspectives 607 outcome-based worksite wellness programs (or wwoca) may be an employer costshifting strategy to lower company insurance costs through improvements to employee health while penalizing employees in poorer health who end up paying higher premiums. employers who use these types of wwoca programs may be at risk of “discriminating against employees based on health status” (horwitz et al., 2013, p. 468) and may undermine laws meant to prevent discrimination on the basis of health status. hence, this type of contingency-based worksite wellness program may be considered as a form of healthcare discrimination and a social injustice (nasw, 2006). hence, social workers in healthcare and administration need to ensure that worksite wellness programs promote human dignity and do not discriminate based on the health status of employees. there were a number of limitations to our study. first, all participants were recruited from one mid-western medical complex within the u.s. secondly, focus groups were not diverse as they consisted of 100% white participants of whom 93% were women; therefore, the current findings are not necessarily generalizable to other settings and demographics. third, phase two convenience sampling groups were not designated according to participant health ranks (i.e., excellent, average, or below average) and therefore focus group member statements, whether positive or negative, were not directly linked to their health ranking scores. fourth, health goal outcome data was not collected from focus group participants, so analysis of whether outcome results can predict qualitative feedback is not possible. lastly, the focus group facilitator seemed to inadvertently use leading questions in some instances. leading questions can increase participant bias to responses. recommendations future studies might investigate the specific reasons participants left the wwoca program as well as gathering explanations from participants who were relatively successful in consistently achieving their health goals. this can be achieved by making use of purposive sampling techniques for focus group discussions based on participant health ranks (i.e., excellent, average, or below average) in the wellness intervention. new incentives for health goal attainment can be explored so that participants’ evaluation apprehension and personal sense of 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(2005). the theory and practice of group psychotherapy. ny: basic books. author note: address correspondence to: david bruno, phd, ma, msw, department of social work, valdosta state university, 1500 n. patterson, valdosta, ga, 31698. dgbruno@valdosta.edu https://doi.org/10.1007/s00420-011-0675-y https://doi.org/10.4135/9781412991841 https://www.healthcare.gov/glossary/wellness-programs/ https://doi.org/10.1186/1471-2458-14-458 mailto:dgbruno@valdosta.edu participants’ perspectives of a worksite wellness program using an outcome-based contingency approach david gerard bruno james r. brown evan d. holloway abstract: worksite wellness programs in the u.s. are increasingly common. social workers in healthcare and administration should familiarize themselves with the various wellness programs and the impact they have on workers and organizations. this stud... worksite wellness programs methods study design sample collection and analysis of quantitative data for the quantitative phase, physical health outcome measures were used to record participant health indicators on an ongoing basis from january, 2010 to december, 2012 for the following measures: body composition, cardiovascular functioning, and stren... descriptive statistical procedures were conducted using microsoft excel and spss 22 (ibm corp, 2013) to analyze demographic and health information for the employees who participated in the wellness program. aggregate data included the number of partic... focus groups in order to help focus group participants feel empowered to discuss their opinions freely at the medical facility, medical center physicians and their family members were excluded from focus group meetings. with the exception of two middle managers, f... a semi-structured interview guide was used for all six focus groups. each focus group had the same moderator and was conducted at the participants’ worksite. focus group meetings were held in a secluded area of the medical complex that was not in clos... analysis of narrative data two researchers first reviewed transcripts for each of the six focus groups independently and then as a dyad. a thematic analysis was used which involved the five steps outlined by qualitative experts (braun & clarke, 2006; santos, hayward, & ramos, 2... results participant involvement in the wwoca program focus group results personal self. the majority of focus group comments under the personal self category were critical of the program, and were often expressed with sad or frustrated affect. in this category, out of a total 128 coded group dialogue segments from the six ... social self context. a social self theme emerged from participants’ attributions concerning their interpersonal and family relationship experiences. the most frequent comments related to group members feeling overwhelmed due to struggles with trying t... personal health trainer. participant comments about their experience with their licensed trainer were also mixed. focus group dialogue typically had either a critical or positive narrative. most of the critical comments were related to the perception ... organizational and mainstream culture. although the worksite wellness program was voluntary, many focus group participants expressed criticism that the wwoca program was too top-down and rigid. focus group participants expressed a great deal of frustr... discussion recommendations _________ cherése godwin, msw, phd, faculty, school of social policy and practice, university of pennsylvania, philadelphia, pa. judith crocker-billingsley, msw, phd, assistant professor, social work in the school of social work bsw program, johnson c. smith university, charlotte, nc. sharlene allen-milton, edd, lcsw-c, assistant professor, school of social work, morgan state university, baltimore, md. chad dion lassiter, msw, executive director, pennsylvania human relations commission, harrisburg, pa. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 475-498, doi: 10.18060/24903 this work is licensed under a creative commons attribution 4.0 international license. social entrepreneurship and social work for transformational change: re-envisioning the social work profession, education, and practice cherése godwin judith crocker-billingsley sharlene allen-milton chad dion lassiter abstract: social entrepreneurship is a social action that the profession of social work can use as a working model to propel the profession forward economically, professionally, and socially. social entrepreneurship can help mitigate complex and vexing social and environmental issues in the future, while creating a larger social impact and transformational shift to social change and social justice, through the social enterprise. the social enterprise brings social policy efforts to life through immediate social action. this article will discuss the historical perspective of the social work profession and social entrepreneurship, the imperative need for social innovation and social impact through the utility of education of social entrepreneurship, and the social enterprise in social work practice models. keywords: social entrepreneurship, social enterprise, social innovation, social impact, social justice, contemporary social problems, social work transformational change the profession of social work was formalized due to the economic and social pandemonium wrought by the industrial revolution, supremely the societal struggle to cope with the consequential large-scale urban-based poverty and its underlying problems (lau, 2020). currently, those who enter the social work profession achieve high credentials such as graduate degrees and licensure exams, but they are met with laborious work and low pay due to the profession’s historic orientation. more than 100 years later, the social work profession is now pondering, where do we go from here? in the true nature of the social work profession, we must begin where we are, while operating in the profession’s three tiers of micro, mezzo, and macro practice. in the profession’s historical context, emerging social workers have been educated to work for others as the national association of social worker’s (nasw) code of ethics seldom discusses social entrepreneurship beyond microlevel private practice. however, the profession of social work was birthed from the creation of the social enterprise of the jane adams hull house and many other social work pioneer settlement houses. these houses were developed during the progressive era as institutions in an inner-city area providing an ecosystem inclusive of educational, recreational, and other social services to the community and families. to address the overworking and underpayment of today’s social workers, the social work profession should return to its roots of the social enterprise. today, a social enterprise can be described a communitybased, for-profit business aimed at building a sustainable, fair, and socially just future by providing services which facilitate a social need within a specific population centered in connectedness, equality, and solidarity. about:blank advances in social work, summer 2022, 22(2) 476 due to the lack of social entrepreneurship competencies in social work curriculum, there is a synapse in education and implementation in carrying out various social work entrepreneurship services outside of nonprofits (e.g., briar-lawson et al., 2020; nandon et al., 2019). similar to the industrial revolution, the current social climate of racial unrest, exacerbated by a longstanding global pandemic, has adversely impacted many people throughout all levels of the socioeconomic stratification. parelle to the industrial revolution, the social work profession has played a strong role in the world’s response to the pandemic. social workers have created and advocated for social inclusion for the most vulnerable populations, provided awareness, served on task groups and coalitions, facilitated mental health therapy, created and advised policies, engaged in philanthropy, strengthened communities, conducted research and data analytics, lectured, and provided psychosocial support in a myriad of other ways. now social workers must find various ways to participate effectively in the pandemic-related recovery and rebuilding on a larger scale through economic and community development. this is where social work social entrepreneurs come in. these entrepreneurs can fill the social and financial gaps that covid has created, providing social action through coaching, resources, support, and technical advancement to all people in a way that generates an increase in income. social entrepreneurship differs from traditional forms of entrepreneurship, as the primary goal of the social venture is to address social problems and needs that are as yet unmet; the driving force of such ventures is social value creation (beugré, 2016). berzin (2012) defines social work entrepreneurship as a transformational practice that creates social value. they turn to authors such as dees (1998), who links the skill set of the entrepreneur with the purpose of the social worker and surmised mission-driven business acumen would lead to the alleviation of suffering. where reisch and other social policy advocates see the marketplace as the source of problems, berzin, dees, and others see the marketplace as the template for solutions. as stated by mcneill (2011), whilst the practice of social entrepreneurship and social enterprise are distinguishable, the terms have begun to become interchangeable over the past fifteen years. since the terms of social entrepreneurship and social enterprise first began to appear in text and practice, advocates and practitioners have discussed and debated definitions, forms of practice, and other technical considerations in the field of social work. definitions remain diverse and contested. the social enterprise refers to a broad set of approaches that use business acumen to address social goals for social action. though minimally used in social work for a long time, social enterprise has recently been thrust into the spotlight in debates about the future of social policy and community services (gray et al., 2003). it is imperative social workers conceptualize the epistemology and implications of the social enterprise if they are to apply them critically, reflectively, and responsibly, as well as partake in debates in reference to its relevance in promoting individual and community empowerment (gray et al., 2003). however, being in the capacity of the business sector in the field of social work can result in new service delivery models and concepts which would not have been established under traditional auspices, therefore sustaining the profession of social work. it is the responsibility of professional social workers to experimentally test the effectiveness of such models to determine whether to continue them or to revert to traditional models (germak & singh, 2010). godwin et al./social entrepreneurship & swk 477 in the competitive global market, many professions and roles have encroached upon the profession of social work; as the world changes, so must the profession. social work must alter how and whom it serves in order to generate professional and monetary growth, and social entrepreneurship is an essential tool in this shift. however, this alteration must take place without sacrificing the profession’s ultimate goals to serve, impact, and empower vulnerable populations. this article will focus on action-oriented components of social entrepreneurship, social work education, social innovation, social impact, and the social enterprise in order to pivot and rebrand the social work profession. social workers must make this pivot by changing our perception of vulnerable populations in our care models and including social work entrepreneurship in social work practice models. social entrepreneurship is a mindset, and it establishes awareness of the importance of social change and sustainability for a transformational shift to society. this sets the profession of social work and its practitioners apart by applying business and entrepreneurship competencies in the social sector, including revenue strategies that further the social work mission, social work education, social work policy, and the social enterprise—these elements of social entrepreneurship will be identified further in an all-encompassing holistic approach to the profession of social work. literature review the historical perspective of the social work profession and social entrepreneurship ambrosino et al. (2015) indicated that as early as 1814 in scotland, the reverend thomas chalmers expressed concern over the wasteful and inefficient approaches of relief programs. chalmers encouraged the development of a more humane and effective system for providing services and support. the progressive era (1895-1915) is often hailed as a proud moment in social work history as early figures in social work have been lauded for their efforts on behalf of social action. jane addams is frequently chosen as a model of the “involved” social worker and social entrepreneur. not only was the progressive era a prominent time for social work advocacy, but these were also the years during which social work was established as a distinct vocation. case managers from charity organizations and settlement houses that existed in that era are heralded for having been in the vanguard of advocacy and social reform through social enterprise development. according to fernando (2015), in the united states, more than 400 houses were formulated across a 20-year period in the early part of the 20th century. organizations such as hull house were created to meet the social, economic, and cultural needs of select disadvantaged populations. these organizations have framed the way social welfare has been done in this country since the 1900s. although the spread of these organizations has not been considered an entrepreneurial endeavor, the vast growth of settlement houses across england and the united states demonstrates that early social workers created socially innovative organizations to meet a variety of contemporary social problems. ambrosino et al. (2015) further mentioned that for more than 100 years, social workers have entered the profession with a desire to serve people in need, especially the vulnerable, advances in social work, summer 2022, 22(2) 478 and have since been preoccupied with professionalizing social work. the structured approach to managing charitable efforts quickly resulted in the need for the trained social workers movement initiated by mary richmond who inaugurated the first training program for social workers at the new york school of applied philanthropy. however, african americans did not share in the country’s good fortune as they were not allowed to participate in settlement houses or receive care from the settlement homes. between the 1890s-1920s rampant anti-african american literature was published throughout the south and the nation, with many scientists and social scientists publishing in journals about racial inequities and the inferiority of african americans. african americans were viewed as intellectually inferior, uncivilized, and immoral. as a result of institutionalized racism and discrimination, african americans began erecting social welfare organizations. african american women’s clubs were formed by historic women social worker pioneers such as ida b. wells and mary churchill. the social enterprises created for african americans included the national association of colored women founded 1896; the national league of urban conditions among negros founded 1911, which was synonymous with social work in the african american community by 1916; and the american branch of the universal negro improvement association formalized in 1916 (carlton-laney, 2001). many african american settlement houses sprung up during that time, including the white rose mission and industrial association founded in new york city in 1897 by victoria earl mathews. this association included a mother’s club, adult classes, home lodging for young women, service for domestic workers, traveler’s aide, kindergarten classes, a social club, relief assistance, and a library made available to members of the community (waites, 2001). haynes and mickelson (2000) wrote that with the new deal era of the 1930s came another wave of engagement from social workers. during the years from the new deal through the 1950s, social work matured as a profession and had the methods and sanction to engage in social reform. schools of social work developed community organizing curriculum. social workers became active in antiwar, civil rights, and welfare organizations. black social workers such as serial social entrepreneur and powerbroker, whitney m. young jr., were active in the political arena. one of the most significant and controversial efforts to achieve social reform in the 1960s came through the economic opportunities act of 1964, commonly known as the war on poverty. the objective of this act was to eliminate poverty through institutional change (ambrosino et al., 2015). the hallmark of social worker’s engagement in the social reform of this era revolved around focus on community organizing, social action, increasing economic opportunities, and empowering (rather than “fixing”) the poor— social workers commonly accomplished this through different business endeavors. initially, this movement did not incorporate social workers because the intent was to rely less heavily on professionals and instead acknowledge that groups in the community were experts on how to escape their own poverty (chapin, 2017). however, social workers were providing advocacy through community involvement for social justice through social entrepreneurship and the social enterprise. the 1950s and 60s brought a variety of events that distressed the country—and the settlement house movement—to the core. against the backdrop of the undeclared war in vietnam that generated ever rising phrenzy, there were godwin et al./social entrepreneurship & swk 479 intertwined movements of profound significance for low-income neighborhoods. one of the endings to the settlement house movement was the rediscovery of poverty and a crusade for its elimination, and the other was the civil rights movement (chambers, 1986). reid-merritt (2010) indicated most notably that the civil rights movement was a strong social enterprise in the community that gathered all walks of life to support the need for equality and equity of african americans and black people in the united states in efforts to end racism. due to racism, african americans were not allowed to join settlement houses, african american social workers relied heavily on black intellectuals, sociologists, and psychologists such as carter godwin woodson, w.e.b. dubois, e. franklin frazer, william cross, na’im akbar, whitney m. young jr., and kobi kabon. understanding this important historic role that social work has played in the battle for civil rights not only provides inspiration for social workers, but it also illuminates the influence social work has had on society as a whole (social work license map, 2013). decades after the civil rights movement, considering the stagnation and lack of federal programs from previous administrations, the clinton administration placed greater pressure on nonprofits to fill gaps in service provision. in 1996, the controversial welfare reform bill known as temporary assistance for needy families was passed. during this decade, schools of social work received increased funding for research and evaluation activities in areas such as domestic violence, child welfare, mental health, and aging that shifted the social work paradigm (simmons university, 2021). this increased funding led to the growth of the social work profession into what it is today. in the current era of mass change, the profession should implement new skillsets in the growing economy in order to participate in the global competitive market by creating social change on a larger level, using the social enterprise as a conduit. the need for social work rebranding in order to address the demands of the profession, the nasw’s code of ethics underwent a formal and thorough revision process in 2021 in response to the covid-19 pandemic and the racial and social justice crises (national association of social workers [nasw], 2021). therefore, nasw (2021) states the primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, or living in poverty. according to kurzman (2000), social workers operating in industries outside of traditional social work must not only abide by the nasw code of ethics, but also establish a “normative discipline of morality that underscores the principles of advocacy and equity” (p. 160). a historic and defining feature of social work is the profession’s focus on individual well-being in a social context and the well-being of society. fundamental to social work is attention to the environmental forces that create, contribute to, and address problems in living. social workers promote social justice and social change with and on behalf of clients. the term “clients” is here used inclusively to refer to individuals, families, groups, organizations, and communities. social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice. these activities may be in the form of direct practice, community organizing, supervision, consultation, administration, advocacy, https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true advances in social work, summer 2022, 22(2) 480 social and political action, policy development and implementation, education, and research and evaluation. social workers seek to enhance the capacity of people to address their own needs. social workers also seek to promote the responsiveness of organizations, communities, and other social institutions to individuals’ needs and social problems (nasw, 2021). one problem with the public’s perception of social work as a profession is the unrestricted use of the title “social worker.” paraprofessionals, including technicians and social service aides, whose job qualifications may derive from life experiences or from educational backgrounds in fields other than social work, are often labeled as social workers alongside professionally trained individuals who hold a bsw or msw degree from an accredited social work education program (crocker-billingsley, 2015). this indiscriminate use of the title “social worker” causes public confusion and is the principal impediment to the unequivocal recognition of social work as a profession (nasw, 1987). in the minds of many, social workers are identified as “welfare” workers who are employed in public assistance programs (ambrosino et al., 2015) boles (2021) articulated that to begin the rebranding process inclusive of social entrepreneurship concepts, we must define social work in terms that are understandable to the business world. the social worker’s perspective equips and qualifies social workers to take on some of the world’s most pressing business and social challenges and can transform business, which confirms the need to rebrand (boles, 2021). following the lack of unanimity in earlier literature, nouman and cnaan’s (2021) research goal was to provide some clarification and define social entrepreneurship. as a result, the authors defined social entrepreneurship as a vital practice in social work that delivers pioneering, unique, and prolonged solutions to difficult and pervasive societal issues (nouman & cnaan, 2021). social entrepreneurship provides a revitalization of social work’s action from individuals, groups and / or communities by allowing social guidance assistants to act proactively, focusing always on critical reflection, applying their experience, knowledge, and skills in the most dynamic situations through a social enterprise lens (germak & singh, 2010). according to mouro (2006), the professional future of social work depends on its own capacity of self-confrontation by meeting itself in the reality of where it is, and reconstruction of its intervention styles and the re-identification of social problems, by beginning with the end in mind, as they are among the best prepared professionals to respond to the world’s social problems given the tremendous need for solutions to today’s pressing social challenges, it is time for social workers to stand up and embrace much of the business sense found in social entrepreneurship, a hybrid of social work macro practice principles and business innovation activities (germak & singh, 2010). berzin’s (2012) makes plain the need for the rebranding of social work to encompass social entrepreneurship. according to berzin (2012), although the business and public policy communities have ignited a national movement toward embracing social entrepreneurship as a laudable enterprise and a critical piece in addressing social problems, social work remains notably absent from the discussion and definition of this field. though the values and practices of social entrepreneurship are closely aligned with social work, social work scholars godwin et al./social entrepreneurship & swk 481 and institutions have been less at the forefront of this movement than have representatives of other disciplines. (berzin, 2012, p. 185) forbes author josh bersin (2018) identified through data that companies today must be social in a truly extrinsic sense. customers, stakeholders, communities, business partners, and employees all have an expansive impact on a business’s brand, growth, and profitability. facilitating a social enterprise illustrates proceeding beyond a focal point of revenue and profit and distinctly comprehending that we all operate in an ecosystem. all the relationships in the community and social arena are equally important (bersin, 2018). social entrepreneurship is a process in which social entrepreneurs establish business ventures called the social enterprise. by instituting the social enterprise, businesses strive to convey fundamental, systematic, and sustainable social change in whatever field they work, such as education or healthcare, economic development, or social work (dees, 1998). social entrepreneurship has been viewed as a method of ameliorating the position of the disadvantaged groups in the society as well as the environment, facilitating connectedness (hibbert et al., 2001). the social enterprise is committed to nurturinging economic empowerment and self-determination among the individuals in the community through its socio-political activities. by empowering the community, social enterprise amplifies the productivity and ascends the assets of the individuals in the community (wallace, 1999). according to the organisation for economic co-operation and development and european union (oecd & european union, 2017), social enterprises are long-standing agents of inclusive growth and democratization of the economic and social spheres. they have demonstrated resilience amid economic adversity, all while addressing contemporary social problems and socioeconomic challenges in social innovative procedures, reintegrating people back to the labor market and contributing to overall social cohesion. social enterpriseis an operator in the social economy whose main objective is to have a social impact rather than make a profit for their owners or shareholders. it operates by providing goods and services for the market in an entrepreneurial and innovative fashion, usingusing profits to achieve social objectives. social enterprises are managed in an open and responsible manner and, in particular, involve employees, consumers and stakeholders affected by its commercial activities (european commission, 2011). the social policy and public debate increasingly call attention to the contribution of social enterprises in tackling socio-economic challenges—such as widespread unemployment and increased inequalities—often in socially innovative and sustainable ways at the local, regional, and global levels. more precisely, social enterprises provide the opportunity to disadvantaged individuals to integrate or re-integrate into the labor market while contributing mainly to building cohesive and creative societies (oecd, 1999; noya & clarence, 2007). united nations children fund (unicef, 2020), inclusive of social workers and other helping professions, reported that a wide range of stakeholders, including policy makers, entrepreneurs, citizens, and investors have become increasingly interested in social enterprises and social entrepreneurship as a result of this positive dynamic; millennials and generation z in particular are displaying great willingness to participate actively in addressing societal issues through social entrepreneurship (hill, 2022). many social workers are heretofore exposed to the business sector by virtue of their working in nonprofit environments. encompassing nearly 1.6 million organizations while advances in social work, summer 2022, 22(2) 482 experiencing an aggregate budget of approximately $820 billion, the nonprofit sector in the united states has a robust socioeconomic influence (bain & company, 2006). social workers and the human service enterprises that they manage sit squarely in the midst of this competition. “as responsible social work professionals, we would be remiss not to mind our own business and join the ever-increasing ranks of social entrepreneurs” (germak & singh, 2010, p. 80). brinckerhoff (2000) adequately expounded on the client need versus client demand, stating that conceptualization of market demand is so fundamental to the success of a forprofit business, but it can also be explored in a social services context. what do our clients candidly want? is what we dictate that the client needs, really what they want? in a sense, a client’s right to self-determination is impeded by programs that dictate what a client needs. questions of client’s rights and autonomy can be assuredly resolved in a social entrepreneurship paradigm. when a business is immune from dependency on government contracts and designated charitable donations, the business can act in response to market demand and, in fact, develop services in reciprocity to what consumers are acquiescent to pay for (brinckerhoff, 2000). fernando (2015) posited that today’s world is experiencing unprecedented complexities, and governments, businesses and nonprofits have longevity in solving these contemporary social problems. the economic recession of 2007 exposed a significant decline in public and private support for social services (pitt-catsouphes et al., 2012). it also exposed the need for social workers to facilitate new ways of addressing the complex, interwoven problems of poverty, racism, social inequity, and discrimination. this need results from the complex, unprecedented social issues we face in the united states from a global pandemic with many variants to racial injustice, global warming, and more. now more than ever, social workers need to understand how social services can utilize new strategies with new solutions to address these issues (berzin, 2012). shuman and fuller (2005) originated the phrase revolution will not be funded, indicating that nonprofits all over the country must devise new income-generating strategies to empower disadvantaged groups. although the media reports that the u.s. economy has rebounded, foundations and governments still expect social service nonprofits to leverage new forms of revenue to accomplish their missions. there is also some precariousness with regard to how nonprofits will be funded sustainably as local, state, and federal government dollars dwindle. in addition, some have declared that social service organizations develop complex programs that do not match the business pursuits of funders (foster et al., 2009). due to the uncertainty of non-profits, there is a shift to social enterprises that have the ability to take on a new responsibility. social policy and social entrepreneurship the organisation for economic co-operation and development (oecd/european union, 2017) based in the paris, france, pronounced social enterprises can be significant partners for governments, assisting them to meet major chosen policy objectives (e.g., addressing poverty, reducing unemployment, and increasing social connectedness). however, they are often faced with numerous barriers (e.g., a lack of legal recognition and https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true https://www.researchgate.net/profile/rukshan-fernando godwin et al./social entrepreneurship & swk 483 difficulty accessing markets and finance) that can confine and stifle their impact and halt them from reaching their full potential. the recent report of the expert group on social entrepreneurship of the european commission (european union, 2020) stressed that favorable policy ecosystems are essential to helping social enterprises overcome these barriers. with the assistance of political social workers and policy advocates, social enterprises can secure the funding, concessions, and rights it needs in order to sustain itself. “to build tailored policy ecosystems, policy makers first need to develop a sound understanding of the features, mission and needs of social enterprises before translating into policy actions supporting their development. policy makers can also support efforts to raise funders’ awareness of social enterprises, aided by social finance intermediaries, who help funders design appropriate financing schemes” (oecd/european union, 2017, p. 5). sustained policy support is critical to constructing an enabling ecosystem that permits social enterprises to prosper over the long term. political impetus can act as a catalyst to bolster well-established ecosystems, fostering and accelerating beneficial conditions for social enterprises (oecd & european union, 2017). germak and singh (2010) recounted that, additionally, some theorists accredit the advent of entrepreneurial pursuit among nonprofits to the rise of conservative american policies since the mid-1970s in which the federal government has strived to lessen welfare spending and alter the responsibility for social welfare funding to the nonprofits themselves or to induce for-profit alternatives, such as privatized social services (abramovitz & zelnick, 2015). political arguments notwithstanding, unknowing of the drive toward social entrepreneurship, it is now a viable, functional, and increasingly popular alternative to traditional operating funding models in the non-profit and for-profit sectors. social work education and social entrepreneurship the council on social work education (cswe) is the governing body for social work education and uses the education policy and accreditation standards (epas) to validate and champion baccalaureate and master’s level social work programs that have met baseline aptness. cswe (2001) first stated that the educational policy of schools of social work must promote “excellence, creativity, and innovation in social work education and practice” (p. 3). however, the 2015 epas lack social entrepreneurship competencies (cswe, 2015). considering the future of social work, the current 2022 epas has addressed antiracism and diversity equity and inclusion to competency 2 (cswe, 2022). there is no distinction as it relates to competencies focused on macro practice to focus on social entrepreneurship. cswe standards highlight excellence, creativity, and innovation as key foundational concepts of schools of social work, and these same key concepts are also found in social entrepreneurship—there is no reason why social work educational institutions cannot incorporate social entrepreneurship into the curriculum (germak & singh, 2010). researchers have advocated social workers need more training in leading and managing social enterprises that are currently shaping the field of social work (chandra & shang, 2021; healy, 2002; nouman & cnaan, 2021; shier & van-du, 2018). one of the advances in social work, summer 2022, 22(2) 484 most constructive ways of helping social enterprises become viable and sustainable is to foster social entrepreneurs’ business skills and know-how. to this end, support structures (e.g., incubators) and networks rely on professionals who understand both traditional businesses and social enterprises and build social entrepreneurs’ capacity to become sustainable without diluting their social mission (oecd & european union, 2017). according to nandan et al. (2015) one of the paradoxes of trying to convey the significance of social entrepreneurship and social work practice surrounds ethics. while social workers have historically been innovative in their approaches to designing social programs and facilitating systems change for problem-solving at the local, national, and international levels of intervention, many practitioners and academics have unwittingly viewed social entrepreneurship by social workers as unethical and detrimental to the core values of the profession (nandan et al., 2015). according to germak and singh (2014), given the funding crisis in the nonprofit sector combined with the professional training and motivation of social workers to respond to social problems, social work administrators must take more risks by embracing entrepreneurial endeavors into practice. if master’s-level social workers do not reclaim such discourse and establish themselves as leaders in an ever-changing environment, other professionals may lead social work agencies in greater proportions, and the social impact on the clients served would be a result of the values and ethics of professions other than social work (wuenschel, 2006). in fact, according to healy (2002), if social workers are to generate service outcomes consistent with their values, they must be au fait with the new public management discourses now shaping the field. subsequently, social workers practicing social entrepreneurship need to be aware of the field-shaping management discourses that now involve applications of business sector practices such as strategic planning, market research, and response to consumer demand in the community (germak & singh, 2014). nandan et al. (2015) reported that in order to reply to students’ expanding interest, business schools have adopted social enterprise clubs and competitions. in addition, business schools have redesigned their curriculum to include social entrepreneurship. the business sector seeks sustainable models, and business schools have responded by developing programs that meet the aspirations of a generation of social change makers, but that do not have the social work or helping professional knowledge, values, or skills to truly educate the social entrepreneur. as a result, as the nonprofit sector continues to grow, the administrators of social service agencies are not social workers, but public affairs and business professionals (wuenschel, 2006). tan (2004) recognizes that without social workers in capacities of leadership, these agencies may not prioritize social work’s contributions of service, empowerment, and social justice. social work educators need to be willing to reshape the curriculum to equip students with the values of the profession and the business sense to make these social entrepreneurial organizations sustainable. in light of these realities, social work education must include social entrepreneurship in its body of knowledge so that it can develop students who understand the business side of social work. this will equip them with forward-thinking knowledge, skills, and abilities to respond to the complex social https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true godwin et al./social entrepreneurship & swk 485 problems. in doing so, social work schools could attract emerging social entrepreneurs with an educational experience that develops competencies related to cultural humility, social and economic justice, and the social environment. they could also build understanding of social problems at the micro, mezzo, and macro levels. unfortunately, only a few social work schools have incorporated social entrepreneurship curricula into their bsw and msw programs (fernando, 2015). figure 1 adapted from heinecke et al. (2014) depicts a high percentage of master’slevel social entrepreneurs. figure 1 indicates that there is a high percentage of current social entrepreneurs that have master’s degrees at 38.9%. if social work master programs cater to future social entrepreneurs, there can be an increase in enrollment and models that transform the profession. following behind is bachelor’s degrees, and then doctorates, indicating that social entrepreneurs are highly educated. if there is an increase in social entrepreneurship, then there will be an increase in enrollment if there are structured accredited academic programs centered in the growth of this needed area. figure 1. education of social entrepreneurs—schwab foundation survey results heinecke et al. (2014) berzin (2012) mentioned congruence between social entrepreneurship and social work that suggests a need to revisit the role of the social work field in developing this area and navigate how to implement social entrepreneurial concepts into social work teaching. social workers could benefit from exposure to these concepts and the ability to obtain funding through these sources. the social work profession could learn from the work of current social entrepreneurs and their approaches to solving contemporary social problems. increasing course offerings in msw programs, bolstering collaborations with business schools in this domain, engaging in public discourse through conference presentations and journal articles, and connecting to foundations that focus on social entrepreneurship could 3.3% 2.2% 20.0% 38.9% 16.7% 18.9% vocational degree high school diploma bachelors masters mba doctorate advances in social work, summer 2022, 22(2) 486 strengthen this collaboration. models that could be adapted to traditional social service agencies could also spur innovation and change within existing structures. social entrepreneurial leadership germak and singh (2010) posited that, given the tremendous need for resolutions to today’s pressing social challenges, it is time for social workers to accept much of the straightforward business sense found in social entrepreneurship, embracing a hybrid of social work macro practice principles and business innovation activities. there are three levels of analysis that are pertinent to social entrepreneurship: the micro, mezzo, and macro levels. the micro level concentrates on the traits and the leadership of the individual. the mezzo level focuses on cultivating innovation, while the macro level focuses on economic and social development (cukier et al., 2011). the world economic forum (heinecke et al., 2014) professed that leadership is about both character and competence, and the crucial question remains surrounding what leaders need to cope with, given constant changes, crashes, and crises. specifically, leaders of social enterprises face manifold challenges: many leaders do not have a formal business education and were driven by the passion to solve a social cause. their intrinsic motivation comes first, and economic reasons rank low. but business procedures need to be implemented, teams built, and money earned to run a social enterprise successfully. delegation of tasks and, more importantly, responsibilities, by the social entrepreneur is key to the success of a growing organization. a conducive organizational structure and environment needs to be built to allow for the heavy load of tasks and responsibilities to be distributed across the team, including comprehensive organizational charts, adequate job descriptions with clear allocation of responsibilities and defined processes for communication and decision-making, and good governance. for any highly engaged, overworked, and self-sacrificing social entrepreneur, it is important to realize that appropriate delegation benefits not only themselves but also the team members and the organization as a whole. this produces less workload for the leader and more capacity for other important tasks, development opportunities for the team members and motivation from new challenges, and better performance due to appropriate division of labor and avoiding bottlenecks in the organization (heinecke et al., 2014). social entrepreneurship, social impact/innovation, and scale social entrepreneurship promotes innovation and adaptable, yet scalable, strategic responses to complex social and human problems. the recent economic crisis and global recession have increased the already tremendous need to position a social question at the heart of the economy. social entrepreneurship can prove to be an effective tool for economic value creation and simultaneously a means to deal with various social issues. this coexisting concept appears to be developing popularity in spheres of both theory and practice, with the rise of social entrepreneurship as a new field of research (nicholls, 2010). the concept of social entrepreneurship has been quickly emerging in the private, public, and non-profit sectors over the last few years (anderson et al., 2006). social entrepreneurship is especially important in developing countries, where there is a lacuna in godwin et al./social entrepreneurship & swk 487 terms of social development and economic discrimination still exist, not unlike the united states of america (chell, 2007). social entrepreneurship catalyzes different social capabilities to conquer inequalities across different spheres (social, economic, environmental, and political). this can bridge social gaps by making social and economic development desirable (light, 2006; mair, 2010, seelos & mair, 2005). pearce and conger (2003) described that in early stages of the development of the social entrepreneurship and social enterprise field, policy and funding goals were largely concerned with propagating larger numbers, greater variety, and more geographic spread in activity. the centrality of social impact to the work of social entrepreneurs and social enterprises is a uniting factor in discussions on the way forward for social action (anderson battle & dees, 2008). for social entrepreneurs, the point is not to be more business-like or more nonprofit-like. “it is to be more effective at changing the world, using whatever organizational forms or management methods are most conducive to that” (anderson battle & dees, 2008, p. 156). there is no good reason why social workers cannot work in for-profit, proprietary settings or behave entrepreneurially, compensating themselves accordingly for innovative practice (masi, 1992). likewise, social workers should not necessarily take a vow of poverty even though they frequently work with populations stricken by poverty. arguably, a for-profit mentality, such as higher compensation levels for social workers or bonus schemes, could attract more talent to the field and bolster the morale of those already practicing at marginally acceptable income levels (giffords, 2000; guo, 2006). el fasiki (2012) emphasized that social entrepreneurs are individuals who start up and lead new organizations or programs that are dedicated to mitigating a social problem and positioning change strategies that differ from those that have been used to address the same social problems in the past (bloom, 2009). while specifying the mission of their enterprise, social entrepreneurs have to specify their systematic, strategic path of scaling social impact as well. it is obvious that their position between lucrative and social, meets the challenge of expanding social impact. in their thinking of scaling social impact, social entrepreneurs think not of competitive activities but rather of cooperative forms of activities (el fasiki, 2012). the willingness to allow others to replicate the same business model helps change attitudes and thus change social actions. defining the innovation is the most effectively transferable way of scaling social impact. as a way to define their innovations, social entrepreneurs need to specify the nature of their ventures, the way they will help spread the innovation, and how they will be accepted in other communities (el fasiki, 2012). social impacts include all social and cultural consequences to human populations of any public or private actions that alter the ways in which people live, work, play, relate to one another, organize to meet their needs, and generally cope as members of society. cultural impacts involve changes to the norms, values, and beliefs of individuals that guide and rationalize their cognition of themselves and their society (burdge & vanclay, 1996, p. 59). social enterprise models theorists have described social enterprise in terms of more than one model. figure 2is an example of how social work is imperative to the social entrepreneurial venture for https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true https://www.tandfonline.com/doi/full/10.1080/03643100903432974?scroll=top&needaccess=true advances in social work, summer 2022, 22(2) 488 education, sustainability, and framework. the models aim to provide a comprehensive, cutting-edge resource, introducing the unique concerns and challenges that face social ventures through a comparison with the principles of traditional entrepreneurship with solutions through the social enterprise model. figure 2. social work and social entrepreneurship model (veni mary, 2018) figure 2. displays that in order to sustain the social enterprise venture, one must use skills and strategies from business administration, entrepreneurship, social work, and social supports such as social policy and public-private partnerships. according to a study by wolfgang grassi (2012), there are nine types of social enterprise business models 1. the entrepreneur support model that sells business support services directly to the entrepreneurs in its target population, 2. the market intermediary model that helps clients by marketing or selling clients’ products or services for them, 3. the employment model, in which a social enterprise provides clients with job opportunities and job training, 4. the fee-for-service model where a social enterprise charges the customer directly for the socially beneficial services it provides, 5. the low-income client model where a social enterprise generally offers social services directly (as in the fee-for-service model) while focusing on low-income clients, 6. the cooperative model, a fee-based membership organization that provides member services to a group that shares a common need or goal, 7. the market linkage model that focusses on building relationships and otherwise connecting clients with markets for clients’ products and services, 8. the service subsidization model that funds social programs by selling products or services in the marketplace, and facilitating factors for the sustainability of social entrepreneurial venture skills & strategies from business administration skills & strategies from entrepreneurship skills & strategies from social work social supports sustainability of entrepreneurial venture godwin et al./social entrepreneurship & swk 489 9. the organization support model, which also sells products or services to fund social programs (as the service subsidization model). however, the social programs they fund are part of a separate, parent organization. as there are many variations of these models, they can provide ideas on to how to create sustainable benefit to society while balancing one’s finances. discussion the social work profession is constantly evolving and continuously learning and acquiring new values and skills to be au courant of developments within the industry. the profession of social work is that of advocacy, which produces agents of change. solutions and ideas that will help pivot social work to mitigate complex and vexing issues into the future will utilize social entrepreneurship and the social enterprise as a social action that should be implemented on the micro, mezzo, and macro practice level. this will move toward envisioning a future of larger profit, larger impact, and greater innovation. social enterprise can facilitate the rebuilding and recovery of our nation due to the impact of the global covid-19 pandemic, poverty, and its underlying issues, racial, gender, and political unrest. it can also uncover and help to address issues like the need for criminal justice reform, climate change, environmental and animal cruelty, disparities, and limited access to mobility for many people of color and people who are in poverty, food scarcity, and disenfranchisement. additionally, social enterprise certainly addresses the need for funding social work agencies. all of this can be accomplished with the assistance of social work implementation to carry out effective, sustainable, and professional virtue in our communities. the social work professional approval is the current missing link to the social enterprise model. having the social work professional approval of social work and social entrepreneurship and enterprise model, would assist in greater integrity and soundness in the social enterprise. the social work framework would provide the social enterprise the professional, intellectual guidance needed for working with communities, individuals, families, and groups. social work will enable the social enterprise to manage governance as it creates efficiency in the social entrepreneur’s conduct. in addition, good social work governance practices in social entrepreneurship and the social enterprise highlight errors and problems in the field. by flagging potential issues, social entrepreneurs have the chance to respond quickly and appropriately with the assistance of the social work profession and social policy. a key strategy for closing development gaps is by recognizing and promoting social entrepreneurial leadership and taking advantage of social workers’ talent internationally in the context of commercial agreements and regional integration platforms, and by utilizing their talent within companies. equality and equity in economic activity and development are profitable, generate wealth, are sustainable, further welfare and opulence, and above all fortify our democracies. social entrepreneurs have helped fight the covid-19 global pandemic and will participate greatly in the rebuilding, recovery, and restructuring of our communities. the advances in social work, summer 2022, 22(2) 490 world health organization (who) declared in the year 2020, a global pandemic emerged. governments have struggled greatly to respond to the public health crisis, but also to the economic and social consequences. with great optimism propelled by social innovation, thinkers and doers envisioned not just to address urgent social and basic needs, but to transform entire systems and ecosystems through social entrepreneurs. the world needs social entrepreneurs right now—hyper-practical, disruptive leaders who relinquish traditional practice to tackle enormous social problems. we stand at the nexus of multiple, colliding crises; thus, we need to invest in converging solutions. who better to find and implement those solutions than social entrepreneurs and social workers? social enterprises are well positioned to address gaps in the market and to grasp constituents whom governments can or will not. economically and socially distressed communities are the hardest hit by this pandemic; but that same disadvantaged position makes it difficult for government relief and services to make any resolve, making the efforts of social enterprises even more vital to the global society (bersin, 2018). social entrepreneurship is a mindset, and the social enterprise is the business model. in order for the mindset and business model to work cohesively to promote outreach, growth, and development, the profession of social work should make its efforts to announce the model as new outreach efforts arise in the profession. the profession of social work has a historical involvement in social entrepreneurship. in fact, one can argue that the profession of social work created social entrepreneurship and the social enterprise with the onset of the jane addams settlement house. this served as a catalyst of mass following and formation of settlement houses across the united states of america and europe, creating global reach. social enterprises offer an innovative approach to bringing about desired change through reconceptualizing the mission of the enterprise and rethinking the of value creating logic (brown & wyatt, 2015). social entrepreneurship starts with comprehending a social opportunity, then moves into an enterprise model, amasses the necessary resources for execution, gives life to and nurtures the enterprise, and eventually reaches the intended destination (doherty et al., 2014). social workers have been notarized for working for agencies; however, the creation of social enterprises provides an opportunity for social workers to become leaders in their communities by using the same social work cswe knowledge, values, and skills to solve societal problems through creating a social enterprise and implementing social impact in communities. social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice (nasw, 2021); therefore, social entrepreneurship should be placed within the cswe curriculum and placed in social work models and care models and recognized by the nasw. social policy and social enterprises can act as collaborators and actors for the united states and globally for the destruction of social problems. social enterprises are developed to assist social policies in carrying out and facilitating the needs of the community, prior to and after the formation of policies. policy creators can create opportunities for social workers who operate in social enterprises with funding, and with student loan forgiveness for the development of agencies to this magnitude. social work education governed by the cswe should address social entrepreneurship in the 2022 epas to provide social work godwin et al./social entrepreneurship & swk 491 students the opportunity for advancement to tackle social problems, and provide them the knowledge, values, and skills needed to implement this model. with the rise of social and racial injustice in the united states and abroad, social enterprises alleviate these problems and add value to the community at large. with field placements for social workers in scarcity, this also provides the ability for social work placements in social enterprises facilitated by social workers. what is the future of social work? michael reisch (2013) posed this question in his paper, critical and radical social work and later that year in his book social policy and social justice: meeting the challenges of a diverse society. this question is a good place to anchor a discussion on what practitioners will face moving forward and how social work entrepreneurship can and should be situated as the transformational change needed to deal with a country in the midst of historic inequities and widening disparities. it is within this political context of welfare reform and economic context of neoliberal policies that social entrepreneurship has evolved. the social policies we as a culture promulgate and the social systems that we build reflect the biases, priorities, and goals of a society. neoliberal principles also gave rise to a positive view of entrepreneurs and their skill set. it is a small step to bring that unique ability to the social workspace. social work training has meant in the past, teaching the ability to translate theory into effective practice. however, social enterprise training embeds entrepreneurial thinking within social work instruction and practices, essentially, as germak and singh (2014) suggest, changing the way social workers do business and ultimately changing the way they are perceived in the country. germak and singh (2010) implore social workers to move from the periphery of social policy debates with creative solutions that combine business innovations with social work practices. this pushes back against reisch, who sees the market as a problem, and against staid curricula that remain out of step with 21st-century social work demands. as gray et al. (2003) contend, social entrepreneurship should work in tandem with government, funders, and the nonprofit community. at the same time, entrepreneurship should encourage students and early career social workers to take a solutions-driven approach based on experience and design creative, credible answers that sustain social value. however, that will require today’s social workers to fearlessly jump into debates around some of the community’s most pressing social issues and develop options to mitigate human suffering. grassi (2012) indicated that social enterprises are independent businesses autonomous of state or government control, owned and controlled by the interest of the organization’s social and environmental mission. there are three measures that define whether a business model in general is successful or not: the model’s ability to generate profit for its owners, its ability to generate positive change in the world, and its ability to achieve a balance between profit and positive change. the latter is applied to social enterprises. a social enterprise model is therefore a structure, design, or framework that a social enterprise follows in order to bring about a positive change while maintaining healthy financial returns. social enterprises constitute the three levels of social work practice: micro, mezzo, and macro practice. the micro level are private practices that provide fee by income or offer a advances in social work, summer 2022, 22(2) 492 certain amount of pro bono cases a year or coaching people in the community on various matters from love, self-esteem, self-help, or on a specific topic that will enhance the human experience. social enterprises on the mezzo level of social work can provide group services and, on the macro level, can provide various services to the community that make an impact for the greater good. social entrepreneurs around the world have been unparalleled catalysts for social change. they use market-driven strategies to tackle critical social issues in brand new ways. social entrepreneurs have promoted a broad range of solutions focused on sustainable development, decades before they were called sustainable development goals (sdgs). the real power of social entrepreneurs is their talent for identifying market failures that are holding humanity back, and their skill in tailoring and implementing solutions. these include providing access to renewable energy, clean water, financial inclusion, high-quality educational resources, and critical information that allows lifegiving agriculture to flourish like hydroponics in urban communities. the world economic forum (göler von ravensbur et al., 2018) insisted that as the field of social entrepreneurship has matured, so too has the complexity and depth of the social issues at stake. we are confronted by a rising tide of crises—fluctuating democracies, racial injustices, gender and lgtbq discrimination, environmental catastrophes, population growth, food instability, nationalism, and technological advances that require new skills and workforce training. not to mention the alarming rise of displaced populations caused by natural disasters or conflict, including the global pandemic and wars. the time is now for social action, social change, and continued growth in the social work profession. the time is now for inclusiveness, community, and connectedness. these can be achieved through social entrepreneurship in the profession of social work as a working model that can propel the profession forward professionally and financially. it can also create a larger social impact and transformational shift to social change and social justice by addressing contemporary social problems through the social enterprise. references abramovitz, m., & zelnick, j. 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(2020). moving on up: jordan’s young social entrepreneurs go global. https://www.unicef.org/innovation/jordan-young-socialentrepreneurs author note: address correspondence to dr. cherése godwin, school of social policy and practice, university of pennsylvania, philadelphia, pa, 19123. email: cgodwin@upenn.edu https://doi.org/10.1080/21650993.2004.9755956 https://doi.org/10.24327/ijrsr.2018.0903.1869 https://doi.org/10.18084/1084-7219.7.1.27 https://www.proquest.com/docview/208425218?pq-origsite=gscholar&fromopenview=true https://www.proquest.com/docview/208425218?pq-origsite=gscholar&fromopenview=true https://doi.org/10.1300/j147v30n04_02 https://www.unicef.org/innovation/jordan-young-social-entrepreneurs https://www.unicef.org/innovation/jordan-young-social-entrepreneurs mailto:cgodwin@upenn.edu ______ jessica donohue-dioh, phd-lcsw, university of houston-downtown, houston, tx. jacqueline wilson, mba shrmscp, director field hr, business partnerships, and founder, open door culture, houston, tx. stephani-nicole leota, msw, political social worker, houston, tx. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 1045-1063, doi: 10.18060/24164 this work is licensed under a creative commons attribution 4.0 international license. the woke disrupter: a call to action jessica donohue-dioh jacqueline wilson stephani-nicole leota abstract: this article examines one of the most dangerous personifications of white supremacy, the woke vigilante the “liberal do-gooder” and the social work profession’s role in their creation. white supremacy is frequently named to identify overt racism and discrimination by hate groups, ultra conservatives and increasingly throughout the government. there is another breed of white supremacy which lies beneath the surface and believes itself to be an ally, this is the woke vigilante. unexamined social work education provides the right ingredients with the moral authority to turn white social workers into woke vigilantes. this conceptual article highlights the ways in which social work education currently addresses competencies of diversity and difference, as well as social justice. the authors then present a persuasive argument for white academic social workers to alter course and promote teaching and practice skills which incorporate social justice skills at all levels of practice, in other words social justice meta-practice skills. the danger of white supremacy when it is disguised as the woke vigilante may be best captured by malcolm x when he spoke of the white liberals who disguise themselves as friends to the black man only as a means to benefit their own self-interest without genuinely asking or listening to that which the black community actually wants (x, 1963). social work is all too familiar with the white liberal and must consider this a call to action, as well as a forewarning against further perpetuation of white hegemonic societal structures giving license to white do-gooders eager to go into black communities and effect change. authors present a resolve for white social workers to adopt the role of the woke disrupter. keywords: dismantling racism, anti-racism, white supremacy, institutional racism the term white social worker will be used regularly throughout this manuscript. the reader should recognize that statements of generalization regarding white social workers do not indicate there are no exceptions. however, particularly relevant to the nature of this manuscript, the authors chose not to make an ongoing statement of exception for those white social workers to which this conceptual piece might not apply. the perspective of the authors is that making any acknowledgement beyond this note continues to center whiteness as the sacrifice of all those who are marginalized. as the authors of this conceptual paper, we intend to offer transparency from our first sentence through to our final words. as a manuscript selected for inclusion in a special issue called “dismantling white supremacy in social work education,” we believe it is not only beneficial, but crucial for us to share aspects of our identities which have shaped our lives, as well as our perspectives of the future, both personal and professional. we are cisgender female, gender non-conforming, queer, and heterosexual. we are a white mother of biracial and multiethnic children, a black single mother of a black boy, and a biracial about:blank advances in social work, summer 2021, 21(2/3) 1046 black and samoan wife and mother. professionally, we have an mba focused in leadership and organizational behavior, a phd, msw, bsw, and a ba in political science while also seeking completion of an msw at the time of writing this piece. there are intentionally coded examples and language used throughout our narrative. if you find yourself thinking “that sounds awfully white” you might be right and it is likely intentional that we want you thinking and feeling that way. in addition to situating ourselves as authors, there are societal and professional contexts relevant to the writing of this manuscript. white supremacy, racism and anti-blackness have plagued our united states of america (u.s.) since its birth under the exploitative, barbaric, and inhuman enforcement of colonists. lastly, as the authors of this manuscript we have included firsthand narrative examples which we have experienced throughout our careers. we have intentionally referenced these narratives as “author’s experience.” recently, the u.s. has experienced a resurgence of civil rights activism and protest after yet another killing of a black man by police: george floyd (nuyen & slotkin, 2020). not only did the world bear witness to myriad protests, the world participated at levels unseen since the height of the civil rights movement in the 1960s (cave et al., 2020). as sherrilyn ifill (president and director-counsel of the legal defense fund national association for the advancement of colored people [naacp]) stated in a 60 minutes interview, mr. floyd’s death provoked a different and more powerful response, likely in part due to the length of the video captured by witnesses (whitaker, 2020). in the following weeks and months protests stood strong, occupying city streets throughout the country and throughout the world, all echoing one central message: black lives matter (#blm). and yet, in the midst of worldwide protests, white supremacy took no pause, demonstrating its insidious and relentless nature, making way for a white man to openly murder two men, and walk freely, maybe to one day face consequences (mihalopoulos, 2020) while breonna taylor, a black woman, was gunned down and killed by police officers in her own home (bbc, 2020). not surprisingly, this global attention to #blm has spurred new and renewed interest in race relations from nearly every corner of u.s. society, including from within the social work profession. as such, the social work profession, in efforts to reconcile its own history and role in upholding white supremacy and anti-black racism, has created additional space for conversations (singer, 2020a, 2020b, 2020c; swcares, 2020) such as the one presented here. it must be acknowledged, as a predominantly white female profession (salsberg et al., 2017, pp. 15-18), social work struggles with interconnected issues of patriarchy and misogyny. however, it is white supremacy that garners our attention at this time. please understand this manuscript is intended to ignite critical thought by offering perspectives on social work education and proffering the enormous responsibility to prevent woke vigilantes being sent out into society proudly displaying their credentials as professionally trained social workers. this. is. a. call. to. action. and a forewarning. while history cannot be changed, we are obligated to purposefully and thoroughly extract the stronghold white supremacy has maintained, in part, through our professional education. social workers must review and revisit the pedagogy, texts, policies, licensing, practice arenas, and importantly our values and ethics; turning them inside out and unearthing the white supremacist roots. in no uncertain terms do the authors advocate for donohue-dioh et al./woke disrupter 1047 an erasure of the white supremacist historical knowledge foundations of social work. in fact, it is the commitment of current social work educators to hold these racist roots out in the light of day that will lead to long term erasure of the influence and corruption inhibiting meaningful realization of the full potential for social work social justice values. any profession which does not examine its oppressive and racist tendencies is indeed creating harm to society; this is not negotiable. social work is a practice profession with immense responsibility to actively engage social justice at all levels. advocacy and activism are explicitly identified as central to the profession and as necessary skills to become a social worker (council on social work education [cswe], 2015). recognizing the power which lies in the invisibility of white hegemony, this manuscript aims to bring clarity to the subtle and powerful ways social work education can go awry by creating the woke vigilante. and how it can reclaim its professional value of integrity and embrace a position as a woke disrupter, utilizing social justice meta-practice skills for anti-racist professional practice. a final note of introduction: racism, tribalism, ethnocentrism, and colorism exist and perpetually marginalize individuals who identify or who are perceived as being black, indigenous or a person of color (bipoc). while all of the methods, forms and systems in which white supremacy are upheld require dismantling, as stated previously, it is antiblackness which has awakened protests throughout the world. colorism, of which antiblackness is the ultimate embodiment, underscores the negative consequences and privileges of passing as one moves in proximity to blackness and whiteness respectively (telles, 2014). this does not invalidate or discount racism experienced by persons who are lighter skinned. rather, this is to acknowledge the universality of anti-blackness. additionally, region and history strongly influence the multitude of ways in which antiblackness takes shape. it is for this reason that our manuscript remains focused on a u.s. context. background the u.s. has a long and sordid history of race relations. one need not look very far to find confirmation that the u.s. was founded upon genocide (miller & garran, 2017), enslavement of africans (jones, 2019), white supremacy and anti-black racism (patterson, 1998), systematic oppression of black/african americans, and discrimination (alexander, 2012; miller & garran, 2017). it should not then be surprising that the institutions established to uphold and maintain american society and culture are also rooted in these same principles of white supremacy and oppression (bell, 2018; miller & garran, 2017). scholars provide clear evidence of these social institutions that perpetuate historical and ongoing discrimination, abuse and violence against black people in america: education (morris, 2016), criminal justice (alexander, 2012), health care (roberts, 1997), mental health care (walker, 2020), finance/banking (baradaran, 2017), and housing (rothstein, 2018) to name a few. it is also very clearly established that these social institutions are operating as a collective to uphold white supremacy. the web of institutional racism is brilliant in design in that it is self-sustaining, invisible to enemies, and just like a web it is strong and advances in social work, summer 2021, 21(2/3) 1048 withstanding (bell, 2018; miller & garran, 2017). this is the function of a web, and as such, the web of institutional racism is performing and carrying out its full intended functions. social work is present throughout all of these institutions, be it politics, child welfare, criminal justice, education, health care, mental health, environmental stewardship, and countless others. and so, the question becomes: if social work is not an institution yet maintains a professional presence in all institutions, where do we start? although still bound by institutional structures, there is one space in which social work can assert its influence and shape its future: social work education. uprooting, uncovering, and dismantling social work’s role in maintaining white supremacy culture and, therefore, anti-blackness is urgent and crucial. however, it must be made explicit that there have always been anti-racist social workers, all along, fighting this fight; for example, dominelli (1998), jaggers (2003), and lasch-quinn (1993). while these few are acknowledged and published, it is important to recognize that the same circumstances by which this manuscript is made necessary have simultaneously created spaces in which many voices of resistance have gone ignored and unacknowledged. after all, this is the nature of the beast of white supremacy in education. the professional embrace of addressing white supremacy and anti-black racism need not pat itself on the back for finally getting the message. becoming social workers in the field, as well as those in academia, can all too readily identify the most common reason a student states for having entered the profession… “to help people.” this statement is spoken hundreds, if not thousands, of times each year by new majors and echoed throughout careers by seasoned professionals. this initial discovery and draw to social work is not the seed, but rather the sprout of a seed sewn by a white hegemonic societal structure. that seed is the toxic messaging that to be white is to be better (hooks, 2000, p. 116). this messaging, in its most noble form, encourages a humble acceptance of superiority in which one must “help” and “do good” for those less fortunate; the less fortunate being those who are black, immigrant, and poor and living in the margins. never mind the fact that they were forced into the margins as a result of the racialization of early american society in an effort to protect the wealth and assets (buck, 2013) of the already well-established white anglo-saxon protestant (wasp) (stalvery, 1970). make no mistake; there are poor whites; however, their position is somewhat less dire because, after all, there is hope, for at least their skin color opens the door of opportunity. “race privilege has consistently offered poor whites the chance of living a better life in the midst of poverty than their black counterparts” (hooks, 2000, p. 116). this is where it begins. before new social work majors sign up, society has already filtered through, sending those “helpers” on their rightful path as future social workers. let us be clear, it is not that all white social workers come from well-to-do families without difficulties—and truly, we as authors struggle with even feeling the need to explicate this. nevertheless our goal is to reach a broad audience. it is to say that even when class, education, gender identity, and sexual orientation are marginalized, whiteness will still place white social workers ahead of their black peers and better off than their black clients. donohue-dioh et al./woke disrupter 1049 and when the degree is done and a college education is added to that whiteness, the privilege is compounded and then upheld by the web of institutional racism (miller & garran, 2017). not unlike other professions, there is bias and privilege in the very people who find their way to a certain career or field. the difference for social work is that because the profession holds itself up as a beacon for diversity and social justice, we must do better. in discussing the danger of the woke vigilante, please know the authors maintain the position that social work education has consistently failed to maintain the professional value of integrity by excluding its white supremacist and anti-black racist foundation; the actions and attitudes of earlier social work pioneers; as well as, the subsequent centering of whiteness throughout the profession’s development. similarly, there has been a failure to uphold social justice by sustaining practices of centering whiteness and thus maintaining white supremacy. day one so here they are; a new class of social workers, all of them on day one! changing in demographics, yet still a statistical majority of white cisgender females (salsberg et al., 2017). academic social workers’ responsibility to educate students in what it means to be a social worker begins here. curricula are required to “engage diversity and difference in practice” according to the cswe educational policy and accreditation standards (epas, cswe, 2015, p. 7). however, all too often diversity becomes a problematic lecture, riddled with language such as cultural competence only to be followed up with multiple slides on native americans, african americans, latinx americans, asian americans and maybe white ethnic groups. and then done. to be clear there is rarely malicious intent. cultural competence and diversity when carried out in this manner fall into a broad range and focus on appreciating difference across and within various groups of a pluralistic society (adams & zúñiga, 2018). often, this display of “difference” is followed with unsettling lectures on “human rights, social, economic, and environmental justice” (cswe, 2015, p. 8). educators address and share the realities of modern society as it relates to disproportionate wealth, structural racism, gender gaps, marginalization of immigrant communities, and many more important and relevant social issues demonstrating inequity and injustices throughout our societies. commonly, all of this is to be presented and understood within a systems or ecosystems theoretical perspective. these theoretical approaches, while explanatory in nature do little to provide direction or action for change (rogers, 2019). and so, the unexamined message is to accept the system and learn to adapt and work within the system (finn & jacobson, 2003). this approach at best maintains a system of white supremacy and oppression. at worst, for now, it promotes an erroneous self-assurance that one has achieved competence in diversity. advances in social work, summer 2021, 21(2/3) 1050 now do it is not new to social workers that practice courses heavily lean into micro and maybe mezzo level skills. building upon the introduction of diversity and difference and social justice, students are taught a variety of engagement, assessment, intervention, and termination skills. at every step, students are reminded to be cognizant of diversity and engage their awareness of cultural competence. consider this author’s experience: i sense a shift in my social work program compared to just one year ago. the conversations around systemic change are becoming more explicit and action oriented. this may be due to the ever-evolving political climate and upcoming presidential election or the fact that i am now in macro classes with other macro students. when i was in foundation classes, i felt a resistance from other students to fully question the systems that we will one day work within. the overwhelming majority of my classmates in the first year of the program were clinical students which is the norm for most social work programs. i fully appreciate the need for clinical/micro social work, but i wish the conversations around systemic change and social justice had gone deeper in those foundation courses. if we don’t delve too deeply into those conversations in the classroom, what will we do in the real world? the conversations are uncomfortable, to be sure, but they feel necessary when we call ourselves “agents of change.” my assumption, from a student’s perspective, is that teaching social justice tools is more abstract than clinical skills. it may be easier to teach objective facts about the history and theories of clinical social work skills. the difficulty notwithstanding, new and experienced social workers suffer from not knowing exactly what to do when presented with the overwhelming knowledge of systemic oppression in every institution. the majority of social work students will go on to be clinicians and the curriculum reflects that. the tools that most students are given to deal with systemic problems are micro-level tools. of course, helping individuals through acute difficulties is important and life-saving for some, but if the social work education ends at that then what happens to the institutions that employ us? if we are solely focused on helping the individual in front of us, what do we do when we look up and see how agencies who employ us continuously oppress us and our clients? i understand my viewpoint is limited in this regard. i am a career changer with minimal experience in social service organizations and i am only in my second year of an msw program. however, i have jumped headfirst into my commitment to racial equity and justice and the resistance from experienced social workers is disappointing. i have read comments from white social workers on social media who espouse “all lives matter” or “blue lives matter” in response to posts about black lives matter. in a few months, those same white social workers will be my colleagues, or even my superiors. social work curriculum does an amazing job of making students aware of social injustice and oppression. it does not do a great job of giving us tools and donohue-dioh et al./woke disrupter 1051 opportunities to dismantle that injustice. the constraints of a two-year professional program are acutely felt as i sit at the beginning of my second year. i understand that not everything can be touched on or taught in this limited time frame. i argue that social justice advocacy and activism should be a part of the foundational curriculum for all social work students. the dump of knowledge on social work students about social injustices leaves us feeling overwhelmed and powerless. our foundational education should prepare us to affect systemic change and dismantle systemic injustice at all levels. this student experience is not an isolated incident, nor is this program a terrible program. however, the process of introducing such powerful stories of social justice without any real examination, ongoing dialogue or interrogation abandons students of color, especially black students. without calling attention to anti-blackness, white academic social workers leave a void that gets filled with a sense of neutrality, permitting the perpetuation of a “not-racist” pedagogy (kendi, 2019, p. 9). the invisibility of whiteness fills all voids with a normalization of white supremacist culture. the power of nothingness, avoidance, and omission has been known throughout time as evidenced in the words of desmund tutu, “in a situation of injustice and oppression such as we have in south africa, not to choose to oppose, is in fact to have chosen to side with the powerful, with the exploiters, with the…oppressor” (as cited in leonard, 2013, p.1581). skills such as cultural humility (gallardo, 2014) are insufficient to meet social workers’ mandate to be the social justice worker (finn & jacobson, 2003) they had envisioned upon pursuing a social work degree. additionally, the challenges presented by this student capture a related and ongoing hurdle of social work education which is bridging macro concepts such as social justice to micro course work and consequently incorporating social justice work for the macro student into the foundational micro focused courses. androff and mcpherson (2014) wrote of utilizing a human rights framework to bridge this gap and particularly as it relates to maintaining the mission of social justice in social work education. recall, social work demographics continue to reflect predominately white women who enter into the profession to “help” people. white women who have now come to recognize diversity, cultural “competence” and oppression of all people, including themselves, marginalized by patriarchy. while on the surface this may appear “nice” and “good,” beneath this sentiment remains the corrosiveness of whiteness, including complexities of othering, saviorism, classism, and racism. captured so simply, yet so profoundly by professor chey davis, who states “you came to sw [social work] to ‘help people,’ i came to free myself and my people. we are not the same” (davis, 2020). the “you” davis refers to are white social workers, whereas “myself and my people” refer to chey davis as a member of the black and african american community. white social workers must be made to understand the difference and accept the role anti-blackness plays in conceptualizing shared privileges and disadvantages. terms such as social justice warriors have been used to describe the passion driven white women who have crusaded through history shouting chants of social justice, feminism, and equality. the result: decades and generations of social workers who believed advances in social work, summer 2021, 21(2/3) 1052 and felt themselves allied with their colleagues, clients, and communities of color but who have not done the hard work of true introspection. home grown professional social work set the target and the arrow has landed precisely in the bullseye. generations of white social workers giving quite literally everything they have to a profession they love; the attachment to their social work identity so salient that discussions of serious concerns within the profession feels like a threat to their personhood. this brings up the question of responsibility: is the white student responsible for asking about the social work history they were not educated about? how does one begin to know? arguments can be made for social workers’ responsibility to continue their education and think critically about the structures in which they engage daily. there is hypocrisy hidden within though. social workers recognize that clients are shaped, nurtured and grown with context, environment, values, beliefs, etc. (rogers, 2019). and so, the same is true for white women who become social workers. why and how white people come to social work is a larger socialization discussion, referenced earlier, but outside of the scope of this paper. this is where it begins and ends though: the professional education and experiences shape, inform, and nurture professional beliefs and values. these values and norms are too similar to the larger white hegemonic structure and as such social work maintains and perpetuates white supremacy in house, but with a special twist. the white supremacy maintained in social work is tied to “cultural competency” and “social justice” education and training. not to mention a white-washing of all oppression, giving white women license to embrace their gendered oppression in sameness with the anti-blackness experienced by the black community. recall, this is not a comparison of oppressions (lourde, 1983), and even without hierarchical comparison anti-blackness can still be recognized with the severity, persistence, and inescapability which is profoundly distinct from gender oppression experienced by white women. when luck is in the favor of professional social work, things are “fine” and no new harm is committed, similarly no new progress towards a truly anti-racist and just society. let’s call this your standard social worker unintentionally and possibly unknowingly perpetuating systemic racism. when that luck runs out, social work is responsible for birthing woke vigilantes. merriam-webster broadly defines a vigilante as “a self-appointed doer of justice” (n.d.-a, definition 2). likewise, woke is defined in the context of u.s. slang as “aware of and actively attentive to important facts and issues (especially issues of racial and social justice)” (merriamwebster, n.d.-b, definition 1). a woke vigilante in social work is someone who has done the baseline work of becoming a social worker, and either due to the comfort in such a safe space or due to lack of awareness, has moved forward without interrogating the basis of that education and the subsequent implications for themselves, their colleagues and their future clients. the potential for a social worker, from this all too familiar educational path, to practice in the world and be “harmless” is a possibility and is not what the authors identify as the woke vigilante. however, it is clear that being harmless is not sufficient in a society and world that requires active seekers of justice. donohue-dioh et al./woke disrupter 1053 woke vigilante somewhere in between non-racist and an antiracist modern society a new docile breed of woke vigilantes has found a home. these are the social workers who retweet the hashtag #alllivesmatter, because after all, the social work profession values every human being as having dignity and worth. after all, the profession urges a respect of all diversity and human rights, social justice for everyone. consider this author’s experience: in the summer of 2020, i and other social work graduate students formed a group to demand racial equity and police reform on our campus in response to the murder of george floyd and subsequent protests. an article about our efforts was shared on a social workers’ social media page to raise awareness and to highlight our work. the backlash to that article was unexpected. many commenters respectfully disagreed with our position, but nevertheless showed support for our activism. however, others were more vitriolic in their disagreement and they unfortunately drowned out the rest. the two most vocal opponents were two white women. one explained that if we didn’t agree with the police, we were free to join the local police department. the other expressed the same idea while also offering that she and members of her family were members of law enforcement implying a certain authority on the matter. these women commented “all lives matter” on other posts because they had experience working with all kinds of people and they could never exclude anyone by saying “black lives matter.” (it is possible that these women were not actually social workers as this group is open to anyone. however, previous and subsequent posts from them lead me to believe that they are practicing social workers.) as a social worker-in-training, i was taken aback by their negativity and crudeness. to see this sentiment on a page for professional social workers was a wakeup call. i went into my social work program with high hopes of being surrounded by like-minded people who recognize inequality and inequity and stamp it out at every opportunity. my hope is that the current crises will force the cswe, social work academic programs and social work organizations to review their standards and eradicate any semblance of racism or prejudice within our profession. speaking frankly about race in relatively safe classroom settings should be standard for all social work programs across the country. beyond the perspective of students, social work occurs in many places and spaces. social workers have a professional responsibility not only to their clients, but also their colleagues (national association of social workers [nasw], 2020). consider this author’s unchecked behaviors as a woke vigilante: remembering my attendance at a social work conference. excited and eager to meet new colleagues and network, a group of social workers met out at café, after sessions had ended for the day. i was one of two individuals who would be perceived as white (i don’t actually think the other individual identified as white). as we wrapped up we called an uber to take us back to the hotel, we needed an xl to accommodate all of us. our driver, a non-black man of color, arrived and brought us to the hotel safely. upon pulling up to the hotel a police car was advances in social work, summer 2021, 21(2/3) 1054 blocking the curbside drop-off, so our driver pulled around and over safely in front of the police car. as we exited the vehicle the police officer came over and started to give our driver a hard time, that he shouldn’t have pulled over there, blah blah blah-truly because it was bs. we had all exited and the driver could have easily pulled away if the officer felt it was an issue (which i guarantee it would not have been if i had been driving). the driver apologized and was happy to move on his way, but the officer kept on lecturing. i, the white woman, feeling frustrated by what i clearly saw as a racist encounter, felt empowered to step in. i verbally went after the officer. the officer warned me to stop talking, and as i physically moved closer he warned me to step back and stay on the curb. still, i didn’t back down, i thought i was doing the right thing, defending this helpless (insert saviorism) uber driver being targeted by a racist cop. after some additional back and forth, and some words from my colleagues of color i snapped into awareness. i stopped. i realized that the uber driver appeared concerned with my engagement with the officer, as did some of my colleagues of color. the officer ticketed the uber driver and thankfully that is where the police encounter ended. it is possible that i pushed that officer to give a ticket and that without my woke vigilantism the driver may have gotten away with a warning. my anger, frustration and sloppy display of privilege clearly escalated the police officer. had i not snapped to, only by the continued efforts of my colleagues of color standing by my sides, would i have caused a more harmful situation to occur, it is absolutely possible. i am grateful i did not contribute to a more dangerous police encounter and embarrassed by not having recognized the danger of my provocation prior to this encounter. i did the only thing i could do at that moment; i left a hefty tip for the uber driver to hopefully cover the ticket and i committed to continuing to examine the space i occupy as a white woman and my presumptive actions as an “ally.” the true fear, and yes fear, is the fully engaged and willing to fly woke vigilante. recall, this social worker is white, is culturally competent, has skills to engage and practice with the most vulnerable communities (due to their forced marginalization), and has a sense of morality to back them up: professional values and ethics. this is the child protective services social worker we see reporting a mother’s use of marijuana, traumatizing and disrupting an entire family unit, to only then go home and unwind with a bottle or two of wine while caring for her own children. imagine the white social worker, now the woke vigilante, working in black neighborhoods. one night they find themselves feeling uneasy (read as there is an adult black man walking his dog at night), feeling confident in their diversity cultural competency, they do not pause and evaluate, and instead believe firmly to be acting out of safety, calling the police on a black man at night for scaring a white person. this is not a far-fetched story. the white people who call the police repeatedly on black people are not all racist and in-fact it appears that some of them were those very liberal do-gooders. social work cannot be complacent, forgetting the forewarnings of malcolm x, martin luther king, jr., and many others as to the danger of the liberal white (wo)man. social work must be explicit to distinguish themselves beyond the basicness of (white) liberal and good. donohue-dioh et al./woke disrupter 1055 in the same way that scholars throughout race relations and diversity studies recognize that white people are harmed by racism, this acknowledgement of the woke vigilante is a recognition that white social workers are similarly harmed by white supremacist structures being upheld in their professional education and training. white social workers do not want or consciously desire to maintain oppressive and racist structures. white social workers, particularly upon entering the profession, are idealist and hopeful of a different world where equity exists and justice is accessible to everyone; they may not yet know the language of “anti-racist.” these hopeful white social workers are subsequently harmed by trusting a professional education system that hasn’t done its homework. getting it right social work diversity education need not stop with friendly lectures of “diversity and difference.” competency 3: advance human rights and social, economic, and environmental justice completes a curricular focus on diversity and difference (cswe, 2015). it is precisely the active and dynamic combination of these two competencies in social work education that cracks open the earth, exposing the roots of white supremacy and racism. to be clear, social justice is the game changer. as conceptualized by adams and zúñiga, social justice is separate and different from diversity and difference in education (2018, p. 41). social justice draws attention to “unequal social structures, supremacist ideologies, and oppressive politics and practices” and teaches us that it is through these mechanisms that “dominant social groups” perpetuate privilege and maintain the subordination and disadvantage of marginalized social groups (adams & zúñiga, 2018, p. 41). without the anchoring of diversity and difference to social justice, social work takes a chance in graduating the woke vigilante. to borrow ashley ford’s (2020) tweet, “empowered incompetence is so dangerous.” day one do-over from the beginning academic social workers are modeling social work relationships and engaging in mutually symbiotic relationships with students, whether they intend to or not. intentional, informed, and purposeful engagement with students is the first step for white academic social workers committed to uprooting white supremacy and racism within the profession. with this in mind, it is pertinent that white academic social workers consider their approach to the classroom, plan, and establish a means of reaching and engaging with students. if white academic social workers are to truly model a collaborative relationship, with foresight for students and clients, their approach to teaching needs to reflect as much. adopting a teaching-learning philosophy provides the platform on which white academic social workers can acknowledge their position and simultaneously acknowledge the centering of the student experience (grise-owens et al., 2018). drawing upon basic tenets of symbolic interaction theory, this can be viewed as demonstrative of the social worker and client relationship in recognizing that we each bring certain skills, resources, and expertise to the relationship (rogers, 2019). without one the other does not exist: without students there is no teacher. at this juncture it would be remiss to not acknowledge the discussions and concerns within social work regarding a need to advances in social work, summer 2021, 21(2/3) 1056 dismantle social work as we know it, so that the profession can be built anew. as a part of this reference discussion there is healthy critique and concern regarding how the oppressive systems in the u.s. maintain and produce a constant source of clients for social workers. this manuscript is not situated to address this larger discussion and recognizes the limitations of not doing so. similarly, educators are situated within a larger social institution and must confront the challenges or limitations presented in fully engaging an anti-racist pedagogy for social work curricula. the day one conversations must include a reckoning of the terminology and socialization behind “helping” and encouragement to question and critique identification of values such as service defined as helping (nasw, 2020). programs must incorporate an unaltered and full spectrum display of history, founding figures, skills development and practice implications, theoretical approaches, acceptance, and understanding and application of research. upholding the values, namely integrity, of the profession, students must be entrusted to know the full story without rose-colored glasses. students must know from day one the complexity in which this profession was born. there must be a foundation laid beginning with comprehensive history: actively identifying, naming, and decentralizing whiteness, thus modeling and flexing the social work values of integrity in combination with social justice. white educators need to be comfortable in acknowledging their identity and positionality of privilege as well as disadvantage in setting the stage to recognize and make visible whiteness, among other identities. shame, embarrassment, or concern of being recognized as white and privileged is an exercise in futility; regardless of acknowledgement black students, as well as others forced into the margins, see whiteness. recognition and awareness instead can serve to model and teach meaningful actions from a position of privilege, specifically that of becoming a social worker and committing to decentralizing privilege, in exchange for a move to the margins, expanding them in comparison to a center stage (rogers, 2019). just practice framework remember, this is not new. some 17 years ago finn and jacobson (2003) identified the need for a new social work paradigm, shifting away from previous theoretical perspectives and recognizing the need for a just practice framework in which the authors identified the need for engaging and evaluating social work practice through five key themes: meaning, context, power, history, and possibility (finn & jacobson, 2003, pp. 6973). utilizing the just practice themes, social work practice moves away from an acceptance of the systems (oppressive) as they exist to an acknowledgment of the historical developments, exclusions, and influences that have shaped social work practice. in addition, the practice moves toward acknowledging the importance of shaping what social work can and will look like in each collaboration with a client system (finn & jacobson, 2003, pp. 69-73), be it to dismantle the child welfare system (dettlaff et al. 2020), or to reinvent the role, responsibility, and engagement of social workers with police (miller, 2020a). donohue-dioh et al./woke disrupter 1057 as mentioned previously, authors androff and mcpherson (2014) offer a human rights framework as an approach to bringing together micro and macro practice arenas. the authors accurately recognize and acknowledge human rights are individual and universal, protecting the rights of every person and nations carrying out this responsibility (androff & mcpherson, 2014). this framework is complementary to the implementation of a just practice framework. even with two monumental concepts, just practice and human rights, there must still be action, and social workers need specific skills to take action. social work practice skills are often micro focused and like the narrative above illustrates, students are left feeling unsure of how those skills translate into social justice action. now do better so how is it done? first, social work must recognize the uniqueness of our work and the implications of accepting a person-in-environment (pie) perspective supported by ecological systems theories (kirst-ashman & hull, 2018) – implications which require a shift in understanding practice arenas. if social work is to truly operate at the nexus of individuals, their environment, concentric and overlapping systems, then social work must teach skills which resonate in similar application. social work must teach social justice meta-practice skills. social workers cannot back down from their commitment to integrity and that requires an uncomfortable look at the allegiances, actions, and attitudes of white social workers. using a just practice framework, white social workers must re-envision the doing of social work (finn & jacobson, 2003). social work is unique in that practice skills include those applicable to micro, mezzo and macro level practice. however, as stated in the aforementioned discussion, this approach is problematic in that all too often social work education is overly focused on micro level skills, without an explicit connection to social justice, leading to social work practice which perpetuates and maintains oppressive systems. within a just practice framework, we posit a reconceptualization of social justice as more than a value, perspective, concept, or macro level skill of advocacy. social justice is a meta-level practice skill. central to social work is empowerment, and critical to social justice is recognition of power structures and oppression. meta-practice “emphasizes collaboration, connection and (w)holism, proposing an exposition of ‘power’ as primarily an exponential process (power with/within) rather than a linear/hierarchical” (grise-owens et al., 2014, p. 51). meta-practice is beyond the micro, mezzo and macro delineations of practice and yet is an “inter-locking whole” all of these practice arenas. meta-practice is so uniquely captured with the original words of the authors, “relevant practice requires that social workers not merely understand micro-, macroand mezzo-practice….the profession of social work can engage the ‘and’ that both connects and overarches our traditional understandings of practice” (grise-owens et al. 2014, p. 51). accepting social justice as a meta-practice skill that requires teaching, role playing, recording, critique, development, and enhancement over time positions all students advances in social work, summer 2021, 21(2/3) 1058 interested in all levels of social work to engage social justice in a purposeful and intentional practice. in this way, social work curricula reinforce skill development in a meaningful way, particularly related to competencies of diversity and difference and social justice (cswe, 2015). it is of particular importance to recognize that while social justice is taught in accredited programs throughout the country, most often social justice equates to the activity of advocacy or activism on the macro level, an important and necessary role. it can be argued that those are the skills of social justice. this manuscript need not negate that position to affirm the position taken here of identifying social justice as a meta-practice skill. anti-racist social justice skills in education recognize that no, not all students need the same lessons, and yet all graduates must be capable of the same skills. social justice skills uphold the identities of all people, while simultaneously moving privilege into the margins by decentralizing whiteness. social justice skills include restructuring an intake form to remove boxes of race and ethnicity, encouraging clients to self-identify. application of social justice skills is recognizing and saying out loud the privilege and power that you hold in a client collaboration, creating space for the client (system) to also speak freely to power and privilege in their journey with you. social justice skills are advocating for the removal of “competence” in discussions of culture and diversity. social justice skills are critiquing interventions and research with intention to move away from a binary lens of good and bad which inherently centralizes whiteness. social justice skills create space for clients to recognize their freedom and work towards claiming their freedom. social justice skills are liberatory in meta-practice. beyond careful social work has known for a long time that we need to do better; social work has known for decades the harm and the potential for harm that exists in the current structures of social systems of all sorts. it is not necessary to reinvent the wheel. in the aforementioned writings the social work value of integrity has been mentioned more than once. again, this value of integrity is of the utmost importance for engaging social justice work. this will likely be difficult for many white social workers. white social workers cannot collapse into the state of white fragility feeling victimized, overwhelmed, and embarrassed for their history and role in maintaining anti-black racism and oppressive systems (diangelo, 2018). social workers know their uniqueness in being able to engage the most difficult work this world has to offer. let us not stop with the work being our client collaborations and partnerships. as a white social worker, the most difficult work you have to engage in is also your work to confront social injustice and move forward in ownership of your role, complacency and/or ignorance. now, today, when you read this, you know better. the desire to do good is no longer enough, nor should it have ever been. with social work projected to be one of the fastest growing professions, now is the time (u.s. bureau of labor statistics, 2019). social workers must implement change and accept change! yes, social work needs the radicals, the non-conformists, and those who simply want to reposition their privilege. whether these are new students or the practitioners and academics with knowledge and wisdom of many years past, come out and show up to disrupt the trajectory of the social work woke vigilante. donohue-dioh et al./woke disrupter 1059 woke disrupter there is no shortage of terminology when identifying the role of white social workers in anti-racism work; ally, co-conspirator, saboteur, race traitor, accomplice and many more (anderson & hill, 2020). social work will be faced with an absolute soul-shaking encounter and the subsequent ripping out of toxic anti-black racist and white supremacist roots. it will be and must be uncomfortable. it is only through being pushed to the “learning edge” that comfort of the known can no longer protect us from learning that which is necessary (miller & garran, 2017, p. 8). social workers have never shied away from a difficult job, the work has always been heavy. in a time when black communities engaging with social workers have been so unjustly, unlawfully, and inhumanely traumatized, social workers have an obligation to commit to the hard work of removing themselves as contributors and maintainers of white supremacy. social work must disrupt the profession from the inside out and from the outside back in. social work must show a willingness to own and acknowledge the depth of harm and destruction social work has committed against black clients, communities and colleagues, by a dismissal of the whiteness within the profession. this. is. integrity. social workers must commit to the development of meta-level social justice practice skills and stop relegating social justice to the confines of macro practice. social justice skills are meta-practice skills and must show up in all places where social work happens. skills can be taught, practiced, learned, and expanded upon. social justice is an ideal and it is achievable when we reconceptualize it as an action. after all, “[social] justice is a verb” (miller, 2020b, 2020c). in embracing social justice meta-practice skills, white social workers must also embrace their necessary role as woke disrupters. white social workers cannot stand on the backs of their black colleagues, black clients, and black communities allowing them to carry the weight. woke disrupters must be willing to step forward and dismantle the profession, taking responsibility for the role and benefit white supremacy has afforded them. and in establishing a new paradigm for social justice work (finn & jacobson, 2003), woke disrupters must remain committed to hearing, supporting, and following the direction of black social workers, students, clients, and communities. conclusion social workers have power – it is a collective power to transform the profession. white social workers must embrace the role of a woke disrupter. white social workers must own and sit in the discomfort, acknowledging their role in perpetuating white supremacy and anti-black racism. social workers must embrace social justice meta-practice skills outside of the macro arena, recognizing the arbitrary eurocentric confines that have neatly organized boxes and delineated levels of practice. the time has come for the tables to turn. black people have lived and died in discomfort and trepidation. no, every white social worker does not commit racist acts, and yet every white person is part of a racist system protecting their very skin. white social workers have a responsibility to examine and change those systems most accessible to them, certainly that includes the very profession advances in social work, summer 2021, 21(2/3) 1060 to which they belong. woke disrupters must apply gate-keeping skills like never before to address those white social 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(1963). malcolm x speech. digital history id 3619. digital history 2021. https://www.digitalhistory.uh.edu/disp_textbook.cfm?smtid=3&psid=3619 author note: address correspondence to jessica donohue-dioh, phd, lcsw at the university of houston-downtown, jdonohuedioh@gmail.com acknowledgement: thank you to chey davis for agreeing to read this manuscript prior to submitting for peer review. https://www.cswe.org/centers-initiatives/initiatives/national-workforce-initiative/sw-workforce-book-final-11-08-2017.aspx https://www.cswe.org/centers-initiatives/initiatives/national-workforce-initiative/sw-workforce-book-final-11-08-2017.aspx https://www.cswe.org/centers-initiatives/initiatives/national-workforce-initiative/sw-workforce-book-final-11-08-2017.aspx https://www.socialworkpodcast.com/2020/07/socialworkpolicing.html https://www.facebook.com/swpodcast/videos/605407770084865 https://www.facebook.com/swpodcast/videos/682858909246575 https://www.youtube.com/watch?v=wa5zwkfhlca https://www.bls.gov/ooh/community-and-social-service/social-workers.htm https://www.cbsnews.com/news/naacp-sherrilyn-ifill-george-floyd-donald-trump-response-60-minutes-2020-06-07/ https://www.cbsnews.com/news/naacp-sherrilyn-ifill-george-floyd-donald-trump-response-60-minutes-2020-06-07/ https://www.digitalhistory.uh.edu/disp_textbook.cfm?smtid=3&psid=3619 mailto:jdonohuedioh@gmail.com ________ michelle d. garner, msw, phd, licsw, acsw, associate professor of social work, school of social work and criminal justice, university of washington tacoma, tacoma, wa. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 26-44, doi: 10.18060/24035 this work is licensed under a creative commons attribution 4.0 international license. dyslexia primer for social work: translational research to update strengths-based practice, advocacy, and attitudes michelle d. garner abstract: dyslexia is a lifelong epigenetic neurobiological difference (neurodiversity) in brain formation and processing. though highly prevalent, most people, including social workers, know little about dyslexia. whereas dyslexia predicts common cognitive strengths and weaknesses, it is most often associated only with weaknesses, due to misinformation or a simple lack of information. as a result, pervasive myths (e.g., laziness, low iq) drive beliefs, attitudes, and policies that contribute to disproportionally poorer educational, financial, justice system, and mental health outcomes for individuals with dyslexia – a cycle of externally and internally applied stigmas with significant practical effects. this analysis applies a person-in-environment conceptual framework to explain this cycle, as a step toward disrupting it. the analysis uses translational research methods, drawing from current science, to provide positive framing to dispel common stigmatizing myths and to foster strengths-based social work practice and advocacy by and for individuals with dyslexia. keywords: dyslexia, special education, disability, stigma, neurodiversity, translational research in 2016, national public radio (npr) aired a series on “unlocking dyslexia,” opening with a headline that captures an unsettling truth: “millions have dyslexia, few understand it” (emanuel, 2016). dyslexia affects millions of lives but remains poorly identified and understood by many of those affected – and by many professionals positioned to make a difference, including social workers. dyslexia, like other learning disabilities, historically has been siloed within the academic and professional purviews of medicine, education, and psychology. this compartmentalization has had the unintended consequence of limiting the dissemination of accurate knowledge and narrowing the framework within which dyslexia is understood and treated across modern life, from our educational and justice systems to the workplace and mass media. our culture perpetuates reductive and biased misconceptions of dyslexia, creating a vicious cycle of externally and internally applied harmful stigmas. this environment has produced disproportionately poorer outcomes for individuals with dyslexia. according to the diagnostic and statistical manual of mental disorders (dsm-5) of the american psychiatric association (apa, 2013), the functional consequences of specific learning disorders – dyslexia being the most prevalent – include disproportionally lower academic achievement, employment, and income, with disproportionally higher comorbidity of mental health challenges and suicidality. too often these outcomes are seen as a direct consequence of dyslexia rather than as a consequence of stigmatized interactions with an uniformed public. social work is uniquely positioned to address these misconceptions and promote positive outcomes through application of a person-in-environment (pie) approach and emphasis on strengths (council on social work education disability-competent care about:blank garner/dyslexia primer 27 curriculum workgroup [cswe], 2018). disability issues reside at the core of social justice, equity, and inclusion. by definition, “disability” describes how a person, because of inherent characteristics, is systematically challenged in (if not precluded from) physical, social, financial, or civic dimensions of life (cswe, 2018). disability falls on a continuum, and like other aspects of diverse identity characteristics that are too often linked to inequity and social injustice, the meaning and impacts of disability emerge from the interplay between a person and the environmental forces surrounding them, which can be either constricting or empowering (bean & kreck, 2012; cswe, 2018; nalavany et al., 2015). given social work’s tools, training, and values, we can and should intervene on behalf of this population, but are largely unprepared to do so. this article aims to bring light to this oversight within social work, applying translational research methods to bring knowledge from neurobiology and other academic/professional fields, to begin to build context and understanding for enhanced social work education and practice. this work is predicated upon, and illustrative of, the applicability of pie to dyslexia, illuminating how the environment creates disability (social model of disability, gilson & depoy, 2002), thus contributing to the profession’s general resources on disabilities. the analysis is intended to transfer knowledge across disciplinary silos to social work practitioners drawing from current science and relevant literature to eliminate the harms of myths and misinformation and to reframe dyslexia and its associated strengths. the latter is not only important for strengths-based social work direct practice, but is also key in micro-macro intervention, by and for individuals with dyslexia. this article, therefore, has implications for advancing micro through macro practice, social work education, and the “public realm” (ogilvie et al., 2009) of knowledge, attitudes, and practices regarding people with dyslexia. after stipulating the purpose and approach for the analysis, i discuss and analyze the current dyslexia landscape, signs, and interventions, laying out the negative person-inenvironment cycle. i then highlight a current shortcoming within social work, namely that while expertise on dyslexia is clearly indicated as integral to our practice, literature and educational resources are conspicuously sparse. finally, i employ translational research to highlight important knowledge generated by other professions which dispels many misconceptions about dyslexia and provides a foundation for a strengths-based approach. the paper concludes by highlighting existing multidisciplinary strengths-based research and advocacy that serves as an entry and launch point for social work. purpose and approach the purpose of this analysis is to improve opportunities and outcomes for individuals with dyslexia by sensitizing social work practitioners to available, evidence-based research literature and practices. the paper aims to educate caseworkers, counselors, and advocates about the need to provide strengths-based framing and support to those with dyslexia (influencing the mezzo-macro/environmental-level health pathway, see ogilvie et al., 2009). an intended result is that those with dyslexia, in turn, will be better empowered to locate resources and support, and to gain insight into their brain function as grounds for self-advocacy and self-esteem (influencing the micro/individual-level health pathway). a advances in social work, spring 2021, 21(1) 28 secondary purpose is to contribute to the social work profession’s disability practice literature and educational resources, more broadly. dyslexia is a striking case-study for illuminating the importance of a pie approach to any level of practice supporting those with disabilities. consistent with these purposes, the article highlights the urgent need for social work to enter the fray regarding dyslexia and other learning disabilities. while laboratory bench, medical, and psychoneurological knowledge bases on dyslexia will continue to grow, the biggest obstacles to better outcomes for those with dyslexia currently are societal attitudes, stigma, and entrenched systematic and differential detrimental norms and practices (shaywitz, 2017; shaywitz & shaywitz, 2020). these must be addressed with education and advocacy, and – along with the broader overarching commitment to eradicating intolerance and enhancing diversity and social justice – are tasks social workers are wellsuited to undertake. translational research is a useful, recent, multidisciplinary field that seeks to leverage disciplinary knowledge and methods by working across traditional knowledge silos in laboratory bench, social, and population sciences, to improve interventions and outcomes (austin, 2018), including mitigating implicit biases (van schalkwyk & harris, 2018). ogilvie et al. (2009) highlight that translational public health research encompasses the “public realm,” and the importance that media, culture, and public opinion have in improving health through individual and environmental pathways. others assert that the use of stories and persuasion in translational science can advance better policy (cairney & oliver, 2017). challenging pervasive myths with factual education is a common strategy to counter the stigmatization of specific identities, and based on analyses of the stigma associated with mental illness, can help to change the public’s stigmatizing attitudes (corrigan et al., 2012; national academies of sciences, engineering, & medicine, 2016). based on their survey data, nalavany et al. (2015) specifically argue that a supportive family who actively sees beyond the stigmatized identity can play a critical role in the selfesteem and well-being of those with dyslexia. a central claim of this paper is that translational research can itself serve as an intervention, and the sharing of knowledge drawn from other disciplines (dissemination as methods) is offered as an intervention. since attitudes and perceptions directly impact interpersonal interactions on micro-macro levels, translational research that corrects misinformation and improves and expands knowledge can be an intervention aimed at attitudinal change and empowerment outcomes (ogilvie et al., 2009). in the case of dyslexia, there is a clear need for targeted educational messaging to improve knowledge and thereby change attitudes and behaviors. a humanities lens may frame this work consciously as a performative act (butler, 2009) toward greater social justice in its direct challenge of pervasive and stigmatizing myths (corrigan et al., 2012; rössler, 2016). analysis and discussion dyslexia: the current landscape the environment for individuals with dyslexia is characterized by confusion and a garner/dyslexia primer 29 negative feedback loop of externallyand internally-applied stigmas and misinformation. dyslexia is commonly misunderstood or missed altogether. messaging reinforces cognitive deficiency, and well-intended solutions focus on weaknesses of dyslexic brain differences without acknowledging the related strengths. worse, because of a lack of appropriate knowledge, professionals often proceed unwittingly from misconceptions, interpreting dyslexic traits as character flaws or innate inadequacies (e.g., laziness, low intelligence, poor eye function). this reality should raise alarm and serve as a call to action for social workers, as they are likely among professionals most likely to encounter unidentified dyslexia across contexts (including education drop-outs, mental health, unemployed, and prison populations); social workers should be educated and trained to disrupt the cycle. current prevailing definitions of dyslexia identify it as a biological learning disability and identify neurobiological deficiencies that correlate with poor learning performance. the dsm-5 folds dyslexia within the descriptive text of specific learning disorders (rather than as a disorder itself), within the broader chapter on neurodevelopmental disorders (apa, 2013). according to the dsm-5, 5-15% of school-aged children across cultures have a specific learning disorder, summarized as persistent deficits in accurate or efficient ability to perceive or process input, despite adequate instruction, which should be characterized by severity level (mild, moderate or severe). the dsm states that while specific learning disorders are lifelong, the clinical course is influenced by “the task demands of the environment, the range and severity of the individual’s learning difficulties, and the individual’s learning abilities, comorbidity, and the available support systems and intervention” (apa, 2013, p. 73). the dsm-5 cites risk factors of low birthweight, prenatal nicotine exposure, and heritable genetics, while social or emotional support can be protective for mental health (apa, 2013). the international dyslexia association (ida) noted in 2002 that dyslexia involves “a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction,” (para. 1) and identified secondary consequences that “may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge,” (para. 1). the british dyslexia association (n.d.) observes that “[i]n reality, dyslexia can affect memory, organization, time-keeping, concentration, multi-tasking and communication. all impact on everyday life” (para. 1). while patterns among dyslexia emerge, each individual is different, and a person’s abilities and challenges fall on continuums (shaywitz & shaywitz, 2020). while it is assumed that dyslexia is underdiagnosed, and complete information is unavailable (horowitz et al., 2017), experts believe that 5-17% of the population experience dyslexia (ozernov-palchik et al., 2016). it has been estimated that about 4% of the population has severe dyslexia (british dyslexia association, 2015) and about 2-5% of the population is both intellectually gifted and dyslexic, termed “twice exceptional” or “2e” (ida & gilger, 2013, para. 1). despite definitions that technically identify dyslexia as brain variance, dyslexia is culturally stigmatized as a mental deficiency and/or character flaw. survey data from the national center for learning disabilities (ncld) indicate some “43% of parents say that advances in social work, spring 2021, 21(1) 30 they wouldn’t want others to know if their child had a learning disability” (horowitz et al., 2017, p. 1). and, in a national survey administered to a representative sample of 1,000 u.s. adults, 80% of the general public equated learning disabilities with intellectual disability (cortiella & horowitz, 2014), despite clearly-established refuting evidence (tanaka et al., 2011). among those surveyed, that belief was held by 81% of teachers (cortiella & horowitz, 2014) and 58% of school administrators. fifty-one percent of all respondents attributed learning disabilities to laziness, and 55% of respondents to ncld’s survey believed learning disabilities could be corrected with glasses (cortiella & horowitz, 2014). lack of self-awareness compounds these misconceptions. even as a majority of educators and administrators negatively misinterpret dyslexia and other learning disabilities, a majority also regard themselves as appropriately trained to serve these populations: 80% of educators felt competent to teach those with a learning disability (cortiella & horowitz, 2014). in describing her in-depth qualitative research on the academic identity development of youth with social and learning disabilities, baines (2014) observed: they were singled out as different. while this social positioning was often unintentional, these everyday interactions communicated low expectations, restricted opportunities, and revealed academic stereotypes, contributing to the damage to their sense of self…these practices, which often are taken for granted as a natural part of schooling, confront students with discouraging and stigmatizing messages about their intelligence, impacting their identities in the long term. in particular, it is the unconscious nature of these practices and the ways they are reproduced by teachers and students themselves that is most harmful to youth. (pp. 2-3) baines also highlights a disconnect between academic awareness and educational application: even though conversations about the harms of children being dubbed “lazy” or “unmotivated” occur at academic conferences, such understanding fails to alter classroom norms. fassett and morella (2008) illuminate parallel problems facing those with dyslexia in higher education, addressing the conundrums of navigating “coming out” (p. 147) as dyslexic within a “culture of suspicion” (p. 142), wherein one’s capabilities, needs, and rights to participation are questioned and (dis)ability is constructed as a stigmatized binary of abled or disabled. there is clearly a disconnect between contemporary evidence-based understanding of dyslexia, the learning needs of persons with dyslexia, and the public’s and general educators’ understanding of dyslexia. people with dyslexia directly suffer the multifaceted consequences of these misconceptions, though the toll ultimately extends throughout society (sherman, 2004). unfortunately, this disconnect results in frequent dismissal and misinterpretations of signs of dyslexia, resulting in delayed, inadequate, or wholly absent interventions. the next section discusses current data on signs and interventions. subsequent sections highlight and explain relevant, contemporary, evidence-based information (translational research) and strengths-based approaches which, once adopted, can improve outcomes. garner/dyslexia primer 31 signs and interventions manifestations of developmental dyslexia in youth include issues in recognizing letters, words, and rhymes; inability to connect letters with sounds or phonemes; slow and inaccurate reading, word finding, word recall; and problems with spelling, organization, and written expression (eide & eide, 2011; nichd, 2018b). the yale center for dyslexia & creativity (2017a) explains that, in addition to impacting reading, dyslexia is a difficulty appreciating the individual sounds in spoken language. it affects a person’s ability to rapidly retrieve the word he or she wants to say, to isolate the sounds within a spoken word and then to attach the appropriate letter to the sound. (p. 1) many individuals with dyslexia have poor working memory, manifesting in difficulty with executive function tasks such as following directions, organization, sequencing, planning, and timing (ida & berg, 2019). because dyslexia is a “glitch within the language system, at the level of the phonological module,” (p. 51) individuals with dyslexia are challenged in segmenting out the phonemes of words, resulting in errors in reading or generating spoken or written language (e.g., “humanity” for “humility; shaywtiz & shaywitz, 2020). dyslexia is characterized by a “spiky” psychometric profile (stein, 2017, p. 318), meaning the group is defined by marked peaks and troughs in performance across measures. individuals with dyslexia may become identified through scholastic failures, or they may do well compared to peers, based on extraordinary effort and compensation (apa, 2013). there is considerably less research on the manifestations, impacts, and needs of adults with dyslexia (frith, 2013) who run the gamut of compensating and doing well to chronically struggling. because of practice trends, older adults are less likely than those born more recently to have been diagnosed with dyslexia. even those who have been diagnosed may be reluctant, because of shame and prior related trauma, to disclose such a diagnosis. moody (2014) suggests that adults with dyslexia may read slowly, but struggle most with phonology, working memory, and visual processing; they may present to a primary care provider with work stress, “low self-esteem, lack of confidence, feeling of shame and embarrassment, inability to study or work efficiently, panic at the thought of going to the office, poor concentration, memory lapses, periods of going blank in a conversations, and difficulty relating to people” (p. 252). the national institute of child health and human development (nichd, 2018a) recommends that adults manage their dyslexia through self-advocacy, assuring supportive environments, and leveraging assistive technology. the knowledge gaps and misconceptions have created a poor environment for individuals with dyslexia, where defeating stigmas are imposed and reinforced while strengths are overlooked. as a result, dyslexia is correlated with poor outcomes and consequences across lifespans (apa, 2013). for example, it is estimated that nearly half (49%) of those in prison have dyslexia (moody et al., 2000). people with learning disabilities are more likely to drop out of school, be underor unemployed (apa, 2013), live in poverty, and have trouble with the law (cortiella & horowitz, 2014). individuals advances in social work, spring 2021, 21(1) 32 with dyslexia are six times more likely than their peers to experience physical child abuse (fuller-thomson & hooper, 2015). they disproportionately experience psychological distress, have poorer mental health (predominantly depression, anxiety, suicidality), and frequently have co-occurring additional neurodevelopmental disorders (e.g., other learning disabilities, adhd, autism; apa, 2013; ijeoma & ugwu, 2019). based on decades of research at the yale center for dyslexia and creativity lab, shaywitz and shaywitz (2020) assert “it is rare to see a dyslexic who doesn’t also have anxiety or, for that matter, adhd” (p. 419). dyslexia is highly associated with stigma and shame (leitão et al., 2017; nalavany et al., 2015; shaywitz & shaywitz, 2020). because it is brain-based, mental illness tends to be internalized, or generalized as identity (rössler, 2016). this is also true for dyslexics. while dyslexia is life-long and cannot be cured, early interventions in instruction, supports, and self-advocacy can ameliorate the personal and societal toll (haft et al., 2016; sherman, 2004). early recognition and intervention with evidence-based reading instruction, accommodations and/or modifications, and support for positive self-esteem and mental health can alter the primary and secondary impacts of dyslexia (haft et al., 2016; nichd office of communications & miller, 2017). as a starting place, the ncld (2020b) has created an all-ages, online symptom screening checklist. there are junctures when the brain may be more plastic, and best outcomes take advantage of these, but evidence suggests the underlying dyslexic brain organization remains atypical across the lifespan, even with well-timed intervention (danelli et al., 2017; shaywitz & shaywitz, 2020). receiving an appropriate diagnosis of dyslexia and sharing information about its true nature is therapeutic for many, and necessary for building self-advocacy and self-esteem (shaywitz & shaywitz, 2020). early and documented intervention for potential learning issues is important to leverage windows of neuroplasticity, gain effective compensatory instruction, and access rightful and life-altering aids and legal protections (afforded in the united states, through the individuals with disabilities education act (idea, 2004), section 504 of the rehabilitation act of 1973, or the americans with disabilities act of 1990 amendments act of 2008). typical school and work accommodations for dyslexia would include: extra time (to compensate for the additional neurological steps), assistive technology (hardware and software that aids with reading, note-taking, organizing writing, and spelling), and modifications (e.g., customized expectations, processes, or environments; alternative content or testing, altered job duties, and adjusted schedules or work space; ida & white, 2018; u.s. equal employment opportunity commission, n.d.). however, such intervention is happening neither systematically nor uniformly. according to shaywitz and shaywitz (2020) “our knowledge gap is closing; the frustrating news is that it has been replaced by an action gap – that is, we, especially schools and policymakers, are behind in translating the existing scientific progress into policy and practice” (p. 86). stated differently, there is a “research-practice gap,” (mallonee et al., 2006, p. 357), or an “evidence-practice gap” (kristensen et al., 2016, p. 1). in other words, knowledge about dyslexia exists but currently is missed or underutilized in training, practice, and policy. garner/dyslexia primer 33 implications for social work the brain variances associated with dyslexia produce significant strengths and upsides, some of which are particularly well-suited for modern world challenges but are ignored or misconstrued, and thus are under-valued and under-developed within the current negative cycle. for example, it is now clear that dyslexia is a language-reading issue, not a thinking impairment, and shaywtiz and shaywitz (2020) effectively argue that specificity about dyslexia, rather than using the broader “specific learning disability,” is important for proper understanding and micro-macro interventions. dyslexia is a prime example of disability born of pie interplay, a framing promoted by the cswe disabilities workgroup (cswe, 2018, p. 4). social workers should empower individuals experiencing disability while also improving formal and informal social systems for better inclusivity, health, and social justice and equity outcomes. modern culture, which requires visual reading and writing for participation and competency, is generally inhospitable to the physical neurobiological characteristics of individuals with dyslexia, for whom these tasks are challenging and resource-intensive, if not impossible. the person with dyslexia is not inherently flawed; they are simply at a disadvantage in meeting the select but privileged expectations of their environments. a person with dyslexia may be functionally disabled because of their environment. yet, social work research and education has largely overlooked dyslexia, despite the facts that learning disabilities are among the most prevalent of disabilities (nichd office of communications & miller, 2017) and that people with dyslexia are more likely to have intersections leading to clinical, agency, or governmental involvement. social work literature reflects a dearth of material on dyslexia, indicating an important knowledge gap among social workers. a keyword search of “dyslexia” in the social work and social service abstracts databases on november 10, 2019, produced only 31 unique results within the discipline’s primary literature. prevalence statistics and correlations suggest social workers frequently encounter people with dyslexia in all practice settings. dyslexia assessment should be a common element of direct practice, given the widely acknowledged concerns within other professional literatures about the prevalence, inaccurate diagnosis, intervention of dyslexia and dire outcomes, and comorbidities common to individuals with dyslexia. an obvious recommendation is that direct practitioners should consider that dyslexia may be a primary or secondary factor in a client’s presenting issues. there is a recognized general lack of training within the social work profession about competency with disabilities, and by extension, a deficit within the ranks of practicing social workers. analysis of courses being offered by the 2008 u.s. news and world report’s top-25 social work programs found that 20% of these programs had no courses in which disability content appeared in either the course title or description (bean & kreck, 2012). disability content was limited in virtually all programs, appearing in the description of only 5% of the courses surveyed, and in only 1% of the titles of the 1,620 courses reviewed. while disability content should be assessed and enhanced within institutional practices and implicit social work curricula (kim & sellmaier, 2019), the cswe advances in social work, spring 2021, 21(1) 34 disabilities workgroup highlights the imperative for more literature and educational resources, framed using pie, if social workers are to become competent with disability in their practice (cswe, 2018). finally, irrespective of practice setting, sound social work praxis demands that practitioners work to advance social justice through reflexively checking their own biases and behaviors, and fostering similar work among individuals, communities, organizations, and cultures (garner, 2011). dyslexia translational research: what is known translational research provides useful knowledge for social workers. while professional and academic literature tends to pathologize dyslexic traits, research and advocacy from different corners have illuminated a more nuanced, balanced understanding of dyslexia that should be drawn upon. for example, educational neuroscience has contributed significantly to creating a knowledge base that dispels common misconceptions about dyslexia (ida et al., 2014; ncld, 2020a). educational neuroscience emerged in the 1990s to join speech and language therapists, cognitive psychologists, special education specialists, and other allied professionals in striving to understand and intervene with this population. neuroscience, which studies the anatomy, physiology, and mechanics of the brain, has helped clarify and concretize specific attributes of dyslexia. in neurobiological terms, dyslexia is a heritable (epigenetic) condition marked by alterations in brain organization and processing that impacts reading (caverzasi et al., 2018; ozernov-palchik et al., 2016). dyslexia functions independently of intelligence quotient (ferrer et al., 2010; tanaka et al., 2011) or eyesight (handler et al., 2011). for the typical reader, written and audial words trigger the same regions of the brain, thus words and their symbols become overlaid and synonymous, which is conducive to fluent and automatic word comprehension. conversely, the dyslexic brain employs different brain regions to process written and audial language; thus, reading and writing involve more structures, time, and purposeful effort – in short, more resources (shaywitz & shaywitz, 2020). dyslexia is a language-based disorder, believed to have multiepigenetic etiology (i.e., varying risk factors and causes) that result in structural and functional uniquenesses (nichd office of communications & miller, 2017). preverbal infants of those with dyslexia show an atypical brain activation on eegs (molfese, 2000), strongly suggesting an innate, organic manifestation of neurodiversity. based on brain imaging of distance and density of modular cortical circuitry found in those with the conditions, some experts are putting dyslexia and autism spectrum disorder on opposite sides of a bell-curve continuum (williams & casanova, 2009). it is estimated that one in five people may have some degree of dyslexic style brain organization and function (shaywitz & shaywitz, 2020), although prevalence estimates are impacted by characteristics of primary language, definitional variation, and diagnostic challenges (dyslexia international, 2018). dr. sally shaywitz’s (2003) groundbreaking work, the “sea of strengths model of dyslexia,” describes the higher order cognitive abilities that commonly occur in some mix alongside the cognitive profile weaknesses associated with dyslexia. dyslexic thinkers tend to be top-down, rather than bottom-up thinkers (thus big-picture and non-linear). those garner/dyslexia primer 35 with dyslexia tend to excel in holistic understanding and aptitude in “reasoning, problem solving, concept formation, comprehension, critical thinking, general knowledge, and vocabulary” (shaywitz, 2003, p. 58).the yale center for dyslexia and creativity (2017b) advocates that “while those with dyslexia are slow readers, they also, paradoxically, are often very fast and creative thinkers…we should recognize and embrace those with dyslexia as often among the most intelligent and creative members of society” (pp. 2-3). indeed, according to survey results, roughly 35% of successful entrepreneurs are dyslexic (logan, 2009), as are some of the most brilliant and successful people (according to ida, 2019: thomas edison, stephen spielberg, f. scott fitzgerald and charles schwab; according to made by dyslexia, 2019: agatha christie, jamie oliver, richard branson, albert einstein, alexander graham bell, henry ford, and the wright brothers). toward a strengths-based perspective of dyslexia the cswe disabilities workgroup (2018) suggests pie balances support and empowerment of the individual experiencing disability alongside efforts to alter social determinants of health (such as collective of attitudes, behaviors, and policies). applied to dyslexia, an individual with dyslexia is not inherently flawed because they have variances in abilities, but they might be quite disabled because of rigid and narrow demands of their environment. the impact of being dyslexic is a function of not only the individual’s unique profile, but of the social (e.g., attitudes, biases) and structural (e.g., school, work and civic policies; characteristics of their surrounding language) environment in which they are located. dominant american culture privileges legacy, reified roots of education such as visual reading, writing and arithmetic, which disproportionately tax dyslexic brain resources and underutilize dyslexic strengths. just as adverse effects of dyslexia vary by specific language, dyslexic brains have comparative advantages within cultures where oral storytelling, physical navigating, or analogy are of core value and importance and hence, culturally privileged. the fact that the struggle and disability of dyslexia, on a population basis, is correlated to characteristics and orthography of a given language (dyslexia international, 2018) – meaning a given individual with dyslexia would be more or less challenged based on their mother tongue – establishes that at the most base level, dyslexia is a disability because of pie context. applying a pie approach in education and practice means that steps toward mediating or eradicating the experience of disability also fall across the micro-macro spectrum (inclusive of changes on an individual level through collectively held attitudes, behaviors, and policies). thus, consistent with translational research and the cswe disabilities workgroup premise, this present analysis is also a consciously-performed act aimed at expanding knowledge, and thereby altering general beliefs, attitudes, and stigma about dyslexia and environmental dimensions of disability more broadly. toward that end, there are existing movements, discrete knowledge bases, and examples of strengths-based approaches, highlighted below, that social workers can draw upon both to inform their own micro-macro practice with those with dyslexia and, more generally, as a basis for competent social work with people experiencing other disabilities. advances in social work, spring 2021, 21(1) 36 the concept of neurodiversity is an accurate and powerful reframe of the current pathologized concept of dyslexia. a social movement which emerged in the late 1980s, neurodiversity asserts that biodiversity of neurological development is normal and valuable within a population (sherman, 2004). neurodiversity challenges the deficit, pathologized conceptual model that constructs those deemed not normal (neurodivergent versus neurotypical) as flawed, and in need of fixing, cure, or prevention (nicolaidis, 2012). the neurodiversity social movement affirms the complexity of cognitive strengths and challenges a person might possess, and positions neurodiversity alongside equity and social justice issues related to gender, race, ethnicity, and sexual orientation (nicolaidis, 2012; robertson, 2010). physicians brock and fernette eide, dyslexia specialists, marshalled their research and clinical expertise to provide an evidenceand strengths-based framework that helps illuminate dyslexia for a general audience. eide and eide (2011) propose the organization and anatomy of a dyslexic brain are wired for broad, lateral thinking and have strengths that come with cognitive trade-offs. their 2011 book, the dyslexic advantage, develops an understanding of dyslexia as a “pattern of brain organization and processing that supports wider thinking and cognitive gains, in direct trade-off of fine-detail processing” (p. 171). eide and eide present the synthesis of aptitudes characteristic of dyslexics as “dyslexic m-i-n-d strengths” (see table 1). dyslexic mind strengths is a powerful summation of corresponding dyslexia strengths and weaknesses that can be an essential starting point for social work education and practice. there also have been fruitful contributions from advocacy and outreach entities to distill and conceptualize dyslexia in ways that emphasize strengths and disrupt common misconceptions. for example, “made by dyslexia” is a global british charity led by and for individuals with dyslexia that provides an articulation and framing of common strengths. a 2017 made by dyslexia public education campaign parses dyslexic strengths within the areas of: “visualising: moving, making, and inventing; imagining: creating and interpreting; communicating: explaining and storytelling; reasoning: simplifying, analysing, deciding, and visioning; connecting: understanding-self, understanding-others, influencing and empathizing; exploring: leaning, digging, energizing, and doing,” (emphasis added, made by dyslexia & griggs, 2017, p. 12). this compilation echoes the contributions of shaywitz (2003) and eide and eide (2011) and highlights the inquisitive and social nature of many individuals with dyslexia. made by dyslexia’s framework also helps differentiate dyslexic characteristics from other neurological and developmental disabilities in that dyslexics often have strong social skills. another example comes from select universities. the university of michigan’s (petrova, 2019) student support services lists ten dyslexic strengths: “strong memory for stories, excellent puzzle-solving skills, brilliant spatial reasoning, great conversationalists, tremendous empathizers, wonderfully imaginative, abstract thinkers, think[ing] outside the box, critical thinkers, and astutely analyze[ing] stories told or read to them.” stanford university’s student affairs website (n.d.) affirms that: “rather than try to change the way individuals with learning disabilities learn, we are beginning to change environments so that all individuals can learn […] to adopt a strengths-based model that embraces the whole person” (para. 5). garner/dyslexia primer 37 table 1. m-i-n-d strengths and their corresponding trade-offs* dyslexic-style brain strength strength manifested corresponding trade-off material reasoning (m): “threedimensional, visual, spatial, & navigational abilities.” • important in fields such as engineering, surgery, art, & it. • creativity, particularly in understanding of movement, shape, & force. • may compete for brain regions supporting language processing. • expressive difficulties manifested as slow responses, symbol reversals, & subtle language challenges. interconnected reasoning (i): recognizing relationships, shifting perspectives/disciplinary lens, & global thinking. • important in fields such as medicine, software design, acting, & invention. • broad, “creative, perceptive, interdisciplinary, & recombinatory thinking.” • recognition of patterns, relationships among concepts & content, & the gist or synthesis among & across things. • challenges in quick, accurate, & efficient fine-detail processing used in decoding & encoding written language or in declarative memory. • challenges in narrowing & linearizing thinking to allow other to follow train of thought. • challenges in organization of physical files. narrative reasoning (n): personal, “episodic memory, storytelling, & scene creation” • important in fields such as teaching, counseling, politics, sales, & writing. • learning, recall, reasoning & expression focused on a specific, scene-based instance (i.e., thinking in stories). • wired to note differences from the norm or to observe lessobvious connections among things. • may not function as well with fact-nugget processing of semantic memory, which is prioritized in the current education system. dynamic reasoning (d): an intuitive sense of complex systems & an ability to retain & manipulate discrete episodic simulation to anticipate real-world circumstances—a combination of “i” & n” strengths. • important in fields such as economics, organizational leadership, farming, policy, & business. • wired to track the gestalt, while retaining discrete known & unknown variables to identify a best fit. • iterative, circular default neuro network processes that occur outside consciousness & generate leaps of insight rather than systematically linear reasoning. • same trade-offs as “i” & “n” strengths. • in addition, d strengths are fostered by a relaxed mental & emotional state, but inhibited by focused, purposeful effort & pressure. • may appear like daydreaming to some. • may prove elusive on the spot or require backward reconstruction of a linear path for communication to certain audiences. *table adapted from eide, dyslexic mind strengths [poster], 2019 and eide & eide, 2011. advances in social work, spring 2021, 21(1) 38 another contribution to normalizing dyslexic neurodiversity, and showcasing dyslexic strengths, comes from a 2018 ernst and young study (commissioned by made by dyslexia), which concluded that hard-wired strengths common among dyslexics make them particularly well-adapted to meet the demands of the evolving workforce. ernst and young (2018) analyzed and mapped the world economic forum’s (2016) 35 core workrelated skills onto the survey-based identified strengths common among dyslexia. the report concludes that, amid increasing job demands for “flexible skills in a highly collaborative and interdisciplinary environment,” individuals with dyslexia have “much to offer but are still a largely untapped and misunderstood talent pool” (p. 5). specifically, the report concludes that people with dyslexia can offer alternative perspectives and creative problem-solving, frequently performing as: “exceptional: visualization, creativity, cognitive flexibility, active learning; very strong: logical reasoning, systems analysis, complex problem solving, written expression, programming; [and] strong: problem sensitivity, active listening, technology and user experiences design” (punctuation added to original bi-level bullet-point list, p. 26). a harvard business review article (austin & pisano, 2017) lauds neurodiversity as a “competitive advantage,” integral in innovation, and now actively sought among many premier companies such as microsoft, hewlett packard, and ibm. as reflected in these examples, the enhanced circuitry of a brain with dyslexic variance makes it strongly suited for a number of high-level mental tasks, even if it is not optimized for written language tasks. of course, each individual is unique; however, there are patterns of strengths among those with dyslexia which could and should provide the basis of selfesteem, coping, and advocacy skill-building. further, understanding and normalizing dyslexic strengths can be used by professionals and allies to inform empowerment practice and advocacy. conclusions this analysis employed translational research methods to illuminate dyslexia to accomplish multiple ends. a main goal is to educate and sensitize social work practitioners for evidenceand strengths-based practice with people with dyslexia. it is also hoped that this article become a resource useful as a basis for advocacy, understanding, and destigmatization of dyslexia among those with dyslexia, their family members, and citizens of conscience. ideally, this work will galvanize greater attention and further research on dyslexia within social work and strengthen the training and practice of social workers among those experiencing any disability. 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(2009). autism and dyslexia: a spectrum of cognitive styles as defined by minicolumnar morphometry. medical hypotheses, 74, 59-62. https://doi.org/10.1016/j.mehy.2009.08.003 world economic forum. (2016). the future of jobs, employment, skills and workforce strategy for the fourth industrial revolution (ref 010116; global challenge insight report). http://www3.weforum.org/docs/wef_future_of_jobs.pdf yale dyslexia. (2017a). speaking with one voice: a guide to talking about dyslexia (pp. 1-4). yale center for dyslexia & creativity. http://dyslexia.yale.edu/wpcontent/uploads/2017/07/ycdc-guide-to-talking-about-dyslexia_final032017.pdf yale dyslexia. (2017b). what is dyslexia? the yale center for dyslexia & creativity. http://dyslexia.yale.edu/dyslexia/what-is-dyslexia/ author note: address correspondence to michelle garner, school of social work & criminal justice, university of washington tacoma, 1900 commerce st, tacoma, wa 98402. email: mdgarner@uw.edu acknowledgements: this paper has greatly benefited from thoughtful contributions of two anonymous reviewers, journal editors, and editing by suzanne garner. you all have my appreciation for improving this work. https://doi.org/10.1080/23273798.2017.1325509 https://doi.org/10.1177/0956797611419521 https://www.eeoc.gov/facts/ada18.html https://www.eeoc.gov/facts/ada18.html https://doi.org/10.1177/0141076817735692 https://doi.org/10.1016/j.mehy.2009.08.003 http://www3.weforum.org/docs/wef_future_of_jobs.pdf http://dyslexia.yale.edu/wp-content/uploads/2017/07/ycdc-guide-to-talking-about-dyslexia_final032017.pdf http://dyslexia.yale.edu/wp-content/uploads/2017/07/ycdc-guide-to-talking-about-dyslexia_final032017.pdf http://dyslexia.yale.edu/dyslexia/what-is-dyslexia/ mailto:mdgarner@uw.edu _________ lisa werkmeister rozas, phd, lcsw, associate professor, and milagros marrero-johnson, msw, director of strategic programming, university of connecticut school of social work, hartford, ct. tracy davis, msw, director-academy for workforce development, connecticut department of children and families, hartford, ct. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 499-516, doi: 10.18060/24973 this work is licensed under a creative commons attribution 4.0 international license. educating bilingual social workers for the child welfare workforce: a distributive justice approach lisa werkmeister rozas milagros marrero-johnson tracy davis abstract: spanish/english bilingual (seb) speaking social workers are in high demand, particularly in the area of child welfare. most require training and institutional support to increase their cultural and linguistic competence, yet the majority receive no specific education or support. as a result, many encounter inequities in the workforce. research points to several elements that are essential to the education and development of seb social workers. they include professional terminology, supervision in spanish, and the opportunity to integrate theory and practice. to respond to the needs of a growing spanishspeaking population, the uconn bsw program has added a child welfare and protection (cwp) track. cwp is designed to provide bsw seb speaking students with specialized knowledge and experience to meet the needs of latinx families served by the connecticut department of children and families (ct dcf). this paper describes how the uconn bsw program and dcf collaborated to re-envision social work education for seb students and contribute to distributive justice for client and worker. the cwp track prepares bsw students to work with a range of spanish-speaking clients while facilitating institutional support including incentives to create a much-needed workforce pipeline for seb social work students interested in child welfare. keywords: social work education, spanish-english bilingual, distributive justice, equity, child welfare according to the 2020 united states census bureau (2021), in the past decade, the latinx population has increased from 16% to 18% maintaining their place as the largest non-white racial/ethnic group in the us. the black/african american population comprised 12% of the population and whites 61% of the population (u.s. census bureau, 2021). yet the children’s bureau office of the administration for children and families (acf) reports that of the 407,493 children in foster care, 22% are latinx, 23% are black, and 43% are white (u.s. department of health and human services [us dhhs], 2021). this overrepresentation of black and latinx families in the child welfare system is not new and the mechanisms that contribute to such disparities are not all the same (miller et al., 2012). both populations are affected by racial bias and discrimination imposed by professionals (dettlaff & rycraft, 2008). for latinx families their disparate numbers in the child welfare system are also indicative of the social forces that disproportionately affect latinx families, such as poverty, health inequities, mental health issues, language barriers, and stressors related to immigration status (cardoso et al., 2014; garcia et al., 2012; olcón & gulbas, 2021). when it comes to meeting the needs of the latinx population in the child welfare system, the social work workforce is not prepared, particularly around issues of language (ayón, 2011; sevilla et al., 2018). salsberg et al. (2017) estimate that less than about:blank werkmeister rozas et al./educating bilingual swkers 500 10% of masters level social workers in the workforce are latinx. not included in this assessment is the number of social workers who are spanish-speaking. for spanishspeaking clients seeking treatment in their preferred language, the lack of spanish/english bilingual (seb) social workers impacts client outcomes (ayón, 2011; gonzalez et al., 2015; marrs fuchsel, 2015) as well as workforce equity (lanesskog et al., 2015; logan, 2018). many seb social workers experience additional demands and challenges or have added workloads when working with spanish-speaking clients yet are not appropriately compensated (engstrom et al., 2009; garcia et al., 2012; lanesskog et al., 2015; olcón & gulbas, 2021; wall et al., 2016). this article will assess the disparate treatment and expectations of seb social workers from their english-speaking colleagues. the term latinx and hispanic are used interchangeably depending on the context and source of the information provided. although in academic settings latinx is widely used, the client population discussed here are more likely to use the term latino/a. using rawl’s (1971) concept of distributive justice it will also introduce an initiative created to address the service needs of spanish-speaking children and families in order to reduce the inequities that exist institutionally for both latinx clients and seb social workers. since nearly 40% of social work activity comprises work with individuals and families (salsberg et al., 2017), there is good reason for child welfare agencies to be concerned about how to best meet the linguistic and cultural needs of the latinx population through added education, training, and workforce equity. the difficulties latinx families face in the child welfare system are not always related to general accessibility but to accessing ethical and equitable services (thomas et al., 2010). therefore, it is incumbent on social work programs to appropriately train social workers, not only in the general nine competencies required by cswe, but in linguistic and cultural competencies essential to providing ethical service. while the disparities facing latinx families need to be addressed, what can not be ignored are the inequities that exist for the latinx social workers who service these families. by addressing important gaps in social work education, training, and awareness, the goal of this initiative is for latinx families to receive and seb social workers to provide ethical, and socially equitable services. the focus of this article will primarily be on seb social workers who are what lewelling and peyton (1999) call heritage spanish speakers. heritage spanish speakers are those who grew up in the us, educated in the us and learned to speak spanish as a result of their parents, friends, or other spanish-speaking relatives. heritage spanish speakers face the unique challenge of being educated and trained in one language (english) for most or all of their life but use another language (spanish) in the workplace. an initiative created by the uconn school of social work and the state of connecticut department of children and families (dcf) was developed to address issues of equity for seb social workers and their spanish-speaking clients. the educational program facilitates the development of skills specific to culture, language use, and professional identity germane to seb social workers, while highlighting the cultural, linguistic and social justice issues present when working with a latinx population. advances in social work, summer 2022, 22(2) 501 literature review latinx children and families in the child welfare system within the last decade the latinx population has grown by 23% in the us (jones et al., 2021). nationally, latinx children constituted 26% of the u.s. child population, with 22% of children in foster care being latinx (us dhhs, 2021). of the children in connecticut’s foster care system, the administration on children, youth and families, children’s bureau (afcars) reports that 33.6% are latinx, 32.8% are white, and 24.9% are black (us dhhs, n.d.). although this is a snapshot of children in foster care, it indicates that latinx families in connecticut are overrepresented in this area of the child welfare system. these data do not indicate the number of latinx children and families that are spanish-speaking; however, according to the us census bureau (2019a) 13.5% of u.s. latinx households are spanish-speaking and 12.5% are limited english proficient, or lep (us census bureau, 2019b). in addition to social workers needing spanish language proficiency to effectively serve lep families, research indicates that understanding a client’s culture can be vital to ethical service delivery, particularly since the majority of child welfare systems follow a western individualistic model (templeman & mitchell, 2002; miller & gaston, 2003). as a result, it is incumbent upon social workers to assure the ethical and equitable treatment of latinx families and children through language accessibility and culturally informed treatment that meets the needs of these families. in order for this to occur, more seb social workers must enter the workforce. however, research suggests that seb social workers providing services to latinx families have differential work experiences than their monolingual english-speaking colleagues (engstrom et al., 2009; garcia et al., 2012; logan, 2018). for example, engstrom et al. (2009) found that many seb social workers report higher rates of fatigue due to working in two languages as well as having to spend more time with their lep clients. on paper, even though seb social workers are expected to maintain a caseload equal to that of their englishspeaking colleagues, in practice, seb social workers report having higher caseloads and added responsibilities (bok, 2005; engstrom & min, 2004; garcia et al., 2012; lanesskog et al., 2015; olcón & gulbas, 2021; wall et al., 2016). even when caseloads are equal in number, the workload is far from equitable due to the increased time required as well as the psychological, cognitive, and physical burden (olcón & gulbas, 2021). this invisible and unacknowledged burden does a disservice to both client and worker (logan, 2018; olcón & gulbas, 2021). working with lep families often requires the seb social workers to take on demands and responsibilities that are not required of their monolingual english-speaking colleagues (engstrom & min, 2004; garcia et al., 2012; olcón & gulbas, 2021). such tasks might include, providing in-depth information not only about the child welfare system but other systems such as immigration or social welfare services, translating documents not available in spanish, and translating for non-spanish-speaking staff when a translator is not available (engstrom et al., 2009; engstrom & min, 2004; garcia et al., 2012; logan, 2018). these time consuming tasks may or may not be related to the issue that brought the family to the child welfare system but regardless, seb social workers complete them without extra werkmeister rozas et al./educating bilingual swkers 502 compensation because they understand that they may be the only one available to provide these services in spanish to their lep clients (lanesskog et al., 2020; logan, 2018). distributive justice the basic tenet of distributive justice puts forth that all members of society are afforded the same rights, protections, opportunities, obligations, and social benefits to increase one’s chances in life (rawls, 1971). wakefield (1988) demonstrates how social work’s primary tasks centered around people’s “social functioning” and “linking people and resources,” intuitively follows the principles of distributive justice (p. 209). distributive justice concerns itself with how primary goods that are necessary for members of society to live, are distributed. the two types of primary goods are natural and social (rawls, 1971). natural goods pertain to health and intelligence and can exemplify differences between people and often fall outside the auspices of distributive justice. social goods reflect aspects of society that encompass issues of liberty, power, opportunity, economic needs, and self-respect (rawls, 1971). the aspect of distributive justice which refers to the manner in which “economic and social goods and services are distributed in a society” (longres & scanlon, 2001, p. 448) is particularly important when examining the delivery of social services to clients and the equitable treatment of its workers because it is likely to have an effect on client outcomes (gonzalez et al., 2015; marrs fuchsel, 2015; wakefield, 1988). currently, in our child welfare system, both latinx service providers and latinx service users are experiencing systemic barriers to important services, limiting their opportunity and power and enabling inequities and unfairness (engstrom et al., 2009; garcia et al., 2012; logan, 2018). the need for a distributive justice lens when it comes to servicing lep families in child protection/welfare is two-fold. first, as mentioned above, spanish-speaking families deserve to receive treatment in the language of choice. research has been conducted on the advantage of speaking in one’s preferred language when it comes to emotions, experiences, engagement and therapeutic alliance (gonzalez et al., 2015; lanesskog et al., 2020; marrs fuchsel, 2015; sevilla et al., 2018; verdinelli & biever, 2009b). second, due to the increase of lep children and families in need of services, there are insufficient seb social workers to meet this need (gonzalez et al., 2015; lanesskog et al., 2020; marrs fuchsel, 2015; verdinelli & biever, 2009b) often resulting in inequitable work demands (engstrom & min, 2004; lanesskog et al., 2020; verdinelli & biever, 2009b). this puts an undue strain on seb social workers who often begin their work without any specialized education or training around language use. issues such as translating terminology or clinical concepts learned in english as well as understanding the impact on code switching (changing from one language to the other) has on client/worker relationship and worker’s use of the bilingual self, are specialized skills not taught in most social work programs (biever et al., 2002; engstrom et al., 2009; liu, 2013; oliva, 2019). the execution of social work is integral to the workings of socio-political aspects of society, which includes cooperation among its members and the ability for social workers to enhance selfrespect, esteem, confidence and knowledge (wakefield, 1988) to those they serve. where this is particularly important is when members of society are underadvances in social work, summer 2022, 22(2) 503 valued and subjected to unfair and discriminatory treatment based on their race, ethnicity, legal status, or linguistic ability (garran et al., 2021a, 2021b). the notion of fairness must go beyond everyone having access to the same services; particularly since very few services models have been created to meet the needs of a spanish-speaking population (ayón, 2011). in this case, fairness must include quality services that align with ethical treatment through the equitable distribution of social goods (miller & gaston, 2003; olcón & gulbas, 2021; templeman & mitchell, 2002). language and social work education most social work programs in the us do not prepare seb social workers to work with lep clients (lanesskog et al., 2020; olcón & gulbas, 2021). courses are taught in english, reading materials are in english, assignments are expected to be turned in in english, and simulations or role plays that occur in class are in english (sevilla et al., 2018). this gives seb social workers little opportunity to hone their spanish language skills while learning the profession which could increase their efficiency (lanesskog et al., 2020; olcón & gulbas, 2021; sevilla et al., 2018; verdinelli & biever, 2000b). just as english-speaking social workers have the opportunity to practice their clinical engagement skills in their own language and language they will be using in their work, so should seb social workers who will be using spanish in their work. in any profession, part of the education is learning and practicing the terminology in the classroom and experiential settings. addressing this from the perspective of the just distribution of social goods can help in developing educational opportunities that address the unmet needs of seb social workers in delivering services. the social work profession acknowledges its commitment to providing services in languages other than english. the national association of social workers (nasw, 2015) statement on cultural competence standard 9 language and communication, asserts “it is the responsibility of both social workers and organizations to provide services in each client’s preferred language” (p. 45), but does not expand on how to deliver such services. to accomplish this, social workers can turn to the two amendments in the 2021 nasw code of ethics that relate to seb social workers and their clients within the context of distributive justice. the first appears under the ethical principle of “social workers behave in a trustworthy manner” which acknowledges that a part of ethical practice includes personal and professional self-care (nasw, 2021, para. 15). olcón and gulbas (2021) found that providing seb social workers with stress management and coping skills in efforts to enhance self-care is not enough, which implies that this ethical standard which refers to professional self-care is not being upheld. therefore, for the profession to be able to equip seb social workers with the capacity to abide by this ethical standard it must facilitate seb social workers to receive education and training in spanish as it provides them with skills that are needed to prevent fatigue and burnout (olcón & gulbas, 2021). the second is located under 1.05 cultural competence which is a subsection of ethical standards. this standard requires social workers to “take action against oppression, racism, discrimination and inequities” (nasw, 2021, para. 17). providing services to lep children and families without the capacity to practice self-care can prevent seb social workers from providing their clients with services of the best quality. this potential inequity in service quality as well as inequities in the workforce exemplify the ethical responsibilities of the werkmeister rozas et al./educating bilingual swkers 504 profession and social work educators to ensure the needs of seb social workers are met. at the same time seb social workers have an ethical obligation to advocate on behalf of their clients and the profession. they must challenge the education and training they currently receive and explain how this neglected aspect of their education has real consequences for providing equitable care to lep children and families in the child welfare system. cultural and linguistic competency there are several elements to cultural and linguistic competency in addition to understanding the language, different values, and cultural practices. dettlaff et al. (2009) explain the importance of being knowledgeable about acculturation and generational differences. researchers highlight the importance of understanding cultural historic and contemporary narratives and experiences of systemic and interpersonal discrimination (garcia et al., 2012; huang et al., 2011). knowing how to speak the spanish language is but one aspect of linguistic competence. varying degrees of fluency in reading, writing, and speaking can make a difference in whether or not families are receiving all they need. recognizing the various meanings codified in different spanish words based on a person’s ethnicity or country of origin is important, as not all words have the same meaning and not all meanings are expressed using the same spanish word (oliva, 2019). in most instances, seb students have obtained their elementary and secondary education from english dominant institutions (sevilla et al., 2018). during the course of their education, seb students not only have to learn the content being taught but also attempt to understand how certain concepts or techniques can be delivered in spanish. additionally, their educational experience is often compounded by the lack of economic and social resources (schneider et al., 2006). these initial disparities disadvantage latinx students and frequently derive from their parent’s immigration status, socioeconomic factors, and their lack of familiarity with the united states education system (schneider et al., 2006). latinos are not a monolithic ethnic group. traditions, beliefs, and language can differ among ethnicities, enough to cause confusion and disruptions in the work. first and secondgeneration latinos can have different points of reference for everything from gender roles to familial expectations. research shows that just speaking spanish with lep clients is not enough to ensure a client-worker alliance to develop (marrs fuchsel, 2015). seb social workers are in need of training and institutional support to increase their cultural and linguistic competence. there are myriad dynamics that reside within the latinx population. contemporary and historic tensions between countries, economic differences, citizen and immigration status can affect the seb social worker lep client relationship. also, simply by being a seb social worker does not guarantee they will have knowledge of all issues facing the various latinx ethnic groups (lanesskog et al., 2020). one area that is important in any social worker’s practice is supervision. among other things, supervision provides social workers with a place to reflect on their practice and discuss ways to improve their skills. there is strong evidence illustrating the importance of supervision being held in the same language that was being used in the treatment setting advances in social work, summer 2022, 22(2) 505 (lanesskog et al., 2020; sevilla et al., 2018; verdinelli & biever, 2009a). research suggests that the majority of their seb participants felt that they needed further training to help with fluency in conversation, the acquisition of particular vocabulary that was specific to the clinical context, and the application of theoretical concepts to their work (lanesskog et al., 2020; sevilla et al., 2018). from a distributive justice standpoint, seb social workers have the same obligations to their clients as english-speaking social workers and should be provided the same opportunities and resources. service delivery seb social workers are well aware that there are not enough resources to service the spanish-speaking population (engstrom et al., 2009; olcón & gulbas, 2021). the workload issues experienced by seb providers often result in high turnover and burnout in child welfare services (barbee & antle, 2011; engstrom et al., 2009; engstrom & min, 2004; garcia et al., 2012; logan, 2018), interrupting continuity of care. aware of the demand, not only do seb social workers often agree to increase their caseload because of the need, they do so without added compensation or adjustments to other work-related responsibilities (lanesskog et al., 2015; olcón & gulbas, 2021; wall et al., 2016). knowing that their clients often wait longer for referrals because of the lack of spanishspeaking providers, seb workers often continue to engage with them until they are connected to another provider (engstrom et al., 2009; olcón & gulbas, 2021). examining these differential work demands from a distributive justice perspective, the issue of workload equity extends beyond having a larger caseload. as mentioned above, as a result of limited resources and inadequate support available to seb social workers, leb clients take more time and attention (olcón & gulbas, 2021). when seb social workers need to refer their clients to other agencies or services and are unable to locate a spanishspeaking worker for these services, seb social workers often spend more time researching other possible referrals, while still working with these clients until an appropriate referral can be found. seb social workers also spend time discussing cultural differences and simple systems, such as education, taxes, utility bills, often translating documents for them in the process (engstrom et al., 2009; olcón & gulbas, 2021). they also are frequently asked to translate for other colleagues who may have brief or limited contact with a spanish-speaking client, often educating them about latinx socio-political-cultural issues as well (engstrom et al., 2009; lanesskog et al., 2020; logan, 2018; olcón & gulbas, 2021; verdinelli & biever, 2009a). although most seb social workers have little difficulty in acquiring employment, job satisfaction is often a challenge as many feel the amount of specific language skill, extra labor, and minimal support is tiring (engstrom et al., 2009; lanesskog et al., 2020; logan, 2018; olcón & gulbas, 2021). when seb workers want to advance to a higher position, particularly one where they may not have a caseload, they are often not selected for the position because their language ability is essential to the agency’s direct services (engstrom & min, 2004). seb social workers also do not receive the appropriate professional development and training that must be ongoing (lanesskog et al., 2020; verdinelli & biever, 2009a). having a bilingual supervisor is not a luxury but a necessity werkmeister rozas et al./educating bilingual swkers 506 for seb workers to be able to process everything from abstract dimensions of language to how they may see themselves differently when working with a spanishvs. englishspeaking client (lanesskog et al., 2020; sevilla et al., 2018; verdinelli & biever, 2009b). from a distributive justice perspective, seb social workers should be afforded the same protections from these factors that influence their burnout and high turnover. overview of child welfare and protection track in an attempt to respond to the needs of an ever-growing spanish-speaking population in child welfare settings, the uconn school of social work and the connecticut dcf collaborated on an initiative formed to specifically address the lack of much-needed linguistic and culturally competent spanish-speaking social workers in the workforce. the child welfare and protection (cwp) track was designed to holistically prepare seb baccalaureate social work students interested in child welfare and protection services. uconn’s long-standing relationship with dcf allowed the evolution of this program to develop swiftly and will serve as a pipeline for its bsw interested students to join the child welfare workforce upon graduation. the goals of the program are 1) increase student’s interest and knowledge in child welfare and child protection 2) provide a foundational understanding of the skills needed to engage, assess, and secure services that will meet the needs of spanish-speaking families, and 3) increase student’s interest in pursuing a career at dcf. the uconn school of social work and connecticut’s department of children and families partnership extends across several years. the partnership is sustained by sharing mutual values centered around the importance of promoting the educational goals of students and employees who are vested in expanding their knowledge base of child welfare and child protection services. the sharing of this educational value has benefited both institutions and the people they serve. the connecticut dcf is similarly situated with other child protection agencies across the nation with respect to the rate of children of color entering the system at a disproportionate rate compared to their white counterparts. currently, hispanic children represent 31% of the population of children who are placed in care by the agency (connecticut dcf results oriented management, 2021). in addition, the hispanic families currently receiving services from the agency represent 29% of the total population of families who receive services from dcf (connecticut dcf mindshare, 2021). these numbers, although lower in comparison to the black/african american population, are evidence of the disproportionality that remains to date for families and children involved in connecticut's child welfare system. it is also important to note that latinx children often remain in the system longer and have a delay in the achievement of permanency (connecticut dcf mindshare, 2021). although the data sets at any given point in time can and do fluctuate, this does not negate the need to address the presence of disproportionality amongst the families and children of color, specifically the latinx population. the connecticut dcf has been steadfast in its desire to ensure equity for all involved in the system seeking to improve safety, permanency, and well-being for all children. this initiative was created as a way to enhance equity for its spanish-speaking population. advances in social work, summer 2022, 22(2) 507 in order to combat the rate of disproportionality and disparate treatment families of color face upon referral and acquisition of services, the agency has a decade long commitment, evidenced through its mission and goal, to becoming a racially just organization (connecticut dcf, 2022). as cited in the report on the connecticut dcf (2020) racial justice data, activities and strategies legislation was codified in 2018 to exemplify the value and importance of such work. all facets, from policy development, practice guides, supervision, engagement skills, assessments and hiring practices, are viewed from a racial and distributive justice lens. from a dcf organizational development standpoint, attention to equity issues around service delivery was embedded in a statewide group, composed of members from varying levels within the organization and community partners. the work was segmented into the following areas: policy/practice, workforce development, and contracts and services. the concepts from these areas are then promulgated with local racial justice groups within the area offices, divisions and facilities of the department. newly hired social workers, social worker trainees and interns are exposed to the work via various workforce development opportunities in the form of training. each training opportunity requires staff to delve deeper into a contextualized level of self-reflection in relation to recognition of their internalized implicit bias. the workforce development opportunities provide a clearer understanding of oppression, poverty, the underpinnings of historical trauma, and the ambiguity felt by families of color when mandated to receive services from a child protection service agency. staff are called upon to examine more thoroughly the correlation of their assessments with the disparate treatment of children and families entering the system. in addition to the professional development opportunities, leaders within the agency are charged with developing racial justice change initiatives. each change initiative includes delineated strategies that will guide staff in lessening the rate of disproportionality and disparate treatment experienced by families and children of color. the cwp track is one of these initiatives. the success of this and other initiatives will be measured from a qualitative and quantitative lens in order to capture the changes from a micro and macro perspective from the vantage point of the agency. professional education professional education comprises not only the formal classroom education students receive in the school of social work and wider university, but field education and ongoing professional mentorship are crucial to students’ identity as social workers. addressing each aspect of a student’s educational experience is a part of ensuring culturally competent, ethical, and equitable practice. program model given that the majority of latinx social work students are educated in english (sevilla et al., 2018), in order to ensure an equitable educational opportunity for seb social work students, the same social goods known to enhance professional outcomes for englishspeaking social work students must be available to seb students. consequently, the bsw cwp track was developed with distributive justice in mind. the bsw cwp track is a werkmeister rozas et al./educating bilingual swkers 508 voluntary option and is open to students in junior standing. student participants are required to fulfill the obligations of this non-credit bearing program in addition to completing other course requirements including a senior field placement at dcf. students also have the option of petitioning to have their work in this program count toward an independent study, satisfying one of their elective courses. upon successful completion of the spring and fall semesters, cwp students are awarded a financial stipend of $500. students who consider the cwp track as an option, should have an interest in child welfare, agree to participate in the program track series of eight sessions (spring-fallspring) and complete their senior year field internship at dcf. the commitment involves 17 hours of in person participation and up to five hours for preparation of their presentation. as part of the program criteria, students 1) must have the ability to speak spanish fluently fluent is defined as the ability to converse with another person in a language other than english on a variety of subjects without much strain; 2) have a minimum cumulative gpa of 2.7 and remain in good academic standing; 3) have junior standing with a minimum of 54 credits by the end of the semester of the application cycle; and 4) are required to meet uconn and dcf’s internship requirements. submission of application materials includes an application form, a transcript, current resume and a personal statement. recruitment for the program begins during the incoming student orientation and throughout the fall semester. in order to ensure students are fully informed about the program, uconn and dcf staff conduct an informational session. the program track series begins in the spring semester and includes an opening reception with the program participants and representatives of the uconn school of social work and dcf. the purpose of this reception is to underscore the importance of this initiative and how it aligns with the mission and goals of dcf as it pertains to racial justice and the school of social work’s commitment to social justice and equitable education. students are also given the opportunity to introduce themselves and share their background and interest as it relates to child welfare. subsequently, there are three additional sessions during their first spring semester 1) a focus on the history of child welfare and protection services and the role of the social work profession, 2) an overview of dcf as the largest child welfare organization in the state of connecticut and 3) an experiential shadowing of a dcf spanish-speaking social worker working with latinx families. the fall semester consists of 1) a session on understanding the latinx population connecticut’s demographics, diversity within the latinx population including culture, beliefs, values, as well as language challenges and 2) a session on understanding how dcf works within a cultural and linguistic competence and racial justice frame when serving latinx families. the end of the program concludes with an evaluation session and a celebration of the graduating cohort which includes a poster presentation session by cwp students. all these sessions are conducted by faculty/staff of the uconn school of social work or dcf. as the program grows, additional trainings on language skills and development; specific information on barriers to engagement due to issues of immigration and/or undocumented status; intergenerational barriers between parents/children and workers/clients; and reflection on their own positionality will be provided. advances in social work, summer 2022, 22(2) 509 particularly important to this program is exposing the students to the field. field education is the signature pedagogy of social work education (wayne et al., 2010). through the field education experience, students learn how to apply theory to practice under the guidance and supervision of an experienced professional social worker. in developing the program model, the shadowing of a dcf latinx social worker and completion of a one-year field internship at dcf are considered integral and valuable components of the students’ learning. the shadowing opportunity will aim to prepare the students for the year-long internship. the full day experience will consist of an overview of the agency, its mission and guiding principles, along with the demographics of their assigned office. students will be afforded the opportunity to shadow spanish-speaking workers to gain an understanding of their role and responsibility as a department social worker. during this interaction, they will have the opportunity to participate in various case management activities associated with current spanish-speaking families. these activities range from administrative case reviews, meetings with community providers, court appearances and home visits. this day-long opportunity serves as a prelude to the full internship consisting of 400 hours during the academic school year. during this time students will experience the breadth of child protection services ranging from investigations, in-home services, children in placement, to permanency. students will learn the importance of working with all families with a lens towards achieving racial equity. opportunities will be created for students to assume case management responsibilities for the spanish-speaking families with direct oversight provided by the assigned social worker and the spanish-speaking field intern supervisor. student assessment one of the challenges verdinelli and biever (2009b) found facing many of their seb participants is the difficulty applying theory into practice, particularly when their education occurred in english, and they are practicing in spanish. in an effort to respond to this, students in this program create a poster presentation to reflect their cumulative experience with the bsw child welfare and protection track program and how it impacted their personal and professional development as a social work student. the main components of the presentation include students highlighting two key areas: 1) integration of theory to practice and 2) how the use of self-reflection throughout their program contributed to their professional development. students need to demonstrate their learning of theory to practice by choosing two of the educational session topic areas: child welfare & protection services, dcf 101, experiential shadowing, understanding the latinx population and dcf’s racial justice framework. in addition to their coursework content the students will use their dcf field experience to highlight the linkage between what they have learned and how it was applied to working with latinx families. students also need to demonstrate how self-reflecting on child welfare practice with latinx families, and the significance of language, culture, values, and beliefs in working with latinx families influenced their professional development. as part of this process, students also describe their most memorable experience and how it influenced their personal and professional development as a seb social worker. students then integrate supporting sources, demonstrate their creativity and conduct a professional presentation. students are werkmeister rozas et al./educating bilingual swkers 510 asked to present in spanish as well as in english. the students are assessed on four key elements 1) their ability to identify theories that guided their practice; 2) the ability to complete a bio-psycho-social-cultural assessment of a client; 3) the ability to self-reflect on the influence that language had on their practice and 4) their ability to reflect on their professional identity as a seb social worker. program evaluation as the child welfare and protection track program becomes fully operational, the challenge will be deciphering the impact the experience has on the identified students and the long-term effects. it is not sufficient to simply provide the students with training and shadowing opportunities. the key is to determine ways in which they are able to capitalize on their experiences to make a difference in the lives of the lep families with whom they engage. student retention rates along with an evaluation of their work in the program will be used to assess the progress of the program. the students will be asked to complete a survey at the end of each semester while in the field, which will assess their knowledge and skill acquisition when working with lep families. they will also be asked questions about their own professional identity as an seb social worker and learning experience. this experience of observation and practice provides students the opportunity to apply their knowledge, skills, values, and spanish language to their work with latinx families. by doing so, they continue to develop strategies to culturally and linguistically meet the needs of these families that often go underserved due to the lack of seb social workers represented within the child welfare system. to ensure the goals of the cwp track are being met, ongoing program evaluation will be conducted to assess the various stages of the program’s development to determine its efficacy. a total of three anonymous surveys are disseminated throughout the program at the conclusion of the first spring semester, the subsequent fall semester and the final spring semester. the first survey assesses the application process and communication, the informational sessions conducted by social work faculty and dcf staff, and the experiential shadowing of dcf social workers assisting latinx families. these areas assess the increase in knowledge of topic areas, the amount of information presented and length of sessions, the role of social workers in child welfare and protection services, the benefits of the shadowing experience and overall semester participation. the second survey is distributed after the fall semester to assess the informational sessions conducted by social work faculty and dcf staff and the dcf field experience which includes areas such as utilizing engagement skills in spanish to work with latinx families and working from a racial justice framework. the third survey is distributed in the last semester of the spring to assess the continuation of the field experience and the overall cwp track experience since students began the program. as the students complete the program a follow up fourth survey will be administered six months post bsw graduation to identify employment and workforce readiness in serving latinx families. after the completion of each cwp track cohort, an analysis of program outcomes provided by the various assessments and evaluations mentioned above will be conducted. this information will be used to determine the achievement and sustainability of the advances in social work, summer 2022, 22(2) 511 program goals and program modifications will be made accordingly. ongoing evaluation will continue to allow for continuing feedback of the cwp track to ensure the programs goals are being met and demonstrate the program’s progress toward the ultimate goal of increasing workforce readiness for seb social workers. with the next cohort the program will look to adapt the existing scale, promoting cultural and linguistic competency self-assessment checklist for personnel providing health care services (pclc; goode, 2009), which measures cultural and linguistic competence. the measure comprises a 41 item scale with three subscales: the physical environment which measures the degree to which the agency environment is reflective of the clients’ cultures; the communication style measuring the worker’s cultural and linguistic competence in communication practices, which measures the use of materials in the client’s language, use of translation; and the values and attitudes, which measures acceptance of differing viewpoints on health practices, family, gender roles, etc. this would be a pre/posttest survey which would be given before the students begin the program and at the end of the program. another area for consideration would be the collection of qualitative data through focus groups and interviews, which would focus on the students’ experience with supervision and overall usefulness of the various program components. findings from these pilot tests would provide useful information on which aspects of the program might need to be enhanced. implications for social work educators and child welfare practice addressing the need for latinx children and families to receive services in their preferred language and the workforce disparities that exist for seb social workers due to their invisible and extra labor are crucial to the ethical treatment of lep latinx families. seb social work students have the right to be equitably trained to work with the spanishspeaking population as well as to advocate for employers to recognize the added time spent with lep clients. applying the distributive justice lens uncovers the inequity that exists in the education of seb social workers as well as in the workforce. seb social workers should be afforded the same primary social goods necessary for linking lep families to resources and aiding in their social functioning. without the same opportunities to attain the necessary social goods seb social workers will continue to experience discrimination and exploitation. at the same time, this inequitable distribution of work among social work professionals disproportionately negatively affects lep families. knowing that latinx children and families are overrepresented in the child welfare system and have disparate outcomes in comparison to their white counterparts (gonzalez et al., 2015; lanesskog et al., 2020; marrs fuchsel, 2015; sevilla et al., 2018; verdinelli & biever, 2009b), the social work profession must attempt innovative ways to address changes needed in seb social worker education. the ethical issues that have been raised regarding the provision of services to lep individuals and families need to be addressed in every social work program. offering educational opportunities that focus on the linguistic and cultural competencies of all seb social work students is a tool that enhances their professional education and thereby increases spanish-speaking individuals’ and families’ access to ethical and equitable werkmeister rozas et al./educating bilingual swkers 512 services. further research is needed to assess the particular elements of programs addressing cultural and linguistic competence to ascertain the aspects most conducive to providing ethical practice. from a child welfare practice perspective, the overrepresentation of latinx children in the child welfare system requires agencies to equitably and effectively recruit, hire and train prospective seb staff. as indicated, recruitment and training of seb social work students at the bsw and msw level is vital in order to expand the seb workforce. by having more culturally and linguistically competent seb social workers working in child welfare, lep client’s quality of care will improve as well as workforce equity for many seb social workers. innovative programs such as the cwp track places students with interest in the field on a trajectory for potentially sustaining a gratifying career in child protection services. child welfare/child protection service agencies must review their latinx demographics within their respective counties and states to determine the level to which their recruitment efforts will represent those families. statewide partnerships with local colleges and universities can serve as a valuable resource for recruiting prospective latinx employees. more research needs to be conducted to measure outcome differentials based on language provision because most assertions about better outcomes are vague. the literature that does exist states that lep individuals and families who have their services provided in spanish “adopt healthier practices” (marrs fuchsel, 2015, p. 252) and have better treatment outcomes (gonzalez et al., 2015; lanesskog et al., 2020; sevilla et al., 2018; verdinelli & biever 2009b) such as higher satisfaction and greater likelihood of following recommendations given by the provider (diamond et al., 2019). having had better training, seb social workers who are able to do their work more efficiently and effectively will be better prepared for the workforce and potentially be less susceptible to burnout (lanesskog et al., 2020; 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(2019a). american community survey 1-year estimates. language spoken at home (table id. s1601). http://dx.doi.org/10.1016/j.childyouth.2012.07.022 https://www.jstor.org/stable/45390120 https://www.socialworkers.org/about/ethics/code-of-ethics/highlighted-revisions-to-the-code-of-ethics https://www.socialworkers.org/about/ethics/code-of-ethics/highlighted-revisions-to-the-code-of-ethics https://www.socialworkers.org/linkclick.aspx?fileticket=7dvckzayumk%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=7dvckzayumk%3d&portalid=0 https://doi.org/10.1177/1473325020919804 https://doi.org/10.1080/15313204.2017.1384946 https://doi.org/10.4159/9780674042605 https://hsrc.himmelfarb.gwu.edu/sphhs_policy_workforce_facpubs/16 https://www.ncbi.nlm.nih.gov/books/nbk19909/ https://doi.org/10.1080/08841233.2018.1474839 https://www.jstor.org/stable/45390089 https://doi.org/10.1606/1044.3894.3975 werkmeister rozas et al./educating bilingual swkers 516 https://data.census.gov/cedsci/table?q=%22spanish%20at%20home%22&tid=acss t1y2019.s1601 us cb. (2019b). american community survey 1-year estimates. limited english speaking households. (table id. s1602). https://data.census.gov/cedsci/table?q=language%20spoken%20at%20home&tid=a csst1y2019.s1602 us cb. (2021). race and ethnicity in the united states. https://www.census.gov/library/visualizations/interactive/race-and-ethnicity-in-theunitd-state-2010-and-2020-census.html u.s. department of health and human services [us dhhs]. (2021). afcars report #28. administration on children, youth and families, children's bureau. https://www.acf.hhs.gov/cb/report/afcars-report-28 us dhhs. (n.d.). connecticut context data. race/ethnicity of children in foster care, ct. https://cwoutcomes.acf.hhs.gov/cwodatasite/pdf/connecticut.html verdinelli, s., & biever, j. l. (2009a). experiences of spanish/english bilingual supervisees. psychotherapy: theory, research, practice, training, 46(2), 158-170. https://doi.org/10.1037/a0016024 verdinelli, s., & biever, j. l. 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(2010). field education as the signature pedagogy of social work education. journal of social work education, 46(3), 327-339. https://doi.org/10.5175/jswe.2010.200900043 author note: address correspondence to lisa werkmeister rozas, university of connecticut school of social work, 38 prospect street hartford, ct 06103. email: lisa.werkmeister_rozas@uconn.edu https://data.census.gov/cedsci/table?q=%22spanish%20at%20home%22&tid=acsst1y2019.s1601 https://data.census.gov/cedsci/table?q=%22spanish%20at%20home%22&tid=acsst1y2019.s1601 https://data.census.gov/cedsci/table?q=language%20spoken%20at%20home&tid=acsst1y2019.s1602 https://data.census.gov/cedsci/table?q=language%20spoken%20at%20home&tid=acsst1y2019.s1602 https://www.census.gov/library/visualizations/interactive/race-and-ethnicity-in-the-unitd-state-2010-and-2020-census.html https://www.census.gov/library/visualizations/interactive/race-and-ethnicity-in-the-unitd-state-2010-and-2020-census.html https://www.acf.hhs.gov/cb/report/afcars-report-28 https://cwoutcomes.acf.hhs.gov/cwodatasite/pdf/connecticut.html https://doi.org/10.1037/a0016024 https://doi.org/10.1037/a0015111 https://doi.org/10.1086/644542 https://doi.org/10.1007/s10730-015-9266-8 https://doi.org/10.5175/jswe.2010.200900043 mailto:lisa.werkmeister_rozas@uconn.edu microsoft word 02_boateng_24196_accidental_opportunities _________ doris a. boateng, phd, senior lecturer, department of social work, university of ghana, legon, accra, ghana. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1083-1099, doi: 10.18060/24196 this work is licensed under a creative commons attribution 4.0 international license. accidental opportunities? women in family businesses taking the lead in a new market economy in accra, ghana doris a. boateng abstract: social workers have been working to empower women of diverse backgrounds across several practice settings. however, for women entrepreneurs in ghana generally and those in family businesses specifically, some socio-cultural factors have persisted to hinder their abilities to promote and sustain their businesses. this paper describes the ways in which women in family businesses in accra, ghana have identified and leveraged opportunities presented by structural, cultural, socio-economic, and technological changes to ensure the success of their businesses. the study employed a qualitative research approach with purposive and snowball sampling used to identify and interview 15 women in family businesses. findings indicate that women in family businesses in accra, ghana have creatively made use of the changing socio-cultural and economic landscape of the country to promote their businesses through three main trends which are significant in business growth: the advent and increasing use of social media, innovative business practices, and weakening patriarchy. we recommend that social workers apprise themselves of contexts which have unequal consequences for women and mobilize around these changes to help women entrepreneurs to take full advantage of the opportunities that are being offered in ghana’s emerging economy. keywords: family business, women, opportunities, success, new market economy, ghana family businesses have been on the increase in ghana since the early 1980s. defined as a business that is “owned, controlled and operated by members of a single family”, family businesses “undergird and sustain” many economies throughout the world (lerner & malach-pines, 2011, p. 113). from pre-colonial times through the struggle for independence in ghana, indigenous family businesses have been part of the country’s economic make-up. traditionally, family businesses in ghana have been male dominated, but women are increasingly entering into the space either by setting up their own businesses or through inheritance. as a result of the structural adjustment programs the nation embarked on in the 1970s and 1980s, dynamics for women’s participation in the emerging market economy have changed considerably (debrah, 2007; dzisi, 2008). family businesses have engaged the attention of scholars due to their peculiarity of straddling both the domains of family and business (payne, 2018). studies have focused on the contributions of small family businesses to national development (basco, 2015; mason & harrison, 2017), succession issues in family businesses (bozer et al., 2017; thurman & nason, 2016), and have mainly taken a business and marketing outlook (acquaah, 2016; amankwaa et al., 2016; cabrera & mauricio, 2017). there has been little attention from the field of social work or a social justice approach. as part of its quest for social justice for all people, social work is concerned with the economic empowerment of women in lower and poor socio-economic contexts (deka, advances in social work, fall 2021, 21(4) 1084 2012; lombard & twikirize, 2014). social workers have been working to empower women of diverse backgrounds across several practice settings. however, for women entrepreneurs in ghana generally and those in family businesses specifically, some socio-cultural factors have persisted to hinder their abilities to promote and sustain their businesses. in the larger socio-cultural framework of ghana, women entrepreneurs face challenges such as lack of control over resources including land and labor, which in turn limit their eligibility for loans to expand their businesses. this accounts for the largely unsuccessful empowerment interventions and persistent gender inequalities in the country, as most of such empowerment initiatives fail to address existing socio-cultural barriers and inequalities (ayentimi et al., 2020; britwum et al., 2019). when women are economically empowered, they are able to contribute equitably to the development of their communities, leading to sustained development of the entire economy of the country (dandona, 2015). seeking to proactively empower its women population will help ghana attain the fifth and eighth united nations (n.d.) sustainable development goals (sdgs, boateng, 2020). these goals seek to achieve gender equality and empower all women and girls and promote sustained, inclusive, and economic growth, full and productive employment, and decent work growth for all. currently, several opportunities are emerging for women entrepreneurs generally, which those in family businesses are also leveraging to promote and sustain their businesses. many opportunities have emerged on the ghanaian economic landscape, which were hitherto, either not available or accessible to women. however, due to the ingenuity of women entrepreneurs in family businesses, they have created spaces for themselves to flourish, break barriers, and overcome challenges to their personal and business benefits. keeping sight of the global attention and the opportunities present for women in family businesses, this article highlights the ways in which women entrepreneurs in family businesses in accra, ghana have identified and leveraged the opportunities presented in a new market economy to ensure the success of their businesses. the findings presented will aid in providing recommendations for taking critical steps to ensure that such opportunities are harnessed while systemic, socio-cultural, and institutional barriers are removed for women to thrive like their counterparts in other developed economies. family businesses in a new market economy women in small, family businesses extant literature on women in family businesses reflects an ongoing debate among scholars belonging to two schools of thought (bessière, 2014; cesaroni & sentuti, 2014; lerner et al., 2016). on one hand are those who believe that family businesses offer women opportunities that other businesses do not, while on the other are the scholars who have documented the many difficulties women endure in family businesses (lerner & malachpines, 2011). faraudello and songini (2018) reviewed the literature on women in family businesses and sought to develop a framework for discussing obstacles and opportunities for women in family businesses. they adopted martinez jimenez’ (2009) classification of glass ceiling boateng/accidental opportunities 1085     and women’s invisibility, emotional leadership, succession and primogeniture – where women are hardly thought of as candidates but rather the firstborn male child is preferred to succeed to leadership – as the main factors that prevent women from reaching important positions in family businesses. among these factors, glass ceilings and invisibility were considered the strongest obstacles. glass ceilings refer to the invisible and subtle barriers that prevent women from moving up in higher professional positions within organizations. in most instances, they apply to women and are used to keep them from advancing to higher levels based on their gender and not on their ability to handle higher level responsibilities (faraudello & songini, 2018). in family businesses, glass ceilings become a major barrier to women’s career advancement especially when there are male contenders for top positions. in addition to glass ceilings, women’s traditional gender roles as homemakers result in many of them being forced to devote more attention to the responsibilities connected to the family, while those connected to the business are addressed by a male counterpart within the family. these dynamics result in women’s invisibility in family businesses. women are also more likely to be ignored by non-family members who conduct business with the firm even if the woman is at the helm of affairs in the business (martinez jimenez, 2009). working in a family business thus means that women must contend with all the problems associated with the family as well as those associated with the business. danes et al. (2007) indicate that family businesses owned or managed by women earn less revenue than those owned by men, explaining that women and men tend to structure the interaction between work and family differently when they are running a family business. also, many women in family businesses have had to contend with conflicts and doubts about their own identities, competencies and what they believe are the expectations other members of the family have of them. women who work in family businesses are more likely to have the freedom to find and achieve personal fulfilment coupled with greater opportunities for career advancement than women who work in organizations that are not owned by their families (faraudello & songini, 2018). in an environment where women must work twice as hard before they can get the same recognition as men, working in a family business becomes the most fertile ground for career advancement and the attainment of success. until recently, female economic activities in the ghanaian setting did not attract academic, scholarly, or political attention, making them relatively invisible, unrecorded, and disregarded as marginal (langevang et al., 2015). however, there is now a growing recognition of the importance of women’s economic roles as they provide goods and services in addition to employment, financial, and social support for their families, communities, and the country at large (adom & asare-yeboa, 2016). women’s historical contributions to the anti-colonial struggles have been recorded and recognized. for instance, manuh (1991) reports that women traders and their associations organized and rallied to support dr. kwame nkrumah in the lead up to the country’s independence in 1957. to underscore the importance of the traders in the anti-colonial struggle and the success of nkrumah’s convention people’s party (cpp), it was argued that “in the struggle for independence, one market woman…was worth any dozen achimota graduates” advances in social work, fall 2021, 21(4) 1086 (manuh, 1991, p. 108). while women entrepreneurs have faced several challenges, they continue to be influential in ghana’s past, present, and future economy. ghana as a new market economy ghana became independent in 1957 and a republic in 1960. although relatively poor, the country is fast becoming a middle-income country with its rich natural resources, mineral deposits, and high economic prospects for businesses (debrah, 2002). however, like other african countries and similar to all emerging economies, ghana has inadequate market supporting institutions and weak enforcement capacity of regulatory and legal institutions in ghana (acquaah, 2007; adomako et al., 2020). this notwithstanding, the government of ghana has exhibited commitment to ensuring the growth and success of the economy through various legislative and policy frameworks and reforms that seek to promote the welfare of its citizens. new market economies are the “low-income, rapid-growth countries using economic liberalization as their primary engine of growth” (hoskisson et al., 2000, p. 249). they are characterized as undergoing accelerated economic development with policies that favor economic liberalization and the adoption of a free-market system. as one of the 10 fastestgrowing economies in the world with high prospects for export-driven growth, ghana is considered one of the emerging economies in africa (acquaah et al., 2008). amoako-adu and eshun (2018) argue that economic growth in africa will be enhanced by the expansion of small and medium-sized enterprises, most of which are sole proprietorships or family businesses. such businesses have been identified to have a significant impact on the growth of national economies through the generation of employment, productivity, and innovation (abor & biekpe, 2006). to date, there has been little focus on the role of women in contributing to this economic growth. as a result of trade liberalization, the removal or reduction of barriers and restrictions on the exchange of commodities between nations, many manufacturing firms find it easier to obtain raw materials and inputs for production, while there has been an increase in the demand for goods from western countries. in addition, “businesses have become more customer-friendly and competitor-focused, developing strategies to enhance product quality, relationships with customers and suppliers …in order to reduce operating costs, increase demand, and deal with the heightened competition in the domestic market” (acquaah, 2005, p. 209). beyond the institutional structures, there are also several socio-cultural factors that regulated the way businesses are operated in ghana, and which also tended to influence the formal ways of doing business. however, in recent times, ghanaian women entrepreneurs are setting trends in the entrepreneurial landscape by establishing businesses that were hitherto considered outside the domain of women (dzisi, 2008). for instance, many women are now seen to be operating in construction or auto mechanic businesses, a feat that would have been considered foreign or even impossible about ten years ago. women entrepreneurs in ghana are important parts of the economic fabric of the country. they create, manage, and ensure the sustainability of several innovations in the boateng/accidental opportunities 1087     form of small and medium-scale enterprises (amu, 2005). women in ghana are disproportionately concentrated in the informal sector in ghana where most are generally self-employed. their main activities in this sector are petty trading, food processing, and marketing food crops (prah, 1996). agyemang-duah and colleagues (2006) indicate that about 60 percent of women entrepreneurs in ghana are engaged in the informal sector in the areas of agriculture, manufacturing, and food processing. many ghanaian women tend to operate more traditional businesses with low potential for growth, such as food processing activities, handicrafts of various kinds, and dressmaking. most microenterprises owned by women are operated by one person with over 70 percent of such businesses operating with capital ranging from less than $100 to $1000 (amu, 2005). traditionally, due to the socio-cultural roles of women as homemakers, they are socialized from childhood to acquire entrepreneurial skills such as retail trading, food processing, and commerce (dzisi, 2008), as these would allow them to remain close to home. in addition, informal sector activities such as trading and farming were, in the past, left for people with little or no education. in recent times, however, women entrepreneurs have carved a niche for themselves within the sector through enterprise development, capital mobilization, and social networking (darkwah, 2007). many women entrepreneurs can contribute equitably to the education and health of their children and also to household incomes (amu, 2005). contrary to the characteristics of traders in the past, bowles (2013) notes that there are new emergent categories of entrepreneurs in ghana, […] businesswomen who successfully navigate international networks in ways that rely on hyper-mobilized movement garnered through dual citizenship, affluent economic status stabilized by educational experiences abroad, and social ties fostered within and across nation-states. the results are incredible economic successes that are often unparalleled among their peers in ghana. (p. 209) ghanaian women entrepreneurs thus “defy the general idea of the oppressed third world woman that is sometimes evident in the literature on women/gender and development” (darkwah, 2002, p. 17). there is a gap in the existing literature on the roles women have played in building and ensuring the sustenance of successful family businesses in ghana, despite the sociocultural challenges that abound in ghanaian society. though the number of women involved in the ownership, management, and direction of family businesses is increasing over time, their efforts are too often “invisible” and go unrewarded. thus, this study sought to answer the following research questions: i. from the perspectives of women in family businesses in ghana, in what ways have women’s roles in family businesses changed over the last five years? ii. what do women in family businesses in ghana consider as opportunities for recognition and success? method the study employed a qualitative research design in its approach. fifteen women in family businesses were recruited to participate in the study to discuss the ways in which advances in social work, fall 2021, 21(4) 1088 their roles have changed over the past five years and highlight how these changes have impacted their businesses. women in family businesses were the population of choice due to the patriarchal nature of the ghanaian society that negatively reflect on issues of succession in family businesses, irrespective of primogeniture, qualification, or ability to perform for women. the 15 respondents were recruited mainly through purposive and snowball sampling techniques. initially, 3 participants were purposively selected based on the researcher’s familiarity with their businesses. after interviewing each participant, they were asked to recommend other women in family businesses for participation in the study. it was necessary to rely on snowball sampling techniques due to the difficulty in identifying and separating women in family businesses from women entrepreneurs. information was solicited mainly through in-depth interviews (idis). data were collected between october 2017 and march 2018. ethical approval was sought from the university of ghana college of humanities institutional review board (irb) before proceeding to collect data. due to the exploratory nature of this study, in-depth interviews served as a powerful way of helping participants to make explicit things that have hitherto been implicit – to articulate their tacit perceptions, feelings, and understanding. a semi-structured interview guide was developed with open-ended questions which allowed respondents to tell their stories from their own perspectives. with permission from the participants, all interviews were audio-recorded for later transcription. interviews were conducted in english, and each interview lasted an average of 45 minutes. all the interviews were one-on-one sessions except for one, in which a mother was interviewed with her daughter at the same time. although this was not planned, it allowed for differences in views and opinions that reflected the changing patterns in the ghanaian culture to be evident. the recorded data were transcribed verbatim from audio to text. data were analyzed using clarke and braun’s (2014) six steps of thematic analysis. these steps are becoming familiar with the data, generating codes, categorizing generated codes into themes, reviewing and identifying themes, defining and naming the themes, and preparing a report based on the themes. themes and sub-themes were then subjected to member checking and peer vetting to ensure trustworthiness and credibility of findings. the identified broad themes with its sub-themes were used to characterize the study’s key findings. in order to safeguard the identities of the participants, pseudonyms are used in the reporting of their views. the author conducted all the interviews and analyses independently. profile of study participants the fifteen women who participated in the study were all entrepreneurs who were engaged in family businesses in accra, ghana. they ranged in age from 26 to 63 years old. the ages of the participants are indicative of the fact that women are encouraged to be entrepreneurial from a very young age through to their late adulthood in order to be able to provide for themselves and their families (britwum et al., 2006). in terms of education, three of the participants had post-graduate education, five had bachelor’s degrees, two each had middle school leavers’ certificates, national vocational training institute certificates, secondary school (high school) certificates, while one had a certificate in nursing and midwifery. eight of the participants were first generation women in family boateng/accidental opportunities 1089     businesses who had either started the businesses by themselves or with their husbands and six were second generation with one being a third-generation woman in the business. this is consistent with the african business landscape in which few family businesses survive beyond the third-generation (amankwaa et al., 2016). to be able to solicit views from as many perspectives as possible, the women were selected from varied sectors of the economy. five of the women were engaged in the trading of general household consumables and beauty products, three were operating basic schools, two were in the catering industry, while one each was engaged in health care provision, construction, freight forwarding, sculpture and export, and fashion design and export. the distribution of women across the different sectors also indicates the concentration of women in the provision of services that reflect the socio-cultural roles of women in ghanaian society. table 1 provides a synopsis of the profile of the study participants. table 1. socio-demographic characteristics of participants (n=15) participants’ pseudonym age (years) educational level marital status business miss abby 32 master’s degree single sculpting & export miss ash 42 middle school leavers’ certificate married trade in household products miss babs 26 national vocational training institute certificate ii married catering miss bea 40 bachelor’s degree married freight forwarding miss cee 34 postgraduate diploma married school proprietor miss dede 33 postgraduate diploma married school proprietor miss ed 58 national vocational training institute certificate i married catering miss em 38 bachelor’s degree married construction miss gee 35 bachelor’s degree married wholesale & retail trade in hair & beauty products miss kay 35 bachelor’s degree single fashion design & export miss lou 42 secondary school certificate married wholesale trade in general consumables miss naa 36 secondary school certificate single retail trade in household products miss nora 65 middle school leavers’ certificate widowed trade in greeting cards & other products miss pee 34 bachelor’s degree married school proprietor miss shay 66 diploma in nursing & midwifery married healthcare provider findings the findings of the study indicate that women in family businesses in accra, ghana have creatively identified and made use of the changing socio-cultural and economic advances in social work, fall 2021, 21(4) 1090 landscape of the country to promote their businesses. this paper highlights three main trends that have been significant in business growth and success and, in turn led to economic empowerment for women in family businesses in accra, ghana. these trends are termed broadly as accidental opportunities because they were not deliberately planned but were still identified and exploited in ways that are increasingly beneficial to women and their businesses. advent and increasing use of social media in recent years, smart phones and their accompanying social media usage have provided avenues for many women entrepreneurs to reach, advertise, and conduct business with people all over the country and all over the world. the study participants indicated that, through social media portals like facebook, twitter, whatsapp, and instagram, they are able to advertise their products to clients, share information, and generally conduct business in ways that they could not have conceived of in the past. however, the use of social media was more popular and useful for those women who traded in goods than those who provided services: facebook has been instrumental in the way i conduct business. at first, people had to come into the shop to see my products, but now, all i have to do is post pictures on facebook, and people are able to see them and place orders from all over the world. it is great! (miss kay, fashion designer). i use instagram, facebook, and whatsapp. i take pictures and post them online and people are able to call or send messages to order. it is that simple. for customers in ghana, they pay when i deliver but for those abroad, they have to pay before shipping. oh yes, social media has been great, i am able to transact business all over the world. once people know that you will deliver, they are willing to do business with you. who would have thought that i will sit here and be able to ship products to france, germany and even australia? (miss abby, sculptor & exporter). for the women whose businesses entailed the provision of services, social media is useful since it allows people to review their businesses and recommend them to others. they strive to provide top-notch services to clients so that they will receive good ratings and get referrals. as some noted: these days, if you offend a client, they can use social media to destroy your business with the click of a button, so i make sure to train my staff to be most professional to everyone. in that same breath, if a client is truly satisfied, they use social media to help promote the business (miss dede, school proprietor). i often get clients who only come because they read something positive about us on one social media platform. i have a page on facebook where i ask clients to share their experiences, and i believe that my business has improved greatly due to that (miss shay, healthcare provider). boateng/accidental opportunities 1091     innovative business practices many women entrepreneurs in ghana are applying different innovations in conducting and promoting their businesses. among them are the conversion of cars to shops, organizing street mall events, identifying the needs of people, and providing targeted solutions. it is not an uncommon feature to see many women entrepreneurs carrying their products in their cars to vantage business locations to advertise and sell them. the participants indicated that these innovations on their part have proven to significantly contribute to the success of their businesses. even for participants who provided services, these innovations have been useful: when i took over the business, i realized that sales at the shop were low, so i would put some of my products in a car and drive from office to office. i could make more sales that way than sitting at the shop and expecting people to show up (miss naa, trader). you see, it could be that people need items but do not have the time to go shopping, or that you are located too far from where they are, but if you make the effort to take the things to them, they will buy. i go to the banks and other offices with different designs and people are more than happy to just buy them (miss kay, fashion designer & exporter). we package sauces and soups for career women all the time. if they call and tell us what they want, we prepare and package them so they either pick them up or we deliver them in ice chests so that when they get home, they refrigerate them. women are busy these days and are grateful that we are here to offer them such services. recently a customer called to order food that would last a whole month (miss babs, caterer). other entrepreneurs organize and participate in street malls. this is a recent phenomenon where a whole stretch of road is blocked off (with permission of city authorities) and stands are mounted for a day to advertise and sell products. the entrepreneurs who participated in these events appreciate the ways they contribute to the success of their businesses: these street malls are one-day events, but you make the most sales. you know how people of a certain caliber patronize these events, and such people like to shop so it is very good, but then, many more people tell me if not for such events they would not even know of my business (miss abby, sculptor & exporter). one would think that as a construction company, we would not benefit from the street malls, but we really do. when we go and meet people, tell them what services we can provide for them and even the kind of financial arrangements we can go into in the construction of their homes, we often get follow up jobs. i think those events are great and wish they could be organized more frequently (miss em, construction worker). advances in social work, fall 2021, 21(4) 1092 weakening patriarchy the ghanaian society is experiencing fast-paced development in which patriarchy is increasingly weakening. due to several campaigns and efforts by government to promote gender equality, many men have become more sensitive to the needs of women and have become allies in the promotion of women’s rights. the study participants have identified this as great leverage upon which to launch and promote businesses in the country to inure to their benefit: if i should say so myself, the business has greatly improved since i took over from my mother. when i compare myself to my mother, she could not travel to china and hong kong to buy the goods because she could not leave us at home, so the business was not doing well. but since i took over, me, i travel all over – china, hong kong, thailand, and dubai. nobody ever gives me grief that a woman’s place is the home or the kitchen (miss naa, trader in general consumables). i think the way the system [sic] has changed in ghana is very good. these days when you are doing business, nobody looks at you like you are doing something wrong. at first, people didn’t think construction could be women’s business, but now, i wear my hard hat and boots and go to sites without any problems (miss em, construction worker). in the mother and daughter interview, some of these changes were also evident: although my husband invested in the business, he has not been a great support. he insists that catering is a business for women, so he does not even encourage my son to be part of the business, but he had no problem when i started grooming her [the daughter] to take over the business. now, she is married, and her husband helps out here all the time. he keeps our books, helps with purchases or deliveries when we need extra hands, and just keeps an interest in the business (miss ed, caterer). besides the changing perspectives in the broader social system, in private homes the weakening patriarchy is also evident in the way men do not have expectation of their wives as being solely responsible for cooking, cleaning, and taking care of children. most of the time, i close from the shop late, so it is my husband who picks the children from school, does homework, feed, and bathe them before i get home. he does not have any complaints whatsoever about doing that and this gives me the peace of mind to also focus on my business (miss kay, fashion designer & exporter). i like how my husband does not insist that i cook. usually, i order food and we eat, or he would cook. growing up, i never saw my father cook and i am sure in times past, i would have been considered a bad wife, but not now (miss bea, freight forwarder). boateng/accidental opportunities 1093     discussion this paper sought to answer two research questions regarding women in family businesses in ghana from their own perspectives: 1) in what ways have women’s roles in family businesses changed over the last five years and 2) what are their opportunities for recognition and success? from the findings of this study, it is evident that some ghanaian women in family businesses in accra, ghana are able to identify and leverage opportunities in their communities to promote and sustain their businesses, which ultimately lead to their economic empowerment. empowered women are able to make decisions that benefit them and their families, and they contribute positively to the development of their communities. since such women also seek the well-being of others, they in turn ensure the empowerment of other women and children associated with them. it is, therefore, instructive that at the micro level, women who participated in this study have identified and utilized the opportunities in their environment to promote their businesses. while women in family businesses are doing their bit to promote social justice, they need to be further supported to ensure that opportunities be institutionalized and spread to cover all women in the country through advocacy, brokering, facilitation, and education. at the macro level, there appear to be more opportunities for women in both the formal and informal sectors due to changes in gender roles and weakening patriarchy in ghanaian society. through social change, exposure, and education, the burden of keeping the home and caring for children is no longer the sole responsibility of women. more men are now taking up domestic responsibilities in the home, giving women more time to pursue their professional endeavors. there also appears to be cracks in glass ceilings in many organizations and family businesses, and so women who push hard enough are able to pass through the cracks and rise to the top. although many women have to work twice as hard to get the same kind of recognition and promotion as men, the fact that some have identified these cracks and are taking advantage of the opportunities presented is worthy of recognition. in addition, the new market economy with its accompanying policy reforms has resulted in women having more agency. unlike the past, women are now able to procure and own assets. this means that women are also able to start their own businesses, use their assets to secure loans from banks to expand and even contract with third parties to do business. these changes and the opportunities they come with must be consciously created and presented to women in other sectors of the economy to ensure that they can also succeed in their fields of endeavor. this is where the expertise of social workers can prove to be most useful. social workers could work with the women themselves, civil society, and government to formulate policies that would create the opportunity for women entrepreneurs in both the formal and informal sectors in order to sustain their businesses. in this regard, social workers in accra, ghana have a duty to work with women entrepreneurs so that they are able to galvanize around the changing economic landscape for the benefit of themselves and their families. advances in social work, fall 2021, 21(4) 1094 in an emerging economy like ghana, social workers can provide women in family business with technical assistance and information on how to navigate the terrain and make use of their networks to ensure the success of their businesses. they can also work in concert with the women themselves to advocate for better working conditions with an emphasis on increasing support for women entrepreneurs. as deka (2012) notes, social workers have been instrumental in expediting approaches for change which have proven useful in countering the marginalizing effects of poverty in several jurisdictions. again, social workers, having gained a clear understanding of the dynamics of rural settings as it relates to entrepreneurship development, can liaise with other female business owners to provide training to meet the specific needs of rural women. many scholars whose research has focused on women entrepreneurs in ghana have either centered on their challenges (dzisi, 2008), entrepreneurial choices (acheampong, 2017), the economic landscape or factors that affect the success of female entrepreneurs (cabrera & mauricio, 2017). presently, the nexus between social work practice models and economic empowerment of women in emerging economies is very much untapped (havig & byers, 2019). there is need to identify the physical, social, economic, and cultural barriers that continue to disempower women entrepreneurs in ghana and strive for their removal. the united nations (n.d.) sustainable development goals have provided social workers with new opportunities to protect and promote social justice, human rights, and sustainable development. the sdgs – goals 1, 2, 5 and 16 among others – provide the framework for social workers to challenge the status quo, advocate for the rights of populations such as women entrepreneurs who are pioneers with a unique set of strengths, to be respected and to pursue the dignity and worth of all individuals in the ghanaian society. social work practice implications the international federation of social workers (ifsw), the international association for schools of social work (iassw), and the international council for social welfare affirm that past and present political, economic, cultural, and social orders, shaped in specific contexts, have unequal consequences for global, national, and local communities and can have negative consequences on individuals (jones & truell, 2012). it is imperative, therefore, for social workers to be more aware of these past and present conditions and their impacts on specific groups of people, so that interventions for and/or with such groups will be tailored to reflect these unequal consequences. for women entrepreneurs in ghana, there continue to be systemic and socio-cultural barriers that hinder them from expanding and competitively running their businesses like their counterparts in other developed countries. despite the socio-economic and cultural barriers faced by women in ghana, some are still finding ways to thrive to assist their families and contribute to economic development. hence, policy makers should recognize their efforts and eradicate systemic barriers to allow women full access to enable their growth and contribution to economic development in ghana. social workers can also play their part in educating and training women who are not yet aware of these emerging opportunities or not yet using these emerging opportunities to their advantage. social boateng/accidental opportunities 1095     workers can also advocate for the eradication of policies that create and perpetuate systemic barriers for women in ghana. there have been calls for african governments to deliberately target the informal sector for the creation of gainful employment opportunities to spur development (debrah, 2007). social workers in ghana should work with the government to identify the informal sector as an area that possesses great potential for women, young and old, educated and otherwise, to exploit for greater economic empowerment. there is potential for future 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(n.d.). sustainable development goals. https://sdgs.un.org/goals author note: address correspondence to doris a. boateng, department of social work. p. o. box lg 419, university of ghana, legon. email: dboateng@ug.edu.gh _______ david c. kondrat, msw, phd., associate professor, school of school of social work, indiana university, indianapolis, in. w. patrick sullivan, professor, school of school of social work, indiana university, indianapolis, in. kelli e. canada, associate professor, school of social work, university of missouri, columbia, mo. jeremiah w. jaggers, assistant professor, college of social work, university of utah, salt lake city, ut. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 637-654, doi: 10.18060/23817 this work is licensed under a creative commons attribution 4.0 international license. the role of social support and ego network characteristics on quality of life: implications for persons involved with mental health courts david c. kondrat w. patrick sullivan kelli e. canada jeremiah w. jaggers abstract: mental health courts offer alternatives to incarceration for persons with severe mental illness who are involved in the criminal justice system. these courts have the dual function of ensuring treatment for persons involved in the court as well as ensuring the safety of the public. persons with severe mental illness who are involved in mental health courts rely on others for support, such as family members. others may buttress the participant from engaging in criminal activities and provide for needs of the participant. the supportiveness as well as the composition of one’s network members may play a role in the success of mental health court participants, such as successfully completing the mental health court program and avoiding incarceration. little research has explored how social support impacts mental health court participants. we explored how the composition and sense of support of network members were associated with mental health court participants’ quality of life. we regressed quality of life on social support and network characteristics of 80 participants in two mental health courts. findings suggest that perceived support is positively associated with quality of life, and the proportion of family in one’s network was negatively related to quality of life. findings suggest that persons involved in mental health courts need supportive others in their social networks in addition to family. more research is needed to explore the reasons having a higher proportion of family members in one’s network is associated with lower quality of life. practitioners need to pay attention to and leverage mental health court participants’ social networks to help improve their quality of life. keywords: ego network, social support, severe mental illness, mental health courts persons with severe mental illness (smi) are disproportionality represented among inmates of jails and prisons. penal institutions have become the largest providers of mental health care in the united states (baillargeon et al., 2010), though the quality of this care is questionable. the 12-month prevalence rate of persons with severe mental illness in state or federal prison is about 15% (pinta, 2001). to address the large number of persons with smi entering the criminal justice system, practitioners and researchers have developed several interventions to decrease the likelihood that a person with smi will have repeated contact with the criminal justice system (heilbrun et al., 2012). mental health courts (mhc), one of these interventions, are increasingly becoming a point of entry into the mental health system of care for persons with smi (redlich et al., 2006). mhcs operate under the principle of therapeutic jurisprudence (petrila, 2003). once a person with smi enters a mhc, the court works with the person with smi and a team of providers to ensure https://creativecommons.org/licenses/by/4.0/ kondrat et al./role of social support 638 that needed treatment is received by the participant, while ensuring public safety is maintained. the goals of mhcs are therefore both therapeutic and public safety. persons with smi are at risk of experiencing challenges that expand beyond the symptoms associated with their illnesses. for example, people with smi may experience changes in their network of friends and supports (ego network) at different stages in their illness. the ego networks of persons with smi often shrink after diagnosis, though the process of losing friends and supports may begin when persons with smi start to exhibit symptoms of their illness (perry & pescosolido, 2012). the loss of friends in one’s ego network is important because persons with smi may lose the very individuals they count on for help. ego networks are the people with whom one regularly interacts. the loss of key supports may increase the risks that people with smi face, such as engaging in illicit behavior with new and risky persons (denton et al., 2017). risky persons are those who engage in activities that may increase the likelihood of the ego engaging in illicit activities, such as individuals who use illicit drugs or engage in criminal activities. in addition, persons with smi may have close family members as the core of their support network (perry & pescosolido, 2012). while not explicitly a goal of mhcs, increasing contact with new friends and supports that are positive and committed may be an important secondary outcome of mhc treatment (canada, 2013). while much of the research on mhcs focus on recidivism and program completion (dirks-linhorst & linhorst, 2010; kondrat et al., 2018; moore & hiday, 2006; ray, 2014; sarteschi et al., 2011), little research has explored the extent to which these programs achieve mental health recovery-based outcomes, such as quality of life (honegger, 2015). the purpose of the current study was to explore those social support and ego network properties that relate to quality of life among persons participating in mhcs. mental health courts mhcs are treatment-oriented, special jurisdiction courts that are “…based on the assumption that treatment and other types of problem-solving responses are more appropriate than punishment for certain types of individuals” (petrila, 2003, p. 6). individuals enter mental health courts after they have been arrested for city ordinance violations, misdemeanors, and/or felony charges. mhcs are premised on therapeutic jurisprudence and divert individuals from jail/prison into community-based mental health treatment, where participants receive needed treatment. participation in mhcs is voluntary (hasselbrack, 2001). in addition to arranging treatment, the court is also tasked with ensuring public safety (tyuse & linhorst, 2005). successful participation in mhcs may result in having lesser charges or elimination of all charges before the court; and, nonparticipation may lead to added jail time, the case being sent back to a criminal court, or other sanctions (redlich et al., 2006). one important assumption underlying mhcs is that participants will receive and continue to receive needed treatment, resolve the mental health issues that lead to the criminal charge, and not engage in future criminal behavior (petrila, 2003). social networks are thought to play an important role in bringing about these outcomes (canada, 2013). advances in social work, fall 2020, 20(3) 639 research tends to support the effectiveness of mhcs from a criminal justice frame of reference (dirks-linhorst & linhorst, 2010; kondrat et al., 2018; moore & hiday, 2006; ray, 2014; sarteschi et al., 2011). for example, sarteschi et al. (2011) conducted a metaanalysis of 19 studies of mhcs. they found that mhcs were effective at reducing recidivism. in a more recent study, ray (2014) found that re-arrest rates were lower among persons with mental illness who participated in mental health courts as compared to those who did not. further, he found that time to rearrests was longer among those who participated in mhcs compared to those who did not. however, little research has explored the extent to which mhcs achieve treatment-related outcomes (honegger, 2015). honegger (2015) found only one study that explored the extent to which participation in mhcs was associated with quality of life. honegger found that mhcs improved overall quality of life among participants. social support, ego networks, and mental illness human beings are inherently social; so, reliance on others is a social certainty (donev, 2005). social support is a psychosocial construct that refers to social and emotional care provided in the course of primary and secondary socialization (thoits, 2011). types of social support include emotional, informational, and instrumental (thoits, 2011). social support is often thought of as a mechanism for dealing with life’s challenges and stressors (chronister et al., 2015). among persons with smi, positive social support has been associated with reductions in mental health symptoms (sundermann et al., 2014), increases in mental well-being (kondrat et al., 2017), and enhanced quality of life (chronister et al., 2013). yet, little is known about how social support impacts the quality of life of mhc participants. the converse of social support is social undermining. vinokur and van ryn (1993) write: …social undermining is theorized to consist of behaviors directed toward the target person that display (a) negative affect (anger or dislike), (b) negative evaluation of the person in terms of his or her attributes, actions, and efforts (criticism), and (c) behaviors that make difficult or hinder the attainment of instrumental goals. (p. 350) social undermining has been shown to have a negative impact on mental health (vinokur & van ryn, 1993). joseph et al. (2011) found that the effects of social undermining on depression were moderated by race. the authors found that higher levels of social undermining were associated with symptom reduction among persons who were white; however, social undermining negatively impacted depression among persons who were black. another way to understand the support received from others by persons with smi is understanding her or his ego network (perry & pescosolido, 2012). ego network research focuses on exploring the connections that a person (ego) has with those around them (alters). unlike social network research, which explores the relationships of a whole group of individuals with one another, ego network research focuses on the relationship of the ego to her or his alters (perry et al., 2018). aspects of ego networks, such as number, kondrat et al./role of social support 640 strength of the relationship, type of relationship, and the interconnection of alters, provide meaningful information about a person’s network of friends (donev, 2005). ego networks have several properties that can be measured and used to understand the psychosocial world of persons with smi. one such property is network degree, or the number of alters in an ego network. as noted above, perry and pescosolido (2012) found that persons with smi often have a smaller number of alters than the general population. these authors argue that, over time, less supportive members drop out of the network of persons with smi. loneliness, which can result from a loss of connectedness to others, is a pervasive problem among individuals with major mental illnesses. research suggests that those with mental illness experience loneliness more frequently than the general population, with prevalence rates ranging from one-half to as high as 80% (koenders et al., 2017; lim et al., 2018; prince et al., 2018). loneliness is associated with a range of negative outcomes including heightened morbidity, mortality and stress, earlier onset of psychosis, and poor recovery outcomes (koenders et al., 2017), as well as illness and premature death (prince et al., 2018). when one has a larger and committed social network, there is a greater likelihood that the necessary and specific help needed will be available. however, a few committed alters may be more important than a large and uncommitted network. perry and pescosolido (2012) observed that “the social consequences of people’s lives shape the structure, function, content, and membership of personal social networks at any particular point in time” (pp. 135-136). perhaps more importantly, it is posited that what is required in terms of effective support is impacted by the specific difficulty faced, and even the stage of the problem confronted. as perry and pescosolido (2015) argue, social networks have the potential to serve as conduits of general emotional support and information. however, according to our findings, it is not these general support processes that drive recovery outcomes. rather, the key factor appears to be the activation of particular kinds of people for health discussion. this indicates that achieving a state of recovery may be facilitated by cultivating a social safety net that can provide targeted, health-related advice, information, and instrumental aid that buoys the treatment process and permits gains in self-sufficiency and productivity. (p. 126) knowing the types of alters an ego has in her or his network may provide useful information that can be used to predict outcomes. the characteristics of alters can impact the behaviors and choices made by persons with mental illness (perry & pescosolido, 2010). for example, perry and pescosolido (2015) found that partners, mothers, siblings, and children were more likely to comprise those networks of persons who one talked to about important health matters. relevant to the current study, networks with alters who have been arrested or display deviant behavior predict criminal engagement. thus, networks with concentrations of alters who have been arrested may affect a person’s contact with the criminal justice system and, subsequently, the person’s quality of life. advances in social work, fall 2020, 20(3) 641 family and ego networks there was a time when theories on the origin of serious mental illness emphasized the deleterious impact of families on the well-being of individuals. decades of advocacy and research have largely discredited such theories (e.g., butzlaff & hooley, 1998). however, some families are not supportive, while others need basic information and tools to be helpful to their loved ones. a fundamental question is to what degree are families important to the well-being of persons involved in the criminal justice system. criminal justice, social support, and ego networks cullen (1994) suggested that social support and social networks play a large role in criminal behavior. in fact, he argues that one’s friends and the support that those friends provide are strongly associated with arrests. specifically, high levels of constant social support, as opposed to erratic social support or coercion, are associated with low levels of criminal activity (colvin et al., 2002). further, colvin et al. (2002) posit that coercion can push one to commit a crime. social support can buffer a person from committing a crime and coercion can create the context for criminal behavior. social support and coercion are the result of those with whom one interacts. marsden and friedkin (1993) argue that individuals with whom one interacts influences one’s behavior. persons use others for social comparison. individuals engage in what cooley (1902; 1967 as cited by kondrat & teater, 2012) termed the looking-glass self; that is, persons look to others to understand themselves. this influence of others can be traced back to the groups with whom one interacts (i.e., one’s reference groups; shibutani, 1955). therefore, social support may not be the only mechanism through which others influence behavior. merely having risky others in one’s ego network may influence criminal behavior by providing a basis for viewing oneself. research on ego networks demonstrates how the presence of risky others may influence one to engage in deviant and criminal acts. papachristos et al. (2012) explored the role of having persons in one’s network who were risky on views of the legitimacy of the legal system and violent behavior. the authors found that having a high density of risky persons who have been arrested as members in one’s network was associated with a decreased belief in the legitimacy of the legal system. further papachristos et al. (2012) found that having fewer than 50% of one’s network who have been arrested was associated with a decreased risk of engaging in violent behavior, and having at least one gang member in one’s network was associated with an increased risk of engaging in violent behavior. haynie et al. (2014) found a link between an alter’s criminal behavior and the criminal behavior of the ego, such that committing the same crime in a previous criminal act predicts future criminal behavior. haynie (2001) found that the size and composition of one’s network was associated with more behavior that is delinquent. having multiple others who commit crimes in one’s network may lead one to view themselves as a “criminal” and was associated with greater likelihood of engaging in criminal behavior. kondrat et al./role of social support 642 social support, ego networks and justice involved persons with smi although the type and severity of smi is commonly recorded in arrests and recidivism studies, it is not the most significant factor when determining risk for recidivism in this population (skeem et al., 2014). instead, risky personality, cognition, and risky peers explain the risk of recidivism in this group (andrews et al., 2006). davis and brekke (2013) found that persons with smi who have frequent contact with their ego network increased the likelihood of their arrests by nearly five times. conversely, having a large social network decreases the odds of arrest. while too much contact with friends may increase the risk of recidivism, having a large network serves as a protective factor. in a sample of mhc participants, canada (2013) found that the density of one’s ego network was positively related to treatment adherence, suggesting, as coleman (1988) posited, that interconnected networks serve to keep the social order. the key may be to have a socially dense network that is free of risky others. quality of life, social support, and mental illness the connection between social support and quality of life is well-documented (hansson & bjorkman, 2006; lam & rosenheck, 2000; munikanan et al., 2017). lam and rosenheck (2000) discovered that quality of life was associated with social support among a sample of homeless persons with smi. munikanan et al. (2017) showed that support from family, friends, and significant others were all positively associated with quality of life. ruesch and colleauges (2004) reported a positive link between social support and quality of life that was irrespective of one’s employment status. the impact of social support on quality of life among persons with mental illness changes over time. hansson and bjorkman (2006) demonstrated that social support remained a significant predictor of quality of life at baseline, 18 months, and at 6 years for persons with smi. the impact of social support increased over time. at baseline, social support accounted for 16% of the variance in quality of life. by 6 years, social support accounted for 51%. clearly, social support is an important indicator of quality of life. less studied is how ego network characteristics relate to quality of life. the studies that have explored network characteristics on quality of life have consistently found that network properties are positively related to quality of life. perry and pescolsolido (2015) showed that network size positively correlated with quality of life. sibitz et al. (2011) reported that the number of connections was indirectly related to quality of life through stigma and empowerment. more research is needed to explore the impact of social network variables on quality of life. the aim of this study was to fill this gap in the literature. our research question was: to what extent do social support and network characteristics relate to quality of life among persons involved in mhcs? specifically, we investigated how network size and density, and proportion of family and risky persons in mhc participants’ networks relate to quality of life. advances in social work, fall 2020, 20(3) 643 method this study used secondary, de-identified data to answer the research questions. data were originally collected for a mixed-methods project on two midwestern mhcs with the aim to explore the mechanisms that promote positive outcomes for mhc participants and the impact mhcs have on participant experiences. data collected from the primary dataset, the data used in the secondary analysis, were derived from in-depth structured interviews with 80 participants from two mhcs in the midwestern region of the united states. the two mhcs included the 10 essential elements outlined by thompson and colleagues (2008). data were collected between september 2010 and october 2011. recruitment for the original study is outlined below in order to describe the data source. recruitment all eligible participants in the two mhcs were invited to take part in this study. eligible participants were in their second to 18th month in the mhc, 18 years or older, and able to understand english. the window of two to 18 months was selected due to the aims of the original study. information about the study was distributed through the mhc staff. if participants were interested, the staff would assist the individual in calling the researcher, or the staff would provide the researcher with participants’ contact information for followup. if the participant met the eligibility criteria, the researcher met individually with participants in a convenient location and conducted a 60-minute, in-depth, structured interview. participants were compensated $20 in cash or gift certificates. ninety-three participants between the two courts were eligible for study participation. the 13 eligible participants who did not participate did not return follow-up phone calls, did not provide a working phone number, were in custody throughout the entire recruitment period, or had severe paranoid delusions that interfered with the consent process. the final response rate was 86%. measures outcome variable. quality of life was measured using 11 items from the subjective portion of lehman’s (1988) quality of life interview (lqoli). specifically, we measured qol using five life domains from the lqoli, including general life satisfaction (1 item), living arrangements (3 items), daily activity (4 items), family (2 items), and social relationships (3 items). responses for each item used the seven-point terrible/delighted scale. internal consistency reliability was .68. independent variables. data for our primary independent variables were derived from information about up to five persons (alters) that participants identified as people with whom they spend time. degree, or network size, was the number of individuals (alters) that the individual nominated as being part of their ego network. network density is a measure of interaction between alters and the extent to which alters were connected to one another. we also calculated the proportion of alters who were family (parents, children, siblings, and partners) and the proportion who were risky (uses alcohol, drugs and or has been arrested). to calculate proportion of family, we divided the number of family by the kondrat et al./role of social support 644 total number of alters. to calculate the proportion who were risky, we divided the number of risky network members by the number of alters. two other independent variables were social support and undermining. data on social support were collected about each alter, using 8 items from vinokur and van ryn’s (1993) social support scale. according to the authors, the scale has shown evidence of construct validity. social support is the positive aspect of interpersonal relationships. responses ranged from 1 (not at all) to 5 (a great deal). we used the average score across alters. internal consistency for this scale was .92. all items that related to social support were used. we used five additional items from vinokur and van ryn (1993) to measure perceived undermining, which is the negative aspect of interpersonal interactions. the authors found preliminary evidence of construct validity. responses ranged from 1 (not at all) to 5 (a great deal). we used the average score across alters. internal consistency for this scale was .89. all items that related to social undermining were used. control variables. in addition to the network variables, we controlled for a number of variables. we included psychiatric diagnosis as a series of variables. participants were able to endorse multiple diagnoses, including schizophrenia, bipolar disorder, and substance abuse disorders. the absence of each diagnosis served as the reference category for these variables. further, we included gender, with male being the reference category, and age. finally, we included race, with white being the reference category. analysis we used both bivariate and multivariate statistics to explore the relationship between network variables and quality of life. specifically, we explored if and how network size and density and proportion of family and risky persons in consumers’ network correlated with quality of life. we used pearson product moment correlations to explore the relationship between the network variables and quality of life. we then ran two regression equations. the first equation included demographic information; in the second equation, we entered the network variables. we ran the two regression equations so that we could determine the amount of variance in quality of life incremented by the network variables. stata 15 (statacorp, 2017) was used to analyze the data. results descriptive statistics eighty persons participated in this study. just over half were male (55%). the average age of participants was about 40 (sd = 1.35). most participants endorsed having bipolar disorder (71%). about 41% identified being diagnosed with schizophrenia. the majority (84%) had a substance abuse diagnosis. the average perceived social support score was 32.84 (sd = 6.44), which was above the median score of 20. on average, participants rated their alters as supportive. the average perceived undermining score was 7.06 (sd=2.86), which is below the median undermining score of 12.5. on average, persons did not rate alters as high in undermining. the average density of ego networks was 3.05 (sd = .12). advances in social work, fall 2020, 20(3) 645 the average proportion of family was .70 (sd = .04), and the average proportion of risky alters was .35 (.05). the average total quality of life score was 52.46 (sd =11.28). see table 1 for demographic and network information from the sample. table 1. sample characteristics n (%) race – minority 53 (66.3%) gender – female 36 (45.0%) diagnosis schizophrenia 32 (40.5%) bipolar 56 (70.9%) substance abuse 67 (83.8%) degree* [avg. 2.7, sd (1.25)] zero 1(1.3%) one 13 (163% two 22 (27.5%) three 23 (28.8%) four 14 (17.5%) five 7 (8.8%) mean (sd) age (years) 39.6 (1.35) alter’s characteristics proportion who were family 0.70 (0.04) proportion who were risky 0.35 (0.05) perceived social support 32.8 (6.44) perceived undermining 7.1 (2.86) network density** 0.41 (0.19) total quality of life 52.5 (11.28) *degree or network size = number of alters **network density = measure of interaction between alters and extent to which alters were interconnected. bivariate analysis we first ran pearson product moment correlations on the network variables and qol. three variables were significantly related to qol. proportion of family was negatively related to qol, r = -.23, p<.05. higher proportions of family were associated with perceptions of more negative qol. the degree, or number of alters, was also negatively related to qol, r = -.21, p<.05. social support was positively related to qol, r = .34, p<.01. perceiving greater amounts of social support was associated with perceptions of better qol. in addition, the proportion of family was inversely related to the proportion of risky alters, r = -.23, p<.05. having more family members in one’s network was associated with fewer risky alters. finally, social support was inversely related to undermining, r= .48, p<.01. perceiving greater amounts of support was associated with perceptions of less undermining. see table 2 for a correlation matrix of these findings. kondrat et al./role of social support 646 table 2. correlation coefficients between network variables and quality of life variables 1 2 3 4 5 6 7 1. quality of life 1 2. proportion risky -.07 1 3. proportion family -.23* -.44* 1 4. degree -.21* .19 -.11 1 5. density -.08 .07 .03 .20 1 6. social support .34* -.01 -.05 -.01 .20 1 7. undermining -.14 -.02 .15 -.11 -.10 -.48* 1 *p<.05 multivariate analysis we ran two regression equations to determine the impact of network variables on qol. the first equation containing only demographic variables was not significant, f (6,72) = 1.77, p = .11, accounting for about 13% of the variance in quality of life. inspection of the regression coefficients for this first equation yielded one significant finding: females reported perceptions of lower quality of life than males, b=-5.42. t (1) = -2.1, p <.05. females in mhcs report having lower quality of life compared to males. specifically, females had quality of life scores 5.42 points lower on average than males. see table 3 for the results of all regression analyses. table 3. hierarchical regression predicting perceived quality of life by network characteristics model 1 model 2 variable b (se) β b (se) β race – minority -1.40 (2.85) -.06 -2.53 (3.16) -.10 gender – female -5.42 (2.54)* -.24 -1.51 (3.10) -.11 age -0.03 (.11) -.03 -0.09 (.12) -.10 diagnosis schizophrenia 1.06 (2.90) .07 0.16 (3.57) -.05 bipolar -3.54 (3.06) -.14 -4.32 (3.34) -.18 substance abuse -4.52 (3.47) -.15 -1.62 (4.33) -.10 perceived social support 0.69 (0.33)* .32 perceived undermining 0.02 (0.56) .01 density 0.40 (0.46) -.11 degree -2.27 (1.50) -.16 proportion family -9.02 (4.38)* -.27 proportion risky -4.17 (3.71) -.15 constant 62.51 (5.99) 51.82 (6.27) f 1.77 2.38* r2 .13 .32 *p <.05 **p<.01 for the second equation with the network variables, the model was significant, f(10, 50) = 2.38, p <.05. the amount of variance accounted for by this model was 32%; thus, the model with the network variables explained an additional 19% of variance in quality of life above the model with only the demographic information. two ego network variables were advances in social work, fall 2020, 20(3) 647 significantly associated with quality of life. social support was positively associated with quality of life, b = .69, t (1) =2.04, p<.05. perceptions of stronger social support were associated with perceptions of greater quality of life. for every one-unit change in social support, perceptions of quality of life increased by .69 points. finally, proportion of family in the network was negatively associated with quality of life, b = -9.03, t (1) = -2.06, p <.05. participants with networks that had a higher proportion of family reported lower quality of life. specifically, for every one unit increase in the proportion of family in one’s network, the ego’s perception of quality of life was reduced by 9.03 points. when comparing the two network variables, social support had the greatest association to quality of life as evidenced by the standardized regression coefficient. discussion social support and proportion of family play important, though different, roles in perceptions of qol of participants of mhcs. a curious finding in this study indicates that a higher proportion of family in one’s social support network was associated with a perceived lower quality of life. no firm statements about this association are offered, due to the limitations of the available data. nonetheless, some observations are in order. first, while much of the research on social support networks focuses on the positive nature of such support on emotional and physical well-being, some network members may be nettlesome, quarrelsome, and intrusive. offers of emotional and tangible support may be accompanied by requests for reciprocity that cannot be fulfilled. as rook (1984) elucidates, while there is much interest in the role of support networks as a buffer for stressful life events, non-supportive relationships may exacerbate stress, even in the presence of positive social relationships. in essence, social networks can be a source of strain as well as support (walen & lachman, 2000). further, research suggests that social support is about meaning-making, especially as meaning-making relates to experienced traumatic events (brinn & auerbach, 2015). past research suggests that experiencing stigma diminishes one’s perception of social support (kondrat et al., 2017). basically, meaning-making is not simply only an intrapersonal process but one that extends well into the social environment. thus factors such as stigma, acceptance or non-acceptance, affirmation or the lack of affirmation impacts meaningmaking (brinn & auerbach, 2015). either a traumatic event is assimilated in a person's assumptive world, new meanings are made, or there is increased distress because one cannot assimilate it and new meaning systems are not forthcoming or are replaced with perspectives of the world as a dangerous or scary place. future research needs to account for the presence of traumatic events on the role of social support and other network measures on quality of life. families an important finding in this study is that having a high number of family in one’s network leads to poorer views of one’s quality of life. the onset of an illness often leads to significant disruptions in the lives of persons with mental illness, including for those in the person’s ego network (perry & pescosolido, 2012). it would be easy to assume that the results indicate that family members are unsupportive, and having a higher proportion of kondrat et al./role of social support 648 family members means having more unsupportive alters in one’s network. however, results from the bivariate analysis indicate that there is no correlation between proportion of family members and social undermining. what the findings are likely indicative of is the loss of friend. replacing friends is a higher proportion of family who take up the mantle of helping mhc participants. had we explored the proportion of friends in the network, instead of family, we may have found that the number of friends is positively correlated with qol. so, it is likely not the high proportion of family that is problematic, but the low proportion of friends. however, it may be that families surround persons with smi whom are the most sick and, thus, need the most support. risky alters an interesting finding is that the mere presence of persons in one’s network who engaged in risky behavior did not relate to perceptions of quality of life. there is scant research on the role of risky others on persons’ quality of life. this does not mean that risky individuals affect persons in mhc not captured by this research. carrington (2011) describes differential association theory, which has also been called social learning theory of deviance and peer influence. consonant with the above-mentioned theory, pratt and colleagues (2010) describe that we learn information about our social world from those around us. being embedded in a network with risky individuals may result in the individual engaging in risky behaviors. rather than having a direct impact on a person’s current quality of life, engaging with high risk individuals may result in future arrests. social support our findings regarding social support are consistent with the literature on social support and smi (kondrat et al., 2017; sunderman et al., 2014). as with previous research, greater amounts of social support lead to perceptions of a better quality of life (chronister et al., 2013). while social support was related to qol, undermining by alters was not. more research is needed to understand the mechanisms through which social support operates to create appraisals of a greater quality of life. limitations this study has a number of limitations. first, we collected data on only up to five alters. this limits the number of potential alters participants could identify, which can lead to an inaccurate count of the size of the networks. while the average number of alters participants identified was small, over 9% identified five network members. any or none of these nine percent could have identified more than five persons. further, limiting the number of alters can lead to inaccurate calculations of the density scores (perry et. al., 2018). in addition, we used a nonrandom sampling procedure, which means that the results are not generalizable beyond this study. finally, we did not account for the severity of mental illness so that we have no way of knowing how negatively impacted participants were by their illness. despite these limitations, this study provides some valuable insight into network properties that are associated with quality of life. the findings contribute to the nascent advances in social work, fall 2020, 20(3) 649 body of knowledge about ego networks and persons involved in mhcs (canada, 2013). further, these findings add to the body of literature on ego networks with persons with smi (perry & pescosolido, 2010; perry et al., 2016) and persons who are involved in the criminal justice system (andrews & bonta, 2015; davis & brekke, 2014). finally, these findings have practical import for improving the quality of life of persons involved in mhcs. implications for social work practice this study has implications for practice with persons with smi. the findings suggest that having a high proportion of family in one’s core network could be detrimental to one’s quality of life. the findings suggest that having family as one’s primary source of support was associated with lower quality of life. this may be because families contribute to the problems of persons with smi or because families rally around their relatives with severe mental illness. social workers are encouraged to help participants develop social supports outside of their families, such as friends or peers who have experienced success with an mhc. further, social workers are encouraged to continue working with families and persons with smi involved in mhcss to develop appropriate coping strategies. for example, the national alliance on mental illness offers a 12-week psychoeducation course, family-to-family, to help families learn strategies for helping their loved one with mental illness (dixon et al., 2001). past research suggested that family members who participated were less worried or displeased and may interact differently with their loved one in such a way as to increase the loved one’s quality of life. mhcs and social workers who work in mhcs are encouraged to help link families of participants to programs like family-tofamily. these findings have import for social work education. educators need to continue teaching students about the importance of clients developing strong and supportive social networks. as is evidenced from the findings of this study, the number of supports (degree) was not significant. this suggests that clients need to have at least one strong and supportive 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(2000). social support and strain from partner, family, and friends: costs and benefits for men and women in adulthood. journal of social and personal relationships, 17(1), 5-30. https://doi.org/10.1177/0265407500171001 author note: address correspondence to david c. kondrat, school of social work, indiana university, school of social work, 902 w. new york street, es 4118, indianapolis, in, 46202. email: dckondra@iupui.edu https://doi.org/10.1016/j.eurpsy.2010.08.010 https://doi.org/10.1037/lhb0000054 https://doi.org/10.1007/s00127-013-0754-3 https://doi.org/10.1177/0022146510395592 https://bja.ojp.gov/sites/g/files/xyckuh186/files/publications/mhc_essential_elements.pdf https://bja.ojp.gov/sites/g/files/xyckuh186/files/publications/mhc_essential_elements.pdf https://doi.org/10.1093/hsw/30.3.233 https://doi.org/10.1037/0022-3514.65.2.350 https://doi.org/10.1177/0265407500171001 mailto:dckondra@iupui.edu _________ ann t. riley, phd, msw, clinical assistant professor, kirby bewley, msw, lcsw, online msw program coordinator, renea l. butler-king, phd, msw, instructor and program manager child welfare training & simulation, lisa g. byers, phd, associate professor and affiliate faculty with native american studies, christina r. miller, phd, msw, associate director and associate professor, jennifer e. dell, msw, lcsw, ladc, undergraduate program director and instructor, and charlotte j. kendrick, msw, lcsw, msw program coordinator and an instructor, anne & henry zarrow school of social work, university of oklahoma, norman, ok. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 898-919, doi: 10.18060/24117 this work is licensed under a creative commons attribution 4.0 international license. finding shelter in the storm:  undoing racism in a predominantly white school of social work  ann t. riley kirby bewley renea l. butler-king lisa g. byers christina r. miller jennifer e. dell charlotte j. kendrick abstract: this paper presents the case study of a 100+ year old school of social work recently shaken by acts of racial aggression targeted toward our black/african american community. following campus incidents that received national attention, minority social work students urged faculty to organize action to voice values of equity and justice, and to provide an intentional safe space within our school. in response, a volunteer faculty committee dedicated themselves to the group’s formation and implementation of the undoing racism principles from the people’s institute for survival and beyond (pisab, n.d.), beginning internally and expanding outward. representing multiple identities and positionalities of power, committee members use these principles to process our privilege. we reflect on our journeys with racism as social work educators and as individuals who are, and have been, influenced by internalized historical and contemporary racism. guided by pedagogy of the oppressed (freire 1970/ 2002) and critical race theory (sulé, 2020), the praxis of reflecting in-and-on our work has evolved (schön, 1983, 1987). authors share their personal experiences, professional impacts, and efforts to implement anti-racist pedagogy. contextual implications for schools of social work that aim to become anti-racist within their implicit and explicit curricula are provided by this case study. keywords: anti-racism, critical race theory, pedagogy of the oppressed, social work education, undoing racism, white supremacy undoing racism as the all-encompassing aim of the people’s institute for survival and beyond (pisab), the primary principle of undoing racism is trademarked as, “racism is the single most critical barrier to building effective coalitions for social change. racism has been consciously and systematically erected, and it can be undone only if people understand what it is, where it comes from, how it functions, and why it is perpetuated” (pisab, n.d., para. 11). in approaching this difficult work within our own academic about:blank riley et al./finding shelter 899 community, we humbly lean on the wisdom and teachings of the pisab to guide our efforts at addressing racism for social transformation. this paper presents the antiracism efforts of a 100+ year old school of social work across two major campuses in norman and tulsa oklahoma. in this article, authors describe the formation of an undoing racism committee (urc) as the active mechanism to transform our school from one anchored in white supremacy to one that actively dismantles it. deepak and biggs (2011) offer a definition of antiracism that requires whites to acknowledge participation in racism and (emphasis added) to make an active commitment to the disruption of racism. recent racist events, rather than being isolated incidents, have been painful layers atop the long and enduring history of racial oppression and white supremacy inherent within our academic communities, cities, and state. the anne & henry zarrow school of social work, housed within the college of arts and sciences, is at the university of oklahoma, which is a research-1 institution. with approximately 600 msw and 150 basw students, the 2019 student body self-identified as: 54% european american; 16% native american/alaskan native; 13% african/afrocaribbean/ african american; 7% hispanic/latinx; 2% asian/asian american; and 8% as not otherwise listed. recognizing the racial diversity of our current students further spurred the desire to address this history of oppression. it was amid campus unrest that the urc began its mission of learning, envisioning, and operationalizing undoing racism principles (pisab, 2018) within socratic circles, collegial relationships, and classes at our school of social work. we chose the anti-racist principles of the people’s institute for survival and beyond (pisab) as the foundation and guide for our aims, actions, and advocacy efforts. this was due to the years of training and experience by one of our faculty members who uses this work. pisab (n.d.) offers the following anti-racist principles as the roots for their effective “broad-based movement for social transformation” (para.1). including the overarching purpose of undoing racism, the nine principles are: learning from history, identifying and analyzing manifestations of racism, analyzing power, developing leadership, maintaining accountability, gatekeeping, sharing culture, and undoing internalized & racial oppression (pisab, n.d.). reflecting on this work to date we examine our process through each principle’s lens, secure our theoretical stance, and share our experiences in narrative form through case study methodology. true to this process, our first aim is to understand our recent campus turbulence, as explained in the following section, by researching lessons from the past within our state and our school of social work. learning from history the pisab (n.d.) principle learning from history is a: “...tool for effective organizing. understanding the lessons of history allows us to create a more humane future” (para. 6). an honest synopsis of our state and institution’s history, plus that of our school of social work, reveals well-established roots of white supremacy that permeate painfully into present day. advances in social work, summer 2021, 21(2/3) 900 historical landscape of racism in oklahoma the following section contains references to racial slurs and violent acts of racism. founded on land taken from native americans by the u.s. government, the university of oklahoma existed before statehood.  in 1907, the state constitution did not include strict segregation because delegates feared president theodore roosevelt would veto the document. immediately after the state was included in the union, the first legislature passed segregation laws (smallwood, n.d.). across our state, schools and public facilities were segregated and interracial marriages outlawed. to maintain a strict jim crow system of control over black/african americans, lynchings were commonplace from 1907-1930's (smallwood, n.d.). many believe one of the most extreme examples of racist violence in america occurred in 1921 in tulsa, oklahoma when a white mob destroyed more than one thousand black/african american-owned homes and businesses, murdered many people (ellsworth, 1982), and made clear the message of white supremacy. according to resources from the oklahoma historical society, norman, oklahoma (the university’s main campus), was known as a sundown town until the 1960’s and in an historical account by givel (2018), it was enforced not by law but as evidenced by threat. loewen (2006) describes a sundown town as, “any organized jurisdiction that for decades kept african americans, or other groups, from living in it and was thus all-white on purpose” (as cited in givel, 2018, p. 261). typically, sundown towns were enforced by both legal and extralegal means. in the 1920’s, the university town displayed prominent signs that said “n-----, don’t let the sun go down on you in this berg” (black dispatch, 1922, p. 1). during this same era, the 1920 university yearbook featured a student chapter of the ku klux klan. according to the u.s. census bureau, there were no black/african americans in  norman, oklahoma from 1907-1940 (givel, 2018). lynchings and other violence, known as “extralegal vigilante incidents” (givel, 2018, p. 263), continued from 1899 to the early 1920s, effectively excluding black/african americans from working and living in norman (wommack, 1976). in february 1922 the norman transcript printed a letter from the kkk stating, “…from now on no negroes will be permitted to reside, work, or entertain in the city of norman and no negroes will be permitted to remain in norman after the sun goes down” (ku klux klan takes a hand, as cited in givel, 2018, p.276). the first challenge to the city’s sundown status came in 1940 when a group of students and local church leaders passed a resolution denouncing the job ban on african americans. further pressure on the city to cease its extralegal actions occurred in 1942 when the navy constructed housing for black/african americans on the north side of the town. then in 1946, a black/african american woman was denied admission to the ou college of law. in an historical lawsuit, she sued the university and her case went to u. s. supreme court, which resulted in a landmark ruling that ordered the university to admit her. thus, 1949 marked the beginning of the end of the city’s sundown practices and the university’s segregation practices. seventeen years later in 1967, dr. george henderson and his wife, barbara henderson, became the first african american homeowners in the city. sundown practices lasted in norman, oklahoma from 1889-1967, a 78-year span (givel, 2018). riley et al./finding shelter 901 the school’s history of racism  from 1917, when the school of social work at the university of oklahoma (ou) began, it did not hire a tenure-line black/african american professor until 1964 notably the same year as the civil rights act. an interview with dr. kenneth wedel, an ou school of social work historian, revealed that between 1960 and 2020 only 57% of the faculty of color hires were on tenure-track lines; whereas, 43% of the adjuncts, instructors, and grantfunded positions were poc (personal communication, september 11, 2020).  his unofficial review estimates only half of the 19 tenure-track faculty of color during these years were retained or successfully promoted, which may be an indication of the lack of support for poc faculty versus the support for white faculty hires during these years. the undoing racism committee attempted to learn from history by reaching out to prior african american graduates. six alumni were contacted but only three responded and agreed to be interviewed. similarities between their anecdotal responses were striking, even though there was a 20-year span across their time in the program. all alumni mentioned micro-aggressions and racism. one alumni respondent shared that she felt marginalized and vulnerable because she was outspoken about racism and social justice. this was especially obvious when this student and her family were impacted by the bombing of the murrah building in oklahoma city, a major event of domestic terrorism, and neither faculty members nor leadership reached out to her with support. she did not know if faculty reached out to other students or not (renea butler-king, personal communication, august 15, 2020). every year the school administers a survey to all graduating students as part of an annual program assessment during their final practicum. the 2020 program assessment surveys student data on implicit curricular items specific to inclusivity and oppression experiences. students’ reported experiences indicate that 71% had no experiences of intolerance or oppression, 12% did experience cultural intolerance, 11% experienced racism, and 4% experienced ethnocentrism. the identified context or location of the oppression was depicted as follows: 35% peer interactions, 31% classes, 21% faculty interactions, 8% school-based events, 3% virtual spaces, and 2% student organizational meetings (brady et al., 2020). although 71% of students reported no experiences of intolerance or oppression, it is noteworthy that 54% of all responding social work students demographically identified as white, with 13% black and 33% other (brady et al., 2020). these results indicate the school’s need to examine the experience of bipoc students more closely. recent atmosphere of racism at ou   on march 8, 2015, a video surfaced showing sigma alpha epsilon (sae) fraternity members on the university of oklahoma campus chanting and singing a racial slur. their national president immediately placed the fraternity on a “cease and desist” order. in january 2019, near the commemoration of dr. martin luther king, jr., two separate incidents of “blackface” occurred on campus. the first of these occurred over social media and the second was when an individual wore blackface while walking across the advances in social work, summer 2021, 21(2/3) 902 campus. in september 2019, yet another incident surfaced on instagram of an image of a student in “blackface” with the caption “another day, another case” (hermes, 2019). then, in february 2020, there were two incidents of professors who used the “n-----” word in their classes. the first was from the college of journalism who compared use of the “n----” word to saying “okay, boomer,” meant to be a derogatory term for older adults or people in the baby boomer generation. the second was a history professor who provided a trigger warning before reading aloud from a historical document that had the “n-----” word repeatedly throughout. both faculty members who said the “n-----” word caused pain and discomfort for students. the events of 2015, 2019 and 2020 gained national attention on news outlets and comedy programs further illustrating the work that needs to be done to combat racism on our campus (hassan, 2020; saturday night live, 2020; the daily show, 2015). identifying and analyzing manifestations of racism the pisab (n.d.) principle of identifying and analyzing manifestations of racism declares, “individual acts of racism are supported by institutions and are nurtured by the societal practices such as militarism and cultural racism, which enforce and perpetuate racism” (para.5). a critical examination of our process efforts to undo and dismantle racism requires confirmation of our theoretical foundations. standing on theoretical ground as a team of seven faculty members within the school of social work who represent multiple identities regarding ethnicity and positions of power as a group, we recognize that the basis of our work rests on pedagogy of the oppressed (freire 1970/2002) and critical race theory (sulé, 2020). both of these are foundational supports for dismantling racism within our school of social work. as social work educators, we honor the theoretical lenses through which our committee has endeavored to uphold this work. theoretical perspectives allow us to analyze our efforts through a continual praxis of reflecting on our actions; both as a committee that is unique in purpose and as individuals dedicated to this mission. each lens brings depth to discussion while also allowing for ample critical reflection. pedagogy of the oppressed members of this committee team are drawn to freire (freire 1970/2002) for his theoretical and pragmatic conceptualization of transformation through praxis (action/ reflection) within the process of dialogue to promote conscientization concerning power realities (freire institute, 2021). freire identified conscientization as “the process of developing critical awareness of one’s social reality through reflection and action” (freire institute, 2021, para. 6). the aim from freire’s pedagogy of the oppressed (freire 2002) is to educate people who are dehumanized and oppressed by a dominant social order that seek to maintain the status quo. his pedagogical lens provides inspiration and guidance as we process undoing racism ourselves while also implementing the work within our school. by enacting his ideas, we utilize a dialogical approach as a core method that offers trustriley et al./finding shelter 903 building and respect, thereby enabling a safe dynamic for raising critical consciousness toward undoing racism. critical reflection on theory, practice, and self-awareness are promoted through these safe spaces to encourage dialogue, enhance understanding, and build compassion. cooperation and communication are essential elements for transformation in this process of dialogical action and cultural revolution (freire, 2002). from the challenges of the instructor/student power dynamic, to that of peer-to-peer interactions, the team echoes the need for bravery in doing this work.  the undoing racism principles were selected as the means by which we dedicate our efforts to embracing dialogue that allows for resistance to change within the process, and encourages people to think and respond freely as unique and valued individuals, regardless of the cost. as freire (2002) proposed, we believe the continued practice of dialogue will yield long-term results. pedagogical cost of conscientization our task then at the school, the academy, and in society, according to freire (2002), is to create a relationship between the struggle for freedom from oppression and authentic authority. what is the cost of our commitment to actively undoing racism? to unpack this question, we know the development of critical consciousness requires that we share our power by being both engaged participants with our students and a witness within the process. freire (2002) reminds us that we must have critical knowledge of the current historical context, see through the people’s eyes, and understand existing societal contradiction. this does not mean that we are the experts quite the contrary. for faculty members of the academy, open dialogue about racism in the classroom may be uncomfortable because it requires true self-examination. teachers, mentors and leaders (even anti-racists well-intended), who have not yet discovered for themselves the invasive nature of their interactions, may become defensive when given feedback that their actions feel dehumanizing to recipients of their efforts. as professionals affirmed by the dominant culture, social work educators (regardless of their racial identity) can and do struggle with their place of privilege and power in promoting racial equity with students. societal oppression has a strong grip as a force that will attempt to continue to occupy what it perceives as its rightful place. remnants of the past will inevitably remain, even as transformation begins. freire (2002) explains that this is “…a highly educational process in which leaders and people together experience true authority and freedom, which they then seek to establish in society by transforming the reality which mediates them” (p. 178).  engaging in these change efforts is expensive. from the dynamic of extending relational power to the emotional impact of examining one’s truths, transformation is a demanding process. critical race theory critical race theory (crt) provides a framework for understanding the past and present experiences surrounding the formation of the urc. sulé (2020) lists five crt assumptions that apply. the first assumption is that racism is endemic and ordinary. the premise creates the expectation that racism would pervade the university and the school of social work. further, this racism would be unacknowledged based on its common nature. advances in social work, summer 2021, 21(2/3) 904 the second assumption is that progressive change occurs only when the interests of the dominant and oppressed groups converge. progressive changes requiring training for the student body, staff, and faculty were based on years of overt racist incidents committed by community members that had both received national attention, and also campus incidents that were only reported in the local paper. the recent national level media reports of overt racism by two faculty members appears to have been the change point to confirm that students were not the only issue. thirdly, crt proposes that people represent multiple identities that intersect to define experiences with racism. sulé (2020) states, “the lived experience of racially marginalized [committee members] is instrumental to challenging inequities” (p. 2). therefore, experiences of these members are a valued source of knowledge building. experiential knowledge is the fourth tenet that promotes the experiences of the oppressed as the source for understanding oppression and instituting change that is inclusive. it is through intentional socratic circles that we operationalize these experiences. the final assumption requires the rejection of meritocracy and colorblindness in our society. instead, whites have defined the standards that continue to favor them. the belief that merit defines our opportunities and successes perpetuates racism by denying those lived experiences (sulé, 2020). therefore, committee members expect to encounter inequity in the past and present academic communities. studying our method from these theoretical posts, we offer this case study as supported by greenwood and lowenthal (2005) of our undoing racism efforts and describe our use of narrative elements. first, use of case study as a methodology has the advantage of supporting a reflexive approach to practice. professional descriptive data presents evolving knowledge on the process for study and provides context for any adaptations that are needed. this approach can showcase “... knowledge that emerges as a consequence of experience rather than from a preoccupation with proof” (greenwood & lowenthal, 2005, p. 193). as a fitting addition within this case study, narrative strategy utilizes creative and collaborative research methods and provides both the structure and flexibility for describing our aims and efforts to dismantle racism (riessman & quinney, 2005). in reflecting on the choice of method for researching the experience of authentic white allies, hornung (2012) wonders if narrative approaches help build “…‘emotional muscle’ in order to go through, rather than around, the complex and traumatic history of race relations in the united states” (p. 96). just as social work is an academic discipline built on multiple theoretical frameworks, we offer our case study experience as one that is inclusive of our stories. rather than a thematic analysis, our stories reflect the parallel process (haber et al., 2009) that emerged from self-exploration and collective connections within the evolution of our case study. within this case study, the use of sharing and revealing our stories with one another has been crucial to the communication and trust-building process within our ongoing commitment to undoing racism at our school. as urc members engage in this difficult work together, some very experienced and others newly oriented to it, the praxis of reflecting in and on our actions occurred (schön, 1983, 1987). the willingness to be vulnerable within a culture of white supremacy by exposing personal histories of living and working, along with the fears and doubts we carry, is uncommon to most academic riley et al./finding shelter 905 committee work even among faculty colleagues with good rapport. the use of sharing our stories has been essential to processing the socially constructed impacts of white supremacy. support comes from holland and kilpatrick (1993) as their early efforts to enhance multicultural social work education promoted the use of narrative techniques. “stories invite teachers, practitioners, and students to consider how persons, in any culture, come to understand themselves as they do, how such understanding influences behavior and relationships and how change in self-understanding occurs” (p. 302). we offer a retrospective look at our committee’s efforts to date and include the parallel process we experienced through sharing collective connections uncovered along the way. developing leadership the pisab (n.d.) principle developing leadership states: “anti-racist leadership needs to be developed intentionally and systematically within local communities and organizations” (para. 3). as racist campus events prompted student cries of concern, an approach of leadership collaboration to address and undo racism within our school of social work began. students sound the alarm  the january 2019 campus events prompted conversations about racism in the common areas, classrooms, and hallways of our school of social work. these offered spaces to process the most recent high-profile racist incidents and vocalize the reality that racism was happening across campus with far more frequency than news outlets suggested. they were not producing results, however, and students wanted to do more than continually ask why this was happening. when the associate director of the school of social work asked leaders of the social work student association (swsa) if their meeting could serve as a student forum to debrief, they knew this was their invitation. essential to the process, the swsa undergraduate president, a black man, co-led the first listening session with a black social work faculty member, who leveraged two decades of experience in facilitating community conversations about race in diverse communities. the faculty member was versed in operationalizing the principles of undoing racism and between her guidance and the student’s enthusiasm and passion for racial justice, the first session moved forward. the student appreciated the official school-sanctioned platform and opportunity to co-facilitate this crucial discussion. he recalled, “i just needed a foot in the door. once i was in the room, i was ready” (dedrick perkins, personal communication, august 25, 2020). during that first listening session, safety was not yet established, and the tension was high. trust in social work school leadership was building due to the inclusion of student voices, and thus began our collective dedication to undoing. this foundational meeting set a course to follow for those who were ready for meaningful action, with faculty and staff attendees asked to simply “listen and learn.” many students at the first listening session approached with skepticism and uncertainty. some were angry that conversations had not been sooner; several brought their racial trauma in with them; a few shared what it was like to be a student of color in a primarily white space, while others wrestled with how to be advances in social work, summer 2021, 21(2/3) 906 an ally. students initially requested the next session be “students only,” but then wondered what faculty leadership had to say about racism, so future meetings were again open to all. fueled by a desire to respond with meaningful action, faculty and students set about to write the next chapter in this story. the undoing racism principles helped create sacred (or intentionally safe) space and united everyone to get to work. this collective action led to the intentional organization and planning for an experiential learning opportunity for students and faculty to learn from history by engaging in a social justice spring break 2020 trip along the historic civil rights trail to birmingham. this student group also launched a successful fundraising campaign and hosted a benefit dinner that together raised over $5,000 to support the trip. these immersive plans were publicized in the community and university newspapers. involved students gained valuable leadership experience and community around their commitment to racial justice as they engaged in these efforts. due to covid-19 the trip was postponed; however, with the undoing racism principles in place to guide and protect our path forward, faculty sought next steps to support student voice during the global pandemic. creating a climate of safety at the school following the initial student listening sessions, in march 2019 at a faculty meeting, members acknowledged the challenges for our campus regarding racism, and our responsibility to students for holding conversations about race. faculty members voiced the need to demonstrate our ongoing commitment to addressing racism. a motion was approved for an “undoing racism” committee to develop a strategic response to undo racism within our school and campus, provide advice on continuing education, and to help build bridges with students on this work. we vowed to acknowledge historical patterns of racism and to work on reconciliation within our school (march 8, 2019 faculty minutes). it was apparent we needed a long-term, committed team to address ongoing racism. this work would be arduous, so it was paramount that members be self-appointed to do this work of their own accord. committee members were challenged to address and manage the dynamics of power and privilege due to race, tenure status, and administrative authority. co-chairs stepped up because they represented crucial communities, and each had years of research and practice in the areas of race and culture. an administrative member offered support and commitment. as with the creation of any group, the committee struggled with forming and norming (connors & caple, 2005) and specific barriers challenged our academic committee. due to the distance between our two campuses across the state, we relied on electronic communication, which can lack the full context and of a writer’s intention. though we expected some tension due to developing group dynamics, this forced each of us into a parallel process (haber et al., 2009) of individually doing the work while also experiencing the storming associated with group formation (connors & caple, 2005). face-to-face communication has been the most productive for strategizing our anti-racist work. through one-on-one and group retreat settings, the intentionality and real-time processing of conversations has proven to be our best pathway through the tension. due to varied campus cultures, erupting community stressors, and emerging consciousness about our individual riley et al./finding shelter 907 racism journeys, we expect challenges will continue. however, with each situation comes new insight and greater depth. we are not discouraged by our struggles, but rather see them as a model for anti-racist practice that generates communication patterns of growth and resilience. maintaining accountability the pisab (n.d.) principle of maintaining accountability affirms “to organize with integrity requires that we be accountable to the communities struggling with racist oppression” (para. 7). in addition to these guiding principles, specific methods served to respectfully hold and facilitate difficult conversations with respect for both committee members and community members. sacred work and socratic circles to understand the methods chosen to implement this sacred work, requiring both safety and trust, the newly formed urc adopted the use of socratic circles (chisom & washington, 1997; freire, 2002; thomas & goering, 2018). this approach allowed us to investigate and discuss the truths of our varied opinions (to agree where we could and agree to disagree where we could not) and to continue the work tasked to do. in partnership with the student association, the urc hosted four listening sessions and facilitated the mirrors of privilege: making whiteness visible (gutierrez & shwartz, 2006) structured discussion sessions. this documentary features white social justice advocates and their confrontation of racial privilege. further faculty listening/dialogue sessions were also held for those who were interested in learning more about the undoing racism principles (pisab, n.d.). in addition, workshops were facilitated across campus, at the nasw state conference, as continuing education events, and at field education training for faculty and staff.  the committee also developed a 2020 undoing racism film festival series for the campus community in partnership with three departments. due to the covid-19 campus closure, the film series was cancelled after the first movie event. individual committee members were also planning to attend undoing racism training in new orleans and portland; however, those were also cancelled. accessible online member trainings are now the focus. sheltering in place at the time of our committee establishment, campus offices for diversity and inclusion were also being developed. with pressure from university administration to be reactionary and expansive, as a team, we felt the need to start with intentional and centered aims. initially, we declined invitations to participate in dei. the urc chose to focus specifically on race rather than on broad categories of inclusion for the purpose of sustainability. a founding team member had recently left the committee and our nation was facing a pandemic, plus black lives matter uprisings. in late spring of 2020, the urc also made the difficult decision to close membership for several months. the committee’s effort to maintain its focus has at times resulted in other faculty members feeling excluded, and accusations about the committee’s exclusivity have popped up as red flags. while advances in social work, summer 2021, 21(2/3) 908 frustrating, these are no surprise, but rather a manifestation of the nature of this difficult work around race. to mitigate these reactions, we chose to use social media messaging and develop opportunities for involvement. the team felt called to hunker down and emerge with a vision for the coming year. during this regrouping, we decided to expand communication and collaboration efforts. soon, the urc will thoughtfully add new members who are drawn to this work. although we value the intimacy of a smaller group, there is also value to greater diversity of voices at the table, including those of students. gatekeeping the pisab (n.d.) principle of gatekeeping reminds us, “persons who work in institutions often function as gatekeepers to ensure that the institution perpetuates itself. by operating with anti-racist values and networking with those who share those values and maintaining accountability in the community, the gatekeeper becomes an agent of institutional transformation” (para. 4). engagement of undoing racism within our school community prompts us to see the significant connection that social work gatekeeping has to our efforts.  as a role that is crucial to the social work profession, gatekeeping functions to ensure a high standard of competence and to protect the public from potentially incompetent or unethical social workers. lafrance and colleagues (2004) suggest that gatekeeping is an obligation to ensure that students resolve the personal issues that could interfere with their becoming competent practitioners. this becomes more intense when adding a race/racism context since, as social work educators who are the gatekeepers; we are also obligated to eradicate unconscious or implicit racial bias ourselves to be effective in our jobs.   during committee formation, the urc members worked conscientiously to establish our mission, vision, activities, and roles, while being mindful of the balance of relational power (chisom & washington, 1997; lerner, 2010). schools of social work are reminded to ensure the gates are open to students who have been marginalized by white supremacy (billings, 2016; singleton, 2015) and provide sacred spaces inside for everyone (chisom & washington, 1997; younes, 1998). the practice of anti-racist student advisement, and creating a school environment that enables black and brown students to succeed, can be challenging (kendi, 2020; singleton, 2015). as a gatekeeper in an institution predominately white, actively recruiting faculty and staff with lived experience as indigenous or as people of color can be our most compelling efforts. the committee began to respond to the wisdom of anti-racist gatekeeping practices in a proactive way. sharing culture the pisab (n.d.) principle of sharing culture claims: “culture is the life support system of a community. if a community’s culture is respected and nurtured, the community’s power will grow” (para. 9). paulo freire (2002) echoes this principle in his sentiments as well: “the pursuit of full humanity, however, cannot be carried out in isolation or individualism, but only in fellowship and solidarity; therefore, it cannot unfold in the antagonistic relations between oppressors and oppressed” (p. 85). riley et al./finding shelter 909 many students told their stories in the listening sessions, which helped explain their beliefs and frame of reference, and how they interpreted the incidents that were occurring on campus. students also expressed how the incidents on campus were changing their view of the world, and altering some of their beliefs and expectations. as students shared through these and other events, urc committee members began to learn with them how best to process these incidents on campus. collectively, we began to form ideas of what might be needed to help our students and faculty heal, grow and move forward. the students and the committee members began a parallel process of learning how to cope and to reframe the negatives into positive action (haber et al., 2009). the committee members began to tell their stories in our committee meetings, furthering both individual and committee growth. some members shared these stories with students as well. we dedicated ourselves to sharing cultures, calling out and acknowledging acts of racism within the school and university, and to maintaining accountability to one another. undoing internalized racial oppression the pisab (n.d.) principle of undoing internalized racial oppression is known to manifest in the forms of inferiority and superiority. internalized racial inferiority is described as, “the acceptance of and acting out of an inferior definition of self, given by the oppressor, is rooted in the historical designation of one’s race. over many generations, this process of disempowerment and disenfranchisement expresses itself in self-defeating behaviors” (para. 10). internalized racial superiority is described as, “the acceptance of and acting out of a superior definition is rooted in the historical designation of one’s race. over many generations, this process of empowerment and access expresses itself as unearned privileges, access to institutional power, and invisible advantages based upon race” (para. 10). reflecting on the richness of our efforts to effectuate this work, urc members offer collective stories on the challenges of using praxis and reflection-in-action (schon, 1987) to examine our pedagogies along with our personal racial identities and internalizations. though not a topic of exploration for this manuscript, we do acknowledge that the struggle to promote racial equity is a dynamic process that is distinctively different for bipoc educators and white educators. this committee understands that to do this type of work well within the school, we must allow differences to strengthen and not divide us. to accomplish this, we looked to the principles of undoing racism to help us understand our own internalized racial inferiority and superiority. individuals on the committee differ regarding positionality. each has come to their own identity of privilege and power based on such things as race, income, educational attainment, and gender. currently, all members are female, but do vary in power and privilege within the school. one member is from upper administration at the school of social work, several have ph.ds. and the rest have msws. the racial makeup of the committee includes one woman of american indian and alaska native identity, one a black woman, with the rest identifying as white. one of the white members also identifies as gay. all of these racial terms are in the own words of members as personal identifiers, and our ages span four decades. the oppression experienced by members, due to the intersection of their race and gender, or gender and educational attainment, or even their sexuality and society, also influences the lenses through which each of us views advances in social work, summer 2021, 21(2/3) 910 undoing racism. some members have been addressing racism for several years and others are new to the work. white member awareness concerning their own white privilege varies. our collective efforts are enriched by the deepening and evolving internal understanding of the impact of racism, and vice versa. christina’s story  the headline, bold type across the front page of the local newspaper, “ou student in blackface,” stared up at me while i sipped my morning coffee. five months into my role as interim director of the school and my heart sunk. what do we say that hasn’t already been said? what can we do to respond to the pain and fear experienced by our students? what do my colleagues think? these questions swirled in my mind as i began to enter the work of undoing racism with intention. though i found myself growing into this new area of work, i was not prepared with the skills and training needed to lead effectively. i leaned heavily upon the expertise of a new faculty member with years of practice in undoing racism but only months of experience on our faculty. i was and continue to be grateful for her steady mentorship and encouragement as i took my firsts steps in active anti-racist work. she introduced me to the principles of undoing racism and modeled the deeply intensive work of facilitating these conversations about race, privilege, oppression, and white supremacy. the following weeks were full as i composed a statement calling out racism on our campus and hosted listening sessions with students, faculty, and staff within the school. a common message emerged from these listening sessions: the students wanted sustained action from the school. as i raised my hand to join the ur committee during a faculty meeting, my head filled with doubt. i’m not ready to lead others in discussions about race. what if i say or do something offensive? i am the acting director; will my role as an administrator stifle the process of the group? on the other hand, as a leader i cannot remain silent on the issue of racism and white supremacy.  through the remainder of that spring semester, i forged ahead letting my intentions and actions move beyond my knowledge and skills. the summer was filled with reading white fragility (diangelo, 2018), processing, and training on the principles of undoing racism alongside my urc colleagues. we prepared for the upcoming school year and the return of our director from a yearlong sabbatical.   fall 2019, i gratefully stepped back into my role as associate director of the school and the university welcomed our third president in three years. the urc established a mission and vision statement. during spring 2020, i left for a semester sabbatical and from active work on the committee. i returned in may as our state was reopening after a period of quarantine, finding ourselves uncertain how to proceed with this work in our new virtual environment. summer 2020 unleashed a wave across the country of racist violence, protest, and calls for action to fight racist policies and practices. school colleagues stepped up to lead book discussions, listening sessions, organize speakers, and talks about racism. i found myself pulled by the urc to maintain intentional and steady work aligned with the principles, while also being pressed by administration of the university to engage in an riley et al./finding shelter 911 ever-growing list of more. we experienced tension between what university leadership expected us to be and what our urc mission and vision statements say we are. renea’s story as with most of my service and research, i approach it with the idea of opportunities to be of service in my various communities without breaching integrity. i look for ways to increase race literacy and relevancy and the need for incremental change that comes from learning race literacy. my lenses when engaged in race work reside in discourse framed by undoing racism (pisab, n.d.) and/or pedagogy of the oppressed (freire, 2002). both frames allow for the unpacking of systematic oppression and systematic racism. both allow for development of language between two individuals, two communities, and two organizations, in a collaborative or collective manner which paulo freire (2002) presents as one of the gifts of conscientization.   we buckled our seat belts and planned the first meetings that year. we were naïve to think that we would have one meeting and get back to social work education as usual. that did not happen because it became necessary to add more faculty to the working process of trying to dismantle white supremacy with students in a socratic circle (listening session) at the school of social work. we had pop-up cafés and planned listening sessions for various types and combination of groupings. as the students started to learn more about the process of engaging in undoing racism work, the students, faculty, and staff, decided they needed more information and wanted more engagement that was practical; subsequently, the undoing racism committee was born. the committee is self-selecting and progressive in doing anti-racist work. the dance of a dialogue is empowering for all. i began the journey of dismantling white supremacy in social work education after our associate director asked me to provide a listening session for our students challenged by the racist behaviors on our campus. students stated they wanted to talk about racism, some of the racist behavior on campus and that of faculty members too, and they wanted the school to provide a safe space to do so. dr. christina miller’s response was quick in approaching me about facilitating a listening session defined by the students as a sacred and safe place to have dialogue about race. i had been doing race work within my community for the last 20 plus years. as a grassroots activist now academic, i shifted this work to the undoing racism framework as developed by the pisab’s principles (n.d.).  lisa’s story  i was at an inter-tribal stomp dance when i began receiving texts from students that a video of an ou student in blackface was going viral. students were upset and angry. i validated the individual student reactions and assured them i would make the social work administration aware. i contacted the acting associate director to let her know that students were reacting to the racist video. i was shocked when she immediately responded by drafting a statement denouncing the incident, and by the end of the evening, had a statement from the school completed. i had never expected a public statement. overt racist incidents advances in social work, summer 2021, 21(2/3) 912 were not new; however, we had never published a statement before. i was grateful for what i interpreted as a new responsiveness. the acting director validated my interpretation with her call for a staff/faculty meeting following the blackface incident. at this meeting, i spoke about the overt and covert racism our students experienced and my alienation as an ethnic faculty member. i asked that we form a committee to institutionalize our work against racism.   as an american indian and alaska native woman, disconnection has been a constant in my academic career. my cultural teachings that focus on a communal sense of self, balance in all relationships, and collaboration, have been at odds with the individualistic and competitive orientation of american educational institutions. one critical change came with my exposure to jean baker miller’s (1986) relational cultural theory (rct). reading this work gave me a feeling of coming home based on synergy with my cultural teachings. rct focuses on the primary factor of relationship in understanding human development. miller challenged traditional western theory as misguided in its focus on the attainment of individuality as the pinnacle of development. instead, miller (1986) theorized that we grow through and toward connection throughout life. connection is defined as an authentic interaction between two or more people that is balanced in its mutual empathy and mutual empowerment. this type of interaction is poised to become a growth-fostering relationship characterized by zest, clarity, sense of worth, desire for more relationships, and productivity. in contrast, when interactions lack authenticity, empathy, and empowerment, disconnection results. disappointment and a sense of being misunderstood ensues that can lead to an impasse, danger, and even violation.   relational cultural theory captured my marginalized reality in higher education. additionally, it validated my approach to teaching and mentorship (byers et al., 2020). finally, it offered a framework for approaching the aims of the committee. now in our third year, i can report that it has been difficult to share my and my community’s reality. fear was ever-present as i anticipated individual repercussions for sharing a reality of racism. the white members of the committee listened and never denied my lived experience. instead, they have used those experiences as reflection points. my connection to the other ethnic member has deepened with empathy that can only be gained from sharing the micro to macro tortures of racism. i sense a growing mutual empathy and empowerment based on listening and learning from the stories of our students, our communities, and ourselves. threads of connection are beginning to replace the burdensome blanket of academic isolation (byers et al., 2020). kirby’s story  i started this work as a new employee in the department not only new, but young, and without a phd. i knew i entered academia at a disadvantage. my work experience brought value and knowledge, but i knew i lacked influence in some spaces. i decided to stay steady and constant, as much as could be. there would be no race to acknowledgement or recognition because i knew a foundation would need to be built. at times, i felt useless spending my time reading and listening. we live in a world that prioritizes productivity over all else, but we forget that no one ever becomes successful overnight. riley et al./finding shelter 913 as systems began to shake across the university through sit-ins and vocalizations of inequality, i felt steady. these were the moments for which i had been preparing. i chose not to act as a leader or advocate running into the fire, but rather as a place where others could come to rest. i sat across from students who told me tales of the injustices they had faced. i listened to fellow faculty members express their frustrations. i created space in my classes for discussion and validation. i would not back away, i would not break. i would dig in and find strength in the stillness. a shelter in the midst of a storm. throughout this process, i found myself modeling what it means to learn and grow as an anti-racist. changing our mind or admitting that we were wrong is not weakness, but rather, displays resiliency and awareness. walking along with our students as we grow and learn does not disqualify us from teaching. for us to become anti-racist, it means that there is hard work to do. in those moments spent reading and listening, we must not disqualify ourselves. missteps facilitate learning for us, and those around us. so, build your foundation and find your team, for there is still so much work to be done. jennifer’s story   the spring semester of my first year teaching full time was just underway when two back-to-back racist incidents shook our campus. i was lecturing when the room jolted to attention one student had seen a social media post of a person in blackface walking through campus. i had never watched in real time how the life could be sucked out of a room so quickly. we were consumed and all questioning, why does this keep happening? as the undergraduate coordinator, part of my job was helping students figure things out, but there was no course override for racism. so, what now? insulated by my white privilege, i was ill equipped to lead the needed critical conversation about race.   a few days later, outraged students linked arms and walked through campus in protest. some held signs; others wore tape over their mouths bearing the words #stillunheard. was i listening? the group stopped at the steps of the university president’s office chanting, “what do we want?” “justice!” how was i standing up for justice? there are minority students, staff, and faculty who did not (and still do not) have the same sense of safety and belonging that i had come to expect at this predominately white institution. i spent the rest of the academic year intentionally learning and listening. it never felt like enough. over the summer of 2019, i committed to doing more. the words of my colleague who reminded us “if it can be done, it can be undone” were ever present in my thoughts. so, what could i do? the 2020 bachelor’s program directors conference was scheduled to take place in birmingham, alabama during our spring break. with the blessing of our associate director, i approached the same colleague who had opened my eyes to the undoing racism work about taking a group of students to the conference. twelve social work students joined our planning efforts and aptly helped name the journey “historical footprints.” we had finalized an itinerary that would include daily opportunities for individual reflection and for large group discussion. one student checked out recording equipment for video diaries and we developed plans to highlight key takeaways from the journey to carry lessons forward through the creation of a historical footprints podcast. then, four days before we were set to leave, the global pandemic brought the country to a screeching halt. advances in social work, summer 2021, 21(2/3) 914 the conference was cancelled, historical sites and museums closed, and university travel was banned. we were devastated. however, the time since then has brought additional meaning to this work. the last five months of protests have caused much heartache but have also given me hope as i see racism challenged and change demanded. important conversations continue about how to discuss race in our classrooms and on our campus, book clubs that encourage authentic dialogue about race, and a level of support and accountability. most days it still does not feel like enough. nevertheless, this journey my journey of learning and unlearning continues. charlotte’s story   growing up in the late 1960s and early 1970s in a northern college town where the only people of color were the migrant farm workers who lived on the outskirts of town (and whom no one paid attention to) taught me nothing about oppression nor did it prepare me for the work i am engaged in now. in retrospect, if not for some key events in my life, this work might not even be important to me. my first encounter with a black person was in high school, my second while working in an oil refinery in the mid-70's. being paired with the only two black men at the refinery taught me a bit about racism. i saw hatred and the use of power by those in power in ways that sickened me all done simply because they could. it was not until 1998 though, during my msw, that my education in oppression and racism continued. a black professor accused me of being a racist and i took issue with his statement. he told me i had no idea of how privileged i was simply because i was white. what i learned from those experiences helped prepare me for my 20 years in the field.   yet i admit i still was not truly prepared for the racial incidents that began to occur on our campus in early 2019. i felt many emotions, anger being the first one. anger that this could still be happening, anger that what i had seen as progress over the last decade was not true. then guilt that i had not done more in my career, that i was gullible enough to believe that progress had really been made. i knew that i had to do something and working on the urc has been a good outlet for my anger and guilt.   i will never know what it is like to be oppressed or to be a person of color and to be hated for it. i do know what it is like to be white with all the privileges that affords me. this is what brought me to this committee; what makes this work important to me. beyond the urc, my charge is to try as best i can, wherever and whenever i can, to educate other white people about their privilege. i speak about white privilege in my classes, no matter the subject of the class, do presentations when asked, take the time to have conversations with individuals when the opportunity presents itself, and use my privilege of those unearned benefits to benefit others. i must remember to maintain accountability to those who are struggling with racist oppression. ann’s story  as an adult boomer, from a family of generational legacy and alumni pride in our state’s flagship university (the university of oklahoma), i had always believed our town riley et al./finding shelter 915 and campus were among the safest in the country. ironically, coloring this idyllic impression was my white privilege and what i thought was my non-racist view of the world. growing up i was only minimally aware of my immersion in white supremacy. now, i more readily recognize the institutionalized presence of white man’s manifest destiny. the culture and climate here are thick with resistance to being uprooted and undone. the more aware i become, the more i sense the tenacity of these historic roots and their powerful grip. how do we uncover resistance so deeply planted to ensure true racial justice?   when initially presented, i did not raise my hand to join. though i was deeply concerned for our students of color, i doubted whether i was best for this committee. i had never taught the diversity course and wondered if those faculty members were better prepared (comfortable) than me to act on and articulate what the school and our students needed. after a year of engaging in this work, i still feel somewhat inadequate like a weak link trailing my colleagues just trying to catch up. the intentional work of learning and living the principles of undoing racism (pisab, n.d.) takes time and continues to challenge me, both personally and professionally. with developing critical consciousness, i do believe “my heart is in the right place”; but i rightly question that of my privilege. honestly, i have made mistakes. after i offended a respected colleague, i met with her and apologized for having allowed my privilege to lead. because she is brave and believes in this work, she was willing to help me begin to understand her lived perspective as a black woman with a worldview much different from mine. i value the relationships that are helping me grow. in mid-march 2020, i set off to attend the people’s institute training; excited about the deep work ahead and the tools i hoped to walk away with to promote this work. unfortunately, the training was cancelled just as i arrived in new orleans; suddenly the pandemic was real. amid the public health crisis and political tension, nationwide protests are collectively exposing the ugly reality of ongoing white supremacy and raising our (primarily whites’) awareness that black people are in dire need of protection. these systemic atrocities present opportunities for dialogue that require safe space in the classroom. in my graduate direct practice courses, the impact of trauma (historical, current, and now social media triggered) presents a lens to explore clinical treatment approaches with clients of color and for raising white consciousness. as i create teaching moments based on the pisab’s principles and pedagogies that promote praxis for student truths about their own racism, i aim to be actively and accountably anti-racist myself.  analyzing power the pisab (n.d.) principle of analyzing power contends that, “as a society, we often believe that individuals and/or their communities are solely responsible for their conditions. through the analysis of institutional power, we can identify and unpack the systems external to the community that create the internal realities that many people experience daily” (para. 2). indicative of this work, our case efforts to undo racism and analyze power within our community at the school of social work and the university is an on-going and persistent work in progress. advances in social work, summer 2021, 21(2/3) 916 the long game power is difficult to deconstruct when it is built into the foundation of an institution. racism is part of the origin story of higher education more broadly and must be addressed by the development of new infrastructure. students, faculty, and staff from multiple departments have given voice to historical trauma and acknowledgment that racism is not just a storm from our past; we are, in fact, in the eye of the storm. university leadership has historically adopted reactionary measures to racist incidents. these have sent the outward message “not on our campus” and chipped away at the foundation but have not led to a systemic transformation. important changes at our university have happened since february 2019, fueled by a convergent interest between oppressed and dominant groups. individuals at all levels have said, “enough is enough” and the university has finally acknowledged the value of dismantling racism. the last eighteen months have led to numerous positive developments, including a restructuring of the first-year student diversity experience; creating the office of diversity, equity, and inclusion (dei); forming a bias response committee; and increasing diversity and inclusion education for faculty and staff. in addition, a #weare media campaign focuses on dei values, and beginning 2021, a requirement that all students will take the new dei course. in september 2020, the student government authored the indigenous land acknowledgement to pay respect to the indigenous history of the university within our state of oklahoma. further progressive institutional change began with the search and appointment of a vice president of diversity and inclusion in january 2020. for the first time in the history of the university of oklahoma, we have mandated training on diversity, equity, and inclusion for not only students, but also administration, faculty, staff, and even regents. tracking the data shall inform future training needs. in addition, a protocol using restorative practices is in development for student-experienced bias incident reporting.   a true anti-racist reckoning must come from all levels of power. at our school of social work, a convergence at various levels of authority received support. first, officially authorized conversations about race occurred in an open forum lead by the experience of a new non-tenure-line faculty member who represents the black/african american community. secondly, shared power from faculty voices concurred in response to the students’ call for action. as we continue to weather this difficult work, student voices will always be the source of energy for our efforts. the future forecast the undoing racism committee is dedicated and committed to long-term efforts to dismantle racist and oppressive systems. after meeting with the university’s new vice president of diversity and inclusion, the urc will join in efforts to institute a solid foundation for anti-racist work across the university of oklahoma’s campuses. motivated by the newly established partnership, and humbled by the invitation to participate, committee members feel ready to embrace both the anticipated resistance and hopeful growth that lie ahead. through continued learning alongside our students and colleagues riley et al./finding shelter 917 within the school, we plan to secure training from the people’s institute. one school of social work recently conducted an exploratory study of their student’s responses to pisab training (hamilton-mason & schneider, 2018), reporting outcomes that recognize the reinforcing nature of effective antiracist pedagogy for both the students who learn and the faculty who commit to teaching it, as well as, the impacts on the implicit curriculum. according to ronald chisom, founder of pisab, “…effective community and institutional change happens when those who serve as agents of transformation understand the foundations of race and racism and how they continually function as a barrier to community self-determination and self-sufficiency” (personal communication, may 18, 2021). although the journey ahead is long, we are encouraged by the power of knowing that we are not there yet as #wearelearning, while also unlearning, along the way. references billings, d. 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(1998). the gatekeeping dilemma in undergraduate social work programs: collision of ideal and reality. international social work, 41(2), 145-153. https://doi.org/10.1177/002087289804100203 author note: address correspondence to ann riley, university of oklahoma, anne & henry zarrow school of social work, 700 elm ave, zarrow hall, norman, ok, 73019. email: annriley@ou.edu https://pisab.org/our-principles/ https://doi.org/10.1177/1473325005058643 https://www.youtube.com/watch?v=kol7re3wcna https://doi.org/10.2307/j.ctvpbnpjg.24 https://www.okhistory.org/publications/enc/entry.php?entry=se006 https://doi.org/10.1093/acrefore/9780199975839.013.1329 https://www.youtube.com/watch?v=tudyrn6hgps https://pisab.org/our-principles/ https://doi.org/10.1080/00098655.2017.1411132 https://doi.org/10.1177/002087289804100203 _________ donisha shepherd, msw, political outreach strategist for full circle strategies, houston, tx and founder of d political, and social worker, llc, richmond, tx. suzanne pritzker, phd, msw, associate professor, graduate college of social work, university of houston, houston, tx. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 241-258, doi: 10.18060/24135 this work is licensed under a creative commons attribution 4.0 international license. political advocacy without a choice: highlighting african american political social workers donisha shepherd suzanne pritzker abstract: from social work’s early days, african american social workers were engaged in what today is termed as political social work, yet their work is often overlooked in both social work education and the broader retelling of our profession’s history. this article examines the early history of african american political social work, using lane and pritzker’s (2018) five domains of political social work. we outline ways in which african american social workers’ lived experiences led them to engage in political social work to support community survival and to challenge injustice during the black migration period post-slavery, the jim crow era, and the civil rights movement. even as broader structural dynamics sought to exclude african americans from the political arena, dynamic and influential african american social workers laid the groundwork for modern political social work. they politically engaged their communities, lobbied for legislation, worked in the highest levels of government, supported campaigns, and ran and held elective office to ensure that civil rights were given and maintained. this manuscript calls for a shift from social work’s white-dominant historical narrative and curricula (bell, 2014; deloach mccutcheon, 2019) to assertive discussion of the historic roles african american political social work pioneers played in furthering political empowerment and challenging social injustice. keywords: political social work; african american social work; social work pioneers; social work history too often, social work education lacks attention to diversity in teaching students about the profession’s historical context. within social work education, black and brown communities historically have been constructed as oppressed people in need of rescue from those who often resemble the oppressor. this can ignore the survival tactics through which african american social workers have sought to dismantle injustice throughout the profession’s history, including the black migration period post-slavery, the jim crow era, and the civil rights movement (mccoy, 2020; peebles-wilkins, 1994). while african americans could not access formal social work training until 1911, african american educators were already teaching social work values to survive adversity and advocate for basic human rights (gary & gary, 1994). from social work’s early days, many african american social workers – whether with a professional degree or excluded from the profession due to structural barriers to accessing a formal social work education – were engaged in what today is termed as “political social work,” yet their work is often overlooked in both social work education and the broader retelling of our profession’s history. these dynamic and influential african american social workers laid the groundwork for modern political social work, as they politically engaged their about:blank advances in social work, summer 2021, 21(2/3) 242 communities, lobbied for legislation, worked in the highest levels of government, supported campaigns, and ran and held elective office to ensure that civil rights were given and maintained. using lane and pritzker’s (2018) five domains of political social work, this manuscript examines the early history of political social work. we offer a historical corrective that brings attention to a deep history of african american political social workers and associated organizations fighting for social, economic, and political justice. while the history of african american engagement in political social work stretches across over a century of practice, we focus here on political social workers from the progressive era of the late 1800s, early 1900s, and the first half of the 20th century through the civil rights movement. while some of the individuals discussed here did not receive formal social work training or credentials, each has since been described as part of the profession (e.g., through recognition by national association of social workers [nasw] foundation (n.d.) as a social work pioneer). we shift the current social work narrative by assertively outlining ways in which early african american social workers’ lived experiences led them to engage in political social work for the survival of their communities. african american social workers created their own organizations and structures for communal care and political empowerment at a time when well-known frameworks for activism and advocacy commonly associated with social work, such as white-led settlement houses, were not accessible to african americans (hounmenou, 2012). political social work’s five-domain framework the national association of social work’s (2017) code of ethics calls on social workers to engage in political action, expand choice and opportunity, promote policies that protect the rights of all people, and confirm equity and social justice for all. while social workers have engaged in political action throughout the profession’s history, the specific term “political social work” originated in the 1990s and gained growing traction in the profession beginning in the late 2010s. political social work refers to “social work practice that explicitly attends to power dynamics in policy-making and to political mechanisms for eliciting social change” (lane & pritzker, 2018, p. 4). although there has been extensive scholarship on social workers’ contributions to social policy, the first framework that explicitly focuses on social workers’ involvement in political action was developed by lane and pritzker (2018). this five-domain framework is outlined in table 1. in the sections that follow, each domain will be utilized to highlight the historical foundations of african american engagement in political social work. shepherd & pritzker/political advocacy without a choice 243 table 1. domains of political social work practice domain example strategies domain 1: engaging individuals and communities in political processes • increasing voting and voter registration via community outreach • working with communities to build political power • advocating for increased voting rights and more just and responsive electoral processes domain 2: influencing policy agendas and decision making • influencing candidates’ policy agendas • influencing elected officials’ policy agendas and policy decision-making • influencing government agencies’ policy agendas and policy decision-making domain 3: holding professional and political staff positions • working on policy via civil service or other professional positions • serving as a political appointee in a government office • working in an elected official’s office domain 4: engaging with electoral campaigns • working as a volunteer or paid campaign staff member • seeking ballot initiative or referenda passage or defeat • educating voters about policy issues at stake in specific campaigns • influencing which candidates run for elected office domain 5: seeking and holding elected office • running for elected office • serving in elected office sources: lane and pritzker (2018); pritzker and lane (2021) african american political social workers from the profession’s earliest days, african american social workers harnessed collective power to work towards social and political change. this political activity emerged in response to structural and individual violence targeted toward african americans, as well as repeated systematic efforts to deny black americans core civil rights (lowe & hopps, 2007). while the 15th amendment to the u.s. constitution, ratified in 1870, made it unconstitutional to deny black men the right to vote on the basis of race, social work’s early years saw extensive denial of black political rights. jim crow laws and practices explicitly erected barriers to black political participation; for example, in mississippi, just 9,000 of 147,000 black citizens of voting age were registered to vote by 1890 (erb, 2018). even as early white social workers like jane addams actively engaged in the women’s suffrage movement, many explicitly advocated for white women’s voting rights at the expense of those of black men and women. the ongoing violence, oppression, and denial of political rights created a unique sociopolitical experience for black americans (carlton-laney & hodges, 2004; lowe & hopps, 2007). as a result, african american social workers, like those discussed in the following sections, worked to build political awareness, and organize fellow african americans to ensure communal survival and self-empowerment (carlton-laney, 1999). while we specifically locate the work of each pioneering political social worker within a single domain, the methods they utilized extend across multiple domains of political social advances in social work, summer 2021, 21(2/3) 244 work, illustrating the substantial breadth of african american political social work engagement and influence. domain 1: engaging individuals and communities in political processes early african-american political social workers paired political advocacy with individual and community outreach and education, often key to enabling impoverished african americans to receive assistance during an extensive era of segregation (mccoy, 2020). social work education and retellings of the profession’s early history tend to focus on settlement houses like hull house, founded by jane addams to create social welfare services for european immigrants and migrants in industrial cities while organizing residents around political reform efforts. yet like many contemporaneous services created by white americans, the settlement houses commonly described in social work education were not accessible to african americans migrating to urban areas. despite such exclusion, african american female political social work pioneers used the hull house framework to create and provide safe havens for migrant african americans, many of whom were experiencing similar circumstances as european immigrants including poverty, lack of housing, and limited basic resources (hounmenou, 2012). these settlement houses provided housing, resources, and opportunities for residents to develop educational, recreational, and social skills to survive during uncertain times, while also teaching residents activism, advocacy, and the importance of civic engagement. one such leader was ida b. wells-barnett, who created a settlement house for black men in chicago. while wells-barnett did not receive a formal social work education, she is recognized as a social work pioneer (nasw foundation, n.d.). her research, activism, community organizing, and program implementation skills exemplified a dedication to advocating for social justice and uplift for african americans. wells-barnett believed that the survival of african americans was equally important as the survival of white americans and argued that african american residents should be both informed and part of efforts to identify social problems and help create solutions to those issues (stevens, 2003). wells-barnett worked with communities to build political power using journalistic strategies. she authored anti-lynching pamphlets designed to spread public awareness and call readers to action around the blair bill, which would have created a federal task force to investigate all rapes and lynchings in the previous decade (bent-goodley, 2001). her fearless advocacy efforts led to a decrease in lynching of african american men (brown & stentiford, 2008). in addition to creating national and international awareness and promoting anti-lynching activism, wells-barnett held leadership positions in numerous african american organizations including the national association of colored women (nacw), national afro-american council, and the national equal rights league, and co-founded the national association for the advancement of colored people (bentgoodley, 2001). she utilized these platforms to build awareness and organize social justice, racial equity, and gender equality efforts (stevens, 2003). she was a renowned leader in ensuring african americans participated in democracy and had their voices heard because she understood that the survival of the race depended on it. shepherd & pritzker/political advocacy without a choice 245 born into slavery, victoria earle matthews was brooklyn, new york’s first african american social worker (thorpe, 2015). like wells-barnett, matthews utilized journalism to educate and organize supporters around political activism. also, like wells-barnett, matthews was often referred to as a “black club woman,” a phrase used to describe women who created social service programs that organized, educated, and expanded political power among african american women (stevens, 2003). matthews was actively involved in founding these clubs and the nacw, in response to the social and political conditions of african american women in the jim crow era (waites, 2001). in 1897, matthews founded the white rose mission in new york. this black settlement house began as a social haven for women and children but grew into temporary housing for african american women migrating from the south who needed assistance surviving their new urban environment (hounmenou, 2012). matthews provided education, self-help trainings, and services while organizing residents into political engagement and unions. she advocated for preservation of african american history and facilitated the social uplift of african american women through political awareness and engagement. through the white rose mission and the black women clubs that expanded throughout the u.s., matthews’ efforts helped to shape the social welfare movement (hounmenou, 2012). with the survival of the african american race in mind, wells-barnett, matthews, as well as other black female political social workers of the progressive era like jane edna hunter and lugenia burns hope, illustrated the power of this first domain (carlton-laney & hodges, 2004). they understood the importance of empowering african americans through education and community organizing, raising awareness, and mobilizing african americans around the social injustices they experienced daily. domain 2: influencing policy agendas and decision making paired with the kinds of political organizing efforts described above, african american social work pioneers sought to directly influence the policy agendas of elected officials and government agencies to combat social injustices experienced by african american communities. one such pioneer, native houstonian thyra edwards, became so influential in influencing policy both in the u.s. and worldwide that civil rights leader a. philip randolph referred to her as “one of the most brilliant young women of the negro or any other race, in public life today” (andrews, 2011, p. 1). a granddaughter of slaves, born in 1897, edwards believed that policy advocacy that sought to impact people’s everyday survival was critical to social work. her advocacy and activism focused on labor issues, women’s rights, international affairs, and race relations (martin & martin, 2001). edwards highlighted struggles black people experienced worldwide to show ways that racial injustice was not unique to the u.s., believing that social workers should influence policy in governments around the globe. she studied in multiple countries to strengthen her understanding of how to do so, subsequently taking strong stances in the spanish civil war to challenge fascism in that country. domestically, edwards sought to influence policy working with the international ladies garment workers union and international labor defense. in these roles, she worked to force change within the largest employer of african american women, ben j. advances in social work, summer 2021, 21(2/3) 246 sopkins apron factory, and protested apartment evictions (andrews, 2011; martin & martin, 2001). edwards was a contemporary of social worker jane addams; upon addams’ death in 1935, edwards wrote an article praising her work on labor reform, women’s rights, and global peace, yet also explicitly critiquing what she perceived as addams’ too-gradual approach to policy and societal reform (andrews, 2011). despite public criticism of her stances and allegations that she was too allied with the communist party, edwards believed that economic and employment circumstances played a huge role in black communal survival and continued to strive to create change in these arenas worldwide (martin & martin, 2001). edwards’ work as a political social worker demonstrates the interplay that can occur between distinct domains of social work, as she both advocated for policy change and played an intricate role in relief administration to counter deep depression-era unemployment, holding professional positions guiding and supporting these efforts (domain 3). this included work with the chicago relief administration and the illinois emergency relief commission (martin & martin, 2001). by working within relief administration, edwards believed that she could advocate for the poor and ensure relief policies provided justice and equity to all clients. although edwards viewed president roosevelt’s new deal policies to be faulty and insufficient, she supported these policies, believing they were a start to progressive social legislation. the first african american president of the national conference of social work, lester blackwell granger has been described as the individual responsible for leading the social work profession to prioritize civil rights (nasw foundation, n.d.), and a leader in explicitly centering social work attention on supporting democracy for marginalized communities (toft, 2020). as was the case for many early african american social workers, granger began as an educator. in 1922, he shifted to a social work career providing case management to african american youth in new jersey’s vocational school system (ruffin, 2007). granger’s experiences as an artillery lieutenant in wwi subsequently informed his work as a navy special consultant in wwii and his advocacy efforts to integrate the u.s. military. granger’s efforts persuaded president roosevelt to issue an executive order banning racial discrimination in federal contracts, leading thousands of african americans to be hired in manufacturing industries. these efforts also led to integration of the u.s. navy and to president truman’s issuance of an executive order to create a committee to focus on equal treatment and opportunity in the armed forces (ruffin, 2007). beginning in 1941, granger served for twenty years as executive secretary of the national urban league (nul), the largest and oldest nonpartisan civil rights organization in the u.s., dedicated to empowering african americans and working towards economic and social justice. in this role, he provided a national voice for continued civil rights advocacy, including efforts to integrate education (thompson, 1952). granger joined with martin luther king jr. and other activists to push president eisenhower to enforce the civil rights act of 1957 and demand justice for african americans’ right to register and vote (martin luther king jr. research and education institute, 2010). shepherd & pritzker/political advocacy without a choice 247 edwards and granger, along with other black social work advocates from the progressive era and the civil rights era including whitney young, jr. and dorothy height, exemplify ways in which african american political social workers have worked throughout the profession’s history to influence policy and dismantle injustices within societal structures. their advocacy impacted working conditions, access to democracy, civil rights, and the overall survival of african americans and, in fact, of all of humanity. domain 3: holding professional and political staff positions holding staff positions focused on policy and politics, whether as a political appointee or in a professional civil service position with policy influence, enables social workers to have a front-row seat in shaping policy to advance social justice (lane & pritzker, 2018). george edmund haynes, a southern african american social worker born in 1880, grew up in a time where education was often limited or non-existent for african americans. despite this, haynes became the first african american student to receive a degree from new york school of philanthropy (now known as the columbia university school of social work) in 1910 and the first black student to receive a ph.d. from columbia university two years later (nixon, n.d.; peebles-wilkins, 2013b). haynes co-founded and became the first executive director of the nul. through both nul and his relationship with the new york school of philanthropy, haynes played a significant role in expanding access for african americans to social work education and practice. he created the firstever social work training center for african american graduate students at fisk university in nashville, tn and offered field placement opportunities through the nul (carltonlaney, 1983; nixon, n.d.). in 1918, haynes was appointed to the position of u.s. director of negro economics, serving as a special assistant to the u.s. secretary of labor. in this role as a high-ranking federal employee, he was the first african american to shape policy and government operations at the federal cabinet level (nixon, n.d.). haynes analyzed the impacts of racism on employment, housing, and recreation, and promoted policies challenging the exclusion of african american workers from various trade unions, interracial conditions in the workplace, and growth in child labor in america (nixon, n.d.). the impacts of his work in this position led to his subsequent appointment to the u.s. president’s unemployment conference in 1921. unlike haynes, sarah collins fernandis was not appointed directly to government leadership positions; instead, she influenced policy decision-making as a staff member on both local and national government initiatives. born in 1863, during the same year as the signing of the emancipation proclamation, fernandis received an msw from new york university in the early 1900s. she was part of establishing multiple settlement houses specifically for black americans, one in washington d.c. and one in rhode island (peebles-wilkins, 2013a). she organized and became the first leader of the women’s cooperative civic league between 1913-1917, where she worked to improve health within black communities in baltimore, including placing pressure on the city government and its health department to improve sanitation (crouse et al., n.d.). in 1920, she became the first african american social worker hired by baltimore’s health department, becoming a staff member in the city’s venereal disease clinic. in advances in social work, summer 2021, 21(2/3) 248 1922, she was invited by the u.s. surgeon general to serve on a women’s advisory council to the u.s. public health service in washington, d.c. (smith, 1996), and soon after, helped organize the opening of a maryland state hospital to serve african american patients with tuberculosis. subsequently, she played a key role in opening a baltimore office for the national youth administration, a new deal-era federal agency, designed to provide work, education, and support for teenagers and young adults (crouse et al., n.d.). early african american political social work pioneers like haynes and fernandis sought governmental staff positions through which they could advocate for policies that directly benefited black communities and promoted the survival and well-being of african americans. despite limited attention to their contributions within social work education (carlton-laney, 1983), each helped set the precedent for african american political social workers holding staff positions with substantial policy influence in local and federal governments. domain 4: engaging with electoral campaigns political social workers use electoral methods to influence policy through campaign work, providing voters with knowledge about candidate or issue campaigns, and influencing ballot initiatives and which candidates run for office (lane & pritzker, 2018). electoral methods were used alongside other methods of political social work by african american social workers including ida wells-barnett, mary church terrell, victoria earle matthews, and lugenia burns hope, who together with other black women social reformers, came together to form the nacw in 1896 (roberts, 2005). during a time where african american communities faced frequent racial terror and the impact of jim crow laws (stevenson, 2015), the nacw was created to bring public attention both to the needs of african american children and families, and to civil rights. the nacw created a black women-led system of social reform and a policy agenda that sought to challenge systemic racism and its negative impacts on african americans (roberts, 2005). nacw’s policy agenda included job training, wage equity, childcare, challenging segregated transportation systems, and anti-lynching efforts. this policy agenda was paired with electoral-focused efforts to pursue women’s suffrage via constitutional amendment. nacw became the leading african american women’s voice in the suffrage movement, seeking both access to the vote for women via the 19th amendment and increased access for black men who were denied their constitutionally-granted right to vote due to jim crow laws. the nul, co-founded by social worker george edmund haynes in 1911, began as the national league on urban conditions among negros. while nul helped introduce social work to young african americans by providing trainings in african american history, economics, sociology, and political advocacy, and built coalitions to advance civil rights legislation in congress, it also extensively organized, demonstrated political power, and utilized electoral methods to impact policy (carlton-laney, 1999; martin luther king, jr. research and education institute [mlk rei], 2010). under the leadership of social worker lester granger, it supported the 1941 march on washington to call for integration of labor unions and challenge anti-black discrimination during wwii (mlk rei, 2010). in 1951, granger and other nul leaders specifically called on president eisenhower to protect shepherd & pritzker/political advocacy without a choice 249 voting rights (mlk rei, 2010). in the 1960s, under the leadership of political social worker whitney young, the nul became increasingly active in the civil rights movement, joining in organizing the 1963 march on washington and engaging in electoral methods such as registering voters. today, the nul continues to use nonpartisan electoral methods such as educating underrepresented communities about redistricting (brennan center for justice, 2011). nul and nacw chapters and their members worked to racially uplift african americans during a period of extensive oppression, segregation, and discrimination in the progressive era and the early 1900s. african american survival and self-empowerment was critical to these organizations’ programming and to the ways they sought to expand electoral participation and representation on the part of african american citizens (carltonlaney, 1999). in these early years of social work, electoral methods also were adopted by individual african american political social workers; for example, lizzie koontz weeks, the first black social worker in portland, oregon, mobilized african american female voters in support of the republican party in the 1910s (corppetts, 2019). in 1914, just as women were preparing to be able to cast their first congressional ballot in oregon, weeks became the first president of portland’s colored women’s republican club; building on her successful voter registration and mobilization efforts, she ran as a candidate for the republican precinct committee in 1918. domain 5: seeking and holding elected office while much of the pioneering political social work on the part of african american social workers described thus far has focused on advocacy efforts or political appointments that grant policy decision-making authority, african american political social work pioneers also ran for and held office at various levels of government. one such early african american social worker was mary church terrell, who has been recognized as a social work pioneer (nasw foundation, n.d.). although terrell’s parents had both been slaves, they were financially successful. she dedicated her career to self-help, racial uplift, and empowerment of african americans during the era of terror that emerged after reconstruction. in 1891, terrell was forced to resign from her job as an educator in the washington d.c. public school system because women could not work as educators once they became married (steptoe, 2007). a year later, her political activism was ignited when a close friend’s life was taken by lynching. terrell became deeply active in political engagement surrounding child welfare, women’s suffrage, and re-establishing african americans’ rights. a co-founder of the nacw, she spent years working alongside the infamous fredrick douglass, unsuccessfully advocating to multiple u.s. presidents to enact anti-lynching laws (steptoe, 2007). despite not having access to the right to vote herself, terrell became a member of the republican party and president of the women’s republican league. she served on the washington d.c. board of education from 1895-1901 and from 1906-1911. while at the time that position was appointed, not elected, she was the first african american woman in the country to serve in such a role (martin, 2018). she advocated for school integration and education equity for all children (steptoe, 2007) and was the only board member with experience teaching in public schools (martin, 2018). advances in social work, summer 2021, 21(2/3) 250 while his time in elected office reflects a somewhat later era than the other political social workers discussed in this manuscript, edolphus (ed) towns grew up in the south during the jim crow era. after serving for two years in the u.s army, towns earned a master’s degree in social work and began his social work career as a hospital director (u.s. house of representatives, n.d.). he became increasingly active in the brooklyn democratic party, and was elected as democratic party state committeeman in 1972 and as brooklyn’s deputy borough president in 1976. towns ran and won election to the u.s. house of representatives in 1982, where he served for 14 terms before resigning in 2013 (u.s. house of representatives, n.d.). although towns maintained a “low-key legislative style” during his time in congress (u.s. house of representatives, n.d., para 1), he sponsored legislation to mitigate health disparities impacting african americans and other underserved populations, as well as other forward-thinking polices that would directly benefit his constituents. towns also was influential in terms of establishing a social work presence in congress. with the support of staffer and fellow political social worker charles lewis jr., he founded the congressional social work caucus to create a space within congress for members of congress who are social workers or who explicitly support the social work profession to engage and connect (lewis, 2013). honoring the contributions of two african american political social work pioneers, towns sponsored the dorothy i. height and whitney m. young, jr. social work reinvestment act (h.r. 795). if passed, this bill would have mitigated social and economic challenges experienced by social workers, such as school loan debt and underpaid wages. while terrell and towns are comparatively well known within the social work profession, they are just two of the many african american political social workers that have run for or held elective office over the profession’s history, with candidacies that often marked important societal firsts. for example, social worker irene mccoy gaines was the first african american woman to run for the illinois state legislature; though she lost that 1940 election, she subsequently helped organize the 1941 march on washington, became one of the first people worldwide to testify before the u.n. about discrimination toward women of color in the u.s., and later ran again for further elective office (o’donnell, 2001). in 1934, social worker eunice hunton carter was the first african american nominated by the republican party to represent her district in the new york state assembly (smith, 2013), while social worker cora mae brown was the first african american woman elected to michigan’s state senate in 1952 (wolcott, 2007). the first african american social worker in congress, ron dellums, began his career in psychiatric social work before running for and being elected to the berkeley, california city council in 1967 (dellums & halterman, 2000). dellums was elected to the u.s. house of representatives in 1970, where he co-founded the congressional black caucus. when he retired from congress in 1998, he was succeeded by another african american social worker, rep. barbara lee. discussion and implications while “political social work” is a relatively new conceptualization within the social work profession (lane & pritzker, 2018), african american social workers have practiced shepherd & pritzker/political advocacy without a choice 251 political social work since the early days of the profession. this manuscript focuses attention on several african american political social work pioneers. across five domains of political social work practice, these pioneers laid the groundwork for modern political social work, spearheading advocacy and policymaking around the critical policy issues of their time. the practice of these early african american political social workers focused directly on challenging systemic oppression towards african americans, such as lynching, racial discrimination in federal contracts, exclusion from labor unions, segregation in the military, and voter disenfranchisement. the lives and work of these political social workers illustrate a critical implication for understanding a critical implication for a comprehensive understanding of social work’s history – that the lived experiences of early african american social workers required them to engage in political work for the survival of their communities. o’donnell (2001) juxtaposed the activism of early african american female social workers and early white social workers, suggesting that african american social workers engaged in activism to uplift their own communities, often building non-governmental organizations like the nacw and other black women clubs to provide this self-help, while early white social workers tended to engage in activism as a charitable endeavor, seeking reforms via government public welfare. the pioneers described here demonstrate ways in which early political social work was grounded in african american social workers’ lived experiences. these experiences informed their work toward policy change, building on community strengths, self-determination, and communal empowerment in order to improve community well-being. as noted previously, not all of the individuals discussed in this manuscript possessed formal social work training or degrees. by 1930, there were just over 1,000 black social workers identified in the u.s. based on that year’s u.s. census (gary & gary, 1994). african americans faced limited access to both higher education and the financial resources necessary to attend higher education throughout the progressive era and the first half of the 20th century. apprenticeship, an early model of social work training, often excluded aspiring black social workers (gary & gary, 1994). while black students could attend social work training programs at educational institutions in northern states; in the south during this era, black students were not permitted to attend colleges serving white predominantly students. the first undergraduate social work program to educate black students in the south was established by george haynes at fisk university in 1911 (gary & gary, 1994). in the 1920s, two professional social work training programs were established for black students in the south. while some of the social workers discussed here have subsequently been identified by the nasw as “social work pioneers,” the lack of formal social work training for others may have contributed to a lack of attention to their professional contributions. although this manuscript focuses on social workers during the progressive era and the first half of the 20th century, the ways in which african american social workers of these eras responded to racial exclusion by organizing for policy change to uplift their communities set the stage for subsequent political social work practice on the part of african american social workers. for example, while black panther party (bpp) leaders did not necessarily hold social work training or degrees – and the bpp’s work has rarely advances in social work, summer 2021, 21(2/3) 252 been acknowledged within social work history – individuals identifying as social workers, like ruth beckford, were involved in developing bpp programs that served as alternatives to inadequate governmental policies and that informed the bpp’s political agenda (jackson, 2020; lateef & androff, 2017). for example, beckford helped found bpp’s free breakfast for children program, one of the most influential programs in social welfare history, linked to the development of the u.s. department of agriculture’s federal free breakfast program (lateef & androff, 2017; milkman, 2016). shifting the social work narrative the african american political social work pioneers discussed here, working across all five domains of political social work, serve as a direct counterpoint to the whitedominant narrative too common within social work (e.g., bell, 2014; deloach mccutcheon, 2019; gregory, 2021; johnson, 1991; wilson, 2020). in this narrative, the history of social work often has involved white women stepping in to help communities of color and low-income communities, while framing african americans as in need of both government and charitable service (dominelli, 1989). this narrative risks perpetuating white supremacy, as it implies that white social workers are critical to moving those who have been victimized forward. the influence of these pioneers, from the earliest days of the social work profession, shows this narrative to be false. early african american social workers were political leaders, even as broader structural dynamics sought to exclude black americans from the political arena. these social workers challenged systemic racism via community self-help and mutual aid and took on leadership roles that created long-term meaningful change for their communities. they used strategic organizing and communication methods to build awareness of discriminatory policies and to mobilize black americans to action. they stood up against these discriminatory policies and pressured policymakers to eliminate them. they built relationships with the political leaders of their time, gaining access to positions with direct influence over policies affecting african american well-being. they organized together to demand the right to vote for black women and men and to ensure black women were able to participate in elections. and in quite a few cases, black social workers led the way in ensuring black political representation on government decisionmaking bodies. in bringing limited attention to the leadership of pioneers like these, the social work profession perpetuates a narrative of white paternalism and charitable aid. it portrays african americans as oppressed victims in american society, rather than recognizing the strength of african americans’ survival strategies (pebbles-wilkins, 1994). this narrative neglects attention to the ways in which community self-empowerment, self-help, and mutual aid have been critical to communal survival among african americans (o’donnell, 2001). this criticism is not new to social work; in fact, it was part of the impetus for the creation of the national association of black social workers (nabsw) in 1968. black social workers walked out of the 1968 annual meeting of the national conference on social welfare, critiquing the lack of commitment to racial equity within social work, the lack of representation of black social workers in leadership positions, and insufficient attention to shepherd & pritzker/political advocacy without a choice 253 white racism. subsequently, nabsw chapters were developed across the u.s., focusing attention on the survival, well-being, and liberation of black communities both outside and inside of social work (bell, 2014). by highlighting these early political social work leaders, we hope to contribute to rethinking the narrative of the social work profession to one that assertively recognizes the historic roles african american political social workers have played in furthering political empowerment and challenging social injustice. the leaders discussed here underscore the power of black-led advancement of the african american community and its centrality to social work. these leaders also underscore the critical role that african american social workers played in the activist orientation of social work in its early years, even as clinical forms of social work began to take on more attention from white social workers (o’donnell, 2001). social work education cswe first implemented an accreditation policy requiring social work programs to incorporate diverse groups within social work curricula in 1968 (bent-goodley, 2006). yet over 50 years later, ensuring that the profession’s diverse social work history is accurately reflected continues to be a challenge. more recent calls to decolonize social work education (tamburro, 2013) and to better integrate social work practices contributed by african americans create an opportunity to revisit how social work history is addressed within social work education. the contributions the african american political social work pioneers described here made both to the social work profession and to their communities display a diverse lens currently missing in social work education. the pioneers and organizations discussed throughout this manuscript engaged in social work practice specifically to help their communities survive adversity and injustice. they found it necessary to adopt political tactics to maneuver racist systems and institutions in order to achieve social, political, economic, and racial justice. through attention to the historic roles african american social work pioneers played in furthering political empowerment and challenging social injustices (bent-goodley, 2006), this manuscript calls on social work educators to recognize – and assertively incorporate into social work education – these survival strategies (pebbles-wilkins, 1994). as political social work continues to be institutionalized within social work as a critical method for pursuing justice (lewis, 2018), it is imperative that social work’s historical lack of an african american centric lens not be replicated within scholarship and education focused on political social work. political social work education and scholarship can contribute to actively dismantling the white-dominated narrative of social work history by elevating the influential contributions of african american pioneers. further, teaching about these political social work pioneers can expand students’ understanding of the profession’s history and tactics, while specifically affirming black students’ identities within the profession (green, 2015). advances in social work, summer 2021, 21(2/3) 254 conclusion as the profession continues to progress, the social work profession must be careful not to continue to suppress the historic roles african american social workers have played in seeking policy change and facilitating political empowerment in african american communities. african american political social workers and the organizations they developed have been vital to the survival and empowerment of african american communities and are critical parts of the history of the social work profession. disrupting white supremacy within social work requires shifts both in the profession’s historical narrative and in the ways in which the diverse history of our profession is reflected in social work curricula. moving forward, increasing attention is needed within the social work profession to highlighting self-help survival tactics used by african american social workers through our history. by shining a spotlight on the communal selfhelp tactics and political strategies early african american political social workers implemented as they sought to challenge societal violence, oppression, and marginalization, social work can move away from mitigating challenges caused by failing systems and toward creating new racially just structures that promote community wellbeing. references andrews, g. 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(2015). victoria earle matthews and urban human services students. journal of human services, 35(1), 98-101. toft, j. (2020). words of common cause: social work’s historical democratic discourse. social service review, 94(1), 75-128. https://doi.org/10.1086/708165 u.s. house of representatives. (n.d.). towns, edolphus [biography]. history, art & archives. https://history.house.gov/people/detail?id=23035 waites, c. (2001). victoria earle matthews: residence and reform. in i. carlton-laney (ed.), african american leadership: an empowerment tradition in social welfare history (pp. 1-16). nasw press. wilson, a. k. (2020, july 27). guest column: white people, it’s time to listen and act. the state news. https://statenews.com/article/2020/07/guest-column-white-peopleits-time-to-listen-and-act?ct=content_open&cv=cbox_latest wolcott, v. w. (2007, january 19). cora mae brown (1914-1972). blackpast. https://www.blackpast.org/african-american-history/brown-cora-mae-1914-1972/ author note: address correspondence to donisha shepherd, d political social worker, llc, richmond, tx, 77407. email: admin@dpoliticalsw.com https://doi.org/10.1086/708165 https://history.house.gov/people/detail?id=23035 https://statenews.com/article/2020/07/guest-column-white-people-its-time-to-listen-and-act?ct=content_open&cv=cbox_latest https://statenews.com/article/2020/07/guest-column-white-people-its-time-to-listen-and-act?ct=content_open&cv=cbox_latest https://www.blackpast.org/african-american-history/brown-cora-mae-1914-1972/ mailto:alex.redcay@millersville _________ matthew a. walsh, phd, msw, lsw, assistant professor, department of social work, marian university, indianapolis, in. jeremiah w. jaggers, phd, msw, assistant professor, university of utah college of social work, salt lake city, utah. carol satre, msw, lcsw, retired faculty, and james hall, phd, lcsw, professor of pediatrics & social work, indiana university, indianapolis, in. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 233-250, doi: 10.18060/25294 this work is licensed under a creative commons attribution 4.0 international license. evaluation of interprofessional practice education for master of social work students: student perspectives of a short-term ipe observation matthew a.walsh jeremiah w. jaggers carol satre james hall abstract: as interprofessional education (ipe) continues to grow as part of social work programs, it is important to evaluate how best to engage students in understanding this material and explore possible barriers. with this in mind, researchers conducted qualitative interviews and focus groups to explore perceptions of three cohorts of social work students (n=29) participating in short-term interprofessional practicum experiences. perceived benefits included improvements in communication and client care. the study also uncovered various barriers with implementing ipe-focused practicums such as time, scheduling and role uncertainty. students shared the impact their experience had on knowledge and perceptions of the social work role in interprofessional collaboration. even so, students were able to observe important elements of interprofessional practice from these relatively short practicums, indicating they may be a viable option for programs looking to expose students to real world interprofessional experience. keywords: interprofessional collaboration, interprofessional education, social work field education, qualitative methods a growing body of literature promotes the benefits of interprofessional education (ipe) (charles et al., 2008; gilbert et al., 2000; jones et al., 2020; kim et al., 2020; salhani & charles, 2007) and the benefits of interprofessional collaboration in the work-place (macdonnell et al., 2012; matthews et al., 2012; nimmagadda & murphy, 2014; pecukonis et al., 2013). this literature also focuses on barriers that interfere with the implementation of interprofessional collaboration within a practice setting. examples include role insecurity (hornby & atkins, 2000); closed role boundaries and protection of professional knowledge (miller et al., 2001); fear of domain infringement, power differentials, and struggles over territory (geva et al., 2000; hornby & atkins, 2000); and different philosophies and values of the professions involved (drinka & clark, 2000; miller et al., 2001). though introducing interprofessional practicums can be a challenging endeavor (bogo, 2015), ipe is gaining momentum within social work classroom and practicum settings as varying approaches to incorporate interprofessional concepts and practices have been undertaken including forums/case studies, workshops, courses, and practicum (adamson et al., 2020; bilodeau et al., 2010; bonifas & gray, 2013; clarkson-hendrix & warner, 2020; jones et al., 2020; kim et al., 2020; salm et al., 2010). an important aspect of ipe is the first-hand experiences students engage in through simulated or real practice. about:blank advances in social work, spring 2022, 22(1) 234 as more social work programs incorporate ipe into their curriculum, it is important to explore how students view interprofessional collaboration. social work students who have engaged in interprofessional collaboration have identified benefits such as enhanced overall learning, exposure to other professionals, and the opportunity to expose other professionals to social work and the role it can play in interprofessional teams (charles et al., 2011). students have also expressed how interprofessional opportunities enabled them to gain insight into other roles and fostered respect for each profession among the interprofessional team (lumague, 2006; salm et al., 2010). additionally, interprofessional experiences allow students to gain a deeper understanding and appreciation of their own professions (salm et al., 2010) and interprofessional collaboration as a whole (holmes et al., 2020). students who participate in simulations, case studies, or interprofessional forums have shown improvement in interprofessional skills and attitudes (kim et al., 2020). field education and ipe field education is the cornerstone of social work education as the council on social work education (cswe) designated it as the signature pedagogy in 2008 (cswe, 2008). field education in social work has relied on a voluntary agency-based model where social work programs ask local agencies to provide high quality learning experiences to prepare the next generation of social workers (bogo, 2015). however, finding enough quality sites or qualified and willing field instructors can be challenging in general (greenblatt et al., 2019). as a result, rotational models where students spend shorter amounts of time with multiple supervisors and even multiple organizations can be used as an alternative to the traditional year-long approach with one supervisor (birkenmaier et al., 2012; lawrence et al., 2007). well-established in the medical field (gough & wilks, 2012), rotational models are now emerging within social work programs (birkenmaier et al., 2012; lawrence et al., 2007). rotational models allow supervisors who may not be able to commit to a full year of supervision to play a role in field education (ivry et al., 2005; muskat et al., 2011) while allowing students the benefit of being exposed to multiple systems and teaching and practice styles (gough & wilks, 2012; greenblatt et al., 2019). despite the benefits, both supervisors and students have identified negative aspects of this approach. reported challenges include students experiencing fragmented learning, limited opportunities for in-depth work with clients, and anxiety and decreased selfconfidence due to frequent transitions (gough & wilks, 2012). additionally, the shortened time period can negatively affect the supervisor-student relationship (vassos et al., 2018). by the time the supervisor and student develop rapport and the student starts honing their skills, the student moves onto the next rotation (greenblatt et al., 2019). finally, both students and supervisors may feel overwhelmed by the amount and pace of the work (greenblatt et al., 2019). the interprofessional education collaborative (ipec) has outlined four competencies of interprofessional collaborative practice which encompass values/ethics, roles/responsibilities, interprofessional communication, and teams and teamwork (ipec, 2016). the ipec is supported by cswe (ipec, 2016), which itself supports ipe (cswe, walsh et al./evaluation of ipe 235 2015), along with the national association of social workers (nasw, 2021). the call for ipe in social work education is clear; however, there is a dearth of knowledge surrounding interpersonal practicum experiences. while some interprofessional practicums have been examined (clarkson-hendrix & warner, 2020), interprofessional experiences like workshops, forums, or case studies are better represented in the literature (adamson et al., 2020; bolin & chapman, 2013; bonifas & gray, 2013; clarkson-hendrix & warner, 2020; comer & rao, 2016; jones et al., 2020; kim et al., 2020). health research service administration (hrsa) fellowship this study of interprofessional training was supported by a three-year grant from the department of health and human service’s hrsa. this national training program focused on assisting msw students in enhancing their practice knowledge and skills regarding transitional age youth (tay) in behavioral health settings. the training program included three cohorts (one cohort per academic year) for a total of 98 msw students. all fellows (students who participated in the program) had to apply to the program and were selected by a committee based on a combination of academic performance, references, and personal statements. fellows were required to attend monthly seminars on topics related to the needs and special considerations of tay. additionally, fellows were required to complete two practicum settings--one 640 hour practicum required by the school and one lasting between 32-64 hours that was specifically designed by the grant team to expose fellows to primary care settings and interprofessional collaboration. as such, fellows were placed primarily in local primary care settings and clinics that employed social workers in interprofessional modalities. in these short-term practicum settings, fellows were able to witness collaborations between teams involving doctors, nurses, dieticians, pharmacists, and social workers. though students may have had elements of interprofessional collaboration in their required practicum, this additional practicum was explicitly designed to expose them to interprofessional collaboration concepts. furthermore, students were required to write reflections highlighting the concepts they learned and to critique what they witnessed in practicum sites. it is this second, additional practicum that is the focus of this study, particularly,the experiences and perceptions students had regarding their interprofessional learning. though not a rotational model in the traditional sense, these short-term practicum experiences did have features of the rotational model as students were placed in truncated placements. time constraints, scheduling issues, and limited locations forced the cohorts to engage in slightly different interprofessional practicums. fellows in cohort 1 and 2 engaged in the practicum lasting four hours per week for 16 weeks for a total of 64 hours. cohort 3 engaged in practicums that were still four hours per week but lasted 8 weeks, resulting in 32 total hours. based on student evaluations from the previous cohorts, students in cohort 3 had placements that the grant team believed would provide fellows with more interprofessional experiences. the shortened timeframe allowed students to complete agency orientation processes during the first eight weeks of the semester. following this, advances in social work, spring 2022, 22(1) 236 the grant team divided the group into thirds so they could all have eight week blocks for their interprofessional practicum.. fellows’ primary role was to observe how interprofessional teams interact with clients and each other, focusing on the social worker’s role within the team. students were not expected to be the lead therapist or maintain a caseload of their own due to the short timeframe but were asked to take a broader approach and identify best practices of interprofessional teams. though a more experiential placement would have been ideal, due to time and other logistical issues, the grant team opted for a shorter practicum focused on observation. while the team was aware that this approach has its limitations, it still allowed students to witness interprofessional teams in action in areas of social work where they could not otherwise. fellows shadowed their social work supervisor in daily tasks and interactions with other team members and clients, and were encouraged to shadow other professionals on the interprofessional team if their supervisor was unavailable or did not have activities for students to observe during parts of the day. through their observations, the fellows were expected to witness interprofessional collaboration that demonstrated all four competencies of the ipec (2016). the grant team selected sites where they would be able to see social workers and the team promote a climate of respect and use their own and each other’s strengths and expertise to best help their clients. although these practicum experiences were interprofessional in nature, they did not involve other students from different disciplines, which makes them unique compared to other documented social work ipe experiences such as case studies (bolin & chapman, 2013; bonifas & gray, 2013; comer & rao, 2016) or modules (hall et al., 2014). however, this practicum used an approach recommended by jones and phillips (2016) by having students shadow other professions in the healthcare setting. while the lack of interprofessional student-to-student interaction may not meet some definitions of interprofessional education experiences, they are still interprofessional in nature as the students were engaged with multiple professions. furthermore, the experiences allowed students to be involved in real world healthcare settings, observing interprofessional collaboration skills and techniques firsthand. with this modified approach to interprofessional experiences in mind, researchers sought to answer two research questions: 1) what are the students’ perceived benefits and barriers to engaging in a shortterm practicum of an interprofessional nature? 2) after observing interprofessional collaboration in real world settings, what do students perceive to be the benefits and drawbacks of interprofessional practice? method sampling following their short-term placements, fellows were invited by email and during seminars to participate in focus groups. this was not a requirement of their fellowship. walsh et al./evaluation of ipe 237 thus, with irb approval, the team was able to interview 29 of 98 fellows over the course of the grant’s three years. participants (n=29) were fellows of the interprofessional training program meaning they were all msw students in a mental health and addiction concentration and were in their last year of graduate education. participants from all three cohorts are represented in this study: eight from cohort 1, seven from cohort 2, and 14 from cohort 3. there were 25 females and four males. twenty-five of the participants were caucasian, three were african american, and one was native american. ages of participants ranged from 22 to 44 with the majority of participants being under 30 years of age. though not diverse, this sample provided an accurate demographic representation of the grant fellows. data collection qualitative interviews were used to gather information on student experiences and perceptions of the training program. these interviews were implemented as part of the program evaluation at the end of participants’ primary care practicum experiences. interviews took the form of focus groups, group interviews (interviews with two participants), and individual interviews. group interviews were not part of the original design and only occurred when an individual recruited another fellow to join her for her interview in cohort 1 or when multiple focus group members did not show for their scheduled interview in cohort 2. each cohort had multiple interviews (see table 1) resulting in one focus group (n=6) and one group interview (n=2) for cohort 1, one focus group (n=5) and one group interview (n=2) in cohort 2, and two separate focus groups (n=7; n=5) and two separate individual interviews in cohort 3. the focus groups lasted one hour, the group interviews lasted 40 minutes, and the individual interviews both lasted approximately 20 minutes. table 1. breakdown of all 3 cohorts cohort qualitative method total (n) interview focus group group individual 1 1 (n=6) 1 (n=2) 0 8 2 1 (n=5) 1 (n=2) 0 7 3 2 (n= 7; n=5) 0 2 (n=1; n=1) 14 all 29 all interviews were semi-structured, allowing the interviewer to ask follow-up questions when relevant and appropriate. the research team developed questions focusing on the participant’s overall experiences within their interprofessional primary care settings, perceived benefits and barriers, and areas for improvement. data analysis once completed, interviews were transcribed and coded by members of the research team. the researchers conducted a thematic analysis first using line-by-line coding advances in social work, spring 2022, 22(1) 238 (charmaz, 2014; glaser & strauss, 1967) attempting to stay as close to participants’ own words as possible. next, focused and axial coding were used (charmaz, 2014; glaser & strauss, 1967) to categorize the data into themes. two researchers completed their initial coding independently and then compared codes to arrive at a consensus initial code. they then worked together with the consensus codes to identify the larger themes. memoing was used by the two coders in both the independent and collaborative coding process. additionally, the two other members of the research team served as peer debriefers throughout the process to help improve the rigor and trustworthiness of their analysis. findings two major themes emerged through the qualitative analysis conducted by the researchers. the first theme, “engaging in an interprofessional practicum” revolves around the act of engaging in the interprofessional practicum itself with students pointing out benefits as well as barriers and frustrations they encountered. regardless of some negative aspects of these practicums, it was through these observations that students were able to identify both positive and negative aspects of interprofessional collaboration. the theme of “perception of interprofessional collaboration” is the second theme that will be discussed. engaging in an interprofessional practicum benefits. students from all cohorts appreciated the overall experience. the main theme that emerged when discussing benefits was the theme of exposure. as one student put it, it’s one thing to read something on a page in a book but it’s another to meet the client and there’s a life behind that and a face and a story, so i thought that was really important to me because i would never have had that exposure otherwise. this exposure allowed students to see social workers practice in a different setting than they would have otherwise. additionally, it allowed them to witness professionals working with social workers that may not have been present during their required practicums. at times this exposure was discussed in terms of general interprofessional collaboration, as one participant from cohort 1 stated, “you really got to see how mental health can and really should be integrated in a primary care setting.” at other times, this practicum exposed fellows to different environments as demonstrated from another cohort 1 participant: i was put in an environment that i had never been in and probably will never be in after doing it. it was great and…i never would have had that exposure had i not done this and so i definitely appreciated that piece. students expressed not only appreciation for and improved understanding of different team members but also a newfound respect for social work, as they were able to see social workers provide needed services in a healthcare setting and be respected by the medical professionals who sought them out for consultation. walsh et al./evaluation of ipe 239 barriers. though students appreciated the opportunity to engage in a primary care setting, another major theme was wanting more, including a desire to observe and participate in more client interactions. this disappointment appears to be the result of unforeseen challenges and barriers with the practicum supervisor and site as a whole. one such challenge, lack of work, included both tasks and client contact. there was variation, however, as a minority of students discussed how full of activity their days were in contrast to others who criticized the lack of work and client contact. this discrepancy was highlighted by an example in one focus group, where one student had no client contact while another saw eight clients in a typical 4-hour day. as one participant from cohort 2 put it, “it was challenging to fill up the time, but i feel like i was learning something every single week i was there.” the experience of not having enough to do on slower days was echoed by a participant from cohort 3: “three families in four hours is not a lot, especially when [consults] only take ten minutes. even the social worker was like, ‘this is really boring.’” the theme of placement issues also emerged as a challenge for these interprofessional practicums in primary care settings. here participants mentioned issues with the social worker, the site itself, and timing of the placement. participants perceived stress of the social workers due to the heavy student load the social workers had at each site. this concern was mentioned mostly by those in cohort 1 in which all of the 33 placements occurred in one semester, resulting in some supervisors having over ten fellows. as a result, fellows felt guilty about asking questions and even shadowing in general. students also felt they were not being fully invested in because of their limited time at the site. this is best summed by a participant in cohort 1 who, when referring to her supervisor, stated that “it’s not worth her time [to train me and teach me skills] since, you know, i’m not going to have ample time to practice them or see clients.” some sites were not well-equipped for student learning, as several students mentioned they had to leave the room when the full team was with a patient simply because there was not enough space to accommodate them. issues with the time of placement occurred because some students were assigned less busy days and times, such as friday afternoons. the final barrier in this primary care experience was the lack of clear expectations regarding the students’ learning experiences. students reported feeling this themselves and believing their sites also experienced a lack of clarity. one student summarized, it was a lot of talk between, in my experience with fellows…people talking about their experiences and trying to figure out what we are supposed to be getting out of it. what are we supposed to be doing? so, there was a lot of that piece, and i definitely can understand since it’s a new experience…so there definitely was a little bit of vagueness that made a little too much of a buffer for some people. so it made some people desk writers and then other people had an awesome experience, and they were doing a ton of stuff. so i think not having those clear objectives kind of made it a little bit of a challenge. this sentiment was especially relevant to the first cohort, to which this student belonged, with the majority of fellows stating they were not entirely sure what the grant team expected them to do throughout the day or what they were supposed to be accomplishing advances in social work, spring 2022, 22(1) 240 by their observations. in some cases, this vagueness provided flexibility for students to create their own experiences by shadowing other professions, but the majority of interviewees reported it hindered the overall experience. fellows who sought out meaningful experiences with their sites during down time appeared to value it, while some who did not obtain additional experiences expressed disappointment. for example, one student spoke of the lack of client interaction: “why am i going there for four hours and sitting there and not doing anything? i could be doing something better with my time.” perception of interprofessional collaboration benefits. researchers discovered several common participant beliefs regarding the benefits of interprofessional collaboration. one such theme was holistic treatment, with participants identifying this as a beneficial outcome of interprofessional collaboration. one participant spoke of this holistic approach metaphorically, stating that “providers each are like different pieces of a puzzle, adding a unique part to a picture that needs to be completed.” many participants believed this approach helped clients achieve their desired goals. another theme mentioned frequently involved colocation, which includes the convenience of having a diverse and needed group of professionals in one building. this was credited with improved communication, follow through, and referrals. as one participant put it, “because they all work within the same office, the patient has more assurance that the person they are being referred to is good.” drawbacks. participants identified several drawbacks at the conclusion of their practicums. a common drawback identified was the issue of power differentials, with the physician often wielding more power than the rest of the team and at times not giving enough weight to others’ opinions or expertise. one participant described this potential drawback: the perspectives of social workers may not carry the same value or urgency as that of a clinical psychologist, physician, or administrator of higher rank due to an implicit assumption that more years of schooling equals greater wisdom or greater insight into the human condition and a better understanding of the most valid means for addressing client needs. another theme, lack of understanding, involved team members’ lack of knowledge for the role and responsibility of each member on the team. one participant spoke of a case where the client missed several appointments due to transportation issues. the doctor was frustrated and did not know the social worker could help with transportation needs until the social worker explained their full scope of practice. this exchange was concerning as a core value of ipe is understanding the roles and responsibilities of each member (ipec, 2016). the student expressed alarm that a team member did not know about a valued service that social work could provide. a final theme, issue of time, was mentioned by many participants. several drawbacks were mentioned under this theme, such as the professionals not having the time to meet with each other when needed, the time-consuming nature of interprofessional appointments with clients, and the amount of time it took for members to communicate with each other walsh et al./evaluation of ipe 241 to develop effective and truly interprofessional collaboration. case conferences were highlighted by several participants as necessary for effective interprofessional collaboration but were noted as a time-consuming exercise that was spent away from clients and billable services. several participants spoke about the difficulty team members encountered when they needed time-sensitive consultation with another professional to help a client. although consultation was typically brief, it was sometimes not possible because schedules did not always align for impromptu communication. this issue can impact clients, as one participant relayed it was not uncommon for clients to be at the office for hours in order to be seen by different professionals. although viewed as a positive to address several needs at one appointment, it was acknowledged that clients can be overwhelmed by seeing so many professionals over the course of the day, especially if not prepared to do so. when looking at these drawbacks as a whole, one participant noted that “the drawbacks of interprofessional collaboration are rooted in the cultural shift required when interprofessional collaboration is introduced to a primary care setting.” this was echoed by others participants who stated fields like social work and medicine have different foci and views. some participants highlighted different education and training of the professionals involved as a possible contributor to challenges. although most participants spoke about their placements in terms that indicated there was a commitment to interprofessional collaboration, others highlighted team members who were more reluctant to commit or demonstrated lack of respect for certain professions. discussion student perceived benefits and barriers of engaging in interprofessional practicums participants identified both benefits and barriers for engaging in interprofessional practicums. as with prior studies (charles et al., 2011), in addition to the benefits of overall exposure to interprofessional concepts and processes, this practicum allowed fellows, who were in the mental health and addiction concentration, specific opportunities to see how social work and mental health concepts are integrated into the healthcare field in an interprofessional manner. consistent with the literature (lumague, 2006; salm et al., 2010), this allowed fellows to see different areas of social work practice, different types of social workers, and a variety of professional disciplines. several participants reported newfound respect for social work due to how the social workers carried themselves and were valued by some doctors, which aligns with the findings of salm et al. (2010). many barriers appear to stem from the fact that these placements were newly formed partnerships between the grant team and the university. the process of recruiting agencies and field instructors can be challenging (greenblatt et al., 2019), and these interprofessional practicums were outside previously established university-agency field placements. developing that working relationship with agencies and individual supervisors took time, as did the elimination of placements with agencies or supervisors who were unable to serve effectively as fellowship sites. this seemed particularly challenging as advances in social work, spring 2022, 22(1) 242 opportunities for interprofessional experiences within sites required support and time from all involved professions. additionally, as indicated by some students’ observations, sites varied in their level of investment and immersion in interprofessional values and practices. some barriers appear to have emerged because this practicum was “supplemental” and thus may not always have been given full commitment by fellows or supervisors. this can be expected as students were already attempting to balance courses and their advanced practicums in addition to other responsibilities like employment and family. as this additional practicum became more formalized in the second cohort, fellows faced an unanticipated hurdle of having to go through an orientation process which led to unexpected delays in starting dates. this was addressed in cohort 3 by reducing the total required time, which allowed all fellows to be certified in the first eight weeks of the academic year and to begin their practicum on their planned start date. however, there were still issues due to sites dropping out, which resulted in about a third of cohort 3 going through the orientation process in september only to have it not be required by their new site once they were finally placed in march. additionally, this truncated time contributed to some students’ beliefs that they were not fully invested in by their supervisors, which is reflected in the literature about shortened practicum experiences (gough & wilks, 2012; greenblatt et al., 2019; vassos et al., 2018). it is important to note students’ individual experiences seemed to vary greatly in part due to their own levels of advocacy for an enhanced experience. students who were comfortable within their sites and took more initiative were more likely to ask for experiences like shadowing other professionals to increase their learning. this occurred throughout the three cohorts, which is significant because only cohort 3 was given explicit instruction in how fellows should spend their time, such as shadowing other team members during times of inactivity. cohort 3 also had the benefit of a new grant team member who occupied a newly formed position, which was solely dedicated to the interprofessional practicums in order to address placement and communication issues. despite improvements, some cohort 3 fellows claimed they did not engage in sufficient direct practice learning experiences during their practicums and were unsure how they might have rectified this. some students and placement sites were unsure of expectations, which is an issue also found in the literature (o’leary et al., 2019). similarities and differences among experiences of the different cohorts suggest an interplay of factors, such as student assertiveness regarding learning needs, program communication of expectations, and site capacity to provide learning experiences, which contributed to the successes and challenges of this program. a few participants from each cohort identified time taken away from their required practicum for the ipe placement as a drawback.. they reported frustration with shifting from direct practice with clients in the required practicum to observation in the interprofessional practicum. for some it felt like a step backward and not as valuable as the required practicum where they were able to practice and hone their skills. however, other fellows felt they did not spend enough time at their interprofessional practicums and the time should be expanded. while some university required practicum sites allowed students to use their additional practicum hours as part of their required hours, others did not; this resulted in differences in total hours spent at the required practicum, which may walsh et al./evaluation of ipe 243 contribute to varying student perspectives on time spent at each practicum and overall time commitments. understanding concepts and techniques of interprofessional collaboration with regards to the second research question, it appears students participating in interprofessional practicums within a primary healthcare setting are able to gain a wellrounded understanding of interprofessional concepts and techniques through their observations. students were able to define interprofessional collaboration in ways that mirrored what is found in the literature and demonstrated a strong comprehension of the concept. fellows remarked that multiple professionals from various backgrounds must work together in a coordinated effort to help clients. this acknowledgment of mutual respect and shared values mirrors competency 1 of ipec’s four core competencies (ipec, 2016). the importance of knowing not only one’s role but others’ roles on the team is also a core competency of interprofessional collaboration (ipec, 2016). this too was highlighted by participants as they discussed the value of social workers within primary healthcare teams, particularly their holistic and strengths-based approach and their skills with advocacy and relationship building. the participants, particularly those who had fewer interactions with medical professionals, often believed social workers acted as bridges or mediators between the client and the rest of the treatment team, demonstrating competencies about interprofessional communication and team work (ipec, 2016). this was often discussed in contrast to the medical team members who participants perceived as less empathetic, less informed about community resources, and more concerned with the biomedical aspects of patient care than the social and emotional aspects. despite, seeing examples of the ipec’s (2016) four core competencies in action, not all participants witnessed them as they should play out. one example of this involves the competency of having and using the knowledge of one’s own role and others’ roles to address the needs of the patient (ipec, 2016). in this example provided by a participant, a doctor did not know that the social worker in the office could assist with transportation needs of the patient struggling to make appointments. the patient missed several appointments with this doctor because of this and their immediate health needs were not being met during this time. this is just one example of the importance of roles and responsibilities in interprofessional care and how not all team members may be aware of all the knowledge and skills each member possesses. though positive experiences may have enhanced fellows’ views of social workers, it could also have also reinforced their own biases or stereotypes about doctors and other medical professionals. even those who reported positive experiences with the doctors they observed in meetings, indicated holding different initial expectations of other professionals’ behavior. for example, one participant praised a doctor for being present and asking others for their opinions. this practice is a basic expectation of interprofessional collaboration, and the recollection of it as noteworthy might indicate an existing bias towards the expectations for the more medical or more prestigious team members. it might advances in social work, spring 2022, 22(1) 244 also accurately reflect differences in standards to which professionals on the team are held, specifically doctors, as compared to social workers. participants highlighted many benefits of interprofessional collaboration found in the literature, such as clients receiving holistic treatment (lalayants, 2013), achieving desired results (drinka & clark, 2000), and having the convenience of multiple providers in one location (lalayants, 2013). this occurred throughout all three cohorts, indicating that being in an interprofessional practicum for 32 hours compared to 64 hours was sufficient for fellows to witness and improve their knowledge about interprofessional collaboration. participants also witnessed and highlighted common drawbacks found in the literature, such as power differentials (ambrose-miller & ashcroft, 2016; frost et al., 2005; magnuson et al., 2012; rose, 2011; salhani & charles, 2007), lack of understanding team members’ roles and responsibilities (ambrose-miller & ashcroft, 2016; brown et al., 2011; frost & robinson, 2007; lalayants, 2013), and the time-consuming nature of communication necessary for effective care (lalayants, 2013; lewandowski & glenmaye, 2002). again, these themes occurred across all cohorts regardless of the agency or the length of the practicum. limitations even though participation in this program had considerable benefits for these msw students, the study has limitations common to qualitative analysis, including lack of generalizability. participants who selected to apply for this program may already have been more attuned to interprofessional collaboration concepts than the average msw student. not only were the students selected based on established criteria, but the interprofessional sites were also. sites used in this study may already possess a greater degree of commitment to preparing professionals for interdisciplinary practice than peer agencies. it should also be noted that less than a third of the fellows participated in this study, which may affect how representative the findings are to the fellows as a whole. additional limitations may result from the mix of focus groups, group interviews, and individual interviews. researchers intended to use solely focus groups but altered those plans as the grant progressed. as such, some participants were able to respond to each other’s responses while others were not. conversely, some focus group participants may have shared more in an individual format. previous studies using individual and group interviews to collect data show mixed results regarding which format is more likely to result in the sharing of sensitive information (guest et al., 2017; kruger et al., 2019). while this study did not ask participants to share sensitive personal information, it did ask them to share positive and negative experiences with their site, and it is feasible some participants’ sharing could have been influenced by what others shared or did not share in their focus group. additionally, there is overrepresentation from the last cohort of the grant. by cohort 3, the grant team had adjusted the interprofessional practicum based on feedback from the first two cohorts’ focus groups, which resulted in improved site selection and communication of expectations. the grant team’s use of data to modify the program and walsh et al./evaluation of ipe 245 select beneficial sites might have factored into the apparent absence of negative effect from cohort 3’s reduced time requirement. the expectation would be that these changes would alter the findings from the last cohort’s focus groups. though many of the same themes emerged from all three cohorts, available data does not indicate the extent to which changes made during the grant had an impact on the study outcomes. implications and recommendations as ipe continues to grow, it is important that social work programs not only have a seat at the table but also act as leaders and continue to find new, innovative, and effective ways to disseminate ipe concepts to future social workers. interprofessional practicums are an example of this and should continue to be explored and examined. they might also offer a less resource-intensive alternative for msw programs, compared to symposiums, conferences, or simulations in which students from multiple disciplines are brought together. the benefit of such programs is established, and dedicated practicum experiences could easily be added to an existing ipe model. within themes regarding improvement, there are clear recommendations for others seeking to incorporate a primary care component into the advanced practicum. it is essential to ensure that all those involved, including students and sites, have a clear understanding of learning objectives and general expectations. program developers are recommended to give themselves ample time to recruit diverse placement sites staffed with sufficient social workers dedicated to provide beneficial learning experiences for students. this relationship is important in order to have quality sites that offer the appropriate level of exposure to interprofessional collaboration. ensuring there are robust placement options can reduce pressure on individual sites, mitigate negative effects that may lead to sites refusing to accept students, and allow students greater choice, which may increase their investment in the learning experience. finally, msw programs should consider offering training to students prior to and outside of their placement sites if they intend to use shortened timeframes so that students are better prepared to engage in the learning process once they reach their sites. this training should cover both general interprofessional skills as well as site-specific training if possible. if such training was offered with a large group, the need for site supervisors to continuously train a rotation of students would be reduced. furthermore, when developing interprofessional practicums, learning objectives should be prioritized within the time allotted. . based on the findings of this study, practicum length is not necessarily the primary determinant of quality. although longer periods of time may allow for greater familiarity and comfort for some students, social work programs should not disregard shorter placement options in which students can observe interprofessional practice in action. however, it would likely be better for all if ipe exposure and training was incorporated into their existing practicums. references adamson, k., ashcroft, r., langlois, s., & lising, d. 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(2018). supervision and social work students: relationships in a team-based rotation placement model. social work education, 37(3), 328-341. https://doi.org/10.1080/02615479.2017.1406466 author note: address correspondence to matthew a. walsh, phd, msw, lsw, department of social work, marian university, indianapolis, in. email: mwalsh@marian.edu acknowledgment: the authors would like to acknowledge dr. james a hall who was the principal investigator of this grant. he passed away before submitting this manuscript but without his hard work, dedication, and leadership we would not have been able to work on this grant and we would not be able to share our findings here. https://doi.org/10.3109/13561820903051469 https://doi.org/10.1080/02615479.2017.1406466 mailto:mwalsh@marian.edu _________ patrick j. meehan, phd, university of michigan school of social work, ann arbor, mi 48109, pjmeeh@umich.edu copyright © 2019 author, vol. 19 no. 2 (sping 2019), 276-289, doi: 10.18060/22576 this work is licensed under a creative commons attribution 4.0 international license. political primacy and msw students' interest in running for office: what difference does it make? patrick meehan abstract: although social workers are understood to participate in politics more than the general public, little is known about their interest in running for office. to understand how individuals in “helping” professions like social work may think about running for office, this study introduces the concept of political primacy. political primacy refers to the value individuals assign to elected office’s ability to make a difference, relative to alternative ways of making a difference. using data from the michigan law & social work study, representing a sample of 545 msw and 200 jd students across michigan, political primacy was shown to significantly predict msw students’ interest in running for office at the local level. consequently, the more msw students see elected office as a more effective way of making a difference than alternatives, the more interested they will be in running for office. implications for social work education are discussed, including the socialization of social work students into politics. keywords: social work education; elected office; political primacy; political participation the rhetoric of difference-making in relation to social work is ubiquitous, particularly in schools of social work. many of these schools describe their students as “change agents,” or consider changing society as an outcome of their instruction. however, it is not clear whether social work education emphasizes the political system in general, or elected office in particular, in relation to making change. although it has been understood for some time that social workers participate in politics to a greater degree than the general public, particularly as it concerns voting (ezell, 1993; parker & sherraden, 1992; ritter, 2008; wolk, 1981), less is known about their interest in and attitude toward running for office. this notion should not sound far-fetched. currently, in the 118th congress, there were two social workers in the united states senate, and two social workers in the house of representatives in positions of leadership. thomas (2014) finds that for women, in particular, professions like social work and education are more common pathways into politics than fields such as law and business. indeed, it should be noted that the first woman ever elected to the house of representatives, jeannette rankin, was a social worker. moreover, the issues that social workers are passionate about often find expression in legislation, which has been true for some time. writing in 1953, for example, schottland claimed “the great battles of social work today are being fought in the political arena” (p. 19). as a consequence, patti and dear (1975) argued “of all available avenues for social change…the legislative process would seem to demand the profession’s most urgent and informed action” (p. 113). more recently, lane, ostrander, and rhodes-smith (2018) connect educating msw students for political campaign work to “the struggle to change mailto:pjmeeh@umich.edu https://creativecommons.org/licenses/by/4.0/ meehan/what difference does it make? 277 the oppressive social forces that keep” populations “from successfully utilizing existing structures and systems” (p. 1). but running for office is not like other forms of political participation. milbrath (1965), for example, classified it as a “gladiatorial” (p. 21) form of political participation (see also hull, 1987; rose, 1999). the rough and tumble imagery this conjures helps explain why many social workers see politics as a “dirty” business (ezell, 1993, p. 82). lane and humphreys (2011) similarly acknowledge that social workers associate politics with power, and are trained to be skeptical of power. in anticipation of this criticism, mahaffey (1977) wrote “our efforts to achieve power [through political office]…must be for the goal of helping the have-nots, those who are hurt and are in pain, rather than for power as an end in itself” (p. 36). mahaffey’s words offer a way of understanding when and under what circumstances social workers may take an interest in running for office. helping the have-nots, or for the purposes of this study, individuals from oppressed communities (i.e., racial/ethnic minorities, those below poverty, survivors of domestic violence, etc.), is consistent with social work’s identity as a “helping” profession. “helping” professions can be understood as those in the human and social services. they are characterized by concern for the welfare and well-being of vulnerable populations. many kinds of social work practice fit under this label, such as clinical counseling, substance use counseling, case management, school counseling, community organizing, and many others. but clearly not every social worker sees elected office as a way of helping the oppressed and those less fortunate. consequently, this study offers a new concept for understanding social workers’ interest in elected office. i offer this concept as political primacy, which refers to the value individuals assign to elected office’s ability to make a positive difference, relative to alternative ways of making a difference. this concept is particularly useful in understanding the motivations of individuals in helping professions like social work. that is, social workers like mahaffey value helping others, and may evaluate our political institutions by their ability to help others as well. to the extent social workers (and others) see elected office as a better way of helping others than available alternatives, they may be more interested in running for office than those who do not see elected office this way. to test the robustness of political primacy as a motivator for pursuing elected office, this study used data from the michigan law & social work study (mlsws; meehan, 2017). the study represents a sample of 545 msw students and 200 jd students from four universities in michigan, who provided observations on their interest in running for office and other political characteristics, such as political efficacy and partisan identification. with a unique measure of political primacy, the mlsws allowed the strength of its relationship to their interest in running for office to be measured. the inclusion of jd students in the mlsws also allowed this strength to be measured for individuals in a “nonhelping” profession that otherwise has a close relationship to elected office (fox & lawless, 2005). “non-helping” professions can be understood as generally lacking both a human service component as well as an explicit interest and concern for vulnerable populations. public defenders do provide service to vulnerable populations, but this does not characterize the legal profession as a whole. observing a similar relationship between advances in social work, fall 2019, 19(1) 278 political primacy and interest in running between msw and jd students may suggest the concept has wider applicability to running for office than simply for individuals in helping professions. theory and literature review political science has understood political participation largely through the lens of costs and benefits (green, palmquist, & schickler, 2002; leighley & nagler, 2013; verba, schlozman, & brady, 1995; wolfinger & rosenstone, 1980). that is, the benefits of participation are not without costs. these can be understood in different ways. for example, time represents a cost. some individuals have more time to participate in politics than others. thus, understanding participation requires understanding how individuals overcome the costs of participation. moreover, the costs of participation do not fall equally on all individuals. the civic voluntarism model (cvm; verba et al., 1995) has been a popular way of explaining how certain individuals, including social workers, overcome the costs of participation (hamilton & fauri, 2001; lane & humphreys, 2011, 2015; ostrander et al., 2018; ritter, 2008). three overlapping themes in the cvm help explain who participates. the first of these is psychological engagement, or an individual’s interest in politics, party identification, family influences, etc. the more engaged an individual is with the political system, the easier it is to acquire the information necessary to participate. the second is resources such as income and education. those with higher incomes have more freedom to participate. the third is recruitment; all things being equal, an individual who is asked to participate, or who is given transportation to the polling place, for example, is more likely to participate. with respect to social workers, hamilton and fauri (2001) find that membership in social work organizations such as the national association of social workers (nasw) strongly predicts political participation. they argue membership provides a ready pool from which to recruit participants. ritter (2008) corroborated this finding with 396 randomly selected licensed social workers, arguing that organizations also provide members valuable skills (organization, communication) that translate well to politics. resources, on the other hand, did not significantly predict their participation. as it concerns running for office, lane and humphreys (2011) find that membership in organizations like nasw matters less for recruitment. of the 416 social worker candidates they surveyed, friends and acquaintances recruited 75% of them to run for office, with another 65% recruited by elected officials. they do find, though, that resources matter when running for office. specifically, they find that the average income of social worker candidates was higher than the average social worker in general. political primacy the conundrum of political participation, generally, is that the benefits are widely distributed. although an individual may derive personal satisfaction from participating, they will enjoy the “benefits” of their preferred policies regardless of their participation (downs, 1957). the cvm attempts to account for this collective action problem by meehan/what difference does it make? 279 inflating the value of intangible personal benefits to account for individuals’ greater than expected participation in politics (verba et al., 1995). but the benefits of running for office are different from other forms of political participation. first, they are not widely distributed—they are exclusive to the individual running. this exclusivity can be thought of as a prestige benefit. most of the literature that associates ambition with running for office makes allusions to the prestige benefit (black, 1972; fox & lawless, 2005; fox & lawless, 2011). those who crave the spotlight, for example, may relish the opportunity to run for office. second, and more important, the benefits of running for office are instrumental. unlike voting, donating money, volunteering for a campaign, or other forms of political participation, running for office allows the individual to shape the issues and policies under consideration during the campaign. this can be thought of as an instrumental benefit, and it exists regardless of the outcome of the election. consequently, those who have a sincere policy goal may see running for office as a way of advancing movement toward this goal. it is worth considering the attraction social workers might have to the benefits of running for office. social work is not understood as a vainglorious profession, so the prestige benefit should have little value to social workers. social work is understood as a helping profession, though, so the instrumental benefit may be of value to social workers, to the extent they see elected office as a way of helping others. political primacy represents a way of quantifying how social workers (and others) value elected office as a way of helping others. it is important to note that, in terms of running for office, this value does not exist in isolation. it exists alongside (a) alternative ways of helping others, and (b) the costs of running for office. accordingly, political primacy quantifies the value of elected office’s ability to help others, relative to alternative ways of helping others, while the costs of running for office are held constant. individuals may be unable to separate the costs of obtaining and holding elected office from its ability to help others when valuing it against alternative ways of helping others. this is not to suggest political primacy is an unreliable measure. rather, these perceptions of cost may be built into how individuals evaluate elected office. it is reasonable to expect variation in political primacy among social workers. after all, most incoming msw students are not interested in public policy or politics (ostrander et al., 2018). most msw students want to use their degree to help others on an individual basis (butler, 1990; ostrander et al., 2018; rubin & johnson, 1984; rubin, johnson, & deweaver, 1986). however, the likelihood of running for office among social workers cannot be reduced to facile micro-practice and macro-practice distinctions (ostrander et al., 2018). it may be that micro-practice social workers with a generalized interest in helping others evaluate our political institutions with this interest in mind. it may also be that macro-practice social workers prefer helping others through community organizing because they see our political institutions as incapable of helping them. taken together, these nuances are an indication that running for office is a unique form of political participation. the cvm literature’s concentration on the differential costs of advances in social work, fall 2019, 19(1) 280 participation (hamilton & fauri, 2001; ritter, 2008; verba et al., 1995), while meaningful, ignores the instrumental benefit available to social workers through running for office. political primacy offers a way of understanding how social workers weigh this benefit. methods sample data for this study come from the michigan law & social work study (meehan, 2017). the sample consists of graduate students in social work and law, respectively, and was recruited from four universities in the state of michigan, each with law and social work schools. the schools were the university of michigan, michigan state university, wayne state university, and western michigan university. email invitations were sent to students—3,000 in total—through the respective university listservs. the invitations were emailed between february and march 2017, and included a link to the survey instrument. the language of the invitation invited students to participate for their “attitudes on several subjects.” no mention was made of the specific content of the survey. students received a $5 amazon.com redemption code for completing the survey. a total of 854 surveys were started by social work and law students. of these 109 had to be discarded, leaving 745 usable responses, for a response rate of 22.8%. although several studies have used non-probability sampling to understand the political participation of social workers (felderhoff, hoefer, & watson, 2015; ostrander et al., 2018; swank, 2012), most studies on this subject have used random sampling (hamilton & fauri, 2001), often of nasw members (ezell, 1993; parker & sherraden, 1992; ritter, 2008; rome & hoechstetter, 2010; wolk, 1981). the mlsws is a nonprobability sample. although this sampling method limits the generalizability of the findings to all msw and jd students, it is not inherently biased toward identifying a relationship between political primacy and interest in running for office. the schools included in the mlsws, for example, operate at different levels of prestige, and draw students from a variety of income and educational backgrounds. the mix of nationalserving and regional-serving msw and jd programs also means the students included have different intentions of working in michigan and working outside the state. this may relate to their interest in running for local and higher office in that students from national-serving universities who intend to leave michigan may not know where they will be living in order to run locally. survey instrument the survey instrument used in the mlsws consisted of 42 items. among these was an original measure of political primacy inspired by seiz and schwab’s (1992) study of social worker values. in their questionnaire, respondents were asked to rank-order a list of value statements, under the assumption that social workers in private practice have a different value system than social workers who work for an agency. social workers understand there are many ways of helping people and making a difference in a community. a measure was needed in this study that forced respondents to rank order various ways of making a difference, with elected office as one of the options. meehan/what difference does it make? 281 such a measure would indicate the value individuals give to elected office as a way of making a difference, relative to alternative ways of making a difference. the list of alternative ways of making a difference, much as seiz and schwab’s (1992) list of value statements, was not meant to be exhaustive. it was kept sufficiently brief so that respondents could weigh all options against each other. the language of the item referenced “contributing to the community” rather than making a difference or helping others specifically. this avoided different interpretations of making a difference, particularly across professions. social work students may have a different idea on what making a difference means than law students. the item read as follows: “what is the best way of contributing to your community? please rank from 1 (best) to 5 (worst). • giving money to good causes, such as non-profit, community, or religious organizations. • volunteering your time to good causes, such as non-profit, community, or religious organizations. • speaking at meetings of local government, including the school board, city council, or other municipal boards. • serving in local government, such as on the school board, city council, or other municipal boards. • other (specify). respondents could then move the answer choices into their preferred order. those who moved “serving in local government” to the top were indicating it as the best way of contributing to the community. importantly, the order of the answer choices themselves was randomized, except for “other,” which always appeared last. this prevented response bias through the ordering of the answer choices. to account for the prestige benefit of running for elected office, the instrument included a measure of “competitive traits” (fox & lawless, 2005). two items asked students to indicate how important it was that they: (1) “earn a lot of money from their job,” and (2) “have an important and influential job.” their answer choices were “not important” (1), “somewhat important” (2), “important” (3), or “very important” (4). their answers to these items were combined to form a competitive traits scale, with a cronbach 𝛼𝛼 = 0.43. this represented low reliability, so these items were not necessarily consistent with how respondents understood competitiveness. the scale was used in analyses to conform with previous research (fox & lawless, 2005). the dependent variable in this study was modeled after fox and lawless’ (2005) citizen political ambition study. they use the term nascent political ambition to refer to “the embryonic or potential interest in office seeking that precedes the actual decision to enter a specific political contest” (p. 643). accordingly, students were asked to indicate their interest in running for offices at all levels of government, including school board, parks commission, city council, county commission, mayor, state legislature, and u.s. house or senate. their answer choices were “not at all interested” (1), “not very interested” (2), “somewhat interested” (3), or “very interested” (4). their answers were divided into advances in social work, fall 2019, 19(1) 282 separate scales for local and higher office. the local office scale combined their interest in school board, parks commission, city council, and county commission, with a cronbach α= 0.74. the higher office scale combined their interest in mayor, state legislature, and u.s. house or senate, with a cronbach α= 0.89. additional items on the survey instrument covered political efficacy and partisan identification. the survey instrument also included a broad swath of demographic characteristics. importantly, the instrument was pretested twice on amazon.com’s mechanical turk platform. the first test occurred on june 29, 2016, while the second test occurred on december 29, 2016. the combined responses across both tests was 1,285. respondents were paid $0.25 for completing the survey. in both instances the items on the survey instrument performed as expected and produced results consistent with expectations. specifically, political primacy was shown to strongly predict interest in running for office, controlling for a variety of additional factors. results sample characteristics table 1 displays the characteristics of the two groups in the mlsws. the msw sample was older, more likely female, and had a higher percentage of married respondents than the jd sample. the jd sample also came from more educated households, as more than 37% of respondents had mothers who completed graduate school. table 1. demographic characteristics of msw (n=545) and jd (n=200) students in the mlsws msw* n (%) jd* n (%) non-white 156 (28.6%) 64 (32%) female 485 (88.9%) 146 (73%) democrat 418 (76.7%) 162 (81%) married 118 (21.7%) 20.8 (10.4%) children less than 6 years old in the household 39 (7.2%) 5.2 (2.6%) mother’s highest degree graduated 8th grade 26 (4.7%) 3 (1.5%) graduated high school 101 (18.6%) 17.4 (8.7%) some college 105 (19.2%) 22.4 (11.2%) graduated college 207 (38.0%) 81.6 (40.8%) graduated graduate school 107 (19.6%) 75.6 (37.8%) *age: years (sd)-msw 28.6 (7.2), jd 26.4 (2.7) bivariate statistics as it concerns competitive traits, table 2 shows the average score on this scale for msw and jd students, respectively. meehan/what difference does it make? 283 table 2. average characteristics of msw (n=545) and jd (n=200)* students in the mlsws subscales range of subscale scores msw avg (sd) jd avg (sd) t df p competitive traits 2-8 5.45 (1.39) 5.55 (1.40) -0.85 743 0.39 serving in local gov. is the best way to contribute to community* 1-5 3.54 (1.11) 3.89 (1.02)*** -3.71 685 <0.001 interest in running for local office 4-16 9.09 (2.83)** 8.37 (2.87) 3.05 743 0.002 interest in running for higher office 3-12 6.53 (2.77) 7.31 (2.81)*** -3.39 743 0.001 *for this subscale, n= 496 (msw); 191 (jd) **p<0.01, ***p<0.001 no statistically significant difference was observed between msw and jd students in terms of their competitive traits. table 2 also shows the average political primacy for msw and jd students, respectively. the answers to the political primacy scale were reverse coded so that higher values meant greater value to elected office over the alternative answer choices. five indicated serving in local government was the best way of contributing to the community. jd students had significantly greater political primacy than msw students. in other words, jd students were more likely to feel serving in local government was a better way of contributing to the community than msw students. table 2 reports the average interest msw and jd students have in running for local and higher office. msw students were significantly more interested in running for local office than jd students, while jd students were significantly more interested in running for higher office than msw students. multivariate analysis to observe the relationship political primacy had with students’ interest in running for office, a multivariate regression model was applied to respondents’ interest in running for office at the local level. the model included political primacy, as well as fox and lawless’ (2005) notion of competitive traits. it also included items related to political efficacy, along with several demographic controls. table 3 displays the results of the regression model. political primacy was significantly related to msw students’ interest in running for local office. for every one-unit increase in political primacy, their interest in running increased 0.29 (p<0.009). the relationship was marginally significant (p<0.066) for jd students. male msw students were also significantly (p<0.004) more likely to be interested in running for local office than their female counterparts. this relationship was not observed in jd students. similarly, non-white msw students were marginally (p<0.05) less interested in running for local office than white students. advances in social work, fall 2019, 19(1) 284 table 3. regression results on interest in running for local office for msw (n=484) and jd (n=185) students in the mlsws msw β coef. (se) jd β coef. (se) political primacy 0.29** (0.11) 0.41 (0.22) competitive traits 0.03 (0.10) -0.21 (0.15) sometimes politics is too complicated for people like me to follow -0.39*** (0.11) -0.11 (0.20) public officials don’t care what people like me think -0.07 (0.13) 0.04 (0.21) age -0.03 (0.02) 0.13 (0.08) non-white -0.55 (0.29) 0.69 (0.51) male 1.11** (0.38) 0.44 (0.51) mother’s education -0.12 (0.10) 0.00 (0.22) married -0.10 (0.38) 0.89 (0.73) children under 6 at home -0.55 (0.72) -0.08 (1.96) children over 6 at home 0.24 (0.54) -1.14* (0.65) r2 0.08 0.08 se= standard errors in parentheses **p<0.01, ***p<0.001 table 4 reports the results of the regression model on students’ interest in running for higher office. table 4. regression results on interest in running for higher office for (n=484) and jd (n=185) students in the mlsws msw β coef. (se) jd β coef. (se) political primacy 0.19 (0.11) 0.46* (0.21) competitive traits 0.14 (0.10) 0.02 (0.15) sometimes politics is too complicated for people like me to follow -0.65*** (0.10) -0.13 (0.19) public officials don’t care what people like me think -0.01 (0.13) 0.01 (0.20) age -0.02 (0.02) 0.13 (0.07) non-white -0.45 (0.27) 0.27 (0.44) male 0.98** (0.37) 1.09* (0.45) mother’s education -0.13 (0.11) -0.17 (0.21) married -0.14 (0.36) -0.01 (0.63) children under 6 at home -0.08 (0.66) -0.35 (1.66) children over 6 at home 0.03 (0.53) -1.14* (0.58) r2 0.12 0.09 se= standard errors in parentheses p<0.05, **p<0.01, ***p<0.001 the relationship between political primacy and interest in running for higher office remained marginally (p<0.071) significant for msw students, while it became significant (p<0.034) for jd students. similarly, gender remained a significant predictor of interest in running for msw students and became significant (p<0.017) for jd students as well. meehan/what difference does it make? 285 discussion in the wake of the 2016 presidential election, schools of social work are grappling with how to channel student activism toward the political environment, and what the role of the profession should be in the political arena. political social work refers to using political mechanisms and institutions to create social change (lane & pritzker, 2018), and running for office is one way social workers can influence the policy debate in the united states, as well as policy outcomes. but it is not the only way. social workers who care about helping others have many options for working with individuals and communities, so running for office will have greater appeal to some social workers and less for others. indeed, running for office is not like other forms of political participation. the prestige and instrumental benefits of running are exclusive to the individual running. in order to take advantage of the instrumental benefits of elected office, social workers (and others) must see it as an effective way of making a difference. political primacy offers a way of quantifying the value individuals place on elected office’s ability to make a difference, relative to alternatives. using data from both msw and jd students in the mlsws, political primacy was shown to significantly predict students’ interest in running for office at all levels of government. it was speculated that social work’s identity as a helping profession would make political primacy more meaningful to msw students than to jd students. the results on this point were inconclusive. political primacy mattered to nascent political ambition for both groups, but at different levels of government. this may mean msw and jd students view the difference-making potential of elected office differently at different levels of government. social work students may place greater value on the differencemaking potential of local government, while law students place greater value on that of higher office. there are likely other unobserved characteristics between the groups contributing to this difference that future research will need to tease out. the fact that law students had more political primacy to begin with may mean many things, including the notion that running for office is more accepted and socialized in law school than in social work programs. that is, political primacy may be endogenous to law students with a pre-existing interest in running for office in ways it is not for social work students. sorting out the temporal order of political primacy’s relationship to nascent political ambition will require further research. for social work educators especially, it will be important to know if political primacy is malleable (fox & lawless, 2011), or if students have fixed opinions on the value of elected office when they enter the classroom. swank (2012) also notes that social work students care about the legitimacy of political institutions when they participate in politics. this speaks to the power of the political efficacy items included in the msw regression models. if students see political institutions as illegitimate, it will be difficult to persuade students that political institutions can be a venue for making positive change. data from the mlsws indicate gender acted as a significant predictor of nascent political ambition across social work and law students, respectively. it may be necessary to interact political primacy with gender to see if its relationship to nascent political ambition is stronger for women than it is for men. the gender distribution in the mlsws advances in social work, fall 2019, 19(1) 286 did not allow for interactions to be calculated. meehan (2018) observes that female msw students doubt their qualifications to run, so it is necessary to remember that the costs of running are not distributed equally across gender identities. in other words, no matter the instrumental benefit of running for office that political primacy measures, women face greater costs to running for office than men. this disparity speaks to the challenge of understanding all aspects of what is known as the candidate emergence process (maisel & stone, 1997). political primacy may be a necessary condition for candidacy, but it may also be insufficient on its own to inspire an individual to run for office. relatedly, although nascent political ambition is an accepted dependent variable in political science, it is not clear it is predictive of who ultimately runs for office. fox and lawless (2011) find that an individual’s interest in running waxes and wanes in response to the political environment. this study, for example, did not account for recruitment, which matters to running for office, particularly for women (fox & lawless, 2010). future research on political primacy will need to account for a wider array of characteristics included in the cvm to see if its relationship to nascent political ambition holds. several limitations are worth considering in relation to the results of this study. the mlsws, for example, was not a representative sample of msw and jd students, respectively, in general or at the participating institutions specifically. although the email invitation did not address the content of the survey instrument, in the case of msw students it only reached students who elected to participate in the university listserv. moreover, the exploratory nature of much of this research requires that the results around the key concepts be interpreted with caution. competitive traits have meaning in the political science literature (fox & lawless, 2005), but the scale as measured in the mlsws may not have adequately measured this concept. consequently, ambition may still have meaning for nascent political ambition that the mlsws did not account for. the same holds for political primacy. given that the concept behaved differently for msw and jd students, respectively, there is likely greater variation in how individuals in these groups value the difference-making potential of elected office than is captured in the mlsws. nevertheless, social work educators can take heart. in this moment of political turmoil, students are interested in running for office. although law students show a greater interest in higher office, social work students in the mlsws show an interest in their local political institutions such as school boards and city councils. and the more they see holding office in one of these institutions as a way of making a difference in their community, the more likely they are to express an interest in running for one of them. this is not insignificant; local governments play important roles in providing services to populations social workers interact with. having social workers in the rooms where decisions are made will make it more likely those decisions reflect the values of the profession (lane & humphreys, 2011). it is worth asking, if not social workers, then who? someone is going to occupy our elected offices; social workers cannot afford to hold their nose at the unseemliness of politics and hope that those in positions of power will make the right decisions. as ribicoff (1962) noted, “the public business is an undignified business only if we abandon it to those of narrow or selfish motives” (p. 5). if schools of social work truly want to make their meehan/what difference does it make? 287 students “change agents,” then they cannot avoid discussing politics and running for office, where real change happens. references black, g. s. 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(1986). direct practice interests of msw students: changes from entry to graduation. journal of social work education, 22(2), 98-108. doi: https://doi.org/10.1080/10437797.1986.10671744 schlesinger, j. a. (1966). ambition and politics: political careers in the united states. chicago, il: rand mcnally. schottland, c. i. (1953). social work issues in the political arena. in the social welfare forum: official proceedings of the annual meeting, 1953 (pp. 18-33). ny: columbia university press. seiz, r. c., & schwab, a. j. (1992). value orientations of clinical social work practitioners. clinical social work journal, 20(3), 323-335. doi: https://doi.org/10.1007/bf00754643 swank, e. w. (2012). predictors of political activism among social work students. journal of social work education, 48(2), 245-266. doi: https://doi.org/10.5175/jswe.2012.200900111 thomas, s. (2014). introduction. in s. thomas & c. wilcox (eds.), women and elective office: past, present, and future (3rd ed., pp. 1-26). ny: oxford university press. doi: https://doi.org/10.1093/acprof:oso/9780199328734.003.0001 verba, s., schlozman, k. l., & brady, h. e. (1995). voice and equality: civic voluntarism in american politics. cambridge, ma: harvard university press. wolfinger, r. e., & rosenstone, s. j. (1980). who votes? (vol. 22). new haven, ct: yale university press. wolk, j. l. (1981). are social workers politically active? social work, 26(4), 283-288. author note: address correspondence to: patrick meehan, phd candidate, school of social work, university of michigan, 1080 s. university ave, ann arbor, mi 48197. email: pjmeeh@umich.edu acknowledgements: shauna shames, assistant professor of political science at rutgers university-camden, was instrumental in the development of political primacy as a concept, and helped design the measurement used in the mlsws. https://doi.org/10.1080/00220612.1984.10778733 https://doi.org/10.1080/10437797.1986.10671744 https://doi.org/10.1007/bf00754643 https://doi.org/10.5175/jswe.2012.200900111 https://doi.org/10.1093/acprof:oso/9780199328734.003.0001 mailto:pjmeeh@umich.edu theory and literature review political primacy methods sample survey instrument results sample characteristics bivariate statistics multivariate analysis discussion references microsoft word 14_barsky_and_spadola_25190_dont_shame_me _________ allan barsky, jd, msw, phd, professor, and christine spadola, phd, ms, lmhs, assistant professor, phyllis and harvey sandler school of social work at florida atlantic university, boca raton, fl. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1300-1315, doi: 10.18060/25190 this work is licensed under a creative commons attribution 4.0 international license. “don’t shame me; walk with me”: the impact of sanctions for social work licensing violations allan barsky christine spadola abstract: although prior research has explored the types of sanctions imposed by regulatory boards on social workers for licensing violations, empirical investigations surrounding the impact of sanctions on social workers is limited. this qualitative study explored the lived experiences of 13 licensed social workers who participated in licensing investigations and received sanctions by a state licensing board for violating state laws, rules, or ethical standards. the researchers used a phenomenological approach to analyze the interviews and identify common themes. participants described the impact of the investigation process and sanctions on their emotional well-being, reputation, finances, and careers. they also expressed concerns about the potential impact on their clients. participants’ recommendations for licensing boards include greater use of corrective actions rather than relying on punitive measures, avoiding suspensions, and a more strategic use of supervision and consultation. keywords: licensing, sanctions, investigations, social work, regulatory the primary purpose of social work licensing is to protect clients and the public from harm (boland-prom et al., 2018). as with other licensed professions, when social workers breach licensing laws, they may be held accountable by their state licensing board. research on ethics allegations against social workers suggests that the most common complaints are related to boundary violations, substandard practice, recordkeeping, competence, informed consent, honesty, and conflicts of interest (bolandprom, 2009; daley & doughty, 2006, 2007; strom-gottfried, 2000a, 2000b, 2003). prior to 2007, most research on ethics violations by social workers was based on professional review processes conducted by the national association of social workers (phelan, 2007). more recently, research has focused on licensing violations and sanctions. in the most recent study of licensing sanctions, boland-prom et al. (2015) found that 2,607 licensed social workers were sanctioned between 2000 and 2009. the most common corroborated violations were related to record-keeping and confidentiality. other corroborated violations were related to informed consent, standards of care, continuing education, and lapsed licenses. the most common sanctions for serious offenses were licensure revocation and voluntary surrender of licenses. while there is significant research on the types of complaints against social workers, there is little research on the consequences experienced by clinical social workers who have been sanctioned for licensing violations (gricus, 2018). this article shares the findings of a qualitative study of the experiences of 13 clinical social workers who were sanctioned for licensing violations by the ohio counselor, social worker, and family and marriage therapist board (ocswfmt). barsky & spadola/don’t shame me 1301 literature review social work licensing boards are mandated to protect the public and client systems by promoting safe, competent, and ethical social work practice (donaldson et al., 2014; magiste, 2020). to practice clinical social work in the united states, state licensing laws require social workers to have clinical licensure. different states have different categories of social work licensure and different requirements for social work education, field training, supervision, and continuing education (boland-prom et al., 2018). for clinical licensure, states typically require a master’s degree in social work plus two years of supervised post-master’s experience. in ohio, the state where the current study was conducted, clinical social workers are licensed under the title “licensed independent social worker” (ocswfmt, n.d.b). some states use alternative designations such as “licensed clinical social worker” or “licensed independent clinical social worker” (association of social work boards, n.d.b). when clients or others submit complaints about the actions of a licensed social worker, licensing boards are responsible for conducting investigations to determine whether the licensee has violated any licensing laws (carnahan, 2019). the board’s investigators conduct investigations in a private and confidential manner (ocswfmt, n.d.b). in situations where the licensee admits to a violation, the licensee may agree to sanctions or corrective actions. if the licensee does not admit to a violation that has been identified by the investigation, the case proceeds to a hearing by the board. if the board determines that a violation has occurred and the licensee does not sign a consent decree, the board determines appropriate sanctions or corrective actions. in ohio, the consequences for violations may include:  permanent reprimand placed on the license,  disciplinary action, including suspension or revocation of the license or certificate,  probation and/or limitations added to the license or certificate through the implementation of a legal consent agreement, constructed by the ohio attorney general’s office,  a requirement for the licensee to take part in impairment-appropriate therapy or treatment (ocswfmt, n.d.a). in a study of the prevalence of licensing complaints against licensed independent social workers (lisws) in ohio between 1985 and 2013, magiste (2020) found that the board substantiated 592 complaints (averaging 21 per year). the most common complaints were failure to comply with licensing standards (221), nonsexual boundary violations (120), standards of care breaches (65), legal issues not related to direct practice (62), fraud (59), sexual violations (36), and confidentiality breaches (17). licensing boards may investigate and adjudicate upon complaints that relate specifically to violations identified in state licensing laws. although violations such as breaches of confidentiality and standards of care are common across various states, there are significant differences in the scope of violations across states. for example, some states incorporate the national association of social workers (2021) code of advances in social work, fall 2021, 21(4) 1302 ethics into their licensing laws, giving their licensing boards jurisdiction over a greater range of violations than in states with licensing laws that have a more limited range of violations. the association of social work boards (n.d.b) maintains an online database that includes comparisons of licensing laws and regulations across different jurisdictions in canada and the united states. research into the impact of licensing board decisions on licensed social workers is limited (gricus, 2018). accordingly, this literature review includes the findings of studies related to social workers and allied professionals. existing research on licensed social workers, nurses, family and marriage therapists, psychologists, and counselors suggests that when licensees are sanctioned for ethical or legal violations, they experience significant personal and professional consequences (laduke, 2001; thomas, 2005; warren & douglas, 2012; wilkinson et al., 2019). personal consequences refer to physical, emotional, and social impacts, including relationships with family and friends. professional consequences include effects on work, finances, and professional reputations. prior to the current study, the only published research on the experiences of american social workers disciplined by their licensing board was gricus (2018), a qualitative study of 17 sanctioned social workers in an unnamed state. gricus found that sanctioned workers suffered feelings of embarrassment, shame, fear, and anxiety. they also experienced sleep problems, financial issues, and missed time at work. some social workers “connected the experience of disciplinary action with feelings of being watched” (gricus, 2018, p. 9). participants feared the discipline would be a scarlet letter haunting them throughout their careers. many participants were no longer proud to be social workers. some became ambivalent about the profession or disheartened about the investigation process and their ability to gain employment as social workers. others contemplated leaving the profession. while gricus (2018) identified many negative results from discipline, some social workers said the experience of being disciplined resulted in some positive outcomes, particularly, greater attention to practice and ethical concerns. in a qualitative study of 8 registered social workers in england, worsley and colleagues (2017) found workers who were the subject of a complaint often experienced negative impacts on their mental and physical well-being. some workers experienced suicidal thoughts. worsley et al. (2017) note, “although they did survive this process, few emerged unscathed” (p. 2433). certain workers believed their problems escalated when they were investigated “because they feared losing their professional identity, credibility, and career for which they had worked hard” (worsley et al., 2017, p. 2434). sanctioned social workers also reported negative financial impacts related to the cost of legal defense and lost ability to work. in a phenomenological study of 8 sanctioned marriage and family therapists (mfts) from three states, coy et al. (2016) found that some mfts reported positive outcomes, including increased professional knowledge, skills, resilience, and personal growth and understanding through therapy. however, mfts also experienced negative consequences, including lost income and business relationships, stigma, and feelings barsky & spadola/don’t shame me 1303 of isolation. some mfts felt the licensing boards shared too much information. they questioned the necessity of publicizing their sanctions. in an article based on a case study of sanctioned counselors, warren and douglas (2012) highlight the negative impacts of stigma and professional isolation. given the stigma associated with being sanctioned, licensees may have trouble identifying and accessing support such as professional supervision or counseling. stigma and lack of support may exacerbate their problems. schoenfeld et al. (2001) surveyed 240 psychologists who experienced licensing investigations in a southern state. seventy-one received sanctions for licensing violations. study participants identified the following negative effects from the investigations: shock, depression, anxiety, anger, sleep disorders, sexual dysfunction, interpersonal stresses, and costs in time and money to defend themselves. the negative effects were greater for psychologists found to have committed a violation than for those not found to have committed a violation. although there is a growing body of research regarding the impact of sanctions on licensed psychologists and other mental health professionals (peterson, 2001; wilkinson et al., 2019), little research exists regarding the impact of sanctions on licensed clinical social workers (gricus & wysiekiersky, 2021). the purpose of the present research is to explore how sanctions affected the professional and personal lives of social workers who received sanctions for licensing violations. research methods this study used a phenomenological approach (neubauer et al., 2019; wojnar & swanson, 2007) to explore the lived experiences of 13 lisws in ohio who had been sanctioned by their state licensing board for violating laws, rules, or ethics. the study was approved by the institutional review board of the first author’s university. potential research participants were identified through the ohio counselor, social worker, and family and marriage therapist board’s website, which lists lisws who received sanctions. the first author emailed and phoned a random sample of 62 lisw from this list, inviting them to participate in the research. among those contacted, 13 agreed to participate, 9 declined, and 40 did not respond (including at least 8 people whose email addresses or phone numbers were not working). the first author conducted in-depth, semi-structured interviews. questions surrounded participants’ perceptions of the impact of the sanctions on their personal and professional lives. each interview lasted 30 to 60 minutes. eleven participants allowed the interview to be audio-recorded and transcribed. one participant requested no audio recording so the interviewer took detailed notes. one participant submitted responses in a text document. the first author analyzed the interviews using qualitative data analysis, including word coding to identify patterns of words, phrases, and contexts within the transcripts and notes (denzin & lincoln, 2017). they identified quotations relating to the impact of sanctions and tentatively labeled each quotation with the essential theme for each quotation (e.g., lost income, expensive to defend, fearful, cannot sleep, traumatized, advances in social work, fall 2021, 21(4) 1304 reputation hurt, shame, punitive, disproportionate sanctions, permanent record). they then identified common themes among the quotations (denzin & lincoln, 2017), as presented in the findings section. to promote rigor of the analysis and ensure the accuracy of the themes, the second author conducted an external audit of the transcripts and themes (creswell & miller, 2000). this external audit involved the second author reading and coding all transcripts independently, developing major themes and subthemes, and comparing them with the first author’s themes and subthemes. the first and second authors discussed differences in their theming and built consensus about which themes fit best with the data. findings the research participants comprised 11 female and 2 male lisws who received sanctions for violating licensing laws between 2004 and 2020. table 1 indicates the participants’ years of post-licensure practice experience, practice settings, and areas of practice. table 2 indicates the reported licensing violations and the outcomes imposed by the board. when asked about their experiences of being sanctioned, research participants discussed the fairness of the sanctions and the impacts of the sanctions on their personal and professional lives. the “fairness” theme comprised two factors: whether participants felt sanctions were needed and whether they felt the sanctions were proportionate to the type of violation. the “impacts” theme involved three types of impacts: emotional impacts; reputational, career and financial impacts; and impacts on clients. fairness of the sanctions some participants suggested the sanctions imposed by the board were fair. these participants tended to be licensees who acknowledged they had violated a regulatory law and signed a consent agreement. they were also able to maintain their jobs or obtain a new position. they did not necessarily think that the board needed to punish them, as they had acknowledged their offenses; however, they thought the types of sanctions were proportionate to the type of violation. table 1. practice experience, contexts, and areas (n=13) n (%) post-licensure practice experience 1-5 years 6 (46.2%) 6-10 years 2 (15.4%) 21-30 years 3 (23.1%) over 30 years 1 (7.7%) unanswered 1 (7.7%) practice contexts private practice 10 (76.9%) agency-based 3 (23.1%) retired 1 (7.7%) practice areas mental health 10 (76.9%) forensic 1 (7.7%) addiction 1 (7.7%) supervision 1 (7.7%) older adults 1 (7.7%) total may add up to more than n=13 because some respondents gave more than one answer. barsky & spadola/don’t shame me 1305 most participants felt that the sanctions were disproportionate or unfair. some did not think that they violated any laws. others felt that their violations were relatively minor, for instance, not submitting the appropriate paperwork to document their continuing education. the fact that certain participants signed consent agreements with the board did not mean that they actually agreed with the finding of a violation or the sanctions imposed. they felt that it was not worth fighting the board or they did not have the financial means to contest a decision by the board. some participants tried to retract their consent agreements; however, they said the board would not allow them to do so. one participant noted that the consent agreement with the board stated that the consent was “in lieu of formal discipline;” however, the participant felt the consent agreement was indeed formal discipline. some participants suggested the board went too far in meting out sanctions, particularly in situations where the clients did not incur harm. as one participant noted, “although there was a conflict of interest, which i agreed, there was no harm… i felt there was a complete overreaction by the board.” several participants noted that the board treated them more harshly than social workers who had sex with their clients: “i think it’s ridiculous. i mean people sleep with their clients.” others suggested that the social work board was much harsher than boards that oversaw other licensed professions: “when are other disciplines going to be held by the same standards as social work and mental health professions?” several participants said they felt they were treated too harshly based on their research of prior board decisions or based on what they had been told by their attorneys. as one participant said, “[my attorney] got [the board] down to 18 months [license suspension], but they wouldn’t go below that. he said, ‘you’ve got to be kidding. all these other cases, very severe… what [is the board] doing?’” some participants who felt the sanctions were disproportionate received severe sanctions, such as permanent license revocation. others received less severe sanctions, such as a suspended license or an order requiring supervision. even a relatively minor sanction, however, could be experienced as disproportionate. some felt that they had admitted their wrongdoing and had taken corrective steps, so a warning letter would table 2. reported violations and investigation outcomes violations n (%) nonsexual boundary violations 5 (38.5%) not obtaining informed consent 2 (15.4%) felony 1 (7.7%) inappropriate documentation 1 (7.7%) insufficient continuing education 1 (7.7%) impaired practice 1 (7.7%) making threats 1 (7.7%) sex with client 1 (7.7%) not reporting a supervisee’s violation 1 (7.7%) bias 1 (7.7%) outcomes permanent revocation 5 (27.8%) supervision 5 (27.8%) ethics course 4 (22.2%) suspended sentence 3 (16.7%) reprimand 1 (5.6%) total may add up to more than n=13 because some respondents gave more than one answer. advances in social work, fall 2021, 21(4) 1306 have been sufficient. although the board was authorized to take admissions and expressions of remorse into account, several participants felt that the board did not consider their remorse as a mitigating factor. participants also expressed concern that even a short suspension would leave a permanent mark on their reputation. in advocating for time-limited sanctions, one participant stated, “just, the blanket rule about everybody’s disciplinary actions stay on their record forever. even serious violations, people can turn around and people can redeem themselves. to leave it on their records for 10, 20, or 30 years, it just seems extreme.” impact of the sanctions emotional impacts two participants indicated they became happier after the board’s decision. they did not enjoy having to go before the board or being sanctioned. however, they used the board’s decision as a “wake-up call,” decided to leave social work, and started new careers. as one participant noted, "i was hurt emotionally. so, what do you do with that? i went back to school… i don’t like walking around like i’m a victim. i feel like i persevered… i’m probably the happiest i’ve ever been in the career where i am.” these participants suggested they were less stressed in their new careers and made more money. most participants reported a much stronger emotional impact, with experiences ranging from severe stress to high levels of anxiety, sleep disturbances, and symptoms that they attributed to the possibility of post-traumatic stress disorder. one participant suggested that she awoke with a panic attack every morning, beginning just after the first meeting with the investigator and lasting 18 months. she said she was paralyzed by fear. although she continued to practice social work, her constant state of fear and anxiety made it very difficult to work. another participant shared that she continued to have difficulty sleeping years after the investigation ended. “it’s hard in the middle of the night…i wake up in the middle of the night, at 3 in the morning. i can’t sleep.” a third participant described having a “nervous breakdown” and living in constant fear that another client might report her to the board. she avoided being assertive with clients, worrying about how they might respond: “if a client got mad about something, normally, i’d stand up to them and say, ‘come on, let’s get on with it, it’s a clinical issue.’ and now… i was starting to cower.” a fourth participant described having a sense of paranoia, fearful about making any missteps because they could result in further board investigations. the fears were not just about potential findings of violations, but also fears of having to go through the investigation process. finally, one participant suggested that the board contributed to her experiencing “compassion fatigue.” as a social worker, she hoped the board would be supportive and offer resources. instead, she felt the board undermined her confidence and left her in a constant state of anxiety and fear. a common theme emerging from the participants’ experience of the investigation process was that they came away feeling demeaned and traumatized. barsky & spadola/don’t shame me 1307 reputation, career, and financial impacts some participants shared that having a violation on their record did not have a substantial negative impact on their reputation, career, and finances. they suggested that their colleagues, coworkers, and clients knew about the quality of their work. they did not think the licensing violation affected how they were perceived, ethically or professionally. in the words of one participant, “my staff know who i am. my clients know who i am. [the board’s decision] can’t hurt that.” some participants felt that people who did not already know them might question their reputation if they discovered the violation; however, they were unsure about what effects, if any, this had on their practice or ability to attract clients. one participant said she was very well known in the community, so she was not concerned about how potential clients and referral sources might perceive her. some participants who were less concerned about their reputation believed that the specific violation appeared trivial (e.g., receiving a 10-day license suspension). other participants believed that having a violation on their records affected their reputation significantly. as one participant said, “i have a scarlet letter… and i’m sure it affected my business.” another participant who lost her license noted that the violation prevented her from getting jobs that did not require licensure. “when i tried to get jobs that weren’t licensed jobs, i would have to explain the whole situation and whatnot, and that would always allow me not to have the jobs.” a participant from a small town noted that everyone knew about her licensing violation and she had to contend with a lot of false rumors about the violation. participants suggested it was embarrassing when they applied for jobs and had to disclose their licensing violations. one participant said that although she was able to obtain a new job, her employer required her to have additional in-house supervision. she did not think she needed additional supervision because she was already paying for outside supervision as part of her consent agreement with the licensing board. many participants felt that simply having their name and violation on the board’s website was embarrassing. as one participant said, “i’m mortified. i have an excellent reputation… my name means a lot to me.” participants felt ashamed even if they were not aware of any specific instances when friends, potential clients, or others went on the website and learned that they had a violation. another participant noted, “it was shameful. nobody ever said anything to my face… but who knows. i knew anybody could go and see my name. it was shameful.” several participants expressed concerns that the violation stays on the board’s website forever. they also expressed concerns that others might repost the information. one participant noted that even after seven years, the effects of the violation continued to have a strong impact. “i had tons of friends who were clinical people. i’m like a joke… ‘see, you lost your license.’ i’ve lost my professional standing, money, future prospects…” some participants struggled with when to tell potential employers about their violation. if they informed potential employers too soon, they risked not getting the job; if they did not disclose early on, the employer might also reject them. advances in social work, fall 2021, 21(4) 1308 although some participants continued to struggle with the impact on their reputation, others said they were moving on. “the fact that you can look at my license, it drives me crazy, but i’ve got to let it go. it doesn’t define me. i’m not giving them the power to define me.” some participants moved out of state to re-establish their reputations and careers. some participants returned to school and entered new professions. of the 5 participants who had their licenses revoked, 4 wanted to continue to practice social work. one participant was planning to leave social work even before the licensing investigation. among the 8 participants who did not have their licenses revoked, all said they continued to practice social work right after the investigation process ended or after their licensing suspension ended. not surprisingly, some of the strongest financial and career impacts were reported by participants who had their licenses permanently revoked. one participant said that she was unable to return to work and was living in poverty. some participants reported having large debts, in part because of legal expenses to defend themselves and in part because of lost jobs or lost business (for those in private practice). one participant reported that her practice was $40,000 in debt and she paid $13,000 in legal fees. although some participants had professional liability insurance that covered legal fees, others did not. several participants suggested that the board did not consider the impact of its decisions, not only on them, but also on their family. the lost jobs and lost income affected their whole families. some participants had recently experienced the death of a spouse, a divorce, or mental health issues within the family. after the finding of a violation, they were no longer able to support their families, including basic needs such as housing. one participant estimated lost income at over $1,000,000 over the prior 10 years. some participants believed that the information on the internet continued to affect their reputation and ability to earn a living. another participant said she took a job at a restaurant, earning minimum wage and struggled to support her children. she was eventually able to return to school and earned a new degree to obtain a better paying job. impact on clients some participants who continued to practice social work suggested that the emotional impact of the licensing investigation and sanctions affected the way they practiced. they chose not to accept clients in risky situations, for instance, clients with borderline personality disorder, families with conflictual dynamics, and clients involved in the legal system. as one participant suggested, “i am scared to death to do custody work… i’m too concerned about losing my license… it was valuable work… i won’t do it anymore because i’m too fearful with my board.” another participant said, “i started distrusting my clients, started living in fear… looking over my shoulder.” the participant went through her client list with a professional colleague and decided to terminate work with clients who could be too risky to work with, including clients who experienced trauma. the participants felt bad about having to turn away clients in need, but they were too scared about losing their licenses and barsky & spadola/don’t shame me 1309 livelihoods. some participants reported that other professionals in their agencies quit practice due to their fears about the licensing board. one of the biggest concerns among participants who lost their licenses or had them suspended was that they were forced to terminate work with clients who still needed help. one participant noted, “i had people who were suicidal who ended up in the hospital… another man who’s going through divorce, is depressed and going through substance abuse… and more. and i wasn’t able to do anything but cancel.” some participants who worked in agencies were not allowed to terminate work or transfer them to other workers; the agency took responsibility for the clients. other participants were able to contact their clients and explain their license suspensions. although participants provided referral information, many clients did not want to switch therapists. several participants felt the board should consider the impact of license suspensions on clients, for instance, by giving licensees time to speak with clients before the suspensions took effect or by offering sanctions other than suspensions. rather than suspensions, for instance, one participant suggested that the board could arrange opportunities for clients and licensees to meet and work through the issues themselves. the participant felt that it would have been much more helpful for the board to mediate a solution, bringing a sense of peace and closure to the issues between the licensee and client. the participant believed the current process was more punitive rather than restorative or helpful to the client. because regulatory processes and sanctions are governed by state laws, boards would need legislative reforms in order to incorporate some of these suggestions. some participants whose licenses were revoked believed that they lost their ability to contribute to their clients, community, and society. one participant said, “i have a lot to offer to the public. i have a lot of experience… i do substance abuse work. i do mediation. i do court work. i’ve got a unique blend of experience.” this participant felt the board ignored her capacity to contribute as a social worker and the license revocation brought about more harm than good. limitations this study was based on a sample of 13 participants from a licensing board in one state. accordingly, the primary limitation of this study is the transferability of the findings (denzin & lincoln, 2017). although the sample was drawn randomly from a list of lisws who had received licensing sanctions, the sample may be skewed because 9 people declined to participate and 40 others did not respond to calls or emails (including the possibility of incorrect contact information). people with stronger concerns, lower feelings of shame, or less trauma may have been more likely to respond. others may have felt they had little of significance to share regarding their experience. still, the sample generally mirrored the demographics of the ohio board’s cases regarding gender, agency-based versus private practice, practice areas, and the range of violations. the findings may be more transferable to licensing boards with investigation processes similar to those of ohio (e.g., boards with paid professional advances in social work, fall 2021, 21(4) 1310 investigators rather than volunteer investigators selected from among board licensees). conclusion as the reported experiences of research participants and prior research suggest, being involved in a licensing investigation and having a violation found against them can be stressful and traumatizing (gricus, 2018; worsley et al., 2017). although some participants reported the ability to get on with their lives in a positive manner, many experienced significant negative impacts on their professional, emotional, and financial well-being. the primary purposes of licensing investigations are to protect the public and promote safe, competent, and ethical practice (donaldson et al., 2014). to reduce the risks of unwarranted negative impacts on licensees, social work boards could consider the following strategies:  different types of violations may require different types of actions. when licensees have engaged in sexual exploitation, harassment, or other conduct that has caused or could cause serious harm to clients, boards may need to use stronger and longer-term actions than for less serious violations such as not completing continuing education requirements or failure to document fees in an appropriate manner.  avoid licensing suspensions unless they are absolutely necessary. licensing suspensions may have a negative impact on the licensee emotionally and financially. they may also have negative impacts on clients, whose treatment and support services may be disrupted. if the purpose of short-term licensing suspensions is to act as a punishment or deterrent, boards could use fines or other methods of deterrence.  for licensing violations that do not cause significant harm to clients, designate a timeframe after which information about violations will be removed from the board’s website. many participants expressed concerns about having permanent marks on their records. for less serious violations, it may be appropriate to have a process to expunge violations from public records to reduce the negative impact on a licensee’s emotional, reputational, and financial well-being. when determining appropriate responses to violations, licensing laws require boards to take the seriousness of the violations into account.  when requiring supervision as a consequence for a licensing violation, boards should offer support in identifying an appropriate supervisor for the licensee. if the purpose of supervision is to ensure that licensees practice ethically and avoid similar violations, then clinical supervision may not be necessary in situations where the licensee accepts responsibility for the violation and can demonstrate that they will not repeat it. in some situations, there may be a need for monitoring the licensee’s practice rather than clinical supervision. boards should take the licensee’s prior experience and practice record into account when barsky & spadola/don’t shame me 1311 considering whether mandated supervision will be useful. it may also be helpful for the board to provide specific training for supervisors who intend to work with licensees with violations. the type of supervision that they require may be different from general social work supervision, given the need to focus on specific violations or practice risks. supervisors should also help licensees cope with the stresses associated with having a licensing violation on their records. one participant suggested the need for “trauma-informed” supervision (pennsylvania coalition against rape, 2020). “even if i did the worst thing, don’t judge me, don’t shame me. walk with me. help me know why i did it. help me so i don’t do it again. don’t put me down further because that’s not going to help.” social work licensing boards could draw upon the experiences of the legal and nursing professions which offer alternatives to the traditional disciplinary approach, including the use of diversion, mediation, probation, remediation, and supervision (burgoon, 2021; matthews et al., 2019). these approaches are based on the principles of restorative justice, corrective action, and rehabilitation rather than punishment or retribution (barsky, 2017).  boards should encourage licensees to make use of social work consultants throughout the investigation process and following the findings of a violation. trained consultants could provide coaching and support, helping licensees understand the process, respond to the licensing board in an effective manner, and identify appropriate support systems to help them with any emotional or financial stresses that may arise. for social workers who lose their licenses, consultants could assist with the practical and emotional issues that arise when having to transition to a new career. given the limited budgets of social work boards, it is likely that licensees would need to pay for these consultants (just as they currently pay for any mandated supervision). licensing boards could build on the consultation model used by the national association of social workers (nasw, 2012), which encourages social workers to use consultants when they are involved in professional review processes regarding allegations of unethical conduct. for future studies on licensing violations and sanctions, researchers could conduct an in-depth study of the processes of supervision, consultation, and other corrective actions. different types of violations may require different responses. accordingly, the research could focus on licensing board responses for specific types of violations such as sexual misconduct, nonsexual boundary violations, practicing outside of competency, breach of confidentiality, and failure to report abuse. in order for licensing boards to ensure that their decisions are based on evidence-based practice (gambrill, 2018), it would be useful to identify which types of supervision, consultation, and corrective actions are most helpful and under what circumstances. it would also be helpful to study the processes that licensing boards use to determine which types of corrective sanctions or corrective actions to use for particular situations. advances in social work, fall 2021, 21(4) 1312 although confidentiality and privacy concerns may prevent investigators or licensing boards from discussing particular cases, they could provide information about their decision-making processes and criteria without disclosing identifying information about licensees or clients. future research could also explore the experiences and perspectives of investigators. this research could be used to inform social workers about effective and ineffective ways to respond when they receive notifications of complaints and are participating in investigation processes (barsky, 2020). in addition, this research could illuminate similarities and differences in the ways that investigations are conducted in various jurisdictions (krom, 2019; phelan, 2007). as licensing boards consider the best ways to promote safe and competent practice, it is incumbent upon them to evaluate the impact of their investigatory processes and sanctions. by having a greater understanding of the impacts of licensing revocations, suspensions, supervision, corrective actions, fines, and other sanctions on social workers and the people they serve, licensing boards can make better decisions about what types of actions are most effective for particular violations and situations. as a profession, social work values respect for the dignity and worth of all people (nasw, 2021). the value of respect includes empowering clients and giving them second chances when they make mistakes. the participants in this study suggest that social workers who violate licensing laws should be treated in a similar manner, with respect, empowerment, and compassion. references association of social work boards. 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(2017). a subject of concern: the experiences of social workers referred to the health and care professions council. british journal of social work, 47, 2421-2437. https://doi.org/10.1093/bjsw/bcx005 author note: address correspondence to allan barsky, sandler school of social work, so 321, florida atlantic university, boca raton, fl, 33431. email: abarsky@fau.edu ___________ isok kim, associate professor and director of msw program, school of social work; diane e. elze, associate professor and associate dean for academic affairs, school of social work; patricia j. ohtake, assistant vice president for interprofessional education, office of the vice president for health sciences; associate professor, physical therapy program, department of rehabilitation science, school of public health and health professions, university at buffalo, buffalo, ny. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 204-215, 10.18060/23661 this work is licensed under a creative commons attribution 4.0 international license. social work students’ attitudes and skills self-efficacy toward collaborative practice improve after interprofessional opioid use disorder case discussion isok kim diane e. elze patricia j. ohtake abstract: few studies have examined social work student outcomes after engagement in interprofessional (ip) learning experiences. we examined self-reported attitudes and skills self-efficacy among social work students before and after their engagement in ip forums. the data comes from social work students who participated in 2016-2018 fall ip forums focusing on opioid use disorder. using the interprofessional attitudes scale (ipas) and the interprofessional collaborative competency attainment scale, revised (iccas), we assessed students’ self-reported attitudes (ipas) and skills self-efficacy (iccas) before and after the fall ip forums. paired t-tests identified significant changes in ipas and iccas scores. students reported increases in their ip attitudes and skills self-efficacy following participation in the ip forum as measured by pre-ipas score (n=236, m=4.56, sd=0.29) to post-ipas score (m=4.68, sd=0.27; t(156)=-5.31, p<.001). post-iccas score also increased (n=48, m=4.26, sd=0.69; t(33)= -5.75, p<.001) from the pre-iccas score (m=3.55, sd=0.92). the 2015 council on social work education accreditation standards require that social work students learn how to value and engage in interprofessional teams. given the self-reported increases in ip attitudes and skills selfefficacy seen in this study, ip forum participation will help foster greater engagement and contribution to overall ip experiences for social work students. keywords: interprofessional education; collaboration, opioid use disorder, interprofessional attitudes scale, interprofessional collaborative competency attainment scale the integration of interprofessional (ip) education into the 2015 educational policy and accreditation standards council on social work education (cswe) requires social work (sw) students to learn how to value and engage in ip teams. the cswe accreditation standards assert the importance of social workers’ understanding of the roles of other professions when engaged in ip teams and valuing interprofessional collaboration in engagement, assessment, and interventions (cswe & commission on accreditation and commission on educational policy, 2015). in response, sw programs have begun to integrate interprofessional education (ipe) into their curricula (bonifas, 2017; elze et al., 2017; macmillan & rejent, 2017; rubin, et al., 2018). while a robust body of research has examined ip attitudes and skills among students across many health professions (e.g., kent & keating, 2015; olson & https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 205 bialocerkowski, 2014; reeves et al., 2016), fewer investigations have examined sw students’ engagement with ip learning experiences (e.g., park et al., 2014). among the limited studies, the findings are mixed regarding sw students’ attitudes towards ip collaboration following engagement in ipe (e.g., addy et al., 2015; park et al., 2014). on one hand, some studies found a positive impact of ipe among sw students. for example, curran, sharpe, forristall, and flynn (2008) found that sw students reported the highest mean satisfaction score for small ip group learning methods compared to their counterparts from medicine, nursing, and pharmacy. ko, bailey-kloch, and kim (2014) also found that sw students reported a positive attitude towards ip collaboration when improving the overall quality of care for patients. however, other studies found negative outcomes associated with ipe. park et al. (2014) found that sw students reported the least positive attitudes when collaborating with physicians. lidskog, löfmark, and ahlström (2007) found in their qualitative study that sw students reportedly felt like an outsider and needed to depend on other professionals to do their job. west, miller, and leitch (2016) found that sw students reported perceptions of lower prestige when thinking about participating in ip collaboration with students in medicine, nursing, and pharmacy. notwithstanding that most of these studies contained a small number of sw students as study participants, the inconsistent findings suggest that there is a need for more empirical studies with more participants. thus, our study addresses this research gap. we examined self-reported attitudes and skills self-efficacy among a large cohort of social work students enrolled at the university at buffalo before and after their engagement in fall ip forums in 2016, 2017 and 2018 that focused on the public health crisis of opioid use disorder. interprofessional education at the university at buffalo the university at buffalo established the office of interprofessional education to develop and implement interprofessional educational and clinical experiences that address the interprofessional education collaborative (ipec) core competencies for collaborative practice (ipec, 2016; ipec expert panel, 2011). the office of ipe is supported by the university’s schools of medicine and biomedical sciences, dental medicine, nursing, pharmacy and pharmaceutical sciences, public health and health professions, and social work. since 2016, the office of ipe has held a fall ip forum, “confronting opioid dependence: an interprofessional strategy,” to educate students about the opioid epidemic and the necessity of ip collaboration to address this public health crisis at both the individual and population levels. the fall ip forum, which enrolls approximately 900 students from 12 health professions, is an exposure level ip activity that introduces students to the importance of ip collaborative practice, the unique roles and responsibilities of the different professions, and ip communication and teamwork skills. pre-ip forum preparation the office of ipe’s faculty leadership team collectively developed a case study for the fall ip forum that presents students with a portrayal of a female patient with opioid kim et al./swk students’ attitudues 206 dependence, other chronic health conditions, and complex psychosocial challenges. prior to the fall ip forum, students completed three online modules from the online module series, foundations of interprofessional collaboration, developed by faculty associated with the office of ipe: (a) a welcome from the vice president for health sciences, (b) introduction to ip collaborative practice, and (c) roles and responsibilities. they also viewed several brief videos about opioid dependence (total of 31 minutes); completed a pre-assessment; and reviewed the case study. one faculty facilitator was assigned to each ip group of ~7 students. in preparation for their role as ip small group facilitators, faculty were asked to view the same videos as the students and were equipped with a faculty facilitator guide, which provided a detailed summary of pre-fall ip forum preparation activities, the fall ip forum schedule, student learning objectives, the ipec competencies addressed by the fall ip forum, and detailed instructions for the small group activities. faculty were also given a case facilitator guide that outlined the physical and mental health, and psychosocial issues relevant to the case, organized by profession, to facilitate discussion of roles of professions not represented in their small group. additionally, the office of ipe offered interprofessional small group facilitator training that facilitators completed prior to the fall ip forum. this training was offered in three formats: written instructions, online video, and a 30-minute just-in-time training held immediately prior to each fall ip forum session. format of the fall ip forum each fall ip forum was offered three times during the day (i.e., morning, afternoon, and evening). each session accommodated approximately 300 students, for a total of ~900 students from the 12 participating health professions education programs. students convened in a large lecture hall to hear short keynote addresses about the opioid epidemic from the population health and individual health perspectives. the county commissioner of health described the prevalence, causes, consequences of, and effective interventions to address opioid dependence. another healthcare provider described the importance of medication-assisted treatment and the need to reduce stigma and bias to optimize patient outcomes. students then dispersed to their pre-assigned, faculty-facilitated, interprofessional discussion groups. within their small group (~7 students), the participants introduced themselves, reviewed guiding principles for the small group (e.g., fully participate, model respect for your colleagues and for yourself), and engaged in an initial activity to share information about their professions’ roles and responsibilities and correct any misperceptions about their professions. following the initial discussion, students then proceeded to develop a comprehensive list of the issues experienced by the patient described in the case. collaboratively, the group developed an integrated ip plan of care. a faculty facilitator then conducted a short debriefing with all groups assembled in the room, asking the groups: (a) what was something you learned about another profession that you did not know before? (b) what worked well within your group? (c) what did you learn today that you will incorporate into your clinical practice? following the small group discussion, students completed postassessments and a program evaluation. advances in social work, summer 2020, 20(2) 207 method sample sw master’s level students that participated in the 2016, 2017, or 2018 fall ip forum were included in the study, with equal representation from foundation and advanced year students. irb approval was received for this study from the social and behavioral sciences irb committee at the university at buffalo. the study is a records review and received exempt status. measures we used two measures to assess students’ self-reported attitudes and skills selfefficacy before and after the ip activities associated with the fall ip forum: the interprofessional attitudes scale (ipas, norris et al., 2015) and the interprofessional collaborative competency attainment scale, revised (iccas, schmitz et al., 2017). the ipas measures students’ self-reported attitudes that are aligned with the 2011 ipec’s four core competencies (i.e., values/ethics; roles/responsibilities; ip communication; and teams and teamwork; ipec expert panel, 2011) using a 5-point likert scale (1=strongly disagree to 5 = strongly agree). the ipas was administered in all three (2016, 2017, 2018) fall ip forums. the iccas measures self-reported ability (self-efficacy) to perform the ipec core competencies using a 5-point likert scale (1 = poor to 5 = excellent). the iccas has been used in past literature with good reliability (e.g., langford et al., 2019). the iccas was administered only in the 2018 fall ip forum. data analysis the analyses were conducted using stata se version 12. descriptive statistics are provided for sample characteristics, including age, gender identity, and prior ip experiences. paired t-tests were used to examine any significant differences in preand post-test results for ipas and iccas scores. significance was set at p<0.05. results participants included sw students who participated in one of the three fall ip forums between 2016 and 2018, for whom the data (n=236) were aggregated. the majority of the participants self-identified as female (88.8%) with an average age of 28.2 (sd=9.9) years. one hundred nine (46.2%) students reported having prior ip experiences, defined as any ip experiences in which they participated in the past through personal, work, and/or academic settings. table 1 shows sample characteristics by year of fall ip forum attendance. kim et al./swk students’ attitudues 208 table 1. sample characteristics (n=236). 2016 (n=126) 2017 (n=62) 2018 (n=48) all (n=236) age avg years (se) 26.9 (7.1) 30.5 (14.5) 28.4 (8.5) 28.2 (9.9) gender, female % n (%) 114 (90.2%) 53 (85.5%) 43 (89.4%) 210 (88.8%) has prior ip exp. 29 (46.8%) 47 (97.9%) 109 (46.2%) note: the data regarding prior ip experiences for sw students are not available for the 2016 fall ip forum. the cronbach’s alphas (table 2) were calculated to examine the reliability of the pre and post-ipas subscale scores for ipas-trr (teamwork, roles, responsibilities), ipaspc (patient-centeredness), ipas-ib (interprofessional biases), ipas-de (diversity & ethics), and ipas-cc (community-centeredness). the cronbach’s alphas of all preand post-scores on the ipas subscales were 0.77 or higher, except for the ipas-ib (α=0.66), which is considered minimally acceptable reliability range for measures with low stakes (nunnaly, 1978; ponterotto & ruckdeschel, 2007). similar to the ipas, the cronbach’s alphas (table 2) were calculated to examine the reliability of the preand post-iccas subscale scores of iccas-com (communication), iccas-col (collaboration), iccas-rr (roles & responsibilities), iccas-pfc (collaborative patient & family-centered approach), and iccas-cmr (conflict management & resolution). all iccas subscales had cronbach’s alpha scores of 0.85 or higher, which is considered excellent. table 2 shows the means, standard deviations and cronbach’s alphas for ipas and iccas subscales. table 2. the calculated means and internal consistency for composite and subscales of the ipas (n=236) and the iccas (n=48) in this study measures items cronbach’s alpha (pre/post) interprofessional attitudes scale (ipas)-composite 27 0.83/0.83 teamwork/roles/responsibilities (ipas-trr) 9 0.84/0.85 patient-centeredness (ipas-pc) 5 0.77/0.92 interprofessional biases (ipas-ib) 3 0.66/0.66 diversity/ethics (ipas-de) 4 0.79/0.85 community-centeredness (ipas-cc) 6 0.89/0.92 interprofessional collaborative competency attainment scale (iccas)-composite 20 0.98/0.99 communication (iccas-com) 5 0.93/0.92 collaboration (iccas-col) 3 0.95/0.95 roles and responsibilities (iccas-rr) 4 0.92/0.95 collaborative patient-/family-centered approach (iccas-pfc) 3 0.85/0.95 conflict management and resolution (iccas-cmr) 3 0.93/0.87 team functioning (iccas-tf)* 2 *tf subscale only consists of two items, which is not enough to calculate cronbach’s alpha. advances in social work, summer 2020, 20(2) 209 sw students reported strongly positive overall attitudes toward ip collaboration prior to the fall ip forum as measured by the ipas (m=4.56, sd=0.29; table 3). students’ overall attitudes toward ip collaboration showed a small, yet significant increase following the fall ip forum as evidenced by their post-ipas composite score (m=4.68, sd=0.27; t(156)=-5.31, p<.001). examining the changes in the ipas subscale scores (table 3), there were increases in positive attitudes in the subscales of teamwork, roles, responsibilities; interprofessional biases; and community-centeredness. additionally, post-hoc analyses showed that there was no statistically significant difference of pre-ipas score between those with (m=4.59, sd=0.29) and without (m=4.54, sd=0.28) prior ip experience (t(155)=-1.09, p=0.28). prior to the fall ip forum, sw students’ perceived self-efficacy in performing the skills associated with the ipec core competencies averaged between good and very good on the iccas (m=3.55, sd=0.92). following participation in the fall ip forum, sw students’ perceived self-efficacy increased as shown by the post-iccas composite score (m=4.26, sd=0.69; t(33)=-5.751, p<.001). examination of the changes in the subscale scores (table 3) shows that all subscale scores improved following participation in the fall ip forum. table 3. the results of paired t-tests between preand post-fall ip forum ipas and iccas assessments (composite and subscales) and their corresponding effect sizes. scales means (pre/post) std. dev. (pre/post) d(f) t p-value cohen’s d ipas-composite 4.56/4.68 0.29/0.27 156 -5.314 <.001* .411 ipas-trr 4.49/4.65 0.50/0.48 157 -4.128 <.001* .334 ipas-pc 4.90/4.92 0.23/0.36 156 -0.565 .573 .059 ipas-ib 3.43/3.71 0.88/0.87 155 -4.108 <.001* .312 ipas-de 4.88/4.89 0.30/0.30 155 -0.491 .624 .043 ipas-cc 4.74/4.85 0.40/0.34 155 -3.695 <.001* .288 iccas-composite 3.55/3.73 0.92/0.94 33 -5.751 <.001* .879 iccas-com 3.73/4.25 0.94/0.67 33 -4.700 <.001* .643 iccas-col 3.46/4.24 1.07/0.77 33 -4.742 <.001* .844 iccas-rr 3.44/4.26 0.98/0.73 33 -6.225 <.001* .961 iccas-pfc 3.50/4.24 0.99/0.77 33 -5.056 <.001* .841 iccas-cmr 3.72/4.38 0.94/0.66 33 -4.993 <.001* .835 iccas-19(tf) 3.29/4.15 0.18/0.13 33 -5.575 <.001* .946 iccas-20(tf) 3.35/4.21 0.19/0.14 33 -6.055 <.001* .929 note: ipas=interprofessional attitudes scale; trr=teamwork/roles/responsibilities; pc=patientcenteredness; ib=interprofessional biases; de=diversity/ethics; cc=community-centeredness. iccas= interprofessional collaborative competency attainment scale; com=communication; col=collaboration; rr=roles and responsibilities; pfc=collaborative patient/family-centered approach; cmr=conflict management and resolution; tf=team functioning. *significant = p<.001 following the best practice standard of interpreting cohen’s d scores (cohen, 1988; kirk, 2001), we were able to determine that all of the ipas subscales with statistically significant pre/post changes showed small effect sizes. on the other hand, all of the iccas subscale differences showed large effect sizes. kim et al./swk students’ attitudues 210 discussion the purpose of this research was to examine the changes in sw students’ self-reported attitudes and skills self-efficacy in ip collaborative practice before and after participating in the fall ip forums at the university at buffalo. this study employed a large number of sw students who participated in one of three fall ip forums between 2016 and 2018. overall, this study’s findings were consistent with previous literature (e.g., curran et al., 2008; ko et al., 2014) that found a positive association between participation in ip activities and an increase in attitudes and skills self-efficacy related to the ipec competencies. it is important to note that sw students in this study reported very high initial scores in the ipas, and they scored even higher after their participation in the ip forum. on the contrary, their initial iccas scores were lower but improved significantly after their ip forum participation. this suggests that while sw students have positive attitudes toward collaboration (ipas), they report lower levels of self-efficacy in the ability to perform the ipec core competency skills. providing the sw students with experiential learning seems to have contributed to improving their self-efficacy in all skills self-efficacy components measured by the iccas (i.e., communication, collaboration, roles and responsibilities, collaborative patient-/family-centered approach, conflict management and resolution, and team functioning). the comparisons between the preand post-fall ip forum scores for the ipas and the iccas measures indicated that sw students who participated in the fall ip forums improved in their self-reported attitudes and skills self-efficacy, which are essential for successfully working in an ip collaborative practice setting. the subscales of ipas and iccas measures were designed to assess self-reported attitudes and skills self-efficacy, respectively, related to the 2011 ipec’s four core competencies for ip collaborative practice. self-reported attitudes toward three ipas scales improved following fall ip forum participation: ipas-trr, ipas-ib, and ipas-cc. changes in these subscales are consistent with the focus of the learning objectives and activities of the fall ip forum. with respect to the ipas-trr subscale, sw students were brought together to work in small groups as a healthcare team. students shared their professional roles and responsibilities and collaborated to develop an integrated, ip plan of care. considering the ipas-ib subscale, this collaborative group activity served to reduce biases among students from differing professions through discussion that promoted a more accurate understanding of each of the health professions. finally, the small group discussion also involved exploring the community and population-level strategies for the prevention and management of the current opioid health crisis. these discussions are consistent with the increase in positive attitudes toward community-centeredness and thus the ipas-cc subscale score. two subscales of the ipas did not change in response to participation in the fall ip forum. the ipas-pc subscale is designed to measure perceived attitude around “patientcenteredness,” which addresses the importance of establishing trust, communicating compassion, and understanding issues from a patient’s perspective. this is not surprising as the ipas-pc were the highest scores reported by the sw students (4.90±0.23/5.00) prior to the fall ip forum and remained at this high level following the fall ip forum (4.92±0.36/5.00). this same phenomenon has been observed in another study (fusco et al., 2019) based on the same fall ip forum experience at the university at buffalo, in which advances in social work, summer 2020, 20(2) 211 the authors found that the pharmacy students’ ipas-pc scores were very high and did not significantly change after the ip forum. the other subscale, ipas-de, deals with the importance of paying attention to the diversity and unique cultures of health professionals as well as serving anyone regardless of their background. the ipas-de subscale had the second-highest subscale score reported by the sw students (4.88±0.30) and the score also remained at this very high level following the fall ip forum. given the social work education’s emphasis on the person-in-environment perspective and social justice mission, it is not surprising that the sw students in this study had reported high levels of attitudinal competencies on these two dimensions before the ip forum. on the other hand, the iccas measures self-efficacy in behavioral competencies as they relate to ip core competencies, including communication, collaboration, roles and responsibilities, collaborative patient/family-centered approach, conflict management/ resolution, and team functioning (macdonald et al., 2010). unlike the ipas, the iccas was administered for the first time in the 2018 fall ip forum. therefore, we only had a single data point to examine the changes in students’ self-efficacy in the skills associated with the ipec core competencies. nonetheless, based on overall and subscale scores of the iccas, the sw students reported that their post-fall ip forum level of ipec core competency self-efficacy improved from their pre-fall ip forum level in all areas. though almost every sw student reported prior ip experiences, their changes in iccas scores yielded the large effect size. this could mean that ip forum experience may be robust enough to further enhance the ip-related skills among sw students with prior ip experiences. the observed large effect size response is consistent with the iccas validation study (archibald et al., 2014) and the replication of the iccas validation study (schmitz et al., 2017), and has been reported by others following similar interprofessional learning experiences (nagge et al., 2017). it is worth noting that the iccas uses a retrospective pre/real-time post survey design (archibald et al., 2014; schmitz et al., 2017). this survey is deployed following the learning experience and asks students to reflect “on both their current and prior level of competency regarding ip collaboration.” the survey designers believe this retrospective pre/real-time post survey design results in better identification of students’ own weaknesses before completing ip activities (macdonald et al., 2010). our study has important strengths and some limitations. the strengths of this study include a large sample size collected over several offerings of the fall ip forum. the large sample size provides the opportunity for more robust statistical analyses. including data across several fall ip forums demonstrates the consistency of this learning experience to positively impact sw students’ self-reported attitudes toward collaborative practice. as is with any study, the results of our study must be interpreted in the context of its limitations. first, it is possible that sw students who willingly participated in the fall ip forums may be motivated and therefore possibly biased toward the positive nature of ip educational opportunities (reeves et al., 2016). however, more than half of sw students (n=126) in this study were required to participate by their instructors in the 2016 fall ip forum, which lessens the outright dismissal of the study’s results due to self-selection bias alone. second, we relied on the self-reported perceived attitudinal changes and skill kim et al./swk students’ attitudues 212 improvements by the students, and therefore, observed improvements could be attributed to a social desirability bias. third, this study was conducted at one large research-intensive university and may not be generalizable to other institutions. lastly, the significant selfreported attitudinal and skill improvement identified in this study were captured within days after the fall ip forum participation and, therefore, maintenance of improved attitudes and skills cannot be ascertained into the future. it is possible that the initial excitement of learning and participating in an ip educational activity would wane once the students recognize the challenge of collaborative practice in real healthcare settings. recommendations even though social work as a profession is no stranger to ipe, social work scholars and educators are not always adequately represented in informing and developing ipe (kobayashi & fitzgerald, 2017). at the university at buffalo, this was not the case: the school of social work and its faculty representative (second author) were at the table from the exploration to inception phases, directly involved in informing and influencing the structure of the office of ipe and the resulting fall ip forum. the current ip leadership team, which is led by the assistant vice president for interprofessional education (third author), includes the director of the msw program (first author). as a result, each time we offered the ip forums in the past, students in the other health professions have given consistent feedback year after year about the importance of having a social worker as a member of their team. fraser et al. (2018) emphasized in their systematic review that “integrated primary care provided by interprofessional teams that include social workers significantly improves the behavioral health and care of patients” (p. 175). what fraser and his colleagues have found in their systematic review further solidifies the critical need for educating social work students through interprofessional collaborative practice framework. our study found that sw students’ significantly increased in their self-reported ip attitudes and skills self efficacy after participating in our ip forum, an interprofessional collaborative educational opportunity. it is important that future social workers are well-prepared to work collaboratively in interprofessional settings like the healthcare system—doing so will help them to maximize their efficacy as social workers when they represent and advocate for clients. beginning the 2019-2020 academic year, sw students enrolled at the university at buffalo were required to participate in the fall and spring ip forums. based on our study findings, the required ip forum participation will likely increase social work students’ iprelated attitudes and skills and foster greater engagement and contribution to the overall ip experience for every student involved from all professions. references addy, c. l., browne, t., blake, e. w., & bailey, j. 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(2016). professional socialization and attitudes towards interprofessional collaboration among graduate social work and health professions students. advances in social work, 17(2), 134-150. https://doi.org/10.18060/19809 author note: address correspondence to isok kim, school of social work, university at buffalo, 685 baldy hall, buffalo, ny 14260. email: isokkim@buffalo.edu https://doi.org/10.2466/pms.105.7.997-1014 https://doi.org/10.3109/0142159x.2016.1173663 https://doi.org/10.1080/02615479.2017.1363174 https://doi.org/10.1080/13561820.2016.1233096 https://doi.org/10.18060/19809 mailto:isokkim@buffalo.edu this work is licensed under a creative commons attribution 4.0 international license. evaluation of a multi-phase trauma-focused intervention with latino youth anne s. j. farina michael mancini abstract: this pilot study examined the effectiveness of a multi-phase trauma-informed intervention with 24 trauma-exposed latino youth. treatment included a somatic-based intervention to target physiological hyperarousal symptoms and a sensory/cognitive-based trauma-focused intervention targeting stabilization of the trauma experience. twenty-four participants completed several measures for mental health symptomatology and psychosocial functioning at baseline, at the conclusion of treatment, and at 3-month followup. results of paired sample t-test analyses showed significant improvements in scores on measures for trauma, anxiety, depression, psychosocial functioning, and emotional dysregulation following 12 weeks of treatment when compared to baseline. improvements were maintained at 3-month follow-up. this community-based intervention shows promise in helping latino children who have experienced trauma. research using randomized controlled designs with larger samples is suggested to further test the efficacy of this intervention. keywords: post traumatic stress disorder; trauma-informed treatment; latino youth; mental health latino children in the u.s. experience various traumatic events such as exposure to political and other forms of violence prior to and during the journey to the u.s., maltreatment, sexual abuse, and parental deportation (cuevas, sabina, & milloshi, 2012; dettlaff & johnson, 2011; fortuna, porche, & alegria, 2008; rojas-flores, clements, koo, & london, 2016; sedlack et al., 2010; u.s. department of health and human services 2015). experiencing prolonged violence within a chaotic environment can lead to complex trauma that can impair the ability to regulate emotions, thoughts, and physiological reactions (cook et al., 2005; lawson & quinn, 2013). physiological responses to traumatic events are associated with the body’s natural stress response (i.e., fight or flee) and can lead to somatic reactions long after the trauma is over (ogden & minton, 2000). trauma can lead to physiological reactions to both traumatic reminders and neutral stimuli that can activate states of hyperor hypoarousal (van der kolk, 1994). hyperarousal may include sensations of feeling frozen, racing thoughts, aggression, fear and emotional reactivity or dysregulation, while hypoarousal may include collapse (i.e., fainting), dissociation and emotional numbness (ogden & minton, 2000). the high rate of violence experienced by latino children and youth may make them more susceptible to difficulties with affect and behavioral regulation (cook et al., 2005) that can lead to problem behaviors, depression, and anxiety (buckner, mezzacappa, & beardslee, 2009; warner, koomar, lary, & cook, 2013). furthermore, emerging evidence suggests that latinos who have experienced trauma may experience more severe symptoms ______________________ anne s. j. farina, msw, lcsw is a phd student, school of social work, saint louis university, saint louis, mo 631031021. michael mancini, phd is associate professor, school of social work, saint louis university, saint louis, mo 63103-1021. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 270-283, doi: 10.18060/21296 https://creativecommons.org/licenses/by/4.0/ farina & mancini/evaluation of multi-phase 271 for longer periods of time and may be more likely to develop ptsd (alcántera, casement, & lewis-fernández, 2013). they may also be more likely to report positive symptoms of trauma such as hypervigilence, emotional reactivity, hyperarousal, and intrusive thoughts than their non-hispanic, white counterparts (marshall, schell, & miles, 2009). trauma intervention and research has focused on cognitive behavioral therapies (such as trauma-focused cognitive behavioral therapy) and other language-based interventions (warner, spinazzola, westcott, gunn, & hodgdon, 2014). according to warner et al. (2013), for interventions that are language-based, “the child must be sufficiently regulated, organized, grounded and present, such that language, imagination, and symbolic expressive function can emerge” (p. 730). these interventions are generally effective in treating children, but may be less effective for those who experience intense physiological symptoms (perry, 2009; raio, orederu, plazzolo, shurick, & phelps, 2013; wolf, 2013). somatic-based interventions, movement, and physical activities can help children develop self-regulation skills that help prepare them for traditional therapy interventions (corrigan, fisher, & nutt, 2010; perry, 2009; van der kolk, 2006; warner et al., 2014). latino children with histories of trauma may benefit from somatic-based interventions either in lieu of or as a precursor to language-based interventions. these interventions aim to decrease states of arousal and may be especially helpful for community-based mental health programs with limited resources or that lack bi-lingual services. the purpose of this pilot study was to evaluate the impact of multi-phase therapy that combined a somatic-based intervention with a trauma-informed language-based cognitivebehavioral intervention for latino youth to address symptoms and behaviors related to emotional dysregulation and physiological hyperarousal. we hypothesized that the use of a multi-phase intervention would be associated with a significant reduction in traumarelated symptoms including depression and anxiety. we also hypothesized that these reductions would be maintained at 3-month follow-up. methods participants and setting this study used a one-group pretest-posttest follow-up design. all participants were latino children and youth exposed to traumatic events and who experienced clinically significant psychological or behavioral symptoms. this convenience sample included selfreferrals and referrals from local schools or agencies to a community-based health clinic serving latinos in a midwestern city. the decision to not use control or comparison groups was based on the agency’s reluctance to deny or delay services to their constituency. a total of 53 participants enrolled in treatment. out of that number, 24 (45%) fully completed both the treatment and follow-up phases of the study. eligibility criteria included: (1) ages between 5 and 20 years of age; (2) lifetime experience of a traumatic event as determined by the dsm-iv-tr which involves actual or threatened loss of life or serious injury to oneself or others causing intense fear or horror (apa, 2000); and (3) the experience of clinically significant psychological or behavioral symptoms. the study advances in social work, spring 2017, 18(1) 272 included a wide range of ages to maximize the number of persons who could be assisted by the intervention. the intervention was adapted to accommodate age differences on a case-by-case basis. persons experiencing intellectual disabilities, active psychosis, suicidality, or who were receiving trauma-focused treatments or psychotropic medications in another setting were excluded. eligible participants were guided through an informed consent process by a bi-lingual researcher. informed consent documents were translated into spanish by a professional service, using back-translation procedures. ethical approval was obtained for this study from the institutional review board at the host university of the principal investigators. interventions the first author, a licensed clinical social worker employed at the agency at the time of the study, provided all treatment. this person developed the somatic soothing intervention (ssi) manual (farina & silversmith, 2013) and was trained in structured sensory intervention for traumatized children, adolescents and parents (sitcap; steele & malchiodi, 2012). to ensure fidelity, session checklists tracked the use of key intervention principles and activities. participants received ssi until they were deemed physiologically stable enough to begin the sitcap intervention. some brief ssi activities were also used at the opening and ending of each sitcap session. somatic soothing: a somatic-based intervention for the treatment of trauma. ssi helps children who experience hyper-arousal and dissociation develop skills that help them reach a state of stabilization. key components of ssi include safety, choice, pace, success, checking in/mindfulness, and relaxation/breathing. the principles of ssi involve giving the child a sense of safety, mastery, and control. the intervention emphasizes the importance of checking in with the child about their internal experience throughout the intervention to help them build a sense and mindfulness of their internal experiences. activities flow between activation and relaxation mimicking the body’s natural rhythm of calming down after being activated. main categories of activities include relaxing, creating space and boundaries, movement, body resources, defending space, building core, and grounding. relaxing activities counter the activation from the arousal activities such as rolling on a large exercise ball. there are a series of movement activities in which the child exerts some force with their bodies. movement activities may be chosen based on problematic behaviors noted in a behavior checklist and can include activities such as squeezing the large exercise ball, rolling the ball up the wall, and running one’s legs while pushing against a large stationary ball. body resources are movements that invoke a sensation of calm used during times of stress (i.e., moving in hips, opening of the chest, stretching, hugging self, hugging legs to chest, putting hand to heart). grounding resources help children learn how to stay present during dissociation such as lightly tapping on extremities. clinicians continually assess the child to ensure activities are developmentally appropriate and engaging. they establish safety through routine and predictability, while also introducing new activities at the pace set by the child. farina & mancini/evaluation of multi-phase 273 this was the first study to test the effectiveness of ssi as a part of a multi-phase intervention. this intervention is based on research and theory on the use of somatic-based interventions to aid in decreasing hyperarousal symptoms as a means to prepare children for more cognitive-based interventions (perry, 2009; van der kolk, 2006; warner et al., 2014). interventions that contributed to the development of ssi include sensory diet activities (wilbarger, 1984), sensory motor arousal regulation treatment (warner, koomar, & westcott, 2009), sensorimotor psychotherapy (ogden, pain, & fisher, 2006), impact basics (rosenblum & taska, 2014), and yoga. structured sensory intervention for traumatized children, adolescents and parents (sitcap). sitcap is a sensory and cognitive-based trauma intervention that was developed by the national institute for trauma and loss for children. sitcap is considered a promising practice in samhsa’s national registry of evidence-based programs and practices and has been used in multiple settings with diverse children and adolescents. the intervention uses exposure, trauma narrative processing, and cognitive reframing through a series of drawing activities designed to process trauma while identifying thoughts, feelings, and body sensations (steele & malchiodi, 2012). assessment measures participants and/or their guardians completed a full assessment at three time periods: (1) prior to treatment (baseline); (2) upon completion of both phases of treatment (posttest); and (3) at three months after treatment (follow-up). the first author, who previously worked for more than ten years providing mental health services to spanish-speaking individuals and families, performed all research interviews. all assessment tools not previously available in spanish were translated by a professional translation service, using back-translation procedures. in addition, assessment tools were pilot-tested to ensure clarity and understanding. all parents and caregivers in this study chose to complete the assessment in spanish. trauma symptomology. trauma histories and symptoms were assessed using the ucla ptsd index for dsm-iv (birman & chan, 2008; pynoos, rodriguez, steinberg, stuber, & frederick, 1998). this measure screens for the presence of any type of traumatic event and the frequency of dsm-iv ptsd symptoms in children, adolescents, and parents. a number of studies across cultures indicate that the ucla ptsd index has good validity and reliability of the scale in terms of both internal consistency and test-retest reliability (birman & chan, 2008). for a sample of children and youth who have experienced at least one trauma, steinberg et al. (2013) reported cronbach’s alpha across race/ethnicity from .88 to .90. the measure has an overall severity score that can indicate the presence of a potential post-traumatic stress disorder condition and a clinical cut off score of 38 (rodriguez, steinberg, saltzman & pynoos, 2001; steinberg, brymer, decker, & pynoos, 2004). anxiety. anxiety symptoms were assessed using the screen for child anxiety related disorders (scared). the scared is a 41-item parent and child self-report screening instrument used to detect anxiety in children across the anxiety domains of panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia (birmaher et al., advances in social work, spring 2017, 18(1) 274 1999). participants rated a series of questions as 0 (not true), 1 (somewhat true), and 2 (very true) over the previous 3 months. the clinical cutoff score for the measure is 25. the scared has shown good convergent and divergent validity when compared to empirically supported scales such as the child behavior checklist (cbcl) and the statetrait anxiety inventory for children (staic, monga et al., 2000). though a castilian spanish version has shown promise in barcelona, spain (cronbach’s alpha coefficient .83 and scale reliability between .44 and .72; dobal, martínez, & doménech-llaberia, 2011), a spanish version translated by a professional service was used due to language and cultural differences for this latino sample. depression. depression symptomatology was measured using the national institute of mental health center for epidemiological studies depression scale for children (cesdc). the ces-dc is a 20-item self-report depression inventory with scores ranging from 0 to 60, with a clinical cutoff score of 15. participants rate the frequency of a range of depressive symptoms as rarely (< 1 day), a little of the time (1-2 days), a moderate amount of time (3-4 days), and most/all of the time (5-7 days) over the past week. this scale is well established with good reliability and validity (faulstich, carey, ruggiero, enyart, & greshem, 1986; weissman, orvaschel, & padian, 1980). the ces-d has shown good reliability (alphas between .84 to .87 across four racial/ethnic groups [anglo, mexican, cuban, and puerto rican]) and has been found appropriate for use with mexican american youths (crockett, randall, shen, russell, & driscoll, 2005). psychosocial functioning. cognitive, emotional and behavioral functioning was assessed using the pediatric symptom checklist (psc). the psc is a 35-item, parentcompleted screening questionnaire of children's psychosocial functioning (jellinek et al., 1988). parents rated the frequency of the items on a 3-point likert scale ranging from 0 (never) to 2 (often). the clinical cutoff score on the psc is 24 for younger children and 28 for older children. in validity studies the psc has correlated highly with the children's global assessment scale (shaffer et al., 1983) and the cbcl (jellinek et al., 1988). the psc showed good sensitivity, specificity, and internal consistency (cronbach alpha score of .94) across gender and race/ethnicity among a group of children and youth (6-22 years old) enrolled in medicaid (boothroyd & armstrong, 2010). physiological hyperarousal checklist. the physiological hyperarousal checklist is a 15-item parent self-report checklist developed by the first author. no reliability data currently exists. this measure was used in this study as opposed to the cbcl in this clinical setting and population due to the length and availability in spanish and because of its clinical specificity in determining the somatic-based activities targeted towards decreasing hyperarousal behaviors. the measure asks about the frequency ranging from 0 (not at all) to 3 (a lot) of several hyperarousal behaviors including hitting, agitation, fighting, tantrums, etc. this instrument was developed in both english and spanish. emotion regulation checklist (erc). the erc is a 23-item parent/caregiver report scale that assesses emotional regulation and dysregulation (shields & cicchetti, 1997). the emotion regulation subscale (cronbach’s alpha = .68) consists of 8 items that assess emotional competence and the ability to empathize (shields & cicchetti, 1997). the negativity subscale includes 15 items that assess emotional dysregulation and reactivity. farina & mancini/evaluation of multi-phase 275 higher scores on the negativity subscale indicate decreased emotional regulation. higher scores on the emotional regulation subscale indicate greater emotional regulation skills (shields & cicchetti, 1997). data analysis descriptive statistics were used to identify participant demographics and the mean scores for each measure at baseline, posttest, and follow-up observation points. independent samples t-tests and paired t-tests were used to test for differences in scores based on gender and age level at baseline, post-test and 3-month follow-up for each of the measures and the number of trauma events experienced. for gender, females (n=14) were coded as 0 and males (n=10) were coded as 1. for age, participants were split into two age groups. participants aged 5 to 10 (n=13) were coded as 0 and those aged 11 to 20 (n=11) were coded as 1. due to the small sample size, it was not feasible to break participants into more age groups. paired sample t-tests were used to test the differences in baseline and post-intervention scores for each measure for the entire group. the same procedure was followed to compare posttest scores and scores collected at 3-month follow-up to see if gains were maintained. the alpha level was set to .01 to better control for type i errors. in the final dataset, scores for the depression (ces-d) and anxiety (scared) scales were missing for three participants. these missing scores were determined to be random and not due to systematic bias. adding in mean scores for the missing data did not significantly alter scores or significance levels when compared to analyses that excluded these participants. results participant characteristics table 1 displays the sociodemographic characteristics of the sample. the mean age for participants was 11.4 years and just over half the sample were aged 10 or older. the majority of the sample was female and born in the u.s. a third of the sample was born in mexico. all of the parents/caregivers of the participants were born outside of the u.s. the average length of time between baseline and posttest was 12 weeks. participants experienced on average 2.4 traumatic events (sd = 1.94). females average 2.5 events, while males averaged 2.3 events. the most common events experienced were domestic violence and sexual assault. over 83% of participants reported either experiencing or witnessing domestic violence, and almost 40% of the sample reported experiencing sexual abuse. independent samples t-tests were conducted to explore the presence of any sub-group differences. males had significantly higher hyperarousal levels than females, t(22) = -3.49, p = .002. younger participants had significantly higher posttest scores for emotional dysregulation, t(22) = 2.87, p = .009. no other significant differences were found for age or gender across the three time periods. to test if any of these sub-group differences impacted treatment outcomes, four separate paired sample t-tests were conducted with each advances in social work, spring 2017, 18(1) 276 sub-group (males, females, younger and older). similar to the full participant group, results showed significant differences in mean scores for each sub-group between baseline and posttest for trauma, anxiety, depression, psychosocial functioning, emotional dysregulation and physiological hyperarousal. table 1. sociodemographic characteristics of sample (n=24) sociodemographic factors n (%) age range 5-9 years 11 (45.8%) 10-15 years 6 (25%) 16-20 years 7 (29.2%) gender female 14 (58.3%) male 10 (41.7%) country of origin united states 14 (58.3%) mexico 8 (33.3%) honduras 2 (8.3%) traumatic events witnessing domestic violence 15 (62.5%) experiencing domestic violence directly 5 (20.8%) sexual abuse 9 (37.5%) natural disaster 5 (20.8%) bad accident 5 (20.8%) experiencing or witnessing physical assault 3 (12.5%) trauma, anxiety, depression, psychosocial functioning, emotional regulation and hyperarousal as shown in table 2, participants reported clinically significant symptoms for trauma, depression, anxiety, and psychosocial functioning at baseline. results showed that the severity levels of participants’ symptoms of trauma, depression, and anxiety significantly decreased following participation in treatment. posttest scores for trauma and depression dropped an average of 48%, while anxiety posttest scores dropped an average of 42%. similar decreases in posttest scores were seen in psychosocial functioning, with an average decrease of 38% from baseline. average posttest scores on the negativity subscale of the erc showed a 27% reduction in scores from baseline indicating decreased emotional dysregulation. finally, there was a 45% reduction in posttest scores for physiological hyperarousal from baseline. reductions in scores at three-month follow-up for trauma, depression, anxiety, psychosocial functioning, emotional dysregulation, and physiological hyperarousal were maintained. scores on trauma significantly decreased further during follow-up, t(23) = 3.11, p = .005. farina & mancini/evaluation of multi-phase 277 table 2. paired t-test results for baseline, posttest, and 3-month follow-up (n=24) baseline posttest posttest follow-up outcome m (sd) m (sd) mean diff. 95% ci t (23) m (sd) m (sd) mean diff. 95% ci t (23) trauma 43.8 (11.3) 22.8 (8.7) 21.0 17.10, 24.73 *11.34 22.8 (8.7) 19.3 (8.4) 3.5 1.17, 5.83 *3.11 depression 20.6 (9.9) 10.8 (5.5) 9.8 6.72, 12.90 **6.57 10.8 (5.5) 10.2 (5.3) 0.6 -1.07, 2.12 .678 anxiety 33.3 (11.7) 19.4 (7.0) 13.9 9.82, 17.99 *7.05 19.4 (7.0) 17.8 (6.0) 1.6 -.336, 3.57 1.71 psychosocial functioning 24.8 (11.0) 15.3 (7.5) 9.5 6.34, 12.74 **6.17 15.3 (7.5) 14.5 (7.0) 0.8 -1.33, 2.74 .720 emotional dysregulation 31.9 (10.9) 23.2 (10.0) 8.7 4.21, 13.21 *4.01 23.2 (10.0) 23.0 (9.4) 0.2 -2.44, 2.78 .132 emotional regulation 24.5 (4.8) 27.5 (5.1) -3.0 -5.32, -0.68 -2.679 27.5 (5.1) 26.5 (5.8) 1.0 -1.59, 3.59 .800 physiological hyperarousal 17.3 (8.6) 9.5 (7.9) 7.8 5.49, 9.93 **7.19 9.5 (7.9) 8.7 (6.5) 0.8 -.882, 2.55 1.01 *p<.01 **p<.001 farina & mancini/evaluation of multi-phase 278 discussion this pilot study explored the usefulness of a multi-phased, trauma-focused intervention with 24 latino youth experiencing significant trauma-related symptomatology. participants reported significant reductions in symptomology after intervention, which were maintained at 3-month follow-up. developing emotional stability and physiological calming may provide benefits for those not ready to undertake the intense work of trauma reprocessing due to mistrust, cultural barriers, lack of access to adequate bi-lingual services, or lack of emotional readiness to address traumatic experiences directly. while this intervention could provide benefits across multiple cultural groups, it may be particularly beneficial to latino populations in at least three ways. first, latino parents are less likely to seek mental health services for their children (gudiño, lau, & hough, 2008). this intervention has the potential to decrease problematic behaviors in a targeted and safe manner without addressing trauma events before families are ready to discuss them safely. second, latinos may also be more likely to meet criteria for ptsd following a traumatic event, report greater severity in symptoms, and experience their symptoms for longer periods of time (alcántera et al., 2013; galea et al., 2004; lewis-fernandez et al., 2008). studies have also found differences in the consequences of sexual abuse among latinas, including greater psychological, emotional, and behavioral difficulties than african-american and white females (lefley, scott, liabre, & hicks, 1993; shaw, lewis, loeb, rosado, & rodriguez, 2001). in addition, marshall et al. (2009) found evidence suggesting that latinos may be more likely to experience hyperarousal symptoms such as hypervigilience and emotional reactivity than non-hispanic caucasians. these factors may suggest that latinos, in particular, may benefit from interventions designed to reduce somatic symptomatology related to trauma. third, latino youth are at risk of experiencing traumatic events (cuevas et al., 2012; dettlaff & johnson, 2011; fortuna et al., 2008; kaltman, green, mete, shara, & miranda, 2010; sedlack et al., 2010) also placing them at risk for complex trauma. indeed, our sample experienced multiple trauma events that included high rates of violence and high degrees of trauma symptomatology including physiological arousal and emotional dysregulation. latino youth exposed to multiple traumas may benefit from somatic-based interventions, particularly prior to undergoing language-based interventions such as tf-cbt, which work best when youth are physiologically and emotionally regulated and can express feelings and thoughts effectively to a practitioner (perry, 2009; raio et al., 2013; warner et al., 2013; warner et al., 2014; wolf, 2013). these somatic-based interventions may be beneficial in agencies with limited clinical capacity or bi-lingual resources that serve latino populations. several limitations exist in the present study. first, the study employed a one-group pretest-posttest design with a small convenience sample. a waitlist-control was not implemented due to the request of the organization and in attempts to encourage individuals seeking treatment, especially in this community with low mental health service utilization. this design limited the ability to control for various threats to internal validity. future research should assess the impact of this intervention using a randomized control design farina & mancini/evaluation of multi-phase 279 with a larger, more diverse sample. second, the dropout rate in the study was high (45%). reasons for incomplete participation include lack of transportation, mistrust, change of residence or work schedules, symptom improvement, or a lack of treatment readiness, among others. third, due to design limitations it cannot be determined if one phase of treatment (i.e., somatic soothing vs. sitcap) had a disproportionate effect on symptoms compared to the other phase. future research should rely on randomized control groups that assess the impact of each phase of the intervention. lastly, there are limitations in the measurement instruments that we used because of the lack of psychometric testing with latino children and youth, which may impact the reliability of test scores and interpretation. references alcántera, c., casement, m. d., & lewis-fernández, r. 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(2013). the dissociative subtype of ptsd: rationale, evidence, and future directions. ptsd research quarterly, 24(4), 1-8. author note: address correspondence to: anne farina, school of social work, saint louis university, tegeler hall, 3550 lindell boulevard, saint louis, mo 63103, farinaas@slu.edu https://doi.org/10.1007/s10896-013-9535-8 http://www.traumacenter.org/announcements/tconf.09_smart_handouts.pdf https://doi.org/10.1007/s40653-014-0030-z https://doi.org/10.1097/00005053-198012000-00005 microsoft word 04_lechuga-peña_et_al_24385_incorporating_photovoice _________ stephanie lechuga-peña, phd, msw, assistant professor, and felicia m. mitchell, phd, msw, assistant professor, school of social work, arizona state university, phoenix, az. charlene poola, phd, lcsw, clinical research associate/behavioral health specialist, albuquerque area southwest tribal epidemiology center, albuquerque, nm. mónica gutiérrez, msw, doctoral candidate, school of social work, arizona state university, phoenix, az. lizette a. rivera, msw, school social worker at palomino primary school, phoenix, az. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1124-1140, doi: 10.18060/24385 this work is licensed under a creative commons attribution 4.0 international license. incorporating photovoice into a community-based intervention with latinx families: lessons learned from your family, your neighborhood stephanie lechuga-peña felicia m. mitchell charlene poola mónica gutiérrez lizette a. rivera abstract: photovoice is a qualitative community-based participatory research (cbpr) method used by researchers and communities to inform policy and advocate for community change. photovoice was piloted within an established community-based intervention, your family, your neighborhood (yfyn), within a predominantly latinx community. yfyn is a dual-generation, evidence-based, manualized curriculum supporting and strengthening bonds between parents and their children while fostering neighborhood social cohesion among families living in low-income communities. the photovoice project was conducted with five families (n=20 participants) in english and spanish. participants guided the photovoice process to uncover complex community issues from their direct perspectives to accurately capture the challenges and strengths they encounter in their community. community challenges identified by participants included the dumping of trash in their neighborhood, inadequate space for their children to play, and heavy traffic that impedes their ability to walk their children to school safely. participants identified three main community strengths: the local park, the boys & girls club, and personal connections with other yfyn family participants. when participants guide the photovoice process, it helps stakeholders understand and uncover complex issues from community members’ direct perspectives to capture the meaning of the issues accurately. production of knowledge from the community rooted in their lived experience can help reshape the narrative of latinx families living in low-income communities and allows for social workers to more adequately respond to their specific needs. keywords: latinx; photovoice; families; community strengths, community challenges photovoice is a qualitative community-based participatory research (cbpr) method developed by wang and colleagues (1996) in the early 1990s to assist rural chinese women in documenting their everyday health and work conditions. the method has three primary goals: 1) recording and reflecting on community strengths and concerns, 2) promoting critical dialogue and knowledge about important issues through large and small group discussions, and 3) communicating with policymakers and those in power to advocate for change (wang & burris, 1997). in developing photovoice, wang and colleagues were influenced by paulo freire’s (1970) concept of empowerment education that integrates consciousness-raising and dialogue with teaching efforts to promote individual and community quality of life and promote policy changes to achieve equity (wang et al., lechuga-peña et al./incorporating photovoice 1125 1996). through freire’s influence, photovoice recognizes how power informs oppression and domination, as one party’s interests dominate and oppress other parties’ well-being based on their position of power within society (wang & burris, 1997). further, the approach is designed to empower action as community members advocate for creating positive community change. photovoice has proven to be a convenient research method that can be used by a variety of researchers and communities, and it supports elevating community members into the policy sphere to advocate for local community change (harley, 2015; jarldorn, 2019; lennon-dearing & hirschi, 2019; mitchell, 2018; rahman et al., 2020). wang and burris (1997) advise that photovoice should be “creatively and flexibly adapted to the needs of its users” (p. 383). the creative and flexible allowances of photovoice are especially crucial for research contexts that emphasize cbpr principles of community input and choice (israel et al., 2010; minkler, 2005; wallerstein & duran, 2010). in particular, photovoice uses participant-generated photographs and storytelling to convey perspectives on central issues that can then be communicated to key stakeholders and other people outside of the community. the photos become part of data analysis, as they are connected to the community’s broader story and serve an illustrative purpose beyond the basic description of the place, object, or person photographed. photovoice has been used to convey a variety of issues and concerns with diverse communities, including food justice with youth of color (leung et al., 2017), environmental change and water with american indians (mitchell, 2018), and health and nutrition education with latinx groups, among others (alcazar et al., 2017). in this project, photovoice was incorporated into an established community-based intervention, your family, your neighborhood (yfyn), to support the curriculum’s original goals and highlight accommodations made to honor community preferences and the realities of community-based participatory research (cbpr). yfyn is a 12-week community-based dual-generation intervention developed and launched in 2012 in denver, colorado and phoenix, arizona in 2019 (lechuga-peña & brisson, 2018a). yfyn aims to build socially cohesive communities among family cohort participants to address adverse conditions in neighborhoods with a high concentration of poverty by fostering a network of trusting and cohesive relationships among participants (brisson et al., 2019). this photovoice project was piloted with a latinx community in english and spanish simultaneously to accommodate the participant's preferred language. photovoice with families and latinx communities although photovoice has gained popularity in recent years (harley, 2015; lennondearing & hirschi, 2019; mitchell, 2018; rahman et al., 2020), few studies have used the family unit as participants, in which both parents and children work together in all aspects of the project. bredesen and stevens (2013) worked with homeless families living in st. paul, minnesota, to offer health providers insight into where to focus their efforts and resources. using photovoice, they provided cameras to participants to capture their everyday experiences of homelessness. photos were used to guide the participant interviews to identify their health and basic living needs. other projects have used advances in social work, fall 2021, 21(4) 1126 photovoice with families as a tool to assess community programs and their impact on participants. for example, the brighter bites program solicited low-income spanishspeaking families’ perspectives to learn about the effects of the weekly distribution of fresh produce, recipe tastings, and nutrition education to improve dietary habits (alcazar et al., 2017). woodgate and colleagues (2016) used photovoice to explore youth perspectives of health, including the impact of chronic illness on families, to develop better policy and services. latinx communities have utilized photovoice to address a range of issues including public housing conditions and health (evans-agnew et al., 2016), childhood obesity (torres et al., 2013), and youth engagement (kia-keating et al., 2017; madrigal et al., 2014; noone et al., 2016). public housing communities across the united states experience deteriorating neighborhoods and a lack of resources (gennetian et al., 2012; lechuga-peña, & brisson, 2018b). researchers have found photovoice to be a valuable tool at the mezzo level to visually represent a community’s self-identified issues visually. goals from previous photovoice studies include documentation of community pride through positive well-being (aber et al., 2017), reducing mental health disparities to advocate for enhanced housing policies (duffy, 2010), and improving housing wraparound service models (keller, 2011). from a micro-level system perspective, photovoice research with lowincome latina mothers enhanced their ability to communicate pressures related to parenting as a result of acculturation to child-rearing norms and values in the united states. latina mothers utilized photovoice to demonstrate to local policymakers evidence of environmental injustice in their neighborhood affecting their children’s health (evansagnew et al., 2016; torres et al., 2013). latinx youth face unique cultural stressors related to teen pregnancy, environmental injustice, and violent and lethal assaults. these studies illustrate how the youth had the opportunity to provide their perspective as active and knowledgeable members of their community. in most studies, youth were able to enhance their leadership skills while addressing relevant issues identified as barriers to their ability to thrive (kia-keating et al., 2017; madrigal et al., 2014; noone et al., 2014). limited studies exist that use photovoice with the entire family unit as participants, in which parents and children work together in all aspects of the photovoice project. additionally, to our knowledge, no studies have explored the practice implications of photovoice and its integration into an established community-based intervention with families, offered in both english and spanish. your family, your neighborhood yfyn is a 12 session, family-based program offered in local community settings at convenient locations to eliminate barriers to program access that low-income families commonly face. research indicates that serving a group of people who live near each other increases the likelihood that participants will form social networks and friendships beyond the intervention period (cdc, 2011). yfyn strengthens the bonds between children and parents, builds parents’ attachment to their child’s school, fosters neighborhood social cohesion, promotes positive youth development, and improves health and well-being (lechuga-peña & brisson, 2018a). yfyn focuses on issues that impact parent-child lechuga-peña et al./incorporating photovoice 1127 relationships and family functioning within the context of local neighborhood schools. the manualized curriculum is available in english and spanish. it includes information about parental school engagement, problem-solving, developing coping skills, and building relationships and communication skills within families and communities. each two-hour session begins with a family dinner where families interact with one another and focus on their familial bonds through active engagement in a neutral environment (i.e., school building). after dinner, parents/guardians participate in group-based sessions to learn ways to engage in their child’s school, support academic achievement, advocate for their children, and create healthy communities. the children participate in concurrent sessions that mirror the parent curriculum, where they engage in skill-based learning activities aligned with the program’s goals. each session concludes with parents/guardians and children coming back together as a large group to discuss what they learned and how to apply it to improve their lives and their community. the program’s final sessions are focused on completing a community project together to promote family and neighborhood cohesion. together, families identify a community concern and then plan and carry out a project designed to address the issue. active engagement in the community develops neighborhood social cohesion among yfyn participants and within the broader community. neighborhood social cohesion is defined as the trusting relationships and shared values and norms of residents (lin, 2001; sampson et al., 1997) and is a protective factor for the health and well-being of families living in low-income neighborhoods (kawachi et al., 2008). in 2019, photovoice was piloted with yfyn to enhance community engagement and provide participants a greater participatory, collaborative experience during their community project. photovoice is a way for community members to share about their lives from their perspective to promote understanding and ultimately improve the health and well-being of their community. method setting and participants during fall 2019, yfyn was administered at a large public title i elementary school in the southwest. nearly 75% of the elementary school students identify as latinx and live in the surrounding low-income neighborhood. yfyn sessions took place after the traditional school day ended and in the early evenings on the elementary school campus. participants were recruited through teacher referrals and the school social workers. flyers were also sent home with students, providing additional information about the program. five families (n=20 participants) participated in the yfyn intervention and all five families participated in the photovoice project. all project materials were translated and back-translated into spanish/english. participant demographics were collected via a survey at the beginning of the yfyn intervention. three fathers, four mothers, one grandmother, and their respective children between the ages of seven and twelve participated. two families were bilingual, two families spoke spanish only, and one family spoke english only. four families identified as latinx, and one family identified as white. the families’ mean years of residency in their community was 5.7, and approximately half of the parent participants had completed some high school or less, and the other parent participants had advances in social work, fall 2021, 21(4) 1128 a high school degree or equivalent. the parents’ mean age was 38.3 years, and the children’s mean age was 9.1 years. nearly 63% of the child participants were female, and 37% were male. the study was approved by the institutional review board at arizona state university. informed consent was obtained from all participants in their preferred language. procedures yfyn sessions 1 through 9 focus on the parent-child relationship and parental school engagement, while sessions 10 through 12 address community social cohesion. as part of the community sessions, photovoice was used to visually explore community strengths and challenges from the family unit’s perspective. in preparation for the photovoice project, families were asked during session 10 to create an asset map that included resources they value in their community (see table 1). next, they were asked to write or draw the components they liked about their community on one side of the paper, and on the other side, the aspects they did not like or would like to change in their neighborhood. participants were prompted to consider the many different aspects, including, but not limited to, community associations, institutions, individuals, physical spaces, and the local economy. this exercise was an essential starting point for both parents/guardians and children to consider their community’s strengths and challenges as they prepared for the photovoice project. table 1. yfyn session number, title, purpose, and goals yfyn session title purpose goals 10 what does my community mean to me? intended to help families identify the strengths & challenges of their neighborhood identify:  strengths & challenges of their neighborhood using an asset map  what their neighborhood means to them  who is in their community  their priorities for change in their neighborhoods 11 my community through photovoice used to go over the photo technique & to determine the emerging themes & findings photo worksheets, photograph presentation, & focus group 12 connecting with your community through photovoice planned community event wrap up the sessions, celebrate the families’ accomplishments in the sessions & present the photovoice project during session 11, participants were provided an overview of photovoice and its related procedures, including a training and ethics component informed by wang and burris (1997). during the training and ethics learning session, participants were asked to consider the following questions when deciding what they would photograph: 1) how lechuga-peña et al./incorporating photovoice 1129 might my community react to this photo? 2) will it create a scandal or conflict in my community? 3) could the photo create negative perceptions of some individuals or groups in my community? the following instructions were also given to participants: 1. please do not intrude into a person’s private space, and respect people’s wishes if they do not want their photograph taken. 2. if you do take photographs of people, you must get a signed photo release from every person that can be identified in the photographs you take. 3. avoid taking photos of embarrassing things about yourself or others. do not take photos that show people or yourself in a false or negative way. 4. please do not take photographs of people, places, or things that should not be photographed or shared outside your community. what will this photo say about my community? during the photovoice learning session, families were given a photography assignment and asked to photograph a total of eight images, including four strengths and four challenges in their community. participants were also asked to take these photographs during the following week. their photographs would build upon the asset map activity from session 10. parent participants were reminded to encourage their children to participate in decision-making while taking photographs in their community. participant photos and activity during the week leading up to the 12th and final yfyn session, parent participants forwarded the photos their family took to the lead yfyn facilitator through text message or email. the lead facilitator then printed two copies of each photo. one copy of each photo was to be used for the photovoice display boards families would create, and one copy was given to the families for them to keep. during the 11th yfyn session, families were given the option to be divided into mixed groups or work with their family unit to complete their photovoice displays. participants chose to work together as a family unit to create their photovoice displays and present them to the larger group. in preparing to create their photovoice displays, families were asked to choose two of the photos they took that represented their community’s strengths and two that represented challenges in their community. once families had selected their photos, the facilitators used the photo technique, similar to the showed technique (see catalani & minkler, 2010; hergenrather et al., 2009; shaffer, 1983), to guide participant discussion and dialogue. each family was provided a worksheet to capture their responses for each photo they chose and were encouraged to write down their responses in their preferred language. the photo technique worksheet includes the following prompts and questions: 1. pdescribe your picture. 2. hwhat is happening in your photo? 3. owhy did you take a picture of this? 4. twhat does this picture tell us about your life and your community? 5. ohow can this picture provide opportunities to improve your community? advances in social work, fall 2021, 21(4) 1130 participants primarily wrote their responses to the photo prompts in spanish; however, some families chose to write their responses in spanish and english. this activity took approximately 45 minutes to complete, and in total, the families selected 20 photos, including ten strengths and ten challenges. upon completion of the photo worksheet, a large group discussion was conducted with all participants. one representative chosen by each family shared, at minimum, two photos (one strength and one challenge) and the accompanying worksheet with their responses. as each family presented, a yfyn facilitator wrote down a description of their picture on the whiteboard, while another facilitator took each photo around for participants to view. participants were invited to ask clarifying questions or provide feedback. finally, program facilitators worked with the participants to identify the overarching themes (top three challenges and top three strengths) and to select the final photos to be displayed in the dissemination event. participant photos and dissemination to key community stakeholders an important aspect of photovoice is the dissemination of findings to key community stakeholders. dissemination in photovoice is typically done in two ways: (1) the process of creating visual images is often a source of empowerment, and (2) photographs are displayed in the community’s public spaces, where people can see the issues captured through photography (wang et al., 1996). during the last yfyn session, participants were provided a poster board, a copy of the photographs they had taken, the photo worksheets they had completed with their narratives, and additional supplies to create their family’s photovoice display. each family member was encouraged to help create their family’s display board. once each family had created their photovoice display, they were asked to choose one person from their family to present their project to the stakeholders and each other. the families decided that their children would present on each family’s behalf. the presentations were both personal and powerful; children read their narratives aloud in spanish and english and explained what their family had photographed and why. community stakeholders, including the school principal and social workers, the afterschool program director, and the grantor of programs, attended the dissemination event that included a celebration of program completion with food and participant presentations about the photovoice project and its findings. participants shared that the community’s challenges include the dumping of trash in their neighborhood (see figure 1), inadequate space for their children to play (see figure 2), and heavy traffic that impedes their ability to walk their children to school safely (see figure 3). participants identified the local park (see figure 4), the boys & girls club (see figure 5), and connections with other yfyn families (see figure 6) as strengths in their community. participants stated they believed their voices were important and felt like they were heard. they also shared how much they appreciated the community stakeholders attending their presentation and thought this demonstrated their commitment to their community. the community stakeholders indicated how impressed they were with the presentations and learned more about the participants’ lived experiences. they also noted how pleased they were with participant engagement and supported continuing the intervention at their school with the photovoice component. lechuga-peña et al./incorporating photovoice 1131 figure 1. community challenges-dumping of trash in their neighborhood esta imagen describe cómo se coloca la basura en la ubicación incorrecta y siempre hay basura en todas partes y nunca se limpia. da una mala reputación sobre nuestro vecindario. [this picture describes how the trash is placed in the wrong location, and there is always trash everywhere, and it never gets clean. it gives a bad reputation about our neighborhood.] yfyn participant-age 51 figure 2. community challenges-inadequate space for their children to play nadie puede jugar porque siempre está mojado; la gente también pelean allí. [no one can play because it’s always wet; people fight there too.] yfyn participant-age 8 figure 3. community challengesheavy traffic when walking their children to school aquí hay demasiado accidentes, y cada día corremos un riesgo. [there are too many accidents here, and every day we run a risk.] yfyn participant-age 30 advances in social work, fall 2021, 21(4) 1132 figure 4. community strengths-local park en esta foto, hay mucha luz. porque me gusta el parque. que podemos jugar porque hay muchos juegos y luz. pues porque podemos jugar “tag” y hay mucho espacio para jugar todo. [in this picture, there is a lot of light. because i like the park. that we can play because there are many games and light. well, because we can play tag, and there is a lot of space to play everything.] yfyn participant-age 7 figure 5. community strengths-boys & girls club tenemos el club de boys and girls. la gente está dejando a sus hijos en un lugar seguro donde [los niños se] pueden divertirse. [we have a boys & girls club nearby. people are dropping their children off in a safe place they could have fun.] yfyn participant-age 28 figure 6. community strengths-connections with other yfyn families me hace sentir emocionado y feliz a venir aquí cada semana. me gusta ver a mis amigos. [it makes me feel excited and happy to come here every week. i like seeing my friends.] yfyn participant-age 9 lechuga-peña et al./incorporating photovoice 1133 discussion this paper highlights the practice implications of integrating photovoice into yfyn, a family-based bilingual intervention. to our knowledge, there are few, if any, familybased interventions that use this community-based approach with the family as the unit of analysis, in dual-languages, in a low-income latinx community. photovoice methodologies provide a tool for individuals and communities experiencing marginalization to address broad concerns that directly relate to social equity (wang & burris, 1997). while some studies have noted challenges with using photovoice, this approach provides an intimate look into the obstacles encountered from latinx communities’ perspective, potentially resulting in a means to a solution (evans-agnew et al., 2016; torres et al., 2013). results from our study highlight the range of methodological modifications made to accommodate community preferences and the realities of cbpr in a primarily latinx bilingual community. challenges and limitations challenges and limitations were evident and ultimately informed the photovoice process. first, even though the yfyn facilitators were also the school social workers, it was challenging for some families to submit their photos on time. phone calls to participants reminded them to take their photos and submit them via text or email to the lead facilitator. second, due to the 12-week yfyn program’s time limitations, only the final three sessions were dedicated to the photovoice project. participants and facilitators each said they needed more time for each aspect of the project. facilitators had to be creative when balancing participant approaches while making sure to finish the project in time for the community event. this time constraint may have influenced the participants' photographs and their decisions in determining their emerging themes and findings for the presentation. third, it was necessary to facilitate the project in the participant’s preferred language, adding more time for each step. while most families preferred spanish, one family was exclusively english speaking. therefore, all participants’ instructions and materials, the focus group, and community presentations were conducted in english and spanish. finally, the technology available for the participant photos posed a challenge. due to limited funding, participants agreed to use their cell phone cameras to take photos for the project. however, we realize this may have put an unexpected burden on families. while it was not an issue for most families, one family had experienced a disruption in their cellular service and relied on an outside family member’s phone when taking their photographs. lessons learned first, building rapport with participants is essential to the success of community projects. yfyn staff, who were also the school social workers, had built a rapport with families before the program and over several program sessions before implementing the photovoice project. since families had existing relationships and met weekly leading up to the photovoice project, they were much more committed and engaged in all steps of the advances in social work, fall 2021, 21(4) 1134 process. second, introducing the program’s photovoice component including the background and method to participants during the first few sessions of yfyn created excitement and anticipation for the project. third, although participants were given the initial prompt of identifying community strengths and challenges, it was imperative to give them the lead on all aspects of the project. participants chose which photos they wanted to use for their photovoice display and determined the focus group’s structure (working with their own family first and then coming together as a larger group). participants also chose who from their family would present to disseminate findings during the community event (they chose their children to present, some of whom were as young as seven-years-old) and conducting the project in two languages, spanish and english. fourth, ensuring all family members participated in the project provided parents and children a platform for their voices to be heard as experts on their lived-community experiences. finally, participants were encouraged to invite community stakeholders to attend the presentation and approve the community stakeholders that requested to attend, including the school principal and after-school program director and grantor of programs. implications for social work education social work education, research, and practice must reflect our evolving systems to work alongside clients and communities in challenging social injustices (national association of social workers [nasw], 2015). this ethical principle is directly in line with the emancipatory pedagogical work of paulo freire (1970), which influenced wang and colleagues’ development of photovoice as a methodology. this philosophy is a practical pedagogical framework that should be deeply rooted at all levels of social work education. photovoice provides social work educators the ability to demonstrate the intrinsic power that communities hold by centering the voices and lived experiences of the communities we serve. acknowledgment of the community as leaders is key given the current complex social justice issues in which social work is embedded. social work education should upend the idea that we enter communities to “save people.” as freire (1970) states, teaching is not the primary objective; instead, teachers must reciprocate the learning process by gaining insights from their students and establishing a critical dialogue; thus, community members become the teacherand social workers become the students. implications for social work individual level influence: given that photovoice can be taught to all individuals regardless of education or ability, it is a valuable tool to support community members in conveying issues of importance to them. photovoice, in turn, can educate, inspire, and influence decisions that affect the individual, their family, and their community. photovoice allows individual voices from groups that experience underrepresentation in the policy arena to frame issues using a readily accessible medium. from a research perspective, photovoice helps the researcher understand and uncover complex issues from the direct perspective of community members to accurately capture the meaning of the issues. the photovoice tool can be used with almost anhyong and gives expertise and insight into communities and worlds that professionals and outsiders cannot access. lechuga-peña et al./incorporating photovoice 1135 programmatic level influence: to support photovoice as a tool for community-based programs like yfyn, introducing photovoice early on in the project is essential to bolster community support. neighborhood-based programs present many opportunities for communities experiencing marginalization and underrepresentation to collaborate with practitioners and researchers. this cross-collaboration provides focused attention on key community issues that can potentially inform social work practice and strengthen partnerships that benefit the communities that social workers serve. one of the most successful impacts of yfyn is the length of the program. yfyn began in 2012 and has worked alongside approximately 150 families in denver, colorado, and phoenix, arizona. the yfyn community-led team continues to evaluate the program and challenges the neighborhood perceptions of low-income communities. community collaborations require a significant amount of planning, with trust being built over time. therefore, introducing photovoice early on is essential to ensure community buy-in and support. policy level impact: another significant aspect of photovoice is reaching policymakers to influence public policy. the yfyn intervention has shown effective results related to the active role community members had in the intervention. as coresearchers, they created knowledge through their photos and promoted their ideas and perception of their neighborhood. this creation of knowledge directly relates to the central tenets of photovoice, where community members are the experts about their own lived experiences. researchers should be encouraged to work alongside the community to incorporate a policy recommendation into their project. community members can guide these recommendations and further promote community participation. it is important to acknowledge that photovoice activities do not always result in direct policy change given the varied policy streams and timing (problems, politics, and policies) needed for a specific policy to emerge (kingdon, 1984). however, van wormer’s (2004) anti-oppressive policy analysis differs from the traditional policy framework in that it focuses on the structural barriers that exist and not on pathologizing the individual. this approach attempts to shape and refine policies that relate specifically to oppressed populations and even more to prevent oppression in the first place. anti-oppressive policy focuses on the client and uses their expertise to contribute to research and policy change to attain social and economic justice. therefore, collaborating with community members to influence local policy through photovoice can help bring their voices to the forefront. furthermore, community collaboration is crucial in identifying the public policy problem, and this action alone is key in influencing community change. suggestions for future photovoice iterations photovoice is still a relatively new research methodology. there can be a learning curve when educating others about the method's validity and its ability to be a powerful research method for marginalized communities. however, photovoice can be an empowering method when added to existing programs and provides opportunities for participants and researchers to work collaboratively to identify important community issues. recommendations for future iterations include allowing more time for the photovoice project when implemented within an existing program. the photovoice project took place during the final three sessions of yfyn, which lasted two hours each. advances in social work, fall 2021, 21(4) 1136 participants need more time to take photos, write their narratives during the photo technique, participate in the focus groups, and create the display boards for the community presentation. additionally, if funding had been available to purchase digital cameras, this would have prevented barriers with using mobile phone cameras. further discussions about privacy violations and undue stress placed on families when using personal cellular phones should be considered. the tenets of photovoice align well with social work, especially given the profession’s focus on social justice (nasw, 2015). therefore, additional iterations of this project could potentially include community awareness and attitudes about the built environment of their communities in low-income neighborhoods (nykiforuk et al., 2011; pruitt et al., 2018; vásquez-vera et al., 2019). production of knowledge from the community rooted in their lived experience can help to reshape the narrative of latinx families living in low-income communities. thus, photovoice can potentially challenge stereotypes and offer counternarratives for the causes of social problems. conclusion this article contributes to the increasing body of research that demonstrates how community-based participatory research approaches such as photovoice are important in understanding the experiences of historically underrepresented communities in the united states, in this case, a latinx bilingual (english and spanish) community. communitybased programs present many opportunities for marginalized, underrepresented communities to collaborate with practitioners and researchers around key community issues that can inform social work practice and strengthen partnerships that benefit the communities that social workers serve. this approach is a departure from conventional research where those in power with no direct lived experience define the problem for communities. photovoice is an empowering tool and can be taught to almost anyone because they do not have to know how to read or write to participate; they only need a camera to capture a photo. the photo captured by the individual is used as a communication tool to educate, inspire, and influence decisions that affect the individual, their family, or community. photovoice allows individuals from groups whose voice is not typically heard in the policy arena to voice their concerns through photography. the use of photovoice methodologies recognizes the commnity members as experts into their communities 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(2016). worth a thousand words? advantages, challenges and opportunities in working with photovoice as a qualitative research method with youth and their families. forum: qualitative social research, 16(1), 1-11. https://doi.org/10.1177/1609406917696743 author note: address correspondence to stephanie lechuga-peña, phd, msw, school of social work, arizona state university, phoenix, az, 85004. email: stephanie.l.pena@asu.edu _________ chandra crudup, phd, msw, associate clinical professor, school of social work, arizona state university, phoenix az. chris fike, ms, llmsw, clinical social worker with mcdowell healing arts center, saginaw, mi. claire mcloone, lmsw, lecturer, school of social work, arizona state university, phoenix, az. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 654-671, doi: 10.18060/24120 this work is licensed under a creative commons attribution 4.0 international license. de-centering whiteness through revisualizing theory in social work education, practice, and scholarship chandra crudup chris fike claire mcloone abstract: institutions that frame social work education and prepare future practitioners are firmly rooted in hegemonic philosophies and practices that perpetuate colonization, oppression, and white supremacy. in recognizing that white supremacy is a mechanism of social control, that our current social structure is grounded in liberal-patriarchal capitalism, and that social work conforms to prevailing social norms, we, as social workers, must acknowledge our complicity in perpetuating a white supremacist master narrative (pewewardy & almeida, 2014). the white supremacist ideology inherent within western social work literature, teaching methodologies, and practice strategies only serves to perpetuate an oppressive system. this structure does not envision social workers as agents of change, but rather as essential cogs of the status quo who foster client dependence on a system that is inherently marginalizing. one mechanism for disrupting the white supremacy that has become a master narrative in social work is to create a counter-narrative (pewewardy & almeida, 2014). this paper creates a counter-narrative by using the pyramid of white supremacy framework (safehouse progressive alliance for nonviolence, 2008; tuzzolo, 2016) to critique social work and deconstruct post-racial fallacies ascendant within the profession, and re-visualizes ecological systems framework as a mechanism for de-centering whiteness in social work scholarship, practice, and education. keywords: antiracism; de-centering whiteness; white supremacy; ecological systems framework; counter-narrative; pedagogy; practice; scholarship as a profession informed by such lofty values as service, social justice, dignity and worth of the individual, integrity, competence, and the importance of human relationships (national association of social workers [nasw], 2018), social workers often become so infatuated with the idea of helping or saving “people who are vulnerable, oppressed, and living in poverty” (nasw, 2018) that we fail to acknowledge the ascendancy of white supremacist norms in our profession. we become socialized by the same hegemony we claim to fight against. this often leaves us blinded to issues of internalized white ideology within the profession and resistant to race-based self-critique (pewewardy & almeida, 2014). we must name white supremacy and intentionally work to disrupt it. as kendi (2019) notes, “the only way of undoing racism is to consistently identify and describe it, and then dismantle it” (p. 9). white supremacy is a mechanism of social control (pewewardy & almeida, 2014). shannon (1970), longres (1972), and mcmahon and allen-meares (1992) identified how white supremacist norms became a master narrative in social work practice, research, and education. one mechanism for disrupting the white supremacy that has become a master about:blank crudup et al./re-visualizing ecological systems theory 655 narrative in social work scholarship, practice, and education is to create a counter-narrative (pewewardy & almeida, 2014). this article serves as a public counter-narrative to that normative white supremacist narrative in social work. we, as authors, outline how the three core pillars of social work (scholarship, practice, and education) perpetuate white supremacy, critique white supremacy frameworks ascendant within social work, deconstruct post-racial fallacies within the profession, and re-visualize ecological systems framework. we, as authors, acknowledge that we are part of a history and profession of social workers, who are collectively responsible for doing the work of decentering whiteness in social work education, practice, and scholarship. therefore, we will use “we” and “us” to acknowledge that as a profession this work must be done by all who educate, practice, organize, are activists, and do research in the name of social work. pyramid of white supremacy in social work as an arm of colonization, social work has foundational roots of racism centering whiteness, maleness, elitism, and anti-immigrant ideals. the most commonly taught origin story of social workfriendly visitorsconsisted of white upper-class women that deemed poverty as a moral deficit and aimed to assimilate immigrants, by othering them and infiltrating their communities (maylea, 2020; park, 2008). similarly, today wellintentioned social work scholars, practitioners, and educators do not always recognize the ways we have inadvertently ascribed to the ideas of white supremacy because the profession is functioning by design in centering whiteness. the pyramid of white supremacy created by safehouse progressive alliance for nonviolence (2008) and then adapted by tuzzolo (2016) helps us identify how socially acceptable practices (covert) and socially unacceptable practices (overt) are all forms of white supremacy and counter to what we say we value in the profession. visual depictions like the pyramid assist us in recognizing how our narrative does not match our actions. connecting covert actions with socially unacceptable forms of racism, we acknowledge the pervasiveness and danger of all forms of white supremacy. realizing the connection of social work’s legacy of oppression guised as moral forms of helping is vital to a path towards an anti-racist narrative forward. moving beyond a critique of our existing frameworks into a true paradigm shift requires reimagined foundations and theories – ones that acknowledge the reality of systemic racism within our own profession. re-visualizing ecological systems framework the ecological systems framework is foundational to social work research, practice, and pedagogy. it is used by practitioners to better understand how a client and their multiple environments influence each other. bronfenbrenner (1986) created a five-level model of personal and environmental influence to address his concerns that developmental psychologists were neglecting the impact of environmental factors on human development, specifically focusing on children (renn, 2003; seshadri & knudson-martin, 2013). his model focused on influences placed upon an individual by their environment, their responses to their environment, and the context of the socially constructed time (renn, advances in social work, summer 2021, 21(2/3) 656 2003). to decenter whiteness from the pillars, we must critically review the ways it has seeped into our foundational theories and frameworks. the traditional social work understanding of the ecological systems framework is often depicted visually by layered circles with macro systems representing the outside circles moving towards a circle in the middle representing the individual at the center of the systems. nesting systems surrounding the individual represent the process and outcomes that each system has on the individual at the core of the system (stormshak & dishion, 2002). this bullseye depiction of the model was created to help better understand the framework. after reviewing the literature, crudup (2014) found the traditional conceptualization (see figure 1) of the ecological systems theoretical model does not seem to accurately depict the interactions among and between systems. though each circle looks embedded, the solid lines of each circle or system visually depicted in the traditional visual model do not allow for the permeation and overlap that often occurs between and among systems. the ecological systems model encompasses both processes and outcomes by placing an individual at the center or origin of development with nested systems surrounding the individual or couple, increasing in distance between the singular self and the self as a component of a much larger community (stormshak & dishion, 2002). figure 1. traditional visual of ecological systems framework this visual representation puts focus and responsibility on the individual to overcome years of historical trauma and social constructs created to prevent them from succeeding rather than a community's responsibility of supporting humanity. distancing the individual from the community is consistent with a systemic structure that puts the pressure on an individual to pull themselves up by their bootstraps, perpetuating a myth that avoids recognition and solutions to deal with societal constructs that do not make that possible for crudup et al./re-visualizing ecological systems theory 657 historically marginalized populations. it centers the idea that one is functioning within a system that sees them and is created for them. this model was created for a system that centers whiteness and maleness, therefore, the model really only functions as originally visualized if the individual at the center is white and male. not only does this reinforce the systems of white patriarchal supremacy and how it works, it visually shows the barriers with the bullseye image. though one could argue that if you are a white person in the middle of this system all of the lines between the individual and each surrounding circle are gray, the fact is the entire model was built with a white person being in the middle. therefore, whiteness is centered, literally. having a relational focus rather than an individual focus could be one way to reimagine how a framework such as the ecological systems framework could de-center whiteness. the individual is by themselves in the middle, with a sole focus, with barriers between them and the systems around them. what would happen if the community was at the center rather than the individual? what if the role individuals play within their community was the focus to balance the importance of an individual's contributions to their society and society’s responsibility to support the individual was more clearly depicted? this framework directly informs social workers’ person-in-environment understanding of working with individuals (karls & wandrei, 1994). focusing on the person rather than the community and how the individual contributes and receives from the community is by design in line with white supremacist ideology. social workers must reconstruct this inherent individualism and focus on how an individual’s health, wellbeing, and sense of self is a direct result of how they contribute to the community, as well as how a community's overall well-being then gives back and contributes to the individuals wellbeing and health. this relational focus as opposed to the individualistic focus has seeped into social work pedagogy, practice, and scholarship, the three pillars, in ways that have made our profession complicit with oppressive white supremacy. we teach multiculturalism rather than racism because it feels better for the individual rather than addressing racism – a more uncomfortable topic, but racism is the core of what we need to address. in scholarship, quantitative research is valued despite it stripping humanity and context from individuals and turning them into manipulatable numbers. in practice, we perpetuate the system by focusing on what the individual can do for themselves and take from society or gains from systems rather than how they can contribute to their community for a mutual individual and collective benefit. crudup (2014) developed a new visual representation that portrays a more accurate reflection of the systems encountered by interracial couples in her study as a means of understanding how systems and social constructions impact their couple identity. crudup’s (2014) ecological systems framework for understanding interracial marriage (see figure 2) used the concept of a funnel rather than the traditional bullseye visual representation previously associated with the ecological systems framework. the funnel represented the social constructions that have been created throughout history, shaping society and influencing history, policy, popular media, and other macro level systems of which individuals and couples are a part. within the funnel there were the two major socially advances in social work, summer 2021, 21(2/3) 658 constructed systems that impacted black female/white male interracial couples: race and gender. the “structural power constructed by whiteness and maleness” has influenced the construction of both concepts and its function within community, social, and familial systems (root, 2001, p. 11). race and gender have socially constructed known roles, boundaries, and expectations that have become understood in society. the overlapping race, gender, community, social networks, and family systems capture how neither acts alone, but each intersects and impacts the other resulting in individual and in the case of crudup’s (2014) research, couple identities. figure 2. ecological systems framework for understanding interracial marriage crudup (2014) used the funnel conceptualization and its incorporation of social construction of the systems framework to understand how black female/white male interracial couples navigated their experiences as an interracial couple. recognizing that the bullseye visual centers whiteness, describing how it perpetuates systemic oppression, and then re-visualizing the ecological systems framework is an example of the work that is needed by the profession to de-center whiteness. if the profession continues to value social justice, we need to be willing to do the work of reconceptualizing a world and a way of practicing that is antiracist. this work is difficult because of how conditioned we have been by whiteness. challenging a core component of a profession, such as ecological systems framework, is difficult not only because of how it has been established within the profession, but also because of the linear way of thinking that was used in the original design. linear notions of understanding are similar to white systemic ways of knowing. we can counter this linear narrative by focusing less on the individual and how they fit within an exclusionary system, and focus more on narratives, testimonials, oral histories, and other ways of knowing that can create a community that crudup et al./re-visualizing ecological systems theory 659 focuses on the actual strengths of every person. adding a racial justice lens and reconstructing the model is an invitation to move back to humanity, at the same time embed and expand our strengths perspective to include the power of both community and individual identities. building on crudup’s (2014) original image we are able to see the systems perspective in a way that more accurately represents how the framework applies to all populations, not just white people, with the revised ecological systems framework (see figure 3). figure 3. revised ecological systems framework the revised ecological systems framework converts crudup’s (2014) image that focused on understanding interracial couple identities to a visual that can be applied similarly to the bullseye depiction of the ecological systems framework. this illustration depicts the overlapping systems that have been influenced and constructed through historical and social constructs, while taking into account the strong implications of race and gender at every level and its impact on an individual moving within those systems. the individual therefore is influenced by and interacts with each system while also holding on to their unique self (self-determination). the individual is a part, but not the sole center of the worlds surrounding them. advances in social work, summer 2021, 21(2/3) 660 figure 4. comparison of traditional and revised ecological systems framework. when viewing the two images side by side (see figure 4), it is clear the revised ecological systems framework image is more intersectional. this aspect alone helps in understanding the true influence and relational nature of all systems demonstrating how they converge and impact each other. the individual moves through and is impacted by the community, and thus the community is impacted by the individual. this relational impact helps better depict the person-in-environment that is a hallmark of the social work profession. the revisualization of this framework allows us to move from a siloed framework that lends to deficit assumptions to a more inclusive focus on strengths. this neutralizes the model to be strengths focused for all communities, not just those benefiting from white privilege. simply reflecting on and revisualizing a core framework in the profession, through a decentering lens, we create a counter-narrative that should start a ripple effect across the pillars that has a long lasting and sustainable impact on our communities. creating a counter-narrative in crafting a counter-narrative we recognize that antiracist approaches to social work require us to challenge professional hegemony through deconstructing, disrupting, and dismantling traditional ivory tower conceptualizations of social work scholarship, practice, and education (tamburro, 2013). we further acknowledge that, historically, antiracist perspectives have fallen short because they “promote equity and parity within a hierarchical system that has been re-inscribed following every movement to dismantle white supremacy” (pewewardy & almeida, 2014, p. 234). to reinforce the urgency of the need to de-center white ideology in social work we must also contextualize this counternarrative within this moment in history, a juncture characterized by the acceptance of black americans dying at the astoundingly disproportionate rate of nearly 1 in 1,000 (or 97.9 per 100,000) as a result of a global pandemic (apm research lab, 2020) and by the normalization of a president of the united states failing to condemn white supremacy during a presidential debate (national public radio, 2020). as pewewardy & almeida crudup et al./re-visualizing ecological systems theory 661 (2014) concede, there is “no better way for people to develop the skills and determination to interrupt white supremacy than to be unsettled by anger, fear, and/or guilt” (p. 231). the counter-narrative outlined herein is one that leans into this revolutionary moment, taps into the emerging racial disquietude, and brings to bear our experiences as social workers, educators, scholars, organizers, and activists. james baldwin spoke of witness, “witness to what i’ve seen and the possibilities that i think i see” (lester, 1984, para. 25). sparked by public witness to the murders of ahmaud arbery by armed vigilantes and of botham jean, atatiana jefferson, breonna taylor, sean reed, tony mcdade, and george floyd at the hands of police, brands, companies, businesses, sports teams, universities, and schools of social work all publicized their support for the movement for black lives. but we also witnessed the emergence of an antiracist narrative that not only failed to challenge the white supremacy master narrative, but served to reinforce it (monteiro, 2020). we saw rich white capitalists donate millions to black lives matter, while at the same time funding and praise were being heaped upon racial justice and antiracist narratives that remained grounded in conservative ideologies and the existing hegemonic structure (monteiro, 2020). then we witnessed the social work profession double back its investment in that white supremacy master narrative while feigning antiracist intentions. for example, we saw the nasw (2020) issue a statement in support of strengthening social worker and police partnerships in response to the ongoing racist violence perpetrated by law enforcement. we even saw an emergence of performative antiracist messaging among other social work institutions, some of which seemed to acknowledge the need to “address the social ills, inequities and systematic disparities that have divided american society” (special commission to advance macro practice in social work, personal communication, 29 june 2020) while others seemed to recognize that social work has, “not yet reckoned with the racism and anti-blackness that exists among ourselves and our key social welfare institutions” (adams & dettlaff, 2020, para. 2); very few actually were willing to name white supremacy. fewer were willing to address the equally destructive nature of oppression perpetuated by fields most closely associated with social work, such as child welfare. the child welfare system is another system complicit with white supremacy across the pillars that the profession must reckon (dettlaff, 2020). this “well intentioned” system historically has perpetuated and caused harm to individuals and communities of marginalized populations in the name of “helping” (mulzer & urs, 2017). the process of moving from witness to action requires us to name and disrupt white supremacy and to craft a counter-narrative that intentionally and specifically de-centers whiteness. three pillars of social work we, as authors, conceptualize social work as consisting of three interlocking pillars: pedagogy, practice, and scholarship. the pillars of social work serve as a system of checks and balances on the profession. each pillar of the profession is important to ensure the profession is meeting its charge to “promote social justice and social change with and on behalf of clients” (nasw, 2018, para.3). the convergence of pillars outlines the advances in social work, summer 2021, 21(2/3) 662 overarching narrative of what social work aspires to be: practice informing pedagogy and scholarship, scholarship informing practice and pedagogy, and pedagogy informing practice and scholarship. each pillar must move beyond cultural awareness and individualistic approaches and deconstruct western ivory tower conceptualizations of pedagogy, practice, and scholarship by holding each linking pillar accountable to do the same. it is also important to highlight that two of the three pillars mostly fall within academia. those teaching future generations of social workers and advancing social work scholarship must begin doing the work to truly shift the narrative of our racist profession. mcmahon & allen-meares (1992) posited the question of whether social work was racist. their content analysis focused on interventions with historically marginalized populations. they found that the social work profession was superficial in its attempts to be antiracist because of its colorblind approach, its normalized oppression of clients by centering awareness of social workers, its intense focus on the individual rather than the structural systems that need to be addressed to assist the client, and its repetitive nature of normalizing the status quo (mcmahon & allen-meares, 1992). despite concluding that, “programs will require a more advocating, proactive, organized, and antiracist stance from the profession” (mcmahon & allen-meares, 1992, p. 538), the profession continues to struggle with how to actually de-center racist white patriarchal ideologies that infiltrate our pedagogy, practice, and scholarship. in the almost 30 years since the publication of the work of mcmahon & allen-meares (1992), it seems as though there is a disconnect among the pillars. while there has been scholarship asking the right questions and determining that the profession needs to move towards being antiracist, there continues to be a struggle to de-center whiteness within each of the pillars (kolivoski et al., 2018; maylea, 2020; pewewardy & almeida, 2014). the profession itself continues to grapple with how to address the work that must be done to eradicate white supremacist ideologies from within the profession. it is the responsibility of social workers and allied organizations within each pillar to address ways in which we have been and continue to be complicit in perpetuating white patriarchal systems that are harmful to historically marginalized populations. contextualizing the pillars pedagogy the pillar of pedagogy is the foundation of the profession. it is within this pillar the journey of every social worker begins. this pillar is responsible for building a firm understanding of the ethics and values of the profession, the skill set of working with individuals, groups, and community settings, the value of ongoing learning and practitioner self-reflection, and all other aspects of quality related to the social work profession. it is within this pillar that we educate the next generation of scholars on what is valued in scholarship and practice. field experience is a staple component of the social work pedagogical structure for the preparation and development of the practitioner (cswe, 2008). practice and scholarship directly influence what is taught, and what is taught directly influences practice and scholarship. therefore, pedagogy is the place we often see the crudup et al./re-visualizing ecological systems theory 663 perpetuating of white patriarchal ideas. it is here that much of what has been done in practice or scholarship is seen being repeated as the guide post on how social workers are supposed to practice or conduct research. a critical conceptualization of social work education frames learning as a practice of freedom, wherein educators create spaces for students to critically and creatively engage reality to discover how to participate in sociocultural transformation (freire, 1970). decentering whiteness in social work pedagogy demands that we address underlying colonial philosophies rather than simply altering theoretical frameworks and choosing different methods (crampton, 2015; gray et al., 2013). as integrated members in institutions that perpetuate colonization, social work educators have a responsibility not only to decolonize and deconstruct or de-center whiteness in social work (tamburro, 2013), but to amplify critical antiracist frameworks. ideas of “multiculturalism” and “cultural competence” stand in the way of a clear and untethered examination of white supremacy (kolivoski et al., 2018; pewewardy & almeida, 2014). for example, critical race theory is discussed as a pedagogical answer to the shortcomings of social work’s flawed multiculturalism perspectives (kolivoski et al., 2018), but is not quantified, assured, prioritized or required in standard practice. doing so would no doubt be met with controversy given that social work tends to conform to prevailing social norms and that any work that counters those racist master narratives tends to be met with experiences of anger, fear, and/or guilt, particularly from white consumers (pewewardy & almeida, 2014). in order for pedagogical changes to hold any weight in our lived realities, we must connect them to tangible, material changes in our communities. otherwise, pedagogical changes only exist to uphold the performance we seek to abandon. social work educators must teach students how to recognize and confront colonized approaches and spaces as a means of shifting the educational paradigm beyond colonial constraints. inclusion of such approaches must move beyond superficial discussions but rather include in depth exploration and practice of how to disrupt generations of historical systemic trauma. new theories that abandon individualism and provide space for a realignment towards truly ethical social work are a starting point for the radical change this moment necessitates. crudup’s (2014) model, along with the revised ecological systems framework (see figure 3) creates a starting point where the true complexity of social problems can be captured, analyzed, and understood pedagogically. students in field must develop tools to define and operationalize colonization, decolonization, and deconstruction. instructors must be able to teach these concepts and be able to critically examine colonized social work classroom spaces and pedagogical approaches. pedagogy must move beyond the hollow fulfillment of vague accreditation criteria which frames antiracism as a linear objective focused on individual self-reflection, rather than a material reality that is imperative to the health of all of society. historical context should frame the rationale for why we must deconstruct, disrupt, and dismantle traditional social work pedagogy in our current sociopolitical climate. social work educators must learn to recognize and confront problematic ways in which we perpetuate educational models that are anti-black and center whiteness. social work pedagogy should transform classroom spaces (in-person and online) and shift the educational paradigm. this advances in social work, summer 2021, 21(2/3) 664 would entail a radical reassessment of foundational theories, assessment methods, and institutional cultures. it necessitates that we are actively interrogating our own ideas, supporting one another in accountability, and changing harmful dynamics within our own organizations. we can begin this work by having guest speakers from historically marginalized populations share with our students about topics not directly tied to historically marginalized populations. this avoids the dehumanizing pitfall of tokenizing our colleagues and valuing them for their skill set. social work educators must equip practitioners and scholars with the language and context to recognize and confront the ideology of white supremacy inherent within hegemonic conceptualizations of the profession. educators must challenge and recognize ways in which they perpetuate colonized philosophies, pedagogies, and research methodologies. this means that instructors both in the classroom and in the field must name and address the ways racism is threaded through the systems and profession, rather than avoid discussions due to individual discomfort (hair, 2015). it is imperative that educators can disrupt antiquated anti-black and white-centered pedagogical practices and explore the role of individual and collective critical consciousness in deconstructing social work education. the council of social work education must intentionally hold programs accountable to the inclusion of such pedagogical practices and curriculum to ensure that the profession is actively dismantling the racism and oppressive ways that have nestled themselves within the preparation process of practitioners and scholars. practice the practice pillar is the heart of the profession. it is the central realization of the pedagogy taught and the lessons learned from scholarship. it is the practical application of theory that has lasting impact and change on communities and individuals we work with. practice is the most public-facing, frontline aspect of the field. social workers have been seen making changes in individual lives, within communities, and influencing policy at local, state, and national levels for almost 150 years. practice is the profession. it is the implementation of skills taught in the pedagogy pillar and actualization of the evidencebased practices demonstrated in the scholarship pillar. the practice pillar interlocks with scholarship through practice-oriented research, using scholarship to inform practice, and teaming up with scholars to evaluate innovative new practices. this is where the opportunity to perpetuate or prevent harm is most tangible. it is within this pillar that individual social workers have direct contact with historically marginalized populations and are responsible for not invoking further trauma. without the other pillars doing the work to address this, industry standards continue to gloss over true reparative work that social workers should be doing with individuals and communities. it is the role of licensing committees and regulatory boards to continue to identify, describe, and dismantle ways in which practitioners are held accountable to do no harm-including oppression. at the same time, we must recognize licensing boards are not immune from systemic racism, and may not be the only solution (castex, 2019; woodcock, 2016). without understanding the impact of colonization, social workers are not prepared to engage in the social justice work that guides our professional values and ethics (tamburro, 2013). further, institutions that prepare future practitioners – namely, academia and crudup et al./re-visualizing ecological systems theory 665 professional associations-remain firmly rooted in hegemonic philosophies and practices that perpetuate colonization, oppression, and white supremacy (gray et al., 2013; pyles, 2016). the white supremacist ideology inherent within the majority of western social work literature, teaching methodologies, and practice strategies only serves to perpetuate an oppressive system. this structure does not envision social workers as agents of change, but rather as the cogs of the status quo who foster client dependence on a system that is inherently marginalizing. social work practice must move away from this dynamic if we ever want to move beyond the lip service of what our value statements are to actualizing an anti-racist and anti-oppressive profession. recognizing and dismantling colonized professional practices aligns with antioppressive critical theory as well as with critical constructivism (eketone & walker, 2013). practice methodologies that integrate a decolonizing framework focus on critique and deconstruction of and resistance to the dominant western structures that create and maintain oppression and exploitation while also acknowledge the inherent validity of accumulated knowledge within oppressed societies, particularly socially constructed values, cultural ethics, and language (eketone & walker, 2013). decolonized practice methods are often grounded in a grassroots perspective on professional engagement, looking to community members as experts of their own experiences, strengths, and needsinformed by native american traditions, worldviews, and practices (eketone & walker, 2013). de-centering whiteness from social work practice requires us to challenge professional hegemony through deconstructing, disrupting, and dismantling western ivory tower conceptualizations of practice. this work demands that we address underlying colonial philosophies rather than simply altering theoretical frameworks and choosing different methods (crampton, 2015; gray et al., 2013;). practitioners must recognize and confront colonized approaches and spaces as a means of shifting the practice paradigm for working with individuals and communities beyond colonial constraints. practitioners must become accustomed to dismantling notions of white patriarchal systems that permeate micro, meso, and macro levels of social work. the revised ecological systems framework is a catalyst to begin this work, which is non linear and a continuous process. social workers must be able to identify language and context to recognize and confront the ideology of white supremacy inherent within hegemonic conceptualizations of social work practice. practitioners must recognize ways in which they perpetuate colonized philosophies, strategies, and practice methodologies, and disrupt antiquated colonial practice approaches. they must learn to move beyond the individualized nature inherent in the core frameworks from which they work to approaching their work through collective critical consciousness that is able to deconstruct social work practice. organizations like nasw and association of social work boards (aswb) must revisit their purpose to not only advocate for communities and social work practitioners but to also ensure that social work professionals are held accountable with service protocols, hiring standards, funding sources, and addressing personal bias. advances in social work, summer 2021, 21(2/3) 666 scholarship the scholarship pillar has legitimized the profession. through establishing sound evidence to support the work that is done by practitioners, social work researchers provide the evidence needed to justify funding to continue work supported by government and other funding agencies. social work scholars serve as members of interdisciplinary research teams that impact every aspect of human well-being from the individual to influencing policy change. beyond evaluating and building knowledge to inform social work practice, the scholarship pillar assesses and evaluates the other two pillars. while social work scholars have started to recognize and acknowledge the ways in which traditional western research methods perpetuate colonialism (gray et al., 2013; pyles, 2016), the institutions that employ scholars – namely academia, professional associations, and research centers – continue to encourage hegemonic philosophies and practices that promote the perpetuation of oppression and white supremacy. an antiracist social work framework requires that the profession must acknowledge its complicity in colonizing practices and research projects and condemn past and ongoing effects of colonialism (gray et al., 2013). evidence based practice – a term social work borrowed from the medical profession (jenson & howard, 2013) – is one mechanism that social work scholarship has used as a gatekeeping mechanism. though gatekeeping is not inherently something to be avoided, we must be cautious on how it is used intentionally or unintentionally to exclude. one way of doing this is to move towards evidence based africentric practice that ensures a comprehensive scope of the practice when working with our complex society (gilbert et al., 2009). de-centering whiteness within the pillar of scholarship means deconstructing oppressive aspects of research from design, implementation, analysis, and dissemination. decolonized research methodologies align with anti-oppressive critical theory as well as with critical constructivism (eketone & walker, 2013). research methodologies that integrate decolonization frameworks tend to focus on critique and deconstruction of the dominant western structures that create and maintain oppression and exploitation (eketone & walker, 2013). decolonizing methodologies demonstrate hegemonic resistance through acknowledging the inherent validity of accumulated knowledge within oppressed societies, particularly socially constructed values, cultural ethics, and language (eketone & walker, 2013). social work scholars who integrate decolonized research methods recognize that research involves more than simply visiting a community, doing the work, and leaving (gray et al., 2013). gray et al., (2013) reference community-based participatory research (cbpr) as a methodological example, wherein scholars are expected to spend time with participants, become a part of the community, and learn “through direct experience and sustained interaction with people in the community” (p. 15). decolonized research methods are often informed by a grassroots perspective on scholarship, looking to community members as experts of their own experiences, strengths, and needs. social work scholars must undo racism within their research by identifying, describing and dismantling the way it seeps into their work (kendi, 2019). they must do this at every step of the research process, including examining and naming their own biases, beliefs, and ways of knowing. critically examining methodologies, theories, and dissemination crudup et al./re-visualizing ecological systems theory 667 practices is a challenge when confronting larger ways of knowing, but must be done to address embedded mechanisms of whiteness that infiltrate knowledge production and dissemination. this means utilizing case studies, participatory action research (par), video ethnography, and other methodologies that capture a holistic narrative that critically analyzes beyond the individual and captures more than the depersonalizing nature of solely reductive quantitative scholarship. par is viewed as an example of a decolonized approach, one in which people from the community are engaged from problem definition though to findings dissemination (gray et al., 2013). grounded in critical constructivism, video ethnography integrates elements of a decolonized research methodology by enabling researchers to reobserve, and analyze, the nuances of an interview that are not always captured, documented, or remembered through “re-living” a live account of the interview leading to greater accuracy and more information gleaned (gottdiener, 1979). one of the most notable organizations to advance and legitimize the scholarship pillar is the society for social work and research (sswr). sswr “advances, disseminates, and translates research that addresses issues of social work practice and policy and promotes a diverse, just, and equitable society” (sswr, 2021, para. 5). though this mission aligns well with the nasw code of ethics’ description of a profession that promotes social justice and social change, not one of the seven statements of its mission explicitly references the promotion of a diverse, just, and equitable society. nor does the sswr mission include the disruption and deconstruction of white patriarchal systemic ways of knowing through methodologies or dissemination. social work scholars and organizations must deconstruct colonial ways of conducting and disseminating research to de-center mechanisms of whiteness with the social work profession. this includes acknowledging ways of complicity and reflecting on the ways scholarship impacts the other pillars by shackling knowledge production through perpetuating white patriarchal norms within the profession. rather than being a resource for social work practitioners, responding to the needs in the field, institutions separate themselves and create barriers for collaboration. one example of this includes exorbitant conference fees. another is scholarship published behind a paywall, where it often remains within academia, inhibiting the ability for meaningful scholarship to reach the people who need it most. conclusion ...it is absolutely too late for you to be an ally. at this moment in history, as we move to abolish racism, it calls for you to either be an accomplice or completely get out of the way. ~ rev. dr. stephany rose spaulding (spaulding, 2020, para. 1) in recognizing that white supremacy is a mechanism of social control, that our current social structure is grounded in liberal-patriarchal capitalism, and that professional social work tends to conform to prevailing social norms (pewewardy & almeida, 2014), we have to acknowledge social work’s complicity in perpetuating a white supremacist master narrative. if the social work profession is going to continue forward with such aspirational values such as service, social justice, dignity and worth of the individual, integrity, competence, and the importance of human relationships (nasw, 2018), then we have to advances in social work, summer 2021, 21(2/3) 668 be intentional about de-centering whiteness in scholarship, practice, and pedagogy. there must be an immediacy to this work. the interlocking pillars create an accountability system that can and should hold the profession accountable in decentering whiteness. each pillar has a responsibility to do their part and not leave it to another pillar to pick up and lead, we all must be leaders in actualizing the values of our profession. it is time to move beyond identifying and describing the ways that white supremacy have infiltrated the three pillars of social work and move to dismantle this master narrative. counter-narratives, such as revisualizing the ecological systems theory, de-center whiteness by centering humanity. in replacing archaic structures with reimagined, multidimensional models, we, as authors, offer a new narrative for social workers that reflects both lived reality and a future grounded in community centered healing, change, and power. references adams, l., & dettlaff, a. 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(2013). including decolonization in social work education and practice. journal of indigenous social development, 2(1), 1-16. tuzzolo, e. (2016, august 14). now… where do you draw the line? [facebook post]. https://www.facebook.com/photo.php?fbid=10155008422952523&set=a.851275125 22.81621.626002522&type=3&theater woodcock, r. (2016). abuses and mysteries at the association of social work boards. research on social work practice, 26(2), 225-231. https://doi.org/10.1177/1049731515574346 author note: address correspondence to chandra crudup, school of social work, arizona state university, phoenix, az, 85004. email: ccrudup@asu.edu acknowledgment: some content within this article was previously presented in the unpublished doctoral dissertation a multi-decade look at black female/white male interracial marriages (crudup, 2014). https://www.facebook.com/photo.php?fbid=10155008422952523&set=a.85127512522.81621.626002522&type=3&theater https://www.facebook.com/photo.php?fbid=10155008422952523&set=a.85127512522.81621.626002522&type=3&theater https://www.facebook.com/photo.php?fbid=10155008422952523&set=a.85127512522.81621.626002522&type=3&theater https://doi.org/10.1177/1049731515574346 pyramid of white supremacy in social work re-visualizing ecological systems framework creating a counter-narrative three pillars of social work contextualizing the pillars conclusion this work is licensed under a creative commons attribution 4.0 international license. culturally effective practice with refugees in community health centers: an exploratory study nicole dubus ashley davis abstract: the global refugee crisis requires providers of health and behavioral health services to develop culturally-effective practices that can meet the needs of the everchanging demographics of those being resettled. community health centers in the united states are often asked to provide services during the first year of resettlement for refugees. social workers are among those professionals who provide the behavioral health services in the community health centers. to better understand the challenges for these providers, this qualitative study examines the experiences of 15 providers of refugee behavioral health services at community health centers in the northeast of the united states. the participants were interviewed, and those transcribed interviews were analyzed for themes. findings revealed three main themes: client engagement as crucial; collaboration with interpreters; and cultural competence is an imperative but ill-defined. important implications focus on the need for cultural competence and the challenge to obtain this competence given the resources and demands in community health centers. keywords: refugee; community health center; cultural competence currently, there are over 65 million forced migrants throughout the world (united nations high commissioner for refugees [unhcr], 2017). forced migrants are individuals that are required to relocate due to internal conflicts, persecution, or unsustainable environments due to social/economic factors or climate changes. of the 65 million forced migrants, over 23 million are united nations designated refugees. the current refugee crisis is the largest in history and is not abating. in fact, by all statistics it is increasing and rapidly changing (unhcr, 2017). with the effects of climate changes accelerating, one can expect forced migrations due to climate changes to increase (campbell, 2014; farbotko, stratford, & lazrus, 2016; yoosun, 2008), adding to our current refugee crisis. while the legal term “refugee” has been in use since 1951, the united states, and many other countries, have been receiving refugees for centuries (matera, stefanile, & brown, 2015). throughout much of the history of the united states, social workers have in some form or other been providing direct services to refugees (healy, 2008). our long history of working with refugees continues today. each year the president determines the number of refugees allowed to enter the united states (unhcr, 2017). in 2016, under president obama, the united states, accepted nearly 85,000 refugees (krogstad & radford, 2017). in 2017, president trump set the cap to 45,000 refugees, and in 2018, the cap was placed at 21,292 refugees to be accepted into the united states (unhcr, 2017). while at the time of this writing, the numbers of new refugee arrivals have been restricted, the global crisis has not abated, and the needs of refugees will continue to be a dynamic and demanding _______________________ nicole dubus, phd, msw assistant professor, social work. san jose state university, san jose ca, 95112. ashley davis, associate professor, social work, boston university, boston ma. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 874-886, doi: 10.18060/21731 https://creativecommons.org/licenses/by/4.0/ dubus & davis/culturally effective practice 875 concern for social workers well beyond any current presidential administration. in the united states, community health centers are on the front lines of working with refugees. a community health center is a nonprofit comprehensive primary care facility that is federally mandated to provide services to underserved areas (taylor, 2004). through the assistance of local agencies, the un-designated refugee is connected to a local community health center that provides health and behavioral health care services (bruno, 2015; morland & levine, 2016). refugees have often survived traumatic events, leaving many with symptoms of depression, anxiety, and post-traumatic stress disorder. all refugees need housing, support entering into the labor field, and many need assistance learning english (esses, hamilton, & gaucher, 2017; moulton, 2016). in addition, individuals and families may enter the united states with pre-existing health and mental health conditions that can complicate their resettlement (burnett, 2016; bustamante, leclerc, mari, & brietzke, 2016; ellis, murray, & barrett, 2014; hansen & huston, 2016; moulton, 2016). social workers are among the healthcare professionals who serve refugees in community health centers and must help them navigate an under-resourced system to meet their needs (adams, gardiner, & assefi, 2004; al-husban & adams, 2016; ay, arcos gonzález, & castro delgado, 2016; barghadouch et al., 2016; bozorgmehr, szecsenyi, stock, & razum, 2016; burnett, 2016; esses et al., 2017). challenges in cross-cultural social work interventions this study examines in particular the cultural challenges of providing effective interventions. in this section we introduce some of the major cultural challenges that other studies have researched. refugees may come from situations and cultures not accustomed to seeking mental health services. providing culturally-effective services to this group may also involve addressing possible stigma the individual, family or community may experience when seeking mental health services (al-makhamreh, spaneas & neocleous, 2012). additionally, some cultures may be more family-centric than the united states, and therefore may expect to involve family members in their care (weaver, 2005; weine, kuc, dzudza, razzano, & pavkovic, 2001). for social workers, this can create ethical issues regarding privacy and confidentiality. service delivery may need to be modified to be culturally-effective. weaver (2005) posits that group-based interventions grounded in cultural competency and spirituality could more effectively provide support to refugees. in a meta-analysis of refugee programs, sossou, craig, ogren, and schnak (2008) found that some recipients of refugee services were more responsive to a “contact perspective approach”, a cross-cultural approach that involves an exchange of ideas, negotiation, and interaction among refugees, their families, and professionals. un designated refugees are provided medicaid to cover health expenses their first year of resettlement. however, many are prevented from receiving care because of communication and transportation barriers (fike & androff, 2016). social workers are crucial players in knitting together services and supporting refugee communities. in addition to collaboration, outreach, and culturally-sensitive practice, work with refugees requires language services and experience in working with interpreters as cultural brokers (decola, 2011; fondacaro & harder, 2014; hsieh & kramer, 2012; njeru et al., 2016). the issues involved in working with refugees are complex. social workers in community health advances in social work, spring 2018, 18(3) 876 centers are on the front lines of managing the needs of newly arrived refugees. it is important to understand more about these challenges. our current refugee crisis provides a painful and critical moment to learn best-practices, and to share those practices with others in the field. this study is timely and important in expanding the field’s knowledge on the best practices in working with refugees in community health centers. purpose of the study this study sought to understand how community health centers are responsive to differing refugee populations. understanding the experiences of community health center social workers working with refugees, may provide helpful information on best practices and current challenges. this article reports on a descriptive study of how social workers in community health centers perceive their provision of services to refugees across cultural and linguistic barriers. this study examines community health centers (n=15) in six northeastern states in the united states to gain a deeper understanding of the challenges for centers. for example, how do the centers address the needs of refugees? what do providers see as important components of culturally-effective services? what have they found to be successful approaches in bridging the cultural and linguistic challenges of providing services to an ever-changing refugee population? method participants this purposive sample consisted of 15 mental-health workers in community health centers in all six new england states, including 12 social workers, 1 psychologist, 1 psychiatrist, and 1 program manager. these community centers are located in large and small cities where refugees are resettled in the largest numbers. the researchers contacted each center to invite the social worker—or, in the absence of a staff social worker, another professional in a similar role—to participate in the study. the sample consisted of 9 women, 6 men; three of the men had been refugees from countries in southeast asia or africa. the participants worked in interdisciplinary teams with medical and behavioral health providers, and often held multiple roles: administrator, clinician, case manager, and program manager. procedure the institutional review board reviewed and approved the study. after having participants sign an informed consent, the researchers conducted one-time interviews held at each participant’s health center. a semi-structured interview schedule was used, and the topics explored included: characteristics of the health center (e.g., services provided, funding sources), refugee populations served, training for practice with refugees, and approaches for addressing linguistic and cultural barriers. the interviews lasted between 60-90 minutes, and were digitally recorded and transcribed by a research assistant. dubus & davis/culturally effective practice 877 data analysis the interview transcriptions were uploaded to dedoose, a qualitative data analysis application. two research assistants were trained in the process of inductive qualitative data analysis from the grounded theory tradition (bryant & charmaz, 2007). both researchers and research assistants independently open-coded one interview; by comparing our respective coding decisions, we came to agreement on concepts that would be used by the research assistants to analyze the subsequent interviews. after coding the remaining transcripts, the researchers reviewed their data analysis, and together, we discussed their decisions and resolved any discrepancies. the research assistants were not involved in conducting the interviews, and thus, provided fresh perspectives on the data during the analysis. this team approach increased the trustworthiness and credibility of the analysis by allowing for greater fidelity in the coding decisions (denzin & lincoln, 2011). in the next stage of analysis, the researchers expanded or collapsed concepts to ensure accuracy, and considered relationships across the concepts. finally, exemplars were identified to reflect the concepts surfaced through the coding process. findings in describing their work with refugee populations, three main themes arose across all interviews: client engagement as crucial; collaboration with interpreters; and cultural competence is an imperative but ill-defined. this last theme, cultural competence is an imperative but illdefined, is an overarching theme that is woven throughout the other two. client engagement as crucial seems to be a component of effective service delivery that the participants subjectively used as an assessment of their own cultural competency. working with interpreters seemed to be a resource participants used as they tried to provide culturally competent services. the participants also acknowledged on-going challenges with being culturally competent, both on an individual level for the provider and on a systemic level throughout the center. the participants identified the countries where their refugee populations originated from, including: bhutan, bosnia, burundi, burma, cambodia, congo, djibouti, eritrea, iraq, nepal, somalia, and sudan. new groups of refugees from new countries continue to arrive for services. each community health center reported that the populations were everchanging, and most centers had no more than two weeks’ notice of the new arrivals. this created a shared challenge among the participants as they felt ignorant of the historical and cultural experiences of the new arrivals, and ill-prepared to tailor services to them. each theme will be described below with exemplars from the participants. client engagement as crucial participants reflected on the process of engagement with the client, and seemed to subjectively use their feelings of engagement with the client as an indicator of their own ability to bridge the cultural differences between themselves and the client. participants understood that the journey for the refugees had been stressful. they also understood that many of the refugees felt mistrustful. the participants stated that engaging the client in each session was a crucial component to effective interventions. many health centers advances in social work, spring 2018, 18(3) 878 received a couple of weeks’ notification that new refugees would arrive, rarely with any medical or behavioral health history. one participant explained: “we have a general sense in terms of numbers. every few months we get an update from the [office for refugees and immigrants] to get an idea of what to be ready for.” this “general sense” seemed insufficient to fully anticipate and prepare for engagement with new refugee populations. client engagement often involved providing practical help to improve access and utilization of the health center’s services. one participant explained, “the health center spends half a million dollars a year on what are called enabling services: interpretation and transportation.” while resettlement agencies meet many of the refugees’ concrete and immediate needs, the health centers tended to supplement these efforts with onsite assistance (e.g., a food pantry) and community referrals (e.g., english classes). a participant linked the provision of these services to their clients’ clinical presentation and goals. at this center, social workers helped refugees obtain work experiences to help individuals feel more competent. “whether volunteering or internships, it helps with mental health, gets people out of the house, helps get references, and maybe builds connections towards a job.” participants spoke about the complexity of work, and thus, the need for collaboration with other providers. one participant described, “these are very time-consuming cases, and so if that team—everybody who is touching the case—doesn’t have a forum to meet, then the case doesn’t work.” another participant noted that social workers often are particularly skillful at client engagement, which can be modeled for a physician if they are both present. she explained the benefit of an integrated model that paired a clinician with a primary care team, “very often the doctor will say, ‘oh, okay you go into room so and so.’ then that doctor doesn’t see what that mental health person does. it’s good for them to see what [the clinician] asks the person.” with effective client engagement, participants noticed that refugees knew they could turn to the health center for assistance. a participant described, “our friends and colleagues in the cambodian community said, ‘there’s a mental health crisis. would you go over and take a look?’” refugees likely know the needs of the community more quickly than the clinicians. when a rapport has been established, refugees could partner with the center to meet their needs. for example, one participant described: “most of our interpreters have approached us because they see the need that is in their own communities.” collaboration with interpreters the theme of engagement was often interwoven with the participants’ experiences with using interpreters in sessions with clients. most of the participants were english-speaking and required interpreter services when working with clients. health centers had different resources available for meeting this need, including bilingual staff who were trained as interpreters but also served other functions, part-time or per-diem professional medical interpreters, or telephone interpreters. some centers had a combination of these options, depending on the needed language, availability of interpreters, and cost. a participant explained that his administrators favored phone interpretation for cost-savings: “per-diem is expensive if there’s a no-show or for just a few hours. they have to have a certain number dubus & davis/culturally effective practice 879 of patients willing to be seen in order to justify a full-time interpreter.” participants believed how the interpretation services were offered affected the quality of their interactions with the clients. this participant expressed the conflict between what the community health center could provide, versus what she believed enhanced client/provider engagement, “i get that the phone is cheaper, but i wish we could choose an interpretation service based on what is most helpful to establishing trust.” the participants varied in how they perceived the experience of in-person versus telephonic interpretation. for some, telephonic interpretation services were efficient and convenient, and allowed them to provide services for clients who spoke nearly any language. they also felt that it made the client feel safer than working with an in-person interpreter. since many of the refugees fled due to internal conflicts, having someone from their culture and who lived in their current community, might feel unsafe, especially if the interpreter and client came from different sides of the conflict. one participant described, “we’ve found, most especially for our iraqi patients, that they don’t want an arabicspeaking face-to-face interpreter. they prefer telephonic because that feels more protective and private.” another participant echoed this concern and described that patients sometimes insist keeping matters within their family unit: some of the cultures are a very close-knit group and they don’t want this person to know their personal business, like our nepali interpreter knows a lot of our nepali patients, so they don’t want him to know their business. they want their family member [to interpret]. for participants who favored telephone interpretation, they encouraged a greater engagement between the provider and client without an interpreter present. in these discussions, the participants returned to issues regarding engagement of the client, and how the use of an interpreter enhanced or impeded engagement. one participant reported that many of his colleagues felt interpreters were “in the way,” and another wished that she could speak another language so as “not to have that third-party in the room.” others, however, experienced phone interpretation as a barrier to the therapeutic relationship because there can be difficulty hearing exactly what it being said, a lack of body language, and a lot of repetition. another participant described the impact on client and provider engagement of using phone interpretation: “you sit there and you’re really both looking at the phone, rather than interacting with each other. [the phone] is this plastic thing.” for the participants who preferred in-person interpretation, they believed the third person in the room enhanced engagement and made the visits go “smoother.” participants described several different roles that the interpreter played. oftentimes, the interpreter shared cultural similarities to the client, and thus provided a sense of comfort and trust. in this sense, the interpreter “becomes part of the treatment team.” all three parties— clinician, client, and interpreter—negotiate to find the most helpful balance between being a verbatim translator, a cultural broker, and a “clarifier when the terminology or jargon is too high.” one participant described the process she engages in to determine if the arrangement is working: “it’s always been a dialogue, and i always check in with the interpreter and the client to see what’s going on, if i need more clarification or if they need clarification.” another participant echoed that it is helpful for the client and interpreter to advances in social work, spring 2018, 18(3) 880 “develop a rapport between them.” sometimes as the client feels more comfortable a shift can happen, and the client can engage with the clinician as well as the interpreter. a participant described: oftentimes because of the work we’re doing, because of the trauma history, one of the shifts i’ll notice is when the client starts to trust you. in the beginning they would just talk to the interpreter, and the interpreter talks back to me, but it’s so cool to see that trust shifting, because then the person starts looking at me directly when they talk. it’s that moment i know that the trust is building because it’s awkward to talk to someone when they don’t understand what you’re saying, but that begins shift. in this sense, the interpreter appears to meet needs of the client and the clinician, and assists with effective client engagement. community health centers had difficulty finding qualified interpreters who also knew the community. health center employees who spoke multiple languages were tapped to add interpretation work to their existing jobs on an adhoc basis, although this could be an imposition, may or may not be compensated work, or create a dual relationship. the participants were aware of the burden this can be on a staff worker, as this quote demonstrates, our front staff worker often is asked to interpret on-the-fly. it means that when she is called to interpret, either we have no one at the front desk, or we have to pull someone else in. and, you know, she doesn’t get paid more for doing two jobs [interpreting and front desk].” another participant explained: one of our case managers does [interpretation], but again, our case manager is very much in the community and has functions as a case manager here. we rarely use her as an interpreter for anything, because that complicates her life trying to do her actual job in terms of what she knows about their psychosocial needs, like food and housing. cultural competence is an imperative but ill-defined while the participants reflected on the importance of engagement with the clients, and the challenges in using interpreters, these themes were parts of a larger theme: the need to be culturally competent yet with no clear definition or guidance on what constitutes cultural competence. the participants each expressed a need for cultural competence when working with refugees. in their assessments and interventions, participants found that some things were culturally unacceptable to inquire about, particularly mental health issues. a participant explained, “i did have one interpreter who said we don’t ask about coping [coping is not a concept in the culture]. i tried to figure out another way to ask the same question.” another participant noted that the hesitancy goes beyond privacy concerns: “sometimes people don’t feel comfortable talking [about mental health], even if they don’t know the interpreter.” participants also noted that health beliefs are culturally determined: you could explain to them simple diabetes stuff, and diabetes is non-existent in some parts of somalia. it’s a challenge trying to convince them that there is dubus & davis/culturally effective practice 881 treatment and medications for it, and people have lived with the disease 15, 20, 30 years, so [it seems like] nothing to worry about. cultural competence related to effective client engagement. knowing the cultural norms for cross-gender encounters helped one female participant navigate seating arrangements: i let the people choose whether they want to sit. if a male doesn’t feel comfortable being in here with me alone, i often have a male interpreter. there is one man i keep the door half-open with because he doesn’t feel comfortable being in here by himself. the community health centers worked with refugees from several countries and experienced little training or information on the clients’ needs, culture, or history. in addition, each client came to the center with multiple needs that reached beyond the services the centers could provide. this added stress to the participants who often felt ineffectual in bringing about changes the refugees needed most to feel less anxious and depressed: housing or work. services would be improved if there were more trainings, education, and preparation for working with each group of refugees. while the participants assumed most of the refugees experienced some form of trauma prior to arriving, there were few other common characteristics among the different refugee populations. participants stated that culture, language, and geographical differences made service delivery challenging as one approach was not universally effective. knowing more about the specific group would enable the providers to know what questions to ask, what to look for in assessing trauma, and to better engage. participants saw themselves as responsible for becoming culturally competent in their work with refugee clients, especially as the countries of origin were regularly changing. one participant described learning from missteps early on. for example, she described, “when we got a new population, we were just looking around for somebody in the community who spoke arabic, not realizing there’s going to be all these different cultural issues.” she learned from her clients and the interpreters in the community that the regional, ethnic, and religious differences needed to be considered in order to meet the clients’ needs. one participant described that she could not tailor her work to a particular cultural group because they work with so many different, ever-changing groups. “i tend to use the same approach with everyone. i use cognitive behavioral therapy with my clients. i don’t have the time to individualize, especially when we don’t even speak the same language.” while another participant believed that services needed to be targeted to each culture and felt limited by lack of time and training. we’re not familiar with any of our cultures. when i first came on board, i would spend an unbelievable amount of time before i met with a family researching that culture, but there’s so many cultures that we work with that it’s one of those things were i probably do less. some health centers had developed the cultural knowledge and skill set for working with a particular population, and while others had to constantly adapt to refugees from different countries of origin. advances in social work, spring 2018, 18(3) 882 sometimes, demonstrating cultural competence meant changing aspects of how the center managed services. for example, one center set up blocks of time during the week when clients could drop-in as needed. this was initiated when refugees from some countries had a difficult time understanding the concept of “appointment time”. instead of having repeated no-shows from these clients, the clinic changed their concept of appointment. providers aimed to engage refugee clients in a culturally effective manner, but at times encountered systemic issues that needed to be addressed for centers to be responsive and strategic with their limited funding. discussion this study examined the views of 15 social service providers from 15 community health centers that serve refugees. the participants discussed challenges in providing culturallyeffective care to a clientele that is ever-changing. the voices of the participants echo what many in community health centers and those who work with refugees know: the needs of this population are great, and the services few. community health centers and other agencies that serve refugees and forced migrants are required to be culturally adept, flexible in the services provided and even in the structure of their agencies. these findings also highlight the need for more support to providers of refugee services. there was a range of how each center described or demonstrated cultural competence. the range included, on one end, wall posters that presented ethnically diverse populations to, the other end, décor that reflected diverse cultures as well as bi-cultural staff, information posted in multiple languages, and in-person interpreters or bilingual staff. some participants stated that they took extra measures to learn about the history of the refugee population. these participants wanted to know why the individual or family had to flee, which camps they were in while waiting for resettlement, and what their cultural beliefs were about health and well-being. these differences in the participants’ understanding of cultural competence was also evident in the interventions the participants used. for some participants, they felt that most of the refugees experienced depression and/or anxiety and would benefit from cognitive behavioral therapy (cbt). for these participants, cbt was effective across cultural differences. those participants that believed culture differences affect the efficacy of an intervention, stated that they tried to understand the refugee’s cultural beliefs about the presenting symptoms. these participants might use cbt and mindfulness practice, as well as draw from the refugee’s own beliefs regarding healing and encourage the refugee to incorporate his/her own cultural remedies (i.e., coining, cupping). limitations of the study this study interviewed one primary provider in each of the 15 community health centers in this study. interviewing more staff at each center might provide additional information and alternate voices than those captured in this study. this study did not interview interpreters or clients. such interviews might offer important insights into how each member of the interventions (client, interpreter, social worker) experienced the quality and effectiveness of the services provided. the scope of this study was focused on the dubus & davis/culturally effective practice 883 providers. future studies should include recipients of refugee services. studies that examined the satisfaction the recipients of the services experienced alongside the providers’ perceptions of the effectiveness of the services might reveal interesting findings. in addition, the experiences and ability of multiple systems to provide culturally-effective services (providers, interpreters, governments, resettling agencies, communities) involved in providing for refugees should also be examined. through such studies, a larger understanding of the challenges, opportunities, and current barriers to providing culturallyeffective services can be examined through a multi-systems and dynamic perspective that acknowledges the complexity of this global crisis implications an important finding in this study is the acknowledged need by the participants that cultural competency is imperative to provide effective services, and the shared frustration among the respondents that that competency is difficult to define and harder to reach when working with multi-need clients from populations that are ever-changing. the participants from the 15 community health centers in this one region of the united states individually reported a similar challenge that service providers for refugees world-wide face: how to define cultural-competence and what do providers need to be competent. in this study, the participants focused on engagement as a critical component in cultural competency, and the use of interpreters as both a challenge and a conduit in developing engagement. there are a number of on-going multi-system factors that complicate service provision to refugees. community health centers and other agencies charged with providing services to refugees are often under-resourced and expected to be prepared with little to no advance notice or training. the global refugee crisis we face shows no signs of lessening. agencies are asked to meet the needs of an ever-changing demographic without the resources, training, and combined applied knowledge that each center/agency requires. current and future political conflicts and the increasing climate changes point toward a chronic refugee crisis. social workers will continue to be called on to serve individuals and families who are forced to flee their homelands. it is imperative that social workers are prepared to meet this demand. being prepared means better coordination of the involved systems (involved governments, resettlement agencies, communities), and embracing the practice of cultural competence within health and behavioral health teams. we do not need to acquire these skills in isolation from other agencies who provide for refugees. sharing of experiences, such as in this study, can enhance our understanding of culturally-effective practice, and lessen the burden of learning new practices each time the population changes. it is hoped that this study widens the literature and that future studies will seek answers to questions such as: how does a profession learn to 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(2008). making refugees: a historical discourse analysis of the construction of the 'refugee' in us social work, 1900-1957. british journal of social work, 38(4), 771-787. doi: https://doi.org/10.1093/bjsw/bcn015 author note: address correspondence to: nicole dubus, phd, msw, school of social work, san jose state university, one washington square, san jose, ca 95192, nicole.dubus@sjsu.edu https://doi.org/10.1503/cmaj.109-5288 https://doi.org/10.1503/cmaj.109-5288 https://doi.org/10.1186/s13033-016-0044-z https://doi.org/10.1080/15313200802467908 https://www.nhpf.org/library/background-papers/bp_chc_08-31-04.pdf http://www.unhcr.org/en-us/figures-at-a-glance.html https://doi.org/10.1177/0886109905274546 https://doi.org/10.1023/a:1017533214935 https://doi.org/10.1093/bjsw/bcn015 mailto:nicole.dubus@sjsu.edu this work is licensed under a creative commons attribution 4.0 international license. child attributions mediate relationships between violence exposure and trauma symptomatology kathryn s. collins pamela a. clarkson freeman george jay unick melissa h. bellin polly reinicker frederick h. strieder abstract: violence and trauma exposure have been increasingly investigated as contributing to a range of negative outcomes in child physical, cognitive, emotional, social, and psychological functioning, particularly among youth who are racial/ethnic minorities. this study presents findings related to children's attributions of their violence and trauma exposure. attributions are inferences made about the cause of an event, situation, or action, with internal, stable, and global attributions most likely to lead to negative psychological outcomes. data were drawn from an on-going clinical intervention study with families at risk for child maltreatment and/or neglect residing in a large metropolitan city on the east coast. mediation models provide evidence for a mediated relationship between violence exposure and ptsd through child attribution. children develop their definitions of violence, formulate reasons why the violence occurs, and react to violence based on interpreting and developing cognitive attributions and schema about their experiences with violence in order to adaptively cope. keywords: attributions; trauma; violence; ptsd; child therapy violence and trauma exposure continues to be an alarming public health concern and contributes to a wide range of negative outcomes for children. violence and trauma exposure includes being a direct victim to, witnessing, or hearing about an actual or perceived threat of death, sexual violence, or injury (american psychiatric association [apa], 2013) as well as includes child neglect and abuse, community and family/intimate partner violence, natural and manmade disasters, accidents, and hospitalizations (ghoshippen et al., 2002). the majority of children living in the united states will be exposed to violence directly (e.g., direct victim of violence, abuse, or trauma) or indirectly (e.g., witnessing or hearing about violent events from family or peers) at some point during their childhood, and recent data suggest nearly 60% of children were violence exposed in the previous 12-month period (finkelhor, turner, shattuck, hamby, & kracke, 2015). research also suggests that children are more likely than adults to be exposed to violence at home, at school, or in the community (finkelhor, turner, ormrod, hamby, & kracke, 2009). further, children from low-income urban neighborhoods are disproportionately ______________________ kathryn s. collins, msw, phd is an associate professor and co-pi of the center for family informed trauma treatment at the university of maryland school of social work. pamela a. clarkson freeman, phd, msw, is a research assistant professor, school of social work, university of maryland. george jay unick, ma, msw, phd. is an associate professor, school of social work, university of maryland. melissa h. bellin, phd is an associate professor at the university of maryland school of social work, polly reinicker, msw, is a research assistant at the university of maryland school of social work, frederick h. strieder, phd, mssa, is clinical associate professor, school of social work, university of maryland, baltimore md 21201. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 284-299, doi: 10.18060/21283 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 285 impacted since they are more likely to experience continuous exposure to traumatic events and violence in their home and community environment. impact of violence and trauma on children exposure to violence can negatively impact and erode a child's physical, emotional, social, and psychological functioning. violence exposure has been associated with numerous health risks including obesity, asthma, liver disease, heart disease and chronic obstructive pulmonary disease (alves, santos, feitosa, & barreto, 2012; centers for disease control (cdc), 2014; mitchell et al., 2013; sternthal, jun, earls, & wright, 2010). the adverse childhood experience (ace) study assessed over 17,000 participants to examine the long-term effects of violence and trauma on biological, social, and psychological outcomes (cdc, 2014). the disturbing results suggest exposure to adverse childhood experiences often leads to depression, suicide attempts, alcohol abuse, sexual risk behaviors, illegal drug use, and unintended and early pregnancies (cdc, 2014). other social effects of child exposure to trauma and violence include behavior problems in school, aggressive or criminal behavior, and setbacks in academic achievement (busby, lambert, & ialongo, 2013; kliewer & sullivan, 2008; salzinger, feldman, rosario, & ngmak, 2010). children exposed to violence and trauma are also at increased risk for post-traumatic stress disorder (ptsd) which includes symptoms of unwanted, intrusive memories, avoidance of places, activities or talking about the event, emotional numbness and irritability, inability to maintain close relationships, guilt or shame, and inability to sleep or concentrate (american psychological association, 2017). elevated rates of externalizing problems (anger, aggression and violence) and internalizing problems (anxiety, depression, and intrusive thoughts) are likewise found in youth who are exposed (kelly, 2010; salzinger et al., 2010). the deleterious impact of violence exposure on psychological symptoms is particularly pronounced among youth who are impoverished and are racial/ethnic minorities (andrews et al., 2015). risk and protective factors associated with trauma outcomes while exposure to violence and victimization has the potential to cause harmful consequences, there are a variety of risk and protective factors that influence the effect of trauma on the individual child. polyvictimization, which is the simultaneous exposure to violence across several domains (e.g., school, home, community), elevates risk for more severe child outcomes (cyr, clement, & chamberland, 2014; finkelhor, turner, hamby, & ormrod, 2011). individual characteristics, such as the developmental and psychological levels of family processes (i.e. parent-child interactions), and the broader social context made up of neighborhoods, community resources, and social support are all proposed to shape a child’s response to trauma (belsky, 1993). specific protective factors that seem to ameliorate the impact of violence and trauma exposure include child perceived safety, social and family support, family cohesion and stability, and ability to discuss the violent event in a safe space (gorman-smith, henry, & tolan, 2004; ozer & weinstein, 2004). collins et al./child attibutions 286 the role of attributions in trauma response the role of attributions that the child makes about the traumatic or violent experience is a fertile area of study in trauma science (cohen & mannarino, 2002; collins, koeske, russell & michalopoulos, 2013). attribution theory suggests that the reason a child gives to the occurrence of a violent event or traumatic experience will impact his or her ability to cope with the event (heider, 1958). attributions are often characterized by the locus of control (internalizing versus externalizing), stability, and globality of the events. internalizing attributions occur when people blame themselves for causing the event to happen, while externalizing attributions claim that the event was caused by factors outside of oneself (kelley, 1973). stability refers to whether the person views the cause of the event as constant or variable over time; such as saying that the event is inevitable (constant), versus attributing the cause of the event to be unstable (variable; abramson, seligman, & teasdale, 1978). globality describes whether or not the event is generalizable to other aspects of life, or attributed to specific causes. a global explanation a person might make is "i am a bad person and nothing good will ever happen to me." the majority of the literature on attributions posits that internal, stable, and global attributions are most likely to lead to negative psychological outcomes regardless of trauma type (deblinger & runyon, 2005; knight & sullivan, 2006; wenninger & ehlers, 1998). existing research suggests child attributions exert a significant influence on subsequent trauma symptomology (collins et al., 2013; knight & sullivan, 2006; wenninger & ehlers, 1998; zinzow & jackson, 2009). both collins et al. (2013) and knight and sullivan (2006) found that children who are low-income living in urban environments have higher levels of trauma symptomology and also report negative attributions such as self-blame, feeling different from peers, lack of trust in others, and lack of credibility. similarly, adolescents who had negative threat appraisals (i.e. concerns about harm to others, harm to self, selfblame for violent events were more likely to report internalizing problems such as depression and anxiety (collins et al, 2010; kliewer & sullivan, 2008). present study the current study aimed to delineate the role of children’s attributions of trauma on trauma symptomatology using a sample of children from a clinical intervention research protocol. our main hypothesis is that both children’s direct exposure (de) and indirect exposure (ie) traumas and ptsd would be mediated by the children’s attributions. however, consistent with the literature on negative attributions, we further hypothesized that the relationship between exposure to de traumas and ptsd would be more strongly mediated by the attribution constructs compared with the ie traumas. additionally, we expected each of the four attribution constructs (i.e., feeling different from peers due to their exposure, lack of perceived credibility [being believed] about their experience, lack of trust in others, and self-blame for the negative events or violence that occurred) to moderate the relationship between traumatic experiences and ptsd symptomatology. advances in social work, spring 2017, 18(1) 287 methods data for the current study were drawn from families who are residing in extreme poverty and at risk for child maltreatment and/or neglect residing in a large metropolitan city on the east coast who were referred for treatment and services because they were having difficulty meeting the basic needs of their families. to be eligible for services, families must have at least one child between the ages of 5 and 11 years old, and have.at least two child, family and/or caregiver risk conditions and one risk factor for child maltreatment or neglect. at the time of referral, families could not be involved in the child protection system, and the child had to reside with the custodial caregivers/guardians. families are eligible for specialized trauma services if they have clinically significant scores on standardized measures for trauma symptomatology for caregiver and/or child. this includes caregivers with post-traumatic checklist-civilian (pcl-c; weathers, litz, herman, huska, & keane, 1993) scores greater than or equal to 50, children with ucla ptsd index scores greater than or equal to 25, or children who met criterion a (exposure to a traumatic event in which they felt threatened and responded with intense fear, helplessness, or horror) and any combination of criterions b (intrusive recollection), c (avoidance/numbing), or d (hyper-arousal) on the ucla ptsd index (e.g., criterion b and c, c and d, b and d)(ruggiero, ben, scotti, & rabalais, 2003). participants must also sign an informed consent and child assent to participate in the study. sample a total of 259 out of 389 children screened for the trauma services program were deemed eligible (figure 1). eight families refused study participation resulting in a baseline sample of 251 families. due to the decline in children with complete data (130/251), attrition analyses were conducted to examine systematic patterns of missingness. independent-samples t-tests were conducted to determine any systematic patterns of missingness comparing the full sample of eligible children to the analytic sample. children with missing data were slightly younger, t(189) = 2.14, p < .05), and had higher average scores on two of the caps subscales: feeling different from peers, t(147) = -4.34, p < .01; and lack of trust, t(146) = -2.85, p < .01) (please see discussion on the caps instrument below). there were no other significant differences in socio-demographic characteristics or study constructs between the children with complete data versus those who were removed from the sample due to incomplete data. collins et al./child attibutions 288 figure 1. ta-fc data collection diagram demographic characteristics for the current sample are provided in table 1. the sample was comprised of 54% males and 46% female. on average, children were 8.35 years (sd = 2.12), and the majority of children were african american/black (92.31%, n = 120). table 1. child demographic characteristics n % gender male 70 53.85 female 60 46.15 race african american/black 120 92.31 caucasian/white 6 4.62 mixed race 4 3.08 m sd child age (± sd; in months) 8.35 2.12 instruments children's attributions and perceptions scale (caps). the caps was created by mannarino, cohen, and berman (1994) to assess children's attributions and interpretations after exposure to sexual abuse but is valid for use in children who have not experienced abuse. the scale contains four subscales which include eighteen total items. the four children screened (n = 389) declined family declined ta-fc (n=8) children enrolled in ta-fc (n = 251) missing data incomplete study measures (n=65) caregiver unavailable (n=49) child not available (n=5) early termination from ta-fc (n=2) children eligible (n = 259) ineligible not of age (n=98) developmentally not appropriate (n=21) child no longer in home (n=5) active cps report (n=1) family relocated (n=5) children with complete data (n = 130) advances in social work, spring 2017, 18(1) 289 subscales measure "feeling different from peers, self blame for violence and negative events, perceived lack of credibility, and lack of interpersonal trust in others" (mannarino et al., 1994, p. 206). internal consistencies range from = .65 to = .73 for the various subscales (mannarino et al., 1994; current study  = .53 to  = .85). children are given the scale in an interview format, and are asked to respond based on a likert scale from 1 (never) to 5 (always). ucla ptsd symptom scale – child/adolescent version. the ucla ptsd symptom scale is taken from the ucla ptsd reaction index developed based off of the criteria for ptsd in the dsm-iv-tr (pynoos, rodriguez, steinberg, stuber, & frederick, 1998). the symptom scale is comprised of 22 items that investigate reactions and feelings to a trauma that have occurred. participants are asked to only evaluate their symptoms within the past month, and in the case of multiple traumas, are asked to evaluate their most severe or disturbing trauma. the frequency of symptoms is measured on a rating scale from 0 (none of the time) to 4 (most of the time). the ptsd reaction index has high internal consistency (= 90; steinberg & vivrette, 2013; current study  = .86) and high test-retest reliability (.84; steinberg et al., 2013). traumatic events screening inventory (tesi-c). the 16-item tesi-c is used to screen for a child’s history of exposure to potentially traumatic events. the instrument assesses whether the event was perceived as potentially life threatening and/or a risk for severe injury, and includes three probes that elicit the child’s appraisal of the event. the tesi-c includes violent and/or potentially traumatic events towards both self and others, such as community and family/intimate partner violence, disasters, physical and sexual abuse, accidents, hospitalizations, and injuries (ghosh-ippen et al., 2002). the 16 items are broken into four groups of traumas: being sick or injured in an accident, being directly exposed to violence, witnessing domestic violence, and witnessing community violence. for this study we use only 11 of the 16 items to construct our two subscales: direct exposure (de) if the trauma exposure was the result of being directly exposed to violence; or indirect exposure (ie) if they were the result of witnessing domestic violence or community violence. the de subscale is comprised of five items such as “has someone ever told you they were going to hurt you really badly, or acted like they were going to hurt you really badly?” ie is comprised of six items such as “even if they weren't physically attacking each other, have you ever heard people in your family really yelling and screaming at each other a lot?” data analysis means, standard deviations, frequencies and percentages were calculated for the ucla ptsd symptoms scale, the four caps subscales, the overall tesi, and two interpersonal violence subscales (see table 2). the main analytic approach was a set of moderation models, followed by mediation models, quantifying the role that the four caps attribution subscales have on the relationship between trauma exposure (e.g., de and ie) and ptsd symptoms. collins et al./child attibutions 290 table 2. summary of means and standard deviations for measures m sd min max ucla ptsd overall score 28.0 19.83 0.0 83.0 caps feeling different from peers due to their exposure subscale 8.73 4.06 0.0 20.0 caps self blame for negative events or violence that occurred subscale 7.28 3.66 0.0 18.0 caps lack of perceived credibility subscale 13.47 4.60 0.0 25.0 caps lack of trust in others subscale 12.01 5.26 0.0 25.0 tesi scale – total traumatic events 4.50 3.60 0.0 15.0 direct exposure subscale 1.04 1.27 0.0 5 indirect exposure subscale 3.12 3.12 0.0 9 the moderation models test for the effect that attribution has on changing the direction or strength of the relationship between the trauma and ptsd. moderation is tested by interacting the attribution subscale with trauma exposure. we estimated eight moderation models (four for de traumas and four for ie traumas) using stata 14.1. the dependent variable for all eight moderation models was the ucla ptsd symptom scale and all models adjusted for the age of the child. we estimated models for each of the four caps subscales, either de and ie, and an interaction term of between attribution and trauma exposure as the key moderation variables. we also adjusted models for family clustering using cluster adjusted standard errors. the regression models also serve as tests of main effects between trauma exposure and attribution with the dependent ptsd variable. in contrast to moderation, mediation models test whether the mediating variable (e.g., attribution) accounts for the relationship between the independent variable (e.g., trauma exposure) and dependent variable (e.g., ptsd). for the mediation analysis we used stata 14.1 and the package sgmediation, which performs the regression calculations and conducts a sobel-goodman test of the mediator, and then used bootstrap estimation to calculate confidence intervals for the standard errors (preacher & hayes, 2004). as with the moderation analysis, we estimated eight mediation models; each of the four subscales of the caps instrument were tested separately with the two different independent variables (de and ie) and adjustments for child age and within family clustering. for each of the models the ucla total ptsd scale score was used as the dependent variable. we also tested models that included sex and ethnicity, but they had no effect on either the moderation or mediation model coefficients (model results available on request). the stata user written command sgmediation uses three regression models to estimate the indirect and direct effects between the independent variable, the mediating variable and the dependent variable (see figure 2). in the case of this analysis the first regression model estimated the association of the violence exposure (direct or indirect) with the ucla ptsd scale (path c in figure 2). the second model estimated the association of the de or ie variables with one of the four attribution scales (path a in figure 2). the final regression model estimated the association of both the attribution scales and the violence exposure scales with the ptsd scale (path b and c from figure 2). the program then estimates the joint effect of paths a and b, which is the indirect mediation effect, and the path c or direct effect of violence exposure on ptsd. we then used bootstrap resampling procedures to advances in social work, spring 2017, 18(1) 291 get a more robust estimate of the standard errors of the direct path (c path) and the (a and b) indirect paths. the use of the empirical bootstrap approach is particularly important for the indirect path, since it is not clear what the appropriate distribution for the joint a*b coefficient is. figure 2. attribution mediating the relationship between de and ptsd results descriptive data for our measures are provided in table 2, including means, standard deviations, and ranges. overall raw scores on the ucla ptsd can range from zero to 88. the average ptsd overall score was 28.0, sd = 19.83, and there was a large range in symptomatology, with scores ranging from 0.0 to 83.0. the caps feeling different from peers due to their exposure subscale consists of 4 items, and scores can range from four to 20. the average score for the youth in our sample was 8.73, sd = 4.06, and a wide range of scores was reported. the self blame for negative events or violence that occurred subscale also consists of four items. the average score for our sample was 7.28, sd = 3.66, with a range of scores from 4.0 to 18.0. the lack of perceived credibility subscale includes five items, and scores can range from four to 25. the average score of our sample was 13.47, sd = 4.6, with a full range of scores from four to 25. lastly, the lack of trust in others subscale contains five items. the average score for our sample was 12.01 (sd = 5.26), with a range of scores from five to 25. these averages are consistent with youth who have experienced trauma (mannarino et al., 1994). on average, children reported being exposed to 4.5 different traumatic events, sd = 3.6, with the number of exposures ranging from zero to 15 exposures. table 3 relays the results from eight moderation models that test the association between de and ie, four attribution subscales, and ptsd as the dependent variables. the test for moderation effects is the interaction between the exposure to violence (de and ie) and child attribution on child ptsd symptomotology. we did not find any evidence for an attribution moderated relationship between the effect of trauma (e.g., de or ie) and ptsd in this sample of minority children who are low-income. further, there is little evidence of collins et al./child attibutions 292 a main effect relationship between exposure to trauma and ptsd and there is wide variation in the coefficients for violence exposure variables association with ptsd depending on which of the four attribution subscales were included. this wide variation in the violence exposure coefficients on ptsd and their wide confidence intervals suggests that after adjusting for children’s attribution scores, there is little evidence for a main effect of exposure to violence to independently predict ptsd scores. the adjusted r2 value suggests that the combination of violence exposure variables, attribution variables and child age account for a relatively large 30% of the variance in ptsd. table 3. moderation models of attribution and violence exposure on ptsd attribution and de on ptsd (ucla) coefficient se t p-value 95% ci r2 de 6.84 13.89 0.49 0.62 -20.83 34.50 0.26 feel different 1.61 0.40 4.07 <.001 0.82 2.39 interaction (de by different) 0.25 1.09 0.23 0.82 -1.91 2.41 child age 1.12 0.59 1.88 0.06 -0.06 2.30 intercept 4.84 6.65 0.73 0.47 -8.41 18.08 de 1.95 12.83 0.15 0.88 -23.59 27.49 0.28 self blame 1.90 0.53 3.59 <.001 0.84 2.95 interaction (de by self blame) 0.36 1.19 0.30 0.76 -2.01 2.73 child age 1.16 0.57 2.05 0.04 0.03 2.28 intercept 5.66 6.25 0.90 0.37 -6.80 18.11 de -9.06 14.02 -0.65 0.52 -36.97 18.85 0.31 lack credibility 1.33 0.40 3.30 <.001 0.53 2.14 interaction (de by credibility) 1.21 0.90 1.35 0.18 -0.58 3.01 child age 0.89 0.55 1.62 0.11 -0.21 1.98 intercept 2.97 7.94 0.37 0.71 -12.83 18.77 de -4.81 12.52 -0.38 0.70 -29.75 20.13 0.32 lack trust 1.15 0.32 3.59 <.001 0.51 1.78 interaction (de by trust) 1.12 0.77 1.45 0.15 -0.42 2.66 child age 0.92 0.49 1.87 0.07 -0.06 1.91 intercept 6.64 6.34 1.05 0.30 -5.99 19.27 attribution and ie on ptsd (ucla) coefficient se t p-value 95% ci r2 ie 5.03 8.88 0.57 0.57 -12.65 22.72 0.29 feeling different from peers 1.33 0.60 2.22 0.03 0.14 2.52 interaction (other by different) 0.61 0.88 0.69 0.49 -1.15 2.36 child age 0.70 0.65 1.08 0.28 -0.59 1.99 intercept 7.25 7.00 1.04 0.30 -6.69 21.19 ie 23.25 8.06 2.89 0.01 7.21 39.30 0.32 self blame 3.17 0.87 3.63 <.001 1.43 4.91 interaction (ie by self blame) -1.98 1.09 -1.81 0.07 -4.16 0.20 child age 0.58 0.63 0.92 0.36 -0.68 1.84 intercept -1.49 7.85 -0.19 0.85 -17.13 14.15 ie 6.68 11.94 0.56 0.58 -17.09 30.45 0.32 lack credibility 1.42 0.68 2.08 0.04 0.06 2.78 interaction (ie by credibility) 0.29 0.90 0.33 0.74 -1.49 2.08 child age 0.53 0.58 0.92 0.36 -0.62 1.69 intercept 1.06 9.36 0.11 0.91 -17.59 19.70 ie 17.88 8.68 2.06 0.04 0.60 35.16 0.32 lack trust 1.77 0.53 3.33 <.001 0.71 2.82 interaction (ie by trust) -0.69 0.74 -0.94 0.35 -2.16 0.77 child age 0.33 0.54 0.62 0.54 -0.74 1.40 intercept 1.73 6.64 0.26 0.79 -11.50 14.96 note. de = direct exposure to violence; ie = indirect exposure to violence. significant values are in bold. advances in social work, spring 2017, 18(1) 293 table 4 shows the results from the eight mediation models. in general, these models provide evidence for a mediated relationship between violence exposure and ptsd through child attribution. for each of the violence exposure variables (de and ie) three of the four subscales of the caps had a statistically significant mediating effect on ptsd with only children’s lack of trust in others not being significant at the p < 0.05 level. figure 2 presents the first regression displayed in table 4. the indirect path though the mediator (children feeling different from their peers) accounts for 43.10% of the total variance in the relationship between de and ptsd. these findings of a mediated relationship, provide support for the hypothesis that children’s attributions about their violence and trauma exposure impact their risk of developing ptsd. table 4. indirect and direct mediation effects ie (se) z-score p-value de (se) z-score p-value % mediated de to violence regressed on ptsd (ucla) feel different from peers 7.12 2.62 2.72 0.007 9.40 4.87 1.93 0.053 43.10% self blame 11.17 3.12 3.58 <0.001 5.34 5.21 1.03 0.305 67.65% lack credibility 6.98 2.83 2.47 0.014 9.53 4.68 2.03 0.042 42.29% lack trust in others 5.52 2.96 1.86 0.062 11.00 4.84 2.27 0.023 33.41% ie to violence regressed on ptsd (ucla) feel different from peers 5.04 2.08 2.09 0.016 10.50 3.60 2.91 0.004 32.44% self blame 5.84 2.10 2.23 0.009 9.70 3.70 2.62 0.009 37.57% lack credibility 4.92 1.98 2.18 0.024 10.62 3.05 3.48 0.001 31.66% lack trust in others 5.71 2.38 2.32 0.014 9.83 3.42 2.87 0.004 36.74% as a further check on our hypothesis we believed that de to violence and trauma would be more strongly mediated by attributions than children’s ie. for three of the four caps subscales the relationship between the de variable had a higher percent of total effect for a given the caps subscale, i.e. the mediating variables. only children’s lack of trust in others had a stronger mediating effect on ie variable compared with the de variable (33.41% vs 36.74%, respectively). this provides some confirmatory evidence that the identified mediated relationship is consistent with the literature on risk of developing ptsd associated with internalizing and externalizing attributions. discussion and practice implications as indicated in the core curriculum on childhood trauma (national child traumatic stress network [nctsn], 2012), traumatic experiences are inherently complex. children, adolescents and their families who are exposed to trauma experience subjective reactions to traumatic events that include changes in feelings, thoughts, and physiological responses, identity, relationship changes, and concerns for the safety of others. through the range of experiences and attributions expressed by the children in both the de and ie groups, we noted differences in exposures and the impact on ptsd. garbarino (1995) stated that the most crucial feature of child development is the child's emerging capacity to form and maintain social maps. he suggested that social maps represent the world, reflect the simple cognitive competence of the child, and indicate the child's affective inclinations. children's social maps include experiences in the larger environment in counterpoint with the child's collins et al./child attibutions 294 inner life, both rational cognitive forces and the unconscious impetus. in our study, the social and internal maps of the children included feeling different from their peers because of their exposure, not being believed when they told their stories of exposure, having a great amount of self blame for violence and victimization as well as not trusting others in their environments. our supported hypothesis that attributions mediate the relationship between exposure and ptsd at a great degree suggests the importance of continuing to create specific therapeutic strategies and tools aimed to help children learn about the impact of violence and trauma exposure via psychoeducation. further, practitioners may consider methods to help the children deconstruct and rebuild the meanings they make about their experiences to challenge negative attributions, such as self blame. as practitioners work with children and families affected by trauma, briere and scott (2006) suggest the following areas as a focusing psychoeducation on types of violence and trauma, myths associated with trauma including “blaming the victim”, long and short term reactions to exposure and developing safety plans. each of these areas may provide the children in both the de and ie groups with accurate information to lessen the burden of exposure and begin reframing attributions. based on the data garnered from the children in this study and the research literature on the development of children’s cognitive schema, our present study indicates that there are associations between levels of violence and trauma exposure and children’s attributions. children from the de group expressed higher levels of problematic attributions about their exposure than the ie group. however, one cannot overlook that both groups were similar in their patterns of attributions as well as had the outcome of developing ptsd. children in this study constructed their personal realities based on a learning process of being active participants in their environment. this is evidenced through the extent of specificity of children's attributions as they had higher frequencies and degrees of violence exposure. simpson (1996) stated, "perceptions of safety and danger are 'intersubjective' products of social construction, collective agreement, and socialization" (p. 549). this suggests that although objective danger and violence exist, perceptions do not derive directly from observation of the empirical world. instead, the objective environment provides only discrepant and ambiguous information about danger and violence, providing room for socially constructed beliefs. narrative therapy is one approach that may be beneficial to help children make meaning out their traumatic experiences and their social and emotional environments. this postmodernist approach is grounded in the concept that people’s socially constructed interpretations of their life experiences and the meanings linked to these interpretations shape subsequent experiences. the goal is to help children reauthor and re-produce their life script, also known as a conversational map, according to alternative stories of identity. for example, a child with a history of repeated victimization might be encouraged to transform her life story, through telling and retelling, to one that emphasized themes of survivorship (white & epston, 1990). duvall and beres (2007) emphasizes, “through the therapeutic conversation, this map provides a structure for therapists to introduce scaffolding to the person’s story, helping him or her to move from the despair inherent in the knowable and taken-for-granted dominant story to the hope that is inherent in what is possible to know in the emergent alternate story” (p. 235). advances in social work, spring 2017, 18(1) 295 limitations our study had limitations. our data were collected at intake for services from families struggling to meet the basic needs of their children in one area of a large metropolitan city on the east coast. the data, while providing informative results do not represent the general population. our sample was also nearly 100 percent african american and not representative of other races or ethnicities. we did not analyze data from parents or teachers related to child outcomes and solely relied on the child’s self report of their exposure, attributions and trauma symptomatology. gaining information from a broader population with the inclusion of differing ages of children, parents, extended family members, teachers, and clergy, would be helpful contributions to the literature. we were concerned about the low alphas on a few of the subscales of the caps. we conducted a factor analysis that replicated the four factors of the developers to aid in establishing validity. yet, the study would have benefited from a psychometrically stronger attribution measure. finally, it is important to continue to use quantitative and qualitative research to study the mediators and moderators that promote and deter children’s health and well-being as they are exposed to violence. conclusion overall, children in our society live, play, learn, and grow in a world where violence is pervasive. children develop their definitions of violence, formulate reasons why the 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(2009). attributions for different types of traumatic events and post-traumatic stress among women. journal of aggression, maltreatment & trauma, 18(5), 499-515. doi: https://doi.org/10.1080/10926770903051025 author note: address correspondence to: kathryn collins, department of social work, university of maryland, 525 west redwood street, baltimore, md 21201, 410-706-0814, kcollins@ssw.umaryland.edu https://doi.org/10.1023/a:1024451103931 https://doi.org/10.1080/10926770903051025 mailto:kcollins@ssw.umaryland.edu _________ eun koh, phd, msw, is an associate professor in the national catholic school of social service at the catholic university of america, washington, dc. allysa ware, msw, lgsw, is a doctoral student in the national catholic school of social service at the catholic university of america, washington, dc. eunju lee, phd, ma, is an associate professor in the school of social welfare at the university at albany, albany, ny. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 77-99, doi: 10.18060/23942 this work is licensed under a creative commons attribution 4.0 international license. state implementation of the fostering connections to success and increasing adoptions act: exploratory study on kinship care eun koh allysa ware eunju lee abstract: fostering connections to success and increasing adoptions act of 2008 (fc act) has been in place for over 10 years. however, children in kinship care continue to receive fewer benefits, supports, and access to resources due to challenges with fully integrating kinship care into the child welfare system. the current study explored the state implementation of the fc act with a focus on kinship care. representatives from 15 states across the u.s. completed an online survey focused on their state’s response to the fc act, and 14 participated in a follow-up survey on their states’ plan for kinship navigator programs with the passage of the family first prevention services act of 2018 (ffpsa). the findings show that the most common change after the fc act was observed in the act’s mandatory requirement to identify and search for kinship caregivers. states were less likely to implement non-mandated services or programs despite their potential benefits. in response to the ffpsa, states were looking for opportunities to learn from other states implementing kinship navigator programs. more support and oversight from the federal government are needed to promote successful policy implementation at the state level. in addition, social work practitioners need to be aware of programs and legislation on kinship care in order to advocate for and ensure the well-being of children and caregivers who provide kinship care. key words: kinship care; child welfare; social policy; policy implementation kinship care refers to full-time care of children by grandparents, other relatives, and family friends (child welfare information gateway [cwig], 2016). the availability of relatives or kin as caregivers is critical to the welfare of vulnerable children when parents cannot care for them. in the united states (u.s.), kinship care is the preferred out-of-home care option for children who must be separated from their parents due to maltreatment, parent inability, or other reasons, because it allows children to maintain family ties and thus experience less disruption in their lives (annie e. casey foundation [aecf], 2012; geen, 2004; rubin et al., 2017). prior studies reported positive outcomes for children in kinship foster care, particularly in the domains of placement stability and developmental outcomes, compared to those in non-kin foster care (bell & romano, 2017; winokur et al., 2014). according to the annie e. casey foundation (aecf) kids count (2018) report, there were approximately 2.7 million children in kinship care in the u.s. in 2018. children enter kinship care either through informal arrangements based on an agreement among family members or through an arrangement facilitated by the public child welfare system (cwig, 2016). when the public child welfare system is involved, children can be placed with about:blank advances in social work, spring 2021, 21(1) 78 family members on a voluntary or informal basis preventing their entry into foster care. alternatively, children can be formally placed with kin as a foster care placement with the state retaining legal custody (malm et al., 2019). it is estimated that approximately half of children in need of an out-of-home placement after maltreatment investigation are placed in kinship care outside of the public child welfare or foster care system (malm et al., 2019; walsh, 2013). of the 437,283 children who entered foster care in 2018, nearly one-third (32%) were placed in kinship foster homes (cwig, 2020). children in kinship and nonkinship foster homes were reported to be similar in their length of stay in foster care and the likelihood of reunification (winokur et al., 2018). recognizing the increased prevalence and benefits of kinship care, federal legislation in the u.s. has evolved to encourage and support kinship care as a viable out-of-home care option. two major federal laws impacting foster care, the fostering connections to success and increasing adoptions act (fc act, 2008) and the family first prevention services act (ffpsa or family first act, 2018), include several provisions on kinship care. one of the fc act’s goals is to “connect and support relative caregivers” with provisions on identifying and notifying a child’s relatives and kinship navigator programs that connect kinship caregivers to programs and services (cwig, 2019a, p. 13). similarly, the ffpsa, which emphasizes prevention services for children and families at risk of entering out-of-home care, offers additional federal funds for kinship navigator programs (cwig, 2019a; national conference of state legislatures, 2020). despite these provisions, there is a limited understanding of how states have responded to the fc act in promoting kinship care over the last decade (u.s. government accountability office report [gao], 2014), while prior studies reported states’ challenges in implementing the act (perfect et al., 2013; u.s. gao, 2020). this lack of knowledge presents a significant challenge in understanding how states will improve their kinship care practice in response to the ffpsa. the current study explored states’ implementation of the fc act and its implications for the ffpsa. evolution of kinship care and related policies kinship care and child welfare kinship care has long been a part of society and is widely practiced in many countries, including the u.s. kinship care has been primarily informal, meaning that the child was voluntarily placed with a family member by the parent, often to keep the child out of foster care (walsh, 2013). over the last decades, public child welfare systems began incorporating more relative caregivers, resulting in the establishment of kinship foster care (aecf, 2012; geen, 2004). however, incorporating kinship care as part of public child welfare systems has been uneven across the states (aecf, 2012; testa, 2017). the recognition of kinship care in child welfare policies and legislation has evolved. despite the supreme court ruling in miller v. youakim (1979) that licensed relative foster parents should receive the same payment amounts as non-relative foster parents, the 1980 landmark adoption assistance and child welfare act failed to explicitly promote kinship care as an option for children entering the child welfare system (beltran & epstein, 2013; koh et al./state implementation of fostering connections 79 geen, 2004). however, since the late 1980s, kinship foster care's rapid growth was observed primarily due to the lack of available non-relative foster homes (berrick et al., 1994). recognizing the child welfare systems’ increasing reliance on kin for out-of-home placements, the 1996 personal responsibility and work opportunity reconciliation act (prwora) required that states give preference to relatives over non-relatives when determining an out-of-home placement (u.s. department of health and human services [dhhs], 2000). under the prwora, relative caregivers must meet state safety guidelines in order for a child to be formally placed in their home. in 1997, the adoption and safe families act (asfa) was passed, which solidified the requirement that states place children with relatives upon the relative passing a background check (geen, 2004). the asfa, however, allowed states to waive non-safety standards for relative caregivers but required that states have the same licensing requirements for kinship foster homes and nonkinship foster homes (geen, 2004; jantz et al., 2002). despite significant policy changes, little agreement still exists as to who should bear the costs for kinship care (nelson et al., 2010; testa, 2017). society’s view of family responsibility and fiscal concerns further complicate this debate. as a result, wide variations are observed across the states in their service provision and payments for kinship foster caregivers (geen, 2004; testa, 2013). the complicated evolution of kinship care is further reflected in the different types of kinship care. types of kinship care while there is no consensus on types of kinship care, testa (2013, 2017) offered a conceptual framework that would explain different types of kinship care (i.e., private, voluntary, public, and permanent). within this framework, he applied the intersection of the two dimensions: first, the “locus of agency relationships” addresses the question of whether the care of children should be informal responsibilities of extended kin or tribal members or formal responsibilities of governmental agencies (testa, 2017, p. 14). the “scope of public interest” refers to whether child welfare policies should be constrained to a limited set of goals such as children’s safety or unconstrained in pursuit of children’s general well-being (testa, 2017, p. 13). out of the estimated 2.7 million children in kinship care, the largest group consists of children in private kinship care. in private kinship care, an arrangement is made privately between parents and kin caregivers, and children may have no known prior or current involvement with child protective services (cps). an estimated 49% of all children living with kin are in private kinship care (bramlett et al., 2017). the second largest group is children in voluntary kinship care in which child welfare services arrange the kinship placement. while there may have been a cps investigation, kin caregivers voluntarily step in to avoid the state taking children into legal custody. in voluntary kinship care, children’s legal custody remains with their biological parents (aecf, 2012; bramlett et al., 2017; cwig, 2016). informal kinship care consists of private and voluntary kinship care, although there is a lack of consensus over this terminology. since children in these arrangements are not in the foster care system, kinship caregivers cannot receive title iv-e foster care payments. advances in social work, spring 2021, 21(1) 80 they are eligible to receive benefits through the temporary assistance for needy families non-parent caregiver (npc) child-only grant (gibbs et al., 2006). however, kinship caregivers often are not fully aware of their eligibility, and the utilization of npc childonly grants is reported to be low (gibbs et al., 2006; golden & hawkins, 2012; xu et al., 2020). public or formal kinship care is generally known as kinship foster care, where caregivers are certified as foster parents and are entitled to receive foster care payments with some exceptions. in public kinship care, the child welfare agency has legal custody of children while relatives have physical custody (cwig, 2018b). permanent kinship care has emerged more recently and refers to the arrangements where relatives become children’s legal guardians or adoptive parents (cwig, 2018b; testa, 2017). the child welfare agency transfers legal custody to the relatives when they become the child’s legal guardian, thus ending the agency's involvement. the kinship guardianship assistant program (kingap) offers such permanency options for children in foster care. if states and tribes choose to participate in kingap, relatives can have permanent legal guardianship of children in foster care and continue to receive payments through title iv-e funds (i.e., federal payments for foster care and adoption assistance). unlike adoption, kinship guardianship does not require the termination of biological parents’ rights (cwig, 2018b). the states significantly vary in how they use kin as part of their child welfare and foster care systems (aecf, 2012). this variation is partly because each state has different views of who may serve as the best agent for maltreated children and/or the extent to which government agencies should intervene when kinship placements are used. also, the boundaries between informal and formal kinship care are often fluid, and the concept of permanency remains unsettled (testa, 2017). the fostering connections to success and increasing adoptions act of 2008 in 2008, the fostering connections to success and increasing adoptions act passed with bipartisan support from congress. the fc act is one of the most significant pieces of legislation in child welfare since the adoption and safe families act of 1997. the fc act provides policy guidelines and resources on a range of areas, including 1) increasing connection with relatives and support for kinship caregivers; 2) improving outcomes for children and youth in foster care; 3) increasing support for american indian and alaskan native children; and 4) improving incentives for adoption (cwig, 2019a; fosteringconnections.org project, 2013). while previous child welfare legislation acknowledged kinship care as a viable option for children in need of out-of-home placements, the fc act codified its increasing recognition with designated titles and sections on kinship care, contributing to the continuing growth of kinship foster care (williams & sepulveda, 2019). these titles and sections reflect three policy directives around kinship care: 1) identification and notification of relatives; 2) family connection grants and kinship navigator programs, and; 3) kingap. koh et al./state implementation of fostering connections 81 the fc act requires all state and local child welfare agencies to exercise diligent efforts to identify and notify relatives within 30 days of children’s removal from their home. relatives are to be informed of their option to participate in the children’s care and placement. while child welfare services have been increasingly reliant on relatives for outof-home placements since the late 1980s (berrick et al., 1994), the fc act mandated this process of involving relatives in children’s out-of-home placements. within the fc act, this is the only mandatory provision on kinship care. the fc act authorized matching grants, known as family connection grants, to child welfare agencies to increase the family connection for children in or at risk of out-of-home placements. directly related to kinship care, a kinship navigator program is supported under these grants. a kinship navigator program ideally provides information on available services and eligibility for all kinship families. the program aims to promote collaboration between public and private agencies to ensure that kinship families receive fair and equitable services. child welfare agencies were encouraged to start kinship navigator programs within their communities under the fc act (casey family programs, 2018). another critical provision under the fc act is to give states and tribes an option to offer kingap. under kingap, grandparents and other relatives who have assumed children’s legal guardianship may receive a subsidy using federal title iv-e funds. kingap is an indication that the legal guardianship with a relative is acknowledged as a permanent placement. additionally, the fc act extended the medicaid eligibility for children receiving kingap services. under the fc act, federally recognized tribes are now allowed to apply to receive title iv-e funds for the operation of foster care, adoption, and kingap. state implementation of the fc act in response to the fc act, states have taken several steps to implement the required and optional provisions related to kinship care under the guidance of the u.s. department of health and human services (dhhs). first, states made changes in their child welfare practices and policies to meet the provision that mandated the identification and notification of relatives upon children’s removal from their original home. the u.s. government accountability office (u.s. gao, 2014) states that 37 states enacted, issued, or revised their laws or regulations in response to this provision. thirteen states did not make any changes since their existing law or regulations were in compliance with this provision’s mandate. however, the states varied in how they implemented this provision. for example, among the 43 states requiring written notification to relatives, only 20 mandated verbal notification. most states and the district of columbia (dc) required the documentation of their efforts to identify and notify relatives in their case files. many states opted to apply for the federally funded kingap. as of 2017, 36 states, dc, and eight indian tribes received dhhs approval to use their federal title iv-e funds for kingap. another seven states used their state funds for their guardianship programs, and thus are not required to follow the federal requirements, and the other seven states did not have any guardianship programs (killos et al., 2018). however, even among those states that obtained approval to use federal title iv-e funds for kingap, the actual implementation varied. six states accounted for three-quarters of kingap caseloads in the advances in social work, spring 2021, 21(1) 82 u.s. no kingap cases were reported for some states even though they received approval to use their federal title iv-e funds for the program (killos et al., 2018; u.s. dhhs, 2018). while there have been efforts to understand the fc act's implementation at the state level, the current knowledge is still a “work in progress,” as the title of the u.s. dhhs’s report (2018), title iv-e gap programs: work in progress, suggested. for example, prior studies on implementing the fc act, particularly concerning kinship care, focused on specific provisions, including kingap (children’s defense fund et al., 2012; killos et al., 2018; u.s. dhhs, 2018). the u.s. gao (2014) completed a review indicating several implementation challenges, but there are still areas not yet explored, including the provision on family connection grants. furthermore, considering that states may continue to make changes in their child welfare practices and policies in response to the fc act, more current, updated information is needed. besides, the knowledge of why states varied in implementing the fc act is even scarcer, impeding its fuller implementation. the limited literature suggested that the mandate for identifying and notifying relatives required extra time and effort of frontline child welfare workers, who already haves high caseloads and competing mandates (u.s. gao, 2014). the uneven implementation of kingap across the states was attributed to different licensing requirements, budget constraints, and limited funding for implementation (aecf, 2018). states identified the federal government’s lack of oversight as another barrier, resulting in limited awareness of kingap and its potential benefits among state administrators and frontline child welfare workers (u.s. dhhs, 2018). with the varied implementation of the fc act across the states, it is imperative that attention shifts toward the reasons behind such variations and the states’ needs related to achieving full implementation of the act. the current study aimed to address these gaps in the existing literature, improving understanding of the fc act's implementation with a focus on kinship care. specifically, the study sought to understand how states have responded to the fc act, including what changes they have made in their practices and policies around kinship care. the study also explored states’ current implementation and plans regarding kinship navigator programs and their needs. the knowledge obtained from the study can offer useful perspectives and insights on the future implementation of the recently enacted ffpsa. methods data collection procedures in this study, two questionnaires were developed and administered, the first focusing on the fc act’s implementation and the second on the early implementation of the ffpsa. using mainly open-ended questions, the first questionnaire inquired about states’ practices, programs, and policies around kinship care before and after the fc act. the survey investigated the impact of the fc act, focusing on its policy directives around kinship care, in particular: 1) states’ use of kinship placements (e.g., identification and licensing of kinship caregivers), and 2) programs and services for kinship care (e.g., kinship navigator programs and family connection grants). the questionnaire did not inquire about kingap koh et al./state implementation of fostering connections 83 since recent studies have explored this issue in detail (killos et al., 2018; u.s. dhhs, 2018). the second questionnaire aimed to examine the initial implementation of the ffpsa, focusing on states’ plans related to kinship navigator programs, as a one-time funding opportunity for these programs became available under the ffpsa. the survey items were created using the funding announcement information (children’s bureau, 2018). specifically, the survey inquired whether states were currently implementing kinship navigator programs, whether they were planning to initiate or continue the programs, and whether they were planning to apply for this one-time funding opportunity. for the states planning to apply for the funding, their representatives were asked to list proposed activities to be implemented. the questionnaire also asked what support states would like to have in implementing and/or expanding kinship navigator programs. the study was exempt from the institutional review board’s review at the university the authors were affiliated with because it sought information on public policies around kinship care. study sample in march 2018, initial contacts were made via email with a state representative of kinship programs for all 50 states and the district of columbia. contact information was obtained from the child welfare information gateway (cwig, 2017) state kinship care contacts and programs website. the initial email included a brief description of the study and introduction of the research team, and inquired about their interests in participating in the online survey on their states’ implementation of the fc act. five of the state contacts’ email addresses were invalid. a follow-up call to these five states was made, and updated email addresses for the person in charge of kinship care programs were obtained. after the initial email, two follow-up contacts were made in march and april 2018, one via email and the other via telephone, to those who had not yet responded. out of the 51 representatives, 24 expressed an interest in participating in the study. the representatives from five states formally declined to participate in the study, and those from the remaining 22 states did not respond. out of the 24 representatives who indicated an interest in participating in the study, 15 completed the first questionnaire in its entirety or partially: nine representatives completed the entire survey, and six responded to parts of the survey. three representatives stopped the questionnaire after providing their contact information, and six did not complete the survey at all despite their initial interest. a new invitation was sent out to all 51 representatives in august 2018, asking for their participation in the second survey that focused on kinship navigator programs. a followup contact was made in september 2018 to the 44 representatives who had not yet responded to the initial invitation, and the survey remained open until october 1, 2018. out of the 51 representatives, 16 completed the second questionnaire in its entirety. however, states or jurisdictions were not identifiable for two responses and thus were excluded from the study. among the remaining 14 states, half completed the first questionnaire while the other half did not. advances in social work, spring 2021, 21(1) 84 the states who participated in the study appeared to be diverse in their characteristics (table 1). for example, among the states who responded to the first questionnaire, six were from the west region and four from the south, reflecting regional diversity. the participating states also varied in the size of their child and foster care populations. in most states in the u.s., child welfare services and programs are administered at the state level (cwig, 2018a), and this was true for the states in the study sample. table 1. characteristics of participant states by time characteristics spring 2018 (n=15) fall 2018 (n=14) region1 n (%) states n (%) state(s) northeast 2 (13.3%) m, s 1 (7.1%) v, midwest 3 (20.0%) a, e, k 3 (21.4%) e, q, u, south 4 (26.7%) d, f, j, l 5 (35.7%) d, l, o, p, t, west 6 (40.0%) b, c, g, h, i, n 5 (35.7%) c, g, h, n, r child welfare administration state-level 13 (86.7%) a, b, c, d, e, f, g, h, j, l, m, n, s 12 (85.7%) c, d, e, g, h, l, n, o, q, r, t, u county-level 2 (13.3%) i, k 2 (14.3%) p, v number of children < 500,000 4 (26.7%) b, d, m, s 3 (21.4%) d, q, r, 500,00 – 999,999 3 (20.0%) c, g, n 4 (28.6%) c, g, n, u 1,000,000 – 1,999,999 5 (33.3%) e, f, h, i, j 4 (28.6%) e, h, o, t ≥ 2,000,000 3 (20.0%) a, k, l 3 (21.4%) l, p, v number of children in foster care1 < 5,000 7 (46.7%) b, c, d, f, m, n, s 6 (42.9%) c, d, n, q, r, t 5,000 – 9,999 3 (20.0%) g, i, j, 4 (28.6%) g, o, p, u ≥ 10,000 5 (33.3%) a, e, h, k, l 4 (28.6%) e, h, l, v percentage of children in kinship foster care2 < 32% 9 (60.0%) b, c, d, e, i, j, k, m, s 6 (42.9%) c, d, e, o, p, t ≥ 32% 6 (40.0%) a, f, g, h, l, n 8 (57.1%) g, h, l, n, q, r, u, v note: 1. the total percentage may not add up to 100% due to rounding; 2. the denominator is the number of children in foster care, and 32% was the national average. while the characteristics of the states that responded to the first questionnaire were similar to those of the states that completed the second questionnaire, the most considerable difference was observed in the percentage of children in kinship foster care. nationally, 32% of children in out-of-home care were placed with relatives (child trends, 2020). on the first questionnaire, the number of states that most recently placed children with relatives at or above the national average of 32% was 6 out of the 15 states (40%). on the second questionnaire, 8 out of 14 states (57.1%) placed children with relatives at or above the national average of 32% koh et al./state implementation of fostering connections 85 data analysis since the questionnaires mainly used open-ended questions, we followed the analytic methods for narrative data. however, strategies to increase the rigor and trustworthiness of study findings typically used for qualitative studies (lincoln & guba, 1985; shenton, 2004) were not employed because the questions inquired about facts rather than participants’ experiences and/or perspectives. descriptive analyses (i.e., frequency) were completed for dichotomous questions. two researchers independently engaged in the analysis of responses to open-ended questions. first, these researchers reviewed the responses to familiarize themselves with the data. as a next step, the researchers engaged in open coding (i.e., identifying, naming, and categorizing the responses), documenting patterns or themes across participants within a thematic framework based on each question (braun & clarke, 2006). the identified patterns or themes were reviewed and refined between the two researchers. findings the study examined changes in state practice and policy around kinship care in response to the fc act and states’ early reaction to the ffpsa. accordingly, the findings are organized and presented in three main areas: 1) use of kinship placements; 2) programs and services for kinship families; and 3) early reaction to the ffpsa. the number of respondents varies by survey item as well as by questionnaire. use of kinship placements preference for kinship care before fc act prior to the fc act, states (n=13) already had policies that would give preference to kinship care over non-kinship care when children needed out-of-home placements. however, the policies varied across these states. eight out of 13 representatives (61.5%) provided a clear policy that would prefer kinship placements over non-kinship placements, recognizing the importance of kinship connections. a representative from state a provided the following policy: when out-of-home placement is necessary, relative placements should be assessed immediately based upon the needs of the child and the relative placement's potential for facilitating the goal of return home if that is the plan…the worker should ask each parent and child to identify all relatives, including siblings, related to the child(ren) by blood, marriage, or adoption. state b has a large population of native american children in its foster care system, and its preference for kin was mainly based on the indian child welfare act of 1978 (icwa). this state’s representative noted, “[our state] has much experience with icwa, where relatives and extended family and other preference placements are mandated.” in two states (15.4%) preference was given to kinship placements, but children could not be placed with relative caregivers until they became licensed or certified before the fc advances in social work, spring 2021, 21(1) 86 act. the respondent from state c noted that they did not have clear policies on what workers’ responsibilities were concerning identifying and searching for kinship caregivers even though kinship care was a preferred option. the respondents from the remaining three states (23.1%) commented on limited policies and/or policy implementation even though kinship care was recognized as a preferred placement in practice. examples of these limitations included no centralized systems or no active efforts in searching for kinship caregivers, and workers’ lack of awareness of policies on identifying and searching for kinship caregivers. table 2. states’ kinship care (kc) practices/policies and fostering connections (fc) act’s impact yes no total [n] n (%) states n (%) states policies changed after fc act in: kinship caregiver identification 12 (85.7%) a, c, d, e, f, g, h, i, j, l, m, s 2 (14.3%) b, n 14 programs & services for kc 3 (27.3%) h, i, n 8 (72.7%) a, b, d, e, f, g, j m 11 program & services were different between: formal & informal kc 4 (33.3%) g, h, i, l 8 (66.7%) a, b, d, e, j, m, n, s 12 licensed & unlicensed kc 5 (41.7%) f, i, j, m, n 7 (58.3%) a, b, d, e, g, h, l 12 new programs supported by fc act: as of march/april 2018, states: ever applied for family connections grant 4 (50.0%) f, h, i, j 4 (50.0%) b, d, g, n 8 had kinship navigator programs 4 (36.4%) a, f, h, s 7 (63.6%) b, d, g, i, j, l, n 11 identification and licensing of kinship caregivers twelve out of 14 states (85.7%) indicated that their policies on identifying kinship caregivers had changed after the fc act's passage, while two states reported no changes (table 2). the two states with no changes had a state policy in place that would give preference to kinship care before the fc act. among the 12 states that experienced policy changes, nine provided the details of these changes. the main changes focused on the revision or refinement of previous policies and the creation of a specific protocol, unit, and/or staff dedicated to locating kinship caregivers. a respondent from state d described a new protocol as follows: a protocol was developed for child welfare workers to identify kinship/relative caregivers. potential providers are identified by the biological family, and the child welfare worker contacts the families, typically via telephone but can also contact them by mailing a letter. koh et al./state implementation of fostering connections 87 in state e, grandparents were preferred over other relatives. state f made efforts to offer in-home services for relative caregivers who were willing to provide a permanent placement for children, preventing children’s entry into foster care. the participant states experienced policy changes at different time points. among the six states that provided the information on the year of policy changes, four initiated such changes in 2008, 2009, and 2010 while two did so in 2013 and 2014, almost five or more years after the fc act’s passage. furthermore, many states reportedly continued to change policies over the years; the most recent changes occurred in 2015 in states f and g, and in 2017 in state h. current practices and policies for kinship caregiver search in most states, it was a caseworker’s responsibility to locate a kinship caregiver upon children’s removal from their original home. out of the 14 states who responded to a question about who is responsible for locating a kinship caregiver, 13 (92.9%) listed a caseworker. however, the caseworker was a sole responsible party in only two states; oftentimes, the responsibilities were shared. for example, in six states, a caseworker and another specialty unit/staff were responsible for locating kinship caregivers. a representative from state b stated, “the caseworker and other specialty staff located within field offices [are responsible for locating kinship caregivers].” another respondent from state i said, “[the search is conducted by] county departments at intake…this is done by a caseworker, case services aide, and sometimes specialized units.” in two states, the responsibility transitioned from one worker (i.e., an assessment worker or a worker who removed the child) to another (i.e., assigned caseworker). two states involved parents in the search process. while a caseworker was mainly responsible for locating a kinship caregiver in most states (n=13), state j had a designated staff for the search process. the representative from this state noted, “each region has at least one kinship coordinator: these folks work in conjunction with the cps unit in researching and assisting potential relatives and kin through the foster home approval process.” in most states (i.e., 10 out of the 14 states), the search for kinship caregivers was an ongoing process throughout the duration of the case. however, four states (28.6%) required that relatives be notified or the search be completed within 30 days of a child’s removal. for example, a respondent from state k said, “there are no time limits. counties should always be looking for kinship placements, even after a child is placed into a foster home.” state a requires the search process to begin even before the child’s removal from the original home. state e dedicates its initial search efforts to locating grandparents and extends its search to all relatives after a child is placed in foster care. the states used different approaches in reaching out to kinship caregivers, including a letter, a phone call, or in-person contact. a representative from state d noted, “the relative caregiver is notified through phone calls, a letter, or the notification from the child's parents from whom the child was removed.” advances in social work, spring 2021, 21(1) 88 programs and services for kinship families programs and services before fc act programs and services for children and caregivers in kinship care seemed to be limited prior to the fc act. among the 12 representatives who responded to the question, five (41.7%) noted that they were not sure about programs and services offered before the fc act or that programs and services for kinship care were limited before the fc act. a respondent from state b stated, “[programs and services for kinship care prior to the fc act] are unknown,” and a representative from state f commented, “[i am] not sure [about programs and services before the fc act].” the other seven states' representatives noted programs and services for kinship care before the fc act, but many of them did not provide detailed information. for example, a respondent from state d wrote down “in-home services and support,” and a representative of state e put “licensure and payment as well as supports.” only one respondent who represented a southern state (state l) provided concrete information as follows: [prior to the fc act] program provided [kinship] caregiver with a one-time integration payment ($1,000) and annual per-child reimbursement payments ($500), and daycare services. our kinship program has provided the following services: case management, caregiver training, financial assistance, home visits, and referrals to resources and services. it should be noted that the respondents from two states commented on the population they served (i.e., “in-home cases” in state m and “non-custodial relatives” in state j) while the representative from state a described the principles (e.g., “proximity to the child's family,” “placement of sib groups”) rather than specific programs and services. changes in programs and services after passage of the fc act out of the 11 representatives with a valid response, three (27.3%) noted that their states had implemented changes in programs and services for kinship care in response to the fc act. the other eight reported no changes (table 2). in two of the three states that introduced changes, kinship care programs and services were limited before the fc act. these two states' changes primarily focused on preventing children’s entry or reentry into foster care or supporting kinship caregivers as foster parents. for example, the representative from state n said, “some of our jurisdictions are able to offer advanced placement specialists to new foster parents and those with more difficult children as a support system. some also have foster parent support groups.” state h had existing programs and services for kinship care before the fc act. they implemented more comprehensive changes in response to the fc act, and the changes seemed to be ongoing. some of these changes (e.g., “parent-child interaction therapy, family functional therapy, family preservation services, triple p parenting, visitation coaching, and much more”) were targeted to foster care in general, which includes kinship care. other changes were designed explicitly for kinship care, which was described as koh et al./state implementation of fostering connections 89 follows: for the last three years, 2015 forward, the contract for these providers [who offer “assistance with the licensing process and help navigating our system, as well as resource referral”] has included an increasing emphasis on kinship caregiver support. a kinship caregiver class, kinship 101, was developed and offered as of 2014 to provide kinship caregivers information about the child welfare system and other systems they interact with, information about financial supports available, and other resources such as support groups to assist with family dynamics. in 2017, kinship 101 expanded from classroom-based only to being offered as a monthly webinar as well. the webinar includes help navigating the technology. later in 2018, one-on-one coaching will be offered for kinship caregivers who have barriers to attending both the class and the webinar. programs and services for different types of kinship care respondents were asked whether programs and services were different depending on the types of kinship care. out of the 12 states with a valid response, four (33.3%) indicated that they had different programs and services for informal and formal kinship care (table 2), and they were offered mainly for formal kinship care. however, it is important to note that the definition of informal kinship care appeared to be inconsistent among the states. for example, a representative from state h said, “if [in]formal means unlicensed, our unlicensed providers do not have to take the licensure classes nor complete ongoing training requirements,” while a respondent from state i commented, “our definition of informal kinship care is those caring for children outside of the child welfare system.” the survey also asked respondents about whether programs and services were different for licensed and unlicensed kinship placements. out of the 12 state representatives who responded to this question, five (41.7%) said that their states had different programs and services for licensed and unlicensed kinship care (table 2). however, little difference was observed in programs and services for licensed and unlicensed kinship placements in one of these five states. according to this state’s representative: non-certified kinship families who had come to the attention of the county departments could receive the same services if there was an open case or a dependency & neglect, depending on the needs. in the case of a d & n, the services would be the same as a certified foster parent. in three states, the main difference between licensed and unlicensed kinship care was that subsidies or stipends were only available to licensed kinship placements. subsidies or stipends were not noted in state n. instead, this state’s representative said, “licensed homes had access to our licensing staff who were sometimes able to assist them, but the service array in this state is inadequate.” family connection grants and kinship navigator programs the family connection grants and funding for kinship navigator programs became advances in social work, spring 2021, 21(1) 90 available under the fc act. at the time of the original survey, the responses were evenly distributed between those who applied for the grants and those who did not among the eight states with a valid response (table 2). out of the four states that applied, two were awarded the grant. the four states who never applied for the grants expressed their interest in future funding opportunities. four (36.4%) out of the 11 states with a valid response had kinship navigator programs (table 2), and three provided more detail on the programs. both informal and formal kinship caregivers could access the programs in two states, while the programs were only accessible to informal kinship caregivers in the other state. the system navigation, including referrals, was a standard service across the three states, and support groups were offered in two states. one state provided consultation and advocacy support services, and another state offered emergency funds to informal kinship caregivers. the programs were implemented statewide in two states, but not in the other state. when asked about future interests, four out of the seven states who did not have kinship navigator programs expressed an interest, while the other three said “perhaps” or “possibly.” the representatives noted “funding” as a helpful resource as well as the need for “evidence-based practice models.” one respondent indicated that they would like to have “information about implementing programs like this in rural areas.” early reaction to the family first act under the family first act of 2018, the federal government published a request for proposal for kinship navigator programs while the first questionnaire was being administered. the second questionnaire was thus developed and conducted to explore states’ interest in this funding opportunity. out of the 14 respondents, four currently had kinship navigator programs. regardless of whether they currently had kinship navigator programs or not, all representatives shared their states’ interest in this funding opportunity except for two states that were undecided. the most common activity states planned to perform was evaluation (n=2) for states with existing kinship navigator programs (table 3). other activities included needs assessment and technology development. a participant from state h said: we plan to have the current kinship navigator program evaluated in order to move it forward to a promising practice program. this proposed activity would be completed with the partnering organizations (the name of the partnering organizations was removed for confidentiality) and would include program fidelity monitoring. one state representative noted that they had not decided what activities they would propose to perform even though the state already had kinship navigator programs. for those states who did not have kinship navigator programs at the time of the survey, the most common activities they planned to perform were program development and implementation (n=4, table 3). developing a platform that offers information and resources to kinship caregivers (e.g., online portal, call center) was another common koh et al./state implementation of fostering connections 91 activity the states without existing programs proposed. a respondent from state p said, “if our state is awarded funding, a statewide web-based platform will be used as the vehicle for the kinship navigator program.” table 3. states’ plan on kinship navigator programs under family first act state programs at follow-up had or were developing (n=4) did not have programs (n=10) n states n states activities to be performeda evaluation 2 c, h 2 g, l needs assessment 1 c 2 d, g strengthening partnership 1 c 2 d, g developing a platform (e.g., online portal, call center, 800 number) where kinship caregivers can obtain information & resources 1 o 4 e, g, p, t initial program development & implementation 4 g, l, q, t researching & determining the best program model 1 g creating positions 2 d, e developing training 1 t developing support groups 1 e not yet decided 1 r not specified 1 n population to be serveda kinship caregivers 2 h, o 6 e, g, l, n, p, t formal kinship caregivers 1 d informal kinship caregivers 1 c 1 q not yet decided 1 r statewide implementation planning 3 c, o, r 9 d, e, g, l, n, p, t, u, v already statewide 1 h unsure 1 q support neededb funding 2 c, h 1 v evidence-based model 1 c how to sustain programs after the exhaustion of a one-time funding 1 r guidance on how to engage stakeholders, how to train staff, & how to transition to the next step 1 o lessons learned from states with existing kinship navigator programs 3 d, g, q, marketing materials 1 g none 1 n unsure 4 d, q, t, v note: a. two states did not respond to this item. b. four states did not respond to this item. advances in social work, spring 2021, 21(1) 92 eight out of the twelve representatives noted that their programs would be for both formal and informal kinship caregivers or did not specify whether the eligibility would be limited to formal or informal kinship caregivers. for example, a respondent from state p commented that their programs would be for “all kinship providers, including relative and fictive kin caregivers.” on the other hand, the programs were targeted only for informal or formal kinship caregivers in three states. a representative from state c noted that their programs would be for “kinship caregivers whose children are not in foster care across the state.” all states planned to implement the programs statewide except for one state who was not sure (table 3). differences were noted between states with and without existing kinship navigator programs in the support they would like to receive (table 3). for states with existing programs, funding was the most needed support. other support included the plan for sustainability, evidence-based model, and guidance on how to engage stakeholders. a respondent from state r noted, “we would like assistance on how to sustain the program after the one-time funding is exhausted.” the most common response for states without kinship navigator programs was that they were not sure about the support they would need (n=4). while unsure, states still identified a few areas in need, and the lessons learned from states already implementing the programs (n=3) were most frequently noted. a respondent from state d said, “perhaps ideas from other states who have already implemented the kinship navigator program [would be helpful].” discussion the study aimed to expand our knowledge of the fc act’s impact on states’ practice and policy around kinship care. while it has been over ten years since the passage of the fc act, our understanding of the extent to which the act has changed state-level kinship care practice and policies is limited. with the recent passage of the ffpsa, the knowledge obtained from this study can serve as the basis for more comprehensive future research and offer helpful insight and guidance on the future implementation of the ffpsa and other legislation in improving the well-being of children in kinship care. the study's findings show that the most common change after the fc act occurred in the states’ efforts to identify and search for kinship caregivers. this change reflects the public policy’s preference for kinship caregivers as an agent for children when their biological parents cannot care for them (rubin et al., 2017; u.s. gao, 1999; winokur et al., 2014). while most states noted that kinship care had been a preferred option for children’s out-of-home placement even before the fc act, the act’s requirement for identifying and notifying relative caregivers within 30 days of children’s removal led to changes in the states’ policies and practices. some states appeared to rely on existing resources to identify and search for kinship caregivers, while others created a new structure dedicated to these efforts. states also varied in the timeframe that they implemented the changes. the representative of the state with a large number of native american children in its child welfare system commented that its preference for kinship placements was mainly based on the indian child welfare act of 1978 rather than the fc act. while this koh et al./state implementation of fostering connections 93 preference was only noted for one state, it implies that multiple federal laws could affect and govern state policies and practices around kinship care. future studies should examine how states establish their policies and practices when multiple federal laws exist with potential overlap and/or contradiction. it is not surprising that most states surveyed implemented changes to identify and search for kinship caregivers considering that it is the fc act’s sole mandatory requirement. the two states that did not introduce any changes in this area seemed to have policies and practices already in place before the fc act. on the contrary, states were less likely to implement non-mandated programs and services despite their potential benefits for children and caregivers in kinship care, and variations were observed across the participant states. for example, out of the 11 states, only three (27.3%) reportedly implemented changes in programs and services for kinship care in response to the fc act. furthermore, only one state made comprehensive changes in its programs and services for kinship care. this state was also the one that offered concrete examples of programs and services available before the fc act. the changes in the other two states, which had limited programs and services for kinship care before the act, were mainly to prevent children’s entry or reentry into foster care and to support kinship care within the foster care system. this finding is consistent with the literature indicating that states’ implementation of federal policies may be unpredictable and inconsistent (mclaughlin, 1987; u.s. gao, 2014). states may not act to maximize the intended goals and objectives of a given legislation due to the different issues each state and their communities are faced with and their capacities (mclaughlin, 1987). the lessons learned from earlier policy analysis emphasize that states’ successful implementation of a federal policy requires both the pressure and the support from the federal government (mclaughlin, 1987; montjoy, & o'toole, 1979; u.s. gao, 2014). while the fc act put pressure on states in their use of kinship placements, there may not have been enough support, leading to its limited implementation. when states were asked about the support they would like to receive in the implementation of kinship navigator programs, many of them, particularly those without existing programs, could not specify the areas of their needs. this may imply the lack of guidance and support from the federal government, echoing the conclusion of the prior governmental report on the fc act (u.s. gao, 2014). as new funding opportunities are available under the ffpsa, particularly for kinship navigator programs, it will be important to reflect on the federal government’s roles. the participant states’ responses in this study offer guidance and direction: the federal government may consider creating a learning community where states can share their successes and challenges as well as lessons learned. furthermore, consultation should be made available to states so that they can incorporate their unique needs and capacities in planning and implementing given legislation. additionally, before issuing new funding opportunities, the federal government should conduct a needs assessment to address states' challenges in interpreting and implementing federal legislation at the state level. it should consider convening a steering committee of stakeholders, including kinship caregivers and young adults previously placed in kinship care, to help guide the needs assessment, shape policies and funding requirements, and advances in social work, spring 2021, 21(1) 94 advise implementation. engaging kinship families will help develop effective programs and services rather than create ones that still leave gaps. the study provides valuable information on kinship care policies that will inform the work of social workers who play an integral role in the development of policy, research, and programs. it is imperative that social workers work with legislative officials in their state to successfully implement kinship policies based on the fc act and ffpsa. social workers can also use the information from this study to assist children and caregivers in kinship care in accessing needed programs and services. kinship caregivers are often pressured to make unexpected, quick decisions in the midst of a crisis, including taking the custody of children for whom they are not prepared to provide care (bailey, 2020; gentlesgibbs & zema, 2020; gleeson et al., 2009). these kinship caregivers, especially grandparents, are caught between family responsibilities and personal needs, and often do not have access to needed resources (cwig, 2019b; u.s. gao, 2020). to ensure the wellbeing of children and caregivers in kinship care, social workers should make diligent efforts to make informed decisions and engage in practice with a keen knowledge of programs and services available to kinship families. finally, the study illuminates the need for additional research on kinship care policies, programs and services, and their impact on kinship families’ experience. future research can help to create better systems of care and outcomes for children and caregivers in kinship care, which works toward the grand challenges for social work aiming to ensure “individual and family well-being” (grand challenges for social work, n.d., “an urgent appeal for needed change” section). the findings of the study should be interpreted with caution due to its limitations. first, only 15 states responded to the first questionnaire, and not all respondents completed the questionnaire in its entirety. the study also used an online survey method, and the questionnaires were not field-tested. it is thus not clear whether the questions were interpreted as intended, affecting the validity of the study findings. moreover, the state representative completed the survey, and it is unknown how the fc act is implemented at the county or local levels. despite these limitations, the study expanded our understanding of the implementation of the fc act. as this was an exploratory study, future studies should investigate the more detailed policy implementation process at both state 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(2020). a new kinship typology and factors associated with receiving financial assistance in kinship care. children and youth services review, 110, 1-11. https://doi.org/10.1016/j.childyouth.2020.104822 author note: address correspondence to eun koh, national catholic school of social service, the catholic university of america, washington, dc, 20064. email: koh@cua.edu https://doi.org/10.1177/1049731515620843 https://doi.org/10.1016/j.childyouth.2020.104822 mailto:koh@cua.edu _______ melissa copenhaver, rn-bc, ms, lmsw, instructor, department of nursing, and ann crandell-williams, lmsw, field placement coordinator and assistant professor, department of social work, northern michigan university, marquette, mi. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 320-337, doi: 10.18060/23318 this work is licensed under a creative commons attribution 4.0 international license. a safe place: using clinical supervision groups to build interprofessional collaborative practice skills melissa copenhaver ann crandell-williams abstract: interprofessional collaborative practice (icp) is an essential skill in today’s healthcare environment that can be cultivated through interprofessional education (ipe) in higher education, as students are in the process of developing their professional identities. undergraduate social work field students and nursing students in clinical rotation explored their experiences together in clinical supervision groups co-led by instructors from both fields. researchers used a mixed methods approach to measure changes in feelings and skills related to icp among students who participated in clinical supervision groups. eighteen nursing and social work students participated; those involved in the interprofessional clinical supervision groups performed better on the interprofessional socialization and valuing scale (isvs) than the comparison group. qualitative themes indicated that students enhanced their interprofessional knowledge; improved their interprofessional communication skills; and increased their comfort levels on an interprofessional team. implications and suggestions for implementation are discussed. keywords: interprofessional education, interprofessional collaborative practice, roles, teamwork, clinical supervision, professional identity in the ever-evolving field of healthcare, legislative initiatives like the affordable care act and the social work reinvestment act present opportunities for scholars to explore innovative approaches to preparing future healthcare providers. the enhancement of interprofessional collaborative practice (icp) among providers of varying disciplines has been identified as important to the future of the healthcare system and key to improving patient outcomes (herath et al., 2017; reeves et al., 2013). icp happens when professionals from different backgrounds work together with patients, families, providers and communities to deliver the highest quality of care (gilbert et al., 2010). marshall (2011) notes that interprofessional collaborative practice “promotes team identity, conserves energy by a unity in direction, and invites harmony of efforts” (p. 158). historically, literature regarding interprofessional collaborative practice focused on the nurse-doctor relationship; however, for icp to improve healthcare outcomes, the focus needs to include all professionals involved in the care of the patient (pollard et al., 2005). separation is common between health care professionals, such as physical therapists, doctors and nurses; and social care professionals such as social workers and aides. communication is often limited when undertaking patient care. health and social care professionals appear to understand that icp is important, and nurses in particular view themselves as playing a key role in the icp process (miers & pollard, 2009). however, there remains a need for significant improvement of icp skills within the healthcare https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 321 environment and improving icp will only result from the advocacy and implementation efforts of experienced leaders (mulvale et al., 2016; pollard et al., 2005). nursing and social work are two fields of study, among others, whose curricula have evolved to include standards that require integration of icp skills. currently, interprofessional education (ipe) programs are most common in healthcare fields and at the undergraduate level (herath et al., 2017). the commission on collegiate nursing education (ccne), which accredits schools of nursing, has worked to develop the core competencies for interprofessional practice (interprofessional education collaborative, 2016). the field of nursing identifies interprofessional communication and collaboration for improving patient health outcomes as standard number four in the essentials of baccalaureate education for professional nursing practice (american association of colleges of nursing, 2015). the council on social work education, the accreditor of social work programs in the united states, discusses “using interprofessional collaboration as appropriate to achieve beneficial practice outcomes” as a practice behavior within competency 8 of the 2015 educational policy and accreditation standards (epas) (council on social work education, 2015, p. 8). additionally, the national association of social work (nasw) code of ethics, section 2.03, specifically discusses the importance of interdisciplinary collaboration (2017). while these professional guidelines establish standards for these practice behaviors, best practice for instructing students in icp skills has yet to be established. at the mid-sized, comprehensive regional university where this study was conducted, there are limited opportunities in the program curriculums of nursing, social work, and other health and social sciences for students to learn and practice icp skills. these are typical of curriculums throughout the united states that remain largely confined within academic silos, which do not reflect prevailing expectations for graduates entering the workforce. isolated curriculums inevitably result in relational biases between graduates of different professions (lapkin et al., 2013). opportunities to participate in interprofessional collaborative practice are often arbitrary and there is limited support for students to engage in icp (pollard, 2009). failure to engage students in interprofessional experiences can lead to barriers to icp, such as lack of knowledge and lack of effective communication among professions, once students enter the workplace (pfaff et al., 2013). providing opportunities for future healthcare professionals to practice icp can be accomplished through ipe, which occurs when students of two or more professions practice together in providing collaborative, safe, high quality, accessible patient-centered care (interprofessional education collaborative, 2016). while coordination of curricula among academic programs can present a challenge, experts have found far more opportunities than barriers to enacting ipe activities across programs (homeyer et al., 2018). it is increasingly apparent that ipe within higher education is central to achieving the key educational competencies of engaging in icp and ultimately improving healthcare outcomes (reeves, 2016). despite the increasingly perceived value of ipe, there is little conclusive evidence in the literature regarding interventions that are most effective. approaches most commonly used in ipe are patient scenarios/simulations, small group work focused on teamwork, copenhaver & crandall-williams/safe place 322 online discussions, lectures and small group activities (olson & bialocerkowski, 2014). the uncertainty regarding best ipe practice provides an opportunity to explore interventions not typically found in classrooms, such as clinical supervision. scholars define clinical supervision as an opportunity for persons from various backgrounds to reflect on their work with patients and families in a trusting and supportive environment that promotes growth (butterworth et al., 2008). this occurs through regular meetings between a qualified, knowledgeable and experienced supervisor and one or more supervisees. meetings are facilitative in nature and involve reflection and discussion around clinical and interpersonal issues encountered in the workplace (martin et al., 2017). background theoretical framework a systematic review of the ipe/icp literature revealed the central importance of theory; however there is no working consensus on the superiority of any one theory (hall et al., 2013; hean et al., 2013; olson & bialocerkowski, 2014). the literature suggests that learning theories, behaviorism, cognitive constructivism, and social constructivism all have the potential to play a role in ipe curriculum development. however, ipe curricula are most often developed in a top-down manner and their design has little, if any, basis in theory (craddock et al., 2013). based on the lack of theoretical orientation found in the ipe literature, it was determined that it would be important to ground this project in a theoretical framework. after review, social identity theory (sit), originally conceptualized by tajfel and turner (1979), was the theoretical orientation most suited to ground this process (burford, 2012; pecukonis, 2014). research suggests that ipe is more effective when undertaken while students are in the process of establishing professional identities, as students can more easily transfer these skills into the professional work environment (pollard & miers, 2008). therefore, the concept of identity development discussed in sit provides the perfect foundation for this study. sit provides a theoretical basis for facilitating collaboration among students from different fields of study as they are in the process of learning professional roles and boundaries. sit suggests that part of individuals’ self-identify arises from group affiliations, and emphasizes how the group affiliation is reflected in the individual (pecukonis, 2014). sit identifies four different types of social identity: • person-based social identity are characteristics internalized by the groups that become a part of the groups members’ self-concepts • relational social identity refers to the individual identifying themselves in relation to other group members • group-based social identity is consistent with the traditional view of social identity, like identifying with a particular professional label • collective identity suggests that beyond shared attributes, the groups engage in social activities that further solidify the group identity advances in social work, summer 2020, 20(2) 323 it was anticipated that through the clinical supervision group process, students would have opportunities to experience shifts in each of the four types of social identity. as they develop their identity as individuals, professionals, and as part of a team through the group process, sit suggests the process has the potential to assist students in identifying as part of an interprofessional team. additionally, sit suggests that the establishment of normative or comparative fit influences group interactions (burford, 2012). a more normative fit within the group facilitates collaboration. sit suggests that ipe efforts need to address relational bias issues like power, hierarchy, professional culture, professional roles and team interaction (pecukonis, 2014). researchers hoped to explore whether the supportive group culture created by clinical supervision could break down potential relational biases and allow students to realize not only differences but also similarities. sit provides a rationale for the use of clinical supervision in ipe by addressing barriers such as biases and silos created through professional identities. although many methods have been proposed for interprofessional education, none of the current methods clearly address the need to maintain professional identities while providing enough permeability in professional boundaries to encourage effective icp. this project focused on the application of clinical supervision groups to enhance students’ professional identities as interprofessional collaborative practitioners and improve their perspectives and skills around icp. literature review interprofessional education. communication is an essential component of icp, however practicing healthcare professionals do not consistently engage in interprofessional communication, which leads to fragmented care and errors (lancaster et al., 2015). senior staff and students have been found to be even less likely to engage in icp (lancaster et al., 2015; pollard et al., 2005). in order to engage in effective icp, the sheffield capability framework suggests that the practicing professional should be able to lead and participate in the interprofessional team, consistently communicate sensitively in a responsive and responsible manner, demonstrate effective interpersonal skills in the context of patient/client focused care, and share uniprofessional knowledge with the team in ways that contribute to and enhance service provision (stevenson et al., 2012, p. 228). professionals participating in interprofessional activities report that it encourages clearer communication and use of less profession-specific jargon (davys & beddoe, 2009). pollard el al.’s (2012) study suggests that programs that incorporate ipe better prepare students for icp as working professionals. therefore, the idea of ipe with soon-to-be-qualified health care professionals has emerged as a key practice within higher education as it addresses communication barriers that commonly occur on interprofessional teams. buring et al. (2009) define ipe as educators and learners from two or more health disciplines who jointly create and foster a collaborative learning environment with the goal of developing knowledge, skills and attitudes that result in interprofessional team behaviors and competence. literature suggests that facilitators designing an ipe activity should engage in effective preparation and ongoing support; co-facilitate with an instructor from a different professional background; display humor, enthusiasm, and empathy; and provide copenhaver & crandall-williams/safe place 324 students with opportunities for shared reflection (reeves et al., 2016). literature consistently reveals that students clearly see the value in ipe, as their reactions have been shown to be generally very positive and create an improved appreciation of icp (addy et al., 2015; chan et al., 2010; o’brien et al., 2013). clinical supervision. this project aimed to explore the use of clinical supervision groups in higher education as an innovative ipe method, as it addresses the development of identity discussed in sit, as well as addresses communication issues that commonly arise as barriers to icp. lyth (2000) defines clinical supervision as a support mechanism where supervisees can share clinical, organizational, developmental and emotional experiences in a confidential environment to enhance knowledge and skills. this process leads to an increased awareness of concepts such as accountability (iliadi, 2010) and reflective practice (mann et al., 2009). for supervisees, it provides a supportive, safe place to work out problems and stressors that occur in a clinical environment (pack, 2012). clouder and sellars (2004) suggest that “clinical supervision has the potential to move beyond preserving the status quo to enhancing practice, the full potential of which might be recognized more readily in a group supervision context or in an interprofessional setting” (p. 266). research in the literature on clinical supervision within healthcare settings has shown promising results. bradshaw at al. (2007) demonstrated that when participants received clinical supervision, there was an improvement in patient outcomes as compared to a control group. studies on clinical supervision in healthcare show that it serves restorative, normative and formative functions (brunero & stein-parbury, 2008). davys and beddoe (2009) and townend (2005) found that interprofessional clinical supervision group participants were able to develop a more diverse understanding of patient issues and felt the experience encouraged the use of clearer communication. in addition, interprofessional clinical supervision group participants felt that the perspectives shared by group members were more open and diverse (davys & beddoe, 2009). a recent systematic review of clinical supervision in health care environments found that clinical supervision of health professionals was associated with effectiveness of care (snowdon et al., 2017). however, there continues to be a need to explore clinical supervision. systemic reviews completed by butterworth et al. (2008) and dilworth et al. (2013) call for continued implementation alongside further research. literature review summary. the topic of interprofessional collaborative practice is not a new concept in the health care literature and more recently it has been identified as a means to improve healthcare outcomes by breaking down communication barriers. although ipe is identified as a means to achieve improved icp among professionals, there is limited research that identifies best ipe practices in higher education. clinical supervision is currently used more frequently outside of the united states, and the majority of studies related to clinical supervision thus far has been positive, yet qualitative in nature and unable to demonstrate quantifiable outcomes. this project explores the relatively untested idea that interprofessional clinical supervision groups could be an effective ipe strategy when implemented as students are in the process of actively developing their professional identities. advances in social work, summer 2020, 20(2) 325 method this study was conducted during the winter semester (january through may) of 2016 and provided opportunities for undergraduate level social work field students and nursing students to explore their experiences together, in interprofessional clinical supervision groups, as a means of interprofessional education. the authors used a mixed-method, action research approach. the university’s institutional review board approved methods prior to implementation. a small monetary incentive, in the form of campus gift cards, was provided to students for completing surveys and additional forms requested by researchers. poling et al. (2016) used the core competencies for interprofessional collaborative practice to develop guidelines for interprofessional research with the intent of generating more robust research outcomes. these guidelines informed the process utilized in this project. the guidelines emphasize working with professions with mutual respect and shared values, using knowledge of one’s own role and the role of others, communicating in a responsive and responsible manner, and utilizing relationship building values and principles to guide the actions of the research team (poling et al., 2016). a non-probability convenience sample of 34 undergraduate, final year students from both nursing and social work participated in the project. nursing students were selected from those enrolled in mental health nursing and community-based nursing courses. social work students were recruited from concurrent field placement and senior seminar courses. these courses were selected because both sets of students were in senior-level, pre-professional stages of forming professional identities, and were experientially engaged in completing clinical hours in community social service agencies such as substance abuse treatment facilities, mental health organizations, and child welfare agencies. emails were sent to eligible students offering information regarding the study, and students who wished to participate responded and completed consent forms. the authors selected a comparison group from the same pool of candidates. a non-probability convenience sample of eight students each from both nursing and social work participated in clinical supervision groups. sixteen students made up the experimental group. eighteen students made up the control group, who received the standard curriculum for their respective disciplines. students in both experimental and control groups were provided varied opportunities in their clinical sites to interact with professionals of other disciplines. the control group students in their respective programs were provided opportunity, while limited, to discuss or process these experiences using standard academic instruction at their clinical sites. the intervention provided to students in the experimental group differed in that (1) students engaged with students from other disciplines; (2) groups were co-led by two facilitators from different areas of study with a focus on interprofessional collaboration; and (3) groups were facilitated using a clinical supervision approach. when forming the experimental groups, researchers split social work and nursing students evenly into two groups, totaling eight students in each group. each group met five times during the winter semester. groups were 90 minutes long and scheduled every two weeks at times most convenient to students’ schedules. groups were co-facilitated by the researchers, comprised of one nursing instructor and one social work instructor, who both had experience with clinical supervision and running groups. copenhaver & crandall-williams/safe place 326 prior to participation in clinical supervision groups, an interprofessional clinical supervision orientation was provided for students in the experimental group as a shared learning experience. the orientation provided students with an overview of interprofessional education and the purpose, function, and methods used during a clinical supervision group. students were also taught the basics of how to effectively interact in a clinical supervision group, such as how to present a case, give feedback, and effectively interact in a supportive and collaborative manner. the interprofessional clinical supervision groups then commenced. during the first experimental group session, students introduced themselves and identified the agency to which they were assigned clinicallyrelated course work. focus in subsequent sessions then moved to discussion of issues or cases the students encountered at their clinical sites. assigned facilitators remained the same throughout all sessions to facilitate the supervisor/supervisee relationship imperative to the clinical supervision process. per the conceptualization of clinical supervision outlined by martin and colleagues, meetings were semi-structured, facilitative in nature and involved reflection and discussion around clinical and interpersonal issues encountered at field sites (2017). facilitation focused on promoting communication and support among students. data collection in order to capture the possible impacts of the interprofessional clinical supervision groups, researchers used an emergent, mixed-methods approach. this approach was selected to ensure the findings would be grounded in the participants’ experiences as informed by knowledge of ipe, clinical supervision, and the sit theoretical framework. an emergent method was used to balance the study and measurement with the educational focus of the project. quantitative methods were used as the researchers wanted to fully capture how the participants’ social identities as students and future professionals were influenced by the experience. a mixed-methods approach allowed researchers to explore the multiple implications of the use of clinical supervision as an ipe intervention. the quantitative method utilized a quasi-experimental design that analyzed preand post-data captured with a standardized evaluation tool that measured attitudes about interprofessional collaboration. the standardized tool selected for this study was the interprofessional socialization and valuation scale (isvs). the isvs is a 34-item tool measuring respondents’ agreement level with statements about icp behaviors using a seven-point likert scale. examples of isvs items are “i feel confident in taking on different roles in a team,” “i am able to share and exchange ideas in a team discussion,” and “i have gained an enhanced awareness of roles of other professionals on a team.” statements are intended to measure changes in beliefs, behaviors, and attitudes that are foundational to interprofessional collaboration. author permission was obtained prior to employing the tool. the isvs tool demonstrated reliability and validity, was determined to have broad application across professions, and fully met the standards for instrument development (king et al., 2010; oates & davidson, 2015). de vries et al. (2015) completed bartlett’s test to assess relationships between the variables and found a significance of less than 0.001. cronbach’s alpha was completed and found good reliability for factors 1, 2 and 4 advances in social work, summer 2020, 20(2) 327 while factors 3 and 5 demonstrated lower reliability (de vries et al., 2015). coefficient for factor 1, self-perceived ability to work with others, was .89; factor 2, value in working with others, .82; and factor 4, comfort in working with others, was calculated at .79. factors 3 (self-perceived ability to work with others) and 5 (value in working with others) had coefficients of .55 and .34, respectively. (devries et al., 2016). devries et al. state that this low value “…indicates the difficulty of working collaboratively with others, despite positive attitudes toward interprofessional practice” (p. 83, 2016). participating students were randomly assigned to experimental and comparison groups. students in both groups completed the isvs at both the start and conclusion of the winter 2016 semester in which the clinical supervision groups were held. the comparison group was used to help differentiate whether potential changes in the preand post-test scores of the isvs were the result of the intervention. the qualitative method involved a survey comprised of open-ended questions that the experimental group completed at the conclusion of the interprofessional clinical supervision group intervention. to reduce the possibility of perceived participant coercion since the lead researchers were program faculty, a graduate student assisted with student recruiting and data collection. data analysis and results group demographics. participants included seven male and 27 female students. the mean age of all students who participated was 24 years old. eighty-eight percent of the students identified their race as caucasian with one selecting asian, one selecting native american, and one selecting other. the average age was 26 years in the experimental group (age range 21-36 years) and 23 years in the control group (age range 21-32 years). levene’s test suggested the two groups were similar. quantitative data analysis. researchers analyzed quantitative data from the preand post-tests using the statistical package for social sciences (spss) software program. the overall range of the scores for all groups on the isvs for the pre-test was 98-212 with a standard deviation of 28.3. for the post-test, the range was 162-235 with a standard deviation of 19.3. all students combined in the experimental group had a mean pretest score of 170 and the control group had a mean pretest score of 182. the mean post-test score for the experimental group was 219 and the control group had a post-test score of 207. this indicated a 49 point (129%) increase in total score in the experimental group and a 25 point (114%) increase in the control group. this increase in scores suggests a robust improvement in knowledge and beliefs regarding interprofessional collaboration in the experimental group (see figure 1). examination of variations between nursing and social work students identified that the average increase in the isvs post-test for nursing students in the experimental group was 43 points and for social work students 63 points. nursing students in the control group had a 14-point increase in the isvs and the social work control group increased 32 points. although the sample size of 16 was not large enough to establish significance, the increase in the scores of those in the experimental group compared to the control group suggests interprofessional clinical supervision shows promise as a means of implementing ipe (see figure 2). copenhaver & crandall-williams/safe place 328 figure 1. comparison of the average preand post-scores on the isvs for the control and experimental groups note: increases in preand post-test scores of isvs between control and experimental figure 2. average increase in isvs scores between social work and nursing control and experimental groups qualitative data analysis. a qualitative survey was developed for members of the experimental group to complete as part of post-test data collection. the survey asked how many sessions the student had attended; what the student found helpful and unhelpful about participation in the groups; how (if at all) the students felt their icp skills improved; and advances in social work, summer 2020, 20(2) 329 how (if at all) the experience would impact the students’ reactions to icp situations in their future professional work. researchers analyzed qualitative data using braun and clarke’s (2006) thematic analysis approach. during analysis of qualitative comments on interview feedback forms, researchers first performed immersive, independent analyses of the data. researchers independently searched for themes using manual coding methods. researchers then met to review, define and name themes for each data set, using an iterative approach until themes were refined. themes were based primarily on prevalence using inductive methods from an essentialist/realist perspective. through the revision process, latent themes were identified and further refined that were consistent with concepts related to ipe. other qualitative methods used for data analysis included utilization of independent expert reviews, consideration of negative case samples, and use of low inference descriptors. expert review involved presentation of the research as a doctor of nursing practice (dnp) scholarly project and at several academic and professional conferences. possible explanations for outliers emerging from the data were noted and may be tested through further research. low-inference descriptors were used by integrating verbatim accounts of student responses within the reporting of results. overall, students’ responses were highly favorable regarding the interprofessional clinical supervision experience. three primary themes gleaned from qualitative analysis were: (1) enhancement of interprofessional knowledge; (2) improvement of interprofessional communication skills; and (3) increased confidence in interprofessional settings. students appeared to value the multiple viewpoints offered by interprofessional clinical supervision groups, further expanding their professional knowledge base. they indicated that clinical supervision was helpful because the groups allowed students to explore different perspectives from students in another discipline. as one student noted, “being part of a team with different viewpoints expanded my knowledge base and views of clients or situations.” students commented that they gained additional professional knowledge from the groups that they planned to take with them into their practice. students felt their interprofessional communication skills improved because of participating in the interprofessional clinical supervision groups, specifically by sharing cases and receiving feedback in an interprofessional setting. one student commented, “it was very helpful to talk about situations that happened in field and receive feedback.” students expressed appreciation for being able to “get things off their chest” by sharing difficult experiences. one student stated he/she valued “being able to talk out issues i would have been otherwise uncomfortable with and would have hindered my effectiveness…” the collaborative environment within the groups appeared to create a space where students felt emotionally safe to share, such as one student who indicated, “it was refreshing to feel part of a team that wants you to succeed.” students noted that they found communicating with students from other professionals a helpful and positive experience. furthermore, students realized that receiving feedback from students of other academic backgrounds improved their communication skills and enhanced their approach to clients. students felt this would enhance their communication skills as future copenhaver & crandall-williams/safe place 330 professionals, such as one student who stated “i will be more open to listening and collaborating with other disciplines." additionally, the clinical supervision experience allowed for students of different disciplines to increase their confidence in an interprofessional team atmosphere. one student commented, “i am much more comfortable speaking as a part of an interprofessional group and sharing ideas. i gained confidence in my professional viewpoint.” another stated, “i feel my opinions will be valued within these situations as my skills have improved.” sharing, acceptance, and commonalities appeared to improve students’ confidence on an interprofessional team. as one student said, "this group taught me how to work together as a whole to provide holistic nursing care.” the interprofessional clinical supervision group experience appeared to further enhance students’ faith in their abilities in a team atmosphere and increase likelihood of future interprofessional behavior. one student stated, “i feel like i will go into [interprofessional] situations more positively knowing how much i will get out of the experience.” certain themes appeared more common among students based on their academic background. nursing students gained confidence in their ability to express concerns in front of a group and improved self-efficacy in dealing with mental health patients in particular. social work students gained an increased understanding of their role on an interprofessional team and developed an increased sense of confidence that their opinion would be valued in an interprofessional setting. despite some differences in student reactions to the event, reactions from students of both disciplines included an understanding that their improved skills would benefit clients, as reflected by one student who stated, "i now have greater experience working collaboratively over patient's care which will help with patient-centered care overall." discussion applying sit to this theme, the interprofessional clinical supervision group appeared to diminish barriers between professions and assisted students in strengthening their person-based, group-based, and collective identities (burke, 2006). students from both areas of study showed improvements in the following icp skills: ability to see different perspectives; ability to receive feedback; ability to speak in groups; and feeling like a member of a team. a main theme that emerged was an improved level of comfort with being able to work as a member of a team in interprofessional situations. several students reflected sentiments such as “i [now] will be very excited and motivated to be a part of an interprofessional team.” perhaps most importantly, students reported that they were able to improve skills related to working with clients as a result of participation in the clinical supervision groups. students identified the ability to see different perspectives, improve communication skills with other professions, and increase skills for working with clients. students consistently felt that their improved icp skills would enable them to provide better care to clients in their respective professions. findings reflect that interprofessional clinical supervision groups fostered an ipe environment that improved nursing and social work students’ icp skills, knowledge and advances in social work, summer 2020, 20(2) 331 attitudes for future professional practice. data show that students improved their ability to clearly and sensitively communicate, understand multiple perspectives, and feel supported as part of an interprofessional team. students clearly articulated the value and benefits of participation in the interprofessional clinical supervision groups and expressed the importance of providing this type of experience for future students in their respective programs. drawing from the sit framework, as students engaged in this activity while in the process of developing professional identities, there is optimism that they will develop into professionals who are more likely to engage in icp, resulting in improved quality of health care environments where they will ultimately practice. in the search for effective ipe interventions, this study provides promising evidence that the use of interprofessional clinical supervision groups in higher education warrants further exploration. this study further supports prior research by davys and beddoe (2009) and townend (2005), who found that interprofessional clinical supervision group participants developed a more diverse understanding of patient issues and encouraged the use of clearer communication, and expanded this idea to the ipe environment. the sit framework suggests that clinical supervision provides a valuable opportunity to for students to develop a collective identity as part of an interprofessional team. clinical supervision provides a safe space where students of varying disciplines can openly communicate, break down barriers, and learn from students of other disciplines, ultimately enhancing their icp skills. it was anticipated that both control and experimental groups would have some increase in their isvs scores due to standard professional development experiences within their senior level placements. however, quantitative data demonstrated that students in the interprofessional clinical supervision groups experienced a greater degree of increase in their isvs scores than the control group, suggesting these students experienced a greater degree of improvement in their knowledge and attitudes around icp. qualitative responses supported this idea as well and showed that students found the experience highly beneficial. recurrent qualitative themes included enhancement of interprofessional knowledge; improvement of interprofessional communication skills; and increased comfort levels on an interprofessional team. applying sit to these outcomes, it is reasonable to assume that students’ collective experiences in the clinical supervision groups at a time when they are developing professional identities will enhance their future behavior as members of an interprofessional team. while responses among nursing and social work students varied in some ways, both groups had positive reactions to the interprofessional clinical supervision groups. many skills, such as giving and receiving feedback and developing a broader understanding of the patient, suggest that this approach as an ipe intervention can improve the quality and safety of care provided. analysis of quantitative data also supports this idea. additionally, this project itself represents improved interprofessional collaboration among faculty members, as the foundation of interprofessional education is modeling of such behavior by faculty. study results further support the idea that emphasis on the importance of interprofessional collaboration is necessary to further ipe in academia. copenhaver & crandall-williams/safe place 332 limitations although attempts were made to minimize perceptions of coercion, the involvement of two faculty members known to the students may have produced some bias in their responses. additionally, the sample size does not allow definitive measurement of the effects of the ipe intervention as sample sizes were too small to determine meaningful inferential statistics. the project site was a public university in a rural area of a midwestern state, therefore further research is needed to replicate findings. furthermore, the initial design of this project did not assess the sustained impact of the clinical supervision groups. there is limited literature that looks at the long-term outcomes of ipe interventions. due to limited follow-up data, a second irb was submitted to allow for follow up data to be solicited. conclusion data suggests that interprofessional clinical supervision groups in higher education show promise as an ipe intervention to prepare undergraduate students for interprofessional practice. this study provides insight into the benefits of group clinical supervision as an ipe method, which existing research has thus far failed to quantify. using the isvs allows better comparisons with other methods. qualitative data illustrates the benefits students gained from the experience such as improved ability to see different perspectives and improved communication skills. as one participant noted, “i have begun viewing clients’ treatment more holistically” which reflects a long-desired outcome sought by many health and social care curriculums. student responses suggest they overwhelmingly perceived the experience of interprofessional clinical supervision groups as beneficial to their future careers as health care providers. interprofessional collaborative practice has the potential to improve patient outcomes and interprofessional group clinical supervision has potential as an ipe intervention in higher education and beyond. since professional identities continue to develop over time, on-going clinical supervision groups may provide professionals of varying backgrounds with opportunities to explore boundaries and promote development of normative fit not only within the educational environment, but in the professional arena as well. further studies need to be completed using larger samples to definitively quantify the impact of interprofessional clinical supervision groups on ipe, icp and ultimately on health care outcomes. additional studies should also explore if the main positive impacts of interprofessional clinical supervision persist and are sustained as undergraduates join the workforce. interprofessional clinical supervision groups show considerable promise as an intervention to prepare undergraduate students to become effective members of an interprofessional team once they enter the workforce. with support from innovative leaders, clinical supervision has promise as a means to develop effective health care teams capable of high-quality patient care. advances in social work, summer 2020, 20(2) 333 references addy, c. l., browne, t., blake, e. w., & bailey, j. 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(2005). interprofessional supervision from the perspectives of both mental health nurses and other professionals in the field of cognitive behavioural psychotherapy. journal of psychiatric & mental health nursing, 12(5), 582-588. https://doi.org/10.1111/j.1365-2850.2005.00878.x author note: address correspondence to ann crandell-williams, department of social work, northern michigan university, 1401 presque isle ave., 2408 jamrich hall, marquette, mi, 49855. email: acrandel@nmu.edu https://primarycare.imedpub.com/preparing-students-to-work-effectively-in-interprofessional-health-and-social-care-teams.pdf https://primarycare.imedpub.com/preparing-students-to-work-effectively-in-interprofessional-health-and-social-care-teams.pdf https://doi.org/10.1111/j.1365-2850.2005.00878.x mailto:acrandel@nmu.edu _________________ deepika goyal, phd, ms, fnp-c is a professor, the valley foundation school of nursing, san josé state university, san jose, ca, 95192-0057. meekyung han, phd, msw, is a professor, school of social work, san josé state university, san jose, ca, 95192-0124. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1135-1146, doi: 10.18060/21640 this work is licensed under a creative commons attribution 4.0 international license. perinatal depression knowledge, attitudes, and beliefs among msw students deepika goyal meekyung han abstract: the purpose of this study was to identify the proportion of master of social work (msw) students who received perinatal depression (pd) training as part of their coursework. additionally, we sought to identify differences in pd knowledge, attitudes, beliefs, and openness to further education between students who had received pd training compared to students without pd training. using a cross-sectional design and convenience sampling, 177 largely female (91.0%), hispanic (46%), and caucasian (28.2%) msw students from five public california universities electronically provided demographic data and completed the depression in women's health settings scale. most msw students reported health/mental health (38%) or children/youth/and families (47.5%) as their field of practice. twenty-nine msw students (16.4%) reported receiving pd training, 61% child abuse/neglect training, and 50% domestic violence training. students with pd training were significantly more knowledgeable and reported having the skills to assess, screen, identify, and care for women with pd symptoms versus students without pd training. given the well-documented association of pd with child abuse/neglect and domestic violence, early pd screening, identification, and referral information must be incorporated into msw curricula and continuing education in order to promote maternal-infant well-being outcomes. keywords: social work training, perinatal depression, postpartum depression, antenatal depression with a prevalence rate of 15 to 20%, perinatal depression (pd) is one of the most common pregnancy-related health problems and a significant public health concern (acog, 2015; sit et al., 2015) that is closely associated with other public health issues including domestic violence (kothari et al., 2016) and child abuse (schury et al., 2017). the perinatal period encompasses pregnancy through the first 12 months after the birth of a child (american college of obstetricians and gynecologists [acog], 2015). hormonal shifts, physical changes, and the emotional demands of the perinatal period can be a vulnerable time for women and places them at an increased risk of developing pd (kendig et al., 2017). perinatal depression is further defined as the onset of depressive symptoms during the pregnancy (antenatal depression) and any time up to 12 months after the birth of a new infant (postpartum depression; acog, 2015). antenatal depressive symptoms are the same as symptoms for major depressive disorder including poor sleep and appetite, anxiety, loss of interest, low mood, and feelings of guilt (american psychiatric association, 2013). antenatal depression has been associated with fetal abnormalities including premature birth, low birthweight, congenital anomalies, and stillbirth (raisanen et al., 2014). a recent meta-analysis indicated 10% of https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2018, 18(4) 1136 women will experience antenatal depressive symptoms (falah-hassani, shiri, & dennis, 2017). when left undiagnosed and untreated, antenatal depression is strongly associated with developing postpartum depression (ppd; faisal-cury & menezes, 2012). affecting up to 20% of new mothers (centers for disease control and prevention, 2017; gaynes et al., 2005), postpartum depression (ppd) presents with a constellation of symptoms including sadness, crying, feelings of inadequacy, guilt, loss of interest, insomnia, anxiety, and somatic symptoms (o'hara & wisner, 2014). although ppd is easily treated once identified, up to 60% of women are left unidentified (ko, rockhill, tong, morrow, & farr, 2017). untreated ppd has been associated with poor maternalinfant bonding and low breastfeeding rates (kingston, mcdonald, austin, & tough, 2015; wouk, stuebe, & meltzer-brody, 2017). additionally, ppd contributes to infant safety risks (e.g., incorrect car seat use, sleep positioning; balbierz, bodnar-deren, wang, & howell, 2015), poor infant feeding practices (e. g. juice; balbierz et al., 2015), and an increased risk of suicide and infanticide (kingston et al., 2015; sockol, epperson, & barber, 2013; wouk et al., 2017). recent research suggests long term consequences of untreated ppd are farreaching, going beyond poor maternal-infant bonding (netsi et al., 2018). children of women with persistent ppd are more likely to exhibit behavioral disturbances at age 3.5, have lower high school math scores, and higher prevalence of depression at age 18 (netsi et al., 2018). although ppd can affect all women, studies show that first-time mothers (leahywarren, mccarthy, & corcoran, 2012), adolescents (torres, goyal, burke-aaronson, gay, & lee, 2017), immigrants/refugees (collins, zimmerman, & howard, 2011), and women from diverse racial or ethnic groups (goyal, park, & mcniesh, 2015; goyal, wang, shen, wong, & palaniappan, 2012; hutto, kim-godwin, pollard, & kemppainen, 2011; ta park, goyal, nguyen, lien, & rosidi, 2015) are at an increased risk. given the morbidity and mortality associated with unidentified and untreated ppd, nationwide organizations have developed position statements and recommendations for screening and management including the american medical association (ama, 2018), acog (2015), the association of women’s health, obstetric and neonatal nurses (awhonn; awhonn position statement, 2015), and at the federal level, the u.s. preventive services task force (uspstf; siu et al., 2016). all of these organizations recommend that childbearing women be screened for depressive symptoms throughout the perinatal period. in 2010, the patient protection and affordable care act (aca) section 2952 included funding to support maternal mental health research and education (us government publishing office, 2010). since the enactment of the aca, research regarding pd identification and treatment has been widely published in the medical and nursing literature. however, screening practices for pd has received little empirical attention especially in the field of social work, with no studies to date that have included master of social work (msw) students in study samples (keefe, brownstein-evans, lane, carter, & rouland polmanteer, 2015). the paucity of research that has included social work is concerning as social workers, particularly clinical social workers, are known to make up the majority of mental health providers and provide mental health services in the u.s. (national association of social workers [nasw], 2017). moreover, social workers interact with childbearing women in a variety of settings including hospitals, employee goyal & han/perinatal depression knowledge 1137 assistance programs, and community mental health programs, where they are well positioned to recognize pd symptoms (nasw, 2017). to our knowledge, only rouland polmanteer, keefe, and brownstein-evans (2016) have examined pd screening practices in the social work arena. their sample of female social workers (n = 261) completed a 32-item online survey about ppd screening practices. over half (n = 149, 57.1%) reported not receiving any information about ppd in undergraduate or graduate coursework, 25% (n = 66) had never used a ppd screening tool, and most reported never having read professional literature on ppd. although welldesigned, study findings had limited generalizability due to the homogeneous sample that was largely (79%) female caucasians. the well-documented effects of untreated pd on the infant (smith-nielsen, tharner, krogh, & vaever, 2016) and long-term child outcomes (netsi et al., 2018) underscore the need to train future healthcare providers, including social workers, to identify pd. based on the limited research to date that has included social workers and none that have included msw students in study samples, the purpose of this study was to answer the following research questions: 1) what percentage of msw students receive pd-related training as part of their professional development?; 2) do msw students with pd-related training have a higher level of pd knowledge?; and 3) do msw students with pd training report increased pd related skills and openness to further education compared with msw students with no pd training? methods study design a descriptive, cross-sectional design was used for this study. the convenience sample was drawn from five public universities across california. all currently enrolled full-time and part-time msw students in face-to-face, hybrid, or online programs were invited to participate. students were not excluded based on program focus. measures participant characteristics. a short demographic questionnaire assessed participant age, gender, education level, type of current field placement/internship and/or employment (hospital, public health, other), and frequency of interacting with women of childbearing age in their place of paid employment or internship placement. perinatal depression knowledge and attitudes. the depression in women’s health settings nurses version (sofronas, feeley, zelkowitz, & sabbagh, 2011) was used to assess pd knowledge, attitudes, and beliefs among msw students. originally developed to assess primary care physician knowledge (leiferman, dauber, heisler, & paulson, 2008), the 40-item questionnaire assesses a broad range of pd-related phenomenon such as healthcare provider attitudes, beliefs, current practices, management, perception of barriers to management of pd, perceptions of patient attitudes towards pd, level of mental health training, and openness to further education. for the purpose of this study, we selected 14 items that assess the level of knowledge and attitudes regarding pd. content advances in social work, fall 2018, 18(4) 1138 validity of the questionnaire was established by women’s health nurses (sofronas et al., 2011). with author permission, questions were modified by replacing the word “nurse” with “social work students” throughout the instrument without effect on the reliability and validity of the tool. the 14 items used to assess pd knowledge and attitudes were scored on a likert scale from 1 (strongly disagree) to 6 (strongly agree). despite the small sample size and the number of questions, this 14-item subscale demonstrated fairly good internal consistency with this sample (cronbach alpha = .74). further, we chose three items to assess pd-related openness (cronbach alpha =.80 in this sample) and one item to specifically measure students’ perceived pd-related skills. data collection procedure after obtaining university human subjects’ approval, an e-mail describing the study and a link to the questionnaire was sent to directors of social work schools at 17 public universities within the california state university system. directors were asked to distribute the study information through student e-mail listervs to all msw social work students. five of 17 (30%) directors and/or chairs of social work schools agreed to distribute the study information to their students. three of the schools were located in northern california and two were located in southern california. after reading a short introduction about the study, students wishing to participate were directed to a qualtrics® survey link that included an informed consent and the online survey. to maintain participant anonymity, no directly identifiable information was requested. to enhance participation, five $20 amazon gift cards were distributed through a raffle at the end of the study. participants who wanted to take part in the raffle provided an e-mail address at the end of the survey. in order to maintain participant anonymity, email addresses were copied onto a separate document before the winners were randomly selected. data analysis demographic data and level of pd knowledge were analyzed using descriptive statistics (frequencies, means, and measures of central tendency). in response to research question one, descriptive analyses (i.e., frequencies and percentages) were conducted to identify the number of msw students who had received pd-related training as part of their msw education. based on the training categories used in research question one, students who had received any pd-related training were coded as 1 and considered “group a: students with pd training,” and students who reported receiving no pd training were coded as 0 and referred to as “group b: students without pd training.” for research question two, an independent samples t-test was conducted to examine whether there were significant differences between the two groups of msw students with regards to their knowledge, attitudes, and beliefs regarding pd. for research question three, an independent samples ttest was conducted to investigate whether there were significant differences between the two groups of msw students with regards to their pd-related skills and openness to further education. for both research questions two and three, a two-tailed test was used because goyal & han/perinatal depression knowledge 1139 the current study was an exploratory analysis and did not specify whether there might be significant difference between the two groups on knowledge and attitudes towards pd (research question two), and pd-related skills and openness (research question three). all analyses were performed using ibm spss statistics 24. results participant characteristics. of the 233 returned surveys, 177 (76%) were completed and thus included in the data analysis. the sample was primarily female (n = 161, 91.5%), hispanic (n = 82, 46.3%), single (n = 102, 57.6%), ranged between 21 and 57 years of age, with a mean of 31.2 (sd = 7.4) years. one-third (n = 68, 38%) reported that their field of practice/concentration was the health/mental health field and 48% (n = 84) focused on children, youth, and families. see table 1 for full participant characteristics. table 1. participant characteristics (n=177) characteristic n (%) gender female 161 (91.0%) male 15 (8.5%) prefer not to answer 1 (0.5%) race-ethnicity hispanic 82 (46.3%) caucasian 50 (28.2%) asian/asian american 15 (8.5%) african american 12 (6.8%) biracial/multiracial 7 (4.0%) other 5 (2.8%) native american 3 (1.7%) middle eastern 3 (1.7%) marital status single 102 (57.6%) married 64 (36.2%) cohabitating/domestic partnership 6 (3.4%) engaged 3 (1.7%) prefer not to answer 1 (1.1%) field of practice children, youth and families 84 (47.5%) aging 68 (38.4%) health/mental health 15 (8.5%) community development & administration/management 8 (4.5%) no response 2 (1.1%) type/frequency of professional development training. as shown in table 2, child abuse/neglect (60.5%) was the most frequently reported training. only 16.4% of msw students reported they had received pd-related training. advances in social work, fall 2018, 18(4) 1140 table 2. percentage of students receiving pd-related training type of training receiveda n (%) child abuse/neglect 107 (60.5%) general depression 91 (51.4%) domestic violence 88 (49.7%) substance abuse 85 (48.0%) other mental health problems 84 (47.5%) none 52 (29.4%) symptoms of perinatal depressionb 29 (16.4%) note: a participants were asked to indicate all training they had received. the cumulative frequencies exceed the value of 100% (n = 177) because of multiple indications; b including postpartum training and depression during pregnancy. association between pd related training and knowledge, attitudes and beliefs regarding pd. table 3 presents the mean score for the 14 items that measured pd knowledge and attitudes of participants for the whole sample. means are also presented for participants who had received pd-related training (group a) (n=29) and for those who had not received pd-related training (group b) (n=148). findings for all participants suggest that students in this study generally showed a good understanding of depression (e.g., “i am familiar with the diagnostic and statistical manual of mental disorders, fifth edition (dsm-5) criteria for depression,” [m = 4.47, sd = 1.45], and “i feel comfortable talking about depression with patients,” [m = 5.13, sd = 0.94]), and a good sense of their responsibilities regarding pd (e.g., “recognizing symptoms of maternal depression (smd) is my responsibility,” [m = 4.67, sd = 1.28], “intervening in smd is my responsibility,” [m = 4.74, sd = 1.25], and “it is my responsibility to refer depressed moms for further mental health treatment” [m = 5.27, sd = 0.97]). participants reported relatively less knowledge of pd itself and assessments and interventions related to smd (e.g., “smd are as common in the perinatal period as 2-3 years postpartum,” [m = 3.79, sd = 1.42], “i feel confident in my ability to assess for smd,” [m = 3.51, sd = 1.38], and “i feel confident in my ability to intervene with smd” [m = 3.91, sd = 1.46]). to address research question two, a comparison of the two groups of students indicated that participants who had received any pd-related training (group a) showed a higher level of pd knowledge (“smd are as common in the perinatal period as 2–3 years postpartum,” t (175) = -2.05, p < .05, a higher level of confidence in ability to assess smd (“i feel confident in my ability to assess for pd,” t (175) = -3.83, p < .001, and a higher level of confidence in their ability to intervene for pd (“i feel confident in my ability to intervene with smd,” t (175) = -3.08, p < .005 compared to their counterparts who had not received any specialized pd training (group b). goyal & han/perinatal depression knowledge 1141 table 3. social work students’ attitudes and beliefs regarding perinatal depression questionnaire item m (sd) all (n=177) with pd training (n = 29) without pd training (n=148) depressed moms provide more inconsistent care 4.06 (1.48) 4.79 (1.37)** 3.92 (1.46) pd often goes away without treatment 2.75 (1.39) 2.55 (1.64) 2.78 (1.34) it is normal for pregnant women and mothers of young children to feel depressed 3.81 (1.50) 3.90 (1.48) 2.55 (1.64) recognizing pd is my responsibility 4.67 (1.28) 4.74 (1.58) 4.66 (1.22) recognizing pd is my unit’s responsibility 4.67 (1.24) 4.76 (1.46) 4.66 (1.19) intervening in pd is my responsibility 4.74 (1.25) 4.82 (1.44) 4.72 (1.21) it is my responsibility to refer depressed moms for further mental health treatment 5.27 (0.97) 5.14 (1.33) 5.29 (0.89) i am familiar with the dsm-v criteria for depression 4.47 (1.45) 5.00 (0.96)* 4.36 (1.50) pd are as common in the perinatal period as 2–3 years postpartum 3.79 (1.42) 4.28 (1.44)* 3.69 (1.40) i feel confident in my ability to assess for pd 3.51 (1.38) 4.38 (1.08)*** 3.34 (1.17) i feel confident in my ability to intervene with pd 3.91 (1.46) 4.66 (0.97)** 3.76 (1.50) i feel comfortable talking about depression with patients 5.13 (0.94) 5.38 (0.68) 5.08 (0.98) i am familiar with available mhr in my institution 4.75 (1.29) 5.41 (0.73)** 4.61 (1.33) i am familiar with available mhr in the community 4.78 (1.10) 5.28 (0.70)** 4.69 (1.13) note: mhr=mental health resources; * p < .05, ** p < .01, *** p<.001 (2-tailed) association between pd-related training and pd-related skills and openness to further education. the independent samples t-test (see table 4) indicated that no statistical difference was detected in the participants’ openness to receiving further pdrelated training. specifically, group a (m = 4.34, sd = 0.86) reported a higher level of perceived skills in pd screening/detection than their counterparts in group b (m = 3.59, sd = 0.71), t (173) = -5.054, p < .001. all participants showed a high level of willingness to fill out a screening tool (m = 5.24, sd = 0.87), to intervene based on the results of screening (m = 5.37, sd = 0.80), and to learn about ways to enhance communication about smd (m = 5.57, sd = 0.62). table 4. social work students’ mental health training and openness to further education questionnaire item m (sd) all (n=177) with pd training (n = 29) without pd training (n=148) do you think you have the appropriate skills to assess, screen, and care for women with pd? 3.71 (0.79) 4.34 (0.86)*** 3.59 (0.71) willing to fill out screening tool 5.24 (0.87) 5.21 (0.94) 5.25 (0.86) willing to intervene based on results of screening 5.37 (0.80) 5.48 (0.69) 5.34 (0.83) willing to learn about ways to enhance communication regarding pd 5.57 (0.62) 5.62 (0.69) 5.56 (0.64) *** p <.001 (2-tailed test) advances in social work, fall 2018, 18(4) 1142 discussion to our knowledge, this is the first study to examine pd screening, knowledge, identification, beliefs, and attitudes among a diverse sample of msw students. sixty percent of participants reported they had received training related to child abuse/neglect and about half of participants (49.7%) reported they received training on domestic violence. however, only 16.4% reported receiving any pd training which is concerning given the well-documented association of pd with domestic violence (kothari et al., 2016) and child abuse (schury et al., 2017). moreover, the majority of participants reported working with families (47.5%) or in the health/mental health field (38%), placing them in direct contact with women of childbearing age. findings of this study should be interpreted with caution given the relatively small convenience sample from one geographic area and the use of self-report questionnaires. moreover, since the survey was administered via an anonymous electronic link, the exact respondent rate is unknown, further limiting our findings. participants in this study included part-time, full-time, as well as first year students. first year msw students without previous social work experience and without pd knowledge may have skewed results in favor of low-level exposure to pd. additionally, a cause and effect relationship between pd-related training and pd knowledge/skills cannot be ascertained due to the cross-sectional design of this study. further, although the sub-scales used in the data analysis demonstrated good reliability, they were modified from their standard forms. further testing on larger samples is necessary to validate these scales. lastly, as addressed in the results section, we created a dichotomous variable based on pd-related training; however, this variable did not take into account factors including any content-related information, frequency and length of any training received, or the helpfulness/usefulness of training. future studies should consider these factors. conclusions and future directions findings of this study reveal limited pd training in a racially and ethnically diverse sample of msw students. given the well-documented association of pd with child abuse/neglect and domestic violence, it is essential for pd education to be threaded throughout social work curricula. the national association of perinatal social workers (napsw, 2009) approved standards of care for social workers specifically working with women experiencing pd. the low proportion of msw students knowledgeable about pd in our study is concerning. among the nine competencies strongly suggested for social work programs by the council on social work education (cswe, 2015), the addition of pd content directly relates to competency 4, “engage in practice-informed research and research-informed practice” (cswe, p. 8). pd education training and education should be offered to all msw students in order to build and expand the “informed” future professional workforce as social workers often come in contact with women during the perinatal period. an interdisciplinary approach to managing pd (selix et al., 2017) should be integrated into social work curricula (keefe et al., 2015) along with providing msw students with tools to promote timely referral and treatment and to reduce the risk of child abuse/maltreatment. in addition to the traditional goyal & han/perinatal depression knowledge 1143 classroom setting, technological options (e.g., smartphone applications, webinars, online short courses) should be examined as ways to provide pd education and information to msw students and practitioners. field offices of msw programs should establish partnerships with key community perinatal care stakeholders and develop interdisciplinary training materials and consider utilizing pd experts to conduct workshops. educating future social workers regarding pd screening, referral, treatment options, availability of 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(2017). patterns of symptoms of perinatal depression and stress in late adolescent and young adult mothers. journal of obstetric, gynecologic, & neonatal nursing, 46(6), 814-823. doi: https://doi.org/10.1016/j.jogn.2017.08.002 us government publishing office. (2010). the patient protection and affordable care act: subtitle lmaternal and child health services, sec. 2952 retrieved from https://www.gpo.gov/fdsys/pkg/plaw-111publ148/pdf/plaw-111publ148.pdf wouk, k., stuebe, a. m., & meltzer-brody, s. (2017). postpartum mental health and breastfeeding practices: an analysis using the 2010–2011 pregnancy risk assessment monitoring system. maternal and child health journal, 21(3), 636-647. doi: https://doi.org/10.1007/s10995-016-2150-6 author note: address correspondence to: meekyung han, phd, msw, school of social work, san josé state university, san jose, ca 95192-0124. meekyung.han@sjsu.edu acknowledgements: we thank the california state university chairs and directors of schools of social work for their support and the study participants for completing surveys. funding for this study was provided by a research and scholarly activity grant from the college of applied sciences and arts, san josé state university, san jose, ca. https://doi.org/10.1111/sjop.12321 https://doi.org/10.1016/j.cpr.2013.10.004 https://doi.org/10.3109/01612840.2011.609635 https://doi.org/10.1007/s11414-015-9476-5 https://doi.org/10.1016/j.jogn.2017.08.002 https://www.gpo.gov/fdsys/pkg/plaw-111publ148/pdf/plaw-111publ148.pdf https://doi.org/10.1007/s10995-016-2150-6 _________ stephanie odera, ed.d, msw, associate professor, teaching and director of field education, m. alex wagaman, phd, msw, associate professor, ashley staton, b.s, msw student, and aaron kemmerer, msw, doctoral student, school of social work, virginia commonwealth university, richmond, va. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 801-820, doi: 10.18060/24151 this work is licensed under a creative commons attribution 4.0 international license. decentering whiteness in social work curriculum: an autoethnographic reflection on a racial justice practice course stephanie odera m. alex wagaman ashley staton aaron kemmerer abstract: the social work profession has historically been dominated by the presence and perspectives of whiteness. the centering of whiteness in social work education is reflected in course offerings, course content, assignment construction, and inherent racialized assumptions about who clients and social workers will be in practice spaces. critical race theory (crt) and liberation theory provide a framework for considering how to make visible the ways in which white supremacy is embedded in social work education, and to identify strategies for disrupting its presence by decentering whiteness. the purpose of this project is to foster critical thought about ways to dismantle racism and white supremacy in social work educational spaces. using the reflexive methodology of collaborative autoethnography, the four authors two course instructors and two students with varying racial identities and positionalities, reflected on the experiences of coming to, being in, and transitioning out of the course. areas of convergence and divergence in the autoethnographic reflections revealed strategies such as embracing vulnerability, promoting authentic relationships, and normalizing emotional as well as cognitive engagement for decentering whiteness in social work education. implications and recommendations for social work educators and students committed to engaging in antiracist practice are also discussed. keywords: decentering whiteness, social work education, anti-racist, critical race theory, autoethnography social workers are expected to confront social injustices such as discrimination and oppression using a culturally sensitive lens, while social work programs are required to ensure students “engage diversity and difference in practice” (council on social work education [cswe], 2015, p. 7; national association of social workers [nasw], 2017). both the nasw and cswe have publications outlining the concept of cultural competence, encouraging social workers to acknowledge cultures other than their own and understand that diversity has an influence on an individual’s behaviors and thoughts. while these guidelines addressing diversity exist, research has found a significant gap in social work’s ability to address racism in an explicit manner (campbell, 2017). as racial injustices continue to persist, social work education focuses on prejudice reduction, equity, and normalizing oppression and privilege rather than addressing the oppression that fuels these plights (constance-huggins, 2012). the systemic refusal to address the roots of racial inequality permeates to the individual, as research has found that students and educators alike tend to resist their own racial privilege. the profession itself promotes racial homogeneity, as 69% of social workers are white and mostly female (salsberg et al., about:blank advances in social work, summer 2021, 21(2/3) 802 2017). the lack of diversity in the profession places a continued strain on the relationship between social workers and clients in black, indigenous and latinx communities, as well as black, indigenous and latinx folks who choose to practice social work. the glaring gaps in the social work community have inspired many to take a closer look at social work curriculum. critical race theory (crt) has been a foundational influence, as it acknowledges race as a social construct and racism as integral to society (constance-huggins, 2012). crt also emphasizes intersectionality, or the interconnection of one’s identities, encouraging acceptance and empowerment of the human experience as pedagogy (wagaman et al., 2019). to maximize the advantages of lived experiences, liberation theory can be paired with crt, as it removes the power differentials from the classroom, making educator and student learning equals. by utilizing crt and liberation theory, the social work classroom can be an environment of personal and professional growth. two professors at a predominantly white institution in richmond, va created this environment in their own classroom in the spring of 2020. the societal landscape changed drastically during the course, disrupting the delivery of the course but increasing the relevancy tenfold, as a global pandemic exposed racial disparities in healthcare and video footage exposed systemic racism in the police force. using collaborative autoethnography, the professors, along with two students, reflect on their experiences with the course. literature review extant literature suggests that social work educators should become versed in pedagogical techniques aligned with crt and liberation theory as mandatory aspects of the social work curriculum (campbell, 2017; constance-huggins, 2012; einbinder, 2020; nixon & mcdermott, 2010; olcoń et al., 2020; razak & jeffery, 2002). schools of social work, by offering formal training programs for future social workers, assume an ethical responsibility to embody antiracism, yet curricula typically utilize hegemonic “multiculturalism” and “cultural competency” models to discuss race in the classroom (campbell, 2017; constance-huggins, 2012; ladson-billings & tate, 1995/2017; razack, 2002). critical race and liberation theories urge us to move beyond these models. this is not merely a theoretical proposition, but a practical necessity—social workers can both cause social change as racial justice agents and cause harm to black, indigenous, and latinx communities as pawns of state repression; thus, researchers urge social workers to embrace an anti-oppressive community practice model and strive for community equity (edmonds-cady & wingfield, 2017). critical race theorists assert that racism is the water we swim in. crt emerged from legal scholarship in the 1980s as a system of analyzing race and racism in u.s. law (hutchinson, 2004). crt developed in response to the slow pace of transformation of racial oppression in the u.s., despite the civil rights movement’s liberal and legal strategies to address racism (constance-huggins, 2012). nearly four decades of development expanded crt’s influence into interdisciplinary terrain — including social work education (einbinder, 2020). as early as 2002, social work scholars razak and jeffery introduced eight crt-inspired tenants for social work: (1) racism as the norm, (2) odera et al./de-centering whiteness 803 value of storytelling, (3) critique of liberalism, (4) recognizing power and privilege, (5) critique of whiteness, (6) integrating antiracist discourse, (7) legitimizing race scholarship, and (8) globalized understandings of race (razak & jeffery, 2002). the endemic nature of racism shaping compulsory and institutional education in the u.s. shapes the professional training experiences of the country’s social workers (ladsonbillings & tate, 1995/2017, p. 18). before they decide to follow the social work career path, conventional school systems socialize university social work students: public high schools, community colleges, and state universities. lower socioeconomic backgrounds in families of origin plus the desire to serve their communities typically motivate black, indigenous, and latinx social work students’ career choices (carlton-laney, 1999; daniel, 2011). simultaneously, black students at predominantly white institutions report experiencing microaggressive violence during their experiences in graduate-level social work education (hollingsworth et al., 2018). under these racist educational conditions, earning an advanced degree becomes deeply associated with both racial and socioeconomic privilege. racial capitalism makes the disentanglement of race and class unrealizable; thus, we must address their simultaneous role in racialized educational disparities along with other systems of oppression such as patriarchy and heterosexism (card, 2020). the entanglement of race and class speaks to the larger need to incorporate an intersectional theoretical approach to understanding oppression and guiding anti-oppression education. intersectionality [also coined by a legal scholar, kimberle crenshaw (1991)] offers a perspective on the collective and individual experiences of people who embody multiply marginalized identities under interlocking oppressive social systems such as race, class, gender, ability, region, and sexuality (crenshaw, 1991; dill & zambrana, 2009). we need an intersectional approach to understanding inequity, yet because of the tendency to erase race in (neo)liberal institutions, we must focus on the primacy of race as a social determinant in u.s. society. ladson-billings and tate (1995) asserted race remained untheorized into the mid-1990s: marxist theory related to class, feminist theory to gender, but neither theoretical model genuinely considered racism in theorizing social inequity. ladson-billings and tate also analyzed race and property rights in the u.s. and problematized simplified black/white notions of ethnicity and race. the (neo)liberal u.s. context frames equality in terms of individual property rights; the authors argued that educational curriculum extends this concept in the notion of intellectual property rights (ladson-billings & tate, 1995/2017). rejecting propertyand rights-based concepts of “knowledge production” connects to liberation theory, which serves as another theoretical foundation for racially just social work education. brazilian educator and philosopher, paulo freire proposed that liberatory education recognizes students as subjects, not objects and emphasizes the co-creation of knowledge among facilitator-educators and learners, rejecting the capitalist “banking metaphor” that characterizes knowledge as possessed by the educator and somehow disbursed to students (brigham, 1977). the incorporation of liberation theory, intersectionality, and crt in our analysis speaks to the epistemological task inherent in dismantling oppressive systems and the need to accept multiple ways of knowing and learning. liberation theory promotes freire’s argument against teacher-student hierarchies, metaphorized in a “banking” model advances in social work, summer 2021, 21(2/3) 804 of education. in this educational scenario, typical of the u.s. classroom, the teacher supposedly holds “the knowledge” which will be distributed to the students’ minds through lecture-notetaking (brigham, 1977; freire, 1970/2005). liberation theory stems from liberation theology and the spiritual nature of social action. multiracial feminists (like gloria anzaldúa, bell hooks, audre lorde) uplift the practices of “loving criticism,” such as honoring and “recovering old knowledges,” (doetsch-kidder, 2012, p. 449), accepting our shared humanity while theorizing difference, accepting the powerful nature of pain stemming from oppression, facing conflict with kindness, and nourishing ourselves through positive action. theorist-activists underscore liberatory spiritual practices to ground social change work, writing that the systemic nature of oppression requires lifeaffirming spiritual practices in order to dismantle oppressive systems while healing ourselves and transforming society (doetsch-kidder, 2012). importantly, crt and liberation theory explicitly reject individualist frameworks, while recognizing the inadequacy of an oppositional “counterstance” and the deep personally felt pain of racial oppression (doetsch-kidder, 2012). these theoretical groundings also ask us to practically reimagine educational spaces and authentically embody racial justice practice in classroom activities. as brigham pointed out in 1977, it is impractical for social work educators to employ the traditional “lecturer-notetaker” model for teaching about group work. correspondingly, social work educators who wish to embody racial justice practice must design courses specifically to decenter whiteness in syllabi and classroom dynamics (anaissie et al., 2020). in a content analysis of 14 peer-reviewed articles related to social work and crt published from 2007 to 2014, campbell (2017) shows education was a major theme — 43% of content focused on social work curricula and education. campbell reiterates the importance of the paradigmatic shift from “cultural competency” and “multiculturalism” toward critical race theory, as many researchers discuss the importance of creating educational environments that disrupt traditional hierarchies and engage students on individual/personal levels. researchers also found that while addressing the systemic nature of race, racism and racial-consciousness, social work students struggle with the emotional nature of internal work to unlearn racist beliefs and patterns (brigham, 1977; campbell, 2017; constance-huggins, 2012; einbinder, 2020; nixon & mcdermott, 2010; olcoń et al., 2020). this point brings up questions about how whiteness is centered and requires decentering in antiracist social work educational discourse. use of “voice” and counter-narrative is a central strategy of crt in education: storytelling underscores the social construction of racial realities and provides a situational context for understanding race. stories can affect the behavior of the oppressor and serve as “psychic preservation of marginalized groups” (ladson-billings & tate, 1995/2017, p. 20). they write, “storytelling has been a kind of medicine to heal the wounds of pain caused by racial oppression” (p. 21). scholars view the contrast between the traditional civil rights legal approach and crt legal approaches as analogous to the central tension between a multicultural paradigm and critical race theory in education (ladson-billings & tate, 1995/2017). by 1995, a watered-down “multiculturalism” emerged as the paradigm for talking about race in education. as a much less critical version of the intentions of liberation movements of the 1960s and 70s, multiculturalism is a political philosophy https://doi.org/10.5296/jsr.v9i1.11965 odera et al./de-centering whiteness 805 urging respect and “tolerance toward many cultures” without explicitly naming racial hierarchies (ladson-billings & tate, 1995/2017, p. 24). in 2020, a quarter-century later, where is social work education? stagnant on multiculturalism and cultural competency? for nearly two decades, scholars like razak and jeffrey (2002) have been urging the field to embrace crt and a growing cadre of social work educators are echoing their call today. across disciplines, our current moment requires a more thorough, rigorous, and critical antiracist pedagogy; and social work education particularly requires drawing from crt, intersectionality, and liberation theory (brigham, 1977; olcoń et al., 2020; wagaman et al., 2019). method in an effort to honor the theoretical underpinnings of intersectionality, critical race and liberation theories, collaborative autoethnography (cae) was chosen as the research methodology for this study. cae is a reflexive methodology that aligns with the principles of crt and liberation theory by centering (counter)storytelling, resisting a dominant narrative, and openly addressing power. this methodology is also multi-vocal, relational, and centers dialogue, which are core components of anti-racist practice. given the intention of the course and the dynamic time in which it was offered, it was important to examine the course through various lenses of positionality, relationship, and the complexities of navigating the covid-19 pandemic. even as the course was being developed, the two instructors discussed the idea of cae as a tool to examine the pedagogical intent and impact of the course as well as the multi-racial lens that was used in course development. as a qualitative ensemble methodology, cae centers the collective “we” in research as opposed to the individualistic “i” that is often seen as preeminent in research (hernandez et al., 2017). with the intention of dismantling white dominance in social work education, it was important to avoid research methodologies that reinforced the value of singular expertise without adequate acknowledgment of positionality and relational consciousness. as audre lorde (1984/2007) notably stated, “the master’s tools will never dismantle the master’s house” (p. 111). cae as a liberatory research practice acknowledges difference in identity and power, and attempts to create and explore knowledge with instead of for others (anaissie et al., 2020). additionally, thinking about the role of social work education, utilizing a research methodology that is a model for practice with clients is an additional attempt to decenter whiteness in favor of collective voice throughout this process. the philosophical values of cae offered the authors the opportunities to engage in participatory storytelling, explore areas of divergence and convergence in perspective and experience within the course, embracing ambiguity, emergence, and exploration as a destination instead of a starting point. with the intention of resisting traditional power structures within academe and white dominant narratives regarding expertise, the authors consciously chose to center the voice of both student and instructor. in an effort to contextualize the author voice and variation of experience during the course, positionality statements have been included in table 1 below. aligned with antiadvances in social work, summer 2021, 21(2/3) 806 racist practices, noting positionality within teaching and research acknowledges the influence of identity, location, time, and space on our work and understanding of it. positionality statements table 1. author positionality statements author positionality statement a1 i enter this process as a black, cisgender woman, raised in the south by a single parent. growing up in a working class neighborhood, i learned the value of community and collective responsibility. i am able-bodied and have terminal practice degrees in both social work (msw) and education (edd). my auto-ethnographic reflection is based on my role as a co-instructor of the racial justice course being examined. a2 i enter this process as a white, cisgender, middle class, able bodied, queer woman. i have a phd in social work and am a tenured faculty member in the social work program where this class was taught. i was born and raised in the southern u.s., in communities where i observed significant racial injustice about which i rarely had opportunity to discuss. my auto-ethnographic reflection is based on my role as a co-instructor of racial justice course being examined. a3 i enter this process as a black, able-bodied, working class, cisgender woman. i was raised by my pentecostal paternal grandmother who protected me from the poverty, racism, and sexism we experienced in our southern home. i am currently pursuing my masters of social work. my autoethnographic reflection is based on my role as a student in the racial justice course. a4 i enter this process as a white, transgender, queer, working class, able-bodied person. i am currently in a doctoral program studying social work, although i was finishing the msw program during this course. i was born in the north to a jewish family who moved south, where i witnessed myriad social injustices about race, class, gender, and sexuality. my autoethnographic reflection is based on my role as a student in the racial justice course. each author positionality statement was written independent of each other and without prior discussion. authors statements are an authentic reflection of how they see themselves positioned within the world. course overview during the spring 2020 semester, a racial justice practice course was offered to msw students as a topical elective. the primary objective of the course was to prepare students to engage in racial justice work across multiple settings of micro, mezzo, and macro practice settings. using the four modules of examining self, engaging one another, analyzing our context, and actionizing collective liberation as a framework, the course explored topics such as anti-black racism, white fragility and dominance, identity salience and intersectionality, and intergroup dialogue. the course was designed and co-taught by two instructors of differing racial backgrounds. the instructors sought to model racial liberatory practices in their pedagogy by using their positionality and relationship with each odera et al./de-centering whiteness 807 other to engage students in critical thinking and dialogue regarding race, racism, and justice. a note about context it is important to note that the covid-19 pandemic occurred while the course being discussed in this manuscript was offered. the disruption of the pandemic not only significantly altered how the course was delivered, it also impacted how the authors reflected on the experience. it was impossible to reflect on the course without acknowledging the devastating impact of the virus. the shift to exclusive online learning occurred at the halfway point of this course and prevented the instructors and students from finishing the course as planned. while every attempt was made to maintain the integrity of the course and the explicit anti-racist focus, the perpetual impact of the pandemic must be noted. it is also important to note that the pandemic continued throughout the collaborative autoethnographic process that resulted in this manuscript. while we can only speculate as to how the cae method would have been implemented in a different time and context, it is most likely that the reflective meetings would have happened in person rather than virtually. otherwise, the method was carried out in a manner that would have been similar in a non-pandemic context. the reader can infer what they will about the impact of the virtual reflection meetings on the outcome of the study. the authors were all personally and professionally impacted by the pandemic, which may have had a greater impact on reflections than any methodological adaptations. table 2. reflective prompts framing our cae reflective prompt key questions 1. coming to the class • what did you think and/or feel about joining the racial justice social work practice course? • what assumptions (if any) did you make about the course? • what led you to the course? 2. being in the class • what was your experience being in the course? • what did you notice? • were you impacted in any way? if so, how? 3. transitioning out of the course • what did you think and/or feel as you left the racial justice practice course? • what did you take with you and to what spaces did you take it? process shortly after the conclusion of the course, the instructors approached two students to discuss this study, methodology, and the intended impact. beginning with an exploratory conversation set the tone for what the process would be as well as how each researcher advances in social work, summer 2021, 21(2/3) 808 would honor the unique perspective that the others brought to the process. through an engaged discussion, the authors mutually agreed upon three reflective prompts for individual and group processing. see table 2 for a list of reflective prompts we used to frame our cae. each author was given one week to respond to each reflective prompt. at the end of the week, the authors exchanged reflective writing and read each other’s responses. after a week for review, the authors met virtually to check in with each other, discuss the prompt and the process of writing. the authors also discussed the upcoming writing prompt and the timeline for the manuscript. meetings were audio-recorded and transcribed. additionally, we co-created guidelines to inform the reflective writing process. see table 3 for a list of process guidelines for the project team. table 3. process guidelines for the project team • space will be made for different forms of writing and expression. rather than privileging academic writing, we will open it up to the form that is most comfortable to the writer. this is not to say that academic writing will not be an option, just not the only option. • each writer will write for expression and openness. the writing piece will be shared internal to the project team only, and selected reflections will be edited (with writers having control over what is included in the final version) as a team before being sent out for publication. • the team will discuss and be attentive to the literal and visual power that is given to each voice. • we will talk openly about power at our debriefing meetings. • if a project team member decides to end participation prior to project completion, then they will have full control over whether their stories are removed or kept in the project. • we will try not to self-edit too much before sharing our writing with each other. • let your process come as it comes. reflections can be submitted as poetry, narrative, visual, etc. analysis in cae, data is created through narrative and repetitive, collective reflection (gant et al., 2019). words, tones, inflections, and any other evidence of reflection are analyzed through lenses of connection and relationship, positionality, and current socio-cultural phenomena (gant et al., 2019; tham et al., 2020). analysis in cae is truly dynamic in that each author is not only engaging in radical self-study, but transformative collective examination as well. relationships often shift and deepen through the process of repetitive reflection and discussion. in the words of famed author anais nin (1974, as cited in gant et al., 2019) “we write to taste life twice…in the moment and in retrospection” (p. 149). within this study, the authors reviewed each prompt again as well as the transcriptions of each of their virtual meetings once all three reflective prompts were completed. the use of cae as a qualitative methodology helped neutralize power amongst the authors, as everyone was equally required to be vulnerable in their individual prompt reflections as well as during the reflective dialogues that occurred after each writing prompt. cae allowed the authors to step in, out, and aside in the examination of the course from multiple odera et al./de-centering whiteness 809 vantage points. through analysis of personal and collective narratives and emergent reflection, the authors were able to interrogate assumptions made about the function of social work education, target audiences for anti-racist education, and the value of intellectual and emotional engagement in teaching. through several rounds of review, reflection, and collective processing, the authors identified several themes. the authors also uncovered several points of convergence and divergence in reflection. additionally, similarities and differences were uncovered related to author positionality, specifically in regard to racial positionality. these themes will be defined and explored further in the following section. limitations as with most studies, limitations exist. as previously noted, the impact of the pandemic undoubtedly influenced the conclusion of the course as well as the way in which the authors reflected upon it. teaching the course uninterrupted for a second time and engaging in the cae process with another group of students may yield different results. however, the value of cae is in the positional storytelling. the pandemic became a part of the course and in many ways during the instructions and subsequent reflection served to further illuminate racial disparities discussed in the course as well as the role of social work in addressing them. while cae may not be a widely used or popular methodology, the authors believe that social work educators can learn from the practice, particularly as they seek to deepen their understanding of racial justice and anti-racist pedagogical practices. what it does not lend itself to is findings that can be generalized to other contexts. a different method would be required to include the experiences of all people who participated in the course. findings/uncoverings we use the word findings to introduce this section because it is a positivist research tradition; rooted in the belief that we have somehow discovered something new and not yet known. but we know and feel compelled to acknowledge that this is not the case. so we choose to use the word uncoverings too because it better describes what we present here. this knowledge is not new. it has been known and has been silenced for a long time. black, indigenous, and latinx students and faculty in social work programs have been talking about the need to decenter whiteness in spaces and places where they have found one another and sought refuge from the violence that is white supremacy in the social work classroom (carlton-laney, 1999; daniel, 2011; einbinder, 2020; hollingsworth et al., 2018; nixon & mcdermott, 2010; razak, 2002). they have also spoken publicly about these experiences, forming organizations like the national association of black social workers (nabsw) in direct resistance to the erasure of black knowledge and practices in social work education (nabsw, 1998, 2020). our collaborative autoethnographic process has simply uncovered some of these truths and we use this space to lift them again, perhaps extending in some small way, while acknowledging the shoulders of many students, scholars and faculty who have come before us. advances in social work, summer 2021, 21(2/3) 810 three primary areas of convergence and three primary areas of divergence emerged from the individual and collective analysis of the data generated through our collaborative auto-ethnographic process. these uncoverings will be described in this section with emphasis on the ways in which these areas offer insight into strategies and considerations for decentering whiteness in the social work classroom. the words and reflections of the co-authors will be woven into the descriptions in order to illustrate how points of convergence and divergence manifested in our experiences. overall, our reflections through the autoethnographic process highlighted some important lessons for social work educators seeking to decenter whiteness in course design and implementation. we will begin with these. first, decentering whiteness requires constant and persistent effort. it does not happen solely in the course design process. it requires a vigilance that is maintained through consistent and intentional reflective practices. these practices require an examination of self that is painful and uncomfortable. use of self is necessary. and in that, reflexivity is key. second, decentering whiteness is not just about changing texts and creating new assignments. it must be embedded in the very essence of the classroom, which is a politicized space. and it requires an ability and willingness to identify the educational practices that need to be resisted as well as the pivots required to move us away from what we have come to know and understand as a learning space. in particular, whiteness has been conflated so perniciously with concepts like rigor and quality and effectiveness in educational settings that making intentional moves to decenter it can generate internal and external resistance. white supremacy is embedded in us all. and it can cause us to doubt and question ourselves and the credibility of anything different. this process of questioning and resisting is best done in relationship and community. and third, the work of decentering whiteness in social work education is simultaneously exhausting and liberating. it is important to find and soak up the moments where we feel the latter to fortify us for the long-term investment this requires. like any social work practice though, the proximity to those most directly affected (in this case the social work students) reinforces our awareness that this decentering is necessary. it is essential. it cannot be ignored. if we don’t make movement in the direction of decentering whiteness we are complicit in causing harm. areas of convergence centering relationship and connection as a praxis a primary area of convergence across all of the reflections and discussions among the authors was the importance and value of relationships and connection. pre-existing relationships and connections were what brought each of us to the course, intentional efforts to build connections within the classroom created spaces for vulnerability that fostered learning, and relationships allowed for a level of reflexivity about dynamics within the classroom that fostered analysis and practice that would have otherwise been unattainable. in reflecting on the first day of class, a3 described the chemistry she felt between the instructors. odera et al./de-centering whiteness 811 we were all in a relationship rather than a lecture. a1 and a2 intentionally talked about their connection and relationship with the class, including their desire to model interracial racial justice work as co-instructors of the course. as a2 shared in one of her reflections, we [a1 and a2] built in a lot of time to prepare and feel centered in our process and planning, which really helped us to pay attention to where we might be slipping into modeling things we didn’t want to reflect in the class. and just like we do in other places/spaces where we work together, we centered our relationship first. if we weren’t ok then we didn’t push into the work until we were. the relationship between a1 and a2, as co-instructors, was invested in throughout the course. there were multiple weekly meetings for reflection and class preparation. there were conversations about intentional use of self, particularly our racialized selves, to challenge students to push themselves further in their reflections and assignments. the abrupt nature of the class having to shift online and our limited ability to acknowledge an end to the relationships within the context of the class was difficult. a4 reflected on this. i look back with sadness and resentment about the abrupt way we ended though. it was no way to say goodbye unable to wrap up relationships with classmates or professors from school...especially in our racially just practice in social work course, with the emotional nature of discussing racism and the rawness of the material, i wish we had had more time together. this speaks to the importance of paying attention to the building of connection as well as the transition of those relationships as a course comes to an end. engaging the head and the heart: resisting intellectualization a second area of convergence across all of the authors’ reflections was the balance and tension between engaging in the heart or emotion-oriented work of racial justice with the head or thinking-oriented work of racial justice. first, we embrace that this is a false binary. at the same time, there is a tendency in white-centered classrooms to intellectualize race and racism without acknowledging the deep emotions that people experience. as a1 pointed out in one reflection, what's missing is like the heart of it. the heart leads to the action. cause you can think something all day and do nothing. it's a little bit harder to resist doing something when you've connected like a full body experience or like it's connected to your heart. in our experience, when emotions around race and racism are addressed in the classroom, it is usually to take care of white people’s emotions rather than centering the emotional experience and labor of black, indigenous and latinx persons. heart work allows people to name and sit with their feelings. it allows students and instructors to have differences of emotion in relationship to the content or topic of advances in social work, summer 2021, 21(2/3) 812 discussion. it explores those different emotional responses without trying to come to consensus or aim for resolution or comfort. during the semester in which the class was taught, two public anti-black incidents occurred. a3 reflected on how the discussion of these incidents blended the heart and head starting with the heart to engage the students in racially just social work practice. we opened up with a really transparent and slightly painful conversation about the school of social work and the racial events that were happening. we had an actual discussion, we named our feelings, we explored race for what it was. our professors were honest with us. they allowed us to ask questions, we had space for the first time. i think it was actually perfect timing it was our class in practice for the first time. tapping into our emotions and intentionally sitting with them helps us to resist intellectualizing too quickly, or going straight into thinking, analyzing and explaining. in our experience, white people, in particular, have a pattern of doing this in both mixed-race spaces and homogeneous spaces. this tendency played out with a2 and a1 as a teaching team. it took intentional effort to hold both as important, and in some cases to prioritize the heart or feeling work because we knew that we were counteracting the head or thinking work tendency. a2 reflected on her own tendency to intellectualize in the following quote. something that a1 has taught me (well before this class) is the importance of making space to honor how racism impacts how we are our feelings, our being, our sense of self rather than jumping straight into intellectualizing and/or straight into action. vulnerability as an act of resistance the third area of convergence across our reflections was the role of vulnerability in decentering whiteness as there are a number of risks. first and foremost, we acknowledge that teaching a course like this and signing up to be a student in the course is a risk. students come to their courses having personal history with classes and spaces that aim or claim to address race and racism. those have not always been positive. putting hope into a new space that feels uncertain is making oneself vulnerable. a4 captured this sentiment in the following reflection. after we endured oppressive circumstances in all classes and field placements where classism, racism, sexism, and transphobia played out daily in covert and overt ways, i entered this class in a sense hopeful that we would get into some rigorous discussions and, on the other hand, guarded and prepared for classmates to keep enacting the same b.s. the effort that is required of each person in the classroom to be open enough to share things that feel deeply personal or that extend ourselves beyond what we have been asked to do in other classes is an act of vulnerability. odera et al./de-centering whiteness 813 for the instructors, there is vulnerability in releasing power and control power over content, power over process, power over allowing the outside world into the classroom in raw and real ways. a2 reflected on this. i think i will end on a reflection about my own sense of vulnerability in teaching this class. it is intense to have confidence and passion and energy while also experiencing a lot of uncertainty and personal exposure in a class. it is risky to try things like facilitating an intergroup dialogue about a recent anti-black incident that happened in your school and having no idea what is going to happen or if you will be equipped to handle it. the aspect of this area of convergence that was a point of divergence for us was the acknowledgement that each of us had differences in the amount of risk we took on when we allowed ourselves to be vulnerable. for example, a1 and a2 identified different risks they assumed in embodying honesty and transparency with students in the classroom. a1 reflected, i am intentional about being 100% myself in classroom and professional settings because i spent too many years of my life shrinking myself and hiding to be seen as more palatable/credible. now that i have gotten used to the freedom of radical authenticity, i can’t go back. i also know that it makes some folks uncomfortable initially because they don’t know what to do with me and may not take me as seriously. this dynamic is a perfect storm in that i had to be myself but knew that in doing so i might be making it easier to not see me as an equal instructional contributor. our identities and positions shaped how we viewed and experienced vulnerability. areas of divergence the areas of divergence that emerged from our reflections and discussions highlight the fact that a racial justice social work practice course must attend to the differences in perspective, experience and positionality of students and instructors, particularly those related to race. courses such as this one cannot be one size fits all. our divergences in experience and reflection draw our attention to key areas where the needs of students of color may differ and where instructors can center and prioritize those needs as they seek to decenter whiteness. making and taking space there was a constant unspoken negotiation around participation in the class that all of us noticed and that we experienced very differently. the racial dynamic of politeness moving in and moving out of active participation was a trend among white students that placed significant burden on the black, indigenous and latinx students. the experience of this dynamic was personalized and intellectualized by a2 and a4, the white co-authors, making them hyper-aware of their own participation and raising feelings of frustration targeted at other white people in the classroom targeted at the whiteness. and both white advances in social work, summer 2021, 21(2/3) 814 co-authors, a4 and a2, reflected on the potential for harm. a4, after reflecting on observing a white classmate’s growth in the class, wrote, ...at what cost did her evolution come? what did she say that might have harmed bipoc in her life and social work practice? this dynamic often shifts focus to the needs of white students, centering their limitations and comfort. through collective reflection, the question of who racial justice classes are really for was asked by a1. who is gaining? when white students feel ill-informed or miseducated or uncomfortable, their participation wanes and the unspoken expectation is that students of color will fill the void. but what do students of color gain from this environment? have their needs been considered and incorporated? this is further amplified by where the course is situated in the curriculum. this course, specifically, was taught in the msw program as an elective. electives in this program’s curriculum are reserved for advanced msw students, and the msw program is predominantly white. in a reflective discussion during the autoethnographic process, the authors explored this question. ...thinking about social work as a profession and the value of having these types of discussions. but yeah, a lot of times like those critical conversations or that access to knowledge only happens when you’re at the most advanced point of education. this question of who courses like this are designed for was further emphasized in reflections on the second area of divergence affinity groups. affinity groups the experience of racial affinity groups during the class was identified as an important and meaningful point in the class by the two black co-authors, a1 and a3. as a point of divergence, it highlighted the differential impact of the experiences of black, indigenous and latinx students on black, indigenous and latinx faculty. it also highlighted the value and complexity of having space just for black, indigenous and latinx students to discuss their experiences and needs without the presence of white students, particularly in the context of a predominantly white institution (pwi). a1 described the way that hearing about the experiences of students of color in the affinity group space impacted her sense of responsibility to black, indigenous and latinx students in the program. i was particularly excited to see so many black women in this class. it was rare to have more than 1-2 in a course and during my own msw experience, i was often the only one in my courses. while i was excited to see them i was also nervous because i felt an additional responsibility towards them. i knew how isolating the program could be and how rare it was to be taught by someone who looked like them. this feeling of guilt and responsibility would increase after the affinity group class when they shared the depth of their experiences within the program. i remember leaving that class angry and even more determined to be supportive given their experiences and the numerous acts of anti-black racism occurring within the school. odera et al./de-centering whiteness 815 for a3, she described the affinity group experience as painful and a space that generated motivation to work for change. it felt good to sit in the room with these beautiful, smart, brown women and know we all face a similar hell everyday, and we still choose to do it. some would think that’s insanity, i think it’s beautiful and necessary. for social work educators seeking to decenter whiteness, it is important to acknowledge that the affinity groups in this class experience were approached with a common general theme but then allowed to take shape as was needed for the particular students in the group. for example, the class had been assigned to read robin diangelo’s (2018), white fragility. the white students wanted and needed to unpack and discuss the aspects of the book that were new to them and to explore how they manifested in their own experiences of whiteness. the black, indigenous, and latinx students shared that they had not read the book and instead explored the ways that they experienced the burden of participation in their classes when race and racism came up; what a3 called the “reliance on the black story.” the power of representation similar to the divergent areas of experience described above, the final area highlights the importance of representation in class instructors, class readings and other course materials resources for all students with a differential impact on black, indigenous and latinx students. a1 and a3 both acknowledged the importance of having a black woman as instructor for the course. representation in the course materials was also experienced differently by the co-authors along lines of race. a4 described the ways that white students read the content for the course, when reading was often seen as optional if time allowed for other courses. he reflected, i keep thinking about a few of my white classmates in particular who seemed committed to a lot of intellectual understanding of antiracism. in short, they (we) did the reading. due to the rigorous nature of clinical internships, it is not uncommon for sw students to fully skip the intellectual side of the program and skim over academic readings. this is certainly not a negative divergence. the importance here is the ways in which the reading is done and the impact it has. similar to the reading and subsequent discussion of white fragility, reflecting on the readings and authors highlights how much of this learning is soul work, heart work. a3 reflects, i’d heard of james baldwin before but reading his work was so nurturing to me. it gave me hope, especially in such a hopeless time as covid started. the readings were either nurturing or triggering depending on the students’ positionality. advances in social work, summer 2021, 21(2/3) 816 discussion and implications for social work with social work practitioners, educators, and students all over the globe working to address social inequities and injustices made worse by the covid-19 pandemic, specific training in anti-racist practice is needed now more than ever. while the revolution may not come in the form of a diversity training, it should be informed and sustained by anti-racist socio-political action. the themes uncovered in this paper highlight a need to re-examine social work curriculum and pedagogy through an anti-racist lens. adding authors of color and discussing white supremacy is not sufficient. social work courses intended to adequately prepare students for racially just practice must consciously decenter whiteness in the construction, delivery, and assessment of learning. recommendations for social work programs as social work is a practitioner-focused discipline, much of the curriculum centers the practical application of skills and theory (brigham, 1977). however, courses regarding race and racial justice are frequently offered as topical seminars or concept courses that do not include direct connections to social work practice. a consequence of such course offerings is that racial justice is only conceptualized for content and is not applied to the conscious construction of the syllabus, assignments, and teaching modalities and in an effort to disrupt white supremacy. as noted in our findings, it requires conscious and persistent effort to decenter whiteness in the classroom. many of us have been socially conditioned to question the credibility of black, indigenous, and latinx persons in academic spaces. assignments that do not center the written word are often viewed as less rigorous. emotion, in particular, has been separated from the educational process. however, how can we teach about race and justice without acknowledging, exploring, and sitting with the impact of racism and oppression? how can you objectively intellectualize lived experiences of trauma in real time? most importantly, what is the impact of this expectation on black, indigenous, and latinx students enrolled in our courses? such questions should guide curriculum and pedagogy development for all social work courses not just those centered on race. as referenced in our findings, transformation occurs through radical resistance. embracing vulnerability, promoting authentic relationships, and normalizing emotional as well as cognitive engagement with course content are key takeaways for social work educators. while none of our areas of convergence are novel phenomena, they are atypical in social work curriculum development and at times even discouraged. resisting white supremacy and learned social messages about value, belonging, and credibility in academia is incredibly hard. in fact, it is a direct function of white supremacy that it is so difficult, as noted in all of the author reflections on the course. social work educators must take a conscious stance to resist white supremacy in the totality of their teaching and scholarship and not just discuss the concept within the context of courses. racial justice work is a full body experience. additionally, as noted in our areas of divergence more time and attention should be devoted to differential student and instructor experiences based on racial positionality. odera et al./de-centering whiteness 817 consideration for conscious and unconscious impact of content and pedagogy on black, indigenous, and latinx students and faculty should be openly acknowledged and addressed during course construction and delivery. the question of who is the intended audience of racial justice education arose during the delivery of our course and in our cae reflections. therefore, making space and acknowledging the various entry points of engagement with racial justice content becomes a more critical consideration in course construction and delivery. we must decenter whiteness because social work education does not occur in a cultural or political vacuum. if we intend to teach about racial justice and decentering whiteness, then we must do so in the construction and delivery of the courses as well. a host of social work educators and practitioners have vocalized the need to facilitate effective conversations about racial justice in social work classrooms for decades (brigham, 1977; constance-huggins, 2012; daniel, 2011; einbinder, 2020; razak & jeffery, 2002). the time is ripe (and long overdue) for dialogue about how race and racism shapes our daily social realities and thus our experience within social work (as practitioners, educators, and students) in the united states. our cae reflects the need to decenter whiteness. the integrity of our racial justice work depends on our ability to co-create vulnerable educational spaces which decenter whiteness. contemporary schools of social work, which continue churning out msw-holding social workers every semester, would benefit from mandating crt and intersectionality components in the social work curricula (crenshaw, 1991; constance-huggins, 2012; ladson-billings & tate, 1995/2017; olcoń et al., 2020). in addition, in spaces where black, indigenous and latinx faculty are in the numeric minority this becomes added labor that faculty take on in addition to navigating their own experiences of racism in the academy. administrators within schools of social work must acknowledge the added workload for faculty of color and shift expectations in other areas in order to decenter whiteness. compared to other professional training programs, the ethical stakes are arguably higher for 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(2020). toward a radical collaboratory model for graduate research education: a collaborative autoethnography. technical communication quarterly, 29(4), 1-17. https://doi.org/10.1080/10572252.2020.1713404 wagaman, m. a., odera, s. g., & fraser, d. v. (2019). a pedagogical model for teaching racial justice in social work education. journal of social work education, 55(2), 351-362. https://doi.org/10.1080/10437797.2018.1513878 author note: address correspondence to stephanie odera, school of social work, virginia commonwealth university, richmond, va, 23284. email:sgodera@vcu.edu https://doi.org/10.1080/10572252.2020.1713404 https://doi.org/10.1080/10437797.2018.1513878 _________ getaneh mehari, phd. associate professor, department of anthropology, addis ababa university, addis ababa, ethiopia. alice k. butterfield, phd, professor, jane addams college of social work, university of illinois, chicago, il. wassie kebede, phd, associate professor, school of social work, addis ababa university, addis ababa, ethiopia. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 657-675, doi: 10.18060/27656 this work is licensed under a creative commons attribution 4.0 international license. graduate research through the rebirth of social work education in ethiopia: trends, geographic distribution, and thematic areas getaneh mehari alice k. butterfield wassie kebede abstract: the research activities of graduate students of social work at addis ababa university (aau) have not been documented and analyzed in a way that it could be published. this article explores and examines social work graduate research from 2006 to 2019. data and our unit of analysis included 580 theses and dissertations listed in graduation books and another 280 electronically stored master’s theses and dissertations from the aau institutional repository. the total graduates in the program (2006-2019) were 752, of which 65% (484) were males. further analysis was made based on review of 280 master’s theses and doctoral dissertations. the study site for 73% of these theses and dissertations was in addis ababa. the rural-urban comparative analysis indicates that 84% of research projects were carried out in urban areas. in terms of the methodological orientations, 81% employed qualitative methods. from the fifteen thematic categories identified in our study, the five most researched thematic areas which covered 67% of all master’s thesis and phd research projects include issues of children; women and gender; health and healthcare services; community and community development, and family, marriage, and divorce. this article concludes that the rebirth of social work education at aau in 2004 paved the way for the expansion of graduate social work research. the urban bias of the research demonstrates a limitation of social work graduate research. keywords: research, ethiopia, social work, education researching and recording the origins and development of academic programs and research activities has been a tradition at the college of social sciences (css), addis ababa university (aau). such publications in the departments of sociology and anthropology are good examples (admasie & yntiso, 2006; shigeta & yntiso, 2005). mehari (2018) reports on research activities of anthropology graduate students from 2006 to 2016. other scholars have published articles on social work education in ethiopia (e.g., baynesagn et al., 2021; kebede, 2019). nonetheless, an analysis of the research activities of graduate social work students at aau has not been published. this article explores and examines social work graduate research from 2006 to 2019. the analysis is particularly important because graduate social work education began for the first time in ethiopia in 2004. this article briefly describes the historical background of social work in ethiopia, emphasizing the role of an international partnership in the development of graduate education. the article analyzes enrollment and graduate trends, as well as thematic areas of master’s theses and phd dissertation research in social work. the purpose of this work is to evaluate the trends of graduate research in the school of social work (ssw), make about:blank advances in social work, fall 2024, 24(3) 658 the findings available for action during curriculum review, and reveal information for further discussion to improve research trends and methods. the expansion of higher education in ethiopia ethiopia has a long history of traditional education closely tied with the introduction and expansion of christianity (4th century) and islam (7th century). more specifically, saint (2004) notes that ethiopia “possesses a 1700-year tradition of elite education linked to the orthodox church” (p. 84). the introduction of modern education in ethiopia is associated with the arrival of christian missionaries in the first half of the 19th century, and began with the establishment of menelik ii school in addis ababa in 1908. most students came from upper class families including the royal family. haile selassie i, the last emperor of ethiopia (1930-1974), was one of the first students in the modern school (zewde, 2002). until 1991, ethiopia had only two universities, aau first established as haile selassie i university college in 1950, and asmara university founded in 1958. in 1991, eritrea, the home of asmara university, seceded from ethiopia. although there were several colleges and institutions in addis ababa and other major cities, aau remained the only university in a country of approximately 28.4 million people in 1970 and 49.6 million people in 1990. in 1994, the democratically-elected government embarked on an ambitious university expansion program (saint, 2004), which radically altered the landscape of higher education. by 2005, the number increased to nine public universities, collectively known as first-generation universities, followed by 12 second-generation universities in 2006. between 2007 and 2014, 12 third-generation universities were added. in 2012, there were 47 public universities including 11 fourth-generation universities and three universities founded for specific purposes, a metropolitan university, and two civil service universities. consequently, the overall enrollment and graduation of university students has increased profoundly. at the end of 1980s, fewer than 10,000 students were enrolled in ethiopian higher education institutions. by 2009, the number of students enrolled in higher education increased to 210,456 (abye & butterfield, 2012). this type of development and investment in higher education is similar to what occurred with the passage of the morrill acts that set aside land and funding for development of universities. commonly called the land grant period, more than 70 universities were established and built from the ground up between 1862 and 1890 in the united states (u.s. national archives and records administration, 2022). historically, the overall trend of the enrollment and graduation of master’s and doctoral students at aau was extremely low. for example, from 1978 to 2006 (for 28 years) only 3,000 master’s and 60 phd students graduated. in 2011, enrollment of master’s and phd students increased to 9,000 and 1,300, respectively (abye & butterfield, 2012). the graduate program expansion activities in aau started with the support from swedish international development agency (sida). as the result of expansion activities, the number of graduates from master’s and phd programs increased, for example, in 2020, 3,372 students (3,128 master’s and 244 phds) received their degrees. more than 2,000 mehari et al./ethiopian swk education 659 graduates received a master’s degree from the css where social work is located, between 1993 and 2016 (mehari, 2018). a brief history of social work education in ethiopia the history of social work education passed through different routes during three regimes ruling ethiopia since 1950s. revolutionary changes and subsequent shifts in the macro political landscape in the country heavily influenced the history of social work. these include its introduction and early development (1959-1974) and the closing of social work education (1974-2004). social work was introduced during the imperial period, during which it flourished and successfully upgraded from a diploma to the bachelor of social work (bsw) level. initially, the introduction of social work education in ethiopia was not linked to higher education. the ssw was established in 1959 through joint efforts by the ministry of public health and the united nations technical assistance board. its purpose was to address the demand for trained medical social workers. the school started with a nine-month training program, which subsequently developed into a two-year diploma program. after seven years, in 1966 the school of social work started as a four-year bsw program at the haile selassie i university (sedler, 1968a). according to rozanne f. sedler, during its early development, the inadequate number of ethiopian academics was one of the main problems for social work education in ethiopia. the school had three teaching staff until 1965, one of which was rozanne f. sedler, who spent three years as a social work faculty while her husband was sponsored by the ford foundation to help set up a new law school at the university (lessenberry, 2021; wayne state university, 2009). to manage the shortcomings of teaching staff, the school of social work mainly relied on foreigners as part-time instructors from international organizations. the other challenge was lack of employment opportunity for graduates. to solve the problem, the school engaged in advocating for the potential contribution that social work graduates could make in public sector offices (sedler, 1967, 1968a, 1968b). the steady progress of social work education at haile selassie i university was terminated immediately after the september 1974 ethiopian revolution. in its last days, the monarchy attempted to introduce reforms to contain the revolution but in vain. amidst the confusion and uncertainties brought about by the popular uprising, the military regime, known as the derg military junta, came to power. with the coming to power of the socialist regime, social work was labelled as a bourgeois profession and was forced to close. the derg grabbed marxist-leninist ideology, declared a socialist government, and emerged as a military dictatorship. zewde (2002) portrayed the situation as follows: the disaster started when the derg tried to combine marxism and nationalism. desperate to hang on to power, it imbibed the dominant marxist-leninist intellectual discourse as the only guarantee of preserving its political ascendency. but it appropriated the dogma rather than the spirit of marxism. it followed in the footsteps of stalin rather than marx or even lenin. the result was a reign of terror that became its hallmark…. (p. 274) advances in social work, fall 2024, 24(3) 660 taking revolutionary measures, the military regime transformed the political, social, and economic landscape of the country. the radical measures taken by the military government include the confiscation and nationalization of domestic and foreign private firms; the 1975 land reform proclamation which abolished private land ownership and related rights such as selling and leasing of rural land; and the nationalization of urban land and extra houses. initially, these measures enabled the government to mobilize the masses (gudina 2003; zewde, 2002). moreover, the military regime considered itself a patron of the working class, the urban poor, and the peasantry, which assumed collectively that the state would take care of its people in all aspects of life. its solidarity with the socialist world led by the former soviet union brought the government into conflict with the western world. the contradiction between the socialist-revolutionary regime and the western world had negative implications for social work education. the education sector, from primary to higher levels, experienced major changes. for instance, haile selassie i university was renamed aau. it was closed and reopened with major structural changes including the dissolution of the faculty of arts, which was replaced by the college of social sciences, and the introduction of marxist courses in the departments of philosophy, political science, sociology and anthropology. labeled as reformist and bourgeois, the school of social work was closed, with sociology, social anthropology and social work merged into the department of applied sociology (admasie & yntiso, 2006). elements of social work education were maintained at aau largely through the effort of two ethiopian social work educators, drs. seyoum gebreselassie and andargachew tesfaye, who managed to “hide” six social work courses in the applied sociology curriculum (johnson butterfield, 2007). though a trace of social work remained alive, decisions of the socialist-military government led to a three decade-long interruption of social work education in ethiopia from 1974 to 2004. similar to the way that the change from a monarchy to a military ended formal social work education in ethiopia, the fall of the military government paved the way for its rebirth. defeating the military regime in guerilla warfare, the ethiopian peoples’ revolutionary democratic front (eprdf) captured the state power in 1991. the eprdf government institutionalized ethnic federalism and cancelled the marxist educational policy of its predecessor. it expanded primary and secondary education, and as noted, increased the number of universities, and encouraged the expansion of graduate programs. in the context of this progressive educational policy, the rebirth of social work education in ethiopia was developed through an international higher education partnership. social work education and international higher education partnership the process of re-establishing social work education was part of a dynamic universityto-university partnership (abye & butterfield, 2012), which also coincided with the government’s plan to expand graduate programs in ethiopia. in 2004, the social work program at aau was launched through an international university-to-university partnership named the social work education in ethiopia partnership (sweep, 2024). through the partnership, aau launched the msw program in 2004, and after the first cohort of msw students graduated, 8 msw graduates were admitted to the phd program mehari et al./ethiopian swk education 661 in social work and social development. as the university’s capacity increased through resident students in its new phd program, sustainability increased. aau opened a bsw program in 2008, and two additional master’s programs, an extension program involving evening and weekend classes in 2011, and a distance education program started in 2014. project sweep was successful for various reasons. the commitment of aau’s top leadership contributed a lot to its success. professor andreas eshete, the then president of aau, personally supported the graduate school of social work. president andreas appointed dr. abye tasse, aau’s vice president for international partnership, as the first dean of the school. the commitment of president eshete and dr. abye was critical. the mantra of everyone involved was adopted from dr. abye’s “can do” attitude. we would all work together to start the school of social work with or without money, with or without resident faculty, with or without books, with or without office space and computers. we would all work together, tapping into our international networks, and moving forward with our common vision (johnson butterfield et al., 2009, p. 61). as planning moved forward, these two top officials of the aau strengthened the graduate school by providing materials, computers, library space, offices, classrooms, and so on for master’s students, including dormitory space for phd students. overall, support from the top of aau administration provided the graduate school with an independent working environment and a semiautonomous status, which enabled the school to accomplish its activities without passing through the various bureaucratic structures of university administration. at the programmatic level in ethiopia, leadership was anchored in the work of two senior ethiopian scholars -associate dean melese getu of the css at aau and dean abye tasse, who at the time was also the president of the international association of schools of social work. on the us side, the collaborative partnership was led by professors alice k. butterfield and nathan linsk of the university of illinois chicago. project sweep mobilized human and material resources from a wide range of international networks of prominent scholars and institutions. for instance, using their global connections, dean abye and professor butterfield rallied scholars from different corners of the world to serve the newly established graduate school. no one was paid to participate. voluntary service included teaching master’s and phd courses, chairing and examining theses and dissertations, providing training and giving seminars. professors from universities in the united states, united kingdom, france, norway, israel and tanzania were involved in teaching graduate courses until aau had qualified academic staff to sustain the programs. professors teaching phd courses came from world-class universities such as suny albany, indiana university, university of illinois chicago, university of michigan, university of missouri, and australian catholic university (johnson butterfield et al., 2009). another factor that created the success of project sweep was its innovative and pragmatic approaches. the block teaching model introduced to the partnership by the us faculty allowed professors to come to ethiopia to teach courses during their vacation, semester breaks or sabbaticals. course offerings were supplemented by international seminars and short-term trainings offered and facilitated by professors from well-known institutions around the world. the efforts made by project sweep were not limited to mobilizing scholars and facilitating formal teaching and learning activities. it also involved advances in social work, fall 2024, 24(3) 662 mobilizing other resources including books and other reading materials. for example, professor butterfield used her international networks to collect thousands of academic books and through collaboration with books for africa, three containers of books were shipped to aau, bahir dar university, and the university of gondar. guest professors supported phd students by bringing books and other reference materials and assisted them in publishing their research (e.g., adamek et al., 2024; minaye, 2012). one of the major contributions of the rebirth and expansion of graduate school of social work at aau is building the capacity of academic staff. the school had no ethiopian staff when it reemerged in 2004. currently in 2023, the school has 15 phd and four ethiopian staff with master’s degrees. fourteen of the 15 phd holders received their doctoral degrees from aau’s phd program in social work and social development. with 19 academic staff, the school of social work is ranked second in the college of social sciences after the department of geography and environmental studies, and leads in the number of female academic staff. three of the seven phd-holding female staff of the college social sciences are in the school of social work. the development of the phd program in social work and social development at aau has had a spiraling effect on the expansion of social work education in regional universities across ethiopia. the social work phd program launched at aau in 2006 attracted young instructors from newly emerging regional universities. as of january 2018, 18 staff of regional universities received their doctorate degrees. moving back to their home universities, phd graduates have been instrumental in establishing social work programs at bahir dar university, university of gondar, and jimma university. bahir dar university and university of gondar, both located in the amhara regional state, have emerged as regional centers of social work education. gondar has a bsw, msw and phd program. they also play an important role in sharing their experience with other regional universities. jimma university introduced social work education establishing the department of sociology and social work, which later became independent departments. other public universities launching social work programs in various years include ambo university, mizan tepi university, arsi university, jijiga university, nekemte university, wollo university, and mekele university (e.g., kebede, 2019). at present the ssw at aau functions independent of international support from any available or specific national and international partnerships. faculty members at the ssw provide support in the areas of teaching, student supervision and research to other emerging social work graduate programs in ethiopia. key findings data for this study were generated from graduation books published for a 14-year period. these official lists included titles and abstracts of theses and dissertations (aau, 2006-2019). our data included the graduation book lists of 580 theses and dissertations and 280 electronic theses and dissertations available in the institutional repository of aau (2023). the data analysis paid attention to the trends in number of graduates, gender distributions, thematic areas of research, the rural-urban distribution of research sites, and the methodological orientation of research projects. thematic areas of research were mehari et al./ethiopian swk education 663 identified from expanded abstracts required for theses and dissertations, key words, and executive summaries. categories were identified and tabled so that thematic areas could be cross-checked. data analysis was carried out by the first author. data from the registrar office provided an overall picture related to trends of student enrollment and graduation. the geographic distribution and methodological orientations of the research projects were analyzed based on the data obtained from the aau online repository. key findings are presented on student enrollment and graduation, geographic distribution of research activities, and thematic areas of research. data from registrar were useful to examine the overall student enrollment and graduation trends of students. figure 1 summarizes the number of social work students who successfully defended their master’s theses and doctoral dissertations from 2006 to 2019. the numbers of graduates fluctuated. for example, between the 2006 and 2012 graduation years, the highest number of graduates was 39 in 2006 and the lowest number was 20 in 2008. over 14 years, the school had its highest number of graduates, 112, in 2017. the increase in the number of graduates since 2013 was due to the opening of evening and distance classes in the msw program. these programs expanded the opportunity for those pursuing graduate education while staying employed in companies, non-governmental organizations (ngos), or government offices. figure 1. msw and phd graduates of the school of social work, aau (2006-2019) source: aau, graduation books. office of the registrar (2006-2019). in 2015, the curriculum was revised to feature three specific concentrations, community & social development, health social work, and families, children & youth. this allowed students to focus on specific fields of social work practice after taking foundation courses, and allowed the school to admit greater numbers of students. after 2019, the authors have observed that due to covid-19, the number of graduates declined. 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 female 8 4 6 16 10 14 10 11 40 44 17 45 26 17 male 31 30 14 13 14 22 20 33 53 55 50 67 53 29 total 39 34 20 29 24 36 30 44 93 99 67 112 79 46 0 20 40 60 80 100 120 n o. o f g ra du at es advances in social work, fall 2024, 24(3) 664 covid-19 created a situation that did not allow in-person classes. online formats were not easily acceptable due to inaccessible internet bandwidth as well as a lack of student access to computers. based on the faculty roles in the school of social work of two authors, admissions as well as degree completion suffered. consequently, data analysis for this article comprises 2006-2019. nonetheless, although the number of graduates in 2019 was only 46, the number is still highest compared to all departments in the college of social sciences. gender composition figure 1 throws light on graduation trends and proportion of female and male students. traditionally, social work has been a female profession. this is true in western europe and north america. the demographic characteristics of social work education in the united states from 1974 to 2000 demonstrate an increasing involvement of women in graduate programs. the proportion of women msw graduates increased from 65% in 1974 to 85% in 2000. similarly, the percentage of females receiving their doctoral degree increased from slightly less than 36% to about 73% in 2000 (schilling et al., 2008). the ethiopian experience shows a different pattern. about 64% of the 752 graduates who received their msw and doctoral degrees from ssw between 2006 and 2019 were male. the gender dimension of social work education reflects the ethiopian context where higher education is dominated overwhelmingly by male students. however, the percentage of female graduate students in the ssw is higher compared to, for example, female graduates from the department of social anthropology in the college of social sciences. according to mehari (2018), about 85% of the 175 ms and phd graduates from 2006 to 2016 and all 11 phd graduates were male. geographic distribution figure 2 shows the map of ethiopia and summarizes the regional distribution of social work graduate research. the analysis of regional coverage and rural-urban distribution indicates that the majority (73%) were carried out in addis ababa. graduate research carried out in oromia regional state, the biggest regional state in terms of geography and population, was only 12.5%. research in amhara regional state, the second largest population region accounted only for 6%. altogether, only 23 (8%) of research projects were carried out in other regions. the rural-urban comparative analysis indicates that 84% of msw and phd research projects were carried out in urban areas. mehari’s (2014) earlier analysis of 187 msw theses in the social work library found that 89% were carried out in urban areas, indicating an urban bias of graduate research. despite the fact that nearly 80% of the ethiopian population live in rural areas, rural communities and issues are marginalized. mehari et al./ethiopian swk education 665 figure 2. map of ethiopia: regional distribution of msw and phd research activities (mappr, 2025) region # grad. research addis ababa 205 oromia 35 amhara 17 southern r. 15 gambella 4 tigray 2 somali 1 benishangul 1 afar 0 total 280 methodological orientation and thematic focus the 15 thematic areas listed in figure 3 are ranked from the most researched theme to the least. the great majority, 81%, employed qualitative methods, with only nine percent employing quantitative methods and the remaining 10% applying mixed methods. at the same time, these graduate research activities focused on a wide range of socio-economic, psychosocial, and development issues, with some thematic areas attracting large numbers of graduate research. five of the most researched thematic areas cover 67% of all thesis and phd research projects. these are children (22%), women and gender (12%), health and healthcare services (12%), community and community development (11%), and family, marriage, and divorce (10%). thematic areas, ranked from 6 to 10, comprise 112 projects or 19% of the total. these include youth-related issues, social work education/practice, aging/older people, employment/unemployment/ livelihoods, and disability-related topics. the remaining five themes, ranked 11 to 15, consist of 47 graduate research projects (8%). the topics in these five themes include development, substance abuse, street life/displacement/resettlement, and condominium houses. the remaining 33 (6%) examined diverse issues including micro-finance and credit, the impacts of government policies on the operation of ngos, corruption, revenge killings, the social exclusion of people with leprosy, commercial sex work, and teenage pregnancy. advances in social work, fall 2024, 24(3) 666 figure 3. thematic distribution of ssw graduate research activities child-related studies. child-related research was carried out through 128 social work masters’ and doctoral research projects. a total of 23 theses explored the lives, experiences, challenges, and coping mechanisms of street children. issues include the lived experiences of female street children, rehabilitation and reunification, sexual and reproductive health problems and coping mechanisms to survive street life. research also addressed the influence of drug abuse on psychological wellbeing and the resilience and coping strategies of street children engaged in shoe shining as a means of livelihood. ten theses explored child migration and child trafficking. these studies examined the lived experiences of rural-urban migrant children in urban settings including shoe-shining and lottery vending in addis ababa. the studies also focused on the relationship between rural-urban child migration and child labor in urban settings. they explored issues such as child domestic workers trafficked to addis ababa and the implications of child trafficking for their wellbeing. child labor, a widely observed phenomenon in both rural and urban areas of ethiopia (borko, 2017; sorsa & abera, 2006), was also covered. six graduate students examined problems related to child labor including its impacts and child labor’s relation to child migration, commercial farming, child wellbeing, and school attendance of children engaged in weaving in addis ababa. social work graduate research also explored child abuse and neglect, child vulnerability, and child health. seven msw theses focused on sexual abuse, including the sexual abuse of male children, sexual abuse practices in child rehabilitation centers, and the traumatic experiences of abused children. other research topics include orphaned and vulnerable children, child-headed households including children who lost parents due to 0 20 40 60 80 100 120 140 child women/gender health community family youth social work employment older people disability development substance street life housing others number of research activities mehari et al./ethiopian swk education 667 hiv/aids, child rights, health issues such as mental illness, children with autism, children affected by hiv/aids, and child sex workers. women and gender. the second major thematic area is women and gender. this theme attracted more than 12% of the social work graduate research. seventy of the 580 research projects examined diverse issues related to women, including health and healthcare services (23 projects), gender-based violence including sexual abuse of domestic workers (15 projects), women’s empowerment (13 projects), migration and trafficking of female domestic workers to the middle east countries (4 projects), and migration of domestic workers from rural villages of ethiopia to addis ababa (8 projects). health and healthcare services. social work graduate research on health and healthcare services is ranked third. this thematic area embraced 12% (69 projects). under this thematic area were hiv/aids-related studies (20 projects), sexual and reproductive health (12 projects), and cancer and non-communicable diseases (11 projects). hiv/aidsrelated research explored single mothers and other people living with hiv/aids, and the vulnerability of women to hiv/aids. some projects focused on hiv/aids among commercial sex workers and among men having sex with men. other research focused on child-related issues such as vulnerability of children to hiv/aids and caregivers and orphaned children. several graduate students conducted their research on cancer, including breast cancer, cervical cancer, and non-communicable diseases such as heart disease, an emerging health problem in ethiopia. other research topics included mental health including family caregivers’ experience, women living with hiv/aids who were experiencing mental illness, the socio-economic impacts of mental health, and mental health services. fourteen graduate research projects examined various reproductive health issues such as lived experiences of women with obstetric fistula, a widespread health problem affecting thousands of ethiopia women as well as women in developing countries who have very limited resources. other issues were parent-adolescent communication on sexual and reproductive health issues, reproductive health problems of women with disabilities, and abortion. research also explored youth reproductive health services and integration of adolescent sexual and reproductive health issues in high school education. community. the strong emphasis on community-related research is the fourth major thematic area. this can be seen as contributing to the knowledge base of community social work in ethiopia. sixty-six students (11%) conducted research on three major sub-themes: community development, community health, and community policing. community development resulted in 18 projects including volunteerism, social capital, and corporate responsibility. other topics include the contribution of local ngos and international organizations to community development, university-community partnerships, and community-based research for sustainable development. some graduate students conducted their research on asset based community development (abcd), including abcd with farmers, and community radio and community-based organizations in mobilizing community assets and promoting abcd activities. community health and community policing were the other sub themes. nine students conducted research on community health, mainly on topics of community participation to advances in social work, fall 2024, 24(3) 668 curb the spread of hiv infections, community role in care and support of people living with hiv/aids, the effects of solid waste on community health, and community health insurance. graduate students also studied community policing, a new area of research in the ethiopian context. the notion and practice of community policing has been introduced and expanded in urban areas of ethiopia, including addis ababa, as a means of controlling crime through community-police partnerships. focus areas were the role of local community assets in promoting community policing, community policing and gender violence, and community policing as a new paradigm. a few students studied social exclusion and the marginalization of minority groups, but in general, this area was overlooked. social justice, one of the principles of the social work profession, requires challenging discrimination and exclusion on the basis of gender, age, culture, and so on. one of the core purposes of the profession is working to assure social justice and the inclusion of marginalized, vulnerable and at-risk populations. although social exclusion and marginalization of minority groups are major areas of research and practice in the western world, very few social work graduate students studied these issues. only two students studied social exclusion, with one study on leprosy-affected people and another on the social exclusion of the manja community, a marginalized group in southern ethiopia. family, marriage, and divorce. much attention was given to family, marriage, and divorce. fifty-five research activities (10%) focused on family-related matters, including 23 projects on family structure and juvenile delinquency, family structure and child sexual abuse, and extended family support mechanisms for older people. other topics included child-family reunification, family resilience and child protection, professional family mediation, foster family care, and foster parenting. seven projects examined divorcerelated issues including causes and impacts of divorce, child marriage and divorce, pre and post-divorce experiences of divorced men, and the psycho-social conditions of divorced men and women. studies conducted on family, marriage and divorce paid attention to child marriage, a practice that affects the lives and wellbeing of younger girls living in rural areas of ethiopia (harper & marcus, 2018; jones et al, 2018). according to the demographic and health survey (dhs) of ethiopia, 8% of ethiopian girls in the 15-19 age-category were married before the age of 15 years old. the prevalence of child marriage is much higher in the amhara region (central statistics authority csa of ethiopia and icf international, 2012). youth. graduate research on youth-related issues is ranked 6th with 6% of the total number (35 out of 580 projects). major topics include youth unemployment, drug abuse, youth street life, and reproductive health. employment-related research focused on unemployment reduction efforts implemented by government agencies and other stakeholders, including job creation and capacity building interventions, and micro and small-scale entrepreneurship programs. youth unemployment and vulnerability of unemployed young people to illegal migration were other topical issues. drug and substance abuse issues have become a widespread problem in private and public universities in ethiopia (keno tulu & keskis, 2015; kumesa et al., 2015). female youth living on the street, contraceptive use, and having children were studied. research mehari et al./ethiopian swk education 669 also explored the reproductive health of female youth working in flower plantations, and reproductive health services for the youth. social work practice. social work education and practice is the seventh major theme. of the 23 projects, nine examined the role of social workers in the provision of social support for disadvantaged children, and the service provided in federal and regional courts of law. some studied services provided by social workers to physically abused children in the federal court of law, and the role of social workers in the juvenile justice system. others assessed challenges and prospects of social work practice in hospitals and other healthcare facilities, including models of practice dealing with youth affected by substance abuse, the role of spirituality and religion, and social work practice with children as victims of crime at the ministry of justice. employment, unemployment, and livelihoods. the eighth thematic area focused on employment and livelihood issues. topics include the role of savings and credit/microfinance associations in empowering women and enhancing self-employment, the role of micro and small-scale enterprises in reducing youth unemployment, and employment opportunities for persons with disabilities, including visually impaired women and university graduates with disabilities. other projects focused on the unemployment on urban refugees, and the social impacts of unemployment on family relationships. some explored the impact of urban agriculture on household improvement, the livelihoods of urban street venders, and industrial waste and its implications for the livelihoods of smallholder farmers. additional topics include child out-migration, agricultural cooperatives, and rural women, and begging as a livelihood strategy of older people in urban settings. aging and older people. aging and older people, the ninth thematic area, accounted for slightly more than 3% of the total. nineteen research activities were conducted, including the lived experiences of older people in rural farming, abused older people, homeless older people, their living conditions and coping strategies, and lives of older veterans of ethio-italian war (1935-1941). others examined the effect of institutional care on the lives of older people, community-based care systems for older people in the egalitarian rural awramba community, and service delivery for older persons in public hospitals in addis ababa. disability. sixteen research projects, nearly 3%, examined issues related to persons with disabilities, the tenth thematic area. among the topics explored were experiences of family members caring for a child with a disability, problems of accessibility of social services, and coping mechanisms of parents caring for children with intellectual disabilities. others included employment opportunities, reproductive health problems of women with intellectual disability, and violence against women with disability. the third set of five research themes, ranked from 11 to 15, accounted for 8% (47 of 580) of the projects. these thematic areas, listed in descending order, explored development-related issues (2.4%), substance abuse (1.9%), street life (1.6%), displacement and resettlement (1.4%), and housing (0.9%). research projects that are not included in the fifteen research themes are labeled as “others." these projects accounted for slightly more than 6% (33 of 580) of the entire graduate research. topics included living advances in social work, fall 2024, 24(3) 670 conditions of inmates and their rehabilitation and reintegration in post-prison life, and corporate social responsibilities of business firms such as hotels. discussion and implications this section discusses graduate research carried out through the school of social work at aau. the data for this study did not consist of a survey or interviews with students regarding their theses or dissertations. while the data reported were obtained from aau, all three authors have been involved in teaching and theses/dissertation research since the start of the program in 2006. consequently, author comments should viewed as contextual observations and experiences with students and their research. reflective comments on the data are based on the extensive 16-year experience of the authors. comments are offered to make sense, explain, contextualize and offer understanding of the data per se. critical findings include the geographic coverage of research, its methodological bias and the sustainability of social work and its expansion. geographic coverage of 580 master and phd research projects reviewed, 73% were conducted in addis ababa. as professors and deans at the school of social work at aau, the authors have observed and heard concerns regarding the difficult financial situation that students face in carrying out theses and dissertation research. financial limitations and time constraints are repeatedly reported by students as major barriers to conducting their research outside of addis ababa. the authors have observed this common problem—one which has plagued the ssw for many years. private students have no access to university funds to conduct their research. government-sponsored students, although they have access to research funding from the university, claim that the funds are inadequate to travel great distances to research sites. in addition to limited research funds, time is another constraint reported mainly by msw students. msw students are given a semester, which is about four months, to launch and complete their thesis projects. on the other hand, phd students are given four and half years in total for course work including the one-semester requirement to take bridging courses from the msw program. doctoral students also prepare and defend a portfolio, develop a research proposal, conduct their research, pass through blind review and review by examiners, and also publish two journal articles. therefore, fearing such time constraints, many students are not eager to risk travel to distant or rural areas to conduct their research. this gap demonstrates the contradiction with aau’s vision which is “to be the leading advocate for higher education in africa, with the capacity to provide support for its member institutions in meeting national, continental and global needs” (aau, 2024, p. 1). research projects by social work researchers need to ally with the university’s vision statement to advance national needs. this is not the case of the present status of social work graduate research projects. the geographic skewness of urban settings represents a small proportion of the country’s geographic and population proportions. other authors report similar concerns as well as additional barriers. for example, pierce and scherra (2004) note the utility of tools developed for urban settings, environmental barriers, and ethical considerations related to conducting research in rural mehari et al./ethiopian swk education 671 settings as among the many challenges related to conducting studies areas far from urban settings. ritter and stillman (n.d.) further describe the limited resources, transportation, the lack of best practices for rural research, and limited funding as some of the critical challenges for data collection in rural areas. methodological bias methodological challenges also require discussion. among the 580 reviewed theses and dissertations, 81% of them applied qualitative methods. only 9% applied mixed methods and only 10% used a quantitative methodology. our participation in supervision informs us that many students pre-determine the methodology they select based on their confidence and try to twist the research agenda towards their methodological interest, skills or expertise rather than the other way round. in many instances, students lack confidence in applying quantitative methods and fear applying statistical tools and analysis. they also wrongly perceive that qualitative methods are easier than analyzing quantitative or mixed methods. methodological skills of faculty members are another dimension that needs scrutiny. like the methodological bias towards qualitative research demonstrated by students, many faculty members appear to lack confidence in supervising research projects that apply quantitative or mixed methods. however, this issue requires a more systematic review of the methodological skills and interests of faculty. students are also influenced by the social sciences discourse arguing that human behavior and day-to-day experiences are best explained by qualitative information compared to numeric presentations tong et al. (2012) explain that “qualitative research aims to provide an in-depth understanding into human behavior, emotion, attitudes and experiences” (p. 1). ezer and aksüt (2021) gathered opinions of graduate students in the field of social studies about the use of qualitative methods. the authors analyzed and reported various reasons ascribed by their study participants regarding the use of qualitative methods. these include methodological appropriateness, strength and limitations, importance of qualitative research in social studies, and challenging stages while using qualitative methodology. most social work students in the ssw at aau believe, however, that qualitative methodology is more appropriate for their study, and has the strength to generate new facts they hope to reveal. looking at the profession at-large in terms of social work research, social work researchers have leaned toward qualitative methodology. it is not a surprise, then, that the majority of graduate students in the school of social work at aau have applied qualitative methodology. thelwall and nevill (2021) report that qualitative research utilizing interviews, case studies, focus groups or ethnography became “more common in all broad fields between 1996 and 2019” (p. 1). in part, the use of quantitative methods is constrained by the fact that only few of the faculty members are trained in quantitative research methods and thus have the passion and commitment to assist students who show interest in applying quantitative methods. for example, when students are assigned a faculty supervisor for their thesis or dissertation, topical areas of the proposed research are used as the main criterion for assigning supervisors. once students are assigned, supervisors align students to their methodological expertise or else students are recommended to change advances in social work, fall 2024, 24(3) 672 supervisors. therefore, in fear of the challenges of moving from one supervisor to the other, and knowing that faculty supervisors are colleagues, students stick to the interest of their supervisors which is not necessarily what the research area requires. the sustainability of social work and its expansion the sustainability of the social work program at aau was grounded in a homegrown faculty development strategy. the school was reopened in 2004 by launching a msw program. the school recruited graduates from the msw program and launched a phd program in 2006, and at the same time employed seven of its doctoral students as faculty members. in addition, some students admitted to the phd program in 2007 were employed as staff of the school. this strategy ensured the sustainability of social work education over time, including teaching, research and community service. the gradual replacement of visiting and short-term international faculty by ethiopian phd holders has not only contributed to the sustainability of aau’s social work programs but also to the expansion of social work education. for example, once a phd holder at the school of social work at aau reaches the associate professor rank, he or she can now teach in the doctoral program. as more social work faculty were promoted to the rank of associate professor, this has strengthened the school’s capacity, enabling it to completely take responsibility, not only for its bsw and msw programs, but for its phd program as well. the graduate programs in social work at aau have played an important role in accelerating the expansion of social work education across regional universities in ethiopia. the government wisely required that students admitted to doctoral study in social work had to be employed already as a lecturer in the broader university system. these lecturers were supported by their home universities while obtaining their phd degrees and were required to return after receiving their degree. new and regional universities sent their young faculty members to study social work. upon returning to their home universities, almost all were given the charge to start social work education, sometimes at the bachelor’s level, and in some cases immediately at the master’s level. this process spread social work education across the country. thus, it was the graduates of social work, at the msw and phd levels, from the reborn aau school of social work that played an essential and critical role in opening social work education throughout the country. as of 2023, 17 universities, 12 public and 5 private, operate social work programs at various levels. all of the 17 universities have a bsw program. two public universities run three levels (tiers) of training at bsw, msw and phd levels. another public university that currently operates bsw and msw programs is at the stage of designing curricula to open a phd program. conclusion the development of social work research in ethiopia is closely associated with the expansion of social work graduate programs at aau. although social work education was introduced to ethiopia in the 1950s, it was limited to undergraduate training until it was interrupted in 1974 because of the ethiopian revolution and subsequent regime change. social work graduate research has been flourishing after the aau school of social work was reopened in 2004. the rebirth of social work education at aau paved the way for the mehari et al./ethiopian swk education 673 expansion of graduate research. social work graduate research at aau exhibited a stunning growth in terms of number and thematic areas covered since 2006. social work graduate research explored a wide range of issues including health, family, community, employment, and housing. moreover, graduate research projects examined issues related to marginalized groups (e.g., children, women, and older people) and emerging themes such as disability, street life and substance abuse. despite these strengths of the social work post-graduate research, the following issues require further research and programmatic evaluation by the school of social work and the css at aau. these include the urban bias of social work research in ethiopia. this urban-rural imbalance marginalizes ethiopia’s rural populations and precludes knowledge development through social work research. a second issue is the methodological gap, especially in the quantitative skills of faculty and graduate students. a third limitation is the misalignment of social work research in the aau’s vision statements. consequently, social work education should revisit its curricula to fit national research interests. efforts should be made to provide faculty with advance training, particularly in quantitative methods. this would improve the competency of both students and faculty in applying all research methodologies, without prejudice. references abye, t., & butterfield, a. k. 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(2002). pioneers of change in ethiopia. aau press. author note: address correspondence to alice k. butterfield, jane addams college of social work, university of illinois chicago. email: akj@uic.edu https://files.hudexchange.info/resources/documents/ruraldatacollectionchallenges_presentation.pdf https://doi.org/10.57054/jhea.v2i3.1667 https://doi.org/10.1093/sw/53.2.103 https://doi.org/10.1093/sw/53.2.103 https://doi.org/10.1177/002087286701000401 https://doi.org/10.1177/002087286801100102 https://doi.org/10.1177/002087286801100102 https://doi.org/10.1177/002087286801100206 https://doi.org/10.1177/002087286801100206 https://doi.org/10.14989/68450 https://doi.org/10.14989/68450 https://doi.org/10.14989/68450 https://www.ejhd.org/index.php/ejhd/article/view/611/443 https://www.ejhd.org/index.php/ejhd/article/view/611/443 http://www.aboutsweep.org/ https://doi.org/10.1016/j.lisr.2021.101094 https://doi.org/10.1016/j.lisr.2021.101094 https://wlv.openrepository.com/handle/2436/624020 https://doi.org/10.1186/1471-2288-12-181 https://doi.org/10.1186/1471-2288-12-181 https://doi.org/10.1186/1471-2288-12-181 https://doi.org/10.1186/1471-2288-12-181 https://www.archives.gov/milestone-documents/morrill-act https://www.archives.gov/milestone-documents/morrill-act https://academy.wayne.edu/docs/acadamy-brochure.pdf https://academy.wayne.edu/docs/acadamy-brochure.pdf mailto:akj@uic.edu _____________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2019 author, vol. 19 no. 2 (fall 2019), i-vii, doi: 10.18060/22952 this work is licensed under a creative commons attribution 4.0 international license. editorial 2020: the future is here margaret e. adamek at the dawn of a new decade, i cannot help but recall that when i started my academic career in social work in the 1990s, it was common to look ahead to how life would be in the next century. statistical projections forecast various demographic changes, often using 2020 as the future time frame. back then, 2020 sounded far away and almost alien. well folks, the future is here. now that 2020 has dawned, it seems that the more things change, the more they stay the same. certainly, the specific issues that social workers address have changed over the decades, and our approaches have been modified to tackle the new issues, but the struggle to understand and meet emerging needs persists. i used to jokingly hear that the ultimate goal of the social work profession was to put ourselves out of business. given the intransigence of intolerance for difference and the persistent emergence of needs arising from “advances” of modern living, it seems the social justice stance of our profession will never be fully met. indeed, our social contract is continually expanding. in the fall 2019 issue of advances in social work we are pleased to present 14 papers-11 empirical, 3 conceptual--written by 29 authors from 12 states across the u.s., representing different regions of the country and ghana. each paper is briefly introduced below. research given the commitment of the social work field to promote diversity and ensure social justice for all population groups, it is not surprising that many of the studies presented in this issue relate to diversity in some way. with an eye toward enhancing the diversity of the social work student body, simmons interviewed black male graduates of an accredited bsw program to examine their perspectives of factors that contributed to their persistence. based on his findings, simmons offers a number of suggestions to social work programs looking to retain black male students. with an overall goal to inform culturally responsive social work practice with puerto rican fathers, mogro-wilson, loomis, hayes and rojas examined puerto rican men’s perspectives on fatherhood, including how puerto rican fathers incorporate bicultural influences on their parenting roles. such findings have particular significance due to the growing latino population in the u.s. based on in-depth interviews with educators and social workers in ghana, mills identified several challenges with implementing inclusive education for children with intellectual disability in ghana. by describing the key roles that social workers can play in promoting inclusive education, mill’s work has implications not only for ghana but for other developing nations that have yet to embrace inclusive education. https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) ii mirick and wladkowski explored the factors that contribute to female doctoral students and graduates’ persistence in their doctoral programs after a pregnancy and/or birth. based on the findings, several recommendations are offered to social work programs to better support students who have a child during their phd studies. using a narrative analysis of three case studies of adolescents with a mental health diagnosis, kranke concluded that youth empowerment is a critical avenue for reducing mental health stigma while engaging adolescents in treatment and meaningful opportunities as well as increasing their self-esteem. sichling and o’brien surveyed 250 practitioners about their sources of practice knowledge. their analysis revealed that co-workers and continuing education programs are the most important sources for knowledge and information that influences practice. sichling and o’brien call for agencies and researchers to think more purposefully about the infusion of knowledge into practice through opportunities for professional socialization, the use of research briefs, and open-access, peer-reviewed journals. in light of children’s mental health being recognized by the cdc as a public health problem, bonnano and veselak surveyed parents about their preferred sources of information about mental health services for their children. the analyses revealed that trust was an overarching theme in parents’ pursuit and evaluation of mental health information. given the need for reliable mental health information, bonnano and veselak suggest that social workers play a more active role in educating families and service providers about child mental health. staudt and williams-hayes examined the associations among secondary traumatic stress, burnout, and compassion satisfaction in interdisciplinary team members at a child advocacy center. based on their findings, staudt and williams-hayes recommend that agency supervisors and administrators regularly assess their staff regarding the impact of trauma work and provide regular opportunities for support and debriefing. teaching innovations richards-schuster, ruffolo, hoffman, and kwesele describe the process they followed in launching multiple moocs (massive open online courses) offering social work content to enrollees from over 180 countries. their analyses suggest that moocs are a potential avenue for expanding the global reach of social work. pittman and gioia describe a short-term international course with graduate students from social work, public health, and nursing. this study gave traditionally underrepresented students an opportunity to identify the opportunities and barriers they experienced related to international study. recommendations for improving learning and increasing cultural and interprofessional learning include having guided group discussions on critical incidents, using a critical reflection process focused on cultural assumptions, and focusing on the psychological, convictional, and behavioral dimensions of learning. adamek/editorial iii while it is not uncommon for instructors to use the track changes function in word to give students feedback on their writing, sanchez, corbin, and norka examined the use of “comment bubbles” to engage students in thinking about and commenting on their writing choices in a social and economic justice course. their analysis revealed that allowing students to comment on their own writing facilitated self-expression, self-reflection, and critical thinking. dual degrees in social work and public health are considered critical to enhancing our understanding of the social determinants of health and eliminating health disparities. salm ward and reeves describe the process they pursued in launching an msw/mph program and share the lessons learned to assist other schools who are considering this increasingly popular dual degree. policy and practice sinha, shrivastava, and paradis review a variety of mobile phone-based applications (‘apps’) aimed at preventing violence against women. based on a brief survey and classification of existing mobile phone apps, this paper explains how the apps work, pointing out both their capabilities and limitations, so that social workers can better guide their clients in using these technology-based services. boys and harris argue that if roe v. wade were to be overturned, there could be negative consequences for ivf. with concern that the united states supreme court could abandon the legal right to early pregnancy terminations, boys and harris suggest such a reversal would open the door for states to enforce laws defining life to begin at conception, potentially resulting in multiple unintended consequences on the cost, availability, safety, and success rates of ivf. in memoriam we dedicate this issue to our friend and colleague, dr. bill barton, who served as a founding board member, reviewer, and past editor (2008 to 2015) for advances in social work. sadly, dr. barton passed away from leukemia this past year. dr. barton’s many contributions to the journal were significant and cannot be over-emphasized. under his leadership, advances in social work converted from a traditional paper journal to the first open access journal in social work. dr. barton’s dry sense of humor and efforts toward enhancing the scholarly standards of the journal are greatly missed. in gratitude with this issue we would also like to thank the many reviewers worldwide who contributed to the scholarship represented here and in other issues of advances in social work this past year. in 2019, 189 individuals from 7 countries, 43 states, and 1 territory, and representing 112 colleges/universities and 3 organizations served as aisw reviewers. we truly appreciate the voluntary efforts of our reviewers in enhancing the scholarly contributions of the journal. we are very proud of both the broad participation of reviewers and of our legacy as an open access journal since 2008. advances in social work, fall 2019, 19(2) iv i would also like to take this opportunity to acknowledge the many contributions of our assistant editor, ms. valerie decker. valerie’s diligent efforts on behalf of the journal include assigning reviewers, communicating with authors, copyediting accepted manuscripts, assisting guest editors with all phases of the review process, and basically keeping the whole process on track. her work on the journal is what keeps it flowing. thanks, valerie! advances in social work 2019 reviewers and affiliations we would like to acknowledge the contributions of the following individuals who reviewed manuscripts for advances in social work in 2019. without their time and expertise, advances in social work would not be possible. emily akerson, james madison university karen m. allen, indiana university susan c. allen, university of mississippi stephanie baird, university of toronto adrienne baldwin-white, university of georgia jo ann m. bamdas, florida atlantic university mahasweta banerjee, kentucky university joseph b. bartholomew, indiana university larry bennett, indiana university rebecca bonanno, suny empire state college ashleigh borgmeyer, louisiana state university dara bourassa, shippensburg university natasha wine miller bragg, indiana university richard brandon-friedman, indiana university jodi constantine brown, california state university bj bryson, james madison university barb j. burdge, manchester university jamie burgess-flowers, university of north carolina ryan camire, city university of new york jennifer chappell deckert, university of kansas bethel college jill m. chonody, boise state university kameri christy, university of arkansas alberto cifuentes, university of connecticut carol cleaveland, george mason university monique constance-huggins, winthrop university dianna cooper bolinskey, indiana state university john cosgrove, fordham university rebecca davis, rutgers denise davison, morgan state university valerie d. decker, indiana university pete delany, george mason university denise dews, university of north carolina michael dover, cleveland state school of social work neil e. duchac, kennesaw state university tapati dutta, indiana university adamek/editorial v stacey edgar, colorado state karen c. ellinwood, university of arizona gretchen e. ely, university at buffalo school of social work kathleen ezell, ohio dominican university anne sj farina, saint louis university phil farmer, jarvis brandi jean felderhoff, university of texas at arlington dan ferguson, health workforce deneece ferrales, tarleton state university amy killen fisher, university of mississippi karen a. ford, james madison university nicholas forge, georgia state university kelli fox, university of new england fran franklin, delaware state university sadaaki fukui, indiana university john robert gallagher, indiana university michelle d. garner, university of washington allison k. gibson, university of kentucky annalease gibson, albany state university fredi jo giesler, idaho state university susan l. glassburn, indiana university ronnie glassman, yeshiva university jillian graves, eastern michigan virgil lee gregory, indiana university kristen guskovict, klg consulting services, llc and heart (humanitarian empathy and refugee trauma) of aid work kristin hamre, indiana university barbara mary harris, creighton university evan harris, indiana university helen p. hartnett, west virginia university krystal hays, california baptist jocelyn hermoso, san francisco state university linda herzberg, oglala lakota college steven hoffler, southern connecticut state university mark s. homan, pima community college michin hong, indiana university carol hostetter, indiana university ran hu, university of toronto rosemarie hunter, university of utah emily ihara, george mason university brooke l. jordan, university of north carolina heather kanenberg, university of houston john m. keesler, indiana university nancy kelley, university of omaha teri kennedy, university of kansas medical center hossein khalili, university of wisconsin lalit khandare, pacific university daniel kikulwe, york university m. killian kinney, indiana university wayne kinney, university of cincinnati julia kleinschmit, university of iowa andrzej klimczuk, warsaw school of economics rie kobayashi, eastern washington university david c. kondrat, indiana university advances in social work, fall 2019, 19(2) vi shelley cohen konrad, university of new england danel a. koonce, governors state university eric kyere, indiana university dr. tiffany lane, norfolk state university kathy r. lay, indiana university zulkipli lessy, sunan kalijaga state islamic university younghee lim, university of mississippi megan lindsey, northern kentucky university brianna lombardi, university of pittsburgh mayra lopez-humphreys, cuny college of staten island robert lucio, saint leo university michael a. mancini, saint louis university jill m. manit, sacred heart university susana mariscal, indiana university james marley, loyola university chicago jennifer martin, swin australia christie mason, loyola university chicago carol rippey massat, indiana university heather a. mccabe, indiana university rebecca mccall, university of north carolina katie mccarthy, indiana university michael e. mcguire, university of north carolina john g. mcnutt, university of delaware william james mello, indiana university joseph merighi, university of minnesota alyssa middleton, university of louisville christina miller, university of oklahoma stacy c. moak, university of alabama at birmingham margaret moore-nadler, university of south alabama carmen morano, albany amy murphy-nugen, western carolina university* laura mutrie, quinnipiac university hieu van ngo, university of calgary kristina nikolova, wayne state university jayashree nimmagadda, rhode island university debra s. norris, university of south dakota kieran barry o'donoghue, massey university vickey r. olds sultzman, indiana university mark d. olson, illinois state university john orwat, loyola university chicago nora padykula, westfield state university kimberly pendell, portland state university panagiotis pentaris, university of greenwich katherine perone, western illinois university linda plitt donaldson, james madison university marciana l. popescu, fordham university stephanie quiring, indiana university lisa ann rapp-mccall, saint leo university melissa reitmeier, university of south carolina hasan reza, indiana university adamek/editorial vii dasha rhodes, morgan state university karen rice, millersville university telvis m. rich, kean university tonya kay ricklefs, washburn university carrie w. rishel, west virginia university marinilda rivera-diaz, pontifical catholic university of puerto rico victoria rizzo, binghamton university maria y. rodriguez, city university of new york sunny harris rome, george mason university* jennifer root, wilfred laurier university abigail ross, fordham university diana rowan, university of north carolina melanie sage, university at buffalo school of social work adriana sandu, anglia allison schad, university of north carolina uma segal, university of missouri elizabeth sharda, hope college yasoda sharma, kutztown university erica shifflet, michigan state university florian sichling, university of missouri brian sick, university of minnesota chris simmons, univeristy of south florida jonathan singer, loyola university chicago john thomas solas, bradford university yolanda d. spears, univeristy of iowa graeme robert stuart, university of newcastle lin sun, indiana university carolyn sutherby, michigan state university michael talamantes, denver university andrea g. tamburro, indiana university jacky t. thomas, california state university molly tovar, washington university of st. louis kristin trainor, ball state university kathi r. trawver, university of alaska laura trull, james madison university dr. valandra, university of arkansas karen marie vandeusen, western michigan university joseph j. varga, indiana university bryan g. victor, indiana university peter h. vlasses, accreditation council for pharmacy education holly danforth vugia, california state university elizabeth a. wahler, indiana university betty a. walton, indiana university donna wang, liu brooklyn amy ward, east central university allison west, johns hopkins university celia williamson, university of toledo aaron willis, salisbury beth young, western carolina university meg zomorodi, university of north carolina *special issue guest editor ________ shirley gatenio gabel, phd, msw, mphil, professor and the mary ann quaranta chair, social justice for children, fordham university graduate school of social service, new york, ny. susan mapp, ph.d., mssw, associate provost for institutional effectiveness and innovation and professor, social work, elizabethtown college, elizabethtown, pa. david androff, associate director for doctoral education and associate professor, school of social work, arizona state university, tempe, az. jane mcpherson, phd, mph, lcsw, director of global engagement & associate professor, school of social work, university of georgia, athens, ga. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 416-435, doi: 10.18060/24971 this work is licensed under a creative commons attribution 4.0 international license. looking back to move us forward: social workers deliver justice as human rights professionals shirley gatenio gabel susan mapp david androff jane mcpherson abstract: social work was a progressive profession at its founding, and social workers sought to transform people’s lives through wide-ranging reforms and work with individuals and communities. over time, social work has evolved into a more conservative profession. social workers have perpetuated oppressive policies, structures, and practices that marginalize vulnerable populations. this paper revisits the history of our profession and presents a human rights approach toward justice in social work practice and education that is more in line with its roots and the intentions of its founders. this renewed approach requires the participation of communities and the full inclusion of client voices, creating an atmosphere supportive of human rights, different curricular methods of delivering human rights and justice content, and new skill development in courses and fieldwork. this paper demonstrates how a rights-based approach bridges the divide between macro and micro practice and permeates all professional education and practice aspects. the paper shows how social work education can orient classroom and field curricula to promote human rights by emphasizing community-based practice frameworks and system-wide changes. keywords: human rights, social work education, justice, social work curriculum, rightsbased approach social workers worldwide have a long history of working to achieve human rights, as they have been defined in international law, including an explicit grounding of practice in human rights principles: human dignity, non-discrimination, participation, transparency, and accountability (androff, 2016; gatenio gabel, 2016; mapp et al., 2019). these principles advance justice and guide social workers to move away from the deficit model of the needs-based approach by contextualizing individual issues in a larger human rights framework. yet, social work education in the united states has not fully embraced the human rights approach nor adequately prepared social work students to practice from a human rights perspective. as a value-based profession, as evidenced in our code of ethics (national association of social workers [nasw], 2021a), social workers cannot be “value-neutral.” they must be working to achieve these aims. therefore, practicing from a human rights framework is essential if justice is at the core of the social work mission. scholars continually debate the definition of justice, and their work has shown us that conceptions of justice vary by individual, culture, time, and power (barry, 1995; haeffele about:blank gabel et al./looking back to move 417 & storr, 2019; rawls, 1971; resich, 2002; sen, 2009). human ethnocentrism (i.e., preferences for practices and values reflective of our culture) determines an individual’s or community’s definition of justice (rawls, 1971; resich, 2002; sen, 2009). majority views or those of the powerful often inform a culture's definition of justice, which can further marginalize or “otherize” the vulnerable. "justice" to a marginalized community may look very different than the dominant culture's view of justice (haeffele & storr, 2019), as we can see in the current u.s. debates over gender policies, mass incarceration, policing, access to public welfare, and many other issues. justice is fluid and varies across cultures and times (barry, 2009; haeffele & storr, 2019; rawls, 1971; resich, 2002; sen, 2009). a culture's sense of justice often emerges from the interaction among contending perspectives of justice; thus, a culture's definition of justice evolves as new practices and ideas arise (barry, 2009). the benchmark used to determine just or unjust treatment of societal members will differ depending on the period and the cultural conflicts of that period. as a profession, social work's articulation of justice best resembles the basic human rights principles. these internationally recognized principles include the equality of each individual as a human being, the inherent dignity of each person, and the rights to selfdetermination, peace, and security. respect for all human rights is the basis for all civil, political, social, and economic aspirations that seek to establish well-being standards for all persons. rights-based efforts see people as active rights holders and place accountability on policymakers and other actors whose actions impact their rights. human rights offer a normative standard to guide justice as it evolves within and across cultures (androff, 2016). unlike charity-based and needs-based approaches that determine who is worthy or unworthy of assistance by assessing their behaviors and viewing those behaviors as the causes of marginalization, poverty, and disease, rights-based practice is built upon a foundation of universal human dignity and deservingness. furthermore, rights-based practice emphasizes a participatory process and the need for a shift in power, thus making it political (androff, 2016; gatenio gabel, 2016). therefore, placing a rights-based approach at the heart of social work practice has the power to transform the profession by elevating human respect and dignity, participation, accountability, and transparency. to promote justice, the social work curriculum, both implicit and explicit, should educate social work students about human rights principles and documents and prepare them to practice from a human rights perspective. to do this, we begin by reviewing social work’s roots as a human rights-based profession and how the profession has diverged over time. it is important to note that our interpretation of this history is rooted in our own time and is fully informed by international human rights documents and treaties–beginning with the universal declaration of human rights (udhr, u.n., 1948) – which early u.s. social reformers were necessarily unaware. social work's history as a human rights profession the birth of social work as a profession was, in part, a reaction to an era in u.s. history known as the gilded age, a period roughly from the 1870s to about 1900. mark twain's 1873 work, the gilded age: a tale of today, satirized an era of serious social problems masked by a thin gold gilding (twain, 1873/2001). the era is remembered for its rapid advances in social work, summer 2022, 22(2) 418 economic growth, especially in the north and the west, and dominated by the building of railroads across the u.s. and the emergent prominence of manufacturing, mining, and finance across the country. however, beneath the gilded, highly-concentrated economic growth and prosperity for a few were millions of immigrants as well as migrants from rural areas of the u.s. who were drawn to cities seeking economic opportunities and higher wages but who ended up living in poverty without access to their rights as human beings (trattner, 1998). moreover, despite abolishing slavery in 1865, most southern localities re-stripped formerly enslaved persons of political power and economic rights following the reconstruction period that ended in 1877 (foner, 2014). the dominant social philosophy of the time, social darwinism, championed the survival of the fittest and condemned government assistance for those living in poverty, living with a disability, or who were uneducated, claiming that charity would only weaken the human race (trattner, 1998). the growing levels of inequalities and suffering, particularly in urban areas, led advocates to adapt two english approaches in the u.s. – charity organization societies and the settlement house movement. most large u.s. cities, beginning with buffalo in 1877, established charity organization societies (cos), seeking to organize a city's voluntary relief associations “rationally” by interviewing persons in need of assistance, determining the relief needed, and arranging for home visits to dispense caring and advice (lubove, 1965). cos workers believed poverty could be remediated and prevented from spreading if the poor adopted middle-class values and ideas (chapman & withers, 2019). settlement houses, also based on an english model, were established in large cities in the u.s. during the 1880s. settlement houses, like chicago’s hull house, provided services to help immigrants assimilate and build bridges between the classes in an increasingly stratified and fragmented society (addams, 1893/1969). african-americans migrating to northern cities found themselves excluded by many of these early settlements and developed their own settlement houses, many with roots in southern missions and black institutions like the tuskegee and hampton institutes (luker, 1985). unlike the cos, the settlement house movement believed that efforts should be directed at social and economic reforms rather than reforming individuals. charity workers, settlement house workers, and social reformers concerned with juvenile delinquency, known as child savers, created the national conference of charities and correction in 1880. this became the national conference of social work in 1917 – knitting the different threads of social work into one profession (bruno, 1957). in this way, early social work organizations understood themselves to be united with a common purpose to give dignity and respect to individuals living in poverty and precarity and to help individuals and families navigate the complex social and economic challenges before them. advocacy became the bedrock of the new profession. still, many leaders and individuals who first identified as social workers in the u.s. were white people from privileged class backgrounds who did not reflect the values, goals, and cultures of the populations they sought to help. indeed, many of our well-respected early agencies excluded african americans (carlton-laney & hodges, 2004). in the u.s. black community, social work thus developed separately as mutual aid and institutions, including gabel et al./looking back to move 419 orphanages, settlement houses, and other social services (brantley et al., 2021; harty, 2020). in the first part of the 20th century, social workers worked with a widening range of populations and social issues. social workers sought to address the needs of those in poverty, children and youth, immigrants, migrants, those who were or had been previously incarcerated, those with mental health and physical disabilities, and soldiers. social workers also advocated for peace, human rights, improved sanitation, housing, labor protections, and much more. the biographies of pioneering social workers make clear that they were fighting social exclusion and discriminatory practices that denied persons their rights as humans (nasw, 2021b). the diversity of the populations served by social workers even in the early decades of the profession led to the development of a range of social work methods. some methods emphasized interpersonal interventions, while others accentuated the need for societal reforms. still, advocacy for human rights and justice was a critical component of all efforts. over time, social work divided itself into two dominant forms of practice – micro or macro. this was a response to myriad political, economic, and social factors, including the drive for professionalization, the ascendance of the medical model and concomitant psychological approaches, and the rise of managed care health insurance. this micro/macro division delegated the advocacy for human rights and justice primarily to those practicing at the macro level. in its quest for professionalization, social work turned to specializations that then overshadowed core social work values and promoted clinical approaches over advocacy and societal reform (abramovitz, 1998; reeser & epstein, 1990; reisch & andrews, 2001). during this time, social workers such as bertha capen reynolds argued for a holistic practice that would see clients within the bigger picture of their social conditions (abramovitz & sherraden, 2016). unfortunately, such voices, which we would now consider advocating for a human rights-based approach, were repressed and silenced within the mainstream profession (reisch & andrews, 2001). the focus on clinical methods was detrimental to social work’s mission to build just societies. breton (2006) notes that social work became locked into a mold privileging clinical/micro work over community/political/social action/macro work. there is no doubt of the need for both clinical and macro work in social work; rather, the tension centers on casting clinical and macro work as a mutually exclusive dichotomy and simultaneously heralding clinical approaches as superior. specht (1991), a well-known critic of social workers' prioritization of clinical techniques, especially for those who opt for private practice, explains that the issue is that these practitioners “remove themselves from the problems, settings, and populations that social work was created to deal with" (p. 107). instead, the profession should support practice models that promote justice (parker, 2003). a human rights approach brings justice as the focal point to all forms of social work practice: micro, macro, community, policy, and international (androff & mcpherson, 2014). at the inception of the profession, human rights and justice were at the core of social work practice. however, over the decades, calls for the professionalization and legitimization of social work triumphed over social action, eventually widening the advances in social work, summer 2022, 22(2) 420 micro/macro divide (haynes, 1998). for example, the “rank and file” movement beginning in the 1930s called for social work to be the profession at the forefront of social and economic rights and justice, but the focus of social work at the time was on legitimizing the profession and building social work education (haynes, 1998; reisch & andrews, 2001). consequently, the profession again turned away from strengthening its activism and instead focused on professionalization by developing scientific rigor in the field (abramovitz, 1998; haynes & mickelson, 1992). the path creating a dichotomy in social work was also affected by political context. the onset of mccarthyism in the early 1950s further dampened efforts to seek wideranging social and economic approaches to social change for fear of being persecuted or labeled communists (abramovitz, 1998; reisch & andrews, 2001). in the 1960s, the johnson administration’s war on poverty, the civil rights and peace movements, women's marches, and other social service reforms rekindled hope for social action to be a more salient aspect of social work, but the ultimate failure of the great society resulted in a retreat once again (reisch & andrews, 2001). this retreat was deepened by the 1980 election of ronald reagan to the u.s. presidency. the reagan administration made massive cuts to social services and challenged individuals to be self-sufficient and free of government assistance (reisch & andrews, 2001). in addition, reagan’s remix of social darwinism portrayed poverty, illness, and disability as personal failures and favored clinical approaches in social work practice. as a result, social action during the reagan era prioritized defending existing programs rather than building social infrastructure in ways that promoted human rights (karger & stoesz, 1993; reisch & andrews, 2001). the resulting micro/macro divide throughout social work history has implications for incorporating social justice and human rights in social work (androff & mcpherson, 2014). strategies to promote justice, human rights, and social change are generally relegated to policy and community work the macro part of social work practice (e.g., policy analysis, development, and advocacy; community organizing and development; and the promotion of organizational change; mattocks, 2018). within a dichotomized model of social work, clinical work is thought to be built on scientific objectivity (breton, 2006; haynes, 1998), and its objectivity is protected by remaining outside the realm of advocating for human rights and justice. in this way, direct work practice has been cast as a value-free approach, and infusing it with social work values for rights and justice can be viewed as tainting professional objectivity (abramovitz, 1998). this division within social work threatens the future of the profession. clinical social workers, without question, dominate the profession today, but without anchoring their practice in human rights, social work’s role as an advocate for justice will continue to recede (mattocks, 2018). social work education focuses on transmitting knowledge, skills, ethics, and values and contextualizing situations within larger environmental forces. without this, social work professionals are therapists like all other therapists, are bureaucrats without a vision for improving systems to better the lives of beneficiaries, are administrators who value efficiency over service, and community workers who administer government programs without raising consciousness. gabel et al./looking back to move 421 human rights education in social work as stated, the u.s. has lagged in its commitment to human rights, and u.s. social workers are similarly behind their international peers in understanding human rights. for example, while other national social work bodies such as in australia, canada, and great britain include human rights in their codes of ethics, the u.s. nasw does not. in addition, human rights were again omitted in 2021 when an update to the code strengthened cultural competence and anti-oppression standards (nasw, 2021a). the u.s. national social work education accrediting body, the council on social work education (cswe), however, did add human rights to its educational policy and accreditation standards (epas) in 2008, 60 years after the signing of the universal declaration of human rights (cswe, 2008; united nations [u.n.], 1948); the human rights focus were expanded in subsequent versions (cswe, 2015; 2022). the 2022 epas explicitly places human rights as central to the purpose of social work in competency 2 to advance human rights and social, racial, economic, and environmental justice e as well as in the description and practice behaviors of competencies 1 on ethical and professional behavior and 5 on policy practice (cswe, 2022). in addition, as noted by steen (2018), human rights can also be easily integrated into the other competencies by reconceptualizing the practice behaviors through a human rights lens. still, state licensing boards typically do not assess this mandated human rights competency (human rights educators usa and university and college consortium for human rights education, 2018). social work students have a fairly high endorsement of human rights principles (witt, 2020), and exposure in the curriculum increases their engagement with and support for human rights (steen et al., 2016). a survey of u.s. social work education programs found that the accreditation mandate beginning in 2008 spurred many programs to add content on human rights. among respondents, 45% said they had added content – either as standalone content (22%) or appending it to the material on social justice (22%); one-third stated that they did not need to add content because they already had it, while 12% said they had not added any content on human rights (gatenio gabel & mapp, 2020). however, despite this mandate, how schools and programs integrate human rights education into the social work curriculum remains uneven. some researchers emphasized the content of human rights instruments and principles rather than how to actualize a rightsbased approach in social work practice (chen et al., 2015; swigonski, 2011). in contrast, gatenio gabel and mapp (2020) found that when administrators were asked about the aims of human rights education in their program, respondents prioritized a rights-based approach for students to use in their work over knowledge of the major international human rights instruments. how and whether human rights are taught can be affected by faculty preparedness and level of interest. the number of faculty who identify human rights as an area of specialty impacts the number of methods used to educate students about human rights, as well as the level of knowledge programs want students to have about human rights and rights-based practice (gatenio gabel & mapp, 2020). many faculty members have little preparation in advances in social work, summer 2022, 22(2) 422 human rights (especially if their education was completed before the cswe human rights competency was established in 2008), and they may believe that human rights belong only in macro, international or policy classes, rather than viewing the issues that confront u.s.based service users as human rights violations (chiarelli-helminiak et al., 2018; richardsdesai et al., 2018). as noted in the book edited by libal et al. (2014), rights-based social work practice can be integrated into social work education in a variety of ways. for example, it can be integrated throughout the curriculum, be a focus of particular classes, or infuse experiences such as study abroad. the most common methods are integrated into classes (especially cultural diversity, policy, and macro classes) and through the implicit curriculum, such as seminars and talks (gatenio gabel & mapp, 2020). in contrast, some programs have developed an intentional integration across the curriculum, such as fordham university, the university at buffalo, and west chester university. at fordham university’s graduate school of social service, all syllabi are required to demonstrate how the course furthers human rights and justice. at the university at buffalo, the mission, vision, and curriculum were updated to integrate a trauma-informed, human rights approach, and "the school's curriculum development guidelines stipulate that human rights content must be included and measured through critical assignments in each course" (richards-desai et al., 2018, p. 172). similarly, west chester university linked experiences of trauma and human rights violations and updated the department's mission, vision, and goals and the msw specialization year competencies to include human rights (quzack et al., 2021). the west chester social work department revised foundation classes, learning agreements, and evaluations for fieldwork to "foster anti-racist, anti-oppressive, and human rights-based practices" (p. 34). assessing the impact of these changes, quzack et al. (2021) found high levels of student exposure and engagement among their graduating msw students, as well as a tendency to view their work through a human rights lens. much like other forms of student learning, experiential and critical learning are needed to help students learn how to apply human rights principles, values, and approaches to their work. these methods should include experiential, reflexive, and reflective opportunities for students to assimilate knowledge and incorporate it into their skill development (chen et al., 2015; swigonski, 2011). while study abroad opportunities can be one way to educate students about human rights (e.g., bell et al., 2015; gammonley et al., 2013; gonzalez benson & siciliano, 2021), not all students are able to participate. therefore, field education is the prime setting for social work students to hone this skill, as they do with all their other skills. a special issue of the journal of human rights and social work (2021) focused on field education as a method to teach human rights (steen, 2021). it examined topics such as the training of field instructors, inclusion of human rights in different types of field placements or with particular populations, as well as human rights issues within field education itself, such as unpaid internships creating disproportionate impacts for povertyaffected students (smith et al., 2021). like social work faculty, many field instructors have not received formal training in human rights and may lack the competency to do this as they guide social work students' field practice experiences (banks et al., 2021; mcdermott gabel et al./looking back to move 423 et al., 2021). mcpherson and libal (2019) found that while field instructors generally rated their knowledge of human rights as high, many also reported never having read the universal declaration of human rights. when surveyed, these instructors neither understood their u.s. service users to experience human rights violations nor recognized the human rights to food or an adequate standard of living (mcpherson & libal, 2019). thus, a review of the literature finds that despite the cswe mandate that social work educators prepare their students to advance human rights, the application is spotty. while some schools integrate human rights throughout their curriculum, others report that coverage is uneven and dependent on having faculty who happen to have human rights as an area of focus. similarly, while field practica are the place for students to practice and demonstrate all the competencies, field supervisors need the training to help them support student learning in this critical area. righting social work education in order to prepare students for rights-based practice, social work programs can build on the core concept that human rights are universal and interdependent. as such, human rights education can fit all levels of social work education and forms of social work practice (androff & mcpherson, 2014). rights-based approaches can be applied to work with children, older adults, and in settings such as anti-poverty, health care, and mental health, and across all methods of practice such as clinical practice (berthold, 2015), community practice (libal & harding, 2015), social policy (gatenio gabel, 2016), and research methods (maschi, 2016). rights-based approaches embrace fundamental human rights principles congruent with social work ethics and values. human rights-based principles for social work practice are human dignity, non-discrimination, participation, transparency, and accountability (androff, 2016). the principle of human dignity encompasses the concepts of universality, inalienability, and dignity and worth of the person. it reconceptualizes all people as deserving rights-holders, not passive objects of charity. non-discrimination means that social work practice does not discriminate based on identity characteristics such as gender, age, sexual orientation, ability status, nationality, race or ethnicity, language, religion, and migrant status. this principle is also about remedying the historical exclusion of people from access to social services, policy benefits, and resources. participation is a principle that requires social workers to work with people, not on their behalf, but in solidarity so that they can influence decisions, policies, and programs that affect their welfare. transparency refers to openness and reflexivity in assessment, monitoring, evaluation, and research. accountability involves activism, advocacy, community development and organizing, lobbying, and social movements that build and apply power to advance human rights. to facilitate a rights-based approach in social work education, human rights should be at the core of social work education and integrated across epas competencies with an emphasis on human dignity across the curriculum, as illustrated in table 1. promoting human dignity in social work education would emphasize a "do no harm" philosophy and support people to self-determine their own practice methods and goals. non-discrimination requires that students are taught to challenge discrimination on any basis, including that of advances in social work, summer 2022, 22(2) 424 race or ethnicity, religion, sex, gender identity, sexual orientation, immigration status, national origin, political opinion, or other social difference. non-discrimination in social work education provides a needed focus on how certain groups are excluded from society, including from social work services. students are trained in anti-racist, anti-oppressive, and inclusive social work practices and take affirmative action for equity, repair, remediation, and reparations. table 1. translating human rights principles into practice human rights principle putting the principle into practice examples of social work practice participation • to practice the principle of participation is to ensure that service users & community members are not passive or powerless beneficiaries of services but are active participants in their own development & in agency decision-making. • service users are full partners in the processes of assessment, intervention, & evaluation. • agencies seek service user participation in agency decision-making. • agencies help service users develop any skills needed for them to participate fully as effective partners & engaged citizens. non-discrimination • to practice non-discrimination is to identify & undo the specific patterns of discrimination, so that community members who have experienced such discrimination can achieve equality. • the practice of non-discrimination calls for cultural sensitivity. • to practice non-discrimination is to specifically combat stigma by focusing on compassion & strengths. • social workers identify service users’ strengths & work with them to overcome social stigmas. • social workers empower service users to change unfair personal & social conditions & join with them to advocate for change. • social workers make information accessible in multiple languages as well as to those who live with disabilities. transparency • rights-based agencies are accountable to their service users & therefore practice inclusive decisionmaking & operate with transparency. • social workers are clear with their service users about why they are collecting any personal information & how that information will be protected. • social workers explain all interventions, along with their purpose & intended effects. social workers collaborate with service users to evaluate their practices. accountability • to practice accountability requires professionals to educate government leaders about their rights-related duties, as well as to partner with rights-holders in their efforts to claim rights that have been denied. • to practice accountability requires professionals to be reflective about their practices & to rigorously evaluate its impact. • social workers educate local leaders to increase their knowledge of human rights & advocate for the expansion of service users’ access to rights. • social workers help service users develop skills to effectively assert their rights & join with service users to lobby for access to rights. • social workers & social work agencies promote accountability to their service users by including service users in program evaluations & sharing the results. adapted from mcpherson (2015). gabel et al./looking back to move 425 human rights-based social work education centers on the right of people to participate in decisions and processes that affect them at the core of all social work engagement, assessment, intervention, and evaluation. rights-based practice counters the disempowering and paternalistic model of practitioners speaking on behalf of service users and openly incorporates the voices of service users in all research and funding decisions that affect them. finally, rights-based social work education ensures that practitioners are prepared to both be accountable and to hold accountable the institutions that bear responsibility for upholding human rights. to change the way we practice, social work curricula should facilitate knowledge acquisition of human rights, new perspectives on social issues, and new skills. in 2013, cswe created a human rights committee to strengthen the integration of human rights into social work education. the committee holds events at cswe annual program meetings to introduce social work educators to u.s.-based human rights practitioners and provide educators with deeper exposure to u.s. human rights concerns, such as environmental justice, the death penalty, criminal justice reform, and higher education for undocumented students. the committee also advocates for the integration of human rights into the educational policy and accreditation standards for baccalaureate and master’s social work programs (epas) by submitting suggested revisions. much as mapp et al. (2019) called for "righting the code of ethics" (p. 264), the committee works to “right” social work education to ground the profession's purpose in the realization of human rights. table 2 summarizes the human rights committee's proposal, which reviewed the 2015 epas (cswe, 2015) and offered suggestions on how to integrate a rights-based approach. this table presents a human rights critique and re-frames epas for the purpose of social work education, each of the nine competencies, as well as field education. for example, competency 2, engage diversity and difference in practice, did not link oppression to people’s human right to be free from such experiences, even though the convention on the elimination of racial discrimination is one of the few that that u.s. has ratified. competency 9, which relates to the evaluation of service provision, could be “righted” through sharing these evaluations with people and communities in order to promote transparency for social work practice and organizations. these revisions called for a rights-based perspective, knowledge, and skills to be infused throughout the curriculum, some of which were included in the 2022 revision. for example, related to field education, the 2022 standards state, “the field setting is where students apply human rights principles from global and national social work ethical codes to advance social, racial, economic, and environmental justice” (cswe, 2022, p. 20). advances in social work, summer 2022, 22(2) 426 table 2. righting social work educational standards cswe 2015 epas human rights critique rights-based reframe purpose of social work practice, education, & epas reactive, remedial, residual framing social work creates the conditions that facilitate the realization of human rights competency 1: demonstrate ethical & professional behavior ethics tangentially linked to human rights & justice connects to the international association of schools of social work (iassw) & the international federation of social work (ifsw) global statement of ethical principles; mandates technology use in a way that promotes human rights competency 2: engage diversity & difference in practice oppression not connected to human rights explicitly frames oppression & discrimination as human rights violations competency 3: advance human rights & social, economic, & environmental justice human rights are not presented as actionable; they are not linked to practice social work is linked to the human rights movement; it recognizes people as rightsholders; shifts from needs-based to rights-based approach; highlights human rights-based approaches for social work practice; emphasizes human rights principles for the practice of human dignity, non-discrimination, participation, transparency, & accountability competency 4: engage in practice-informed research & research-informed practice research not linked to human rights or other ethical obligations research must respect human rights; the science of social work is anchored in rights principles competency 5: engage in policy practice human rights are framed as a policy goal, not a process; no focus on changing structures human rights-based policy advances justice; understands how policy can violate human rights; facilitate people & communities' participation in the policy-making process competency 6: engage with individuals, families, groups, organizations, & communities power differences & hierarchies not addressed; no focus on educating people about rights within systems & institutions' responsibilities to people value non-hierarchical human relationships; understand how to manage power differences; educate people on their rights & the obligations of duty-bearers in systems; engage in a way that respects human rights; competency 7: assess individuals, families, groups, organizations, & communities needs-based, deficit-based model of assessment; upholds expertise of the practitioner assess for human rights violations & the dutybearer with responsibility for protecting any violated human rights competency 8: intervene with individuals, families, groups, organizations, & communities emphasis on meeting needs, as the current symptoms of structural problem intervene to achieve human rights competency 9: evaluate practice with individuals, families, groups, organizations, & communities preserves hierarchy of the practitioner over others share evaluations with people & communities; promote transparency for social work practice & organizations epas 2.2 – signature pedagogy: field education field is not linked to human rights field is the setting where students apply human rights principles to advance social, economic, & environmental justice gabel et al./looking back to move 427 righting the social work curriculum however, social work programs do not need to be dependent on epas to be teaching their students and faculty (including field instructors) how to be rights-based practitioners, regardless of practice level or population of focus. human rights must be integrated into social work education in two ways: first, as a basis, social work students and practitioners should be knowledgeable about human rights instruments so that they can transfer this knowledge to stakeholders; and then, critically, how to actualize them in practice. we must provide our students with human rights content that feels applicable and approachable (more than a compendium of treaties and protocols), and most importantly, we need to teach (and model for) our students how to practice social work in a way that promotes human dignity and human rights for all. human rights must be taught as a set of powerful tools for ensuring that we practice ethical, justice-focused, liberatory social work. social work programs should be structuring their curricula to ensure the achievement of these two levels of knowledge and practice. much as students cannot jump fully-fledged into being rights-based practitioners, neither can social work programs expect an immediate full transition as centers of rightsbased education. programs must ensure their instructors – both classroom and field – have the knowledge and understanding to guide students on their learning journey in this area since it cannot be expected that social work faculty would have studied human rights in their own social work education. programs can then conceptualize a multi-year approach, focusing first on the knowledge and then on the actualization, as students will. human rights should not be segregated into one class and expect students to gain the requisite skill. rather programs must demonstrate the importance by prioritizing it throughout students’ educational experiences in both the explicit and implicit curricula. introducing human rights knowledge to provide the basis for rights-based practice, students must first be taught the major human rights instruments and the interdependence of rights work, as well as the core principles of the rights-based approach. this will provide the requisite foundational knowledge of what human rights are, that we are all rights holders and that as social workers, we are also duty bearers to help fulfill those rights. students need to fully grasp the concept that in the rights-based approach, the outcome of fulfilling rights is important, but centering on human rights principles is essential to ensure the process is also rightsbased. thus, the rights-based approach is inherently political because it requires a change in power relationships not only in a society but also in social work practice. this is true whether the social worker is primarily working on the micro or macro level; all social workers are change agents. thus, when introducing human rights, it is important for instructors to provide students with the political context of human rights in the u.s., starting with the universal declaration of human rights (udhr, 1948). the udhr is the founding document of human rights, unanimously affirmed at the u.n. on december 10, 1948. the udhr lays out our human rights briefly in 30 articles; however, it is not a treaty and does not have the advances in social work, summer 2022, 22(2) 428 force of international law. for a treaty, also known as a convention, to become law, a country’s government must ratify the treaty. typically, this means that nations agree to be bound by the terms of a treaty under international law. there are nine core international human rights instruments: international covenant on economic, social, and cultural rights (icescr), international covenant on civil and political rights (iccpr), international convention on the elimination of all forms of racial discrimination (icerd), convention on the elimination of discrimination against women (cedaw), convention against torture and other cruel, inhuman or degrading treatment or punishment (cat), convention on the rights of the child (crc), international convention on the protection of the rights of all migrant workers and members of their families (icmw), convention on the rights of persons with disabilities (crpd), and the international convention for the protection of all persons from enforced disappearance (cepd, u.n. office of the high commissioner for human rights, 2021). some of the treaties are supplemented by optional protocols addressing specific concerns. though the u.s. was a leader in the development of the udhr, it has only ratified three of the major conventions: the iccpr, cat, and icerd, reflecting the u.s. view that its sovereignty reigns supreme and should not be subject to international scrutiny (kahn, 2000). notable is the u.s. non-ratification of the icescr. the u.s. non-ratification of the icescr helps students understand why social and economic rights are still so disputed in the u.s. context, and also to explain why so many u.s. citizens—including social work faculty and field instructors, as discussed previously—may be unaware of the existence of social and economic rights, such as food, medical care, housing, work, and leisure. this discussion should then move on to discuss why the u.s. has ratified a few of the other human rights treaties as well, including being the only nation not to ratify the convention on the rights of the child (mapp et al., 2019). teaching human rights as a practice. human rights must be taught both as a content area—a list of rights and treaties that are recognized in international law—and a practice rooted in the human rights principles of human dignity, participation, non-discrimination, transparency, and accountability. as noted by reynaert et al. (2019), “social work needs to develop its own approach to human rights and implement this approach in social work curricula, emphasizing the fact that human rights need to be practiced” (p. 23, emphasis added). field education is a prime vehicle for human rights education (steen, 2021). students can begin to see how human rights violations occur in their everyday practice by learning to complete a human rights assessment using the udhr (e.g., mapp et al., 2019). completing such an assessment is ideal for use in field instruction to help students understand the impacts of various systems on those they serve; further, it introduces students to the human rights lens and how that lens shines a light on how rights violations are experienced by individuals, as well as by entire communities (mapp et al., 2019). students should evaluate their service user’s access to each of the rights listed in the udhr or one of the other major conventions and consider the level of access to that right across the whole community. in policy and other macro courses, students should practice framing a social issue/problem from a rights-based perspective. in clinical courses, students should https://www.ohchr.org/en/hrbodies/ced/pages/conventionced.aspx https://www.ohchr.org/en/hrbodies/ced/pages/conventionced.aspx gabel et al./looking back to move 429 reframe the intersection of the personal situations of people with the realization of their rights. students should be learning to contextualize clinical issues within socio-economic and political climates and discuss the consequences of policies on the self-identity and emotional well-being of individuals and communities. all students should be learning that advocacy is critical to practice as a social worker, regardless of one’s chosen method of practice. the micro/macro dichotomy should not be promulgated by deferring advocacy to macro practice. all social workers are change agents. finally, rights-based intervention requires social workers to practice, as has been described earlier in this article, in ways that promote human dignity, service-user participation, non-discrimination, transparency, and accountability and students need to practice this approach in the field the same as they hone all their other skills. instructors must help students identify how the everyday interventions they complete in the field are rights-based—or not. for example, when students cultivate democratic and clear engagement with their service users, they are communicating respect and promoting human dignity; when they work together with the client in the selection of interventions, they demonstrate participation; being open about the content and purpose of interventions practices transparency; and when they are choosing to be nonhierarchical in their communication style, they are promoting non-discrimination (table 1 provides additional practice examples). teaching students to give rights-based labels to the actions they take with individuals, families, and communities, underscores how human rights practice emphasizes process, not just goals. of course, rights-based practice aims at rights-based goals like expanding the rights to non-discrimination, housing, healthcare, and a living wage, but it also aims to promote human dignity more generally. certainly, working on expanding individuals’ access to human rights without listening to their voices and fully including them in the process is not rights-based practice. implicit curriculum human rights and the rights-based approach must also be integrated into the implicit curriculum for maximum benefit. social work educators should model rights-based practice in their teaching by treating everyone with respect (human dignity); being proactive about including the voices of students from marginalized groups (nondiscrimination); inviting students to co-create assignments (participation); by being very clear about course policies and grading (transparency); and by modeling a reflective, critical approach towards their teaching and the social work profession (accountability). it is particularly important that educators who wish to teach rights-based practice reflect on their own practice. similarly, social work programs should model these principles in their policies and procedures through the inclusion of both students and service users. in britain, it is a requirement that service users be given a voice in social work education (mclaughlin et al., 2016). programs can hold events on their campus to highlight human rights concerns and explicitly link discussions of social issues to human rights and social workers’ role as dutyadvances in social work, summer 2022, 22(2) 430 bearers. programs can also promote participation in other events, such as social work day at the u.n. conclusion during this critical time in our history and the current attention to social justice, human rights offer a path to guide equity and justice efforts. given social work’s identification as a human rights profession, practicing from the rights-based approach aligns with the profession’s values and ethics, and thus all social workers must be trained in human rights instruments and their application. it is not sufficient to focus only on educating students; faculty and field supervisors need to be better trained in rights-based approaches to social work practice. online or in-person courses should be available to faculty and field supervisors to learn about the ways that a rights-based approach could be integrated into social work courses and field experiences. to achieve the goal of social justice, we must eliminate the deficit model of the needsbased approach by contextualizing individual issues in a larger human rights framework. it is not for social workers, or anyone, to determine who deserves to have their rights met. to encompass this framework, we must move past the false micro/macro dichotomy within social work. all social workers must be advocates for change and are agents of transformation. there have been recent efforts to eliminate the micro/macro divide in social work that are a very good sign (association for community organization and social action, 2021); however, these efforts must be rooted in human rights to achieve justice. a rights-based approach is much more than identifying human rights violations and castigating authorities who have not lived up to their responsibilities to promote, protect, and realize human rights. it is important to recognize human rights violations and the consequences of rights not being realized, but all social workers should understand that this is the beginning of change, not the end of their advocacy efforts. a human rights approach also requires us to challenge ourselves and our practices: for example, knowing our history of excluding african americans from services, we must be vigilant to hold our profession to its promise to promote the human rights of all service users. a rights-based approach seeks to transform societies in ways that care for one another with respect and dignity for one another. to transform our societies into just societies, social workers must elevate dignity, participation, equity, accountability, and transparency. in doing this, we allow more voices to be heard and power relations within communities to change. social workers trained to do this will help societies evolve, moving us away from elite groups determining how justice will prevail and leading us to justice for all. references abramovitz, m. 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(2020). do us social work students view social work as a human rights profession? levels of support for human rights statements among bsw and msw students. journal of human rights and social work, 5, 164-173. https://doi.org/10.1007/s41134-020-00126-0 author note: address correspondence to shirley gatenio gabel, graduate school of social service, fordham university, new york, ny. email: gateniogabe@fordham.edu https://doi.org/10.1007/s41134-021-00163-3 https://doi.org/10.1007/s41134-021-00163-3 https://doi.org/10.1080/08841233.2016.1234534 https://doi.org/10.18084/basw.16.2.dp1ht167100h1819 https://www.un.org/en/about-us/universal-declaration-of-human-rights https://indicators.ohchr.org/ https://doi.org/10.1007/s41134-020-00126-0 mailto:gateniogabe@fordham.edu _________ steven seiler, phd, professor, department of sociology & political science, tennessee tech university, cookeville, tn. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 44-64, doi: 10.18060/26115 this work is licensed under a creative commons attribution 4.0 international license. intersections of institutional racism, racial microaggressions, and minority stress in the lived experiences of black people steven seiler abstract: macro-level institutional racism and micro-level racial microaggressions have an insidious effect on the social experience and, consequently, mental health of black people. the purposes of this study were to compare the differential experiences of structural uncertainties, racial microaggressions, and minority stress between a nationwide sample of people who are black and people who are white as well as to understand the impact of racial stressors on minority stress among people who are black, specifically. it is argued that minority stress among people who are black is a central process that inherently connects institutional elements and the lived experience and, ultimately, provides a context for a deeper understanding of the connection between racism and mental health among people who are black. a secondary data analysis of survey data from the “2016 racial attitudes in america ii” was conducted by the pew research center in which perceptions and experiences of people who are black and white (weighted n=3,036) and, subsequently, patterns among a subsample of people who are black (weighted n=480) were examined. the study found that larger percentages of people who are black in the u.s. experience structural uncertainties and racial microaggressions than people who are white. among people who are black, as the intensity of racial stressors increases, the level of minority stress increases. ultimately, the study substantiates the structural uncertainties, racial microaggressions, and minority stress experienced among people who are black and suggests that minority stress among people who are black is a psychosocial response to everyday structural uncertainties and racial microaggressions. based on the results, it is recommended that on a macro-level, healthcare policy acknowledges minority stress among people who are black and, on a micro-level, that addressing minority stress be incorporated into therapeutic interventions by social workers and other helping professionals as an important component of cultural competency. keywords: racial microaggressions, racial stressors, minority stress on may 25, 2020, george floyd was murdered in broad daylight by four minneapolis, minnesota police officers who restrained and subsequently choked the life out of him while on-lookers pled for his life – all over a suspicion of using a counterfeit $20 bill (hill et al., 2020). on march 13, 2020, breonna taylor was killed in her own home in kentucky by two undesignated police officers because the police believed the occupants of the home were selling drugs – which they were not (burke, 2020). on february 23, 2020, while jogging in georgia, ahmaud arbery was killed by two white men because they suspected him of robbery of local homes – which he did not do (bbc, 2020). these all-too-common events are tragic and unquestionably racist in nature, but they are only the mine canaries sounding alarms about the much broader, more subtle forms of racism experienced by people who are black throughout their everyday lives. about:blank seiler/racism, microaggressions, & minority stress 45 one of the 12 grand challenges for social work (2018) is to “achieve equal opportunity and justice,” which involves social workers “addressing racial and social injustices, deconstructing stereotypes, dismantling inequality, and exposing unfair practices [that] will lead to the full social, civic, economic, and political integration of these marginalized groups” (p. 1). in order to achieve the objectives of this challenge, it is necessary to understand the lived experiences of marginalized groups. for racial injustice, it is critical to understand the impact and consequences of racial inequality on the everyday life experiences of black people. studies have addressed the impact of minority stress and racial microaggressions on mental and physical health and identity (arbona & jimenez, 2014; meyer, 1995; o'keefe et al., 2015). however, previous research has not necessarily substantiated the intersections between minority stress, racial microaggressions, and mental and physical health as unique experiences or feelings among black people, specifically. for any policy or program aimed at reducing racial inequality to maximize its effectiveness, it must account for the micro-level dynamics of racial injustice, the macrolevel social patterns of racism in and across social institutions, and the connections between the two levels. in this study, we argue that minority stress among people who are black is a central process that inherently connects institutional elements and individuals’ lived experience. ultimately, the concept provides a framework for understanding the connection between racism and mental health among people who are black. accordingly, through a secondary data analysis of a nationally-representative survey conducted by the pew research center, this study aimed to examine structural uncertainty, racial microaggressions, and minority stress by comparing the experiences and feelings of people who are black and white. the study also examined the impact of structural uncertainties and racial microaggressions on minority stress among a subsample of people who are black. literature review institutional racism, microaggressions, and microassaults are well-documented in the literature, and the implications for health, including mental health, are very concerning. current research in social work explores these issues for minorities. however, the field lacks a specific examination of the impact of institutional racism, microaggressions, and minority stress on the black community in the u.s., and especially the relationships and correlations between these different levels and dynamics of racism. this research addresses these relationships and examines the correlation between racism and mental health outcomes. the following literature review provides background information about institutional racism, interpersonal racism, and the current awareness of how minority stress impacts the black community. the lives of people who are black, a marginalized group in the u.s., are shaped by institutional and interpersonal forms of racism. in previous research, institutional racism is often referred to as a type of racism without racists (bonilla-silva, 2006; harper, 2012; carroll massey et al., 1975; müller-uri & opratko, 2016). formally, institutional racism is a race-based inequality that is built into the cultural structures, over the course of time, advances in social work, spring 2023, 23(1) 46 within all areas of social life and that is routinized in a manner that disconnects racism from conscious individual action. whereas some define institutional racism in terms of organizations and social policies (see brondolo et al., 2011; jeanquart-barone & sekaran, 1996), others, more comprehensively, explain it as a system-wide cancer embedded within culture, the effects of which “are suffused throughout the culture via institutional structures, ideological beliefs, and personal everyday actions of people in the culture, and… are passed on from generations to generations’’ (griffith et al., 2007, p. 384). since such racism is built into culture, it becomes a foundational element in organizational processes and uncoordinated social interaction. for people who are black, such institutional racism is evident in macro-level patterns that are well-documented in previous research. within our economic institutions, in 2020, nearly 20% of people who are black and just over 8% of people who are white live in poverty; moreover, the median income was just under $46,000 for people who are black and just under $75,000 for white people (shrider et al., 2021). unemployment among people who are black is more than two times higher than among people who are white (u.s. bureau of labor statistics, 2020). within healthcare, black people are at greater risk of “earlier onset of disease, greater severity and progression of disease and higher levels of comorbidity and impairment” (williams & mohammed, 2013, p. 1153) and have less access to health insurance. just over 55% of people are black have private insurance compared to nearly 75% of people who are white (berchick et al., 2019). moreover, compared to white people, people who are black are more likely to die at early ages “from all causes,” as 406 out of every 100,000 black people between the ages of 18 and 64 die early compared to 347 out of every 100,000 white people within the same age range (centers for disease control, 2017). life expectancy is lower for people who are black, as the average years of remaining life for black people between the ages of 20 and 40 is just over 47 years compared to over 50 years among white people in the same age group (arias & xu, 2019). additionally, about 47% of people who are black between the ages of 35 and 64 have high blood pressure compared to just over 31% of people who are white in this same age group (cdc, 2017). just over 16% of people who are black within this age group have diabetes, compared to 10% of people who are white. nearly 5% of people who are black in this age group have had at least one stroke, compared to just under 3% of people who are white (cdc, 2017). within politics, nearly 80% of voting members of the u.s. congress are white (bialik, 2019). while these statistics describe the context within which black people live, they do not account for the lived experiences of people who are black. within the lived experience, people who are black are exposed to interpersonal racism, which consists of “directly perceived discriminatory interactions between individuals whether in their institutional roles or as public and private individuals” (brondolo et al., 2011, p. 522). interpersonal racism occurs as various forms of racial microaggressions, which are “brief, everyday exchanges that send denigrating messages to people of color because they belong to a racial minority group” (sue, bucceri et al., 2007, p. 72). two forms of microaggressions are microassaults (i.e., overt forms of verbal, nonverbal and environmental attacks aimed at hurting people of color) and microinsults (i.e., are actions or comments that offend people’s racial identity; sue, capodilupo et al., 2007), “such as ascribing a certain degree of intelligence based on the person’s race, being treated as seiler/racism, microaggressions, & minority stress 47 inferior to others of a different race, and assuming that the person is a criminal or deviant in some way because of his/her race” (wong et al., 2014, p. 183). whereas microassaults are overt forms of racism, microinsults “tend to operate unconsciously, are unintentional, and generally outside the level of conscious awareness” (sue, bucceri et al., 2007, p. 73). although a large amount of research into racial microaggressions substantiates the concept and the uniqueness of racialized experiences, much of the research focuses on college students or small samples of people of color. of the comparative research, torresharding et al. (2012) and forrest-bank and jensen (2015), for example, found people who are black were far more likely to experience racial microaggressions than people who are white. however, in both studies, the participants were largely college students. although the findings were very meaningful, the generalizability of the findings might be limited. numerous studies have found a relationship between institutional racism and health outcomes (alang, 2019; anderson, 2013; brondolo et al., 2011; paradies et al., 2015; phelan & link, 2015; williams & mohammed, 2013). although correlations between racism and health are present in the research, the exact reason for the correlations remains unclear. additionally, a large body of research has examined the consequences of microaggressions (forrest-bank & jenson, 2015; o'keefe et al., 2015; smith et al., 2011; sue, capodilupo et al., 2007). this research establishes correlations between microaggressions and health in the lived experiences of people who are black. however, the reason for the correlations is unclear, and the relationship between microaggressions, institutional racism, and mental health is less clear. one possible reason for the correlation between microaggressions and mental health that has been under-explored is minority stress. minority stress, or “excess stress to which individuals from stigmatized social categories are exposed as a result of their social, often a minority, position” (meyer, 2003, p. 678), could be a missing conceptual link between institutional racism, microaggressions, and the mental health of people who are black. the current study aimed to provide a deeper understanding of the nature of these correlations. a number of studies have examined the effects of minority stress on mental and physical health among various minority groups such as latino/a college students (arbona & jimenez, 2014), racial and ethnic minority college students (wei et al., 2010), lgbtq asian americans (szymanski & sung, 2010), lgbtq people of color (balsam et al., 2011), and black lesbians (bowleg et al., 2003). however, few studies have examined minority stress exclusively and generally among the black community. minority stress is likely the byproduct of racial microaggressions. such microaggressions are traumatic, yet the trauma can be as subtle as this type of racism itself. such racial trauma is experienced both directly and indirectly; that is, not only do the victims of racial microaggressions experience direct trauma, but also those who hear about or see via media platforms people who are black victimized through racial microaggressions can experience vicarious trauma (bernstein et al., 2007; heard-garris et al., 2018). from a constructivist perspective, social reality is constructed through knowledge in the lived experience (marsiglia & kulis, 2016). for people who are black, oppression and advances in social work, spring 2023, 23(1) 48 uncertainty become built into the social reality through navigating institutional racism and microaggressions in daily social interaction. within this reality, they experience a very real level of stress related to their racial minority status – incomparable to the social realities of whites. meyer (2003) explains, minority stress is (a) unique—that is, minority stress is additive to general stressors that are experienced by all people, and therefore, stigmatized people are required an adaptation effort above that required of similar others who are not stigmatized; (b) chronic—that is, minority stress is related to relatively stable underlying social and cultural structures; and (c) socially based—that is, it stems from social processes, institutions, and structures beyond the individual. (p. 678) people who are black experience minority stress as unique additive stress due to the consequences of institutional (i.e., chronic) racism and microaggressions within their social reality. this claim should be able to be empirically verified in the following ways. first, since institutional racism is built into social structure, it is experienced indirectly in the micro-process of everyday social interactions through structural uncertainties such as unemployment, food insecurity, and the inability to pay bills. these uncertainties are not exclusive experiences of people who are black, as many people living in poverty experience them. however, previous research provides substantial evidence that people who are black are disproportionally affected by job insecurity (freeman, 2012; landsbergis et al., 2014), financial insecurity (hill et al., 2017; ortiz & zimmerman, 2013; western et al., 2012), and food insecurity (allen et al., 2016; balistreri, 2016; myers & painter, 2017). therefore, in anticipation of verifying previous studies regarding disparities between people who are black and people who are white in these three areas, this study tests the following confirmatory hypotheses: h1a: people who are black are more likely to experience job insecurity than pwople who are white. h1b: people who are black are more likely to experience financial insecurity than people who are white. h1c: people who are black are more likely to experience food insecurity than people who are white. second, within daily life, people who are black experience overt (microassaults) and subtle (microinsults) forms of interpersonal racism. such racial microaggressions are one of the elements defining the unique experience of people who are black and should be identifiable and disproportionately experienced by people who are black when compared to people who are white, leading to the following hypotheses: h2a (microassault): people who are black are more likely to experience discrimination, generally, because of their race than people who are white. h2b (microassault): people who are black are more likely to be treated unfairly by an employer in hiring, pay, or promotion because of their race than people who are white. h2c (microassault): people who are black are more likely to be unfairly stopped by police because of their race than people who are white. seiler/racism, microaggressions, & minority stress 49 h3a (microinsult): people who are black are more likely to be treated with suspicion because of their race than people who are white. h3b (microinsult): people who are black are more likely to be treated as unintelligent because of their race than people who are white. since minority stress is a “psychosocial stress derived from minority status” (meyer, 1995, p. 38), disparate feelings among people who are white and people who are black about the state of race relations and racial equality should also be empirically verifiable. people who are black have historically been and are currently subjected to inequities such as unfair lending practices and racism in the workplace and public spaces (bartlett et al., 2022; kau et al., 2012; opie & roberts, 2017). the previous hypotheses account for experiences leading to minority stress; however, feelings about race relations and equality are likely to represent the psychosocial nature of minority stress (meyer, 1995). accordingly, the following hypotheses are tested: h4a: people who are black are less likely to feel the country has made the changes needed to give blacks equal rights with people who are white. h4b: people who are black are more likely to feel that blacks are treated less fairly in the workplace than people who are white. h4c: people who are black are more likely to feel that blacks are treated less fairly in stores or restaurants than people who are white. h4d: people who are black are more likely to feel that blacks are treated less fairly when applying for loans or mortgages than people who are white. h4e: people who are black are more likely to feel that blacks are treated less fairly when dealing with the police than people who are white. h4f: people who are black are more likely to feel that blacks are treated less fairly in courts than people who are white. finally, a central argument here is that structural uncertainties and racial microaggressions are social experiences that likely impact minority stress, which, theoretically, is likely to influence mental health. for people who are black, the presence of racial stressors – both structural uncertainties and microaggressions – is likely to contribute to minority stress. formally, the following hypothesis is tested: h5: as the level of racial stressors increases, the level of perceived minority stress increases. methods survey data the data for this study came from the “2016 racial attitudes in america ii” survey conducted via telephone in spanish and english from february 29, 2016 to may 8, 2016 among 3,346 adults (18 years old or older) in the united states by the princeton survey research center for the pew research center (pew research center, 2016). as a nationally-representative sample, weights were used in order to account for demographic discrepancies between the sample and the population and nonresponse patterns. the advances in social work, spring 2023, 23(1) 50 weighted data of the original dataset had a margin of sampling error of ±2.2 percentage points (pew research center, 2016). the actual sample used in this study was smaller. first, to test h1-h4, the sample was reduced to only people who are black and people who are white (weighted n=3,036). additionally, to test h5, the weighted data were reduced to a subsample of people who are black (weighted n=480). variables dependent variables the study focused on 15 dependent variables in the three categories – (1) structural uncertainties, (2) racial microaggressions, and (3) minority stress – consisting of 14 dichotomous variables to test h1-h4 and one index to test h5 (see table 1). structural uncertainties were measured using three survey questions addressing job insecurity, financial insecurity, and food insecurity. first, job insecurity was measured using the survey question, “in the past 12 months, have you been laid off or lost your job?” second, financial insecurity was measured using the survey question, “in the past 12 months, have you had trouble paying bills?” finally, food insecurity was measured using the survey question, “in the past 12 months, have you gotten food from a food bank or food pantry?” the response options for the three questions were (0) “no, has not happened” and (1) “yes, has happened.” racial microaggressions were measured using five survey questions separated into two categories – microassaults and microinsults – that capture whether or not respondents have experienced racism (microassualt), have been treated unfairly by law enforcement (microassault) or by an employer (microassault), and treated as suspicious (microinsult) and treated as unintelligent (microinsult). for the measures of microassaults, experienced racism was measured using the survey question, “thinking about your own experience, have you ever personally experienced discrimination or been treated unfairly because of your race or ethnicity, or not;” unfair treatment by law enforcement was measured using the survey question, “in the past 12 months, have you been unfairly stopped by police;” and unfair treatment by an employer was measured using the survey question, “in the past 12 months, have you been treated unfairly by an employer in hiring, pay, or promotion?” for microinsults, treated as suspicious was measured using the survey question, “in the past 12 months, have people acted as if they were suspicious of you,” and treated as unintelligent was measured using the survey question, “in the past 12 months, have people acted as if they thought you were not smart?” the response options for all questions were (0) “no” and (1) “yes.” minority stress was measured using six survey questions in two categories: perception of equality (one question) and perceptions of fairness (five questions). first, perception of equality was measured using the survey question, which of these two statements comes closer to your own views -even if neither is exactly right: our country has made the changes needed to give blacks equal seiler/racism, microaggressions, & minority stress 51 rights with whites [or] our country needs to continue making changes to give blacks equal rights with whites. table 1. descriptive statistics, dependent variables: structural uncertainties, racial microaggressions, & minority stress weighted/ unweighted n (valid %) total no yes structural uncertainties job insecurities u 3750 3308 (88.2%) 442 (11.8%) w 3585 3150 (87.9%) 434 (12.1%) financial insecurities u 3757 2591 (71.6%) 1066 (28.4%) w 3590 2574 (71.7%) 1016 (28.3%) food insecurities u 3756 3358 (89.4%) 398 (10.6%) w 3592 3201 (89.1%) 391 (10.9%) racial microaggressions experienced racism u 3739 1903 (50.9%) 1836 (49.1%) w 3589 2117 (59%) 1472 (41%) unfair treatment by law enforcement u 3749 3434 (91.6%) 315 (8.4%) w 3586 3352 (93.5%) 235 (6.5%) unfair treatment by an employer u 3629 3221 (88.8%) 408 (11.2%) w 3490 3166 (90.7%) 323 (9.3%) treated as suspicious u 3746 2980 (76.9%) 866 (23.1%) w 3584 2956 (82.5%) 629 (17.5%) treated as unintelligent u 3769 2902 (77.7%) 833 (22.3%) w 3575 2960 (82.8%) 615 (17.2%) minority stress perceptions of equality a u 3700 1245 (72.4%) 475 (27.6%) w 3540 1082 (86.2%) 533 (33%) perceptions of fairness b in the workplace u 1825 1277 (70%) 548 (30%) w 1746 1340 (76.8%) 406 (23.2%) in stores or restaurants u 1849 1419 (76.7%) 403 (23.3%) w 1836 1433 (81.1%) 334 (18.9%) when applying for a loan or mortgage u 1561 952 (61%) 609 (39%) w 1444 1002 (69.4%) 442 (30.6%) in dealing with the police u 1810 863 (47.7%) 947 (52.3%) w 1740 949 (54.5%) 792 (45.5%) in the courts u 1720 913 (53.1%) 807 (46.9%) w 1617 990 (61.2%) 628 (38.8%) total mean/sd min/max index of minority stress (black subsample) w 450 3.56/2.40 0/10 a our country has made the changes needed to give blacks equal rights with whites b blacks treated less fairly than whites in community… for efficiency in reporting, the response options for this study were treated as (0) “no” (i.e., “our country has made the changes needed to give blacks equal rights with whites”) and (1) “yes” (i.e., “our country needs to continue making changes to give blacks equal rights with whites”). second, perceptions of fairness were measured using five survey advances in social work, spring 2023, 23(1) 52 questions: “thinking about your community, overall, would you say that blacks are treated less fairly than whites, whites are treated less fairly than blacks, or both are treated about equally…” (1) “in the workplace,” (2) “in stores or restaurants,” (3) “when applying for a loan or mortgage,” (4) “in dealing with the police,” and (5) “in the courts.” for this study, the response options for these four questions were (0) “no” (i.e., “whites treated less fairly” and “treated about equally”) and (1) “yes” (i.e., “blacks treated less fairly”). to test h5 among a subsample of people who are black, a mean index of perceived minority stress was created from the five questions asking if people who are black are treated less fairly than people who are white within different areas of the community. a reliability analysis indicated that, when combined, the index had a 73% internal consistency (chronbach’s α=.73). independent variables for hypotheses h1-h4, race was the independent variable, coded as (0) “white” and (1) “black.” to test h5 among a subsample of people who are black, a mean index for the intensity of racial stressors, consisting of the three survey questions for structural uncertainty and five survey questions for racial microaggressions, was created. a reliability analysis indicated an internal reliability of 68% (chronbach’s α=.68), which is not ideal but acceptable for exploratory measures such as this one. table 2. descriptive statistics: independent variables weighted/ unweighted total n (valid %) white black race u 3171 2094 (66) 1077 (34) w 3066 2586 (84.3) 480 (15.7) total mean/sd min/max index of racial stressors (black subsample) w 450 3.56/2.40 0/10 analytic strategy all data were analyzed using spss 26. first, demographic data were summarized using univariate analysis. second, univariate analyses were conducted to provide descriptive statistics of variables in advance of testing hypotheses. third, h1a-h4f, were tested using 2x2 crosstabulations and, for h1a-h3b, subsequent risk estimates determined odds ratios (or). finally, the dataset was reduced to a subsample of people who are black in order to test h5, which was tested using a bivariate ols regression analysis. results demographics in this study, over 84% of respondents were white, and nearly 16% were black (see table 2). just under 45% were younger than 50 years old. just over 7% had less than a seiler/racism, microaggressions, & minority stress 53 high school degree, 30% had a high school degree, 31% had some college, and 31% had at least a bachelor’s degree. additionally, about half (48%) were women (see table 3). table 3. additional demographics weighted/ unweighted total n (valid %) 18-29 yrs. 30-49 yrs. 50-64 yrs. 65+ yrs. age u 3127 489 (15.6%) 903 (28.9%) 963 (30.8%) 772 (24.7%) w 3027 570 (18.8%) 942 (31.1%) 853 (28.2%) 662 (21.9%) > high school high school some college bachelor or higher education u 3160 228 (7.2%) 732 (23.2%) 857 (27.1%) 1343 (42.5%) w 3060 228 (7.4%) 922 (30.1%) 954 (31.2%) 956 (31.2%) female male sex u 3171 1515 (47.8%) 1656 (52.2%) w 3066 1478 (48.2%) 1588 (51.8%) structural uncertainties h1a-h1c were supported (see table 4). first, regarding job insecurity, almost 17% of people who are black and about 11% of people who are white have been laid off or lost their job, suggesting people who are black were almost 60% more likely to lose their job than people who are white (h1a: or=1.59; χ2=11.29; df= 1; p<.001). second, people who are black were more likely to experience financial insecurity. they were nearly 91% more likely to have trouble paying bills than people who are white; that is, nearly 40% of people who are black and about 26% of people who are white had trouble paying bills (h1b: or=1.91; χ2=39.39; df=1; p<.001). finally, people who are black were much more likely to experience food insecurity than people who are white. in fact, they were three times more likely to receive food from food banks or pantries; specifically, just under 9% of people who are white and about 23% of people who are black received food from such sources (h1c: or=3.28; χ2=91.68; df=1; p<.001). table 4. crosstabulations of experiences of structural uncertainty among blacks and whites structural uncertainty % (n) odds ratio χ2 white black been laid off or lost job 11.1% (286) 16.6% (79) 1.586 11.29*** had trouble paying bills 25.7% (663) 39.7% (190) 1.905 39.39*** gotten food from food bank or food pantry 8.4% (217) 23.2% (111) 3.279 91.68*** note: * p<.05; ** p<.01; *** p<.001 racial microaggressions h2a-h3b were all supported (see table 5). considering racial microassaults, first, people who are black were five times more likely than people who are white to be victims of racism (or=5.352); that is, just over 72% of people who are black experience racism, whereas about 33% of people who are white experience racism (h2a: χ2=264.83; p<.001). advances in social work, spring 2023, 23(1) 54 second, nearly 24% of people who are black and only around 5% of people who are white experience workplace racial discrimination, suggesting people who are black were five times more likely to be subjected to racism in the workplace than people who are white (h2b: or=5.714; χ2=180.10; df=1; p<.001). third, 18% of people who are black and under 4% of people who are white were unfairly stopped by police because of their race, which means people who are black were five times more likely to be victims of racial discrimination by law enforcement than people who are white (h2c: or=5.581; χ2=180.10; df=1; p<.001). considering racial microinsults, nearly half of people who are black and about 11% of people who are white were treated as suspicious because of their race; that is, people who are black were seven times more likely than people who are white to be treated as suspicious (h3a: or=7.184; χ2=376.49; df=1; p<.001). additionally, people who are black were seven times more likely than people who are white to be treated as unintelligent because of their race, which means nearly 45% of people who are black and 10% of people who are white were treated as unintelligent because of their race (h3b: or=7.309; χ2=375.15; df=1; p<.001). table 5. crosstabulations of experiences of racial microaggressions among blacks and whites racial microaggressions % (n) odds ratio χ2 white black experienced discrimination/treated unfairly because of race/ethnicity 32.5% (838) 72.1% (343) 5.352 264.83*** treated unfairly by an employer in hiring, pay, or promotion because of race/ ethnicity 5.1% (127) 23.4% (109) 5.714 180.10*** been unfairly stopped by police because of race/ethnicity 3.8% (97) 18% (86) 5.581 143.98*** people acted as if they were suspicious of r because of race/ethnicity 10.9% (280) 46.9% (224) 7.184 376.49*** people acted as if they thought r was not smart because of race/ethnicity 10.2% (261) 45.3% (216) 7.309 375.15*** note: * p<.05; ** p<.01; *** p<.001 minority stress h4a-h4f were also all supported (see table 6). first, nearly 40% of whites and less than 9% of people who are black felt the u.s. has already made the necessary changes to give blacks equal rights as whites (h4a: χ2=81.77, df=1; p<.001). second, only about 17% of people who are white but nearly 54% of people who are black felt blacks are treated less fairly than whites in the workplace (h4b: χ2=152.71; df=1; p<.001). similarly, about 14% of people who are whites and over 40% of people who are black felt that blacks are treated less fairly than whites in stores or restaurants (h4c: χ2=96.78; df=1; p<.001). just over 22% of people who are white and nearly 67% of people who are black felt blacks are treated less fairly than whites when applying for loans or mortgages (h4d: χ2=166.31; seiler/racism, microaggressions, & minority stress 55 df=1; p<.001). just under 40% of people who are white but almost 75% of people who are black felt blacks are treated less fairly than whites in dealing with police (h4e: χ2=97.14; df=1; p<.001). finally, 32% of people who are white but almost 73% of people who are black felt blacks are treated less fairly than whites within the courts (h4f: χ2=132.59; df=1; p<.001). table 6. crosstabulations of perception of treatment of blacks. feeling of the treatment of blacks % (n) odds ratio χ2 white black our country has made the changes needed to give blacks equal rights with whites 39.7% (457) 8.9% (21) 81.77*** blacks treated less fairly than whites in r’s community… in the workplace 16.8% (210) 53.9% (124) 152.71*** in stores or restaurants 13.7% (173) 40.4% (95) 96.78*** applying for a loan or mortgage 22.2% (221) 66.5% (145) 166.31*** in dealing with the police 39.1% (486) 74.1% (172) 97.14*** in the courts 32% (367) 72.9% (164) 132.59*** note: * p<.05; ** p<.01; *** p<.001 relationship between racial stressors and minority stress a bivariate ols regression analysis of the index for racial stressors and the index for minority stress provides support for h5 (see table 7). that is, about 8% of minority stress is explained by racial stressors (r2= .077; f[1,236]= 19.65; p<.001). specifically, for every one-unit increase in the intensity of racial stressors, the level of minority stress increases by .38 (unstandardized b=0.38; t= 4.43; p<.001). this suggests that people who are black with the highest intensity of racial stressors (i.e., 10 on a scale from 0 to 10) experience a very high level of minority stress (i.e., 8.75 on a scale from 0 to 10). the relatively low r2 suggests that just under 94% of minority stress is not explained by racial stressors; however, it is the perspective of the author that this reflects both the limitation of the specific measures as well as the multifaceted complexity of racial stressors as well as minority stress. table 7. ols regression of level of racial stressors on the level of minority stress among a subsample of blacks (n=237) b (se) level of racial stressors .379*** (.085) constant 4.758*** (.367) f 19.65*** r2 .077 note: * p<.05, **p<.01, ***p<.001 advances in social work, spring 2023, 23(1) 56 seiler/racism, microaggressions, & minority stress 57 discussion the theory of minority stress among people who are black proposed here and supported by the findings of this secondary data analysis is that minority stress is a psychosocial response to everyday structural uncertainties and racial microaggressions. the many macro-level patterns of chronic institutional racism are experienced in daily life as structural uncertainties, and these uncertainties contribute to a unique form of stress associated directly with the minority status of people who are black. moreover, minority stress is exacerbated by microaggressions – both microassaults and microinsults – and other stressors experienced by people who are black within daily life. first, the findings confirm that, although structural uncertainties pertaining to employment, ability to pay monthly bills, and food insecurity are experienced by people of all races, people who are black are disproportionately more likely to experience these uncertainties than people who are white. in this sense, in addition to being undeniably social in nature, the experiences meet the unique criteria in meyer's (2003) definition of minority stress. specifically, considering that people who are black are 60% more likely to lose their jobs, 91% more likely to have trouble paying bills, and three times more likely to receive food from food banks/pantries than people who are white, this level of uncertainty is clearly a basis for minority stress and undeniably distinct from the experiences of people who are white. second, similar to structural uncertainties, the findings provide evidence that people who are black disproportionately experience both overt and subtle forms of interpersonal racism. that is, of the microassaults, people who are black were five times more likely to be victims of racism, to face racial discrimination in the workplace, and to experience racial discrimination with law enforcement than people who are white. experiences of microinsults were no less polarized, as people who are black are seven times more likely than people who are white to be treated as suspicious and treated as unintelligent. these findings leave no gray area; only around 5% of people who are white face racial discrimination at work and by law enforcement, and less than 10% of people who are white have been treated as suspicious and treated as unintelligent. juxtapose this with nearly a quarter of all people who are black experiencing racial discrimination in the workplace and by law enforcement. not only are these racial microaggressions, but they also meet meyer’s (2003) unique criteria for minority stress. third, the findings clearly suggest that people who are black experience minority stress as it relates to unfair treatment in many areas of social life. the feelings about unequal treatment among people who are black and white were separated by no less than 30 percentage points between people who are black and white, suggesting not only very different views of race in the u.s. but also that people who are black experience “psychosocial stress derived from” their minority status (meyer, 1995, p. 38). finally, the analysis of the relationship between racial stressors – both structural uncertainties and racial microaggressions – and minority stress among the black subsample validates that racial stressors, as structural experiences, increase minority stress, as a psychological characteristic, among people who are black. that is, whereas earlier advances in social work, spring 2023, 23(1) 58 analyses provide support for the concept of minority stress among people who are black, the regression analysis provides evidence of the connection between racial stressors and minority stress. the concept of minority stress has received a substantial amount of attention in research among members of the lgbtq+ community, and importantly so. this study provides evidence that it is an equally useful concept for understanding the intersection between environmental factors and indicators of mental health among people who are black. stated differently, racial microaggressions and structural uncertainties take a toll on the mental health of people who are black. contribution to social work policy, practice, and knowledge the findings of this study reinforce the need for healthcare policy that acknowledges minority stress among people who are black and call for services that include acknowledgment of and treatment for minority stress among people who are black and other racial minorities. on a micro-level, although minority stress might not be a common presenting problem among black clients, practitioners must be cognizant of the additional stress experienced as a result of minority status and have the training necessary to explore minority stress within the unique lived experiences of black americans. it is likely that such stress could exacerbate conditions leading to clients seeking clinicians (e.g., for anxiety, depression, or anger). moreover, considering that nearly 70% of social workers are white (salsberg et al., 2017), and many of their clients are from marginalized groups, licensing and requirements for continuing education courses must prioritize training in diversity, equity, and inclusion. on a macro-level, organizations must continue to identify and seek to rectify institutional racism. this involves racial dialogue and education for organization members at all levels (miller & garran, 2017). that is, racial dialogue among racially mixed groups could initiate communication about diversity, equity, and inclusion, assist in increasing people’s understanding and consciousness of institutional racism, and begin building bridges across races and allow for the inclusion of dei in policy initiatives. strengths and limitations strengths of this study include that it used data from a nationally-representative sample of people in the u.s. collected by an uninterested, non-partisan research center. however, the study had a number of limitations. first, as with all secondary data analyses, the questions were predetermined by the pew research center and, thus, only marginally ideal for measuring the concepts outlined here. testing the reliability of previous measures of racial microaggressions (e.g., nadal, 2011; torres-harding et al., 2012) and minority stress (e.g., balsam et al., 2013) among people who are black and white would have been preferred. testing current indices with a nation-wide sample would provide a much clearer picture of the context of both racial stressors and minority stress, as well as the relationship between the two. second, although this study provides support for the concept of minority stress and the impact of racial microaggressions and structural uncertainties on minority stress, additional research is necessary to understand minority stress as a genuine mental health indicator for people who are black. that is, future research should work to develop seiler/racism, microaggressions, & minority stress 59 and validate a minority stress index, and the index should be studied alongside other, more conventional measures for mental health disorders such as depression, anxiety, mood disorders, and post-traumatic stress disorders. third, the data were collected in 2016, and, by many measures, outcomes for people who are black have worsened with the election of donald j. trump at the end of 2016, especially with the onset of the coronavirus pandemic (cdc, 2020; horowitz et al., 2019); therefore, replicating this study with more recent data would produce a more current understanding of minority stress among people who are black. third, the study only accounted for bivariate relationships; replicating this study using multivariate analyses would provide a more robust analysis of minority stress. finally, since this study only compared people who are black and people who are white, future research should examine both within-group differences (i.e., intersectionality) among people who are black and across-group differences with other racial minorities. despite the limitations, the findings provide empirical evidence that institutional racism, microaggressions, and macroaggressions exist, that they impact people who are black more than people who are white, and that they contribute to minority stress. ultimately, the findings here reinforce the importance of social workers’ ethical responsibility to treat people “in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity” (national association of social workers, 2020, ethical principles, para. 7). in order to pursue the 12th grand challenge for social work that calls for equal opportunity and racial justice, social workers must work to understand the unique racial context of and consequences of racism for their clients. minority stress is only one element within the complex web of institutional and interpersonal racism. conclusions this study sought to understand the intersection between institutional racism, racial microaggressions, and minority stress. minority stress is an indicator of mental health unique to minority groups. however, it has been an underutilized concept in social science and social work research, particularly related to the lived experiences of people who are black. this study provided evidence, first, of macro-level (structural uncertainties) and micro-level (racial microaggressions) stressors through the different racialized experiences of people who are black and people who are white. second, the study provided evidence of minority stress among people who are black. finally, among a subsample of people who are black, the study provided evidence of a strong, positive correlation between racial stressors and minority stress. this study calls for future research into minority stress as a unique mental health indicator among people who are black, specifically, and people of color, generally, as it is potentially a critical element in cultural competency that has not received significant attention within a therapeutic context. advances in social work, spring 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(2007). racial microaggressions in everyday life: implications for clinical practice. american psychologist, 62(4), 271-286. https://doi.org/10.1037/0003-066x.62.4.271 szymanski, d. m., & sung, m. r. (2010). minority stress and psychological distress among asian american sexual minority persons. counseling psychologist, 38(6), 848-872. https://doi.org/10.1177/0011000010366167 torres-harding, s. r., andrade jr, a. l., & romero diaz, c. e. (2012). the racial microaggressions scale (rmas): a new scale to measure experiences of racial microaggressions in people of color. cultural diversity and ethnic minority psychology, 18(2), 153-164. https://doi.org/10.1037/a0027658 u.s. bureau of labor statistics. (2020). labor force statistics from the current population survey. https://www.bls.gov/web/empsit/cpsee_e16.htm wei, m., liao, k. y. h., chao, r. c. l., mallinckrodt, b., tsai, p. c., & botellozamarron, r. 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(2014). the what, the why, and the how: a review of racial microaggressions research in psychology. race and social problems, 6(2), 181-200. https://doi.org/10.1007/s12552-013-9107-9 author note: address correspondence to steven seiler, department of sociology & political science, tennessee technological university, cookeville, tn 38505. email: sseiler@tntech.edu https://doi.org/10.1037/0003-066x.62.4.271 https://doi.org/10.1177/0011000010366167 https://doi.org/10.1037/a0027658 https://www.bls.gov/web/empsit/cpsee_e16.htm https://doi.org/10.1037/a0020790 https://doi.org/10.1146/annurev-soc-071811-145434 https://doi.org/10.1177/0002764213487340 https://doi.org/10.1007/s12552-013-9107-9 mailto:sseiler@tntech.edu _______ william r. frey, msw, doctoral student, noelia mann, msw, alex boling, msw, and parker jordan, msw, alumni, karma n. lowe, associate dean of diversity, equity, and inclusion, and susan s. witte, phd, msw, professor, school of social work, columbia university, new york, ny. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 954-977, doi: 10.18060/24140 this work is licensed under a creative commons attribution 4.0 international license. uprooting (our) whiteness william r. frey noelia mann alex boling parker jordan karma n. lowe susan s. witte abstract: social work education reinforces hegemonic whiteness through pedagogies and practices that rely on an entitlement to and harvesting of black, indigenous, and people of color’s lived experiences for the purpose of its tacit audience: white students. despite this exploitative and harmful reliance on objectified lived experiences, white students continue to lack critical understanding of their racial positionality and connections to racism. uprooting whiteness requires sitting with what it means for white people to be “a white problem.” drawing on the work of yancy, we (group co-facilitators; our dean of diversity, equity, and inclusion; and three msw student participants) describe the creation, organization, facilitation, and experiences of the first year of the space for uprooting whiteness—a biweekly space where white social work students examine and uproot their relationship to white supremacy and domination. we argue for white social workers to take collective responsibility for racism in and beyond our institutions—requiring interrogation of our everyday practices and their (inter)dependence with and on systems of domination. this paper ends with three experiential narratives from student participants in the space and implications of critical intragroup dialogic pedagogy among white students in social work education and beyond. keywords: whiteness, white supremacy, racism, anti-racism, social work education although social work holds social justice as a central ethical principle, social work education is steeped in white supremacist culture and ideologies (ife, 2020; tascon, 2020). curricula and central texts have been written primarily by and for white peoplei, lacking integration and representation of marginalized voices, narratives, and experiences. centering the education of white students continues to harm black, indigenous, and people of color (bipoc)ii students through exploitation of their lived experiences with racism to educate white students (srivastava, 1996)—or what hartman (2020) named “a translation of black suffering into white pedagogy.” of equal concern, white social work students graduate every year without critically understanding their role in (re)producing systems of whiteness, racism, and how they cause harm through their everyday actions and behaviors as social workers and throughout their lives (frey, 2018). as social work programs begin to utilize the term “anti-racism” and shift curricula, we must recognize that these actions are insufficient for disrupting white people’s investment in whiteness and systems of racism. interrogating and uprooting (our) whiteness is a lifelong practice that extends beyond the classroom and social work into everything we about:blank frey et al./uprooting (our) whiteness 955 believe and do. these practices have implications for our involvement in other people’s lives and our (lack of) service to collective movements—that is to say, these practices are relational and shared. despite the insufficiency of current symbolic institutional posturing—or perhaps because of it—we, as white students, faculty, staff, and administrators must develop an ongoing engagement—rooted in clarity and acknowledgement of our positionalities—with the reality of our educational environments and join the struggle against whiteness. in october 2019, 26 white-identifying students at columbia school of social work (cssw) began to meet in a space for uprooting whiteness (sfuw), a biweekly intragroup dialogic space where white-identifying students examine and uproot their everyday relationship to whiteness. this content and these processes are often missing from current social work pedagogy, despite their importance when engaging in professional uses of self. this paper is a descriptive and narrative exploration of the space’s creation, facilitation, organizing principles, and expectations during the first year. it also includes narratives from three student participants who attended the space since its creation. we begin with a brief history of white supremacy in social work education in the united states and frame our understanding of racialization and whiteness. then, we describe the events leading to the organization of the sfuw, including the original intentions, organizing principles, and expectations. narratives written by three original participants highlight the various complex and conflicting experiences with this intragroup space. finally, we discuss the implications of this dialogic pedagogy for white students in social work education and beyond. we end dedicated and unresolved. a brief history of white supremacy in social work education from its inception in 1898, social work education in the united states has a long history of racism and white supremacy. exemplifying the historical racism of the 20th century in the united states, many social work programs were racially segregated (kayser, 2000), and evidence of integrated teaching or attention to needs other than those of white students is scant. kayser (2000) noted that despite prominent black social work educators addressing racial discrimination in the profession during the progressive era (frazier, 1924), these voices were ignored. instead, most texts and references on the history of social work education remained silent on the topic (e.g., alexander, 1995; austin, 1986; hollis, 1951). indeed, a vanguard of black social workers worked throughout the progressive era (carlton-laney, 1999, 2001), including, dr. e. franklin frazier, who established and accredited the atlanta school of social work, the first black school of social work, yet whose biography was not included in the encyclopedia of social work until 1987 (chandler, 2001). frazier demonstrated an uncompromising stance against segregation, racism and oppression, believing that of the professions, social work had “the greatest promise for improving race relations,” (frazier, 1927, as cited in bowles et al., 2016, p. 123). frazier applied the “new psychology” of freud to analyze race prejudice in whites in “the pathology of race prejudice.” published in 1927, the manuscript asked why white people, who were otherwise “kind and law abiding,” were capable of “revolting forms of advances in social work, summer 2021, 21(2/3) 956 cruelty” towards black people (frazier, 1927, p. 857). consequentially, he was dismissed from the atlanta school and ended his association with social work, fleeing north from atlanta under literal threat to his life (chandler, 2001). the 1960s and 1970s presented an opportunity for professional self-reflection on embedded racism that was clearly missed. in an aptly named essay, the year 1968: the turning point when us social work failed to turn, reisch (2018) reflected on how the profession was unprepared to respond to or join more radical social movements that were portents of change, many of which remain in this historic moment—such as calls to defund and abolish the police, rather than replacing police with social workers. at the height of the civil rights movement, leading social work publications made few references to racism or racial inequality (simon, 1994, as cited in reisch, 2018) and focused on individual interventions as opposed to advocacy and social justice. in 1972, longres described why social work education contributed to racism and why it was (and remains) difficult for social work education to commit itself to ‘eradicating racism’. social work education maintained racism through the exclusion of non-white students and faculty members from schools of social work, course content that emphasized subject areas and theoretical viewpoints that were “not particularly helpful to non-whites or those who are interested in working with the poor and non-white groups” (p. 35), and educational and socialization processes exclusive of non-whites. curricula remained largely white-centric, regardless of the growing and evident needs in non-white communities (longres, 1972). longres expressed the belief that “social work educators are collectively desirous of putting an end to racial strife in the united states by putting an end to racism. … that is, we assume that social workers would want to change existing authority relationships so that more equitable arrangements come about” (p. 34). however, this historically familiar urgency and commitment—similar to calls in 2020 for increased attention to anti-racism in social work education—illustrates a pervasive, historical resistance to understanding the nature of white supremacy culture and its embeddedness in our pedagogy and professional practices, as opposed to individual racist acts and intentions. herrick (1978) articulated clarity about this resistance in social work and invited pedagogical innovations to address white supremacy in his thesis, which called out this paradox of the profession’s ongoing attempts to address institutional racism through individual-level coursework and practice. herrick acknowledged and argued that as long as the primary mission of social work education and practice is to help people live “within the existing institutions of our society,” (p. 529) its mission serves to enhance—not dismantle—institutional racism, along with the other features of dominant institutions. although attempts to incorporate materials related to ‘ethnic and racial minorities’ occurred in social work education, he maintained that institutional racism—as part of the fabric of the dominant institutions of society—would be further reinforced and perpetuated by adding this content to the social work curriculum (herrick, 1978). these patterns of white supremacy and racism in social work pedagogy remained throughout the 20th century and we only begin to see movement toward addressing whiteness in social work education in the 21st century. frey et al./uprooting (our) whiteness 957 “teaching notes” by abrams and gibson (2007) traced the evolution of multicultural education and teaching about diversity in social work, refocusing the profession’s pedagogical attention to problematizing whiteness. they acknowledged that teaching about diversity must include content on the workers themselves, including examining personal white privilege. such content, borrowed from education and sociology, includes training teachers in concrete strategies and acknowledges that unlearning racism is a longterm process. abrams and gibson called on social work to “follow this trend,” (p. 157) and echoed hooks (1994) in noting that “teaching and learning about cultural diversity often demands being comfortable with that which is uncomfortable” (p. 158). even in this pivot to internal examination of white privilege, however, pedagogy remains centered on the needs of white social work students. as reisch (2019) examined issues of contemporary relevance through the lens of social work history, he found that the profession remains “torn between social justice and status enhancement … between advocating for social reform and seeking elite support” (p. 581). white dominance can be seen through these reformist leanings and contradictory loyalties, which expose the profession of social work as a mode of white hegemonic social control. the need remains for pedagogical innovations to engage and disrupt whiteness as a system of everyday domination in and beyond the classroom and profession. whiteness the current pedagogies and practices of social work education reinstitute hegemonic whiteness, training white social work students to secure white supremacy and domination through specific, everyday practices and procedures. for example, the normalized social work procedures we often unquestionably follow are rooted in specific racialized ideologies—like mandatory reporting, practices of client surveillance, and gatekeeping resources—and framed as innocuous and neutral. the continual reinstitution of hegemonic whiteness requires “a process of domination or acts, decisions, and policies that white subjects perpetuate on people of color” (leonardo, 2004, p. 137). thus, any attempts at exposing and disrupting whiteness necessitate an inquiry into “direct processes that secure domination and the privileges associated with it” (leonardo, 2004, p. 137)—a focus on the everyday. as yancy (2015) stated, “much more is required at the level of white everyday practices and the ways in which those white practices re-center white power or challenge white power” (p. xii). everyday racist practices by white people are critical to securing hegemonic whiteness—such as implicit devaluing and erasure of black and indigenous knowledge and people in social work classrooms by white educators. essed (2008) described everyday racism as cumulative practices, often covert and hard to pinpoint, and drew connections between structural racism and these everyday practices: “there is no structural racism without everyday racism. … by the same token, everyday racism is always structurally contextualized” (p. 214). the everyday actions of white social workers are of consequence. they carry the weight of sociopolitical histories of domination and power—beyond mere bias and prejudice, and beyond individual interactions. more specifically, whiteness operates in and beyond individual actions, requiring white people to take account for how whiteness operates through them, while acknowledging and situating those actions in the advances in social work, summer 2021, 21(2/3) 958 larger institutional and structural contexts of hegemonic whiteness and systemic racism. although this may be (mis)perceived as centering whiteness, it is a acknowledgement and objectification of whiteness not for hegemonic reinvestment, but for analyzing, challenging, and disrupting whiteness as a constructed system of power with implications for social work education (e.g., morrison, 1992; roediger, 1998). opportunities to interrogate systems of whiteness are scant in diversity, equity, and inclusion courses, often reaching no further than racial identity development. this call to take responsibility beyond our immediate actions runs contrary to the individuality embedded in whiteness, rendering it a potentially powerful site for interrogation, disruption, and commitment to collective movements and action. for decades, bipoc have been calling for white people to take action and commit to resistance movements and justice—especially with other white people in our own communities. “get your people” in his 1965 autobiography, malcolm x asks the question: “how can white society atone for enslaving, for raping, for unmanning, for otherwise brutalizing millions of human beings, for centuries?” (x & haley, 1965, p. 377). he answers: combat, actively and directly, the racism in other white people. … where the really sincere white people have got to do their “proving” of themselves is not among the black victims, but out on the battle lines of where america’s racism really is—and that’s in their own home communities. (pp. 383-384) many black people echo malcolm x’s sentiments, demanding that white individuals get your people (e.g., brown, 2020; giorgis, 2016; morris, 2016; mystal, 2020; oluo, 2017). in social work, white people have yet to significantly answer these calls to engage in antiracist practices with and take responsibility for other white people. these calls are often answered with white confusion and what seems to be the national white liberal anthem: “but what should or can i do?” this question is based on a limited framing of ‘action’ and ‘doing’, as if we are not engaging in actions and making decisions every day. although that question is rarely generative, it does open space for white people to engage in groups, spaces, and practices to figure out better questions to ask of ourselves and other white people: what are our everyday practices and actions in and beyond social work? how do they affect bipoc? how do they (re)secure and extend systems of whiteness and racism? when we focus on our everyday actions and behaviors, how does our understanding of individual and collective action begin to shift? conceptual framings of dr. george yancy yancy provided a critical framework for interrogating the everyday processes and practices of whiteness and white racism. in this section, we introduce some of yancy’s concepts—ambush, arrival, crises, lingering, losing one’s way, and (un)suturing— centering and taking seriously his question: how does it feel to be a white problem? frey et al./uprooting (our) whiteness 959 in the introduction to white self-criticality beyond anti-racism, yancy (2015) outlined various conceptual framings involved in processes of vigilance and interrogation around problematizing whiteness and white people’s relations to and investments in it. yancy described whiteness as “a master of disguise” (yancy, 2015, p. xiii) with a shapeshifting capacity that can trick white people through attempts of self-mastery and the belief that we ‘have things figured out’—aiming to master anti-racism so we can be absolved of our responsibility for and involvement in white racism (yancy, 2015, 2016). however, he cautioned, whiteness exists beyond the white self. if we see ourselves as anti-racist and make outward claims as such, we will inevitably face moments of ambush. yancy (2015) described ambush as “a surprise attack, a form of attack that points to how whiteness insidiously returns, how it ensnares, and how it is an iterative process that indicates the reality of white racist relational processes that exceed the white self” (p. xiii). arrival assumes we can create ourselves beyond whiteness and white racism—systems that operate and implicate our actions beyond our autonomous control. this is insufficient for undoing whiteness: “whiteness is undone through profound irruptions that belie selfmastery” (yancy, 2015, p. xiii). forms of arrival can happen iteratively and necessitate processes of individual and shared interrogation and vigilance for unsettling the settled. the process of white people claiming—and fighting—to be outside of and autonomous from whiteness is an example of what yancy (2015) calls suturing. he defined it as “the process whereby whites install forms of closure, forms of protection from counter-white axiological and embodied iterations, epistemic fissure, and white normative disruption” (p. xv). white people are socialized to engage in suturing, to protect not only the white self (which we mistakenly believe to be our natural and neutral self), but also systems of whiteness and racism. being unsutured, however, involves cultivating a dispositional and aspirational practice of “coming to terms with the realization that [our] embodied existence and embodied identities are always already inextricably linked to a larger white racist social integument or skin which envelops who and what [we] are” (yancy, 2015, p. xvii). being unsutured necessitates an engagement in processes of losing one’s way. yancy (2015) noted that “one must be prepared to linger, to remain, with the truth about one’s white self and the truth about how whiteness has structured and continues to structure forms of relationality that are oppressive to people of color” (p. xv). given the impossibility of individually arriving beyond whiteness as people categorized as white (at least at this moment and possibly our entire lives), yancy emphasized the importance of cultivating spaces where students can experience crises (yancy, 2015; yancy & del guadalupe davidson, 2014). in this context, he spoke of crises as decisions and of creating spaces where students can experience and practice deciding— “a life of commitment to ‘undo,’ to ‘trouble,’ over and over again, the complex psychic and socio-ontological ways in which one is embedded in whiteness” (yancy, 2015, p. xiv). the iterative and ongoing nature of this deciding is critical because “a single action or intention does not ‘undo’ whiteness” (p. xiv). the sfuw is an initial attempt at cultivating a space for ‘putting whiteness in crises’ among white social work graduate students through the modality of critical intragroup dialogue (yancy & del guadalupe davidson, 2014). traditionally, intergroup dialogues seek to provide a structured space for meaningful engagement between two or more social advances in social work, summer 2021, 21(2/3) 960 identity groups, potentially with a history of conflict (ford & orlandella, 2015; zúñiga et al., 2007). critical dialogue seeks to engage power and privilege and how they structure life for specific groups of people, while cultivating individual and collective responsibility for engaging in social justice work (delgado & stefancic, 2000; freire, 1970; nagda & maxwell, 2011). these framings inform our understandings and practices of critical intragroup dialogue. we create experiences of being in crises through prompts, activities, naming and questioning dynamics, and delaying or resisting arrival at solutions or answers in hopes of building white graduate students’ capacities to take these practices into their everyday and intimate lives. as painful as it is for students to be in what they termed “existential crises,” yancy argued this is critically necessary for continued involvement in shared practices of disrupting whiteness—disrupting false beliefs of arrival from whiteness. the sfuw attempts to disturb forms of arrival and learned practices of suturing through experiences of crises, losing our (individual and collective) way, and unsuturing. however, cultivating a space for holding and engaging in such practices is a constant challenge, because it may easily (re)produce whiteness and white racism without iteratively questioning itself. critical intragroup dialogue may allow for this type of iterative and constant questioning. the space for uprooting whiteness the sfuw began as a biweekly space where white graduate students confront what it means to be (categorized as) white. this confrontation includes coming to terms with having specific (individually unique and collectively interrelated) relationships to systems of racism and grappling with what it means to uproot and divest from those relationships as individuals and a collective. based on the principles of critical intragroup dialogue, we attempt to co-create a space to engage our relationships to whiteness in and among people who are positioned as white. although this may seem counterintuitive—white people engaging in dialogues about racism and whiteness by ourselves—research has shown that white people can effectively learn about and foster responsibility regarding race, racism, and whiteness through structured intragroup dialogic spaces and affinity groups (ford, 2012; ford & orlandella, 2015; tatum, 2017). despite the potential educational efficacy of intragroup dialogic groups, many remain skeptical of these white spaces (delgado, 2017; hughey, 2007)—and rightfully so. research has shown that “antiracist work among whites even with the knowledge of institutional racism and in viewing the world in color-conscious ways, still allows for— and perhaps even facilitates—the reproduction of racism” (hughey, 2007, p. 96). hughey (2007) mentioned common problems among white anti-racists, like essentializing race and making whiteness everything. although our article does not tackle all these challenges— and we may often find ourselves involved in their perpetuation—we felt it is important to mention them here. these sites of unease with intragroup spaces are ongoing points of reflection and contention in the sfuw. it is necessary to note that social work education attempts to engage in intergroup dialogic practices in classrooms across the united states (e.g., white and bipoc students). although much research supports the effectiveness of these practices in fostering learning frey et al./uprooting (our) whiteness 961 and cultivating relationships among students from different social positionalities (dessel & rodenborg, 2017; nagda et al., 2009; zúñiga et al., 2007), these attempts may still lead to further harm to bipoc students as white students engage in suturing strategies to separate themselves from responsibility and harm—centering their emotions and selves. the sfuw diverges from more traditional intragroup dialogic spaces, which often have a narrow identity focus on how participants socially and personally identify themselves (often stripped of political implication). we structure our conversations around white positionality. in her 1988 paper arguing for a new feminist theory of gendered identity, alcoff presented the concept of positionality—one that may be useful for understanding the white racialized subject. positionality refers to …a posit or construct, formalizable in a nonarbitrary way through a matrix of habits, practices, and discourses … an interpellation of our history within a particular discursive constellation, a history in which we are both subjects of and subjected to social construction (alcoff, 1988, p. 431). as individuals and a collective, we attempt to locate our habits, practices, discourses, and selves in systems of whiteness and racism, critically engage with how these systems position us in relation to other people, and what anti-racist actions this positioning may require of us in various everyday contexts. many students who participate in the sfuw have a specific, and limited, understanding of whiteness. often, they have rarely uttered the word. many are beginning to engage with what it means to be white and have white privilege. however, when participants first enter the space, these are still individual pursuits: becoming ‘better white people’ and ‘less harmful’. work such as this would fall into the category of white reconstruction, or seeking to “transform whiteness, and therefore white people, into something other than an oppressive identity and ideology” (leonardo, 2009, p. 92). fewer students enter the space with intentions and framing of the other main camp of whiteness intervention, white abolition, which positions whiteness as irredeemable—“not merely oppressive and false, it is nothing but oppressive and false” (roediger, 1994, p. 13). although many participants engage in practices of white reconstruction, we seek to complicate and interrogate these actions. the sfuw seeks to employ leonardo’s (2009) comparative conclusion: “there is a way that reconstructionism would provide the entrance into whiteness and abolitionism its exit” (p. 105). the following section describes the timeline of the sfuw’s creation, the original organizing principles, and expectations of the space. brief history of the space for many years, cssw has wrestled with a climate and culture where bipoc students have felt and are marginalized in the classroom, often by white peers. through some recognition of whiteness and how they perpetuate white supremacy, some white peers have sought to find ways to dismantle this specter of whiteness. in 2013, a student leader attempted to create a “white anti-racist group,” motivated by the desire to not put any emotional labor on bipoc classmates in discussions about white privilege. after three meetings, the group disbanded, and its creation was not embraced by bipoc students. an advances in social work, summer 2021, 21(2/3) 962 attempt was made again in 2016, with some white-identified students attempting to form a student group called “unpacking identities of privilege.” unfortunately, organizing meetings led to lack of consensus in the group, and it never officially coalesced. in 2018, in conjunction with the creation of an office of diversity and inclusion and the integration of a required course with a lens on power, race, oppression, and privilege, the need for a ‘white accountability space’ became amplified. in august 2018, william frey—a doctoral student—met with a cssw professor (susan witte), a student from a prior white affinity space (alex boling), and the assistant dean for diversity, equity, and inclusion (karma lowe) to consider how to create a consistent and intentionally facilitated space (all coauthors of this paper). in late october 2018, the first sfuw gathering was held with 26 student participants—25 master’s students and 1 doctoral student. organizing principles the space is organized based on three main purposes. first, the sfuw attempts to provide a space for white people to interrogate (their own) whiteness without acting on their presumed entitlement to and harvesting of bipoc students’ lived experiences. much of social work pedagogy situates bipoc as the only people who have racialized experiences. there is often an unspoken expectation in the classroom that bipoc students must engage in the mental, emotional, and intellectual labor of rehashing their knowledge and experiences for the benefit of white students and their learning (srivastava, 1996). the space challenges white students to question their own relations to whiteness and systemic racism. second, the space intends to support white students in the lifelong process of building everyday practices of considering and confronting their racial positionality and role in sociopolitical systems of white racism. students often frame anti-racist actions as additional things they must do, rather than acknowledging our everyday actions that reify racism and investments in white hegemony. actions like protests, further education and awareness raising, and calling other people out for their racism are often the focus of white conversations about action. although these actions can have critical impacts, what happens when we interrogate the mundane moments of our everyday life: the procedures we follow at work and in institutions; the everyday decisions we make that seem unquestionable and common sense? each moment is a site of recentering or challenging whiteness. part of confronting the truth about our racial positionalities is recognizing the limitations of our individual actions for challenging and disrupting systems of racism (i.e., what can individual actions do and not do?) and understanding which disruptions require our involvement in collective actions and movements. although it is necessary to explore how we must shift our individual actions and behaviors, these shifts are often insufficient for addressing systems of white hegemony and racism. if participants have intentions of self-mastery and individual white reformation, they are likely to engage in work rooted in the mistaken belief that they can be autonomously white and harmless—separate from whiteness. this requires telling ourselves the truth by asking ourselves: what are we (not) doing? what is the space (not) doing? frey et al./uprooting (our) whiteness 963 the third purpose of the space is to challenge students to engage in these (anti-racist) practices in their everyday and intimate lives, where hegemonic whiteness normatively exists and functions without thought or challenge. the spaces where we protect and invest in whiteness are often the spaces where we rarely consider its involvement and influence. we attempt to create a space where participants question how their intimate lives are informed by and built on systems of whiteness. we also ask: what must change in our intimate lives? what must be questioned and changed in our families, friendships, intimate partnerships, and workspaces? again, whiteness roots itself in the places we do not want to look. expectations to follow through on these organizing principles, the sfuw has three expectations for participation, which are shared with all prospective participants: consistently showing up, meeting with accountability partners, and engaging in critical reflective processing. the first expectation is consistent attendance and participation in the biweekly facilitated spaces. consistency is critical for building capacity and embodying processes of uprooting whiteness. harkening to the work of herrick in 1978, simply adding content to social work programs to address the need for anti-racist practices cannot disrupt the embeddedness of white supremacy in the academy. systems of hegemonic whiteness—including social work education—continue to socialize people every day. our practices of resisting this socialization must also be daily and active if we are ever going to shift our worldview and actions. the second expectation is that participants meet with their accountability partners between spaces. an accountability partner is another participant in the group who can provide a space for support and challenge outside of the facilitated space. toward the end of each session, each participant is paired with another participant (this person rotates every week to build networks of challenge and support). they are expected to meet for at least 30 minutes between spaces. some weeks, there may be specific prompts and activities for this time. for example, participants were asked to build a vision for the future and then, with their accountability partner, interrogate the silences and gaps in their vision (e.g., how do white ideologies and racism play a role in this envisioned future?). other weeks, it is up to the participants to use the time to process their personal experiences related to race, racism, and whiteness. the participants are reminded that these accountability partnerships are foundationally rooted in challenging and pushing each other deeper into the process and practice—these partnerships are not intended to coddle, although this is something to continually notice. they are a resource for continuing conversations and experiences that happen in the space. because white people often rely on the educational labor of bipoc for white education and discovery, we must build racial stamina for seeing, questioning, and engaging whiteness and racism with other white people (diangelo, 2018). the final expectation is that participants engage in some form of individual reflective processing. processing can be an important tool for building a consistent critical reflective practice of understanding race, racism, whiteness, and our own positionality as individuals advances in social work, summer 2021, 21(2/3) 964 in relation to one another, institutions, and systems. between each space, participants are asked to intentionally reflect on their experiences in and beyond the sfuw. this expectation is important for participants to build personal accountability and prioritize this work of confronting their racial positionality in their inevitably busy lives. if the participants find themselves not engaging in this practice or becoming comfortable and complacent with their practices, it is up to them to consider why and make adjustments, while utilizing the space and their accountability partners. bipoc participants/observers in the sfuw the original invitation for the sfuw mentioned that although the space is intended for white-identifying or -identified participants, no one would be turned away.iii bipoc students have attended the space in different capacities—some as observers, others as participants. when a bipoc student expresses interest in attending the space, we are honest about the racial positionalities of the facilitators (both white) and the vast majority of the participants (also white), including the potential limitations of the space to deliver what they may be seeking, despite everyone having a relation to whiteness. we also give interested bipoc students examples of how bipoc have been involved in the past. they then define their own role and the terms of their involvement. most people who have observed the space identify as black and most who decided to participate identify as nonblack or multiracial/mixed. for example, after moving from in-person to online dialogues, one person visited the space with their camera and microphone off for a few weeks. others have and continue to participate weekly, engaging with their relationship to whiteness as bipoc. it is important to mention that bipoc participation in the sfuw is not meant to be an accountability mechanism, nor is anything expected in return (e.g., feedback). as people learn about the space, many express interest in observing, and we find it necessary to make that available for bipoc students. participant reflections on the sfuw from the sfuw’s inception, it has been the facilitators’ intention for participants to be co-creators and have agency in shifting, changing, and reimagining the space. in the spirit of this co-creation, the following vignettes are reflections by social work student participants involved in the space from the start in response to the prompts: what brought you to the space? what keeps you coming back? how have you changed over the last year? to prepare this manuscript, each participant shared multiple drafts and the facilitators asked further questions, mirroring how we engage in the space. however, these reflections did not necessarily need to promote the space or speak of it kindly. each vignette shows some of the various and often differing experiences of participants, and we hope they bring to life the theoretical and conceptual work outlined thus far—especially the messiness and ongoing challenges. the vignettes are the original words of the participants and have not been modified. frey et al./uprooting (our) whiteness 965 “confronting my (white) body” (noelia mann) my first draft of this piece was a series of about 50 questions i have come to ask myself over the course of my participation in the space for uprooting whiteness. i thought these might be an accurate reflection of my process thus far, and where i’m at today. more importantly, i wanted to write something i could look back on in 10 years and not feel embarrassed about. something others could read, especially the people of color in my life, and still possibly think of me as “good.” because the thing about just asking questions is you don’t have to tell anyone what you think. thankfully, participating in the sfuw has meant there are people to check my bullshit. william has said often that the nature of whiteness is that it’s sneaky, it changes. it will look different in the future, and so i should respond to it differently. i should hate this in a few years (or days …) if it’s going to be of any value at all, and it should mean confronting my fear of being “found out” as racist, problematic, “bad,” etc. i am all of those things and i need to stop pretending i can trick people into not finding out. as my partner once said to me: “they already know you’re white.” i wrote that list of 50 questions because i thought i was protecting myself, but i was actually protecting whiteness. it’s a mistake i’ve been making for a long time, because i’ve bought into the lie, articulated poignantly by james baldwin, that whiteness is who i am, rather than what i am/have been categorized as (pavlić, 2014). when whiteness is who i am, attacks on whiteness become existential, making it almost impossible not to respond with defensiveness. and it means i’m making the same decision my ancestors made, at various points in history, when they decided to buy into the invention of whiteness in order to advance their own interests. i’m not suggesting distancing from or denying my whiteness, and i’m not suggesting that i don’t go through the world deeply benefitting from the many ways whiteness is designed to ensure and protect my comfort, safety, enjoyment, wealth, status, health, and so on. those things are deeply true, and i learn more about them every day. but, by agreeing that white is who i am, it means that i’m putting my energy and attention towards finding ‘healthy’, less-harmful ways to be white (one of the reasons i articulated for joining the group on my first day). in doing so, i am still investing in, rather than putting my energy towards destroying, the system and structures of whiteness. when i do turn my attention and energy in that direction, i find myself, inevitably, inescapably, confronted with the reality of my body. race and racism manifest their harm upon bodies (coates, 2015), and so it makes sense that any exploration of racialization has to include (i’d argue, center) the body. the thing is, i’ve spent most of my life not engaging with my body, doing anything i can to escape it, to escape the present moment. unable to sit with what is, i’ve sought to destroy it. unsurprisingly, much of my (conscious and unconscious) visualization of antiracist work has been about destroying my body as well— as if somehow by peeling off my white skin, by annihilating my white body, i could, in some small way, annihilate racism too. i’ve come to understand the many ways in which this is untrue, including (1) the false power this gives me, as one (white) individual, to impact racism and white supremacy; advances in social work, summer 2021, 21(2/3) 966 and (2) the fact that whiteness is far more than skin deep (bennett, 2020). it lives deep inside me (bellamy, 2020), in my spinal cord, my muscles, my conscious and unconscious memory. it manifests itself in the many ways i physically and emotionally experience false senses of ease, constriction, and fragility, which then forces me to confront the terrifying possibility that my most basic “instincts,” the “authentic” truths i believe my body to hold, are shaped by and in service of white supremacy. to confront the possibility that i don’t know myself at all (yancy, 2015). challenging ease is painful. a little voice in the back of my head/heart says, “can’t there just be one thing that’s easy, that feels good?” but if something requires the domination and exploitation of others, is it actually easy? does it actually feel good? is it possible that what i think feels good actually doesn’t? the kind of ease i feel around other white people, for example, is based on the belief that they don’t represent an existential threat to my self-narrative as a “good white person.” the physical ease manifests in very real behavior; i am a better listener, i am more able to receive people as complex and multifaceted, i practice fewer reassurance-seeking behaviors that demand emotional labor. how does this “misidentified ease” then uphold, protect, and serve white supremacy? what is being required of me in order to experience that ease? more broadly, what does the white body have to do in order to be settled in a world of white supremacy? (menakem, 2017). on the other end of the experiential spectrum lies constriction; the way my body physically contracts during moments of perceived racial threat (i.e., when my “good white person” narrative is challenged). that contraction transforms into the dominating and manipulating behaviors of white fragility (diangelo, 2018) as i frantically seek an end to the unbearable constriction (not, notably, an end to whiteness). what purpose is this constriction serving? how does it support the compartmentalization whiteness thrives upon? how might finding expansiveness in those moments, instead, allow me to behave differently? in my grandmother’s hands, resmaa menakem (2017) locates these experiences of ease and constriction alongside what he calls “false fragility,” or the belief that “we white people are incapable of soothing ourselves and feeling safe in the presence of black bodies. we are not just physically vulnerable; we are also emotionally helpless when we are around black bodies” (p. 104). i think this is especially true in the construction of white womanhood, which is cast as doubly vulnerable. how does the belief that i’m feeble and helpless—physically, but also, and importantly, emotionally—in the presence of black bodies serve whiteness? how is it reinforced by the myriad formalized institutions aimed at soothing my constriction, especially as a white woman? how can i understand social work as one of those institutions? moreover, how does my white “fretting” (as another student in the group put it), the vocal anxiety about being “good” that so seems to plague the construction of white womanhood in particular, actually protect whiteness by saying “here, look how badly i want to get it right, you’ll break me if you tell me i fucked up.” the ultimate question is, literally, “who do you think you are?” and, just beyond the question, the possibility of not knowing. i guess i could wrap my head around the idea that my thoughts and behaviors are shaped by white supremacy, as long as my body, my unconscious—what i identify as my “authentic” self—are untouched. as long as they are frey et al./uprooting (our) whiteness 967 still “good.” what if, in addition to not literally being possible, the whole construction of “good white person” is an intentional distraction, designed to keep me pouring my energy into making sure i am, or am perceived as, “good,” and turning my antiracism into what zoé samudzi calls “a quest for white redemption” (instagram highlight, july 29, 2020)? it keeps (and is meant to keep) me focused on chasing ease, minimizing constriction, believing in my own false fragility, and behaving, for all intents and purposes, like black lives don’t matter, regardless of what i say. “shifting without resolution” (alex boling) this drafting process has provoked deep feelings of anxiety, fear, and shame as i am tempted to present a perfectly packaged and performative story of my transition from a harmful white person to a “good” antiracist. the truth is i feel chaotic in my thoughts, hesitant in my actions and inactions, and i’m still grappling with my role and responsibilities in this work daily. initially i desired a space outside of classrooms and away from the inevitable exploitative labor of bipoc colleagues to learn how to not cause harm as a social worker. after witnessing attempts at a space for white social workers at cssw who wanted to support antiracism, i was unsettled by the focus on external group actions without discussion of internal processes. while i didn’t have the words for my feelings at the time, my inherent belief in the dignity of all human beings was compelling me to become more aware of my own biases and problematic thinking. while i believe in the value of protests, donations, and contacting legislators, none of those address my individual conditionings, habits, beliefs, and the ways i move through the world. i thought that i would arrive at understanding racism and at being antiracist. i thought that if i could identify where whiteness resides in me, then maybe i can figure out how to extract it, or at least distance myself from it. if i can do that, i can achieve “antiracism” and be absolved of the ways my whiteness benefits me at the violent expense of my bipoc clients, friends, and colleagues. this long-held belief dismisses that racism is systemic, constructive, and adaptive. i cannot undo it as an individual. i have come to understand my individual work as the continuous learning and challenging of beliefs and choices i make each and every day—how i challenge the status quo. how do i embrace the risks and consequences of daily practices to examine and challenge my whiteness and position in society, knowing that even in this process i make choices that consciously and subconsciously perpetuate racism individually and systemically? building a consistent individual practice of interrogating everything that comes to my mind has often felt overwhelming and cyclical. i’ve come to realize my so-called “spin cycles” do not serve this work well, but they’re important for me to understand and acknowledge. one of my internal thoughts has looked like the following: my mental health is deteriorating and preventing me from engaging deeper in these thoughts. personal suffering must not be anti-racist. racism is dehumanizing. personal wellness must then be an anti-racist practice. but advances in social work, summer 2021, 21(2/3) 968 centering my personal needs can’t be anti-racist because i’m white and centering myself. does this mean personal wellness is only challenging racism when it’s done by bipoc? can i attend to my personal needs without attending to my whiteness? hating myself is not serving anyone. am i allowed to have compassion and gentleness for myself, if i need it to sustain this work? but what does that say about meeting white folks where they are? does this not just continue to center whiteness? how much of this thinking is rooted in tenets of white dominance? i am aware that i can’t stay here. if systemic racism is ever going to end, then white folks and those who benefit from whiteness can’t stay here. systems and those who defend them cannot stay here. here meaning unchanged, unmoved, unwilling to devote time, energy, risks, and resources to change, while bipoc continue to experience violence and death. whiteness is aggressively self-preserving though. most of the time, i will be here in spite of any individual efforts. i feel urgency in my limitations in moving differently, with myself, with my relationships, within larger societal structures. this ongoing interrogation also highlights my individual limitations in this work. i have internalized limitations as weakness, and by hyper-focusing on myself, i’m actively resisting thinking about myself as part of a racial collective. i am engaged in this work because change needs to happen, individually and collectively. i remember my body would begin slipping into a fight-or-flight response when responding to the simplest “why are you here?” questioning almost a year ago. a year later, that stress response has lessened as the interrogation has become normalized. my stamina to hold conversations has expanded, and because i’m not as constantly in fight-orflight mode, i actually have physical and emotional space to critically examine my relationship with whiteness. at the same time, i am recognizing a hypervigilance around my self-interrogation that sometimes feeds into my general anxiety. this has led me to consider different supports for my mental health. my questions are also changing. as soon as i become a little comfortable and fully knowing that i’m always going to be part of what is referred to as a “white problem” (yancy, 2015), a new situation, or thought, or challenge, inevitably pulls any shred of certainty from under me. the longer i spend in the space, the more able i am to critique the limitations of the space itself. we lack direct accountability from bipoc, and the nature of the space encourages closer community with other white folks, which takes up energy and resources, which have all been topics of conversation in the group without resolution. at the same time, i have needed this provocation. i have needed relationships with others who could call me out or in, who could relate to my “spin cycles,” and who could challenge everything i bring and push me to dig deeper. this group was willing to offer the accountability structure i sought and cannot get from other communities in my life. it has enabled me to continue to name other tools and resources and communities i need in order to continue the work outside of the space. at the beginning of last year, my social work community was my only community having this conversation. i have a baseline set of expectations that i now try to bring to other spaces in my life to assess if/how they will allow me to do the work there too. frey et al./uprooting (our) whiteness 969 i’m also still exploring how to accept my whole self and love my whole self, if part of my identity is always tied to whiteness. awareness that i have limited control over how i will harm bipoc always invokes a visceral reaction. how i choose to carry that without allowing it to paralyze me is one of my current explorations. it also requires me to acknowledge that i am a human being who will keep messing up. but i need to push myself to show up anyway. i think my inability to accept collective action right now comes from the need to protect myself. if everything i focus on is individual, it centers me, and i believe i can control that narrative. joining and supporting collective work means not only believing other voices and experiences, but choosing to relinquish control to those voices. but there is no “escape button” from whiteness. i’m still struggling to figure out how to accept this, incorporate it into my emotional experience, relational experiences, and perceptions of myself and others. this always leads me to wonder, “what do i do with this? what is the point if i can’t ever truly escape the larger structures and values of white dominance that sanction my existence in this world?” i’m finding that it helps me to recognize my paralysis as an indicator that i am spending too much time in my head and that i need to check in with my body. when i’m feeling self-loathing, it helps for me to question my self-worth narrative and where that narrative originated. what would it look like for me to shift the framing of myself as whiteness, and instead look at myself as a beneficiary of whiteness and conditioned by whiteness? this shift leads me from accepting blame to accepting responsibility and an obligation to engage in the work. it compels me to move instead of remaining stagnant. this messy tension is a practice in what yancy refers to as “unsuturing” or leaving myself open to the pain and stress of this work and resisting the urge to close myself off from vulnerability. i frequently feel as though i should know/be/do more and differently. i know there isn’t a place of arrival, but that doesn’t stop me from subconsciously still trying to get there, and it surely doesn’t suggest that there isn’t progress to be made and work to be done. “what brought me in (and out of) the space” (parker jordan) as news about the group’s creation spread through cssw, i was fixated on finding out who had signed off on it. i knew that the previous attempt at holding a white affinity group had caused significant discomfort, and in some cases outright harm, among black classmates and other classmates of color. i wanted to know from whom the group had approval, or to whom the group was accountable. (a conflation, i realize now, of two different things.) i wasn’t sure how the space could exist in a way that did not do more harm than good. despite my reservations, i wanted to be in the loop on whatever larger conversations were happening within cssw related to students’ own whiteness. at the time, i didn’t see myself as being very connected to the larger white cssw community. i felt i had a different relationship both to whiteness and to social work than many of my white classmates did, almost like my whiteness was on one side of a scale, against which my queerness, my transness, my mental illness, my lower-income background, etc. were combined and weighed. i viewed my whiteness as a compartmentalized bad thing that i needed (with much guilt and shame) to quickly and quietly minimize so as not to be a problem for the people of color in my life. advances in social work, summer 2021, 21(2/3) 970 my desire to confirm that there had been some sort of trusted administrative sign-off on the space was a form of my own approval seeking, in itself demonstrating how terrified i was of being implicated in the white supremacy that manifested itself daily within cssw. this fear led me to avoid association with anyone i perceived as one of the harmful white people there, and i clung to even the smallest indications from people of color that i was conducting myself acceptably. i misunderstood accountability to be an act, and in this context, one taken by a white person or people at cssw to obtain permission from an unspecified black person or people at cssw to hold the space. while this was an incredibly messed up and dehumanizing framing, i was too preoccupied with staying distanced from other people’s whiteness to examine what my own was producing. the first night in the space, will referenced our tendency to locate white supremacy as being outside of ourselves. i realized in that moment that i secretly considered myself, especially in the context of cssw, one of the “good” white people. embarrassed that as a trans person i was still buying heavily into a different false binary, i decided to keep participating to work through why. i wanted to process what it meant that i tried so hard to separate myself from other white people in my profession, and what it could look like to do otherwise. i saw value in cultivating a practice of engaging more with other white people about our whiteness, especially with other white social workers, regardless of whether we knew each other well or i perceived us to be in similar headspaces. in the year since then, i’ve experienced a huge shift from considering uprooting whiteness to be hard and challenging, but necessary work, to seeing it more as something i’m excited and eager to do in order to be in better community with the people around me. i’m no longer so invested in trying to distance myself from whiteness by elevating other identities that i somehow feel tip the scales and align me more with “oppressed” than “oppressor.” i’ve also stopped compartmentalizing my whiteness, viewing myself not as “white but also trans, queer, etc.” but rather white and my other identities, and white in my other identities. i’m eager to examine how white supremacy is deeply entrenched, upheld, and perpetrated throughout all my identities, relationships, and interactions. with different needs and priorities than when i first joined the space, i ultimately decided to stop attending. i left the space because we weren’t holding each other accountable to uproot whiteness in our social work practice specifically, and because i realized the space wasn’t where i wanted to prioritize having conversations about other aspects of my life. participants in the space rarely talked about our shared profession at all—to the extent that someone who joined later in the semester told me it took her several weeks to realize we were all social workers. my admittedly late attempt to consciously shift the space in this direction did not produce much sustained conversation either. it speaks volumes that a room of white people co-created a space to discuss white supremacy as mostly located away from our shared profession, rather than one where we supported each other in examining and taking accountability for how we perpetuate white supremacy in our work. as we weren’t talking about social work, i began to really question why i was investing so deeply in conversations within the space when most participants were not people with whom i was otherwise in community. talking with people who didn’t know me outside frey et al./uprooting (our) whiteness 971 the context of the space limited the specificity and applicability of our conversations. uprooting whiteness felt increasingly difficult in a space where many of the identities and relationships most central to my life weren’t present, shared, or seen in a way that lent itself well to my taking active accountability. i can’t imagine i was alone in feeling this. holding a space where our whiteness is inherently decontextualized (because our day-to-day lives are the context, we’re mostly strangers, and we’re not talking about social work) in my opinion makes this sort of tension unavoidable. as i continue to reflect on my time participating in the space, i’ve realized that for a time it gave me an elusive sense of “doing the work,” but in a way that lessened my sense of urgency for having these discussions with people who know me well. i also remain uncomfortable with the intimacy and solidarity i began to feel with other participants in the space prior to leaving. i believe that cultivating a sense of closeness and community based solely on shared whiteness is irresponsible and harmful, and at the same time can’t imagine how i could have held people i met with for several hours every week at arm’s length. discussion these illustrative vignettes offer unique perspectives on how the various concepts of yancy—ambush, (lack of) arrival, crises, lingering, losing one’s way, and (un)suturing— show up in the reflective work of students as they seek to address his question: “how does it feel to be a white problem?” students displayed a reflective practice of locating themselves in relation to whiteness, which is rarely cultivated in social work educational spaces. they displayed the usefulness of not centering whiteness through hegemonic normalization, but objectifying and analyzing it through confronting its role throughout our lives (including in social work as trained social workers). noelia mann lingers with connections of whiteness to the body, demonstrating a practice of disturbing her own potential moments of tempting but fictional arrival beyond whiteness. she engages in a messy and ongoing confrontation of her inevitable relationship to whiteness. when whiteness is understood as what we are, rather than who we are, our vantage point shifts, and we are able to—as mann suggests—shift our attention away from investments in a so-called personal ‘healthy whiteness’ towards our role in collective struggles against systems of whiteness. alex boling provides us with a vulnerable look into the internal pressures to perform a “good” and “harmless” whiteness and arriving at “self-mastery.” similar to mann’s explanation of annihilating the white body, boling expresses a desire to “extract” whiteness from herself. these lines of reflection represent the challenging confrontation of the constructed/imagined overlaps between whiteness, our bodies, and our humanity. throughout her reflections, boling presents the psychological toll it takes when attempting to disentangle how whiteness has attached to our lives, ideologies, meaning-making, and life practices, while building the stamina to continually show up—even though she acknowledges an ongoing resistance to engage beyond the individual work. parker jordan’s vignette poses important challenges to the sfuw, directly naming a continued resistance to confront whiteness in social work and the messiness of building advances in social work, summer 2021, 21(2/3) 972 community in an intragroup dialogic setting founded on a collective relationship to whiteness. while ultimately deciding to stop attending, jordan highlights a recognition of the shifts in his understandings of whiteness and clarity around prioritizing this work in other areas of his life. still, we sit with jordan’s poignant acknowledgement that the sfuw may give us a false sense of ‘doing the work’, releasing any urgency for engaging in other forms of collective action (e.g., mobilization and organization). all three students provide insight into their everchanging understanding of what it means to be in proximity to whiteness, and all that it entails. the uniqueness of each vignette highlights the different priorities of each student, who may require different educational support (even if this leads them to leave the group). as these priorities change and students sharpen their reflective and analytic understanding, it is inevitable that the space must be questioned—as well as become questionable—and in some cases, abandoned. our investments do not lie in the group, but in students continuing to show up and engage in individual and collective work throughout the various spaces of their lives. nevertheless, few white social work students and educators consistently practice confrontation and engagement of our proximities to whiteness. if we are unable to build everyday practices of divesting from and organizing against whiteness, there is little hope we can disrupt its further reproduction in social work and beyond. conclusions and implications we argue for white social workers to take collective responsibility for racism in and beyond institutions—requiring interrogation of our everyday practices and their (inter)dependence with and on systems of white domination. two main intentions of the sfuw are to complicate students’ understandings of whiteness and begin to see our everyday and intimate lives as sites for the (re)production and challenge of hegemonic whiteness. regardless of the impacts, questions remain about the space, social work education, and the role of people categorized as white in collective movements against whiteness and racism. what role do spaces such as the sfuw play in the journey and struggle against hegemonic whiteness? what is the space doing to and for participants throughout their lives? is the sfuw similar to or different than other spaces, and if so, in what ways? should effectiveness of the space be measured, and if so, using what metrics? what unique challenges and opportunities does social work pose for processes of uprooting whiteness? in 1920, w.e.b. du bois (1999) wrote: “the discovery of personal whiteness among the world’s people is a very modern thing—a nineteenth and twentieth century matter, indeed” (p. 17). until the 21st century, social work education—or perhaps more broadly, our entire u.s. educational enterprise—has mostly resisted any attention to whiteness. currently, social work education (often through diversity, equity, and inclusion) situates whiteness as something a person has, often as an identity, with little focus on whiteness as processes and practices securing domination. this leads many white students to come to abstract conclusions—such as “i am white” and “i have white privilege”—with little engagement in what these declarations mean (frey, 2018). as schools of social work proclaim commitments to try anything and everything to further anti-racist pedagogy, what frey et al./uprooting (our) whiteness 973 are the implications of further institutionalizing such spaces and practices? how can the work of uprooting whiteness happen in racialized institutions, and can this be carried out at all by the institution itself? (see, ray, 2019). finally, how can and should we connect shared practices in spaces such as these to larger, collective movements led by bipoc organizers? how is this already being done, and what role does social work education play in furthering these connections? the sfuw cannot and will never be sufficient by itself for disrupting and abolishing whiteness. nor is it meant for that. it is nothing more or less than an ever-changing process for cultivating and sustaining capacity for white people’s involvement in individual and collective shared practices for disrupting hegemonic whiteness and systems of racism— the capacity to act at any given moment, whatever that moment requires (not necessarily attachment to any specific actions). the sole act of meeting in the sfuw and with other white people does nothing to disrupt whiteness. disruption is based in practice and cannot be found in intention. it comes down to what is done in the space and how this connects white people to broader struggles against whiteness and systemic racism (e.g., current abolitionist organizing through direct action, protest, sabotage, and community building against capitalism, colonialism, and imperialism). in 1874, brooklyn schoolteacher, william j. wilson—signing himself as ethiop— asked the question, “what for the best good of all shall we do with the white people?” (roediger, 1998, p. 66). leonardo (2009) expansively echoed: “what are we to do with whiteness?” it is clear that education without collective action—where social work education and pedagogy sits right now—is not enough to address systemic inequity (ray & aja, 2020). we hope these words—in conversation with yancy, leonardo, and many others—can lead to deeper commitments of losing our way, while engaging in shared practices to abolish and divest from everyday practices of hegemonic whiteness in and beyond social work education. i though contentious, we chose to capitalize “white” and “whiteness” throughout this article for the sake of clarity and consistency. however, it is important to note that this term involves many layers of sociopolitical, legal, and historical construction—categorization, classification, identification, ideology, culture, and imagination (see, for example, ewing, 2020; painter, 2020). ii we use the term “bipoc” throughout this article unless context requires more specificity, also involving the abovementioned layers of construction. we made this decision to acknowledge the unique ways that whiteness affects varying groups of people (e.g., systems of anti-black racism and settler colonialism), while recognizing that any generalizing term is insufficient to truly do so. iii additionally, the space has had white participants from outside social work, including the mother of a former cssw student. this presented added facilitation and practice challenges. the covid-19 pandemic pushed the space online, and the global black lives matter protests expanded the number and pool of group participants beyond cssw and the profession of social work in summer 2020. this required us to expand our content and context beyond social work to meet the needs of new participants. frey et al./uprooting (our) whiteness 974 references abrams, l. s., & gibson, p. 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(2014). exploring race in predominantly white classrooms: scholars of color reflect. routledge. https://doi.org/10.4324/9780203416716 zúñiga, x., nagda, b., chesler, m., & cytron, a. (2007). intergroup dialogue in higher education: meaningful learning about social justice. ashe higher education report, 32(4), 1-128. https://doi.org/10.1002/aehe.3204 author note: address correspondence to william r. frey, school of social work, columbia university, new york, ny, 10027. email: wf2220@columbia.edu 38_frey_et_al_24140_uprooting_our_whiteness 38_frey_et_al_24140_uprooting_references _________ robert h. keefe, phd, acsw is an associate professor in the school of social work at the university at buffalo, suny, buffalo, ny. rebecca rouland, phd, msw, is an assistant professor in the department of social work at nazareth college in rochester, ny. sandra d. lane, phd, mph is laura and l. douglas meredith professor of public health and anthropology at syracuse university, syracuse, ny. audrey howard, msw is school support specialist and family support specialist for student success, coordinated care services, inc. in syracuse, ny. carol brownstein-evans, phd, lmsw is professor, department of social work, nazareth college in rochester, ny. xiaozhong wen, md, phd is associate professor, division of behavioral medicine, department of pediatrics at the jacobs school of medicine and biomedical sciences at the university at buffalo, suny, buffalo, ny. lorinda parks, md is staff physician at the anthony jordan health center in rochester, ny. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 176-198, doi: 10.18060/23937 this work is licensed under a creative commons attribution 4.0 international license. “i gotta carry the burden by myself:” experiences of peripartum depression among low-income mothers of color robert h. keefe rebecca rouland sandra d. lane audrey howard carol brownstein-evans xiaozhong wen lorinda parks abstract: despite prevalence estimates indicating that upwards to 38% of new mothers of color will experience perinatal depression, little research has been published that investigates how they cope with the stressors in their daily lives. this article presents the findings of semi-structured in-depth interviews with 30 low-income new mothers of color about parenting their children despite the burden of ongoing depression. narrative analyses revealed three themes: feeling alone, isolated, and overwhelmed; feeling misunderstood, betrayed, and judged by others; and having to carry their burden alone. despite having depression, the mothers spoke of ways they were able to persevere even with the enormous burden of raising their children while living in high-crime, low-income neighborhoods. recommendations include the need for social workers to recognize lowincome mothers’ inner strengths; recognize why mothers may not trust professionals to be of help; and take the time to build strong therapeutic relationships with mothers who perceive their families, friends, partners, and often social service professionals as being of little help. keywords: poverty, mothers of color, postpartum depression the national institutes of health (nih) have identified depression as being an important public health priority (nih, 2010a, 2010b). while 6.7% of the adult population in the united states suffers from depression, the percentage among women is 8.5% (national institute of mental health, 2017). african american women are disproportionately affected: in aggregated samples, 24.0% to 39.0% have been found to have depressive symptoms (abel et al., 2014; bronder et al., 2014). mothers living with depression have poorer health and are less likely to participate in healthy behaviors (roshanaei-moghaddam et al., 2014; yu et al., 2014). approximately four million women give birth in the united states each year (centers for disease control & prevention [cdc], 2017) and of the new mothers, between 9.7% and 23.5% will develop peripartum depression (ppd; bauman et al., 2020; commonly about:blank keefe et al./i gotta carry the burden 177 known as postpartum depression). new mothers living with ppd experience dominant symptoms of sadness, hopelessness, and loss of interest or pleasure in activities previously enjoyed (american psychiatric association [apa], 2013). under the current edition of the diagnostic and statistical manual of mental disorders (apa, 2013), ppd is considered a form of major depression that develops during pregnancy or within one month after childbirth. although many mothers experience a period of sadness after giving birth (often referred to as the “baby blues”), ppd is far more debilitating and can have long-lasting effects on new mothers and their babies (langan & goodbred, 2016). low-income mothers (goyal et al., 2010; gress-smith et al., 2012; hutto et al., 2011) and mothers of color experience significantly higher rates of ppd than middleor upper-class and white mothers (ertel et al., 2011). while the prevalence estimates indicate that upwards to 38% of new low-income mothers and mothers of color will develop ppd (gress-smith et al., 2012), they are far less likely to receive formal support services than white mothers (kozhimannil et al., 2011). consequently, the needs of new mothers of color and mothers of low incomes are less likely to be considered in the research and support recommendations (keefe et al., 2015). predictors of ppd lower socio-economic status has been shown to be one of the biggest predictors of ppd (lara et al., 2015). other stressors predicting ppd which are highly correlated with lower socio-economic status include having limited employment and educational opportunities, residing in insufficient housing and in high-crime neighborhoods, being unemployed, having lower levels of education, job-related stress, and being food insecure (goyal et al., 2010, zekeri, 2019). trauma, particularly from physical, psychological, or sexual abuse or community violence has been shown to have a cumulative effect on the development of ppd (gaillard et al., 2014). additional risk factors include an unplanned or unwanted pregnancy and a contentious or inconsistent relationship with the child’s father (fellenzer & cibula, 2014; grote & bledsoe, 2007). psychological factors affecting ppd include having a history of depression, anxiety and other mood, personality, panic, bipolar, obsessive-compulsive, and post-traumatic stress disorders (bayrampour et al., 2016; johansen et al., 2020). see table 1 for a comprehensive review of the predictors of ppd. gap in the literature most of the studies on maternal depression focus largely on white, heterosexually married women who have access to services, live in middle-class neighborhoods, and have supportive relationships with service providers (keefe et al., 2015). much less research has been conducted on low-income mothers of color using the mothers’ own voices (keefe et al., 2015, 2019). to help fill this gap in the literature, the authors interviewed 30 lowincome new mothers of color living with ppd who receive services at an inner-city federally qualified health center (fqhc). some of the issues we identified in previous advances in social work, spring 2021, 21(1) 178 analyses generated questions that led to this particular analysis (keefe et al., 2016b, 2018a, 2018b, 2019). specifically, this analysis examined the question: how do mothers cope with the daily stressors of caring for their children and themselves while living in impoverished, under-served, and often violent neighborhoods? table 1. literature on predictors of ppd predictor literature lower socio-economic status ahmed et al., 2012; dennis et al., 2012; dolbier et al., 2013; eastwood et al., 2011; goyal et al., 2010; hayes et al., 2010; lara et al., 2015; munger et al., 2016; pooler et al., 2013 limited employment & educational opportunities, residing in insufficient housing & in high-crime neighborhoods cdc, 2008; choi et al., 2012; dolbier et al., 2013; ertel et al., 2011; ghosh & goswami, 2011; goyal et al., 2010; gress-smith et al., 2012; sidebottom et al., 2014 being unemployed goyal et al., 2010; lara et al., 2015; woolhouse et al., 2012 having lower levels of education cdc, 2008; choi et al., 2012; ertel et al., 2011; goyal et al., 2010; lara et al., 2015; pooler et al., 2013; savarimuthu et al., 2010; wisner et al., 2013 job-related stress & being food insecure zekeri, 2019 trauma, particularly from physical, psychological, or sexual abuse ahmed et al., 2012; bayrampour et al., 2016; cdc, 2008; cerulli et al., 2011; dennis et al., 2012; gaillard et al., 2014; ghosh & goswami, 2011; pooler et al., 2013; savarimuthu et al., 2010; sidebottom et al., 2014; woolhouse et al., 2012 community violence dennis et al., 2012; ertel et al., 2011; guintivano et al., 2018 unplanned or unwanted pregnancy fellenzer & cibula, 2014 contentious or inconsistent relationship w/the child’s father grote & bledsoe, 2007 psychological factors history of depression batmaz et al., 2015; dennis et al., 2018; dennis et al., 2012; ertel et al., 2011; gaillard et al., 2014; guintivano et al., 2018; jobst et al., 2016; johansen et al., 2020; woolhouse et al., 2012 history of anxiety guintivano et al., 2018; johansen et al., 2020 other mood & personality disorders ahmed et al., 2012; bayrampour et al., 2016; ghosh & goswami, 2011; turkcapar et al., 2015; viguera et al., 2011 panic, bipolar, obsessivecompulsive, & post-traumatic stress disorders johansen et al., 2020 methods this descriptive qualitative study was conducted at the main office of a fqhc in rochester, ny and is among the first fqhcs to be developed in the united states. the center has 10 locations throughout the area and serves residents of the lowest income census tracts in the city. institutional review board approval was granted by the first author’s institution. keefe et al./i gotta carry the burden 179 conceptual model/framework a phenomenological approach was used to understand the lived experiences of the mothers. we used in-depth, semi-structured interviews and frequently went on walks around the neighborhoods and visited local businesses; stores; and women, infant, and children (wic) clinics to help us gain a more nuanced understanding of the community in which the mothers live. two of the researchers (rhk and cbe) who interviewed the mothers have a longstanding interest in the needs of mothers and children from traditionally oppressed backgrounds. both of the researchers have worked in maternal and child health settings for five or more years prior to completing their doctoral degrees. each is a white, nonhispanic, middle-class professor, one of whom is male. to address the potential obstacles of being of different backgrounds than the mothers, we asked for input from the fqhc staff who agreed that the project was important and were very willing to discuss it with new mothers. we also engaged in ongoing communication with our fellow co-authors, consulted with minority health researchers, and participated in ongoing training in qualitative methods held at various professional conferences. the interview guide questions were based on our previous research including the effects of food deserts on low birthweight babies, paternal incarceration on post-neonatal mortality, and community-based gun violence on post-traumatic stress disorder among new mothers. we then met with professional nurses, social workers, public health administrators, and attorneys who work with low-income mothers of color to seek their input on the interview guide. after incorporating the feedback, we met with 11 research assistants from diverse backgrounds who provided additional feedback. three of the research assistants (two female and one male) self-identified as latinx, three (all female) as african american, four (all female) as white, and one (female) as bi-racial. mock interviews with the research assistants and other colleagues were conducted and additional feedback was obtained on the actual interview guide, the clarity of the questions asked, and the overall flow of the interview process. each research assistant participated in one interview with one of the mothers conducted by one of the researchers and could ask questions if they wished. flyers were hung in the center’s waiting room – where one of the authors (lp) is a practicing physician – inviting mothers who gave birth within the past 24 months and who met the inclusion criteria of being 18 years of age or older; self-identifying as black/african american or hispanic; parenting at least one child residing with them; and experiencing sadness, fatigue, or difficulty concentrating or sleeping since the birth of their most recent child. the researchers sat at a table in the waiting room, frequently speaking with new mothers about the project. some of the mothers spoke of their own experiences with depression two or three times before agreeing to be interviewed. the interviews were held in a private conference room next to the waiting room. advances in social work, spring 2021, 21(1) 180 data collection the interviews were conducted between 2013 and 2015. at the beginning of each interview, we handed the informed consent form to the mother, offering to read the form to her if she wished. each mother read and signed the consent form. the mothers were then given a pen to complete the paper version of the 10-item, self-administered edinburgh postnatal depression scale (epds; cox et al., 1987 – a screening tool for maternal depression that asks the mother to report her mood state during the past week). scores on the epds range from 0 to 30 with a score of 12 or above indicating increased likelihood of depression (cox et al., 1987). the epds has been validated across cultures and languages with acceptable internal reliability (alpha = .84 for both african american and latina mothers; hartley et al., 2014). in the current study, the mean score of the epds for the mothers was 17.6 with a range from 14.0 to 29.0, indicating each mother was experiencing depression. table 2. interview guide 1. how has having a baby affected your overall wellbeing? 2. please describe the feelings you experienced after having your baby. 3. how has being african american or latina played a role in your transitioning into caring for a new baby? 4. what was most stressful for you during your pregnancy? 5. what was most stressful for after your pregnancy? 6. who has been the most helpful to you during your pregnancy? 7. who has been the most helpful to you after your pregnancy? 8. describe your neighborhood. 9. how do you feel living in your neighborhood/community? 10. what are some of the challenges you face living in your neighborhood/community? 11. when you were feeling _____ how comfortable were you reaching out to different people? 12. how did these feelings affect your relationship with family members? 13. how did you cope with your feelings? 14. what is postpartum depression and how do you describe it? 15. what do you want health providers to know about your experiences with your pregnancy? 16. what are your thoughts on going to counseling or professional help during pregnancy of after pregnancy? 17. how do you cope with difficult feelings while trying to be a mother? after the mothers completed the epds, a digitally recorded, semi-structured, face-toface interviews were conducted, lasting between 60 and 95 minutes (see table 2 for the final interview guide). the recorded interviews were then transcribed verbatim by a research staff person employed by the second author’s college and then coded by three of the authors (rhk, rsr, and cbe). for their participation, each mother received a $20 gift card to a large grocery store and a referral sheet listing additional agencies providing mental health and other services to new mothers. we explained that the mother could stop the keefe et al./i gotta carry the burden 181 interview at any time and meet with her social worker at the fqhc if she wished. none of the mothers indicated they wanted to stop the interview or requested to meet with their social worker. all mothers completed the interview and reported feeling positively about the process. to protect the mothers’ anonymity, at the end of the interview the mothers selected a pseudonym. see table 3 for the demographic profile of study participants. data analysis data analysis plan line-by-line coding was used to analyze the data, relying on the constant comparative method, including breaking down the responses to each question into conceptual units that were compared to each other and then coded into related categories (corbin & strauss, 2008; glaser, 1965; walker & myrick, 2006). we continued the analysis by exploring emerging themes in responses and between fragments of the interviews (corbin & strauss, 2008; walker & myrick, 2006), looking for similarities in perspectives, attitudes, experiences, actions, and explanations of behavior (walker & myrick, 2006). categories and themes were refined by making comparisons between older and newer data. as we examined what living with postpartum depression was like for each mother, descriptions emerged about “carrying the burden alone” as they coped with depression while carrying on with their daily responsibilities. we then compared the mothers’ descriptions of carrying the burden and how they see themselves meeting their maternal responsibilities to their children. we continuously re-read the data to identify subcategories within each of the themes to understand each emerging category and its relationship to the larger themes as well as subcategories. trustworthiness and credibility trustworthiness was achieved through a seven-phase process. first, two of the authors (rhk and cbe) familiarized themselves with the data by reviewing the interview transcripts, conducting ongoing meetings to discuss the data and emerging themes, and discussing notes collected after each interview (walker & myrick, 2006). second, the same two authors developed a coding framework by immersing themselves in the interview transcripts to discover emergent themes. third, diagrams were made to code themes from the transcripts (glaser, 1965). fourth, a third researcher (rsr) joined the team to help vet themes and subthemes that emerged from the data (corbin & strauss, 2008). fifth, consensus was achieved during face-to-face team meetings and emails to name the themes. sixth, the researchers met periodically to discuss additional thoughts, hunches, and reflections on the data (walker & myrick, 2006). seventh, the researchers engaged in negative case analysis by searching for quotes that contradicted emergent themes. advances in social work, spring 2021, 21(1) 182 findings sample a purposive sample of 30 low-income new mothers of color, including 19 who selfidentified as black/african american and 11 who self-identified as hispanic/latina, participated in individual interviews. their ages ranged from 19 to 44 (mean = 28.6). the mothers had between one and seven children (mean = 3.1, mean age of youngest child = 1.6 years), and 11 were currently pregnant. all but one of the mothers was a medicaid recipient. all 11 of the hispanic mothers were also fluent in english and did not wish to have an interpreter present during the interviews (see table 3 for a profile of study participants). table 3. demographic profile of study participants (n=30) participant’s name age race/ethnicity number of children pregnant epds score* alexia 19 latina/puerto rican 1 n 18 anjelica 25 latina/puerto rican 4 n 19 arissa 31 latina/jamaican 3 y 14 cortney 19 african american 1 n 14 dena 28 latina/el salvadoran 2 n 18 fatima 29 african american 2 y 18 felicia 39 african american 7 y 14 gloria 27 latina 3 n 17 gwen 31 african american 3 y 18 jacquelina 19 african american 1 n 18 jezel 27 african american 1 n 19 latoya 29 african american 3 n 15 marta 27 latina/puerto rican 2 n 19 nadia 44 latina/puerto rican 2 y 21 raquel 27 african american 2 y 18 rhesa 36 african american 3 y 20 roberta 32 african american 4 n 18 rochelle 29 african american 5 n 19 selena 22 latina/puerto rican 2 n 21 shameeka 24 african american 1 n 14 sophia 27 latina/puerto rican/cuban 4 y 29 tabitha 34 african american 5 y 15 tamara 30 african american 7 n 16 tamika 23 latina/puerto rican 1 n 15 tammy 38 african american 4 n 13 tanisha 26 african american 4 y 19 tonya 35 african american 5 n 16 yamina 27 latina/puerto rican 4 y 18 yolanda 35 african american 7 n 20 yvonne 20 african american 1 n 15 *scores of 12 and above indicate an increased likelihood of depression keefe et al./i gotta carry the burden 183 themes and categories the mothers discussed their experiences of living with depression. each mother reported that having limited support from others, including their child(ren)’s father, family of origin, community, and service professionals worsened their depression. the main themes included: (a) feeling alone, isolated, and overwhelmed; (b) feeling misunderstood, betrayed, and judged by others including service providers, their child(ren)’s father, and their friends; and (c) needing to carry the burden by themselves. feeling alone, isolated, and overwhelmed despite having large families and living in crowded neighborhoods, all 30 mothers discussed how alone, isolated, and overwhelmed they felt while living in poverty and taking care of their children. we offer quotes from 10 mothers who provided rich detail about their experiences. in terms of physical space, most mothers lived in crowded neighborhoods where despite their location, they felt disconnected from neighbors. for example, dena, a 28-year-old el salvadoran mother of two reported, “i did not really know the neighborhood…you have to have transportation, or a car, and i didn’t have money to take transportation. there was nothing nearby but houses in the neighborhood, and i didn’t know any of the neighbors.” the situation is much the same for raquel, a 27-year-old african american mother of two. she stated, “you need a vehicle, you need transportation. and i didn’t have money to take transportation…i didn’t know anybody in the neighborhood…it was just me…depressed, and…overwhelmed with four kids.” rochelle, a 29-year-old african american mother of five stated that she felt similarly: “i don’t have any friends. neighbors no.” yolanda, a 35-year-old african american mother of seven added, “i don’t really know too much about the neighborhood, because i really try not to socialize too much with the people.” these feelings of isolation and loneliness even applied to friends and family. cortney, a 19-year-old african american mother of one stated, “i know it’s a lot, like going to school, living on your own, and have your child. ‘cause all i feel like is being alone.” similarly, gwen, a 31-year-old, african american mother of three said, “i don’t have friends.” in some cases, feelings of abandonment in other personal relationships further contributed to loneliness and isolation. of her partner who left her, raquel noted, “he went back to new york. and i felt alone, devastated. i don’t think any words could explain how i felt. and that got me to a point where i was like ‘i can’t anymore.’” for gwen, the sense of isolation reaches back to her childhood: “when i was 16, my mom died and the year after that, my dad died. …and all my family is still in texas.” although other mothers had extended family living nearby, some mothers such as marta, a 27-year-old puerto rican mother of two, reported her husband’s family kept her at a distance. advances in social work, spring 2021, 21(1) 184 his family is…not as welcoming …like i had went to some of their gatherings, and i would sit at the table by myself, and they wouldn’t say hi to me or look at me or anything like that. but i did it anyways, just so i can try to make him happy. so, after two years, i was like... i shouldn’t go no more, because nobody really tries to even interact with me, or i … try to make conversation and they turn away. yamina, a 27-year-old, puerto rican mother of four reported she has felt isolated from her own family of origin, “i have sisters; they have their own lives. you really don’t wanna be involved with them, because sometimes they tend to criticize you rather than listen to you. and that just makes your depression worse.” this sense of isolation seemed to further exacerbate some of the mothers’ depression, which worsened their isolation. tonya, a 35-year-old african american mother of five shared, “well, i don’t really have no support here. i’m basically by myself. i don’t wanna be around nobody. i stay to myself; i mind my business.” rhesa, a 36-year-old african american mother of three stated, “i can’t sleep. i just don’t wanna be around people … i feel nervous, and i wanna like shut away, in my house, i don’t ever wanna go outside.” yolanda shared that she too chooses to avoid people, even close friends. she recalled a friend trying to contact her saying, ‘why girl, i was trying to call you, where you was at?’ and i be saying to myself, ‘i’ve been sitting here all alone. i just looked over at the phone and i see your phone call, ‘i don’t say it to people because you don’t wanna be, oh, i’ve been sitting here …i just didn’t wanna be bothered.’ despite each of the 30 mothers describing similar feelings of isolation, some mothers found one or two friends. felicia, a 39-year-old african american mother of seven reported, “i have neighbors that i sit there and talk. just sit there and joke.” likewise, tabitha, a 34-year-old african american mother of five stated, “i have a few friends that i talk to from time to time. …so i do have a few people, but i’m…kind of a private person… but…push come to shove, if i did need them i can call and they’re there.” she goes on to say, “my neighborhood [has] neighborhood watch…and it’s a kid-friendly neighborhood. feeling misunderstood, betrayed, and judged by others all but three of the mothers reported feeling misunderstood and even betrayed by various individuals including the professionals they saw for services, their child(ren)’s father, and their friends and coworkers. quotes from the following eight mothers substantiate this point. speaking generally, sophia, a 27-year-old puerto rican/cuban mother of four, summed up the sentiment of many of the mothers reporting, “i don’t ask nobody for anything. i will go with nothing before i have my hand out to call anybody. i just don’t ask people for nothing. they throw stuff in your face.” likewise, roberta, a 32year-old african american mother of four added, “you have to find somebody that you trust, and i have a big trust issue. i don’t trust anybody.” feeling misunderstood and judged by professionals. among the mothers, gloria, a 27-year-old, latina mother of three described an incident involving her social worker: keefe et al./i gotta carry the burden 185 i’ve known [her] forever and a day…i talk to her all the time. i told her one day that i was overwhelmed…and that i need help because i’m a new mom and i really don’t know everything. and next thing you know…i got people at my house, knocking on the door, that said that i…don’t want my daughter, that i can’t handle her, that i have such a hard time with her that i can’t cope for myself. and i looked at them. i bugged out bad. and i was like, ‘where and how and in what words did i tell you that? i never, not once, said anything like that. she went on to say, “i feel that if i say something, when i’m only trying…to get the right help that i need, professional-wise…why bother? if…i’m gonna end up getting railroaded, the person’s gonna make it seem a lot uglier than it needed to be.” finally, she indicated, “you know, when you talk to somebody…[t]hat’s supposed to be…‘confidential’ nobody outside of there is supposed to hear anything.” after a group session at another agency, tabitha echoed this suspicion saying, i’m not about to sit up and talk around...no. because people judge you, they always judge you, and got something to say. they could say ‘oh, it’s confidentiality,’ but in the long run, you see that they know your whole life history now, or they judge you now. because you’re not gonna feel comfortable sitting in a group and sharing your life story with a group. because you’re not gonna wanna share. jacquelina, a 19-year-old, african american mother of one reported feeling guarded around professionals stating there is “a lady at my school that do it all the time. i be telling her like, ‘why you being so nosy?’” gwen says simply, “you have a lot of people you go and talk to, and…all they wanna do is judge you.” these mothers expressed feelings of mistrust of professionals when the information they shared was passed on to others. they found that by sharing personal information with professionals, they risked being labeled as a “bad” mother. these same sentiments were shared by the mothers who reported their concerns are not only for themselves, but for their children as well. alexia, a 19-year-old, puerto rican mother of one is fearful of professionals who are hired to take care of children. she states, “i don’t trust anybody. ‘cause of videos you see [on the television shows] all over.” selena, a 22-year-old puerto rican mother of two stated similarly, “i don’t need nobody take my son and my daughter. i gotta have time for me, but i still keep them with me at all times.” the lack of trust in childcare professionals is related to concerns about inadequate physical or emotional care, as well as the risk of child abuse or neglect as depicted in television shows. this is not to say that all mothers felt the professionals they saw for services were unhelpful. fatima, a 29-year-old, african american mother of two said of her social worker, “i’ve seen her tear up before, like her eyes got watery, and that said a lot, like she felt me, she felt what i was saying, she didn’t just listen, like yeah, yeah, yeah you feel like that because you need to…you know, she felt more what i was saying. i feel like she cares.” of her primary care physician who moved to another healthcare facility, tabitha stated, “i miss her so much…she understood me. she left. so that’s bothering me. so, i’m gonna try to go to [the hospital] where she [works now]. because i just i gotta have this connection advances in social work, spring 2021, 21(1) 186 back with her.” sophia reported child protective services “they’re helping you so you don’t get your kids taken. there’s a lot of help you can actually get from them.” feeling disrespected by their child(ren)’s father or male partner. twenty-five of the mothers spoke of how their current or former partners, including their child(ren)’s father, present as untrustworthy. the following quotes from 10 of the mothers provide examples of untrustworthiness. jezel, a 27-year-old african american mother of one, reported that her baby’s father, “was [at home] a lot. until everything changed…then he found another girl and...had another baby.” at times, the mother’s partner was described as controlling, which contributed to distrust and isolation. gloria shared that her babies’ father “don’t like me to have friends. he don’t like me to talk to nobody. he don’t like me to go nowhere. he wants me to stay in the house all the time, cook, clean, [do] laundry, do the baths, do this, and do that.” raquel reported, “you know, a man has a lot of pride. and i’m very prideful too we bump heads. because i don’t think that i could ask him for the help.” many of the mothers considered their partners to be unhelpful. reflecting on initial motherhood, tonya shared, “you happy you got your baby, you bring your baby home. and then what triggers it off? the man. not being there…so now you frustrated, and you mad at him…‘cause now the baby’s crying. i don’t wanna do this by myself. i don’t want the baby.‘cause you worrying about the man.” of her babies’ father, tanisha, a 26-year-old african american mother of four stated, they were there when my kids were first born. but it was more of like, just their bodies were present. it wasn’t too much of helping, or too much of doing anything but what they wanted to do. tabitha reported, so, it seemed like i was always by myself to begin with, so, it was just like…he knows what needs to be done, but he just chooses not to. ‘cause i feel like most men, they don’t feel obligated to be in that parental role. because they feel [when] push come to shove the mother’s just not gonna abandon and leave their child. you know, so, i feel like most men need to own up to that. arissa, a 31-year-old jamaican mother of three, added, “i mean, imagine having two kids at one time at the age of 19, and…the father’s there, but he’s not physically there to help get up throughout the middle of the night, fix two bottles, and do this, do that.” unfortunately, experiences of being disrespected, controlled, ignored, and left by the child(ren)’s father to manage alone seemed to exacerbate symptoms of depression for many of the mothers. anjelica, a 25-year-old puerto rican mother of four, similarly stated, “[my baby’s father] he’s no help. he makes me even more crazy.” gloria added, “i would just rather you go, you do your thing, you wanna see the kids, i have no problem with that. but there’s no point of you sitting around, underneath me stressing and struggling, and you’re not trying to do nothing to help.” she added, “you’re just becoming more of a headache, ‘cause now i gotta hear your complaints, and what you need, and what you want, when i got babies to worry about.” rhesa said nearly the same, “he comes around. and i don’t keefe et al./i gotta carry the burden 187 wanna be bothered with him either. even when i tell him not to come over, he still comes over. but when he feel like he don’t wanna come over, he don’t come over.” the unhelpfulness of many fathers left mothers feeling frustrated and down. although they did not want to care for their children alone, they reported that being alone was preferable to dealing with the father’s unpredictability and lack of support. despite feeling their child(ren)’s father was disconnected, most mothers chose to focus on themselves and their children. shameeka, a 24-year-old african american mother of one, said of her babies’ father, “i didn’t harass him, ‘oh, why you don’t know your daughter?’ like, no. i didn’t do none of that. i moved on. i didn’t wanna turn to welfare, but i did that. but...she’s taken care of; i can tell you that much. i didn’t even…put him on child support. i didn’t even do that, because...i’m not gonna force anyone to take care of her, who doesn’t want to.” some of the mothers report their baby’s fathers were helpful. anjelica stated, “i’m not gonna lie--he helped out a little bit with the kids, changing pampers and stuff like that.” jezel reports feeling better because “i was happy but then sometimes i was sad, i’m happier right now that he’s here.” dena added that her husband has helped her feel less overwhelmed, “he is the one who will take initiative now to do things around the house, before i feel overwhelmed. latoya, a 29-year-old african american mother of three, acknowledged the father of her baby is trying to help her and her child by “looking to move out to [the suburbs] right now, to get out of the inner-city life and give us a better start at life.” being betrayed and disrespected by friends. while several of the mothers discussed how their friends betrayed them, other mothers simply had no time for existing friends or to develop new friendships. of the 30 mothers, 22 stated specifically that they do not have any friends. cortney stated, “sometimes your business get out to the whole world…you shouldn’t tell nobody nothing about her or her business unless she tells me that it’s okay.” furthermore, “you’ve gotta be careful. some people just be in it to get information and put it out there. i’ve been through that before.” gloria shared her experience of being betrayed by a close friend: me and my kids’ father went to one of my friends, and she accused us of stealing money from her. she went out to my mom’s and told her me and my boyfriend were on crack, and…just a lot of stupid stuff…none of it was true. [later, she said] ‘i’m so sorry …that i accused you. i found my money. i put it in one of my old purses and threw it in a closet. and when i was going through stuff, i found my purse, i found every dollar.’ tanisha reported that to avoid such stress, she stays away from people by claiming “i don’t really do the friend thing. i’d rather it just me and my kids. and i don’t really have time for females. they wanna party, drink, club, you know. or men, i just don’t have time for it. i’d rather all my time go for my kids.” similarly, sophia said, “i have, maybe, four or three people that i’ll consider friends, but i don’t even talk to them. i don’t like to tell people my…business, because when you tell people your business, most of the time, it turns out they try to use it against you.” advances in social work, spring 2021, 21(1) 188 some of the mothers felt having friends was important. crystal, a 27-year-old, african american mother of two acknowledged, “there’s a lot of mothers out there that don’t have friends, or don’t have people to associate with. they wanna get out of their circle. i think [that] would be the perfect way for them to meet other people…hear stories and try to better themselves.” arissa stated her friendships are important to her. “[w]hen i do need to do something for myself…i’ll hang out with some friends, just, you know, try to get your mind off of things.” some mothers reported they wished they had friends. tabitha states “because you can’t really call people your friends. i have a few friends that i growed up with…but they ain’t around. i wish i did have friends like other people have.” i gotta carry the burden by myself although the mothers indicate they love their children, the lack of resources and positive relationships with friends and family contribute to their perception of mothering as a burden. most of the mothers, however, accepted their situations as ways to push themselves forward in their lives. their fierce determination was echoed by 12 of the mothers who spoke of their ability to carry the burden by themselves. as tabitha shared: it’s only the mom…that’s what those kids have to depend on…ninety percent of the time, the father’s not there. so, that mother has to play both roles. she has to be a mom, and then she also has to be that father figure…it’s a hard role to play. but i see a lot of african american, latina women, they hold that role, and really carry it well. so…it’s more mothers in the homes…without the fathers, so it’s kind of stressful…for any mother in my shoes. similarly, tamika, a 23-year-old puerto rican mother of one, shared: when [my son] ended up in the hospital for five months...that was a lot of stress…i did really everything by myself, ‘cause his father, he was there, but he wasn’t like a person that i could just sit there and count on to help me, and stay overnight with him, ‘cause he wouldn’t. he’ll leave the hospital and go out to parties, with other guys, and other girls, and so i had to deal with it on my own. the mothers spoke strongly about the strides they took to become self-sustaining. tonya pointed out, “i know i’m gonna have to cook dinner, i know i’m gonna have to do this and that.’ i’m used to cleaning up. i’m used to taking care of the kids by myself.” jacquelina added, “the hard part is raising them by ourselves.” some of the mothers described how they exhausted themselves while trying to be independent. tamara, a 30-year-old african american mother of seven, stated, “i just ran myself ‘till i was tired exhausted at the end of the night…it was just like a whole bunch going on at the time…i just…was go, go, go, from the time i opened my eyes…i [was] just basically…speeding all the time.” raquel added, “it was very difficult...and at times i feel like i…fall down again. but i…pick myself back up.” arissa reflected, “i gotta keep pushing, and do what i have to do.” keefe et al./i gotta carry the burden 189 several of the mothers strove to become independent and take responsibility for themselves and their children. tammy, a 38-year-old, african american mother of four shared, “do it for you…you don’t need a man to go forward. you don’t need a man for backbone. you got your own backbone. you got your kids, and they need your support.” rochelle likewise added, “i have no choice. i brought my kids into this world so now i have to take care of them. that’s how i look at it like it’s not their fault they’re here. i made wrong choices and i have kids by one man and he’s not much help at all. i don’t want anyone else taking care of my kids.” of their own independence, jezel said, “i’m not gonna depend on nobody” while gloria echoes this point by stating, “you’ve gotta count on yourself.” latoya concluded by saying, “like when i was pregnant, i had that mindset that we’re gonna…raise them, you’re going to help me. but neither one of them did that and it’s always like i gotta carry the burden by myself.” discussion and implications for practice the findings from this study help to fill a gap in the research on the experiences of ppd among low-income mothers of color. although the research on mothers of color with peripartum depression is growing, this study specifically asked low-income mothers of color how they carry on throughout the day while living in challenging environments. most of the research on depressed low-income mothers of color focuses largely on how the mothers are affected by their depression, but not on how forcefully some mothers push themselves forward to become good mothers. the findings from this study revealed a dominant theme of “i gotta carry the burden by myself” with additional themes of feeling alone, isolated, overwhelmed, and feeling disrespected and betrayed by various individuals in their lives. throughout their experiences, many of the mothers reported becoming more determined to persevere and to be good mothers despite ongoing burdens. although the mothers discussed the difficulties, they described their tenacity to be independent. this finding is reinforced by maxwell et al.’s (2018) meta-analysis, which indicated that low-income mothers do their best to cope with the pressures of mothering despite often feeling isolated and alone. keefe et al. (2018a, 2018b) concluded that lowincome mothers of color strive to be excellent mothers while only rarely giving themselves credit for handling the ongoing difficulties of living in poverty. when working with mothers of color, the strengths and resiliency of these individuals should be acknowledged and celebrated. all the mothers tested within the depressed range on the epds, yet most did not acknowledge having depression. given that many new mothers are frequently unable to take time for themselves, particularly when faced with multiple psychosocial stressors (alloy et al., 2010; gallo et al., 2005; shih et al., 2011), and may be unable to acknowledge having depression (keefe et al., 2019), they should be given the space to process their feelings in a warm and caring environment (atkins et al., 2020). because women of color are less likely than white women to access mental health services (kozhimannil et al., 2011), health professionals should address access barriers to services and engage in rapport and trust-building to link mothers with professionals. furthermore, practitioners, advances in social work, spring 2021, 21(1) 190 particularly social workers, are encouraged to screen mothers for ppd and receive education on best screening practices with mothers of color (polmanteer et al., 2016). some of the mothers in this study report wanting connection and friendship with other adults including other mothers. having a strong support system has been shown to positively affect the well-being of new mothers of color (o’neill et al., 2019; stana & miller, 2019), while isolation contributes to ppd (ganann et al., 2016; hahn-holbrook & hastleton, 2014). offering peer-support groups can enhance mental health well-being among mothers with ppd (prevatt et al., 2018). as limited support, childcare responsibilities, and other stressors can negatively affect relationship-building among mothers, including mothers of color (carter & butler, 2008; jordan & zitek, 2012), online support groups or text messaging can promote engagement and decrease feelings of depression and isolation (broom et al., 2015). many of the mothers in this study reflected on strained or stressful relationships with their partner or child(ren)’s father. although the partners were not interviewed, and therefore their perspective is unknown, research supports that mothers who perceive their relationships with their baby’s father to be negative had worse depression (cheng et al., 2016; grote & bledsoe, 2007), particularly in non-co-habitating couples (garfield et al., 2015). as positive relationships with their baby’s father contributes to lower levels of depression (easterbrooks et al., 2016), promoting trust, communication, and respect within the couple or coparenting relationship is important. low-income mothers in other studies report the fathers of their babies remained involved despite living apart often due to incarceration (keefe et al., 2017). implementing evidence-based co-parenting programs may assist parents in developing the necessary skills to address relationship conflicts that arise from parenting (florsheim et al., 2012). limitations this study is not without limitations. given the sampling approach and small sample size, the findings cannot be generalized to other mothers. likewise, given the research on use of the epds among various groups is quite plentiful, we did not calculate the internal consistency of our sample. it is possible that the internal consistency for our sample is not as strong as others have reported. furthermore, the researchers were of different backgrounds than the mothers in the study. despite having support from the agency staff as well as taking time to form relationships with several of the mothers before the interviews, the researchers caution that the study findings must be considered in light of these differences. although the mothers reported feeling positively about the interviews, many were often exhausted and overwhelmed with their daily stressors which likely affected how they responded during the interviews. finally, the interviews on which this analysis is based were conducted between 2013 and 2015. it is possible that mothers in 2021 might provide different responses to our questions than we got from the mothers in this study. in our more recent research, conducted in another city, mothers reported their babies’ fathers were more supportive (keefe et al., 2019). however, those interviews were conducted with non-service seeking mothers who had closer bonds with their babies’ fathers. keefe et al./i gotta carry the burden 191 recommendations social workers who work with low-income new mothers must recognize the mothers’ inner strengths and capacities to become self-sustaining despite the mothers’ social location. mothers often feel judged and misunderstood by providers (humphries & mcdonald, 2012) and many low-income mothers are reluctant to reach out for help (keefe et al., 2018b; loudon et al., 2016; moore et al., 2016). social workers should focus on developing a trusting relationship by clearly communicating the limits of confidentiality while bearing in mind that the mothers may distrust service providers. additionally, social workers should help mothers to broker appropriate social services including financial and job training resources (atkins et al., 2020). additional interventions should focus on enhancing positive coping skills to assertively deal with daily stressors. as this study has supported, low-income mothers of color experiencing depression want to build their independence while focusing on their children’s needs. social workers can encourage mothers to develop relationships by reaching out to informal support services such as faith-based organizations the mothers may already access (keefe et al., 2016b), and advocating for more flexible hours of operation among formal service organizations to help facilitate new mothers’ entry into various programs (keefe et al., 2016a, 2018b). supporting opportunities for women and mothers to come together, developing strong engagement skills, setting safe parameters such as confidentiality and professionalism, and engaging in conflict resolution among parents can help new mothers of color not only carry the burden of new motherhood but lead fuller and more engaged lives. references abel, w. m., crane, p. b., & mccoy, t. 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(2019). food insecurity and maternal mental health among african american single mothers living with hiv/aids in the alabama black belt. journal of health care for the poor and underserved, 30(4s), 151-159. https://doi.org/10.1353/hpu.2019.0124 author note: address correspondence to robert h. keefe, school of social work, university at buffalo, suny, buffalo, ny 14260-1050. email: rhkeefe@buffalo.edu https://doi.org/10.1080/15456870.2019.1616736 https://doi.org/10.1186/s12884-015-0532-1 https://doi.org/10.1176/appi.ajp.2011.11010148 https://doi.org/10.1177/1049732305285972 https://doi.org/10.1001/jamapsychiatry.2013.87 https://doi.org/10.1111/j.1471-0528.2011.03219.x https://doi.org/10.1111/j.1471-0528.2011.03219.x https://doi.org/10.1016/j.ypmed.2013.12.022 https://doi.org/10.1353/hpu.2019.0124 mailto:rhkeefe@buffalo.edu epds score* number of children participant’s name pregnant race/ethnicity age _________ matthew w. epperson, phd, msw, associate professor, crown family school of social work, policy, and practice, university of chicago, chicago, il. alexa cinque, am, doctoral student, crown family school of social work, policy, and practice, university of chicago, chicago, il. hannah lee, lsw, practicing clinical social worker, former project coordinator, the smart decarceration project, university of chicago, chicago, il. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 27-47, doi: 10.18060/27398 this work is licensed under a creative commons attribution 4.0 international license. addressing the complexity of illegal gun possession for participants in gun diversion programs matthew w. epperson alexa cinque hannah lee abstract: incarceration-based approaches to illegal gun possession have not proven effective at reducing gun violence, and they have created dramatic racial disparities. within this context, a small number of jurisdictions have developed prosecutor-led gun diversion programs (plgdps), which offer diversion from prosecution and an opportunity to engage in community-based services with a common goal of reducing illegal gun possession. the purpose of this paper is to explore the factors that contribute to illegal gun possession among plgdp participants, and the extent to which plgdp programming addresses these complex factors. semi-structured interviews were conducted with 32 plgdp stakeholders (8 plgdp participants, 15 prosecutors, and 9 service providers), and qualitative analyses identified themes related to illegal gun possession and plgdp programming connections and disconnections. findings indicate that safety concerns related to structural issues of community violence are a primary factor driving gun possession among plgdp participants. while plgdps were viewed as having some benefits, disconnects in plgdp programming centered on assumptions made about the target population and the limitations of individual-level interventions to curb gun violence. if plgdps are to have an impact on gun violence, trauma-focused approaches must be incorporated, and efforts should be made to better understand and address environmental factors. keywords: diversion programs; gun possession; decarceration; prosecutors; violence prevention the persistence and urgency of gun violence in the u.s. gun violence is a persistent public health issue in the united states that has become increasingly salient in recent years. in 2020, the u.s. saw the highest number of gun-related deaths since the 1990s and the highest number of gun-related homicides since 1968 (gramlich, 2023). the covid-19 pandemic has had both shortand long-term impacts on incidents of gun violence; for example, in buffalo, new york, kim and phillips (2021) found that the pandemic caused a temporary increase in fatal shootings and a longer-term increase in non-fatal and gang-related shootings. the impacts of gun violence are disparate by race and neighborhood as well. black boys and men between the ages of 15-34 are 10 times more likely to die due to a firearm-related homicide than their white peers (centers for disease control and prevention, 2023), and urban gun violence is often concentrated to particular neighborhoods or even blocks within neighborhoods (braga et al., 2010; larsen et al., 2017). the pandemic-related increases in gun violence exacerbated these about:blank advances in social work, spring 2024, 24(1) 28 racial and neighborhood disparities even further (macdonald et al., 2022). this persistent and disparate impact of gun violence on communities across the country highlights the imperative for policymakers, scholars, and community advocates to further understand why firearms are so prevalent throughout the united states and act with urgency to curb gun violence and enhance safety across communities. drivers of gun ownership and illegal gun possession gun ownership and decisions about when and where to carry a gun are multifaceted and driven by complex, intersecting factors. while individual attitudes toward firearm ownership, influenced by political ideology, race, and gender, impact decisions to possess a gun (celinska, 2007; shapira & simon, 2018), there is also evidence that environmental factors, such as neighborhood violence, influence these decisions as well (molnar et al., 2004; patchin et al., 2006). in general, rates of gun ownership have also increased since the beginning of the pandemic. although gun sales are not uniformly tracked across jurisdictions, the number of background checks for gun purchases was three times higher in june 2020 than the previous year (arnold, 2020). while these figures provide insights into increasing rates of gun ownership, they underestimate the overall rate of gun ownership as they do not take into account legal gun sales that do not involve background checks as well as illegal firearm acquisition. overwhelmingly, studies include safety and protection as major influences on both legal and illegal firearm ownership (barragan et al., 2016; carlson, 2015; cook & goss, 2014; cook et al., 2018). barragan et al. (2016) found that illegal gun possession (i.e. either owning or carrying a gun without the proper licensure and permits) is distinct in that it is often driven by community-level violence and first-hand exposure to gun violence. in a survey of 221 men incarcerated for illegal gun possession in the illinois department of corrections, survey respondents reported feeling unsafe in their neighborhoods as a major factor driving their illegal gun possession, with shootings reported as the most common reason for feeling unsafe (40%), followed by gang activity (29%), and general violence (24%; cook et al., 2018). in a study focused on youth, beardslee et al. (2018), found that youth who witnessed or directly experienced gun violence were 40% more likely to carry a gun following the experience and were also more likely to carry firearms into young adulthood. low-income communities of color suffering from high rates of gun violence often experience a situational context in which self-protection strategies such as illegal gun possession are seen as a more viable option than seeking out the police for protection, due to discriminatory treatment and/or a lack of responsiveness (barragan, 2022). in recognizing the impact of trauma and violence exposure on illegal gun possession, as well as the urgency of mitigating gun violence, it is crucial to consider the implementation of trauma-informed interventions as a viable strategy to do so (beardslee et al., 2018). more commonly, however, strategies to reduce gun violence involve traditional law enforcement through arrest and prosecution for gun-related charges, including illegal gun possession. epperson et al./guns & diversion programs 29 the limits of addressing gun violence through law enforcement and prosecution as the increase in gun violence has become a more salient concern across the country, the criminal legal system has focused primarily on arresting and prosecuting individuals for illegal gun possession as a gun violence prevention strategy (olson et al., 2021; webster et al., 2020; weiss, 2022). consequently, arrests for illegal gun possession have increased over the past 10 years across various localities (chavis & hing, 2023). however, there is little evidence that criminalizing and punishing illegal gun possession meaningfully decreases future gun violence (barragan, 2022; kollmann & nong, 2013; olson et al., 2021). for instance, in a recent study of people released from prison, those with a gun offense conviction were more than twice as likely to be arrested for another gun offense after their release from prison than those without a past gun conviction; however, even among those with a prior gun offense, the rate of a post-prison gun offense was just 4% (ostermann & hashimi, 2022). a limitation of this study is that all gun-related offenses were aggregated, so distinctions between gun possession versus use/discharge of a gun in an offense could not be examined. in one of the only known studies to focus solely on illegal gun possession offenses, just 7% of individuals who were prosecuted and incarcerated for illegal gun possession were re-arrested for a violent offense within a 3year period (olson et al., 2021). aggressive law enforcement and harsh sentencing may ultimately create more harm to individuals and communities than successfully curbing violence: the harms of incarceration include its potential criminogenic effect, the disproportionate impact on disinvested communities of color, and the erosion of legitimacy of the legal system when those impacted by it see their sentences as discriminatory (barragan, 2022; webster, 2022; weiss, 2022). it is important to note that there are benefits to reducing the number of guns in communities, with multiple studies linking firearm prevalence to rates of homicide and violence in urban areas (hepburn & hemenway, 2004; moore, 2017; stroebe, 2013). one recent study specifically connected the prevalence of illegal firearms to rates of homicide, particularly in disinvested communities (semenza et al., 2021). while the aim to reduce illegal gun possession seems sensible in reducing gun violence, the broadness of this enforcement strategy is often applied in a racially disparate manner, frequently resulting in black men being disproportionately arrested for minor gun possession charges (armalas & thompson, 2022.). for example, from 2008-2019, 74% of individuals convicted for illegal gun possession in cook county, illinois were black men, and the volume of arrests yielded limited impact on public safety (olson et al., 2020). although targeted, problemoriented policing initiatives have shown some success in reducing illegal gun possession, the simultaneous under and over policing of disenfranchised communities is damaging to the efforts to reduce gun violence and illegal possession (barragan, 2022; kollmann & nong, 2013; webster, 2022; weiss, 2022). while punitive approaches to social ills are familiar, their lack of efficacy and potential to cause harm drive the pursuit of communitybased alternatives. advances in social work, spring 2024, 24(1) 30 alternative responses to illegal gun possession community-based models reflecting on the lack of the criminal legal system’s ability to reduce gun violence, branas et al. (2021) write: the public health, medical, and scientific research communities can no longer be at the mercy of us state and federal legislators, simply waiting for them to successfully pass or repeal laws as the only source of scientific and policy innovation to prevent gun violence in the us. (p. 243) and communities have not waited idly by, but have initiated interventions to interrupt gun violence and illegal gun possession. a recent review of 13 community-based interventions for gun violence described three main types of approaches: systems, public health, and community mobilization, with many sites adopting more than one approach (richardson, 2019). systems-based approaches conceptualize gun violence as a combination of overlapping issues at the individual, familial, educational, and environmental levels and work to address multiple spheres of risk simultaneously. community mobilization approaches center a community as both the focus of the intervention and integral to its development and execution. lastly, the public health approach adopts a framework of risk and protective factors to treat gun violence similar to a disease. richardson’s (2019) review found that public health and systems approaches were most effective in reducing gun violence. a growing body of research connects illegal gun possession with both individual and environmental factors; using data from project on human development in chicago neighborhoods, researchers found that illegal gun possession among youth was associated with individual exposure to violence, as well as their neighborhood’s lack of safe places for children to play and high levels of social and physical disorder (molnar et al., 2004). as such, interventions that target both the individual and the community can have a positive impact on gun violence. hospital-based violence intervention programs (hvips) or the cure violence model can interrupt and deescalate conflict and reduce recidivism by treating the mental health impacts of violence exposure (butts et al., 2015; wical et al., 2020). at the community level, expanding services such as youth programming and reinvesting in neighborhood housing and transportation can positively impact rates of violence by addressing structural factors (branas et al., 2021). similarly, hureau and wilson’s (2021) longitudinal study of youth who both engaged in illegal gun possession and were exposed to gun violence found that, in the context of concentrated gun violence, gun possession was fluid and often involved periods of not illegally possessing a gun. these community-based approaches highlight a malleability in illegal gun possession behavior and the potential for such interventions to reduce rates of gun violence. prosecutor-led gun diversion programs and implications for social work in recognition that these community-focused, public health approaches to gun violence and illegal gun possession are more effective at reducing the cyclical harms of gun violence epperson et al./guns & diversion programs 31 than traditional law enforcement strategies, a small number of prosecutors have begun implementing diversion programming for some gun charges that incorporate communitybased services. by applying lessons learned from public health-oriented and communitybased violence intervention programs, these prosecutor-led gun diversion programs (plgdps) aim to reduce rates of illegal gun possession, and ultimately, incidents of gun violence across their jurisdictions. expanding diversion programming is part of a larger trend of prosecutors and other criminal legal stakeholders moving toward alternatives to punishment and incarceration, where individuals are able to complete various programmatic requirements in exchange for the dismissal of their case(s) (epperson et al., 2023). plgdps are an extension of this trend, particularly as prosecutors and gun violence reduction advocates have begun to recognize that traditional approaches to prosecution and incarceration have not yielded the public safety outcomes intended, and more frequently, perpetuate racial disparities and unnecessary collateral consequences of criminal legal involvement for communities of color (giffords law center to prevent gun violence, 2021). law enforcement's increased focus on illegal gun possession and the implementation of plgdps to address the prevalence of illegally owned guns and gun violence has great implications for social work and social justice. the racial disproportionality of arrest and incarceration for illegal gun possession charges, and subsequent criminal legal records, have immense collateral consequences on communities of color (levin, 2015). as plgdps potentially provide alternatives to obtaining such records, these programs may have strong implications for social justice and racial equity. additionally, plgdps tend to center cognitive-behavioral and mental health interventions (sharif-kazemi et al., 2021), and social work is especially suited to understanding the interaction of clinical and environmental factors impacting behavior and behavioral change (berlin, 1982). until recently, gun-related charges have broadly been ineligible for diversion programs or other alternatives, positioning plgdps as novel interventions to interrupt cycles of incarceration and violence. in 2021, a landscape scan identified eight plgdps across medium and large midwestern and east coast cities (sharif-kazemi et al., 2021), and as advocates and system reformers call for both reductions in instances of gun violence and mass incarceration, these programs are well-positioned for implementation in additional jurisdictions. however, as emerging programs, plgdps require reflexive and critical engagement and analysis to understand whether their programming actually addresses drivers of illegal gun possession and, potentially, gun violence. current study the current study aims to explore the individual and environmental factors that contribute to illegal gun possession behavior among participants in plgdps and the extent to which plgdp programming addresses these complex factors. within this paper, illegal gun possession is defined as the behavior of either owning or carrying a gun without the proper licensure and permits. drawing on qualitative interviews with program participants, prosecutors, and service providers, the study also examines variations in plgdp stakeholder perceptions of illegal gun possession and how these perceptions align with the programming offered to participants. while the findings from this study can be used by advances in social work, spring 2024, 24(1) 32 any stakeholder engaged in criminal legal reform efforts, these insights will be particularly important for social work and furthering the field’s goals of enhancing smart decarceration (epperson & pettus-davis, 2015). as plgdps develop, it is crucial for social work to engage critically in assessing whether these programs are responsive to participant needs and continue to emphasize community-based practices over punitive methods, and more broadly, whether these programs encourage movement away from carceral logics and toward public safety and community well-being. methods sample and plgdp sites description as part of a larger mixed methods research project on plgdps, this study entails qualitative interviews with a range of stakeholders from five plgdps that are in various stages of development. four of the plgdps are located in the midwestern u.s., and one program is located in the south. four of the plgdps are actively accepting participants and have been operational from less than one year to six years; one plgdp is still in the planning and development phase. three plgdps included in this study were included in the initial plgdp landscape scan conducted in 2021, while two of the plgdps have been implemented since that time. the size and capacity of these programs vary greatly by jurisdiction; for example, for two plgdps implemented during the same year, one program has diverted 39 cases in its first two years, while the other diverted 17 in the same time period. the size and scope of each plgdp are largely dependent on the number of cases screened, eligibility criteria, goals of the program, and/or capacity of the host prosecutor’s office. each plgdp in this study is primarily focused on offering programming that will reduce each participant’s likelihood that they will engage in gun violence in the future, and three of the implemented plgdps are also explicitly focused on reducing racial disparities and improving social outcomes for young men of color. the four plgdps in operation accept participants charged with illegal gun possession, which may be filed as a gross misdemeanor or felony charge, depending on the state in which the plgdp is located. each program has additional eligibility criteria, which typically include no prior offenses involving interpersonal violence or, in some cases, any felony conviction. all of the programs offer dismissal of the illegal gun possession charge for participants who complete plgdp programming and are not arrested for a disqualifying charge within the program’s length, which ranges from six months to two years. programming varies somewhat across the four existing plgdps, but in all cases it involves a combination of group and individual counseling, using four primary approaches: cognitive-behavioral therapy (cbt), life skills and anger management training, service and resource provision, and restorative justice circles. all of the plgdp services and programming are provided by local social service agencies, and services are provided by trained social workers, psychologists, or other helping professionals. members of the research team conducted semi-structured qualitative interviews with a total of 32 plgdp stakeholders, including eight plgdp participants, 15 prosecutorial staff that were involved in the development of each program, and nine social service providers epperson et al./guns & diversion programs 33 from agencies contracted to provide plgdp programming. prosecutorial staff and service providers were recruited directly by the research team via email invitations to participate in an interview. plgdp participants were recruited in two ways. for one plgdp, members of the research team attended a group session and presented the study with an invitation to participate in an interview. for the remaining plgdps, service providers informed participants about the study and asked who would be willing to be contacted by a member of the research team to learn more about participation. because most of these programs were in the early stages of implementation at the time of recruitment, there were a limited number of plgdp participants available for recruitment. plgdp participant interviews focused on a range of participant experiences and perspectives on the program, including program entry and participation (i.e. “what ultimately convinced you to participate in the program?”), experiences in the program (i.e. “what services did you receive in the program?” “do you think the program is doing what it was designed to do?”), and recommendations on how the plgdp could be improved. for prosecutorial staff and social service providers, collectively referred to as “plgdp professionals,” interviews focused on plgdp purpose, development and implementation, target population(s), rationale for services provided, and how success is defined and measured. example questions from the plgdp professional interview guide include: “to what degree has your plgdp reached the target population?” “how does the fact that your clients are in a gun diversion program shape your thinking about treatment?” “please describe the typical profile of a successful (and unsuccessful) participant in the program.” data analysis interviews, which lasted between 45 and 90 minutes, were audio recorded (with consent) and transcribed verbatim. transcribed interviews were analyzed using a thematic analysis approach (braun & clarke, 2006) combined with elements of flexible coding as described by deterding and waters (2021). first, three members of the research team conducted line-by-line coding of all interview transcripts, applying an initial set of index codes derived from topics covered and questions from the interview guide (deterding & waters, 2021). members of the research team met regularly to review memos, draft summaries of index codes, and relevant questions to explore in the analysis. because plgdps focus on illegal gun possession charges, we focused our analyses on two aspects of gun possession: 1how do plgdp participants and professionals describe the factors related to illegal gun possession? and 2to what extent does plgdp programming address these factors and additional needs of plgdp participants? indexed excerpts related to assessments of plgdps, program design and implementation, and plgdp participants were reviewed and flagged for potential relevance to the two research questions. additionally, all eight plgdp participant interviews were reanalyzed and excerpts of relevance to the research questions were identified. next, a set of analytic codes was developed and applied to the indexed data, including the following analytic codes: contextual drivers of gun possession, individual vs. environmental factors, connections and disconnections between programming and needs. summaries of analytic code excerpts were written and reviewed, and the various codes were sorted and organized into potential themes (braun & clarke, 2006). this distillation of themes was organized into two advances in social work, spring 2024, 24(1) 34 sections: 1the context of gun possession and related needs, which included the following themes: safety, demographics and policy context, and additional needs; and 2plgdp connections and disconnections to participant needs, which included the following themes: mental health and group programming, assumptions on target population, and limitations of individual-focused intervention. results in total, 32 plgdp stakeholders across five sites participated in semi-structured interviews. eight program participants were interviewed across three plgdps. all interviewed program participants identified as male, six participants identified as black, one identified as biracial, and one identified as white. the interviewed participants’ ages ranged from 25-45, with an average age of 32 and median age of 29. among the 15 prosecutorial staff interviewed, 12 (80%) identified as white, two (13%) identified as black, and one (7%) identified as latinx; 12 prosecutorial staff (80%) identified as female, and three (20%) identified as male. all prosecutorial staff had received a degree in law, and they ranged from one to 23 years in their current position. among the nine service providers interviewed, seven (78%) identified as black and three as white; five (56%) identified as male and four as female. three of the nine service providers had obtained degrees in social work, three in counseling or psychology, one in communications, and two service providers had received training in human services or trade school. context of illegal gun possession and related needs safety safety and violence concerns were primary factors driving illegal gun possession that were similarly discussed by plgdp participants, prosecutors, and service providers. stakeholders across plgdps acknowledge that many of their program participants possess firearms because they are afraid of gun violence in their communities, and these stakeholders provide various reasons why participants feel unsafe, including communitylevel gun violence, gang affiliation or fear of retaliation, and knowing a loved one impacted by violence. this recognition seems to be one of the motivating factors in developing plgdps – many stakeholders do not want to punish young people for illegally possessing firearms due to fears for their safety. in the following quote by a prosecutorial staff member, the recognition of illegal gun possession behavior due to safety concerns (versus intention to “commit crimes”) provides a rationale for offering plgdp participation as an option after arrest. so some kids are getting guns, not because they want to commit crimes or they're part of a gang, but maybe they think they have to have a gun to be safe in their school. and if that child gets picked up with a gun, they get kind of funneled into the process with a label and a stigma about being a gun carrier. although it's a very risky proposition in a sense that no one wants to divert someone that's got a previous gun case for possession and then find out later on they're involved in a shooting, that doesn't look good for anybody. but we recognized that we wanted to epperson et al./guns & diversion programs 35 be able to offer an olive branch to people and say, "we recognize that you're on the really outer peripheral of the major crime problem, the assault problem in our city, and if we can divert you and get you onto a better track sooner, now how do we do that?" (plgdp prosecutor) plgdp participants also described safety concerns as a primary reason for gun possession, although many quotes discussed a broader context involving intersecting issues of poverty, trauma, neighborhood violence, and systemic issues like racism and policing that affect plgdp participants’ illegal gun possession behaviors. the most frequent environmental issue discussed was the prevalence of gun violence, which was described as “common as rain.” interviewees frequently connected the environmental factors above with individual-level attributes related to illegal gun possession. the most prevalent belief discussed was that gun possession was necessary for personal safety, which is clearly linked to an overall feeling of being unsafe within their neighborhoods. as illustrated in the following quote, plgdp participants discussed being aware of the potential violence around them, at times being hypervigilant, and desiring the feeling of protection that a gun is perceived to provide. take a little more into consideration the grim reality of certain people's situations. me, myself where i live, where i come from, where i was arrested, all that, it's not a very bad place, it's not a bad neighborhood. however, there are far worse neighborhoods this way. and a lot of people live, work and play in those areas. and it's just a reality. and you could literally die at any one time through no fault of your own, whether you're outside or in the house. it's just messed up like that. stray bullets are common as rain in certain places. and not only that, that's just for people that are out the way. you got people that are moving and grooving in the streets and whatnot, and that's a whole other risk to your health. so they got to deal with not only the passive risk, something happening to them, but now you've got an active risk. you've got police, you've got other street dudes, you got just... everything is against you. (plgdp participant) exacerbating these feelings of lack of safety and hypervigilance is a recognition of the “passive” and “active” risks – multiple levels of personal and environmental trauma, which can also lead to mental health difficulties and a feeling of hopelessness. many plgdp participants also recognized that these same neighborhoods are heavily policed, and that young black men are often socialized to distrust police. this distrust of police, along with other risks, contributes to gun possession behaviors as plgdp participants take it upon themselves to ensure their own safety. demographics and policy context there was frequent recognition by both plgdp professionals and participants that the overwhelming majority of participants in plgdps are young black men from specific neighborhoods within cities. there are certainly older individuals, non-black individuals, and women in plgdps, but the dominant characterization was of young black men and the unique impact of illegal gun possession on them. many of the subsequent discussions of individual, neighborhood, and societal factors were tied to this primary identity. at advances in social work, spring 2024, 24(1) 36 times, this identity was contrasted with others who may illegally possess guns (i.e., white men) but are not caught up in the criminal legal system for it. additionally, there was a frequent humanizing of the general type of plgdp participant, that they are “good guys,” they are not “gang-bangers,” and that they are merely trying to protect themselves and make a living. there was also frequent mention of the fact that many of these young men were “first-time offenders” and were also referred to as “kids.” at times, the focus on young black men fed into stereotypes of the target population: the program is set up for the inner city... the typical poster child for this program is going to be an inner city 19-year-old male, a 20-year-old male. that's where most of our gun cases are. and those tend to be people of color, because they're living in inner city. they're probably lower income folks. and the type of kid that has a gun for his own protection, because he lives in a gang neighborhood. and he needs it, or at least he feels like he needs it. that's the type of person that's our model here that we think we can help. if i had to sell it, i would mention that in a community meeting. (plgdp prosecutor) to a lesser extent, illegal gun possession was explained by lack of awareness of the legal technicalities of how and when a gun could be legally owned and carried, and these decisions tended to be framed as mistakes versus a more sustained pattern of gun-carrying behavior. the plgdps involved in this study represent several different states, each with unique and variably restrictive laws and processes for legally possessing and carrying a gun. for example, one participant who worked as a truck driver was arrested in another state for having a gun in their truck – a behavior that would be considered legal in their home state. plgdp professionals also noted the challenges of implementing these programs within their distinct state contexts. some states provide easy access to legal gun ownership, whereas some make it incredibly difficult and inaccessible to obtain proper licensure. in discussing their plgdp clients, one service provider stated “there's a nice amount of guys that actually had a [legal gun ownership] card. so it's not like they were just oblivious. they took the necessary steps. again, they just didn't go all the way with the conceal and carry [permit].” additional needs both plgdp participants and professionals discussed a range of additional needs for services and supports including employment opportunities, housing, substance use, mental health, education/ged pathways, transportation, and family challenges. in particular, service providers had holistic understandings of the varying challenges that the participants may face in their day-to-day lives. now, if we're talking about our clients, we're talking about, on average, each client has a minimum of three barriers. that's what i've surmised. and i say on average. some have more. very few have less. when i'm talking about barriers, i don't know if i need to go into it, but we're talking about employment barriers, some educational barriers, some criminal barriers, some attitude barriers, some esteem barriers, some family barriers. so, there's all these things going on. maybe they have some mental health stuff going on. they have some learning disabilities. epperson et al./guns & diversion programs 37 there's all this different stuff that's going on with these folks. (plgdp service provider) however, plgdp professionals (versus participants) more frequently tied these needs directly to illegal gun possession behavior. most frequently, professionals focused on the importance of obtaining stable employment to reduce likelihood of illegal gun possession, connecting participants to jobs as well as providing help with resumes and interview preparation. well, one is that we hope they never carry a gun again. some of these kids came into our program with nothing to lose. and by them coming to our program and getting a job, and finding stable housing, and having relationship with us, they now have something to lose and stuff. they now have something that they can complete and help them in life. (plgdp prosecutor) overall, stakeholders across programs emphasized how economic needs and barriers must be addressed to reduce illegal gun possession behavior. as we will discuss in the following section, this assumed connection and focus on individual-level intervention was often experienced by plgdp participants as a disconnect from their actual needs. plgdp connections and disconnections to participant needs the overarching goal of plgdps is to provide participants with various services that address the needs that led the participant to possess a gun illegally. in attempting to meet these needs, plgdps aim to reduce future criminal legal involvement and, potentially, reduce gun violence within their jurisdictions. building on the contextual drivers of illegal gun possession behavior discussed in the previous section, the following section considers whether plgdps are addressing these drivers through their programming. interview excerpts were coded as “connections” or “disconnections” to signify alignment (or misalignment) between programmatic aspects, participant needs, and drivers of illegal gun possession behavior. connections: mental health and group programming the bulk of the excerpts coded as “connections” were from participant interviews, along with fewer excerpts from treatment providers and/or prosecutors. among the participant interviews, there was remarkable consistency in the aspects of the plgdp interventions that were discussed as helpful components. most of this revolved around cbt approaches (although cbt was rarely named), such as connecting thoughts, feelings, and actions, learning how to replace and restructure thoughts, and managing anger. many excerpts also discussed the benefits of developing skills such as decision-making, how to recognize risky situations and scenarios, practicing problem-solving, coping skills and selfcontrol, and how to deal with conflict. participant engagement with cbt approaches is exemplified in the following response to the question “do you think that the program addresses the situation that led you to getting a gun charge?” advances in social work, spring 2024, 24(1) 38 yeah, because of the simple fact it helps us with replacement thoughts, like maybe i wanted to come outside and i feel like that i needed to take my firearm somewhere versus ... what we talk about up in the group is maybe you can replace that thought with maybe you shouldn't go if you feel like that you need your firearm, or maybe you should just go about finding a better way to go about going, or going about and interacting with the situation. (plgdp participant) very rarely were more typical mental health concepts such as depression, anxiety, trauma, or substance use discussed by participants. at times, participants did describe gaining insight and understanding, both about themselves generally and about their own emotions and thinking. although participants discussed mental health focusing on skill-building, among the few service provider/staff excerpts, there was also a stated focus on cbt and connecting thoughts, feelings, and actions. plgdp professionals also talked about larger issues such as trauma, values, childhood experiences, and being authentic, and they connected trauma and hypervigilance with the importance of offering a second chance for people who are arrested for illegal possession, as illustrated in the following quote: so from my understanding, the criminal legal system was not working in a favor of those who made mistakes. and as you know, the people who make these mistakes, which are formerly incarcerated people, and also people who have gotten these charge, it’s kind of that one mistake kind of ruined their lives. and usually from my experience, working with this population, it comes from them making these mistakes, comes from their environment, being hypervigilant and things that have transpired throughout their childhood, which cause them to be on edge. and so circling back around to your question, i think the impetus behind this program was to provide not only a second chance, but be that conduit between the community in which they're servicing and the core systems to provide these people another chance, another shot at life. (plgdp service provider) two facets of the plgdp intervention approach were also repeatedly mentioned as being appreciated by participants: the group format and structured activities. many participants discussed the value of the group, talking with others with similar backgrounds and experiences, and being able to share and relate to one another. most helpful? i would say the group, how it allows all of us to share our experiences as a collective and collectively... it allows us to actively converse about what's going on [in the world], give someone else an example of a situation that they may have been in that they didn't want to talk about previously or somebody else, "i didn't know you've been through this just as many times as i." it allows individuals to know that they're not by themselves. we all feel like at certain times, stuff just happens to us. and it doesn't, it happens to people all the time, across all walks of life for the same reasons or lack of reasons as it may or may not have happened to you. and that is a big thing as far as connection. if you can connect with somebody more, you're going to be more open. and that's what the group is focused on, being open to ideas but also opening yourself up so you know what's going on within you, and it does a really good job with that. (plgdp participant) epperson et al./guns & diversion programs 39 the group session was also the setting where structured activities, assignments, and skill-building were referenced. participants seemed to appreciate the structure of the activities, and the opportunity to work through them with others with whom they could identify. disconnections: assumptions on target population as discussed in the previous section, the contexts shaping illegal gun possession for plgdp participants is multifaceted and complex. stakeholders involved in the development and implementation of illegal gun possession diversion programs acknowledge these complexities by thinking critically and thoughtfully about systemic challenges that may lead to illegal gun possession behavior. as noted previously, in expressing their goals for these programs, programmatic stakeholders across jurisdiction frequently noted that they hope their programs address underlying needs such as employment, housing, mental health, and substance use to disrupt future instances of criminal legal system involvement. although there is promise in developing plgdps that holistically meet the needs of participants, we found disconnections between the types of services offered within the programs and the stated needs of the participants. many of the participants of gun possession diversion programs are considered “low risk” due to the eligibility criteria of the programs and often do not require the types of assistance these programs are offering. for instance, plgdp participants often discussed that they were employed and do not require assistance finding employment. one participant expressed that even though some people may benefit from the programming offered, they have personally never required housing or employment assistance, even though they have previously possessed guns: i feel this class will help so much people that—'cause i don't need a lot. like i do have a great paying job. like i always kept a job. i don't get in that much trouble. i have been caught with some guns, but i try to do them the legal way. i was halfway there. didn't always get there. but there's some people that just need a lot more guidance than i do. so i don't need a lot. i don't ask for a lot. i got my own place, always have my own place, always had a job. like, i've never been fired before. if i didn't like a job, i will find another job before i leave that. i've always been that type of person. (plgdp participant) these disconnections could speak to the fact that the underlying assumptions stakeholders have about the population in their program are not aligned with their lived realities; it may also speak to the idea that plgdps should consider widening their offerings for current participants or eligibility criteria to include individuals who will benefit from the current services. plgdp prosecutors and service providers often conveyed implicit or explicit assumptions about the participants and their needs, and these assumptions were largely negative. some of the programming was experienced by participants as being somewhat common sense and included aspects that they had already learned in their families. one advances in social work, spring 2024, 24(1) 40 participant shared, “i had an awesome mother, you know, and a lot of this stuff was like instilled in me, you know… a lot of the stuff i caught on to naturally.” the assumptions around participants’ unemployment had a detrimental effect on their experiences in the programs, as many noted that they had to take off from work to attend weekday plgdp programming. one plgdp participant speaks directly to assumptions made about the group: right. and i think honestly, when they created the program and they created a thursday [for programming], they were probably looking at it like a lot of these people were maybe carrying guns, maybe don't have a job. okay, so we could do it on a weekday because they probably don't work. i think that's probably was the mindset. and a lot of people actually do still work. and a lot of people don't work saturdays, but they are probably looking at it, saturdays the weekend. what if a lot of people don't show up? i get that too. (plgdp participant) the most prevalent disconnect noted was assumptions about illegal gun possession, criminality, and risk. participants discussed a somewhat indirect sense that the plgdp was made for more serious, high-risk participants, “repeat offenders,” “gang-bangers,” etcetera. participants were likely to distance themselves from this perception, noting that many of them were in the plgdp for a first offense and that their illegal possession charge was because of a technicality in how/where they carried the gun. another participant discussed the importance of looking at the whole individual, not just the fact that they carried a gun, in developing programming. as one participant stated, the programming “doesn’t hurt,” but also noted that the cbt-based intervention does not address the real causes for why he and others might illegally possess a gun, which is largely due to neighborhood and environmental factors related to community violence. disconnections: limitations of individual-focused intervention broadly, the analyses highlight a significant disconnect between feelings of safety and plgdp programming. although plgdp stakeholders consider safety and violence concerns as primary factors driving illegal gun possession behavior, there are limited programmatic interventions to address these concerns. currently, plgdps tend to address feelings of safety through individual mental health treatment and cbt programming, and both prosecutors and service providers acknowledge that trauma often stems from community violence and prioritize offering mental health programming through plgdps to address this trauma: because for most of these individuals, they have experienced various levels of trauma. a young man has experienced his brother dying in his arms, gunshot wounds. people are feeling the need to even retaliate and not think clearly about that in issues that affect family and someone takes a life. and that is somewhat of the cultural dynamic in those areas, crime ridden areas, where you retaliate. and so trauma by more trauma. (plgdp service provider) [participants] always tell the police in their police interviews upon arrest, they're carrying the gun for protection. and that was a key factor. i think that's what led epperson et al./guns & diversion programs 41 to them developing the trauma piece because they believe they've witnessed some sort of violence as a young kid and that they end, but in the majority of our cases, when they get interviewed by the police, and they're like, "yes, it was my gun and i, i found it on the street and i decided to carry it to protect me and my family." 90% of them, that's what they told the cop. they weren't like i wasn't carrying it, because i want to go do a robbery, it's to protect me. but that was a key piece of that. (plgdp prosecutor) however, there is little to no focus on broader violence prevention or the widespread presence of firearms in communities that address the contexts that made people feel unsafe in the first place. providing mental health treatment may provide individuals with tools to manage trauma or fear, but ultimately, none of these program offerings are changing the underlying issues that initially created the sense of fear, anxiety, and hypervigilance experienced by participants. some stakeholders spoke to the disconnect between plgdps and their ability to curb or prevent violence that leads individuals to illegally possess guns. the prevalence of gun violence and illegal gun possession is cyclical: neighborhoods with high numbers of illegal gun possession cases have high incidence of gun violence, creating a cycle that leads to a disparate rate of surveillance, arrests, and criminal legal involvement. one participant expressed their disbelief that plgdps (and the criminal legal system more broadly) can address these systemic issues: but as far as the problems directly leading to why we got in a situation that directly led us up to being arrested, those are things they can't change, and that's just one of those kinds of harsh truths. the way i got got, the way the other guys in our group got got, how it happened will never change just because that's people, that's politics. that's an entire institution we're talking about changing, which it will not. so i'm just going to leave it at that. (plgdp participant) this same plgdp participant later wrestled with the potential benefits of plgdp programming in the broader structural context of gun violence: they can't [change the environment]. how could they? [the program] changing the entire city, specifically the south side, that's just... that's where most of us are, we're on the south side of the city and that's the problem side if you want to call it that. they can't change, as much as they want to. and i want to change it too, but they just can't, that's a few million people you talk about that just are out there. so that? no, they can't do anything about it. but as far as changing us, the individual or at least changing in the way we think about a situation for a second, that has a positive ripple effect and that's what they're going for and i think they're achieving. (plgdp participant) discussion overall, there is a rationale for focusing on illegal gun possession as a means to curb future gun violence in communities, and plgdps are one potential pathway to disrupting future criminal legal involvement. plgdps seek to rectify some of the problems with advances in social work, spring 2024, 24(1) 42 traditional enforcement and punishment of illegal gun possession, such as racial disparities in arrests and convictions, the limited impact on public safety outcomes, and the collateral consequences of criminal legal records and incarceration, by providing participants with social services that prevent them from continuing illegal gun possession behavior. it is important to note that diversion in and of itself is a form of intervention – the benefits of avoiding the negative consequences of a conviction for both individual and community safety cannot be overstated. however, gun possession diversion programs face issues with implementing an approach that is targeted enough to curb violence in a broad way. while possessing a gun is a necessary precursor to committing gun violence, the majority of people who possess guns do not engage in violence. plgdps initially appear to be focusing on especially lower-risk cases, accepting participants who possess guns for safety or protection reasons. while these participants will benefit by avoiding a conviction, the potential impact of plgdps on reducing gun violence will depend greatly on who is allowed into the programs and to what extent the programming addresses illegal gun possession behavior. one aspect of this disconnect is the political construction of “illegal gun possession” as a criminal charge that varies greatly depending on state contexts. for example, in one state represented in this study, gun laws are highly restrictive; most of the participants in the program held firearm ownership licenses but lacked conceal and carry permits, leading to their arrest. in other states with less restrictive laws, illegal gun possession may not even exist as a criminal charge – necessitating that individuals diverted into these programs are charged with much more than simple possession. in recognizing these variations, it is important to consider whether criminal charge is the best proxy for developing programmatic interventions that will strongly impact gun violence. convergent and divergent perspectives our qualitative analyses revealed many points of converging and diverging perspectives between plgdp professionals and participants on the factors that contribute to illegal gun possession and the extent to which plgdp programming addresses these factors. both plgdp participants and professionals recognize safety concerns as a significant driver of illegal gun possession, yet participants described the limitations of individual-level intervention to address community safety, particularly in communities with high levels of gun violence. and while both the plgdp professionals and participants in this study recognize that those charged with illegal gun possession are overwhelmingly young black men, plgdp participants pushed back on perceived assumptions of criminality and violence, family dysfunction, and types of services needed. indeed, this point of divergence appears to be directly related to the misalignment between who is currently accepted into plgdps (i.e. relatively “low risk” individuals) versus who plgdp programming is intended for, that is, individuals who demonstrate greater needs and likelihood to engage in gun violence. as plgdps evolve and expand, it will be important for programs to work to align programming to the types and intensity of participant needs. epperson et al./guns & diversion programs 43 mental health and trauma it is notable that so many plgdp participants speak highly of the mental health components of the programs, particularly in providing them with strategies like replacement thoughts to manage anxieties or fears that led to illegally possessing a gun. based on participant responses, providing access to mental health services is a highlight of these programs and displays a strong connection between the stated needs and interests of the participants, illegal gun possession behavior, and the programming offered. the fear, trauma, and safety aspects of illegal gun possession is understood by other interviewed stakeholders and, generally, the acknowledgment that most people arrested for illegal gun possession do so due to past trauma and current fears around safety stands out as a strong motivator for the development of these programs. as participants express positive reactions to the mental health services that they receive through plgdps, this programming may be considered a success in meeting the needs of participants that influence their illegal gun possession behavior. on the other hand, it is important to critically assess whether plgdps are enabling the further criminalization of trauma. it is understood by almost all plgdp stakeholders that most people who engage in illegal gun possession behavior are doing so due to safety fears that developed from exposure to personal or community-level violence. although diversion programs are off-ramps from traditional prosecution, they can still result in consequences and prosecution if they are not successfully completed. it is therefore essential that plgdps adopt trauma-informed approaches and provide realistic program requirements to avoid high rates of termination. individual versus environmental factors across interviews, stakeholders understand that there are both individual and environmental reasons that people possess firearms illegally, and these reasons are frequently entangled and cyclical: first-hand exposure to gun violence, community violence, and fear create internal conditions that drive individuals to illegally possess guns for safety purposes; constraints on and lack of access to time, money, and/or information block these individuals from obtaining proper licensure; and the environmental exposure to such violence and the inaccessibility of the proper resources to obtain licensure are tied to the broader disinvestment of communities of color in urban areas. as these individual and environmental factors interact, both individuals and communities also find themselves caught in cycles of arrest, incarceration, and collateral consequences. plgdps seem well-equipped to address some of the individual factors leading to illegal gun possession behavior. in particular, providing access to mental health services is useful, as participants consistently expressed their appreciation for these services. importantly, this can help individuals learn the skills to manage some of the fear and integrate the trauma that led them to illegally possess a gun. another promising practice is programs that offer pathways or resources for participants to obtain the proper licensure for their guns, so they are registered and regulated properly. although the current population of especially low-level participants did not seem to require additional social services as frequently as program developers may expect, as programs scale up to include advances in social work, spring 2024, 24(1) 44 new or higher-risk populations, access to these social services may become more important. limitations and conclusions this study has several limitations that should be noted. although the five sites and four active plgdps offer a richness of data, the qualitative analyses do not provide a site-level comparison of each plgdp and its ability to address illegal gun possession behavior. similarly, this exploratory study relies on the perceptions and experiences of plgdp participants and professionals. because these plgdps were in the early stages of implementation at the time of the study, there was a limited number of participants available for recruitment. as plgdps mature, it will be important to continue to learn from the perspectives and experiences of a greater range of participants. additionally, quantitative studies must also be conducted to assess not only whether these programs impact illegal gun possession behavior, but also the degree to which their intended intervention targets and mechanisms contribute to the broader goal of reducing gun violence. plgdps are not equipped to address the environmental factors that lead to illegal gun possession behavior, such as structural disinvestment at the community level that contextualizes the drivers of illegal gun possession. more broadly, the criminal legal system is not equipped to address these factors; 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(2020). a credible messenger: the role of the violence intervention specialist in the lives of young black male survivors of violence. violence and gender, 7(2), 66-69. author note: address correspondence to matthew epperson, crown family school of social work, policy, and practice. the university of chicago, 969 e. 60th st., chicago, il 60637. email: mepperson@uchicago.edu https://doi.org/10.1177/10887679211043806 https://doi.org/10.1177/10887679211043806 https://doi.org/10.1007/s11133-018-9374-2 https://grandchallengesforsocialwork.org/publications/principles-of-prosecutor-led-gun-diversion-programming/ https://grandchallengesforsocialwork.org/publications/principles-of-prosecutor-led-gun-diversion-programming/ https://doi.org/10.1016/j.avb.2013.07.025 https://publichealth.jhu.edu/sites/default/files/2023-11/reducing-violence-and-building-trust-gun-center-report-june-4-2020a11y.pdf https://publichealth.jhu.edu/sites/default/files/2023-11/reducing-violence-and-building-trust-gun-center-report-june-4-2020a11y.pdf https://doi.org/10.1162/daed_a_01886 https://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=7727&context=jclc https://doi.org/10.1089/vio.2019.0026 https://doi.org/10.1089/vio.2019.0026 https://doi.org/10.1089/vio.2019.0026 mailto:mepperson@uchicago.edu _______ jill manit, ph.d., msw, clinical assistant professor, social work department, fairfield, ct, 06825; aleksey kolpakov, ph.d., assistant professor, department of political science, university of nevada reno, reno, nv, 89557, william eubank, ph.d., associate professor, department of political science, university of nevada reno, reno, nv 89557 copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 23-38, doi: 10.18060/22631 this work is licensed under a creative commons attribution 4.0 international license. analyzing social policy from a network perspective jill manit aleksey kolpakov william eubank abstract: governance models influence the approach that public service organizations take when implementing programs, policies, and practices. the networked model of governance supports the involvement of multiple actors who span organizational boundaries and roles to implement solutions to address complex social problems. this paper presents the utility of network analysis for the study of policy implementation from a network perspective. the paper describes networks within the context of social work policy implementation, basic network components, common structural variables, and sources of data for the study of policy implementation. a study of a statewide policy implementation is partially presented as an illustration of the use of network analysis in social policy research. the illustration uses primary and secondary data with network analysis techniques to identify and describe the patterns of interactions that comprise the structure of the implementation network. the illustration will present examples of the study findings to demonstrate the utility of network analysis in identifying central network actors and describing the density of the network according to different network variables. the paper concludes with a summary of the utility of network analysis in the study of policy implementation with recommendations for future research. keywords: networked governance; network analysis; policy implementation; policy process in responding to complex social problems, social work policy researchers and practitioners are frequently called upon to advocate for, develop, and implement policy solutions that are vague and span multiple entities. the type of governance model used to guide implementation influences incentives, opportunities, and constraints which become the context of the policy implementation. attention to the implementation process is important for providing a contextual understanding of how social workers can both influence and explain policy outcomes. emerging attention to the role of networks across the policy process requires social work policy researchers and practitioners to apply network analysis techniques to the study of policy implementation in social work. the networked governance model has been gaining attention as it attends to both the complexity and the boundary spanning issues of policy implementation. measuring the impact of this type of governance structure is as complex as the implementation itself. however, the rise of analytical tools and prolific publication of network analysis research has resulted in increased attention to analyzing policy implementation from a networked governance perspective. monge and contractor (2003) state “complex systems analysis explores the behavior of a network … the network is important because it provides the context or the environment for the individual agents” (p. 86). advances in social work, spring 2019, 19(1) 24 in policy implementation, the network can be the dependent variable whereby the researcher is concerned with factors that impact the formation and operation of the network itself; or, it can be the independent variable whereby the structure of the network impacts the outcomes of implementation (yang, keller, & zheng, 2017). additionally, network analysis can serve as a tool for social work policy practitioners to empirically analyze measures of power that are essential to informing strategies aimed at influencing policy. this paper presents network analysis as a methodological approach to the study and practice of policy implementation. the fundamental premise is that the governance approach used during implementation influences the outcomes of the policy or program. more specifically, the patterns of interactions within a networked governance approach shapes the incentives, opportunities, and constraints of implementation which, in turn, impacts the outcomes. this paper describes the basic premises of governance, networks, network analysis and its varied application as both a tool and an analysis of policy implementation. common network measures such as centrality and reciprocity are described for their utility in empirically analyzing critical aspects of policy practice including identifying decision-makers, an understanding of power, and maximizing the diffusion of information and resources. a statewide policy implementation is partially presented as a case illustration of the use of network analysis in social work policy research. the illustration describes the use of primary and secondary data with network analysis techniques to identify and describe the patterns of relationships in a network. the illustration will present examples of the study findings to demonstrate network analysis’ utility in identifying central network actors and describe the density of the network according to specific network variables. the paper concludes with a summary of the utility of network analysis to study the social policy with recommendations for future research. governance and policy implementation governance governance is not synonymous with government; it is focused on an overarching structure and meaning of government as opposed to the functions of government itself (rhodes, 1996). governance is more about the “process” of governing as opposed to the institutions themselves (bevir, 2012, p. 11). in their summary of the literature on governance, or and aranda-jan (2017) describe governance as encompassing a movement to pull back from state-based perspectives while adding increased involvement of citizens. while there are “imprecise” definitions of the term “governance” (rhodes, 1996, p. 652), one definition is “the pursuit of collective interests, with the state as a coordinating and enabling actor” (pierre, 2011, pp. 984-985) and “at its most basic level, governance means the capacity to steer the economy and society toward collective goals” (peters, 2011, p. 996). governance is a process that is both internal to the state as well as external as it interacts with “other actors in society” (pierre, 2011, p. 985). the increasing complexity of social problems requires the capacity of multiple governments and partners to solve problems manit et al./analyzing social policy 25 through formal and informal network partnerships. the networked governance model has emerged as the set of institutions, their arrangements and relationships that impact how policies are developed and implemented (pierre, 2011). network governance model. older generations of bureaucracy aimed to solve problems that were more specific and discrete (agranoff & mcguire, 2001). in doing so, there was greater ease in developing and implementing policy instruments focused on insulated goals and objectives and implemented with hierarchical control. however, with increased attention to complex problems where solutions are either unknown or not feasible, there has been a shift in governance to a networked approach. this approach becomes one of “governance with government” (weber & khademian, 2008, p. 341) whereby government retains an obligation to the public good while acknowledging government, alone, cannot solve problems. rather, it can serve as a catalyst and facilitator of the networked model. the network model of governance is responsive to “complex public problems” (weber & khademian, 2008, p. 335). in response to such complex problems, there is typically the formation of special task forces, committees, work groups, or public-private partnerships, who organize to coordinate a response (o’toole, 1997). the response to such problems typically involves the implementation of complex policy solutions in partnership with multiple individuals and organizations across public and private sectors (agranoff, 2017). “it is at the local level where policies and programs are implemented, where the routines build policy, and where the enduring challenges of promoting economies, eliminating poverty, integrating immigrants, and building democracy take place” (agranoff, 2014, p. 57s). as such, the networked approach provides a structural mechanism for shared information, resources, and expertise across policy partners (weber & khademian, 2008). there has been a rise in the networked governance approach since the global financial crisis of 2008 when resources for public services were constrained (or & aranda-jan, 2017). in response, flexible and collaborative service arrangements across public and private sectors became a strategy for maximizing limited resources. a basic premise of the networked governance model is the state does not carry the sole burden of solving the problem and it involves actors who are close to the problem in developing the solution. this model includes a shift from the state being the sole provider of services to an increasing trend where the central government is providing funds to “regional actors” to implement policy solutions (klaster, wilderom, & muntslag, 2017, p. 676). the nature and structure of this coordination is referred to as a network. the characteristics of the network, such as the patterns of relationships amongst the actors, can impact the outcomes of the policy on the social problem. hall and o’toole (2000) describe the phenomenon of multiple organizations working together on all or parts of the program as “networked arrays” of implementation (p. 673). networked implementation assumes “outcomes and performance result from interactions between a variety of actors rather than from the actions and policy of one actor alone” (klign & koppenjan, 2012, p. 589). networked governance shifts policy implementation from the sole public entity responsible for the policy to a collaborative network consisting of actors from public and private entities who have a stake in the outcome of the policy. however, the network advances in social work, spring 2019, 19(1) 26 perspective does not necessarily replace the bureaucratic perspective (o’toole, 2014). instead, it adds layers of “structural complexity” (o’toole, 2014, p. 361). the rise of networks in policy implementation is a result of trends in dispersing resources across public and private entities and shifts from a hierarchical approach to more collaborative decisionmaking processes amongst actors involved in the development and implementation of policy solutions (knoke, 2011). networked implementation when viewed as a process, stakeholders or actors engage in public policy across phases ranging from problem identification and agenda-setting to implementation and evaluation (birkland, 2001; weible & sabatier, 2018). implementation is a “problem-solving activity that involves behaviors that have both administrative and political content” and it unfolds as a process over time (goggin, 1986, p. 330). governance structures such as those described above impact the resources, constraints, and opportunities necessary to implement policies. implementation of public programs from the networked perspective essentially means “funding and implementation will not be concentrated in a single government entity” (weber & khademian, 2008, p. 341). within networked implementation “interorganizational linkages” become a central component of implementation whereby “governance is about managing networks” (rhodes, 1996, p. 658). under this model, a government entity may take on the role of creating and managing networks for problem solving and service delivery as opposed to directly providing services. by nature of complex problems, it is not always feasible to achieve policy or program outcomes in the exact manner initially prescribed. thus, the benefit of networked implementation can be its responsiveness to programmatic needs and resources. however, networked implementation presents unique challenges for conducting research on the effectiveness of the network activities. dispersed service delivery under a networked implementation model presents a challenge as there is reduced control over the specific program activities. private providers may be less inclined to abide by strict implementation rules; thus, making it difficult to achieve accountability and performance outcomes (agranoff, 2017; rhodes, 1996). describing or predicting how a network’s structure impacts outcomes becomes as complex as the implementation itself. networked implementation is multi-level and involves multiple actors across various levels in a flexible and adaptable manner. it is not a stagnant nor prescriptive approach to implementation. analyzing policy implementation from a networked perspective acknowledges the inherent complexity and impact of context. at the same time, it also acknowledges the difficulty in measuring implementation from this perspective (ward, stovel, & sacks, 2011). networks a network is comprised of actors (individuals, groups, organizations) who use “flexible, dynamic communication linkages” to span boundaries and work collaboratively on complex issues (contractor, wasserman, & faust, 2006, p. 681). from those efforts, manit et al./analyzing social policy 27 patterns of relationships amongst the actors emerge (kapucu, hu, & khosa, 2017). the patterns of relationships occur at different levels: the individual actor, between two actors (dyads) and relationships between small groups (yang et al., 2017). the patterns of relationships across the different levels comprise the overall structure of the network (o’toole, 1997; ward et al., 2011; wasserman & faust, 1994). essentially, the network structure is the collection or pattern of smaller structures within the network. the network structure represents an interdependence amongst the actors where hierarchy is not simply the result of a formal position or bureaucratic structure (o’toole, 1997). one of the earliest known studies of a social network was by psychiatrist moreno in 1933 (ward et al., 2011; yang et al., 2017). the new york times (1933) reported his study of relationships amongst girls within a school. in his results he was able to identify girls who are isolated, cliques, as well as popular and unpopular girls. moreno accurately predicted that two of the girls would run away from the school. moreno was quoted as stating “such an invisible structure underlies society and has its influence in determining the conduct of society as a whole” (the new york times, 1933, p. 17). in applying moreno’s statement to the study of policy implementation, the “invisible structure” would underlie the context of implementation thereby influencing the outcome of the policy. policy networks consist of “a set of public and private corporate actors linked by communication ties for exchanging information, expertise, trust and other political resources” (kenis & schneider as cited in knoke, 2011, p. 211). given a network is comprised of individuals and organizations connected through various types of relationships, network analysis is the study of those patterns of relationships that comprise the structure of the whole network. while this notion of collaborative policy implementation is not new, the use of network analysis to empirically describe and predict network outcomes is on the rise. application to social work policy research and practice network analysis and policy implementation have several applications to social work policy research and practice. when treated as the independent variable, the structure of a network can be used to explain and, to a certain extent, predict contextual factors of the implementation outcomes such as access to resources (yang et al., 2017). when treated as a dependent variable, a social work practitioner can employ network analysis to understand specific network behaviors and factors that may influence those behaviors (yang et al., 2017). for example, a social worker facilitating a networked response to a social issue may employ network analysis to understand the patterns of information dissemination and referral structures of community-based services. or, they may utilize network analysis to understand and identify strategies for building certain relations such as trust amongst their network members. network analysis can also describe the patterns of connections amongst network subgroups (i.e., cliques). this information is useful to the social worker in identifying strategies to navigate sub-groups, facilitating sharing of key resources across network members and identifying communication breakdowns as a result of “structural holes” in the network (burt, 1992, p. 27). for example, when implementing a needle exchange advances in social work, spring 2019, 19(1) 28 program, the social worker may discover that both the network of organizations as well as the recipients of the program operate in geographically organized cliques. the social worker can identify organizations or stakeholders that “span” the boundaries of the cliques and utilize them to improve coordination amongst all entities. thus, the network itself is a form of social capital whereby it becomes the “conduit” for the flow of information and resources and is impacted by the size and range of the network (burt, 1992, p. 12). additionally, network analysis can be used as a tool for analyzing power within the policy arena. for example, lane and pritzker (2018) describe strategies for assessing power within the political context. in their text, the authors describe specific tools for conducting a “power analysis” or creating a “power map” (pp. 97-99). network analysis techniques can be employed to empirically analyze the results of such power analyses utilizing the tools lane and pritzker describe as sources of data. basic network components the following describes the basic components of a network, which is necessary to define before describing network analysis as a methodology. nodes. the members of the network, who become the focus of the analysis are often referred to as the actors (wasserman & faust, 1994). in the public policy field, they may also be considered key stakeholders. as stakeholders, network members can include funders, clients, and members of the general public (klaster et al., 2017, p. 677). in network analysis, the actors are described as nodes (lecy, mergel, & schmitz, 2014; mischen & jackson, 2008). in visual depictions of networks, nodes are typically represented by a circle or dot. however, colors, shapes, and sizes can also be assigned to the nodes to illustrate certain characteristics of those nodes. ties. ties are the types of relations that connect nodes throughout the network (yang et al., 2017). how a tie is defined is often dependent on the nature of the study. common approaches in defining ties can include physical presence together such as working together in an organization, inclusion or proximity to a geographic area, interactions such as attending events at the same time (lecy et al., 2014), and communication (mischen & jackson, 2008). ties can represent specific dimensions of interorganizational relations, including trust, support, and the exchange of resources (knoke, 2011). bridges. when a network is visually depicted, it is possible to observe clusters of network members tied as groups or cliques. given these clusters, there may be some network members connected to more than one group, i.e., span groups. these network members are referred to as the bridge. granovetter (1973) describes the important role of bridge actors as they can serve as the only information route between other actors who would otherwise not be connected. network analysis network analysis is the study of the patterns of connections among actors within a policy or administrative arena (provan, veazie, staten, & teufel-shone, 2005). network analysis “provides a language and methodology to examine relationships in order to manit et al./analyzing social policy 29 facilitate the achievement of goals, such as implementing policy, or to identify roadblocks to successful implementation” (mischen & jackson, 2008, p. 324). an understanding of the network structure can provide insights into the potential successes, barriers, and changes necessary for a network to function effectively. in any network analysis, it is important to define the boundaries of the network to be studied. however, it can be difficult to draw an absolute boundary as the network actors are “relatively bounded” (wasserman & faust, 1994, p. 31). there are two kinds of network research designs: whole network and individual or ego network designs (borgatti, everett, & johnson, 2013; marsden, 2011; yang et al., 2017). the whole network approach studies the ties amongst all nodes within the network and is concerned with how those ties comprise an overall network structure (marsden, 2011; yang et al., 2017). the individual or ego network approach places the individual or node in the center of the analysis and is concerned with the ties connected to a particular node (marsden, 2011; yang et al., 2017). the whole network approach is most appropriate in the study of policy implementation. however, the individual or ego approach may be useful in analyzing power or specific patterns of interaction for targeted individuals such as elected officials. there are two primary types of variables included in network analysis: structure and composition (wasserman & faust, 1994). as discussed above, structural variables are the distinct transactions or ties between pairs of actors within the network; whereas, composition variables measure certain attributes of the actors such as basic demographics and geographic locations (wasserman & faust, 1994). thus, conducting a network analysis requires a determination of whether to measure only the structure or to also include an analysis of the composition of the structure. sources of data in network analysis primary sources of data in network analysis typically ask respondents about their network relations directly via interview or survey. surveys are one of the most common sources of data in network analysis (kapucu et al., 2017). “because social network data are relational, the survey instruments used to collect the data are formatted quite differently from traditional surveys” (mischen & jackson, 2008, p. 324). the surveys typically include a list or roster of names of actors known to be in the network and then asks respondents specific questions about their relational ties to each of the actors. in an open-ended or free recall format, respondents may be prompted to generate their own list of actors and then respond to questions about their relational ties to the actors they named (wasserman & faust, 1994). common threats to the validity in the design and collection of primary network data include: omission errors, commission errors, node attribution errors, data collection and retrospective errors (borgatti et al., 2013). in analyzing policy implementation, network actors may be surveyed on their patterns of interaction with other members of the network specific to the implementation activities such as sharing information and resources or referring clients to one another. secondary sources such as government records, newspaper articles, and online resources are common sources of data for identifying connections between actors such as attendance at events, similar behaviors such as voting or positions on social issues (borgatti advances in social work, spring 2019, 19(1) 30 & halgin, 2011). other secondary sources included in large network studies include patterns of interaction in social media platforms and online behaviors such as commenting or liking certain web pages. common measures in network analysis given network analysis is the study of relationships among specified actors, those relationships are not independent from one another nor is the sample representative of the general population. therefore, common statistical methods such as analysis of variance are not typically employed in network research (borgatti et al., 2013; contractor et al., 2006; monge & contractor, 2003). there is a reliance on “graph realizations” to measure the patterns of relationships existing at multiple levels where the number of actors in a network are graphed with the number of possible ties with other members of the network (contractor et al., 2006, p. 685). while not exhaustive, the following describes common statistical methods to analyze network structure at multiple levels of analyses (actor level, dyadic, and triadic). density. the density of a network is a whole network level measure of the total ties measured in relation to the total number of possible ties (yang et al., 2017). density describes the overall connectedness of the network actors (milward, provan, fish, isett, & huang, 2010; provan et al., 2005; yang et al., 2017). this produces an analysis of the network structure ranging from sparse, where there are not many ties between actors, to dense indicating a large number of ties (contractor et al., 2006; monge & contractor, 2003). high levels of density are not always indicators of network effectiveness as the increase in number of ties generally requires increased costs in managing those ties (milward et al., 2010). density may also influence an actor’s decision to participate in the network. for example, if it takes too many resources (i.e., time) for the actor to gain access to information, then this sets the context for their participation behavior. centrality. centrality is both an actor level and a whole network level measure (yang et al., 2017). within a network, central actors are influential in the flow of information, opportunities, constraints, and resources important to policy implementation. crucial to this centrality are characteristics of trust, reputation, and influence (provan, huang, & milward, 2009). at the whole network level of analysis, overall centralization represents the distribution of ties amongst the actors in the network (yang et al., 2017). in other words, a highly centralized network would be represented by a small number of people with the greatest number of ties. network structures with a high degree of centralization are more likely to achieve their collective goals (contractor et al., 2006). in social work policy research and practice, centrality is one of the most useful empirical measures of power amongst network actors. at the actor level of measurement, centrality is the actor’s unique position within the network and is an indication of power (borgatti et al., 2013). centrality is a measure of connectivity among the actors within the network (borgatti & halgin, 2011; contractor et al., 2006). identification of actors who are more “central” in the network can indicate who has increased power through their access to others. additionally, central actors can inhibit or promote the spread of knowledge and innovation (mulvaney, lee, hook, & prokopy, 2015). borgatti (2018) manit et al./analyzing social policy 31 describes four common actor level measures of centrality: degree, betweenness, closeness, and eigenvector. the following describes the degree and betweenness centrality measures as they are common in network analysis (yang et al., 2017). the “degree measure of centrality” is the number of direct ties an actor has with other actors in the network and is an indication of power and prestige within the network (borgatti & halgin, 2011; contractor et al., 2006; yang et al., 2017). in network communications, a large number of ties can increase communication and mutual trust (mulvaney et al., 2015). when utilizing survey data, centrality is based on the respondents’ perception of how central a node is within the network and is measured by the number of direct or indirect ties a network member has (klaster et al., 2017; provan et al., 2005). the “betweenness centrality” measure captures the position of an actor as a bridge between others in the network, where they serve to connect network members who otherwise would not have been connected (kolpakov, agranoff, & mcguire, 2016; monge & contractor, 2003; mulvaney et al., 2015). centrality is a measure of the frequency with which a given actor falls along the shortest path between other actors (borgatti et al., 2013). the path is the ties between the network actors. a higher betweenness score indicates an actor is along the shortest path between the other nodes lending power to that actor as information, for example, would have to go through them in order to get to the others because they are “between” the actors. other network measures. mutuality and reciprocity measure the extent to which actor’s exchange information and resources and the extent to which the exchange is reciprocated (contractor et al., 2006). the absence and presence of mutual and reciprocated ties can reveal clusters of relationships and expose patterns of the control or flow of information, opportunities, constraints, and resources. additionally, the triadic level of measurement analyzes the structure of relationships amongst groups of three actors and the frequency those structures are present throughout the network. this level of analysis reveals the network’s sub-structures and is an indication of the whole network structure such as the persistence of hierarchy in the network (nooy, mrvar, & batagelj, 2011). case illustration the networked governance perspective for public policy implementation is useful in describing how the network can shape resources, constraints, and opportunities associated with public policy implementation. the following provides an example of findings from a network analysis study on the implementation of a multi-agency and stakeholder effort to change a statewide service delivery system. the study examined the extent to which that effort resembles a network for implementation and describes the patterns of relationships that comprise the structure of that network. the study measured network structures across four relationship ties: working together, sharing information, sharing resources, and trust. a mixed method approach was employed by analyzing public meeting minutes as secondary data to first identify network actors and then implement a subsequent survey of those actors to analyze their patterns of interaction. table 1 presents the raw score of the overall density of the whole network across the four relationship ties. the closer a density score is to one, the higher the density of the advances in social work, spring 2019, 19(1) 32 network (indicating a high number of ties amongst the network actors). thus, in the example below, the network is moderately dense for the “working together” relationship (.407) and sparse for the “trust” relationship (.201) meaning survey respondents reported fewer “trust” ties with other network actors when compared to the other relationships. table 1. overall network density by relationship variable working together information resources trust density .407 .262 .229 .201 # of ties 1039 668 583 512 figures 1 and 2 are visual representations of the same network density findings found in table 1. figure 1 is the network density for the “working together” relationship while figure 2 represents density of the “trust” relationship. the decreased density is evident in the depictions by observing the decrease in the number of black lines (representing ties) from figure 1 to figure 2. figure 1. “working together” network relationship in figure 1, the density is observed by the number of black lines (ties) amongst the nodes within the network. utilizing a network analysis software program, the degree centrality technique measures how central an actor is within the network. in figure 1, the actors’ degree centrality is represented by the size of the shape representing the node; the manit et al./analyzing social policy 33 bigger the shape, the more central the node. the varied shapes and colors included in the network visualizations represent the capacity to include attributes of an actor such as their job position or geographic location where each color or shape would represent a certain attribute. thus, the social work researcher can utilize the network visualizations to identify actors that are most central, their attributes and observe their overall patterns of interaction. for example, the actors represented by circles in figure 1 tend to have a smaller shape than those represented by a box, indicating decreased centrality for that role or type of actor. from an implementation standpoint, the central actor(s) have the “power” to control resources, constraints, and opportunities that impact implementation (borgatti et al., 2013). from this understanding, social work policy practitioners can design strategies to influence policy by way of identifying and accessing the central actors in the network. figure 2. “trust” network relationship figure 2 depicts the network for actors who share a “trust” tie. as depicted, there is a decrease in the number of black lines (ties) when compared to figure 1. essentially, actors within the network have more ties amongst one another for the “working together” relationships as opposed to those who reported having a trusting relationship with other actors in the network. while it may be obvious that it is easier to work together than to trust one another, the findings and visual depictions allow social work administrators to identify strategies necessary to successfully implement a policy. for example, an administrator can strategically position the central actors for trust (represented by the size of their shape) in key collaborative arrangements necessary for the implementation of the policy. advances in social work, spring 2019, 19(1) 34 in the depictions above, the central nodes are evident by the size of the shape associated with them. this is also supported in the individual level results reported in table 2. table 2 is an example of how network analysis can identify the most central actors within the network. the example lists the degree and betweenness centrality scores in rank order for the top five actors in the “trust” relationship. in their structural role, the central node(s) can control the flow of information (i.e., messaging), impede the travel of information (i.e., bottlenecking information), or promote expedited travel of information. table 2. top five actors for degree centrality and betweenness centrality scores, trust relationship trust in degree centrality trust betweenness centrality rank actor # # of ties rank actor # # of ties 1 55 26 1 57 1081 2 57 24 2 55 490 3 29 23 3 84 311 4 28 21 4 107 242 5 10 20 5 29 220 again, social work policy researchers and practitioners can utilize network analysis in policy implementation by identifying strategies to strengthen a network, understanding the impact a network structure may have on policy outcomes, or as a tool for understanding power amongst actors within the network. for example, in table 2, we can see that actors 55, 57 and 29 rank in the top five for degree and betweenness centrality for the trust relationship. thus, power and influence over opportunities and constraints of implementation is centralized to a few actors within the public system. strategically, a social work policy practitioner would devise ways to utilize the trust those actors have within the network to promote the goals of the network. conclusion this paper is based on the premise that the type of governance structure a public entity employs influences how the policy or program is implemented, which then influences the outcomes achieved. the concept of networked governance provides a foundation from which to explain policy implementation from a networked perspective. the case illustration included is an example of how network analysis empirically describes the patterns of interactions amongst network members to inform the context of the policy or program implementation. embracing the networked approach in governance and policy implementation carries potential for the social work practitioner or lead implementing agency to draw upon the rich network management literature to strengthen the overall functioning of the network toward achievement of the goals. by doing so, the implementing agency acknowledges the power and influence that the network structure, as well as the individual actors within it, have to shape the opportunities and constraints of implementation. in turn, this increases our understanding of the process of implementation and evaluation of how the process impacts targeted outcomes. manit et al./analyzing social policy 35 for example, key decision-makers frequently make sweeping conclusions about the success or failure of policies important to social work practice. such dichotomous declarations are detrimental to policy implementation as the policy itself may have had sound goals, but implementation essentials such as information and resources are constrained by powerful opponents and prevent the policy from actualizing its potential. for example, a state legislative body may pass legislation to develop statewide violence prevention programs in schools. however, when the programs move forward to implementation, opponents who also occupy a central role in the implementing network (such as a school administrator), are in a position to constrain access to adequate resources for the program such as access to additional staffing. thus, the violence prevention programs may appear ineffective for reasons that are unrelated to the specific program activities. in this example, a network analysis contextualizes such outcomes by identifying those who are central to the network and may or may not contribute to effective implementation. network analysis would also identify the connections amongst the network members so that strategies to influence key decision-makers can be formulated. the social worker can then determine other in-network connections with access to the targeted actor. equipped with their skill sets in engagement, communication, flexibility and facilitation social workers have the unique capacity to apply their skills to an understanding of network behaviors in order to organize and steer the network toward its goals. the example above represents a distinction between policy implementation processes and policy outcomes (goggin, 1986). as such, further study is needed to examine the extent to which a network’s structure predicts network outcomes. considering the example above, is a violence prevention program more likely to be effective if it is implemented by a dense, centralized and hierarchical network of actors? or, is it more likely to achieve outcomes with a sparse and de-centralized network structure? additionally, actors that are more central to the network have the power to influence incentives, create opportunities, or 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(2017). social network analysis: methods and examples. thousand oaks, ca: sage. author note: address correspondence to jill manit, ph.d., social work department, sacred heart university, 5151 park avenue, fairfield, ct, 06825. manitj@sacredheart.edu https://doi.org/10.4135/9781412959636.n231 https://doi.org/10.4135/9781412959636.n230 https://doi.org/10.1093/jopart/mun036 https://doi.org/10.1111/j.1540-6210.2005.00487.x https://doi.org/10.1111/j.1467-9248.1996.tb01747.x https://www.nytimes.com/1933/04/03/archives/emotions-mapped-by-new-geography-charts-seek-to-portray-the.html https://www.nytimes.com/1933/04/03/archives/emotions-mapped-by-new-geography-charts-seek-to-portray-the.html https://doi.org/10.1146/annurev.polisci.12.040907.115949 https://doi.org/10.1017/cbo9780511815478 https://doi.org/10.1111/j.1540-6210.2007.00866.x https://doi.org/10.4324/9780429494284 mailto:manitj@sacredheart.edu governance and policy implementation governance networked implementation basic network components network analysis sources of data in network analysis common measures in network analysis figure 2 depicts the network for actors who share a “trust” tie. as depicted, there is a decrease in the number of black lines (ties) when compared to figure 1. essentially, actors within the network have more ties amongst one another for the “working... in the depictions above, the central nodes are evident by the size of the shape associated with them. this is also supported in the individual level results reported in table 2. table 2 is an example of how network analysis can identify the most centr... table 2. top five actors for degree centrality and betweenness centrality scores, trust relationship references microsoft word 08_holcomb_25213_leveling_the_playing_field _________ dana holcomb, dsw, lmsw-clinical, assistant professor and director of field in the department of social work, ferris state university big rapids, mi. copyright © 2021 author, vol. 21 no. 4 (fall 2021), 1193-1211, doi: 10.18060/25213 this work is licensed under a creative commons attribution 4.0 international license. leveling the playing field: a conceptual framework for formal faculty mentorship in social work dana holcomb abstract: despite the numerous benefits of formal mentorship for all faculty, it remains underutilized within the academy. specifically, this lack of critical support leaves historically marginalized groups, particularly women, underrepresented minorities, as well as part-time, intermittent, adjunct, or non-tenure track faculty, to struggle with navigating the challenging climate of higher education. to counter these inherent power differentials, this article asserts that formal mentorship is the responsibility of social work educators. this article presents a conceptual framework that integrates relational cultural theory (rct), the national association of social work (nasw) code of ethics’ core values, and the council on social work education’s (cswe) educational policy and accreditation standards (epas) as a mechanism to support faculty through formal mentorship practices. this article advocates for an amendment to the epas to include formal faculty mentorship within accredited programs. keywords: formal mentorship, relational cultural theory, nasw code of ethics, cswe epas, social work faculty the benefits of formal mentorship are widely accepted within the context of higher education as an integral part of supporting faculty professionally and personally (allen et al., 2018; brady & spencer, 2018; holosko et al., 2016; jackson et al., 2017; schmidt & faber, 2016; sheridan et al., 2015; smith et al., 2016). formal mentorship assists in offsetting challenges faculty face when navigating a career within the complex structure of the academy (holosko et al., 2016; wilson et al., 2002). additionally, formal mentorship is considered particularly critical for women, underrepresented minorities, and those in non-tenure track, part-time, adjunct, or intermittent faculty positions as it serves to counteract the uneven political and power differentials, implicit racial bias, gender discrimination, and rank/status disparities existing within higher education (brady & spencer, 2018; denson et al., 2018; espino & zambrana, 2019). despite numerous benefits, formal mentoring in the academy remains underutilized (carmel & paul, 2015; ellison & raskin, 2014; wilson et al., 2002). robbins’ (1989) seminal study found only about one-third of social work faculty within higher education received formal mentoring. these results remain unmoved over the past 30 years despite significant changes to the landscape in higher education. according to zerden et al. (2015), though mentoring is recognized as the most common form of faculty development, it is scarce in many institutions. holosko et al. (2018) indicates that formal mentoring programs are absent in many schools of social work. further, few institutions are noted to provide formal mentorship supports to new instructors (brady & spencer, 2018). the rates of formal mentorship are even lower for women, underrepresented minorities, and non-tenure track, part-time, adjunct, and intermittent faculty members advances in social work, fall 2021, 21(4) 1194 despite the benefits being significantly greater (allen et al., 2018; brady & spencer, 2018; clark et al., 2011; denson et al., 2018; espino & zambrana, 2019; holosko et al., 2016; hoyt et al., 2008; simon et al., 2004; sorkness et al., 2017; tower et al., 2015; webber, 2018; webber & rogers, 2018; zambrana et al., 2015). without formal mentorship supports, these faculty groups often experience significant barriers when transitioning to the academy and may experience further marginalization (pifer et al., 2019; ronfeldt & mcqueen, 2017; sanders, 2011; staniforth & harland, 2006). numerous studies note women disproportionately face challenges related to isolation, sexual discrimination, work-life imbalances due to caregiving responsibilities, and gender bias within teaching evaluations and research agendas (denson et al., 2018; holosko et al., 2016; rivera & tilcski, 2019; webber, 2018). a substantial body of literature illustrates the challenges underrepresented minority faculty members face navigating implicit racial bias, feelings of otherness, and inequitable political power structures that are based on exclusion (chadiha et al., 2014; denson et al., 2018; espino & zambrana, 2019). finally, despite a substantial increase in and reliance on non-tenure track faculty, this population often experiences feelings of isolation, a lack of understanding related to institutional and performance expectations, and a sense of disenfranchisement when expressing their views in department and institutional governance (clark et al., 2011; fagan-wilen et al., 2006; hoyt et al., 2008; shobe et al., 2014). social workers are called to be a voice for those who are marginalized by actively working to dismantle systems of oppression. likewise, social workers are strong advocates for equity and justice within all practice settings. challenging systems of oppression is particularly important in the academy as the purpose of social work education is to promote human and community well-being. as such, the purpose of this article is to respond to these disparities within the academy through the presentation of a conceptual framework for formal faculty mentorship that integrates principles of relational cultural theory (rct), the core values espoused in the national association of social work (nasw) code of ethics, and the purpose of social work education as identified in the council on social work education’s (cswe) educational policy and accreditation standards (epas). an argument is made that formal mentorship is a responsibility of the professoriate and as such social work educators should advocate for formal mentorship practices within their respective institutions to rectify inherent disparities amongst faculty members. to underscore the importance of formal mentorship, this conceptual framework is presented. one consideration of its implementation may be to amend the epas to include a provision for formal faculty mentorship. the topic of formal mentorship is vast in nature and the scope of this article cannot serve to address all areas. it is beyond this article’s scope to operationalize how institutions should create or implement formal mentoring programs. also, it is beyond the scope of this article to quantify or prescribe specific mentorship curricula. decisions related to developing, implementing, and evaluating such endeavors should be explored on an institutional level as each has unique needs, challenges, goals, available resources, and a diverse set of campus and community climates to consider. finally, this article uses rct as a theoretical framework, though there are numerous theories and constructs that could holcomb/leveling the playing field 1195 be applied in developing formal faculty mentorship practices. to understand the topic of formal mentorship in the academy further, an overview of the literature is presented. literature review despite substantial research on the positive benefits of formal faculty mentorship within the academy, these programs remain underutilized in higher education (carmel & paul, 2015; ellison & raskin, 2014; wilson et al., 2002). this literature review explores four major themes reflected in the research: a) the various concepts of mentorship; b) the benefits associated with mentorship for all faculty, faculty from marginalized backgrounds and institutions; c) the importance of fit between the mentor and mentee; and d) the challenges of implementing and sustaining formal mentorship practices. gaps in the literature are also explored. concepts of mentorship there has been a lack of consistent definition and conceptualization of mentoring (schmidt & faber, 2016). for example, schmidt and faber (2016) conducted a systematic literature review and identified over 50 varying definitions of mentoring. some definitions focus on roles and functions involved in mentoring, others concentrate on the mentors’ responsibilities, while still others explore the structural considerations of developing such a relationship. this lack of consensus has been noted in social work and other fields in academia (muschallik & pull, 2016). according to a mixed-methods study conducted by zerden et al. (2015), the term faculty development and mentoring are often used interchangeably and though related, are different. despite the lack of an exact definition, researchers widely agree on the basic principles (muschallik & pull, 2016). the consensus in the field is that mentors contribute to the mentee’s overall achievement and acquisition of knowledge, provide emotional and psychological support, and engage to ensure professional development (schmidt & faber, 2016). it is critical to reach an agreed-upon definition of formal mentorship. without a clear definition, barriers to studying formal mentorship, understanding the intricate nature of these relationships, and developing best practices will persist. as such, the definition of formal mentorship for purposes of this article is two-fold. first, formal mentorship is considered to be a relationship where a more experienced mentor acts as a guide for a less experienced mentee by providing the mentee with career relevant support and advice (muschallik & pull, 2016). further, formal mentorship includes the provision of emotional and psychological support as well as increasing the mentees; level of knowledge to ensure professional development (schmidt & faber, 2016). these areas of formal mentorship serve as the guiding principles of formal mentorship and were intentionally selected for this article as each focus on relationship building through providing connection and guidance to faculty as they navigate the inherent challenges of the academy. advances in social work, fall 2021, 21(4) 1196 benefits of formal mentorship the benefits of formal mentoring have been extensively studied. for example, brady and spencer (2018) indicate mentorship helps to orient and include new faculty members. faculty members who participate in formal mentoring report higher levels of collegiality and commitment to departmental and institutional relationships and experience more satisfaction with the promotion and tenure process (jackson et al., 2017; schmidt & faber, 2016). in a quantitative meta-analysis of literature related to formal mentoring relationships, allen et al. (2004) found the presence of formal mentoring to be positively related to an increase in salary level, promotion rates, and job satisfaction. additional benefits of formal mentoring include having a designated person to provide support and direction, becoming acclimated to the university system, and receiving help with course and curriculum development (brady & spencer, 2018; schmidt & faber, 2016). in a qualitative study that focused on informal interviews, document analysis, and participant observation, smith et al. (2016) found that formal mentoring increased participants’ social collaboration, reduced anxiety and isolation, and led to shared responsibilities for faculty projects. mentoring assists faculty members in prioritizing and obtaining work-life balance as well as gaining moral and psychological support (schmidt & faber, 2016). further benefits for faculty include a clearer direction for scholarly endeavors, an increase in research confidence, and an overall increase in career recognition (eby et al., 2008; schmidt & faber, 2016; sheridan et al., 2015). junior-level faculty benefit from formal mentorship whereas mid and later career faculty often find personal satisfaction from serving as a mentor (schmidt & faber, 2016; webber & rogers, 2018). given the substantial benefits to faculty who participate in formal mentoring, it is imperative that the professoriate engage in these supportive practices. such practices should be embraced within social work departments and the larger institutional structure. impact of formal mentorship on faculty from marginalized backgrounds substantial literature indicates formal mentoring is particularly important for women, underrepresented minority faculty, and those who are in non-tenure track, part-time, adjunct, or intermittent positions. women are more likely to report lower satisfaction within the academy, have a shorter career trajectory, struggle with feelings of isolation and sexual discrimination, and have difficulties in balancing their work and personal life (holosko et al., 2016; webber, 2018). women are also disproportionately represented in non-tenure or part-time professoriate positions and often women and minorities receive less mentoring compared to their white male counterparts (sorkness et al., 2017; webber & rogers, 2018). research indicates women benefit from access to female mentors as there is often a shared lived experience related to issues of access, sexism, and discriminatory or oppressive organizational cultures that are disproportionately punitive towards women (simon et al., 2008). formal mentorship has been noted to provide supports to alleviate many of these stressors (denson et al., 2018). formal mentorship for women has proven critical in aiding female faculty to navigate the gender biases that exist within the academy, providing a safe space to have honest discussions around these barriers, and to support women in challenging these noticeable power imbalances (alvarez & lazzari, 2016). holcomb/leveling the playing field 1197 finally, formal mentorship has been identified as a supportive mechanism to lessen the career impediments within institutions for women (tower et al., 2015). formal mentoring is beneficial for underrepresented minority faculty members as it provides skills and knowledge on how to navigate implicit racial bias and political power structures based on concepts of exclusion often found in the academy, particularly in predominantly white institutions (espino & zambrana, 2019). formal mentoring relationships amongst faculty of color are critical as underrepresented minority members benefit from a space to share their lived experiences regarding prejudice and discrimination (chadiha et al., 2014). mentors of color transfer knowledge on the institutional norms and behaviors, means to access social capital, impart information on how to navigate systems of oppression, acknowledge feelings of isolation, and address issues related to the hidden agenda found within higher education (espino & zambrana, 2019; zambrana et al., 2015). this mentoring support is particularly important for women of color. davis (2009) describes formal mentorship for african american women as critical to achieving promotion, being socialized to formal and informal norms, and in reducing barriers that allow for advancement into administrative and leadership positions. however, this type of mentorship often does not occur and despite the significant benefits, minority faculty members receive even less formal mentorship compared to their white counterparts (sorkness et al., 2017; webber & rogers, 2018). access to mentors of the same racial or ethnic background is often impossible as there are a limited number of minority faculty within positions of leadership, particularly women of color (denson et al., 2018; simon et al., 2004; zambrana et al., 2015). across higher education, only 16% of full professors belong to an underrepresented minority group meaning that even when mentoring is present, these faculty are often mentored by white colleagues (denson et al., 2018). while mentorship can still be helpful, there may be difficulties with mentors relating to the experience of mentees based on differences in racial/ethnic background (espino & zambrana, 2019). to combat these challenges, and to increase effective mentorship practices, evidence-based cultural awareness training and skill development is critical to provide for mentors of all races and ethnicities (byars-winston et al., 2018; national center for faculty development and diversity, n.d.; national institute of general medical science, 2020). finally, formal mentorship for non-tenure track, part-time, adjunct, and intermittent faculty is also crucial, though these faculty receive significantly less mentorship support when compared to their tenure-track and tenured faculty counterparts. an exploratory survey conducted by hoyt et al. (2008) found that only 19% of the adjunct faculty participants surveyed were assigned formal faculty mentors. in another exploratory survey, clark et al. (2011) indicated that approximately 29% of social work programs provide formal mentoring to adjunct faculty. this lack of formal support has significant implications for the quality of teaching in higher education as there has been a shift in the culture of the academy to use more part-time and non-tenure track positions to fill teaching loads (brady & spencer, 2018; webber & rogers, 2018). non-tenure track faculty members often express difficulties understanding the curriculum, course structure, and overall progression or scaffolding of courses (clark et advances in social work, fall 2021, 21(4) 1198 al., 2011). further, non-tenure track faculty often indicate being unclear about the policies and procedures of the university and lack a sound understanding of various teaching pedagogies (clark et al., 2011). shobe et al. (2014) note non-tenure track faculty members repeatedly experience poor working conditions such as not having an office phone, desk, or workspace. non-tenure track faculty report increased feelings of isolation from colleagues and the overall institutional environment and are often alienated from discussions around change or governance (fagan-wilen et al., 2006). much research has been conducted on the critical function of non-tenure track faculty within the academy. however, despite the vital need for non-tenure track faculty, there are limited supports provided that demonstrate a commitment to their contribution within departments and higher education institutions. formal mentorship is a critical step towards supporting and valuing non-tenure track, adjunct, part-time, and intermittent faculty and can serve to alleviate many of the issues noted (clark et al., 2011; fagan-wilen et al., 2006; hoyt et al., 2008; shobe et al., 2014). given the profession’s ethical commitment to social justice, equity, and inclusivity, it is critical to provide this group of faculty members with the formal mentorship supports necessary to feel respected and valued. institutional benefits not only are there benefits of mentoring to faculty members, but these also extend to the institutions themselves. institutions benefit when there are intentional investments made in formal mentoring practices to assist all faculty members in achieving a work-life balance (jackson et al., 2017). institutional benefits of formal mentorship include higher rates of faculty recruitment, retention, and commitment to their institution which culminate in an overall richer environment for students (allen et al., 2004; miller et al., 2016; sheridan et al., 2015). an additional benefit of formal mentorship includes enhancing faculty diversity (chadiha et al., 2014; sheridan et al., 2015). this increase in diversity is noted to extend to retaining faculty and students of color, as well as enrolling higher numbers of underrepresented minority students (chadiha et al., 2014). having a diverse faculty prepares students for participation in an increasingly diverse society and workforce (chadiha et al., 2014). an increase in prestige indicators, such as program rankings and attracting quality students, are also noted as an institutional benefit of formal mentoring (miller et al., 2016). overall, institutional climate, work environment, and scholarship productivity is noted to be higher when mentoring is present (gilroy, 2004; schmidt & faber, 2016). to successfully implement mentoring practices, institutions must create a culture that encourages and promotes mentoring (chadiha, et al., 2014; espino & zambrana, 2019; pifer et al., 2019; salinas et al., 2020). institutions must be committed to facilitating multiple mentoring opportunities and building support mechanisms to ensure individual and organizational success (sheridan et al., 2015). further, institutions must have appropriate infrastructure supports that align mentoring relationship goals with institutional goals as well as clear mechanisms in place to match mentors and mentees (sheridan et al., 2015). holcomb/leveling the playing field 1199 the importance of fit in addition to institutions having clear structures in place to support formal mentorship programs, arguably the most important predictor of success is the match between mentor and mentee. ragins et al. (2000) state that while dysfunctional and harmful mentoring relationships are not the norm, there is potential for these challenges to arise. while serious issues are uncommon, some mentoring relationships are described as only marginally satisfying and at times challenges from the mentor’s personal life can spill into the relationship, causing dissatisfaction on the part of the mentee (ragins et al., 2000). when engaging in formal mentorship relationships, it is critical to address any challenges related to hierarchy or superiority. angelique et al. (2002) assert that mentoring relationships can lead to replaying dominant, hierarchical power structures found in the workplace. concerns have been raised regarding the dyadic relationships formed in mentorship (waddle et al., 2016). it is critical to be mindful of the expectations around formal mentorship as some mentors may take advantage of a mentee by having unrealistic expectations of the relationship, place excessive time demands on the mentee, or engage in inappropriate sexual relationships (angelique et al., 2002). to promote the best mentor-mentee match, allen et al. (2004) suggest that mentors focus on providing career and psychosocial supports which encompasses a more holistic relational approach. bozeman et al. (2008) also adds that aligning mentor and mentee expectations, preferences, communication, learning styles, and personality types are critical in assuring a good fit. without this, mentees may experience increased levels of stress which decreases the positive impact formal mentorship can have. challenges of implementing and sustaining formal mentorship practices despite the multi-faceted benefits of mentoring, there are several obstacles to implementing and sustaining these practices within academia. there is often a lack of institutional support and resources to implement sustainable formal mentoring programs (sheridan et al., 2015). institutions are facing financial challenges leading to deep department budget cuts (pifer et al., 2019). due to these budget constraints, tenure-line positions may not be replaced when a faculty member leaves the institution, is promoted, transitions to a new position, or retires. this might decrease the number of experienced faculty at an institution to serve in a mentor role. institutions often lack a methodological approach to mentoring that is individualized and collaborative (zerden et al., 2015). frequently, there is no prescribed curriculum for mentors, and some mentors struggle to adequately provide help to underrepresented scholars (lewis et al., 2017). mentors often lack awareness of their own privilege and may not know how to connect with those from a diverse population (lewis et al., 2017). further, mentoring check-ins and meetings can be difficult due to scheduling conflicts, particularly if the faculty member being mentored is part-time and not on campus during traditional hours (brady & spencer, 2018). advances in social work, fall 2021, 21(4) 1200 despite these challenges, mentors’ express feelings of personal satisfaction in giving back to faculty (salinas et al., 2020; schmidt & faber, 2016; webber & rogers, 2018). however, mentors resoundingly indicate mentorship would be a more sustainable practice if institutions were intentional in this process and provided additional staff or release time to assist in mentoring efforts (brady & spencer, 2018; schmidt & faber, 2016). to truly actualize the goal of higher education, institutions must commit to living their mission and values through the relational connection provided by formal mentorship practices. while these practices may have an associated cost to implement and sustain, faculty turnover, poor morale, and lower institutional outcomes also have a cost. gaps in the literature while qualitative research has been conducted to shed light on the experiences of faculty mentors and mentees, quantitative research is limited (andreanoff, 2016). additionally, there have been minimal studies that specifically explore the attitudes of those across social work departmental leadership positions on the impact of formal mentoring and the apparent disconnect between the benefits and the underutilization of mentorship in the academy. research that explores this area would be valuable as those in positions of leadership create the department and institutional culture, set program initiatives, and prioritize where resources and energy will be expended. further, there has been minimal research that explores formal mentorship programs that specifically employ principles grounded in the rct framework as well as how this perspective impacts faculty, social work departments, and institutions. there is a substantial body of literature on the positive impacts of formal mentorship on all faculty as well as literature on historically marginalized groups such as women, underrepresented minorities, and those in non-tenure track, part-time, adjunct, or intermittent positions. however, there is a lack of research on how formal mentorship grounded in rct principles compares to other theoretical frameworks. further, since this conceptual framework proposes a new set of integrated components, it is vital to determine its viability and impact through further research. additional areas that would be beneficial to explore are the development and implementation of a formal mentorship curriculum for mentors and mentees using the components highlighted in this conceptual framework. proposed conceptual framework to respond to this need within the academy, this conceptual framework is offered as a mechanism to support formal mentorship practices within social work departments. the conceptual framework presented provides a roadmap to assist in the creation of formal mentorship practices based on professional values such as respect, inclusion, and empowerment that may significantly improve overall faculty and institutional culture. through the integration of rct principles, the core values identified in the nasw code of ethics, and the purpose of social work education as defined in the cswe epas guidelines, formal mentorship can serve to address inequities situated within the academy in a manner that is consistent with our professional and professorial responsibilities. in this spirit, this author strongly urges those at institutional and departmental levels to employ holcomb/leveling the playing field 1201 formal mentorship practices with all faculty members; however, attention should be paid to those from historically oppressed groups within the academy. to understand these components more thoroughly, each will be explored individually. following this, a discussion will be presented identifying how each component is integrated into this framework. finally, a diagram of the conceptual framework is presented. relational cultural theory the main theory integrated within this conceptual framework is relational cultural theory. rct, originally developed by the well-known feminist scholar and activist dr. jean baker miller, asserts that growth occurs through connection, mutual and empathic relationships, and empowerment (jordan & hartling, 2008; miller, 1986). rct has three implicit assumptions that fit well within a formal mentorship paradigm focused on the inclusion of marginalized groups in the academy. this theory is unapologetically pro-social justice oriented and focuses on marginalized and oppressed groups by utilizing a depathologizing perspective to view relational approaches in non-judgmental contexts (comstock et al., 2008; duffy & trepal, 2016). explicit assumptions of rct also connect to formal mentorship endeavors. the core belief of rct is that people seek connection, which can be achieved through empathy and empowerment (jordan & hartling, 2008). growth-fostering relationships are actualized by increasing a person’s sense of worth as well as the ability for each person to view him/herself more clearly within the context of the relationship (jordan & hartling, 2008). finally, rct emphasizes the necessity of environments to be responsive to individual needs through outwardly recognizing and correcting power differentials and oppressive imbalances (comstock et al., 2008). employing formal mentoring practices that apply components of rct directly allows for the acknowledgment and challenging of structural power imbalances that are often perpetuated within the academy. core values of the nasw code of ethics the second component within this integrated conceptual framework on formal mentorship uses the six core values of the nasw code of ethics which serves as an anchor for the profession. the purpose of the nasw code of ethics (2017) is to provide the profession with a basic set of values, ethical principles, and standards that guide the conduct of social workers, regardless of practice setting. formal mentorship within the academy fits squarely within each of these six core values: service, social justice, dignity and worth of the person, the importance of human relationships, integrity, and competence. the value of service requires social workers to help those in need, which directly relates to acclimating faculty throughout their career to the many responsibilities within the academy. a lack of formal mentorship within the academy disproportionately impacts the groups that are the focus of this article, an issue connected to the value of social justice. systems of oppression that further marginalize groups within higher education must be confronted by social work educators. this is accomplished through employing formal advances in social work, fall 2021, 21(4) 1202 mentoring practices that respect the inherent dignity and worth of a person through mindful consideration of individual differences, appreciation of diversity, and connection through relational practices. next, social workers recognize the importance of human relationships by strengthening, restoring, maintaining, and enhancing relationships with all people to ensure overall well-being and belonging. this value is clearly demonstrated through the authentic connection and empowerment found within formal mentoring practices. the value of integrity requires social workers to act in a trustworthy manner that promotes ethical practices particularly within the institutions they are affiliated with. this value can be demonstrated within formal mentorship practices. the mentor-mentee relationship is critical in acclimating faculty to the department and the larger institution’s practices. finally, competence is demonstrated through the development and enhancement of professional expertise, transmitted through the mentor-mentee relationship. council on social work education’s educational policy and accreditation standards the third component integrated within this conceptual framework is the 2015 cswe (2015) epas which is the basis to view social work education. it should be noted that the 2022 epas is in draft form and as it is currently written includes no provisions for formal faculty mentorship. adding this provision should be considered. according to cswe, the purpose of social work education is to promote human and community well-being, respect human diversity, and enhance quality of life through the pursuit of social and economic justice. within these standards, there are sections related to the implicit curriculum where formal mentorship would clearly serve as a benefit to educators and social work programs. specifically, sections related to the culture of human interchange, support for difference and diversity, and the recruitment and retention of personnel support the inclusion of formal mentoring. embedding formal mentorship into the accreditation standards and embracing a commitment to this in the academy would ensure all social work programs are firmly grounded in the core values of the social work profession, which is the obligation of all accredited programs. living the core values of the profession and espousing, through actions, the ethical principles of social work, the professoriate is called to make substantial change to address the inherent disparities noted within the academy. in achieving this systemic change, the professoriate would be fully recognizing the overarching purpose of higher education. formal mentorship, through its endeavor to level this uneven playing field, therefore, is a means to actualize this goal. integration of components when considering integrating the three components of this conceptual framework, the author sought to connect the core values of social work with the educational practices that guide social work programs. equally important to the author was the focus on relationships and empowerment as the catalyst to impact change and sustainable outcomes on an individual, departmental, and institutional level. rct serves as the theoretical underpinnings of this conceptual framework and connects seamlessly to the profession of holcomb/leveling the playing field 1203 social work and to the overarching goals of social work education. by using a relationallybased framework that connects to the social work profession’s core values, and to the purpose of social work education, formal mentorship can serve as the beginning point to empower faculty who are often excluded. marginalized faculty members are often silenced within the academy. this exclusion is noted in disparities related to the overall culture, voice in governance, and true belonging within the structure of the academy (clark et al., 2011; fagan-wilen et al., 2006; hoyt et al., 2008; shobe et al., 2014). this framework is a step towards beginning the critical work necessary to rebalance uneven power structures, oppression, and marginalization found within higher education. by integrating these components, a supportive departmental and institutional culture can be created where the explicit curriculum can be fully recognized. within this framework, the implicit curriculum is transparent and no longer a secret that only some faculty gain access to. as such, providing formal mentorship for faculty is a necessity that should be fully embraced by social work educators as it aligns with the profession’s responsibilities and values. figure 1 depicts this integrated conceptual framework. discussion providing formal mentorship supports for all faculty is critical to actualizing the purpose of higher education and to fulfilling the responsibilities of social work educators. social workers should be committed to advocating for and implementing inclusive, relationally-based practices on a mentor-mentee level and institutional level for historically marginalized groups within the academy. examples of inclusive and relationally-based mentor-mentee practices include developing reciprocal relationships built on mutual respect, empathy, and empowerment; providing intentional connections and guidance for mentees navigating the challenging climate of higher education; and acknowledging and actively addressing inherent power differentials often based on concepts of exclusion (alvarez & lazzari, 2016; angelique et al., 2002; chadiha et al., 2014, denson et al., 2018; miller, 1986). on an institutional level, social workers should be committed to advocating for flexible and inclusive policies to meet faculty life obligations; recognize and celebrate faculty contributions; challenge practices that are exclusionary and based on privilege; and actively seek to recruit and retain underrepresented faculty (chun & evans, 2008; duntleymatos, 2014). formal mentorship practices are a vital part of empowering, supporting, recruiting, and retaining a diverse faculty. there is a substantial body of literature that demonstrates the positive impact formal mentorship has on faculty, institutions, student outcomes, and the social work profession. despite these benefits formal mentorship remains woefully underutilized, particularly for the most marginalized groups within the academy. to counter these power differentials and disparities, this author strongly argues for the inclusion of formal mentorship, based on the integrated components of this conceptual framework, to the epas guidelines. advances in social work, fall 2021, 21(4) 1204     figure 1. formal mentorship conceptual framework for social work principles connection achieved through empathy & empowerment responsive environment rebalance power differentials m en to r r el at io n sh ip mentor & mentee engage in a reciprocal relationship where each are seen as a whole person. mutual respect & trust are formed within the context of a growth-fostering relationship. empowerment occurs through building confidence & success. mentor provides connections for mentee & assists in professional development. coaching & professional advice is provided to assist the mentee in navigating the institutional & political environment. intentional focus on hierarchical relationships & historical marginalization. power differentials in relationships acknowledged & work towards balancing. differences in background recognized with commitment to life-long learning that is inclusive. trust is built by acknowledging each person is an expert of their own experience that are honored & valued. in st it u ti on policies are flexible & inclusive. policies reflect real-world challenges faculty encounter & are responsive to their needs. institutional leadership expresses gratitude & demonstrates that faculty are valued. faculty input sought & pro-active approach is taken to reduce barriers. when issues arise, institution responds appropriately. department & larger institution provides faculty with tangible supports to meet developmental goals. a thorough examination of historical policies that prioritize/ privilege only a few while excluding others occurs with a commitment to change exclusive policies & practices acknowledge inherent structural power differentials that continue to marginalize groups within the academy. commitment to eliminating patterns of marginalization & enhancing efforts to recruit & retain underrepresented faculty. o u tc om es faculty are more connected to their institution & experience feelings of belonging, understanding, success, & are valued. justice oriented environment that meets individual, department, & institutional needs. creation of a more equitable & justice-oriented culture where difference & diversity are celebrated. holcomb/leveling the playing field 1205    implications for social work education the impact of formal mentorship cannot be overstated and is repeatedly demonstrated within the literature. recruitment and retention of a more diverse faculty body, a more positive department and institutional work culture, and a more satisfied and engaged faculty body are present when formal mentorship is intentionally employed. formal mentorship that is consistent with this conceptual framework would positively impact these outcomes and work to shift the paradigm within higher education. as the landscape and culture of higher education is changing, it is more important than ever to implement formal mentorship supports to ensure faculty, departmental, and institutional success. there are significant implications and challenges presented within higher education due to this shifting landscape. these challenges can be mitigated by implementing formal mentorship. it is imperative that the profession continue to maintain its focus on the guiding purpose of social work education, which is to promote human and community well-being, respect human diversity, and enhance quality of life through the pursuit of social and economic justice. given this charge, it is our professional duty to provide formal mentorship supports to all faculty, particularly those who are often the most marginalized. therefore, we are called as a profession to re-affirm our commitment to the purpose of social work education. limitations the topic of formal mentorship is complex in nature. thus, there are multiple avenues to explore what approach is the best in terms of supporting faculty within the academy. as this article is conceptual in nature, it presents one perspective on how to view, organize, and study the phenomenon of formal mentorship. this approach may not work for all departments or types of institutions. as noted previously, multiple approaches to formal mentorship have been considered with varying levels of success. this conceptual framework adds to the existing body of literature on the topic and warrants further exploration and testing to ascertain its viability within departments and institutions. conclusion and recommendations advocating for marginalized groups is a fundamental responsibility of the social work profession. historically, social work’s roots and ethical obligations are grounded in a commitment to social justice, equality, and inclusivity. considering this focus, it is a professional imperative that those within the academy advocate to mitigate the disparities that exist within higher education for women, underrepresented minorities, and those in non-tenure track positions. the literature on the positive impact formal mentorship has, particularly for these marginalized groups, is well-established and compelling. despite this, there has been a lack of response from the majority within the academy to address these inequities. this silence has further disempowered those most vulnerable within higher education. in response, this integrated conceptual framework acknowledges the disparities and presents a path forward that mitigates the inequities through the inclusion of formal advances in social work, fall 2021, 21(4) 1206 mentorship practices for all faculty members. by instituting formal faculty mentorship practices consistent with this conceptual framework, inherent power differentials within the academy are brought to the forefront. these issues are explicitly recognized in the mentor-mentee dyad, as well as at an institutional level. this recognition and active work towards addressing these disparities begins to move the needle towards an inclusive system where diversity is respected and true growth-fostering and connecting relationships are actualized. the author proposes that formal mentorship practices should be included in the epas guidelines to address these disparities. these practices solidify a commitment to support faculty, departments, and institutions. this addition should be viewed through a supportive lens and not as an infringement on academic freedom or as a mechanism to prescribe a strict matrix of activities and tasks that must be completed. this addition would ensure that all accredited social work programs provide formal mentorship supports to faculty but leaves the implementation of such practices to the individual schools’ best judgement given their unique position in understanding their faculty as well as their departmental and institutional needs. future research while formal mentorship is not a new concept within higher education, further study regarding this topic is needed. there is a lack of literature related to implementing formal mentorship based on the integrated components put forth in this conceptual framework. both quantitative and qualitative research is needed to explore whether this framework is a viable model for faculty mentorship. further, creating a curriculum based on these integrated components would provide concrete support and a professional knowledge base to mentors and social work departments who wish to implement a formal mentorship program based on these principles. additionally, there is a lack of research on institutional and departmental leaderships’ commitment to implementing and sustaining formal mentorship practices. this author is engaged in exploratory research to ascertain a deeper understanding of the attitudes toward formal mentoring among those in leadership positions. to date there is limited literature available on how this population views formal mentorship opportunities. this is a critical voice to capture and thus warrants further investigation. understanding the value those 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(2015). social work faculty development: an exploratory study of non-tenure track women faculty. journal of social work education, 51, 738-753. https://doi.org/10.1080.10437797.2015.1076284 author note: address correspondence to dana holcomb, department of social work, ferris state university, big rapids, mi. email: danaholcomb@ferris.edu this work is licensed under a creative commons attribution 4.0 international license. interdisciplinary issues at the intersection of assessing and treating substance use disorders and post traumatic stress disorder: clinical social work and clinical behavioral analysis with veterans monica m. matthieu alyssa wilson robert w. casner abstract: veterans and military personnel may be at higher risk for developing addictions due to increased prevalence rates of co-occurring mental health disorders including posttraumatic stress and substance abuse disorders. however, clinicians may feel unprepared to assess and to treat these co-occurring disorders, especially when it includes a behavioral addiction such as gambling. clinical social work and clinical behavior analysis are two fields with complementary interdisciplinary approaches that can lead to improved client-centered outcomes. yet, limited evidence exists to guide interdisciplinary treatment teams in effective treatment of gambling addictions and post traumatic stress disorder (ptsd). the current article provides an interdisciplinary treatment model to assist clinicians in selecting appropriate evidence-based assessments and treatments. a case example focuses on the use of assessment tools and treatment approaches drawn from recommendations from best practice guidelines for veterans. finally, resources related trauma and addictions are presented. keywords: post traumatic stress disorder; substance-related disorders; gambling; veteran; united states department of veterans affairs; social work; behavioral disciplines and activities in 1989, the national associations of social work (nasw) standards for the practice of clinical social work defined clinical social work by an emphasis on the process of assessment, diagnosis, intervention, treatment, collaboration, case management, and evaluation of the psychosocial functioning of individuals, families, and small groups (nasw, 1989). as this standard is currently undergoing revision, it can be expected that the collaboration aspect will expand to encompass more modern views on interdisciplinary collaboration with other allied health professions, namely those with similar traditions, theoretical perspectives, and methods. once such discipline is clinical behavioral analysis. clinical behavioral analysis is defined as a professional practice that utilizes a similar individually-focused process model to examine, assess, measure, and treat a problematic human behavior. while the main tool is a functional analysis of the behavior, clinical behavioral analysts examine the biological and social forces that impinge on an individual and apply behavioral, cognitive behavioral, and other behavioral medicine methods to instigate change (association for behavior analysis international, 2017). ______________________ monica m. matthieu, phd, lcsw is assistant professor, school of social work, college for public health and social justice, saint louis university, saint louis. mo 63103. alyssa n. wilson, ph.d., bcba-d, lba is an assistant professor of applied behavior analysis in the school of social work, college for public health and social justice, saint louis university, saint louis. mo 63103. robert w. casner, lmsw is doctoral student in the school of social work, college for public health and social justice, saint louis university, saint louis. mo 63103. this work does not represent the views of the department of veterans affairs or the united states government. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 217-234, doi: 10.18060/21320 https://creativecommons.org/licenses/by/4.0/ matthieu/interdisciplinary issues 218 with such common ground as the person-in-environment theoretical perspective, clinical social work and behavior analysis have a special interdisciplinary connectedness that can be helpful in addressing and treating complex behavioral issues. both disciplines subscribe to a process model for clinical practice that includes five steps (wilson & matthieu, 2015). the steps are: 1) identification of clinically relevant target behaviors; 2) use of reliable and valid measurements; 3) relationship between target behaviors, measures, and treatment; 4) data-based treatment decisions; and 5) social validity of treatment process and outcomes. at present, there are a number of clinically relevant areas of overlap between the two disciplines that are not well known. some however, are gaining more notice and relevance for extremely high-need clients with behavioral issues, such as children with autism and individuals with complex clinical presentations requiring behavior based interventions, such as veterans with post traumatic stress disorder (ptsd) and co-occurring substance use or gambling disorders. as the department of veterans affairs (va) expands services to the newest generation of veterans and continues to serve all veterans from military discharge to death, there is a growing need for community providers to understand, address, and treat the biopsychosocialspiritual aspects trauma. while the health and psychosocial needs of veterans are paramount, clinicians need to ensure they have the competencies to support shared decision-making, patient-centered care, and collaborative case management of veteran clients who seek services both in the community and in the va health care system. in this way, interdisciplinary collaboration, such as that between clinical social work and clinical behavior analysis, can lead to significant client-centered outcomes and changes in health behaviors (wilson & matthieu, 2015). while there are also many barriers to treatment in the community and the va such as client follow-through, mutual agreement on target behaviors (e.g., who decides on the target behavior during treatment?), and clinician ‘choice’ of intervention selection when co-occurring conditions are present (e.g., treatment of what condition is primary?), the use of evidence based behavioral practices joins these professionals in the pursuit of psychosocial recovery for complex conditions such as ptsd, substance use, and addictions. specific aims the aim of this paper is to provide a framework for clinicians to effectively, and collaboratively, assess and treat ptsd and substance use disorders, in particular gambling. this manuscript will outline a model for interdisciplinary practice to assist social work, behavioral analysis, and other allied health clinicians working with addictions and traumarelated symptoms in selecting appropriate evidence based assessments and treatments. further, a case example focused on the use of these assessment tools and treatment approaches drawn from recommendations from best practice guidelines from the department of veterans affairs/department of defense (dva/dod) clinical practice guidelines will be presented for veterans with ptsd and addictive behaviors. finally, resources related to the training of interdisciplinary treatment teams on trauma and addictions, particularly for behavioral additions such gambling, will be presented. advances in social work, spring 2017, 18(1) 219 overview of gambling and substance use disorders gambling is one of the most frequent activities that people engage in around the world. raylu and oei (2002) defined gambling as placing value upon a game/event or a bet of any type that has an unpredictable outcome, and in which the result to some magnitude is determined by chance. gambling occurs in many different forms to include cards, sports betting, casinos, etc. and is participated in widely across socioeconomic levels. research has demonstrated that gambling was a frequent occurrence in the earliest of societies, and modern games of chance have evolved from the games once played by our ancestors (bolen & boyd, 1968). in the united states, as in many countries, individuals gamble on games and events, and most do so without experiencing problems. numerous people play games of chance for recreation, however, for some individuals, gambling becomes problematic. previous editions of the diagnostic and statistical manual (dsm iv) (apa, 1994, p. 615) defined pathological gambling as a progressive and chronic disorder that encompasses an unrelenting failure to resist impulses to gamble and where this “maladaptive behavior disrupts, or damages personal, family, or vocational pursuits.” the negative impact that individuals experience is far reaching. pathological gamblers have high rates of cooccurring disorders, including mood, personality, and substance use disorders (kessler et al., 2008; petry, stinson, & grant, 2005). the most recent update, dsm v, changed the way pathological gambling is classified. pathological gambling is no longer viewed as an inability to resist impulses, but rather a substance use disorder (sud), specifically named, gambling disorder. dsm v (apa, 2013, p. 586) states that “although some behavioral conditions that do not involve ingestion of substances have similarities to substance-related disorders, only one disorder— gambling disorder—has sufficient data to be included in this section.” with regard to gambling being classified as a disorder that is included in this section with substance use, the dsm v (apa, 2013) provides criteria and organization for the associated symptoms. additionally, dsm v (apa, 2013) now provides specific diagnoses associated with this substance class with regard to sud. ten substance classes, relevant to sud, are highlighted in the dsm v chapter. a side by side comparison of a substance related disorder, alcohol use disorder, and a non-substance related disorder, gambling disorder (gd), highlights the parallel in behavioral symptoms and thus, clarifies the rationale for including gd in the sud discussion. (see table 1). when comparing to the criterion, the rational for including gd in the sud section of the dsm v becomes evident. for example, sud criterion states that “the individual may express a persistent desire to cut down or regulate substance use and may report multiple unsuccessful efforts to decrease or discontinue use” (apa, 2013, p. 483). furthermore, “the individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects” (apa, 2013, p. 483). similarly, individuals who experience gd “need(s) to gamble with increasing amounts of money in order to achieve the desired excitement, has made repeated unsuccessful efforts to control, cut back, or stop gambling, is often preoccupied with gambling” (apa, 2013, p. 585). while diagnostically similar, clinicians with familiarity with the diagnostic criteria now have the foundational knowledge to begin to identify gd, however additional training in a clinical process that matthieu/interdisciplinary issues 220 blends identification, assessment, and treatment may be necessary to ensure competency when gambling may co-occur with other conditions. table 1. comparison of diagnostic criteria for gambling and alcohol use disorder. gambling disorder criteria alcohol use disorder a. persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: 1. needs to gamble with increasing amounts of money in order to achieve the desired excitement. 2. is restless or irritable when attempting to cut down or stop gambling. 3. has made repeated unsuccessful efforts to control, cut back, or stop gambling. 4. is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). 5. often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). 6. after losing money gambling, often returns another day to get even (“chasing” one’s losses). 7. lies to conceal the extent of involvement with gambling. 8. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. 9. relies on others to provide money to relieve desperate financial situations caused by gambling. a. a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: 1. alcohol is often taken in larger amounts or over a longer period than was intended. 2. there is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 3. a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 4. craving, or a strong desire or urge to use alcohol. 5. recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 6. continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 7. important social, occupational, or recreational activities are given up or reduced because of alcohol use. 8. recurrent alcohol use in situations in which it is physically hazardous. 9. alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 10. tolerance, as defined by either of the following: a. a need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. a markedly diminished effect with continued use of the same amount of alcohol. 11. withdrawal, as manifested by either of the following: a. the characteristic withdrawal syndrome for alcohol (refer to criteria a and b of the criteria set for alcohol withdrawal, pp. 499–500). b. alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. advances in social work, spring 2017, 18(1) 221 gambling disorder criteria alcohol use disorder b, the gambling behavior is not better explained by a manic episode. specify if:  episodic: meeting diagnostic criteria at more than one-time point, with symptoms subsiding between periods of gambling disorder for at least several months.  persistent: experiencing continuous symptoms, to meet diagnostic criteria for multiple years. specify if: in a controlled environment: this additional specifier is used if the individual is in an environment where access to alcohol is restricted. specify if:  in early remission: after full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met for at least 3 months but for less than 12 months (with the exception that criterion a4, “craving, or a strong desire or urge to use alcohol,” may be met).  in sustained remission: after full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion a4, “craving, or a strong desire or urge to use alcohol,” may be met). specify current severity:  mild: 4–5 criteria met.  moderate: 6–7 criteria met.  severe: 8–9 criteria met. specify current severity:  305.00 (f10.10) mild: presence of 2–3 symptoms.  303.90 (f10.20) moderate: presence of 4–5 symptoms.  303.90 (f10.20) severe: presence of 6 or more symptoms. note. dsm-v criteria summarized from the american psychiatric association (apa). (2015). diagnostic and statistical manual of mental disorders (6th ed.). washington, dc: author. bold indicates similarity of criteria. screening brief intervention and referral to treatment as noted earlier, there are five phases to interdisciplinary treatment from a clinical social work and clinical behavioral analysis perspective (wilson & matthieu, 2015). the focus here is now on the first two phases of that model, the identification of clinically relevant target behaviors and the use of reliable and valid measurements. as one example of an evidence based process, the substance abuse and mental health services administration (2016) describes screening, brief intervention, and referral to treatment (sbirt) as a sequential assessment and referral approach to the delivery of early intervention and treatment to individuals with substance use disorders and those at risk of developing these disorders. screening quickly assesses the severity of substance use using a standardized assessment instrument and identifies the appropriate level of treatment. brief intervention focuses on increasing insight and awareness regarding substance use and eliciting motivation toward behavioral change. referral to treatment provides those identified as needing more extensive treatment with access to specialty care. gambling as matthieu/interdisciplinary issues 222 an additional substance use disorder can be easily integrated into this protocol, with the addition of appropriate gambling screening measures (which will be discussed later) and community referrals located for gambling treatment. protocols for assessing ptsd and substance use disorders in veterans clinical practice guidelines (cpg) are guiding principles that include evidence based treatment recommendations intended to enhance the quality of care that individuals receive. the guidelines are built upon the knowledge gained through systematic reviews and meta-analysis of evidence, and assessments regarding potential benefits and risks of alternative interventions. clinicians utilize cpg’s in order to apply the best available evidence supported interventions and to make informed clinical decisions (dva/dod, 2015; dva/dod, 2017). additionally, cpg’s often include decision aids or clinical tools that provide a flow chart, or an algorithm, aimed at selecting the most appropriate clinical intervention for a situation. as defined, a clinical algorithm is a diagram that utilizes a stepby-step decision tree approach in order to assist a clinician in the decision making process (dva/dod, 2015; dva/dod, 2017. symbols are used to display each step in the process, and arrows connect numbered decision points that indicate the order and direction the steps in the decision process should be made. for example, “if symptoms x and y are present, then use intervention z”. what follows are summaries of the cpg’s utilized by the dva/dod for the management of ptsd and sud. the dva/dod clinical practice guideline for management of substance use disorder (december, 2015) is designed to assist providers in managing or co-managing patients with sud. the patient population of interest for this cpg is adults who are eligible for care in the va and dod healthcare delivery systems that includes veterans, as well as, deployed and non-deployed military service members. as such, it does not provide recommendations for the management of sud in children or adolescents. this cpg includes an algorithm, a step-by-step decision tree, which is designed to facilitate understanding of the clinical pathway and decision making process used in management of sud. standardized symbols are used to display each step in the algorithm, and arrows connect the numbered boxes indicating the order in which the steps should be followed. the cpg includes algorithm a: screening and treatment, and algorithm b: stabilization. although gd is included in the sud section of dsm v, gd is not included in this cpg. with regard to other co-occurring conditions, this cpg notes that “of those with an sud diagnosis, 55-75% also received diagnoses for ptsd or depression” (p. 9). the dva/dod clinical practice guideline for management of ptsd (ver 2.0, 2010) is relevant to all healthcare professionals who are providing or directing treatment services to patients with a history of trauma exposure. post-traumatic stress is one disorder along a spectrum of anxiety disorders that focus on the individual’s stress reaction to the trauma. these disorders are arranged along a temporal axis, from acute stress reaction, to acute stress disorder, acute ptsd, and chronic ptsd. each of these may be associated with serious mental and physical co-occurring conditions. some trauma survivors may experience only a part of this spectrum, while others may progress through the entire range, requiring different types of treatment along this temporal sequence. algorithms included in this cpg are core algorithm: initial evaluation and triage, algorithm a: acute stress advances in social work, spring 2017, 18(1) 223 reaction/disorder prevention of ptsd, algorithm b: assessment and diagnosis of ptsd. this cpg (p. 90) identifies a documented and strong relationship between co-occurring ptsd and sud, and recommends that all individuals with a diagnosis of ptsd should receive comprehensive assessment for sud. however, in this cpg as the one previous, gambling is not included. screeners the complexity of symptoms associated with co-occurring disorders often make the task of diagnosis difficult resulting in people receiving treatment for one disorder and not another. however, if a problem is not identified, one can expect that it will not receive the appropriate clinical attention. the importance of screening for co-occurring disorders is difficult to overstate. the following section identifies assessment measures that are utilized in the domains of ptsd, hazardous drinking or active alcohol use disorders, and severity of gambling symptoms. the list in table 2 is not exhaustive and yet includes some strong, well-established screening measures. table 2. short screening instruments for ptsd, alcohol, drug, and gambling disorders measure # of items domain website primary care ptsd screen (pc-ptsd5) 5-item ptsd prins, a., bovin, m.j., smolenski, d.j. et al., 2016; http://www.ptsd.va.gov/professional/ assessment/screens/pc-ptsd.asp audit-c 3-item hazardous drinkers or active alcohol use disorders http://www.integration.samhsa.gov/i mages/res/tool_auditc.pdf dast-10 10-items drug use (not including alcohol) http://www.integration.samhsa.gov/cl inical-practice/screening-tools brief biosocial gambling screen (bbgs) 3-item gambling contact author. south oaks gambling screen (sogs) 20-item gambling severity http://www.ncrg.org/sites/default/file s/uploads/docs/monographs/sogs.pdf note. many assessment measures can be obtained at the national center for ptsd by completing the request form located at http://www.ptsd.va.gov/professional/assessment/ncptsd-instrumentrequest-form.asp the primary care ptsd screen (pc-ptsd; prins et al., 2003), is a 4-item screener that was designed for use in primary care and other medical settings, and is currently used to screen for ptsd in veterans using va health care. the screen includes an introductory sentence to cue respondents to traumatic events and asks about four main clusters of symptoms. a dsm v revised version of the pc-ptsd has been developed with 5 items (prins et al., 2016) and will be available from the nc-ptsd website once it is validated and ready for wide scale dissemination (nc-ptsd, 2016). the audit-c (bush, kivlahan, mcdonell, et al., 1998) is a three item alcohol screener that can help identify persons who are hazardous drinkers or have active alcohol http://www.ptsd.va.gov/professional/assessment/screens/pc-ptsd.asp http://www.ptsd.va.gov/professional/assessment/screens/pc-ptsd.asp http://www.integration.samhsa.gov/images/res/tool_auditc.pdf http://www.integration.samhsa.gov/images/res/tool_auditc.pdf http://www.integration.samhsa.gov/clinical-practice/screening-tools http://www.integration.samhsa.gov/clinical-practice/screening-tools http://www.ncrg.org/sites/default/files/uploads/docs/monographs/sogs.pdf http://www.ncrg.org/sites/default/files/uploads/docs/monographs/sogs.pdf http://www.ptsd.va.gov/professional/assessment/ncptsd-instrument-request-form.asp http://www.ptsd.va.gov/professional/assessment/ncptsd-instrument-request-form.asp matthieu/interdisciplinary issues 224 use disorders. the audit-c is a modified version of the 10 question audit instrument and is available for use in the public domain. dast-10 (skinner, 1982) is a 10 item screener related to an individuals’ possible involvement with drugs, not including alcoholic beverages, during the past 12 months which is adapted from the full 28 item dast screen. "drug abuse" refers to (1) the use of prescribed or over‐the‐counter drugs in excess of the directions, and (2) any nonmedical use of drugs. the various classes of drugs may include cannabis (marijuana, hashish), solvents (e.g., paint thinner), tranquilizers (e.g., valium), barbiturates, cocaine, stimulants (e.g., speed), hallucinogens (e.g., lsd) or narcotics (e.g., heroin). the brief biosocial gambling screen (bbgs; gebauer, labrie, & shaffer, 2010) is a 15-item screening tool targeting past year experiences of withdrawal, deception, and bailout related to gambling behaviors. to date, no research has been conducted on the clinical validity or reliability (see also volberg & williams, 2011). gambling proclivity is assessed using the south oaks gambling screen (sogs; lesieur & blume, 1987), where scores of 5 or higher indicate disordered or pathological gambling. gambling severity is assessed using the gambling severity assessment scale (gsas). function of gambling play is also assessed using the gambling functional assessment ii (gfa-ii; dixon, wilson, belisle, & schrieber, under review). table 3. evidence based treatments recommended in publically available clinical practice guidelines for trauma, substance use and gambling disorders domain treatment publically available clinical practice guidelines ptsd prolonged exposure http://www.healthquality.va.gov/guidelines/mh/pts d/ cognitive processing therapy http://www.healthquality.va.gov/guidelines/mh/pts d/ eye movement desensitization and reprocessing http://www.healthquality.va.gov/guidelines/mh/pts d/ stress inoculation therapy http://www.healthquality.va.gov/guidelines/mh/pts d/ sud cognitive-behavioral coping skills therapy http://www.healthquality.va.gov/guidelines/mh/sud/ index.asp community reinforcement approach http://www.healthquality.va.gov/guidelines/mh/sud/ index.asp motivational enhancement therapy http://www.healthquality.va.gov/guidelines/mh/sud/ index.asp gambling cognitive behavioral therapy https://store.samhsa.gov/shin/content/pgkit07/pgkit-07-03.pdf acceptance and commitment therapy https://www.guideline.gov/summaries/summary/39 327 note. a listing of all current and updated dva/dod clinical practice guidelines can be found at http://www.healthquality.va.gov http://www.healthquality.va.gov/guidelines/mh/ptsd/ http://www.healthquality.va.gov/guidelines/mh/ptsd/ http://www.healthquality.va.gov/guidelines/mh/ptsd/ http://www.healthquality.va.gov/guidelines/mh/ptsd/ http://www.healthquality.va.gov/guidelines/mh/ptsd/ http://www.healthquality.va.gov/guidelines/mh/ptsd/ http://www.healthquality.va.gov/guidelines/mh/ptsd/ http://www.healthquality.va.gov/guidelines/mh/ptsd/ http://www.healthquality.va.gov/guidelines/mh/sud/index.asp http://www.healthquality.va.gov/guidelines/mh/sud/index.asp http://www.healthquality.va.gov/guidelines/mh/sud/index.asp http://www.healthquality.va.gov/guidelines/mh/sud/index.asp http://www.healthquality.va.gov/guidelines/mh/sud/index.asp http://www.healthquality.va.gov/guidelines/mh/sud/index.asp https://store.samhsa.gov/shin/content/pgkit-07/pgkit-07-03.pdf https://store.samhsa.gov/shin/content/pgkit-07/pgkit-07-03.pdf https://www.guideline.gov/summaries/summary/39327 https://www.guideline.gov/summaries/summary/39327 http://www.healthquality.va.gov/ advances in social work, spring 2017, 18(1) 225 overview of evidence based treatments for veterans as noted in table 3, there are a variety of evidence based treatments for ptsd, substance use, and gambling disorders, noted in the dva/dod clinical practice guidelines for ptsd and substance use. given that veterans have high rates of co-occurring ptsd and substance use disorders, the guidelines recommend treatments for each condition separately. however, in both of these guidelines, when conditions of ptsd and substance use co-occur, the recommendations include standardized assessments of both conditions and using a shared decision making process to prioritize care when recovery is emerging. yet in both, gambling is not included as a behavioral addiction or as a sud. the following section will review specific treatments that are evidence based for ptsd and substance use and recommended by the guidelines for veterans. ptsd treatments clinical practice guidelines for ptsd recommend four psychotherapies as having good evidence for effectiveness: prolonged exposure (pe), cognitive processing therapy (cpt), eye movement desensitization and reprocessing (emdr), and stress inoculation training (sit) (dva/dod, 2017). vha policies and implementation efforts for ptsd have focused particularly on cpt and pe because they had the strongest evidence base at the time, including at least one study with veterans (karlin et al., 2010). as a quick overview, both cpt and pe are manualized, trauma-focused cognitive-behavioral therapies that address and treat the cognitive and behavioral symptoms of ptsd, with improvements also seen in other outcomes such as depression and anxiety (haagen et al., 2015). cpt typically includes 10-15 sessions lasting 60 minutes if delivered individually or 90 minutes if delivered in a group. it is broadly divided into three main parts: 1) ptsd symptom overview and psychoeducation, 2) the cognitive triad, and 3) examining and challenging beliefs related to the trauma and its impact. pe is only provided in 90-minute individual sessions and the number of sessions range from 8-15 sessions. the treatment consists of four main components: 1) treatment rationale and psychoeducation, 2) breathing retraining, 3) in vivo exposure, and 4) imaginal exposure. substance use treatments clinical practice guidelines recommend the following interventions for substance use as having good evidence for effectiveness: cognitive-behavioral coping skills training, community reinforcement approach, and motivational enhancement therapy. cognitivebehavioral coping skills therapy consists of “related treatment approaches for substance use that focus on teaching patients to modify both thinking and behavior related not only to substance use, but to other areas of life functionally related to substance use” (dva/dod, 2015, p. 92). individuals learn to identify thoughts and actions that have behavioral consequences that relate to and reinforce substance use. as a way to interrupt a problematic relationship between their thoughts and behaviors, individuals acquire skills aimed at “changing thinking and behaviors that contribute to substance use, and to strengthen coping skills, improve mood, interpersonal functioning and enhance social support” (va/dod, december, 2015, p. 92) matthieu/interdisciplinary issues 226 environmental factors can impact and influence an individual’s behavior. community reinforcement approach (cra) “is a comprehensive cognitive-behavioral intervention for the treatment of substance use by focusing on environmental contingencies that impact and influence the patient’s behavior” (va/dod, december, 2015, p. 92). based upon the assertion that the environmental factors play a key role in additive behavior, cra utilizes changes in natural environmental supports, such as family, social, and occupational, to enhance the opportunity to change drinking/using behaviors. an individual’s motivation to change is an important indicator of success with regard to behavior change. motivational enhancement therapy (met) is based on “principles of motivational interviewing (mi) including an empathic, client-centered, but directive, approach intended to heighten awareness of ambivalence about change, promote commitment to change, and enhance self-efficacy.” (va/dod, december, 2015, p. 92). effectively enhancing an individual’s willingness to effect change in their behavior can greatly increase the effectiveness of and commitment to an individualized recovery plan. overall, these sud treatments draw heavily from behavior theories and utilize strategies for specifically targeted behavioral change. gambling treatments selecting an evidence-based intervention includes the integration of best available research with clinical expertise in the context of client characteristics, culture, and preferences (apa, 2015). meta-analyses of gambling treatment have found the effects of psychotherapeutic interventions to have positive outcomes (pallesen et al., 2005; cowlishaw et al., 2012). for example, cbt (gooding & tarrier, 2009) has proven effective in reducing problem gambling with significant effect sizes across 3, 6, 12, and 24 month follow up. overall success rates for gambling treatments are estimated at 70% for six months follow up and 50% for one year follow up (lopez-viets, & miller, 1997). utilizing cbt as a therapeutic intervention, and internet based cbt (casey et al., 2017), to treat gambling disorder typically involves three targets that include 1) identifying and changing cognitive distortions about gambling, 2) reinforcing non-gambling behaviors, 3) and recognizing positive and negative consequences (petry, 2009). additionally, emerging evidence suggests mindfulness-based interventions, such as acceptance and commitment therapy, for disordered gambling demonstrate positive and significant effects on gambling behavior and symptoms, urges, and financial outcomes (maynard, wilson, labuzienski, & whiting, 2015). the goal of act is to enhance an individual’s psychological flexibility. act targets psychological flexibility through the use of six interconnected processes that include acceptance, present moment focus, diffusion, self as context, committed action, and values (dixon, wilson, & habib, 2016). the empirical evidence in support of act as an effective therapeutic technique continues to expand (maynard et al., 2015; dixon et al., 2016), and has been evidence of an effective treatment option for substance use disorders (dixon et al., 2016). both, cbt and act, are effective interventions with regard to treating the behavioral symptoms presented in gd. advances in social work, spring 2017, 18(1) 227 gd is very likely under-idenified by mental health clinicians, as well as those in the community, bearing in mind the high rates of co-occurring disorders associated with gd. edens and rosenheck (2012) concluded that in a sample of veterans affairs (va) specialty mental health services users (n = 1,102,846) was indicative of gd under-diagnosis with a rate of six times below national estimates. given serious associated co-occurring conditions, increased awareness of this condition among mental health clinicians could facilitate referral and utilization of effective services and timely access to treatment (edens & rosenheck, 2012). although a significant association between gd and other disorders have been identified, the gd literature has largely overlooked the importance of trauma and posttraumatic stress disorder (ptsd) as a prevalent co-occurring condition (ledgerwood & milosevic, 2015). in fact, those with lifetime ptsd also were more likely to use gambling as a way to cope with negative emotions and experienced greater negative emotionality (ledgerwood & milosevic, 2015). ptsd is a prevalent condition in many subpopulations such as, women who have experienced sexual assault, and veterans, and is associated with greater psychiatric co-morbidity. considering that ptsd is not an uncommon diagnosis in the veteran community, effective assessment and treatment of concurrent gd and ptsd is crucial to providing appropriate health care services to veteran population. given a similarity in functional response, research has identified a compelling association between posttraumatic stress disorder (ptsd) and gambling disorder (gd). the national comorbidity study replication identified that 14.8% of those with lifetime gd met criteria for lifetime ptsd (kessler et al., 2008). overall, co-occurring disorders often have a larger impact on individuals when compared to those with only one of the problem areas. as examples, individuals who experience increased depressive symptoms (taber, mccormick, & ramirez, 1987), engage in gambling at a younger age, experience more severe gambling problems (petry & steinberg, 2005), and experience greater psychiatric symptom severity, impulsivity, and dissociation (ledgerwood & petry, 2006). amid this strong and growing evidence base on gd, to our knowledge, there is a compelling lack of guidance, inclusion, or discussion of gd in clinical practice guidelines nor co-occurring treatments for the veteran population. while glaring, this omission is an opportunity to reinforce the interdisciplinary treatment model suggested by clinical social work and behavioral analysis. interdisciplinary treatment model as noted previously, there are five areas of interdisciplinary social work and behavior analytic practice (wilson & matthieu, 2015) to assist clinicians with case conceptualization: 1) identification of clinically relevant target behaviors; 2) use of reliable and valid measurements; 3) relationship between target behaviors, measures, and treatment; 4) data-based treatment decisions; and 5) social validity of treatment process and outcomes. in the following case example, we highlight the use of this process model using the first two steps. matthieu/interdisciplinary issues 228 case example cindy was a 42-year-old african american female with chronic pain, rheumatoid arthritis, and a neck injury from her service in the army. she was a wife and mother to her only son, who was 21-years-old. she worked in an administrative position for the department of defense, and took pride in her job still being connected to serving her country. she reported recent mood swings, nightmares, and intrusive thoughts related to a sexual assault that occurred during her military service. currently, she reported that her and her husband spent more and more time at the local casino, as a way to spend time with each other and to get out of the house. eventually, she was trading in her car title for quick cash, and went through the family savings within 6 months. when cindy self-referred for gambling services, her family did not know of her condition, and she had gambled away two cars, countless household items, and was unable to pay her mortgage. a retrospective baseline of her gambling the 60 days prior to her intake, identified cindy had gambled for 35 days in the casino (slot machines), over 6 hours per visit, and had wagered over $10,000. during screening, she was identified as having severe gambling disorder (south oaks gambling screen (sogs; lesieur & blume, 1987) score of 18), and gambled to access escape and tangible items according to the gambling functional assessment (gfa; dixon & johnson, 2007). during treatment, she was concerned with her gambling behaviors. according to the pc-ptsd screener (prins et al., 2003), cindy scored a 4 (yes to all 4 items) and then completed the self-report post traumatic stress disorder (ptsd) checklist -military version (pcl-m; blanchard, jones-alexander, buckley, & forneris, 1996). cindy met criteria for ptsd and scored in the clinical range on the pcl with a score of 45, and endorsed a number of ptsd symptoms in the extreme range in the month prior (e.g., daily and nightly repeated, disturbing memories, thoughts, or images of a stressful experience from the military; avoiding thinking, talking, or similar activities or situations that remind her of her military experience; and feeling jumpy or easily startled, or being “super alert” or watchful and on guard). clinical interviews were then completed to identify functional relations between cindy’s co-occurring symptoms and environmental events. sbirt assessment using the audit-c revealed that cindy was in the risky range of substance use with a score of 10 and was proved patient education materials and referred to treatment. therefore, cindy’s target behaviors included gambling, trauma related symptoms and alcohol use. trauma treatment, specifically pe was initiated to address the trauma symptoms while initiating treatment for gambling disorders to include acceptance and commitment therapy. referrals to self-help programs for substance use were also provided. resources for practice there are a host of available materials related to the training of interdisciplinary treatment teams on trauma and addictions. however, more limited are publically available resources and those specifically on behavioral additions such gambling and targeted to veterans. therefore, here we highlight a number of these resources and offer additional resources to support interdisciplinary clinical practice in table 2 and table 3. advances in social work, spring 2017, 18(1) 229 the substance abuse and mental health administration (samhsa) has invested heavily in disseminating the evidence based treatment protocol entitled screening, brief intervention and referral to treatment. at present, there is an sbirt core curriculum that is publically available by request for the cd-rom from samhsa. there are also a number of free publically available online sbirt training courses listed on the samhsahrsa center for integrated health solutions. some additional particularly easy to navigate and free online sbirt courses are also available online (see table 4). table 4. publically available resources to support clinical practice. topic description publically available resource sbirt cd-rom http://www.samhsa.gov/sbirt online training course http://www.integration.samhsa.gov/clinicalpractice/sbirt/training-other-resources online courses http://healtheknowledge.org/course/index.php?categ oryid=50. ptsd assessment measures online request form http://www.ptsd.va.gov/professional/assessment/nc ptsd-instrument-request-form.asp. dva/dod clinical practice guidelines http://www.healthquality.va.gov community provider toolkit http://www.mentalhealth.va.gov/communityprovide rs/clinic_sud.asp. sud dva/dod clinical practice provider, family and patient resources http://www.healthquality.va.gov/guidelines/mh/sud / self-help toolkit: the 3 step referral method http://www.mentalhealth.va.gov/providers/sud/selfh elp/ with regard to assessing and treating ptsd, the va’s national center for ptsd hosts a list of assessment measures that can be obtained by completing the online request form. for practice guidelines, there are a variety of dva/dod clinical practice guideless that are publically available for download, and can be found on the va health quality website. for each guideline, there are free downloadable additional tools for the provider, family, and patient resources, such as the one for substance use noted in table 4. one substance use related link in the online resources is to a particularly good self-help toolkit: the 3 step referral method. finally, the va disseminates many of the mental health products, trainings and resources available on a community provider’s website, called the community provider toolkit. this website offers a military culture training, mini clinic topics on couples and family, disability benefits, posttraumatic stress disorder, serious mental illness, smoking and tobacco use, substance use, suicide prevention, technology in care, and women veterans, and other clinician friendly tools and handouts. discussion the use of an interdisciplinary model can assist clinicians in the identification of appropriate evidence-based assessments and treatments for co-occurring ptsd and http://www.samhsa.gov/sbirt http://www.integration.samhsa.gov/clinical-practice/sbirt/training-other-resources http://www.integration.samhsa.gov/clinical-practice/sbirt/training-other-resources http://healtheknowledge.org/course/index.php?categoryid=50 http://healtheknowledge.org/course/index.php?categoryid=50 http://www.ptsd.va.gov/professional/assessment/ncptsd-instrument-request-form.asp http://www.ptsd.va.gov/professional/assessment/ncptsd-instrument-request-form.asp http://www.healthquality.va.gov/ http://www.mentalhealth.va.gov/communityproviders/clinic_sud.asp http://www.mentalhealth.va.gov/communityproviders/clinic_sud.asp http://www.healthquality.va.gov/guidelines/mh/sud/ http://www.healthquality.va.gov/guidelines/mh/sud/ http://www.mentalhealth.va.gov/providers/sud/selfhelp/ http://www.mentalhealth.va.gov/providers/sud/selfhelp/ matthieu/interdisciplinary issues 230 substance use disorders. a case example focused on the use of specific assessment tools and treatment approaches drawn from dva/dod clinical practice guidelines demonstrate how clinicians can use the model in practice, to identify target behaviors, valid screening measures, and effective behavior-based treatments. finally, resources related to the training of interdisciplinary treatment teams on trauma and addictions, particularly for behavioral additions such gambling, was presented. by noting the exclusion of gd, we strongly hope that the future will bring an integration of gambling as a behavioral addiction into the evidence-based practices of clinicians who assess and treat co-occurring conditions. implications for practice with veterans and va recent changes to the dsm has re-categorized gambling as a substance use disorder. for the va, this change may instigate major national service delivery changes with substance use disorder treatment for veterans to now include gambling treatment and services within the existing “minimum requirements” services mandate (dva, 2008). as outlined in vha handbook 1160.01, uniform mental health services in va medical centers and clinics, this document requires va facilities to offer or to contract out to the community substance use treatment for all veterans with a clinical need. at present, to our knowledge, gambling addiction is not addressed in any of the va’s mandatory national screening and treatment requirements. to determine if pathological gambling is currently an unmet need in the va, the national council on problem gambling recently recommended a two-part study of all va patients to determine the severity of gambling problems and to determine if the va health care system has the capacity to serve this population (newhouse, 2013). until this national study is completed, it is critical to assess local services for the capacity for referrals and the barriers and facilitators to veterans receiving evidence based assessments and treatments for gambling. with the advent of new changes to the dsm v and the requirements for sud treatments provided by the va health care system, there are various individual, provider and system level factors that may limit the extent to which gambling treatment options are offered. first, military service members may face disciplinary action (e.g., demotion) for seeking help while still serving in the armed forces (emshoff, gilmore, & zorland, 2010). secondly, the extent to which va and military providers are systematically identifying atrisk or disordered gamblers is unknown (whiting et al., 2016). lastly, system level accessibility issues are also unknown. these issues include the frequency of gambling treatment referrals from national gambling helplines (1-800-5224700) or local crisis lines for veterans (1-800-273-8255 and press 1 for military or veteran) to the few existing out of state va facilities with gambling treatment services (e.g., va new england health care system, louis stokes cleveland health care system), to local gambling treatment programs or specialty behavioral health providers such as social workers and applied behavior analysts in the community, or to self-help groups (e.g. gamblers anonymous). given that co-occurring addictions treatment for veterans may occur in the va for ptsd and sud, and more commonly in the community with specialized gambling treatment programs or private practitioners, this fragmented system of care will require an interdisciplinary, collaborative, case management approach. collecting information within local communities and in the va to assess the availability advances in social work, spring 2017, 18(1) 231 of gambling treatment services is the first step in determining the local accessibility and then the quality of services for military and veterans. while there is an emerging picture of the etiology and prevalence of gambling in general (petry et al., 2005) and among veterans and military personnel specifically (newhouse, 2013) it is still unclear the extent to which clinicians in the community or va are identifying and treating disordered or atrisk gamblers. conclusion co-occurring mental health and substance use issues can present challenges to clinicians in recognizing both disorders and obtaining utilizing the best intervention for individuals. limited evidence exists to guide interdisciplinary treatment teams in effective behavioral treatment of co-occurring ptsd and gd. the aim of the article was to begin to address that gap in literature. we provided a model for interdisciplinary practice to assist social 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(2015). clinical application of behavior analytic social work practice. in h. s. roane, j. l. ringdahl, & t. s. falcomata (eds.), clinical and organizational applications for applied behavior analysis (pp. 501-522). london: elsevier. author note: address correspondence to: monica m. matthieu, phd, lcsw, school of social work, college for public health and social justice, 3550 lindell blvd., saint louis university, saint louis. mo 63103. http://www.samhsa.gov/sbirt http://www.integration.samhsa.gov/images/res/tool_auditc.pdf http://www.integration.samhsa.gov/clinical-practice/screening-tools https://doi.org/10.1016/0306-4603(82)90005-3 https://doi.org/10.3109/10826088709027414 http://www.ptsd.va.gov/professional/assessment/screens/pc-ptsd.asp https://www.uleth.ca/dspace/bitstream/handle/10133/2561/2011-brief%20screen-agri.pdf?sequence=1&isallowed=y https://www.uleth.ca/dspace/bitstream/handle/10133/2561/2011-brief%20screen-agri.pdf?sequence=1&isallowed=y https://doi.org/10.1556/2006.5.2016.027 __________ margaret e. adamek, phd, professor and editor, and valerie d. decker, msw, researcher and assistant editor, advances in social work, indiana university school of social work, indianapolis, in. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), i-vii, doi: 10.18060/27206 this work is licensed under a creative commons attribution 4.0 international license. fall 2022 editorial: questioning the status quo margaret e. adamek valerie decker in the fall 2022 issue of advances in social work, we are pleased to present 17 fulllength papers (11 empirical, 6 conceptual) written by 52 authors representing all different regions of the country and one paper hailing from ethiopia. the papers in this issue are organized into five areas of contribution: challenges to national social work organizations, technological innovations in social work, curriculum innovations, covid-related impacts, and diverse client populations. each paper is introduced briefly, followed by our annual recognition of aisw reviewers. challenges to national social work organizations in another critique of national social work guidelines, apgar and parada decry the 2021 revision to the nasw code of ethics that makes self-care “largely a personal responsibility,” thus blaming the victim, in this case overworked, underpaid, inadequately supervised, and under-recognized social workers. apgar and parada assert that the expectation for social workers to take responsibility for their own self-care overlooks the reality that much of the stress, burnout, and even trauma experienced by practicing social workers stems from macro or environmental stressors. by reframing social work burnout as a social justice issue, apgar and parada call for mobilization, advocacy, and political engagement to improve the working conditions of social workers. looking through the lens of the cswe epas, harrell, suslovic, johnson, boys, anderson-nathe, and botts call into question the apparently common practice of moral reconation therapy (mrt) being taught to social work students placed in correctional settings. though touted on the mrt website as a cost-effective and evidence-based intervention, harrell and colleagues point out ethical concerns with training social work students to implement an approach that targets perceived moral failing. the authors assert that mrt is unsuitable for use in social work field placements and call for it to be discontinued as a part of accredited social work education. technological innovations in social work with the goal of establishing best practices for use of information communication technology (ict) in social work practice, randolph, latham, gross, and constantino outline four challenges and five benefits of ict in relation to the worker-client relationship. randolph and colleagues argue that by applying basic principles of communication theory, social workers can make better-informed choices and use of technology tools to enhance the worker-client relationship. synthesizing the research literature on the impact of two common forms of media (television viewing and smartphone use) on child development and family functioning, https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2022, 19(3) ii bates and john highlight the importance of social workers acknowledging the impact of technology use by children and families. based on their analysis of the literature, bates and john offer several recommendations for social work educators to prepare students for new areas of practice with families in a technology-driven future. despite major challenges and significant loss of human life as a result of the covid19 pandemic, a major advance from this crisis was the widespread emergence of telehealth. the research team of dehart, iachini, king, lecleir, reitmeier, and browne interviewed 14 health care providers and 17 patients after the onset of the pandemic in a predominantly rural southern state to examine perceptions of telehealth. while telehealth improved access to care and is convenient for rural residents, several challenges persist. dehart and colleagues call for social workers to play a key role in ensuring that rural residents can benefit from telehealth to the same extent as urban residents. curriculum innovations as the healthcare field shifts from a disease model of health to a more holistic approach, integrated behavioral healthcare has emerged as a best practice model. benton, allen, anderson, and nason describe a training program to prepare msw students to provide trauma-informed, culturally relevant, evidence-based behavioral health prevention and intervention services in integrated healthcare settings. using preand post-surveys, benton and colleagues found a significant increase in knowledge, skills, and attitudes among training participants compared to a control group. further study might gauge to what extent msw graduates transfer their enhanced knowledge to the workplace. while we know that suicide is a major public health issue in the united states and that social workers are the primary providers of mental health services, what we don’t know is how many social work programs have courses specializing in suicide prevention and interventions. to address this gap, mirick collected data from 151 program directors from schools of social work around the country to establish baseline knowledge of suicidefocused course offerings. she reports on suicide content in social work curricula at three levels: bsw, msw, and continuing education. with only 6% of programs offering a required course on suicide, mirick calls for more courses specializing in suicide, especially within msw programs, so that future practitioners are well-prepared to intervene with suicidal clients using best practices. to enhance student engagement in macro social work practice, twis, greenwood, and files developed the macro practice assignment (mpa) which offers students a real-world learning exercise with embedded micro, mezzo, and macro social work applications. partnering with a community agency serving survivors of human trafficking, twis and colleagues found that multidimensional mpa improved students’ appreciation of and interest in macro practice. covid-related impacts using a mixed methods approach, keesler, wilkerson, white, and dickinson examined the experiences of social work students (n = 884) during the pandemic and their adamek& decker/editorial iii associated level of burnout, considering resilience as a moderating variable. regression analyses explained up to 45.5% of variance across three domains of burnout (i.e., exhaustion, cynicism, and professional/academic efficacy), with covid-related experiences accounting for most of the variance. coupled with the narrative results, keesler and colleagues recommend humanistic education as a possible approach to circumvent burnout, bolster student resilience, and encourage academic success. using an online survey of the general population, chonody, teater, hannan, and hal explored the factors that contribute to covid-related stress reactions among individuals across the age spectrum. among other findings, chonody and colleagues found a significant increase in stress from before the pandemic to during the pandemic across all three age groups. the results underscore the importance of understanding and responding to fear as well as other sources of stress during public health crises. diverse client populations hellman, pharris, and mũnoz call on social workers working with clients impacted by adverse childhood experiences (aces) to consider the positive psychology construct of hope. they propose a hope-centered and trauma-informed framework for responding to the negative consequences of aces. social work researchers, educators, and practitioners are challenged to learn more about the relationship between aces and hope in order to better assist ace survivors. in contrast to stereotypes of asian american students as the “model minority,” chockgoldman points out that high-achieving asian american adolescents are an underresearched population at-risk of suicide. after documenting the increase in suicidal ideation and suicide attempts within this at-risk group, chock-goldman explores ecologically valid social work interventions, including culturally appropriate suicide assessments and family therapy. an actual case study is used to illustrate key issues and relevant interventions. terzin and beasley synthesized the empirical literature focused on the adjustment experiences of international student athletes (isa) at division i universities in the u.s. using qualitative interpretive meta-synthesis, they identified three overarching themes: acculturative stress, adjustment to the college experience, and adjustment to u.s. athletics. based on their finding that isas experience stress related to their identities as students, as athletes, and in relation to acculturation experiences, the authors propose that social workers employed at division i institutions and especially within athletic departments understand and advocate for the unique needs of this population. tefera explored the challenges of social workers in addressing gender-based violence (gbv) in ethiopian refugee settings. in-depth interviews were conducted with eight social workers who had at least five years of experience working with refugees experiencing gbv. the primary challenges experienced by social workers were structural barriers emanating from the unbalanced power relationship and political interest between and within institutions, strategic/policy gaps, and organizational resource limitations. social workers in refugee settings must be trained to function in a politically-sensitive practice advances in social work, fall 2022, 19(3) iv setting. anti-oppressive and integrated developmental approaches are recommended to resolve the complex socio-economic and political forces behind the widespread gbv in ethiopian refugee settings. using a community-based participatory approach and a two-phase mixed methods research design, carrillo, pichardo, o’grady, rak, and berumen conducted a comprehensive assessment of the mental health needs of primarily mexican heritage residents of ten marginalized communities in chicago. the survey revealed that depression, anxiety, and trauma-related symptoms were prevalent and stemmed largely from oppressive national and local level structural contexts. structural and programmatic barriers were the greatest challenges to accessing mental health services. social work advocacy is needed to bring about organizational and policy changes to address these structural barriers. cross highlights the role of nicu social workers advocating for policies that support breastfeeding and thus mother-infant attachment. cross explains that breastfeeding can serve as a prevention strategy for child maltreatment by improving bonding between mother and infant. through education, promotion, and support of breastfeeding policies, nicu social workers serve a pivotal role in preventing child maltreatment. due to the lack of available validated instruments, deck, eisensmith, and cafaro developed such a measure to assess conflict in parenting couples in the process of divorce. the 8-item parents divorcing conflict scale (pdcs) is a promising measure to help identify families at risk for a high-conflict divorce process. such a tool can inform early intervention strategies that will serve to support healthy communication among divorcing couples and minimize harm to children. reviewer appreciation with this issue we would also like to thank the many reviewers worldwide who completed reviews for advances in social work this past year. in 2022, 172 individuals from 6 countries and 40 states and territories representing 124 colleges/universities and agencies served as aisw reviewers. we greatly appreciate the voluntary efforts of our reviewers in enhancing the scholarly contributions of the journal. we are very proud of both the broad participation of authors and reviewers and of our legacy as an open access journal since 2008. advances in social work 2022 reviewers and affiliations we would like to acknowledge the contributions of the following individuals who reviewed manuscripts for advances in social work in 2022. without their time, commitment, and expertise, advances in social work would not be possible. a. christson a. adedoyin, samford university abha rai, loyola university chicago alex casiano, inter american university of puerto rico alexandra jacobs, university of houston adamek& decker/editorial v alicia chatterjee, university of pennsylvania allison mason, northeastern state university (2) amanda aykanian, university of texas at arlington (2) amber sutton, auburn university at montgomery amy doolittle, university of tennessee chattanooga (3) amy levine levine, university of north carolina at chapel hill (3) amy phillips, minot state university (2) angela pittman-vanderweide, university of kentucky (2) anne sj farina, saint louis university april steen, warner university april viverette, virginia commonwealth university (4) bala raju nikku, thompson rivers university barbara pierce, indiana university bassima hussein schbley, washburn university bertha dejesus, millersville university (2) beth young, western carolina university (2) betty a. walton, indiana university beverly wagner, texas woman's university blanca codina, tulane university braveheart gillani, case western reserve brian kelly, loyola university (2) brie radis, west chester university (2) brittanie atteberry-ash, university of texas at arlington brittany lynch, new york university carmen m. cusack, nova southeastern university carol hostetter, indiana university cathy beck-cross, grand view university (2) charles leung, bnu-hkbu united international college christina borel, clinical social worker/therapist christina opolko, mcgill university (2) claire dente, west chester university of pennsylvania (2) cyndi thomas, wright state university cynthia george, tennessee state university danny carroll, indiana university david c. kondrat, indiana university david j. westhuis, indiana university (2) dawn apgar, seton hall university denise dews, university of north carolina at chapel hill dennis cornell, university of kentucky diane k. vinokur, university of michigan doris boateng, university of ghana ebony n. perez, saint leo university elisa kawam, arizona state university elisabeth counselman-carpenter, adelphi university elizabeth sharda, hope college erica mcintosh, california baptist university; va loma linda healthcare system erin stevenson, eastern kentucky university erin boyce, metropolitan state university of denver erlene grise-owens, the wellness group, etc erum agha, university of north carolina at chapel hill fabienne snowden, medgar evers college fran franklin, delaware state university frederic reamer, rhode island college gail m. augustine, indiana university gerald bean, the ohio state university gerald t. powers, indiana university graeme robert stuart, university of newcastle greta slater, ball state university hannah britton, university of kansas hasan reza, indiana university advances in social work, fall 2019, 19(3) vi heather arnold-renicker, university of denver (2) helen cahalane, university of pittsburgh (2) helen robinson, washington university in st. louis hellen gerolymatos mcdonald, university of illinois, urbanachampaign holly danforth vugia, california state university east bay i-hsuan lin, the college of saint rose jackie claes, university of iowa james marley, loyola university chicago janaki santhiveeran, california state university long beach jason newell, university of montevallo jean carruthers, queensland university of technology (2) jennifer l. bellamy, university of denver jennifer root, wilfred laurier university joan groessl, university of wisconsin green bay joan pittman, university of maryland (2) john tracy, council bluffs, ia john g. mcnutt, university of delaware karen a. ford, james madison university karen marie vandeusen, western michigan university karina gil, our lady of the lake university katrina hannan, college of staten island (2) kelley reinsmith-jones, east carolina university (2) kelly melekis, skidmore college-new york kelly sullivan, anna maria college kimberly carter, southern illinois university-edwardsville kimberly mudd-fegett, campbellsville university kori r. bloomquist, winthrop university kristi roybal, indiana university kristin hamre, indiana university kristin trainor, ball state university (3) kristina nikolova, wayne state university l. justin wheeler, ohio university (2) lana cook, university of south carolina (2) lara vanderhoof, central christian college of kansas laura kaplan, clinician lauren busfield, doylestown, pa (2) lirio k. negroni, florida gulf coast university (2) lisa de saxe zerden, university of north carolina at chapel hill (2) lisa elizabeth mcguire, james madison university (9) lorraine y. howard, rutgers, the state university of new jersey lujie peng, university of maryland makisha gunty, grand canyon university (2) margaret lane, brockport, ny (2) mark d. olson, illinois state university marriah lombardo, united states public health service mary nienow, st. catherine university matt moore, ball state university (2) matthew myrick, widener university melissa earle, stony brook university melissa singh, university of southern california meredith tetloff, university of montevallo (2) michael clarkson-hendrix, fredonia state university of new york (2) michael mcguire, university of north carolina at chapel hill michael rangel, youth support manager, skyart (2) michel coconis, ohio university zanesville (2) michelle d. garner, university of washington, tacoma michin hong, indiana university mohammad mostafizur rahman khan, indiana university (2) adamek& decker/editorial vii mónica gutiérrez, university of denver monique constance-huggins, winthrop university nancy franke, university of maryland baltimore (2) natalie montero, pennsylvania western university natasha s. mendoza, arizona state university neil bilotta, university of north carolina nicholas mazza, florida state university (2) nora padykula, westfield state university ohenewaa white, alvernia university paul archibald, college of staten island peter kindle, university of south dakota pious malliar bellian, indiana university ralph cuseglio, monmouth university ran hu, university of toronto (2) rebecca g. mirick, salem state university renee betts, indiana university robin hernandez-mekonnen, stockton university ryan savino, city university of new york saadet durmaz, indiana university samantha wolfe-taylor, indiana university (2) sandra wexler, university of pittsburgh (2) sandy leotti, university of wyoming (2) sara plummer, rutgers, the state university of new jersey sarah nightingale, eastern connecticut state university (2) shannon mount, indiana university shauntisha pilgrim, morgan state shayna harris, florida state university (2) shelby clark, university of kentucky (2) sondra fogel, university of south florida stephanie bryson, portland state university (2) stephanie rudd, university of indianapolis susan l. glassburn, indiana university susan nakaoka, sacramento state susan reay, university of nebraska at omaha (2) t. vogel, washington university in st. louis tapati dutta, fort lewis college tarkington newman, university of new hampshire (2) tayon swafford, indiana university (2) theresa palmer, university of north carolina at chapel hill thomas patrick felke, florida gulf coast university tianca crocker, university of north carolina charlotte tyleen caffrey, our lady of the lake university tyrone cheng, university of alabama valerie borum, ryerson university veronica timbers, boise state university (2) walter la mendola, university of denver (2) wanja ogongi, millersville university willa casstevens, buena vista university william frey, columbia university yolanda d. spears, univeristy of iowa zulkipli lessy, sunan kalijaga state islamic university this work is licensed under a creative commons attribution 4.0 international license. contemporary trauma theory and trauma-informed care in substance use disorders: a conceptual model for integrating coping and resilience revital goodman abstract: national data of children’s exposure to traumatic experiences are alarming. research asserts the interconnectedness between experiencing childhood trauma (ct) or adverse childhood experiences (ace) and developing substance use disorders (suds) in later adulthood. trauma definition and contemporary trauma theory (ctt) provide the foundation for trauma informed care (tic) in social work practice with co-occurring trauma and suds. tic re-conceptualizes suds as a mechanism to cope with the effects of trauma. coping and resilience are relevant factors to the ramifications of ct on suds, and are the manifestation of key tic principles. integrating tic practices aimed at enhancing coping and resilience into treatment for co-occurring trauma and suds is needed in order to negate the devastating impact of trauma and propel recovery. conclusions and implications to social work practice are discussed. keywords: childhood-trauma; ace; tic; substance use disorders; coping; resilience national data of children’s exposure to traumatic experiences are alarming. according to the national center for mental health promotion and youth violence prevention (2012), 26% of children in the united states will witness or experience a traumatic event before they turn four, with four of every 10 children reporting experiencing a physical assault during the past year (finkelhor, turner, shattuck, & hamby, 2013). other reports indicate that more than 60% of youth age 17 and younger have been exposed to crime, violence, and abuse either directly or indirectly (finkelhor, turner, shattuck, hamby, & kracke, 2015). the high prevalence of substance use disorders (suds) constitutes a growing problem in the united states, with an overwhelming number of persons challenged with this cluster of disorders (u.s. department of health and human services, office of the surgeon general, 2016). research asserts the interconnectedness between experiencing childhood trauma (ct) or adverse childhood experiences (ace) and the subsequent underlying mechanisms that contribute to the development of suds and to recovery from drug and alcohol addiction (driessen, et al., 2008; dube, et al., 2003; elwyn & smith, 2013; felitti, et al., 1998; harris, lieberman, & marans, 2007; levenson, 2016; levenson & grady, 2016). compelling associations between ct and suds define a growing need for social workers practicing in the field of suds to frame clinical practices through the lens of trauma-informed care (tic; levenson, 2015). social workers practicing in the field of addiction need to thoroughly assess past trauma experiences in order to have a better understanding of clients’ presentation and symptoms. through the lens of tic, clients’ poor clinical presentations and maladaptive functioning are perceived as the manifestation of unresolved trauma and impaired self-regulatory skills; higher dysfunction and disruptive clinical presentations suggest higher probability for a complex history of unresolved trauma. discounting the role of trauma within this clinical population may lead to inaccurate diagnoses and to subsequent inaccurate treatment, which may result in a ___________ revital goodman, phd, lcsw, is a clinical practitioner and an adjunct professor at barry university school of social work, miami shores, fl 33161 copyright © 2017 author, vol. 18 no. 1 (spring 2017), 186-201, doi: 10.18060/21312 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 187 higher percentage of treatment attrition or relapse. in order to better understand and practice tic for this clinical population, it is essential to integrate recent findings from the fields of trauma and suds with a comprehensive theoretical foundation. finally, the current knowledge about the curative influence of coping and resilience on co-occurring ct and suds provides social workers with tangible tools to improve treatment and enhance recovery. theoretical foundation for trauma informed care: trauma, and contemporary trauma theory trauma has been perceived and defined in different ways over the years, contingent on the development of knowledge and the understanding of the impact of traumatic experiences on the individual, family, community, and society (van der kolk, 2014). in recent decades, the definition of trauma has been consistently inclusive of the following elements: (1) an identified event or series of events, that is (2) experienced by the individual as physically or emotionally harmful, threatening, or overwhelming, and (3) has lasting and holistic effects on the individual’s functioning (herman, 1992; laplanche & pontalis, 1973; ringel & brandell, 2012; substance abuse and mental health services administration (samhsa), 2012; van der kolk, 2014). ct “overwhelms the ordinary human adaptation to life” (herman, 1992, p. 33) and the person’s sense of control, which may lead to maladaptive internalization of the event. such maladaptive internalization may result in disturbance to bio-psychosocial functioning, healthy development, and brain performance in regions that are related to emotions, behavior, and executive functioning (lizeretti, extremera, & rodriguez, 2012; samhsa, 2012; suleiman, 2008; van der kolk, 2014). the development of contemporary trauma theory (ctt) represents a paradigm shift in how social workers perceive and treat survivors of trauma. the new trauma-based paradigm, refrains from viewing survivors’ poor functioning as resulting from sickness, weakness, or deficiencies in moral character, and reframes viewing survivors as psychologically and physically injured, and instead, in need of healing and help (bloom & farragher, 2011; salovey & sluyter, 1997; van der kolk, 2014; williams, 2006). ctt provides a theoretical framework for understanding the impact trauma has on a person’s functioning, and is based on the following central properties: a) dissociation. dissociation in trauma “entails a division of an individual’s personality, that is, of the dynamic, bio-psychosocial system as a whole that determines his or her characteristic mental and behavioral actions” (nijenhuis & van der hart, 2011, p. 418). dissociation is the main defense mechanism used by a victim to negotiate and tolerate the horrific traumatic experience (herman, 1992; siegal, 1999; suleiman, 2008; van der kolk, 2014; williams, 2006). b) attachment. ct impacts a person’s ability to develop healthful interpersonal relationships and to establish trust, leading to impairment in the abilities to form secured attachment with others and to interruptions in interpersonal relationships (o’connor & elklit, 2008; siegal, 2010; tarren-sweeney, 2013). c) reenactment. a phenomenon in which victims seek relationships and display behaviors that reenact the original traumatic event (courtois & ford, 2016). goodman/trauma theory and tic 188 reenactment elicits an intense emotional state that releases tension or anxiety and provides the person with a sense of control and connectedness (van der kolk, 2014). d) long-term effect on later adulthood. unresolved ct may have devastating effects on functioning in adulthood (becker-blease & freyd, 2005). trauma that is experienced by a child inhibits appropriate development and predisposes the child to negative recurrence later in life, including comorbidity in physical and mental health problems (ross, 2000; williams, 2006). in addition, ct diminishes the basic sense of self and leads to destruction of intrapersonal and interpersonal capacities (courtois, 2008; herman, 1992; lewis, 2012; ringel & brandell, 2012; salovey & sluyter, 1997; shapiro, 2012; van der kolk, 2014; williams, 2006). e) impairment in emotional capacities. emotional numbing and the break down of the self-regulatory system are direct impacts of trauma on the brain and on the adaptive functioning of the limbic system, the part of the brain that supports a variety of functions, including the emotional life (badenoch, 2008; salovey & sluyter, 1997; siegal, 1999; van der kolk, 2014). traumatic events, and especially prolonged exposure to trauma, which is typical in childhood abuse or neglect, diminish the sense of baseline state of both emotional and physical calm or comfort, resulting in hyper-arousal symptoms that include hypervigilant, anxiety, agitation, night terror, and somatization (herman, 1992; siegal, 1999; shapiro, 2010; van der kolk, 2014; van der kolk, mcfarlane, & weisaeth, 2006; williams, 2006). victims of ct display compromised ability to regulate their moods and their emotional responses as adults, including the ability to identify emotions in self and others, to understand emotions, and to self-regulate, which may lead to dissociation and dissociative identity disorder in extreme cases of abuse (levendosky & buttenheim, 2010; mészáros, 2010; salovey & sluyter, 1997; schutte, malouff, & hine, 2011; shapiro, 2010). ctt provides a conceptual foundation for understanding the bio-psychosocial impact of trauma on children and adults. given the devastating impact ct has on brain functioning and on adequate development of social and emotional skills, the correlation between ct and suds is prescient. the link between substance use disorders and childhood trauma studies validate the deleterious effects of accumulative ct or ace on future life outcomes, including mental and physical health, social problems, sexually offensive behaviors, and death (felitti, et al., 1998; heffernan et al., 2000; jung, herrenkohl, klika, olivia-lee, & brown, 2014; levenson, 2016). research in the area of mental health indicates high correlations between ace or ct and suds (banducci, hoffman, lejuez, & koenen, 2014a). these correlations signify an essential need to integrate tic into treatment for suds. advances in social work, spring 2017, 18(1) 189 research provides robust correlation between trauma and substance abuse, ace and serious problems with drug use, and trauma as an independent risk factor for drug or alcohol relapse in substance-abusing populations (dube et al., 2003; elwyn & smith, 2013; felitti, et al., 1998; harris, lieberman, & marans, 2007; levenson, 2016; levenson & grady, 2016; torchalla, nosen, rostam, & allen, 2012). child maltreatment refers to dominant and/or persistent environmental stressors that hinder the development of personality and may lead to increased psychopathology (handley, rogosch, guild, & cicchetti, 2015; oshri & rogosch, 2013). exposure to chronic victimization results in more global dysfunction, added distress, and vulnerability (turner, finkelhor, & ormrod, 2010) and is linked to increased risk for substance abuse problems in adulthood (driessen, et al., 2008; elwyn & smith, 2013). felitti et al. (1998) found that ace account for one-half to two-thirds of increased problems with drug use among over 17,000 adult patients of the kaiser permanente health system. the writers identified strong positive correlations between the ace score and initiation of illicit drug use problems and drug addiction. similarly, later studies linked exposure to violence in childhood with a greater risk for alcohol and drug abuse in adulthood (harris, et al., 2007; jung et al., 2014; van der kolk, 2014). ct was identified as an independent risk factor for drug or alcohol relapse in a sample recruited from a substance-abusing population (driessen et al., 2008). finally, while ct adversely affects both men and women, studies indicate higher rates of childhood sexual abuse among women diagnosed with suds compared to childhood physical abuse among men diagnosed with suds. data suggest ct rates between 60%-75% of women enrolled in suds treatment (keyser-marcus, et al., 2015). consequences of co-occurring trauma and suds research highlights severely adverse consequences of co-occurring trauma and suds. significant correlations exist between ct and suds and deleterious patterns of substance abuse comorbidity, and higher rates of all psychiatric disorders, including mood disorders, anxiety disorders, psychotic symptoms, and personality disorders (bombardier et al., 2004; brucker, 2007; dickey, azeni, weiss, & sederer, 2000; ross, 2000). persons with a ct history and suds diagnosis report high frequency of suicidal thoughts and suicide attempts (keyser-marcus, et al., 2015). there is recent evidence that type of childhood abuse correlates with maladaptive emotional and behavioral patterns among adults diagnosed with suds. childhood sexual abuse is linked with risky sexual behaviors in adulthood, childhood physical abuse with aggressive behaviors, and childhood emotional abuse with emotion dysregulation (banducci, hoffman, lejuez, & koenen, 2014b). finally, cooccurring ct and suds are correlated to myriad physical health problems, sexually transmitted diseases, homelessness, decreased psychosocial functioning, poor well-being, and an overall reduction in quality of life (levenson, 2015; wu, schairer, dellor, & grella, 2010). goodman/trauma theory and tic 190 the curative roles of coping and resilience research findings indicate that coping and resilience are curative factors that play an important role in mitigating the impact of ct on later suds (kuper, gallop, & greenfield, 2010; schneider, lyons, & khazon, 2013; weiland, et al., 2012). coping is defined as a range of skills and strategies employed by the individual in counteracting the negative impact of stressful or challenging life experiences (valtonen, sogren, & cameronpadmore, 2006). coping includes a wide range of behavioral and cognitive activities that play an important role in functioning, adaptation, and general quality of life (toker, ti̇ryaki̇, ozçürümez, & iskender, 2011). resilience is defined as the capacity to spring back and successfully adapt in the face of adversity (henderson & milstein, 1996). the resilient person is able to develop adaptive functioning and competences despite exposure to severe stress (henderson & milstein, 1996). in the context of drug addiction, resilience is defined as the person’s ability to tolerate, adapt, or overcome crises (beauvais & oetting, 1999). coping style is a vital protective factor associated with substance use abstinence and maintaining sobriety (kuper et al., 2010). advanced coping is associated with decreased internalized stigma and with increased adaptation among persons diagnosed with suds (chou, robb, clay, & chronister, 2013; valtonen, et al., 2006). poor coping styles are associated with more severe and detrimental substance use pathways and relapse (franken, hendriks, haffmans, & van der meer, 2003; lyvers & edward, 2008). furthermore, nonadaptive coping is prevalent among clinical samples of adults with a history of ct and cooccurring suds. findings indicate ct significantly compromises overall coping capacities; those already compromised coping capacities are further weakened by harmful patterns of alcohol and drug abuse (lyvers & edward, 2008; smyth & wiechelt, 2005; toker, et al., 2011). recent conceptualizations of coping highlight the interconnectedness between coping and emotional regulation skills and impulse control, and suggest that better coping skills are contingent on sophisticated emotional capacities (erozkan, 2013; mikolajczak, nelis, hansenne, & quoidbach, 2008; saklofske, austin, galloway, & davidson, 2007). emotional capacities and advanced coping are significantly and positively correlated, with the ability to regulate emotions being a reliable predictor of the ability to employ a wide range of coping strategies to negotiate stressors (downey, johnston, hansen, birney, & stough, 2010; mikolajczak, et al., 2008; perera & digiacomo, 2015; zeidner, kloda, & matthews, 2013). research affirms the central role of resilience in ct and suds. higher resilience is related to lower levels of substance use, fewer alcohol problems, and a delayed onset of substance abuse (weiland et al., 2012). similarly, enhanced resilience plays a significant protective role in successful recovery from suds (roberts, galassi, mcdonald, & sachs, 2002). researchers provide compelling evidence in support of the association between emotional capacities and resilience, and of resilience as a mediating factor among advanced emotional capacities, affect balance, and well-being (armstrong, galligan, & critchley, 2011; liu, wang, & lu, 2013; zeidner, matthews & roberts, 2012). advanced emotional capacities relate to stress resilience (schneider et al., 2013) and demonstrate strong relationships with resilience factors among clinical samples of young adults with cooccurring ct and suds (montgomery et al., 2008). as such, enhanced resilience is tied to enhanced abilities to tolerate stress and to regulate emotions despite adversities, reducing advances in social work, spring 2017, 18(1) 191 the person’s need to self-medicate with substances. contemporary trauma theory and trauma-informed care: an emerging conceptual and integrative model for enhancing coping and resilience (core) building on the existing literature pertaining the high rates of co-occurring ct and suds among adults, research asserts both the need and the effectiveness of adding tic and trauma-focused strategies into standard suds treatment (back et al., 2014; covington, 2008; van dam, ehring, vedel, & emmelkamp, 2013; farrugia et al., 2011; torchalla, et al., 2012). the national center for trauma informed care (samhsa, 2015) published six key guiding principles that inform the spirit and the application of working with trauma survivors. these principles are: (1) safety; (2) trustworthiness and transparency; (3) peer support; (4) collaboration and mutuality; (5) empowerment, voice and choice; and (6) cultural, historical, and gender issues. these six principles reflect and define a resiliencebased approach to enhanced coping. these principles correspond with empirical research that asserts the curative roles of resilience and coping to the ramifications of ct on suds. as such, it is postulated that coping and resilience are relevant and essential components that need to be integrated into a tic model for the treatment of co-occurring trauma and suds. furthermore, it is suggested that an integrative and comprehensive model of tic to suds needs to encompass scientific research, theory, and practice. the research component consists of recognition of the prevalence of childhood trauma, familiarity with the existing scientific correlations between ct and the development of suds, and the integration of findings related to the curative roles of coping and resilience. the theoretical component incorporates a clear definition of trauma and a comprehensive understanding of the five tenets of ctt. the theoretical component further illustrates a realistic expectation of clinical presentations that are based on ctt, and provides clinicians with an enhanced understanding of clients’ symptomology. finally, the practical component guides clinicians to proactively apply the key principles of tic as defined by samhsa (2015), in order to originate a superior therapeutic environment and to deliberately create opportunities for clients to enhance coping and resilience within treatment for suds. goodman/trauma theory and tic 192 figure 1. contemporary trauma theory and trauma-informed care: an emerging conceptual and integrative model for enhancing coping and resilience (core). figure 1. core model summary: this emerging integrative core model for treating suds incorporates scientific findings of the positive correlations between ct and suds, the negative correlations between ct coping and resilience, and of the curative role of coping and resilience in recovery from suds. ctt and tic are the overarching frameworks of the model. ctt provides the framework for understanding clinical presentations and symptomology. tic defines guiding principles for delivery of services in a manner that recognizes the impact of trauma history and actively seeks to avoid retraumatization. the core model suggests viewing suds through the lens of childhood trauma history and ctt as well as through the application of tic principles; these clinical components will directly impact resilience, coping and current trauma symptoms in order to enhance substance use recovery. childhood trauma is placed outside the direct impact of the intervention in that it provides the lens of treatment needed, and has an impact on current symptoms, yet is not directly impacted by the treatment since the childhood trauma has already happened and cannot be changed. a trauma-informed approach views presenting problems and symptomology as a maladaptive coping with unresolved traumatic experiences (levenson, 2014). from a neurobiological perspective, ct and childhood maltreatment -including the types of trauma or maltreatment, the developmental timing in which the events occurred, and the degree of chronicity -have an adverse impact on brain structure and development, and on the brain’s functioning specifically in regions responsible for impulse control, executive functioning skills, and emotion-focused tasks (cowell, cicchetti, rogosch, & toth, 2015; toth, gravener-davis, guild, & cicchetti, 2013). while tic does not necessarily mean directly addressing trauma (brown, baker, & wilcox, 2012), it does signify the need to conceptualize the person’s presentation through the lens of trauma and ctt. tic in the context of suds views drug and alcohol abuse as a tool to self-medicate and negotiate capacities impeded by unresolved trauma (khantzian & albanse, 2008). the application of tic to suds treatment refrains from viewing the person as deficient in moral character or as lacking motivation, and re-frames the person’s presentation as resulting from contemporary trauma theory & trauma informed care history of childhood trauma resilence coping substance use outcomes current trauma symptoms advances in social work, spring 2017, 18(1) 193 unresolved psychological trauma. the application of tic into treatment for suds promotes viewing the person as lacking a basic sense of safety and as challenged with his or her abilities to display adaptive functioning and employ accurate judgment, especially in emotionally charged situations. drug and alcohol abuse is perceived as the person’s attempt to cope with these deficiencies not in order to make the person “feel good” but in order to make the person feel “normal” -or not to feel at all. persons diagnosed with co-occurring trauma and suds are at particular risk for being re-traumatized (van der kolk, 2014). first, addiction in itself is highly traumatizing, exposing the person to life-threatening experiences and to severe disturbances. second, both trauma and addiction adversely impact the person’s ability to form safe and secure attachments (siegal, 2010). hence, the combined effect of ct with suds creates a snowball effect that leads to decreased functioning, reenactment, and an overall loss of a basic sense of safety and trust. this destructive cycle makes psychoactive substances catnip, and relapse a cure. often times, this is the presentation of clients who are classified by professionals as problematic, defiant, resistant to treatment, or lacking motivation to change -perceptions and views that further marginalize and re-traumatize survivors. tic for social work practice with co-occurring trauma and suds deliberately avoids the use of marginalization and detrimental views of clients. applying tic requires assessing, diagnosing, perceiving, and approaching the most difficult client presentations through a thorough understanding of the impact of trauma and of ctt. conclusions and implications for social work research findings concerning the relationship between ct and the subsequent underlying mechanisms contributing to the development of suds and to recovery from drug and alcohol addiction instigate a need for a comprehensive tic model to guide clinical practices. an integrative tic model is based on a sound theoretical foundation, cutting edge research findings, and clear targets for clinical intervention. specifically, the relevancy of coping and resilience as curative factors to negate the impacts of ct hinder the development of suds, and are crucial in providing a sound base to tic practices. treatment centers and programs for suds need to invest in training all personnel that are in direct contact with clients on the impact of trauma in order to apply a systematic trauma-informed therapeutic environment that is congruent with samhsa’s (2015) guiding principles. practicing in the field of addiction through the lens of tic requires a shift in understanding the epidemiology of suds to include a consistent comprehension of the global impact of trauma, an ability to detect and determine the existence of trauma among diagnosed individuals, an integration of trauma-based knowledge and theory into policies and practices, and an active seeking to avoid re-traumatization of individuals (samhsa, 2015). social workers need to be knowledgeable of the prevalence of ct among this clinical population and of the potential existence of ct history, especially among clients with challenging clinical presentations. moreover, social workers need to deliver treatment interventions that are aimed at strengthening resilience and coping skills among clients. for example, integrating obtainable tasks and behavioral rewards that will mobilize clients to action such as: problem solving challenges; assuming responsibilities and roles within the residential treatment; and expanding communal connections by goodman/trauma theory and tic 194 volunteering or attending self-help meetings. social workers whose practice involves atrisk and traumatized populations need to integrate trauma-informed practices that are focused on creating opportunities to develop and enhance coping skills and resilience into prevention and early intervention programs for youth. finally, it is recommended for social work educational institutions to adequately train bsw and msw students – especially those entering the workforce in the field of addiction, whether in direct practice, administration, or policy -in incorporating trauma-informed practices into prevention, assessment, and intervention in work with at-risk and clinical populations. references armstrong, a. r., galligan, r. f., & critchley, c. r. 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(2012). the emotional intelligence, health, and well-being nexus: what have we learned and what have we missed? applied https://doi.org/10.1016/j.jsat.2011.09.001 https://doi.org/10.1017/s0954579413000795 https://doi.org/10.1016/j.amepre.2009.11.012 https://doi.org/10.1093/bjsw/bch247 https://doi.org/10.1111/j.1530-0277.2012.01741.x https://doi.org/10.1080/15325020600663078 https://doi.org/10.1016/j.addbeh.2009.09.003 https://doi.org/10.1037/a0034009 advances in social work, spring 2017, 18(1) 201 psychology: health and well-being, 4(1), 1-30. doi: https://doi.org/10.1111/j.17580854.2011.01062.x author note: address correspondence to: dr. revital goodman, revital goodman psychotherapy, llc, 9858 glades road #d3-218, boca raton, fl 33434. 561-212-8446, revitalgoodman@gmail.com https://doi.org/10.1111/j.1758-0854.2011.01062.x https://doi.org/10.1111/j.1758-0854.2011.01062.x mailto:revitalgoodman@gmail.com _______________________ jacky thomas, phd, msw, lcsw is an associate professor of social work at california state university, san marcos, ca, 92096 . blake beecher, phd, msw, lcsw is associate professor and social work program director, also at california state university san marcos. copyright © 2018 authors, vol. 18 no. 4 (fall 2018), 1113-1134, doi: 10.18060/21589 this work is licensed under a creative commons attribution 4.0 international license. what doesn’t kill you: correlates of resilience among master of social work students jacky t. thomas blake beecher abstract: the purpose of this exploratory study was to examine the relationship between adverse childhood experiences (aces) and resilience in a sample (n=139) of masters of social work (msw) students. perceived stress, religious faith, experiential avoidance, and mindfulness were also examined as correlates of resilience. resilience scores for the msw students were comparable to general population and college student norms, but aces and perceived stress scores were higher. despite a broad literature supporting associations of high ace scores with varied measures of physical and psychological problems, this study paradoxically showed a positive relationship between higher ace scores and resilience. regression analysis indicated a model including age, ace scores, experiential avoidance, religious faith, and perceived stress explained 39.2 % of the variance in resilience scores. prior adverse childhood experiences and stronger religious faith are associated with increased resilience, while experiential avoidance and perceived stress are associated with lower resilience. this study provides further evidence that many students come to social work education with substantial trauma histories and experience considerable stress during their studies. results suggest that social work educators should acknowledge risks associated with avoidant coping, and provide learning experiences aimed at developing students’ capacities for increased awareness and acceptance of challenging experiences— their own and others. keywords: resilience, adverse childhood experiences (aces), experiential avoidance, msw students the concept of resilience, defined generally as the experience of having relatively good outcomes in the face of adversity (rutter, 2007), has received considerable attention in the research literature. in light of greater understanding of the substantial risks involved in providing services to persons who are suffering or traumatized, researchers more recently have attempted to investigate resilience among helping professionals and trainees. in the social work profession particularly, work-associated stress is high, with burnout, vicarious trauma, and compassion fatigue taking a significant toll on individual workers, on the clients they serve, and on the stability of the professional workforce (bride & figley, 2007; grant & kinman, 2012). social work students also experience high levels of stress in both coursework and field placements (carello & butler, 2015; grant & kinman, 2012), but are often hesitant to speak about their stress to instructors and supervisors (grant & kinman, 2012). additionally, the experience of prior trauma is fairly consistently considered a risk factor for the development of stress-related disorders among helping professionals (zosky, 2013), and many, if not most, students in clinical training programs have experienced trauma (carello & butler, 2015, p. 263). several studies have indicated https://creativecommons.org/licenses/by/4.0/ thomas & beecher/what doesn’t kill you 1114 that many social workers come to the profession with a personal history of adverse childhood experiences, and that those trauma histories may, in fact, have motivated them to enter the profession (grant, 2014; rompf & royse, 1994). with increasing awareness of the stressors faced by social work professionals and students, educators and researchers have begun to examine ways that resilience can be developed and enhanced during training. this study explored the associations between adverse childhood experiences and resilience, and also examined relationships between resilience and perceived stress, religious faith, experiential avoidance, and mindfulness among a sample of msw students. literature review resilience we know that trauma does not invariably result in bad outcomes (dumont, widom, & czaja, 2007; yehuda & flory, 2007); rather, there is great variability in responses to traumatic events (rutter, 2013). about half of those who experience childhood physical or sexual abuse, for example, show positive psychosocial functioning in adulthood (rutter, 2007). what makes one person able to endure significant adversity and survive, even grow, while another can experience the same event and suffer chronic, debilitating effects? is it possible for individuals and organizations to develop strategies which contribute to resilient responses to adversity? the idea that people can thrive despite challenges, and that the capacity to do so can be developed or enhanced, is congruent with the strengths-based, person-in-environment focus of social work, and with the recovery model of mental health practice (atkinson, martin, & rankin, 2009). resilience has been defined as “a dynamic process encompassing positive adaptation within the context of significant adversity” (luthar, cicchetti, & becker, 2000, p. 543). rutter (2007) described it as “the phenomenon that some individuals have a relatively good outcome despite suffering risk experiences that would be expected to bring about serious sequelae” (p. 205). richardson’s (2002) model of resilience suggested that stressors or traumas challenge bio-psycho-spiritual homeostasis, resulting in disruptions in that homeostasis (depending on the interaction between stressors and existing protective factors). the individual’s worldview is then changed, requiring a reintegration of the new experiences. the result may be: resilient reintegration (posttraumatic growth), implying growth from the original homeostatic state; reintegration back to the original state, in which people just get through the crisis and back to their homeostatic state (but without growth); reintegration with loss, meaning that some motivation, hope or drive is lost as a result of the stressor; or dysfunctional reintegration, when people resort to various destructive behaviors to deal with the experience (richardson, 2002). viewed as successful stress coping (connor & davidson, 2003), resilience is not a collection of personality traits, but a biopsychosocial process which can only be developed in the presence of adversity (rutter, 2007). resilience occurs in a complex ecological context (greene, 2008) and involves reciprocal interactions between a person experiencing stress and his or her environments. it involves an intricate interplay of genetics and advances in social work, fall 2018, 18(4) 1115 environment, coping styles, and mental processes, and may depend on experiences that occur subsequent to risk exposure (rutter, 2006, 2007). in short, what people do in response to the challenges they face matters (rutter, 2007). various authors argue that within clinical training programs, including social work, more attention should be paid to developing intrapersonal, interpersonal, and organizational capacities that contribute to a more resilient and sustainable professional workforce (grant & kinman, 2012; howard et al., 2015). yet, information is limited regarding the types of experiences that contribute to resilient responses. according to rutter (2013), stable and positive social relationships, social role satisfaction, and a sense of community all had positive associations with resilience. particular emphasis was placed on “inoculation”, “steeling”, or “turning-point” experiences which involve exposure to manageable stressors and opportunities for successful coping, intentional self-reflection, and a sense of personal agency (rutter, 2007, 2013). kinman and grant (2011) found trainee social workers who showed greater emotional intelligence, reflective ability, social confidence, and aspects of empathy were more resilient to stress. wilks (2008) studied a sample of undergraduate and graduate social work students and found that social support was positively associated with resilience, and that social support from friends, specifically, moderated the negative relationship between academic stress and resilience. kapoulitsas and corcoran’s (2014) qualitative study indicated the complexity of various personal and organizational processes in the development of practitioner resilience, including the importance of supportive supervision and training and the development of professional wellness. although this current study does not examine social support or organizational/structural variables related to resilience, we wish to explicitly acknowledge the importance of these considerations. we agree with grant and kinman (2014) who caution against attempting simply to enhance the ability of clinicians to cope with difficult circumstances without also making needed institutional and structural changes in resources and organizational culture (p. 12). adverse childhood experiences the adverse childhood experiences (aces) study, a large prospective epidemiological study conducted in 1994 by the u.s. centers for disease control and kaiser permanente health network, examined rates of childhood adverse experiences among over 17,000 health maintenance organization participants coming in for routine wellness checks (anda et al., 2006). the participants reported on 10 categories of adverse experiences occurring before age 18, including physical, emotional, and sexual abuse, emotional and physical neglect, domestic violence, parental separation or divorce, and mental illness, substance abuse, or incarceration of household members. the study found that most respondents had experienced at least one adverse event, and 12.5% had experienced four or more (anda et al., 2006). rates of childhood adverse experiences were strongly correlated with a remarkable variety of negative health and social outcomes in later life, including obesity, heart disease, anxiety, depression, substance abuse and interpersonal violence (anda et al., 2006; dube, williamson, thompson, felitti, & anda, 2004). aces can cause neurodevelopmental injuries and deficits (anda et al., 2006; thomas & beecher/what doesn’t kill you 1116 nurius, green, logan-greene, & borjaa, 2015), which then result in an increase in risk behaviors used to cope with trauma reactions, ultimately compromising healthy future adaptation. the original ace study has been replicated in various populations, and findings are beginning to shift our understanding of trauma and the multiple and cascading consequences of early adverse events (center for youth wellness, 2013; centers for disease control and prevention, 2010). efforts are increasing to incorporate the implications of the ace study (and consequent trauma-informed practices) into organizations, policies, and provider networks (larkin, shields, & anda, 2012). researchers are beginning to examine adverse childhood experiences not just in clinical populations, but also among helping professionals, including social workers and social work students (thomas, 2016). esaki and larkin (2013) looked at adverse childhood experiences among social workers employed at a residential child service agency serving traumatized children, and found much higher ace scores than those reported in the original ace study. for example, 27.6% of the child service workers had ace scores of 4 or more, compared with only 12.5% in the general population sample. howard and colleagues (2015), in a study of 192 social workers providing services to children in foster care, examined the relationship between professional quality of life, adverse childhood experiences, resilience, and work environment. this study again showed higher rates of aces among these workers than in the general population (25.1% vs. 12.5% with ace scores of 4 or more). however, contrary to expectations, higher ace scores predicted greater compassion, satisfaction, and reduced risk for burnout (howard et al., 2015). several other studies have examined trauma histories among social work students, though few have used the exact criteria from the adverse childhood experiences study. black, jeffreys, and hartley (1993) found that msw students reported a significantly higher frequency of family trauma than did the comparison group of mba students, and rompf and royse (1994) found that social work students reported significantly more marital discord, familial emotional problems, and alcohol or drug addiction in their families of origin than did a comparison group of students in english classes. dykes (2011) reported 73% of social work students in her sample had experienced adverse childhood experiences. additional variables perceived stress. stress occurs when the resources of an individual are insufficient to manage existing demands (lazarus & folkman, 1984). the prevalence of stress is increasing among college students, and the perception of stress influences adjustment to academic life and academic success (friedlander, reid, shupak, & cribbie, 2007; robotham & julian, 2006). relatively high levels of perceived stress are found among graduate students in general, and msw students in particular (addonizio, 2011; collins, coffey, & morris, 2010). graduate students participate in the full complement of adult life stressors, including financial and employment worries, relationship conflicts, and family and health concerns. additionally, grant and kinman (2012) suggest that social work students may face stressors beyond those faced by other graduate students because of the complex and http://www.tandfonline.com.ezproxy.csusm.edu/doi/full/10.1080/03098770600617513?src=recsys advances in social work, fall 2018, 18(4) 1117 emotionally demanding content within the curriculum and field placements, and also may be more reluctant to disclose their stress and seek assistance. previous studies have shown significant associations between perceived stress and resilience in college student and general adult populations (abdollahi, talib, yaacob, & ismail, 2014; abolghasemia & varaniyaba, 2010; moore et al., 2015; mroz, 2015; seyedfatemia, pourafzalb, inanlooc, & haghani, 2015; willis & burnette, 2016). religious faith. according to canda, nakashima and furman (2004), the majority of social work students, faculty, and practitioners see religious faith and spirituality as important to themselves and their clients. religion is defined as “an organized, structured set of beliefs and practices shared by a community related to spirituality” (p. 28), while spirituality is broader and reflects a search for meaning and purpose in life and a morally fulfilling connection to self and others (canda et al., 2004). religious faith is increasingly associated with a variety of health benefits (plante, vallaeys, sherman, & wallston, 2002), including hardiness and self-esteem (kamya, 2000), lowered depression in older adults (koenig, george, & peterson, 1998), and resilience among persons in substance abuse recovery (pardini, plante, sherman, & stump, 2000). religious faith and spirituality may buffer the impact of stress in both msw (lee, 2007) and psychology students (brown, 2012) and has been positively correlated with resilience (eriksson & yeh, 2012; javanmard, 2013). experiential avoidance. traumatic states can be perpetuated by maladaptive coping strategies which, though aimed at protecting the self, actually keep the traumatized person stuck in negative patterns of thinking and behaving leading to problems in flexible and adaptive self-regulation (wells & sembi, 2004). these coping strategies include vigilant attention to threat, worry and ruminative thinking, and attempts to suppress or avoid thoughts and reminders of the trauma. the latter strategy, experiential avoidance, is especially relevant in examining vulnerable or resilient responses to trauma. experiential avoidance is described as an unwillingness to experience thoughts, memories, emotions, and bodily sensations, even when doing so interferes with quality of life (hayes, wilson, gifford, follette, & strosahl, 1996). experiential avoidance reduces psychological flexibility (boulanger, hayes, & pistorello, 2009) and is associated with lowered functioning in both clinical and non-clinical populations and a broad range of psychological and behavioral problems, including depression, anxiety, substance abuse, and post-traumatic stress disorder (ptsd) symptoms (boulanger et al., 2009; thompson, arnkoff, & glass, 2011). bond and colleagues (2011) similarly found that greater experiential avoidance is associated with increased symptoms of anxiety, stress, depression, thought suppression and psychological distress, and suggest that it may increase risk for mental health problems. campbell-sills, cohan, and stein (2006) found associations between experiential avoidance and lowered resilience, and boulanger and colleagues (2009) cite several longitudinal studies examining the predictive power of experiential avoidance for later development of psychopathology and argue that strategies of avoidance may prevent healthy resolution of traumatic experience and predict disordered responses such as ptsd. thomas & beecher/what doesn’t kill you 1118 mindfulness. mindfulness is most commonly defined as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (kabat-zinn, 1994, p. 4) and involves an ability to pay attention to what is occurring in the present moment, in which the person is able to simply observe what is taking place, without filtering events through cognitive appraisals, evaluations, memories, beliefs, etc. (brown & ryan, 2003). mindfulness is associated with greater psychological adjustment following trauma (thompson et al., 2011), improved academic performance (shapiro, brown, & astin, 2008), and increased resilience among social work students (roulston, montgomery, campbell, & davidson, 2017) and professional social workers (crowder & sears, 2017; kemper, mo, & khayat, 2015). mindfulness has also been linked to improved stress coping, decreased rates of burnout, and greater compassion satisfaction among healthcare workers, physicians, and social workers (galantino, vaime, maguire, szapary, & farrar, 2005; krasner et al., 2009; thomas, 2013). current study many msw students come into their training with histories of adverse experiences, and then encounter additional stressors as they complete academic and field education. resilience is not fixed and static, and may be influenced by experiences both prior to and following stressful events. given this, it is important that social work educators understand factors associated with resilience in order to do the best job possible in preparing students for sustainable careers. resilience can be learned, and social work education should place explicit focus on ways to better develop resilient practitioners (beddoe, davys, & adamson, 2013). we know that the meaning people make of their experiences can be critical in how they cope with traumatic and stressful events (calhoun & tedeschi, 2013). there is evidence that the ability to acknowledge and reflect on experiences is important to meaning-making, and is an important factor in the development of resilience (rutter, 2013; kinman & grant, 2011). this study examined relationships between resilience and several factors which may influence how msw students cope with, interpret, and ultimately respond to challenges they have experienced or are currently experiencing. based on the review of the literature cited above, we hypothesized the following: 1) ace scores for this sample of msw students would be higher than those reported in general population and college samples described earlier; 2) higher ace scores would be associated with lower resilience scores; 3) higher perceived stress scores would be associated with lower resilience scores; 4) higher scores on religious faith would be associated with higher resilience scores; 5) higher experiential avoidance scores would be associated with lower resilience scores; and 6) higher mindfulness scores would be associated with higher resilience scores. advances in social work, fall 2018, 18(4) 1119 method sample and procedures this study used cross-sectional data to explore the relationship of resilience with adverse childhood experiences, perceived stress, religious faith, experiential avoidance, and mindfulness in a convenience sample of 139 master of social work (msw) students at a regional university in the western united states. after receiving approval from the university institutional review board, anonymous surveys consisting of demographic questions and 6 established scales measuring resilience, adverse childhood experiences, perceived stress, religious faith, experiential avoidance, and mindfulness were distributed to msw student volunteers in 2015. one hundred and thirty-nine students (93.2%) chose to complete the cross-sectional survey. an analysis of the ace prevalence data with a portion of this sample was previously reported (thomas, 2016). participants were drawn from both 2-year and 3-year msw cohorts, and were concurrently completing internships in community field placements for 16-20 hours per week. students were offered a $5 gift card for participation, and were provided with informed consent documents regarding procedures to protect confidentiality and assurances that there would be no consequences if they chose not to participate. the final sample consisted of 139 msw students (see table 1). eighty-one percent of students were younger than 35, and about 82% were female. less than half were white/caucasian/european and 32% were hispanic/latino, with other categories making up the other 23%. table 1. demographics of participants (n=139) characteristics n % gender (n=138) female 113 81.9% male 25 18.1% race/ethnicity (n=138) alaskan native/america indian/first nation 3 2.2% asian/asian american/pacific islander 16 11.6% black/african american 7 5.1% hispanic/latino 45 32.6% white/caucasian/european 62 44.9% other/mixed 5 3.6% age (n=139) <25 35 25.2% 25-34 78 56.1% 35-44 19 13.7% 45-54 5 3.6% >54 2 1.4% thomas & beecher/what doesn’t kill you 1120 survey instrument the survey instrument consisted of 13 demographic questions; 6 established scales measuring resilience, adverse childhood experiences, perceived stress, religious faith, experiential avoidance, and mindfulness; and questions related to career motivation and coping (not addressed in the present article). resilience is considered the primary outcome variable in this study. scores for aces, perceived stress, religious faith, experiential avoidance, and mindfulness are included as correlates. see table 2 below for scale properties. resilience. the connor-davidson-resilience scale, cd-risc 25 (connor & davidson, 2003) was used to measure resilience. the cd-risc contains 25 items rated on a 5-point likert scale from 0 to 4, with a total summed score range of 0 to 100 with higher scores indicating greater resilience. the scale has been translated into many different languages and studied in a variety of populations, with multiple studies demonstrating validity and reliability of the measure (cd-risc, n.d.). cronbach’s alpha in this study was α = .88. correlates. five variables are included as potentially relevant correlates to resilience. these include aces, perceived stress, religious faith, experiential avoidance, and mindfulness. aces. the adverse childhood experiences (aces) questionnaire (felitti et al., 1998) consists of 10 items inquiring about physical, emotional, and sexual abuse; emotional and physical neglect; domestic violence; parental separation or divorce; and mental illness, substance abuse, or incarceration of household members. the measure has been validated in subsequent studies (dube et al., 2004; esaki & larkin, 2013). one point is assigned for each category of adverse experience endorsed, with a range of total scores between 0 and 10. cronbach’s alpha in this study was α = .77. perceived stress. the cohen perceived stress scale 10 (pss-10) measures “the degree to which individuals appraise situations in their lives as stressful” (cohen, kamarck, & mermelstein, 1983, p. 385). the pss demonstrated adequate reliability and correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance (cohen et al., 1983). the measure uses a 5-point likert scale ranging from 0-4, with several reverse-scored items. total scores range from 0-40, with higher scores indicating greater perceived stress. cronbach’s alpha in this study was α = .86. religious faith. the brief santa clara strength of religious faith questionnaire (bscsrfq, plante et al., 2002) is a 5-item scale measuring religious belief and involvement, strongly correlated with the longer 10-item scale found to be reliable and valid (plante et al., 2002). the scale uses a 4-point likert scale with total scores ranging from 5-20. higher scores indicate greater strength of religious faith. cronbach’s alpha in this study was α = .95. experiential avoidance. the acceptance and action questionnaire ii (aaq ii) is a 7item scale measuring psychological inflexibility, or experiential avoidance, which is an important predictor of psychological distress and behavioral ineffectiveness (bond et al., http://www.sciencedirect.com/science/article/pii/s1976131712000527#bib6 http://www.sciencedirect.com/science/article/pii/s1976131712000527#bib6 advances in social work, fall 2018, 18(4) 1121 2011). the aaq ii uses a 7-point likert scale with total scores ranging from 7-49. higher scores indicate greater psychological inflexibility or experiential avoidance. cronbach’s alpha in this study was α = .91. mindfulness. the mindful attention awareness scale (maas) is a 15-item scale designed to assess individual differences in the frequency of mindful states over time (brown & ryan, 2003). the scale has been shown to have excellent psychometric properties. it uses a 6-point likert scale with scores ranging from 1 to 6. a mean score is calculated, thus total scores range from 1-6 with higher scores indicating greater mindfulness. cronbach’s alpha in this study was α = .89. table 2. scale properties scale* number of items possible range of scores α (in current study) mean sd cd-risc 25 25 0-100 0.88 77.46 9.88 aces 10 0-10 0.77 3.04 2.51 pss-10 10 0-40 0.86 18.29 6.19 bscsrfq 5 5-20 0.95 12.01 5.96 aaqii 7 7-49 0.91 19.02 8.47 maas 15 1-6** 0.89 3.99 0.89 *resilience (cd-risc 25), aces, perceived stress (pss-10), religious faith (bscsrfq); experiential avoidance (aaq ii), and mindfulness (maas) **mean score data analysis variables were examined for normality, homogeneity of variance, and linearity. skew and kurtosis statistics indicated that data were normally distributed and examination of tolerance and variance inflation factors indicated no problems with collinearity for study variables included in the regression analysis. descriptive statistics, bivariate correlations, t tests, analysis of variance tests, and multiple linear regression were used to examine the data. results comparisons with previously normed scores mean scores for msw student participants in this study were similar to previously normed scores (or to comparison scores in studies examining similar populations) for all variables except aces and perceived stress (see table 3). prevalence of aces almost 38% of the msw students in this study reported 4 or more aces. only onefifth reported no adverse childhood experiences (see table 4). the most frequently cited aces were emotional abuse (46%), parental divorce/separation (43.9%), and substance abuse by a household member (41%). more than a third of participants (36.7%) reported emotional neglect, and 32.4% of participants reported mental illness in their families. thomas & beecher/what doesn’t kill you 1122 almost one-fourth reported a history of childhood sexual abuse. table 5 indicates the percentage of students endorsing each of the adverse experience categories included in the ace study. table 3. resilience, ace, perceived stress, religious faith, experiential avoidance, and mindfulness scores and comparisons scale mean (sd) notes on population or scale source of comparison score current study comparison scores resilience (cdrisc 25) 77.46 (9.88) 80.4 (12.8) 72.9 (13.5) us gen pop college students cdrisc users’ guide (n.d.) aces 3.04 (2.51) 2.18 (2.13) human services providers howard et al., 2015 perceived stress (pss-10) 18.29 (6.19) 13 considered average; 20 > considered high stress cohen et al., 1983 religious faith (bscsrfq) 12.01 (5.96) 13.56 (4.46) plante et al., 2002 experiential avoidance (aaqii) 19.02 (8.47) 18.51 (7.05) 28.3 (9.9) non clinical pop clinical pop bond et al., 2011 mindfulness (maas) 3.99 (0.89) 4.20 (0.69) 3.83 (0.70) community adults (4 samples) college students (14 independent samples) brown & ryan, 2003 table 4. ace scores (n=139) number of aces n % cumulative % none 29 20.9 20.9 one 20 14.4 35.3 two 19 13.7 49.0 three 17 12.2 61.2 four 9 6.5 67.7 five 13 9.4 77.1 six 16 11.5 88.6 seven 7 5 93.6 eight 4 2.9 96.5 nine 3 2.2 98.7 ten 0 0 98.7 missing 2 1.3 100.0 table 5. number and percentage of students endorsing each item (n=139) ace category n % physical abuse 50 36.0 emotional abuse 64 46.0 sexual abuse 33 23.7 physical neglect 17 12.2 emotional neglect 51 36.7 household mental illness 45 32.4 family violence 26 18.7 parental divorce/separation 61 43.9 household member incarceration 17 12.2 household substance abuse 57 41.0 advances in social work, fall 2018, 18(4) 1123 bivariate correlations table 6 presents zero-order correlation coefficients for all continuous variables. resilience was moderately correlated with perceived stress, experiential avoidance, and mindfulness (all at the p<.001 level) and weakly correlated with aces and religious faith (p<.05). additionally, perceived stress was moderately correlated with experiential avoidance (p<.001) and mindfulness (p<.001). experiential avoidance was also correlated with mindfulness (p<.001) and aces (p<.05). table 6. correlations among predictor variables and resilience variable 1. 2. 3. 4. 5. 6. 1. resilience 1 2. ace .180* 1 3. stress -.471*** -021 1 4. religious faith .213* .068 -.032 1 5. exp. avoidance -.471*** .173* .595*** -.471*** 1 6. mindfulness .337*** .055 -.463*** .098 -.482*** 1 *p<.05; **p<.01; ***p<.001 analysis of variance and t-tests for descriptive purposes, analysis of variance and t-tests were included to examine any influence of demographic variables of age, race/ethnicity, and gender on study variables. one-way analysis of variance (anova) tests were used to examine four different age categories (<25, 25-34, 35-44, and 45+) in relation to other variables. for the purposes of this test, the 45-54 and > 54 age categories were combined because there were too few cases in the >54 category. anova testing showed that the effect of different age categories was not significant in predicting ace scores, religious faith, experiential avoidance, resilience, or mindfulness. age was a significant predictor of perceived stress, f(3, 132) = 3.233, p<.05, with younger students reporting higher levels of stress than older students. fisher’s least significant difference (lsd) post-hoc tests indicated students in the age category <25 (m=18.94, sd=5.96) and 25-34 (m=19.03, sd=5.79) had significantly higher mean total perceived stress scores (p<.05) than students in the category 35-44 (m =15.50, sd 6.71) or 45+ (m =13.71, sd=5.44). anova testing was also used to look at the four different race/ethnicity categories in relation to other variables in the study. the “alaskan native/american indian/ first nations” category (n=3) was combined with the “other/mixed” category (n=5) for statistical analysis. none of these tests were significant. independent samples t-tests were conducted to compare male and female responses to all continuous variables. no significant differences were found based on gender. regression analysis a three step hierarchical multiple regression was conducted with resilience as the dependent variable (see table 7). age was entered at step one of the analysis, given the thomas & beecher/what doesn’t kill you 1124 anova results suggesting age was the only demographic variable significantly related to any of the other correlates. ace scores were then entered at step two, based on the hypothesized relationship between ace scores and resilience. the remaining variables, perceived stress, religious faith, experiential avoidance, and mindfulness were entered at step 3. step 1, containing age only, explained only about 3% of the variance, f(5, 124) = 3.900 p = .050). the model for step 1 was just short of reaching the p<.05 significance level, with an r2 ∆ of .03. step 2 added ace scores; that model was significant, f(2, 123)=3.413, p<.05, with an r2 ∆ of .022 (p<.05). the total model (age and aces) explained about 5.3% of the variance in resilience scores. step 3 added the four additional correlates of perceived stress, religious faith, experiential avoidance, and mindfulness. this final model was significant, f(6, 119) = 12.781, p<.001, and explained over 39% of the variance in resilience scores, with an r2 ∆ of .339 (p<.001). all of the variables in the final model except age and mindfulness made significant individual contribution to the model predicting resilience, including aces (β = .204, p<.01); perceived stress (β = -.229, p<.05); religious faith (β = .203, p<.01); and experiential avoidance (β = -.349, p<.001). religious faith was positively associated with resilience, and both perceived stress and experiential avoidance were negatively associated with resilience. contrary to expectations, however, aces were associated with greater resilience and mindfulness was not significantly associated with resilience at all. table 7. hierarchical regression predicting resilience variable model 1 model 2 model 3 b se b β b se b β b se b β age 2.143 1.085 .175 1.805 1.095 1.47 .336 .917 .027 aces .594 .351 .151 .802 .293 .204** perceived stress -.365 .149 -.229* religious faith .337 .119 .203** exp. avoid. -.407 .110 -.349*** mindfulness .816 .926 .074 r2 .030 .053 .392 r2 change .030 .022* .339*** *p<.05; **p<.01; ***p<.001 discussion the results of this study support several of the hypotheses (1, 3, 4, and 5) regarding the prevalence of adverse childhood experiences among msw students, and the associations of perceived stress, religious faith, and experiential avoidance with resilience. however, hypothesis 2, indicating that higher ace scores would be associated with lower resilience scores, and hypothesis 6, suggesting that higher mindfulness scores would be associated with greater resilience, were not supported. advances in social work, fall 2018, 18(4) 1125 prevalence of aces and comparisons with previously normed scores reported rates of aces were much higher among this sample of msw students than those reported in previous studies, supporting hypothesis1. most studies using the aces questionnaire have not reported a mean score, but rather have commonly listed the percentage of participants with various total scores, often using scores of “4 or more” for comparison. almost thirty-eight percent of the msw students in the current study had ace scores of 4 or more, compared to 12.5 % in a general population sample (felitti et al., 1998); 12.4% in a university student sample (mcgavock & spratt, 2014); 27.6% with child care workers (esaki & larkin, 2013); and 25.1% with foster care workers (howard et al., 2015). despite expectations that the student sample would show high ace scores, these results are sobering. associations with resilience four variables in the current study showed a significant relationship with resilience, including ace score, perceived stress, religious faith, and experiential avoidance. contrary to expectations that a history of trauma in childhood would be associated with lowered resilience scores, higher ace scores were actually associated with greater resilience (p <.01). aces. several previous studies have reported that social workers tend to enter their professional training with high rates of adverse life experiences (black et al., 1993; dykes, 2011; rompf & royse, 1994). results of this current study certainly support this finding. compelling evidence links ace histories with negative health and social outcomes in adult life (anda et al., 2006; dube et al., 2004), and trauma history has generally been viewed as a potential risk factor in terms of msw students’ vulnerability to mental health issues, truncated careers, and compromised therapeutic practice with clients. however, the implications of such trauma histories for social work students and professionals remain unclear (for more detailed discussion, see thomas, 2016). marcus and dubi (2006) found that prior histories of trauma did not predict depression, anxiety, burnout, or compassion fatigue among mental health professionals, and howard et al. (2015) found that higher ace scores among foster care workers were actually associated with reduced risk for burnout and greater compassion satisfaction. hypothesis 2 is not supported. there are a number of possible explanations for this finding regarding aces and resilience. rutter (2007, 2013) states that resilience can only be developed within the experience of adversity. the positive association between aces and resilience found in this study may reflect the “steeling” or “turning point” effects (see rutter, 2006, p. 1; 2013, p. 477) that can sometimes occur as a result of past trauma. alternately, or additionally, it is possible that at least among the subset of students who had experienced trauma and yet were successful in pursuing graduate education, such difficult experiences resulted in a strengthening of purpose to help others who face similar challenges. howard and colleagues’ (2015) finding that higher aces were associated with greater compassion satisfaction supports this explanation. experiential avoidance. of all the variables in the model, experiential avoidance was most strongly associated with resilience. higher experiential avoidance scores predicted thomas & beecher/what doesn’t kill you 1126 lower resilience, supporting hypothesis 5. consistent with prior research on avoidant coping (boulanger et al., 2009; thompson et al., 2011), these findings suggest that persons who adopt cognitive strategies aimed at suppressing or avoiding reminders of difficult experiences may struggle more than those who are able to acknowledge and accept their experiences. this makes sense in light of research suggesting the importance of reflection in resilient processing of trauma (kinman & grant, 2011; rutter, 2013) and the emphasis on meaning-making as a critical factor in the metabolism and transformation of traumatic experiences (calhoun & tedeschi, 2013; mccann & pearlman, 1992). perceived stress. the general population average score for the pss-10 is 13, with scores of 20 or more indicating high stress (cohen et al., 1983). student scores in this study (m=18.29, sd 6.19) did not quite reach the cut-off for “high-stress,” but were well above the population norm of 13. this is congruent with previous research indicating that graduate students in general, and social work graduate students in particular, experience relatively high levels of stress (addonizio, 2011; grant & kinman, 2012). perceived stress was also negatively associated with resilience, supporting hypothesis 3. while a certain amount of stress is needed for optimal functioning, high levels of current stress challenge coping capacities (lazarus & folkman, 1984). past trauma and significant childhood distress (as measured by the aces questionnaire) were correlated with increased resilience, but current distress was correlated with decreased resilience, suggesting perhaps that time, psychological processing, and/or meaning-making modifies the impact of distressing events. bivariate analysis indicated a strong positive correlation between perceived stress and experiential avoidance (and a negative correlation with mindfulness) again indicating that avoidant coping may contribute to greater perception of stress among msw students. these results also suggest that, within social work education, strategies aimed at helping students develop more adaptive coping skills focused on awareness and acceptance may be helpful. religious faith. finally, religious faith was positively, though weakly, associated with resilience, supporting hypothesis 4. previous reports regarding the effects of religious faith and spirituality on coping in the general population (plante et al., 2002) and particularly among social workers and students (canda et al., 2004) suggest multiple benefits from religion/spirituality. as mentioned previously, the meaning people make of challenging life experiences is important and will likely shape consequent responses, and “plentiful evidence” suggests that, for persons who have experienced trauma, religious faith and/or spirituality can be helpful in understanding, interpreting, and coping with subsequent difficulties (calhoun & tedeschi, 2013, p. 128). mindfulness. it was surprising that mindfulness was not significantly associated with resilience in the regression model. however, though some mindfulness measures are multifactorial, the measure of mindfulness used in this study (maas) measures the singlefactor of receptive, open, and non-evaluative awareness, and may have overlapped with the constructs measured in the experiential avoidance measure (aaq ii). hypothesis 6 was not supported. advances in social work, fall 2018, 18(4) 1127 limitations there are a number of limitations to this study, including the relatively small, nonrandom sample from one regional university. additionally, the study relies on self-report data, and despite efforts to assure anonymity, it is impossible to rule out a social desirability bias in the responses. causality cannot be determined due to the cross-sectional research design used in this study. as previously mentioned, the present study did not include information regarding the influence of relationships, social support, or other institutional, organizational, or cultural factors on resilience. all of these factors, in addition to the intrapersonal factors measured in the present study, likely have a significant influence on the resilience of individuals. finally, risk of type i errors is inflated given the multiple comparisons completed in the study. future studies should include larger and more diverse sample sizes, and more robust analytical methods such as structural equation modeling which might better handle any measurement error, allow for testing multiple models and paths, and provide a more accurate examination of the relationship between variables. implications for social work education this study provides further evidence that msw students experience significant stress during their graduate studies, and that many come into social work education with substantial trauma histories. however, it also provides surprising evidence that those trauma histories may have actually contributed to greater resilience, and suggests that social work educators rethink assumptions that such histories are necessarily problematic. further, the results suggest that an ability to face difficult or painful experiences with awareness and acceptance, rather than engage in strategies of experiential avoidance, may be important in strengthening resilient responses. regardless of whether students have had previous trauma histories themselves, we know that indirect exposure to trauma in classes and field experiences can contribute to vicarious traumatization in students (carello & butler, 2015). in the spirit of informed consent and evidence-based intervention, it is important that social work educators explicitly provide information to students regarding trauma exposure and effects, whether past, current, or future. students should understand that what they do (or don’t do) in response to stressful and traumatic experiences matters a great deal. in addition to didactic information about trauma, secondary trauma, and professional resilience, it is important that social work educators create learning experiences that help all students increase affective awareness of emotional responses that may be challenging, whether in response to prior or current stressors, or counter-transference experiences with clients. social work educators can provide solid research information about the problems associated with avoidant coping, discuss the ethics of addressing issues that might impair future professional functioning, and help students with strategies for managing their experiences. these strategies might include additional opportunities for discussion and reflection about challenging or triggering experiences, as well as pro-active development/rehearsal of evidence-based mindfulness and acceptance skills. without engaging in therapy or getting overly involved in student’s personal lives, social work educators can provide classroom experiences and field supervision aimed toward thomas & beecher/what doesn’t kill you 1128 supporting students as they acknowledge, reflect on, accept, and cope with their difficult experiences (rather than suppressing or avoiding them). educators can also ensure that students are aware of local university or/and community counseling/therapy or other supportive resources. based on research suggesting that social work students are often reluctant to speak to teachers and supervisors about their distress (grant & kinman, 2012), we may need to recalibrate our expectations and approaches regarding how to encourage students to use more strengths-based and adaptive ways to manage their stressful and traumatic experiences. providing repeated opportunities for such cognitive and affective experiences early in the 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(2013). wounded healers: graduate students with histories of trauma in a family violence course. journal of teaching in social work, 33(3), 239-250. doi: https://doi.org/10.1080/08841233.2013.795923 author note: address correspondence to, jacky thomas, phd, department of social work, california state university san marcos, 333 s. twin oaks valley road, san marcos, ca 92096-0001. jthomas@csusm.edu https://doi.org/10.1080/01488376.2013.771596 https://doi.org/10.1080/08841233.2016.1182609 https://doi.org/10.1177/1524838011416375 https://doi.org/10.1016/j.jbtep.2004.07.001 https://doi.org/10.1002/jts.20260 https://doi.org/10.1080/08841233.2013.795923 mailto:jthomas@csusm.edu _____________ jason ostrander, phd, assistant professor and msw program director, and janelle bryan, msw, clinical assistant professor, sacred heart university department of social work, fairfield, ct. shannon r. lane, associate professor, yeshiva university wurzweiler school of social work, new york, ny. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 256-275, doi: 10.18060/22609 this work is licensed under a creative commons attribution 4.0 international license. clinical social workers, gender, and perceptions of political participation jason a. ostrander janelle bryan shannon r. lane abstract: political participation to create social change is considered a professional and ethical imperative for social workers. although researchers have examined overall political participation by social workers, little is known about how clinical social workers participate and the broader societal factors that influence their political participation. a critical phenomenological methodology was used with a sample of 23 clinical social workers from new england states to (1) identify how socio-political forces influenced their political activity; and, (2) understand how the concept of power affected individuals’ level of engagement or inclination toward the political process. this article describes one of the study’s major findings. female participants described themselves as unqualified and/or unknowledgeable in the political sphere, with low levels of ambition and confidence to engage in political processes. many female participants also described the challenges of achieving a work-life balance between their careers and traditional gender-based roles with little time left for political engagement. social work education and policy advocacy can affect change that will increase the internal and external efficacy of social workers and create a policy environment that allows more options for all social workers in balancing the demands of professional and personal lives. keywords: clinical social work; civic engagement; policy; political participation; gender; socialization social work has a rich history of helping marginalized and oppressed populations through social reform. one of the primary characteristics of the profession is its dual emphasis on the individual and the environment. the latter includes the social, political, and economic structures and actors that impact clients daily. macro-oriented scholars, however, have accused the profession of neglecting its obligation to social justice and political participation and focusing its energies on micro practice (harding, 2004; haynes & mickelson, 2009). in this article, we examine the ways in which female clinical social workers view their participation in politics within a professional practice context. this understanding can inform the educational standards of schools of social work, which could lead to more politicized practice and thus fidelity to the profession’s defining principles of social justice (fisher & karger, 1997). this article focuses specifically on the experiences of female clinical social workers for three reasons. first, while women as a group have received more attention as active members of the political process in recent years, the consequences of the historical exclusion of women from the political process in substantive ways are still being felt in the united states and most other industrialized democracies. we believe this historical exclusion justifies the focus on this population as the social work profession works to make https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2019, 19(1) 257 our society, including our political process, more socially just. second, clinical social workers are underrepresented in the literature about political participation among social workers, which makes it more important to hear their voices. third, while interviewing the women in this study, it became apparent their experiences of political participation were firmly rooted in social identities connected to gender, specifically connected to identities as mothers, wives, and grandmothers, that it felt authentic to their voices to highlight these identities. literature review in order to address the experiences of female clinical social workers and the lessons learned from this group that can inform political social work and social work education, we will discuss literature that highlights both gender and political participation. first, we discuss issues of gender and inclusive democracy. second, we conceptualize the term political participation as used in this paper. finally, we look at ways that political participation and gender connect with political efficacy. gender and democracy the united nations recognizes increased political participation by women worldwide as “the key to redress gender inequalities in societies” (bari, 2005, p. 1). this argument is made for both intrinsic reasons (women make up half of the world’s population and therefore should have an equivalent representation) and instrumentalist reasons (the argument that women’s contributions to politics will be different from men’s based on their sex and their gender-roles within families). however, across the world, we see women’s “historic exclusion from political structures and processes is the result of multiple structural, functional and personal factors that vary in different social contexts across countries” (p. 2). bari (2005) argues that democracy has fundamentally served men better than women throughout its history, and that the patriarchal structures of modern democracies continue to make it difficult for women to both enter the political arena and to be effective changemakers within it. this article positions female clinical social workers’ participation in the political process within that patriarchal lens, and deliberately focuses on their experiences in order to see how these structural issues affect this population. political participation and social work the first social work published author to analyze the political process was reynolds in 1896 (weismiller & rome, 1995). since then, a variety of studies in the social work literature have examined political participation by various subgroups of social workers, primarily using quantitative methods. within this literature, nine studies used professional social workers as research participants and sampled only national association of social workers (nasw) members. an additional eleven studies have used various other subgroupings, such as executive directors of nasw chapters, administrators, state nasw chapter members, child and family service workers, social work leaders in health care, undergraduate and graduate social work students, and social work educators (ostrander, lane, mcclendon, hayes, & smith, 2017). five additional studies contribute to the understanding of social workers’ involvement in the political arena: rocha, poe, and ostrander et al./clinical social workers 258 thomas (2010) explored the perceived barriers to social workers’ professional advocacy, including legal issues; rome, hoechstetter, and wolf-branigin (2010) discussed empowering clients to participate in politics; salcido (1984) examined social workers’ participation in political campaigns, and haynes and mickelson (2009) and lane and humphreys (2011) studied social workers elected to public office. these studies identified several personal characteristics that correlate with high levels of political participation among social workers such as age, income, and race/ethnicity. for a variety of reasons, macro social workers are frequently over-represented in these studies, except for ritter (2007), who intentionally looked at licensed social workers, who are often micro practitioners. few social work studies have reported how female clinical social workers understand and/or participate in politics. recently, meehan (2018) found significant results supporting the finding that female msw students doubted their qualifications, knowledge, and experience to engage in the political process. since there are no written works on this specific topic in social work, the authors had to rely on the political science literature to help understand this phenomenon. the present study is the first qualitative examination of the experiences and perceptions of female clinical social workers. it comes from a larger 2016 study of male and female clinical social workers. this group is relevant as women make up 81% of licensed social workers (nasw center for workforce studies, 2005). in addition, the focus on women in this paper allows for a focused examination of the effects of patriarchy—a system of oppression—on this population. in a national study of political participation by social workers who are nasw members, rome and hoechstetter (2010) found that 62% of the sample worked in direct practice, nearly half of whom identified their place of employment as private/group practice, a mental health facility, or a hospital. yet, inconsistencies exist in explaining the political participation of clinical social workers (harris & white, 2013). much of the literature demonstrates that social workers participate in politics at higher rates than the general public. the most frequently practiced form of political participation among social workers is voting (ritter, 2007; rome & hoechstetter, 2010; swank, 2012). research shows that macro practitioners engage in higher levels of political participation than their micro counterparts (ezell, 1993; reeser & epstein, 1990; wolk, 1981). in a recent study by mattocks (2018), social workers who self-identified as mezzo or macro level practitioners reported higher levels of political participation in the form of social action. although clinical social workers can wear many hats and hold many roles, their primary work is as therapist or counselor (harris & white, 2013). understanding the experiences of clinicians and direct practitioners who are women is crucial to understanding large-scale political participation among social workers. political participation conceptualized political participation is discussed in a variety of ways in the social work literature, and there is no consensus on the form it should take for all types of social work practice. concepts in this discussion to define political participation include activism (swank, 2012), political action (rome & hoeschstetter, 2010), and advocacy (bernklau halvor, 2016). the most widely used and conceptualized model of political participation originates in advances in social work, spring 2019, 19(1) 259 verba, schlozman, and brady’s (1995) landmark political science study. they characterized political participation as an “activity that has the intent or effect of influencing government action—either directly by affecting the making or implementation of public policy or indirectly by influencing the selection of people who make those policies" (p. 38). activities in their definition included voting, gaining and using political knowledge, being aware of political issues, protesting a policy issue or government decision, contributing money to and volunteering with campaigns or political committees, and, other politically-directed activities such as running for elected office. they separate political participation from awareness activities (e.g., watching the news) and civic engagement activities (e.g., volunteering for a community agency) that do not explicitly target elected officials. an inherent challenge to the adoption of verba and colleagues’ conceptualization, however, is that it makes no distinction between political participation. whether there’s a distinction between personal political action and engaging the political process on behalf of clients remains unresolved, but we hope to offer additional insight to this notion. political participation, gender roles, and political efficacy clinical social workers have an important role to play in the political context of the social work profession. they have direct contact with clients and can see how policies are affecting individuals. one potential barrier to political engagement by clinical social workers is gender. as noted previously, women comprise the majority of clinical social workers. although the social work profession has an ethical obligation to promote social change, it is also influenced by broader societal and cultural beliefs. fox and lawless (2011) explored how gender socialization and traditional gender roles impacted women’s engagement in electoral politics. they found that men are socialized to be “confident, assertive, and self-promoting” (p. 60), and when women demonstrate similar characteristics it is often perceived as “inappropriate or undesirable [for them] to possess these characteristics” (p. 60). this has resulted in women exhibiting a decrease in political ambition due to lower confidence in their leadership capacities, while men demonstrate a higher level of confidence (fox & lawless, 2010, 2012; meehan, 2018). burns, schlozman, and verba (2001) found that women who are employed have a decrease in political participation due to a lack of leisure time. this disparity is magnified for women who are married with children because of traditional views of men’s and women’s gender roles regarding family responsibilities. fox and lawless (2012) found statistically significant differences between 4,000 men and women surveyed between 2001 and 2011, including women doing most household tasks and child rearing. as women's hours spent working increases, their political participation drops. this is not the case for men. essentially, women are more likely to trade leisure time for childand family-related responsibilities than men (burns et al., 2001; fox & lawless, 2012; silbermann, 2015). further, as women spend more hours at work focusing on their career, they tend to participate in less visible and formal political activities (lister, 2007). although attitudes about gender roles may be shifting, these stereotypical norms and attitudes continue to impact engagement in politics (fox & lawless, 2012). when women report having children living in their home, they score lower on measures of political ambition (fox & ostrander et al./clinical social workers 260 lawless, 2010). thus, access to the political arena, both in terms of perceived ability and available time, is different for men and women (enloe, 2004; freedman, 2002). scholars have consistently reported a gender gap in political knowledge as well (dolan, 2010; schlozman, verba, & brady, 1997). when women are surveyed about political issues, they answer fewer questions correctly than men (burns et al., 2001; dolan, 2010) and more often answer with “don’t know” (lizotte & sidman, 2009). this last finding may be explained by a recent study by ondercin and jones-white (2011), which found women have a self-imposed requirement to have higher levels of political knowledge prior to participating in political activities. additionally, women hold themselves to a higher standard than men when deciding whether to run for elected office (fulton, maestas, maisel, & stone, 2006). essentially, women view themselves as lacking the confidence and qualifications to offer political opinions and to discuss politics, even when objective measures of their qualifications are equivalent to men’s (mendelberg, karpowitz, & goedert, 2014; nir & mcclurg, 2015). political efficacy political knowledge, confidence, and competency contribute to one’s sense of political efficacy, or that “a combination of one’s sense of competence in the political sphere and one’s assessment of the responsiveness of the system” (campbell, gurin, & miller, 1954, p. 187). beginning with the work of lane (1959), political efficacy has been used to help explain political participation, and more than a dozen studies have differentiated two types of political efficacy: internal efficacy and external efficacy (beaumont, 2011). a person with high internal political efficacy believes they understand how to take part in the political process and are not intimidated by obstacles that may be encountered. a person with high political efficacy views the political system and leaders as responsive and accessible to the general public (caprara, vecchione, capanna, & mebane, 2009). method research design using a critical phenomenological approach, this exploratory study sought to understand the lived experiences of clinical social workers and the various factors that contributed to their thoughts and decisions about political participation. through delineating power differentials and the social, political, and economic forces impacting clinical social workers’ daily lives and experiences, this study sought to contextualize the decisions they are obliged to make between meeting the profession's mission and ethics and fulfilling their daily job and life responsibilities. this analysis focused on clinical social workers' perception of how their identity as women impacted their political participation. this study was designed to be nonpartisan, and therefore topics that had partisan implications were only discussed when raised by participants. data collection human subject approval was obtained from the institutional review board at the primary researcher’s institution. data was collected using in person (n=17) and skype advances in social work, spring 2019, 19(1) 261 (n=6) interviews. prior to conducting each interview, potential participants were verbally screened for eligibility, and informed consent was obtained. in order to participate in this study, participants needed a master’s degree in social work; two years post-education clinical practice experience; and, experience providing direct clinical therapeutic services to clients. a semi-structured interview guide was used during all formal interviews, which lasted 75-120 minutes. second interviews were conducted with five participants to gain further clarification. a demographic survey was also administered. all interviews were digitally recorded, and thorough field notes and memos were written after each interview. each participant was assigned a unique identifier, and all personal information was removed to protect the confidentiality of the participants. after all data had been collected, the master list connecting the participants' identity and his/her unique identifiers was destroyed. interviews were transcribed, reviewed, and coded using nvivo 11 for mac. demographic survey data was downloaded and entered into spss version 23 for mac. sampling nonprobability purposive and snowball sampling methods were employed due to the survey’s exploratory nature. for the purposes of this study, the sampling frame was designed in order to access clinical social workers, defined as masters-level practitioners who provide direct services to “individuals, couples, families, and groups with a focus on intra-personal and interpersonal problems” (harris & white, 2013, p. 89). specific agencies that employ clinical social workers who reside in connecticut, rhode island, massachusetts, vermont, new hampshire, and maine were contacted to develop the original list of participants. this region was selected to allow the researcher to conduct most interviews in person. at the conclusion of each interview, participants were asked to share the interviewer’s contact information with other potential participants. the goal of this sampling strategy and study design was to capture the phenomenon. participants twenty-three participants were interviewed for this study, and only one participant did not complete the demographic survey, resulting in a 96% response rate. the mean age of the sample was 43 years old, and ages ranged from 28-66 years. regarding gender, 77% of participants identified as female and 18% as male; one participant identified as a transgender male. almost 70% of the sample identified as non-hispanic white, 14% were black or african-american, 9% identified as hispanic/latino, and 4.5% identified as afrocaribbean and bior multi-racial. thus, the sample for this study is primarily white and female, which is reflective of the demographic breakdown of the social work profession. two respondents (9%) identified as republicans, two (9%) were unaffiliated with a political party, and the remainder (82%) identified as democrats. all participants identified their sexual orientation as heterosexual, more than half (54%) were married, 91% of participants had one child or more, and slightly more than one-third (32%) were affiliated with a religion. this article will focus on the experiences of the participants identifying as women, regardless of other social identities. ostrander et al./clinical social workers 262 data analysis coding after transcription and uploading of interviews into nvivo, an initial codebook was created, followed by a first and second cycle coding methodology (saldaña, 2013). in order to further increase the rigor and trustworthiness of the coding process, a trained co-coder was employed to code independently using the initial codebook. once both coders were finished, they met to discuss and reach consensus on all discrepancies. thematic analysis was conducted by both coders to identify meaning for the larger themes using the interview data, member checking, analytic memos, and peer debriefing. this article discusses one of the two primary themes identified: gender identity as a woman and its impact on political participation. validity and trustworthiness were addressed in a variety of ways, including use of an audit trail throughout the collection and analysis of the data, peer debriefing, prolonged engagement over one year—working with participants from the initial interview through reporting the findings, member checking, and awareness of researcher bias. limitations the researcher was cognizant of the stark demographic differences between himself and his interviewees. identifying as a white, heterosexual, cisgender, male political social worker, the researcher remained mindful of potential bias through constantly assessing and being aware of his position (padgett, 2016). as this study’s findings are based on a nonprobability convenience and snowball sample of 23 participants, these findings are not generalizable to all clinical social workers. like all qualitative research, the interviews represent a point in time. the first interviews occurred april to june 2015, and the second interviews were conducted in january 2016. contemporary social, economic, and political events likely impacted the interviewees’ perspectives on political participation. the results of this study need to be examined within the context of the 2016 united states presidential election, which proved to be one of the most contentious election seasons in modern history. findings in the social work literature on political participation to date, no scholars have investigated gender differences among clinical social workers’ engagement in the political process. however, in this study the participants’ identity as women seemed to influence their understanding of and engagement in political participation with four sub-categories: identity as a woman, the impact of their family on political participation; marriage/partnership with men; and, having children and/or grandchildren. identity as a woman the majority of the female participants, without being prompted, personally identified based on their gender, often connecting other intersecting identities around race, ethnicity, or family roles. these identities included being women, feminists, mothers, grandmothers, wives, and spouses. the participants discussed how these identities interplayed with their political participation. unlike the female participants, not one of the male clinical social advances in social work, spring 2019, 19(1) 263 workers mentioned their gender in any context of their interviews unless they were asked about it directly. one of the first participants interviewed was born in puerto rico and moved to the continental united states later in life. she eventually married and worked as a school social worker. discussions about political participation frequently came back to her identity: i am a puerto rican woman who is a social worker. then from there are many other [identities]. i am a foster mom, i am a…godmother to many, [and] i am…a parent to a few. those [identities] are secondary. but my primary identity is that i am a puerto rican woman and i am a social worker. [i] see everything through those lenses. the participants often spoke about their gender as a strength. one participant who worked as an oncology social worker her entire career, viewed herself as a “pioneer in [her] field” and reflected on her identity as a woman: i know my position as a white woman. because i'm white, i already have some doors open that may not be open [for those who are a different race]. because i'm a woman, it seemed to be a traditional social work position. however, i like being a strong woman, an independent thinker, a critical thinker, [and] tenacious. she felt that as a woman and clinical social worker in the medical field, her colleagues and administration did not view her position as a valuable component of the treatment team. she felt their assumptions that she “should just be happy with what [social workers] get,” and that she was “just going to roll over and give in” when she was challenged by a doctor or nurse. her identity as a “strong woman” helped her combat the injustices she encountered at work. one participant worked for many years in a clinical setting, but decided she wanted to have a greater influence on the low-income individuals and families she worked with in her rural community mental health practice. she decided to run for elected office. while going door-to-door to introduce herself to voters, this participant encountered many people who needed social services. she felt as a social worker and as a woman she needed to help them, so she brought medicaid applications and pamphlets for area social service agencies to distribute to people who needed services. impacted by the many experiences she had throughout her life personally and professionally, another participant spoke about how she identified as a “strong feminist, liberal, mother and wife. oh, grandmother, mother, wife.” over the course of the participant’s career, she began to believe the best way for her to bring about broader change was through the political process. this led her to work in a macro setting as an advocate, organizer, and a politically engaged social worker. after reflecting, the participant explained how her different identities impacted her career as a social worker employed in the macro sphere: i have devoted my career to mostly helping women. i mean, i have male clients now, but they're…honorary women. they're good on women's issues, they're ostrander et al./clinical social workers 264 usually men of color, they're usually gay men of color. i feel like i've devoted my whole career to helping women and children. a participant who worked in a community mental health agency also identified as a feminist and described what being a woman meant to her. interestingly, she acknowledged a conflict she experienced as a mother and woman who is impacted by greater society: based on my biology and my physical structure i'm in a position…of becoming pregnant, …carrying a child, and having a child …is both a great privilege and power[ful]…it’s [also] a potential prison, entrapment, [and] social control. family of origin most of the women interviewed discussed how their beliefs, values, and ethics were influenced by their families, often through deliberate messaging about traditional gender roles. participants who came from civically and politically engaged families eventually participated in activities to help impact their communities and the broader society. a participant working in private practice and consulting with a substance abuse agency discussed her socially and politically active family members. she described her family with pleasure and pride: both of my parents were very politically and socially active people…even predating that, my grandfather wrote a book about the first african-american merchant marine captain of a merchant marine ship. harriet beecher stowe is a part of my family lineage. my father's side of the family was very politically active, socially active. her family history was the catalyst for social awareness and curiosity about how people relate to each other. on multiple occasions, this participant discussed trying to understand and develop opinions on how people who are different (e.g., gender, race, ethnicity) are allowed to be disadvantaged economically or marginalized. she reflected, “it's one thing to have strong feelings about social issues, [but] it's another thing to take action and take risks to speak out.” another participant grew up in a very politically active home and had socially conscious and engaged family members. her grandfather was a state representative, which she acknowledged had a direct impact on her father. after her grandfather died, her parents moved to where “no democrat had been elected.” she related a story about her parents’ political involvement and the impact her parents had on her: it took seven years for [my parents] to turn the tide and they did. [m]y father was the town council president. i watched that, i lived that, and i think that made a huge impression on me and made it sort of possible in my little girl brain that i could do that. …he always—there was never a question that because i was a girl i couldn’t, and my brothers could. that didn't exist in my household; i could do anything. advances in social work, spring 2019, 19(1) 265 husband or male partner during the interviews, multiple female participants stated they would “ask [their] husband” whenever they had a concern or question about politics, current events, and/or civically oriented topics. after asking one participant to explain how politics or political participation impacts the work she does with physically and sexual abused children, she quickly minimized her competence and her impact on political systems. she then outlined why her husband was more knowledgeable on the topics: my husband really is involved in a lot of that stuff. he keeps up on a lot of the news. all of my political talk at home is him talking at me about things. but as far as any sort of funding for what we do from the government, i always feel like there could be more. one participant has been out of her graduate program for two years, recently married and has an 18-month old son. the participant repeatedly told me she could not lend her voice to a conversation she had with her husband on politics. like other participants, she also viewed herself as not having enough information to have an opinion. when she was asked why she so readily asked her husband about politics, she responded: i'll ask him questions, what does this mean? or, what does that mean? or, what are they negotiating in congress? because i might not even know. then i have him explain to me, this is what this [bill] means, or this is what that [political issue is about]. this is why the iranian deal is happening or this. i think a lack of knowledge really. like the other participants, she then began to talk about her lack of knowledge and capabilities to discuss political and civic issues with her husband: because of my lack of knowledge, i can't really engage…[my husband] in [political related] conversations. it's more i'm asking and he's providing information. i think sometimes it's probably frustrating for him because those conversations aren't happening and he's super intelligent…. this is the first time that…[i have] ever really…[thought about this topic] and…how disengaged i am from the whole process. further clarification was required to better understand the participants’ answers and comments about their husbands. an important dimension in the lives of these women was the low priority they held for politics, current events, and civic-oriented activities. when these participants were asked what items ranked highest on their priority lists, responses about family were most prominent: “my family will always be the most important priority in my life,” said one. after follow-up questions, one participant stated, “my children are first and then the remaining members of my family come somewhere after. my children are always most important to me.” events involving the participants’ paid work and community involvement appeared at different places on their individual priority lists. the participants’ most frequent community involvement was directly connected to their children’s activities. ostrander et al./clinical social workers 266 when questioned about how their husbands viewed their wife’s role within the family, one participant responded concisely and captured the consensus: “[their wife] is responsible for nurturing and caring for the family.” although the participants did not view their husbands’ role as one of nurturing, the participants did expect their husbands to split home and family responsibilities. thus, the participants believed their husbands cared for their families deeply, but it was understood and demonstrated differently. many believed their husbands viewed their role as being able to financially support their families because they earned higher annual salaries. this allowed these men to pay for the majority of the “family’s expenses,” to have money “to take family vacations together,” and give their children “a jump on life” by providing opportunities to be successful, such as an excellent education. all spoke of their husbands’ interests in being engaged with attending their children’s events and being present for important school functions. participants clearly stated they did not believe their husbands “understood all that was required” and the “time commitment” required to care for children. children and grandchildren many of the women in this study shared a story or an explanation of their limited availability to engage in politics due to their work and family time commitments with their children or grandchildren. one recently retired participant had three grown children who each had families of their own. her eldest daughter was struggling to care for her own teenage daughter and the participant agreed to help care for her granddaughter. she said it was “almost impossible to handle anything else because my daughter and granddaughter need me.” regarding political participation, she said she was “focused on being a grandma.” another participant frequently reflected on her life as a mother and now as a grandmother. she discussed the enormous amount of time it took to raise her children: everyone says [having children is] the greatest thing [they] ever did. i'm not sure it’s the greatest thing i ever did—it's the hardest thing i ever did. my heart breaks for women now who are trying to juggle work, school, babies, and diapers. then i look back and say i did all of that: i worked full-time, went to graduate school, had a baby, and then had [a second] baby…. the participant reflected fondly on the relationship she had with her parents and gave credit to them and her husband for the support she received to accomplish her goals. during that time, she had to move political engagement to the bottom of her priority list and focus on her young daughter and critically ill son. although she is actively engaged politically today, she still faces the struggle of being present in her family’s life. the participant smiled, and became soft-spoken when she described her children’s relationship with their grandparents: my parents lived three miles away and their house was utopia for my children and my children were very close to them. i didn't have grandparents and my husband really only had a grandmother and she was wonderful, we have great, fond memories of her. i'm trying to be a very patient [and] engaged on an almost daily basis. advances in social work, spring 2019, 19(1) 267 political efficacy as discussed previously in the literature review, political efficacy strongly determines political engagement. for this study, political efficacy seemed to be influenced by two subcategories: distrust of the political system and participants’ self-image as knowledgeable and qualified to impact political systems. statements expressing distrust of the political system, or that the system is unresponsive to their needs, are indicative of low external political efficacy, while high external political efficacy is indicated by confidence in and perceived responsiveness of the political system. low internal efficacy is indicated by statements expressing participants’ belief that they lack the knowledge and qualifications to impact political systems, while high internal efficacy is indicated by participants’ selfperception that they are knowledgeable and qualified to engage politically. each of these sub-categories seemed to be influenced by the participant’s identity and socialization as women. distrust of political system the clinical social workers who participated in this study expressed cynicism and distrust of the political system. they shared feelings of not being heard, distrust of politicians, and that involvement in the political system was a waste of time and effort. one female participant noted: i feel very cynical about the effect…of my voice in a political forum. i feel like voting has so little effect. and i don't trust…what is being said is actually accurate and what the [politicians] motivations are. recently, i was reading about a bill…to partition off the national parks to the states so that they can…make decisions on what to do with the national parks. of course, the states [are] going to be motivated…because they're going to be able to drill for oil in this national park, sell a portion of it off, or whatever those decisions are that would be money motivated…. but that's not in the best interest of our environmental needs [or] the satisfaction of our population…. i think that the cynicism or skeptic[ism that has developed] in me...probably does stop me from being more involved or more active, because [i] feel like ‘ah, what's the use.’ i'm probably an outlier, but the more i feel [cynical or skeptical], sometimes it makes me [think], ‘well, they're going to hear from me.’ a puerto rican participant explained how residents of puerto rico and puerto ricans living in the continental united states view politics. she also highlighted the idea of “a lack of trust” that puerto ricans feel toward the political system: in puerto rico, people are more politically inclined because they feel if they fight hard enough, there will be change they can actually see. they believe in [the puerto rican] system a little bit more than the [american federal government] who has historically f**ked them over (excuse my french). it's just such a small island. it's like voting…in the state [elections] versus federal [elections]… [puerto ricans] trust their people more than white [politicians from the continental united states]. ostrander et al./clinical social workers 268 a middle-aged female participant from maine who had been very politically engaged further emphasized how a lack of trust in elected officials led to a reduction in her political activity: believing you can actually make change and…[then witnessing] how our governor just chopped, chopped, chopped up services for the mentally disabled and handicapped. he stood on stage and said, ‘i know cutting these services are going to hurt the mainers who need them the most,’ and he still cut [the] services. that [experience] made me take a step back and say, ‘i can't do this anymore.’ participants’ self-image as knowledgeable and qualified. many of the quotes from female participants demonstrate their belief that they lack adequate knowledge to participate in the political process and rationalizations as to why they were not qualified for politics. as one female participant in her late 20s described: i guess it's just a topic where i [feel]…naïve. i just never…jumped into…or learned more about [politics]. i guess i never literally felt like i had a ball in the game…as far as [politics] was concerned. i just kind of listened to everybody and just kind of stayed back, for fear of saying something incorrect or offensive. there were only three female participants (out of 18) who believed they were knowledgeable enough and qualified to run for elected office. in each case, these participants had previously run or served as an elected official. one of these women, an administrator of a non-profit, described how she became frustrated with the decisions her local town board was making and with hearing from her family, friends, and clients about the consequence of the board's decisions. i decided i'm tired of just hearing all this, i'm going to go do something and i decided to run. [the local board] needed to be different and i thought i had the skills to help make it different...[the other elected members] weren't looking at [the issues before the board] in a social work way. i'm listening to their debates and…i'm thinking, you're just not hearing each other [and] you're not working together. my role on the [local board] became [that of] a…social worker mediator…where i would… find this common ground so we could move forward. discussion the study’s findings suggest female clinical social workers’ perspectives of political participation and their own potential for political involvement align with the extant literature on women’s political participation (e.g., barabas, jerit, pollock, & rainey, 2014; dolan, 2010; fox, 2011; fox & lawless, 2010, 2011, 2012; hannagan, littvay, & popa 2014; thomas, 2012). the participants described their own expectations and their families’ expectations that they would focus on family caretaking to the exclusion of political involvement. they also described themselves as lacking knowledge about the political process and policy, and looking to others, generally husbands, to provide that knowledge. female participants described the challenges of their work-life balance, balancing the work they do as graduate-educated professionals and traditional gender roles as wives, mothers, and grandmothers. these women explained that when they returned home from work, their advances in social work, spring 2019, 19(1) 269 primary concern was caring for their children; other time commitments were less of a priority. most of the female participants exhibited low levels of internal political efficacy, viewing themselves as politically unqualified and un-knowledgeable, and possessing low levels of political ambition and political confidence to engage in politics. the finding that many women reported asking their husbands to explain politics and policy decisions to them was unexpected in light of the women’s professional status and the amount of policy content that is expected to be provided in social work education programs in order to meet the council on social work education (cswe) competency regarding policy practice. more research is needed to determine whether the participants in this study are outliers in this regard, or whether this is a larger issue that needs to be addressed by social work education. further complicating the female participants’ political participation were their low levels of external political efficacy—a distrust in political structures. many of the participants felt that government was present in their lives, but only when something was required of them, such as when they had to take their social work license exam. the exception to this were the four participants with household incomes greater than $160,000 per year, who found government both responsive and able to meet their personal needs, describing, for example, their ability to receive high-quality health insurance through the affordable care act. women in this study who described low internal political efficacy (feeling that they could not make a difference in the political realm) and low external political efficacy (trust of political systems) showed low levels of political involvement, as previous research in this area has uncovered (e.g., lane, ostrander, & smith, 2017; mcclendon, lane, ostrander & smith, in press; ostrander, 2017; ostrander et al., 2017). implications the implications for this study must be considered within the light of the small sample size and qualitative methods. they must also be considered within the patriarchal framework of modern democracies. the findings highlight two significant implications regarding this framework. first, they show that the population studied here is hindered from political involvement by many of the socio-cultural and functional constraints that limit women’s political participation around the world, such as gender roles that conceptualize women’s roles as primarily in the private sphere, while men’s gender roles are in the public sphere (bari, 2005). second, they show that the women in this study have rich positionality and life experiences that, because of these constraints, are not represented in political participation. we believe this is a disadvantage to both the political process and the outcomes of policy, as their participation could inform a different set of policy norms and priorities than exist in the current system. beyond these structural considerations, we suggest three overarching areas of implications: suggestions for social work education, suggestions for clinical social workers who wish to increase their political participation, and future research directions. social work education. the educational policy and accreditation standards (epas) of the cswe outline social work’s important role in political advocacy and political ostrander et al./clinical social workers 270 participation (cswe, 2015). as currently written, these standards outline an expectation that through social work education, social work students should learn to advocate for effective policies that help lift people out of poverty and remove barriers and oppressive forces. in order to achieve this, cswe asserts that students should engage in collaborative action within the profession and in tandem with clients to bring about effective policies if those who control the levers of power are not willing to bring about change (cswe, 2015). social workers facilitating the political engagement of their marginalized clients cannot only affect clients’ lives immediately but potentially have positive ramifications for future generations of these vulnerable families. in 2013, a report sponsored by association for community organization and social administration was critical of social work education’s lack of attention to the importance of macro practice (rothman, 2013). the findings of this research, while small, are consistent with the findings in this report. combined, these findings suggest that one option for improvement within social work education is for cswe to modify epas competency 5 (engage in policy practice) and emphasize the ways in which policy affects the other eight competencies. for instance, female participants’ consistent reference to their spouses’ keeping up with news and current political events, points to the necessity of including political awareness activities in a model of political participation. if these women are typical of other social work students, social work education can serve them well by increasing political awareness. the specialized practice curricular guide to macro social work practice addresses these issues (personal communication, suzanne pritzker & sunny harris rome, june 1, 2018), and should be used regularly by social work programs across the country. based on our research, the rothman report, and other related research, we also recommend an increase in policy-related field placements. the research in this area suggests that policy and politically-related field placements are rare, particularly for generalist and micro students (hill et al., 2017; pritzker & lane, 2014). the work of the social work programs who have received grants from the cswe policy practice in field education initiative highlight the opportunities for this work to occur with micro, macro, and generalist students, in a variety of programs and settings (cswe, n.d.). clinical social workers and policy. lawmakers’ and corporations’ continual push for greater efficiencies with a focus on increased profits comes at the risk of eroding the social work profession’s mandate and the betterment of some of the most vulnerable populations. we believe those who participated in this study may be typical of other clinical social workers who can be part of the efforts to reverse these trends by engaging in the electoral process and encouraging their clients to participate in changing the policies that further marginalize and oppress them. the participant from puerto rico’s perspective on the way that residents of the us territory “trust their people” highlights the importance of engaging with local politics, which are often more accessible and less time-consuming than national politics. clinical social workers who work with marginalized groups can look for opportunities to engage agencies, clients, and communities with local leaders to build knowledge and trust in the political system, which can potentially increase external political efficacy of groups most impacted by social inequities. like the participant who “was tired” of what she saw in the political arena, one strategy for cultivating such leadership lies in social workers’ interventions with clients to help them recognize areas of advances in social work, spring 2019, 19(1) 271 strength, resilience, and expertise that they can contribute at the local/community level. this can contribute to the development of internal political efficacy of these community members. future research. this study highlights several areas where further research should be conducted. as discussed in the limitations section, this group was a small sample from one area of the country. future qualitative research can help us better understand how people who identify as queer, people of color, geographic differences, political ideologies, and other subsets of social workers interpret political participation. although this study seems to identify new areas of research to explore among social workers, different subpopulations may be influenced differently by broader gender socialization, thus warranting further exploratory study. future quantitative research among larger groups of clinical social workers would allow researchers to determine whether this study’s results are reflective of other clinical social workers. the results of such a study would provide strong empirical evidence to help impact policies at nasw, cswe, and social work educators and practitioners around the country. in addition, this study took place within a contentious and divisive national election process. there have been massive demonstrations in opposition to many of the administration’s policy positions and decisions, such as the women’s march, and there has been an influx of female political candidates for local, state and federal office. consequently, a potential area of future research could be identifying the extent to which clinical social workers’ political awareness and involvement have been impacted as a result of these events and activities. finally, further research guided by radical feminism, socialist feminism, or black feminist theory may more accurately portray the lived experiences of female social workers who hold non-white, non-middle-class, and other marginalized identities. conclusion although professional organizations and leaders continue to highlight the ethical and professional responsibilities of all social workers to participate in the political process, clinical social workers, particularly women, face a variety of challenges in reaching these aspirational goals. the negative impressions of the political process and gender gap in political participation described here have roots in socialization and expectations. social work education and policy advocacy can affect change that will increase the internal and external efficacy of social workers and create a policy environment that allows more options for all social workers in balancing the demands of professional and personal lives and in advocating on behalf of disempowered groups. references barabas, j., jerit, j., pollock, w., & rainey, c. 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(1981). are social workers politically active? social work, 26(4), 283-288. author note: address correspondence to: dr. jason ostrander, assistant professor and msw program director, sacred heart university department of social work, 5151 park avenue, room 256b, fairfield, ct 06825. e-mail: ostranderj@sacredheart.edu https://doi.org/10.1093/sw/55.4.317 https://doi.org/10.1080/15588742.2010.487236 https://www.acosa.org/joomla/pdf/rothmanreportrevisedjune2013.pdf https://www.acosa.org/joomla/pdf/rothmanreportrevisedjune2013.pdf https://www.acosa.org/joomla/pdf/rothmanreportrevisedjune2013.pdf https://www.acosa.org/joomla/pdf/rothmanreportrevisedjune2013.pdf https://doi.org/10.1093/sw/29.2.189 http://prospect.org/article/big-tilt https://doi.org/10.1561/100.00014087 https://doi.org/10.5175/jswe.2012.200900111 https://doi.org/10.1017/s0008423912000352 https://doi.org/10.1017/s0034670500020568 mailto:ostranderj@sacredheart.edu __________ estelle simard, msw, visiting professor, and jennifer mccleary, ph.d., associate professor, department of social work, university of minnesota duluth, duluth, mn. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 259-273, doi: 10.18060/24146 this work is licensed under a creative commons attribution 4.0 international license. honoring our ancestors: using reconciliatory pedagogy to dismantle white supremacy jennifer mccleary estelle simard abstract: the us social work profession has historically claimed primarily middle-class white women as the "founders" of the profession, including jane addams and mary richmond. scholarship of the history of the profession has focused almost entirely on settlement houses, anti-poverty advocacy, and charity in the late 1800s in the northeastern united states as the groundwork of current social work practice. courses in social work history socialize students into this historical framing of the profession and perpetuate a white supremacist narrative of white women as the primary doers of social justice work that colonizes the bodies and knowledge of indigenous people and their helping systems. black, indigenous, and people of color (bipoc) in the us have always had indigenous systems of social care. yet, the social justice work of bipoc, and especially indigenous people in the us, is left out of the dominant narrative of the history of social work practice for several reasons including racism, colonialism, and white supremacy. in this paper the authors contribute to the critique of the role of white supremacy as a colonizing process in social work history narratives and discuss frameworks for decolonizing social work pedagogy through a reconciliatory practice that aims to dismantle white supremacy. keywords: dismantling white supremacy, reconciliation, indigenous knowledge, social work history “colonization is a dehumanizing process for both the colonized and the colonizer” (stirling, 2015, p. 37) like any profession, social work in the united states has a series of origin stories that weave together a historical narrative of the birth of the profession during the progressive era (1890s to 1920s). so the story goes, white, middle class women like jane addams, mary richmond, and ellen gates starr built settlement houses and charity organizations in northeastern states and went for friendly visits among neighbors to address issues of poverty and to advocate for immigrant rights (abramovitz, 1998; abrams & curran, 2004; edmonds-cady & wingfield, 2017; franklin, 1986; gregory, 2020; kendall, 1989). the story of social work includes a schism between acolytes of jane addams (macro practitioners in the present day) or mary richmond (micro practitioners today) that is still healing (krings et al., 2020). the story even has a villain in the form of abraham flexner, who maligned fledgling social workers by saying they weren’t “real” professionals and forever altering the course of social work’s disciplinary destiny as social justice advocates sought validity through professionalization (gelman & gonzález, 2016). this is the history of social work that is taught in social work curricula across the united states, and it centers the social caring work and disciplinary priorities and practices of white, middle-class, women in the northeast and obscures or marginalizes social care, about:blank advances in social work, summer 2021, 21(2/3) 260 healing, and advocacy work conducted by black, indigenous, and people of color (bipoc) either historically, or today. because most historical narratives of the development of social work claim primarily white, middle class women as founding ancestors and overwhelmingly ignore bipoc activists and helping systems, our historical narrative is steeped in white supremacy. further, in our rush to professionalize, social work traded the inclusion of bipoc ways of helping and social change agendas for a homogenous and professionalized labor force, consisting primarily of white, middle class women from the northeastern us (gregory, 2020; haley, 2020). in this paper we surface the exclusion of indigenous knowledge and helping systems from the evolution of us social work practice and directly tie this to colonialism and white supremacy in social work today. we provide a path to dismantling white supremacy in social work by reconciling white supremacist social work history with indigenous (specifically anishinaabe) helping systems and indigenous ways of knowing, and include specific examples of reconciliation, especially between the two authors of the paper, one of whom is a member of the couchiching first nation and anishinaabe, and one of whom is a white descendent of colonial settlers. we focus on anishinaabe helping systems because of the specific geographic and socio-historic location of the home academic department of the authors. both authors are faculty at a university in the upper midwest that sits on territory forcefully taken from anishinaabe and other indigenous peoples by settler colonists. in our department we serve a higher than typical proportion of native american students. as a public land grant university, we have a responsibility to confront this specific colonial geopolitical reality within our institution, curriculum, and pedagogy. briefly, land grant universities receive benefits from the morrill acts of 1862 and 1890, which fund higher education institutions by granting states federally controlled land to sell to raise funds for endowments (nash, 2019). nearly 11 million acres of the federally controlled lands granted to states through these acts were indigenous lands stolen through treaties and cessions. many universities have benefitted from land grants without reconciliation with or acknowledgement of the tribes that were dispossessed of their land to build white supremacist institutions (nash, 2019). writing this paper was deeply personal for both authors and we focus on our experience with decolonization in our academic home. because of this, in this paper we specifically focus on reconciliation between white, colonial/settler descendent social workers and indigenous social workers. reconciliation work between other racial or ethnic groups is also essential to dismantling white supremacy in social work education, scholarship and practice. it is not our intention to omit or obscure the ways that white supremacy and reconciliation impacts non-indigenous people of color, but in the context of this paper we view this as a parallel process with many intersections, but with its own history, context, and process. for as long as there have been indigenous languages and ceremonies, there has been an indigenous helping and advocacy process. black, indigenous, and people of color across the world have been helping each other to live and flourish within their societies for generations. the evidence of these systems exists across oral histories which guide the collective nature between neighboring tribes and the dynamic functioning of community and family (baskin, 2018). indigenous traditional knowledge keepers teach the mccleary & simard/honoring our ancestors 261 development of individual roles within a community and how these roles fill the natural communal helping structures within indigenous nations (weaver, 2016). within the anishinaabe nation, these sacred roles or duties exist and are expressed throughout the language, the rituals, the customs, and the ceremonial practices and weave a functional social system designed for wellbeing, abundance, and relationships. anishinaabe language, oral history, and traditional knowledge keepers generate the position that helping people through communal or governmental structures existed long before the origins of eurocentric social work theory and practice. further, these natural helping phenomena were culturally safe, theoretically aligned, consequential in nature, and contextually suited within indigenous worldviews (baskin, 2018). yet these indigenous helping systems have been all but ignored by social workers who purport to practice social work with indigenous communities. white supremacy uses the social construction of race and the racialization of people to assert social control, hierarchies of power, and legitimize the oppression of people racially coded as black and brown. the power of whiteness and white supremacy in the united states is reinforced by systems including the legal system, the education system, and the social welfare system that codify a set of behaviors and values as white and consequently normative (almeida et al., 2019). since its birth, social work has been steeped in white supremacy and has contributed to the colonization and continued oppression of indigenous people in the united states. historically, social workers were complicit in the destruction of indigenous families and communities through the removal of native children from their families (crofoot & harris, 2012). today, child welfare systems perpetuate shockingly high disparities of indigenous children’s involvement with the system (dettlaff et al., 2020). the social care and community healing systems of bipoc have not been entirely ignored by euro-american social work practice. in 1973 the council on social work education guidelines suggested social work curricula should include information about working with racial and ethnic minority groups (jani et al., 2011). these guidelines ushered in an era of “multiculturalism” in social work education programs as they began adding courses such as “social work practice with african americans” or “american indian families” (jani et al., 2011). black and brown ways of knowing and healing were “discovered” in the 1990s and incorporated in small, commodifiable pieces into social work courses. the social work practice taught in these courses is eurocentric or white supremacist social work practice adapted to fit some basic assumptions about homogenized african american or native american cultural practices. rarely do these courses center indigenous or black helping practices as a legitimate form of social work, reinforcing the idea that social workers are white and clients are not, and that legitimate social work practice is eurocentric in origin and adapts to cultural practices of racial and ethnic groups. this is an example of what linda tuhiwai smith describes when she writes “the collective memory of imperialism has been perpetuated through the ways in which knowledge about indigenous peoples was collected, classified and then represented in various ways back to the west, and then, through the eyes of the west, back to those who have been colonized” (smith, 2013, p. 1). advances in social work, summer 2021, 21(2/3) 262 white supremacy and colonization of indigenous peoples white supremacy is intricately tied to the colonization and genocide of indigenous people during the formation of the united states. colonization is an active act that expands a state or settler space at the expense of indigenous land and people. the act of colonization will always create a negative relationship between indigenous people and settler people, as the act of colonization means the absence of empathy, compassion, and love for an indigenous person as they are. the act of colonization is deeply rooted in a colonial mentality or belief system that maintains superiority and privilege for the settler. colonization of the land that is now the united states is rooted in a white supremacist mindset (almeida et al., 2019). colonization was and is empowered and maintained through the laws of the colonial state. a pillar to settler colonial development, colonial laws prepare the pathway to land acquisition, settler state development, and erasure of indigenous ways of knowing, indigenous spaces, indigenous bodies, and indigenous identities. colonization in its most brutal form is extermination of cultural ways and knowledge through violence and genocide (stirling, 2015). formal and informal processes, laws, and practices derived from the act of colonization perpetuate current colonialism in today’s social welfare systems. these processes are designed to increase the social, emotional, educational, political, and economic powers of the colonizer (waziyatawin & yellow bird, 2005). central to this paper is the historical destruction of indigenous knowledge and indigenous forms of social care through colonization and the continued subjugation of indigenous knowledge in current social work pedagogy and social welfare systems. colonialism privileges one way of knowing – the settler way of knowing. colonialism does not allow indigenous ways of knowing into colonial tools, such as laws, policies, procedures, or social helping systems that would support indigenous ways of knowing. colonialism recognizes only the settler world in research, in law, in programs and services (almeida et al., 2019). colonialism like colonization is a verb and therefore an action. it is a settler’s conscious and unconscious effort to maintain power through the social structures designed to support settler ways of knowing (gough, 2013). the colonization of indigenous knowledge and social care is evident in the current structure of the us child welfare system (charbonneau-dahlen et al., 2016; crofoot & harris, 2012; heart et al., 2016; landers & danes, 2016). the roots of today’s child welfare system can be found in the historical legacy of native american boarding schools. residential or boarding schools were established in the late 19th century to remove native children from their homes, families, and lands, and assimilate them into eurocentric ways of being and knowing (charbonneau-dahlen et al., 2016). native children at boarding schools were separated, often permanently, from their families, communities and nations. they were forced to cut their hair, wear european clothing, and were punished for speaking indigenous languages. there is extensive evidence of severe physical and sexual violence, isolation, murder, and other forms of trauma perpetrated against native children at boarding schools (heart, 1999; heart et al., 2016). boarding schools were designed to mccleary & simard/honoring our ancestors 263 socialize and colonize the mind of indigenous children and youth by severing cultural ties and separating indigenous children from cultural knowledge (baskin, 2018). child welfare continues to be the colonial tool of choice in disruption of family systems and forced assimilation of indigenous children, as the dominant colonial settler ideology has prevailed (dettlaff et al., 2020). its deepest impacts are etched in today’s deadly statistics of over-representation of indigenous children in out-of-home care. in addition to this over-representation, indigenous children’s unique development and cultural needs are often not being met either by the child welfare system or the child welfare caregiver (landers & danes, 2016). the disruption of family, the assimilation, and the continued abuse of indigenous children is an unsettling colonial tool designed within a white supremacist legacy. the coloniality of the child welfare system is perpetuated by social work education programs that don’t recognize or teach the historical legacy of colonization and its current effects on indigenous people (coates & hetherington, 2016). when indigenous content is included, it is often historical, minimal, and depicts indigenous people as recipients of social care. indigenous content in social work curricula rarely include adequate or accurate histories of native american genocide and colonization, information about current, living indigenous nations, or models of indigenous social care (coates & hetherington, 2016). this lack of adequate education is one important factor in disproportionately high representation of indigenous children in the child welfare system (hanna 2021). indigenous pedagogical ways of knowing indigenous ways of knowing, being, and pedagogy require a fundamental understanding of indigenous peoples' sacred, traditional, contemporary, and deliberative laws and this knowledge must be included in current social work pedagogy if reconciliation is to occur. indigenous pedagogy begins with the fundamental knowledge that we are on a spiritual journey in a human experience. it is knowing our purpose and integrating that purpose into our families and our communities across turtle island. turtle island is the name that many indigenous people use to refer to the continent of north america. the word originates with algonquian and iroquoian-speaking people but is commonly used by many indigenous people. indigenous pedagogy could be specific to ones’ purpose in life. however, most importantly, indigenous pedagogy is a way of being within this life. the ceremonies, lodges, and rites of passage are designed to support this purposeful learning within an indigenous community. cultural structures bring continuity and wellbeing to the individual, family, and community. as a result, developing an attachment to culture is an indigenous pedagogical practice. in this section we focus on outlining specifically anishinaabe ways of knowing for several reasons. first, if indigenous knowledge is known and visible, it can be included in social work pedagogy as a step toward dismantling white supremacy. second, we focus specifically on anishinaabe knowledge because of the geographic location of our social work program. finally, we acknowledge that indigenous tribes are different and contain a multitude of cultures, traditions, languages, and ways of being. it is impossible to group all tribes into one homogenous indigenous culture. advances in social work, summer 2021, 21(2/3) 264 many different words describe the concept of sacred laws in the anishinaabe language, such as anishinaabe inaakonigewin, or sacred law (courchene, 2015; craft, 2014; fletcher, 2017). sacred law is one of four categories of law, along with natural, customary, and deliberative. sacred law is considered the “original instruction” for the anishinaabe people (craft, 2014). natural law is consistent with the behavior and reaction of the “natural environment” (craft, 2014). customary law is concerned with practices, traditions, and customs of anishinaabe peoples. concerning anishinaabe laws, craft (2014) stated, "most laws flow from sacred law" (p. 12). anishinaabe inaakonigewin speaks to life's responsibility, specifically to one's own life and to all life that exists here. anishinaabe inaakonigewin is the great spirit/creator's law. it understands you are spirit first and come from the spirit, and with this responsibility, you are aware of what this entails. "anishinaabe rules and protocols form and inform anishinaabe inaakonigewin and are meant to be observed. observance of those rules is linked to concrete and spiritual consequences” (craft, 2014, p. 12). in anishinaabe ways of knowing and being, sacred laws are expressed in language. sacred laws guide the spirit's sacred journey on this earth (courchene, 2015; fletcher, 2017). sacred laws are the rules, procedures, responsibilities, and codes within relationships. sacred laws are a legal structure for communal/societal development and guide responsibilities to community, society, and the world. sacred laws are the living embodiment of creation. these laws live as internal/intrinsic standards to personal, familial, and communal development (courchene, 2015; fletcher, 2017). our responsibility to these laws is to ensure they are carried out in good ways and ensure they are shared and promoted as sacred understandings of the creator’s rules. sacred laws are passed on through stories, teachings, or instructions. sacred laws are “embedded in anishinaabe language, sacred narratives, personal reminiscences, and ceremonies” (courchene, 2015, p. 44). sacred laws have protocols, procedures, and at times a formal process that exists before entry into the sacred knowledge. sacred laws in the form of stories allow a process of dialectic learning, which is the substance of indigenous pedagogical frameworks. sacred laws and their stories or teachings promote who you are as an indigenous person and who you are meant to be (dennis & minor, 2019). sacred laws are not only a guide to teach one how to act and be in this world, but provide a context for relations with other beings. an example of sacred law is mino-biimaatiziwin; this is a sacred law for the governance of self and the governance of self with others. sacred laws are with us as they are spiritual, as we are part of the great spirit (courchene, 2015). dismantling white supremacy through reconciliation social work education is eurocentric. it centers eurocentric ideas and theories and sets them as the standard by which to deem indigenous knowledge and healing systems as “other” and marginal. even the practice of seeking to include indigenous knowledge in social work pedagogy as a form of “diversifying” the curriculum reinforces the white supremacist idea that white values, forms of knowledge, practices, and behaviors are at the center and indigenous values, forms of knowledge and practices are at the margins. mccleary & simard/honoring our ancestors 265 numerous scholars suggest frameworks for decolonizing social work education and practice (coates & hetherington, 2016; dumbrill & green, 2008; fellner, 2018; hendrick & young, 2018; tamburro, 2013). some scholars recommend indigenizing social work programs by including indigenous voices, stories, knowledge, and authors in amereuropean curriculums (coates & hetherington, 2016; hendrick & young, 2018). others emphasize that this inclusion is ineffective if done outside of the context of critical selfreflection and the equitable treatment of indigenous knowledge (dumbrill & green, 2008; tamburro, 2013). some scholars suggest the building of critical consciousness (freire, 1970) to name and interrupt white supremacy and coloniality in texts, curricula, and practice modalities (almeida et al., 2019). we argue that decolonizing social work must include a focus on reconciliation between indigenous people and settler/colonizers. the onus of change within a monolithic system comes from within the structure. all people with power and privilege within the system have a responsibility to contribute to dismantling white supremacy and making room for cultural safe spaces to develop. although the dismantling and cultural developing can be simultaneous processes, the dismantling and restructuring must start first. this paper is written by two authors with specific identities. estelle is indigenous and jennifer is white and female identified. jennifer is a descendent of settler/colonists and lives on occupied territory that was forcefully seized from anishinaabe and other indigenous people in the treaty of 1854. both authors are professors at a public land grant university that is also located on forcibly seized indigenous land. in this section of the paper we will describe our personal approaches to decolonizing social work. we take this approach of separate paradigms of decolonization because we believe that we both have unique experiences with colonization and responsibilities for contributing to decolonizing actions. estelle as an indigenous researcher, it is difficult to present the phenomenon of colonization/settler colonial without being influenced by the topic. for example, i am an indigenous woman, and have experienced colonization/colonialism firsthand. as an indigenous woman i have witnessed colonization/settler colonial effects on my family, extended family, community, and nation. as an indigenous woman, i have worked all my life to help indigenous children, youth, families, communities, and organizations, to create a vision of cultural wellbeing as a countering influence to colonization. as an indigenous woman, i have educated myself within academia to learn the tools of research to create and support a better life for indigenous children. as an indigenous researcher, i comprehend the historical etching of colonization/settler colonialism on indigenous peoples. further, i am cognizant of the need to bracket my personal experiences from my academic and professional knowledge. bracketing my indigenous experience of colonization/settler colonial throughout this article has been an experience of blocking reality, guarding against settler colonial mindset, and reflective reconciliatory process of experiences for myself, my children, my family, my extended family, my community, my indigenous nation, and ultimately with united advances in social work, summer 2021, 21(2/3) 266 states/canada. it has not been impossible to bracket my worldview, as it is a daily coping skill many indigenous people acquire to function “normally” within society. be it good or bad, functional or dysfunctional, all indigenous peoples experience a bracketing of their worldview when they intersect with the united states and canada. emotionally charged research, such as colonization/settler colonial, often needs to be bracketed. levels of selfawareness and emotional intelligence are necessary features to the bracketing process because colonization/settler colonial ideologies and their impacts on indigenous peoples are devastatingly haunting. the intention and applications of these ideologies have long lasting impacts on indigenous peoples, because the intention and application make one worldview better at the expense of another worldview. colonization and settler colonialism will always allow for power and privilege to exist within a colonial settler system and society as that is colonization/settler colonialism's only way of knowing and being, in spite of the consequences to others. jennifer i operate from the belief that decolonization is a paradigm shift that happens over time. as a descendent of settler/colonizers, i have been socialized to recreate colonization in my actions and beliefs. i was taught a history in american public schools that effectively erased the genocide of indigenous people during the formation of the united states. further, i was socialized to believe that the colonization of indigenous people has ended and that current public policy sufficiently amends historic mistakes. during a master’s and ph.d. in social work i was trained to identify with foremothers of social work who looked like me (white, middle class, female) and to use eurocentric theories, skills, practice modalities and ways of creating knowledge. i was taught that the helping practices and knowledge of indigenous people are merely cultural relics that can inform my practice, but are not centered in my practice. the first step in my process of decolonization is to critically interrogate and recognize my personal, current role in the history and perpetuation of colonization. i believe that it is my responsibility to learn the history of indigenous people prior to colonization; to understand the extent and method of genocide perpetrated on indigenous people during colonization, and to develop a deep understanding of indigenous people in the united states today, especially focusing on the tribes and nations geographically proximate to me. in addition to learning content, i must also recognize my personal contribution to colonization including living on land that originally belonged to anishinaabe people, working at an institution that frequently replicates colonial practices, and benefitting from race privilege. the second step in my process is to actively engage in resistance to colonial practices (baskin, 2018) and seek ways to reconcile my identity as a white settler/colonizer with my actions. this requires a paradigm shift wherein i continue to interrogate my actions, beliefs, and re-actions through a lens of recognition of socio historical identity. finally, i believe that true dismantling of white supremacy and the decolonization of social work will come from reconciliation between settler/colonizer social workers and indigenous social workers and reconciliation between euro-american and indigenous mccleary & simard/honoring our ancestors 267 ways of knowing, caring, healing, and advocacy. this reconciliation is a process of listening to and learning from indigenous peoples, actively dismantling white supremacist ideas, policies, behaviors, and practices to make space for indigenous ways of knowing, and actively valuing indigenous ways of knowing as important not just for indigenous people, but for all people (baskin, 2018; pratt & danyluk, 2019). frameworks for reconciliation dismantling the white supremacy inherent in social work practice, pedagogy, and scholarship since its inception is at the heart of decolonizing social work education and curriculum. it is the responsibility of both white and indigenous people and should be conducted within the framework of relationships and reconciliation (baskin, 2018). white social workers need to actively resist the colonial practices that are built into our systems of education. below we describe some specific and concrete actions that contribute to dismantling white supremacy through decolonization. we believe the first step in this process must be for both non-indigenous and indigenous people to engage in critical selfreflection, as described in the section above, and to focus on building and repairing relationships between indigenous and non-indigenous people and communities. few social work departments have a critical mass of indigenous faculty, but most social work departments are proximate to indigenous lands and communities. these relationships will be central to the steps described below. within the context of reconciliatory relationships, social work programs can begin to scan and assess all levels of their institution to understand the vortex of unwritten, unearned, and at times the unconscious power and privileges contained within monolithic systems designed for white bodies (almeida et al., 2019; baima & sude, 2020; gregory, 2020; seawright, 2014; tamburro, 2013). decolonized social work paradigms must address social justice issues in ways that are meaningful to indigenous peoples (sinclair, 2019). this includes more than understanding and listening to the plight of indigenous students and faculty, it is actively engaging in the system as a whole to dismantle the historical, spiritual, political, social, educational, and economic implications of colonization on indigenous bodies (pitner et al., 2018). decolonized social work pedagogy and practice requires moral, ethical, and transformative leadership and agendas. leaders within educational systems need to assess their environment for systematic injustices on indigenous bodies (pratt & danyluk, 2017). this assessment requires transformative change teams with skills to manage the dynamics of reconciliatory social work practice. this assessment also requires the understanding of walking through the educational system through the eyes of an indigenous person. decolonized social work pedagogy and practice requires understanding the levels of cultural knowledge incorporated into the institution. after scanning for and developing processes to dismantle systematic injustices, social work programs can document where there could be real and sustainable inclusion of indigenous knowledge. for example, does the curriculum contain accurate and adequate information about indigenous people? is there semblance of reconciliatory relationships with geographically proximate indigenous tribes? is there a land acknowledgement established and presented in all publications of the advances in social work, summer 2021, 21(2/3) 268 university? does the university secure knowledge of indigenous peoples across the system to inform, educate, and support the ghosted students within the monolithic institution? indigenous people want to succeed in the university system; however, the annals of colonial trauma permeate indigenous student learning. decolonized social work pedagogy and practice requires an evaluation of resource development. what types of indigenous knowledge rests within the university and the department? where does it rest? who maintains it and brings it to life for a department and a university? decolonized social work pedagogy is more than culturally congruent lesson plans. it is actively engaging the educational system at all levels of functioning. addressing educational systems means working with indigenous nations, the state, the universities, the management, the departments, the teachers, the curriculum, and the outcomes. decolonizing social work education is not the responsibility of indigenous people, although it is essential for this group to have voice within these sectors. educators within these higher education institutions must establish a culturally informed and culturally responsive agenda to the issues of oppression faced by indigenous peoples. educators need to work with national bodies to give voice to the correct history of indigenous peoples and the impact of this history on indigenous people, families, and communities. institutional works for decolonized social work pedagogy and practice include embracing indigenous ways of knowing that focus on empowerment (root et al., 2019). institutional works require review of bylaws, policies, procedures, and orientation manuals for faculty and staff that include culturally informed/culturally responsive standards. institutional works continue with evaluating the vision, mission and goals that are inclusive of indigenous peoples and poc or minorities. culturally informed policies that include forward thinking cultural approaches for the faculty, staff, and students must be centermost. these policies should include policy statements on culturally responsive practice within the institution. further, these culturally informed policies need to be integrated into the wide systems job descriptions, to ensure the onus of cultural responsiveness rests with staff and faculty. cultural screening competencies for potential hires should include behavioral interviews that assess cultural responsiveness in ways that bring congruent values to the institution (steen, 2018). most importantly, institutions must have innovation to begin to decolonize all sectors of the institution. decolonized social work pedagogy and practice requires very specific education for staff and faculty (hendrick & young, 2018). the assumption that all educators are educated in areas of colonization and decolonization strategies is misleading. not all educators have this knowledge. as a result of monolithic socialization, educators can fall into a space of privilege and complacency which maintains the status quo. consequently, this is the rationale for cultural learning spaces that allow for exploration of critical reflection, cultural courage, and indigenous learning (fernando & bennett, 2019; morcom & freeman, 2018). the need to develop human identity (schiele, 2017) is cornerstone to decolonized social work pedagogy and practice. fortified self-awareness on critical race theory (pulliam, 2017), critical indigenous ways of knowing, and critical multiculturalism (feize & gonzalez, 2018) are essential learning strategies for educators within monolithic metropole state institutions. having opportunities within one’s system to reconceptualize issues of race, racism (tisman & clarendon, 2018), worldview mccleary & simard/honoring our ancestors 269 dichotomies, political, social, emotional, mental, spiritual, and historical dimensions of white power over bipoc people gives opportunities to shift institutional worldviews and assert a humanity framework (tascón & ife, 2019). decolonized social work pedagogy and practice requires careful planning in student learning outcomes (varghese, 2016). application of indigenous best practices and learning strategies are part of the accessible development within the cultural committees or elders associated with the institution’s development. utilization of indigenous content, indigenous authors, indigenous space and land are required throughout the program. nevertheless, having opportunities to decolonize together (nicotera, 2018; pitner et al., 2018) within a social work program builds a different world, one which changes social work practice. conclusion our approach to reconciliatory pedagogy consists of five key elements described above: 1) critical self-reflection and relationship repair/building between indigenous and non-indigenous people, 2) conducting an institutional scan for colonial practices, 3) transforming colonial policies and practices within the institution, 4) incorporating cultural knowledge into curriculum, policy, and practices, and 5) providing an accurate education about colonization and dismantling colonial practices to students, staff, and faculty. these steps require social work faculty, especially non-indigenous faculty, to recognize and name the ways white supremacy and settler colonialism are perpetuated in academic institutions as well as the teaching and practice of social work itself. but beyond simply acknowledging the fact of white supremacy, this framework offers a pathway toward decolonization that guides social work faculty, students, and practitioners through concrete action steps. it is especially important to focus on transformative inclusion of indigenous knowledge and practices in social work curricula. many diversity and equity efforts in academia currently are focused on “inclusion” of historically marginalized groups. including those who have 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(2016). indigenous social work in the united states: reflections on indian tacos, trojan horses and canoes filled with indigenous revolutionaries. in m. gray, j. coates, & m.y. bird (eds.), indigenous social work around the world (pp. 99-110). routledge. https://doi.org/10.4324/9781315588360-14 author note: address correspondence to jennifer mccleary, department of social work, university of minnesota duluth, duluth, mn 55804. email: jmcclear@d.umn.edu. https://doi.org/10.1080/10911359.2016.1252601 https://doi.org/10.1080/00131946.2014.965938 https://doi.org/10.7202/1069584ar https://doi.org/10.1080/10437797.2017.1404526 https://scholarspace.manoa.hawaii.edu/bitstream/10125/29814/v2i1_02tamburro.pdf https://doi.org/10.4324/9780429284182 https://doi.org/10.1080/08841233.2018.1442384 https://doi.org/10.1080/10437797.2016.1174646 https://doi.org/10.4324/9781315588360-14 mailto:jmcclear@d.umn.edu this work is licensed under a creative commons attribution 4.0 international license. interventions supporting the social integration of refugee children and youth in school communities: a review of the literature andrew d. reynolds rachel bacon abstract: schools function as a primary driver of integration and as a link to resources and assets that promote healthy development. nevertheless, most research studies on school-based programs are conducted on mainstream students, and school professionals looking to deliver interventions serving refugee students are forced to choose between evidence-based programs designed for the mainstream and developing new programs in the cultural framework of their students. the purpose of this literature review is to provide a summary of recent research on successful, evidence-based programs as well as promising interventions and practice recommendations in five core practice areas in schools: school leadership and culture, teaching, mental health, after-school programming, and school-parent-community partnerships. these findings are presented drawing from theoretical frameworks of ecological systems, social capital, segmented assimilation, resilience, and trauma, and describe how such theories may be used to inform programs serving refugee children and youth. additionally, this review describes the core components of successful programs across these practice areas to inform researchers and practitioners as they select and develop programs in their own school communities. finally, this review concludes with a discussion of human rights in the education of refugee children and youth. keywords: migration; refugees; children and youth; prevention at the end of 2016, the number of forcibly displaced individuals worldwide reached a record high of 65.6 million people, 22.5 million of whom were formally recognized as refugees. just over half of this worldwide refugee population is made up of children below 18 years of age (unhcr, 2016). when refugee children flee their home countries, the lengthy process of displacement and resettlement can cause protracted periods of disruption, particularly in their education (block, cross, riggs, & gibbs, 2014; mcbrien, 2005; naidoo, 2009; nelson, price, & zubrzycki, 2014). in schools, refugee students encounter academic and social challenges that may hinder processes of integration and healthy development (bal & arzubiaga, 2014; berthold, 2000; kanu, 2008; kia-keating & ellis, 2007; roy & roxas, 2011). schools function as a primary driver of integration and as a link to resources and assets that could promote the healthy development of refugee children. nevertheless, most research on school-based programs are conducted on mainstream students, and school professionals looking to deliver interventions serving refugee students are forced to choose between evidence-based programs designed for the mainstream and developing new programs in the cultural framework of their students (rousseau & guzder, 2008). as the number of refugees across the globe has reached historic highs and has been met with a _________________ andrew d. reynolds, phd, msw, med is an assistant professor, school of social work, university of north carolina at charlotte, charlotte, nc, 28223. rachel bacon, msw, lives in charlotte, nc. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 745-766, doi: 10.18060/21664 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 746 new wave of nativism and xenophobia among far-right movements (minkenburg, 2013), there is a great need for evidence-based prevention programs in school communities that promote tolerance, encourage social integration, and enhance the health and well-being of refugee children. the purpose of this paper is (1) to provide a review of theoretical frameworks informing social work practice with refugee children in schools, (2) to examine existing evidence-based prevention programs in schools, (3) to identify core components of successful programs, and (4) to offer implications for social work research and practice with refugee children with an emphasis on education as a human right. refugee children many refugee children have experienced violence or trauma prior to fleeing their countries of origin. compared with adults, refugee children are at heightened risk for symptoms of posttraumatic stress disorder (ptsd), anxiety and depression, maladaptive grief, social withdrawal, and behavioral and academic difficulties (halcon et al., 2004; layne et al., 2008; masten & narayan, 2012; sullivan & simonson, 2016). further, they must adjust to a completely new culture that includes new customs, a new language, and a new education system (kia-keating & ellis, 2007). once resettled, refugee children begin the challenging process of navigating a new educational environment. many refugee students encounter academic, economic, and psychosocial challenges that include separation from family, cultural dissonance, acculturation stress, limited english proficiency, gaps in schooling, distrust or fear of school personnel, conflicting expectations between families and school faculty, and limited financial resources (bal & arzubiaga, 2014; berthold, 2000; kanu, 2008; kia-keating & ellis, 2007; roy & roxas, 2011). as a result, refugee youth are at higher risk for school dropout. in one longitudinal study, fewer than 2 in 3 refugee youth graduated high school, with age of arrival and experiences of discrimination as factors associated with dropout (correa-velez, gifford, mcmichael, sampson, 2017). because school attendance is associated with developed fluency, many refugee children use these skills to function as cultural and lingusitic brokers for their families (mcbrien, 2005). students take on roles and responsibilities beyond their years and are burdened with leading their families in navigating the resettlement process. it is often students who are helping their parents build cross-cultural community and social networks, who serve as their interpreters, and who translate documents and correspondence for parents (uptin, wright, & harwood, 2013). these barriers and responsibilities may adversely affect refugee students’ abilities to adjust and integrate successfully into a new schooling environment (block et al., 2014). there are a number of theoretical frameworks that can be used to understand the process of refugee resettlement and integration in school communities for refugee children and their families. five theories are reviewed: ecological systems, social capital, segmented assimilation, resilience, and theories of trauma. reynolds & bacon/ schools and refugee 747 ecological systems theory in the context of the resettlement of refugee children, ecological systems theory emphasizes the necessity of understanding the circumstances surrounding and affecting the resettlement and integration process. ecological systems theory asserts that human development and behavior is a product of enduring forms of reciprocal interactions – called proximal processes – between individuals and their environments over time (bronfenbrenner & morris, 2006). this ecological lens acknowledges that the traumatic and rapidly shifting events that occur before, during, and after flight from one’s home country would disrupt and protract these very proximal processes necessary for a healthy course of development (brenner & kia-keating, 2017; mcbrien, 2011; rousseau & guzder, 2008). difficulties surrounding the causes, processes, and effects of forced migration that occur in one area of an ecological system (e.g., the family) have consequences on other systems (e.g., the individual). relationships may also be disrupted as a result of the varied reactions children have to the adversity they experience in forced migration. for example, youth exposed to war and violence commonly experience reactions that can burden their development, including symptoms of ptsd, anxiety, depression, grief, social withdrawal, externalizing behavior, separation anxiety, and ageinappropriate dependence on their caregivers (berthold, 2000; layne et al., 2008). these reactions to adverse experiences can disrupt the structures in the environments of children exposed to violence, persecution, and forced migration (brenner & kia-keating, 2017). social capital theory because forced migration fundamentally restructures social relationships for refugee children and families, the resettlement process also reduces access to the value and resources that come from relationships with others. social capital theory argues that social relationships have value. for youth, social capital in the family, community, and school facilitate the development of new skills and capabilities, and may open doors to new opportunities and relationships (coleman, 1988). however, individuals who are willfully or unintentionally excluded from these networks may not have access to the benefits that these relationships bring (putnam, 1995). a social capital lens acknowledges the losses in access to resources and opportunities that refugee children experience as a result of forced migration, but also views rebuilding and fostering new positive relationships in order to recreate those resources and opportunities in the host country as a central goal of the resettlement process. schools are institutions that have the capacity to help foster the recreation of social capital for refugee children (naidoo, 2009). as institutional agents, school personnel play a large role in both constructing and breaking down barriers to successful integration for refugee students (stanton-salazar, 2011). for refugee children to gain social capital and thrive, they need both social and institutional support from within the networks in which they interact, develop, and learn (stanton-salazar, 2011). advances in social work, spring 2018, 18(3) 748 segmented assimilation theory as refugee communities resettle in their host countries and adapt to a new culture, they may experience different pathways and outcomes of integration one toward successful integration into the social and economic mainstream, and the other “downward assimilation” into a social underclass marked by deviance and reactive ethnicity subcultures (haller, portes, & lynch, 2011; portes & zhou, 1993). segmented assimilation theory argues that three factors – family structure, modes of incorporation, and access to human capital –determine the paths of mobility and integration for refugee communities, from the first to second and third generations and beyond. given the numerous and complex challenges that are likely to occur throughout the resettlement and integration process, it is probable that resettled children will experience varying paths of acculturation that represent the range between successful integration and downward assimilation (mcbrien, 2005). disparities occurring in the three integration pathway determinants for refugee newcomers form into patterned difference over time. for example, factors such as low parental social and economic capital, hostile modes of incorporation in the receiving community, and weak co-ethnic communities, may lead to a particular path of downward assimilation for refugee children (haller et al., 2011; kanu, 2008). school systems may help buffer against these potential risks, or conversely form and reinforce negative pathway determinants for refugee children (kanu, 2008). for example, discriminatory housing practices that disproportionately place refugee families in low-resource school communities may place refugee children in environments more reflective of portes and zhou’s (1993) downward assimilation than successful integration into the middle class. resilience theory nevertheless, refugee children are not entirely at the mercy of their circumstances. resilience theory refers to the capacity of individuals to adapt to adversity and withstand or recover from challenges to one’s development or security (masten & narayan, 2012). refugee children are part of a population the resilience literature identifies as “high-risk” due to the prevalence of adverse, stressful, and violent circumstances many of them endure prior to and throughout the resettlement process (werner, 1995). despite these detrimental experiences, there are multiple predictors for resilience in children, largely based on protective factors in individuals that can help moderate a person’s response to adversity (werner, 1995). such protective factors can make a more profound impact on the lives of refugee children in comparison to their exposure risk factors and adverse life events (werner, 1995). longitudinal studies on resilience have shown that during childhood and adolescence, factors such as social and problem-solving skills, a sense of autonomy, self-efficacy, a sense of purpose, creative interests, and religious beliefs may all promote positive adaptation to adversity (benard, 2004). protective factors in an individual’s community may include family relationships as well as trusting relationships with teachers, neighbors, peers, and other positive role models (werner, 1995). schools play an important role in fostering resilience for refugee youth. for example, many refugee students possess high educational aspirations, which is a significant individual protective factor, and schools and reynolds & bacon/ schools and refugee 749 their faculty can serve as protective agents at relational and environmental levels (brenner & kia-keating, 2017; roy & roxas, 2011). understanding trauma trauma, defined as an inescapable event that overwhelms an individual’s existing coping mechanisms, is a common part of life experience for refugee populations (unhcr, 2016). trauma often follows in the wake of persecution, violence, conflict, and human rights violations in refugees’ countries of origin. experiences of trauma occur in multiple forms and are not limited to circumstances in refugees’ countries of origin; trauma experiences can occur across pre-migration, migration, and resettlement periods (weaver, 2016). examples of pre-migration and migration trauma common to refugee experiences include lack of food or clean water, being displaced, lack of shelter, ill health without access to proper medical care, murder of a family member or other loved one, being detained or beaten, and witnessing war or violence (sullivan & simonson, 2016; weaver, 2016). once refugee families are resettled in a country of origin, they may also experience psychological distress resulting from the difficulties of integrating into a new culture. the arduous process of acculturation is rife with potentially adverse circumstances, involving learning a new language, new customs, and navigating new social, financial, and educational systems (sullivan & simonson, 2016). the experience of trauma in the lives of refugee children can have lasting effects. common child and adolescent responses to trauma may include fear, anger, irritability, sadness, apathy, inattention, anxiety, disrupted sleep, struggling in school, and somatic complaints, such as stomachaches and headaches (sullivan & simonson, 2016). in a study conducted with tamil refugees, most respondents reported that effects of their trauma experiences lingering after migration and resettlement included dwelling at length on their experiences, feeling hopeless, having recurring nightmares, and experiencing retraumatization as a result of triggers (weaver, 2016). these responses reflect long-term behavioral and emotional effects of experiencing trauma, and they also reflect the brain’s responses to trauma, even long after the traumatic event has actually occurred (van der kolk, 2014). when one experiences a traumatic event, the limbic system and brainstem in the lower parts of the brain respond to threat by triggering automatic reactions that may help a person reach safety (nelson et al., 2014). these triggered bodily responses to trauma provide an adaptive and protective function at the time of the traumatic event; however, once these responses have become highly sensitive, similar reactions can be triggered again in situations that may seem similar but are not actually threatening. as a result, circumstances that recurrently trigger a response to distress can disrupt a person’s day-today functioning (nelson et al., 2014; weaver, 2016). in seeking to understand trauma among refugee children, it is important to exercise cultural sensitivity and recognize the many and diverse understandings of trauma. in western countries, trauma is largely understood within a biomedical framework, which may be limited in its capacity to understand refugees as whole, diverse people who live lives that go far beyond the illness boundaries of the biomedical approach (brough, gorman, ramirez, & westoby, 2003). a number of researchers argue that incorporating social factors and the recognition of self-healing capacities can help provide a lens of advances in social work, spring 2018, 18(3) 750 cultural humility and empowerment for refugee children who have experienced trauma (brough et al., 2003; evers, van der brug, van wesel, & krabbendam, 2016; sullivan & simonson, 2016). key practice areas in school-based interventions in light of these theoretical frameworks, the following section describes school-based interventions and recommended practices in five areas: school leadership and culture, teaching, mental health, after-school programs, and family and community partnerships. school leadership and culture school leadership and culture is a critical practice area for integration of refugee youth. school leaders have the capacity to create more culturally and linguistically responsive learning environments that promote the sociocultural integration of refugee youth. in a review of literature on school leadership, khalifa, gooden, and davis (2016) identify four culturally responsive school leadership behaviors: developing critical self-awareness, supporting teachers in becoming more culturally responsive, creating culturally inclusive environments, and engaging parents and communities. school leaders have the capacity to transform school environments to make them more inclusive and more responsive to the needs of refugee students. scanlan and lópez (2014) argue that school leaders have three primary tasks in creating culturally and linguistically responsive schools: promote sociocultural integration, cultivate language proficiency, and ensure academic achievement. these goals are achieved by creating a learning architecture that creates and facilitates design for learning, which occurs in the context of communities of practice. by using the term learning architecture, scanlan and lopez (2014) argue that learning cannot be designed directly; rather school leaders are tasked to design for learning through the creation of processes and products that facilatate it. for educators looking to make their schools more responsive for refugee youth, the focus on learning architecture shifts the emphasis from what is “taught” to the structures in place within a school that facilitate cultural and lingusitic learning and exchange – both for teachers and students. for example, if a school leader wanted help their teachers develop culturally and linguistically reponsive teaching practices, the leader should focus not just on what is taught – e.g. a professional development training – but also on creating structures to faciltiate learning in an ongoing manner. scanlan and lopez (2014) argue that supportive teacher learning communities where teachers engage in regular and ongoing conversations about topics of pedagogy and cultural and linguistic difference provide an example of learning architecture in practice. the authors also argue that the practical elements of a learning architecture throughout a school community take form via integrated service delivery, which encompasses ensuring equal access to educational opportunities through high-quality teaching, resource allocation, and school policy. given the complexity of school leadership and the challenge of conducting randomized controlled trials at the school level, there are few evidence-based examples of school leadership practices that facilitate the integration of refugee youth beyond correlational or single case studies. one study across 44 schools in melbourne, australia used a mixed reynolds & bacon/ schools and refugee 751 methods study that combined organizational ethnography, qualitative interviews, and quantitative tracking of refugee outcomes over time to evaluate an intervention called the school support programme for refugee youth (block et al., 2014). the program involves creating a refugee action team at the school, comprised of teachers and members of the leadership and administration team. each school completes a refugee readiness audit, and in turn develops actions plans to address areas of need. online resources and professional development opportunities are also included. findings across the schools indicate promising results many of the schools developed action plans and put them into action, changed school policies to make them more culturally responsive to refugee youth, and raised awareness among school teachers and staff about the challenges faced by refugees in the school system. two case-study examples also provide evidence of strategies that schools might use to create responsive communities for refugee students. in a study of four australian schools, taylor and sidhu (2012) identify the importance of taking an advocacy role in school leadership through supporting students (particularly those unauthorized) through legal processes of immigration, accompanying families through the refugee review tribunal, and community advocacy efforts through newsletters and public statements in support of refugee well-being even in some cases in response to less receptive language from politicians. the latter emphasizes the need to make the commitment to social justice for refugees explicit through school mission statements, values, and messaging. the authors acknowledge that systemic support via government-sponsored programs is critical to support these efforts. additionally, a case-study of a south australian primary schools emphasized the need for teacher trainings, curricular adjustments, and strategic decisions around integrating mainstream and newly arriving students by reducing tracking practices in classrooms and school activities (pugh, every, & hattam, 2012). more research is needed, however, to examine these practices at the district level in order to identify specific school leadership practices that help to effectively integrate refugee youth. teaching teachers play a primary role in the education and integration of refugee youth, yet research is mixed about the teacher’s perceptions of refugee youth and the practices they use to work with this unique student population. a series of studies have examined teacher perceptions and beliefs about refugee children, each in unique social and political contexts. in a survey of 139 teachers in a large urban school district in the us pacific northwest, kurbegovic (2016) found that teachers reported feeling confident and culturally competent to teach refugee students; however, many of these teachers did not believe that the needs and circumstances of these students were unique from those of mainstream students. because of the significant barriers that culture, language, trauma, and migration play on refugee youth, teacher reports of confidence alongside a lack of acknowledgement of the needs of refugee students suggests a disconnect whereby teachers may be overconfident about their capacity to serve all of their students. this disconnect was also documented by roy and roxas (2011), who found that there was a strong disconnect between somali bantu families’ goals and what their teachers thought their goals actually were, highlighting the ways in which teachers may have overemphasized the deficits of refugee advances in social work, spring 2018, 18(3) 752 families and played down or missed their strengths. in other research, teachers have been more direct about the need for additional supports. in a study of norwegian teachers, pastoor (2015) found that most teachers had neither sufficient knowledge nor competence to adequately account for the psychological problems that were presented by their refugee students, and expressed a need for more adequate teaching resources and supports. similar sentiments are echoed in a study of teachers on prince edward island who confirmed the need for additional professional development resources, particularly in the area of teaching in the context of trauma. one teacher described the process of teaching refugee students without adequate preparation as “like feeling your way around in the dark” (macnevin, 2012). additionally, research has highlighted the work that teachers are doing in the classroom to reach refugee students. windle and miller (2012) used a survey research design to examine the extent to which teachers used commonly accepted language and literacy teaching pedagogies with refugee students, including practices such as scaffolding learners, using direct and explicit teaching of language, activating prior knowledge, modeling metacognitive skills, and focusing on critical and creative skills. study findings indicate that over half of the practices they identified were used routinely by a majority of teachers. in light of research on teacher perceptions and beliefs about refugee students, such research suggests that overall teachers are using commonly accepted pedagogical strategies but that there is a knowledge and practice gap with respect to specific, tailored strategies for working with refugee students. one strategy for engaging refugee students can be to make more explicit the connection between students’ lived experiences and classroom materials through the incorporation of “funds of knowledge” (moll, amanti, neff, & gonzalez, 1992). central to this approach is the understanding that households have cultural and cognitive resources useful for the classroom, and that teachers can use research strategies to engage with parents and households to qualitatively identify funds of knowledge at home that can then be used to augment teaching practices in the classroom. szente, hoot, and taylor (2006) have also developed a series of recommendations for teachers in elementary settings working with refugee youth. these recommendations include: focusing on nonverbal social-emotional interventions, using peer learning strategies when possible, teaching mainstream youth about refugee experiences, and connecting to external resources. mental and behavioral health though refugee children are at heightened risk for a variety of mental and behavioral health problems (halcon et al., 2004; layne et al., 2008; masten & narayan, 2012; sullivan & simonson, 2016), they are also less likely to seek out mental health treatment to address these challenges (de anstiss, ziaian, procter, warland, & bachurst, 2009; ellis, miller, baldwin, & abdi, 2011). in one study in the netherlands, 57.8% of refugee children were identified as in need of mental health services in comparison to only 8.2% of their native mainstream dutch peers, and of these 57.8% only 12.7% actually accessed mental health services. research has identified financial challenges, language and cultural concerns, parental health literacy, distrust of authority, differences in health care systems from the country of origin, and mental health stigma as factors preventing access to services for reynolds & bacon/ schools and refugee 753 refugee children and families (cardoso & lane, 2016; ellis et al., 2011). because children spend extensive time in school settings, schools may be a primary mechanism to identify and provide services for refugee youth in need of mental health services and may be a means through which psychoeducation and other strategies to raise awareness among refugee communities of the importance of seeking mental health services. two reviews of prevention-based mental health programs exist (rousseau & guzder, 2008; tyrer & fazel, 2014), which identify cultural challenges and the heterogeneity of refugee populations and ethnicities as difficult challenges in this work, and also find evidence that interventions in which participants engage in verbal processing of prior experiences showed great promise. these reviews emphasize the heterogeneity of refugee experiences and gaps between school and family marked by language and culture, and note that clinical interventions for refugee mental health that include verbal processing of prior experiences had strong promise while significant changes in symptomatology are also observed for a number of creative arts interventions. some approaches to school-based mental health support use a multi-tiered systems of support (mtss) framework. mtss is a practice whereby teachers and school professionals match services according to a student’s individual need according to three tiers (winfrey avant & lindsey, 2015). tier 1 refers to universal services that all children receive, and often refers to school-wide programming and curricula. tier 2 refers to more specialized services for a subset of students who need additional support, and finally tier 3 is associated with intensive services for students with high needs. layne et al. (2008) conducted a randomized controlled trial of an integrative mental health program that used an mtss framework in a school setting for war-exposed youth in bosnia. the program included psychoeducation and coping skills for all children (tier 1), specialized traumaand grieffocused intervention for youth with more severe needs and higher exposure to trauma (tier 2), and making referrals to community-based mental health providers outside the school for youth with acute levels of risk (tier 3). reductions in ptsd and depression symptoms were observed for both the treatment (tier 1 + 2 intervention) and the comparison (tier 1) groups and reductions in maladaptive grief were observed in the treatment group. studies like these provide helpful guidance and offer examples of how schools might approach the mental health needs of war-exposed and refugee children through an mtss approach, providing services to children based on their specific level of need. a similar study has also demonstrated that working with teachers to identify and refer students with specialized needs to external mental health providers can be a helpful model for addressing the mental health needs of refugee students (fazel, doll, & stein, 2009). cognitive behavioral therapeutic approaches have received some support in the literature as an intervention approach for refugee children with exposure to trauma (for a review, see murray, cohen, ellis, & mannarino, 2008). a body of research examines how these approaches may be used in school-based mental health settings. one example is the “children and war: teaching recovery techniques” cognitive-behavioral psychosocial educational program, which is a manualized program that educates students about the symptoms of ptsd and teaches coping strategies to manage these symptoms. a recent randomized controlled trial of the intervention found clinically modest reductions in ptsd, behavioral problems, and challenging emotional symptoms, though these gains were not advances in social work, spring 2018, 18(3) 754 sustained at two-month follow-up (ehntholt, smith, & yule, 2015). another school-based clinical trial in sri lanka also found that cbt coupled with creative arts activities helped reduce symptoms for boys and younger children, and children experiencing lower levels of war-related stressors, though the authors cautioned that the intervention may have disrupted natural processes of grieving for other children (tol et al., 2012). other research has examined the use of trauma-focused cognitive behavioral therapy (tf-cbt), an evidence-based treatment program for children and adolescents affected by trauma, with refugee populations. unterhitzenberger eberle-sejari, rassenhofer, sukale, and rosner (2015) found promising findings in the use of tf-cbt in reducing post-traumatic stress with unaccompanied refugee minors in germany, though the intervention was not conducted in a school setting. another controlled trial compared tf-cbt with childcentered play therapy (ccpt) in 31 children in the us northwest, finding that both intervention approaches reduced trauma symptoms (schottelkorb, doumas, & garcia, 2012). other research suggests that tf-cbt can be modified slightly for work with refugee youth, including such practice strategies as providing a longer coping skills phase and allowing for adequate treatment closure phase for purposes of trust and safety (cohen, mannarino, kliethermes, & murray, 2012). most school-based mental health interventions are delivered by mental health specialists (social workers, psychologists, counselors, or other support staff). however, one study developed a group-based cognitive-behavioral therapy intervention to be delivered by teachers to war-traumatized syrian refugee children living in istanbul, turkey (gormez et al., 2017). due to a lack of resources and the challenges of recruiting arabic-speaking mental health professionals in turkey, the research team opted to train existing teachers to deliver an eight-week (70-90 minutes per session) group cbt intervention. findings demonstrated reductions in anxiety and in intrusive and arousal symptoms of ptsd and provide promise for the capacity of school communities to train teachers to deliver mental health interventions. other approaches have also garnered attention in the literature, including narrative exposure therapy (ruf et al., 2010), motivational interviewing (potocky 2017), occupational therapy (copley, turpin, gordon, & mclaren, 2011), and arts-based approaches (rousseau, drapeau, lacroix, bagilishya, & heusch, 2005; yohani, 2008). in a clinical trial on the kidnet narrative therapy for 7-16 year old refugee children with trauma backgrounds, researchers found clinical improvements in ptsd symptoms that were stable at 12-months follow-up, though this particular intervention did not take place in a school setting (ruf et al., 2010). narrative exposure therapy differs from other therapeutic approaches by encouraging the client to construct a narrative of their life’s experiences while the clinician focuses on traumatic events within that narrative. in a recent practice brief, potocky (2017) outlined strategies for using motivational interviewing with refugee youth, emphasizing the importance of a working alliance between practitioner and client that emphasizes collaboration, evocation, and autonomy, though future research is needed to examine the effectiveness of this practice with this population. occupational therapy has also been used in school-based settings to assist in social and emotional skill development for refugee children, in which the occupational therapist works closely with the student's teacher to develop social skills seeing occupational tasks as a means to skill reynolds & bacon/ schools and refugee 755 development rather than as an end (copley et al., 2011). finally, a team of researchers in canada have used arts-based approaches to assist refugee students, including the use of drama/theatre, visual arts and photography (rousseau, drapeau, lacroix, bagilishya, & heusch, 2005; yohani, 2008). one of the advantages of such an approach is the nonstigmatizing, preventative nature of arts-based activities that allow for creative expression and affirmation of youth identities. after-school programs after-school programs (asps) have gained renewed attention as a mechanism for supporting students at-risk, in particular due to a recent meta-analysis that demonstrated the capacity of such programs to promote academic, personal, and social skills in children and adolescents (durlak, weissberg, & pachan, 2010). the authors of this study argue that while asps demonstrate great promise, effects are highest among programs with the following four criteria: sequenced, active, focused, and explicit (“safe”). sequenced refers to having a clearly defined set of activities oriented toward a particular measurable outcome, active refers to the inclusion of active forms of learning, focused requires that programs have at least one component focused on personal/social skills, and finally explicit means that outcomes are specific and targeted. most research on asps focuses on mainstream children, and those that examine asps and migration in the united states have focused on immigrant, english-learning, and latino/a groups, but not refugees specifically (greenberg, 2013; mcdonald et al., 2006; park, lin, liu, & tabb, 2015). a set of studies have examined afterschool programming efforts for hmong students including an arts-based theatre program (ngo, 2017), a community-based program (lee & hawkins, 2008), and a program developed through a school-community leadership model (rah, 2013). such programs provide examples of how schools and community-based organizations have the potential to build cultural bridges that may increase the participation in and success of afterschool programming for specific cultural groups. additionally, simpkins, riggs, ngo, vest ettekal, and okamoto (2017) have developed specific culturally-responsive practice recommendations for youth programs in light of the growing cultural and linguistic diversity of children in the united states. example recommendations include crafting explicit policies and procedures regarding inclusivity, creating leadership opportunities for all children regardless of background, structuring activities to foster community and avoid marginalization, and working with staff on areas of cultural responsiveness, awareness, and reduction of bias. still, the evidence of afterschool programming specifically for refugee youth remains scant. some research in this area has used ethnographic or case-study approaches (naidoo, 2009), describing how such programming may provide access to social and cultural capital and facilitate processes of inclusion. however, there is no research currently examining the effectiveness of such programs. in response to this gap in the literature, the authors are currently working with a local community agency to develop and evaluate an after-school program for refugee children. advances in social work, spring 2018, 18(3) 756 school-family and school-community partnerships connections between schools, parents, and communities play an important role in children's success in school, yet for families and children from refugee backgrounds these connections tend to be more tenuous, characterized by cultural misunderstanding and difference. hornby and lafaele (2011) have identified four primary barriers to parental involvement: parent and family factors (e.g., parent’s perceptions beliefs about their involvement, life contexts), parent-teacher factors (differing goals, language differences), child factors, and societal factors. research on refugee families specifically highlight similar themes, including differing expectations, perceptions, beliefs, and roles about parent involvement; language barriers; deference to authority in schools; and challenges associated with the process of resettlement (georgis, gokiert, ford, & ali, 2014; mcbrien, 2011; rah, choi, & nguyen, 2009; roy & roxas, 2011). research on interventions to address these issues tend to be case studies with practice recommendations rather than clinical trials. this is generally due to the difficulty in conducting clinical trials with the school/program as the unit of analysis and the unique contexts that this subpopulation brings. in a recent paper, georgis et al. (2014) recommend the inclusion of cultural brokers between schools and refugee parents, the development of reciprocal opportunities for involvement defined by both the school and parent communities, the fostering of trust and relationships, and being responsive to community needs as four strategies to consider when working with refugee parents. in interviews with school personnel working with hmong migrants and refugees in wisconsin, rah et al. (2009) identified three concrete recommendations from the interviews: 1) creating a bilingual liaison position, 2) partnering with community organizations, and 3) parent education programs focused on issues related to their child’s schooling in the united states. themes of cultural brokerage, community partnership, and advocacy for parents were also present in other research in this area (mcbrien, 2011; taylor & sidhu, 2012). core components of effective programs while the approaches used by school professionals to improve the well-being of refugee students in this paper differ, there are common core components of successful programs and interventions across all five practice areas. broadly, programs that include the presence of four recommended practices (sequenced, active, focused, and explicit) are likely to yield positive outcomes for youth from all backgrounds (durlak et al., 2010). yet there were other consistent characteristics of programs across practice areas unique to the experiences of refugee children and families. in general, programs were 1) tailored to the contexts of the program, and often to the specific cultural and linguistic backgrounds of a particular refugee subpopulation, 2) informed by the resettlement experience, in particular taking into consideration pre-migration, migration, and post-migration factors in designing program activities and intervention approaches, 3) embedded in community with strong linkages between parents, school leaders and community organizations, and 4) coordinated across multiple systems, whereby parent, school, and community leaders sought to use leadership and coordination strategies to draw upon the strength and expertise of multiple stakeholders to address challenges faced by refugee students. in most cases, programs reynolds & bacon/ schools and refugee 757 opted to either adapt existing evidence-based programs for work with refugee students or develop their own program in light of best practices and research in this area. education as a human right the u.n. convention on the rights of the child has affirmed that education is a right and that this right is linked to equal opportunity and inclusion for all children regardless of background. while refugee children face the challenges of a difficult resettlement process, a host of cultural and linguistic barriers, social stigma, and exposure to trauma, it is important to recognize that these difficulties should not be used as an excuse for differential treatment or unequal access to learning opportunities. social workers in collaboration with government, schools, teachers, students, and parents, play a key role in ensuring that this right is protected and ensured for refugee children (thomas, 2016). this is particularly important for social workers practicing in the united states, which has not ratified the u.n. convention on the rights of the child – and where a recent court ruling affirmed that access to literacy is not a constitutionally protected right (fortin, 2018). ensuring this right not only works to advance the well-being of children on the margins, but works to serve the democratic goals of education oriented toward building a more just, inclusive, and equal society, consistent with the fourth sustainable development goal of ensuring quality education for all. what is less clear is how to ensure these rights are carried out at the school level. in contrast to what are called first-generation rights – typically civic and political rights such as the right to free speech – rights related to education are understood as second generation rights, which refer to the social, cultural, and economic rights that require positive action to be ensured by states (willems & vernimmen, 2017). in many cases the historical and current political, cultural, and social realities of each state play an important role in the manner in which these rights are ensured (willems & vernimmen, 2017). in europe, for example, questions as to whether refugee students can be assessed additional fees, have a right to education in their native language, or can/should be placed in a separate learning environment provide examples of how the securing of second generation rights on the ground remain topics of social, cultural, and legal debate (willems & vernimmen, 2017). a second issue emerging with human rights and education relates to how the use of such rights are justified and implemented at the school level. mccowan demonstrates (2012) that the ways in which human rights are justified has important implications for both how human rights inform practice in school communities as well as the sustainability of those rights. for mccown, the inclusion of both status-based (deontological) and instrumental (consequential) justifications for supporting human rights provide learning opportunities where rights are upheld not solely for either their intrinsic value nor their instrumental effects, but both. schools should promote human rights because they are of value in themselves, while also recognizing that the very justification of human rights provides an instrumental opportunity for learning that may make their incorporation in a school community more sustainable. social workers might consider how the very act of supporting a school community in adopting a rights-respecting framework may in itself be an opportunity for learning. advances in social work, spring 2018, 18(3) 758 implications for social work practice in offering a review of theory, evidence-based practice, and human rights, this review aims to provide insight as to how to approach social work practice with refugee students in school communities. while broad in scope, current research and practice efforts in these three areas have important implications for social work practice. in light of these efforts, the following recommendations are offered as potential starting points for working to ensure the welfare of refugee children and families in school communities. 1. support teachers in providing knowledge about the refugee experience and the need for tailoring teaching practices to meet students where they are. teachers need not develop entirely new teaching strategies, but should focus on incorporating knowledge of refugee children’s experiences into their teaching practice. for example, teachers should support refugee students through homeschool communication, drawing on refugee family funds of knowledge (moll, amanti, neff, & gonzalez, 1992), and engaging in goal-sharing strategies rooted in refugee family experiences. 2. use an mtss framework to develop a schoolwide plan for addressing the mental and behavioral health needs of all students, but in particular refugee students. at the first tier, this could involve psychoeducation programs as well as arts-based and other non-stigmatizing forms of school-based programming that affirm the cultures and identities of refugee students. at tiers 2 and 3, this could involve developing community relationships with mental and behavioral health providers, or conversely building a school-based mental health program with licensed clinicians who are experienced in working with children exposed to trauma. 3. continue to develop new therapeutic approaches for working with refugee children, and build upon promising practice-based research on the effectiveness of trauma-focused cognitive behavioral approaches, play therapy, and narrative therapy. 4. ensure that after-school programs are sequenced, active, focused, and explicit (“safe”). this may involve adapting or writing new curricula to help refugee students develop the social, emotional, and academic skills that will help them be successful in school. 5. appoint bilingual liaisons and cultural brokers and support them financially when possible. 6. develop community partnerships that foster mutual trust and provide access to resources to support refugee children in schools. 7. continue to support a culture of research and evaluation in resettlement agencies and programs. in the united states, community-university partnerships may help develop this capacity at the local level and be particularly beneficial for small resettlement nonprofits with limited resources and expertise in research and evaluation. reynolds & bacon/ schools and refugee 759 8. make more effective use of administrative data systems. one key area is to advocate for the collection of refugee status (as distinct from immigration status or race/ethnicity) by local school districts, who can then use this information to provide aggregate data and reporting on the progress of refugee children in their district. 9. continue to use evidence-based prevention programs designed for mainstream students across school communities, but tailor them when possible to meet the unique needs of refugee students without compromising program fidelity. 10. avoid overemphasizing the need for more randomized controlled trials of culturally-tailored interventions, as they are often not reasonable and unrealistic. one strategy to address current research gaps would be to explicitly collect data on refugee status in conventional rcts of mainstream interventions and use post-hoc tests to see if program outcomes are similar for refugee youth in comparison to their mainstream peers. 11. advocate for the protection of funding for resettlement programs at the national level, and work with state agencies to ensure that funding supports for refugee children and families remains in the years following resettlement. 12. work with district administrators and school principals to create a culture that maintains and promotes human rights at the district and school level. this work involes not only communicating human rights and making those rights explicit in district and school communities, but also the educational work of teaching human rights and providing avenues for “deep rooting” (mccowan, 2012, p. 78) and motivation for working to ensure these rights are correspondingly matched by practice and teaching efforts on the ground. these recommendations are hardly exhaustive, but offer starting points for social workers and allied professionals in school communities to begin and continue the work of supporting the learning of refugee students. one of the challenges of working to ensure second generation human rights like the right to education is that they require active promotion and support. education systems need the appropriate funding and resources to carry out this work and ensure that human rights for all are realized. another ethical document that may inform this work for social workers is the national association of social workers code of ethics (2017). in particular, the document calls for social workers to take an active role in advocacy efforts: social workers should promote conditions that encourage respect for cultural and social diversity within the united states and globally. social workers should promote policies and practices that demonstrate respect for difference, support the expansion of cultural knowledge and resources, advocate for programs and institutions that demonstrate cultural competence, and promote policies that safeguard the rights of and confirm equity and social justice for all people. 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(2016). between a rock and a hard place: a trauma-informed approach to documenting the traumatic experiences of tamil refugees. journal of human rights and social work, 1, 120-130. doi: https://doi.org/10.1007/s41134-016-0013-0 werner, e. e. (1995). resilience in development. current directions in psychological science, 4(3), 81-85. doi: https://doi.org/10.1111/1467-8721.ep10772327 willems, k., & vernimmen, j. (2017). the fundamental human right to education for refugees: some legal remarks. european educational research journal, 17(2), 1-14. windle, j., & miller, j. (2012). approaches to teaching low literacy refugee-background students. australian journal of language and literacy, 35(3), 317-333. winfrey avant, d., & lindsey, b. c. (2015). school social workers response to intervention change champions. advances in social work, 16(2), 276-291. doi: https://doi.org/10.18060/16428 yohani, s. c. (2008). creating an ecology of hope: arts-based interventions with refugee children. child and adolescent social work journal, 25(4), 309-323. doi: https://doi.org/10.1007/s10560-008-0129-x author note: address correspondence to: andrew d. reynolds, phd, msw, med school of social work, university of north carolina at charlotte, 9201 university city blvd. charlotte, nc 28223. areyno42@uncc.edu https://doi.org/10.1007/s41134-016-0013-0 https://doi.org/10.1111/1467-8721.ep10772327 https://doi.org/10.18060/16428 https://doi.org/10.1007/s10560-008-0129-x mailto:areyno42@uncc.edu this work is licensed under a creative commons attribution 4.0 international license. an association between implementing trauma-informed care and staff satisfaction travis w. hales thomas h. nochajski susan a. green howard k. hitzel elizabeth woike-ganga abstract: despite its widespread adoption there is limited research on the influence of trauma-informed care (tic). the current study examined the impact of implementing tic on the satisfaction of agency staff by comparing the results of a satisfaction survey taken in january of 2014, a month prior to the agency's implementation of tic, and again twelve months later. as collaboration, empowerment, and self-care are primary components of a tic organizational approach, its implementation was expected to increase staff satisfaction. following the implementation of tic, agency staff reported higher scores on all but one of the six satisfaction survey factors. increases in staff satisfaction have been associated with better staff retention rates, increased organizational commitment and better performance. in consequence, tic implementation is associated with increased staff satisfaction, and may positively influence organizational characteristics of significance to social service agencies. keywords: trauma-informed care; evidence; implementation; staff satisfaction in recent years, trauma-informed care (tic) has become increasingly adopted across disciplines and communities of practice (hodgdon, kinniburgh, gabowitz, blaustein, & spinazzola, 2013; muskett, 2014). the rising interest in tic is a natural consequence of repeated investigations demonstrating the prevalence of trauma in society (kilpatrick et al., 2013), and the negative impact exposure to traumatic events has on a host of social, physical and mental health outcomes (kuo, goldin, werner, heimberg, & gross, 2011; park et al., 2014). tic has three primary components: the realization of the pervasiveness of trauma; recognition of how trauma influences all persons involved in the receipt, delivery, and administration of programs; and being responsive to trauma survivors needs by implementing this knowledge into the organization’s policies, procedures, practices and culture (substance abuse and mental health services administration, 2014). despite the increase in implementation efforts the effectiveness of tic remains largely unexplored, particularly in regards to its impact on the adopting system and accompanying staff members. the current study begins to overcome this gap by examining the effects of implementing tic on the satisfaction of agency staff. the current study is situated within two primary streams of research: research on the effects of implementing tic and research on staff satisfaction. in regards to research on ______________________ travis w. hales, msw, is phd candidate, school of social work, university at buffalo, state university of new york, buffalo, ny 14214-8004. thomas h. nochajski, phd, is research professor, school of social work, university at buffalo. susan a. green, lcsw, is clinical associate professor, school of social work, university at buffalo. howard k. hitzel, psyd, mpa is president, bestself behavioral health, buffalo, ny 14202. elizabeth woike-ganga, lcsw-r, is chief operating officer, bestself behavioral health. copyright © 2017 authors, vol. 18 no. 1 (spring 2017), 300-312, doi: 10.18060/21299 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2017, 18(1) 301 the impact of tic, it is important to differentiate this research from that conducted on trauma in general and on trauma-specific treatments. there has been extensive research conducted on the pervasiveness of trauma and its influence on personal development, perhaps most notably of which is the adverse childhood experiences (ace) study (felitti et al., 1998). the ace study included 17,337 men and women and found that 63.9% of the sample experienced at least one adverse childhood experience (center for disease control and prevention, n.d.). the primary finding in the study was the association between the number of aces participants experienced with risk of alcoholism and substance use, heart disease, sexually transmitted diseases, suicide attempts, adolescent pregnancy, and risk for sexual violence among others (felitti et al., 1998). further, there has been research on specific interventions that treat a variety of trauma and comorbid trauma and substance use or mental health disorders, including trauma focused cognitive behavioral therapy (tfcbt; seidler & wagner, 2006), seeking safety (najavits, weiss, shaw, & muenz, 1998), and cognitive processing therapy (cpt; resick, nishith, weaver, astin, & feuer, 2002). however, there has been extremely limited research on the effects of trauma-informed organizational approaches (kusmaul, wilson, & nochajski, 2015). to differentiate tic from trauma and trauma-specific treatment, trauma-informed approaches such as harris and fallot’s (2001; fallot & harris, 2008) five-dimensional model and sandra bloom’s (2013) sanctuary model are defined by the alteration of systems to ensure their physical and social environments are supportive and conducive to the recovering person that has a history of trauma. this includes creating atmospheres where all persons feel safe and relationships are based on shared assumptions, collaboration and trustworthiness (madsen, blitz, mccorkle, & panzer, 2003). trauma-informed systems recognize the pervasiveness of trauma and revamp formal and informal organizational properties (such as structure, culture, climate, policies, procedures and practices) to ensure trauma-sensitivity and promote growth and empowerment (bloom, 2013; harris & fallot, 2001). note that people as opposed to clients or service-users are referred to throughout this discussion because, contrary to research emphases in the literature, trauma-informed approaches are designed to have a positive influence on the staff of service organizations as well as clients. nevertheless, the limited evidence that exists on implementing tic approaches has focused primarily in its influence on clients (e.g., morrissey et al., 2005). research on the impact of tic the published evidence on the effects of tic on clients has been promising. there are two bodies of research in this area: research exploring the effects of tic reducing the number of seclusions and restraints in psychiatric inpatient settings and research exploring the effects of tic on substance use and mental health outcomes. research on seclusion and restraint reduction began with the work of janice lebel and colleagues from massachusetts’ department of mental health who demonstrated that seclusion and restraints could be greatly reduced through systematic change efforts (lebel & goldstein, 2005; lebel et al., 2004). further, lebel and goldstein (2005) discovered that the reduction in seclusion and restraints led to decreases in employee sick time, turnover, workers’ compensation, injuries to both staff and clients, and recidivism in clients. however, neither published study explicitly refers to the intervention as being part of a hales et al./preliminary support for tic 302 trauma-informed approach. while seclusion and restraints are the prototypical examples of re-traumatization in service systems, because tic is not explicitly referred to in lebel’s work it is unclear whether or not the reduction and subsequent effects are attributable to part of a broader tic initiative. to address this gap in research, azeem, aujla, rammerth, binsfeld and jones (2011) assessed the influence of a tic model developed by the national association of state mental health program directors (nasmhpd). through the implementation of various components of tic including physical and social (i.e., cultural) changes to the environment, staff training on trauma (i.e., prevalence and effects) and trauma-informed care, prioritizing collaboration between staff and residents, and debriefing with staff and clients after a crisis, the tic approach led to a downward trend in seclusions and restraints (azeem et al., 2011). in regards to the second stream of research investigating the effects of implementing tic on substance use and psychiatric outcomes, the women, co-occurring disorders, and violence study (wcdvs) is the singular example (described in morrissey et al., 2005). the wcdvs assessed the impact of core trauma-informed services (including collaboration between service providers and recipients in treatment planning and goal development, resource coordination, staff training on trauma, and crisis intervention) and integrated substance use, trauma and mental health counseling on substance use, mental health, and trauma symptom outcomes (morrisey et al., 2005). the intervention was found to have positive and significant effects on substance use and mental health outcomes and a significant reduction in trauma symptoms. however, the significant effects were primarily attributable to the integrated treatment as opposed to the core ti services. future research is required to determine the underlying mechanism of change in the study and to see if the findings are replicated. (morrisey et al., 2005) the only other studies in the literature examining tic’s effects are kramer, sigel, connors-burrow, savary and tempel (2013) and kusmaul and colleagues (2015). kramer et al. investigated the impact of a two-day training based on the national child and traumatic stress network’s training for child welfare. the outcomes of the kramer et al. study were limited to knowledge on tic and supervisory behaviors (measured through self-report on survey items) which were assessed at baseline, immediately following the final training, and a three-month follow-up. the post-test and three-month follow-up displayed significant increases in tic knowledge and supervisory behaviors supporting its implementation (kramer et al., 2013). kusmaul et al. (2015) explored differences in staff perceptions of the service environment following the implementation of tic based on the principles of harris and fallot (2001). kusmaul et al. discovered that staff members holding master’s level degrees had more positive experiences of the service environment following tic implementation than staff members holding a bachelor’s degree. further, perceptions of the service environment also differed as a function of position, with administrators having the most positive perceptions of the service environment, followed by line staff, and then support staff. both of these findings were consistent across harris and fallot’s (2001) five domains. while further research is needed to explain these differences, what is evident is that persons higher in the organizational hierarchy and persons holding a master’s level degree have more positive experiences of the service environment than their counterparts. this is the extent of published knowledge on the advances in social work, spring 2017, 18(1) 303 effects of tic on both staff and client outcomes. while the evidence is severely limited, especially in regards to the impact of tic approaches on staff, initial reports are promising. there is however a need for continued research on the effects of tic approaches. research on staff satisfaction and its relationship with trauma-informed care on the surface, the relationship between tic and staff satisfaction may be predicated on the emphasis trauma-informed approaches place on staff self-care. that is, a core component of all prevailing tic models is the creation of safe and trusting atmospheres to avoid the re-traumatization of both staff and consumers of service (bloom, 2013; fallot & harris, 2008). as the organization becomes more supportive of direct-care and support staff, it is likely the organization will experience a positive increase in the overall satisfaction of its agents (babin & boles, 1996; griffin, patterson, & west, 2001). above and beyond self-care, the core components of trauma-informed approaches are also expected to have a significant positive influence on staff’s satisfaction with the organization. the elements of safety, trustworthiness, collaboration, choice and empowerment from both fallot and harris (2008) and bloom’s (2013) sanctuary model are expected to enhance staff’s experiences of satisfaction with the agency. through collaboration, where all staff members are treated with equal regard and importance, the problems originating from hierarchy, power and authority may be overcome. collaboration, freedom and autonomy of staff throughout the organization are expected to increase staff member’s sense of commitment and responsibility for the organization’s welfare. for empirical support of these hypotheses, both babin and boles (1996) and strand and dore (2009) discovered that the perceptions of supervisory support were positively associated with increases in staff satisfaction. further, brown and peterson (1993) demonstrated how staff satisfaction predicted organizational commitment, which in turn has been associated with higher staff retention rates (meyer, stanley, herscovitch, & topolnytsky, 2002; strand, spath, & bosco-ruggiero, 2010), and staff satisfaction and organizational commitment have both been tied to organizational performance (koys, 2001; meyer et al., 2002). the current study the current study assessed the influence of a tic implementation approach on staff satisfaction by comparing the results of a satisfaction survey from two time points. the first assessment was taken in january of 2014, a month prior to the organization’s implementation of tic, while the second assessment was conducted twelve months following the organization’s implementation (january of 2015). the satisfaction surveys were conducted by an external agency specializing in workforce development. all staff members within the organization were administered the online survey. following the completion of both surveys, a brief report was provided to the agency summarizing the results and comparing the 2014 and 2015 surveys. because self-care and the creation of supportive cultures are central to the implementation of tic, we expected there to be an increase in staff satisfaction following the twelve-month implementation process. hales et al./preliminary support for tic 304 methods implementation model the implementation model consisted of a series of phases. the first phase included an initial baseline assessment of the organization on trauma-informed care. two assessment tools were utilized: an instrument that assessed the culture and climate (described in hales, kusmaul, & nochajski, 2016) of the organization in the context of harris and fallot’s (2001) five-principles, and an instrument that assessed the organization’s policies, practices and procedures (described in gaurino, soares, konnath, clervil, & bassuk, 2009). following the assessment, all staff members within the organization were trained on the basic tenets of trauma and trauma-informed care. the tic trainings were based on harris and fallot’s five-dimensional model. professional staff holding advanced degrees delivered the trainings using a protocol developed by the authors. after the initial training, the assessment data were used to inform each of the programs of their relative strengths and weaknesses in regard to formal (policies, practices and procedures) and informal (culture and climate) organizational elements. this information was incorporated into all follow-up training sessions, which were tailored to the particular program’s needs and strengths. follow-up sessions recurred on a monthly basis following the initial training. supervisors were mentored and coached on how to incorporate the implementation of tic into weekly supervision. to enhance sustainability, staff members across the organizational hierarchy were trained on how to conduct the initial training and follow-up sessions, which enabled the organization to deliver information to new employees, provide refresher courses to programs seeking them, and continue monthly consultations on the implementation of tic without the aid of the consultants. in addition to the trainings, a sub-group of clinical staff were trained on the delivery of seeking safety, an evidence-based treatment for persons experiencing comorbid substance-use and post-traumatic stress disorders (described in najavits, 2002). this subgroup of personnel received formal training on the intervention’s delivery, treatment protocols to ensure fidelity, and monthly consultations to discuss the implementation processes. thus, the implementation model included the assimilation of a trauma-specific treatment in addition to training and overseeing the implementation of a trauma-informed organizational approach. instrument description the business insight survey from workplacedynamics (n.d.) consisted of a 5-point likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). while the survey has been administered to over 40,000 organizations, the authors do not list the scale’s psychometric properties (workplacedynamics, n.d.). the survey measured staff satisfaction on two primary domains and six sub-domains. the two primary domains consisted of organizational health, which included direction of the agency, execution of the agency’s policies and procedures, and connection with the workplace, and staff’s work positions, which included perceptions of their work, relationship with their manager, and their pay/benefits. to describe the subdomains, direction of the agency inquired into staff advances in social work, spring 2017, 18(1) 305 perceptions of the overall direction the agency, the competencies of leadership, and organizational values. execution of the agency’s policies and procedures measured satisfaction with organizational efficiency, innovation, and being informed of administrative decisions. connection with the workplace assessed whether staff believed their role in the agency was valued by others in addition to whether or not they participated in meaningful work. the connection with the work factor inquired into staff experiences with flexibility in their work roles, receipt of appropriate training to successfully execute role functions, and whether or not their position had met their expectations. the management factor assessed staffs’ relationships with their managers, including whether their manager was sensitive to their needs and concerns, fostered their growth, and enhanced their performance. lastly, pay/benefits inquired into how fair staff believed their wages and benefit packages were. each of the six domains ranged from two to four items, with a total of 19 items in the scale. individual items that experienced the most improvement across time points were included in the report. the individual items were: “new ideas are encouraged at the agency” (encourage new ideas); “senior managers understand what is really happening at the agency” (mgmt. understanding); and “my manager cares about my concerns” (mgmt. care and concern). sample the sample included staff from a private, not-for-profit 501(c)3 corporation that provides a range of services for individuals with mental health and/or substance use disorders. these services include: outpatient programs for adolescents and adults with substance use, mental health, and co-occurring disorders; personalized recovery oriented services (pros); assertive community treatment (act) teams; residential programs for pregnant and parenting women with substance use disorders and chronically homeless persons with mental health diagnoses; homeless outreach services; mobile mental health teams; permanent supportive housing services; and vocational and supported employment services. during the survey period, the number of staff members across all programs ranged from 212 to 238. for 2014, a total of 147 out of 212 employees completed the survey (69 percent completion rate). for 2015, 168 out of 238 employees completed the instrument (71 percent completion rate). the survey was administered to all staff across the organization’s vertical hierarchy and throughout the various programs. specific demographic information could not be reported due to their lack of inclusion in the satisfaction survey’s report. analyses due to the data being collected by an external agency, raw data could not be obtained. the report only contained the aggregate means for the agency on the six factors of satisfaction across the two time points. it was not possible to match participants across time periods, and because the standard deviations were not provided, standard errors and significance tests could not be computed. in consequence, the analyses for comparing the 2014 and 2015 data were limited to assessing mean differences on each of the satisfaction’s subscales. the differences between the years were assessed by comparing likert-point and hales et al./preliminary support for tic 306 percentile differences across time points. further, the comparisons were primarily limited to the six subscales, as only those individual items that experienced dramatic increases or decreases were provided in the report. results following the implementation of tic, the average scores on five of the six factors of staff satisfaction increased. presented in table 1 below, the largest increases were in execution of the organization’s objectives, followed by staffs’ relationships with their manager, staffs’ connection with the workplace, then staff’s perceptions of the work. direction of the agency increased but was more modest relative to the other domains. the only scale which did not increase was pay/benefits, although it also experienced the smallest absolute difference/percentage change. table 1. comparison of average satisfaction subscale scores for 2014 and 2015 (n=168) scales 2014 (mean) 2015 (mean) absolute difference percentage change* execution 3.83 4.14 + 0.31 +8.09 % connection 4.35 4.57 + 0.22 +5.06 % direction 4.62 4.76 + 0.14 +3.03 % manager 4.55 4.81 + 0.26 +5.71 % work 4.21 4.39 + 0.18 +4.27 % pay/benefits 3.51 3.44 0.07 -1.99 % *note: for table 1 and table 2, percentage changes were calculated by dividing the absolute difference by the 2014 mean. in regard to the individual item examination, a total of three indicators were reported, three of which were directly relevant to the implementation of tic. to begin, the encouragement of new ideas by administration increased from an average of 4.10 to 4.52 (.42 likert-points; +10.24 percent). the next item refers to staffs’ perceptions of senior managers understanding the reality of daily programmatic affairs. this item also increased by approximately ten percent (from 3.64 to 4.01 likert points). lastly, staff reported an increase in the extent that management cares about their concerns (from 4.63 to 4.94 likert points; + 6.70%). table 2. comparison of average item scores for 2014 and 2015 (n=168) items 2014 (mean) 2015 (mean) absolute difference percentage change* encourage new ideas 4.10 4.52 + 0.42 +10.24 % mgmt. understanding 3.64 4.01 + 0.37 +10.16 % mgmt. care and concern 4.63 4.94 + 0.31 +6.70 % discussion the current study found increases in staff satisfaction in five of the six satisfaction factors following the implementation of tic. the most notable differences were in staff’s satisfaction with their ability to execute the agency’s executives, their relationship with advances in social work, spring 2017, 18(1) 307 management, and their connection to the workplace. these findings are theoretically plausible considering that trauma-informed approaches are expected to enhance collaboration across vertical hierarchies in addition to empowering staff throughout the organization by maximizing their experiences of control and autonomy (bloom, 2013; fallot & harris, 2008). by engaging members throughout the organization in collaborative approaches in the obtainment of organizational objectives, staff’s experiences of commitment to the agency were expected to increase. the only factor which did not increase across time points was pay/benefits. this is plausible, considering that the second assessment of satisfaction was only conducted twelve months following implementation. while implementing tic may be expected to save the organization material resources by retaining a greater percentage of the workforce and by providing more responsive services to clients, these changes may take a greater length of time to emerge. a body of research indicates that changes to organizational culture generally occurs over a period of time (cameron & quinn, 2005), and the effects of implementing tic on staff retention is expected to be a longer term outcome (esaki et al., 2013). staff also reported increases in satisfaction with management’s encouragement of new ideas and innovation. administrative encouragement of new and better ways of performing their tasks is a critical element of empowerment, one of the primary principles of tic. staff also felt increases in management’s ability to be understanding of the reality of day-to-day affairs. the principle of collaboration in tic approaches requires that organizational hierarchies be flattened, minimizing the physical and social distance between front-line and senior staff members. creating a more collaborative environment could enhance the communication and joint work efforts of management and direct-care staff. staff also experienced an increase in satisfaction with management’s concern over their general welfare, which is plausible considering trauma-informed approaches prioritize the experiences of direct-care staff by ensuring their physical and emotional safety. as there is limited research on the influence of implementing trauma-informed approaches on staff, the positive association between the implementation of tic and increases in staff satisfaction is an important finding. while the implementation of tic only produced modest variations in staff satisfaction, it is important to note that the introduction of new technologies are frequently met with varied responses by staff members (e.g., korunka, scharitzer, carayon, & sainfort, 2003). as a core component of trauma-informed organizations is an increase in staff control, autonomy, and collaboration, it is possible that staff experience an increase in responsibility over obtaining the organization’s objectives. this increase in responsibility and power may have a negative influence on some staff member’s satisfaction, particularly if staff prefer a more centralized organization where job functions and roles are more instructive and formalized. further, while previous research has found moderate associations between staff autonomy and supervisory support with satisfaction (griffin et al., 2001), to the best of our knowledge no studies that have assessed longitudinal differences in satisfaction scores provide neither mean difference scores or effect sizes to compare to the current study’s findings. nevertheless, because all but one of the satisfaction scores increased, the current study’s findings suggest the assimilation of trauma-informed care within organizational settings enhances staff satisfaction. due to the limited evidence supporting the widespread hales et al./preliminary support for tic 308 adoption of trauma-informed approaches, this study provides preliminary support on the positive influence of tic on agency staff. in addition, previous research has demonstrated that satisfaction with the workplace is a powerful antecedent of organizational commitment (brown & peterson, 1993), and that organizational commitment is positively associated with employee retention (meyer et al., 2002; somers, 1995). as staff satisfaction and organizational commitment have been associated with enhanced performance (koys, 2001; meyer et al., 2002), tic may also have positive influence on performance. these arguments suggest that the implementation of tic, through increasing staff satisfaction, may positively influence organizational characteristics of significance to social service agencies. limitations there were several limitations in the current study. a primary limitation is the absence of raw data, and the subsequent ability to match pre and post test responses. the absence of raw data limited the analyses to absolute mean and percentile differences. however, due to the limited knowledge base on the influence of tic implementation, the association between tic and staff satisfaction is an important discovery. further, while association and temporal precedence were obtained, confounding factors that may have explained the differences in satisfaction surveys were not controlled for. for instance, seeking safety was implemented to a subset of staff during the same time that staff were implementing tic throughout the agency. in consequence, it is unclear what elements of the intervention (i.e.,seeking safety, training, or consultation) influenced the aggregate differences in staff satisfaction. the relationship between tic implementation and staff satisfaction is limited to one of association as opposed to causation. further, because the second time point was only assessed twelve months following the initial implementation, it is possible that the effects of tic on staff satisfaction were the result of increases in supervisory and organizational support, and increases in perceived competence as a result of the training and consultation sessions. the more subtle, informal changes to organizational culture and climate generally occur over a more extended period of time (cameron & quinn, 2005; esaki et al., 2013). the contributions of increasing staff’s perceptions of safety, trust, choice, collaboration and empowerment on satisfaction would likely be evident had the follow-up assessment occurred at a later point in time. lastly, a limitation of the current study is the absence of sample demographics. future research directions future research will explore the relationship between the implementation of tic and additional staff and client characteristics. additional research that involves tracking individual scores in satisfaction over time and controlling for the various intervention components will enable a test of association that rules out the confounding factors found in the current study. matching individual scores on culture, climate, and the implementation of tic practices, policies and procedures will enable a more sophisticated model of the unique intervention effects to be explored. future research will also examine a broader array of outcomes. as noted, the implementation of tic is expected to increase employee retention, enhance organizational commitment, and may lead to increases in advances in social work, spring 2017, 18(1) 309 organizational performance: these hypotheses will be tested in future research. in regards to client outcomes, due to the emphasis on collaborative and participative practices, the implementation of tic is expected to positively influence the therapeutic alliance. therapeutic alliance refers to the strength of the relationship between clients and directcare staff (bordin, 1979). enhancement of the therapeutic alliance has been positively associated with retention in treatment and improvement in mental health outcomes (martin, garske, & davis, 2000). these relationships will be tested in future research. references azeem, m. w., aujla, a., rammerth, m., binsfeld, g., & jones, r. b. 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(n.d.). business insight report. retrieved from: http://www.workplacedynamics.com/pdf/sampleco_2016_business_insight_report.pdf author note: address correspondence to: travis hales, school of social work, university at buffalo, 219 parker hall, university at buffalo, south campus, buffalo, ny 14214-8004, 716 829 5857, twhales@buffalo.edu https://doi.org/10.1016/j.psychres.2014.06.009 https://doi.org/10.1037/0022-006x.70.4.867 https://doi.org/10.1017/s0033291706007963 https://doi.org/10.1002/job.4030160107 https://doi.org/10.1016/j.childyouth.2008.09.002 https://doi.org/10.1016/j.childyouth.2009.10.002 http://www.workplacedynamics.com/pdf/sampleco_2016_-business_insight_report.pdf http://www.workplacedynamics.com/pdf/sampleco_2016_-business_insight_report.pdf mailto:melanie.sage@und.edu this work is licensed under a creative commons attribution 4.0 international license. teaching statistics to msw students: comparing credit and non-credit options ashley davis rebecca g. mirick abstract: in professional disciplines like social work, students are expected to be able to understand and apply basic statistical concepts. graduate programs differ in how they expect students to develop this ability; some require a full-credit statistics course as a prerequisite to admission, and others incorporate statistics into social work research courses. the for-credit requirement has a high financial and time cost for students. this exploratory study examined the feasibility of replacing this requirement with a brief, noncredit statistics course. msw students (n=168) who took both types of courses were surveyed. no association was found between the type of course and students’ anxiety, confidence, and the perceived relevance of statistics. students identified factors that impeded or facilitated their learning. the inclusion of the statistics course within the social work program and the use of relevant social work literature was perceived as supporting students’ learning of statistics. the course length was no more of a concern for the noncredit statistics students than for the for-credit students. these findings support the use of a brief, non-credit statistics course as a less costly and time-consuming approach, but raises concerns about consistently high levels of anxiety, and low levels of confidence and statistics ability of msw students. keywords: statistics; research; teaching approaches; msw students in professional disciplines, statistical knowledge and skills are needed to be effective in practice and policy work. within the field of social work, statistics are used to understand and critique empirical research, evaluate practice, disseminate research findings, and promote clients’ interests (capshew, 2005; wells, 2006). when students have developed statistical literacy, they can appropriately apply statistical concepts and accurately use these skills (ramirez, schau, & emmioglu, 2012), which help them engage in evidence-based practice, policy initiatives, and research endeavors. the development of msw students’ statistical literacy differs by program. for many programs, an introductory statistics course is a pre-requisite for admission (elliott, choi, & friedline, 2013). students may have taken a statistics course during their undergraduate coursework. those students who did not already take a statistics course often need to take one at another university before entering their graduate program. this requirement can be inconvenient to fulfill due to work or family obligations and can be a financial burden as well. many of these students complete a statistics requirement in a “service course,” which is taught within a math or statistics department outside of their professional discipline (gordon, 2004). perhaps due to inconveniences or negative feelings about statistics, it is not uncommon for students to avoid completing a required statistics course for as long as they can (macheski, buhrmann, lowney, & bush, 2008). _________________ ashley davis, phd, msw is an assistant professor, department of social work, wheelock college, 200 riverway, boston, ma, 02215. rebecca g. mirick, phd, msw is an assistant professor, school of social work, salem state university, 352 lafayette st., salem, ma, 01970. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 437-455, doi: 10.18060/21448 https://creativecommons.org/licenses/by/4.0/ davis & mirik/teaching statistics 438 it is important to identify and explore possible ways that students can become proficient in statistics and the effectiveness of these various approaches at teaching statistical literacy. a prerequisite statistics courses may cover a range of concepts that may or may not be the most useful for social work students; such courses may vary as to whether they prioritize computations or conceptual understanding and application. when taking a prerequisite course, students may struggle to see the necessity or relevance of the material to their social work education, and may experience the course as disjointed from the rest of their graduate studies (bolen, 2006). some msw programs do not insist that students complete a pre-requisite, but instead incorporate statistics into the curriculum. research courses are the logical place to teach statistical concepts, although many students already experience trepidation about and disinterest in research (bolin, lee, glenmaye, & yoon, 2012). students’ anxiety and reluctance could be heightened by the addition of statistics to the content of a research course. to address these issues, some social work programs offer a brief, non-credit bearing statistics course. while program administrators and faculty members may make assumptions about the benefits and limitations of a brief, non-credit bearing statistics course, research has not studied the efficacy of this teaching approach in comparison with more traditional, full-semester, for-credit statistics courses. this study examined whether there was any association in attitudes and feelings about statistics, or differences in statistical ability between those students who took a brief, non-credit bearing statistics course within their social work graduate program and those who completed a full-semester, for-credit statistics course prior to beginning their graduate studies in social work. literature review within the united states, professional organizations and accrediting bodies emphasize the importance of research to practice, including the use of quantitative methods. in its code of ethics, the national association of social workers (2008) admonishes social workers to “critically examine and keep current with emerging knowledge relevant to social work and fully use evaluation and research in their professional practice” (sect. 5.02). students develop the ability to fulfill this ethical imperative through their social work education. in courses on research and evaluation, they receive training in qualitative and quantitative methods that are used to produce evidence-based findings for enhancing social work practice, policy, and service delivery (council on social work education, 2015). social workers need to possess statistical knowledge and skills to critically analyze the professional literature, skillfully evaluate their own practice, and best serve their clients (harder, 2010). when graduates of social work programs develop an appreciation and understanding of basic statistical concepts, marson (2007) suggests: “great advances in the knowledge base and the evaluation of social work practice are sure to follow” (p. 211). this hopeful perspective is tempered by knight’s (2015) findings that, despite feeling prepared by social work education to engage in evidence-based practice, many graduates do not employ this practice behavior, avoid literature that describes research, and do not understand the discussion of statistics in research articles. despite the ethical imperative, curricular mandate, and ubiquity of statistics, social work instructors face challenges in preparing students to develop the knowledge and skills advances in social work, fall 2017, 18(2) 439 needed for research methods and statistics. social work students are commonly referred to as avoidant, anxious, or reluctant learners of statistics (capshew, 2005; junius & siddell, 2009; marson, 2007). lalayants (2012) reviewed what is known about the effects of students’ attitudes toward statistics. associations were found between students’ anxiety and negative emotions and their learning, including their openness to learn, development of statistical thinking, application of knowledge in the field, and understanding of quantitative studies in the professional literature. even within social work education, there is a particularly complex relationship between students’ statistics knowledge and their attitudes about research courses; increased statistical knowledge was correlated with reduced fear of research courses, but not with greater appeal of research courses (secret, ford, & rompf, 2003). students in the social sciences commonly experience anxiety in learning about statistics (pan & tang, 2005). this anxiety may be particularly strong for social work students (thomas, 2008). onwuegbuzie and wilson (2003) categorized factors associated with statistics anxiety as situational, dispositional, or personal. these categories echo throughout the social work literature on statistics anxiety. for example, elliott at al. (2013) noted situational factors, including the limited number of math courses that social work students take as undergraduates, or the minimal time that gets devoted to research and statistics content in social work education. junius and sidell (2009) focused on dispositional factors, such as the need to help students increase their motivation and ownership of learning statistics. davis (2003) is among the researchers who have explored personal factors, including the higher levels of statistics anxiety among female and minority social work graduate students. while anxiety is a common barrier to learning statistics, a typical social work graduate course includes a “blend of students from more to less interested, anxious, and capable” (bolen, 2006, p. 19) with statistics, and instructors often find it challenging to teach to such a range of feelings and abilities. students’ anxiety about statistics can be affected by teaching strategies, classroom climate, and instructor qualities (lalayants, 2012). these factors are important to understand because they are within an instructor’s control and can be incorporated into the design, structure, and teaching style of a course. teaching strategies the empirical literature is replete with approaches for teaching statistics to students in professional education. instructors do not need to pick only one teaching strategy (secret et al., 2003), but can apply several approaches flexibly and responsively. the pacing and delivery of material can be intentional, such as using repetition, providing immediate feedback (marson, 2007), or flipping the classroom by using class time to apply material learned outside of class (wilson, 2013). similarly, problem-based learning models (junius & sidell, 2009), peer-led team learning (curran, carlson, & celotta, 2013), and servicelearning research projects (wells, 2006) create hands-on, interactive learning opportunities. these collaborative approaches encourage students to relate to their instructor as a mentor and resource person, instead of the traditional role of lecturer. these teaching strategies suggest innovative approaches for helping students learn davis & mirik/teaching statistics 440 statistics, and yet, there is a dearth of empirical literature evaluating their effectiveness in improving students’ knowledge and abilities. elliott and colleagues (2013) measured changes in msw students’ (n=25) perceptions after completing an online statistics lab concurrent with their research methods course. students perceived themselves to be more confident in their knowledge of statistics, their use of this knowledge to enhance practice, and their comprehension of scholarly articles. similarly, wells (2006) used course evaluations to capture msw students’ (n=38) perceptions. students described servicelearning projects as a “purposeful” (p. 401) way to learn statistics with real data sets, and reported that they would be “less fearful” (p. 400) about using these skills in the future. in two studies that measured changes in statistical competence, the use of a flipped classroom (wilson, 2013) and peer-led learning teams (curran et al., 2013) were both found to be effective with undergraduates, compared to a course taught using traditional methods. calderwood (2002) urges that statistics instruction should be modeled after reality, in which practitioners do not memorize formulas or perform calculations by hand. instead, students should be expected to understand the meaning and purpose of statistical tests, and develop the ability to read and critically appraise quantitative findings in scholarly articles (rabin & nutter-upham, 2010). students should know how to use available resources, such as computer applications (wells, 2006) or colleagues who are statisticians, to support their work and make statistics more user-friendly (stickels & dobbs, 2007). classroom climate a well-structured, nonthreatening learning environment can mitigate students’ reluctance to learn statistics (lalayants, 2012). in the beginning of the course, instructors may find it helpful to acknowledge students’ range of feelings. students often anticipate “boring, dry material” (capshew, 2005, p. 860), but instructors can teach in ways that contradict this expectation, set an upbeat, interactive tone, and incorporate fun activities (lesser et al., 2013). students may continue to find the course challenging, but can be socialized to see that “having fun can mix with the difficult subject matter” (macheski et al., 2008, p. 44). other instructors might focus less on making statistics enjoyable for reluctant learners because students can increase their statistical knowledge without improving their attitude about the subject (sizemore & lewandowski, 2009). instructor qualities instructors can engage students in ways that promote statistics learning. they can bring humor to the topic, which is especially useful in engaging students who hold negative attitudes about statistics (neumann, hood, & neumann, 2009). connections with students outside of the classroom positively affect learning. mcgrath (2014) explored the role of instructors’ office hours in student success; students who met with an instructor and engaged in self-assessment improved their performance. classroom assessment techniques are another tool with which instructors can encourage students to assess their developing competence and offer feedback about the course (goldstein, 2007). this approach provides ongoing communication between the instructor and students, which can serve to strengthen their relationship. advances in social work, fall 2017, 18(2) 441 the efficacy of different approaches learning statistics knowledge and skills may not equate to being statistically literate (ramirez et al., 2012). in subsequent courses and later in the field, students should be able to recall and apply what they have learned, and even recognize when they need additional training to further their skills. barnett and ceci’s (2002) taxonomy of transfer may explain the challenge with reaching statistical literacy. “near transfer” refers to students’ abilities to learn and use new material, and thus successfully pass an introductory course; “far transfer” includes the ability to develop “skills that extend beyond the performance in the class in which they were acquired” (daniel & braasch, 2013, p. 201). this theory may explain secret et al’s (2003) findings: despite having completed an introductory statistics course, the majority of social work students in their sample were unable to demonstrate statistical knowledge. there are contextual factors that affect transfer, including the knowledge domain, temporal context, and functional context (barnett & ceci, 2002). knowledge domain, or the knowledge base to which the skill is applied, is a relevant factor since most social work students do not take statistics as part of their graduate education. the temporal context refers to the time elapsed between learning and being tested on new concepts. many students successfully pass a course during their undergraduate program, but experience erosion of knowledge by the time they pursue a graduate degree, take other courses, or begin working after graduation. finally, the functional context relates to whether the academic learning carries over to the field. professional education often involves the acquisition of skills in the classroom that are then applied in the field. it may be especially important for students to learn statistics in ways that can be applied in practice contexts, such as grasping the underlying concepts rather than memorizing formulas (calderwood, 2002; gordon, 2004). learning statistics within social work education there are benefits to a statistics course offered within the discipline. when social work students have a statistics instructor who is also a social worker, they have an opportunity to see a member of their profession who is comfortable, confident, and competent with this material. students may also be more likely to view the material as relevant. unlike a service course, a statistics course offered within professional education would likely use examples from empirical studies that are related to practice. moran (2005) noted that often statistics courses are taught differently from the core courses within the discipline. statistics could be taught in ways that are similar to other professional courses, such as emphasizing how statistics could be used to advocate for clients, analyze social justice issues (lesser, 2007), or “utilizing [students’] own ideas as the medium for analyses throughout the course” (bolen, 2006, p. 20). the similarities and overlap in method and content could help students see that statistics are indeed important and relevant to the rest of the curriculum. in a professional discipline, the most important motivator to learn is a relevant connection to the field (bolen, 2006; davis & mirick, 2015]; lalayants, 2012). this article describes the attitudes, levels of anxiety and confidence, and ability of students who took an accelerated brief, non-credit bearing statistics course within their davis & mirik/teaching statistics 442 social work graduate program compared to students who took a full-semester, for-credit course. the study addressed the following research questions: was there an association between the type of statistics course (i.e., accelerated statistics course offered within a social work graduate program versus undergraduate statistics course) and students’ anxiety, confidence, and belief in relevance to social work education and practice? was there any difference in ability to apply statistical knowledge after the course? what factors do students self-report as facilitating or hindering statistical learning? is there an association between type of statistics course and the factors perceived to facilitate or hinder statistical learning? method participants participants were enrolled in a graduate social work program at a small, accredited, private, urban school in the united states. traditionally, the program required a statistics course taken within the past five years and with a minimum grade of a c. in 2013, the program began offering an accelerated three-week, non-credit option taught by a full-time social work faculty member for students who did not have this statistics prerequisite. this course consists of four 3-hour face-to-face sessions and two hours of online work. the course focused on understanding statistical concepts and interpreting implications of findings, instead of mathematical formulas. the course material included descriptive (percentages, frequencies, measures of central tendency, measures of dispersion) and inferential analyses (t-tests, chi square, correlation, anova, and regression), with an emphasis on the role of hypothesis-testing in determining statistical significance. in class, the instructor engaged students with interactive powerpoint lectures with responseware “clickers,” and used small group exercises to apply the concepts. in each class session, students were assessed on their understanding of the cumulative concepts. outside of class, students completed homework assignments, contributed to online discussion forums, and completed assigned readings. in addition to an introductory textbook (pryczak, 2014), students read several articles from the social work literature that reported on empirical studies using quantitative methods. these pieces provided relevant and relatable examples of how social workers use statistics to answer research questions and inform practice and policy. students developed the ability to read statistical findings presented in narrative and table formats, and consider possible social justice-based implications. the sample consisted of 168 msw students who completed the survey at the end of their required social work research course. forty-five (27%) students had taken the brief, non-credit statistics course, and 123 (73%) took a for-credit statistics course prior to entering the program. of those students who took a for-credit course, 75% (n=92) took the course during their undergraduate program and 24% (n=29) took statistics after earning their undergraduate degree (missing = 2). measures data were collected on students’ experiences learning statistics, their attitudes about statistics, levels of anxiety and confidence about statistics, and their statistical ability. advances in social work, fall 2017, 18(2) 443 students were asked to report where they took statistics (e.g., the non-credit course or a full-credit course) but no other sample characteristics were obtained. experiences learning statistics. participants were asked: “which factors supported your development of statistics knowledge and skills?” students were given a checklist of six factors and asked to select all that related to their experience of learning statistics. the six supporting factors were: 1) course was taught within the social work program, 2) relevant journal articles were used as examples, 3) instructor’s teaching style supported students’ understanding of the material, 4) material was presented in multiple formats, 5) collaboration among peers was encouraged in the classroom, 6) material was reviewed to reinforce previous concepts before introducing new ones. participants were asked: “which factors of the course impeded your development of statistics knowledge and skills?” students were given a checklist of six factors and asked to select all that applied. the six impeding factors were: 1) the statistics material taught was not in-depth enough, 2) material was taught at too advanced a level, 3) the workload was too much, 4) the instructor was not accessible to students, 5) the class size was too big, and 6) connections were not made between statistics and implications for social work practice and policy. these factors were chosen because the literature on statistical learning identifies them as factors that can impede or facilitate learning. additional factors were added because they reflected anticipated or assumed benefits or drawbacks of a brief, non-credit statistics course offered within the social work program. while the measure has strong face validity, other types of validity or reliability have not been determined. attitudes, beliefs, and feelings about statistics. four 4-point likert scale questions (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree) were used to determine the extent to which participants agreed or disagreed that: 1) statistics were relevant to social work education, 2) statistics were relevant to social work practice, 3) they felt anxious about statistics, and 4) they felt confident about statistics. participants were asked whether anxiety was alleviated by the course with possible responses of yes, no, or not anxious. statistical ability. participants matched five statistical terms (frequency, median, mean, standard deviation and chi-square) to definitions. five additional questions required participants to identify a paired t-test and interpret a paired t-test, median, and pearson correlation (see appendix a). the author who taught social work research at the institution developed the questions that include knowledge that the research instructors expect students possess after taking an introductory statistics course. correct answers were given a score of 1. incorrect answers were given a score of 0. these answers were summed (total possible score = 10) to calculate the statistics ability score. procedure data were collected from spring 2014 to spring 2015 through an anonymous, one-time, paper-and-pencil survey. after the research project was approved by the university’s irb, a research assistant or the author who was not a faculty member at the institution visited social work classes to introduce the study and distribute surveys. students were informed davis & mirik/teaching statistics 444 that participation was voluntary and anonymous. students who were absent did not have an opportunity to participate. out of 217 possible participants, 170 (78%) took surveys. two were incomplete, with only the first page filled out. these two surveys were dropped from the analyses, leaving a total n of 168. analyses statistical analyses were performed with ibm corporation (2012) spss statistics 21. descriptive statistics (mean and standard deviation, frequency and percent) explored anxiety, confidence, and perceived relevance of statistics towards education and practice. with a four-point likert scale, the responses were not normally distributed, so these responses were re-coded into a dichotomous variable (1=agree/strongly agree, 0=disagree/strongly disagree). chi-square analyses were used to look for associations between anxiety, confidence, knowledge and the belief that statistics are relevant to social work education and practice and the learning context (i.e., the accelerated, in-program course versus a course taken outside of the social work program). frequencies were used to describe the factors that supported and/or impeded students’ learning. chi-square tests were applied to look for associations between statistics learning context and the factors participants identified as supporting or impeding their learning of statistics. a t-test was used to determine if there was a difference in statistical ability based on statistics learning context. all hypothesis tests were performed at the 0.05 level. findings anxiety, confidence, knowledge, belief in relevance, and ability all participants (n=168) responded to questions about anxiety, confidence, knowledge and relevancy. nearly two-thirds (63%) of participants (n= 105) agreed they felt anxious about statistics and 49 (29%) indicated they felt confident about statistics. one hundred twenty-one (72%) agreed that statistics was relevant to their social work education, and 144 (86%) agreed that statistics was relevant to their social work practice. only 120 students (71%) completed the statistics ability measure; the average score was 6.68 (sd=2.31) out of a possible total score of ten. the internal consistency of this scale was acceptable (cronbach’s alpha = 0.76). perception of factors that affected learning the most common factors that supported learning were instructor’s teaching style (n=92, 55%), material presented in multiple formats (n=80, 48%), and review of material to reinforce concepts (n=78, 46%). the most common factors that hindered learning were a lack of connection between statistics and implications for social work practice or policy (43%, n=72), the workload (21%, n=35), and statistics material being insufficiently indepth (19%, n=32). see table 1. advances in social work, fall 2017, 18(2) 445 table 1. factors that support and hinder statistics learning (n=168) f (%)a factors supporting learning instructor’s teaching style supported students’ understanding of the material 92 (55%) material was presented in multiple formats (lecture, powerpoint, readings etc.) 80 (48%) material was reviewed to reinforce previous concepts before introducing new ones 78 (46%) relevant journal articles were used as examples 62 (37%) course was taught within the social work program 55 (33%) collaboration among peers was encouraged in the classroom 54 (32%) factors impeding learning connections were not made between statistics and implications for social work practice and policy 72 (43%) the workload was too much 35 (21%) the material was not in-depth enough 32 (19%) material was taught at too advanced a level 26 (16%) the class size was too big 24 (14%) the instructor was not accessible enough to students 21 (13%) a participants could choose multiple responses, so the responses add up to more than the total n. anxiety reduction one hundred sixty-three (96%) participants responded to a question that asked if their statistics course alleviated anxiety about statistics. seventy-nine percent (n=133) reported having some anxiety about taking a statistics course prior to the start of the course. fortyfour percent (n=73) did not find the course alleviated their anxiety, 36% (n=60) reported their anxiety was alleviated, and 18% (n=30) were not anxious. comparisons between course type there were no statistically significant associations between course type and anxiety, χ2(1, n=168)=1.07, p=0.30, confidence, χ2(1, n=168)=0.66, p=0.42, or belief that statistics are relevant to social work education, χ2(1, n=168)=0.68, p=0.41, or practice, χ2(1, n=168)=2.14, p=0.14 (see table 2). there was no significant association between the type of course taken and whether the course relieved students’ anxiety about statistics for students who reported they were anxious entering the course, χ2(1, n=132)=3.07, p=0.80. there was no significant difference in statistical ability between the for-credit course (m=6.94, sd=2.55, n=34) and the non-credit course (m=6.57, sd=2.21, n=85), t(117)=0.804, p=0.42. as many (n=49) of the responses for statistical ability were missing on surveys which were otherwise complete, a missing data analysis compared those with missing data to those without. there was no association between missing data and type of course taken, χ2(1, n=168)=0.66, p=0.42, anxiety, χ2(1, n=168)=0.004, p=0.95, confidence, χ2(1, n=168)=0.10, p=2.79, knowledge χ2(1, n=168)=0.24, p=0.62, or belief in relevance of statistics to social work education, χ2(1, n=168)=0.11, p=0.74, or practice χ2(1, n=168)=0.40, p=0.53. davis & mirik/teaching statistics 446 table 2. comparison of feelings and attitudes towards statistics by course type (n=168) there were significant associations between course type and identifying the use of relevant journal articles with statistical examples, χ2(1, n=166)=5.48, p=0.02, and the fact that their course was taught within the social work program, χ2(1, n=166)=41.87, p<0.001, as supporting their learning. there was a significant association between course type and the identification of a lack of connection between statistics and social work practice and policy, χ2(1, n=166)=10.65, p<0.001, as a barrier to learning. there were no significant associations between course type and any other factors supporting or hindering learning, including the depth of material covered in the course, χ2(1, n=166)=1.35, p=0.25 (see table 3). discussion overall, there were no differences in students’ feelings and attitudes towards statistics based on the type of course taken. there was no significant association between feelings or attitudes towards statistics or statistical ability and the type of statistics course nor were there any significant differences in students’ ability to apply statistical concepts. students who took the accelerated, non-credit statistics course were equally able to use statistics, and no more anxious or less confident because they spent less time in a statistics course. in fact, students in the non-credit course were no more likely to endorse the lack of depth of the course as a barrier to their learning than those who took the full-credit course, suggesting that students do not perceive the shorter length of the course as detrimental to their learning. students appear able to learn statistics in a variety of contexts and with different teaching strategies, which is consistent with literature on instruction in introductory statistics courses (curran et al., 2013; wilson, 2013). non-credit course for-credit course χ2 p f (%) f (%) anxiety yes 31 (69%) 74 (60%) 1.07 0.30 no 14 (31%) 49 (40%) confidence yes 11 (24%) 38 (31%) 0.66 0.42 no 34 (76%) 85 (69%) relevance to social work education yes 30 (67%) 90 (73%) 0.68 0.41 no 15 (33%) 33 (27%) relevance to social work practice yes 35 (78%) 107 (87%) 2.14 0.14 no 10 (22%) 16 (13%) course relieved anxiety yes 22 (37%) 37 (63%) 3.07 0.08 no 17 (23%) 56 (77%) note: df = 1 for all analyses advances in social work, fall 2017, 18(2) 447 table 3. supports and barriers to learning statistics for students by course type these results may reflect the fact that the length of the course is only one factor in learning new material. the students who took the non-credit course were more likely to endorse that the following factors facilitated their learning: having the course was offered within the social work program, taught by a social work instructor, and using relevant, social work articles. in contrast, students who took the for-credit statistics prerequisite were more likely to identify a lack of connection between statistics and social work as a barrier to their learning. there may be a benefit to waiting to develop this knowledge and skill set non-credit course for-credit course χ2 p f (%) f (%) course in social work program yes 32 (71%) 22 (18%) 41.87 <0.001 no 13 (29%) 99 (82%) relevant journal articles yes 23 (51%) 38 (31%) 5.48 0.02 no 22 (49%) 83 (69%) instructor’s teaching style yes 30 (67%) 61 (50%) 3.50 0.6 no 15 (33%) 60 (50%) material in multiple formats yes 24 (53%) 65 (54%) 0.65 0.42 no 21 (47%) 56 (46%) collaboration encouraged yes 18 (40%) 36 (30%) 1.57 0.21 no 27 (60%) 85 (70%) review of material yes 24 (53%) 53 (44%) 1.20 0.27 no 21 (47%) 68 (56%) lack of connection with practice/policy yes 10 (22%) 61 (50%) 10.65 <0.001 no 35 (78%) 60 (50%) material not taught in depth yes 11 (24%) 20 (17%) 1.35 0.25 no 34 (76%) 101 (84%) material too advanced yes 8 (18%) 17 (14%) 0.36 0.55 no 37 (82%) 104 (86%) workload too heavy yes 10 (22%) 25 (21%) 0.05 0.83 no 35 (78%) 96 (77%) instructor inaccessibility yes 2 (4%) 19 (16%) 3.76 0.05 no 43 (96%) 102 (84%) class size too big yes 4 (9%) 20 (17%) 1.55 0.21 no 41 (91%) 101 (83%) note: df = 1 for all analyses davis & mirik/teaching statistics 448 until graduate school, and learning and applying statistics within the same knowledge base, which is their professional discipline. indeed, previous studies have shown that msw students find statistics learning to be meaningful, relevant, and applicable when connected to practice settings and their coursework (elliott et al., 2013; wells, 2006). by taking the non-credit course, students may have benefited from instructors’ familiarity with social work practice and values, and their own beliefs about the relevance of social work research (barretti, 2004). scholarly articles may relate to topics students are familiar with and interested in, and therefore, they may be motivated to read the material closely and understand it thoroughly (bolen, 2006; lalayants, 2012; rabin & nutterupham, 2010). relevant journal articles may become another vehicle for connecting the material to the discipline, which increases the likelihood of “far transfer” (barnett & ceci, 2002, p. 612; daniel & braasch, 2013). using the concepts from barnett and ceci’s (2002) taxonomy of transfer, the students in the for-credit course were more likely to have learned statistics apart from the knowledge base to which the skill is applied. it is concerning that regardless of where students took statistics, the majority of students remained anxious, not confident, and demonstrated a low ability to use and apply statistics. over three-quarters (79%) of the students endorsed some anxiety about learning statistics before entering the course. this finding is consistent with the literature that emphasizes social work students’ anxiety about statistics (capshew, 2005; junius & siddell, 2009; marson, 2007). however, 44% of students did report that taking a statistics course alleviated their anxiety. once students begin learning statistics, some appear to find it less overwhelming, and their anxiety dissipates. students identified several reasons for their lessened anxiety: instructor qualities (e.g., being knowledgeable, patient, and kind), teaching approaches (e.g., normalizing anxiety, making material relevant), and the perception of the course as less overwhelming than expected. there were no differences between learning contexts; it may be that, as with anxiety about graduate school in general, students’ anxiety tends to lessen once they have taken a course and start to know the unknown (gelman, 2004). while almost half (44%) of these anxious students experienced a decrease in anxiety after taking the course, by the time of this survey, 63% reported being anxious about statistics. clearly, anxiety about statistics is prevalent for students in this msw program. of even more concern than student anxiety is the low level of ability to use and apply statistics (m = 6.68 out of a possible 10), demonstrated by all the students in this sample, regardless of the type of statistics course. this reflects previous findings by secret et al. (2003) who found that levels of ability to use statistics remained low even after the course was completed. being able to understand, use, and apply statistics is an important component of many social work jobs and is necessary for consuming professional research, managing and tracking program statistics, and evaluating programs for effectiveness and/or grant funding. this finding suggests that most graduate social work students need more instruction in statistical concepts; determining how to do this in ways that are effective and feasible should be a focus of future research in this area. advances in social work, fall 2017, 18(2) 449 limitations there were several limitations of this study. the participants who attended the inprogram course were enrolled in just one social work graduate program, and therefore, caution should be taken in generalizing the findings to other in-program statistics courses. students’ attitudes and statistical ability may be related to how statistics is, or is not, incorporated in the social work curriculum in that program. the number of individual statistical analyses used in this research study leads to an increase in the likelihood of type1 errors; this suggests the possibility that some of the significant findings might be the result of a type-1 error. the cross-sectional design of the study, while practical, makes it impossible to determine whether there were significant differences between the students who took the non-credit course and those who entered the program having already taken statistics. there was no way to determine whether one group entered with higher levels of anxiety, less experience with math, or a great number of years between their undergraduate program and their graduate program. in fact, some of the assumptions of differences between the two groups may not have been true for all students. for example, while this research project assumed that the for-credit students did not learn statistics within their discipline, in all likelihood, this is not true for some of the students, who might have been social work or psychology students and therefore, learned statistics in their undergraduate program within the context of their discipline, just as the non-credit statistics students did in this graduate program. the measures that were used were developed for this project, so determinations of reliability and validity are preliminary. while the measures have face and content validity, test/re-testing is required in order to evaluate whether the measures produce reliable, consistent results over time. the measure of internal consistency for statistical ability was adequate (cronbach’s alphas = 0.756) suggesting that, although the survey was brief, it adequately measured a unidimensional construct. with the overall low scores on the measure of ability to apply statistics, a lengthier survey would have been more effective as it would be more sensitive to small differences between groups. the sample size for the group of students that took the accelerated, in-program statistical course, was small (n=45). this may have impacted the power of the study and whether significant results were found. a future study using a larger sample size could validate the findings in this study. despite the limitations, these preliminary findings highlight important information about feasible options for statistical learning, which are less costly and time-consuming than a for-credit prerequisite. implications students taking the brief, non-credit statistics course appear to leave the course with similar feelings and attitudes towards statistics, and a similar ability to apply statistical knowledge, as students who took a full-semester, for-credit course. this finding is important for social work graduate programs because brief courses, like this one, may be a convenient, timeand cost-effective option for students who have not already completed this pre-requisite in their undergraduate program. these courses have the benefits of being davis & mirik/teaching statistics 450 able to consciously connect statistics with practice, which students in this study identified as facilitating their learning of statistics. these findings suggest that social work graduate programs that currently require a statistics prerequisite might consider the development of a brief, non-credit option within the social work department, especially if their students experience the statistics pre-requisite as a financial or time burden. a substantial number of social work students (63%) remain anxious about the material after the course is completed, and it is important for social work programs to consider how to address this anxiety in their students. however, it is noteworthy that, prior to the start of the course, some students (11%) were not anxious about statistics. this finding indicates a wide diversity in feelings about statistics, from not at all anxious beginning the course to anxious about statistics even after successfully completing the course. instructors need to assume a wide variation in students’ attitudes, rather than a universal aversion toward research and statistics (secret et al., 2003). incorporating this into statistical course planning might improve feelings, attitudes, and ability for all students, not just those who are extremely anxious. regardless of the context for learning statistics, many students struggled to retain the material they have learned. they demonstrated “near transfer” (barnett & ceci, 2002, p. 615), or gaining enough knowledge to pass an introductory course, but had considerable erosion of knowledge afterward. in order to retain their knowledge, students may need frequent opportunities to review and integrate the material more fully. these opportunities can be provided throughout the curriculum, such as incorporating statistics within research methods courses, using statistics to show the efficacy of evidence-based practice models, analyzing statistics used in policies and advocacy work, and including the use of statistics in field placements. in this way, statistics are not set apart from the rest of the curricular content. this approach also models the instruction after reality; rather than the mathematical computations, students learn the meaning, purpose, and utility of statistical tests (calderwood, 2002). additionally, instructors may select examples related to social justice issues that students care about (lesser, 2007); this focus can increase student engagement, motivation, and interest, and may make the content particularly relevant for students pursuing a profession aimed at addressing inequities. instructors can note the factors that students identified as facilitating or hindering their learning. students valued having the material presented in multiple formats and being reinforced through repetition and review. some of these factors were echoed in the ways that their course lessened their anxiety, such as making the content relevant and engaging students with clickers. clickers encourage students to pay attention and actively participate, without the embarrassment of getting a question wrong or admitting not knowing an answer (smith, shon, & santiago, 2011), which is important within a class where many students report anxiety and lack of confidence with the material. clickers provide immediate feedback and are a technologically savvy version of the classroom assessment technique that goldstein (2007) encouraged in introductory statistics courses. advances in social work, fall 2017, 18(2) 451 conclusion this study evaluated the use of a brief, non-credit statistics course in place of a requirement for a full-length, for-credit course. this option is a timeand money-saving solution for students who did not take, or successfully complete, an introductory statistics course during their undergraduate education. findings suggest this is a comparable alternative for msw students in terms of anxiety, confidence, and ability to apply statistics. the findings suggest that students identify benefits of a non-credit statistics course, including its location within the social work program and the use of relevant journal articles. while the majority of students in this study struggled to demonstrate strong statistical knowledge, those who took the non-credit statistics course performed comparably on a measure of statistics ability as their peers who completed the statistics pre-requisite elsewhere. however, the overall low ability to apply statistics and high levels of anxiety are concerning. future research should explore the experiences of students who have passed an introductory statistics course and maintained their statistical literacy (ramirez et al., 2012). what helped them develop this lasting competence? given that professional disciplines prepare students for practice, the functional context, or academic learning that carries over to the field (barnett & ceci, 2002), is most important. once in professional settings, graduates may face barriers in using research and statistics to inform and evaluate their practice, such as a lack of time and inconsistent access to the literature (edmond, megivern, williams, rochman, & howard, 2006). social work educators can help students become aware of these realities of practice, and become intentional and resourceful in retaining their knowledge, maintaining their skills, and locating statistical resources. social work educators need to develop an understanding of approaches for effectively socializing students to value and develop enduring competence with statistics. references barnett, s., & ceci, s. 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(2003). undergraduate research courses: a closer look reveals complex social work student attitudes. journal of social work education, 393, 411-422. doi: https://doi.org/10.1080/10437797.2003.10779146 sizemore, o., & lewandowski, g. (2009). learning might not equal liking: research methods course changes knowledge but not attitudes. teaching of psychology, 362, 90-95. doi: https://doi.org/10.1080/00986280902739727 smith, l., shon, h., & santiago, r. (2011). audience response systems: using ‘clickers’ to enhance bsw education. journal of technology in human services, 292, 120-132. doi: https://doi.org/10.1080/15228835.2011.587737 stickels, j. w., & dobbs, r. r. (2007). helping alleviate statistical anxiety with computer aided statistical classes. journal of scholarship of teaching and learning, 7(1), 1-15. thomas, l. 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(2013). the flipped class: a method to address the challenges of an undergraduate statistics course. teaching of psychology, 403, 193-199. doi: https://doi.org/10.1177/0098628313487461 author note: address correspondence to: ashley davis, phd, msw, wheelock college, department of social work, 200 riverway, boston, ma, 02215. adavis@wheelock.edu https://doi.org/10.1080/10437797.2003.10779146 https://doi.org/10.1080/00986280902739727 https://doi.org/10.1080/15228835.2011.587737 https://doi.org/10.1080/08841230802179357 https://doi.org/10.5175/jswe.2006.200400466 https://doi.org/10.1177/0098628313487461 mailto:adavis@wheelock.edu advances in social work, fall 2017, 18(2) 455 appendix a: application score questions 1. a social worker helps people who are unemployed transition back to work. she tracks how long it takes people to get a job again and finds a mean of 12 months and a median of 6 months. why might the mean and median be different values?  outliers affect the mean, but not the median.  the median is always less than the mean.  the median reflects the frequently occurring value.  all of the above. 2. a social worker learns that there is a significant strong negative correlation between number of days of exercise and severity of depression (as measured by a standardized instrument). what does this finding mean?  people who exercise more frequently are more likely to experience severe depression.  people who exercise less frequently are more likely to experience depression.  frequency of exercising and severity of depression are not related. 3. three social workers develop an all-day training on the best practices for suicide assessment and prevention. the social workers want to see how effective the training is at increasing participants’ knowledge, confidence, and competence around suicide assessment and prevention. prior to the start of the training, participants take a pretest, measuring these three areas. at the end of the day, after the training, the participants take a post-test. a t-test was run to look at the change in scores from pretest to posttest for each participant. the table below illustrates the means and standard deviations for the participants’ scores as well as the mean difference between participants’ pre and post-test scores and the standard deviation of this difference. higher scores indicated higher levels of knowledge, competence, and confidence. training participants’ scores mean sd mean of the differences between pre and post tests sd of the difference between the mean scores n pre-test 131.2 16.64 26.8 15.34 59 post-test 158.0 14.32 after conducting a t-test, she learns: t = -13.421, p < .001. based on the example above, answer the following questions. 4. is the difference in mean scores statistically significant?  yes  no  cannot determine 5. why? 6. based on these findings, can they conclude that the training is effective?  yes  no  cannot determine 7. why? ashley davis rebecca g. mirick keywords: statistics; research; teaching approaches; msw students literature review teaching strategies classroom climate instructor qualities the efficacy of different approaches learning statistics within social work education method participants measures procedure analyses findings anxiety, confidence, knowledge, belief in relevance, and ability perception of factors that affected learning table 1. factors that support and hinder statistics learning (n=168) anxiety reduction comparisons between course type table 2. comparison of feelings and attitudes towards statistics by course type (n=168) table 3. supports and barriers to learning statistics for students by course type limitations implications conclusion references appendix a: application score questions after conducting a t-test, she learns: t = -13.421, p < .001. based on the example above, answer the following questions. _______ nathan h. perkins, phd, msw is an assistant professor, school of social work, loyola university chicago, chicago, il 60611. susan f. grossman, phd is a professor, school of social work, loyola university chicago, chicago, il 60611. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 138-156, doi: 10.18060/22611 this work is licensed under a creative commons attribution 4.0 international license. sibling violence: the missing piece in family violence policy nathan h. perkins susan f. grossman abstract: social work has played an integral role in the conceptualization and implementation of policy aimed at prevention and intervention of various forms of family violence. seminal federal policies to address child abuse and neglect (child abuse prevention and treatment act), elder abuse (elder justice and older americans acts), and intimate partner violence (violence against women and family violence prevention and services acts) all focus on specific types of violence in the family. to date, however, there are no federal policies specifically addressing physical and/or emotional sibling violence (perkins, coles, & o’connor, 2017; perkins & o’connor, 2016). this article examines the exclusion of policy addressing physical and emotional sibling violence considering other family violence policies. along with prevalence, consequences, and associative factors connected to sibling violence, definitional issues that impede the creation of policy to address this form of family violence are highlighted. children as a marginalized population, deserving the attention of social workers through policy advocacy will be discussed as well as psychoeducation and interprofessional collaboration that may facilitate the creation of policies aimed at addressing this form of family violence. keywords: sibling violence; family violence; policy; policy advocacy; policy research; research in 1975, straus, gelles, and steinmetz (1980) collected data on different types of family violence in the national family violence survey. one of the findings from the analysis of these data is best presented exactly as it appears in a heading from their book on the study, “sibling violence is the most frequent type of family violence” (straus, gelles, & steinmetz, 1980, p. 83). physical sibling violence was found to be more frequent than parent-to-child violence and interparental violence. despite consistent research in the four decades since this study underscoring the negative consequences and associations of physical and emotional sibling violence, no federal or state policies address this form of family violence. although there are policies to address child abuse and neglect, inter-partner violence, and elder abuse, violence between siblings remains substantially neglected and dismissed in terms of the need for policy creation and advocacy. recently there has been an increase in research highlighting sibling violence as a problematic phenomenon for children and families, although this literature is substantially less prevalent than works related to other forms of family violence. this increase may be attributed to the association between sibling violence and bullying between peers (tucker, finkelhor, turner, & shattuck, 2014). many terms and definitions of sibling violence exist. for purposes of this discussion, we define physical and emotional sibling violence as the use of physical (e.g. kicking, perkins & grossman/physical & emotional sibling 139 slapping, biting, etc.) or emotional behaviors (e.g. manipulating, teasing, name-calling, etc.) directed toward a sibling with the intent to harm (perkins, coles, & o’connor, 2017). the behaviors included here can be synonymous with the behaviors of bullying as well as other terms that are used to describe physical and emotional violence between siblings. as with family violence, state laws and policies addressing peer-related bullying have increased; however, there are no federal or state policies or laws specifically aimed at preventing or intervening to address physical and emotional sibling violence. nonetheless, there is substantial research providing considerable justification for creating and implementing such policies. this article provides background information on physical and emotional sibling violence including prevalence and ramifications, the connection between sibling violence and other forms of family violence, policies addressing various types of family violence as well as bullying, potential reasons for the lack of policy addressing sibling violence, and future directions that social work needs to take in order to prevent and intervene in sibling violence. background information on physical and emotional sibling violence prevalence violence between siblings has been found to be the most common form of family violence (straus, gelles, & steinmetz, 2006) with approximately 29.4% of a national representative sample of children younger than 17 having experienced at least one incident of assault by a juvenile sibling (finkelhor, turner, shattuck, & hamby, 2015). using data from the national survey of children’s exposure to violence, tucker, finkelhor, shattuck, and turner (2013) found that approximately 23% of children less than one year old, 45% of twoto five-year-olds, 46% of sixto nine-year-olds, 36% of tento thirteenyear-olds, and 28% of fourteento seventeen-year-olds had experienced at least one form of sibling victimization within the past year. interestingly, data also indicated that, although preschool and elementary school children experienced the most sibling victimization, adolescents aged 14 to 17 reported the highest rates of injury. sibling victimization has also been found to be chronic, with roughly 40% of children and adolescents aged 2 to 17 from a national sample reporting chronic victimization by a sibling compared to only 15% who experienced chronic peer victimization (finkelhor, turner, & ormrod, 2006). in an analysis of the prevalence rates for sibling bullying, wolke, tippett, and dantchev (2015) found “about 15% to 50% for victimization by siblings, and 10% to 40% for perpetrating sibling bullying” (p. 920). in a study examining sibling aggression in a clinic-referred sample of youth, mothers indicated that 93% of youth had perpetrated aggression toward a sibling in the past year, with 82% of youth reporting they had engaged in sibling aggression (tompsett, mahoney, & lackey, 2018). the aforementioned studies highlight the extent of physical and emotional violence between siblings, underscoring the chronicity with which this form of family violence can occur. the following section highlights associations with and consequences of experiencing sibling violence both as a recipient and initiator. advances in social work, spring 2019, 19(1) 140 associations and consequences the negative effects of physical and emotional sibling violence are extensive and have been examined in both children and youth and to a lesser extent in adults. delinquent behaviors (tucker et al., 2015), including illegal substance use and aggression (button & gealt, 2010), family adversity (tucker, finkelhor & turner, 2018), moral disengagement (tanrikulu & campbell, 2015), behavioral problems, and impaired peer relations (stormshak, bellanti, & bierman, 1996) have been associated with sibling violence and sibling bullying. research has also found sibling violence to be connected to mental health issues (duncan, 1999; patalay & fitzsimons, 2016; phillips, bowie, wan, & yukevich, 2018; tucker, finkelhor, turner, & shattuck, 2013; van berkel, tucker, & finkelhor, 2018) and problematic psychological adjustment (graham-bermann, cutler, litzenberger, & schwartz, 1994). frequent sibling bullying was found to double of the odds of children experiencing depression, self-harm, and anxiety compared to those who have not been bullied by a sibling (bowes, wolke, joinson, lereya, & lewis, 2014). recent studies have examined sibling violence in more context-specific ways. tucker, finkelhor, and turner (2017) found that children with a physical disability or children who were perceived by their parents as being underweight or overweight were more likely to experience sibling victimization than children without a physical disability or those perceived by parents as having normal weight for their age. children who engage in sibling violence, including bullying, as perpetrators also experience consequences of their behavior. in a sample of children aged five to twelve, sibling bullying perpetrators (including cyberbullying perpetrators) were found to have increased anger and moral disengagement (tanrikulu & campbell, 2015). hostility directed toward a sibling has also been found to be significantly correlated with reactive aggression, proactive aggression, and behavioral problems in children in out-of-home placements (milojevich, quas, & adams, 2017). experiencing violence by a sibling in childhood has been linked to lasting negative consequences in young and older adulthood. in younger adults, being a victim of sibling hostility (including physical and emotional violence) in childhood was found to be a predictor of current conduct disorder symptoms (king et al., 2018). it was also associated with lifetime aggressive acts in both men and women. similarly, dantchev, zammit, and wolke (2018) found that those respondents who reported having experienced several instances of sibling violence a week at age 12 were more than three times likely to have a psychotic disorder at age 18 compared to those who never experienced sibling violence. other adult consequences of sibling conflict in childhood include poor self-esteem (meyers, 2014), eating disorders (wiehe, 1997), and marital conflict (shalash, wood, & parker, 2013). in their book focusing on adult sibling relationships, greif and woolley (2016) note that unresolved conflict and violence between siblings in childhood has implications for sibling interaction in adulthood and can impact how siblings negotiate and care for elder parents. perkins & grossman/physical & emotional sibling 141 sibling violence and family violence the aforementioned research highlights the impact of physical and emotional sibling violence on children as well as adults. physical and emotional sibling violence has also been connected to other forms of family violence. violence directed toward a child (eriksen & jensen, 2006) and spousal abuse between parents (hoffman, kiecolt, & edwards, 2005) have been found to predict sibling violence. in a study of college students aged 18 and older, sibling violence perpetration and victimization were significantly associated with mother-to-participant, participant-to-mother, participant-to-partner, and partner-to-participant violence (hendy, burns, can, & scherer, 2012). data from a national sample of 5to 17-year-olds indicated that sibling victimization was correlated with parentto-child physical abuse as well as neglect (van berkel et al., 2018). tompsett and colleagues (2018) found that mother-to-child verbal aggression and corporal punishment also predicted both mild and severe sibling aggression. the occurrence of sibling violence has potential implications for violence outside of the home. being victimized by a sibling has been found to be a significant predictor of experiencing peer victimization (tucker et al., 2014). additionally, an older sibling’s use of physical aggression has been found to predict a younger sibling’s use of physical aggression with peers (ostrov, crick, & stauffacher, 2006). compared to adolescents involved in a family violence intervention program who had engaged in child-to-parent violence, youth who perpetrated physical sibling violence were more likely to be involved in fighting in school (nowakowski-sims, 2019). ostrov and colleagues (2006) note that it is likely children learn how to interact with peers through their interactions with siblings; therefore, if violence is a common occurrence within sibling relationships, violence may also be carried out in relationships with peers. similarly, children may also learn to be violent in their communities due to engaging in violence with their siblings (perkins & shadik, 2018). despite these connections to other forms of family violence, policy to address physical and emotional violence between siblings remains nonexistent. the context of family violence the most obvious explanation as to why sibling violence, particularly emotional and physical abuse between siblings, is not seen as a problem requiring legislative action may be because we, as a society, believe that the behavior of siblings toward each other is a private matter to be addressed within the family system. yet this same argument has been made prior to the passage of legislation governing other forms of violence between family members, particularly between husbands and wives and parents and children. child abuse as nelson (1984) notes in her book, making an issue of child abuse, public efforts to address the problem of abuse emerging initially in the late nineteenth century, coincided with a changing view of childhood and the movement away from parents as authority figures. rather, the parental role was re-conceptualized as one in which parents would serve as teachers and nurturers who would help the child to develop in a positive direction. jimenez (1990) similarly argues, “one of the major themes in child welfare since the advances in social work, spring 2019, 19(1) 142 progressive era has been a growing commitment to the emotional, social, and economic dependence of children” (p. 55). at the same time, both jimenez (1990) and nelson (1984) discuss how the period leading up to the passage of the child abuse prevention and treatment act (capta) in 1974 as well as succeeding legislation was characterized by a tension between the role of the family in assuring the child’s positive development and the role of the government when the family fails to do so. despite this tension, capta is a policy response to the problems of child abuse and neglect. in its initial passage, it was fairly modest, authorizing limited government research into child abuse and treatment, creating a national clearinghouse for data on child abuse, and establishing funding incentives to tighten state reporting laws (jimenez, 1990, p. 61). in its most recent reauthorization in 2010, it expanded to provide federal funding to states to support “prevention, assessment, investigation, prosecution, and treatment of activities related to abused and neglected children” (harfeld & marlowe, 2017, pp. 117-118). of note is that for all its provisions, capta does not directly address violence between siblings. as perkins and colleagues (2017) point out, under capta, parents could be held accountable for neglect in cases of sibling violence but there is no recourse to directly address the violence. domestic violence similar to the issue of child abuse, wife abuse was seen as a private matter essentially until the latter part of the twentieth century (see siegel, 1996 for an historical overview). barusch (2002) notes that wife abuse was sanctioned by some early christian ecclesiastics who felt that it would save the soul of wives. “no thicker than his thumb” was established as the benchmark for the size of switch that could be used for wife beating (barusch, 2002, p. 244; see also bailey, 2010 for a discussion). growing out of other rights movements in the late 1960s and 1970s, the battered women’s movement emerged in the early 1970s with the dual purpose of raising public awareness of the problem and providing a shelter for victims (barusch, 2002; fernandesalcantara, 2017; grossman, lundy, george, & crabtree-nelson, 2010; sacco, 2014, siegel, 1996). barusch (2002, pp. 244-245) and others (e.g., bailey, 2010) note that, beyond assisting survivors, the battered women’s movement, in concert with the feminist movement, sought to challenge male violence and change women’s position in society. as researchers began to collect data on family violence and link declines in spousal assault to greater awareness of the issue by both men and the criminal justice system, the criminal justice system and the public started to see family violence as a crime rather than as a private family issue (sacco, 2014, p. 1). in response to growing concerns, many states began to pass legislation aimed at addressing domestic violence throughout the 1970s, but it was not until 1984 that the first federal legislation was passed. this legislation, the family violence prevention and services act (fvpsa, 1984), specifically provided funds for shelters and services for survivors as well as establishing a national domestic violence hotline (fernandesalcantara, 2017). perkins & grossman/physical & emotional sibling 143 in her analysis of the fvpsa, fernandes-alcantara (2017) notes that it is somewhat limited in its definition of violence, focusing primarily on physical violence. further, it mainly concerns violence between current and former spouses or individuals similar to spouses, cohabitating individuals, and parents of children (fernandes-alcantara, 2017). she notes that, “while family violence can encompass child abuse and elder abuse, fvpsa programs focus on individuals abused by their spouse and other intimate partners” (p. 2). the fvpsa was clearly an important piece of legislation intended to publicly address the problem of domestic violence. nonetheless, ten years after its passage, and in recognition of the need for a criminal justice response to the problem of domestic violence (conyers, 2007; office on violence against women, 2016; sacco, 2014), congress passed the violence against women act (vawa, 1994) originally as title iv of the violent crime control and law enforcement act of 1994 (1994; sacco, 2014, p. 1). the 1994 violence against women act provided grants to states to improve responses to violent crime against women and children (by adult perpetrators), encouraged the development of coordinated prevention efforts, and created new legal remedies for certain victims of violent crime when the crime was motivated by gender. vawa increased penalties for domestic offenders and sex abusers, made stalking a crime, and allowed for interstate prosecutions. in addition, it required states to honor orders of protection obtained in different states (barusch, 2002; office on violence against women, 2016; sacco, 2014). the violence against women act (1994) has subsequently been reauthorized three times, with each reauthorization expanding the groups and types of crimes addressed. yet vawa is not a vehicle for addressing sibling violence. like the fvpsa, its focus is primarily on violence between adult partners. indeed, the most recent reauthorization, which occurred in 2013, contained a revision of the definition of domestic violence to specifically include “intimate partners,” expanding the definition beyond “current and former spouses” (sacco, 2014, p. 12). it does include provisions to address violence between adults and children, particularly sexual violence, but it does not appear to be a vehicle through which violence between siblings, whether they are children or adults, can be addressed. elder abuse although the problem of elder abuse may not seem relevant to the issue of sibling violence, caregivers may be siblings, or as noted in the discussion above regarding the consequences of sibling violence in adulthood, abuse between adult siblings and/or unresolved issues from childhood violence between siblings may affect the well-being of an elderly parent (perkins, spira, & key, 2018). thus, legislation focused on the issue of elder abuse could potentially be one policy venue for addressing the issue albeit in later life. the problem of abuse among older adults came onto the public agenda similar to other forms of abuse in that increasing awareness of the problem eventually led to a policy response. however, unlike child and spousal abuse, abuse of older adults did not have the same legacy of tolerance. kreinert, walsh, and turner (2009) note that a pivotal article about “granny bashing” published in 1977 in great britain (see walshe-brennan, 1977), advances in social work, spring 2019, 19(1) 144 as well as a number of studies in the united states “…brought the issue to the center of the american conscience” (kreinert et al., 2009, p. 328) during the 1970s. initially, our understanding of the problem of abuse of older adults was that it resulted from the stress of the caregiver, who was most often an adult child (lundy & grossman, 2005). therefore, the response was to provide respite care and support to the caregiver rather than addressing the problem as a criminal justice issue (kreinert et al., 2009). by the late 1980s, however, there was increasing evidence to support that “at least some elder abuse is spouse abuse grown old” (lundy & grossman, 2005, p. 87; see also, for example, antley, 2017; brandl & raymond, 1997; national center on elder abuse, 1998; pillemer & finkelhor, 1988; podnieks, 1992). it also became clear over time that adult children who abuse elders may not only need respite but they may also have problems of their own that contribute to their abusive behavior (johannesen & logiudice, 2013; moore & browne, 2017; pillemer & finkelhor, 1988). two federal policies relate to the abuse of older adults. the first, the older americans act of 1965, was the culmination of a number of efforts by the kennedy/johnson administration to address the needs of this population (agency for the elderly, 1966). not only did this act lead to the creation of the first federal agency whose purpose was to address the needs of the elderly (the administration on aging) but it specifically addressed the social service needs of older adults (administration for community living, 2017; o’shaughnessy, 2012). according to o’shaughnessy (2012), “its mission is broad: to help older people maintain maximum independence in their homes and communities and to promote a continuum of care for the vulnerable elderly” (p. 1). programs specifically intended to address elder abuse were not included in the original act although it might be argued that some of the social services provided under the act addressed the problem of caregiver neglect or need for respite. however, in 1992, when the act was reauthorized, title vii, otherwise known as the “vulnerable elder rights protection law,” was added (national center on elder abuse, n.d.). according to the national health policy forum (o’shaughnessy, 2012), this title authorized a long-term care ombudsmen program to help address complaints of residents in institutional care settings such as nursing homes and adult care homes and provided funds to states to ‟carry out activities to make the public aware of ways to identify and prevent abuse, neglect, and exploitation and to coordinate activities of area agencies on aging with state adult protective services programs” (p. 8). the second policy, the elder justice act (2009), was passed in 2010 as part of the patient protection and affordable care act (aca; 2010; colello, 2017). colello notes that the act “represents congress’s first attempt at comprehensive legislation to address abuse, neglect and exploitation of the elderly at the federal level” (p. 2). the elder justice act allows the federal government to coordinate responses to elder abuse and neglect and authorizes federal funding for elder abuse prevention services (kohn, 2012, p. 7). rather than providing additional services to abuse victims, the act essentially provides additional funds through existing state mechanisms to address the problems of elder abuse including adult protective service programs supported by title xx and long-term care ombudsmen programs at the state level (selberg, 2014, p. 54). further, embedding the act within the perkins & grossman/physical & emotional sibling 145 aca reflects concerns about addressing institutional abuse (selberg, 2014, p. 54). finally, the elder justice act does not make elder abuse a federal crime like child abuse and domestic violence (kohn, 2012, p. 7; see also colello, 2017). it is likely that decriminalization results from the belief about why abuse occurs. if we believe that caregivers abuse elders because of the stress of caregiving, it is hard to see the abuse as deliberate or necessitating a criminal justice response. bullying legislation related to bullying began to increase after 1999, in response to both the columbine shootings and bullying-related suicide (stuart-cassel, bell, & springer, 2011, p. xi). although there is no federal bullying legislation, many laws related to discrimination or discriminatory harassment on the basis of race, gender, national origin, age, and ability may apply and federally funded schools (including colleges and universities) must resolve harassment (stopbullying.gov, 2017, para. 1). legislation related to bullying does exist at the state level. indeed, cosgrove and nickerson (2015) report that 49 states have enacted legislation to address bullying and harassment behaviors as of the date of their publication (p. 521). most state policies focus on bullying in educational institutions and direct their laws at school districts, requiring them to adopt anti-bullying policies (stuart-cassel et al., 2011). in response to this growing body of legislation, the department of education adopted a framework for states that they outlined in a “dear colleague” letter in december of 2010 (stuart-cassel et al., 2011). this framework includes a number of elements: definition of bullying behavior and protected groups; development and implementation of district policy; parameters for applying policies, including policy communication and recordkeeping; and monitoring of policies, procedures, actions and interventions that may be employed to prevent bullying (cosgrove & nickerson, 2015; stuart-cassel et al., 2011). in a study looking at the extent to which states implemented these suggested components, stuart-cassel and colleagues (2011) noted that only two states include all of the identified features. furthermore, states differ substantially in terms of the number of components covered by their legislation as well as the ways in which they address each component (stuart-cassel et al., 2011, pp. xiii-xiv). considering the connection between sibling violence at home and bullying behavior at school, school policies regarding intervention in bullying behaviors may be particularly relevant to addressing the problem of sibling violence. although we can presume that schools provide supports to families in the context of addressing school bullying, bullying laws and policies focus on behavior in the schools and the actions schools must take to prevent and address bullying. they are not designed to directly support parents in the home. further, in their analysis of the components contained within state policies, stuart-cassel and colleagues (2011) reported that only thirteen states have specific provisions related to responding to the mental health needs of victims, and not all of these thirteen require that services be made available (p. 39). only five state policies “contain explicit language related to providing student support to both victims and bullies” (stuart-cassel et al., 2011, p. 39). in contrast, the children’s act, which was enacted in the united kingdom in 1989 (legislation.gov.uk, n.d.), considers bullying as a child protection concern and allows advances in social work, spring 2019, 19(1) 146 schools access to a range of services to address the problem (sims-schouten & edwards, 2016). potential reasons for lack of sibling violence policy as noted throughout this article, despite the clearly negative consequences of sibling violence and its chronicity (finkelhor et al., 2006), there are no policies to address, intervene in, and ameliorate this form of family violence. the following sections consider possible reasons for the lack of policy addressing sibling violence. some of these issues are not new, having impeded the creation of other policies related to family violence. however, they need to be considered again in the context of sibling violence if social workers are to be successful in their policy creation efforts. definitions and labels of violence between siblings labeling and definitional issues may impede the creation of sibling violence policy. deleterious behaviors between siblings have been conceptualized, labeled, and defined in a multitude of ways. for example, sibling abuse, sibling aggression, sibling assault, sibling conflict, sibling hostility, sibling maltreatment, sibling negativity, sibling rivalry, sibling violence, and many other labels have been used to refer to physically and emotionally violent behaviors between siblings (see perkins, 2014). sibling bullying is also a recent term used that can encompass violent behaviors (skinner & kowalski, 2013). the use of this term can likely be attributed to the research and literature on bullying between peers as well as familial and societal recognition of this form of interpersonal violence. sibling violence is substantially more abundant than literature, research, and family and society recognize. the vast number of labels used to refer to sibling violence (kettrey & emery, 2006) likely makes it difficult to collectively conceptualize violence between siblings as a problematic phenomenon. the lack of one term, or even a few terms, used consistently to refer to sibling violence impedes the process of policy creation. multiple labels make it much harder to reach a consensus as to what behaviors policies should address. confounding the issue of having multiple labels, a variety of definitions have been used to refer to sibling violence. although no overarching definition of sibling violence currently exists, this construct has been defined as physical behaviors directed toward a sibling with an intent to harm and that are reproduced over time (caffaro, 2014). perkins and colleagues (2017) extend caffaro’s definition to include emotional/psychological behaviors. the lack of a clear-cut comprehensive definition prohibits the creation of policy addressing sibling violence. without a precise definition, sibling violence policy cannot be targeted toward particular behaviors; this would lead to an inadequate policy that is likely unenforceable due to ambiguity. familial and societal normalization of sibling violence in addition to the many labels and lack of an accepted definition of sibling violence, policy creation is impeded by family and societal views of sibling violence. caspi (2012) notes that problematic interactions between siblings can include aggressive behaviors that are often dismissed. caspi also states however, that “the mistaken belief that sibling perkins & grossman/physical & emotional sibling 147 violence is not harmful further minimizes it” (p. 11) when families do not register highly conflictual sibling interactions as warranting concern and attention. in a study of sibling abuse survivors, wiehe (1997) found that some parents of survivors denied, disbelieved, minimized, ignored, showed indifference, viewed as sibling rivalry, and normalized sibling abuse. in some cases, parents even joined in the abuse as well as blamed the victim and ridiculed the survivor for the abuse. parents may dismiss violent behaviors that they view as normative due to experiencing similar behaviors with their own siblings in childhood. parents may also have a schema about sibling relationships that allows for more violent behaviors between their children. this may be reinforced by societal dismissal of violent behaviors between siblings as problematic. phillips, phillips, grupp, and trigg (2009) argue that, along with parents, mental health professionals, teachers, and other adults should know that physical and emotional violence between siblings can have negative consequences. they argue that often these individuals do not stop negative behaviors because they view sibling violence as “a natural and normal part of sibling relationships” (p. e13). phillips and colleagues (2009) also note that parents, professionals, and even children and adolescents may dismiss violence between siblings due to its lack of inclusion as a component of family violence as determined by the u.s. department of justice. parents and professionals are individuals in positions of power who dictate the discourse on sibling violence and therefore, if they ignore or dismiss violent experiences between siblings, children and adolescents likely will too (kettrey & emery, 2006). the role of social work social work has a responsibility to help children, a group often viewed as marginalized, by addressing physical and emotional sibling violence. arguably, four of the six core ethical principles of the national association of social workers (nasw, 2018) are directly related to why social work should be involved in addressing physical and emotional sibling violence: • social workers’ primary goal is to help people in need and to address social problems (nasw, ethical principles, 2018, par. 2): children victimized by a sibling are in need of assistance, and given the prevalence of this form of violence, this is clearly a social problem. • social workers challenge social injustice (nasw, ethical principles, 2018, par. 3): social workers need to be advocates for change in helping children, as a vulnerable group, in prevention and intervention efforts to address sibling violence given the societal normalization of this form of family violence. • social workers respect the inherent dignity and worth of the person (nasw, ethical principles, 2018, par. 4): for social work to ignore sibling violence is to disregard a child’s efforts for self-determination while subsequently failing to help protect a child’s physical and emotional development. • social workers recognize the central importance of human relationships (nasw, ethical principles, 2018, par. 5): if social workers are going to be “partners in the helping process” and use their relationships with children to change the course of sibling violence, then social work needs to be present at advances in social work, spring 2019, 19(1) 148 the table in creating relationships with individuals, families, communities, organizations, and the state in combating physical and emotional sibling violence (nasw, ethical principles, 2018, par. 5). the recognition of violence between siblings through policy promotion and advocacy in social work is meant to be a step toward helping families function in ways that promote positive interactions between all members. dismissing, ignoring, and devaluing sibling violence can have significant consequences for children and adults (wiehe, 1997). it is critical that social workers interacting with clients in any capacity acknowledge and listen when confronted with instances of sibling violence. it is imperative that social workers respect this form of family violence as a valid instance of violence so as not to exacerbate harm and trauma for those who have already experienced it. to dismiss this type of violence is to neglect the experiences of others, as many families and society already do; this is not the role social work should take. we also need to include information about physical and emotional sibling violence in our practice classes so that students are aware of and prepared to respond to this problem appropriately in their work with clients and family systems. further, physical and emotional sibling violence is a social justice issue (perkins et al., 2017; phillips et al., 2009), and efforts by the profession of social work to address this issue are essential. if we wish to help children who are marginalized, unable to speak up regarding their experience of physical and/or emotional violence from a sibling, and involved in a system that oppresses them by discounting the violence they experience, then social work needs to advocate for policy creation. to neglect the creation of policy to address physical and emotional sibling violence for children, adolescents, and adults is to neglect the occurrence of this form of family violence just as the current societal discourse does. future directions toward sibling violence policy it is evident that physical and emotional sibling violence warrants policy consideration due to its substantial prevalence, negative consequences for both children and adults, connection to other forms of familial and societal violence, and misconstrued normalization by families and society. although the various labels and lack of a global definition may pose challenges to policy creation and advocacy, many children and adults deal with the ramifications of sibling violence. further, such challenges existed and were overcome in the creation of policies related to other forms of family violence. there are several ways in which social work can begin efforts toward policy creation to address sibling violence. psychoeducation and family violence interventions that work with parents and families to increase the attention on sibling violence are likely to be beneficial (shadik, perkins, & kovacs, 2013). however, these programs alone are not sufficient to increase the visibility of sibling violence as a problematic issue within families and society. outreach to agencies, organizations, communities, politicians, schools, and others involved in helping to shape and create policies is critical. adults who provide services to children or who influence the programs and policies that affect them need to be aware that physical and emotional sibling violence is a problematic occurrence for millions perkins & grossman/physical & emotional sibling 149 of children and subsequently adults. it is also critical to include the voices of survivors of sibling violence in education and advocacy efforts. this not only empowers survivors but may also help others to understand the impact sibling violence can have on mental and physical health. large-scale efforts, like public service campaigns to educate the public on sibling violence, are likely to increase the knowledge and understanding of various stakeholders as well. once increased recognition of this issue is achieved though advocacy, addressing this form of family violence is likely to be met with less resistance. another avenue in helping social work to create policies to address sibling violence is interprofessional collaboration and advocacy with other professions. if familial and societal discourse egregiously neglects physical and emotional sibling violence as normative (kettrey & emery, 2006; phillips et al., 2009), then collaboration among various professions is not only warranted but essential in creating change through policy creation and advocacy. much of the research related to understanding aspects of sibling violence has been done in sociology, psychology, family science, and to a lesser extent social work. interestingly, however, interventions directly aimed at addressing sibling violence are scant (tucker & finkelhor, 2017). not only can social work build upon these research studies and collaborative efforts to create interventions, but it can take an active part in leading interprofessional collaboration to advocate for, create, and implement sibling violence policies. social work needs to be at the table and leading the call for action to address sibling violence given its determination to challenge systems that oppress and marginalize individuals. unfortunately, the current societal system and discourse oppress and marginalize children and adults who have experienced physical and emotional sibling violence, and that must change. creating policies to address violence between siblings is a step in the right direction toward correcting the current lens of injustice. using the childcare policy perspectives (fox-harding, 1997), perkins and colleagues (2017) also argue that, in addressing and responding to sibling violence, efforts to include children, parents, and the government in creating policies are essential. as evidenced by the policies and laws that directly address child abuse and neglect, interpartner violence, elder abuse, and even bullying between peers, policies can and are created to address violence in a variety of contexts. policy to address physical and emotional sibling violence should not be an exception to this rule. advocates for change have been essential for drawing attention to other types of family violence and leading efforts to enact relevant policies and fighting to ensure gains that have been made are not lost. typically these efforts have not included social workers in the forefront. in addressing the problem of physical and emotional sibling violence, social workers can lead the way. drawing attention to the problem and advocating for such policies provides us with an opportunity to act in accordance with the principles of our profession while having an impact on the lives of countless children, youth, and adults. references administration for community living. 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(2015). bullying in the family: sibling bullying. lancet psychiatry, 2(10), 917-929. doi: https://doi.org/10.1016/s2215-0366(15)00262-x author note: address correspondence to: nathan h. perkins, phd, msw, school of social work, loyola university chicago, 820 n. michigan ave, chicago, il 60611, nperkins2@luc.edu https://doi.org/10.1016/s2215-0366(15)00262-x mailto:nperkins2@luc.edu ____________ elizabeth a. mulvaney, msw, lcsw, clinical assistant professor, school of social work, university of pittsburgh, pittsburgh, pa 15260. rachel jantea, md, ms, assistant professor, division of geriatric & palliative medicine, uthealth mcgovern medical school, texas school of medicine, houston, tx. paula leslie, phd, ma (bioethics), frcslt (uk), ccc-slp (us), senior lecturer, speech and language therapy, university of central lancashire, school of sport and health sciences, preston, lancashire, uk. pamela toto, phd, otr/l, bcg, faota, associate professor, school of health and rehabilitation sciences; mary allias, mpas, pa-c, dfaapa, assistant professor, school of health and rehabilitation sciences; catherine grant, dnp, fnp-bc, assistant professor, school of nursing; victoria hornyak, dpt, gcs, assistant professor, school of health and rehabilitation sciences; julie klinger, ma, center manager, national research and training center on family support, health policy institute; rhaven nelson, bs, research programmer, university center for social and urban research; susan skledar, rph, mph, fashp, professor of pharmacy & therapeutics, school of pharmacy, university of pittsburgh. pittsburgh. kylea covaleski, msw, mph, ches, program associate, jewish healthcare foundation, pittsburgh, pa. rollin m. wright, md, ms, mph, assistant professor, division of geriatric medicine, school of medicine, university of pittsburgh, pittsburgh. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 184-203, 10.18060/23682 this work is licensed under a creative commons attribution 4.0 international license. improving the interprofessional practice, knowledge, and skills of health professions students through an interactive course in gerontology elizabeth a. mulvaney rachel jantea paula leslie pamela toto mary allias catherine grant victoria hornyak julie klinger rhaven nelson susan skledar kylea covaleski rollin m. wright abstract: interprofessional, collaborative health care is the ideal standard in geriatrics. students’ interprofessional practice skills are limited in typical siloed education. an experiential, team-based geriatrics course was designed to improve health professions (hp) students’ knowledge, skills, and attitudes about interprofessional practice. students (n=209) from dentistry, medicine, nursing, nutrition, occupational therapy, pharmacy, physician assistant, social work, and speech-language pathology were assigned to interprofessional (ip) and medical-student only teams. the interprofessional collaborative competency attainment survey-revised (iccas-r) was administered pre and post-course, along with program evaluations. seventy percent of students completed both preand post-surveys. iccas-r scores were analyzed comparing the impact of training for medical students (n=78) on ip teams and remaining hp students (n=58). students rated themselves as improved on all six iccas-r subscales (paired t-tests, p < 0.05). sixty-nine percent rated themselves as better able to collaborate interprofessionally. a competitive team-based learning exercise using gamification was rated as the most authentic skill-building interprofessional activity. experiential learning where students worked with the same team helped to build interprofessional and teamwork skills. findings will be used to improve authenticity of the clinical and teamwork content, increase the use of gamification as a teaching technique, and refine students’ practice of ip teamwork competencies. keywords: interprofessional education, gamification, geriatrics, competency, teamwork population trends in the united states show more people are living to an advanced age and that by 2035 older adults will outnumber children (vespa et al., 2018). u.s. data suggest that 40% of hospital admissions (excluding those under age 1 year) are for people 65 years and older and that they have longer lengths of stay than other demographics (u.s. https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 185 centers for disease control and prevention, 2010). as health care utilization has shifted from inpatient to outpatient settings (national center for health statistics, 2017), older adults have more office-based physician visits than people at other ages (excluding infants under 1 year; ashman et al., 2019). moreover, one third are likely to experience a hospitalassociated disability (covinsky et al., 2011). meeting the needs of older patients and preventing such disability across all settings is advisable in terms of patient outcomes and health care costs. although professionals trained in geriatrics can assist in meeting the needs of older adults, the nation faces a shortage of specialized geriatric practitioners in most health professions, and a lack of geriatric skills and knowledge among other health practitioners (institute of medicine, 2008). the john a. hartford foundation and the health resources and services administration (hrsa) have engaged in strategies to improve workforce capacity over the last decade. the john a. hartford foundation invested in developing specialized scholars and practitioners in three disciplines and concluded it would not be possible to train enough specialized professionals (isaacs/jellinek, 2019). they pushed “that all of the nation’s practicing physicians, geriatric nurses or geriatric social workers who provided care to older adults received geriatrics training in the course of their professional education” (isaacs/jellinek, 2019, p. 4). hrsa (n.d.) continues to make older adults’ needs a focus area for its workforce development initiatives, frequently partnering with universities in this effort. both recognize universities’ role in preparing emerging professionals by assuring they have both geriatric and interprofessional education and collaborative practice (ipe/cp) knowledge and skills. team-based, interprofessional care surpasses care provided by individual health care professionals in both quality and safety (baker et al., 2006; baker et al., 2005; barker, 2007; cerra & brandt, 2015; kohn et al., 2000). interprofessional teamwork skills, like any other ability, need to be targeted directly in education and not left to chance in the workforce (greiner & knebel, 2003; hall & weaver, 2001). the institute of medicine’s (2015) interprofessional learning continuum model suggests that ipe should begin at the undergraduate level, continue in graduate study, and be embedded in continuing professional development. according to the world health organization (2010), “interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (p. 7). a review of ipe-related research suggests that it can promote knowledge, build skills, and positively alter attitudes about ip practice (reeves et al., 2015). there is also a growing body of evidence that ipe might improve collaboration and patient care (reeves et al., 2015). in 2019, the health professions accreditors collaborative (hpac) suggested consensus ipe terminology, definitions, and concepts compatible with existing accreditation guidelines for the 24 health professions that participated in the process. this guidance created a more uniform understanding of ipe/cp while allowing for professionspecific standards or requirements. the hpac (2019) defined “face-to-face, synchronous learning” as “activities where students from one program learn with students from another program or with practitioners representing different professions from their own” (p. 15) and endorsed case discussions, simulations, service-learning, clinical observations, and mulvaney et al./improving ipe 186 clinical rotations as ipe learning modalities. the hpac guide built on the 2011 interprofessional education collaborative (ipec) consensus statement, which was updated in 2016, to promote competency in teamwork over taskwork in order to learn interprofessional skills (ipec, 2016; ipec expert panel, 2011; salas et al., 2008). characteristics of successful health care team training include multiple disciplines teaching and learning together, use of crisis resource management tools, experiential team-based training or simulation exercises that reproduce realistic tasks and problemsolving scenarios, and real-time feedback to the trainee team (chakraborti et al., 2008; hall & weaver, 2001; ipec, 2016; ipec expert panel, 2011; salas et al., 2009). still, it is unclear which aspects or modalities of ipe are most effective in building interprofessional practice (ip) competence (guraya & barr, 2018; reeves et al., 2015). ideally ipe programs demonstrate learner competence and impact on patient care for both students and practicing professionals continuing their development (hpac, 2019; institute of medicine, 2015). to date, most studies and evaluation of university-based ipe/cp involving students are more focused on short-term change in knowledge, skills, and attitudes rather than patient outcomes (brandt et al., 2014). in 2008, this university’s schools of medicine, nursing, and pharmacy created an introductory, experiential ipe curriculum in geriatrics to teach health professions students (hps) about teamwork as they worked in interprofessional groups. by 2018, this effort expanded to include students and faculty from the schools of dental medicine, health and rehabilitation sciences, and social work—a collaborative representing ten professions. the course planning committee hypothesized that placing students in ip teams that completed face-to-face case discussions, simulations, and service-learning would improve their interprofessional competence as they gained knowledge and skills in geriatric practice. method setting and participants the course planning committee which consists of faculty representatives from each discipline (hereafter referred to as “we”) developed a five-day introductory curriculum on geriatrics and interprofessional teamwork in health care for students from ten health professions representing six schools at a university in a midsize, midwest city. the course was sponsored, coordinated by, and housed in the school of medicine. all third-year medical students and fourth-year medical students who missed the course the previous year were required to attend. this was communicated as a curricular expectation. graduate professional students from ten other health professions were invited to participate electively based on curricular considerations from their programs and factors such as student knowledge, student skills, curriculum sequence, clinical responsibilities, and schedule logistics. faculty in each school and/or program recruited eligible students via email or personal communication, alerting them to the opportunity and explaining it. students asked questions, checked with faculty from other courses, and checked with preceptors at clinical/field sites to determine feasibility of participation. participating students included fourth year predoctoral dentistry; second-year doctor of nursing practice advances in social work, summer 2020, 20(2) 187 (dnps) concentrating in family, acute, psychiatric, or nurse midwifery; second-year master’s occupational therapy (ot); fourth-year pharmacy; second-year physician assistant; and first year master’s speech language pathology (slp). october 2018 represented the first year that second-year master’s nutrition students and second-year or advanced standing master’s social work (sw) students specializing in gerontology or integrated health care participated. physical therapy students, who participated in years past were unable to participate during the year of this study. curriculum design two-hundred and nine students participated in the week-long program. one-hundred and seventy-nine completed learning activities with balanced ip teams made up of 4-5 medical students and 3-4 students from the remaining health profession training programs. based on the collective experiences in teaching ip activities, the authors rationalized that by ensuring other health profession students made up approximately half the team, we could optimize the ip experience by interrupting the concentration of power and control over the material that can occur when medical students make up the majority of the team. this resulted in 26 student teams of 8-10 people, 23 of which were interprofessional and three of which were medical student only. each team stayed together for five team-based simulations throughout the week. medical students attended all activities as a requirement for graduation. the experiences of the hp students, who volunteered to take the course and made it interprofessional, varied due to competing academic interests and clinical responsibilities for their respective training programs. most hp students attended at least three days. the original course integrated a geriatrics curriculum with some of the ipe training strategies that are currently endorsed by hpac. consistent with curricular quality improvement, feedback from students and faculty has continued to shape the course annually, along with evolving scholarship in geriatrics and interprofessional training. the course covered geriatrics (i.e. geriatric syndromes, preventive health and wellness, falls, mobility, functional status, pharmacology, dementia, delirium, acute care, depression, anxiety, pain, and advance care planning) and interprofessional teamwork topics (i.e. ip roles and responsibilities, communication, collaboration, and conflict management) in a variety of formats. see table 1. gamification was added to increase interest and investment in learning activities, particularly for students who were required to attend rather than attending electively (biehle & jeffres, 2018; gentry et al., 2019). gamification refers to using elements or features of games to address “real world” challenges or problems, in this case geriatric patient concerns (biehle & jeffres, 2018; gentry et al., 2019). the term often refers to using such elements in association with digitally-based learning; however, it can refer to such elements in face-to-face and simulation activities (gentry et al., 2019), as in this course. ip teams had the opportunity to accrue points for performance on learning activities, compete head to head in activities (is it worth it? activity or hospital survivor), use peer polling feedback through an audience response system, and earn small prizes (candy or gift cards) as well as bragging rights with their peers. mulvaney et al./improving ipe 188 table 1. ipe team learning activities learning activity* description modality team building ice breaker get to know team members & begin to work together through an ice breaker (paper chain exercise) requiring communication & cooperation, introducing concepts related to high-functioning teams. ice breaker game in teams & large group debrief geriatric syndromes review geriatric syndromes (i.e., incontinence, mobility, cognitive impairment) & their impact on care, treatment outcomes, & quality of life in older adults. team engages in problem-based, case-focused learning. brief lecture with facilitated small team discussion & large group debrief geriatric assessment skills fair learn to use 12 of 18 geriatric assessment tools/skills (e.g., phq9, mini-cog, orthostatic hypotension, cam) by rotating to skills stations in 15-minute intervals, receiving a skill card from each for future use/reference at health fairs. skills taught by faculty & trainees from ten professions. see table 2 for list of skill stations. demonstration & rehearsal for each skill health assessment fairs work in ip pairs to assess participants from senior independent & assisted living communities for geriatric conditions using the tools learned at the skills fair. service-learning by applying recently acquired skills long-term care (ltc) site visits visit & interact with residents & providers in three settings within a ltc health care system: a dementia support unit, a rehabilitation therapy room, & an assisted living community. service-learning in conversation with ltc residents & clinicians advance care planning consider & discuss own health care values & priorities to learn strategies for helping patients approach & discuss their health care values & priorities. large & small group discussion is it worth it debate argue the pro or con position on pursuing a specific course of medical treatment for multiple patients considering complex biopsychosocial factors, patient preferences, evidence-based literature, & ethical considerations. case-based simulation of complex multidisciplinary decision-making about a medical intervention with a discussion & live debate between ip small groups geriatric pharmacology apply principles of geriatric pharmacology to a medication regimen review for older patients transitioning between care settings, identifying potentially harmful medications. brief lecture followed by multidisciplinary problem-based case discussion in teams hospital survivor answer questions to safely guide the course of an older patient through a typical acute care hospital experience wrought with risk of iatrogenic complications, prolonged hospitalization, & readmission. team-based case discussion & decision-making using gamification hospital horror visit a simulated older adult’s hospital room, identify potential & existing threats to the patient’s safety, & collaborate to develop patient-centered & systems-based solutions. simulation, problem-based case discussion, & large group debrief dementia positive approach to care learn how brain changes in dementia lead to certain behaviors & communication mishaps. learn how to decode the meaning of these behaviors, communicate, interact with, & counsel people living with brain change. interactive large-group lecture * all activities were team-based unless otherwise noted & represent different types of real-life clinical decisionmaking; faculty facilitators were interprofessionally paired. advances in social work, summer 2020, 20(2) 189 table 2. geriatric assessment skills fair stations skill station citations for skill stations teaching faculty’s discipline aging in place–pre-clinical disability screen fried et al., 1996; kempen et al., 2008 occupational therapy anticholinergic (medication) screening collamati et al., 2016; coupland et al., 2019 pharmacy anxiety (generalized anxiety disorder-7) spitzer et al., 2006 nursing brief language assessment speech-language pathology cognition (mini-cog)* borson et al., 2005; mini-cog©, n.d. geriatric medicine & physician assistant confusion assessment method – delirium inouye et al., 1999 geriatric medicine deprescribing felton et al., 2019; holmes et al., 2006; kua et al., 2019; pruskowski et al., 2019; scott, et al, 2015; thompson, et al, 2019 pharmacy depression (phq2)* kroenke et al., 2001; sheikh & yesavage,1986; shear et al., 2011 internal / geriatric medicine fall risk (timed up and go) quach et al., 2011 physical therapy frailty (frail scale)* morley et al., 2013; rockwood et al., 2005 geriatric medicine hearing & communication (hhie-s) ventry & weinstein, 1983 audiology malnutrition* white et al., 2012 nutrition oral health screening / denture evaluation safety net medical home, n.d. dental medicine orthostatic blood pressure* centers for disease control, 2017 geriatric medicine pain interference weiner et al., 2016 geriatric medicine smart goals* doran, 1981 speech language pathology social isolation gottlieb & bergen, 2010; maguire, 1991 social work vision impairment ophthalmology * indicates required skills station; students assigned to 10 stations; could elect 2 to 4 more. evaluation design & instruments this course evaluation was deemed exempt per institutional irb policy since it examined the effectiveness of and compared instructional techniques and curricula and was designed to evaluate the program not the students. to examine interprofessional skill and competency, students completed a preand post-course interprofessional collaborative competency attainment surveyrevised (iccas-r; schmitz et al., 2017). the iccasmulvaney et al./improving ipe 190 r is a 21-item scale designed for retrospective pre-post learner self-assessment of interprofessional competency attainment and is a modified and separately validated version of the iccas scale developed by mcdonald et al. (2010). the first 20 items use a 5-point likert response scale (1 = poor to 5 = excellent) to measure self-rated ability to perform each item. the last item is a transition item to assess self-rated ability to collaborate interprofessionally compared to the time before the course (1 = worse now to 5 = much better now). responses to this item moderately correlate with pre-post changes in responses to individual items and support learner global insight into impact of an educational intervention (schmitz et al., 2017). to enhance priming effect on interprofessional learning objectives, we administered the pre-portion of the iccas-r prior to the course. we administered the post-portion, along with the transitional item, at course completion. due to the dunning-kruger effect (kruger & dunning, 1999), whereby novices tend to overestimate their abilities, and become more accurate with increasing competence, administering the test in this manner may overestimate pre-course ability and, therefore, underestimate overall change in self-rated ability for individual items. for this reason, we used the transition item, which correlates with pre-post change in self-rating on individual iccas-r items, as a second measure of self-rated change in ability. individual iccas-r items map onto both the canadian interprofessional health collaborative interprofessional competency framework (2010) and the interprofessional education collaborative (ipec, 2016) core competencies for interprofessional collaborative practice. the items can be grouped into subscales for (1) interprofessional communication, (2) interprofessional collaboration, (3) roles and responsibilities, (4) collaboration with patients and families, (5) conflict management and resolution, and (6) team functioning. the scale has been validated by archibald et al. (2014), schmitz et al. (2017), and violato and king (2019) with interprofessional students. in addition to the iccas-r, at post-test, we asked students to indicate which of the learning activities “provided the most authentic (interprofessional) collaborative experience.” demographic data were also collected. data analyses student names were never placed on the surveys to protect privacy; each student was given a unique identifier, and only one administrative staff person had access to information connecting that identifier to a name. that person was not course faculty and did not participate in data analysis. personnel with training in statistical and data analysis who did not have any direct interaction with students or access to student names completed the data analysis. descriptive statistics on age, race, gender, disadvantaged background, and response rate were analyzed. descriptive statistics were generated on iccas-r items by profession. because the number of students in the separate health professions outside medicine was small, paired t-tests compared pre and post ratings of competence on iccas-r items for two groups of students: health profession students (hps) and hp medical students. medical students in non-ip groups were excluded as their learning experience was fundamentally different than students in ip groups. advances in social work, summer 2020, 20(2) 191 results a total of 209 students participated in the 2018 ip geriatrics course with the following professional distribution: 131 medical, 4 dental, 15 nursing, 17 nutrition, 8 occupational therapy, 20 pharmacy, 4 physician assistant, 9 social work, and 1 speech language pathology. physical therapy students typically enroll in the course; there were no participants in 2018 due to schedule restrictions. physical therapy faculty members remained involved as facilitators. one hundred sixty-two students (77%) answered a portion of the demographic questions. please see table 3 for details. thirty-two of the 38 people who disclosed they were males were medical students. thirteen percent (n=21) of the students indicated that they considered themselves as having come from a disadvantaged background, defined as coming from an environment with barriers to attaining skills or accessing education for training as a health professional or from a family with low income; 13% (n=21) did not respond or disclose this information. table 3. descriptive information about students (n=162) n (%) age 20-29 years 120 (74.1%) 30-39 years 19 (11.7%) did not respond/disclose 23 (14.2%) gender female 77 (47.5%) male 38 (23.5%) did not respond/disclose 47 (29.0%) race / ethnicity african american 11 (6.8%) asian 18 (11.1%) caucasian 105 (64.8%) latinx 4 (2.5%) mixed 3 (1.9%) did not respond/disclose 25 (15.4%) location “grew up” suburban 94 (58.0%) rural 31 (19.1%) urban 15 (9.3%) did not respond/disclose 22 (13.6%) as presented in table 4, descriptive statistics and paired t-tests of pre and post iccasr responses examined change in self-rated competency for hps (n=58) and medical students on ip teams (n=78). analysis of the surveys using t-tests (p < 0.05) for each of the six iccas-r subscales indicated that both medical students and hps rated their interprofessional competency greater after completing the week’s activities. hps rated themselves as having improved skills on all 20 items with statistical significance at < 0.05. mulvaney et al./improving ipe 192 an item-by-item analysis of each iccas-r item using t-tests resulted in only two items out of the 20 where the mean self-rating of medical students was not significantly higher: (1) including the patient/family in decision-making, t(78)=0.830, p=.205; and (2) taking into account the ideas of other ip team members t(78)=1.524, p=.066). table 4. pre – post self-rated ip competence (iccas-r subscale comparison) hp* medical students hp students iccas-r subscale mean change sd t(78) p mean change sd t(58) p ip communication 0.39 0.67 5.17 <.001 0.45 0.73 4.38 <.001 ip collaboration, 0.34 0.84 3.57 <.001 0.47 0.80 4.18 <.001 roles & responsibilities 0.25 0.70 3.18 0.001 0.56 0.73 5.54 <.001 collaboration with patients & families 0.33 0.74 3.93 <.001 0.60 0.63 5.54 <.001 conflict management & resolution 0.21 0.78 2.36 0.011 0.40 0.66 4.33 <.001 team functioning 0.28 0.79 3.14 0.001 0.68 0.86 5.63 <.001 *hp=health professions descriptive statistics were generated for each iccas-r item if the profession had five or more student responses. post-test mean scores represented higher self-rating in ip skills after the week’s activities for each profession except for two items for one profession. dnps reported the only drop in mean (3.92 to 3.73) on a single item, rating themselves lower for actively listening to ip team members’ ideas after the experience. nutrition students indicated no change (mean 3.57) in their ability to work effectively with ip team members to enhance care after the experience. for a more global impression of students self-rated skills, we used the iccas-r single transition item “compared to the time before this course, would you say your ability to collaborate interprofessionally is: worse now, somewhat worse now, about the same, somewhat better now, or much better now.” sixty-nine percent of students (62% medical, 94% pharmacy, 75% dnp, 100% sw, 83% ot, 62% nutrition) rated themselves as somewhat or much better able to collaborate interprofessionally after the course. no students rated themselves as worse or somewhat worse. students were asked to identify which of the learning activities “provided the most authentic collaborative experience” (see table 5). a competitive team-based learning game entitled “hospital survivor” was rated as the most authentic skill-building interprofessional activity by 33% (n=45) of the students. this was followed by the “health assessment fairs” (n=24, 18%) and “most of the activities” (n=23, 17%). the health assessment fairs were a service-learning activity where students used skills learned during the geriatric assessment skills fair [table 2] to screen older adults nine 9 senior communities for various health needs and provide them with information to take to their primary care provider. further breakdown by professions with 5 or more responses indicated that the medical (n= 23, 29%), pharmacy (n=11, 61%), dnp (n=3, 38%), and nutrition (n=6, 38%) students selected “hospital survivor” as the most authentic. sw (n=2, 40%) indicated that most of the activities were authentic, and the health assessment fairs (n=2, 40%) as the most authentic. advances in social work, summer 2020, 20(2) 193 only a small group of medical students indicated that they found none of the experiences as authentic (n=11, 14%). table 5. health profession students’ most authentic ip learning experiences activity n (%) medical (n=79) dnp (n=8) nutrition (n=16) pharmacy (n=18) sw (n=5) team-building ice breaker 3 (4%) 1 (13%) 1 (20%) is it worth it 10 (13%) 1 (13%) 1 (6%) 2 (11%) hospital horror 10 (13%) 1 (13%) 2 (13%) hospital survivor 23 (29%) 3 (38%) 6 (38%) 11 (61%) health assessment fairs 13 (16%) 1 (13%) 4 (25%) 2 (11%) 2 (40%) most of the experiences 9 (11%) 1 (13%) 3 (19%) 3 (17%) 2 (40%) none of the experiences 11 (14%) ot and slp students not included as there were <5 useable responses discussion evaluation of this ip geriatrics course suggests that students, overall, rated themselves as more competent to practice interprofessionally after participating in ip team-based learning activities related to geriatrics—a finding consistent with faculty hypotheses prior to the training and student reports from previous years of this program. this was true when the data were analyzed along the iccas-r subscales and when analyzed item-by-item, except for two items for medical students: including patients/families in decision-making and taking into account the ideas of other ip team members. for those items, the medical students still rated themselves as improved, but these changes were not significant. it should be noted that medical students reported significant improvement in the iccas-r competency subscales (interprofessional communication and collaboration with patients and families) in which these two individual items were grouped, suggesting that the lack of significant improvement on these two specific items did not negatively impact overall perceived improvement in competence. the amount of pre-test to post-test change appears to be slightly greater for the remaining health professions students than for the medical students. violato and king (2019) suggest that effect sizes using the iccas are likely to be greater in students without interprofessional experience than those who have interprofessional experience during their training prior to using the tool. our study seems to reveal the opposite. based on our knowledge of students’ curricula related to interprofessional and clinical experiences, our medical students seem to have had less ip experience than students in the other health professions. even so, they report significant gains in perceived interprofessional competence that were only slightly less than the students who seem to have more ip experience. sixty-two percent of medical students reported that they perceived themselves as somewhat or much better able to collaborate after the course, the same percentage as students from nutrition. medical students’ and health professions students’ comments to an open-ended question about the week suggest that each group started the week with a different mulvaney et al./improving ipe 194 understanding of interprofessional practice and may have gained something different from it. the results may reflect these differences in the student groups. the hp students from the schools of nursing, pharmacy, rehabilitation sciences, dentistry, and social work volunteered to participate in the program; they rearranged busy academic schedules to complete the week’s activities, suggesting high motivation and interest in ip practice. most, like social workers (with generalist field placement) or dnps (with past work experience), already had ip clinical experience before the course, which may have primed them for how to use the week to grow their ip skills. as one social work student commented, “the biggest take away for me was that i have an important contribution to make to the team, especially around psychosocial factors and community, plus i feel more confident in my ability to contribute to the team.” on the other hand, the interprofessional geriatrics course is required for medical students to graduate. the course takes place near the midpoint of third year in between clerkship (clinical) experiences. many medical students indicate reticence to be pulled back into the classroom from clinical, direct patient care experiences which seem more important, authentic, and relevant to their training. as a result, some medical students report starting the course with lower expectations for its value and lower motivation to build ip skills. these contextual realities may exert some influence over medical students’ attitudes and explain the somewhat smaller effect sizes for change in the medical students’ self-rating. faculty decisions about which of the health profession students to invite as participants may also have contributed to the difference in the two groups of students. baseline skills and knowledge were considerations, in addition to ip experience, when faculty selected students. in social work, for example, faculty made the decision that students should be familiar with medical terminology and settings or gerontological or health care social work based on expectations for the learning activities. faculty thought this would make the learning activities more meaningful and enable them to participate more fully. this led to only inviting students pursuing integrated health or gerontology certificates who had completed their generalist course work (typically done in the first year of social work training). in discussion with course faculty after the experience, integrated health students (i.e., social work students learning how to integrate behavioral health intervention into health care settings) anecdotally reported gaining more new knowledge about geriatrics; gerontology students stated that they added more knowledge depth and nuance in some areas. even though more advanced social work students were selected, they reported struggling to participate in the geriatric pharmacology case activity and is it worth it debate. they also reflected verbally that they might not have been prepared to participate at the beginning of their training as they did not yet know the social work role in health care. as social work continues to participate, faculty will need to elicit further feedback to determine which students can benefit the most and whether students earlier in their social work education or in other specializations, such as mental health, might benefit. faculty in the other professions must also continue to evaluate student selection criteria, and the course planning team will need to continue to modify the activities to be inclusive of any new professional students that join. advances in social work, summer 2020, 20(2) 195 the strengths of this study include the design of the educational intervention used to teach ip teamwork competency, the deliberate balanced interprofessional team structure, the use of a validated, reliable and widely used tool to measure change in interprofessional competency, and the ip teamwork of its faculty to design the course and interpret the evaluation results. the design of the curriculum—using real-life case exemplars that students would face in multiple experiential formats and service-learning activities that moved students outside the classroom—was deliberate and meant to address the apprehension the medical students expressed about classroom-based learning. one-third of students rated a gamified, case-based, team simulation exercise entitled “hospital survivor” (see table 1) as the most authentic interprofessional learning experience. this was followed by the health assessment fairs (16% of students), a service-learning activity. inclusion of such activities is not only supported by hpac (2019), it is consistent with educational theory about creating scaffolding that reinforces the process of transferring learning from training settings to real-world settings (roumell, 2019). we cannot determine based upon our evaluation if it was the gamification features that contributed to the high rating of “hospital survivor.” we believe the team composition, attempting to have only about half of the students from medicine with 3 to 5 professions per team, resulted in students’ valuing interprofessional teams and the improvement in ip competency. this is consistent with lairamore et al.’s (2018) work that suggests smaller ipe team composition and not having every profession represented produces a greater recognition by learners that they need 1) exposure to the expertise and contributions of multiple health care disciplines in patient care and 2) teamwork to comprehensively address the challenges of complex patients. additionally, the team composition also seemed to address perceived stereotypes or expectations that physicians would be the leaders in patient care, particularly in acute care. for example, during the is it worth it exercise, teams realized that the physician is not always the best person to lead on specific patient needs and features, sometimes choosing one of the other professionals to lead. while there has been little attention to power perceptions in ip learning, wharton and burg (2017) suggest, that training like this can lead to the more egalitarian, shared leadership philosophy of the high-functioning ip team. one strength of using the iccas-r is that it covers most, if not all, domains or characteristics of high-functioning teams. administration of the iccas-r at the outset of the course may have served to “prime” students’ learning by introducing them to core concepts, characteristics, and competencies associated with high-functioning teams. this evaluation cannot determine if it did that, in part, because the faculty also communicated these concepts with the opening ice-breaker exercise and as they explained the week’s activities, encouraging students to try to form their own high-functioning teams. the authors, who are also course planning committee members, wove bits of expertise from every discipline into each ip activity to emphasize the interdependent nature of highfunctioning teams. limitations we acknowledge several limitations. medical students were required to attend while health professions students volunteered. students also came with a range of real-life mulvaney et al./improving ipe 196 clinical and interprofessional team experiences that we did not measure in advance. the medical students, for whom the course was initially created and required, may have had less clinical and interprofessional experience to inform their ip behavior and performance in this course; social work and nurse practitioner students may have had more. this may make the comparisons less valid. further complicating the interprofessional team dynamic is the traditional hierarchical culture of medicine where the physician has often been the default leader charged with decision-making authority. this traditional culture, which is shifting slowly, probably continues to exert some influence on students’ understanding of patient care and health-care decision-making, despite changes in both educational and clinical settings. using an instrument that relies on the student’s self-reported competence may also be a limitation. self-report, especially among high achievers, can skew to overly confident subjective estimates of ability. furthermore, the authors wonder about the students’ level of familiarity with the competencies and the sophisticated ip terminology used on the questionnaire they were completing. perhaps the newness of or unfamiliarity with these ip concepts at the beginning of the week attenuated the confidence bias students might have otherwise exhibited. these points suggest we may wish to use the iccas-r retrospectively rather than as a tool to prime students. in analyzing the results and running the high number of tests, we are unable to rule out type i error (rejecting the null hypothesis when the null is actually true). we also acknowledge the short period that we gave students to learn and practice interprofessional competencies and the fact that they did so outside the realm, reality, and highstakes of actual patient care. transfer of learning into clinical practice will take more than four 8hour days and five ip team experiences to achieve mastery in interprofessional team competencies. still, this experience is an excellent foundation on which to build future clinical ipe experiences. clearly there is less urgency to achieving mastery in a low-stakes, simulated learning environment. simulation is intended to facilitate learning and practice of high-stakes skills in low-risk environments, in preparation for real-world settings, giving students a chance to make mistakes and grow without harming patients. simulated, casebased learning can help students understand each discipline’s role and expertise and realize that no single profession can deliver high quality patient care without collaborating with professionals from different disciplines. future evaluation of the course could examine if the ip learning in this short-term experience transfers into greater competence once the experience is over. conclusion we developed a highly experiential five-day geriatrics course with an integrated interprofessional education curriculum for health professions students from 10 disciplines who worked in 23 interprofessional teams to complete multiple patient care simulations. the simulations were carefully created to emphasize the contributions and expertise of every discipline and to force team members to rely on each other’s expertise to provide optimal patient care. the results of a pre-test/post-test survey on interprofessional team competencies showed that all students made significant gains in all 6 subscale domains. students from social work, nurse practitioner, pharmacy, and rehabilitation sciences (ot, advances in social work, summer 2020, 20(2) 197 slp, nutrition) seemed to have more clinical and interprofessional health care team experience at the time of the course and reported a slightly greater degree of improvement in their ip competency levels than third year medical students. medical students, the majority of the students, also significantly improved in all subscale domains of ip competence. based on this evaluation, faculty will increase the authenticity of future 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(2010). framework for action on interprofessional education & collaborative practice. author. https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng. pdf?sequence=1 author note: address correspondence to elizabeth mulvaney, school of social work, university of pittsburgh, 2117 cathedral of learning, pittsburgh, pa 15260. email: eam65@pitt.edu acknowledgement: we are grateful for the leadership, administrative and financial support needed to implement this course provided by the university of pittsburgh office of medical education, the school of medicine, john mahoney, md (associate dean of the office of medical education), and the division of geriatric medicine. we are also grateful for the support and volunteer faculty provided by the university of pittsburgh’s schools of pharmacy, nursing, social work, and health and rehabilitation sciences. https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf?sequence=1 mailto:eam65@pitt.edu _________ katherine m. mccarthy, phd, lcsw, associate professor, and e. susana mariscal, phd, professor, indiana university school of social work, indianapolis, in. elizabeth a. wahler, phd, msw, affiliated research faculty and previous director of the school of social work, university of north carolina, charlotte, nc. nina c. johnson, mssw, doctoral student, indiana university school of social work, indianapolis, in. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 442-454, doi: 10.18060/27149 this work is licensed under a creative commons attribution 4.0 international license. does proactive stress management increase msw students’ training satisfaction and substance misuse practice readiness? katherine m. mccarthy e. susana mariscal elizabeth a. wahler nina c. johnson abstract: social work educators aim to increase the goodness of fit between student preparation and the needs of the community. because working with individuals with substance use disorders (sud) can be emotionally challenging, training msw students to do this well does require not only development of skills and knowledge but also a capacity to maintain personal wellness. the purpose of this study is to better understand how wellness strategies affect msw students’ preparation. this study examined two strategies to maintain wellness used by msw students, pro-active stress management and classmate support network, and their relationship to training satisfaction and student readiness to assist clients struggling with substance use. thirty-three msw students in the final month of their degrees completed program evaluation surveys in spring and summer 2020. we conducted linear regressions to assess how proactive stress management and classmate support network contributed to student satisfaction and practice readiness. while both proactive stress management and supportive classmate networks were significantly predictive of training satisfaction, only pro-active stress management also predicted several measures of student readiness to address substance misuse. findings highlight the importance of student wellness in preparing students for practice, particularly the value of fostering student capacity for proactive stress management. keywords: msw students, social work education, wellness, substance misuse social workers in many practice settings are prone to burnout, secondary traumatic stress, and compassion fatigue (shepherd & newell, 2020; travis et al., 2016; wilson, 2016), particularly when working with individuals who have substance use disorders (baldwin-white, 2016; tartakovsky & kovardinsky, 2013). the chronicity of substance use disorders, risk of client relapse or overdose, and high rates of trauma and abuse experienced by individuals with substance use disorders (cosden et al., 2016; fahy, 2007; gielen et al., 2012) exacts a heavy emotional toll on their social workers. msw students working with clients who misuse substances may face an even higher risk of vicarious trauma than those working in other fields (cosden et al., 2016). workforce shortages and developing a skilled workforce to address substance misuse have long been a concern in the united states (hoge et al., 2013), and is expected to continue to be a growing concern due to the increase of rates of substance misuse observed with the covid-19 pandemic (horigian et al., 2021). it is essential that social work education adequately prepares students for this work and for strong, sustained, and balanced growth, increasing their predisposition for longevity in the field. about:blank mccarthy et al./msw student wellness 443 vicarious trauma and the need for self-care although social workers, including those serving individuals who struggle with substance misuse, are in positions where they could be at great risk of encountering distress-inducing situations, the social work code of ethics states …social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interest of people for whom they have a professional responsibility. (national association of social workers [nasw], 2021, ethical standards, 4.05) to assist clients, social workers are expected to maintain sufficient personal wellness and prevent distress from interfering with their work. however, vicarious trauma is a serious risk for social workers in substance use disorder treatment settings (gielen et al., 2012), and vicarious trauma not only impacts the professional self but can also impact the social worker’s personal functioning (ashley-binge & cousins, 2020). self-care is one strategy for maintaining social workers’ personal wellness, and recent literature emphasizes self-care as a crucial part of the social work role (willis & molina, 2019), so much so that it was recently added to the revised national association of social workers (nasw) code of ethics (nasw, 2021). self-care can protect social workers from the hazards of burnout, compassion fatigue, and vicarious trauma (martin et al., 2020). social work education and student wellness there is a clear need to build capacity around social work students’ strategies for affective regulation, empowerment, and stress management that can support their ethical and competent practice as well as their personal wellbeing. this is particularly important to build a skilled, sustained, and growth-oriented workforce to effectively address substance use disorders. accrediting standards promoted by the council on social work education recognize that self-regulation is a skill that social work students are expected to gain and demonstrate (cswe, 2015). the first social work competency articulates the need for students to manage their personal reactions, noting graduating students must be able to “use reflection and self-regulation to manage personal values and maintain professionalism in practice situations” (cswe, 2015, p. 7). not only are social work students expected to manage emotional reactions sufficiently well to earn the degree, but this skill also helps them navigate school if gained earlier in their educational process, since the demands of graduate school can be difficult to balance (diebold et al., 2018). for example, a recent study of graduating msw students found that feelings of being overwhelmed and stressed frequently interfered with student learning in field placement. in fact, personal distress was identified as a more frequent barrier to learning than concerns about learning opportunities, supervisors, class concerns, or agency issues (grady et al., 2020). variation in privilege can also contribute to differential experiences of personal distress. food insecurity is correlated with impaired academic performance (martinez et al., 2020). racially minoritized individuals and students on financial assistance are more advances in social work, summer 2024, 24(2) 444 likely to experience food insecurity (weaver et al., 2020). students who have experienced more trauma may experience more impaired wellbeing and greater likelihood of secondary traumatic stress, but also demonstrate resilience (bishop et al., 2024). covid-19 also exacerbated student mental health distress, access to resources, and capacity for learning (apgar & cadmus, 2022; cummings et al., 2023; scheffert et al., 2021). assisting students with managing stress and self-regulation can improve all students’ learning as well as their ability to practice as social workers in the substance use disorder field. pro-active stress management skills are intentional efforts to be cognizant of personal stress level and take steps to reduce it. effective stress management techniques can help to decrease anxiety, depressive symptoms, and enhance overall emotional well-being (benjet, 2023). o’neill et al. (2019) found that social work students who engaged in daily self-care practices experienced less perceived academic stress. social work students who perceive adequate self-care also report greater personal wellbeing (bishop et al., 2024). classmate support networks are the social connections a student has with their peers that can help them manage challenges. student peer networks contribute to a sense of community and enjoyable classroom learning experiences, which can ease stress (grady et al., 2020; grady et al., 2014; hunt et al., 2012) and student compassion fatigue decreases when students communicate their distress to peers (knight, 2010). both proactive stress management skills and classmate support networks may contribute to msw student capacity to maintain wellness. how proactive stress management skills and classmate support networks relate to student readiness to assist individuals struggling with substances has not been explored. thus, this study explores the relationship between student wellness indicators (proactive stress management and classmate support networks), student perceived readiness to assist clients misusing substances, and student satisfaction with their msw training. this study’s research questions are, for msw students enrolled in a mental health and addictions curricular area: 1. does a relationship exist between proactive stress management and perceived readiness to assist individuals who misuse substances (e.g., role adequacy, role legitimacy, and role support)? 2. does a relationship exist between proactive stress management and training satisfaction? 3. does a relationship exist between classmate support and perceived readiness to assist individuals who misuse substances (e.g., role adequacy, role legitimacy, and role support)? 4. does a relationship exist between classmate support and training satisfaction? methods this quantitative study examined the relationship between student wellness, readiness to assist clients who misuse substances, and training satisfaction. this study used a convenience sample consisting of msw students entering a specialized mental health and addictions-related curricular area in the fall 2019 semester at a midwest public school of social work. fifty-five msw students enrolled in this curricular area were invited to mccarthy et al./msw student wellness 445 complete a program evaluation survey at the end of their final semester. the survey was anonymous and distributed online through qualtrics. students responded to closed-ended questions (e.g., likert scales) about their tendency to monitor and address their stress, their connection with classmates, their readiness for practice, and their satisfaction with their msw education. regression analysis was used to determine potential relationships between variables. since the original data collection was done for program improvement purposes, no identifying information were collected. the university’s institutional review board reviewed the study procedures and identified minimal risk to the participants, qualifying this research as exempt from further federal regulation by the federal policy participants thirty-three out of 55 invited msw students completed the survey, representing a 60% response rate. the mean age was 30.58 years (range of 22-56 years). most students identified as white (n=24, 73%) and cisgender female (n=28, 75%). these demographics are similar to the university’s msw population which is 72% white and 88% female. an intention to pursue a clinical social work license after graduation was reported by 90.1% of these students. instruments student wellness two aspects of student wellness are considered in this study: proactive stress management and peer support. pro-active stress management scale. pro-active stress management involves awareness of personal stress and taking steps to reduce it. the authors developed a statistically reliable scale to assess student tendency to reflect on their stress and actively engage in self-care, creating questions from literature on needed social work self-care skills (lee & miller, 2013; willis & molina, 2019). students were asked to use a 0 to 10 scale to respond to the following questions: “how knowledgeable are you about how to address the stress that may come with being a social worker?,” “how often do you monitor your levels of wellness (physical, emotional, mental, social, spiritual)?,” “how often do you take proactive steps to address personal wellness needs (physical, emotional, mental, social, spiritual)?,” “how aware are you of your personal reactions to internship or social work challenges?” higher numbers indicated greater amounts (range = 5.25-10, m = 8.061, α = 0.835). exploratory factor analysis of the proactive stress management scale was conducted to demonstrate reliability of this measure using principal components and direct oblimin rotation to assess the underlying structure of the scale. four criteria were used to determine the appropriate number of components to retain: eigenvalue, variance, scree plot, and residuals (watson, 2017). the results of these assessments indicated that one component should be retained, accounting for 67.94 % of the variance. all variables had positive loadings ranging from .705 to .900, indicating all questions correspond to proactive stress management. see appendix a. advances in social work, summer 2024, 24(2) 446 classmate support network scale. the classmate support network is the extent to which students rely upon each other to manage challenges. the authors used three questions to measure quality of students’ classmate support networks: “i work well with my classmates,” “my classmates encourage and support me,” and “i am likely to reach out to my classmates in the future.” these questions were informed by lee and miller’s (2013) self-care framework for social workers, which describes the need to access professional support, including peer support. each question was measured on a 7-point likert scale ranging from 1 (strongly disagree) to 7 (strongly agree; range = 5-7, m = 6.365, α = 0.786). again, exploratory factor analysis of the scale was conducted, which indicated that one component should be retained accounting for 70.37% of the variance. all variables had positive loadings ranging from .753 to .898, indicating that all questions correspond to classmate support. see appendix b. satisfaction with training one question measured students’ satisfaction with training to address issues of substance misuse, “please describe your satisfaction level with your education and training to assist clients with substance use disorders between 0 and 100, with 0 meaning ‘unsatisfied’ and 100 meaning ‘extremely satisfied’” (range = 20-100, m=69.39). readiness for practice in 2003, watson and colleagues developed the drug and drug problem perception questionnaire (ddppq), as an adaptation of a comparable scale around alcohol concerns (aappq; cartwright, 1980). the retested 20-point scale was used (watson et al., 2007) to examine student attitudes towards individuals abusing substances, with the word “drug(s)” replaced with “substance(s)” per the recommendation of previous researchers who adapted the scale for msw students (senreich & straussner, 2013). three subscales were used: the role adequacy subscale assesses an individual’s experience of being able to perform effectively as a substance misuse counselor, the role legitimacy subscale measures the individual’s conviction of their right to be in a counselor role, and the role support subscale measures the experience of support felt by the individuals from supervisors and colleagues (watson et al., 2007). all items were measured on a scale of 1-7, with items being summed for the total subscale score. higher scores indicated higher levels of role adequacy, legitimacy, and support. in this study, role adequacy mean was 5.823 and had strong internal consistency (range = 3-7, α = 0.945); role legitimacy mean was 5.439 and had adequate internal consistency (range = 3-7, α = 0.767); and role support mean was 6.1 and had strong internal consistency (range = 4.33-7, α = 0.907). analysis factor analyses were conducted to examine the underlying structure of the two scales developed for this study: proactive stress management and classmate support network scales. linear regressions were conducted to assess if there were associations between readiness for practice and proactive stress management and/or classmate support network mccarthy et al./msw student wellness 447 and whether there were associations between training satisfaction and proactive stress management and/or classmate support network. assumptions for linear regressions were assessed and met, including linearity, homoscedasticity, residual normality, no multicollinearity, no autocorrelation, and independence (mertler & vannatta, 2013). a sensitivity analysis was conducted to determine that an outlier was not influencing results. spssv27 was used for the analysis. results linear regression analyses assessed if there were relationships between the wellness variables (proactive stress management and classmate support) and the outcome variables training satisfaction and readiness for practice (role adequacy, role legitimacy, role support). the bonferroni correction (mertler, & vannatta, 2013) was used to ensure that power was not inflated with multiple linear regressions and a significance criterion of .0125 was established. proactive stress management has significant positive associations with role adequacy with β = .489 (t=2.978, p=.006), role support with β = .553 (t=3.555, p=.001), and training satisfaction, β = .610 (t=4.620, p<.001). indicating that students who reported higher levels of proactive stress management tended to report higher levels of role adequacy (effective role performance) and role support (perceived support in role from supervisors and colleagues). students who reported higher proactive stress management tended to report also higher levels satisfaction with their msw training. proactive stress management was not significantly associated with role legitimacy. there were no significant associations between classmate support network and student readiness for practice (role adequacy, role support, role legitimacy), or training satisfaction. see table 1 for specifics. table 1. linear regression estimates proactive stress management classmate support b se b β b se b β training satisfaction 10.681 2.312 .610* 8.929 4.187 .282 readiness for practice role adequacy .386 .130 .489* -.031 .235 -.022 role legitimacy .169 .161 .193 .142 .291 .090 role support .333 .094 .553* .044 .170 .040 * significance identified at the 0.0125 level discussion the aim of this study was to identify if proactive stress management and supportive classmate networks, two indicators of msw student wellness, were related to student readiness to assist clients struggling with substances and/or msw training satisfaction. students who reported proactive stress management use reported feeling more prepared to work with individuals who misuse substances, as they reported increased confidence in their ability to perform effectively in the substance use disorders (sud) field and higher levels of support from supervisors and colleagues in their roles at their internships. advances in social work, summer 2024, 24(2) 448 however, students who felt more connected to their classmates were not necessarily more prepared for this work. these findings highlight two important points. first, using stress management skills intentionally can help students maintain the interest and energy needed to learn and invest in their field experiences. student capacity to reflect upon and intentionally manage personal stress could assist them in feeling confident and supported in assisting individuals struggling with substances. our findings corroborate literature that indicates that by supporting student development of self-care strategies, social work programs can strengthen students’ overall wellness, reduce their level of academic stress, and improve their work with clients (cuartero & campos-vidal, 2019; diebold et al., 2018; newell & nelson-gardell, 2014; o’neill et al., 2019). although our findings suggest that these stress management skills aid students in their practicum placements, future research should examine what factors impact the continued use of stress management skills post-graduation to help social workers maintain longevity in the sud field. future research should also explore additional factors contributing to student perceived readiness, and role legitimacy, in particular. the second major point is that despite evidence that peer connections can be beneficial for msw students (grady et al., 2020; grady et al., 2014; hunt et al., 2012; knight, 2010), this classmate support may not directly relate to students feeling more effectively prepared as social workers. it is possible that students with strong peer networks may connect with peers around pro-education and internship factors, such as sharing resources and support, or they could connect in ways that interfere with learning such as modeling problematic behaviors. thus, while close classmate networks may help students feel connected, they may not lead directly to field readiness. if educators want to nurture peer connections as a method of supporting student efforts, it may be necessary to provide opportunities for students to pro-socially support or model responses to challenging situations. our findings do not corroborate recent studies that suggest that the role of relationships with fellow students, faculty, and supervisors is strongly associated with msw student satisfaction with their training (grady et al., 2020). future research should examine the type and quality of the social network to determine whether there are related factors which could impact training satisfaction and career preparedness. related future research could also explore how msw students perceive their personal wellbeing and to what extent they feel distressed when working with clients who misuse substances. implications considering the positive relationship between msw student proactive stress management and both training satisfaction and readiness to assist clients with substance use concerns, this study highlights the importance of training students in proactive stress management skills. students and social workers who are intentional with monitoring and addressing their stress may feel better prepared to work with clients, especially folks misusing substances. both the explicit and implicit cswe curriculum could serve to hone these skills in msw students to prepare them to navigate challenging situations and be successful in the sud field. some strategies found in the literature include course-based mccarthy et al./msw student wellness 449 efforts to train students in mindfulness (bonifas & napoli, 2014; decker et al., 2019) and goal articulation of stress management techniques (grise-owens et al., 2018). in addition, this study provides preliminary psychometric information, including internal consistency and construct validity, corresponding to the proactive stress management scale and the classmate support network scale. measuring student utilization of active efforts to reduce and manage their stress load could be incorporated into class contexts and guide advisors or students to pinpoint growth areas and/or track progress. validation of these scales with larger samples of social work students would contribute to the literature by providing a practical tool. this could support the 2022 epas (cswe, 2022) which emphasizes self-care for social work students. limitations this study has some limitations to consider: first, it used a small convenience sample of msw students and, second, it used new scales. conducting this study with a larger and more diverse sample of students would increase our understanding of the relationship between proactive stress management and readiness to work with clients who misuse substances, as would evaluating students post-graduation. while the instruments we used were new, the concepts were anchored in the literature and demonstrated adequate psychometric properties. however, data were cross-sectional, so it was not possible to know the time order of the variables tested. while the assumption of independence of observations was met to the best extent of our knowledge, the study did not explicitly investigate potential relationships between respondents where the value of one observation could influence the value of another observation, which could potentially violate this assumption. however, it is worth noting that such violations, while unlikely, are possible. considering the information that was collected, we could not differentiate whether students built these capacities during their time in the msw program or if they came to the program with such varied ability, resources and support to attend to personal wellness, so generalizations are limited. notably, results were gathered in the spring or summer of 2020 as students were also experiencing increasing stressors related to the covid 19 pandemic. during this time, social work students were known to experience additional mental health complaints and familial concerns (cummings et al., 2023), trouble with food access, increased stress, and income loss (apgar & cadmus, 2022). there is also evidence to suggest that the pandemic prompted social work students to try out new coping skills (apgar & cadmus, 2022). so, it is unclear if the multiple new and overwhelming stressors experienced and coping strategies employed when these data were gathered exacerbated the relationship between stress management, readiness, and training satisfaction or if the period of increased isolation altered their experience of their classmate support network. information on students’ exposure to oppression, economic security, access to health insurance, or other indicators of privilege were not assessed or controlled for but can certainly play a role in general student wellness or the development of proactive stress management techniques and should be included in future research. working to strengthen student readiness for enjoyable and effective careers in the sud field should include both enhancing student awareness and proactive capacity to reduce stress and altering social conditions that inequitably overburden some students. advances in social work, summer 2024, 24(2) 450 conclusions this study highlights the positive relationship between msw student proactive stress management skills, readiness to assist clients struggling with substances, and student satisfaction with their msw training. fostering self-awareness and intentional efforts to reduce one’s stress is relevant throughout the curriculum and encourages interactive growth (martin et al., 2020). amidst limited curriculum space, social work education should support students’ intentional efforts to proactively manage their stress and balance their work demands as a key factor in their preparation to effectively treat their clients, particularly clients struggling with substances. future research with a larger sample of students holding varied social identities, learning at different schools across the country, and preparing for careers in assorted social work areas would expand our understanding of msw student training needs around proactive stress management and practice readiness as well as our overall training supports to foster msw student personal wellbeing. references apgar, d., & cadmus, t. 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(2016). identifying, preventing, and addressing job burnout and vicarious burnout for social work professionals. journal of evidence-informed social work, 13(5), 479-483. author note: address correspondence to katherine m. mccarthy, indiana university school of social work, indianapolis, in, 46202. email: mccartka@iu.edu https://doi.org/10.1080/07481756.2017.1336931 https://doi.org/10.1080/07481756.2017.1336931 https://doi.org/10.1080/07448481.2019.1600522 https://doi.org/10.1080/07448481.2019.1600522 https://doi.org/10.1093/sw/swy049 https://doi.org/10.1093/sw/swy049 https://doi.org/10.1080/23761407.2016.1166856 https://doi.org/10.1080/23761407.2016.1166856 mailto:mccartka@iu.edu advances in social work, summer 2024, 24(2) 454 appendix a. pro-active stress management scale on a scale of 0 to 10, with 0 meaning "not at all" and 10 meaning "extremely knowledgeable," how knowledgeable are you about how to address the stress that may come with being a social worker? 1. how knowledgeable are you about how to address the stress that may come with being a social worker? 0 not at all 1 2 3 4 5 6 7 8 9 10 extremely knowledgeable on a scale of 0 to 10, with 0 meaning "never" and 10 meaning "regularly," how often do you monitor your levels of wellness (physical, emotional, mental, social, spiritual). 2. how often do you monitor your levels of wellness (physical, emotional, mental, social, spiritual)? 0 never 1 2 3 4 5 6 7 8 9 10 regularly on a scale of 0 to 10, with 0 meaning "never" and 10 meaning "regularly," how often do you take proactive steps to address personal wellness needs (physical, emotional, mental, social, spiritual). 3. how often do you take proactive steps to address personal wellness needs (physical, emotional, mental, social, spiritual)? 0 never 1 2 3 4 5 6 7 8 9 10 regularly on a scale of 0 to 10, with 0 meaning "not at all” and 10 meaning "highly aware," how aware are you of your personal reactions to internship or social work challenges? 4. how aware are you of your personal reactions to internship or social work challenges? 0 not at all 1 2 3 4 5 6 7 8 9 10 highly aware appendix b. class network scale indicate how much you agree or disagree with each statement. 1 st ro ng ly d is ag re e 2 d is ag re e 3 so m ew ha t d is ag re e 4 n ei th er a gr ee no r d isa gr ee 5 so m ew ha t a gr ee 6 a gr ee 7 st ro ng ly a gr ee 1. i work well with my classmates 1 2 3 4 5 6 7 2. my classmates encourage & support me 1 2 3 4 5 6 7 3. i am likely to reach out to my classmates in the future 1 2 3 4 5 6 7 _________ shannon lane, phd was an associate professor at sacred heart university and is now an associate professor at wurzweiler school of social work, katharine m. hill, phd, is an associate professor at the university of st. thomas. jason ostrander, phd is an assistant professor at sacred heart university. jenna powers, msw, is a doctoral student at the university of connecticut. tanya rhodes smith, msw, is the director of the nancy a. humphreys institute for political social work at the university of connecticut. mary hylton, phd is an associate professor at the university of nevada reno. copyright © 2019 authors, vol. 19 no. 1 (spring 2019), 86-105, doi: 10.18060/22614 this work is licensed under a creative commons attribution 4.0 international license. creating a culture of voting in direct and generalist practice: training field instructors shannon lane katharine hill jason ostrander jenna powers tanya rhodes smith mary hylton abstract: social workers have an ethical responsibility to be engaged in policy change, regardless of their practice area or specialization. voter engagement and the importance of political power through voting is often overlooked in the literature as a valid and important component of social work practice. creating a culture of nonpartisan voter engagement in practice settings can help empower individuals who have been historically and intentionally disenfranchised from our electoral system. training for field instructors, faculty, and field staff is a key aspect of voter engagement in social work education. unfortunately, social work education is unlikely to include substantive content on voter engagement or its connection to social work practice and impact. this article presents one component of a model for integrating voter engagement into social work education: the provision of training for field instructors on nonpartisan voter engagement at two universities over two years. evaluation findings suggest that pre-existing levels of political efficacy affect the reaction of field instructors to nonpartisan voter engagement training. furthermore, findings indicate that field instructors who receive voter engagement training are more likely to serve as resources for their students and to consider voter engagement as part of their own practice. we offer evidence on the important role field educators can play in the success of the larger national effort to integrate voter engagement in social work education. increasing awareness of what social workers, nonprofit, and public agencies are allowed--or even required--to do is a critical first step. keywords: voter engagement, field education, empowerment, political social work, political engagement the act of voting has the potential to benefit individuals and their communities, change public policy, and address issues of social justice and human rights. political action to achieve social justice, including voting, is addressed in the national association of social workers (nasw) code of ethics, the council on social work education (cswe) educational policy and accreditation standards, and is promoted by social work’s professional organizations (cswe, 2015; nasw, 2017). political advocacy is also part of the profession’s original foundation and has become increasingly appreciated throughout https://creativecommons.org/licenses/by/4.0/ lane et al./creating a culture of voting 87 social work’s history (mahaffey & hanks, 1982/1993). yet social workers, even while voting at relatively high rates themselves, are likely to see voter engagement as either macro social work or outside of social work practice (ritter, 2008). social workers can engage in the voting process in a variety of ways (lane & pritzker, 2018). the most basic involvement is to engage civically by voting; encouraging others to vote; and staying engaged and educated about policy, candidates, and the election process. the next level of involvement includes more active engagement of others, who could include colleagues, client groups, and community members. this level includes assisting others with voter registration; education about the process of when, where, and how to vote; and sharing information about candidates and the issues. these steps can be partisan or nonpartisan depending on the social worker’s role and employment. a social worker who is employed by a political candidate’s campaign will do partisan voter engagement, while a social worker in a nonprofit setting can do nonpartisan voter engagement. the final level of voter engagement for social workers includes leadership in voter engagement, ranging from running voter engagement drives or voter education events, working as an election official, training and mentoring others in voter engagement, and engaging with the media about related issues. increased levels of voting by clients and communities served by social workers could have a significant impact on the outcome of elections (lane, humphreys, graham, matthews, & moriarty, 2007). building political power of oppressed clients and communities is a key component of taking an empowerment approach in social work practice (postle & beresford, 2007), as it explicitly recognizes clients as “members of the community with certain rights and obligations” (davis, 2010, p. 245) rather than as passive recipients of services. voting addresses key empowerment concepts such as inclusion, mastery and control over key issues, self and community advocacy, and representation in the power structure (davis, 2010; gutierrez, 1999). treating social work clients as full members of society recognizes their essential humanity and importance in the creation of a functioning democratic society. recognizing clients as the “experts in their own lives”, postle and beresford (2007) argue for connecting social work values of client empowerment and self-advocacy and recognizing the political power of clients and the need to create pathways to democratic and political participation (p. 146). the nasw code of ethics (2017) explicitly calls for social workers to empower clients. integrating voter engagement into our practice is an effective, professional, and legal way to meet this ethical mandate. the social work profession is well-positioned to engage oppressed and underrepresented communities in voting, but social workers do not always seize these opportunities. studies show that many social workers still wrongly believe voter mobilization is partisan, illegal or unimportant (rocha, poe, & thomas, 2010; rome, hoechstetter, & wolf-branigin, 2010). in social work practice political power remains an overlooked indicator of self-actualization and community health (klar & kasser, 2009). social workers can create alliances with clients to create change. indeed, fostering political engagement is “a crucial part of the social workers’ role, consistent with building capacity within groups of people using services and thus enabling them to work autonomously” (postle & beresford, 2007, p. 153). social workers can help to address barriers to voting, advances in social work, spring 2019, 19(1) 88 which include confusing registration processes and deadlines; lack of transportation; not knowing where, when or how to vote; long lines; little to no information about who is on the ballot; and a feeling that one’s vote does not really matter (piven & cloward, 2000). many people are disengaged and disconnected from voting; nearly 40% of nonvoters state they do not like the candidates, the issues, or believe their vote does not matter (frint, 2018; lópez & flores, 2016). research suggests successful, ongoing engagement around voter registration, voter education, and encouragement to vote can increase social dialogue around voting and support voting as a social norm (nonprofit vote, 2013). this is similar to findings that nonpartisan door-knocking campaigns to encourage people to vote are effective because of the social interaction between the volunteer and potential voter (bedolla & michelson, 2012). when nonvoters engage in dialogue about voting in general, not related to a particular campaign, it can influence their perceptions and increase their interest in voting (rolfe, 2012; sandler, 2017). this article describes the implementation of a model of nonpartisan voter engagement within schools of social work. leveraging the strength of social work’s signature pedagogy of field education (cswe, 2015; wayne, bogo, & raskin, 2010) to reach students, field instructors, and educators, this model posits that training agency-based field instructors on, and working with these instructors to identify barriers to voter engagement, is pivotal to establishing a culture of voting. literature review a direct relationship exists between voting, power, resource allocation, and community well-being. voting benefits individuals and their communities, including higher levels of civic participation, stronger relationships, and better outcomes for the individual voters themselves, in areas like health, social connections, mental health, and overall well-being (avery, 2015; blakely, kennedy, & ichiro, 2001; griffin & newman, 2005; klar & kasser, 2009; martin, 2003). voting influences political decision-making (avery, 2015; griffin & newman, 2005), overall community health (blakely et al., 2001; martin, 2003), and overall health and well-being on an individual level (klar & kasser, 2009; sanders, 2001). studies show that elected officials award more attention and more resources to communities that vote in higher numbers (martin, 2003; martin & claibourn, 2013). thus, the advantages of engaging voters extend beyond partisan concerns of specific political offices into individual and community well-being, which are directly related to social work’s values, professional mandate, mission, and impact. disadvantaged and oppressed groups served by social work face obstacles in voting (rolfe, 2012) and their lack of political participation harms both their lives and our democracy. many individuals and communities do not vote regularly. there are many reasons that individuals and communities may not participate in voting. in many states, there are both official and unofficial restrictions that lead to voter disengagement and voter suppression (mcelwee, 2015). low-income communities, people of color, and young voters are disproportionately affected by structural barriers (mcelwee, 2015; rolfe, 2012). these structural barriers include the disenfranchisement of people who have been convicted of felonies (the sentencing project, 2016), registration deadlines, requiring photo identification, and closing or relocating polling places in certain districts (brennan lane et al./creating a culture of voting 89 center for justice, 2018; mcelwee, 2015, rolfe, 2012). low voter participation, particularly by members of oppressed communities, reduces the likelihood of responsive governmental solutions to problems that are prevalent in these communities (bartels, 2008; frasure & williams, 2009; verba, schlozman, brady, & nie, 1993). in 2017, one qualitative study asked community college students who received meanstested government assistance about their approach to voting, both in terms of internal decision-making and structural factors (sandler, 2017). in this study, a subset of respondents were very strategic about their approaches to voting and were aware of the relationship between electoral politics and government assistance. interestingly, this includes people who chose not to vote because of their knowledge of political structures. other members of the sample, both those who voted and those who did not, were less aware of the structural connections. this study suggests that multiple intervention strategies and tactics are needed to encourage voting among this group who are very affected by policy decisions (sandler, 2017). more research is necessary to develop the connection between the experiences of those who receive government assistance and the political process. voter engagement and social work practice social workers have a long history of registering clients to vote beginning with the women’s suffrage in the mid-19th century, the civil rights movement in the 1960s, and continuing with the work of human serve in the 1980s (piven & cloward, 1988, 2000). piven and cloward founded the human serve (service employees registration and voter education) project (piven, 2011). the project mobilized social workers and successfully campaigned for the passage of the national voter registration act (nvra) of 1993, commonly referred to as the “motor voter” law. to this day, the nvra enables public agencies (including social service agencies) to help clients register to vote (piven, 2011). in the present day, the national social work voter mobilization campaign is a national collaborative effort intended to train social work practitioners, students, and educators in voter engagement for the 2018 elections and beyond (voting is social work, n.d.). however, despite the documented need and historical roots, many social workers are not politically active within their professional roles. one reason for this may be due to popular misconceptions about what activities are acceptable within the structure of public and non-profit agencies. many social workers believe that they are not allowed to engage in voter engagement within their organizations (hardina, 2013; lane et al., 2007; rocha et al., 2010). contrary to these common misperceptions, most agencies that employ social workers are allowed to engage clients in the voting process, and some are legally required to do so. for example, the 1998 reauthorization of the higher education act of 1965 has required institutions of higher education such as colleges and universities to conduct voter registration activities in years where there are federal or gubernatorial elections (american association of collegiate registrars and admissions officers, n.d.). the national voter registration act mandates that all state agencies which administer driver’s licenses, welfare assistance (now temporary assistance to needy families), food stamps (now supplemental nutrition assistance program), medicaid, and disability benefits offer assistance in registering to vote (piven & cloward, 2000). additionally, nonpartisan voter advances in social work, spring 2019, 19(1) 90 engagement, education, and outreach, which stays away from support of individual candidates or political parties, is permitted in nonprofit organizations (nonprofit vote, 2017). voter engagement and social work education most social workers are not provided substantive opportunities to increase their knowledge or experience of voting or other political activities while they are in social work schools, field settings, or in professional development training or continuing education activities once they enter practice. consequently, the connections between these political activities and the social work profession are generally not learned. past studies (ritter, 2008; rome & hoechsetter, 2010) found that over half of licensed social workers are only minimally involved or not involved at all in political activities, including voting. pritzker and burwell (2016) found that voter registration efforts are included in fewer than half of all accredited social work programs. an increase in civic engagement in social work education is necessary in order to continue the social work profession’s ethical commitment to creating and implementing just and inclusive social policies (hylton, 2015; mccabe, hylton, kooreman, mellinger, & day, 2017). given that voting behaviors are largely habitual (miller & shanks, 1996) and developmental (plutzer, 2002), strengthening participation habits early is important. pritzker, springer, and mcbride (2015) suggest that both classroom-based and communitybased opportunities for political engagement and civic involvement in college are effective in laying the foundation for adults’ ongoing engagement. furthermore, a deeper understanding of specific “regulatory and legislative processes” (mccabe et al., 2017, p. 91) may be even more critical for social workers than the general public, given the expectation of competency in policy practice set forth by cswe (cswe, 2015). several studies have indicated that professional social workers feel that they did not receive adequate opportunities for developing political advocacy skills during their master of social work (msw) programs (hill, donaldson, fogel, erickson, & ferguson, 2017; ostrander, 2016; ritter, 2008; rome & hoeschetter, 2010). integrating voter engagement activities into social work education can be an opportunity for students to practice political advocacy that is nonpartisan and impactful, while also building on and using their core social work practice skills (hylton, rhodes smith, powers, ostrander, & lane, 2018). field education is a critical component of social work education with long-term impacts on future social workers’ preferences, competencies, and understandings of social work practice (deal, hopkins, fisher, & hartin, 2007; mizrahi & dodd, 2013; wayne et al., 2010). field settings provide students with hands-on learning, access to social work role models, and mentorship that they may carry throughout their practice. in addition, direct-service agencies are particularly effective in engaging underrepresented communities and individuals to participate directly with electoral processes (leroux & krawczyk, 2012; nonprofit vote, 2017). unfortunately, little political or policy content is present in most social work students’ field placements (pritzker & lane, 2014). further, much of the emphasis on voter engagement is on the rules and process of registering people to vote versus how it connects to social work’s organizations, missions, or impacts. lane et al./creating a culture of voting 91 lane and colleagues (2007) examined agency-based voter registration programs through their review of msw students’ voter registration projects within their field placements. evaluation of this project found that “sustaining momentum, supplying userfriendly information, and providing open lines of communication for assistance” (lane et al., 2007, p. 85) are all critical components to successful implementation of a voter registration project in a field setting. challenges to implementing voter engagement projects within a field setting included the short timelines between the beginning of field placements and voter registration deadlines, competing demands in field placements, and client ineligibility to vote (lane et al., 2007). findings also indicated that voter registration work in agencies should be an ongoing activity, rather than something done only once or only immediately preceding an election. finally, participants of this study recommended training on voter engagement for both students and field instructors (lane et al., 2007). voter engagement model given that field education is social work education’s signature pedagogy (wayne et al., 2010), the current project is centered in field education at two public universities’ schools of social work. in both schools, voter engagement training is integrated into courses (policy or macro practice) which are required of all students. bsw (bachelor of social work) and/or msw students are provided training on the importance of voting to community outcomes, human rights, anti-oppression work, empowerment practice, and social work’s impact. students are also provided tools and resources on basic civics, the voting rules in their state, and how to integrate nonpartisan voter engagement into social service delivery and social work practice. to reinforce these concepts and build students’ efficacy, they are asked to complete a required assignment in field. this training model is designed to provide students and practitioners with a foundation of the importance of voting, an understanding of the barriers to being an informed and consistent voter, and the knowledge needed to create a culture of voting in all practice settings. the objective of the model is for field instructors to expand their knowledge of voter engagement and support student-driven change within their field placements related to the activities outlined in the students’ assignments. although the training module was developed jointly by faculty at both sites, there are a few key differences in its implementation. all students are asked to develop a plan for their field agency, which suggests all the ways in which their agency could support clients, staff, and communities to vote. it is an exercise that addresses micro, mezzo, and macro touchpoints and interventions. at one school, the assignment is simply a planning exercise (as they are not required to implement their plans), and students are asked to discuss the training and their plan with their field supervisor (the individual employed by the agency who supervises the student at the field site). these students also write a reflection paper on the significance of voting to social work practice, the intersection between voter engagement and communities of color, and a policy they would change to make voting easier. students at the second school are required to implement their plans within their field placements. after implementation, students submit final papers in which they reflect on the successes, barriers, and learning outcomes of their voter engagement projects. in order to clarify this project for field supervisors and to address any questions or concerns they advances in social work, spring 2019, 19(1) 92 may have, a shortened version of the student training is given to all new field supervisors at one site during the required orientation course. this additional training was not required at the second site. students at both schools are given a letter to bring to supervision, which provides their field instructors with background information on the training, objectives, and assignment. this voter engagement model has been implemented and evaluated since 2015 at the two schools of social work, reaching about 250 students annually, and 75 new field supervisors in total. preliminary evaluation findings from students indicate that students are more likely to recognize the importance of voter engagement to social work practice and gain valuable knowledge about best practices for implementing voter engagement in their practice after their participation in this training model (e. g. hill, lane, powers, & smith, 2019). this paper examines the evaluation data provided by field instructors on the impact, implementation, and efficacy of these student projects. research questions initial data from 2015, the first year of implementation, illuminated that field instructors can serve as key support for students or as substantial barriers for implementation. lack of support from agencies also emerged as a significant barrier for 44% of students at one university and 25% at the other (lane et al., 2016). training for field supervisors is a key aspect of this voter engagement model because the research discussed above, along with our professional experiences, suggests practitioners’ social work education was unlikely to include voter engagement content. based on this information and evaluation results from students after the first year of implementation, increased effort was made to include field instructors, faculty, and field office staff as important stakeholders in the voter engagement model. specifically, a shortened (45-60 minutes) version of the training presented to students was added to the annual field instructor seminar training (required of all new field supervisors) beginning in the second and third year of implementation (2016 and 2017). similar to the student training, the objective of this field instructor training is for participants to connect voting and voter turnout to all social work practice and its overall impact. this includes voting as a social determinant of health; a basic human right; a central component to social justice and equity efforts; and a legal, effective, and ethical intervention at the macro, mezzo, and micro levels. training also clarified the student assignment for instructors, including providing them with an opportunity to process how this might fit into their organizational context. a longer version of this training was also offered to all field instructors as a free professional development opportunity with ceus (continuing education units) available. the research reported here asks the questions: 1. what is the impact of voter engagement training on field instructors’ perceptions of the importance of voter engagement in social work practice? 2. what barriers do field instructors perceive in implementing student-driven voter engagement projects within field agencies? lane et al./creating a culture of voting 93 3. what is the impact of participation in voter engagement training on self-reported future behavior of field instructors? methods sample the sample for this study included all field supervisors who participated in the trainings at two schools of social work in 2016 and 2017. the training was also provided to faculty at one of the schools. this sampling frame was chosen in order to identify the effects of this training on individuals who were agency employees, held supervisory responsibility, and who would be in a position to help or hinder students from completing voter engagement projects. both schools of social work are located in urban areas. the school in the northeastern united states had an msw and phd program, while the school in the western united states had a bsw and msw program. participants were full-time employees of agencies in the communities near the two schools of social work. the majority of trainees (for whom demographic data were available, approximately n=41) were women and identified as white. a total of 120 people attended the trainings across the two locations. measurement instrument the instrument used for this study was developed by the authors for work on political engagement. it includes questions about demographics, current political knowledge and activity, previous experience with voter engagement, future plans for voter engagement, and any barriers they experienced, as well as questions about the training overall. questions about political efficacy were taken from the american national election studies (anes; 2012) refined by niemi, craig, and mattei (1991). these questions measure both internal and external efficacy. internal political efficacy refers to the confidence individuals’ have in their ability to intervene in the political system, whereas external efficacy refers to the confidence individuals’ have in the system’s capacity to respond to their intervention. these anes scales of internal and external efficacy have each been tested for validity and reliability (niemi et al., 1991). all of the items have five likert responses, with a total score ranging from 0 to 32; high scores indicate strong political efficacy. the internal political efficacy scale was comprised of four questions (“how often do politics and government seem so complicated that you can’t really understand what’s going on?”; “how well do you understand the important political issues facing our country?”; “how much do public officials care what people like you think?”; and “how much can people like you affect what the government does?”). likert response options range from 0 (never, or not at all) to 4 (always or a great deal.). some items are reverse-coded within this internal efficacy subscale, with a total range from 0 to 16. the external political efficacy scale also had four questions (“there are many legal ways for citizens to successfully influence what the government does”; “under our form of government, the people have the final say about how the country is run, no matter who is in office”; “if public officials are not interested in hearing what the people think, there is really no way to make them listen”; and “people like me don’t have advances in social work, spring 2019, 19(1) 94 any say about what the government does”), with likert response options ranging from 0 (strongly disagree) to 4 (strongly agree)—some of which are reverse-coded—with a subscale ranging from 0 to 16. data collection and analysis data were collected at the start of each training session and at the completion of training. surveys were offered in hard copy or electronically. approval was received from the institutional review boards at the participating universities and all research partners’ universities. data was imported from qualtrics or manually entered into spss and analyzed using versions 24 and 26. limitations the biggest limitation of this study is the small sample size and geographical areas. we are in the process of larger scale studies in a variety of geographic areas in order to assess whether these results are characteristic of other social work field instructors. another limitation of the study is the timing—these studies were done during the contentious 2016 u.s. presidential election and in the year following. it may be that this time period has affected the results. in an effort toward minimizing potential non-response or attrition, the researchers decided to omit survey questions asking for sensitive information, such as political affiliations. therefore, our data limits our understanding of the potential impact that participants’ political affiliations may have on their voter engagement perceptions or behaviors. social desirability is also a concern; as the training was designed to encourage voter engagement, participants may have chosen survey answers that they expected would meet the researchers’ expectations. finally, this data only reflects the participants’ selfreports that are retroactive or their immediate reflections after the training. for example, this study would be strengthened by collecting data that reflects their voting behaviors more accurately than retroactive self-reports and their planned behaviors, such as participants’ publicly available voting records. however, the authors were unable to collect participants’ names (in order to preserve anonymity, as required within our irb approval) nor dedicate the extensive time required to achieve this task. relatedly, longer-term follow up with participants would provide more information about the impact of the training, both for individual behaviors as well as for changes in participants’ work with agencies (for example, advocacy for changes in agency policy around voter engagement). more research needs to be done on the long-term outcomes, as well as the effect on students of their field instructors receiving this training. results a total of 44 individuals completed the pre-test before training in 2017. (pre-tests were not administered in 2016.) forty participants were field supervisors, one universityemployed field advisor, and three faculty members. they ranged in age from 25 to 44 (m=38.50, sd=11.52). the majority of the 41 participants who identified a race were white (n=33, 80%), with the remainder identifying as black/african-american (n=4, 10%), latina/hispanic/puerto rican (n=2, 5%), or bior multi-racial (n=2, 5%). the majority lane et al./creating a culture of voting 95 who identified a gender were female (n=38, 93%), with the remaining identifying as male (n=3, 7%) and no one identified as transgender. we asked participants a set of questions to identify their baseline political activity. forty respondents (91%) were registered to vote. the remaining four were not registered to vote and reported no plans to register. eighty-six percent (n=31) reported voting in federal elections always or most of the time, with just over half (n=24, 54%) reporting the same for state elections and 41% (n=18) reporting the same for local or municipal elections. on the less politically active side, six participants (14%) reported rarely or never voting in federal elections, one-fourth (n=11, 25%) rarely or never voting in state elections, and 39% (n=17) rarely or never voting in municipal or local elections. one-third of this group (n=15, 34%) had engaged in behavior to promote voting prior to the training. barriers thirty-seven (47%) of the 2016 respondents and 18 (49%) of the 2017 respondents perceived significant barriers to implementing voter engagement in their agency settings. the barriers could be broken down into five sub-themes. these are: need for approval/concerns from higher-ups, needs of clients, agency policy, attitude, and other barriers. each is discussed in more detail below. need for approval/concerns from higher-ups. one of the two most commonly reported concerns (n=13, 54% of concerns listed) related to the need for approval from those in authority and their potential disapproval. one school social worker wondered if voter engagement projects would need approval from the board of education and another wondered if the superintendent would need to approve projects. another reported, “administration would need to be on board; but i will assist in advocating for it.” another said that any project would need to be approved by the ceo, which would require additional time because that person “is hard to reach and takes a long time to decide things. by the time he decides, the election may have happened.” one non-profit social worker commented, “my director may not be aware that this type of work is legal in our agency setting,” and others in non-profit and public agencies wondered whether their administration would be supportive. needs of clients. an equal group of respondents (n=13, 54%) described concerns about the setting and clients with which they worked, particularly those who generally worked with individuals in crisis. one noted a concern about “doing this in a way that makes sense with the current level of need vs. crisis our youth experience on a day-to-day basis,” and others stated: “usually only see parents at time of crisis” and “difficulty with engagement during crisis situations.” another wrote that “clients are coming to the agency for a specific service and could feel blindsided by questions about voting” while another commented, “when people are trying to survive, voting isn't exactly at the top of the list.” concerns about conducting voter engagement with several specific client populations were identified, including young children, people with cognitive disabilities, students at a private university, and people who are homeless. a field instructor who worked with survivors of domestic violence listed concerns including “the homelessness, lack of ids (though not technically required), ptsd, and safety needs of dv survivors.” advances in social work, spring 2019, 19(1) 96 agency policy. concerns were also raised by seven participants (13%) about agency policies that might prohibit political action. field instructors who were most likely to raise these concerns were those in state agencies and those working for federal elected officials. it was a concern that state agencies might see voter engagement as a “conflict of interest.” field instructors working for federal elected officials, such as members of u.s. congress, have a firm line between official and political actions. others described more general agency policy restrictions without specifying barriers. attitude. six (11%) participants discussed mindset and attitudinal concerns. one reported that their agency “is not political and would not want to do this” while others describe bureaucracy and hierarchy as barriers. another described “fear of change” or potential controversy. one social worker noted that “even though it is ‘nonpartisan’ people assume an agenda” and another stated that their agency was “not willing to be involved in engaging clients in political conversations.” other barriers. the remaining 15 (28%) barriers included issues such as lack of time (n=4), the current political climate (n=3), and lack of interest by intern or others (n=2). furthermore, participants identified the need to know more about logistics, the need to be careful of stepping on the toes of other departments already doing voter engagement and concerns that clients would move into partisan territory as possible barriers. impact of training. the impact of the training was measured using several variables. first, participants were asked about how important they believed voter engagement to be to their social work practice, using a scale of 0 (low importance) to 4 (high importance) prior to the training (as a retrospective baseline) and at the end of the training. the 2016 respondents moved from 2.10 to 3.45 (df=108, t=-9.247, p<.001) with 22 (26%) reporting choosing the highest response before the training, compared to 53 (62%) after the training, and the lowest level dropping from 20 (23%) to 1 (1%). the 2017 participants’ change was positive and statistically significant, though lesser compared to 2016, from 2.30 to 3.03 (df=52, t=-2.361, p=.024). in this iteration, 13 (30%) chose the highest response prior to the training, 18 (42%) after the training, and the number choosing the lowest response dropped from 7 (16%) to 3 (7%). sixty-six total respondents (81%) reported that they planned to change their work with students and/or practice as a result of the training. planned changes included: discussing voter engagement with all students every year, bringing voter registration forms to class (from a faculty member), inviting local elected officials to their agency, being more creative about encouraging voting, providing education about voting, encouraging students to engage clients about the topic, putting registration information in intake packets, more in-depth discussions with students, and connecting with clients’ parents. two variables that correlated positively with participants’ likelihood to change their work with students were political efficacy and their rating of the importance of voter engagement after the training. as shown in table 1, for the 2017 respondents who could have their pre-test and post-test responses matched, efficacy was positively correlated with likelihood of changing work with students. matching was not possible with 2016 data. lane et al./creating a culture of voting 97 table 1. correlations between likelihood to change work with students and efficacy variables (n=29) efficacy external internal overall pearson’s correlation 0.358 0.406 0.416 significance 0.057 0.029 0.025 correlations were also found between participants’ rating of the importance of voter engagement to their social work practice and their stated intention of changing their work with students to include voter engagement. this was true for both 2016 (r=.315, p=.004, n=81) and 2017 (r=.456, p=.010, n=31). those who saw barriers to voter engagement in their agencies were also less likely to report that voter engagement was important to their practice in 2016 (r=-.269, p=.017, n=78). discussion multiple prior studies have indicated that integrating voter engagement into nonprofit agencies, particularly social service agencies, is an effective way to engage traditionally marginalized populations in voting (lane et al., 2007; leroux & krawczyk, 2012; nonprofit vote, 2017). moreover, leroux and krawczyk (2012) report that each votingrelated contact a client receives through a service agency results in an increase in likelihood of voter turnout by 11%, even after controlling for other factors that may influence voting behavior. findings reported by leroux and krawczyk (2012) also support previous research which indicates that many social workers do not integrate voter engagement into their practice settings due to various barriers (ritter, 2008; rome & hoeschstetter, 2010). voter education programs such as the model discussed in this paper may help address many of the barriers to voter engagement in social work practice identified in previous studies (leroux & krawczyk, 2012; ritter, 2008; rome & hoeschstetter, 2010). concerns about the legality and ethics of voter engagement in nonprofit and social service agencies are widespread. however, as previously discussed, voter engagement is both legal and ethical, as long as it is nonpartisan in nature and provided in a way that is respectful of clients’ social and community locations. increasing awareness of what social workers, nonprofit, and public agencies are allowed--or even required--to do is a critical first step. allowing social workers to conceptualize and practice how they might integrate voter engagement into their own practice settings is an equally important second step. the findings from this training evaluation indicate that integrating voter engagement training and activities into social work field education, specifically for field instructors, is an effective method for increasing the recognition of voter engagement within social work practice. field instructors indicated intentions to take concrete steps toward integrating voter engagement activities into their practice settings, as well as in their work with students. they also recognized the importance of voter engagement to their social work practice at higher levels after the training. advances in social work, spring 2019, 19(1) 98 despite these positive impacts of the training, however, participants also continued to identify barriers to creating a culture of voting within their social work practice. many of these barriers (i.e., agency policies, needs of clients, and concerns about the political environment) have been identified in previous literature (hardina, 2013; postle & beresford, 2007; rome & hoeschetter, 2010). indeed, previous literature also identifies possible responses to these perceived barriers, including more education for both practitioners and social work managers about the legal, ethical, and professional frameworks that support voter engagement in social work settings (hylton et al., 2018; lane et al., 2007; postle & beresford, 2007); greater emphasis on the positive impact of voter engagement for nonprofits and their clients (leroux & krawczyk, 2012); and creating learning opportunities for social work students to practice voter engagement within supported settings (hylton et al., 2018; lane et al., 2007). this study supports these recommendations of increased and ongoing education for social work practitioners, as well as a broader voter engagement model discussed below. findings suggest that field instructors’ increased knowledge of voter engagement, its level of importance to their practice, and their political efficacy related to their plans to practice more voter engagement in the future. the training aimed at addressing these knowledge, attitude, and behavior changes by including the what, why, and how of voter engagement within social work practice: what is nonpartisan voter engagement; and what is allowed, or even required, within various social work agencies and organizations? why is voter engagement important to social work’s mission and impact? and how can social work practitioners navigate barriers and advocate for practices aimed at voter turnout within their agencies? findings from this training evaluation suggest that field instructors’ increased knowledge of voter engagement increases their planned voter engagement behaviors. however, field instructors may need additional guidance in order to overcome potential barriers, both perceived and actual, to incorporating voter engagement within their professional practice. implications for practice short-term trainings are helpful, but are not enough to overcome the barriers discussed. evaluation is currently underway of the overall voter engagement model, of which this field instructor training is one component, that aims to empower social workers to create a culture of voting within their practice settings to increase voter turnout of marginalized communities and, thus, be represented within policy-making in order improve their outcomes. the overall model includes providing ongoing connection and support for voter engagement in social work settings. one method of continuous access to voter education includes providing field instructors, students, and schools of social work with a number of voter engagement resources, some of which are outlined in table 2. lane et al./creating a culture of voting 99 table 2. resources for voter engagement in social work practice organization summary of resource national social work voter mobilization campaign (nswvmc, n.d.) beginning as a website of voting-related resources, votingissocialwork.org has grown to include the nswvmc, home of the national campaign to engage social workers in nonpartisan voter registration. center for information and research on civic life and engagement (circle, 2010) circle is a national leader in civic engagement and education in higher education. many valuable resources can be accessed on their website: civicyouth.org. nancy a. humphreys institute for political social work, (university of connecticut, n.d.) the institute works to increase the political power of all social workers and the communities they serve. to learn more about their projects and for contact information, go to their website: ssw.uconn.edu/political institute. nonprofit vote (n.d.) a national partner for nonprofit organizations that fosters their engagement of the people they serve in voting and political engagement. resources, including free webinars, can be accessed on their website: www.nonprofitvote.org. turbovote (democracy works, 2019) turbovote.org is an online application that aims to make voting easier and more accessible to all americans. vote.org (2018) vote.org is a clearinghouse of voter information by state. implications for education by linking voter engagement with field education, the overall voter engagement model described above builds on the pre-existing strengths of social work education. this education model is also an example of best practices in civic education, including leveraging pre-existing trusting relationships to share voter registration information (bogard, sheinheit, & clarke, 2008); explicitly linking community-based (field) and classroom-based activities (pritzker et al., 2015); and creating multiple opportunities for students to practice citizenship while they are enrolled in postsecondary or graduate education (mccabe et al., 2017; pritzker et al., 2015). increasing social workers’ civic “toolkit” of skills such as civic knowledge, political efficacy, and participation in political activities will serve the training participants and our profession’s mission and impact into the future (hylton et al., 2018). implications for policy in order to effectively advocate for marginalized and vulnerable populations, social workers must be aware of discriminatory policies that contribute to voting disparities as well as policies and programs that increase voter turnout. informing social work practitioners about these policies can increase the effectiveness of voter engagement strategies as well as help to alleviate concerns about the legality of nonpartisan voter engagement within social service agencies. given that the field instructors involved in this training saw agency prohibitions to voter engagement as a barrier, social work practitioners may need to be educated about the rights of staff and clients in relation to nonpartisan http://votingissocialwork.org/ http://civicyouth.org/ https://ssw.uconn.edu/politicalinstitute/ http://www.nonprofitvote.org/ http://turbovote.org/ https://www.vote.org/ advances in social work, spring 2019, 19(1) 100 voting activities. if unjust policies do in fact exist, training programs must empower social workers to advocate for policy change within their agencies. in order to justly serve their clients and communities, nonprofit and social service agencies—where nonpartisan voter engagement is legally permitted—must implement policies that encourage a culture of voting. similarly, in order to adequately advocate and support their clients, social work practitioners also need to be informed of the government-level policies that inhibit or support equal access to voting for disadvantaged populations. as previously noted, many of the communities that social workers work with face multiple barriers to voter engagement (hill et al., 2019; hylton et al., 2018). there are numerous laws that specifically limit the ability of many americans to vote. this category of laws includes those that disenfranchise individuals with prior felony convictions, photo identification laws, purges of voting rolls, closing of polling places, or limiting the hours that polls are open. each of these laws negatively impact the ability of many people to vote, particularly young people, people of color, people in poverty, and people who are highly mobile (mcelwee, 2015). social workers should advocate for national, state, local, and organizational policies that seek to remove systemic barriers to voting. social workers have been active in advocating for voting rights throughout history: the movements for women’s suffrage from the mid-19th century to the early 20th century, the civil rights movement in the 1960s, and the work of human serve in the 1980s (piven & cloward, 1988, 2000). in keeping with social work’s historic and current commitment to social justice, access, and empowerment, social workers should advocate for policies that support engaging all of our clients in voting. for example, policies such as same-day voter registration, early voting, no-excuse absentee voting, and vote-by-mail have each been demonstrated to have positive impacts on voter turnout, particularly for marginalized groups (national conference of state legislators, 2017; perez, 2017). social workers should continue to advocate for policies that increase access to voting for all members of our communities, and ensure that they are being implemented effectively. the social, political, and economic justice of historically oppressed communities largely relies on the social work profession ensuring that policies and practices enhance the representation of all voters within local, state, and federal elections. conclusion voter engagement is a professional, legal, and ethical obligation for social workers. by building upon one of the primary areas of strength of social work education, we are able to help students and community agencies to connect voter engagement to the social work field. field education as the venue for voter engagement education allows both current and future social workers to learn why and how to incorporate voter engagement into their practice, thus magnifying the reach of social work education and practice. social workers are well-situated to play a critical role in engaging communities within the political process who have typically been disenfranchised and disconnected from the political arena. this begins with providing all clients and communities with equitable opportunities and access to increasing their participation in voting. taking on this work is consonant with our lane et al./creating a culture of voting 101 profession’s historic commitments and current ethical responsibilities to empowerment and social, economic, and political justice. the findings from the evaluation of these trainings evidences the important role field educators can play in the success of the larger national effort to integrate voter engagement in social work education. references american association of collegiate registrars and admissions officers. 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(2010). field education as the signature pedagogy of social work education. journal of social work education, 46(3), 327-339. doi: https://doi.org/10.5175/jswe.2010.200900043 author note: address correspondence to: katharine hill, msw, phd, school of social work, university of st. thomas, 2115 summit avenue scb #201, st. paul, mn 55104. katharine.hill@stthomas.edu https://doi.org/10.1017/cbo9781139058513 https://doi.org/10.1080/15588742.2010.487236 http://www.nonprofitvote.org/documents/2010/11/the-psychological-benefits-of-political-participation.pdf http://www.nonprofitvote.org/documents/2010/11/the-psychological-benefits-of-political-participation.pdf https://opencommons.uconn.edu/dissertations/1462/ http://www.sentencingproject.org/issues/felony-disenfranchisement/ https://ssw.uconn.edu/politicalinstitute/ https://doi.org/10.2307/2939042 https://www.vote.org/ https://votingissocialwork.org/ https://doi.org/10.5175/jswe.2010.200900043 mailto:katharine.hill@stthomas.edu _________ micah saviet, msw, lmsw is director at springer institute, cheverly, md. geoffrey greif, phd, lcsw-c, is a professor at the university of maryland baltimore school of social work, baltimore, md. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 154-175, doi: 10.18060/23935 this work is licensed under a creative commons attribution 4.0 international license. relationships between parents-in-law and children-in-law of differing racial and ethnic backgrounds: an initial qualitative exploration micah saviet geoffrey l. greif abstract: in-law relationships have drawn recent interest from family scholars. historical trends demonstrate a significant rise in newlyweds marrying someone of a different race or ethnicity. given this growing population of inter-racial marriage, the need to know more about these couples and their families is paramount. this article describes four themes that emerged from qualitative interviews with nine parents-in-law discussing their relationships with their child-in-law who is of a different race. the overarching themes identified for in-laws included: being initially hesitant based on race and/or culture; managing barriers pertaining to communication, language, and/or culture; differences that were enriching to the in-law relationship; and bonding related to shared minority status. based on these findings, social workers may assume a supportive role for members of interracial families as they navigate not only social barriers but also their in-law relationships. keywords: couples, interracial, interethnic, in-laws, qualitative more than 2 million couples marry each year in the united states (centers for disease control and prevention, 2015), giving rise to multiple in-law relationships. these in-law relationships are drawing increasing attention from family researchers (rittenour, 2012), as well as social workers (greif et al., 2019; greif & wooley, 2018). the relationships that are formed when a person of a different race or ethnicity marries into the family have been virtually unexplored (fingerman et al., 2012). in 2015, 1 in 6 persons who got married chose a spouse of a different race or ethnicity, a significant increase over the 1967 rate of 1 in 33 (livingston, 2017). with this growing population of inter-marriages, the need to know more about these couples and their families is paramount. marriage profoundly changes the families of origin of each partner with the addition of a new individual in the familial dynamic. with this expansion, in-law relationships are formed, which can include parents, adult children, siblings, and other relations. in-law relationships, regardless of the racial and ethnic match, can be difficult (morr serewicz, 2008). a myriad of factors affects both how well families adapt to having a new person in their midst as well as the adjustment process for that new individual. as we live in a society where racism exists (e.g., skinner & hudac, 2017) and where people may be especially wary of “others” during a pandemic, it is easy to see how interracial relationships between generations, specifically parents-inlaw and children-in-law, could be a challenge for some family members. literature review as there is little known about in-law relationships in interracial marriages, we first review the literature on interracial marriage and then the literature on in-law relationships. about:blank saviet & greif/relationships between parents-in-laws 155 we then offer intergenerational ambivalence as a lens for understanding these relationships. interracial marriage the united states supreme court decision loving v. virginia (1967) ruled that state laws banning interracial marriage were unconstitutional. this pivotal verdict continued an emerging trend towards a dramatic increase in the number of interracial couples marrying, as well as a shift in both public perception and popular opinion regarding interracial marriage. garcia et al. (2015), using data from the general social survey, examined public attitudes related to laws regarding interracial marriage in the u.s. between 1972 and 2002 and reached three conclusions that bear on the topic we are investigating. first, social acceptance of interracial marriage has increased dramatically. second, older people of all races, and this is relevant when looking at parents-in-law, are generally less accepting of interracial marriage. third, whites are less accepting of interracial marriage than people of other races. despite growing acceptance, historical societal factors (such as discrimination, antimiscegenation laws, and cultural taboos) have negatively affected couples in interracial marriages (bratter & eschbach, 2006). even since the passage of loving v. virginia, couples may feel a toll (bratter & eschbach, 2006; killian, 2003; leslie & letiecq, 2004; skinner & hudac, 2017). bratter and eschbach (2006) used five years of pooled data from the national health interview survey to compare the likelihood of experiencing psychological distress among interracial married/cohabiting adults. being in an interracial couple was linked to higher rates of distress as compared to same-race couples. those with an interracial partner who reported higher distress included native american men, hispanic men, white women, women married to non-white spouses, and african american or native american husbands or wives. skinner and hudac (2017) found that white and black interracial couples experience more reactions of affective and implicit bias compared to white and black same-race couples. coping and adaptive strategies can help to combat the stress faced by interracial couple. killian (2003) interviewed 12 interracial couples to learn about the strategies they used to combat racism both in society and in personal relationships. six strategies arose: (a) fighting fire with fire (e.g., scowling back at people who made racist remarks); (b) making a special effort (e.g., dressing nicely when going out); (c) dissociating from one another (e.g., not sitting together on public transportation); (d) not discussing public reactions (e.g., not sharing any racism that was experienced that day); (e) restricting itineraries (e.g., avoiding travel to the deep south); and (f) deprioritizing racial and ethnic differences (e.g., considering themselves like other couples; killian, 2003, p. 8). among the 76 african american and white interracial couples that leslie and letiecq (2004) surveyed, having pride in one’s race and being accepting of other races were the most significant predictors of marital quality among the african american partners. further, the more the african american partners had a strong black identity, the less ambivalent they felt about the marriage. for white partners, viewing white culture as superior to black culture was associated with less marital satisfaction. advances in social work, spring 2021, 21(1) 156 the research also looks at familial influences on the interracial couple. using data from three separate general social surveys completed in 2000, 2010, and 2012, djamba and kimuna (2014) examined the attitudes of both black and white americans regarding how they felt about relatives marrying outside of their race. the authors found that more than half of black americans and one-quarter of white americans favored a close relative marrying either a white or black person, respectively. bell and hastings (2015) interviewed 38 individuals who were partnered in black and white interracial relationships to explore the couples’ experiences, particularly pertaining to parental approval or disapproval. they found that while all the interracial couples endured societal disapproval, most felt parental support helped to mitigate the negative impact of societal disapproval. one of the few surveys of parents’ attitudes about having a child-in-law of a different race came from survey data from the baylor religion study conducted by perry and whitehead (2015). the authors found that whites who identified as christian nationalists had a significantly greater degree of discomfort with a daughter marrying any racial minority, most notably an african american. systemic racism, and the recent increase of discord throughout our country, have the potential to significantly impact interracial couples and should not be overlooked. further, intergenerational differences concerning views on race relations have shown the younger generation to be more open to such relationships so that parents-in-law may have more difficulty accepting an interracial marriage in their family than their child and child-in-law (frey, 2016). at the same time, the literature suggests that couples in interracial marriages are impacted by other factors that lead to increased personal and relationship-related stress. while many have developed coping strategies, individuals with spouses of a different race or ethnicity may face societal opprobrium as well as rejection from other family members. in-law research the research literature on in-laws provides another context for considering the lived experience of interracial couples. as the in-law relationship is considered an involuntary one (morr serewicz, 2008), a parent approving of her or his child’s selection of a spouse could go a long way toward enhancing the intergenerational ties. apostolou and colleagues (2014) conducted three studies in cyprus in which participants were asked to hypothesize about mate selection both for themselves as well as for their son or daughter. in each study, participants believed it would be more important for their child than for themselves to marry someone with a similar family orientation and a similar religion and ethnicity. one reason the match was believed to be less important for the parents than for their children was that the parents valued long-term mating strategies for their children more than for themselves. a number of researchers (e.g., marotz-baden & cowan, 1987; merrill, 2007; turner et al., 2006) have looked at a mother-in-law’s relationship with her daughter-in-law, while few have studied the relationship with the son-in-law. none has focused on interracial or inter-ethnic relationships. turner et al. (2006) conducted focus groups and semi-structured interviews with 19 mothers-in-law, 16 of whom were white and three of whom were hispanic. in these intraracial relationships, many said that they were struggling to let go of saviet & greif/relationships between parents-in-laws 157 their son without losing a connection to him and that they struggled with their relationship with their daughter-in-law even though it had begun positively. others had very positive relationships with their daughter-in-law and felt included in the lives of their son and daughter-in-law. merrill (2007) interviewed 14 white mothers-in-law and 53 daughters-in-law. mothers-in-law tended to give more positive descriptions of the in-law relationship than did their daughters-in-law. merrill, consistent with turner et al. (2006), also noted that mothers-in-law worried about losing contact with their son and so were less likely to express that there was conflict with their daughter-in-law. the reluctance of mothers-inlaw to express conflict with their daughters-in-law was also reported in marotz-baden and cowan’s (1987) study in montana. for their sample (no race was given), 44 mothers-inlaw and 55 daughters-in-law working together on family-owned farms completed questionnaires. when conflict arose, it usually revolved around differences in values and opinions as well as a lack of communication. less is known about relationships with sons-in-law. a sense of inclusion was an important variable in positive relationships. mikucki-enyart (2011) used an on-line survey and reached 104 parents-in-law, close to 90% of whom were mothers-in-law and were white. a slight majority chose to describe their relationship with their son-in-law. in examining their communication patterns, mikucki-enyart concluded positive relationships existed when parents-in-law felt that their child-in-law was a genuine member of the family, as measured by comfort in disclosures to that child-in-law. greif and woolley (2018) explored, through qualitative interviews and questionnaires, the relationships of 35 fathers-in-law with their sons-in-law. fathers-in-law who had positive relationships with their sons-in-law were married; close with other children-inlaw; did not need physical assistance; were highly inclusive by nature; thought of their sonin-law as a son or as a friend; described their son-in-law as having a strong relationship with their daughter; and had grandchildren. intergenerational ambivalence the relationships that parents-in-law form with their children and children-in-law can be understood through a lens of intergenerational ambivalence. ambivalence in family relations refers to feelings that may exist toward a family member that are both positive and negative (willson et al., 2003). connidis and mcmullin (2002) offer that, “…familial ties can involve more or less ambivalence at different points in the life course” (p. 564). such feelings between parents and their adult children arise when attempts to negotiate how to make relationships work and resolve any contradictions are thwarted. turner et al. (2006) write that ambivalence between generations is common, for example, as a young person strives to establish independence from their family of origin, an identity of their own, and also an intimate relationship with their spouse. the young person’s parents may have mixed feelings about these attempts while, at the same time, their parents-in-law are trying to redefine their relationship with their own child and their new child-in-law. this dynamic may precipitate lack of clarity in the interactions between the generations. advances in social work, spring 2021, 21(1) 158 ambivalence, as was noted, was also a variable in leslie and letiecq’s (2004) research on black-white couples. the present qualitative study was intended to describe the experiences of parents-inlaw whose child married someone of a different race and/or ethnic background. given how little is known about the growing population of parents-in-law of children in interracial marriages (livingston, 2017), the goal was to help social workers better understand potential issues that these couples and families may present with when seeking services. methods the interviews for this preliminary study were gathered as part of a larger mixedmethods study of sons-in-law, fathers-in-law, mothers-in-law, and daughters-in-law and their relations with their same gender in-law (greif & woolley, 2021). one arm of the study, using qualitative methods, had master of social work students in an advanced research class in 2018 and 2019 survey and interview fathers-in-law about their son-in-law and mothers-in-law about their daughter-in-law. following hipaa (health insurance portability and accountability act) and citi (collaborative institutional training initiative) training, as required by the university’s institutional review board, the students were trained in administering a consent form, a survey, and in conducting a qualitative interview. using convenience sampling, students could interview people they knew and people they recruited using social media platforms (e.g., facebook). they were required to interview a mother-in-law, father-in-law, daughter-in-law, and son-in-law. the participants could not be related to the student or to each other. in total, 68 parents-in-law participated and 68 children-in-law. here we report on the results of the interviews with the parents-inlaw. demographic questions on the survey asked about the participant’s race and the daughteror son-in-law’s race, and, if not the same, the race of the child-in-law. no survey questions specifically asked about ethnicity; individuals who responded with hispanic/latino to the race question were considered from an ethnic perspective, as per the u.s. census bureau definition (2018). we were interested in learning whether having a child in an interracial marriage affected the relationship with that child-in-law. interview questions included: “how important is your relationship with your daughter-/son-in-law?”; “describe in broad terms what the relationship is like with each of your in-laws?”; “describe a difficult event or interaction with your child-in-law”; and “describe a positive event or interaction with your sonor daughter-in-law.” when appropriate based on the survey response, participants were also asked in the interview, “you shared on the survey that there are differences in race with your child-in-law. how do you see the impact of those differences in your relationship with your child-in-law?” the authors separately read interviews with nine participants who had identified on the survey, and confirmed during the interview, that they and their child-in-law were a different race. in this multiple case analysis (padgett, 2017), the authors identified initial themes that emerged from the relationships described by study participants. they were sensitized to the topic of interracial relationships through reviewing the literature, a process recommended by padgett (2017), and to the topic of in-law relationships through their onsaviet & greif/relationships between parents-in-laws 159 going research with this population. following bradley et al.’s (2007) approach to coding thematically where each author separately read all the interviews and identified themes that arose, the authors met to resolve differences in what they had individually coded as themes. the authors then agreed on common themes and returned to the narratives to re-identify themes. they then grouped the respondents within each theme and checked with each other to resolve differences. results description of the sample nine participants of the larger pool indicated on the survey, and confirmed during the interview, that they and their child-in-law were a different race; 59 parents-in-law did not indicate this and so did not meet criteria for participation. this study sample (n=9) consists of four males and five females with an average age of 67 years (sd = 9; range = 56–83). the average age of the parent-in-law’s child was 40 years (sd = 8; range = 30–51). four of the participants identified as white, two as black/african american, two as south asian, and one as both hispanic/latino and white. the average age of the child-in-law was 41 years (sd = 11; range = 27–60). four of the parents-in-law have grandchildren from this couple’s marriage. the average amount of time since the child-in-law married into the family was 8 years (sd = 7; range = 1–21). respondents had an average number of 18 years of education (2 years beyond a bachelor’s degree with a range from 16 to 20 years (sd = 2). in terms of household income, one respondent (11%) indicated having a lowermiddle income, 3 (33%) endorsed middle, and 5 (56%) endorsed upper-middle. themes from the interviews the nine participants described experiences with their children-in-law that fit into four distinct thematic categories; one participant’s experience aligned with two of the overarching themes identified. the overarching themes identified included: initial hesitation based on race and/or culture (n=4); existing barriers pertaining to communication, language, and/or cultural barriers (n=1); existing differences enriching the in-law relationship (n=4); and connection related to both the father-in-law and son-in-law being minorities (n=1). the following paragraphs further elucidate each of these four unique dynamics by painting a picture of the individual participants and providing pertinent quotations. saviet & greif/relationships between parents-in-laws 160 table 1. participant demographic information id age gender racea child age child-inlaw age child-in-law racea time in familyb (years) theme(s) f 60 female white 44 35 asian 5 i g 66 female white 39 33 asian 12 i h 66 male white 37 38 black/african american 13 i t 83 male south asian 51 52 white 2 ii n 64 male white 31 36 hispanic/latino 3 i, iii c 56 female black/african american 30 27 filipino 1 iii d 76 female south asian 47 52 white 21 iii e 58 female black/african american 31 35 white 7 iii r 71 male hispanic/latino & white 46 60 native american unknownc iv aracial categories were self-reported by the participant and are categorized in this table based on the u.s. census bureau’s proposed race/ethnicity question for the 2020 census, which asks about hispanic/latino origins in a separate question from race (wang, 2018). the u.s. office of management and budget classifies individuals who identify as hispanic, latino, or spanish as “…a person of cuban, mexican, puerto rican, south or central american, or other spanish culture or origin regardless of race” (u.s. census, 2018, para. 1). for the purpose of this table, we include hispanic/latino as a racial category. bthis survey question was phrased as follows: “how long ago did this [son-in-law or daughter-in-law] marry into your family?” cinformation was not collected on this question for this respondent saviet & greif/relationships between parents-in-laws 161 theme i: initial hesitation based on race/culture the first theme to emerge from these nine interviews can best be described as relationships between a parent-in-law and child-in-law that are marked by initial hesitation based on race (and even racism) and/or cultural differences. of the four cases that fit into this theme, the parents-in-law describe several different outcomes of their relationships with their children-in-law, which include: still struggling; continuing to have pluses and minuses; and having overcome differences/racism. ms. f is a 60-year-old white woman, and the ceo of a computer company. her 35year-old mixed-race asian daughter-in-law married into the family 5 years ago. ms. f describes a relationship with her daughter-in-law in which she “walks on eggshells” to avoid conflict. she also openly acknowledges the struggle between them and the lack of respect that she has for her daughter-in-law. i look at her marriage to my son as almost like a gold-digger type thing. she is a perennial student. god only knows when she will graduate. thank god they don't have kids. she doesn't work. i value hard work and she has been in school ever since i’ve known her, which has been almost 12 years. she is 35 and has never finished anything. never graduated. she goes from one thing to the next. now she wants to be a nurse. i just don't have a lot of respect for people who don't work when they are capable of working. while the lack of respect may be, in part, an issue of personality or personal values, the cultural differences at play between ms. f and her daughter-in-law are stark, and suggest that ms. f’s initial perceptions of these differences may have stuck in her mind and tainted the dynamic between the two women. ms. f describes her daughter-in-law’s mother, in what could be seen as a racially insensitive term, as a “mail-order bride.” she was brought over from indonesia to marry this guy. she brought three kids over. she married the guy and that’s whom p refers to as her dad. they got married and then divorced. she is supposed to be getting married again. i don't know how many marriages this is for her. another study participant, ms. g, is a 66-year-old white woman, and works in support services at a law firm. she readily acknowledges that racial differences between her 33year-old adopted korean daughter-in-law and herself initially presented a challenge. distinct from ms. f, whose issues between her and her daughter-in-law stayed the same over time, ms. g’s dynamic with her daughter-in-law has unfolded with both pluses and minuses. i think she’s wonderful and hardworking and she annoys the hell out of me sometimes. i’ve been so furious at her that i can’t see straight, you know. it just really is the full spectrum. having welcomed her daughter-in-law into their family 12 years ago, ms. g discusses the racial and religious differences between the two families. advances in social work, spring 2021, 21(1) 162 my son is biracial; his father is african american. my son’s wife is korean; her parents are white. so, here’s a good example of their religious differences; i put him in a church choir. he was in that choir for eight years because i thought it was good for him. the other private school boys were in it, and it gave him something constructive to do after school. i liked the structure. my daughter-inlaw’s parents assumed that there was some religious component that wasn’t there … when they got married. my daughter-in-law could’ve just kept her mouth shut, but she didn’t. she said, ‘we can’t get married in a chapel or church because he [interviewee’s son] isn’t baptized.’ her mother’s reaction was, ‘don’t be ridiculous, of course he’s been baptized.’ so, there was a big ‘oh god, now what?’ i said to my son, ‘whatever you want to do: if you want to elope, if you want to get baptized... i don’t care.’ he said, ‘i’ll do whatever my fiancée wants me to do.’ they compromised. it was fine, but her parents were horrified. ms. g articulated the aftermath of this cultural /religious dissonance. “so, i’ve been ousted as a total heathen with them.” further along in the interview, ms. g described how the racial differences between her and her daughter-in-law have played out. one day we were somewhere with my son, daughter-in-law, her parents, me, and my son’s best friend, who is white. my daughter-in-law turned to me, laughed, and said, ‘look at us and our caucasian entourage, which i thought … was hilarious. also, they’ve had some weird stuff. for example, they moved into a development and they went to a homeowners’ meeting and they got kind of a weird reception, but it doesn’t seem to bother them, and people get over it. two other cases grouped in this theme of initial hesitation based on racial and cultural differences take a turn from the first two described above, in which ms. f continued to struggle and ms. g described the in-law dynamic as the “full spectrum”. both mr. n and mr. h detail a process of confronting initial hesitation based on bias or overt racism, respectively, as it pertained to their sons-in-law, and eventually overcoming this bias, even undergoing personal growth. mr. n, a white 64-year-old retired man appears here because of what he articulated about the initial hesitation based on bias that he had in relation to his son-in-law from guatemala and the process that he went through to overcome this. mr. n shared that he had to “readjust his thinking” in the process of coming to terms with the fact that his daughter was in love with his future son-in-law, despite the apparent racial, cultural, and financial differences at play. i think we just realized that l and v really loved each other and that was the most important, and the fact that she was making an informed choice to pursue the relationship with v. in the end, we realize that we can either be happy with the decision and be happy with them, or we can do things that will ultimately alienate us from our child, and we don’t want that either. we realized this is her decision, that she loved v, and that prompted us to look for the good things in v and accept him as our son-in-law. saviet & greif/relationships between parents-in-laws 163 despite his initial hesitation about the racial and cultural differences, mr. n articulated his eventual desire for a close relationship with his son-in-law. i really don’t have any negative feelings toward v. i think that i would like to be able to spend more time and get to know him better. he’s quite private. there would be more opportunity for self-revealing that would lead to a deeper friendship if we lived closer. arguably the most profound shift in relationship dynamics among these study participants comes from mr. h, a retired, 66-year-old white, jewish man. mr. h shared his journey from what initially was overt racism toward his african american son-in-law to having overcome those feelings, leading to growing personally and, now, enjoying a fulfilling and open relationship with his son-in-law. mr. h reported his initial perception once he found out that his daughter was going to marry an african american. i did not know him well at all. i don’t know how long it took before i even met him. when they got engaged, my wife and i were on vacation, and i got a call that morning from my daughter that he had proposed to her. i didn’t know what to do at that point…. [i wondered] whether i should kill myself now or later. mr. h shed insight into the initial shift of perspective that he underwent from racism to how he feels today about his son-in-law. it started to shift as i got to know him. once they got engaged, they were married within a year, so i started to see him a little more. it wasn’t like it is now, because i think it was still a guarded kind of relationship. it definitely took me time to change my views and my opinion of him. i had only had a negative opinion of him because he was black. i hate to say that but i didn’t know anything else about him. mr. h articulated some of the events that occurred, both leading up to the marriage and afterward, that illustrate his process of accepting his son-in-law. he’s got a very good job. when they first decided to get married, when he first proposed, and i found out… he didn’t ask for my permission because he was afraid i was going to say no… but once they decided to get married, he ended up converting to judaism, which i thought was really something. i never expected it. i never brought it up. it was something he did on his own, and i think that made me really believe he’s the perfect one. he’s black, okay… it’s something i have to overlook and live in the 21st century. mr. h expounds on his current degree of closeness with his son-in-law, and the openness between them about their differences. we’re very close now. when he first became my son-in-law, we weren’t. he was always afraid of me, which i later found out. we do a lot of family things together, and he’s at my house, whether it’s for dinner or whatever the occasion, so we talk about a lot of different subjects, and about him being black and me being white. we talk a lot about racial issues, how i grew up and what i faced, and what he goes through being a black person. our relationship is very strong and we’re very advances in social work, spring 2021, 21(1) 164 open to one another. i’m not afraid to say how i feel, and we can discuss it. i definitely understand where he’s coming from. mr. h reflected back over the personal shift that he went through in accepting his sonin-law, a challenging situation that turned into a positive one: “i look at what it is and i think that i’ve changed for the better in that i’m much more open-minded today than i was years ago.” in these four cases, it was common for parents-in-law to experience some initial hesitation in relation to a child-in-law based on racial and/or cultural differences. these parents-in-law spanned a wide spectrum in terms of where they ended up regarding their current dynamic with their child-in-law. ms. f is still struggling; ms. g acknowledged that pluses and minuses remain; and mr. n and mr. h largely overcame their biased and racist viewpoints. theme ii: cultural barriers the theme of communication, language, and/or cultural barriers emerged in the relationships between parents-in-law and their children-in-law. one of the participants’ experiences was best categorized under this thematic umbrella. mr. t is an 83-year-old man from india, retired, with a phd in economics, whose 52year-old white son-in-law married into his family two years ago. mr. t painted a rich picture of cultural distinctions that exist between his own culture of origin and his son-inlaw’s culture of origin in the united states. this dynamic was highlighted when mr. t was asked about differences between his and his son-in-law’s parenting philosophies. in our culture, a child depends on the parent until he’s grown up and gets a job. lives in the same house. so, i think if there are parental differences, it’s because of culture. in this country, they send the child out after high school, to live on their own and earn money. not true in our case. if a child is less than 21, they are welcome to stay at home, we don’t kick them out. as the interview progressed, mr. t shared how his own cultural assimilation over time in the united states shifted his views and expectations of interracial marriage. i don’t see these differences anymore. partly because we have been here almost 60 years, we are conscious of american culture a little bit. we are not new here. we are part of the culture. i believe we are less indian now than we are american. otherwise, we would not have allowed this intercultural marriage. not that we would not have allowed, but she’s 21, or whatever, she can do whatever she wants, but the whole idea is we agreed to it. mr. t shared his thought process pertaining to acceptance of his daughter’s marriage to a white man from the u.s., further illuminating the culture barriers surrounding traditional marriage in india that he has overcome. if we had moved at a later stage, she might have been married to an indian anyway. of course, india is not just one country, there are different religions and castes, saviet & greif/relationships between parents-in-laws 165 parts, and each state has its own language and culture. therefore, she might have been married outside our community, outside our tribe. so maybe she would have been married to a quote un-quote foreigner for us, but it would not have been an american. while there were clearly cultural differences between mr. t and his son-in-law, these differences are no longer barriers, perhaps due to mr. t’s length of time in the united states, and the two enjoy a close relationship. theme iii: differences enrich four participants described the dynamics with their child-in-law as one in which the differences between them enriched the relationship. mr. n’s (already described in the “initial hesitation based on race/culture” theme above) story is one example of differences enriching a relationship. mr. n’s 36-year-old son-in-law, from guatemala, met his daughter in an english as a second language class she was teaching, and married into the family three years ago. mr. n explained the differences between his daughter and son-in-law: when l was in college, i imagined she would find a boyfriend there and marry someone who was from a similar socioeconomic background. it is natural for parents to think that ... i had to readjust my thinking when we realized that this was serious and that they were going to get married. l is obviously more educated than v, but v has lots of intuitive knowledge. i think that they’re well suited for each other because of that. he is equally intelligent to l but just hasn’t had the opportunities to get an education like she has. mr. n explained how the differences between his son-in-law and himself have impacted their relationship, ultimately strengthening it. i think that they enrich our relationship in a lot of ways. for example, having gone to guatemala and seen his parents and the culture, we have grown to appreciate the richness that a cross-cultural son-in-law brings to our family. v’s brother and sister and uncle live in baltimore, so we’ve had a chance to meet his extended family and celebrate christmas with them in some uniquely guatemalan ways. we have accepted v as part of the family and appreciate the cultural enrichment having him as part of the family brings. another participant, whose racial and cultural differences with her daughter-in-law have enriched their relationship, is ms. c, a 56-year-old african american woman who works as a registered nurse. ms. c describes a “very close” relationship with her 27-yearold filipino daughter-in-law. the daughter-in-law met her son, a military service member, when she was the server administrator for an online video game that her son also played. ms. c spoke to the cultural differences between her son and daughter-in-law. she is from the philippines. she was raised christian, so there is no religious difference there. they’re both really into computers and computer games. advances in social work, spring 2021, 21(1) 166 culturally, filipino women are very dedicated, very hardworking, and very loyal. so, truthfully, with his career, that’s the perfect kind of woman he needs. ms. c also elaborated on the cultural adjustment that her daughter-in-law experienced moving from the philippines to the united states. it has been a culture shock for her because she has not started looking for jobs outside the home. she just got all her paperwork allowing her to work officially outside the home. she was initially in culture shock because when she was in the philippines, she was used to working 10-hour days and making this crazy little amount of money. here they are starting at, like, $10 an hour. as she articulated the importance of the compatibility between her son and daughterin-law, as well as the close dynamic that has developed between her daughter-in-law and herself, it can be concluded that ms. c has always looked beyond racial and cultural differences. i feel like she truly was a great match for my son. they have such similar interests. they’re very even-tempered people. i really believe they were meant for one another. we literally talk about everything. there is no subject that she doesn’t broach with me. she told me about growing up, her relationship with her parents, the difference between them, and the health issues that she’s had. she hasn’t been secretive about anything. a third participant, ms. d, is a 76-year-old self-described homemaker, originally from india, who discussed her relationship with her 52-year-old white daughter-in-law who married into the family 21 years ago. ms. d suggested that, although she and her daughterin-law are from different generations and cultures, they have found a way in which these dissimilarities enrich their relationship. ms. d spoke to the initial political differences between the two women and the evolution that occurred. one of the best experiences i’ve had with my daughter-in-law is talking politics. when they got married, she was a southern baptist and a staunch republican. now she’s more a democrat than me. she volunteers, so when obama won, she and i had the best moment, and were on a high. one of the things that we have in common is we’re both democrats. she is very appreciative that she was a republican and i helped her get better informed. ms. d also spoke directly regarding the racial, ethnic, and religious differences between the two women. even though she’s southern baptist, she’s christian, and she believes in jesus as the son of god, she’s vedantic in many ways. so, religion has never been a problem with us. they’ve gone to india and she’s been very open to everyone there. all our relatives love her. she gives them something that is very genuine. she’s very forthright as we discovered. a final example of a relationship between a parent-in-law and child-in-law in which the racial and cultural differences enriched the dynamic comes from a 58-year-old african american k-12 female substitute teacher, ms. e, who was previously married to a man, saviet & greif/relationships between parents-in-laws 167 but is now married to a woman. ms. e describes the relationship with her 35-year-old white daughter-in-law who has been married to her daughter for seven years. ms. e set the stage for the interviewer by explaining her thoughts regarding the background of this relationship. first of all, i did not know that she was bringing a woman home, but that’s okay. when i dropped her off at college, i never knew that she would find someone of the same sex. i really didn’t imagine that for her. when she was twelve, she told me that she loved me, and that she didn’t care that i liked women. she said that it was okay but she was not going to be like that. and then i drop her off at college, and three years later she comes home with a woman. it was just… it was nice. it was relatable to me because, you know, i am married to a woman. ms. e expressed having a relationship with her daughter-in-law in which “we respect each other’s difference,” in this way portraying both the initial hesitation that she felt and subsequent openness with which she has addressed both her daughter’s lesbian relationship as well as the racial differences. because she was caucasian, i know there is a difference in the way they grew up. i did have some apprehensions about the fact that she married out of her race. don’t get me wrong; i don’t see anything wrong with that. it was just different. i had always seen her with young black males at the school when she went to the prom…well i think that was just a front…it was a good front, because it fooled me. i didn’t have any preconceived ideas about what i thought my in-law relationship would be. i just took it at face value and dealt with it that way. ms. e shared more about how and why the racial differences, and same-sex marriage, at play between her daughter and daughter-in-law have caused her concern and worry. the fact that she’s caucasian and my daughter is african-american, when i first thought about it, i was like ‘oh, okay.’ i recognize a difference and i hope and pray that they can come together. however, when you come from different backgrounds, sometimes it’s hard to maintain. in my generation growing up, i saw interracial couples being treated really badly. but they never told me anything that they had experienced about that. because they have a double whammy—they are gay and they are interracial. so, if you look at it from the right-wing perspective, i just pray that they don’t have to deal with the interracial relationship type situations that went on in my era. the above cases illustrate relationships between a parent-in-law and child-in-law in which the racial differences served to enrich the relationship. in summary, these dynamics are as follows: (1) mr. n, who regards the racial and ethnic differences as ultimately strengthening; (2) ms. c, who acknowledges the existence of stark cultural differences, but emphasizes the importance of the compatibility between her son and daughter-in-law; (3) ms. d for whom cultural and generational differences between her daughter-in-law and herself augment the relationship; and (4) ms. e, who describes a relationship in which respecting differences is the key ingredient for a wholesome and satisfying in-law relationship. advances in social work, spring 2021, 21(1) 168 theme iv: both minorities all eight of the nine cases described up to this point have involved either the parentin-law or the child-in-law being a racial and/or cultural minority, but not both of them. the dynamic changes with the final theme in which both the parent-in-law and child-in-law are minorities. mr. r is a 71-year-old retired executive coach who identifies as half-cuban and half-white. his 60-year-old native american son-in-law is married to his 46-year-old daughter. mr. r opened the interview by speaking to his concerns surrounding the age difference between his daughter and son-in-law. at first, i had concerns. i was worried about my daughter in their relationship. she is younger, so there’s that age difference, and i worried about her being able to pursue her interests and live her life. she’d never been married, and my son-inlaw is older, so i wasn’t sure how it was going to work. i worried that he would not give her the space she needed. she always lived by herself and didn’t have kids so she always made her own decisions. it’s hard to change that and your ways when you’re married and live together. mr. r described his son-in-law, and his racial/ethnic background, as follows: my son-in-law is of cherokee descent; he’s very proud of being cherokee. you can’t miss him; he’s a ‘big person.’ he is a good man, but i mean he really is a big guy, very, very tall. mr. r also described how the cultural differences in his relationship with his son-in-law influenced their relationship. if anything, i can relate to him in the aspect of being “other.” i am half-cuban, half-white, and i’ve lived here almost all my life, but i feel cuban, and we both share that, the being connected to our heritage. further along in the interview, mr. r shared how the bonding process that the two men went through related in part to their similar ages and in part to a shared interest. i see him as a friend, almost. we’re not that far away in age, so we can really talk and be around each other. not that long ago we had a really nice time, nothing special or planned; we were just spending time and having drinks. we ended up drinking a whole bottle of whiskey while talking. just two guys sitting, drinking, and talking about life. it wasn’t forced or weird and after that i really felt closer, like we had begun a friendship. toward the end of the interview, mr. r described his current sense of connection with his son-in-law. i feel close to him. we take cruises and vacations together. i care about him and there is this mutual sense of respect. he is a caring man and those are really big characteristics. saviet & greif/relationships between parents-in-laws 169 mr. r described a rich and unique dynamic between his son-in-law and himself, in which the shared experience of both men being racial and cultural minorities brought them closer. the above four themes provide a glimpse into the experiences of nine parents-in-law who are of different racial or ethnic backgrounds than their children-in-law. the following discussion section ties our findings to relevant literature, after which we address limitations and implications for social work practice. discussion consistent with research suggesting that, from the perspective of parents-in-law, inlaw relationships between the two generations are frequently viewed as positive (e.g., fingerman et al., 2012; merrill, 2007), most relationships in this study sample evolved over time, ending up in a positive place. nonetheless, struggles do exist in in-law relationships even when race and culture are not different, and such struggles often center around communication (marotz-baden & cowan, 1987; mikucki-enyart, 2011). taking the concept of struggle deeper, connidis and mcmullen (2002) discuss ambivalence arising in relation to structural contradictions manifest in interactions, such as family ties. the present study offers further support for these findings. in this study sample, struggles emerged related to culture and language, and mr. a’s relationship with his child-in-law from a different cultural background is an example of a relationship that began with pre-existing ambivalence, even though the ambivalence resolved over time. the experience of diversity within a family is a complex phenomenon. while we live in a racist society, the addition of a family member is enriching for many families (greif & woolley, 2018), and many individuals in society value seeing their son or daughter happily married. the current study suggests that this potential contradiction is one that can raise ambivalent feelings in a parent. parents may also value diversity, and even have a history of welcoming people of diverse races into their family, yet still wonder about how bi-racial grandchildren might fare. we hypothesize that people who marry someone from a different race or culture may have been raised in a family where acceptance of others was a byword, as we heard from ms. d and ms. e. while such openness to others could be handed down inter-generationally as a value (e.g., bowen, 1985), it may be experienced differently when individuals are asked to accept someone racially different from themselves into their family. bell and hastings (2015), reporting on parental disapproval, found that openness to others is a positive trait for parents-in-law. however, sometimes acceptance never becomes part of an interracial in-law relationship. not accepting a daughteror son-in-law may be due to a number of factors, which could include a parent-in-law feeling excluded by the couple (mikucki-enyart, 2011) or being unclear to what extent they are accepted, leading to ambivalence. the present research extends findings on acceptance by indicating that even when race is immediately identified as a barrier, and in some cases never overcome, families may forge ahead with their relationships. for example, race, as mr. h admitted, advances in social work, spring 2021, 21(1) 170 was the crux of his initial hesitation, although he was able to overcome it with both time and by getting to know his son-in-law better. still, differences can be difficult to surmount and, even if the parents-in-law come to accept someone of a different race or culture, others in their family or social network may never come around and can make family gatherings uncomfortable. greif et al. (2019), in their study of gay and lesbian couples, found that in-law relationships were often hampered by the extended network, even when the motheror father-in-law was accepting of the couple. the case of ms. e, in this study, an african-american mother-in-law whose daughter married a white woman, also emphasizes this finding. killian (2003) described how couples have to navigate talking about race, sometimes avoiding it. mr. r’s situation in this study paints an opposing picture. both he and his sonin-law consider themselves as an “other” within the majority society which helped to reinforce their relationship. his account underpins the part that race plays for both generations as they negotiate around their relationship and the broader society, and we see openness around race as a reason and catalyst for bonding. other researchers (e.g., greif & woolley, 2018) have found that fathers-in-law are closer with sons-in-law when there are grandchildren. that may be truer for same race marriages. in this study, the presence of grandchildren did not seem to impact relationships, perhaps because the legacy of carrying on family traditions is less clearly delineated when a grandchild is bi-racial or multi-ethnic. implications for social work practice social workers may receive a referral for, or be working with, families where an interracial marriage is planned or has already occurred. given that interracial couples experience more marital stress than same-race couples (brown et al., 2019), social workers may have to provide additional support to the interracial couple as they navigate both society and, as our research indicates, potential family opprobrium. to engage in these conversations, social workers must be aware of their own biases and beliefs. sue et al. (2016) advise, “the cultural perspectives of clients may often clash with the well-intentioned social worker, who must develop culturally appropriate intervention strategies in working with clients and client systems” (p. 22). cultural competence is an on-going process, sue et al. (2016) state, and involves understanding oneself and being, “… vigilant to prevent emotional reactions that may lead to a negation of other group values and lifestyles” (p. 39). working with parents-in-law around intergenerational issues, social workers will recognize that, as marotz-baden and cowan (1987) and mikucki-enyart (2011) suggest, while talking about race and ethnicity openly is not often easy, willingness on the part of parents-in-law to communicate in general and to discuss issues directly with their children-in-law can foster better relations. social workers can help lay the groundwork for encouraging open communication by raising the importance of the concept during sessions with clients. saviet & greif/relationships between parents-in-laws 171 social workers should also be attuned to the role that microaggressions may play in the relationship. according to sue et al. (2019), microaggressions can vary on a continuum from the overt, intentional and explicit, to the unintentional and implicit. parents-in-law, in an attempt to become closer to their child-in-law and solidify their relationship with their child, may not be aware of their own communications and behaviors which may be a reiteration of what their child-in-law is experiencing in broader society. for parents-in-law who are struggling in their relationship with a sonor daughter-in-law who is different from them, one approach is to educate them about the negative societal narratives around people of color—such as, asians or blacks, among others (robinson-wood et al., 2018)— to which they might be susceptible. furthermore, encouraging more inter-generational communication geared towards learning about each others’ family experiences and cultures of origin may also promote greater understanding and acceptance. finally, accepting that relationships can be ambivalent both with one’s child and one’s child-in-law can help normalize what a parent is feeling (connidis & mcmullin, 2002; turner et al., 2006). such an awareness can also lead to discussions about how the parentin-law, and potential grandparent of a multi-racial child, can become an ally in combatting racism by speaking out against it (sue et al., 2019). limitations limitations of this study include the use of a sample gathered at one point in time. family relationships can be highly dynamic (connidis & mcmullin, 2002), and an interview at another time could have produced different results. in addition, the participants usually knew the student interviewers and, because people are often uncomfortable admitting to feelings that might depict them as racist, this might have led to more contextually desirable responses. therefore, the nature of an in-law struggle may have been consciously or unconsciously denied. another limitation is that only one question was specifically used during the interviews to ask about the interracial nature of the marriage and the parent-in-law’s relationship with the child-in-law. additional questions would have allowed obtaining information about other family reactions to the interracial couple and the context in which the couple lives. certain regions of the country, and even neighborhoods, may be more friendly to interracial couples, which could result in less stress on them (killian, 2003). also, the educational level of the respondents was higher than the national average (census, 2020, table 3), which brings into question the generalizability of our findings. a final limitation was that multiple interviewers conducted the interviews. despite training, questions may have been asked by different interviewers in different ways. conclusion four overarching themes were identified in this preliminary exploration of interracial and cross-cultural in-law relationships. future research on in-law relationships could benefit from longitudinal studies (morr serewicz, 2008). changes in the social environment can affect how families are seen by society as well as by other family advances in social work, spring 2021, 21(1) 172 members, so studying interracial and cross-cultural families across time might help identify just how families are affected. while it might seem ideal, and enriching, for parents-in-law to positively embrace the addition of a family member from a different background, this does not always occur. in fact, as evidenced by the current debates around immigration policies in the united states, potential struggles emerging from a world health crisis where chinese have been viewed by some as blameworthy, and the 2020 racial protests views of race and race relations are continuing to undergo dynamic shifts. social workers working with interracial couples and their families must be knowledgeable about, and sensitive to, this ever-changing cultural environment and the fact that the environments may change dramatically from one geographic community to the next. references apostolou, m., philippou, d., andronikou, z., argyridou, k., kasapi, k., kourouklari, i., & anotniou, a. 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(2018). 2020 census to keep racial, ethnic categories used in 2010. https://www.npr.org/2018/01/26/580865378/census-request-suggests-no-raceethnicity-data-changes-in-2020-experts-say https://doi.org/10.1080/15267430802397161 https://doi.org/10.1080/01419870.2015.1015584 https://doi.org/10.1080/15267431.2010.537240 https://doi.org/10.1037/qup0000113 https://doi.org/10.1016/j.jesp.2016.05.008 https://doi.org/10.1037/amp0000296 https://doi.org/10.1111/j.1741-3729.2006.00428.x https://www.census.gov/topics/population/hispanic-origin/about.html https://www.census.gov/data/tables/2020/demo/educational-attainment/cps-detailed-tables.html https://www.census.gov/data/tables/2020/demo/educational-attainment/cps-detailed-tables.html https://www.npr.org/2018/01/26/580865378/census-request-suggests-no-race-ethnicity-data-changes-in-2020-experts-say https://www.npr.org/2018/01/26/580865378/census-request-suggests-no-race-ethnicity-data-changes-in-2020-experts-say saviet & greif/relationships between parents-in-laws 175 willson, a. e., shuey, k. m., & elder, g. h. (2003). ambivalence in the relationship of adult children to aging parents and in-law. journal of marriage and family, 65, 1055-1072. https://doi.org/10.1111/j.1741-3737.2003.01055.x author note: address correspondence to micah saviet, springer institute, cheverly, md, 20785. email: micah@springerinstitute.org https://doi.org/10.1111/j.1741-3737.2003.01055.x mailto:msaviet@springerinstitute.org this work is licensed under a creative commons attribution 4.0 international license. assessing receptivity to empirically supported treatments in rape crisis centers tonya elaine edmond rachel voth schrag abstract: survivors of sexual violence are at risk for ptsd, depression, and anxiety. there are several empirically supported treatments (est) that are effective for addressing these trauma symptoms; however, uptake of these ests among rape crisis center (rcc) counselors is low. this research project sought to determine counselors’ attitudes toward evidence-based practices (ebps); their perceptions of the intervention characteristics of three specific ests: prolonged exposure (pe), cognitive processing therapy (cpt) and eye movement desensitization and reprocessing therapy; and differences in attitudes and perceptions based on agency setting (urban/rural) and counselor education. the consolidated framework for advancing implementation science (cfir) was used to construct a web-based survey to send to all rccs in texas (n=83) resulting in an overall agency response rate of 72% (n=60) and responses from 76 counselors. counselors’ attitudes towards ebp and perspectives on specific ests suggest that dissemination and implementation efforts are needed within the rcc service sector to advance the uptake of cpt, emdr and pe. keywords: trauma; evidence-based practice; ptsd; rape; rape crisis centers sexual violence, including child sexual abuse, rape, sexual assault, and threat of sexual assault, is a serious and widespread problem in the united states. data from the national intimate partner and sexual violence survey find that nearly 1 in 2 women and 1 in 5 men have experienced sexual violence other than rape, while 1 in 5 women and 1 in 71 men have experienced rape in their lifetime (black et al., 2011). survivors of sexual violence face serious mental health consequences including ptsd, depression, anxiety, and substance abuse (jordan, campbell, & follingstad, 2010). although there is a strong evidence base for the effectiveness of several interventions at reducing trauma-induced ptsd, depression, and anxiety in survivors of sexual violence, there is low utilization of these interventions in rape crisis centers (rccs; edmond, 2004; edmond, lawrence, & voth schrag, 2016). rcc counselors indicate they have limited familiarity with, knowledge about, or training in key evidence-based treatments (edmond, 2004; edmond et al., 2016). this is not unique to rccs. broadly speaking, there is an underutilization of evidence-based treatments in mental health service sectors. numerous barriers to adoption of evidence-based treatments have been identified including: attitudes about evidence-based practice, intervention characteristics, costs, and access to training, supervision, and consultation (aarons, 2004; barnett et al., 2017; beidas, edmunds, marcus & kendall, 2012; dorsey et al., 2017; ragavan, 2012). in order to promote the use of effective treatments for ptsd in rccs, the current study sought to assess rcc counselors’ attitudes towards evidence-based practices (ebps) in general (i.e., how they _________________ tonya e. edmond, phd lcsw, is associate dean for diversity, inclusion, & equity and associate professor, george warren brown school of social work, washington university in st. louis, mo, 63130. rachel j. voth schrag, phd, lcsw, is an assistant professor, school of social work, university of texas-arlington, tx, 76019. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 611-629, doi: 10.18060/21338 https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2017, 18(2) 612 feel about movement towards the use of ebps), understand counselors’ perceptions of specific empirically supported treatments (ests) for ptsd, and evaluate any differences in attitudes and perceptions based on agency location (urban/rural) and counselor educational attainment. background rape crisis centers (rccs) provide critical services to survivors of sexual violence, including crisis intervention, medical and legal advocacy, and counseling (macy, rizo, johns, & ermentrout, 2013). rccs are frequently independent agencies doing work in individual communities, with over 1,000 rccs in the united states working together to run the national sexual assault hotline (rape, abuse & incest national network [rainn], 2017). evidence shows that survivors of sexual violence rate these services more favorably than those provided in other service sectors, including health care, legal, and other mental health sectors, and are more likely to access services from an rcc than another agency or system because they fear judgment or blame (campbell & martin, 2001; patterson, greeson, & campbell, 2009). thus, the rcc service sector serves a unique role in meeting survivor needs. systematic reviews of the adverse effects of childhood sexual abuse and sexual assault in adulthood reveal a broad constellation of psychological, behavioral, social, and physical health difficulties that negatively impact the lives of survivors (bohn & holz, 1996; campbell, dworkin, & cabral, 2009; jordan et al., 2010). ptsd, depression, anxiety, and substance abuse are among the most frequently reported mental health consequences and are often co-occurring (chen & ullman, 2010; jordan et al., 2010; kilpatrick, resnick, ruggiero, conoscenti, & mccauley, 2007; walsh, galea, & koenen, 2012). voth schrag and edmond (2015) found that for rcc counselors reducing symptoms of anxiety, depression, and ptsd were among the most frequently endorsed treatment goals. in their systematic review of the mental health impact of violence against women, jordan and colleagues (2010) report that the most common mental health consequence of sexual violence is ptsd, with 33%–45% of women experiencing it in their lifetime. the number of rape survivors, combined with the incidence of ptsd among survivors, has led rothbaum, astin, and marsteller (2005) to contend that “rape victims may constitute the largest number of ptsd sufferers in the united states” (p. 607). many survivors with ptsd suffer with persistent and debilitating symptoms that can severely impact functioning and quality of life by significantly interfering with marital and social relationships, and work and school responsibilities (foa, keane, friedman, & cohen, 2009). furthermore, women who have had multiple life-time victimizations have been shown to present with more severe ptsd symptoms (schaaf & mccanne, 1998). research has also shown that ptsd increases the risk of substance abuse (chilcoat & breslau, 1998; kessler et al., 1997) and in the aftermath of rape, many survivors use drugs or alcohol as a coping strategy (kaukinen & demaris, 2005; mcfarlane et al., 2005). largely because of the increased vulnerability produced by both the direct responses to trauma and the coping strategies survivors develop to confront it on a day-to-day basis, revictimization is also a serious concern. untreated ptsd and substance abuse have both been found to increase risks of sexual and physical revictimization (classen, palesh, & edmond & voth schrag/assessing receptivity 613 aggarwal, 2005; lalor & mcelvaney, 2010; steel & herlitz, 2005). women who have been sexually victimized once have a higher likelihood of being raped again by perpetrators who specifically target such vulnerability (macy, 2007). lalor and mcelvaney (2010) found that adult survivors of child sexual abuse/assault with both ptsd and depression are 13.7 times more at risk for experiencing some type of interpersonal revictimization. effectively treating ptsd enhances functioning and quality of life for survivors and serves as a form of prevention by reducing risks for future revictimization. in addition, the most effective evidence-based treatments for ptsd also have been shown to simultaneously and significantly reduce trauma-related depression and anxiety (bisson & andrew, 2007). yet in the face of clear need, survivors access mental health services at a low rate, with estimates ranging from 16.1% to 39-60% (campbell et al., 2009; golding, siegel, sorenson, burnam, & stein, 1989; zinzow, grubaugh, frueh, & magruder, 2008). for those survivors who do access mental health services, there is a strong evidence base for a group of effective interventions to treat ptsd and related trauma symptoms (depression and anxiety) in sexual violence survivors. cognitive processing therapy (cpt), prolonged exposure (pe) and eye movement desensitization and reprocessing therapy (emdr) have the strongest evidence for effectiveness in reducing ptsd symptomology among adult survivors. meta-analyses comparing these treatments have found all to be effective, with none demonstrating superiority (bisson & andrew, 2007; regehr, alaggia, dennis, pitts, & saini, 2013). these evidence-based interventions have been endorsed by several national guidelines for the treatment of ptsd including: the international society for traumatic stress studies (foa et al., 2009), the cochrane database (bisson & andrew, 2007), the u.s. department of veteran’s affairs (2017), the national registry of evidencebased programs and practices of the substance abuse and mental health services administration (nrepp, 2017). pe is an exposure-based psychotherapy approach for the treatment of trauma. pe starts with education about the therapy, common reactions to trauma, and ptsd. clients are taught breathing retraining skills to facilitate relaxation. there are two types of exposure: in vivo (real world practice) and imaginal (repeatedly retelling the trauma narrative). in real world practice, the client approaches situations that although safe, the client has been avoiding because of trauma reminders. during imaginal exposure, the client talks about the trauma memory repeatedly in the presence of the therapist to reduce fear and anxiety related to the memory. as homework, the client also listens to an audio recording of the trauma narrative (foa et al., 2009). cpt is a cognitive-based psychotherapy approach for the treatment of trauma. cpt starts with education about ptsd and trauma. the client is also asked to write a detailed trauma narrative that is read during therapy. the primary focus is on helping the client recognize the connections between thoughts and feelings and to develop skills to challenge negative or unhelpful thoughts and beliefs. particular attention is given to beliefs related to safety, trust, control, self-esteem, and relationships. the client is given homework after each session to practice skills for challenging faulty thinking patterns (resick & schnicke, 1993). advances in social work, fall 2017, 18(2) 614 emdr is an integrative psychotherapy approach for the treatment of trauma. emdr involves the use of an eight phase, three-pronged approach to treatment that targets past experience, current triggers, and future potential challenges. the eight phases include taking a good history and treatment planning, preparing the client for treatment, assessment, desensitization and reprocessing, installation of a positive cognition, body scan for physical sensations related to the trauma, closure, and reevaluation. specific procedural steps are used to access and reprocess information that incorporate alternating bilateral eye movements, audio sounds or hand taps to help the client achieve a sense of integration and resolution of the traumatic experience (shapiro & maxfield, 2002). despite the availability of ests to decrease ptsd among sexual violence survivors, and a clear link between ptsd and increased future sexual violence risk, there is low utilization of these treatments in the rcc service sector. in a nationwide sample of practitioners, edmond (2004) found that, while 91% of rccs provided individual counseling to survivors of sexual assault, only 50% reported the use of at least one of these ests to address the mental health needs of survivors. there is a clear need for information regarding promotive factors and barriers to est implementation in rccs. greater clarity about rcc counselors’ attitudes about est is needed to determine appropriate dissemination and implementation strategies. attitudes towards ebp and ests factors at the individual, organizational, and system level influence the implementation and uptake of ests, including practitioner attitudes and perceptions (aarons et al., 2012). a significant body of research has established practitioner attitudes as an important individual level factor that can influence est implementation efforts, with positive attitudes towards ebp in general identified as a key practitioner level factor for successful implementation efforts (aarons et al., 2012; herschell, mcneil, & mcneil, 2004; palinkas et al., 2008). aarons and colleagues (2010) identify a number of specific vectors through which practitioner attitudes to ebp can influence ebt uptake. they suggest that provider attitudes influence their choice to try new practices, the effectiveness of their implementation and fidelity to a model when using an ebp, and the likelihood of sustained use of an ebt. additionally, research is emerging suggesting that attitudes towards specific ests play an important role in implementation. in a study of practitioner attitudes, borntrager, chorpita, hilga-mcmilan, and weisz (2009) found that general ebp attitudes changed from pre to post-test based on factors such as the perceived adaptability of specific ests. similarly, reding, chorpita, lau, and innes-gomberg (2014) found that the appeal of a specific est is related to practitioner uptake of that est. to promote the implementation and uptake of ests to treat ptsd within rccs, this project sought to answer the following questions: (1) what are rcc counselors’ attitudes toward ebp in general? (2) what are their perceptions of the intervention characteristics of three specific ests: pe, cpt and emdr? (3) are there differences in est attitudes and perceptions based on agency setting (urban/rural) or counselor education? edmond & voth schrag/assessing receptivity 615 methods study design services provided by rcc counselors are critically important; however, much remains unknown about their attitudes towards ebp and specific ests for ptsd, and how those might differ by agency setting or counselor level of education. to gain perspective on these issues, a statewide web-based survey of texas rccs was administered during the summer/fall of 2013. the quantitative, cross-sectional survey was constructed with two different modules: one for executive directors and the other for practitioners providing individual and/or group counseling. the director module contained questions about respondent demographics, organizational characteristics, leadership style, and funding. the counselor module was comprised of questions about counselor characteristics and demographics; agency services provided and clients served; training obtained and desired; interventions employed; attitudes toward ebp in general; and views of three specific trauma-focused ests: cognitive processing therapy (cpt), eye movement desensitization and reprocessing (emdr), and prolonged exposure (pe). conceptual model evidence suggests that understanding counselor ebp attitudes in general as well as perceptions of specific ests can inform efforts to increase implementation of specific treatments. the conceptual framework for implementation research (cfir), developed by damschroder and colleagues (2009), merges aspects of 19 conceptual frameworks. it establishes five domains that together capture the key influences on the implementation of ests: intervention characteristics (evidence for the intervention, complexity of the intervention, adaptability of the intervention, and advantages the intervention has over others); outer setting (policies and incentives external to the agency as well as pressure from peers and clients); inner setting (characteristics of the organization setting and structure, culture, climate, and readiness for change); characteristics of individuals involved in implementation (their knowledge, skills, and attributes, and educational attainment), and the process of implementation. the cfir provides a menu of potential areas for research with the expectation that scholars select constructs that are most salient to a particular study or setting to guide their evaluation of the implementation process. within the intervention characteristics domain, the cfir provides guidance regarding key characteristics that influence counselor perceptions and intervention uptake (damschroeder et al., 2009). these include the source of the intervention (internal or external development), the evidence strength and quality for intervention effectiveness, the perceived relative advantage, the adaptability, trailability, complexity, design quality and packaging, and cost. the cfir suggests that taken together, these indicators will impact counselor uptake of a new est, and should be considered when designing an implementation strategy. the indicators of interest for this analysis were intervention characteristics, individual characteristics, and inner setting. the data comes from the counselor module. data from the director module examined organizational level variables and were analyzed and reported separately. advances in social work, fall 2017, 18(2) 616 measures evidence-based practice attitudes scale (ebpas). the ebpas (aarons et al., 2010) was used to assess counselor attitudes towards ebp in general. the ebpas includes 15 items measured on a 5 point likert scale, spanning four lower-order subscales and one higher-order factor (aarons et al., 2010). the four ebpas subscales include appeal, which assesses the likelihood of adopting an est if it were intuitively appealing (i.e., if it makes sense, or colleagues are happy with it), requirements, assessing the extent to which a provider would adopt based on employer or funder requirement, openness, which assesses openness to new interventions (i.e., willingness to follow a treatment manual, the attractiveness of therapy developed by researchers), and divergence, which assesses the extent to which a provider sees ests as less useful than clinical experience (i.e., the extent that they prefer clinical experience or view research-based treatments as not useful) (aarons et al., 2010). in aarons et al.’s (2010) national sample, the alpha reliability for the total scale was .76, and .81 for rccs. the total ebpas score with 15 items was used to compare the rcc sample to a normed sample of national mental health practitioners (aarons et al., 2010). the same national normed sample is used for comparison with the rcc sample on the four original subscales: requirements, appeal, openness, and divergence. additional ebpas subscales were added based on the expansion proposed by aarons and colleagues (2012). while aarons et al (2012) outlines eight additional subscales, we chose three to include in the current study due to their alignment with key cfir constructs. these domains include organizational support, which assesses the perceived role of organizational training, ceus, and assistance in the uptake of ebps. fit, which assesses the extent to which a treatment would be adopted if it felt right and met their clients’ needs and treatment approach, and limitations, which assesses the counselors’ perception of the limits of ebp to meet client needs or the extent to which it creates barriers to treatment (aarons et al., 2012). aarons’ and colleagues (2012) sample is used for comparison with the rccs sample for these three subscales because they were not included in the nationally normed sample (aarons et al., 2010). perceptions of empirically supported treatments (pest). the study team developed a single factor scale to assess counselor perceptions of three empirically supported treatments for survivors of sexual violence (pe, cpt, & emdr) based on the intervention characteristics domain of the cfir (damschroder et al., 2009; edmond et al., 2016). for each est, respondents were asked to provide their level of agreement on a 1-5 scale with ten questions tapping counselor perceptions regarding the evidence strength and quality, the relative advantage of that est over other treatments, the adaptability, and complexity of the treatment, and the cost or resource constraints caused by the treatment (see table 4). pest items also assessed perceptions of acceptability, appropriateness, and the counselor’s current level of knowledge regarding the est procedures and techniques. to create a global measure of est perceptions, items 4 and 10 were reverse-scored, and items were then totaled and divided by the number of items in the scale (n=10). higher scores indicate a stronger opinion of the est in question. in the current sample, the reliability alpha for the pest was .87 when administered for prolonged exposure, .86 for emdr, and .91 for cognitive processing therapy. edmond & voth schrag/assessing receptivity 617 procedures a comprehensive list of texas rccs was developed by the texas association against sexual assault (taasa), the state coalition (n = 83). each executive director of every rcc in the state received an invitation through postal mail and e-mail to participate in the study. the invitation included an endorsement from taasa. the executive director was asked to complete their module and to distribute the web-survey link to each of the eligible counseling staff to complete the counselor module. each participant was given a $20 gift card. prior to data collection, approval was obtained from the washington university irb. data analysis descriptive statistics including frequencies and central tendencies provide initial data regarding the sample and counselor perceptions. a chi-square test was used to assess differences in educational attainment by agency setting. two-sample t-tests were used to assess differences in ebpas total score and subscale scores between the rcc sample and aarons et al. (2010) normed national sample of mental health service providers. t-tests and anovas were used to assess differences in ebpas and pest scores by educational attainment and agency setting (rural/urban). missing data occurred due to attrition over the course of the web-based survey and were treated on an available-case basis (pigott, 2001). sample in the overall study, the agency response rate was 72%, with 60 rccs providing a minimum of one survey from either an executive director or a counselor. cases in which respondents indicated that counseling tasks were not a part of their job description were excluded from analysis. for this analysis the sample is comprised of respondents to the counselor-focused survey (n=76). results counselor demographics & characteristics. counselors were overwhelmingly female (95%), the majority identified as white (66.7%), and had been at their current agency for an average of three years (range= 1 month-18 years; see table 1). professionally, they were predominantly social workers (34.2%), although many of those without an advanced degree identified more with their job title (‘advocate,’ ‘counselor,’ etc.) than a specific profession. fifty-four percent had a master’s degree or phd, 22% had a bachelor’s degree, and 24% had less than a bachelor’s degree. nearly sixty percent worked in urban or suburban settings (see table 1). advances in social work, fall 2017, 18(2) 618 table 1. demographics for rcc counselors (n=76) frequency (%) mean(sd) age 39.5 (12.1) years of experience 7.8 (6.8) agency tenure 3.0 (3.5) gender (female) 71 (94.7%) race/ethnicity white 50 (66.7%) hispanic/latino 17 (22.7%) african american/black 3 (4.0%) american indian/alaska native 1 (1.3%) native hawaiian/pacific islander 1 (1.3%) more than one race 3 (4.0%) professional discipline social work 26 (34.2%) counseling 23 (30.3%) psychology 6 (7.9%) education 3 (4.0%) divinity/theology 2 (2.6%) criminal justice 1 (1.3%) job title 13 (17.1%) other 2 (2.6%) educational attainment high school degree 3 (4.0%) some college 15 (19.7%) bachelor’s degree 17 (22.4%) master’s degree 39 (51.3%) doctoral/equivalent 2 (2.6%) agency setting urban/suburban 45 (59.2%) rural 31 (40.8%) educational attainment & agency setting. significant differences were observed in level of educational attainment between rcc counselors working in rural and urban areas. among rural rcc counselors, 41.9% had less than a bachelor’s degree, 22.6% had a bachelor’s degree, and 35.5% had an advanced degree. comparatively, 11.1% of urban counselors had less than a bachelor’s, 22.2% had a bachelor’s degree, and 66.7% had an advanced degree χ2(2)=10.67, p<.01. counselor attitudes towards evidence-based practice. the rcc sample had a significantly lower ebpas total score compared (m=2.57, sd=.47) to aarons and colleagues’ (2010) normed national sample of mental health providers (m=2.73, sd=.49) t(1147)=2.51, p=.012, indicating less willingness to adopt evidence-based practices (see table 2). rcc counselors also had significantly different outcomes on several ebpas subscales compared to aarons’ 2010 and 2012 samples. differences were observed between samples on requirements t(1147)=2.87, p=.004; divergence t(1147)=2.84, p=.005; organizational support t(478)=4.72, p=.001; fit t(df)=4.34, p=.0001; and limitations t(478)=5.2, p=.0001 subscales. edmond & voth schrag/assessing receptivity 619 table 2. comparison of attitudes towards ebp among a national provider and rcc sample national mh provider sample1 rcc sample (n=60) two sample t-test p-value mean (sd) mean (sd) ebpas total score 2.73 (.49) 2.57 (.47) 2.51 .012* requirements 2.41 (.99) 2.78 (.97) 2.87 .004** appeal 2.91 (.68) 2.98 (.66) 0.79 .430 openness 2.76 (.75) 2.57 (.70) 1.95 .052 divergence 1.25 (.70) 0.99 (.72) 2.84 .005** organizational support 3.07 (.82) 2.54 (.86) 4.72 .0001*** fit 2.90 (.75) 2.46 (.72) 4.34 .0001*** limitations 1.28 (.91) 0.65 (.75) 5.20 .0001*** notes. for requirements, appeal, openness, & divergence, n=1,089, for org. support, fit, and limitations, n=420 mh= mental health, rcc= rape crisis center, *p<.05 , **p<.01, ***p<.001 within the rcc sample, no significant differences were observed in ebpas total or subscale scores between rural and urban counselors (see table 3). when comparing counselors by education level (no degree, bachelor’s, advanced), differences were observed in ebpas total score f(2)=8.55, p=.001; appeal f(2)=6.58, p=.003; limitations f(2)=5.72, p=.006; fit f(2)=5.72, p=.006; and organizational support f(2)=11.04, p=.000. counselors without bachelor’s degrees tended to have the most negative views of evidence-based practices, while those with advanced degrees had more positive views. table 3. ebpas score by agency setting and counselor education item total sample mean (n=60 rural mean (n=25) urban mean (n=35) less than ba (n=15) ba (n=10) masters/phd (n=35) ebpa total score 2.57 2.55 2.59 2.4 2.7 2.6* appeal 2.98 2.97 2.99 2.5 3.2 3.1** requirements 2.78 2.76 2.80 2.8 3.1 2.7 openness 2.57 2.55 2.59 2.3 2.8 2.6 divergence .99 .96 1.01 1.1 1.0 .96 limitations .65 .765 .565 1.2 .33 .49** fit 2.46 2.33 2.54 1.8 2.3 2.8*** org. support 2.54 2.44 2.60 1.76 3.1 2.7*** *p<.05 , **p<.01, ***p<.001 counselor perceptions of ests for ptsd. counselors had the most positive perceptions of cpt, followed by prolonged exposure and emdr (see table 4). cpt was rated the most highly across cfir domains, including evidentiary support, relative advantage, adaptability, and resource constraints, as well as on acceptability, appropriateness, and current level of knowledge. counselors endorsed emdr and cpt equally on complexity. counselors had mixed perceptions of pe and emdr across cfir domains, with pe scoring higher than emdr on adaptability and emdr scoring higher than pe on evidentiary support, relative advantage, appropriateness, and complexity. advances in social work, fall 2017, 18(2) 620 table 4. perceptions of est scale (1=disagree strongly-5=agree strongly) pe mean score emdr mean score cpt mean score 1. i have a good understanding of the procedures and techniques involved in [the est]. 2.9 2.6 3.3 2. there is a high quality, strong base of evidence demonstrating the effectiveness of [the est] in treating ptsd in rape & sexual abuse survivors. 3.4 3.4 3.6 3. the quality and strength of the evidence base around the effectiveness of [the est] makes me want to use it with my clients. 3.3 3.4 3.6 4. the procedures and techniques involved in [the est] are too complex to use with clients at a sexual assault program. 2.9 2.8 2.8 5. [the est] could be adapted, modified, and tailored to meet the needs of our clients within our program. 3.5 3.3 3.6 6. [the est] has advantages over other treatments for ptsd that make it a better choice for sexual trauma survivors. 3.1 3.2 3.4 7. i believe the use of [the est] is an acceptable treatment option for treating sexual trauma survivors with ptsd. 3.4 3.5 3.6 8. within our program, [the est] would be viewed as an appropriate treatment option for our clients. 3.1 3.3 3.6 9. with training and supervision i would be likely to use [the est] with my clients on an ongoing basis when appropriate. 3.4 3.4 3.7 10. it is not feasible to use [the est] in our program because of resource constraints and training requirements. 3.1 3.0 2.8 total scale mean: 3.2 3.1 3.3 among rcc counselors, significant differences in perceptions of emdr were seen between those working in rural and urban areas, with urban counselors rating emdr significantly higher than rural counselors t(51)=2.23, p=.031 (see table 5). no differences were seen between urban and rural counselors on their perceptions of pe or cpt. across all three ests, counselors with less than a bachelor’s degree had more positive views of the interventions than those with a bachelor’s degree. approximately 38% (n=23) of counselors reported having a “fair amount” or a “great deal” of training in cpt, compared to 17% in pe and 8% in emdr. edmond & voth schrag/assessing receptivity 621 table 5. perceptions of ests by agency setting and counselor education prolonged exposure emdr cognitive processing total sample mean 3.2 3.1 3.3 rural 3.3 2.9 3.2 urban 3.2 3.3* 3.3 less than ba 3.2 3 3.2 ba 3.1 2.9 3 masters/phd 3.2 3.2 3.4 *p<.05 discussion the mental health effects of sexual violence are well-documented, and effective treatments for ptsd exist that can help promote healing for survivors. however, there has not been sufficient uptake of these treatments by counselors in rccs, who are viewed as the primary response system in place to support victims of sexual violence. although rcc counselors had a lower overall ebpas score than aaron’s 2010 nationally normed sample of mental health providers, an examination of the seven subscales provides some useful information. the three subscales that the national sample more strongly endorsed were openness, organizational support and fit. these subscales reflect that the mental health counselors were more open to new interventions, were more influenced toward adoption of ests by organizational support, and had a sense that the intervention felt right and would meet their clients’ needs. interestingly, rcc counselors were significantly more likely to see fewer limitations in the use of ests and the mental health providers were significantly more likely to see ests as less useful than clinical experience (divergence). rcc counselors were also more likely to adopt an est if a supervisor, agency, or state required it compared to the national sample. both groups had comparable scores on the appeal subscale, reflecting equal likelihood of adopting an est if it were intuitively appealing. this suggests that rcc counselors could be receptive to adopting ests since they see few limitations and value them as much as clinical experience, if it is an appealing est and adoption is reinforced by organizational or funder requirements. these differences could be partly attributed to educational differences between the samples, with over 80% of aaron’s sample holding advanced degrees, and less than 3% having less than a bachelor’s degree. we found significant differences in counselor level of educational attainment between rural and urban settings, with rural rccs having significantly fewer counselors with advanced degrees and more counselors without a degree. they are providing critical individual and group counseling services to highly vulnerable survivors of sexual assault in geographic areas that often have no other options for mental health services. while it is clear that these counselors are the best and often the only resource available for vulnerable survivors, it is essential that we consider strategies for putting the best available treatments safely in the hands of counselors with bachelor’s degrees as well as those without degrees. given that the trauma-focused ests in question are all designed and implemented with advanced clinicians in mind, and that in some cases advanced degrees are required in order advances in social work, fall 2017, 18(2) 622 for counselors to receive training in the est, strategies for working in rural settings, in which providers face both geographic and educational barriers to est adoption, are needed. the fact that rural settings are nearly four times as likely as urban settings to be providing counseling through a non-degreed counselor, suggests that one such strategy would be identifying effective trauma treatments that can be implemented without a college education or with only a bachelor’s degree. both cpt and emdr have developed modified versions of these interventions that have been used by paraprofessionals to effectively treat ptsd and related trauma symptoms (bass et al., 2013; jarero, amaya, givaudan, & miranda, 2013; plouffe, 2007). evidence from the developing world suggests that this may be an option for under resourced areas in the united states. in the democratic republic of congo, bass and colleagues (2013) tested the implementation of a modified (cognitive only) form of cpt with psychosocial assistants. these paraprofessionals had experience with survivors of sexual violence, as well as case management and supportive counseling, but no educational credentials. using the group-based protocol, they were able to achieve significant reductions in ptsd, depression, and anxiety after just two weeks of training. similarly, jarero and colleagues (2013) piloted a randomized clinical trial to evaluate the efficacy of a modified form of emdr created for paraprofessionals (emdr-propara), for responding to acute traumatic stress. the outcomes showed that propara was significantly more effective in reducing post-traumatic stress symptoms than supportive counseling. rcc counselors are first responders who engage with survivors immediately after a sexual assault, and many of them are paraprofessionals, therefore, emdrpropara might be a viable intervention option for this service sector. given the limited amount of evidence available on these modified paraprofessional versions of emdr and cpt, their application in low-resourced, rural rccs would require careful evaluation to determine acceptability, treatment fidelity, effectiveness, and feasibility. other strategies for working in rural settings might include greater utilization of technology to deliver training, supervision and consultation to support the implementation of evidence-based interventions by counselors in rural communities with less than a master’s degree. social work might also adopt a strategy that medicine has employed to recruit doctors and nurses into rural communities and advocate for school loan forgiveness for msws to incentivize them to work in these low-resourced settings. an advantage to this strategy would be the ability to not only use evidence-based treatments, but also to strengthen the training and supervision of those with less education in their use. while there were significant differences in educational attainment between providers in rural and urban settings, there was no difference between urban and rural providers on their ebpas scores, suggesting that counselors from across service settings are equally interested in incorporating evidence-based approaches into their practice. there were however, significant differences by educational attainment. across ebpas subscales, counselors with advanced and bachelor’s degrees had more positive attitudes towards ebps in general than those without degrees. however, when assessing their perceptions of specific ests (e.g., cpt, emdr and pe), those with advanced degrees and those without any degree had consistently stronger endorsements than those with bachelor’s degrees. taken together, these findings suggest that implementation efforts aimed at rcc providers edmond & voth schrag/assessing receptivity 623 could be successful, and should make special consideration of differences in provider educational attainment and agency setting. counselors were asked to provide their perspectives on three ests for ptsd among sexual trauma survivors: pe, emdr, and cpt. among these three ests, cpt was the most favorably endorsed, with the highest ratings on measures of evidentiary support, comparative advantage, adaptability, acceptability, and appropriateness. counselor reactions to these intervention characteristics suggest that cpt may be the best candidate for implementation and uptake in rccs. therefore, implementation strategies to support the adoption of cpt in rccs need to be identified and tested. counselors’ perceptions of emdr and pe were more mixed, with more favorable perceptions of pe overall, but with emdr scoring higher than pe on a number of factors, including appropriateness, comparative advantage, and perceived complexity. urban providers also had significantly stronger overall perceptions of emdr than rural providers. given the familiarity and receptivity among urban providers, as well as the presence of higher numbers of master’s level counselors in these rccs, dissemination of information and education efforts might have the biggest impact for uptake if offered in urban settings. rcc counselors reported a lack of familiarity with the procedures, techniques, and evidence base supporting all three ests, as well as mixed opinions regarding their acceptability and feasibility. the most frequently endorsed response to questions regarding counselor perceptions of the three ests was “uncertain,” suggesting that counselors lack key knowledge about these ests. as such, efforts focused on dissemination of information regarding the procedures, effectiveness, and evidence base for these interventions could support counselors in making informed decisions around obtaining training and implementing these practices in their agencies. given that a practitioner’s perception of the empirical support for an intervention significantly predicts the chance of receiving training and using that intervention, implementation efforts could start with dissemination by educating the rcc workforce on the merits of these interventions (allen, gharagozloo, & johnson, 2011). community-based therapists with training in these interventions could volunteer to provide in-service informational sessions or introductory workshops at individual rccs, or at regional and state coalition meetings or conferences. this would give rcc counselors the information needed to decide whether it is a treatment approach that they would be willing to invest time and money into acquiring. that said, the standard costs of training for these ests would be prohibitively expensive for many rcc counselors given the typical salaries within this setting. consequently, trainers are encouraged to offer reduced costs or pro bono trainings and consultation to support advancing uptake of these treatments in rccs. it is also important to acknowledge that while ptsd is prevalent and needs to be addressed, many survivors seeking services do not have ptsd, but are struggling with other trauma symptoms such as depression, anxiety, low self-esteem, a lack of selfconfidence, self-harming behaviors and suicidal ideation, and/or relationship difficulties. although the evidence-based treatments for ptsd discussed in this paper are robust and tend to produce symptom relief across a number of symptom domains, they may not be the best intervention choice for every survivor. there may be other evidence-based treatments advances in social work, fall 2017, 18(2) 624 that would be a better fit given a particular survivor’s presenting concerns for example, interpersonal therapy for depression and relationship difficulties, dialectical behavioral therapy for reducing self-harming behaviors, or cognitive behavioral therapy or mindfulness based stress reduction for reducing anxiety and increasing positive coping. intervention selection should be driven by the treatment needs and goals developed collaboratively between the counselor and the survivor. evidence-based practice includes not just scientific evidence of effectiveness, but also practitioner expertise and client preferences (sackett et al., 1996). limitations. a number of limitations should be considered when evaluating the findings of the current study. these data comprise a small sample of counselors in a single state, all working at agencies that are members of the state coalition, and may not reflect the population of rcc providers across the country. additionally, due to the small sample size, multiple bivariate analyses were run on the same sample and potentially important control variables (for example, potential differences in education between mental health providers and rcc providers) were not included. the scale used to measure counselor perceptions of specific ests was developed for the current study, and although it is informed by theory and evidence, it should be replicated with larger samples in order to assess its validity, psychometric properties, and reliability. conclusion. participants’ attitudes towards evidence-based practices and perspectives on specific ests suggest that dissemination and implementation efforts should be made within the rcc service sector to advance the uptake of cpt, emdr and pe to address the impact of ptsd among sexual trauma survivors. however, given that cpt was perceived most positively by rcc counselors in terms of its intervention characteristics, initial implementation efforts could begin there. implementation strategies to support the adoption of cpt in this low-resourced, decentralized, nonprofit service sector could yield knowledge that would be 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(2015, january). frequently reported treatment goals and issues assessed among clinicians in rape crisis centers. society for social work and research annual meeting, new orleans, la. zinzow, h., grubaugh, a., frueh, b., & magruder, k. (2008). sexual assault, mental health, and service use among male and female veterans seen in veterans affairs primary care clinics: a multi-site study. psychiatry research, 159(1-2), 226-236. doi: https://doi.org/10.1016/j.psychres.2007.04.008 author note: address correspondence to: tonya e. edmond, phd, lcsw, george warren brown school of social work, washington university in st. louis, mo 63130 tee1@wustl.edu https://doi.org/10.1111/cpsp.12004 https://doi.org/10.1016/j.psychres.2007.04.008 mailto:tee1@wustl.edu tonya elaine edmond keywords: trauma; evidence-based practice; ptsd; rape; rape crisis centers background attitudes towards ebp and ests methods study design conceptual model measures procedures data analysis sample results table 1. demographics for rcc counselors (n=76) table 3. ebpas score by agency setting and counselor education table 4. perceptions of est scale (1=disagree strongly-5=agree strongly) table 5. perceptions of ests by agency setting and counselor education references _________ anjali fulambarker buehler, phd, msw, assistant professor, department of social work, governors state university, park, il. christine rogerson, phd, msw, lcsw, assistant professor, school of social work, radford university, radford, va. melinda gushwa, phd, licsw, associate professor and director, school of social work, simmons university, boston, ma. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 779-800, doi: 10.18060/24092 this work is licensed under a creative commons attribution 4.0 international license. “not the time for kumbaya”: an exploratory study of race-based caucusing in the social work classroom anjali fulambarker buehler christine rogerson melinda gushwa abstract: this paper describes the use of race-based caucusing in a foundation-level msw course focused on racism and other systems of oppression at a primarily white university in the northeast. this technique was chosen based on the desire to allow space for students to examine and dismantle their internalized racialized socialization. this strategy was used in three sections of this course across two semesters, and this paper describes the findings of focus groups conducted with students at the end of each semester to understand their experiences with caucusing and their perceptions of the drawbacks and benefits of using this strategy in the classroom context. we discovered that student experiences of caucusing centered around the separate spaces that race-based caucusing created. specifically, we learned from students that they had varied initial reactions to the idea of race-based caucusing as well as encountering challenges and seeing benefits to the strategy. as instructors, we provide our own experiences with caucusing and, based upon our analysis of the focus group data, conclude that this strategy yielded different results for bipoc and white students and offer some suggestions to aid other instructors considering implementation. keywords: caucusing, race-based caucusing, racism, social work education regardless of the class content or context, it is imperative to the accreditation and values of our profession to provide social work students with a comprehensive education on social and economic justice, structural power, oppression, diversity, and difference (council on social work education [cswe], 2015; national association of social workers [nasw], 2017). while this is the goal, it is our experience that discussions of these concepts are abstract and theoretical. further, we find that these discussions can, even if they do not intend to, reinforce white supremacy by focusing on disparities experienced by people of color (powell, 2013), resulting in the “objectification” of the communities of color and the students that belong to them. finally, the teaching of concepts related to racism can demonstrate an assumption that all students come from a place of racial privilege, such as the need of white students to “check their privilege” and erase or make invisible the experiences of students that identify as black, indigenous, and people of color (bipoc). these common components of class discussions simultaneously reinforce and normalize white supremacy to the detriment of students of color in the classroom. this paper describes our use of race-based caucusing in a foundation-level msw course focused on racism and other systems of oppression at a primarily white university in the northeast. this technique was chosen based on the desire to allow space for students to examine and dismantle their internalized racialized socialization while also avoiding the about:blank advances in social work, summer 2021, 21(2/3) 780 above-described manifestations of white supremacy. at the end of each semester, students were asked to participate in focus groups to share their experiences with caucusing. in addition to the themes that arose from the focus groups, we will also share our own experiences with caucusing and offer suggestions for instructors considering implementing this strategy in their classrooms. while this paper and the strategy of race-based caucusing focuses specifically on race, the authors acknowledge that we all have multiple, intersecting identities that impact one’s experience of racialization (crenshaw, 1991). while we did not provide caucusing experiences or analyze data based on these intersectional identities, we do think an intersectional lens is vital for understanding power and oppression, and this was reflected in other readings and coursework in this course. literature review racialization and racism omi and winant (1994) describe the historical and ongoing process of naming individuals to racial groups and ascribing certain characteristics or stereotypes to members of these groups as racialization. racialization, as a concept, situates race not as something inherent to us, but rather, as social constructs placed upon us. it should be noted that the power to create and shape these categories belongs to those in the dominant group (bailey, 1998) – the terms “racializer” and “racialized” used by gans (2017) denotes this power dynamic. this hierarchical system of racialization places one group in a dominant position over another group and results in different access to opportunity and resources, which are maintained and contested by the collective interests of racial groups, and govern racial relations (bonilla-silva, 2001). of course, this process of racialization occurs not only among or within individuals; it is systemic (omi & winant, 1994). in other words, wider societal culture and institutions embody the same racial assumptions and attributions. these assumptions do change over time, but they are embedded in a way that makes the racialization of groups “normal” (omi & winant, 1994). while a discussion of the intersections of race, class, gender, sexuality, and other identities is outside the scope of this paper, it should be noted that many of the authors discussed here do make mention of the importance of considering the different facets of identity and the way in which these shape the experience of race (and vice versa). whiteness, the racialization of white people, has broad and varying definitions, but includes the racial characteristics or assumptions, as described above, that are attributed to people that are seen as white (rasmussen et al., 2001). whiteness, through this multifaceted conceptualization, frames white people as outside of race and serves as the unnamed standard to which other groups are measured; with that comes the privileges that go unseen and that are embedded into societal systems (rasmussen et al., 2001). the acceptance of whiteness at the individual level can be described as internalized dominance, defined as the way in which one makes the notions of entitlement, and the myths and narratives that support this entitlement, a part of themselves (diangelo, 2006; hardiman et al., 2013). according to white racial identity development theory (helms, 2008), identity development is a process and through which white individuals may move from unconsciously accepting their whiteness and the privileges and power that come along with fulambarker buehler et al./not the time for kumbaya 781 it, to developing a non-racist conceptualization of their white identity (helms, 2014). while white individuals are taught to not see, and do not have to accept, the privileges that come with whiteness in order to benefit (mcintosh, 1989), helms’ (2008) theory asserts that white individuals develop schemas. these schema frame how one understands their whiteness, which can evolve to an identity that is not grounded in racism. this individuallevel manifestation of whiteness mirrors a broadened definition of white supremacy as a system, “a political and socio-economic system where white people enjoy structural advantages and rights that other racial and ethnic groups do not.” (racial equity tools, 2020b, para. 1). as discussed above, the power wielded by the dominant racial group results in the oppression of bipoc (young, 1990). the racialization of bipoc as subordinate stems from an explicit history (omi & winant, 1994). as the other side of the coin of privilege, oppression occurs at multiple levels including cultural, structural or institutional, individual or personally-mediated, and internalized (demos et al., 2007; dominelli, 2002; jones, 2000). at the individual level, oppression describes the limits, inhibitions, and restrictions that are placed upon bipoc (frye, 1983). we see these restrictions in the lived experiences of bipoc as they move through the world, interacting with other individuals and systems, facing discrimination, marginalization, and stereotypes. importantly, as mentioned above, the sole focus only on these disparities can disguise the structural or systemic forces that cause the disparities (powell, 2013). structural racism, or structural racialization, as described by powell (2013), is “when structures unevenly distribute opportunities or depress life chances along the axis of race” (p. 3). another conception of oppression is that of the “five faces of oppression” that describe the different ways in which oppression happens (young, 1990). notably, this framework describes oppression experienced across multiple identities such as race, gender, class, and sexuality. this allows for the understanding of the connection of different oppressive experiences across groups and within groups, as is the case with bipoc. these “faces” of oppression include: exploitation, marginalization, powerlessness, cultural imperialism, and violence (young, 1990). just as with whiteness, the oppression exerted upon bipoc does not require conscious acceptance. because we all “steep” in a racialized culture, we as individuals come to internalize the ideologies associated with race. bipoc experience not only internalized racism, which can be described as the ways in which one takes in or believes negative messages about one’s group (jones, 2000); but also importantly the internalized resistance to this oppression or the internal and external actions that racialized folks take on to counter these oppressive messages (sue, 2003). becoming aware of these internalizations and working to counter them, as well as working to change the institutions that reinforce them, is necessary to achieve social and racial justice. social work education as the mission of social work education is focused on pursuing social justice, ensuring the equitable access and opportunity to resources (e.g., income, wealth, education, health care, etc.), and the ability to “come as we are” for to participate in society. put another way, the goal of social justice “is full and equitable participation of people from all social identity groups in a society that is mutually shaped to meet their needs” (bell, 2016, p. 3). advances in social work, summer 2021, 21(2/3) 782 social justice requires that individuals not only have access to spaces, but are accepted, heard, and valued in these spaces as their full selves. another key component to achieving social justice is focused on removing structural sources of oppression (young, 1990). specifically, racial justice is focused on dismantling structural racism, as the source of inequities, to allow the full participation of bipoc. to work toward social, and specifically racial justice, social work education must be grounded in frameworks that align with social justice principles. anti-racism education focuses on preparing students with not only the knowledge about oppression, as described above, but also the opportunity for students to engage in their own process of self-reflection (ladhani & sitter, 2020) and to situate themselves within power structures. similarly, adams (2016) advocates for using a social justice education pedagogy (sje) that utilizes learning strategies that align with social justice principles and engage students actively with the content (adams, 2016). the sje pedagogy posits that social justice is also a process that should mirror this goal (adams, 2016). ladhani and sitter (2020) call for a revival of anti-racist education, both institutionally and in the classroom, to counter “hegemonic discourses” (p. 60) in academia. in the classroom, the authors advocate for the use of activities that can help students to practice critical selfreflection (ladhani & sitter, 2020). similarly, sje pedagogy makes a purposeful connection between the explicit and implicit curriculum, with social justice content and strategies that work to dismantle the ways in which power dynamics are reproduced in the traditional classroom (adams, 2016). the use of caucusing allows the classroom process to be one that can further the “full and equitable participation” of students of color in discussions about racism (bell, 2016, p. 3). landhani and sitter (2020) also propose racial identity caucusing as a strategy to confront internalized racism and dominance. using the approach of race-based caucusing is one way that allows for experiential learning and exploration of oneself in relation to course content on power and oppression. race-based caucusing caucusing is a strategy that asks people with shared identities to come together to discuss a specific topic. race-based caucusing, or sometimes called affinity groups (abdullah & mccormack, 2008), is a strategy used in diversity, difference, and social justice education contexts (adams, 2016). race-based caucus groups can be useful for making separate spaces where individuals can do the different work required of white people and bipoc (racial equity tools, 2020a). these groups provide a space for individuals to explore their experiences and questions separate from those that do not share their identity (bell et al., 2016). this strategy has been employed in multicultural training settings (obear & martinez, 2013), within academic institutions generally (michael & conger, 2009; myers et al., 2019), and within the classroom (hudson & mountz, 2016; walls et al., 2010). caucusing is useful for participants to find affirmation and growth through their shared experiences, support, and an opportunity to practice discussing race and racism (abdullah & mccormack, 2008). specifically, caucus spaces allow white people to learn about their privilege and role in anti-racism work without placing the burden to teach them on people of color (western states center, 2003). in a classroom setting, white students are asked to discuss and critically reflect on privilege, guilt, and fulambarker buehler et al./not the time for kumbaya 783 bias, both implicit and explicit, in a space that does not further marginalize students of color (hudson & mountz, 2016). they also provide a space for people of color to find support and solidarity (western states center, 2003) and interrupt the patterns of whiteness and white dominance that are found in integrated spaces (blackwell, 2018). current study: race-based caucusing for this study, students participated in a race-based caucusing experience as part of a course focused on racism and other systems of oppression. students in each class participated in either the group of white students or students of color. students who selfidentified as white participated in the white student caucus, and the students that selfidentified as bipoc participated in the students of color caucus. a week before the first caucus, students were introduced to the concept of caucusing, along with a reading (western states center, 2003, pp. 73-75) describing the caucusing process. the concept was also introduced within the classroom as an opportunity for all students to engage in dialogue with the understanding that each group has different, albeit important, work to do to address their own racialized socialization. during the first session, students were asked to develop their own guidelines or rules for their subsequent caucusing sessions. in addition, the instructor provided general tasks or purposes for the group, upon which the groups were invited to expand or edit. for example, the students of color group was asked to focus on sharing their experiences of racism and their different experiences between and within different racial/ethnic groups and support one another while identifying their strengths. white students were asked to focus on identifying and recognizing their own participation in systems of racial domination and their internalized dominance. each group’s purpose was designed to encourage group members to focus on the intended work and goals of race-based caucusing (western states center, 2003). to also focus the caucus discussions, each group was given a handout with different discussion questions designed to help them to explore course readings through the lens of their caucusing group. caucusing groups met between four to six times during the semester for approximately 30-60 minutes. students met with their caucus groups in separate rooms, with one group of students leaving the primary classroom and the other group staying. due to space constraints, the smaller group in both classes during one semester was asked to leave the classroom, as a small conference room was the only available space. for the class in a subsequent semester, a larger second classroom was secured, and the groups took turns leaving the main classroom. students in the initial two sessions facilitated themselves using guided questions prepared by the instructor (buehler) who moved back and forth between the two rooms for observational purposes. during the third semester, students in each group still took turns facilitating; however, both the instructor and a doctoral student (rogerson), conducting a teaching assistantship in the course, were able to be present in both rooms consistently. the instructor stayed with the students of color group, and the teaching assistant stayed with the white students, and both instructors were available at all times for clarifying or interjecting. in all classes, a focus group was conducted at the end of the semester to learn about students’ experiences with caucusing and their perceptions about the strategy’s benefits and drawbacks. advances in social work, summer 2021, 21(2/3) 784 method to better understand and identify the lived experiences of students involved in racebased caucusing within the social work classroom, a phenomenological approach was used to gather qualitative data. both the how and what people view as part of this shared experience were examined to determine the essence of race-based caucusing in the social work classroom (creswell, 2013). the main purpose of this exploratory study was to examine students’ experiences and the perceived benefits and drawbacks of using identitybased caucusing groups. all procedures were approved by the university institutional review board. sample race-based caucusing occurred as part of the curriculum in a class focused on racism and other systems of oppression. all students enrolled in dr. buehler’s sections of the course during two semesters (three sections total) participated in race-based caucusing activities throughout the duration of the course. for the study, informants were limited to students who were enrolled in the course and volunteered to participate in a focus group at the end of the semester. data collection students in each class were informed by the instructor two weeks prior that focus groups would be conducted during the regularly scheduled class time and that their participation would be completely voluntary. students were provided with written informed consent information sheets, and verbal consent was obtained (a waiver for documentation of consent was granted). dr. gushwa, serving as facilitator of the focus groups, provided students that did not want to participate in the focus group an opportunity to leave the classroom before the start of the focus groups but after the instructor(s) left the classroom. this technique prevented the instructor(s) from knowing the identity of students that chose to participate in the group. the focus groups were conducted within each class, with both caucus groups together. the focus group engaged informants in a dialogue about their experiences. the questions posed to students included: 1) “what were your initial reactions to the idea of using race-based caucusing in this course?” 2) “did your feelings about the caucus groups change over the semester? if so, in what ways?” 3) “what were the benefits of using caucusing groups in this course?” 4) “what were the drawbacks of using caucusing groups in this course?” 5) “what overall feedback do you have on the process and implementation of caucusing groups in this course?” a total of thirty-six students were enrolled across all three sections of the course, and thirty-five students chose to participate in the focus groups. the racial identity, or any other potentially identifying information, was not collected in order to minimize the risk to confidentiality, as the class sizes were small. as a point of reference, at the time of the study, 27% of all students enrolled in the msw program (both fulland part-time programs) at this institution identified as african/african-american, latinx, asian or native american. additionally, fulambarker buehler et al./not the time for kumbaya 785 81% identified as female, 15% as male, and four percent of the students did not answer this question. data analysis procedures a hermeneutic phenomenological lens was used in data analysis to interpret and explore meaning as to how students experienced race-based caucusing in the social work classroom (van manen, 1990). the methodology first focused on what the students experienced during race-based caucusing. focus group transcripts were analyzed and coded by two researchers to explore general themes and shared experiences. the researchers met to discuss initial codes, explore meaning, and condense the experiences shared into the essence of race-based caucusing, as shared by the participants (van manen, 1990). thematic analysis was used to isolate themes and build a description of the experience (van manen, 1990). this approach allowed the researchers to utilize their experiences related to their own racial affiliations while acknowledging the difficulty in separating bias from student experiences (van manen, 1990). findings analysis of data generated from the focus groups is presented based upon the answers that students provided to focus group questions, specifically their initial reactions to caucusing, their experiences within their separate caucus spaces, and the benefits and challenges to caucusing. for direct quotes reported below, we indicated from which focus group (class) the comments came. since both caucus groups in each class participated in one focus group and we did not collect student’s racial identity, we were only able to draw conclusions about experiences for students in different caucus groups if they mentioned the caucus group in which they participated. after reporting student reactions to each topic, the authors will offer their own experiences with caucusing. these findings will be further interpreted in the discussion, and the authors will offer recommendations for instructors that may decide to utilize this approach in their classrooms. initial reactions students were initially asked how they felt about the idea of race-based caucusing when it was introduced at the beginning of the semester. student conceptions around the topic varied significantly, with some students feeling confused and apprehensive, others feeling threatened and discriminated against, and some excited. the confusion that some students expressed came from not understanding the purpose of caucusing or what caucusing even was. it felt weird, at least for me, trying to figure out the purpose of the group and how it would be integrated into the classroom. (focus group #1) i thought it was kind of odd but i trusted anjali and i thought, well, if she’s asking for it, there is some point to it. (focus group #3) advances in social work, summer 2021, 21(2/3) 786 initially i didn’t really understand what the goal was at first, just preliminarily. (focus group #2) i didn’t even know what caucusing was. i wanted to know more, but i was curious. (focus group #1) i would second that of just being intrigued— how is this going to go? i don’t know? (focus group #1) some students echoed this confusion along with the addition of some apprehension, making more specific mention of the utility of white students and students of color working separately. for these students, it was unclear how discussing race and racism without people of different races would be productive. …but at first i thought how will we make progress if we aren’t talking together. (focus group #2) a little nervous— it was the first time it kind of feels counter-intuitive to what we usually try to do. (focus group #1) some students also experienced discomfort because the prospect of separate caucus spaces brought to light racial differences, especially illuminating a lack of diversity in the classroom. in all sections included in this study, the number of students of color was smaller than that of white students. additionally, the feelings of discomfort, particularly for students of color, were expressed by feeling discriminated against or segregated. due to space constraints during one semester, the smaller group often was asked to move to another (smaller) space during the caucusing exercise, and some students noted this as a negative experience: at first it felt uncomfortable just the size of the group, the students of color caucusing was very tiny, kind of felt segregated. (focus group #1) i felt, at first i really didn’t like it, wasn’t open to it, kind of discriminated against, like we weren’t good enough to be with the white group, she sent the minorities to the small room and i kind of took it like sending the black people to the back of the bus. (focus group #2) i remember thinking, who are they going to make leave the class? (focus group #3) i texted my husband and said, i told you they are going to make the black people, the people of color leave first. (focus group #3) the questions about separate spaces and sentiments of apprehension were also present when students shared their curiosity and concern about what would be happening in the other group. i felt like what is the other group going to say about us? is it negative? there was some apprehension. (focus group # 3) i think it gave everyone, most of us, the element of “what’s going on in the other room?” (focus group #3) fulambarker buehler et al./not the time for kumbaya 787 i remember in the first couple of ones, a big part of me was wondering what the other group was saying, i wanted to be a fly on the wall. (focus group #2) in contrast to the reactions of discomfort, apprehension, and confusion expressed above, other students shared their excitement for the opportunity to be in separate spaces. for these students, there was an opportunity that race-based caucusing would allow. the students that were excited seemed to have previously heard about caucusing. i had heard about caucusing and affinity groups before and what i heard, they can be pretty effective and i was pretty excited for it. (focus group #3) i was super excited because i’ve been trying to start race-based caucusing as part of my day job. (focus group #1) i was excited. it felt, like good, it was a relief. (focus group #3) in response to the above comment, a student shared, i can agree with that, it was an immediate sense of solidarity and talking about things since we started. (focus group #3) i would second that too— i was excited because it seemed like the best space to be going in because the instructor was really great, and this was a good environment and it seemed like it would be fostered really well. (focus group #3) both students of color and white students expressed openness and concern in their initial reactions to the experience of caucusing. the initial reactions of students were varied and based upon both their prior experiences and the introduction of the topic. we found that there was also a range of reactions in their descriptions of their experiences in their separate caucus spaces. separate space experiences students had varying experiences within the separate spaces they occupied for their caucuses. by design, these separate spaces were intended as a place for reflective thinking using guided questions to challenge their personal and professional socially constructed identities and infrastructures of power and oppression. experiences within the separate spaces ranged from feelings of solidarity and connection to disappointment and missed growth opportunities. challenges student perceptions of the challenges of race-based caucusing included having differing expectations of how the caucus groups would interact with one another and missed opportunities for growth. there were different expectations among students about if and how they should come together after separate caucuses. some white students felt allowing white students to be in a group without a person of color did not create a space that holds people accountable for their biases. for other students, there was a desire to share more space together in order to hear about the process or experiences of other students rather than from a standpoint of accountability. however, not all students, particularly advances in social work, summer 2021, 21(2/3) 788 students of color, shared this perspective of wanting to always have more shared space. the other challenge was experienced specifically by individuals in the white student caucus. they expressed disappointment that opportunities were missed, at times, to challenge structures of oppression. some white students expressed frustration with their experience in the white student caucus because it was superficial and fell short in challenging the members on their privilege and complicity in the system, potentially wanting a facilitator to challenge beliefs, statements, and biases. differing expectations. students expressed varying expectations regarding what should happen after caucusing. some students felt the experience of students of color should be the focal learning point to help white students understand. others felt white students should report back or come back together as a larger group as a way to be accountable to others and themselves. i was hoping that the white caucus would report to the people of color caucus so there would be some accountability to what we discussed— that’s how i’ve seen it before— so we could report actions out of it. (focus group #1) but the accountability piece, it felt there wasn’t a lot of accountability in the room, and a lot of power in the room, we could talk about what was comfortable because we didn’t report out-it felt like it perpetuated some power dynamics for me. (focus group #1) i think on top of being uncomfortable and like not coming together at the end with a group discussion, i think that it was kind of difficult because the questions were so… like we weren’t really able to learn from the other perspective, in my case i would have wanted to know how people who don’t identify as white experience similar situations and we never got to do that as a group. (focus group #2) i agree. when you think about it, what really was the purpose of it? i think one of the reasons why we are here is to learn and grow and when we are separate we aren’t really doing that. (focus group #3) for other students, the desire to come back together was more about wanting to hear about the process or topics discussed in the other group, perhaps from a place of curiosity or closure rather than accountability. we were wondering if others were having the same conversations, but it we come back to class, and then sit awkwardly-we were waiting for a day of caucusing so that we can talk together and see, i really appreciated our second to last caucus where we came together because it felt like a complete session instead of waiting around and not being a follow up to it. (focus group #1) it kind of felt like i wanted more, like i didn’t get the closure for us. i was hoping we would talk about what we had discussed, what our experiences were like all together. (focus group #2) i also think it could have been really helpful to, in the same day, have caucuses and then come together rather than do it on a separate day because that would force us to have a brave space, because the day we did check ourselves on whether fulambarker buehler et al./not the time for kumbaya 789 we were actually doing the work was when people were becoming vulnerable. (focus group #3) i really appreciated that we did come back as a group at our last caucus to share together, but i do think that it was beneficial that we did a few individual caucuses without that at first, personally if only kind of sort of feeling left out because you want to think that you can provide the same safe environment as a white person as you care, and maybe that’s not true, having a few sessions were we didn’t come back, it helped me to learn. (focus group #1) this previous comment, from a white student, echoed comments shared by students of color who did not feel the need to share space because the separate spaces were more comfortable and needed. these students felt the separate spaces provided an opportunity for safe conversations in a manner that was different from everyday interactions in a primarily white institution. people of color need that space among white people because we go through things differently, that space and time is effective and i don’t think it should always be a time to come back together, to pretend to be kumbaya. (focus group #3) i felt more comfortable sharing things with the minorities than i would have with the dominant group. (focus group #2) i don’t know if it was our group was so tiny, i found that we kind spoke about the question without even reading the questions ahead of time...we had answered them, it felt natural (focus group #1) i don’t know-i don’t know if i would have been as open with a white instructor [observing the student of color caucus]. (focus group #3) missed opportunities. another challenge that mainly white students expressed was that they felt the experience was a missed opportunity for further growth. these students saw their discussions as superficial and wanted to see more in-depth discussions that dissected and addressed racism and oppression to move towards core systemic change. students attributed these missed opportunities to a lack of facilitation and peer challenges without an outside faculty facilitator. i liked it less as the semester went on because i don’t think we did as good as a job of facilitating ourselves. the white group— i wish there was someone there to challenge us more, it was just kind of an echo chamber of being white— maybe if there were two faculty members. (focus group #1) just to give you some diversity, i had a different experience, i was initially really excited and ended up feeling pretty disappointed, i didn’t feel like we were as pushed as i was hoping we would be. i wanted more discomfort, in other words. (focus group #2) i think and when we did the white caucus we kind of discussed in the first couple of caucuses as well, we were coming to the class kind of tentative anyway, knowing we were going to learn about ourselves, being white and whiteness, we were advances in social work, summer 2021, 21(2/3) 790 willing to learn, but we learned early on that white people should have a voice in the racism conversation and debate, but maybe that we didn’t have the tools to do that effectively on our own. (focus group #2) i personally thought it could have been more beneficial to have a little more facilitation in our caucus because it felt disorganized or that we were rushing through things a lotthere were significant tensions and issues that arose in our caucus at times, to be able to have some kind of structure could have been helpful. (focus group #3) benefits students also shared the benefits they found in their experiences with race-based caucusing. some experienced solidarity; others stated the separate spaces allowed for different work to be done, as well as an increased appreciation of others and the ability to have conversations that might not have been possible in the larger group. growth. students shared experiences that represented growth that resulted from their participation in caucusing. this growth was related to learning from one another and about one another. these learning experiences allowed students to recognize the differences they shared with one another even though they were in the same caucusing groups, as well as their similarities. i thought it was interesting that we were talking about privilege, in a way this was an example of dismantling oppression in the sense that because we are all unified by being the same race, it doesn’t mean we agree to the same norms. like because we are all white, we have the same perspectives, but that’s not true— we have different perspectives on race and racism, so i think there was growth in that area. (focus group #3) i think that having the focus on a dedicated opportunity to discuss the topic was something that i feel like i don’t get enough of in my life, even though i put my spaces and communities to find that, so to have that space that was carved out and devoted to that— i felt that it should be everywhere. (focus group #2) actually doing it pushed me out of my comfort zone because there’s only so much you can learn in the classroom. anjali said it would challenge us, and it did-that was beneficial. (focus group #1) the people of color group, we came from very different backgrounds, so it was interesting to hear everyone’s point of view and how there was commonalities of experiences of oppression and the differences as well. (focus group #2) i thought that it was very beneficial just because we were a caucus of people of color but not from the same ethnicity but not with the same experiences. (focus group #1) connection. another benefit shared, particularly by students of color, was the bonds and connections they formed with the other students in their caucusing group. solidarity fulambarker buehler et al./not the time for kumbaya 791 was developed through shared experiences and exploring their differences. the experiences of being able to develop friendships came from being able to have a space to share and be able to be themselves, particularly in a primarily white institution. i can say that in the people of color caucus group, we definitely developed a nice little bond, i feel like when we broke out into groups, we had fun, it was positive, we attributed it to the caucus group positivity because we got together, had fun, and worked and made friendships. (focus group #2) i agree, in addition we did develop a bond where we were comfortable in expressing how we felt, we all mattered, but we came from different places, but we had differences. (focus group #2) i feel like it strengthened relationships that probably wouldn’t have been fostered had we not separated. i feel like we’ve gotten stronger collectively. (focus group #3) it was a benefit—it was a little freedom, it was freedom, it was showing what [name of institution] could be if it would lighten up and let in some diversity. (focus group #3) i felt like i was able to connect more with my peers in our [student of color] caucus group. we were able to be open and honest. (focus group #1) student experiences of caucusing were varied and provided insight into both the successes and shortcomings of this strategy to dismantle white supremacy in the classroom. as instructors, we had our own processes, perceptions, and feelings about using race-based caucusing in the classroom. below we share these experiences to illuminate not only the product of race-based caucusing but also the process. instructor perspectives the course instructor, a bi-racial woman of color, led the first two courses, and in the third section, a white doctoral student joined the class as a teaching assistant. with this addition, each caucusing group had an observer/facilitator. the authors believe both the instructor and teaching assistant experiences of race-based caucusing provide additional context for the study. their experiences are as follows: course instructor my initial decision to start incorporating caucusing came after teaching this course for several semesters and recognizing patterns in my attempts to facilitate a discussion with the whole class around racialized socialization and participation in systems of power and oppression. it was clear that white students “tip-toed” around discussing their whiteness in a way that signaled their participation in the system. assigned readings were focused on power and white supremacy, but class discussions often turned abstract, with students citing “they” or “the system.” students also discussed the consequences of racial oppression, with many white students talking about people of color as an abstract “other.” advances in social work, summer 2021, 21(2/3) 792 it felt like these conversations occurred to the detriment of students of color, and some shared that it felt like a class meant for white people, not them. i sought to provide a space where students would have more critical and hands-on experiences discussing race and racism and their own internalized racialization. it felt a bit controversial to introduce the concept of race-based caucusing to students. students reacted with shock and confusion to the idea, and my nervousness about employing a new technique added to my apprehension. in the first semester, when i was the only instructor, i would move back and forth between the rooms to listen to both caucuses, and at first, it was definitely awkward for students. as the semester went on, students seemed to adapt to both the concept and the routine of caucusing, as well as my presence in the room. like my co-author, i noticed that white students focused on feeling “bad” or “guilty” about the oppression that people of color experience. i worked to develop discussion questions that would push white students to talk about whiteness and their complicity in white supremacy; however, there certainly was room for more critical discussion. i also was able to witness the positive impact that the experience had on students of color. as was demonstrated in their quotes above, it was a space that enriched their experience in the class and the institution. in both the first semester on my own and in the semester with a co-instructor, i observed positive experiences and heard from students that it was valuable. there were certainly some unanticipated considerations, successes, and challenges, all discussed below. teaching assistant as a white person who facilitated one semester of the race-based caucusing with white students, i noticed apprehension during the initial stages of meetings. it felt as if the group was “playing nice,” so to speak, by gauging what they were saying when responding to the questions, almost providing the “social work” answer, instead of acknowledging personal biases. i felt that at times students believed acknowledgement of bias or difference to be “bad,” so they avoided acknowledging bias or difference in any way. everyone has biases. i was hoping the group would get to a place where they could acknowledge these biases and have an open dialogue, getting to where, i felt, the real work lived. several sessions into the caucusing, one student did share a personal belief/bias with which students visibly struggled. it was upsetting to some, and the conversation became difficult. i allowed the conversation to continue, wondering if someone might dig a little deeper. instead, the group became divided, using their visible anger and sadness about what was said to judge. in future opportunities, i hope to be able to facilitate this conversation differently by exploring bias and creating a space for this discussion to occur, acknowledging the emotional response it may elicit. discussion overall, we found that the themes outlined above reflected that, in some ways, the caucus groups were successful in progressing toward their intended purpose, but there were also some shortcomings. in addition to discussing these outcomes, we offer some suggestions for other instructors who may want to implement caucusing to address white supremacy in their classrooms. fulambarker buehler et al./not the time for kumbaya 793 outcomes race-based caucusing was implemented in the classroom context as a method to decenter the experience of whiteness in learning about racism and other systems of oppression. the caucus groups were tasked to approach the course material through the lens or purpose of their individual caucus groups. the white students were asked to focus on identifying and recognizing their participation in systems of racial domination and their internalized dominance. students of color were encouraged to share their own experiences of racism and their different experiences between and within different racial/ethnic groups and support one another while identifying their strengths. based on our reading of what students shared in the focus groups and our own experiences in the classroom, we did not feel that both of these desired outcomes were fully realized. while the students of color seemed to find many strengths in the experiences within their caucus space, we see from the white students’ feedback that further facilitation and challenge were needed for their caucus. it was primarily white students that reported that the group missed the mark. specifically, some white students felt that they were not pushed enough to challenge their own or their colleagues’ privilege. as a result, the conversations were cautious and approached gingerly by students, and we do not feel that the aspirations of the white student caucus group were fully met. one factor to which we attribute not reaching the desired outcomes is white fragility (diangelo, 2011). diangelo (2011) defines white fragility as a state in which even a minimum amount of racial stress becomes intolerable, triggering a range of defensive moves. these moves include the outward display of emotions such as anger, fear, and guilt, and behaviors such as argumentation, silence, and leaving the stress-inducing situation. (p. 57) as students from the white student caucus reported, classmates were “tentative,” and their groups were an “echo-chamber.” the discussion questions provided by the instructor were intended to dissect their own participation in white supremacy and the implications of their privilege, which could have provoked white fragility and stifled the conversation. despite students saying that they wanted to be “challenged” and “pushed,” diangelo (2011) describes the process of avoiding this racial stress as unconscious and motivated by the desire to “restore equilibrium” (p. 58) of racial privilege. students themselves did not attribute the lack of challenge to white fragility but rather to not having a facilitator at all times. while facilitators are generally used in caucusing (abdullah & mccormack, 2008; walls et al., 2010), in the initial iterations of the caucuses, practically speaking, one instructor could not be in two places at once. as mentioned above, across all semesters, students were asked to choose a facilitator for the session and guide the discussion based upon the questions provided by the instructor. for white students, these questions were designed to frame readings and course material in a way that would allow them to challenge their own conceptions and experiences with whiteness. in the semester when there was a second instructor, we made a conscious decision to have students still to facilitate themselves, as we were concerned that the pattern of saying “the right” thing would persist if an instructor were an active part of the discussion. student advances in social work, summer 2021, 21(2/3) 794 remarks in the one focus group supported this: “my concern is that would heighten the effect of trying to say the right thing as progressive social workers vs. being honest and going deeper” (focus group #1). we further address the topic of facilitation below. the students of color caucus focused on sharing their experiences of oppression and learning from one another about their different experiences between and within different racial/ethnic groups. their discussion questions were framed around identifying these experiences, supporting one another, and identifying their strengths. based on the findings outlined above, we feel that students of color were indeed able to build connections with one another and find solidarity in shared experiences. they also identified within-group differences that were an opportunity for their growth and development. these outcomes for students of color were especially meaningful within a primarily white academic institution. as blackwell (2018) notes, people of color need their own spaces. black people need their own spaces. we need places in which we can gather and be free from the mainstream stereotypes and marginalization that permeate every other societal space we occupy. we need spaces where we can be our authentic selves without white people’s judgment and insecurity muzzling that expression. we need spaces where we can simply be— where we can get off the treadmill of making white people comfortable and finally realize just how tired we are. (para. 3) our intended outcome was to create a space for students of color within our primarily white institution to have space where they could connect, be themselves, and have their experiences validated (obear & martinez, 2013). similar to the bsw students that do not belong to dominant groups that participated in a variety of affinity groups (myers, et al., 2019), our students expressed relief and found connection in the face of an environment that can feel isolated. unanticipated outcomes one theme or topic we had not anticipated was the desire of some students to come back together at the end of each session. the inclusion of a reporting or processing component was not included in the structure of caucusing. coming together to report on accountability and shared goals over long periods of time is typical in some contexts, such as ongoing caucusing in an organization (blitz & kohl, 2012) or training sessions (obear & martinez, 2013), and is recommended by bell et al. (2016); however, we chose not to do this for several reasons. first and foremost, the design of caucusing in this context was to de-center whiteness and remove the responsibility often placed on students of color to “teach” white students. the idea of coming together and reporting out felt as if it would still place a burden on students of color. as noted in the findings, some white students expressed a desire to be “accountable” to the students of color. the expression of this desire to be accountable appears as an extension of this expectation of white students to be taught by or that they can only learn from students of color. when conversations of coming together came up after caucusing, the instructor (buehler) did reframe for students the purpose of the groups was not to be accountable to one another, but rather to engage in the work of recognizing and working through their own racialization. further, while bell and colleagues (2016) do suggest reporting out in an anonymous way what the caucus groups fulambarker buehler et al./not the time for kumbaya 795 discussed, the students of color caucus groups were very small, and it seemed that anonymous reporting out would risk the confidentiality of group members. accountability was not the reason that all students wanted to come together. for others, it seemed a desire to know what was happening in the other group or a desire to come together to work toward a common goal. in response to this desire, in the first semester, the instructor did have both groups come together at the very end of the semester to talk about what they felt would be their goals to continue dismantling racism as social workers. in the third section, both caucus groups did not come together at the end of the semester due to time constraints associated with a shortened summer semester. suggestions the use of race-based caucusing at a primarily white university in the northeast was chosen as a technique to allow space for students to examine and dismantle internalized social constructs while challenging white supremacy and fragility. while our findings show that this technique allows students opportunities for safe or brave spaces (arao & clemens, 2013), connection, growth, and reflection, there are changes that could be made in the future to amplify the benefits of race-based caucusing. race-based caucusing groups utilized two different separate spaces to engage in their work during the determined times. for this study, one group remained in the classroom, while the other group left the room to utilize another space. the group that left the room varied between cohorts, sometimes it was the students of color, and other times it was the white students. logistically, one group had to remain in the classroom because of space constraints; however, in the future, it is recommended to have two separate spaces (other than the classroom) for the caucusing to occur. this allows for a differentiation between the purpose of the shared classroom and the purpose of the separate caucus spaces. while self-reflection and critical thinking should occur in both the shared class and caucus groups, the distinction between the spaces may serve as a marker or reminder to students of the purpose of engaging in race-based caucusing. additionally, the optics and experiences of students of color who were asked to leave the room are acknowledged and validated. the impact of the decision made by the instructor (buehler) is owned, and she would recommend that it is essential for both groups to leave the classroom space. furthermore, the need for different spaces will allow the groups to return to the shared classroom once their group concludes and not require them to wait for the other group to finish. while it was not practical based on the racial breakdown of the classes in the context of this study, we also would recommend offering a “third space” (hudson & mountz, 2016) for students that identify as biracial or multiracial. the instructor prepared students for the experience by explaining race-based caucusing and providing a reading that described its purpose. additionally, students were equipped with guidelines for dialogue (arao & clemens, 2013), which they developed during the first class and in the individual caucuses. further, expectations were discussed before separating for the caucusing. despite this preparation, student feedback indicates that students were seeking more clarity regarding expectations and the purpose of the caucusing. suggestions for improvement would be to provide a written structure before each session to be utilized during the caucus. this could provide supplementary guidance advances in social work, summer 2021, 21(2/3) 796 that the students were seeking. additionally, engaging students in a more in-depth and ongoing discussion about the purpose of caucusing, including a clear conversation about the idea of accountability and the burden placed on people of color to educate white people would further clarify the activity. an additional recommendation would be to have each group select a student facilitator and a student note-taker for their time together. these roles should differ and rotate between different students for each session and could provide additional structure as suggested by students. students also indicated a desire for more time allotted to caucusing and that the time/days for caucusing be standardized throughout the term, so they are both expected, but also allow for ample discussion time. certainly, this is a limitation to using this strategy as part of the structure of the class; however, it is also a benefit as students can consistently meet throughout the semester, integrating the course content. finally, one of the strongest recommendations from this experience is the ability to provide facilitation or support for both groups with facilitators that share the racial identity of the group (instructor of color and white instructor). we recognize the reality of the limits on faculty time, but based on our experience, a teaching assistant, doctoral student, or even a former student would be beneficial to bolster the success of this strategy in the classroom. students of color and white students had different perceptions of the need for more direct or hands-on facilitation. as we discussed above, this is likely due to the nature of the work expected of the white students. while students may be inclined to say the “right” thing in front of an instructor, it is suggested that the facilitator be aware of this tendency and use the opportunity to challenge students in these teachable moments. we recommend facilitators provide support and guidance as requested by students, as well as based on the opinions and experience of the facilitator with the students. we offer the recommendation that facilitators can invite and challenge students to self-reflect and challenge themselves. implications for social work providing social work students with ongoing educational opportunities that address structural power and oppression is imperative to their responsibility to demonstrate the core value of social justice as future practitioners. engaging difference and diversity in practice is both a central tenant to social work education (cswe, 2015) and the profession (nasw, 2017). race-based caucusing “is one strategy we use to confront the effects of internalized racist oppression and internalized racist superiority” (crossroads, n.d., p. 1). this strategy allows students to actively work to dismantle internalized socially constructed beliefs while being afforded the opportunity to do so in separate spaces, allowing for different work to become the focus. social workers should confront the structure and effects of racism. racebased caucusing provides a step towards this. it allows students an opportunity to engage in an experiential learning activity that focuses on dismantling their own internalized power and oppression. it also provides students concrete strategies that they can then utilize in the field to address systemic racism in organizations in which they work and within broader society. fulambarker buehler et al./not the time for kumbaya 797 conclusion the use of race-based caucusing in an msw classroom setting for the purposes of providing students the experience of examining and questioning their internalized racialization and de-centering the focus on whiteness in the classroom proved to be a beneficial strategy with unique challenges. based on the experiences shared by students, there was strength in the connections forged, particularly for students of color, and the growth it fostered across groups. with the suggestions outlined above, we believe that the challenges experienced by students can be overcome. race-based caucusing is one strategy that can be implemented in the social work classroom to work toward social justice and dismantle white supremacy. references abdullah, c. m., & mccormack, s. 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(1990). justice and the politics of difference. princeton university press. author note: address correspondence to anjali buehler, department of social work, governors state university, university park, il 60484. email: abuehler@govst.edu https://www.racialequitytools.org/act/strategies/caucus-affinity-groups https://www.racialequitytools.org/resources/fundamentals/core-concepts/system-of-white-supremacy-and-white-privilege https://www.racialequitytools.org/resources/fundamentals/core-concepts/system-of-white-supremacy-and-white-privilege https://doi.org/10.1515/9780822381044 http://www.wpcjournal.com/article/view/6262 http://www.resourcesharingproject.org/dismantling-racism-resource-book-social-change-groups http://www.resourcesharingproject.org/dismantling-racism-resource-book-social-change-groups mailto:abuehler@govst.edu this work is licensed under a creative commons attribution 4.0 international license. refugee health education: evaluating a community-based approach to empowering refugee women in houston, texas elizabeth leah frost christine markham andrew springer abstract: although resettlement agencies in the united states assist refugees by offering a variety of local social and health services, refugees are still less likely to access these services. few studies have evaluated refugee health education interventions focusing on barriers to accessing healthcare and overcoming negative social determinants of health. this study evaluated the feasibility, acceptability, and perceived impact of a yearlong health education intervention to empower burmese refugee women living in houston, texas. the intervention included workshops, community excursions, question and answer (q&a) sessions, and home visits. the evaluation was a formative qualitative study including interviews with burmese refugee women who participated in the intervention and local resettlement agency caseworkers. qualitative content analysis guided the data analysis and was conducted to identify categories and emergent themes. key findings indicated that motivation to participate in the intervention was impacted by the women’s perceived relevance of health education material to burmese cultural values and opportunities for hands-on learning to promote self-efficacy. recommendations for future interventions include the use of community health workers to train refugee health educators, pairing english lessons with health education material to promote development of english language skills, developing teaching materials for refugees with low literacy, establishing bottom-up support from refugee resettlement agencies, and incorporating the social work ecological model to tailor health-focused interventions to the specific needs of the refugee community. keywords: refugee health; women’s health; health education; program evaluation in fiscal year 2015, the united states received approximately 70,000 refugees (united states department of state, 2015),p pof whom 7,479 refugees were resettled in texas. houston received 39% of the refugees, making it one of the top destinations for refugee resettlement in the u.s. (montour & kazmierski, 2013).p pburmese refugees make up the second largest refugee group in texas (montour & kazmierski, 2013). in houston, resettlement agencies assist in connecting refugees to various services including food stamps and health insurance, as well as english as a second language (e.s.l.) classes, job development, and linkage to health clinics. despite local services offered by resettlement agencies, refugees are less likely to access health and social services due to low health literacy, inability to navigate the healthcare system, scheduling challenges, lack of daycare options, language barriers, differing cultural beliefs, and lack of access to experienced interpreters, all of which lead to an overall decline in health (murray, mohamed, & _________________ elizabeth frost msw, mph is a graduate of university of houston graduate college of social work and the university of texas health science center at houston (uthealth) school of public health, houston, tx 77030. christine markham phd, ma is an associate professor, uthealth school of public health, houston, tx 77030. andrew springer, drph, mph is an associate professor, uthealth school of public health in austin, austin, tx, 78701. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 949-964, doi: 10.18060/21622 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 950 ndunduyenge, 2013; vermette, shetgiri, al zuheiri, & flores, 2015). key health issues for newly arrived refugees to the u.s. include a high prevalence of musculoskeletal and pain issues, mental health challenges such as depression, anxiety, and posttraumatic stress disorder, and social problems such as isolation, financial challenges, culture shock, and employment difficulties (eckstein, 2011). for burmese refugees, infectious diseases such as hepatitis b, hiv and tuberculosis are also prevalent (montour & kazmierski, 2013). medical screenings in texas reveal that recently arrived burmese refugees make up 47% of newly diagnosed hepatitis b cases and 24% of newly diagnosed hiv cases among all recently arrived refugees (montour & kazmierski, 2013). also, 44% of newly arrived burmese refugees settling in texas were found to have a positive tuberculosis skin test (montour & kazmierski, 2013). poor initial health outcomes for newly arrived refugees often are a result from living in a refugee camp for numerous years before coming to the u.s. designed to tackle health disparities within the refugee population, refugee-focused health and social interventions typically center around community capacity-building, developing self-efficacy to navigate the u.s. healthcare system, and encouraging community empowerment (baird et al., 2015; glanz, rimer, & viswanath, 2008; im & rosenberg, 2016; wieland et al., 2012). despite an important foundation of public health social work research on refugee health education interventions, few interventions designed specifically for burmese refugees have been implemented, and little to no program evaluations have been conducted to assess the feasibility and acceptability in delivery of these health education interventions for burmese refugees living in the u.s. (hartwig & mason, 2016; ornelas et al., 2017; rowe et al., 2016; walker, koh, wollersheim, & liamputtong, 2015). in responding to the public health needs of the local burmese refugee community in houston, texas, a pilot community-based health education intervention, titled refugee women’s health initiative, was developed in partnership with a local refugee resettlement agency and implemented by two students from the university of texas health science center in houston (uthealth). focusing on burmese refugee women, the pilot intervention provided health education and life skills coaching. empowerment was defined as building knowledge, skills and self-efficacy across a range of health topics related to both preventive behaviors and navigation of the healthcare system. the intervention provided health education via a life skills approach. workshops focused on real-life applications to practice new skills and improve skills needed to navigate life in the u.s. workshop topics were identified from focus groups with burmese refugees and case managers at the resettlement agency over a two-month period prior to the implementation of the intervention. workshops were held weekly for one year and included presentations and discussions on a range of health topics, dissemination of health education materials, question and answer (q&a) sessions with medical providers, and excursions to promote community exploration. a workshop, excursion, or q&a session was planned weekly for the duration of one year. the hour-long workshops were held in a classroom space offered by the resettlement agency with a burmese interpreter to assist with communication. home visits were completed twice a month by the intervention team to build rapport with the refugee women. table 1 provides a summary of the intervention activities and workshop frost et al./refugee health education 951 topics identified by the women. table 1. workshop topics, excursions, and q&a sessions: april 2014-may 2015 uworkshop topics • cultural adjustmentlife in the u.s. • navigating the public school system for parents • nutrition • job development where to start job hunting • dental care and oral hygiene • planned parenthood well woman exam & family planning • personal hygiene • budgeting skill building and financial advice • substance abuse and domestic violence • obesity and diabetes prevention • how to become a community health worker • photo voice • ophthalmology vision screening • self-esteem, self-care, and goal-building uexcursions • zumba in park • grocery store visit • family trip to beach • children’s museum • houston zoo • health fair • art museum • houston medical center uq&a sessions • ob/gynecology • pediatrician • psychiatrist the priority population of the pilot intervention was burmese-speaking refugee women enrolled in services at the local resettlement agency. since participation in health education interventions is typically low in minority populations (mirza et al., 2014; zanchetta & pourselami, 2009), and given the pilot nature of this intervention, there were no restrictions on ethnicity. while burmese refugees from all ethnic backgrounds were invited to participate, due to funding restrictions, only a burmese-speaking interpreter was available to assist with the focus group, workshops, and all other activities. as such, only women who were comfortable speaking burmese attended. burmese refugee women were specifically invited to participate because of their central role in influencing health outcomes of the family. this includes their important role in managing childcare, and making health decisions for their children and families. likewise, refugee women are an at-risk priority population because they are typically more isolated, have limited english skills, and feel unsure about their future (walker et al., 2015). recruitment for the pilot intervention was facilitated through the case managers from the resettlement agency. case managers contacted all burmese refugee clients who were enrolled in services at the agency to provide information about the focus group and future workshops. a total of thirty-eight burmese refugee women participated in the intervention activities from april 2014-may 2015. this study was a process evaluation of the refugee women’s health initiative that had the following objectives: 1) to assess the feasibility, acceptability, and initial impact on health knowledge and self-efficacy of the refugee women and resettlement agency staff, 2) to understand process-related aspects of the intervention including knowledge, perceived benefits and implementation barriers, 3) to assess feasibility for future implementation of this health education initiative on a larger scale, and 4) to contribute to the growing public advances in social work, spring 2018, 18(3) 952 health social work literature on interventions for burmese refugee communities resettled in the u.s. by providing insights from refugee women and resettlement agency staff on best practices for developing and delivering health education programming for recently resettled refugees. methods this evaluation study used an exploratory, post hoc, single-group only research design to better understand the delivery and initial impact of health education and health promotion strategies in the refugee communities upon completion of the intervention. the evaluation was formative and qualitative in nature, relying on semi-structured interviews to capture perspectives of the refugee women and resettlement agency staff. the same graduate student from the university of texas health sciences acted as the evaluator and conducted data collection and data analysis. the study was approved by the university of texas health sciences committee for the protection of human subjects. participants only burmese refugee women who had previously participated in the refugee women’s health initiative intervention were eligible to be part of the evaluation. participation in the intervention was defined as having attended one or more workshops over the course of the year-long intervention. a total of 38 burmese refugee women were eligible. with the help of the burmese interpreter, the evaluator reached out to all eligible participants by phone or home visits to recruit for the evaluation study. a total of 11 burmese refugee women agreed to participate in the evaluation. twenty refugee women were lost to follow-up, and seven women were unavailable at the time of the interviews. of those who were lost to follow-up, five had moved to another state, and 15 had changed cell phone numbers and addresses. figure 1 provides an outline of the recruitment process. figure 1. recruitment cascade because of low literacy in both burmese and english, verbal consent was considered pre-intervention focus group (n=9) intervention & evaluation (n=38) lost to follow-up (n=27) 5 participants moved away 15 participants with phones out of service 7 participats not home at time of interview recruited for evaluation study (n=11) frost et al./refugee health education 953 most appropriate for the women to fully understand the study and consent process. a scripted consent form was read to the women with the aid of a burmese interpreter. participants were informed that participation in the evaluation study would not impact social services received from the refugee resettlement agency. participants were able to withdraw from the evaluation at any time. resettlement agency staff members were selected to participate in the evaluation based on the following criteria: 1) having worked at the resettlement agency for the past year, and 2) having had some type of role in the intervention such as acting as the driver in transporting the women to the workshops or providing case management. permission from the resettlement agency supervisor was obtained for staff to participate in the evaluation. staff members were provided letters informing them about the study which served as passive consent to participate. staff were informed that participation would not lead to repercussions in employment status. confidentiality of information was paramount to protect both the refugee women and staff. based on the study’s criteria for selecting agency staff members, five staff were eligible for interviews and asked to participate. data collection a semi-structured interview guide was used to guide interviews with the refugee women. the guide included twelve questions focusing on perceived benefits to participating in the intervention, cultural appropriateness of topics, barriers to attending the workshops or excursions, cues to action for participating, and suggestions for improvement. interviews were conducted by the evaluator and a native burmese speaker from the university of texas health sciences who served as the interpreter. interviews were conducted and audio recorded in the homes of the women with the assistance of the interpreter. in accordance with the preference of the women, interviews with the refugee women included a mixture of individual and group. a brief survey was administered at the time of the interview to collect demographic information. survey data were verbally collected by the interpreter and recorded on paper by the interviewer. a separate semi-structured interview guide was administered to the resettlement agency staff and comprised of seven questions addressing the role of the intervention within the resettlement agency, staff’s knowledge of the intervention, perceived benefits and barriers of the intervention, and general comments or observations about the overall initiative. all staff interviews were conducted face-to-face with the evaluator and were audio-recorded. all recorded interview data from both refugees and staff were transcribed verbatim and entered into atlas.ti for coding (lapan, quartaroli, & riemer, 2012). using a native burmese speaker as an interpreter, the interview questions were translated from english to burmese so the refugee women would understand the questions being asked. all responses were interpreted back into english and audio recorded. the interviews were then transcribed and an english transcription was used for data analysis. analysis interviews were analyzed using conventional qualitative content analysis to generate advances in social work, spring 2018, 18(3) 954 categories inductively from the data. conventional content analysis is often used when there is limited existing research (hsieh & shannon, 2005), which was the case with existing research on burmese refugee women. after transcribing the recordings and translating the interviews to english, open coding was performed to examine smaller units of meaning and repeating patterns (lapan et al., 2012). themes and codes were shared with the interpreter and colleagues for further contextualization and confirmation of the findings. a coding manual was developed with code names and definitions for assigning codes. a separate coding manual was created for refugee women and staff. the coding manuals evolved throughout the analysis as part of inductive category development. there was no adoption of coding schemes from previous studies (zhang & wildemuth, 2009). secondary coding established categories to organize key themes, highlight patterns, and make inferences. the interviews with the refugee women were analyzed separately from the interviews with the staff. quotations from the women were kept in third person to maintain the manner in which the interviews were translated during data collection. results characteristics of participants of the eleven women who agreed to participate in the interviews, six women were interviewed one-on-one, and five were interviewed in groups of two and three. the average age of the women participating in the evaluation was 34 years. on average, the women had spent almost half of their life in a refugee camp and had lived in the united states an average of 3.25 years. a majority (81%) of the women had a primary school education or less and, of those, 45% of the women had no education. interviews with refugee women interview themes. four prominent themes were drawn from the interviews with the refugee women: 1) perceived benefit of participating, 2) opportunities to practice english, 3) community as a cultural value, and 4) family as a cultural value. for the women attending the intervention, there was a perceived benefit in learning new information that was relevant and useful to their everyday lives. during an interview with a refugee woman who had attended the workshop hosted by planned parenthood and the workshop on personal hygiene, the woman spoke at great lengths about the information she learned from the experience. the interpreter translated, “she found the discussion on topics of health, and you know, reproductive health, and personal hygiene was a draw [to attend the workshop].” for this particular woman, there was a perceived benefit in learning about reproductive health and hygiene that attracted her to the workshop. that benefit was a motivator for her to attend. likewise, the women felt empowered when learning new skills. the interpreter assisted in translating for one woman by stating, “because she didn’t know about family planning before, and then she learned about it in the workshops. so, that’s why she liked it. it was useful for her.” empowerment was noted when the women learned a skill that was beneficial in being able to navigate and manage life in the u.s. some of the women identified the perceived benefit of learning a new skillset as the most important aspect of the intervention, as was noted in the following quote from a woman frost et al./refugee health education 955 who had attended the houston medical center excursion where she learned to ride the city bus. the interpreter explains, “her favorite part was the visit to the hospital because she learned how to get there and then how to ask for help at the hospital.” knowledge gained on various health topics and the opportunity to practice a new skillset was a strong motivator for the women to attend the workshops and other activities of the intervention. overall, there was positive reinforcement associated with attending the intervention. when interviewed, one of the women mentioned knowledge gained as a positive reinforcement to attend the workshops. the interpreter summaries for her, “she said like she didn’t know anything about—anything about hygiene, family planning, personal hygiene and family planning or health, but she learned something from this—all these workshops, particularly about the intrauterine device.” in general, the women felt they had gained something in return for attending the intervention, whether it be knowledge about a relevant topic or the opportunity to practice certain skillsets. the opportunity for the women to practice english language skills was a big draw for the women to attend the workshops. hands-on learning opportunities were embedded in the workshops and community excursions, and workshops were perceived as a safe space to practice the health behavior or life skill while using english. as a result of increased opportunities to practice english and learn vocabulary related to life skills, the women felt more confident in their ability to execute certain life skills such as calling the doctor to make appointments or taking the city bus. a group interview with three women denotes this change in confidence. the interpreter translates for the women, “…now they feel a little bit more confident to call for the appointment or to ask for the appointment [in english].” using english in the workshops and activities was a strong motivator for some of the women to attend. this was apparent with one woman’s quote which was interpreted as, “she thinks it really helped to gain knowledge and also to learn english a little bit more, to talk with friends. that’s why she also always liked to participate on all these activities.” the women developed a unique community identity that was formed from a shared experience of participating in the intervention, and it created a foundation for community development and exchange of knowledge and skills. the social aspect was a significant draw for the women to attend the intervention. as was noted from the workshops, a strong sense of community was an observed shared cultural value among the burmese women, which the intervention helped to nurture and support. the community of women formed through the intervention provided a communication channel for the health education messages. one participant described to the interpreter how she and others would spread the health messages to others in the houston burmese refugee community. the interpreter reported that, “they discuss the [home] visits and the workshop at home among each other—they also then talk to other people about the workshop.” relationships were cultivated over the course of the intervention, leading to reciprocal rapport-building among the women. information was discussed among the women at home and knowledge was passed from woman to woman and from family to family. health education messages also spread to the larger burmese refugee community. at one point during an interview, the interpreter stated, “they are karen not karenni. but they met with other karenni women in the workshop and then they learn about them, too.” communication channels were not advances in social work, spring 2018, 18(3) 956 impacted by ethnicity. health education messages passed between karen and karenni burmese refugees living in houston. family was another strong cultural value identified by the women. knowledge and skills gained in the workshops were framed in the context of benefiting the family. one woman emphasized the importance of family in the following quote which was translated as, “she felt more confident about healthy behaviors after the workshop, not only for her but also her family and especially for her children.” the women wanted their children to become healthier and better adjusted to life in the u.s. the women were more likely to retain information pertaining to the children because of the value placed on family, as was noted in an interview in which the interpreter claimed, “she remembered it because it was the one [topic] she liked to know and it was useful for her, too, because she has kids going to the school. so that is why she still remember.” the women’s information retention was significantly improved for topics that had a perceived benefit and touched on cultural values such as family or community. during the interviews, the women spoke about the information they were best able to retain, which revolved around topics pertaining to their children’s health. the interpreter assisted in translating one woman’s views on the workshop topics in a statement, “the most memorable part for her was one of the workshopsa teacher came in and then talked about how to take leave for her children and also how to communicate with the schoolteachers.” linking the intervention to relevant topics and shared cultural values had significant impact on the women’s participation in the intervention. as is consistent with best practices in adult health education (national committee for health education, 2016), motivation for the women to attend the workshops was found to be tied to a perceived benefit of attending, opportunities for hands-on learning, and the inclusion of topics that the women felt were applicable to their everyday lives and culturally relevant. interviews with resettlement agency staff a total of five interviews were conducted with the agency staff. all staff came from the same department within the agency, the long-term case management department. staff members were in charge of assisting refugee clients who had been in the u.s. for any length of time from three months to five years. none of the staff declined the request for an interview. goodness of fit staff interviews revealed the importance placed on the intervention as being a good fit for the agency, as well as a good fit for the refugee community. goodness of fit was defined by the agency staff as an intervention that: 1) has flexibility and the ability to mold to the structure or schedule of the agency, 2) encourages agency and staff involvement, 3) fills service gaps and addresses client problems that the agency does not have the capacity to handle, and 4) does not burden the agency for classroom space, time or financial support. in a comment about program scheduling being a good fit for the agency, a staff member stated, “[other outside health education programs] kind of have their own kind of timeframe and their own schedule in mind, and they don’t really seem to want to work with frost et al./refugee health education 957 what’s best for the entire agency overall, thinking that the only thing we have to do really is like their programming” the emphasis on health education programs being a good fit relates to the work burden placed on case managers at refugee agencies. a case manager who was interviewed reported managing 300 clients who were assigned to his caseload. refugee case workers oftentimes have extensive caseloads and struggle to provide the indepth attention to all clients. those with major medical problems often consume the attention of case workers, leaving limited time for interventions aimed at improving the long-term health outcomes in the refugee population. in one particular instance, a staff member claimed, “and so i think that that was great as well that you guys needed less space and much of those women didn’t need a lot from us, and i think that was helpful to the staff as well who were overwhelmed with a lot of work already.” the need for programs that counter the heavy work load of the case managers is echoed in the following statement, “it was almost like a breeze honestly compared to others that we’ve had there, honestly, because—you know—some of the other people we worked with—they really were super kind of needy. like we had to do all the calling [for program recruitment]. we had to do all the da-da-da—you know. they didn’t want to kind of go into the community themselves and do some work. they’d want us to do everything and they would just show up and present.” agency staff who had worked with previous programs that were organized by groups of volunteers were weary of any new projects that would require extra time. disconnect the heavy work load of the staff at the agency coincided with a certain level of disconnect between the staff and the intervention. the intervention was not fully integrated and adopted into the structure of the resettlement agency. in one interview, a staff member mentioned, “i don’t know [about the workshops] because i’m always outside. we provide them transportation. from outside it looks like it goes well. i don’t know inside, because i’ve never been in [the workshops].” staff who were involved in the intervention were not knowledgeable about some aspects of the program or understood the objectives of the project. staff involvement in the pilot intervention was limited to providing transportation for the women. none of the agency staff attended a workshop or q&a session. future implementation of the full-scale intervention would ultimately have to depend on external organizers, either social workers or health educators. discussion this evaluation provides an overview of the feasibility and acceptability of implementing a health education intervention targeted at refugee communities. the findings from the evaluation are consistent with health promotion literature that links peerto-peer learning with community building, increased community participation, and creating a sense of belonging within the refugee population (im & rosenberg, 2016). the strength of the intervention was nesting the health education program within the burmese refugee community to encourage community members’ on-going participation in the development and implementation of the intervention. this was done through an initial focus group with the refugee women to select topics for the workshops, the use of an interpreter from the refugee community, and home visits that allowed an opportunity for advances in social work, spring 2018, 18(3) 958 regular, in-person feedback from the women. community-building was evident in the development of social networks among the women. community involvement in the design and implementation was critical for the intervention to be successful. refugee health literature has established that community-based approaches to implementation and evaluation research are more effective with vulnerable populations such as refugees. models such as the community based participatory research (cbpr) and participatory action research (par) are recommended strategies (baird et al., 2015; balcazar, garciairiarte, & suarez-balcazar, 2009; wieland et al., 2012). the intervention created a social space for helping refugee women to connect with each other socially and emotionally. given the multiple health benefits of positive social relationships (hartwig & mason, 2016; im & rosenberg, 2016; khawaja, white, schweitzer, & greenslade, 2008; simich, beiser, stewart, & mwakarimba, 2005; walker et al., 2015) as well as the adverse health consequences of social isolation (thoits, 2011; wilkinson & marmot, 2003), public health social work interventions for refugees should be intentional about creating spaces for their participants to get to know each other and to develop social relationships and support. connections the refugee women make with each other may be even more important than the specific lifestyle skills the program aims to deliver. the most significant barrier to implementing the intervention was lack of buy-in from the resettlement agency. staff interviews highlighted the importance of the organizational compatibility of the intervention. when examining whether an agency will adopt an intervention, compatibility of the intervention with the overall mission statement and goals of the agency is a fundamental component (roger, 2003). this study demonstrates that compatibility and agency buy-in were two of the most significant barriers to creating a feasible and sustainable intervention. the intervention had agency buy-in from the leaders of the resettlement agency, but not from the ground workers who oversaw the daily running of the organization. there needed to be leadership from the bottom up, including incorporation of frontline staff in planning the intervention, as recommended by health promotion planning frameworks such as intervention mapping (bartholomew et al., 2016). it is important to note the low participation in this evaluation (n=11 out of possible 38). this is particularly important due to the fact that actual participation in a specific health promotion intervention is traditionally low among ethno-cultural groups. this is due to difficulty accessing health information, language barriers, and a lack of culturally appropriate or tailored health education material (mirza et al., 2014; zanchetta & pourselami, 2009). these low participation rates in the refugee health education programs make it difficult for program planners to fully evaluate outcomes and understand the long term impact of refugee-focused programs. as shown from this evaluation of an intervention for refugees, health educators and social workers working with these populations should focus on developing evaluation strategies that are incorporated into the intervention to overcome problems with low attrition. however, few studies have been done to explore secondary migration of refugees within the first three years after initial resettlement in the u.s. in this study, 18% of the women participating in the intervention had moved away by the time the evaluation activities began. also, 55% did not have a phone that was working which could also indicate that they had moved out of the area. innovative approaches are frost et al./refugee health education 959 needed to discover various ways of maintaining communication with a vulnerable population such as the refugee communities so that health care professionals can follow up on healthcare needs, and social workers can provide long-term services to this particular population, and evaluate program outcomes. while it may be difficult to analyze long-term impacts of an intervention with the burmese refugee population due to attrition, short-term outcomes can be assessed by continuous monitoring and evaluation of the intervention. the implications for social work point to a need for the ecological approach in better understanding the social determinants of health that impact refugee communities (ostrander, 2017). integrating the biopsychosocial, cultural and environmental perspectives is an essential skill for social workers, as recognized by the nasw (nasw, 2016). to utilize the ecological perspective, social workers must be able to move away from the traditional division of micro, mezzo and macro practice in order to view the refugee community in context of the diverse components impacting refugee health (griseowens, 2014). likewise, social workers are key components in the resettlement process because of their ability to analyze situations from a wholistic approach, build cross-cultural connections with clients (russell, 2001), connect refugees to resources or services, and provide emotional support during the resettlement process (agbenyiga, 2012). social workers are ideally placed in resettlement agencies and have the needed skills to be able to positively impact health education messaging, reduce the high loss to follow up rates when implementing programs, and improve overall agency buy-in for future health education programs. research studies on refugee health have not focused enough on discovering effective methods for interviewing refugee women. this study used mixed interview styles by interviewing the women individually and in small groups. a mixed interview style was chosen based on the idea of being culturally appropriate and attuned to the needs of the women who requested that they be interviewed in groups. there is little to no existing evaluation data available for the burmese refugee population, and little to no data on the best practices for conducting evaluations for resettled burmese refugees in the u.s. hence, future public health social work research should focus on developing best practices for qualitative methods that address cultural sensitivity and research standards when working with the refugee population. recommendations public health social work interventions aimed at improving health outcomes for refugee communities in the u.s. may benefit from the following considerations in regards to designing and implementing health-focused public health social work programs: 1) incorporate the community health worker (chw) model as a solution to overcome language and cultural barriers. language and cultural differences act as significant barriers for refugees attempting to access the healthcare system and negatively impact health outcomes (clark, gilbert, rao, & kerr, 2014; morris, popper, rodwell, brodine, & brouwer, 2009; pesata, pallija, & webb, 1999; sheik-mohammed, mcintyre, wood, leask, & isaacs, 2006). the chw model takes into consideration cultural values such as social networks and community identity among communities. furthermore, peer-to-peer advances in social work, spring 2018, 18(3) 960 teaching is an effective approach using cultural values and existing strengths of the community. the chw model may also act as a method to overcome high attrition rates in refugee-focused interventions by providing the motivation to stay active in a health education intervention. the chw certification of completion is a tangible goal that in turn can lead to employment in community health clinics. having tangible goals and motivators such as a certificate of completion for chw training can prove to be key in the success of refugee participation in future health promotion programs. 2) pair english language lessons with health education lessons to promote development of language skills in understanding health. english language competency is an essential survival skill for refugees living in the u.s. due to a lack of accessible and available interpreter services. oftentimes, refugees do not have the medical vocabulary to feel confident interacting with a health provider when describing health concerns or receiving a diagnosis (murray et al., 2013; vermette et al., 2015). english lessons intertwined with health education lessons would provide refugees with vocabulary specific to mental, physical, and social health. 3) develop partnerships with resettlement agencies to establish agency buy-in and support for health education interventions. participation from the resettlement agencies is crucial to achieve the intended outcomes of any intervention. development of an intervention for refugees should begin with the staff members and directors of the resettlement agencies acting as stakeholders in planning and implementation which follows best practices of current health promotion program planning models (bartholomew et al., 2016). the agency can provide significant resources toward the intervention and assist with accessing the refugee population. 4) incorporate the social work ecological framework in designing future interventions targeted at refugee communities. the use of a multi-dimensional intervention that addresses social determinants of health at each level and works to address those factors has the potential to positively impact health outcomes for refugee communities. limitations although this study has a small sample size, the purpose of this study was to examine the feasibility and acceptability of conducting a year-long pilot health education program for the burmese refugee population, and to understand the perceived benefits and barriers in implementing such a program. the participant’s views obtained in the evaluation may not necessarily reflect those of the burmese refugee community located in other geographic areas. however, this study provides a description of a health education program for refugees that may serve to guide the development of other interventions. other refugee populations may have varying cultural beliefs, practices, and cultural experiences that were not identified by this study. the study also has limited geographic bounds and may not be applicable to other regions of the u.s. where social services and healthcare access differ. the design of this study does not address outcome data that measures changes in health behavior of the refugee women. furthermore, data collection relied upon self-reported data and may reflect some level of response bias. frost et al./refugee health education 961 conclusion the refugee population has often been neglected in health care policies and medical practices. with opportunities in preventive medicine provided by the expansion of the affordable care act, there is a greater need to reach neglected populations to provide preventive care and health education. unlike other populations, resettled refugees in the u.s. face particular barriers to accessing healthcare or health education programs. likewise, the refugee population has particular motivation to attend health education programs that must be understood in a larger cultural context. this study provides information on best practices for working alongside refugees in the u.s., and explores various cultural and programmatic components to consider when designing a health education program for refugees who have been resettled in the u.s. furthermore, the highlighted recommendations in this study demonstrate the need for social workers to consider the cultural context of the target population as it relates to health-focused social work programs, and the specific programmatic needs of the refugee population in the u.s. recommendations from this evaluation study were drawn from a pilot intervention. the lessons learned can be transferred to a larger more in-depth intervention and expanded to meet the needs of refugees from other cultural and language backgrounds. while few studies have been conducted to evaluate burmese refugee health education in the u.s. and examine the best practices in refugee health education, this study provides a foundation for public health social workers to explore critical knowledge missing in immigrant and minority health research. references agbenyiga, d. l., barrie, s., djelaj, v., & nawyn, s. j. 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(2009). qualitative analysis of content. in applications of social research methods to questions in information and library science (pp. 1-12). santa barbara, ca: libraries unlimited. author note: address correspondence to: elizabeth frost, msw, mph. graduate of university of houston graduate college of social work. houston, tx 77204. 35teltfrost@gmail.com. https://doi.org/10.1111/hsc.12155 https://doi.org/10.1016/j.whi.2011.10.002 mailto:eltfrost@gmail.com methods participants figure 1. recruitment cascade data collection analysis results characteristics of participants interviews with refugee women family was another strong cultural value identified by the women. knowledge and skills gained in the workshops were framed in the context of benefiting the family. one woman emphasized the importance of family in the following quote which was translat... interviews with resettlement agency staff discussion recommendations limitations conclusion _________ carolyn sutherby, phd, lmsw, acsw, assistant professor, department of social work, ferris state university big rapids, mi. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 65-84, doi: 10.18060/26149 this work is licensed under a creative commons attribution 4.0 international license. "here they look at us as people”: comparing mothers’ experiences with an alternative to incarceration (ati) program and incarceration carolyn sutherby abstract: approximately 60% of all incarcerated women in the united states are mothers with minor children and most of them are single mothers. when mothers with minor children are incarcerated, the disconnection and loss of tangible support can have a traumatic impact on families. alternatives to incarceration (ati) can be a viable option to maintain their significant relationships while holding them accountable for their crimes and providing them with necessary rehabilitation. the purpose of this study was to examine how mothers participating in an ati program compared this experience to conventional incarceration. data were collected from eight focus groups involving 34 mothers who were current participants or graduates of an ati program. data were analyzed using exploratory thematic analysis. analysis revealed four salient themes characterized by these in vivo themes: incarceration is not rehabilitation; incarceration is easy, the program is hard; i’m not the same person; and connection with children. findings suggest that mothers find the ati more rehabilitative and relational than incarceration. future research should explore outcomes for graduates of ati specific to their rehabilitation and connections to children. a mother’s readiness for change while incarcerated and when participating in an ati intervention should be evaluated in relation to these outcomes. the social work profession can increase research, policy, and direct service efforts in criminal legal reform by advocating for appropriate alternatives to incarceration for mothers. keywords: alternatives to incarceration (ati), mothers, minor children, mother-child community-based ati approximately 60% of all incarcerated women in the united states are mothers with minor children and most of them are single mothers (glaze & maruschak, 2009). within jail systems, the number of incarcerated women who are mothers increases to nearly 80% (swavola et al., 2016). most incarcerated women have behavioral health issues as well as histories of trauma (belknap, 2007; covington & bloom, 2007; komarovskaya et al., 2011; mears et al., 2012; pimlott & sarri, 2002; steadman et al., 2009; swavola et al., 2016). in addition to the strain of separation from her children, incarceration can cause a mother to lose employment, child-care options, and housing (la vigne et al., 2008; thompson & newell, 2021). upon reentry, mothers with a criminal record face a multitude of challenges to reintegrate into society and resume parenting (garcia, 2016; leverentz, 2014; mitchell & davis, 2019; swavola et al., 2016). alternatives to incarceration (ati) are any kind of punishment or treatment other than incarceration given to a person who commits a crime (families against mandatory minimum sentencing, n.d.). the landscape of ati in the united states is largely uncharted. there is significant diversity among what constitutes an ati as well as differences in philosophies of governance and oversight (skeem et al., 2006). currently, no universal benchmarks exist for collecting and publishing data for purposes of evaluating ati about:blank advances in social work, spring 2023, 23(1) 66 programs against common sets of performance measures such as cost-savings or reduced recidivism (center for health and justice at tasc, 2013). there is also a lack of consensus on eligibility criteria for ati (patchin & keveles, 2004) and on the most effective ati for specialized populations such as pregnant/parenting women, juveniles, and people who commit violent crimes (berman & adler, 2018). although there is some flexibility in how atis are implemented, typically they occur at four levels: 1) the law enforcement level, 2) the pretrial or prosecution level, 3) the specialty court level, and 4) the post-sentencing level (center for health and justice at tasc, 2013). common ati include probation, treatment courts, electronic monitoring, and substance use rehabilitation (center for health and justice at tasc, 2013). berman and adler (2018) report that ati are less expensive than incarceration, focus on rehabilitation, and allow low-risk offenders to remain in the community as active citizens. it is important to note that ati are not without challenges. schenwar and law (2020) note that many recent ati efforts are grounded in control and confinement which mirror the prison structure they are meant to avoid. research is scarce on ati for mothers in the u.s despite them being appropriate candidates due to their pathways into the criminal/legal system, treatment needs, and family circumstances (kates, 2011; shdaimah & bailey-kloch, 2014). alternatives to incarceration (ati) can be a viable option to hold women accountable for their crimes while maintaining their significant relationships and providing them with necessary rehabilitation (goshin, 2015). the purpose of this study was to contribute to the current gap in literature on ati for mothers and, importantly, to elevate the voices of mothers themselves. this study examined how mothers view the experiences of incarceration and ati in terms of treatment for behavioral health issues, reentry into the community, and their relationship with their children. literature review impact of maternal incarceration on children the literature regarding the effects of parental incarceration on children is vast (annie e. casey foundation, 2016; arditti, 2012; johnson & easterling, 2012; roberts, 2012; turney, 2017; wildeman, 2009; wildeman et al., 2018). however, research exploring the specific impact that maternal incarceration has on children is much less common. studies have found some children with an incarcerated mother have poor educational outcomes (dallaire, 2007), antisocial behavior (murray & farrington, 2008), and higher rates of becoming incarcerated themselves (phillips et al., 2007). secondary data analysis from two separate studies using the national longitudinal study of adolescent to adult health found maternal incarceration to have damaging effects on children's overall well-being (foster & hagan, 2017; hagan & foster, 2012). huebner and gustafson (2007) found that children of incarcerated mothers were significantly more likely to be involved in the criminal legal system as adults. trice and brewster (2004) examined the impact of maternal incarceration on adolescent educational outcomes. results indicated that children with an incarcerated mother were significantly more likely to have failing grades and higher rates of dropping out of school than the comparison group. another study found that adults who had an incarcerated mother at any time in their life had significantly increased odds of sutherby/mothers & alternative incareration 67 becoming incarcerated themselves (burgess-proctor et al., 2016). reintegration for mothers and children during reentry most mothers are not incarcerated for a crime related to their parenting (luke, 2002) and reunifying with their children is a main priority upon their release from prison or jail (brown & bloom, 2009; robison & hughes miller, 2016). many mothers report looking forward to resuming the parental role (bachman et al., 2016; ferraro & moe, 2003; vandermause et al., 2013), but state they were not prepared for how challenging this can be (brown & bloom, 2009; gurusami, 2019). arditti and few (2006) interviewed mothers (n=28) who were reentering society; every mother reported that their incarceration put a significant strain on their children and family. they also stated that reacclimating to the role of motherhood was more difficult than they expected. similarly, michalsen (2011) interviewed formerly incarcerated mothers (n=100) and found that many confirmed that the difficulties with parenting were more stressful than anticipated. through qualitative interviews with women on parole, opsal (2011) found that mothers struggled to reestablish relationships with their children and feel confident in their parenting role after separation due to incarceration. in addition to the challenges of adjusting to the role of parenting upon reentry, mothers have an additional stress of meeting demands of probation and parole which can directly impact their contact with their children and their custody status (gurusami, 2019; opsal, 2015; robison & hughes miller, 2016). ati strive to eliminate the challenges for mothers and children associated with incarceration and reentry. alternatives to incarceration for mothers the most widely studied programs involving incarcerated mothers and their children are prison nurseries (byrne, 2010; byrne et al., 2012; goshin & byrne, 2009; goshin et al., 2014) where infants reside with mothers in a segregated prison unit. in contrast to prison nurseries, advocates for ati prefer that mothers remain in a community setting with their children rather than be imprisoned with them (correctional association of new york, women in prison project, 2015; rebecca project for human rights, 2010; women’s prison association, 2022). some incarcerated mothers themselves have advocated for ati. dworsky et al. (2020) interviewed 42 mothers in a midwestern prison to learn about their parenting experiences while incarcerated. these mothers recommended “communitybased alternatives to incarceration, including substance abuse treatment, that would allow them to maintain contact with their children and continue to play an active parenting role in their children’s lives” (p. 19). community-based correctional programs for mothers are not without challenges. although they maintain the maternal/child connection, some still adhere to “prison-like rules” (schenwar & law, 2020, p. 120). haney (2013) studied one such facility and found the strict punitive nature to be counterproductive to mothering. three studies were found that evaluated residential ati for mothers. lichtenwalter et al. (2010) evaluated the house of healing, a residential ati for mothers with mental health and/or substance use disorders in pennsylvania. logistic regression analysis concluded that the more children a mother had residing with her, the higher her likelihood of a successful discharge. also, mothers who successfully completed the program were nearly seven times advances in social work, spring 2023, 23(1) 68 less likely to recidivate compared to women who were unsuccessful in program completion. brennan (2007) conducted a process evaluation of the summit house program in north carolina, an 18-24 month residential ati for mothers and their minor children. brennan evaluated how the ati operated and highlighted program strengths and weaknesses. the study also sought to examine how the ati assisted mothers (n=44) in building competency in the relationships with their children. results indicated the ati preserved connections between mothers and their children, enhanced the mother-child bond, and taught parenting skills. participants reported that they were motivated to participate in the voluntary ati because unlike prison, they could live with their children. goshin (2015) conducted an ethnography of a residential ati for women with minor children (state not identified), spending 8 months observing the mothers (n=8), children (n=12) and staff (n=1). based on unstructured and semi-structured interviews with the mothers and children, goshin found positive experiences such as staying together as a family, having their own space, and feeling safe. however, themes also emerged that mothers’ mental health, parenting, and health needs were unmet. lastly, staff reported that they were unprepared to manage the behavioral health issues of the women and were not equipped to provide parenting support. these studies indicate successes and areas of growth for ati for parenting women and provide a foundation for future research. the literature is clear that women and children suffer as a result of maternal incarceration. alternative options that address the underlying causes of women’s offending could be more effective than incarceration while allowing mothers to maintain connections with their children. little is known about the experiences of mothers who participate in rehabilitative ati programming in lieu of incarceration. the comparison between this type of intervention and incarceration for mothers is understudied. knowledge of the reported benefits and challenges of an ati compared to incarceration may assist in further developing ati options that avoid becoming “prison lite” (schenwar & law, 2020, p. 140) and assist the field of social work in creating and implementing these programs. the research question guiding this exploratory study was: how does the ati compare to any previous incarceration mothers experienced from their perspective? methods the data from this study stem from a larger dissertation research study conducted with mothers participating in an ati in oklahoma (sutherby, 2020). the ati is a communitybased, comprehensive intervention for mothers convicted of non-violent crimes, currently parenting minor children. the program is designed to support mothers facing incarceration by helping them recover from addiction and mental health issues, obtain employment, maintain parenting responsibilities, desist from future crime, and become financially stable (agency director, personal communication, march 28, 2019). the program provides an array of evidence-based clinical models to address trauma, mental health, and substance misuse issues including, dialectical behavioral therapy, cognitive behavioral therapy, and seeking safety (clinical program director, personal sutherby/mothers & alternative incareration 69 communication, july 2, 2019). each participant works with a team consisting of a therapist, care coordinator, peer recovery support specialist, health and wellness coordinator, strengthening families coordinator, and probation officer. the study’s theoretical foundation is grounded in the pathways perspective (belknap, 2007; bloom et al., 2003; chesney-lind, 1997; daly, 1994) and relational cultural theory (rct; miller, 1976, 2008). according to the pathways perspective, women involved in the criminal legal system have histories of poverty, mental illness, trauma, substance misuse, domestic violence, and abuse/neglect (brennan et al., 2012; cobbina, 2010; salisbury & van voorhis, 2009; wattanaporn & holtfreter, 2014). relational cultural theory posits that maintaining connections and relationships are a central concern to women (emerson & ramaswamy, 2015; miller, 2008). carceral settings are meant to keep the public safe from criminals (covington & bloom, 2007) and are not designed to meet the behavioral health and relational needs of women (covington & bloom, 2007). the focus group method for data collection was chosen for this study based on several factors: the mothers having limited time for interviews due to daily programming, the reported preference of sharing among other mothers, and a long history as an effective data collection method (cyr, 2016; krueger & casey, 2015; macnaughten & myers, 2004; madriz, 2001; morgan, 2019). focus groups allowed these mothers to “tell their stories” in a safe, confidential environment with the understanding that their voices may assist in helping other women in similar situations (liamputtong, 2011). prior to beginning the research study, the semi-structured interview questions (braun & clarke, 2013) were piloted (bearman, 2019) with two mothers participating in an ati and one woman recently released from jail. interview questions included: “when a mother is facing incarceration, what do you think are some of her main needs?” “what are the pros and cons of an ati option for women?” “how does the ati compare to incarceration?” a total of eight focus groups were conducted, averaging five participants and each lasting approximately 90 minutes. to enhance the accuracy of the data collection, each focus group was audiotaped, and field notes were taken by the researcher and an assistant. pseudonyms were used to protect participants’ identities. the study was approved by the social sciences institutional review board at michigan state university. a purposive sampling site-based recruitment method was executed for this study (patton, 2002). mothers were offered a $25.00 gift card for their research participation. the sample was comprised of mothers with minor children who have graduated from or are currently involved in programming at an ati (n=34). of the sample, 3 participants were graduates and 31 were current participants. at the time of the study, 45 mothers were enrolled in the program and 122 total graduates. participants’ ages ranged from 22-43 years, with a mean age of 32.2 years (sd= 6.03). more detailed participant demographics are included in table 1. advances in social work, spring 2023, 23(1) 70 data analysis an exploratory thematic analysis was conducted (braun & clarke, 2013) and data were analyzed in partnership with a trained research assistant and in consultation with the researcher’s dissertation chair. interviews were transcribed verbatim, and a complete coding process occurred (braun & clarke, 2013). the initial stage used in vivo coding to prioritize and honor the participants’ voices (charmaz, 2014). a pattern-based analysis (braun & clarke, 2013) was used to systematically identify and report the salient features of the data. codes were analyzed and combined to form themes that have a “central organizing concept” (braun & clarke, 2013, p. 224). themes were further analyzed to answer the research question and consensus was reached on four themes that emerged from the data. results “incarceration is not rehabilitation” the first theme that emerged from the data revolved around incarceration not being rehabilitative. all the mothers who participated in the focus groups had previously been in jail, prison, or both, so they had firsthand experience in how the ati compared to incarceration. in every focus group, rehabilitation, namely in terms of addiction, was mentioned as a difference between incarceration and the ati. regarding assistance with substance use disorders, no participants reported receiving help while incarcerated and in fact, it was the opposite. besides not offering alcohol or drug treatment or recovery meetings, a few participants stated that drugs were readily available in jail and prison. in describing the main difference for choosing the ati versus going to jail, one woman stated, “i would have probably continued using drugs and learned how to be a better table 1. participant demographics (n=34) demographic mean age in years 32.2 n (%) gender (female) 34 (100%) education did not graduate high school 8 (23.5%) high school diploma/ged 11 (32.4%) some college 13 (38.2%) graduated college 2 (5.9%) race/ethnicity african american/black 6 (17.6%) american indian/alaskan native 4 (11.8%) caucasian/white 16 (47.1%) latino/hispanic 1 (2.9%) multiracial 7 (20.6%) income < $5,000 21 (61.8%) $ 5,000 $19,000 8 (23.5%) $ 20,000 $29,000 1 (2.9%) $ 30,000 $39,000 3 (8.8%) $ 50,000 $59,000 1 (2.9%) employment full-time 9 (27.3%) part-time 9 (27.3%) not employed 15 (45.5%) relationship status married 2 (5.9%) dating 4 (11.8%) single 27 (79.4%) number of minor children 1 7 (20.6%) 2 9 (26.5%) 3 11 (32.4%) 4 4 (11.8%) 5 or more 3 (8.8%) minor child age <1 5 (5.5%) 1-5 28 (30.8%) 6-10 34 (37.4%) 11-17 24 (26.4%) sutherby/mothers & alternative incareration 71 criminal.” similarly, a participant talking about her experience in prison said, “it’s like so easy to do drugs, might as well do drugs because there's nothing else to do.” one mother shared that she sold and used drugs while in prison and described her time as “a big party, because behind the walls you’re not really worried about the outside.” a participant who had been in several jails and spent “a lot of time” in prison claimed that therapeutic groups and education classes were rare and when someone participated, it was for the “wrong reason.” she explained that sentences can be reduced for attending group therapy or a ged class “but they’re not doing it to make better choices, they're doing it so they can get out of jail faster. so, it’s just survival. it’s incarceration, not rehabilitation.” similarly, in a different focus group two women shared the following exchange: lilac: the difference between rehabilitation and prison is like when you’re worried about not using and how you’re going to get your life together and what steps you need to take and um, like not staying at a standstill, while when you’re in prison, you’re at a standstill the whole time. you’re not learning any knowledge to keep you from going back to prison, you’re not getting resources for housing when you get out or getting resources for jobs when you get out, you know things like that. instead you’re getting resources from other inmates. rose: yeah, how to sell drugs or who their plug is, or who’s bringing their stuff in and, uh, when you get out, you can run sh-t for my uncle, or like, what you can do for me and what i can do for you and that’s it. a mother shared her thoughts on prison not providing rehabilitative services: [prison] doesn’t teach them anything, actually causes them more trauma in there because of the things they have to do, like, um you know, or have to see or whatever because that’s prison life you know what i’m saying. you’ve been locked up, you have these felonies, a lot of people don’t even want to give you a chance and then when you...and then you get discouraged when you do go job-searching and they don’t call you and then it’s like what do you go back to? selling drugs, doing whatever you gotta do to survive, then you get caught up in your addiction and then you catch another case and then you’re back in there. when discussing this cycle of returning to incarceration one mother said, “they send us to lock us up in cages, and then you know we get back out. that’s not rehabilitating nobody.” a few mothers claimed a strength of the ati was the help they received throughout the program to be successful in the community. these women described leaving jail and prison as the same or worse than when they walked in, but when graduating from the ati they were set up for success. one mother stated: i know that if i were to have went into prison i would’ve came back out to the same lifestyle. i know that, most definitely, i would've gone back into my addiction. just because the help that i really need, as far as mental help and substance abuse stuff [that] i want to get, you know, i wouldn’t have had that kind of help or the tools that i needed, um, like i do here. advances in social work, spring 2023, 23(1) 72 staff at the ati were overwhelmingly described in a positive way such as “supportive” “kind”, “non-judgmental”, “trusting”, “caring”, “they have our back” and “our po (probation officer) is awesome, she’s my number one.” whereas the following exchange between two participants provides perspective on the attitude of corrections officers in prisons: lily: guards don’t really look at you as a person. they look at you as a number and a criminal. here they look at us as people. iris: yeah, as somebody that can do better in life and make something out of themselves, as increasing their life. lily: when you’re incarcerated and stuff you can say all day what you need and what you want, and they’re gonna tell you “oh well, you done messed up. you can’t get anything; you don’t deserve anything.” “incarceration is easy, the program is hard” the second theme is the concept that incarceration is easier than participating in the ati. many mothers reported that if a woman were motivated to change her life, she could be successful in the ati. however, incarceration was less challenging and an option for women who were not ready to change. one woman shared that she interviewed for the ati and decided not to enroll at the time because she was not ready to stop using drugs. after a subsequent arrest, she felt motivated to get her life together and entered the ati. some mothers described incarceration as time that they did not have to invest in themselves or “face their issues.” some participants described incarceration as “dead time” where they were not concerned with finances, looking for a job, finding a place to live, or managing stress from the outside world. one participant explained incarceration this way: like, going to prison is really the easiest way. that’s easy. you can go sit, and do your time, and go to sleep, read a book, wake up, and do it again the next day. you know what i’m saying? even with no money. one mother said the ati was challenging because “i have to deal with all the sh-t that got me here in the first place.” another woman described how she was incarcerated several times for issues related to her addiction, but it was not until she participated in the ati that she understood that her addiction stemmed from trauma. she thought about quitting the program many times because therapy was difficult and going back to jail “would have been easy.” however, she was committed to providing her children with “a better life” and said that she knew the ati could assist her. one woman shared that she learned about the ati from someone at court who told her not to participate because it was “so hard.” some mothers discussed that while incarcerated they were not working towards a goal or taking active steps in improving their situation but in the ati, they spent two years putting in effort. a few mothers discussed feeling exhausted from the “mental” work they did, which they said was not an expectation while incarcerated. there were comments in nearly every focus group regarding the environment of jail and prison being sutherby/mothers & alternative incareration 73 violent. despite this, several mothers said it was easier to do time than complete the ati. one woman explained how incarceration became easier for her each time: the longer...each time i got incarceration, it became easier and easier and easier and easier to me. so therefore, it’s not even hard to me to lay in a jail cell. that’s easy. i can do that all day long. just lay there and look at the walls. that’s nothing. when you actually have to train your mind to think a different way and learn how to act a different way and learn how to be a mother...because sitting in a jail cell, the day, the day you go in that jail cell you’re...whatever day you come out you're still that same person as you were when you went into that jail, so you’re not learning nothing. “i’m not the same person” a third theme emerging from the data references the positive changes mothers made throughout their experience in the ati helping change them into “different people.” one mother reported that the ati “is life changing”; another said, “it’s changing my life, making a difference.” several reasons were given throughout the focus groups for how this transformation occurs, including learning “new skills”, “thinking differently (not catastrophizing)”, “talking about feelings”, “communicating”, “learning to trust”, “getting sober”, and “setting healthy boundaries”. one mother reported that she now has routines and coping skills to keep her stable and another stated that she did not realize how much she had to learn before coming to the ati. another participant shared, “i’m a totally different person than the day when i walked in here.” during a dialogue regarding changes that mothers have seen in themselves while being at the ati, one woman said, “now, like i care about other people. like it teaches you how to be the exact opposite of what you used to be.” while comparing the ati and being incarcerated, one graduate of the ati stated, “nothing changed” when she returned home from incarceration in reference to her substance use and “toxic relationships.” when she left the ati, she noted that she “stayed sober.” a few mothers said they went back to criminal legal involvement and strained relationships with children and family upon reentry from prison/jail. one of these mothers further shared that because she is a “different person” after ati, her reentry experience will be more positive. “connection with children” the fourth theme related to how the ati helped to improve the connection between mothers and their children. a few participants reported that while incarcerated, they had little to no contact with their children and the contact they did have was distressing. some mothers said they did not have any phone calls, letters, or visits with their children while incarcerated in jail or prison. a few other women stated that whoever was caring for their children would not allow contact or in one case, there was a court order prohibiting contact between a mother and her child. a few mentioned that this was their choice because they did not want their children to visit them or have to explain where they were. one mother advances in social work, spring 2023, 23(1) 74 said she lied and told her children she was going on vacation and others said they were working or going to school. a mother who was pregnant while in prison shares how she wished she could have been in the ati throughout her pregnancy: at least i would’ve been working towards seeing my kid and not sitting there in dead time. ‘cause being in prison is dead time and visits and letters are a big deal, you know what i mean? if you...if your kid isn’t old enough to write you a letter, well those are just years you’re missing. i get you’re an addict, or, you know, i get all that. you know what i’m sayin’...but even the worst of the worst moms still deserves to see her baby. a couple of mothers said that to have contact with children while incarcerated, they needed family who could afford to “put money on the books” so they could pay for phone calls or write letters. for instance, one of the graduates spoke with her children a few times a week while she was in jail because her mom regularly sent money. a few mothers who had older children said they enjoyed talking with them even sporadically, just to have some contact. however, a mother who had spent several years in prison regretted having her teenage children visit her because she felt like it was “selfish and traumatized them.” when discussing contact and relationships with children during the ati, many mothers expressed gratitude to the program for teaching them how to be better mothers. one woman said, “i wasn’t the parent that i should have been and [the ati] has helped me realize that, like it’s okay to not know how to do it because we’re going to help you through it.” another mother credited the parenting education classes she took and the ability to talk through issues she was having with her children with staff. many participants shared examples of how the ati attempted to improve the mother/child connection. a mother captured this by stating that the ati helps improve “connection with children.” one woman said that her teenage son was struggling with his own criminal legal issues and ati staff helped her set healthy boundaries, process her feelings, and refer him to counseling services. similarly, a single mom with no family shared that her son recently needed to have surgery and if she were in jail instead of the ati, she would not have been able to sit with him at the hospital. one mother described how she used to avoid her son when she was drinking so he would not see her intoxicated. now she says they have a great relationship because she is sober with the help of the ati. she further shared that she learned how to process the guilt she feels from abandoning him. through tears, she exclaimed: i don’t dwell on how much i’ve missed out on because i know that he’s got such a full life ahead of him that i get to be a part of, you know, and um, it’s just, it’s the best feeling ever to be able to...i’m his mom, you know. another mom said that the ati “taught me and my kids how to use our words so we get along good. i’m able to discipline them without spanking them or yelling at them and stuff like that.” participants overall reported that their relationships with children were positively impacted through their involvement in the ati. sutherby/mothers & alternative incareration 75 discussion studies of maternal incarceration (allen et al., 2010; barnes & stringer, 2014; enos, 2001; ferraro & moe, 2003) demonstrate the negative consequences that criminal legal confinement can have on mothers and their children. the current study supports this notion through mothers' accounts of fractured relationships with their children and continued substance use upon their reentry from jail and prison. the positive changes reported by this group of mothers due to their participation in an ati intervention warrants further exploration into outcomes of ati for mothers specific to their substance use and connections to children. the data revealed an interesting paradox that is worthy of discussion. participants made many references to the negative environment of jail and prison – how terrible the staff treated them, a lack of options for behavioral health treatment, and very limited contact with their children. however, one woman described prison as “a big party” and a few mothers said they could use drugs and get a break from reality while incarcerated. several mothers reported that while they were incarcerated, they were isolated from the outside world, including responsibilities, so they said their time in jail/prison felt like a break. these findings are similar to women describing incarceration as a respite from their arduous life in the community (douglas et al., 2009; ferraro & moe, 2003). some study participants claimed that incarceration was traumatizing to them, which is supported by previous research (green et al., 2016; harner & riley, 2013). a necessary survival mentality while incarcerated was mentioned by participants and the need to be on high alert, whereas claims were also made by some mothers that they could relax most of the day during their incarceration. building off bradley and davon (2002), more research is needed to understand the way women interpret safety while incarcerated and how this may be connected to a trauma history. the concept of incarceration being easier than the ati may be centered on mothers’ readiness for change and capacity to put in effort to rebuild their lives. a woman's state of mind while incarcerated may contribute to the lens she viewed the experience through (i.e., “those interested in assistance for addiction or reentry recognized the lack of services available to them.”) women who were not considering treatment or their objective was simply to survive the experience may not feel as pessimistic. participants did comment on the need to be motivated “to make it” in the ati. future research could study a mother's readiness for change and involvement with rehabilitative services during incarceration and when participating in an ati. mothers in this study attributed aspects of their success in the ati to the support from staff. while many reported the challenges associated with rehabilitative work, they seemed to credit ati staff with helping them manage this aspect. more information on how staff and ati programming specifically support participants is needed to inform current and future ati for mothers. when discussing the differences between incarceration and the ati, many mothers expressed that a significant difference was the contact they had with their children. while incarcerated, most mothers reported having no or limited contact with their children. a couple of participants stated they chose not to talk to or visit their children to “protect them,” while one mother shared that her guilt kept her from contacting her children. this advances in social work, spring 2023, 23(1) 76 supports research findings that incarcerated mothers are sensitive to the possible harm visitation may cause their children, leading them to avoid contact (e.g., casey-acevedo & bakken, 2002; loper et al., 2009). several mothers reported that the main reason they agreed to participate in the ati was so that they could maintain contact or custody of their children. brennan (2007) found similar results that mothers were motivated to participate in an ati because they could live with their children, an option typically not available in prison. mothers in this study did not have consistent, meaningful contact with their children while they were incarcerated. on the contrary, they stated that the ati preserves connections with their children and helps enhance their relationships. this study confirmed the findings of previous research that many mothers involved in the criminal legal system are devoted to maintaining relationships with their children (arditti & few, 2008; brennan, 2007; brown & bloom, 2009; ferraro & moe, 2003; goshin, 2015). implications this study supports a broader understanding that the current practice of incarcerating mothers with minor children is not working. the american academy of social work & social welfare (aaswsw, 2016) and the national association of social workers (nasw, n.d.) have prioritized issues related to reducing incarceration. further, the concept of smart decarceration remains a focus of the grand challenges of social work (epperson & pettus-davis, 2017). however, mothers are not exclusively mentioned in these efforts. social workers should embrace the notion that mothers in the criminal legal system are stigmatized (corston, 2007; sharp, 2014) and have been deemed among the most marginalized women in society (aiello & mcqueeny, 2016). the profession is grounded in helping vulnerable and oppressed people (nasw, 2017) and therefore social workers should take an active role in advocating for less harmful, more supportive alternatives to incarceration for mothers (o’brien et al., 2019). the current study fills a gap in the literature focusing on mothers participating in an ati. mothers described how their ati experience compared to incarceration from a relational and treatment perspective. this is the first known study of its kind to hear from mothers directly about their experiences within a carceral setting and ati regarding rehabilitation and connection to children. mothers in other ati programs may be interviewed using similar semi-structured questions to see if the findings are confirmed. additionally, only three of the 122 ati graduates participated in the study. a future study interviewing more graduates of the ati could provide data on how mothers fare in the community without the hands-on support they received while in the program. limitations while this study contributes to the understanding of previously incarcerated mothers participating in an ati, there are some limitations to this research. first, the sampling was nonrandomized, and the study design does not have a control or comparison group. however, a thematic analysis study design and focus group data collection are appropriate https://www-tandfonline-com.proxy1.cl.msu.edu/doi/full/10.1080/10509674.2016.1159641 sutherby/mothers & alternative incareration 77 for an exploratory study (braun & clarke, 2013; morgan, 2019). further, the inclusion of a purposive sample of the women that participated in an ati intervention makes it more likely that their authentic experiences were shared. the research participants were primarily caucasian women. studies involving women of color and ati are needed, including the likelihood that they are offered ati and reasons they may decline the option. also, interviews did not occur with women who disenrolled from the ati. it is possible that their perceptions about incarceration and the ati are different from the study participants and therefore these populations should be included in future qualitative research. the data collected from this study came from a group of mothers participating in one ati in the united states. additionally, due to variations of types of ati, eligibility criteria and program-specific data cannot be generalized to all mothers enrolled in ati programs. nonetheless, the exploratory nature of the study could help inform future research studies that are larger and more rigorous. despite these noted limitations, the present study elevated the voices of mothers themselves regarding their perspectives of incarceration versus ati participation. insight was gained about some of the strengths and challenges of each which may help the development of current and future ati for mothers. conclusion mothers in the criminal legal system are uniquely marginalized due to their pathways into crime, the stigma of being a bad mother, and the social consequences 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(2022). a continuum of care. http://www.wpaonline.org/services/alternative-to-incarceration author note: address correspondence to carolyn sutherby, department of social work, ferris state university, big rapids, mi 49307. email: carolynsutherby@ferris.edu https://doi.org/10.1177/0093854805284420 https://doi.org/10.1176/ps.2009.60.6.761 https://d.lib.msu.edu/etd/48640 https://www.vera.org/publications/overlooked-women-and-jails-report https://www.vera.org/publications/overlooked-women-and-jails-report https://doi.org/10.4324/9780367365127 https://doi.org/10.1007/bf02802572 https://doi.org/10.1007/s13524-016-0543-1 https://doi.org/10.1177/1473325012447591 https://doi.org/10.1177/1557085113519491 https://doi.org/10.1353/dem.0.0052 https://doi.org/10.1093/epirev/mxx013 http://www.wpaonline.org/services/alternative-to-incarceration mailto:alex.redcay@millersville reintegration for mothers and children during reentry “incarceration is easy, the program is hard” “i’m not the same person” “connection with children” the fourth theme related to how the ati helped to improve the connection between mothers and their children. a few participants reported that while incarcerated, they had little to no contact with their children and the contact they did have was distr... implications _________ danté bryant, phd, msw, mts, assistant professor, school of social work, university of north carolina charlotte, charlotte, nc. karen m. kolivoski, phd, msw, associate professor, school of social work, howard university, washington, dc. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 481-499, doi: 10.18060/24158 this work is licensed under a creative commons attribution 4.0 international license. the stories we tell: examining the persistence and impacts of normativewhiteness and white supremacy within social work education danté bryant karen m. kolivoski abstract: although there is a growing body of literature denoting social work’s efforts to engage many of the internal racial challenges it faces, there remains a paucity of research exploring the impacts of normative-whiteness and white supremacy within the profession. in an effort to address this gap in the literature, this investigation uses quantitative survey responses from 167 non-racially specific, currently active, social work faculty and administrators, and 12 qualitative interviews with african american, currently active, social work faculty and administrators to gain a more lucid understanding of how they view the roles and impacts of whiteness and white supremacy within social work. thematic findings from this investigation include narratological-deception, epistemological-omission, and a divided-profession. implications for social work suggest the need to equitably incorporate the contributions of racially underrepresented populations, while critically engaging and responding to the “why,” “how,” and “impacts” of their historical omission. keywords: normative-whiteness, whiteness, white supremacy, social work education in 1971, the council on social work education (cswe) publicly acknowledged the need to develop trainings and resources that would better prepare social workers to engage effectively with racially marginalized, and non-majoritarian populations (pinderhughes, 1995). as a result, by the early to mid-1980s, social work programs across the country began to enact a series of initiatives focused on developing and importing a wide range of cultural competency and diversity trainings, workshops, and curricula, many of which have become synonymous with today's profession (corley & young, 2018). however, in the last two decades, these efforts have come under considerable scrutiny. the primary source of criticism has been informed by the a-political or de-political nature of these initiatives (bowles & hopps, 2014; briggs et al., 2018; pon, 2009; sakamoto, 2020). for instance, sakamoto (2020) suggests that existing cultural competency literature largely omits any meaningful analysis of power, specifically as it relates to culture as a racialized-politic. correspondingly, culture is presented as a socially and politically neutral phenomenon that exists independent of social determinants of capital, access, or power. as a result, the systems of racial inequality that prompted social work’s call to action remain largely unchallenged, and in more extreme cases, unacknowledged. as it relates to the latter, many of the educational resources deployed within the profession fail to name or engage what mills (1997) once referred to as the most pervasive, and influential social and political systems in the modern world; white supremacy. about:blank advances in social work, summer 2021, 21(2/3) 482 the ongoing absence of such naming has captured the attention of social work professionals, some of whom have begun to express concerns regarding social work’s potentially unacknowledged investments in normative-whiteness, particularly when contrasted with social work’s assumed ability to model the type of racial equity it professes to publicly propagate (corley & young, 2018; cramer & mcelveen, 2020; loya, 2011; sakamoto, 2020). in light of these concerns, the dearth of literature exploring social work faculty’s perceptions of white supremacy within the profession are troubling, particularly given how faculty function as professional gatekeepers who not only police but also produce scholarship, thought, practitioners, and future educators. to this extent, it is imperative that social work researchers critically explore their awareness of, and the profession’s potential relation to, unexamined practices that may contribute to the persistence of white racial hegemony. in an attempt to support these efforts, this investigation uses a convergent mixed-method approach to explore how social work faculty and administrators perceive and experience the roles and impacts of normative-whiteness and white supremacy within the profession (rubin & babbie, 2016). literature review although research explicitly examining the perceived implications of normativewhiteness and white supremacy among social work faculty are limited, efforts have been made to investigate alternative articulations and impacts of racial inequality within social work and social work education (abrams & gipson, 2007; basham et al., 1997; bowles & hopps, 2014; briggs et al., 2018; davis, 1985; davis et al., 1983; garcia & van soest, 1997; nylund, 2006). for example, in 2015 deepak and colleagues conducted a series of focus groups with the intent of elucidating how social work students, faculty, and staff viewed the delivery of diversity and social justice materials. results from their investigation suggest that effectively discussing systemic issues of social injustice requires that instructors exercise a level of self-actualization (e.g., a clear awareness of their social identities, biases, triggers, competencies, etc.) they may not have obtained. according to deepak et al. (2015), in the absence of these resources, instructors too often function as topical-referees, retarding both their and their students’ opportunities to confront, be confronted by, or engage more difficult and complex systemic issues. correspondingly, varghese’s (2016) qualitative exploration of 15 clinical social work faculty, 80% of whom identified as white, offered support for deepak’s et al. (2015) claims. according to varghese (2016), the majority of participating members conceptualized racism as an individual construct, disconnected from historical and cultural productions of structurally institutionalized systems and practices of marginalization. in addition, varghese’s (2016) content analysis of 27 master of social work syllabi revealed that materials related to diversity and social justice topics largely omitted epistemological vantages informed by systemic acts of institutionalized oppression. in keeping with deepak’s et al. (2015) proposition, in the absence of these vantages, social work faculty and students are denied the opportunity to critically explore, engage and deploy social work’s most prized conceptual model (i.e., person in space). as a result, both are encouraged to individualize the cause and effects of racial inequality, thus, turning their bryant & kolivoski/the stories we tell 483 attention toward reforming individuals or communities while simultaneously omitting the need for institutional transformation. however, while much of the current literature has tended to focus on pedagogical concerns, in the 1980s researchers such as davis et al. (1983) and davis (1985), actively explored experiential discrepancies between black and white social work faculty. for example, in their 1983 investigation of 133 black social work faculty employed at predominantly white collegiate institutions, davis et al. (1983), found that black social work faculty not only expressed feeling as though their chances for professional advancement were less than their white colleagues, but that pejorative racial ideologies served as the primary source of professional tension. in keeping with the theme of experiential demarcation, in 1985 davis surveyed 133 black and 114 white active social work faculty employed at predominantly white collegiate institutions. according to the results, black faculty experienced receiving less respect from students and colleagues, lower levels of job satisfaction, and felt the need to manage both overt and covert acts of racism engendered by peers and students (vakalahi et al., 2007). although the existing body of literature helps to denote social work’s efforts to engage some of the internal articulations of racialization, the paucity of research exploring their shared socio-political contextual determinants (i.e., normative-whiteness and white supremacy) remains largely unexamined. in an effort to address this gap in the literature, the current investigation uses quantitative survey responses from 167 non-racially specific, active, social work faculty and administrators across institutional types, and 12 qualitative interviews with active, african american social work faculty and administrators employed by predominantly white collegiate institutions. the purpose of this investigation was to gain a more clear understanding of how academic social workers view the roles and impacts of whiteness and white supremacy within their profession. method this study, which was approved by the university of north carolina at charlotte’s institutional review board, used a convergent mixed-method approach (rubin & babbie, 2016). according to rubin and babbie (2016), this particular methodology allows the researcher to collect and analyze qualitative and quantitative data both concurrently and independently. as a result, each data set is independently assessed then synthesized with the corresponding data type to provide a more comprehensive view of the topic under investigation (see figure 1). quantitative data were collected using an online, 25-question, likert scale survey that was disseminated to more than 200 schools of social work across the country. see table 2 for sample survey items. concurrently, qualitative results were collected via 12 one-on-one, phenomenologically informed interviews conducted using a virtual web-based platform (smith et al., 2009). see table 1 for the interview guide. advances in social work, summer 2021, 21(2/3) 484 figure 1. convergent mixed methods table 1. interview guide* section research question addressed interview question i: background demographic questions none ii: questions i how do aa faculty and administrators perceive the role or impacts of whiteness and white supremacy within social work education? descriptive/narrative: please, can you tell me what roles or impacts, if any, you believe whiteness and or white supremacy to play in social work education? prompts: • can you tell me a bit more about that? • what do you mean when you say…? iii: question ii how do aa faculty and administrators perceive the role or impacts of whiteness and white supremacy within social work practice? evaluative: please, can you tell me what roles or impact, if any, you believe whiteness and or white supremacy have on social work practice? prompts: • can you tell me a bit more about that? • what do you mean when you say…? *questions are based on smith et al. (2009) suggestions for a set of in-depth interview questions (pp. 59-61). stage design data collection data conversion data analysis data interpretation (contextualization) data integration integrative, analysis, drawing conclusions iterative, inductive content analysis, member checking, triangulation transcription thematic identification audio recording, written notes open ended exploratory qualitative interviews model interpretation descriptive analysiscodes and scalessurvey responses items and scalesquantitative survey data process contextualization advances in social work, summer 2021, 21(2/3) 485 operational definitions whiteness: a conscious or unconscious set of cultural behaviors or practices, performed by persons who are or do identify as white, which rely upon, contribute to, or fail to challenge the production and maintenance of structures that produce white-privilege and systemic-racism. white supremacy: a set of conscious or unconscious beliefs, practices, or ideologies which support, perpetuate or fail to challenge the social, political, historical, economic or institutional dominance and assumed superiority of persons socially identified as white. table 2. sample survey items (likert-scale*) • whiteness and white supremacy are two primary social contexts that influence the lives of all us citizens. • preparing social work students to deal specifically with whiteness and white supremacy is consistent with social work’s code of ethics. • preparing social work students to deal specifically with whiteness and white supremacy is consistent with social work’s use of person in space/environment. • standard diversity or cultural competence course textbooks do an adequate job of addressing the impacts of whiteness and white supremacy. • graduating social work students are adequately prepared to contextualize their clients (i.e., person in space) without additional coursework focused on whiteness or white supremacy. • my formal social work education adequately prepared me to identify, engage and respond to issues of whiteness and white supremacy. • i have received professional or formal training on the social implications of whiteness or white supremacy. • whiteness and white supremacy are significant problems within the social work profession (i.e., academic or direct practice). • as a whole, my department believes that whiteness and white supremacy are significant problems within the social work profession (i.e., academic or direct practice) • society for social work and research is fully committed to addressing whiteness and white supremacy within the social work profession (i.e., academic or direct practice). • council on social work education is fully committed to addressing whiteness and white supremacy within the sw profession (i.e., academic or direct practice) *score ranged from 1 (strongly agree) to 5 (strongly disagree) quantitative sample survey participants (n=167) were limited to active fulland part-time university social work faculty, staff, and administrators who were english speaking and identified as 18 years of age or older. of the 167 anonymous survey participants, 70% (n=117) identified as non-hispanic white, 17% (n=29) as black-african american, 5% (n=8) as not listed, 3% (n=5) as latinx, 2% (n=4) as being of asian descent, 1% (n=2) as indigenous american, .6% (n=1) as pacific islander and .6% (n=1) did not declare. furthermore, of those who completed the survey, 83% (n=138) identified as female, 16% (n=26) as male, 2% (n=3) did not declare, 49% (n=81) were between the ages of 39 to 55, 25% (n=41) were advances in social work, summer 2021, 21(2/3) 486 38 years of age or younger, 26% (n=43) were 56 years of age or older, 1% (n=2) did not declare, 28% (n=47) were full-time assistant professors, 17% (n=29) were administrative faulty, 14% (n=24) were associate faculty, 13% (n=22) were adjunct faculty, 10% (n=16) were full-time lectures, 8% (n=13) were full professors, 4% (n=7) were clinical professors, 4% (n=7) were full-time administrators and 1% (n=2) did not declare. quantitative data analyses used statistical package for social science (spss) software to run descriptive, frequency, and cross-tabulations (see table 3). table 3. demographics profile of survey respondents (n=166) characteristic n (%) race / ethnicity non-hispanic white 117 (70.5%) black-aa 29 (17.5%) latinx 5 (3.0%) indigenous american 2 (1.2%) asian decent 4 (2.4%) pacific islander 1 (0.6%) not listed 8 (4.8%) biological sex female 138 (83.1%) male 26 (15.7%) not listed 2 (1.2%) age <38 41 (24.7%) 39-55 81 (48.8%) 56< 43 (25.9%) not listed 1 (0.6%) education msw 59 (35.5%) dsw 9 (5.4%) phd 98 (59.0%) academic classification* adjunct professor 22 (13.3%) ft-lecturing professor 16 (9.7%) ft/pt-clinical professor 7 (4.2%) ft-assistant professor 47 (28.5%) ft-associate professor 24 (14.5%) ft-full professor 13 (7.9%) administrator / faculty 29 (17.6%) ft-administrator 7 (4.2%) *n=165 bryant & kolivoski/the stories we tell 487 qualitative sample qualitative participants included 12 individuals who identified as currently active african american university social work faculty and/or administrators, who were englishspeaking, and were 18 years of age or older at the time of the interview. of the qualitative study participants, 75% (n=9) identified as woman, 25% (n=3) as men, 42% (n=5) as tenure track assistant professors, 25% (n=3) as tenured full professors, 25% (n=3) as tenured associate professors, and 8% (n=1) as a full-time lecturer. all qualitative interviews were conducted via a webex video-conferencing platform and lasted no more than 45 minutes. all recorded interviews were transcribed verbatim, and data analysis consisted of an iterative and inductive analytic framework informed by smith et al. (2009), an interpretative phenomenological approach. in keeping with smith et al. (2009), data analysis consisted of a cyclical review of each audio recording, and its corresponding transcript, the generation of preliminary exploratory comments, the conversion of this data into a series of themes, thematic clustering of individual transcriptions, and the clustering of all transcription data themes into meta super and subordinate themes representative of relevant participant cases (smith et al., 2009). additionally, bracketing, triangulation, and member checking were used when possible. the results of this process were the identification of 10 sub-ordinate themes: dishonesty, denial, suspended development, invisibility, marginalization, neglect, isolation, professional conflict, differing ethical obligations, and differing practices. these 10 subordinate themes were then distilled into three super-ordinate themes: narratologicaldeception, epistemological-omission, and a divided-profession. results and findings quantitative results of the survey participants, 98% (n=163 of 164) expressed that they either agreed or strongly agreed that whiteness and white supremacy are two of the primary social contexts influencing the lives of united states citizens. in keeping, 93% (n=154 of 166) of respondents either agreed or strongly agreed that preparing social work students to deal with these issues is not only consistent with social work’s code of ethics but social work’s use of person-in-space. however, despite these beliefs, 91% (n=149 of 164) of participants did not feel (61% at n=100 of 164) or were unsure (30% at n=49 of 164) if social work’s standard diversity and cultural competency text provided students with an adequate foundation to engage these efforts. in keeping with these results, 74% (n=123 of 166) of participants agreed that if graduating social work students are going to be expected to adequately contextualize their clients, then they need additional coursework focused on whiteness and white supremacy. additionally, when reflecting on their education preparation, 78% (n=129 of 166) of faculty, either did not feel (63% at n=105 of 166) or were unsure (14% at n=24 of 166) if their formal social work education adequately prepared them to identify, engage or respond to these same concerns. still, although expressing personal awareness of their advances in social work, summer 2021, 21(2/3) 488 under-preparedness, 54% (n=89 of 165) of participants stated that they had not received or pursued supplemental education specifically focused on these topics. building on the perceived dearth of formally required social work training in this area, 91% (n=151 of 166) of all respondents agreed, or strongly agreed, that whiteness and white supremacy are significant problems within the social work profession. however, only 67% (n=111 of 166) of participants felt that their departments view these issues similarly. the lack of individual confidence in social work’s institutions is further reflected in respondents’ views regarding the commitments of the society for social work and research and the council on social work education to dismantle whiteness and white supremacy within the profession. more specifically, when asked if the society for social work and research was truly committed to these efforts, a combined 81% were either unsure (50% at n=83 of 165) or disagreed (30% at n=50 of 165) altogether. similarly, when responding to inquiries related to the council on social work education’s perceived commitment, a combined 74% of participants were either unsure (45% at n=74 of 166) or disagreed (30% at n=49 of 166) altogether. the cumulative notation of these results suggests that while participants believe whiteness and white supremacy to be significant issues confronting the social work profession, they are not confident that social work’s primary institutions are either prepared or committed to addressing them. qualitative findings the following section seeks to provide plausible interpretations of participants’ qualitative responses. table 4 provides a detailed account of the super and sub-ordinate themes identified in the data. to protect the anonymity of all qualitative participants, pseudonyms are used throughout this document. table 4. theme identification super-ordinate themes sub-ordinate theme narratological-deception 1.1 dishonesty 1.2 denial 1.3 suspended development epistemological-omission 2.1 invisibility 2.2 marginalization 2.3 neglect professional division 3.1 profession conflict 3.2 isolation 3.3 differing ethical obligations 3.4 differing form of practice narratological-deception narratological-deception was the first super-ordinate theme to emerge. this term was developed by the investigators in their attempts to capture the unique ways social work’s educational and professional practices promote a constitutive narrative-identify that misssituates the profession as historically and currently independent of investments in practices of normative-whiteness and white supremacy. all 12 interview participants explicitly bryant & kolivoski/the stories we tell 489 identified narratological-deception as a primary means of engendering an autopoietic professional identity that not only undermines social work’s ethical commitments, but dampers its capacity to identify, engage or critically assess its investments in, and dependencies on, white normativity (maturana & varela, 1972). within the context of narratological-deception, the researchers identified overlapping and compounding sub-ordinate instances of dishonesty, denial, and a suspendeddevelopment. for example, dr. tyson highlighted how the use of dishonesty and denial results in a suspended professional development when discussing what she perceived as a lack of congruency between social work’s narratological/ethical commitments, and its professional practices, “we are not who we say we are, we never have been, and i’m not convinced we have what it takes to ever be.” dr. tyson went on to say, “…it takes real courage… until we are honest about who we are… we will always look like this [referring to practices of racialization and normative-whiteness within the profession]…” additionally, dr. jackson echoed dr. tyson’s relational claims when he asserted, “… we think, somehow, we are separated from the things we are trying to change in the world [referring to the persistence of white supremacy]… the problems out there are the same problems in here… in some cases worse, because we think we don’t do that…” however, while drs. tyson and jackson addressed the perceived impacts of dishonesty and denial within the profession, dr. anderson focused on how these practices matriculate through the educational process and contribute to suspending the development of future social workers by further concretizing, and extending the persistence of the existing narrative, and its relational dependency on normative-whiteness. …we don’t tell the truth, we’re not honest about who we are and where we come from. from the time a student walks through the door, we tell them what it means to be a social worker… we tell them what makes us different from everyone else [referring to sociology, psychology, and counseling]. but what we don’t tell them how we practice the same stuff they practice, how everything we teach them was developed by white people, or how our profession is dominated by white folk and white literature and white research and white everything …we exclude black and brown people from our history…. by the time they [social work students] leave our programs, a lot of them are worse off than when they came… when they came they thought they had work to do … when they leave, they think they're done… conversely, while reflecting on the matriculating effects of dishonesty and denial, dr. chambliss recalled interactions she had with students following the conclusions of her race and social justice courses, “…every time, i have a least two or three [referring to white students] say they didn’t get much out of the class… they already learned all this stuff…i’ve never had a black student say that, and they live this stuff every day.” similarly, dr. dixon exclaimed, …every semester i have msw [master social work] students who don’t understand why they have to take diversity in their bsw [bachelor of social work] and msw … some of them, and some of our faculty too, really think if you get an a in the class, then you’re done… advances in social work, summer 2021, 21(2/3) 490 however, while some participants noted the internal effects of narratological-deception, others focused on its external impacts. one such notation was provided by dr. mccormick who stated, … we’ve been saying this [referring to professional claims of racial equity] for so long, and criticizing everyone else… we think we've got it all worked out, and we don’t… we haven't even dealt with our own stuff, but now you want us to ride along with police when we are the same people who over-report black families for child neglect … you're just replacing lethal criminal treatment with non-lethal criminal treatment… it's the blind leading the blind, but everyone thinks we know what we’re doing. similarly, dr. davidson exclaimed, …it's dangerous… our entire college comes to us [referring to their school of social work] for anything about race… we lead every diversity committee, every race committee, everything. mind you, we have a chair who says she doesn’t use the phrase white supremacy because she doesn’t think it’s an accurate description of america… almost none of them [referring to other non-black social work faculty] seem to have a problem with this. but everyone is lifting us up like we’re doing something progressive because that’s what we go around telling everyone… epistemological-omission building on narratological-deception, the super-ordinate theme of epistemologicalomission refers to the absence, or limited presence, of resource materials, critical discussions, or non-eurocentric epistemological contributions that challenge either the existing narrative identity or social work’s investment in perceived forms of white normativity. of the 12 interview participants, 11 explicitly identified epistemologicalomission as not only a product of narratologicaldeception but a primary means by which social work encumbers the decentralization of normative-whiteness within the profession. within the context of epistemological-omission, the researchers identified overlapping and compounding sub-ordinate instances of invisibility, marginalization, and neglect. for example, dr. paul touched on the invisibility of non-eurocentric voices in social work when he stated, …you don’t hear about us [referring to black contributions to the profession] social work is rooted in white progressive views, beliefs, perspectives... they protect it, whether they admit it or not, but they think they’re doing the work… if you really challenge that, they’ll let you know. correspondingly, dr. adams echoed these sentiments when discussing the compounding effects of marginalizing voices that challenge existing practices within the profession. while recalling her failed attempts to publish a series of articles on white supremacy and social work practice as a junior faculty, dr. adams stated, …all i kept hearing was, get publications, use your dissertation so i did… i took some articles to my chair that kept getting pushed back, and she was like, these bryant & kolivoski/the stories we tell 491 are good, but you’re going to need to wait for a special edition… this isn’t a topic too many journals like to normally publish on. dr. adams later expressed, “...after a while i left it alone, all i could think was, let me get tenure first, then i’ll come back to it.” similarly, dr. everest offered a parallel experience within her department while trying to help integrate more non-eurocentric materials into the curriculum as a first-year assistant professor, …it was my research, [referring to racial inequality and curriculum] they knew that when they hired me… the chair pulled me aside, and said to my face, we appreciate everything, but i don’t know that we're quite ready for all of this, just give us some time to catch up. dr. everest went on to explain that she was then encouraged to focus on developing positive relationships with faculty … she really said, it will be important when you go up for tenure and that they had a lot of applicants and that i should be thankful i got the job. i was blown away, i am the only black person in the department and the only one from a top ten r1 program… and you're telling me i need to be thankful, and stay in my place if i want tenure? although the majority of faculty denoted personal experiences of omission, others acknowledged pedagogical or practice-related concerns, …if 80% of social workers and social work faculty are white then at least 20% of the materials we use should be produced by black and brown social workers. but they’re not, all our human development theories are based on the white experience… you cannot say the scholarship isn’t there because there are entire departments dedicated to it… we incorporate stuff from women’s and gender studies all the time and just about everything we use for lgbtq content is produced by them… we choose not to do it when it’s time to talk about race… (dr. hollands) when asked why she believed social workers have chosen to engage in the limited incorporation of non-eurocentric materials, dr. hollands went on to say, people are comfortable talking about their specific marginalization, and the ways that they are disadvantaged, which is why social workers are so comfortable talking about gender inequality or lgbtq issues… but not how these things intersect with race to create new inequalities... we are not comfortable talking about how white privilege shows up all over social work. although mirroring dr. hollands’ initial remarks, dr. davidson departs from the notion of discomfort as determinant of instances of invisibility, marginalization or neglect, “…we don’t incorporate other voices because deep down we don’t feel like it’s necessary… the white perspective is the only thing that has serious value in social work.” later, when reflecting on her remarks dr. davidson exclaimed, advances in social work, summer 2021, 21(2/3) 492 … when it comes to racial issues, social workers have convinced everyone they are better than they really are… everyone except the non-white social workers who have to deal with them, and those are the same people they ignore…the truth is they’re not prepared to have honest discussions about race, even if they really want to, they aren’t ready, and every black person knows it, so what do you do, you nod and pretend to have honest discussions because that’s really all they are, pretend… we do the same with the students… then send them out into the world… it's saddening… the final super-ordinate theme identified was professional-division. this term professional-division refers to the unique ways narratological-deception and epistemological-omission intersect to inform two pragmatically and experientially distinct forms of social work. more specifically, professional-division denotes the perceived experiential needs of african american social workers to conceptually differentiate their professional and ethical identity, and commitments, from those practiced by many of their non-african american colleagues. of the 12 study participants, 11 explicitly expressed experiencing or engaging in professional-division. within the context of professiondivision, the researchers identified overlapping and compounding instances of professional conflict, isolation, differing ethical obligations, and differing forms of practice. when initially asked how she reconciles the professional persistence of normativewhiteness with social work’s professed ethical obligations, dr. townson stated, “… i don’t… there’s black social work and there’s white social work, i leave it at that… we don’t do the same things...”. similarly, dr. lawson shared how he deployed notions of differing obligations and practices to account for his experiences with professional conflict and isolation when he stated, …when i first got into social work i realized when i read the code of ethics i saw one thing, but the person [referring to white social workers] sitting next to me saw something totally different … we [referring to black and white social workers] don’t have the same commitments, because we don’t have the same concerns and we don’t have the same problems… we’re both technically social workers, but we have different professions. dr. anderson echoed dr. lawson when she declared, …we don’t have the same concerns, because they [referring to non-african american social workers] don’t have to deal with the contradictions like we do, they don’t affect them like they do us. if black people aren’t treated fairly it doesn’t affect them, if we don’t really deal with white supremacy, it doesn’t affect them… i don’t know what kind of social work they practice, but i know it’s not what i do… however, while some participants chose to manage experiences of professional conflict and isolation by dividing the profession into differing ethical and practice obligations, others, such as dr. marbury, simply denounced or relegated any practice of social work that did not explicitly work to ameliorate racism and white supremacy to professional dishonesty, denial, or narratological-deception; “if you are not trying to liberate all people, which means you have to get rid of white supremacy, then you’re not bryant & kolivoski/the stories we tell 493 a social worker… you might say you are, you might be a social activist, but you’re not a social worker…” discussion according to survey responses, the overwhelming majority of participants recognize normative-whiteness and white supremacy as primary social (98% at n=163 of 166) and professional (91% at n=151 of 166) issues confronting social work today. in addition, social work faculty acknowledge that it is not only necessary to prepare current students to deal with these systems, but that doing so is consistent with social work’s code of ethics (93% at n=154 of 166) and its primary conceptual model of person-in-space (93% at n=154 of 166). however, despite this awareness, the majority of faculty are either unsure or do not feel as though their formal education (78% at n=129 of 166) or current standard diversity and cultural competency curriculum text, adequately address these challenges (91% at 149 of 164). furthermore, the majority of faculty expressed a lack of confidence in their departments (81% at n=135 of 166) and national organizations’ (sswr 81% at n=133 of 165, cswe 74% at n=123 of 166) commitments to dismantle such practices within the profession. interestingly, these findings not only provide contextual support for the qualitative experiences of interview participants but are, in part, explained by them. for example, the shared experience of narratological-deception suggests that the persistence and pervasiveness of social work’s professed identity hampers its efforts to fully come to terms with the profession’s investment in, and dependency on normative-whiteness and white supremacist practices. this is demonstrated in the data in two ways. the first can be seen via participants' recognition that additional course work focusing on whiteness and white supremacy is needed to aid current social work students in their attempts to better contextualize their clients (75% at n=125 of 166). the second is presented via faculty’s recognition that addressing issues of normative-whiteness and white supremacy are not only consistent with the profession’s code of ethics (93% at n=154 of 166), but social work’s primary conceptual model (93% at n=154 of 166; i.e., person-in-space). as a result, what is implied in the public and private promotion of social workers’ ethical obligations and theoretical position is an educational and professional experience that equips students to address whiteness and white supremacy in their various articulations. however, as noted by survey participants, social work as an institution has not only failed to adequately equip past now acting as practitioners and faculty and present learners, but they have failed to redress a public and professional identity that is shaped by social work’s expressed ethical commitments to fully engage racial inequality. the resultant effect is an existing educational model that does not fully support the pronounced ethical obligations or the expressed identity of the profession. in light of such incongruence, social work is confronted with having to either alter its existing professional and pedagogical models, resign its current identity, or mute its detractors. if defaulting to the last option, the voices and positional knowledge of those who are not only in the profession but best situated to testify to its internal dissonance must be marginalized, muted, or omitted (warren, 2018). within this context, intentional or not, advances in social work, summer 2021, 21(2/3) 494 the presence and more specifically the voices of black social work faculty, serve to disrupt and undermine the legitimacy of the existing social work project (harney & moten, 2013; lomax, 2018; moten 2018; warren, 2018; wilderson, 2020). as a result, the act of epistemological-omissions must be, if it is expected to aid in stabilizing the perceived legitimacy of the professional narrative, chronically protected, pervasive, and transmittable (dubois, 1920; glaude, 2016). put differently, in order to sustain its sense of personal and public integrity, the social work profession must continually deny or at the very least marginalize dissenting voices or epistemological realities that do not comport with its current narrative identity. furthermore, social work must also reproduce and re-assert this narrative within successive generations of practitioners, faculty, and administrators (baldwin, 2010; glaude, 2016; mills, 1997). this medium of narrative-identity production serves as an autopoiesis – that is, a self-perpetuating and sustaining system of interactions that not only engenders normative-whiteness, but positions the experiential and professional epistemological realities of black social work faculty as aporetic – that is, a source of internal contradiction (baldwin, 2010; mills, 1997; merriam-webster, 2016; warren, 2018; wilderson, 2020). to the extent to which this holds, black social work faculty are confronted with the challenge of reconciling social work’s continued omission of the aporetic (i.e., the voices and epistemological vantages of black social workers) with its professed professional and ethical commitments. as a result, many of these faculty, to borrow from harney and moten (2013), will not deny that the profession as it currently stands is a place of refuge, but they will not accept that it is a place of enlightenment or liberation. the resultant impact is the experiential need to re-imagine the profession, and self-differentiate, via the import of a professional-division. limitations given the dearth of literature on this topic, it is difficult to cross-reference findings with existing research. further, qualitative outcomes cannot be generalized or broadly compared to participants outside of the existing study. in addition, given the sensitivity of the topic and the broader political climate at the time of survey data collection (the summer of 2020), social desirability should be considered. lastly, given the race and profession of the primary investigator – a black male university social work faculty member – social desirability, confirmation bias, and those associated with an emic perspective were a constant threat. however, mediation efforts did include bracketing, member checking, and triangulation of data. implications for social work if it is assumed that who and what social work highlights and omits tells something about what social work values and who social work is, then it also holds that to advance the profession, social work must redress its narratological identity. however, to do so requires that social work critically engage itself, by turning itself over to the critiques of bryant & kolivoski/the stories we tell 495 those within and without the profession who have been most adversely impacted by its current narrative identity. this means that social work, which has historically exalted the voice of individuals such as jane addams, must now temporarily render her mute, while lifting her up to be compassionately interrogated by works produced by persons such as ida b. wells, charles mills, audre lorde, bell hooks, paulo freire, james baldwin, frank wilderson, dorothy height, e. franklin frazier, mit joyner and others. this performance of care is an essential act of destabilization that undermines the pervasiveness of normative-whiteness, as a professional and ideological taken for granted, while providing social work with the reflective resources it needs to evolve (baldwin, 2010; watson, 2013). it is only by offering her and her colleages up in this way to be examined by those who have documented and critically explored the implications of whiteness for more than two hundred years that jane addams will ever come to truly know who she is, what she is, and what she can become. however, if social work is unwilling to do so, the profession will be no better tomorrow than it is today, and those who are dependent on the stability of the existing story will remain less free to evolve than those whose voices they currently exclude. to this end, social work must begin to not only engage in a compassionateinterrogation, but it must practice the equitable incorporation of knowledge shared by racialized groups who have been historically excluded from full participation in shaping what is accepted as normative-canonical notions of truth. in addition, social work must engage the “why,” “how,” and “impacts” of the historical omission of these groups. this means social work must revisit its historicity of unspoken assumptions regarding what is considered knowledge, who possesses it, who the social worker is, who they serve, and the truth of their mission. the comingling of a compassionate and epistemological-integration can guide and support social work’s efforts to not only expand the existing narrative but to demystify the ethical commitments and practices within the profession. by incorporating the voices from the margins, social work can begin to decentralize whiteness, while aiding students and faculty in their development of a more expansive epistemological repository. furthermore, the examination of the historical absence of such vantages can help to call attention to the need to actively critique both past and present social work practices. these types of efforts can help to provide faculty and students with the preliminary intellectual freedom and tools they need to confront, question, critique and reimagine what was, what is, and what could be. the import of such efforts should be articulated at the national, programmatic, and pedagogical levels. at the national and programmatic levels, social work must publicly acknowledge and wrestle with its relationship to normative whiteness. in addition, it must speak to its matriculating effects within racialized communities, and among non-racialized majoritarian practitioners, faculty, and administrative staff. however, to do so implies that social workers have taken the time to educate themselves on whiteness as an identity, politic, religion, ideology, and source of power. lastly, social work must engage and prioritize the voices of historically marginalized racial communities within the profession. this means that social work must invest, advances in social work, summer 2021, 21(2/3) 496 promote, and help cultivate scholars, practitioners, administrators, scholarship, and faculty among racialized populations. the co-mingling of these activities is essential if the profession desires to ascend to its ethical ideals in both proclamation, and practice. at the pedagogical level, the practices of recognition and equitable incorporation should be pervasive. however, they will likely have their greatest impact within an introductory social work course. this is primarily informed by the course’s function and placement within most programs. often situated as either a prerequisite for admission or advancement, the introduction to social work courses provide students with conceptual frames for filtering and understanding the profession, its obligations, their place in it, and all other future information and activities. by gifting aspiring social workers with these tools and opportunities, social work can invest in a future narratological identity that not only encourages critical professional engagement, but increases the likelihood of participation in a more expansive and just conception of justice. implications for future research future research should explore the experiential perceptions of whiteness and white supremacy across racial categories within social work. in addition, quantitative investigations should seek sample sizes that will allow for more in-depth analyses of the differences and similarities across various cohorts of social work faculty and administrators. furthermore, future inquiries should explore curriculum, policies, practices, and the racial cultural climate within social work programs. lastly, these efforts should look to more fully incorporate theoretical models and lenses such as black feminist theory, critical race theory, intersectional theory, and afro-pessimism. conclusion it could be argued that social work is at a crossroads. according to participants, social work's greatest obstacle is not the character or integrity of the individual, rather it is the persistence of a culture and narrative mythology that suggest that the profession either fully understands or has adequately addressed its relation to, and potential dependency on, whiteness and white supremacy. in this sense social work has, by and large, narratively insulated and positioned itself outside the reach of racial critique. as a consequence, manifested acts of normative whiteness within the profession are too often unrecognizable, unacknowledged, or unaddressed by those who perform them. however, those instances that are highlighted, or placed on center stage, are too frequently viewed as abortions or disconnected acts that simply reflect social work’s failure to live up to its ideals. however, if one were to assume that a system is what it persistently produces over time, then social work must confront the possibility that such acts are not abortions or failures, but the successful articulation of its values. such recognition is the beginning of a new beginning, the point in which social work pivots, choosing to be more, choosing to be what it has always claimed to be but is yet to become. bryant & kolivoski/the stories we tell 497 however, if unwilling to engage in the possibility, social work will likely continue to move to-and-fro in what glaude (2016) describes as a “thick fog of unreality” (pp. 5-10). this is, beyond dispute, a life of willful ignorance, a conscious decision to choose to remain deceived by the stories one tells and the voices one mutes. ultimately, if social work is unwilling to redress, it will remain a profession whose ethics, identity, and value are supported by nothing more than a “fantastic system of evasions, denials, and justification” (baldwin, 2010, p. 95). references abrams, l., & gipson, j. 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(2018). ontological terror: blackness, nihilism and emancipation. duke university press. https://doi.org/10.1215/9780822371847 watson, v. t. (2013). the souls of white folk: african american writers theorize whiteness. university press of mississippi. https://doi.org/10.14325/mississippi/9781617038891.001.0001 wilderson, f. b. (2020). afropessimism. liveright publishing. author note: address correspondence to danté d. bryant, school of social work, the university of north carolina charlotte, charlotte nc 28223: dante.bryant@uncc.edu https://doi.org/10.1080/10437797.2016.1174646 https://doi.org/10.1215/9780822371847 https://doi.org/10.14325/mississippi/9781617038891.001.0001 mailto:dante.bryant@uncc.edu _______ kelechi c. wright, med, lcpc, doctoral student, kourtney angela carr, msw, lcsw, professor of practice and doctoral student, and becci a. akin, phd, associate professor and phd program director, university of kansas in the school of social welfare, lawrence, ks. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 274-297, doi: 10.18060/23946 this work is licensed under a creative commons attribution 4.0 international license. the whitewashing of social work history: how dismantling racism in social work education begins with an equitable history of the profession kelechi c. wright kortney angela carr becci a. akin abstract: severe racial inequity has characterized the incorporation of ethnic minorities’ contributions to u.s. history and advancements (sandoval et al., 2016). these disparities are inextricably connected to white supremacist ideologies and practices, and are perpetuated in higher education through textbooks, pedagogy, and research. social work, like many disciplines, teaches about its early roots with a whitewashed historical lens. indeed, review of the social work literature reveals the scarcity of attributions to black, indigenous, and other people of color (bipoc). without a more racially diverse perspective on social work’s history, social work scholars promote and sustain white supremacy. the implications of this are crucial since social work education is predominantly populated by privileged white students who adopt this mentality, unaware of black, brown, latino, asian, native or other ethnic “jane addams” who have massively promoted the social welfare of communities for decades without historical recognition or the privileged positions of addams and richmond. historical distortions also potentially discourage bipoc social work students’ self-efficacy and future efforts to contribute and excel in the discipline. to properly address this issue, social work history must be refaced with a more equitable and just lens. this review seeks to address the gap in the literature pertaining to the need for a greater integration and infusion of racially diverse social work historical contributions in several ways. recommendations will be made for future research in this area to dismantle racist perspectives in social work history, and strategies will be offered to help social work educators and researchers address this critical issue. keywords: dismantling racism, social work history, bipoc contributions symbols of white supremacy are not just limited to the confederate flag and iconic statues of soldiers vehemently supporting the degradation of black, indigenous, and other people of color (bipoc). if removing these overt symbols were that simple, the problem would be uncomplicated to mend. what is more insidious is a mindset that is perpetuated with countless and ubiquitous narratives that whites are supreme. numerous academic and vocational institutions attribute their innovation and earliest beginnings to white people. earliest framers of institutions are almost always of european descent, creating a subconscious and conscious paradigm that whites are innovators, originators, and generators of everything needful and new. in contrast, bipoc are receivers. this phenomenon is one of the worst catalysts of the false narrative suggesting that whites are supreme. social work is no stranger to this white supremacist narrative. ironically, a discipline that prides itself on social justice and racial equity is historically framed by the same whitewashed narrative. as in other disciplines, social work’s traditional texts, the earliest founders of social work are predominantly white, while many of the recipients of about:blank wright et al./whitewashing of swk history 275 their sacrifices are poor and/or bipoc even though this was not always the case. countering the ideology of white supremacy requires an injunction on perpetuating this belief and reworking an understanding of the diverse characters that shaped the social welfare field. this matter is urgent and significant if the social work discipline is to make sincere attempts to stop, resist and repair the damage done by white supremacy’s dominance. institutionalized racism in documenting history an inaccurate view of the past always distorts efforts to make a more just future. academic social work, like other academic disciplines, depends on history for training and equipping students. it also readily uses history to inform theories, philosophies and ideologies that shape the discipline and next generations of social workers. this historical information disseminated is vitally important. many disciplines like medicine (newsome, 1979), music (mahon, 2015), science technology engineering and mathematics (stem; mack et al., 2011), and mathematics (shetterly, 2016) have, just within the last few decades, began to excavate the voices of many marginalized ethnic groups, revealing their unique role in contributing to their disciplines historically. history holds great significance in the fight against white supremacy. history is like a silent but powerful weapon that is reinforced by being retold repeatedly to a newer generation of leaders. as it relates to social work history, students are retold the same whitewashed narrative about the discipline’s inception. the dynamics of social work are important to remember considering that it is typically populated by white individuals often assisting and serving people of color. according to the council on social work education (cswe) 2019 annual report, 61.1% of full-time faculty and 58.3% of part-time faculty identify as white (cswe, 2019). the 2019 cswe annual report also demonstrates that the predominant group of social work students at all levels identify as white (cswe, 2019). while 48.7% of baccalaureate identify as white, 50.2% of master’s level students, 36% of practice doctorate and 46% of research doctorate students identify as white (cswe, 2019). new students seeking to be scholars, practitioners, or researchers in social work populate cohorts who are learning a specific history that reinforces the stereotype and serves as the seed bed of white supremacy: that bipoc individuals are the weak and inferior receivers while whites are the innovators and distributors of all things good. this is not a suggestion to fail to tell history without the statistical accuracy that supports the notion that the majority of the people in helping professions such as social work are white (cswe, 2019, 2020, lin et al., 2018). however, failing to tell the stories of social work leaders who were persons of color creates an inaccurate view of history and reinforces white supremacist ideologies. these bipoc historical leaders largely remain unnamed and have been barred access to professional recognition for their contributions to social welfare. another prominent example of white supremacy in the biased and inaccurate documentation of history occurs when white people bring a new concept from a culture different than their own. frequently, the focus is not the innovation; rather, the focus becomes the glorification of the white person that shared the concept. often omitted is a advances in social work, summer 2021, 21(2/3) 276 focus on the theory or understanding or new understanding as greater attention is placed on the innovator, again reinforcing white supremacist ideology. connecting this process to social work education, we recognize it affects the minds of white social work students who will most likely serve people of other ethnic backgrounds. they will take with them the inaccurate belief of their culture disseminating everything and helping remedy other cultures supposed “primitiveness.” when thinking philosophically, it can create a subconscious paradigm of white dominance. if this dynamic of teaching and translating incomplete history does not end, it will continue to reinforce white supremacy in social work education and practice. social work must be accountable to telling the complete story of institutional racism and how it has placed people of color into downcast roles since the inception of the discipline. failing to tell the full narratives around how people of color have helped themselves and led as helping professionals within their own communities is a disservice to a complete and honest understanding of this unique discipline. furthermore, at work is a pervasive historical pattern where whites were often the “wounders” and then a profession, like social work, was praised for founding a response that represented the “healers.” for social work to truly dismantle the complexities and paradoxes of white supremacy and racism from its checkered past, a critical lens is necessary. social work – a tradition intertwined with racism racism in social work is an unfortunate blemish on the history of the profession. social works’ inception dates to the mid to late 1800s (austin, 1983). the origins of social work are of course debatable as the deeds of the profession historically outdate its officiation process vocationally (ehrenreich, 1985). complicating the discussion is how to characterize or conceptualize what was or was not social work in times past (reisch, 2019). this paper assesses the topic, utilizing what was popularly deemed as social work to help better understand the challenges in magnifying the role people of color had in creating the profession. it is traditionally upheld that social work began from frameworks and principles that span from europe, the united states, and the middle east (dulmus, 2012). these regions are credited with the earliest conception of social work due to the fact the some of the earliest recorded charitable community-based initiatives were tied to these regions. earliest records of the first orphanages, hospitals, and nursing homes are attributed to these regions guided by strong religious principles (vanderwoerd, 2011). interestingly, it is difficult to date whether these principles or practices existed in other regions of the world, such as asia, central america, south america, or africa. importantly, communal societies have long held the family or village responsible for the care of vulnerable persons. additionally, many indigenous peoples groups did not record their history in the same manner as europeans and some of their close geographical neighbors. that is, oral traditions were the manner in which history was disseminated from generation to generation. it is also clear that scholars from indigenous people groups were many times denied the privilege of being recorded into history as european explorers downgraded the humanity of non-white groups, asserting non-white groups were inferior to european people. wright et al./whitewashing of swk history 277 given that the united states and europe are typically credited with officiating and establishing social work in the midto late 1800s, it is helpful to consider the social and political climate towards people of color in these two regions. despite the oppressions of slavery, black leaders were creating and developing social welfare systems (carltonlaney, 1999; o’connell, 2013; hounmenou, 2012). however, the “racial sciences” that were disseminated by british and french scientists in the 1800s were used to proliferate the false notions that the “negroid” and other persons of color were inherently genetically inferior to whites (miles, 1997/2014), uphold racial slavery, place western europeans at the top of a human hierarchy, and exclude bipoc leaders from participation in the official development of social welfare reforms (o’connell, 2013). these racialist theories intersected with emerging social welfare policies at the time and established a racialization of poverty (o’connell, 2010, 2013). black churches and charities were faced with countering slavery and other racist policies, and they struggled with “the political risk of forming their own social welfare measures or accepting white philanthropy while attempting to combat racial hatred” (o’connell, 2013, p. 17). in the united states, the genocide of indigenous people groups is one of the earliest works of white supremacy. armed with the false notion of manifest destiny, settlers created a framework for the nation built on the blood of native indigenous populations. the nation was established and conceived upon a central tenet that those who were ethnically different from whites were inferior. indigenous scholars have explained that european explorers who colonized north america were unable or unwilling to even conceive of the community-oriented leadership that was used effectively by indigenous peoples (weaver, 2020). thus, the contribution native peoples could have had on social work or social welfare initiatives would have been omitted, ignored, or downplayed. native peoples were seen as subservient to europeans and their contributions to a new social system that was established by early settlers would have been unsurprisingly edited from history books and other documentation. the crowned white founders of social work from the murder of native peoples and the stealing of their land, to legalized slavery and the jim crow era, bipoc were subjected to institutional racism for centuries while the white founders of the social work discipline were emerging. jane addams was born in 1860 and died in 1935 (alonso, 2004). addams worked in an age when social work was not yet labeled a “profession.” she was coined as many things including sociologist, philanthropist, labor reformist, advocate for juvenile justice, women’s suffrage proponent, and settlement activist (harris, 2011). another founding pioneer of the social work discipline was a contemporary of addams, mary ellen richmond, whose life spanned from 1861-1928 (murdach, 2011). richmond’s parents were well off and her father amassed the family’s wealth as a jeweler and through real estate. richmond was seen as an activist, community organizer and social reformer (agnew, 2004). john augustus was a white male figure who is also noted for helping shape early social work at the same time as addams and richmond. he is recorded as a philanthropist and activist in the criminal justice system (lindner, 2006). his “case records” and management notes have been archived from the 1800s. in sum, the social work discipline acknowledges these early figures as central to advances in social work, summer 2021, 21(2/3) 278 understanding the blueprint for how social work came together historically before the term “social worker” or “social welfare” were common terms. it is also important to highlight the societal response these individuals received for work connected to social welfare. addams is noted for having a long list of accolades that credit her with many accomplishments in her service. for instance, yale university awarded addams the first honorary degree ever given to a woman. she was also the first woman to receive the nobel peace prize (alonso, 2004). she is recognized in textbooks as one of the earliest formers of the juvenile justice system and assisting in earliest conceptualizations of the child welfare system. and of course, she has been crowned by the social work profession as the mother of social work (joslin, 2004). with a critical lens and a both/and approach to this historical analysis, the whitewashing of social work’s history is revealed even around the most sacred historical figures of social work history. these identified founders and framers may be seen as facing some measure of challenge in their efforts to support the most marginalized peoples of society and holding what we now coin as “white privilege” as they did so. by current understandings, addams was born into “white privilege” and was highly praised in life and death for her sacrifices as her many awards suggest. while addams, richmond, and augustus were heralded as founders or framers of social work, the discipline is negligent in failing to mention people like eugene kinckle jones who was an advocate and known for his contributions towards the professionalization of social work (armfield, 2011; carlton-laney & alexander, 2001). also largely omitted is w.e.b. dubois, who was known for his scholarly research of social phenomena, social justice advocacy, and was one of the founders of the national association for the advancement of colored people (naacp; du bois, 1896/2006; green & wortham, 2015; morris, 2015). one explanation may be that social work, from its inception, has tended toward centering and praising a certain “kind” of work. although the cswe introduced cultural diversity as an area of focus for both social practice and education in 1978 (mcmahon & allen-meares, 1992), the study of whiteness over the last 20 years and new understandings of white supremacy help uncover and reveal that history books document events, persons, and explanations of value that maintain white culture (jeyasingham, 2012). in contrast, those events, people, and principles upheld and applauded by bipoc have seldom made it into history books, including those that tell the history of social work. bias is further seen in comparing social work’s identified founders to other reformers like frederick douglas. douglas was noted for his social activism, education, and significant research as it related to social welfare issues. his work was crucial in its advocacy for human rights, women’s rights, peace activism and other social justice issues (simba, n.d.). yet social work’s history does not acknowledge how douglas’s work on these highly relevant issues contributed to the discipline’s focus on social justice. one reason may be that addams and richmond, as white women, were recognized in their time with greater respect for their contributions due to the “great white hope” phenomenon. this phenomenon glorifies the white hero who “selflessly” comes to aid the ethnically different marginalized community (pimpare, 2010). such efforts are seen as sacrificial as many white women like addams or richmond spent their time fulfilling duties and responsibilities as wives, mothers, and did not work outside of the home during this time wright et al./whitewashing of swk history 279 period (brownlee, 1979). by serving the “disenfranchised” and challenging the status quo mentalities, addams and richmond appeared to be “selflessly” deviating from their privilege. this deviation from the norm allotted them great attention. therefore, their “sacrifices” were worthy of nobel peace prizes, honorary degrees, and recognition from those in power. to recognize and challenge this whitewashing of social work’s history, the discipline must consider whether these criteria continue to be valid in determining who is deemed a founding member of social work and who is not. as discussed above, history supports that addams and richmond were not alone in their quest for social welfare for the oppressed. many bipoc sacrificed more than upsetting the status quo so that future generations would experience social justices that they were denied during their lifetimes. few bipoc were awarded prizes; nor can their families celebrate their names in history books. yet their hidden and downplayed efforts set waves into a network of social efforts that is now called social work. while jane addams and her hull house contemporaries were creating what many coin as the earliest roots of social work in boston, in the same city, bipoc were not seen as complete human beings by the law. still, bipoc served as addams and richmond’s hidden contemporaries. these early bipoc social work pioneers were unable to vote and legally challenge the social systems for which addams is noted as reforming. they would not have been allowed at meetings to discuss child welfare policies. and forcing their way into such venues may have led to their arrest or death. a host of black activists such as edgar daniel nixon and a. philip randolph, both presently recognized for their avid social action, did jail time and suffered many hardships for contending for justice in the same period that addams was gaining attention for her noteworthy activism (baldwin & woodson, 1992; kersten, 2007). more frightening examples are husband and wife, harry and harriette moore, both fired from their jobs and later assassinated for their social activism (green & kennedy, 1999). fighting and challenging gender dynamics, seeking to reform institutions like the court system was valiant; however, the identified founders of social work experienced an earlier form of white privilege. acting similarly to support such insurrection may have led bipoc individuals to much greater loss, such as incarceration, physical abuse, or death due to racial enmity, discord and legalized segregation and brutality. in short, the consequences of challenging the system were much more staggering and significant for bipoc individuals in this time. bipoc social work forerunners while addams and richmond were awarded for their sacrifices to these communities, many people of color faced harsh social sanctions. well into the 1960s and beyond, individuals like dr. martin luther king, jr. were placed on fbi watch lists and profiled by local and national governments as communists. dr. king received hate mail and death threats for his social welfare efforts. he fought for an enduring process of liberation for oppressed peoples and gave his life for it. as social welfare remedies its past, it should consider this. dr. king was not alone, he is joined by many others. during the civil rights movement, many black leaders who were advocates and employed interventions for change in these communities were targeted, harassed, assaulted, and murdered. ultimately, advances in social work, summer 2021, 21(2/3) 280 their actions proved to be very costly while individuals such as addams and richmond received acknowledgment and praise. two historical bipoc leaders of social welfare two examples of bipoc early social welfare leaders are w.e.b. dubois and eugene kinkle jones. dubois was born in 1868 and died in 1963 (lewis, 1993). he was born during the same time period as richmond and addams. dubois was the first african american to receive a doctorate from harvard university (morris, 2015). interestingly, his work parallels that of the two founding women of social work. his work mirrored “macro” focused social work. similar to richmond, he led several studies. in fact, his research and work were so prolific that some scholars coin him a sociologist (green & wortham, 2015). one scholar suggests that dubois is the rightful, forgotten heir to the title of “father of social work” (morris, 2015). dubois fervently wrote to advocate for the advancement of people of color. he poignantly spoke and organized civil action petitioning for structural change in institutions. despite these ideas and actions that were well-aligned with social work, dubois is almost never mentioned as a founder of social work. dubois, like richmond and addams, did not have an opportunity to study social work, since the discipline was not officiated as an academic or vocational category when they were college-aged. yet his labor to study for the purpose of social activism and reform seems synonymous with the same efforts as richmond and addams. moreover, the level of opposition dubois worked under was much harsher than that of richmond and addams. dubois fought for social justice amid jim crow, legal lynching practices (morris, 2015), and legally supported institutional racism. due to widely held racist views and structures, the assumption is made that dubois most likely would have not received a nobel peace prize due to the color of his skin. his work never would have made it to the pulitzer list because of his ethnicity. a second example of bipoc social work pioneers is eugene kinkle jones. jones was born in 1885 and died in 1954. jones was a leader in the national league on urban conditions among negroes, now renamed the national urban league (nul; fenderson, 2010), an organization that has historically advocated against racial discrimination. the nul fervently sought to eliminate institutional racial segregation and improve living conditions for the black community. jones is well known for his focus on advocating for better health, housing, and economic conditions. he worked for the incorporation of blacks into labor unions, organized civil rights activism against businesses that were legally able to deny jobs to blacks, and advocated for school reform to incorporate more opportunities for people of color. jones, though likely not widely known by many social workers, was elected amongst the leadership of the national conference of social work in 1925. he was the first black person on the executive board of the national conference (armfield, 2011; armfield & carlton-laney, 2001). this was a major milestone for social work, though still not widely taught nor known in many social work programs. in sum, few bipoc were documented or recognized, much less honored, for their contributions to social work. rather, bipocs’ contributions to the progression of society in many professions were wright et al./whitewashing of swk history 281 erased or ignored, and the narrative for how they edified society was scarcely acknowledged in comparison to their white counterparts. modern day bipoc scholars currently, some social work scholars are seeking to uncover the work of people of color’s contributions to social work, including those historical figures less known than dubois and jones. one scholar, dr. crystal coles, uses a method called prosopography to examine older documents from the southern region of the united states (coles et al., 2018). coles highlights this unique role of research inquiry to explore marginalized peoples’ influences on social work. coles studies primarily the impact african american women have had on social work in specified regions of the south. coles recommends the use of prosopography as it involves a detailed historical investigation into the lives and works of people (hohl, 2010) whom are no longer available to interview (coles et al., 2018). hohl (2010) used similar methods to examine the revolutionary lives of 121 black women who led in many social welfare-involved vocational roles, though they were legally barred from doing so because of the color of their skin. hohl posthumously renamed their social roles and vocational titles that many were denied legal rights to claim because of their ethnicity and/or gender identity. these women, each of them born in the 1800s like richmond and addams, were deemed to have embodied roles such as: “community educators,” “civil rights advocate,” “abolitionist,” “community leader,” or “philanthropist” (hohl, 2010). when looking deeper into the lives of these individuals and the types of activities in which they engaged, many of them could be known as a social worker or social welfare advocate. one notable challenge with finding and naming standalone social workers among bipoc is that many bipoc communities valued and practiced co-sharing of roles. focusing on an individual’s influence is more of a white culture characteristic (okun & jones, 2000), which has been accomplished in raising up the work of addams and richmond. another example of bipoc’s more collective approach is found in coles and colleagues’ work. they reference the work of a 100-year collaboration of women of color to create and sustain a health system in virginia. these women, amidst the majority culture’s societal opposition and legal barriers were able to create a social welfare structure within the health sector that endured for a century. many of these women’s prolific efforts are found in cole’s et al. (2018) work. a few noteworthy women are: • lucy goode brooks (1818–1900) remarkably noted for having been a former slave; helped found the friends asylum for colored children. • grace evelyn arents (1848–1926) created a public housing association for workers. • mrs. thomas nowlan was the residing president of a what would now be considered a retirement home and oversaw the spring street house, a facility known for assisting unwed mothers and women leaving prostitution. coles and colleagues’ work have initiated the process of uncovering and documenting the lesser known and uncelebrated bipoc individuals who embodied social work alongside those who have been identified in mainstream literature. advances in social work, summer 2021, 21(2/3) 282 another example of a modern day bipoc is hilary weaver (lakota) whose work on indigenous peoples uncovers many untold stories of advocacy and social welfare efforts. in one piece of her work, weaver described the four-decade story of two indigenous women, the conley sisters, whose social activism was projected in individualistic terms, through their work to protect a wyandotte burial ground in kansas city was a vibrant and successful collective struggle. in this same chapter, weaver described laura cornelius kellogg, an oneida woman and activist who founded the society of american indians and who fought for economic self-determination, education, and land recovery at great personal cost. the retelling of these stories of indigenous advocacy and leadership further demonstrates how white filtering of history has omitted many bipoc contributions to social work. integrating and honoring bipoc contributions in social work in addition to individual scholars, some social work professional organizations have established initiatives to excavate the early role of bipoc in social work history. the national association of black social workers (nabsw) has sought to highlight the marginalization of people of color’s influence in early social work. the nabsw created the academy for african-centered social work. the academy emphasizes that the work of people of african ancestry has not only been barred from access to social work history, it is also presently excluded from mainstream social work pedagogy and curriculum, seriously minimizing the contributions they could make to inform and strengthen current policy and practices (bent-goodley et al., 2017). the nabsw has challenged the discipline to diversify social work curricula, asserting that failing to intentionally diversify educational materials leaves students to assume the main contributions to the discipline are white (bent-goodley et al., 2017), overtly and covertly reinforcing white supremacy. looking at afro-centered social welfare uncovers that much of what is deemed as white ingenuity for social welfare practice has been routine practice for bipoc. for example, strengths-based theories (saint-jacques et al., 2009), treatment courts, and trauma-informed practices (maxwell, 2014) have been presented as new concepts. yet these concepts are foundational and historical to bipoc communal practices. often, the eurocentric pattern is to rename indigenous practices and reclaim them as their own. the strengths perspective is a known framework often referred to and utilized in the discipline of social work. although many scholars have contributed to the knowledge and understanding of the strengths perspective, dennis saleebey is often noted as the scholar associated with the development and advancement of the strengths perspective. according to saleebey (1996), the strengths perspective seeks to develop the natural abilities of clients and posits that clients already possess various competencies and resources to improve their situation (saleebey, 2006). outside of work focused on black scholars and social work pioneers, one may never learn about how those, such as w.e. b. dubois, contributed to the knowledge and foundation of what is now the strengths perspective. dubois’ work regarding double consciousness speaks to the “strength” of blacks to adapt and survive in hostile environments (bent-goodley et al., 2017). progressive era black social workers, such as birdye henrietta haynes, elizabeth ross haynes, and many others, are wright et al./whitewashing of swk history 283 acknowledged by scholars, including iris carlton-laney (1994, 1997, 2001; carltonlaney & burwell, 1996/2014; carlton-laney & hodges, 2004) for their work utilizing strength-based models (brice & mclane-davison, 2020). in the book, a strengths perspective for social work practice, weick et al. (1989) mentioned scholars such as hepworth and larsen (1986), shulman (1979), and germain and gitterman (1980) and their work on the dangers of focusing on pathology while ignoring strengths. however, there was no mention of the prior work of scholars such as billingsley (1978), hill (1972), nobles (1974), and solomon (1976), who focused on disrupting the pathologizing of black families (brice & mclane-davison, 2020). due to the marginalization of communities of color, much of the work of bipoc pioneers and scholars today focuses on empowerment, pride, self-help, and communal health, and healing practices. barbara solomon (1976) notes the need for social work practitioners to utilize an empowerment approach when working with black families (brice & mclane-davison, 2020). slight language differences should not negate the strengths-based work that was foundational and continues to occur. calls to decolonize trauma theory as currently conceptualized, and related interventions, include critiques that trauma studies have remained stuck within euroamerican conceptual and historical frameworks (visser, 2015). these critiques also question whether trauma frameworks consider the histories of violence in the colonized world (rothberg, 2008; visser, 2015). further, these critiques are somewhat rooted in the narrow conceptualization and pathology of trauma to diagnosing post-traumatic stress disorder (ptsd; visser, 2015). evidenced-based interventions are either trauma-focused with the aim of directly addressing memories, thoughts, or feelings, or non-trauma focused interventions aimed at reducing ptsd symptoms (watkins et al., 2018). recommended evidence-based interventions include prolonged exposure therapy, trauma-focused cognitive behavioral therapy, eye movement desensitization reprocessing therapy, and narrative therapy (watkins et al., 2018). the focus and attention given to the conceptualization of trauma and trauma-informed practices in the twentieth and twentyfirst centuries do not acknowledge indigenous healing movements focused on restoring family and broader social relations (maxwell, 2014). identifying the pathology of diagnosing trauma in people of color and the lack of acknowledgment of the historical violence and oppression experienced (visser, 2015), the work of indigenous scholars, including eduardo duran and maria yellow horse brave heart, contribute to the understanding and conceptualization of historical trauma (maxwell, 2014). much of the trauma work and interventions were rooted in either neuroscience or focused on psychosocial components (balaev, 2014; cohen, 1989; johnson, 2001). more recently, scholars and initiatives have encouraged a marriage between neuroscience and social work theory, including psychosocial factors (johnson, 2001; matto & strolin-goltzman, 2010). this recent push comes long after perspectives and practices employed by black and indigenous people. throughout history, african communities have identified factors such as the transgressions of society related to relationships and social roles and the harmful intentions of another person as some factors that influence illness (monteiro & wall, 2011; sow, 1980). traditional african worldviews include communalistic social structures, encourage harmony with the environment and nature, and identify that healing must include the mind and body (monteiro & wall, 2011). advances in social work, summer 2021, 21(2/3) 284 many common concepts, such as the strengths perspective, are currently coined as typical social welfare practices that, when taught, never mention bipoc social work pioneers. these concepts were often employed in their practice before any formalization of noted white social pioneers and scholars. for example, the african worldview and healing practices are holistic and focus on community and interconnectedness (eagle, 1998). this holistic view encompasses the interrelatedness of physical, emotional, cognitive, and spiritual functioning (eagle, 1998), which mirrors what is now conceptualized as the biopsychosocial-spiritual approach. george edmund haynes, the cofounder of the national urban league, committed his early career to not only developing competent social work practice but also focused on the importance of cultural awareness (eagle, 1998). haynes discussed that social work practice should not be rooted in theory and knowledge development alone (eagle, 1998). this conceptualization of what may now be considered culturally competent practice occurred before and concurrent with the development of the profession (bent-goodley, 2006; eagle, 1998; ross, 1978). pioneers such as ida b. wells-barnett and lugenia burns hope created what may be conceptualized as modern-day social service programs and organizations. wells-barnett established the negro fellowship league and reading room, a settlement house that provided services including job placement and training, voting access, parenting, reentry initiatives, and healthcare (bent-goodley, 2001; bent-goodley et al., 2017). hope focused the work at the atlanta neighborhood union on supporting health care and access, addressing environmental hazards and social injustice, and conducting clubs for children (bentgoodley et al., 2017). if social work is to reinvigorate its commitment to ethnic and racial justice, it must acknowledge and name bipoc’s leadership and contributions to social work ideologies and practices. to fully understand and support the historical and present-day sources of social work, prominent concepts and terms should be vetted as to their connections with multiple and diverse ethnic communities that may embody such theories or practices before claiming them as innovative to the discipline. because our culture is infiltrated with white supremacist mindsets, social work scholars and practitioners must interrogate innovative educational material that has been attributed to a white individual, seeking to understand where the concept may have existed previously among non-majority groups. with knowledge of oppression and institutional racism as a backdrop, social work needs to push to explore research from various people groups rather than the dominant one that is easiest and most accessible. incorporating bipoc significant contributions to social work history also helps reduce issues of indigenization. indigenization is a modern form of colonization where traditional white models of social work are transposed to communities of color (megahead, 2015). refacing history with consistent and inclusive ethnic diversity is a segue to better cultural accuracy in implementing social remedies and services for communities of color, helping address this crucial issue in present day practitioner work. wright et al./whitewashing of swk history 285 excavating bipoc roles and influences excavating the histories and stories, and identifying the roles that people of color played in social work’s development and ongoing growth, will require various strategies for historical digging. it requires looking deeply into the roles many people of color played to rout social ails on micro and macro levels. considering how communal many bipocs are (bent-goodley et al., 2017; carlton-laney, 2015; kleibl, 2020; weaver, 2020), researchers must find the language and labels commonplace within ethnic cultures that mirrors “social worker.” many people of color do not often think of the same systems and structures as professional social work (bent-goodley, fairfax & carlton-laney, 2017; schiele, 2017). furthermore, the discipline prizes itself with the concept of being an outsider who enters another community to bring resolution, rejecting a more commonly held practice of people of color who only engage healing for its social ails amongst its own members (duran et al., 1998). therefore, these bipocs efforts again may very likely not be advertised among bipoc communities because such work is not prized, rewarded, or highlighted; it is the norm (carlton-laney, 2015; carlton-laney et al., 2001). another important aspect to explore is the fact that many black social welfare pioneers were conscious of white efforts to maintain supremacy and cutdown their progress. attempts to circumvent the progress of blacks can be seen in the jim crow era and other policies that were enacted to place fines on those who attempted to help black people leave the south for work (mccoy, 2020); several massacres such as the tulsa massacre of 1921, where the black business district was completely destroyed (mccoy, 2020; messer et al., 2013); the federal housing administration’s intentional shut out of households of color from the opportunity to buy homes through their practice of redlining (asante-muhammad et al., 2017); and the dismantling of the black panther party which was established to protect blacks from white brutality and promoted black power and control over their own communities (clemons & jones, 1999). bipoc were aware of this intentional work done to hinder the developments of their communities, businesses, schools, etcetera. with this history of longstanding oppression, many bipoc communities have been accustomed to maintaining privacy as it relates to collective efforts to remedy how gross injustices have infected people. this would then be unsurprising that many social action efforts to advance the black community would be internal and often covert (silver & moeser, 2014). for example, people in the black community have legitimate reasons and fears that their efforts will be sabotaged, establishing another reason why many people of color’s achievements may not have been recorded in the same manner as in the white culture. one example of this was the collective efforts blacks made at escaping slavery. what has been simplistically coined as the underground railroad was an ingenuous social effort and network to free slaves and re-unite them with families whenever possible. presently, scholars are still uncovering evidence of this remarkable social movement for liberation (bishop, 2018; broyld, 2019; foner, 2015; haro & coles, 2019; kantrowitz, 2015) . in sum, uncovering bipoc’s contributions to social welfare must take into account the necessity of secrecy at times. efforts to reveal the bipoc social work forerunners must be constructed on more creative and inclusive methods than have traditionally been accepted in the mainstream advances in social work, summer 2021, 21(2/3) 286 literature. two examples include prosopography and oral tradition. both serve as viable research method to find key and influential individuals in the past. other disciplines have prepared encyclopedias of people groups, highlighting marginalized people groups that often fail to make mainstream textbooks (low & clift, 1980; mjagkij, 2001; rasmussen, r. k., 2001). second, oral tradition is another form of historical research that can honor bipoc and their traditions of communication. these archives not only highlight individuals that are key in social welfare’s early origins but also do so by respecting and esteeming bipoc’s traditional ways of telling their stories. another approach to holding up the contributions of bipoc to social work lies in the education of social workers. in a discipline coined and founded upon white supremacy and sustained by institutional racism and policies that have been reinforced for centuries, a thorough evaluation of the past uncovers a great need to revise the way the past is taught. currently, social work is not taught with an understanding of the subtle promotion of white supremacy interwoven in its history. from our observations, it seems that few social work education programs have exposed the concept of the “great white hope” yet this needs to be exposed and dismantled. not only does there need to be a revision of the title upon whom the discipline bestows the honor as founders, there also needs to be a greater understanding of ensuring that what is defined as social work is not defined only from a eurocentric lens, as this continues to perpetuate white supremacy historically. to begin to dismantle white supremacy also requires dethroning the white idols of social work. founders in history tend to be glorified, especially white ones. if social work is not careful and fails to use a critical lens, it can glorify these early contributors of the social work movement and foundation. we must soberly assess where addams and richmond stood on various injustices based upon what they did and failed to do in their works. questions must be asked as to why these early founders failed to incorporate the voices of bipoc in their scholarly work and why they never fought harder for racial injustices in their documented work. we should question why ida b. wells had to persuade addams to take a stand on racial injustices (mcdermott, 2018). critical analysis of addams and richmond indicates not only a reluctance to speak out on racism, but also explicit actions that wholly aligned with racist ideologies, and oppressed and harmed bipoc communities. for example, both addams and richmond supported the eugenics movement and its scientific racism, which grew during the early 20th century and promoted the propagation of “wellborn” people and the prevention of having children among those who were determined to be defective mentally, morally, or physically (kennedy, 2008). addams served as the honorary vice president of the american social hygiene association, which called for preventing “reproduction of defectives” (kennedy, 2008). beyond a pro-eugenics stance, richmond’s writing in social diagnosis has noticeable undertones of racism in the dozens of assessment questions. for example, in her chapter on the unmarried mother, richmond instructs social workers to ask about the mother’s community: “what is the character of the city quarter or town in which the girl or woman grew up – in size, race, religion, general moral standards, faithfulness to church, predominating occupation, if any, recreations and social life?” (richmond, 1917, p. 414). finally, historical analysis of social work’s white forerunners must also reconcile that black social workers of the progressive era were sidelined from the work of white social wright et al./whitewashing of swk history 287 workers (mccutcheon, 2019). scholars have begun to document the stories of how black social work leaders could not depend on or wait on white social work leaders and, therefore, developed parallel educational and service systems themselves (bent-goodley et al., 2017; carlton-laney, 1999; carlton-laney & alexander, 2001; hounmenou, 2012; mccutcheon, 2019; rasheem & brunson, 2018). we suggest dethroning of social work’s historical icons and seeing them for what they were – individuals who sought to make change in one area of injustice while perpetuating injustice in another area. perhaps social work must sit with a more sobering reality of individuals considered “founders” or pioneers of the social welfare discipline. maybe the answer is not to make them an “angel” or a “demon” but live in the tension and sobriety of who these individuals really were and what they believed. it requires telling their stories in the history books in light of such frictions. yet it also calls for a radical review of who should be embraced as a founder of a discipline that is committed to equity “and the “inherent dignity and worth of all persons,” a principle embedded in the nasw code of ethics (national association of social workers [nasw], 2021, para. 1). considering that many of these icons failed to prize equality amongst races and ethnicities could help us to understand why progression for racial equity has been so slow. one cannot be a true advocate for social justice while holding another group as inferior. perhaps it would be fitting to critically analyze the legacies of white pioneers and assess what work social work founders did to be anti-racist. historically, more attention is given to social work figures who favored particular social groups, yet still upheld racist perspectives with regards to other marginalized groups. perhaps identifying pioneers and scholars who clearly demonstrate anti-racist views, practices, and research, even in the 1800s and earlier, would make for a more fitting perception of who truly deserves the designation of early founder for a unique discipline like social work. further research must also embrace the tension of the wounder becoming the healer and what it does for bipoc to see white people reap the benefits of the oppression of others while being rewarded nobel peace prizes for helping to fix it. understanding and dismantling white supremacy okun and jones’ (2000) work on white supremacy is instructive for the current analysis. they explain that white supremacy exists in an effort to hold what is white as superior, and that white supremacy is supported by overt and covert ideologies. three of the characteristics that okun and jones describe are important to this discussion. first, white supremacy focuses on the written word. in the white culture if it is not written down, it did not happen (okun & jones, 2000). this is a mantra that is learned in most helping professions, including among social workers. addams and richmond and their contemporaries came from a majority culture where they understood this value of the written word and richly documented their research, observations, conversations, and findings. in contrast, many bipoc come from traditional settings where such an effort is a luxury in comparison to focusing one’s energies on survival, especially in addams and richmond’s time period. in shining a light on the value of the written word as a characteristic of white supremacy, it is clear that dismantling racism requires social work advances in social work, summer 2021, 21(2/3) 288 to assess how bipoc pass down information and conduct historical assessments that support the discovery of various peoples’ contributions to the advancement of the social welfare movement. the second highly relevant aspect of white supremacy that contributes to the marginalization of bipoc is the belief that there is only “one right way” (okun & jones, 2000) of doing things. with this characteristic in mind, it is necessary to consider whether the identified social work founders incorporated the opinions of marginalized peoples in their work. failure to do so only perpetuates oppression and white dominance beliefs as it embodies the “one right way” of doing things. moreover, “one right way” is at the forefront of whites bringing their “solutions” to ethnic people groups. though the “founders” may have done remarkable things, their efforts reduced injustice on one hand, while adding to or sustaining injustices on the other hand by keeping marginalized people from actively engaging in the solution processes. third, individualism is highlighted as another relevant characteristic of white supremacy. to single out richmond and addams is to add to the white supremacist notion that highly prizes “individualism” (okun & jones, 2000). in this context individualism focuses on the advancement of one person, rather than the collective whole. this contributes to an atmosphere where cooperation is rarely valued. interestingly, if efforts for advancement are referenced by bipoc, it is usually praised in context of a movement (e.g., civil rights movement). whereas white culture highly prizes individualism, monuments for racial advancements are designated to icons like abraham lincoln and john f. kennedy. likewise, whites focus on martin luther king jr. as the individual leader, while it is commonplace in the black community to think of him as synonymous with his collaborators. to counter this white supremacist value of individualism, a reframing is required to understand and honor founders and forerunners of the discipline. to embrace more than just white ways of perceiving, founders call for a radical change and reframe of thought and communication about how social work was formed. integrating bipoc contributions in social work following are recommendations that serve as a framework to begin incorporating bipoc contributions into social work. social work needs to be close to the historical findings found in ethnic studies. much of the contributions of bipoc are hidden, and now more attention is being given to this reality. scholars and academics of color are continuously resurfacing more people of color who helped advance the nation. as these other disciplines excavate the work of numerous bipoc contributors, social work must be committed and fluid in its attempts to present anti-racist views of history. as new knowledge is excavated about long forgotten or omitted bipoc contributors to social work, the discipline’s history must be revised and taught, revealing that what is known is known with racist blind spots. this reality should be freely acknowledged and shared each time the narrative of how the discipline was founded is told by professors to new generations of social workers. it must be named that key players, particularly bipoc key players, are missing in current understandings of social work history. further, social work educators must communicate that we will never fully know the discipline’s earliest wright et al./whitewashing of swk history 289 foundations and frameworks because of racism, but we should keep making attempts at a more equitable understanding of it. social work’s history and founders must be examined with a critical lens. to dismantle racism and authentically work toward social justice, addams’ and richmond’s influences need to be revised from this critical lens. their work should be referenced yet understood for what it lacks: a deficit in understanding how outside white entities affect frail communities, the lack of collaboration in efforts to “fix” problems without using the voices of the communities to address the issues that are being faced. future research and scholarship should assess whether earlier recognized contributors approached marginalized groups with an understanding of those respective groups, honoring those groups’ inherent strengths, and clearly understanding how those groups were able to sustain throughout the adversity of harsh conditions. textbooks matter. a failure to accurately depict the past will lead to continually slanting the way the future is framed. without critical analysis, this slant will only continue to perpetuate white supremacist mindsets. it is time to deconstruct the icons of social work and develop a more equitable understanding of the ethnically diverse efforts that advanced social welfare. required is vigorous work from social work educators and researchers to stop reusing the same publications about the past and make intentional attempts to present the history of social work equitably. needed is a novel approach to convening conversations on social work and social welfare to include new voices. to dismantle white supremacy and racism, ideologies on whose voices count must be reconsidered. along these lines, dr. patricia hill collins challenged the issue of whom gets named as a scholar (collins, 1989). this same mindset holds fast to the social welfare dialogue. if we keep using the tools of the primarily white culture to inform the history of social work, we will continue to think in white supremacist terms in how we view the etiology of problems. therefore, we must reconsider who is an “expert” to ensure a more equitable view of the past. what is required is a robust rewriting of history that affirms the internal strength upon which many poor and marginalized communities have always thrived. social work as a discipline cannot turn a blind eye to the whitewashing of its history. it cannot herald a commitment to equity and fail to address the obvious discrimination in its archives (nasw, 2021). perhaps what activates and energizes the spirit of social work, serving populations that are undeserved and vulnerable, is not that mainstream individuals sacrifice their dreams to serve the poor. rather, a more just narrative can be written that affirms and praises that the poor have always served themselves. the marginalized have always been strong. they have always advocated for restorative and not punitive strategies. they have always had their own form of “treatment courts” and homelessness programs. it is time to re-write history in light of these understandings. social work cannot move forward unless we tear down the icons of the past that have been glorified and resurrect a new view of the discipline’s earliest beginnings with one that is realistic in acknowledging and honoring the contributions from the very people social workers seek to serve. advances in social work, summer 2021, 21(2/3) 290 references agnew, e. n. 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(1989). a strengths perspective for social work practice. social work, 34(4), 350-354. https://doi.org/10.1093/sw/34.4.350 author note: address correspondence to kelechi wright, school of social welfare, university of kansas, 1545 lilac lance, lawrence, ks, 66045. email: kelechiwright@ku.edu https://doi.org/10.3390/h4020250 https://doi.org/10.3389/fnbeh.2018.00258 https://doi.org/10.4324/9780429468728 https://doi.org/10.1093/sw/34.4.350 mailto:kelechiwright@ku.edu the whitewashing of social work history: how dismantling racism in social work education begins with an equitable history of the profession kelechi c. wright abstract: severe racial inequity has characterized the incorporation of ethnic minorities’ contributions to u.s. history and advancements (sandoval et al., 2016). these disparities are inextricably connected to white supremacist ideologies and practic... institutionalized racism in documenting history social work – a tradition intertwined with racism the crowned white founders of social work bipoc social work forerunners two historical bipoc leaders of social welfare modern day bipoc scholars integrating and honoring bipoc contributions in social work excavating bipoc roles and influences understanding and dismantling white supremacy integrating bipoc contributions in social work references _________ dianna cooper-bolinskey, dhsc, msw, acsw, lcsw(in), lcac(in), associate professor, carver school of social work, campbellsville university, campbellsville, ky. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 841-855, doi: 10.18060/24976 this work is licensed under a creative commons attribution 4.0 international license. dismantling structures that impede clinical social work practice: exploring the relationship between hours of supervised experience and licensure violations dianna cooper-bolinskey abstract: the current study examined the relationship between pre-licensure supervised experience requirements and license violations in order to ascertain whether jurisdictions requiring higher numbers of hours of supervised experience to obtain clinical social worker (csw) licensure had fewer violations. the purpose of the study was to explore if there is a measure of “enough” supervised experience without compromising protection of the public. three data files were used to complete the study: national practitioner data bank (npdb), association of social work boards (aswb)’s supervision requirements per jurisdiction data, and aswb’s u.s. social work licensee data. results indicated that jurisdictions requiring less than 4,000 hours of supervised experience reported fewer violations than would be expected, whereas jurisdictions requiring 4,000+ hours of supervised experience reported more violations than would be expected given the number of csws within the respective groups. results question the practice of requiring higher amounts of supervised experience as a regulatory standard. implications for social work regulation include support for nationally standardizing the required amounts of supervised experience outlined by groshong (2011) and the aswb (2018) model social work practice act. keywords: clinical social work, regulation, supervised experience requirements, violations clinical social workers (csws) are regulated in every u.s. jurisdiction. the basic requirements for obtaining initial clinical licensure in each jurisdiction are similar and include earning a master of social work (msw) degree from a council on social work education (cswe) accredited program, completing an application, paying an application fee, passing a specific association of social work boards (aswb) examination, and acquiring post-degree supervised experience. however, there are some variations in requirements among jurisdictions; the more notable difference is the number of required hours of supervised experience, which ranges from 1,500 to over 5,000 hours. the lack of consistent standards for licensure affects csws’ abilities to practice through unnecessary delays in obtaining licensure, cost (kleiner, 2006), and limits of practice portability (aswb, 2021). practice portability includes practitioner relocation to another state, practicing across jurisdictional borders, or virtual practice (aswb, 2021). examples of limits to csw portability include veterans and spouses of veterans who relocate often, individuals who live near jurisdictional borders and practice in multiple jurisdictions concurrently, and experienced professionals who move across jurisdictions in life transitions. establishing nationally standardized supervised experience requirements about:blank advances in social work, summer 2022, 22(2) 842 facilitates portability. although supervised experience requirements are not the only limiting variable on portability, they certainly represent one substantial barrier. the current study reviews the broader context of csw licensing requirements and explores the relationship between supervised experience requirements and csw practice violations. the study used data from the u.s. department of health and human services’ (usdhhs) national practitioner data bank (npdb; usdhhs, 2019) to review licensure violations by csws by jurisdiction. the study explored the relationship between jurisdictions’ required number of hours of supervised experience (aswb, 2019a) (categorized), number of licensed csws (aswb, 2019b) (categorized), and cases of violations recorded in the npdb. literature review there is a relative dearth of literature related to social work regulation and when the focus is narrowed to csw practice the resultant literature is even more sparse. this serves as further evidence of need for more research on the effectiveness of social work regulation (bibus & boutté-queen, 2011; grise-owens et al., 2016). a review of the extant literature can provide a basic context for understanding the need for the current study, its results, and its implications for regulating csw practice. brief history of social work becoming a regulated profession social work roots reach back into the days of 1910 when jane addams and mary richmond formed the national federation of charities and corrections, later renamed the national conference of social welfare (groshong, 2011). social workers were referred to as “friendly visitors,” reaching out from faith-based organizations, to assure the well-being of children. clinical social work emerged in the 1930s with a shift in focus to treating veterans returning from combat (american board of examiners in clinical social work [abecsw], 2018; groshong, 2011). although many different scopes of social work practice have emerged, clinical social work has consistently grown. social work was not readily recognized as a profession. according to bibus and boutté-queen (2011), “physicians were regulated in every state by 1900, teachers by 1930, and attorneys and dentists by 1940” (p. 8). arne (1952) stated that as of the 1950s, additional regulated professions included medicine, engineering, pharmacy, nursing, and chemistry. psychologists were regulated in all jurisdictions by 1977. the first documented conversation of licensing social workers was in 1920 in california (arne, 1952). samuel goldsmith presented a paper to the national conference of social work in minneapolis in 1931, proposing the regulation of social work (bibus & boutté-queen, 2011). social work was actually first regulated in puerto rico in 1934, but most jurisdictions did not know about it until much later (bibus & boutté-queen, 2011; cswe, 2018). the california conference of social work worked with the legislature to establish regulation through registered social workers (rsw) in 1945 (bibus & bouttéqueen, 2011; cswe, 2018). the council on social work education (cswe) was created in 1952 as the accrediting body for social work programs (dyeson, 2004). the national cooper bolinskey/dismantling structures that impede 843 association of social workers (nasw) was founded in 1955 and was responsible for creating and evolving the code of ethics (nasw, 2021) as well as advocating on behalf of practicing professional social workers (dyeson, 2004). california passed new legislation in 1968 that formalized the first known regulation of csws (goldstein, 1996). by the early 1970s schools of clinical social work were emerging, creating expanded practice specialties (abecsw, 2018). in 1974, nasw issued a policy statement calling for the regulation of social work practice (abecsw, 2018; grise-owens et al., 2016). in response to this call, aswb was formed in 1978 as a non-profit organization whose focus was on regulation (abecsw, 2018). aswb began administering licensing exams in 1983 (abecsw, 2018). the 1970s and 1980s were an active time for developing regulatory statutes; 13 jurisdictions established professional regulation of social work in the 1970s and 24 jurisdictions did so in the 1980s (groshong, 2011). some jurisdictions only regulated the master level of practice, some required two or three years of full-time supervised training, and passing the clinical exam while other jurisdictions required anyone working in the field of social work to be licensed (dyeson, 2004). licensing clinical social work california licensing statutes in 1968 were among the first to formalize use of the title of csw (goldstein, 1996). by the 1970s, the drive for csws to become licensed increased with the need for access to reimbursement for mental health services (bibus & bouttéqueen, 2011). in 1976, nasw recognized csws by issuing a registry of clinical social work (goldstein, 1996). nasw recognized csws as “those who, by education and experience, were qualified at an autonomous level of practice to provide direct, diagnostic, preventive, and treatment services to individuals, families, and groups …” (goldstein, 1996, p. 92). this demand resulted in all fifty states establishing csw licensing by 1992 (bibus & boutté-queen, 2011). groshong (2011) reported that csws were the largest professional group providing mental health services in the u.s. further, the nasw workforce study reported that most csws were in private practice or working within forprofit agencies (29%), private non-profit agencies (42%), and public agencies (28%) (groshong, 2011). tosone (2016) compared definitions of csw as defined by nasw, cswe, and abecsw. tosone (2016) explained that the abecsw definition was perhaps most fitting, due to its focus on mental health practitioners who were educated in graduate school and trained under the supervision of an experienced social worker in order to develop mastery of key skills in serving people of all ages and backgrounds. regulation as a means of public protection prior to the establishment of licensure laws, professional regulation had been occurring through professional organizational membership, primarily through nasw, and through public agency supervision (bibus & boutté-queen, 2011). the nasw code of ethics served as the standard for professional review; nasw chapter committees on inquiry served as the reviewers of behavior (berlinger, 1989). the committee used a three-level adjudication process that was executed using a peer review model. advances in social work, summer 2022, 22(2) 844 according to arne (1952), in 1945, the public demanded professional competence of professionals who served them. state governments fulfilled the need by administering licensing and examination boards who set minimum standards and qualifications. in california, a seven-member board was created to regulate social work. members were appointed by the governor to four-year terms. standards included applicants completing at least one year of full-time graduate study from an approved school of social work and passing a written exam. the 1950s also brought forth the notion of qualifying professional exams and the establishment of hearings for professional misconduct. minimum educational requirements were also raised. the supervised experience requirement bibus and boutté-queen (2011) reported that older professions, such as medicine, evolved from requiring no specialized formal training to establishing standards requiring at least two years of premedical college training. goldsmith proposed that social work follow suit. supervised experience was considered necessary for less advanced practitioners to develop their identity and to develop skills needed to practice effectively (abecsw, 2018; gray, 1990). since the beginning of social work practice in the early 1900s, neophyte practitioners relied on the guidance and supervision of the more experienced (abecsw, 2018; hardcastle, 1977). csws are required to complete an msw, then be employed for at least two years in intensive post graduate supervision to qualify to practice autonomously (abecsw, 2018; gray, 1990). hoffman (2002) explained the complexities that developed over time, including defining hours of supervision, individual vs group supervision, hours of supervised experience (hours vs years), and credentials of qualified supervisors. emphasis on standards of supervised experience have evolved and were further developed in the nasw & aswb (2013) best practices in social work supervision. national practitioner data bank the usdhhs (2011) maintains the npdb which is essentially a collection of data about violations by health care practitioners. the npdb collects information about malpractice, disciplinary actions, and board sanctions and reports the confidential data to hospitals, health care facilities, and state and federal agencies. these data are collected by authority of the npdb statute 42 u.s.c. § 11137 (usdhhs, 2011). the usdhhs provides access to the npdb public use data file (pudf) to the public through the npdb website, though individually identifying information is not published. the npdb was created in 1986; the current version of the pudf holds data relevant to 54 variables on 1.42 million cases (usdhhs, 2019). examples of the variables include record type (board sanctions, malpractice claims, etc.), year of report, practitioner demographics and work state, state of license, age group of practitioner, malpractice allegation group, specific allegations, severity of malpractice injury, payment amount, age group of patient, gender of patient, adverse action classification, basis for action, adverse action length of penalty, number of licensure reports, number of exclusion reports, number of government cooper bolinskey/dismantling structures that impede 845 administrative reports, number of contract termination reports, and state patient compensation (usdhhs, 2019). the npdb fulfills a great purpose, but as with most data sources, it is not without fault. boland-prom et al. (2015) reported that 46 of 50 state boards regulating csws were in compliance with the federal mandatory reporting statutes. boland-prom (2009) also reported that there are discrepancies in data between state board reports and results in the npdb. licensure violations in clinical social work aswb (2011) stated that social work boards were empowered to regulate social work practice within the jurisdiction by imposing disciplinary sanctions. some boards function in a public forum while others utilized closed sessions. national level data about licensure violations, sanctions, and board actions can be nearly impossible to access. as a matter of benchmark data relevant to the current study, three studies discussed ethical (not licensure) violations. nasw’s chapter commission on inquiry (coi) review of ethical behavior was a precursor to jurisdictional board regulation of violations. since there is relatively no literature of this nature, this section is reviewed to help formulate some context for the study. berlinger (1989) reported that the nasw chapter coi reviewed individual cases between 1979-1985. the committee reported 292 cases on file; 34 of the 55 chapters had filed at least one complaint. of the cases reviewed, 41% were determined to have substantiated claims and three fourths of the cases had more than one issue. kleiner (2006) stated that during a 22-year period between 1955 and 1977, a total of 154 complaints were processed; 40% were handled in two years (1976 and 1977). boland-prom (2009) reported on findings from five studies published by the nasw ethics committee. the report focused mainly on types of violations and changes in the types of violations over time; specific numbers of cases were not included in the article. current study this study explored the relationship between hours of supervised experience necessary to obtain csw licensure and reported practice violations. although jurisdictions requiring a higher number of supervision hours for licensure may have done so on the assumption that more is better, there has been no research examining whether this assumption is supported by evidence. the goal, then, was to examine whether increased supervision requirements are, indeed, associated with fewer licensure violation reports. if this were found to be the case, it would suggest that other states should adopt more rigorous prelicensure supervision requirements as a potential public-safety measure. the failure to find such a relationship, however, could also have important public policy implications as it might suggest that increased supervision hours present an unnecessary burden on young professionals and may be viewed as an unfair restriction of trade. a corollary purpose of the study was to identify the measure of “enough” supervised experience necessary for safe advances in social work, summer 2022, 22(2) 846 practice (i.e., without potentially compromising public protection) without placing an undue burden on developing professionals and their clinical supervisors. method the study used three datasets: the npdb pudf as of december 2019 (usdhhs, 2019), aswb’s supervision requirements per jurisdiction data as of 2019 (aswb, 2019a), and aswb’s u.s. social work licensee data as of 2019 (aswb, 2019b). the basic premise of the study was that these three datasets would provide the relevant data needed to answer the research question, and then to fulfill the purpose of the study. as one might expect, some data cleaning was necessary to standardize measures for analysis. the npdb pudf data (usdhhs, 2019) the npdb pudf contained 1,478,943 cases collected between september 1990 and december 2019. csw is one of the 160 categories of professions/facilities listed in the databank, and included 12,621 cases (0.8% of total cases). each u.s. jurisdiction included at least one case, indicating that all jurisdictions had reported violations. the highest percent of cases were against allopathic physicians (md; 32.5%) with registered nurses (rn) having the second highest percent (17.6%). the nature of violations was included in the data file, but these data were not used in the analysis for this study. to give some context for the discussion later, the most common categories of allegations against csws were failure to comply with continuing education requirements (10.9%), other (not classified; 6.9%), unprofessional conduct (6.3%), criminal conviction (6.1%), practicing without a license or with an expired license (9.6%), and fraud (4.1%). sexual misconduct was found in 3.4% of the cases. supervision requirements per jurisdiction data (aswb, 2019a) the aswb 2019 data file was used to record the number of required hours of supervised experience to become a licensed csw, per jurisdiction. as with the other data sets, this one also required some adjustments for standardization. first, iowa required supervised experience, but a specific number of hours was not defined, so it was omitted from the study. next, four jurisdictions (al, in, ms, sd) defined “two years” or “24 months” of full-time supervised work experience, but other jurisdictions defined specific numbers of hours. for these jurisdictions, adjusted hours were calculated based on multiplying 40 hours per week, 50 weeks per year (accounting a reduction for paid time off), and two years to equal 4,000 hours. jurisdictions defining associate or conditional csw licenses with reduced numbers of hours (ca, il, me, ne, nc) were not categorized dually, just with the full csw licensing requirements. the jurisdiction requiring the fewest hours of supervised experience was florida (1,500 hours); the jurisdiction requiring the most hours of supervised experience was louisiana (5,760 hours). once standardized to hours of supervised experience, the categories were created for use in analysis as outlined in table 1. cooper bolinskey/dismantling structures that impede 847 table 1. categories of supervised experience category hours jurisdictions states # (%) 1 <3,000 fl, ia, ny 3 (6%) 2 3,000-3,999 ak, az, ca, co, ct, de, dc, ga, hi, id, il, ks, ky, me, md, ma, mo, mt, ne, nv, nh, nj, nm, nc, nd, oh, or, pa, ri, sc, tn, tx, vt, va, wi, wy 36 (71%) 3 4,000-4,999 al, ar, in, mi, mn, ms, ok, sd, at, wa, wv 11 (22%) 4 5,000 > la 1 (2%) u.s. social work licensee data (aswb, 2019b) to examine how well the observed distribution of reported violations for each category of supervision hours fits the expected distribution, it was necessary to know the number of csws per jurisdiction. aswb collects data on licensed social workers in each jurisdiction, and their 2019 data file was used in this study. aswb collects five categories of data, per jurisdiction, with one category being msw (clinical). aswb received this data from licensing board reports, so there was no means of verifying numbers. as one might expect, there was some missing data, which was usually in the form of not separating social workers into each of the five reporting categories. the msw (clinical) data were recorded for 45 jurisdictions; however, six jurisdictions (al, ca, ct, in, mi, wi) were missing data; as noted above, iowa was omitted from these analyses due not having a specified number of required hours. for states that had missing or incomplete reporting, the number of csws was estimated from the available data. table 2 shows jurisdictions and their actual data, from the aswb data file. alabama demonstrates the first adjustment necessary in the data file. alabama’s msw (other) number (1,681) was used to represent csws. for the other states (ca, ct, in, mi, wi) that did not distinguish between clinical and non-clinical master’s level social workers, an estimate based on the computed average of the csws among the total number of licensed social workers in the u.s. was used (41.9%). it is assumed the adjusted number is slightly lower than actual, but is representative overall. table 2. aswb u.s. social work licensee data jurisdiction non-sw bsw msw (no exp.) msw (clinical) msw (other) us (total by category) 6,963 58,188 186,673 208,204 36,919 541,116 alabama 1,906 1,736 1,681 1,681 7,004 alaska 53 173 671 897 arizona 106 2,640 2,562 5,308 arkansas 428 1,099 2,031 3,558 california 15,743 26,978 17,899 60,620 colorado 1,203 1,250 87 2,540 connecticut 4,004 9,558 13,562 d. of columbia 75 1,375 3,396 51 4,897 advances in social work, summer 2022, 22(2) 848 jurisdiction non-sw bsw msw (no exp.) msw (clinical) msw (other) us delaware 967 967 florida 15,122 19 15,141 georgia 2,890 4,036 6,926 hawaii 14 1,064 1,058 2,136 idaho 1,061 1,299 1,685 4,045 illinois 194 4,111 12,998 17,303 indiana 3,250 7,756 11,006 kansas 21 1,773 3,743 2,068 7,605 kentucky 576 2,525 2,825 5,926 louisiana 1,703 2,799 3,123 7,625 maine 25 1,570 182 545 2,965 5,287 maryland 553 4,275 9,341 318 14,487 massachusetts 2,682 3,349 6,278 15,000 27,309 michigan 1,313 5,112 22,253 12,015 40,693 minnesota 6,072 2,955 6,125 745 15,897 mississippi 1,788 1,115 909 3,812 missouri 76 1,759 5,987 7,822 montana 315 2,095 2,410 nebraska 598 1,388 5,688 7,674 nevada 78 1,820 1,008 18 2,924 new hampshire 1,158 1,158 new jersey 2,842 7,975 10,008 20,825 new mexico 554 1,543 1,990 4,087 new york 29,339 28,205 57,544 north carolina 80 177 11,365 11 11,633 north dakota 1,577 389 414 2,380 ohio 953 17,596 9,566 28,115 oklahoma 18 421 1,704 41 2,184 oregon 48 1,404 4,446 5,898 pennsylvania 10,427 6,673 17,100 rhode island 594 1,869 2,463 south carolina 702 2,380 1,486 85 4,653 south dakota 122 300 263 397 1,082 tennessee 581 3,006 2,934 267 6,788 texas 5,298 10,612 8,316 309 24,535 utah 1,257 725 1,354 3,952 7,288 vermont 5 1,234 1,239 virginia 739 6,458 7,197 washington 1,909 4,417 6,326 west virginia 512 2,308 751 535 309 4,415 wisconsin 5,320 12,699 18,019 wyoming 90 129 587 806 following the estimations to fill in missing data, the study was completed using an estimated total of 252,373 licensed csws, which includes representation from every u.s. jurisdiction except iowa. cooper bolinskey/dismantling structures that impede 849 procedures with each of the three data sets standardized, actual cases of violations were then computed, per jurisdiction (omitting iowa), and within the categories of supervised experience requirements. expected case counts for each jurisdiction were computed by multiplying the total number of cases (12,424) by that jurisdiction’s proportion of the total estimated number of social workers derived above. for example, az had 2,562 reported csws, which was 1.02% of the actual total of csws; thus, the expected number of cases for az was 1.02% of 12,424, or 126.12. table 3 demonstrates this calculation for all jurisdictions. table 3. expected # of cases of violations jurisdiction # csws % of total csws expected # cases alabama 1681 0.67% 82.75 alaska 671 0.27% 33.03 arizona 2562 1.02% 126.12 arkansas 2031 0.80% 99.98 california 17899 7.09% 881.13 colorado 1250 0.50% 61.54 connecticut 4004 1.59% 197.14 d. of columbia 3396 1.35% 167.18 delaware 967 0.38% 47.60 florida 15122 5.99% 744.44 georgia 4036 1.60% 198.69 hawaii 1058 0.42% 52.08 idaho 1685 0.67% 82.95 illinois 12998 5.15% 639.87 indiana 3250 1.29% 159.97 kansas 2068 0.82% 101.80 kentucky 2825 1.12% 139.07 louisiana 3123 1.24% 153.74 maine 545 0.22% 26.83 maryland 9341 3.70% 459.85 massachusetts 15000 5.94% 738.43 michigan 12015 4.76% 591.49 minnesota 6125 2.43% 301.53 mississippi 909 0.36% 44.75 missouri 5987 2.37% 294.73 montana 2095 0.83% 103.13 nebraska 5688 2.25% 280.01 nevada 1008 0.40% 49.62 new hampshire 1158 0.46% 57.01 new jersey 10008 3.97% 492.68 new mexico 1990 0.79% 97.97 new york 28205 11.18% 1388.49 north carolina 11365 4.50% 559.48 north dakota 414 0.16% 20.38 advances in social work, summer 2022, 22(2) 850 jurisdiction # csws % of total csws expected # cases ohio 9566 3.79% 470.92 oklahoma 1704 0.68% 83.89 oregon 4446 1.76% 218.87 pennsylvania 6673 2.64% 328.50 rhode island 1869 0.74% 92.01 south carolina 1486 0.59% 73.15 south dakota 397 0.16% 19.54 tennessee 2934 1.16% 144.44 texas 8316 3.30% 409.39 utah 3952 1.57% 194.55 vermont 1234 0.49% 60.75 virginia 6458 2.56% 317.92 washington 4417 1.75% 217.44 west virginia 535 0.21% 26.34 wisconsin 5320 2.11% 261.92 wyoming 587 0.23% 28.90 total 252373 100.00% 12424.00 the total numbers of expected cases for each supervision category were created by summing expected frequencies for each jurisdiction within each category as shown in table 2. calculations to standardize data were computed using excel; spss was used to analyze the overall data for the study. results results of a χ2 test for goodness of fit revealed that the distribution of observed violations by required hours of supervised experience differed quite substantially from the expected distribution, χ2 (3) = 6016.5, p < .001. given the unstructured nature of the source datasets, it was necessary to assure goodness of fit. jurisdictions requiring less than 4,000 hours of supervised experience had fewer violations than would be expected, whereas jurisdictions requiring 4,000+ hours of supervised experience had more reported violations than would be expected given the number of csws within those respective groups. further, the significance of this finding was not a statistical artifact of the large samples, as the effect size was large, φ = .70. a graph of the expected and observed distributions is shown in figure 1. cooper bolinskey/dismantling structures that impede 851 figure 1. expected vs actual violations, categorized by supervised experience hours discussion the first, and most obvious, point of discussion is that results indicated fewer actual than expected reported violations in the two categories encompassing less than 4,000 hours of supervised experience, as compared to the greater actual than expected violations in the two categories encompassing 4,000 or more hours. although this result is the converse of what one might expect, it should be noted that it in no way implies that increased supervised experience causes increased practice violations, as any number of unmeasured factors may be associated with this relationship. however, it is important to explore possible explanations for this result. obviously, there is not a clear explanation, but some assumptions can be made. it remains an assumption that the data are relatively representative, despite the fact that some estimation algorithms were used to standardize the data; the strength of the effect size and goodness of fit test support this notion. one possible explanation for this result could be that the jurisdictions with higher-thanexpected violations have laws that yield more violations than others, have more rigorous reporting requirements, or are more likely to follow reporting requirements of violations. this line of reasoning would suggest that the more stringent oversight of potential csws extends to more stringent oversight of actual csws. for the purposes of this study, however, this hypothesis cannot be tested as there are no known ways to compare the rigor of laws, or to verify jurisdictional reporting practices. thus, this study operated on the advances in social work, summer 2022, 22(2) 852 assumption that there is no relationship between reporting standards and required supervision hours among jurisdictions. it is also possible, even probable, that there are some errors in the npdb cases of violations data. the laws requiring that violations and misconduct data be reported to the npdb were established in the health care quality improvement act of 1986 and the npdb began accepting data in 1990 (boland-prom, 2009; us dhhs health resources and services administration, 2018). it is possible that some more established jurisdictions began reporting sooner than others, so the records for those jurisdictions may be more comprehensive. the bottom line is that data regarding violations are difficult to obtain, and the npdb data file is the best we have. when designing this study, aswb was approached about using data from their public protection database (ppd) and using the npdb was recommended because multiple entities (hospitals, health plans, jurisdictional licensing boards, medical malpractice payers, and other healthcare entitles) are required by law to report. reporting to the aswb ppd is voluntary by jurisdictional boards. the author recognizes that hours of supervised experience is an oversimplification of the relationship between supervision and licensure violations. supervision involves many activities that affect the quality of the experience. it is beyond the scope of this study to explore quality and content of the supervisory experience itself. the study was designed to explore the relationship between hours of supervised experience requirements and licensure violations. it is by no means suggested that supervision, whether higher or lower amounts of hours, better or lesser quality, or any other aspect of supervision causes licensure violations. exploring the relationship was simply a way of considering if there is a “sweet spot” in the requirements, and if so, what it might be. limitations each of the three data files used to complete the study may have included errors, and each required some standardization in order to complete the study. using expected numbers of violations compared to actual violations was not an exact science and left room for error. in spite of these extrapolations of data, the trends were real. the errors in estimations were not stronger than the trends seen in the results. the study was created with an underlying assumption that violations equate to unethical practice that ultimately affects public protection. under or over reporting of violations was a valid concern; however, there was no know way to control for this variable. variables other than supervised experience affect practice violations. the scope of this study did not include this type of analysis. implications an underlying assumption of the study was that higher amounts of required supervised experience would yield fewer practice violations. this assumption perhaps serves as an explanation for the range of supervised experience requirements among jurisdictions. cooper bolinskey/dismantling structures that impede 853 results of this study do not demonstrate an association between higher amounts of required supervised experience prior to licensure as a csw. the discussion then shifts to the issue of “enough” supervised experience to support a safe level of practice. first, florida (with 1,500 hours) and new york (with 2,000 hours) had notably fewer actual violations than expected. one might argue, then, that the data suggest that this represents “enough” supervision to adequately protect the public. even though florida measures direct contact hours, their defined hours requirements are low. supervisees may get more hours, but this was not measured in the context of this study. however, it can also be seen that 4,000 hours of supervised experience is the point at which actual violations shifted above expected violations. perhaps just under 4,000 hours of supervised experience is “enough.” interestingly, groshong (2011) recommended 3,200 hours of experience in clinical social work in a supervised setting. the model social work practice act (aswb, 2018) outlined csw eligibility criteria to include 3,000 hours of supervised clinical social work practice over a minimum two-year and maximum four-year period. one might interpret the results of this study as supportive of the hours of supervised experience suggested by both groshong and the model social work practice act. why should the profession of social work be concerned about this issue of required hours of supervised experience prior to licensure? with csws providing more mental health services than all of the other professions (psychologists, mental health counselors, and marriage and family therapists) combined (groshong, 2011), the time required of an entry-level professional to obtain licensure has a direct impact on the availability of mental health care – especially in rural or traditionally underserved areas. given the shortage in the workforce that provides mental health care, standardizing supervised experience requirements could result in shortened time to become licensed; the impact to individuals in need of care may include shorter wait times and more availability of care. the amount of time it takes to get licensed has a meaningful effect on csws through limited employment options, as well as cost and time to complete supervised experience. many employers only hire licensed csws because of the revenue stream generated with billable services. employers who hire unlicensed csws may pay less or be more demanding. some employers offer supervision that qualifies for licensure whereas others do not, leaving the csw to seek and pay for supervision on their own. when in-house supervision is not available, some employers pay for external supervision, but this is not the usual practice. private practice is usually reserved for licensed csws who can practice independently. supervised experience requirements also have an ongoing effect on csws, well after initial licensure is achieved. active military members, veterans, spouses, and other individuals who relocate after earning licensure must deal with differing jurisdictional licensure requirements. these issues also affect csws who want to practice in multiple jurisdictions, including the current explosion of telehealth services that easily cross into many jurisdictions. as stated previously, the current range of required supervised experience spans 1,500 to over 5,000 hours. some jurisdictions have provisions to support portability while others do not. for jurisdictions who do not have laws that support portability, the supervised experience requirements must be met in order to become advances in social work, summer 2022, 22(2) 854 licensed. if a csw completed supervised experience in a jurisdiction requiring fewer hours, then additional hours may be required to become licensed in another jurisdiction. this debacle can escalate, in some cases leaving a csw with need for full-time employment to get supervised experience, as a new practitioner again. aswb and the department of defense are working with the council on state governments to create a social work compact at the same time this article is being published. clearly, the issues are real, and the time is now. dismantling the structures that support a broad range of supervised experience requirements is reasonably supported, timely, and relevant. references american board of examiners in clinical social work. 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(2018). curricular guide for licensing and regulation: 2015 epas curricular guide resource series. sponsored by cswe, aswb, and nasw assurance. https://www.abcsw.org/assets/clinical%20supervision.pdf https://www.aswb.org/wp-content/uploads/2021/01/aswbdisciplinaryguidebook.pdf https://www.aswb.org/wp-content/uploads/2021/01/aswbdisciplinaryguidebook.pdf https://www.aswb.org/wp-content/uploads/2020/12/model-law-for-web.pdf https://www.aswb.org/wp-content/uploads/2020/12/model-law-for-web.pdf https://movingsocialwork.org/ https://www.jstor.org/stable/23715623?seq=1#metadata_info_tab_contents https://doi.org/10.1093/sw/54.4.351 https://doi.org/10.1080/10911359.2014.947464 https://www.cswe.org/getattachment/accreditation/standards-and-policies/2015-epas/2015epasandglossary.pdf https://www.cswe.org/getattachment/accreditation/standards-and-policies/2015-epas/2015epasandglossary.pdf cooper bolinskey/dismantling structures that impede 855 https://www.cswe.org/getattachment/e8bf5aa1-4a57-4079-991a-a0544c359e52/cswelicensing-regulation-curricular-guide.pdf?lang=en-us dyeson, t. 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(2002). the basics of social work licensing. the new social worker, spring, 28-30. kleiner, m. (2006). licensing occupations: ensuring quality or restricting competition? w. e. upjohn institute for employment research. https://doi.org/10.17848/9781429454865 national association of social workers. (2021). code of ethics. nasw press. https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english nasw & aswb. (2013). best practices in social work supervision. nasw press. https://www.socialworkers.org/linkclick.aspx?fileticket=gbrlbl4buwi%3d&portalid = tosone, c. (2016). clinical social work practice and education: what would flexner think now? journal of social work education, 52(1), 28-37. https://doi.org/10.1080/10437797.2016.1174649 u. s. department of health and human services [us dhhs]. (2011). statement of the national practitioner data bank. https://www.npdb.hrsa.gov/resources/publicdatastatement.jsp us dhhs. (2019). national practitioner data bank public use data file. https://www.npdb.hrsa.gov/resources/publicusedatafile-format.pdf us dhhs health resources and services administration. (2018). national practitioner data bank guidebook. https://www.npdb.hrsa.gov/resources/aboutguidebooks.jsp author note: address correspondence to dianna cooper-bolinskey, campbellsville university, carver school of social work, 1 university drive, campbellsville, ky 42718. email: drcooper@cam-pbellsville.edu https://www.cswe.org/getattachment/e8bf5aa1-4a57-4079-991a-a0544c359e52/cswe-licensing-regulation-curricular-guide.pdf?lang=en-us https://www.cswe.org/getattachment/e8bf5aa1-4a57-4079-991a-a0544c359e52/cswe-licensing-regulation-curricular-guide.pdf?lang=en-us https://doi.org/10.1177/1084822304264657 https://doi.org/10.1007/bf02189944 https://doi.org/10.1300/j001v08n01_05 https://doi.org/10.1080/10437797.2016.1174641 https://doi.org/10.1177/002087287702000204 https://doi.org/10.17848/9781429454865 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.socialworkers.org/linkclick.aspx?fileticket=gbrlbl4buwi%3d&portalid= https://www.socialworkers.org/linkclick.aspx?fileticket=gbrlbl4buwi%3d&portalid= https://doi.org/10.1080/10437797.2016.1174649 https://www.npdb.hrsa.gov/resources/publicdatastatement.jsp https://www.npdb.hrsa.gov/resources/publicusedatafile-format.pdf https://www.npdb.hrsa.gov/resources/aboutguidebooks.jsp mailto:drcooper@campbellsville.edu this work is licensed under a creative commons attribution 4.0 international license. the dilemma of spare embryos after ivf success: social workers’ role in helping clients consider disposition options stephanie k. boys julie s. walsh abstract: social work services for persons undergoing the in vitro fertilization process (ivf) has greatly lagged behind the medical technology opportunities provided to these clients. advocacy for social work services for persons undergoing ivf was advanced upon the procedure’s initial development, but there has been a stark lack of recent scholarship regarding social work in fertility health services. the existing literature suggests several talking points regarding the ivf process to be discussed with persons considering ivf, especially the medical and psychological risks of failure. this article discusses a newer and necessary topic to cover in pre-ivf counseling: the possibility of too much success in the form of excess embryos. although the topic must be covered with sensitivity to the relatively low rate of ivf success, persons receiving care through assisted reproductive technology (art) need to be prepared for the difficult moral questions raised when ivf procedures result in even more embryos than intended. social workers need to be prepared to explore the pros and cons of each disposition option with ivf clients. keywords: in vitro fertilization (ivf); assisted reproductive technology (art); reproductive counseling; frozen embryos; embryo disposition the advance of assisted reproductive technologies (art) has revolutionized the world of reproduction. until approximately 50 years ago, there was one conceptual understanding of procreating: one man and one woman. today, there are many possibilities for persons experiencing infertility, the inability to conceive due to the structure of their relationship, or the desire to be a single parent. however, along with the development of these technologies has come a vast range of ethical dilemmas. the focus of this article is a dilemma common after persons have undergone in vitro fertilization (ivf): the existence of excess embryos. options for disposing of the embryos and considerations relevant to each option are presented. the process of ivf involves combining egg and sperm to create embryos in a lab. in order to have the highest odds of a resulting pregnancy, as many embryos as possible are produced. persons undergoing ivf have often experienced years of heartbreak trying to conceive naturally and view ivf as their final opportunity (chochovski, moss, & charman, 2013). although ivf success rates have been improving, the success rate per cycle still stands at 32.7% (centers for disease control and prevention [cdc], 2017). however, for persons who do succeed, there are often extra embryos after a live birth. the dilemma resides when parents have completed their desired family but still have fertilized embryos remaining. people are often unprepared for this situation and may be unaware of their options. thus, many avoid the decision, leaving their embryos literally frozen in time (nachtigall et al., 2009). ________________ stephanie k. boys, phd, jd, msw is an associate professor of social work and adjunct professor of law, indiana university, indianapolis, in 46202. julie s. walsh, msw, lsw is a doctoral student, school of social work, indiana university, indianapolis, in 46202. copyright © 2017 authors, vol. 18 no. 2 (fall 2017), 583-594, doi: 10.18060/21551 https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2017, 18(2) 584 the authors present a brief overview of ivf and cryopreservation, an overview of the literature on social work involvement in reproductive services, and an examination of the disposition options for spare embryos, including the pros and cons of each option. the growth of ivf for most of human history, there was essentially one way to create a child that involved two persons of the opposite gender; however, the opportunities for conception have evolved rapidly since the 1970s with the development of assisted reproductive technologies (art). one of the most dramatic advances was the invention of in vitro fertilization (ivf), a process that involves combining egg and sperm outside the human body in a petri dish prior to returning the fertilized egg into a woman’s uterus. in july 1978, the first baby produced from ivf procedures was born in england. her parents named her louise brown, but she is famously known as the first “test tube baby” (baron & bazzell, 2014, p. 59). the first ivf birth in the united states occurred in 1981, and today the cdc (2012) consider ivf the primary type of art. the united states has experienced an ever-increasing number of ivf births each year, resulting in the influx of fertility clinics across the united states (crockin & debele, 2014). the use of ivf doubled between 2000 and 2010, with 1% of all infants born in the united states in 2010 as a result of ivf (cdc, 2012). according to the cdc (2017), of the 231,936 art cycles performed in 2015, 60,778 resulted in live births and a total of 72,913 infants; thus, approximately 1.6% of all infants born in 2015 in the united states were conceived using ivf. however, 45,779 procedures were banking cycles that resulted in eggs or embryos frozen for future use (cdc, 2017). cryopreservation brings about new possibilities in ivf although medical protocols vary by clinic and per individual client needs, a single ivf cycle involves several stages over a few months. first, the potential mother takes a course of medications to stimulate egg production and to prepare the uterine lining for embryo implantation. during a normal menstrual cycle, a woman produces one egg. the purpose of the ivf medications is to produce as many eggs as possible, without causing medical risks associated with hyperstimulation. before ovulation, the eggs are retrieved in a medical procedure usually involving light anesthesia, then combined with sperm in a petri dish. the development of the embryos are monitored over the next few days since it is common for several embryos to arrest, or cease further development. on approximately the fifth day, or the blastocyst stage of development, one or more of the embryos is transferred to a woman’s uterus (o’brien, 2010). the process can vary depending on whether a couple’s own egg and sperm are used, if donor egg and/or sperm are used, or if a surrogate is used (crockin & debele, 2014). when ivf practices were first developed, medical protocol was generally to transfer all created embryos to the uterus, but as the technology improved, there was a boom of multiple births (mastenbroek et al., 2011). the risks associated with pregnancies involving multiple fetuses compelled the american society of reproductive medicine (asrm) to establish guidelines for how many embryos to transfer based primarily on the age of the boys & walsh/too much success 585 mother, as well as other medical factors that influence success rates (murphy, 2013). with the goal of facilitating safe, healthy pregnancies by reducing the number of embryos transferred, clients did not want to waste other embryos developed during the cycle, especially since each cycle can cost an average of $8,000 plus $3,000-$5,000 for the necessary medications (johnston & gusmano, 2013). thus, cryopreservation technology was developed. embryos that are well-developed but not selected for fresh transfer can be frozen, or cryopreserved (mastenbroek et al., 2011). the first theory of cryopreservation emerged in the 1930s by b. j. luyet; the attempts to develop the theory into a procedure had very little success (gosden, 2011). over the next 40-50 years, slow progress was made by adjusting protocol, until cryo development surged almost simultaneous to in vitro fertilization. a slow freezing practice was developed in 1985 and used widely until vitrification recently became the protocol encouraged for use by clinics due to higher pregnancy rates after this faster type of freezing technology was used with embryos (kuwayama, 2007; whittingham, leibo, & mazur, 1972). today, over 600,000 embryos are being cryopreserved, with a 30-50% infant birth success rate from frozen embryos (robertson, 2014; us dhhs, 2017). current pre-ivf legal procedures one of the first steps in the current ivf procedure is to read and sign a large packet of informed consent documents. these documents are written by attorneys to relieve clinics of any legal liabilities; however, they are often presented to ivf clients with little explanation (madeira, 2015). this packet includes an embryos’ disposition form, which provides options regarding the status of an embryo in several circumstances including divorce, death of one of the embryo creators, and failure to pay annual storage fees. in 2015, madeira conducted the first, and to date only, qualitative analysis of ivf clients’ perceptions and understanding of informed consent documents. the researcher interviewed 66 clients who had undergone ivf procedures. results indicated that most of the forms are generally read and understood, except for the embryo disposition section of ivf informed consent packets. the form regarding embryo disposition shocked clients when they read it. many participants said they felt very uninformed about the decision. they reported doing their own internet research on ivf prior to the procedure, but said they had not thought about the possibility of embryo disposition as they were “thinking about whether or not [they could] even make an embryo” (madeira, 2015, p. 21). nachtigall et al. (2009) conducted a qualitative assessment of how persons make decisions regarding how to dispose of embryos. the researchers interviewed 77 families with cryopreserved embryos and found that nearly two-thirds (63%) of participants had embryos that had been in storage for at least five years, “either passively through disagreement or indecision or actively to maintain embryo potential, avert feelings of loss, or as psychological or genetic ‘insurance’” (p. 2094). the researchers concluded that persons struggle with embryo disposition decisions after successful ivf treatment, have not considered the potential dilemma in-depth prior to undergoing ivf, and maintain cryopreservation indefinitely as a result of the struggle (nachtigall et al., 2009). for these advances in social work, fall 2017, 18(2) 586 persons, excess embryos were an unintended consequence of ivf, and a dilemma they had not anticipated facing. embryos frozen in time in the united states, approximately 600,000 embryos are currently stored in cryopreservation banks (crockin & debele, 2014). this number is destined to continue rising as more persons undergo ivf and more embryos are abandoned or stored indefinitely (tucker, 2014). current estimates are that up to 25% of embryos in cryopreservation are abandoned as the “parents stop paying the storage fee, they move away, or they divorce and forget about their frozen embryos” (o’brien, 2010, p. 172). the owners of the embryos might purposefully forgo paying the storage fee out of financial necessity or as a passive form of indecision about what to do with the embryos. another reason for abandonment of embryos may be that the owners move and forget to forward their address; thus, the annual bill reflecting the need to maintain storage would be lost. in other cases, persons divorce and forget about paying or they are unable to arrive at a mutual decision. in each of these scenarios, embryos that could form life for the parents, for other persons experiencing the devastation of infertility, or that could be used to further scientific discovery are abandoned, all while taking up valuable cryopreservation space. additionally, the ethical dilemma might continue to plague persons who knowingly abandon the embryos or later remember they were abandoned (o’brien, 2010). while facilities may follow the legal paperwork decision of persons who abandon their embryos be that to destroy or donate them many facilities are loath to do so in fear that these persons might resurface, and present legal studies finding that informed consent at the time of ivf may not represent a person’s decision once a child is produced and other life events have unfolded (o’brien, 2010). in one study, after an average of 4.2 years of cryopreservation, 72% of participants had not made a disposition decision (nachtigall et al., 2009). in another, 87% of the participants were undecided about the disposition of leftover embryos (clark, 2014). "most couples had not anticipated or appreciated the consequences of having surplus embryos" (nachtigall, becker, friese, butler, & mcdougall, 2005, p. 431). additionally, “many professionals think couples severely underestimate the difficulty of destroying remaining frozen embryos once they have a child from that batch of embryos” (mundy, 2008, p. 185). mundy (2008) reasons that when disposition forms are signed prior to the ivf process, embryos are merely understood to be human tissue; however, once a child has been born, the parent’s understanding of the embryos transforms into a “potential child, a potential sibling, and a potential life” (p. 185). social work has not kept pace with reproductive technology as the use of ivf grew in the 1980s and 1990s, literature on social work services needed by persons undergoing the ivf process emerged (blyth, 1999; greenfeld, mazure, haseltine & decherney, 1985; walther, 1991). the scholarship that arose alongside the birth of ivf included discussion of the role of social workers in ivf services, the psychological and medical risks to be discussed with clients, and the counseling services necessary upon the failure of fertility treatments (bergart, 2000; black, walther, chute & boys & walsh/too much success 587 greenfeld, 1992; blyth, 1999; daniels, 1990; greenfeld et al., 1985; walther, 1991). while this literature is still useful, it has failed to keep up-to-date with new technological advances such as cryopreservation and the ensuing issue of spare embryos. as ivf has become more common practice since the beginning of the new millennium, there has been a stark lack of new research on the role social workers should play in infertility health care. just a few years after the first baby conceived via ivf in the united states was born, greenfeld et al. (1985) highlighted the need for specialized counseling by social workers practicing in infertility clinics. the authors presented the unique “emotional spectrum of euphoria, anxiety and dysphoria” of patients undergoing ivf, in comparison to the less invasive and less complex infertility treatments of the past (greenfeld et al., 1985, p. 71). in addition to literature regarding social work’s role during ivf procedures are studies on the services needed after unsuccessful ivf (bergart, 2000; black et al., 1992). bergart (2000) argues that social workers should play a role in educating “medical professionals about the needs of their patients when treatment fails” (p. 45). as use of ivf expanded in the 1990s, blyth (1999) stressed the importance of social work’s role at the macro level to ensure that the increasing commodification of ivf services maintained a focus on the humanity of persons experiencing infertility. the author further emphasized the need for social work advocacy on behalf of patients due to the profession’s unique set of values and ethics (blyth, 1999). more recently, fronek and crawshaw (2015) made a similar argument regarding the need for social workers to be advocates in international policy debates regarding bioethics matters, including ivf, among a host of other issues. as technology has advanced, persons who undergo ivf face new challenges. yet, the literature on social work services in the infertility field has not kept pace with technology, such as the disposition of spare embryos and the resulting ethical dilemma. the following section presents options for persons with excess embryos and how social workers can help explain those options to prospective parents. disposition options for frozen embryos options for spare embryos include having more children than initially desired, undergoing compassionate transfer, donating the embryos to research, donating the embryos to prospective parents, or purposefully thawing, abandoning or indefinitely freezing the embryos. the following section provides an overview of each option. the authors do not advocate asking clients to select one of these options prior to ivf treatment since “most patients have tunnel vision focused entirely upon having a child and cannot fully appreciate the inherent complexities of decisions such as donation of excess embryos to others for procreation” (tucker, 2014, p. 20). however, making clients aware of the possible dilemma and presenting options in advance could reduce the delay in decisionmaking later or ameliorate the abandonment of embryos in the future. social workers need to be prepared to explore the pros and cons of each option with ivf clients. advances in social work, fall 2017, 18(2) 588 option 1: have more children many people begin to contemplate the number of children they desire at a very young age, and it is often a topic of discussion for couples early in a relationship. for some, attempts to have this set number of children is stalled and marked by profound sadness and frustration. as these persons seek medical intervention to build their families, the concept of too many children is often far from their minds. the issue must be approached with the utmost consideration of the fact that some will leave ivf treatment empty-handed. however, in order to fully inform clients of the risks of ivf and prepare them for the possibility of spare embryos, the options for extra embryos must be discussed. the most obvious solution to the spare embryo dilemma is to have more children than originally anticipated. people undergoing ivf may believe they will have as many children as are produced by the process. however, with advancing technology, the number of embryos can be quite high. the average number of eggs retrieved from a woman undergoing ivf can range from 10 to 40 (lyon, 1999). although it is rare for all of these eggs to reach the developmental stage necessary for transfer to a uterus or cryopreservation, it is possible that several embryos will develop. in presenting this possibility, the realities of having more children than anticipated must be presented. because there are health issues associated with high frequency pregnancies, a higher number of embryos could be transferred at a time to reduce the number of ivf cycles and pregnancies. however, transferring more embryos heightens the risk of pregnancy with multiple babies which is risky for both the mother and the children. cost is also an important point to consider. well beyond the cost of multiple ivf transfers and pregnancies, families will spend an average of $233,610 to raise a child from birth through age 17 (lino, kuczynski, rodriguez, & schap, 2017). finally, time is a valuable and finite resource. potential parents must consider the time necessary to devote to each child in a large family. option 2: pursue compassionate transfer as an alternative to having more children for clients desiring a natural disposition of their remaining embryo(s), a new practice has been offered by some clinics termed compassionate transfer. in this process, the embryo(s) are thawed and transferred to the woman’s vagina or uterus in a way that will not allow further development. if transferred to the uterus, the procedure is done without the use of hormones typically given during the ivf process to increase odds of pregnancy and during a time of the menstrual cycle that is not conducive to implantation of embryos. ellison and karpin (2011), who have written one of the few scholarly pieces on compassionate transfer, contend that the practice can be presented to clients as a way to grieve the loss of the embryo as it is returned to and absorbed by the body in the same manner that is common in early-stage miscarriages. however, when presenting the option to clients during the initial ivf information stage, the cost should also be disclosed since this adds to the overall expense for ivf procedures. boys & walsh/too much success 589 option 3: donate to research another option for disposition of excess embryos is to donate them to research. the legality of stem cell research has changed with each recent presidential administration. if stem cell donation is not a possibility during a given time or if clients are uncomfortable with stem cell research, embryos can alternatively be donated for ivf training purposes. stem cell research donation. there are multiple ways embryos can be donated to research. one of the most beneficial from a practical standpoint, but also most controversial, is stem cell research. federal regulations and funding of stem cell research has been in turmoil since its development. the william clinton administration supported stem cell research, but was followed by the george w. bush administration that suspended funding (davis, 2014). the barack obama administration reversed that executive order (carbone & cahn, 2009). it remains unclear to date what the current administration’s position on stem cell research will be. among nachtigall and colleagues’ (2009) 77 families, 22% donated their embryos to research. clients who select this option cited four reasons: a) awareness through media publicity of the benefits of stem cell research, b) positive experiences with clinic embryologists, c) belief that their low-quality embryos are unlikely to result in conception, and d) a reconceptualization of the embryos as tissue that could be socially beneficial (nachtigall et al., 2009). choosing to donate an embryo to stem cell research is dependent on donors’ moral perspective on the issue. some donors have emotionally detached from the embryo as a personal creation, and instead place value on its social benefit and contribution as an altruistic gesture (nachtigall et al., 2009). sympathetic donors feel that it furthers scientific understanding of diseases such as parkinson’s and diabetes, can help cure diseases, and can help further scientific infertility treatments (kalb, 2010; synesiou, 2010). donors typically do not know in advance how their embryos will be used in stem cell research, so their provision of informed consent covers only the general disposition of embryos to stem cell research. donation for training purposes. due to the ethical dilemmas raised by stem cell research and the legal barriers to donation for stem cell research in some states, ivf participants can choose to donate their embryos to their storing clinic for general research purposes. these embryos are often used to train lab workers on new techniques, such as removing cells for preimplantation diagnosis (pgd). this alternative may be presented to each client after discussing the pros and cons of stem cell research. option 4: donate to prospective parents another option for disposing of spare embryos is to donate them to persons wishing to build their own families. similar to the adoption process, the client could put the embryos up for adoption. laws on this process vary by state; however, many allow donors to set the parameters of the adoption, such as whether it is open or closed and who takes possession of the embryos. in one study, only 6% of participants favored donation to other parents, with primary concerns centered around the donation process, the potential caregivers, and fear of the financial and legal ramifications (nachtigall et al., 2009). however, these fears are mostly unfounded because organizations exist to guide people through embryo advances in social work, fall 2017, 18(2) 590 donation, and the cost is typically borne by the adoptive parents. nachtigall et al. (2009) suggest making information about the organizations more widely available at ivf clinics. in the united states, there are approximately 200,000 families seeking to adopt (clark, 2014). embryo adoption could substantially add to the pool of potential babies available for adoption. persons who wish to adopt embryos desire the fullness of giving life to a child, not unlike the donor parents, which includes pregnancy, bonding, and breastfeeding (clark, 2014); however, cost can be a substantial barrier to accessing ivf. embryo adoption offers a less costly option. in 2014, the cost of embryo adoption averaged $5,000 for all assessment, laboratory, and medical expenses, which is substantially less expensive than a full ivf cycle or acquisition of a donor egg (clark, 2014). some embryo donors choose an open adoption program where they have the opportunity to meet with the adoptive family prior to embryo transfer and throughout the process, depending on the agreements made beforehand. according to frith, blyth, and lui (2017), donors and adoptees expressed great value in having contact with each other. both the adoptive parents and the embryo donors believed that the openness and honesty of these visits was in the best interest of the children. alternatively, donors may opt for a closed adoption process and sign consent to do so. regardless, discussing these options with clients up front could alleviate some of their fears and more properly address their concerns. furthermore, counseling should be made available to families considering embryo donation (crawshaw, hunt, monach, & pike, 2013). option 5: thaw, abandon, or indefinitely freeze the embryos the final options for persons with spare embryos after ivf treatment are to purposefully thaw the embryos, abandon them, or indefinitely cryopreserve the embryos (o’brien, 2010). abandonment and indefinite storage are the types of decisions that might be avoided if clients are counseled prior to undergoing ivf. thawing the embryos involves a conscious decision to inform the clinic storing the embryos to thaw them (o’brien, 2010). after embryos are thawed, the embryos will not develop any further and will be disposed of as biomedical waste. clinics typically charge an annual cryopreservation fee, which currently averages approximately $500 a year at cryobanks (tucker, 2014), but can be as high as $1200 per year (johnston & gusmano, 2013). persons might fail to pay these bills for a variety of reasons including the inability to afford the bill, relocation without a forwarding address, or consciously choosing to ignore the bill in order to allow the clinic to take custody of the embryos. clinics have the right to thaw and dispose of abandoned embryos, and many do. however, some clinics in the united states are choosing to store the embryos indefinitely due to reservations about the owners resurfacing, for moral reasons, or because of mere indecisiveness about what to do with them (o’brien, 2010). similarly, many people are uncertain about what to do with the embryos and continue to pay the storage fee year after year. with advances in cryopreservation protocol, embryos can remain viable indefinitely. boys & walsh/too much success 591 importance of social workers presenting the five disposition options pursuing ivf is an exciting, though nerve-wracking and somewhat arduous process that requires decision-making about both implanted embryos as well as those potentially left over after the completion of a family. this moral dilemma is addressed far too infrequently. cryopreservation facilities are reaching maximum capacity and are often left in a lurch to make decisions on behalf of clients who are indecisive, do not communicate their wishes, or abandon their embryos by failing to pay storage fees. conversely, persons beginning the ivf process experience cognitive dissonance when presented with bureaucratic forms to create life, while simultaneously being required to make what often feels like pre-mature decisions about the disposition of embryos not yet in existence and that they are fighting so hard to create. bureaucratic demands to make decisions regarding embryo disposal prior to embryo creation results in clients feeling shocked, confused, and overwhelmed. social work consultation and counseling about the options available to ivf clients before they are issued consent forms might lower client anxiety. discussing the options with a social worker requires clients to assume personal responsibility, prompts crucial discussions, and promotes ethical decision-making that is right for the family. offering detailed information about the choices available to clients takes the mystery out of the various options. these discussions can help clients gain closure about how their remaining embryos will be handled. ongoing social work support throughout the ivf process, as well as at the completion of family-making, would also benefit clients who may experience a shift in their moral conceptualization of embryos. conclusion success in ivf treatment is often celebrated. the moral and ethical weight of too much success, however, is often felt as a burden. yet, the facilitation of meaningful discussion by a social worker who understands the implications of each of the options for embryo disposition helps clients to confront these dilemmas, thereby increasing their intellectual and philosophical understanding, hopefully resulting in client empowerment to make fully informed decisions. references baron, n., & bazzell, j. 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(2013). access to in vitro fertilization deserves increased regulation in the united states. journal of sex & marital therapy, 39(2), 85-92. doi: https://doi.org/10.1080/0092623x.2011.632072 nachtigall, r. d., becker, g., friese, c., butler, a., & mcdougall, k. (2005). parents’ conceptualization of their frozen embryos complicates the disposition decision. fertility and sterility, 84(2), 431-434. doi: https://doi.org/10.1016/j.fertnstert.2005.01.134 nachtigall, r. d., macdougall, k., harrington, j., duff, j., lee, m., & becker, g. 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(2014). egg freezing and egg banking: empowerment and alienation in assisted reproduction. journal of law and the biosciences, 1(2), 113-136. doi: https://doi.org/10.1093/jlb/lsu002 synesiou, k. (2010). the dilemma of remaining frozen embryos. retrieved from http://www.creatingfamilies.com/surrogacy/?the-dilemma-of-remaining-frozenembryos-169 tucker, c. (2014). abandoned embryos: the dilemma of eternal storage. new hampshire bar journal, spring/summer, 54(3), 18-23. u.s. department of health and human services, office of population affairs [us dhhs]. (2017). embryo adoption. retrieved from https://www.hhs.gov/opa/aboutopa-and-initiatives/embryo-adoption/index.html walther, v. n. (1991). emerging roles of social work in perinatal services. social work in health care, 15(2), 35-48. doi: https://doi.org/10.1300/j010v15n02_04 whittingham, d. g., leibo, s., & mazur, p. (1972). survival of mouse embryos frozen to 196 degrees c. and 269 degrees c. science, 178(4059), 411-414. doi: https://doi.org/10.1126/science.178.4059.411 author note: address correspondence to: stephanie boys, phd, jd, msw, school of social work, indiana university, 902 w. new york st., indianapolis, in 46202. email: sboys@indiana.edu https://doi.org/10.1093/jlb/lsu002 http://www.creatingfamilies.com/surrogacy/?the-dilemma-of-remaining-frozen-embryos-169 http://www.creatingfamilies.com/surrogacy/?the-dilemma-of-remaining-frozen-embryos-169 https://www.hhs.gov/opa/about-opa-and-initiatives/embryo-adoption/index.html https://www.hhs.gov/opa/about-opa-and-initiatives/embryo-adoption/index.html https://doi.org/10.1300/j010v15n02_04 https://doi.org/10.1126/science.178.4059.411 mailto:sboys@indiana.edu abstract: social work services for persons undergoing the in vitro fertilization process (ivf) has greatly lagged behind the medical technology opportunities provided to these clients. advocacy for social work services for persons undergoing ivf was a... the growth of ivf cryopreservation brings about new possibilities in ivf current pre-ivf legal procedures disposition options for frozen embryos option 1: have more children option 2: pursue compassionate transfer option 3: donate to research another option for disposition of excess embryos is to donate them to research. the legality of stem cell research has changed with each recent presidential administration. if stem cell donation is not a possibility during a given time or if clients a... stem cell research donation. there are multiple ways embryos can be donated to research. one of the most beneficial from a practical standpoint, but also most controversial, is stem cell research. federal regulations and funding of stem cell research ... donation for training purposes. due to the ethical dilemmas raised by stem cell research and the legal barriers to donation for stem cell research in some states, ivf participants can choose to donate their embryos to their storing clinic for general ... option 4: donate to prospective parents option 5: thaw, abandon, or indefinitely freeze the embryos conclusion references _______ sarah r. robinson, lmsw, doctoral student, university of texas at arlington school of social work, arlington, tx. nada elias-lambert, phd, lmsw; abdel casiano, lbsw; lauren ward, lmsw, texas christian university, fort worth, tx. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 45-60, doi: 10.18060/23381 this work is licensed under a creative commons attribution 4.0 international license. “culture-bearer, culture-sharer, culture-changer”: the role of faculty in preventing sexual violence on campus sarah r. robinson nada elias-lambert abdel casiano lauren ward abstract: sexual violence is a prevalent issue on university campuses today. bystander intervention programs, which frame violence as a community problem, are a possible solution to address the issue of sexual violence on campus. as members of the university community, faculty can play an integral role in preventing sexual violence on campus. however, little research has assessed faculty members’ perceptions of their role on campus in the prevention of sexual violence. in this study, three focus groups were conducted with ten faculty members who had participated in a faculty-focused bystander intervention workshop. researchers coded the narrative data from the focus groups and three themes emerged about faculty members’ perceptions of their role on campus: 1) modeling bystander behavior, 2) ally to students, and 3) changing cultural norms. the study findings reveal that faculty see themselves as having varied roles in the prevention of sexual violence on campus. social work faculty can use their unique skillset to raise awareness among their faculty colleagues about the need for bystander intervention training for all faculty. the findings also reveal important implications about including faculty in bystander intervention programs in order to change cultural norms around sexual violence on university campuses. keywords: bystander intervention, faculty, sexual violence prevention, qualitative, university sexual assault is the most common violent crime committed on college campuses today (carey et al., 2015). one in three women and one in four men will experience sexual violence in their lifetimes (smith et al., 2018). one in five women is sexually assaulted while in college; 16% of women experience some form of sexual violence during the academic year, with 47% identifying as repeat victims (fisher et al., 2010). female victims of sexual violence often experience long-term psychological and physical effects and are more likely to drop out of college than other female students (maletzky, 2000; monnier et al., 2002; schiefelbein, 2002; söchting et al., 2004). as part of an institution of higher education’s comprehensive plan to prevent sexual violence on campus, it is critical to select prevention strategies that adhere to specific principles for effective prevention and are based on best practices and available evidence (nation et al., 2003). research is clear that using a multi-pronged approach to prevention is most effective (dahlberg & krug, 2002; nation et al., 2003). the centers for disease control and prevention (cdc, 2004) recommends adoption of a public health approach that focuses on the responsibility of all community members to reduce sexual violence. https://creativecommons.org/licenses/by/4.0/ robinson et al./culture-bearer, sharer, & changer 46 the cdc uses the social-ecological model to better understand violence and the effect of potential prevention strategies (dahlberg & krug, 2002). the social-ecological model offers a theory-based framework to promote prevention of sexual violence through bystander intervention. bystander intervention works at multiple levels of the socialecological model. this model considers the complex interplay between individual, relationship, community, and societal factors and suggests that in order to prevent violence, it is necessary to act across multiple levels of the model simultaneously (dahlberg & krug, 2002). while previous research explores factors that influence bystander behavior on the microsystem level, banyard (2011) uses the ecological model to emphasize the importance of analyzing the next levels in bystander behavior, the macro and exosystem, to ask questions concerning different communities, cultures, norms, and peer groups to better understand the leverage points to increase bystander behavior. this comprehensive approach is more likely to sustain prevention efforts over time than any single intervention (nation et al., 2003). the campus sexual violence elimination (save, 2013) act and the white house task force report to protect students from campus assault call for institutions of higher education to increase efforts to address campus sexual assault and explicitly promote a bystander approach (department of education, 2014; white house, 2014). the bystander model frames sexual violence as a community issue and focuses both on increasing community members’ receptivity to prevention messages, training, and supporting bystander behaviors (banyard et al., 2007; edwards, 2009; foubert, 2000; moynihan & banyard, 2008). the bystander model is unique in that it does not solely target victims or perpetrators of violence; rather, it calls upon all community members to work together to enhance efforts to change broader group and community norms around sexual violence (banyard et al., 2007). most campus-based bystander intervention programs currently target students; however, offering bystander intervention programming to faculty is critical to preventing sexual violence since faculty play significant roles in shaping the norms on college campuses (hektner & swenson, 2012; kousholt & fisker, 2015; sanner-stiehr & ward-smith, 2017). as members of the campus community, faculty can play an integral part in preventing sexual violence on college campuses. mcmahon (2015) calls for further research with campus authority figures to determine the impact modeling bystander behaviors may play in the prevention of campus sexual violence. however, no studies known to the authors assess how faculty perceive their roles pertaining to sexual violence prevention on campus. the purpose of this study was to gather university faculty perceptions regarding their role in prevention of sexual violence on campus. faculty role in shaping campus culture as part of the campus community, faculty play a role in shaping the culture on campus. research has primarily focused on the role of teachers in preventing bullying in primary and secondary schools and healthcare faculty in universities. in a study with elementary and middle school teachers, hektner and swenson (2012) explain how teachers’ beliefs about bullying determine both the culture of the school environment as well as how teachers respond to both bullying and students who are victimized within that environment. advances in social work, spring 2020, 20(1) 47 the results of the study show that, although the teachers sampled did not agree on any measurable belief about bullying, teachers' attitudes and behaviors about bullying shape the overall culture of bullying in schools. furthermore, in a review of research to reduce bullying in primary and secondary schools, kousholt and fisker (2015) identified the need to target both first order and second order perspectives in preventing bullying in schools. first order perspectives on bullying, which influence traditional strategies to prevent bullying, assert that bullying happens solely on individual levels between the perpetrator and the victim (kousholt & fisker, 2015). second order perspectives, however, incorporate social contexts as the basis of bullying and address teachers’ bystander behavior as the goal of prevention strategies (kousholt & fisker, 2015). these kinds of approaches shift the focus away from individual bullying experiences to the overall school environment to implement prevention methods on multiple levels and bring about large-scale cultural change (farley, 2018). second order change takes place when social structures change (kousholt & fisker, 2015). therefore, teachers have the ability to influence the culture of the classroom through their beliefs about appropriate behavior and their actions towards students (farley, 2018; storer et al., 2017). in addition to primary and secondary education teachers, research has focused on healthcare faculty members’ ability to shape the culture of the university. sanner-stiehr and ward-smith (2017) found that nursing faculty have the ability to shape norms around appropriate workplace behavior by modeling appropriate conduct with students. this, in turn, demonstrates how nursing students should treat their patients as well as their colleagues (labrague et al., 2015). faculty can play a large role in creating environments on campus that are safe, respectful, and that reward professionalism (moutier et al., 2016). these studies exemplify the overarching concept that those in leadership roles greatly influence the culture of an institution (hektner & swenson, 2012; kousholt & fisker, 2015; sanner-stiehr & ward-smith, 2017). therefore, faculty, like teachers, play a critical role in shaping campus culture. faculty role in sexual violence prevention in addition to impacting campus culture, faculty may also influence the prevention of sexual violence on campus. graham and colleagues (2019) recommend faculty leverage their leadership positions on campus to advocate for the prevention of intimate partner violence among students. graham et al. (2019) also recommend that faculty use their various roles in research, teaching, and service to create opportunities to advocate for students who have experienced violence, whether it be intimate partner violence or sexual violence. furthermore, laughton (2015) argues that faculty should be included in bystander intervention programs given that faculty members’ leadership on campus gives them the ability to model appropriate prosocial behaviors such as expectations of respectful classroom conduct. while there are no empirical studies about the role of university faculty influencing attitudes about bystander intervention related specifically to campus sexual violence, a few studies on bullying show that expectations of teachers and other authority figures may have an impact on students’ decisions to intervene (fonagy et al., 2009; hektner & swenson, 2012; jaime et al., 2014; mclaughlin et al., 2005). while researchers robinson et al./culture-bearer, sharer, & changer 48 recommend faculty be involved in prevention efforts, there has been some resistance from faculty about whether their involvement is part of their faculty role. research indicates that faculty face challenges setting boundaries with students who are experiencing mental health challenges (hughes & byrom, 2018; laws & fielder, 2012; poorman et al., 2011). particularly faculty in healthcare fields, such as nursing, find difficulty in knowing when to assist students facing personal challenges with their mental health, as students often come to them for healthcare advice (hughes & byrom, 2018). furthermore, faculty expressed that the university administration is often unaware of the time faculty devote to assisting students with personal challenges and fails to provide faculty with resources to address the additional emotional load of this work (laws & fielder, 2012). when it comes to interpersonal violence prevention, faculty have expressed resistance incorporating violence prevention messages into their curriculum for fear that it would lead students to disclose violence, for which the faculty would be unprepared (lovi et al., 2018). in addition, faculty feel unprepared to intervene if they are presented with a student in need of assistance with violence-related issues (kousholt & fisker, 2015). however, no research known to the authors specifically explores faculty members’ perceptions of their role in sexual violence prevention. because faculty have the potential to shape attitudes by modeling prosocial behavior and contributing to a safe campus culture, it is critical to understand how faculty perceive their role on campus. mcmahon (2015) calls for future research to examine the influence of role models on college campuses, such as faculty, staff, and administration, to determine how they respond to sexual violence as well as how they promote bystander intervention when working with students. therefore, the purpose of this study was to explore faculty members’ perceptions of their role in preventing sexual violence on university campuses. method a qualitative, exploratory design was used to gather university faculty perceptions regarding their role in the prevention of sexual violence on campus. this study is part of a larger evaluation study of a faculty-focused bystander intervention program. the study was grounded in a constructivist theoretical framework in which themes and patterns in collected data were discovered rather than predetermined. focus groups were chosen to collect the data for several reasons. first, focus groups are a way of listening to people and learning from them, which was a main goal of this study (morgan, 1998). also, the researchers were interested in creating lines of communication between facilitators and participants, as well as between the individual participants. using focus groups allows the researcher to gain information about a particular topic and listen to people’s perspectives in a safe, non-threatening environment (litosseliti, 2003). the flexible nature of focus groups offers the researcher insight into the participants’ unique description of their beliefs and experiences, which then fosters opportunities to explore new ideas as a group (litosseliti, 2003). also, the researchers wanted to use the faculty members’ actual statements in communicating the results of this study. the study received university human subject approval. advances in social work, spring 2020, 20(1) 49 recruitment a purposive sample of faculty at a university in the southwestern region of the u.s. was recruited for this investigation. all members of the sample must have attended both the faculty-focused bystander intervention program and the faculty-focused train-thetrainer bystander intervention program. the sample met the following inclusion criteria: (1) participant in a faculty-focused bystander intervention program; (2) participant in a faculty-focused train-the-trainer bystander intervention program; (3) currently working as an instructor at the university in the southwestern us; and, (4) fluent in the english language. the first author shared the study flyer via email with all faculty who had attended both the bystander intervention workshop and the bystander intervention train-the-trainer workshop. bystander intervention program the two-hour bystander intervention workshop empowers faculty members to recognize, discourage, and prevent a culture that enables violence. faculty participants learn to recognize dangerous behaviors, work to create a safe learning environment, model bystander skills, support students and colleagues, and promote a culture of nonviolence. faculty participants learn facts about sexual violence in america, learn how to apply the five bystander intervention steps (see latane & darley, 1970), discuss the culture of violence on college campuses, and understand mandated reporting guidelines. faculty participants also discuss and practice specific bystander intervention strategies for interacting with students and other members of the campus community. the two-hour bystander intervention train-the-trainer workshop provides a sustainable way for participants to facilitate the bystander intervention program with colleagues in their units. the train-the-trainer workshop includes a discussion of potential issues that may arise during the workshop facilitation as well as ideas about how to customize the workshop to meet the needs of different groups. train-the-trainer workshop participants receive all materials needed to facilitate the workshop and join a collaborative team of trainers who work together to build a safe campus community. both workshops, which are evidence-informed, were developed by one of the authors over the past four years. no incentive was provided to faculty to attend the workshops; however, many faculty clearly expressed interest in learning how they could help change campus culture. data collection procedures three mixed-gender focus groups were conducted in 2017. two focus groups included three participants and the third focus group had four participants. each focus group lasted from 60 to 90 minutes. the research team conducting the focus groups consisted of one university professor and three social work students: one undergraduate student, one graduate student, and one phd student. each focus group was led by the university professor and one of the students. three focus group facilitators were women and one, the undergraduate student, was a man. the social work students were trained in best practices for facilitating focus groups by a co-investigator with experience conducting qualitative research involving focus groups. all focus groups were hosted on campus in locations that robinson et al./culture-bearer, sharer, & changer 50 were familiar and easily accessible to the participants. no faculty members participated in more than one focus group. informed consent was obtained from all participants. the focus groups were directed by a semi-structured guide created by the researchers (see appendix a). the guide included questions that addressed faculty perspectives regarding their participation in the faculty-focused bystander intervention program and the train-thetrainer workshop. the guide was followed by each facilitator for consistency, but each facilitator went into greater depth with questioning when appropriate. data analysis the focus groups were audiotaped and professionally transcribed. to assist with the analysis, the transcriptions were imported into the qualitative software analysis program, dedoose, and analyzed using open coding that sought meaningful categories via inductive content analysis (creswell, 2007). using dedoose, three of the researchers independently read and coded the transcripts to generate a series of emergent themes and subthemes. the three researchers met several times to compare their assigned codes. when differences emerged, the authors discussed the differences in codes using an agreed upon definition of the codes until a consensus was reached. the authors also used memoing during the coding process to aid in theme development. data analysis included initial open coding during the data collection process. initial open coding was used to break down the data into first level distinct concepts and categories. this allowed for the later exploration of themes that had been identified in early focus groups. initial coding also allowed for the recognition of potential gaps in the data that led to positive methodological changes in future focus groups. focused coding was then performed to condense and sharpen the themes and concepts that emerged from the data (creswell, 2007). focused coding required examining what the initial codes implied and revealed about the data. this coding was guided by concepts and categories identified during the initial coding process. a thematic analysis was then used to identify faculty perceptions regarding best practices for bystander intervention programming on campus. to enhance the rigor of this study, the researchers used three different types of triangulation strategies (patton, 2001). first, investigator triangulation (using multiple analysts to review findings) by two of the researchers was used. this type of triangulation can provide a check on selective perception and illuminate blind spots in an interpretive analysis. the fact that both researchers produced similar themes enhanced the validity of the key themes. second, triangulation of sources (examining the consistency of different data sources from within the same method) was achieved by searching the data to determine whether points existed at which the data from one group supported the data from other groups. there were several instances in which this occurred. lastly, the researchers used perspective triangulation (multiple perspectives to examine and interpret the data) as they identified relationships among the codes. advances in social work, spring 2020, 20(1) 51 results participants ten faculty members participated in three focus groups. at the time of this study, there were 14 faculty members who were eligible to participate in the study as they had attended both the faculty bystander intervention program and the train-the-trainer workshop. thus, 71% of eligible faculty participated in the study. table 1 reports the demographic characteristics of the sample. sixty percent of the participants were women. the majority of the participants (90%) were european american. table 1. sample demographic characteristics (n=10) this study yielded results that are important for gaining a better understanding of faculty perceptions regarding their role in preventing sexual violence on campus. three main themes emerged from the focus groups: 1) modeling bystander behavior, 2) ally to students, and 3) changing cultural norms. each theme is accompanied by participant statements that were made during the focus groups. modeling bystander behavior faculty discussed their perception of their role as a model for prosocial bystander behavior. participants described how they gained an increased awareness of the need for prosocial behavior which informed their views of their role on campus. one participant said, “i think it's reminded me that it is my business, it is my obligation, it is a part of my job and my duty as a human being and as a professor and as a part of this community to variable % gender female 60 male 40 ethnicity european american 90 african american 10 college representation fine arts 30 nursing and health sciences 20 science and engineering 10 communication 10 liberal arts 30 faculty position associate professor 20 assistant professor 30 instructor 30 phd student instructors 20 robinson et al./culture-bearer, sharer, & changer 52 intervene. i think before i would tell myself it's my job to teach them this subject not to get involved in their personal life.” participants also described how they have changed their personal behavior to be a better model for students. one participant said, “it’s a difference, so it makes me think about my own language when i speak, the kinds of ways that i talk with my colleagues. it just makes me reevaluate the kinds of, the ways that i talk and how that fits into this goal of creating a better culture.” furthermore, participants discussed how their position of authority places them in a role to be a model for prosocial behavior which made them mindful of their actions. one participant, who was a graduate teaching assistant, said, i think i see myself as like a bridge builder kinda role with my students, cause, as a grad student i'm still very close to them in terms of education and everything. and i think also because i look like a lot of the (university’s) undergrads, so kind of modeling, you know, you know, someone that they can, you know, look at and be like, "oh, okay, he's a grad student and he's white," you know, like, okay, so here's how you ... here's how masculinity probably should be, that kinda thing. an increased awareness of the need for prosocial behavior allowed the faculty included in the focus groups to view their role as models for prosocial behavior. one participant summed up their view of faculty members’ role saying, “by understanding that we can intervene in a non-threatening way. in a non-confrontational way, but, but simply intervene in a way that is effective, that we can think through our behaviors and hopefully change how the community functions.” participants felt that by modeling prosocial behavior for students, they could make an impact on campus culture relating to the prevention of sexual violence. ally to students the second theme that emerged from the data concerned the participants’ views of their role as a resource to students. faculty included in the focus groups perceived their role as a potential confidant for students. one participant said, “i want students to know they can come to me without having to like mention it every day in class, like, by the way if you're having a problem, you know.” several participants discussed the importance of creating an open line of communication so that if students needed assistance or resources, they would perceive faculty members as open to discussing sensitive topics. one participant said, “i try creating a space where students feel they can approach us if they have concerns, fears, anxieties, that they know that we're a resource for them to get them to a place where they can seek help, guidance, those kinds of things.” furthermore, they discussed the importance of faculty remaining open and non-judgmental. one participant said, “if students understand we get it, we're not judging you in any manner. we just want to support and, i think that’s important.” in addition to viewing themselves as a potential confidant for students, the participants discussed how their role puts them in the position to identify students who are potentially at risk. one participant said, “i look at it from the perspective of a faculty member that i think sometimes we can be folks who are identifying, or at least in a position to get those students to support, who don't even know sometimes they need it.” the participants also advances in social work, spring 2020, 20(1) 53 noted that they could influence students to take care of themselves. one participant said, “it is my job to become invested in the community. and to remind them to take care of themselves.” the participants viewed their role as a potential confidant for students who could provide a safe space for support and resources when necessary as well as individuals who are in the position to recognize when a student is at risk and therefore, model how to take care of themselves. changing cultural norms finally, faculty involved in the focus groups commented on their perception of their role in changing cultural norms around the topic of sexual violence. participants expressed that if faculty recognized their role as prosocial bystanders, change is possible on campus. one participant said, “i feel that this work (bystander) allows for more visibility on campus, both in terms of this work and my role in culture-bearer and culture-sharer and a culturechanger. so, you put out this information and it is reflected back at you. i'll speak for myself, reflected back at me, and so i'm able to see, what needs to be nuanced in terms of my delivery and my leadership.” participants each described individually how they viewed their role in preventing sexual violence on campus. most commonly, the participants perceived their role as decreasing victim blaming and changing gender norms. one participant said of their role, “and that's, to me that's the piece i feel like, that's the part i want to solve is, is taking the, the blame away from the victims. and i, that's, that's that emotional hygiene piece i don't know how to fix.” the participants also discussed how they could use their position as faculty to leverage change in views of gender norms. one participant said, and i'm thinking about gender and gender politics and gender roles. i'm gonna be teaching a ballet class for some football players in the next semester and i recognize that not all sexual violence is targeted at women and, given the research, as you've shared with us, there's a higher percentage. so i think it's, i think for me in terms of my role in changing the culture around sexual violence, it's a conversation about gender and what it actually means to be a man, and the ways in which we are programmed to be and act. another participant, in describing their view of faculty members’ roles, said, “i think that's a responsibility that all of us needs to take more seriously, to be fighting the toxic masculinity that's intrinsic in rape culture.” the participants acknowledged that their role as faculty gave them the position to make changes that could begin to prevent sexual violence on campus, and they felt they could have the greatest impact decreasing victim blaming and changing views of gender norms. discussion the results of this study reveal important insights into faculty members’ perspectives about their role in preventing violence on campus as well as their role in the lives of students. after participating in bystander intervention training, faculty members felt that they could play a critical part in violence prevention and should be included in efforts to prevent sexual violence on university campuses. robinson et al./culture-bearer, sharer, & changer 54 first, participants viewed one of their roles as modeling prosocial behavior. the participants gained an awareness that part of their job as faculty was to model prosocial behavior for students considering they are in a position of authority. this was particularly noted by participants who possessed similar attributes to the majority of the student body, such as being a member of the majority racial group and having a younger looking appearance. therefore, participants described changing their personal behavior to be more effective examples for students. while research has demonstrated the potential role conflict and boundary confusion some faculty may face modeling prosocial behaviors (hughes & byrom, 2018; kousholt & fisker, 2015; laws & fielder, 2012; poorman et al., 2011), these results demonstrate that after receiving bystander intervention training, the participants developed a new understanding of their role which empowered them to model prosocial behavior for students. incorporating faculty into bystander prevention programming has the ability to help faculty navigate their role as both faculty and university culture-bearers and ultimately empowers them to challenge cultural norms by changing their personal actions (graham et al., 2019). the faculty involved in this study also discussed their role in the lives of students. participants expressed the desire to be perceived by students as an ally and as a resource. participants wanted students to feel comfortable talking with faculty about their personal struggles and experiences with violence. this finding emphasizes the importance of providing faculty the necessary training in order to have conversations with students and inform them about the appropriate resources. research has demonstrated that faculty are apprehensive about being involved in the lives of students since they feel unprepared for what students might disclose (kousholt & fisker, 2015; lovi et al., 2018). therefore, providing faculty with the knowledge of available resources for students and also giving them the ability to practice having hypothetical conversations about violent experiences with their colleagues during training could empower faculty to step into their role as allies for students. finally, participants described their role as culture-changers who challenge cultural norms around sexual violence. specifically, they discussed their role in terms of decreasing victim-blaming and changing gender norms. participants felt they could have the greatest impact by targeting maladaptive beliefs about gender in their classroom. although some faculty may express hesitation in incorporating discussions on violence in their classes, findings further demonstrate the need to provide faculty with appropriate training to effectively broach these topics with students (baldwin-white & elias-lambert, 2016; lovi et al., 2018). giving faculty the space to learn about these issues and brainstorm with their colleagues on the appropriate places to incorporate issues of gender into their curriculum could empower faculty to see the importance of having these conversations and the skills to navigate them effectively. by including faculty in bystander intervention programming, faculty could gain the skills to recognize when students are at risk and intervene safely by providing students with needed resources. limitations the results of this study should be considered in light of a few limitations. since inclusion in this study was limited to those who had completed a faculty-focused bystander advances in social work, spring 2020, 20(1) 55 intervention program, the sample size was relatively small in comparison to the size of the university. in addition, the faculty that participated in this study may feel more strongly about the need for faculty to be involved in sexual violence prevention given they were motivated to participate in the bystander intervention program even though it was not a requirement for their employment. finally, the researchers who analyzed the qualitative data were part of the bystander intervention program’s development and therefore there is the potential for bias during the data analysis process. implications for future research and practice the results of this study demonstrate the importance of including faculty in bystander intervention programming. participants included in this study felt faculty play a critical role in shaping campus culture and should be given the tools and training to be able to create a campus culture that is safe and free of violence. since this study included only those faculty who had been through a bystander intervention training specifically targeting faculty, future research should seek to gather perspectives of faculty who have not received formal training. understanding the perceptions of untrained faculty members could reveal important implications for the continued development of bystander intervention training for faculty. in addition, exploring faculty members’ perceptions of their role in other social issues, such as racism, ableism, and heterosexism, could aid in the development of a program which targets multiple maladaptive cultural norms that perpetuate discrimination and violence on college campuses. future research should also focus on determining the benefit of expanding bystander intervention training to both faculty and staff members as well as the benefits and challenges to mandating this type of training for faculty and staff. social work educators, given their potential for understanding larger social issues affecting university campuses, are in the unique position to formulate evidence-based bystander intervention programs and model prosocial behavior for their colleagues. this study revealed important implications for social work faculty who can use their unique positions to raise awareness among their colleagues from other professions about the need for bystander intervention training for faculty. advocating for more faculty to be involved in bystander intervention training has the potential to create a safer campus environment as faculty challenge cultural norms around violence and model prosocial behavior. references baldwin-white, a., & elias-lambert, n. 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(2014). the first report of the white house task force to protect students from sexual assault. retrieved july 9, 2019, from https://obamawhitehouse.archives.gov/1is2many/notalone author note: address correspondence to sarah robinson, university of texas at arlington school of social work, 211 south cooper street, arlington, tx 76019. email: sarah.robinson@uta.edu http://dx.doi.org/10.1016/j.childyouth.2017.01.018 https://obamawhitehouse.archives.gov/1is2many/notalone mailto:sarah.robinson@uta.edu robinson et al./culture-bearer, sharer, & changer 60 appendix a. focus group guide involvement in the faculty bystander intervention program (fbip) • why have you committed to being involved in this initiative? o what was your motivation for involvement in this initiative? • has your involvement in this initiative benefitted you? if so, how? • has your involvement in this initiative benefitted students? if so, how? • what do you see as your role in changing the culture on campus regarding sexual violence? o has your perception of your role changed based on your involvement in the fbip? • what do you see as your role in changing the culture on campus, in general? o has your perception of your role changed based on your involvement in the fbip? fbip skills development • what new skills have you learned through your involvement in this initiative? o how will/have you use(d) the skills you have learned when interacting with students? o how will/have you use(d) the skills you have learned when interacting with colleagues? • how would/do you address sexual violence on campus? • if you acted as pro-social bystander, do you believe there would be the repercussions? o if so, what would those be? (tcu, college, department) • do you believe you have the skills to teach others how to be pro-social bystanders? • do you have suggestions on ways to encourage faculty to act as pro-social bystanders on campus? the fbip • what worked well in the fbip? • what could be improved in the fbip? • how do you think your involvement in the fbip has been received by your college? • have you experienced any victories or challenges through involvement in the fbip? o if so, please share (if they share a challenge, ask for further information about strategies they used to overcome that challenge) • do you have suggestions on how to improve the implementation of the fbip? • do you have suggestions on how to recruit more faculty to participate in the fbip? the two-hour bystander intervention workshop empowers faculty members to recognize, discourage, and prevent a culture that enables violence. faculty participants learn to recognize dangerous behaviors, work to create a safe learning environment, model... the two-hour bystander intervention train-the-trainer workshop provides a sustainable way for participants to facilitate the bystander intervention program with colleagues in their units. the train-the-trainer workshop includes a discussion of potenti... _________ tonya d. bibbs, erikson institute, samantha wolfe-taylor, indiana university, nicole alston, columbia university, mackenzie barron, portland state university, lillian beaudoin, samuel bradley, boston college, alexis speck glennon, colby-sawyer college, julie muñoz-najar, university of illinois champaign urbana, laura nissen, portland state university, juan rios, seton hall university, hannah szlyk, washington university, anjanette wells, university of cincinnati, jaehee yi, university of victoria, and jimmy a. young, california state university san marcos. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 132-147, doi: 10.18060/24978 this work is licensed under a creative commons attribution 4.0 international license. constructing the future of social work tech habits of mind with the ethical os tonya d. bibbs samantha wolfe-taylor nicole alston mackenzie barron lillian beaudoin samuel bradley alexis speck glennon julie munoz-najar laura nissen juan rios hannah szlyk anjanette wells jaehee yi jimmy a. young abstract: technological innovation has long been seen as a hallmark of progress in the modern world. while these advances may facilitate advantages to individual and social well-being, they have the potential for creating new areas of risk and for exacerbating those that already exist. in addition, a global pandemic has reshaped how we interact with one another, as more people connect online. social work’s ongoing relationship with technology necessitates that we evaluate and re-envision how tech ethics create, shape, and transform social work practice. this paper has three goals. first, we argue that technologies have long been a hidden driver of social work practice and provide an initial mapping of their current influence. second, we introduce the ethical os as a tool for conceptualizing ethical issues that may arise in social work practice, education, and policy. we ask if this tool could promote seeing around corners regarding how developing technologies might be advantageous or disadvantageous for reference or consumer groups. for example, how do they reify historical injustices such as structural racism and how do they offer remediation? third, we discuss the importance of building coherent, social work tech habits of mind, in practice now and for the future. we provide recommendations for how social workers and clients alike can be adequately informed and empowered in an ever-evolving technological world. keywords: ethical os, social work tech, social work futures, structural racism, habits of mind the past several years have included monumental events that will forever shape our world. the covid-19 pandemic and a summer of racial reckoning were two events that greatly impacted the united states and that were closely tied to the use of technology. during the initial months of the pandemic, technology served as the primary medium to track and receive information about the virus, and quickly became a way for many people to remain engaged in their jobs and education. technology was also how many people publicized and learned about hate crimes and murders of black people, and, consequently, organized nation-wide rallies protesting police brutality. in addition to personal and collective impact, these events, and the subsequent role of technology affect both the present and future of the social work profession. the fact that about:blank advances in social work, spring 2023, 23(1) 132 technology has become a pervasive and indispensable tool in everyday life suggests that this is also a reality for social work. thus, social work should examine how technology use may influence the profession’s code of ethics (national association of social workers [nasw], 2021). for example, a social worker’s commitment to their client’s well-being may now involve educating a client about resources identified via technology, informing them of best practices for technology use, or the integration and use of artificial intelligence for a variety of reasons. yet, problem-solving for the present and preparing for the future of social work is no easy endeavor, especially as the profession must consider the needs and safety of the respective clients and communities, and the capacity of its own members (nasw, 2021). hence, social work requires the assistance of conceptual frameworks, particularly from private industry, to inform the less-defined intersection of technology and professional social work conduct. this paper represents the analysis of the social work health futures lab, a collaborative of social work scholars, researchers, and practitioners studying the future of the field, sponsored by the robert wood johnson foundation. as a collaborative group of students, professionals, educators, and researchers with different practice backgrounds who are invested in exploring future issues in social work, the ethical operating system (ethical os, 2021) stood out as a potentially valuable tool for consideration when working with technology in the social work discipline. it is important to note that the authors do not view the tool as exclusively or singularly adequate to meet all of the needs of the profession. rather, social work now requires a tool to understand and grapple with the ways in which technology may intersect with and create opportunities and challenges of current and future practice. the purpose of this conceptual paper is to explore if a tool such as the ethical os that can be a steppingstone to increased imagination, understanding and fluency in some of the ethical issues that are likely to appear in the social work practice landscape, and/or if social workers themselves seek to develop or amplify use of technology in a specific way. a further aim of this paper is to map out a conceptual, as well as practical, “tour” of the tool which would be an unlikely part of contemporary social work ethics discourse as evidenced by our very preliminary social work tech ethics “frame” at this moment in history. this tour is guided by and built upon social work values and ethics – and the authors approach the effort with curiosity. this analysis builds on the work of important researchers (benjamin, 2019; eubanks, 2018; noble, 2018; o'neil, 2017) who collectively performed essential scholarship regarding the current and future dynamics of racism and structural disadvantage during a time of technology proliferation. advancing social work's ability to understand and participate in ethical practice with regard to the seminal and central issue of racism in our increasingly technologically infused practice landscape is informed by their contributions. prior to diving into the use of the ethical os tool in social work practice, this conceptual paper will offer a brief exploration of the history of technology in social work practice and the impact that power and privilege have on technology and social work. subsequent sections build upon this concept by examining the ethical os tool, how the ethical os could inform the development of social work tech habits of mind, and the implications of an ethical os tool in social work practices. bibbs et al./future swk tech habits 133 history of technology in social work practice the history of technology in social work is long and complex. in 1982, dick schoech wrote one of the first published books to examine how technology could improve social work practice (goldkind et al., 2019). as technology continued to innovate and expand across society, social work responded slowly and with trepidation (krueger & stretch, 2000; parrott & madoc-jones, 2008; schoech, 2013; york, 2008). more recently, digital technologies permeate the fabric of social work in nearly every aspect of the profession. the influence of digital technologies and connected devices is evident in direct clinical practice (mishna et al., 2012), child welfare (sage et al., 2017), community practice (sitter & curnew, 2016), as well as in advocacy and activism (brady et al., 2015; mcnutt & menon, 2008). organizations are using digital technologies to make data-driven decisions that impact community-centered service provision (kline & dolamore, 2020; schoech et al., 2002). likewise, virtual reality technology plays a critical role in both the treatment of post-traumatic stress disorder (nason et al., 2020) and the enhancement of student knowledge through virtual training simulations (lee et al., 2020). social media, such as twitter and pinterest, are also used in social work education to engage students in the classroom and support the implicit curriculum (baker & hitchcock, 2017; hitchcock & young, 2016). this diffusion of digital technologies throughout social work has generated needed discussions about policy and the use of these technologies across research, education, and practice arenas (young & glennon, 2021). proponents cited the benefit of “creat[ing] massive change and radical transformation in who is served and how” (berzin, et al., 2015, p. 4), capitalizing on the intersection of social work professional presence as the largest provider of mental health services in the u.s., combined with the growing presence of personal technology in the field. proponents further suggested that technology could improve perceptions of safety, client disclosure, geographical access, and cost options (lamendola, 2010; reamer, 2021). current literature points to possible risks in using technology in social work practice. chief among them are the loss of human connection, potential fraud, and privacy violations (reamer, 2021). social work scholars boddy and dominelli (2017) describe social media as a new ethical space. the authors present a series of social media case studies then analyze the implications for social work practice. the following implications were highlighted: • technology’s compression of time, such that relationships developed at a rapid pace. • the distribution of the social worker and client’s self across virtual space without considering the in-person implications. • the potential for anonymity to embolden persons to broadcast hateful speech. the authors urge deep engagement with critical social work and critical theory to raise questions about risk and identify opportunities for liberation (boddy & dominelli, 2017). boddy and dominelli’s findings are yet another indication that the sheer ubiquity of advances in social work, spring 2023, 23(1) 134 technology in the modern world is compelling the social work profession to evolve faster and with intention on this issue. power and privilege in social work technology social work’s commitment to social justice goes beyond these general ethical concerns of technology use. gangadharan and niklas (2019) examine inequities in social work technology use through nancy fraser’s model of abnormal injustice, which examines ways in which social and political institutions operate to create and maintain inequality. from the perspective of this model, technology use in social work has the potential to reinforce current systems of oppression and discrimination, rather than serving as a starting point for new forms of injustice (gangadharan & niklas, 2019). helsper (2021) calls upon us to recognize that the digital inequality debates have moved from digital divides to gradations of exclusions through our skills and use, motivation, access to technology, engagements with technology, participation levels, and outcomes. designers could develop technology that accelerates surveillance of government benefit recipients, and such practices in the united states have been presented by eubanks (2018) in their book automating inequality: how high-tech tools profile, police, and punish the poor. some technologies make black people hypervisible and expose them to systems of racial surveillance while other technologies fail to see blackness at all (benjamin, 2019). social workers may use technology intended to aid practice that also targets certain communities or racial groups for increased policing. when designers infuse their implicit biases into design, the potential for technology to accelerate discrimination and oppression underscores the need for thoughtful ethical guidance (gangadharan & niklas, 2019). current literature discusses varying perspectives on the issues of discrimination and social injustice related to the integration of technology into social work practice. reamer (2018, 2021) suggests the use of technology as a method of expanding services to cover those living in rural or underserved geographical areas. additional benefits include the opportunities for flexible scheduling or limited commute time for those with unpredictable work schedules (reamer, 2018). similarly, parrott and madoc-jones (2008) underscore the ability of technology to promote practical, social, economic, and political empowerment among traditionally disenfranchised populations through community building, service accessibility, and prevalence of information. reamer (2014) also noted that benefits of technology in practice are limited to only those who are able to access particular services. yet traditionally disenfranchised populations, who generally comprise the majority of service users, disproportionately lack access to technologies that are most prominently used in social work, such as computing devices or video chat applications (perron et al., 2010). gangadharan and niklas (2019) discuss methods of high-tech discrimination, including misrepresentation, over-targeting, and maldistribution of services to disenfranchised populations. for example, gangadharan and niklas (2019) highlight the misuse of sensitive or personal data in poland, where local government officials created a database of houseless individuals meant to be used by social service organizations but became widely available to the polish judicial and police system. bibbs et al./future swk tech habits 135 therefore, social work’s commitment to combatting suffering and structural oppression mandates an ethical approach beyond the standards of private industry and government. the progression of technology standards in social work practice in response to this mandate, the national association of social workers (nasw) developed specific “standards for technology in social work practice” in 2005, with revisions in 2017 (nasw et al., 2017). prior to the development of these standards, social workers had to navigate the use of technology in practice through experiential learning, scholarly publications that provided a few recommendations, and “word of mouth” wisdom. due to a general lack of guidance on the use of social media in social work education, many educators crowdsourced a document to provide specialized knowledge of teaching and supervision with technology (hitchcock et al., 2018). this academic literature provided suggestions that range from taking a very cautious and restrictive approach to refocusing the ethics discussion on improving the technological competence or digital literacies of social workers (young et al., 2018). prior to the standards for technology revisions, the american academy of social work and social welfare (aaswsw) launched the 13 grand challenges for social work. unlike the other grand challenges, the grand challenge to harness technology for social good sought to fundamentally transform social work with respect to its relationship to technology rather than address a specific issue or problem (aaswsw, 2021). this grand challenge placed an emphasis on harnessing big data and deploying information and communication technologies (icts; aaswsw, 2021), but did not offer social workers a framework for anticipating the future impact of technology on social work practice. in 2018, the cswe futures task force provided an additional call for action, contrasting high-tech versus low-tech future scenarios with critical questions for social work educators, practitioners, researchers, and students (wilkerson et al., 2020). they provided several scenarios for the future of social work that describe alternative contexts in which social workers will be operating (cswe, 2018). however, the report lacked an ethical framework to guide social workers in future planning for the field and its development, implementation, and evaluation of technology in practice. scholars have suggested that social workers consider their professional identities, what information they share online, and how various state, federal, or other institutional policies govern their practice (kimball & kim, 2013; reamer, 2021; walter-mccabe, 2020; young & ronquillo, 2022). in addition, the covid-19 pandemic created an influx of telebehavioral health policy, services, and technology changes (walter-mccabe, 2020; wilkerson et al., 2020), leading to additional evaluations and considerations of these standards and calls to “harness technology for social good” (aaswsw, 2021, p. 24). although the technology standards, grand challenges, and cswe futures task force provide some foundational ethical guidance toward achieving this good, they lack a practical set of heuristics that social workers can enact as they engage in everyday practice. furthermore, they require a more direct and robust set of statements and guidelines addressing issues of racism and structural oppression. the next section introduces the habit advances in social work, spring 2023, 23(1) 136 of mind concept to move toward the development of initial guidelines. subsequent sections build upon this concept by considering how a new tool – the ethical os – could inform the development of social work tech habits of mind. habits of mind education researchers costa and kallick (2008) introduced the habits of mind concept to describe effective patterns of intellectual behavior. they asserted that these processes and strategies were particularly useful when a person encountered dichotomies, dilemmas, or uncertainty. in this instance, the habits of mind provide a cognitive frame in which a thinker can comprehend, analyze, and eventually integrate novel material into their existing understanding. costa and kallick’s initial framework contain 16 discrete habits of mind, each with a pathway to behaving intelligently when confronted with problems. for example, thinking flexibly invites a learner to use a novel approach when solving a problem. a learner draws strong conclusions by considering disparate perspectives and comparing multiple sources yet remains open to change. educational theorist john campbell enhanced costa and kallick’s model by outlining the theoretical influences supporting the habits of mind (campbell, 2006). according to campbell (2006), the habits of mind framework is supported by what we know about constructivist learning theory, emotional knowledge and understanding, and the malleability of brain architecture. in the case of flexible thinking, the ability to discern how context influences diverse ethical conclusions illustrates the cultural construction of knowledge. reflecting on how one’s own experiences affect their conclusion draws on emotional understanding. both activities are enabled by the brain’s ability to reorganize in response to new experiences (armstrong, 2020). this paper builds upon the habits of mind concept by initiating a conversation about how social workers can reimagine the use of technology in their social work practice. the essence of ethical decision-making is the ability to make decisions based on evidence in conditions of uncertainty. namely, the authors ask, “what habits of mind are relevant to the encounter among ethics, social work and technology?” social workers will need rigorous cognitive frameworks to guide our deliberations regarding the effective and liberatory uses of technology in everyday practice. therefore, this paper culminates with an initial proposal for social work tech habits of mind. in the next section we provide a summary of the “ethical os” tool in order to detail the technology categories of concern that the social work tech habits of mind will address. background of ethical os key experts at the institute for the future developed the ethical os (omidyar network, 2018) through investments from the omidyar network – a silicon-valley based venture capital and philanthropic organization. jane mcgonigal, an expert in foresight and game design, samuel wooley, an expert in disinformation, and raina kumra, an entrepreneur in tech and society, designed the tool to be exceptionally user-friendly. it includes 14 “risky futures” related to existing emerging technologies, as well as eight risk zones in the real world, and seven future-proofing strategies. it is a tool to imagine, name, bibbs et al./future swk tech habits 137 and explore unintended consequences of ever-proliferating technologies – especially at the start up stage. it has been utilized in tech start-ups, foresight training settings, and in a variety of organizational and government settings over the last few years (j. mcgonigal, personal communication, january 15, 2021). the types of questions considered include: • “if the technology you’re building right now will someday be used in unexpected ways, how can you hope to be prepared?” • “what new categories of risk should you pay special attention to right now?” • “which design, team, or business model choices can actively safeguard users, communities, society, and your company from future risk?” (institute for the future, omidyar network, 2018, p. 3). early reviews of the ethical os from media and academia were positive (pardes, 2018). they highlighted it as a practical tool that enables users to assess ethical issues in real-world applications. another review delivered a dose of skepticism (watson, 2019), reminding users that tools developed from within the tech sector were not going to disrupt larger industry-related ethical concerns (benjamin, 2019; hao, 2021). one research investigation explored the use of the tool in emerging user-experience practices. their findings spoke to the strengths of using the ethical os in the early stages of tech development, as well as including it in educational settings for those learning to build technologies (lilley et al., 2020). overall, the ethical os appears to have practical application but may be constrained by the tech insider view of its authors. figure 1. ethical os (institute for the future and omidyar network, 2018, p. 6) advances in social work, spring 2023, 23(1) 138 this paper integrates the ethical os as one emerging model that can benefit a social work profession that is both lagging behind and grappling with its understanding of technology use. however, we also recognize the contribution that social work values make to the ethical os. as a field committed to social justice, social work has an opportunity to broaden and deepen the tool’s ability to respond to critical societal concerns. figure 1 illustrates the ethical os architecture. it is followed by a brief description of each of the eight risk zones. descriptions of ethical os risk zones zone 1: truth, disinformation, and propaganda risk zone one requires tech designers and users to identify how shared information may be under attack while examining the truth in the information, properties, and technologies being used, presented, or represented. zone 2: addiction and the dopamine economy risk zone two requires tech designers and users to think critically about the implications of technology tools on human interactions. by identifying the potential for tech addiction and increased distraction, this zone addresses the physiological and psychological effects tech can have on well-being. zone 3: economic and asset inequalities risk zone three requires tech designers and users to assess how new and emerging technologies could affect global economic and asset inequality. the authors outline three areas of ethical decision-making that could influence societal risk – access to technology, the ability to monetize and profit from technology, and potential job displacement. zone 4: machine ethics and algorithmic biases risk zone four requires tech designers and users to examine the human bias in algorithms and deep data sets. it acknowledges that persons bring their biases with them when they construct technology. this zone also suggests accountability for algorithms that misidentify or unfairly assess someone. zone 5: surveillance state risk zone five requires tech designers and users to examine how technology can be co-opted by governments and militias for use in attacking the opposition. it also considers the long-term effects of data sets on people’s opportunities and privacy. zone 6: data control and monetization risk zone six requires tech designers and users to address the private and public sector’s vast collection of personal and institutional data. the authors outline four domains of ethical decision-making related to data control and monetization – data collection, selling data, user rights, and safeguarding of data. an ethical public or private entity would need to provide an ethical rationale and transparent process for collecting data, a set of bibbs et al./future swk tech habits 139 rights for persons represented in the data set, a declaration of monetization as well as a plan for profit sharing, and a reliable means for safeguarding privacy. zone 7: implicit trust and user understanding risk zone seven requires tech designers and users to consider the implicit trust and general understanding users have about their technology. it requires them to develop a universally applied code of user rights. zone 8: hateful and criminal actors risk zone eight requires tech designers and users to anticipate how their technology could be used for anti-social purposes. they must consider how hateful actors can push their agenda in tech spaces, as well as use it to further disenfranchise marginalized communities and further structures of systemic oppression. furthermore, designers and users must question their obligation to prevent or mitigate these potential effects. table 1. risk zones and social work practice: how ethical os risk zones inform questions of social work practice and technology use. risk zone questions practitioners may ask one: truth, disinformation, propaganda does this technology spread disinformation and propaganda that could lead to confusion, fear, and harm among the clients and communities served? how can social workers educate colleagues, clients, and communities on how to vet information shared via technology? two: addiction & the dopamine economy how may the use of this technology enhance or hinder the client/community’s quality of life? how can social workers provide recommendations for when to adopt or pause technology use? three: economic & asset inequalities does the community have reliable access to this technology? if not, how can access be increased? how will access and use of the technology provide new economic opportunities and resources to the communities? four: machine ethics: algorithmic biases who developed the products/software in use? how were algorithms trained? when is it appropriate to use algorithmic tools as a supplement to practice wisdom? five: surveillance state is the client/community aware of how the data are audited, used in reporting, and decision making? do the pros of using the technology outweigh the cons? six: data control & monetization who controls the data that is collected? how do funders use data from the technological tool/platform used? how do these processes impact the personal agency and privacy of the client/community? seven: implicit trust & user understanding how can social workers create more transparent systems that allow clients to see every aspect of their data? how can a client have control over their data? eight: hateful & criminal actors how can social workers collaborate with colleagues, clients, and communities to help prevent and/ resolve bullying, harassment, and criminal/fraudulent activities that include technology or online platforms? table 1 summarizes how these risk zones could inform critical social work practice questions. it applies the ethical os to social work practice scenarios and considers if the advances in social work, spring 2023, 23(1) 140 tool can be a steppingstone to increased social work tech imagination, understanding, and fluency. social work technology habits of mind the questions in table 1 illustrate the potential application of the risk zones to technology use in social work practice. this section conceptualizes these questions and advances six social work tech habits of mind. these habits of mind provide a cognitive starting point for social workers when they encounter tech-related ethical dilemmas. 1. think about the intention of the technology and its potential ripple effects. consider how the designer intended for the technology to be used. ask how the purchasers intend to use the technology in social work practice. brainstorm about possible effects outside of designer or user’s intentions. 2. listen deeply and to multiple sources. devote mental and emotional energy to understanding the experience of all users. 3. consider multiple effects and outcomes. stay open to the possibility that though a given technology might be unethical in one situation, it might be ethical in another. 4. ask if the technology promotes or inhibits liberation, harm, and unnecessary risk. remain vigilant about the ongoing effects of technology on social work values. identify ways in which the technology extends pre-existing marginalization. analyze the degree to which it benefits persons versus the potential harm and risk. 5. respond as a student of technology. always acknowledge the rapid pace of technological change and assume that you need to stay up-to-date on how a given technology may have changed. engage experts outside of the field in order to understand how a given technology works and is being used in other places. 6. be temporally flexible. learn from the past. use the best knowledge available to act ethically in the present. anticipate how technology will affect social work’s future. practice implications ethical tools and habits of mind are only useful to the extent that they provide a bridge between a practice dilemma and the ethical use of tech. a cursory and superficial nod to ethical deliberation amounts to a rubberstamping described as “ethics washing”. this term refers to superficial efforts to organize, position, and empower specific agents within a sector to “work on” ethics but simultaneously somehow not really change the way things happen (metcalf et al., 2019). social work could say that it has met its ethical obligation while client populations suffer. there are at least four social work practice considerations crucial to engaging in ethical technology use. first, social work governing bodies, social service agencies, and other sites bibbs et al./future swk tech habits 141 of social work practice will need to develop procedures and processes that encourage practitioners to engage in ethical technical behavior. for example, a committee formed of administrators, tech specialists, social work practitioners and members of a client population could convene to assess tech use, future tech needs, and the impact such tech has or might have on the client populations being served. second, social workers will need to be able to state their ethical concerns without fear of consequences. when agencies or governments have invested a great deal of material resources into tech adoption, they are more likely to dismiss or punish detractors. therefore, it is important to embark on a pilot of new tech prior to adopting it. third, social work users of technology will need to engage in continuous and rapid ethical monitoring. as this paper has shown, a beneficial technology can easily become weaponized against clients without proper monitoring. responsible users are duty bound to proactively consider unintended consequences. data from on-the-ground social workers should be collected to engage in this process. finally, social work will need to continue to develop transparent methods for informing practitioners and client populations about the technology they are using (nasw, 2021). client populations will need opportunities to opt-out without consequences to their service use. conclusion collectively, the authors find the ethical os potentially useful with additional study and exploration in the intersectionality of the field of social work and technology. that said, the authors recognize that there are emerging additional frames and models that also merit attention and consideration for the social work profession (gasser et al., 2020) – and that each of these frames and models have potential to enrich and strengthen ethical tech practices across the profession if used in a way that is guided by ethical social work or informed by the code of ethics (nasw, 2021). this exploration is preliminary and offers an orientation, not an endorsement, of the ethical os tool. accountability at all levels of practice is essential to social workers and their clients’ lives. as technology rapidly advances and expands its presence in social workers’ lives, the profession, and their practices, social workers need to be aware of how the technology was developed and the ethical considerations when using technology (belluomini, 2013; reamer, 2021; young et al., 2018). social workers can learn to exercise old but newly applied ethical muscles in this territory to avoid being co-opted into tech industry standards and/or committing ethics washing (bietti, 2020). as technology is further integrated into our services, accountability to clients through transparent processes at micro, mezzo and macro levels is one step toward maintaining current ethical standards (nasw, 2021), all while considering the ways in which our profession can reimagine ways to remain as a guiding standard. references american academy of social work and social welfare. 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(2022). enhancing new media literacies of social work students through a participatory learning environment. journal of technology in human services, 40(1), 58-78. https://doi.org/10.1080/15228835.2021.2004572 https://doi.org/10.7312/ream18828 https://doi.org/10.1016/j.childyouth.2017.04.018 https://doi.org/10.4135/9781412976640.n39 https://doi.org/10.1300/j147v26n01_01 https://doi.org/10.1080/02615479.2015.1131257 https://doi.org/10.1080/19371918.2020.1751533 https://cyber.harvard.edu/story/2019-04/industry-efforts-arent-about-disrupt-techs-ethics-problem https://cyber.harvard.edu/story/2019-04/industry-efforts-arent-about-disrupt-techs-ethics-problem https://doi.org/10.1080/02615479.2020.1807926 https://doi.org/10.5175/jswe.2008.200700031 https://doi.org/10.7312/ream18828-002 https://doi.org/10.1080/15228835.2021.2004572 advances in social work, spring 2023, 23(1) 146 author note: address correspondence to tonya d. bibbs, ph.d. senior research associate, james bell associates. email: tonyadbibbs@gmail.com funding: support for this article was made possible by the robert wood johnson foundation. mailto:tonyadbibbs@gmail.com this work is licensed under a creative commons attribution 4.0 international license. social work with migrants and refugees: challenges, best practices, and future directions editorial marciana popescu kathryn libal this special issue of advances in social work focuses on current challenges and best practices with migrants and refugees, in an increasingly difficult global context. over the past decade, forced migration and displacement reached record numbers, while complex geopolitical, economic, and environmental factors contributed to escalating current challenges. international human rights and migration laws provide a framework too narrow and too limited for these recent developments. political pressure and a growing identity crisis add to the xenophobia and climate of fear, in which security has in some cases become the primary rationale underpinning rapidly changing migration policies. social work as a profession – in education and practice – has an important (if largely unfulfilled) role to play in advancing the human rights of migrants and refugees. in this commentary, we outline the macro contexts that shape social work practice with migrants and refugees, highlighting the great potential for social work to do much more to advance the rights and interests of those fleeing conflict, economic or natural disasters, or other upheavals. setting the stage: global context of a governance crisis on migration and refugees over the past 10 years, the public discourse on migration in general and forced migration in particular was shaped by the ongoing armed conflict in syria, the postwar volatile situation in afghanistan and iraq; famine, increased poverty and armed conflicts in several regions in africa (e.g., south sudan, eritrea, and yemen); civil unrest, drug wars, and violence in central and south america; and large magnitude natural disasters throughout the world. these events led to a sharp increase in forced migration, with 68.5 million people being counted as forced migrants at the end of 2017 (united nations high commissioner for refugees [unhcr], 2017). of these, a total of 40 million were internally displaced people (idps) and afforded limited international protection and 28.5 million had crossed nation-state borders seeking refuge, either as refugees (25.4 million) or as asylum seekers (3.1 million). political reconfigurations of nationality or citizenship also have contributed to an increased number of stateless people, who are either internally displaced or migrants. they navigate between the interstices of a nation-state system that fails to recognize their rights claims and makes them invisible and extremely vulnerable. one example is the most recent change in the dominican constitution following the 2010 earthquake in haiti, and the decision to apply changes retroactively, to 1929, rendering an estimated 250,000 people stateless, or, as amnesty international report noted, “ghost citizens” (amnesty international, 2015). ___________ marciana popescu, phd, msw, associate professor at fordham university, graduate school of social service, senior fulbright scholar, austria 2016-2017, fulbright specialist, 2018-2021, w. harrison, ny, 10604. kathryn libal, phd, associate professor of social work and human rights, school of social work and human rights institute, university of connecticut, director of the human rights institute, hartford and storrs, ct 06269. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), i-x, doi: 10.18060/22600 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) ii within this global migration context, many national governments revised migration policies– but instead of aiming to increase protection for the forced migrants, they added layers of restrictions. moreover, exclusionary asylum policies have become increasingly shaped by discretionary national political decisions rather than norms of international humanitarian and human rights standards (greider, 2017). the quotas for resettlements dropped significantly, leading to a 54% drop in resettlement requests by unhcr in 2017 compared to 2016. increasingly restrictive immigration policies continue to threaten resettlement programs as an option for refugees. with over half of all the displaced people globally being children, and an increasing number of children traveling alone, the effects of current population movements caused by forced migration carry long-term implications. in 2017 alone 173,800 children were either unaccompanied or separated from adults (unhcr, 2018). two significant larger migration movements, from syria and other countries in the middle east and africa to europe; and from central and south america into the united states and canada have led to increasingly politicized and polarizing national responses in europe and north america. in 2015, these large movements created what was framed in the political discourse as a “migration crisis” with over 1 million people aiming to find refuge within the european union (eu). as this is a global crisis of governance, to which nation states either had no appropriate response or responded through ad hoc and often unjust policies, the united nations became an important forum for attempting to establish a substantive global response. these efforts were symbolically initiated by the new york summit (september 19, 2016) which aimed to establish forced migration as a global issue and discuss potential global strategies to address it. an immediate product of the summit, the new york declaration (united nations, 2016) created a framework for future deliberations. two distinct strategies were to be developed as part of this framework: one focusing on safe and regular migration and the protection of migrants within specific legal definitions of “regularity” (global compact on safe and regular migration), and the second one focusing on refugees and asylum seekers (global compact on refugees) (hansen, 2018). yet, despite the swift response at a global level, several major challenges remain: there is little to no cohesion or agreement between countries on a global response on migration; the new york declaration has no legally binding power; and these frameworks do not explicitly align with human rights principles, aiming to limit access to protections rather than recognize and protect the rights of all migrants. anti-immigrant attitudes and a rise in nationalism and xenophobia the main reason for these challenges emanates from national and regional political reactions to large-scale forced migration (polakow-suransky, 2017). in 2015, the waves of refugees fleeing the syrian war and other regional conflicts seeking refuge in europe elicited a significant commitment to provide refuge in eu member countries. germany made the boldest political move, by announcing that they would take in 1 million refugees and work to provide relief and safety for incoming migrants. yet, shortly after germany’s statement, throughout the european union a new rhetoric emerged, marked by xenophobia and strong anti-immigrant attitudes. this sentiment of “backlash” fed into rising nationalist popescu & libal/swk with migrants and refugees iii movements throughout europe (polakaw-suransky, 2017). even the most liberal eu member countries increasingly defined migration policies within a securitization framework. this led to an externalization of borders to ensure control and limit access, not only in europe, but also in australia and the united states, pushing immigration control into international territories (peterie, 2018). among the european nations, most restrictive immigration policies were pursued by hungary (infamously closing its borders in 2015 and criminalizing support for asylum seekers and migrants in 2018). these actions in turn triggered similar anti-immigrant responses in poland and serbia and were followed by more restrictive border control imposed (temporarily) by germany and austria (european commission, migration and home affairs, 2018), with italy and other eu countries aiming to follow suit (deutsche welle, 2018). noteworthy, the closed borders and restrictive policies prevalent throughout europe, australia and the united states, has motivated other countries to provide an alternative response and work on sustainable solutions for migrants and refugees. canada, under the lead of prime minister justin trudeau, introduced a new strategy on immigration in 2016, aiming to increase support through welcoming refugees and allocating funds for better integration in the canadian society as well as through regional and local supports in the fight against isis and local governmental oppression (trudeau, 2016). france, through the french office for the protection of refugees and stateless persons (ofpra), and working closely with unhcr, adopted an innovative approach to preventing smuggling and perilous journeys of forced migrants to and throughout europe, by vetting asylum seekers on african soil and expediting resettlement into france (brice, 2018). in this context, it is important to note that in europe and the united states, civil society actors are deeply engaged in challenging anti-immigrant sentiments and working with international and local non-governmental organizations (ngos) to protect migrants. yet there is a need for better collaboration between the volunteers and the ngos, and for an increased focus in preparing a qualified workforce to effectively work with asylum seekers. social workers are not as deeply engaged as they should be in governmental levels of response or within local or international humanitarian non-governmental organizations. this special issue aims to address some of these gaps by increasing awareness among social work educators, scholars, and practitioners of the complex migration issues we face today and pointing to areas of research and practice requiring further attention. radical “restrictionism” in the united states the united states has long touted its record for resettling refugees and welcoming immigrants through a range of programs (u.s. department of state, refugee admissions, n.d.). yet that “history” has always been mixed – reflecting moments of heightened xenophobia or opposition to accepting immigrant or refugee groups (haines, 2010; zolberg, 2006). immigration has always been a deeply political process; during the cold war the united states prioritized accepting refugees who were from the soviet union or other eastern bloc states. refugees from southeast asia and iraq, for example, were accepted only in the face of strong political pressure to address the consequences of u.sadvances in social work, spring 2018, 18(3) iv led war (harding & libal, 2012). throughout u.s. history, immigration and refugee policies have swung between restriction and relative access, reflecting white house and/or congressional priorities. as guest editors, we recognized as we issued the call for papers in 2017 that opposition to immigration and refugee resettlement had gained a strong ally in president donald trump and that support for immigrants and refugees had few visible champions in congress. while restrictionism is a global phenomenon, its manifestation in the united states under the trump administration represents one of the most radical shifts; unfortunately the administration’s decision to severely limit refugee resettlement encourages other governments to implement exclusionary policies. as of june 2018, the current administration has moved to effectively close borders, limiting access to immigration and refugee resettlement from several countries including north korea, venezuala, syria, iran, libya, somalia, and yemen. this restriction systematically refuses to provide timely due process rights to refugees claiming asylum at u.s. borders; enforcing a “zero tolerance” policy that separated parents and guardians from children at the u.s.-mexico border, and later detained families together; and increasingly criminalizing undocumented migrants and subjecting them to inhumane treatment during detention and deporting migrants without observing laws protecting due process rights (blitzer, 2018; pierce, bolter, & selee, 2018). the attorney general, jeffrey sessions, has reinterpreted established standards for grounds for asylum in the united states, including gender-based violence and gang violence (blitzer, 2018). immigration and customs enforcement has ramped up targeting of businesses and communities where undocumented migrants live and work, detaining and deporting record numbers of migrants who have not committed crimes. a new interpretation of the “public charge doctrine” promises to punish immigrants without permanent residence for accessing benefits they have a legal right to use (shear & baumgaertner, 2018). and, notably, under the white house leadership, admissions have been cut in the refugee resettlement program to historic lows (international crisis group, 2018). these policies must be taken within a broader shift that celebrates “u.s. exceptionalism,” including the decision by the trump administration to withdraw from the paris accord, the negotiation of the global compacts, and, more recently, its membership in the human rights council at the united nations. a core concern that we share with a number of authors in this special issue is how to foster advocacy at local, national, and international levels that advances the human rights of migrants and refugees. the enforcement of “zero tolerance” – whether through policies to separate families as they enter the united states or to incarcerate families for indefinite periods without due process – has become a focus of advocacy and action in social work education and practice. one example of such work is demonstrated by advocacy taken on by finno-velasquez and the center on immigration and child welfare at new mexico state university. the center, working with colleagues across the country, has taken a lead role coordinating social work advocacy in the wake of “zero tolerance.” zayas’ (2015) engaged scholarship on the experiences of children in mixed status families offers both empirical understanding of the impacts of unjust immigration policies and a model of effective advocacy at state and national levels. commenting on a case filed by the american civil liberties union, he recently stated “the separation of children from their popescu & libal/swk with migrants and refugees v parents is universally regarded as one of the most unconscionable and harmful acts that any society or government can commit” (myers, 2018). national association of social workers (nasw), in the u.s., issued a strong statement in the wake of ramping up “zero tolerance” and the policy to separate children from their parents or guardians at the u.s.-mexico border. nasw stated that “the decision to separate children from their parents as soon as the parent crosses the border into the united states is both harmful and inexcusable. more concretely, the policy imperils the health and safety of immigrants. it is wholly un-american to weaponize children as a deterrence against immigration” (nasw, 2018). and, while this statement is an important step in staking a position vis-a-vis this unjust policy, it is time for a renewal of solidarity work in alliance with targeted groups of refugees and migrants in the united states. one place to start – a modest place that is only a first step – is to foster deeper understanding of current social work practice with (im)migrants and refugees. overview of the organization and contents of the special issue the articles in this special issue address a range of concerns central to social work. as a collective they speak to the importance of integrating exemplars and approaches to social work practice on migration as a matter of advancing social justice and human rights. a majority of articles address social work practice in the united states, though a number of contributions address social work practice in other global contexts, including sweden, canada, thailand, and greece. the first set of articles examine rights-based approaches to addressing structural inequalities facing newcomer immigrant communities in the united states. roth, park and grace tackle the challenges of carrying out policy advocacy in a state that is not “welcoming” to immigrants, examining the indirect tactics of service providers in doing advocacy in the face of increasingly restrictive anti-immigrant policies in south carolina. carillo and o’grady highlight the importance of community-based work from a structural and rights-based social work lens, focusing on labor rights and access to mental health services in the chicago area. the second section of this issue takes up themes of social work practice with children and youth. finno-velasquez and dettlaff tackle the increasingly punitive u.s. government practice of separating immigrant children from families. they outline the critical role that social workers should play in leading efforts to respond to immigrant families’ rights and needs, focusing especially on developing social work expertise; cross systems and cross disciplinary collaborations; leveraging resources and supports; documentation and collection of data; and targeted advocacy. reynolds and bacon examine the role of schools in supporting integration of refugee children in the united states. regarding schools as a primary driver of integration, the authors provide insights from a systematic review of literature on school-based programs to support refugee integration. they highlight the importance of successful programs being responsive to the cultural and linguistic backgrounds of refugee subpopulations; informed by the experiences of resettlement, including all stages of the migration process; “embedded in community” and “coordinated across multiple systems.” pryce, kelly, lawinger, and wildman examine the role of a advances in social work, spring 2018, 18(3) vi canadian conversation club for refugee youth in three locales in ontario. their evaluation demonstrates the promising practice of conversation clubs in increasing participants’ sense of hope and belonging. finally, evans, diebold and calvo launch a call to action for social workers, in regards to the rights of, and protections provided to unaccompanied minors (uam) in the united states. in light of the increasing numbers of uams, the authors identify available services for children in this category. they also highlight the gaps in services, and provide a list of recommendations for social workers aimed to address the gaps and improve practice. a third group of articles focuses on health, mental health, and well-being of refugees. drawing on findings from a larger qualitative study with cambodian genocide survivors in the united states, berthold, kong, ostrander, and fukuda find that isolated elderly cambodian survivors benefit from efforts to promote social connectedness and support networks. yalim and kim provide a review of the state of scholarship on mental health and psychosocial needs of syrian refugees, while naseh, potocky, burke, and stuart provide the first systematic assessment of poverty and capabilities of afghan refugees in iran. in the latter study, the authors point to the limits of measuring poverty by income or monetary levels, given the fact that many afghan refugees who could not be categorized as “poor” in iran were still unable to meet basic needs. while community-based approaches to social work practice with refugees and immigrants is addressed throughout the special issue, the fourth set of articles spotlights a number of different community-based interventions to foster greater social inclusion and wellbeing among newcomers to the united states. dubus and davis focus on the importance of community health centers in providing services to refugees resettled in the united states. presenting findings from interviews with 15 mental health workers in six new england states, the authors highlight three crucial elements of best practices with refugees in such centers: client engagement; collaboration with interpreters; cultural competence. deckert, warren and britton maintain the focus on service providers, writing about the tension between the politics of migration at the state level, the increasing anti immigrant sentiments, and community engagement in welcoming and supporting migrants. the authors focus on the perspectives of service providers on migrants’ vulnerability to exploitation and trafficking, and highlight the need for an expanded definition of trafficking, increased cultural competency among service providers, and the importance of social networks in building communities that will support migrants. mccleary and colleagues introduce the readers to community-based approaches to dealing with refugee chemical dependency, proposing a framework for sustainable collaborations between refugees and health and social service providers to reduce chemical dependency. pointing to the prevailing unidirectional practices with resettled refugees, the authors call for participatory practices that will lead to mutual learning and adaptation. the role of community involvement and peer support, and the importance of recognizing and building on refugees’ capacity are further highlighted by block, aizenman, saad, harrison, sloan, vecchio, and wilson. presenting the findings of a program evaluation of a peer-support program adopted by the jewish family and community services, the authors talk about the effectiveness of the support group with iraqi and buthanese (ethnic nepali) communities, particularly in increasing the refugees’ autonomy and their ability to access popescu & libal/swk with migrants and refugees vii services. this section of articles concludes with frost, markham and springer’s article on creating effective health education programs for refugee communities. based on a program evaluation of a community-based program for burmese refugee women in houston, tx, the authors stress the need for participatory, bottom-up approaches to health education; the engagement of community health workers in health education trainings (with an emphasis on the cultural fit and relevance of such trainings for refugee women); and the importance of incorporating a social work ecological model to frame health focused interventions for women refugees. the fifth group of articles spotlights the role of social workers and others working to support refugees and immigrants. articles in this group provide insight into international work with refugees from greece, sweden, and thailand with the common thread of social work roles and responsibilities in the migration context. guskovict and potocky present a case study of humanitarian staff working with the danish refugee council in greece. the authors emphasize the importance of training and education on the impact of stress on humanitarian workers, the contribution that social work professionals can make in assessing the impact of secondary trauma, working with humanitarian agencies to develop training on the main stressors and effective self-care techniques, and providing mental health care services to aid workers, normalizing the need for such services, and facilitating access throughout their work. gustaffson and johansson write about social work’s ambivalence towards refugees and migrants in sweden, and the impact of current asylum policies on reception practices. making the distinction between ability (as affected by shifting migration policies and resources) and willingness (influenced by individual perceptions and biases, as well as personal experiences), the authors propose a shift from providing “minimum standard” services towards a “worthy reception” of asylum seekers and refugees. the article discusses the complexity of the reception structure in sweden, and identifies three essential barriers to such a shift: the lack of attention to the essential needs of refugees; the lack of gender-sensitive practices (and an overall gender-sensitive framework); and the perception of “worthiness” of refugees amongst service providers. keeping with the concept of “worthiness” and the tension between security and human rights and social work values, tecle, byrne, schmit, vogel-ferguson, mohamed, mohamed, and hunter write about the absence of a legal framework for asylum seekers and refugees in thailand, and the lack of protection for urban refugees in bangkok – particularly women and youth from pakistan and somalia. using both refugee and service providers’ voices to reflect on the challenges in accessing and providing services to refugees, the article highlights the need for collaborative work between different stakeholders and the importance of social work-led innovation in improving services. one critical domain of social work research remains a “new frontier.” powers, schmitz, nsonwu, and matthew examine climate change as a factor that pushes migrants to leave their homes and communities. they argue for the creation of “transdisciplinary, community-based response systems which are holistic, multi-pronged, and inclusive of migrants’ voices and strengths” and point to the importance of storytelling as a methodology to highlight the voices of migrants and advocate for change. the approach suggested by the authors is one that could be heeded for many domains of social work practice, building on testimonio and witnessing methodologies being adapted and advances in social work, spring 2018, 18(3) viii pioneered by other practitioner-scholars (delgado bernal, burciaga, & flores carmona, 2016). overall interest within social work has gained momentum in recent years, as is demonstrated by the number of initial submissions for this special issue and the interest of social work educators in participating in emerging networks working on migration issues. yet, the current issue reveals several gaps in research focus and interest. notable is that we received few submissions that addressed the differential and uneven global and local policies governing asylum requests and limited access to services for asylum seekers. another gap within social work literature concerns examining immigration detention practices and the role of social work in addressing widespread human rights violations occurring in the united states, australia, and sites throughout europe and north africa. more research is sorely needed on a number of topics within social work practice globally. this includes developing a clearer understanding of where and to what extent trained social workers are contributing to programs within the migration sector, whether in terms of policy advocacy, community organizing, or direct practice as service providers working with immigrants and refugees. developing new approaches to grappling with ethical dilemmas when participating in the implementation of unjust policies; pioneering responsive methods for social workers to engage in dialogue with varied stakeholders to address xenophobia, nationalism, restrictive migration policies; and promoting innovative practices for the integration of asylum seekers and refugees are all vitally needed. references amnesty international. 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(2016). new york declaration for refugees and migrants, a/res/71/1. retrieved from http://www.un.org/en/ga/search/view_doc.asp?symbol=a/res/71/1 united nations high commissioner for refugees [unhcr]. (2017). global trends: forced displacement in 2016. retrieved from http://www.unhcr.org/globaltrends2016/ unhcr. (2018). figures at a glance. retrieved from http://www.unhcr.org/en us/figures-at-a-glance.html u.s. department of state. (n.d.). refugee admissions. retrieved from https://www.state.gov/j/prm/ra/ zayas, l. h. (2015). forgotten citizens: deportation, children, and the making of american exiles and orphans. new york: oxford university press. zolberg, a. r. (2006). a nation by design: immigration policy in the fashioning of america. cambridge, ma: harvard university press. author note: address correspondence to dr. popescu and dr. libal: marciana popescu, fordham university, 400 westchester ave., w. harrison, ny, 10604. email: popescu@fordham.edu. kathryn libal, university of connecticut, human rights institute, 405 babbidge rd, storrs, ct 06269. email: kathryn.libal@uconn.edu. acknowledgements: we are very grateful for the opportunity to co-edit this special issue, and for the interest of the journal in publishing an entire issue on migration and related issues. special thanks to valerie decker, for her tireless work on this issue, and to dr. margaret adamek, for her support and careful overview of the processes involved in bringing this issue to print. we would like to thank each of the authors for their patience and their commitment to raising awareness on migration and forced migration, for conducting research on these topics, and contributing to the existing social work literature, while aiming to improve practice with immigrants and refugees. we would also like to thank all authors who submitted manuscripts, and although not every manuscript could be included in this issue, we hope that such work will continue to be published to raise awareness of the challenges facing migrants and refugees globally. as social work researchers, educators, and practitioners we are called to continue to work on advocacy at local, national, and global levels, to promote safe migration, and introduce best practices that will protect the rights of all migrants. http://www.unhcr.org/globaltrends2016/ http://www.unhcr.org/en-us/figures-at-a-glance.html http://www.unhcr.org/en-us/figures-at-a-glance.html https://www.state.gov/j/prm/ra/ mailto:popescu@fordham.edu mailto:kathryn.libal@uconn.edu _____________________ carol hostetter, lcsw, phd., editor and professor emerita, school of social work, indiana university, bloomington, in. valerie d. decker, msw, assistant and managing editor, school of social work, indiana university, indianapolis, in. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), i-iii, doi: 10.18060/28597 this work is licensed under a creative commons attribution 4.0 international license. summer 2024 editorial: critical and innovative views of the impact of violence, clinical and community practice, and social work education carol hostetter valerie d. decker in the summer 2024 issue of advances in social work, we continue our examination of violence and social work’s response in the three initial papers. the next 13 articles focus on clinical and community practice, through both empirical work and conceptual pieces. we wrap up this issue with a guide to conducting evidence synthesis reviews, which can help improve our understanding of the literature in whatever field we dive into. consequences of violence our previous issue addressed gun violence with several compelling articles. we open this issue with a powerful examination of the lives of 13 men through salaam and bruhn’s mixed-methods study. beginning their lives with aces scores above 8, then having over 12 arrests each, the men describe their trauma and make suggestions for lowering violence in their communities. who else is affected by violence, and what can be done to help them? morris and martinez show us the work being done by women whose loved ones have been murdered. the women survivors of homicide movement in boston, ma, provides a case study of community-based advocacy and the gains that can be made to support survivors of violence. hill and soprych address ways to help survivors of violence through a community practice called the tree of life. this group storytelling intervention is used at chicago survivors, and organization dedicated to aiding survivors of gun violence through narrative healing practices. social workers are called on to join in the initiative and provide both practice and research skills. responses to violence and injustice myers addresses concerns similar to the opening article about challenges facing african american men. systemic racism and the failures of the social work profession have created long-standing distrust for clinical social work, among many african american men. myers presents improvements that can be made in assessment, diagnosis, and clinician engagement through the therapeutic dyad. african american women can also be better served by social workers, according to alford, who directs clinicians to acknowledge and fight against the strong black woman stereotype. african american women could instead be supported through a therapeutic framework that synthesizes black feminist thought, intersectionality, and social constructivism theory. about:blank advances in social work, summer 2024, 24(2) ii bussey, eliach, and jemal conducted a case study examination of community wise, a clinical intervention based on critical consciousness theory. using data from community wise sessions, the authors show the value of critical dialogue and difficult conversations that connect macro and micro contexts by exploring issues of power, privilege, and oppression. turning our attention to clinical supervision, norris identifies how this mentorship of new social workers can be used as a way to develop their skills in social justice-focused practice. this shift away from the medical model and evidence-based practice toward the critical relational model offers promise for clinicians to look beyond the four walls of the interview room and engage in a more socially-just practice. rao utilizes the critical social work perspective to examine power imbalances in the us healthcare system, and to advocate for true equality and equity in health care. decrying the current state of healthcare, characterized as slightly better than inaction, she seeks to bring more attention to the need for a comprehensive answer to the problem of healthcare inequities. the focus of the qualitative exploratory study by marmo, pardasani, and vincent is on senior centers serving the needs of lgbtq+ citizens. themes uncovered, such as adaptation, interconnectedness, virtual preference, and lack of service can guide future practice. pivoting from in-person to online services during the covid-19 pandemic resulted in a variety of experiences. responses by social work education social work education once again is a fruitful area of study for our authors. responding to the charge by cswe to include environmental justice in the curriculum, thibeault, jamie, and cherry conducted a case study examining the awareness and concerns that undergraduate and graduate social work students experienced. students appeared to need more clarity about what environmental conservation and environmental justice are, as well as increased practice opportunities. continuing the look at the needs of social work students, anderson provides a thorough examination of the development and usage of the aces survey in social work and related professions. finding that social work students have some of the highest rates for each ace type and the total ace score than other students, we see the implications for social work educators. high ace scores may call for more attention to students’ life histories, but they can also be considered a potential benefit for entering a helping profession. as we examine who we teach, we also must look at who our students serve. mccarthy, mariscal, wahler, and johnson studied how prepared msw students were to practice in the field of substance misuse. their quantitative survey contributes to our understanding of the relationship of students’ wellness strategies to their practice readiness. pro-active stress management had the most impact on several measures of student readiness to address substance misuse. hostetter & decker/summer 2024 editorial iii shifting our focus from who and what we teach, to how we teach, orwat, dentato, and herweh explain an evidenced-based interprofessional education (ipe) experience that can be used by other programs to meet their ipe needs. the emphasis on clinical skills for client substance use with diverse populations may be of particular interest to social work educators. another article about social work pedagogy examines the effectiveness of team-based learning (tbl). minnick, weathersby, and hobson surveyed 166 social work students to learn how they felt about being taught with tbl, and how well they learned course concepts with this method. results indicate that tbl was a successful teaching strategy on both aspects. chiarelli-helminiak, elias-lambert, lane, and papanikolaou studied conceptualizations of leadership, through open-ended survey questions of 50 fulland parttime faculty and staff. the major themes were conceptualization of leadership, support for leadership, and barriers to leadership, with a call for more training and fewer barriers to leadership in higher education. what are evidence synthesis reviews, and how do we conduct them? readers of academic journals such as advances in social work encounter several types of literature reviews, with names such as systematic reviews, scoping reviews, metaanalyses, evidence gap maps, and qualitative interpretive meta-syntheses. such reviews can be very helpful for educators, practitioners, and researchers seeking to deepen their understanding of their topic of interest. the differences among the various types, and the process for conducting them, may be confusing to readers. marsalis provides useful stepby-step instructions for conducting high-quality evidence synthesis reviews. _________ fabienne snowden, phd, msw, assistant professor, department of social work, medgar evers college, cuny, brooklyn, ny. willie tolliver, dsw, msw, associate professor, silberman school of social work, hunter college, cuny, harlem, ny. amanda mcpherson, bssw, graduate, department of social work, medgar evers college, cuny, brooklyn, ny. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 217-240, doi: 10.18060/24469 this work is licensed under a creative commons attribution 4.0 international license. needing, kneading, and eating black bodies: the history of social work and its concern for black citizenship in the united states fabienne snowden willie tolliver amanda mcpherson abstract: social workers have been on the frontlines alongside marginalized communities since the profession’s emergence. this stance continues with supporting the black lives matter movement and centering the structural inequities that the covid-19 pandemic highlights. a narrative that centers the history of social work’s concern for black citizenship in the profession’s formation is neglected in the literature. this historical review traces the genesis of the profession’s work to expand access to the entitlements of citizenship among black communities. thematic analysis of secondary sources is used to investigate the formation of the profession and its work to ensure access to resources among blacks communities. study findings identify that the profession emerged from the bonds between the abolitionist movement and the women’s suffrage movement, then moved away from working with black people during the settlement movement and did not return to addressing the needs of these communities until the 1960s during the civil rights movement. black social workers answered the call to support black and non-black communities in the absence of the profession’s national organization’s presence. social work needs, kneads, and eats black bodies by being in complicity with systems of oppression. the history of social work and its concern and lack of concern for black citizenship is a pedagogical innovation that addresses the historical amnesia that white domination fosters. the findings of this analysis call social workers to task to disrupt white dominant epistemologies of ignorance by incorporating this historical context into their social work pedagogy. keywords: white domination; history; social work with black communities; african americans; jane addams; mary richmond; radical social work the ongoing second-class citizenship of black communities in the u.s. blacks/african americans were granted citizenship status in 1866 through the 14th amendment (lee, 2012) yet continue to be barred from the necessities and entitlements of full citizenship status, including adequate health care and non-stigmatizing social welfare programs (dattel, 2009; dubois, 1935; mills, 1997; roberts, 1996). citizenship is the legal relationship between individuals and the governing state or country that the person pledges allegiance to. this legal contract explicates the rights and responsibilities of the citizen to fellow citizens, and the state or country to its citizenry (britanica, 2021; us immigration.org, 2021). citizenship bestows the entitlement to move freely within the borders of the country of allegiance while guaranteeing equal protection to all citizens (lee, 2012; national archives, 2021). citizens are granted rights and held accountable to about:blank advances in social work, summer 2021, 21(2/3) 218 responsibilities that are not extended to or expected of people without this status. the responsibilities of any country’s citizenry generally include allegiance, adherence to the law, participation in the political process, service in the military, and taxation. second class citizenship is when people within a country have citizenship status and are held accountable to the responsibilities of citizenry but do not receive equal access to the entitlements of being a citizen. before the u.s. could be built on immigration, it was built by the forced labor of first nation indigenous peoples, low-income whites/european americans, blacks and african americans (bennett, 1993), latinx communities, asian communities, and various othered communities of color (snowden, 2015). the 14th amendment guarantees access to all basic rights of the u.s. constitution to all u.s. citizens and was extended to blacks in 1866 (lee, 2012). however, blacks/african americans continue to be more likely to be incarcerated, live in poverty, and are less likely to collect social security than any other group of citizens in the u.s. (butrica & smith, 2012). black communities continue to be under siege by disproportionate rates of negative health outcomes, poverty (jones et al., 2018) and criminalizing systems of injustice (gramlich, 2020). these structural inequities are rooted in white domination (hadden et al., 2016; rodriguez, 2020; snowden, 2018; tolliver et al., 2016). covid-19 has further highlighted the already existing federal, state and city disinvestment in access to life sustaining services amongst black communities, resulting in lack of access to basic needs, such as quality healthcare (artiga & orgera, 2019; kaiser family foundation [kff], 2019; ndugga & artiga, 2021) and housing (hutchinson, in development; rothstein, 2017). the main provisions of the affordable care act (aca) went into effect in 2014 and significantly expanded access to insurance coverage amongst black, african american, and latinx communities (snowden, 2018) in the u.s. (artiga & orgera, 2019; baumgartner et al., 2020). the rates of being uninsured amongst black, white, and latinx adults dropped to historic lows (baumgartner et al., 2020). racialized disparities in being insured narrowed in most u.s. states regardless of whether or not eligibility criteria for access to public health insurance was expanded. in 2019, black adults in states that expanded eligibility for public health insurance reported being insured at rates that were comparable to or better than states that had not expanded the criteria to qualify for medicaid (baumgartner et al., 2020). african american communities significantly benefitted from the aca, despite disproportionately living in 15 states that did not expand access to public health care programs (baumgartner et al., 2020). the increased access to health insurance coverage that the aca instituted led to widespread reductions in barriers to this basic need. however, these medical advances have slowed down and, in some areas, have been receding, over the past four years (artiga & orgera, 2019; baumgartner et al., 2020; kff, 2019). the covid-19 pandemic exacerbated epidemics that were already worsening amongst black and latinx communities, and communities of color in the u.s. (cdc, 2020a; rodriguez, 2020). in february 2020, the community transmission of covid-19 in the u.s. was first detected. less than a month later, covid-19 had been reported in new york city, washington, d.c., and in all 50 states of the u.s. (centers for disease control and prevention [cdc] covid-19 response team, 2020). black, african american, and snowden et al./kneading, needing, & eating black bodies 219 latinx communities that are disproportionately low-income were, and continue to be, most immediately affected by this virus. as of august 2020, black communities were twice as likely to die from and almost five-times as likely to be hospitalized for covid-19 (cdc, 2020a). the covid-19 pandemic in the u.s. began at the start of 2020. however, comparable public health crises, such as hiv and aids among black communities, have lasted almost 40 years (snowden, 2015, 2018). black communities are more likely to test hiv-positive and to have low-income status in the u.s. (cdc, 2020a; 2020b). researchers identify that racial status is a stronger predictor of proximity to covid-19 transmission than income, with blacks and african americans being amongst the groups that are most at risk (adhikari et al., 2020). these study findings underscore that “…racism kills” (adhikari et al., 2020), and reiterate earlier research findings that the u.s. remains a high-risk social, economic and political system for black communities (wheeler et al., 2010). in 2019, blacks/african americans accounted for 23.8% of people living in poverty, despite comprising only 13% of the u.s. population (creamer, 2020). poverty in the u.s. continues to serve as a pathway for viral and bacterial transmission through enclosed spaces, inadequate ventilation, crowded situations, and close physical contact that lowincome communities often endure (cdc, 2020a, 2020b, 2020c). people of color, including black and latinx communities, are also more likely to serve on the frontlines of viral and bacterial communicability (cdc, 2021; thorbecke, 2020). in other words, black and brown bodies being needed for the day-to-day functioning of municipalities also kneads their bodies as buffers between privileged communities that are not essential workers but are in need of essential worker-services. this process illustrates the second-class citizenship of black communities in the u.s. that mckittrick (2013) coined “plantation futures” to refer to a conceptualization of time-space that compares the enslavement plantation to being a prison within impoverished and destroyed city sectors (p. 3). the concept of a plantation future brings into sharp focus the ways that the plantation is an ongoing locus of anti-black violence and death. income and race are also linked with disproportionate incarceration. the number of people incarcerated in the u.s. is declining, however, blacks continue to outnumber any other race or ethnicity among people that are in prison (gramlich, 2019). national, international and global-level economies thrive on the maintenance of poverty that disproportionately laminates the lives of black/african american communities (mckittrick, 2013). in other words, having the basic needs of access to quality medical care, housing, and equal protection under the law serve as buffers to negative outcomes. these buffers are the entitlements of u.s. citizenship (roberts, 1997). lack of access to these basic entitlements of citizenship indicates that black/african american communities continue to experience second class citizenship in the u.s. and a status closer to subject of the u.s., rather than a u.s. citizen (clarke, 2018). the plantation system during and after transatlantic slavery permeated black life by contributing to the interlocking workings of dispossession and resistance. this interlocking working is prevalent in every major u.s. city through gentrification, police violence and humiliation as a side dish to the ultimate erasure: death (laymon, 2018). advances in social work, summer 2021, 21(2/3) 220 second class citizenship functions as kneading black bodies by predisposing them to negative health outcomes, needing black bodies as frontline workers, and eating black bodies as the fuel or input for systems of domination. social workers are intricately involved in needing, kneading, and eating black bodies in the doing of social work (chapman & withers, 2019). social work’s role in the doing of these three processes is owing to what is taught to social workers as education for practice. the focus of clinical practice continues to see and “treat” human behavior and conditions as the function of individual failure (kennedy, 2008). the profession’s dependence on ego psychology, object relations theory and other individual-focused psychological theories has separated social work from its historical focus on social and economic contexts that eviscerate people at the bottom of a caste system in a capitalist economy (wilkerson, 2020). social workers and the legacy of their fight for black citizenship social workers have been and continue to be on the front lines of supporting communities to pressure political administrations and organize for equitable access to the basic foundations of citizenship in the u.s. (hadden, 1998, 2019; roberts, 1996; rodriguez, 2020; snowden, 2015, 2018; tolliver, 1993). historically and presently, social workers continue to partner with community members to expand awareness of viral infection and safer methods of prevention, engage in social welfare policy formulation, support communities and advocate for their needs to be met, provide one-on-one and group counseling, ensure that individuals and families have the resources that they need (snowden, 2015), assist in planning, carrying out and successfully debriefing social demonstrations (rodriguez, 2020), engage in research that centers the perspectives of marginalized communities (hadden, 1998; hadden et al., 2016; tolliver et al., 2016), and provide quality social work education that is relevant to today’s context (snowden, 2018). social work professionals in the u.s. have carried out these roles and activities since the profession’s emergence in the 1800s. this legacy continues with social workers actively supporting the black lives matter movement 2013-present (rodriguez, 2020) and serving on the frontlines of covid-19 testing, treatment, and prevention (nasw, 2020; truell, 2020). the role of social workers has included working as guides for social, economic and political well-being, and has been to equip individuals, families and communities for citizenry since the onset of the profession (nasw, 2020; wilensky & lebeaux, 1965). the work, ideals, and professional affiliations that this role has translated into have inextricably taken shape within the context of eurocentric ideals of nationhood and have been in service to an exploitive market-based society (roberts, 1996; wilder, 2000). these ideals of u.s. national identity continued to be core tenets of the forming and on-going professionalizing of the social work profession (kennedy, 2008; nasw, 2020). white dominant ways of knowing continue to be deeply rooted in social work higher education. the inclusion of narrative that centers the history of social work and its concern for the well-being of black people in the profession’s formation is largely neglected in the formal preparation of social workers. this narrative includes that the formation of social work has its roots in communities organizing for the emancipation of enslaved africans and their black/african american descendants, and the equal rights of women. the snowden et al./kneading, needing, & eating black bodies 221 knowledge that this study produces better equips social work educators in higher education to prepare social work professionals to interrogate their role in either maintaining or challenging the second-class citizenship of black communities. finally, the findings generated from this research serve as an opportunity for social workers to re-examine how they teach their positionality in all forms higher education classrooms. analysis questions and theory this historical analysis poses five (5) questions that investigate and explore the history of social work as a means of tracing the genesis of its work to support the well-being of black communities in the u.s. these questions include: q1: what is the history of social work in the u.s.? q2: if there were efforts of early social work professionals to address the needs of african american communities in the u.s., what were these efforts? q3: what accomplishments, if any, did these efforts achieve? q4: what are the legacies of these efforts? this study hypothesizes that early social work in the u.s. began in the 1880s and that professionals were predominantly formally educated white/euro-american women that primarily provided social work services to white, euro-american, or european communities that recently immigrated to the u.s. according to this hypothesis, early formally trained social workers did not serve or interface with black and african american communities. critical race theory serves as the theoretical framework for this historical review. critical race theory is the practice of interrogating the centrality of race and racism in u.s. laws and the disproportionate outcomes that racialization produces (george, 2021). crenshaw (2011) and bell (1995) asserted this theoretical framework to counter the legal discourse that the civil rights movement (1936-present) had realized its purpose of extending equal access to the entitlements of citizenship to black/african american communities. critical race theory evolves in its critique of the construction of social identities. this critique is situated within the context of how racialization relegates blacks, african americans, and all othered communities of color to second-class citizenship within a race-based caste system in the u.s. (crenshaw, 2011; george, 2021; wilkerson, 2020). the profession is an extension of social welfare policy, which makes critical race theory relevant to social workers. the profession’s ability to broker and provide services to the most amount of people possible expands or contacts according to the u.s. welfare state and its social welfare policies (jansson, 2005). the larger the welfare state, the greater the need for social workers to distribute social services. racialized social welfare laws impede on the profession’s ability to actualize the social justice mandate of the nasw (2021) code of ethics. social welfare policies determine the role of social workers as either serving as the moral police, gatekeepers, or supporters of the liberation of marginalized communities. finally, the conundrum of social work is that its formal credibility as a profession is extended to it by the same status quo communities that social workers are mandated to advances in social work, summer 2021, 21(2/3) 222 challenge. using critical race theory to interpret the genesis of the profession enables social workers to center racialization in the history and the emergence of their concern for black citizenship. the study findings are presented from the positionality of the authors being black, cis-gender, and serving as social work practitioners, educators, researchers, and a bachelor’s of science in social work [bssw] social work student/scholar that serves as a burgeoning practitioner, educator, and researcher. pivotal events in the profession’s presence in or absence from supporting the full citizenship of black communities within the context of macro-level factors, such as the enslavement of africans and african americans, women’s suffrage, ensuing poverty, and the passing of the 14th amendment, are made sense of within the lens of racialization as a structural factor. these events predate the development of critical race theory. however, crenshaw (2011), bell (1995), and snowden (2018) remind social workers that the civil rights movement (1936-present) and its most recent incarnation, the black lives matter movement (2013-present), demand that legal citizenship be fully extended to people of african descent in the u.s. previous research identifies that the profession was historically developed with white/euro-american formally educated women at its frontlines (snowden, 2015). however, there is a dearth of research that investigates if, when, where, and how the profession was or was not present in the fight for social justice alongside black communities prior to the civil rights movement (1936-present). an extensive literature search that investigated the emergence of the social work profession in the u.s. was executed. the search primarily accessed secondary sources. some of the secondary sources included primary sources and historical documents that had served as data from previously conducted research, such as addams (1910/2017), richmond (1917), the hull house museum (2021) roberts (1996), gordon (1994), lasch-quinn (1993), and berson (2004). all of the sources were accessed either online through the hull house museum (2021), at a local library in new york city, an out of state library in the u.s., or in-person at the library of social sciences and east european studies of the freie universität berlin in berlin, germany. all of the texts used in the analysis were in english. the study scope was expanded to investigate the time period that spanned from the first arrival of the english in the u.s. in 1609 to the present. this was done as a means of ensuring the validity of any findings regarding the emergence and subsequent themes in the genesis of social work. in other words, the years and social climate that occurred before the onset of the formation of social work were examined to understand how the social work profession became the only possible and plausible outcome of the events that necessitated its creation. the themes that emerged from an exhaustive review of the literature (hsieh & shannon, 2005) indicate that the social work profession has its roots in the common ground between the abolitionist movement (1783-1888) and the women’s suffrage movement (1848-1920) in the u.s., then abandoned black communities as early at the settlement movement (1880s-1910), leaving black social workers to pick up the slack until the 1960s, during the civil rights movement (1936-present). thirty texts were read and used in the analysis. six (6) themes emerged, and they include: snowden et al./kneading, needing, & eating black bodies 223 1. anti-slavery and anti-black: early social workers and social motherhood 2. jane addams and mary richmond: social workers of the same struggle 3. the progressive era (1890-1920) social work 4. black social workers 5. the civil rights movement and the social work profession 6. radical social work each theme identifies a component of the simultaneous evolution of social work and its role in ensuring that the needs of black communities are met. all six themes are outlined in detail and presented in chronological order. results theme 1: anti-slavery and anti-black: early social workers and social motherhood working to protect individuals, families, and communities from the hazards of industrialization served as a platform for white/euro-american women to renegotiate their role in 19th century u.s. society. early social workers effectively advocated that working to maintain social order by ameliorating social problems was a form of community motherhood (harkavy & puckett, 1994; wencour & reisch, 1989). social or community motherhood meant working to maintain social order as being an extension of woman’s work outside of the home (harkavy & puckett, 1994). settlement houses and charity organization societies provided a socially acceptable and at times, profitable professional outlet for a labor force that was predominantly comprised of college-educated white/euroamerican women (wencour & reisch, 1989). however, influencing public opinion, and persuading financial sponsors and white euro-american male gatekeepers of the professional status of social work meant underscoring the second-class citizenship of black communities. advocacy and activism for european and white/euro-american women to have more sanitary working conditions, access to higher education and opportunities for careers outside of the home was born out of their work in the abolitionist movement (1783-1888) in the 1830s (davis, 1983). white/euro-american housewives and “mill girls” experienced their respective oppressions as a shared lot with enslaved blacks and african americans (davis, 1983, p. 33). white/euro-american women were actively drawn into the abolitionist movement (1783-1888) and the women’s suffrage movement (1848-1920) simultaneously (davis, 1983). reflective of the ideals of the abolitionist movement and despite the success of the freedman’s bureau (dubois, 1935), by 1870, political administrations, buoyed by public opinion, had determined that african americans were incapable of being assimilated into u.s. nationhood (dattel, 2009). whites/ european americans that were in defense of enslavement believed that blacks were biologically inferior to whites. abolitionists believed that slavery had irreparably damaged the ability of african americans to effectively participate in the nation’s citizenry (dattel, 2009). earlier research has found that anti-slavery had gone hand in hand with antiblack racism (genovese, 1989). while blacks continued to be locked by racialization into continuing to mine cotton, the large-scale immigration of europeans replaced women and advances in social work, summer 2021, 21(2/3) 224 children in factory work in the north (wilensky & lebeaux, 1965). cities were not growing fast enough to accommodate the rapid urbanization of previously rural communities. factory work and community life took place in squalid conditions (wilensky & lebeaux, 1965). industrialization within the context of a free-market added on to what was already intense social upheaval and further highlighted a need for social, economic, and political change (molina, 2006; wilensky & lebeaux, 1965). politicians and stakeholders identified cultural differences among newly arrived european immigrants as the social problem and cause of the foul living conditions of city life (berson, 2004). by the advent of the settlement movement in 1890, social welfare services were only accessible to abandoned white/euro-american women (roberts, 1996) and european immigrant communities (wilensky & lebeaux, 1965). the fate of black people as racially inferior was sealed by demographer fredrick l. hoffman’s interpretation of 1890 census data (muhammad, 2010/2019). hoffman mined census data from a half dozen cities from chicago to charleston and concluded that blacks were inherently prone to criminal-behavior. these findings were used to persuade policy makers that black people, many of whom were 25 years post-slavery, were identified as not deserving of an investment of federal, state, or local dollars. theme 2: jane addams and mary richmond: social workers of the same struggle in the latter half of the 19th century, organizing the distribution of charity and adapting european immigrants to u.s. cultural norms through settlement houses coexisted together. both approaches to social work epitomized the themes of the progressive era (1890-1920): social reform and social uplift (wencour & reisch, 1989). jane addams believed that research, residence, and immersion in the communities of the people she and her staff acculturated would alleviate poverty (berson, 2004; hull house museum, 2021). addams’ community-based approaches to making sense of poverty and its causes predate the first university sociology courses in the u.s. (harkavy & puckett, 1994). jane addams and the university of chicago worked together in engaging in social research and ensuring its direct use for the benefit of european immigrant communities (harkavy & puckett, 1994). the scientific charity movement (1877-1893) among charity organization societies was simultaneously quickly gaining in prominence in the u.s. (hansan, 2013; waugh, 2001). charity organization societies worked to blend pre-industrial revolution alms-giving with new scientific methods of the progressive ideals of social uplift and philanthropy (waugh, 2001). settlement house supporters and charity organization society sponsors agreed that the industrial economy simultaneously produced immense wealth and vast poverty (addams, 1910/2017; hull house museum, 2021). charity organizations answered this dilemma by encouraging members of prosperous upper classes to sympathize with the harsh realities of the poor by financing solutions to poverty (waugh, 2001). however, while the settlement movement sought to americanize european immigrants, charity organization societies used punitive approaches to reduce poverty (waugh, 2001). these early social work approaches to addressing social problems reinforced the belief that the reform of the individual was essential to enabling them to become an independent and snowden et al./kneading, needing, & eating black bodies 225 productive member of u.s. citizenry. both the settlement and charity organization workers utilized what they had identified as scientific methodological approaches to social service delivery and poverty reduction, despite the differences in these approaches to community well-being (wencour & reisch, 1989; wilensky & lebeaux, 1965). settlement houses and charity organization societies modeled their approaches after the prevailing features of corporate management, such as investigation, organizational structure, and curtailing any superfluous spending to solve the problems of poverty (wencour & reisch, 1989). the notion of “scientific charity” had advocated doling out all charitable relief in a businesslike, scientific, and efficient manner as a means of alleviating the lot of the poor (wencour & reisch, 1989, p. 31). modeling corporate structure fortified racialized attitudes about the behaviors of poor people and had already informed social service policy and delivery. implementing these changes included restricting access to services and support, while eliminating any input from the social service user in determining the goals of service outcomes (wencour & reisch, 1989). mary richmond marketed this new approach to corporate sponsors of charity organization societies (richmond, 1917; wencour & reisch, 1989) while jane addams worked with the university of chicago to institutionalize social activism en route to social reform (harkavy & puckett, 1994). mary richmond’s new approach later evolved into the “casework” method of social work (richmond, 1917; wencour & reisch, 1989, p. 97), which continues to be the primary commodity of social work services (bureau of labor statistics, 2020). mary richmond’s (1917) response to flexner’s (1915) question helped social workers to shape their professional identities and exert their expertise by embracing scientific practice methods (harkavy & puckett, 1994; wencour & reisch, 1989). these methods included an emphasis on detailed case records, scientific nomenclature, social diagnosis, and an exhaustive investigation. casework had become social work’s main service commodity in its use of psychoanalytic approaches to helping individuals to adapt to their surroundings (richmond, 1917; wencour & reisch, 1989). the shift moved social workers and the social work profession even farther from its focus on social change, social uplift, and social justice, especially among black communities. the political climate shifted to a more rigid focus on adapting the individual to the greater society at the close of the progressive era (1890-1920) and following wwi. by 1920, universities of higher learning had fully distanced themselves from social reform (harkavy & puckett, 1994). natural science and scientific rigor circumscribed the focus on social problems (harkavy & puckett, 1994). empirical science was no longer deemed compatible with social action, social justice, or direct democracy. eugenic ideas that took shape in the 1800s gained increased corporate sponsorship and state-level legislative support at the turn of the century. in the early 1920s, medical approaches to achieving social unity were now considered to be the cutting edge of social reform. addams’ and richmond’s structural approaches entailed the active support for forced sterilization and or permanent institutionalization for communities that were identified by early social workers and their financial sponsors as incapable of assimilation, such as african americans (kennedy, 2008; washington, 2006). advances in social work, summer 2021, 21(2/3) 226 sterilization and permanent institutionalization served as common ground between addams’ settlement house approach and mary richmond’s (1917) social diagnosis approach to social problems (kennedy, 2008). by 1920, public service was left for public agencies while social work professionals generally moved onto working in private agencies with middle/upper class communities (harkavy & puckett, 1994; wilensky & lebeaux, 1965). theme 3: progressive era (1890-1920) social work the progressive era (1890-1920) refers to a time when the economic and social problems that industrialization in a capitalist context introduced to the u.s. were believed to be most effectively addressed by providing quality education to children, a safe environment for communities, and a safe workplace for workers (the eleanor roosevelt papers project, 2015). early progressives, like jane addams, believed that government could be a tool for change in ameliorating the social and economic problems that society faced. the campaigning of social workers like jane addams and mary richmond achieved the remarkable feat of changing the understanding of public welfare and single motherhood (roberts, 1996). addams and richmond advocated for mothers’ aid programs which called for prevailing laissez-faire approaches to social welfare and poverty to be recast. the activist work of progressive era organizers also aimed to remove public assistance from the stigma of earlier forms of social alms-giving (roberts, 1996). through the work of these and similar reformers, public opinion and federal sponsorship had been convinced that single motherhood was an urgent social problem that would most effectively be addressed through institutionalized social welfare programs (roberts, 1996). as a result, federal-level aid was provided to female survivors of misfortune and male irresponsibility (dauber, 2013; gordon, 1994). black communities, in general, and black women, in particular continued to be more likely than white women to be in need of social support, and less likely to benefit from this economic safety net (gordon, 1994; roberts, 1996). theme 4: black social workers despite its roots in the abolitionist movement (1783-1888), the profession did not provide services to black and african american communities until the 1960s of the civil rights movement (1936-present). blacks and african americans did not wait for the profession to take an interest in their struggles in order to help themselves (carlton-laney, 1999, 2001; snowden, 2018). during the progressive era, african american social workers were concerned with the individual-level challenges that black individuals, families and communities were facing, while simultaneously working to address larger macro-level systems, such as racialization. for black social workers, effective practice necessitated and entailed a micro and macro-orientation (carlton-laney, 1999). black social workers worked tirelessly to start settlement homes, open schools, provide classes, create the option for repatriation to african nation-states, engaged in social activism against lynching, and distributed public assistance among african american communities (carlton-laney, 2001; lasch-quinn, 1993). e. franklin frazier, an african american snowden et al./kneading, needing, & eating black bodies 227 sociologist turned social work practitioner, worked to establish and accredit the first african american school of social work (chandler, 2001). theme 5: the civil rights movement and the social work profession charles hamilton houston, dean of howard university school of law, was instrumental in developing the strategy that led to brown vs. the board of education. the first case that was used to build towards this series of legal challenges to the constitutionality of segregation was litigated in 1936 (jamar, 2004). during the earlier years of the civil rights movement (1936-present), the kennedy administration, followed by the johnson administration, had increased funds for community development through housing assistance, equal opportunity employment, public assistance and communities organizing (roberts, 1996). low-income communities that were disproportionately black now served as “new markets” for social work services, especially since these contracts included a community clause that mandated the involvement of community members. social workers served as service brokers and community supports. the profession did not have the same influence in federal or state level conversations regarding social welfare funding and program design as it did during the settlement movement (1880-1910). less access to these federal and state level conversations was a direct result of the profession’s move into private practice and out of communities living on and closest to the margins of the u.s. (carlton-laney, 1999, 2001). this shift affected the profession in two ways. first, with the exception of andrew young, social work had wielded less political pressure than in prior administrations and had little influence in the design of the funded programs (carlton-laney, 1999, 2001). social workers working with low-income black communities were largely funded through civil rights and war on poverty-based grants and programs. when a majority of the civil rights legislation was defunded by 1972 by the nixon administration, so were most of the federally-funded contracts that social workers had acquired. social workers responded to being out of the job market by leaving black communities and returning to fee-for-service work and private practice in predominantly white middle and upper class enclaves (specht & courtney, 1994). social workers re-entered private practice while social welfare was shifting from social insurance to returning to its earlier iteration of punitively executed public support (roberts, 1996). when black communities had attained access to social welfare support, public assistance served as a tool of institutionalizing social control over and legislating the behaviors and the lives of the disproportionately black poor (piven & cloward, 1993). when the funding dried up, the social work profession and social work practitioners distanced themselves from working with low-income communities of color at a time when these communities might have benefitted most from the support of the profession (roberts, 1996, 1997). individual social work practitioners continued to serve blacks and african americans, despite the flight of the profession from black communities. these practitioners include and are not limited to dr. elaine pinderhughes (pinderhughes, 1983), dorothy i. height, whitney m. young (carlton-laney, 2001), and many black social workers that were not named in the historical texts accessed for this study. on may 8th, 1968, a group of black social workers attending the national conference on social welfare advances in social work, summer 2021, 21(2/3) 228 walked out of this meeting and formed what became the national association of black social workers (nabsw; reid-merritt, 2010). dr. shirley better, lenny barry, joan coleman, and their peers recognized the ongoing social injustices that communities of color continued to experience despite the achievements of the civil rights acts and the great society programs (reid-merritt, 2010). the nabsw has become the foremost advocacy group that was established by black social workers to address social inequities and concerns of black communities throughout the u.s. (bell, 2014; reid-merritt, 2010). the formation of the national association of social workers (nasw) reflected a need among social work practitioners for greater unity within the social work profession. practitioners had also expressed desire for an organizational structure where resources for social workers could flow more freely through and be utilized more effectively for supporting social welfare programs (bell, 2014; reidmerritt, 2010). despite the formation of nasw speaking to these needs, providing social work services to black communities was not placed at the center of these efforts. the formation of the nabsw addressed this gap in services and was formed to support black communities receiving all of the entitlements that citizenship entails (reid-merritt, 2010). notwithstanding valiant effort, access to all of the entitlements that citizenship entails still eludes black, indigenous, latinx, and people of color. theme 6: radical social work radical social work is the theorizing and practicing of social work with a philosophical leaning toward the importance of identifying the primary causes of oppression, while transforming the insights gained from individual-level experiences into direct social action that challenges macro-level structures (de maria, 1992). moving from structural analysis to structural practice is a core tenet of radical social work practice (reisch & andrews, 2002). radical social work pulls on a class analysis to reduce poverty by addressing economic injustice and develop radical social work approaches (reisch & andrews, 2002). radical social workers promote radical ideas and practice techniques by providing forums for developing critical awareness of social issues, clarifying views, sharing experiences, and discussing current events (bailey & brake, 1975; reisch & andrews, 2002). all radical social workers may share the common ground of focusing on macro-level structures as producing micro-level deficits, with some working to establish redistributive tax programs, and others working to transform capitalist institutions into publicly run industries (jansson, 2005). critical social work theory, feminist social work, and structural social work have their roots in radical social work. all of the sub-theories of radical social work theory center transforming power-relations at every level of social work practice (ferguson, 2013). in its formation, radical social work theory centered class-based oppression. contemporary radical social work theory has expanded to include that all forms of oppression need to be eradicated. radical social work existed as organized approaches to addressing the social problems that individuals faced from the mid-1930s to the present (ferguson, 2013; reisch & andrews, 2002). only a few radical social workers existed prior to the new deal. radical social work practice continues to draw support from social work students, community level snowden et al./kneading, needing, & eating black bodies 229 practitioners, world renowned academics, and researchers. however, it has never been the primary approach of the social work profession in the u.s. (ferguson, 2013; reisch & andrews, 2002) except in the work of black social workers and their allies. jane addams is frequently identified by radical social work theorists as one of the earliest radical social work practitioners of the profession because of her focus on cross-class connections, policy level change, and the necessity of cultural expression classes at hull house (ferguson, 2013; reisch & andrews, 2002). in this lens, addams’ hull house policies of prohibiting service to black, latinx, and indigenous/first nation peoples communities (ferguson, 2013) and her strong support for forced sterilization of members of these communities (roberts, 1996) are seen as congruent to her radical social work approaches. interpreting addams’ work as demonstrating radical social work practice illustrates two flaws within radical/critical social work theory and providing services to black communities. the formation of radical social work was largely influenced by marxism and centers class-based oppression with little to no focus on white domination. this trend continues in more recent theories that have grown out of radical social work theory, such as critical social work theory and structural social work theory (ferguson, 2013). more recent offshoots of this theory center all oppressions without a clear and focused approach to race. racialization is interpreted as one of many forms of oppression that may or may not interlock, despite the unique history or on-going maintenance of race in the u.s. current directions in critical social work theory include a post-modernist approach to mapping the location of individual level identity in working to challenge and change macro-level structures (ferguson, 2013). these approaches conceptualize racialization as one of several identities that has been created by imperialist, macro-level structures. according to radical social work, race-based identities, like gender-based identities and able-body based identities, must be eradicated in order to embrace the belief that all people belong to one race/group: the human race (ferguson, 2013). radical social work and its contemporary off-shoots mirror the 1980s-1990s cartoons, the flintstones and the jetsons, with black people depicted as non-existent in the past and unimaginable in the future (goldberg, 2017; tv guide, 2003). implications for social work social work needing black bodies to add credence to its calls for social change, and abandoning black communities until the 1960’s, kneaded black bodies according to the profession’s aspirations for formal recognition. consuming black bodies en route to professionalization feeds on black communities as fodder for maintaining systems of oppression. despite social work’s inclusive beginnings, the profession moved away from its work with black communities as early as the settlement movement (1880s-1910) and did not return to serving the needs of these communities until the 1960’s civil rights movement (1936-present). black social workers answered the call to support black and non-black marginalized communities in the absence of the profession prioritizing the wellbeing of these communities. the findings of this analysis inform social work in at least five (5) key ways, including: advances in social work, summer 2021, 21(2/3) 230 a. exemplifying for social workers and social service recipients how the profession has and can continue to uphold its commitment to ensuring full access of the entitlements of citizenship amongst black communities. b. underscoring that interventions that simultaneously incorporate individual and societal-level approaches are needed and possible. c. informing social workers that white domination and the u.s. caste system (wilkerson, 2020) are the primary sources of the second-class status of black communities. d. expanding social work education to include the narrative of this study’s findings as a pedagogical innovation that challenges the historical amnesia of white domination’s impact on social work education. e. reminding social workers that the extent to which the profession challenges the second-class citizenship of blacks/african americans is contingent on the actions of social workers on micro, mezzo and macro levels of u.s. society. the findings of this historical review exemplify for social workers and social service recipients how the profession has and can continue to uphold its commitment to ensuring full access to the entitlements of citizenship amongst black communities. the impetus that led to the call for the professionalization of social work stemmed from the solidarity of members of the abolitionist movement (1783-1888) and the women’s suffrage movement (1848-1920). sojourner truth, frederick douglass, and the grimke sisters were activists that were engaged in social change by joining the agendas of both movements (davis, 1983). the roots of the profession are embedded in the linking of the liberation of black communities with the liberation of white communities from ideologies of domination, such as transphobia, sexualization, racialization, patriarchy, ableism, ageism and all othering binaries in the matrix of domination (collins, 2004). however, the formation of the profession, itself, took shape as the voice of white/euro-american middle/upper class women to prepare white/euro-american and european immigrant communities for citizenry, while inherently and directly participating in the denial of full citizenship status to blacks communities – the requisite price exacted by the u.s. caste system to the coveted white identity and professionalization. the narrative that the settlement movement utilized a structural approach to social problems, while charity organization societies employed a micro-level approach to remedying pauperism is flawed. both approaches to social work practice worked to fuse structural approaches with micro-level service distribution, albeit each accomplished this in their own ways. both approaches shared the common ground of designating black communities as unworthy of the entitlements of full u.s. citizenship, including childbearing (kennedy, 2008; roberts, 1996, 1997). a critical race theory frame is indispensable in identifying that even in the context of supporting an anti-black hierarchy of belonging, social work with mothers that were challenged by economic insecurity and newly arrived immigrants took the form of social control, moral policing, and pressure to adapt to the u.s. caste system (the combahee river collective, 2009; crenshaw, 2011; schulz & mullings, 2005). white/ european americans living in poverty and european immigrants were treated as being both deserving of public support and in need of being reformed, bettered, educated, and acculturated into whiteness. the profession abandoned snowden et al./kneading, needing, & eating black bodies 231 black communities as early as the 1890s and returned to providing services to black communities the during the 1960s because there was federal money available to support social work services in black communities. study findings add to the evidence that interventions that simultaneously incorporate individual and societal-level approaches are needed and possible. black/african american social workers designed their interventions to access planned change in communities and community-level institutions while working to locate, develop, link, and harness community resources. advocacy for mothers that were outside of the patriarchal wife/husband binary as deserving of support expanded access to social services and problematized poverty on a national level. however, limiting advocacy for social welfare to mothers alienated everyone living in poverty who was not a white/euro-american female or a child. the deserving poor were exclusively identified as women and children. more progressive and universalist approaches to social support that included men, black communities, and adults were also being advocated at that time, but were defeated in favor of more excluding legislation (gordon, 1994). by supporting deserving/undeserving approaches to social welfare in place of more progressive and universalist proposals, the profession co-signed on and reinforced ability, class, gender, sexual-identity, and racialization-based disenfranchisement. this advocacy for maternalist legislation during the progressive era (1890-1920) is the origin of the u.s. social welfare system’s stratified structure (gordon, 1994; roberts, 1996). the themes present in the literature interpreted within the context of critical race theory further inform social workers that white domination is the primary source of black communities still experiencing second-class citizenship status. at its foundation, federal/state-level aid provides citizens with the necessary prerequisites to fully participate in the social life of the community and the political-decision making of the nation (roberts, 1996). a minimum sense of dignity, well-being, and security are necessary for people to fulfill the responsibilities that citizenship entails (gordon, 1994). social welfare in all of its forms is a badge of membership in the u.s. national community and a basic necessity to fully participate in this membership and the political process (roberts, 1996), including voting. blacks have historically been barred from the entitlements of u.s. citizenship with black social workers working tirelessly to ensure that the needs of black and non-black communities are addressed. despite the profession’s work to serve as a force for social justice, acquiescing to racialized ideals of u.s. nationhood undermines social work’s potential to actualize this long-held value, especially in regard to blacks having full citizenship (roberts, 1996; rodriguez, 2020; snowden, 2018). findings from this study identify that social work education does not include this significant history. incorporating this narrative interrupts the historical amnesia that racialization necessitates. using critical race theory to center racialization as the primary source of black communities’ experiencing second-class citizenship status addresses how the absence of settlement or community-level practices has contributed to the maintenance of the status quo (harkavy & puckett, 1994). addressing this pedagogical lapse is also an opportunity to contextualize radical/critical social work theory and its contributions to the profession. these contributions include radical social work being a deliberate call to the development of critical consciousness for all social workers. advances in social work, summer 2021, 21(2/3) 232 fanon (2005), freire (1970/2000), and pinderhughes (1983) highlight the importance of coming to consciousness in the work to create a new society. in addition, radical social work calls on social workers to be deliberately active in working with communities living on the margins to achieve the social change that these communities envision. radical and critical social work theories, and their more recent iterations, support creating spaces for critical conversations and dialogues about the second-class status of black americans. an outcome that these theories may offer is for social work to organize itself to develop the needed resources to engage in this work making it possible for social work to fund, finance, and maintain social services without overly relying on status quo communities (michals, 2015; washington, 2018). it is important to note that critical race theory includes what radical/critical social work theory do not: a centering of racialization. without deliberately centering black communities and working out the contradiction of what becomes fee-for-social-change-services, radical social work continues in the same tradition of the social work profession by falling short of supporting the social justice that is stipulated in the nasw code of ethics (nasw, 2021). the findings of this research call social workers to update the nasw code of ethics (2021) to include a clause that social workers challenge white domination as a means of challenging the second-class citizenship of blacks/african americans. finally, the themes of this review remind social workers that whether or not the profession challenges or carries out white domination is contingent on the actions of social workers on micro, mezzo and macro levels of u.s. society. in other words, social workers have a responsibility to incorporate these findings into social work education in higher education and social work pedagogy. including this history of social work may make social work professors and students more knowledgeable of the past and more aware of the injustices in society that continuously occur. pedagogues and social work learners may find that learning how blacks challenged injustice and took matters into their own hands informative and inspirational, especially in relationship to nasw’s mandate to address social injustice (nasw, 2021). tolliver (1993) identifies that social justice is exactly what african american social workers advocated for by opening schools and starting their own settlement homes because they were not thought of in the 19th century when jane addams first started hull house. learning this fuller history of social work can further prepare social work students to face injustice in the u.s. history is repeating itself through the disproportionate rates of the covid-19 pandemic. these rates reiterate how blacks were denied access to the same opportunities as european immigrants. knowing the history, events that occurred, and how these events affected othered communities enables social workers to uphold the nasw code of ethics (nasw, 2021). the nasw code of ethics serves as guidance and a reminder for social workers and soon-to-be social workers of why we became social workers in the first place (nasw, 2021). analysis limitations and future research a limitation of this historical analysis is that most of the sources utilized are secondary sources, as opposed to firsthand accounts, case notes, case records, or archival material of the formation of social work and its concern for the citizenship of black communities. a snowden et al./kneading, needing, & eating black bodies 233 follow up to this historical analysis could include a series of in-depth archival reviews of documents containing narratives of people that were directly a part of the social work profession’s efforts to ensure the well-being of black communities. data collected from these interviews or archival materials could further inform the future analysis of social work’s advocacy for black citizenship and improve the efforts of the social work profession to challenge white domination. a second limitation of this study is that some readers may infer that the study premise may assume that white/euro-american social workers share the same anti-black biases despite different life and or educational experiences. all whites/european-americans benefit from white domination, however, these communities may not all benefit in the same ways (lipsitz, 1998). future research is needed to investigate the biases that white/euro-american social workers may and may not have in order to ascertain how they re-enact and or deliberately challenge their racialized privileged status in the social work professional relationship. conclusion full access to the entitlements of u.s. citizenship may be the missing link in black communities accessing the resources central to the meeting of their basic needs. if so, study findings underscore support for micro-level social work approaches being supplemented with full access to all of the entitlements of citizenship to enhance efficacy. this change necessitates that social work practice approaches include practices for service users to engage in community dialogue to problematize the impact of structural oppressions, such as white domination, in addition to promoting individual level adaptation to oppressive conditions methods, such as condom use, access to personal protective gear, and access to pre-exposure prophylaxis [prep]. the evidence continues to suggest that macro-level factors cannot be covered by condoms (snowden, 2015), face-masks, vinyl gloves, or mediated by early detection. the history of social work and its concern for black people receiving all of the entitlements of u.s. citizenship present at least five implications for social work professionals. the uppermost suggestions of how to incorporate the study themes into social work are the need to expand the nasw code of ethics (2021) to problematize white domination and for pedagogical innovations among social work educators to address the historical amnesia that white domination fosters in all facets of knowledge building in the u.s. this thematic analysis calls all social workers to act to disrupt white dominant ways of knowing in social work education by incorporating the presented history in classroom pedagogy and internship training for social work practice, research, and policy. these findings implore social workers to understand that if service users “…[have] 99 problems…,” white domination is all of them (jay-z, 2004). doing so enables the profession to honor its roots of grassroots organizing and actualize its ethical commitment to social justice, integrity, service (nasw, 2021), and supporting communities to access all the entitlements of u.s. citizenship and belonging (rodriguez, 2020; snowden, 2018). references addams, j. 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(2020). caste: the origins of our discontents. random house. author note: address correspondence to fabienne snowden, department of social work, medgar evers college, cuny 1650 bedford ave, brooklyn, ny 11225. email: fsnowden@mec.cuny.edu https://www.muse.jhu.edu/article/32182 mailto:fsnowden@mec.cuny.edu _______ robert lucio, phd, associate professor, graduate social work, lisa rapp-mccall, phd, professor, graduate social work, and patricia campion, associate professor, global studies and sociology, saint leo university, saint leo, fl. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 394-408, doi: 10.18060/23679 this work is licensed under a creative commons attribution 4.0 international license. the creation of a human trafficking course: interprofessional collaboration from development to delivery robert lucio lisa rapp-mccall patricia campion abstract: human trafficking is a serious global crime, particularly catastrophic in africa. an asynchronous, online, interprofessional course on human trafficking was developed to educate interprofessional catholic sisters in africa who are attempting to intervene in the crisis. this article describes an interprofessional university team’s development, work processes, course product, and the initial impacts of the utilization of the interprofessional skills by the students. specific elements deemed essential for success in creating and implementing ipe are delineated, including commitment from departments and colleges, respect for other professionals/disciplines, library support, time allowances, technology and learning design, and community relationships. challenges and recommendations in the process as well as suggestions for future research are also discussed. keywords: interprofessional education; human trafficking, higher education according to the global slavery index (2018), human trafficking has become a pressing social problem internationally, with numerous entities estimating the number of victims at close to 40.3 million. it is difficult to estimate the prevalence of human trafficking due to, among other problems, differences in definitions, law enforcement tracking, poor record-keeping, and the furtive nature of the crime (counter trafficking data collaborative, 2019). africa is particularly susceptible to human trafficking crimes based on several deeply embedded social problems. these include overwhelming poverty, government corruption, violent conflicts, weak borders between countries and other continents, lack of education, and lack of human rights (african sisters education collaborative [asec], 2019; aronowitz, 2017; chuang, 2006; ezeibe et al., 2019; rafferty, 2016; warria, nel & triegaardt, 2015). africa is a source, destination, and place of transit for numerous forms of human trafficking (counter trafficking data collaborative, 2019) and 9.26 million individuals are projected to be victimized by human trafficking in africa, which is almost a quarter of the victims worldwide (asec, 2019; global slavery index, 2018). women and children are the most frequently trafficked group, representing 71% of victims (global slavery index, 2018). human trafficking includes a variety of covert criminal operations, which continually adapt their means and methods to avoid apprehension. in africa, human trafficking may take many forms, including labor trafficking, sex trafficking, forced child marriages, organ harvesting, child soldiers, baby adoption mills, and infant sex trafficking/pornography (asec, 2019; hepburn & simon, 2013; makinde, 2015; mancuso, 2014; sawadago, 2012; van reisen & estefanos, 2017; warria, 2017). according to hodge (2014), victims, their https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 395 families, and communities sustain serious short and long-term consequences from trafficking. victims present with a wide variety of biological, psychological, social, and spiritual symptoms, and interface with many different organizations, such as healthcare agencies, social services, addictions services, child welfare agencies, spiritual organizations, legal services, and schools. they also interact with varied professionals, like doctors, nurses, teachers, social workers, spiritual leaders, judges, and police officers. however, many times, they are not recognized as victims of trafficking (hargreavescormany & patterson, 2016). in order to effectively identify, assess, intervene, and eradicate human trafficking, multiple professions need to be fully informed and work collaboratively. this requires training and education that is comprehensive, interprofessional in nature, and provides opportunities for multiple professions of students to interact, network and partner. interprofessional education (ipe) is still rare in academia due to academia’s history, culture, and organization (olenik et al., 2010). for instance, academia has traditionally been organized to provide degrees or majors, with varying silos of disciplines ready to deliver these. separate colleges and departments reinforce these silos. except for the health disciplines, which embraced the philosophy and practice of interprofessional education years ago, the culture of academia has often dismissed the value of interprofessional education and reinforced competition between departments and professions rather than collaboration among them (gilbert, 2005). for instance, departments must compete against one another over the same students and departments or majors with low enrollment are eliminated. as a result, many resources are expended to create and deliver interprofessional courses or programs. multiple faculty members are required to create one course and employing a large staff team from various university departments generates large expenses in time and financial resources. additional barriers, such as the assignment of credit or pay for the creation or teaching of an ipe course, cause faculty to avoid the endeavors. the university processes result in fewer ipe, which is unfortunate because universities may miss opportunities to address the needs of the current workforce: employers typically expect graduates to think creatively, critically, and interprofessionally. in addition, these traditions discourage students from thinking broadly beyond their own discipline to solve complex problems or work collaboratively and efficiently with other professions (schaefer & larkin, 2015). the eradication of social problems requires unique skills, creativity and interprofessional thinking and action. studies on interprofessional education have shown positive outcomes for students, including improved collaboration and cooperation with other professions, increased respect for other professions, and improved attitudes toward teamwork (barr et al., 2005; who, 2010; zucchero et al., 2010). suiter and colleagues (2015) found an increase in students’ knowledge and practice-based competencies after completion of an interprofessional practice-based course. most studies to date have been focused on interprofessional health care education and practice and further research is needed to clearly understand the benefits of other interprofessional educational programs (schaefer & larkin, 2015). lucio et al./creation of a human trafficking course 396 social work education has not advanced much further on this undertaking even though social workers engage in interprofessional work more often than not (mosser & begun, 2014). besides field practicum assignments or additive ipe assignments in courses, there are few examples of ipe courses described or evaluated (schafer & larkin, 2015). yet, social work students could greatly benefit and be better prepared for their professional practice by interacting and understanding how other professionals think and work. current article this article examines two aspects of interprofessional education related to the development and implementation of a human trafficking course. first, we describe the interprofessional team’s development processes, the interprofessional nature of the students intended to enroll in the course, and the final developed course product. second, we provide insight into how the catholic sisters who have taken this course plan to use the knowledge and skills they have gained to address human trafficking by engaging in interprofessional practice in their communities. in addition, we discuss specific elements deemed essential for success in creating ipe: the need for commitment from departments and colleges, respect for other professionals/disciplines, library support, time allowances, technology and learning design, and community relationships. finally, we discuss challenges and recommendations for undertaking this type of endeavor. method development processes the project was funded by a grant from the conrad n. hilton foundation, which supported course development, course delivery, and evaluation. the intent of the grant was to specifically upskill catholic sisters in africa regarding human trafficking. the development team from saint leo university consisted of social work, sociology, and criminal justice faculty members, a librarian, a learning designer, and a catholic sister alumna from africa. social workers possess knowledge and skills which directly relate to the problem of human trafficking but also make them natural team leaders. in this project, two social work professors led an interprofessional team to create an innovative, microcredential (not for college credit), online course to specifically educate an interprofessional group of catholic sisters working in countries throughout africa. the catholic sisters were part of the talitha kum network, an international and interprofessional network of catholic sisters dedicated to ending human trafficking. sisters are expected to educate communities, develop prevention programs, network, advocate for policy changes, and intervene at micro, meso, and macro levels to eradicate human trafficking. the sisters generally receive brief webinars and workshops on human trafficking, but these are focused on teaching basic knowledge and are usually not competency based. for example, sisters are not well versed in trauma-informed practices, conducting assessments, interviewing, practice, networking, and advocacy skills, or developing programs. first, course objectives were delineated based on the grant requirements and the needs of the sisters belonging to the talitha kum network. next, a curriculum map was used to identify content and skills from current courses offered by saint leo university. advances in social work, summer 2020, 20(2) 397 curriculum mapping is an evidence-based approach to curriculum assessment and development, which helps educators align content, skills, and standards for a course (arafeh, 2016). in this case, a list of learning outcomes and associated course activities across various social work and criminal justice courses were developed to identify content and skills that were already being taught. some of the identified activities, readings, and assignments were then deconstructed from already developed courses and adapted for the human trafficking course. at that stage, the librarian used her knowledge of the available resources to assist in finding appropriate content, references on african cultures, statistics, and government policies for the course. in addition, an alumna of the university who is a catholic sister from africa educated faculty about african cultures and the culture of catholic sisters. all resources, cases, images, and local contextual knowledge were then incorporated into to the course. once the syllabus was complete, the coordinator of the talitha kum network reviewed the content and provided recommendations, which were incorporated into the course. then, a learning designer who worked exclusively on our course was introduced to the team, course content, and syllabus. his task was to create online modules and visuals, based on the content and direction from the faculty. online modules were checked every week and modified as necessary. assignments were checked and re-checked, including the coordinator of talitha kum, who reviewed the online content and made recommendations, to ensure the best possible fit with the target population. students the students for this course were catholic sisters who lived and worked in various countries across africa. they all had a bachelor’s degree in varying disciplines and their professions and roles were highly diverse, including but not limited to administrators, educators, psychologists, accountants, nurses, and social workers. for most of the students, english was a second, third, or fourth language. often, access to technology was limited. the sisters had all interfaced with human trafficking, either through working with victims, seeing trafficked individuals in their towns, or hearing about citizens being lured from their villages into trafficking situations. they were deeply motivated to gain knowledge and skills to prevent and address human trafficking in their regions. course product the purpose of the course was to provide an opportunity for catholic sisters to develop new skills and the knowledge and competencies required to interfere with human trafficking in africa, and to encourage sisters to work interprofessionally. the asynchronous, online course included 12 modules for students to learn to identify and understand consequences of human trafficking; apply trauma informed theories; conduct assessment; use practice skills; develop prevention strategies; and create and use networking and advocacy skills. students worked together through one module per week, completing readings, watching videos, and working through quizzes and interactive exercises. in addition, they completed role-plays with colleagues online and in-person. lucio et al./creation of a human trafficking course 398 two cases were used throughout the course for students to actively apply their learning. each case study portrayed how a victim of human trafficking might evolve over time. these cases allowed students of different professions to understand how their profession and other professions intervene with the client and to learn skills beyond their profession, which would be effective in assisting a victim of human trafficking. throughout the week, students interacted with one another through discussion boards and soon developed connections with one another. these connections soon led to collaborations, shared ideas, and networking with each other beyond the course, thus directly affecting their efforts to interfere with trafficking. finally, students developed a training manual throughout the course to use for themselves and to train others upon completion of the course. sample forty-six catholic sisters were enrolled and completed the course from fall 2018 through summer 2019. they were all serving in africa, with most of them coming from nigeria (45.65%), followed by kenya (10.87%), south africa (8.70%), and uganda (8.70%). the rest were working across various other countries (see table 1 for full details). the mean age of the sisters was 44.34 (sd = 11.81). in terms of current occupation, the largest proportion worked as educators (28.57%), followed by program coordinators (14.29%), counselors (14.29%), and direct community practice workers (11.90%). a full list of the professions can be found in table 2. no racial/ethnic demographics were collected. table 1. country of service (n=46) country n (%) nigeria 21 (45.7%) kenya 5 (10.9%) south africa 4 (8.7%) uganda 4 (8.7%) zimbabwe 3 (6.5%) tanzania 2 (4.4%) mauritania 2 (4.4%) burkina faso 2 (4.4%) rwanda 2 (4.4%) ghana 1 (2.2%) total 46 (100%) table 2. catholic sisters professions (n=46) area of work n (%) education 12 (28.6%) program coordinator 6 (14.3%) counselor 6 (14.3%) community practice/engagement 5 (11.9%) social work 3 (7.1%) rehabilitation 3 (7.1%) healthcare 2 (4.8%) environment/agriculture 2 (4.8%) justice department 1 (2.4%) finances 1 (2.4%) technology 1 (2.4%) unlisted 4 (9.5%) total 46 (100%) analysis the saint leo university irb approved the study. a three-month post course, followup question asking the sisters how they were using the course content in their work, in addition to the end-of-course training manual assignment and the discussion posts from the weekly course discussions, were also included in the analysis. responses were coded for types of activities planned; partners to be involved in the plans; plans to keep in touch with advances in social work, summer 2020, 20(2) 399 other students; and aspects of the course found to be useful. the goal was to examine how the course affected the sisters’ interprofessional work and planned approach to addressing human trafficking. results impact on interprofessional collaboration for catholic sisters when asked about identifying intervention strategies they would employ and the implementation plan they created for their community, 86% (n=40) of sisters reported plans for various forms of networking and collaboration. fourteen (30.4%) had already initiated various contacts. a few students reported specific action steps while others referred to a desire for greater cooperation. likewise, some of the contacts they listed identified a specific organization or individual, even including a name, but others referred to a professional category or type of organization. students may have discussed engaging more than one interprofessional group or organization in their action plans. almost half of the sisters discussed making connections with nongovernmental organizations (45.7%; n=21). another 37% (n=17) mentioned they planned to connect to other sisters in the course, 34.8% (n=16) planned to work with other catholic organizations, and 32.6% (n=15) discussed working with government agencies or officials. this was followed by grassroots groups (19.6%; n=9), traditional community leaders (17.4%; n=8), schools (13%; n=6) and even media organizations (13%; n=6). how the sisters planned to collaborate with these groups varied, but the most common planned activities were the creation of coalitions (36%; n=17), the dissemination of information gained from the course (34.8%; n=16), and the organization of meetings or visits (26.1%; n=9). table 3 provides full details on how the students planned to engage others in addressing human trafficking. table 3. type of interprofessional activity planned (n=46) type of activity n (%) create a group/coalition 17 (37%) disseminate information 16 (34.8%) organize meeting/visit 12 (26.1%) organize workshop/conference 9 (19.6%) seek information 6 (13.0%) advocate 4 (8.7%) volunteer 4 (8.7%) the students specifically identified other professions they would involve in addressing the issue of human trafficking in their local area. their action plans most often mentioned spiritual leaders (80.43%; n=27), followed by school personnel, including teachers and administrators (58.70%; n=27), governmental representatives from the local to national levels (54.35%; n=25), and law enforcement personnel (54.35%; n=25). other key professions and groups mentioned, included community members (leaders and members), medical personnel (doctors, nurses and health workers), family members, media lucio et al./creation of a human trafficking course 400 (traditional and social), mental health professionals, legal personnel (judges, prosecutors and lawyers), and social workers. table 4 provides full details on the number and percentage of professions that the sisters mentioned in their action plans. table 4. interprofessional groups to engage in action plans (n=46) profession n (%) spiritual leaders 37 (80.4%) schools (principals & teachers) 27 (58.7%) governmental representatives (local, regional, national) 25 (54.4%) law enforcement 25 (54.4%) community (leaders & members) 19 (41.3%) medical personnel (doctors, nurses & health workers) 15 (32.6%) family members 13 (28.3%) media (traditional & social) 13 (28.3%) mental health professionals 12 (26.1%) legal (judges, prosecutors, lawyers) 9 (19.6%) social workers 6 (13.0%) through this course, sisters were able to create crucial connections to other sisters in africa who are fighting human trafficking. they were eager to network with other sisters in the course who worked close by and/or could bring expertise from other countries. for instance, a couple of sisters in mauritania who were tasked with creating a branch from their organization to address human trafficking were able to connect with coordinators from ghana and nigeria to give information on how to start developing anti-trafficking programs. one-third of the students expressed a desire to establish continued communication with the other students in their cohort, ranging from establishing an online forum to meeting face-to-face. many of the students were isolated, as they were the only ones addressing human trafficking in their region. one of the key benefits of this course was that the students were able to share ideas, tactics, and information with other students in different parts of africa. this allowed the students to learn from one another. this was reiterated by one student who said: discussing tactics for advocacy for human trafficking as a tool and networking with other organizations was a keynote that will remain in me to continue and bringing on board to work with others in fighting this vice. having learned and been made aware that human trafficking is a global network/global issue and to deal with it i must also be in a network or work as a team in order to come to an end was a key study for me in this course. the difficult task of working with the individuals, families, and communities victimized by human trafficking cannot be completed alone. sisters developed an essential network with each other. they understand the stress and secondary trauma of this work and were able to support one another. at the end of the course, they asked faculty to create a spreadsheet of all students and their contact information to be shared. the faculty advances in social work, summer 2020, 20(2) 401 members have done so and have built on the list by adding each cohort’s information as the course proceeds to be delivered. the list is shared with all students (after consent) upon completion of the course. finally, the students utilized their learning to develop a training manual based on their own region and its unique human trafficking issues. the manuals would be used by the sisters to train further trainers. since each region is unique regarding available resources, dangers, advocacy groups, and services, participants developed their manual through community resource mapping, which included: identifying available services and gaps in services, identifying current and needed prevention efforts, specifying approaches to advocacy and networking, and determining safe connections. for instance, in some communities, police officers were an ally, but in others they may be involved in helping traffickers. the benefits of the assignment were noted in one student’s comment: the opportunity to review the services available for victims and their families in my region, and to assess what could be missing. i became more aware of the prevention measures for tackling human trafficking in nigeria, such as shelter homes, the need for formation of coalition, advocacy, awareness creation, legal support, workshops and seminars, and working with government agencies. the course, overall, inspired the participants to make plans to reach out to a very diverse set of agencies and professionals, from the local level to the international level. this interprofessional collaboration highlights the value of each participant’s unique skillset and the need to work together across different types of agencies and professions in order to truly address human trafficking. discussion the intent of this article is twofold: to describe the interprofessional team’s development, processes, and interprofessional human trafficking course; and to provide results on the utilization of interprofessional practice upon completion of the course. the process of developing, delivering, and evaluating an interprofessional course provided many opportunities for learning. following are some recommendations for others interested in pursuing ipe at their institution. sunguya and colleagues (2014) examined forty articles to identify common problems with developing ipe courses and how those lessons could be applied to developing countries. they found ten challenges across their study, including curriculum, leadership, resources, stereotypes, variety of students, ipe concepts, teaching, enthusiasm, professional jargon, and accreditation. in the development of the ipe course on human trafficking at saint leo university, many, though not all, of these issues emerged as well and had to be overcome. these included curriculum (working with learning design, engaging the library in course development, and developing community relationships), leadership (commitments at the university level), embracing ipe concepts (respect for the interprofessional approach), teaching (different departmental expectations and policies), and resources (understanding the impact of time). lucio et al./creation of a human trafficking course 402 course content barriers can occur with course content, structure of the course, and time for participants to adequately participate (sunguya et al., 2014). in this case, working with technology and a learning design team can have its own set of unique challenges. learning designers have expertise in course design and the technological skills to create best practices in integrating design elements into courses. however, they are not content experts and time must be spent on each topic area to exchange information and insight into both the content, the learning objectives, and the course designers’ vision. being able to work with one learning designer through the whole process can make this a more seamless experience and raise the final quality of the product. having one single point of contact for the course design also helps integrate cultural competence and understanding of how other cultures learn through each design element. human trafficking in africa has aspects that are unique to each area and these differences must be incorporated into the learning experience of the students, from the assignments to the visual elements that represent the student’s experiences. it should also be noted that the process of course development requires a lot of paperwork and is a cumbersome process that can be foreign to a faculty member. multiple faculty members working to create one course can be a difficult endeavor, especially when differing professions and disciplines are involved. continuous conversations with each other as well as with the learning designer were critical to create a seamless course and to ease frustrations. additionally, the university library is an oftenforgotten resource which can be utilized as a key member of the ipe team. their knowledge of resources is critical to harvest high-quality content across multiple topics. working collaboratively with the library team is a crucial step to reduce search time and to ensure the relevance of the materials used for the course content and readings. the library personnel’s expertise can also be helpful in developing open educational resources, or oers, for each topic/module. when the course is launched, they can also provide support for additional resources and writing help for student participants. finally, cultivating community relationships is an invaluable piece of developing an ipe course. this included working with those who might have experience working within the specific geographic area the course was focused on. fortunately, there was a catholic sister alumna at the university who was from africa and was able to provide her perspective of her country’s culture, a localized perspective of human trafficking, and most importantly how the content related to catholic doctrine. other groups that are critical are any organizations or agencies who are already working in the area of human trafficking, such as several existing networks of catholic sisters that were found currently addressing human trafficking in africa. throughout this process, it is also important to recognize that the grant funder has its own needs and agenda, which may not be the same as the course developers’. balancing each of these perspectives helped create a collaborative course that incorporates the perspectives of all stakeholders and addresses the needs of the catholic sisters who would ultimately take the course. advances in social work, summer 2020, 20(2) 403 leadership leadership issues in ipe can be defined as the level of support and organization of university administration (bridges et al., 2011; sunguya et al., 2014). one of the barriers to the course development was the level of commitment at the university level. initially, decisions around the course development were being made by a project manager who resided in a department different from the course developers. this caused a lack of communication and unclear timelines and commitment from university administration. it is critical to ensure that everyone who has a voice in the progress of the project is engaged in the process and invested in the course success. this includes the registrar’s office, university technology services, deans, any vice presidents, and the vice president of academic affairs. the project manager did not have a clear understanding of academic processes. as a result, he was not able to fully address many issues critical to both course design and faculty engagement in the process, such as how credit for joint course development and delivery would be assigned, the impact of the ipe course development on tenure and promotion, and even how or if the courses would be accepted as part of existing majors/degrees. the ipe course development process was halted at some points until the course developers directly engaged the upper level administration to ensure commitments and provide direct answers to the questions relating to faculty involvement in the project. ipe approach working in an interprofessional team requires everyone be committed to this approach (sunguya et al., 2014). faculty must work across fields in the course development and engage with a learning design team, and librarians, while at the same time being able to value and incorporate differing contributions and viewpoints. for instance, the integration of theology was a unique challenge because the course was designed specifically to address human trafficking but also had to address the students’ catholic perspective. engaging theology and catholic experts to provide insight and feedback across each stage of development was a crucial element. embracing an ipe approach not only involves faculty but extends to the interaction of students with their community and each other. as noted previously, students enrolled in the human trafficking course came from over eleven professions. using an interactive discussion was one way to engage participants in hearing the unique perspectives of this issue from the lens of each student’s perspective. another way this was addressed was having the sisters develop an implementation plan within their community by identifying the multitude of resources, agencies, and organizations that would need to collaborate to address this issue in their communities. teaching in the creation and delivery of this ipe course, several challenges related to teaching arose. first, the team needed to manage different policies across academic and nonacademic departments. expectations of what online courses should look like differed in each of the academic departments and these differences needed to be resolved to develop lucio et al./creation of a human trafficking course 404 one consistent course. with respect to non-academic departments, barriers to student enrollment and library access required working with university technology services and the library to change or create new systems to accommodate the demands of an ipe course. another teaching challenge involved finding ways to engage the catholic sisters, given that they were taking this course on a continent different from the instructors’ and perhaps thousands of miles away from their online classmates. the time-zone difference had to be considered in the design of the assignments and the participants’ interactions with each other. one strategy employed was to have the sisters practice role playing with others online or in their local communities. when they competed this activity, they were able to post in an online discussion forum and get constructive feedback from their peers and the instructor. resources the development of an ipe course took more time than initially planned. when developing a course for a single profession, the content and context are often familiar to the course developer. however, when working in an ipe team, it is important to spend time developing relationships among team members, managing differences of opinion about content, course design elements, and accreditation requirements, and even adjusting to differing workstyles across participants and disciplines. use of interprofessional course previous studies as well as our initial findings suggest there are strong benefits for students in taking interprofessional courses. creating opportunities for students to develop collaborations within their local context is a key element to a successful ipe experience (green & johnson, 2015). our results found that 86% of our students had a plan to begin networking and collaborating with others and 14% had already begun these practices. this was illustrated by one sister who was able to develop an opportunity to link together two existing contacts, the international office on migration (iom) and her local parish priest: i have learnt that networking is more beneficial than fighting this issue alone. therefore, i have already shared with iom’s coordinator my desires on how i want to sensitize the migrants that come at our parish. i met the parish priest and he agreed to offer us a conference room. after this encounter, iom gave me a collaborator named mohamed [pseudonym]. we are already planning to have three events: one for the minors, one for women and another for men. we will start these events in september after my holidays; the date is not yet set. in addition to specific events and activities, many of the sisters were able to identify how their own professional skills could complement those of others by working collaboratively with different groups and professions. the students talked about organizing meetings with stakeholders such as community members, parents, youth leaders, school personnel, government officials, local organizations, and local businesses. whether it was with local nongovernmental organizations or advocacy groups, there was a recognition that addressing this problem was not something that could be done alone. having allies was an important component of their plans moving forward when fighting to solve this issue. advances in social work, summer 2020, 20(2) 405 in addition to a range of stakeholders, there was also discussion of the different types of professionals that would be needed to create a comprehensive prevention, intervention, and recovery model. this included addressing economic issues that might put youth at greater risk for being trafficked, listing different groups that could be enlisted to rescue victims, and finally the hosting of professionals that would be needed to help address, physical, emotional, and spiritual trauma that survivors endure. these findings support earlier studies but elaborate further with specifics on how collaborations may occur, where, and with whom. limitations there are limitations to this study which hinder generalizing the findings. for instance, the students were rather homogeneous in that they were all catholic sisters working in africa. these are not the typical students that social work educators teach or for whom they develop courses. however, that was a restriction of the funder. an additional limitation was the use of only qualitative data. this limited the scope of the findings and implications. implications for interprofessional education overall, this project included developing an interprofessional course for catholic sisters and providing insight into how the students used interprofessional skills after taking the course. while the barriers presented several challenges in the development and implementation of this ipe course, many of these were overcome through collaboration, communication, partnerships, and structural changes. although not all challenges can be anticipated, the recommendations should help other social work educators as they develop ipe courses moving forward. having administrative support, committed collaborative relations, and an underlying technological infrastructure are required to implement a successful ipe course (bridges et al., 2011). how these are addressed may vary by institution but being able to pre-emptively address potential challenges allows the design and development process to be more efficient. further research regarding outcomes for academic organizations, faculty, and staff are warranted to support further interprofessional courses. these results could support the changes required to successfully create and deliver these types of courses. infrastructure in academia must be reconsidered in order to facilitate these endeavors more efficiently. for instance, policies regarding credit, pay, and full-time equivalency (fte) must be addressed, as well as silos, which interfere with interprofessional course development and delivery. resources must be provided as well as other experts (i.e., librarian, learning designer) in order to efficiently and effectively produce quality courses. in addition, there is a dearth of studies assessing the application of interprofessional skills and the students’ attitudes. beginning studies have suggested improvements in collaboration, connection, and respect for other professions; however, far more studies are needed. if academia is to remain relevant, it needs to provide educational experiences which directly influence professional work. interprofessional courses may provide students an opportunity to think beyond their discipline and enhance critical thinking skills and problem-solving skills. this is what the workforce is demanding. lucio et al./creation of a human trafficking 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(2015). challenges in identification of child victims of transnational trafficking. practice: social work in action, 27(5), 315-333. https://doi.org/10.1080/09503153.2015.1039974 world health organization. (2010). framework for action on interprofessional education and collaborative practice. https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng. pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 zucchero, r., hooker, e., & larkin, s. (2010). an interdisciplinary symposium on dementia care improves student attitudes toward health care teams. international psychogeriatrics, 22(2), 312-320. https://doi.org/10.1017/s1041610209991293 author note: address correspondence to lisa rapp-mccall, department of graduate social work, saint leo university, po box 1667, saint leo, fl 33574. email: lisa.rappmccall@saintleo.edu https://doi.org/10.1017/s0001972018000815 https://doi.org/10.1016/j.childyouth.2017.06.024 https://doi.org/10.1080/09503153.2015.1039974 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessionid=35be21ab8f459d58bb7ae93ed9db8c20?sequence=1 https://doi.org/10.1017/s1041610209991293 mailto:lisa.rapp-mccall@saintleo.edu mailto:lisa.rapp-mccall@saintleo.edu _________ elizabeth king keenan, phd, lcsw, assistant professor, department of social work, southern connecticut state university, new haven, ct. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 240-261, doi: 10.18060/26382 this work is licensed under a creative commons attribution 4.0 international license. for white social workers: re/un/discover heuristic for dual awareness in ongoing anti-racist practice elizabeth king keenan abstract: although many white social workers engage in ongoing anti-racist actions, they may still be complicit in perpetuating and reinforcing racism and white supremacy culture. black, indigenous, and people of color (bipoc) social workers, activists, and scholars have described the numerous ways in which the harmful impacts of white supremacy culture appear in the well-intentioned efforts of white people who seek to be anti-racist. white social workers are thus responsible for engaging in intentional ongoing practices to identify, interrupt, and shift their interpersonal oppressive uses of power in their practice. the re/un/discover heuristic is an iterative, embodied set of three practices for working with one’s experiences of shame and internalized dominance, habitual not-seeing, and in-the-moment activations. literature theorizing white supremacy ideology and culture frames the description of the re/un/discover heuristic. this paper describes several heuristic applications, including prompts for engaging in recover, uncover and discover practices and two composite examples. these applications illustrate how to use the heuristic practices with dual awareness of self and one’s social work practice in the moment and over time. white social workers are encouraged to learn and use the re/un/discover heuristic practices to guide their efforts to more fully live into their anti-racist commitments in moments of not-seeing and moments of activation. keywords: white social workers; anti-racist; social work practice; power; heuristic whiteness is a socially constructed structural position of dominance that bestows material, social, and psychological advantages to those who pass the pigmentocracy criteria (bonilla-silva, 2004; menakem, 2022). w.e.b. du bois (1935/1997) described these advantages as an invisible public and psychological wage exported throughout the world through color prejudice. inverting long-standing causal assumptions, kendi’s (2016) analysis illuminated the ways that white economic and political self-interests have fueled racist policies and laws which became buttressed by racist ideologies and racial bias. to maintain dominance and control, whiteness has justified genocide, enslavement, and other forms of systemic brutality with white supremacist ideology (plummer et al., 2021). critical race theorists articulate how dominance and control are further perpetuated with various permutations of racialized societal practices in structural, disciplinary, hegemonic, and interpersonal forms of racism (see, for example, collins, 2008; crenshaw et al., 1996). after the jim crow era, investment in this public and psychological wage (dubois, 1997) spawned a racialized structure of social practices that turned white supremacist beliefs into everyday institutional policies and procedures, rendering whiteness more and more invisible (hanna et al., 2021). bonilla-silva’s (2022) research on color-blind racism illuminates the invisible power dynamics operating through mutually reinforcing interactions of material benefit and racial ideology in this racialized social structure of about:blank keenan/for white social workers 241 social practices. the four frames of color-blind racism (abstract liberalism, naturalization, minimization, and cultural racism) make racial stratification appear “non-racial, habituated, and even apparently race-neutral” across institutions, including capitalist market system inequities (bonilla-silva, 2021, p. 514). white affective, attitudinal, behavioral, and cultural standards interwoven with “ableist, capitalist, christian, european, heteronormative, and patriarchal values” maintain these interand intra-racial hierarchies by reifying existing power relationships across other social hierarchies” (miller, 2022, p. 5). social movement and progressive organization leaders, along with many social science and social work faculty have utilized this knowledge about whiteness and racism to develop a variety of trainings and courses for students, employees, and activists. in addition to learning about structural forms of racism, these offerings typically focus on discrimination, microaggressions, bias, and other racial societal practices. the current educational policy and accreditation standards of the council on social work education (2022) supports such learning with competencies about racial justice and anti-racist practice. developing the capacity to see and understand the shifting manifestations of whiteness and white supremacy over time is necessary to resist and redress the insidious effects on black, indigenous, and people of color (bipoc; frey et al., 2021). less attention has been paid to how social work manifests whiteness. the profession has participated in and perpetuated white supremacy ideology and culture through efforts for legitimization, and through oppressive practices across all fields of practice (mccoy, 2020; stanley, 2020). as bonilla-silva (2021) states, “the ‘systemic’ in ‘systemic racism’ means that we all participate in the reproduction of the racialized order” with “normative, habituated, and often unconscious” behaviors and practices (p. 513). examining social work practices to understand how they may be perpetuating racial stratification is beginning to gain traction with the rise of more black, indigenous, and people of color (bipoc) social work leaders and increased numbers of bipoc social workers in general. since approximately 65% of social workers in the u.s. are white, white social workers also need to actively participate in this work to stop reproducing racism (u.s. bureau of labor statistics, 2022). contemporary bipoc social workers, activists, and scholars have described the numerous ways in which the harmful impacts of white supremacy culture (wsc) appear in the well-intentioned efforts of white people who seek to be anti-racist (okun, 2021). some of these include: generations of white bodies being conditioned to disconnect from sensing and feeling violence in all its forms and remaining silent (menakem, 2022; ricketts, 2021); to have limited self-knowledge and a distorted sense of self (goodman, 2011; mattheus & marino, 2011); to experience shame and harsh self-judgment out of expectations for perfectionism and mastery (diangelo, 2021; okun, 2021); to expect comfort and familiarity during interactions rather than taking individual responsibility for one’s experience of emotions (menakem, 2017; ricketts, 2021); and to express niceness or politeness rather than authenticity (diangelo, 2021). white people often become activated because they have not had to learn how to hold space for racialized tension and discomfort (menakem, 2022). the insidiousness of white advances in social work, summer/fall 2023, 23(2) 242 supremacy culture requires ongoing practice to dismantle its many tentacled manifestations. white social workers are thus responsible for engaging in intentional practices to identify, interrupt, and shift interpersonal oppressive uses of power in their practice (e.g., conducting intakes in a routinized manner, using an individual diagnostic lens to formulate understandings of challenges, failing to engage clients in meaningful creation of goals and plans, devaluing contributions of colleagues who have less organizational status). developing the capacity to unlearn wsc and be more fully present and responsible for one’s inner experiences regarding racism responds to fisher’s (2021) clarion call to “evolve because systems will always continue to find ways to evade and pervert justice” (p. 704-705). at an institutional level, the profession’s construction of continuing education for licensure paradoxically works against ongoing anti-racist learning and practice. an underlying assumption that one need only “clock” a certain number of continuing education hours per year on any practice topic enacts wsc’s emphasis on quantity over quality, mastery, perfectionism, and either/or thinking (asher blackdeer & gandarilla ocampo, 2022; okun, 2021). white comfort is promoted since one can say “i’ve done my 15 hours of training, so i am competent to practice.” recommendations for what white people can do after public outcry to the brutal murder of a black person, such as mr. george floyd, can also unintentionally feed notions of false comfort (e.g., one can say one is antiracist after reading a book or viewing a podcast about racism). to counter these tendencies, anti-racism, and unlearning whiteness workshops provide experiential learning and strategies that address discomfort and deepen awareness (see, for example, the peoples’ institute for survival and beyond, n.d.). these time-limited events typically conclude with recommendations to continue to “do the work” of unlearning racism and wsc, however, white people have generally not continued to engage in such ongoing practices, individually or collectively. wsc’s expectations about perfectionism also serve to surreptitiously inhibit unlearning and ongoing practice through a preoccupation with racial group membership and standards (miller, 2022). internalized wsc patterns of self-judgment can trigger shame and emotional reactivity when one does not measure up to wsc standards (diangelo, 2021; okun, 2021). one typically cannot be open to hearing nor respond to one’s impact in interactions if feeling fearful of being judged (by oneself; ibrahim, n.d.). neuroscience research sheds light on what may be happening. through neuroception, our bodies sense whether situations and people are safe, dangerous, or potentially threatening (porges, 2011). humans shift into reactive states when feeling real or perceived threats (e.g., hypoand hyper-arousals, fight, flight, freeze, and feign reactions; malchiodi, 2021). shame-based judgments are often perceived as threats, triggering a shift out of an optimal zone of arousal, resulting in reactive and defensive behaviors that diminish the capacity for anti-racism work with others (ogden & fisher, 2015). menakem (2017) stated that white bodies can be thinking they are “safe” yet their bodies signal otherwise when in the presence of bipoc because of the “ideas and images that were created, perpetuated, and institutionalized over hundreds of years—all for the benefit of powerful, white bodies” (p. 206). the danger is not coming from black bodies, but rather from the generations of keenan/for white social workers 243 conditioning perpetuating that perception, including internalized wsc patterns of judgment. white social workers have the potential to engage when in an optimal zone of arousal, or window of tolerance (siegel, 2020). within this optimal zone, one can be present, open, and aware of what is going on in the moment, and with curiosity, reflect, consider choices, and interact with others in racialized situations. one also has the capacity to be with one’s intense reactions and perceived threats without automatically reacting out of them, allowing for intentional action. when mind and body are connected in the present, “we are less swept away by our habitual thinking and feeling that colours our perceptions” (wong & vinsky, 2021, p. 191). white people can more accurately assess threats and sift out the conditioning that fuels perceived threats. throughout this paper, this optimal zone will be referred to as the window of capacity (woc) to reflect the current emphasis on going beyond the tolerance of distress within trauma literature, and to focus on the potential when in this embodied space (malchiodi, 2021). neuroscience research and okun’s (2021) antidotes to wsc can inform white people’s efforts to shift their expectations from wsc perfection/mastery to an expectation that they will be activated. expecting activation creates an inner space from which to learn (not just suppress, push through, or hold firm), and with self-compassion, notice and work with what arises. working on one’s inner experiences with others over time will strengthen one’s holistic capacity to be more fully present, notice how power is used in everyday spaces, and make courageous choices within interactions. the re/un/discover heuristic is a guide for working with one’s inner experiences while working to dismantle white supremacy and co-create anti-oppressive cultures with groups of people with whom one works and lives. the heuristic can guide the ongoing practice of unlearning racialized socialization habits, working with the bodily sensations and emotions associated with the impact of white societal practices and beliefs, and learning how to resist and shift the racialized social systems in which white social workers work. developing new cultural practices and habits requires commitment, intentionality, and collective ongoing practices, attending to the mutually reinforcing relations between body, mind, and relationships (siegel, 2018). this paper further develops the re/un/discover heuristic (keenan, 2021) to guide white social workers’ intentional responses regarding racism and wsc in the moment and over time. re/un/discover is an iterative, embodied heuristic that builds the capacity for white social workers to identify, interrupt, and shift interpersonal oppressive uses of power in their practice, to attend to one’s inner experiences as one engages in periods of unlearning, and to discover ways to live into one’s anti-racist commitments across a range of interactions. re/un/discover heuristic a heuristic is a process or method that guides efforts to work with complexity (frimodig, 2023). this heuristic is an intentional, iterative flow of movement between three advances in social work, summer/fall 2023, 23(2) 244 sets of practices and qualities: recover with compassion; uncover with curious, critical reflection; and discover with creative courage in relational connection (see figure 1). figure 1. re/un/discover heuristic all three sets of practices are based on the experience of “holding space” with self, and others, in a social field (scharmer & pomeroy, 2020, para. 9). within oneself holding space is a felt sense of internal spaciousness to be with one’s inner experiences and witness one’s urges and impulses from the reptilian brain without automatically reacting from them. the spaciousness also allows for “dual awareness to witness and embody the felt sense of empowering impulses for action” within one’s woc (ogden, 2015, p. 516). people can hold space for and with each other to strengthen group capacity to collectively face experiences and challenges. the felt sense of holding space supports “trust in acting from a place of humility, vulnerability, and surrendering to what wants to emerge” in the company of others (scharmer & pomeroy, 2020, para. 21). recover with compassion recover practices facilitate shifts back into one’s woc when one is activated to the edge or out of their woc. two images capture this awareness: a stop light (green is woc, yellow is at the edge, red is out of woc) or thumb signals (thumb up is woc, thumb to the side is at the edge, and thumb down is out of woc). routine tuning in throughout one’s day facilitates more immediate awareness when one is activated. as noted above, white people interacting in predominantly white spaces often do not need to tune into self because the spaces provide white people with comfort through various norms and taboos mitigating against discussing racism and white supremacy. white people may also be challenged to notice and work with one’s inner sensations and activations out of their woc. engaging in anti-racism work thus includes shifting one’s expectations from “having” an external holding space to taking responsibility and consistently practicing creating an inner one. keenan/for white social workers 245 figure 2. re/un/discover practices to create an inner holding space, one begins by identifying which existing practices support attention, awareness, and holding space in the present moment (see figure 1). routine tuning in throughout one’s day will illuminate opportunities to use recover practices with everyday stressors. practicing with compassion conveys a felt sense of holding space for these inner shifts. as one becomes more skillful, these practices can be used with racial activations. since it is possible to expand one’s woc, one also engages in regular recover practice with a frequency similar to regular exercise habits. consistent recover practices •brief pause •paced breathing •orient to one’s surroundings •touch one’s palm, thigh, arm, face, abdomen, or chest •gently rock or other movements •use imagery of trusted people or pets being behind or next to you and sense their support •other mindfulness, somatic, sensory, or contemplative practices •sources: center for contemplative mind in society (n.d.), kabat-zinn (2003), menakem (2017, 2022), ogden & fisher (2015), and siegel (2018) uncover practices •alone and with others: •examine one's beliefs and biases •do a power analysis to identify the way(s) power is being used and its impacts •use critical frameworks to interpret situations •identify oppressive and anti-oppressive patterns across time and/or ecological levels •replace negative (colonized) patterns of thinking, emotions, and actions with affirming patterns •sources: building movement project (2018), drworks (2021), fook (2022), pyles (2021), wong & vinsky (2021), yellow bird (2013) discover practices •listen for multiple visions and intentions within a group •hold space for one’s discomfort in a situation •resist the urge to fix •imagine what dismantling wsc and amplifying flourishing look like •use a dual focus on self and others in a situation •hold space for not knowing and “do not know how to” •use a group-level lens to understand racialized interactions and situations •learn how to act with courage and respect when interrupting and resisting oppressive patterns •co-create pathways to move from how things are now toward a specific vision •try, do, and learn from the impact •hold space for the uncertainty in between existing patterns and new patterns •sources: brown (2017), building movement project (2018), fisher (2021), gottlieb, (2020), haga (2020), menakem (2017, 2022), okun, (2021), and vinsky and prevatt-hyles (2022) advances in social work, summer/fall 2023, 23(2) 246 practice strengthens one’s capacity to hold space with compassion for the intense sensations, emotions, thoughts, and urges that arise when having a new race-related awareness (e.g., seeing how an administrator expresses cultural racism by blaming bipoc people with low incomes for “failing” to access an organization’s services rather than changing the organizational procedures that create barriers), and when working with others to dismantle it. uncover with curiosity and critical reflection curious, critical reflection seeks to unearth patterns of power to see the connections between oneself and the social structures within one’s life (finn & jacobson, 2003). intentional curiosity can counteract white social workers’ tendency to engage in harsh critiques towards self and other white people. through uncover practices, white social workers examine how their positionality informs what they see and how they are impacted or advantaged in specific situations (see figure 2). white social workers’ positionalities are a combination of professional power by virtue of one’s credentials and white advantage along with one’s other intersectional social identities. they critically reflect on how their assumptions, beliefs, and potential biases influence how they experience a situation and how they use their power (wong & vinsky, 2021). white supremacy culture exerts power in the ways it both constructs what people know and constrains people’s actions (collins, 2008; solorzáno & yosso, 2002). uncover practices illuminate these patterns with frameworks such as critical theories and cultural humility to “organize and to interpret information through a specific lens as well as to ground and to center the mind” (lerner, 2022, p. 610). intentionally selecting frameworks for uncover practices can thus serve as antidotes to white supremacy ideology and disrupt the plasticity paradox (i.e., how the brain persists in existing habits and ways of thinking; yellow bird, 2013). the main uncover practice is power analysis, looking at the range of ways that power moves in specific interactions, organizational structures, and cultures (pyles, 2021). power can be harmful, taking form as oppressive “power over” impositions or as collusive power to hold onto control of resources or decisions within a group (tew; 2006). power can also be fruitful, taking form as power from within self, power with others, and power to do individually and collectively (townsend et al., 1999). social workers need to be particularly mindful when using protective power, i.e., seeking to use one’s status in the service of those who cannot act on their own behalf or are blocked access to full participation. the impact of protective power can be experienced as either supportive and/or oppressive (tew, 2006). from a space of curiosity, uncover practices look at the meaning and impact of how past patterns of power (harmful and fruitful) might still be alive in the present, and at what levels (intraand interpersonal, and in organizations and institutions). through conversations, white social workers uncover how other white people might be advantaged in a situation and in what ways, and how those who are targeted or impacted are responding and making sense of what is happening (finn & jacobson, 2003). yellow keenan/for white social workers 247 bird (2013) notes that these practices liberate “the mind and brain from oppressive thoughts, emotions and actions” (p. 294). discover with creative courage since oppressive and collusive forms of power are inherent in wsc, discover practices rely on creative courage to attend to how white people are with themselves and others in the doing of the work as well as the work itself (see figure 2). discover practices focus on “what’s possible” because social workers believe in the capacity of human beings to “act in the world as an intentional, creative, meaning-making being, whose actions are shaped and constrained but never fully determined by life circumstances” (finn & jacobson, 2003, p. 71). although the need for structural transformation is indeed pressing and urgent, action to dismantle white supremacy also includes white people discovering how to be in relationship with self and others from a stance of cultural humility (gottlieb, 2020). discover practices counteract wsc pressures in three ways: 1) by engaging in a slow, deliberate pace to disrupt the urge to fix while also interrupting and stopping harm when indicated (brown, 2017; haga, 2020); 2) by adopting a “not yet” experimental mindset of noticing, trying, experiencing shifts, and using the learning to continue trying to interrupt perfectionism and mastery (building movement project, 2018); and 3) by centering relationships, recognition and co-creation to disrupt individualism and control (brown, 2017; okun, 2021). discover practices use uncover understandings of patterns of power, and draw on many ways of doing, knowing, and being to interrupt and resist wsc and to imagine and co-create ways of being and flourishing that “serve more than one worldview” (brown, 2017, p. 159). how to use the re/un/discover heuristic to use the re/un/discover heuristic, white social workers engage in an iterative flow of heuristic practices that are responsive to each situation. figure 1 shows overarching questions for each set of practices: how are you doing? what’s happening? what’s possible? if at the edge of or outside of one’s woc, one engages in recover practices to shift back into one’s optimal level of arousal to continue. depending on what is already understood about activation or specific situation, one delves into uncover practices or moves to discover practices to imagine, create, learn, interrupt, resist, disorganize, and/or reorganize. the heuristic can be used to work with oneself over time as well as when working with others in specific situations. bringing compassionate response to recover, curious critical reflection to uncover understandings, and creative courage to discover how to work with one’s learning edges can strengthen white people’s ability to participate in dismantling, rather than perpetuating white supremacy. re/un/discover heuristic to strengthen and expand self capacity dismantling white supremacy requires focusing on three aspects of self: a) working to build the muscle to hold space for one’s inner experience, sensations, thoughts, emotions, advances in social work, summer/fall 2023, 23(2) 248 and urges to be able to choose actions that are anti-racist, b) working with the ways white people internalize and enact dominance and superiority, and c) shifting from shame to guilt. holding space for inner experiences intentional, ongoing practice is necessary to work with reactive defensiveness unconsciously activated when one experiences anxiety or perceives threat (marino & mattheus, 2011). white people can perceive threat in the face of losing power, face, comfort, and privilege (okun, 2021). lacking capacity to hold space for these feared losses, white people have the tendency to treat themselves with wsc messages and behaviors by “pushing through” the discomfort and intense emotions to get “past” them to feel “better.” defensiveness and pushing through both result in “dirty pain,” the “pain of avoidance, blame, and denial” that hurts and harms others with the impact of those actions (menakem, 2017, p. 20). while psychological defenses decrease the intensity of anxiety, defending against and trying to push through pain and discomfort blocks one’s ability to fully engage and learn (goodman, 2011, p. 51). some common white group-level defensive behaviors emerging from psychological defenses include: giving “perfectly logical explanations,” separating oneself from group (“i’m not like that”), devaluing white people who act “like that,” overidentifying with bipoc, making dismissive statements (“oh, that’s not about race”), minimizing, joking about or denying the racialized aspect of a situation, negating bipocs’ reality, and taking charge to feel in control (marino & mattheus; 2011; saad, 2020). white people can learn to experience and work with “clean pain,” the “pain that mends and can build our capacity for growth” by cultivating the ability to hold space to witness, not react out of inner experience, allowing the pain to move, shift, and metabolize within one’s body (menakem, 2017, p. 19). the heuristic supports building the muscle to work with the “clean pain we experience when we don’t know what to do, when we are scared, and when we step forward into the unknown anyway, with honesty and vulnerability” (menakem, 2017, p. 19). this is slow, deliberate, embodied work. much like physical muscle strengthening or desensitization, one starts building embodied muscle to hold space for one’s inner experiences with awareness and the use of recover practices in situations of mild activation. it is common for many white people to initially have difficulty noticing and experiencing bodily sensations due to wsc socialization. awareness can be learned, however, with consistent practice of various mindfulness and somatic practices (siegel, 2018). once awareness is established, one can start with racialized memories that are not too overwhelming (an interaction that recently happened, an awareness about oneself) before moving to past and current situations that activate stronger reactions. here is an initial flow for how to work with those memories: keenan/for white social workers 249 figure 3. initial flow for working with racialized memories create a consistent time to practice working with recover practices and your awareness of your woc in your body when you call up racialized memories. it can be helpful to identify someone who is willing to engage in these practices to serve as an accountability partner for support and feedback as you create a larger buffet of choices and develop your ability to be aware of what is going on inside you. working with internalized dominance and superiority working with internalized dominance and superiority is optimally done with individual practice and in groups of white people who commit to accountability and accompaniment (e.g., white caucuses, affinity groups, accountability spaces; racial equity tools, 2020). many white people are willing to participate if someone extends an invitation and organizes the group. similar to other mutual aid groups, members optimally identify your existing practices to recover in the moment. tune in to your woc. if none come to mind, try new re practices to use in the moment from these or other sources: ogden & fisher’s (2015) sensorimotor psychotherapy strategies, menakem’s (2017; 2022) somatic abolitionism practices, and the center for contemplative mind in society’s (n.d.) practices. call to mind a brief racialized memory and notice what happens in your body. be with your sensations, urges, shifts in breathing, emotions, thoughts about self, and thoughts about others, including urges to suppress or avoid. pause, tune in to woc; try a recover practice and notice impact. if you are not in your woc, stay with the practice; if needed, step away and return later. tune into your woc throughout your day and notice your inner experiences. re dis un re re advances in social work, summer/fall 2023, 23(2) 250 co-create the structure and culture of the group, including sharing intentions, agreeing on a feedback process for accountability, and making a commitment to meet consistently. circle practices can guide the co-creation of a culture that provides processes for noticing and pausing when charged moments arise and for noticing and addressing wsc patterns in group interactions (e.g., politeness, right to comfort, not taking up too much space; circle way, n.d.; hanna et al., 2021; saad, 2020). the pattern of tuning into one’s woc and using recover practices as one is uncovering and discovering can then be used to work with the ways white people have internalized and enact dominance and superiority to interrupt and shift habitual reactions. vinsky and preyatt-hyles (2022) used the metaphor of “systemic chatter” to describe the pervasive ways in which dominant cultural sets of practices and ideas influence one’s thinking, feeling, inner experiences, and practice actions. some common thoughts about self that reflect internalized wsc patterns include: “i’m one of the good white people” (binary thinking); “i’m not like that white person” (superiority); “i’m an ally” or “oh yeah, i know about that” when one does not know (individual self-image); “i’m using this great new strategy” without naming the source (exploit bipoc ideas; okun, 2021; saad, 2020). “doing the work” with these internalized patterns means not only becoming aware of them through uncover practices, but also using recover practices to hold space for uncovering the impact of the expression of those patterns on self and others. recover practices help metabolize one’s reactions about what is uncovered so one can discover how to more genuinely enact anti-oppressive actions (menakem, 2017, 2022). discover practices can gradually shift internalized dominance and superiority through imagination and experiences. imagining various scenarios such as showing up with cultural humility and relating in ways that value what people of less organizational status have to say can begin to provide opportunities for fuller expression of one’s embodied self. workplace experiences can also provide opportunities to practice shifting what was uncovered, such as naming patterns of who tends to speak or what standards are used for decision-making, pausing to listen if one tends to jump in, speaking up if one tends to be silent, and expressing vulnerability or say “i don’t know.” shifting into relating with cultural humility can include noticing the impact of one’s communication on others or asking for feedback during or after the interaction to see if one’s intention aligned with how it was received. it is common to experience activation when trying something for the first time. tuning into one’s body and compassionately working with activations increases one’s ability to more accurately perceive what is happening in interactions. figure 2 provides some prompts for re/un/discover practices to use when working with internalized wsc patterns within oneself over time. keenan/for white social workers 251 figure 4. heuristic prompts for working with self to expand self capacity as you practice, you are strengthening your capacity to recover with compassion to your window of capacity and from the reactivity, emotional intensity, distancing and inner “systemic chatter” that activates defensive responses. from shame to guilt with compassion white social workers’ efforts to strengthen their capacity can become stalled by shame responses triggered by thoughts such as “i’m a social worker, i should be able to” or “i’m not as ‘woke’ as i thought.” the literature on whiteness and wsc note how prevalent shame is amongst white people (diangelo, 2021; saad, 2020). wsc expectations for perfectionism, focus on individual identity, and use of binary thinking can elicit shame when a white person micro aggresses, feels discomfort, and remains silent, or acts in ways that reinforce white supremacy in a group or organization. shame is a pervasive feeling that one is a bad person and that one’s whole self is bad when one has done something wrong or perceived that one has. shame is experienced as “internal violence of the spirit,” and can also be triggered when perceiving threat from others’ judgments and verbal attacks (e.g., call out culture; haga, 2020, p. 197). in contrast, guilt is a feeling of remorse when one does something wrong; it is limited to that specific action. when feeling guilt, people have a sense of themselves as a whole person that is separate yet responsible for the harmful recover with compassion •tune into your whole self: sensations, thoughts, emotions, inner knowing, actions •what are you experiencing in your body? •try various practices that recover into, strengthen, and expand window of capacity uncover with curious, critical reflection •what about this situation sparked an activation within me? •what am i saying about myself? what meaning am i making about this situation? •how am i using power with self and others? what is the impact? •which past patterns are alive in the present that perpetuate white supremacy culture? •how am i treating myself when my impact is not my intention? when i have a new awareness? when i harm someone with silence, words or actions? discover with creative courage •create regular meetings with other white people to collectively practice •practice shifting from harsh judgment to learning in relationship •imagine interactions and experiences of power sharing while being in relationship •explore how understandings inform what's needed: what are your learning edges? •practice holding space for "not yet being able to" and not knowing •try out new recover practices to use in the moment •with creative courage, try out new way of seeing, being, or doing and notice impact •ask for feedback from trusted others, embrace the learning advances in social work, summer/fall 2023, 23(2) 252 action. reactivity from wsc’s focus on individual identities and binary thinking fuels these shame-based responses (e.g., “i’m a good person, i don’t intentionally cause harm”). yet, as saad (2020) noted, the “purpose of this work is not for you to end up living in shame. the purpose is to get you to see the truth so that you can do something about it […] channel those feelings into action and change” (p. 25). here is a composite illustration of how some white social workers have engaged in practices to shift their experiences of shame to guilt. the singular pronoun “they” is used for inclusion. during a case conference with other social workers, a white social worker stated they had frozen and been unable to address the racial microaggressions a white teacher was making about an african american student. on the way out of the meeting, a puerto rican social worker said to them: “why didn’t you say something? you should have done better.” ouch. those words landed in the pit of their stomach as they felt their face flush and had the urge to look down, to turn away, to get away and hide. they couldn’t respond to the puerto rican social worker who said that and felt themselves oscillating between emotional flooding and numbness. re: they went home and wrapped themselves in a fuzzy blanket and rocked for a while. gradually the oscillations became less dramatic; they were able to look around and orient themselves by looking at familiar pictures and lighting a candle. they went to bed early, deciding to uncover the next evening. un: after work the next day, they started uncovering with gentle, curious wondering: what’s this shame about? what am i expecting of myself? how do i think that person sees me right now? what am i saying about myself to myself? re: when wondering about how that person sees them, they immediately got flooded with a wave of shame and felt spacey. they paused, slowed things down, and did some paced breathing to return to the present. they continued to uncover, tuning in to their woc as awarenesses surfaced. un: they noticed that they felt like a total failure and expected themselves to be able to do better because they had been to a lot of trainings, and they really wanted to make a difference. re: as they paused and sat with that awareness and their breathing, memories came to mind. un: they realized that these judgments were connected to wsc messages in their family—they were “only lovable if you perform brilliantly and you always work hard.” they were surprised that those family messages were linked to their anti-racism work. they realized that they did a weave-and-dodge dance in high school to try to stay in their grandparents’ good graces and had never really sorted out how to feel “good enough” in their own eyes. ugh. feelings of disappointment and discouragement arose. keenan/for white social workers 253 re: this was surfacing much more than they thought. this needed more time. they paused for that night and went for a walk to let the activation and energy move in their body. this slower pace was new but felt right. dis: two nights later they picked this up again. they started imagining what it would feel like to experience guilt instead of shame. they didn’t want to make things worse and wanted to figure out how to show up differently. they remembered a few situations with white people where they had messed up and been able to acknowledge it. they took time to be with those memories to feel what that was like in their body, and how that was connected to what they thought about themselves. re: they paused and went for another walk. dis: as they were walking, they imagined what it would be like to feel guilt and not shame with bipoc people. they played out various situations where they would mess up or not be able to process as quickly as they wanted, and just sat with what that felt like in their body. re: walking helped the sensations and emotions flow. they focused on their exhalations. dis: they started hearing some possible things they could say to themselves: “i am learning how to take risks,” “i’m learning with others who have more capacity than i do right now,” “i’m feeling vulnerable and missed the mark and i’m still here,” “i’m sorry, i will do better.” they started wanting to talk about this shift with a couple of other white people that they admire. they got together and talked to learn more about their inner experiences in similar situations, and how they became able to respond in the moment without shame. after a few more days they started having more possibilities come into awareness in the form of “i could haves” which they used to rehearse/replay/prepare for next opportunity. re: they monitored their woc and kept trying and failing forward as they practiced working with inner sensations and activations to shame. shortly thereafter, they asked to meet with the person who made that comment. they said to the person: “yes, i should have done better, and i didn’t. thank you for telling me how that affected you. i am sorry. i’ve been working on it. i’m going to stay at it.” one can use the heuristic to discover ways of working with one’s own moments of causing harm. after uncovering the internal “systemic chatter,” you can tune into your woc and use recover practices to be present with what you have noticed. this can lead to discovering what it feels like to bring humility to moments where you have harmed. with creative courage, these moments can be contextualized within your full self as someone who can be loving, helpful, and hurtful. taking time to hold space with compassion for the people you have harmed and yourself can broaden one’s focus. discovering ways to be more present and do better in the next similar situation can increase advances in social work, summer/fall 2023, 23(2) 254 the likelihood of responding relationally when those moments happen. it can also be helpful to continue practicing with other white people to strengthen your capacity to hold space for owning your impact, remaining in or moving back into one’s woc, and trying new ways of responding in future interactions (frey et al., 2021). focus on being with self in everyday moments although focusing on self in spaces that provide time for slow, intentional practice expands one’s capacity to be more fully present with inner experiences in racialized moments, white people also need to expand capacity to bring that presence to momentary interactions. similar to social work practice, this involves cultivating a dual awareness of what is going on within one’s body and what is taking place with others in a specific situation, of simultaneous attention to inner and outer experiences. with ongoing practice, one can become more and more able to tune into one’s inner experiences during meetings and gatherings and with emails, texts, and social media—attending to the how as much as the what. the prompts in figure 3 can be used to guide one’s thinking and actions with dual awareness of self and a practice moment in the moment and over time. figure 5. heuristic prompts for dual awareness of self and practice moment recover with compassion: • tune into your body: identify urges, emotional reactions, defensiveness to uncover later • hold space for inner activations and use in the moment recover practices • create time to be in relationship with people doing anti-racist work uncover with curious, critical reflection: •how are you using power within this situation? what is the impact? •how are others using power? in what ways (power over, power with)? what are the impacts? •patterns of power in meetings: who talks? who decides? who’s included? in what way and how meaningfully? •how are you and others experiencing your work together? what does it mean to each of you? what's at stake? discover with creative courage: •in conversation with others imagine: what does white people supporting and amplifying bipoc look like in this group, in this situation? •briefly say when you do not know or do not know how to do something •use clear communication (state your thoughts, ask questions, and listen to others) •recognize how wsc shows up in this group notice impacts and talk with bipoc group members •practice interrupting or resisting wsc processes and notice impact (see something, say something) •engage in agreements of who will do what (give and receive) in interdependent relationships •ask for feedback; use learning to inform next conversations and actions keenan/for white social workers 255 as white social workers become able to ignore wsc pulls for superiority and perfectionism, they can take individual responsibility with courage and humility to contribute to collective anti-racist actions. using dual awareness with habitual not seeing one of the advantages of being a member of the dominant group in wsc means that white people can move through their days as individual people without seeing the grouplevel patterns of power continuously reinforcing this dominance. although many white people seek to dismantle white supremacy, there are few negative consequences for not seeing and addressing wsc in one’s family, workplace, and neighborhood. in addition, the stressors of everyday living often pull well-intentioned white people away from conscious awareness and action until the next “horrific” incident occurs because wsc actively encourages emotional detachment and desensitization to violence (ricketts, 2021). wsc perpetuates “a kind of numbness—a numbness of empathy, a numbness to human interconnection” and a failure to see “tiny moments of violence” (morgan, 2022, as cited in bouie, 2022, para. 50). in addition to expanding capacity to address activations out of one’s woc, white social workers also need to awaken from numbness with the forms of racism one does not yet consistently recognize. this can be done by uncovering areas you tend to notice already. combining selections across these categories can provide a multifaceted view: • ecological levels: intrapersonal, interpersonal, group, organization, community, structural • groups of people: clients, colleagues, administrators, community members, family, friends • situations: policies, procedures, meetings, informal conversations, written communications • types of racism: microaggressions, discrimination, structural processes, systemic violence next, you can reflect on what you did not select. are there any patterns that emerge? working with one area or pattern at a time can help you to become more consistently aware of what you have not typically seen. after selecting the area or pattern, creating reminders, prompts, and habits can spark noticing and being present with fresh eyes throughout your day. uncover resources and the heuristic prompts in figure 2 can also guide your efforts to see more broadly (see, for example, diangelo, 2021; drworks, 2021; kivel, 2007; mccoy, 2020; saad, 2020; vinsky & prevatt-hyles, 2022; yosso, 2005). the noticings from your habitual awareness practice can be processed alone and with others, as you uncover patterns of power and do more work with self. this includes continuing to notice how one is treating oneself while working with the new awareness, and drawing on recover practices to support holistic engagement. discover practices with others can provide various ways of using power to support flourishing for bipoc or interrupt or resist wsc. cultivating dual awareness of oneself in specific situations while practicing intentional seeing and being with others can become increasingly possible with advances in social work, summer/fall 2023, 23(2) 256 practice and feedback from others. the prompts in figure 3 can be used as a guide as you practice dual awareness of yourself and others in specific situations. using dual awareness with in-the-moment activation as a reminder, working with activations starts with expecting that white bodies are going to be activated to create a habit of noticing and metabolizing the impact when it occurs. rather than impulsively reacting, metabolizing happens by linking awareness of one’s inner sensations with somatic responses to allow the intensity to diminish (e.g., use of touch on one’s palms or face, rocking back and forth, or vigorous movements). over time, one also can become familiar with one’s activation tendencies (e.g., shifts in breathing, muscle constriction, dissociating, racing thoughts, urges to fix, take charge, hide, or leave; intense feelings of anger, sadness, fear; menakem, 2017, 2022). when activated, one can use in-the-moment recover practices to remain present in a situation: taking a brief pause; engaging in abdominal, square, or paced breathing; orienting self to one’s space; touching one’s palm, thigh, arm, or face; engaging in gentle rocking and other movements; and imagining people or pets behind or next to one for support (menakem, 2017; ogden & fisher, 2015). if possible, it is helpful to notice any “shoulds,” harsh judgments, and “systemic chatter” to uncover later. if you are feeling flooded and unable to remain present in the situation, you can send a message to others to let them know that you need to step away and will be back. stepping out of the room or away from an online meeting can provide the space for recover practices to decrease the likelihood of reactivity so one can rejoin the situation in one’s woc. white people have a role to play in anti-racism work. that includes taking responsibility for one’s impact and communicating what one can and cannot do in specific situations so one’s reactivity does not get inflicted on others through avoidance and denial (menakem, 2017). with practice, it is possible to expand capacity to recover in the moment in others’ presence. composite illustration here’s a composite of a few university and community groups illustrating how the heuristic informed actions of white social workers as they collaborate with bipoc and white colleagues and community members. a multiracial group has been working for racial justice in predominantly white spaces for a few years. this group has organized protests, facilitated educational events, and lobbied for policy changes regarding multiple issues, including anti-black violence, equitable workload distribution, healthcare discrimination, and equitable access to higher education. white people in the group have participated in learning about racism and white supremacy, expanding their understanding of microaggressions, discrimination, and systemic racism. this group has also begun to work more intentionally towards becoming an anti-racist group/organization. keenan/for white social workers 257 people in the group know each other and are in relationship with each other in varying ways. some have close friendships, some have met with each other for a conversation to get to know each other, and some have familiarity from participation in multiple meetings together. the group has tended to be outward facing (i.e., the group came together out of a shared purpose to work for racial justice in predominately white spaces). challenges have recently arisen regarding how the work was being done. who was leading? how did people assume leadership positions? how are new people invited and brought into the group? these questions started a ripple of uncover awareness and uncertainty about what had not been attended to. the emotional intensity was heightened by a couple of incidents of harm in the larger predominantly white space, coupled with white people’s urges to fix, that caused further harm to bipoc members who were already engaging in various forms of self-protection. white social workers met to hold space for their inner experiences, to uncover connections to wsc, and to discover how they could show up in less harmful ways in the group. slow, intentional critical reflection with curiosity surfaced awareness of how sexism and heterosexism were clouding their ability to see the impact of their use of power as white people. they began to see how this showed up in meetings: they jumped in to talk and ask questions, and they felt an urge to focus on one or two white people in the predominantly white space who were doing or accused of doing harm while not seeing how their “white moves” were also negatively impacting bipoc members. they took time to collectively pause, and use recover practices to hold space for those urges to see how they have participated in power over patterns within the group. they turned to patterns that bipoc people identified to uncover patterns they had not been aware of (e.g., menakem, 2022; okun, 2021; saad, 2020). some participants also did individual uncovering to identify the connections to familial patterns or other social identities that were being activated now. recover practices were used to hold space for what each was sensing in their bodies. this was a painful process, because these individuals had been invested in racial justice actions for years and viewed themselves as some of the “good ones” who were helpful and caring (aka, “nice”; diangelo, 2021). a few took time to work with their feelings of “badness,” others practiced slowing down and holding space for their urgency to make things “right” so they would feel more “comfortable,” and a few became aware that their ethnic cultural practices of jumping in or talking over others were causing harm in multiracial group conversations. the larger group is still working with the tensions and impact of harm in an intentional way. the ongoing work for white people focuses on de-centering wsc patterns and trying to co-create embodied relational patterns with bipoc members. this includes being able to hold space within themselves to receive feedback and to use discover practices to express care by listening, pausing, asking more questions, limiting sharing of their ideas and opinions, and holding space for the inner experience of new efforts. in addition, some white group members want to do follow-up work to address low levels of anxiety and fear that their new ways of being will be met with judgments, including “you’re still doing it” or “you need to do better.” advances in social work, summer/fall 2023, 23(2) 258 meeting as a white affinity group can support recovering, holding space to uncover what these fears are linked to, and discovering how to bring courage and humility into trying anyway. expectations for perfection and harsh judgments are often activated in these moments and then projected onto bipoc people. these fears also make it likely that feedback would be perceived as harsh judgments rather than information about their impact. ongoing meetings to practice how to bring compassion to one’s efforts, to hold space for the vulnerability one feels when responding in new ways, and to rehearse holding space for one’s inner experience when asking for and receiving feedback can expand one’s capacity to be more fully present. the re/un/discover heuristic offers practices for working with one’s activations and for responding to everyday interactions when engaged in work to dismantle white supremacy ideology and culture. by engaging in these practices over time, white social workers can discover and consistently draw on recover practices that settle themselves, uncover response tendencies that negatively impact self and others, and discover ways of being that express respect and fuel relational connection. these efforts strengthen one’s capacity to be more fully present and flexibly respond when working with others to cocreate anti-racist white culture. references asher blackdeer, a., & gandarilla ocampo, m. 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(2005). whose culture has capital? a critical race theory discussion of community cultural wealth. race ethnicity and education, 8(1), 69-91. author note: address correspondence to elizabeth king keenan, department of social work, southern connecticut state university, new haven, ct, 06515. email: keenane1@southernct.edu https://doi.org/10.1177/107780040200800103 https://doi.org/10.1177/107780040200800103 https://doi.org/10.1080/10428232.2019.1703246 https://doi.org/10.1080/10428232.2019.1703246 https://doi.org/10.1177/1468017306062222 https://doi.org/10.1177/1468017306062222 https://www.bls.gov/cps/cpsaat11.htm https://www.bls.gov/cps/cpsaat11.htm https://doi.org/10.4324/9780429351501-4 https://doi.org/10.4324/9780429351501-4 https://doi.org/10.4324/9780429351501-4 https://doi.org/10.1080/0312407x.2020.1850816 https://doi.org/10.1080/0312407x.2020.1850816 https://doi.org/10.1080/1361332052000341006 https://doi.org/10.1080/1361332052000341006 mailto:keenane1@southernct.edu ________ cara gray, ph.d., lrt/ctrs, assistant professor, school of health and applied human sciences, robin cunningham, msn, rn, lncc, cne, chse, coordinator of simulation center, school of nursing; stacey r. kolomer, ph.d., mssw, professor and director, school of social work, university of north carolina wilmington, wilmington, nc. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 338-354, 10.18060/23615 this work is licensed under a creative commons attribution 4.0 international license. it’s time to go! unfolding interprofessional simulations to promote health team communications cara gray robin cunningham stacey kolomer abstract: interprofessional education provides an opportunity for allied health professions to gain knowledge of health care team roles, and how discrete disciplines collaborate to contribute to a healthcare team. this interprofessional activity used simulation scenarios with simulated patient actors to introduce students in three healthcare disciplines to the communication and collaboration skills used by teams for hospital discharge planning and follow-up care in a home setting. participation in the simulations was voluntary and open to students majoring in either social work, recreation therapy, and nursing. three, twoperson teams, representing each discipline, participated in a two-part, unfolding simulation to assist with the discharge of an older adult from the hospital, and an assessment and care/teaching one week later in his home. following the simulation, students wrote reflective journals about their experiences, and completed a brief survey. post simulation responses to the ripls questionnaire, and one of its subscales, yielded positive results in relation to improved attitudes towards interprofessional learning and positive professional identity. students’ reflective journals reinforced the impact of interprofessional educational activities on acquiring knowledge about other disciplines. lessons learned from this activity are being used to develop future interprofessional scenarios to augment the academic preparation of pre-professional healthcare workers in multiple disciplines. keywords: communication, interprofessional, simulation, simulated patient a team approach or collaborative model of service delivery in health care is considered a best practice for achieving client outcomes, and exists in a variety of forms depending upon the population served and/or setting (american nursing association [ana], 2017; anderson & heyne, 2012; national association of social workers [nasw], 2005). this approach to care is also within the scope and standards of practice for most allied health disciplines (e.g., nursing, occupational therapy, physical therapy, recreation therapy, social work, speech therapy, etc.), yet, until recently, its emphasis has varied in the educational preparation of these pre-professionals (ana, 2017; american therapeutic recreation association [atra], 2013; nasw, 2005). while collaborative care requires a commitment to shared decision-making for a client, a formal communication structure is also needed to coordinate services, and at times, create one unified plan as a result of independent assessments, planning processes, as well as implementing and evaluating services (anderson & heyne, 2012; who, 2010). the challenge with these highly processdriven technical skills is that they have not been routinely taught at a pre-professional level, and instead have been loosely acquired on the job. due to the common occurrence of collaboration and team approaches in health care, familiarity and comfort with these https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 339 interactions is vital prior to serving a client in any environment. this article will describe an interprofessional simulation experience with three allied health disciplines at a mid-size public university in the southeastern united states. faculty from the social work, recreation therapy, and nursing programs created a twopart, unfolding, interprofessional education (ipe) simulation using a simulated patient and family member in both a hospital and home setting as a method for students in these preprofessional healthcare programs to learn about each other’s scope of practice, roles, and communications on an interprofessional health care team. the use of simulation was chosen as an evidence-based method to augment standard academic learning due to its documented effectiveness in nursing and related fields (cant & cooper, 2017). using the interprofessional education collaborative (ipec; 2016) competencies, faculty focused on three learning outcomes based on ipec’s four core competencies for this project. the three areas of interprofessional education learning outcomes that were included were: (a) demonstrate efficient communication and assessment skills with patients during simulation; (b) communicate clearly one’s roles and responsibilities to patients, families and other professionals; and (c) listen actively and engage other health professionals in shared patient-centered problem-solving and discharge planning. the assumption was that if these learning outcomes could be tested in this pilot project, then the scenario could be refined and replicated every semester with new students. additionally, embedding interprofessional simulation into the standard curriculum for all three pre-professional programs provides opportunities to conduct research, thereby adding to the body of knowledge about the efficacy of using ipe in pre-professional programs for social work, recreation therapy, and nursing. there is a paucity of recently published data (within the past 10 years) about recreation therapy students working alongside nursing and social work students in an interprofessional educational context, let alone via simulation, yet these three disciplines often work in parallel, if not collaboratively, for patient care in mental health, skilled nursing/long-term care, educational, and other settings (davidson et al., 2008; devries, 2016; mcpherson et al., 2001; montemuro et al., 1999). moreover, there is no evidence of the three disciplines working together in a two-part, unfolding simulation with a simulated patient and/or family member. providing students the experience of interprofessional teams in health care, including discharge planning and home care, can offer both a complete and tangible understanding of these processes. these experiences may also foster confidence, while positively viewing and supporting the roles and skills of their allied health counterparts. this article provides a comprehensive overview of the two-part, unfolding ipe simulation designed to improve basic/standard curriculum-based instruction through ipe/training and participation in a typical healthcare scenario. the feedback from students is presented to determine the value of adding simulation to the curriculum, as well as improve the processes and experiences for future students. gray et al./it’s time to go! 340 background interprofessional education ideally, interprofessional teams communicate and collaborate to provide optimal patient care (kolomer et al., 2010). interprofessional education, defined here by the world health organization (who, 2010) is “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (p. 7). the benefits of interprofessional education include improving overall patient care through enhancing communications within and across disciplines and shaping professional identity (brock et al., 2013; buring et al., 2009) traditionally, interprofessional education pertaining to health care professionals occurred on the job; however, a shift in the past decade has pushed pre-professional health care programs in higher education to introduce this knowledge earlier. moreover, interprofessional education was found to be particularly effective when students focus on a specific population (e.g., pediatrics or older adults), or setting (e.g., physical rehabilitation; davidson et al., 2008; mcpherson et al., 2001). while many authors have tried to identify best practices in interprofessional education, all agree that increasing the number of opportunities in health care, in both pre-professional training (higher education) and post-professional continued education, are needed. one example of this is observed in a survey of social work programs in the united states, canada, and israel. of the 106 respondents 93% of programs are integrating a wealth of interdisciplinary activities in social work education (bronstein et al., 2010). in addition to the improvement of patient care, interprofessional education also assists with shaping one’s own professional identity. early contact with other health professions supports students’ understanding the ethics, approaches, communication, and scope of practice of other disciplines, while creating a safe place to confront misinformation and make mistakes (pastor et al., 2016). interprofessional education supports the achievement of these and other goals for students. for example, a study by bridges et al. (2011) of 105 nursing and medical students engaged in interprofessional education activities, found a majority of the student participants stated that interprofessional education improved overall teamwork, trust, and respect. lastly, in a recent study on perceptions and valuing of interprofessional collaboration between therapists in a rehabilitation setting, devries (2016) found therapists who participated did not have varying degrees of beliefs, behaviors, and attitudes about interprofessional collaboration. the participants of this study “indicated a collaborative attitude and equal valuing of the other therapy disciplines” (devries, 2016, p. 12). devries’ study further demonstrated the need for developing and evaluating such interprofessional collaborative opportunities, both in higher education, as well as continued education, for health care professionals. simulation as an interprofessional teaching method simulation is an educational strategy where certain conditions are created or replicated to resemble authentic situations that are possible in real life (gaba, 2004). an ipe advances in social work, summer 2020, 20(2) 341 experience involves simulation-based activities with two or more professions placed into a simulated health care experience with shared or linked educational goal(s) (seymour et al., 2013). the participants learn from, about, and alongside each other to enable effective collaboration that will transfer into practice with the goal of improving patient health outcomes. in studies that have examined the effectiveness of ipe simulation with nursing and medicine, evidence has shown increases in communication, teamwork skills, interconnectedness, self-efficacy, overall collaboration, and has led to improvement in attitudes about interprofessional education (baker et al., 2008; bolesta & chmil, 2014; king et al., 2013; king et al., 2014; saylor et al., 2016; watters et al., 2015). simulation has also shown to be an effective method for students to learn about their roles and identity on a health care team, and increase confidence (saylor et al., 2016; shrader et al., 2011). overall, studies have demonstrated the positive effects of interprofessional education, and the use of simulation as effective teaching methods for aiding students in their chosen disciplines to become more well-rounded, confident, and competent professionals. student feedback and the literature confirm that interprofessional education has immense benefits. however, a majority of these publications have been about nursing and medicine. in social work education more scholarship about interprofessional simulation with other disciplines is needed. method this project used a mixed methods approach to receive feedback from students about how the ipe simulation improved efficient communication and assessment skills and engaged other health professionals in shared patient-centered problem-solving and discharge planning. approval from the university’s institutional review board (irb) was sought and granted, enabling the project to start and continue via amendments. this simulation was unique in that it was two-part and in two settings, coined an “unfolding” ipe case, as each scenario revealed more information about the specific case. a week prior to the first simulation, faculty met with the students for an extensive pre-briefing to learn collectively about each other’s disciplines, ipe, the three learning outcomes of the project, and the simulation activities. the first part of the simulation was the case of an older male patient (simulated patient actor) admitted to the hospital for a fractured femur/hip replacement. the second part, which took place one week later, found the same patient in his home with care being provided by home health and his daughter (simulated patient actor). student teams had the opportunity to assess the patient in each of these settings. students were expected to learn how to communicate to benefit patient care, observe one another’s disciplines, to assess and prioritize a patient’s needs, explore potential interventions, and develop plans for patient education and discharge. following the simulation students met as an interprofessional team to share their assessments, patient teaching, and collaborated on a discharge plan. they then individually responded to questions in reflective journals and completed the readiness for interprofessional learning scale (ripls). gray et al./it’s time to go! 342 participants participation in this project was voluntary and open to social work, recreation therapy, and nursing students enrolled in one of three classes at the university of north carolina wilmington. the courses the students were enrolled in are unique to their disciplines and also relevant to the simulations. the social work students were enrolled in an ethics course, the recreation therapy course was specific to physical rehabilitation, and the nursing course focused on adult health. students in these classes volunteered for the project by notifying faculty of his/her interest and availability. for each part of the simulation, student teams were designed to include two recreation therapy, two nursing, and two social work students. assignment of which simulation to participate in was also based on student availability. since not all students could participate in the simulation, it was filmed and made available to all students enrolled in the three classes. for the first part of the simulation, there were three social work, four recreation therapy, and four nursing students; ten females and one male. social work students were graduate level, and the recreation therapy and nursing students were undergraduates. only three of the eleven had ever participated in an interprofessional educational experience prior to participation in this project, and the students who had exposure were all from social work. the simulation was repeated to maximize student participation. the first time the simulation occurred there were two social work students, two recreation therapy students, and two nursing students. each discipline observed the other disciplines interacting with the simulated patient actor through the two-way mirrors. when the first part of the simulation was repeated there was one social work student, two recreation therapy students, and two nursing students. as with the first time, each discipline observed the other disciplines interacting with the simulated patient. the second part of the simulation included four students from each discipline (social work, recreation therapy, and nursing); in total, eleven females and one male. as with the first, all but the social work students were undergraduates. only two of the twelve students had ever participated in an interprofessional activity prior to this project, and the students who had previous experience were in the social work program. as with the first simulation, the simulation was repeated to maximize student participation and each discipline observed the other professions with the simulated patient. during each run of the simulation there were two social work students, two recreation therapy students, and two nursing students. setting: simulation labs the university houses a state-of-the-art 10,000 square foot simulation learning center which includes eight acute care hospital labs (scene for scenario 1), a home apartment which includes a den, kitchen, bedroom, and bath-scene (scene for scenario 2), and a clinic which mimics a physician’s office. all equipment is current with what students will see and use in practice, essential to maintain realism in simulated learning. each room has twoway mirrors as well as recording equipment. advances in social work, summer 2020, 20(2) 343 data collection qualitative. the project sought to collect qualitative and quantitative data on attitudes toward interprofessional communication and about the simulation exercise itself. this information was provided by responses to questions in the reflective journals. students completed these within two weeks after each simulation. although the reflective journals contained 23 questions, the first seven questions were mandatory for all students to respond to, while each discipline responded separately to the remaining 5-6 discipline-specific questions (see table 1). the trustworthiness or content validity of the reflective journals was evaluated by determining the degree to which the responses paralleled or expanded upon the quantitative responses in the ripls. table 1. reflective journal questions for student groups group reflective journal question all 1. what else would you want to know or should have asked about this patient situation? 2. what did you see as the biggest obstacle in working with this patient? 3. give examples of how the roles and responsibilities of the team members were communicated to the patient and other team members. 4. what emotions were being conveyed by the patient and how well were they addressed? 5. discuss any cultural implications of this scenario. 6. who is a part of your treatment team and what were their roles? 7. what type of patient and family education was important to carry out in this scenario? why? explain. recreation therapy 8. what aspects of this patient and his situation will you consider when selecting an assessment to use? 9. how will you involve the patient in their care? 10. how will the assessment be administered to the patient? 11. what information will be utilized for planning (discharge planning)? 12. how will progress/regress/no change be measured? 13. what evaluation methods will be used? nursing 14. what assessments did you carry out and why? what were the priorities for the hospital and the home? 15. what were the priority nursing diagnoses with this patient scenario? 16. how would you involve the patient in their care? 17. what teaching was a priority in the hospital and for discharge home? 18. what are some safety considerations in the hospital and after discharge? social work 19. what were some ethical challenges in this scenario? 20. what is the most significant learning that you took away from viewing these videos? 21. is using simulation exercises as a method instruction useful? why or why not? 22. did you notice any differences in how the sw students handled the scenario, as compared to the way the nursing or recreation therapy students did? 23. make a link to the issue of selfdetermination and health policy. gray et al./it’s time to go! 344 quantitative. the instrument selected to provide the quantitative data was the readiness for interprofessional learning scale questionnaire (ripls) via hardcopy (i.e. paper), which was completed by individual students in each team after each part of the simulation (post-team meeting; parsell & bligh, 1999). the ripls assesses attitudes towards interprofessional education for students in training and was chosen due to its relevant focus on teamwork, shared learning, and communications. additionally, the ripls was chosen due to its ease of completion for the participants and the time it takes to complete (parsell & bligh, 1999). the ripls uses a standard likert-scale with a range of 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating more positive attitudes towards interprofessional learning. created by parsell and bligh (1999), the ripls has an internal consistency of 0.90 (cronbach’s alpha). this 19-item self-report scale contains three validated subscales (binienda, 2015; mcfadyen et al., 2005): a. teamwork and collaboration (valuing cooperative learning and respecting students from other health care professionals); b. negative and professional identify (valuing and benefiting from collaborative relationships with other health care professionals); and c. roles and responsibilities (practical application of interprofessional skills with other health care professional students). procedures simulated patient (sp). the simulated patients (sps) for the unfolding simulation scenarios, a father and daughter, were recruited from a volunteer list of 23 people. the sp for both scenarios was selected based on his appearance resembling a 78-year-old, hispanic male (compared to other male sps in the pool) to ensure realism in the scenarios. the daughter for the sp in scenario 2 was selected due to her small stature and resemblance of someone age-appropriate for the role to keep as much realism as possible. both sps were brought in two weeks before the first simulation to meet with the three faculty for training, which included a review of student learning outcomes for the simulation, information on each discipline, discussion of both scenario scripts, and explanation of verbatim statements for each of their roles. time was provided for the sps to practice their roles and discuss aspects of their roles with the faculty. in addition to this preparation the sps arrived 1 hour early on the days of the simulation to ensure sufficient preparation time (props in place such as hospital gown, id band, home props), and comfort in their roles. pre-briefing. the interprofessional teams were provided the opportunity to engage with each other before the simulations took place. prior to participating in the simulation, students attended a pre-brief meeting in which they were oriented to the learning environment, educated about roles of participants, informed of expectations, and encouraged to feel safe in presenting as their identified profession. the pre-briefing was led by course faculty and the simulation lab coordinator. students were provided the goals, the three learning outcomes based on ipec’s four core competencies for this project, and expectations for the interprofessional simulation experience. they were given case advances in social work, summer 2020, 20(2) 345 background information, in addition to any other pertinent information. confidentiality was stressed, along with establishing a psychologically safe environment where learners could ask questions prior to the experience, and then openly reflect after the experience via debrief (rudolph et al., 2014). students were also provided a fictional contract to sign prior to participating. the fiction contract reminds students to engage as fully as possible in the scenario and treat the actor like a real patient. this contract is an agreement between participants and facilitators about interacting during a simulated situation in a professional manner, as if a situation were real, and to maintain levels of ethical and responsible conduct, as well as confidentiality (rudolph et al., 2014). at the pre-brief students were also given information packets, created by faculty, containing a document with the rationale for carrying out the two-part scenarios, the interprofessional simulation learning objectives with ipec competencies, scope of practice document for each discipline, and basic information about hip replacement surgery, and the important precautions for the patient to learn post-operative (e.g. information on general incision care and possibility of complications such as a blood clot(s) or infection, etc.). finally, participants were given the expected roles of each discipline for each scenario. additional information provided to the students was dependent upon discipline. for example, since the scenario was focused on a hospital discharge, social work students were provided with information regarding self-determination and patient choice as well as community resources. recreation therapy students were provided with a 12-item, standardized assessment to use with the patient in both simulations (who, 2010). nursing students were given directions for administering an abbreviated physical assessment (vital signs, heart, lung, skin, mobility), as well as for providing patient education on hip replacement precautions in preparation for discharge. ipe simulations this project used a two-part, unfolding ipe simulation that included two separate ipe simulations, and were inextricably linked through the typical patient experience of first being treated in a hospital, then in a follow-up visit at home. both scenarios were conducted in simulation labs at the university (e.g. simulated hospital room, simulated apartment). each discipline met with the patient for 15 minutes in the hospital and 15 minutes in the home for a total of 45 minutes. each part described below was provided to the students’ in their information packets (table 2). interprofessional team meeting. each scenario ended with an interprofessional team meeting to discuss observations, assessment results, interventions used, and provide an overall evaluation of what each group experienced with the patient and/or his daughter. these meetings, led by a simulated charge nurse (faculty from each discipline rotated this role), concluded with the development of a plan for the patient and his providers to ensure mr. garcia’s goals would be met moving forward. readiness for interprofessional learning scale questionnaire (ripls) and reflective journals. following the interprofessional meetings, the students returned to a conference room to complete the ripls and debrief the simulation. students completed gray et al./it’s time to go! 346 reflective journals and returned them to their respective faculty via email within two weeks of participating to provide enough time to reflect on the experience. at this point, student participation in this project ended. table 2. ipe simulation scenarios simulation scenario hospital mr. robert garcia, is a 77-year-old hispanic male, who fell at home last evening and sustained a left femur fracture. a neighbor heard him yelling and called ems. he underwent a left total hip replacement last night, he came to the unit at 0100. his history is significant for: alcohol abuse, diabetes, heart disease, but has been stable on meds at home. he has tolerated liquids only. he has po (oral) meds ordered now. he is to get up with assistance by this evening. he has a son living far away and daughter in town, but they have not arrived yet. his wife of 52 years died from an mi (heart attack) 6 months ago. he lives alone in a 2-story home. the time is now 1pm. the three disciplines will visit him, conduct an assessment based on their discipline, and then share their findings collaboratively at a team meeting in the hospital immediately after the visits. home mr. robert garcia, 77, was discharged from the hospital one week ago. he is receiving home rehabilitation and follow-up nursing care. he will receive a follow-up visit by social work, recreation therapy, and nursing to assess his physical and emotional needs, progress with rehab therapy, wound care, nutritional intake, activities of daily living, and home safety. he will be assessed and given needed teaching information during the visit by each of the disciplines. the time is now 1pm. the three disciplines will visit him in his home, conduct an assessment based on their discipline, and then share findings with each other immediately following the visit. analyses qualitative. the reflective journal responses were de-identified by each discipline’s faculty and compiled in an aggregate-type word document. all three faculty members reviewed and analyzed the content of the responses, paying close attention to themes mirroring the learning outcomes. the same was done with the de-identified, qualitative responses from the ripls. quantitative. quantitative data analysis occurred in three parts. first, demographic information from the ripls was recorded regarding the student’s discipline, sex, if they had completed the ripls prior to this project, and if they had previous experience(s) with interprofessional teaching/learning. next, likert-scale data were recorded on the full ripls scale for all participants, and a basic univariate analysis was run. subsequently, scale data from the ripls subscale focusing on professional identity was recorded and run through another basic univariate analysis. both sets of scale data were run using ibm spss statistical software for macintosh, version 22.0. after all descriptive statistics from the ripls data were completed, the qualitative remarks from the ripls were de-identified and recorded on a microsoft word document to be analyzed with the other qualitative data from the reflective journals. this same process was repeated after each simulation. advances in social work, summer 2020, 20(2) 347 results the purpose of this project was to use simulation as a means to introduce and educate students in three allied health care disciplines to the communication and collaboration skills used by interprofessional teams for discharge planning in a clinical setting, and follow-up care at home, by using two-part unfolding ipe simulations. qualitative responses responses in student journals revealed a few themes which included: benefits resulting from participation, questions that arose about practice amidst simulation, observations of other disciplines’ contributions to care, and general statements indicating a positive evaluation of participating in an ipe simulation. benefits. reduced anxiety was a common response by students. as one student stated, “before, i felt nervous and apprehensive, and sort of unprepared. after i felt it was much more natural and realistic than i imagined.” another student stated something similar and added, “after the simulation i feel more excited to work with other professionals.” another benefit to the simulation was the value of communicating and collaborating with other disciplines. as one student noted, “i learned about the professions i will work with, this helps me learn how we can effectively help the client in unison.” in addition to the value of communicating with other disciplines was the excitement to work with other professionals. a student commented, “this is an amazing exercise that could benefit all students. having this hands-on experience has really helped me get a better idea of what my career will look like.” what we wish we knew. the simulation raised questions about real life challenges. students reflected about things they wish they knew, had access to, or knew what to ask from the start. one student stated, “i would like to know how his home life after the fall compared to his home life before the fall, was the patient taking anti-depressants before he had the surgery?” another student noted, “i wish i would have asked which specific questions from the assessment were more important for our patient’s situation to have used my interview time more efficiently.” students also reported that the biggest obstacles encountered were the limited length of time with the patient, and how they needed to be more efficient with time because of that; this is also an obstacle in practice, so developing such awareness as a student is promising for post-graduate professional practice. these questions reveal the critical, reflective thinking that simulation can mimic prior to these pre-professionals entering practice. observations of other professions statements made pertaining to student observations of other disciplines’ contributions to care included the following: “i liked how social work asked about his favorite meal that his wife cooked,” and, i really like how the rec therapists asked the patient to go into the kitchen and explain how he was able to access and use everything there. i think this really engaged the patient and shifted the focus to what he and his daughter found important. gray et al./it’s time to go! 348 overall, the students found value in working alongside other professionals to discuss patient care, as they were able to recognize both overlap and where things were missed, as evidenced by this student response: many of the team members brought up the same points to the patient without even knowing they were doing so. the team members also did their best to stay on track with their specified field by saying things such as “that is something you could talk to nursing about,” etc. the team members also got together at the end to meet and discuss their findings. most of the findings were similar, i also noticed that each team seemed to notice things that another team did not. it is always good to have as many eyes as possible because each person sees something another does not. quantitative results based on the aggregated results of the quantitative analyses performed (see table 3), the overall means score for the first simulation (n = 11) was m = 76.4 (sd = 3.6), and the overall means score from the second simulation (n = 12) was m = 75.1 (sd = 4.2). the maximum value of the scale was 95, therefore, these scores indicated a mostly positive attitude towards interprofessional learning. included in the aggregate data for the full scale, questions 1-9, which surveyed overall attitudes towards interprofessional learning and its benefits, responses averaged 4.8687 for the first simulation and 4.8704 for the second simulation, indicating a high degree of agreement. average scores for questions 10, 11, 12 and 18 indicated strong disagreement with devaluing interprofessional learning (i.e., seeing it as unnecessary and/or unwarranted), responses m = 1.5227 for the first simulation and m = 1.4792 for the second simulation. another question included in the aggregate data for the full scale but investigating if respondents place more value on their own role(s) than the role(s) of others yielded an average score of 2.4545 for the first simulation and 2.1667 for the second simulation. based on the results of the analysis of the subscale for positive professional identity, the first simulation (n = 11) scored m = 19.5 (sd = 1.0), while the second simulation (n = 12) subscale score was m = 18.7 (sd = 2.0). responses for the first simulation averaged 4.8637 and 4.667 for the second simulation. the maximum value of this subscale was 20, therefore, indicating an overall positive attitude toward one’s professional identity. table 3. ripls scores of students in interprofessional collaborative care teams in multi-day simulations scales items range of possible scores* m (sd) simulation 1. hospital (n = 11) simulation 2. home (n = 12) ripls scale* 19 19-95 76.36 (3.64) 75.08 (4.17) positive professional identity** 4 4-20 19.45 (1.04) 18.67 (1.97) *based on standard 5-point likert scale. higher scores indicate positive attitudes towards interprofessional learning. **subscale measure of positive professional identity included q13, 14, 16, 17, with q17 substituted for q15. advances in social work, summer 2020, 20(2) 349 discussion before this project began, students were asked in the pre-briefing meeting by their faculty and simulation coordinator to identify and discuss what they knew about the other disciplines, and how they worked together. while the majority of the students could briefly discuss the roles of other health care providers, few could articulate other allied provider’s approaches to care, or scopes of practice. the results from this preliminary project indicate that the students from three disciplines at this university held overall positive attitudes towards interprofessional learning and perceived themselves and their disciplines in a positive manner. as reported in their journals, students felt more comfortable with their own professional role and in working with others post-simulation and were therefore better prepared for future practice. although the overall findings of this project were positive, many limitations exist and present future challenges. limitations the first limitation is the number of students who could participate in-person. this project was designed to allow for a maximum number of students to participate in-person; however, this only yielded n = 11 for the first and n = 12 for the second scenario; n= 23. due to the time required, it was not possible to include all students in each discipline’s courses to participate in-person unless each scenario was replicated multiple times. this option was not available for many reasons, some of which included demands of other courses, faculty and administrative responsibilities, time and simulation lab availability. to increase exposure, the simulations were video and audio-recorded and shared with students who did not participate. these video and audio links were made available to all students via each course’s digital learning platforms. a lesson learned from this initial project is that while these links were not incorporated into the courses via lecture or mandatory assignments, they should be in order to increase active participation and engagement by all students; this will be done with future ipe simulations. the reality of including every student in-person will always present as a challenge; however, with the use of technologies such as live-streaming or pre-recorded links into the curriculum, all students could respond to the ripls and reflective journals, and perhaps gain similar benefits as those who participate in-person. a second limitation was not using the ripls prior to students participating or viewing the simulation. due to the timing needed for the project, the use of ripls was only completed post-simulation. a third limitation was the lack of diverse simulated patients (sps). the simulation program has been successful recruiting older, white, retired volunteers. as a result, the sp who played mr. garcia was an older white man, and an older white woman played his daughter. as we move forward to incorporate more simulated experiences within interprofessional education, especially experiences addressing more age and culturallyrelated foci, effort must be made to engage and sustain a diverse sp pool to support the pre-professional development of culturally sensitive and competent practitioners. gray et al./it’s time to go! 350 for this pilot project, satisfaction with achieving the goals and learning outcomes occurred despite the limitations identified. identifying the limitations provided issues to consider for both maintaining, and improving the quality experience, and outcomes of ipe simulations to improve pre-professional education for allied health care providers moving forward. implications for education: future simulation considerations future considerations for ipe simulation in pre-professional education for health care students were identified as the following: using preand de-briefing, preand post administration of ripls or another instrument, continuing cross-disciplinary education, increasing education and exposure to diverse scenarios, as well as including other disciplines in the ipe simulations. pre-briefing is an area gaining more attention and development due to its positive impact on both proximal and distal outcomes for the pre-professional education of health and human service workers, as well as health care workers in general (rudolph et al., 2014). a pre-briefing informs and familiarizes providers prior to interacting with patient(s), while also decreasing their anxiety and increasing both individual and group confidence in provider-client interactions (rudolph et al., 2014). debrief is then used post-interaction to clarify and allow for critical thinking through evaluation and supports knowledge synthesis through making connections during discussion; drawing conclusions; questioning observations, conclusions and perspectives, then applying this more refined knowledge into action via patient care plans and implementation processes. in both preand debriefing, faculty/supervisors can correct misinformation and challenge the student(s)/provider(s) beliefs, and assumptions. another consideration is for both preand postadministration of the ripls. this would strengthen the interpretation of results pertaining to attitudes and effect of the simulation experience on students in a pre-professional educational context. using the ripls preand post-simulation may provide more insight into initial perceptions of interprofessional education, attitudes and emotions, professional identity, roles and responsibilities, and could prove to be more beneficial in identifying the effect of simulation participation. in addition, there are other instruments to consider using that may provide richer information about interprofessional learning. continued interprofessional education in the core curriculum informing students about other professions, their approaches (roles), and scope of practice is also vital due to the nature of collaboration and team-approaches in health care. addressing this early in the core curriculum, especially prior to participation in simulation experiences, should further bolster role-clarification and confidence within the students/future providers through increasing their understanding of the roles and responsibilities of all team members and of how each contributes to goal achievement. an example early in core curriculum in social work education, would be to introduce ipe simulations in introduction to social work classes. these courses provide an ideal opportunity for interprofessional instruction. many schools use introduction classes as a recruitment tool to the major. interprofessional simulation exercises in such classes may create more interest in the profession and allow advances in social work, summer 2020, 20(2) 351 other students in different majors to have exposure to how professions work together. assumingly, this would also enhance future collaborative skills and solidify professional identity. another area illuminated for future development is in preparing students for working with and managing relevant, pressing patient challenges, and ethical issues (e.g. falls, alcohol abuse, addiction) which often accompany a patient’s primary diagnosis or reason for treatment. increasing education about prioritizing patient needs due to comorbidities or other personal and/or environmental challenges, (there is rarely a textbook example patient) will help students learn how to manage multiple factors to achieve specific outcomes. an example during the second simulation was student participants appearing uncomfortable addressing the patient mixing alcohol with his medications during the home scenarios. while each discipline emphasizes the importance of self-determination, simulation exercises provide an opportunity to see how each profession applies the value of self-determination, particularly when a patient was exhibiting an unhealthy behavior. more education and practice with addressing these types of concerns could increase student confidence. like this, is developing additional scenarios which address diversity in multiple forms (e.g. age, gender, ethnicity, language, health conditions). this can only improve overall provider competence when working with diverse clientele. lastly, including other allied health disciplines such as medicine, nutrition, physical and occupational therapies can also increase understanding of other providers, their roles, responsibilities, and scope of practice. early exposure to, and emphasis using multidisciplinary approaches to managing and treating health conditions in an individual and community, can only increase interprofessional communication and team approach to patient centered care. conclusion over a 2-week period a 2-part unfolding ipe simulation was conducted including three disciplines from a public university in the southeastern united states. both ipe simulations concluded with all student-participants completing the ripls and responding to questions in a reflective journal. results from the ripls and reflective journals revealed positive attitudes towards interprofessional learning by all students. additionally, data from a subscale of the ripls indicated positive professional identity by all students in each of the three disciplines (social work, recreation therapy, and nursing). providing these interprofessional experiences, students’ academic knowledge was enhanced while supporting translation of that knowledge into practice. this benefits each student in each discipline, as well as collectively, by improving skills, confidence, attitudes, and competence. moving forward, developing other unfolding simulations using multiple disciplines and settings will further support the aim of improved communications between disciplines to benefit patient care and achieve outcomes. while not every student may be able to participate in every simulation, the benefit of live stream into classrooms or prerecorded audio and video links incorporated into curriculum via lecture or assignments, would enable full participation for all students, and further augment pre-professional education in health care programs. gray et al./it’s time to go! 352 introduction of interprofessional practice 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(2010). framework for action on interprofessional education & collaborative practice. author. https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng. pdf;jsessio author note: address correspondence to cara gray, university of north carolina wilmington, 601 s. college road, wilmington, nc, 28403. e-mail: grayc@uncw.edu https://www.socialworkers.org/linkclick.aspx?fileticket=yog4qdeflbe%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=yog4qdeflbe%3d&portalid=0 https://doi.org/10.1046/j.1365-2923.1999.00298.x https://doi.org/10.1016/j.ecns.2016.03.005 https://doi.org/10.1097/sih.0000000000000047 https://doi.org/10.1097/nne.0000000000000228 https://doi.org/10.1016/j.surg.2013.04.057 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3138354/pdf/ajpe61.pdf https://doi.org/10.1136/bmjopen-2014-005472 https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessio https://apps.who.int/iris/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf;jsessio mailto:grayc@uncw.edu _________ mark a. shaffer, phd, msw, assistant professor, and linda houser, phd, msw, professor, school of social work, salisbury university, salisbury, md. karla hembree, msw, jewish family and children’s services in minnesota, minneapolis, mn. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 102-113, doi: 10.18060/27963 this work is licensed under a creative commons attribution 4.0 international license. the connection between anxiety and empathy in social work students mark a. shaffer linda houser karla hembree abstract: anxiety and empathy are familiar concepts for social work students. this study explored levels of anxiety and empathy in a group of students to understand if there was a connection between the two. the participants were current social work students studying at the undergraduate or graduate level. they were studying in in-person and online classrooms. a total of sixty-five participants completed two instruments, the generalized anxiety disorder (gad-7) scale for anxiety, and the interpersonal reactivity index (iri) for empathy. within this sample of social work students, anxiety and empathy were moderately correlated. at p<.05, gad-7 scores were significantly correlated with total iri scores (r = .38, p < .01), as well as sub-scores for fantasy (r = .34, p < .01), personal distress (r=.30, p < .05), and empathic concern (r = .31, p < .05). gad-7 scores were not significantly correlated with perspective taking. findings suggest that both educators and practitioners have roles to play in helping emerging professionals develop awareness of their reactions to those with whom they work. through developing awareness, social workers may be better able to minimize emotional burden and maximize the advantages that come from empathic engagement. keywords: anxiety, empathy, social work education, student teaching in a social work program is different than teaching in other disciplines. the goal is to prepare students to practice in a variety of roles that involve working with populations that may have significant trauma, difficult life situations, and mental and emotional stressors. learning how to use empathy in practice both ethically and effectively often involves an introspective look at one’s own functioning. to guide students in their learning journeys, social work educators benefit from a strong understanding of the social work student population (undergraduate and graduate), including how students deal with academic and life stressors. incorporating this understanding into curriculum and program planning can help social work educators and programs enhance students’ abilities to care for themselves while learning to care for others. social work is a demanding academic program of study and a demanding profession (collins et al., 2010). researchers examining individuals’ pathways to the profession have observed the prevalence of adverse childhood experiences, trauma, and traumatic stress in individuals pursuing careers in social work (branson et al., 2019; mazza, 2015; shannon et al., 2014). in a study of undergraduate students in the united states, branson et al. (2019) found that those majoring in social work were more likely than those majoring in other disciplines to report adverse childhood experiences. the connection between childhood adversity and clinically significant levels of anxiety and depression is well-established in college students (davies et al., 2022; watt et al., 2020). thus, the experiences that about:blank shaffer et al./swk student anxiety & empathy 103 introduce or draw individuals to social work may also be those that make them more vulnerable to the emotional strain often accompanying this work. adverse experiences have also been shown to be negatively correlated with empathy (cerqueira & almeida, 2023), albeit in studies often conducted with justice systeminvolved adolescents and adults (narvey et al., 2021). despite the high value and recognition accorded to empathy as a skill in social work practice, it has rarely been studied in student populations (greeno et al., 2018). in a study of social work and nursing students, greeno et al. (2018) found high levels of empathy across all groups, with higher levels recorded for graduate social work (msw) and nursing students than for undergraduate social work (bsw) students. work engagement and volunteer experience were positively related to empathy (greeno et al., 2018), suggesting that exposure to the experiences of those receiving social services can enhance empathy. this study investigated levels of empathy and anxiety among social work students and explored the connection between these two concepts. information derived from the study can be used to enhance social work educators’ understanding of students, as well as to plan and create programs, curricula, and assignments that enhance students’ experiences and prepare them for the challenging nature of the career. literature review empathy: conceptualization and measurement empathy is the ability not only to understand another’s emotional experience but also to take part in the emotions themselves (knight et al., 2019). in healthcare settings, empathy enables connection. empathic interaction allows for sensitivity and delivery of humane and effective treatment interventions (barbosa et al., 2013). in prior studies, empathy has been correlated with positive provider and patient interactions as well as an improved quality of care (hojat et al., 2002). knight and colleagues (2019) described two distinct types of empathy: affective empathy and cognitive empathy. affective empathy happens when a person experiences the emotional state of another, whereas cognitive empathy encapsulates the ability to understand or take someone else’s point of view (knight et al., 2019). in a seminal and oft-cited work in the field of empathy research, davis (1983) described empathy as a deeply felt reaction to observations of someone else’s experience. davis (1983) asserted that empathy is multidimensional and that to understand one’s response to others, these dimensions should be explored. as a measure of the concept of empathy as a multidimensional construct, davis created the interpersonal reactivity index (iri). the iri assesses empathy using four distinct areas or dimensions: perspective-taking, fantasy, empathetic concern, and personal distress. the perspective-taking dimension addresses “the tendency to spontaneously adopt the psychological point of view of others” (davis, 1983, pp. 113-114). according to davis, individuals who scored high in this dimension tended to function better socially and had higher levels of self-esteem. fantasy “taps respondents’ tendencies to transpose themselves advances in social work, spring 2025, 25(1) 104 imaginatively into the feelings and actions of fictitious characters in books, movies, and plays” (p.114). davis found no statistically significant connection between fantasy and self-esteem or the ability to function in social settings. he also discovered that when a person scores higher on the fantasy subscale, they tend to show their intelligence verbally. such individuals also had a “tendency towards emotional reactivity” (p. 120) and to be more sensitive to other people. the empathetic concern dimension of the iri assesses “‘other-oriented’ feelings of sympathy and concern for unfortunate others” (p. 114). davis found a weak connection between empathic concern and how a person functions socially; having a high score in empathetic concern can lead to the person being shy and anxious. there was a weak relationship between empathetic concern and self-esteem. empathetic concern was significantly and moderately associated with emotional reactivity and having a selfless care for other people. the fourth and final dimension of the iri personal distress “measures ‘self-oriented’ feelings of personal anxiety and unease in tense interpersonal settings” (p.114). this dimension of empathy addresses how an individual feels while being around others and viewing their experiences. according to davis, individuals who scored high in personal distress “tended to report being more shy, more anxious, and less extroverted than those with low [personal distress] scores” (p. 121). they were more likely to be emotionally vulnerable. empathy in social work students while there is little current research on the correlates of empathy in social work students, some authors have described ways that empathy might be cultivated or enhanced. walter and shenaar-golan (2018) explored incorporating exercises in sensory language to try to enhance empathy in social work students. gair (2017) researched the impact of increasing social work students' levels of confidence on their empathy for social justice issues. researchers in australia explored reflections from students on social media and empathy in a course that focused on interpersonal skills (blakemore & agllias, 2020). another article explored the use of “diversity dolls” to help students develop empathy for populations the student and social worker would serve who would be considered vulnerable (papouli, 2019). none of these studies was conducted with students in the united states, and none examined correlates of empathy in students. anxiety in social work students while most college students experience some degree of anxiety during their educational journeys, social work students may experience it more frequently and at higher levels. some studies have documented specific sources of anxiety in social work students, such as the effects of climate change (doğan & buz, 2024) and the impact of the covid19 pandemic (díaz-jiménez et al., 2020). in a study of social work students in peru, palomina-coila et al. (2020) found that 48% of the study participants reported symptoms of depression, anxiety, and stress. shaffer et al./swk student anxiety & empathy 105 social work students are expected to work in different environments and understand and react to many situations through their internships and education. while researching anxiety among social work students, baird (2016) found that students experience anxiety from a variety of situations such as their field practicums, statistics classes, research, and overall fear because of how they might be performing. multiple reasons for this anxiety exist, like events that occur during practicum, the pressure put on students during internships, lack of confidence, lack of preparedness, and stress and concern (baird, 2016). students who have difficulty regulating their emotions during these stressful or tough experiences have been found to struggle with anxiety as well and have less confidence in their abilities (baird, 2016). symptoms of anxiety could also be prominent in social work students due to underlying mental health issues, their relationships with their field instructors, and their level of education and age which might determine the amount of experience they have (baird, 2016). connecting empathy and anxiety in social work students prior studies exploring relationships between empathy and anxiety suggest that these constructs may share an underlying foundation of sensitivity and emotional awareness (knight et al., 2019). knight and colleagues used neuroimaging, functional mri, visual images, and validated questionnaires (i.e., toronto empathy questionnaire, state-trait anxiety inventory, penn state worry questionnaire, and ruminative response scale) to investigate the underlying neural correlates of empathy and anxiety. their findings demonstrated that empathy was highly associated with worry and that worry, rumination, and anxiety were all highly correlated. higher empathy related to higher worry which then increased anxiety. furthermore, empathic concern and empathy in general were reported more frequently when self-reflection and predicting the emotional responses of others occur. anxiety then tends to be present when internally generated thought is reinforced by emotion-driven rumination (knight et al., 2019). knight et al.’s findings are consistent with the results of prior studies conducted with helping professionals. in a study of staff nurses in madrid, spain, ayuso-murillo et al. (2020) identified a positive relationship between anxiety and empathy (specifically the components of warmth and liveliness). rodrigues sampaio et al. (2020) found a positive relationship between anxiety and empathy in a sample of brazilian nurses and physicians, with the relationship driven primarily by the components of fantasy and personal distress. within the past five years, researchers have published two meta-analyses examining relationships between anxiety and empathy in adults. the first, published in 2021 by pittelkow et al., included 48 studies, some using clinical samples (i.e., individuals with social anxiety disorder) and some using non-clinical samples. the authors reported a weak, positive association between social anxiety and affective empathy, but a weak, negative association between clinically significant levels of social anxiety and cognitive empathy. this suggests the possibility that, at sub-clinical levels, individuals with more social anxiety may feel or experience greater empathy. however, social anxiety that reaches a level of clinical concern may compromise individuals’ capacities for cognitive empathy (i.e., their capacity to take another’s point of view). advances in social work, spring 2025, 25(1) 106 the second recent meta-analysis to examine anxiety and empathy identified 116 quantitative studies, covering nine types of anxiety (e.g., global anxiety, social anxiety, agoraphobia) and three categories of empathy (i.e., cognitive, affective, general; nair et al., 2024). nair et al. (2024) found weak, statistically significant relationships between anxiety and empathy, across types of anxiety. consistent with pittelkow et al. (2021), nair et al. (2024) found the relationship between anxiety and empathy to be weaker and less consistent for cognitive empathy than for affective empathy. this study explored levels of anxiety and empathy in social work students to see if there was a connection between the two constructs. there is limited literature on anxiety in social work students and very little on empathy in social work students. we found no prior studies exploring possible connections between anxiety and empathy in social work students in the united states. method we surveyed students enrolled in either an undergraduate (basw) or graduate (msw) program at a public, teaching-focused university. the survey included questions about gender and age, as well as items from two assessment scales, the generalized anxiety disorder (gad-7) scale to measure anxiety and the interpersonal reactivity index (iri) to measure empathy. the information was gathered using qualtrics, allowing participants to take the survey either on computer or their mobile phone. participants and recruitment participants were recruited through constant contact during the spring of 2022, using an email list containing current social work students. in addition, flyers with a qr code linked to the survey were distributed directly to students, as well as to students via faculty and staff. the students were all currently enrolled in classes (either in-person or online) and included basw students (junior or senior) and msw students. of the approximately 651 students enrolled that spring, 65 completed the measures of both anxiety and empathy (for a response rate of 10%). respondents were invited to self-identify their gender. of the 63 who provided their gender identity, 54 identified as female/woman, 7 as male/man, and 2 as non-binary, queer, and/or trans. of the 64 respondents who provided data on age, a quarter (n = 16) reported being between ages 18-21; just over a quarter (n = 17) were between 22-25; another quarter (n = 17) were between 26-40; and the remaining 14 students were over 40. responses were collected between march 23, 2022, and may 11, 2022. assessment measures we chose two instruments to assess anxiety and empathy. developed by spitzer et al. (2006) as a brief, self-report measure used to detect generalized anxiety in adults, the gad7 includes seven items inquiring about the frequency of respondents’ anxious experiences over the previous two weeks (i.e., “feeling nervous, anxious, or on edge”; “not being able to stop or control worrying”; “worrying too much about different things”; “trouble shaffer et al./swk student anxiety & empathy 107 relaxing”; “being so restless that it is hard to sit still”; “becoming easily annoyed or irritable”; “feeling afraid, as if something awful might happen”). individual item scores range from 0-3 (0=not at all; 1=several days; 2=more than half the days; 3=nearly every day). the scores are then totaled, with totals corresponding to degrees of anxiety: 0-4 indicating minimal anxiety; 5-9 indicating mild anxiety; 10-14 indicating moderate anxiety; and 15-21 indicating severe anxiety. in its initial validation study, the gad-7 was shown to have excellent internal consistency reliability (α = .92) and test-retest reliability. factorial validity, construct validity, and convergent validity were also good, with gad-7 scores correlated with scores on both the anxiety subscale of the symptom checklist-90 and the beck anxiety inventory (spitzer et al., 2006). we measured empathy using the interpersonal reactivity index (davis, 1980). the iri is a 28-question assessment with four subscales, each with seven items. the subscales are perspective-taking, fantasy, empathic concern, and personal distress. perspective-taking measures how a person responds when attempting to see things as another person might (e.g., “i believe that there are two sides to every question and try to look at them both”). fantasy measures the person’s response to taking on “feelings and actions of fictitious characters in books, movies, and plays” (davis, 1983, p. 114) in an imaginative manner (e.g., “after seeing a play or movie, i have felt as though i were one of the characters”). empathetic concern measures the level of “‘other-oriented’ feelings of sympathy and concern for unfortunate others” (p. 114; e.g., “i would describe myself as a pretty softhearted person”). personal distress describes how the person responds to being exposed to the experiences of others which can result in anxiety and feeling ill at ease (e.g., “i tend to lose control during emergencies”). individual item scores range from 0-4, with 0 indicating that the statement “does not describe me well” and 4 indicating that the statement “describes me very well.” according to davis (1983), “all four scales have satisfactory internal and test-retest reliabilities (internal reliabilities range from .71 to .77; test-retest reliabilities range from .62 to .71)” (p. 117). results we began by calculating mean scale scores on anxiety and empathy for the 65 students in the sample. the average gad-7 score for the sample of social work students was 9.61 (sd = 4.87), indicating mild to moderate levels of anxiety. coefficient alpha (α) for the 7item scale was .85, indicating good internal consistency reliability. the average iri score for the sample was 2.53 (sd = 0.47). coefficient alpha (α) for the 28-item scale was .85, indicating good internal consistency reliability. table 1 summarizes descriptive statistics and coefficient alpha for each of the four iri subscales. as was the case for both the gad-7 and the total iri score, alpha coefficients were all above .70, a range generally considered acceptable (doval et al., 2023). advances in social work, spring 2025, 25(1) 108 table 1. descriptive statistics and reliability: iri subscales (n = 65) mean (m) standard deviation (sd) coefficient alpha (α) perspective-taking 2.99 .55 .72 fantasy 2.30 .89 .82 empathic concern 3.27 .59 .78 personal distress 1.56 .69 .72 we then examined correlations between anxiety and empathy, as well as between anxiety and each of the empathy subscales. as shown on table 2, gad-7 scores were positively correlated with total iri scores (r = .38, p < .01), as well as with subscale scores for fantasy (r = .34, p < .01), empathic concern (r = .31, p < .05), and personal distress (r = .30, p < .05). gad-7 scores were not significantly correlated with perspective-taking. table 2. correlation matrix: anxiety and empathy (n = 65) anxiety perspective -taking fantasy empathic concern empathy .38** perspective-taking .04 fantasy .34** .27* empathic concern .31* .52*** .45*** personal distress .30* -.02 .36** .17 notes: *p < .05, **p < .01, ***p < .001 as noted above, we collected data on two demographic indicators: self-described gender and age (in categories). consistent with the profession of social work in the united states (salsberg et al., 2020), as well as with the population of social work students at the research site, women comprised a majority (86%) of the study sample. to explore whether gender and age play a role in the anxiety-empathy connection, we conducted a multivariate linear regression, regressing total iri scores on gad-7 scores, controlling for age and gender (with female/woman compared to all other genders). the relationship between anxiety and empathy remained the same in magnitude, direction, and level of statistical significance with the introduction of control variables for gender and age (table 3). table 3. linear regression: regressing empathy on anxiety (n = 62) variable b (se) 95% ci ß p empathy (iri) 3.49 (1.39) [.71, 6.28] .33 .01 age -.28 (.35) [-3.93,3.33] -.11 .41 woman (excl. man/non-binary) -.30 (1.81) [-.98,.41] -.02 .87 f(3, 58) = 3.29, p < .05, adjusted r2 = .10 notes: se = standard error; ci = confidence interval shaffer et al./swk student anxiety & empathy 109 discussion anxiety and empathy in social work students the social work students who participated in this study had average gad-7 scores of 9.62, between mild (5-9) and moderate (10-14) levels of anxiety. the finding that the participants, on average, scored in the mild to moderate range of anxiety on the gad-7 is consistent with prior studies. specifically, baird (2016) discussed how events that occur during practicum, the pressure put on students during internships, lack of confidence, lack of preparedness, and stress and concern can lead to anxiety. palomina-coila et al. (2020) observed symptoms of anxiety, as well as stress and depression, in 48% of social work students studying in a university in peru. davies et al. (2022) and watt et al. (2020) linked clinically significant levels of anxiety to experiences of adversity in childhood, an area that may warrant further exploration in future studies of social work students. relationships between anxiety and empathy in social work students in the current study, the correlation between anxiety and empathy was low-to-moderate (r = .38, p < .01) and positive. higher levels of anxiety corresponded with higher levels of empathy. these results do not reveal the direction of the relationship and, indeed, it is likely that additional factors, such as emotional sensitivity, may underlie both (knight et al., 2019). results of studies conducted with other helping professionals, such as nurses, are generally consistent with our results, suggesting positive relationships between anxiety and empathy, driven primarily by affective components. davis (1983) identified four key aspects of empathy: perspective-taking, fantasy, empathetic concern, and personal distress. in this study, anxiety was significantly correlated with fantasy, empathetic concern, and personal distress. it was not, however, correlated with perspective-taking, a particularly cognitive dimension of empathy. such a pattern of relationships is consistent with the results of meta-analyses conducted by pittelkow et al. (2021) and nair et al. (2024). both concluded that relationships between anxiety and empathy varied by the measures used, by whether clinical or subclinical groups were examined, and by whether cognitive or affective components of empathy were examined. overall, however, relationships between the two constructs tended to be stronger and more consistent for affective empathy than for cognitive empathy. these findings are particularly worthy of note when considering how these elements may present in students. according to davis (1983), those who score high in the fantasy dimension of empathy may be more emotionally reactive and sensitive to others’ emotions. it is not unusual for social work students to believe that they are high in empathetic concerns for others. however, davis (1983) found that those high in empathic concern may experience shyness and anxiety in social situations. while the settings in which social work programs place students are professional rather than social, social work educators, practicum coordinators, and practicum supervisors can be attentive to the ways that anxiety may show up alongside empathy something we often try actively to cultivate in students. advances in social work, spring 2025, 25(1) 110 limitations the students in this study were all actively studying social work which can cause them to be more introspective in general about what they experience and to have some level of anxiety about how they relate to others in a helping role. it is possible they were already familiar with these measures due to their own personal experience in therapy or use of the instrument in a class or field setting. while both measures used in this study have demonstrated good reliability and validity (in both the current study and prior studies), these measures were self-scored and are vulnerable to response bias. our response rate was also low at approximately 10% (65 respondents). the gender and age profile of the sample was similar to the profile for the student population from which the sample was drawn. the small sample size and reliance on participants from a single university limits the ability to generalize results to a larger group of social work students in different geographic areas. due to both assessments being quantitative measures, there is no significant explanation of the students’ experiences with empathy or anxiety as would be gathered in a qualitative study. implications for social work education this study examined anxiety and empathy in students who are taking social work courses. the information can be used to build awareness of the person in the environment. in this case, the person in the environment is the student who is sitting in the classroom or field setting. greeno et al. (2018) emphasized using this information to guide curricular development and enhance the chances of success in professional endeavors. social work programs can be purposeful in helping students to develop their empathy skills but also to learn to regulate their responses to empathy to be able to protect themselves and promote their overall wellbeing (grant, 2014). to this end, this research should be used to guide overall curriculum development and classroom and field/practicum experiences. educators can help students to be aware of their own reactions to others, not as “right versus wrong,” but as characteristics of how they feel when experiencing working with troubled individuals. skill-building in managing and keeping a balance in their empathetic response could enhance how students feel about themselves and their ability to take perspective of the clients they will serve (davis, 1983). by understanding the challenges that social work students may face during their education, professors and field instructors can implement new strategies to help relieve anxiety. the strategies differ depending on a variety of factors such as the individual’s characteristics, the student’s context and situation, and the way the student experiences anxiety. strategies to help social work students manage their anxiety include mindfulness and cognitive behavioral therapy, identifying specific teaching strategies, normalizing anxiety, providing stress management techniques, preparing students fully for their practicum, facilitating supportive relationships with field instructors, or reducing organizational stressors during students’ practicum (baird, 2016). learning basic skills of emotion regulation can help them deal with their own levels of anxiety but could also be applied to their work with anxious clients. measures of empathy can be used with students to engage them in reflecting on ways in which their shaffer et al./swk student anxiety & empathy 111 own distinct profile of empathy may show up in practice settings, both now and in the future. future research there are several areas of interest that could drive future research efforts. it would be helpful to study different skill building exercises and their impact on empathy and anxiety. it would also be interesting to study in general the somatic experience of students who have higher levels of anxiety and empathy. this could be done in a mixed-methods study using both quantitative scales and qualitative interviews. references ayuso-murillo, d., colomer-sánchez, a., santiago-magdalena, c. r., lendínez-mesa, a., gracia, e. b., lópez-peláez, a., & herrera-peco, i. 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(2020). the unique nature of depression and anxiety among college students with adverse childhood experiences. journal of child & adolescent trauma, 13, 163-172. author note: address correspondence to mark a. shaffer, salisbury university school of social work., salisbury, md, 21801. email: mashaffer@salisbury.edu https://doi.org/10.22235/cp.v14i2.2215 https://www.socialworkers.org/linkclick.aspx?fileticket=1_j2exvnspy%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=1_j2exvnspy%3d&portalid=0 https://doi.org/10.1080/10437797.2014.947901 https://doi.org/10.1080/10437797.2014.947901 https://doi.org/10.1080/10437797.2014.947901 https://doi.org/10.1080/02615479.2018.1451505 https://doi.org/10.1080/02615479.2018.1451505 https://doi.org/10.1007/s40653-019-00270-4 https://doi.org/10.1007/s40653-019-00270-4 https://doi.org/10.1007/s40653-019-00270-4 mailto:mashaffer@salisbury.edu _________ swaha pattanaik, drph, bds, doctoral student, department of community health behavior and education, jiann-ping hsu college of public health, georgia southern university, statesboro, ga. april m. schueths, phd, lcsw, professor, department of sociology and anthropology, georgia southern university, statesboro, ga. raymona h. lawrence, drph, mph, professor, department of community health behavior and education, jiann-ping hsu college of public health, georgia southern university, statesboro, ga. bettye apenteng, phd, professor, department of health policy and management, jiann-ping hsu college of public health, georgia southern university, statesboro, ga. georgia dounis, dds, professor, department of clinical sciences, university of nevada, las vegas school of dental medicine, las vegas, nv. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 354-374, doi: 10.18060/26118 this work is licensed under a creative commons attribution 4.0 international license. does where we live matter to oral health? tensions between rural older adults’ concept of community and health individualism swaha pattanaik april m. schueths raymona h. lawrence bettye apenteng georgia dounis abstract: oral health is essential to overall health; however, structural obstacles influence older rural residents' oral health outcomes, especially those from disadvantaged backgrounds in the south. poor oral health is typically attributed to individual choices, shifting the focus from the inconspicuous community influences, making it more difficult for older rural people to obtain oral healthcare. this qualitative study explores how older adults in rural georgia understand the community's role in shaping their oral health. twenty-two older adults were interviewed from five rural communities in southeast georgia. participants defined their community in geographic terms. community barriers and self-reliance emerged as themes of how living in a rural community affects oral health. the concepts of community and one's oral health were perceived as distinct. participants did not see how where they lived could matter to their oral health, even when they identified critical community barriers to oral health. in collaboration with rural healthcare systems, social workers can support healthy self-reliance, moving beyond a health individualism lens, by helping bolster older adults' social supports, an essential function of social relationships that positively influences a sense of community. additionally, social workers can advocate for equitable policies to create opportunities for rural communities to support and maintain oral health. keywords: rural, older adults, oral health, community, self-reliance, qualitative, health individualism the rapidly growing older population in the united states is disproportionately concentrated in rural areas compared to the younger population (glasgow & brown, 2012), with more than one in five older americans living in rural areas (smith & trevelyan, 2019). according to the american community survey (acs) data from 2012-2016, there were 46.2 million older people in the united states, with 10.6 million living in areas designated as rural by the u.s. census bureau (smith & trevelyan, 2019). cromartie (2018) explains, “rural counties make up nearly 85 percent of the 1,104 “older-age counties”—those with more than 20 percent of their population age 65 or older” (para. 1). adults aged 65 and above make up about 14% of georgia’s total population of 10,799, 566 residents (u.s. census bureau, 2021). georgia is projected to have the 11th fastest about:blank pattanaik et al./community and oral health 355 growing 60 and older population and the 10th fastest growing 85 and older population in the united states between 2010 and 2030 (polaceck, 2019). during the 20th century, the number of georgians aged 60 and over increased ninefold, compared to a fourfold growth in the population overall (ga-dhs, 2017). akin to the national trends, the older population in georgia is growing more rapidly in the rural counties compared to the nonrural counties (tanner, 2021). adults aged 65 years and above make up about 18% of the rural population in georgia compared with about 13% of the nonrural population in georgia (office of health indicators for planning, georgia department of public health, 2020). rural older residents face structural barriers which may prevent them from reaching their full health potential including oral health. historically, u.s. medical and dental health services have been separated, which created lasting public health consequences still seen today (otto, 2017), especially for marginalized, rural aging populations. o’neil and colleagues (2017) point out that poor modern-day communication and different healthcare insurance plans between dental and medical services generate “missed opportunities to further the knowledge base for prevention and treatment efforts that address oral health issues in the context of overall health” (p. 3). they also suggest that keeping these two systems separate relegates dental services to be considered nonessential, further distancing oral healthcare from comprehensive healthcare. understanding older adults' accounts of living in rural communities is necessary as a robust sense of community has been found to preserve aging adults' oral health, a pivotal component of overall health (mao et al., 2021). however, research is needed to examine the connection between community and oral health among rural older adults in the united states. this study investigated how older adults living in rural communities of southeast georgia perceive whether and how their community impacts their oral health. the connection between oral health and general health most chronic systemic conditions and oral disease share common lifestyle modifiable risk factors mediated by genetic, environmental, behavioral, and socioeconomic factors. oral health is one domain of health that can affect general and cognitive health including emotional, cultural, psychosocial, and functional well-being. the u.s. department of health and human services (2000) report of the surgeon general highlighted the link between oral and general health. the oral cavity is a well-balanced ecosystem that harbors diverse bacterial species in high-density biofilm. lifestyle habits, environmental disparities, as well as host/individual response to bacterial accumulation on the hard and soft oral tissues will shift the balance to initiate an inflammatory response with entry points to the respiratory system, digestive tract, the bloodstream, and with the possibility to penetrate the blood brain barrier. in addition, numerous systemic conditions first present as changes in the oral cavity. for example, autoimmune diseases such as lupus erythematosus, systemic sclerosis, sjogren syndrome, and amyloidosis are manifested as oral ulcerations, changes in the salivary and parotid glands, as well as changes in the tongue (napeñas et al., 2020). while hematologic disease is often observed as gingival bleeding as well as tongue changes, endocrine disorders also are manifested in various oral markers (napeñas et al., 2020). advances in social work, summer/fall 2023, 23(2) 356 oral health disparities in rural aging populations aging is a cumulative process that occurs at different rates in different tissues impacted by factors such as socioeconomic stressors, lifestyle habits, genetics, physiologic reserves, and biological resilience that influence health, severity of cellular, and molecular damage, resulting in disease over the life course (kirkwood, 2017). according to the centers for medicare & medicaid services (2021), most medicare (federal health coverage for adults 65 years and over) recipients are diagnosed with one or more noncommunicable lifestyle related chronic systemic conditions that affect their quality of life, loss of autonomy/function, and result in increased health care costs. modern technological advancements and poly-pharmaceutical interventions have transformed once fatal diseases into chronic conditions expressed later in life that exacerbate oral manifestations. oral health status during the early years of life lays the foundation for good oral health in the later years of life (schroth et al. 2014). employer-based dental insurance has enabled older adults to retain their natural dentition, yet they are still in need of complex dental services post-retirement (simpson et al., 2021). post-retirement/vulnerable populations also encounter environmental barriers that limit access to oral health care services with the emergency room as the only viable option to access dental services (centers for disease control and prevention [cdc], 2021; dye et al., 2015). older adults are at higher risk of poor oral health due to lack of dental insurance, underlying chronic systemic conditions, and compromised immune systems. lack of access to oral health care providers is especially prevalent in underserved urban, rural communities, and those with limited financial resources as dental care becomes an out-of-pocket expense post-retirement (national institute of health [nih], 2021). since oral health is an important component of overall health and well-being, structural obstacles also influence the oral health of older rural residents. rural areas are typically geographically and socially isolated and lack transportation, healthcare, retail, and other needed services (rural health information hub [rhihub], 2022a). many rural areas are designated dental health professional shortage areas (dhpsas). according to the health resources services administration (hrsa), 68% (4,297/6,319) of the nation’s dhpsas were in rural or partially rural areas (health resources services & administration [hrsa], 2020; rhihub, 2022b). the majority of counties, 122 out of a total of 159 counties in georgia are considered dental health professional shortage areas (dhpsas) including those areas where only specified populations (e.g., low-income populations) face a shortage of dental care providers (hrsa, 2020; rhihub, 2022b). most of these counties are considered non-metro or rural counties. approximately 1.4 million georgians live in nonmetro counties designated as dhpsas (rhihub, 2022b). many rural residents do not have dental insurance because of higher rates of poverty and unemployment in rural areas compared to urban areas, and hence rely on public health insurance programs such as medicaid (foutz & artiga, 2018). few rural dentists accept medicaid patients because of low reimbursement rates (rhihub, 2022b). medicare, the main health coverage for adults 65 years and over, does not cover dental services. some medicare advantage (ma) plans cover dental care; however, a recent study reported that more rural ma enrollees (10.5%) switched to traditional medicare compared pattanaik et al./community and oral health 357 to urban ma enrollees (5%) because of challenges to gaining access to care (sungchul et al., 2021). more recently, federally qualified health centers (fqhcs) have helped close gaps in access to timely and appropriate dental services, thus reducing disparities in oral health (crall et al. 2016; jones et al., 2013). however, an analysis of trends between 2011 and 2014 showed an overall decline in the capacity to serve dental patients, resulting in lower levels of utilization of oral health services among fqhcs in the south compared to the northeast, the midwest, and the west regions of the us (surdu & langelier, 2018). based on data from 2018, older adults living in rural communities were less likely to have visited a dentist in the past year (60.6%) compared to their suburban (69.5%) or urban counterparts (69.3%). they were also more likely to have all their teeth removed (19.9%) compared to suburban (13.7%) and urban older adults (13.6%; foutz & artiga, 2018). these trends were consistent over the four-year period examined (united health foundation, 2018). previous research also shows high levels of dental anxiety among rural older adults (bell et al., 2012; eitner et al., 2006). high dental anxiety has been linked to poor oral health outcomes including periodontitis or gum disease (bell et al., 2012). additionally, the american dental association (ada) reported that there is a bidirectional relationship between oral health and nutrition as poor nutritional intake affects oral health, and loss of teeth and dental infections can prevent individuals from consuming a healthy diet (swift, 2021). poor oral health in rural older adults can further exacerbate their nutrition problems, as they already experience challenges related to food insecurity, access to healthy foods, and the ability to shop for groceries and cook for oneself easily (valliant et al., 2021). poor oral health among older americans is also more likely when they report low income (griffin et al., 2012; northridge et al., 2020), lower educational attainment (assari & bazargan, 2019; northridge et al., 2020), lack of insurance, and/or they belong to racial/ethnic minoritized groups (assari & bazargan, 2019; fleming et al., 2022). for those living in rural areas, the impact of these social factors is compounded by barriers inherent to rural areas such as lack of transportation and limited access to healthcare services (rhihub, 2022a). health individualism despite growing evidence of systemic challenges contributing to poor oral health (northridge et al., 2020), the public dialogue surrounding oral health in america is highly individualistic (o’neil et al., 2017). “americans focus narrowly on brushing, flossing, and eating habits as the primary causes of oral health or the lack thereof. problems are assumed to be the result of poor personal hygiene” (o’neil et al., 2017, p. 7). aubrun et al. (2006) define health individualism as “an individual’s personal responsibility to make healthy or unhealthy choices, and the impacts affect the individual…both the external causes of health and the broader implications of people’s health disappear from the picture” (p. 3). drawing from “health individualism,” o’neil and colleagues (2017) explain that poor oral health is typically attributed to individual choices and lack of control, ultimately shifting the focus from the inconspicuous community or political causes, making it more difficult for older rural people to obtain oral healthcare. advances in social work, summer/fall 2023, 23(2) 358 views of health individualism may be more prevalent for people living in rural communities with few resources and may involve a level of perceived self-reliance. for example, o’neil et al. (2017) theorize that, people don’t connect the absence of water fluoridation or a shortage of oral health care providers in rural areas with their perception that a region has “bad teeth.” they simply assume that such areas have a preponderance of people with poor personal hygiene and that these failures of personal responsibility aren’t a matter of public concern. (p. 8) research on how older adults in rural areas manage their understanding of health provides insights into rural aging older adults’ struggles in maintaining oral health. ultimately, individuals normalize self-reliance and assume personal responsibility for poor health outcomes without realizing that “resources create choices” and community healthcare systems are not apolitical (page-carruth et al., 2014, p. 8). research with u.s. rural older adults is needed to examine whether health individualism is also prevalent regarding oral health. community the concept of community refers to a group of people situated in the same geographically-bound area (neighborhood, town, or city) or to a group that shares common interests, characteristics, or skills. previous research shows strong feelings of community belonging among rural (ramos et al., 2017; walker & raval, 2017) and/or older residents (michalski et al., 2020) in countries such as the united states and canada. the psychological sense of community, a widely used construct in community psychology, was defined by mcmillan and chavis (1986) as “a feeling that members have of belonging, a feeling that members matter to one another and to the group, and a shared faith that members’ needs will be met through their commitment to be together” (p. 9). a strong sense of community has been associated with increased community engagement and participation (talò et al., 2014) and with positive oral health (mao et al., 2021) and general health behaviors (michalski et al., 2020). social support is one of the important functions of social relationships and positively influences the sense of community (hombradosmendieta et al., 2019). house (1981 cited in heaney & israel, 2008) conceptualized social support as “aid and assistance exchanged through social relationships and interpersonal transactions” that’s meant to be beneficial (p. 191). social support can be divided into categories of supportive behaviors and includes emotional (expressions of empathy, love, trust, and caring), instrumental (tangible aid and service), and informational (advice, suggestions, and information) support (glanz et al., 2015). although types of social support are distinct, they can be challenging to research as “relationships that provide one type often also provide other types” (heaney & israel, 2008, p. 190). another related concept is that of social capital. while sense of community is a psychological construct, social capital is embedded within communities, and entails informal or organized social networks and social structures which have the potential to tie people and communities together socially (kitchen et al., 2015). mapping and mobilizing social capital in communities has been one way of collective action to promote health pattanaik et al./community and oral health 359 (eriksson, 2011). growing evidence supports the association of oral health with social capital, social support, and a sense of community in older adults (mao et al., 2021; rouxel et al., 2015a, 2015b) and other age groups (batra et al., 2014). examining older adults’ experience in rural communities is essential as a strong sense of community is protective to older adults’ oral health (mao et al., 2021). yet, no studies have explored the concept of community concerning oral health in u.s. rural older populations. this study aimed to fill a gap in the literature by examining how older adults living in rural communities of southeast georgia understand their community's role in shaping their oral health. types of social support were also assessed as it is vital to understand the nuances of social support that can influence a sense of community needed to promote oral health in rural communities. methods study design and participant recruitment this study is part of a larger mixed-methods study. participants were recruited through senior centers and other community-based services, including meal delivery services. the surveys in the first phase of quantitative data collection in the study were conducted at senior centers and at participants’ homes from september until december 2018. at that time, the participants filled out a form expressing their willingness to participate in a follow-up interview during the study's second phase of qualitative data collection. the follow-up interviews were conducted between march and april 2019. only findings from these interviews are presented in this paper. the study sites were located in five rural counties in southeast georgia using convenience and snowball sampling. several definitions of “rural” are available (cromartie & bucholtz, 2008). we followed the office of management and budget’s (omb, 2018) guidance for selecting the counties that would participate in the study. omb’s guidance is used by many federal programs and policies when determining funding, financial incentives, and targeting (pipa & geismar, 2021). omb designates the counties with 50,000 or more people as “metropolitan” (metro) areas; and those between 10,000 49,999 people as “micropolitan” (micro) or nonmetropolitan areas (cromartie & bucholtz, 2008; omb, 2018). often micropolitan or nonmetro is used as a proxy for rural (pipa & geismar, 2021). based on this guidance, all the study sites were in micropolitan, nonmetropolitan, or rural counties. participants twenty-two participants were interviewed. the study participants were adults aged 50 years and over who lived in their own homes. the choice of a cutoff at 50 was deliberate to encompass a broader range of older adults, allowing us to explore the early stages of aging-related dynamics. while census statistics focus on adults 65 and older, including those aged 50 and above provides a more comprehensive understanding of aging experiences. this approach aligns with recent research trends aiming to capture a diverse aging population and its evolving needs. this study did not include those living in assisted advances in social work, summer/fall 2023, 23(2) 360 living communities and skilled nursing facilities. both edentulous and dentate individuals were included. the katz index of independence in activities of daily living (katz adl) was used to screen the participants (katz, 1983; katz et al., 1970). the eligible participants scored between three (moderate impairment or partially dependent) and six (full function). individuals who scored two or less (severe functional impairment) were excluded from the study. all interview participants received a $15 walmart gift card for their participation. table 1. descriptive statistics of interview participants (older adults) characteristic category n (%) age in years 50-54 1 (4.5%) 55-59 3 (13.6%) 60-64 3 (13.6%) 65-69 5 (22.7%) 70-74 6 (27.3%) 75-79 1 (4.5%) 80-84 2 (9.1%) 85 and older 1 (4.5%) gender male 8 (36.4%) female 14 (63.6%) county of residence bulloch (urban) 15 (72.7%) evans (rural) 4 (18.2%) screven (rural) 1 (4.5%) tattnall (rural) 1 (4.5%) toombs (rural) 1 (4.5%) race/ethnicity black/aa 14 (63.1%) white 7 (31.8%) biracial 1 (4.5%) annual income ≤ 20,000 11 (50%) 20,001 to 42,000 4 (18.2%) above 42,000 2 (9.1%) refuse to answer 5 (22.7%) education high school degree or less 11 (50%) some college, no degree/associate degree 7 (31.8%) bachelor’s degree or higher 4 (18.2%) marital status married 7 (31.8%) widowed 6 (27.3%) divorced 6 (27.3%) separated 1 (4.5%) never married 2 (9.1%) lives alone yes 10 (45.5%) no 12 (54.5%) total 22 (100%) most of the participants were female (n = 14). the ages of the participants ranged from 50 85 years, with most participants ranging in ages from 70 74 years. a majority of the participants were african american (n = 14) and had annual incomes below $20,000 (n = 11). half of the participants reported having a high school degree or less (n =11), followed by some college (n = 7), and bachelor’s degree or higher (n = 4). the largest group of pattanaik et al./community and oral health 361 participants reported being married (n = 7), followed by those who were widowed (n =6), divorced (n=6), never married (n =2), and separated (n =1). please see table 1 for respondents’ demographic profile. data collection interviews were conducted over the telephone allowing for privacy and to engage participants dispersed across different communities, especially those who were homebound. the recruitment and interviews were done simultaneously, and participant recruitment continued until no new information emerged from the interviews. the principal investigator conducted all the interviews. the average length of the interviews was between 30 and 45 minutes. participants were asked to describe what it means to live in a rural community, how living in a rural community affects the health of their teeth, gums, and mouth, and how important oral health is for their community and how their community can help with their oral health. all interviews were audio-recorded and supplemental notes were taken. interviews were transcribed verbatim by a professional transcription service. pseudonyms were used to protect participants’ identities. any personal information identifying the participant was removed from the transcripts. the proposed study was approved by the georgia southern university institutional review board. verbal consent was obtained from all the interviewees prior to beginning the interviews. data analysis data analysis was guided by the following question: how do older adults living in rural communities of southeast georgia understand their community’s role in shaping their oral health? two analysts, including the principal investigator, reviewed the data independently using braun and clarke’s (2006) framework for thematic analysis. the first five transcripts were used to inform the development of the codebook. inductive codes were developed and modified throughout the coding process, and the first five transcripts were revisited after all the codes had been finalized. nvivo11 (qsr international, 2018), a qualitative data analysis software, was used. steps were taken to ensure that the data were trustworthy. the two analysts met intermittently to discuss their analysis, including any disagreements. the analysts also maintained memos or notes while understanding and interpreting the data to ensure that the meaning of codes did not drift or shift during the process of coding. finally, because social support positively impacts a sense of community, deductive coding using a social support framework (heaney & israel, 2008, p. 190) was applied to the data, using instrumental (tangible aid and service), emotional (expressions of empathy, love, trust, and caring), and informational (advice, suggestions, and information) support. findings first, participants defined their understanding of community, and subsequently, two themes were identified: community barriers and self-reliance. findings centered on the tensions between rural older adults’ concept of community and independence related to advances in social work, summer/fall 2023, 23(2) 362 oral health. types of social support, including instrumental, emotional, and informational, were also applied. defining community overall, participants tended to define community as geographic, as a group of people getting together or living together in proximity to one another. community included the town or neighborhood they lived in and the people in their immediate surroundings, such as their friends, family, and congregants at their faith community. community also meant the people who shared common interests and values, such as social clubs. most participants enjoyed living in what they described as a quiet and serene rural community rather than living in a more urban area. participants tended to speak positively about their community. for example, ross (male, 50-54 years, african american) explained how meaningful the relationships in their community are and how helpful people can be, community means a lot, you know. they can do a welfare check, come, and see how if i’m okay, and sometimes you have cold, real cold night and stuff, and they come and make sure i’m okay, you know? make sure you’re taking your medication and everything alright with you. and, you know, in my case sometimes i may need help opening a can, can of food, to get something to eat, you know. and they can help me out, you know? so, community means a lot. to have good neighbors and family, you know? eleanor (female, 80-84 years, african american) also found community members to be supportive. she lived by herself and had only one neighbor she did not interact with much. regardless, she posited that her neighbor would likely lend a helping hand, “if there’s something going on with you and you have to go to them, and i feel like they would help you with whatever you needed.” on the other hand, some participants, like deena (female, 65-69 years, white) were less optimistic. “well, my neighbors and friends don’t help me. i have to do that myself. they don’t help me, yeah.” community barriers despite noted strengths from many participants, they were well aware of the downside of living in a rural community, including the impact on their oral health. first, isolation was discussed by the participants and reflected difficulties with all three types of social support (instrumental, informational, and emotional). the geographic seclusion made it difficult for them to access instrumental and informational social supports such as oral health care and education resources. when asked about the experience of living in a rural community, sheila (female, 55-59 years, white) described a sense of geographic and social isolation. pattanaik et al./community and oral health 363 it's got nothing but a post office and a gas station. but i really don't know nobody in this town…it’s real quiet. i don’t ever see nobody. i just see the cars and trucks that go by the road and that’s it. vera (female, 60-64 years, african american) shared a similar sense of seclusion and said: it’s not really a community to me…and the rural area don’t get as much togetherness as you would have a community…you don’t get much, you don’t get no education, you don’t get no help. and stuff like that. it don’t help you. cause you be left out, when you in a rural area. and you isolated—you can't get the things like you should and could. donald (male, 65-69 years, african american) was concerned about the lack of informational support in his community and articulated the consequences for peoples’ oral health: your teeth get rotten faster, what to do when your gums are bleeding, you have lack of information of how often you should brush your teeth and the information you need about how often you should go to the dentist, how often you should get your teeth cleaned because you brush them and that's it. you learn to brush them, but you don't know how to take care of them. you learn brushing them is all you need to do. steve (male, 50-54 years, african american) shared ideas for improving oral education. he suggested a type of informational support and proposed that dental providers could hold an exhibition with specific resources for low-income people. have a doctor, dentist, or something you know to come out and talk to everybody, and everybody would learn certain things, you know, show us any stuff we need to know we might not know about our mouth, teeth and gums and stuff. and the ones that can't afford to go to a dentist and get advice, they could have one come out and talk with us or someone of that nature, you know? participants explained that isolated rural areas lacked other instrumental social supports like public transportation, making it difficult to get to their doctor’s appointments. they relied on either special transportation services provided by their health insurance program or on family or friends to drive them to health appointments. dwayne (male, 70-74 years, african american) stated, “i find it to be peaceful [to live in a rural community], but when you do need medical services, you got be able to go where you going, get where you going because there is no public transportation or anything.” earl (male, 66 years, african american) compared resources in the city to his rural community and is fortunate to have access to transportation through his health insurance. he reported, “chicago has the street buses if you don't have a car. down here, you need transportation. i have united healthcare and they have a system where i can get special transportation to my doctor's appointments and things like that.” when asked directly about oral health in their community, participants believed that it was essential, and it often centered on emotional support and concern about disconnection from others. according to vera (female, 60-64 years, african american), “all oral health advances in social work, summer/fall 2023, 23(2) 364 is important to the community.” most people thought it was socially undesirable to have poor teeth. earl (male, 65-69 years, african american) stated, “it's very important because when you meet people you don't want an odor from your mouth or anything like that.” likewise, marvin (male, 80-84 years, white) explained: it's kind of embarrassing to be around people that doesn't have good teeth, good healthy mouth and teeth and gums. especially when you're speaking with them, you're near them. probably they have an odor, even though they might brush their teeth, if their teeth is bad, it's still gonna be kind of embarrassing and have a bad look. another reason participants may believe community is important to their oral health is that their oral health tends to worsen with age. steve (male, 50-54 years, african american) suggested, “the older i get. i know the worst state my mouth gets in.” vera, (female, 6064 years, african american) has the same challenge. “as i got older my teeth have gotten weaker in my mouth and they also have gotten tooth decay as i get older.” deteriorating oral health may lead to further isolation, social disintegration, and potentially less emotional support. instrumental support is needed to cover the high cost of dental services, blocking some participants from the oral health care they would like to have. linda (female, 70-74 years, white) is unable to afford dentures, “well, i wish i could get some dentures. i haven't got much money. with my medicaid and medicare, i thought i might could get dentures without costing me anything.” in some cases, the absence of teeth or dentures can be distressing and may reduce social interaction and emotional support. thus, the lack of instrumental support may lead to less emotional support. kim (female, white, 55-59 years) described the connection between the shame of tooth loss and low self-esteem—another instance where instrumental support and emotional support are paired. in the apartment complex that i live in, the majority of the people that live in this apartment complex are in the same boat that i'm in. a lot of them have had all their teeth removed, but they can't afford dentures. a lot of them have teeth that are broken, missing, and it just looks bad. and like i said, it destroys your self-esteem and your self-confidence. it just does. participants, however, indicated that few people have direct conversations about oral health because it is a private matter, likely shameful for some people. bob (male, 70-74 years, african american) stated, “we don't sit around and discuss oral health, we really don't.” michelle (female, 75 -79 years, biracial) explained, “it’s very important to people around me [oral health], but that's something we don't ask other people about is their oral health. that's a personal thing with them.” she continued, “that's something private that i don't talk about it, my mouth to other people.” dwayne (male, 70-74 years, african american) explained that oral health is only brought up in passing conversation. “we discuss little things if we have a colonoscopy done, if we have a tooth pulled, you know we'll talk about that…but kind of briefly.” pattanaik et al./community and oral health 365 self-reliance interestingly, participants expressed a disconnect between the concepts of “community” and “oral health.” despite rural community barriers and lack of emotional, informational, and instrumental support that participants could easily list, they believed they were solely responsible for maintaining their health. from their perspective, their community neither supported nor hindered them in maintaining their oral health. they did not think that geography or social support impacted their oral health in a major way. the only instance of social support suggested by the participants was that of getting a ride from a family member or a friend to dental appointments. the participants believed their oral health was solely dependent on how regularly they performed oral hygiene habits such as brushing, flossing, and visiting the dentist. although they knew that regularly visiting dentists was important for preventing oral diseases, they felt that dental work was expensive and they could avoid it if they maintained regular oral hygiene habits. kim (female, 55-59 years, white) stated, “i don't think it [community] has any effect on it [oral health]. that's something an individual has to do.” vera (female, 60-64 years, african american) explains the contradiction between community and self-reliance. “but, you know, the community is supposed to be a unity, but it's not really like that but that's why i tell you, have to take care of yourself.” although dwayne (male, 70-74 years, african american) identified a lack of transportation in rural areas as problematic, he did not see place mattering to his oral health. i don't think living in rural community would make me pay less attention or more attention to my dental care, my dental savvy, because i would still go to the dentists and get cleanings, checkups, i would do that no matter where i lived. trevor (male, 55-59 years, white) stated, “i don't see anything about being in this community that limits someone's ability to get proper oral care.” regardless of community belonging, participants tended to use an individualistic rather than collectivist interpretation of oral health. michelle (female, 75-79 years, biracial) explained: you have to do it all the time, because if you stop [caring for] your mouth...your teeth will start deteriorating, but if you don't keep it up, that's how you get a bad mouth. that's how you get gingivitis and bad teeth. if you dental floss and brush every day, you still have to see a dentist, but it won't be as bad as it is .... if you don't do these things, of course they're gonna deteriorate and rot, and you're gonna have to go to the dentist, and that's a lot of money going to the dentist. some people can't even afford to pay for them, because i've been around people that have their teeth, but they are soft and they're dingy, and that's because of the build-up that over the years has caused. there's nothing much you can do except try to do the best you can to keep them clean and keep the upkeep of them. discussion this qualitative study explored a gap in the literature regarding how older adults living in rural georgia perceive the role that community plays in shaping their oral health. it is advances in social work, summer/fall 2023, 23(2) 366 essential to explore the lived experiences of older rural georgians to best meet their unique regional health needs. participants defined their understanding of community and similar to previous research (walker & raval, 2017), most described a sense of at least some community belonging. community barriers and self-reliance were identified as the key tensions between the concept of community and independence of oral health among rural older adults. participants recognized the inherent barriers and absence of social support in a rural community, such as isolation, lack of transportation, educational resources, and cost, that prevented them from getting the care they needed. however, they expressed notions of health individualism (aubrun et al., 2006; o’neil et al., 2017) and felt they were fully responsible for their oral health. in their estimation, poor oral health resulted from them not keeping up with dental care habits such as brushing and flossing; thus, in their view where they lived did not matter to their oral health despite the barriers they identified. most participants desired going to a dentist and getting dentures, but they recognized that dental services were expensive, and hence they had to do the best they could to avoid these outofpocket expenses or live with the consequences. they also may have relied on hygiene habits more because issues like lack of affordable dental coverage were beyond their control. like in other qualitative studies (bacsu et al., 2014; lawrence et al., 2018; neville et al., 2018), the participants in this study described “community” in terms of where they lived, and the groups of people who they shared a connection with. family, friends, neighbors, and those who they shared common interests and values with and obtained support from when needed were considered as part of their community. however, these aspects of a community were not viewed as enablers to optimal oral health. in general, living in a rural community was described as an isolating experience for many participants, which is similar to the experience of rural residents participating in previous studies conducted in the united states as well as in other countries (buys et al., 2015; walker & raval, 2017). social isolation and loneliness have been linked to poor health outcomes among rural older people (rouxel et al., 2016). a strong sense of community belonging and social capital have been associated with positive oral health outcomes (mao et al., 2021; rouxel et al., 2015a, 2015b) and general well-being (carver et al., 2018) among older adults in both rural and non-rural areas (au et al., 2020). altogether, the participants in this study recognized factors that influenced their oral health, yet ultimately “oral health” and “community” were disparate concepts for them. they viewed oral health as a product of sustained and regular dental care habits such as brushing and flossing. this is not surprising, as previous research has shown that the public perception of oral health and health in general is highly individualized; they are viewed as isolated concepts, without awareness of the social and structural factors shaping them (o’neil et al., 2017). limitations study findings must be considered in light of its limitations. for example, the research consisted of a small convenience sample conducted in five rural counties in the southeast pattanaik et al./community and oral health 367 region of georgia approximately four to five years ago, which limits the generalization of the results to older adults in other rural regions, especially those in other countries. the study consisted of people served by specific community-based programs that consented to become study sites. the demographic composition of this study sample emulated the demographic characteristics of the program clients. hence, some biases may have been introduced during the participants' selection, which may have influenced the findings. nevertheless, this study gave voice to older rural georgians’ understanding of how community impacts oral health, a neglected topic in the literature. in the current sample, african american participants took part in this study at higher rates than their white counterparts. most african americans live in the southern united states, and georgia currently ranks as the second largest state for the black population (u.s. department of health and human services, office of minority health, 2021). racial equity and oral health are critical so this area deserves intentional inquiry. as one of the social work grand challenges is closing the health gap and eliminating racism (barth et al., 2022), future research should explicitly highlight oral health disparities among aging african americans living in rural areas. please note that the data used in this study is limited to the timeframe of four to five years ago, serving as a contextual snapshot for our analysis. implications for social work practice to move u.s. discourse beyond health individualism frames, social workers can follow the oral health framing reform recommendations by o’neil et al. (2017, p. 12). o’neil and colleagues advocate using images and discussion of oral health that intentionally link oral health with overall health and avoid using conceptions only of teeth. they recommend using health equity frames rather than a one-size-fits-all health approach. they found health equity boosts “the public’s agreement that society has a collective responsibility to address oral health inequities” (p. 15). o’neil and colleagues (2017) promote using effective economic frames that include a discussion of avoidable costs, “highlighting how current approaches create incentives for people to defer treatment, leading to more serious problems that are ultimately more expensive to treat” (p. 16). they also call for the public to reimagine oral healthcare delivery systems beyond the dentist office to interdisciplinary teams (o’neil et al., 2017). social workers must be included in these teams as they work across numerous community locations and have specialized training in biopsychosocial models (pope et al., 2014; slovak et al., 2011; warren et al., 2017). as recommended by lyons et al. (2021), licensed social workers can be integrated into dental teams to improve access to care which would help promote better oral health outcomes. social workers are uniquely positioned to reduce barriers to care in rural communities as they are already working closely with underserved populations (azhari, 2021). social workers can also help interdisciplinary teams apply strengths-based, personin-environment approaches and policies that help move the public discourse away from a health individualism perspective and reduce health disparities. in line with o’neil et al., (2017), social workers can advances in social work, summer/fall 2023, 23(2) 368 direct public attention away from deficit thinking about populations that experience poor oral health and toward systems thinking about how disparities arise and how they can be redressed and to explain how structural factors—income, race and ethnicity, language, geographic location— influence oral health outcomes and show how shifts in the system can address disparities. (p. 8) within a strengths-based perspective, it is essential to identify and build on existing assets or supports and services that already exist within rural communities to help prevent oral diseases among older people in rural areas (rhihub, 2021). individuals, associations, and institutions can be mobilized to come together to build on their assets rather than focus on just their needs. for instance, oral health education programs and risk assessment and examination can be integrated with community-based supports and services such as mobile dental vehicles (gao et al., 2019), home-delivered meals (“meals on wheels”), chronic disease management classes at senior centers, and mental health services (siegler et al., 2015). social workers need to include oral health as a part of biopsychosocial assessments and provide community resources. azhari (2021) points out, since many social workers, dentists, and health care professionals have mutual clients, it is crucial to understand the connection between oral health, mental health, and general health. social workers can partner with dentists to provide clients with the tools (knowledge, access, and resources) to take responsibility for their oral health (p. 92). to further enhance holistic healthcare and bridge the gap between oral and general health, it is recommended to incorporate basic dental screenings into routine general health check-ups. this integrated approach aligns with the comprehensive perspective advocated by o’neil et al. (2017), emphasizing the interconnectedness of oral and overall health. by including basic dental screenings in general health appointments, social workers can play a pivotal role in early identification of oral health issues, promoting preventive measures, and fostering a more inclusive healthcare delivery system. this step aligns with the strengths-based, person-in-environment approaches, and policies recommended by o’neil et al. (2017), lyons et al. (2021), and azhari (2021), empowering social workers to address disparities and contribute to the overall well-being of rural older adults. upstream interventions can help target and improve structural factors identified by the participants in this study, such as lack of transportation, lack of dental coverage, and changing the built environment of rural communities. equitable policies focused on decreasing economic inequality (moeller et al., 2017) can help create opportunities within rural communities to support and maintain oral health along with overall health and wellbeing (daniel et al., 2018). social workers can be a bridge/link to other types of health/oral health needs and community support. social workers already integrate physical and behavioral health in their healthcare delivery systems, thus including them in oral, physical, and behavioral health care settings, including fqhcs, is a practical solution to improving oral healthcare for rural and underserved groups. adding oral health to social work education will benefit the participants in this study as well as other excluded groups. incorporating social workers pattanaik et al./community and oral health 369 may be the key to empowering rural older adults to pursue and advocate for their oral health. references assari, s., & bazargan, m. 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(2017). the role of social work in free healthcare clinics and student-run clinics. social work in health care, 56(10), 884-896. author note: address correspondence to swaha pattanaik, georgia southern university email: swahapattanaik@gmail.com https://www.census.gov/quickfacts/ga https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61 https://doi.org/10.1080/19320248.2021.1977208 https://doi.org/10.1080/19320248.2021.1977208 https://doi.org/10.1080/19320248.2021.1977208 https://doi.org/10.1037/rmh0000059 https://doi.org/10.1037/rmh0000059 https://doi.org/10.1080/00981389.2017.1371097 https://doi.org/10.1080/00981389.2017.1371097 mailto:swahapattanaik@gmail.com _________ ebony n. perez, phd, msw, assistant professor, department of undergraduate social work, saint leo university, st. leo, fl. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 500-521, doi: 10.18060/24178 this work is licensed under a creative commons attribution 4.0 international license. faculty as a barrier to dismantling racism in social work education ebony n. perez abstract: facilitating learning around race and racism is often uncomfortable for faculty as well as students. the purpose of this qualitative case study was to investigate the experiences of undergraduate social work educators who teach about race and racism in social work programs. i employed a qualitative case study design to understand the lived experience of undergraduate social work educators who teach race specific content. i employed a combination of purposive sampling and snowballing methods to identify nine participants from the southeast region of the united states. utilizing a critical race theory (crt) framework to analyze interviews, several key findings emerged revealing faculty as barriers to facilitating learning around anti-racist content in the classroom. these findings were a) their own racial identity; b) insufficient formal preparation around race and racism; c) lack of faculty comfort with anti-racist content; and d) lack of skill in teaching anti-racist content. recommendations include the implementation of scaffolded antiracist content throughout social work curricula that would be required by the council on social work education as part of the accreditation process. keywords: critical race theory, social work, faculty, race, racism davis (2016) posited that for “far too long, race has been america’s postponed grand challenge” (p. 397). referencing the 12 grand challenges revealed in 2015, which do not specifically include race or racism, davis (2016) highlights how race has “been put on the back burner" (p. 397) even within the self-proclaimed profession for social justice. scholars note that teaching strategies are not only shaped by the faculty’s personal beliefs and motivations but also by the departmental structure and the relationship with their colleagues (brew & mantai, 2017; love, 2019; smith et al., 2017). the intersection of race and gender are relevant within social work education due to 61.1% of social work educators identifying as white, 17.6% identifying as african american/ other black, and 6.8% identifying as chicano/puerto rican/or other latino (cswe, 2020). additionally, 73% of social work educators identify as female (cswe 2020). the lack of culturally relevant skills within the social work profession begins with social work educators. social work education programs have no reason to be invested in critically attending to race as it would not serve the interests of whites (bell, 1980). there is little incentive to eradicate racism within social work education as it would require the system to work to dismantle the current power structure. the inclusion of diversity content in curricula typically does not mandate critical self-examination to prepare students for practice (deepak et al., 2015). lack of critical engagement of race is one way social work supports the persistence of racial disparities and inequities (constance-huggins, 2018; ortiz & jani, 2010). the current structure of the social work profession is dominated by whiteness and women, particularly white women. thus in line with bell (1980), gains within the educational structure and industry of social work have only come about due to desired political and personal gains, primarily of white women, that were supported by social work about:blank perez/faculty as barriers to dismantaling racism 501 praxis. the training ground for this colorblind approach has been and continues to be the social work classroom. the result is a persistent lack of cultural relevant content in social work education. the purpose of this qualitative case study was to investigate the experiences of undergraduate social work educators who teach about race and racism in social work programs. literature review scholars argue it is possible for a college student to go through their academic career never having critically examined their own racial bias (diangelo, 2018; love, 2019; patton, 2016). social work education is not exempt from this phenomenon. the literature suggests skin color impacts pedagogy when teaching about race and racism (holland, 2015; pittman, 2010, 2012). holland’s (2015) work specifically revealed whiteness of participants obstructed their ability to both understand and teach content around race. with social work educators being primarily white and female this creates a paradox within social education programs. jeffery’s (2005) work illuminates that although the profession mandates the benevolent treatment of society’s “unfortunate” souls the day-to-day practices of social work education reproduce whiteness. she argues the “good” social worker, "the white liberal subject, has the presumed capacity and potential to be chameleon-like: to know, see, and adapt as is necessary to maintain dominance in the situation” (jeffery, 2005, p. 411). the current demographics of social work educators, along with race being part of diversity management, point to the continued likelihood of reproducing the status quo. jeffery (2005) further asserts that “critiques of whiteness, whether implicit or explicit, call into question the desirable identity of oneself as a good person, a good and altruistic helping professional” (p. 412). therefore, educators need a "coherent theory of race" to develop their understanding of persistent racial inequalities, historical structure of race, the historical impact of race on contemporary practices, and their positionality as well as a specific focus critiquing whiteness (bonilla-silva, 2018; jeffery, 2005; smith et al., 2017). smith-maddox and solòrzano (2002) assert such an agenda is key to move towards social justice and racial equity. cultural competency and multiculturalism (ccm) comprise the existing conceptual framework for meeting the mandate to engage diversity and difference in social work education and eventual practice. this chosen model highlights micro-level change and is largely focused on exposure, cultural awareness, and attitude readjustment of social work students (campbell, 2014; constance-huggins, 2012; rahill et al., 2016). it allows for the development of cultural appreciation and recognition of clients (constance-huggins, 2012) as well as the realization that clients may possess a cultural wealth that is absent from the practitioner's purview. for all of its good, this micro-level approach is limited in its ability to make a significant impact when engaging race and racism (campbell, 2014). relying on socially constructed u.s. categories, ccm does little to promote anti-racist activism. abrams and moio (2009) challenged social work educators to engage in developing a more relevant model and work towards anti-racist pedagogy. without these skills, social workers may misapply principles to become the "white savior" negating their culpability in advances in social work, summer 2021, 21(2/3) 502 maintaining contemporary racism (matias & mackey, 2015). therefore, when it comes to the analysis of race, racism, and anti-racism on a macro level, the conceptual framework of ccm are largely ineffective (abrams & gibson, 2007; rahill et al., 2016). additionally, this framework ignores the historical legacies of race and how differences were, and continue to be, used to justify inhumane policies and practices (adams & zuniga, 2016; deepak et al., 2015; love, 2019). it does not consider the emotional toll of learning new knowledge associated with race, racism, and anti-racism as well as the emotional stamina required to engage in such work. without attention to the emotional component of learning, students may become discouraged or fatigued and therefore cannot fully engage in dismantling whiteness (matias & mackey, 2015; rahill et al., 2016). the challenge to social work education has been how to effectively address racial inequality within social work pedagogy. in 2014, the national association of social workers (nasw) issued an action brief where part of their recommendations was for social workers to “understand, study, analyze, and address the ways ‘color-blind racism’ has become the dominant ideology in our work, conversations, and institutions” (p. 2). therefore, social work educators need to train social work students to “identify and interrupt color-blind ideology” (nasw, 2014, p. 2). yet the council on social work education (cswe) still has not centered race within the educational standards, thus hindering social work educators’ participation in moving students towards more racially just practitioners. critical race theory (crt) critical race theory (crt) provided a framework to study the relationship between race, racism, and power within social work education. crt was described by delgado and stefanic (2012) as an activist movement grounded in legal scholarship which seeks to understand the effects of race and racism on society and change society for the better. crt challenges normative standards of whiteness and provides insight into how race, racism, and power interact to maintain and support racial inequality. additionally, crt supports the view that race is socially constructed rather than a biological fact (crenshaw, 1995; delgado & stefanic, 2012). this theory promotes a structural approach to addressing social injustice in a diverse society that goes beyond the expansion of access to opportunities. crt contends that race is a social construct that impedes every aspect of social life, it promotes social justice, employs intersectionality concepts, and seeks to provide a space for marginalized voices (delgado & stefanic, 2012). furthermore, crt operates multidirectionally to acknowledge personal resistance and distress as well as promotes structural approaches to address racism. in this study, crt offered a unique opportunity for social work researchers and educators to explore and respond to the challenges of the prevailing multicultural framework used in social work curricular approaches. multicultural approaches touted to advance cultural competency dominates the social work literature as social work education’s response to the cswe (2015) mandate to “engage in diversity and difference in practice” and “to advance human rights” (p. 7). the dominant position of social work perez/faculty as barriers to dismantaling racism 503 has been one of celebrating diversity and confronting individuals instead of systematic change. context historically marked by chattel slavery, the southeast region of the u.s. remains distinct in its political, economic, and social landscape. this study was conducted during the 20182019 academic year when the united states saw a rise in race and gender police brutality, anti-immigrant rhetoric and policy, and increasingly overt racism. additionally, the southern poverty law center (splc) reports a higher concentration of hate groups in the southeastern region of the united states (splc, 2018). one state in the region was the first to champion and pass the controversial stand your ground law. this offers a unique landscape to investigate how social work educators deliver substantive content, employ pedagogical approaches, and educational activities that provide learning opportunities for students around race and racism. for this study, a case is defined as bsw educators who teach a required designated diversity and/ or social justice course in the southeast region of the u.s. sample in this inquiry, i employed a qualitative case study design to understand the lived experience of undergraduate social work educators who teach race-specific content. i used purposive sampling method (patton, 2015; lincoln & guba, 1985; shavers & moore, 2014) to select cswe-accredited social work programs in the southeast region of the u.s. and identified 9 participants. inclusion criteria for study participants were to teach bsw courses at cswe accredited institutions, and to teach the required diversity course which included specific content on race and racism in undergraduate social work programs. although there are other non-required courses where race may be discussed, the selection of the required diversity course was based on the premise that racism would be highly likely to be discussed in the required diversity course. i specifically looked for faculty who have taught courses that fit the diversity and social justice description set by cswe and is required for all bsw students. additionally, i used snowball sampling to assist in the identification of participants by asking those who responded if they knew other faculty who might be interested and met the inclusion criteria (creswell, 2013; patton, 2015; shavers & moore, 2014). this technique helped increase the likelihood of adjuncts participating in the study. all of the adjuncts who participated in the study were obtained through snowball sampling. exclusion criteria were master level social work educators (msw) and doctoral level educators (dsw or ph.d.), those who teach an integrated race-content course, and educators with less than three years of teaching experience. nine social work educators agreed to take part and share their experiences teaching about race, racism, and antiracist practice in social work education programs. given the sensitive nature of the topic, great care has been taken to protect the identity of the study participants. protecting the identity of the participants is particularly important because advances in social work, summer 2021, 21(2/3) 504 discussions of the persistent racism and anti-racism content in the u.s. are being met with both public and private backlash. participant selection was intentional and sought information-rich or thick descriptions of cases for in-depth study (lincoln & guba, 1985; patton, 2015). according to the cswe 2016 annual statistical report on faculty, adjunct faculty comprise 52.9% of both full-time and part-time faculty (cswe, 2017). additionally, less than half (44.3%) of all full-time faculty were tenured. table 1 details the demographics of the participants in this study. one participant had an edd as their highest degree, six had a ph.d., and two had earned their msw degrees. continuing from left to right each participant self-assigned a pseudonym for this study. next is the participant’s self-identified gender category, labeled “gender.” as indicated in table 1, seven participants identified as women, and two identified as men. afterward is the category of “race” where each participant selfidentified as well. five of the participants held some type of social work licensure as indicated in the fifth column. following the “licensure” category is the total number of years of teaching experience indicated in the column marked, “teaching.” the seventh column titled “teaching diversity” indicates the number of years the participant has taught the requisite diversity course. the “public, private, or religious predominately white institution (pwi)” column indicates the type of institution the participant currently teaches in. the “full time appt type” column shows that two out of the nine participants were contingent or adjunct faculty. table 1 summarizes the demographic information of the study participants. method sample utilizing purposive sampling (lincoln & guba, 1985; patton, 2015; shavers & moore, 2014) i identified participants who met the following criteria: bsw faculty who (a) teach/ have taught in the southeast region of the u.s.; (b) teach/ have taught a social work program’s required diversity and/or social justice course; (c) had three or more years of experience teaching about race and racism; (d) who had taught a required designated course a minimum of three times. participants held either full-time or adjunct faculty status and were either non-tenured, tenure-track, or tenured faculty. exclusion criteria for the study were those who only taught about race or racism when it is embedded in other courses, had taught about race and racism for less than three years, and were either msw, dsw, or ph.d. only level educators. table 1. participants demographics # pseudonym degree sex race/ethnicity licensure* teaching experience (years) teaching diversity experience (years) public, private, or religious pwi* full time appointment type 1 cj edd woman white lsw 13 10 private tenure 2 cynthia phd woman african american none 25+ 25+ public tenure 3 doc phd woman african american lmsw 18 3 religious tenure track 4 isabel phd woman white lcsw 5 4 public adjunct 5 michael phd man white lisw-s 6 3 public tenure track 6 niang msw man senegalese none 8 5 public non-tenure track 7 regal phd woman black/african american none 3 3 public tenure track 8 taffy phd woman white none 19 3 private tenure 9 wonder woman msw woman african american lisw-s 4 3 public/religious adjunct *lsw= licensed social worker (swk); lmsw= licensed master swk; lcsw= licensed clinical swk; lisw-s= supervising independent swk **pwi=predominantly white institution data collection guidelines set forth by the institutional review board (irb) were followed before collecting data. i provided all participants the informed consent document via email and verbally informed all participants they could withdraw from participation at any time before beginning data collection. i obtained their consent either in person or via electronic means (i.e., a combination of email and phone or videoconferencing). i conducted three semi-structured interviews with participants. table 2 shows a sample of standard interview questions asked during sessions. all interviews were digitally recorded and transcribed using temi, an audio to text transcription service. i also kept a research journal to reflect on my thoughts throughout the process. initial interviews were more general in focus and ranged from 45 minutes to an hour. subsequent interviews were 60-90 minutes and were to garner more in-depth insights. ultimately, 27 interviews with an average of 61 minutes were obtained. these interviews focused on professional insights, both as a social worker and as an educator, as well as gathered data regarding the pedagogical strategies educators employed to develop students' understanding of the role of race and racism in contemporary u.s. society. i coded the data into themes utilizing the council on social work education educational policy and accreditation standards (epas) and the specific tenets of crt relevant to this inquiry. table 2. sample interview questions interview 1: general questions 1. tell me about yourself. (probe: area of social work practice, teaching experience, etc.) 2. why did you decide to pursue teaching in a bsw program and what are your motivations to continue? 3. what historical and societal messages have you received about your racial heritage? about others? can you describe your racial heritage? 4. what messages have you received (from family, friends, school, work, etc.) about your racial heritage? what 5. what have some of your supports been in understanding the importance of race and racism in social work practice? interview 2: social work values with regards to race/racism 1. do you believe the social work profession works to eliminate oppressive barriers? why or why not? 2. tell me: what is it like helping students understand structural barriers to social goods and resources? (probe: access to quality services, education, and maintaining voting rights). 3. what is the role of a social workers in addressing racism and how do you help students understand this role? (probe: do you feel there is a professional ethical duty to do so?) interview 3: experiences and strategies teaching race/racism (knowledge/skills) 1. cswe identifies race as one mechanism of oppression students need to understand, what are your thoughts about that? (probe: do you agree/disagree?, why/ why not?, to what extent?) 2. as you see it, what skills do students need to be able to promote social justice before they enter the field? how do you help them gain those skills? 3. what have been major barriers in teaching about race and racism, either inside or outside of the classroom (probe: scholars note student resistance or lack of institutional support, what are your experiences?). perez/faculty as barriers to dismantaling racism 507 additionally, i collected course syllabi, powerpoints, and assignment descriptions specific to race, racism, and anti-racism that the participants utilized in the classroom. i viewed these items as constructed within and through structural conditions, context, and ideologies, which is consistent with my epistemological stance of critical constructivism. specifically, i regarded the language within these texts as reflective of larger power structures that simultaneously informed and limited the fields' current stance and content delivery on issues of race, racism, and anti-racism. crt served as an avenue to highlight these larger structures by centralizing the endemic nature of racism. the inclusion of syllabi, powerpoints, and assignment descriptions helped to frame how these courses have been conceptualized, delivered, the program mission and goals, explicit and implicit curricula, and assessment criteria. qualitative content analysis provides the means to interpret contextual data through systematic coding and identification of themes that may allow me to increase my understanding of the dominant frame adopted in undergraduate social work education regarding race and racism. data analysis a pattern-coding procedure was utilized to bring structure and meaning to data and identify emergent themes and patterns (patton, 2015; saldaña, 2015). the first coding cycle began with open coding technique (saldaña, 2015) to get a sense of what the participant is sharing relative to teaching race and racism in the classroom. in the second coding cycle, i utilized focused coding to analyze how participants discussed pedagogical strategies of any kind (saldaña, 2015). next, in the third level of coding i employed pattern matching using dedoose to determine how findings aligned, or misaligned, with the tenets of crt, as well as with competencies two: engage diversity and difference in practice and three: advance human rights and social, economic, and environmental justice presented by cswe and the corresponding epas. informed by crt, i also analyzed institutional arrangements that either contributed to or limited the delivery of race, racism, and anti-racism content with particular attention given to those who have less power in social and institutional settings (e.g. adjuncts, tenure-track faculty, and people of color). furthermore, the syllabi, assignment descriptions, and powerpoints began with coding focused by the epas composition of knowledge, values, and skills to systematically identify patterns and themes within the data. this was helpful as these categories put forth through the epas shape and drive course content; programs must meet these standards to earn accreditation (cswe, 2008, 2015). in the second phase of coding, i conducted a descriptive analysis and sorted codes into the specific categories of knowledge, values, and skills and then looked for patterns within each category (patton, 2015; saldaña, 2015). trustworthiness is a critical component of the qualitative research process (creswell, 2013; lincoln & guba, 1985). lincoln and guba (1985) suggested trustworthiness increases the overall value of a research study. strategies to augment the quality of my analysis included (a) prolonged engagement with 3-5 interviews; (b) triangulation to situate my emergent findings within the literature; (c) creating an audit trail; (d) thick, rich descriptions; and (e) engaging in a reflexive process throughout to consistently identify areas where my positionality, lived experiences, and epistemologies are located within advances in social work, summer 2021, 21(2/3) 508 analysis (creswell, 2013; lincoln & guba, 1985; patton, 2015). employing multiple techniques increases the credibility, rigor, and trustworthiness of my research design (amankwaa, 2016; creswell, 2013; lincoln & guba, 1985; patton, 2015). positionality harding (1993) maintains that all human beliefs are socially situated, "including our best scientific beliefs" (p. 142). to put it another way, when researchers acknowledge their biases and the potential influence that may have on how they interpret the data, there is potential for more honest and truthful research to emerge. it is not possible to dismiss a person's experiences, perspectives, or knowledge in the analysis of data (strauss & corbin, 1998). criticalists seek to look for ways to make sure their lenses and biases don't overly impact various aspects of the study. strauss and corbin (1998) state this knowledge may be useful sources of data generation in itself. likewise, merriam (2009) insists there is a need for the use of critical self-reflection with regards to "assumptions, worldviews, biases, theoretical orientation, and relationship to the study that may affect the investigation" (p. 229). in this next section, i pull back the curtain on the foundation of my worldviews, assumptions, and biases. i acknowledge and accept the fact that each interview is a co-constructed product between the interviewer and the interviewee, and no two interviews are going to garner the same information out of the same person because every interaction is different (holstein & gubrium, 1995). i hold several salient identities through which i live. i occupy several social identities; i am a christian, a daughter, and a sister, as well as a wife and mother. however, as a black person living in the u.s., my entire life has been lived as an explicitly racialized being that intersects with those other identities. as a past social work student, current social work professional and educator my blackness allowed for me to frame this project through a lens absent of racial neutrality. my education as a masterlevel social work student was primarily void of any discussion of race or the impact of race on policy and practice. in my experience in the early 2000s, the topic of race was regulated to a single course and was not explored in any other courses. it was not until my full-year placement in my second year of the program that i began to realize that many of the theories and techniques taught in the program did not accurately prepare me to think about or work with communities of color. i am fully aware and in acknowledgment that the prevailing ideology of colorblindness is not only a fallacy, but it serves to reinforce racism and maintain the current system of oppression even as the mechanisms may change. social work education and practice have served as co-conspirators in preserving the very racism and oppression it has vowed to dismantle. crt notes that my voice is unique, my perspective is valuable, and the absence of my experience, and other people of color, leaves us examining only part of the landscape. as a black woman, i occupy an almost constant state of awareness and reflection as i situate and process events, interactions, responses, and other daily occurrences of the world about race, both mine and those around me. this decades-long, formalized, non-academic education provided the foundation and passion to engage in this work. perez/faculty as barriers to dismantaling racism 509 key findings six of the nine competencies outlined by cswe specifically discuss diversity as being a central component. thus, social work educators bear the responsibility of implementing the program's curriculum in a way to prepare students to demonstrate the integration and application of the knowledge, values, skills, and cognitive and affective processes required to engage in anti-racist social work practice. several key factors emerged from the analyses that contribute to faculty themselves being barriers to the effective delivery and facilitation of anti-racist content within social work programs. those factors were a) their own racial identity; b) insufficient formal preparation around race and racism; c) lack of faculty comfort with anti-racist content; d) lack of skill in teaching anti-racist content. faculty racial identity the racial identity of the faculty served as an element that shaped the classroom environment. three white participants specifically attributed their own racial identity as a barrier or adding to the challenge of teaching about race and racism. cj stated, “as a white person it’s a challenge [to teach about race].” as a white female in a rural setting, cj appeared almost apologetic throughout the interview process. while she never hesitated in answering the interview questions, she often made remarks such as "i am ashamed to say" or "i really try" throughout the interviews. at the end of the process, she commented that she felt "good about" being able to talk about race and racism in social work in "an open way.” isabel echoed her feelings, “i think since i am white sometimes, i’m seen as not credible because i haven’t experienced, or they think i haven’t experienced racism. they don’t know my story.” race was not a salient part of her identity growing up yet after a series of life events she began to discover how much race “really matters.” she credits these series of discoveries for providing her with the motivation to begin and continue to “explicitly teach about race and racism in america.” when asked to explain isabel continued, “okay, so i am white right? no big deal. but in my life, i am the odd one out. most of the people in my life are black or brown because my family no longer speaks to me because of race. students don’t and won’t know that about me. it just sometimes makes it hard because i don’t have the same experience as my family and friends with racism, but i do have a personal connection, so it impacts me.” admittedly michael’s struggle was more internal as he openly acknowledged that he believed him being a “white dude” at the front of the room played a major role in the lack of challenges he received in class. due to his relationship with a colleague he could see the difference in the response to both teaching the same content. michael offered, “there are things that at the front of the room i need to say and it's just complicated because i have had a different lived experience. a colleague of mine is an african american woman. her [students] are at times so skeptical that they openly challenged her authority, her expertise maybe. i have never had to deal with that.” in like manner, taffy also revealed, “i suppose one barrier in part is me teaching it. i don't know if that's my own discomfort with realizing that i'm teaching about something i can't say i've experienced.” advances in social work, summer 2021, 21(2/3) 510 the racial identity of black faculty also impacted the classroom experience. doc approached the interview with wisdom that exposed her almost two decades of social work practice in a variety of social work settings working with youth. as a former practitioner in multiple states, she was able to compare her experiences as a practitioner across geographic locations to her time teaching in the rural southeast. from her accounts, facing race within the classroom as an african american female has been far more challenging than when in practice. likewise, niang also expressed that his presence as a black male faculty member at times negatively impacted the classroom when he taught about race and privilege. in his interview, he shared, “oh i have been openly challenged in the classroom about racism and privilege. most often by white students.” wonderwoman1920 also disclosed that she too had been challenged by students in the classroom. “sometimes they get quiet and disengage when you talk about racism,” she shared, “however several times, especially early on, students would just come at me. like, there is no such thing as white privilege and we don’t have to worry about racism anymore. the first few times i was shocked they would talk to their professor like that but then i realized i represent what they are fighting to ignore.” insufficient formal preparation to teach race and racism the singular feature identified by each participant was the need to seek out and craft their process of self-study around race, racism, and antiracist practice. each participant noted there was information about race and racism situated in their educational content however no one found that content sufficiently prepared them for practice nor teaching. three participants identified the starting point of their self-education was when they knew they would be assigned to teach the required diversity course. taffy shared, “i saw how race played out in practice. how nurses treated patients differently and whatnot but that didn’t mean i could teach it. so i figured i needed to learn. there's compilations of books… takaki, bell hooks, freire, and others. i taught myself while i taught [race and racism], and i picked out the stuff that made sense, and it was a lot for me.” likewise, for regal, critical scholars were important for grounding her teaching about race and antiracist content. she shared: within social work education, material on race and racism was really meaningless and generic. i take my cues from freire, bell hooks, and that’s what helped me a lot. i started bringing that into my program and asking well what about the power dynamic around race? having taught in social work education for over 25 years cynthia averred, “ignoring race in social work education or practice is not new. you have to keep looking for ways to get students to even acknowledge it much less talk about it. and the universities and conferences don’t help. you have to learn it for yourself. books, articles, and if you’re black or brown in america just living.” cynthia continued: perez/faculty as barriers to dismantaling racism 511 you know back when i started in school there was very little significant talk about race other than black people being a problem. i remember talking to my professors and saying, “okay so we talk a bit about feminism, but what about black women, not just women? what about all of the barriers for black people in this country?” (laughs) you know those professors looked at me and said, “oh you’re one of them.” i was thinking if by them you mean thinking folk then, yes, i am (laughs louder). it was difficult to get any content about black people incorporated into the curriculum. so, i read. i read freire, and lorde, and hooks, and many others. lack of faculty comfort with anti-racist content when the conversations turned to experiences delivering race and racism content in the classroom participants noted that faculty should have some level of comfort around the topic in the classroom. anti-racism is not an affable topic yet if faculty approach the topics of race and racism with apprehension the effect on the classroom can be detrimental to students’ learning process around race. seven of the nine participants specifically noted that either they have experienced this themselves or have witnessed colleagues fumble around concepts of racism and white supremacy. wonder woman1920 placed responsibility on the educator to not be timid about broaching race and racism with students. she reasoned, “faculty, adjunct or full-time, need to be able to talk about race. we need to know what our feelings are on issues and what are the hot buttons so we can help students work through them. really so we can help our clients and our students.” regal shared a conversation she had with a faculty member who was uncomfortable with the use of the term white supremacy being explicitly in the classroom. she described a conversation with a colleague: this white colleague of mine was so uncomfortable with that word and i'm like, huh? you know, to me that was kind of alarming, but it shouldn't have been, i guess. but you know so you have a problem with the term white supremacy i know you ain't talking about it [in class]. i know this doesn't come up in your class at least not from you. you're not initiating this conversation about white supremacy because you're uncomfortable with it. and when it does come up what do you do? niang noted that “social work education programs don’t prepare faculty or students to deal with racism, in or out of the classroom. so then how are social work faculty, especially white faculty, supposed to be comfortable with it? and then how do we expect them to teach it especially when white people don’t usually even deal with race or racism.” similarly, michael shared, …as a white male i didn’t really ever talk about race growing up. and there was no in-depth discussion of racism in my courses as a student. i was really nervous and i think about that first term teaching race and it was a disaster. but i wasn’t comfortable with it even though i tried. i feel bad for those students. it definitely could’ve been much better. advances in social work, summer 2021, 21(2/3) 512 lack of skill in teaching anti-racist content as participants revealed, comfort level with white supremacy, racism, and race can hinder the learning environment. yet they were vocal about the importance of needing to have the skill to discuss and facilitate learning explicitly focused on progressing students towards future anti-racist social work practice. isabel stated, “race and privilege are difficult alone yet when you put them together it’s like creating a pressure cooker situation. but it is so critical to being able to be a social worker. you have to know the areas you are privileged in or even how others may wrongfully perceive you as privileged. you need to know what to do with that.” lack of faculty skill teaching anti-racist content was also identified as a challenge for both full-time and contingent faculty. cj recounted a time when a last-minute change in faculty resulted in an adjunct teaching the required diversity course and negatively impacted the cohort. she recounted: when a white student created tension in the classroom, neither the other students nor the faculty knew how to respond, and i was not made aware of the problem until late in the term. it ended up being really, really bad and i don't think anyone really learned much about race. if anything, i think the adjunct's silence made some students believe she agreed. regal shared that her first time teaching the diversity course was as a doctoral student. this led her to question how much the program truly valued the content in the course. she reflected, i'm a doc student and i'm teaching the diversity class. so that makes me wonder, well, how much do ya'll really care about this class if you're letting someone who’s never been formally trained to teach this class? and even like the same for like adjuncts. they don't have the support full-time faculty have so what happens to prepare them? what resources do they have to process all of this because i know how little we have as full-time faculty? discussion social work is guilty of actively maintaining racial disparities and inequities within its education structure despite the outward commitment to social justice. for example, some of the participants remarked on the twelve grand challenges developed to “initiative to champion social progress powered by science. it’s a call to action for social work researchers and practitioners” (grand challenges for social work, 2021, para. 1). for these participants, this effort does not amount to any more than the typical incremental changes, if any at all. yet these grand challenges do not center nor critically engage the topic of race and racism within social work praxis and research. the initial lack of overt attention on race and racism within their initial call to action embraces a colorblind ideology (bonillasilva, 2018) and ignores inequity even while trying to attend to social injustice (kolivoski et al., 2014). the creators and supporters of the twelve grand challenges have chosen to ignore the longevity of systemic racism and provides justification for avoiding the perez/faculty as barriers to dismantaling racism 513 responsibility of challenging and dismantling racism within social work praxis (bell, 1980; kolivoski et al., 2014). moreover, cswe full endorsement of this initiative and the overt act of offering focused workshops and presentations at the annual program meeting allows for the appearance of progressiveness without actually developing and supporting practitioners to be able to enact substantial social change (bell, 1980; bonilla-silva, 2018). the participants in this study, irrespective of race, contend that a deeper, more critical understanding of race and racism has been largely ignored in social work education and practice alike marginalizing race to a burden to bear by people of color, depleting our racial stamina to engage in ongoing education, self-awareness, and anti-racist practice. study participants believed providing the opportunities to foster a critical self-awareness and selfregulation around is not only an accreditation task but a moral, professional obligation. throughout their commentary participants noted that it is critical to foster selfawareness of bias and give students the opportunity to practice processing their emotions around race and racism. the participants in this study noted that initiating the topic of race and discrimination was hard work and conversations about race, particularly in interracial spaces, are difficult and uncomfortable. participants shared the shifting sociopolitical climate that has allowed once-covert bigoted ideologies to become the norm has made it more difficult in some cases to raise students’ self-awareness. essed (1991) stated students ignoring or denying racist acts can become a common strategy to deny the existence of racism in a society. the participants were ill-prepared through academic and professional channels to correct bigoted thoughts around race. given the potential for intense emotion and friction around race and racism, it is understandable why people are eager to avoid such conversations. albeit difficult, study participants maintained such conversations were crucial to developing students’ self-awareness yet admitted to having to intentionally work on building those skills. within higher education, patton (2016) argues that higher education is rooted in white supremacy and serves as a primary source in enforcing inequities, and continues to represent a complex relationship between race, property, and oppression. jay (2003) asserts, “the teaching of transformative knowledge poses serious threat to the dominant power structures operating in american society that privileges whites over all other racial groups” (p. 5). diversity courses are a non-threatening way for social work programs to appear they are committed to diversity without requiring transformative pedagogical changes. the council on social work education (2015) sets the standard within the accreditation competencies to “engage difference and diversity” (p. 7). competency two in the accreditation standards expressly states, “social workers apply self-awareness and selfregulation to manage the influence of personal biases and values in working with diverse clients and constituencies” (cswe, 2015, p. 7). this mandate by cswe is a call to action to examine implicit bias within both our profession and within our education programs. probing the implicit bias of social work students can be visualized as a foundational step for bswes to answer the call of guiding students to develop the necessary self-awareness and self-regulation to manage their personal bias while working with clients of diverse racial backgrounds. implicit bias, eberhardt (2019) argues, influences all people by acting advances in social work, summer 2021, 21(2/3) 514 as a “distorting lens” that has the power to sway our perceptions and ideas about race (p. 6). they further contend this bias is “not limited to one profession, one race, or one country” (eberhardt, 2019, p. 7). social work education has thus far been content with reinforcing bias by only celebrating race and focusing primarily on self instead of interrogating and challenging the faulty system that allows racist inequities and disparities to persist. implications for social work both the nasw and cswe emphasize the importance of social workers and social work students increasing their knowledge of personal biases and values to mitigate the potential negative impact on clients. after roughly 30 years, in 1992 cswe made diversity content a program accreditation requirement (garcia & van soest, 1997; kohli et al., 2010). regardless of the recent attention given to cultural competence within social work education, scholarship has called to question this foundational tenet of the profession. despite the foundational legacy cultural competency holds in modern social work the profession is not above criticism. the current multiculturalism and cultural competency framework does not critique social systems and focuses on individual change rather than systems of oppression (abrams & moio, 2009; jeyasingham, 2012; sakamoto, 2007; varghese, 2016). according to sakamoto (2007), cultural competency rarely critically analyzes whiteness within social work. scholars have argued whiteness is the default standard for all others to be measured by (applebaum, 2010; davis, 2016; delgado & stefancic, 1997, 2012; diangelo, 2018; owen, 2007; young & zubrzycki, 2011, zembylas, 2015). scholars assert that social work is built on a foundation of whiteness; thus, cultural competency is implicitly bound to the principles of whiteness (abrams & moio, 2009; sakamoto, 2007; varghese, 2016). the findings for this study have implications for faculty development and education. these participants portrayed ideologies and strategies that align with social justice theoretical foundations, however, none of them identified social justice pedagogy explicitly. davis (2016) argues it seems unusual that ph.d. level graduates “are not required to learn much about race at the ph.d. level” although they will at some point be required to teach about it (p. 400). i would further argue that race and anti-racist education needs to be critically incorporated into the curriculum at all levels for two primary reasons. first, in social work education, cswe does not require any additional training, scholarship, or education specific to racism before they can teach. yet in line with the research, participants in this study shared that a lack of faculty readiness, their own and colleagues, to engage in critical conversations about race is one barrier faculty must overcome to effectively teach about racism. while the majority of the social work faculty hold ph.d.s (67.6%), having a ph.d. is not required to teach in social work programs (cswe, 2017). therefore, as davis (2016) noted that those in ph.d. programs will have to teach content on race, i assert so will those social work educators who do not hold ph.d.s. faculty at the master’s level must also be prepared to teach content on race with the foundation for understanding the impact of race and racism beginning in the undergraduate program. centering and requiring content on perez/faculty as barriers to dismantaling racism 515 race should be critically and explicitly taught throughout all levels in social work education. this may contribute to both the foundation of future educators and to help develop students’ knowledge and skills to participate in a broader analysis and collaboration to address race and racism in social work practice and policy. second, the need for current social work educators to have access to professional development centered on strategies for teaching anti-racism in their professional networks is evident. social work educators are not trained in pedagogy nor are they typically socialized into classroom teaching. social work scholars have failed to intently examine the knowledge, skills, or disposition of social work faculty who teach about race and racism and the impact on their teaching practice. this creates tension within social work preparation programs to provide recommendations for evidence-based teaching practices as the focus of social work programs is to develop practitioners. this study displayed that although faculty may be committed to teaching anti-racist content, they lack the formal training, curriculum knowledge, experience with pedagogical strategies, and professional development support to fully engage in critical anti-racist content in social work programs. social work programs (and the institutions that house them) could develop required professional development workshops for both full and part-time faculty, irrespective of their tenure status, that addresses racism and provides strategies for anti-racist teaching. additionally, cswe could revise its teaching requirements to include documented antiracist teaching professional development. to help fuel this effort cswe could work with experts, as well as nasw, to create training opportunities and make them available online and at the annual program meeting (apm). lastly, there is a need to support the growth of practitioners who want to become educators and social work education leaders who understand social justice pedagogical strategies beyond professional development. there is a copious amount of empirical work, articles, and essays detailing the racial and gendered bias experienced in higher education, such as racial microaggressions encountered by faculty of color from students and colleagues (edmondscady and wingfield, 2017; love, 2019; richards, 2019; smith et al., 2017), and bias embedded in students’ evaluations of teaching (edmonds-cady & wingfield, 2017; richards, 2019). richards (2019) further illustrates how faculty assessments have been weaponized against faculty who teach about racial injustice. utilizing a color-blind racism frame she outlined how institutions can both claim to value diversity and inclusivity, while simultaneously contributing to the marginalization of some of its faculty. richards (2019) advocates for the institutionalization of race-and gender-conscious systems of evaluation, mentorship, and support. institutions that proactively create antiracist and anti-sexist systems of support that clearly outline tenure expectations offer robust professional development provided by those with expert knowledge, and centers mentorship that is explicitly anti-racist and anti-sexist can help develop a set of best practices. i assert that social work programs can lead the way by enacting these ideas at the program level. furthermore, cswe can support this work by incorporating these steps into the revised accreditation standards as a way to offer social work programs support in the implementation of these race-conscious pedagogical strategies. advances in social work, summer 2021, 21(2/3) 516 recommendations racism has a complicated history in the united states. it is a complex set of events that encroaches on our daily lives. therefore, the role of race and racism should not be regulated to one course within social work education or only infused throughout the curriculum. a comprehensive approach that incorporates both a course focused on race and racism and antiracist content scaffolded throughout the curriculum should be implemented. the council on social work education (cswe) should consider making this scaffolded approach part of the accreditation process. the inclusion of specific strategies to build faculty’s comfort and skills around facilitating learning around race and racism should be incorporated into graduate-level social work programs. this is my second recommendation. crt combined with social justice pedagogy offers social work education the opportunity to restructure the curriculum to center race and its intersectionality with all forms of oppression. racism continues to be america’s original sin. some social work educators are employing social justice strategies in the learning environment but these participants highlighted the haphazard way educators may become familiar with social justice strategies. participants reflected on their own college experiences with race and racism and revealed they desired a more meaningful experience. crt and social justice pedagogy can provide a foundation and a framework to engage in addressing the challenge of critical analysis of race and racism within social work curriculum. my final recommendation is related to the professional development opportunities for faculty who teach content on race and racism. due to the unique skills required to effectively facilitate learning around anti-racism additional opportunities should be presented through cswe, the association of baccalaureate social work program directors (bpd), nasw, and other organizations to provide training and professional development. therefore providing both full-time and contingent faculty more opportunity to increase their pedagogical skills around anti-racism and anti-blackness. this may also further foster more critical research about race and antiracist praxis within social work scholarship to focus on ways to impact social policy and dismantle racist systems. conclusion racial disparities within the united states continue to be pervasive and persistent. i conducted this study during a time of the resegregation of public schools (hannah-jones, 2014); a mortality rate for black infants being twice the rate of white infants (mathews et al., 2015); increasing white nationalist activity (splc, n.d.); native american young adults having the highest suicide rates of all other groups (jiang et al., 2015); and 32% of black men killed by police in the united states in 2015 were unarmed (swaine et al., 2015). with the prevalence of social media, the persistent white supremacy embedded into the very marrow of the united states has been exposed through the onslaught of racist conflicts, crimes, and counter-protests that have occurred in recent years. as a true “boots on the ground” profession, social work is uniquely positioned to ameliorate racial bias, racial injustice, and racial discrimination with its engagement of virtually every social perez/faculty as barriers to dismantaling racism 517 problem. the findings in this study are significant for social work education and practice by providing a more nuanced examination of undergraduate social work educators who encourage students to engage in anti-racist social work praxis. 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(2015). ‘pedagogy of discomfort’ and its ethical implications: the tensions of ethical violence in social justice education. ethics and education, 10(2), 163-174. https://doi.org/10.1080/17449642.2015.1039274 author note: address correspondence to ebony perez, department of undergraduate social work, saint leo university, st. leo, fl 33574. email: ebony.perez@saintleo.edu https://doi.org/10.1177/107780040200800105 https://www.splcenter.org/hate-map https://www.splcenter.org/hate-map https://www.splcenter.org/ https://doi.org/10.4135/9781452230153 https://www.theguardian.com/us-news/2015/jun/01/black-americans-killed-by-police-analysis https://www.theguardian.com/us-news/2015/jun/01/black-americans-killed-by-police-analysis https://doi.org/10.1080/10437797.2016.1174646 https://doi.org/10.1177/1468017310386849 https://doi.org/10.1080/17449642.2015.1039274 mailto:ebony.perez@saintleo.edu this work is licensed under a creative commons attribution 4.0 international license. mental health and psychosocial needs of syrian refugees: a literature review and future directions asli cennet yalim isok kim abstract: since 2011, the syrian refugee crisis has resulted in a massive displacement of syrians, inside and outside of syria. the enormous psychosocial needs of displaced syrians have been documented by various reports and studies. with expected arrivals of syrian refugees resettling in the united states in the near future, the intensity of the challenges for both resettlement agencies and the syrian refugees themselves are expected to increase. a literature review was conducted for publications produced between march 2011 and january 2017. academic and grey literature were explored to provide an overview of the psychosocial well-being and cultural characteristics of syrians. additionally, current models were analyzed to identify future directions for social work practice. it is vital to understand the syrian refugee crisis through a multidisciplinary lens. responding to the challenges found among syrians requires deliberate consideration for sociocultural, historical, and political issues that uniquely describe them and their contexts. identifying psychosocial needs may facilitate other aspects of resettlement outcomes, such as employment, education, and social integration. incorporating a holistic model that reflects trauma-informed and human rights perspectives into clinical as well as policy practices is critical for better overall resettlement outcomes for syrian refugees, and refugee populations in general. keywords: syrian refugees; refugee mental health; refugee crisis; refugee resettlement; psychosocial wellbeing as of may 2017, over 13.5 million displaced syrians were in need of humanitarian assistance (usaid, 2017). on average, 3,300 syrians arrived in neighboring countries every day in 2014 (e.g., turkey, jordan, lebanon, iraq, and egypt), creating a large burden on the host countries (zetter & ruaudel, 2014). not all syrians who have crossed into neighboring countries are registered refugees. even though nearly half of the syrian population has been displaced since the crisis began in 2011, only 5.2 million are formally registered as refugees (united nations high commissioner for refugees [unhcr], 2017). thus, the majority still do not have refugee status as recognized by the international community. the government of turkey, alone, has registered almost 3 million syrians (unhcr, 2017). the large number of refugee arrivals has begun to exact severe negative social and economic tolls on the region (zetter & ruaudel, 2014). given the host countries’ own political and societal challenges, they are having a difficult time meeting even the basic needs of the refugees, and lack sufficient capacity to cope with the vast influx. addressing the syrian refugee crisis refugee flows are the result of regional and international conflicts, contributing to social and political instability in neighboring countries (newman & selm, 2003). over the ____________ asli cennet yalim, msw, doctoral candidate, university at buffalo, school of social work. isok kim, phd, university at buffalo, school of social work. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 833-852, doi: 10.18060/21633 https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2018, 18(3) 834 past 50 years, the globalization of technology and communication has popularized images of refugees. thus, there is a constant reminder of what is assumed to be a “flood” of refugees from “non-western” countries to the “west” (gale, 2004, p. 336). the images of the refugees attempting to cross from turkey to greece, and then to other european countries, have been intensified by traditional news and social media outlets. these visual images are often used by governments or media to create political rhetoric around national security in resettlement countries that undermine efforts to provide safety for refugees and their families (gabiam, 2016; united states congress house, 2015). therefore, countries like the united states acknowledge that they would actually prefer these refugees to stay in the region, closer to their home country, and deliver humanitarian assistance through neighboring countries. in 2015, the u.s. government announced that nearly $419 million would be provided for those affected by the war in syria (u.s. department of state, 2015). the monetary aid allows international aid agencies to work in collaboration with host countries to provide shelter, food, water, healthcare, education and employment for syrian refugees (unhcr, 2014a). providing financial support to the neighboring host countries could prevent syrians from seeking assistance abroad. however, the large numbers of people in need make it extremely difficult for humanitarian organizations to manage even the basic needs of refugees; despite receiving aid from the international community, only about 54% of the money is spent on the direct care of syrian refugees (center for middle eastern strategic studies, 2014). although keeping refugees in the region may have seemed like a good idea at first, providing financial aid to neighboring host countries may not be a long-term solution to meet refugees’ health and psychosocial needs. countries with more stable political, social, and economic environments can afford to provide better health care services, social services, education for children of refugee families, employment, job-training opportunities, and housing options for displaced populations like the syrians. the lack of appropriate services in neighboring host countries to meet the basic needs of refugees, such as food, housing, and safety, has meant that addressing mental health services has not been a priority for refugees in the region. it is nearly impossible for humanitarian organizations to follow up on the healthcare needs of refugees because of refugees’ relocation patterns in neighboring countries. for instance, turkey has an unconditional “open door policy” that allows syrian refugees to move freely within the country’s border. only about 10% of the syrian refugees live in camps throughout turkey, while the rest of them live either in cities along the turkey-syrian border, or are dispersed throughout the country (ferris & kirişci, 2015). thus, humanitarian organizations are only able to reach a small percentage of syrians in need, and are unable to follow-up on their physical and mental health needs. even in refugee camps, many mental health issues and psychosocial needs are not being addressed because of limited monitoring capacity (aziz, hutchinson, & maltby, 2014). mental health and psychosocial services barely exist for syrian refugees residing outside of the camps in neighboring host countries, who are colloquially referred to as “urban refugees” (unhcr, 2015). they live in cities, towns, and rural areas, often in dire circumstances, and are not easily reachable by humanitarian aid organizations (cultural orientation resource center, 2014). these logistical barriers make it challenging for academic researchers to carry out studies beyond basic needs assessments on syrian refugees’ mental health status (jefee-bahloul & khoshnood, 2014). yalim & kim./mental health and psychosocial 835 the neighboring host countries lack long-term refugee policies, resulting in their seeking ways to resettle syrian refugees in countries that have established resettlement policies. even though these countries, such as the united states and canada, have limited mental-health-related services tailored to refugees, they have other policies that can lead to improvements in providing these services to the syrian refugees. for instance, the united states has the office of refugee resettlement incorporated into the department of health and human services, which provides assistance for accessing health care, housing, and employment services (office of refugee resettlement, 2016; pace, al-obaydi, nourian, & kamimura, 2015). with these basic necessities secured, there is a greater possibility of identifying psychosocial needs and connecting refugees to the appropriate services. however, the executive order banning travel from seven muslim countries, which initially went into effect on january 27, 2017, has begun to have a significant impact on individuals and families from these countries, including syria. it has reignited the debate about whether to further restrict existing refugee processing and security screening protocols. the resettlement program will be capped at 50,000 refugees for the 2017 fiscal year, down from the 110,000-person ceiling instituted in the previous year (migration policy institute, 2017; the white house, 2017). the order has limited the capacity of governmental and non-governmental organizations to respond to the needs of refugees, and created ambiguity globally (spiegel & rubenstein, 2017). it is now even more important to create awareness about the needs and challenges of incoming and resettled syrian refugees, and refugees in general. thus, this paper aims to provide a review of the current literature addressing the mental health and psychosocial needs of syrian refugees, and to inform social work practitioners and scholars about the experiences and cultural characteristics of upcoming and/or resettled syrian refugees in the resettlement countries. methods the literature on refugee studies encompasses a wide variety of academic disciplines, including international relations, law, anthropology, sociology, economics, social work, geography, medicine, psychology, and history (skran & daughtry, 2007). the area of refugee studies lacks standard textbooks, a theoretical structure, and a systematic body of data. researchers must be prepared to incorporate and modify ideas, concepts, and theories from multiple disciplines (stein, 1986). some academic journals have devoted certain issues to humanitarian crises; however, this does not guarantee that the information will be delivered to the target audience, such as humanitarian organizations workers, social services workers, and policy makers. combining the academic and humanitarian platforms can allow professionals to share experiences, interact, and collaborate on needed mental health research areas (jefee-bahloul & khoshnood, 2014). recognizing risk and protective factors for the psychological wellbeing of the refugees is a prerequisite for establishing a knowledge base for effective services (beiser, 2006). to identify factors that play a role in the mental health of syrian refugees, the literature review focused on articles and reports published between march 2011 and january 2017. peerreviewed journal articles were searched through academic and public databases, including psychinfo, social work abstracts, academic search complete, journals@ovid full text, proquest, google scholar, and medline. a combination of the following key terms advances in social work, spring 2018, 18(3) 836 was used: syrian refugees, syria, refugee mental health, psychosocial wellbeing, mental health, refugee resettlement, ptsd, and trauma. additionally, reports from various government agencies and non-governmental organizations were identified via their official websites, including the united nations refugee agency and the world health organization (who). grey literature from published chronicles and dissertations were also used to identify relevant literature for this study. both academic and grey literature were searched using the following inclusion criteria: 1) studies that examine only the mental health needs and psychosocial wellbeing of adult syrian refugees, or 2) studies that examine both the mental health/psychosocial wellbeing and physical health needs of adult syrian refugees. studies about syrians’ mental health before 2011, when the syrian conflict began, were not included in this review. sixteen peer-reviewed journal articles and ten publications from the grey literature met the inclusion criteria. in this paper, the needs of displaced syrians are reviewed and discussed according to this literature. additionally, cultural/religious considerations and gender-specific issues emerged as sub-categories based on the review. results mental health and psychosocial needs of syrian refugees many displaced syrians experience a variety of mental health problems, including distress, sadness, fear, anger, nervousness, disinterest and hopelessness (unhcr, 2014b). severe emotional disorders, including depression and anxiety, are the most common mental health problems (54%) the refugees experience (hijazi & weissbecker, 2015), with the reported problems causing disruptions in their daily functioning. the stressors faced by syrians can be classified into three major categories. the first stressor category contains concerns regarding security and protection, such as difficulties obtaining legal status and protection in the host countries, and worries about protecting children. the second category is about limited access to health services, especially for those who require continued care and follow up. the third category is about dealing with misconceptions that often paint syrian refugees as exploiting their refugee status and diverting resources away from local residents, all of which contribute to increasing group tensions that already existed (hijazi & weissbecker, 2015). since the syrian crisis began in 2011, only a handful of studies have been published examining the mental health and psychosocial needs of syrian refugees. almost all of these studies were conducted in either refugee camps or in clinics in one of the neighboring host countries. barriers to conducting academic research in the region hinder the ability to identify and meet the support and treatment needs of syrians (jefee-bahloul & khoshnood, 2014). the number of syrians in need is expected to increase due to the lack of mental health care and professionals in the region. approximately 600.000 syrians are estimated to need treatment for severe mental illness, and another 4 million may be suffering from mild or moderate mental health problems (who, 2015). the large number of people in need makes it difficult to assess the impact of displacement on the mental health of the population, and to deliver the appropriate services and treatments. in addition, the stigma attached to individuals with a mental illness, and their families, may make it even more yalim & kim./mental health and psychosocial 837 difficult to deliver mental health services to syrian refugees. for instance, 354 syrian refugees in a refugee camp in turkey were asked about their openness to a referral for psychiatry and tele-mental health, which is the use of technology to offer treatment options and accessibility for people with mental illness (jefee-bahloul, moustafa, shebl, & barkiloteo, 2014; nelson, 2008). even though 41.8% of the sample met the criteria for posttraumatic stress disorder (ptsd), only 34% reported the need to see a psychiatrist. of those, only 45% were open to mental health services via technology. their reported reasons for declining tele-mental health services were privacy, distortions in the doctor–patient relationship, and unfamiliarity with the technology (jefee-bahloul et al., 2014). according to hassan et al. (2015), many syrians were also skeptical about psychology, psychiatry and utilizing mental health services in the past, which created a negative perception of mental illness, along with the fear of being stigmatized. before the crisis, most syrians viewed mental illness as something that brought shame to the family, and syrians with mental health needs were usually reluctant to seek professional help. today, however, with such a large increase in the level of psychological distress among syrian refugees, they might be more open to seeking professional help for mental health and psychosocial support (cultural orientation resource center, 2014; hassan et al., 2015). el chammay, kheir, and alaouie (2013) conducted an assessment in lebanon’s different districts to gather detailed information about the quality and coverage of services for syrian refugees. the study illustrated four levels of activities based on the assessment: basic services and safety (level 1); strengthening community and family support (level 2); focused non-specialized psychosocial support (level 3); and specialized or clinical services (level 4). focused non-specialized psychosocial support accounted for 52.4% of all activities, while 37.3% of service activities concentrated on strengthening community and family support. this assessment points out the importance of non-specialized psychosocial support services and community programs, which can facilitate improved responses to the present problems of syrian refugees, and reduce the stigma attached to mental health treatment among syrians. recognition of the syrians’ experiences is critical to evaluating their mental health. hassan et al. (2015) stressed the need to consider the following conditions for delivering appropriate services: 1) manifestations of pre-existing mental disorders; 2) conflict-related violence and displacement; and 3) the post-emergency context, such as those related to living conditions in the host countries. almost no data is available regarding pre-existing mental disorders of syrians before the war. however, the number of syrians with severe mental disorder symptoms might have increased given risk factors such as potentially traumatic events, forced displacement and loss of social support (hassan, ventevogel, jefee-bahloul, barkil-oteo, & kirmayer, 2016). additionally, the largest psychiatric hospital in lebanon reported increased admissions of syrians after the crisis started (lama, françois, marwan, & sami, 2015). both internally and externally displaced syrians have faced war-related violence, including massacres, murder, torture, hostage-taking, enforced disappearance, rape and sexual violence (hassan et al., 2015); these potentially traumatic events increase the possibility of mental health concerns among displaced syrians. aside from the impact of pre-resettlement conditions on mental health, syrians who flee syria and arrive in a host or a resettlement country may experience further difficulties due to advances in social work, spring 2018, 18(3) 838 poverty, loss of livelihood, unemployment, and limited access to housing, health care, and education (hassan et al., 2015). these conditions do not necessarily result in mental disorders but it is important to differentiate preand post-resettlement contexts when helping syrian refugees. this type of approach to assessment may reduce the propensity to simply label refugees with mental illnesses and allow service providers to deliver more appropriate services. the approaches that national and international organizations have adopted toward the mental health care of refugees have been criticized for their focus on western psychiatric categories, as these approaches pay little attention to the social, political and economic factors that play a vital role in refugees’ lives (jeon, yoshioka, & mollica, 2001). an overemphasis on traditional counseling models and individualistic theoretical approaches may also devalue some of the refugees’ cultures that are more collectivistic (brown, jones, nilsson, russell, & klevens, 2006). although post-emergency, context-related studies are almost non-existent, most studies in the developing literature on the mental health of syrian refugees still focus on psychiatric diagnosis and treatments (acarturk et al., 2016; alpak et al., 2015; lama et al., 2015). trauma-focused models highlighting pathologies may not always be helpful for refugees whose immediate needs are social and economic (hutchinson & dorsett, 2012). institutional and treatment services that pay more attention to refugees’ own perceptions and expressions of their needs can be a more appropriate approach for delivering services. it is critical that intervention studies with syrians and other refugee populations take cultural and sociopolitical context into consideration, to bridge between research and practice with refugees. cultural and religious considerations it is important to understand and distinguish among the cultural and religious value systems of syrians when exploring the perspectives of families and individuals, and when evaluating the psychological and social problems they face. hassan et al. (2015) underlined the wide diversity of socioeconomic, ethnic and religious backgrounds found within the syrian population, which influence the dynamics and relationships among members of the syrian communities and families. these varied backgrounds may have some common religious and cultural characteristics but providers should take care not to overgeneralize these characteristics when delivering services. as noted by moustafa (2015), it is difficult to develop a single, generalized arab or muslim view on the concept of mental health. nonetheless, there are several common themes that are unique to middle eastern cultures. for instance, the concept of majnoon, which roughly translates to “crazy person,” “mad,” or “insane,” is often used to describe individuals who need psychiatric attention. “the symptoms/behaviors associated with majnoon overlap with those of psychotic disorders, such as schizophrenia, but not with common mental disorders such as depression, anxiety or posttraumatic stress disorder” (hassan et al., 2015, p. 24). it is common to experience and interpret psychological symptoms physically rather than emotionally (i.e., psychosomatic symptoms) in non-western cultures (bou khalil, 2013; dwairy, 2006). arabic and syrian idioms describe distress with both somatic yalim & kim./mental health and psychosocial 839 complaints and psychological symptoms (hassan et al., 2015). similarly, a syrian in need of psychological help may use metaphors, expressions, or proverbs to express distress. the somatic symptoms can be expressed in the syrian context as heaviness in the heart, cramps in the guts, burden or weight on the chest, or having the feeling of ants crawling over the skin (hassan et al., 2015). understanding these cultural expressions of mental health symptoms may allow mental health providers to properly interpret psychological and physical complaints. syrian refugees struggle with their sudden loss of autonomy, sense of control over their lives, and loss of their family members and homelands (hassan et al., 2015; moustafa, 2015). the idea of carrying on a new life in foreign places causes anxiety, fear, uncertainty, frustration, and emotional disturbances. these experiences influence social functioning and/or result in specific symptoms that may be the criterion for the diagnosis of a mental disorder. thus, it is important not to over-diagnose syrian refugees with clinical disorders, since their experiences cannot be described strictly using western-based, evidence-driven medicine (bou khalil, 2013; hassan et al., 2015). daily concerns about their safety and difficult life circumstances may exacerbate their mental health conditions, which might contribute to developing mental disorders, but will also contribute to a feeling of demoralization and hopelessness. improving their circumstances and delivering appropriate services can significantly improve their mental health, which may not then require any psychiatric interventions. gender-specific considerations in syria and neighboring countries, women and girls are strongly affected by the recent conflict. meeting their basic rights, such as safety, health, and education, are immensely important because women are essential stakeholders in a post-conflict reconstruction and recovery process (sami et al., 2014). in the syrian culture, although men have historically been perceived as protectors of the family, this perception has now dramatically changed. women continue to take care of the family; their workloads have increased while men’s workloads have decreased overall because legal restrictions make it difficult for syrian men to find employment in the host countries. thus, they experience boredom, disempowerment, and low self-esteem. lower self-esteem may lead refugee men to express their masculinity negatively. for example, these feelings are used as excuses to act violently against family members. this has contributed to an increase in gender-based violence among syrians (anani, 2013; charles & denman, 2013). syrian refugee men reported that they are physically aggressive toward their spouses and children (unhcr, 2014b). the lack of employment among syrian refugees has also disproportionately affected women and youth. child labor and survival sex among young girls have increased, with refugee households succumbing to impoverishment, and issues of their immediate wellbeing rising (el chammay et al., 2013; zetter & ruaudel, 2014). girls as young as 10 years old have been used for prostitution. the number of early marriages has increased, because families want to “protect their daughters from being raped and ensure that they are under the protection of a man” (anani, 2013, p. 76). many families also arrange marriages for advances in social work, spring 2018, 18(3) 840 their young daughters in order to alleviate financial burdens. they believe that girls can be protected if they are married into a more financially secure family (charles & denman, 2013). however, this results in marriages happening at a very early age for these girls. some families even resort to selling their daughters to older men in order to decrease their overall family expenses. according to aid workers in lebanon, young girls and women also consider prostitution in order to provide money and food for their families (unhcr, 2013). this issue is not restricted to lebanon; in some camps in turkey, women have been sold under the guise of “temporary marriage.” two women refugees, who act as companions to male customers at a bar in turkey, explained that women between the ages of 15 and 50 have been sold for up to 5,000 turkish lira (about $1700 us dollar) in the camps (acarer, 2015). these arrangements are not only made by families; there are also many organized illegal groups involved in this issue. government controls in the camps are inadequate for preventing syrian women and girls from facing these challenges. sami et al. (2014) underlined the fact that these risks to refugee women and children are significant, and that gender-based violence (gbv) might worsen as the conflict in syria continues. the lack of adequate shelter caused by overcrowded camps and high rent in urban areas increases the risks for women, particularly those in female-headed households. in jordan, nearly half of households headed by females have no monthly income, and mainly survive on donations. additionally, women and girls are exposed to harassment, including offers for sex and marriage in the community (care, 2013). syrian parents and other family members also end up demonstrating poor parenting skills due to distress borne out of their refugee-related experiences (james, sovcik, garoff, & abbas, 2014). refugee household members spend time at home, and rarely socialize due to safety and security concerns for women and children. males who are the heads of households feel depressed, anxious, and useless since they are unable to adequately provide economic and psychological safety for their families. fathers are also ashamed that their children are unable to continue their education, and that some male children are working at low-paying and harsh jobs to help support their families (care, 2013). some researchers looked into the psychosocial needs of syrian refugee women through studies that included women’s health conditions. a needs assessment conducted in lebanon indicated a significant relationship between violence and reproductive health among displaced syrian women. thus, better reproductive health services in refugee settings, along with referrals to psychosocial services, are immediate needs for refugee women (masterson, usta, gupta, & ettinger 2014). according to the un population fund, about 1.7 million women need access to reproductive health services (as cited in sami et al., 2014). however, many women are unaware of reproductive and psychosocial services provided by humanitarian organizations and ngos available to them (al-qdah & lacroix, 2017; charles & denman, 2013). in the long term, the loss of education about, and access to, reproductive health may contribute to negative effects on their well-being in terms of fertility, health of offspring, and maternal care (charles & denman, 2013). another important issue for syrian refugee girls is their inability to continue their education due to the conflict. these girls are at risk of survival sex and early marriage. furthermore, school-aged children without access to education severely compromise their yalim & kim./mental health and psychosocial 841 chances to lead a stable life in the future, as they are more likely to suffer from prolonged psychological stress (charles & denman, 2013). access to education at all ages is one of the priorities in supporting children’s mental health and well-being (patton et al., 2016). promoting schooling in each neighboring country could directly affect children’s future. however, in some cases, refugee children are the family breadwinners because it is easier for them to find paid work in host countries like turkey (human rights watch, 2015). not being able to provide for their families and witnessing their kids’ vulnerability due to financial and social struggles may additionally contribute to parents’ sense of powerlessness and psychological distress (dejong et al., 2017). access to education for refugee children may reduce child labor, deter early marriage and recruitment by armed groups, foster their mental health and resilience, strengthen social cohesion, and raise hope for an entire generation (human rights watch, 2015; unicef, 2014). securing education for children can be done through advocacy by establishing minimal accreditation standards, assessing and monitoring children’s vulnerability, strengthening institutional mechanisms and referral systems; fostering awareness among parents about available educational options in host countries, and addressing gender-based violence and specific needs of girls (msyd, 2017; unicef, 2014). practice and policy recommendations there have not been any studies published that look into resettlement outcomes of syrian refugees in the united states. among the reasons for the lack of studies are the disputes over resettling syrians in the united states, with strict screening processes and only a relatively small number of resettled syrian refugees to date. in addition, syrian refugees resettled in the united states have mostly been assigned to places where they have personal or family connections (welsh, 2015). thus, syrians are not usually placed together in the same towns or cities, but are scattered throughout the united states, which makes it difficult to conduct a viable study. the expected arrivals of syrian refugees in the near future means that the number and intensity of challenges for both the resettlement agencies and the syrian refugees themselves are also expected to increase. the following intervention and policy recommendations are made to deliver better services for syrian refugees—those who are already resettled and those who will be resettling in the united states in the future. elements of effective interventions with syrian refugees with the number syrian refugees ever-increasing, it is crucial that refugee mental health models respond to the needs of the population in relevant and appropriate ways. multi-layered models that are used by unhcr programs in the pre-resettlement context have been helpful for syrian refugees in camps and urban settings (budosan, benner, abras, & aziz, 2016; hassan et al., 2015). these models can be adapted to refugees’ postresettlement settings. the programs include four layers: 1) basic services and security; 2) community and family support; 3) focused psychosocial or non-clinical support; and 4) clinical/psychiatric services (hassan et al., 2015). security is an important aspect because most persons with early posttraumatic symptoms are expected to recover if conditions of safety are re-established (jefee-bahloul, barkil-oteo, pless-mulloli, & fouad, 2015). advances in social work, spring 2018, 18(3) 842 thus, a basic needs assessment along with a mental health screening can be helpful during the first months of resettlement. providing this type of assessment is critical within the first three months so that appropriate referrals can be made while refugees still have access to intensive case management. some elements beyond basic and safety needs can be added to the second and third layers of the models for the syrian population in the postresettlement context. efforts should support individuals to restore relationships and build healthy patterns of interaction. this can be accomplished through creativity-based programs using the arts (e.g., theatre, singing, drawing, or poetry) and community activities designed to attract people with social events, educational workshops, cultural shows, or community dialogues (jefee-bahloul et al., 2015; nazzal, forghany, geevarughese, mahmoodi, & wong, 2014). a few psychosocial and community-based interventions were tested with syrian refugees in turkey and jordan. budosan et al. (2016) implemented a three-component model with urban syrian refugees at an outpatient health center and a community center. first, a mental health team received comprehensive training to become familiar with intervention, and with issues among displaced syrians. the second component consisted of non-intrusive care and support through assessing the needs and concerns of refugees. the last component included educational activities (english, turkish language, computer classes, etc.), vocational activities (cooking, journal & media design, graphic design, a beauty course), and recreational activities (children’s activities, cinema, music, etc.). these activities aimed to restore social cohesion, and to rebuild trust and capacity. according to the results, there were improvements in resilience and general well-being measurements. the model seems to meet the increased demand for context-sensitive, multi-level, and community-based interventions. another study was undertaken at the zaatari refugee camp in jordan. it was based on a vocational program with women refugees (jabbar & zaza, 2016). the results indicated that women’s confidence, self-esteem, and skills improved; the program helped women to generate income to build a better life, and gave them hope after experiencing conflict-related traumas. one last intervention study with syrian refugees was conducted at an urban area in jordan. it was designed to help refugees rediscover their basic psychological needs, learn how to satisfy them in small but meaningful ways that are achievable within their circumstances, and promote well-being within their new way of life (weinstein, khabbaz, & legate, 2016). the intervention aimed to enhance need satisfaction through encouraging small acts that facilitate closeness and reconnection with family or loved ones, instill a sense of achievement and engagement in interesting acts, and encourage self-congruent decision-making. this intervention reduced need frustration, symptoms of depression, and general stress. although these studies were conducted in host countries, the findings offer ideas about what might work for syrian refugees in the united states, or in any other resettlement country. utilizing a similar integrated approach with multilayered services can be helpful to improve the psychosocial wellbeing of syrians. some syrian refugees may need a social space where they can share their challenges and deal with their past experiences. this element does not usually require clinical treatment; rather, it is a psychosocial support group that re-creates social networks and facilitates engaging in meaningful daily activities (hassan et al., 2015). community yalim & kim./mental health and psychosocial 843 members from refugee groups can be good candidates for a role in peer-to-peer support. prominent individuals in communities (e.g., imams, leaders, and women with strong social networks) need to be consulted on traditional ways of healing and the appropriateness of the model. mental health professionals can play an instrumental and supportive role in this type of intervention but not a lead role in facilitating pathways of natural recovery from stress (silove, 2004). psychosocial but non-clinical groups can also be developed with syrians, using a strength-based perspective. according to boswall and al akash (2015), stigma and isolation are common among syrian women in jordan due to limited resources and a lack of networks. an intervention that targets this and similar populations may create contexts in which silent and isolated people can be reached (fitzsimons & fuller, 2002). facilitating groups at smaller, local facilities can be helpful for increasing participation in activities in both preand post-resettlement contexts. thus, there should be creative solutions to increase participation by isolated people, and decrease the stigma about mental health. a further area of study into the mental health of refugees should also consider the circumstances in resettlement countries. studies of refugees’ mental health have a tendency to emphasize the impact of past traumatic events, particularly in the country of origin and/or in the process of flight (kim, 2016). scant attention is paid to the impact of postresettlement experiences on mental health. competently designed and implemented interventions that focus on long-term benefits and on sustainability are what refugees need once the resettlement agencies have departed the scene (williams & thompson, 2011). resettlement policy addressing mental health services may not become a priority even after refugees resettle in the united states because the u.s. refugee resettlement policy focuses heavily on refugees becoming self-sufficient in a short time (i.e., 6-8 months; beiser, 2006; pace, et al., 2015). this policy offers overseas and domestic medical screening guidelines for every refugee who resettles in the u.s. (centers for disease control and prevention, 2013). the guidelines are designed to ensure that refugees' health problems do not become obstacles to employment, and the focus is primarily on screening for communicable diseases. however, this may mean that significant opportunities to protect the refugees’ mental health are being missed through the narrow focus on their employability based purely on physical health status. even for the u.s. population in general, navigating the complex u.s. healthcare system and getting access to mental health services1t 1tare challenging because of stigma, cost, and1t 1ta shortage1t 1tof mental health care professionals (bushak, 2016). difficulties in understanding the u.s. health care system limit accessibility to services for refugees as well. in 2015, the office of refugee resettlement implemented the refugee health promotion program to increase health literacy among refugees (office of refugee resettlement, 2016). this program relies on self-sufficiency in navigating the complex u.s. healthcare system (pace, et al., 2015). given the difficulties refugees face in trying to be self-sufficient in such a short time, language and structural barriers, it is critical to implement policies and programs that provide easier pathways for refugees to access care services, as well as comprehensive advances in social work, spring 2018, 18(3) 844 health education programs (beiser, 2006; pace et al., 2015). improving ways to detect mental health needs early in the resettlement process may facilitate a better adjustment by the refugees overall, which would have a subsequent positive impact on other aspects of resettlement outcomes, such as employment, education, and social integration. for instance, poor mental health outcomes are associated with unemployment and social isolation among resettled refugees (blight, ekblad, persson, & ekberg, 2006; hollander, 2013). paying more attention to psychosocial needs through a mandatory mental health assessment in the early stages of resettlement might improve daily functioning and long-term adjustment to the host country. taking intersectional characteristics of refugees into account—particularly for syrian refugees—should be a prerequisite for policymakers. being a refugee coming from an arabic-speaking country may result in experiences of discrimination and xenophobia against syrians. despite a lack of evidence,1t 1tsyrian refugees are considered a threat to u.s. national security (the white house, 2017). political discourse about needing to implement stricter security measures in refugee screening and banning syrian and other refugees from muslim countries from entering the united states can normalize the enforcement of discrimination and exclusion. this rhetoric increases confusion and misunderstandings among local communities. the risks of everyday discrimination and micro-aggression attached to the political discourse can lead to psychological distress among those who are perceived to have minority characteristics such as gender, race, or religion (seng, lopez, sperlich, hamama, & reed meldrum, 2012). initiating programs that bring social harmony, and changing the political rhetoric are critical for successful overall refugee resettlement, which would help to reduce misconceptions about the refugees. implementing community-based protection strategies that include promoting refugee rights, creating public awareness on refugee issues, and preventing abuses may reduce negativity and hostility towards refugees in host countries (al-makhamreh, spaneas, & neocleous, 2012; zetter, & ruaudel, 2014). having refugees take on advocacy roles may also protect and empower those who resettle in another country. activities such as information dissemination, collective decision-making with consideration for sociocultural norms, and cooperating with agencies whose are responsible for serving the refugees can help transform policies and services at local, national, and global levels. bowen and murshid (2016) suggest a conceptual framework in which traumainformed care (tic) can guide social policy and advocacy efforts to address social problems related to trauma. of the five tic principles (safety, trustworthiness and transparency, collaboration and peer support, empowerment, choice, and intersectionality of identity characteristics), the principles of safety and trustworthiness may be the most critical when instituting a policy for syrian refugees, and for refugees in general. policymakers should ensure that policies clearly articulate the importance of providing a basic safety net for refugees while guaranteeing that refugees are treated with dignity and respect. identifying issues that arise due to the lack of trust between institutions and refugees may also facilitate the successful integration of refugees. a refugee policy with tic principles can create 1tn1tew pathways for psychological safety among refugees because of tic’s commitment to preventing re-traumatization. yalim & kim./mental health and psychosocial 845 finally, the role of social workers is to some extent ambiguous in host countries (e.g., jordan) and academic programs lack staff with a degree in social work or experience (almakhamreh et al., 2012). internationally, there has been a lack of social work involvement in policy development, service provision and advocacy related to refugee issues (harding & libal, 2012). in host and resettlement countries, social workers should be acknowledged as key players in refugee policy decisions and delivery of psychosocial services. the international alliances between educators, practitioners, researchers from professional associations and social work educational institutions need to be built to address needs of today’s refugees (al-makhamreh et al., 2012). social work as a profession must advocate on behalf of displaced people and have a more activist role to promote social justice and human rights in all contexts; not only in global north (harding & libal, 2012). conclusion addressing the mental health and psychosocial needs of syrian refugees requires deliberate considerations of sociocultural and historical issues that uniquely describe syrian refugees and the contexts that result in their refugee status. in addition to physical and mental health problems, the cultural, historical and political aspects of the syrian refugee experience should be reflected in social work research, practice, and policy. therefore, promoting research that is based on multidisciplinary perspectives incorporating various viewpoints about syrian refugees’ mental health may be vital. an understanding of unique issues involved in working with syrian refugees would allow social work practitioners and scholars to deliver the most effective interventions, and improve policies to better serve syrian refugees. several vulnerable and marginalized syrian refugee groups (e.g., lgbtq refugees, elderly group, and refugees with specific needs due to disability, injuries or chronic disease) could not be included in this review since the needs of these groups have not been addressed in the literature including social work. the risks these groups face due to limited services and discrimination escalate their psychological stress and contribute to their feelings of powerlessness. the needs of vulnerable and marginalized refugees must get more attention and be a part of humanitarian practice conversations to assist them to restore control over their lives (al-qdah & lacroix, 2017; hassan et al., 2015). these groups might be better identified through innovative methodologies such as participatory rapid appraisal or transformative mixed-methods (see al-qdah & lacroix, 2017 and mertens, 2012). other groups whose needs do not get adequate attention in the literature is older schoolaged refugees such as high schooland university-aged syrians. the official language in almost all neighboring countries is arabic except turkey; the country has hosted the largest syrian refugee population. turkish proficiency is the core challenge for especially older school-aged syrian refugees (karipek, 2017). the lebanese curriculum also includes french and english depending on the school (dejong et al., 2017). lack of language proficiency results in low self-confidence and socialization, and feelings of inadequacy, insecurity, hopelessness and worthless in the host country. (human rights watch, 2015; karipek, 2017). almost 50% of syrians in lebanon ages between 15 and 24 reported having thoughts about committing suicide (unfpa, 2014). the mental health and advances in social work, spring 2018, 18(3) 846 psychosocial needs of these individuals are evident. as the conflict in syria enters its seventh year, the literature regarding these groups is still scant. there should be more local and global endeavors to make the needs of these groups more visible. additionally, there is a need for a more concerted effort in developing social work scholarship on refugee mental health and wellbeing so that the role of social work as a profession and a discipline on these issues can globally and locally be recognized. the length of the conflict and its effect on the displaced syrian population will determine the future of refugees’ migration patterns and needs (dewachi et al., 2014). organizations must ensure that their work strengthens the local systems in the region. the international arena needs to consider today’s refugees as more than just a displaced group, but also as individuals on their way to becoming citizens of the future (mollica & mcdonald, 2002). services that strengthen psychological well-being and prevent retraumatization need to be adopted by international, national and local efforts. the impact of the conflict may well last a lifetime for syrian refugees. delivering services with a more holistic model for understanding refugee experiences, and adopting a human rights perspective and trauma-informed care to clinical and policy practices are critical to responding to the psychosocial needs of the syrian refugee population and other refugee populations in a more effective and meaningful manner. references acarer, e. 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(2014). development and protection challenges of the syrian refugee crisis. forced migration review, 47, 6-10. author note: address correspondence to: asli cennet yalim, msw, doctoral candidate, school of social work, university at buffalo, the state university of new york, 685 baldy hall buffalo, ny 14260-1050. e-mail: 35tasliyali@buffalo.edu35t http://www.unhcr.org/5423f9699.html https://data.unhcr.org/syrianrefugees/download.php?id=6650 http://www.unhcr.org/pages/49e48e0fa7f.html http://data.unhcr.org/syrianrefugees/regional.php https://www.unicef.org/appeals/files/no_lost_generation_strategic_overview__january_2014.pdf https://www.unicef.org/appeals/files/no_lost_generation_strategic_overview__january_2014.pdf https://www.usaid.gov/crisis/syria/fy17/fs05 https://doi.org/10.1037/ccp0000095 http://www.usnews.com/news/articles/2015/11/20/8-facts-about-the-us-program-to-resettle-syrian-refugees http://www.usnews.com/news/articles/2015/11/20/8-facts-about-the-us-program-to-resettle-syrian-refugees http://applications.emro.who.int/dsaf/emropub_2015_en_1876.pdf?ua=1 https://doi.org/10.1007/s10903-010-9417-6 https://doi.org/10.1007/s10903-010-9417-6 mailto:asliyali@buffalo.edu cultural and religious considerations gender-specific considerations practice and policy recommendations elements of effective interventions with syrian refugees resettlement policy conclusion references _____________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2016 author vol. 17 no.2 (fall 2016), i-iv, doi: 10.18060/21452 editorial: together we are strong margaret e. adamek we are pleased to bring you this issue of advances in social work presenting innovations in emerging areas of policy advocacy, community organization, research, teaching, and clinical practice. this collection of papers includes the results of eleven empirical studies and five diverse conceptual pieces that offer new insights and strategies to assist social work students, educators, practitioners, and policy advocates. we offer these contributions to the field with the hope that the advances shared here will ultimately benefit and empower those we serve. in light of the perpetually negative reports of worker turnover in public child welfare, willis, chavkin and leung recommend a new approach to calculating turnover that considers different types of staff turnover and the possibility of a desirable level of turnover. by critically questioning how turnover is socially constructed, measured, and addressed, and integrating seminal management principles, willis and colleagues propose an alternative metric that may result in more accurate perceptions of the public child welfare workforce. the proposed changes to conceptualizing and calculating staff turnover ultimately have the potential to reduce the impact of dysfunctional turnover within public child welfare systems. four articles spotlight increasing social work involvement in various aspects of interprofessional education and practice. in a survey of 157 graduate students in four health care disciplines, including social work, west, miller, and leitch examine the impact of professional socialization within one’s discipline on attitudes toward interprofessional collaboration. their results point to a potentially problematic connection between professional socialization during graduate study and students’ views of interprofessional collaboration. unless managed strategically, professional socialization may diminish positive perceptions and attitudes towards interprofessional collaboration. west and colleagues caution social work educators to pay careful attention to the role of professional socialization and how it is manifest in both the explicit and implicit curriculum. in a second study addressing interprofessional education, rishel, hartnett, and davis present data from a federally funded integrated mental and behavioral health training program (imbtp) within an msw program emphasizing rural practice. the shift to integrated models of service delivery that emphasize preventative services prompts the need for providers who understand the interrelationship among physical and behavioral health and who are prepared to practice using a team-based approach. results suggest that an intentional focus on fostering relationships may enhance the knowledge-building and skill development that are inherently emphasized in most training programs. rishel and colleagues recommend offering multiple opportunities for relationship-building among trainees and program faculty, clinical supervisors, and interprofessional colleagues in order to improve learning outcomes in behavioral health training programs. advances in social work, fall 2016, 17(2) ii the third paper addressing interprofessional practice highlights the crucial need for school-based professionals to work with a specific high-needs population: culturally and linguistically diverse foster youth with disabilities. green and mathiesen enumerate a set of interprofessional competencies for school professionals developed based on the lessons learned in the first three years of a federally funded grant. recommendations to improve practice with diverse foster youth with disabilities include increasing the number of culturally affirming and responsive education specialists (cares) who are trained to respond to and advocate for the educational and mental health needs of diverse foster youth. to address the multiple and sometimes complex needs of this student population, cares work in collaborative interdisciplinary teams. green and mathiesen advocate for school professionals to receive early training in culturally competent interdisciplinary practice. in a fourth paper involving interprofessional practice, desrosiers, mallinger, and bragg-underwood highlight patient navigation as an emerging area of health care practice aimed at reducing health disparities and improving patient health outcomes. based on an integrative review of literature, desrosiers and colleagues offer a clear definition of patient navigation and delineate social work competencies with patient navigator requirements. they further argue that social workers are well-equipped to carry out a variety of patient navigator responsibilities buttressed by their social justice advocacy skills. through involvement in patient navigation, social workers can promote the development of socially just healthcare systems that respect the dignity and worth of all patients. six empirical studies explore emerging and diverse practice arenas including teen dating violence (tdv), the use of social media in child welfare, school-community partnerships, screening for post-partum depression, dispersed social work, and foreclosure. in recognition of the prevalence of teen dating violence (tdv), rueda, hawley, black, and ombayo examined graduating msw students’ preparedness to work with adolescents affected by tdv. msw students responded to two vignettes reflecting various types of violence among a same-sex and heterosexual couple. the two most commonly proposed interventions were education and counseling. students’ recommendations for education and counseling rather than safety planning or multi-level interventions indicate that social work programs need to provide specific content in msw curricula on evidence-based interventions for tdv. in a national survey of public child welfare training administrators, stott, maceachron, and gustavsson examined issues related to the use of social media in child welfare practice. despite the ubiquity of social media, few state agencies who responded to the survey had comprehensive policies on the use of social media for case management or for connecting with youth in out-of-home care. stott and colleagues suggest that agencies would reduce their liability risks and benefit their staff and clients by developing policies aimed at protecting agency and staff privacy and safety, as well as client privacy and safety. agencies may promote the well-being of youth in out-of-home care by providing guidelines to staff and caregivers regarding the safe use of social media. baldwin-white and elias-lambert designed a study to examine social work students’ acceptance of various rape myths based on four vignettes that portrayed different patterns of alcohol consumption of the victim and perpetrator. their descriptive analysis showed adamek/editorial iii that social work students were willing to accept certain rape-supportive beliefs, but not others. based on their results, baldwin-white and elias-lambert call for social work students to be educated about how endorsements of rape myths can affect their interaction with survivors and perpetrators. blitz, yull, solá, and jones describe a faculty-led experiential learning project aimed at teaching macro practice skills along with research methods. as part of a grant-funded school-university partnership, msw field students participated in collective family engagement in diverse, low-income communities, using community organizing skills and community-based participatory research methods. blitz and colleagues discuss msw students’ learning in the context of cswe’s 2015 epas competencies. this project illustrates the potential of school-university partnerships involving msw field students to help bridge the gaps between schools and families, particularly in diverse and low-income communities. spurred by reports that up to 1 in 4 new mothers face post-partum depression (ppd), rouland polmanteer, keefe, and brownstein-evans conducted a national online survey to examine perinatal social workers’ screening practices with new mothers. despite the ready availability of ppd screening instruments, only one-quarter of respondents indicated they used formal screening instruments. based on their survey results, rouland polmanteer and colleagues recommend that social workers integrate relevant findings from evidencebased research about ppd into their practice, and that bsw and msw curricula also incorporate research and practice information addressing ppd. in light of the growing practice of social workers working outside of the traditional workplace, allen milton, sinclair, and vakalahi interviewed dispersed social workers to understand how interactions via new communication technology impacts organizational identification. their findings revealed that although dispersed social workers perceive themselves as having more autonomy and flexibility, they can sometimes feel socially isolated and disconnected from their peers and supervisors. allen milton and colleagues note that despite the enhanced efficiency that technology can bring, human service organizations should carefully consider the unintended consequences of a dispersed workforce. in the under-explored area of housing foreclosure, murphy-nugen and hensley beck examined the lived experiences of former homeowners who faced foreclosure. themes from in-depth interviews revealed the intersection of the hopes and dreams of homeownership with the grief and loss of foreclosure. this polarizing experience points to the need for innovative policy and practice interventions. murphy-nugen and hensley beck recommend strengthening the bridge of microand macro-level interventions to more effectively address former homeowners’ grief and loss along with their hopes and dreams. in recognition of the emerging need to develop and implement succession plans for leadership in human service organizations, gilliam, chandler, al-hajjaj, mooney, and vakalahi call for schools of social work to prepare and encourage their graduates to seek such leadership roles. to fill the expected gaps left by retiring administrators, leaders must be cultivated through intentional recruitment and continuous training of social workers in human service leadership and administration. adopting the type of succession planning advances in social work, fall 2016, 17(2) iv that is common in the corporate world would help to ensure the continuous availability of competent and visionary leaders for human service organizations. due to growing concerns about student incivility, wahler and badger surveyed a national sample of social work instructors about their experiences with social work student incivility in both undergraduate and graduate classrooms. some behaviors often deemed disrespectful or inattentive were reported, more so in undergraduate than graduate classrooms. openly hostile behaviors were rarely reported. wahler and badger offer several recommendations for addressing incivility, conceptualizing such instances in the classroom as opportunities to prepare social work students for professional practice. given that most adults spend some or nearly all of their lives in a romantic couple relationship and that such relationships are critical to well-being, chonody, killian, gabb, and dunk-west sought to develop a valid and reliable measurement tool that can be used to assess the maintenance of healthy adult relationships. with data gathered online from participants from 60 countries, chonody and colleagues assessed the measurement properties of the relationship maintenance scale (rms). this brief measure of relationship maintenance (8 items) has great promise for enhancing practice with couples and families. acknowledging the centrality of empathy to effective social work practice, vancleave articulates the connection between empathy and neuroscience, offering an epistemology of empathy and a synthesis of literature from diverse fields that extends empathic practice theory. after explaining the neurobiological foundation of empathy, vancleave offers several recommendations for empathy training of social work students. in the process of preparing this overview of the 16 articles published in this issue of advances in social work, i could not help but notice that 15 are collaborative projects, involving a total of 47 scholars. it is interesting to note the growing extent of collaborative work in the field---a welcome trend indeed. together, we are strong. finally, i would like to extend our sincere appreciation to all of our reviewers from near and far who make the work of publishing scholarship possible. i believe it takes a scholarly village to produce such a varied and cutting edge body of work. starting in january 2017, each year we will publish a list of all of our reviewers for the preceding year. our initial list for 2015 and 2016 includes 283 individuals from 17 countries and 45 states in the u.s., representing 180 institutions. we are pleased that our “scholarly village” is both global and diverse. more evidence in my book that together, we are strong. _________ alexandra pajak, lcsw, graduate student, department of social work, tulane university new orleans, la. copyright © 2024 alexandra pajak, vol. 24 no. 3 (fall 2024), 580-593, doi: 10.18060/27770 this work is licensed under a creative commons attribution 4.0 international license. critical race theory: origins, principles, applications, and evidence alexandra pajak abstract: critical race theory (crt) is a unique analytic lens through which to examine and ultimately dismantle racism within united states society. crt has been applied to a variety of contexts including education, therapy, and law. little is known about the application of crt to the field of social work. this paper aims to investigate the ways in which crt has been applied to the field of social work. utilizing major academic databases, the researcher identified 617 unique references. a total of 14 articles were included in this review following exclusion criteria and full-text review. this paper provides an overview of crt and its potential to inform social work practice. keywords: social work, critical race theory, racism within the last ten years, awareness has increased regarding the systemic nature of racism. racism can, for example, emerge though mortgage redlining (delgado & stefancic, 2023; riccucci, 2021), the school to prison pipeline (crawley & hirshfield, 2018; dutil, 2020), and racist hiring practices (delgado & stefancic, 2023; riccucci, 2021). systemic, racially skewed outcomes are also apparent in the child welfare system (cénat et al., 2021; feely & bosk, 2021), education (bonilla-silva, 2021; pak, 2021), healthcare (feagin & bennefield, 2014; hamed et al., 2022), and criminal justice system (rucker & richeson, 2021; najdowski & stevenson, 2022). these patterns are imperative for social workers to identify and ultimately dismantle. despite being applied to other professions including law and education. this paper investigates the origins of crt and examines the extent to which crt has been applied in the social work field. origins legal scholars developed critical race theory (crt) to reflect the ways in which racism emerges in american law (matsuda, 1990; solorzano, 1997; west, 1995). freeman (1978) applied critical legal studies to examine how some legal implications of brown v. board of education (1954) were at best, complex, and in fact an avenue through which discrimination continued. he rather shockingly posited that brown v. board of education was created by white elites to serve their own purposes and not, in fact, to end segregation on moral grounds (freeman, 1978; west, 1995). following this seminal work, bell (1980) published two essays foundational to the development of crt. he posited law is in fact neither a neutral nor dependable system by which to attain racial equality. bell argued that racism is systemic, predictable, and deeply rooted in american law and society. his concept of “interest convergence” suggests that racial change is inconvenient for the racial white majority and therefore unlikely to occur unless interests align with white elites. additional significant scholars of this time include calmore and crenshaw, both of whom argued the legal system is a system through which certain racial and ethnic groups are subordinated (calmore, 1992; crenshaw et al., 1995). about:blank pajak/crt 581 delgado (1990) introduced what would later evolve into the crt concept of counternarratives. delgado posited that a person’s race can have an influence when writing about racism (delgado, 1984). delgado found that at the time civil rights legal scholars who were published were largely white and largely cited each other, excluding scholarship by legal scholars of color, in effect silencing the scholarly voices of the very people about whom research was written (delgago & stefancic, 2023). delgado (2023) asserted the race of a scholar matters in terms of perspective; counterstorytelling by people of color (poc) can provide insights that may be unseen or impossible for people of the majority to see. counterstorytelling fits within the larger epistemological framework of critical theory, which relies on discourse analysis, genealogies, and histories and is distinct from positivist empirical methods. friere (1970), for example, posited dialogue is a “way of knowing” and an “indispensable component” of the knowing and learning process (p. 17). foucault similarly argued that power itself produces discourse. discourse can reinforce power but can also expose and subvert power (foucault, 1984; power, 2011). ultimately these new narratives fight oppression by revealing the experiences of the oppressed. another important voice in the formation of crt is that of gotanda (2000), who offered a critique of liberalism. specifically, gotanda (2000) argued that the concept of colorblindness and preference for race neutrality is not only impossible, but in fact benefits the interests of the racial majority. kendi has emerged as a contemporary contributor to crt. kendi, a professor of history at boston university, founded the boston university center for antiracist research. his seminal book, how to be an antiracist, explores and develops the crt concepts of intersectionality, the ways in which white people benefit from structural racism, and systemic racism inherent in the united states criminal justice system. like previous critical race theorists, kendi criticizes the notion of colorblindness and asserts his call for action that all people engage in self-reflection to best fight racism in united states society (kendi, 2019). this follows fook’s (2007) assertion that critical reflection is imperative for social workers. fook (2007) states this model of self-reflection is based on the idea that critical reflection involved the identification of deep-seated assumptions, but with the primary purpose of bringing about some improvements in professional practice. (p. 2) in 1995, ladson-billings and tate applied crt to the field of education. ladsonbillings and tate (1995) made the following three propositions about education, based on crt: “(1) race continues to be significant in the united states; (2) u.s. society is based on property rights rather than human rights; and (3) the intersection of race and property creates an analytical tool for understanding inequity” (ladson-billings & tate, 1995, p. 55). crt, they argued, can provide a lens through which scholars and educational practitioners can understand and dismantle racism within the education system (ladsonbillings & tate, 1995; delgado & stefancic, 1997). following ladson-billings and tate’s (1995) application of crt to the field of education, multiple fields have since incorporated crt into their scholarly community, advances in social work, fall 2024, 24(3) 582 including the latino community (latcrit; solorzano & yosso, 2001; valdes, 1997), the asian american community (chang, 1993; liu, 2009), the muslim community (ali, 2022; breen, 2017; breen & meer, 2020), and lgbt communities (delgago & stefancic, 2023). tuck and yang (2012) created an indigenous american version of critical race theory in the early 2010s. they argue that decolonization is not simply a metaphor for wanting to change aspects of schools and societies. like crt, decolonization is systemic, and society must address uncomfortable realities before positive change can occur (tuck & yang, 2012). this follows mezirow’s (2000) assertation that transformative education must include one being uncomfortable for learning to be transformative. this discomfort includes facing “disorienting dilemmas,” examining assumptions about others and self, challenging one’s habits of mind are all critical to transformative thinking, and selfexamination of uncomfortable feelings including guilt, anger, shame, or fear (mezirow, 2000). within the last 25 years, scholars have suggested that crt can be applied to the field of social work. specifically, scholars have posited that crt can inform social work pedagogy (abrams & moio, 2009; ortiz & jani, 2010; pulliam, 2017; razack & jeffery, 2002), social work direct practice (kolivoski et al., 2014; quinn & grumbach, 2015), and intersectionality (daftary, 2018). crt, all listed authors agree, can play a pivotal role in social workers effectively understanding and ultimately dismantling systemic racism and oppression. additionally, the council on social work’s education (2022) educational and policy accreditation standards include antiracist practice, engagement in the advancement of racial justice, and demonstration of cultural humility through critical reflection. principles crt’s fundamental principle is its assumption that racism is an endemic part of united states society. this assumption stands in contrast to the civil rights movement, which approached the fight against racism and oppression in a sequential, step-by-step approach to end racism. (west, 1995). according to crt, the systemic structures of society— economic, legal, social—all operate with racism deeply imbedded in them. crt’s principles are the following six tenets (crenshaw et al., 1995; delgado & stefancic, 1993; delgado & stefancic, 2000, 2023; taylor, 1998). • racism as ordinary. crt posits that racism is an inherent, endemic aspect of society’s very systems including legal, economic, and social systems (bell, 1992). whites ultimately occupy a privileged space while people of color are seen as “others” (decuir & dixson, 2004). racism is so inherent, in fact, it is difficult to even notice and address (crenshaw et al., 1995; delgado & stefancic, 2000, 2023; ladson-billings & tate, 1995). • interest convergence/materialist determinism. white elites benefit from racism materially and working-class whites benefit psychically. for this reason, racial change is unlikely to happen as there is little benefit for whites to fight the very structures that provide them privilege (bell, 1980; crenshaw et al., 1995; delgado & stefancic, 2000, 2023). pajak/crt 583 • race as a social construction. crt argues that there is no genetic or biological basis of race. race is instead a concept that is socially constructed and therefore fluid. this concept, as it is a social construct, can be described, examined, and dismantled (crenshaw et al., 1995; delgado & stefancic, 2000, 2023). • differential racialization. the concept of a race can change at different times and for different reasons based on economic or social need (crenshaw et al., 1995; delgado & stefancic, 2000, 2023). • antiessentialism/intersectionality. crt maintains that forms of oppression can intersect with race. these can include sexuality, class, income, religion, and other ways in which people can be marginalized (crenshaw et al., 1995; delgado & stefancic, 2000, 2023). • unique voices of color. crt emphasizes the lived experiences of people of color and that knowledge gained. experiential knowledge can include family history, biographies, narratives, and counterstorytelling (bell, 1987). the unique voices of color provide a crucial narrative for racism and its effects that may be difficult and even impossible for whites to comprehend (crenshaw crenshaw et al., 1995, 1995; delgado, 1984; delgado & stefancic, 2000, 2023). mechanisms of action/causation the presumptive etiology in critical race theory is that racist outcomes in american societal systems are caused by the endemic nature of racism in american society. over time, racist societal structures are reinforced, and racist outcomes therefore continue. explaining things crt explains things through application of its principles of endemic racism, differential racialization, and interest convergence. the endemic nature of racism, for example, concretely emerges through and explains mortgage redlining (delgado & stefancic, 2023; riccucci, 2021), racist hiring processes (delgado & stefancic, 2023; riccucci, 2021), and the school-to-prison pipeline (crawley & hirshfield, 2018; dutil, 2020). differential racialization explains both why various racial groups’ social constructions can change over time. the social constructs of a racial group change based on labor needs and social factors. for example, asian americans, once viewed as harmless when the united states required a large labor force, were later perceived as an economic threat when that need changed. currently, people refer to asian americans as a “model minority.” the racialization of muslims stands as another example. while at once appearing perhaps odd but harmless, post-9/11 muslims were racialized as a dangerous threat to personal safety and national security (delgado & stefancic, 2023). advances in social work, fall 2024, 24(3) 584 interest convergence explains why racial change can be difficult to achieve. racial change often does not occur because whites benefit from racist systems. racial change only happens when the interests of racial change align with those of white elites. as stated above, bell (1980) provided the example of brown v. board of education as an example of racial progress only when that progress benefited white elites. while brown v. board of education appeared to promote racial equality and social justice, the decision was in fact made for political self-interest both among black americans and to improve credibility internationally. in 2010, ortiz and jani advocated for the incorporation of crt in social work education. they specifically identified the ways in which crt theory can identify systemic institutional racism and how this affects marginalized communities. crt can assist social workers in identifying institutional, structural racism, the intersection of multiple identities and “integrate an explicit social justice orientation” (ortiz & jani, 2010, p. 175). applications this section will review literature on crt and its application to social work practice. to locate this peer-reviewed scholarship, academic search premier/ebscohost, psycinfo, and jstor were the selected databases. search terms included “critical race theory,” social work,” “racism,” “antiracism,” “intersectionality,” “counternarratives,” “colorblindness,” and combinations of these words. see table 1 for how the papers we selected for review. table 1. selection of papers for review identification databases • academic search premier/ebscohost • psycinfo • jstor timeframe • 9/23/2023-11/30/2023 search terms • antiracism • colorblindness • counternarratives • critical race theory • intersectionality • racism • social work • combinations of these words screening inclusion criteria • peer-reviewed • published in english exclusion criteria • not peer-reviewed • not published in english • studies not focused crt • studies not focused on social work initial articles found • 617 eligibility final articles found • 14 pajak/crt 585 the application of crt to social work practice is not yet common (campbell, 2014; kolivoski et al., 2014). i was able to locate five studies which examined the application of crt to social work practice. the studies examined racial competency among social workers (campbell, 2014), microaggressions (robinson-perez et al., 2020), the effects of racial profiling on families (teasley et al., 2018), police shooting of unarmed black men (moore et al., 2018), and the overrepresentation of african american girls in the juvenile justice system (kolivoski, 2022). campbell (2014) applied crt in the measurement of racial competency among social work practitioners. the social work practitioners, all based in the midwestern united states and all of whom had at least a master’s degree in social work, completed the critical race theory measurement (crtm) questionnaire (campbell, 2014) in an attempt for the author to assess their racial competency. the crtm is a 19-item scale measuring crt’s six tenets on a likert scale. the outcome of this study found that while social work practitioners both of color and not of color identified racism as systemic across institutions and daily interactions, the social workers “lacked a clear, concrete understand of race as a social construct” (campbell, 2014, p. 82). robinson-perez et al. (2020) applied crt as a framework through which to view and understand microaggressions experienced by undergraduate students of color in a social work graduate program in the northeastern united states. through this quantitative study, they found that the systemic nature of racism manifested through microaggressions, which created psychological distress among those students. robinson-perez et al. (2020) then urged social workers to apply crt to increase awareness of microaggressions to better support this population. teasley et al. (2018) applied crt as a theoretical framework to understand the significance of racial profiling and its effects on families of color with the goal of educating social workers to the experiences of these families. viewing the familial effects of racial profiling through a crt lens, teasley et al. (2018) posit, social workers can apply crt in their treatment planning in the following ways. the concept of counter-storytelling provides social workers a way to learn how to address the existence of racial profiling to better establish rapport with african american male clients. this counternarrative of personal experience in racial profiling is imperative to understand the ways in which african american male clients may have experienced psychological trauma. in addition to comprehending the concept of racial profiling from a crt systemic racism approach, teasley et al. (2018) argue crt can also be applied by the rejection of colorblindness among social workers in their practice. moore et al. (2018) applied crt to their study of police shooting of unarmed black males. they concluded that crt be applied to social work through social workers taking on an activist role in “ameliorating the dehumanization of the black males” (p. 44) by, for example, identifying specific neighborhoods, companies, or agencies that are involved in discriminatory practices, then mobilizing community resources to address such social iniquity...further, social work activism can also include influencing police advances in social work, fall 2024, 24(3) 586 and legislative outcomes and empowering or collaborating with black institutions such as the black church to address this malaise. (p. 44) kolivoski (2022) applied crt to make sense of and analyze the overrepresentation of african american girls involved in both the child welfare system and the juvenile justice system. in this conceptual article, kolivoski examined the factors of endemic racism and intersectionality as primary causes for the overrepresentation of this population within the juvenile justice system. kolivoski (2022) concludes with the recommendation that social workers center race and racism in their work by encouraging counter-storytelling. kolivoski (2022) also states they should be mindful of systemic racism and intersectionality of clients when building rapport and intervention plans with this population. counter-storytelling would allow, for example, justice-involved african american girls to provide their own narrative of their experiences in the justice system, thereby shifting power away from more stereotypical and deficit-based narratives. like campbell (2014), robinson-perez et al. (2020), teasley et al. (2018), moore et al. (2018), and kolivoski (2022), kendi (2019) advises his concept of antiracism—to identify, describe, and ultimately dismantle racism—be applied to counter microaggressions and to better understand and dismantle systemic racism in the united states criminal justice system and child welfare system. evidence in my search of academic sources, i found few studies that examined the efficacy of crt’s principles. in terms of measuring the efficacy of crt principles, the literature largely points to the purported inability for the principles of crt to be qualitatively or quantitatively examined. specifically, some scholars posit that statistics and quantitative methods of measurement have origins in white supremacy, and therefore these methods of measurement cannot reliably nor ethically measure the validity of crt principles (bonillasilva & zuberi, 2008; carbado & roithmayr, 2014). still other sources posited that crt is in fact a form of qualitative methodology (carbado & roithmayr, 2014; decuir & dixson, 2004; ford & airhihenbuwa, 2010; garcia et al., 2018; mccoy & rodricks, 2015; solorzano & yosso, 2002). the principles of storytelling, counterstories, positionality and intersectionality can be used to elicit information in studies, thereby making crt principles collectively its own methodology. notably, one dissertation that examined the effectiveness of crt principles to explain experiences of ethnic minority mothers with incarcerated sons. in-depth, semi-structured interviews of eight ethnic minority mothers with incarcerated sons elicited information about intersectionality. the author concluded that the outcome of their study confirmed the validity of crt principles. the systems “designed to protect their sons failed them, and their sons suffered the consequences of the inequities” (mendoza, 2022, p. vi ). in this one study, therefore, the crt principles were examined and assessed for effectiveness in describing a situation involving systemic racism. researchers have assessed teacher efficacy following application of crt in a school setting. in another dissertation, a student examined the effectiveness that applying crt has pajak/crt 587 shown to increase teacher efficacy in post-covid-19 classrooms (kent, 2021). a study by marx and pennington (2010) examined preservice teachers with crt being presented as a lens through which to view teaching. this ethnographic studied specifically outcomes of dialogical conversations between white preservice teachers in majority racial minority schools. marx and pennington (2010) concluded that applying crt in a school training setting, white teachers were able to more effectively understand matters related to race and a had new ability to address racism with white students (marx & pennington, 2010). despite crt being applied in a variety of contexts, including the criminal justice system and education, studies examining the effectiveness of crt’s principles themselves are highly underdeveloped. sablan (2018) asserted “predictive, experimental/ quasiexperimental, and evaluative modeling is underdeveloped in regard to crt” (p. 185) garcia et al. (2018) stated an “ontological reckoning” (p. 149) regarding historical power relations must occur before quantitative measures can be applied to measuring crt’s applications. a way to begin an ontological reckoning, garcia et al. (2018) posit, is for quantitative research to be considered in the larger context of political, economic, social, and historical power relations. ways to practice crt in therapy is an underdeveloped topic (pierson et al., 2022) and are for the most part not yet developed in therapeutic relationships or clinical settings (taliaferro et al., 2013). four studies examined the efficacy of applying counterstorytelling in a therapeutic context. gwathney (2021) examined the use of counterstorytelling as an intervention in a group and individual therapeutic intervention within the context of a school setting. based on post-intervention data, gwathney (2021) concluded that counter-storytelling increased the client’s participation in therapy and sense of empowerment as a student. gwathney (2021) also concluded that staff understanding of the client’s experience as an african american student increased, as well. williams (2023) also applied counter-storytelling as an intervention in group therapy. similar to gwathney (2021), based on post-intervention data, counter-storytelling increased client engagement in the group therapy, this time in the context of substance abuse treatment among african american adolescents (williams, 2023). taliaferro et al. (2013) came to a similar conclusion. taliaferro et al. (2013) combined counter-storytelling with narrative therapy with clients of color. based on post-intervention data, they concluded that counterstorytelling increased engagement in therapy sessions. mbilishaka (2018) combined crt with narrative therapy to create psychohairapy, a practice which may have implications for social work practice. psychohairapy refers to therapy that occurs within black hair care spaces in which a therapist is present and hair care specialists are trained in basic narrative therapy techniques. following implementation of narrative therapy in this context, the authors concluded, post-intervention measurement, that combining counter-storytelling with narrative therapy allowed clients to effectively process their experiences of racial trauma. as stated above, a positive outcome of therapy derived from crt is client participation in individual and group intervention. another positive outcome is the ability of social workers to gain more information about the impact of racism on their clients, thereby allowing the social worker to create ethical and efficacious interventions for clients of color (taliaferro et al., 2013; traham & lamberger, 2014). advances in social work, fall 2024, 24(3) 588 over the past several years crt has been accused, however, of a variety of poor outcomes including the indoctrination of young people, promoting racial divides, being racist, and making white students “uncomfortable” in classrooms (filimon & ivanescu, 2023; kendi, 2019; morgan, 2022; watson, 2023). k-12 teachers generally do not even teach crt, making the protests against crt being taught in classrooms rather odd (morgan, 2022). recent legislation in various states has restricted the mention of critical race theory in classrooms (green, 2022; kim, 2021; schwartz, 2022). the criticism of crt has manifested in such contexts as the disruption of school board meetings and the creation of anti-crt rallies (lopez et al., 2021). some researchers have described the strong reactions as “anti-crt panic” (filimon & ivanescu, 2023, p.183) and “hysteria” (watson, 2023, p. 503). watson (2023) suggested crt is a way to “have honest engagement about systemics of oppression” (p. 488) in school settings as well as in other contexts. as of 2025, however, the backlash against crt continues (conyers & white fields, 2025; karakaya & egdell, 2025). in spite of politicized and spurious claims that crt may cause harm, crt bans have been shown to harm the racial climate of schools and lead to teachers leaving the classroom entirely (jayakumar & kohli, 2023). conclusion crt is a widely used theoretical framework applied in a variety of professional practice contexts including law and education. this paper has examined the origin, central tenets, application, and evidence of crt in the context of social work. crt has the potential to be a strong framework by which to inform social work education and practice. given that the council on social work’s educational policy and accreditation standards include antiracist and anti-oppressive practices, crt offers a practical framework by which to apply antiracist principles in higher education. social workers should likewise engage in crt’s urging of self-reflection and rejection of the concept of colorblindness to best fight racism in united states society. despite stigma against crt, given the systemic nature of racism in untied states society and social work’s dedication toward antiracism, crt is an imperative theory for social workers to understand and apply to fight racism in their field and in society. references abrams, l. s., & moio, j. a. 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(2023). substance abuse treatment, critical race theory, and counterstorytelling, for the black emerging adult male. journal of racial and ethnic health disparities, 11, 1-10. author note: address correspondence to alexandra pajak, department of social work, tulane university, new orleans, la, 70112. email: apajak@tulane.edu https://www.jstor.org/stable/23478088 https://www.jstor.org/stable/23478088 https://doi.org/10.1080/09518390110063365 https://doi.org/10.1080/09518390110063365 https://doi.org/10.1177/107780040200800103 https://doi.org/10.1177/107780040200800103 https://doi.org/10.2307/2998940 https://doi.org/10.2307/2998940 https://doi.org/10.1002/j.2161-007x.2014.00045.x https://doi.org/10.1002/j.2161-007x.2014.00045.x https://doi.org/10.2307/3481057 https://doi.org/10.2307/3481057 https://doi.org/10.1007/s40615-023-01586-6 https://doi.org/10.1007/s40615-023-01586-6 mailto:apajak@tulane.edu _________ dawn apgar, phd, lsw, acsw, associate professor, department of social work, college of arts and sciences, seton hall university, south orange, nj. katherine dolan, msw, graduate of seton hall university and columbia university. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 482-504, doi: 10.18060/27233 this work is licensed under a creative commons attribution 4.0 international license. post-master’s career progression of social workers: a developmental perspective dawn apgar katherine dolan abstract: social work is one of the fastest growing professions in the nation with an expected job growth of 9% by the end of the decade and more than 62,888 masters of social work (msw) students in the united states in 2021 (bls, 2022; cswe, 2023). the receipt of a graduate social work degree represents an important milestone, often accompanied by entry into professional practice. while much is written about formal social work education, scholarly literature has far fewer articles about the work life of social workers after graduation. this article presents social work career progression from a developmental perspective, an approach that has historically been used to examine the life course of clients. typical tasks or “milestones” in early, middle, and later stages of clinical or direct practice careers are discussed. adapting life course theory to examine the professional evolution of social workers is beneficial as it helps illuminate the typical stressors facing practitioners after completing their formal education. understanding potential career opportunities and issues may help those entering social work to better socialize into the profession and transition from one stage to the next by anticipating what lies ahead. using a developmental perspective to professionalization is also appropriate as, like in the life course, opportunities for growth should be ongoing and lifelong. early, middle, and later career opportunities and challenges are identified within the three pillars of social work – regulation, education, and practice. policy reforms to enhance social work licensure portability, life-long learning in the form of continuing education, and self-care practices will assist social workers to thrive in all career stages. keywords: professional development; supervision; licensure; career development professional development of social workers is critical to competent practice with clients. while the literature contains articles about the motivations of those entering the profession (runell, 2020), scholarly works that examine the career progression of practicing social workers are more difficult to find. the lack of guidance provided to social workers as they transition from students to practitioners is surprising as the responsibilities required to provide competent care are numerous and the workplace stressors are significant (burghardt, 2021; nasw, 2021a). research indicates guidance by others, in the form of mentorship and supervision, has positive impacts that result in more skillful practice and better client engagement (wilkins et al., 2018). while universally accepted as beneficial, the content and type of supervision given to social workers varies depending upon whether they are newly qualified practitioners or are later in their career progression (o’donoghue & engelbrecht, 2021). these modifications result from the changing needs of social workers as they grow professionally and are consistent with using a developmental perspective to understand the professional life course. about:blank apgar & dolan/sw career progression 483 social workers often assist others with successfully making life transitions, but research aimed at helping social workers with career progression focuses mostly on transitioning between public and private sectors (austin et al., 2012), changing service focus (gustavson et al., 2020), or mitigating the negative impacts of retirement (mcfadden et al., 2020). social workers may look to more experienced colleagues to assist with anticipating their professional futures as the scholarly literature is devoid of a conceptual framework specific to social workers. this haphazard approach is interesting for a profession that takes such care in documenting typical developmental milestones of those served. in this article, the authors examine the expected achievements of social workers during the early, middle, and later stages of their careers after earning an msw degree. given that more than half of professionals earn msws the terminal degree in social work and most social workers enter professional practice at the master’s level (cswe, 2021), specific attention is needed on ensuring a smooth transition from the classroom to professional practice for this target group. a social worker’s developmental stages are not age-related as some enter the profession in early adulthood while others discover social work as a second career. however, regardless of age, typically social workers wrestle with similar tasks associated with the three pillars of social work – regulation, education, and practice – in various stages of their careers. while the experiences of social workers can vary depending on practice specialty, work setting, etc., common challenges in each professional stage are consistent based upon a review of the professional and practice literature. memorializing these ‘milestones’ is useful for both practitioners and supervisors. social workers can use this information to anticipate work activities and transitions, helping them be adequately prepared. supervisors can help gauge professional development of supervisees based on the identified stages, providing support as needed. literature review understanding human development is critical in social work for understanding client problems and developing sound treatment plans. developmentalists break the life course into stages to highlight the importance of the growth process. such a framework can be appropriately used to conceptualize the various segments of a professional career, though no such application exists in social work academic journals to date. career development theories promote understanding of areas such as self-efficacy and aptitude; however, social workers would benefit from a framework that speaks directly to their professional underpinning. key concepts of developmental theory are briefly reviewed so that its application to career progression of social workers can be better understood. subsequently, the common tasks facing early, middle, and later career social work professionals are described. lastly, micro, mezzo, and macro strategies for supporting practitioners at all career stages are presented as recommendations for the future. advances in social work, summer/fall 2023, 23(2) 484 conceptual framework: developmental theory social workers learn the life course perspective as understanding human behavior is important for engaging and assessing clients, competencies that must be demonstrated prior to graduation according to the council on social work education (cswe, 2022). both engagement and assessment are critical steps in problem-solving, the basis of the planned change process used to assist clients with ameliorating problems. hutchinson (2018) states that the life course is a path that often involves continuities, twists, and turns. a life course perspective sees humans as capable of making choices and constructing their own life journeys, within systems of opportunities and constraints. central to a life course perspective is the notion that people in a particular cohort experience events in the same sequence and at the same point in a trajectory. this path has patterns of stability and change that usually includes transitions. within developmental theory, changes in roles and statuses are identified as transitions. transitions mark changes in events that may produce long-lasting effects. while developmental theory aims to provide some predictability to the future, as well as provide normative contexts for current challenges, individual experiences do not always follow the same course. development can be impacted by cultural and ethnic norms, socioeconomic factors, and other life circumstances (amso et al., 2019; roby & scott, 2022). these factors can impact career progression, including in social work (womack & shi, 2022); however, these effects on the professional development of social workers are much less studied (brooks & clunis, 2007). while some prominent theorists studying adult and career development link stages to chronological age (levinson, 1986; super, 1990), a review of the literature indicates that dividing development into three distinct phases that occur sequentially after beginning to work in a profession is appropriate and supported by empirical data (slocum & cron, 1985). while there is no consensus of what time periods constitute one’s early, middle, and later career, the first decade (up to 10 years) appears to represent the initial skill-building or trial stage of development (early career), the second decade (11-20 years) represents a period of stabilization (mid-career), and the remaining years of employment (21 or more years) represent maintenance as workers enter the later stages of employment. career stages using these time frames were used in an american psychological association workforce study, though “late senior career” (31 or more years) experiences were also tracked, with findings indicating that employment hours in this phase decreased as many professionals entered retirement (stamm et al., 2017, p. 1). using a developmental perspective to describe career progression has value. social workers can experience different stressors as they acclimate to workplace demands after graduation and assume more supervisory and other responsibility in their positions over time. employment trajectories can also have significant positive or negative impacts on the financial, social, and emotional well-being of workers during their life course (henretta, 2003). understanding the common experiences of social workers in the early, middle, or later stages of their careers may assist those entering the profession, as well as supervisors and administrators charged with facilitating successful career advancement. the following sections describe the major foci, as depicted in table 1, associated with each stage as they apgar & dolan/sw career progression 485 relate to regulation, education, and practice. table 1. summary of major developmental foci for social workers within each career stage career stage education regulation practice early translate academic knowledge to practical application navigate eligibility requirements & regulations to obtain licensure secure employment participate in lifelong learning opportunities to gain knowledge & meet ethical & regulatory obligations secure appropriate supervision build resiliency skills mid seek advanced degrees, certifications, & training meet requirements to maintain licensure balance personal & professional responsibilities advance supervisory & teaching skills manage practice risk expand the scope of one’s career by venturing into new roles with more responsibilities later transition to a mentor role to extend knowledge & train new social workers leverage career experience & knowledge to inform policies & regulations prepare for termination by succession planning & getting ready for retirement stage: early career early in their careers, social workers focus on continued skill acquisition and identity formation as they transition from roles as students to professionals in the world of work. acclimating to a professional environment outside the classroom requires recent graduates to put academic knowledge into action, continue education formally and informally, and assume workplace responsibilities. the literature indicates most social workers first entering the profession after graduation feel unprepared, and do not have a firm sense of professional identity (hochman et al., 2022; spivak et al., 2021). this perceived lack of preparedness is concerning, as the early, formative years of a career serve as a foundation for opportunities and challenges social workers face. new social workers navigate personal, educational, and professional pressures in the early stage of their career as they must develop and hone their knowledge and skills, begin satisfying regulatory requirements to gain licensure, and adjust to the vast differences between classroom settings and professional environments. despite intensive preparation through the rigors of accredited academic programs, early career social workers can easily become overwhelmed, experience burnout, and question their commitment to their chosen profession, making adequate support and supervision critical within this stage (glassburn, 2020). advances in social work, summer/fall 2023, 23(2) 486 education education requirements of early career social workers include transitioning from formal to informal learning, adopting lifelong learning practices, and navigating the opportunities and challenges associated with continuing one’s education to meet the practice demands espoused in the nasw code of ethics (nasw, 2021a). new social workers move away from structured education, often done in classrooms, to learning ‘on the job’ within professional settings. students are given access to university and department support, as required by cswe (2022) accreditation standards, to help them problem-solve and navigate the process of earning their graduate degrees. prior to graduation, students are presented numerous opportunities to advance their knowledge and skills through formal classes, workshops, field placements, and supervision. these opportunities are organized for students, readily available, and typically included in the cost of tuition. new social workers must transition between environments with clear expectations and available resources (academic settings) to those in which resources may not be readily available and formal education has less priority (professional settings). voll et al. (2022) discuss the difference between “knowing-that” and “knowing-how,” which aptly applies to early career social workers entering the field. while “knowing-that” refers to recall and understanding of concepts and theories, “knowing-how” requires translating knowledge into action and is consistent with the competency-based approach which has been adopted in social work (cswe, 2022). as mandated by the nasw code of ethics (2021a), social workers must engage in lifelong learning, as they intervene with clients in changing socioeconomic and political environments. to do so, social workers must locate and attend continuing education presentations, retain the information they absorb (knowing-that), and thoroughly understand how to apply the information within the context of their employment settings in relevant and equitable ways (knowing-how). after graduation, early career social workers have fewer professional supports and greater workplace demands, causing them to possibly feel ill-prepared to handle new challenges. when graduates become employed and move to professional settings, structures and routines vary. while the priority of academic institutions is student learning, professional organizations focus on workplace responsibilities and fulfillment of roles needed. responsibilities may be diverse and changing, often extending beyond the scope of initial employment offers. social workers hired in settings such as schools may be the only employees in their work environment with social work training. educational opportunities may be few and far between, social workers may be required to take time off to attend them, and the cost of offerings are often assumed by employees themselves. thus, social workers must often learn informally through mentorship or conversing with more experienced coworkers. academic literature is limited in its assessment of the accessibility of continuing education opportunities for social workers. social work is considered an underpaid profession (proctor, 2017; wermeling, 2013), which may impact choices made by social workers about the type and number of continuing education courses they take annually due to affordability. whether educational seminars are in-person or hosted virtually may also affect social workers’ decisions to participate. support provided by employers impacts apgar & dolan/sw career progression 487 accessibility; access to childcare, and cost of seminars and transportation, as well as use of unpaid time off, are barriers that can prevent early career social workers from not gaining additional education, despite a desire and/or need to do so (carnahan et al., 2016). early career social workers often face additional financial burdens due to substantial student loan debt. loan debt for msw graduates has increased by almost 50% over the past ten years, averaging close to $50,000 in 2020 (cswe, 2021). recent msw graduates may also find themselves grappling with loan debt accumulated during their baccalaureate programs with bachelor of social work (bsw) students possessing an average of about $28,000 in student loan debt (cswe, 2021). educational debt is higher among black and hispanic social workers, demonstrating a racial disparity between borrowers (salsberg et al., 2020). despite the growth in loan debt, salaries among social workers have increased only modestly. the average income for a new social worker with an msw is almost $48,000 (salsberg et al., 2020) compared to an average of $44,200 in 2012 (keziah, 2014). financial pressure associated with loan debt and salary dissatisfaction are exacerbated by the slow progression of wage growth within the social work profession (burghardt, 2021). some social workers leave the profession due to financial pressures, coupled with caregiving responsibilities. a recent british study found that social workers in the united kingdom have a very short working life period as compared with all health service professionals, with the difference not explained by gender-related familial roles (curtis et al., 2010; wermeling, 2013). regulation social workers are licensed in all 50 states and the district of columbia in the united states, with many jurisdictions requiring licensure prior to working in the field. as most states do not regulate the activities of students engaged in field practicums, graduates are surprised to find they can no longer do the work they did prior to graduation without taking an examination (in some jurisdictions), paying fees, and completing necessary paperwork. in addition, many jurisdictions require background checks, as the primary purpose of licensure is consumer protection. the many regulatory demands placed on early career social workers may pose unanticipated barriers to realizing their intended career plans. licensing increases social workers’ access to specialized roles, enhances salary potential, and holds social workers to a legal standard of competency and commitment to ethical practice (monahan, 2016). while the benefits of licensing are abundant, the process of becoming licensed is not straightforward. social workers must meet specific education and supervised experience standards to obtain desired licenses. geographical, economic, racial, and other barriers also prevent aspiring licensees from obtaining necessary credentials (kim, 2022). the financial burden of licensing fees, as well as the necessary exams to obtain licensure, present difficulties for new social workers, especially those who are struggling to find employment or have student loan debt (knepper et al., 2022). black social workers have, on average, $35,000 more in educational debt, as compared with white social workers, with $21,000 attributed to earning their msws. thus, the need to get licensed and obtain employment quickly may be even more pressing for early career professionals of color (salsberg et al., 2020). advances in social work, summer/fall 2023, 23(2) 488 variability among state licensure is quite high, including titles of licenses, number of supervised hours of experience necessary, types of supervision, and continuing education requirements, leading to many questions by early career professionals concerning jurisdictional differences and requirements. state regulation variability may impact career mobility and time needed to become licensed. social workers who are licensed to practice in one state may not be eligible for a license in another state due to eligibility differences, which can limit the locations where social workers can practice. there were enhanced portability allowances during the covid-19 pandemic to ensure continuity of care as individuals moved to other jurisdictions to socially distance, though some of these reciprocity provisions have since expired (apgar, 2022). the association of social work boards (aswb) offers social workers online tools to help identify the requirements of each state license (aswb, 2021). states may require supervision within the employment setting unless certain criteria are met. without appropriate supervisors in agencies, early career social workers can be forced to hire external supervisors, at their own expense, if they are allowed to use them (new jersey division of consumer affairs [njdca], 2022). the complexity of social work regulation and requirements for licensure can leave early career social workers surprised, confused, and even frustrated as they discover additional demands beyond their graduate degrees to do the work that inspired them to enter the profession initially. additionally, a report by aswb indicates racial and other disparities in passing licensure exams, which means that some early career social workers may experience additional hardships in meeting the requirements for licensure (aswb, 2022). delays in licensure result in lost job opportunities and lower wages which are unanticipated given the positive job outlook for those entering the profession (bureau of labor statistics [bls], 2022; salsberg et al., 2017). practice social workers enter new professional environments that can inhibit the use of learned skills and knowledge and meeting employment expectations. new social workers need enhanced formal and informal occupational support. induction and orientation, supervision, and assistance with identity development are particularly important for new social workers. recent graduates often hope to transfer skills and knowledge gained in past field placements as they attempt to fulfill employment responsibilities, which depends upon the degree that their employment settings and expectations are similar to their past practicums (glassburn, 2020). student interns are closely supervised, unable to conduct certain tasks due to legality and confidentiality concerns, and often serve reduced numbers of clients. professionals may not receive formal supervision, are held liable for legal concerns, and often experience overwhelming numbers of clients with intense needs. deadlines, expectations, and responsibilities of full-time employment are more stringent than field placement protocols, which put recent graduates at risk of experiencing “reality shock,” whereby initial or anticipated perceptions and expectations of the workplace do not match what is actually experienced (bates et al., 2010). along with differing expectations, types of work skills completed inside the classroom may also differ from work completed in professional environments. students author academic research papers, participate in role plays, and take exams. in professional apgar & dolan/sw career progression 489 settings, production expectations include one-on-one or group sessions with clients, policy writing, recordkeeping, and other hands-on interventions. studies show that many students feel ill-prepared by their academic education (tham & lynch, 2020; voll et al., 2022) while other students have feelings of preparedness (choi et al., 2021). while social work accreditation standards are consistent across msw programs, operating practices across agency settings, ‘rules’ that dictate workplace etiquette and service delivery, vary greatly. adequate induction and orientation to the workplace are essential for new employees to adjust to their new environments and be successful in their positions, though a study of early career social workers in the united kingdom found that 88% had difficulty fitting in training and 63% felt that they did not get enough supervision in their first year in the job (burke, 2012). social workers are charged with connecting theory to practice in these new and varying environments, making workplace orientation vital. factors such as robust induction to the workplace, appropriate supervision, and clear perceptions of their role as a social worker positively impact those new to the profession (choi et al., 2021; cleveland et al., 2019). orientation and pre-service training often include in-depth information about the technical skills necessary for successful job performance, information regarding the operational systems used by agencies, organizational leadership styles, administrative requirements, and requisite communication processes appropriate for partner agencies and clients. new professionals with inadequate pre-service training have described their transition from the classroom to the workplace as a “baptism of fire” (bates et al., 2010, p. 162). without support and guidance from administrators and thorough review of agency policies, newly hired social workers are at greater risk of malpractice (reamer, 2015). early career social workers often feel emotionally overwhelmed by blurred boundaries between work and home life, a lack of supervision, and a strong disconnect between their perception of the world during their msw programs compared to the reality seen from a professional perspective (segev et al., 2022). social work is portrayed to students in msw programs as a helping profession that makes great strides in enhancing human well-being. however, common hierarchical and bureaucratic barriers often inhibit or slow progression of systemic change, disillusioning new workers who now realize making real differences in the lives of their clients and broader changes among communities, is likely to be more difficult than they initially thought due to factors beyond their control (segev et al., 2022). given that social workers are particularly susceptible to burnout (grant & kinman, 2014), building resiliency skills in the early stages of a social work career helps social workers better navigate the emotional and mental demands of the profession. factors such as peer support, good communication skills, setting work and non-work boundaries, structured work routines and self-reflection have each contributed to increased resiliency among social workers (cleveland et al., 2019). recent graduates may also experience a lack of confidence in their skillset. it is common for those entering the profession to experience imposter syndrome or to doubt their abilities (urwin, 2017). despite demonstrating practice behaviors necessary for competent social work practice prior to graduation, new social workers may still feel as though they do not have the abilities needed to appropriately work with clients. lack of experience in working with the complex issues seen in the field can cause new social advances in social work, summer/fall 2023, 23(2) 490 workers to question their abilities, mistrust their confidence, and seek reassurance from supervisors and/or others for guidance. supervision is vital, and often required, for new social workers, especially those who seek licensure. the literature lacks consensus about the amount and types of supervision required for new social workers. often, supervision is dictated by resources, licensure requirements, specialization (clinical versus macro), and/or accreditation or regulatory standards. social workers who receive supervision usually value the social/emotional support obtained and the knowledge gained from more experienced supervisors and welcome the opportunities for feedback on their work (borders et al., 2014; carpenter et al., 2015). receiving feedback and positive reinforcement is extremely important for the professional growth of early career social workers and assists them to develop resiliency skills that are critical for sustained competent practice as they move into mid-career social work practice. professional membership organizations provide a wide range of services to and on behalf of social workers. founded in 1955, the national association of social workers (nasw) is one of the largest membership organizations of professional social workers in the world, with more than 120,000 members (nasw, n.d.). while social work students are encouraged to join through significantly discounted student dues structures, many social workers do not realize the networking and other benefits until after graduation. state and local chapter activities serve as opportunities for learning about service availability and job opportunities in provider organizations, as well as receiving formal and informal continuing education instruction. access to liability insurance is also viewed as a substantial reason for joining or maintaining membership (davis et al., 2021). while early career social workers find the information and resources provided by nasw valuable, a survey by davis et al. (2021) found many social workers questioned the value of their membership, especially if not active, given the high yearly membership costs that continue to increase over time. enhancing ways to be involved and solidifying the value of offerings will be necessary for social workers to stay connected or join nasw as they move into the middle stage of their careers. mid-career stage as social workers gain more practice experience, their understanding of the profession, generally, and their specialized areas of practice expand. mid-career professionals often continue to develop their knowledge and skills, take on more responsibility, and gain interest in earning practice certifications and credentials. midcareer social workers may continue their work in a chosen specialization or seek employment in a different area of practice. after gaining experience, social workers in clinical practice often have an opportunity to work for themselves or others in private practice. they may start the transition slowly by having part-time private practices until they have enough clients to constitute full-time employment and a steady income. social workers then may decide to leave agency employment completely, enjoying the ability to set their own hours and be freed from the bureaucratic processes that often accompany agency-based practice. while the exact number of social workers in private practice is apgar & dolan/sw career progression 491 unknown, workforce data indicate that 23% of social workers with msws are employed in for-profit companies, businesses or individual businesses, with an additional 4% being self-employed (salsberg et al., 2017). while not all of these social workers are in solo or group private practices, these percentages indicate that a substantial proportion of social workers are in non-agency or governmental settings, perhaps due to the financial and other advantages that urged social workers to consider such work more than 50 years ago (kurzman, 1976). social workers who transition to administrative roles may need additional education to ensure they have the competency and project management skillset to assume leadership roles. training in entrepreneurship and business may be required for social workers to be successful in owning and operating private practices. macro social workers working in policy-related domains may eventually seek an elected position, also requiring a new set of skills they may not have anticipated. for some, mid-career social work can be particularly challenging given growing demands associated with parenting, caregiving of aging parents, and enhanced professional opportunities. while the life circumstances of social workers vary significantly, recognizing that there may be additional pressures present in the lives of mid-career social workers is important. the lack of resources available to address complex issues and the challenges of trying to meet client needs with inadequate resources can result in emotional and mental exhaustion. social workers who developed resiliency strategies and coping skills early in their careers fare better as protective factors are more likely to slow burnout and compassion fatigue (ostadhashemi et al., 2019; padín et al., 2020). while early career social workers often focus their learning on how to operate in their employment settings and become licensed, middle career social workers seek advanced training to maintain the licenses they worked so hard to get. education middle career social workers often need to meet continuing education requirements for license renewal as licenses that allow professionals to provide services independently often require continuing education hours. slightly more than half of all degreed social workers are licensed (salsberg et al., 2017), creating great demand for new and specialized training opportunities for those who already have experience in the field. while some states restrict the types of offerings that can be used for license renewals, social workers who are midcareer recognize the value of interdisciplinary education and seek out offerings taught by allied professionals due to their value, regardless of whether they are required for licensure. social workers may also seek out courses that are required for specialty certifications in areas such as addiction and gerontology. for social workers who are already licensed, specialized certifications are appealing as they demonstrate competency beyond the minimum standards associated with licensure. social workers who do not work directly with clients may not seek licensure but continue to keep up with changing policies and trends to inform their work, topics that are often covered in continuing education courses. social workers may explore new education opportunities as they continue to learn about social work specialties, client populations, and the demands imposed by systemic advances in social work, summer/fall 2023, 23(2) 492 issues. doctoral programs, such as those awarding doctor of social work (dsw) or doctor of philosophy (phd) in social work degrees, are often appealing to social workers who wish to advance their skills and education as well as distinguish themselves from colleagues. while the msw is the terminal degree for social work, earning a dsw or a phd increases salary potential and employment opportunities; professionals with dsws or phds earn between $20,000 and $25,000 more than those who have msws (salsberg et al., 2018). the demands of doctoral programs can be taxing on students. expense, length of program, and the difficulty of maintaining full-time employment during enrollment act as barriers (thyer, 2019). admission and retention rates of non-white students are low among research-based social work doctoral programs (ghose et al., 2018). financial barriers, experiences with racism, and a lack of diversity among faculty often prevent nonwhite social workers from pursuing or finishing these degrees (ghose et al., 2018). however, targeted efforts have been made by the southern regional education board (sreb) and the cswe to provide financial assistance and mentoring to increase the number of minority students who earn doctorates, with sreb hoping that these doctoral graduates will choose to become faculty at colleges and universities and serve as role models for and mentors to others (cswe, n.d.; sreb, n.d.). there are approximately 6,595 part-time faculty members teaching in accredited social work programs, representing more than half of all social work educators (cswe, 2023). mid-career social workers may decide to take on adjunct roles to develop their teaching and supervisory skills through classroom instruction and give back to the social work profession (i.e., the value of service), both of which have been found to be rewarding (hitchcock & marquart, 2023). however, many social workers interested in being parttime instructors do not know how to get started and what is required of them in these roles. hitchcock and marquart (2023) warn that teaching comes with challenges, such as managing conflicts, grading, and dealing with the non-academic issues that affect students’ academic performance. many adjuncts do not know how to connect with other social work instructors and administrators in their programs or have limited time due to balancing fulltime work with teaching, which can lead to feelings of isolation. mid-career social workers must consider if they are ready to spend the estimated 7 to 12 hours weekly of out-ofclassroom time required for each course taught as a part-time lecturer role. becoming a field instructor can be a more feasible alternative to adjunct teaching, though some professionals do both. mid-career social workers often have become field instructors as a way to strengthen the learning culture within their employment settings and demonstrate the importance of professional development to colleagues in their places of employment (globerman & bogo, 2003). regulation as social workers advance in their careers, they become more familiar with laws and regulations associated with the profession; of particular concern is management of risk which can lead to malpractice claims, whether they are substantiated or not. while the prevalence of malpractice claims among social workers is relatively low compared to other professionals (reamer, 2015), it is important social workers understand potential risks and the inherent tension that exists working in practice environments that often lack adequate apgar & dolan/sw career progression 493 resources. common allegations in social work malpractice lawsuits and complaints are those involving breaches of confidentiality, practitioner impairment, and incompetence (reamer, 2015). social workers who engage in malpractice face suspension or total loss of license and/or termination of employment, as well as difficulty finding future employment in the field as disciplinary actions are usually made public. it is important that social workers in this career stage take note of their mental and physical health to ensure they do not negatively impact service delivery. risk management becomes more challenging for mid-career social workers as they are often likely to be in supervisory or administrative positions, called upon to deal with more challenging clients and situations, and are now responsible for the actions of others who report to them. maintaining licensure requires additional commitments such as tracking renewal time frames and continuing education credits. license renewal standards vary by state, with annual renewal required in some states and multi-year regulatory periods in others. continuing education requirements depend on jurisdiction and license category. social workers who are licensed may no longer require formal supervision to legally practice, though, ongoing supervision for middle and later career social workers is encouraged for ongoing emotional and educational support. mid-career social workers often shift roles as they begin to supervise those who are entering the field. many social workers enter supervisory positions with little training on how to properly function in these roles and use their own experiences as a supervisee to guide them. if supervision is going to be used to assist others to gain licenses for independent practice, mid-career social workers who are providing the supervision need to be aware of varying jurisdictional standards. while new supervisors may be eager to share their knowledge and guide developing professionals, supervisory roles can be challenging without support. supervisors often report feeling unprepared for their new roles, even with years of experience in the field (zhou, 2022). while supervisors help others enhance their direct practice skills by leaning on their own as examples, supervisors must also utilize a different set of skills in these new roles. leadership training has been found to be particularly important to assist mid-career social workers with this adjustment (zhou, 2022). practice while some social workers in the mid-career stage assume managerial roles in agency settings, others opt to open their own private practices. private practice can increase flexibility in work scheduling, allow autonomy in choosing clinical specializations, and increase compensation, while alleviating the need to conform to the managerial styles of others. social workers who are self-employed or are in small group practices may experience negative effects of isolation such as a lack of peer and supervisory support (nasw, 2011). access to peer consultation, while voluntary, can provide practitioners with an informal opportunity to gain guidance and clarity in risky or confusing situations. mid-career social workers may decide to move to different organizations as they now have experience that can lead to opportunities for career growth. additionally, mid-career advances in social work, summer/fall 2023, 23(2) 494 social workers often have increasing family responsibilities or face familial relocation, which results in changing practice jurisdictions. career mobility within the social work profession is limited by a lack of license portability. practicing across state lines presents legality concerns, as licensing requirements vary state-to-state, meaning social workers who are already licensed to practice in one state may not be allowed to practice in another. the creation of an interstate licensure compact, funded by a grant received by aswb, is currently underway with implementation targeted in the coming years (nasw, 2021b). however, whether there will be legislative support in at least seven states needed to realize the compact or the degree to which it will assist with license portability of social workers is still unknown. lastly, mid-career social workers often find themselves with enhanced opportunities to engage in mezzo or macro practice. those in the social work field often work closely with individuals and families in the early part of their careers, and then move into mezzo or macro-level work, as they see the need for advocacy and the impact that policy changes can make on the lives of others. while some have asserted that all social work practice should include micro, mezzo, and macro practice, the transition from direct to indirect practice often occurs over time as social workers move into supervisory or administrative positions (burghardt, 2013; finn & molloy, 2021). later career stage much of the professional literature about later stage career progression focuses on transitioning to retirement (gettings & anderson, 2018). in the life course, erikson (1994) suggests later adulthood is important to find meaning and satisfaction rather than to become bitter and disillusioned. central to social work is the strengths perspective, which posits growth and development are perpetual with individuals being valuable contributors to both their own well-being and that of others. this stage of social work career progression focuses on generativity or nurturing others or charities that continue to work to make positive changes in the future. social workers in the later stages of their careers often turn their attention to mentorship or providing supervision in the spirit of moving beyond their own achievements and helping others to achieve success. role shifts in education and practice often occur while regulatory tasks are less predominant, though challenges associated with changing jurisdictions due to retirement moves or putting licenses on inactive status can present themselves. education the importance of teaching others is instilled in the educational preparation for the profession with social workers learning from more experienced practitioners in field education in their undergraduate and/or graduate programs. social workers in the later stages of their careers have witnessed firsthand the impact that formal and informal training and supervision can have on learning and development. as field education is the signature pedagogy of social work education (cswe, 2022), much professional preparation has occurred under the guidance of practitioners in the field. research indicates field education is highly rated by students as instrumental in their professional preparation (bogo, 2006) apgar & dolan/sw career progression 495 and the feedback received from their field instructors helps with developing essential social work skills (kourgiantakis et al., 2019). field instructors guide students through their field practicums, performing a myriad of professional skills including modeling, coordinating, mediating, teaching, and evaluating. social workers are often ‘called’ to give back later in their careers through formal or informal education of future generations of practitioners. the profession is predominately comprised of women (85% of those with msws or above) and those who are white (73% of those with msws or above) (salsberg et al., 2017). this composition results in many caregiving and financial demands placed upon those in the workforce. chen and crown (2019) found social work faculty are among the lowest paid, compared with other disciplines, with significant gender wage disparities existing within the academy. the average compensation for a master’s level social worker teaching an undergraduate and graduate social work course is $3,668 and $4,078 per course, respectively, with more than 9,600 faculty employed part-time in 2019-2020 (cswe, 2021). given the levels of compensation, many social workers cannot afford to teach in social work programs until later in their careers. with 88% of accredited social work programs reporting use of parttime faculty to teach (cswe, 2021), a significant demand exists for social workers who want to teach, though justifying the commitment given the compensation is difficult for those who have not reached some financial stability and who are not ‘settled’ in their careers. despite the many years social workers have spent in classrooms as students, much learning may need to occur as social workers transition into roles as educators. while social workers may be responsible for case presentations or training new employees in their employment settings during mid-career, teaching in a university setting can present challenges for the later career social worker, though job satisfaction of part-time faculty is quite high overall (nelson et al., 2020). social workers who assume the role of adjunct faculty may need to learn new pedagogical techniques. additionally, technological advances have made online education increasingly popular with about a third of all bsw and msw programs online or having some online coursework (cswe, 2021). thus, later career social workers are often challenged as they are called to teach remotely, using their ability to foster relationships with others and engage students to make outcomes of online education comparable to face-to-face in both knowledge acquisition and satisfaction (forgey & ortega-williams, 2016). however, social workers are often unfulfilled by these remote jobs as diaconu et al. (2020) indicate the level of satisfaction of social work faculty teaching online is compromised by lack of institutional support for online instruction, technological challenges, and the enhanced time taken to monitor online students. thus, the satisfaction of later career social workers who choose to help educate future generations of professionals given low compensation and increasing popularity of online education is uncertain. regulation social workers often possess licenses for independent practice before entering the later stages of their careers. becoming independent practitioners is usually required in midadvances in social work, summer/fall 2023, 23(2) 496 career work to advance professionally and supervise others. however, some social workers are unlicensed or licensed to practice clinically under supervision for most of their careers. later career social workers planning for retirement may consider the possibility of opening private practices, making licensure at the independent level a necessity. taking licensure examinations later in a social work career can be particularly stressful as research indicates pass rates are lower for older adults (senreich & dale, 2021) and the length of time needed to study increases given the time lapse since graduation. social workers who are licensed often weigh the value of maintaining their licenses once they retire and explore whether there are opportunities to place their licenses on inactive status. inactive status often provides later career social workers the opportunity to reinstate their licenses if needed without having to meet the ongoing continuing education requirements and pay the administrative fees (njdca, 2022). like mid-career social workers, later career social workers face issues of licensure portability if they decide to move due to their own retirement or the retirement of partners/spouses. later career social workers are also more commonly found on regulatory boards than those in early and mid-career. as appointments to licensing boards are often made by state governors or high-level officials, they can require political capital, which is more likely among those who have established reputations in their professions. serving as regulators is a wonderful way for more experienced social workers to inform policy related to the practice of social work in their jurisdictions. such bodies also are often involved in investigations of unlicensed practice or malfeasance by social workers. later career social workers have the experience needed to understand the complexities often associated with these situations and understand the standard of care called into question. practice while not often studied in later adulthood, research indicates resilience is a defining feature in later life as individuals have developed adaptive processes to deal with stress (ong et al., 2009). by the time social workers enter the latter parts of their careers, they have often developed coping skills that have been used to deal with client, organizational, and service delivery stressors. the vast knowledge accumulated by those who have a lot of practical experience in the profession is extremely valuable. for experienced social workers, mentorship is a way to give back and help new and mid-career social workers maintain the passion that initially attracted them to the field. mentorship in social work has been found to be rewarding for mentors and mentees as the former are forced to keep abreast of new trends and challenges facing the profession while the latter get questions and concerns addressed by those who have lived experiences in the profession. social workers with vast experience often move into paid or unpaid consultant roles, in addition to or in place of permanent employment. as consultants, social workers serve as skilled advisors and collaborators. clinical social work consultants focus on providing staff with guidance about specialized therapeutic interventions and mental health services. macro-level social work consultants, on the other hand, assist with tasks related to community development, policy analysis, and/or advocacy to influence positive social change. additionally, social workers who have vast organizational experience are sought apgar & dolan/sw career progression 497 after to assist with improving workplace dynamics, conducting program evaluations, and/or facilitating strategic planning. in addition, or as an alternative to part-time teaching in undergraduate and graduate social work programs, later career social workers, like their mid-career counterparts, may choose to give back to the profession by being social work field instructors either in their own private practices and/or in agency settings. later career social workers are well suited for these roles as research indicates burnout of field instructors is a real concern for the profession (mccarthy et al., 2022). later career social workers can be better able to balance professional responsibilities with supervising students. additionally, they have developed extensive professional networks and collegial relationships that are useful to students and early/mid-career social workers. additionally, social workers in later stages of their career may be questioning what is next in their personal and professional lives as they have often reached their career goals. generativity or the concern for establishing and guiding the next generation of social workers is often prioritized (doerwald et al., 2021). social workers may be engaged in succession planning within their agencies to ensure there are smooth transitions for clients and coworkers as they reduce their responsibilities or work hours, as well as begin the process of retirement. this process mirrors that which social workers do with their clients as they prepare for termination of services. termination is seen as a crucial and inevitable part of social work practice and similarly, activities in this career stage should be deliberate and planned to ensure an orderly transition to retirement. while social workers understand the importance of work-life balance, many may have difficulty retiring as the need for their services persists. often, organizational or other factors help social workers move toward retirement. for example, ashcroft et al. (2022) found the covid-19 pandemic resulted in retirement of social workers earlier than planned as agencies were shut down and client services ceased. the passion that fuels social workers throughout their professional journey often remains or even intensifies over the years, so later career social workers may have difficulty leaving clients and service settings that have been the focus of their careers. recommendations social work career progression can best be understood using a developmental perspective. each stage, early, middle, and later, is characterized by new demands and challenges, as well as shifting roles. it is helpful for those entering the profession to not only learn about the educational, regulatory, and practice issues facing them as new practitioners but also to anticipate what lies ahead in their career progression trajectory. while not all social workers have the same professional experiences, they often share milestones. the identification of these commonalities is helpful to assist social workers individually navigate workplace demands but can also be used to identify mezzo and macro supports to assist social workers at all stages of career advancement. education social workers can meet the demands of their career progression by continuing their advances in social work, summer/fall 2023, 23(2) 498 education both informally and formally, seeking professional instruction from continuing education courses, and engaging with peers and colleagues. continuing education course providers should explore options to virtualize courses so as to promote and expand access to professionals. academic institutions should prepare students for the world of work and offer curricula related to the exigencies of private practice like recordkeeping and professional liability, as well as mezzo and macro position requirements such as leadership and project management exercises. extending ongoing access to career centers and libraries for alumni may also support the continuing education of social workers. regulation license portability would ease the strain placed on social workers and clients due to greater mobility and the expansion of telehealth. the ability of state legislators to recognize social work licenses issued by partnering jurisdictions is a challenge but mirrors the commitment made by other professional groups so there is precedent to do so. changes to public policy can also assist social workers as they move through their career stages. expanded access to loan forgiveness occurred in response to the covid-19 pandemic (us department of education, 2022). memorializing this expansion of eligibility requirements, as well as streamlining program application processes, would improve efficiency and satisfaction of loan forgiveness programs for social workers. practice given the importance of supervision, social workers should seek out appropriate supervisors according to licensure and certification requirements. because burnout and compassion fatigue are of particular concern, social workers need to employ effective work-life balance practices and engage in self-care regularly to supplement their coping and resiliency skills. just as social workers advocate for clients, they should also honor their own needs by advocating for adequate workplace support and compensation to meet personal and professional demands. while personal attributes and ambition can impact the trajectory of social workers’ careers, support from employers, supervisors, and academic institutions can ease transitions. clear role expectations and protocols, robust induction, and onboarding, as well as promoting licensure, can help employers remove barriers for social workers and improve workplace satisfaction and retention. employers can promote licensure by covering exam preparation in supervision and helping with licensure costs. conclusion social workers dedicate their careers to addressing both individual and systemic hardships. promoting human well-being and empowering others are pivotal to the mission of the profession. similar to clients and constituents, social workers are human beings with unique needs and experiences. social workers must act as agents of change to improve professional supports for themselves. applying a theoretical perspective used to understand the behavior of others to the career trajectory of social workers has value but is apgar & dolan/sw career progression 499 uncommon. the developmental stages of a social work career early, middle, and late have distinct characteristics and require developmentally-appropriate resources and training to prepare social workers for entering the next stage with ease. if pivotal milestones in each stage are not achieved, social workers will have a more difficult time navigating the field, putting them at risk of malpractice and loss of professional opportunities and subsequent growth. social workers, in the early stage, cultivate a foundation for a professional identity as they enter the field, navigating complex regulations, learning best practices, and often shadowing more experienced colleagues. employment and supervisory supports serve to assist during the early stage as social workers gain confidence and identify gaps in their knowledge base. after exploring and narrowing their career interests while seeking guidance from others, social workers enter the middle stage of their career, honing their skills and assuming additional responsibilities as they move into new roles aligned with their experience level and refined skillset. navigating the middle stage of a social work career requires access to new educational opportunities and skill in balancing professional and personal responsibilities. as social workers gain more experience, their knowledge base grows, with some becoming experts in their areas of practice. in the later stage of their careers, social workers may take a step back from direct practice and policy work to focus on mentoring and teaching a new generation of social workers. promoting and enabling professional growth of social workers is vital as there is a significant need for social work services, especially given the mental health and other challenges caused by the covid-19 pandemic. social work is a profession that has always utilized a person-in-environment perspective to understanding human behavior. using a developmentalist approach to examine professional growth of social workers assists with identifying normative professional milestones. better understanding social workers’ career trajectories can be helpful to supervisors and mentors, as well as professional organizations that aim to support social workers throughout their careers. references amso, d., salhi, c., & badre, d. 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https://www.ed.gov/news/press-releases/thanks-temporary-changes-us-department-education-announces-public-service-loan-forgiveness-surpasses-10-billion-debt-relief https://doi.org/10.1093/bjsw/bcx109 https://doi.org/10.1093/bjsw/bcx109 https://doi.org/10.1080/13691457.2021.1964441 https://doi.org/10.1080/13691457.2021.1964441 https://doi.org/10.1080/13691457.2021.1964441 https://doi.org/10.1080/03643107.2012.693057 https://doi.org/10.1080/03643107.2012.693057 https://doi.org/10.1111/cfs.12442 https://doi.org/10.1111/cfs.12442 https://doi.org/10.1111/cfs.12442 https://doi.org/10.1080/02615479.2022.2053098 https://doi.org/10.1080/02615479.2022.2053098 https://doi.org/10.1080/23303131.2021.1919266 https://doi.org/10.1080/23303131.2021.1919266 mailto:dawn.apgar@shu.edu post-master’s career progression of social workers: a developmental perspective dawn apgar katherine dolan conceptual framework: developmental theory stage: early career education regulation practice mid-career stage education regulation practice later career stage education regulation practice education regulation practice conclusion ______ sunny sinha, ph.d., associate professor, school of school work, marywood university, scranton, pa-18509; aviral shrivastava, ph.d., associate professor, school of computing, informatics, and decision systems engineering, arizona state university, tempe, az-85281; christiana paradis, msw, adjunct faculty, susquehanna university, selinsgrove, pa 17870. copyright © 2019 authors, vol. 19 no. 2 (fall 2019), 493-517, doi: 10.18060/22526 this work is licensed under a creative commons attribution 4.0 international license. a survey of the mobile phone-based interventions for violence prevention among women sunny sinha aviral shrivastava christiana paradis abstract: information communication technologies (ict), particularly mobile phone technology, has increased the propinquity between individuals by enhancing their ability to frequently communicate with one another through different mediums, like text, audio, video, and emojis. cell phone technology is being used to combat various social issues, including several public health-related problems such as violence against women. over the past two decades several cellphone-based apps, including circle of 6, myplan, panic button, and aspire news have been developed in several countries to prevent violence against women. anecdotal evidence suggests that these apps are effective both as violence prevention and as an intervention tool in public as well as private spaces. however, very little awareness exists among social workers about these mobile phone applications (apps), particularly the capabilities and limitations of these apps. based on a brief survey and classification of the existing mobile phone apps designed to prevent violence against women, this paper aims to explain how these apps work, and point out their capabilities and limitations so that social workers and public health professionals can better guide their clients in using these technology-based services. it is highly recommended that social workers evaluate how their clients are affected by the use or non-use of violence prevention apps and advocate for their client’s right to digital literacy and internet access. keywords: cellphone-based; violence prevention; violence intervention; ict; health; social work practice cell phones are ubiquitous. even in 2014, 90% of adults in the u.s. had cell phones, and 55% could access the internet through mobile data (shaw & lee, 2014). mobile phones are not only being used to increase propinquity between individuals by enhancing their ability to frequently communicate with one another through different mediums (e.g., text, audio, video, emojis, etc.), but are also being used by women as subtle means of selfdefense (by calling someone when they are walking alone in a perceived risky location), and are even reported to be more effective than pepper spray (cumiskey & brewster, 2012). cell phones are already in use to aid in several public health-related problems, including adherence to diabetes treatment (kwon et al., 2004), smoking cessation (obermayer, william, ofer, & jersino, 2004; rodgers et al., 2005; vidrine, arduino, lazev, & gritz, 2006), suicide prevention (aguirre, mccoy, & roan, 2013) and adherence to hiv treatment (dean, makin, kydd, biriotti, & forsyth, 2012; ingersoll et al., 2014; mbuagbaw et al., 2012; puccio et al., 2006; rodrigues et al., 2012). for example, the sexinfo program, developed by levine, mccright, dobkin, woodruff, and klausner (2008), is an sms text messaging-based program for adolescents in the san francisco area through https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) 494 which teens can text message “sex info” to a five-digit number from a cell phone to receive information on sexual health-related matters. once the user sends the text message, they receive a message instructing them to text back an appropriate code related to their question (for instance, b3 for hiv prevention). depending on the code entered, the users will receive a text message with all the information about sexual health and referral to a local sexual health organization working with youths. over the last decade — ever since smartphones became popular — several cell phone apps, such as bsafe, circle of 6, hollaback!, panic button, lifeline response, and guardly, (brathwaite, 2012; jones, 2014; rosenthal, 2013; zraick, 2010) have been developed to address the general issue of women’s safety. typically, these smartphonebased apps enable users to send predetermined text messages to their registered emergency contacts along with the global positioning system (gps) location and physical address by just shaking the device or pressing the panic alarm /danger alert button. a few of the smartphone apps come with features that enable users to get connected with nearby support services, such as pre-programmed hotline numbers along with the contact information of nearby police stations, hospitals, social networking sites, and other counseling services. since most of these apps do not have user evaluation built, very little can be said about the effectiveness of these apps based merely on the number of downloads (westmarland et al., 2013). a study interviewing 10 women residing at a domestic violence shelter in the united states revealed that not knowing how to securely and privately use the social networking sites was primarily responsible for women refraining from using their mobile phones (dimond, fiesler, & bruckman, 2011) even though they admitted that it was a valuable tool for seeking social support. a randomized controlled trial study was designed to evaluate the effectiveness of the myplan app, an interactive safety decision-making webbased and smartphone application (app) for college women survivors of intimate-partner violence and their friends. this study found that after 12 months of using this app, the percentage of students experiencing physical or sexual abuse declined, and the support groups of survivors of violence were more prepared to help their friend leave the relationship safely (glass, eden, bloom, & perrin, 2010). users of the myplan app also pointed out that the electronic medium of communication was preferred, and not having to discuss “face-to-face” at the counseling center reduced the social desirability bias in their responses (alhusen, bloom, clough, & glass, 2015; eden et al., 2014; glass et al., 2015; glass et. al., 2017; lindsay et al., 2013). the discourse about using information communication technologies (icts) such as mobile phones and the internet to tackle the issue of violence against women has remained slanted with a heavy focus on the negative effects of technology on the lives of individuals, such as invasion of privacy, confidentiality, and the technology-facilitated marginalization and sexual victimization of individuals, such as cyberbullying, cyberstalking, sexting and cyberharassment (dimond et al., 2011; henry & powell, 2015; martinez-pecino & durán 2016; mason & magnet, 2012). however, it cannot be negated that much of the technology-related problems stem from users not knowing how the issues of security, surveillance, privacy, and confidentiality are tackled in each of these apps (mason & magnet, 2012). sinha et al./a survey of the mobile 495 social work scholars also increasingly argue that technology-based interventions can enhance social work practice, as it ensures continuity, client engagement, affordability and accessibility of services (craig & lorenzo, 2014; ramsey & montgomery, 2014). however, since many disenfranchised and marginalized communities do not have access to icts or the internet, scholars have argued that social workers should actively advocate for policy and program initiatives that addresses these infrastructural gaps related to technology(perron, taylor, glass, & margerum-leys, 2010). in 2017, four prominent social work organizations, the national association of social work (nasw), association for social work boards (aswb), council for social work education (cswe), and cswa (clinical social work association) recognized that technology is transforming the social work practice arena, particularly the nature of the client-worker relationship, and came together to adopt a uniform set of technology standards focused on addressing issues that arise with social worker and client use of technology (nasw, 2017b). the nasw and the aswb standards for technology and social work practice recommend that “social workers should be proficient in the technological skills and tools required for competent and ethical practice and for seeking appropriate training and consultations to stay current with emerging technologies” (as cited by lopez, 2014, p. 821). yet, most social work undergraduate and graduate programs do not prepare their students to achieve digital literacy (craig & lorenzo, 2014; robbins, coe regan, williams, smyth, & bogo, 2016), defined by hague (2010) as “ the ability to participate in a range of critical and creative practices that involve understanding, sharing and creating meaning with different kinds of technology and media” (p. 3). the knowledge and awareness among social workers about the new information and communication technologies (ict), and in particular cellphone applications, how they work, what are their capabilities and limitations, and how they can be meaningfully used to enhance the quality of lives of their clients remain limited (parrott & madoc-jones, 2008; perron, taylor, glass, & margerum-leys, 2010). the findings from a qualitative study aimed at examining domestic violence service provider’s needs and perceptions of using technology found that service providers have limited experience and knowledge about technological advances which resulted in them feeling anxious and uncertain about their abilities to use and learn new technological advances. therefore, ongoing ict related training and support needs to be provided to social workers for them to be able to effectively address technology-related concerns and questions that may arise in therapy for their clients and themselves (murray, nemati, white, chow, & pow, 2015). this article provides a survey, comparison, and classification of the existing cell phone-based violence prevention/intervention applications (apps). first, we present an overview and classification of violence prevention apps. second, we discuss the metrics of evaluation we used to compare and contrast the various violence prevention apps. third, we provide a brief overview of how these apps work, their capabilities, limitations, and focus area. fourth, we offer an analysis of what features of the apps work well and what aspects need improvement. finally, we conclude by discussing the implications of these violence prevention apps for social work practice and future research. advances in social work, fall 2019, 19(2) 496 overview and classification the existing mobile phone-based apps designed to prevent violence against women can be classified into three broad categories: a) crowdsourcing reporting apps, b) emergency assistance apps, and c) self-assessment/ learning apps. the crowdsourcing reporting apps attempt to tie violence to users’ space/location (geography) enabling them to report incidents of violence, and then put them on a map to visualize the violence “hotspots.” these apps not only help collect data on violent incidents in the community, but they may be used by local law enforcement in deciding where to concentrate their surveillance efforts, and by ordinary individuals to determine which spaces to avoid. the second category of apps is the emergency assistance apps, which is by far the largest category. these apps have been designed to enhance the personal safety of users. to use these apps effectively, users must first enter contact information for their preferred emergency contacts. then, when users are in an emergency situation, they can trigger an sos alert which sends messages to their emergency contacts. some apps also allow users to call emergency dispatch when the emergency alert is triggered. the third category of apps is the self-help learning/assessment apps. these apps are designed to increase users’ understanding of violence and also engage in self-learning and self-assessment of their risk of abuse. they may also link users to supportive services, including lawyers, social and community workers, shelters, and clinics. the following section discusses the evaluation metric used to compare and contrast the various categories of violence prevention apps. prior researchers have used a similar metric to evaluate mobile phone apps developed in the other fields such as suicide prevention (aguirre et al., 2013) and unintended pregnancy prevention (mangone, lebrun, & muessig, 2016). evaluation metric for violence prevention apps 1. stated purpose – the stated purpose of the app is an important metric because it clarifies to users what life problems they can solve using these apps. mancini & o’reilly (2013) argue that the socio-cultural, and political contexts vary widely among communities, and therefore one technological solution may not be equally effective across different communities. therefore, the context driven nature of the stated purpose of the apps is an important metric to judge the usability of the app. 2. privacy – another important consideration for violence prevention apps includes how much personal information users are required to disclose in order to use the app for its stated purpose. for example, a lengthy registration procedure, or a registration procedure that asks several personal questions (e.g., name, date of birth, location) from the users can be a strong deterrent in using the app. there can be even more subtle deterrents to the use of apps. for example, a well-known icon of the app may be a problem for survivors of domestic violence who live close to the abusers and are always under surveillance by their abusers. therefore, the apps’ ability to report incidents anonymously and the password or pin features are a critical factor in enhancing the effectiveness of these apps (aguirre et al., 2013). 3. ease of use – this metric assesses the understandability of the app. for example, if the user wants to report an incident, they should have the option to either write a text sinha et al./a survey of the mobile 497 description of the incident or submit audio or video report. in addition, if users have to fill too many required fields before submitting the report, then it may act as a deterrent. therefore, the option to select ‘fields’ that are pertinent to their situation will prove crucial in enhancing the usability of these apps. 4. geography –to be usable, an app should fit the socio-cultural profile of the place, including language requirements. as a result, apps may not be as useful for other geographical regions. in addition, what languages are supported in the app? 5. access to supportive services/resources access to supportive services is an essential aspect of violence prevention apps, especially emergency-assistance apps. some apps may only connect to user’s friends and family, while others can connect to private security, law enforcement, and first responders. 6. affordabilitycost is an important consideration since the individuals who are at an increased risk of violence are often socially and economically marginalized individuals (heerde & hemphill, 2019; walls et al., 2019). therefore, it is critical to assess if there is an additional cost associated with using the app. for instance, while an app could be free, essential and helpful features may be locked behind a paywall, requiring users to make an in-app purchase to unlock premium features. survey of mobile phone violence prevention apps crowdsourcing reporting apps. crowdsourcing reporting apps allow users to access a website via a smartphone or computer. once on the designated site, users can fill out a violence incident report. the incident report is then logged in real-time through an interactive map and enables identification of “hot spots”referred to as places with the most frequent reports of violence. crowdsourcing reporting apps serve four purposes. first, they create a database of information about gender-based violence incidents happening in cities or towns across select countries. second, to help prevent violence, the institutions collecting the data can use it to advocate for increased patrols by local law enforcement authorities in what emerges as the “hot spots”. third, users can access these interactive maps and get an understanding of places that can be dangerous, or violence-prone as the maps identify the “hot spots” for violence. finally, reports can be submitted by victims as well as by bystanders witnessing the incident. for instance, i’ve got your back campaign was launched by hollaback! in collaboration with green dot to encourage bystanders to upload their anecdotes as witnesses to street harassment, allowing bystanders to show their support for people sharing their stories of violence (livingston, wagner, diaz, & liu, 2012). table 1 provides a comparative overview of four projects using crowdsourcing reporting apps to gain a nuanced understanding of the issue of violence against women in their communities. for instance, these apps allow for clarity to emerge on who are the perpetrators, what type of violence gets frequently reported, and in which sites these violent incidents are being reported. please note that, even after our best efforts, the list below may not be exhaustive, but we believe we have covered all the major variations of the apps to examine their strengths and limitations. advances in social work, fall 2019, 19(2) 498 table 1. overview and features of projects using crowdsourcing reporting apps name of crowdsourcing apps purpose privacy ease of use geography access to supportive service & resources affordability gbv project cambodia to combat & eliminate genderbased violence in cambodian society. identifying information is optional when making reports using web form. anonymous reporting permitted. users can report incident in their text. users need to select the type of harm & the location where violent incident occurred. available to users in their language (khmer). users can upload photos & videos of incidents. cambodia only for reporting. internet access fee harassmap, egypt to end all forms of sexual harassment encountered by women in public spaces identifying information required when using sms, facebook, email or twitter to make a report. identifying information is optional when preparing reports using a web form. anonymous reporting permitted. users can report incidents using web-based forms in which they have to describe incidents in text, select the type of harm applicable in their situation, & the location of incidents. other ways to report are sms, facebook, email, or twitter (harassmap, 2015). egypt free legal services, psychological support, & lawyers self-defense classes information how to file police reports information on how to deal with phone harassment internet access fee hollaback! multiple countries to end street harassment against women & lgbtq communities in public spaces. registration required for the app (must create a log-in or facebook login) but the option to remain anonymous while making reports is always there. identifying information is optional when making reports using a web form. users can make online reports of incidents by sharing their story in text. entry is optional but encouraged for users. users can upload photos & videos of incidents. users can choose more than one form of street harassment from list while making reports. fewer required fields for submitting reports, so users can report as much or as little information as they desire. region: more than 30 countries in europe provides information for local sexual assault centers. internet access fee women under siege, ukraine & syria to end rape & all forms of sexualized violence occurring against women in conflict-prone regions. identifying information is optional when preparing reports using the web form. anonymous reporting allowed users can report incidents in text & create a title for incidents. description of incidents, title of incidents, type of harm & location where violent incident occurred are required information for form to be submitted. users can upload photos & videos of incidents. ukraine, lebanon, & the middle east used only for reporting. internet access fee advances in social work, fall 2019, 19(2) 499 sms alert-based emergency assistance apps. numerous cell phone applications (apps) have been designed to enhance the personal safety of the users. the way to operate these apps is first to enter information about the users’ emergency contacts so that the app can contact them when an emergency arises. when users press the “help” button within the app, it will send out automated sms alert messages to the listed emergency contacts along with the gps coordinates of the users. some of the apps also have the feature to automatically connect users with first-line responders, such as the police, firefighters, and medical personnel when pressing the “help” button within the app. table 2 provides an overview of the different types of sms alert-based emergency assistance apps for violence prevention and intervention. we have included many different models of cell phone apps to facilitate a more in-depth understanding among social workers about the various ways in which these cell phone apps can be designed to address the specific needs of their clientele. however, by no means is the list exhaustive. self-help learning/assessment apps. the last category reviewed in this survey are apps that are designed to increase the user’s understanding of violence and also engage in self-learning and self-assessment of their risk of abuse/danger in the relationship. table 3 lists some of these self-help learning/assessment apps. we have included different types of self-help learning/assessment apps to facilitate an understanding among social workers of how apps can be designed and used to promote education and learning among their clients about dating violence, domestic abuse, and healthy relationships. critical analysis of the violence prevention apps violence against women is a highly sensitive and stigmatized issue. the term “violence against women” (vaw) falls on a continuum, and refers to several different types of violences including, domestic violence, rape, ipv, sexual harassment, or any other term referenced typically in the mainstream anti-violence literature. hooks (2000) argues the terminology violence against women/patriarchal violence denotes the connection between acts of violence and the systemic structures of oppression. in other words, violence experienced by women both inside and outside the home is linked with and sustained by the other matrices of domination, including racism, sexism, homophobia/transphobia, ableism, and neoliberalism (collins,1999; hooks, 2000; mason & magnet, 2012). however, in many cultures, including the united states, india, egypt, cambodia, united kingdom, and syria, women tend to internalize the blame and shame for their experience with violence/abuse. this prevents women from stepping forward to take action against the perpetrators of violence (kalra & bhugra, 2013; overstreet & quinn, 2013). therefore, it is crucial that violence prevention interventions (both cell phone apps-based interventions as well as traditional interventions) aim to empower their users by reducing the culture of victim-blaming that exists in these societies. for instance, both #metoo and time’s up movement are rare examples of `icts-based interventions that have successfully reframed the understanding of violence against women to be a social and cultural problem (hostler & o’neil, 2018). in the following section, we use the evaluation metric discussed previously to critically evaluate the three categories of cell phone-based violence prevention interventions. advances in social work, fall 2019, 19(2) 500 table 1. features of emergency assistance apps name of the app, location features of the app uniqueness of the app limitations/obstacles for social work clients type of violence; target audience; link to app pukar, india push button alerts five pre-registered contacts with sms & location details of user. emergency contact can then choose to send sms to local police response team who then tracks incidents. phone automatically switches to silent mode & gps tracking device is turned on. police will receive signal only when one of your emergency contacts forwards sos alert sms on a number given in message. acts only as a deterrent or sos device. users cannot directly contact police. requires users to purchase data package for its features to become operational. street-based violence individuals http://peopleforparity.org /pukar-app/ eyewatch, india panic button sends sms & email alerts, as well as initiating phone calls to designated emergency contacts one after other (calls are on speakerphone). in case of false alarm, or once user is safe, safety confirm feature allows users to message their emergency contacts & confirm their safety. unlike other apps, panic button can record 60 seconds of audio-visual information before it was activated & send it to your emergency contacts & police control rooms. in cases of false alarm triggered by users, gives an option to turn off panic alert & notify contacts with message that user is safe & it was a false alarm. also has accelerometer-based trigger which automatically alerts your emergency contacts when phone detects a sudden jerk or fall. registration is required to use app. access to local police & other support services is through your call guardians. option of directly contacting police is not available; no access to supportive services. street-based violence prevention app individuals https://eyewatch.in/login.action circle of six, internationally free personal safety mobile app that allows users to seek help from their chosen circle of 6 emergency contacts under crisis situations. with two taps on app, users can send sms to their 6 contacts with gps location (if enabled) & message about nature of assistance needed from them. for instance, app is designed to send “come get me,’ “call me,” or “i need to talk” messages. in addition to personal safety, app also provides users education about sexuality, healthy relationships, & safety, by explaining abuse, understanding consent, how to say no, sexual safety, safety plans. also has direct access to national hotlines like lgbtq, suicide prevention, aids info., national dv, planned parenthood, & others. users must enter six emergency contacts for app to start working. without six contacts app will not work. app requires a couple of taps to send alerts to user’s 6 contacts & that can be difficult. smartphone only app; cannot operate on a basic phone. indirect cost of purchasing data plans. street-based violence prevention & intervention app individuals at risk of violence http://www.circleof6app. com/ (circle of 6, 2016) panic button, internationally free mobile app that allows users to discretely & rapidly alert their three trusted contacts in an emergency. maps of users’ location (if gps is enabled) can be sent by pressing power button. unlike other apps, alerts discreetly & rapidly by pressing phone’s power button. data sent is protected with disguised screen & pin code. economically marginalized clients cannot afford cost of smartphones which are typically higher than traditional phones. street-based violence prevention app https://www.amnesty.org /en/latest/campaigns/201 5/07/panic-button-oneyear-on/ (amnesty international, 2016) http://peopleforparity.org/pukar-app/ http://peopleforparity.org/pukar-app/ https://eye-watch.in/login.action https://eye-watch.in/login.action http://www.circleof6app.com/ http://www.circleof6app.com/ https://www.amnesty.org/en/latest/campaigns/2015/07/panic-button-one-year-on/ https://www.amnesty.org/en/latest/campaigns/2015/07/panic-button-one-year-on/ https://www.amnesty.org/en/latest/campaigns/2015/07/panic-button-one-year-on/ https://www.amnesty.org/en/latest/campaigns/2015/07/panic-button-one-year-on/ sinha et al./a survey of the mobile 501 table 1. features of emergency assistance apps name of the app, location features of the app uniqueness of the app limitations/obstacles for social work clients type of violence; target audience; link to app bsafe, usa free mobile app that allows users to seek help in emergency/ dangerous situations by tapping sos guardian alert button. immediately notifies user’s friends & family members that they need help & let them know where they are (gps) & what’s happening (video & voice). will set off a siren (optional) & flashlight. asks user’s preset contacts to walk them home with “follow me” feature of app, which sends live gps trace to friends timer mode allows user to program automatic alarm which will trigger if users fail to check in within specified time. “i am here” can be used by users to let their preselected contacts know where they are right now. ‘fake call’ allows users to make phone ring whenever situation demands. users can define who call should be from. unlike other apps, contacts entered by users as ‘guardians’ in personal safety network are sent an invitation to let them know guardian’s role in app & they can accept or decline to serve as user’s guardian. users cannot directly initiate contact with police or other social services. a premium service is available for a fee ($20 annually or $30 for two years), & goes beyond alerting your contacts/guardians by providing 24x7 monitoring by professional security service centers. (please note: premium service is currently available only in norway, sweden, & south africa. will be launched in us). no access to supportive services, such as counseling centers, social service agencies street-based violence prevention app individuals at risk of experiencing violence https://getbsafe.com/ (bsafe, 2016) lifeline response, usa fee-based personal safety app allows users to trigger an alarm in event of an emergency or untoward situation. if user within a stipulated time does not disarm alarm, app automatically notifies authorities & their emergency contacts with links to their last gps location. during an emergency, if user cannot be reached to verify their safety after setting alarm, 24x7 lifeline response call center operators informs emergency dispatchers (police, medical, fire department) with all location details of user & ensures that emergency services reach user. allows users to deactivate alarm in case it was triggered accidentally. has secret alarm feature which makes it seems that app has been disabled, but in reality, it automatically dials 911 & prompts user to call emergency contacts/lifelines that they had specified in app. also, a way to tell emergency aids & lifeline response verification center that user is in trouble & that they shouldn’t call user to verify. smartphone only app; cannot operate on a basic phone. indirect costs of purchasing data plans requires a subscription fee of $3.75 per month no access to supportive services, such as counseling centers, social service agencies street-based violence prevention & intervention app individuals at risk of experiencing violence or survivors of violence http://llresponse.com/ https://getbsafe.com/ http://llresponse.com/ advances in social work, fall 2019, 19(2) 502 table 1. features of emergency assistance apps name of the app, location features of the app uniqueness of the app limitations/obstacles for social work clients type of violence; target audience; link to app guardly, usa one-touch access to personal safety networks sends sos alert notification to friends, family, & campus safety across us via phone call, sms, & email. another tap on app enables user to escalate their alert to include contacting authorities. allows users to configure groups of personal contacts for different emergency scenarios. users can have one group of contact for health emergencies & another contact group for dating violence-related emergencies. fee-based service that goes beyond notifications & instantly connects users to their contacts through a conference call, sms, instant messaging & real-time location tracking throughout an incident. additional built-in security features, including ability to snap/share photos & sound loud whistle to deter potential assailants or draw attention to their situation. premium features of app like conference call, link to emergency response website, realtime tracking & audio-visuals of location may costs $9.99/month or $99 yearly. smartphone only app; cannot operate on a basic phone. indirect costs of purchasing data plans no access to supportive services, such as counseling centers, social service agencies street-based violence prevention app college-going women in us http://appsagainstabuse.d evpost.com/submissions/ 4899-guardly guard my angel, usa free mobile app that allows users to designate a few contacts to watch over in emergency situations. users can set a timer for “angel” to watch over them. for instance, if users are going alone for a night walk, they can choose to designate a few contacts to watch over them for set number of hours. if user does not confirm during specified period that they are safe, & timer expires, app will instantly notify user’s pre-designated contacts via sms, email, & facebook posts with a google map link for their user’s last location details. notification goes out when phone is disabled afterward. runs in background, does not interfere with phone’s functions & operates independently of battery life. smartphone only app; cannot operate on a basic phone. indirect costs of purchasing data plans does not give users option to contact 911 dispatchers or summon other emergency services. no access to supportive services, such as counseling centers, social service agencies street-based violence prevention app individuals at risk of experiencing violence https://www.myangelgua rd.com/ react mobile, usa personal safety smartphone app used to prevent violence as well as to intervene in a situation. for instance, “help me” tab of app allows you to alert your preregistered emergency contacts (friends or family) & authorities via email & sms about your whereabouts in times of danger. users contacts & 911 officials receive a text & email with user’s gps location. option of making facebook & twitter post is also possible. ‘follow me” tab allows users to let their contacts keep a virtual watch on their activity for a period in which they feel unsafe. provides option of buying wearable react sidekick device which looks like a keychain. alerts friends & authorities when phone is out of reach in times of emergency. has option to call 911 & also to deactivate alert within 6 seconds. no subscription fee. smartphone only app; cannot operate on a basic phone. indirect costs of purchasing data plans or internet. no access to supportive services, such as counseling centers, social service agencies street-based violence & intervention prevention app individuals at risk of experiencing violence & survivors of violence https://reactmobile. com/ http://appsagainstabuse.devpost.com/submissions/4899-guardly http://appsagainstabuse.devpost.com/submissions/4899-guardly http://appsagainstabuse.devpost.com/submissions/4899-guardly https://www.myangelguard.com/ https://www.myangelguard.com/ https://reactmobile.com/ https://reactmobile.com/ sinha et al./a survey of the mobile 503 table 1. features of emergency assistance apps name of the app, location features of the app uniqueness of the app limitations/obstacles for social work clients type of violence; target audience; link to app staysafe, internationally smartphone-based personal safety app allows user’s family & friends to know about their whereabouts in case they get in trouble. app lets users set an alert timer on their phone for any single activity/ situations. alarm timer can be deactivated by user alone as it is password protected. if not disabled by user, app will inform via email & text their emergency contacts with exact location details of users. app has option to discreetly raise a panic alert alarm using power button. 4-digit pin code for ending tracked sessions. reminds users that their session is due to expire in 5 minutes with an onscreen message. alerts from staysafe are sent to emergency contacts when phone is switched off, or battery runs out of power. smartphone only app; cannot operate on a basic phone. one-time fee of $6.99 to purchase app. potential additional cost of purchasing data plans or internet. users report that only one emergency contact can be alerted. does not give users option to establish contact with law enforcement authorities or 911 directly. no access to supportive services, such as counseling centers, social service agencies street-based violence prevention app individuals at risk of experiencing violence https://personalapp.stays afeapp.com/ aspire news, usa personal safety mobile app designed for victims of dv. users can covertly send texts to their trusted contacts in times of crisis. help section is disguised as a newspaper app, but contains complete resources for victims of dv, phone #s of women’s shelters, & helplines. tapping app three times will alert users’ emergency contacts to come to their immediate help. disguised app that includes links for victims of abuse to learn more about their situation & seek help. smartphone only app; cannot operate on a basic phone. indirect costs of purchasing data plans or internet. does not give users option to efficiently & surreptitiously contact 911 & provides a list of domestic service providers, local shelter options, reads about domestic abuse without creating a browsing history. intimate-partner violence prevention & intervention app victims of dv https://play.google.com/s tore/apps/details?id=com .aspireapp&hl=en_us https://personalapp.staysafeapp.com/ https://personalapp.staysafeapp.com/ https://play.google.com/store/apps/details?id=com.aspireapp&hl=en_us https://play.google.com/store/apps/details?id=com.aspireapp&hl=en_us https://play.google.com/store/apps/details?id=com.aspireapp&hl=en_us advances in social work, fall 2019, 19(2) 504 table 2. self-help assessment/learning apps name of the app features of the app uniqueness of the app limitations/obstacles type of violence; target audience link to the app how can social workers be included in this app? bright sky, uk free to download. provides information & support services on issues of stalking & harassment, sexual violence & consent, & domestic abuse. secure my journal tool to record incidents of abuse via text, audio, video or photographs, without any content being saved on device itself. questionnaires for users to assess safety of their relationship, with a section on dispelling myths around domestic & sexual abuse. has unique uk-wide directory of specialist domestic abuse support services with contact details. available in 4 languages: english, urdu, punjabi, & polish. smartphone only app; cannot operate on a basic phone. indirect costs of purchasing data plans or internet. dv victims of domestic abuse https://www.hestia.o rg/brightsky educate clients about apps, particularly clients who appear reluctant to share their information about abuse with helping professionals. myplan, usa interactive safety decision aid for college going women (18-24) experiencing intimate partner violence (ipv) as well as supporting their friends & family members in taking action while keeping themselves safe. users can access tool via mobile app, tablet or internet browser. components of app: • introduction on safety in relationship • danger assessment tool to assess for safety • my priorities decision-making tool • my plan provides a personalized safety plan suggestion. inconspicuous name & logo & password protected. incorporates best practices for ipv, including evidence-based assessment, individualized feedback & support. specifically tailored to meet needs of survivors of ipv & provides users with danger risk assessment & a checklist of safety behaviors such as a safe place to go & someone from whom they can ask an emergency loan of us $100. smartphone only app; cannot operate on a basic phone. indirect costs of purchasing data plans available only in english & spanish language ipv friends of survivors of violence & college-going women at risk of experiencing violence in their relationships. https://www.myplan app.org/home educate & train survivors of violence as well as their friends in using this app & learning about their safety in the dating relationships. evidentiary abuse affidavit (ieaa) app, usa provides victims with a step-by-step method for legally creating & recording evidence of abuse histories that are needed in order to prosecute the perpetrator should the victim be harmed. users of the app are given instructions on how to prepare specialized documents that will, when combined with other evidence (e.g., police reports, phone records, medical records, texts, voicemails), provide law enforcement & prosecutors with vital information needed for an investigation & criminal case. apple only app. not available to android smartphone users. costs $9.99 for downloading the app from apple ios app store. ipv victims experiencing violence https://docume nttheabuse.com /evidentiaryeducate victims about this secure evidence building resource. https://www.hestia.org/brightsky https://www.hestia.org/brightsky https://www.myplanapp.org/home https://www.myplanapp.org/home https://documenttheabuse.com/evidentiary-abuse-affidavit/eaa https://documenttheabuse.com/evidentiary-abuse-affidavit/eaa https://documenttheabuse.com/evidentiary-abuse-affidavit/eaa sinha et al./a survey of the mobile 505 table 2. self-help assessment/learning apps name of the app features of the app uniqueness of the app limitations/obstacles type of violence; target audience link to the app how can social workers be included in this app? users can fill out the eaa documentation pages & they will be notarized utilizing an enotarization process. evidence is stored in a safe place with only trusted contacts aware of its location. to ensure the users safety from their abusers, apple app uses cloud technology to store eaa in a forensically secured database & not on the victim’s phone or computer. abuseaffidavit/eaa love is not abuse app to teach parents about teen dating violence/abuse & also providing them with information on what actionable steps they can take to prevent abuse of their children. users can watch educational videos on how to tackle dating violence experienced by their children. available only to users of apple devices; not available to android smartphone users. dating violence parents of children experiencing dating violence https://www.techsaf ety.org/loveisnotabu se/ direct parents to these resources for learning about dating violence. https://documenttheabuse.com/evidentiary-abuse-affidavit/eaa https://documenttheabuse.com/evidentiary-abuse-affidavit/eaa https://www.techsafety.org/loveisnotabuse/ https://www.techsafety.org/loveisnotabuse/ https://www.techsafety.org/loveisnotabuse/ advances in social work, fall 2019, 19(2) 506 crowdsourcing reporting apps. the crowdsourcing reporting apps presented in table 1 are useful in providing a more nuanced understanding of the reasons, patterns, and mechanisms through which violence spreads in any given region. crowdsourcing apps are a beneficial tool in a society where violence against women is dismissed, negated or yet to be recognized as a systemic issue, as witnessed in the case of egypt using harassmap app (peuchaud, 2014). in contexts where culture of silence prevails, the #metoo & # timesup movement serves as a useful example of how crowdsourcing reporting platforms can not only raise public awareness about an interrelated systemic issue of workplace sexual harassment and gender inequality but also some creative solutions to these complex problems (choo, byington, johnson, & jagsi, 2019). for instance, a study aimed at interviewing people who contributed stories of harassment online using hollaback! reported that online storytelling had a transformative effect on the cognitive and emotional experience and their understanding of the problem (dimond, dye, larose, & bruckman, 2013). this study noted that a shift occurred in the minds of women about the knowledge of street harassment as a larger problem tied to their right to public space and freedom. the study also revealed that online sharing of stories resulted in participants proactively responding and learning how to tackle the issue of street sexual harassment in the future. many of the reasons for non-reporting of violence, such as privacy concerns, fear of reprisal, sympathy for the offender, police leniency (felson, messner, hoskin, & deane, 2002), embarrassment/shame, and the incident being too trivial to report (birdsey & snowball, 2013) are well addressed when the users are given the option to make an anonymous report of the incident. for instance, harrassmap allows users to report and share their sexual harassment experience anonymously and also give users access to resources and support from the online community (young, 2014). as per the report evaluating the harassmap initiative aimed at ending the social acceptability of violence in egypt, the online reporting mechanisms had 88,851 visits per year and received an average of 40 reports per month, with 700 accurate reports in a year (harassmap, 2012). therefore, anonymity in reporting is a critical feature that needs to be built into the violence prevention apps for individuals to come forward and share their stories of violence. table 1 indicates that the crowdsourcing reporting apps are designed with the capabilities of not only making incident reports but also linking affected individuals with appropriate services, such as police, legal counseling, online support groups, and available local resources. if users do not perceive any direct benefit, then they will not make reports of violence. for instance, a study examining the barriers to reporting of domestic violence incidents to police found that victims were less likely to report if the police are not sufficiently understanding or proactive in their handling of domestic violence cases (birdsey & snowball, 2013). another study conducted by cornell university and hollaback! found that taking action “generally has a positive influence on targets emotional response to the experience of street harassment” (livingston et al., 2012, p. 3) as it can help victims avoid the stigma and proactively seek help. collectively, these findings suggest that users are more likely to report violence if they directly benefit from making such reports, such as gaining direct access to existing resources and information on violence prevention in their location. sinha et al./a survey of the mobile 507 another aspect crucial to improving the usability of these apps is the required reporting format of the incident. if the form for reporting is too complicated, or if there are too many required questions posed to the victims, or if the format is too rigid, that is only written reports are accepted, it may cater to the needs of only literate groups. for instance, if users can report the incident using video, audio or images, then it is possible for users who are not so literate to make a report and avail the services. also, mandating a particular type of information can act as a deterrent depending on the situation. for instance, for project women under siege, it is mandatory to describe the incident, a title for the event, type of harm, and their location to make a report (women under siege, 2015). however, hollaback! does not mandate any form of information but instead allows users to provide only information that they choose to share (hollaback!, 2016). the geographical coverage of these apps to users is also determined by the language supported in these apps. for instance, the open institute’s gender-based violence project used “ushahidi map-based tool” in the khmer language to reach out to a broader audience in indonesia. similarly, projects like women under siege, hollaback, and harrasmap support local languages have greater reach. a report titled the impact of app translations, prepared by distomo analytics (2012) showed that localizing iphone apps by including native languages in the text feature led to a 128% rise in downloads. availability of different languages is particularly important when working with culturally diverse populations in the united states. further, most app developers realize that cost is a significant barrier to the usage of apps; as a result, most apps are free to download. however, the use of apps often results in the use of data, which is a crucial concern because data plan expenses may discourage use. as a result, the privilege of being able to use these apps may remain in the domain of an “elite” section of society. marginalized groups, such as poor, vulnerable women, who are at an increased risk of facing violence, are less likely to be able to afford the extra cost. the availability of unlimited data plans for a subsidized rate by the government for socially and economically marginalized groups may alleviate this problem in the future. emergency assistance apps. table 2 indicates that the emergency assistance apps can serve as an intervention tool. for instance, some of the apps like guard my angel, reactmobile, bsafe and staysafe’s “follow me” or “watch over me” feature allows users to let their emergency contacts know their whereabouts when venturing out alone. these apps act as a strong deterrent once the perpetrator gets to know that the app has contacted 911 or some other emergency contacts. while these emergency assistance apps may be effective against street violence, they may not work against domestic violence. apps like aspire news are designed to meet the needs of women in abusive intimatepartner relationships. some of the obstacles that users, particularly the social worker’s client might face in making use of these apps are as follows: first, the registration requirements can deter some users from using the app as most of the apps require users to register with an email or facebook account. second, access to the apps becomes a real issue if users have to incur additional cost, as some of the apps like lifeline response, bsafe, and staysafe have a monthly subscription fee, a one-time fee, or charge users for their premium features like “follow me” or sending alerts to first-line responders. all of advances in social work, fall 2019, 19(2) 508 the apps listed in table 2 are designed for users who can afford smartphones and data plans which cost more than traditional phones. in addition, if the perpetrator also has complete control over the victim’s finances, then a line item on a credit card bill for something like “staysafe” could put a victim in more danger if their perpetrator notices it. the third factor limiting the usability of cell phone apps is the issue of literacy as most of these apps are written solely in english. non-english speaking individuals may not be able to use the apps. fourth, since apps are typically not designed to work across the multiple smartphone platforms, such as android, iphone, blackberry, or windows, it can be challenging for users to come up with their list of trusted emergency contacts that are on the same platform. the trusted contacts might not have smartphones that support their software platforms. fifth, it is essential to assess the safety of the users when reviewing various sms alertbased emergency assistance apps. like panic button and aspire news, apps should be disguised. users should have the option to choose between whether they want the alert to be concealed or not depending on the situation. also, users should have the choice of establishing direct contact with law enforcement like pukar, guardly, guard my angel, lifeline response, and react mobile. finally, to help increase the safety of individuals, there needs to be access to supportive services which only eyewatch, circle of six, panic button and aspire news app features. in general, the names of the app should also be covert and culturally appropriate names, like pukar in india which means “shout out” and is a very generic name. self-help assessment/learning apps. table 3 shows how interactive smartphone apps can be designed to increase awareness about domestic abuse and the resources and support available in the local community to address domestic abuse, cyberstalking, and dating violence. this is quite a constructive use of cell phone technology as much of the education that happens in face-to-face interactions with social workers can be done through the medium of cell phones – minus the associated feeling of being judged. apps like myplan, love is not abuse, and bright sky are designed to educate users about the dangers of unhealthy relationships and the warning signs of abusive relationships and how to help victims of abuse. social workers can direct their clients to these resources in case they find their clients are reluctant to broach the topic due to fears of being judged or further victimized. the evidentiary abuse affidavit (ieaa) app goes a step further by helping build a strong legal case against the abuser (document the abuse, 2016). this app enables users to create safe, reliable and effective evidentiary documentation about abuse, which can be used for the prosecution of perpetrators. this is a very unique feature of this app as it eases the process of collecting evidence for survivors, but may be prohibitively expensive. while the myplan app is a research-based app developed with input from survivors of abuse and includes the danger assessment survey (alhusen et al., 2015), this app is currently available only in spanish and english. on the contrary, bright sky app is available to users in english, urdu, punjabi, and polish. for broader reach, these apps need to be made available in local languages. sinha et al./a survey of the mobile 509 implications for social work practice based on the description of the varied mobile phone-based violence prevention apps, we recommend that social workers take the lead in evaluating the impacts of the technology on their clients, mainly how use or non-use of these mobile phone apps are affecting their clients. the nasw code of ethics states that …social workers should assess the client’s suitability and capacity for electronic and remote services. social workers should consider the clients’ intellectual, emotional, and physical ability to use technology to receive services and the clients’ ability to understand the potential benefits, risks, and limitations of such services. if clients do not wish to use services provided through technology, social workers should help them identify alternate methods of service (nasw, 2017a, standard 1.03 g, p. 8) while it is clear from the review of these apps that affordability of smartphone apps might be an issue for economically and socially marginalized clients, the nasw code of ethics also states that “social workers should act to expand choice and opportunity for all people, with special regard for vulnerable, disadvantaged, oppressed, and exploited people and groups” (nasw, 2017a, standard 6.04 b, p. 30), who are highly prone to experiencing violence and should enjoy the right to affordable internet access and digital literacy. social workers should advocate for the use of the crowdsourcing reporting apps at the agency level to develop evidence-based violence prevention campaigns and programs. rather than staying focused on survivors of violence, social workers can raise community awareness among bystanders about these apps so that they can intervene and act in ways that would show direct support to the survivors of violence. also, social workers, through their governing bodies such as nasw, cswe, and cswa advocate for funding to provide coupon codes that allow people to get the apps at a discounted price so it’s more accessible to more people. scholars have argued that whatever social workers do in their face-to-face interaction with clients, can now be done online using e-therapy (santhiveeran, 2009), online counseling/therapy (rochlen, zack, & speyer, 2004; ross, 2011; shaw & shaw, 2006), and telehealth (peddle, 2007). the literature also acknowledges several benefits of technology-based interventions in practice, such as enhanced inter-professional communication and clinical decision-making, streamlined case management and improved client access to data, rapid assessment, and clinical interventions, and enhanced client selfmanagement and self-efficacy (craig & lorenzo, 2014). the benefits of technology-based interventions can be reaped only if social workers are trained and educated on the ethical, technical, and cultural issues that come in the way of implementation of these apps. for instance, social work practitioners working in the field of violence against women can use technology to innovatively meet the challenging and complex demands of their job. when working with clients residing in rural areas or who would otherwise not seek formal services, social workers can guide them to the self-help assessment/learning apps like myplan, love is not abuse, bright sky, and evidentiary abuse affidavit (ieaa) app. hawkins, pearce, skeith, dimitruk, and roche (2009) found that when social workers used hand-held technological devices as opposed to paper-and-pencil questionnaires to screen advances in social work, fall 2019, 19(2) 510 for domestic abuse and neglect while out in the community, there was a significant reduction in collection of redundant domestic abuse data and more effective mobilization of resources, initiation of same-day in-depth social work assessment, and referrals to appropriate community agencies. further, in the case of victims of rape and sexual assault, the availability of crowdsourcing reporting apps can make it easier for clients to take the first step of anonymously reporting the incident and seeking online support and services without the fear of being judged. social work practitioners should be made aware that a one-size-fits-all approach will not work and to keep in mind the unique needs of their clientele when considering programs, policies, and practices involving the use of technology (nasw, 2017b). for instance, circle of 6 is a personal safety app designed for college students and is based on the assumption that individuals using this app will have six friends to add in the circle. this app might not apply to clients who are stigmatized and living a life of isolation and fear, such as women in the sex trade or survivors of trafficking who might not have six friends. as a result, social workers need to educate themselves first about the purpose of the app and make clients aware of the possible benefits and limitations of each app in their therapy. social workers providing counseling to clients at risk of high violence can ask them to make use of the emergency assistance apps listed in table 2 and opt to be listed as their emergency contacts or call guardians so that they can take immediate steps to remedy the situation. this is particularly useful for clients who have had previous brushes with law enforcement or criminal histories and may fear contacting the police authorities. social work agencies can also create a circle of support for their vulnerable and isolated clients by asking them to watch out for each other through these emergency assistance apps. implications for future research unlike myplan – an interactive safety decision app for college women in abusive dating relationships and their friends (alhusen et al., 2015) and ieaa app, there are very few apps that are grounded in research that is based on the input of survivors of different types of violence and targeted population. therefore, future research should evaluate the effectiveness of these mobile phone-based applications for violence prevention in different settings and target populations. social workers should actively study the consumer perspective on app-based violence prevention interventions, particularly how mobile apps have changed the lives of their clients and how they prefer the services to be delivered. we recommend that the design and development of mobile phone-based interventions be based on the input and feedback from social workers with expertise in the field of violence prevention as they will be better able to speak to the risks, safety issues, and socioeconomic challenges of their clients with regards to using icts. conclusion this article surveyed mobile phone-based interventions for violence prevention and has offered critical insights on the purpose, benefits, and challenges associated with the use of mobile phone apps-based interventions for violence prevention. the different types of apps for violence prevention and intervention include crowdsourcing reporting apps, sms alert-based emergency assistance apps, and self-help learning/assessment apps. each app sinha et al./a survey of the mobile 511 is designed to address the issue of violence at different levels. crowdsourcing apps aim to increase community awareness as well as community ownership for dealing with the problem of violence, whereas sms alert-based emergency assistance apps and selfeducation apps tackle the issue of abuse at the individual level. social workers working in the field of violence prevention need to be aware that through these apps they can monitor their client’s status in real time and respond rapidly to clients with resources and support in crises. many times, a delay in response time, paperwork, long travel times, and the fear of being judged act as barriers for clients in accessing formal institutional services, such as counseling centers, and criminal justice interventions such as protective orders or arrest warrants. the review of these mobile phone apps indicates that the use of technology can enable clients to access violence prevention resources without the fear of being judged and can be instrumental in creating a secure support network for victims. as a result, social workers responsible for conducting the biopsychosocial assessments with clients should also evaluate the technology needs of their clients and their comfort with using technology, particularly their digital literacy skills and challenges (nasw, 2017b). additionally, social workers can play a crucial role in collaborating with ict professionals in the design and development of socially and culturally relevant mobilephone-based interventions that take into consideration the unique needs of their diverse clients, such as the issue of affordability, language, and the preference for different medium of electronic communication (interactive voicemail, text, email, phone, video). since social workers typically work with economically and socially marginalized groups and are responsible for advocating for social change and social justice issues experienced by these groups, they are well-positioned to leverage their client’s position, enhance the clientworker relationship, and fulfill the promise of equal and ethical digital citizenship (henry & powell, 2016). social workers can play a significant role in advocating 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(2010, november 7). new phone apps aim to combat harassment. retrieved from the new york times: https://www.nytimes.com/2010/11/08/nyregion/08hollaback.html author’s note: address correspondence to: dr. sunny sinha, associate professor, school of social work, marywood university, immaculata hall, room 205, 2300, adams avenue, scranton, pennsylvania18509. e-mail: sinha.sunny@marywood.edu; dr. aviral shrivastava, associate professor, school of computing informatics and decision systems engineering, arizona state university, centerpoint 203-15, 660 south mill avenue, tempe, arizona-85281. email: aviral.shrivastava@asu.edu funding: this research project was supported by the marywood university’s research initiation grant. acknowledgement: we would like to thank the anonymous reviewers of this journal for their excellent feedback and very grateful to marywood university for a grant that laid the groundwork for this research project. in addition, many thanks to indulata prasad and ilya issenin for their encouraging and helpful comments on the earlier draft of this paper. https://doi.org/10.1097/01.aids.0000198094.23691.58 https://doi.org/10.1016/j.jadohealth.2018.08.011 https://www.dur.ac.uk/resources/sass/research/briefings/researchbriefing12-protectingwomenssafety.pdf https://www.dur.ac.uk/resources/sass/research/briefings/researchbriefing12-protectingwomenssafety.pdf https://womenundersiegesyria.crowdmap.com/reports/submit https://doi.org/10.22215/timreview/770 https://www.nytimes.com/2010/11/08/nyregion/08hollaback.html mailto:sinha.sunny@marywood.edu mailto:aviral.shrivastava@asu.edu overview and classification evaluation metric for violence prevention apps sms alert-based emergency assistance apps. numerous cell phone applications (apps) have been designed to enhance the personal safety of the users. the way to operate these apps is first to enter information about the users’ emergency contacts so that ... self-help learning/assessment apps. the last category reviewed in this survey are apps that are designed to increase the user’s understanding of violence and also engage in self-learning and self-assessment of their risk of abuse/danger in the relatio... critical analysis of the violence prevention apps implications for social work practice implications for future research conclusion references _________ w. patrick sullivan, msw, phd, professor, school of social work, indiana university, indianapolis, in. carol hostetter, msw, phd, professor, school of social work, indiana university, bloomington, in. miriam commodoremensah, msw, doctoral candidate, school of social work, indiana university, indianapolis, in. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 221-239, doi: 10.18060/25294 this work is licensed under a creative commons attribution 4.0 international license. experiences of mental health professionals in the rapid pivot to telehealth: implications for social work practice w. patrick sullivan carol hostetter miriam commodore-mensah abstract: during the covid-19 pandemic, the adoption of telehealth in behavioral healthcare was rapidly accepted. this article reflects one component of a larger qualitative study that sought to understand the personal and professional experiences of front-line workers and their supervisors during the pivot to virtual services during the covid-19 pandemic. the current article is focused on the question, what were mental health workers’ reactions, both personal and professional, to the rapid adoption of technology in their community mental health center practice? thirty-six mental health professionals, ranging from front-line workers to supervisors, participated in telephone and zoom interviews between late august and mid-november 2020. respondents spoke of their organization’s rapid response, the switch to telehealth for many services, the impact of this switch on professional practice, and their perceptions of the effectiveness of virtual services. they also shared their thoughts about the future of telehealth. the rapid changes, necessary for clients and the organization alike, brought an opportunity to reimagine service delivery. as social work is a profession that heavily emphasizes ethics and advocacy, and is the predominant professional group in community mental health, the final section examines implications for social work practice including practice ethics, consideration of factors on a micro, macro, and environmental level, the need to balance protection of the individual with the rights of many, and the necessity to take care of those doing the work as well. keywords: covid-19, social work, community mental health, telehealth during the covid-19 pandemic, the adoption of telehealth in behavioral healthcare was rapidly accepted. if one were to chart the rate of adoption of telehealth in social work and behavioral healthcare in the years before 2020, the overall trend would suggest a slow and steady introduction of such practices at least as an adjunct to traditional services. then, in an endorsement of the adage that necessity is the mother of invention, the coronavirus pandemic spurred a dramatic rise in the use of various distance and virtual modalities (gentry et al., 2021; maese et al., 2020; wilkerson et al., 2020). the rapid ascension of telehealth was facilitated by significant alterations in public policy, in particular the relaxation of restrictions that had traditionally curbed the broad use of such technology and limited reimbursement for services rendered (haque, 2021; maese et al., 2020). researchers began seeking to understand the reactions of mental health workers, both personal and professional, to this unprecedented shift in 2020. in the best of times, the introduction of new services and novel technology is generally a multifaceted and time-consuming process that begins with the engagement of end users (rogers, 2003). however, amid the coronavirus pandemic a perfect storm was brewing. about:blank advances in social work, spring 2023, 23(1) 222 not only were health care organizations forced to respond nimbly to this external threat, but the nature of the crisis at hand resulted in an increased demand for services among established recipients and an influx of new clients (lin et al., 2020; mochari-greenberger & pande, 2021; oesterle et al., 2020; tse et al., 2021). as was true in other sectors of healthcare, some behavioral health services continued to be delivered face-to-face. yet as the lethality of the virus was established, and casualties mounted, it was clear that telehealth offered an alternative pathway for some to receive needed services while safeguarding the health and safety of both clients and staff. the fact that such interventions were now deemed acceptable to external funders, including state and national policymakers, also provided a mechanism that helped mental health organizations remain afloat. while many providers were forced to take a deep dive into the world of telehealth, with time, end users were in a better position to assess the relative strengths and weakness of this service delivery modality. certainly, there is growing evidence that telehealth is effective and acceptable to service recipients (bashshur et al., 2016; gentry et al., 2021; haque, 2021; hilty et al., 2013; lowden & hostetter, 2012; mishkind et al., 2021; mochari-greenberger & pande, 2021; sasangohar et al., 2020; tse et al., 2021). some of the impediments that were encountered in this tumultuous time were predictable. at the top of the list was the availability of needed technology by both clients and professionals, and widely varying levels of comfort and competence in the use of these tools (funk, 2021; medalia et al., 2020; tse et al., 2021; yellowlees et al., 2020). emerging and challenging issues around confidentiality were also seen, along with the now permeable boundary between home and work for therapists, and between home and services for clients (crockett et al., 2020; jeffrey et al., 2020; sasangohar et al., 2020; yellowlees et al., 2020). it is also clear that telehealth is not suitable or palatable for every client, is not effective in every situation, and cannot serve as the lone platform for needed assessments and intervention for all (mishkind et al., 2021; tse et al., 2021). because of these issues and more, in time the process of triage may also include the consideration of the appropriateness of telehealth for discrete clients. the current article seeks to connect the experiences of mental health workers to the implications for social work mental health practice specifically, since social work is the predominant professional group in mental health (american board of clinical social work, 2023; heisler & bagalman, 2013) and the field heavily emphasizes ethics and advocacy. a useful contribution in understanding social work practice during this crisis is walter-mccabe’s (2020) birds’-eye view of how the pandemic affected social work in all of its arenas, from access to resources, systemic criminal injustices, and systemic racism, encouraging not only “macro folks” but all practitioners to work at the macro level (waltermccabe, 2020, p. 70). similarly, in an editorial written in the first months of the pandemic, golightley and holloway (2020) advocated that “…social work must look out for and speak for, the most marginalized and vulnerable in our society” (p. 637). in addition to concerns about the effects on client populations, attention has been given to examining how working in the pandemic was affecting social workers and other colleagues. in a survey of behavioral health clinical and administrative staff, morse and dell (2021) found concerns about secondary traumatic stress, burnout, and the well-being sullivan et al./future of telehealth 223 of mental health workers. they called for more research on the effects of the pandemic on these crucial workers. in an opinion piece, dominelli (2021) shared a “green” social work perspective on the importance of social workers’ learning about issues such as disaster management and the relationship between the environment and human health. banks et al. (2020) researched the ethical challenges provided to social workers during the beginning stages of the pandemic. the importance of taking a hard look at what the pandemic has done to the working conditions of social workers was the focus of a study by de jonge and colleagues (2020). they anticipate that the increased demand for services will take a toll on social workers, along with an increase in flexible contracts that provide less job stability. relatedly, dima and associates (2021) conducted a mixed-methods study in order to learn about job stress and burnout among social workers during the pandemic, finding a high level of reported stress and unpredictability in employment. litam et al. (2021) documented similar results in their national survey of mental health counselors, finding compassion fatigue, burnout, vicarious trauma, and stress among the counselors. to learn how sustainable social work can be in a time of great challenge, redondo-sama and associates (2020) conducted semi-structured interviews with 23 social workers in a variety of practice areas. the efforts to maintain communication and increase dialogue throughout the pandemic were found to be crucial strategies that had a positive impact on client care (redondo-sama et al., 2020). the use of technology itself was the focus of work by mishna and collaborators (2021). they studied the use of information and communication technologies such as cell phones to supplement more formal telehealth sessions, finding that a key element to help workers cope was maintaining boundaries around their work hours and means of communication. litam et al. (2021) similarly found enforcing personal boundaries was key for mental health counselors in their study. the current study was designed to answer the research question, “what were mental health workers’ reactions, both personal and professional, to the rapid adoption of technology in their community mental health center practice?” this is a component of a larger qualitative study that sought to understand the personal and professional experiences of front-line behavioral healthcare workers and their supervisors during the pivot to virtual services during the covid-19 pandemic. through an extensive literature search, we were unable to find research studies using interviews of mental health workers to learn about their experiences. likewise, billings et al. (2021) were unable to find studies on mental health professionals who provided services to health and social care workers. using an online written qualitative survey format, banks and collaborators (2020) examined changes in social work practice in general during the pandemic. their implications focused on ethical challenges, which is valuable information but was not specific to mental health practice. miller et al. (2021) conducted an online survey to inquire about the stresses experienced by mental health workers during the pandemic, finding that self-care, whether it is done by the workers on their own or through an agency-based program, made an important difference in helping clinicians cope. one of the closest articles we found on our topic and methodology was by ashcroft and colleagues (2021), who conducted focus group interviews to understand the impact of the pandemic on primary health care providers. while the study does report the increased demand for mental health care and the effects on individual providers, the study participants were canadian family health teams, comprised primarily of nurses and physicians. our study sought to address the gap in the literature by advances in social work, spring 2023, 23(1) 224 describing the personal and professional reactions to the rapid adoption of technology in their community mental health center practice. methods this study reflects one component of a larger qualitative study that sought to understand the experience of social workers and other professionals offering mental health and addictions care in the early days of the covid-19 pandemic. while the larger study examined mental health providers’ experiences during the beginning of the pandemic in general, in this article we focused on telehealth specifically. we sought to learn respondents’ perceptions of the rapid transition to various forms of telehealth, the impact of these helping modalities on all parties, the strengths and weaknesses of these interventions, and what might be the future of telehealth. chief administrators at the agency agreed to allow staff to participate in the project which was supported by a university-sponsored rapid response research initiative focused on the covid-19 pandemic. the project protocols were approved by the indiana university institutional review board. staff were recruited from a large rural midwest community mental health center which operates multiple offices covering a wide geographic area. like most community mental health centers, the organization offers a diverse range of programs focused primarily on mental health and substance use. a general description of the study aims was distributed by administrators to employees across the organization, with an invitation email from the researchers. participation was voluntary. we originally sought to interview 20 people, but there was more interest so we ended up with 36 participants. at that point, it was clear that we had reached saturation. telephone and zoom interviews took place between late august and mid-november 2020, lasting between 30-60 minutes. the interviews followed a semi-structured format that focused on the experience of behavioral health service in the age of covid. see the complete list of interview questions in the appendix. participants were asked to share their personal reactions to their telehealth work, how the covid pandemic altered the delivery of services, how their agency had responded to the pandemic, and the general impact on clients. some respondents worked in residential settings and their involvement in telehealth practice was not as extensive as their peers who swiftly began working from home. respondents the 36 respondents included 25 women and 11 men, 16 of whom provided direct services and 20 of whom served primarily in supervisory roles. among the respondents, 11 had earned msws (with one also holding a doctorate), three had bachelors’ degrees in psychology, one had a bsw, 13 completed other bachelors’ programs, two had nursing degrees, five individuals had attained an associate degree or high school diploma, and one was not collected. in terms of experience, interviewees ranged from one participant who was in their first year on the job to one who had been in the field for 40 years. thirteen of the respondents had fewer than five years’ experience, 10 had 6-10 years’ experience, six had 11-15 years’ experience, and seven had 16 or more years of experience. we did not sullivan et al./future of telehealth 225 collect data on the race of the participants, because with such a small number of respondents, the identity of the people of color could be exposed to the administration. overall, this was a seasoned group who, on average, had spent over a decade in the field. the respondents represented several discrete center service lines, and while the ways covid-19 influenced their daily work varied, all were impacted in some fashion. four respondents worked in residential programs and thus continued to provide some level of face-to-face services throughout the time of the study. data analysis all interviews were recorded and transcribed. using the six-phase process of braun and clarke (2006), the two interviewers provided a rough transcription of each of their interviews, with the third author cleaning up the transcripts. this provided the researchers the time to read and re-read the data. we each recorded our initial themes and began the process of systematically coding notable aspects of the data, collating quotations relevant to each code. we then each organized these codes into preliminary themes, using inductive analysis that was grounded in the data (braun & clarke, 2006). at that point, the three researchers compared our initial codes and came to consensus on the themes we found in the data, following the guidelines for investigator triangulation (nowell et al., 2017). together we reviewed the themes, referring again to the entire data set. we settled on the final themes and the specific quotations that illustrated each theme, generating our overall analysis of the data. in addition to the main themes, outliers were noted and included. in sum, we sought to establish the trustworthiness of the data (nowell et al., 2017) by engaging in an iterative process of triangulation through discussing themes, reaching consensus on themes, and documenting each step. the two interviewers were well-versed in community-based mental health and substance use services, therefore there were few language barriers, and, in general, responses needed little additional interpretation in developing the themes. the authors used a strengths perspective in their approach to the study, because although designed for practice, it is useful in research since the perspectives of the participants are heard and respected without judgment (weick et al., 1989). bakker and van woerkom (2018) write about the value of using the strengths perspective in employee functioning and while a literature review on the topic (miglianico et al., 2020) indicates that research in this area is modest, the authors viewed it as helpful in maintaining focus on participants’ experiences and thus bracketing their own experiences so as not to bias the data analysis. one author is a researcher, rather than a clinician, further helping mitigate any preconceptions the other authors might bring. findings respondents shared their experiences of a rapidly changing organizational response to the pandemic and how it affected their practice, on what seemed to work, and what got lost in the transition. the analysis revealed four themes from the interviews: responding to the advances in social work, spring 2023, 23(1) 226 pandemic, introducing telehealth, impact on professional practice, and the future of telehealth. responding to the pandemic: “it was ever-changing” when thinking about how rapidly the organization pivoted and altered daily procedures as the gravity of the situation became clear, one supervisor with 23 years of experience noted, “yes it was quick, but it had to be quick. we had meetings every day for a while, so it was pretty intense.” as for the change in protocols that followed, this respondent added, “they seemed to be very cautious, and it seems like in some ways they had been extra cautious. . . we have been on the cutting edge of it.” many supervisors and staff took a step back and reflected on the enormity of the task at hand and the responsibility that rested on the shoulders of senior leadership. one respondent who has been at their post for two years reflected: when you are responsible for the physical and mental health of all of these clients and all of these staff, the ceos had to really come together, and this was the subject of conversation after conversation. i think the organization, with the information the public had, made appropriate decisions and i think they responded quickly and safely. as all grappled with the task before them there was some level of chaos, multiple meetings, and a measure of communication fatigue, but many realized leadership was dealing with a nearly unknown threat. speaking to the idea of potential information overload, one supervisor with 20 years of experience recalled: we were meeting with anybody who was a coordinator or above. we were having a meeting monday, wednesday, and friday and i was like, stop! this is too much information. while the commitment to sharing information was strong, the message often changed rapidly in the early days of the pandemic. while it was frustrating to some, to one nineyear center veteran the changing messages were understandable: it was ever changing and hard to keep up with. but i think most people understood that we just didn’t know, it was a new virus, and we just didn’t know what it was or how to treat it, and how to not get it. introducing telehealth: “once people got through the learning curve” of the major adjustments made by the organization in response to the pandemic, the shift to a telehealth platform may have been the most extreme. suddenly, a host of clinicians were offering remote services, primarily from their own home, and trying to figure out how to provide the best care they could for their clients. it was a dramatic change for many. looking back to the early days of the transition, a seasoned supervisor admitted it took some effort to get staff comfortable and competent with providing online services, sullivan et al./future of telehealth 227 none had ever done telehealth. i had people struggle, i had some who loved it, some floundered and some got really creative. so, we started out mostly with the phone and questions like how to keep your clients talking. evidently, the technology was a barrier for some staff and clients. looking back one respondent admitted, “zoom was a little frustrating to learn. i was in an office that had a tech savvy boss. so, we had plenty of opportunities to learn about it as quickly as we could.” in a similar vein, one professional added, “i think now it is really pretty good. at least 90% or better. if i had to rate it in march when we were doing the switch-over the first several weeks maybe just 50%, but once people got through the learning curve, i thought people were meeting the clients’ needs.” given that no clients were interviewed in this study, any report on their experience comes solely from the observations of the staff who worked with them. one can easily imagine that there were clients who lacked needed technology (even modern cellphones) and struggled with telehealth. respondents felt it was also likely that some clients fell through the cracks, especially with the volume of outreach services curtailed. as one clinician observed, “for a certain amount of people it helps them access services because they don’t have to go into the office. but with that i would be careful to allow people with depression to stay home and never have to go anywhere. i think it has its benefits, and if used carefully, it can be a good thing.” many of the professionals in this study did see an array of positive outcomes emerging from this difficult time. for example, one respondent said, telehealth has really helped my clients in dealing with the doctor. they don’t have to leave the house to go to the doctor’s office. they don’t have to walk into the doctor’s office and wait. it is right there on the screen so their engagement in their care or health care or psychiatric care has improved. with respect to engagement, one respondent noted, “i do think there are some clients who are meeting with me more regularly.” perhaps as a function of sharing the same troubling reality as their clients, and the fact that help is occurring in settings more informal than an office, one staff member observed, “we have definitely come together more, you know, that emotional connection. like the professional part has kind of worn off. it is kind of like when you have stayed at someone’s house for too long, then you really get to know them.” in an interesting twist, several informants suggested that the pandemic forced some clients to do more for themselves, and perhaps staff have truly begun to see that those they work with have untapped strengths. for example, … the surprise is watching my client’s natural human responses come about as such positive ones. it has surprised me, and it has been a delight actually. i think we get mired down in this idea that they are not as capable of correctly achieving activities in their daily lives because we expect that, and the negative is what we work on, and it is what we note. many staff expressed the easing of tension about the financial stability of the organization as they could see that telehealth took hold for many clients. having seen friends and family be laid off due to the pandemic, some staff members worried about advances in social work, spring 2023, 23(1) 228 keeping their own jobs. one participant answered the question about the impact of the pandemic stating: “it’s been stressful. i mean some people are oh they got laid off or their job changed and they are home with nothing to do.” but when they saw the number of clients who were able to be helped, they began to worry less about their jobs, and began to have a sense that they were becoming too busy (see section on drawbacks below). impact on professional practice benefits: “there are more opportunities for the clients” through the efforts of staff, and with new reimbursement streams supporting telehealth, over time it was clear that the organization had enough client contact to ensure its survival. one of the key issues that fueled this productivity spurt was improved client access to care. previously, a well-known barrier to care was transportation, a particularly strong impediment to service utilization in rural settings. with telehealth now an option, the issues of time and cost associated with travel for both clients and staff were minimized as these new tools became accepted service delivery methods. even those staff who were already accustomed to offering services in the home and community could see the benefits of telehealth. it has helped a lot of our clients with the transportation barrier they had before, so this has allowed us to connect with a lot more people. before i was actually going out and working with folks in their homes. it has been really good on a personal level. it has allowed me to be more productive . . . i am able to get to individual clients more quickly. many benefits to providing services in the home can be found, and outreach has long been a staple of work with those facing severe and persistent mental illnesses. because of concerns over safety, these visits were reduced, and for some this was unfortunate. however, one supervisor, drawing from anecdotes shared by staff, reported, clients (are) feeling more comfortable through zoom as opposed to coming to someone's office and, you know, opening up those wounds, because they're in their safe place. that’s allowing them to feel a level of comfort that they didn't feel in an office. another factor in the rise in productivity was the freedom and flexibility that came by moving to a telehealth platform particularly relevant for this multi-county organization. suddenly clients were not restricted to seeking service in one locale and could be assigned to any professional in the entire organization. speaking to this trend one supervisor noted, i think it is remarkable that we can do telehealth now, and that we don’t have to refer just in our county. i can refer people to an mrt group in (city a) even though they are in (city b), eliminating the longer wait to see a prescriber or a therapist. and i love that. sullivan et al./future of telehealth 229 providing even more detail, one professional enjoyed how quickly they could connect with clients, adding, when we get new referrals, we are getting connected with those individuals and getting them connected to services a lot faster than what we did before, and i think that is a huge positive in itself. drawbacks: “i find myself being way more busy now” increased productivity is certainly a positive for the host organization, but can exact a toll on clinicians. for those working at home there was increased isolation and the separation between home and work was lost. thinking of the adjustments that were made, one professional noted, being at home for me was very stifling. and i felt very kind of confined, shut in. i was having to work out of my bedroom. so, i was like, you know, two feet away from my bed and so there was no real separation for me. and i didn't realize how much i value that fiveor ten-minute drive i have to work in the morning. offering a similar observation, a long-term employee shared this sentiment, you used to have the ability that it was friday, i am leaving work, and i am shutting down. now i leave the room and i go to a different room, but you are still working. we have had to give clients our phone numbers. so now they have access to us all the time. do you pick up your phone and respond to a crisis if they call you on a weekend? you have your computer in front of you all the time, do you work on the weekends to try to catch up? so, i find myself being way more busy now than i was in the office. you would think it would be the opposite. one person stated, i think as time has gone on it is more emotionally taxing because i am doing so much, if you look at my schedule it is like a bad game of tetris, and generally i go from eight in the morning to 5 or 6 p.m. and it is just one thing after another. respondents also noted that their practice was impacted by the lack of immediate access to peers and supervisors. now they need to make an extra effort to touch base with peers and supervisors to provide or receive technical and emotional support. speaking to this loss, a respondent added, “we are very much a work family. my supervisor and direct co-workers are very much a family and so you have this group of people who you are very invested in, and have a high stress job, and now we can’t see them.” reports indicate that there were increased efforts to check in by telephone or zoom, but there was little question that some of the basic human connection between peers had been lost or altered. to this point, one professional who began offering groups via zoom noted: when i run my iop group i take a fifteen-minute break in between and they think it is for them, and it’s not, it’s for me. i tell them to work on their worksheets, get a drink, whatever. it’s me. but [not being able to say] hi to a colleague or having that support, that has definitely been huge. advances in social work, spring 2023, 23(1) 230 services both positive and negative: "it’s really gone both ways” not surprisingly, not all respondents in this study were convinced that the services offered virtually were on par with customary practice. thinking about the care that had been offered a few months after the change in routine forced by the pandemic, one clinician said, “i think maybe the quality has declined a little bit. it is hard to say how. i think for the clients, telehealth doesn’t work well for them. i think they are really impacted.” being a bit more specific, a ten-year veteran of the organization opined, “i don’t think telehealth is as good as in-person therapy. i have seen a lack of engagement; some clients don’t want to do it. i think the therapists are doing a great job in spite of the circumstance. but it's really gone both ways.” other respondents were more positive. as some became more comfortable, they found new avenues to deliver services abetted by technology. one respondent captures this phenomenon, i have a system. i do a check-in, so everybody talks. i love zoom because i can do breakout rooms, i can do the whiteboard, i can share my screen, i can share ted talks, brene brown, father mark videos. i have actually implemented art activities into my zoom platform. my groups have grown, they continue to grow, so we still have a really great success rate in terms of attendance and graduation. echoing several themes that emerged in this study, an experienced social worker remarked, actually, across the board the therapists have been able to do more, like their productivity is higher, because they can call and do therapy, and they can call and check in with people, and even do short sessions where people are in distress. it was impossible to bill before. now they can. at the very least, even those not particularly enamored with the use of telehealth in all its forms agreed that it was nearly essential in this timeframe. for example, one supervisor was particularly pleased with the chance to reach out in this fashion. they note that one strength involved … being able to connect more frequently with people and being able to bill. my recovery coach really stepped up and called all the clients every day, and so it really seems our client care is better now. an unexpected benefit from the pandemic is that it prompted this organization to look at the way services were organized and delivered with a fresh perspective. speaking to this, one supervisor remarked, “if anything, a good thing about the whole covid epidemic has definitely been that we have had to be more creative and figure out different ways of doing things, which in the grand scheme of things is beneficial.” going a bit more in depth, another respondent captured what seemed to be a prevailing opinion about the impact of the pandemic on their immediate situation and even into the future. it has truly changed everything that we've done, but actually in a really good way. in other ways we just had to learn and adapt. covid has allowed us to reevaluate how we provide treatment and structure our program actually for the better. sullivan et al./future of telehealth 231 the future of telehealth: “gives us the chance to be a bit more person-centered” at the time of this study, where things were headed with the pandemic was far from certain. like much of the country, personal reactions to the virus and the response to it varied widely. vaccinations were not yet offered, and the death toll from the virus continued to climb. where it was possible, supervisors and their staff transitioned into a more virtual form of services and internal operations by mandate. despite the sometimes overwhelming challenge before them, many were willing to peer into the crystal ball and consider how services would look in the future. while some hoped that business would return to normal, most sensed this was unlikely. furthermore, most now hoped that the future of telehealth was secure and would remain a service option in the long-term. reflecting the sentiment of many who had a chance to get comfortable with this new way of providing services, one relative newcomer to the agency said, “i like the tele option. does it work for everybody? probably not. like a child in school, people learn differently.” supervisors already heard from staff who wanted to continue in this direction postpandemic and could see many ramifications from what had been learned in this tumultuous time. one direct service provider, offering their glimpse forward added, i think we will do telehealth. we’re in the middle of doing a little survey on our own by talking to staff. what do you like about telehealth, what do you not like, would you like to continue it, are you set up for it? space is such an issue in this building, and it seems to me if we have people who want to do telehealth and have a good setup, why not free up some space for groups that we really need to do in person rather than take up space with an office with someone who could do telehealth? when asked if they thought telehealth would continue in the future one participant replied, i certainly hope so, i mean we have just come across so many benefits. i would hope for mental health services in general it continues to be just a variety of inperson, video and even phone capability . . . it seems like often all of these things give us the chance to be a bit more person-centered easier, and a little faster. and it is based on what their needs are. discussion in the face of a crisis that was unprecedented in recent history, the mental health staff of this behavioral health organization, like so many across the country, were asked to react quickly and competently to an unseen force that threatened the health and safety of both clients and staff and jeopardized the future of the organization. the quest was to provide the highest quality services possible in trying circumstances. as a multi-faceted organization that provided a wide range of services required by those facing mental health and substance use challenges, staff made the commitment to continue to provide residential services and some level of face-to-face care. however, therapists were suddenly tasked with providing care remotely. for some staff and clients this required them to get comfortable and proficient with unfamiliar technology. to no one’s surprise, there were advances in social work, spring 2023, 23(1) 232 struggles, barriers, and growing pains. overall, respondents knew that they were a part of a crucial rapid response to a crisis. they recognized the enormity of the task, and while they felt the weight of the information overload from administrators, they knew it was necessary. as mishkind et al. (2021) found, one key ingredient to the successful transition to telehealth in this period of crisis was a strong organizational response and involvement of all parties. in this case there was no time to get complete buy-in among staff, and the messaging around the pandemic frequently changed as more became known. in a world far less than ideal, all the implications of this dramatic shift could not have been anticipated. similarly to what mishkind and associates (2021) foresaw, operational changes were paramount, there was stress on the technological infrastructure, and serious fiscal considerations were at hand. beyond this, and most crucially, there were changes in all aspects of clinical practice from outreach to intake and assessment to the provision of care. gentry et al. (2021) observed that the acceptance of telehealth and new technology begins with the clinician’s acceptance of these new approaches. in the time of covid-19, particularly as the country was shutting down, there was little time to be proactive. similarly, redondo-sama and associates’ (2020) study highlighted the power of social workers’ communication and commitment to serving the needs of the community in a crisis. the leap to telehealth was viewed as an extreme shift, one that taxed workers and clients alike. the learning curve for many was steep (tse et al., 2021), yet there was a camaraderie and engagement that connected people. similarly, in their study on perceptions of videoconferencing, lowden and hostetter (2012) found that while participants were bothered by technology challenges, they appreciated the access and usefulness of videoconferencing. as telehealth policies and services changed locally and nation-wide, more support for the use of technology in practice was sought (wilkerson et al., 2020). participants recounted their realization that the organization was surviving, due in large part to increased numbers of clients. initially, they experienced some alarm as they observed schools, businesses, and even local branches of government curtailing hours or shutting down completely. but with the access to social work that telehealth provided through a reduction in transportation barriers and geographical region requirements, along with the stressors of the pandemic increasing the demand, productivity numbers were good. as documented by others, telehealth contributed to higher productivity (mocharigreenberger & pande, 2021), which seemed to counter the alarm people might have felt. at the beginning of the pandemic, many of the respondents in this study had felt uncertain about the ability of the organization to survive financially, and many feared that their jobs were in jeopardy. while the increase in productivity began to allay those fears, with the increase in productivity came an increase in work stress. therapists and their supervisors often felt they were always working. the lack of a physical boundary between work and home was wearing on some. respondents also mentioned that the immediate “hallway conversation” that provided support from peers and supervisors was missing. our findings affirm what crockett and associates (2020) state regarding the stressors providers face with remote work. in addition, sasangohar and associates (2021) observed the informal and spontaneous communication between peers about a case or situation was lost. sullivan et al./future of telehealth 233 the study elicited the workers’ perceptions of the effectiveness of virtual services. as rogers (2003) states, any time an innovative or novel approach is introduced in a host environment, the reaction and appraisal of end users is critical. some respondents were concerned about the quality of care, but others were more positive. respondents mentioned the creative ways they had discovered to deliver services, and felt that they had more frequently engaged with clients. much of the available research on the effectiveness of telehealth is promising, and efforts are ongoing to explore the use of these technologies in greater depth (bashshur et al., 2016; gentry et al., 2021; haque, 2021; hilty et al., 2013; mishkind et al., 2021; mochari-greenberger & pande, 2021; sasangohar et al., 2020; tse et al., 2021). the final theme from the interviews reflected on the future of telehealth. in the early days of the pandemic, social workers and other practitioners in this study were for the most part interested in having telehealth as part of their arsenal of service delivery approaches. as noted by many authors, telehealth is an option that is highly likely to continue. implications in response to the pandemic, this behavioral health organization quickly expanded its telehealth program and, on the face of it, did so successfully. the question is, how will services look going forward? everything is contingent on fiscal policy decisions yet to be made and the advocacy social workers can engage in. if the bulk of telehealth services remain reimbursable by third party vendors, the services will likely flourish. if the present public and private policy course is reversed, at least on the clinical side of the ledger, telehealth services will retreat to some degree, but will not go away. as golightley and holloway (2020) state, social work as a profession is in a position to advocate for those who have been marginalized and ignored by our society. social work as a profession has as a constant goal, the need to balance the competing responsibilities of promoting human dignity and ensuring “… the greatest good for the greatest number” (de jonge et al., 2020, p. 1034). like a child trying to stand on the center of the teetertotter, it is nearly impossible to get the two sides exactly even. we must constantly work to right the wrong. evidence from social work practice such as that reported by redondosama and associates (2020) shows that social workers have an important part to play in keeping our services sustainable. banks et al. (2020) raise implications for the ethical balancing that social workers must do with telehealth. do policies need to flex to meet the needs of clients? how do we ensure confidentiality when clients are in their homes or other exposed locations? who decides which clients are given mobile phones or access to a conference room to use the videoconferencing system? social workers’ advocacy and ethical responsibilities are larger than their clinical practice. as the environment becomes more fragile, social workers have a responsibility to understand and fight the ensuing threats, such as global climate change, diseases that jump from animals to people, and increasing numbers of natural disasters (dominelli, 2021). social workers must recognize the importance of their working outside of their own service advances in social work, spring 2023, 23(1) 234 delivery area to advocate for issues such as lack of equal access to health insurance, paid leave, flexible jobs, the impact of unequal access to care that increases health disparities, the criminal “justice” system, the impact of systemic racism, the rights of people experiencing homelessness, and so many other issues (walter-mccabe, 2020). social workers need to turn their gaze to themselves, as well. as dima and partners (2021) recommend, addressing social work job stress during these difficult times, social workers need to collectively work from the grass-roots up to develop policies, laws, and practices that sustain them. they recommend that social workers should “be proactive regarding their mental health status, prioritize self-care, and develop plans for work-life balance” (p. 7129). in addition, social workers must stop the encroachment of work into their personal lives, such as letting clients know “…the boundaries of communication prior to beginning service (e.g., expectations regarding response time, social media use)” (mishna et al., 2021, p. 492). the authors recommend promoting informal supports among colleagues to continue the emotional care that workers can provide to each other. organizations must ensure social workers have a safe and sustainable workplace when a virus rages through the community (banks et al., 2020; mishna et al., 2021). in the study organization, telehealth gained some adherents, suggesting it is an innovation that has been embraced. what is also clear is that this is just the beginning of the work to be done. future studies will need to take an even harder look at outcomes, discern to the best degree possible what kind of factors portend success or failure with this treatment platform, examine possible disparities in access to and quality of care, and address responsibilities for advocacy and ethics on both the micro and macro scale. training and credentialing of professionals who practice in a telehealth environment will take on greater significance, as will concerns centered on hipaa compliance and confidentiality. in the end, what the coronavirus pandemic has forced is a challenging re-examination of how behavioral health services are organized and delivered. this alone presents the possibility that one aspect of our social safety net may emerge from one of the most difficult periods in history, stronger. limitations the limitations of this work are clear. this is one exploratory study of the staff experiences at a large behavioral health care organization in the midwest. the degree that the response of the agency to the pandemic and the reaction of the practitioners to the changes that followed is representative of other similar organizations is difficult to state. the host also employs many professionals and it cannot be claimed that those who volunteered to participate are representative of the organization as a whole. conclusion the behavioral health organization has withstood the challenge of the pandemic and services, both in-person and virtually, continued to be offered. the concern that some clients did not fare well in this period, with some slipping through the cracks, is a significant worry. behavioral healthcare workers are first responders too, and the bottom sullivan et al./future of telehealth 235 line is that many people continued to receive services amid the pandemic. while it is the perception of some staff that the level and quality of care suffered at least initially, others perceived quite the opposite. additional data are needed to sort out all these questions. yet in the main, supervisors and staff who participated in this study were proud of their individual and collective efforts and of their ongoing commitment to those they served. what this crisis did provide was a chance to take the plunge in the world of telehealth quickly and broadly. it has forced a reexamination of all facets of the organization from clinical work to basic operations. while the coronavirus pandemic has now receded, the practice landscape will never be the same. our respondents underscored that many of the changes wrought by this threat appear to be quite beneficial. many professionals became versed in a new form of helping and many found it useful. of note was the ability to connect individuals to needed services quickly. no longer were clients only served by the nearest office, and thus at the mercy of available openings at that locale. significantly, as some professionals became more proficient with the technology, they experimented with breakout rooms and incorporated other helpful media into their virtual work. the possibilities these technological platforms offer remain largely untapped for many. that alone is exciting. it was also clear that staff could reduce unnecessary travel to see clients or to attend meetings. for clients, transportation was no longer a barrier, and the use of zoom or even a smart phone was particularly welcome for those meetings that constituted a mere check-in or to complete a less weighty clinical task. there were barriers that came with availability of needed technology and comfort with using it. the separation between home and work became blurred for professionals, and a similar boundary issue impacted some clients. in this new world, confidentiality can be difficult to ensure for clients and staff. as crockett and associates (2020) have detailed, as we move forward there is much work to be done in areas like privacy, consent, emergency procedures, credentialing, training, and access to care. in addition, as the responses of many practitioners indicate, the well-being of professionals also must be considered as improved access and increased demand could result in a burdensome workload. only with careful attention to the needs of clients, workers, and the agency can mental health care thrive and effectively meet the future demand for telehealth services. references american board of clinical social work. 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(2020). rapid conversion of an outpatient psychiatric clinic to a 100% virtual telepsychiatry clinic in response to covid-19. psychiatric services, 71(7), 749-752. https://doi.org/10.1176/appi.ps.202000230 author note: address correspondence to carol hostetter, indiana university school of social work, bloomington in. email: chostett@indiana.edu appendix 1. in general, how has the pandemic impacted your work? 2. how have current conditions impacted your ability to receive or provide supervision? • has the content of your supervision sessions changed? • are you doing supervision and/or therapy via electronic means? if so, what do you perceive as the pluses and minuses of this? 3. in general, what kind of economic impact has the pandemic had on the organization? • how has this impacted your work and supervision? 4. how have your current conditions impacted your sense of well-being? • how has that impacted your work? 5. how has the pandemic seemed to impact your staff and clients? 6. have any positives emerged from this crisis for you, your staff or clients? at the end of the interview, we will ask some general demographic information such as educational background, job title, and years of experience. https://doi.org/10.1093/sw/34.4.350 https://doi.org/10.1080/02615479.2020.1807926 https://doi.org/10.1176/appi.ps.202000230 microsoft word 13_nightingale_25211_it_probably_hurt_more __________ sarah nightingale, ph.d., assistant professor, department of sociology, anthropology, criminology, and social work, eastern connecticut state university, willimantic, ct. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1280-1299, doi: 10.18060/25211 this work is licensed under a creative commons attribution 4.0 international license. “it probably hurt more than it helped”: lgbtq survivors of sexual assault and their experience with the college title ix reporting process sarah nightingale abstract: sexual assault in the college context disproportionately impacts lesbian, gay, bisexual, transgender, and queer (lgbtq) students. title ix law requires that college campuses have a mechanism in place to respond to reports of sexual assault, and professional social workers are often embedded throughout this process as advocates oncampus and in the community. this study explores the experience and perceptions of lgbtq survivors with the title ix reporting process. a sample of 409 lgbtq survivors of college sexual assault were recruited via social media. results of bivariate analysis indicate that lgbtq survivors who reported had less trust in college officials and a more negative perception of the reporting climate than those who did not. further thematic analysis suggests that students who reported faced issues related to mandatory reporting policies and accountability in sanctioning. to improve the experience of survivors with reporting sexual assault to college officials, social workers can advocate for transparency at the institutional level and less stringent mandatory reporting policies. keywords: sexual assault, lgbtq college students, title ix, institutional betrayal, institutional courage sexual assault on college campuses is a persistent problem (cantor et al., 2020; fedina et al., 2018; krebs et al., 2016) that impacts the well-being (carey et al., 2018) and academic success (jordan et al., 2014) of students. while early research focused almost exclusively on the experience of college women without assessing for sexual orientation, more recent studies have found that lesbian, gay, bisexual, and queer/questioning (lgbq) students are between two (greathouse et al., 2018) and three times (coulter et al., 2017) as likely to experience sexual assault in college compared to heterosexual students. college students who identify as transgender are also significantly more likely to experience sexual assault than their cisgender peers (griner et al., 2017; krebs et al., 2016). lgbtq students who experience sexual assault in the college context are also more likely to experience negative mental health outcomes (graham et al., 2019) and negative academic outcomes after an assault than cisgender, heterosexual students (kammer-kerwick et al., 2019). title ix of the education amendment act of 1972 has been the primary policy tool used to address these educational inequities. despite changes in political party leadership, the united states department of education (us doe) has consistently communicated, through both title ix guidance and regulations, that sexual assault in college impedes students’ ability to access their education free of discrimination (us doe, 2020; us office of civil rights, 2011). the white house task force to protect students from sexual assault (2014) also reinforced that how colleges and universities respond to sexual assault is an important part of providing a safe learning environment for all students. for several decades higher education institutions have been required to have a procedure in place, separate from the criminal justice system, to respond to reports of sexual assault among advances in social work, fall 2021, 21(4) 1281 students (us doe, 1997). recent title ix regulations further specified required aspects of the college response including the provision of supportive measures for reporting parties, live adjudication hearings with optional cross-examination, and the ability to address some reports through informal measures (us doe, 2020). a variety of staff and administrators in higher education who work directly with the application of title ix. this includes investigators, title ix coordinators, student conduct officials, hearing advisors, and victim/survivor advocates. victim/survivor advocates assist student survivors through the navigation of reporting options and supportive services, and provide emotional support (association of title ix coordinators, 2015). professionals in this advocacy role are often trained social workers (brubaker, 2019) who may be embedded in the campus environment or contracted from a community agency. they are uniquely positioned to not only assist individuals who have experienced sexual assault, but also to advocate for policy change at the institutional level. while colleges are required to have these reporting mechanisms in place, few students actually use them. between 4% (fisher et al., 2003) and 12% (krebs et al., 2016) of students who experience sexual assault in college report the incident to a campus official. research has found little difference in the reporting rates between the lgbtq community and cisgender, heterosexual students (eisenberg et al., 2017; landgenderfer-magruder et al., 2016). however, there is some evidence that compared to heterosexual students, lgb students are more likely to perceive that their university responds poorly to incidents of sexual assault (smidt et al., 2019; smith et al., 2016). while there is emerging research on general student perceptions of university reporting systems, less is known regarding the experience of students who do report to campus officials. this study seeks to fill this gap through a focus on the following research questions: 1. is there a difference in perceptions of the sexual assault reporting climate between lgbtq survivors who make a formal report of sexual assault to college officials and those who do not? 2. is there a difference in perceptions of trust in campus support systems between lgbtq survivors who make a formal report of sexual assault to college officials and those who do not? 3. how do lgbtq college student survivors who do report the incident to college officials experience the title ix reporting process? and 4. how do lgbtq survivors of sexual assault in the college context believe the title ix reporting process can be improved? theoretical framework: institutional betrayal the concept of institutional betrayal provides a path to consider questions related to the relationship between individual survivors and institutions when sexual assault occurs. the phenomenon is understood to take place when an institution such as a school, the military, or a faith-based center “…deliberately or unknowingly causes harm to an individual who trusts or depends on that institution to keep them safe and treat them fairly…” (stader & williams-cunningham, 2017, p. 198). institutional betrayal has been primarily used to explain reactions to sexual assault victimization on college campuses. it is theorized that colleges can create a sense of betrayal through both overt actions such as punishing people who report sexual assault, or through perceived failures to act, such as not preventing sexual assault that occurs (smith & freyd, 2014). studies have found that nightingale/it probably hurt more 1282 survivors who experience a sense of institutional betrayal report significantly increased anxiety, dissociation, and trauma-specific sexual symptoms, compared to those who did not (smith & freyd, 2013). additionally, smidt and colleagues (2019) found that lgb college student survivors experience higher levels of institutional betrayal after a sexual assault compared to heterosexual students suggesting that sexual orientation plays a role in survivors’ relationship to and perception of their campus. the concept of institutional betrayal was used to develop the research questions for this study and as a guiding touchstone throughout the analysis. literature review reporting sexual assault in the aftermath of experiencing sexual assault, college student survivors have two primary reporting options: law enforcement and college title ix officials. emerging research has explored student awareness of college-based reporting options after an assault. in a small study of lgbq college students, schulze and perkins (2017) found that 62% of participants were aware of at least one on-campus service for survivors of sexual assault, but only 3.7% identified the title ix coordinator as a possible service. in a single qualitative study of sexual and gender-diverse college students, researchers found that students had limited knowledge of services available to survivors (hackman et al., 2020). however, in one of the largest data sets of campus-based sexual assault, cantor et al. (2020) identified an upward trend from 2015 to 2019 in student awareness of the on-campus reporting process and procedures. despite this increased awareness of reporting, actual reports of sexual assault remain low in the u.s. studies of college students have consistently found low rates of reporting sexual assault to police (krebs et al., 2007; sabina & ho, 2014). college survivors are slightly more likely to report sexual assault to campus officials than to police (fisher et al., 2003). in one study of sexual misconduct and campus climate, approximately 20% of survivors contacted campus officials about title ix violations in general (i.e., sexual harassment, intimate partner violence, stalking, and sexual assault; cantor et al., 2020). krebs et al. (2016) found that only 2.7% of students who experienced sexual battery and 7% of students who experienced rape reported the incident to a college official. studies have not found a significant difference in the rate of reporting sexual assault to campus authorities between heterosexual and lgbtq college students (eisenberg et al., 2017; richardson et al., 2015). perceptions of the reporting process perceptions of the reporting process may influence formal help-seeking intentions (mushonga et al., 2021). lgbtq adults in the u.s. express concerns about systemic discrimination and bias within reporting agencies (gentlewarrior & fountain, 2009), and fear of being “outed” by authorities, which could lead to negative implications in other aspects of their lives (cruz, 2003; mendez, 1996; merrill & wolfe, 2000). in communitybased studies of sexual and gender minority adults, participants perceived police officers advances in social work, fall 2021, 21(4) 1283 to have a lack of sensitivity, competence, and education in working with the lgbtq community (nadal et al., 2015; todahl et al., 2009). in the college context, lgbtq students are more likely to perceive that their college responds inadequately to reports of sexual assault than their cisgender, heterosexual peers (mennicke et al., 2019; seabrook et al., 2018; smith et al., 2016). lgbtq survivors of sexual assault are also more likely to perceive the response from their university as negative and harmful (mushonga et al., 2021; smidt et al., 2019). echoing the results of communitybased studies, sexual and gender minority students express a strong lack of confidence in college administrators’ ability to adequately respond to sexual assault in the lgbtq community (hackman et al, 2020; ollen et al., 2016). experience with the reporting process while there is a small but growing body of research focused on perceptions of reporting sexual assault to college officials, few studies explore the experience of individuals who have reported. it is possible that this gap in the research is due to the extremely low rate of reporting sexual assault to college officials. however, there is some evidence of reporting experiences from data presented in community-based studies. amongst lgbq adolescents who reported sexual assault to law enforcement, half of the survivors described the experience as blaming of the victim (koon-magnin & schulze, 2016). additionally, only half of bisexual and lesbian women who reported sexual assault to police found them to be helpful (long et al., 2007). in a qualitative study of transgender women, participants were discriminated against by law enforcement when reporting sexual violence (hereth, 2021). these studies suggest that some gender and sexual minority survivors of sexual assault have a negative experience reporting to law enforcement. more research is needed to understand the experience of reporting to both law enforcement and college officials. method sample and procedures lgbtq college students are an under-studied population in the college sexual assault literature and are considered hard-to-reach (ellard-gray et al., 2015). on-line surveys that utilize social media as a recruitment tool have successfully attained samples of lgbtq persons (edwards & sylaska, 2013; murchison et al., 2017; sterzing et al., 2018). for this study, an on-line, anonymous survey was administered through social media to collect data. after receiving approval by the university of connecticut institutional review board (protocol # x19-085), recruitment efforts were conducted. data were collected from july 2019 through mid-september 2019. participants were recruited through several means: sponsored social media posts, social media posts shared by relevant organizations to closed and/or open groups, and individual social media users sharing the recruitment information with their peers. ultimately, participants were recruited from the following social media platforms: facebook (55%, n = 213), instagram (22%, n = 87), reddit (20%, n = 78), and twitter (3%, n = 11). in order to deter participant misuse, no incentive was provided for participation. nightingale/it probably hurt more 1284 eligibility criteria for the study included the following: at least eighteen years of age, currently attending a four-year college or university located in the united states, a current undergraduate student, identify as a sexual minority, and experienced sexual assault while attending their current college. a total of 409 individuals ultimately qualified to participate in the study. the sample of participants who had experienced sexual assault attended colleges throughout the four major regions in the united states: northeast (21%, n = 87), midwest (26%, n = 107), south (25%, n = 101), and west (27%, n = 109). approximately half of participants attended a public institution (58%, n = 234) and the remaining attended a private school (42%, n = 167). slightly over half of participants lived on-campus (53%, n = 216) and just under half lived either at home or at an off-campus apartment or house (47%, n = 193). first-year college students were excluded from participation as recruitment was primarily conducted during the summer of 2019. students entering their fourth year (42%, n = 171) represented the largest academic class, followed by students entering their third year (32%, n = 130), second year (20%, n = 82), and fifth year (6%, n = 26) in college. see table 1 for further sample demographics. table 1. demographic characteristics (n = 409) characteristic n (%) gender identity (n = 407) female 210 (51.3%) male 72 (17.6%) transgender 30 (7.4%) genderqueer/gender non-conforming 35 (8.6%) non-binary 55 (13.4%) another 7 (1.7%) sexual orientation (n = 409) bisexual 183 (44.7%) gay 76 (18.6%) lesbian 69 (16.9%) questioning 13 (3.2%) another 9 (2.2%) asexual 14 (3.4%) queer 23 (5.6%) pansexual 21 (5.1%) race (n = 403) people of color 49 (12%) white 354 (86.6%) ethnicity (n = 403) hispanic 43 (10.5%) not hispanic 364 (89%) age (n = 409) 18 16 (3.9%) 19 79 (19.4%) 20 124 (30.4%) 21 118 (28.9%) 22+ 71 (17.4%) advances in social work, fall 2021, 21(4) 1285 measures the following measures were used in this study: formal report of sexual assault participants were asked several questions regarding reporting sexual assault. first, participants were asked if they “told anyone” about the assault, and could answer “yes”, “no”, or “prefer not to respond”. participants who answered “yes” were asked who they told about the incident and provided a series of responses that encompassed their personal and campus life. participants could mark multiple responses. respondents were then asked whether they made a formal report using campus procedures. participants had the options of, “yes”, “no” or “unsure”. participants who marked “yes” were considered to have made a report. participants who marked “unsure” were excluded from the study. participants who responded “yes” were then asked who they formally reported the incident to at their college. response options included, “title ix coordinator”, “student conduct official”, “police officer/safety officer”, “faculty member”, “other college administrator” and “other”. these questions were adapted from the university of new hampshire unwanted sexual experience survey (banyard et al., 2012). perpetrator affiliation participants were asked two questions regarding the perpetrator’s affiliation with their college. first, they were asked whether the person (or any of the people) was a student at their college. next, they were asked whether the person (or any of the people) was an employee, staff, or faculty member of their college. responses for both questions included “yes,” and “no” (banyard et al., 2012). trust in campus support systems (tcss) perceptions of participant trust in campus officials to manage a crisis and keep students safe was measured using the tcss scale (sulkowski, 2011). example items include “if a crisis happened on my campus, officials would handle it well” and “my campus does enough to protect the safety of students.” the six-item measure had responses ranging from “strongly disagree” to “strongly agree” on a five-point likert scale. in a pilot study with college students, the scale has been found to have strong validity (sulkowski, 2011). the cronbach’s alpha coefficient for this study was .79. sexual assault reporting climate (sarc) participant perceptions regarding the reporting process were measured through their score on a revised perceptions of leadership, policies and reporting scale (white house task force, 2014). twelve questions were asked regarding how likely it was that campus authorities, other students, and alleged perpetrators would respond in a fair and sensitive manner if someone were to report a sexual assault to a campus authority. example items include “campus officials would support the person making the report” and “campus nightingale/it probably hurt more 1286 officials would take corrective action against the offender.” response options for each statement ranged from “very likely” to “not at all likely” on a four-point likert scale. in the current study, the cronbach’s alpha coefficient was 0.87. gender identity and sexual orientation the participants were asked to identify their gender identity. responses included “female,” “male,” “transgender female,” “transgender male,” “genderqueer,” “gender nonconforming,” and “other (please specify).” as more than three people identified as nonbinary in the “other” category, this was added as an additional category. the participants were also asked about their sexual orientation. responses included “gay,” “lesbian,” “bisexual,” “questioning,” and “other (please specify).” answers in “other” were coded by the researcher and new categories were created when more than three participants identified the same category. the new categories were “asexual,” “queer,” and “pansexual.” race and ethnicity two questions were used to operationalize race and ethnicity. first, participants were asked what their race is (as they define it). responses included “american indian or alaskan native,” “asian,” “black or african american,” “native hawaiian or other pacific islander,” and “white.” participants were able to mark all categories that apply. second, participants were asked about their ethnicity. responses included “hispanic or latino,” and “not hispanic or latino.” student status and housing participants were also asked about demographics related to their student status. as recruitment for the study was conducted during the summer, questions were developed to best understand their relationship to their campus. first, students were asked about what best described their living situation during the past academic year. responses included “oncampus”, “off-campus (apartment, sorority/fraternity house),” and “off-campus (at home).” second, students were asked what their academic status would be in the forthcoming academic year. responses included “first year undergraduate student,” “second year undergraduate student,” “third year undergraduate student,” “fourth year undergraduate student,” and “other.” participants who selected “other” were able to write in answers which were primarily “fifth year undergraduate student” and coded in to a new category. perceptions of title ix reporting two open-ended questions addressing title ix reporting were included in this study. first, all participants were asked, “what recommendations do you have for college officials that might improve the reporting process for lgbtq survivors of sexual assault?” next, all participants who indicated that they reported a sexual assault to campus officials were asked, “what else would you like to share with us about your experience of reporting sexual assault to college officials?” participants could either skip open-ended questions or write an answer. advances in social work, fall 2021, 21(4) 1287 analysis plan first, categorical and continuous variables were assessed using descriptive statistics. next, bivariate analysis was conducted through independent sample t-tests to explore the relationship between independent variables (trust in campus support systems, sexual assault reporting climate) and the dependent variable (reporting to college officials). missing data were handled using pairwise deletion during all statistical analyses. all statistical analyses were conducted using spss 22. responses to open ended questions were reviewed by the researcher using an open-coding technique (saldaña, 2013) and then assessed for specific themes (padgett, 2016). results descriptive statistics an analysis of descriptive statistics was conducted. participants were asked questions about the status of the person who assaulted them. sixty-two percent (n = 243) said that the person who assaulted them was also a student at their college at the time of the assault, while 28%, (n = 113) said they were not. additionally, 10.5% of participants said that the person who assaulted them was affiliated with the college as an employee, staff, or faculty member at the time of the assault, while the majority of participants (79%, n = 322) indicated that they were not. approximately 36% (n = 145) of participants told no one, including family and friends, about the sexual assault, while 60% (n = 242) did disclose to at least one other person. amongst all student survivors, 10% (n = 41) formally reported the incident to their college. more than half of participants who made a formal report did so by communicating with the title ix coordinator at their college (56%, n = 22). this was followed by reporting to another college administrator (21%, n = 8), a faculty member (12.8%, n = 5), and a safety officer (10%, n = 4). initial analyses of continuous variables indicates that, amongst all student survivors, there was a moderate level of trust in campus support systems (m =13.1, sd = 4). also, on average participants reported a moderately strong perception that their campus would respond appropriately to reports of sexual assault by students (m = 30.5, sd = 7.14). bivariate analyses independent-sample t-tests were conducted to compare trust in campus support systems and perceptions of the sexual assault reporting climate for participants who made a formal report to campus officials and those who did not. there was a significant difference in the perceptions of the sexual assault reporting climate for participants who made a formal report (m = 27.4, sd = 7.78) and those who did not (m = 31.09, sd = 6.91; t (226) =2.99, p = .003, two-tailed). the magnitude of the difference in the means (mean difference = 3.69, 95% ci: 1.26 to 6.12) was moderate (cohen’s d = .5). there was also a significant difference in the trust in campus support systems scores for those who made a formal report (m = 11.63, sd = 3.78) and those who did not (m = 13.05, sd = 3.98; t (234) nightingale/it probably hurt more 1288 = 2.09, p = .037, two tailed). however, the magnitude of the difference in the means (mean difference = 1.42, 95% ci: .08 to 2.75) was between small and moderate (cohen’s d = .36). table 2. reporting to college officials by trust in college officials and sarc reported to college officials? m (sd) t(234) p cohen’s d reported did not report trust in college officials (n=230) 11.6 (3.78) 13.1 (3.98) 2.09 .037 .36 sexual assault response climate (sarc) (n=228) 27.4 (7.78) 31.1 (6.91) 2.99 .003 .50 open-ended results after completing descriptive and bi-variate analyses, two open-ended questions were explored to further understand the experience of reporting sexual assault to college officials for sexual minority survivors. first, all student survivors who reported sexual assault to campus officials (n = 41) were asked to respond to the question: “what else would you like to share with us about your experience reporting sexual assault to college officials?” more than half of these participants responded to the question (n = 26). overall, the open-ended written answers expressed a highly negative experience with the title ix reporting process. this is exemplified by one participant’s overall assessment of their experience, “it probably hurt more than it helped, as i reported it and received little to no help after. having them know but not do anything was hard. it made me doubt that i was even being taken seriously.” while participants who reported sexual assault to college officials indicated a negative experience, it was often noted that the negative experience was not with title ix officials but rather with student conduct and law enforcement officials. at many campuses in the u.s, student conduct campus officials will actually investigate and adjudicate sexual assault reports when a current student is accused of violating title ix policy, while title ix officials provide oversight for the process. several themes emerged from these participant experiences: heightened risk after reporting, limited communication from officials during the reporting process, and a lack of accountability for offenders of sexual assault on campus. participants wrote about feeling more unsafe after reporting to college officials. in every instance, this heightened risk was connected by the participants to being required to make a formal report due to mandatory reporting policies at their college. for example, one participant wrote, “[i was] forced to report, despite asking not to out of fear for my own safety. the situation got so severe after reporting that i wanted to transfer schools.” another participant explained further, “i did not have a choice to formally report as an ra found out, and it was the worst thing that had ever happened to me. going through the title ix process scarred me and they did absolutely nothing to help me.” multiple participants also provided detailed accounts of how limited communication during the title ix process, and the amount of time the process took, impacted them negatively. in the words of one participant: advances in social work, fall 2021, 21(4) 1289 my assault happened on the very last day of classes. because i first told a professor who i already had a super close relationship with… and trusted a lot. he helped me secure incompletes for my classes and made the formal report. title ix was very accommodating and kind. the college has not done anything since i left the campus three days after it happened. i have no idea what they’re doing internally and feel like i am being pushed into making a criminal investigation of it which i do not want to do. participants also discussed the amount of time the process took and how it negatively affected them. for example, “the title ix office was phenomenal. the conduct office was what made my life miserable. they prolonged the hearing for over 6 months all while i had to live with the person who assaulted me.” another participant expressed the following, “when i reported, i had to sit down with male police officers to describe every detail of my incident which was not very comfortable. i also had a month-long delay between reporting and my on-campus trial date, so i spent a month constantly looking over my shoulder and being afraid. it was my first semester on campus too.” notably, 14 participants wrote explicitly and at length about how their campus failed to hold their offender accountable, most often by finding the offender responsible for sexual assault but giving them an outcome perceived by participants as too lenient. one participant wrote, “the school found my assailant guilty of rape formally after an investigation but they did not punish him in any serious way. he had to go to therapy for the rest of the semester and that’s it.” another student, who attended a religious school with a very small program for their academic major wrote, “they did nothing to keep the person out of my classes even after i ‘won’ the case. they weren’t punished at all and were still in all my classes.” several participants discussed how they used the appeal process to push back on the sanctions that they perceived as lenient. even though there are immediate protective measures, the situation didn’t completely resolve until after i went forward with charges (via title ix officer) and appealed the original sanction for being too lenient. he was originally placed on probation, in addition to a no contact order and room change. he was banned from living on campus after i appealed it. the appeal process for these students helped them continue to pursue their education in a safe environment but also contributed to their feelings of blame and mistrust of college officials. there was no way to get around the fact that reporting forced me to face memories that i didn’t want to or couldn’t face/remember. that didn’t help but it wasn’t the school’s fault. however, the initial result was very invalidating. they gave my attacker a 5-page essay and academic probation as sanction for finding him guilty of raping me. i protested that and the sanctions were increased, but it was still invalidating that some people thought it wasn’t that bad. also, (again, not the school’s fault) nothing would feel like justice. no revenge or punishment would nightingale/it probably hurt more 1290 feel adequate or make me feel any better or fix the situation or undo what he had done. next, all student survivors in the sample (n = 409) were asked the following question: “what recommendations do you have for college officials that might improve the reporting process for lgbtq survivors of sexual assault?” approximately 50% of participants provided a written answer to this question (n = 206). a number of participants (n = 61) wrote explicitly about the need for their college or university to include the experience of sexual minority, as well as transgender and gender non-conforming college students with sexual assault in campus-wide trainings. these students indicated that sexual assault in the lgbtq community is not addressed by their college, creating an appearance that sexual assault only occurs between cisgender, heterosexual individuals. for example, one student wrote in response to this question regarding improving the reporting process, “stop ignoring us. at the beginning of college, they talk to us about consent. straight consent. we’re always left out.” other participants further recommend, “bring lgbtq people into the conversation so that we feel confident enough to report incidents of sexual assault without fear of discrimination.” another participant wrote, “i think most materials focus on women as the victims of sexual assault prevention. i think it's important that colleges include lgbtq people in their materials, and also emphasize that sexual assault does not determine someone's sexual orientation (e.g., if a man is assaulted by another man, that does not mean that he is gay or reflect on his orientation in any way).” second, students (n = 28) also identified that acknowledging that there are lgbtq students on campus, and providing support to these students, would improve the reporting process for survivors of sexual assault. a written answer that exemplifies these responses was, “create a culture where it is okay to be out in all ways.” another participant recommended that administrators should, “yell to the mountains that our experiences are valid and that we have a safe place to report. they’re scared of promoting that they have services specifically for lgbtq+ students because we are located in a conservative area. their reputation matters more than our safety.” underlying these responses is a perception that when lgbtq students are not welcomed on campus, and when their experience of sexual assault is not part of the narrative of sexual assault communicated by campus officials, reports of sexual assault are also unwelcome. many participants (n = 45) also suggested that to improve the reporting process for lgbtq survivors, colleges should provide resources for these students, in particular a mental health counselor who had experience with both trauma and the lgbtq community. as one participant explained, offer counseling and therapy for issues other than homesickness. at [my school] if you have a history of mental illness you're generally not considered fit for treatment thru the university. this is extra bad bc through the university is often the only way it would be affordable to the masses. another student eloquently wrote, “give us a place to turn to. the amount of times i was asked to be silent and had no one to talk to destroyed me. give us some support in the meantime while we wait. i don't think it's asking for much to want someone to be with you through the trauma of the reporting and investigation process.” participants also repeatedly advances in social work, fall 2021, 21(4) 1291 recommended hiring lgbtq staff in both counseling and title ix areas. for example, one student wrote, “have more lgbtq representing officials so that we feel more comfortable confiding and reporting. it’s a bit hard to say anything when a majority of college officials are cisgendered and straight/straight passing.” and finally, several students (n = 20) recommended that colleges provide additional training on how lgbtq identities intersect with gender and racial identities for staff who interface with the title ix process. one participant explained that this suggestion came out of barriers that they faced with the reporting process, “educate yourself on transgender people because lgbt doesn’t just stand for gay men. i was misgendered my entire interaction with reporting my rape and may have been more likely to file a formal report with the school if i had been shown more respect and consideration.” another student explained, “i recommend that college officials do their research on identities. no one wants to report to someone who does not understand intersectionality, especially as many who get assaulted are also minorities and people of color.” discussion findings from this study expand the college sexual assault knowledge base through a focus on the experience of lgbtq student survivors who have made a formal report of sexual assault to college officials. notably, only 10% (n = 41) of survivors in this sample made a formal report to their college, consistent with previous research regarding low rates of reporting (cantor et al., 2020; krebs et al., 2007). lgbtq survivors who had reported sexual assault to college officials had less trust in college officials and a less positive perception of the reporting climate than lgbtq survivors who had not reported. this suggests that the act of reporting to campus officials is associated with negative perceptions. open-ended responses from survivors who did and did not report provided a more nuanced understanding of the relationship between reporting experiences and perceptions. overall, lgbtq survivors who reported sexual assault to college officials indicated having a negative experience with the process. when survivors of sexual assault report the incident to their college and then receive a response that is not supportive of their well-being, survivors may experience institutional betrayal (smith & freyd, 2014). institutional betrayal has been found to exasperate posttraumatic stress symptoms experienced after an assault (smith & freyd, 2013). additionally, sexual minority identified college students may experience institutional betrayal at higher rates (smidt et al., 2019). freyd (2018) has conceptualized a path for college campuses to address sexual assault through institutional courage rather than institutional betrayal, which involves transparency, education for leadership, and sensitive responses to disclosures. the experiences highlighted by lgbtq survivors in this study inform the experience on the ground of students who proceed through the title ix process, and how policies and practices can be improved through institutional courage. lgbtq survivors in this study who had reported an incident of sexual assault to college officials expressed concerns about both being forced to report due to mandatory reporting policies and limited accountability for offenders. mandatory reporting has been an oft-discussed policy area in higher education for the last ten years. the now-rescinded nightingale/it probably hurt more 1292 dear colleague letter (office of civil rights, 2011) guided colleges to include a wide swath of faculty, staff, and student workers as “responsible employees” who must report any information regarding possible sexual violence to campus officials, who in turn must respond to the allegation. since then, a great majority of colleges and universities identified all employees, except for those with unique confidential roles such as campus clergy, medical professionals and counselors, as responsible employees (holland et al., 2018). mandatory reporting policies have proved controversial. faculty members who teach on college campuses have been outspoken critics (flaherty, 2015; moody-adams, 2015). a primary concern of this population is that mandatory reporting can change the relationship between faculty and students, limiting trust and openness, which could impact the learning experience (weiss & lasky, 2017). however, college students generally believe that such policies would increase their personal likelihood of reporting sexual assault and that they prevent colleges from covering up sexual assaults (mancini et al., 2016). the general public also tends to support mandatory reporting policies as a way to keep campuses transparent and safe (mancini et al., 2019). regardless of these perceptions, new title ix regulations do not prohibit campuses from including all employees as “responsible employees” but they do clarify that colleges are only officially “on-notice” regarding an allegation of sexual violence if the title ix coordinator or other such authority is notified (us doe, 2020). lgbtq survivors who were forced to report sexual assault due to mandatory reporting policies have indicated that this process often made them feel less safe than before reporting. students who were forced to report perceived the process as harmful to their well-being and their academics. the institutional response to these disclosures of sexual assault lacked sensitivity at the institutional level. in order to address sexual assault with institutional courage, campuses should allow student survivors to maintain control during the reporting process (freyd, 2018). while there is limited research exploring the experience of students who report sexual assault to college officials, it is possible that the experiences of the students in this study may also apply to students outside of the lgbtq community. social workers who are involved in the title ix process as advocates should consider how to balance ensuring that sexual assault is addressed in their community and supporting the reporting decisions and safety of survivors. to this end, social workers can advocate for policies which allow survivors to disclose to trusted faculty and staff on campus without being then forced to pursue a grievance process or criminal action. college officials should also consider providing well-trained, confidential resources for students who would like to access accommodations and/or support services without making a formal report. these confidential resources may provide survivors with further resources to support their safety and well-being. lgbtq survivors who reported sexual assault to college officials also indicated that a major issue they faced was the lack of accountability for the accused student, even when the university found them in violation of title ix policies. multiple survivors noted that it was only through further appeals via the title ix process that they were able to find the accountability that they thought justified. while the appeal process helped these survivors, it also created further steps in a cumbersome process. in using an institutional courage frame, colleges can address such issues through increased transparency (freyd, 2018). advances in social work, fall 2021, 21(4) 1293 social workers involved in title ix should encourage college officials to provide deidentified information about reports and sanctions, which can be shared in aggregate form with the public, so that campus faculty, staff, and students can provide feedback on the consistency and proportionality of sanctions. lgbtq students who experienced sexual assault in college and did not make a report to college officials also shared information about the reporting process. these students overwhelmingly identified that for campuses to improve the title ix reporting process, they needed to create campuses that are inclusive of lgbtq students. this feedback reinforces a long line of inquiry that has established the importance of inclusive campus climates on the well-being and academic success of lgbtq college students (rankin, 1998, 2003, 2005; rankin et al., 2010). in particular, survivors indicated that campuses should include more information about lgbtq student experiences in required title ix training, provide mental health support for lgbtq survivors, and provide more training for title ix officials on the experience of lgbtq college students. freyd and smidt (2019) delineate the difference between training on sexual assault and education on the matter. they assert that for institutional leadership to address sexual assault with institutional courage they should use research and on-going inquiry on sexual violence, rather than a brief annual training module. social workers who interface with the title ix process at any level should seek out education on the experience of lgbtq students, sexual assault in the lgbtq community, and the campus climate. institutions should also be thoughtful about hiring mental health counselors and title ix staff who have expertise in supporting lgbtq students who have experienced trauma, especially since the prevalence of sexual assault in the lgbtq community is disproportionately high on college campuses (cantor et al., 2020; krebs et al., 2016). as in all research, this study does have limitations. first, as participants were recruited via social media, it is not possible to identify a sampling frame. therefore, this research cannot be generalized to the wider population of lgbtq college students. second, the sample for this study lacks racial and ethnic diversity. future research should use sampling strategies that reach a more diverse population of lgbtq college students. and finally, this study used a cross-sectional research design that only recorded participants’ perceptions and experiences at one point in time. while associations between variables can be identified, causality cannot be determined. participants in this study shared information about their experiences with and perceptions of the sexual assault reporting process on college campuses. findings suggest that lgbtq survivors of sexual assault in the college context often have a negative experience with this process, which impacts their trust in college officials and perceptions of the reporting process. lgbtq survivors who did report indicate that they faced issues related to mandatory reporting policies and accountability in sanctions. lgbtq survivors also stated that the reporting process can be improved through more inclusivity for lgbtq students. institutional courage (freyd, 2018) shines a light on how social workers involved in the title ix process can work to establish reporting processes that are closer to the spirit of title ix law through transparency and education. nightingale/it probably hurt more 1294 references association of title ix coordinators [atixa]. 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(2014). climate surveys: useful tools to help colleges and universities in their efforts to reduce and prevent sexual assault. united states white house. https://www.justice.gov/ovw/page/file/910426/download author note: address correspondence to sarah nightingale, department of sociology, anthropology, criminology, and social work at eastern connecticut state university, willimantic, ct, 06226. e-mail: nightingales@easternct.edu _______ barbara l. jones, phd, msw, fnap, associate dean for health affairs and professor, steve hicks school of social work, university of texas at austin, austin, tx. jennifer currin-mcculloch, phd, lsw, assistant professor, colorado state university school of social work, colorado state university, fort collins, co. liana petruzzi, lcsw, doctoral student, ; farya phillips, phd, ccls, research assistant professor, steve hicks school of social work, university of texas at austin, austin, tx. shivani kaushik, mssw, rsw, graduate research assistant, school of social work, colorado state university, fort collins, co. blake a. smith, lmsw, development & communications specialist, family eldercare, austin, tx. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 424-439, doi: 10.18060/23658 this work is licensed under a creative commons attribution 4.0 international license. transformative teams in health care: enhancing social work student identity, voice, and leadership in a longitudinal interprofessional education (ipe) course barbara jones jen currin-mcculloch liana petruzzi farya phillips shivani kaushik blake smith abstract: this paper describes social work pedagogy and outcomes in a multi-year longitudinal interprofessional education (ipe) course incorporating b.s.w, and m.s.s.w. students. social work students participated in an irb-approved mixed-method study designed to evaluate individual growth and identity transformation throughout the twosemester course. students’ semi-structured reflection papers (n=113) were analyzed qualitatively to identify core themes. students voluntarily completed interprofessional assessment scale (ipas) surveys, a measure of core competencies in interprofessional care, before and after the class (n=48). social work students reported that they developed increased personal and interprofessional confidence, awareness of social work role in health care, increased social work skills and leadership to use their voice in interprofessional health care teams. all levels of social work students can and should be incorporated into ipe education. social work educators and practitioners should continue to take leadership in ipe education at all levels of curriculum design and implementation. keywords: interprofessional education; social work leadership; collaborative practice the national academies of sciences, education, and medicine (nasem) recently released a report stating that social care needs must be integrated into health care and that there is a need for more social workers in health care (2019). further, the report stated that interprofessional health care teams must include experts in social care and build an adequately trained interprofessional work force (nasem, 2019). similarly, the institute of medicine (iom, 2001, 2013) and the world health organization (who, 1998, 2010) have recommended interprofessional education to create “collaborative ready” graduates capable of joining and promoting team-based models of health care delivery. the iom’s (2013) report concluded that patient care was enhanced when health care teams communicated well and understood each other’s roles. there has recently been a tremendous amount of activity and enthusiasm for interprofessional education (ipe) and interprofessional collaborative practice (ipcp) in the changing health care environment (bridges et al., 2011; greiner, 2003; guraya & barr, 2018; iom, 2013; interprofessional https://creativecommons.org/licenses/by/4.0/ advances in social work, summer 2020, 20(2) 425 education collaborative expert panel, 2011, 2016; marcussen et al., 2019; riskiyana et al., 2018). the iom (2001, 2013) and who (1998, 2010), both highly endorse the concept of interprofessional education and practice. the 2003 iom report, health professions education: a bridge to quality, cited “working as part of interdisciplinary teams” as a core proficiency area for health professionals (p. 45). interprofessional education is a critical pedagogy for training professionals practicing in interdisciplinary and transdisciplinary health care settings. interprofessional education can occur at any level and involves intentionally engaging two or more health professions to learn with, from and about each other (who, 2010). interprofessional collaborative practice occurs when different disciplines are working collaboratively together to enhance patient and community outcomes (ipec, 2016). perceptions of the value of interprofessional practice are best shaped at a time in the educational process when students have developed a professional identity but have limited experience in clinical settings that may have already fixed their perceptions of health care delivery (ipec, 2011, 2016). the iom’s 2001 report concluded that when health care teams communicated well and understood each other’s roles, patient care was enhanced. interprofessionalism can improve teams, increase social capital and trust, and positively impact patient health outcomes (herbert, 2005; jadotte et al., 2019; who, 2010) the iom (2013), nasem (2019), and who (2010) all advocate for creating “collaborative ready” graduates capable of joining and promoting team-based models of health care delivery. systematic reviews conducted between 2007 and 2019 (guraya & barr, 2018; hammick, 2017; marcussen et al., 2019; reeves et al., 2016; reeves et al., 2013; riskiyana et al., 2018) found 97 studies evaluating the effectiveness of ipe on professional practice and health care outcomes. the summary of the data showed that all of these ipe interventions were feasible and positively received by students and professionals. the majority of ipe programs had positive outcomes in particular with regard to learners’ reaction to ipe and changes in students’ knowledge and skills. results suggest that most participants of ipe responded well to the curriculum and obtained the knowledge and skills needed for interprofessional practice. the interprofessional education collaborative expert panel (ipec 2011, 2016) outlined the core competencies necessary for collaborative practice: values/ethics for interprofessional practice, interprofessional communication, roles and responsibilities, and teams and teamwork. these competencies match well with the core values and code of ethics of the social work profession, the 2015 council on social work education (cswe educational policy and accreditation standards (epas, cswe, 2015), and the national association of social workers (nasw; 2016) standards of practice in health care settings, which all highlight the need for collaborative practice in social work. ipe is now mandated as part of the accreditation process for many health care professions including medicine, nursing, and pharmacy (accreditation council for pharmacy education, 2015; commission on collegiate nursing education [ccne], 2018; ipec, 2011, 2016; liaison committee on medical education, 2019). and the recent cswe epas states, “social workers value the importance of interprofessional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary interprofessional and inter-organizational collaboration” (cswe, 2015). jones et al./transformative teams 426 as a licensed health profession, social work’s education, values, and educational accreditation standards are consistent with the ipec core competencies, and academic programs must find ways to provide practice knowledge, skills, and learning experiences necessary to prepare the next generation of health care social workers. for social work, it is essential to secure our position as a core member of the interprofessional team by ensuring our students are actively involved in ipe. social work educators must be involved in creating and offering ipe opportunities for social work students which will serve as an important step in social workers successfully integrating into health care teams in practice. indeed, social work has a critical leadership role to play in ipe based upon our unique competencies and skills in collaboration, communication, and cultural humility (jones & phillips, 2016). therefore, it is important to train the next generation of social work educators in ipe pedagogy. while ipe is considered an essential element of training for health professional students, academic institutions are encountering obstacles to its development and implementation (reeves et al., 2016; rubin et al., 2018). some of these obstacles include different academic calendars, difficulty recruiting and rewarding faculty, and challenges to placement in overarching degree programs. this article aims to describe social work pedagogy and student outcomes in a fully integrated multi-year longitudinal interprofessional education course incorporating b.s.w., and m.s.s.w. social work students. the social work course described here, transformative teams in health care, is currently embedded in the larger interprofessional course, foundations for interprofessional collaborative practice, which is a two-semester, three-credit, in person, longitudinal, interprofessional flipped classroom design that teaches the core competencies of ipe and specific skills in ipcp as defined by the interprofessional education collaborative expert panel (timmerman et al., unpublished manuscript; ipec 2011, 2016). the foundations course evolved from a twelve person, one-semester course with only medical and social work students to a two-semester course with over 250 students and 45 faculty facilitators per year from four health professions (social work, nursing, pharmacy and medicine). the class is typically comprised of 40% pharmacy, 20% medicine, 25% nursing and 15% social work students. the course is organized in three cohorts of 36 teams of interprofessional students and facilitators. each cohort meets six times in the fall and six times in the spring to cover the class material. the course is led by four course directors from each of the representative schools who serve as the instructors of record for their students. faculty facilitators from the four health professions receive extensive training and ongoing just-in-time preparation and debriefing for each class. each interprofessional team of 10-12 students has 1-2 faculty facilitators who stay with them for the entire year. in addition to the ipec core competencies, students work together in tenperson interprofessional teams to learn specific skills in motivational interviewing, implicit bias reduction, conflict resolution, teamstepps™ communication, palliative care collaboration and error reduction. on average, there are 40-45 social work students per year. social work student interest in the foundations course grew exponentially from the first course design and expanded from 2nd year m.s.s.w students to include senior b.s.w. and ph.d. students. social work students receive a specific, tailored orientation to the advances in social work, summer 2020, 20(2) 427 course and check in at the beginning of each semester. this is offered by the social work course director and co-course director, the social work faculty facilitators, and phd students. this course not only offered unrivaled learning opportunities for b.s.w. and m.s.s.w. students; it also enabled doctoral students to participate through a specially designed independent study to serve as teaching assistants and learn first-hand the pedagogy of interprofessional education. six ph.d. students participated in the course over the same three-year period. they worked alongside course directors to develop and participate in every aspect of the course, including as teaching assistants. they were engaged in leadership roles in the development of course modules in areas such as communication, culturally inclusive practice, and palliative care. doctoral students also served integral roles in the administration and facilitation of the course through evaluating student team’s community health proposal projects; coordinating student peer reviews; cofacilitating student teams; and managing classroom logistics. methods social work students (n=113) participated in a two-semester course entitled, foundations for interprofessional collaborative practice (ficp), at the university of texas at austin. the majority of social work students participated in the course during their master’s program (n=91, 81%). social work students took the course alongside first year pharmd and medicine students, and final year nursing students. participation in the ficp course was voluntary for social work students but mandatory for all other disciplines. the one exception was for social work students that were completing the healthcare certificate program, as they were required to enroll in this course. all disciplines enrolled in the class for two semesters, except the nursing students who only completed one semester of the course. this study utilized a mixed methods approach. quantitative data for this study includes scores of the interprofessional attitudes scale (ipas, norris et al., 2015) taken preand post-completion of the ficp course. qualitative data included student’s responses to a semi-structured reflection essay. prior to initiating the study, the research team received approval from the university of texas at austin’s institutional review board (irb) to analyze and report findings from the student ipas surveys and reflections. while the reflection essay was a required component of the class, the quantitative survey was voluntary; therefore, there are different sample sizes for each component of the study. in total, 113 students completed the qualitative reflections, 85 students completed at least one quantitative survey and 48 students completed both the pre and post quantitative surveys. quantitative the ipas is a self-assessment measure of interprofessional skills as they relate to the four core competencies of interprofessional practice: collaboration, communication, values/ethics, and teamwork (ipec, 2011). it includes 27, likert-scale questions with rating responses from 1 (strongly disagree) to 7 (strongly agree). sample survey questions include: “learning with other students will help me become a more effective member of a jones et al./transformative teams 428 health care team.” and “it is not necessary for health sciences students to learn together.” in addition to a total score, there are five subscale scores based on 1) teamwork, roles and responsibilities (trr); patient centeredness; interprofessional biases; diversity and ethics; and community centeredness. social work students (n=85) accessed and completed the survey online through a confidential link. data were collected over two academic years between the fall of 2017 and the spring of 2019. data were collected at two time points, before the semester began and at the end of the semester to conduct pre and post comparisons. however, since survey completion was optional, only 42% of the sample (n=48) completed both pre and post assessments. a paired sample t-test was conducted for the 48 students that completed an assessment at both time points. finally, the research team tested the internal consistency of the scale with cronbach’s alpha with the full sample of data (n=85) since this is a relatively new scale and this the first study to use it with social work students to our knowledge. qualitative social work students from the 2017, 2018, and 2019 cohorts submitted end-of-course reflections after completion of the course. the reflections (n=113) explored social work students’ personal and professional development in the context of the interprofessional educational arena. the written assignment invited students to reflect on how and why their perspectives (or viewpoints) on the following three areas have evolved as a result of course participation: interprofessional practice, your own professional role, and the roles of the other three professions. the grading rubric for the reflection instructed students to (a) describe an event (or series of events) that impacted you or spurred your learning and development; (b) reflect on what you learned; and (c) discuss how you believe this will be relevant to your ongoing studies and/or future practice? students had 500-1000 words to craft their responses. analysis of the reflection data incorporated template analysis methodology, a form of thematic analysis. this type of analysis employs a constructivist framework that enables multiple interpretations of data based on researchers’ expertise and the social context of the research (brooks & king, 2014). as researchers analyze data, themes begin to resonate between participants’ responses and answer particular aspects of the research questions. within template analysis, themes may center on a set of a priori themes that the research team brings into the study, whether to answer specific research questions or through the design of the data collection (brooks & king, 2014). for example, this study incorporated a priori themes as prescribed in the grading rubric for their reflection assignment. template analysis enables flexibility in evolution of themes as compelling data emerges. through data analysis, themes begin to cluster, and pervasive themes emerge as integrative themes (brooks et al., 2015) and serve as the thematic backbones of the coding template. the analysis of data for this study follows template analysis guidelines as proposed by brooks and king (2014). two social work researchers with extensive histories in interprofessional health practice performed the qualitative analysis of students’ reflections. one coder initially read through ten student reflections to discern emerging themes within the reflections. based on a priori themes derived from the reflection assignment, the same advances in social work, summer 2020, 20(2) 429 person coded the first ten reflections into thematic clusters utilizing maxqda (verbi, 2018) to assist with management of data analysis. these thematic clusters served as the initial coding template. additional modifications to the template were made to reflect nuances in students’ experiences. code saturation occurred at reflection number 15 when no new integrative themes emerged (hennick et al., 2017). at this time, the main structure for the coding template solidified. variances in students’ experiences within each integrative theme occurred until reflection number 32, meaning saturation occurred (hennick et al., 2017). the second researcher assessed the accuracy of the codebook in capturing relevant codes within the same set of initial reflections. both researchers then met to compare coding strategies. through the assistance of maxqda software (verbi, 2018), the team performed inter-rater coding reliability and determined that they had 82.7% agreement in code occurrence within a sample of 36 coded student reflections. then, both researchers completed coding all 113 reflections utilizing the revised coding template. results quantitative findings eighty-five social work students submitted at least one ipas assessment (single submission), and 48 students submitted both pre and post ipas assessments. additional demographic data were not collected from students who completed the quantitative survey. a paired-sample t-test was completed with the sample of matched data (n=48) and there was no significant difference in ipas subscale or total scores before and after the class (table 1). in terms of internal consistency, cronbach’s alpha scores ranged from .412 to .808 for each subscale score and the total score (table 2). the number of questions per subscale and the highest subscale and total scores are also listed in table 2. the full sample of quantitative data (n=85) was only used for the cronbach’s alpha assessment. table 1. social work scores before and after ipe class (n=48) ipas subscale m (sd) diff. t p pre-test post test teamwork, roles, & responsibilities 58.8 (3.6) 59.2 (4.5) 0.4 -0.511 0.612 patient centeredness 34.2 (1.2) 34.3 (1.3) 0.1 -0.164 0.871 interprofessional biases 12.9 (3.1) 12.2 (2.2) -0.7 1.41 0.165 diversity and ethics 27.4 (1.3) 27.5 (0.9) 0.1 -0.73 0.469 community centeredness 39.7 (2.3) 40.2 (2.2) 0.5 -1.141 0.260 ipas total 172.9 (8.2) 173.3 (7.4) 0.4 -0.251 0.803 jones et al./transformative teams 430 table 2. internal consistency of ipas (n=85) ipas subscale cronbach’s alpha # of items highest score teamwork, roles, & responsibilities 0.794 9 63 patient centeredness 0.646 5 35 interprofessional biases 0.412 3 21 diversity and ethics 0.426 4 28 community centeredness 0.790 6 42 ipas total 0.808 27 189 qualitative findings student reflections of the 113 students that completed reflection essays, 22 students were b.s.w. students and 91 students were m.s.s.w. students. social work students embedded within the interprofessional collaborative course unanimously gained insight into the value of collaborative practice and their role as social workers and of collaborative practice. the main themes that emerged were: the whole is greater than the sum of its parts; taking leadership; finding their voice, and future practice. the whole is greater than the sum of its parts. social work students entered the course with mixed feelings. they shared excitement about their desire to gather collaborative practice skills for their future, and also some trepidation about the role within the team. a few students had personal experience working on interprofessional teams in their internships or volunteer work. understanding of interprofessional teams in medical settings was limited to their personal experiences receiving care or visiting family in hospitals. thus, students commonly expressed hesitation in joining teams and fears of looking naïve, uninformed, or ill-prepared. one student reflected: i was a little fearful going into this course because i was not sure how the other teams viewed my profession and what biases already existed directed at me, however, my goal going into this course was not only to learn more about interprofessional collaboration, but as well to teach the others on my personal team about social work and all it entails. (p98, the letter “p” and numbers in parenthesis following students’ quotes refer to their deidentified participant number) for many social work students, the course offered the first time for them to explore their own roles on teams and talk with others across campus. social workers shared that their limited health literacy entering the course created some trepidation; however, through support from the other health professions, their health literacy and confidence improved. they displayed a steep learning curve in attaining health care literacy and were grateful for opportunities to learn from their team. by the end of the second semester, social work students became more confident in their role on the team and within a health care setting. advances in social work, summer 2020, 20(2) 431 they also gained increased awareness of other’s roles and admitted some biases they carried about other professions. previous experiences provided familiarity with the roles of nurses and physicians; yet, the activities in the course enabled social work students to acquire new knowledge of how they can partner with mds and rns to enhance their role and improve patient care. many students shared the following sentiment, with this insight, i have a different understanding of the other three professions i worked with. rather than further differentiating the nuances of each discipline, i learned the commonality between us all—the goals we share. (p07) social workers described how nurses provide a greater extent of psychosocial care than they previously assumed and how nurses hold a vital role in promoting safety. social workers expressed greater appreciation for the medical students and honored the weight they carry in managing patients’ outcomes and the care provided by the entire team. echoing throughout social worker’s narratives was empathy for pharmd students as they also struggled to find their voice on the team. they also reflected greater understanding of the vital role pharmacists play in counseling the physician, the team, patient and family. lastly, social workers also conveyed assumptions they carried about the role of social work in health settings and how they learned social workers’ roles extend far beyond discharge planning and transportation resources. the year-long course and interactive activities enabled students to see the person behind the role and the internal motivations that drive individuals to choose their profession. taking leadership. several pivotal events throughout the course empowered social work students to embrace their role as a leader. they described the simulations as the most powerful moments during the course as these opportunities tested their comfort; forced them to speak up; and gave them pseudo real world experiences dealing with challenging situations. students reflected the simulations provided a safe setting to experience professionally overwhelming moments. case scenarios presented by actors and faculty challenged students to think on their feet and participate in activities at the edge of their comfort level. students described simulations as, …by far the most powerful in terms of personal reflection and learning what areas we need more professional practice/awareness. (p18) most of their coursework solely engaged social work students; thus, interprofessional teams tested their ability to explain their roles and skill sets. building rapport within a team of varied professionals appeared challenging and exceptionally fulfilling to the students. social workers commonly acknowledged that team cohesion displays competence to patients and thereby eases stress and builds trust between patients and their providers. (p23) this trust also nurtured social workers’ confidence in taking leadership and mentoring roles within the team. among the events students found most rewarding were the role plays where the team collaboratively practiced teamstepps™, error disclosure, palliative care simulations, and motivational interviewing. students’ mentioned the palliative care simulation most jones et al./transformative teams 432 frequently and cherished the space to embody the role of leader and model communication techniques while comforting an actor coping with intense emotions surrounding a lifelimiting illness. error recovery role plays enabled social workers to insert themselves into medical dialogues and step up when other professions became frozen. team strategies and tools to enhance performance and patient safety (teamstepps™), an evidence-based interprofessional training program created by the department of defense and the agency for healthcare research and quality (king et al., 2008), focuses on improving patient safety within a team using four core facets: leadership, situational monitoring, mutual support, and communication. while teamstepps™ activities empowered social work students by providing concrete language and team planning activities to address safety concerns, despite power differentials. lastly, the motivational interviewing exercises in the addictions care module permitted social workers to shine by demonstrating the skills they had gathered in social work motivational interviewing coursework. social work students enjoyed teaching their peers communication skills and often commented on how being a mentor on their team fostered their confidence and earned their team’s trust. one student reflected, in those experiences i was able to teach my teammates practical tools to talk to families and patients and in those moments my value was solidified. (p35) lastly, simulated scenarios, such as role plays within their interprofessional team and with community actors, offered students a feedback loop in which to affirm their professional competence and ability to carry out their role upon graduation. finding their voice. the student narratives highlighted the strengths of the course in acknowledging the value of their own social work skills and the role of social work within health care settings and teams. flowing throughout students’ stories were expressions of expanded confidence, pride, professional growth, and compassion for other team members. each described increased comfort in explaining their role to patients and families and other health professionals. they acknowledged confidence in leading teams; addressing challenging situations and dialogues; and advocating for their patients’ needs and safety. social workers conveyed excitement that collaborative practice would enable them to highlight the techniques they have gathered throughout their education such as communication skills, therapeutic interventions, and group leadership techniques. one student explained, by helping other roles improve their relationship with patients, a social worker can help the team be more effective in providing care and empathy. (p44) students better conceptualized others’ roles and frequently recognized unique strengths that each individual and profession brought to their team. stories of interprofessional encounters during their internships solidified social workers’ knowledge and value of collaborative practice. students portrayed examples of challenging moments within their team interactions at their internship in which they felt limited respect personally and professionally. they identified ways in which their knowledge from the course could help them improve the team dynamics and times where they ventured to assert themselves using skills practiced in class. some students revealed advances in social work, summer 2020, 20(2) 433 internship environments that exemplified excellence in collaborative practice and described excelling in carrying their skills garnered in class into their internship teams. as explained by an m.s.s.w. student: i found myself surprised when i realized how much i have come to learn and appreciate the roles and skill sets of the other members of my team. it came together when i implemented my knowledge in my field placement. i felt more comfortable in my role within the interdisciplinary teams, and i navigated my way by using the tools i learned in class. (p26) those not working in health care internships also reaped benefits from the course in navigating difficult team relationships in their practicums. b.s.w. students not in practicums shared examples of how they applied leadership skills acquired from this course into social work classroom settings or expressed enthusiasm about trying their new interprofessional skills in their upcoming practicums. future practice participation on their interprofessional teams influenced social work students’ visions for future practice. the majority of students became fueled by their collaborative practice experiences and expressed strong desire to continue team-based practice, whether in medical or other fields. a few social workers acknowledged the opportunities garnered through their participation in this course solidified their desires not to work in medical settings due to the associated grief, which extended beyond their professional/personal comfort. regardless of desired practice setting, students conveyed confidence in their skills and an eagerness to feature their new collaborative competencies. one graduating student proclaimed: this course has planted an excitement to continue to grow working with other professions and learn with and from them. i look forward to utilizing these skills and growth on teams in health care and in schools. the learning from this course is universal and transferable to any inter-professional setting or work on a team. (p73) reflections focused on the ways in which interprofessional practice offers unparalleled opportunities to share their expertise, learn from other professions, and mentor others. overwhelmingly, social workers recognized their professional expertise and the added value they can bring to interprofessional teams. discussion this study was a mixed-method evaluation of social work students’ individual growth and identity transformation throughout a two-semester in-person interprofessional education course. quantitative surveys were completed before and after the course, while qualitative essays were submitted after the first and second semesters. quantitative results were inconclusive in their ability to demonstrate change while qualitative findings showed increased awareness of interprofessional roles, discipline-specific strengths, and improvement in leadership and confidence in finding their social work voice in a health jones et al./transformative teams 434 care team. we will discuss the results and their implications for practice, education, and research. while the quantitative scores did not show improvement, there are a few reasons that might explain this result. first, other colleagues who have used the ipas have found similar results. specifically, marshall et al. (2019) assessed a one -day, interprofessional simulation with medical, pharmacy, nursing and physician assistant students and had mixed quantitative results in terms of ipas score improvements with positive qualitative results from focus groups. this closely mirrored our own study’s findings. second, even though the ipas scale has good internal consistency overall, we were not able to replicate norris et al.’s (2015) findings and only 3 of the 5 subscales had acceptable or good consistency (nunnally & bernstein, 1994). further, the ipas does not seem to be sensitive to showing growth or improvement over time as other studies have also found that students score on the high end of the scale (norris et al., 2015). it is likely that the social work students entered the course with high levels of interprofessional collaborative skills gained from their social work education as the pretest scores among sw students were quite high (173 out of 189 for the total score). therefore, this did not leave much room for students to improve over time. this would be consistent with the preparatory social work curriculum approved by the most recent cswe (2015) epas which includes competencies on interprofessional practice and interdisciplinary communication. this would also be consistent with the qualitative results of the social work students who consistently indicated that they felt better prepared for interprofessional practice than their medicine, nursing and pharmacy colleagues but lacked the health care specific knowledge prior to the class. this is the first study to use the ipas with social work students to assess growth in interprofessional core competencies and it will require further study to know if this measure is sensitive to these students. the qualitative data suggests that social work students did find the class to be helpful in improving their core competencies, such as improving their understanding of other health care roles and interprofessional communication. social work students resoundingly walked away from their collaborative practice course with a greater appreciation for their own expertise and the role of interprofessional teams in promoting patient-centered care. simulated learning activities offered social workers real-world challenges they missed in other social work courses and nurtured their confidence to engage complex client and interprofessional dynamics. course reflections provided a glimpse into student’s identity development and concrete ways in which simulated interprofessional team activities offer students unparalleled opportunities to test and enhance their social work skills. social workers reflected on the parallel process of finding their own voice while also learning to advocate for their patients. taking initiative and leadership roles came more easily for students as they explored ways to nurture team cohesion and productivity. lastly, social work students valued the growth of their interprofessional team identity. they acknowledged the strength of each member of the team and the increased power of their reach when they worked together. while the ph.d. students participating in the course were not formally evaluated, there are outcomes of their success that should be mentioned. during the time period studied, six advances in social work, summer 2020, 20(2) 435 ph.d. students participated in the class either as formal teaching assistants or by enrolling in a specially created independent study on ipe pedagogy which was supervised by the lead author of this paper. all six students were required to participate in the class as team facilitators and to complete a manuscript or independent project on interprofessional collaborative practice. most of the students went well beyond the minimum requirements of the independent study and participated in course development and leadership as their skills and confidence grew. each student who participated is continuing to be involved in publications and presentations on ipe pedagogy. another outcome of their participation is the interprofessional respect that they gained from the course directors from the other health profession schools (nursing, pharmacy and medicine). three of the six students who participated have since graduated and obtained assistant professor positions in prestigious social work schools where they are currently engaged in ipe activities. all of them indicated that the ipe training helped them in their job search and in their current faculty positions. limitations quantitative findings in this study are limited due to small sample size. since the survey was voluntary, only 48 of 85 social work students completed both the pre and post course surveys. there was also limited demographic data collected, so other comparisons could not be conducted. additionally, even though the ipas scale has acceptable internal consistency overall with five factors that ranged between .62 and .92 in the original validation study, our analysis subscale 3 (.412) and subscale 4 (.426) had poor internal consistency (nunally & bernstein, 1994; norris et al., 2015). qualitative findings from this study highlight the significance of collaborative practice in fostering social work students’ professional and interprofessional development. these students’ levels of confidence and competence in collaborative practice may be influenced by the amount of opportunities available for them to interact with other professions over the course of a two-semester course. the qualitative data being drawn from the class assignment could have produced some response bias as students were graded in the class, although all received a pass/fail for turning in the assignment. other interprofessional education courses may not have resources to offer a longitudinal learning experience or faculty and the number of students to support as extensive a learning endeavor. the majority of students in the course were in their masters’ program and may represent experiences of students further embedded within their coursework and practicum. conclusion there is a growing awareness of the importance on interprofessional collaborative practice to address the quadruple aim of improving care, costs, population health and provider wellbeing (bodenheimer & sinsky, 2014). given the recent focus on integrating social care into health care, the need to include social work students in interprofessional education is paramount. however, there are few models of integrated, in-person, longitudinal, interprofessional education that include social work students and faculty. this paper describes the impact of a two-semester interprofessional education course on social work students’ professional identity and confidence. it also describes outcomes of jones et al./transformative teams 436 engaging social work doctoral students in ipe pedagogy. results showed that social work students learned about the role of other professions in health care but perhaps more importantly, they found their voices as valuable members of the interprofessional team. ph.d. students gained confidence and skills as educators. this type of interprofessional pedagogical approach can and should be replicated in social work education. this has the potential to address the workforce shortage of social workers in health care and improve outcomes for patients, families, and teams. references accreditation council for pharmacy education [acpe]. 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(2010). a framework for action on interprofessional education and collaborative practice. https://www.who.int/hrh/resources/framework_action/en/ author note: address correspondence to barbara jones, steve hicks school of social work, university of texas at austin, 1925 san jacinto rd., d3500, austin, tx 78712. email: barbarajones@mail.utexas.edu https://www.who.int/hrh/resources/framework_action/en/ mailto:barbarajones@mail.utexas.edu _________ jessica aldrich strassman, msw, lcsw, dsw student, university of pennsylvania, school of social policy & practice, philadelphia, pa. sara l. schwartz, phd, msw, clinical associate professor, university of southern california suzanne dworak-peck school of social work, los angeles, ca. eugenia l. weiss, phd, associate professor, university of nevada, reno school of social work, reno, nv. ann petrila, msw, mpa, professor of practice, university of denver graduate school of social work, denver, co. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), v-x, doi: 10.18060/26263 this work is licensed under a creative commons attribution 4.0 international license. everyone’s war becomes my war: the far-reaching impact of the invasion of ukraine jessica aldrich strassman sara l. schwartz eugenia l. weiss ann petrila the invasion of ukraine has been difficult to watch for individuals around the world. feelings of disbelief and helplessness arise as violent images of murdered children, bombed apartment buildings and shelters, and fleeing families waiting in freezing temperatures at border crossings flash across our screens. this is especially challenging for survivors of world war ii (wwii) and their descendants, particularly holocaust survivors of eastern european and ukrainian descent. the impact, however, is not limited to this population and has been felt by survivors of war crimes committed in bosnia, syria, and elsewhere. world war ii re-traumatization for wwii survivors and their families, the constant barrage of media about the attack on ukraine has been excruciating, particularly for ukrainian holocaust survivors. at the start of wwii, ukraine housed the largest jewish population in europe but 1.5 million were killed during the war (united states holocaust memorial museum [ushmm], 2021). twenty percent of the population resided in kyiv at the time of the war where over 33,000 jews were murdered over two-days at babyn yar, a ravine located outside the city (ushmm, 2021). the memorial for these ukrainians was recently damaged by a russian missile (bloomfield, 2022). watching the war rage in the ukraine brings up painful memories for survivors and reminds them of their own trauma, with some speaking about their experiences for the first time (cohen, 2022). kira brodskaya, 90-year-old queens, new york resident and ukrainian holocaust survivor, cries every day as she watches the news unfold remembering when hitler bombed her neighborhood in kharkiv when she was nine (cohen, 2022). gdalina novitsky, age three and living in kyiv when the nazis invaded, was forced to flee with her mother and leave behind her disabled grandmother who was murdered, along with her great grandparents, at babyn yar (bahrampour, 2022). erica b., founder of the american kriegsenkel website, whose father was forced to flee wwii poland at age 13 shares: what i am watching, and reading is literally my family story, repeated and played out again some 80 years later. the split-second decisions whether to flee or to stay. the looks of the traumatized women and children as they go into the unknown….that sound (the air raid siren she heard in a news report)...that about:blank advances in social work, spring 2022, 22(1) vi sound…that gets at something deep in me. (personal communication with erica b, april 11, 2022) bosnian re-traumatization the primary narrative of the media covering the war in ukraine is that nothing like this has happened in europe since wwii. bosnians watching this reporting are painfully aware that this is not accurate as they view scenes that are regrettably familiar to them, especially those who lived through the war that began in 1992. bosnia was also a sovereign european nation attacked by a neighboring country, in this case by serbian forces and the bosnianserb army. the intention was to “ethnically cleanse” the country of non-serbs with the primary target being the bosnian muslims. by the end of the war 100,000 people had been killed and tens of thousands had become refugees (international committee of the red cross [icrc], 2015). the capital city of sarajevo was under siege for 1,425 days with constant shelling and no food, water, or electricity. ultimately more than 11,000 civilians (morrison, 2021), including 6,000 children (sabic, 2020) were killed in the city. in the town of srebrenica in eastern bosnia, more than 8,000 muslim men and boys were massacred over a period of 6 days in july 1995, a slaughter that was later ruled a genocide (icrc, 2015). mass graves were found throughout bosnia. systematic rape and sexual violence were used as weapons of war (bassiouni & mccormick, 1996), and the same atrocities are now being uncovered in ukraine. images and stories from the cities and villages of ukraine have retraumatized bosnians of all ages. as shared by a bosnian woman on social media, “every time a war starts, near or far, the trauma returns. back to square one. everyone’s war becomes my war…” (buturovic, 2022). far reaching and long-lasting effects of war related trauma the long-lasting mental health impact on war survivors is well-documented. of particular concern today is that mental health symptoms can resurface or intensify when new stressors arise (comtesse et al., 2019; frounfelker et al., 2017; schock et al., 2016). refugees are at risk of long-lasting mental health symptoms and higher rates of anxiety, depression, and ptsd than non-refugee populations with symptoms that can remain elevated years after displacement (bogic et al., 2015). as of mid-2021, the united nations refugee agency (unhcr) reports 82.4 million people have been forced to flee their homes, and a staggering 26.4 million are refugees (unhcr, 2021) who have been forcibly displaced worldwide because of persecution, violence, and human rights violations. this alarming rate does not include the residents of ukraine forced to flee their homes, currently estimated to number over 10 million (bbc news, 2022). world war ii and bosnian survivors research focused on wwii survivors of holocaust, forced migration, and the civilian population, have demonstrated adverse mental health outcomes. frounfelker et al. (2017) surveyed 3,370 wwii civilian survivors in europe and japan and found respondents who had been in a war zone had higher lifetime risk of major depressive disorder (mdd) and strassman et al./everyone’s war vii anxiety disorder than other respondents. mdd was more elevated in the early years after the war while anxiety increased over time (frounfelker et al., 2017). survivors of world war ii’s forcibly displaced population (“expellees”) now living in germany were surveyed and, sixty years later, demonstrated significantly more anxiety symptoms and less resilience than non-displaced participants (kuwert et al., 2009). the long-term psychological distress of 299 adult male bosnian war survivors were measured over an eleven-year period and adverse mental health consequences were found to last as long as fourteen years, especially when paired with current stressors (comtesse et al., 2019). schock et al. (2016) echoed these findings when they conducted a longitudinal study assessing the impact of new traumatic or stressful life events on pre-existing post-traumatic stress disorder (ptsd) in refugees seeking asylum in germany from 2009-2011. the study determined that stressful life events may lead to an increase in existing ptsd symptoms as well as significant increases in ptsd avoidance (schock et al., 2016). descendants of war survivors: intergenerational trauma and mental health impact the children and grandchildren of war survivors are shown to exhibit adverse psychological outcomes in comparison to a non-traumatized population. this intergenerational trauma was first documented in 1966 when higher rates of psychological distress were found among some children of holocaust survivors (danieli et al., 2015). more recently, sangalang and vang’s (2016) systematic review addressing intergenerational trauma in refugee families found increased risk of ptsd, mood, and anxiety disorder symptoms in more than half of the studies examined. bezo and maggi (2015) conducted a three-generation study of the holodomor (“murder by hunger”) genocide against the ukrainians by the russians from 1932-1933 (p. 88). they found that the trauma still exerts an emotional and behavioral influence on survivors, their children, and grandchildren decades later (bezo & maggi, 2015). in the last months, many descendants of war trauma survivors have begun to share their stories of how they were impacted by the attack on ukraine. stories they were told by their grandparents are now playing out in real time, sometimes in the same geographic areas of their ancestors. “it’s as though i’m reliving the trauma of my ancestors while simultaneously experiencing the trauma that is unfolding actively….the persecution and sense of fear that was and is being felt is very much living within me” (sudakov, 2022). additional stressors to be considered while the outpouring of refugee support has heartened many, it can rankle other refugee communities who have not been as warmly welcomed into europe or into the united states. ten european union member countries have built over 1,000 miles of walls to keep out refugees from africa and the middle east (sajjad, 2022). families who settled long ago may also experience stress as they watch how putin has so rapidly changed the narrative about ukraine citizens. in 2016, abrupt changes in the united states political advances in social work, spring 2022, 22(1) viii climate, immigration policy, and media rhetoric on refugees led to fear, anxiety and feeling “othered” by individuals who migrated to the united states (funk & shaw, 2021). re-traumatization of symptoms can be exacerbated by the continual play of tragic images on screens. these are often unfiltered and originate from eye-witness experiences that can result in frightening images (spangenberg, 2022). viewing this content can cause re-traumatization for anyone already working to manage symptoms of ptsd but especially for war survivors, refugees, and their children. additionally, the international pandemic has led to increased isolation and difficulty accessing support. new york resident, bordskaya, notes that the pandemic has left her and other elderly immigrants feeling more alone during this challenging time (cohen, 2022). social workers around the world can expect to see traumatized refugees from the ukraine and should begin to prepare themselves for assisting with war-related traumas and forced migration. as these are not typical topics covered in graduate social work curricula or continuing education training, it is essential for social workers to become aware of the connection between historical trauma and mental health. it is especially important for clinicians to include geo-political history and intergenerational trauma in their clients’ biopsychosocial assessments to recognize the potential for increased stress brought about by the invasion of ukraine for war crime victims and their descendants. references bahrampour, t. 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[@amila295]. (2022, february 24). every time a war starts, near or far, the trauma returns. back to square one. everyone’s war becomes my war… [tweet]. twitter. https://twitter.com/amila295/status/1496732078184017922?cxt=hhwwhmc5wat5 usupaaaa cohen, h. (2022, march 16). ukraine invasion retraumatizes us holocaust survivors. jerusalem post. https://www.jpost.com/diaspora/article-701330 comtesse, h., powell, s., soldo, a., hagl, m., & rosner, r. (2019). long-term psychological distress of bosnian war survivors: an 11-year follow-up of former displaced persons, returnees, and stayers. bmc psychiatry, 19(1), 1-10. https://doi.org/10.1186/s12888-018-1996-0 danieli, y., norris, f. h., lindert, j., paisner, v., engdahl, b., & richter, j. (2015). the danieli inventory of multigenerational legacies of trauma, part i: survivors' posttrauma adaptational styles in their children's eyes. journal of psychiatric research, 68, 167–175. https://doi.org/10.1186/s12888-018-1996-0 frounfelker, r., gilman, s. e., betancourt, t. s., aguilar-gaxiola, s., alonso, j., bromet, e. j., bruffaerts, r., de girolamo, g., gluzman, s., gureje, o., karam, e. g., lee, s., lépine, j. p., ono, y., pennell, b. e., popovici, d. g., ten have, m., kessler, r. c., & who world mental health survey collaborators. (2017). civilians in world war ii and dsm-iv mental disorders: results from the world mental health survey initiative. social psychiatry and psychiatric epidemiology, 53(2), 207-219. https://doi.org/10.1007/s00127-017-1452-3 funk, m., & shaw, a. (2021). “i remember when donald trump was elected. it broke a lot of refugees’ hearts”: refugee perspectives on the post-2016 u.s. political climate. advances in social work, 21(4), 1100-1123. https://doi.org/10.18060/25184 international committee of the red cross. (2015, july 10). remembering nine icrc employees killed 20 years ago in srebrenica. international committee of the red cross. https://www.icrc.org/en/document/remembering-nine-icrc-employees-killed20-years-ago-srebrenica kuwert, p., brähler, e., glaesmer, h., freyberger, h. j., & decker, o. (2009). impact of forced displacement during world war ii on the present-day mental health of the elderly: a population-based study. international psychogeriatrics, 21(4), 748-753. https://doi.org/10.1017/s1041610209009107 morrison, k. (2021, april 19). how the siege of sarajevo changed war reporting. aljazeera. https://www.aljazeera.com/features/2021/4/19/how-the-siege-of-sarajevochanged-journalism sabic, a. (2020, december 11). sarajevo agrees new memorial for child casualties of siege. balkan transitional justice. https://balkaninsight.com/2020/12/11/sarajevoagrees-new-memorial-for-child-casualties-of-siege/ https://twitter.com/amila295/status/1496732078184017922?cxt=hhwwhmc5wat5usupaaaa https://twitter.com/amila295/status/1496732078184017922?cxt=hhwwhmc5wat5usupaaaa https://www.jpost.com/diaspora/article-701330 https://doi.org/10.1186/s12888-018-1996-0 https://doi.org/10.1186/s12888-018-1996-0 https://doi.org/10.1007/s00127-017-1452-3 https://doi.org/10.18060/25184 https://www.icrc.org/en/document/remembering-nine-icrc-employees-killed-20-years-ago-srebrenica https://www.icrc.org/en/document/remembering-nine-icrc-employees-killed-20-years-ago-srebrenica https://doi.org/10.1017/s1041610209009107 https://www.aljazeera.com/features/2021/4/19/how-the-siege-of-sarajevo-changed-journalism https://www.aljazeera.com/features/2021/4/19/how-the-siege-of-sarajevo-changed-journalism https://balkaninsight.com/2020/12/11/sarajevo-agrees-new-memorial-for-child-casualties-of-siege/ https://balkaninsight.com/2020/12/11/sarajevo-agrees-new-memorial-for-child-casualties-of-siege/ advances in social work, spring 2022, 22(1) x sajjad, t. (2022, march 9). ukrainian refugees are welcomed with open arms – not so with people fleeing other war-torn countries. american university school of international service. https://www.american.edu/sis/news/20220309-ukrainianrefugees-are-welcomed-with-open-arms-not-so-with-people-fleeing-other-war-torncountries.cfm sangalang, c. c., & vang, c. (2017). intergenerational trauma in refugee families: a systematic review. journal of immigrant and minority health, 19(3), 745-754. http://dx.doi.org/10.1007/s10903-016-0499-7 schock, k., böttche, m., rosner, r., wenk-ansohn, m., & knaevelsrud, c. (2016). impact of new traumatic or stressful life events on pre-existing ptsd in traumatized refugees: results of a longitudinal study. european journal of psychotraumatology, 7, 32106. https://doi.org/10.3402/ejpt.v7.32106 spangenberg, j. (2022, march 9). how war videos on social media can trigger secondary trauma. deutsche welle. https://www.dw.com/en/how-war-videos-on-social-mediacan-trigger-secondary-trauma/a-61049292 sudakov, m. (2022, march 4). my family survived the holocaust. now, the invasion of ukraine is a trauma trigger. themighty.com. https://themighty.com/2022/03/russiaukraine-trigger-trauma-intergenerational/ unhcr: the un refugee agency. (2021, november 10). refugee data finder. unhcr the un refugee agency. https://www.unhcr.org/refugee-statistics/ united states holocaust memorial museum. (2021, september 29). mass shootings at babyn yar (babi yar). united states holocaust memorial museum. https://encyclopedia.ushmm.org/content/en/article/kiev-and-babi-yar author note: address correspondence to sara l. schwartz, usc suzanne dworak-peck school of social work, university of southern california, los angeles, ca, 90089. email: saraschw@usc.edu https://www.american.edu/sis/news/20220309-ukrainian-refugees-are-welcomed-with-open-arms-not-so-with-people-fleeing-other-war-torn-countries.cfm https://www.american.edu/sis/news/20220309-ukrainian-refugees-are-welcomed-with-open-arms-not-so-with-people-fleeing-other-war-torn-countries.cfm https://www.american.edu/sis/news/20220309-ukrainian-refugees-are-welcomed-with-open-arms-not-so-with-people-fleeing-other-war-torn-countries.cfm http://dx.doi.org/10.1007/s10903-016-0499-7 https://doi.org/10.3402/ejpt.v7.32106 https://www.dw.com/en/how-war-videos-on-social-media-can-trigger-secondary-trauma/a-61049292 https://www.dw.com/en/how-war-videos-on-social-media-can-trigger-secondary-trauma/a-61049292 https://themighty.com/2022/03/russia-ukraine-trigger-trauma-intergenerational/ https://themighty.com/2022/03/russia-ukraine-trigger-trauma-intergenerational/ https://www.unhcr.org/refugee-statistics/ https://encyclopedia.ushmm.org/content/en/article/kiev-and-babi-yar mailto:saraschw@usc.edu microsoft word 00_adamek_26130_editorial_fall_2021 __________________________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2021 author, vol. 21 no. 4 (fall 2021), i-x, doi: 10.18060/26130 this work is licensed under a creative commons attribution 4.0 international license. editorial fall 2021: struggles bring opportunity margaret e. adamek in the fall 2021 issue of advances in social work, we are pleased to present 15 fulllength papers written by 29 authors from different regions of the u.s. including puerto rico as well as from ghana. an underlying theme of many of these contributions is the opportunity brought about through various struggles: patriarchal systems leading to innovative women entrepreneurs, social distancing measures spawning new ways of learning virtually and new ways of practicing social work, and mental health challenges exposed among elite athletes leading to new frontiers of practice. the variety of social work contributions to wellness, advocacy, and social justice seem to be ever-expanding. interestingly, despite the trend toward multiple-authored papers over time, 7 of the papers in this issue are solo-authored--perhaps an artifact of the pandemic. each paper is introduced briefly below, followed by our annual recognition of reviewers for advances in social work. international perspectives in this issue’s lead article, popescu and alonzo propose an organizing framework for community-engaged international social work and social development. cleverly named the strengths and participation to accomplish capacity and empowerment (space) conceptual framework, this model is founded on human rights principles and informed by the strengths perspective, empowerment and participation of local communities, and the capabilities approach. the utility of the space conceptual framework is illustrated using two community-based change projects in guatemala. a growing number of women entrepreneurs in ghana are taking advantage of the emerging economy. based on interviews with 15 women entrepreneurs in the capital city of accra, boateng identified three trends that have fostered the women’s success in business: social media, innovative business practices, and weakening patriarchy. to enhance opportunities for women, boateng calls for social workers to work with and train additional women entrepreneurs and to advocate for government policies that support women’s economic empowerment. uncertainty greatly increased among refugees in the u.s. in response to the antiimmigrant rhetoric promoted by former president donald trump. to elevate refugee voices in this uncertain climate, funk and shaw interviewed 88 refugees who resettled in the u.s. based on their findings, funk and shaw emphasize the continuing need for social workers to facilitate cross-cultural understanding and decrease stigma towards refugees and other immigrants. advances in social work, fall 2021, 21(4) ii latino issues to engage low-income latinx families in community change projects, lechcugapeña, mitchell, poola, gutiérrez, and rivera incorporated a photovoice approach within an established community-based intervention, your family, your neighborhood. using photovoice, parents and their children worked together to uncover and document the strengths and challenges in their community from their perspectives. the project illustrated that knowledge production rooted in community members’ lived experience can help reshape the narrative of latinx families living in low-income communities and enable social workers to better respond to specific needs. as the latinx population in the united states grows, the need for bilingual professionals will continue to expand. in light of this growing demand, logan and negroni conducted a study to examine whether bilingual professionals view their language skills as an asset or liability. using focus groups, data were collected from 15 bilingual professionals who speak english and spanish and work in a court system in the eastern region of the united states. while bilingualism is typically considered an asset, in a court system setting, the bilingual professionals’ sometimes perceived their language skills as a liability. discrimination and unfair practices affecting limited english proficiency (lep) clients may lead bilingual professionals to become protectors and gatekeepers to prevent adverse outcomes and provide access to services in the court and across social service systems. logan and negroni argue that social work administrators must evaluate structural supports and provide training specific to the cultural aspect of language for all employees. considering that by 2060, 40% of the children in the united states will be latino and that many of these children will be raised by single mothers, bishop conducted a study to uncover the perceptions of latino youth about influential adults in their lives. in contrast to the persistent negative images of latinx individuals portrayed in u.s. media, bishop uncovered the very positive perceptions latino youth have of their single mothers. social workers who work with latino families are urged to consider the strengths and familyoriented cultural values of latino americans. social work education we learned a lot about ourselves during the pandemic. we learned that distancing measures could exacerbate the struggles of those with mental health conditions and thus the demands on caring professionals. in an effort to support the wellness of social work field students, faculty at one school of social work worked with students to develop wellness plans during their field seminars. reay describes the process of developing and implementing student wellness plans to safeguard students as they endeavored to meet their field learning objectives in the midst of the pandemic. pandemic or no pandemic, student wellness plans help students to internalize the importance of self-care, hopefully beyond their student phase and into their future careers as professional helpers. while the value of mentoring for social work faculty is widely recognized, a best practice model is yet to be widely adopted. holcomb proposes an integrated conceptual adamek/editorial iii     framework to undergird formal mentoring programs for all categories of social work faculty, particularly historically marginalized groups including women, underrepresented minorities, as well as part-time, intermittent, adjunct, or non-tenure track faculty. holcomb advocates for an amendment to the epas to include formal faculty mentorship within accredited programs. emerging areas of policy and practice one emerging area of social work practice is work with athletes in various sports settings. by interviewing licensed social workers working in division i athletic departments, beasley, newman, and hardin aimed to understand how these practitioners applied social work values in collegiate sports settings. the application of social work values was evident in how the social workers recognized student-athletes as a vulnerable population, worked on social justice issues, placed an emphasis on the diversity of studentathletes, built relationships with both student-athletes and sport staff, and advocated for social work values in athletics. beasley and colleagues call for social work programs to increase efforts to prepare students for careers in sport through elective courses and by providing sport-specific practicum opportunities. while various community-based residential options have opened up for people with intellectual and developmental disabilities over time, presnell and keesler point out that living in a community is not the same as having meaningful opportunities to be a full member of that community. many people with intellectual and developmental disabilities (idd) are isolated and lack social networks within their communities. presnell and keesler present a call-to-action for social work to engage in strategies and solutions to resolve macro barriers to community inclusion, to dismantle the injustices that people with idd continue to experience, and to move the promise of community inclusion from rhetoric to reality. in a bold call for legislative action on racial injustice, mcelderry and jones challenge social workers to mobilize in support of reparations for african americans as proposed in hr 40. providing an interesting historical context of reparations for other categories of americans, mcelderry and jones raise awareness about the potential for hr 40 to improve the lives of african americans through strategies such as establishing a commission to consider various remedies for slavery and institutionalized discrimination. mcelderry and jones argue that the social work profession can play a pivotal role in capacity-building in order to dispel the myths and fears associated with reparations and move h.r. 40 forward. trauma practice as our understanding of the long-term and serious impact of childhood trauma has grown, so has the need for sensitive and accurate screening tools. evans, king, and holmes identify several recommended features of an evidence-informed framework for a pictorial child trauma screening tool. the features of a recommended tool include that it is: child-centered, brief, useable by a broad range of practitioners, culturally sensitive, advances in social work, fall 2021, 21(4) iv includes the child’s relational context, and measures not only the trauma itself, but also the child’s responses to trauma. legislative protections put into place to ensure the safety of certain population groups may not actually ensure safety equitably among sub-groups. title ix refers to the federal mandated reporting procedures for sexual assault on university campuses. based on a national sample of lgbtq survivors (n=409) of college sexual assault, nightingale found that only 10% of respondents made a formal report to campus officials. those who did submit a report tended to have negative experiences with the reporting process and struggled with the leniency of sanctions for perpetrators. nightingale calls for social workers who interface with the title ix process to advocate for greater inclusivity of the needs and perspectives of lgbtq students. accountability/ethical issues and ipe sustainability examining the responses of a state licensing board to ethics violations by social work practitioners, barsky and spadola call into question the punitive and often shame-based approaches still being used. to explore the impact of sanctions on social workers and their clients, barsky and spadola interviewed 13 practitioners who were sanctioned by the state board in ohio. among other findings, respondents questioned the practice of permanently posting their names on the state board website. instead, barsky and spadola recommend that social work as a profession consider implementing the restorative approaches used by other disciplines in response to ethics violations. in a profession focused on empowering clients and second chances, should we not do the same with our own? finally, kennedy provides an overview of the development of the research-based kennedy model of sustainability and its subsequent application to interprofessional practice and education (ipe) initiatives. presenting the model in the context of implementation science and the know-do gap, kennedy illustrate how the model has provided additional strategies to foster sustainability of ipe initiatives and heighten the likelihood of attaining the quintuple aim of improving care, reducing costs, improving consumers’ experiences, enhancing providers’ experiences, and achieving health equity. reviewer appreciation with this issue we would also like to thank the many reviewers worldwide who completed reviews for advances in social work this past year. in 2021, 430 reviews were completed by 322 individuals from 17 countries and 45 states and territories representing 208 universities and organizations. that is a lot of working parts! we truly appreciate the voluntary efforts of our reviewers in enhancing the scholarly contributions of advances in social work. we are grateful for the contributions of authors and the generosity of reviewers and of our legacy as an open access journal since 2008. adamek/editorial v     advances in social work 2021 reviewers and affiliations we would like to acknowledge the contributions of the following individuals who reviewed manuscripts for advances in social work in 2021. without their time and expertise, advances in social work would not be possible. janet acker, college of saint rose stephanie adams, eastern kentucky university erum agha, unc chapel hill (2) karen m. allen, indiana university (2) skye allmang, rutgers university (2) debra allwardt, western illinois university (2) david alonso gonzalez, universidad complutense de madrid dawn apgar, seton hall university (2) steven applewhite, university of houston paul archibald, college of staten island heather arnold-renicker, university of denver nina asaki, springfield college autumn asher blackdeer, washington university in st. louis (2) gifty d. ashirifi, indiana university (2) gail m. augustine, indiana university joshua baldwin, lesley university rosemary barbera, lasalle university* ivette barbosa, indiana university amber bell, lincoln university of missouri (2) natalie bembry, rutgers university amy benton, texas state university renee betts, indiana university christine bishop, etoile academy charter school kori r. bloomquist, winthrop university ashleigh borgmeyer, louisiana state university dara bourassa, shippensburg university elizabeth bowen, university at buffalo erin boyce, metropolitan state university of denver (2) stephanie k. boys, indiana university (2) shane ryan brady, university of oklahoma (2) richard brandon-friedman, indiana university hannah britton, university of kansas james roger brown, indiana university michele brown, missouri state university stephanie bryson, portland state university barb j. burdge, manchester university tyleen caffrey, our lady of the lake university helen cahalane, university of pittsburgh ryan camire, city university of new york (2) michael campbell, saint leo university elba caraballo, university of saint joseph (2) laura cardinal, university of southern california joan marie carlson, indiana university danny carroll, indiana university cheri carter, temple university (2) suzie t. cashwell, auburn university at montgomery (2) alex casiano, inter american university of puerto rico kala chakradhar, murray state university jennifer chappell deckert, university of kansas bethel college karen g. chartier, virginia commonwealth university jeannine chester, college at old westbury ga-young choi, california state university los angeles (3) jill m. chonody, boise state university shelby clark, university of kansas advances in social work, fall 2021, 21(4) vi michael clarkson-hendrix, fredonia state university of new york jessica d. cless, university of rhode island michel coconis, ohio university zanesville (3) shani collins woods, austin peay state university susan a. comerford, university of vermont monique constance-huggins, winthrop university (2) lana cook, university of south carolina john cosgrove, fordham university elisabeth counselman-carpenter, adelphi university (2) travis w. cronin, california state university, fresno janeen cross, howard university (2) mo cuevas, our lady of the lake university linda k. cummins, northcentral university (2) karen d'angelo, southern connecticut state university ashley davis, boston university (2) audrey davis, university of st. francis premela deck, university of north carolina (2) valerie d. decker, indiana university bertha dejesus, millersville university claire dente, west chester university of pennsylvania alan dettlaff, university of houston (2) mery f. diaz, new york city college of technology/cuny quincy dinnerson, norfolk state university jessica donohue-dioh, university of houston amy doolittle, university of tennessee chattanooga donna dopwell, middle tennessee state university paul duongtran, csu dominguez hills melissa earle, stony brook university (2) stacey edgar, colorado state (2) michele eggers, california state university-chico bonnie ervin, arizona state university anne sj farina, saint louis university thomas patrick felke, florida gulf coast university dan ferguson, yakima valley college joseph ferrandino, indiana university amy killen fisher, university of mississippi* dale fitch, university of missouri karen a. ford, james madison university fran franklin, delaware state university carly franklin, university of arkansas paul freddolino, michigan state university william frey, columbia university (2) sadaaki fukui, indiana university dashawna fussell-ware, university of pittsburgh (2) erika galyean, indiana university (2) michelle d. garner, university of washington, tacoma (2) ann marie garran, university of connecticut carolyn s. gentle-genitty, indiana university michelle george, messiah college karina gil, our lady of the lake university braveheart gillani, case western reserve philip gillingham, university of queensland megan gilster, university of iowa steven granich, lock haven university dorothy saxon greene, east tennessee state university virgil lee gregory, indiana university susan grossman, loyola university chicago ginger gummelt, lamar university makisha gunty, grand canyon university seth gurell, utah valley university (2) adamek/editorial vii     kristen guskovict, klg consulting services, llc and heart (humanitarian empathy and refugee trauma) of aid work (3) mónica gutiérrez, arizona state university (3) kristin hamre, indiana university victoria hanson, college of medicine and science, mayo clinic health system kiva harper, university of texas at arlington sam harrell, portland state university shayna harris, florida state university (2) ethan haymovitz, utica college (3) daphne henderson, university of tennessee martin robin hernandez-mekonnen, stockton university (3) mark s. homan, retired cole hooley, brigham young university carol hostetter, indiana university* stephenie howard, howard university lorraine y. howard, rutgers university andrea imafidon, tuskegee university dorothea ivey, university of southern maine aesha john, texas christian university (2) sarah c. johnson, hunter college (2) nia johnson, west chester university laura kaplan isaac karikari, university of north dakota saliwe moyo kawewe, southern illinois university at carbondale nancy kelley, university of nebraska at omaha khadija khaja, indiana university mohammad mostafizur rahman khan, indiana university lalit khandare, pacific university suk-hee kim, northern kentucky university peter kindle, university of south dakota (2) julia kleinschmit, university of iowa (2) david c. kondrat, indiana university (2) debra kram-fernandez, empire state college (suny) eric kyere, indiana university walter la mendola, university of denver (2) shannon lane, yeshiva university julie anne laser-maira, university of denver stephanie lechuga-pena, arizona state university amy levine levine, university of north carolina at chapel hill patricia levy, fort hats state universitykansas (2) i-hsuan lin, college of saint rose (2) megan lindsey, northern kentucky university marriah lombardo, united states public health service (2) denise longoria, the university of texas rio grande valley (2) mayra lopez-humphreys, cuny college of staten island robert lucio, saint leo university (2) phil mach, vancouver island health authority maureen macnamara, appalachian state university dale dagar maglalang, boston college mavis major sara makki alamdari, west texas a&m university (2) gayle mallinger, western kentucky university angie malorni, university of washington michael a. mancini, saint louis university susana mariscal, indiana university (2) james marley, loyola university chicago malikah marrus, university of coloradocolorado springs james ashworth martin, bryn mawr college advances in social work, fall 2021, 21(4) viii allison mason, northeastern state university (2) michael massey, catholic university of america december maxwell, university of hawaii carl mazza, city university of new york katie mccarthy, indiana university irene searles mcclatchey, kennesaw state university (2) kristin mccowan, university of missouricolumbia henrika mccoy, university of illinois chicago lisa elizabeth mcguire, james madison university (2) michael mcguire, unc chapel hill denise mclane-davison, morgan state university anne marie mclaughlin, university of calgary tara mclendon, northern kentucky university david axlyn mcleod, university of oklahoma john g. mcnutt, university of delaware monica medina, indiana university kelly melekis, skidmore college-new york (2) natasha s. mendoza, arizona state university lori messinger, university of tennessee knoxville julie e. miller-cribbs, university of oklahoma rebecca g. mirick, salem state university (2) natalie montero, edinboro university matt moore, ball state university brenda morris, carleton university deana f. morrow, west virginia peg munke, murray state university emily murphy, mercy college amy b. murphy-nugen, western carolina university laura mutrie, quinnipiac university toni naccarato, suny albany susan nakaoka, sacramento state lirio k. negroni, florida gulf coast university jason newell, university of montevallo tarkington newman, university of new hampshire mary nienow, st. catherine university (2) sarah nightingale, eastern connecticut state university kristina nikolova, wayne state university (2) carolyn noble, acap, sydney stephanie odera, virginia commonwealth university (2) kieran barry o'donoghue, massey university (2) esther ogunjimi, prairie view a&m university mark d. olson, illinois state university tamara pace-glover, university of arkansas at pine bluff nora padykula, westfield state university phill pallas, university of newcastle kimberly pendell, portland state university panagiotis pentaris, university of greenwich ebony n. perez, saint leo university (2) katherine perone, western illinois university (2) liana petruzzi, university of texas at austin angela b. pharris, university of oklahoma kate phillippo, loyola university chicago amy phillips, minot state university barbara pierce, indiana university joan pittman, university of maryland linda plitt donaldson, james madison university (2) marciana l. popescu, fordham university dana prescott, boston college (3) mary a. provence, indiana university adamek/editorial ix     camille r. quinn, ohio state university brie radis, west chester university smitha rao, ohio state university susan reay, university of nebraska at omaha (2) sarah c. reed, california state university, sacramento kelley reinsmith-jones, east carolina university (3) hasan reza, indiana university ann riley, university of oklahoma (2) hilda p. rivera-rodríguez, university of puerto rico helen robinson, washington university in st. louis rebecca rouland, nazareth college (2) kristi roybal, university of denver deborah rubin, lehman college jennie ryding, university west (2) dolly sacristan, ramapo college of new jersey (2) saleem saleem, capital university linda f. samuel, north carolina agricultural & technical university mary angeline santhosam, university of madras beth sapiro, montclair state university (2) jennifer j. savage, university of louisiana monroe ryan savino, city university of new york edward scanlon, university of kansas maria scannapieco, university of texas, arlington sara laura schwartz, university of southern california (2) beverly cynthia sealey, simmons college dee ann sherwood, western michigan university (2) melissa singh, university of southern california (2) greta slater, ball state university carmela smith, southern connecticut state university alexa m. smith-osborne, university of texas at arlington tracy m. soska, university of pittsburgh yolanda d. spears, univeristy of iowa (2) jewel stafford, washington university in st. louis (2) kimberly stauss, university of arkansas erin stevenson, eastern kentucky university (2) anne l. stewart, james madison university hannah stohry, miami university sabrina sullenberger, belmont university (2) kelly sullivan, anna maria college patrick sullivan, indiana university jamie sundvall, touro college michelle sunkel, colorado mesa university (2) betty surbeck, west chester university carolyn sutherby, ferris state university peter szto, university of nebraska at omaha peter szto, university of nebraska at omaha andrea g. tamburro, indiana university sarah tarshis, university of toronto (2) sarah taylor, california state east bay (2) maria teahan, barry university meredith tetloff, univerisity of montevallo (2) melissa thompson, university of south florida emily tillotson, walla walla university (2) jelena todic, university of texas, san antonio (2) amanda toler woodward, michigan state university john tracy kristin trainor, ball state university wendy turner, university of southern indiana dr. valandra, university of arkansas (2) advances in social work, fall 2021, 21(4) x miriam valdovinos, university of denver lara vanderhoof, tabor college suzanne l. velazquez, stony brook university (2) daniel velez ortiz, michigan state university bryan g. victor, indiana university mohan vinjamuri, lehman college diane k. vinokur, university of michigan april viverette, our lady of the lake university (2) t. vogel, washington university in st. louis (2) holly danforth vugia, california state university east bay beverly wagner, texas woman's university n. eugene walls, university of denver matthew walsh, marian university (2) betty a. walton, indiana university (2) marie watkins, nazareth college patricia weldon, college of saint rose lisa werkmeister rozas, university of connecticut sandra wexler, university of pittsburgh l. justin wheeler, ohio university (3) ohenewaa white, alvernia university (2) david wilkerson, indiana university (3) aaron willis, salisbury university shanika wilson, north carolina central university (2) tuwana wingfield, california state university at northridge heather witt, boise state university (2) lea wolf, city university of new york (2) samantha wolfe-taylor, indiana university (2) kelechi wright, university of kansas aaron wyllie, university of essex jessica yang, winthrop university charla yearwood, connected community* jimmy young, california state university san marcos (2) luis h. zayas, university of texas at austin lisa de saxe zerden, unc chapel hill (3) tarek zidan, indiana university *special guest editor _________ christina chiarelli-helminiak, phd, msw, professor, graduate social work department, west chester university, west chester, pa. nada elias-lambert, phd, lcsw, associate professor, department of social work, texas christian university, fort worth, tx. shannon r. lane, phd, lmsw, associate professor, wurzweiler school of social work, yeshiva university, new york, ny. melina papanikolaou, msw, graduate assistant, graduate social work department, west chester university, west chester, pa. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 481-502, doi: 10.18060/27503 this work is licensed under a creative commons attribution 4.0 international license. social work education leadership: insights from faculty and staff christina chiarelli-helminiak nada elias-lambert shannon r. lane melina papanikolaou abstract: social work education-specific leadership models are necessary to maximize the effectiveness of the profession’s role in addressing societal issues that impact individuals, families, and communities and promote feminist leadership within the profession and academy. a cross-sectional electronic survey design gathered information from faculty and staff members at accredited social work programs within the united states. study participants included 88 fulland part-time faculty and staff. 50 of the 88 participants (57%) answered the open-ended question from which data for this study were analyzed and triangulated with responses to other questions. the data analysis process resulted in identification of three main themes: conceptualization of leadership, support for leadership, and barriers to leadership. participants expressed the need for more thoughtful succession planning, leadership specific training, and support in removing barriers to leadership. many of the problems raised could be addressed through systemic change in higher education, including the proposed model of social work education leadership praxis. keywords: higher education, leadership, social work, feminist leadership the demand for social workers across the globe continues to grow. the consequences of covid-19, concerns about unmet mental health needs, and racial injustice highlight and exacerbate societal inequalities and the necessity of socially just services and advocacy. leadership in social work education will drive how our profession emerges in a post-pandemic world. yet, as a profession we lack a social work-specific or social work education-specific leadership model (peters, 2018; peters & hopkins, 2019; rofuth & piepenbring, 2020). this manuscript will present the qualitative findings of a study focused on leadership in u.s. social work education as well as a model for social work education leadership praxis. leadership within social work social work education-specific leadership models are necessary to maximize the effectiveness of the profession’s role in addressing societal issues that impact individuals, families, and communities. with the u.s. bureau of labor statistics (2022) estimating 715,600 social work positions currently existing, leaders of the 860 programs accredited by the council on social work education (cswe; 2023) have a vast opportunity to influence how the values of the social justice-oriented profession are put into practice. the cswe 2022 educational policy and accreditation standards (epas) highlight that social about:blank advances in social work, summer 2024, 24(2) 482 work faculty and administrators “based on their education, knowledge, and skills, are best suited to make decisions regarding the delivery of social work education” (p. 29). leadership of accredited programs is required through identified program directors at the baccalaureate and master’s levels. according to cswe (2022), program directors’ leadership ability is described “through teaching, scholarship, curriculum development, administrative experience, and/or other academic and professional activities in social work” (p. 31). while the accreditation standards are clear that program directors provide educational and administrative leadership to the program (cswe, 2022), there is no common expectation on how to preside over an accredited program, making it difficult to isolate the specific skills necessary to become an effective social work education leader. a discrepancy also exists in how much time cswe requires for these leaders to execute their responsibilities, with baccalaureate program directors requiring, at minimum, 25% release time and master’s program directors requiring, at minimum, 50% assigned time. additionally, program directors are just one type of social work education leaders. schools or centers of social work are frequently led by deans, associate deans, directors, or chairs. these roles are not completely addressed within the accreditation standards. there are also informal leaders within programs at the local level, and social work educators who serve in administration at the university level. social workers employed within the higher education host setting may also enter the academy with social service organizational leadership experience. social work leaders are often called on to make changes other leaders may not be bold enough to address (holosko, 2009). current societal issues that require an anti-racist or anti-oppressive approach to advance human rights in the u.s. context are within the wheelhouse of social work practice expertise. powell and kelly (2017) highlight the need for social work academics to be leaders in fighting white supremacy within our communities and institutions, particularly calling on white academics to consider their roles as allies, accomplices, and agitators in this work. cswe reiterated the importance of anti-racist work in the 2022 epas. over the past 20 years, research on social work leadership development has increased due to the national shortage of leaders who utilize social work values to address social injustices (peters, 2017). social work leaders with decision-making power are likely to be more empathetic and prioritize the health and well-being of human beings (sullivan, 2016). choy-brown and colleagues (2020) found that in comparison to social service leaders with non-social work backgrounds, social work leaders were more likely to use transformative leadership, that social work leaders and their staff members were more likely to say their environments were reflective of recovery-oriented values, and that social work leaders fostered environments with less stress and better open communication between staff and management than non-social work leaders. in a qualitative study of social work practitioners in canada, vito (2020) found seven key areas that leaders found important. these included the ability to influence and motivate others towards common goals; building and investing in trusting relationships; and creating shared and achievable visions in collaborations with colleagues. participants in this study emphasized the need to serve as role models and exemplify the values they wanted to reinforce in others. participants emphasized that successful motivating, coaching, and chiarelli-helminiak et al./swk ed leadership 483 mentoring of staff should be done in strengths-based and supportive manners. they were in agreement on the importance of fostering teamwork and collaboration. one area they saw as important, but many struggled with, was finding meaningful, personal, and positive ways to recognize staff. social work-specific leadership professional development can foster inclusive leaders who value the expertise of front-line workers and clients (sullivan, 2016). there is a critical need for leaders who embrace social work values crucial in creating equitable and inclusive working environments (peters, 2017). a social work education-specific leadership model has the potential to increase confidence, authority, and clarity within social work education, research, and practice. social work leadership models numerous organizational leadership models exist but are rarely from a social work or feminist-based approach. leadership models are frequently adopted from outside the social work sphere and focus on transactional or transformational leadership (iachini et al., 2015). transactional leadership focuses on transactions or exchanges between the leader and worker with external motivation offered in the form of performance-based rewards. alternatively, transformational leadership is characterized by leaders using their behaviors and philosophies to motivate employees and develop a high functioning work environment. components of this style include idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration of each employee to benefit the organization (iachini et al., 2015; rofuth & piepenbring, 2020). transformational leadership is aligned with the social work values of dignity and worth of the person and the importance of human relationships (national association of social workers [nasw], 2021); however, spillane (2005) argues that this style lacks the complexity and in-depth approach of participatory or distributive leadership often adopted in feminist-led organizations. the distributive leadership approach is centered around the value of supportive interactions between people and their situations (iachini et al., 2015). utilizing the distributive leadership model, leaders allocate tasks and depend on colleagues to meet the goals of a project. this supportive group mindset is a practice familiar to social workers as it strongly aligns with the values of the profession (iachini et al., 2015). participatory leadership engages the team in decision-making, rather than applying a top-down approach. distributive and participatory leadership align with the social work values of the importance of human relationships and competence as they empower employees to grow and learn professionally (lawler, 2007; nasw, 2021). the social change model (scm) of leadership, which incorporates aspects of servant and collective leadership, centers on empowerment and collaboration. similar to distributive leadership, scm encourages leadership development through the consideration of multiple perspectives when evaluating the most effective approach toward social change and social justice. the scm is grounded in individual, group, and community values that parallel social work values, including consciousness of self, congruence, commitment, common purpose, controversy with civility, and citizenship (iachini et al., 2015; rofuth & piepenbring, 2020). advances in social work, summer 2024, 24(2) 484 social work education-specific leadership model when promoted to formal leadership roles, social work faculty are often underprepared. academic training primarily focuses on research production and only 17% of social work phd programs indicate a focus on leadership (lee et al., 2023). training for academic administrative positions often aligns with managerialism, which includes being taught to manage higher education institutions as if corporations. such training can be counterproductive because it focuses on end goals rather than student-centered approaches and valuing every employee’s potential impact on the students and the institution. sullivan (2016) proposed social work-specific leadership training on how to combat social injustices, embrace the worth of each person, and offer services that work to reduce inequities among marginalized populations. social work education leadership informed by this approach would encourage issues related to gender, discrimination, and power inequities to be addressed by those in leadership roles (peters, 2017). lazzari and colleagues (2009) state “leadership guided by feminist principles can serve as a facilitator of social change” (p. 357). identity, intersectionality, and academic experiences identity characteristics such as race, gender, sexual orientation, and ability status play a key role in the experiences of those in academia. women in general are more likely to be assigned or agree to take on housekeeping or caregiving tasks in teaching and academic service, tasks which require a significant amount of time and emotional labor but are less visible and unlikely to lead to proportionate career advancement. women of color are expected to spend time on these caregiving tasks, as well as additional responsibilities related to anti-racism, diversity, equity, and inclusion (adei) initiatives, and intensive mentoring and support of black, indigenous, people of color (bipoc) students and colleagues, while also doing this within institutions that are often hostile places replicating white supremacy (docka-filipek & stone, 2021). in a systematic review, friedensen and colleagues (2021) found that research about the experience of faculty members with disabilities was sorely lacking and that visible disabilities were overrepresented compared to research on invisible disabilities. faculty members with disabilities report discrimination, harassment, and unfair treatment related to their disability at higher rates (shigaki et al., 2012). faculty members with chronic illness face stigma and confusion about how they fit into the academy and what policies exist to support them (goodwin & morgan, 2012). intersectionality among social work faculty and leaders while the diversity of social work degree holders has increased in recent years, this has not been reflected in the diversity of those in current social work education leadership positions. according to bryan and colleagues (2019), african american and latinx social work faculty are disproportionately underrepresented compared to the number of african american and latinx students. they also report experiencing fundamentally different treatment than their white colleagues. faculty members of color report assumptions that chiarelli-helminiak et al./swk ed leadership 485 they are the expert on their culture and are frequently assigned to lead curriculum and events related to their racial or ethnic identity (bryan et al., 2019; chiarelli-helminiak et al., 2021). social work faculty members who identify as queer, a person of color, or from working-class backgrounds spend more time on invisible service to their departments and institutions, which can negatively affect their opportunities, including work that makes them competitive for tenure and promotion (chiarelli-helminiak et al., 2021; social sciences feminist network research interest group, 2017). the feeling of isolation is common among leaders of diverse racial identity because of the limited faculty who also identify as a person of color (bryan et al., 2019). furthermore, pay inequity persists in social work education given that women in administrative positions earn less than men in non-administrative faculty positions (tower et al., 2019). a qualitative study involving social work faculty members who identified as lesbian, gay, bisexual, transgender, and queer (lgbtq), with diverse gender, religious, and racial identities, found that risks to personal and professional safety were important to the experience of being “out” in the academy (prock et al., 2019). similar to the experiences of faculty of color, lgbtq faculty were asked to represent all other members of their community, participate in time-consuming activities, or assumed to be experts on all issues in the queer and trans communities. participants expressed concern about lack of support within their schools or universities, including blocking access to funding and concerns about whether research on sexual minorities was “important,” and at times felt they had less credibility among colleagues. participants in leadership discussed their responsibilities as leaders to support diversity and be role models. research purpose social work has made strides to advance leadership-specific social work education but there is still work to be done to ensure that future social work education leaders are equipped to implement social work values within the higher education host setting. the purpose of the current research was to examine the factors, including identity and professional factors, that contributed to decisions among social work faculty and staff to pursue leadership opportunities. social work education leadership as described below includes both formal and informal leadership, as defined by participants. materials and methods a cross-sectional electronic survey design gathered information from individuals identified as faculty and staff members at cswe-accredited social work programs in the united states. as neither a public list nor database of all the social work faculty and staff existed, recruitment consisted of two methods. first, fliers were posted and distributed at cswe’s annual program meeting in denver, co in fall 2019. second, a recruitment email was sent to the baccalaureate program directors (bpd) and national association of deans and directors (nadd) listservs. all recruitment material included an informed consent and the contact information for the institutional research board (irb) at texas christian university which approved the study (#1920-38-am2). data collection began in november 2019. unfortunately, the onset of the covid-19 pandemic precluded further advances in social work, summer 2024, 24(2) 486 in-person recruitment necessary to diversify the sample and data collection was therefore concluded in march 2020. according to cswe’s (2020) statistics on social work education during the academic year of data collection, there were more than 5,616 full-time social work educators in the united states as reported by 538 participating social work programs. data on social work program staff are currently unavailable. data were collected via qualtrics survey software, with ip addresses not included to maintain anonymity. the online survey included questions related to demographics, leadership and leadership preparation, attitudes toward institutions, and job satisfaction. data analysis included univariate and bi-variate analysis of variables related to leadership as well as qualitative analysis of several open-ended questions. this manuscript focuses on the qualitative responses to one open-ended question asking participants to share any final thoughts about their experience as a social work leader. the qualitative data were manually analyzed using methods as suggested by corbin and strauss (2008). data were then triangulated with quantitative results and qualitative findings of other open-ended questions—additional sources of data will be identified throughout the manuscript. as the research team continually engaged with the quotes and understanding the data, peer support and debriefing were utilized. as faculty and researchers with our own experiences in social work education leadership, we were mindful of assessing personal bias and reactivity, and included coders who were not members of the population of interest. comparative analysis was utilized while simultaneously refining themes for meanings and patterns. when discrepancies arose among the research team, the literature was consulted and discussion ensued to come to a consensus regarding themes. chronological notes detailing analysis were maintained to document how the three final themes emerged. the rigor and trustworthiness of the following findings are increased due to the use of the above strategies (padgett, 2008). further analysis ensued to determine whether a social work education leadership model could be extrapolated from the data. the findings were analyzed within the context of the theory and concepts peters and hopkins (2019) evaluated in their scale development for social work leadership principles, lazzari and colleagues’ (2009) integrated feminist principles in leadership, and mehrotra’s (2023) call to action for social work scholars to intentionally incorporate an intersectional queer praxis into their work. results study participants included 88 fulland part-time faculty and staff in us-based accredited social work education programs. out of those who responded, 50 participants (57%) answered the open-ended question from which data were analyzed. the majority of participants reported being in faculty roles (70%), with additional participants holding administrative roles (23%) and staff roles (3%). participants had been in social work education for an average of 7.4 years (range 1-35 years). they were overwhelmingly white (80%), while 7% identified as black/african american, 4% latinx, 3% asian, and 3% biracial. the majority identified as female (75%) with 23% identifying as male, and one each identifying as femme or mostly male. the largest age groups chiarelli-helminiak et al./swk ed leadership 487 represented were 46-55 (34%), 56-65 (25%), and 36-45 (24%). eleven percent of participants identified as a member of the lgbtq community and 9% reported they have a disability. most participants were located at large universities with more than 10,000 total students (54%), with additional participants at midsize (24%) and small universities (14%). they overwhelmingly worked at public universities (66%) and were more likely to be at a carnegie classified doctoral (38%) or master’s (36%) institutions as defined by the american council on education (2024). most participants were located in the southern (38%) and north central (28%) regions of the u.s. as organized by the council for higher education accreditation (n.d.). the data analysis process resulted in identification of three main themes: conceptualization of leaders, support for leadership, and barriers to leadership. each main theme also included two to four sub themes. all social identity characteristics used in participants’ quotes are their own descriptors. conceptualization of leaders respondents conceptualized their understanding of leadership as a social work educator through role models, understanding the dynamics of structural politics of universities, and fostering organizational skills. participants described social work education-specific leadership styles as decision-making within teamwork. the multifaceted nature of teamwork leads to the intention to foster others’ leadership development in the spirit of collaboration. figure 1. visual illustration of themes and subthemes preparation barriers preparation supports concepualization of leaders •lack of understanding •needs & resources •sacrifices & reluctance •adress barriers •education, experience & identity •training & investment •personality characteristics •organizational skills •sw specific skills •values advances in social work, summer 2024, 24(2) 488 leadership characteristics and skills fifty-three characteristics and skills specific to social work education leadership were identified through the iterative analysis process. four sub themes emerged, including personality characteristics, organizational skills, social work-specific skills, and values as illustrated in table 1. table 1. skills identified as necessary for social work education leadership personality characteristics skills values organizational sw specific skills • authenticity • comfortable in groups • flexible • follows through • gives team credit • hardworking • honest • imaginative • innovative • intentional about leadership style • internally motivated • intuitive • respectful • serves when asked • thoughtful • trustworthy • understands what team members need for motivation • willingness to accept success short of perfection • balance task & socioemotional behaviors • can say no • delegation • development/ fundraising • forward thinking • goal & objective setting • knowledgeable • mentorship • management • marketing • networking • professional development • risk analysis/ assessment • strategic planning • supervision • team management • training • visionary • willingness to address conflict • willingness to receive feedback • advocacy • apply sw values & principles • eco-systems lens for assessment • balances social worker & educator • commitment to service, social justice, & human rights • grounded in values • shows what sw does as essential to the university • understands how sw fits into larger scheme • up-to-date on sw practice needs • collaboration • communication • democratic decision making • fairness • humanistic approaches • teamwork personality characteristics. participants identified 18 personality characteristics important for social work education leaders. descriptions of characteristics that benefit social work education leadership included a person’s ability to understand the role and work hard, but not need to be perfect. other descriptors included honest, thoughtful, trustworthy, and comfortable in group settings. social work education leaders should also be intentionally innovative while remaining grounded in their intuition. flexibility was also described as important in deciding when to assert authority versus when to remain in the background allowing the team to shine. the term respect or respectful came up repeatedly. chiarelli-helminiak et al./swk ed leadership 489 authenticity and confidence in oneself were presented as important within this theme. as one participant articulated: …i am a thoughtful person …i am told that i am fair and authentic, which makes my peers respect my decisions even if they do not like or agree with them. (african american, female, department head, associate professor, tenured) organizational skills. participants identified 20 organizational skills necessary for social work education leadership. organizational skills are often taught through specialized training programs, frequently outside of the social work program curriculum, unless an administration specialization or track is offered. these skills include management, marketing, networking, conflict management, risk analysis/assessment, development, and goal/objective setting. being able to delegate, have a vision, as well as balance tasks and socio-emotional behaviors in work were identified as important. providing training and mentorship were other skills valued in social work education leadership, as well as being able to receive critical feedback. as one participant stated, “…i use my department to work with me to help brainstorm ideas and identify directions we want to go, then follow through to see where it will take us” (white, female, associate professor, tenured). social work-specific skills. specific skills frequently used in social work practice were described as applicable in social work education leadership. nine social work-specific skills were identified by participants. the skills include advocacy, assessment from an ecosystems lens, application of social work values and principles, and commitment to service, social justice and human rights. a leader also demonstrates how social work is essential to and fits into the larger scheme of the university. as one participant summarized “of course social work values and principles apply (democratic decision making, for example)” (caucasian, female, bsw program director, chair, professor, tenured). values. six values were highlighted by participants. values were described as team collaboration, communication, fairness, and using a humanistic approach. participants frequently highlighted the importance of a leader’s team and democratic decision making. as one participant highlighted, “leadership isn’t about who’s at the top, it’s about those who sometimes move at the front as leaders, but who are also aware of the need to fall back behind to encourage the stragglers, forward” (white/euro, male, associate professor, tenured). preparation for leadership preparation for leadership in social work education comes in many forms. respondents most frequently described preparation to include education and specialized leadership training programs. social work educators see themselves as qualified due to existing experiences in leadership, willingness to serve, advanced education, and personal leadership characteristics. participants emphasized that social work state board licensure is not a requirement or pre-requisite for education leadership. experience in volunteer and academic leadership roles in organizations such as cswe and nasw have given participants the confidence to take on higher education leadership responsibilities. specific to social work education, advances in social work, summer 2024, 24(2) 490 participants described the desire to lead becoming part of one’s identity as well as the intentionality to function from an anti-oppressive and anti-authority framework. as one participant stated, “social workers … have been trained to lead from a position of partnership/collaboration as opposed to from a position of oppression/authority.” (female, instructor, not tenure eligible). participants spoke of the opportunity to lead and feel secure in that role depending on privilege and one’s ability to connect with peers. with the desire and interest in being a leader, participants highlighted their training and personal experience as preparation for the commitment to leadership. as one participant expressed, i was trained in… administration before becoming a social worker, that training has been instrumental in my marrying my social work knowledge and experience. (female, white, bsw program director/chair/school director, not tenure eligible) respondents who were turned down for a formal leadership role most frequently described their lack of experience, politics, and lack of personal fit as factors. to qualify for leadership roles, participants also emphasized their university’s expectations that future leaders be on a tenure track. supports participants, especially those from large, public, doctoral universities, emphasized that identifying leaders comes through an investment in people and continued training. as one participant highlighted, it seems that time is one of the factors in academia, whereas skills and experience are more important in the agency. fortunately, there are opportunities for leadership training, but a stronger focus on what…leadership means and look like would be helpful (white, female, bsw program director, associate professor, tenured) building relationships was another key component identified as peer support is critical to managing leadership responsibility. the triangulation of data was used in analysis. when asked, “my social work education adequately prepared me to take on leadership roles,” roughly half of respondents felt their social work education was adequate preparation for leadership (i.e., somewhat agree or strongly agree), while the other half disagreed (i.e., somewhat disagree or strongly disagree). the beneficial components of social work education were the general knowledge of the profession they learned, the administrative and organizational practices gained through their practicum experience, and the knowledge from policy courses. participants in leadership roles volunteered harvard institutes for higher education programs leadership, cswe program directors academy, cswe scholars program, nadd leadership academy for deans and directors, and hers leadership institute as additional sources of training about leadership. chiarelli-helminiak et al./swk ed leadership 491 being encouraged by other individuals supports engagement in social work education leadership. existing peers’ encouragement and leaders’ mentorship had a significant impact in calling participants to leadership. family support was another factor that contributed to participants dedicating more of their time to lead. individual judgment of abilities and self-motivation were also found to be factors that encouraged participants to pursue leadership. funding for leadership training, related travel expenses, and providing time away from the university also supported social work educators to consider future leadership. barriers to leadership understanding what social work education leadership looks like was a barrier to success in these roles, especially within the hierarchical model and politics that exist within academia. respondents expressed that ideologically conceptualizing oneself in leadership roles meant working within the understanding of the status quo of the management hierarchies and privileges that function through university corporate values, especially those at public universities classified as master’s and doctoral institutions. as one participant who was interested in dean/director opportunities expressed, some of the barriers and challenges i anticipate are in the areas in which i do not like or don't want to be involved in, such as development and marketing. more and more, it seems that a dean's job is to go out and raise funds and market your program, as higher education is more corporatized… (asian, female, associate professor, tenured) participants expressed a lack of desire to engage as a formal leader and the accompanying increased workload as a barrier to seek out the leadership roles available. instead, participants focused on students by teaching about challenging systems, while at the same time adjusting to increasing classroom ratios that provide additional income for the educational institutions but not the educators. respondents identified bias as a barrier to leadership opportunities. connections with current university leaders, who are frequently white men, contributed to participants' socialization into leadership, especially at predominantly white institutions (pwi). lack of connections with current university leaders, especially at pwi, was a disadvantage for participants of color seeking leadership opportunities. as one participant expressed, i believe that my experiences as a male of color who grew up below the poverty line in a field dominated by white middle class women provides me a good sense of perspective in terms of members of out groups and how they are discussed in our program. i have been challenged annually over the years regardless of whether or not i have been in a leadership position by both university personnel and my colleagues… (caucasian/latinx, male, associate professor, tenured) ageism was found to be a bias barrier when “older” individuals felt they were not given serious consideration by younger colleagues. introversion as a personality characteristic was also identified as a reason why some participants have been passed over for leadership positions. one participant captured both sentiments, stating, advances in social work, summer 2024, 24(2) 492 as i have grown older in my role, i have observed that even though i am more qualified than ever for leadership, i am more likely to be overlooked by younger people. that is disheartening in social work. i am also shy and introverted, so i am not noticed for my potential, and i am not likely to grab at opportunities the way more extroverted people do… i have felt overlooked and not recognized for all that i do and can bring to the table. (white, italian, ashkenazy, irish, female, professor, tenured) when discussing leadership within social work education professional organizations, participants expressed that not being part of internal networks lessens the available opportunities as well. as one participant voiced, social work organizations seem, from my experience, to be quite adept at limiting leadership opportunities to fairly tight networks of close acquaintances and peers…[in] general it is who you know and who knows you… paves the way to leadership. (white, male, professor, tenured) participants expressed time as a barrier to managing workloads and personal lives while working to achieve tenure and get promoted. with a lack of available opportunities for untenured faculty, they focus on moving to tenure status as a goal, before focusing on leadership opportunities and development. educational preparation to develop organizational leadership skills was not readily available to social work graduate students at some institutions. there was a described gap in leadership, supervision, and management training in undergraduate, graduate, and doctoral social work education. as one participant highlighted, so few courses address leadership among social workers…i never learned practical skills about supervision and management that are so important for being an effective leader. the most relevant skills that i have are related to goal setting, objective setting, and strategic planning...i only learned these organizational skills because i took extra macro courses. (caucasian, female, assistant professor, tenure track) without the resource and time investment from university administrators, potential leaders may struggle to function effectively. barriers also existed for individuals offered a leadership opportunity. when asked, have you ever declined a leadership position, or chosen not to pursue a leadership position, 33 participants stated that they had declined leadership roles. in the open-ended follow-up question, participants expanded that they declined leadership opportunities due to the projected struggles in managing the added responsibilities. reluctance due to personal sacrifices was found to be a major factor for participants not actively working towards formal leadership roles, especially those at large, public, doctoral institutions. additional factors included the increased time commitment and administrative work added to teaching loads. as one participant stated, “…when i do good work, i am presented with more work because i am trusted…” (caucasian, female, bsw program director, director of field, not tenure eligible). chiarelli-helminiak et al./swk ed leadership 493 participants expressed that within the demands of managing teaching and scholarship responsibilities, leadership roles often come with a personal cost. other factors included lack of interest, inadequate resources, a dysfunctional environment, the need to relocate, not being able to identify clear benefits, and the role not aligning with social work values and ethics. preferring to support leadership was an option to build leadership skills for some respondents; while other participants declared leadership was not valued as worthy of one’s interest or time. achieving tenure was a hurdle for some participants who expressed challenges with managing their various job responsibilities. there was also an expressed hesitancy to take on the personal cost of leadership that may jeopardize future tenure and promotions. as one participant shared, as a brand new, assistant professor, i was asked to take over the administration of the women and gender studies program… i said no to the opportunity. the chair of my department was quite frustrated that i did not take that opportunity… if i had taken the opportunity, it would have derailed my research, which would have derailed my application for tenure… (european american, femme, associate professor, tenured). another participant expressed, the challenge to leadership is the slow climb. you step into an academic leadership role and it is difficult to exit and also difficult to advance. while leadership can be a great role, it often takes you away from teaching and research… if i could find a way to do both as well as leadership i would be more eager to take on that role (white, female, assistant professor, tenure track). politics were overwhelmingly described as a factor that defines who is chosen and given leadership positions, especially at public master’s and doctoral granting institutions. participants were interested in leadership when invited but noted that organizational politics often interfered with leaders’ ability to make decisions and enact higher level change. to put this into context of the larger study, the overall group were asked if anyone had suggested that they should take on leadership roles within social work education. forty-eight of the 88 total participants reported being recruited for leadership. in the follow-up question, co-workers and mentors were identified as who most often made the suggestion, yet even with encouragement these 48 participants were still not willing to take on the formal roles. discussion implications for social work education programs the findings highlight several implications for social work education programs. leadership development begins long before social work program faculty and staff begin at a university. leadership development begins with students at the bachelor’s and master’s levels and should be strengthened at the doctoral level as we prepare the next generation of higher education leaders. with only half of the participants reporting that their social advances in social work, summer 2024, 24(2) 494 work education adequately prepared them for leadership, cswe must consider whether to mandate curriculum specific to leadership development so students are ready to lead organizations and eventually educational programs (peters & hopkins, 2019). with the cswe 2022 epas’ emphasis on engagement of adei, leadership courses should have at minimum modules on feminist leadership and intersectional queer praxis as models aligned with social work values and ethics (lazzari et al., 2009; mehrotra, 2023; nasw, 2021). resources for curriculum development were previously curated by the cswe council on the role and status of women in social work education (2017) and offer a starting point for further expansion in social work programs. cswe must also consider whether the minimum release time for program directors is adequate. a first step would be addressing inequity in the epas by increasing bsw program directors’ minimum release time to 50%, equitable with msw program directors’ release time. although the respondents to this survey under-represented social workers of color and should therefore be interpreted through that limitation, we did find some patterns in responses related to identity. the responses captured in the preparation for leadership theme were mostly not tenure eligible participants with a combination of diverse racial identities. in contrast, the participants’ responses in the supports subtheme were mostly white tenured female educators at large, public, doctoral universities, while respondents whose responses were coded within the barriers theme included diverse races, gender identities, and tenured status mostly at public universities classified as master’s and doctoral institutions. the triangulation of these findings indicate that those who identify as white and non-hispanic were supported to move into leadership more frequently than faculty of color, while racially diverse faculty with less status (i.e., not tenure eligible) are interested and prepared for more leadership, but often not offered such opportunities. this is especially important for public universities with an access mission; as the student population diversifies, so must the leadership profile. individuals may feel more supported to enter leadership positions due to social validation related to their social identities, including white tenured females as they fit into the white culture of academia, while tension persists related to the patriarchal system that remains in most universities. faculty and staff of diverse identities and not on the tenure track also benefit from encouragement to pursue roles from other educational leaders, as peer validation is motivation to pursue and thrive in leadership roles knowing they have supporters and mentors. there is a substantial need to provide training, help new faculty and staff develop relationships, and identify a wide range of individuals with diverse social identities to consider leadership early as they plan out their academic careers then continue to support and encourage them in formal and informal leadership roles. in addition, more research with a diverse set of participants is needed. participants also shared their university’s expectation that leaders successfully navigated the tenure process. tenure status is a privileged position to hold as it provides job security and academic freedom necessary in a political profession such as social work. yet, the responsibilities and expectations of the tenure track may be in conflict with the responsibilities of leadership roles. this is not to say that holding a pre-tenure leadership position is not possible, as many have successfully done so and is sometimes necessary in smaller social work education programs, but these findings suggest institutions need chiarelli-helminiak et al./swk ed leadership 495 consideration of succession planning and supporting faculty in both their tenure pursuits and leadership position. the tenure requirement for leadership must also be considered within the context of tenure track positions decreasing across the higher education landscape as universities increasingly hire temporary employees to teach. a decrease in tenure track positions paired with increasing temporary positions inadvertently reduces the future social work education leadership pipeline, especially the potential increase in future leaders with diverse social identities. tenure remains an important component of university life and academic freedom, therefore social work leaders must find ways to maintain or increase tenure track positions within their programs. implications for social work leaders social work leaders sit at the intersection of universities which are generally hierarchical structures and professional mandates for anti-oppressive and collaborative praxis. it is critical that social work education leaders analyze individual and systemic dynamics from a structurally competent approach (avruch & shaia, 2022). this includes examination of our roles within institutions which may not provide additional compensation for administrative work, hold expectations for unpaid service, often done by women and people of color, and the elimination of administrative support personnel in many institutions as cost-saving measures. from a structurally competent frame, social work education leaders must also advocate for leadership training and thoughtful succession planning as a step toward strengthening their program and supporting future social work leaders. coaching with its focus on professional development, implementation of goals, and organizational processes (rondero hernandez & douglas, 2022) is a way to transfer feminist leadership skills during times of transition. current social work education leaders are also invited to provide transparency regarding the duties of their position with all unit members to offer space for any interested colleagues to better understand the responsibilities associated with the leadership role. leaders must lead with intention. within our profession, leaders have a higher burden given their position and responsibility to model the implementation of social work values and ethics within their leadership praxis. social work leaders have the opportunity to shift the current neoliberal corporate higher education model. we do not purport that this will be an easy or fast change. organizational cultural shifts are difficult because universities are intentionally designed as hierarchical organizations. even institutions with a mission to be more inclusive are challenged within hierarchies because job responsibilities often go beyond job descriptions and university politics make it difficult to pinpoint one’s position on the social pyramid. yet, if change is to occur, there is a need for social work education leaders to adopt a more intentional feminist model of leadership that incorporates intersectional queer praxis (lazzari et al., 2009; mehrotra, 2023). advances in social work, summer 2024, 24(2) 496 proposed model of social work education leadership praxis this research provides an opportunity to propose a model of social work education leadership praxis grounded in professional values and ethics, critical feminist principles, and intersectional queer praxis intended to facilitate change within the academy (lazzari et al., 2009; mehrotra, 2023; nasw, 2021; peters & hopkins, 2019). the purpose of a social work-specific leadership praxis for higher education is an expansion of peters and hopkins’ (2019) leadership principles intentionally applied to facilitate change which ultimately benefits service users (i.e., students). while peters and hopkins specify positive change, we acknowledge that whether change is positive is subjective and a leader cannot know if change is perceived as positive until after implementation and evaluation. below, an initial attempt to conceptualize a model is proposed, but further research is necessary. the proposed model of social work education leadership praxis includes five components: empowerment of the leader, faculty, staff, and students; promotion of organizational health; grounding in social work values and ethics; enhancement of organizational capacity; and promoting social work within the university. as mehrotra (2023) encouraged “build your theory, reflect, take action, reflect on the impacts of actions, and continue to refine as you go… [because] praxis has transformative aims” (p. 558). empowerment the first component of social work education leadership praxis is the empowerment of the leader, faculty, staff, and students aligned with the program. empowerment is a key component of social work practice, and aligns with participants’ identified skills and characteristics. many of the personality characteristics (authenticity, comfort with groups, flexibility, follows through, hardworking, honest, intentional about leadership style, internally motivated, respectful, thoughtful, trustworthy, understanding what the team members need for motivation, and willingness to accept success short of perfection), organizational skills (can say no, knowledgeable, mentorship, and willingness to receive feedback), social work-specific skills (balances social work and educator roles and up-todate on practice needs), and values (collaboration and teamwork) aligned with peters and hopkins’ (2019) leadership principles, lazzari and colleagues (2009) feminist principles, and mehrotra’s (2023) call for intersectional queer praxis. organizational health the second component of social work education leadership praxis is the organizational health of the program within the context of the larger university. participants reported organizational skills (delegation, goal and objective setting, and willingness to address conflict), social work-specific skills (eco-systems lens for assessment), and values (communication, democratic decision making, and fairness) in line with peters and hopkins’ (2019), lazzari and colleagues (2009), and mehrotra’s (2023) conceptualizations of leadership. chiarelli-helminiak et al./swk ed leadership 497 organizational capacity the third component of social work education leadership praxis is the enhancement of organizational capacity. organizational capacity is related to the resources necessary to develop and sustain initiatives that realize a social work education program’s mission. this can include human and physical resources, as well as skills possessed by leaders, faculty, staff, students, and alumni (peters & hopkins, 2019; toma, 2010). participants identified personality characteristics (gives team credit, imaginative, and innovative) and organizational skills (development and fundraising, forward thinking, management, marketing, professional development for self, risk analysis and assessment, strategic planning, supervision, team management, training for faculty and staff, and visionary) aligned with peters and hopkins’ (2019) and lazzari and colleagues (2009) conceptualizations of leadership. social work values and ethics the fourth component of social work education leadership praxis emphasizes the inherent nature of social work as a feminist profession (collins, 1986) that disrupts “neoliberal and normative assumptions” of the academy aligned with intersectional queer praxis (mehrotra, 2023, p. 556). participants identified personality characteristics (intuitive, respectful, serves when asked), organizational skills (balance task and socioemotional behaviors), social work-specific skills (apply social work values and ethics, commitment to service, social justice, and human rights; grounded in values, and up-todate on social work practice needs), and values (democratic decision-making and humanistic approaches) compatible with peters and hopkins’ (2019), lazzari and colleagues (2009), and mehrotra’s (2023) leadership concepts. promotion of social work the fifth component of social work education leadership praxis is the promotion of social work within the context of the university system. applying an eco-systems lens, social work education programs are one part of the larger university system that is influenced by other exo, macro, and chrono systems (bronfenbrenner, 2004; chiarellihelminiak et al., 2021). participants identified organizational skills (networking) and social work-specific skills (advocacy, shows what social work does as essential to the university, and understands and promotes how social work fits into the larger scheme) in line with peters and hopkins’ (2019) and lazzari and colleagues (2009) leadership concepts. advances in social work, summer 2024, 24(2) 498 table 2. components of social work education leadership praxis component personality characteristics skills values organizational sw specific empowerment • authenticity • comfort with groups • flexibility • follows through • hardworking • honest • intentional about leadership style • internally motivated • respectful • thoughtful • trustworthy • understand what the team needs for motivation • • willingness to accept success short of perfection • can say no • knowledgeable • mentorship • willingness to receive feedback • balances sw & educator roles • up-to-date on practice needs • collaboration • teamwork organizational health • • delegation • goal/objective setting • willingness to address conflict • eco-systems lens for assessment • communication • democratic decision-making • fairness organizational capacity • gives team credit • imaginative • innovative • development/fundraising • forward thinking • management • marketing • professional development • risk analysis/assessment • strategic planning • supervision • team management • training • visionary social work values & ethics • intuitive • respectful • serves when asked • balance task & socioemotional behaviors • apply sw values & ethics • commitment to service, social justice & human rights • grounded in values • up-to-date on sw practice needs • democratic decision-making • humanistic approaches promotion of social work • networking • advocacy • shows what sw does as essential to the university • understand & promotes how sw fits into the larger scheme advances in social work, summer 2024, 24(2) 499 limitations and future research limitations within this research are acknowledged. as data were self-reported, participants may have had personal reasons to participate in a survey related to leadership different from those who opted to not participate, therefore all responses are assumed to contain some response bias. the participants in this study all work within the united states and future research should include social work education leaders from a variety of countries in other academic contexts. participants were also slightly less diverse than the demographics as reported by cswe (2020). given that cswe only provides data on social work faculty, not administrators and staff, we assume this to mean those in administrative and staff positions were less diverse than faculty, as other researchers have suggested (bryan et al., 2019). more research should be done to examine whether these results hold true for people of color and others who were under-represented in the research. further research is necessary to document the social identities of those in management and administrative positions. while many universities, and social work programs in particular, have sought to diversify their faculty, higher education institutions must strive to have diversity represented throughout university positions, especially those who have decision-making capacity in recruitment, practicum placements, and management roles. specifically, modifying peters and hopkins’ (2019) social work leadership measure for applicability in the higher education host setting is an ideal next step to further this line of inquiry and praxis. findings could result in identifying areas for improvement within social work education programs, to enhance leadership capacity, and identify curricular enhancements for students’ leadership development (p. 107). researchers are also invited to extend this research to include the perspectives of current university leaders, beyond just social work education. impact of covid-19 the covid-19 pandemic created limitations for this research in two ways. first, the onset of covid required an end to data collection, which lowered the sample size and may have resulted in respondents who are not typical of social work educators. second, since the covid-19 pandemic began, there have been significant changes within universities and social work programs which are not captured in this data. researchers will need to establish whether the findings here are consistent with the experiences of social work educators in a future still being reshaped by the covid-19 pandemic. conclusion the current research sought to examine factors related to social work faculty and staff decisions to pursue formal and informal leadership opportunities. the call to leadership is a need within social work education in order to fill leadership roles for program director, dean, and associate dean positions in accredited programs across the united states. without the proper resources available, such as mentorship, potential leaders are left feeling powerless and overworked without the inspiration to lead. social work education advances in social work, summer 2024, 24(2) 500 leadership from a feminist perspective has the potential to challenge the status quo within universities and lead with social justice work at the forefront of praxis. references american council on education. 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(2020). how do social work leaders understand and ideally practice leadership? a synthesis of core leadership practices. journal of social work practice, 34(3), 263279. author note: address correspondence to shannon lane, wurzweiler school of social work, yeshiva university, new york, ny, 10033. email: shannon.lane@yu.edu https://doi.org/10.18060/24949 https://doi.org/10.18060/24949 https://doi.org/10.3233/wor-2012-1409 https://digitalcommons.humboldt.edu/cgi/viewcontent.cgi?article=1016&context=hjsr https://digitalcommons.humboldt.edu/cgi/viewcontent.cgi?article=1016&context=hjsr https://digitalcommons.humboldt.edu/cgi/viewcontent.cgi?article=1016&context=hjsr https://doi.org/10.1080/00131720508984678 https://doi.org/10.1080/10437797.2016.1174644 https://doi.org/10.1177/0886109919836105 https://doi.org/10.1177/0886109919836105 https://www.bls.gov/ooh/community-and-social-service/social-workers.htm https://doi.org/10.1080/02650533.2019.1665002 https://doi.org/10.1080/02650533.2019.1665002 mailto:shannon.lane@yu.edu this work is licensed under a creative commons attribution 4.0 international license. peer support groups: evaluating a culturally grounded, strengths-based approach for work with refugees azadeh masalehdan block leslie aizenman adam saad stephanie harrison amanda sloan simone vecchio vanessa wilson abstract: many refugees will face unique socio-emotional stressors before, during, and after resettling in their new home country. the program presented herein focuses on the use of para-professionals, peer educators, from within refugee communities to build upon the center for torture and trauma survivors clubhouse model. group leaders seek to provide supports that will: 1) decrease feelings of isolation; 2) build community networks and; 3) increase feelings of empowerment within the community. to accurately represent the fluidity of the refugee population in this metropolitan region, background is presented on an established refugee population from iraq and a more recent influx of refugees of bhutan (ethnic nepali). the juxtaposition of the two groups underscores the importance of presenting a dynamic program that is peer-led to provide the supports necessary to acclimate to their new environment. program evaluation results from groups run in 20162017 indicate that the groups have been successful in helping participants make friends, get information, become more independent, and feel better about life in america. additionally, participants report a significantly higher number of individuals who they can “talk to about problems or worries” and connect to with a sense of trust within their ethnic community. finally, the utility of other therapeutic and support processes, such as horticultural and expressive arts therapies, are discussed apropos work with refugee populations. keywords: refugee; peer support; social work; community; group work background and significance according to the united nations high commissioner for refugees (2010), a refugee is someone who "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country" (p. 3). refugees come from a variety of locations around the world, and each refugee carries with them a unique set of values, cultural _________________ azadeh masalehdan block, msw, phd is an assistant professor, department of social work, california university of pa, california, pa. leslie aizenman, mppm is director of refugee services at jewish family and community services of pittsburgh, pa. stephanie harrison, ma and adam saad, ma are affiliated with chatham university, pittsburgh, pa. amanda sloan is a student at the school of social work, university of pittsburgh, pittsburgh, pa. simone vecchio, mid is a project manager at jewish family and community services of pittsburgh, pa. vanessa wilson, ms, is a statistician at the oregon health authority, salem, or. copyright © 2018 authors, vol. 18 no. 3 (spring 2018), 930-948, doi: 10.18060/21634 https://creativecommons.org/licenses/by/4.0/ block/ peer support group evaluation 931 identity, and language. refugees do not choose to relocate themselves but are instead compelled to leave their countries in order to protect their lives and/or their freedom. refugees are subject to a variety of stressors both before and after their resettlement. the events leading up to their displacement can be wrought with political violence, war, or related threats (cole & blythe, 2010). many refugees will have been subject to some form of trauma either directly or indirectly. refugees from collectivistic cultures will often share traumas of oppression, discrimination, and torture through a collective identity (karcher, kuperminc, portwood, sipe, & taylor, 2006). however, individuals of a certain nationality may experience persecution or trauma because of their belonging to a certain subgroup. this is prevalent in cases of ethnic and religious persecution. it is common for researchers and practitioners to focus on the trauma that refugees have endured; therefore, the majority of treatment programs for refugees focus on symptoms of post-traumatic stress disorder (ptsd, obradovic, tirado-strayer, & leu, 2013; watters, 2001). symptoms of ptsd can include difficulty sleeping, bad dreams, and loss of interest in activities. this can be a major concern for health care providers of refugees as ptsd can be difficult to treat in cultures where psychotherapy is not widely accepted. nevertheless, it is important not to label all refugees as suffering from some type of pathology because they are all individuals going through extraordinary circumstances. health care professionals should be conscious of cultural differences that may arise when interacting with refugees, and to seek strengths-based approaches for work with clients (congress & chang-muy, 2015). various cultures have differing concepts on time management, family dynamics, and social interactions. often the circumstances that refugees experience upon resettlement may also be complex and can include poor school systems, poverty, unsafe neighborhoods, and bullying (cole & blythe, 2010; mentor, 2009; schweitzer, brough, vromans, & asic-kobe, 2011). social workers and others working with refugees must consider and acknowledge cultural differences on the pathway to acculturation/assimilation. after resettlement, a variety of factors can affect refugees: feelings of isolation, depression, and somatization. research that studied the mental health of refugees and their resettlement found an association between post-displacement conditions and mental health outcomes (kaslow, 2014; porter & haslam, 2005). therefore, psychopathology among refugees is not necessarily a consequence of posttraumatic wartime stressors but can reflect contextual factors about the displacement process (kim, 2013). in order to provide adequate care to refugees, it is necessary to realize that the stressors that are a part of their resettlement can have significant impacts on their mental health (shannon, vinson, wieling, cook, & letts, 2015). the psychological consequences of displacement cannot simply be labeled the product of acute stressors of trauma but should instead be understood in the context of the economic, social, and cultural conditions from where the refugees are displaced and those in which they are resettled (shannon, wieling, simmelink-mccleary, & becher, 2015). this paper presents the results of a program evaluation designed to obtain information about social services desired and utilized in an urban/suburban population of immigrants and refugees engaged in a peer-support group. agency administrators at a pittsburgh based advances in social work, spring 2018, 18(3) 932 jewish family and community services (jfcs) chose a strengths-based peer support model for myriad reasons, including, but not limited to: cultural sensitivity, costeffectiveness and face validity in promoting social integration. program goals included: 1. decrease feelings of isolation, 2. build community networks, and 3. increase feelings of empowerment within the community. literature review group work with refugees jfcs assists refugees in several ways: gaining access to welfare, english as a second language programs (esl), accessing health services, and assistance in green card applications. additionally, jfcs provides acculturation workshops to refugees with information about topics such as safety, hygiene, healthcare, u.s. laws, public benefits, employment, banking and budgeting, etc. as it applies to health, these workshops also stress the importance of preventative care as opposed to reactionary health care. however, the needs of the refugee populations extend beyond the confines of an acculturation workshop. connecting clients with support networks is a critical tool in the broader issue of addressing social and mental health. a strengths-based group therapy approach to working with refugees addresses the need for community healing of the refugee population (drozdek & bolwerk, 2010; im & rosenberg, 2016; kira, ahmed, mahmoud, & wassim, 2010). this strengths-based approach is culturally appropriate, flexible, and tailored to the unique needs of this population. many clients of jfcs belong to collectivistic cultures in which healing takes place within the community. individual psychotherapy is often steeped with individualism and western ideals, which may not coincide with the refugees’ cultural values. additionally, because refugees often experience cumulative trauma, challenges to personal identity as well as community and social identity occur. in order for community and social identity to be repaired, a group therapy approach targeting collective self-esteem and rebuilding group identity are essential (drozdek & bolwerk, 2010; kira et al., 2011). research with this population suggests more positive outcomes for refugees receiving group therapy compared to those receiving individual therapy (bass et al., 2013). peer models have been used successfully in immigrant/refugee acculturation programs throughout the world including peer education programs for communicable illnesses (broadhead et al., 2002; thomas, clarke, & kroliczak, 2008); whereas support groups have been efficacious in treating numerous populations ranging from addiction to new parent support groups (yalom, 2005). research suggests that after social support interventions, refugees reported increased social integration, decreased loneliness, and healthier coping skills (stewart, simich, shizha, makumbe, & makwarimba, 2012). a strengths-based support group model embraces concepts like cultural humility and competence as it is rooted in community growth and strength. researchers have suggested that having others from their homeland as a part of the group welcoming and acclimating them to their new surroundings helps in easing into the transition to a new location (kaslow, 2014). therefore, a peer-administered social support group is an excellent fit for the growing refugee communities in allegheny county as it is grounded in the communities’ natural block/ peer support group evaluation 933 support system, is a strengths-based approach, and is sustainable as peers learn the tools to empower and continually learn from and support one another. additionally, because refugees are less likely to use traditional mental health services, the strengths-based peer support model provides a much-needed outlet for social and emotional healing (cole & blythe, 2010). in fact, the use of peer models may have a positive impact on stigma in using mental health services aiming to potentially empower the community in addressing mental health issues from within (thomas et al., 2008). evidence suggests that refugees are likely to seek out services based on meeting their hierarchical needs (food and shelter before education) (geltman, augustyn, barnett, klass, & groves, 2000). this approach is also economically practical as it has the ability to address the needs of several individuals concurrently, and the cost of staffing is less than that of a traditional mental health group. peer support models with refugees peer-led interventions start from a point of commonality. in the realm of health outcomes, have been proven to increase positive outcomes in members of their community (im & rosenberg, 2016; webel, okonsky, trompeta, & holzemer, 2010). extensive research has been done using the promotores model and it is well-documented that this peer health education model is beneficial to client health outcomes. a recent meta-analysis found that peer groups are especially effective with hard-to-reach and cultural minority populations--further evidence that the peer model is the right fit for the populations and communities in the pittsburgh region (webel et al., 2010). in researching best practices for strengths-based support group work with the refugee population, several “best practice” guidelines were identified. these included: a community-based model focused on present stress first and past trauma second, homogeneity of members, flexible but structured sessions, and community network building (kira et al., 2011). jfcs has adapted the center for torture and trauma survivors’ (ctts) clubhouse model for use with the refugee and recent population in allegheny county. the ctts clubhouse model follows each “best practice guideline” and was adapted to fit the needs of refugees from numerous cultural backgrounds. it is critical that evidence-based practice (ebp) be the centerpiece of the work with these populations. ebps include a grounding in empirical evidence coupled with integration of the latest research evidence: a critical combination for effective treatment with clients who may have additionally experienced trauma (strand, popescu, way, & jones, 2017). the clubhouse model is a culturally sensitive, adaptable, and sustainable model that provides evidence for therapeutic efficacy. several organizations around the globe have adopted similar support group models including: freedom from torture based in the u.k, the bellevue/nyu program developed by dr. hawthorne smith, the advocates for survivors of torture and trauma model based in baltimore, and nah we yon, an african women’s refugee support group based in new york city. all of these organizations have documented the economic and therapeutic sustainability of their adaptations of this model. advances in social work, spring 2018, 18(3) 934 jfcs peer support program jfcs has adapted the ctts clubhouse model for use in an eight-week open format support group (sometimes separated by gender depending on the ethnicity). the group follows an open format in that men or women are invited to participate and drop-in attendance is permitted. the concept behind the drop-in attendance is to allow the communities to view the group as being open, and in tune with cultural mores, where attendance does not prevent an individual from participation. peer facilitators receive training at jfcs in group dynamics, cultural sensitivity, and recognizing and referring individuals: 1) in need of mental health services, or 2) at risk of harm to self or others, to the appropriate resources. peer facilitators are encouraged to check in with group members via telephone or email in order to facilitate communication and develop stronger bonds and to acknowledge that pressing questions or concerns cannot always wait until the next meeting (fischhoff, 1986). allowing group members to check in with the facilitators or other group members in between sessions serves to strengthen the group’s sense of community and build upon community ties that are being built during group sessions. pre/post group assessments are conducted in the first session (in person) and after the final session (via phone using an interpreter) in order to obtain data on the progress of the group. following best practice guidelines, the ctts clubhouse model combines a variety of therapies into one cohesive strengths-based support group environment. ctts developed groups for iraqi men, women, and families, burmese men, bhutanese (ethnic nepali) families, and pan-african women who have survived torture, trauma, and oppression (kira et al., 2011). session content includes: emotional exploration, education on topics ranging from building a resume to symptoms of ptsd, traditional healing methods such as dance and movement therapy, art and music therapy, as well as meditation, storytelling, cooking and eating, and bead working have been used depending on the preference of the group. the emotional exploration provides community building, normalization, support, and acceptance, which can lead to decreased feelings of isolation, depressive symptoms, anxiety, and ptsd symptoms (kira et al., 2011). exploration of current life stressors, acculturation issues, religious, and political issues are common. the education involved in the session largely depends on the needs and desires of the clients. members suggest topics for discussion allowing the concrete, present needs of the individuals to be met. this also allows the clients to feel empowered and strengthened by decision-making and knowledge. members are able to brainstorm, use problem-solving skills, and learn from one another thus producing community network building, community self-esteem, and a sense of support (lubin, loris, burt, & johnson, 1998). jfcs was not able to obtain any formal training curriculum from ctts. a manual was created based on evidence-based practice with peer-led groups for refugee populations completed by ctts and described by kira et al. (2010) and kira et al. (2011). the manual includes two sections, part 1: basic instruction and information on group dynamics, group participation styles and how to manage groups effectively; and part 2, which offers a curriculum that can be tailored to meet the needs of each unique population and provide block/ peer support group evaluation 935 the resources needed. the ten different content areas to be covered over the eight weeks (i.e. some weeks may include more than one content area), see table 1. table 1. ctts weekly content areas section(s) content area 1 an introduction and overview of group structure and foreshadowing for more distinct content 2 life in a different culture: which focuses on issues of acculturation 3 & 4 taking care of yourself: which focuses on tools for self-care and stress management 5 health care in the united states: which provides group members information on how to seek health care in the united states 6 building a strong support system: which provides instruction on identifying friends, family members and other resources who they can turn to for support and help 7 family life in the united states: which helps group members identify the differences between family life in their native countries and give group members an opportunity to discuss challenges they’ve faced in adapting to family life in the united states 8 employment: which helps participants to recognize and promote their personal strengths to improve chances of employment 9 legal immigration and naturalization issues: which provides group members with needed information on legal issues regarding immigration and naturalization 10 final session: which provides for debriefing, identifying next steps and connecting group members to new resources as necessary homogenous groups are generally preferred when working with refugees (fischman & ross, 1990). the ctts clubhouse model also stresses the importance of homogeneity within the groups, including homogeneity by ethnicity, gender and if possible, age. the principles guiding these decisions are that the more similar the experiences among group members, the greater sense of community built between members, collective self-esteem, and greater cohesion leading to better outcomes for each individual. according to yalom (2005), groups are ideally homogenous for earlier work and heterogeneous, mixed groups may be best for an advanced group setting. in many cultures, it is taboo for women and men to discuss together many of the social, political, and economic topics that could be content for a support group. both genders may feel uncomfortable opening up and sharing issues that may prove beneficial and healing when discussed separately. additionally, women and men may also differ in their level of interest in the topics discussed. for women, themes such as care for family, particularly during war, relationships, and parenting issues commonly occur (kira et al., 2011). for men, these topics seem less important making a mixed gender discussion on these issues less effective. according to the ctts clubhouse model, mono-ethnic groups are also important in creating ethnic-specific expression, greater ethnic identification, and collective selfesteem. these groups seem more effective and practical, as mono-ethnic groups have advances in social work, spring 2018, 18(3) 936 shared experiences, language and culture. age may also be an important factor in separation of groups; however, gender and ethnicity seem to be most important. nevertheless, because the more similar the experience among group members the better, a 65 year old iraqi male refugee may have different needs than a 17 year old iraqi male refugee. at jfcs all of the groups are mono-ethnic while only some of the groups are mono-gender. paraprofessional community members facilitate and lead these groups following the model, training and handbook created by jfcs staff. by using leaders within the refugee community jfcs builds on the natural supports already existing within the community. using a similar argument used as homogeneity of group members, jfcs feels that community members are able to relate and build collective self-esteem better than mental health professionals outside of the community again, due to shared experience, language, and culture. training and challenges of peer facilitators are discussed in detail later. refugee characteristics the characteristics of refugees both before and after their displacement can be predictors of mental health. female refugees tend to have worse mental health outcomes than male refugees (porter & haslam, 2005; ringold, burke, & glass, 2005). older individuals have a more difficult experience with the resettlement process while children and adolescents are less affected by the stresses of displacement (porter & haslam, 2005; ringold et al., 2005). higher levels of education and socioeconomic status were also found to be predictors of poorer mental health outcomes (porter & haslam, 2005; ringold et al., 2005). once refugees arrive, they can encounter unstable living environments and a lack of economic opportunity, which can further place them at risk for poor mental health outcomes (cole & blythe, 2010). soon after arrival, children and youth face a unique complication: they often attain language fluency quickly and, as a result are often negotiating the complex role of being an interpreter and culture-broker for parents and elders in their community (cole & blythe, 2010). this displacement of power and cultural expectations can make the acculturation process even more burdensome to families. in the following section, critically important history and data about cultural uniqueness will be discussed to underscore the flexibility of the ctts model to provide services to an established refugee community and to a newer, growing community in the region. iraqi community administrators at jfcs chose to root their group in the ctts model because this model has an evidence base for use within the specific communities prevalent in pittsburgh, pa. in speaking with bhavini solanki-vasan (personal communication, may 12, 2013), the former clinical director of family intervention specialists at ctts, “iraqi refugees seem to be much more focused on obtaining jobs and housing rather than addressing any trauma or current stress they have endured.” she recommends an adaptation of the original model with the inclusion of a solution-focused approach (based on solution-focused therapy) for iraqi refugees. block/ peer support group evaluation 937 solution-focused therapy involves setting clear, specific, and attainable goals and working in small increments to achieve these goals (malan, heath, bacal, & balfour, 1975). this type of therapy is used at the family center located in milwaukee with documented success with refugees as well as with other abuse and trauma victims. this strengths-based approach is clearly utilized in work with all clients at jfcs and is incorporative of creating self-sufficient goal setting capability. peer educators focus on long term goals for clients and utilize group work to share strategies to successfully engage clients in the pittsburgh services, communities or work forces that will improve life circumstances. because of the conservative nature of iraqi culture, homogeneity of groups by gender is extremely important to the success of the group. sensitive issues are bound to come up and clients will be more apt to speak openly about these if there is a single gender group. many individuals who flee their home countries because of changing geo-political factors that result in some aspect of their identity (e.g., being a member of a minority religious sect) putting them at risk of peril often have family still living in their home country (rosseau, mekki-berrada, & moreau, 2001; simich, hamilton, & baya, 2006; turner, bowie, dunn, shapo, & yule, 2003). a study done with iraqi mandaneans, a small pre-christian sect, prior to the war in 2003 demonstrated high rates of ptsd (29%) and/or prolonged mental health disability (54%) in this minority refugee population (steel, silove, brooks, momartin, alzuhairi, & susljik, 2006). furthermore, research has found that iraqi refugees who still have family in iraq are more likely to experience an increased mental health disability in addition to ptsd and depression (nickerson, bryant, steel, silove, & brooks, 2010). observations done over the past three years of groups in the iraqi community of jfcs underscore these findings in that support group members speak about trauma related to their experience in iraq and/or their experience of resettlement in the usa (jfcs, 2016a). the clinical observer for the iraqi peer support group additionally observed participants developing friendships and community relationships, increasing knowledge about resources in the community, and venting frustrations/identifying solutions with issues regarding their resettlement (jfcs, 2017a). the group has provided an opportunity for education and networking opportunities for the refugees. members report that it has been cathartic just to speak about these issues as it alleviates feelings of isolation. some of the issues the group is currently grappling with include intergenerational conflicts, deaths of family members in iraq, experience of discrimination from employers and the recognition/conferral of degrees and titles from iraq in the us (jfcs, 2016b). the iraqi group maintains cultural traditions, such as the sharing of fruit, tea and pastries at their meetings; group leaders are given a budget to provide snacks or items to facilitate group cohesion (jfcs, 2016a). the three tenets of the ctts model are followed while tailoring the group approach to the iraqi population and the unique challenges they face in the pittsburgh region. advances in social work, spring 2018, 18(3) 938 bhutanese community the ctts clubhouse model has provided group therapy to the bhutanese, ethnic nepali (persecuted and forced to flee bhutan over 20 years ago) community in the past where they incorporated a community representative to lead their groups. a primary goal for the bhutanese group was to develop a social organization for the bhutanese community, which in turn would facilitate community healing. developing social networks can be critical in creating support within the community through mutual sharing of experiences, collective problem solving, and the reduction of feelings of isolation (miller, 1999). currently, the bhutanese community has a good infrastructure for connecting with its community members. through the use of the bhutanese community association of pittsburgh (2016) established in 2012, information is distributed through their weekly community bulletins. these bulletins are done through online video, which makes the information easier to obtain for many bhutanese due to the high rates of illiteracy within their population. sessions have an emphasis on the emotional exploration aspect of the ctts model as research suggests that the bhutanese will greatly benefit from exploration through discussion and shared stories. seminal work done over nearly twenty years underscores the central use of “folk” stories as a way to observe social worlds and to understand the female sense of self in nepalese (specifically southeastern tarai culture) (davis, 2014). storytelling allows the group members to engage with each other in a manner that allows for collective healing. ctts uses basic stress coping techniques that could be employed in this model. such techniques included the use of laughter and humor where group members were encouraged to share humorous events relating to their present situation. the goal was to help normalize issues, deal with stress, and allow for the group members to engage in healthy laughter. other group activities used within the bhutanese community are culturally grounded. these include yoga and meditation, which provide a spiritual approach to the group meetings. the groups being run by and for the bhutanese community use yoga, breathing techniques, mind/body techniques, music, storytelling, citizenship, active participation from group members and discussions of resources and cultural differences (jfcs, 2016c). groups ranging in size from 15-40 typically meet early in the day on saturday. the group often starts with some light physical exercise to get everyone up, moving, and feeling connected to the group (jfcs, 2016d). next, group members are educated about important issues relevant to their resettlement. this could include the issues of underemployment or unemployment, use of public transportation, understanding different aspects of the public schools and their current emotional status (jfcs, 2016c). groups always include time for open discussion (topics can include gender roles, cultural beliefs, holidays, school practices) and this can sometimes include a compare/contrast session of how things were in the refugee camps or in their native bhutan. the time in the camps was very hard, and for some, may result in a diagnosis of ptsd (jfcs, 2015). there is a lot to process in terms of the social, economic and political differences between cultures; the group lends itself naturally to be the host of such conversations. block/ peer support group evaluation 939 program evaluation methods participants participants were adults that participated in a peer support group sponsored by jfcs between august 2016 and august 2017. two hundred-twenty unique participants participated in at least one group and completed pre-group and/or post-group assessments. post-group assessments were not completed by a large number of subjects. additionally, some individuals participated in multiple groups (n = 42). this analysis focuses on the 79 unique individuals who completed both preand post-group assessment. when a participant completed multiple sessions, data from the earliest session with both preand post-group assessments was included. note: when considering only first-time group participation, preand post-group data was available for 45 participants. the results obtained from that sample were qualitatively similar to those presented below, but not all results reached statistical significance due to reduced power. the majority of participants were bhutanese (ethnic nepali) (bhutanese: n=62; congolese: n=4; iraqi: n=10; korean: n=3; latina; n=2). these sample sizes did not allow statistical comparison between groups. design training peer educators presents various challenges for those supervising the group. the model utilized by jfcs stresses the importance of using lay leaders, from the communities they intend to peer educate, as they will be able to create a better dynamic within the group rather than using a professional social worker and interpreter. the layout of the 8-week sessions is described in the aforementioned literature review section. during the course of the sessions a clinical observer with a degree in social work sits in on one meeting (approximately 3 hours) for each group cycle. this individual does not have an interpreter and is there to observe group dynamics and group process; the individual debriefs with the group leader at the end of the session to ensure all content discussed is documented. yalom (2005) suggests that one supervisory hour per group session is the optimal ratio for leaders-in-training. however, this ratio is a guideline for mental health professionals and can be adjusted accordingly for peer leaders. measures the effectiveness of the support group was measured using an agency-specific pre/post survey that focused on the group goals. surveys were translated into the languages of the communities served. when clients were not literate, the surveys were intervieweradministered using interpretative services. the questions focused on one’s ability to utilize or obtain public transportation, employment services, health services, school, support networks, employment, food, bill payment, and read mail. group members are then specifically asked about feelings of hopelessness, size of their support network, group and leader satisfaction levels, likelihood of referring others to the group, and need for additional services or referrals. members are offered space on the pre and post surveys to write in additional comments as necessary. jfcs collects data on whether the survey was read to the member, or completed by the member independently. advances in social work, spring 2018, 18(3) 940 to ensure that accurate feedback is obtained, only individuals who have attended at least four of eight group meetings complete the post-survey. work, health issues, etc. can affect attendance any given week. jfcs has worked hard to limit the impact of childcare obligations and barriers to transportation by providing bus passes and/or group leaders assist in providing transportation to the groups and baby-sitting. locations of the groups are carefully determined based on where the participants live. results: paired samples analysis analyses mcnemar’s tests were used to compare the responses between preand postassessments for questions 1 and 2/3, i.e., are participants’ responses consistent or do they change between the pre-assessment and post-assessment? (note: binomial exact tests were used if cell counts were too low to use mcnemar’s test). questions 4, 5, 6 were scored from 0-2 based on a 3 level likert scale and were examined using non-parametric wilcoxon signed rank tests. due to modifications to the survey instrument and missing data, some items do not have data from all participants. participants who chose “does not apply” were treated as missing, as this was not an option on some survey versions. all analyses were completed using spss v. 25. expectations vs. outcomes. the majority of participants expected group participation to help them with all four items (making friends, getting information, becoming more independent, feeling better about life in america) and for most participants, these expectations were met (see table 2). however, there was a significant difference in responses for items “getting information” and “feeling better about life in america,” indicating that not all participants’ expectations were met for these two items (all ps<0.05). table 2. participants' expectations of how group will benefit them vs. reported benefit at post-assessment (n=78-79) uquestion uoutcome at post-assessment uexpectatio n uno uyes utotal % p make friends (n=78) no 0 2 2.6% 0.687 yes 4 72 97.4% total % 5.1% 94.9% get information (n=79) no 3 5 10.1% 0.017* yes 17 54 89.9% % 25.3% 74.7% become more independent (n=79) no 13 14 34.2% 0.286 yes 8 44 65.8% total % 26.6% 73.4% feel better about life in america (n=79) no 4 2 7.6% 0.007* yes 13 60 92.4% total % 21.5% 78.5% note. *significant at the p<.05 level block/ peer support group evaluation 941 ability to access services. for most items, participants were more likely to report ability to access at completion of the group. this change was significant for accessing transportation, health care, and ethnic community supports (all binomial exact tests, all ps<0.001). for example, 10 participants reported not being able to access health care before the group, but were able to do so at the end of the group, while only one participant reported change in the opposite direction. (see table 3 and figure 1 below). there was not a significant change for some items, e.g., accessing school and jobs. this may be due to changes in whether the person was in school or employed, which was not assessed. table 3. participants’ ability to access services (n=40-78) upost-group uquestion upre-group uno uyes utotal % p transportation (n=77) no 2 10 15.6% 0.039* yes 2 63 84.4% total % 5.2% 94.8% health care (n=78) no 2 10 15.4% 0.012* yes 1 65 84.6% total % 3.8% 96.2% jobs (n=40) no 14 13 67.5% 0.167 yes 6 7 32.5% total % 50.0% 50.0% school (n=60) no 3 11 23.3% 1.000 yes 10 36 76.7% total % 21.7% 78.3% ethnic community supports (n=75) no 2 24 34.7% <0.001** yes 1 48 65.3% total % 4.0% 96.0% daily needs (n=74) no 3 9 16.2% 0.664 yes 12 50 83.8% total % 20.3% 79.7% note. *significant at the p<.05 level, **significant at the p<.001 level feelings of hopelessness/loneliness, friends, trust. results indicated no significant differences between levels of hopelessness/loneliness before and after group participation. however, participants did report an increase in connection and sense of trust with their ethnic community between preand post-group assessment (z=-2.78,p pp = 0.005; see table 4 and figure 2). specifically, 28 participants showed an increase in this measure between the pre-group assessment and post-assessment, while 11 participants showed a decrease. additionally, there was a trend for participants to report an increase in the number of people in pittsburgh that they felt comfortable talking to about their problems or worries (p= 0.070). advances in social work, spring 2018, 18(3) 942 figure 1. participants’ ability to access services before/after grp participation (n=40-78) table 4. participants’ feelings about hopeless/loneliness, people they can talk to, feelings of trust in their community before and after participation. (n= 55-75) uquestion upost-group upre-group uhardly ever usometimes ua lot % p in the past 2 months, how often have you felt hopeless? (n=55) hardly ever 0 17 6 36.2% 0.244 sometimes 11 14 1 53.2% a lot 4 1 1 10.6% % 27.3% 58.2% 14.5% how many people in pittsburgh do you feel comfortable talking to about your problems or worries? (n=74) upre-group unone u1-2 u3+ % p none 0 0 2 0.0% 0.070 1-2 2 14 22 57.1% 3 or more 0 12 22 42.9% % 2.7% 35.1% 62.2% how much do you feel a connection and sense of trust with your ethnic community? (n=75) upre-group unone usome ua lot % p none 0 0 1 0.0% 0.005* some 0 19 27 63.3% a lot 0 11 17 36.7% % 0.0% 40.0% 60.0% note. *significant at the p<.005 level 84.4% 94.8% 0% 20% 40% 60% 80% 100% pre post transportation 84.6% 96.2% pre post health care 32.5% 50.0% pre post jobs 76.7% 78.3% 0% 20% 40% 60% 80% 100% pre post school 65.3% 96.0% pre post ethnic community 83.8% 79.7% pre post daily needs block/ peer support group evaluation 943 figure 2. comparison of “how much do you feel a connection and sense of trust with your ethnic community?” from pre-group to post-group assessment discussion results indicate that the participants felt significantly more independent and more connected with members of their ethnic community after participation in these groups. this indicates that the groups have been successful in two critical ways that help in the assimilation and acculturation of refugee populations. in general, participants showed an increased ability to access health care, job resources, transportation, school, and their own ethnic community. one surprising finding was that participants’ expectations were not met for “getting information” and “feeling better about life in america.” possible explanations for this may include the simultaneous ending of case management services, creating a gap in services for those who had not yet fully engaged in services like transportation, food/meals, health care, and employment services. perhaps feeling more connected to your ethnic community or acculturation may be indicative of the complimentary issue of assimilation to american culture. many of the individuals who have resettled from bhutan tend to be older (ages 45+) and research has shown that age is a significant factor in the lengthening the processes of acculturation and assimilation (cheung, chudek, & heine, 2011). limitations an important issue to note is that some individuals participated in these groups two, three, and even four times. the groups are designed for disparate states of assimilation/acculturation within groups. some individuals may feel they have reaped the benefits from the groups with one session (8 weeks) whereas for others repetition of concepts and supports may be necessary for internalization of key concepts and resources. as stated previously, only the earliest record of participation (pre/post) was used for individuals in which, this occurred. moreover, the agency may want to consider methods of recruitment for the peer groups so that repetition is less of an issue for future groups. power for this analysis was greatly reduced by the issue of repetition, and the sample size shrunk from 79 to 45. even more of an impact was the lack of data from the post surveys. 40.0% 63.3% 60.0% 36.7% 0% 20% 40% 60% 80% 100% post pre none some a lot advances in social work, spring 2018, 18(3) 944 future directions organizations around the globe are continuing to develop and test programs for refugees and their families (ostrander, melville, & berthold, 2017). social work interventions with refugee populations are well equipped to focus on the strengths perspective by incorporating empowerment workshops into curricula for assimilation and acculturation (carlson, cacciatore, & klimek, 2012). empowerment workshops are another creative treatment being used to heal refugees. free to grow (ftg), an organization using a holistic approach to well-being has been employed by organizations such as unicef and multichoice africa to provide workshops for refugees and survivors across the globe (jaranson & quiroga, 2011). the workshops focus on life skills, interpersonal growth, self-esteem, and the “ownership” of personal growth and development. ftg workshops include 4 sessions spanning 4 days. in the context of family work, the cultural context model aims to make clients aware of the context of power and privilege in their newly adapted culture (environment) and provides them with a familybased intervention that simultaneously seeks to ensure social justice (mcdowell, libal, & brown, 2012). group work is particularly effective with small groups of individuals who have had similar experiences (i.e., siblings, peer groups, or others from refugee backgrounds) to demonstrate shared feelings and show those who feel alienated that they are not alone (mcmahon, 2009, p. 75-76). working with refugee clients from similar backgrounds in a group setting also promotes community-building through cultural education and preservation (a.r.t., 2017). many refugee populations demonstrate this, such as at the za’atari refugee camp in jordan where community artwork represents a variety of cultural themes and issues. group work allows clients to develop social skills, decreases feelings of isolation through peer support, and increases self-awareness (coholic, 2010). research has shown that children and adults alike are able to bond with others, both locally and internationally, through their creativity, empowering them to overcome obstacles and increasing their self-esteem (ely, koury, bennett, hartinger, green, & nochajski, 2017). the peer support group model provides clients with the social network and grounding in community resources necessary for them to feel a sense of mastery in their new environment. however, it is also limited in scope because the leaders do not have a specific therapeutic mental health and/or clinically therapeutic focus in the work that is being done. future direction may include utilizing a social worker beyond the training of the peer leaders and instead engaging leaders in a more in-depth social work educational experience; including, but not limited to, taking select social work courses at local community colleges with a focus on ethics, interviewing and engagement skill building. currently jfcs offers additional supportive services to refugees including the immigrant services & connections (isac) program that connects refugees to existing services in the 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(2001). emerging paradigms in the field of mental health care of refugees. social science and medicine, 52, 1709-1718. doi: 33thttps://doi.org/10.1016/s02779536(00)00284-733t webel, a., okonsky, j., trompeta, j., & holzemer, w. (2010). a systematic review of the effectiveness of peer-based interventions on health-related behaviors in adults. american journal of public health, 100(2), 247-253. doi: 33thttps://doi.org/10.2105/ajph.2008.14941933t yalom, i. (2005). the theory and practice of group psychotherapy. new york city, ny: basic books. author note: address correspondence to: azadeh masalehdan block, msw, phd assistant professor, department of social work, california university of pa, box 90, california, pa 15419. email: 33tblock@calu.edu33t https://doi.org/10.1080/15325024.2014.934629 https://doi.org/10.1177/1363461506066985 https://doi.org/10.1192/bjp.bp.104.007864 https://doi.org/10.1111/j.1365-2524.2012.01069.x https://doi.org/10.1606/1044-3894.2017.8 https://doi.org/10.1080/15362940802480407 https://doi.org/10.1192/bjp.182.5.444 http://www.unhcr.org/protect/protection/3b66c2aa10.pdf https://doi.org/10.1016/s0277-9536(00)00284-7 https://doi.org/10.1016/s0277-9536(00)00284-7 https://doi.org/10.2105/ajph.2008.149419 mailto:block@calu.edu azadeh masalehdan block leslie aizenman adam saad stephanie harrison amanda sloan simone vecchio vanessa wilson background and significance literature review group work with refugees peer support models with refugees jfcs peer support program table 1. ctts weekly content areas refugee characteristics iraqi community bhutanese community program evaluation methods participants design measures results: paired samples analysis analyses discussion limitations future directions references _________ rae rosario stevenson, phd student, social work in the interdisciplinary city, culture, and community program, and joan m. blakey, msw, lmsw, phd, assistant professor in the department of social work at tulane university, new orleans, la. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 989-1005, doi: 10.18060/24103 this work is licensed under a creative commons attribution 4.0 international license. social work in the shadow of death: divesting from anti-blackness and social control rae rosario stevenson joan m. blakey abstract: in its current form, the field of social work does not reflect the ongoing reality of black death and the embeddedness of anti-blackness in everyday life. this omission leads to catastrophic failures of the profession’s most essential tasks: the advancement of social justice and future social workers’ education. this paper will discuss why the police’s ongoing murder of black people will not be resolved by simply replacing the police with social workers. we will argue that social workers serving black people must anchor their work in theoretical perspectives articulated by black people. finally, we challenge social work to live up to its social justice mission by divesting from systems of social control and anchoring their work in theoretical perspectives articulated by black people. keywords: defunding police, social work, anti-blackness, disproportionality, social control nadia king likes to wear her afro puffs in bright pink bows. photos of her include a bright smile full of baby teeth. in february 2020, police took nadia king from her school in jacksonville, florida, put her in a police car, and involuntarily committed her to a mental health facility. they acted on the request of the clinical social worker from nadia king’s elementary school. the social worker told police officers that nadia was “a threat to herself and others” (aguilera, 2020, para. 4). she was having a tantrum, destroying property, and attacking staff. her mother was not contacted until after the decision was made to admit nadia and the police were transporting her to the facility (chavez & alonso, 2020). on the way to the police car, king asked the officer quietly if she was going to jail. nadia king was 6 years old. her mother was not allowed to see her for two days. nadia king’s involuntary commitment is legal under the baker act (2020), a florida statute which authorizes the involuntary commitment of someone who poses a risk to themselves or others due to mental illness. the baker act does not distinguish between adults and children, and it was not written with children in mind. despite this, in the 12month period between 2018 and 2019, 38,000 of involuntary commitments under the baker act were children (evans, 2021). nadia king’s involuntary commitment is especially troubling because the way it was handled was incongruent with the law. the wording of section 394.459 of the baker act (2020) states, “express and informed consent for admission or treatment of a patient under 18 years of age shall be required from the patient's guardian, unless the minor is seeking outpatient crisis intervention services” (section 3a.1). additionally, the baker act (2020) specifically states that confining individuals is not appropriate when an individual has willing family members or friends who can help. the number of baker act intakes rises each year, with police officers enforcing more than half of them (evans, 2021). about:blank advances in social work, summer 2021, 21(2/3) 990 nadia king’s experience is just one example of the many ways the social work profession participates in criminalizing and controlling the behavior of black children. the toll of criminalizing black children is steep. a recent study in pediatrics (badolato et al., 2020) found that black children are six times more likely to be shot to death by police than white children. black children who are not killed by police are still are twice as likely to be arrested and four times as likely as white children to be incarcerated (puzzanchera et al., 2020). they face harsher sentencing, a greater likelihood of being denied bail, less advantageous plea deals, and an increased risk of wrongful convictions (puzzanchera et al., 2020). these disproportionalities are not because black children commit more crimes (puzzanchera et al., 2020). officers routinely perceive black children as older than their white peers of the same age and are more likely to perceive black children as guilty and dangerous (goff et al., 2014). with this in mind, we argue that calling the police on a black child especially during this #blacklivesmatter moment, when police brutality is so widely publicized is nothing less than an act of antiblack violence, which implicates the entire social work profession. as thousands march in the streets in nationwide protests to end police brutality and the extrajudicial murder of black people, social workers have found themselves thrust into the national conversation. as the calls to defund the police gain volume, calls to redirect this funding to social work and social services have followed. many have even suggested that police be replaced with social workers (foiles, 2020; kwon, 2020). in the nadia king case, what does it mean when a social worker calls the police on a black six-year-old child instead of nadia’s mom? how is calling the police part of a routine procedure? are the police called on all children who pose a threat to themselves and others? how does a profession predicated on social justice deliver a child to the criminal justice system, thus increasing the possibility of violence, even death? more importantly, if social workers already act as ready participants in systems of social control of black bodies, how can replacing police with social workers be the solution? in this paper, we utilize afro-pessimist theory to suggest that the commitment of a black child to a mental health facility without her mother’s consent and the impulse to call the police on a six-year-old black child is rooted in a system of social control anchored in anti-blackness and “bold and wanton disregard” for black life (bell, 2020, p. 750). we suggest that whatever protocols led a school social worker to take these actions function for the expedient control of black bodies, rather than this child’s safety. this incident could have ended fatally, like so many others, when the police are called (bell, 2020). for social workers to even begin to do more good than harm, we must understand how real this threat of death is for black people. we also must understand the sociohistorical context under which this threat of death persists. the police killing of people of color has become shockingly commonplace, even expected (shullman, 2020). on average, police officers kill about 1,000 people annually in the united states (dewan, 2020). since 2015, 5,935 people have been killed by police (tate et al., 2020). of those killed, 2,418 of those deaths were black and latino individuals and the vast majority (97%) of them were male (tate et al., 2020). in the majority of shootings, police are cleared of all charges. it is rare for a police officer to be convicted of killing someone (ross, 2020). since 2005, only 121 (2%) police officers have been arrested for stevenson & blakey/swk in the shadow of death 991 murder or manslaughter (dewan, 2020). of the 95 cases when a decision was reached, only 44 (46%) were convicted but often for a lesser charge than murder or manslaughter (dewan, 2020). there have been widespread proposals to defund the police and revert the money to funding social workers and social services (kwon, 2020). the purpose of this conceptual paper is to explore the reasons why replacing police with social workers is problematic, given that social work itself is a profession in need of reform. in many ways, the police and social work professions are grappling with many of the same issues. both systems cause racialized harm and dehumanize people of color who come in contact with them. both systems were designed as mechanisms of social control. both systems have racist histories rooted in anti-blackness. according to muñoz-guzmán (2015), in the 1960s social work embraced liberatory and antiracist practice in which they fought against structural, economic, and politically oppressive forces disproportionately affecting certain groups. social workers must renew their commitment to liberation theory and antiracist practice if they are to affect the systemic change needed to eradicate the police sanctioned killing of people of color (muñoz-guzmán, 2015). until social work can come to terms with its history, the treatment of black and brown people, and the ways social work is a mechanism of social control, replacing police with social workers will only exacerbate the problems proposals to divert funding from police are trying to solve. afro-pessimism in this conceptual paper, we utilize afro-pessimism to discuss why black people will be made no freer or safer by replacing one system of control (police) with another (social workers). antiblack sentiments and widespread police killings are destructive forces in mainstream society requiring the social work profession to call attention to oppressive practices and structures contributing to and often harming the most disadvantaged groups (muñoz-guzmán, 2015). afro-pessimism is a theoretical perspective articulated by black people (wilderson, 2010; sexton, 2016) that can benefit social work research, practice, and education. afro-pessimism theorizes that black people exist in a structurally antagonistic relationship with humanity…the very technologies and imaginations that allow a social recognition of others’ humanness systemically exclude this possibility for the black….the black cannot be human, is not merely an other but is other than human…antiblackness marks an irreconcilability between the black and any sense of social or cultural regard. (dumas, 2016a, p. 13) afro-pessimism reveals a more in-depth and fundamental understanding that globally, there is contempt for blackness, which results in the sanctioning and acceptance of violence against black people (wilderson, 2010). central to this theory is the idea that the process of transatlantic slavery stripped black people of their humanity, and it has never been meaningfully restored (mckittrick, 2006; wynter, 2003). slavery necessitated an institutionalized system—still prevalent today—that regarded africans as not less than advances in social work, summer 2021, 21(2/3) 992 human but something other than human entirely (wilderson, 2010). our conception of the human is historically produced and inextricable from transatlantic slavery (mckittrick, 2006). during the transatlantic slave trade era, enlightenment philosophers created definitions of the human that excluded the enslaved (sorentino 2016). to be human was to be free and able to reason, two traits violently and systematically denied to the enslaved (sorentino 2016). being “human” has been positioned as not black (wilderson, 2010). freedom is understood as not slavery. under this calculus, the death of black people is expected and deserved. according to dumas (2016a), there is no precise historical moment in which there was a break between slavery and acknowledgment of black citizenship and humanness; nor is there any indication of a clear disruption of the technologies of violence—that is, the institutional structures and social processes—that maintain black subjugation. (p. 14) as long ago as 1903, du bois wrote that the abolition of slavery had not resulted in “real” freedom for most black americans, who continued to live in the shadows of slavery, in abject poverty, and faced the ongoing ill effects of imperialism, capitalism, and racism. du bois lamented, “a people thus handicapped ought not to be asked to race with the world, but rather allowed to give all its time and thought to its own social problems. but alas! […] the very soul of the toiling, sweating black man is darkened by the shadow of a vast despair” (du bois, 1903). the enduring afterlife of slavery has positioned black bodies as a fundamental threat to authority. control of black bodies, then, is “the definitive reinforcement of security and order” (dumas & ross, 2016, p. 434). from this impulse come the ready justifications for the extrajudicial deaths and a highly visible suffering of black people. we see the workings of social control in these all-too-familiar statistics: black people are disproportionately shot and killed by the police (fox et al., 2019). black people are approximately 13% of the u.s. population, yet they account for more than 25% of those killed by police. this disparity is even more pronounced for unarmed black people (fox et al., 2019). unarmed black men are four times as likely to be killed by police than unarmed white men (fox et al., 2019). social death afro-pessimism is concerned with what saidiya hartman (2008) calls the “afterlife of slavery” (p. 6). slavery transformed africans into a racialized group stripped of its humanity and rendered as property. the result is black ontological death, or social death. it is the mechanism by which black people become unrecognizable as human. it is the mechanism by which what is human becomes defined in terms of what is not black. patterson (1982) defined the process of social death as including three key, dehumanizing features: natal alienation, gratuitous violence, and social dishonor. natal alienation refers to the process of severing enslaved people from all land and family. enslavement tore apart family ties and rendered enslaved africans a people without a homeland. descendants of slaves are left with incomplete histories with irreparable gaps in family histories that continue to wound into the present. hartman identified this wound stevenson & blakey/swk in the shadow of death 993 as an “essential inheritance of slavery” (hartman, 2008, p. 28). afro-pessimists would identify this wound as a characteristic of social death. the second dehumanizing feature, gratuitous violence, refers to the systematized violence required to maintain and uphold black inhumanity. “gratuitous violence” is inclusive of the indescribable violence enacted during transatlantic slavery to maintain black people as property. it is also inclusive of the indescribable violence enacted against black people into the present. douglass (2018), for example, wrote about korryn gaines, a black woman murdered by police whose filmed murder went viral online. in the wake of her death, reporters and commentators online speculated about what she might have done to deserve her death. this story is not unlike six-year old nadia king’s, whose brush with police was justified because she was “out of control.” it is not unlike hundreds of stories that never make the news. social death acts as a perverse loop that cycles in new violence, new victims, new perpetrators, but always the same script. always the threat of violence or death, or the threat of death itself. as violence becomes routinized, so too is the inhumanity of black people reified and upheld. christina sharpe (2016) argued for an understanding of black life as always lived in proximity to social death, as “deathliness” (sharpe, 2016, p. 9). sharpe connected the endless, highly visible spectacles of black suffering with the same ongoing catastrophe that began with slavery. she referred to the coverage of natural disasters such as hurricane katrina in 2005 and haiti’s 2010 earthquake as examples of the media reducing black suffering to the same anonymous and inhuman spectacle yet again, even now. if we look to nadia king, again, we see the function of social death. king’s suffering is unsurprising because she is a black child; indeed, it is only possible that she could suffer this way because she is black. these spectacles of suffering contribute to an endless reified status of social dishonor, which ray et al. (2017) described as “blacks’ low status in every corner of society” (p. 150). diverging from other critical theories afro-pessimism diverges from other critical theories, including critical race theory, in its centering of anti-blackness. afro-pessimists insist no other racialized group has experienced a system of control and dehumanization so enduring, total, and global as has risen from north american chattel slavery. this dehumanization has produced a system of anti-blackness different from other forms of racism. rather than a black/white binary, afro-pessimism suggests our society is ordered along a black/non-black continuum that positions all in hostility against those who are black. this framework acknowledges a society ordered around anti-blackness, where proximity to whiteness is awarded, and proximity to blackness is punished. afro-pessimist theory critiques “people of color” as a construct and emphasizes the centrality and historical specificity of anti-blackness in the wake of transatlantic racial slavery (sexton, 2008). this lens understands other marginalized, racialized groups in terms of their social proximity to blackness. it acknowledges the anti-blackness carried out by other groups, including efforts to distance themselves from the social consequences of blackness. other marginalized groups may adopt the language and tactics of the civil advances in social work, summer 2021, 21(2/3) 994 rights struggle but have ultimately abandoned coalitional approaches where better outcomes can be obtained by distancing from black people (sexton, 2008). in this way, afro-pessimism extends critical race theory’s idea of “interest convergence” to include any group with social distance from blackness. interest convergence refers to the legal trend where civil rights advances only occur when black interests and white interests converge (bell, 1995). afro-pessimism argues that all racialized groups benefit from interest convergence with white interests, even when they may diverge from black interests. controversially, afro-pessimism does not seek solutions indeed, it is pessimistic about whether any meaningful solution to global anti-blackness exists. rather, its theoretical task resides in an “epistemology of mourning” (dumas, 2014, p. 26), where black suffering itself is investigated in its own right, rather than in a cost-benefit analysis. the motivating question becomes how black people and communities navigate suffering, because suffering is inevitable in a society predicated on anti-blackness. it is precisely because of this theory’s aversion to finding solutions that we believe it is of value to social workers. it is not the task of this paper to convince social workers to abandon hope that their profession can be agentive in social change. instead, we ask social workers to break from their relentless pursuit of the solution to racial inequality to better understand how racial inequality works in the first place we believe if all social workers were armed with a robust understanding of anti-blackness's scope and history, our profession would necessarily become a radical one. histories of social control another similarity between the police and social work professions is that both have origins rooted in social control. social control is defined as “the entire range of actions and pressures which are designed to lead the individual to function within society without threatening to disrupt the social order” (goroff, 1974, p. 19). police forces in the northern united states emerged to regulate disorder from the “dangerous classes,” which at the time were considered to be “poor, biologically inferior, morally intemperate, foreign immigrants, unskilled, uneducated, underclass, and free blacks” (potter, 2013, par. 2). disorder consisted of public drunkenness, hooliganism, public disorder, political protests, worker riots, and prostitution. the primary reason for controlling disorder was the burgeoning economic interests, which were more concerned with social control rather than controlling crime. profitable business required a stable and orderly workforce and environment (spitzer & scull, 1977). therefore, policing was focused on controlling “bad” individuals (e.g., black people), which remains the focus today (potter, 2013). an early form of policing in the southern united states was known as “slave patrols” (platt, 1982). the carolina colonies established the first organized slave patrol in 1704 and they remained commonplace across the southern states until the civil war ended slavery in 1865 (potter, 2013). the primary function of slave patrols was to track down, apprehend, and return runaway slaves. the intent of these “slave patrols” was to create organized terror to deter slave revolts, and maintain slavery (potter, 2013). after the civil war and with the end of slavery in 1865, slave patrols in the south evolved into police departments, serving a similar role in the lives of newly freed slaves. police in the u.s. northern and southern stevenson & blakey/swk in the shadow of death 995 states were responsible for controlling freed slaves and enforcing jim crow and other racist laws to maintain the workforce needed to keep the southern economy afloat (potter, 2013). the police were the only authorized entity to use force to maintain law and order. the mere presence of police was meant to prevent crime through surveillance and observation (potter, 2013). similar to the history of policing, since the inception of social work, social control has been a primary function of the profession (day & schiele, 2013). social work practice is one of the many ways society attempts to socialize clients to comply with the norms and behavior deemed acceptable by white middle-class cultural norms (abbott & wallace, 1990). social work has created, upheld, and strengthened oppressive systems (social service workers united-chicago [sswuc], 2020): “the history of psychiatric hospitalization, drug treatment, child welfare, and immigration programs and services cannot be divorced from america’s history of creating systems to control and harm people of color” (para. 22). the government is one of the largest employers of social work services. how do social workers advocate against the very entity that is paying their salary? they do not! kivel (2007) reported, we committed to building an organization that could contribute to ending violence through community prevention and education, not just reforming individual perpetrators…nearly 30 years later, i look around and see many shelters and services for survivors of domestic violence, but no large-scale movement to end male violence…we could continue doing what we are doing for another 100 years, and the levels of violence would not change. (pp. 129-130) this pattern will not change because all too often, social work focuses on meeting the needs of individuals affected by the personal and devastating impact of institutional policies and practices as opposed to fighting against the root causes of the institutional policies and practices (kivel, 2007). most social work interventions focus on individualistic causes and explanations to social problems, distribution of resources that ensure compliance and acquiescence, and regulation of black people, other communities of color, and lower classes via surveillance and observation (abulhul, 2021). social workers have long been tasked with “policing the boundaries of welfare” (humphries, 2004, p. 93). social workers are the enforcers, gatekeepers and arbiters of state policies such as temporary assistance for needy families (tanf), welfare, and public assistance housing, yet we are rarely the architects or the opponents of those policies. enmeshed in social work profession are mechanisms of surveillance and supervision that have been present since its inception. social work’s earliest ideologies were influenced by eugenics, and the impulse to separate, police and socialize the poor (lapan & platt, 2005). social workers in the early 1900s were responsible for forced sterilizations of vulnerable people under their care, including inmates and mentally ill clients (lapan & platt, 2005). lapan and platt (2005) argue that “the race, class, and gender biases permeating eugenics left an enduring legacy in the profession” (p. 141). child welfare shares a similarly troubling past. black children were excluded from child welfare services until the end of world war ii. once african american children entered foster care during the 1950’s, their numbers soared. cooper (2013) writes, “it is no coincidence that foster care policies became more punitive precisely when african children entered the system” (p. 234). advances in social work, summer 2021, 21(2/3) 996 despite the profession’s claims that they are working in clients’ best interests and believe in self-determination, social workers often find themselves in the position of exerting control, rather than care (abulhul, 2021). social work practice has been reduced to individualistic explanations of social problems or “the least complex, narrowest, most ‘doable,’ private or internal aspects of cases” (meyer, 1993, as cited in long, 2000, p. 67,). according to warde (2017), “in becoming a profession, social work concentrated its practice focus on casework with individuals and families (micro) and de-emphasized concern with institutional causes and social reform (macro)” (p. 11). de-emphasis on the macro leaves the profession toothless against the problems it seeks to correct and complicit in the entrenchment of “interventions that neither disrupt the white supremacist racial hegemony, nor threaten the capitalist economic order” (dumas, 2016b, p. 108). in other words, social work has become an arm of the government to establish social control. disproportionality the final similarity between criminal justice and social work professions is that they both have high disproportionality rates. disproportionality is defined as “the underrepresentation or overrepresentation of a racial or ethnic group compared to its percentage in the total population” (child welfare information gateway, 2021, p. 2). in 2018, black people made up 13.4% of the u.s. population (u.s. census bureau, 2020). according to the federal bureau of investigation (united states department of justice, 2020), black people were 27.4% of the individuals arrested (united states department of justice, 2020). in terms of mass incarceration, the united states has the highest incarceration rate in the world (carson, 2020). black men have the highest incarceration rates of any group (carson, 2020). in 2018, the incarceration rate of black males’ was 5.8 times higher than white males, while the incarceration rate of black women was 1.8 times the rate of white women (carson, 2020). despite social work’s explicit commitments to antiracism, the field still disproportionately engages with communities of color and black communities in particular (dettlaff, 2021). “black children are involved in reported and substantiated cases of child abuse and neglect at approximately twice the rate of white children” (drake et al., 2007, p. 471). in 2018, there were 435,052 children in care, 262,204 entering foster care, and 249,980 exiting foster care (puzzanchera & taylor, 2020). for black children, rates of disproportionality range from 1.52 to 1.66, while white children range from .93-.98 (see table 1). table 1. disproportionality in child welfare 2018 total black children (15.1% of the population) white children (52.5% of the population) in care 435,052 25.2% (1.66) 48.9% (.93) entering foster care 262,204 23.5% (1.55) 51.2% (.98) exiting foster care 249,980 23.1% (1.52) 50.9% (.97) stevenson & blakey/swk in the shadow of death 997 disproportionality in child welfare and other social work-related fields is an ongoing problem, yet child welfare is one of the remaining sectors still dominated by social workers (child welfare information gateway, 2021; dettlaff, 2021). fluke et al. (2011) offer four possible explanations for disproportionality in child welfare: 1) high rates of poverty create disparate needs among children and families of color, 2) racism, discrimination, and bias by individuals throughout the child welfare system, 3) system-related factors such as the race of workers, social support, and resources available to families of color increase the likelihood of children of color becoming involved with the system, and 4) the region, state, and neighborhood where children reside increases the likelihood of their involvement with the child welfare system. divesting from social control and anti-blackness we must acknowledge that anti-blackness—the devaluing and dehumanizing of black life functions in social work's everyday mechanisms. anti-blackness is so enmeshed in social work practice and policy that it has become hard to see it could be any other way (bell, 2020). when the school social worker called police to collect six-year-old nadia king before calling her mother, it was an example of anti-blackness—an act of casual cruelty we would never think of imparting on a white child. if nadia king had white skin and blonde pigtails, she would not have been “out of control.” she would have been a child having a tantrum, and her mother would have been contacted prior to any action taken by the school. anti-blackness is what renders king inhuman and “out of control” at 6 -years old. what would it mean to divest the social work profession from its intricate commitments to social control and anti-blackness? we cannot answer that in one paper. to attempt to prescribe solutions would be to understate the scope and scale of the problem. yet, we know that we must begin with a sense of urgency. the slow, incremental, and highly individualized modes of “change” prescribed implicitly by social work do not address the ongoing catastrophe of anti-blackness. the scope of the problem requires more potent tools than personally investigating and confronting one’s own biases. on this subject, dumas (2016a) wrote, “this is different from a broad stance against intolerance or racism, or an admission of the existence of white privilege” (p. 17). while necessary, these first steps cannot be where social work education ends. afro-pessimism asks us to investigate the internal logics we take for granted. are we intervening in the lives of individuals, or are we dismantling root causes? we hold the black families we interact with up against standards that do not take into account the afterlife of slavery—the irreparable rupture from which all new wounds burst forth. that we work with police officers is an indicator of our collusion. that we continually reproduce disproportionalities is an indicator of our complicity. those we seek to serve in black communities often fear us (devoe & smith, 2003), an indicator of our capacity for terror. afro-pessimism suggests that these failures are not mistakes; this is how the gears of antiblackness remain well-oiled. advances in social work, summer 2021, 21(2/3) 998 schools of social work our first and most enduring socializing force as social workers is schools of social work, and anti-blackness is enmeshed here. whiteness remains the cultural standard and currency of social work (nylund, 2006; harney & moten, 2013), despite the psychic turmoil this inflicts on black students. proximity to whiteness fashioned as “professionalism”—is rewarded, while proximity to blackness is treated as wholly unwelcome in the university setting. black social work students are othered, their ways of being and knowing sidelined, and their perspectives decentered. in a 2011 study on the experiences of black social work students, bernard et al. found that students in their study experienced: derogatory stereotypes and hostility from practice assessors and other staff members; feeling excluded and isolated; being expected to work harder and to be more capable than their white counterparts; being placed in agencies where racist practices were in evidence; and being subject to racist discrimination by service users, and, on occasions not being supported by other staff members in challenging this. (p. 72) afro-pessimist theory invites us to look beyond quantifiable outcomes and investigate the everyday suffering of black people. the ordinary suffering of black students in schools of social work is well documented. black social work students still face constant, fatiguing microaggressions from professors and peers (bernard et al., 2011). social work curriculums still center and cater to whiteness (nylund, 2006). generally, social work schools cannot promise that social work students’ field placements will not be racist (brown et al., 2019). cumulatively, these everyday wounds are anchored in anti-blackness and uphold the dehumanization and devaluation of black people and black life. in addition to the anti-blackness these students experience, anecdotal evidence suggests that black social work students feel beleaguered by the profession's pathways to social change. many of us come to the profession seeking radical change, and we are offered no meaningful pathways to enacting it. this is exacerbated by our lived experiences of anti-blackness. we come to social work to free ourselves from the structural racism and anti-blackness and find that social work is no different from anywhere else despite its social justice commitments. schools of social work must take more serious their duty to create agents of change. an earnest and honest look at the scope and scale of anti-blackness should have a radicalizing effect on every student who graduates with a degree from a program claiming to promote social justice. yet, we routinely train students who do not understand their work as countercultural, radical, or transformative. even worse, we release these students into communities without a complete and robust historical understanding of the legacies of violence, historical trauma, and social control that led society to this current political moment. schools of social work need to offer social work students an unflinching introduction to their capacity for racialized harm. how are we conceptualizing and contextualizing our role as enforcers to social work students? how do we fit our standard policies and practices into the longer historical narrative of black social death? while there stevenson & blakey/swk in the shadow of death 999 are no simple solutions to anti-blackness in social work schools, beginning with those questions is a good place to start. resisting carcerality in social work divesting from antiblackness in social work also requires divesting from police-social work collaborative models and carceral social work practices. jacobs et al. (2021), define carceral social work “as a form of social work that relies on logics of white supremacy and that uses coercive and punitive practices to manage bipoc and poor communities” (p. 39). carceral social work includes direct partnership with police, but also implicates the profession in the myriad of “tactics dependent on the same white supremacist and coercive foundations as policing” (jacobs et al., 2021, p. 39). the social work profession is complicit in paternalistic practices of oversight, regulation, and punishment of black populations in ways that mimic and work in unison with law enforcement (jacobs et al., 2021). police and policing have no place in a profession that espouses a commitment to social justice. inequality is strengthened through police and policing. policing contributes to the increase of mass incarceration and sustains minimal educational and economic resources. within social work programs, collaboration with police provides further pipelines to the criminal justice system in communities that are already disproportionately surveilled and policed (jacobs et al., 2021). richie and martensen (2020) propose that social work take on an “abolition praxis” which “avoid[s] even the most subtle or indirect reliance on the punishment industry as a way to restore equilibrium to individuals or groups” (p. 14). abolition praxis, or anti-carceral social work (jacobs et al., 2021) is anchored in transformative and restorative justice approaches and community-centered solutions to social problems. a shift toward abolition praxis would require the profession to embrace mutual aid traditions, adopt alternatives to policing, and transition away from individualized practices toward collective solutions (jacobs et al., 2021). call to social work to embrace its radical roots the killing of black people at the hands of the police is an ongoing catastrophe. according to howard (2017), “social workers are in an advantageous position to join with black and [brown] communities to shepherd this unrest into social change” (p. 81). however, social workers would need to be more active and vocal if they want to effect change (howard, 2017). at various points in social work history, “black social workers worked to deconstruct racist systems of inequity and to empower the black community” (howard, 2017, p. 83). unless social work can return to these early practices and live up to its social justice mission, replacing police with social workers is not the answer to this pandemic. according to william de maria (1992 as cited in reisch & andrews, 2001), the social work radical has philosophical leanings towards the importance of discovering the causes of oppression (or injustice or disadvantage). however, that is only half the story and many social workers who are called radical end here. the next stage is to transform the insights gleaned from the foundation material into advances in social work, summer 2021, 21(2/3) 1000 immediate social action…to move from structural analysis to structural practice. (p. 5) there are three underlying principles of radical social work: 1. structural and economic inequality is the primary source of clients’ problems. 2. social work and social service agencies have become instruments of social control, co-optation, or stigmatization. 3. social workers need to focus on structural and internalized oppression (longres, 1996, as cited in reisch & andrews, 2001). conclusion we must acknowledge the totality and embeddedness of anti-blackness and our complicity in the control of black bodies. for this reason, the field’s explicit antiracist commitments do not interrupt the normal function of social work—to reproduce and reify (every day) acts of violence in an anti-black society. with anti-blackness as a tool, we can begin to see racial disparities in the field as unsurprising. we can begin to critically assess whether our social justice goals can be meaningfully mitigated without broader, more radical change. we can begin the process of reimaging social work as an emancipatory project, rather than an endless series of band-aids ill-equipped to stop the bleeding. when audre lorde (1984) wrote, “the master’s tools will never dismantle the master’s house,” (p. 110) social work was not excluded. we either dismantle oppressive systems, or we maintain them. we cannot do both. social workers cannot achieve their mission—social justice—without being disruptive. references abbott, p., & wallace, c. 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(2003). unsettling the coloniality of being/power/truth/freedom: towards the human, after man, its overrepresentation—an argument. c.r.: the new centennial review, 3(3), 257-337. https://doi.org/10.1353/ncr.2004.0015 author note: address correspondence to rae stevenson, department of social work, tulane university, new orleans, la. email: rstevenson@tulane.edu https://www.census.gov/popclock/ https://ucr.fbi.gov/crime-in-the-u.s/2019/crime-in-the-u.s.-2019 https://ucr.fbi.gov/crime-in-the-u.s/2019/crime-in-the-u.s.-2019 https://doi.org/10.4324/9781315726656 https://doi.org/10.2307/j.ctv11cw61k https://doi.org/10.1353/ncr.2004.0015 mailto:rstevenson@tulane.edu __________ margaret e. adamek, phd, professor and editor, advances in social work, and valerie decker, msw, researcher and managing editor, school of social work, indiana university, indianapolis, in. madamek@iupui.edu copyright © 2023 author, vol. 23 no. 1 (spring 2023), i-iii, doi: 10.18060/27533 this work is licensed under a creative commons attribution 4.0 international license. spring 2023 editorial: “intersectional injustice” margaret e. adamek valerie decker in the spring 2023 issue of advances in social work, we are pleased to present 12 papers written by 44 authors from different regions of the u.s. and finland. ten empirical studies and two conceptual/advocacy pieces offer new perspectives and findings on emerging areas of social work practice, policy, and education. the title of this editorial, “intersectional injustice,” is borrowed from the lead article by leotti, sugrue, itzkowitz, and williams who point out the contradiction between social work’s core value of social justice and our complicity as a profession with state intervention in the lives of marginalized families through the current foster care system. leotti and colleagues invite readers into a critical conversation about how to work collaboratively with families (as happened during the pandemic) with a focus on supportive and preventive interventions rather than relying so heavily on out-of-home placements. “multiply-marginalized” populations in an effort to promote socially-just human services organizations, miller and ball collected data from 52 women and non-binary people of color regarding their experiences with microaggressions on the job. acknowledging the role of “multiple marginalization” and “intersectionality” of employee identities, they found that employees of color in particular faced many stereotypical misperceptions by their co-workers. miller and ball call for human service organizations to offer training and establish policies that intentionally address workplace microaggressions. offering another contribution to our understanding of the impact of racial discrimination, seiler’s study used a nationally representative u.s. sample to help us connect the dots between experiences of racial microaggressions, institutional racism, and minority stress. seiler’s hope is that by acknowledging the deleterious impact of racism experienced by people who are black in the u.s., macro-level health care policies and micro-level therapeutic interventions can be developed to counteract and ameliorate the harmful consequences of racial discrimination. while jails and prisons are meant to be punitive and not rehabilitative, the impact of incarceration on families is rarely emphasized, especially for mothers. sutherby collected data from 34 mothers who experienced both incarceration and an alternative to incarceration (ati) program. elevating their voices, sutherby calls for social work to lend greater support and advocacy for mothers in conflict with the law through non-carceral approaches that allow mothers to receive help with addictions, past trauma, and parenting. another marginalized population in the u.s. is low-income spanish-speaking adults with learning disabilities. in order to improve access to needed benefits and interventions, cordón and colleagues tested 3 brief screening tools to determine which had the best mailto:madamek@iupui.edu https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2023, vol. 23 ii predictive utility. a culturally-sensitive and validated ld screen will help ensure that social workers can better connect latine clients with appropriate and legally required interventions. kirjavaninen and jalonen point out the paradox of social media becoming a primary means of social interaction among youth and yet there are growing levels of loneliness and social withdrawal. using sen and nussbaum’s capability approach to frame the phenomenon of social withdrawal among youth in the digital age, kirjavvaninen and jalonen analyzed posts on a popular discussion forum among finnish youth. their findings highlight the exclusion felt by many such youth and point to social media as a potential bridge for social services providers to reach socially withdrawn youth. innovations in social work education and practice we live in an increasingly digital world. bibbs and colleagues consider how social work’s ongoing relationship with technology necessitates that we evaluate and re-envision how tech ethics create, shape, and transform social work practice. in this contribution, bibbs and colleagues introduce a tool—the ethical os—to help social workers thoughtfully consider the technology-related ethical issues that may arise in social work practice, education, and policy. regular use of the ethical os can help practitioners to build coherent social work tech habits of mind. social work students are trained to offer resources to clients who experience food or housing insecurity. but what happens when our students themselves are food or housing insecure? gilster, hein, perruzzi, conrad, and croft surveyed 125 bsw and msw students at a school of social work in the midwest and found that more than half experienced food or housing insecurity, sometimes with negative impacts on academic outcomes. gilster and colleagues offer several suggestions for schools of social work to address food and housing insecurity among their students. as public libraries increasingly serve as a setting for social work practice, the boundaries and arenas of practice are undergoing development. to add to our understanding of this emerging area of practice, johnson, paauw, and giesler investigated the perspective of social work interns placed in public libraries. while the participants noted several challenges including unclear boundaries, confusion about their roles, and physical space limitations, overall they appreciated the tremendous learning experience that came with helping to define the role of library social workers. does understanding systems of privilege and oppression translate into greater engagement in social and political activism? based on a survey of over 300 msw students, digby franke explored this question by making comparisons of students with different intersectionalities including gender, race, sexual orientation, and macro concentration. as digby franke asserts, “without discussions about privilege and power, education about diversity and social justice falls short.” using the epas self-studies from 16 bsw programs as data, skeen questions whether field education in social work fits shulman’s criteria for signature pedagogy. after presenting an historical overview of accreditation oversight of social work education, adamek & decker/editorial iii skeen offers a number of suggestions to ensure a bi-directional integration between classroom coursework and field education. life as we know it changed as a result of the covid-19 pandemic. while mostly behind us, the repercussions of the pandemic persist—some negative, some positive. just this week, a colleague reported being newly infected with the virus. sullivan, hostetter, & commodore-mensah interviewed 36 mental health professionals during the height of the pandemic in 2020 to learn about their experiences and impressions of transitioning to telehealth. after overcoming the initial challenges of learning to offer virtual services, many study respondents embraced telehealth and were able to articulate several unexpected benefits since as reaching more clients and connecting them with providers in a more timely manner. while the pandemic forced a transition to virtual services, the potential of telehealth in the future is ever-evolving. passing the baton with the next issue of advances in social work, i will be passing the baton as editor to dr. carol hostetter as i take on a new administrative role at the indiana university school of social work. dr. hostetter has capably served as a guest editor for our sole double-issue of advances in social work as well as a reviewer for several years. i am confident that advances in social work will continue to thrive under her leadership. i appreciate the camaraderie with the aisw team including authors, reviewers, board members, and guest editors and of course our staff: valerie decker, our managing editor as well as our editorial assistant, michael hernandez, our statistical consultant, dr. jieru bai, as well as our ojs support, ted polley, who has helped us stay abreast of developments with open access publishing. serving as editor since 2015 has greatly enriched my career as well as my teaching about scholarly writing and publishing. best wishes to the aisw team moving forward! _________ casey bohrman, phd, lsw, associate professor, and alison updyke, phd, lsw, assistant professor, department of graduate social work, west chester university, west chester, pa. brie radis, phd, lcsw, associate professor, department of undergraduate social work, west chester university, west chester, pa. jeanean mohr, msw, assistant director of recruitment, admissions, and enrollment, west chester university, west chester, pa. mia ocean, msw, phd., associate professor, department of graduate social work, west chester university, west chester, pa. yve lopes, msw, lcsw, behavioral health consultant, florida department of children and families, west palm beach, fl. anais bailly-mompoint, msw, lmsw, owner and founder, abm structured solutions, lumberton, nj. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 338-359, doi: 10.18060/24917 this work is licensed under a creative commons attribution 4.0 international license. criminal records as predictors of harm: questioning social work’s reliance on records for gatekeeping casey bohrman alison updyke brie radis jeanean mohr mia ocean yve lopes anais bailly-mompoint abstract: the national association of social work code of ethics requires advocacy on behalf of groups experiencing oppression, and yet it can be difficult to recognize when the oppression is emanating from the profession itself. social work has enacted numerous barriers to entry for people with criminal records, a group that disproportionately includes people who are poor, black, disabled, and or lgbtq+. while previous articles have examined the role of criminal records in the social work admission process, scholars have not comprehensively examined the role criminal records play throughout the career of a social worker. this article provides an overview of how records are used in higher education admissions, licensing, and employment, highlighting the limitations of criminal records as future indicators of harm. we argue that the broad use of criminal record checks not only harms marginalized individuals with records but is a disservice to clients who would benefit from the unique strengths derived from their social work training and lived experience. we conclude with future policy directions informed by abolitionist practices including non-reformist reforms that can reduce barriers to entry into the profession and build upon the strengths of people with lived experience in the criminal legal system. keywords: criminal justice, gatekeeping, admission, collateral consequences, harm in 1915, abraham flexner raised fundamental existential issues for the profession of social work by questioning whether it is a legitimate discipline. in the years that have followed, social work has responded to flexner’s challenge by instituting several gatekeeping and monitoring processes, seeking to develop rigor, and the ability to provide the best services to vulnerable clients (hanesworth, 2017; prescott, 2019). california was the first state to register social workers in 1945 (california board of behavioral health services, 2022), laying the foundation for what has become the modern licensure process, while the council on social work education (cswe) was founded in 1952 to monitor the educational pathway to becoming a social worker (cswe, 2021). however, the discipline has never quite shed the existential angst introduced by flexner’s challenge, with sowbel (2012) arguing that gatekeeping is a “fundamental ethical obligation” (p. 27) about:blank bohrman et al./criminal records 339 of the discipline, and that selectivity measures should be made even more rigorous gatekeeping mechanisms have been established at all levels of the social work discipline, from academic admissions to professional licensure and accreditation (bramley et al., 2021). criminal records have emerged as an important litmus test for fitness to practice social work and stand as significant barriers to entering educational programs and securing licensure (curran et al., 2020; custer, 2016). national association of social workers (nasw, 2021b) membership is immediately revoked on conviction of a felony. however, social movements like black lives matter have turned the spotlight on the structural racism that results in such convictions, with black and marginalized communities being significantly more likely to be burdened with criminal records (bennett, 2018; blume & helm, 2014; davis, 2017; james, 2021). social workers have been on the front lines of some of these movements and have increasingly begun to explore abolitionist orientations in their practice settings (richie & martensen, 2020). however, despite some efforts to reform the discipline’s relationship with the carceral landscape, there is a noticeable absence of scholarship surrounding the application of abolitionist frameworks to institutional gatekeeping processes within the field. addressing this gap in the literature, we re-envision inclusion in the social work profession by exploring: (a) the implications of a carceral orientation to disciplinary gatekeeping in social work, (b) the need for an abolitionist framework to include marginalized communities, and (c) solutions to instantiate such a framework for the discipline. the carceral landscape and gatekeeping the u.s. has the largest incarcerated population of any nation in history, with one in three u.s. americans burdened with a criminal record (vallas & dietrich, 2014). while blacks comprise 14% of the us population, they represent 38% of the us prison system (bureau of prisons, 2021; us census bureau, 2021). moreover, people who identify as gay, lesbian, bisexual, transgender, or queer (lgbtq+) are three times more likely to be incarcerated as those who identify as cisgender and heterosexual, and about half of all black trans people will experience incarceration at some point in their lives (grant et al., 2011; meyer et al., 2017). people in prison are also two and a half times more likely to have a disability than those in the general population (bureau of justice statistics, 2019). over the last half-century, with the criminal legal system’s shift in focus from rehabilitation to punishment, criminal records have become increasingly utilized to restrict people from access to a range of opportunities such as housing, education and employment (american bar association, 2018; corda, 2016; mctier et al., 2020). these forms of extra-legal punishments are known as collateral punishments. across the u.s. there are currently over 40,000 restrictions placed on people with criminal records (umez & gaines, 2021). while the use of extra-legal penalties dates back to the concept of “civil death” imported from england to the colonies, they are of particular concern now given the large numbers of individuals with records (pinard, 2010, p. 1214), the ease of accessibility of once private information, and the lasting impact of such sanctions (corda, 2016). advances in social work, summer 2022, 22(2) 340 in recent years, as a result of concerns over the growing prison population, disproportionate punishment of certain populations, and the use of collateral consequences to inhibit people’s re-integration in society, groups across the political continuum have begun advocating for the restoration of rights and opportunities for people leaving jails and prisons. for example, in 2019 the american legislative exchange council (alec), known for the writing and dissemination of conservative policies, wrote the collateral consequences reduction act as sample legislation for states to use to limit work-related regulations imposed on individuals with criminal records. the nasw names criminal and juvenile justice as one of its five social justice priorities and the grand challenges for social work calls for an end to collateral consequences through “smart decarceration” (epperson & pettus-davis, 2016, p. 4; nasw, 2021a). and yet, social work schools and employers continue to utilize criminal records resulting in the alienation of large numbers of individuals. gatekeeping in social work the use of criminal background checks is part of a larger focus within the profession on gatekeeping, which has long been accepted as a necessary practice in ensuring academic program integrity, graduating competent social workers, and protecting clients from harm (madden, 2000; miller & koerin, 1998; sowbel, 2012; zellmer & knothe, 2011). social work educators and practitioners take their gatekeeper roles seriously, implementing screening strategies across students’ professional journeys, but at each stage of gatekeeping, social workers face complex ethical dilemmas, uncertainties, and contradictions. despite pervasive inconsistencies, our commitment to screening out those deemed “unsuitable” remains intact (sowbel, 2012, p. 31). across the academic and professional spectrum, there is a lack of empirical data and guidelines from accrediting bodies of social work informing effective techniques and criteria for predicting success or suitability for the profession (curran et al., 2020; madden, 2000; miller & koerin, 1998; sowbel, 2012; zellmer & knothe, 2011). this is cause for concern. given the ways that oppressions such as racism, classism, and ableism infiltrate all institutions, one must question whether it is even possible to create standardized metrics that do not inadvertently, or perhaps even intentionally, disproportionately exclude marginalized populations. while gatekeeping is ostensibly about protecting clients from harm, social work professionals must also acknowledge the ways that gatekeeping intimately ties to concerns about the legitimacy of our profession. from the inception of social work, people like abraham flexner, in his famous 1915 speech to the national conference of charities and corrections, have questioned whether social work is a real profession (prescott, 2019). one way of authenticating disciplines is through specialized degree programs, which may selectivity as a means of separating professionals from the lower socioeconomic classes (kunitz, 1974). within the field of social work, processes of exclusion, such as licensing, accreditation, and gatekeeping have been used to elevate the profession’s status and public image (gushwa & harriman, 2019; weeden & siegel, 2020; vliek, 2018; zellmer & knothe, 2011). because of this constant struggle for legitimacy, it is not always bohrman et al./criminal records 341 clear when gatekeeping decisions are about prioritizing the safety and needs of clients or are driven by the goal of elevating the profession. the use of criminal records in gatekeeping while there are few standardized metrics used to assess a candidate’s suitability for the profession or a specific social work position, criminal background checks, more than any other measure, have consistently been used for this screening purpose. the opportunity for individuals with criminal records to become social workers may technically exist, but those with records have to successfully pass “the gauntlet of supplemental requirements” (rosenthal et al., 2015, p. 21) known to be barriers and deterrents to success. after rosental and colleagues (2015) from the center for community alternatives reported that merely having to respond to questions about criminal records potentially deterred over 60% of applicants with felonies from finishing their applications, many schools eliminated questions about criminal records (curran et al., 2020). the us department of education (2016), through the beyond the box report, has urged schools to forgo these questions in admissions, citing potential violations of the civil rights act of 1964, and yet these practices persist. surveys from universities over the past 20 years have found that close to 70% of colleges and universities, and perhaps not surprisingly nearly 65% of msw programs which operate within these larger systems, ask questions about criminal backgrounds in their admissions processes. (epperson et al., 2021; weisman et al., 2010). in their research study, curran et al. (2020) found field placement concerns to be the primary factor influencing msw program’s decisions to inquire about criminal record histories during the application process. based on existing literature, it is unclear what scientific evidence informs screening policies and which procedures, if any, are most effective at enhancing public safety. in fact, researchers have highlighted the misalignment between recidivism research and dominant perceptions of social work professionals charged with decision-making and risk-assessment of individuals with criminal records (brodersen et al., 2009; curran et al., 2020). prior to the 1970s, prevailing practices supported the notion that widespread availability of criminal record histories was at odds with individuals’ reintegration (corda, 2016). a shift in focus from “rehabilitation” to prevention as well as over-criminalization contributed to a drastic increase in criminal background checks in employment settings (corda, 2016; jacobs, 2015). the emphasis on preventing harm occurred at the expense of the individual rights of those with criminal conviction records and in the absence of empirical data. jacobs (2015) states that courts have held that while employers have to do some due diligence in the hiring process, they are not necessarily required to conduct a background check. presumably, agencies require background checks to reduce liability and potential harm. research suggests that employers may also be concerned about the social implications of hiring candidates with records. society for human resource management (2018) found that while the majority of employees said they would not mind working with advances in social work, summer 2022, 22(2) 342 someone with a record, managers, hr professionals, and other employees assumed that others would be less accepting than they were. requirements to apply for licensure have varied across states since their inception (donaldson et al., 2014; dyeson, 2004). epperson and colleagues (2021) examined a sample of licensure policies across a range of locations in the u.s. and found that most states require background checks (epperson et al., 2021) – with some states automatically denying those with certain convictions and others assessing on an individual basis (association of social work boards [aswb], 2021). resources have been developed to guide individuals interested in pursuing social work through expungement processes and navigating siloed systems, but the most frequently cited advice is to consult an attorney, presumably if one can afford to do so (carnahan, n.d.). the need for an attorney to help someone with a record navigate the employment process reflects the complexities of the gatekeeping practices. the limits of carceral gatekeeping given the profession’s over-reliance on criminal records as a means of gatekeeping, as well as the seeming lack of awareness among social workers regarding criminal justice research (brodersen et al., 2009; curran et al., 2020), it is important to examine the limitations of using criminal records in gatekeeping. further, the fact that poor, black, brown, disabled and/or lgbtq+ people are more likely to have criminal records should cause social workers to question their content and meaning. it is also vital that we examine the recidivism data and research in our exploration of how criminal records are used. most employers conduct criminal background checks through private companies that use commercial databases with incomplete information (corda, 2016; department of justice, 2006). these private search firms are huge businesses, generating nearly four billion dollars per year (jacobs, 2015). because of their profit motive, most private vendors do not spend the money to search criminal records in every state so they may miss criminal charges and convictions (jacobs, 2015). even state-run databases can have errors. for example, a review of new york’s division of criminal justice services found that error rates on criminal histories exceeded 80% (rosenthal et al., 2015). the federal bureau of investigation maintains the most comprehensive database on criminal histories, known as the interstate identification index (iii), by pulling together information from all state databases. still, the iii database is missing final dispositions on up to 50% of its records (department of justice, 2006). missing data on criminal records means an employer might not know if charges were dropped or whether the person was found not guilty. rates of conviction can range from 25-50% depending on the charges, and the conviction may be for a less serious crime than the initial charge (mcelhattan, 2021). without complete and correct data, employers may assume that arrest equals guilt. even in cases where records are thorough, employers may have difficulty interpreting the details because of industry-specific abbreviations and jargon (jacobs, 2015). bohrman et al./criminal records 343 other common problems with background checks include multiple entries for one arrest and cases of mistaken identity (jacobs, 2015). errors sometimes occur with what the national consumer law center calls sub-sub-sub-contracting, where private screening companies contract with other companies who contract with third or fourth companies resulting in data loss or distortion (yu & dietrich, 2012). there is currently no federal oversight to ensure accurate reports about criminal histories and addressing errors on criminal history reports can be too complicated, expensive, and time-consuming for many people to navigate (lageson, 2016). beyond limitations of the criminal record itself, there are systematic disadvantages some individuals, particularly those who are poor, face in the process leading up to a record. with the exception of murder charges, less than 6% of cases go to trial (pastore & mcguire, 2003). individuals who are economically disadvantaged have greater challenges posting bail, leading to pre-trial detention and incentivizing guilty pleas as a means of getting out of jail (bennett, 2018; rabuy & kopf, 2016). defendants who are incarcerated before trial plead guilty close to three times more quickly than those not being held (petersen, 2020). while individuals pleading guilty include those who have engaged in the behavior for which they are charged, it can also include people who are innocent and want to avoid pre-trial detention or who are intimidated by prosecutorial threats of harsh sentences (blume & helm, 2014). as a practical matter, defense attorneys may encourage innocent clients to plead guilty (helm et al., 2018). part of the logic of using criminal records is the belief that people charged with or convicted of behavior labeled as criminal will engage in similar behavior in the future. recidivism data has been used to examine whether this is true, but there are many limitations to this research. one issue is with the definition of recidivism. recidivism can refer to arrests, violation of probation or parole, convictions, or prison returns. violations of probation and parole conditions often involve behaviors that are not otherwise considered criminal such as alcohol use, staying out too late at night, moving to another state or even crossing state lines. probational officers have wide discretion on whether to violate someone for not following through with a condition, creating the possibility of further bias by race, gender or other factors (ruhland & scheibler, 2022). additionally, once a person has a record, there is widespread bias, increasing rearrests when they encounter a police officer or interact with their parole officer (stolzenberg et al., 2021). one of the biggest limitations of recidivism data is that we have no way of conducting a study to control for the stigma and wide range collateral consequences people face when they leave jail or prison. how many people would actually harm others if their psychological, social and physical needs were met? another problem with relying on recidivism data, or really any criminal records, to document previous instances of harm is that most cases of sexual assault, rape, and abuse are never reported (mulder et al., 2021; schwartz et al., 2017). therefore, using records as a primary means of screening out individuals may create a false sense of safety. advances in social work, summer 2022, 22(2) 344 differentiating crime from harm the concept of crime is often conflated with harm and assumed to be a predictor of future harm (green & pemberton, 2017). the term crime encompasses so many disparate acts that it is almost impossible to come up with one definition (hillyard & tombs, 2017). essentially any action or lack of action a government deems illegal is considered a crime. while some crimes involve injury to other people, many others, such as full-service sex work, do not (minichiello et al., 2018). in contrast, many harmful behaviors are not illegal. for example, a social worker engaging in sexual activities with an adult client, while unethical, is not unlawful. similarly, disclosure of private information such as an affair or a trauma history could cause serious lasting harm with employment or intimate relationships but is unlikely to result in a criminal record (reamer, 2014). an examination of some of the most common ethical violations committed by social workers, such as lack of commitment to clients, conflicts of interest, privacy and confidentiality abuses, and sexual relationships, indicates that many of these harmful behaviors would not be documented in a criminal record (nasw, 2021b). as a result of neoliberal influences, the criminal legal system has shaped our thinking about harm as an individual rather than societal issue (collins & rothe, 2019). we can label an individual a “criminal,” remove them from society, and have the illusion that we are safer, ignoring the historical oppressions and contexts which contributed to the person’s actions. in doing so, we minimize the strengths and humanity of people caught up in the criminal legal system while neglecting to acknowledge the harms we all engage in (scott & brown, 2018). governments and corporations often have the greatest abilities to produce harm through acts that are not considered illegal (clark‐ginsberg & petrun sayers, 2020; hyra et al., 2019). similarly, the focus within the profession around gatekeeping and reducing risk of harm by individuals distracts from focusing on how organizations contribute to or even perpetuate harm (astvik & melin, 2013; lewis, 2018). harms such as racism, cisheterosexism, ableism and so many other forms of oppression are not captured in our criminal codes and are arguably some of the most damaging dynamics that can occur in a social work context. re-visioning disciplinary inclusion: developing abolitionist solutions as awareness of the perversities of the criminal legal system has grown through increasingly widespread familiarity with concepts like mass incarceration, the prison industrial complex, and the egregiously disproportionate economic and racial impacts of these systems, discourses around abolition have begun to gain traction (alexander, 2019; davis, 2011). abolition is a multifaceted framework – as mariame kaba, a leading abolitionist thinker and scholar defines it, abolition is “a political vision, a structural analysis of oppression, and a practical organizing strategy” (kaba, 2020, para. 3). it is important to emphasize that while abolition argues for the need to end our systems of policing and mass incarceration – the stance for which it is perhaps best known – it is, at its core, a vision of inclusion (rodriguez, 2019). this is in stark contrast to the orientation of our current incarceration system, which is built almost entirely on the premise of exclusion as the essential form of punishment – physical exclusion from loved ones and bohrman et al./criminal records 345 communities, and ultimately, lifelong social exclusion from education, housing, employment, and other opportunities. our persistent reliance on these systems of exclusion is illogical given the overwhelming evidence that not only do they unfairly target people experiencing structural marginalization, they also do not make our communities safer (clear, 2009). as previously discussed, these multiple forms of exclusion are inextricably linked to high recidivism rates, posing barriers to financial and social stability, and establishing ongoing levels of increased surveillance and bias through probation and permanent criminal records (bureau of justice statistics, 2019; bureau of prisons, 2021; grant et al., 2011; myers et al., 2017; us census bureau, 2021). these conditions contribute to an endlessly revolving door of punishment and the development of virtually insurmountable forces of social oppression, ultimately resulting in reduced community safety and well-being. the continued use of criminal background checks as a gatekeeping mechanism for social work requires a willful ignorance of the reality that these do not serve as an accurate or reliable tool in assessing a person’s likelihood to cause harm. and given that the structural disadvantages that social work seeks to redress are the very same forces that increase one’s likelihood to have a criminal record, there is a deep existential dilemma inherent in this practice within the field of social work. in addition to the false sense of security that we are successfully screening out those who may perpetrate harm, reliance on background checks perpetuates an inherently racist and classist system that upholds white supremacy. the profession’s growing emphasis on anti-racist practices in social work further underscores the importance of correcting this ethical inconsistency (grand challenges, 2020). the logic of inclusion tells us that everyone, regardless of their history, deserves a fair chance in social work. and a fair chance can never exist when there are oppressive gatekeeping mechanisms that include criminal record checks. the social work profession, including our educational institutions, licensing institutions, and our practitioners from individuals engaged in micro work to those engaged in policy practice should recognize that any processes that rely on or legitimize racist systems are, in and of themselves, racist. existing systems of oppression (racism, poverty, homophobia, sexism, ableism, etc.) have disproportionately set marginalized people, such as those with criminal records, up to fail. holding individual people, rather than these oppressive structures, responsible for the outcomes of this oppression–even when it results in harm or trauma perpetrated by community members–is oppressive. exclusion, therefore, becomes oppression. abolition, then, is an essential path to anti-oppressive practice for social workers (choonara, 2021). the implications are, admittedly, fairly drastic. not nearly as drastic, however, as the current harmful landscape of the growing prison industrial complex, which reaches well beyond the walls of the prisons into every nook and cranny of our society. approximately one third of americans have criminal records (goggins & debacco, 2018), as many black men have felony convictions, and people are systematically and permanently excluded from the very fabric of society (davis, 2017). social workers have been engaging with abolition frameworks and grappling with how to translate them to social work practice for some time now (brown & mcgee, 2018; advances in social work, summer 2022, 22(2) 346 chandler, 2018; willison & o’brien, 2017). as the black lives matter movement has gained traction in response to police killings of unarmed black people, so too have the calls for police and prison abolition (james, 2021). social workers, who are positioned in various capacities across the front lines of the mass incarceration system, have begun to take up this call (richie & martensen, 2020). from police stations to defender’s and district attorney’s offices, prisons, courts, reentry programs, and even child welfare settings, abolition has increasingly become a rallying cry for social workers across these settings (clayton-johnson et al., 2021; rabuy & kopf, 2016). with this growing interest in alternative ways of responding to harm has come a greater demand from social work students for relevant course content focusing on decolonization and abolition, and many social work programs have responded accordingly (hutchison, 2021; udah, 2020). inclusion of abolition, harm-reduction and anti-carceral strategies, restorative and transformative justice, and decolonizing and radical social work have become more prevalent in msw programs across the country (gregory, 2020). and yet, these same social work programs persist in their own institutionally carceral practices through ongoing use of criminal records as gatekeeping mechanisms. social work programs appear to be responding more to the market-driven demand for course content, rather than substantively aligning with and implementing abolitionist orientations or practices. this neoliberalization of abolition, or selectively and publicly adopting strategies that translate to profit but not fully embracing less visible and meaningful work by institutions, is troubling (martínez herrero, 2021; morley et al., 2017). of course, we must critique systems of mass incarceration, but we must also interrogate ourselves as our profession continues to center whiteness, ableism and middle-class values. to simultaneously be part of upholding the conventions of prisons while also profiting from an abolition framework is in stark contrast to social work’s increasingly explicit ethical commitment to social justice and anti-racism and underscores the urgency of the abolition movement. radical re-imagining the abolition movement is committed to not only dismantling carceral systems, but also to imagining and building a new society in which sources of crime are minimized through ensuring that basic needs are met for all. kaba discusses some of the challenges we face to this call to radically re-imagine, specifically our intense collective socialization around punishment and social control as the only acceptable responses to harm, as well as our inclination as a society to “turn away from any social concern that overwhelms us” (kaba & hayes, 2018, para. 9). as writer erica meiners once noted, “liberation under oppression is unthinkable by design” (kaba & hayes, 2018, para. 25). of course, it is difficult to envision a new society, just as it was to imagine the end of slavery, or of segregation. but it is not impossible. kaba (2021) refers to this ability to engage in radical re-imagining as “a jailbreak of the imagination” and challenges us to consider a world that “nurtures human growth and potential rather than incubating desperation” (para. 1). abolitionist scholars and activists have enunciated strategies for building this new society, including the eradication of poverty through access to quality education, affordable housing, a livable minimum wage, and access to healthcare and affordable bohrman et al./criminal records 347 childcare (critical resistance, n.d.; kaba, 2020). while this may sound implausible, it is important to consider that the annual cost to maintain the prison industrial complex is estimated at 182 billion dollars per year (wagner & rabuy, 2022). as abolitionists have argued, building this new world isn’t about more resources, but rather about a reallocation of resources from punishment and social control to infrastructure and support. just as there have not always been prisons, there has not always been easy access to criminal records. while the united states made the conscious decision to make records more publicly available in the 1960’s, most of europe did not. in europe, criminal records are generally not considered public (jacobs, 2015). in the united kingdom (uk), researchers found using criminal histories to vet employees is costly, ineffective, and produces disparate impacts (appleton, 2014). the uk supreme court ruled disclosing an excessively broad criminal history to employers infringes on one’s human rights (gallagher v. secretary of state, 2019). in europe, there is a greater investment in individuals’ privacy and rights to move forward after making mistakes, as evidenced through laws such as the right to be forgotten (bramley et al., 2021) and spent and unspent crimes. many crimes in the uk, after a certain period of time, are considered “spent” and permanently removed from the person’s record. even so, there is a 34-page list of crimes that never get unspent. the list comprises crimes such as murder and rape, but also includes things like “procure or attempt to procure homosexual act between two other males” (p. 9) and “furious driving” (p. 20) (gov.uk, 2018), providing an illustration of how oppression shows up in law. these examples of unspent crimes demonstrate the ways that cisheterosexism, as well as something as simple as a momentary lapse in judgment (“furious driving”), particularly if the driver belongs to a demographic that is disproportionately targeted by policing, could result in a person being labeled for life. these laws could be more expansive, yet they are examples of how to reduce the availability of criminal background information in a systematic fashion. for social workers, this is also about fully embracing our stated commitments to antioppressive practice through recognizing the strengths of people who have experiences in the incarceration system, and the unique and necessary contributions they can offer to the field. rather than replicating the carceral system’s strategy of keeping people with lived experience in the system out, we should be embracing an abolitionist orientation of inclusion, and inviting them in. while these arguments are certainly relevant to other professions, social work is both well positioned, and also obligated to take the lead in changing the culture around the use of criminal background checks. rather than creating a professional and disciplinary enclosure through boundaries that exclude, this is an opportunity for radical inclusion of marginalized communities, and for social work to become an abolitionist model for the helping disciplines. reformist vs. non-reformist reforms while efforts to reform (rather than eliminate) the use of criminal background checks in employment and college admissions have gained steam in recent years – particularly “ban the box” initiatives– this reformist approach is problematic. as kaba discusses, “the limit of prison reform is that it validates the institution of prisons overall” (as cited by advances in social work, summer 2022, 22(2) 348 madden et al., 2020, para. 6). in other words, by reforming when or how we use criminal records in screening (i.e., admissions, employment, licensure), we reinforce the idea that criminal records are necessary in the first place, and the goal should be to use them more strategically or efficiently. given the evidence that race, disability status, and poverty are the best predictors of whether a person will have a criminal record (davis, 2017), to argue the legitimacy of using background checks at any stage of a social work hiring or admissions process is an inherently oppressive endeavor. “banning the box” prohibits employers from asking about people’s criminal records in their initial hiring paperwork, but they still allow employers to do background checks later in the process (agan & starr, 2018). as an alternative to such reformist approaches that reinforce existing structures, non-reformist reforms seek to shrink harmful systems and create pathways for broad and sweeping change (gorz, 1968/1987). in the example of criminal records, a non-reformist reform solution eliminates background checks in the hiring and admission process. several of these authors were involved in a successful nonreformist reform effort at their university to abolish questions about criminal records on admissions applications. this approach differs from the “ban the box” in the employment context because it removed all questions about criminal records from the admissions process. another recent example of a non-reformist reform related to criminal records is senate bill 637, enacted in pennsylvania in 2020. the bill makes it easier for people with criminal records to obtain occupational licenses in all fields, including social work. under the new law licensing boards cannot consider expunged crimes or those considered part of juvenile records (s.b. 637, 2020). additionally, it removed language regarding “moral character” and “moral turpitude” as vague terms used to restrict people with criminal records from gaining licenses (s.b. 637, 2020). however, the bill also contained reformist elements that reinforce reliance on criminal records. for example, the bill retains very complicated processes for obtaining a license for those with an adult criminal record and excludes all people with sex offenses from getting health care licenses, including those charged with prostitution (s.b. 637, 2020). given the challenging nature of identifying and implementing non-reformist reforms, several scholars and activists have proposed criteria to assist in determining whether a proposed reform is truly non-reformist. when exploring strategies to reduce discrimination against people with criminal records, social work schools and practice settings are encouraged to consider the following questions: • “does it legitimize or expand a system we are trying to dismantle?” (spade, 2020, p. 133) • “does it mobilize people, especially those most directly impacted, for ongoing struggle?” (spade, 2020, p. 133) • “does it improve material conditions?” (critical resistance, 2020, 1:08) • “are we able to try something new or different as a result?” (critical resistance, 2020, 1:08) • “does it advocate for more police and policing?” (kaba, 2014) bohrman et al./criminal records 349 at the heart of the abolitionist framework and non-reformist reform initiatives is a desire to invite people in rather than keep people out. this paradigm shift towards inclusion is why reform initiatives, which are still fundamentally about exclusion, fall short. radical inclusion while some reforms must happen at the state and national level, perhaps even more importantly, we also need to make policy and cultural changes within the profession. for example, what if instead of academic programs focusing on screening out, we looked to screen people into the discipline (madden, 2000)? what if we spent more time examining ways to attract more individuals that come from the same communities as the clients they serve? what if we spent less energy validating the profession as defined by white supremacist standards and more time examining and ameliorating the barriers to entrance into the profession, such as criminal records? the social work profession believes in change, growth and that individuals can heal; thus, a criminal conviction does not equate to poor moral character or practice negligence (carnahan, n.d.). rather than replicating the carceral system’s strategy of keeping people with lived experience in the system out, we should be embracing an abolitionist orientation of inclusion, and inviting them in. an msw is the most soughtafter degree for returning citizens (vliek, 2018). research suggests that returning citizens provide a unique set of skills, strengths for the helping profession due to their lived experiences (robins, 2012; rosenthal et al., 2015). individuals with criminal records are likely to have an intimate knowledge of complex systems and have the skills to bridge relationships between communities and academic institutions (halkovic & greene, 2015). individuals with criminal records may have unique mentorship skills, experiences with reentry, social enterprise, creative ways to engage in post-traumatic growth, and distinctive coping skills, and the social work profession can only be enhanced and made stronger by calling in these resilient credible messengers (baskaran, 2018; kenemore & in, 2020; vanhooren et al., 2018). efforts to make social work a more welcoming field for people with criminal records must go beyond removing background checks in college applications. for individuals with criminal records, who do enter the bsw or msw classroom or placement they must navigate rampant discrimination and stigma in order to graduate (halkovic & greene, 2015). vliek’s (2018) research shows that returning citizens graduate at lower rates due to these challenges. field directors have little guidance on how to navigate placing students with records (dottin, 2018). truly, social work practitioners, administrators and faculty need to partner to advocate for change in criminal record requirements within agencies. unchained scholars, a student interest group at university of south california (usc), that arose out of a group of students with records having trouble finding field placements, serves as a model program for helping people navigate the current system (lipinski, 2020). clinical assistant professor susan hess brought this group of students together to navigate the field placement process and develop narratives that highlighted the strengths of their lived experience. according to genevieve rimmer, a recent graduate of the dsw program and a member of unchained scholars, the group moved on to also work on advances in social work, summer 2022, 22(2) 350 advocating for policy change within their university as well as within the social work profession as a whole (personal communication, may 13, 2021). they serve as a model for other social work programs to support and build upon the strengths of people with prior criminal convictions. conclusion it is time for a radical culture shift in the way we think about people with criminal records, and how we think about harm. social work is a profession that believes in the inherent worth of all individuals and in everyone’s ability to change. we understand that an individual’s behavior does not occur in a vacuum and that various forms of oppression influence the choices people have as well as how they are treated once they make certain choices. we also understand that well-intentioned policies can have unintended consequences, and often those consequences fall on the backs of those who are most marginalized by our society. we also acknowledge that a shift in philosophy and practice varies in complexity depending on the social work setting. for example, in schools, child welfare, shelters, or long-term care facilities, there are laws outside of the profession requiring background checks. we also recognize that there are understandable concerns and risks associated with an adult who has a documented history of repeated violence against children, or a range of other concerning behaviors, working with vulnerable individuals. further, we recognize that in this current climate where there are significant restrictions in licensure and employment, social work programs have an ethical obligation to be transparent about the barriers, allowing students with records the choice about whether to invest their time and money in a social work degree. admissions staff, faculty, and others who support students ideally would advocate these requirements be based in science and simultaneously understand these barriers, particularly how these dynamics function within their local agencies and state licensing board. at time of this writing, we found limited research on securing social work employment or licensure for those with criminal records. while criminal records still play a role in licensure in the united states, there is a need for greater transparency around how criminal background checks are used in licensure in all fifty states. there is also a need to survey social work employers to see how many utilize criminal background checks and whether those background checks are mandated by the government or by agency policy. future research could help us to understand how people with criminal records are navigating the challenges of higher education, licensure and employment so that we can better target nonreformist reforms. scholarship in this area could also help us understand how to enact nonreformist reforms and which are most effective in moving towards a socially just society. as the social work profession moves toward creating a “just society,” we challenge our regulatory bodies such as the nasw, cswe, aswb, and state licensing boards to recognize the rampant white supremacy and respectability politics tied up in the use of criminal records as a gatekeeping mechanism and predictor of harm (de bie et al., 2020; haley, 2020). since the flexner report was written, 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(2011). the use of criminal background checks in social work education. journal of baccalaureate social work, 16(2), 1733. https://doi.org/10.18084/basw.16.2.b44t18268523v76n author note: address correspondence to casey bohrman, department of graduate social work, west chester university, west chester, pa, 1938317551. email: cbohrman@wcupa.edu https://www.aacrao.org/docs/default-source/signature-initiative-docs/disciplinary-notations/ed-guidance.pdf?sfvrsn=61d160cc_4 https://www.aacrao.org/docs/default-source/signature-initiative-docs/disciplinary-notations/ed-guidance.pdf?sfvrsn=61d160cc_4 https://www.americanprogress.org/issues/poverty/reports/2014/12/02/102308/one-strike-and-youre-out/ https://www.americanprogress.org/issues/poverty/reports/2014/12/02/102308/one-strike-and-youre-out/ https://doi.org/10.1177%2f0032885517753151 https://scholarworks.wmich.edu/dissertations/3210 https://www.prisonpolicy.org/reports/pie2017.html https://doi.org/10.18084/1084-7219.25.1.105 http://www.communityalternatives.org/pdf/reconsideredcriminal-hist-recs-in-college-admissions.pdf http://www.communityalternatives.org/pdf/reconsideredcriminal-hist-recs-in-college-admissions.pdf https://doi.org/10.1177/0886109916658080 https://doi.org/10.1177/0886109916658080 https://www.nclc.org/images/pdf/pr-reports/broken-records-report.pdf https://doi.org/10.18084/basw.16.2.b44t18268523v76n mailto:cbohrman@wcupa.edu _________ chan m. hellman, phd, professor, angela b. pharris, phd, msw, assistant professor, and ricky t. muñoz, jd, msw, associate professor, anne & henry zarrow school of social work, university of oklahoma, tulsa, ok. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1066-1083, doi: 10.18060/25632 this work is licensed under a creative commons attribution 4.0 international license. responding to adverse childhood experiences: the science of hope as a framework for action chan m. hellman angela b. pharris ricky t. muñoz abstract: research has long supported that adverse childhood experiences (aces) are linked with reductions in well-being across the lifespan. however, less is known about the best practices for intervening with ace to buffer the long-term negative effects beyond clinical settings. the current paper proposes that the positive psychology construct of hope offers guidance for understanding and responding to aces. we propose a theoretical model for developing a hope-centered and trauma-informed framework for responding to the deleterious effects for aces. the paper closes by calling on social work researchers, educators, and those in practice to learn more about the relationship between aces and hope and use that knowledge to help us better assist ace survivors. keywords: hope theory, adverse childhood experiences, resilience, trauma-informed practice in 1998 dr. vincent felitti and dr. robert anda published findings from their seminal adverse childhood experiences study. as one of the first studies to empirically establish a dose-response relationship between childhood trauma and long-term, adverse effects on health and wellness, the study was pioneering. since then, many studies have replicated the same dose-response impact of aces on long-term health risk and disease conditions (e.g., depression, ischemic heart disease, cancer, chronic lung disease, and liver disease). yet, while the negative impact of aces was established, uncertainty remains as to how best to assist ace survivors. our paper suggests that the discipline of positive psychology, particularly the construct of hope (snyder, 1994), provides insight into the mechanisms by which aces produce long-term adverse effects and serves as a theoretical foundation for building better interventions and best practices for ace survivors. the lasting impact of aces the initial ace study introduced a 10-item adverse childhood experiences (aces) scale, which allowed for ease of measurement of individual differences in childhood trauma experiences (felitti et al., 1998). using the newly developed ace scale, felitti and colleagues (1998) investigated the association of childhood exposure to adverse experiences on health risk behaviors and disease conditions within a large sample of adults. at least three seminal findings emerged from the original ace study. first is the prevalence of childhood adversity in adults, with approximately two-thirds of study participants reporting at least one adverse event. second, this initial study showed that those exposed to one category of child adversity were likely to have been exposed to at least one other adversity. that is, exposure to childhood adversities is likely to co-occur about:blank advances in social work, fall 2022, 22(3) 1067 across the 10 events within the abuse, neglect, and dysfunctional household categories. finally, felitti et al. (1998) showed a dosage effect of childhood exposure to adversities on long-term health risk and disease conditions that include the leading causes of adult death in the u.s. (e.g., ischemic heart disease, cancer, chronic lung disease, and liver disease). the original findings from the ace study demonstrated that exposure to certain types of childhood adversity leads to significant health consequences throughout the lifespan. in the decades following the original study (felitti et al., 1998), research has continued to link aces to various negative health outcomes and other indicators of well-being. health outcomes such as obesity, diabetes, sexually transmitted infections, suicide attempts, heart disease, cancer, and other chronic health conditions are linked to aces (centers for disease control and prevention [cdc], 2019). furthermore, research has revealed that aces are associated with an increased engagement in risk-taking behaviors such as smoking, substance use and abuse, risky sexual practices, suicidality, self-injury, and encounters with the criminal justice system (cdc, 2019; layne et al., 2014). these risktaking behaviors may reflect an individual's attempt at short-term coping which evolves into long-term consequences to well-being (felitti, 2003). the cdc (2019) reported that over 40 known outcomes have a graded dose-response (i.e., as the number of aces increases, the risk of adverse health outcomes increases) [cdc, 2019]. aces have also been linked to other critical social indicators of well-being, such as an impact on education, employment, income, and other essential activities of adulthood often associated with stability (cdc, 2019; metzler et al., 2016). the magnitude of the lasting impact of aces has led the president of the american academy of pediatrics, bob block, to state that adverse childhood experiences is the single greatest unaddressed public health issue facing our nation (kennedy et al., 2011). increased professional and public awareness of aces the extensive research base linking aces to adverse outcomes across the lifespan has led to widespread awareness initiatives of aces among helping professionals. over the last several years, there has also been a dramatic increase in local, state, and national efforts to raise awareness of the impact of aces. this includes identifying programs and interventions to reduce their negative effects. for example, organizations such as the cdc coordinate and report on national and state-level screenings for adverse childhood experiences using the behavioral risk factor surveillance system (brfss, dube, 2018). the substance abuse and mental health services administration (samhsa) funds the national traumatic child stress network (ntcsn) to direct access to trauma-informed systems and programs. additionally, the administration for children and families (children’s bureau, n.d.), u.s department of justice (2019), and many other organizations have prioritized responses to aces and provided resources to develop and evaluate interventions aimed at primary, secondary, or tertiary prevention of aces (cdc, 2019). as awareness of aces has grown, policymakers, legal systems, and community leaders have emerged to seek more comprehensive system-based solutions and interventions to adversity. efforts have begun to expand individual and family-level trauma-informed prevention and intervention programs to address the negative impact of aces. hellman et al./respoinding to aces 1068 while the aces research is compelling and wide-reaching, some critiques and challenges exist. the general use of aces may promote misuse and could be stigmatizing and harmful (kelly-irving & delpierre, 2019). there are cautions against using the aces categories as diagnostic criteria or assessment tools, even when the goal is to generate protective measures (anda et al., 2020; finkelhor, 2018). having an individual take an ace score assessment poses some ethical considerations. anda and colleagues (2020) point out that the aces assessment was not intended as a measure of clinical risk but rather a set of measures used in research and health surveillance studies. additionally, the aces study has been criticized for excluding other significant stressors and adversity that can occur during childhood and throughout life. notable is the exclusion of cultural, structural, and systemic oppression and the impact of socio-economic factors that may exasperate the already harmful effects of aces (wade et al., 2014). trauma-informed care recognizing the need to provide better support for ace survivors, service providers have developed an approach known as trauma-informed care (samhsa, 2014). perhaps the most widely used formal description of trauma-informed care is the one adopted by samhsa, which defines trauma-informed care as an understanding of the frequency and effects of early adversity on psychological functioning across the life span. thus, a traumainformed approach responds with compassion and empathy and seeks to intentionally develop systems to be safe places, empower and allow survivors a voice, and nurtures collaboration rather than approaches that may inadvertently re-traumatize survivors (samhsa, 2014). trauma-informed care is distinct from trauma-specific clinical interventions. traumainformed care is rooted in practices that encourage a community and professional responses to children and families affected with trauma as they enter service systems. however, the value of increasing awareness alone and its benefit to children and families is still emerging in the research literature (berliner & kolko, 2016). the framework for trauma-informed care provided by samhsa of safety, trustworthiness, collaboration, and empowerment are standards of quality care, but how do organizations and providers know they are creating a trauma-informed-care environment? one strategy has been to measure knowledge improvements among providers gained from training (bendall et al., 2021). likewise, understanding how the systems change as a result of trauma-informed care system adjustments can be a useful approach, such as examining how casework is managed (lang et al., 2016) or enhancing client screenings, include trauma-informed assessments (bartlett et al., 2018), or evidence of organizational change (bunting et al., 2019). however, additional strategies that deploy theoretically-driven and evidence-supported approaches that can be implemented and evaluated for effectiveness are still needed. deficiencies of the trauma-informed approach much work remains to better define trauma-informed care, as the term remains a concept that has been defined in many ways, making it difficult to evaluate. little is known about how the various initiatives described as trauma-informed care and related traumaadvances in social work, fall 2022, 22(3) 1069 informed interventions improve outcomes for children and families (hanson & lang, 2016). most trauma-focused interventions address some of the symptoms and behaviors associated with aces, such as depression, emotional dysregulation, information processing, or risk-taking behavior. while there is some evidence that existing approaches to counseling and therapy (e.g., cognitive behavior therapy, eye movement desensitization and reprocessing therapy, child-parent psychotherapy, attachment, selfregulation, and competency) provide some assistance for survivors (menschner & maul, 2016), much remains to be understood about how to best intervene to assist ace survivors (finkelhor, 2018; hanson & lang, 2016). hindering those efforts is the lack of consistent definition and framework for trauma-informed care. moreover, most interventions rely heavily on services offered by health and behavioral health professionals, which are not readily accessible to most children or adults with multiple exposures to adversity and trauma (mental health america, 2021). additionally, children's adversities are deeply rooted in systemic issues (larkin et al., 2012). therefore, comprehensive interventions that consider trauma also need to address the structural and systemic changes that prevent childhood exposure to trauma. consequently, expanding evidence-based prevention and intervention for ace survivors is the essential next step in dealing with the impact of aces, especially considering the magnitude of the problem (dube, 2018). moreover, while helpful in moving the field toward better awareness, the trauma-informed care paradigm is not a fully developed theoretical model for interventions. rather trauma-informed care is a way of understanding current coping circumstances in the context of day-to-day interactions with helping professionals. as a result, trauma-informed approaches are being adopted in nonclinical settings such as schools, law enforcement systems, community libraries, parks programs, places of worship, or any other place where individuals and families interact. moving beyond identification of risk to improving well-being while the trauma-informed approach is important for understanding, empathy, and constructing meaningful clinical treatment plans, interventions that aim to buffer the longterm impact of adversity and trauma are scarce in non-clinical settings (e.g., schools, households, child welfare). few theoretically-driven models can simultaneously guide interventions at the individual, family, and community levels. thus, trauma-informed care needs to move beyond the current approaches toward evidence-driven models that develop and sustain systems to act in a way that buffers against the negative impact of aces. the strategies are preferable if they have a balanced perspective of reducing risk while supporting the survivor in addressing the effects of trauma and deploying a framework that directs the survivor's attention toward a future expectation of well-being. such a theoretical framework must be accessible across multidisciplinary teams to be practical and valuable, providing an easily understandable common language across diverse disciplines to deploy a coordinated community response. scholars, advocates, public health officials, and policymakers alike have shifted attention to strategies that could facilitate protective measures to promote well-being, even in the face of adversity (sege & browne, 2017). strategies such as those that focus on hellman et al./respoinding to aces 1070 increasing strengths in parent-child relationships and other strategies that identify and support positive childhood experiences within a community show significant promise (burstein et al., 2021). hope theory provides this much-needed framework as it is both conceptually parsimonious and has robust research-based evidence in many areas impacted by adverse childhood experiences. in this paper, the authors outline hope theory (snyder, 2000) as a unifying conceptual and empirically-based framework to guide social workers, clinicians, community leaders, researchers, and policymakers to provide a coordinated response to the ace epidemic (dube, 2018). we propose a hope-centered, trauma-informed practice approach to assist ace survivors in coping with the lasting effects of trauma and promote individual, family, and community well-being. hope theory hope theory is associated with a segment of modern psychological research known as positive psychology (seligman & csikszentmihalyi, 2000). like aces, positive psychology was born approximately 20 years ago out of the recognition that psychological research has historically centered on understanding and reducing pathology. while this research led to immense gains in treating pathology, positive psychologists recognize the traditional research focus is myopic, leading to a limited understanding of the complete human condition. as a result, positive psychology expanded existing research to study well-being, virtue, resilience, and a meaning-oriented focus on what makes the good life. such research has helped advance the understanding of positive psychological states. since positive psychology is the flip side of traditional research into pathology, positive psychology research has also led to a greater understanding of human functioning. from positive psychology studies, one variable has demonstrated a consistent and significant impact of advancing our understanding of the human condition ( i.e., hope; snyder et al., 1991). hope has been recognized as a central variable of the positive psychology family. some have described (peterson & seligman, 2004, p. 577) hope as a “velcro construct” because it is positively correlated with so many other character strengths associated with well-being. the most well-developed and researched theories of hope were developed by snyder (2000), who held that hope is a cognitive process centered on future expectations for goal attainment. in this context, hope is comprised of three main tenants: goals, pathways, and agency. goals represent the cornerstone of hope theory as the cognitive endpoint to planned behavior (snyder, 2000, 2002). goals can exist in the short or long-term but must be of sufficient value to motivate attention and action. behavior motivated by hope requires the goal to be perceived as potentially attainable, clearly defined, and possess identifiable criteria for measured success. to achieve the goal, one must conceive of one or more viable pathways to goal attainment. pathways thinking represent a mental road map allowing one to consider strategies that will lead to the desired outcome. viable pathways are within the individual's advances in social work, fall 2022, 22(3) 1071 capacity to pursue and are developed with a future orientation of successful goal attainment. in this manner, the hopeful individual can consider potential barriers and identify workable solutions or possess the capacity to find alternative pathways when needed. hopeful individuals can generate multiple alternative pathways toward their goal pursuits even in the face of significant barriers. comparatively, individuals who have lower hope have trouble managing barriers and will have trouble developing alternative pathways (snyder, 2002). agency represents goal-directed motivational thinking for hope theory. agency, or agentic thinking, refers to the capacity to exert mental energy (willpower) to pursue the pathway. hopeful individuals exhibit self-control, regulating their thoughts, feelings, and behaviors during goal pursuits, especially while experiencing stress and adversity (gailliot & baumeister, 2007; valle et al., 2006). individuals with lower hope are more likely to experience difficulty regulating their thoughts and self-control, a condition exasperated by the trauma and adversity associated with aces. pathways and agency are reciprocal, iteratively influencing each other. achieved successes in pursuing pathways toward a goal fuel motivation and desire (agency) to sustain plans. likewise, energized and intentional thinking about a goal encourages planning and strategizing how to achieve the goal (pathways thinking). finally, successful goal pursuits result in an increased tendency to set and pursue more challenging goals in the future. in this context, hope begets hope. as both pathways and agency are required, any deficit in this cognitive process (goal setting, agency, pathways) will result in lower hope. it follows that an individual experiencing lower hope recognizes their deficiency in pathways and/or agency when presented with a goal reacting with negativity and focusing on failure (e.g., the “i can't attitude”). figure 1. snyder's hope theory the benefits of hope are associated with various indicators of well-being, including life satisfaction, affect regulation, meaning in life, and decreased depression and suicidal ideation (cheavens et al., 2005; park et al., 2004). while research supports that hope is an integral part of the healthy human condition, theory and accompanying research suggests goals agency (willpower) pathways hellman et al./respoinding to aces 1072 hope is particularly important for those coping with severe adversity associated with adverse childhood experiences and toxic stress (baxter et al., 2017; snyder, 2000). for instance, among survivors of intimate partner violence, hope is associated with an increased sense of empowerment (muñoz, brady et al., 2017) and life satisfaction (muñoz, hellman et al., 2017). among individuals experiencing homelessness, hope has been linked to less physical pain and greater feelings of health (muñoz et al., 2016). among children in foster care, hope has positively correlated with self-control, grit, and curiosity (hellman & gwinn, 2017). furthermore, hope has been shown to operate as a coping resource buffering the relationship between parental stress and well-being for at-risk parents for potential child maltreatment (hellman et al., 2018). hope has been identified as one of the guiding principles of recovery (samhsa, 2012). finally, hope has also been shown to promote adaptive coping and adjustment to stressful posttraumatic experiences (chang & desimone, 2001), including trauma-exposed veterans receiving mental health care (hassija et al., 2011). considering the importance hope has demonstrated in populations facing adversity, it follows that hope theory holds promise as a tool to help individuals, families, and communities better understand and support ace survivors. low hope and trauma snyder (1994) theorized that higher hope individuals must focus their attention on setting goals and selecting pathways to those goals. individuals with higher hope can focus their attention on those goals and devote the energy to pursue identified pathways. however, trauma negatively impacts attention and focus and affects how much attention or energy a person can devote to their goal pursuits. therefore, snyder (1994) also theorized that low hope is associated with decreased ability and time to devote attention to goal pursuits as a survival mindset results in spending considerable time responding to surrounding people and events, leaving little willpower to concentrate on important goals. the loss of hope, or lower hope, is a process that involves moving from some degree of hopeful thinking to anger when barriers begin to block pathways. if unable to overcome those barriers, we experience despair as goals become significantly blocked or pathways become too burdensome to pursue. finally, one reaches the eventual ending point of apathy towards goals (snyder, 1994). snyder (1994) offered a hope theory-based explanation for the link between trauma experiences and lower hope. snyder believed that trauma causes lower hope because trauma experiences can be relived in the mind (e.g., rumination). the trauma appears to block goal-directed thinking for important life goals, incapacitates the person across a range of goals, and endures over time. research has shown that aces predict lower hope via rumination (muñoz & hanks, 2019). rumination is detrimental to hope because rumination involves regularly filling the mind with intrusive thoughts and images of past traumas (long & gallagher, 2018). as a result, ace survivors, as they experience rumination, may have fewer cognitive resources to identify and navigate pathways to goals, thereby hampering hope. research on trauma, ptsd, and aces demonstrates that survivors often have intrusive memories of the traumatic events; therefore, trauma advances in social work, fall 2022, 22(3) 1073 memories become attention robbers, which take attention away from developing pathways to future goals (hellman et al., 2018; muñoz & hanks, 2019). the second avenue of research that explains lower hope draws from exploring the link between aces and interpersonal relationships into adulthood. hope theory borrows from attachment theory by noting that an individual's hope arises in the context of early childhood relationships with caregivers (snyder, 1994). individuals who experience supportive relationships with caregivers develop high hope (snyder, 1994). in contrast, ace survivors, by definition, have experienced or witnessed some form(s) of maltreatment from parents and/or early caregivers. as a result, individuals can develop a distrust of others associated with insecure attachment styles (snyder, 1994). because relationships with others are important pathways to our goals, the resulting social isolation that often comes from aces can adversely impact hope (bethell et al., 2019; snyder, 1994; sympson, 2000). emerging research supports snyder's views on the link between trauma and lower hope, as aces have been empirically shown to be a driver of lower hope mediated by insecure attachment style (muñoz et al., 2022). therefore, improving an ace survivor’s meaningful connection to others provides the environment to increase hopeful thinking. ensuring children and their families have ample opportunities for supportive relationships, that children can grow and learn in stable and safe environments, and ensuring children have opportunities for connections to others have all been found to promote positive outcomes for children with aces (sege & browne, 2017). these are often the types of relationships that children and youth have access to in non-clinical settings such as those with educators in schools, supportive peers, mentors, coaches, after-school programs, and a host of other resources often found in communities. a growing body of research suggests hope is an important psychological trait in coping with aces (baxter et al., 2017). for instance, hope has demonstrated stronger predictive power for psychological flourishing among aces survivors than resilience (muñoz et al., 2020). hope theory also has value in illuminating the mechanisms linking aces to wellbeing reductions later in life. understanding the mechanisms between aces and wellbeing across the life span is essential if we wish to answer the call to establish best practices for helping ace survivors (finkelhor, 2018). hope theorists have acknowledged a close relationship between hope and resilience (ong et al., 2018; snyder, 2000). however, research supports the distinctiveness of hope from resilience (munõz et al., 2020). while resilience contributes to well-being, there are concerns about the usefulness of the construct (luthar et al., 2000; van breda, 2018). resilience as a construct lacks uniformity in the existing literature, sometimes described as a trait, a process, an outcome, or a version of all three (southwick et al., 2014). additionally, the construct of resiliency has been described as including other established constructs such as self-efficacy, humor, patience, optimism, or grit (connor & davidson, 2003). at the core, resilience involves the ability to bounce back after encountering adversity (smith et al., 2008; southwick et al., 2014), and one’s ability to recover from adversity is no doubt an important characteristic to potentially mitigating the impact of trauma (mcfadden et al., 2015). the concept of hope and it’s positive outcomes have been well-established in the literature. as such, it lends itself to the development of hellman et al./respoinding to aces 1074 interventions to promote a future expectation of achieving goals with individuals, families, communities, organizations, and policymakers. hope as a framework for action on aces although the research on hope in the context of aces remains relatively new, theory and emerging empirical evidence suggest hope offers significant potential as a theoretically driven framework to provide structure for interventions to respond to aces' survivors. the simplicity of hope theory lends itself to a trauma-informed and hope-centered framework to assist survivors of childhood trauma in building pathways for the capacity to thrive. this theory is bolstered by research demonstrating that hope is malleable and can be measured and nurtured via intervention (cheavens & guter, 2018; duncan et al., 2022; pharris et al., 2022; sulimani-aidan et al., 2019). hope theory could assist in responding to aces in various clinical and community (non-clinical) settings. hope theory-based interventions have already been developed that could form a foundation for future hope-centered interventions for ace survivors (cheavens & guter, 2018). there is emerging research on the positive impact of programs that focus on increasing hope. studies have examined the role of hope in single-session therapy, solution-focused brief therapy, and narrative therapies (courtnage, 2020). studies have linked increased hope to improved client engagement and program participation (counts et al., 2017) and demonstrated that hope is malleable even in brief interactions among college students (feldman & dreher, 2012). a five-week school-based program designed to enhance hope by helping children use the core components of hope (goal setting, pathways, and agentic thinking) had a positive association to increased hope, life satisfaction, and self-worth among middle school students (marques et al., 2009). a 12week hope-based school intervention had promising results among adolescents who increased hopeful thinking, resilience, coping skills, and seeking social support (kirby et al., 2021). likewise, studies of camp hope, a children's camp explicitly focused on children and youth who have significant exposure to aces, showed promising results of improving hope as a coping resource among campers (hellman & gwinn, 2017). programs that aim to improve a survivor's well-being could use the science of hope as a guiding framework or approach. for example, mentor and peer support programs are designed from the evidence that meaningful connections to a caring adult have a positive effect and even proven helpful as a protective factor for children, youth, and adults exposed to trauma (zinn et al., 2017). because hope is a cognitive process and can be modeled, nurtured, and enhanced by others, hope provides a possible way of approaching a mentor relationship and building meaningful connections. such interventions use hope theory to shape intervention modalities and track outcomes (cheavens & guter, 2018). using hopebased interventions as a foundation, further research into hope-informed interventions explicitly developed for ace survivors may yield beneficial results. advances in social work, fall 2022, 22(3) 1075 hope in diverse groups while the concepts of goal-setting, pathways, and willpower have consistently been defined, the nature of our goals, the available pathways, and the driving forces of motivation to pursue those goals are unique and may be constrained by other characteristics such as one's socioeconomic status, race and ethnicity. chang and banks (2007) examined the convergence or divergence of hope in the context of different racial/ethnic groups in measures of agentic and pathways thinking, examining the contention that hope may be lower in certain racial/ethnic populations. their findings affirm that the function of hope is similar between groups. as goals are the cornerstone of hope, the diversity of the human experience would suggest that an array of goals are possible and, in part, framed by our cultural characteristics, experiences, and preferences (edwards & mcclintock, 2018). similarly, the pathways and obstacles one will encounter in pursuit of their desired future will be different and shaped by our socioeconomic status and access to culturally relevant services (edwards & mcclintock, 2018). in the same notion, maintaining motivation to pursue those goals are deeply impacted by one’s environment and will likely look different for each individual. identifying culturally relevant strengths as resources, and those strengths often emerge as pathways to goal pursuit. oppression and discrimination undoubtedly impact the type of goals one sets and pursues. power, and the effort to control power from the dominant group, is often focused on blocking certain groups of people from their goal pursuits. and there is no doubt that oppression and discrimination control, limit, or constrain the types of pathways one has access to. but research evidence does not suggest that members of oppressed or marginalized groups do not have and sustain hopeful thinking (snyder, 1994). we cannot overlook or oversimplify how long-term structural and systemic oppression may limit one's sense of possibility of the future. hopeful thinking aims to produce well-being, which is not just an individual function of self-care but is also a function of our collective wellbeing. therefore, hope is a phenomenon that should be examined through our institutions (ginwright, 2016). hope and a collective imagination of the future is the mechanism that activists and social movements use to create strategies that both address oppression and direct social change by shifting how individuals, organizations, and communities relate to one another by envisioning a new way of seeing collective hope (ginwright, 2016). implications for social work practice and research trauma-informed care acknowledges the experiences of the individual and family but alone is not enough to help the ace survivor move to a place of well-being. future practice and research on aces and trauma-informed care need meaningful theoretical and empirically-based intervention strategies and practice models that can be deployed in clinical and non-clinical settings to improve impact on well-being. hope theory is a cognitive process that can be taught and modeled, and provides a framework to build on trauma-informed practice. in addition, psychometric scales to measure hope have been validated for adults and children (hellman et al., 2013; hellman et al., 2017; snyder, 1991; hellman et al./respoinding to aces 1076 snyder et al., 1997). the simplicity of the hope theory also provides a common language that can be useful in interdisciplinary and community settings, making hope a malleable tool for a multi-system response. research attention to implementation strategies and non-clinical interventions using hope theory can add value to the current studies and allow for replication across systems. research attention to examining sources of hope and specific behaviors that model and enhance hopeful thinking are needed. to what role do hopeful others (i.e., parents, teachers, counselors, caseworkers) increase individual hope? additionally, hope is likely different across life domains. most of the existing research treats hope as a generalized state. still, future studies should specifically consider hope in different domains of one’s life (i.e., would provide a better understanding of the construct and opportunities for focused prevention and interventions for survivors). future examination of the role of organizations, programs, and services as the potential source of hope by integrating hope into the systems, policies, and procedures is an emerging area of research that requires further development. just as other theories that draw from positive or strengths perspectives, hope theory could be used as a tool across systems. organizations and organizational leaders could draw from the evidence to consider program design and implementation and introduce the main conceptual components of hope to the workforce. likewise, services deployed to individuals or families can use hope concepts and existing interventions and incorporate them into assessment and case planning, adopting a hope-based approach to case management practice. utilizing a hopecentered approach does not ignore the real challenges that individuals, groups, and communities face. rather, it provides a strategy for helping those who experience adversity imagine a future they can control. a hopecentered approach is a different way of looking at individuals, families, and communities with empirically solid evidence of its protective capacity. future social work research and practice can continue reconceptualizing the strengths perspective and empowerment models commonly adopted to include the existing and emerging literature on hope theory. the strengths perspective devotes attention to the strengths and capacity of service users and systems to acknowledge that strengths make us resilient in periods of adversity (gou & tsui, 2010). hope has emerged as one of the most salient strengths. in fact, in the handbook and classification of character strengths and virtues, working across cultures identified six core virtues and 24 character strengths that exist in human nature and can be activated. studies of character strengths find that hope is perhaps the most significant, with all the other strengths correlated with hope. hope must be activated for well-being (peterson & seligman, 2004). saleebey (2000) believed that hope, as conceptualized by snyder (1994), was the key idea for strengths perspective, recovery, and resiliency movements, noting the critical importance that one must expect their future to get better. he stated, "as social workers, we consort with the subjective, the possible, and help assure the agency of others, working on fashioning their hopes into goals and finding, as patterns with them, those pathways to promise" (saleebey, 2000, p. 133). while positive psychology has led the research on hope, social work is uniquely situated to translate the science of hope into practice and improve advances in social work, fall 2022, 22(3) 1077 the collective response to aces. while the possibilities for future research with aces and hope are numerous, hope theory and associated research offer a promising foundation for answering the call of others who see a need for clarity on how to best intervene on behalf of ace survivors. references anda, r. f., porter, l. e., & brown, d. w. 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(2017). the predictors of perceived social support among former foster youth. child abuse & neglect, 72, 172-183. https://doi.org/10.1016/j.chiabu.2017.07.015 author note: address correspondence to chan m. hellman, anne & henry zarrow school of social work, university of oklahoma, tulsa, ok, 74135. email: chellman@ou.edu https://doi.org/10.3402/ejpt.v5.25338 https://www.dshs.wa.gov/sites/default/files/altsa/stakeholders/documents/duals/toolkit/ten%20guiding%20principles%20of%20recovery.pdf https://www.dshs.wa.gov/sites/default/files/altsa/stakeholders/documents/duals/toolkit/ten%20guiding%20principles%20of%20recovery.pdf https://ncsacw.acf.hhs.gov/userfiles/files/samhsa_trauma.pdf https://doi.org/10.1037/ort0000320 https://doi.org/10.1016/b978-012654050-5/50017-8 https://doi.org/10.1016/b978-012654050-5/50017-8 https://ovc.ojp.gov/events/preventing-adverse-childhood-experiences-aces-martinsburg-initiative-webinar https://ovc.ojp.gov/events/preventing-adverse-childhood-experiences-aces-martinsburg-initiative-webinar https://doi.org/10.1016/j.jsp.2006.03.005 https://doi.org/10.15270/54-1-611 https://doi.org/10.1542/peds.2013-2475 https://doi.org/10.1016/j.chiabu.2017.07.015 mailto:chellman@ou.edu microsoft word 11_mcelderry_and_jones_24414_ending_our_silence _________ cathy g. mcelderry, phd, lcsw, professor, department of social work, middle tennessee state university, murfreesboro, tn. v. nikki jones, dsw, lcsw, lmft, assistant professor, school of social work, spalding university, louisville, ky. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1246-1260, doi: 10.18060/24414 this work is licensed under a creative commons attribution 4.0 international license. ending our silence: promoting h.r. 40 to study slavery and redress institutionalized racism cathy mcelderry v. nikki jones abstract: the u.s. has never fully addressed the legacy of chattel slavery and institutionalized racism. h.r. 40 – commission to study and develop reparation proposals/processes for african americans act presents an opportunity to engage in a national discourse on the topic of federal reparations for the injustices of slavery and the present-day impact. the intent of the bill is to establish a commission to examine remedies for slavery and institutionalized discrimination. enacting this bill is an important step in acknowledging the fundamental injustices of slavery. social work, as a profession, has yet to acknowledge a position on this important issue. the historical context of reparations and institutionalized discrimination are presented to initiate a dialogue and call to action among social workers. social workers are in a unique position to play an integral role in addressing the issues challenging passage of h.r. 40. the advocacy expertise of social workers situates them to support reparations as a policy priority that aligns with the cardinal values of the profession. through capacity-building, the social work profession can dispel the myths and fears associated with reparations and move h.r. 40 forward. keywords: reparations, h.r. 40, social justice, advocacy, institutionalized racism since 1989, h.r. 40 has been proposed to establish the commission to study and develop reparation proposals for african americans (commission to study and develop reparation proposals for african americans act, 2019; national coalition of blacks for reparations, 2020). the bill would authorize the establishment of a commission to examine remedies for slavery and discrimination. the proposed commission would identify “(1) the role of federal and state governments in supporting the institution of slavery, (2) forms of discrimination in public and private sectors against freed slaves and their descendants, and (3) lingering negative effects of slavery on living african-americans and society” (commission to study and develop reparation proposals for african-americans act, 2019, para. 1). however, to date, the only legislative actions on h.r. 40 have been subcommittee hearings and house judiciary committee markup in 2021. through its code of ethics, the profession of social work has a commitment to social justice and the empowerment of vulnerable populations. therefore, social workers are well situated to contribute to the advancement of h.r. 40. the bill serves as a first step in examining the logistics of reparations as a form of redress for the residual inequities created by slavery and systemic racism. the national association of social workers (nasw), the largest professional social work organization in the world, represents the voices of more than 600,000 social workers (nasw, 2020a). through its publications, social media, and other communication modalities, nasw has the resources to identify h.r. 40 as a policy priority with the potential to eliminate many of the social and economic barriers that hinder mcelderry & jones/ending our silence 1247 the collective productivity of the african american community. a call for professional scholarship and action on reparations for african american descendants of chattel slavery is long overdue. nasw and other professional social work organizations are in a key position to advocate for h.r. 40 through their membership roster, stakeholders, and constituents. successful implementation of the provisions of h.r. 40 presents an opportunity to begin a national discourse on the residual impact of chattel slavery and institutionalized discrimination. nasw has a history of advocacy for policies that empower vulnerable populations, such as the civil rights voting act, lily ledbetter fair pay, and the affordable care act (nasw, 2020a, 2020b). the expanding debate around reparations for african american descendants provides a venue for social work to operationalize core values and ethical principles in support of this important social and economic justice issue. the economic harm of 200 years of forced and unpaid labor as well as the denial of wealth-building opportunities post-emancipation have contributed to the persistent financial disparities and wealth divide between african americans and their european american counterparts (darity & mullen, 2020; robinson, 2000). u.s. chattel slavery led to physical, mental, social, and economic injuries to millions of african americans. these human rights violations and systemic injustices requires a systemic response. h.r. 40 provides a process to determine how reparations can be used as a reparative mechanism to address the legacy of slavery and dismantle systemic racism. social workers have a pivotal role in advancing reparations as a social justice issue and a policy priority. support of h.r. 40 is an essential step in the process. to date, nasw has not issued a position statement on h.r. 40. given the current social climate, it is imperative that the social work profession articulate an actionable stance in support of h.r. 40. this article examines the historical development and rationale for support of h.r. 40. the violations of human rights associated with chattel slavery and the legacy of institutionalized discrimination are major economic and social justice issues that warrant the attention and deliberate actions of the social work profession. social workers and social work organizations have the potential to serve as powerful proponents in the quest to advance h.r. 40 through congress. historical development of h.r. 40 in november 1989, representative john conyers jr. (d-mi) introduced h.r. 3745, a bill to establish a commission to study the impact of slavery on african americans. the preamble of the bill stated the purpose of the proposed legislation was: to acknowledge the fundamental injustice, cruelty, brutality, and inhumanity of slavery in the united states and the 13 american colonies between 1619 and 1865 and to establish a commission to examine the institution of slavery, subsequent de jure and de facto and economic discrimination against african americans, and the impact of these forces on living african americans to make recommendations to the congress on appropriate remedies, and for other purposes. (national african american reparations commission, 2022, para. 3) advances in social work, fall 2021, 21(4) 1248 h.r. 3745, entitled the commission to study reparations proposals for african americans act, did not progress to a house vote (brooks, 2004; conyers, 2013). however, conyers vowed to continue efforts to get the bill passed. following recommendations from the national african american reparations commission (naarc), the bill was retitled the “commission to study and develop reparation proposals for african americans act,” (national coalition of blacks for reparations in america [n’cobra], 2018). the revised bill became h.r. 40. conyers stated that he selected the bill number as a symbol of the forty acres and a mule that the u.s. government promised freed slaves (conyers, 2013). since its introduction, h.r. 40 has gained support from more than 127 co-sponsors in congress, as well as numerous organizations, including the black farmers association, institute of the black world, national association for the advancement of colored people (naacp), n’cobra, and more recently black lives matter (king, 2019). congressional proponents of h.r. 40 include joseph kennedy (d-ma), shelia jackson lee (d-tx), maxine waters (d-ca), terri sewell (d-al), alexandria ocasio-cortez (d-ny), and ilhan omar (d-mn; king, 2019). additionally, a number of books, such as randall robinson’s (2000) the debt: what america owes to blacks and a number of journal essays such as “a case for reparations” by ta-nehisi coates (2014) emerged supporting reparations for african american descendants of chattel slavery. based on growing support and the recommendations of the naarc, congressman conyers introduced a revised h.r. 40 bill in 2017 during the 115th congress of the united states. the new bill was drafted to reflect advances in legal and societal discourse around reparations as a mechanism to redress the damages of chattel slavery and institutional racism in shaping present day conditions. while the earlier version of the bill focused on the need to study reparations, the revised h.r. 40 bill emphasized the development of reparations proposals, programs, policies, processes, and initiatives (kruppa & burke, 2019). the retitled bill, h.r. 40, “commission to study and develop reparation proposals/processes for african americans act,” called for the following provisions:  acknowledgement of the fundamental injustices and inhumanity of slavery;  establishment of a commission to study slavery and the subsequent racial and economic discrimination against freed slaves;  research studies to document the impact of historical forces of slavery on living african americans; and  establishment and sanction of a commission to make recommendations to congress on appropriate remedies to redress the harm inflicted on living african americans. (commission to study and develop reparations proposal for african american act, 2021) conyers introduced the bill in every congress from 1989 until his resignation in 2017. two years later, john conyers passed away at the age of 90 without realizing his dream of a bill to examine reparations as a means to address the injustices of slavery and the ongoing legacy of racial and economic discrimination (kruppa & burke, 2019). shelia jackson lee (d-tx), the new sponsor of h.r. 40, has continued to carry on the work to pass the bill in the u.s. house of representatives. mcelderry & jones/ending our silence 1249 reparations became a central topic in the 2020 presidential campaign. as a result, h.r. 40 garnered significant momentum and popularity during the presidential primary. democratic presidential candidates cory booker (d-nj), elizabeth warren (d-ma), tulsi gabbard (d-hawaii), and beto o’rourke (d-tx) individually announced their support for h.r. 40 while on the campaign trail. additionally, representative karen bass (d-ca), leader of the congressional black caucus (cbc), announced her support for h.r. 40 during this period. the majority of proponents, including bernie sanders (d-vt) and kamala harris (d-ca), supported the idea of forming a commission to study reparations. however, marianne williamson was the only presidential candidate in the primary who announced clear support for monetary compensation. williamson also offered a detailed plan for granting reparations to african americans (king, 2019). while shelia jackson lee took up the charge in the house of representative, senator cory booker (d-nj) introduced a companion bill (s. 1083) in the u.s. senate. currently, s.1083 has 12 senatorial cosponsors (u.s. senate, 2019). in the midst of racial tension and the novel coronavirus pandemic in the u.s., there is growing recognition of the need to bring awareness and support for h.r. 40 as a mechanism to begin a national discourse on systemic racism. evidence of systemic racism is made apparent in the persistent wealth gap between african americans and their european american counterparts. darity and associates (2018) noted that median wealth among african american families is significantly lower at every education attainment level. overall, european american families have 10 times the wealth of the average african american family (ray & perry, 2020). scholars suggest that if current economic trends continue, the average african american household will need 228 years to accumulate the wealth of their european american counterparts (n’cobra, 2018). in other words, if current trends prevail, european americans would need to stand still on economic measures for 228 years in order to level the playing field for african americans. absent deliberate and systematic changes in the u.s. economy, data suggest that african americans are unlikely to achieve economic and social equality. correcting racial wealth inequality and economic uplift will require a major redistributive effort on a national scale. darity and mullen (2020) assert that “blacks cannot close the racial wealth gap by changing their individual behavior i.e., ‘by assuming more personal responsibility’ or acquiring the insights associated with [financial] literacy” (p. 3). according to the authors, racist policies, not lack of labor, created the persistent wealth gap between african and european americans. reparations have the potential to redress the socioeconomic damages of chattel slavery and institutional discrimination. however, without the passage of h.r. 40, the feasibility of reparations to address systemic racism remains speculative. h.r. 40 presents the potential to reverse current socioeconomic trends and racial inequities impacting living african americans. a major feature of h.r. 40 is the establishment of a commission to propose appropriate remedies to redress the lingering effects of slavery and prevent future inequities. the novel covid-19 pandemic is likely to place additional burdens on the sparse economic resources of the african american community. according to jones (2020), the disproportionate impact of covid-19 on african americans “is due to a sustainable historical context, namely racial discrimination and capitalism that has restricted their advances in social work, fall 2021, 21(4) 1250 social mobility to largely frontline work” (para-17). as a result of chattel slavery, african american communities are starting from a 250-year deficit of wealth-building, opportunity, and access. in order to fulfill the mission of social work to advance human rights and advocate for social justice, the profession must broaden its lens to focus on community-based approaches aimed at collective equality. h.r. 40 has the potential to redress racial injustices and human suffering for a large segment of the u.s. population. social workers have an ethical responsibility to identify appropriate ways to inform the public and advocate for a means to reverse and redress the social and economic injuries created by chattel slavery and its legacy. the vestiges of slavery continue to hinder the upward mobility of african americans and their communities. the consequences are seen through enormous damages in long-term loss of income and other wealth-building opportunities. professional organizations such as the nasw, council on social work education (cswe), international federation of social workers (ifsw), and influencing social policy (isp) have the collective knowledge and influence to propel h.r. 40 forward. thus far, the national association of social black workers (nabsw) is the only professional social work organization that has articulated a position on reparations and h.r. 40. a policy statement by nabsw makes it clear that the organization supports reparations and h.r. 40 (nabsw, 2020). the social work profession has the power and knowledge base to use its collective voice to foster increased awareness and support for passage of h.r. 40. the delegate assembly of nasw is responsible for adoption, collection, and promulgation of the positions and actions of the profession on various public policy and professional issues (nasw, 2020b). social work speaks represents the collective voice of social workers from across the nation, and therefore can be an influential tool to advocate for the enactment of h.r. 40. the history and development of the 12 grand challenges of social work also serves as a prime example of how to begin the essential work toward the profession taking a pivotal role in the reparations movement (american academy of social work and social welfare, 2013). rationale for support of h.r. 40 perhaps the greatest difference between the values of social work and other human service professionals, such as psychology, nursing, and medicine, is recognition of the impact of broader societal issues on human well-being. awareness and acknowledgement about how societal and cultural issues impact people’s ability to fully realize selfdetermination is represented in the core value of social justice. social workers promote social justice through advocacy, raising public consciousness about social issues, and organizing communities. social workers are ethically obligated to advocate for more equitable resources for vulnerable and marginalized populations. the nasw code of ethics state that social workers have a dual responsibility to clients and to the broader society (nasw, 2020c). standard 6.01 defines social workers’ professional responsibility to promote the general welfare of society. this standard indicates that social workers should promote the development of people, their communities, and environments. in essence, social workers are obligated to seek full equality, social justice, and empowerment of vulnerable populations. mcelderry & jones/ending our silence 1251 similarly, standard 6.02 advises social workers to “facilitate informed participation by the public in shaping social policies and institutions” (nasw, 2020c, section 6.01, para. 1). standard 6.01 encourages social workers to advocate on behalf of the public, while standard 6.02 encourages social workers to empower members of the public to advocate on their own behalf. social workers can support h.r. 40 by educating and raising awareness among clients and stakeholders on the major tenets of the policy. likewise, standard 6.04 obligates social workers to:  ensure equal access to resources, employment, services, and opportunities.  expand opportunities and choices for all people, particularly vulnerable and disadvantaged groups.  promote policies, practices, programs and knowledge-building that respect cultural and social diversity.  take actions necessary to prevent and eliminate domination or discrimination. (nasw, 2020c, paras. 1-4) social workers should use their advocacy skills to dispel myths related to reparations and advocate for passage of h.r. 40. through their interaction with individuals, organizations, and communities, social workers have a “unique, bottom-up knowledge” about the impact of social problems and public policies (weiss-gal, 2017, p. 285). coupled with the professional values and capacity to collaborate with communities, social workers are critically situated to advance or oppose policies. the education policy and accreditation standards (epas) mandated by cswe require that students are trained to engage in practices to advance human rights and social, economic, and environmental justice (cswe, 2015). social workers are taught to recognize the sociopolitical, socioeconomic, and cultural significance of systemic injustice. advancing social justice through political participation and civic engagement is an ethical principle of the profession and a competency standard of cswe. therefore, social workers, social work educators, and social work organizations have a responsibility to study h.r. 40 and to educate others about the potential benefits of repairing the damages of slavery and systemic racism. african americans are the only racial minority group that has had to fight to be considered human (three-fifths compromise) and the only ethnic minority group that has not received reparations for government-sanctioned racial discrimination. systemic oppression and the legacy of slavery in 1619 africans were forced into the american colonies, not as valued members of society, but as chattel slaves for a life of permanent servitude based solely on race (christopher, 2006). the institution of slavery was sanctioned and protected by the american government. it took a civil war to resolve the issue of slavery. however, the hardship for african americans did not end with the emancipation proclamation. freed slaves lived in a new form of bondage. as freeman (2002) described: …within all the history, there is a lie. the lie, told to southerners and everyone else, is that slavery disappeared after appomattox. it did not. slavery existed well into the twentieth century in america, in the form of peonage, whereby blacks advances in social work, fall 2021, 21(4) 1252 were fined for vagrancy or other supposed crimes and then forced to work off the debt on local farms for what often became a lifetime of brutal conditions. for those trapped in peonage, the technical distinction between themselves and the slaves of previous generations was meaningless. (xi) reparations have been proposed to recompense for the institution of slavery and subsequent, ongoing systemic oppression faced by african americans. brooks (2004) described the reparations movement as occurring in three waves—pre-civil war, postcivil war, and post-holocaust. the first major effort toward reparations was the establishment of the bureau of refugees, freedmen, and abandoned lands, frequently referred to as the freedman’s bureau. the bureau was established by congress in 1865. field order 15 authorized the allocation of 400,000 acres of land confiscated from confederate states to be distributed to former slaves. however, few african american families actually received 40 acres and a mule (ray & perry, 2020). shortly after lincoln’s assassination, his successor, andrew johnson, reversed field order 15 and confiscated land was returned to former slave owners (winbush, 2003). the bureau was completely dismantled in 1872, having attained few successes. factors in the failure of the freemans’s bureau include staunch opposition from white americans in the south and the terrorist acts of the klu klux klan (kkk) and similar racist groups (history.com editors, 2020). following the collapse of the u.s. freedman’s bureau, african americans organized self-help groups for their own cause. the ex-slave pensions and bounty movement emerged to address the socioeconomic needs of recently freed slaves. according to winbush (2003), between 1890 and 1917, more than 600,000 ex-slaves lobbied the american government for uncompensated labor. the movement constituted a collective effort by recently freed slaves to address their socioeconomic needs. the best known of the various groups that emerged is the ex-slave mutual relief, bounty and pension association of the united states of america (mrb & pa). walter r. vaughan, a white american newspaper editor in omaha, nebraska, published a pamphlet entitled “freedmen’s pension bill: a plea for american freedmen.” as an editor of a major newspaper, vaughan influenced congressman william james connell (r-ne) to introduce a bill in 1890 that modeled the pension plan for union soldiers. born in selma, alabama and a loyalist to the south, vaughan’s motivation was rooted in a belief that pensions to former slaves would increase financial viability and bring economic stability to the new south (perry, 2010). isaiah dickerson, an african american employed by vaughan as a distributor of the freedmen pension bill pamphlet, would later join with callie house, a single mother and former slave from nashville, tennessee, to launch their own reparations effort. assisted by vaughan, dickerson and house established the mrb & pa in 1897 (perry, 2010). the association became one of the first organizations to campaign for reparations. the organization’s mission was to advocate for congressional legislation to grant financial compensation to former slaves in the form of a pension payment program (perry, 2010). house became the national spokesperson with nashville, tennessee serving as the headquarters for the movement. for nearly 30 years house struggled to secure a pension program for the uncompensated labor of ex-slaves and their descendants. by 1917, the mcelderry & jones/ending our silence 1253 mrb & pa efforts were thwarted by accusations of mail fraud and the conviction of leading reparations activists, including callie house (berry, 1972; francis, 2020; perry, 2010). following the emancipation proclamation, institutionalized racism took the form of black codes, convict leasing, peonage, sundown towns, and jim crow laws. these forms of de jure and de facto practices continued to inflict harm on african americans for more than 100 years after emancipation (blackmon, 2008; evans & wilkins, 2019; freeman, 2002). scholars agree that the residual effects of slavery have contributed to the socioeconomic, sociopolitical, and psychological oppression of african americans (billingsley, 1968; degruy, 2005; wilkins et al., 2013). racially-driven and divisive policies that have excluded or disadvantaged african americans post-reconstruction include the g.i. bill and the social security act (ray & perry, 2020). the transgenerational damages of systemic oppression are evident by the persistent financial and health disparities between african americans and european americans. african americans are overrepresented on measures of adverse health outcomes, the racial wealth gap, and mass incarceration, including the school-to-prison pipeline (alexander, 2010; bond huie et al., 2003; centers for disease control and prevention, 2005; degruy, 2005; skiba et al., 2014). health, education, and economic outcomes are strongly correlated with income and wealth. possession of financial assets (e.g., stocks and bonds, home ownership, retirement savings, etc.) provides a safety net across the lifespan and has the potential to set up future generations for success. a personal safety net reduces vulnerabilities for future generations. contemporary discrimination alone does not adequately explain the persistence of economic and health disparities of african americans compared to other racial and ethnic groups in the u.s. therefore, scholars must look for effective remedies to repair past and present damages. the u.s. government has paid reparations to some groups, but african americans have not received restitution for egregious injustices and human rights violation. in contrast, japanese americans were paid $1.5 billion post-world war ii for their internment during the war (ray & perry, 2020). with the assistance of the u.s. government via the marshall plan, holocaust survivors received financial reparations from west germany. native americans have received land and other financial benefits for forcible removal and exile from their homelands (ray & perry, 2020). atonement and making amends the case for reparations can be made on economic, social, and moral grounds. primarily a political concept, the term reparations means to repair. reparations typically involve a government or an official entity’s efforts to compensate for inflicted harm or social injury upon a group of people (de greiff, 2006). restitution for social injuries committed upon a community by a government or an official entity may take several forms such as direct monetary compensation, formal apologies, or social services and programs (aiyetoro, 2002; robinson, 2000). historically, there are documented cases of successful compensation for social injuries, such as those received by jewish survivors of the german holocaust and japanese americans after world war ii (roht-arriaza, 2004). advances in social work, fall 2021, 21(4) 1254 reparations are an internationally recognized means of restitution and atonement for survivors of egregious acts and their descendants. the dual purpose of this form of redress is to acknowledge the wrong that has been committed and to atone for the injury. reparations allow victims to receive compensation for preventable and avoidable social injuries, while simultaneously requiring legal accountability of perpetrators who commit or reap the benefits of social injuries and human rights violations (roht-arriaza, 2004). according to n’cobra (2020), full reparations involves five major components: cessation (discontinuation of the offensive action), restitution (reversing injuries), compensation (identifies who is eligible and to what or how much), satisfaction (formal apology for the perpetration of gross human rights violations), and rehabilitation (identification of the form and measure of healing warranted). full reparations aim to ameliorate all consequences of the harm caused by gross violations of human rights. n’cobra has proposed potential resolutions in each of the five areas. for example, restitution could take the form of restoring stolen land, intellectual property, and artistic creations, among other possibilities. tax exemption similar to what has been afforded to native americans is presented as a method of compensation. removal of the confederate flag and statues commemorating the institution and perpetrators of slavery may be viewed as a form of cessation. discussion reparations can take multiple forms such as direct monetary payments, formal apology, truth-telling, or social service programs. passage of h.r. 40 would authorize the legislative branch of the american government to form the groundwork for the possibility of a reparations program. the bill would establish a congressional commission to investigate the transgenerational effects of slavery and assess the feasibility of recompense. under the current bill, the commission would be known as the commission to study and develop proposals for reparations for african americans. members appointed to the commission would make a formal recommendation to the u.s. congress on the issue of reparations. a similar commission was established by the u.s. congress to investigate the circumstances of mass internment of japanese americans during world war ii. h.r. 40 calls upon the federal government to acknowledge that the issue of slavery and the abuses inflicted upon african americans warrant investigation and consideration for recompense. atonement by the american government for its part in the institution of slavery and ongoing discrimination might go a long way in repairing past injustices and give credence to the current call to end white supremacy. as a profession keenly aware of the social and economic disparities that exist in contemporary society, social workers should have a moral and ethical interest in passage of h.r. 40. the potential exists for social workers to mobilize support for passage of h.r. 40. social workers’ education and training provides them with a unique understanding of the challenges that oppressed and economically disadvantaged communities confront. understanding how public and social welfare policy contribute, maintain, or ameliorate human suffering is an important component of social work. the profession is also guided by an ethical value of social justice in order to pursue social change and challenge social injustices (nasw, 2020c). the fundamental issue for social workers is examination of mcelderry & jones/ending our silence 1255 opportunities to correct the unequal and inequitable quality of life experienced by individuals and communities. a first step in raising awareness and support for h.r. 40 is acknowledgment and recognition that many of the social programs introduced in the 1930s as a safety net were structured to exclude african americans from benefits. african americans did not get full access to the federal safety net until 1965. moreover, the safety net excluded benefits for domestic and agricultural workers, occupations in which a majority of african americans were employed (darity & mullen, 2020). such past injustices continue to impact the socioeconomic well-being of african americans. structural inequities are a major factor in the current efforts to eradicate covid-19. recht and weber (2021) reported that the vast majority of vaccination sites are concentrated in communities where predominantly european americans reside. moreover, compared to african americans, european americans are vaccinated at two to three times higher rates. the disproportionate effects of covid-19, along with the national outcry to end police brutality (crabtree, 2020), illuminates the necessity to reject the ideology of white supremacy and anti-blackness. at the core of many social problems that social workers are called upon to address is structural and systemic inequities based on race. in many instances, the needs of people of color, particularly, african americans have been neglected, undervalued, and exploited. traditional social service programs have not eliminated the socioeconomic disparities that exist between african americans and european americans. historically, many of these programs excluded individuals and communities most in need. therefore, racial disparities and disproportionality have continued to persist. for example, mcdaniel et al. (2017) identified racial disparities throughout service delivery (access, service, and treatment) for programs such as temporary assistance for needy families (tanf), child support enforcement program, child care and development fund, head start, and family and youth services bureau. research has also documented the ongoing racial disproportionality and disparities in the child welfare system, with african american children and families most significantly impacted by institutionalized racism (dettlaff & boyd, 2020). the ultimate goal of a comprehensive reparations plan is to redress the socioeconomic inequalities associated with race. interpretation of the nasw code of ethics would certainly seem to align with this goal. social workers have an opportunity to make their voices heard and raise awareness about the potential for h.r. 40 to improve the lives and communities of an oppressed population. therefore, it seems social workers should be involved in advocacy, political activism, and public education to ensure passage of h.r. 40. a fundamental component of social work that sets the discipline apart from other helping professions is the quest for social justice. social workers should be engaged in this legislation and become knowledgeable enough about the topic to have an appointment on the commission once the bill is passed. conclusions the human rights of african americans were violated for more than 400 years. as a result of slavery and its residual inequities, african americans continue to endure structural oppression across social, health, and economic systems. while the debate about reparations advances in social work, fall 2021, 21(4) 1256 for african american descendants of chattel slavery is not new, social workers’ position on this issue is largely unknown. the social work profession has a broad reach to positively impact awareness and expand knowledge on reparations and h.r. 40. educating students and other constituents about the legacies and present-day impact of slavery and systemic racism is greatly needed to begin a dialogue on the passage of h.r. 40. as the profession evolves toward the ideology of cultural humility and anti-racism, acknowledging and challenging systemic inequities are essential to dismantling white supremacy and domination. many social workers are comfortable with micro-level interventions that involve working directly with individuals from vulnerable and impoverished populations. what must come into clearer focus is engagement in macro-level work that improves populationbased outcomes. a study by apgar (2020) found that only 13% of 474 graduate level social work students indicated an interest in macro practice at the time of admission. social work curricula must emphasize the need for social workers in administration, community organizing, policy development and evaluation, and other macro-level work (russell, 2020). social workers must not abdicate their responsibility to work toward social reform. through both policy practice and legislative action, social workers can claim a pivotal role in the quest for social justice for african american descendants of chattel slavery. social justice advocacy is driven by policy. h.r. 40 has the potential to usher in an unprecedented level of social reform in the u.s. full participation in the ‘american dream’ has not been practical for a large segment of the u.s. population. passage of h.r. 40 presents an opportunity to repair the racial divide and injuries perpetuated by slavery and institutionalized discrimination. the preamble of the nasw code of ethics establishes an underlying assumption in the inherent dignity and inalienable rights of all human beings. reparations provide a framework to restore the collective dignity and worth of populations impacted by human rights violations. the movement for reparations will depend on support from an array of diverse individuals, groups, and organizations. boris bittker was born 1916 and lived until 2005. he was a yale law school professor and european american who penned the first book on african american reparations, the case for black reparations (bittker, 1973). the groundbreaking work has been described as ahead of its time. it will take continuation of this type of bold scholarship, courage, and commitment to ensure passage of h.r. 40. the historical context for reparations for african american descendants of slavery and the significance of h.r. 40 are the focal points of this article. of primacy is the recognition that social workers can play an integral role in addressing issues and challenges faced by reparation advocates. moving forward, the social work profession can employ its powerful voice to: 1. garner support for passage of h.r. 40 through the dissemination of information and consciousness-raising through organizations such as nasw, cswe, and isp. 2. initiate an educational campaign to promulgate knowledge and dispel myths associated with reparations and h.r. 40. mcelderry & jones/ending our silence 1257 3. draft a policy position on h.r. 40 for dissemination through social work speaks. 4. dedicate a special issue of the profession’s flagship journals to advance literature, research studies, and scholarly work on the topic of reparations. 5. develop a curricular guide as a resource to encourage social work faculty to teach content on reparations as both a social justice issue and policy priority. the vestiges of slavery and systemic racism continue. the consequences are seen through long-term loss of income, opportunity, and premature loss of life. the violent deaths of george floyd, breonna taylor, and other recent abuses of unarmed african americans at the hands of police officers have galvanized americans into unprecedented conversations about systemic racism. this national dialogue presents an opportune time to introduce h.r. 40 and reparations into mainstream thinking as there is growing support for this bill. for example, the iconic ice cream brand ben & jerry announced the company’s support for h.r. 40 in 2019 (taylor, 2020). social work is a profession dedicated to advancing human rights and social justice. it is vitally important that reparations become a central component of the social justice discourse among social workers. social workers are uniquely situated to promote an understanding of the importance of h.r. 40. this is the time to aggressively support the movement of h.r. 40 on capitol hill. it is imperative that the profession articulate a clear stance and disseminate information to stakeholders and constituencies on h.r. 40 and reparations. this is a call to action. references aiyetoro, a. a. 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(2003). should america pay? slavery and the raging debate on reparations. harpercollins. author note: address correspondence to cathy g. mcelderry, department of social work, middle tennessee state university, murfreesboro, tn, 37132. email: cathy.mcelderry@mtsu.edu ___________ skye allmang, phd, msw, mpp, postdoctoral associate, rutgers school of social work, new brunswick, nj. todd m. franke, phd, msw, professor of social welfare, ucla luskin school of public affairs, los angeles, ca. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 152-171, doi: 10.18060/23600 this work is licensed under a creative commons attribution 4.0 international license. “just a job?” an assessment of precarious employment trajectories by gender among young people in the u.s. skye allmang todd franke abstract: precarious employment is on the rise in the united states. research suggests that young workers are more likely than older workers to be in precarious work. yet much remains unknown regarding the precarious nature of employment experienced by young workers, despite evidence of the importance of this period for long-term employment opportunities. to address this gap in knowledge, this study used a nationallyrepresentative, longitudinal dataset to create a multi-dimensional measure of precarious employment, and assessed precarious employment trajectories over time for young women and men. findings revealed that, while there were significant shifts in levels of precarity over time for both males and females, patterns differed by gender. overall, higher percentages of females than males remained concentrated at the semi-precarious level over time—meaning that they did not move further into or out of precarious employment—while higher percentages of males became either much more precarious or much less precarious over time. these findings challenge the common assumption that young people generally move out of low-wage or otherwise “bad” jobs over time, and suggest that there is a need for additional attention to gendered patterns in job quality among young people. social workers have an important role to play in helping young people enter non-precarious jobs, and in engaging in advocacy to improve the quality of jobs available. keywords: precarious employment; gender; emerging adults. it is widely recognized that women and men in the united states have disparate employment experiences. while researchers have identified signs of progress over the past several decades, they have also documented a host of persistent challenges, including gender wage inequality (blau & kahn, 2007; goldin et al., 2017), occupational segregation (cech, 2016; hegewisch et al., 2010), hostile work environments (alterman et al., 2013), and discrimination in accessing opportunities for training and advancement (shaffer et al., 2000). in addition, a growing body of literature has called attention to the gendered nature of precarious work, or work that is characterized by multiple dimensions of instability (vosko et al., 2009). less well-tended to, however, has been the topic of gender differences in precarious employment among young people. while studies show that there is a high number of young people in precarious employment (kalleberg, 2019), and theoretical and empirical studies have highlighted the importance of early employment experiences for long-term wage and employment opportunities (e.g., glatt & wunnava, 2018), much remains unknown regarding young people’s experiences in precarious employment during the early stages of their careers. in other words, at this time, are most young men and women moving away from precarity, moving further into precarity, avoiding precarious employment altogether, https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2020, 20(1) 153 or remaining stuck in precarious employment over time? understanding these trajectories could inform our current understanding of whether a job at the beginning of one’s career really is “just a job”—or whether experiences of remaining stuck in precarious employment reflect and reinforce broad patterns of gender inequality. this study aims to address this current gap in knowledge through the assessment of precarious employment trajectories among emerging adults in the united states. after reviewing the relevant literature, this article describes the methods used to group young people into precarious employment categories, and explores the results regarding whether and how young men and women moved over time. the article concludes with a discussion of the implications of the study’s findings for research, policy, and practice. precarious employment in the united states since the 1970s, globalization, changes in technology, and the weakening of unions, among other economic and social forces, have transformed employment relations in the united states. one indication of this transformation is the rise in precarious employment, or “employment that is uncertain, unpredictable, and risky from the point of view of the worker” (kalleberg, 2009, p. 2). this term was chosen as the focus of this study, instead of other similar terms such as “atypical employment” or “bad jobs” because it “represents a series of questions for the employment structure… [and] represents in effect a research program or agenda that can be used to open up analysis” (vosko et al., 2009, p. 9). in other words, utilizing the concept of precarious employment calls attention to the transformation of employment relations that has recently taken place, and highlights particular job characteristics that researchers can use to measure these changes. specifically, following rodgers (1989), this study conceptualizes precarious employment as a multi-dimensional construct, characterized by four measures of job quality: instability or high risk of job loss, lack of control over one’s work, lack of workplace and employer protections, and low wages. there is a growing body of literature on precarious employment (e.g., benach et al., 2016; cranford et al., 2003; quinlan et al., 2001). precarious employment is often captured through the assessment of one of the job characteristics outlined by rodgers, such as the likelihood that a person will lose his or her job. for example, the 2012 general social survey included the question, “thinking about the next 12 months, how likely do you think it is that you will lose your job or be laid off--very likely, fairly likely, not too likely, or not at all likely?” overall, findings from the survey indicated that approximately 11.2% of workers answered that they expected to lose their jobs (u.s. bureau of labor statistics [bls], 2015, para. 8). two other dimensions of precariousness are wages and the level of control that workers have over their work schedules. while there are various ways to measure low-wage work, bernhardt and osterman’s analyses of the u.s. current population survey data from 2013 found that 39% of u.s. workers earned less than $15 an hour (bernhardt & osterman, 2017). research on workers’ control over their work schedules has also uncovered high levels of precariousness. lambert and henly (2014) analyzed work schedule data from the 1997 national longitudinal survey of youth and found that about half of the hourly allmang & franke/just a job? 154 workers and 35% of non-hourly workers reported that their employer decides when they start and finish work. lastly, the prevalence of precarious work may be captured based on the extent to which workers are able to obtain health insurance and retirement benefits through their employers (kalleberg, 2000). this has been particularly true in the united states, where these benefits have traditionally been accessed through employers. an analysis of the march 2017 current population survey, for example, found that 74% of noninsured workers had an employer that did not offer health insurance coverage (kaiser family foundation, 2017). these dimensions of precarity, when measured separately, provide critical insight into employment patterns in the united states. researchers are also beginning to assess precarious employment using new approaches which capture multiple dimensions in a single measure (e.g., cranford & vosko, 2006; frade et al., 2004; garcía-pérez et al., 2017). much remains to be understood, however, to improve our understanding of precarious employment, in light of what has been described as “the wide gap between the scale of precarious work and social scientific understanding of it more generally” (kalleberg & vallas, 2018, p. 2). gender and precarious employment vosko et al. (2009) note that “[t]he current period is… often characterized as an era of both gendered labour market change and concern about persistent inequality and precariousness” (p. 1). a growing body of research has documented a range of evidence of the overrepresentation of women in precarious employment. information from the u.s. bureau of labor statistics provides insight into gender differences in the number of workers in contingent—or temporary—work. results from the 2005 contingent worker supplement, which was designed to capture information on the number and characteristics of contingent worker in the united states, indicated that contingent workers in the united states were slightly more likely to be female than male, (49 percent versus 47 percent) (bls, 2005). in addition, an analysis of the canadian context by vosko and clark (2009) found that “across all forms of paid employment, but especially part-time forms, prime working age women were concentrated in sales and services occupations, whereas men were spread more evenly across occupations” (p. 33). in the united states, researchers have similarly found that “employment precariousness is distributed in ways that reflect and reinforce gender and racial/ethnic inequalities in the labor market” (carré & heintz, 2009, p. 57). minimum wage research suggests that women are not only more likely to enter lowpaying work—they are also more likely to “get stuck” in it (boushey, 2005). as demonstrated in boushey’s seminal study of minimum wage work, while over a third of workers between the ages of 25 and 54 remained stuck in low-wage work over a period of three years, women had a lower probability of moving out of low-wage work than men . finally, previous research has highlighted the ways in which work-life policies disadvantage women, making it hard to move up over time. comparative studies have found that although these policies—such as parental leave, flexible scheduling, and child advances in social work, spring 2020, 20(1) 155 care policies— have been found to support women’s attachment to the labor force, they have also been found to reinforce occupational segregation and the gender wage gap (mandel & semyonov, 2005). while there is a wealth of research on this topic from various countries, such as germany (e.g., chirkova, 2019) and sweden (haas & hwang, 2008), much remains to be understood regarding the complex ways in which these policies may affect men and women’s decision-making and employment outcomes throughout the life course (hegewisch & gornick, 2011). young people in precarious employment though there is a considerable body of research on gender inequalities in employment, and increasingly on the intersection of gender and precarious employment, there remains a lack of research focusing specifically on gender and precarious employment trajectories among young people in the united states, despite theory and empirical evidence on the importance of early employment experiences. according to developmental theory, when people are approximately 18 to 29 years old, they are exploring various possibilities related to school, work, and relationships, during a stage that arnett (2000) called “emerging adulthood.” this developmental stage is generally considered to be distinct from adolescence and the initial stages of full-fledged adulthood, in that emerging adults are generally done with secondary school and are no longer considered minors, but do not yet have stability in many realms, including housing, romantic relationships, or work. compared to adolescence, when young people are undertaking “transient and tentative explorations,” emerging adulthood is a time of more serious and focused explorations related to employment (arnett, 2000, p. 473). existing empirical research suggests that employment experiences during this stage can have important implications for the person in the future (osgood et al., 2005). specifically, studies indicate that early unemployment and underemployment experiences can have an economic “scarring effect” (glatt & wunnava, 2018, p. 51; kletzer & fairlie, 1999; mroz & savage, 2006). this effect is particularly strong over the first few years after an extended period of unemployment. an analysis utilizing the 1979 national longitudinal survey of youth data, for example, found that an unemployment spell of 26 weeks reduced wages by about 4.6% a year later, and 2.9% up to three years later (mroz & savage, 2006). there are several potential reasons for this scarring effect, including reduced motivation, fewer opportunities to develop new skills, and the potential “signaling” to employers that may come from a period of unemployment (glatt & wunnava, 2018). in addition to the growing body of research on the importance of early employment experiences for young people, there is also a growing body of research on gender differences in employment experiences during this time, as well as the potential repercussions from these experiences for decision-making and opportunities throughout the life course. for example, a qualitative study from australia found that being in precarious employment impacted women differently than men, in that precarious employment appeared to play a role in reinforcing gender imbalances in household labor. in addition, findings from the study indicated that early experiences of precarious employment were related to “reproductive insecurity,” or constrained decision-making around family formation (chan & tweedie, 2015, p. 6). allmang & franke/just a job? 156 similarly, there is evidence that these differences are not ameliorated by postsecondary education. a recent study of trends in precarious employment in the united states found that “young women’s employment quality declined, especially after 2001, in all four education groups [for those with no credentials, a high school diploma, some college, and a college degree]. the declines were substantial, averaging 12 percentage points in a 15-year period” (hout, 2019, p. 30). these findings on the role of education and the long-term impacts of precarious employment suggest that gender differences in precarious employment are not due to young people’s preferences or differences in education. however, much remains unknown regarding the association between gender and precarious employment trajectories among young people in the united states. based on these gaps in current knowledge, this study aimed to illuminate trajectories of employment precarity experienced by young workers, and to identify differences and similarities in these trajectories by gender. specifically, this study sought to answer two main research questions, using a multi-dimensional measure of precarious employment: (1) what were the percentages of young women and men in precarious employment at the first time period, when respondents were between the ages of 18 and 26? (2) what were the similarities and differences in precarious employment trajectories by gender, from the first time period to six years later when respondents were 24 to 32 years old? based on the previous literature, it was hypothesized that somewhat higher percentages of young women than men would be in precarious employment at the initial time point. in addition, it was hypothesized that higher percentages of women would “get stuck” in precarious employment over time. method data source and sample this study utilized data from the national longitudinal study of adolescent to adult health (add health, n.d.), a nationally-representative, longitudinal study of young people in the united states (harris, 2009). data from three waves were used: wave i (collected in 1994-1995, when respondents were in grades 7 through 12), wave iii (collected in 20012002, when respondents were 18 to 26 years old), and wave iv (collected in 2008, when respondents were 24 to 32 years old). wave i provided demographic information for the study, while data from waves iii and iv captured two points within the period of emerging adulthood. all research activities for the study were approved by the institutional review board of the university of california, los angeles. because the individuals in the add health study were selected with unequal probability, adjustment was necessary to ensure that estimates were not biased (chen & chantala, 2014). overall, the study sample was restricted to respondents who had all study weights, strata, and primary sampling units (psus). respondents were excluded if they were missing employment data, or if they worked less than 10 hours a week, during waves iii or iv. the total sample consisted of 5,976 (unweighted) young workers, representing a population of 10,669,830 (weighted) young workers across the united states. advances in social work, spring 2020, 20(1) 157 the sample was approximately 56% male and 44% female, which roughly resembled the gender breakdown for workers between the ages of 16 and 24 in the united states (toossi, 2002). the average age of men and women in the sample was 22 years old (at wave iii). men and women appeared to differ slightly in terms of their age, race/ethnicity, and level of education. for example, a higher proportion of men had a high school diploma or ged, while a higher proportion of women had a bachelor’s degree at wave iii. analyses of pearson’s r and cramer’s v indicated, however, that while these differences were statistically significant, the extent of these differences appeared to be quite small. this information is presented in table 1. table 1. sociodemographic characteristics of the study sample (unweighted) male (n=3,003) female (n=2,973) total (n=5,976) r/v age* (average years) 22.3 22.0 22.1 -.09 race/ethnicity* .07 asian or pacific islander (nh) 6.9% 5.7% 6.3% black (nh) 15.8% 20.9% 18.4% hispanic or latino 17.0% 15.2% 16.1% other (nh) 2.8% 2.0% 2.4% white (nh) 57.5% 56.2% 56.9% level of education (wave iii)* .12 less than high school 8.6% 4.2% 6.4% high school diploma or ged 73.7% 70.9% 72.3% vocational certificate 6.8% 9.0% 7.9% bachelor's degree 10.3% 14.9% 12.6% master's degree 0.4% 0.7% 0.5% phd/jd/md 0.2% 0.3% 0.3% * p<.05 r→pearson, v→cramer nh=non-hispanic measures as mentioned in the previous section, we followed researchers such as rodgers (1989) and vosko et al. (2009) in conceptualizing precarious employment as a multidimensional construct, identifiable based on the assessment of job characteristics. the four measures of job characteristics described by rodgers (1989) were used for this study: job security/insecurity, control over one’s work schedule, employer-provided benefits, and wages. job (in)security to assess job security, the respondent’s major occupational group (the first two digits of the six-digit 1998 standard occupational classification code) was recoded to represent the likelihood of being employed in “alternative work arrangements,” or nonstandard positions, a category that includes temporary help agency workers, on-call workers, contract workers, and independent contractors. this information was obtained from an analysis by lawrence katz and alan krueger of the u.s. bureau of labor statistics’ contingent worker survey (cws) from 2005 (katz & krueger, 2016). in total, 22 allmang & franke/just a job? 158 occupational categories were recoded into percentages, representing the percentage of workers from each occupational category that were employed in alternative work arrangements from the 2005 cws, which ranged from 3.0 to 31.2. control over one’s work schedule whether the respondent had control over his or her work schedule was captured through the question, “which of these categories best describes the hours you work at this job?” responses included: “regular day shift,” “regular evening shift,” “regular night shift,” “shift that rotates, that is it changes periodically from day to evening or night,” “split shift that consists of two distinct periods each day,” and “irregular schedule or hours.” the response “irregular schedule or hours” was considered to represent lack of control over one’s work schedule. employer-provided benefits the measure of whether the respondent received benefits from his or her employer was assessed using the answer to the question: “which of the following currently describes your current health insurance situation?” the response “you get insurance through work” was used to represent whether the person received health insurance through their employer. wages lastly, wages were measured by the question, “now think about your personal earnings. in {year of the survey}, how much income did you receive from personal earnings before taxes, that is, wages or salaries, including tips, bonuses, and overtime pay, and income from self-employment?” responses were grouped into eight categories: $1 to $10,000, $10,001 to $14,999, $15,000 to $19,999, $20,000 to $29,999, “30,000 to $39,999,” “$40,000 to $49,999,” “$50,000 to $74,999,” and “$75,000 and above.” analytic approach to assess underlying patterns that could be used to identify various levels of precarious employment, latent class analysis—a technique to measure unobserved (or latent) groups through the analysis of observed variables (mccutcheon, 1987)—was conducted using mplus (muthén & muthén, 1998). the modeling process began with a one-class model, with the number of classes increasing until there was no additional improvement in the model. fit indices (specifically, the bayesian information criterion and adjusted bayesian information criterion, as well as entropy measures), were used to assess the goodness-offit for each model, and to choose the most appropriate grouping. latent class analysis (lca) was conducted using the four job quality variables from wave iii, and then repeated using the same four job quality variables from wave iv. lca was conducted first with the total sample (males and females), and then separately for males and females. the groups from wave iii were used to answer the first research question on the percentages of young women and men in precarious employment at the first time period, when they were between the ages of 18 and 26. in order to answer the second research question (what were the similarities and differences in precarious employment trajectories by gender, from the first time period to advances in social work, spring 2020, 20(1) 159 six years later when respondents were 24 to 32 years old?), crosstabs were conducted for the total sample, as well as for males and females separately. pearson correlations and cramer’s v were included in order to assess the strength of the association between gender and job characteristics. from there, bowker’s (1948) tests for symmetry were used to assess internal changes from wave iii to wave iv. bonferroni post-hoc tests (dunn, 1961) were then conducted, which generated multiple comparisons of the three possible pairwise shifts that occurred from wave iii to wave iv. information generated from these tests was used to assess employment trajectories for the overall sample, as well as for males and females separately. throughout, all statistical analyses were two-tailed. results the following section presents the results of the study starting with descriptive statistics. next, levels of precarity at wave iii (when the study respondents were between the ages of 18 and 26) and wave iv (ages 24 to 32) are summarized. finally, results from our assessment of employment trajectories are described. table 2. wave iii & iv job characteristics by gender (unweighted) % test statistic r/v male (n=3,003) female (n=2,973) total (n=5,976) wave iii variables probability of job insecurity (average) 11.8 9.7 10.7 13.23* -.16 no employer-provided health insurance 53.8 59.8 56.8 21.51* .06 irregular work schedule 9.7 8.5 9.1 1.8 .02 wages 155.39* .16 less than $10,000 39.7 50.1 44.9 $10,001-14,999 10.9 13.3 12.1 $15,000-19,999 14.4 14.3 14.3 $20,000-29,999 21.6 16.2 18.9 $30,000-39,999 8.1 4.2 6.2 $40,000-49,999 3.0 1.1 2.1 $50,000-74,999 1.7 0.5 1.1 above $75,000 0.7 0.2 0.5 wave iv variables probability of job insecurity (average) 11.5 9.1 10.3 15.33* -.19 no employer-provided health insurance 35.4 41.0 38.2 18.76* .06 irregular work schedule 11.5 8.4 10.0 16.00* .05 wages 257.08* .21 less than $10,000 6.7 12.2 9.4 $10,001-14,999 3.0 5.0 4.0 $15,000-19,999 4.8 7.6 6.2 $20,000-29,999 17.1 23.0 20.0 $30,000-39,999 21.5 21.5 21.5 $40,000-49,999 15.7 13.7 14.7 $50,000-74,999 20.6 13.1 16.9 above $75,000 10.7 4.0 7.4 note. test statistic was generated from a t-test or chi-squared test as appropriate. * p < .05 r→pearson, v→cramer allmang & franke/just a job? 160 descriptive statistics the overall job characteristics of the young men and women in the sample at waves iii and iv are presented in table 2. males and females were statistically different on each of the four job characteristics at both waves, except for one measure—the irregular work schedule at wave iii. women were slightly better off than men in terms of job insecurity, but worse off in terms of access to employer-provided health insurance, an irregular work schedule, and wages at both waves. levels of precarity at wave iii (ages 18 to 26) and wave iv (ages 24 to 32) lca was conducted for the overall sample, as well as for men and women separately, in order to assess levels of precarious employment at wave iii and wave iv. at each wave, statistical measures of model fit (bic, adjusted bic, and entropy measures) suggested that the three-class solution (representing least precarious, semi-precarious, and most precarious groups) best fit the data (nylund et al., 2007). figure 1 presents the various levels of precarity for the overall sample, and for males and females separately. just under half of the overall sample fell into the semi-precarious employment group at wave iii, while about 39% were in the least precarious category, and about 12% were in the most precarious category. slightly higher percentages of females than males were in the semi-precarious employment category, and slightly lower percentages of women were found to be in the most precarious category. figure 2 presents the levels of precarity at wave iv for the total sample, for males, and for females. the overall trend from wave iii to iv was a reduction in precarity (in other 39.1 48.9 12.0 40.2 44.5 15.3 38.0 53.4 8.6 0 10 20 30 40 50 60 70 80 90 100 least precarious semi precarious most precarious p er ce n ta g e figure 1. precarious employment groups at wave iii overall males females advances in social work, spring 2020, 20(1) 161 words, an improvement in job quality). this was the case for the overall sample, as well as the separate analyses for males and females. there were notable differences, however, in the percentages of young people who remained in semi-precarious employment at both points in time. while the percentage of respondents in the overall sample in semi-precarious work decreased from about 49% at wave iii to 31% at wave iv, and the number of males in semi-precarious employment decreased from about 45% at wave iii to 16% at wave iv, the number of females in semi precarious employment decreased from about 53% to about 36 percent. therefore, higher percentages of females than males appeared to remain in semi-precarious employment from wave iii to wave iv. assessing employment trajectories table 3 displays information on employment trajectories from wave iii to wave iv, first for the overall sample, followed by the trajectories for males and females. the people on the diagonal (who were either least precarious, semi-precarious, or most precarious at both points in time) did not change. among those who did not change, approximately 26% of the overall sample was in the least precarious group at both points in time. this group is represented in light gray. slightly more males (about 32%) than the overall sample were in the least precarious groups at both points in time, while slightly fewer females (about 25%) were in the least precarious group at both points in time. in contrast, while about 4% of the overall sample remained in the most precarious group at both points in time, slightly more males (about 7%), and slightly fewer females (about 2%) remained in this group at both points in time. 57.4 30.9 11.7 68.0 15.7 16.3 56.7 35.7 7.6 0 10 20 30 40 50 60 70 80 90 100 least precarious semi precarious most precarious p er ce n ta g e figure 2. precarious employment groups at wave iv overall males females allmang & franke/just a job? 162 the biggest differences between the groups, again, was in the middle—or semi precarious—groups, highlighted in medium gray. while 18% of the overall sample was in semi-precarious employment at both points in time, fewer males (approximately 9%) remained in semi-precarious employment, while about 22% of females remained in semi precarious employment at both points in time. table 3. change in precarious employment from wave iii to wave iv all wave iv w av e ii i least semi most least 26.4 9.9 2.8 semi 26.2 18.0 4.7 most 4.8 3.0 4.2 males wave iv w av e ii i least semi most least 31.6 4.6 4.0 semi 29.7 9.1 5.7 most 6.7 2.0 6.6 females wave iv w av e ii i least semi most least 24.9 11.4 1.8 semi 28.1 21.5 3.9 most 3.8 2.9 1.9 key: least precarious at both waves (no change) moved away from precarity from wave iii to wave iv semi precarious at both waves (no change) moved further into precarity from wave iii to wave iv most precarious at both waves (no change) the changes in level of precarious employment from wave iii to wave iv are above the diagonal (representing moving further into precarious employment or getting worse) and below the diagonal (representing moving away from precarious employment or getting better). while about 17% of the overall sample moved further into precarity, fewer males (about 14%) and the same percentage of females (about 17%) did so. similarly, while about 34% of the overall sample moved away from precarity, a greater percentage of males (about 38%) and the same percentage of females (34%) did. in other words, higher percentages of males than females improved their employment status over time, and lower percentages of males got worse. in order to assess whether there was a significant difference in the patterns of internal change from wave iii to wave iv, bowker’s test of symmetry was conducted for the overall sample and separately for males and females. in each case, it was significant (p < .05), indicating that there were significant differences in the patterns of internal change for the overall sample, males, and females. advances in social work, spring 2020, 20(1) 163 from there, bonferroni post-hoc tests were conducted, in order to compare the various patterns of movement from wave iii to wave iv, and identify any significant differences. table 4 presents the test statistics using the z distribution that were generated from these tests, as well as a key indicating each of the comparisons that were conducted. these results suggest that, overall, the various types of shifts over time captured in tables 3 through 5 were significantly different from each other. the implications of these differences are explored in the discussion. table 4. post hoc tests of internal change shift z total a-comparison of 1-level shifts at lower levels of precarity 21.0* b-comparison of 2-level shifts between lowest and highest levels of precarity 5.6* c-comparison of 1-level shifts at higher levels of precarity -4.7* males a-comparison of 1-level shifts at lower levels of precarity 23.5* b-comparison of 2-level shifts between lowest and highest levels of precarity 4.6* c-comparison of 1-level shifts at higher levels of precarity -7.3 females a-comparison of 1-level shifts at lower levels of precarity 14.5* b-comparison of 2-level shifts between lowest and highest levels of precarity 4.6* c-comparison of 1-level shifts at higher levels of precarity -2.1 * p ≤ .05 key for post hoc comparisons wave iv least precarious semi precarious most precarious wave iii least precarious a b semi precarious a c most precarious b c in summary, findings from the study indicated that high percentages of young people (about 49% of the overall sample) were in the semi-precarious employment category at wave iii, while about 39% were in the least precarious category, and about 12% were in the most precarious category. slightly higher percentages of females than males were in the semi-precarious employment category, and slightly lower percentages of women were found to be in the most precarious category. there were significant shifts in precarious employment levels from wave iii to wave iv, both for the overall sample and when males and females were analyzed separately. overall, higher percentages of females than males remained in semi-precarious employment over time. on the flip side, higher percentages of males were located at the extremes—where they either moved deeper into precarity, or moved away from precarity over time. allmang & franke/just a job? 164 discussion this study contributes new insight into precarious employment trajectories for young men and women in the united states. overall, findings provide support for the hypotheses that higher percentages of young women than men would be in precarious employment at the initial time point, and that higher percentages of women would have difficulty moving out of precarious employment over time. in light of findings from previous studies, several additional interesting points emerged. first, there were three groups with varying levels of precarity at each time point: a least precarious group, a semi-precarious group, and a most precarious group. this finding aligned with previous literature suggesting that precarious employment exists on a continuum (cranford & vosko, 2006). a second finding of note was that, in contrast with previous studies that used a single, dichotomous measure such as the 2005 contingent worker supplement, which found that about 27% of young workers would be considered contingent workers (bls, 2005), this study found a relatively low percentage of young people who were in the most precarious group—only about 12%. one explanation for this lower proportion could be that some of the most precarious workers worked less than 10 hours a week at one or both waves of data collection, and were thus excluded from the study. alternatively, it may be due to the categorization scheme used in the analyses, which grouped workers into three groups instead of two. almost half of the study participants, when they were between the ages of 18 to 26, were in jobs that would be considered semi-precarious. this raises the question: how might the experiences of people in this group differ from those captured in previous studies that used single measures of precarious or non-precarious work? another interesting finding was related to the gender differences in patterns of precarious employment over time. higher percentages of women, compared to men, remained in semi-precarious employment over time. in light of existing research on gender inequalities in employment, this finding might be interpreted as one of the possible ways in which inequality manifests early, and sets the stage for lifelong barriers to opportunities in employment. similar to the wage “scarring” effect of sub-optimal early experiences in the labor market, it may be that remaining in semi-precarious employment over time early in one’s career could contribute to a job quality “scarring” effect, which could lead to challenges to advancing in the workplace over time. this effect may be particularly damaging for women, who have lower rates of advancement and compensation in the workplace (welle & heilman, 2007). while this study represents one step toward assessing gender differences in precarious employment trajectories for young people, findings suggest that there is a need for a range of policy and practice interventions to promote more equitable employment outcomes, as suggested by other precarious employment researchers (e.g., quinlan et al., 2010). one way to address differences in precarious employment by gender would be to implement and enforce national-level policies to ensure that women receive fair treatment and compensation in the workplace. several such policies have been proposed in the past year, including the paycheck fairness act (congress.gov, 2019), which would strengthen the enforcement of anti-discrimination efforts and prohibit retaliation against workers who advances in social work, spring 2020, 20(1) 165 discuss wages, and the pay equity for all act, which would prohibit employers from asking potential employees about their employment and benefits history (congress.gov, 2019; lerum, 2013). in addition, there are numerous other national-level strategies that could be used to address the precariousness of work, such as raising the national minimum wage and improving access to healthcare, regardless of employment status. alternatively, or in addition, policymakers could choose to create legislation to protect workers from insecurity during employment transitions due to losing a job, taking leave after the birth of a child, or changing occupations, as suggested by scholars such as kalleberg and vallas (2018). these findings also have implications for social work practitioners who work directly with young people. while these practitioners (and clients) are limited by the number and quality of jobs available, there may be some potential strategies to explore. first, this study points to the importance of helping young men and women to get onto career pathways that can help them to avoid remaining stuck in precarious work. previous research has found that gender-related differences in occupational aspirations, as well as job-related skills and credentials, contributes to the gender wage gap during the period of career entry (marini & fan, 1997). in addition, gender-based differences in earnings have been found to increase over time (goldin, 2014). therefore, it is critical for practitioners to help young women and men onto pathways to non-precarious jobs during this time. in addition, social workers can engage in advocacy to improve the quality of jobs available, either through a change in policy or through the creation of new social programs. these macro-level changes are necessary, in light of previous research that suggests that while voluntary action can be taken by employers to develop equitable policies and practices, these actions may not fully address problems around gender inequality in the workplace (e.g., lambert, 1993). therefore, social workers should consider supporting innovative strategies taking place at the state and local level currently, which could be expected to have an effect on the number of young people in precarious employment. for example, in several cities, such as san francisco and new york city, “fair workweek” legislation has been passed that has created protections for certain groups of workers, to require employers to create predictable work schedules. legislation such as this may help to reduce the precariousness associated with jobs in certain industries, such as fast food and retail. they can also support efforts to improve employment in particular occupations, such as home health care work and domestic work (boris & klein, 2006; poo, 2011). while this study provides some initial findings around gender and precarious employment in young people, it also has several important limitations. first, some of the dimensions of job quality that were used to create the precarious employment variables were measured indirectly. for example, job security was measured based on the likelihood of alternative work arrangements in the respondent’s occupational category, rather than a more direct measure of job insecurity in which the respondent was asked about their likelihood of losing his or her job. similarly, this study used a variable for whether the study participant received health insurance through his or her employer to represent access to employer-provided benefits, a key aspect of precarious work. there may be better measures of access to employer-provided benefits that could be used in future studies of precarious employment, particularly for studies focusing on emerging adults. in addition, allmang & franke/just a job? 166 this study used data that were collected prior to, and at the beginning of, the recent economic recession. therefore, while the issue of precarious employment is relevant to young people in the united states today, the findings from this study are only generalizable to young people who worked at least ten hours a week in 2001/2002 and 2008/2009. data gathered toward the end of or after the recession might show that many young people from this study lost their jobs during that time, particularly those from groups that were the most affected—men, the less educated, and african americans (kalleberg & von wachter, 2017). post-recession data show that many young people have either dropped out of the labor market, or to obtained jobs at a higher level of precariousness. lastly, this article focuses on paid work, and does not include unpaid work, which could have added an important dimension to the discussion of precarious employment (pulignano, 2019). this study points to several directions for future research on gender and precarious work. for example, it would be helpful for future research to gather data with the specific purpose of assessing precarious employment over time and that includes each of the four dimensions suggested by precarious employment theorists. in addition, future studies could gather data on young people’s decision-making around employment, and the ways in which those in precarious employment may access resources from other sources, such as family members and friends. lastly, researchers could use qualitative methods to explore young people’s understanding of the employment opportunities available to them, the challenges some young people face in obtaining employment, and the strategies that are being used to overcome these challenges. references add health. 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(2000). gender discrimination and job-related outcomes: a cross-cultural comparison of working women in the united states and china. journal of vocational behavior, 57(3), 395427. https://doi.org/10.1006/jvbe.1999.1748 toossi, m. (2002). a century of change: the us labor force, 1950-2050. monthly labor review, may 2002, 15-28. https://www.bls.gov/opub/mlr/2002/05/art2full.pdf u.s. bureau of labor statistics. (2005). contingent and alternative employment arrangements, february 2005. https://www.bls.gov/news.release/history/conemp.txt u.s. bureau of labor statistics. (2015). worker’s expectations about losing and replacing their jobs: 35 years of change. https://doi.org/10.21916/mlr.2015.1 u.s. bureau of labor statistics. (2018). contingent and alternative employment arrangements. https://www.bls.gov/news.release/pdf/conemp.pdf vosko, l. f., & clarke, l. f. (2009). canada: gendered precariousness and social reproduction. in l. f. vosko, m. macdonald, m., & i. campbell (eds.), gender and the contours of precarious employment (pp. 26-42). routledge. https://doi.org/10.4324/9780203874424 https://doi.org/10.7208/chicago/9780226637853.001.0001 https://doi.org/10.4179/nlf.201.0000008 https://doi.org/10.2139/ssrn.3350980 https://doi.org/10.2190/22bk-9xc0-ak7l-m6qh https://doi.org/10.2190/hs.40.2.i https://doi.org/10.4337/9781784715755 https://doi.org/10.1006/jvbe.1999.1748 https://www.bls.gov/opub/mlr/2002/05/art2full.pdf https://doi.org/10.21916/mlr.2015.1 https://www.bls.gov/news.release/pdf/conemp.pdf https://doi.org/10.4324/9780203874424 advances in social work, spring 2020, 20(1) 171 vosko, l. f., macdonald, m., & campbell, i. (eds.). (2009). gender and the contours of precarious employment. ny: routledge. https://doi.org/10.4324/9780203874424 welle, b., & heilman, m. e. (2007). formal and informal discrimination against women at work: the role of gender stereotypes. in s. w. gilliland, d. d. steiner, & d. p. skarlicki (eds.), research in social issues in management: managing social and ethical issues in organizations (pp. 229-252). usa: information age. author note: address correspondence to dr. skye allmang, rutgers school of social work, 120 albany street, tower one suite 200, new brunswick, nj 08901. e-mail: skye.allmang@rutgers.edu acknowledgements: this research uses data from add health, a program project directed by kathleen mullan harris and designed by j. richard udry, peter s. bearman, and kathleen mullan harris at the university of north carolina at chapel hill, and funded by grant p01-hd31921 from the eunice kennedy shriver national institute of child health and human development, with cooperative funding from 23 other federal agencies and foundations. special acknowledgment is due ronald r. rindfuss and barbara entwisle for assistance in the original design. no direct support was received from grant p01-hd31921 for this analysis. https://doi.org/10.4324/9780203874424 mailto:skye.allmang@rutgers.edu _________ virginia rondero hernandez, phd, acc, lcsw, owner of lifeshift coaching and consultation, san antonio, tx. susan douglas, phd, pcc, associate professor of practice, department of leadership, policy, and organizations, vanderbilt university, nashville, tn. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 856-875, doi: 10.18060/24949 this work is licensed under a creative commons attribution 4.0 international license. coaching and social work: a strategy for developing leadership and the workforce virginia rondero hernandez susan douglas abstract: there is increasing recognition of the merits of coaching in social work, yet gaps in knowledge persist about the use and effectiveness of coaching in social work settings. this article bridges concepts and findings from the literature on coaching to provide readers with the information needed for decision-making about whether and how to integrate coaching into practice. coaching is currently being used in a number of social work fields of practice to support the transfer of learning, practice implementation efforts, leadership development, and organizational processes. the evolution of coaching from the corporate world into service delivery settings is reviewed, with special attention to the commonalities and distinctions between coaching and social work practice. knowing more about the background, purpose and value of coaching can equip the profession with further insights about the appropriate application of coaching in the world of social work. moreover, the reader is invited to assess the potential of coaching as a method for enhancing workforce and leadership competencies and practice behaviors in service of improving client outcomes. keywords: coaching; practice implementation; workforce development; leadership development; organizational learning coaching evolved from the fields of higher education, management, and organizational development in the 1980s and has been largely used to support the performance and professional development of leaders in corporate settings and large organizations. since its emergence, the popularity of coaching has expanded beyond the business realm into other professional and personal arenas. too little is currently known about the appropriateness of coaching in social work settings. however, there is evidence that coaching is being used to support social workers as a strategy to improve the transfer of learning and implementation of evidence-based practices in social service organizations. in addition to coaching for professional development, it is also being taught as a competency to enhance practice, both externally with clients and internally for leadership and managerial purposes. coaching holds great promise as both a professional development tool and as a core competency for improving social work practice at practitioner, leadership, and organizational levels. strategically, it behooves the social work community to carefully consider the potential influence, benefits, and challenges of this growing, yet distinct profession. to support informed decisions about integrating coaching into social work practice, this paper briefly reviews the history, purpose, and methods of the coaching profession. commonalities and differences between social work and coaching practice are then addressed before reviewing the current state of coaching as both a support for and a about:blank rondero hernandez & douglas/coaching and social work 857 competency in social work practice. this is followed by a consideration of implications and recommendations for further use and future research in social work. what is coaching? though there are varying definitions of coaching (paul & myers, 2021), the one being used for this article is “…partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential” (international coaching federation [icf], 2021c, para. 5). historically, the profession of coaching has been informed by the fields of business, management, higher education, leadership development, and organizational development. the theoretical bases of coaching draw from developmental psychology, adult learning theory, cognitivebehavioral theory, social systems thinking, and organizational development (edelson, 2010; hudson, 1999; rofuth & piepenbring, 2019; university of california, davis [ucd], 2013; williams, 2015). more recently, the field of implementation science has influenced and helped popularize coaching in social work-related fields. along with staff selection and training, staff coaching has been identified as a core component in the successful implementation of evidence-based practices in human services (fixsen et al., 2005). coaching is also described as a practice competency driver (fixsen et al., 2015) and an implementation support factor in organizational capacity-building (metz et al., 2021). as defined in the literature, coaching is differentiated from other professional development supports such as mentoring, leading by example, facilitation, supervision, or consultation (cameron & ebrahimi, 2014; paul & myers, 2021; ross-sheriff & orme, 2017; tompson et al., 2008; tropman, 2022). specifically, the role of a coach is not to advise or give recommendations about job performance, which is often the case with mentors, facilitators, supervisees, and consultants. rather, coaching is a purposeful and intentional method designed to empower individuals to learn more about themselves, assess how others perceive them, explore questions related to their professional competency, and define goals that support their professional and personal development (cameron & ebrahimi, 2014; ross-sheriff & orme, 2017). although, coaching and supervision does involve the exchange of information about job performance between a knowledgeable source and a less knowledgeable one, it is not considered a form of supervision in social work settings (tropman, 2022), rather an activity that is conducted by either a coach external to the agency or an internal coach whose primary focus is on employee development (paul & myers, 2021). coaching is also different from therapy. while both may focus on the here and now, therapy typically deals with emotional or behavioral issues and mental health disorders. in contrast, coaching is focused on goal attainment related to greater satisfaction in one’s professional and/or personal life (burroughs et al., 2017; ucd 2013; williams, 2015). coaching for management can focus on remedial or developmental purposes (whetten & cameron, 2019). remedial coaching is intended to ameliorate a deficit or problem for performance improvement and is typically behaviorally focused. in contrast, developmental coaching is much more proactive and often provided in preparation for promotion or future roles. advances in social work, summer 2022, 22(2) 858 hudson (1999) was one of the first to clearly define executive coaching. his experiences in higher education, corporate leadership, and organizational development led him to conclude that executives needed highly trained “coaches” to develop their leadership potential and effectiveness. hudson’s (1999) seminal text, handbook of coaching aptly describes the cultural shifts affecting society at that time and the need for organizations and leaders to move from a “command and control” mentality to one that embraced the notions that change is cyclical and continuous, that leaders lead with their values, and that constant learning was in order. hudson argued that coaching was the preferred method for supporting executives in managing change and developing dynamic teams and organizational processes with the end user in mind. coaching as defined by hudson (1999) was an ideal “high touch” vehicle to support leaders in developing individual and interpersonal skills, which were emerging as leadership competencies. for example, stephen covey’s 1992 book, principle-centered leadership, applied his seven “habits” of highly effective people developed in the 1980s, to the business world. he described a form of leadership effectiveness that extended beyond strategic thinking and technical excellence in one’s field to include people-oriented skills such as the ability to build relationships, the willingness to help others succeed, the desire to learn continuously, and the ability to communicate (covey, 1992). since then, the study of leadership effectiveness has expanded exponentially and with it the discovery that the effectiveness of leaders and organizations is grounded in the people-oriented skills or “habits” covey defined in 1992. this skill set now stretches beyond the “soft skills” of self-awareness, communication, collaboration, and leadership defined by levasseur (2013) and includes emotional intelligence (goleman, 2004; goleman et al., 2013), influence (robin & bradford, 2004), authenticity (george & sims, 2007), trust (feltman, 2021), empathy (zaki, 2019), compassion (boyatzis et al., 2019), credibility (kouzes & posner, 2002), and vulnerability (edmondson & chamorropremuzic, 2020). fast forward, coaching has been adopted by corporate, public, and non-profit organizations and continues to evolve. we are currently in a “third generation” of coaching that was initiated in the 2010s. coaching now focuses on assessing the talents and strengths of leaders and has incorporated “a more humanistic, goal-focused version of performance management conversations” (grant, 2017, p. 41), as opposed to the command-and-control model and a hyper-focus on job performance. further, to better integrate coaching into everyday organizational change processes, grant (2017) suggests that coaching shift from scheduled meetings to quality conversations that can happen spontaneously in the hallways. a useful structure for a coaching conversation is the grow (goal, reality, options, way forward) model, which offers a simple way to support someone in identifying a goal, raise awareness of the current context and brainstorm possibilities for moving towards the goal with a clear action plan (fine & merrill, 2010). another helpful model is the auerbach good model of coaching (goal, options, obstacles, do), which builds on the grow model with a strengths-based perspective (auerbach, 2014). coaching theories, methodologies and models like these are currently being used in social rondero hernandez & douglas/coaching and social work 859 work settings today to support the performance and well-being of those being coached (capacity building center for states, 2017; rofuth & piepenbring, 2019; ucd 2013). in addition, coaching is currently responding to the demand for support around hard and necessary conversations about diversity, equity, inclusion, and belonging (deib) in the workplace and adapting current methodologies and models to help build the capacity of individuals and organizations to respond accordingly (wood, 2021). evidence for coaching effectiveness leadership development is a strategic priority for organizations and an estimated $366 billion industry (westfall, 2019). hudson’s (1999) conclusion that executives could benefit from the services of highly trained “coaches” to develop their leadership potential and effectiveness was spot on. the evidence for coaching is strong, with three recent metaanalyses indicating positive effects on organizational and individual outcomes including goal attainment (jones et al., 2016; sonesh et al., 2015; theeboom et al., 2014). google conducted an internal study exploring the characteristics of effective managers, with coaching identified as the number one quality of their best managers (bock, 2015; garvin, 2013). while social work settings may differ from corporate settings (like google), an empowering leadership style has been found to be associated with job satisfaction among social workers (elpers & westhuis, 2008). recent literature reviews of leadership in social work suggest that the type of leadership exemplified by person-centered development and resourcing, which is consistent with a coaching approach, is well aligned with social work values (peters, 2018; sullivan, 2016). a recent meta-analysis found that leadership training programs that focus on interpersonal and leadership skills, and provide feedback over multiple sessions, such as that provided in coaching, are more effective across industries (lacerenza et al., 2017). as the science of coaching has grown, so too has the coaching profession. the estimated market size of the global coaching industry is $20 billion by 2022 (willis, 2021). in its most recent 2021 membership fact sheet, the icf reported a total of 36,680 accredited coaches in 134 countries and territories, a 19% increase from the previous year (icf, 2021a). in a 2020 survey of coaching across allied business and professional organizations and professional coaching bodies, an estimated 71,000 coaches were practicing around the globe, a 33% increase over previous survey in 2015 (icf, 2020). the growing popularity of coaching for leadership development and performance improvement in health and human service sectors (burroughs et al., 2017; capacity building center for states, 2017) has increased visibility and interest in coaching as a professional competency for social workers. type of coaching by format, focus, and coach placement there have been numerous types of coaching identified in the literature including executive, life, personal, business, career, leadership, managerial, workplace, team, organizational, financial, and health and well-being (beattie et al., 2014; cameron & ebrahimi, 2014; edelson, 2010; grant, 2017; moore et al., 2016; ross-sheriff & orme, 2017). however, trying to classify coaching by type can be misleading, since these areas advances in social work, summer 2022, 22(2) 860 may overlap. to sort through the confusion, it may be helpful to consider three aspects of coaching: the format, the focus, and whether the coach is internal or external to the organization. as shown in table 1, the format of coaching can range from working with an individual in one-to-one coaching to working with a group of people in a team or unit. these can be virtual (i.e., remote through telephone or videoconference) or in person. the focus of coaching ranges from the personal to the professional, and even includes specific functional areas such as business development in professional settings, financial goal setting or career development for individuals or groups, or health and wellness in healthcare settings. it is important to note that while some functional areas may require specific knowledge (e.g., business coaching) and even additional accreditation (e.g., health and wellness), coaching may span multiple focus areas across a single engagement. coaching services may be funded by organizations or individuals may secure coaching services on their own. coaches may be external to the organization, although increasingly organizations are employing internal coaches (icf, 2021c). while both internal and external coaching has been found to be effective at influencing organizational outcomes, a recent meta-analysis found a stronger effect for internal coaches, with their greater knowledge of the organizational climate and culture, compared to external coaches (jones et al., 2016). table 1. types of coaching categorized by format and purpose, and coach placement coaching aspect category examples format one-to-one life, executive group team, group, leadership, organizational unscheduled conversations workplace focus personal life, personal specific functional area business, career, financial, health & wellbeing, leadership, organizational general performance managerial, executive development managerial, executive placement internal managerial, executive, organizational external executive, leadership, organizational two types of coaching that may be particularly relevant to social work practice are executive and team coaching. executive coaching, which focuses on improving leadership abilities and managing organizational change and employee performance, has been the predominant model of coaching since the 1980s (hart et al., 2001). team coaching, which is a team-based learning and development intervention, has become increasingly relevant as organizations shift to doing more work in teams (clutterbuck, 2020; hawkins, 2021; jones et al., 2019; widdowson et al., 2020). in team coaching, the focus is on the team, which may entail a variety of activities, such as one-to-one coaching with the team leader, observing and intervening in business-as-usual team meetings, facilitating team building activities, etc. peter hawkins (2021), a founding leader in the field of team coaching, emphasizes that effective team coaching means not just attending to interpersonal and group dynamics, but also task performance and continuous learning. regardless of the type of coaching, a growing number of individuals and organizations, including social workers rondero hernandez & douglas/coaching and social work 861 and social work agencies, have embraced coaching as a method for strengthening workforce development efforts, social work practice behaviors, one’s career, and preparing for leadership opportunities. evolution of social work perspectives on coaching from competency to competitor as personal and executive coaching rose in prominence as a viable strategy for individual behavior change and organizational improvement in the 1980’s and 1990’s (whitmore, 2017), early discussions of coaching in the social work literature focused on the benefit of integrating coaching methods and competencies into social work practice. coaching was described as a transfer technology intervention that held promise for increasing practitioner effectiveness, supporting rapid dissemination of evidence-based interventions, and improving client outcomes (scheyett et al., 2001). shafer and colleagues (2003) described coaching as an innovative method for helping clients recover from addiction and maintain sobriety. perrault and coleman (2004) considered coaching an innovative approach that could be used effectively during social work field supervision. these authors encouraged field educators to integrate and employ coaching strategies (i.e., effective communication, powerful questioning, and direct communication) to facilitate student awareness and transfer of learning. they cited a number of examples, largely from the discipline of education, to demonstrate that coaching was a “good fit for educational supervision” (p. 51) and argued that three particular components of coaching—building trusting relationships, leveraging one’s inner motivation and autonomy, and reflecting on past efforts to inform future responses and behaviors—could be used by social work field educators to support the professional development and practice of their students. in 1995, the international coach federation (icf) was formed to bring greater professionalism to the field of coaching, with the development of an ethics code and a credentialing process within a few years (icf, 2022). in the social work literature, a corresponding shift can be seen where the fields of coaching and social work are differentiated from one another. caspi’s (2005) seminal work described the challenges and concerns that the coaching profession posed to the social work profession. although he acknowledged the similarities between coaching and social work practice behaviors and even endorsed the notion that “…social workers are well-suited to become coaches” (p. 360), he suggested that coaching may pose a threat to the social work profession. caspi’s concerns were related to: 1) the potential encroachment of coaching on social work’s scope of practice; 2) licensing and ethical issues in the unregulated coaching industry; 3) the need for empirical evidence about the effectiveness of coaching in social work settings; 4) the appropriateness of using coaching interventions that were designed for corporate structures, rather than the social services organizations social workers typically experience on a daily basis; and, finally, 5) the need to include and critique coaching in social work educational curriculums, especially at the graduate level. advances in social work, summer 2022, 22(2) 862 commonalities and distinctions between coaching and social work practice in 2010, edelson published a seminal book acknowledging that while its roots are in corporate settings, coaching has characteristics in common with social work that transfer well to social service settings. a former chief psychiatric social worker and private practitioner, edelson described “values-based coaching,” as a strengths-based method informed by the core values of the profession and tailored to support the needs and aspirations of practitioners and leaders working in social service settings. she suggested that coaching supports practitioner, leadership, and organizational development, and can help an organization activate its mission more fully and thus serve its clients more effectively (edelson, 2010). the common characteristics of both coaching and social work practice are a defined mission, core values, ethical standards and principles and practice competencies. though their missions differ, both coaches and social workers abide by a set of core values (edelson, 2010; lasky, 2021; reardon, 2016). the social work values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence serve to operationalize its mission “to enhance human wellbeing, help meet the basic human needs of all people…with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (national association of social work [nasw], 2020, para. 1). the international coaching federation core values of integrity, excellence, collaboration, and respect are also anchored in its mission to “lead the global advancement of the coaching profession and empower the world through coaching” (icf, 2021b, para. 3). though their clientele, workplace, and work activities may differ, both social workers and coaches are guided by a set of ethical principles that describe practice behaviors that are aligned with their professions’ core values. likewise, both social workers and coaches are expected to adhere to standards that define their ethical responsibilities to clients, colleagues, the profession, and greater society. social workers and coaches must adhere to these standards or risk the consequences of review by the profession for ethical violations. in contrast, coaching remains a largely unregulated profession. even though guilds such as the icf monitor their members’ ethical behaviors, violations are not regulated or enforced as they are for state licensed social workers (lasky, 2021; martinez, 2016). finally, social workers and coaches are expected to demonstrate specific competencies. the practice competencies expected of a social worker and a coach align when it comes to adhering to ethical practice, partnering with clients on agreed upon goals, building a trustworthy relationship with the client, communicating effectively, and supporting and empowering the client as they move toward goal completion (edelson, 2010; icf, 2019; lasky, 2021). at first glance, a social worker might reject these comparisons, erring on the side that coaching interventions are not appropriate for social work settings. it is true that the mission of the icf and most coaching certification bodies do not necessarily serve the same populations that social workers do. however, the icf definition of coaching—"partnering with clients in a thought-provoking and creative process that inspires them to maximize rondero hernandez & douglas/coaching and social work 863 their personal and professional potential” (icf, 2021c, para. 5)—aligns with the spirit of social work, which is to engage clients in an effective and authentic manner, work with the client to assess their personal needs, with the goal of enhancing human functioning and well-being in ways that produce positive outcomes for the client (nasw, 2021). even though coaching has primarily been used in the corporate sector, the early social work literature forecasted its potential for improving practice and reinforcing knowledge gained through formal training. more recently, coaching has been cited as a method to enhance organizational and team processes, employee performance, and professional development at all levels of an organization (cameron & ebrahimi, 2014; icf, 2021c; tompson et al., 2008). for these reasons, the social work community needs to know more about coaching and how it can equip the profession with insights about how to apply it to activate practitioner, leadership, and organizational efforts more fully to better serve our clients. coaching in practice settings the discourse about coaching in health and human services sectors—where social workers are often employed—has grown over the last decade. it is generally discussed in the social work literature as an agency-based intervention intended to improve practice and build the capacity of an organization to better serve its clients. here are some examples from the literature. coaching as a practice improvement strategy for social workers peterson (2012) introduced decisional coaching which focuses on engaging patients in shared decision-making processes related to health care treatment and end-of-life decisions. peterson argued that social workers possessed the knowledge, values, and skills needed to engage patients in this process, effectively placing patient concerns at the center of decision-making. burroughs et al. (2017) affirm the relevance of decisional coaching in their article on coaching in social work practice. they also cite several studies where coaching strategies and techniques were successfully used by social workers in wraparound programs for at-risk youth exposed to parental substance abuse, with court-mandated and voluntary clients, during family visits with parents involved in child welfare systems, and with homeless populations to encourage greater use of social services and reduce substance abuse relapse. henwood et al. (2020) report on the results of a clinic-based study on “practitioner coaching,” where physician coaches were paired with behavioral health coaches (some of whom were licensed social workers) to address complex patient care needs with positive outcomes for the physician practitioners and patients. in the field of child welfare, hatton-bowers et al. (2015) examined social workers’ perspectives on the role of coaching in safety and risk assessment training on the safety organized practice model. results showed that social workers reported positive learning gains when classroom training was combined with follow up coaching sessions. in addition, social workers reported stronger critical thinking skills and increased confidence in making risk and safety decisions and engaging families in shared decision-making (hatton-bowers et al., 2015). although more empirical research is needed to assess the effectiveness of coaching in advances in social work, summer 2022, 22(2) 864 practice settings, the studies described here indicate coaching may be a viable strategy for strengthening practitioner skills and has the potential to influence agency practice and client outcomes, especially in behavioral health, child welfare and wraparound services. coaching as a strategy for workforce development and organizational capacitybuilding coaching can play a key role in workforce development (cameron & ebrahimi, 2014) and organization capacity-building for service delivery improvement and innovation (fixsen et al., 2005). the benefits of coaching in these activities are maximized when organizations strive to develop a coaching culture across the workforce (cameron & ebrahimi, 2014; clutterbuck et al., 2016; hawkins, 2012). more than the provision of coaching to develop individuals and organizational capacity, building a coaching culture requires the promotion of coaching as a core competency for managers and leaders. coaching is a complex skill, which involves a mindset shift towards learning and growth and development of a facilitative interactional style (cannon et al., 2021). the coaching toolkit for child welfare practice (ucd, 2013) uses the metaphor of the “coaching puzzle” to explain how coaching supports organizational capacity-building by strengthening the integration of best practices into child welfare agencies and discusses how agency leaders, practitioners, coaches and supervisors can use coaching to promote active learning at all levels of the organization. the quality improvement center for workforce development (n.d.) features several reports on coaching as a strategy for addressing secondary trauma to improve retention in the child welfare workforce and promote resilience for greater social worker self-efficacy, well-being, and job performance. finally, the national child welfare workforce institute (ncwwi; n.d.) has organized a repository of resources in the form of monographs, infographics, recorded webinars, videos, and reference lists on coaching. there is also an interactive course for individuals wanting to learn more about coaching through the ncwwi online training portal. coaching for leadership development the social work literature on coaching in leadership development is less abundant than that for social work practice. however, the existing literature does provide information on how coaching is being used to support the leadership development of social work supervisors and managers. it also offers some indication of the direction coaching for leadership development may be going in our profession. coaching is currently being used reinforce and deepen the leadership learning gains of middle managers and executives within child welfare structures. the ncwwi has developed two leadership academies for child welfare supervisors and managers where participants learn foundational principles of leadership, including how to lead within the organizational context, how to lead people, and how to lead for change and results. coaching is explicitly addressed as a method for leadership development with information and downloadable materials available in the curricula and training materials section of the website. in addition, child welfare managers may attend in-person trainings and receive http://www.qic-wd.org/ rondero hernandez & douglas/coaching and social work 865 coaching for up to six months to enhance their coaching behaviors (national child welfare workforce institute, 2018). in california, the child and family policy institute of california (cfpic) has developed the new child welfare directors development program (ncwddp) to support new leaders in county child welfare structures (cfpic, 2022). the ncwddp pairs a self-paced, guided study approach with coaching and online workforce development resources (california social work education center, 2021). rofuth and piepenbring (2019) refer to coaching in social work settings in several significant ways. they introduce the coaching style of leadership, which can leverage “the kind of resonance that boosts performance” (goleman et al., 2013, p. 53) and offer many examples of how leaders and managers can coach their managers and teams with beneficial results. they emphasize that the “core ingredients” of effective leadership and management are reflected in the four domains of emotional intelligence (ei)—self-awareness, selfmanagement, social awareness, and relationship management. many executive and leadership coaches incorporate ei into their practice for this very reason. rofuth and piepenbring also refer to the human services competencies and practice behaviors defined by the network of social work management (nswm) and the council on social work education (cswe) throughout their book to demonstrate how the leadership and management strategies, including coaching, can be applied to enhance professional behavior and employee performance. there is also evidence that coaching is being incorporated into leadership development efforts in higher education. the american council on education (2021) described a sample of higher education leadership development programs and the use of coaching in mentoring and fellowship programs. the american association of colleges and universities (n.d.) offers an array of leadership development programs to member organizations that include coaching. the national center for faculty development and diversity (n.d.) contracts with subscribing higher education institutions for coaching and other professional development services for faculty members from various disciplines. cruz and rosemond (2017) report on the types of university leadership development models that integrate coaching into their programs. these models include coaching department chairs and other leaders in the academe and teaching leaders to coach, as opposed to giving directives. another example of a campus coaching program designed for campus supervisors, managers, and team leaders is the “growing as a coach” course that teaches participants coaching tools and techniques they can utilize with direct reports (university of california, berkeley, 2021). social workers as coaches coaching appears to offer a promising career path for social workers. reardon (2016) described coaching as a way for social workers to “…diversify their practices, generate additional revenue, and assist clients who would not be candidates for traditional therapeutic services” (p. 18). pace (2016) interviewed several social worker-coaches who indicated that they were able to transfer their strengths-based orientations, practice skills and client experiences into coaching with great success. their social work education and practice experiences, along with coach training and certification helped these social workers to integrate coaching into their clinical practices more fully. in some instances, advances in social work, summer 2022, 22(2) 866 they were able to launch their own life coaching or executive coaching businesses. martinez (2016) described the “draw of coaching” reported by clinical social workers who engaged in the dual practice of therapy and coaching. this “draw” included reduced client stigma attached to coaching vs. therapy, not having to deal with insurance reimbursement systems, working with higher functioning clients, and decreased emotional burden for the practitioner-coach. in summary, the social workers interviewed indicated “…private, dual practice allowed them the flexibility to work with a broader range of clients” (martinez, 2016, pp. 25-30). currently, there are several ways social workers can pursue formal coach training and equip themselves to bring coaching into their practice settings. social workers are among the professional groups that qualify for a national board certified coaching credential (center for credentialing and education, 2021). social workers can also obtain coach training and a coaching credential through the international coaching federation (icf) by attending an accredited coach training program, acquiring coaching experience, and passing a coach knowledge assessment (icf, 2021a). although, there is no published number of social workers who are icf-certified, they are included in the count of its 71,000 plus coach practitioner membership (icf, 2021d). social work’s focus on a person’s strengths, coaching the person as opposed to the problem, a person-in-environment perspective and practice skills in engaging clients, assessing their strengths, collaborating with clients on intervention planning, and evaluating their progress compliment the icf definition of coaching cited earlier (icf, 2021c). if it indeed is the case that interest in coaching continues to grow, it also is incumbent upon social workers to consider enrolling in an accredited coach training program and pursuing coaching certification. a majority of respondents who participated in the 2020 icf global coaching study reported that 55% of their clients expected their coach to be certified or credentialed (icf, 2020). also holding a coaching certificate or coaching credential can strengthen a social worker’s ability to ferret out the distinctions and commonalities of coaching and social work and help to advance knowledge in this area. what else does social work needs to know about coaching? caspi (2005) was the first to identify specific steps that social work should take with regard to coaching. they included 1) actively discussing the role of coaching in social work; 2) organizing the social work community to examine the regulatory aspect of coaching in order to protect clients; 3), assessing the current state of coaching in the social work profession; 4) testing the effectiveness of coaching; 5) studying coaching approaches to determine its appropriateness for social work practice; 6) including and critiquing coaching in social work curriculum; 7) raising public awareness about the differences between social workers who are coaches and those with no mental health training; and 8) investigating how social work coaching presence can be expanded and strengthened in corporate settings (pp. 360-361). while some of these recommendations have been addressed, as described below, there continue to be knowledge and practice gaps about coaching for the social work profession. rondero hernandez & douglas/coaching and social work 867 edelson (2010) addressed the first step of actively discussing the role of coaching in social work and specifically addressed caspi’s concerns about clinical and ethical issues. others have contributed to this discussion, as well as the third step of assessing the current state of coaching in social work (jost, 2013; lasky, 2021; martinez, 2016; reardon, 2016). burroughs et al. (2017) and the ucd (2013) northern training academy have taken the lead in addressing the fifth step, clearly demonstrating the appropriateness of coaching in social work settings. the seventh step of including and critiquing coaching in social work has been recently addressed by several authors (jost, 2013; lasky, 2021; reardon, 2016). pecora et al. (2018) identify staff coaching by supervisors as key to building the capacity of child welfare staff to implement practice models and recommends more rigorous study of coaching to assess its effectiveness. rofuth and piepenbring (2019) identified management and social work education competencies that can guide agency leaders in the use of coaching to support the performance and professional development of employees and teams. das et al. (2021) assessed the viability of coaching with social work interns to support their learning in field and identified the processes and dynamics associated with coaching that affect the implementation of best practices by social work interns in a child and family services setting. the common theme that emerges from these sources is that we theoretically know coaching works, but we need more evidence about the extent of its presence and use in social work settings and its effectiveness at practice, leadership, and organizational levels. implications for social work as this article reflects, there is growing recognition of the potential merits of coaching in social work, but there are knowledge gaps about the extent of its presence, use, and effectiveness in social work settings. what we do know is promising and there is convincing evidence outside of our discipline to affirm coaching works at the individual, team, and organizational levels. the increased interest in coaching in the social work literature aligns with the trajectory of public interest in coaching among social work practitioners, managers, and leaders, as well as university and college leadership development programs that more than likely include social work professionals. in this sense, it is incumbent upon the profession to advance knowledge about coaching further to fill the gaps of what we still need to know. recommendations in order to address the knowledge gaps that currently exist, the following is recommended: 1. launch survey research studies on coaching in various fields of social work practice. participants could be recruited from membership organizations of nasw, cswe, and nswm and their membership branches. an effort could also be made to reach out to social workers in corporate, private and non-profit settings to assess the extent coaching is being used in these settings. it is imperative that surveying participants go beyond the simple gathering of demographics and inquire about the value of coaching as it specifically relates to diversity, equity, inclusion, and belonging issues in the workforce. advances in social work, summer 2022, 22(2) 868 2. develop social work standards for coaching. there is enough evidence that more social workers are pursuing coaching, either as an adjunct to their practice or as a career beyond social work. some are even seeking credential or certification status with organizations such as the icf or the center for credentialing and education. this would help to address caspi’s concerns about the regulatory aspect of coaching and public awareness about the distinctions between coaching and social work, especially as it relates to mental health training. 3. conduct more rigorous research on the effectiveness of coaching in health and human services settings where social workers are likely employed. despite the challenges of adopting and sustaining evidence-based practices, implementation and training interventions that feature coaching have been found to be more effective. likewise, more research is needed on the type of leadership strategies needed to guide health and human services organizations as they implement new models and evidence-based practices. this type of research is nascent in the social work literature, but highly needed to catch up with increased level of interest in coaching in social work settings. 4. explore and question how coaching might be a helpful strategy for yourself, your clients, or your organization. since coaching and social work both use strengths-based and solution-focused perspectives and share more commonalities than differences, should we not add more coaching content to social work practice courses at the micro, mezzo, and macro level? should it not be a role for the profession? since the literature demonstrates coaching is a method that augments the transfer of learning and increases the likelihood of successfully implementing evidence-base practice and organizational change, should it not be used in field practicums, as well as the workplace? and if evidence-based interventions are implemented consistently and with fidelity, resulting in positive client outcomes, would it not be healthy for our organizations and workforce to learn more about the science of implementing practices that are known to produce evidence? if leadership is a critical component of system improvement and implementation of practice changes, ought not leaders, managers, and supervisors learn to coach to support the workforce in this regard? and if universities, colleges, and agencies are intent on developing leaders and expect them to contribute to the organizational development of their institutions, might coaching be a component of leadership programs to facilitate this process? 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(2021, january 4). three trends that will shape the future of coaching. international coaching federation. https://coachingfederation.org/blog/3-trendsthat-will-shape-the-future-of-coaching wood, a. (2021, july 1). go beyond diversity: why inclusive leadership is vital for your deib efforts to succeed. betterup. https://www.betterup.com/blog/inclusiveleadership-deib-efforts-succeed zaki, j. (2019, may 30). making empathy central to your company culture. harvard business review. https://hbr.org/2019/05/making-empathy-central-to-your-companyculture author note: address correspondence to virginia rondero hernandez, lifeshift coaching and consultation, san antonio, tx. email: virginiarh@lifeshiftcc.com https://coachingfederation.org/blog/3-trends-that-will-shape-the-future-of-coaching https://coachingfederation.org/blog/3-trends-that-will-shape-the-future-of-coaching https://www.betterup.com/blog/inclusive-leadership-deib-efforts-succeed https://www.betterup.com/blog/inclusive-leadership-deib-efforts-succeed https://hbr.org/2019/05/making-empathy-central-to-your-company-culture https://hbr.org/2019/05/making-empathy-central-to-your-company-culture mailto:alex.redcay@millersville _________ francisco j. lozornio, dsw, lcsw, assistant professor, erikson institute, chicago il. celeste sánchez, phd, msw, post-doctoral research fellow, maría vidal de haymes, phd, professor, guillermo sanhueza, phd, msw, associate professor, ennio cardozo, msw, and verónica arreola, med, assistant director of academic advising, school of social work, loyola university chicago, chicago il. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 84-104, doi: 10.18060/27427 this work is licensed under a creative commons attribution 4.0 international license. the online bilingual msw program: innovation in social work education francisco j. lozornio celeste sánchez maría vidal de haymes guillermo sanhueza ennio cardozo verónica arreola abstract: the process of design and implementation of the online bilingual (spanish and english) master of social work (obmsw) at loyola university chicago is presented. this innovative program enhances the clinical training of social work students serving latinx, immigrant, and refugee communities. the obmsw utilizes an online platform, offers learning in a bilingual environment, is taught by a completely latinx faculty body, and is guided by a curriculum that is responsive to current challenges experienced by latinx and immigrant populations in the u.s. preliminary, mixed-methods data of this promising approach to social work education is included. additionally, a description of the adjustments and changes made during the implementation stage resulting from student advocacy and the self-evaluation exercises conducted is offered. limitations and potential future opportunities are discussed. the innovative obmsw program can serve as a model for social work programs across the u.s. interested in preparing social workers to meet the unmet, growing mental health service needs of the bilingual latinx populations. additionally, the obmsw program's online format can increase student access on a national level. keywords: bilingual education; social work; innovation; msw; latinx; immigrants; refugees latinxs constitute the second-largest racial/ethnic group in the u.s., comprising 18.5% of the population (u.s. census bureau, 2020). in this paper, the authors will use the word latinx to describe individuals that identify as hispanic, latino, latina, or latine to acknowledge gender diversity. this population has rapidly expanded in the last four decades, primarily due to migration. although latinxs have had a long presence in the united states, it is well-documented that this group has been underrepresented in higher education (burkham, 2019). according to the council on social work education (cswe, 2021), latinx students are also underrepresented in social work graduate programs in the united states. as the u.s. latinx population grows, the unmet health and mental health service needs gap widens for u.s.-born latinxs, latinx immigrants, and refugees (bucay-harari et al., 2020). factors contributing to this unmet need include barriers to access and a shortage of latinx professional personnel. other barriers include a lack of linguistically and culturally appropriate services, insurance coverage, transportation, information about mental health services, and organizational capacity to provide culturally relevant services. the online bilingual master of social work (obmsw) program of loyola university chicago was developed and implemented in the fall of 2018 with the intent to increase bilingual (english-spanish) latinx mental health professionals in underserved about:blank advances in social work, spring 2024, 24(1) 85 communities, and thus, help fill the gap of unmet mental health needs specifically in latinx communities. within an institution committed to social justice for more than a century, with a diverse and excellence-oriented faculty, this program was designed to be online, accompanied by a practical curriculum that includes 1,000 internship hours (or 600 hours, for advanced-standing students). this paper provides an overview of the obmsw’s innovative design and implementation. preliminary results of student surveys, self-assessments, and faculty and staff focus groups identify program implementation challenges. opportunities for growth are also discussed. latinxs in u.s. and mental health access the u.s. latinx population surpassed 62 million in 2020 (krogstad & noebustamante, 2021). health concerns for latinx groups in the u.s. include diabetes, heart disease, liver disease, hiv/aids, high rates of obesity, and access to care (u.s. department of health & human services, 2021b). artiga et al. (2021) state, “nearly one in four (24%) hispanic adults overall report no usual source of care other than an emergency room” (p. 5). mental health concerns and needs for latinxs in the u.s. are also evident. in 2019, serious psychological distress was reported by 12.2 percent of latinx adults, and suicide was the second leading cause of death of latinxs between 15 and 34 years of age (u.s. department of health and human services, 2021a). yet, data from substance abuse and mental health service administration (2020) reports that in 2019, only 9.7% of latinx adults 18 years old and older received mental health services, 7.3% received prescription medications for mental health services, and only 58% of latinxs who had experienced a major depressive episode received treatment for depression. a study conducted by the ucla center for health policy research (2021) found similar trends in mental health needs among latinxs in california; six out of ten latinx adults with serious or moderate psychological distress who were interviewed had unmet needs for mental health care. limited access to healthcare, including high-quality care due to lack of health insurance, and structural and cultural barriers, have impacted the health of latinx populations (shiro & reeves, 2020). keisler-starkey and bunch’s (2020) report for the u.s. census bureau, from data collected in 2019, indicates that of all racial or ethnic groups in the u.s., latinxs had the highest uninsured rates (16.7%). patient limited english proficiency (lep) has also been found to be a barrier to healthcare (becerra et al., 2015; cordasco et al., 2011; marshall et al., 2005; vitale & bailey, 2012). another barrier that has been shown to influence access is the linguistic and racial/ethnic mismatch between healthcare providers and latinx patients (oh et al., 2020; rivers & patino, 2006; tulimiero et al., 2021; vitale & bailey, 2012). federal and state-level immigration policies that impede or restrict access to care are also significant structural barriers, such as the “exclusionary policies negatively affect[ing] the health of latinos in the u.s.–regardless of immigrationor documentation-status” (philbin et al., 2018, p. 37). fear, confusion, and misinformation are common factors that affect and limit access for mixed-status families (castañeda & melo, 2014). there is ample evidence of discrimination in the healthcare advances in social work, spring 2024, 24(1) 86 system (becerra et al., 2015; lópez-cevallos & harvey, 2016). andrade and colleagues’ (2020) systematic review concluded, “the current sociopolitical scenario and overall antiimmigrant rhetoric may place latinos at greater risk of experiencing racial/ethnic discrimination and consequently having poorer mental and physical health outcomes” (p. 13). nevertheless, evidence suggests that facilitating access to healthcare, including mental health services, would increase utilization among this population. a collaborative for community wellness (2018) report conducted to assess mental health needs in latinx communities in chicago found that 80% of latinxs reported they would participate in mental health services if services were geographically accessible, culturally and linguistically appropriate, and affordable. the need for bilingual latinx social workers a skilled and diverse healthcare professional workforce could, arguably, facilitate the processes of marginalized and underserved communities obtaining needed health and mental health services. of particular necessity are social workers who are spanish-english bilingual/bicultural and able to work with spanish-speaking latinx communities (arriaza, 2015 furman et al., 2009; marrs fuchsel, 2015; olcoń et al., 2018). a study by garcia et al. (2019) highlights the need to target and alleviate the mental health risk of certain latinx subgroups (i.e., men with limited english proficiency) by recommending that “to be effective, primary care practices must ensure that screening is closely tied to the provision of culturally, linguistically, and gender-appropriate services” (p. 1250). ayón (2014) similarly calls on social workers to utilize culturally grounded strategies to distribute needed and limited resources, collaborate with immigration advocates, and stay up to date on immigration legislation, to build ties with community members and advocate for immigration reform that supports latinx immigrant families to meet their service needs. lin and wiley (2019) call on social work educators to recognize the potential of students with immigrant backgrounds and bicultural identities to integrate and prepare them to work with immigrant communities. bilingual and bicultural social work students can and should be supported and prepared to actively and intentionally mitigate the inequities that beset latinx communities. latinx students in social work education latinx students are currently and historically underrepresented in social work programs. cswe (2021) reports that in 2020, hispanic/latinx students comprised 17.9% of baccalaureate programs, 15.8% of master’s programs, 14.9% of practice doctoral programs, and 10.7% of research doctorate programs. in their analysis of social work education and latinx students, calvo and coauthors (2018) point out, “social work education is not preparing latinxs to join the profession at a pace comparable to their growth in the general population” (p. 264). factors such as financial conditions, immigration status, adjustments to non-latinx environments, discrimination, limitations with english proficiency, being non-traditionally aged students, and having to balance employment and parenting responsibilities were cited as challenges for latinx social work students by negroni-rodríguez et al. (2006). the underrepresentation of latinx faculty to advances in social work, spring 2024, 24(1) 87 guide and mentor latinx students has also been recognized as a factor impacting latinx student recruitment and retention in social work programs (rojas-schwan et al., 2013; tijerina & deepak, 2014). conversely, there are various strategies and recommendations to foment the presence of latinx students in social work and to support those already enrolled in programs. the presence and mentorship of latinx faculty to support students on various levels have been found to be of great importance (calvo et al., 2018; cordero & negroni, 2013; mendoza et al., 2019; rojas-schwan et al., 2013). alcocer and martinez (2018) found that mentorship supports latinx students in their transitions and adaptations to higher education and helps with retention and academic achievement. olcoń et al. (2018) emphasize the need and impact for social work programs and universities to promote an assets-based perspective, such as building on students’ community cultural wealth. integration of latinx-focused content and research (calvo et al., 2018; chandler et al., 2014; olcoń et al., 2018), financial assistance (longoria, 2010; negroni-rodríguez et al., 2006; olcoń et al., 2018), and bilingual (spanish-english) materials, services, communication, and classes (calvo et al., 2018; negroni-rodríguez et al., 2006; olcoń et al., 2018) have also been found to be key in the experience and environment of latinx social work students. social work with a focus on immigrants and refugees there are a limited, but growing number of domestic and international social work programs with an emphasis or specialization in practice with immigrant and refugee populations. social work practice and education have been signaled as having great potential in their role for advancing the rights of immigrants (padilla, 1997; popescu & libal, 2018). immigration policies, theories, and models of social work practice with immigrants, the development of service delivery models for immigrant populations, and the study of specific issues relevant to immigrant communities are among the areas of focus for social work education (sakamoto, 2007). although some social work programs have made strides towards preparing their students to work with these specific populations, schools of social work are called upon to work towards improving student training and curricula focused on immigrant populations and issues (lin & wiley, 2019; ostrander et al., 2017). bilingual social work education the recognition of the need for bicultural and bilingual social workers to work with predominantly non-english language communities, such as latinx and immigrant populations, has prompted a call to attend to language diversity training and education within social work programs. examples of such pedagogical proposals include a workshop to train monolingual and multilingual students and practitioners (doering-white et al., 2019), a cross-cultural service-learning project that used consultants from the spanish language department (belliveau, 2011), a certificate program that includes a language component with the goal of graduating students fluent in spanish (sisneros & alter, 2009), courses built to improve spanish clinical vocabulary and cultural awareness (lusk et al., 2014; sevilla et al., 2018), a two-semester-long course taught in spanish that focuses on advances in social work, spring 2024, 24(1) 88 cognitive behavioral therapy in spanish (cintrón et al., 2018), cultural immersion study trips to latin america (cox et al., 2006), and a bsw program with a majority latinx student population, many of whom are bilingual and some who are working towards english fluency, that views the utilization of spanglish, “as a valid form of communication rather than a linguistic drawback” (olcoń et al., 2018, p. 356). online learning online learning has come a long way from its origins. a once unfavored method of providing social work education has gained traction among public and private universities in the u.s. (kurzman, 2013; reamer, 2013). detres et al. (2020) report that enrollment in online courses increased by 17.3% between 2002 and 2011 and that msw online program offerings increased from 11% in 2012 to almost 20% in 2017. according to the council of social work education’s website, directory of accredited programs, there are currently 194 active online msw programs and one online bilingual msw program. between 2004 and 2016, there were 22 msw-accredited online programs; between 2017 and 2020, 105 universities added online msw programs to their social work programs. and between 2021 and 2024, during the onset of the covid-19 pandemic, 67 universities adopted online msw programs (cswe, n.d.). research has shown (forgey & ortega-williams, 2016) that online social work education is as effective and comparable to face-to-face programs. according to forgey and ortega-williams (2016), “the benefits of online social work education have been documented, and clear evidence has been mounting as to its effectiveness” (p. 60). jones (2015) notes that a significant benefit of online social work education is access for non-traditional students who would otherwise not be able to obtain a graduate education. also, the online platform provides students with the flexibility to complete their education without social complexities or time restraints that a face-to-face program may have, such as limited transportation, family commitments, or work obligations (kurzman, 2013). conversely, some disadvantages in online learning that have been noted are access to updated hardware and to high-speed broadband internet access in rural areas and lowincome urban communities (eruchalu et al., 2021). additionally, detres et al. (2020) note that some adult learners may experience anxiety while learning to use technology in an online environment, resulting in low retention rates. the obmsw model in 2018, loyola university chicago’s (luc), school of social work (luc-ssw), launched an online bilingual master of social work program (obmsw). the obmsw program directly attends to the unmet needs of the latinx mental health workforce by providing an accessible option for graduate education. the program is unique in its reformatting of the current accredited msw program mental health specialization and migration studies in a bilingual and online format. this reformatting was significant in that it offers: 1) a completely online option, which can be pursued locally or nationally at a distance; 2) a bilingual spanish/english graduate study format that is attractive for heritage spanish-speaking students, english language learning immigrants, and spanish as a second advances in social work, spring 2024, 24(1) 89 language speakers working towards improving their linguistic skills for professional use; and 3) comprehensive integrated mental health training with a focus on refugee and immigration populations. in this program, all students follow a course of study in the advanced clinical specialization and migration studies track. courses are taught in a spanish/english bilingual format by qualified bilingual and bicultural latinx instructors. the online format includes weekly synchronous real-time video conference class sessions and weekly asynchronous learning modules, and flexibility for students to complete coursework at a time that is convenient for them. additionally, students have the option of submitting written assignments and oral presentations in the language that they prefer, while encouraged and supported to complete assignments in the language in which they seek to improve proficiency. a bilingual program much of the uniqueness of the obmsw model is centered around its bilingual instruction aspect. the preparation of social workers with linguistic knowledge and skills is key in collaborating with and meeting the needs of spanish-dominant latinx communities. it is with this end in mind that the obmsw set its deliberate goal of a bilingual program for its students and, by extension, the latinx communities they may work with in the future. the original proposed bilingual graduate study format was believed to be attractive for heritage spanish-speaking, english language learning, and international students. although the original program proposal included international students, the program has not offered international enrollment. the bilingual format makes an msw more attractive and accessible to spanish-english bilingual students, and the professional command of both languages also adds to the skill set employers are seeking. additionally, this programmatic expansion for spanish-speaking students simultaneously supports the lucssw and the university’s common goal of diversifying the faculty, staff, and student body. this purposeful addition indicated a shift in the traditional perspectives and experiences involved in program planning and implementation. various systematic efforts towards the goal of building a bilingual program included, but were not limited to, the development of bilingual courses, the translation of key luc-ssw documents into spanish, collaboration with the luc-ssw librarian to develop new and comprehensive sets of resources in spanish, and the hiring and building of a bilingual and bicultural program team. additionally, before commencing the program, students were encouraged to take recommended spanish and english language assessments to measure their proficiency in both languages. focus on mental health and migration studies another distinctive feature of this innovative program is its focus on mental health practices related to the latinx immigrant and refugee communities in the u.s. these unique foci are meant to recognize and address the latinx and immigrant/refugee community's advances in social work, spring 2024, 24(1) 90 unmet mental health service needs. the program builds on luc-ssw's clinical curricular novelties and strengths in migration studies, clinical and interprofessional practice, social justice-focused policy, and organizational and direct practice interventions. within the program, students take three migration studies courses: • sowk 730 migration dynamics and u.s. social policy • sowk 731 social work practice with refugees & immigrants • sowk 732 migration, social justice, & human rights the program's clinical bilingual curriculum and focus on migration studies prepares students for clinical practice with latinx immigrant and refugee communities. additionally, because of the bilingual format of the program, students can gain proficiency in linguistic and cultural competencies. for example, since instruction is delivered in spanish and english, an instructor might choose to teach in spanish one week and transition to english the following week and rotate every other week. students have the option of submitting their assignments in spanish or english and have the option of conducting oral class presentations in the language that they prefer. students are encouraged to engage in the language that they feel the least proficient in. additionally, about 75% of the course readings within the curriculum, including academic journals and books, are written in spanish by scholars from mexico, central america, and south america. field education a staple of social work education is the curriculum's field education component, which offers students the opportunity to integrate classroom acquired knowledge with demonstrated skills and competencies in community social work practice. the field placement serves as a hands-on training ground where students can hone their practice skills, test theory, and develop a professional identity grounded in social work ethics and values. in this program, students must complete 400 hours of first-level field and an integrative seminar during their first semester. students with advanced standing status complete 600 hours for advanced field and participate in an integrative seminar during their first semester. students have the option of being placed in diverse internship sites that include community schools, community non-profit organizations, faith-based organizations, and hospitals. a requirement of the internship site is that the site must offer opportunities for students to engage and practice their skills with the latinx immigrant and refugee community. challenges in identifying field sites for students outside the city of where the physical location of the university is located have arisen for the obmsw field team and students. most of the enrolled obmsw students are located out of state. students from fall 2019, fall 2020, and fall 2021 cohorts had seven out of forty-three, eight out of twenty-one, and nine out of twenty-one in-state resident students, respectively. students who are based in the metropolitan city where loyola university chicago is located can easily tap into organizations that have long-standing relationships with luc-ssw. students in the obmsw that reside outside of the city and state are required to actively identify potential advances in social work, spring 2024, 24(1) 91 agencies for their internship. once students identify prospects, the field coordinator of the obmsw works to confirm that the organization meets the requirements set forth by the council of social work education. this process has been challenging for students who do not have experience within the social service sector and those who live in rural areas. another challenge in rural areas has been a lack of bilingual field supervisors that can provide supervision to obmsw students. however, the obmsw has been able to hire field-liaisons who are bilingual and bicultural to provide supervision to those students who do not have bilingual field supervisors at their respective internship sites. program instructors and staff members the obmsw adds to its innovative approach through its faculty employment and development. from its inception, the program has been led by a 100% latinx administration, staff, and faculty, contrasting the 7.8% of full-time faculty members in u.s. social work programs who identified as latinx in the fall of 2020 (cswe, 2021). most of the obmsw classes are taught by full-time faculty members, which has been found to positively influence online student learning outcomes (mueller et al., 2013). the presence of latinx faculty has been identified as an important aspect of the experience and success of students (medina & posadas, 2012). similarly, mentoring and relationships with students can also be an opportunity for latinx faculty members to continue strengthening their ties and connections with latinx students and communities (mendoza et al., 2019). the lucssw and its dean considered the unique nature of the obmsw and actively recruited professors who are bilingual, bicultural and have experience in the field, providing the program capacity and expertise. faculty and staff hired were provided with professional development opportunities and guidance to collaboratively create an online instructional format reflecting best practices in online instruction and humanistic tradition and andragogy, as well as the program goal of developing graduates dedicated to attending to the integrated health needs and social conditions impacting marginalized communities. with these goals and the obmsw student population in mind, the staff of the program in its initial year was comprised of a program director, program coordinator, academic advisor, internship coordinator, admissions advisor, assistant director of online learning, and full-time and adjunct faculty who all had heritage from several different latin american countries. obmsw curriculum structure during the fall of 2019, the luc-ssw faculty, in conjunction with the dean’s leadership, voted and approved an update and redesign to the luc-ssw’s curriculum. the overarching goal for this change was to increase accessibility through the reduction in the cost for the degree and to engage in intentional discussion of the core concepts to be infused throughout the curriculum. the new revised curriculum was launched in the fall of 2021. the revisions consisted of a reduction of courses, which brought the required credit units from 60 to 49 credit units, and from 34 to 23 credit units for students with advanced standing. with the revised curriculum, students take two courses per semester during the first three semesters (see table 1). advances in social work, spring 2024, 24(1) 92 table 1. curriculum structure semester classes credits fall 2021 sowk 500lifespan development, human behavior, trauma, & theory sowk 501assessment of client concerns in context 6 cu spring 2022 sowk 502power, oppression, privilege, & social justice sowk 503practice skills with individuals & families 6 cu summer 2022 sowk 504integrated micro/mezzo/macro theory & practice sowk 505group practice in social work: micro, mezzo, macro 6 cu fall 2022 sowk 506research & evaluation in social work practice sowk 509social work policy & community interventions swfi 530field i & simulated experiences swfi 530sintegrative seminar 7.5 cu spring 2023 sowk 680advanced clinical practice sowk 681advanced mezzo & macro practice swfi 531field ii & simulated experiences 6.5 cu summer 2023 sowk 730migration dynamics & u.s. social policy sowk 732migration, social justice, & human rights 6 cu fall 2023 sowk 731social work practice with refugees & immigrants swfi 630field instruction iii & simulated experiences swfi 630sintegrative seminar 4.5 cu spring 2023 sowk 632social work practice with older adults sowk 621treatment in addictions swfi 631field instruction iv & simulated experiences 3.5 cu the restructuring of the curriculum allows for breaks in between semesters, and in addition, students can begin their field internship during the summer semester to disperse the required hours. this flexibility allows students to plan out their schedule around their various responsibilities. students in the advanced standing cohort begin coursework in the spring semester and start their internship during the fall semester (see table 2). table 2. advanced standing curriculum structure semester classes credits spring 2023 sowk 680advanced clinical practice sowk 681advanced mezzo & macro practice 6 cu summer 2023 sowk 730migration dynamics and u.s. social policy sowk 732migration, social justice, & human rights 6 cu fall 2023 sowk 731social work practice with refugees & immigrants swfi 630field instruction iii & simulated experiences swfi 630sintegrative seminar 4.5 cu spring 2023 sowk 632social work practice with older adults sowk 621treatment in addictions swfi 631field instruction iv & simulated experiences 3.5 cu the reduction of courses through the shift to the new curriculum allowed an opportunity to eliminate the obmsw original curriculum carousel model. within the carousal model, students were expected to take three courses per semester, one 15-week advances in social work, spring 2024, 24(1) 93 course and two 7.5-week courses. although the carousel model was initially thought to be a good fit for the obmsw program, there were a few unintended consequences that created stress among students and faculty. for example, the model did not allow for students and instructors to have breaks between semesters, since students were expected to enroll in the summer semesters after the end of the spring semester. students found themselves having to prepare for the following semester while still finishing the current semester. students expressed feeling burned out due to the lack of breaks between semesters. evaluation methodology and preliminary results the subsequent section presents several preliminary results of an internal initial process and outcome evaluation of the obmsw, along with anecdotal evidence regarding more recent shifts within the program. the process evaluation was conducted in the program's first year (ay 2018-2019), and the outcome evaluation was conducted in the program's second year. the evaluation employed a mixed methods design with primary (e.g., online surveys and focus groups) and secondary sources (e.g., student selfassessments). survey and focus group samples included faculty, staff, and student respondents. questions for the survey and the focus groups were developed with the input and collaboration of all obmsw program staff and faculty. seven focus groups were conducted with students from four separate cohort groups to include firstand second-year students, and advanced-standing students. a total of 18 participants were included in the sample. all focus group participants were women and 17 identified as latinx. most indicated that they were employed full-time and attended to family responsibilities as they worked to complete the courses and internship components of the program. focus groups lasted between 60 and 90 minutes and were conducted in english and spanish. a semi-structured interview guide was used to inquire about students’ experiences within the obmsw program, as well as to ask about suggestions to improve the program. open discussions were encouraged by the focus group facilitators. the groups were conducted, transcribed, and analyzed by two latinx and bilingual (english-spanish) researchers; one was a faculty member of luc-ssw and the other a doctoral student within luc-ssw. focus group data were coded by each researcher separately and consensus discussions were used to gain agreement. part of the process and outcome evaluation included a voluntary, brief online student survey intended to understand more about the recruitment application process of the obmsw program. for example, one question asked students how they found out about the obmsw program and another asked if the program’s website provided useful information about the application process. the survey included seven questions; 3 items were multiple choice, two items were a five-point likert scale, one item used ranking questions, and one question was open-ended. most items provided the option of providing more details to the selected response. thirty-nine of the obmsw program students agreed to participate in the survey portion of the research study, with 16 participants identifying themselves as first-year students, 16 as second-year students, and six as advanced-standing students; one respondent did not identify their class standing. the response rate reached 62% of the total number of enrolled obmsw students. advances in social work, spring 2024, 24(1) 94 in addition, there were two rounds of faculty and staff focus groups. the first was conducted at the end of spring 2019 and included nine participants in teaching, admissions, advising, field education, instructional design, and administration. the second round of focus groups took place from december 2020 to january 2021. three focus groups were conducted with obmsw full-time and adjunct faculty, which were comprised of five women and one man. the focus groups used semi-structured interview guides, lasted approximately one hour and were conducted virtually using the zoom video conferencing platform and an interview guide. the focus groups were recorded and transcribed. the focus groups were conducted by a latinx bilingual (english-spanish) obmsw research assistant and a latinx bilingual (english-spanish) faculty member that does not teach in the obmsw program. a thematic analysis of the focus group transcripts and interview notes was done with the assistance of dedoose, a secure web-based qualitative data analysis platform. enrollment and graduation rates in terms of enrollment, the program launched in the fall of 2018 and, even though enrollment goals were not accomplished in the first year of the program, progress has been made since the inaugural year. whereas in fall 2018 the program commenced with ten students, in fall 2021 the total enrollment increased to 44 students (see table 3). since the program started, a total of four students (one from fall 2018 and three from fall 2021) have left the program due to academic dismissals. a total of six students have discontinued the program for other reasons (one from fall 2018, one from fall 2019, and four from fall 2021). the cohort that started in fall 2019 had two students who took a leave of absence, returned to the program and will now graduate with the fall 2020 cohort. table 3. obmsw student enrollment and graduation numbers academic semester number of students enrolled graduated fall 2018 10 8 fall 2019 24 21 spring 2020 advanced standing 13 13 fall 2020 19 19a spring 2021 advanced standing 10 10 fall 2021 44 37b a students currently active in program with expected spring 2023 graduation. b students currently active in a program with expected spring 2024 graduation. program strengths per students student surveys, self-assessments, and focus groups identified various program characteristics that influenced student interest in this msw program, as well as program strengths that students experienced. the student survey conducted in the fall of 2020 revealed that the program’s advertised flexibility to adapt to “non-traditional”/full-time working students as one of the important reasons participants applied to the program. as noted by survey respondents, this was a key factor as most students work full-time and/or advances in social work, spring 2024, 24(1) 95 are caregivers. similarly, the student self-assessments highlighted the convenience of the online format as a positive factor in facilitating a balance in the various roles and responsibilities that students hold. the following quotes, the first from the self-assessments and the second from a focus group, underscore the online format provision of increased access, flexibility, and opportunities to build networks and relationships. it was very helpful in the sense that i did not have to stress [about] traveling across the city from work to the university to attend a class. this was really important because it allowed me to commit more time to the readings and attending the synchronous session. i think they're really able to execute an online piece...so that we’re not just like people from around the world taking the same program, but we actually get to know each other. and we actually get to network and build those relationships with people that have the same values and the same goals, same professional goals. so, i think the online piece is good. the self-assessments positively rated the curriculum content and learning, and students reported being pleased with the theoretical knowledge they were acquiring, with the opportunities of learning from each other and by the opportunities to clarify concepts with professors during the synchronous sessions. during the focus groups, students indicated that the program instructors were knowledgeable and experienced. students shared that they valued the variation of teaching modalities implemented by some professors. i think the professors are phenomenal. i absolutely love it. i think it’s amazing. they all have different backgrounds; they all have a lot of experience. they know what they’re talking about, they’re great. the strength i think that, you know, even [administrator] included, the professors are very, very knowledgeable. i feel like we are learning a lot and they’re great. another positive that was emphasized by some students was the bilingual attribute of the program. the following quote highlights a student’s personal connection as a spanishspeaking latinx student with the program’s bilingual aspect. i understand we are in this country and everything we do, our daily work, including the documentation we prepare, must be in english. yet, as a hispanic student, as a latina, it is very important for me to have that connection with the social work profession in my own language. linked to the bilingual feature of the program is the focus on latinx populations. in the student survey, the latinx focus of the program was identified as the third most important program characteristic that influenced students’ decision to apply to the program. this characteristic was only surpassed by the program’s bilingual aspect and its online format. importantly, several students who participated in the focus groups expressed that the mental health and migration studies emphases of the program were crucial in making their decision to enroll in the obmsw. it was identified as a uniqueness that is valued and sought after. advances in social work, spring 2024, 24(1) 96 ...what made me choose it is that it is focus[ed] on the clinical area, which is a very important area for me, and with a sub-specialization in migration...i think that makes it a different program. and that’s the plus of the program, what i think that, for now, at least, in all the universities i tried searching for [and] wasn’t there. program challenges per students areas of improvement and program challenges were also identified by students who participated in the survey and focus groups. various students shared that a big challenge was the difficulty for the program to adapt to student schedules and realities, even though the program advertised itself as one designed for “non-traditional” students. students asked that the program provide more communication and clarity regarding the program requirements and structure prior to enrollment, as well as more flexibility provided for current students. like we have to complete a minimum of 23-24 hours for a second level internship. like who’s going to be able to work 40 hours at a full-time job and then 23 more hours on top of that? those are things that can be challenging. like, we’re still going to do them, but i would have liked to be aware of that prior. another challenge and area of consideration raised by students from the first cohort was the spanish language dominance in the courses. students shared that they thought the program would have more of a balance between english and spanish because it was advertised as a bilingual program. various students expressed the need to include more english within the program, especially since internship sites and workplaces require social workers to communicate and complete documentation in english. however, i feel there should be more english. because in the field i’m going to work with the latinx population, but all the processes i’m going to do will be in english. i do feel that the master’s should have that balance. the fieldwork component of the program was determined to be a key area for improvement by students. student comments indicated that the original organization of the field component of the program was understaffed, and they did not feel supported to meet some of their needs. the expectation for students to secure two different field site options was particularly challenging. and another thing i would like to see is more support throughout the internship process. basically, i had to…i knew coming in that i would have to do most of the research and find these locations and opportunities…i didn’t feel much support in that aspect. well, i think that [loyola university chicago] could add more administrative staff because [internship staff] i do not think she suffices...it’s something [loyola university chicago] has to also considerthe staffing...i think that affected me a lot and i know it affected other peers more. advances in social work, spring 2024, 24(1) 97 program strengths and challenges per faculty and staff faculty and staff perception of the obmsw has generally been positive. the first focus group with faculty and staff members directly involved with the program was conducted at the end of the spring 2019 semester and other focus groups were conducted in december 2020 through january 2021. some program strengths identified were the target student population, the bilingual and bicultural professors, and the appreciation of teamwork within the program. i think our quality of students. i think sometimes people think that people who are older, who come into a program like this, whose first language might be spanish might be at a disadvantage, but i find that they bring some life experiences and some work experiences that are way beyond what some of the students in other programs have. we saw cultural differences. and there are others whose parents are from latin america, but they received their education here [and] are completely bilingual. having those two perspectives is very important because the students will be that waythey will be a combination of the two and that has helped a lot. i think another strength is that we have worked as a team and that has allowed that the quality of our program be better because it isn't one person's idea but, instead, we have tried to have a conversation regarding all the decisions. several program challenges were also identified through the focus groups. challenges included access to financial aid and scholarship opportunities, especially for those students who might be undocumented, and the university’s structural and administrative barriers that specifically impact potential obmsw students. if they don’t qualify for financial aid...the vast majority of our students are going to be students that perhaps don’t have papers, and so then not being able to apply for financial aid. then that can be a big detriment to the service...i think for me the major weakness right now is the cost to go to this program. so, the type of population that may be interested in our program is people who, in many cases, have received their undergraduate studies in latin america and that is where the difficulties arise...so graduate professional enrollment management has said, if the original transcripts are not sealed, even if the person submits a photocopy, as it is somewhat informal, it cannot be accepted even conditionally. so even if it is a general rule of the whole university, it impacts the students of our program more. student feedback and new leadership student advocacy, initial process and outcome evaluation reports, and the transition to new leadership were the impetus that sparked the implementation of obmsw program reforms. the current online bilingual msw director, hired in july 2021, facilitated a series of meet-and-greet virtual group sessions and held several one-on-one meetings with obmsw program students from two different cohorts. a list of proposed changes to advances in social work, spring 2024, 24(1) 98 restructure the model was brought to the obmsw faculty/staff committee, and the committee voted to make the programmatic changes. data collected from student meetings and the report of the obmsw program drove the decision to eliminate the carousel model, and a new course schedule was adopted. another significant programmatic change was the move to align the obmsw program to the face-to-face msw program calendar to allow obmsw students to take breaks during holidays. another theme that emerged in the student meetings with the obmsw director was the need to institutionalize a system or structure for continuous student and program administration communication, feedback, and response. therefore, the obmsw program committee voted to recruit an obmsw committee student representative to participate in the monthly committee meetings. additionally, the obmsw program director teamed up with the assistant director of field education and held monthly listening sessions with all the obmsw program cohorts. these new methods of communicating and hearing students instituted by the obmsw director will play a crucial role for making necessary changes to the program moving forward. limitations there are various limitations to this program evaluation that should be considered. due to the timing of the evaluation and the obmsw still being in its initial stages, the preliminary findings presented are based on a small sample. the evaluation only captured information from the first and second year of the program and would benefit from a longitudinal study of short and long-term program outcomes that include alumni. additionally, all the changes that have been implemented are new and only anecdotal evidence has been reported. implications for social work the recent influx of immigrants and refugees from central and south american countries into major urban cities in the u.s. has created what some community leaders and politicians call a humanitarian crisis (bosman, 2023). innovative solutions are necessary to solve the crisis and the innovative curriculum of the obmsw program aims to prepare the next generation of bilingual social workers to tackle this critical juncture. in addition, the curriculum focus of the obmsw program on micro practice and migration studies can serve as a model for other social work programs across the u.s. discussion and conclusion the preliminary results of the process and outcome evaluation of the online bilingual msw program provide some evidence in support of its ability to meet the mission of increasing access to quality graduate social work education for latinx students. the obmsw program addresses some of the challenges to entry and completion by providing a bilingual online format with culturally relevant curriculum, student support, mentorship opportunities, and discounted tuition. the program has also demonstrated initial success in promoting student capacity development for providing culturally and linguistically advances in social work, spring 2024, 24(1) 99 relevant mental health services for latinx immigrant and refugee populations and increasing the number of msw-trained bilingual/bicultural practitioners. in the three years of the program’s existence, 52 students have graduated with an msw and enrollments have grown with each year. the number of students enrolling in the program and the number of graduates from the program in its initial years have demonstrated promise for continued growth in the number of graduate-level social workers who are spanish-english bilingual/bicultural and have relevant training for mental health practice with immigrants and refugees. furthermore, the program demonstrated a very strong retention-to-completion rate with only three students leaving the program before completion for the cohort groups that have completed the full program cycle. this represents a 94 percent completion rate. some of the evaluation data suggests that the program’s latinx faculty may have contributed to this high retention and completion rate, as student comments make reference to the relevance to faculty members’ lines of research and areas of practice, as well as their sensitivity to language, culture, and the social realities of the latinx and immigrant communities. the evaluation provided evidence that the online format of the program increased access, while not compromising the rigor and quality of the program. while the increased access was important for individual students’ ability to participate in the program, it also has the potential to impact access to care in underserved communities, such as rural areas or new immigrant destination states and local communities that do not have a history and infrastructure to meet the needs of immigrant and refugee communities. while over time this may make a significant contribution towards addressing the need for spanish language and immigrant community service and workforce capacity development, it has also posed a challenge for the program in securing relevant local field placements. despite the many merits and successes of the program, challenges and barriers remain, such as the prohibitive cost of the program and the insufficient/lack of financial aid for obmsw students, particularly undocumented students. while cost continues to be a barrier, some advances have been made. for example, the program cost is heavily discounted by the university (30% lower cost than the other msw options offered by the school); the reduction in credit hours to complete the programs represents tuition savings, and school-based scholarships are now available to obmsw students. another challenge for the program is to calibrate the bilingual nature of the program to provide more targeted support for students who wish to improve their english, as well as for those who wish to improve their spanish fluency. the program must prepare all students for the realities of the field that require fluency in spanish to work with clients and fluency in english for documentation and licensing purposes. loyola university chicago, the school of social work, and the obmsw program faculty and 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(2012). assessing barriers to health care services for hispanic residents in rural georgia. journal of rural social sciences, 27(3), 17-45. author note: address correspondence to francisco j. lozornio, erikson institute, 451 north lasalle street, chicago, illinois 60654-4510. email: flozornio@erikson.edu disclosure statement all authors are former students, faculty, or staff members of luc-ssw. francisco j. lozornio is the former director of the online msw programs. celeste sánchez is a former doctorate student who conducted the program evaluation with another co-author. ennio cardozo is a former graduate assistant and student in the obmsw. https://healthpolicy.ucla.edu/publications/documents/pdf/2021/unmetmentalhealthneeds-latinxethnicgroups-policybrief-jul2021.pdf https://healthpolicy.ucla.edu/publications/documents/pdf/2021/unmetmentalhealthneeds-latinxethnicgroups-policybrief-jul2021.pdf https://www.census.gov/quickfacts/fact/table/us/rhi725219 https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=69 https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=69 https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 https://egrove.olemiss.edu/cgi/viewcontent.cgi?article=1440&context=jrss https://egrove.olemiss.edu/cgi/viewcontent.cgi?article=1440&context=jrss mailto:flozornio@erikson.edu _________ matt moore, phd, msw, associate professor and associate dean of academic and student affairs, college of social work, university of kentucky, lexington, ky. stephen young, phd, msw, private practitioner, atlanta, ga. judith gray, msw, lcsw, associate professor, department of social work, ball state university, muncie, in. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 594-608 doi: 10.18060/27566 this work is licensed under a creative commons attribution 4.0 international license. i spy implicit curriculum: assessing the climate of an undergraduate and graduate social work program matt moore stephen young judith gray abstract: the council on social work education (cswe, 2022) requires undergraduate and graduate social work programs to conduct self studies to ensure programs meet required standards for accreditation. of particular interest in this case study was the examination of implicit curriculum – the program’s commitment to inclusive excellence, policies and procedures, advising, student participation, faculty engagement, administrative structure, resources, etc. (cswe, 2022). a department of social work located in the midwest collected data from graduating students (n = 269) in both the bsw and msw programs regarding their overall learning climate from 2020-2022. this project introduced a new scale for assessing implicit curriculum using a cross-sectional, webbased design. overall students believed the programs allowed them to speak up about diverse issues important to them. students felt vested partners in the department demonstrated a meaningful commitment to diversity, respected students, and provided a comforting environment for sharing concerns. inferential statistics also indicated no significant differences in experiences between students based on race/ethnicity, online versus face-to-face, or first-generation student status. a significant difference did exist with students from diverse sexual orientations feeling less comfortable in sharing dissatisfaction with classroom discussion of gender and sexuality. the article concludes with implications for social work education and future research directions. this includes specific ways programs can identify concerns related to implicit curriculum from a proactive lens. keywords: social work education; implicit curriculum; accreditation; assessment; student success the learning that occurs in a classroom of a professional degree program is typically more than what is presented in lectures or other course materials. rather, the culture of a particular learning environment in terms of structure, norms, and punishment/reward systems also teaches students how to conduct themselves within the profession at large (grady et al., 2018; grady et al., 2020; morton et al., 2019). ideally, a degree program's learning environment (its "hidden" or "implicit" curriculum) should support the program's mission and goals (its "explicit" curriculum). the council on social work education (cswe, 2022) requires undergraduate and graduate social work programs to conduct self-studies to ensure programs meet required standards for accreditation. these self-studies require social work programs to examine both their explicit and implicit curriculum. of particular interest in this case study is the examination of implicit curriculum – the program’s commitment to inclusive excellence, policies and procedures, advising, student participation, faculty engagement, about:blank moore et al./implicit curriculum and swk 595 administrative structure, resources, etc. (cswe, 2022). these implicit curriculum components link directly to many of the core values within the profession of social work including: (1) respect for the inherent worth and dignity of all people, (2) recognition of the value of human relationships and reciprocal communication, and (3) belief that all citizens should have identical rights, protections, opportunities, obligations, and benefits regardless of their backgrounds (national association of social workers [nasw], 2021). the purpose of this case study was to learn about students' perspectives of the overall learning climate of a midwestern university’s bachelor of social work (bsw) and master of social work (msw) programs. reviewing the implicit curriculum perspectives of students could provide faculty and staff with valuable information to improve and enhance programs (grady et al., 2020). after examining 20 implicit curriculum scales from accredited social work programs, the components of the learning climate included: (1) whether students felt they were treated with respect by faculty/staff, (2) whether students felt they could openly express their ideas and opinions when participating in the program, (3) whether cultural competence and responsiveness was valued by faculty/staff, (4) whether students felt they could discuss concerns about the program with faculty/staff, and (5) whether and to what extent students felt support services and co-curricular opportunities for personal and professional growth were available to them. existing literature also supports the identified components of implicit curriculum (grady et al., 2018; krase et al., 2022). a secondary purpose of the case study was to explore whether the studied bsw and msw programs were experiencing known challenges related to implicit curriculum (jacobsen, 2019; keyes et al., 2023). existing data on programs that do not perform as well in their implicit curriculum show challenges in a variety of areas. first, some programs identify barriers between marginalized and privileged identities (keyes et al., 2023). students from underrepresented racial and ethnic groups (lilly et al., 2023), lgbtqia+ students (timbers, 2023), and faith-based students (barker et al., 2023) often report more concerns about implicit curriculum. second, students learning in an online environment often find diversity, equity, and inclusion to be less prevalent in their educational experience (jacobsen, 2019). third, first generation college students often feel a lack of belongingness, comfort, and respect within higher education settings (laemmli et al., 2022). this study looked specifically at differences among many of these demographic groups. literature review implicit curriculum and social work education recent research illustrates the importance of studying the role implicit curriculum has on social work education (friedman et al., 2020; goode et al., 2021; mcmahon et al., 2020; morton et al., 2019). first, assessing implicit curriculum provides educators the opportunity to identify areas of diversity that students do not believe receive adequate attention within the explicit curriculum (friedman et al., 2020; hosken, 2018; kattari et al., 2020). second, feedback on implicit curriculum provides students a voice for advances in social work, fall 2024, 24(3) 596 discussing the culture and climate of a program as it relates to respect and comfort with faculty and staff (hosken, 2018; kattari et al., 2020; mcclendon et al., 2021; mcmahon et al., 2020). third, student feedback provides guidance for further engaging students in educational and co-curricular activities (goode et al., 2021; mapp & gatenio gabel, 2019; morton et al., 2019; roth et al., 2018). fourth, implicit curriculum feedback provides programs with an opportunity to reflect upon student opinion and to alter the learning environment for enhanced student success (cox et al., 2021; grady et al., 2020). implicit curriculum feedback provides a context for examining how student perspectives relate to other constructs of professional development. a program’s implicit curriculum is meant to support the professional development of students and prepare them for future social work practice (morton et al., 2019; peterson et al., 2014b). for example, a program’s emphasis on implicit curriculum empowers students to be involved in program governance, to participate in extracurricular activities, to feel valued by the program, and to have a higher sense of community (peterson et al., 2014a). these experiences translate to greater satisfaction in academic advising, a deeper understanding of practicum education, and feeling more encouraged within the classroom environment (peterson et al., 2014a). the cumulative outcome of implicit curriculum efforts is professional socialization – students understanding the importance of relationships and normative structures (miller, 2013). the concept of professional socialization helps connect implicit curriculum with the values of the social work profession (bogo & wayne, 2013; nasw, 2021). through routine evaluation of the implicit curriculum, social work programs can also be proactive in identifying concerns that can exist in programs. implicit curriculum challenges in social work involve navigating the unwritten and unofficial aspects of training and practice (friedman et al., 2020; goode et al., 2021). these challenges can include biases and stereotypes present in academic settings or the workplace, which may influence the attitudes and behaviors of students and professionals (barker et al., 2023; lilly et al., 2023; timbers, 2023). for instance, systemic biases can impact the treatment and representation of marginalized groups. additionally, students may face difficulties in reconciling theoretical knowledge with real-world practice, particularly in complex and emotionally charged situations (cox et al., 2021). addressing these challenges requires ongoing self-reflection, mentorship, and a commitment to equity and inclusion in all areas of social work education and practice. assessing implicit curriculum there is little research on assessing the implicit curriculum of social work programs, as much of the research on implicit curriculum views the concept from a larger campus climate (grady et al., 2018; grady et al., 2011; goose, 1999). thus, there is a need for researchers to develop instruments specifically designed to evaluate the implicit curriculum in social work programs. scale development should include a thorough review of existing scales, gathering information from potential users, drafting scale items, piloting a draft of the instrument, and revising the pilot draft to ensure the instrument is both valid and reliable (devellis, 2003). the researchers associated with this study followed these steps in the development of an implicit curriculum scale. the researchers empirically measured the moore et al./implicit curriculum and swk 597 instrument’s internal consistency reliability and construct validity through an exploratory factor analysis (devellis, 2003; grady et al., 2018). current study this case study aided in understanding whether the program's implicit and explicit curricula align. according to cswe (2022), explicit curriculum is the program’s formal educational structure and includes its courses and curriculum design. the programs at the university in this study are generalist (bsw) and advanced generalist (msw) and adhere to the core competencies and practicum education requirements evaluated through measurable practice behaviors comprised of knowledge, values, and skills. the goal of this approach is to demonstrate the integration and application of competencies in practice with individuals, families, groups, organizations, and communities (cswe, 2022). the data provided information for reaffirmation a required cswe (2022) component. data from this assessment helped the department of social work in their journey for inclusive excellence, especially around the integration of diversity, equity, inclusion, justice, and belongingness in undergraduate and graduate programs. it also allowed for a thorough review of known demographic factors (e.g., race, ethnicity, sexual orientation, first-generation status, and program modality) impacting the implicit curriculum results of other social work programs. method research design the department of social work collected data from graduating students in both the bsw and msw programs regarding their overall learning climate from 2020-2022. while previous research investigated the heterogeneity of student experiences with implicit curriculum within social work programs (grady et al., 2020), this case study was unique to the specific department and population of students. this project used a cross-sectional, web-based design to collect scale data from students regarding their perceptions of the bsw and msw program climate. data collection bsw and msw students completed the scale during their final practicum seminar before graduation. students completed the scale through the qualtrics© system. a graduate assistant provided students with the link and remained present as students completed the scale. participation in the scale was 100% voluntary. students received notification of the voluntary nature of this study both verbally from the graduate assistant and before answering any questions in the qualtrics© system. there were no faculty, staff, or administrators from the social work program present during data collection. the scale took 10-15 minutes to complete and received approval from the appropriate institutional review board. advances in social work, fall 2024, 24(3) 598 implicit curriculum scale the scale asked students to identify the extent to which they agree with a series of questions on a five-point likert scale (1 = “strongly disagree” and 5 = “strongly agree”). the scale contained two initial questions about whether the social work program allowed students to speak up about diversity issues and whether the program demonstrated a commitment to social justice. these broader questions transitioned into a section about whether the social work program encouraged discussion about specific areas of diversity (i.e.,, sexual orientation, gender identity, race, ethnicity, religion, disability, socioeconomic status, age, personal culture, family, and political ideologies). the scale then asked questions about how the curriculum, practicum education, program faculty, academic advisor, and program administrators demonstrated a meaningful commitment to diversity. there were also questions about how faculty members, program administrators, academic advisors, staff members, and fellow students respected one another and how comfortable students felt discussing concerns with these various stakeholders. the final two likertscale questions asked students if they felt they grew professionally in the program and whether they were able to participate in leadership development activities. other questions were dichotomous in nature (yes or no). these questions explored whether students had an opportunity to participate in a variety of curricular (e.g., student research, volunteer practicum experiences, immersive learning, etc.) and co-curricular activities (e.g., campus events, student organizations, etc.). students indicated whether they utilized campus services during their time at the university (e.g., writing center, student disability services, financial aid services, campus counseling, etc.). the scale also asked students if they requested faculty members to write letters of recommendations for career placement and/or graduate school, sought informal consultation from faculty members, and whether students applied for scholarships at the departmental, university, or community level. the scale contained a series of demographic questions. demographic questions asked students to share their age, race, ethnicity, gender identification, sexual orientation, and overall gpa. there were also questions about status as a first-generation college student, program modality (online versus face-to-face), how likely students were to apply to the university’s graduate social work program (if a bsw student), and how likely students were to pursue a clinical license (if a msw student). researchers created the scale after a thorough review of existing scales used by social work programs across the united states. researchers reviewed scales from 20 cswe accredited programs and reviewed recent literature on topics important to a program’s implicit curriculum (barker et al., 2023; bogo & wayne, 2013; grady et al., 2018; grady et al., 2020; krase et al., 2022). the final scale had a cronbach’s alpha of 0.95. researchers conducted an exploratory factor analysis for the various question blocks on the implicit curriculum scale. researchers began by confirming that the correlation matrix was factorable. bartlett’s test of sphericity (bartlett, 1954) was used to ensure the correlation matrix was not random and kaise-meyer-olkin (kmo) statistic (kaiser, 1974) was required to be above a minimum of 0.50. an exploratory factor analysis was employed. moore et al./implicit curriculum and swk 599 researchers used an iterated principal axis (pa) extraction method with initial communalities estimated by squared multiple corrections (fabrigar et al., 1999). using guidance from velicer and colleagues (2000), parallel analysis and the visual scree test helped to determine the appropriate number of factors to retain. due to the nature of the constructs, it was assumed factors would be correlated. therefore, an oblimin rotation was used (watkins, 2018). researchers determined the criteria for factor adequacy a priori. per norman and streiner (2014), pattern coefficients ≥ 0.37 were considered salient. salient complex loadings on more than one factor were rejected to honor simple structure (watkins, 2018). factors with a minimum of three salient pattern coefficients, internal consistency ≥ 0.70, and that were theoretically meaningful were considered adequate. the results of bartlett’s test of sphericity indicated the correlation matric was not random, x2 = 2.12, p < 0.001, and the kmo statistic was 0.78, well above the minimum standard for conducting factor analysis. the eigenvalues for the various question blocks were above 1.00. standardized factor loadings for items were 0.40 or higher. researchers evaluated model-data fit for the exploratory factor analysis with normed chi-square (values were less than 5.00), the comparative fit index (values were greater than or equal to 0.95), the tucker-lewis index (values were greater than or equal to 0.95), the root mean square error of approximation (values were less than 0.80), and the standardized root mean square residual (values were less than 0.80). study participants there was a total of 269 students who completed the scale between 2020 and 2022 (see table 1). this included 184 bsw students and 85 msw students. this represented a 93% response rate. the mean age of bsw students was 22 years old. the mean age of msw students was 27 years old. students identified as 92% female, 4% male, and 4% non-binary. the largest percentage of students identified as white (81%) with other students identifying as black or african american (11%), multiracial (4%), hispanic (3%), and asian or asian american (1%). the largest group of students identified as heterosexual (78%). twentytwo percent of students identified as a member of the lgbtqia+ community. the mean gpa was 3.44 (bsw = 3.35, msw = 3.65). first generation college students comprised 41% of the sample. msw students reported a high desire to pursue their lcsw after graduation (m = 4.2). this question used a five-point likert scale with endpoints strongly disagree and strongly agree. msw students also shared some interest in pursuing their lcac (m = 3.0). this question used the same five-point scale. of the graduating bsw students, 80 indicated they were very likely to pursue a msw degree at the university, 28 were very likely. with the msw program only being in the fourth year of existence, information on the tenure of msw social workers remains limited. only 10% of respondents indicated they took most courses online. advances in social work, fall 2024, 24(3) 600 table 1. participant demographics total (n=269) bsw (n=184) msw (n=85) age (years) 23.6 22 27 gender female 246 (91.4%) 168 (91.3%) 78 (91.8%) male 10 (3.7%) 7 (3.8%) 3 (3.5%) non-binary 13 (4.8%) 9 (4.9%) 4 (4.7%) race/ethnicity white 218 (81.0%) 149 (81.0%) 69 (81.2%) black or african american 29(10.8%) 20 (10.9%) 9 (10.6%) multiracial 10 (3.7%) 7 (3.8%) 3 (3.5%) hispanic 9 (3.3%) 6 (3.3%) 3 (3.5%) asian or asian american 3 (1.1%) 2 (1.1%) 1 (1.2%) sexual orientation heterosexual 210 (78.1%) 144 (78.3%) 66 (77.6%) lgbtqia+ community 59 (219%) 40 (21.7%) 19 (22.4%) gpa 3.44 3.35 3.65 first generation college student 110 (41.0%) 90 (48.9%) 20 (23.5%) interest in pursuing additional education or credentials* msw 4.3 na lcsw na 4.2 lcac na 3.0 *average on five-point likert scale with 1= strongly disagree and 5=strongly agree data analysis researchers entered collected data into spss for data analysis. faculty members used descriptive statistics to summarize major findings. researchers used independent sample t-tests to determine any significant differences based on race, sexual orientation, firstgeneration status, and program modality. results overall students believed the social work programs allowed them to speak up about diverse issues that were important to them m = 4.3 (both 2019-2020 and 2020-2021) and m = 4.6 (2021-2022). they also believed the programs demonstrated a strong commitment to social justice with m = 4.3 (both 2019-2020 and 2020-2021) and m = 4.4 (2021-2022). students felt encouraged with the program’s approach to meaningful conversations about diversity topics m = 4.1 (both 2019-2020 and 2020-2021) and m = 4.4 (2021-2022). see table 2 for a complete breakdown of student ratings related to specific diversity topics. moore et al./implicit curriculum and swk 601 table 2. student ratings of program support for diversity topics the social work program encourages discussion about … average 2019-2020 (n=63) 2020-2021 (n=97) 2021-2022 (n=109) sexuality 4.1 4.1 4.1 gender 4.0 4.1 4.1 race & ethnicity 4.4 4.4 4.5 religion & spirituality 3.7 3.7 3.6 ability & disability 4.1 4.0 4.0 socioeconomic status 4.4 4.4 4.5 age-based discrimination 4.0 3.9 3.9 personal culture 4.2 4.1 4.2 family, marriage, & intimate partner relationships 4.2 4.2 4.3 political ideology 3.7 3.7 3.7 1 = “strongly disagree” and 5 = “strongly agree” students evaluated how well their practicum education experiences, program faculty, academic advisor, and program administrators demonstrated a meaningful commitment to diversity. most students either agreed or strongly agreed that these areas of the bsw and msw programs demonstrated a meaningful commitment to diversity (see table 2). students rated the level of respect they felt from their faculty members, program administrators, academic advisors, staff members, and fellow students. the largest percentage of students either agreed or strongly agreed with these statements (see table 3). students also had the opportunity to rate their level of comfort while discussing concerns about the program with their faculty members, academic advisor, and program administrators. scores indicated a high level of comfort with seeking support from all of these individuals (see table 3). table 3. student perceptions of the program’s commitment to diversity, approach to respect, and comfort with discussing concerns topic average 2019-2020 (n=63) 2020-2021 (n=97) 2021-2022 (n=109) demonstrates a meaningful commitment to diversity… social work curriculum 4.1 4.1 4.3 practicum education 4.1 4.0 4.3 faculty 4.1 4.0 4.2 academic advisor 4.0 4.0 4.4 program administrators 4.1 4.1 4.2 i feel respected by my… faculty 4.5 4.4 4.6 academic advisor 4.4 4.4 4.4 program administrators 4.5 4.5 4.7 staff members 4.5 4.4 4.6 fellow students 4.4 4.4 4.4 i feel comfortable discussing concerns with… faculty 4.1 4.0 4.2 academic advisor 4.1 4.0 4.4 program administrators 4.0 3.9 4.1 1 = “strongly disagree” and 5 = “strongly agree” advances in social work, fall 2024, 24(3) 602 additional questions asked students about opportunities they had to participate in high impact learning experiences and their knowledge of campus resources (see table 4). the scale also asked students about their utilization of available campus resources (see table 5). table 4. student chance to participate or had knowledge about curricular and cocurricular resources (n=269) i had a chance to participate or had knowledge about… yes, had chance to participate or knowledge about [n (%)] 2019-2020 (n=63) 2020-2021 (n=97) 2021-2022 (n=107) research 58 (93%) 80 (83%) 95 (89%) immersive learning 56 (90%) 77 (80%) 97 (91%) volunteer experiences 58 (93%) 85 (88%) 104 (98%) campus events 52 (83%) 67 (70%) 99 (93%) sswa 57 (91%) 93 (96%) 95 (89%) bsswa na 81 (84%) 71 (67%) table 5. student use of campus services (n=269) during my time at the university, i used the following… yes, used [n (%)] 2019-2020 (n=63) 2020-2021 (n=97) 2021-2022 (n=107) writing center 22 (36%) 28 (29%) 37 (35%) disability services 11 (19%) 13 (14%) 26 (25%) learning center 17 (27%) 24 (25%) 29 (28%) financial aid 45 (73%) 67 (70%) 77 (72%) campus counseling 15 (24%) 23 (24%) 39 (37%) academic advising 59 (94%) 77 (80%) 94 (88%) scholarships 27 (43%) 31 (32%) 50 (47%) letter of recommendation 41 (66%) 55 (57%) 84 (79%) professional consult 52 (84%) 66 (69%) 92 (86%) overall, students across the three years of data collection agree the bsw and msw program encouraged their professional development m = 4.1 (both 2019-2020 and 20202021) and m = 4.3 (2021-2022). the question about professional development was asked as a standalone question on the survey. students also believed the programs afforded them opportunities to engage in leadership activities m = 3.8 (both 2019-2020 and 2020-2021) and m = 4.0 (2021-2022). data collection is ongoing as part of a longitudinal effort. inferential findings responses did not vary by selected demographic characteristics, except for sexual orientation. students who identified as sexual minorities were more likely to express dissatisfaction with classroom discussion of gender and sexuality, respectively: t(265)= 2.472, p = 0.018 (m = 3.89, sd = 0.93; m = 2.86, sd = 1.35); t(265) = 2.288, p = 0.027 (m = 3.71, sd = 0.96; m = 2.71, sd = 1.50). students who identified as racial minorities, as first-generation college students, and students who took most courses online were not significantly more likely to express dissatisfaction in any particular area. moore et al./implicit curriculum and swk 603 discussion key findings a program’s implicit curriculum should encourage student and faculty conversation about diverse topics (friedman et al., 2020; hosken, 2018; kattari et al., 2020), evaluate the overall climate of a program (hosken, 2018; kattari et al., 2020; mcclendon et al., 2021; mcmahon et al., 2020), suggest strategies for student engagement in curricular and co-curricular activities (goode et al., 2021; mapp & gatenio gabel, 2019; morton et al., 2019; roth et al., 2018), encourage reflection on improving student experience (cox et al., 2021; grady et al., 2020), and help create a sense of community that translates to professional socialization (peterson et al., 2015). results from these implicit curriculum efforts illustrate the department’s success in achieving these outcomes. the department saw an increase in both the student’s ability to speak up about diversity (+0.3) and the student’s belief the program supported meaningful conversations about diverse topics (+0.3) from the first to third year of data collection. the department surveyed students about 10 specific areas of diversity. scores from year one to year three remained consistent. the department has the largest room for growth in discussions related to religion/spirituality, age-based discrimination, and political ideology. discussions about race, ethnicity and socioeconomic status consistently ranked the highest. scores related to the program’s commitment to diversity increased from year one to year three in all areas. this included higher scores for the social work curriculum (+0.2), practicum education (+0.2), faculty (+0.1), academic advising (+0.3), and program administration (+0.1). researchers assessed the overall climate of the department by looking at student perceptions of the respect and comfort they have with faculty, academic advisors, program administrators, staff members, and their fellow students. scores for respect ranged from 4.4 to 4.7 across categories. the highest score for respect was with program administrators followed by faculty and staff. the student level of comfort was above 4.1 for all categories. students felt most comfortable bringing concerns to their academic advisor. to explore student engagement with curricular efforts, researchers looked at whether students had opportunities to engage in scholarly research, high-impact teaching practices, and volunteer experiences. rates of student-engaged research ranged from 89-93%. by year three, 91% of students reported having access to classes using high-impact teaching practices, and 98% of students had opportunities to volunteer as part of a classroom requirement. co-curricular activities included participation in campus events and student social work groups (e.g., student social work association and black student social work association). participation in campus events increased by 10% from year one (83%) to year three (93%). exposure to student social work groups dropped from year to year. this is an opportunity for growth for the department. utilization of campus services increased in nearly all areas from year one to year three. researchers looked at professional socialization by exploring student perceptions around professional development and opportunities to engage in leadership activities. the advances in social work, fall 2024, 24(3) 604 department saw an increase in both professional development (+0.2) and engagement in leadership activities (+0.2) from the first to third year of data collection. utilization of student feedback assessing and improving the implicit curriculum in social work is essential for fostering a more inclusive and equitable learning environment. the implicit curriculum encompasses the unspoken norms, values, and attitudes conveyed through the educational experience. by assessing and addressing these aspects, educators can help ensure that students receive a well-rounded and ethical education that aligns with the values of the profession. improvement efforts can lead to the reduction of biases and stereotypes, promoting a culture of respect and understanding. this, in turn, prepares students to work effectively with diverse populations and challenges them to critically examine their own beliefs and assumptions. ultimately, enhancing the implicit curriculum supports the development of competent, empathetic, and socially responsible practitioners who are better equipped to serve the needs of their clients and communities. researchers placed significant value in taking time to reflect on student feedback and to invest time and resources into strategic areas of change. these strategic areas supported growth in various areas of the implicit curriculum and will continue to provide structure and guidance moving forward. completed or ongoing efforts include: 1. review of bsw and msw curricula to determine new strategies for infusing conversations about diversity components, with a special emphasis on the areas identified by students with the lowest rated scores. this includes a review of course objectives (both stated and unstated). 2. create the black student social work association. this mission is concentrated on the well-being of black social work students and other students from underrepresented minority (urm) groups. 3. explore strategies to keep students informed about available resources on campus, especially the writing center, career center, and learning center. reminders about these services exist in each course in the social work curriculum. 4. create socw 240: critical thinking and writing for social work professionals. this course helps undergraduate students connect cswe competencies with career readiness competencies identified by the national association of colleges and employers (2021). these competencies include a focus on equity and inclusion, leadership, professionalism, and teamwork. 5. review library resources and holdings to update specific resources and materials regarding diversity. this also includes a review of current textbooks, reading, and media. 6. increase interaction and involvement with diverse aspects of the local community by engaging in specific immersive-learning and service-learning experiences addressing the needs and concerns of diverse populations. 7. develop professional mentoring opportunities for social work majors with diverse peers and community professionals. moore et al./implicit curriculum and swk 605 8. use resources of the office of inclusive excellence to assist with programming, increasing faculty’s inclusive pedagogy, and implementing additional diversity research in the department. 9. review of course policies to explore unintended barriers to student success. 10. create a diversity, equity, and inclusion committee with student involvement. study limitations first, while researchers made efforts to decrease discomfort with the scale, it is possible students felt pressure to respond in particular ways out of personal and/or academic concerns. second, this study relied upon self-reported data. without having the ability to verify participant responses, there was no way to know the legitimacy or honesty of participants’ responses. third, this study was unable to control the multiple covariates or confounding variables that could influence a student’s perception of an academic program. while the study provided descriptive information, it is difficult to determine the true reasoning for student ratings. fifth, most of the data collection occurred during the covid19 global pandemic. future directions future research on implicit curriculum should include ongoing data collection to analyze longitudinal trends and shifts in student perspectives. this includes analyzing data from additional inferential and a multivariate statistical approach. additionally, the utilization of focus groups could provide a qualitative component to enhance the understanding of student experiences. this survey also does not capture the concept of belongingness, which should be considered in future efforts. belongingness can provide valuable insight regarding retention and persistence. future studies could also look more closely at other demographic characteristics such as religion, political affiliation, gender identity, etc. conclusion implicit curriculum encourages student and faculty conversations about diverse topics, evaluates the overall climate of a program, suggests strategies for student engagement, and helps create a sense of community for self-reflection and professional socialization. this study provided an initial review of the climate of the bsw and msw programs at a midwest university. from this data, the social work programs can explore strategies for improving student success efforts, identify targeted areas for curriculum and faculty development, and strategies for supporting recruitment, retention, and persistence efforts. references barker, s. l., allen, d., moreau, k., & soverall, n. 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(2000). construct explication through factor or component analysis. a review and evaluation of alternative procedures for determining the number of factors or components. in r. d. goffin & e. helmes (eds.), problems and solutions in human assessment: honoring doubles n. jackson at seventy (pp. 41-71). kluwer academic. author note: address correspondence to matt moore, college of social work at the university of kentucky, lexington, ky, 40506. email: mattmoore@uky.edu https://doi.org/10.1080/02615479.2018.1450375 https://doi.org/10.1080/02615479.2018.1450375 https://doi.org/10.1080/10437797.2022.2119356 https://doi.org/10.1080/10437797.2022.2119356 https://doi.org/10.1177/0095798418771807 https://doi.org/10.1007/978-1-4615-4397-8_3 https://doi.org/10.1007/978-1-4615-4397-8_3 https://doi.org/10.1007/978-1-4615-4397-8_3 mailto:mattmoore@uky.edu _______ jennie ryding, doctoral student, university west, department of social and behavioural studies, se-461 86, trollhättan, sweden. copyright © 2020 authors, vol. 20 no. 3 (fall 2020), 615-636, doi: 10.18060/23517 this work is licensed under a creative commons attribution 4.0 international license. professional learning in family support social work in sweden: practitioners’ integration of ebp and reflection jennie ryding abstract: the integration of evidence-based practice (ebp) in human service organizations has increased during the last decade. providing the best possible treatment by applying research and considering the client’s specific needs, ebp is recommended for human service organizations. however, due to its oftentimes manualbased format, critics claim that ebp is a result of increased focus on cost-efficiency, control, and standardization of work. different conceptualizations of ebp appear to prevail, highlighting the need for more studies that investigate different perspectives and experiences (e.g., that of professionals). in this study, focus group interviews were conducted with family support social workers (n = 19) in sweden who are trained and active in the evidence-based model family check-up (fcu). participants reported that fcu promotes professional learning and development, especially experiential learning. those interviewed felt that research/evidence provided a certain “weight” to the therapeutic situation, so that they were not merely treating patients based on their own opinions. further, fcu was described as empowering and developmental, with an encouraging, reflective, and reinforcing client-related approach. however, to enable these kinds of positive outcomes of ebp, organizations must provide sufficient time and resources devoted to the practical application of ebp. keywords: evidence-based practice (ebp), professional learning, human-service organizations, focus groups, parental support social workers work in multifaceted, stressful, and dynamic work environments. reflection is important for dealing with the complexity, intricate decision-making processes, problem-solving, and protecting oneself as a practitioner from the client’s emotions and, sometimes, troublesome life-situations (ryding et al., 2018; ryding & wernersson, 2019; winter et al., 2018). in addition, reflection is often highlighted as enabling professional learning (dewey, 1997/1910; kolb, 2015; schön, 1991). professional learning can be defined as an ongoing process used for improving the understanding of both tasks and context. to enable learning, an openness and search for new knowledge is required by the individual, especially in more problematic or difficult situations (illeris, 2007). knowledge, understanding, and skills, are multifaceted and acquired either through studies or experience. episteme, techne and phronesis are three forms of knowledge stemming from the work of aristotle (1967), all concerning different content and processes (avby, 2018). in turn, these three concepts represent knowing to/what, knowing how, and knowing why, all of which are important for work and professional life. reflection is a key mechanism for understanding and making use of experiences (e.g., dewey, 1997/1910; schön, 1991). in experiential learning theory (elt), learning is a process in which concrete experience is converted or transformed to learning, and requires an active learner (kolb, 2015). one of many related concepts that originates in experiential learning theories is work-integrated learning (wil). defined as the learning that occurs while doing a job (thång, 2004), wil offers a broad spectrum of https://creativecommons.org/licenses/by/4.0/ ryding/professional learning in family support 616 interpretations depending on context. wil is a way of widening, deepening, and testing individual knowledge (thång, 2004), bearing similarities to the ideas of dewey, schön, and kolb. the “testing” of knowledge relates to the use of reflection in finding solutions to problems or situations (i.e., a process of reflective experimental problemsolving, or inquiry; dewey, 1997/1910). making use of experiences is essential in work life and for improving practice. by reflecting on experiences in the work environment, we can increase professionalism. it is a process of moving from, and between, knowing to/what, knowing how, and knowing why. movement between the small and the big, the specific and the universal, individual observations and general scientific knowledge is made until a coherent picture is achieved (i.e., a solution to the problem, also called inference). inference, like phronesis, requires a critical, analytical, and reflective mind to enable professional learning and knowledge-development (avby, 2018; dewey, 1997/1910). changes in the welfare state affecting everyday practice changes in the western world’s public sectors are impacting everyday practice, affecting practitioners’ conditions at work as well as the clients’ experiences. increased influence from private sector ideals has led to a change in focus and stricter control of human-service organizations, resulting in an emphasis on cost-efficiency, standardization, documentation, and the measuring of service outputs (gursansky et al., 2010; liljegren & parding, 2010; munro, 2004; webb, 2001; winter et al., 2018). implementation of evidence-based practice (ebp) and associated models is another avenue of influence (barker & linsley, 2016; ponnert & svensson, 2016, 2019; webb, 2001). at the same time, practitioners describe reduced resources for reflection and a degradation of “abstract,” or less measurable, qualities like tacit knowledge, proven experience, and intuition (avby, 2018; ryding et al., 2018; winter et al., 2018). in sweden, private sector influences are related to a neo-liberal, new managerial way of organizing practice (bergmark & lundström, 2011; denvall & johansson, 2012; liljegren & parding, 2010; ponnert & svensson, 2019). in a study by ryding and colleagues (2018), swedish social workers describe a change in focus in social work from reflection to production, thus treating clients as if they were on a “conveyor belt,” reduced hours for intervening with clients, and an increase in administrative tasks and meetings. in 2008, a swedish government report highlighted a deficient knowledge base in the social services. the need for increased knowledge-use and knowledgedevelopment was suggested for improving the deficiency, for which ebp was recommended (statens offentliga utredningar [sou, swedish government official reports], 2008). critics, however, argue that this has led to an increased focus on manual-based work, neglecting the need for personalizing treatments. in the swedish context, ebp is thus often equated with changes negatively affecting public service, such as increased focus on cost-efficiency due to stakeholders’ new priorities (denvall & johansson, 2012; mattsson, 2017; ponnert & svensson, 2016). however, with ebp constituting much more than manual-based work, this may be a problematic development, resulting in inaccurate assumptions about ebp, evident both in sweden and internationally. based on previous research, practitioners understand and define ebp in varying ways (e.g., avby et al., 2014; bergmark & lundström, 2011; chonody & teater, 2018; heiwe et al., 2013). varying conceptualizations of ebp provide a rationale for further advances in social work, fall 2020, 20(3) 617 research on practitioners’ perspectives and experiences of ebp and associated models. the aim of this study was therefore to investigate social workers’ experiences of working with the evidence-based family check-up (fcu) model and their thoughts about research and experience in relation to professional learning and knowledge development. family check-up (fcu) fcu is a strengths-based, evidence-based, and adaptive intervention aimed at promoting children’s mental health and providing parent support. the model has been developed and tested since the early 2000s and has a strong evidence base from both cross-sectional and longitudinal studies for parents with children aged 2-17 (see brennan et al., 2013; chang et al., 2017; connell et al., 2008; dishion et al., 2016; van ryzin et al., 2012). fcu has two phases: 1) assessment and feedback, and 2) parent management training. the assessment is strengths-based and includes various contexts, like home and school settings. by using empirically validated questionnaires, teacher ratings of the child’s behavior, as well as videotaped observations, fcu provides an extensive amount of information about the child’s behavior, parenting skills, stressors and dynamics in the family. in the feedback session, the practitioner provides a review of the assessment information to the parents. the family’s strengths and challenges are visually summarized and highlighted. a variety of possible and tailored follow-up interventions are offered to the family, based on the family’s specific needs and life situation. the parents and practitioner discuss the assessment and decide together on the most suitable intervention. one possible parent management training experience that can be offered within the framework of fcu is everyday parenting (arizona state reach institute, n.d.; bengtsson et al., 2017). in sweden, fcu is offered within social services and primary care. at the time of this writing, fcu was provided in the country’s western region and was used for both preventative and treatment-focused interventions. the centre for progress in children’s mental health (cfp-cmh), a unit within public primary care, is, among other things, responsible for the implementation of fcu in sweden. the use of fcu in the swedish context has been subject to research, with evidence of positive effects (e.g., björnsdotter, 2014; ghaderi et al., 2018). ebp: a contested concept ebp and its associated models have been both questioned and praised. the increased implementation of ebp has led to differing perspectives about which knowledge is the best upon which to base practice. for example, ebp has been criticized compared to its original intent as a philosophy or approach to practice (e.g., gibbs, 2003a, in mullen et al., 2005). concerns have also been directed towards the “evidence-hierarchy,” which places findings from meta-analyses of randomized control trials (rcts) at the top, thus considered the most valid source of evidence (mantzoukas, 2008). although rcts provide useful insight regarding the studied object, opponents argue that results from rcts are of little use for the complex and varying character of everyday practice (bergmark & lundström, 2011; heiwe et al., 2013; mantzoukas, 2008). based on the description of ebp as a philosophy (gibbs, 2003a, in mullen et al., 2005), however, several benefits are noted: a reduction of the ryding/professional learning in family support 618 theory-practice gap, promoting professional and lifelong learning, offering a holistic approach to the client-related situation by considering various aspects of impact, providing ethical treatment with the client’s needs and interests in mind, reducing the risk of mistakes, and improving efficiency and effectiveness (gambrill, 2010; gredig & marsh, 2013; heiwe et al., 2013; mullen et al., 2005). given the positive attributes of ebp, its non-use in more complex practices can be problematic. in fields like social work, various sources of knowledge are used for informing and guiding practice (avby, 2018; ponnert & svensson, 2016; messing, 2019; ryding & wernersson, 2019; sichling & o’brien, 2019). with the debate over ebp still prevailing 11 years after the call for an improved knowledge-base in swedish social work (see sou, 2008), there is a need for an improved understanding of how ebp is defined and implemented in clinical practice. one area in need of investigation is practitioners’ understanding of ebp. by providing different perspectives and experiences, an updated and broadened understanding of ebp could be promoted. furthermore, improved insight into practitioners’ perspectives can be of use in both organizational and educational settings, aiding implementation of ebp. the present study ongoing changes in the swedish public sector are affecting practitioners’ everyday practice (e.g., avby, 2018; denvall & johansson, 2012; ponnert & svensson, 2019). previous studies describe how practitioners experience social work as becoming more production-oriented and a matter of people-processing rather than organizing work according to longer-term perspectives (ryding et al., 2018; ryding & wernersson, 2019). some researchers argue that this change has led to a decrease in both appreciation of and resources for “less measurable” elements in social work (e.g., ingram et al., 2014; ponnert & svensson, 2016). with the role of episteme (knowing to/what), techne (knowing how) and phronesis (knowing why) in mind (aristotle, 1967), there are reasons to believe that both research and experience are important sources for professional learning and knowledge development. therefore, this study investigated social workers’ perspectives about both research and experience in relation to professional learning and knowledge-development. the following research questions guided the present study: 1) what are social workers’ perspectives about professional learning and development? 2) how has learning and working with fcu affected social workers in their everyday practice? method participants and procedure the empirical material emanates from a larger data collection conducted in 2016 from focus groups with family support social workers. the collaboration partner for this research project is cfp-cmh. in 2016, fcu was only offered in one city in sweden, and only in seven out of its 10 districts. the selection criteria were therefore made up to be the social services’ resource-units within these seven districts. out of the 12 focus groups, five consisted of practitioners with training and practical experience with fcu. these five groups are the focus for this study. all participants advances in social work, fall 2020, 20(3) 619 belonged to pre-existing workgroups at their respective workplace and shared the same kind of work. to recruit participants, the resource unit managers in the seven selected city districts were contacted to obtain information about their family support social workers. the practitioners were contacted individually by e-mail after the researcher received information from the managers, providing them with information and a consent letter. in total, 30 practitioners with training and work experience with fcu were invited to participate. in the end, 19 decided to take part, forming five focus groups varying in size from three to five participants each. some target participants were unreachable, or their work or personal situations did not allow time for them to join. the focus group discussions lasted between 75 to 102 minutes (in total 7 hours, 34 minutes). further information about the participants is displayed in table 1. table 1. focus group participants (n=19) number of focus groups [n] 5 gender [n (%)] female 18 (94.7%) male 1 (5.3%) age [years] range 34–62 mean (sd) 47.58 (7.87) work experience [years] range 7.5–40 mean (sd) 19.97 (8.69) all participants were engaged in family support. before the focus groups began, participants were asked to fill out a form with some background questions, covering both years of work experience and a specification of what models/methods they were trained in. all except one participant responded (see table 2). many participants shared the same methods/models. besides fcu, practitioners were trained in models/methods such as marte meo (a communication-method and interaction treatment), multisystemic therapy (mst), and solution-based casework. no information about caseload size or characteristics of the presenting problems were available. table 2. focus group details focus group # of participants mean [years] # models/methods reported by participant age work exp. 1 5 40.2 12.9 4, 3, 8, 6, 0 2 5 50.6 24.8 8, 6, 5, 4, 6 3 3 54.7 28.7 5, 4, 2 4 3 52 26.7 5, 2, 8 5 3 41.3 18.3 2, 2, 2 * 1 male participant because the project was financed by cfp-cmh, it was important to maintain a neutral attitude towards fcu as a model and the work of cfp-cmh. the goal of the researcher was to not be affected nor affect the participants in any direction (i.e., favoring or degrading). the co-workers at cfp-cmh and their knowledge of which fcu-trained practitioners participated in the study was also considered. the names or details of the participants were not revealed either to the practitioners’ managers or the ryding/professional learning in family support 620 co-workers at cfp-cmh. nevertheless, it is possible that co-workers at cfp-cmh learned about some of the participants’ involvement in the study. three out of five focus groups were conducted at the office of cfp-cmh in conjunction with fcu supervision. the practitioners themselves suggested the location for the focus groups. some of the participants also received training in fcu in conjunction with a randomized control trial of fcu and icomet in sweden (e.g., björnsdotter, 2014; ghaderi et al., 2018). as a consequence, these practitioners were provided with more time for learning and working with the model (50% of their working hours were dedicated to fcu during the research project). differences in time and resources in relation to learning and practicing the model may have influenced the participants’ experience and discussions about fcu. interviews in order to gain an improved understanding of social workers’ use and experience with both reflection and an evidence-based model, focus group interviews were conducted. focus groups’ capacity to incorporate a breadth of experiences and perspectives, group discussions, as well as complementary and argumentative interaction (kitzinger, 1994) made them a good choice as a method for this study. the interactive character of focus groups makes it possible to achieve a more nuanced picture of the topic discussed compared to individual interviews. similarly, group discussions allow for participants to ask each other questions as well as offer explanations of certain statements and opinions (kitzinger, 1994; morgan, 1996). the focus groups were guided by open questions about reflection, professional learning and development, and fcu. each focus group began with the participants being asked to describe their respective work. the researcher serving as moderator, interfered as little as possible in the discussion, maintained an open climate, and did not allow participants to digress from the subject (e.g., cohen et al., 2007). at the end of each focus group, the participants were offered the opportunity to add any comments or ask questions. the fact that the participants in each focus group knew each other might be one reason for the transparency that seemed to prevail. the swedish research council’s (2017, 2019) ethical rules and regulations for conducting research in sweden were followed in this study. analysis a thematic and question-driven analysis according to braun and clarke’s (2006) recommendations were used to analyze the data. the analysis process can be described as recursive rather than linear, involving a back-and forth movement between data to capture the essence of the participants’ discussions and statements. the audio-files were first transcribed into text format using the software express scribe (nch software, 2016). while listening to the files, the researcher transcribed what the participants were saying word-for-word. the process was done in a slow and careful manner to ensure the transcriptions’ consistency with the audio-files. if difficulties arose with hearing or understanding the participants, the speed of the playback was reduced or files played back until an accurate understanding was reached. afterwards, the text-files were copied and saved into a word-document one for each of the five focus groups. after completing the transcriptions, they were carefully read through, noting important content as well as ideas for possible interpretations. advances in social work, fall 2020, 20(3) 621 the next step in the analysis was completed using the software maxqda (ver verbi gmbh, 2016). the program facilitated the coding-procedure by enabling further coding and analysis and the organizing of the material into categories. to avoid random results, the analysis involved an ongoing correction and adjustment of identified codes, categories, and themes. the analysis can be described as abductive in that a movement between theory and data characterized the process, thus making it neither atheoretical nor theory-driven. an abductive approach implies the presence of theory throughout the whole research-process (timmermans & tavory, 2012). by comparing results to previous research findings, the purpose of an abductive approach was to reach a more nuanced view, possibly facilitating new theoretical insights of use for future research (see timmermans & tavory, 2012). codes were organized into different themes. both codes and themes were given names, which were adjusted to ensure accuracy with the specific content. the swedish transcripts were used throughout the analysis. after gathering codes into themes, english labels were used. a professional proofreader was later consulted for assuring language accuracy and assisting in translating the quotes that are presented. the transcripts were thoroughly reviewed to assure accuracy. prior experience with conducting thematic analysis together with continuous discussions on content, procedure, and results with a colleague contributed to the study’s rigor and trustworthiness. to avoid bias, a thorough and careful analysis, repeatedly moving between the unit of analysis, the research questions, and theory was adopted. the analysis example provided (appendix) is another way of demonstrating the analysis adequacy. the fact that several focus groups were conducted at various workplaces is also a strength that both tests and confirms previously shared information (e.g., sayer, 2010). quotes from the focus groups are used to illustrate the themes. findings the analysis resulted in three themes: learning by doing, practical impact, and empowering (see table 2). theme 2 had two subthemes. when quoting, focus group is abbreviated fg, followed by its specific number. wording was occasionally changed to facilitate the reader’s understanding. the participants are referred to either as “they” or “the participants,” and the service user either as “the client” or “the family.” when participants talk about “theoretical learning” or “theoretical knowledge” they are referring to sources other than purely practical experiences, such as input from books, scientific articles, and the research/evidence in fcu. table 3. themes and subthemes 1. learning by doing 2. practical impact 2.1. the power and role of evidence 2.2. learning enabled by experience and reflection 3. empowering theme 1. learning by doing the participants discussed professional learning and development both in general terms and also in relation to fcu. it became evident that they thought fcu, for many reasons, advanced them professionally. participants said that learning the model laid ryding/professional learning in family support 622 the groundwork for later practical work: much basic knowledge was gained, both about the model and parenting strategies. later, when working with the fcu practically, further experience and knowledge was gained, contributing to professional development. fcu was described as a concrete model, meaning that it is very clear and distinct. one participant said: it is quite concrete. clear. sort of, the assessment, clear, the sessions, clear, their purpose, the rationale, i mean, the choice of sessions is, most of the time, not that difficult, based on needs and so on. so, it’s, well yes, it’s really good. (fg3) according to the participants, the model’s focus is on how to do things and how to continue the client-related work from a specific point treatment-wise. similarly, the participants said that the use of videotaped observations is a source of positive development in enabling self-observation and validation of their behavior. constant and critical observation of themselves is not always easy, but was deemed helpful since it facilitates an awareness of both development needs and opportunities. participants watched how they acted, spoke, as well as their facial expressions and body-language, and described this enhanced self-awareness as a learning process. the video-taped observations also offered an opportunity to see one’s own progress by comparing earlier videos with more current ones. the parents’ feedback was another reason the model was considered to advance professional development. the feedback-session (after the assessment) was one example in which they felt that the parents’ thoughts and ideas regarding the information provided, their experience of the situation, and responses and questions about the treatment-situation contributed greatly. one participant said: after another 10-12 weeks, you have an additional meeting with the parents when they can give something back, where you can learn something yourself, and then it’s also about questions, what questions they are asking. “if we are to start all over again, what would be good, what could we do differently,” and they provide various suggestions, like meeting a little bit more often, or the way you are talking is a bit complicated, you could, then you must learn how to express yourself in a different way, to find the right terminology for the one [client] you are meeting. that i think is a learning experience. i cannot use family check-up terms if i meet a family that has never heard about it before, “what do i know, proactive parenting… what, what is that?” thus, to be able to simplify things, it is also a learning experience. (fg4) participants reported that learning from experience is important when working with fcu. during the training phase, they gained a foundation of knowledge about the model and associated research. the training does not, however, provide the skills of delivering the model to the client (i.e., the practical application). rather, knowledge comes with experience, implying practical use is needed to fully learn the model. the practical “doing” is what leads to actual learning and becoming competent and skilled. high demands during the training facilitated this “doing,” which involved, among other things, applying the model and delivering video-taped observations to the fcusupervisors, which the participants considered to contribute to professional learning. however, to enable learning from experience while working with fcu, some experimenting and thinking “outside the box” was required, implying the need to advances in social work, fall 2020, 20(3) 623 challenge oneself. learning fcu entailed moving beyond previous routines, changing behaviors, and learning new things and ways of meeting people. to enable learning from experience and to develop professionally, reflection, both individually and with others, was described as important. theme 2. practical impact the focus group discussions highlighted an opinion of fcu as affecting practice in a more significant way compared to other models/methods. the model’s concreteness was one reason for this opinion. the participants reported that the model was very clear and provided content as well as equipment and tools for use in practice, resulting in a positive practical impact. another example of the positive impact of fcu on practice was the assessment, which provides extensive information about the client. because it provided much information about the client in a short amount of time, the assessment was described as a useful “short-cut” compared to social services’ investigations. in terms of time, the participants argued that fcu is more efficient in the workplace compared to other models. additionally, they argued that their provider role changed when working with fcu, placing a lot of emphasis on the parents’ own abilities. another type of impact of fcu was increased structure, developed communication-skills, and an awareness of the influence one’s own attitudes may have on the client (i.e., judgmental vs. neutral). participants also mentioned that working extensively with fcu can develop into a common work approach. some of the focus group participants were trained in fcu in conjunction with a research project on the model a few years ago. because of this training, participants were provided with much more time for learning and working with the model than others who had not been part of this research project. this involvement contributed to making fcu a part of both their work and of themselves as individuals. in one focus group (1), the participants talked about a colleague of theirs who was described as highly knowledgeable about and dedicated to the model: compared to xx, whom we all think is, is doing this [fcu] fantastically good, we have seen her movies and so on. but, she had a longer training, she got the opportunity to become fcu, to be fcu and find a way to do it. …. but, i know she said that she has been struggling with it, to make it hers, to find words when using it, and i don’t know if i am prepared for that. another practical impact that was discussed was fcu’s time-consuming character, which the participants considered somewhat problematic in relation to everyday practice. participants claimed much time was needed for preparing the work, for completing the model’s various elements and the work in between, which, due to the prevailing organization of practice, required quite an effort on the part of the practitioner. if too little time is provided for working with fcu, having several “fcufamilies” simultaneously was described as difficult. participants also related that lack of time made it difficult to properly learn the model. however, proper knowledge about the model was simultaneously considered necessary for its practical use. some participants discussed how certain parts of the model were used less often, simply due to lack of knowledge. lack of time and limited use was argued to constitute an obstacle for learning more about these parts and trying them out with clients. ryding/professional learning in family support 624 theme 2.1. the power and role of evidence the role, and according to some of the participants, power and centrality, of research/evidence in the treatment situation was described in the focus groups. some participants argued that fcu, as an evidence-based model, provided a sense of security to them as practitioners, because they had confidence they were not basing their work on merely their own opinions. connecting their work to research, the participants argued, meant “doing” something with the parents: “then, they also become secure and calm, this is sort of, well yes, you really get security, or quality assurance for it all [the treatment/work]” (fg5). the following reasoning occurred in fg2: it [using research] gives a kind of weight, rather than saying “my neighbor knows…” (laughter) yes, so it is. to highlight the research [behind] is much more rewarding than only emphasizing what i think. absolutely! it’s not just thinking this or that, it is in fact researched. although participants reported research as adding a sense of security to the treatmentsituation, the importance of drawing on proven experience was also emphasized. the participants still appreciated and considered experience, intuition, and prior and practical knowledge as well as reflective capacity to be an important complement to the model. participants highlighted how gaining sufficient research-based knowledge was important for ensuring quality. in relation to this, some participants emphasized the importance and need of “knowing” the knowledge (i.e., to be knowledgeable about its meaning). the participants also highlighted the need to know why certain kinds of research are used and referred to in a specific session or situation (e.g., in everyday parenting). without such knowledge it is difficult, as a provider, to explain the research’s purpose and use in relation to the session/situation. using research about which they were not knowledgeable, or mentioning it because they “have to,” as some participants described occurred during the training phase, was seen as awkward. in two focus groups the participants reported that such an approach could transform the clientrelated situation into teaching, in which the practitioner informs the client about the research. some of the participants described how the model builds on statements like “according to research…” or “research says…”, phrases that you also had to say during training in order to “pass” [they said this accompanied with laughter]. in fg 1, the participants discussed how this kind of “demand” might cause a mental lockout, due to lack of sufficient knowledge and experience, or make you feel like an actor saying things according to a script. in fg 3, method fidelity (i.e., treatment adherence to key elements of the model/program) was also mentioned. one participant mentioned how she sometimes felt fidelity was neglected: “you use a little of this and a little of that, however, my opinion is that too much of that is dangerous. …. you cannot use it in a quick way, material like that.” another participant in the same focus group did, however, hold a slightly different opinion: but i think it’s good if you have different methods, you can take a small part here and maybe a small part of fcu and a small part of marte meo [a communication-method and interaction treatment], different parts that you advances in social work, fall 2020, 20(3) 625 work with and go through, based on the specific family. what you feel is most rewarding. no further accounts, apart from the possible “picking and mixing” of various models/methods, was discussed in relation to method fidelity. theme. 2.2. learning – enabled by experience and reflection in relation to fcu’s concrete impact on practice and the potential role of research/evidence in client-related work, participants reported that the process of “making it yours” was necessary. the participants considered reflection to be a key component of “owning” the practice of fcu. reflection implies a process in which the practitioner thinks through the new learning or content, reflects upon what is happening in the session, and how each person is responding. reflection and learning were, at times, even equated to one another, highlighting the importance of inner dialogue, discussing whether one can learn without reflection, and/or whether one can reflect and not learn. when discussing the learning process, a view of learning as a two-fold process emerged, relating to knowledge as either being based in theory, in the shape of a comprehensive explanation, or experience. as one participant shared: one learning [type] is purely formal, learning new theories and so on, that is when it becomes learning, and the other is more of an approach, i mean work attitude and approach. that is also the challenging part of learning i think, to change or learn new ways to respond to people, humans. and to put it in some theoretical context or vice versa. to have those connections, that you get a certain understanding for “ok, this is what is happening,” that maybe i have, in the back of my head that what she [the client] is describing is coercive processes and i have a theoretical connection [scientifically based explanation] for just that, without having to mention it all the time, to have understanding, i mean, in me that, and then a connection between theory and practice is important i think, which also is being practiced and be devoted to that. (fg4) to have a theoretical foundation as a practitioner was considered important and described as a starting point when dealing with practical situations, yet requiring reflective ability. one example mentioned was the handling of a client’s specific problem, about which the social worker was thinking: “what is it that i’m seeing here, based upon what i [previously] have read?” (fg1). however, for connecting theory to a practical situation and putting into words what one is doing and vice versa, reflection was again emphasized. thus, learning was described as occurring in different ways and with varying sources. for learning to occur, however, respondents reported that a connection to “something else” was needed, especially a connection to experiences as a learning source. one participant said: “it’s not just the actual being there (i.e., experiencing the situation), but rather, reflection is definitely necessary for that which you have experienced to generate in learning….” (fg2). similar to the importance of the need to “know” the knowledge/evidence used in the model, the need for feeling both knowledgeable, competent, and confident in using fcu practically was emphasized by the participants: ryding/professional learning in family support 626 i need to know the sessions [everyday parenting-sessions, parent management training (pmt) in fcu], otherwise it’s very difficult to convey to the parents what i am talking about. i mean they go hand in hand, you need to know, you really need to know, otherwise it becomes very difficult to… it will not be good when you explain, like in the beginning, it gets a little tricky when you don’t know what you are talking about, you see that now. (fg5) for gaining confidence about a certain model or way of working, practical application and gained experience were considered to be of primary importance. theme 3. empowering during the discussions, it became evident that working with fcu implies a challenge not only for service providers in their professional roles, but also for the parents involved. participants reported that they became more encouraging in their professional role as a result of implementing fcu. working with fcu includes reinforcing families for positive behaviors, asking reflective questions, continuously making connections between actions observed and parenting, but most importantly, no longer thinking that “someone else should do it” (fg5). the participants compared this client-centered approach to previous experiences and situations in which it was easy as a professional to hand over the responsibility for helping a client to someone else (e.g., welfare officer or to child psychiatrist). the participants therefore argued for fcu to include a challenge in their professional role, not seeking the solution elsewhere. nevertheless, fcu was described as a supportive way to help the parent(s) help their child, without having to add another intervention or professional. empowering parents provided the practitioners a sense of security in their professional role and helped them to continue work with the client no matter the parents’ emotions or reactions. this meant that they, as professionals, were able to tell the parents that they are in the right place and that they will get help and to stay calm in that decision. this approach also helped them, as social workers, to show the parents that they have confidence in their ability. this was argued to affect the parents’ (often positively), providing parents faith in themselves and helping them realize their importance. taken together, fcu was described as professionally challenging, in turn leading to professional development. discussion the results of this study describe how fcu, as an evidence-based model in family support social work, can promote professional learning and development. the study’s participants described how learning the model provided solid ground for later work. however, the hands-on “doing” it, was where professional learning and development occurred. both training and practical experience are important for acquiring researchbased knowledge and experience-based knowledge (also known as theoretical and practical knowledge). complex practices like social work require different forms of knowledge, including a more theoretical dimension and the practical use of new skills (e.g., avby, 2018; julkunen & korhonen, 2011; soydan, 2015). implementation literature shows that development of professionals’ competence and confidence in a model is dependent on factors like training, coaching, and performance assessment, referred to as competency drivers (bertram et al., 2015). the advances in social work, fall 2020, 20(3) 627 infrastructure and success of the implementation process also contributes to professionals’ competence and confidence. for promoting the practical “doing” or application of models, coaching is important since it can be both professionally encouraging and challenging. the function of coaching for preventing a fallback into previous ways of working should also be mentioned (bertram et al., 2015). the need for coaching and support aligns with the participants’ descriptions of moving outside your comfort-zone for learning and working with fcu. furthermore, the practical “doing” is required for developing ability, emphasizing the multifaceted character of the learning process, and requiring different prerequisites and environments. this multifaceted characteristic aligns with kolb’s (2015) experiential learning theory, in which learning is depicted as a recursive process, containing reflection, sense-making of experiences, testing new solutions to situations, and adjusting future behavior. the participants’ discussions about how professional learning and knowledge can be acquired supports the idea of various forms of knowledge (e.g., aristotle, 1967). being trained in fcu can thus be argued to provide the knowing to/what (episteme). the knowing how (techne), or ability, can, on the other hand, be enabled through the practical application of the model. the participants described how the implementation phase of fcu involves fcu-specific supervision including the use of video-taped observations: recorded sessions of the clinician’s practical work with the model. reviewing the sessions with the fcu-supervisor was argued to enable professional learning and development. the latter, more independent work with the model further deepens the knowing how. knowing why (phronesis) could be argued to be present during all stages, yet, deepened when practitioners become increasingly skilled and experienced. aligned with individual motivation and engagement, the combination of various knowledge sources as well as approaches and techniques for learning and utilizing ebp, and for promoting fidelity and effectiveness, is highlighted in previous research (e.g., bertram et al., 2015; lyon et al., 2011; webster-stratton et al., 2014). the participants’ discussion about how they move between different knowledge-sources has similarities with the process of inference, as described by dewey (1997/1910). research-based knowledge can be seen as representing the universal, and the logical inference, while practical experiences, or experience-based knowledge, can be thought of as representing the specific, individual observation (see dewey, 1997/1910). based on this understanding, results from rct’s can be understood as representing the universal, i.e., evidence about “what works,” while practical actions, enabled through such results and modified by the practitioner in conjunction with the specifics of the client, can be argued to represent the specific. moving between these sources of knowledge aids the professional in reaching a solution to the specific problem. the use and integration of various forms of knowledge in complex practices, like social work, is often emphasized also in relation to ebp with a range of knowledge-sources being useful for informing practice (e.g., barker & linsley, 2016; gibbs, 2003a, in mullen et al., 2005; sichling & o’brien, 2019). a reflective and open-minded individual, aware of the importance of continuous learning, that moves between routines and new ways of approaching and dealing with situations is also highlighted as important (e.g., dewey, 1997/1910; kolb, 2015; westlund, 1997, in denvall, 2001). the results of this study illustrate that research evidence is powerful in the treatment situation, providing security to both practitioners and clients. being evidence-based was thought of as quality assurance, providing increased “weight” to ryding/professional learning in family support 628 the treatment. the participants emphasized the need to be knowledgeable about the research they were to use. without sufficient knowledge, a feeling of artificiality might appear if they are to say certain things only because they “must” (e.g., for demonstrating fidelity). without sufficient knowledge, a professional might only reach the stage of episteme being knowledgeable of the know to/what – however, without reaching the stage of knowing how or why (aristotle, 1967; dewey, 1997/1910). although research and evidence provides a sense of legitimacy, there is still a need for reflection, critical thinking and common sense, abilities both included and emphasized in more detailed definitions and descriptions of ebp (e.g., gibbs, 2003a, in mullen et al., 2005; mullen et al., 2005). in addition to being a concrete model, fcu was described by study participants as having a tangible impact on practice. based on their statements, learning fcu can affect the practitioners in various ways. its concreteness was one obvious reason: fcu eases their work as practitioners, while simultaneously helping the client, but only if there was enough time to work with it. the concrete structure of fcu increased the structure of their work, not only in relation to the fcu work but also to work in general. fcu was, however, described as time-consuming and participants emphasized the difficulty of having several fcu families simultaneously. its time-consuming character should not, however, automatically be regarded as negative. some of its more timeconsuming aspects were the amount of time needed for preparing the work, for completing various elements and tasks in the model, as well as for the work “in between.” based on the participants’ statements, the prerequisites for learning the model can be considered dependent on what bertram and colleagues (2015) calls implementation drivers, comprising competency, leadership and organization. in three focus groups, the participants endorsed fcu as an evidence-based model similar to the description of ebp as a philosophy (gibbs, 2003a, in mullen et al., 2005), rather than the mere following of a manual (e.g., ebp as a process or product, chonody & teater, 2018). the participants talked about fcu as an approach to work, making it more than simply a model among others. on the contrary, ebp is at times criticized for leading to increased standardization by encouraging practitioners to follow a manual (i.e., a product). there is thus a difference between practitioners as consumers of manuals and guidelines created by others, and the application of an evidence-based approach (chonody & teater, 2018; mullen et al., 2005). in sweden, ebp is implemented as a result of hierarchy processes and organizational ideas affecting the public sector as a whole. using ebp for increasing cost-efficiency (i.e., focusing on expenses rather than costs in conjunction with successful treatments; ponnert & svensson, 2019), can be regarded as a misuse, at least with the definition of ebp as a philosophy in mind (gibbs, 2003a, in mullen et al., 2005). organizations are, and should, be working towards being cost-effective and, in this case, treating (and helping) as many clients as possible, but not at the price of lowering quality, practitioners’ lack of reflection, or use of proven experience. the problem is thus not the use of ebp per se, but rather, the change of focus in the public sector, leading to a “falsified” or incorrect understanding of ebp, yet also affecting everyday practice as well as practitioners’ and clients’ experiences of ebp (e.g., munro, 2004; ponnert & svensson, 2016). in conclusion, if there is an implementation framework and a preparedness for later maintenance, ebp can provide a way to improve practice. based upon two definitions of ebp and its purpose of increasing the quality of services provided, ebp can function advances in social work, fall 2020, 20(3) 629 as a quality-driving element in practice. furthermore, it can enable professional learning and development and provide the possibility of organizational learning (gibbs, 2003a, in mullen et al., 2005; sackett et al., 2000, in parrish & oxhandler, 2015). by doing so, ebp can benefit various stakeholders not only clients and practitioners, but also the organization and, in a longer-term perspective, society at large. limitations this study has some limitations that need to be mentioned. first, the sample originates from only one city. to include practitioners trained and active in fcu from another setting could have provided other viewpoints. because fcu was only being implemented in one city in sweden at the time, this was not possible. conducting three of five focus groups at the office of cfp-cmh could also be regarded as a limitation. occasionally being the place for the specific fcu-supervision, this was the participants’ suggestion. interviewing the participants in a setting where they normally engage in fcu-related activities could have impacted the discussions about fcu. certain experiences or events in relation to their fcu-work could, for example, have affected the participants’ way of remembering, talking about, or referring to the model as well as the training provided by cfp-cmh. no such impact was, however, obvious at the time. the fact that some of the participants were trained in fcu in conjunction with a research-project on fcu in sweden, constitutes a third possible limitation. these practitioners were provided with more time for learning and practicing the model, a situation different from the normal procedure of training practitioners in fcu. their experience might have impacted these practitioners with regards to their thoughts about fcu. lastly, as a sole author of this article, i was the one conducting the process of data analysis. to analyze data alone might increase the risk of bias. however, a recursive and thorough process of analysis, and with continuous discussions held with one colleague, is argued to add to the study’s trustworthiness. conclusion and implications consistent with previous studies, the importance of sufficient resources for working with evidence-based models, like fcu, is evident (bertram et al., 2015; heiwe et al., 2013; mauricio et al., 2018; ryding & wernersson, 2019). as with the importance of a sufficient knowledgebase for achieving successful implementation and later work with the model, the need for sufficient learning time to master the model cannot be stressed enough. to support the later practical use of models in which the practitioners have been trained, there is need for both preparedness and support. organizational readiness is important for the actual implementation as well as for the maintenance phase (ogden et al., 2009). rather than trying to reduce costs by streamlining practice, agency leadership need to recognize that investing in evidencebased models creates the possibility of professional learning and development. if learning is primarily perceived to take place in formal education (e.g., courses), the ongoing learning made possible in everyday practice (informal/non-formal learning, e.g., eraut, 2000) might be underestimated as a knowledge source. in line with results from other studies (avby et al., 2013; bergmark & lundström, 2011; gambrill, 2010; ryding & wernersson, 2019), varying opinions about ebp are still evident. the problem, though, lies in the misunderstandings and preconceptions surrounding ebp as a phenomenon. consequently, the importance of continued efforts to update and renew the meaning and understanding of ebp and its associated models ryding/professional learning in family support 630 must be emphasized. this is not an easy task, especially since ebp is occasionally implemented for reasons other than those that benefit the professional and the service user, and its use is often determined by politically-initiated decisions, as is the case in sweden (denvall & johansson, 2012). in line with many other concepts, ebp is both complex and multifaceted and occurs in various fields. therefore, we should perhaps refrain from trying to find a single, universal definition of ebp. too much variation though, as between ebp as a philosophy and ebp as a cost-cutting and manual-based way of guiding practitioners, is highly problematic and further implies a misuse of ebp as a concept. the varying experiences of ebp highlights the need to keep on informing and spreading knowledge about various ways of perceiving ebp. through continued research on various stakeholders’ experiences and understandings of ebp, of implementation, training, and the use of evidence-based models, an updated conceptualization of ebp can be reached (e.g., gray et al., 2015; 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(2018). emotional labour in social workers’ encounters with children and their families. the british journal of social work, 49, 217-233. https://doi.org/10.1093/bjsw/bcy016 author note: address correspondence to jennie ryding, department of social and behavioural studies, university west, gustava melins gata 2, s461 86 trollhättan, sweden. email: jennie.ryding@hv.se acknowledgments: i would like to thank the participants for providing both interesting and important insight into the area, the centre for progress in children’s mental health for co-financing this project and the child & youth studies at university west. https://doi.org/10.1093/bjsw/bcy016 mailto:jennie.ryding@hv.se ryding/professional learning in family support 636 appendix data analysis procedure, according to the recommendations of braun & clarke (2006). the examples below were originally in swedish and later translated into english. phase description example transcribing all transcriptions of what the focus groups said are verbatim, using the software expressscribe. reading through all transcriptions were read through so that i became familiarized with the content. important content and initial ideas about interpretations and connections were noted. example of content noted as important: ‘the work of learning the model has made me feel quite secure as a family therapist, i mean in my role today because i, i can sort of lean back on, it is not just me thinking a lot of things, rather it’s connected to research all the time and it does something with the parents i meet too, because they, they become secure and calm too, this is like, well yes, now you really get security, or quality assurance for all of it. so then it’s also important to know when you need to broaden a little bit because it is not a, all families, it doesn’t work for all families and some parts are like, at least the way i think, are missing in the model, in any case in everyday parenting, but there i have added them on my own… but as a family therapist i can also see, you can even watch a video and see your own development, that that has meant so much. how you have gone from being that counsellor to becoming someone that, yes, highlights, or emphasizes what comes from the family instead, that i think is really cool.’ coding a second reading of the transcripts followed, using the software maxqda, and simultaneously organizing data into initial codes that later were organized into groups of codes (i.e. categories). the codes created identified features of the data with relevance to the aim of the study. codes were reworked after the initial coding. the extract above was organized into the following codes: professionally developing; “do it yourself”; the power of evidence; fcu-related; process and progression; the importance of learning; discretion/intuition/proven experience. the above-mentioned codes were later, depending on content, organized into common categories: professional development; concrete impact on practice; fcu-related. searching for themes final codes were categorized into different, initial themes. codes relevant to one area of interest were collected under one theme, some with subthemes, with the aim of providing a true description of the data and in relation to the aim of the study. for example: some of the codes mentioned above were considered to belong together, thus summarized into the tentative theme: process. other examples of tentative themes were episteme, techne and phronesis and to not cease to learn – a mutual responsibility. codes with a connection to each other were thus collected, in an attempt to describe the findings of the study. reworking of themes initial themes were reworked to ensure that they highlight the content of the data. initial theme-names were reworked during the process to ensure their consistency with the data set. the above-mentioned tentative themes, along with the others, were reviewed and adjusted, both in terms of content and names. some codes were removed and others added, all depending upon the focus of the specific theme. for example, the tentative themes process and episteme, techne and phronesis were merged and finally called learning by doing. another example is the tentative theme-names what is learning? and professional learning and development through fcu, that later resulted in one common theme called experiential learning. findings the final themes were used to describe the findings of the study. quotes from the participants are used to further illustrate the content and meaning of each theme. the final themes were used to describe the participants’ thoughts and discussions about professional learning and development as well as their experiences of learning and working with fcu. the aim of the analysis was to capture the participants’ experiences relating to the topic, however, also connecting it and comparing it to previous research by adopting an abductive approach. ebp: a contested concept the present study method participants and procedure all participants were engaged in family support. before the focus groups began, participants were asked to fill out a form with some background questions, covering both years of work experience and a specification of what models/methods they were trai... because the project was financed by cfp-cmh, it was important to maintain a neutral attitude towards fcu as a model and the work of cfp-cmh. the goal of the researcher was to not be affected nor affect the participants in any direction (i.e., favoring... interviews findings theme 1. learning by doing theme 2. practical impact theme 2.1. the power and role of evidence theme. 2.2. learning – enabled by experience and reflection theme 3. empowering discussion limitations ponnert l., & svensson, k. (2019). socionomen i myndigheten: göra gott, göra rätt, och göra nytta [the social worker in the authority: do good, do right and be of help]. malmö: gleerups. sayer, a. (2010). method in social science (rev. 2nd ed.). routledge. schön, d. (1991). the reflective practitioner. aldershot: ashgate sichling, f., & o’brien, p. (2019). knowledge that changes social work practice: an exploration of its sources and content. advances in social work, 19, 383-396. https://doi.org/10.18060/22918 acknowledgments: i would like to thank the participants for providing both interesting and important insight into the area, the centre for progress in children’s mental health for co-financing this project and the child & youth studies at university w... _________ nia johnson, phd, assistant professor, graduate social work department, west chester university, west chester, pa. paul archibald, phd, lcsw-c, assistant professor, department of social work, college of staten island, city university of new york (csi), staten island, ny. anthony estreet, phd, lcsw-c, associate professor, school of social work, morgan state university, baltimore, md. amanda morgan, msw, lcsw-c, field director, master of social work department, chamberlain university, chicago, il. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), #-#, doi: 10.18060/24115 this work is licensed under a creative commons attribution 4.0 international license. the cost of being black in social work practicum nia johnson paul archibald anthony estreet amanda morgan abstract: the social work profession is not exempt from fueling institutional racism, which affects the provision of social work practicum education for black social work students. this article highlights how the historical and current social cost of being black in the united states presents itself within social work education’s signature pedagogy. social workers who hold bachelor’s degrees in social work (bsw) are more likely to be black than those holding master’s degrees in social work (msw; salsberg et al., 2017). it takes black students longer to earn an msw degree though they are more likely to hold a bsw while also having work experience related to the social work profession; this is indicative of a flawed system. the implications of this are explored by highlighting social work’s historical context and the role privilege holds within a profession charged with working towards social justice. critical race theory (crt) is utilized to unearth how the current state of social work practicum upholds a culture of white supremacy through covertly racist requirements and practices. case examples are utilized to demonstrate the challenges black students face as social work practicum mimics oppressive practices and perpetuates disparities in the social work landscape. additionally, this article explores oppression’s role in treating vulnerable social work students and how that treatment is reflected in the workforce, ultimately informing service delivery. keywords: critical race theory, social work practicum, social work education, antiracism racism has been shown to interrupt the success of black people in colleges and universities (kirp, 2019; mcdermott et al., 2020) and has become an area of inquiry in social work research (beck, 2019; tisman & clarendon, 2018). to further illuminate our understanding of racism and social work education, social work researchers have begun to incorporate critical race theory (crt) to help address the profession’s gaps in recognizing privilege and oppression (kolivoski et al., 2014; sulé, 2020). legal scholars founded crt in the 1970s to combat the subtlety of racism through analysis and transformation (bell, 1980; crenshaw, 2010). crt examines the role of race and racism in society by highlighting the ingrained “normalcy” of racism as a means to structurally sustain privilege and oppression (masocha, 2015). as various disciplines have adopted crt, its themes also provide a lens through which the social work profession can critically analyze its role in upholding racist ideals (kolivoski et al., 2014; sulé, 2020). the use of crt for analyzing pedagogical practices is increasingly vital to social work’s progress towards social justice during times of political discord (constanceabout:blank https://oxfordre.com/socialwork/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-1329 https://oxfordre.com/socialwork/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-1329 advances in social work, summer 2021, 21(2/3) 2 huggins, 2019); an exemplar being the executive order on combatting race and sex stereotyping ordered on september 22, 2020, by president donald j. trump. this order required that all federal contractors and subcontractors refrain from conducting workplace trainings that incorporate the following concepts: a) one race or sex is inherently superior to another race or sex; b) an individual, by virtue of their race or sex, is inherently racist, sexist, or oppressive, whether consciously or unconsciously; c) an individual should be discriminated against or receive adverse treatment solely or partly because of their race or sex; d) members of one race or sex cannot and should not attempt to treat others without respect to race or sex; e) an individual’s moral character is necessarily determined by their race or sex; f) an individual, by virtue of their race or sex, bears responsibility for actions committed in the past by other members of the same race or sex; g) any individual should feel discomfort, guilt, anguish, or any other form of psychological distress on account of their race or sex; or h) meritocracy or traits such as a hard work ethic are racist or sexist, or were created by a particular race to oppress another race. (white house, 2020, sec. 4) the effects of executive order 13950 were immediate as stanford university immediately issued a directive to all faculty cautioning the use of the phrases "systemic racism" and "racial humility" within training programs (bagdasarian, 2020). although a federal district court issued a preliminary injunction in december 2020 (united states district court, 2020) and on january 20, 2021, president joe biden issued an executive order 13985 overturning executive order 13950 (white house, 2021), we were given a snapshot into how easy it was to muzzle the necessary efforts of social movements and dismiss the oppression experienced by racialized people. this set a precedent for future attacks on crt, including passing legislation in states like florida and kentucky that restricts comprehensive instruction on race-related topics with hefty consequences, not limited to financial fines and demotions (boyles, 2021; florida department of state, 2021). this conflict between crt and the political climate breeds an opportunity to highlight the relationship between the main propositions of crt and the values and practice of the social work profession. social work education and racism the initiative task force on weaving the fabrics of diversity translated the 2005 social work congress and the national association of social work (nasw) racism policy statement as a call to action to address institutional racism not only in society but within the social work profession (nasw, 2006, 2007). jaschik (2019) described how institutional racism is activated in the lives of black people who attend schools and programs (not all programs are in schools of social work) of social work in the united states. the article described an incident where a white social work student reported that johnson et al./cost of being black 3 the perceived threat that "black presence" poses in the classroom made it uncomfortable for them to lead discussions. the university was able to clearly recognize that there were some long-standing issues of institutional racism at this school of social work, mainly in the classroom. this recognition seems consistent amongst social work professionals focused on addressing racism issues in the classroom and curriculum. there remains a limited emphasis on racism issues in field education, identified as social work practicum throughout this article to interrupt the use of terminology with a racially oppressive association (rzack, 2001; weng, 2017). approximately 17 years ago, smith college school of social work recognized no substantial efforts in the social work practicum process to address anti-racism (donna & miller, 2006). in response to this, an anti-racism practicum assignment was added to the curriculum to allow students to add anti-racism skills to their social work toolbox to be utilized later in their social work professional endeavors (basham et al., 2001). based on the results of the training, it was recommended that there be increased anti-racism training and support for faculty practicum advisors and supervisors. ladhani and sitter (2020) conducted a literature review and proposed that an anti-racism approach in social work education is not enough if it does not include assessing the institutional culture, policy, and standards. they argue that addressing institutional racism in social work classrooms through anti-racism education can attend to the reality of marginalized people's oppression. singh (2019) argued that there is a dearth of empirical evidence that shows how social work education programs are preparing social work students to work with issues regarding racism. failure to address racism in social work practicum serves as a detriment to the social work profession since the council on social work education (cswe) recognized "field education" as the signature pedagogy in the educational policy and accreditation standards (epas) for schools of social work; affirmed in 2008 and reaffirmed in 2015 (cswe, 2008, 2015). social work education requires both academic and professional training, which has been associated with higher stress for social work students than those in traditional academic programs (hemy et al., 2016). the social work educational stress is associated with the requirements of academic and professional skill development coupled with meeting all the demands of the social work practicum (dziegielewski et al., 2004; rosenthal & baum, 2010). anxiety regarding competency and its future impact on career trajectories was a common occurrence at practicum placements (hemy et al., 2016; razack, 2001). balancing social work practicum and course requirements with competing responsibilities and the financial cost of education often served as barriers to degree completion, with barriers experienced at greater rates for black students (masocha, 2015). nonetheless, the social work practicum continues to serve as the signature pedagogy and the central focus of social work education where students are instructed and socialized, primarily outside of the university, to "think, to perform, and to act ethically and with integrity" (shulman, 2005, p. 52). however, black social work students reported exposure to pervasive covert and overt affective (prejudice), behavioral (discrimination, microaggressions), and cognitive (stereotype) components of racism (ostrom, 1969) while in their social work practicum (razack, 2001). racism has been identified as a significant chronic stressor (clark et al., 1999; paradies et al., 2015), leading to racial battle fatigue— physiological and psychological strain of pervasive coping strategies to alleviate effects of advances in social work, summer 2021, 21(2/3) 4 microaggressions and racism (franklin, 2019; smith et al., 2007) and symptoms of posttraumatic stress disorder (ptsd; williams et al., 2018). the cumulative effects of these biopsychosocial disorders seem to spill over into black students' academic processes and may serve as a barrier to successful completion of academic social work programs (rajanrankin, 2014; salsberg et al., 2019). since racism is embedded in every facet of black people's lives and is known to affect their well-being (paradies et al., 2015; sulé, 2020), the social work profession is not exempt from fueling racism. the authors propose that it is time to acknowledge how institutional racism affects the provision of the social work practicum. in this article, we argue that crt can address the institutional racism faced by black students while in their social work practicum. utilizing the lens of crt, the authors challenge the social work profession to consider the extent to which the racial concerns of black students go undetected during the practicum process. three case examples are presented to illustrate the process of using crt to uncover white-supremacist practices in the social work practicum. we propose that social work can fight against white supremacy by providing an enhanced critical analysis of our practices by examining the social work practicum's process through the lens of crt. crt is presented as a means of analyzing the use of race (e.g., black) and place (practicum agency) in the pedagogical practices of the social work practicum to begin to destabilize white-centric ways of thinking about and engaging black students' differences and identities. journey to practicum the current state of social work practicum is a result of the social work profession's historical foundation. embedded in this foundation are the elements that support current labor and economic disparity: oppression and exploitation. massive economic problems and displacement caused by the civil war set the impetus for the social work profession (day & schiele, 2012). charity organization societies (cos) were established as a means of welfare reform by providing case management services via "friendly visitors"; untrained white, wealthy women volunteers tasked with determining the worthiness of need. the use of moral reform – worthiness of provisions based on work ethic – incentivized labor through stigmatizing relief. perceptions of minorities as morally inept supported the absence of provisions for black people and further substantiated a hierarchy within the labor force, a necessary element of capitalism. day and schiele (2012) explain that cos existed to uphold industrial capitalism through subduing dissension among the poor and maintaining a low-wage workforce. similarly, the settlement house movement upheld oppressive practices by excluding black residents, further expanding social work’s foundational racism (mccutcheon, 2019). gary and gary (1994) discuss that the divisiveness and discrimination apparent in the foundation of the social work profession is inherent to social work education. while the cos founded the summer school of philanthropic work in 1898 as the first social work program, it primarily served white students (gary & gary, 1994). during that time, segregated school systems denied black people access to white social work programs. much like the denial of service provision, black people were forced to meet their own https://oxfordre.com/socialwork/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-1329 johnson et al./cost of being black 5 educational needs by establishing the first black social work program at fisk university in 1911 (gary & gary, 1994). black higher educational institutions were, and remain, underfunded and under-resourced, hindering the training needed to thrive in the profession (daniel, 2016). for instance, in 2015, black higher educational institutions received approximately $2.2 billion in funding from federal, state, and local sources, while predominantly white institutions (pwis) received more than $94 billion from these same funding sources (williams & davis, 2019). to put this into a greater perspective, in 2014, four pwis received more revenue from federal, state, and local grants and contracts than all four-year historically black colleges and universities collectively (toldson, 2016). this lack of funding increases vulnerability to low student retention rates, technology and infrastructure deficiencies, lack of vital resources, the decline in enrollments, and threats of closures (gasman & commodore, 2014; richards & awokoya, 2012). this makes it difficult to sustain the disproportionate number of predominantly first-generation black student populations from low-income backgrounds (saunders et al., 2016). consequently, upon graduating, many black social workers could not afford to further their education, accrued higher rates of educational debt, and had to solidify employment immediately; forcing them to settle for lower-paying positions (masocha, 2015; salsberg et al., 2020; saunders et al., 2016). this exploitation exemplifies capitalism by filling labor needs at the lowest possible costs by limiting professional specialization, thus ensuring a division of labor that favors the privileged. initially, social work programs operated without a unified governing organization (day & schiele, 2012). the cswe was established in 1952 to create an accrediting body for social work programs, standardizing social work education programs (cswe, 2021). mandates for social work practicum were established approximately 30 years later through cswe's council on accreditation with the intent to integrate theory and practice; practicum hours were designated at 400 hours for bachelor's level students and 900 for master’s level students (raskin et al., 2008). the impetus for these requirements was to support social work programs in requesting additional funding and resources, though they lacked empirical validity (buck & sowbel, 2016; raskin et al., 2008). consideration was not given to the feasibility of students to meet such requirements; rather, the assumption of availability was made and remains intact. current practicum requirements mirror past practices of professional volunteerism by demanding students to work for free, a privilege few can afford. today, funding for college is an issue for students of many ethnic and racial backgrounds, given increases in fiscal responsibilities (owens et al., 2010). however, black students are more likely to incur substantially higher educational debt rates than their white counterparts; black students incur an average of $92,000 in total educational debt compared to the average debt of $57,000 for white students (salsberg et al., 2020). bachelor's degrees allow social workers admittance to the profession with employment opportunities in direct practice “frontline” positions earning low salaries. master’s degrees serve as the terminal degree for the profession, granting social workers access to leadership and supervisory positions in practice settings. black students take longer to earn an msw degree though they are more likely to hold a bsw while also having work experience related to the social work profession (salsberg et al., 2019). maintaining the status quo keeps the current advances in social work, summer 2021, 21(2/3) 6 demographic makeup of social workers within their current positions; black social workers are more likely to be employed at the bsw level than at the msw level (salsberg et al., 2019). this serves capitalism while being in direct opposition to social work values and tenets. social work practicum process through critical race theory lens the effects of the practicum process on the ability of black social work students to successfully complete bsw and msw programs are not fully understood. however, the disparities in degree attainment and published research results are evidence of race-based issues within social work education. the basic tenets of critical race theory are outlined in table 1 and explored below to illuminate these issues, particularly how social work education's claims of objectivity and neutrality normalize and perpetuate racism. these tenets frame how this is accomplished through the structural inequalities that permeate the requirements of the signature pedagogy of social work education — practicum. table 1. tenets of critical race theory 1. color blindness 2. interest convergence/materialist determinism 3. race as a social construction 4. differential racialization 5. antiessentialism/intersectionality 6. unique voices of color or counterstories 1. color blindness racism is a pervasive, never-ending cycle of occurrences in the lives of black people. it is rooted in the united states (us) social structures and practices and is so embedded in societal norms that the effects on black people often go unnoticed by people with white privilege. this allows racism to permeate and grow from one generation to the next, thus ensuring current power structures are upheld. as a product of us society, social work practicum often displays color blindness masked by the profession's “good” intent and ethical obligations. it is inferred that a profession charged with advocating for social justice and the dignity and worth of a person is inherently equitable and anti-racist. thus, the profession has existed without the necessary interrogation of its practices and practicum placements. practicum instructors and supervisors serve as critical gatekeepers given their role within social work's signature pedagogy. in addition to signing off on student's competency for practicum requirements, they often provide recommendations for employment and further degree attainment. this power dynamic can impact the launching of students' careers and informs their overall professional self-concept. deferring to color-blindness due to discomfort in addressing race-related issues transfers a weighty responsibility from the instructor onto students (milner, 2010). black students must then negotiate between the risk of being labeled as lazy, angry and aggressive, or being silently complicit in the face of oppression. regardless of the decision, johnson et al./cost of being black 7 the experience shapes how students form their identity as social workers and their perceptions of the profession. the use of race-neutral pedagogical and administrative practices not only compromises student's learning outcomes and associated health outcomes but also denotes a lack of competence (razack, 2001; nebeker, 1998). practicum instructors are encouraged to be culturally competent (knowledge-based) but not culturally proficient (action-based) (cross et al., 1989). therefore, most professional training on cultural awareness is insufficient in building that cultural proficiency due to the omission of institutional racism, power dynamics, and white privilege in the training curriculum (shepherd et al., 2019). to shift from the current practice of color blindness, practicum instructors and supervisors should engage in trainings focused on color consciousness, a practice that considers the context of racial discrimination and privilege (constancehuggins & davis, 2017). for example, the color-conscious multicultural mindfulness (ccmm) training allows for persons not directly impacted by racial oppression to enhance their perspective on race and culture through the use of mindfulness techniques (lenes et al., 2020). the ccmm training has been shown to promote significant color-blindness changes related to privilege and institutional and overt racism. 2. interest convergence/materialist determinism racism and oppression are economically and psychologically advantageous to the majority. it has been documented that black workers spend an average of 38.7 hours weekly in the work environment compared to 38.9 for whites (bureau of labor statistics [bls], 2020a). although these working hours are comparable, blacks have an unemployment rate of 6.5 versus 3.5 for whites (bls, 2020b). despite the efforts of the civil rights movement, there has been no real change in the level of racial employment discrimination against blacks over the past 25 years (quillian et al., 2017). this has implications for the black-student professional as they are initiated to social work employment through social work practicums. social work employment is projected to experience a 13% increase by 2029 (bls, 2020b). hence, social work education programs must meet that need while considering the demographic shift towards a more racially and ethnically pluralistic united states (olcoń, 2020). it is in the profession's interest to produce social workers representative of that demographic shift. therefore, progressive change occurs when the majority's interests converge with the oppressed (abrams & moio, 2009; bell, 1995). while progressive change is needed, the lack of interrogating the impetus for needed change ensures that current power structures are upheld. for instance, social work practicum placements benefit from the free labor provided by students (harmon, 2017; unrau et al., 2020). this is particularly taxing for black students as they experience more significant financial strain while enrolled in social work programs (salsberg et al., 2020). therefore, black students are more at risk of missing work resulting in loss of income or practicum hours, resulting in prolonged matriculation. this further ensures that black people are more likely to be in frontline social work adjacent positions that do not require advanced degrees, reassuring the success of capitalism and the continuation of privilege. karl marx pointed out that capitalism exploits working people by usurping their social value through their labor (hollander, 2008). advances in social work, summer 2021, 21(2/3) 8 3. race as a social construction race is designed by society to place individuals in designated categories based on physicality and is not rooted in any biological or scientific reality. these categories are hierarchized as a means to support an economy that ensures privilege by way of disparity. the implications of racial hierarchization can be seen within the social work profession through its composition and service delivery. black students matriculate through social work programs under a white gaze; the scrutiny of white peoples' perceptions is rooted in stereotypes of racialized people's inadequacy (hooks, 1992; miehls, 2001). under the measuring stick of white centeredness and privilege, black students are to learn and perform. this can result in experiences of marginalization within practicum placements (razack, 2001). fairtlough and colleagues (2014) note that the differential access to social, cultural, and economic capital creates challenges for black students' matriculation. these challenges pose a threat to degree completion, which sustains power structures of racial hierarchies. stress related to the responsibilities accrued due to differential access impacts students' experiences and progress. black students are more likely to have caregiving responsibilities, inaccessibility to reliable transportation, and financial responsibilities that require them to be employed while in school (unrau et al., 2020); these stressors are compounded by the judgement and isolation often experienced within predominantly white placements (fairtlough et al., 2014). the negative assessments based on discriminatory perceptions of nonverbal behavior and the assignment of tokenism towards a black student who contradicts stereotypes indicate the power of the white gaze and the social construct of race. the penalization of students for not adhering to white norms and not having the resources for certain placements should be reassessed as a shortcoming of practicum placements and not that of students (fairtlough et al., 2014). 4. differential racialization differential racialization allows for practicum placements to assume a position of diversity and inclusion as the presence of members from one oppressed group can represent all minorities (bonilla-silva, 1997). the fluctuating attention given to racialized groups is attributed to shifts in economic and political climates (campbell, 2014; delgado & stefancic, 2001). historically, groups have been racialized and oppressed based on the needs of the majority at that time. while minorities of one group see progress, other minority groups find themselves at a more significant disparity. this ensures that capitalism can function as intended by way of exploitation. additionally, it waters down the pervasiveness of racism by not overtly oppressing all racialized minorities simultaneously, thus hindering solidarity and collective action. in marginalized black students, their experience with racism may be deflected, which increases feelings of isolation. as the intent to persist within educational programs is impacted by a students' sense of belonging and their relationships with faculty, the muting of experiences with racism can be damaging to academic success (beadlescomb, 2019). johnson et al./cost of being black 9 schiele (2007) conceptualizes how the equality-of-oppressions – a paradigm that assumes no hierarchy in forms of oppression – weakens social work education's capacity to address race and racism effectively. it is critical to support all groups who feel oppressed, discriminated against, and marginalized. however, within the social work profession, this is often done at the expense of black people by leveling the pervasiveness of racism with other oppressions regardless of the variance in risk and impact. for example, graham and schiele (2010) point out that the equality-of-oppressions paradigm takes a one-dimensional assessment of racism mainly focused on economic status. it does not consider the more contemporary face of racism that perpetuates benefits to the dominant population at the expense of the minority population. it also does not consider that there are varying degrees and differential ways that minority groups experience oppression. they posit that this increases the prevalence of color-blindness and increases the idea that racism is declining. they go on to recommend the use of differential vulnerability to determine risk and impact using young's (1990) five faces of oppression paradigm: (1) marginalization; (2) powerlessness; (3) exploitation; (4) cultural imperialism; and (5) violence. in this paradigm, marginalization places minority populations at the most significant vulnerability based on the oppressive acts that place them outside of society. 5. antiessentialism/intersectionality a focus on the social construct of race often ignores the multiple identities of individuals who face different aspects of oppression and marginalization. using a cookiecutter response to oppression may force a person to prioritize one part of their identity, leaving other oppressed parts of their identity to go unacknowledged. negating the full context of black students' identity reinforces racial stereotypes, silences opportunity for self-advocacy, and limits the prospect to harness their greatest professional tool; the use of self. these experiences impact the cultivation of their social work professional identity as having to compartmentalize one's identity creates a level of dissonance. additionally, it models behavior for white interns, which perpetuates the cycle of white supremacy and racist ideologies. not considering intersectionality allows for the misuse of black students within practicum placements. predominantly white placements whose client base is predominantly black may overestimate black interns' competence at rapport building. this monolithic assumption of black people is harmful to the academic process and the outcomes of service delivery. intersectionality allows for acknowledging all dimensions of diversity within the context of societal structures, oppression, and privilege (crenshaw, 1989). failure to instill this concept within students fails to teach students to “engage diversity and difference in practice”; an accreditation standard established by the council of social work education (cswe, 2015; olcoń, 2020, p. 215). 6. unique voices of color or counterstories history is told from a dominant worldview through a white-centered lens and regularly excludes the black perspective. jane addams and the hull house are marked as the birth of social work. however, it is rarely acknowledged that the hull house was segregated advances in social work, summer 2021, 21(2/3) 10 until the 1930s. black settlement houses like the phyllis wheatley settlement house in minneapolis, minnesota; the wendell phillips settlement house in chicago, illinois; and the lincoln settlement house in new york, had limited autonomy on how blacks could be serviced as the board of directors were all white members. this control over service delivery supported the “do-gooder” narrative while maintaining power structures and social control. controlling the narrative is essential to upholding white supremacy, as evident in the erasure of the contributions of black people to the profession. this is done through a social work education that is racially ahistorical. settlement houses that were established and run solely by black people are rarely discussed in classrooms. mutual aid and self-help have historically been fundamental to the black community, with roots in the african tradition, transferred in the transatlantic slave trade, and honed during the american enslavement period (carlton-laney, 1999). the contributions of black social work pioneers such as mary church terrell, lugenia burns hope, or willie gertrude brown are often overlooked. the black historical context is limited to discussions of the contemporary implications of discriminatory policies. carlton-laney (1999) apprises that the profession fails to acknowledge the contributions of black people, evidenced by their lack of interest in researching, attaining, and understanding black pioneers' historical imprint on the profession. by not acknowledging what black people did for themselves and the overall profession, the current narrative supports racial hierarchies and stereotypes by highlighting whites as givers and black people as needy. the centering of the white voice in social work education limits the full context of the profession and disallows black students from seeing themselves within the profession. crt maintains that the use of voices of color is essential as racial minorities have a level of assumed competence on topics of race and racism. a marginalized stance can lend itself to a position of strength and radical possibility (collins, 1990; hooks, 1992). defining student success by the ability to conform to established norms negates the experiences of students who have succeeded from a stance of resistance as a means to transform systems (solórzano & villalpando, 1998). considering these counterstories is to consider and acknowledge students' active participation in social justice while also illuminating the social work profession's role in upholding injustice. this process would require social work professors and supervisors to interrogate their level of competence with diversity. case examples the following case examples are based on the accounts and descriptions of student experiences by a social work practicum administrator who is one of the co-authors. the nature of the social work practicum, in its current form, requires a sacrificial commitment by students that often forces them into similarly precarious circumstances as the clients they serve in their placements. how can the social work profession mandate a requirement that nearly forces students to divest from their own intention to succeed? how do we reflect dignity and worth of the person and social justice as professional values, while devaluing black students through our inattention to systemic challenges that impact their matriculation? the following case examples highlight the practicum experiences of black students through a crt lens. johnson et al./cost of being black 11 case example 1 a 35-year-old black man enrolled in an msw program at a predominantly white institution comes to meet with the social work practicum administrator to discuss his placement options. he requested to meet with the social work practicum administrator to discuss his options for a change in placement that will help to diversify his skillset. he has over 10 years of experience working at a juvenile justice center, where he reported that he will remain employed full time while in school. during the meeting, it was determined that his job, home, and the university he attends are within a 5-mile radius. however, he is placed at a children’s center for court-ordered youth located 45 minutes away from his home. the social work practicum administrator responds to his inquiry by saying, “this really is the best placement for you because the clients need people that are like them who they can connect with.” while the social work practicum administrator meets with the supervisor and reflects on her case notes, it emerged that there was limited consideration for the student’s desire to expand his competence in areas of social work that were not related to criminal justice. the final decision was made that he would remain placed at the children’s center because the practicum supervisor reported that there was a need for black male interns to connect with their current client population. interest convergence allowed for this black male student to be used for free labor at the expense of his educational experiences, making it more beneficial for the practicum than the student (abrams & moio, 2009; delgado & stefancic, 2001). using race as the qualifier for assigning practicum placements is an inherently prejudiced essentialist practice that assumes competence based on a social construct. it implicitly infers black clients’ inability to work with white providers and white providers’ incompetence with anyone who is not white. additionally, it upholds a limiting narrative that black social workers should only work with black clients; a population most often underserved. this can create a false just-like-me social work labor force using the bodies of black studentprofessionals, which may decrease overall self-efficacy related to social work skills. black students who may find it difficult to relate to their clients in a way that is expected by their practicum supervisor may develop an adverse reaction to their practicum experience. an adverse reaction may include experiencing impostor syndrome, coined by clance and imes (1978) — which are internalized feelings of fake intelligence despite ample object evidence of their high level of intellectual capacities. this is a complicated issue for black students as they may already have been treated as impostors in other work environments managed by the white majority. cokley et al. (2013) found that there was a positive association between black college students reporting anxiety and discrimination-related depression and their positive identification of experiencing impostor syndrome. homogenizing black students in the social work practicum environment is beneficial to fill the workforce gaps of many agencies in response to the needs of many of their underrepresented and oppressed clients. however, treating black students as if they have a single shared experience maintains racial hierarchization, power, and privilege. advances in social work, summer 2021, 21(2/3) 12 case example 2 a 24-year-old black woman is in the final year of an msw program. she is assigned a child welfare placement at a predominantly white organization located in a predominantly black urban environment. most of the interns at the placement attend the same predominantly white university. the student is one of two students who attend a historically black university. while the interns and supervisors collectively watch the inauguration of president barack obama in the conference room, the student voices her excitement for the new president. the director of the organization shakes his head and says, “this is a bad move for the country.” the student attempts to professionally engage the director about his comment. during the discussion, the student uses research from black scholars to support her statements; the director denounces the validity of the research because “people have never heard of them.” later that day, the director requests a meeting with the student. he states to her, “your arrogance may not go over well in some spaces.” for the remainder of the semester, she receives lower ratings on her performance reports without any evident changes in behavior or productivity. centering the white voice helps to maintain power. by denouncing the credibility of black scholars, the director in this example attempted to erase the contributions of his black colleagues while also implicitly trivializing the future contributions of a black student. he modelled prejudiced behavior for white students, which could result in them upholding such ideals throughout their careers. additionally, through labeling the student, he helps to shape her social work professional identity and forces her to choose between self-silencing or the consequences of advocacy. case example 3 a 27-year old black woman enrolled part-time in an msw program also works as an assistant director of a local homeless shelter. the student commuted to class from a distance of 4 hours round-trip, once per week. the msw program approved an employment-based placement, since decreasing her full-time work hours posed financial difficulties for her. she also had financial caretaking responsibilities for her grandmother. the student worked at the shelter from 7am 3pm and worked at her practicum placement from 4pm 9pm, monday through friday. she slept an average of 4-5 hours per night to successfully complete her coursework, which impacted her health. she had emergency surgery mid-semester and had a sudden close family death weeks after. the surgery and the sudden loss required her to miss practicum hours and course deadlines, which she worked to make up. she discussed leaving the program with her black professor after her white practicum director indifferently reminded her of her requirements to graduate. black students are often involved in practicum assignments that create chronic stressors and are a burden on their time and finances without opportunities to negotiate. due to the effects of internalized oppression, many students have not fully developed the agency to assert their discomfort and seem to relieve their stress through the process of john johnson et al./cost of being black 13 henryism active coping (jhac; james et al., 1983). black students engaged in social work practicum may use this type of coping strategy to alleviate the stress stimuli associated with racial discrimination by adhering to a sustained intense commitment to hard work and success. in doing so, black students intend to dispel the work-stereotype threat of “laziness” by intensely focusing and increasing practicum task performances. unfortunately, the high-effort strategies used to accomplish jhac in the workplace have been found to be positively associated with a greater likelihood of health issues (hudson et al., 2016; kramer et al., 2015). discussion understanding the current climate, which highlights ongoing racism and social justice issues and the noted historical oppression that permeates the social work profession, it is imperative that the profession engages in an in-depth exploration from an education and practice perspective. attention should be given to how racism and oppressive practices are upheld within social work's “signature pedagogy” and its impact on students and the growth of the entire profession. as highlighted in this article, black students often face many challenges as they navigate their social work education. these challenges can lead to early career burnout (amir et al., 2018), the reduction in workforce diversity (salsberg et al., 2017), increased behavioral health challenges (cokley et al., 2013), and as previously mentioned, increased time to obtain their master's degree (dinnerson, 2019). to reduce and protect black students from the many challenges highlighted in this article, social workers and the profession must move towards increasing anti-racist practices (ladhani & sitter, 2020). it is no longer enough not to be racist; social workers must commit to making unbiased choices and being anti-racist in all aspects of their lives. as a profession, it is crucial to be intentional with our efforts and change the current practices. in keeping in line with the tenets of the crt, the following are offered as suggestions to help reduce the oppressive nature of practicum at the individual and institutional levels within social work education. in particular, we offer practical suggestions which can be implemented immediately by schools of social work. programs can start with the recognition and open discussion among social work programs regarding the role of privilege and microaggressions within and among the existing faculty and staff. it would also require a deep dive into the explicit curriculum to better understand existing practices of covert oppression, discrimination, and racism (brown et al., 2019). one such example of this exploration could be around language, understanding what language is used and how it is perceived by minority and marginalized groups. an example of this is the widely used term “field education” for the social work practicum or internship experience. this term is used without considering its unintentional traumatic associations, among black students, with the terms field slave or field negro, who worked outdoors often in very harsh and oppressive conditions. this is supported by degruy's (2005) theory of post-traumatic slave syndrome (ptss). ptss is a theory that provides a conceptual explanation for the etiology of psychosocial disorders among blacks as a consequence of slavery in the form of multigenerational oppression of africans and their descendants; stereotypes that black people were inherently and genetically inferior to advances in social work, summer 2021, 21(2/3) 14 whites; and institutional racism. while this may not be the intent of the social work practicum, exploring alternative words such as internship, externship, practicum, residency, etc. should be explored to remove the possible negative impact on black students. in addressing the aspect of color blindness, practicum instructors and supervisors should engage in more culturally responsive training that focuses on increasing their understanding regarding contextual factors of discrimination and privilege. this would highlight the importance of seeing an individual's race and the multiple points of intersectionality that could influence various interactions within the placement. moreover, instructors and supervisors should also be open to and embrace the process of storytelling, counter-storytelling, and naming one's reality. to engage in this practice, social workers need to look internally at their understanding of diversity, oppression, and racism. addressing this tenet would mean placing value on the voices and stories of students and their experiences. this includes the negative experiences that may arise from their participation in the program as a whole or within the practicum placement (davis & livingstone, 2016). ongoing assessment of the implicit curriculum must take place using a crt lens to capture these stories better and determine the appropriate corrective actions needed to alleviate oppressive practices. as social work education starts to address racism within the profession, it is imperative that an anti-racist lens be engaged for an active process of understanding race and racism. understanding race as a social construct and taking actions to end racial inequalities is essential. another suggestion for social workers to take an active role in understanding this approach is to understand better the placements' sites with which they partner. this would involve practicum placements identifying the needs of their organizations so that students can better understand what is required of them. this would also involve an active process of students engaging in the placement process rather than being "placed" at the will of the program. this approach would alleviate the negative impact of students not being able to fully meet the agency's needs due to lack of resources or additional obligations, which black students often express. this would also help practicum instructors gain a better understanding of the agency's view of differential racialization. often, black students feel isolated because they cannot identify with the agency and are placed in roles that highlight the agency's ideas of "diversity." understanding how differential racialization impacts black students would allow for increased storytelling and possible counter-narratives (davis & livingstone, 2016). moreover, through a process of in-depth exploration and assessment, social work programs can better understand and recognize the role of interest convergence and materialist determinism which promotes the use of student practicums as a means for realworld training but fails to acknowledge the "free labor" aspect that is provided to practicum agencies. this "free labor" is often touted as a metric for promoting "community service" and other altruistic themes social work programs promote without recognizing that this significantly affects black students as a result of race and economic responsibilities. as mentioned, black students often experience barriers to degree completion, such as employment obligations that perpetuate capitalism through exploiting the labor force (beadlescomb, 2019). johnson et al./cost of being black 15 one last consideration for social work programs is to adopt an approach that centers on anti-racist education. this approach supports the idea of exposing oppressive systems and unequal power within institutional practices. in their book, henry and tator (2009) proposed nine key traits of anti-racist education, which highlight the importance of considering class, race, and gender inequity at the center of conversations: 1. examining the historical roots and contemporary manifestations of racial prejudice and discrimination. 2. exploring the influence of race and culture on one’s own personal and professional attitudes and behaviors. 3. identifying appropriate anti-racist resources to incorporate into the curriculum in different subject areas. 4. developing new approaches to teaching children using varying cognitive approaches to diverse learning styles. 5. identifying and counteracting bias and stereotyping in learning material. 6. dealing with racial tensions & conflicts. 7. identifying appropriate assessment and placement procedures and practices. 8. assessing the hidden curriculum and making it more inclusive and reflective of all student experiences. 9. ensuring that personnel policies and practice are consistent with equity goals and that they provide managers with the knowledge & skills to implement equity programs. incorporating these elements of anti-racist education throughout social work programs voices a commitment to adhering to the profession's ethical code in intent and action. conclusion examining the impact of racially-based inequity within social work practicum is a step towards bridging the profession's intent with its practices. the social work profession cannot afford to remain complicit in upholding structural racism, privilege, and oppression while the world is on the precipice of change. doing so is a commitment to stagnation with negative implications for the future 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(1990). justice and the politics of difference. princeton university press. author note: address correspondence to nia johnson, graduate social work, west chester university, west chester, pa, 19383. email: njohnson2@wcupa.edu https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ http://www.acenet.edu/documents/public-and-private-investments-and-divestments-in-hbcus.pdf http://www.acenet.edu/documents/public-and-private-investments-and-divestments-in-hbcus.pdf https://doi.org/10.1037/pri0000076 mailto:njohnson2@wcupa.edu _________ lauren terzis, phd, msw, clinical assistant professor, school of social work, tulane university, new orleans, la. lauren beasley, phd, ms, lmsw, assistant professor of sport administration, department of kinesiology and health, georgia state university, atlanta, ga. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1116-1140, doi: 10.18060/26266 this work is licensed under a creative commons attribution 4.0 international license. international student-athletes' psychological and sociocultural adjustment experiences: a qualitative interpretive meta-synthesis lauren terzis lauren beasley abstract: international college students face psychosocial adjustment challenges transitioning into college, which may be heightened for international student-athletes (isas) who also have to adjust to division i (di) athletics. even so, there are limited articles that synthesize the research on this population. thus, we sought to fill this gap by examining studies focused on the adjustment experiences of isas. a qualitative interpretive meta-synthesis is a method used in social work research to synthesize the findings of qualitative studies (aguirre & bolton, 2014). we used qualitative interpretive metasynthesis to conduct an exhaustive search of the literature, construct themes, and synthesize themes of qualitative research regarding isas and their adjustment experiences. we identified 11 articles with three overarching themes: (a) acculturative stress, (b) adjustment to the college experience, and (c) adjustment to athletics in the united states. findings suggest isas experience not only transitional stress related to their identities as a student and as an athlete but also from their acculturation experiences. thus, we propose isas transitioning to college experience a ternary-or three way-role negotiation of student identity, athlete identity, and cultural identity. social workers employed at division i institutions and within division i athletic departments have the opportunity to advocate for the needs of this population. keywords: collegiate athletes, student-athletes, international students, ncaa, social work practice, higher education the national collegiate athletic association (ncaa) is the official governing body of university-level sports in the united states. currently, the organization oversees nearly 500,000 student-athletes who participate in 24 ncaa-sanctioned sports across three divisions: division i (di), division ii (dii), and division iii (diii; ncaa, 2021). studentathletes experience both the stress of being a college student and the stress of athletic competition, which may put them at an increased risk for negative psychosocial outcomes. for instance, student-athletes experience high rates of depression (wolanin et al., 2016); illicit substance use (ncaa, 2017); eating disorders (power et al., 2020); and anxiety (li et al., 2017), especially in light of the ongoing covid-19 global pandemic and its impact on college sports (ncaa, 2022b). thus, the ncaa has recently called for member institutions to address the mental health of their student-athletes, specifically citing licensed social workers as a key member of the student-athlete care team (ncaa sports science institute, 2020). as such, social work literature has begun to explore social work practice with the student-athlete population. there is limited discussion, however, on practice specifically with the international student-athlete population, despite the population’s unique service needs. therefore, the purpose of this qualitative meta-synthesis was to explore the psychosocial adjustment experiences of international student-athletes at about:blank terzis & beasley/international student athletes 1117 di ncaa member institutions in the united states in order to guide evidence-based social work practice. literature review di sport is the most elite level of college sports and is a pathway to professional athletics for a small number of student-athletes. students-athletes across all ncaa divisions face stressors of navigating the dual role as a college student and an athlete (lu et al., 2018; settles et al., 2002; wendling et al., 2018); however, di student-athletes may experience high rates of stress and associated negative consequences due to the pressure of competing in elite athletics (brown et al., 2021). interestingly, one study found that depression prevalence was significantly higher for current di student-athletes compared to those who had recently graduated (weigand et al., 2013), which further emphasizes the immense amount of mental stress that elite student-athletes experience while playing in college. additionally, physical risk factors, such as concussions (kontos et al., 2012; vargas et al., 2015) and overtraining syndrome (kreher & schwartz, 2012) are linked to increased rates of depression. due to disruption in athletic identity, injury can also increase the risk of a clinical mental health diagnosis (bader, 2014; putukian, 2016). similarly, research has linked transition out of sport to negative mental health outcomes (jewett et al., 2019; smith & hardin, 2018). in light of all the risk factors, student-athletes are at risk for anxiety, depression, drug and alcohol use, and eating disorders (strohle, 2019). research has found that more than 30% of student-athletes present with depressive symptoms (cox et al., 2017), between 30 to 50% of student-athletes have experienced anxiety (davoren & hwang, 2014), and almost 60% of female student-athletes are at risk for an eating disorder (national eating disorders association, 2022). studies have also found that student-athletes participate in high-risk binge-drinking (druckman et al., 2015; ford, 2007) and drug use (gill, 2009; yusko et al., 2008). furthermore, these statistics may be underestimated, perhaps due to the population’s overall low help-seeking behaviors (drew & matthews, 2019). indeed, studies have suggested that student-athletes have high rates of mental health stigma (bird et al., 2018), which acts as a barrier to seeking behavioral health services. international student-athletes one subset of the student-athlete population that experiences additional stressors are di international student-athletes (isas). according to the ncaa (2022a), there are over 20,000 isas competing at ncaa member institutions from almost 200 different home countries, with the highest percentage of di athletes recruited from canada, the united kingdom, germany, australia, and spain (ncaa, 2022a). in di sport specifically, isas make up approximately 12.5% of the total student-athlete population competing (ncaa, 2020). for both men’s and women’s di sports, the majority of isas compete in tennis, ice hockey, soccer, and golf; however, the fastest growing sports between 2015 2020 for isas were men’s football and women’s water polo (ncaa, 2022a). recruitment of isas often happens by word-of-mouth, when athletes hear about opportunities to play in the united states from friends, family members, and fellow athletes who had previously played advances in social work, fall 2022, 22(3) 1118 in the united states university system. they may also be recruited from coaches or talent recruiters in the united states by way of a “talent pipeline,” connected to university coaches from their current coach or by personal research, or even through a sport recruitment service (pierce et al., 2012). studies suggest isas may face stressors before competing in the united states related to recruitment challenges, such as navigating the visa process (turick et al., 2020) and differing amateurism rules (abbey-pinnegar, 2010). once in the united states, these student-athletes not only face the stress of competing in elite athletics but also might experience the stressors of adjusting to a new culture (ridinger & pastore, 2000). to better understand the isa experience, ridinger and pastore (2000) proposed a model of isa adjustment that includes: (a) antecedents (e.g., interpersonal relationships), (b) adjustments (e.g., academic, athletic), and (c) outcomes (e.g., satisfaction). in this model, mostly qualitative research has suggested family considerations (popp et al., 2010), cultural differences (pierce et al., 2012), and discrimination (lee & opio, 2011) may increase the stress on isas, which may result in negative psychosocial and adjustment outcomes (popp et al., 2011). furthermore, another stressor that may now be impacting high profile isas are new name, image, and likeness (nil) rules. although ncaa student-athletes can now profit off of their nil, isas cannot as it would conflict with student visa status (mccarthy, 2021). despite these unique challenges, there are currently no reviews of the literature that explore the adjustment experiences of isas, even though research suggests international college students face psychosocial adjustment challenges transitioning into college in the united states (mesidor & sly, 2016; zhang & goodson, 2011). systematic reviews (e.g., brunsting et al., 2018; zhang & goodson, 2011) and metaanalyses (e.g., bender et al., 2019) have focused on the adjustment experiences of international college students. taken together, the findings of these reviews suggest social support, english language proficiency, and acculturation/acculturative stress all impact the adjustment of international students in the united states. within student-athlete literature, systematic reviews have examined athletes’ adjustment to transition out of sport. for instance, park et al. (2013) included 122 studies in their systemic review, of which 32 looked specifically at student-athletes’ transition out of sport. in their analysis of psychosocial outcomes, the study did not separate out findings by ncaa division level, but 83 studies found transition had negative psychological adjustment outcomes (i.e., identity crisis). however, none of the studies included in the review focused specifically on isas in the united states and none considered the adjustment process of the transition into college. therefore, a review of the psychological and sociocultural transition experiences of isas is missing both in the student-athlete literature and the broader college student literature. social work in college sport practice with athletes is a growing subspeciality of the social work profession (dean & rowan, 2014; moore & gummelt, 2019; newman et al., 2021). as the ncaa in 2019 passed legislation that requires all member institutions to provide mental health care to student-athletes (adelson, 2019), athletic departments have been one of the largest terzis & beasley/international student athletes 1119 employers of social workers among sport organizations (newman et al., 2022). social workers add a unique perspective to the care of student-athletes. scholars have specifically pointed to social work’s emphasis on social justice and advocacy (moore & gummelt, 2019), the biopsychosocial assessment (beasley et al., 2022), the case management approach (mchenry et al., 2022), and the interdisciplinary nature of the profession (newman et al., 2019) as aspects of social work that can add a unique perspective to the care of student-athletes. from a theoretical perspective, although clinical social workers may ground their work from a variety of paradigms (e.g., psychodynamic theory, cognitive behavioral theory, humanist theory, etc; aron, 2022), social work’s ecological systems perspective distinguishes the social work profession from other behavioral health professions in sport (mchenry et al., 2022). indeed, social workers in sport work at micro, meso, exo, and macro levels (newman et al., 2019). as a systems approach to care takes into account the impact of cultural context on one’s well-being at the interpersonal and intrapersonal level, it may be an especially important approach for work with isas if they are struggling to adjust to a new social, academic, and athletic culture (ridinger & pastore, 2000). in an attempt to understand how social work practitioners in sport are translating theory to practice, a few recent qualitative studies have explored the perspectives of social workers embedded in athletic departments (beasley et al., 2021, 2022; newman et al., 2021). social workers in these studies provided both case management and clinical services to ncaa di student-athletes, including attention to the stressors of transition into elite collegiate sport. however, results across the studies consistently pointed to the need for increased training and empirical literature to guide evidence-based practice with the student-athlete population, suggesting the need for more empirical work as a foundation to evidence-based practice with the general student-athlete population and with specific subsets of the student-athlete population, such as isas. the current study the systems perspective that attends to the impact of culture on one’s well-being is a unique perspective social workers can bring to the care of student-athletes (moore & gummelt, 2019), specifically in work with isas. however, a review of the transition experiences of isas that may guide social work practice with this population is missing from the literature. therefore, we sought to fill this gap by specifically examining studies focused on the adjustment experiences of isas. this qualitative interpretive meta-synthesis (qims) was guided by one primary research question: what are the psychosocial adjustment experiences of isas at di ncaa member institutions in the united states? methods a review of the literature found the majority of studies that look specifically at the psychosocial adjustment experiences of isas are qualitative in nature; thus, we determined a qualitative interpretive meta-synthesis (qims) would be an appropriate methodology to use for this study. qims synthesizes qualitative research to gain a deeper understanding of the phenomenon (aguirre & bolton, 2014). qims focuses on creating a synergy of advances in social work, fall 2022, 22(3) 1120 qualitative findings and is interpretive, as opposed to focusing on the aggregate, which is common in systematic reviews and meta-analyses (aguirre & bolton, 2014). watkinskagebein and colleagues (2019) suggest researchers can use qims instead of conducting one’s own qualitative study, where sample size may be low, to increase sample size by using previous qualitative research on the topic. due to the low number of isas at our respective institutions, and the ability to increase the sample by using existing findings, we opted to utilize the qims approach to provide a deeper understanding of the phenomenon. aguirre and bolton (2014) outline the steps for conducting qims for social work research, which include: formulation of a research question, sampling of studies to include, theme extraction, and synthesis of themes. positionality of authors the two authors were involved in each step of the review process, including constructing the research question, organizing search terms, conducting the search, reviewing abstracts, completing a full-text review, and performing an extraction and synthesis of themes. below is a synopsis of each author to establish credibility and connect their personal experience to the research. first author i have a phd in social work and a master of social work. my primary research agenda centers on immigrant experiences in the united states. i was an isa at a di mid-major university located in the midwest competing in a non-revenue earning sport. therefore, i have had personal experience with the adjustment process as an isa. i am originally from a western country and my first language is english, and while there was an adjustment, i do acknowledge that these factors provided an easier transition to college life and athletics in the united states. as a licensed social worker, i am interested in how athletic departments at universities can utilize social workers, particularly with isas that may be experiencing difficult adjustment experiences. i have experience in quantitative, qualitative, and mixed-methods research. second author i am a licensed master social worker and hold my phd in sport management. my research centers on the intersection of social work and sport, specifically the professional role of social workers in athletic departments. in my work, i advocate for the hiring of social workers in athletic departments due to the unique systems perspective social workers can bring to the care of student-athletes--a belief i bring into this current project. additionally, as both a social worker and an instructor for sport management courses where i teach international student-athletes and have seen many struggle in their academic adjustment, i am interested in how social workers and other university stakeholders can better meet the needs of this specific student-athlete population. as a researcher, i have experience in both qualitative and quantitative research. terzis & beasley/international student athletes 1121 sampling we conducted a comprehensive search of 14 scholarly databases commonly used for social work research and sport/athletic-related research to locate appropriate studies. these databases included: applied social service index and abstracts, health and psychosocial instruments, socindex, social work abstracts, eric, proquest dissertations and thesis, pubmed, psychinfo, conference papers index, google scholar, sportdiscus, sports medicine and education index, and scopus. only 10 of these databases yielded results based on our inclusion criteria. search terms used during this process included: • international student-athlete or international student or international athlete or international collegiate athlete or student athlete and • national collegiate athletic association or ncaa or college athletics or di or division i or di and • psychosocial adjustment or behavior or experiences or adjustment or psychological outcomes or sociocultural adjustment or institutional adjustment or social adjustment or academic adjustment or personal adjustment or emotional adjustment or acculturated stress or social support or english language proficiency or self-efficacy or cultural distance or interpersonal or athletic adjustment or transition and satisfaction or performance or academic performance or athletic performance or anxiety or depression or mental health or well-being in addition to search terms, the inclusion criteria were that studies must include (a) isas competing at the di level in the united states and (b) variables related to psychosocial adjustment and experiences of the isa. from the initial search, we identified 200 articles and dissertations that met the search criteria. however, this included quantitative, qualitative, and mixed-methods studies. when reviewing abstracts of the articles and dissertations further, those that used strictly quantitative methodology were eliminated from the review. there were 81 articles that were moved to the full text review phase. the two authors reviewed the articles for further information on the sample and methods. we included only qualitative articles that consisted of isas and their adjustment experiences for theme extraction. a final 11 articles were identified as meeting the inclusion criteria, consisting of a combined sample of 291 isas (see table 1). we used covidence software for data management and to assist in streamlining the review process between the two researchers. if discrepancies occurred regarding whether to include or exclude an article, the two authors met to discuss and come to a consensus. this included both authors reviewing each article together, and discussing whether it fit the inclusion criteria. there were several instances where this occurred, and a discussion about each article and whether to include it in the analysis took place. theme extraction and synthesis during the data extraction phase, all final studies that met the inclusion criteria were compiled into a table (see table 1), and the main original themes, sample size, isa country of origin, and sport from each study were extracted and recorded. constructing table 1 advances in social work, fall 2022, 22(3) 1122 enabled us to visualize all original themes and engage in qualitative synthesis. the data synthesis phase included both researchers engaging in reviewing and organizing the textual data that were included in the 11 articles. we looked for similarities among concepts and original themes among all studies, and noted where there were common themes, even though there were different terms used across studies and authors (aguirre & bolton, 2014). this included translating each study into one another, while also ensuring that the integrity of each study was not compromised during the synthesis phase (aguirre & bolton, 2014). translation refers to comparing concepts and themes in an account (such as each individual study), and how they interact with one another, while also considering the concepts and themes of other accounts (noblit & hare as cited by aguirre & bolton, 2014). once original themes were compared and grouped, we discussed the new overarching themes that were constructed for our qims. we followed a similar process in identifying sub-themes that fell under each of our new overarching themes. we chose an interpretive synthesis approach to managing the textual data over an aggregate approach as the goal was to focus on the conceptual and theoretical development (aguirre & bolton, 2014). coming to a synergistic understanding of the themes presented in the articles allowed us to delve into a deeper understanding of the phenomenon and experience of isas and their adjustment experiences. to ensure trustworthiness when conducting qims, it is imperative to use participant quotes from the original studies so their descriptions and experiences are not lost in the synthesis (aguirre & bolton, 2014). direct quotes from participants are used to support overarching themes and subthemes and are included in the results section of this paper. table 1. studies included in qims and original themes (n = 11) source sample size isa country of origin sport original themes extracted bentzinger (2016) 7 north america, south america, northwestern europe, western europe, asia, africa soccer, individual sport (not disclosed) • opportunity • process • adjustment garret et al. (2020) 11 (8 di, 2 dii, 1 diii) england golf, soccer, track & field, basketball, tennis, squash • migrating • influencing factors in athletic development in the u.s. hong (2018) 9 germany, china, japan, the netherlands, malaysia, columbia rowing, tennis, soccer, field hockey, fencing, swimming, diving • motivations • recruitment process • adjustment & integration • development of isas • areas of improvement from participants’ perspectives jean-noel (2020) 8 (3 di, 5 dii) argentina, belgium, china, england, france, sweden, turkmenistan basketball, track & field, football, tennis • professional-like atmosphere • isa adjustment to u.s. culture • time needed for adjustment • importance of relationships • influence of host community’s effort & attitude about acculturation laid • microaggressions • availability & helpfulness of academic & international support services terzis & beasley/international student athletes 1123 source sample size isa country of origin sport original themes extracted kontaxakis (2011) 6 greece, france, russia basketball, track & field, tennis • u.s. vs. home country education system • factors that influence decision making • steps to transition • challenges • opportunities after graduation lee & opio (2011) 16 kenya, nigeria, south africa, burundi, uganda, zambia, morocco cross country running, track & field, swimming, basketball • burden of ignorance • negative stereotypes (neo-racism) • discrimination lopes (2015) 15 poland, croatia, brazil, italy, saudi arabia, slovakia, germany, malaysia, china cross country running, volleyball, golf, soccer, swimming • international dislocation among young students • acculturation & integration on campus • academic challenges • cultural shock • plans after graduation pierce et al. (2012) 192 57 countries represented (top countries: canada, england, puerto rico) team & individual sports • homesickness • adjustment to the u.s. culture • strong support system from teammates & coaches, friends & family from home country popp et al. (2010) 13 australia, brazil, canada, congo, england, romania, serbia, slovakia, spain basketball, diving, golf, softball, tennis, volleyball • personal dimension • sense of adventure & previous international travel experience • interpersonal dimension • perceptual dimension • family influence rankine (2014) 11 jamaica track & field • acculturation adjustment • success from guidance & support of other jamaicans • failure/difficulty due to racial acts/discriminations veselinovic (2020) 3 italy, greece, israel golf, rowing, track & field • academic adjustment • personal-emotional adjustment • athletic adjustment • social adjustment • institutional attachment results three overarching themes were constructed with 10 subthemes: 1) acculturative stress: a) discrimination/racism, b) homesickness, and c) culture; 2) adjustment to the college experience: a) social and b) academic; and 3) adjustment to athletics: a) relationships with coaches and staff, b) relationships with teammates, c) training. theme 1: acculturative stress new college students experience acculturative stress due to being away from their home and family for the first time, experiencing newfound independence, and recognizing increases in responsibility, which is particularly exacerbated for international students (sullivan & kashubeck-west, 2015). in our synthesis of themes from the qualitative advances in social work, fall 2022, 22(3) 1124 studies, we noted several compounding stressors that added to the isa’s experience with adjustment to their time in the united states. discrimination and racism articles explicitly discussed themes related to the discrimination, racism, and negative stereotypes isas experienced once in the united states (jean-noel, 2020; lee & opio, 2011; rankine, 2014). isas experienced discrimination from other students, their professors, and their athletic coaches (rankine, 2014). an african student-athlete discussed the challenges and barriers experienced and how negative stereotypes and racism were everyday occurrences for them in the united states (lee & opio, 2011). as one athlete commented, “a lot of people here have a very limited knowledge about africa. most of what they know is from the national geographic channel and those late tv infomercials about starving kids in africa with lots of flies around them” (lee & opio, 2011, p. 638). experiences of racism and discrimination were particularly prevalent in interviews that were conducted with isas who identified as black. a jamaican student-athlete described how they felt they were racially discriminated against because of the color of their skin and felt people “looked down on you, like you’re less than them” (rankine, 2014, p. 98) at their college. the jamaican student-athlete also shared an experience they perceived as “racist” (rankine, 2014, p. 98) where white students were not stopped to ask for their id on campus, but black students, such as themselves, were stopped. although there were participants who experienced overt acts of racism, there were isas who reported incidences of microaggressions, which are considered not as overt as racism yet still have devastating impacts on the student experiences (jean-noel, 2020). after receiving all-american status, an isa reported a u.s. native teammate stated, “that's funny that you are an all-american and you're not even american” (jean-noel, 2020, p. 75). feelings of jealousy that isas had better scholarship offers was discussed as potential motivation for the comment. homesickness being away from one’s home country and family and not being able to travel home as much as one would like was also a prominent subtheme throughout the original studies. participants discussed ways they kept in touch with their family and friends from home, such as using phone calls, the internet, and skype video conferencing (bentzinger, 2016). however, time zone changes between countries often made it hard to call and connect with family and friends whenever they wanted (bentzinger, 2016). the difficulty in connecting led to feelings of isolation and homesickness among isas. one isa discussed their adjustment experience to being away from home: “you feel lonely and you just want to go back, but as time goes by, you meet new people, you kind of get a new family, and you adjust to the new environment” (kontaxakis, 2011, p. 105). although these feelings may be similar to that of any athlete transitioning to college, the lack of ease in communication with family (i.e., time zones) and the inability to take quick trips home confounded these terzis & beasley/international student athletes 1125 issues. additionally, due to the busy schedule of student-athletes (academics, practice, travel, etc.) during their athletic season, often being busy was found to be helpful in alleviating some homesickness. one isa stated there was so much going on during the season that “i didn’t have time to think about how much i miss home and stuff” (veselinovic, 2020, p. 94). however, feelings changed once the off-season started, and “i had more time to myself and then suddenly i’m like, oh i would want to go home now” (veselinovic, 2020, p. 94). culture another adjustment experience that was constructed was the intense cultural shock isas experienced when they moved to the united states. this shock can lead to negative outcomes that students may face during the acculturation phase. cultural shocks international students experienced and discussed in the studies included: language, food, weather, and the need to convert distances from the metric to the u.s. customary system. students-athletes across the studies discussed the difficulties and stress associated with the language barrier between their native language and having to attend an englishspeaking university in the united states (hong, 2018; popp et al., 2010). the language barrier appeared to be more prominent and of issue in the classroom as opposed to the sporting environment. for example, isas discussed having to “spend more time on readings and writings” (hong, 2018, p. 113) of their assignments due to english not being their primary language. spending additional time on understanding class content and assignments that were impeded by the language barrier was a challenge due to isas’ competing interests, such as going to practice and traveling for competitions and meets. university classes place a heavy emphasis on class participation, and one student found her gpa suffering due to the language barrier: like in my first semester, i didn’t really speak in class or anything. because i didn’t want anybody to be like, “can you please repeat that?” you know, so i just didn’t speak; so that first semester, i remember we had to like go to our professors’ office hours; they’d always say you have to participate—20% of the grade is participation. i just did not speak, so . . . it did, ’cause that’s my lowest gpa ever. (rankine, 2014, p. 100) conversely, there were some isas who came from english-speaking countries or had previous experience speaking english who tended to have an easier adjustment experience to college life in the united states compared to their non-english speaking peers (jean-noel, 2020). another important part of one’s culture is food and cuisine, and isas expressed difficulties in adapting to not only the different cuisine in the united states but also to the food at their college’s dining center. an isa reported eating only pasta and cereal for the entire year due to limited food choices (popp et al., 2010). further, lopes (2015) found isas had troubles with the availability of healthy food provided at the dining center. another isa discussed the food at the college: “it’s unhealthy; they always fry everything with bad oil, something like that. i would like to eat something light and healthy and i can advances in social work, fall 2022, 22(3) 1126 choose only between pizza and burger, or burrito” (lopes, 2015, p. 60). another student who was a native of an african country reported being chronically sick due to the different foods and indicated there was “a lot more fast food” (bentzinger, 2016, p. 98) she had to consume at the campus cafeteria, which impacted her ability to attend practice and compete. depending on the location of the university in the united states, weather and climate can be a major adjustment for international students (popp et al., 2010). in particular, harsh winters in some locations, such as the midwest, meant some isas were struggling to adjust to the differences in weather from their home country (bentzinger, 2016, p. 81). isas reported not being prepared for the intensity of the winter weather and it taking a while to get used to the new climate. another isa reported not being prepared for the weather differences and they “didn’t have enough warm clothes.” thankfully, other teammates were able to help by providing the isa with extra jackets to get through the winter (bentzinger, 2016, p. 125). the united states is unique in that it is one of the remaining countries to continue to use the imperial system of measurement (now known as the u.s. customary system) as opposed to the metric system. isas reported needing to get used to this difference and had trouble initially understanding workouts, distances for practice, and gauging performance based on the different systems of measurement in the united states compared to their home country (bentzinger, 2016). further, isas also had to adapt to the different terminology used in the united states with their specific sport (jean-noel, 2020). an isa shared that he “did not understand the workouts his coaches prepared during practice, and he was confused if he was performing well because of the different measuring system in the united states versus the metric system used in his native country” (bentzinger, 2016, p. 143). theme 2: adjustment to the college experience adjusting to the college experience can be an overwhelming experience for students, and isas need to navigate both adjusting to the a) social and the b) academic experience, on top of also participating in athletics. isas also shared that the international student office on campus was a resource in their college adjustment experience. social adjustment experiences student-athletes are often at an advantage socially as they automatically become teammates, roommates, and travel together for competitions throughout the semester (lopes, 2015). being part of a social group immediately via the team and athletics program can be beneficial to the isa’s adjustment to their new life in the united states (lopes, 2015; popp et al., 2010). an isa discussed the benefits of being on a team and having the built-in support system: it was actually really great to have a team because this is such a big school. it’s harder to make friends . . . the fact that i had the team that i could go straight into they had to take care of me . . . especially being with the americans, talking with them made me a better english speaker. (bentzinger, 2016, p. 90) terzis & beasley/international student athletes 1127 however, not all isas found they had an automatic membership to a social group and found it harder to adjust, particularly if their native language was not english: i didn’t know how much people like accents here. i would have, maybe, involved myself a little bit more. because my first semester, i kept to myself. i didn’t want to talk to anyone. it was like don’t approach me, i don’t want to talk. (bentzinger, 2016, p. 72) having a strong support system and social connections with teammates was found to decrease the acculturative stress for isas, whereas having a poor connection to teammates increased their stress (jean-noel, 2020). isas also reported they often relied on other isas (from either the same team or other teams) who were able to give them advice on the “transition” (popp et al., 2010, p. 174) from their home country to college life in the united states (rankine, 2014). as one jamaican athlete said, “having other jamaicans here before, so when i was a freshman, we had a senior on the team at the time from jamaica, and i feel like there’s kinda of a community where once you’re international people, like all of the internationals who were here before you, they like look out for you” (rankine, 2014, p. 94). some isas mentioned becoming friends and making connections with other students on campus who were not athletes was also beneficial in their adjustment experience, particularly if they shared a similar culture: i met my first friend when i was a freshman, and we were both in the same class. . . and after i met her, i came to her a lot, and we did spend time together, hang out, and go to some chinese restaurant, and then i know i got to know more chinese students . . . it was pretty . . . it was . . . yeah, i would say it was a . . . kind of a turning point for me ‘cause, finally, i know someone that i feel comfortable staying with. (jean-noel, 2020, p. 70) academic adjustment experiences a large part of the adjustment experience also has to do with how the isa can successfully engage in the academic portion of their college experience in the united states. on the surface, universities and athletic departments emphasize the importance of being successful in both athletics and academics, such that individuals should be able to manage the balance between both. however, in addition to sport-related activities, which the ncaa (2020b) estimates is on average 34 hours a week for di-athletes despite the 20hour rule, student-athletes also balance attending a full course schedule and maintaining a healthy social life; thus, isas are tasked with using their time management skills. as one isa stated: i feel like the main thing that was hard was just time management. especially with the sports, and practice, and traveling, there’s a lot going on and you need to be very diligent about what you need to do and give it the time. because we travel usually during the week, so you need to work ahead for next week and already do those assignments, so that when you’re at the tournament you don’t have to think advances in social work, fall 2022, 22(3) 1128 about it. it’s just getting into a system and knowing what you need to do. just like knowing how much time to dedicate to everything. (veselinovic, 2020, p. 102) in relation to the cultural and language barrier, isas reported needing to spend more time on assignments, readings, and in the classroom due to the language barrier (hong, 2018; veselinovic, 2020). this meant spending more time than their u.s.-born peers when it came to preparing and studying for class: “you have to listen to what they say, then look at the screen, and the slides. and then you need to also take notes, all at the same time in another language that you are not comfortable with” (veselinovic, 2020, p. 83). in the studies reviewed, isas felt relatively supported in their academics due to the support services available to help student-athletes at their university. this included professors who were helpful in adjusting assignments so isas could balance athletics and school and having tutors on hand if they were struggling with a course (jean-noel, 2020; rankine, 2014). a resource on campus that helped isas adjust to both the social and academic experience included the international student office. the international office on campus provided isas with helpful information and support during their time on campus, with participants noting the office’s importance in the adjustment process (jean-noel, 2020). the international student office could be helpful for both the social and academic adjustment of isas. international offices provide social activities, academic services, student visa concerns, international tax requirements, and a place where isas can meet other international students. one isa stated, “i go a lot to the international student office and sometimes i ask them if they know other people from my country” (bentzinger, 2016, p. 82). however, there was a small number of students who did not have positive interactions with the international office and did not feel the international office supported isas in adjusting to the new culture (kontaxakis, 2011). one student shared the international office at their school made “international students feel like a minority” and that “they don’t have the experience with international students” (kontaxakis, 2011, p. 106). theme 3: adjustment to athletics in the united states one of the primary reasons isas come to the united states is to take advantage of and participate in college athletics, which is structured unlike anywhere else in the world. three distinct sub-themes were constructed with respect to the athletic adjustment that isas face, their a) relationships with coaches and staff, b) relationships with teammates; and c) their training and development as an athlete. relationships with coaches and staff isas tended to view their relationship with their coaches positively, especially when it came to adjusting to life and athletics in the united states. coaches were usually the first point of contact for the isa, starting from the recruiting process, to picking them up at the airport once they arrived, and helping the isa quickly adjust (hong, 2018). isas felt a great deal of support from their coaches and claimed their coaches were not only concerned terzis & beasley/international student athletes 1129 with their athletic well-being but also their personal well-being (popp et al., 2010). isas felt their coaches were always there if they had questions or needed help. one isa appreciated their coach as their focus was developing athletes as individuals, not just in their sport (veselinovic, 2020). these positive experiences and relationships with coaches were beneficial to the isa’s adjustment and were even more helpful if the coach was previously an isa or spoke the language of the isa (jean-noel, 2020). however, not all isas had positive experiences and relationships with their coaches. some isas reported negative experiences and not feeling supported by their coaches, which led to their adjustment experience being more challenging than the experiences of their peers who had positive experiences with their coaches (jean-noel, 2020). an isa claimed, “i did not think that coaches or schools themselves had the mechanisms to support international students with their transition” (kontaxakis, 2011, p. 63). other key figures included the athletic academic coordinators and athletic trainers who also played a vital role in isa’s adjustment (veselinovic, 2020). an isa stated her athletic academic coordinator was “amazing” and said, “i don’t think i could figure out my life without her” (veselinovic, 2020, p. 149). these coordinators helped with regular checkins, study strategies, time management, and ongoing support. they served as someone else the isa could talk to and connect with at the university. relationships with teammates relationships with teammates helped isas socially adjust and adapt to their new life in the united states, as they allowed isas to immediately experience part of a team atmosphere. spending so much time with teammates led to friendships that often became the isa’s “primary social circle” (veselinovic, 2020, p. 129): we are a very tight-knit group and i think that’s why we are one of the best groups within athletics. other coaches actually want their groups to look more like our group because we’re all friends, not just teammates. i think that being a studentathlete you’re automatically given friends within your team. (veselinovic, 2020, p. 129) although having domestic teammates was helpful in the adjustment to college life and athletics, some participants also found being the only isa on the team meant they struggled to connect with their teammates from the united states; thus, they sought friendships with other international students, which helped reduce acculturative stress (hong, 2018; jeannoel, 2020). an isa discussed their troubles with being accepted by teammates: “i was the only foreigner on the track team. and being the only foreigner on the team it was hard for the others on the team to accept me, not for me to accept them” (kontaxakis, 2011, p. 105). training and development as an athlete the u.s. intercollegiate system is unique in that it combines education and athletics and supports students to excel at both. isas have to adjust to the culture of the collegiate athletic system in the united states and how different athletics in college is perceived in advances in social work, fall 2022, 22(3) 1130 their home country (hong, 2018). in the united states, even an individual sport (e.g., swimming, tennis, track and field) is perceived as a team sport, which is different from the nature of individual sports in the isa’s home country, where they may be focusing on competing for themselves (jean-noel, 2020; veselinovic, 2020): now it’s not only about me, it’s the team that needs to grow. so it’s my responsibility to give everything to the team and not only to myself. so that was kind of like a mind shift i needed to do. (veselinovic, 2020, p. 117) in addition, isas also found the intensity of training was different in the united states, with higher training volume, more hours spent on strength and conditioning, and a greater overall general competitiveness (garret et al., 2020; hong, 2018; jean-noel, 2020). isas see another draw of the u.s. collegiate system is the abundance of resources for athlete development and the strong links to a professional sports career after college: “the culture in the u.s. [was] the right way for people to improve in sport, to get a degree, play a college sport and then become a professional” (garret et al., 2020, p. 26), which is unlike the college and sporting experience in any other country. discussion the purpose of this qims was to explore the psychological and sociocultural adjustment experiences of isas. overall, our findings suggest isas in this study faced adjustment challenges not only to life as both a student and an athlete but also to united states culture, both generally (i.e., culture shock) and sport-specific (i.e., use of the customary measurement system). these findings provide support for the importance of social work’s systems perspective in service provision for isas and offer insights for evidence-based social work practice with this population. there is a large body of work in the sport management and sport sociology literature that explores the experiences of student-athletes, which focuses on the stressors of the dual role of being a student and an athlete (e.g., coakley, 1990; steele et al., 2020. for example, killeya-jones (2005) found the more integrated the identity of student and athlete, the higher a student-athlete’s well-being, whereas if there is role discrepancy between the identity of student and athlete, student-athletes are less well adjusted. similarly, barger and seward (2018) found when the identities of student and athlete were merged, studentathletes were more likely to be motivated in both school and sport, perhaps leading to both better academic and performance outcomes. conversely, when student-athletes overidentify as an athlete, they are more likely to experience negative outcomes related both to lower academic achievement in school (lumpkin, 2017) and depression when transitioning out of sport (menke & germany, 2019). overall, the body of literature consistently points to the importance of identity integration between student and athlete identity. the overarching implication is any professional, including social workers, working with student-athletes needs to be attuned to both roles and understand the identity negotiation that takes place between being a student and an athlete. the experiences of the isas in this qims suggest similar tensions in this dual role. for example, participants spoke about the importance of time management to balance terzis & beasley/international student athletes 1131 academic and athletic demands. some even mentioned the importance of academic support counselors in making this transition. therefore, programming and services focused on how to manage the transition into elite collegiate athletics, specifically related to negotiating both the student and athlete identity, may be effective for both international and domestic student-athletes. however, the results of this qims also support the need for culturally competent programming as the isas in this study also experienced acculturative stress related to discrimination and racism, feeling homesick, and adjusting to cultural factors, such as language, food, weather, and converting to the metric system. other literature supports the importance of addressing acculturative stress, as such stress in international college students in the united states can lead to negative outcomes, including increased binge drinking (kim & cronley, 2020), depression and other mental health concerns (shadowen et al., 2019), and challenges in academics (behl et al., 2017). for participants in this study, similar negative impacts of acculturative stress included academic challenges and lower gpas, illness due to nutritional changes, loneliness, and diminished relationships with teammates, peers, professors, and coaches. however, isas in this study also spoke to the benefits of their international status and their status as an athlete. for instance, participants addressed the benefit of having a pre-established social circle with their teammates and immediate support of their coach, which may not be readily available to international students not competing in athletics. participants especially seemed to lean on other isas and the international student center on campus for support. thus, it is evident that isas are influenced by a multitude of factors and relationships that impact their adjustment experiences, both positively and negatively. from a systems perspective, the interpersonal, intrapersonal, organizational, and cultural factors that encompass an individual’s environment all influence well-being (bronfrenbrenner, 1994). in sport, scholars have acknowledged the importance of understanding care of athletes from a systems perspective (e.g., araujo & davids, 2009; bader & martin, 2019; barkley et al., 2018). for example, barkley and colleagues (2018) suggest that solely individual-focused approaches to athlete care neglects the need to integrate campus-wide services available to student athletes resulting in siloed services and neglects efforts to promote health equity. further, they argue a systems perspective sensitizes practitioners to the political impact of college sport, which can lead to care interventions such as working with student-athletes to build skills to navigate what the authors term racialized settings. in light of the findings of this current study, this systems approach to care can be an important approach for work with isas. for example, considering the legalities of gaining a student visa and the complexities of moving to a new country (i.e., phone plans), coordination of care at the organizational level can help ease stressors of relocation to the united states. at the macro level, for instance, practitioners should consider the added stress isas have of navigating the new nil laws, and the impact of microaggressions and racism many isas experience. at the micro and meso levels, feeling a connection, or lack of connection, with teammates and coaching staff can be either positive or detrimental to the isa, and can impact whether they experience challenges or thrive in the social, athletic, and academic environment. thus, interventions can be focused on working with isas to build skills around positive relationship development, as well as with coaches to promote positive team-building from a culturally competent perspective. although these are just a advances in social work, fall 2022, 22(3) 1132 few examples, utilizing a systems perspective enables practitioners to gain a better understanding of how to effectively work with isas in meeting both their individual adjustment needs, as well as illuminates interventions at the meso, exo, and macro levels that can create a more positive environment. overall, the findings of this study suggest that isas, similar to domestic studentathletes, do experience the stress of the role negotiation between student and athlete; however, they also must negotiate a new culture that impacts both their student and athlete identity. extending ridinger and pastore’s (2000) model of isa adjustment, the results of this study show the adjustment experiences of isas are dependent upon the role negotiation and integration of student, athlete, and cultural identity. therefore, we suggest isas experience ternary-or three way-role negotiation, rather than a dual role negotiation, of student identity, athlete identity, and cultural identity. practitioners must consider all three of these roles in understanding isas’ transition experiences and in providing culturally competent services to support isas in their transition to di athletics. implications for the social work profession the findings of this qims have several implications for social work practice. first, in line with the call for more empirical evidence to guide social work practice within sport contexts (beasley et al., 2022; newman et al., 2021), findings offer key insights for providers working with isas. specifically, participants in this study describe adjustment experiences that are comparable to both domestic student-athletes, who struggle being a student and an athlete (steele et al., 2020), and international college students, who experience varying degrees of acculturative stress (koo et al., 2021). however, their adjustment as student-athletes is dependent on their acculturation experience, and their adjustment as an international student is dependent on their athletic identity. social workers and other professionals working with student-athletes need to approach work from this holistic perspective and take a biopsychosocial approach to care, considering the physical, emotional, spiritual, social, mental, and cultural health of student-athletes, a shift from the traditional medical model of care historically persuasive in sport medicine (waller et al., 2016). thus, aspects of cultural adjustment, including the impact on both athletics and academics, should be addressed in any programming offered to isas focused on their transition into di athletics. furthermore, social workers, specifically those working in collegiate athletics, can use this information to advocate for organizational changes that can improve the experiences of isas. for example, social workers could advocate for athletic departments to set up a winter clothing bank to prepare isas for winter weather and to provide training in the u.s. customary measurement system to ease the adjustment to u.s. sport. additionally, it seemed the most positive transition experiences occurred when there was integration among student, athlete, and cultural identity, thus preserving important aspects of their home culture. for example, having strong connections with other isas and teammates form the united states, having a positive supportive experience with the international student office on campus, and developing relationships with peers in classes who were not athletes all diminished acculturative stress. therefore, social workers can advocate for and terzis & beasley/international student athletes 1133 develop more intentional efforts within athletic departments to maintain cultural connections for isas and provide experiences for domestic student-athletes to gain cultural competence in their teammates’ cultural practices, such as celebrating important cultural holidays or providing opportunities for teams to cook specific foods. in these ways, the specific training and perspective social workers bring, with attention to case management and cultural competence, can add to the care of isas. limitations although this study was able to explore the lived adjustment experiences of isas, there were several limitations to note. despite initially identifying a wide range of appropriate articles (see table 1), only 11 studies met the inclusion criteria and were included in the synthesis. bondas and hall (2007) suggest that the ideal number of studies to include in a qualitative meta-synthesis are between 10 (sandelowski et al., 1997) and 12 studies (patterson et al., 2001). in addition, the majority of these studies are considered grey literature because they are graduate theses or dissertations. this points to the lack of qualitative research that exists for isas’ adjustment experience in peer review articles. another limitation is that this study focuses specifically on di isas and does not include an analysis of isas who compete at other levels or divisions, such as dii, diii, national association of intercollegiate athletics, and national junior college athletic association. isas are recruited and choose to compete in other divisions due to scholarship opportunities, academic opportunities, more playing time, and better aligned competitive nature of each division for the individual athlete. thus, these findings are limited in their scope, given the large proportion of isas who compete outside of the d1 system may have different adjustment experiences. due to the large number of quantitative studies identified, future research could include a systematic review of quantitative studies examining isa’s adjustment experiences. conclusion student-athlete transition literature places much attention on the stress of the negotiation between the dual identity of student and athlete. findings of this qims suggest isas experience transitional stress related to not only their identities as a student and as an athlete but also from their acculturation experiences. thus, we suggest isas transitioning to di sport in the united states experience a ternary role negotiation of student identity, athlete identity, and cultural identity. the understanding of the intersectional risk factors associated with the adjustment stress of isas can better inform both athletic and university programming targeted at this population. furthermore, social workers employed at di institutions and within di athletic departments have the opportunity to advocate for the needs of this population. for example, social workers’ attention to social justice issues (i.e., racism these 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(2011). predictors of international students’ psychosocial adjustment to life in the united states: a systematic review. international journal of intercultural relations, 35, 139-162. https://doi.org/10.1016/j.ijintrel.2010.11.011 author note: address correspondence to lauren terzis, school of social work, tulane university, new orleans, la, 70112. email: lterzis@tulane.edu https://doi.org/10.26522/jess.v4i.3717 https://doi.org/10.4085/1062-6050-50.3.02 https://iro.uiowa.edu/esploro/outputs/doctoral/small-fish-in-a-big-pond/9983956194902771 https://iro.uiowa.edu/esploro/outputs/doctoral/small-fish-in-a-big-pond/9983956194902771 https://doi.org/10.1080/1756073x.2016.1221642 https://doi.org/10.1007/s10560-019-00615-w https://doi.org/10.1007/s10560-019-00615-w https://doi.org/10.1177/1941738113480464 https://doi.org/10.1080/00336297.2017.1333437 https://doi.org/10.1136/bjsports https://doi.org/10.3200/jach.57.3.281-290 https://doi.org/10.1016/j.ijintrel.2010.11.011 mailto:lterzis@tulane.edu _________ sam harrell, msw, doctoral candidate, school of social work, portland state university, portland, or. brianna suslovic, msw, doctoral student, crown family school of social work policy, and practice, university of chicago, chicago, il. constance johnson, msw, social worker, bloomington, in. chandler boys, msw, social worker, salt lake city, ut. ben anderson-nathe, phd, professor, child, youth, & family studies, school of social work, portland state university, portland, or. kassandra botts, coalition and capacity building manager, national viral hepatitis roundtable, bloomington, in. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 900-915, doi: 10.18060/26271 this work is licensed under a creative commons attribution 4.0 international license. moral reconation therapy: incompatible with council on social work education competencies? sam harrell brianna suslovic constance johnson chandler boys ben anderson-nathe kassandra botts abstract: moral reconation therapy (mrt) is a manualized treatment commonly used in correctional settings to address perceived moral failing and associated problematic behaviors (e.g., substance use and criminal conduct). many social work students are introduced to mrt as a treatment modality during field placements in correctional contexts. as a group modality that draws from cognitive-behavioral interventions and 12step recovery programs, mrt has been touted as a cost-effective and evidence-based intervention. however, there are substantial reasons to question mrt’s appropriateness as an intervention taught to social work practicum students. using several of the cswe epas standards as guideposts, this paper addresses several key areas of concern with regard to the role of mrt in the training of social work students. through our analysis of mrt’s curriculum, we identify areas of concern with regard to mrt’s ability to teach social work students how to ethically practice, engage diversity and difference in practice, or utilize research to inform practice. despite the widespread use of mrt in correctional counseling contexts, we conclude that mrt is unsuitable for use in accredited social work field placements. educators and accreditation agencies should critically evaluate the treatment models social work students learn and practice in field placements. keywords: evidence-based practice, social work field education, ethics, epas, moral reconation therapy moral reconation therapy (mrt) is a treatment program owned by correctional counseling, inc. (cci), with workbooks and materials published by eagle wing books. cci co-founder and eagle wing books president dr. kenneth robinson and colleague dr. gregory little developed mrt as an intervention to “enhance ego, social, moral, and positive behavioral growth” among “traditionally ‘resistant’ population groups” (little & robinson, 1988, p. 135). robinson has a doctorate in educational psychology and a graduate degree in psychology, and little has a doctorate in counseling and a graduate degree in psychology. mrt facilitators seek to “reeducate clients socially, morally, and behaviorally and to instill appropriate goals, motivation, and values” (p. 135). the model was initially employed in correctional settings in 1987 and is now delivered across a wide range of correctional settings including jails, substance use disorder treatment programs, and medical facilities in every us state and nine countries, with the intention of reducing about:blank harrell et al./moral reconation therapy 901 recidivism (correctional counseling, inc., 1998-2022b). according to cci’s website, over 50,000 people have been trained to facilitate mrt and over two million have gone through the mrt curriculum (mrt, n.d.a). despite cci’s claims to a strong empirical evidence base to support the intervention, very little independent peer-reviewed research has been conducted to assess mrt (harrell et al., 2022; jarldon, 2020). still, the program is widely applied in social work practice settings such as substance use disorder treatment, diversion programs, residential and community corrections programs across the united states. this paper examines the relationship between mrt and the council on social work education (cswe) educational policy and accreditation standards (epas), exploring the intervention’s compatibility with those standards related to ethical conduct, diversity and difference in practice, and research-informed practice. background and significance to social work education cci describes mrt as “a cognitive-behavioral treatment system that leads to enhanced moral reasoning, better decision-making, and more appropriate behavior” (mrt, n.d.a, para. 3). the mrt model asserts that participants who engage in problematic behavior (e.g., drug use, illegal activity) do so at least in part due to compromised moral reasoning and moral behavior. the intervention identifies these participants as possessing “low levels of moral development, strong narcissism, low ego/identity strength, poor self-concept, low self-esteem, inability to delay gratification, relatively strong defense mechanisms, and relatively strong resistance to change and treatment” (little & robinson, 1988, p. 135). this notion of criminal thinking and moral underdevelopment from little and robinson resonated with public and academic discourse at the time, as reflected in books like yochelson and samenow’s (1976) the criminal personality. through a series of workbook-guided exercises, a cci-certified mrt facilitator directs a group of participants through 12-16 lessons, with the intention of moral reeducation and decreased recidivism. ideas of morality and cognition are central to mrt. “moral” is a reference to kohlberg’s (1984) levels of cognitive reasoning. “reconation” comes from the psychological terms “conative” and “conation,” which both reference cognitive decisionmaking (mrt, n.d.b, para. 1). the two concepts converge in what little and robinson (1988) describe as a “simplified personality theory,” blending features of erikson’s ego and identity stages, maslow’s hierarchy of needs, moral development stages from kohlberg and piaget, and features of jungian theory. put together, their theory posits nine personality and behavioral stages (p. 139). participants are sorted “depending upon the individual’s moral level and identity” into one or more stages, and then guided through exercises meant to recalibrate their moral compasses and allow movement to more advanced stages (little & robinson, 1988, p. 140). all participants are understood to enter the program as immoral, selfish, manipulative, and unaccountable, as indicated by the descriptors associated with their identified moral stages upon admission. the mrt facilitator shepherds these participants through a 16-step “freedom ladder” that begins with the stage of “disloyalty” and culminates in “grace” (see table 1), working through cognitive exercises emphasizing personal responsibility, moral judgment, and deference to authority. advances in social work, fall 2022, 22(3) 902 table 1. mrt freedom ladder (adapted from little & robinson, 2006) stage step(s) addresses participant… grace 13-16 relationships between “inner self” & personality normal 12 moral goals emergence 11 moral commitments danger 10 maintenance of positive change 9 commitment to change nonexistence 8 short-term goals & consistency 7 long-term goals & identity injury 6 assistance of others 5 healing of damaged relationships uncertainty 4 awareness opposition 3 acceptance disloyalty 2 trust 1 honesty social work and correctional contexts while schools of social work are not required by cswe to report exact numbers of social work students completing field placements in correctional settings, epperson et al. (2013) found that 18 percent of all cswe-accredited msw programs in the us featured dual degree options with criminal-legal system affiliated programs. further, scheyett et al. (2012) reported that across 63 msw field programs, 7.73 percent of all field placements were connected to criminal justice. according to this article, criminal justice field placements included: prison, jail, community corrections, mental health or drug courts, criminal justice halfway house, juvenile court, juvenile detention center, secure care residential facility, probation/intensive supervision, juvenile justice aftercare house, and "other" categories for adult and juvenile settings such as diversion programs, reentry programs, victim services, etc. these findings, coupled with our own experience and the ubiquity of mrt in corrections and other involuntary treatment settings, suggest that social work students may be exposed to and in some cases required to participate in, receive training in, and even facilitate mrt groups, in field placements and sometimes in the classroom. in doing so, schools of social work place students in direct tension with a number of the profession’s guiding documents, including the grand challenges for social work. in 2013, the american academy of social work and social welfare (aaswsw) launched the grand challenges for social work, a call-to-action to address a series of national challenges. among these is a challenge to “promote smart decarceration” that calls on social workers to create proactive, collaborative, and evidence-based approaches to reduce the size of the us prison and jail system; redress social disparities across the criminal-legal system; and shift public ideas about imprisonment and safety (aaswsw, 2018, p. 1). cci promotes mrt as an evidence-based approach to reducing recidivism. this intervention, purportedly addressing one of the aaswsw’s smart decarceration objectives, is commonplace in social service settings where social workers supervise harrell et al./moral reconation therapy 903 student interns, despite its fundamentally deficit-based characterization of clients and participants. this approach contrasts the strengths-based approach taught to many social work students in practice courses (hepworth et al., 2009). many involuntary treatment contexts, including incarceration, drug and alcohol treatment, drug court, and juvenile corrections feature mrt as a cardinal intervention. as social service providers and educators, the authors have encountered mrt in various court-ordered chemical dependency, diversion, and community mental health settings across the northeast, midwest, and pacific northwest: all authors have worked with clients who were mandated to participate in mrt, one author shadowed mrt in their msw practicum, and one author was certified as an mrt facilitator in their msw practicum. these collective experiences have led us to interrogate the use of mrt as an intervention approach in msw field placements. using the cswe epas, we argue that social work programs’ engagement with and tacit endorsement of pseudo-therapeutic interventions like mrt not only fail to address social work’s call for smart decarceration, but also perpetuate a deep contradiction in terms of the profession’s ethics and standards. given that our analysis focuses specifically on social work education, these sections will refer primarily to cswe competencies rather than referring to corresponding sections of the nasw code of ethics. the epas, used to accredit undergraduate and master’s level social work programs, considers field education the signature pedagogical tool of social work (cswe, 2022). since 2008, the epas has used a competency-based education framework, requiring accredited schools to assess practicum students according to learning outcomes based on nine epas competencies (cswe, 2022). programs may add to, but not replace or retract, the existing competencies. each competency includes a set of observable behaviors that students are expected to demonstrate. in light of the application of mrt in practice settings employing or educating social workers, we use the cswe epas to explore contradictions and tension that mrt raises for social work education. specifically, we ask: is mrt compatible with epas competencies 1 (demonstrate ethical and professional behavior); 2 (engage anti-racism, diversity, equity, and inclusion in practice); and 4 (engage in practice-informed research and research-informed practice) in social work field placements? ethical and professional behavior the cswe’s (2022) first epas competency, “demonstrate ethical and professional behavior,” (p. 8) commits educators and accredited educational institutions to instruct social work students in ethical behavior. among these instructions is a mandate to apply the ethical standards of the profession set forth by the national association of social workers (nasw) code of ethics. below, we describe how fundamental principles of mrt contradict key features of the nasw code of ethics, including social workers’ obligations to 1) “respect the inherent dignity and worth of the person” by promoting their self-determination; 2) “recognize the central importance of human relationships;” and 3) “behave in a trustworthy manner” (nasw, 2021, section 3). advances in social work, fall 2022, 22(3) 904 respect dignity and promote self-determination first, the nasw (2021) principle that “social workers respect the inherent dignity and worth of the person” is incongruous with the norms of mrt. the mrt participant workbook tells the participant that they have “immoral, unethical, evil, negative traits'' and a “screwed-up personality” (little & robinson, 2006, p. 37). facilitators prohibit clients from discussing societal inequity, instead insisting that they “accept reality” (as defined by cci; little & robinson, 2009, p. 5). they are instructed to ignore individual differences and diversity, including the impact of structural oppression, intersectionality, and trauma. mrt disregards the dignity and worth of participants by imposing totalizing and deficitbased labels. mrt undermines a client’s self-determination in part by enforcing a rigid curriculum without consideration for individual literacy and learning-style differences. the involuntary or mandated nature of treatment does not absolve social workers of the ethical obligation to recognize clients’ right to self-determination (nasw, 2021). writing about work with involuntary clients, trotter et al. (2020) re-emphasize social work’s objective to “start where the client is and to work with the client’s goals” and caution against social work interventions that “dispense with the goals of the client and … work with goals set by organizations and social workers” (p. 264). by contrast, mrt tells participants exactly who they are, what they have experienced, and what they think and feel. consider the following examples from the mrt participant workbook: what we want you to do is to think about how happy you were before you came into this crummy, awful place. you had your ups and downs, but were you really happy? you probably had your share of fun but some unhappiness is to be expected in life, right? suffering and unhappiness are to be expected sometimes, right? wrong. unhappiness was and is a part of your life because you chose it. (little & robinson, 2006, p. 2, emphasis in original) little and robinson (2006) go on to explain that as an infant, participants develop selfserving behaviors to manipulate others into giving them what they “think” they “need” to be happy (p. 4). unhappiness, they explain, became a “permanent part” of the participant’s personality in order to manipulate others (p. 4). the mrt facilitator’s handbook encourages practitioners to be skeptical of participants. when participants express their own insights, facilitators are instructed to say that “true insight is shown through a change in behavior and understanding” (little & robinson, 2009, p. 6). while disputed, mrt is sometimes categorized as a type of cognitive-behavioral therapy program. despite the cognitive framing of moral reconation, mrt requires group members to discuss “what they are doing rather than thinking” and claims this helps them focus on true insight in understanding and behavior change (little & robinson, 2009, p. 6). put differently, the model explicitly negates and invalidates participants’ potential insights from their own lived experience, suggesting instead that these insights are simply manipulative. harrell et al./moral reconation therapy 905 recognize the importance of human relationships second, mrt conflicts with the nasw (2021) principle that calls on social workers to “recognize the central importance of human relationships” (section 3). this principle asks social workers to engage individuals as partners and work to strengthen relationships among people. insofar as mrt encourages facilitators to cultivate human relationships at all, it requires relationships to be solely oriented toward compliance and program completion. little and robinson (2009) describe four stages of the mrt group “life cycle”: 1) formation and orientation, 2) conflict, power, and rebellion, 3) cohesiveness, and 4) continuation, staleness, or cessation. stage two prepares facilitators for a power struggle between the group members. the facilitator may emerge as a result of “everyone jockeying to gain control in the group” (p. 7). by enforcing compliance, little and robinson (2009) claim that participants will “resent” facilitators’ power and “belittle” them (p. 7). they instruct facilitators to remind participants that change is “occasionally unpleasant” and to disallow them to “scapegoat anyone” (little & robinson, 2009, p. 7). in alignment with its strict instructions to control undesirable behaviors in groups, cci expects facilitators to enforce the completion of mrt steps at the expense of building rapport with participants. in stage three, little and robinson (2009) advise facilitators that clients will be inclined to tell the group the “real reason” for their problems (p. 7). they remind facilitators to focus on the exercises rather than allow clients to discuss what they are thinking or have experienced. participants should refrain from sharing personal information or histories. lived experiences are framed as unwanted detours on the path to successful program completion. when participants do not comply with mrt's rules, cci expects facilitators to "discipline" them (p. 2). little and robinson do not suggest what form this discipline should take. this orientation to group work decenters human relationships in favor of top-down power dynamics. model integrity through trustworthy behavior third, mrt conflicts with the nasw (2021) principle that social workers should “behave in a trustworthy manner” (section 3). when facilitating mrt, practitioners are expected to simultaneously employ and detect deception. take, for example, the facilitation instructions for the “testimony,” a verbal group share necessary to advance the mrt freedom ladder: in mrt testimonies, clients performing the testimony have to stand. why? as far as clients are concerned it doesn’t matter. that’s the rule and that’s all they need to know. if you are interested in why, we’ll share this with you. most of your clients will be uncomfortable when they stand in front of the group and speak about such things as their honesty and dishonesty. that discomfort will make it more difficult for them to lie in a smooth or slick way. it will make their attempts at deception easier to spot and easier to confront. but keep in mind the clients do not need to know this. (little & robinson, 2009, p. 15) this excerpt raises serious questions related to the principle of trustworthiness. advances in social work, fall 2022, 22(3) 906 co-author constance johnson struggled with the expectation to act “honestly and responsibly” and promote “ethical practices” (nasw, 2021) when they were required to become certified as an mrt facilitator in their msw practicum at a cswe-accredited institution. the mrt trainer instructed them to treat participants in an mrt setting differently than even those same participants in other social work settings (e.g., individual therapy). johnson and their msw student peers were told to disregard best practices and ethical standards to facilitate mrt with fidelity to the facilitator handbook. this places the student-as-mrt-facilitator in a position to behave differently towards the same individuals based on the setting. this encouragement of differential treatment directly conflicts with the nasw code of ethics and its emphasis on trustworthiness. engage anti-racism, diversity, equity, and inclusion in practice the cswe’s second epas competency, “engage anti-racism, diversity, equity, and inclusion in practice,” expects social work programs to impart information and concrete skills pertaining to human diversity and difference in the field placements and coursework offered to social work students (cswe, 2022, p. 9). as mehrotra and colleagues (2017) illustrate, this often translates to coursework focused on privilege, oppression, and identity. in a social work field placement context, the most pertinent behavior associated with this competency is that “social workers…demonstrate cultural humility by applying critical reflection, self-awareness, and self-regulation to manage the influence of bias, power, privilege, and values in working with clients and constituencies, acknowledging them as experts of their own lived experiences” (cswe, 2022, p. 10). this particular behavior requires social work students to develop an approach to micro, mezzo, and macro practice that is grounded in intercultural humility (bibus & koh, 2021). overall, the second epas competency requires social work programs to provide students with sufficient skills to understand and respect the ways diversity and difference shape the experiences of clients. presumed participant identities and attitudes mrt requires facilitators to make deficit-based presumptions about participant identities and to ignore diversity and difference in their practice. for example, little and robinson (2009) tell facilitators that “the vast majority of mrt participants are in the groups simply because they don’t like to follow rules” (p. 14). mrt focuses on remedying the moral deficits of participants (ferguson & wormith, 2013, p. 1079). given this focal point of treatment, mrt facilitators are implicitly and explicitly encouraged to view participants as deficient and “hedonistic” (allen et al., 2001, p. 499). additionally, mrt facilitators are encouraged to see participants as self-centered due to stagnated moral growth, and to work on promoting moral reasoning as a primary objective of treatment (ferguson & wormith, 2013, p. 1078). regardless of differences in identity and personal history, all mrt participants are assumed to lack the moral insight required to contribute positively to society. through generalization about participants’ moral capacities and deficits, mrt effectively forecloses any possibility of exploring and productively engaging with difference in treatment. this rigid construction of the participant may account for mrt https://www.zotero.org/google-docs/?6zitzb https://www.zotero.org/google-docs/?xqaslx https://www.zotero.org/google-docs/?xqaslx https://www.zotero.org/google-docs/?the096 https://www.zotero.org/google-docs/?mlltzq https://www.zotero.org/google-docs/?gjtngr harrell et al./moral reconation therapy 907 creators’ initial research findings that reveal a significant gap in successful treatment completion between black and white participants (little & robinson, 1988, p. 148). whereas other modalities may take into consideration the role of structural forces like racism and sexism, mrt operates on the assumption that individual traits or attitudes can account for participants’ carceral entanglement. with this individualistic assumption at the forefront, mrt fails to engage critically with the ways racism may influence the attitudes and traits of individuals. thus, the racial disparities reflected in other areas of the carceral system are reproduced (alexander, 2012). in field placements, students must demonstrate their ability to treat clients as experts of their own lives (cswe, 2022). the design of mrt precludes this possibility, instead presuming that facilitators will correct participants’ presumed moral deficiencies. this topdown approach results in tensions for social work students navigating between cswe’s recognition of client expertise and mrt’s authoritative facilitation style. for example, facilitators are instructed to avoid arguing with clients about their experiences of the world: the world appears to be unfair to everyone, but the phrase that we try to teach in mrt about it is this: the key to dealing with the world is learning how to live a just life in an unjust world. learn this phrase and tell it to clients. (little & robinson, 2009, pp. 5-6) similarly, facilitators are instructed to prioritize mrt’s instructions over participants’ concerns or “rebellion” by enforcing mrt’s procedures: “tell clients that you didn’t make up the rules, but you believe in them and have to enforce them” (little & robinson, 2009, p. 3). whereas mrt deploys a one-size-fits-all approach to correcting moral reasoning and development, this epas standard promotes culturally-humble approaches to working with participants whose worldviews may differ from those held by social work students or practitioners. as a treatment modality, mrt is discordant with the cswe epas standard regarding diversity and difference. practice-informed research and research-informed practice the cswe’s fourth epas competency, “engage in practice-informed research and research-informed practice,” requires accredited social work programs to teach the methods, logic, and ethics of research to students, demonstrating how and why research and practice should inform one another (cswe, 2022, p. 10). cswe (2022) states that when meeting this competency, social workers “critically evaluate and critique current, empirically sound research to inform decisions pertaining to practice, policy, and programs” (p. 10). students who engage with mrt in field placements face unique challenges in operationalizing this epas competency. cci advertises mrt as a “samhsa nrepp registered program” (mrt, n.d.a). the national register of evidence-based programs (nrepp), a program registered by the substance abuse and mental health services administration (samhsa), cataloged hundreds of mental health and substance use disorder treatment programs judged as scientifically sound by an independent contractor (sun & eilperin, 2018). mrt received this nrepp designation in 2008 (correctional counseling, inc. , 2008, p. 1). a rating of https://www.zotero.org/google-docs/?22akhf advances in social work, fall 2022, 22(3) 908 3.0-4.0 was considered “effective,” 2.0 2.9 “promising,” and 0.0-1.9 “ineffective” or “inconclusive.” nrepp’s archived database shows that mrt received a clearinghouse rating of 2.2 out of four for correctional settings with ages 13-55 for outcomes related to recidivism and personality functioning, meaning the program had a “positive impact based on high-quality evidence” (pew charitable trusts, 2021). this ruling was based on five quasi-experimental sources: one unpublished master’s thesis, one psychological report authored by mrt’s creators, one evaluation of a county drug program, and three articles in cci’s company newsletter. the methodology used to determine this rating is no longer supported by samhsa (amanda doreson, samhsa, email communication, november 19, 2021). the nrepp was frozen in 2017 and indefinitely suspended in 2018 when funding was pulled (peter g. dodge foundation, 2018). samhsa’s assistant secretary dr. elinore f. mccance-katz wrote in a 2018 statement that the nrepp used a “poor approach to the determination of ebps” and represented a “biased, self-selected series of interventions” (para. 7). today, samhsa “no longer classifies programs as evidencebased or not” (email communication, november 19, 2021). despite the outdated and methodologically disputed nature of mrt’s samhsa designation, programs today–including the nineteenth judicial circuit court of illinois (n.d.), minnesota’s great north counseling services, llc (2016), florida’s coalition recovery (2022), and the council of accountability court judges of georgia (2021)–still promote mrt as a samhsa-approved evidence-based program. without further investigation, an outdated samhsa stamp of approval may lead students and practitioners alike to accept mrt as scientifically sound. what happens when students and practitioners do investigate mrt’s research base? blonigen et al. (2022) recently published findings on the first-ever randomized control trial of mrt. their study of 341, mostly male justice-involved patients of three mental health residential treatment programs, found no difference in the risk of recidivism between patients who received usual care and patients who received usual care plus mrt. the most recent meta-analysis of mrt published in a peer-reviewed journal appears in the international journal of offender therapy and comparative criminology. cited 91 times, this meta-analysis by ferguson and wormith (2013) calculated an “overall effect size measured by the correlation across 33 studies” and found that mrt had a “small but important effect on recidivism” (p. 1076). we share this finding cautiously. consulting with a social work and social sciences librarian, we reviewed the methods and findings of this meta-analysis to assess the integrity of the research evidence’s translation into practice. we found two significant issues with ferguson and wormith’s meta-analysis design: replicability and publication source. replicability the authors’ description of their search protocol does not allow for replicability. ferguson and wormith (2013) searched “relevant journals and databases,” providing examples of but no complete list of journals and databases searched (p. 1080). ferguson and wormith contacted cci to obtain additional studies and unpublished documents. cci directed ferguson and wormith to the mrt website and cci’s company newsletter, which harrell et al./moral reconation therapy 909 ferguson and wormith erroneously classify as a journal. in the end, the authors included nine company newsletters that are not publicly accessible. in total, the authors do not provide enough detail to allow for replicability of their search protocol, compromising the reliability of the findings. publication source ferguson and wormith (2013) acknowledge that over half (59%) of the effect sizes used in the analysis come from cci reports that “may not have been vetted by independent peer-reviewed journals” (p. 1080, emphasis in original). they report that most of the data from cci come from reviews of studies reported by cci without detailed information about methods or participants. despite these disclaimers, the authors refer to all sources as “studies” equally throughout their article, conflating peer-reviewed studies, non-peerreviewed reports, program evaluations, and company newsletter columns. ferguson and wormith’s (2013) meta-analysis included only one peer-reviewed, fulllength journal article describing an empirical study of mrt: an armstrong (2003) study comparing the risk of recidivism between a randomized treatment and control group of 256 youth receiving mrt from correctional personnel in a county jail in maryland in the 1990s. armstrong found no significant difference in recidivism rates between groups and cautioned that the primary “empirical justification for [mrt’s] widespread implementation” was based on studies by mrt’s creators (p. 673). upon investigation, ferguson and wormith’s meta-analysis appears to confirm this cautionary note. the meta-analysis relies heavily on “gray literature” or “forms of evidence not controlled by commercial publishers” (e.g., government documents, annual reports, dissertations; boland et al., 2017, p. 65). among their sources were two unpublished master's theses, 15 cci company newsletter columns, four brief reports from psychological reports, two annual reports for a now-closed oregon company that delivered mrt, and four reports from government-sponsored evaluations. it is worth noting that cci’s newsletter is titled, “cognitive behavioral treatment review and moral reconation therapy™ (mrt) news” and its citations look, on the surface, like any journal article citation (cited as “cognitive behavioral treatment review,” followed by a volume and issue number). the newsletter is devoted exclusively to the promotion of evaluations, advertisements, and trainings related to cci products. teaching mrt and research-informed practice to social work students what contradictions and tensions does mrt’s evidence base raise for social work education? while the movement toward evidence-based practice (ebp) has made significant strides in articulating the importance of research-based competencies (e.g., cswe, nasw), the profession’s uptake of these principles has been sparse. practicum students are likely to enter organizations where staff consult the professional literature rarely, if at all (sichling & o’brien, 2020). edmond and colleagues’ (2006) survey of 283 field instructors found that they considered ebp useful but infrequently implemented. similar conclusions were drawn in wiechelt and ting’s (2012) focus groups with 17 bsw advances in social work, fall 2022, 22(3) 910 field instructors. in social work programs where student interns are expected to facilitate mrt, several tensions and contradictions around research-informed practice arise. the body of rigorous, peer-reviewed research underlying mrt is small, and the information presented to trainees (e.g., company newsletters, psychological reports, annual reports) may be misleading. the available literature on mrt poses unique challenges to social work students trying to assess the validity and reliability of research on this intervention. social work practicum students are likely to come across dozens of citations for quasi-experimental studies or evaluations conducted by mrt co-founders and employees, without peer-review and disclosures of conflicts of interest. along with an outdated samhsa label still promoted by public and private organizations, these reports have the potential to mislead students about the evidence base underpinning mrt. without sound evidence, practicum students may attempt to conduct their own evaluative research on mrt. any efforts of student or even practitioner-led research would be significantly limited by an agreement that all mrt facilitation trainees must sign: “i will not directly use the copyrighted moral reconation therapy materials, training and methods in a manner which would be detrimental to correctional counseling, inc.” (correctional counseling, inc., 1998-2022a, para. 3). considering that the only peerreviewed, empirical study of mrt does not support its advertised efficacy, it is possible, if not likely, that a student research project would produce research findings detrimental to cci. such outcomes risk placing the student in violation of the mrt training contract and in tension with their practicum site, who may be financially contracted to facilitate cci’s program. implications for social work many social work students consistently identify their field placement as the site of their most impactful learning (smith et al., 2015). field placements are valued experiences, essential to creating competent and informed social workers (cswe, 2022). these placements grant social work students a means through which they can apply their theoretical knowledge and coursework into practice (bogo, 2015). given the importance of field experiences and their impact on future practice behaviors, it is vital to ensure that the opportunities presented to students during their field placements do not contradict the accreditation standards curated by the cswe. if activities such as mrt, incongruent with the epas, are permitted to influence students as they develop their practice, the integrity of the competencies themselves are fundamentally compromised. student engagement with mrt poses a negative impact to social work practice development and could be counterproductive to the efforts of the organizations and educators that support students on their academic and clinical journeys. bogo (2015) describes how field instructors must “draw attention not only to interventions with the client, but also relate those interventions to students’ understanding of theory and evidence, and of professional use of self” (p. 318). field instructors and site supervisors have a strong influence over what social work students come to identify as “best practice.” if msw students shadow practitioners facilitating mrt with high fidelity, they are likely to infer that participants are morally depraved and that clinicians should reject participant harrell et al./moral reconation therapy 911 statements related to diverse individual experiences, identities, and culture. when students engage with mrt in their field placement, supervisors and liaisons are asking that their students “unlearn” the ethical principles they are trained to uphold. given the incongruency of mrt with social work values and the influence of field placements on the development of social work practice, it is important that educators and accreditation agencies carefully consider and critically analyze the treatment models with which students engage in practice settings. conclusion mrt, used widely throughout correctional and other involuntary treatment settings, poses unique challenges to social work programs and practicum students who aim to adhere to the cswe epas. in this article, we evaluated mrt’s compatibility with three of the nine epas competencies. we argue that when facilitating mrt with fidelity, social work practitioners and students are unable to (1) demonstrate ethical and professional behavior, (2) engage anti-racism, diversity, equity, and inclusion in practice, and (4) engage in practice-informed research and research-informed practice. we also argue that the facilitation of mrt is poorly aligned with the nasw code of ethics. mrt's deficit-based conception of participants denies their inherent dignity and worth (nasw, 2021). the program undermines the right to self-determination by imposing rigid explanations and remedies for their current state, discouraging participants from asserting their unique insight or alternative self-concept. the mrt facilitator handbook pits facilitators against participants, compromising their ability to recognize the importance of human relationships (nasw, 2021). mrt denies diversity and difference, requiring participants to remedy their moral deficits through a one-size-fits-all program. facilitators are expected to remain faithful to the text and ignore structural oppression and cultural humility. despite cci’s claims of a large evidence base supporting mrt, most of the research supporting mrt’s efficacy is not peer-reviewed, and conflicts of interest are of concern in the case of studies funded by the program creators. the assertion that mrt is an evidencebased practice is misleading, as it relies on an outdated nrepp classification that is no longer used or supported by samhsa. ferguson and wormith’s (2013) commonly-cited, peer-reviewed meta-analysis suffers from poor replicability and non-rigorous publication sources. further, a recent scoping review found no additional peer-reviewed outcome studies have been published on mrt since 2011 (harrell et al., 2022). additional assessment of the purported research base supporting mrt is necessary. at the top of mrt’s website is an image of a rotating silver medallion. the words curving around the top edge read, “do the right thing” and the bottom edge, “moral reconation therapy.” as the image rotates, the text in the center switches between “mrt” and the statement “it works!” unfortunately, critical examination of the intervention with regard to social work’s competency standards and ethical principles calls this claim into question on at least two counts. first, the claim itself lacks evidence. second, even if the intervention were effective, such effectiveness would come at a cost to the dignity and worth of the participants and the integrity of the social work profession. advances in social work, fall 2022, 22(3) 912 references alexander, m. 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(2012). field instructors' perceptions of evidence-based practice in bsw field placement sites. journal of social work education, 48(3), 577593. https://doi.org/10.5175/jswe.2012.201000110 yochelson, s., & samenow, s. e. (1976). the criminal personality: a profile for change (vol. 1). rowan & littlefield. author note: address correspondence to sam harrell, school of social work, portland state university, 1800 sw 6th ave, portland, or 97201. email: saha2@pdx.edu https://doi.org/10.5175/jswe.2012.201000110 mailto:saha2@pdx.edu moral reconation therapy: incompatible with council on social work education competencies? background and significance to social work education ethical and professional behavior engage anti-racism, diversity, equity, and inclusion in practice practice-informed research and research-informed practice replicability publication source teaching mrt and research-informed practice to social work students implications for social work conclusion references _________ amy levine, msw, lcsw, clinical assistant professor, and marilyn ghezzi, msw, lcsw, clinical associate professor, school of social work, university of north carolina, chapel hill, nc. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 133-144, doi: 10.18060/25617 this work is licensed under a creative commons attribution 4.0 international license. pedagogical strategies for teaching the dsm: centering diversity and equity amy levine marilyn ghezzi abstract: the diagnostic and statistical manual of mental disorders, fifth edition presents numerous ethical challenges for social workers. as social work educators, we are tasked with preparing students for clinical social work practice, which includes not only instructing students in the use of the dsm-5, but also emphasizing the importance of pursuing social justice and equity in clinical work. with the most recent revision, the dsm5 task force attempted to improve cultural awareness and sensitivity – efforts that yielded mixed results. this article explores the changes, benefits, and shortcomings of these efforts to address cultural diversity and highlights pedagogical approaches for bringing this knowledge to the msw classroom. we describe specific teaching strategies that underscore the importance of a strong cultural formulation of client problems and are designed to inspire critical thinking about the process of diagnosing. social workers are encouraged to adopt these strategies for using the dsm-5 not only to better inform their clinical decision-making but also to better align their clinical practice with social work values and ethics. keywords: clinical social work practice, social work pedagogy, cultural awareness, dsm-5 social work and dsm-5: central tensions in the 70 years since the first edition of the diagnostic and statistical manual of mental disorders (dsm, american psychiatric association [apa], 1952), social workers have had a conflicted relationship with the manual. in their practice, clinical social workers must expertly use the manual to accurately assess clients’ mental health and choose appropriate evidence-based interventions when needed. however, this process is hampered by the serious shortcomings in the dsm’s framework and perspective on mental illness. despite the challenges, the dsm facilitates clear communication among professionals by providing a common language for mental health conditions. the manual has undergone periodic revisions to incorporate new research findings (mcquaide, 1999; petrovich & garcia, 2016). for some clients, receiving a diagnostic label can be validating and is often necessary to receive access to interventions that address their mental health challenges as well as for providers to receive reimbursement (sutherland et al., 2016). further, a diagnosis can enable clients to name, externalize, and better understand sources of great distress in their lives (craddock & mynors-wallis, 2014). despite these benefits, the dsm is a manual primarily designed by and for psychiatrists, and its medical model approach to diagnosis conflicts with social work values and ethics in several important ways. in her seminal article, mcquaide (1999) summarized about:blank advances in social work, spring 2022, 22(1) 134 social workers' concerns about the dsm 's focus on pathology rather than strengths, its lack of person-in-environment perspective, its lack of cultural sensitivity, and its reliance on the medical model as the basis for diagnosing mental illness. these critiques remain relevant even after the dsm’s most recent fifth edition (dsm-5; apa, 2013). moreover, numerous scholars have echoed the limitations of the current system of diagnostic classification as having limited utility, which led to recent efforts by the national institute of mental health to consider new systems of diagnostic classification (bredstrom, 2019; insel, 2014; kozak & cuthbert, 2016; petrovich & garcia, 2016; sutherland et al., 2016; thornton, 2017). to build greater critical consciousness regarding the history and function of dsm in our society, karter and kamens (2019) urged clinicians to apply an ecological framework to the process of diagnosis. their call expands sutherland and colleagues’ (2016) discussion that noted dsm diagnoses frame client distress as purely personal, which not only can increase shame and stigma but also downplay the relational and sociopolitical dynamics that impact clients’ symptoms. by contrast, a hallmark of clinical social work pedagogy is ensuring students understand the ways in which diagnostic labels can affect a client’s sense of self (peter & jungbauer, 2019). social workers using the dsm-5 must be critically aware of the manual’s shortcomings and understand how to align social work values and ethics with the process of diagnosing mental illness. although the diagnostic process is only one aspect of case conceptualization, the use of the dsm-5 is central to many clinical roles across social work settings. as such, social work educators have the responsibility of establishing a learning environment in which students can learn these critical thinking skills and understand how to apply the insight gained to the diagnostic process in their practice. this article focuses solely on the changes in the dsm-5 regarding cultural issues and the implications of these changes for social work education. changes in dsm-5: improvements or window dressing? with the 2013 publication of dsm-5, the apa made some significant shifts, including abandoning the multiaxial diagnostic system that many clinicians viewed as central to highlighting the potential impact of environmental and contextual factors on an individual’s functioning (walsh, 2016). the apa made several explicit attempts to improve the cultural sensitivity in the dsm-5, including adding a section to most diagnostic categories that addresses cultural factors, developing the cultural formulation interview (cfi), and adding a glossary of cultural concepts of distress to the appendix (apa, 2013; lewisfernández & aggarwal, 2013). the introduction to the dsm-5 summarizes various ways that culture can impact diagnosis, including how distress is communicated in different cultures and how culture shapes an individual’s understanding of their illness (apa, 2013). the cfi and its accompanying handbook provide guidance to clinicians about how to integrate ethnographic interviewing into standard psychiatric assessment (lewisfernández et al., 2016). for example, one of the initial questions in the cfi directs the clinician to ask the client to describe their problem as they would explain it to their family, friends, or others in their community (apa, 2013). this line of questioning attempts to decenter the clinician’s conceptualization of the problem and invites the client to share their lived experience. subsequent cfi items prompt the clinician to ask whether any aspects of the client’s identity impact the problem they are experiencing. the client is encouraged to levine & ghezzi/pedagogical strategies 135 share ways they have already attempted to cope with their problem, including consulting healers or helpers from within their community (apa, 2013). the focus of this questioning further supports the client in expressing a holistic understanding of their current challenges, coping strategies, and functioning that can be particularly useful in making a culturallyinformed diagnosis (jarvis et al., 2020). encouragingly, field studies designed to assess the implementation of cfi in clinical practice in six countries concluded both clients and clinicians found the tool “feasible, acceptable and clinically useful” (lewis-fernández et al., 2017, p. 295). these important additions have enhanced and nuanced the dsm-5’s conceptualizations of culture, mental illness, and the diagnostic process. since the dsm-5’s publication in 2013, researchers’ have given mixed reviews of the changes intended to boost the manual’s cultural sensitivity (bredstrom, 2019; petrovich & garcia, 2016; sutherland et al., 2016; thornton, 2017). paniagua (2018) noted the dsm-5 has taken far greater steps toward centering cultural diversity than the world health organization’s (who) international classification of diseases, the global diagnostic classification standard that has far fewer cultural guidelines (who, 2021). however, other authors noted the failure of the dsm-5 to fulfill the promise in its introduction to integrate cultural factors throughout the manual. indeed, the dsm-5 lists of diagnostic criteria fail to integrate cultural factors. for example, cultural concepts of distress remain relegated to the appendix (bredstrom, 2019; paniagua, 2018; thornton, 2017). even though additions such as the cfi can be useful tools in promoting a culturally-informed diagnostic process, this assessment tool is not well-integrated into the primary body of the manual; therefore, clinicians might not consider incorporating additional assessments as an essential part of the diagnostic process (aggarwal et al., 2013). many researchers and clinicians have reported the dsm-5 remains ethnocentric given that cultural aspects are emphasized for non-western cultures but not for socially dominant cultural groups (bredstrom, 2019; thornton, 2017). bredstrom (2019) concluded that throughout the manual, the dsm-5 fails to recognize cultural diversity and psychosocial contexts, noting “context within dsm-5 [sic] becomes an ethnic dividing line between those who are seen as culturally ‘other’ and those who are not” (p. 361). therefore, social work educators have an imperative not only to teach dsm-5 diagnostic criteria but also to highlight important critiques of the manual and explore the ways in which the strengths and weaknesses of the dsm-5 impact assessment in practice. strategies for teaching dsm-5 in social work education given that social workers are becoming the predominant providers of psychotherapy, the ethical tensions clinical social workers face are increasingly discomforting. phillips (2013) focused on this discomfort by asking, “so what are clinical social workers to do, working in a system which they did not create, which, in many ways, is antithetical to their values and beliefs, and which raises a number of new responsibilities and potential liabilities?” (p. 211). social work educators are tasked with preparing students to use imperfect tools—such as the dsm-5—and to work within imperfect systems to treat, support, and advocate for their clients. thus, the central question is how to teach social work students about making clinical assessments using the dsm-5 in a way that refrains from pathologizing human experiences and replicating inequitable power dynamics, but advances in social work, spring 2022, 22(1) 136 instead reinforces diversity, equity, and inclusion. to help answer this question, we present strategies to help social work instructors achieve this balance in training future clinicians. sociocultural context of assessment and diagnosis social work educators can begin achieving a balanced clinical perspective in their courses by ensuring students understand the significance of sociocultural context for a given diagnosis. as a discipline, social work emphasizes an individual’s lived experience is influenced through their culture, identities, relationships, challenges, hopes, and strengths. a central pedagogical goal of the field is to encourage students to consider the ways in which these factors affect an individual’s adaptive functioning. in this regard, it is important for social work courses to examine the ways in which individual, institutional, and cultural racism and other manifestations of oppression can negatively impact an individual’s physical and mental well-being (jones & neblett, 2019). in every reading, case study, or class activity, instructors can raise questions about the ways in which experiences of oppression—especially when coupled with other personal, relational, and sociopolitical dynamics—can contribute to changes and challenges in an individual’s thought patterns, moods, behaviors, and current functioning. additionally, instructors can highlight the limitations of the dsm-5 by demonstrating the ways the manual’s diagnostic criteria fail to meaningfully acknowledge many sociocultural factors. another classroom strategy is to encourage students to examine the ways a diagnosis might further pathologize individuals and reproduce societal power differentials. petrovich and garcia (2016) focused on this issue in their exploration of the harmful impact of misdiagnosis. as one solution to the problem, these authors proposed a “diversity/resiliency formulation” that acknowledges a client’s resources and strengths while highlighting the sociocultural elements that might affect the client’s overall functioning. instructors can use this diversity/resiliency framework to highlight shortcomings of dsm-5 and discuss alternative diagnostic considerations with potential to yield more effective and ethical practice. additionally, incorporating contemporary events (e.g., fear of deportation, anti-transgender legislation, police violence) in class content alongside discussions of specific diagnoses can encourage students to consider the way in which current social issues can directly impact the mental health of individuals and communities (becerra, 2016; devylder et al., 2020; seelman, 2016). by bringing realworld examples into discussions of the diagnostic process, instructors can underscore the importance of incorporating culturally-informed biopsychosocial assessments in making an accurate diagnosis that demonstrates an awareness of the individual’s relationship to their current environment. critical reflection on diagnostic labels beyond highlighting the importance of sociocultural contexts in conducting an assessment, students can be encouraged to critically reflect on the ways diagnostic labels can affect an individual’s sense of self. for example, instructors might ask students to share their perspectives on positive and negative aspects of mental health diagnoses, and then facilitate discussions about the multiple, varied ways a diagnosis can impact individuals based on elements of the individuals’ unique identities, personal histories, access to needed levine & ghezzi/pedagogical strategies 137 services, and a multitude of other factors. for instance, instructors could provide discussion prompts such as, “what might be the benefits of being diagnosed with a particular disorder?” “have you worked with clients who found the label helpful or reassuring?” “what are the possible negative impacts of diagnosis on our clients?” “how might you feel if you were told you had a particular diagnosis?” these questions also help students to clarify their own values and recognize biases held about particular diagnoses as well as the act of diagnosing. the evolution of the dsm is compelling, from its biological origins focused on neurological illnesses, to the strong influence of psychoanalytic theory, to the data-driven medical model of diagnostic criteria. over time, the purpose of the manual has shifted from gathering prevalence data to functioning as the primary mode of monetary reimbursement for clinical practice (surís et al., 2016). in the classroom, an analysis of the dsm history that underscores its changing theoretical bases as well as its lack of cultural awareness will help students understand the manual’s historical context and the subjectivity of the content. additionally, instructors can highlight the significance and meaning of mental illness across sociocultural contexts by exploring global conceptions of mental health. the evolving field of global mental health (e.g., collins, 2020; patel & prince, 2010; watters, 2010) can encourage students to examine culturally diverse narratives about health and healing, and thereby, develop a better understanding of the ways mental well-being and mental illness are conceptualized from non-western perspectives. classroom instructors can delve into the “how to” of assessing a client’s mental health by emphasizing how discussing their findings (i.e., their diagnosis) with the client can provide an opportunity to explore the impact of cultural dynamics on the client’s functioning and experience of mental health symptoms. instead of using a diagnostic label as something that further individualizes, medicalizes, or pathologizes the client, the clinician can approach these discussions in a way that invites a critical conversation with the client about how culture, power, and privilege can directly affect their experience of mental health symptoms (sutherland et al., 2016). as a pedagogical strategy, instructors can present a clinical vignette and ask students to role-play delivering this diagnosis to their client. in the role-play, students can practice providing psychoeducation about the assessment and treatment while strengthening their ability to process a client’s reactions and questions about the diagnosis in a way that validates the client’s identity and experience. clinical case studies and vignettes can easily be accessed through resources produced by the apa (barnhill, 2014). by incorporating these role-plays into the classroom and emphasizing the ways such discussions can ultimately serve to empower the client, instructors can better prepare students for difficult and critical conversations with clients. impact of clinician bias instructors can help students become self-aware clinicians by using pedagogical strategies that address the impact of clinician bias and lack of cultural humility on the diagnostic process. in the classroom, instructors can illustrate this point via an in-depth examination of the relationship of specific diagnoses to culture and identity. for instance, oppositional defiant disorder (odd) is a highly stigmatized diagnosis that often sets a advances in social work, spring 2022, 22(1) 138 negative trajectory for children and adolescents. although epidemiological studies have shown that african american and white children have similar rates of odd behaviors, african american youth, particularly males, are more likely to be diagnosed with odd than white youth (ballentine, 2019; grimmett et al., 2016). multiple scholars have noted this overdiagnosis of odd requires a multi-layered explanation and stems not only from the problematic biases of the odd criteria in the dsm but also from stereotypes of african american male youth as aggressive, hostile, and violent (ballentine, 2019; fadus et al., 2020). additionally, clinicians might misinterpret a client’s behavior as symptoms of other disorders or syndromes (e.g., attention deficit hyperactivity disorder [adhd]) or as irritability or defiance, which are key diagnostic criteria for odd. not surprisingly, this combination of personal assumptions, biases, and failure to acknowledge other contributing factors (e.g., psychosocial stressors, structural racism, or a history of trauma) is likely to lead clinicians to make an inaccurate odd diagnosis that stigmatizes young clients. social work instructors can highlight the research on misdiagnosis and apply insights to a range of evidence-based case examples, including overdiagnosis of schizophrenia spectrum disorders in african american and latinx populations, underdiagnosis of autism spectrum disorders in females, and underdiagnosis of attention deficit hyperactivity disorder in african american and latinx populations as well as females of all races/ethnicities (morgan et al., 2013; quinn & madhoo, 2014; ratto et al., 2018; schwartz et al., 2019; schwartz & blankenship, 2014). as the instructor teaches students about the dsm-5 diagnostic categories, their lessons can openly and regularly explore questions about which clients do and do not receive these diagnoses, and the propensity of clinicians to overdiagnosis disorders in certain populations. the information and insight gained from these discussions are important for social workers to consider in their practice. such critical questioning will encourage students to move beyond rote memorization of diagnostic criteria to a deeper understanding of how diagnostic decisions play out in the real-world with significant ethical and social justice implications. tools for diagnostic formulation another pedagogical strategy is to teach students to use existing tools that can help them consider cultural and identity factors in the assessment process. when used appropriately, the cfi provides a useful guide for strengthening students’ diagnostic skills in this regard. in class, instructors can lead discussions about the utility of the cfi in the context of changes to dsm-5. students can then apply the tool in class activities to practice assessing how a client’s cultural identity, associated cultural factors, and the relationship dynamics between client and clinician may contribute to the diagnostic process (apa, 2013). instructors can also direct students to the apa’s dsm-5 website where students can view videos of clinicians using the cfi during client assessments (apa, 2013). as case studies are presented, students can discuss how using the cfi could enable them to better understand the client’s perspective, current functioning, and presenting symptoms (lewisfernandez et al., 2016). reviewing the other culture-related additions in dsm-5 (e.g., glossary of cultural levine & ghezzi/pedagogical strategies 139 concepts of distress and culture-related diagnostic issues sections) and learning how to effectively use this information when making client assessments is an important skill for students to develop (apa, 2013). as part of class discussions of case studies and activities, instructors can reference the dsm-5 additions to highlight the specific cultural issues pertinent to social workers’ assessments. to mitigate bias and to ensure students consult multiple sources of information, instructors should encourage students to incorporate structured interviews and standardized assessment tools into the assessment process. instructors should discuss the cultural validity of assessment scales and provide examples of adaptations to scales that better address specific cultural needs (e.g., depression selfrating scale and child ptsd symptom scale; kaiser et al., 2019; kohrt et al., 2011). the overall goal is for instructors to show students how and why to thoughtfully consider cultural factors when assessing a client’s current functioning and symptom presentation using multiple methods to arrive at an ethical and accurate diagnosis. clinician bias and the role of advocacy instructors must convey to students not only the need to continually examine their own implicit biases but also their responsibility to continuously advocate for needed systemic change within the world of mental health treatment to foster more inclusive and equitable treatment paradigms (schwartz et al., 2019). numerous studies have confirmed the relationship between the clinician and the client is the most salient factor in a client’s successful engagement in mental health services and positive outcomes (deangelis, 2019; flückiger et al., 2018; shattock et al., 2018). instructors can highlight the value of cultural humility in engaging clients and providing culturally-informed comprehensive assessments, accurate diagnoses, and effective mental health treatment through a strong therapeutic alliance (gottlieb, 2021; lekas et al., 2020). challenging students to identify their preconceptions about specific diagnoses as they learn about dsm-5 diagnostic criteria and using materials throughout the course that center the voices and experiences of people living with mental illness will enable students to learn from and not just about clients. to promote bottom-up systemic change, instructors might encourage students to submit their critical assessments of problematic content in the dsm-5 to the apa via the section of the apa website that invites feedback on the manual. instructors can also present additional opportunities for students to advocate for needed changes in mental health services and delivery of care. moreover, instructors should make clear the connections that exist between dsm-5 misdiagnoses and social problems such as the school-to-prison pipeline, homelessness, and mass incarceration. for example, when noting the underdiagnosis and treatment of adhd in children of color and the ways underdiagnosis can affect behavior, academic success, and self-esteem, instructors can clarify the ways a misdiagnosis (or a missed diagnosis) can impact the trajectory of an individual’s life course (moody, 2016; shi et al., 2021). classroom discussions provide students opportunities to explore macro-level factors that contribute to mental health disparities, such as a lack of access to culturally-relevant interventions and lack of health insurance. additional advocacy efforts could include examining alternatives to dsm-5 as the primary system for clinical reimbursement and urge greater attention be given to developing more holistic and culturally-informed assessments of an individual’s functioning and needs within their advances in social work, spring 2022, 22(1) 140 community (raskin, 2019). last, social work educators must call attention to the immense power clinicians hold when assessing mental illness. educators must explore the weight of this responsibility with students and carefully examine the complexities of promoting ethical practice at the individual, community, and system levels. conclusion to promote ethical practice, social workers must approach assessment of mental health and functioning in a way that supports and empowers clients instead of relying on methods and materials that can contribute to clients’ marginalization and oppression (petrovich & garcia, 2016). given the high stakes for client outcomes, social work educators have a responsibility to teach students to critically examine their assessment practices. this pedagogy requires instructors to underscore the problematic history and current critiques of the dsm-5 while giving students practical strategies for assessing mental health needs within a cultural context and providing culturally-informed, accurate, and ethical assessments. social work educators can also foreground possible tensions between the field’s code of ethics (national association of social workers, 2021) and using dsm-5 criteria to provide a mental health diagnosis. ultimately, educators must assist students, as well as the social work profession, in advancing an understanding of mental health assessment and intervention that is inclusive and equitable for all. references american psychiatric association [apa]. 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(2021). international statistical classification of diseases and related health problems. https://www.who.int/standards/classifications/classificationof-diseases author note: address correspondence to amy levine, school of social work, university of north carolina at chapel hill, campus box 3550, 325 pittsboro st, chapel hill, nc 27599. email: amylevine@unc.edu https://doi.org/10.1001/jamanetworkopen.2021.0321 https://doi.org/10.3390/bs6010005 https://doi.org/10.1080/08952833.2016.1187532 https://doi.org/10.1057/978-1-137-39510-8_3 https://doi.org/10.1080/10911359.2015.1052913 https://www.who.int/standards/classifications/classification-of-diseases https://www.who.int/standards/classifications/classification-of-diseases mailto:amylevine@unc.edu ------------_________ stephanie k. boys, phd, jd, msw, associate professor, and tayon r. swafford, msw, gceswp, mts, phd candidate, school of social work, indiana university, indianapolis, in. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 505-517, doi: 10.18060/26494 this work is licensed under a creative commons attribution 4.0 international license. learning from their stakeholders: social work students’ perspectives on a university’s response to the covid-19 pandemic stephanie k. boys tayon r. swafford abstract: emerging initially in wuhan, china in december 2019, covid-19 steadily spread throughout and overtook the world by march 2020. college and university administrators were tasked with responding to covid-19’s unpredictability and persistence. the purpose of this study was to learn social work students’ attitudes toward a large, public midwestern u.s. university’s response to covid-19 at the outset and in january 2022 during the surge of covid-19’s omicron strain. using mixed methods, 43 social work students were surveyed (28 msw and 15 bsw) in january 2022. the survey’s data suggested four important lessons for universities navigating public health responses. first, students are not oblivious to the politics and budgeting concerns that drive many university decisions. second, pertaining to the emergence of the omicron variant, students are extremely divided over their level of concern with contracting the virus themselves and/or infecting others. third, colleges and universities need to have a plan of action prepared for addressing future public health emergencies and digital equity. finally, faculty and staff from social work departments need to be “at the table” when university decisions are made because social workers will ensure that student concerns and wellbeing are at the core of policy decisions. keywords: scholarship of teaching, pandemic response, covid-19, mixed-methods, social work students, social work education, public health issue emerging initially in wuhan, china in december 2019 (holshue et al., 2020), covid19 steadily spread throughout and overtook the world by march 2020. college and university administrators were tasked with responding to covid-19’s unpredictability and persistence in ways that permitted continued learning and promoted the safety and wellbeing of faculty and students. to this end, the decision was made for many colleges and universities to cease physical operation in march 2020, requiring faculty and students to immediately shift to remote (i.e., online/digital) facilitation and learning. hensley et al. (2021) noted that college and university faculty and students were not prepared to shift and rearrange how they lived so quickly and unprecedently. similar sentiments have been shared by faculty and students regarding remote facilitation and learning. for example, hodges et al. (2020) encouraged members of the academy and public to consider the immediate shift in living and learning to that which was in the best interest to preserve public health and well-being. from march through december 2020, many college and university administrators were once again tasked with making another critical decision—whether and to what extent they were ready, willing, and able to return to in-person/face-to-face operations given covid-19’s persistence. about:blank advances in social work, summer/fall 2023, 23(2) 506 extant literature contains research studies that explore, describe, and explain faculty and students’ attitudes, thoughts, and feelings regarding the shift to remote education. for example, sullivan et al. (2023) interviewed 36 mental health professionals to consider ways to reimagine social work practice with the rapid acceptance of telehealth at the commencement of the covid-19 pandemic. cummings et al. (2023) reported that the majority of the social work students (bsw and msw) sampled in their study struggled to remain focused on coursework, yet they appreciated their faculty members’ flexibility regarding assignment submission. additionally, the students in cummings et al.’s (2023) study reported being grateful for the effort made by faculty members to use video platforming to sustain connections. reitmeier et al. (2023) shared that faculty faced being furloughed or “laid off” due to the strain that covid-19 placed on their respective institution’s budget. although covid-19’s persistence has weighed more heavily and disproportionately on individuals and communities who possess certain identity markers (e.g., black/african americans, first nations/indigenous peoples, and persons with lower socioeconomic statuses) (cummings et al., 2023; reitmeier et al., 2023), the researchers recognize the effect that covid-19 has had on faculty and students, collectively. similarly, the researchers validate decisions made by college administrators to shift to online learning modalities as an attempt to respond to the changing face of the pandemic in ways that they felt would best promote their students’ and faculty members’ overall health and well-being. our study extends covid-19 research by learning and excavating students’ attitudes toward the pandemic at the outset and in january 2022 during the surge of covid-19’s omicron strain. literature review since march 2020, individuals and communities have been advised to incorporate “public care strategies” into their daily routines. these strategies include but are not limited to handwashing, wearing face masks, physical distancing, along with avoiding mass gatherings and assemblies (pokhrel & chhetri, 2021). public health experts advised that these strategies were necessities for mitigating the transmission of covid-19 (sintema, 2020). college and university administrators throughout the world responded and contributed to public health experts’ advice by shifting to remote facilitation and learning in march 2020. extant literature maintains that making the shift required many faculty and students to finish their spring semesters away from their college and university environments. evans et al. (2021) and north (2020) saw covid-19 as upending college students’ (undergraduate and graduate) ability to receive financial, social, academic, and psychological support. moreover, paceley et al. (2021) addressed the inability for students to participate in “rites of passage,” from march 2020 onward, such as college graduation, due to the effects of covid-19. throughout summer 2020, college and university administrators tracked covid-19 data and used it as a tool to aid in their decisions regarding whether and to what extent to re-open campuses in fall 2020. using data from davidson college’s (2020) college crisis initiative (cci) that they retrieved from the chronicle of higher education’s (2020) website on october 22, 2020, felson and adamczyk (2021) used mixed-modeling and found that the most significant factors considered with re-opening colleges and universities boys & swafford/swk students & covid response 507 for in-person instruction were politics and financial health/budget. while felson and adamczyk (2021) showed the role that state/county health, faculty resistance, and market niche had in dialogues pertaining to re-opening, politics (as represented by the percentage of the population who agreed with former president donald trump to re-open colleges/people with an evangelical affiliation) and financial health/budget (by way of tuition, net revenue, endowment per student, and enrollment) were consistent predictors of a college or university’s re-opening strategies. frazier et al. (2022) described an epidemiological model that formed and framed cornell university’s decision to re-open for in-person instruction in fall 2020. the same model described in frazier et al.’s (2022) study was used to support the creation and facilitation of an asymptomatic screening program that helped detect, track, and mitigate covid-19’s spread throughout the university. chang et al. (2021) noted that a number of colleges and universities that reopened in fall 2021 introduced procedures for providing covid-19 testing for faculty, staff, and students. the procedures described by chang et al. (2021) reflected colleges’ and universities’ desire to transition back into in-person learning while continuing to promote faculty and student health and well-being, concurrently. felson and adamczyk (2021) and frazier et al. (2022) used quantitative/ mixedmodeling techniques to show how college and university administrators supported decisions to re-open their institutions. stowe et al. (2021) and vanleeuwen et al. (2021) encourage readers to shift their focus toward considering the effect that the covid-19 pandemic has had on college and university faculty and students’ emotions and behaviors. stowe et al. (2021) and vanleeuwen et al. (2021) portray faculty and students as battling anxiety, depression, and stress due to ambiguity pertaining to whether and when life would return to “normal,” coupled with a lack of institutional support while having to live and learn away from their educational environments. for students, specifically, the rate at which anxiety, depression, and stress have been felt throughout the covid-19 pandemic has contributed to increased psychological, cognitive, and substance use disorders (charles et al., 2021; copeland et al., 2021). charles et al. (2021) and copeland et al.’s (2021) studies segue readers from exploring and examining the impact of the covid-19 pandemic to grappling with its implications. by doing so, charles et al. (2021) and copeland et al. (2021) exposed an additional gap in knowledge that harper (2020) begins to fill by addressing the impact that re-opening college and university campuses has on race equity. harper (2020) explained that college and university administrators and campus task forces worked assiduously to prepare campuses for a successful transition back to “normal operations” pre-march 2020. laying the above entities’ efforts aside, harper (2020) exhorted readers to consider the added barriers and threats associated with race, ethnicity, and nationality. among the 12 implications that harper (2020) provided were three that were most salient: (1) the racial stratification of the workforce, (2) the risk of violence for asian international and asian american students and employees and (3) addressing racialized digital access inequity, such as a lack of access to computing equipment and/or reliable internet for students who depended on their institution’s computing and networking equipment to complete their studies. these three implications reminded us that persons from minoritized and underrepresented communities are more likely to experience the lingering effects of advances in social work, summer/fall 2023, 23(2) 508 covid-19, even after covid-19’s cessation because of the gaps in learning that might remain due to computing and networking equipment being unreliable or nonexistent. harper’s (2020) study showed that decisions made to re-open campuses and facilitate in-person learning environments were made by people in positions of power with little to no contribution from those on the “front lines,” that is—faculty and students. even though covid-19 is not as pernicious as it has been in the past, college and university administrators will continue to field questions, comments, and concerns from faculty and students whose perceptions and lived experiences on the “front lines” might vastly differ based on their identity markers, including but not limited to their race, ethnicity, gender, sexuality, religion, ability, mental health status, and religion/spirituality. this might be more significant if faculty and students either perceive or know with certainty that they and their lived experiences, needs, ideas, and voices were not included in campus re-opening plans. the present study to date, researchers have masterfully captured patterns, trends, attitudes, feelings, and actions pertaining to the decisions leading to the shift to online learning in spring 2020 and to the re-opening of campuses from fall 2020 through fall 2021 (e.g., cummings et al., 2023; reitmeier et al., 2023; scheffert & parrish, 2023). yet, no studies exist that also capture the lived experiences of students as they grapple with their attitudes toward campuses re-opening in january 2022 amidst the ever-increasing presence of the covid19 omicron strain. this is both a gap and social justice issue that our study addresses since covid-19 is an example of a public health emergency to which college and university administrators must respond. this study used a mixed-methodological approach to gathering and analyzing student perceptions of their university’s response to covid-19 at the outset and in january 2022 during the surge of covid-19’s omicron strain. our guiding research questions were: 1. what is your level of concern regarding covid-19? 2. how well did the university respond to the initial covid-19 outbreak? 3. how well did the university respond to the covid-19 omicron surge in january 2022? 4. what factors do you believe drove the university’s response to the initial covid-19 outbreak and the covid-19 omicron surge in january 2022? 5. what recommendations do you have to help the university respond to future public health emergencies? inevitably, another public health emergency will occur. it is imperative for colleges and universities to gather data and obtain suggestions from students to ensure continued enrollment, and retention, to garner their trust, and most importantly, to ensure their wellbeing and successful completion of their studies. boys & swafford/swk students & covid response 509 methods the purpose of this study was twofold: to assess the perspectives of social work students with regard to a university’s response to the pandemic, and to solicit recommendations from students for effectively managing future public health emergencies. a total of 43 social work students (28 msw and 15 bsw) at a large, midwestern university responded to a mixed-methods survey during the height of the omicron surge in january 2022. students were enrolled in one author’s course; however, this irb-approved study was introduced and administered by a neutral, third party. no identifying information was collected. surveys were stored in a locked cabinet and all data was maintained on a secure network. the survey took approximately 15 minutes to complete. the survey was administered during the third week of the semester, at the beginning of a class session, and during the last week of january 2022. no extra credit or any benefit was provided for completing the survey. the survey included a mix of open-ended and quantitative questions about the university’s response to the pandemic and sought recommendations for addressing future public health emergencies. the four quantitative statements were evaluated on a scale from 1 to 5 (from excellent to poor on questions regarding the university response and extremely worried to not worried at all on the question regarding student concern over covid-19). students were given space to provide written comments on their responses. survey questions fell into four categories: (1) student concern regarding covid-19, (2) satisfaction with the university’s response to the initial covid-19 outbreak and then the omicron surge in january 2022, (3) the inclusivity of the university’s responses, and finally, (4) student recommendations for response to further emerging public health crises. quantitative responses were entered into spss version 26 to measure frequency. narrative responses were independently coded by the researchers for reoccurring and emergent themes using grounded theory analysis to avoid overlaying preconceived ideas onto the data (charmaz, 2014). triangulation among the researchers was used to ensure trustworthiness of the analysis. results demographics due to the small sample size, the only demographic information collected was whether students were enrolled in the bsw or msw program. twenty-eight students were in the msw program and 15 were in the bsw program. no significant differences were found between msw and bsw responses on any question. student concern regarding covid-19 students were divided on their level of concern about covid-19 on a 5-point likert scale, with 48% reporting being extremely worried or worried (1 or 2) and 45% reporting advances in social work, summer/fall 2023, 23(2) 510 being only a little or not worried at all (4 or 5). the most common emergent theme from the students who were concerned about covid-19 related to missing class and not being accommodated. “the university has tried to act ‘normal’, but we can’t be ‘normal’ if half of a class is out due to covid [sic],” said one student. similarly, another student said, “with some professors not allowing zoom or not being able to hear when i do [zoom], i am constantly worried i’m missing assignments and participation and will have to re-take the class.” the other common theme from students worried about covid-19 related to infecting loved ones and/or themselves. “i have a weak immune system and am always worried when i have to come to campus, especially now with omicron,” said one student. others mentioned living with older relatives, such as “my 85-year-old grandma lives with us. i wouldn’t forgive myself if i brought home covid [sic] because the university says classes have to be in person.” students who reported little concern with regard to covid-19 most often mentioned fatigue with online classes and the pandemic in general. as one student explained succinctly, “we are all just exhausted.” several students cited not being able to learn well online: i’m a person who needs to be in a classroom to learn. we went online when it was needed and i didn’t learn anything for a year. classes need to be back in person…i’m fully vaccinated now and able to interact with my peers on campus rather than online. student satisfaction with the university response to covid-19 while students were divided regarding their concern over covid-19 in january 2022, they were less divided regarding their perceptions of the university’s evolving response to covid-19. toward the end of the fall 2021 semester, faculty and students received written correspondence from the university that cited rates of vaccinations and boosters, along with masking, as its justification for resuming in-person operation for the spring 2022 semester. while four out of five (80%) participants thought the initial university response to the pandemic in spring 2020 was good or excellent (4 or 5), only 34% thought the response to the omicron variant was good or excellent (4 or 5). both narrative and quantitative data pointed toward lower satisfaction with the omicron response. for instance, a comment on the university’s response was “originally i was impressed by the university response, but as time went on, it seems like the university stopped caring about our safety and individual student needs.” following questions regarding student satisfaction with the university response in march 2020 and january 2022, students were asked the open-ended question, “what do you believe guides university policy with regard to covid-19?” in response, 92% of answers began with either money or politics. the researchers note that students’ responses align with prior literature on what factors informed u.s. college and university administrators’ decisions on whether to operate in-person between the fall 2021 and spring 2022 semesters. boys & swafford/swk students & covid response 511 although 38% of responses mentioned themes of public health and science, these themes were nearly always mentioned later as a response to the diminishing concern of universities for student health and well-being. as one student explains, “the university really seemed to want us safe and doing what the cdc recommended at first, but now the focus feels like it is on appearances for certain donors.” another student explained their view this way, “money and political statements guide the policy now.” moreover, another student responded, sometimes i feel the university does not have the student and staff’s best interest at heart, but cares more about ‘looking good’ or public opinion, as well as the money coming in whether it be from students or the government. as the university had lifted most restrictions prior to the emergence of the omicron variant, a student theorized, “the school is afraid to go back on their new policies, even if it would increase safety, just because of potential backlash.” inclusivity of university response students were asked an open-ended question regarding whether they believed the university took diversity, equity and inclusion (dei) concerns into consideration while making decisions in response to covid-19. two themes emerged from the analysis of the data. the most common theme was a lack of consideration for students at high-risk for covid-19 complications or a lack of concern over students exposing their loved ones to covid-19, particularly if their loved ones are “high-risk.” as one student wrote, at the beginning of the pandemic, we all went online and it allowed everyone to be safe. but with omicron, we just have to be in class. accommodations aren’t being made which is really unfair for people at high risk. another stated, “everyone seems to be getting omicron and we are still required to be in person. what are people living with people at high risk supposed to do now? quit school?” another theme that manifested was a lack of cultural sensitivity due to a vaccine requirement. one student shared, “i’m vaccinated but as a black woman, a lot of my family is vaccine hesitant. i probably wouldn’t have gotten it if i didn’t have to.” another student said, “i bet some people quit school rather than getting the vaccine. and they might have a legitimate reason. the university should grant exceptions on a case-by-case basis.” recommendations for future public health responses finally, students were asked what recommendations they had for the university when responding to the next public health emergency. thematic analysis revealed several useful suggestions by students. the most common was the need for flexible attendance policies. students recommended for the policies to originate from and be disseminated by upperlevel administrators to avoid exposing students to inconsistent policies and protocols from faculty. it was also expressed that policies originating from and being disseminated by upper-level administrators would place less pressure on faculty to develop and enforce policies. as one student explained, “the university seems to let every professor decide advances in social work, summer/fall 2023, 23(2) 512 what their attendance policy is. that’s been really hard during omicron because so many people are out sick, and the attendance policy varies in all my classes.” the second most common theme related to the university providing faculty with guidance on when to move classes online, such as if a state reached a specific case count. again, students mentioned this would bring consistency across their courses and reduce last-minute decisions from individual instructors. during weeks when case counts are high, half my classes might be on zoom and the other half in person. and i’ll get an email from the professor an hour before i leave for campus letting me know class will be online. it’s really hard to keep track of and frustrating if you drive to campus and find out class is on zoom. there should be consistency from the university so we can plan at least a week in advance, explained a student. students discussed how better communication from the university could raise their confidence in safety procedures. nearly one-quarter (23%) of respondents referred to being confused as to why classes were going forward in person during the omicron surge that infected so many more people than any prior wave. “if the university would just explain their thinking, like high vaccination rates, i’d feel better about why we are all forced to be here.” finally, students also had some recommendations for safety and flexibility, including providing online options for taking classes if there were multiple sections of the same class and facilitating classes in larger classrooms. as one student pointed out, larger classrooms might be more available if some sections of a class were offered online. implications for future responses to public health crises nearly two years into the most disruptive pandemic in 100 years, student concern about the coronavirus (covid-19) was highly mixed; nevertheless, this data provides insight for how universities can take student voices into consideration throughout their decisionmaking processes. the survey data indicated four important lessons for universities navigating public health responses. first, students are not oblivious to the politics and budgeting concerns that drive many university decisions. second, with regard to the emergence of the omicron variant, students were divided over their level of concern with contracting the virus themselves or infecting others. third, universities need to have a plan of action prepared for addressing future public health emergencies and digital equity. finally, faculty and staff from social work departments need to be “at the table” when university decisions are made. student recognition of the political context of policy decisions students who responded to the survey were clearly aware of the political considerations that drove responses to the omicron variant. as an interesting aside to this study, the finding demonstrates success in student internalization of the council on social work education’s (cswe) epas competencies requiring social work educators to ensure boys & swafford/swk students & covid response 513 students “recognize the historical, social, racial, cultural, economic, organizational, environmental, and global influences that affect social policy” (cswe, 2022, p. 10). the majority of students mentioned that the political context of the state helped dictate the university’s response to the pandemic. the university in this study is located in a state with a republican super-majority led state legislature. similar universities should recognize that students, at least in social work, are cognizant of the political context in which decisions are made; students know when financial concerns take precedent over their education and safety needs. student divide over concern about the virus the division of student concern regarding the current state of public health can be exceedingly difficult for universities making policy decisions because it seems that there is no way to make everyone happy. the concern of social work students over covid-19 mirrors the public divide across society. with societal tensions high, it is recommended that universities, near and far, ask for and consider student input, particularly pertaining to communication. woodly (2015) has written that clearly communicating the reasons for policy decisions can help encourage acceptance and lessen division. students expect a future action plan taking student recommendations into account, it is clear universities need to have a plan of action prepared to address differing severities of public health emergencies in the future. plans must include metrics for when classes will go online, attendance policies, and plans for when to lift restrictions. these plans should be implemented across the university rather than left to instructor discretion, which causes confusion and anxiety for both students and faculty. if university plans are transparent, faculty and students can prepare so that instructor academic freedom is upheld as much as possible and student learning is disrupted as little as possible. universities must also ensure that digital equity is addressed. when the 2020 covid-19 pandemic struck, many students did not have adequate internet access, or even the equipment, to fulfill transitioned course requirements. students were forgiving about this lack of digital equity in 2020, but they have expected (and do expect) the university to have learned from this recent public health emergency and be better prepared to respond to the next crisis. social work faculty have a duty to help shape the future action plan as future plans to address public health crises are developed, it is imperative that social work faculty and staff play a role in shaping these university plans. the national association of social workers (nasw’s, 2018) code of ethics calls on social workers to “engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully” (p. 30). our profession requires that we work to ensure digital equity and that the concerns of students and others who may be particularly vulnerable to illness are at the core of policy decisions. advances in social work, summer/fall 2023, 23(2) 514 limitations this study was exploratory in assessing student perceptions about a rare historical event that initially took us all by surprise with the sudden onset of a pandemic. the small sample size diminishes the generalizability of the results, and it is not representative of the experiences of all social work students during the omicron wave of january 2022. demographic information beyond program enrollment was not collected due to the small sample. collecting an age range or gender information would have made the surveys identifiable. additionally, the study presents results from one large, u.s. public midwestern university. a larger study that samples students from a broader scope of geographical areas, diverse socio-demographics and varying educational institutions, such as faith-based universities or for-profit universities, would bolster our understanding of student concerns regarding covid-19 and necessary responses. lastly, opinions on public health have evolved substantially since the emergence of covid-19 and its variants. this study only reflects a small point in time, january 2022, during the largest wave of u.s. covid-19 cases due to the initial omicron variant and relatively few governmental mandates to combat the new upswing in cases. the student data collected regarding the initial response is also retrospective as students compared it during the time of the omicron surge. moving forward, future studies should track student opinions on public health and university regulations as crises ebb and flow to better understand how to address new threats. future directions with students at the core of higher education, it is important to understand their position on university responses to public health. however, future studies must also explore the perception and experiences of faculty and staff. the care and concern faculty and staff can show for students is impacted by their own personal challenges brought on by a public health emergency. additionally, future studies must address what funk (2021) terms digital justice as a way to gauge a university’s readiness, willingness, and ability to adapt its operation to meet students’ holistic needs within and beyond course delivery. college and university administrators will be expected to respond more effectively to the next public health emergency; students will be watching. conclusion while covid-19 turned our world upside down too quickly to involve a wide variety of voices in the response, the data in this survey provides information about student perceptions of public health as we prepare for the next emergency. it is imperative for colleges and universities to consider the needs of students and their suggestions as they prepare for the inevitable next public health emergency. without attention to students, colleges and universities will compromise their crucial goals of garnering enrollment, retention, trust, and student well-being. however, with an action plan that is inclusive of student input, universities and higher education will be prepared to persevere and thrive during and after future public health emergencies. boys & swafford/swk students & covid response 515 references chang, j. t., crawford, f. w., & kaplan, e. h. 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(2015). the politics of common sense: how social movements use public discourse to change politics and win acceptance. oxford university press. author note: address correspondence to stephanie k. boys, social of work, indiana university, 902 west new york street, es 4157, indianapolis, in 46202. email: sboys@indiana.edu https://doi.org/10.1093/acprof:oso/9780190203986.001.0001 https://doi.org/10.1093/acprof:oso/9780190203986.001.0001 mailto:sboys@indiana.edu learning from their stakeholders: social work students’ perspectives on a university’s response to the covid-19 pandemic stephanie k. boys tayon r. swafford abstract: emerging initially in wuhan, china in december 2019, covid-19 steadily spread throughout and overtook the world by march 2020. college and university administrators were tasked with responding to covid-19’s unpredictability and persistence. ... literature review the present study methods results demographics student concern regarding covid-19 student satisfaction with the university response to covid-19 inclusivity of university response recommendations for future public health responses implications for future responses to public health crises student recognition of the political context of policy decisions student divide over concern about the virus students expect a future action plan social work faculty have a duty to help shape the future action plan limitations references ________ sam harrell, msw, doctoral student and stéphanie wahab, professor, school of social work, portland state university, portland, or. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 818-840, doi: 10.18060/24910 this work is licensed under a creative commons attribution 4.0 international license. the case for mandatory reporting as an ethical dilemma for social workers sam harrell stéphanie wahab abstract: mandatory reporting of child abuse is a part of the civil legal system that can activate a policy cascade disproportionately criminalizing racialized and marginalized communities. while social work scholarship has explored ways to increase provider compliance with mandatory reporting laws, there is a dearth of research focused on how social work education guides future providers towards the praxis of mandatory reporting discourses. this article presents findings from a content analysis of social work textbook excerpts focused on mandatory reporting of child abuse in the u.s. we found that textbooks affirm social work’s loyalty to the state by approaching mandatory reporting through a deontological lens and systematically reinforcing risk management practices. although some texts offer a nod to mandatory reporting as facilitating ethical dilemmas, none offer guidance for how to navigate competing social work commitments, and none actually treat mandatory reporting as an ethical dilemma. we argue that social work education should equip future practitioners to: a) have a nuanced understanding of mandatory reporting laws and requirements; b) contextualize mandatory reporting within broader discourses of criminalization, professionalization, and neoliberalism; and c) ground future practices in macro social work ethics. keywords: mandatory reporting, child welfare, social work education, ethical dilemma, criminalization the racial reckoning of 2020 in the united states created opportunities and spaces for national conversations focused on racism and criminalization. social work was thrust into the national spotlight as calls to defund the police were accompanied by calls to move funding and responsibilities for responding to people in crisis to social workers (jacobs et al., 2021). calls to abolish the child welfare system were amplified. professional conferences featured organizations calling for abolition, including the movement for family power in new york and the university of houston graduate college of social work and the center for the study of social policy’s upend movement. from dorothy roberts to dominique mikell, critical scholars offered important critiques of child welfare, addressing family separation, racial disproportionality, the criminalization of survivors, and state surveillance. this advocacy came at a time when one in three children, and more than half of all black children in the united states have been the subject of a child abuse investigation (kim et al., 2017). our research builds on critiques of child welfare as complicit in carceral practices and consequently criminalization (bergen & abji, 2019).. mandatory reporting as a technology of criminalization has been legislated over time to increasingly rely on social workers, largely through the influences of neoliberalism, criminalization and professionalization about:blank harrell & wahab/case for mandatory reporting 819 (mehrotra et al., 2016). this article discusses how social work textbooks orient readers to mandatory reporting of child abuse in social work. specifically, we review the existing mandatory reporting content included in 18 introductory social work textbooks to consider the ethical, practice, and policy implications alongside social work’s growing challenge of carceral logics and practices. we discuss our main findings to offer a glimpse into the current landscape of social work education concerned with mandatory reporting. background mandatory reporting mandatory reporting references legal statutes that require certain professions, or in some states, all residents to report suspected child abuse or neglect to child protective services (cps) or law enforcement. mandatory reporting, as a national strategy for detecting child abuse and neglect, is a relatively recent invention. in 1962, kempe and colleagues published a famous report creating a medical profile of an abused child (battered child syndrome), prompting states to pass mandatory reporting statutes for doctors and other medical personnel (lau et al., 2009). it was not until the passage of the child abuse prevention and treatment act (capta) in 1974 that mandatory reporting laws became a federal funding condition (raz, 2020). these laws require reporters to assess the “reasonableness” of their suspicion, a quality that is ill-defined and variably interpreted across professions (bailey et al., 2021; lytle et al., 2021). in subsequent years, the number of reports skyrocketed, prompting states to open hotlines despite a lack of evidence that increased reporting helped better identify and assist children at-risk of abuse (raz, 2020). in 2019, us residents made 4.4 million reports to child welfare departments, alleging suspected maltreatment of 7.9 million children, a 12.6 percent increase since 2015 (us department of health and human services [usdhhs], 2021). report rates vary dramatically by state. less than two percent of all children in hawaii were reported to cps in 2019, compared to almost 17 percent in vermont. the number of investigations into these reports is often used as a proxy for the scope of child maltreatment in the child welfare literature (fong, 2020) which is misleading given that being reported and investigated does not inherently mean that child abuse occurred. in fact, cps screened out over two million reports in 2019, 21.7% increase from 2015 (usdhhs, 2021). reports are screened out when information from the report source is insufficient or does not meet the state’s statutory definition of child abuse or neglect. screen-out ratios also vary significantly by state. for example, 84 percent of reports in south dakota were screened out in 2019, whereas just 1.6 percent of reports were screened out in alabama (usdhhs, 2021). while there is limited empirical data surrounding the influence of professional status on whether reports are screened in or out, damman et al. (2020) report that referrals from professionals (including social workers and the police) are more likely to be screened in, investigated, and substantiated than those from non-professional sources such as neighbors, friends, or family. advances in social work, summer 2022, 22(2) 820 registries forty-seven states have centralized registries of child abuse and neglect investigation records, which may contain information such as family members’ names and investigation findings (child welfare information gateway [cwig], 2018). these registries inform future investigations, further tracking families who are already more likely to be surveilled through government databases (eubanks, 2018). whereas middle and upper-class families can rely on private sources of support, low-income families often rely on helping professionals and state welfare programs that warehouse and share their data. most states have statutes requiring cross-system reporting of suspected child abuse or neglect, which might include sharing information with law enforcement and prosecutors (cwig, 2021a). in nine states, all reports to cps must be cross-reported to a law enforcement agency, further facilitating the criminalization of those reported. some state registries include all reports of suspected maltreatment, even when they are unsubstantiated (i.e., investigators are unable to confirm abuse or neglect has occurred; cwig, 2019c). these registries are often accessed by government-contracted agencies that work with oppressed or “vulnerable” populations, including elderly people and young children, to screen-out potential employees (cwig, 2019c; kramer, 2019). an analysis of the american community survey from 2005 to 2015 found that women of color made up 48 percent of the direct care workforce (i.e., personal care aides, home health aides, and nursing assistants) and were more likely to live in poverty and rely on public assistance than white women (campbell, 2017). similarly, as of 2019, women of color are overrepresented in the childcare workforce, and experience higher rates of poverty than white counterparts (ewing-nelson, 2020). considering that women of color are disproportionately reported and investigated by cps, child abuse registries may disproportionately limit employment opportunities for women of color. social workers as mandated reporters since capta, the reach of mandatory reporting statutes has extended far beyond the medical field. today, approximately 47 states require additional professions to report suspected child abuse or neglect, and 18 require every resident to report (“universal mandatory reporting”; cwig, 2019b) despite the fact that universal mandatory reporting is not associated with an increase in substantiated reports (when upon investigation, abuse is believed to have occurred; krase & delong-hamilton, 2015a). nationally, social service and mental health workers were responsible for over 16% of reports made in 2019 (usdhhs, 2021). social workers represent one of the most common professions with mandatory reporting obligations (cwig, 2019a), placing communities with closer proximity to social services at greater contact with mandatory reporters (roberts, 2002). very little is known about how social workers are trained to think about, understand, or practice mandatory reporting. in their study exploring the role of social work education in training social workers for the responsibility of mandatory reporting, krase and delonghamilton (2015b) report that many programs do provide information about the obligation to report: harrell & wahab/case for mandatory reporting 821 programs provide content on the social worker’s obligation to report suspected child maltreatment most often through social work practice courses (88.9%). the social worker’s obligation to report suspected child maltreatment is covered in policy courses in more than half (53%) of the respondent programs. this content is covered in ethics related courses in almost 40% of respondent programs. social work programs also cover this content in courses in diversity (21%), research (13%), child welfare (6%), and introduction to social work (3%) courses. (p. 976) absent from the research however is attention to the content itself including but not limited to substance, lessons, and quality. while some social workers may be motivated to report suspected abuse based on professional, moral, and ethical obligations (lau et al., 2009), some report only intermittently, if at all. when mandatory reporters “knowingly or willingly fail to make a report when they suspect that a child is being abused or neglected” (cwig, 2019b, p. 2), they “commit” a transgression called failure-to-report. failure to report can lead to legal and professional consequences in at least 49 states, although only 20 states specify those penalties (cwig, 2019b). the national association of social workers (nasw, 2021) code of ethics explains that legal obligations, such as mandatory reporting, can supersede social workers’ commitments to clients (ethical standard 1.01). some providers may take a riskmanagement approach, reporting to avoid legal or professional penalties (cooperson, 2009; wexler, 1990). others may report hoping to get families access to services they believe they need, with the added benefit of state enforcement and surveillance. fong (2020) argues that cps investigations are not a result of “professionals sounding the alarm about children in imminent danger, but from constrained street-level bureaucrats hoping to rehabilitate families in need by shuttling them to a multifaceted surveilling agency” (p. 622). when focused on the moral and obligatory duty to report, mandatory reporters too often miss or ignore the potential consequences of mandatory reporting, including deportation (bergen & abji, 2019), parental incarceration (jensen et al., 2005; matthew et al., 2019), trauma, and an increased likelihood of future investigations (fong, 2020). theoretical framework drawing on feminist critiques of carcerality and neoliberalism, we lean on mehrotra et al.’s (2016) conceptual framework of the braid to ground this study’s exploration of social work textbook engagement with mandatory reporting content. the braid is a metaphor used to explore the intersecting and mutually constituting forces of neoliberalism, criminalization, and professionalization–forces that have had and continue to have a significant influence on domestic violence work and research. while each strand of the braid represents a unique phenomenon articulated through expansive bodies of scholarship across disciplines and social movements, the authors of the conceptual framework were concerned with understanding and articulating the ways comprehensive macro phenomena such as neoliberalism, criminalization, and professionalization function together to shape, constrain, and facilitate engagement with a particular social problem, domestic violence. while a full discussion of the braid can be found elsewhere, mehrotra et al. (2016) argue advances in social work, summer 2022, 22(2) 822 that among other things, the braid marginalizes social and structural change when it comes to domestic violence (dv) interventions, supports the carceral state and mass incarceration, fetishizes physical safety (kim, 2013), and constrains who can/can’t engage in dv work. while the braid was developed with dv work in mind, we believe the framework is also relevant to a range of social work commitments and engagements, including child welfare. woven into the metaphor of the braid are considerations of the impacts of criminalization and neoliberalism on social welfare and services, which has been widely documented (reisch, 2013; rothman, 2012; wacquant, 2009, 2010). numerous critical scholars agree that the penal system has become the “catch-all solution” for many social issues (gilmore, 2007, p. 5), including child welfare. while the child welfare system is not a branch of the criminal legal system, it has and continues to frequently operate in collaboration with penal systems through cps (dettlaff et al., 2020; jacobs et al., 2021). of particular interest to this project is that child welfare systems disproportionately target and disrupt black, indigenous, and people of color (bipoc) communities (bailey et al., 2021; dettlaff et al., 2020; fong, 2020; roberts, 2002, 2020). in order to extend the theorizing of the braid to child welfare, we place the braid in conversation with abolition feminisms (davis et al., 2021; kaba, 2021; ritchie et al., 2021) and born of bipoc, trans, and queer theorizing and practices to end interpersonal and state violence (incite, 2016; kim, 2018; ritchie, 2017). these feminisms express an emancipatory vision to end all forms of violence, including but not limited to settler colonialism, heteropatriarchy, white supremacy, police violence, and imprisonment. abolition feminism inspires us to interrogate social work conventions as taken-for-granted necessities and practices. for example, roberts (2020) invites us to trouble proposed reforms to transfer power, resources, and authority from police to health and human service workers given the role such professionals already play in regulating and punishing black and other racialized and oppressed communities. roberts (2002) and raz (2020) argue that over time, the family regulation system’s (roberts, 2002) primary function shifted from social service to punitive investigation. consequently, this research is more broadly concerned with the ways mandatory reporting automatically places social work(ers) and child welfare in relationship with law enforcement and criminal legal systems, deepening the relationship to carcerality while foreclosing alternative approaches to child abuse prevention and intervention (bergen & abji, 2019). situating ourselves we engage this work as mandatory reporters in multiple capacities. sam’s practice experience began in child welfare, providing case management services to and supervising visitations with parents whose children had been removed following reports of suspected abuse. later, when facilitating violence prevention workshops with youth, sam was encouraged by supervisors to always report suspected abuse; to be “better safe than sorry.” they watched youth make impossible choices between staying silent and risking the myriad of unpredictable and adverse consequences that a report can produce. sam is also a survivor of child abuse. stéphanie’s practice experience began as a domestic violence advocate in a shelter for harrell & wahab/case for mandatory reporting 823 “battered women and children” during the 1990s where mandatory reporting laws influenced her work with moms and their children. mandatory reporting always felt like an ethical dilemma that she was never trained to engage, particularly when the mother was undocumented, perhaps even dependent for citizenship status on the person using violence. we both have additional experience with mandatory reporting policies through the title ix requirement at our university that requires all employees, regardless of work, status, or position, be mandatory reporters of sexual violence. as social workers turned social work scholars, we are curious about the ways students are oriented to mandatory reporting practices through social work education. introductory textbooks transmit latent messages about values and worldviews, and consequently are often seen as authoritative sources of knowledge by students (strier et al., 2012) and instructors. with this in mind, we explored introductory social work textbooks’ coverage on mandatory reporting in social work education. method this study engaged a summative content analysis to understand how social work textbooks orient students to mandatory reporting policies and practice. this method uses manifest analysis to explore the usage of key concepts (identified before and during the meaning making process) and latent analysis to interpret underlying meanings (hsieh & shannon, 2005). sampling with 24.5 years of teaching graduate level social work courses between us, we leaned on our collective teaching experience, across four schools of social work, to identify six popular social work publishers. these publishers (sage, oxford, pearson, nelson, cognella, and routledge) listed 61 introductory social work textbooks on their websites. textbooks were considered “introductory” if the word “introductory” was in the title, and/or if the publisher recommended the text for introductory courses. the following inclusion criteria identified an analytic sample of 18 textbooks: (a) published between 2010-2020; (b) the most recent available edition; (c) mentioned child welfare in a us context; d) not in a workbook format; and (e) published in english. we did not include any supplemental materials or manuals accompanying textbooks. see table 1. we used a ten-year sampling frame for several reasons. first, mandatory reporting laws have not changed significantly within this period, with one exception. pennsylvania significantly expanded reporting laws as a response to the 2012 trial of penn state football coach jerry sandusky following decades of child sexual abuse that went unreported by “responsible” adults (raz, 2017). second, the last 10 years have seen a 30 percent increase in reports of child abuse (usdhhs, 2011, 2020). finally, a nine to 10-year publishing window has been used as an inclusion criterion by numerous other content analyses of social work textbooks (giesler & beadlescomb, 2015; strier et al., 2012; wachholz & mullaly, 2001). advances in social work, summer 2022, 22(2) 824 table 1. textbooks (in alphabetical order) • ambrosino, r., heffernan, j., shuttlesworth, g., & ambrosino, r. (2016). empowerment series: social work and social welfare (8th ed.). nelson. • berg-weger, m. (2019). social work and social welfare (5th ed.). routledge. • bird, m. (2018). sage guide to social work careers: your journey to advocacy. sage. • colby, i., & dzięgielewski, s. f. (2015). introduction to social work: the people's profession (4th ed.). oxford. • cox, l. e., tice, c. j., & long, d. d. (2018). introduction to social work: an advocacybased profession (2nd ed.). sage. • dubois, b., & miley, k. k. (2019). social work: an empowering profession (9th ed.). pearson. • farley, o. w., smith, l. l., & boyle, s. w. (2012). introduction to social work (12th ed.). pearson. • glicken, m. d. (2010). social work in the 21st century: an introduction to social welfare, social issues, and the profession (2nd ed.). sage. • kirst-ashman, k. k. (2017). introduction to social work and social welfare: critical thinking perspectives (5th ed.). nelson. • lewis, l. (2017). social workers as game changers: confronting complex social issues through cases. sage. • martin, m. e. (2016). introduction to social work: through the eyes of practice settings. pearson. • marx, j., broussard, c. a., hopper, f., & worster, d. (2011). social work and social welfare: an introduction. pearson. • popple, p. r., leighninger, l., & leighninger, r. d. (2020). social work, social welfare, and american society (9th ed.). pearson. • segal, e. a., gerdes, k. e., & steiner, s. (2016). an introduction to the profession of social work: becoming a change agent (6th ed.). nelson. • sherr, m. e., & jones, j. m. (2019). introduction to competence-based social work: the profession of caring, knowing, and serving (2nd ed.). oxford. • sinanan, a. (2018). the social work practitioner: an introduction to fundamentals of the social work profession. cognella. • suppes, m. a., & wells, c. c. (2018). the social work experience: a case-based introduction to social work and social welfare (7th ed.). pearson. • zastrow, c. (2017). introduction to social work and social welfare: empowering people (12th ed.). nelson. there are several potential limitations to this sampling strategy. sampling the newest edition of social work textbooks privileges wealth as instructors and students may purchase older editions to bring down the exorbitant cost of books. “human services” textbooks, which some publishers differentiate from “social work and social welfare,” were not included in this study. consequently, this sampling strategy may privilege textbooks that are more routinely offered at 4-year bsw/msw-granting institutions, reinforcing social service work professionalization. harrell & wahab/case for mandatory reporting 825 sample the majority of textbooks (74%) were published in 2016 or later. editions of books ranged from 1st to 12th. pearson had the most textbooks (n=6) meeting the inclusion criteria, whereas cognella and routledge had the least (n=1 each). relevant content were sourced from overview chapters, practice anecdotes, welfare histories, policy reviews, and chapter quizzes. data analysis after accessing this sample of books, sam used a combination of book indexes, tables of contents, and text searches (for e-texts) to identify excerpts discussing mandatory reporting. a preliminary search found that some books referenced mandatory reporting indirectly: a social worker may be called on to work with a problem that clearly falls within one field of practice or a problem that involves several fields. for example, the wullbinkle family comes to a social worker’s attention when a neighbor reports that rocky, their 5-year-old son, is frequently seen with odd-looking bruises on his arms and legs. the neighbor suspects child abuse. (kirst-ashman, 2017, p. 1) this vignette does not use the term “mandatory reporting,” was not indexed as such, and was in an introductory chapter not focused on child welfare. for this reason, the search was broadened to include the following terms in a us context: child welfare, child abuse, child neglect, mandate(d), report(er)(ed), and child abuse prevention and treatment act (capta). once all excerpts were identified, sam consulted with stéphanie on the development of a “text summary sheet” to be used in the second stage of the analysis. the summary sheet served as a repository for documenting themes from the literature (deductive analysis) and emerging themes (inductive analysis) created during the multiple readthroughs of the excerpts. unfortunately, this analytic approach proved to be too broad through the course of piloting it via the analysis of four texts. sam pivoted from this analytic approach to transcribing the excerpts for open coding in atlas.ti cloud. the data were coded for location (where in the text is it appearing?), style (is the writing anecdotal, prescriptive, historical, political?), and function (what does it suggest, explicitly or implicitly, about practice?). fifty-four initial codes were created and then organized into emerging themes: anecdotes, sense of duty, report types, critiques of mandatory reporting, and risk-management. to ensure trustworthiness and rigor, sam memoed frequently about the analytic process and peer debriefed with stéphanie. as a team, we discussed each theme as a standalone grouping of content and discussed the relationships across themes. by placing themes in conversation with the theoretical components of the braid, we were able to map and articulate the relevance of the braid to child welfare, as well as macro forces that shape social work education about mandatory reporting. advances in social work, summer 2022, 22(2) 826 findings in lieu of clear guidance on or critical contextualization of mandatory reporting policies, most textbooks addressed mandatory reporting through practice anecdotes. we identified 22 distinct anecdotes across 13 textbooks. social workers (12) were the most frequent reporters mentioned, followed by equal numbers of neighbors (5) and non-social work school personnel (5). other reporters included a hospital (reporter not specified), a grandparent, and an unknown reporter. six textbooks discussed mandatory reporting within sections addressing values and/or "ethically complicated" issues and discussions (berg-weger, 2019; dubois & miley, 2019; martin, 2016; segal et al., 2016 sinanan, 2018; suppes & wells, 2018). this content rarely identified the specific ethical standards that made mandatory reporting complicated. of equal and perhaps greater importance is that despite offering a nod to mandatory reporting as "complicated” and/or posing an ethical dilemma, textbooks overwhelmingly offer a single and oversimplified solution: report. for example: imagine that you are a social worker at oasis house, where your supervisor asks you to talk with a new resident, cathleen. cathleen told shelter workers that she is 18 and homeless. during your talks with cathleen, however, she admits that she is really only 15 and has run away from home. she further divulges that she does not want to go home because her mother’s live-in boyfriend sexually abused her. she begs you not to share the information about the sexual abuse with anyone or to contact her mother. ...by asking you to keep the alleged abuse in confidence and to help with her emancipation, cathleen is attempting to exercise her right to self-determination, privacy, and confidentiality. however, although you want to maintain her trust, as a social worker you are ethically and legally bound to report the abuse because she is a minor. the ethical dilemma here is clearly between client confidentiality and mandated reporting of suspected abuse. to serve cathleen best, you must stay within your role and report the suspected sexual abuse to the child welfare agency. at the same time, you must continue to respect her right to self-determination and privacy to the extent that you can. (berg-weger, 2019, pp. 255-256) what berg-weger (2019) initially call an “ethical dilemma” is immediately resolved by a legal duty to report. state loyalty and deontological commitments in social work practice literature, “ethical dilemmas” represent competing commitments social workers hold (sasson, 2000), usually grounded in the national association of social workers (nasw) code of ethics. while social work textbooks rarely offer decisive answers to these dilemmas, mandatory reporting appears to be an exception. anecdotes present mandatory reporting as a predicament uniquely solved by a worker’s legal mandate or duty, making us question whether the authors consider it a predicament. harrell & wahab/case for mandatory reporting 827 some authors omitted any dilemma when discussing mandatory reporting, instead offering authoritative instructions that social workers should always report suspected abuse: if a minor client discloses during the counseling session that she is being sexually abused by her uncle, the practitioner is legally obligated to report this information to child protective services to ensure the child's safety. disclosures are not always so clear-cut or direct, though, and there are many occasions where social workers find themselves needing to use their clinical skills to determine whether violating confidentiality is the appropriate course of action. for instance, consider the client who may be suicidal. (martin, 2016, p. 41) martin (2016) frames reporting familial child sexual abuse to cps or law enforcement as a “clear-cut” decision. mandatory reporting becomes amalgamated with a successful child protection outcome, an imagined association that raz (2020) argues is not supported by empirical data. martin’s (2016) subtitle for this anecdote, “the conflict between ethical standards and emotional desires,” further illustrates the author’s position on legal obligations (p. 35). mandatory reporting is framed as purely “ethical.” when juxtaposed with “emotional desires,” mandatory reporting becomes the only rational, professional response. deontological ethics apply “objective” moral rules and principles universally, without attention to context or outcome (gray, 2010; reiman, 2009). mandatory reporting was often framed as an obligation to the state, a “public good” that supersedes obligations to the individual or collective well-being of clients and client populations. berg-weger (2019) embraces this deontological approach to mandatory reporting, positioning reporting as ethically “right” based on legal rules, regardless of social and political consequences for clients. a case study asks the reader to imagine they are serving julio, a 16-year-old, undocumented boy who is houseless, trading sex, looking for his mother who is also undocumented, and needing healthcare access. this vignette raises concerns with immigration enforcement, and issues related to commercial sexual exploitation given state and federal laws that frame youth under the age of 18 engaged in the sex trades as sex trafficking victims. for the sake of our discussion, we focus on concerns around immigration and deportation. berg-weger (2019) acknowledges that reporting julio to cps as an unaccompanied minor could put him and his mother at risk of deportation. while the author asserts that social workers are “ethically bound” to protect client confidentiality and have no legal obligation to report the client to immigration and customs enforcement, they argue that: “reporting julio to the child protection agency, however, is another matter. as a mandatory reporter, you are obligated to report a minor without a guardian. the decision to investigate and/or intervene will rest with the agency” (p. 240). berg-weger’s anecdote relies on; (a) a denial of the ways that social work and crimmigration systems (stumpf, 2006) work together to surveil, punish, and displace undocumented families; (b) a commitment to state loyalty at the expense of clients; and (c) a refusal of responsibility for adverse outcomes. even without the added layer of immigration enforcement, reporting child abuse to state authorities is the first step in a advances in social work, summer 2022, 22(2) 828 chain of events that disproportionately funnels low-income families and families of color into the arms of the carceral-assistential lattice (wacquant, 2009). six textbooks prioritize the duty to report over client confidentiality (berg-weger, 2019; martin, 2016; segel et al., 2019; sinanan, 2018; suppes & wells, 2018; zastrow, 2017). authors support this choice using the nasw (2021) code for client privacy and confidentiality that makes exceptions for cases of child abuse. sinanan (2018) speaks about these exceptions in absolute terms, writing that “a social worker is obligated to break confidentiality” to protect children from maltreatment (p. 43). speaking of social work in criminal justice settings, suppes and wells (2018) write: if a teenaged girl, on probation for running away, admitted to a probation officer that she had been running away because of her father’s sexual abuse, the social worker would feel sorry about having to violate the confidence so painfully shared by the teenaged girl, but there would be no doubt that this situation would have to be reported and assessed further [emphasis added]. (p. 354) in this excerpt, the contraction “but” may serve to minimize the provider’s concern for confidentiality. rather than explain why a provider would hesitate to report interfamilial sexual abuse to cps, suppes and wells (2018) juxtapose feelings (i.e., remorse) with the duty to report. this deontological framing of mandatory reporting is rationalized through arguments supporting criminalization and professionalization, also imbued with the impacts of neoliberalism. several textbooks describe, albeit briefly, criminal (colby & dzięgielewski, 2015; dubois & miley, 2019; martin, 2016), civil (dubois & miley, 2019) professional (martin, 2016), and societal (ambrosino et al., 2016 zastrow 2017) consequences for failing to report suspected maltreatment. pressures to comply with legal mandates and avoid personal penalties take precedence over careful supervision that could inform a more nuanced, contextualized response. repeatedly, textbooks present mandatory reporting as a duty; a responsibility to the client, the state, and the profession. this duty communicated implicitly and explicitly, legitimizes the state as an appropriate, safe, and effective intervention into child abuse and neglect. it positions social workers as uniquely responsible for, and reliable at reporting child abuse. lastly, it decenters clients and neglects their fears of state intervention. criminalization of practice what happens when social workers do not report suspected child abuse and neglect? six textbooks (ambrosino et al., 2016; colby & dzięgielewski, 2015; dubois & miley, 2019; glicken, 2010; martin, 2016; zastrow, 2017) mention penalties yet provide few details about the actual consequences of failure-to-report. such ambiguity can create confusion among providers and perpetuate a risk-averse approach to reporting that furthers the neoliberal embrace of individual responsibility for social problems. we identified three risk domains authors used when discussing failure-to-report: professional status, professional liability, and criminalization of practice. harrell & wahab/case for mandatory reporting 829 professional status accurate data on the scope of child abuse is arguably essential for developing informed and effective interventions. some researchers rely on mandatory reporting as a mechanism to collect data on the scope of child abuse. zastrow (2017) argues that failure-to-report is partially responsible for a lack of data: “the true extent of child abuse is unknown. accurate data are difficult to get for two reasons: the failure of citizens and professionals to report suspected cases and the reluctance of abused children to talk” (p. 182). this assertion makes several assumptions. if the author measures the “true extent of child abuse” by reports, then they risk conflating suspected and substantiated abuse. if instead they rely on substantiated abuse, they take-for-granted decades of research on racial and class disproportionality. regardless of the approach, textbooks do not compel students to think critically about the meaning of harm beyond their states’ respective legal statutes. ambrosino et al.’s (2016) textbook goes so far as to equate reporting with child saving: “many children’s lives are saved because someone took the time to make a report, and children’s lives are lost because individuals who knew or suspected a child was being mistreated failed to make a report” (p. 358). while ambrosino et al. (2016) were the only authors to overtly suggest mandatory reporting can prevent child deaths, several others included statistics on child abuse deaths in the same section of the text, or page. this is notable considering that deaths resulting from child maltreatment are relatively rare (cwig, 2021b) and we could not locate any empirical evidence that links the implementation of mandatory reporting laws to a decrease in child fatalities. rubin (2016), a white house appointee on the commission to eliminate child abuse and neglect fatalities, argued in a 2016 op-ed that there is an insufficient amount of evidence on fatality prevention. this emphasis on child deaths is another feature of individualization within child protective work. we suggest that the impacts of neoliberalism on child welfare work to overemphasize provider responsibility for child maltreatment while downplaying the role of community and structural inequity. individual professional liability in states that license social work, social workers are typically required to follow state laws, including mandatory reporting (krase, 2018). consequently, failure to report can subject a licensed social worker to repercussions from their state licensing board. while professional organizations like the nasw cannot suspend licenses, they can sanction members for failure-to-report. two textbooks stress fear of such professional penalties. for example, while martin (2016) encourages clinical supervision to inform decisions about reporting, they also warn readers about the professional consequences of failure-to-report: determining when that line has been crossed between appropriate parenting and abuse is a clinical issue, best explored within clinical supervision, but it is important to note that, legally, it is the practitioner’s professional license that will be at risk if the appropriate actions are not taken. in some states a failure to report suspected child abuse can result in a range of consequences, such as professional sanctions, or the loss of one's professional license, or criminal charges. thus, advances in social work, summer 2022, 22(2) 830 although clinical supervision can be of significant assistance in making these types of clinical decisions, the practitioner must make the final decision on whether to break confidentiality to protect the child’s welfare. (martin, 2016, pp. 41-42) the risk highlighted by martin (2016) is not the potential adverse consequences a youth might face from staying in an abusive home, nor being forcibly removed. instead, the author focuses on the professional risk of not reporting. the reader is left with an impossible choice: consider the decision carefully with the help of supervision or report immediately to avoid professional sanctions. this risk averse approach is also seen in the colby and dzięgielewski (2015) textbook: if you were concerned that the report is not needed or if you are not sure if you should make the report, call anyway and confer with an intake worker. it is not your responsibility to prove that abuse or neglect has occurred, but only that you suspect it. if you make a report and it is found that the report was made in good faith, you will be immune from liability. (p. 244) overall, the use of risk-averse language without more nuanced and critical discussion may lead readers to prioritize professional liability over the safety and well-being of children and families. criminalization of practice three textbooks highlight criminal penalties for failure-to-report. in some states, mandatory reporters can face up to five years in jail and $10,000 in fines if they fail to report (cwig, 2019b). these penalties criminalize non-compliant providers, effectively criminalizing practice. while textbooks could acknowledge, at minimum, the range of penalties across states or provide state-specific examples, the textbooks surveyed instead spoke in vague terms: if a social worker, similar to other professionals, fails to make a report of an incident involving child abuse or neglect, or knowingly fails to provide additional information, or prevent another person from reporting such an incident, he or she can be found guilty of criminal charges. (colby & dzięgielewski, 2015, p. 244) dubois and miley (2019) and martin (2016) specify that social workers can face misdemeanor and felony charges for failure-to-report: most states have strict laws that define the parameters of child abuse reporting, including delineating what constitutes a reportable concern, the timeframe in which a mandated reporter must report suspected abuse, and the consequences of failing to report suspected abuse, such as the suspension of one's professional license. in fact, in most states, the failure to comply with mandated reporting requirements is a crime (a misdemeanor or even a felony for repeated failures). (martin, 2016, p. 76) with limited details, readers may assume that failure-to-report is rare and often results in prosecution. in actuality, failure to report is common and prosecution is rare (krase, 2018; polowy et al., 2012). delaronde and colleagues’ (2000) study of 382 mandatory reporters harrell & wahab/case for mandatory reporting 831 (social workers, pediatricians, and physician assistants) found that over half of participants failed to report suspected child abuse. it is difficult to prove beyond a reasonable doubt that a social worker knowingly or willingly failed to report. for this reason, “most cases are either dismissed before trial, end in acquittal at trial, or are reversed on repeal” (polowy et al., 2012, p. 21). the frequency of prosecution, however, may be distorted by high-profile media cases, such as the death of gabriel fernandez, profiled in a 2020 netflix docuseries. incomplete information in social work textbooks, combined with moral panics in the media (lash, 2017; raz, 2020), may influence social work students’ motivations for reporting. mandatory reporting and complicity with the state few textbooks address the ways mandatory reporting, as a social work duty, furthers social work’s complicity with systems of surveillance and control. when tensions around mandatory reporting surface in the texts, most authors follow up with a reminder of social workers’ legal obligations to report. two textbooks discuss class disproportionality (marx et al., 2011; popple & leighninger, 2020) and one racial disproportionality (marx et al., 2011) in reporting practices. marx et al. (2011) argue that “disparate reporting” is one of several reasons why “poor and minority children” are more likely to enter the foster system, suggesting that “a combination of socioeconomic factors in various state and federal policies as well as disparate reporting and service delivery increase the likelihood that poor and minority children will enter the foster care system” (pp. 229-230). popple and leighninger (2020) present class-based “reporting bias” as a theory that modern social scientists reject, pointing to research that finds poor people are only “slightly over reported” and a probability that poor parents are more likely to maltreat children (p. 304). popple and leigninger (2020) miss an opportunity to explicate the ways in which capitalism and white supremacy unevenly distribute resources for childrearing and risk reinforcing myths of poverty culture. the robust literature on racial disproportionality in child abuse reporting is largely ignored. troubling complicity while much of the engagement with mandatory reporting echoes the criminalization, neoliberalism, and professionalization found in social work responses to domestic violence, we also found signs of resistance to the braid in the popple and leighninger (2020) textbook, where the authors use anecdotes to explore the tension between legal mandates, social work’s commitment to social justice, and the importance of relationships. a short story about a county-employed social worker considers social justice and the impact of structural oppression on mandatory reporting outcomes. the worker, responding to a new policy requiring she report any new child born to a welfare recipient, weighs her commitment to social justice against her legal duty: the worker is aware of the requirements that social workers should comply with the law. however, she is convinced that reporting newborns might preclude future essential services. [she] also believes that the new regulations will create a new class of citizens (children born to welfare mothers) that might be discriminated advances in social work, summer 2022, 22(2) 832 against in various ways. (popple & leighninger, 2020, p. 133) the “however” is an essential and unusual rhetorical device. while social work textbooks often approach ethical dilemmas, such as intervention with a suicidal client, with an acknowledgment of nuance, the dilemma of child maltreatment is presented as “clear-cut” in most texts. the legal obligation to report to law enforcement or child welfare authorities is paramount and unquestioned regardless of the potential outcome. popple and leighninger’s (2020) anecdote is unique in its invitation to keep talking beyond the declaration of a legal mandate. discussion in this study, we found that social work textbooks’ engagement with mandatory reporting appealed to state loyalty, deontological ethics, and professional liability–each deeply intertwined with the braid. these textbooks take-for-granted mandatory reporting as a fixed and necessary response to suspected child abuse and neglect. mandatory reporting becomes a moral imperative, not because of its efficacy in improving lives or its contributions to social justice, but because of its investment in governing through state surveillance and the regulation of bodies. textbooks privileged deontological perspectives, arguing for the primacy of social work’s legal commitments through the use of decontextualized anecdotes. with a dearth of evidence supporting its effectiveness as a tool to identify and mitigate child maltreatment, mandatory reporting is presented as a morally sound intervention to be universally applied to a vast array of circumstances. pressures to comply with legal mandates and avoid personal penalties take precedence over careful supervision that could inform a more nuanced, contextualized response. when readers suspect maltreatment, they are encouraged to consider an array of individualized consequences if they fail to report. this approach to mandatory reporting assumes the existence of an essential good, which clashes with critical and constructivist approaches to social work practice that stress the significance of context. when contextualized within broader discourses of professionalism, neoliberalism, and criminalization, we are better able to appreciate the ways mandatory reporting may not only work against other social work mandates including social justice and anti-oppression but may work to further entrench social work within carceral logics and systems. neoliberalism’s influence on notions of safety and well-being relies on individual responsibility such that individual “perpetrators” are sought and held responsible for child maltreatment, and individual professionals are made accountable to the state rather than to the alleged victims or their communities. the state then makes social workers individually responsible for child protection through mandating surveillance and reporting, threatening professional sanctions if they refuse or fail to comply. we speculate and worry that child welfare and adjacent organizations, chasing funding within neoliberalism’s competitive and market driven structure, may use the number of reports as markers of efficacy, consequently associating a decline in reports with a decline in individual social workers fulfilling their professional responsibilities. harrell & wahab/case for mandatory reporting 833 criminalization is the process by which behaviors and people become crimes and criminals (michalowski, 1985). decisions to report subject families, disproportionately bipoc and low-income, to additional layers of state surveillance and criminalization. once a call is reported and screened-in, child protection workers can visit homes accompanied by law enforcement, or once inside a home, they can report suspected crimes to law enforcement. what may seem like a simple and procedural decision to phone in a suspected case of abuse may implicate social workers in a broader process of state violence. no surveyed textbooks discussed the relationship between mandatory reporting and criminalization, which we find stunning and troubling. furthermore, only one textbook (marx et al., 2011) touched on racial disproportionality in reporting, attributing it to socioeconomic factors, without any discussion of white supremacy. through processes of professionalization, social workers increasingly employ technical solutions that individualize problems and promote apolitical approaches to practice (mullaly, 2019). across the country, mandatory reporting is just one of many expectations that social workers submit to in exchange for state recognition via credentialing and licensing bodies. as described earlier, social workers who fail to report can face professional sanctions. similarly, in some states, people reported for suspected abuse or neglect are placed on child abuse registries that can inhibit professional and economic opportunities. while social workers surveil clients for suspected abuse and neglect, agencies and regulatory bodies surveil social workers for suspected noncompliance with reporting laws, under the guise of professionalization. this surveillance, in conjunction with other consequences of the braid, positions social work as a precarious practice removed from social change work. if we accept sasson’s (2000) definition of an ethical dilemma as a decision between two or more competing ethical commitments, our analysis shows that many introductory social work textbooks frame mandatory reporting as a non-ethical dilemma. we argue that mandatory reporting is an ethical dilemma and textbooks should treat it as such. mandatory reporting, as an ethical dilemma, calls into question long standing social work tensions between micro and macro practice, as well as competing commitments to professional mandates and social justice. when textbooks privilege legal commitments and deontological reasoning, they promote social work’s complicity in carceral systems. the life-and-death decision to subject a person, and by extension their family and community, to the family punishment system should not be “clear cut” or easily resolvable. in social work education programs, textbooks can function as an authoritative discourse with the power to expand or delimit the possibilities to resist the braid. instructors could benefit from textbooks that reimagine reporting discourses, particularly in generalist programs where they are expected to understand and teach a broad range of subjects. the problem of how we write about mandatory reporting cannot be resolved with individual scholars and instructors. social work needs a reckoning with how it understands the history, function, and future of mandatory reporting. currently, the strands of the braid collide to silence students, instructors, and practitioners. social workers struggle to discuss, debate, and generate new knowledges about mandatory reporting because the very subject is so incredibly elusive, and questioning mandatory reporting automatically renders the questioner professionally suspect. advances in social work, summer 2022, 22(2) 834 conclusion this article explored how social work textbooks orient readers to mandatory reporting of child abuse. we illuminated what content currently exists across the most recent editions of us introductory social work textbooks published in the past 10 years. while this study cannot tell us how instructors understand, make sense of, nor teach about mandatory reporting, it does provide an important baseline for what content is available to students. expanding the information and resources available to students could advance innovations in how we teach, practice, and theorize child welfare work. future studies might explore mandatory reporting coverage in child welfare-focused textbooks; mandatory reporting coverage in instructor manuals or supplemental instructor materials; as well as how instructors make use of textbook coverage on mandatory reporting. below, we offer two suggestions for how scholars can expand writing on mandatory reporting. first, textbooks could expand mandatory reporting content to include mezzo and macro considerations. agency policies and procedures, as well as structural systems of oppression are absent from writing on mandatory reporting. at the agency or community level, social workers may feel pressure to report or not report based on factors such as data-driven funding or political pressure such as being tough on crime. at the societal level, decisions to report cannot be separated from facilitators of inequity including white supremacy, capitalism, and the criminal punishment system. second, textbooks could situate decisions to report child abuse and neglect within the context of social work ethics and principles without privileging deontological reasoning. mandatory reporting is not an activity devoid of structural influence and consequences. social work students should be encouraged to engage with macro-focused ethical principles, such as: awareness of the impact of politics on practice (nasw, 2021); action against “oppression, racism, discrimination, and inequities” (nasw, 2021, 1.05b); resistance to neutrality in the fight for black liberation (national association of black social workers [nabsw], n.d.); protection of the black community against “unethical and hypocritical practice” (nabsw, n.d., para. 8); advocacy against oppressive and harmful agency policies (international federation of social workers [ifsw], 2018); and accountability for harm (ifsw, 2018). integrating macro-focused ethical principles may help address the crisis of complicity currently facing our field. students could be encouraged to engage in ethical decision-making around child maltreatment, weighing not just legal mandates and professional consequences, but also commitments to social justice. this critical deliberation might include deconstructions of constructs like abuse and neglect; interrogations of the disproportionate distribution of surveillance technologies; and education about the legacies of colonialism and white supremacy in child welfare. ultimately, social work students in introductory courses should be encouraged to think critically about social work complicity with systems of oppression, to inform ethical decision-making about mandatory reporting in advance coursework and future practice. references ambrosino, r., heffernan, j., shuttlesworth, g., & ambrosino, r. 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(2017). empowerment series: introduction to social work and social welfare: empowering people (12th ed.). nelson. author note: address correspondence to sam harrell, school of social work, portland state university, portland, oregon, 97201. email: saha2@pdx.edu http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can https://www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment https://www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2019.pdf https://doi.org/10.1300/j059v11n02_04 https://doi.org/10.1162/daed_a_00024 mailto:saha2@pdx.edu the case for mandatory reporting as an ethical dilemma for social workers background registries social workers as mandated reporters theoretical framework situating ourselves method sampling sample data analysis findings state loyalty and deontological commitments criminalization of practice professional status individual professional liability criminalization of practice mandatory reporting and complicity with the state troubling complicity discussion conclusion references ___________ john m. keesler, phd, msw, associate professor, school of social work, indiana university, bloomington, in. david wilkerson, phd, msw, associate professor, school of social work, indiana university purdue university, indianapolis, in. kurt white, phd, consulting associate, and stephanie dickinson, executive director, biostatistics consulting center, school of public health, indiana university, bloomington, in. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1024-1045, doi: 10.18060/26394 this work is licensed under a creative commons attribution 4.0 international license. assessing the impact of covid-19 on social work students: burnout and resilience during a global pandemic john m. keesler david wilkerson kurt white stephanie dickinson abstract: covid-19 had a profound impact on teaching and learning at academic institutions across the globe. this study examined the experiences of social work students (n = 884) during the pandemic and their associated level of burnout. using a mixed methods approach, data from an online survey within a school of social work at a large midwestern university were examined using stepwise regression and thematic analysis. student demographics, academic characteristics, and experiences with covid-19 were examined as predictors of burnout. resilience was tested as a moderator of the association between covid-19 experiences and burnout. regression models accounted for 34.3% to 45.5% of variance across three domains of burnout (i.e., exhaustion, cynicism, and professional/academic efficacy), with covid-related experiences accounting for most of the variance. although resilience had a significant main effect, the interactions of resilience and covid-19 experiences were not significant. quantitative results were illuminated by thematic analysis of the qualitative data from which emerged four major themes: online teaching pedagogy, impact of covid-19, transition of teaching and learning, and affective domains of learning. engaging in humanistic education is discussed as a possible approach to circumvent burnout, bolster student resilience, and encourage academic success. keywords: burnout, covid-19, resilience, social work education in march 2020, the world health organization identified covid-19 as a global pandemic. while bringing about significant global changes, covid-19 profoundly impacted the academic sector (apgar & cadmus, 2021). with an emphasis on physical distancing to decrease the spread of the virus, colleges and universities across the united states cancelled in-person classes and rapidly shifted to emergency remote instruction (quintana, 2020; smalley, 2020). similarly, some academic accrediting bodies such as the council on social work education (cswe, 2020) modified student expectations and activities, such as decreasing the number of required hours and allowing for remote field activities. the challenges of covid-19 have been exacerbated by considerable uncertainty surrounding its impact and a lack of research to support best practices within academe (afrouz, 2021; apgar & cadmus, 2021; holmes et al., 2020). for applied disciplines like social work, the impact may be further increased in field placements where students, who have already experienced disrupted employment, increased caregiving demands, and decreased social contact, began working with pandemic-challenged clients (gonzalezabout:blank keesler et al./assessing covid impact 1025 ramirez et al., 2021; saltzman et al., 2021). the impact of a pandemic emergent research identified significant burnout and stress among healthcare workers involved in the frontlines of the pandemic. for example, nishimura et al. (2021) noted that medical providers who worked in intensive care or who directly treated clients with covid-19 were 6.7 to 8.5 times more likely to experience burnout than those in general medicine. similarly, murat et al. (2020) observed high levels of stress and burnout as well as moderate levels of depression among nurses. those who were younger, had less experience, tested positive for covid-19, or who did not voluntarily work during the pandemic were at greatest risk. social work practitioners were also challenged by covid-19 as many lacked sufficient preparation for delivering online services. banks et al. (2020) noted that, across the globe, social work practitioners encountered numerous ethical challenges, including the unique nature of remote relationships, whether to adhere to policies, managing limited resources, and ensuring the well-being of self and colleagues. for those delivering group interventions, video conferencing elevated concerns with client confidentiality, suppressed group dynamics, and made it difficult for practitioners to observe nonverbal behaviors among group members (hung et al., 2021). yet, despite challenges, covid-19 also presented social work practitioners with the opportunity to become creative and to develop a greater appreciation for client resources and improve access to services (mishna et al., 2021). within the academic sector, covid-19 has impacted students via online learning demands, including gaining access to information and computer technology, and securing a private and quiet workspace. in subsequent research, emergency remote instruction due to covid-19 has been associated with decreased levels of motivation and poorer health behaviors (e.g., decreased exercise) among students (gonzalez-ramirez et al., 2021). studies among social work students noted disrupted routines with sleeping, eating, and exercise; grief and loss; financial hardship; loss of motivation for coursework; increased depression and anxiety, increased smoking, and binge drinking (apgar & cadmus, 2021; lawrence et al., 2021; reznik et al., 2021). similarly, smoyer et al. (2020) found that many undergraduate social work students were challenged by the lack of human interaction and few opportunities for experiential learning (e.g., hands-on activities) often associated with face-to-face classes. students reported that online learning limited opportunities for individual and group dialogue, which was exacerbated when synchronous opportunities were not provided or when written work was substituted for class meetings. however, synchronous classes offered students opportunities to discuss the course materials as well as their personal experiences with covid-19. stress aside from the stress of a global pandemic, higher education is often associated with elevated levels of stress for students due to distance from familial support, substantial advances in social work, fall 2022, 22(3) 1026 academic workloads, financial concerns, and anxiety about the future (shi, 2019). the impact of these stressors can put students at risk for a variety of health problems including sleep disturbances, substance use, depression, and anxiety (hirsch et al. 2019; leppink et al., 2016; shi, 2019). despite such considerations, there is often less emphasis on emotional regulation and less consideration of ways emotions impact student engagement and performance in higher education (gonzalez-ramirez et al., 2021). while some amount of stress (e.g., deadlines, tests, etc.) can increase productivity and promote resiliency, periods of sustained stress can become toxic for the person’s well-being (baethge et al., 2018; roming & howard, 2019). the experience of stress is often dependent upon individual cognitive appraisal; that is, the person’s unique and subjective interpretation of an event or experience as stressful and subsequent response (lazarus & folkman, 1984). the person’s perspective and their ability to cope with or buffer the effects of stress are often influenced by access to resources and engagement in self-care. apgar and cadmus (2021) found that bsw students engaged in various coping strategies during the pandemic, including acceptance or self-sufficiency, venting, use of social and emotional support, and distraction. they also noted that students developed new coping mechanisms to deal with the stress of covid-19, including social media participation, mindfulness, positive reframing, and spirituality. resilience amid discussion of stress management, it is important to also consider psychological resilience. resilience is the ability to cope with a stressor or to return to a pre-crisis state shortly after a crisis (barzilay et al., 2020). resilience is a multidimensional construct that is influenced by individual, biological, and cognitive factors (poole et al., 2017). among those in helping professions, resilience has been associated with lower levels of burnout and fatigue (keesler & troxel, 2020), and has moderated the effects of burnout on perceived health (garcía-izquierdo et al., 2018). similarly, reznik et al. (2021) examined resilience and its correlates among israeli and russian social work students during covid19. although they found significant differences in students’ levels of resilience between the two countries, they also found that higher levels of resilience among social work students were associated with lower levels of fear surrounding covid-19 and lower levels of psycho-emotional distress. positive outcomes associated with covid-19 despite the stressful reality of the pandemic, some good has emerged from the impact of covid-19. for example, earle and freddolino (2021) noted that while the pandemic increased social work students’ awareness of health disparities and inequalities in access to technology, it also provided students with additional education and experience in telehealth or e-therapy (wilkerson et al., 2020). this is consistent with the national association of social worker’s (nasw, 2021) code of ethics that emphasizes the need for social workers to be aware of and critically evaluate emerging knowledge and technology relevant to social work practice. similarly, apgar and cadmus (2021) noted that covid-19 provided a “teachable moment” for students to learn firsthand about stress keesler et al./assessing covid impact 1027 and coping as they experienced the effects of the pandemic in various aspects of their daily life and functioning. the broader literature provides insight regarding the positive and negative effects of covid-19 on students; however, additional information is warranted. by examining unique considerations associated with the pandemic, as well as the influence of demographics and resilience on student burnout, we can more holistically understand social work students’ experiences. subsequently, we can generate data-driven responses to appropriately support their needs inside and outside the classroom. purpose the purpose of the present study was to understand the experiences of students during covid-19 and the impact of resilience. four specific research questions were examined: (1) what are students’ experiences with covid-19, burnout, and resilience? (2) how are students’ levels of burnout (i.e., exhaustion, cynicism, and efficacy) influenced by their demographics and experiences with covid-19? (3) to what extent does resilience moderate the relationship between students’ experiences with covid-19 and burnout? (4) what support do students seek from faculty to mitigate burnout? methods researchers at a large midwestern school of social work sought to understand student experiences during the pandemic to inform teaching strategies and the provision of student support. a survey comprised of several measures was created to gather data regarding student demographics, experiences with covid-19, burnout, and resilience. the survey was uploaded to qualtrics, an online survey platform, and pilot-tested with several students to ensure functionality and logistics. the survey included a total of 40 items and 2 openended questions and took 10-15 minutes to complete. survey participation was incentivized with 10 $25 e-gift cards to amazon that were randomly distributed to students who provided their contact information via a separate link at the end of the survey. bsw and msw students were recruited through an email that described the study and provided the survey link. the email was distributed to the entire student body at three time points from late november through early december 2020. a total of 884 students participated in the survey and represented 52% of the student population (n = 1,692). the original purpose of the survey did not necessitate review and approval by the institutional review board at the researchers’ university. however, because of the high student response rate and the ability for the findings to inform other scholars and programs, the data were re-analyzed as secondary data for the purposes of this study. measures demographics. seven items were constructed to elicit information regarding student gender, ethnicity, age, academic status (i.e., full-time or part-time), program year (i.e., bsw junior or senior; msw 1st year, 2nd year, or advanced standing), percentage of advances in social work, fall 2022, 22(3) 1028 coursework online (i.e., none, approximately 25%, 50%, 75% or 100%), and frequency of synchronous meetings for online courses (i.e., 5-point likert-type scale; 1 = never to 5 very frequently). covid-19 items. at the time of data collection, established measures to assess the impact of covid-19 on students’ academic experiences were unavailable. similar to sveinsdóttir et al. (2021), the research team developed 14 items for this study (see table 2). the items were informed by the authors’ interactions with students and faculty members following the onset of the pandemic and were revised through an iterative process for greater precision. the intention was not to develop a scale but rather to capture and explore individual aspects of student experiences. item response options used a 5-point likert-type scale, from 1 (strongly disagree) to 5 (strongly agree). resilience. resilience was measured using the response to stressful experiences scale-4 (rses-4; de la rosa et al., 2016). this instrument consists of four items that assess a person’s response during and after a stressful event. response options are based on a 5-point likert-type scale, ranging from 1 (not at all like me) to 5 (exactly like me). an item example is “i tend to find a way to what’s necessary to carry on.” preliminary psychometric testing has supported the instrument’s validity and reliability (α = 0.877; de la rosa et al., 2016). the rses-4 demonstrated acceptable reliability in the current study (α = .734). scale scores were calculated as the sum of scores on the four items. maslach burnout inventory – student survey. the maslach burnout inventory – student survey (mbi-ss) includes 15 items across three subscales: exhaustion, cynicism, and professional efficacy (schaufeli et al., 2002). the exhaustion subscale consisted of five items that measure feelings of being strained and exhausted by schoolwork (e.g., “i feel emotionally drained by my studies”). the 4-item cynicism subscale measured indifference toward schoolwork (e.g., “i doubt the significance of my studies”). the 6-item professional efficacy sub-scale measured satisfaction with academic accomplishments and expectations of continued effectiveness (e.g., “i feel stimulated when i achieve my study goals”). scale items were scored using a 7-point scale, ranging from 0 “never” to 6 “always.” subscale scores were calculated as the sum of scores on the respective items. multiple studies have demonstrated the psychometric properties of the mbi-ss, including its reliability and validity (nteveros et al., 2020; portoghese et al., 2018) and its multi-factor structure that supports the use of three subscale scores rather than a total burnout score (morgan et al., 2014; pérez-mármol & brown, 2019). in the present study, the instrument demonstrated good to excellent reliability: exhaustion, α = .949; cynicism, α = .908; and professional efficacy, α = .824 (gliem & gliem, 2003). the measure is not accompanied by cut-off scores to determine high, moderate, and low levels of burnout. although used in earlier research, cut-off scores have been recognized as problematic (leiter & maslach, 2016). open-ended questions. the survey included two open-ended questions to further describe student experiences: (1) how has covid-19 impacted your beliefs, values, and/or attitudes as a social worker? (2) if you are struggling or burned out because of covid, what suggestions do you have for faculty to support you? data from the second question are included in the current study given the alignment of the question with the research questions. keesler et al./assessing covid impact 1029 data analysis data analysis was conducted using sas (2013) statistical software. data were examined to ensure appropriateness of the analytic plan. approximately 5% of cases were missing some data and were addressed through pairwise deletion (dong & peng, 2013). to answer the first research question, descriptive statistics (e.g., frequencies, means, standard deviations) and correlations were calculated to examine student experiences with covid-19, burnout, and resilience. to answer the second research question regarding the impact of covid-19 on student burnout, three separate regression analyses were used to construct models that identified important predictors of burnout (i.e., exhaustion, cynicism, and professional efficacy). stepwise regression analyses with forward selection were used to reduce the number of covid-related predictors to a subset of important variables based on akaike information criterion (aic) for best model fit (hosmer & lemeshow, 2000). the procedure was conducted in three steps. the first step included student demographics (i.e., age, gender, and ethnicity) as predictors. given the sample distribution, ethnicity was collapsed to african american, other, and white. the second step included academic variables (academic status, program year, percent of coursework that was online, and frequency of synchronous content) as predictors. the percentage of coursework online was recategorized such that students who indicated none to 50% were collapsed into a single group. the third step added only the covid-19 variables that provided the best fitting model following forward selection procedures to create a parsimonious model. the third research question sought to determine if resilience moderated the relationship between students’ experiences with covid-19 and burnout (i.e., the 3 mbi-ss subscales). a moderator variable affects the direction and/or strength of the relationship between an independent variable and a dependent variable (aguinis & gottfredson, 2010). only those covid-19 variables that were significant (and/or improved the aic) in the regression models for the second research question were examined. interaction terms were calculated as the product of resilience scores and the covid-19 variables to test resilience as a moderator. regression models were recalculated to examine the effects of the interaction terms. the fourth research question sought to identify areas of support that students desired from faculty and staff. data from a single open-ended question (i.e., “if you are struggling or feeling burned out because of covid, what suggestions do you have for faculty to support you?”) were analyzed using nvivo. a thematic analysis (braun & clark, 2006) was conducted of responses provided by 633 students. responses ranged from a few words to several sentences. thirty-three codes emerged from the data using an open coding and iterative process. data analysis reached saturation and codes were grouped into four main themes: 1) online teaching pedagogy; 2) impact of covid-19; 3) transition of teaching and learning; and 4) affective domains of learning. validity of coding was supported through triangulation with quantitative data and consultation with the second researcher (carter et al., 2014). advances in social work, fall 2022, 22(3) 1030 results sample a total of 884 students (90.7% female, 73.9% caucasian) participated in the online survey and are described in table 1. on average, students were 28.8 years old (sd = 9.14) and ranged in age from 19 to 68 years. two-thirds of students (65.4%) were in school fulltime. the students were distributed across the bsw (38.6%) and msw (61.4%) programs. most students (91.6%) had coursework that was entirely online. regarding online coursework, 89.6% of students had synchronous class meetings with varying frequency, from rarely (24.7%) to very frequently/weekly (25.1%). table 1. sample demographics (n = 884) demographic n (%) gender male 68 (7.7%) female 802 (90.7%) nonbinary 14 (1.6%) ethnicity caucasian 653 (73.9%) african american 108 (12.2%) latinx 65 (7.4%) other (includes first nations, asian, & indian) 19 (2.1%) more than one 39 (4.4%) academic status full-time 578 (65.4%) part-time 306 (34.6%) program year * bsw junior 195 (22.1%) bsw senior 146 (16.5%) msw 1st year 178 (20.1%) msw 2nd year 237 (26.8%) msw advanced standing 128 (14.5%) percentage of coursework online 50% or less 17 (1.9%) about 75% 57 (6.4%) 100% 810 (91.6%) frequency of synchronous meetings for online courses never 92 (10.4%) rarely (once a month or less) 218 (24.7%) occasionally (about twice per month) 213 (24.1%) frequently (about three times per month) 139 (15.7%) very frequently (weekly) 222 (25.1%) note. * three msw categories reflect the categorization used at the respective institution. msw 1st year refers to the generalist year while both the msw 2nd year & msw advanced standing students are in their specialization year; however, msw advanced standing students have a bsw degree. keesler et al./assessing covid impact 1031 student experiences the first research question sought to describe student experiences with covid-19, burnout, and resilience. descriptive statistics (e.g., frequencies, means, correlations) are presented below. covid-19. frequencies and means for each of the covid-related items are presented in table 2. the percentages of students who somewhat and strongly agreed with each item ranged from a low of 26% (i.e., “the stressors i’ve experienced from covid cause me to doubt that i will continue my studies") to a high of 92.1% (i.e., “i worry about my health or the health of loved ones because of covid”). all items, except for one (i.e., “the stressors i've experienced from covid cause me to doubt that i will continue my studies”) were endorsed by more than 50% of the sample. table 2. covid-related items (n = 884) item item description agree (%) disagree (%) m (sd) 1 i worry about my financial resources because of the impact of covid. 74.3 17.4 3.92 (1.25) 2 i feel isolated from others because of covid. 82.4 9.5 4.16 (1.03) 3 i worry about my health or the health of loved ones because of covid. 92.1 3.9 4.50 (.82) 4 the availability of the online courses has enabled me to continue my education during covid. 84.8 5.9 4.34 (.96) 5 i feel disconnected from my peers/faculty because of learning online due to covid. 70.5 17.1 3.86 (1.28) 6 i actively engage in some forms of healthy behaviors (e.g., exercise, nature, meditation) to promote my wellbeing during covid. 72.3 19.9 3.75 (1.15) 7 i am unable to focus on my schoolwork because of covid. 57.3 27.8 3.35 (1.29) 8 i am more supportive of my student peers because of covid. 62.7 8.8 3.80 (1.00) 9 the stressors i’ve experienced with covid make me even more determined to graduate. 56.8 18.0 3.66 (1.21) 10 the stressors i’ve experienced from covid cause me to doubt that i will continue my studies. 26.0 63.1 2.27 (1.35) 11 on average, i am happy with the level of support i have received from faculty/staff since covid. 65.6 19.0 3.70 (1.21) 12 i have the support necessary to cope with stress related to covid. 73.2 16.1 3.82 (1.10) 13 during covid, faculty continue to foster my learning in positive and meaningful ways. 74.2 14.6 3.90 (1.11) 14 during covid, i want more real-time/live online course interaction with faculty/peers. 53.2 19.9 3.56 (1.24) note. agree represents respondents who indicated “somewhat” and “strongly” agree. disagree represents respondents who indicated “somewhat” and “strongly” disagree. respondents who “neither agreed nor disagreed” were omitted to simplify the table. advances in social work, fall 2022, 22(3) 1032 burnout. the ranges, means, and standard deviations for the three mbi-ss subscales are displayed in table 3. on average, students demonstrated a higher level of efficacy, a moderate level of exhaustion, and a lower level of cynicism. resilience. the ranges, means, and standard deviations for resilience are displayed in table 3. on average, students self-reported moderate levels of resilience. correlations between and among resilience, student age, and the mbi-ss subscale scores are displayed in table 3. all correlations were statistically significant (p <.01). table 3. descriptive and correlational data variable range m (sd) 1 2 3 4 1. age 19.0 – 68.0 28.83 (9.14) 2. exhaustion 0.0 – 30.0 17.66 (8.78) -.250** .663** 3. cynicism 0.0 – 24.0 8.38 (7.22) -.228** -.324** 4. professional efficacy 0.0 – 36.0 28.44 (6.11) .155** -.314** -.471** 5. resilience 7.0 – 20.0 15.91 (2.56) .215** .663** -.291** .423** note. *(p <.05). ** (p<.01). predicting burnout the second research question sought to understand the impact of student demographics and experiences with covid-19 on student burnout. exhaustion. the results of the stepwise regression for exhaustion are displayed in table 4. the final model was statistically significant [f(21, 828) = 32.92, p<.001] and accounted for 45.5% of variance in exhaustion. personal and academic variables accounted for 11.8% of variance in student exhaustion; however, experiences associated with covid-19 accounted for an additional 33.7% of variance in exhaustion. age, gender, academic status, synchronicity of classes, and various covid-19 experiences were significant predictors of students’ exhaustion. more specifically, older age (p<.01), being part-time (p<.001), having the support necessary to cope with stress related to covid-19 (p<.01), and having faculty during the pandemic who continued to foster student learning in positive and meaningful ways (p<.01) predicted lower levels of student exhaustion. in contrast, however, identifying as female (p<.01), having synchronous classes frequently or very frequently (p<.05), feeling isolated during covid-19, as well as being unable to focus on schoolwork and doubting continuation of studies due to the pandemic were significant (p<.01) predictors of higher levels of student exhaustion. student ethnicity, program year, and percent of coursework online were unrelated to level of exhaustion. cynicism. the results for the stepwise regression for cynicism are displayed in table 5. the final model was statistically significant [f(21, 823) = 31.28, p<.001] and accounted for 44.4% of the variance in cynicism. while personal and academic variables accounted for 9.3% of variance in student cynicism, covid variables accounted for an additional 35.1% of variance in cynicism. age, academic status, academic program year, synchronicity of classes, and multiple covid-19 items were significant predictors of student cynicism. more specifically, older age (p<.01), being a part-time student (p<.01), feeling more determined to finish the academic program (p<.001), being happy with level keesler et al./assessing covid impact 1033 of support from faculty during covid-19 (p<.01) and, having faculty that continued to foster learning in positive ways (p<.001) predicted lower levels of cynicism. however, being an advanced standing msw student (p<.01) and having synchronous classes frequently or very frequently (p<.05), as well as being unable to focus on school (p<.001) and having doubt about continuing in one’s academic program because of covid-19 (p<.001) predicted higher levels of cynicism. gender, ethnicity, and percent of online coursework were not significant predictors of cynicism. professional/academic efficacy. the results of the stepwise regression for efficacy are displayed in table 6. the final model was statistically significant [f(22, 818) = 19.38, p<.001] and accounted for 34.3% of the variance in efficacy. personal and academic variables accounted for 6.2% of the variance in student efficacy and the covid -19 variables accounted for an additional 28.1%. student age, academic program year, percentage of coursework online, and multiple covid-19 items were significant predictors of student efficacy. more specifically, older age (p<.05), having 75% or more of coursework online (p<.05), engaging in healthy behaviors during covid-19 (p<.001), feeling more determined to graduate (p<.001), having the support necessary to cope during covid-19 (p<.05), and having faculty who foster student learning in meaningful ways (p<.001) were associated with higher levels of student efficacy. significant predictors of lower efficacy included being a bsw senior or msw student in the 2nd year of the program (p<.05), the inability to focus on school because of covid-19 (p<.001) and having doubt about continuing in the academic program (p<.01). gender, ethnicity, and frequency of synchronous classes were not significant predictors of student efficacy. resilience as a moderating factor the third research question sought to ascertain if resilience moderated the relationship between students’ experiences with covid-19 and student burnout. although resilience had a significant main effect in each model, predicting lower exhaustion (b = 0.283; 95% ci: -0.474, -0.093), lower cynicism (b = -0.163; 95% ci: -0.322, -0.004), and higher efficacy (b = 0.585; 95% ci: 0.440, 0.729), all interactions between resilience and covid19 variables were not significant (the results are not presented). so, while students with higher resilience experienced less burnout, resilience did not moderate the effects of covid-19 as measured in this study. student support the fourth research question sought to identify the supports students wanted from faculty to help mitigate burnout. four major themes emerged from the data: online teaching pedagogy, impact of covid-19, transition of teaching and learning, and affective domains of learning. keesler et al./assessing covid impact 1034 table 4. stepwise regression for exhaustion characteristic step 1 step 2 step 3 b se β p b se β p b se β p age -0.22 0.03 -0.24 <.001 -0.18 0.03 -0.18 <.001 -0.08 0.03 -0.09 0.002 gender a female 2.40 1.12 0.08 0.03 2.04 1.11 0.07 0.07 2.23 0.88 0.07 0.01 other 6.78 2.59 0.09 0.01 6.39 2.56 0.09 0.01 1.94 2.03 0.03 0.34 race b african american -1.07 0.91 -0.04 0.24 -0.89 0.90 -0.03 0.32 -0.31 0.72 -0.01 0.66 other 0.08 0.86 0.003 0.93 -0.13 0.86 -0.01 0.88 -0.77 0.68 -0.03 0.25 academic status c part time -2.84 0.71 -0.15 <.001 -2.01 0.57 -0.11 <.001 program year d bsw senior 0.94 0.94 0.04 0.32 0.54 0.74 0.02 0.46 msw 1st year -1.62 0.96 -0.07 0.09 -0.76 0.76 -0.03 0.32 msw 2nd year 1.02 0.93 0.05 0.27 0.66 0.74 0.03 0.37 msw adv. standing 0.31 1.03 0.01 0.76 0.47 0.81 0.02 0.56 percent online e about 75% -1.83 2.35 -0.05 0.44 -0.20 1.86 -0.01 0.91 100% -1.75 2.07 -0.06 0.40 -0.57 1.63 -0.02 0.73 synchronous classes f rarely -0.61 1.09 -0.03 0.58 0.84 0.86 0.04 0.33 occasionally -1.97 1.10 -0.10 0.07 0.37 0.88 0.02 0.68 frequently -0.19 1.20 -0.01 0.88 2.34 0.96 0.10 0.02 very frequently 0.80 1.10 0.04 0.47 3.24 0.89 0.16 <.001 covid-19 g (2) isolated 0.84 0.23 0.10 0.001 (7) unable to focus 2.34 0.21 0.34 <.001 (10) doubt continue 1.21 0.20 0.19 <.001 (12) support to cope -0.87 0.26 -0.11 0.001 (13) faculty foster -0.88 0.25 -0.11 0.001 r2 0.073 0.118 0.455 f-value 13.32*** 6.970*** 32.92*** note. a reference group = male. b reference group = white. c reference group = full-time. d reference group = bsw junior. e reference group = < 75%. f reference group = never. g the numbers refer to the items as they appear in table 2. ***p <.001 keesler et al./assessing covid impact 1035 table 5. stepwise regression for cynicism characteristic step 1 step 2 step 3 b se β p b se β p b se β p age -0.18 0.03 -0.22 <.001 -0.17 0.03 -0.21 <.001 -0.08 0.02 -0.10 <.001 gender a female 0.51 0.93 0.02 0.58 -0.01 0.93 0.00 0.99 0.47 0.73 0.02 0.52 other 4.89 2.15 0.08 0.02 4.48 2.14 0.08 0.04 1.81 1.69 0.03 0.28 race b african american -0.75 0.76 -0.03 0.32 -0.42 0.76 -0.02 0.58 0.18 0.61 0.01 0.77 other -0.35 0.71 -0.02 0.62 -0.15 0.72 -0.01 0.84 -0.45 0.56 -0.02 0.43 academic status c part time -1.82 0.60 -0.12 0.002 -1.54 0.47 -0.10 0.001 program year d bsw senior 0.67 0.79 0.03 0.40 0.54 0.62 0.03 0.39 msw 1st year -0.04 0.81 0.00 0.96 0.41 0.63 0.02 0.52 msw 2nd year 2.30 0.78 0.14 0.004 1.86 0.62 0.11 0.003 msw adv. standing 1.69 0.86 0.08 0.05 1.77 0.68 0.09 0.01 percent online e about 75% -3.08 2.01 -0.10 0.13 -2.10 1.58 -0.07 0.18 100% -3.15 1.78 -0.12 0.08 -2.67 1.40 -0.10 0.06 synchronous classes f rarely -0.05 0.92 0.00 0.96 1.10 0.72 0.07 0.13 occasionally -1.61 0.93 -0.10 0.08 0.80 0.74 0.05 0.28 frequently -0.84 1.01 -0.04 0.41 1.87 0.81 0.10 0.02 very frequently -0.88 0.92 -0.05 0.34 1.88 0.74 0.11 0.01 covid-19 g (7) unable to focus 1.39 0.17 0.25 <.001 (9) more determined -1.09 0.17 -0.18 <.001 (10) doubt continue 0.85 0.16 0.16 <.001 (11) happy support -0.73 0.22 -0.12 0.001 (13) faculty foster -1.30 0.26 -.0.20 <.001 r2 0.059 0.093 0.444 f-value 10.58*** 5.27*** 31.28*** note. a reference group = male. b reference group = white. c reference group = full-time. d reference group = bsw junior. e reference group = < 75%. f reference group = never. g the numbers refer to the items as they appear in table 2. ***p <.001 advances in social work, fall 2022, 22(3) 1036 table 6. stepwise regression for efficacy characteristic step 1 step 2 step 3 b se β p b se β p b se β p age 0.09 0.02 0.14 <.001 0.11 0.03 0.16 <.001 0.05 0.02 0.07 0.03 gender a female 0.02 0.80 0.001 0.98 0.31 0.80 0.01 0.70 0.18 0.67 0.01 0.79 other -2.40 1.84 -0.05 0.19 -2.31 1.84 -0.05 0.21 -0.10 1.56 0.00 0.95 race b african american 1.08 0.65 0.06 0.10 0.91 0.65 0.05 0.16 0.38 0.56 0.02 0.50 other -0.47 0.62 -0.03 0.44 -0.79 0.62 -0.04 0.20 -0.34 0.52 -0.02 0.51 academic status c part time -0.38 0.52 -0.03 0.46 -0.53 0.44 -0.04 0.23 program year d bsw senior -1.20 0.68 -0.07 0.08 -1.26 0.57 -0.08 0.03 msw 1st year -0.41 0.69 -0.03 0.56 -1.10 0.59 -0.07 0.06 msw 2nd year -1.14 0.68 -0.08 0.09 -1.26 0.57 -0.09 0.03 msw adv. standing -1.10 0.74 -0.06 0.14 -1.25 0.63 -0.07 0.05 percent online e about 75% 3.83 1.73 0.15 0.03 3.06 1.45 0.12 0.04 100% 4.43 1.53 0.20 0.004 3.89 1.29 0.18 0.003 synchronous classes f rarely -0.07 0.79 -0.01 0.93 -0.95 0.67 -0.07 0.16 occasionally 0.73 0.80 0.05 0.36 -0.86 0.69 -0.06 0.21 frequently 0.82 0.87 0.05 0.34 -1.01 0.75 -0.06 0.18 very frequently 1.56 0.80 0.11 0.05 -0.09 0.69 -0.01 0.89 covid-19 g (6) healthy behavior 0.76 0.16 0.14 <.001 (7) unable to focus -0.76 0.16 -0.16 <.001 (9) more determined 1.13 0.16 0.22 <.001 (10) doubt continue -0.52 0.15 -0.12 0.001 (12) support to cope 0.53 0.20 0.10 0.01 (13) faculty foster 0.67 0.19 0.12 <.001 r2 0.031 0.062 0.343 f-value 5.27*** 3.38*** 19.38*** note. a reference group = male. b reference group = white. c reference group = full-time. d reference group = bsw junior. e reference group = < 75%. f reference group = never. %. g the numbers refer to the items as they appear in table 2. ***p<.001 advances in social work, fall 2022, 22(3) 1037 online teaching pedagogy. students identified various teaching strategies that they believed were helpful during emergency remote instruction. their responses acknowledged positive strategies that faculty had been using, such as being available/flexible, as well as negative experiences, which often centered around a lack of timely communication, grading, and feedback. students’ recommendations corresponded with what we know are basic tenets of distance education, like timely response to emails and return of assignment grading with substantive feedback. the need for timely and substantive instructor feedback was mentioned as important by students, in order to improve their learning and completion of future assignments. examples of students’ positive experiences with faculty often centered on the element of academic support and included: many professors have already taken some steps to lighten the course load, while still keeping intact the fundamentals. stay supportive, all my professors have been very supportive, and i appreciate that. it makes doing schoolwork more bearable knowing that they are there to help. i am feeling burned-out, but i feel as though the faculty has been doing everything they can to support me. they have been there for every question that i have had and fully understand how stressful it is for students right now and they are more than willing to help us and work through this time with us. student recommendations for improving online teaching pedagogy included: professors communicating more effectively and turning in our grades faster will help us know how we are doing on assignments. majority of my teachers have been slow at providing feedback on assignments, typically after the following assignment is due and i am unable to learn from my mistakes and make corrections. impact of covid-19. students’ personal experiences with stress, burnout, and other struggles with their mental health amid covid-19 were salient. student responses identified strategies that faculty had used to support their wellness, as well as areas for increased emotional support, particularly around workload and mental health. examples of positive experiences with faculty emotional support included: one professor had us share favorite uplifting songs and created a playlist on spotify that was shared with the class…that was a creative way to bring some lightness into our lives. so far, my instructors have been very supportive and understanding of the varying levels of stress that my classmates and i have experienced. examples of student recommendations for improving faculty emotional support included: if your students are opening up and explaining that they are not coping with mental health well you need to back off on the homework, be more understanding of deadlines, and even consider shortening classes. we are not coping. i wish that it felt easier or less stigmatized to tell professors about mental health advances in social work, fall 2022, 22(3) 1038 issues affecting class work abilities. in the same way that a student might let their professor know that a broken arm or pneumonia might affect one’s schoolwork, a student should be able to share their concerns about mental health affecting their schoolwork in a way that will not be judged or dismissed. transition of teaching and learning. the transition to emergency remote learning for students who had enrolled in a face-to-face program, as well as faculty that primarily taught in face-to-face courses, was abrupt and left little time for planning or preparation. however, students acknowledged positive experiences with transitioning to online learning, as exemplified by their comments: continue to offer online options. i work in a long-term healthcare facility so i shouldn’t be coming onto campus. i’m burned out from juggling too many things while trying to parent. and my professors are very kind... my kids jump into the screen while in a seminar, no one seems to mind because we’re all in the same boat, but it’s stressful for me. so i guess that’s a ‘me’ problem. students acknowledged various challenges and corresponding recommendations or areas for faculty consideration. examples include: while we are students, we are also still parents, spouses, friends, employees, and human. there have been instances where i have enrolled in courses that were supposed to be in person, but the material was not adjusted to realistically fit an online course and schedule. when these adjustments don’t happen, students get very stressed and overwhelmed and feel burnout. it’s hard to feel connected to a program that i started in-person now that i have been apart from my cohort for so long. i think if our advisors could make a phone call or email to each of us individually (maybe once a month) it might help to feel more connected… it feels as though the curriculum was not adapted to fit an online schedule. i see how these projects would be beneficial in the classroom, but it just adds so much strain to complete, say a group presentation where we each have to record our voices individually and figure out how to attach them to the slides. affective domains of learning. covid-19, community lockdowns, and social distancing requirements resulted in student displacement, social isolation, and loss of support. the need for increased support emerged in this theme as a focus on affective domains of learning, such as exploring one’s values, self-identity, and sense of purpose. students offered recommendations for increasing the connectivity between one’s identity as a student and a larger experience of self as exemplified by the following exemplar quotes: i think this is a function of not feeling fulfilled externally and somewhat internally given the state of the world and the lack of opportunities for the lgbtq+ community while living back in my home state. so, i guess creating more intentional and meaningful ways to explore the areas that we are lacking in our keesler et al./assessing covid impact 1039 lives by connecting school to our identities. i would offer a support group for students via zoom to discuss struggles, because many people do not have supports who understand the complexities and depths of what we as students and professionals experience. many students also work and have things going on with family, so an outlet would be helpful. in addition, students offered suggestions and provided feedback regarding improvements that centered around affective learning that explored students’ sense of self. i understand the need for discussion posts but replying to other students is repetitive and honestly does nothing for me. i do not mind when it is to help us get to know one another, such as sharing personal stories. have check-ins that are not a survey just to ask about the coursework or the class but include check-in about how the student is doing. discussion covid-19 has had a significant impact on students’ personal and academic lives. many students worried about their finances and health, felt isolated from others and disconnected from the academic community, and were unable to focus on school. yet more than half of the current sample also actively engaged in selfcare, felt more determined to graduate, and reported having beneficial supports that fostered their ability to cope and to learn. experiences related to covid-19 accounted for a significant proportion of variance in student exhaustion, cynicism, and efficacy, above and beyond demographic and academic variables. however, only three of 14 items queried were significant across all three domains of burnout: inability to focus on schoolwork, doubt regarding the continuation of studies, and having faculty who continued to foster student learning in positive and meaningful ways. notably, the average scores (based on student self-report) for the items assessing inability to focus and doubt regarding continuation of studies were the lowest scored. thus, while some aspects of covid were salient in students’ lives (e.g., worry about health), they were not directly associated with student burnout. this, combined with differences in the predictive academic variables (e.g., full-time status and regular synchronous classes were associated with increased exhaustion and cynicism), support more targeted and specific approaches. further, the results suggest a shift from a schoolwide approach (i.e., equality) to teaching approaches that lean toward equity based on individual circumstances (smith et al., 2017). qualitative analyses identified that faculty timeliness of communications and substantive assignment feedback, as well as being mindful of students’ workload and challenges amid the pandemic were all critical to what students felt was helpful. although many of those student concerns would not be unexpected, even outside of the pandemic, a notable exception was student desire for greater emphasis on affective learning. this student concern can address a contradiction between smoyer and colleagues’ (2020) findings on the value of synchronous online learning and our findings of an association between greater experiences of exhaustion and cynicism and synchronous classes attendance. the theme of “affective domains of learning” reconciles this contradiction. advances in social work, fall 2022, 22(3) 1040 students were noted to recommend a greater learner-centered approach for synchronous course meetings that focuses on the affective domain of learning and humanistic education. “humanistic education is therefore interested in educating the whole person-the intellectual and the emotional dimensions. it is most directly related to what is referred to as the “third force,” or humanistic psychology, and the “human potential movement” (khatib et al., 2013, p. 45). in maslow’s (1965) hierarchy of needs, “self-actualization” would be representative of learning outcomes that are sought in this approach. students experience of burnout in emergency remote synchronous classes may represent a desire for greater affective-focused learning in synchronous classes, as opposed to solely a cognitive focus. further, students who engaged in healthy behaviors during the pandemic experienced higher levels of professional/academic efficacy. previous research noted declines in health promoting behaviors like exercise and a healthy diet among students and an increase in maladaptive coping strategies such as binge drinking and substance use, as well as increased risk of burnout during covid-19 among students with poor physical health (apgar & cadmus, 2021; lawrence et al., 2021; reznik et al., 2021; sveinsdóttir et al., 2021). although social work students are often aware of the importance of self-care (which is endorsed by leading social work entities such as nasw and cswe), they may place greater emphasis on attending to academic demands over self-care (diebold et al., 2018). thus, while it is important for faculty members to teach students about self-care, greater emphasis and support for practicing self-care are warranted. various online resources, such as self-care starter kits, that are readily available can supplement these efforts (see university of buffalo, 2023). resilience, and associated factors, as well as student age were significant considerations in students’ experiences of burnout (i.e., older students may be better able to manage the stress of the pandemic). previous covid-related research noted that younger age was associated with increased risk for poorer outcomes and increased burnout (murat et al., 2020; rossi et al., 2021). as people age, they are more likely to have experienced life challenges and have greater insight and ability to face adversity (rossi et al., 2021). in addition, students who had a sense of determination amid covid-19 had lower levels of cynicism and higher levels of efficacy, in contrast to those with greater doubtfulness during the pandemic who had higher levels of exhaustion and lower efficacy. reznik et al. (2021) noted that higher resilience among international social work students was associated with less fear of covid-19, lower levels of depression and exhaustion, decreased loneliness and nervousness, as well as decreased anger during the pandemic. similarly, in the present study, resilience directly contributed to lower levels of exhaustion and cynicism and to higher levels of efficacy; however, it did not moderate the relationship between students’ experiences related to covid-19 and their level of burnout. limitations this study has several limitations. student experiences with covid-19 were assessed using a self-report at one point in time. as such, response bias and cross-sectional design present potential limitations. in addition, experiences with covid were not assessed with a standardized measure; however, the development of the respective items was based on keesler et al./assessing covid impact 1041 teaching experience, the available literature, and several iterations of review. qualitative analyses were conducted by one member of the research team. although this can result in additional bias, the researchers examined and discussed the viability of codes and themes during the analyses. in addition, this study was conducted among students in a single school of social work. despite a large sample size that encompassed students from across multiple campuses, the results may be influenced by unique school dynamics and culture. however, the shift to online learning during the pandemic was common across universities and likely presented similar experiences for students. conclusion the covid-19 pandemic struck with great uncertainty that led some social workers to question their judgment, knowledge, and competence (afrouz, 2021). this study highlighted the negative and positive experiences associated with covid-19 and the effects of these experiences on student wellbeing. without a doubt, the covid-19 pandemic has shown us just how vital it is to understand student learning as a complex web of interconnected personal and academic factors. in addition, the pandemic has underlined the urgent need for teaching strategies that prioritize establishing meaningful relationships with students. as online learning has become a widespread alternative, and new pedagogical techniques are being developed, it is crucial for faculty to explore innovations that create personalized and engaging ways of fostering genuine connections among students, particularly in the virtual classroom. references afrouz, r. 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(2020). telebehavioral practice basics for social worker educators and clinicians responding to covid-19. social work education: the international journal, 39(8), 1137-1145. https://doi.org/10.1080/02615479.2020.1807926 author note: address correspondence to john m. keesler, school of social work, indiana university, bloomington, in, 47401. email: jkeesler@iu.edu https://doi.org/10.3389/fpsyt.2021.635832 https://doi.org/10.1177%2f1609406920986043 https://doi.org/10.1177/0022022102033005003 https://doi.org/10.5993/ajhb.43.2.18 https://www.ncsl.org/research/education/higher-education-responses-tocoronavirus-covid-19.aspx https://www.ncsl.org/research/education/higher-education-responses-tocoronavirus-covid-19.aspx https://doi.org/doi:10.1177/0020872820940021 https://doi.org/10.1016/j.nedt.2021.105070 https://socialwork.buffalo.edu/resources/self-care-starter-kit.html https://apps.who.int/iris/handle/10665/331421 https://doi.org/10.1080/02615479.2020.1807926 _________ kristin trainor, phd, lcsw, assistant professor, department of social work, ball state university muncie, in. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 67-90, doi: 10.18060/24282 this work is licensed under a creative commons attribution 4.0 international license. maternal substance use disorder: a look at provider stigma, attitudes, and beliefs kristin trainor abstract: pregnant women with substance use disorder (sud) can face varying degrees of negative interactions with healthcare providers, including judgment of the individual’s value and involvement in their infant’s care. this research explored potential stigma and attitudes among medical providers within a maternal/fetal healthcare setting towards women with maternal sud. an electronic survey was administered to 117 health care providers, including social workers, who work with pregnant women in an urban, midwest, healthcare facility. attitudes and stigma differed significantly based on the health care providers’ discipline. healthcare providers who viewed sud as a disease had a more positive perception of mothers with sud. by building professional awareness, creating policy change, increasing education, and continuing research regarding maternal sud, social workers have an opportunity to develop responsive support programs for healthcare workers and promote overall change within the healthcare setting. keywords: stigma, nas, drug use, pregnancy, attitudes women of all ages, socioeconomic status, and race are impacted by substance use disorder (sud; prasad, 2014; substance abuse and mental health services administration [samhsa], 2016; stein, 2002). in 2014, over 32,000 babies in the united states (u.s.) experienced prenatal illicit opioid exposure (national institute on drug abuse [nida], 2019). this number did not include other substances like methamphetamine, alcohol, or cocaine – thus, the overall number of women experiencing sud was likely much higher. when looking at all substances, it is estimated that more than 5% of all births in the u.s. involve exposure to illicit prenatal substances (nida, 2017). overall, the incidence of maternal sud may be substantially higher, as substance use is often underreported when not using biomarkers (chiandetti et al., 2017; garg et al., 2016). however, pregnancy can be a prime motivator for sud treatment, thus healthcare providers have a unique opportunity to support, build trust, and positively impact a woman experiencing maternal sud (crawford et al., 2015; marangoni & felix de oliveria, 2015; mitchell et al., 2008; stein, 2002). thus, to maximize beneficial outcomes for babies and mothers, it is necessary to understand the potential stigma that healthcare providers may, intentionally or unintentionally, be imposing on families impacted by sud. increasing self-awareness among practitioners can lead to greater self-management and improved practice skills (sukhera et al., 2018; winstone & gervis, 2006), thus enhancing opportunities for a more positive health situation for mother and baby. barriers to healthcare. women with maternal sud attend fewer prenatal visits on average than women without a sud (little et al., 2005; renbarger et al., 2019; whiteman et al., 2014) due to a host of factors. barriers to prenatal care include limited access to health insurance, limited childcare, inadequate transportation, homelessness, negative about:blank advances in social work, spring 2022, 22(1) 68 provider interaction, low socio-economic status, limited support, general fear and mistrust, and fear of legal implications and child protective services (cps) involvement (howell & chasnoff, 1999; marangoni & felix de oliveria, 2015; paris et al., 2020; roberts & pies, 2010). emotionally, women with sud may shut down, avoid recognizing the pregnancy or become overwhelmed with the process of obtaining care, and thus avoid seeking help (latuskie et al., 2019; roberts & pies, 2010). women can become isolated (stone, 2015), as informing their family or healthcare provider of the pregnancy along with their sud may increase fear of rejection (roberts & pies, 2010) or prosecution (paris et al., 2020; stone, 2015). if the woman’s partner or social circle is also experiencing sud, the woman can be forced to choose between abstinence or treatment and her perceived support group (meurk et al., 2014). this can again be isolating if the woman chooses to abstain from substances or can act as a deterrent to prenatal care if the partner is not supportive of treatment (crawford et al., 2015; mburu et al., 2020). high levels of negative self-image, low self-esteem and paranoia accompanying the belief that others are cognizant of the sud (bowie, 2005; prasad, 2014; sun, 2004) can each act as a deterrent to seeking care. when mixed with limited social support, the opportunity for prenatal care greatly diminishes (roberts & pies, 2010; sun, 2004). limited prenatal care not only decreases the opportunity to support women with maternal/fetal medicine but also decreases access to services for suds, mental health, and general health (prasad, 2014; roberts & pies, 2010). neonatal abstinence syndrome (nas) and staff implications. nas is a medical diagnosis, under icd-10-cm p96.1, and requires the presence of certain symptoms to make a diagnosis. the finnegan score, a tool used to capture nas symptoms, quantifies a baby’s level of drug exposure (busenbark, 2016). typically, nas symptoms will manifest within three days post-delivery, though, in some cases, symptoms may not surface for seven days (bhuvaneswar et al., 2008; logan et al., 2013; mangat et al., 2019). the symptoms may include increased muscle tone, extreme irritability, high pitched cry, poor sleep patterns, and diarrhea (dryden et al., 2009; hudak & tan, 2012; logan et al., 2013; nida, 2020b). from a long-term perspective, prenatal drug exposure can impact growth, behavior, cognitive functioning, language, and general achievement (logan et al., 2013; nida, 2020b; patrick et al., 2012; stein, 2002). there are several non-pharmacological treatment options for babies experiencing nas, which include a low stress, quiet environment; skinto-skin contact; baby massage; dietary changes; and encouragement of breast feeding (busenbark, 2016; dryden et al., 2009; mangat et al., 2019; mcqueen & murphy-oikonen, 2016). specifically, skin-to-skin contact creates a two-fold benefit. it decreases symptoms and improves the baby’s overall well-being (busenbark, 2016; dryden et al., 2009; mcglothen-bell et al., 2021; vogel, 2018). while the baby is able to be comforted via skin-to-skin, the parent can begin the bonding process and learn the individual needs of their baby (mcglothen-bell et al., 2021; vogel, 2018). if the mother does not positively bond with the baby, there can be additional psychosocial stressors including depression, frustration, guilt, and increased substance use for the mother (de bortoli et al., 2014). however, with increased parental visitation, the trainor/maternal substance use disorder 69 hospital staff can assist the mother in recognizing the baby’s irritability as a sign of withdrawal rather than the baby’s lack of attachment to the mother (sun, 2004). some hospitals allow for parental rooming in, which affords the parent time to bond, interact, and become more fully engaged while the baby receives consistent, soothing care (busenbark, 2016; macvicar & kelly, 2019). when healthcare providers encourage visitation, teach skills, and empower the new mother to parent, increased bonding and comprehension of the baby’s medical needs can occur (vogel, 2018) while simultaneously increasing the trust and relationship between staff and caregiver (busenbark, 2016). understanding maternal substance use working with women who have a sud during pregnancy can be challenging, thus, providers must be educated regarding best practices in care for the parents and their children (samhsa, 2016; stein, 2002; woods & conley, 2022; worley, 2014). two contrasting models have evolved to explain the causes of sud: the moral model of addiction and the disease model. the underpinnings of each model funnel into key concepts of potentially increasing or decreasing stigma. the moral model of addiction focuses on the individual’s weakness and subsequent character flaws as the factor leading to substance use (lawrence et al., 2013; nida, 2014; schaler, 1991; van wormer & davis, 2018). the moral model legitimizes a punishment focus, like that evidenced by the war on drugs, which criminalizes drug use over rehabilitation and promotes long prison sentences (frank & nagel, 2017; lemaitre, 2011; van wormer & davis, 2018). state-directed punitive approaches towards addiction are also observed as 23 states identify substance use in pregnancy as child abuse and 3 states allow for civil commitment (guttmacher institute, 2021). however, only 17 states offer priority treatment programs for pregnant women (guttmacher institute, 2021). the moral model appeals to emotion (pickard, 2017); however, this view of substance use fails to recognize the complexities or to explain the sociological and physiological effects of substance use (crawford et al., 2015; koppel; 2016; lawrence et al., 2013; stein, 2002; whiteman et al., 2014). attributes of the moral model remain within the healthcare setting. raeside’s (2003) quantitative study examined midwives and nursing staff working with substance-using mothers and found 76% reported anger towards the mother (raeside, 2003). additionally, in lawrence et al.’s (2013) quantitative study of physician beliefs regarding addiction, 14% attributed the cause of addiction to a moral failing. when healthcare workers and the community operate under the belief that substance use is pleasure-seeking instead of a disease, a punitive and criminal approach takes effect (stein, 2002). however, punitive approaches lead women to avoid prenatal care, withhold medical information, and isolate themselves out of fear (lollar, 2017; stone, 2015; wolfson et al., 2021). in contrast to the moral model, the disease model of addiction views substance use as a medical condition (horvath et al., n.d.; schaler, 1991; van wormer & davis, 2018). according to this conception, sud alters the brain, thus causing the individual to crave the drug, creating a biochemical cycle. among individuals with sud, 40-60% will relapse (nida, 2011). witnessing an individual relapse can be devastating. thus, recognizing that advances in social work, spring 2022, 22(1) 70 relapse may occur is important (nida, 2020a; stein, 2002). bland et al. (2001) reviewed medical students’ beliefs towards maternal substance use. the results indicate a positive change in medical student beliefs after education regarding sud was presented (bland et al., 2001). reframing substance use as a disease may also help providers view a mother with substance use as a person with a health condition, as perceptions towards disease and treatment have been shown to impact provider decision-making (shadowen et al., 2021). hospitals around the country are beginning to reassess the treatment of nas and have found promising results by humanizing the mother. in a tennessee hospital, the mother/ baby nas program functions under the paradigm of addiction as a disease (busenbark, 2016). by decreasing providers’ disapproval and subsequent anger toward the mother’s substance use, providers are better able to support the baby and parent (busenbark, 2016). such changes in the treatment of nas lowered the hospital length of stay (los) from 34 to 23 days (busenbark, 2016). the decrease in los is attributed to staff and community education and a shift in the beliefs about addiction (busenbark, 2016). similarly, the yalenew haven children’s hospital is changing the underlying belief system of maternal sud and placing parents in the center of the treatment/care process for the baby (busenbark, 2016). the parents are included in the treatment plan to help administer the nonpharmacological support. the hospital team empowers new mothers to become the healing component which helps to increase the trust and relationship between staff and caregiver (busenbark, 2016). after two years of implementing this approach, yale-new haven children’s hospital experienced a decrease in length of hospitalization from 27.5 to 7.5 days (busenbark, 2016). stigma health-related stigma is a “sociocultural process in which social groups are devalued, rejected, and excluded on the basis of a socially discredited health condition” (livingston et al., 2012, p. 39). suds are a leading stigmatized health condition among institutions and the community (livingston et al., 2012). additionally, when a sud co-occurs with pregnancy, the potential for stigmatization increases (sun, 2004). healthcare providers can inadvertently perpetuate health disparities due to their own perceptions and stigma (chapman et al., 2013). stigma can lead to additional isolation due to fear of provider reaction and rejection (hatzenbuehler et al., 2013; marangoni & felix de oliveria, 2015), which may lead to poor maternal and fetal care, poor hospital visitation post-birth, or lack of attentiveness during hospital visitation. there are multiple types of stigma: self, social, and structural (livingston et al., 2012). self-stigma can be conceptualized as negative thoughts and feelings regarding one’s self, acceptance of a negative narrative about the self, and the expectation of negative attitude/reactions of others due to status or health condition (livingston & boyd, 2010). self-stigma can lead to self-destructive behaviors and may contribute to poor health outcomes (hatzenbuehler et al., 2013). a vicious cycle ensues. individuals believe the negative attributes that are assigned, which causes continued maladaptive emotional coping strategies (hatzenbuehler et al., 2013). social stigma occurs when a large group engages in stereotyping and negative actions against an already stigmatized group (corrigan et al., trainor/maternal substance use disorder 71 2005a). stigma also increases within health care settings when providers view the individual as refusing to cease their substance use (corrigan et al., 2009). for individuals with sud, their actions can be viewed as disingenuous by providers, which can lead to women underreporting their substance use (paris et al., 2020). structural stigma broadly encompasses the policies and the culture within an institution which promote negative attitudes towards a group, either directly or indirectly (corrigan et al., 2005a, 2005b; link & hatzenbuehler, 2016). this type of stigma suppresses opportunities for the stigmatized group, promotes a loss of status, labeling, discrimination, and stereotyping (corrigan et al., 2005a, 2005b; link & hatzenbuehler, 2016). a policy which criminalizes maternal sud operationalizes structural stigma. for example, in 2014, tennessee passed public chapter 820, or “the fetal assault law” which allows for legal prosecution of women who use illicit substances during pregnancy, if linked to harm to the baby (darlington et al., 2021; lollar, 2017). however, research has shown that such a law is detrimental to both mother and baby, as seeking prenatal care is greatly diminished, and home births increase as a result of fear of prosecution (burke, 2016; darlington et al., 2021; lollar, 2017). the medical community opposed the bill (burke, 2016), and due to ramifications including a greater number of home births, lower rates of prenatal care, and lack of available sud services, the law was suspended in 2016 (burke, 2016; darlington et al., 2021; lollar, 2017). while tennessee is the only state to have a specific statue outlining the criminal offense, other states are creating similar policies (boone & mcmichael, 2021). this emerging national trend toward punitive measures appears ineffective to improve outcomes. faherty et al.’s (2019) study found that states with increased punitive laws and sanctions did not see a decrease in nas, while states with less punitive measures saw improved nas occurrences. enhanced criminalization measures are also disproportionately impacting women of color (haffajee et al., 2021). the u.s. has a high rate of maternal mortality, 17.2 per 100,000 live births, with women of color having much higher rates, 43.5 per 100,000 live births (melillo, 2020). it is estimated that 60% of maternal deaths are preventable (centers for disease control and prevention, 2019) with accidental overdose a prevalent factor in maternal mortality (collier & molina, 2019; indiana department of health, 2020). measures need to be adopted to diminish, rather than escalate, maternal mortality rates. a punitive and stigmatizing approach to maternal sud is counterproductive to improved mortality rates and leads to even greater health concerns for both mother and baby (faherty et al., 2019; goodman et al., 2019). healthcare flourishes when the provider has access to all pertinent data regarding the patient in order to formulate the best plan of care. when a patient realizes that honest communication may result in the loss of her own personal freedom or the loss of contact with her child, the integrity of the system dissolves. a system in which the mother cannot openly share her medical information with her provider, for fear of legal implications, creates fractured and dangerous practices (criminal law, 2020). regardless of type (self, social, or structural), stigma is detrimental to health outcomes (hall et al., 2015; hatzenbuehler, 2016). by increasing provider awareness of advances in social work, spring 2022, 22(1) 72 the negative consequences of stigma, change can occur at the individual, institutional, and cultural level within the healthcare system (carnes et al., 2012; pope et al., 2018; sukhera et al., 2018). research shows that building awareness can lead to initial change in one’s behavior, attitudes, and/or beliefs, creating a snowball effect: a person becomes aware, which triggers change, then becomes a role model to shape new culture (sukhera et al., 2018). thus, understanding and recognizing stigma can positively influence the care and outcomes for women with sud. study rationale although robust research documents nas and addiction, there is a dearth of research regarding healthcare provider attitudes (across disciplines) and stigma attached to maternal sud (fonti et al., 2016). additionally, no studies were found that assessed the attitudes of the multi-disciplinary team of healthcare workers who are involved in the care of women with maternal sud. selleck and redding’s study from the mid-1990s examined the attitudes towards maternal sud of 392 nurses. the results indicated that more than half of nursing staff reported negative or punitive attitudes towards their patients with sud. however, staff with greater education on addiction had more positive attitudes (selleck & redding, 1998). the study included only nursing staff, a limitation given that different disciplines are involved in the care of both mother and baby. similarly, fonti et al.’s (2016) survey of nurses indicated neutral to slightly positive overall attitudes towards maternal sud, though this survey again had a limited professional focus. hospital-based care for both pregnant women and babies is provided by medical doctors and nurses, and augmented by ancillary staff, including social workers, chaplains, supportive care workers, case managers, ultrasound technicians, dieticians, physical therapists, speech therapists, occupational therapists, managerial nurses, lactation consultants, and volunteers. each group may have a different understanding or belief about maternal sud which can negatively or positively affect the outcome of a mother’s medical experience and health outcomes. thus, the goal of this cross-sectional study was to examine providers’ stigma, attitudes, and beliefs of causation associated with women who have maternal sud, across multiple disciplines within a healthcare system. survey review. at the time of this study, there were no specific measures available to examine healthcare provider attitudes (across disciplines) and stigma regarding maternal sud. thus, the researcher developed a new measure to assess belief of causation of sud, stigma, and attitudes toward maternal sud based upon the work of multiple contributors (raeside, 2003; silins et al., 2007; stringer et al., 2016). silins et al. (2007) used an adapted alcohol and alcohol problems perception questionnaire (aappq) to assess medical student attitudes towards sud. reliability and validity were not reported. written documentation allowing for the use and modification of the aapq was obtained. additional items were developed based upon previously available research by raeside (2003) and stringer et al. (2016). raeside’s (2003) survey measured the attitudes of nurses working with mothers experiencing sud. the full survey, including reported reliability and validity, was not available in the public domain and attempts made to obtain the full survey were unsuccessful. stringer and colleague’s 2016 survey focused on healthcare provider stigma related to hiv. while direct questions were not used from this tool, the trainor/maternal substance use disorder 73 modified “measuring hiv stigma and discrimination among health facility staff” survey, it did influence the survey design (cronbach's alpha= .818) given the efforts to measure stigma. due to the new survey instrument, this study had multiple levels of review. the first was a review from a dissertation committee, who provided essential feedback on the instrument. additionally, an outside doctorallevel professional reviewed the survey and offered vital feedback. in addition to the committee review, eight professionals in the healthcare field, including social work, nursing, nutrition/dietetics, and speech therapy, completed the survey. the modified pilot test allowed for review of the survey scales. the scales for attitudes, stigma, and causation of sud were tested for internal consistency using cronbach’s alpha coefficient. the attitudes scale (a=.89), stigma scale (a=.79), and causation of sud scale (a=.80), met the parameters for appropriate internal consistency at the acceptable to high range. sample size. to determine an appropriate sample size, multiple factors, including type of statistical test, the significance level, the expected effect size, the targeted value of power, and the estimated response rate for the survey were assessed. thus, the survey required a target sample of 91 participants. initially 135 individuals opened the survey link, 127 individuals started the survey, and 117 completed it. study participants. the group under investigation were healthcare practitioners within a maternal/fetal and prenatal healthcare setting. all medical practitioners, regardless of discipline within the maternal fetal setting, were ideal for the study, because these practitioners were most likely to be delivering clinical intervention and were at risk of perpetuating stigma. the main inclusion criterion for this sample was active practice in the maternal, neonatal, or pediatric healthcare field (employed either part-time or full-time) at the time of data collection. participants also were required to be able to read english. recruitment. the hospital system selected to recruit healthcare providers was the largest pediatric hospital offering the highest level of care (level iv) in the state. the researcher contacted medical directors and department managers directly to offer an opportunity to participate in the study. the medical directors and managers were asked to send the survey to their staff via the internet through a participant recruitment e-mail written by the researcher. respondents had the opportunity to enter a drawing to win a $10 amazon gift card. individuals were encouraged to participate to help increase understanding of healthcare providers’ attitudes and perceptions of maternal sud. measures. the key variables in this study included healthcare provider attitudes of maternal sud, stigma, and causation of sud. practitioner’s discipline was a predictor variable of particular interest, as little to no research is available on this factor. the measure contained 35-items, categorized into three scales measuring attitudes, stigma, and causation of sud. each of the items, which included statements such as “i am uncomfortable working with pregnant cocaine users” and “i believe more punitive measures should be taken against a mother with pregnancy drug misuse,” was rated on a 5-point likert scale (1 = strongly agree to 5 = strongly disagree). six items were reversecoded. lower scores indicated more negative attitudes and greater stigma related to advances in social work, spring 2022, 22(1) 74 maternal substance use. items used to assess provider stigma included “i prefer not to work with pregnant women with sud,” “hospitals should impose greater sanctions on a mother with sud during pregnancy,” “women should be regularly drug tested,” “i am not comfortable leaving a child in a room with their substance misusing parent,” and “an infant should never discharge with the mother if she misused substances.” control variables. demographic items inquired about respondents’ education level, work status (full or part-time), professional licensure status, race, ethnicity, age, practice location, length of time in practice, and gender. for specific survey questions refer to appendix 1. results demographics. the sample was a non-representative, convenience sample of healthcare professionals (n= 117) in an urban, midwest state in the u.s. the sample was overwhelmingly female (94%) and caucasian (92%). participant ages ranged from 21 to 73 years. of the 24 employment disciplines listed, the most common positions reported were direct care nurse (41%), medical doctor (13%), nurse practitioner (14%), or social worker (13%). the employee discipline affiliations were condensed to yield a higher sample size for each group. the groups were reconfigured to include medical doctor, nurse practitioner/physician assistant, direct care nurse, social work, administration, and support staff. in terms of employment status, more than 94% of respondents were actively practicing in a maternal, fetal, or pediatric setting and 86% were working with a mother or baby affected by nas. most respondents reported they were full-time (73%) employees, and 50% reported spending more than 51% of their work week in direct contact with mothers experiencing a sud. manova. factorial manova was used as it allows for testing mean differences between levels of two independent variables with two dependent variables (french et al., n.d.) and reduces the type 1 error rate (murphy, 2021). the conventional social science alpha level of .05 was used; thus, there was a 5% chance that false significance, or type 1 error, would occur (olejnik, 1984). the results of the factorial manova showed an overall significant difference between an employee’s attitudes and stigma levels among different disciplines (pillai’s trace= .28, f(10, 198)=3.24, p=.001 with a power of 0.99. the post hoc pairwise comparisons between subjects indicate attitudes (f(10,198)=4.63, p=.001, η2=0.12) and stigma levels (f(6,198)=2.64, p < .05, η2=0.19) differed significantly based on providers’ discipline (see table 1). the discipline accounts for 12% of the variance in attitudes (η2=0.12) and 19% of the variance in stigma (η2=0.19). trainor/maternal substance use disorder 75 table 1. post hoc pairwise analysis test for factorial manova attitude stigma current employment discipline mean diff. sd p mean diff. sd p medical doctor administration -.70 7.777 1.00 3.47 2.676 .787 direct care nurse 9.80 4.078 .165 3.73 1.403 .093 nurse practitioner/pa -.14 4.895 1.00 -.18 1.685 1.00 social worker -4.58 4.967 .940 .28 1.709 1.00 support staff 8.61 4.967 -.513 .53 1.709 1.00 administration medical doctor .70 7.777 1.00 -3.47 2.676 .787 direct care nurse 10.50 7.186 .690 .27 2.473 1.00 nurse practitioner/ pa .56 7.680 1.00 -3.65 2.643 .739 social worker -3.88 7.725 .996 -3.19 2.658 .836 support staff 9.31 7.725 .833 -2.94 2.658 .878 direct care medical doctor -9.80 4.078 .165 -3.73 1.403 .098 nurse administration -10.50 7.186 .690 -.27 2.473 1.00 nurse practitioner/ pa -9.94 3.890 .118 -3.91 1.339 .048* social worker -14.37 3.979 .006* -3.45 1.369 .128 support staff -1.19 3.979 1.00 -3.20 1.369 .189 nurse medical doctor .14 4.895 1.00 .18 1.685 1.00 practitioner/ pa administration -.56 7.680 1.00 3.65 2.643 .739 direct care nurse 9.94 3.890 .268 3.91 1.339 .048* social worker -4.43 4.814 .973 .46 1.656 1.00 support staff 8.75 4.814 .654 .71 1.656 .998 social worker medical doctor 4.58 4.967 .973 -.28 1.709 1.00 administration 3.88 7.725 .988 3.19 2.658 .836 direct care nurse 14.37 3.979 .029* 3.45 1.369 .128 nurse practitioner/ pa 4.43 4.814 .973 -.46 1.656 1.00 support staff 13.19 4.866 .211 .25 1.681 1.00 support staff medical doctor -8.61 4.967 .699 -.53 1.709 1.00 administration -9.31 7.725 .917 2.94 2.658 .878 direct care nurse 1.19 3.979 1.00 3.20 1.369 .189 nurse practitioner/ pa -8.75 4.814 .654 -.71 1.656 .998 social worker -13.19 4.886 .211 -.25 -.25 1.00 p<0.05* assumption testing. a series of tests were completed to ensure the assumptions for the manova analysis were met. tests completed were the pearson’s correlation (r=0.602, p<.01), box’s m value of 44.63(p=.688), levene’s f test, and mahalanobis distance. across the dependent variables, the measure of skewness and kurtosis, histograms, and normal q-q plots were examined. all assumptions were met, thus rendering manova an appropriate statistical analysis. advances in social work, spring 2022, 22(1) 76 additionally, correlations were calculated for the perceived causation of sud scale and attitude scale of maternal sud. refer to table 2 for the inter-item correlation matrix. table 2. inter-item correlation causation matrix 1 2 3 4 5 believe addiction is a medical condition 1.000 .357 .346 .280 .466 believe addiction is caused by a moral flaw 1.000 .391 .397 .467 believe addiction is selfish 1.000 .508 .527 person could quit illicit drug use if they really wanted to 1.000 .641 person who uses illicit drugs during pregnancy cares more about drugs than the baby 1.000 the initial research question sought to explore not only the respondents’ attitudes, causation beliefs, and provider stigma, but whether these beliefs differed by healthcare discipline. it was unknown whether the various employment positions might reflect different results because of varying education, training, or experience. the dependent variables, attitudes and stigma, were treated as continuous variables. the attitude scale was created by using the sum score of questions attitude 1-attitude 18. attitude 18 was reverse-coded. the sum numbers were divided into 5 groups: extremely negative attitudes (18-32), negative attitudes (3347), neutral attitudes (48-62), positive attitudes (63-77), and extremely positive attitudes (78+). higher scores represent more positive attitudes. the structural stigma scale was created by using the sum score of stigma items 1-11. stigma 2, 3, and 9 were reverse-coded. the sum numbers were divided into 5 groups: extremely high stigma (11-19), high stigma (20-28), neutral (29-37), low stigma (38-46), and extremely low stigma (47-55). higher scores represent decreased stigma. results show significant differences in attitudes and stigma by discipline. as a group, the respondents report an overall neutral attitude (m=60) toward women with sud, and neutral levels of stigma (m=34.7). direct care nurses had significantly lower scores for attitude (m=55) and increased stigma scores compared to their counterparts: nurse practitioners (m=64.76), medical doctors (m=64.8), and social workers (m=69.3). additionally, direct care nurses on average report having an overall neutral to negative attitude towards women with maternal sud, while medical doctors, social workers, and nurse practitioners report an overall neutral to positive attitude. stigma attached to women with sud was shown by 32% of respondents, who reported that the hospital provided better non-medical care to babies than their mothers provided. further, 25% of respondents reported that mothers deserve less privacy. these findings demonstrate informal and formal levels of stigma, which broadly encompass the policies and the culture within the institution, potentially impacting the mother’s ability to utilize all resources/supports (corrigan et al., 2004, 2005b). overall stigma levels by discipline are found in table 3. trainor/maternal substance use disorder 77 table 3. overall stigma level by discipline position n negative neutral positive md-direct 14 9 (64.3%) 5 (35.7%) md-admin 1 1 (100%) direct care nursing 49 11 (22.5%) 31 (63.3%) 7 (14.3%) np/pa 17 1 (5.9%) 8 (47.1) 8 (47.1%) case manager 4 1 (25.0%) 2 (50.0%) 1 (25.0%) nursing management 3 1 (33.3%) 2 (66.7%) social work 16 12 (75.0%) 4 (25.0%) respiratory therapist 5 1 (20.0%) 3 (60.0%) 1 (20.0%) music therapist 1 1 (100%) lactation consultant 2 2 (100%) nursing educator 1 1 (100%) pharmacy 1 1 (100%) non clinical 3 1 (33.3%) 2 (66.7%) total 117 15 (12.8%) 71 (60.7%) 31 (26.5%) beliefs about the cause of maternal sud were also examined. there were strong correlations (r=0.61) between the perceived cause of sud and one’s attitude towards maternal sud. results indicated that 10% of respondents viewed sud as a moral flaw, while 41% were unsure if it is a moral flaw (see table 4). nearly 50% of respondents did not view sud as a medical issue. in fact, 44% of staff reported more punitive measures should be taken against a mother with sud, with an additional 28% unsure. of the respondents, 37% reported believing a mother with sud cares more about drugs than her baby, while 16% of respondents were unsure. additionally, 36% believed a mother could quit her substance use if she wanted to, while another 22% reported uncertainty as to a mother’s ability to quit. only 43% of respondents believed hospitals provide a supportive place for mothers with sud. refer to table 5 for a complete list of general beliefs and attitudes. table 4. causation of sud by employment discipline position n negative neutral positive md-all 15 4 (26.7%) 8 (73.3%) administration 4 1 (25.0%) 1 (25.0%) 2 (50.0%) direct care nursing 49 8 (16.3%) 28 (57.1%) 13 (26.53%) np/pa 17 1 (5.9%) 4 (23.5%) 12 (70.6%) social work 16 1 (6.3%) 15 (93.8%) support staff 16 2 (12.5%) 10 (62.5%) 4 (25.0%) total 117 12 (10.3%) 48 (41.0%) 57 (51.7%) advances in social work, spring 2022, 22(1) 78 table 5. general beliefs and attitudes (n=117) question strongly agree/ agree undecided strongly disagree/ disagree believe hospital staff can provide better, nonmedical care 38 (32.4%) 44(37.6%) 35 (29.9%) state should impose greater sanctions on a mother with substance misuse during pregnancy 58 (49.6%) 33 (28.2%) 16 (22.2%) schooling prepared me to discuss health risk behaviors with patients 80 (67.2%) 13 (10.9%) 26 (21.9%) satisfied with the level of communication between disciplines 86 (72.2%) 14 (11.8%) 19 (16.0%) organization provides a supportive environment for mothers 52 (43.7%) 41 (34.5%) 26 (21.8%) believe more punitive measures should be taken against 51 (43.6%) 33 (28.2%) 33 (28.2%) burned out working with mothers and babies with drug use/exposure 10 (8.6%) 11 (9.4%) 96 (82.1%) person could quit illicit drug use if they really wanted to 42 (35.9%) 26 (22.2%) 49 (41.9%) person who uses illicit drugs during pregnancy cares more about drugs than the baby 43 (36.8%) 19 (16.2%) 55 (47.0%) empathy for a pregnant/post-partum woman with substance misuse 82 (70.1%) 25 (21.4%) 10 (8.5%) discussion although there are some positive attitudes towards mothers with sud, negative stigma exists across several disciplines. the pervasive non-adherence to the disease model (51%) of sud may, in part, be responsible for this situation. this can cause concern because when hospitals adapt a humanistic approach, supported through a disease model of sud, improved outcomes for the baby are more likely to occur (busenbark, 2016; vogel, 2018). there is also an indication that the healthcare provider’s discipline may influence their attitudes and levels of stigma. this may, in part, be due to the type of discipline and specific teachings within each area, as well as to the potential effects of working directly with the population. these results do not necessarily reflect the realities of professional practice. often direct care nurses spend more direct time working in day to-day contact with mothers and babies affected by maternal sud, which may lead to a more stressful work environment or greater levels of burnout, as providers feel they are ineffective in a mother’s sud (stein, 2002). this may reflect a need for greater education and support, especially at the direct care nursing level. additional factors that may influence a provider are the perceived levels of support and the hospital system cohesiveness. it is promising that 87% of respondents report receiving positive supervision. supervision is powerful when the relationship is viewed by the supervisee as supportive (frimpong et al., 2011). thus, although surveyed healthcare practitioners felt supported by their institutions, it is unknown whether the institutions promote a positive or negative climate towards women with maternal sud. trainor/maternal substance use disorder 79 limitations. the research study has several limitations. the sample was a nonrepresentative, convenience sample with limited sample size of ancillary departments, and data were collected at only one hospital system. the sample was disproportionately white and female. additionally, specific data were not available on the demographics of the women accessing the hospital system services. thus, the survey cannot identify or remark on potential bias masked as sud stigma. there was limited literature available directly reflecting stigma, attitudes, and causation of sud towards pregnant women. this impacts not only foundational literature but the access and availability of valid and reliable survey instruments. consequently, a new instrument was created due to the lack of an available survey instrument. the survey was created based on available literature stemming from other stigmatized groups, specifically hiv and alcohol use disorder. the survey underwent multiple levels of review, though it should be noted that the modified pretest cannot determine generalizability as only eight healthcare professionals participated in the pretest. while reliability of the stigma scale (cronbach alpha =.72) and attitude scale (cronbach alpha = .96) were at least at an acceptable degree of reliability, additional testing and scale adaptions may yield greater reliability. the single survey items addressing burnout and supervision satisfaction may not account for the full scope of other variables that impact attitudes and stigma levels. additionally, the effect size for employment disciplines (0.142) was small, which poses a challenge in estimating the true relationship between variables. however, the power for provider discipline (.987) was well within the appropriate range. additionally, as the research continues to grow surrounding attitudes, causal beliefs, and stigma towards pregnant women with sud, the instrument developed for this study would benefit from further analysis. the study focused on the global stigma and attitudes towards sud and did not extrapolate individualized substance use. further research will benefit from not only looking at the general stigma around maternal sud, but specific substances (e.g., marijuana, alcohol, methamphetamine, opioids, and barbiturates). additionally, response bias among participants may have impacted the study results. the study did not identify if an individual was already aware of their own stigma and attitudes yet chose to continue with said behaviors, as the study examined the general causation beliefs, attitudes, and provider stigma related to maternal sud. further research is necessary to increase understanding and consequences of provider stigma, beliefs around causation, and attitudes towards maternal sud. implications for social work. the social work professional can play a pivotal role in creating supportive change to decrease provider sud stigma and improve care for mothers with sud. the national association of social workers (nasw, 2017) code of ethics values the “dignity and worth of the person” (para. 4). to support this guiding principle, social work practice and policy development can promote and support systemic change within the healthcare field. to assist in improving the attitudes and stigma levels of providers within a hospital environment, policy recommendations and an action protocol were derived from this research. the objective of such an education protocol is to promote a hospital culture of support and education for employees across disciplines working with nas and mothers with sud. increased education could focus on the causes of sud, the advances in social work, spring 2022, 22(1) 80 supports available to mothers, and understanding the ramifications of one’s own attitudes and stigma towards a mother with sud. the importance of human relationships is a core value of the social work profession (nasw, 2017). to support the growth of human relationship between the mother, baby and staff, more inclusive service protocols may provide positive benefit. the objective for a service protocol is to promote an inclusive, supportive, and safe environment for mothers and caregivers with babies experiencing nas. overall, further research is necessary to better understand how families who experience sud view the healthcare system and their experiences within the maternal/fetal care setting. by recognizing this unique experience, practitioners can identify specific needs and concerns. creating policy change, increasing education, and continuing research regarding maternal sud will offer social workers an opportunity to develop responsive support programs for healthcare workers and promote overall change within the healthcare setting. conclusion maternal sud is a public health concern in the u.s. (stone, 2015) with more than 5% of births involving prenatal substances (nida, 2017). the emerging trend toward increased punitive measures toward mothers is especially devastating as research evolves to reflect better outcomes when the mothers are more involved in the healthcare process. enhancing the mother’s experience, rather than utilizing perceived private and privileged patient/ provider conversations to exact punitive measures against the mother, should be the focus to allow for better mother and child outcomes. one aspect of improving the mother’s experience is to minimize the negative perceptions of those involved in her care. although emerging research is available on stigma, it remains in the early stages of understanding and development (link & hatzenbuehler, 2016). this study provides an initial glimpse of healthcare practitioners’ attitudes and levels of stigma within the maternal/fetal healthcare setting. further study of stigma, particularly in the maternal/fetal domain, will enhance the understanding of health outcomes exacerbated by stigma and increase successful interventions (hatzenbuehler, 2016). social workers are on the frontlines to support and advocate for humanistic treatment for all individuals, regardless of substance use. social workers can create an inclusive environment by advocating for policy changes within hospital systems, including but not limited to policies which allow and encourage the mother to “room-in” and provide nonmedical care to their infants. this change in policy may lead to a culture shift as staff members are able to build relationships with the mother given her increased presence within the hospital. going beyond formal policy change, social workers must also champion mothers by speaking up when a staff member perpetuates stigma and negative attitudes towards a mother with sud. this may be implicitly or explicitly at the bedside, in team meetings, documentation, or general conversation. social workers can and should play a vital role in providing ongoing and evidenced-based educational support to trainor/maternal substance use disorder 81 colleagues, including those outside of social work. mothers, babies, and communities deserve efforts towards decreasing stigma and making healthcare a positive experience. references bhuvaneswar, c., chang, g., epstein, l., & stern, t. 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(2014). identification and management of prescription drug abuse in pregnancy. journal of perinatal and neonatal nursing, 28(30), 196-203. https://doi.org/10.1097/jpn.0000000000000039 author note: address correspondence to kristin trainor, department of social work, ball state university, muncie, in, 47306. email: ketrainor@bsu.edu https://doi.org/10.1093/sw/49.3.383 https://doi.org/10.1503/cmaj.109-5550 https://doi.org/10.1155/2014/906723 https://doi.org/10.1123/tsp.20.4.495 https://doi.org/10.1111/hsc.13335 https://doi.org/10.1177/10783903211033033 https://doi.org/10.1097/jpn.0000000000000039 mailto:ketrainor@bsu.edu trainor/maternal substance use disorder 89 appendix a. background information please check the most accurate response. 1. i currently practice in a maternal, fetal, or pediatric setting? yes no 2. i hold the following degree/licensure: please check the highest level of degree attained. high school: diploma ged college: associates b.a./b.s. b.s.w. (social work) masters: msw mba mph mha nursing: l.p.n r.n. b.s.n. n.p. physicians: m.d. d.o advanced training: ob/gyn neonatology other other: physical therapist (p.t.) occupational therapist (otr/l) pharmacist (pharm d) registered dietician (rd) speech/language pathologist (slp) other (please specify: ) 3. my current area of practice is: please check the most appropriate response. nicu picu high risk obstetrics pediatrics ccn family care outpatient clinic other (specify ) 4. my current employment role is: please check the most appropriate response. medical doctor-direct care medical doctor-administration only direct care nurse nurse practitioner case manager lactation consultant nursing management nursing educator social worker pharmacy child life chaplain dietary radiology/imaging language/interpretive services speech therapist respiratory therapist occupational therapist physical therapist music therapist unit representative environmental services administration other (specify: ) 5. in my current position, i spend the following percentage of my work week in direct contact (face to face or on the phone) with maternal/fetal or pediatric clients with pregnancy drug use or exposure: 0 – 25% 26 – 50% 51 – 75% 76 – 100% 6. my current position is: full-time part-time other (please specify ) 7. my race is: american indian/alaska native black/african american asian native hawaiian/other pacific islander white multi-racial other (please specify ) 8. my ethnicity is: hispanic or latino not hispanic or latino 9. i identify as: female male other please provide the most appropriate response. 10. my age is: 11. i have practiced in the health care field for: 0-4 years 5-9 years 10-14 years 15-19 years 20-24 years 25+years advances in social work, spring 2022, 22(1) 90 b. please mark the circle that most accurately represents your response s tr o n g ly a g r e e a g r e e u n d e c id e d d is a g r e e s tr o n g ly d is a g r e e drug use in pregnancy 1. in general, i find it hard to like pregnant cigarette smokers. ○ ○ ○ ○ ○ 2. i am uncomfortable working with pregnant cigarette smokers. ○ ○ ○ ○ ○ 3. in general, i find it hard to like pregnant heroin users. ○ ○ ○ ○ ○ 4. i am uncomfortable working with pregnant heroin users. ○ ○ ○ ○ ○ 5. in general, i find it hard to like pregnant cocaine users. ○ ○ ○ ○ ○ 6. i am uncomfortable working with pregnant cocaine users. ○ ○ ○ ○ ○ 7. in general, i find it hard to like pregnant marijuana users. ○ ○ ○ ○ ○ 8. i am uncomfortable working with pregnant marijuana users. ○ ○ ○ ○ ○ 9. in general, i find it hard to like pregnant methamphetamine users. ○ ○ ○ ○ ○ 10. i am uncomfortable working with pregnant methamphetamine users. ○ ○ ○ ○ ○ 11. in general, i find it hard to like pregnant opioid users. ○ ○ ○ ○ ○ 13. i am uncomfortable working with pregnant opioid users. ○ ○ ○ ○ ○ 14. in general, i find it hard to like pregnant subxone/subutex/methadone/ buphernorphine users. ○ ○ ○ ○ ○ 15. i am uncomfortable working with pregnant subxone/subutex/methadone/buphernorphine users. ○ ○ ○ ○ ○ employment support 16. my schooling has prepared me to discuss health risk behaviors with patients. ○ ○ ○ ○ ○ 17. i receive adequate education and training, on the job, for my current position. ○ ○ ○ ○ ○ 18. i am satisfied with the level of professional supervision i receive in my current position. ○ ○ ○ ○ ○ 19. i am satisfied with the level of communication between disciplines (social workers, nursing, doctors, etc.). ○ ○ ○ ○ ○ 20. my organization provides a supportive environment for mothers with prenatal substance abuse within the organization by having and promoting workplace policies that address issues of women and infants with substance abuse/exposure. ○ ○ ○ ○ ○ drug use outcomes 21. i am satisfied with the level of community support for pregnant addicts. ○ ○ ○ ○ ○ 22. i am comfortable with the discharge plan for a mother with addiction. ○ ○ ○ ○ ○ 23. i am comfortable with the discharge plan for a child with drug exposure. ○ ○ ○ ○ ○ 24. i believe more punitive measures should be taken against a mother with pregnancy drug misuse. ○ ○ ○ ○ ○ 25. i believe hospital staff can provide better, non-medical care for a drug exposed infant than the mother. ○ ○ ○ ○ ○ 26. i believe mothers with pregnancy drug use should place the child for adoption. ○ ○ ○ ○ ○ 27. i have become burned out working with mothers and babies with drug use/exposure. ○ ○ ○ ○ ○ 28. i believe addiction is a medical condition. ○ ○ ○ ○ ○ 29. i believe addiction is caused by a moral flaw. ○ ○ ○ ○ ○ 30. i believe addiction is selfish. ○ ○ ○ ○ ○ 31. i believe a person could quit illicit drug use if they really wanted to. ○ ○ ○ ○ ○ 32. i believe a person who uses illicit drugs during pregnancy cares more about drugs than the baby. ○ ○ ○ ○ ○ 33. i believe women who use illicit drugs during pregnancy deserve less privacy. ○ ○ ○ ○ ○ 34. i have empathy for a pregnant/post-partum woman with addiction. ○ ○ ○ ○ ○ 35. i believe a drug exposed infant should never discharge with the mother. ○ ○ ○ ○ ○ 36. i believe a mother with illicit drug use should be regularly drug tested. ○ ○ ○ ○ ○ 37. i am not comfortable leaving a child in a room with their addicted parent. ○ ○ ○ ○ ○ 38. i believe the hospital should impose greater sanctions on a mother with illicit drug use during pregnancy. ○ ○ ○ ○ ○ 39. i believe the state should impose greater sanctions on a mother with drug use during pregnancy. ○ ○ ○ ○ ○ 40. i would go out of my way to work with a mother or baby with drug use/exposure. ○ ○ ○ ○ ○ 41. i prefer not to work with babies with drug exposure. ○ ○ ○ ○ ○ 42. i prefer not to work with pregnant women with addictions. ○ ○ ○ ○ ○ 43. lastly, what other information would you like this researcher to know about prenatal substance misuse or the effects on health care providers. none: response _________ melissa hirschi, phd, lcsw, assistant professor, anna l. hunter, msw, recent graduate, susan l. neely-barnes, phd, msw, chair and professor, and cherry c. malone, lmsw, clinical assistant professor, school of social work, university of memphis, memphis, tn. julie meiman, lmsw, coc planning director at community alliance for the homeless in memphis, tn. elena delavega, phd, msw, professor, school of social work, university of memphis, memphis, tn. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 91-109, doi: 10.18060/25088 this work is licensed under a creative commons attribution 4.0 international license. covid-19 and the rapid expansion of telehealth in social and behavioral health services melissa hirschi anna l. hunter susan l. neely-barnes cherry c. malone julie meiman elena delavega abstract: the spread of covid-19 changed the landscape of how social service agencies operate. essential services providers have had to adapt and innovate in order to carry out their mission. as a result, technology has become an integral part of their service model, with an increased emphasis on telehealth services. for many agencies, the abrupt transition to remote services has brought about important conversations around access, use, policy, effectiveness, and efficiency. a qualitative, narrative study was conducted with ceos or social work directors of 37 social service agencies in the mid-south region to understand their experience and the impact of the covid-19 pandemic. interviews were conducted and data were transcribed and analyzed. thematic analysis highlighted seven themes: 1) a rapid transition to virtual services, 2) the need to improve infrastructure, 3) new technology and innovation, 4) barriers, 5) benefits, 6) funding, and 7) changes that will be kept. implications at the client level include continuing to offer telehealth services. at the agency level, implications include managing the logistics of telehealth and the need for insurance and regulator changes. implications for social work include ethical considerations for providing telehealth services and educating current and future social workers in the use of telehealth services. keywords: covid-19; telehealth; technology; behavioral health services; social services in january of 2020, a novel coronavirus, covid-19, was being reported by the media, and by march of 2020, it had developed into a global pandemic. this phenomenon of a global pandemic and its impact is unprecedented in our time (nkengasong, 2021). currently, tens of millions of people have been infected worldwide with over six million deaths, while in the united states (u.s.) alone over 80 million cases have resulted in over 900,000 deaths (johns hopkins university, 2022). during the height of the pandemic, state and local governments in the u.s. enacted measures aimed at limiting the spread of the virus. these measures included mandates for business and school closures, mask requirements, social distancing guidelines, and travel restrictions (nashp, 2022). amid this vast uncertainty, social service agencies remained open, finding innovative ways to offer services. one of the most important ways they adapted and demonstrated resilience is through the use of technology. while the use of technology had been increasing in social about:blank advances in social work, spring 2022, 22(1) 92 service agencies prior to the pandemic, the lockdown forced by covid-19 accelerated this trend and forced many hesitant social workers and social service agencies to use technology to conduct services and continue to serve clients (turner lee et al., 2020). social work and social service agencies’ shift to the use of technology can be viewed as a demonstration of resilience. although definitions of resilience may vary slightly, for the purposes of this study, ledesma’s (2014) definition as “the ability to bounce back from adversity, frustration, and misfortune” (p. 1) can be used as an overarching definition. as van breda (2018), points out, the process of adapting to adversity can lead to results that are even better than expected. literature review slowly embracing ict the utilization of information and communication technologies (icts) is routine in most healthcare professions; however, it has only recently gained traction within the social work field (baker et al., 2014; campbell, 2018; mishna et al., 2017). according to baker and colleagues (2014), social work has been slow to embrace technology. the literature suggests this stems from a reluctance to accept it as part of the client’s environment and, perhaps, a fear of losing the human-focus in a digital sphere as well as ethical concerns (baker et al., 2014; tuckson et al., 2017; wolf & goldkind, 2016). however, there is tremendous potential for positive client impact in marrying its ability to reduce barriers of accessibility with the profession’s core values (baker et al., 2014; goldkind & wolf, 2015). with social distancing and safety protocols preventing face-to-face services, technology can play a large role to fill these gaps (gelman & tosone, 2010; turner lee et al., 2020; wolf & goldkind, 2016). icts can facilitate the sharing of knowledge and resources between care providers and with the community. the enhanced ability to communicate, regardless of physical space, creates connection and collective power (turner lee et al., 2020; wolf & goldkind, 2016). while there has been acknowledgement of the potential to harness icts for larger community and advocacy work within the social work field, there is currently limited research on using technology beyond the classroom setting (gelman & tosone, 2010; wolf & goldkind, 2016). telehealth according to the american telehealth association (ata; 2021), telehealth consists of the provision of healthcare (including behavioral health) through virtual or electronic means when provider and patient are in different locations. through telehealth, patients and providers exchange information, and healthcare workers provide advice, treatment, and guidance to prevent or cure diseases or solve other problems (tuckson et al., 2017; turner lee et al., 2020). telehealth and remote services have become increasingly popular due to their flexibility and efficiency for both the client and clinician (ata, 2021; tuckson et al., 2017). a significant surge in usage of telehealth in response to covid-19 has been reported in the literature (clipper, 2020; kaplan, 2020). telehealth promotes social, hirschi et al./covid-19 & telehealth 93 emotional, and physical well-being for children and adults by decreasing isolation and reducing barriers in access to health services (clipper, 2020; goldschmidt, 2020). in addition, it serves as a collaborative tool for clinicians with limited resources and opportunities for continuing education or collegiality due to their physical location (brownlee et al., 2010). telehealth has not always been a viable option for clients, with varied restrictions on its availability based on state licensing laws and insurance coverage (goldschmidt, 2020). as a result of the pandemic, however, the centers for medicare & medicaid services (cms, 2020) were permitted to temporarily reimburse healthcare providers for telehealth services provided from different remote locations, eliminating the need for clinicians or clients to travel into an office setting and removing stipulations surrounding rurality (u.s. department of health and human services [us hhs], n.d.). healthcare providers are lobbying for continued and permanent expansion of telehealth services to help remove accessibility obstacles beyond the pandemic (goldschmidt, 2020), but as of april 25, 2022, this had not happened (us hhs, n.d.). though the use of telehealth and telemedicine were increasing prior to covid-19 (tuckson et al., 2017) they were not widely mainstreamed (smith et al., 2020; turner lee et al., 2020). as telework becomes more common for social service agencies, there may be a permanent increase in the use of technology to deliver services (dey et al., 2020). while temporary orders resulting from the covid-19 health emergency (lee, tenn. exec. order no.36, 2020) have allowed for the provision of telehealth services in ways that had not been authorized previously, for telehealth to become more widespread, it will be necessary to develop networks, policies, procedures, and infrastructure to support it, which includes extensive telehealth training for clinicians and social workers as well as access to the equipment needed (barney et al., 2020; coe & enomoto, 2020). regardless of whether medicine or behavioral health providers utilize telehealth modalities, the same ethical considerations apply regarding patient data, informed consent, respect, and standard of care (tuckson et al., 2017). however, providers have the additional ethical obligation of informing patients of the uses and limits of the technology (tuckson et al., 2017). social work, as a profession, has the same ethical standards (nasw, 2017), although the way those standards are administered may be different when using telehealth (reamer, 2013). adopting telehealth in response to covid-19 shifting to a more technology-based service model spurs questions about the necessary policies, protocols, and ethics brought on by a new medium. agencies that had to make a quick shift in response to covid-19 did not have had time to fully develop comprehensive implementation plans. larger questions surrounding the legal and ethical implications of telehealth in terms of protocol and privacy existed before the pandemic (clipper, 2020; kaplan, 2020; mccarty & clancy, 2002). despite known benefits, technology presents access concerns. economic and geographical disparities in internet stability and broadband access as well as ownership of computerized devices may exclude some populations from the benefits of telehealth (funk, 2021). additionally, there are concerns about the ability advances in social work, spring 2022, 22(1) 94 to form a therapeutic relationship for providers and clients who have never been able to meet face-to-face (mccarty & clancy, 2002). clients may find shifting to digital services to be daunting or too impersonal based on their comfort level and cultural attitudes toward technology (cimperman et al., 2016; clipper, 2020). although now newly and widely accepted by social service agencies, the long-term implications for practice are undetermined. the covid-19 pandemic forced questions for the field of social work about the use of technology in social and behavioral health services to the forefront. as a result of stayat-home orders, which resulted in social distancing, agency leadership were forced to consider non-traditional service delivery formats that enhanced safety. technology played a pivotal role in responding to the crisis while maintaining social distance. this qualitative study examined the impact of covid-19 on social service agencies and how it has highlighted resilience through innovation and the expanded use of technology to continue providing services to their clients. method in april 2020, a local board of community social work leaders of non-profit agencies suggested to one member of the research team that a study be created related to the impacts of the covid-19 pandemic. this request led to a narrative study (creswell, 2013; patton, 2002) that was designed to better understand the impact of the covid-19 pandemic on behavioral health and social services agencies in a specific region in the southeastern united states. resilience theory was used to frame this study. resilience theory broadly looks at risk and protective factors (bolton et al., 2017) as part of a mediating process in the face of adversity leading to better than expected outcomes (van breda, 2018). to better understand the impact of the covid-19 pandemic and the resilience of agencies, a semistructured interview guide was developed. social work community leaders were involved in designing the interview guide, and some of the board members that originally called for the study also served as research participants. a research team was formed, comprised of four faculty members and two master’s level graduate students. the interview guide included 21 openand closed-ended questions (e.g., “how have your services changed since the beginning of the covid-19 crisis? in what ways has the crisis led you to be innovative in your work?” see table 1). the questions were developed with input from social service and social work agency directors. institutional review board approval was obtained prior to beginning the interview process. hirschi et al./covid-19 & telehealth 95 table 1. semi-structured interview guide 1) how have your services changed since the beginning of the covid-19 crisis? 2) what changes have you seen in your clients since the beginning of the crisis? are you seeing more people or fewer people requesting your services? 3) are you seeing a change in the types of services that your clients are requesting? what changes are you seeing in the needs of your clients? 4) have you found a need to change your service model? what challenges has your agency had around that change? 5) what have been the biggest barriers to continuing to provide services to your clients? 6) if you have moved to using more technology in your work, have your clients had any difficulty with access to technology? 7) are there any services being requested by your clients that you cannot provide? do you think that your clients have unmet needs? if so, what are they? were these needs unmet before the covid-19 pandemic? if they have changed, how so? 8) have you seen any beneficial changes to your service model since the beginning of the covid-19 crisis? 9) how has the covid-19 crisis impacted your personnel policies around work from home or sick leave? has covid-19 caused any unforeseen personnel problems? 10) has the covid-19 crisis caused any child care challenges for your employees? 11) in what ways has the crisis led you to be innovative in your work? 12) has this crisis changed the type of data you collect at your agency or the way that you collect data on clients? 13) how do you plan to go about re-opening your agency (if you have closed)? 14) what changes or innovations are you likely keep on an ongoing basis once this crisis is over? 15) is there anything else we have not asked that you would like to add? as a research team, discussions were held to determine which agencies and organizations would be targeted to provide information about the impact of the covid-19 pandemic on the work that they do at the agency, client, and community levels and to look for evidence of the resilience process. a list of 70 organizations was selected for purposive sampling (miles et al., 2014; patton, 2002) to provide representation of agency type, size, geographic location, services provided, and specific populations served. some snowball sampling was used to gain greater participation in rural areas with agencies in those areas being asked to identify other neighboring agencies. in early june, email requests were sent to the ceo, director, chief of social work, or a person in a related position at the agency and electronic informed consent was signed prior to scheduling an interview. agency demographic information is published in a prior study (neely-barnes, et al., 2021). a total of 37 agencies of diverse sizes, service foci, and goals agreed to participate in this study. although there are differing thoughts on the ideal number of participants for narrative studies, creswell (2013) suggests more if developing a collective narrative. the authors used data from all 37 agencies in order to include adequate representation across agency size, type, and location. the agency numbers, a description of their services, and the role of respondents are presented in table 2. advances in social work, spring 2022, 22(1) 96 table 2. list of agencies and description of services provided agency # focus of services role 1 faith-based poverty reduction 2 adult substance abuse & co-occurring treatment president & ceo 3 site-based mental & behavioral healthcare 4 community mental health service director 5 faith-based aid to those in poverty 6 sexual & reproductive healthcare founder 7 clinical services to uninsured 8 integrated health care system & community mental health director 9 holistic services to crime victims 10 wraparound services for persons living with hiv exec director 11 services & advocacy for persons experiencing homelessness 12 integrated healthcare director 13 supports families affected by incarceration 14 legal assistance for persons with low income director 15 support for formerly incarcerated 16 support services for persons with intellectual disabilities ceo 17 legal assistance for persons with low income 18 all ages health & social services manager 19 behavioral health assessment or referral 20 housing support for persons living with hiv director 21 school focused on academic, social, & emotional wellness 22 outpatient mental health & substance abuse exec director 23 behavioral health & substance abuse 24 reducing food insecurity ceo 25 residential trauma & substance abuse support for women & children in poverty 26 poverty reduction through community action founder 27 support services for persons with intellectual and developmental disabilities 28 treating & researching catastrophic illness in children exec director 29 government agency providing legal assistance 30 outpatient mental health dir. & founder 31 wraparound services for survivors of trafficking & prostitution 32 partial hospitalization & intensive outpatient ceo 33 nonprofit agencies funding, coordination, & connection 34 adult inpatient psychiatric services ceo 35 domestic & sexual violence care advocacy 36 services to child victims of sexual or severe physical abuse ceo 37 coalition for agencies reducing homelessness for more detailed information about the agencies see neely-barnes, et al. (2021) interview data were analyzed following creswell’s (2013) five steps to qualitative analysis. in step one, organizing the data, themes were discussed in meetings and an initial coding structure was developed. all interview transcripts were uploaded into nvivo qualitative data software and the coding structure was added to the software. step two, reading and memoing, took place as all six research team members were divided into pairs. each pair was assigned two agencies for the first round of coding. after initial coding was hirschi et al./covid-19 & telehealth 97 completed, the research team again met to discuss themes and the coding structure. step three, describing and classifying into themes, included adjusting the coding structure to better reflect the data and ensure all members of the research team were using the codes in the same manner. all remaining interviews were coded by researcher pairs. the pairings were rotated to strengthen consistency in coding and use of the coding structure. step four, interpreting the data, continued when coding was completed. content analysis of the individual codes was done to better understand the data. in step five, representing the data, identifying quotes were selected to highlight specific themes. findings results of the qualitative analysis indicate that technology played a significant role in the resilient response to the covid-19 pandemic shutdown. every agency that participated in this study turned to technological solutions to minimize face-to-face interaction and create solutions for responding to the crisis. some agencies used relatively simple solutions like making better use of the phone and putting forms on the website. other agencies used new and innovative technology described below. one potential risk factor (bolton et al., 2017) that all agencies shared is the provision of essential services. since all agencies in the study provided essential services, they had the choice to stay open during local safe-at-home orders. yet, many agencies chose to transition to virtual services to protect their staff and clients. the degree to which an agency decided to transition to virtual had to do with the types of services that were provided and whether virtual service provision was possible. most agencies used strategies that included moving individual therapy to telehealth though video conferencing or telephone and reducing the number of face-to-face appointments for new client intake. some agencies provided services that cannot be virtual. agency 7 and agency 23 administer injections which could not be done virtually. agency 29 provides services in the jail setting, and the jail did not allow virtual appointments. many agencies in the study (e.g., agencies 16 & 34) have a residential component of their service model that could not be transitioned. yet, even agencies with a residential component saw an increased use of technology such as video conferencing and video calls. the decision to go virtual had many implications – both positive and negative. seven themes and associated subthemes emerged from analysis of the data which highlight components of the resilience process leading to outcomes that were better than expected (van breda, 2018). these themes and subthemes are: 1) the rapid transition to virtual services; 2) the need to improve infrastructure, including both training staff and the need for new hardware or software; 3) new technology and innovation; 4) barriers including barriers for staff and clients and the specific challenges around certain practice modalities; 5) benefits for both clients and staff; 6) funding and funders; and 7) changes that the agency will keep. see table 3. advances in social work, spring 2022, 22(1) 98 table 3. themes and subthemes • rapid transition to virtual services • improving infrastructure o training staff o buying new software or hardware • new technology & innovation • barriers o barriers for agency staff o barriers for clients and the digital divide o challenges specific to practice modalities • benefits o benefits to clients o benefits to staff • funding and funders • changes that will be kept rapid transition to virtual services in the region in which this study took place, safe-at-home orders were issued with little advance notice in mid-march 2020. agencies had to make a quick decision about how they were going to respond. many agencies decided to move their staff to telecommuting and move all services to virtual (e.g., agencies 17, 31, and 37). some agencies decided to move services to virtual but chose to keep staff in the office while maintaining social distance. one of the themes that agencies discussed was how rapid the change to virtual services occurred. for example, agency 32 is primarily a provider of intensive outpatient (iop). they made their decision to move the iop to virtual very quickly. they explain: agency 32: less than five days. we transitioned very quickly. we were talking about it…within the fifth day we were transitioned. some agencies already had a telehealth component to their services. yet even these agencies who were already engaged in telehealth experienced a transition as their services rapidly shifted from majority in person to majority telehealth. agency 12 explains how they experienced this shift early in the pandemic in march/april and that they had already started to see some shift back to in-person by the time of the interview in june. agency 12: we probably changed from being 85 to 90 percent in-person medicine to 85 to 90 percent telemedicine…i would say at this point, it's probably about 75 percent telemedicine and 25 percent in person. improving infrastructure the rapid shift from traditional in-person services to virtual/telehealth services meant that agencies had to consider infrastructure for the delivery of services virtually, both the protective and risk factors (bolton et al., 2017). understanding what the challenges of risk factors were could lead to finding ways to make adjustments. this might mean investing hirschi et al./covid-19 & telehealth 99 in new technology (hardware or software) or training staff to be prepared to deliver services virtually. another consideration was agency filing and records systems needed to be electronic. if staff were going to telecommute, they needed to be able to access agency files from home. many agencies already had electronic records, but for those that did not, the pandemic provided a reason to move forward with an update to their record-keeping process and to examine how they might improve their electronic systems. agency 15 explains: agency 15: we're going paperless…they're scanning everything and making sure everything's in the database. and that's something we weren't doing at all. training staff another important consideration for agency heads was whether their staff were prepared to deliver services virtually. for some staff, the pandemic represented their firsttime using video conferencing, their first time using a new electronic record system, or their first time working in the telehealth environment. understanding these challenges allowed agencies to bolster their staff and support them through additional training. one agency, agency 30, responded to the sudden shift by looking for opportunities for training: agency 30: we had one person that already was certified in telehealth when this started…so, we set up some trainings from our person who was certified in telehealth to share that with the other clinicians. buying new software or hardware the transition to all virtual services led to a realization for some agency heads that their systems or equipment were not adequate. agency heads discussed the need to buy both hardware (e.g., laptops for all staff so they could work from home) and software (e.g., new systems for telehealth delivery that are hipaa compliant). the head of agency 17 discussed the decision to invest in a new phone system that staff could use from home. agency 17: one of the things that we did is we are getting a new phone system. we needed it anyway. but under our old system, they were all hard wired. and so, if you were going to call someone from your home, you'd have to use your home phone or your cell phone and block the number. and because so many of our clients are in debt, and they’re being called by bill collectors, they won't answer the phone if it's an unidentified number. agencies also had to consider whether clients had adequate technology to interact with them in a virtual environment. since most reported that their clients had smartphones, the preference was for systems that would interface well with smartphones. agencies were aware that many clients experienced a digital divide. without access to technology, it is difficult to apply for jobs, apply for government benefits, or support your children’s education (schools in the region went virtual for the last nine weeks of the school year). the director of agency 1 talked about his focus of buying new devices to support clients. advances in social work, spring 2022, 22(1) 100 agency 1: we are launching, currently launching a telehealth telecom system where all 1,000 of the families that we serve will have a computer device placed into their home with connectivity. new technology and innovation the pandemic provided an opportunity to think about new technology and ways to innovate service delivery. several agency heads talked about the ways in which the pandemic created an opportunity to step back, look at how they always did things, and consider whether they could do things better. the pandemic also provided an opportunity to build partnerships and work across systems to lean into the crisis and support clients, families, and communities. innovation took many different forms. some of the innovations were directly related to making use of new forms of technology. agency 35, which serves survivors of domestic and sexual violence, discussed using texts and even private messaging through social media sites to help their clients reach out when in a dangerous situation. two agencies discussed app development to improve their service provision. agency 13 explains: agency 13: i did develop a 12 to 18-month clinical program utilizing an app to deliver services. so, at first the courses that were a part of this process were going to be face-to-face in one of the homes that we owned. now, there is an opportunity to still reach our potential clients in their own homes, in their space. barriers the pandemic and the sudden shift to virtual services presented a fair number of barriers and challenges for agencies. agencies discussed these barriers primarily under three categories: barriers for agency staff, barriers for clients, and barriers specific to certain practice modalities. barriers for agency staff agency heads frequently described the ways in which their staff encountered barriers to continuing their work during the pandemic. for agencies that chose to telecommute, agency heads reported that their staff missed the office culture or missed the physical separation between home and work. one agency head had to amend policy to allow staff to telecommute. they previously had a policy that did not allow it. another agency head reported that working from home disrupted her sleep schedule because she did not have the mental separation between home and the office that the physical separation normally created. some agencies did not have the funding to buy everyone a laptop and staff were forced to use their own devices. working from home also means using personal wi-fi, and some staff struggled with the additional data costs they were incurring. agency 26 explained some of the challenges. agency 26: i did have the staff who were struggling with, you know, they had bad connections. so sometimes they had a hard time staying connected to what we used as vpn access to continue the work. hirschi et al./covid-19 & telehealth 101 barriers for clients and the digital divide clients also struggled with having adequate technology to access virtual services. many agencies reported that their clients do not have access to laptops and a few reported that most of their clients have flip phones rather than smartphones. access to the internet was an issue for some clients, particularly in rural areas. several agency heads identified this problem as being part of the “digital divide” that gives people with access to technology opportunities and denies those who do not. agencies 16 and 27 explained the challenges for some of their clients: agency 16: but then [list of counties] are a little more rural, so you actually do have some spots where you don't have access to the best internet or system. agency 27: but a lot of the people that we support and their families, they don’t have the technology. they don’t have computers in the home. they don’t have internet in the home. we’ve actually been looking for grants to help provide that. challenges specific to practice modalities the sudden shift to technology presented more barriers to agencies using certain types of practice modalities versus others. agencies that use a lot of group treatment approaches talked about specific struggles with moving groups online. for example, agency 4 reported challenges with maintaining confidentiality; they had an incident with a client walking around a store with her group session on speaker. similarly, agency 12 reported that they had had some clients fall asleep during a telehealth group session. agency 13 typically used food as a draw for their in-person group sessions and to meet a need for their client population who is food insecure. it was not possible to provide food in the virtual setting. agencies that provide services in an inpatient or residential setting faced their own set of challenges around family visitation and community participation. agency 16 was forced to cancel all community participation for a few months, and agency 34 moved to virtual family visitation. again, innovation and creativity were important for managing these barriers. agencies 3 and 36 primarily serve children and reported that it was difficult to maintain the attention of children in a telehealth setting. both agency heads mentioned that in a faceto-face setting, they would use activities to keep children focused during therapy. that was more difficult in the online setting. benefits although there were challenges and barriers related to the sudden shift to the virtual environment, many agencies also saw benefits for both the clients and their employees. one of the most interesting benefits related to transportation. moving to virtual services eliminated the need for transportation and this was to the benefit of both clients and employees. advances in social work, spring 2022, 22(1) 102 benefits to clients many agencies reported that transportation was normally one of the biggest barriers faced by their clients. a few of the agencies (e.g., agencies 7 and 17) are in areas that require paid parking which creates a cost barrier. this study was conducted in a region of the united states that does not have good access to public transportation. in the rural areas, public transportation is nonexistent. clients in rural areas may have to travel great distances to get to the office for services and this costs gas money. agency 3 explains: agency 3: a lot of my rural families keep saying, can we keep this like after this whole thing is over? are you gonna allow me to still do this? so, they see i mean, it greatly has improved their contact, like they're going to come more consistently. they show up when they're supposed to because you've taken away that barrier to transportation. virtual services kept agencies connected to clients during the pandemic. although many agencies reported that clients missed face-to-face services, virtual services offered a much better alternative than no services. the director of agency 10 told the story of a particular client for whom virtual services provided a lifeline during a critical time. agency 10: we were able to convince the client to get a phone. and that has helped tremendously to decrease isolation because the client can still get all the counselling sessions by phone. benefits to staff some agencies worked hard to maintain the office culture during the pandemic. agency 1’s staff had a virtual dance party every week and virtual movie nights to maintain the connection between staff. several of the agencies reported that their staff were preferring the new telecommuting model and saw benefits. one benefit reported was increased efficiency in the virtual setting. agency 18 explains: agency 18: it's interesting to talk to folks and they’re so much more productive, like, yeah, you know, i just roll out of bed, make a cup of coffee. i'm starting work an hour earlier. and, you know, sometimes i found myself staying on and i'm getting more done and i'm not spending the money on lunch and then you know, i'm saving that hour, hour and a half, two hours, whatever it is to commute. funding and funders funding mechanisms and funders played a significant role in decisions about whether to shift services to the virtual environment. some agencies had donors who recognized the need to shift to virtual services and stepped up their support in that area. some local corporations and local foundations allocated money towards technology grants to help the non-profit sector respond to the crisis. for agencies that offered billable health, mental health, and substance abuse services, the most critical issue was whether health insurance would pay for virtual services. several of the agencies we interviewed were primarily hirschi et al./covid-19 & telehealth 103 medicare or medicaid providers. agency 4 explained how the decisions at the centers for medicare & medicaid services (cms) were critical to their decision about whether to start and continue telehealth services. agency 4: you know, fingers crossed that cms is going to [continue to] pay for telehealth to a client’s home. and one thing that's already happened…is that medicare will pay for those psychiatric check-in phone calls for medicare only clients. i mean, thank goodness that we've got some really smart people at cms that understand that we don't need elderly people leaving their home if they don't have to, or people whose immune system is compromised. changes that will be kept nearly every agency that participated in this study said that at least some part of their shift to virtual services will remain after the covid-19 crisis is over. the outcomes from these agencies were better than they may have originally expected and therefore were going to be maintained. the rapid shift for agencies to use telehealth services in response to the covid-19 pandemic brought about change that may otherwise not have come, or perhaps not on this timeline. these changes have been shown to be effective and worth keeping, even beyond the immediate need of the pandemic. certainly, agencies who upgraded technology systems, moved intake applications to virtual, or moved records to virtual planned to keep that after the pandemic. some agencies planned to allow more telecommuting after the pandemic. agency 22 summed up the shift: agency 22: while we don't want 100 percent of our services all the time to be remote, we think that we can do those as needed. maybe, there will be a hybrid of that. moving forward with some of the things that will be permissible to do remotely. discussion the covid-19 pandemic is a global phenomenon that could be viewed as a risk factor that threatened to negatively impact the resilience (bolton et al., 2017) of agencies and their ability to provide services to clients. agencies demonstrated resilience (ledesma, 2014) by adapting and continuing with services during the pandemic. in order to continue to provide services, agencies found that they needed to transition quickly to the use of virtual services. prior to the covid-19 pandemic, the use of telehealth was infrequently or slow to be utilized in the field (e.g., baker et al., 2014; campbell, 2018). this was also seen to be the case for agencies in the study, most of whom were not regularly using telehealth to provide services. this rapid transition also highlighted potential risk factors (van breda, 2018) to the implementation and service delivery which necessitated the need to improve infrastructure for agencies. because using technology was not the standard of practice prior to covid, the shift required ensuring staff were trained and able to provide services with this modality (barney et al., 2020; coe & enomoto, 2020). training staff on the use of new technology allowed agencies to collaborate and continue to work across physical distance, similar to previous research (brownlee et al., 2010). it also required advances in social work, spring 2022, 22(1) 104 agencies to invest in hardware and software that was capable of supporting telehealth services in a manner that continued to meet ethical standards (e.g., kaplan, 2020; tuckson et al., 2017). not only did the transition to virtual services shift how agencies provided standard services, it also allowed agencies to re-evaluate standard practices such as meetings and record-keeping. looking more broadly across their agency, many were able to enhance their practices with clients. additional risk factors (bolton et al., 2017) such as barriers for staff and those for clients arose with the transition. these barriers were similar to those seen previously in the literature. for example, some clients of the agencies in the study did not have equipment or technology services that were sufficient for telehealth services, similar to previous research (e.g., mccarty & clancy, 2002). agencies also reported clients did not feel comfortable using technology, which has been seen previously (e.g., clipper, 2020). despite the barriers, agencies were determined to persist and find ways to deliver services. many agencies found benefits to the clients and agency staff, surprising benefits from funders who were more willing to donate financial resources, and agencies overall found new procedures that have improved their organization that will be continued (van breda, 2018). similar to previous research, the use of technology among agencies in this study was previously not widely used; however, it rapidly increased and will persist (e.g., turner lee et al., 2020). the covid-19 pandemic has created a shift towards virtual service provision in social and behavioral health services (dey et al., 2020). this change will likely remain after the pandemic is long over (van breda, 2018). agencies that were forced to adapt in the shortterm have seen long-term advantages to the shift. virtual service provision in social work may not be the only type of service provision in the future, but it is here to stay (wolf & goldkind, 2016). implications for social work implications for social work with the shift to telehealth can be seen at the client, agency, and professional levels. for clients of some agencies, the shift to telehealth has had a great impact on access to services, including making services more accessible for many by reducing barriers such as transportation (e.g., baker et al., 2014; clipper, 2020; wolf & goldkind, 2016). for other agencies in the study, the lack of reliable internet or equipment to participate in telehealth services has made accessing needed services more challenging and increased those barriers. social workers and the social service agencies that employ them should continue to offer telehealth services, especially in rural and hard-to-reach communities, while also continuing to advocate for resources and provisions for clients with limited technology accessibility (funk, 2021). for agencies, the shift to telehealth has highlighted the need for training of staff and acquiring equipment to provide these services. navigating these changes requires coordinating logistical aspects to ensure services can be provided effectively (e.g., smith et al., 2020). in addition, agencies have historically faced barriers to providing telehealth hirschi et al./covid-19 & telehealth 105 services including insurance regulations, laws, and reimbursement rates (goldschmidt, 2020). advocating at both the state and federal levels for changes to policies, specifically those related to reimbursement for services, will be essential for social workers to be able to maintain the provision of telehealth services beyond the covid-19 pandemic. including other mental health providers, legislators, agency representatives, and clients in advocacy work with social workers will strengthen the impact of their collective voices. opportunities to partner and advocate for telehealth provisions are increasing. as social workers, our guiding principles of social justice and competency (nasw, 2017) can guide our advocacy efforts. joining with others who are seeking to fight for expansion of telehealth reimbursement will strengthen these efforts. many efforts have been made to bring about a 2021 health act specifically focused on technology, expanding lists of services covered by medicare, expanding telehealth services that are reimbursed, and the introduction of laws to allow counselors to be reimbursed by medicare to expand and make permanent more lenient telehealth practices, including addressing geographic restrictions (maheu, 2021a) progress is being made and in the fall of 2021, changes were made to federal policies for medicare and medicaid programs that included reimbursement codes for telehealth services (maheu, 2021b) --evidence of progress toward the continuation of telehealth services. as a profession, social work has an ethical foundation (nasw, 2017) and focus on evidence-based practices (ebp; see gambrill, 2018). the slow incorporation of telehealth services among social workers (e.g., baker et al., 2014; campbell, 2018) highlights gaps that need to be filled moving forward. a growing body of literature indicates that there is a strong evidence base for telehealth and the need for additional research focused on the effectiveness of providing services via telehealth (gros et al., 2013) compared to face-toface services. furthering our understanding of ebp using telehealth, including areas related to confidentiality, engagement, and effectiveness, will allow social workers and the profession to continue to disseminate evidence that will allow for continued practice that is ethical and aligned with best practices. for example, the client may need training on using the technology, communication styles may need to be adapted for the telehealth environment, and some assessment tools developed for the traditional practice setting may not be appropriate for telehealth (gros et al., 2013). social work education, including continuing education, needs to adapt to preparing all practitioners to be ready to practice in the virtual environment. for example, incorporating telehealth-related curriculum, experiences, and ethical considerations into social work courses will better prepare current students and continuing practitioners to incorporate these modalities in their work. research on social work practice needs a greater focus on identifying ebps in the virtual environment. grant funders in social work need to adapt to this new environment by supporting research in best practices and training for the next generation of social workers who are prepared to work in both face-to-face and virtual settings. this study has several limitations that should be noted. first, the study occurred only in one region of the country. the results may not be generalizable to other regions. second, data was collected during only the two-month span of june and july, 2020. the impacts of advances in social work, spring 2022, 22(1) 106 the pandemic shifted rather rapidly and continue to shift today. the results of the study may not be generalizable to what was happening a few months before or a few months after. third, because the sample was varied to include a range of agency types, sizes, and locations, the results of the study should be considered with this in mind. despite the above limitations, this study has some important contributions. the researchers intentionally selected providers that represented a wide array of service settings including mental health, substance abuse, family violence, child welfare, developmental disability, school-based services, gerontology, legal aid, criminal justice, homelessness, and health care. the agencies that participated were also a mix of large and small settings as well as inner city, suburban, and rural settings. the wide array of agencies that participated in this study improves the generalizability and credibility of the findings (patton, 2002). the use of telehealth in social work and social service agencies is a relatively new phenomenon (gros et al., 2013). the closures resulting from the covid19 pandemic accelerated this trend in social work. important future research areas involve the quality of outcomes in telehealth and teletherapy vis-à-vis face-to-face services. in conclusion, covid-19 caught everyone off-guard leaving many agencies and social workers facing an urgent need to rapidly adjust their service delivery in order to continue to provide services to clients. the quick shift to telehealth and technology highlights the resilience and adaptability of social work as a profession as well as areas for further work to be done. at the client level, access issues have been highlighted, including increased access for some and greater barriers for others. agencies must work to build telehealth practice through additional training and equipment as well as developing telehealth-related policies. the social work profession as a whole can build on the rapid gains of telehealth by infusing ethical considerations and ebp in the social work curriculum in order to train the social workers of the future for the world they will likely inhabit. overall, social work should remember the advantages of collective power (wolf & goldkind, 2016) and use this collective power to continue conversations and action around access, use, policy, effectiveness, and efficiency of virtual services. references american telehealth association [ata]. 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(2016). digital native meet friendly visitor: a flexner-inspired call to digital action. journal of social work education, 52(sup1), s99–s109. https://doi.org/10.1080/10437797.2016.1174643 author note: address correspondence to melissa hirschi, school of social work, the university of memphis, memphis, tn 38152. email: mhirschi@memphis.edu https://www.nashp.org/governors-prioritize-health-for-all/ https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://doi.org/10.1080/23303131.2021.1915905 https://doi.org/10.1038/s41591-021-01269-x https://doi.org/10.1093/sw/swt003 https://doi.org/10.1177/1357633x20916567 https://doi.org/10.1056/nejmsr1503323 https://www.brookings.edu/wp-content/uploads/2020/05/removing-barriers-to-telehealth-before-and-after-covid-19_pdf.pdf https://www.brookings.edu/wp-content/uploads/2020/05/removing-barriers-to-telehealth-before-and-after-covid-19_pdf.pdf https://doi.org/10.15270/54-1-611 https://doi.org/10.1080/10437797.2016.1174643 mailto:mhirschi@memphis.edu 680 ________ dashawna j. fussell-ware, phd, lsw, assistant professor, college of social work, university of tennessee, nashville, tn. kess l. ballentine, ma, msw, phd, assistant professor, school of social work, wayne state university, detroit, mi. ana t. flores, msw, phd candidate, and laurenia c. mangum, lmsw, phd candidate, school of social work at the university of pittsburgh, pittsburgh, pa. serwaa s. omowale, mph, lmsw, phd, marc and lynne benioff and a t32 training grant (1t32hd098057) postdoctoral fellow, department of obstetrics, gynecology & reproductive sciences, california preterm birth initiative, university of california, san francisco, ca. kristen t. mackenzie, phd, msw, postdoctoral associate, department of psychiatry, university of pittsburgh, pittsburgh, pa. adrian j. ballard, lcsw, phd candidate, and christopher thyberg, phd candidate, school of social work, university of pittsburgh, pittsburgh, pa. laura ellen ashcraft, phd, msw, scientific officer, center for health equity research and promotion (cherp), corporal michael j. crescenz va medical center, philadelphia, pa. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 680-702, doi: 10.18060/24936 this work is licensed under a creative commons attribution 4.0 international license. using the consolidated framework for implementation research to promote anti-racism in social work higher education dashawna j. fussell-ware kess l. ballentine ana t. flores laurenia c. mangum serwaa s. omowale kristen t. mackenzie adrian j. ballard christopher t. thyberg laura ellen ashcraft abstract: recognizing a clear call to dismantle traditionally racist structures within our nation, doctoral students at the university of pittsburgh school of social work formed the anti-racist doctoral program student committee (ardpsc) to push for systemic changes within our school and profession to eliminate anti-black racism. our student-led initiative is an innovative approach for two reasons. first, we strengthened our community virtually despite the limitations of covid-19 and virtual spaces. second, although collective organizing among students can be seen as threatening, we held a tension between agitation and collaboration, and contributed to, rather than disrupted, implementation of anti-racist reform. we map our experiences onto the consolidated framework for implementation research (cfir) using narrative data and documents produced by our committee. first, we describe how we built anti-racist group processes, established brave working environments, and integrated processes to reflect on change at various system levels. next, we describe our actions to push our school and profession to be anti-racist and assess outcomes using the cfir. finally, we share our reflections on how to continue this work. we hope to document our experiences and reflect on how social work student groups can contribute to dismantling white supremacy and rebuilding institutions with an anti-racist approach. keywords: anti-racism; social work education; higher education; doctoral education; implementation science; cfir the spring of 2020 marked the beginning of a global shift in how we interact, work, and exist. social work education was no exception. unprecedented in the last century, the covid-19 pandemic was a significant threat and disruption to our lives. the pandemic, about:blank fussell-ware et al./using cfir 681 which has disproportionately affected black and latinx communities in the u.s. (figueroa et al., 2021; gold et al., 2020), was later compounded by a reckoning with this nation’s deep-rooted, systemic, and persistent anti-black racism. black lives matter protests occurred across the globe during the summer of 2020 in response to numerous highly publicized incidents of anti-black violence in the preceding months, including the release of video footage of the murder of ahmaud arbery, continuing with the news of the murder of breonna taylor, and climaxing due to the widely viewed video of a white police officer murdering george floyd (buchanan et al., 2020). moreover, calls for transformative change within social work education emphasize how the current climate of anti-black racism creates an undue burden on black educators and students (abrams et al., 2021; davis, 2021; mccoy, 2020). the harsh and racist realities of our country have become too blatant and too harrowing to continue without action for change. we decided to form a social work doctoral student group to advocate for anti-racist pedagogy and confront the enduring problem of antiblackness in the academy. our shared vision for anti-racism in social work academia helped us capitalize on the opening window for change. with a commitment to social justice, we, a group of emerging social work scholars, accepted our collective role as change agents by forming the anti-racist doctoral program student committee (ardpsc). student activism and advocacy for civil rights in higher education is not a novel concept. in fact, because of campuses’ ecological facilitators for recruitment, mobilization, and coalition-building, students played a critical role in the civil rights movement of the 1960s and continue to do so in more recent social movements, such as occupy wall street, the dreamer movement, #blacklivesmatter, and #metoo (earl et al., 2017). modern technology expanded tools for disseminating messages, meeting discreetly, sharing resources and information, and having a central hub for communicating and saving documents (maher & earl, 2019). access to organizing tools for university students was also expanded due to the virtual work requirements during the pandemic (he et al., 2021). the ardpsc capitalized on the availability and power of zoom and microsoft teams for our change efforts, creating a virtual solidarity to facilitate participation regardless of physical location. our work began organically, but when we considered how other student groups might replicate our approach, we determined that the analysis of factors which supported our work aligned well with the consolidated framework for implementation research (cfir; damschroder et al., 2009). through this paper, we describe a novel way of identifying barriers and facilitators to anti-racist work in the social work academy that can be a model for other social work doctoral student advocates and their allies. because the cfir is inherently race-neutral, we have adapted the framework using a three-level conceptualization of institutional racism and applied it to our narrative (griffith et al., 2007). by intentionally centering racism in our analysis, we show how the adapted cfir can support an organized approach to progressive change within academic contexts. we operationalize our innovation of interest, or the product we wish to implement, as antiracist curricula and policies. successful implementation would entail the uptake and sustainment of anti-racist products into the individual, curricular, and organizational advances in social work, summer 2022, 22(2) 682 frameworks of a social work program at a predominantly white institution. we begin by contextualizing our work in the literature and describing the frameworks of anti-racism and the cfir. after setting the context, we share our narrative to explain how our anti-racist work can be described using the cfir. specifically, we describe our innovation and implementation narrative across three of the cfir domains: characteristics of individuals, inner setting, and outer setting. for each domain we discuss the facilitators and barriers for implementation of the anti-racist transformation we advocate. we hope that by connecting our experiences to the cfir, other doctoral student activists can use an anti-racist cfir approach to organize their work and support anti-racist advocacy across social work higher education. instead of using the traditional language of cfir, we replace “intervention” with “innovation” to better encompass the set of products and values we set out to implement in social work education (see rogers, 2003). background and theoretical framework anti-racism: a framework for transformation anti-racism provides a framework through which to reimagine institutions as safe places for black people to work and learn. the anti-racism phenomenon is one that critical social theorists, scholars, and researchers have studied for many years (davis, 1990; dei, 1996; zamalin, 2019), but recently the term gained popularity in the broader community. this may be due to ibrahim kendi’s (2019) book, how to be an anti-racist, becoming the go-to reference guide for anti-racist work in 2020. though not a discrete theory or concept, scholars suggest that discourse around anti-racism shares a few common themes across black history and political movements (dei, 1996; zamalin, 2019). first, the anti-racist perspective seeks to transform society to secure equity for black people by redistributing power. there are many levels at which to achieve this, including centering black thought and scholarship, acknowledging racist outcomes of allegedly colorblind or so-called postracial structures, and transforming those structures to create different outcomes. second, anti-racism celebrates resistance and actively builds resistance to conservativism and reductionist thinking about race and racism. thus, anti-racist advocates are politically involved in collective work while simultaneously participating, individually and collectively, in consciousness-raising and re-education to inform resistance movements. anti-racist advocates regularly participate in collective movements to fight for equity and strategically understand and navigate dynamic political environments. institutional racism in social work higher education anti-black racism, “society’s inability to recognize the humanity of black folks--the disdain, disregard and disgust for our existence” (ross, 2020, para. 6) is pervasive in u.s. society. the most egregious and salient incidents of anti-black racism are often observed within predominantly white spaces (blackstock, 2020). when these spaces are formal institutions, institutional racism occurs. institutional racism is generally understood to mean “discriminatory treatment, unfair policies, or biased practices based on race that result in inequitable outcomes for whites over people of color and extend considerably fussell-ware et al./using cfir 683 beyond prejudice” (dominquez et al., 2020, p. 7). institutional racism presents itself within the combination of policies, practices, and procedures embedded in organizational structures, which lead to systematic, unequal outcomes for people of color (delgado & stefancic, 2017). aligning with the common levels of the social environment used in social work – micro, mezzo, and macro – institutional racism has been conceptualized at three levels of an organization (griffith et al., 2007). at the macro level, extraorganizational racism functions through the reciprocal relationship between organizations and their external environments, such as the interactions of our professional organizations. at the mezzo level, intraorganizational racism functions through organizations’ internal climates, policies, and procedures. at the micro level, individual racism functions through the attitudes, beliefs, and behaviors of organization members. these levels are explained in detail below within the context of cfir. unfortunately, despite an emphasis on social justice in the national association of social workers (nasw) code of ethics, social work institutions are not immune to institutional racism (abrams et al., 2021; mccoy, 2020; nasw, 2021b). institutional racism at any level can have insidious effects on the education, research, practice, and overall experiences of all social work students, yet the impacts are particularly harmful for black students. extraorganizational racism is pervasive throughout social work systems and the profession's history, which has helped stifle the progress, well-being, and liberation of black people in america. social work systems have reinforced anti-black racism through systems, practices, and institutions that are inherently unjust, inequitable, and outright violent toward black people (miller & grant, 2007; mustaffa, 2017). from social work pioneers excluding black people from settlement houses to contemporary racism in child welfare, anti-black racism in social work is well-documented (detlaff et al., 2020; hounmenou, 2012). intraorganizational racism contributes to ahistorical education and field training, enabling social workers to practice with little knowledge of the problematic tensions in our profession’s history and few skills to dismantle them (jeffrey, 2005; mccoy, 2021). this affects doctoral students not only in our practice but also in our role as current and future educators. when our education lacks content and processes to interrogate anti-blackness and build anti-racist skillsets, future social work educators lack a critical competency. indeed, social work faculty train thousands of social workers annually (council on social work education [cswe], 2019). thus, the impacts of instructor capability to teach about the effects of anti-black racism and anti-racist strategies are far-reaching. finally, at the individual level, black social work students are affected by racism individually and through institutional racism within social work schools and programs and through their universities at large (fussell-ware, 2021). meanwhile, white students and predominantly white faculty are not held accountable for their microaggressions and racism in the classroom. dismantling institutional racism at each level is a necessary aspect of anti-racist transformation in social work. advances in social work, summer 2022, 22(2) 684 consolidated framework for implementation research: a tool for implementation as we have described, the harm and insidious nature of institutional racism is significant, making the stakes for doing anti-racist work in social work education high. however, the energy of doctoral students is a precious and limited resource. any framework that can support this challenging work may slightly ease the burden and help sustain these crucial endeavors. implementation science, or the systematic study of how evidence-based knowledge is applied to practice, is a potential tool for guiding anti-racist work. implementation science has traditionally evolved for the purpose of translating research evidence from a laboratory setting to diverse healthcare environments (tinkle et al., 2013). the “evidence-based practices” to which most implementation science literature refers encompass not only preventive, diagnostic, or therapeutic goals, but also cover a broad range of products and processes, including services, programs, methods, techniques, or routines (nilsen & birken, 2020). the focus on organizational structures, processes, and their influence on implementation outcomes offers a useful lens for contextualizing and promoting anti-racist activities in social work academia. one useful implementation science framework is the consolidated framework for implementation research (cfir). this commonly used framework defines and organizes theoretical constructs to describe, understand, or explain factors that may have an impact on implementation success (damschroder et al., 2009). for example, efforts to implement the use of a therapeutic intervention in a mental health clinic may be influenced by broader mental health policy, the support of leadership within the organization, and/or an individual clinician’s perception of the intervention (allchin et al., 2020). researchers have begun to use the tool for implementation research in novel contexts such as k-12 schools (asada et al., 2020; hudson et al., 2020; leeman et al., 2018). one study even used a critical race theory approach to adapt the cfir to investigate the ways in which structural racism interacts with the implementation of a school-connectedness intervention (allen et al., 2021). though the benefits of implementation science in educational settings have been acknowledged (kelly & perkins, 2012), to our knowledge only one study has used the cfir for higher education implementation science research (see soicher & becker-blease, 2020). because the use of the cfir in higher education is a recent development, we have adapted the domains and constructs of the cfir to allow for a university-specific context analysis (see figure 1). the five original domains of the cfir are 1) characteristics of individuals, 2) inner setting, 3) outer setting, 4) innovation characteristics, and 5) process (damschroder et al., 2009). within our analysis, we focus on the first three domains, as they are the most salient to the institutional racism we are combatting, though innovation characteristics and process will be discussed briefly. further, we operationalize our innovation of interest, or our implementation product, as the application of anti-racist curricula and pedagogy in social work doctoral education. advances in social work, summer 2022, 22(2) 685 figure 1. consolidated framework for implementation research (cfir) for anti-racist reform within social work education notes. conceptual model is based on theoretical frameworks by damschroder et al. (2009) and griffith et al. (2007). cswe=council on social work education. gade=group for the advancement of doctoral education in social work. nasw= national association of social workers. consolidated framework for implementation research (cfir) for anti-racist reform within social work education by ana flores is licensed under a creative commons attribution-noncommercial-noderivatives 4.0 international license. fussell-ware et al./using the cfir to promote anti-racism 686 additionally, we reconceptualize the overarching domains of the cfir within the three levels of institutional racism (see figure 1; griffith et al., 2007). at the micro level, the characteristics of individuals domain includes the knowledge and beliefs of individuals within social work education. here we focus on individual interactions within our group of doctoral student colleagues. while individual racism can occur at any level, we focus especially on interpersonal relationships in this section and highlight the complexity of addressing individual racism. at the mezzo level, the inner setting includes the organizational characteristics and culture of social work education. in the current paper, we focus mostly on our social work program and the role of intraorganizational racism therein. at the macro level, the outer setting includes the context surrounding social work education, such as governing bodies (e.g., cswe), the universities that house social work programs, and national-level policies and events. these macro-level influences correspond with the extraorganizational level of institutional racism, or the reciprocal relationship between organizations and their external environments. incorporating the levels of institutional racism into the cfir will allow us to ensure we are addressing racialized practices at all levels. for example, were we to only address anti-black racism at the individual characteristics and the inner setting levels in our social work program, we risk factors from the outer setting perpetuating the status quo and undermining progress. current aim the fight against anti-black racism, both internal and external to the social work discipline, extends far beyond the summer of 2020. however, the national conversation, media coverage, and community-led initiatives presented a rare inflection point in history to make a serious impact. our student-led collaborative to address anti-black racism within our social work program emerged through an organic process of mutual aid, support, and communication. we sought to collaborate with faculty and create a collective that could bridge traditional forms of school hierarchy. this paper documents our processes through the lens of the cfir and seeks to provide an example of how one group of doctoral students worked to support our school in furthering efforts to address anti-black racism within our institution and profession. catalysts for change in march 2020, cases of covid-19 began to proliferate across the united states, resulting in local and state governments implementing shelter-in-place orders to mitigate the risk of exposure and potential for contracting the deadly disease. in alignment with governmental response, universities closed their doors, and social work education, like other disciplines, was disrupted and forced to adapt to new public health measures (allegheny county department of health, 2020; wolf, 2020). with a total shelter-in-place order in april 2020 and subsequent university closures, students were forced to return to their homes to cope with uncertainty and ever-changing university announcements across time. then on may 25, 2020, george floyd was murdered in minneapolis, minnesota. by may 26th, video footage of the murder had circulated the nation widely and was met with grief and outrage (dixon & dundes, 2020; priniski et al., 2021). despite escalating fussell-ware et al./using cfir 687 violence against black people throughout the spring, black students in our school continued to be met with an overwhelming, deafening silence. black students and faculty felt unsupported due to the lack of communication from non-black faculty, a disappointing response consistent with a history of black degradation in higher education (dancy et al., 2018; mustaffa, 2017). unfortunately, the silence was not limited to our university. in fact, it was pervasive across the entire social work community. by may 31st the first author noted on twitter that there was “no public denouncement” of the murder from major social work professional institutions (e.g., cswe, nasw, etc.), and no overwhelming public response from other social work programs across the united states. our social work program did, eventually, formally acknowledge the murder of george floyd at the school level and offered a time to gather as a community to process. while this acknowledgement certainly broke the silence, the suggested action (i.e., a collective one-hour zoom session with breakout groups) was disproportionate to the magnitude of pain and mourning black students were experiencing. additionally, during this same period, we were regularly receiving communication from our program and the university that explicitly acknowledged the impact of the covid-19 pandemic but did not acknowledge george floyd’s murder or the growing civil unrest. for many black students this felt like an erasure of their experience. this kind of communication spurred anger: anger with the apparent inability to acknowledge the social movement, anger with reticence to say george floyd’s name, anger that members of our community had appeared to have already moved on. where were all the social workers in our social work program? in various events in the months that followed, we learned that our program was not unique, that many black students across the country experienced a similar underwhelming response. with this backdrop for our work, we define the characteristics of individuals, inner setting, and outer setting, describe its overlap with our shared lived experience, and discuss facilitators and barriers in the hopes that our experiences may act as a roadmap for other social work doctoral students. characteristics of individuals definition & conceptualization for the purposes of this paper, we conceptualize characteristics of individuals as existing or developed individual factors which influenced the application of anti-racist work. individual-level characteristics, specifically knowledge, beliefs, and self-efficacy, were critical factors for the implementation of anti-racist innovations. the following describes our implementation narrative and the facilitators and barriers we experienced. implementation narrative individual stage of change the ardpsc represents a cross-section of doctoral students who were ready to advances in social work, summer 2022, 22(2) 688 implement anti-racism efforts within our social work program. first, as doctoral students we had experienced or witnessed the difficulties for students of color in academia. second, we were ready for change and equipped with expertise in race and racism literature, critical theories, and the belief that things needed to change. third, our training as social workers meant we were skilled in being resourceful, organized, persistent, and resilient. fourth, we were well-prepared as student leaders to leverage this privilege within the doctoral student body and existing relationships with school administration and faculty. individual identification with the organization as the ardpsc, we worked together to build a brave and healing community of student activists that, over time, demonstrated our commitment to each other and the desire to see change within our social work program. this relates to the cfir construct of individual identification with the organization, which describes individual perceptions and commitment to the organization and is often manifested in the degree to which people are willing to contribute to implementation efforts (damschroder et al., 2009). in our case, we formed in the midst of significant discomfort and tension that, for many of us, has continued throughout our work together. we navigated these tensions in our group. sometimes these were anticipated discomforts associated with challenges to white supremacy, white fragility, or white guilt. at other times, the tensions had to do with differing communication styles, a sense of imbalance in power dynamics and workload, or questions of commitment. often, there were negative feelings, like frustration and anger, which were directed toward entities beyond our committee but needed to find voice in the relative safety we strove to establish among our group. neither we as individuals nor our work were isolated from things happening in our own lives—including our academic pursuits—and in the mezzo and macro social contexts within which we came together. ultimately, it required our individual commitments to our collective pursuit to enable us to persist despite our micro challenges. similar to other organizing spaces, black students are left to do more social justice work with the risk of white students dropping out or doing less (chudy & jefferson, 2021). thus, it was important for white students to commit to showing up, completing work, and being humble and trustworthy. at the start, most of our relationships did not have the necessary depth of trust necessary, so honest conversations and time were important to build trust and accountability. we also needed to establish strong boundaries. in reflection on this work, black authors emphasized the importance of boundaries, acknowledging that caring deeply about the work and setting boundaries were not mutually exclusive. rather, boundary setting is a foundation for sustainable social justice work and overall wellness. setting boundaries was also necessary due to the challenge of completing doctoral coursework and scholarship, graduate assistantships, and service work. we worked toward healthy boundaries and accountability by identifying these issues in our meetings and discussing them with honesty, acknowledging that the solutions would entail a long-term and dynamic process. fussell-ware et al./using cfir 689 self-efficacy at an individual level, every member of the ardpsc was unequivocally motivated by a commitment to ameliorate anti-black violence and persistent, pervasive racism that was permeating our internal and external worlds. this, in conjunction with our diverse lived and educational experiences, empowered us to have confidence in our own abilities to develop and lead anti-racist innovations. the need for anti-racist changes pre-dated the origination of our group and became clearly necessary at the doctoral student organization meetings in spring of 2020. with only doctoral students in attendance, numerous concerns about the safety and success of black students were raised, as well as concerns that our program and university was not supplementing its public acknowledgment of the importance of anti-racist social work with tangible, measurable actions. we were also concerned that momentum for actionable efforts may be waning. we arranged several meetings with the administration to discuss these concerns. the general response was to assure us that a schoolwide plan was being developed. meetings were also characterized by general invitations for students, particularly black students, to provide school leadership with guidance and insight on how best to move forward. we were frustrated by reproductions of traditional systems of oppression inherent in these meetings: white americans demanding emotional labor from black americans and the academy demanding unpaid labor from its doctoral students. our commitment to change in the context of these challenges meant we were often caught between our commitment to social work and feelings of frustration and disappointment that social work often reproduces racial inequities. this overlaps with the cfir construct of individual perceptions of the organization, which describes perceptions and willingness to support the innovation as an outgrowth of commitment (abraham, 2000; greenberg, 1990). furthermore, work to address anti-blackness was routinely diluted by adding it as a task to a long list of tasks, rather than as a central goal. we continue to find this approach unacceptable and have contested it whenever possible. one way we chose to communicate our desired changes was to develop and share a list of demands centered around our innovation of interest: implementing anti-racist pedagogy and addressing anti-blackness in our doctoral program. we developed our demands collectively and sent them to our school leadership. our demands included a requirement that leadership and faculty take responsibility for their own self-education, the immediate initiation of a doctoral program curriculum review, planning anti-racist pedagogical training for all faculty, and distribution of a school-wide racial climate survey. in addition to these demands, we insisted on transparency and consistent updates on progress toward these goals from school leadership. since our group was formed at a predominantly white institution, a key theme in our discussions about anti-racism work was that in-reach must precede outreach. in other words, before we made recommendations or provided technical support to the community, we needed to address racist behaviors and structures in our own institution. ardpsc identified a doctoral vision statement as one way that we could hold ourselves and our advances in social work, summer 2022, 22(2) 690 overall doctoral student community accountable to anti-racist principles. our vision statement centers anti-racism and anti-oppression, establishing the expectation that all current and incoming doctoral students recognize inherently racist structures within academia and the vulnerable communities that we engage within our research and praxis. it stresses that each student will commit themselves to intentional and continued anti-racist praxis by seeking appropriate guidance and education. it also maintains that sustainability of our anti-racist reform will require ongoing reflection and action for which we all accept responsibility. the characteristics of individuals allowed us to not only develop the ardpsc but also become empowered to develop and implement anti-racism products for use in our program. facilitators and barriers technology creating communal spaces was a common challenge during the covid-19 pandemic. prior to the pandemic, our doctoral co-working office often served as a space for connection. during the year of limited access to campus, microsoft teams provided our communal space. we were able to post updates, vote on decisions using the reaction buttons, and provide support to each other. however, using teams was not always easy. each member of our group attempted to develop their own time management related to using teams and participating in the work. some of us were trying to manage our time to maintain productivity – a perpetual challenge even when the stressors of 2020 were not in play – so automatic alerts and the implied continual availability of online platforms was a disruption for some. others were coping with platform overload given how many community organizing groups use similar, but distinct, platforms. however, when these concerns were raised by white students, it was clear this was a moment to stretch ourselves to build the community that was necessary to support each other and engage in the work at hand. teams failed to provide the empathy and warmth of in-person connection and may have been easy to opt-out of. although teams was a powerful tool for our work during this year when we had limited access to campus, it has significant limitations compared to in-person organizing. meeting processes in addition to interacting through teams, we had video meetings. sometimes these meetings were impromptu to address a particular issue, but most were held formally. we determined how frequently to meet based on the pace and quantity of projects occurring at that time. one member with strengths in organization scheduled meetings and wrote draft agendas. agendas were available and editable for the whole group, which was important for transparency and keeping meetings on task. we then rotated the tasks of facilitating and writing minutes based on who had interest and energy at meeting time. we included an ice breaker and/or check-ins during each meeting to continue to get to know each other better. the intentional anti-racist process taken by the ardpsc acted as the primary fussell-ware et al./using cfir 691 facilitator for our implementation success. our regular check-ins and reflections on how our group was interacting were examples of the cfir construct of reflecting and evaluating, which seeks to provide ongoing feedback on implementation efforts. when developing our ground rules, we chose not to implement traditional ones that are steeped in white supremacy, social control, and order. we reflected together that ground rules in many white spaces are built to avoid conflict, often resulting in its mismanagement and contributing to broken or harmed relationships. those of us with experience working and/or living in black community organizing spaces have seen more models of actively managing conflict, addressing harm, and prioritizing, maintaining, and growing relationships. thus, one approach to centering blackness in our work was to seek to maintain relationships, which includes preparing for conflict and promoting care. so, we pushed ground rules and meeting processes beyond traditionally white-centered reflections and check-ins by providing feedback with the goal to center the experience of our colleagues of color. in reviewing products and talking about group processes, the use of our ground rules encouraged open and productive conversations among one another about intersections between race and gender, ways to give feedback, and how we engage with each other. as the ardpsc, we used meeting time to strategically consider how to prioritize our implementation efforts. we then worked together and engaged our mentors and the administration within our social work program. as has been mentioned, we leveraged existing relationships with leadership and administration to promote and build support for our anti-racism efforts. during ardpsc meetings we took time to reflect and process how well (or poorly) our outreach, accountability, and dissemination efforts were received and plan next steps. established structures & relationships at our school, the doctoral student organization is a fully student-run, studentmember organization for all doctoral students in our program with autonomy over our communications and meetings. this group helped us connect and hear broad concerns. however, it was not well-suited to do this work in part because it encompasses all the doctoral students and would have been too large. additionally, the high stakes and potential risks of this work required a subgroup of students who were willing and able to build the depth of relationships required to sustain the challenges of the work. we had to be committed to holding the tension between challenging and working with the established systems, which we discussed regularly. most members of ardpsc also had significant leadership experience or additional roles in the doctoral student organization. inner setting: our social work program definition and conceptualization the cfir inner setting is defined as the context within which the innovation occurs as well as factors which interact with the innovation to affect implementation (damschroder et al., 2009). for purposes of this paper, we conceptualize the inner setting advances in social work, summer 2022, 22(2) 692 as the climate, culture, structure, and procedures within our social work program, including our interactions with faculty, staff, and other students (see figure 1). the inner setting is dynamic, and the year 2020 introduced dramatic disruptions, challenging us to continually adapt. implementation narrative in addition to work within our own group, we worked in concert with schoolwide efforts. the interventions subsequently described, including learning environments and school task forces, were formed by school leadership who offered ardpsc members opportunities to participate as student representatives. through this service we were able to continue to raise students’ experiences of individualand intraorganizational-level institutional racism from our perspective as community members. to adapt to these new roles, the ardpsc made it a point to have students share progress updates from their respective roles in learning environments and school task forces in regular ardpsc meetings. committee members then devoted a portion of meeting time to strategizing how best to advocate for student interests. the ardpsc identified the need for developing a more designated space for antiracist learning and reflection. this aligns with the cfir construct of learning climate, or the degree of psychological safety felt by team members and leaders to try new things and seek input (damschroder et al., 2009). in alignment with this goal, an important part of our work with faculty and staff was creating a space for learning and discussion. the antiracist learning collective served as one space to create such a learning climate. this collective was led by one of the authors and a faculty member during the fall of 2020 and was taken over by another faculty member and doctoral student in spring 2021. interested members in the school community were invited to meet biweekly to discuss issues of race and racism and the role we played, as social workers, in ensuring social and racial justice in society. readings and videos to assist in anchoring discussions were sent out in advance for review by attendees. collective sessions were also supplemented by lectures and events held by other entities in the university. alongside the anti-racist learning collective, four task forces were developed as a mechanism to ensure an ongoing commitment to anti-racist action. each of the four task forces was led by two members of our program’s inclusion and diversity committee (idc) and was tasked with one of four central scopes: 1) faculty and staff, 2) students, 3) curriculum, and 4) infrastructure, policy, and practice. membership in each task force was intentionally diverse and generally included one member from administration, a tenurestream faculty, an appointment-stream faculty, and student representatives from all program levels. as active community members, we also wanted to create products and participate in actions that would further support anti-racism in our school. our first priority was to address the experiences of racism of doctoral students in the classroom. we did this in two primary ways. as discussed above, we wrote demands for our doctoral program specific to anti-racism. to support our request for a curriculum review with a special focus on inclusivity of research and theory by scholars of color, a review of classroom practices, fussell-ware et al./using cfir 693 and transparent decision making, we also wrote an anti-racist syllabus review guide for faculty (university of pittsburgh school of social work ardpsc, 2020). two ardpsc members with expertise in race, racism, and social work education drafted the guide to help faculty interrogate both implicit and explicit curriculum. this document was well-received and has been incorporated into ongoing curriculum review. additionally, it has been shared publicly and seems to have been applied in other programs (devlieger, 2021). facilitators and barriers resources and service capacity an ongoing barrier for doctoral students to lead this effort is access to resources. most of us were participating in service for our social work program, the university, or community partners. though students in our program are typically paid for 20 hours of research or teaching work weekly, additional service added even more unpaid work to our schedules. time can also be a significant barrier for those in doctoral programs. as doctoral students in a competitive research environment, the productivity expected of us remained the same throughout the spring of 2020 and the time since then. in fact, it was even suggested that we could be even more productive due to working from home, and with the additional service work, we were indeed working harder than ever before. it was helpful that ardpsc members spanned the stages of our doctoral program, meaning that our leadership could rotate naturally with the ebb and flow of our individual semesters. ultimately, relationships proved to be the ladder over these barriers. as challenges arose, we used open communication to discuss them and tried to come to solutions that would support individual members. implementation climate one barrier to implementation was a broader cultural resistance to anti-racism work, which affects schools of social work and the broader academy (davis, 2021; jeffrey, 2005; mccoy, 2021). the implementation climate within our social work program is continually evolving and seems to have become more receptive to anti-racism efforts over time. as students seeking change and enhanced transparency, we were grateful to be able to work with faculty, staff, and students across levels to participate in committees and task forces. most of us had participated in service through committee membership as doctoral student representatives and had built credibility with faculty through our coursework and our work as research assistants. initially we had some concerns that adding additional committees might dilute efforts. in large part, they seemed to work as intended, sharing work across the school community. task forces that were designed to be time-limited, with specific goals, seemed to maintain forward momentum better than established committees for whom anti-racist work was one of many tasks and goals set prior to the current year. overall, we valued the opportunity to be on task forces and committees but wish that, in the future, more attention would be paid to these obstacles. advances in social work, summer 2022, 22(2) 694 outer setting definition and conceptualization the outer setting of the cfir includes the larger context within which the inner setting is housed. it encompasses external pressures and incentives as well as their influences on the innovation adoption process. for the purposes of this paper, the outer setting refers to our university and social work education and national organizations (e.g., cswe, group for the advancement of doctoral education in social work (gade; see figure 1), national association of black social workers (nabsw), national association of social workers (nasw)). the following describes the ways in which external entities influenced our experience and innovation implementation. innovation narrative though not our primary focus, we wanted to contribute to national work to reimagine and restructure social work. a primary example of the utility of our social network was becoming aware of the movement to write to the cswe regarding adding “anti-racist pedagogies” to social work competencies. we became aware that other groups of social work doctoral students were writing these letters and were provided with a model letter. our membership then revised the letter and applied our organizing skills to reach out to our current students and alumni to obtain over 100 signatures on our letter. we were subsequently able to share the letter on our social media where it was widely circulated (university of pittsburgh ssw dso, 2020). though not the center of our efforts, engagement in our professional networks was important. as evidenced by changes in the educational policy and accreditation standards (epas), the nasw code of ethics, and the overall social work rhetoric in the last year, collective engagement in the outer setting can lead to meaningful change (cswe, 2015; nasw, 2021a; nasw 2020b). facilitators and barriers one key facilitator of our work at this level was having social networks beyond our school and university, which aligns with the cfir construct of cosmopolitanism or connectedness to external networks (damschroder et al., 2009). one unfortunate experience of many academics, including graduate students, is the experience of feeling confined to a single silo or isolated from peers. however, a number of members of ardpsc had worked to resist this and built a robust social support network. our collective includes students who worked in multiple departments, such as students earning master’s degrees in public health along with their social work doctorates. we represent students working in various campus and community groups, including graduate student organizing, the latin american graduate organization of students, and our program’s msw alumni group on facebook. our membership also includes students with networks across the country, with two members who were part of the society for social work and research doctoral student committee. these connections meant that our members were engaged in the broader university and social work community, facilitating participation in local and fussell-ware et al./using cfir 695 national change efforts. barriers, however, included extraorganizational forces. our school was in the middle of council on social work education (cswe) re-accreditation, which meant that our curricula were already being carefully reviewed by a governing body and needed to be static during the review period. at this time, cswe epas did not include language on anti-racism, and re-accreditation tends to be a meticulous process for which social work programs need to demonstrate that they satisfy accreditation mandates. these reasons were given multiple times by faculty and administration to explain why our syllabus review guide could not be used to revise syllabi until after the accreditation process. our demands included reform within lesson plans and pedagogical techniques, as well, but again, extraorganizational forces impacted this being implemented. additionally, faculty at our school are typically not contracted to work during the summer, while still having the burden of productivity and publishing expectations. thus, following our accreditation year and visit, summer meant anti-racist efforts slowed considerably. implications for social work we frame our implications as recommendations for other social work programs or groups of doctoral students who are working to dismantle institutional racism in their programs. build a multi-level, brave learning environment one potential barrier to anti-racist work is not having strong, trusting relationships as the foundation for doing and sustaining ongoing social justice work. this barrier merits significant attention. educational scholars provide useful concepts for change agents in higher education, advocating for making the contexts in which discussions about race take place brave rather than safe (arao & clemens, 2013; singleton & hays, 2008; sparks, 2002). seeking to ensure everyone feels “safe” in conversations about injustice generally serves only the status quo, which is counterproductive to anti-racist, anti-oppressive, and justice-seeking efforts. rather, members of the ardpsc took the risk of being vulnerable and feeling unsafe at moments and made our committee a brave space. doing so required patience, compassion, ongoing self-reflection, mutual support, and openness to continuous adaptation along the way. self-care for all members was an acknowledged need that was honored, respected, and encouraged. we would also suggest building a sense of community into broader schooland university-wide networks, so individuals feel connected and simultaneously supported. the value of diverse voices contributing to work such as this also requires a respect for diverse ways of working together and of attending to personal needs outside of the group. notably we did this work in our own group even as we worked in multiple groups with other students, faculty, and staff from our social work program. meanwhile students at other levels and faculty and staff had other spaces where we were aware they were organizing around anti-racist learning and change. this reality highlights an important advances in social work, summer 2022, 22(2) 696 lesson for others doing this work. specifically, many brave spaces need to be organized and cultivated for change to progress. some groups benefit from being inclusive. in our experience, the anti-racist task forces within our program made effective progress because representatives from all facets of the school community were involved, and we learned from each other as we worked. other groups benefit from being more like affinity groups. our group only included doctoral students. other groups included only faculty. this created spaces where individuals in similar situations could build relationships and could confront each other without those conversations being widely shared. thus, many groups should be organized to move forward while also working toward all spaces being brave and using an anti-racist framework. finally, we must consider the sustainability of our efforts. within the ardpsc we have taken a number of steps for sustainability. among our members we were constantly communicating about our individual capacities and considering the potential differential consequences for individual students who took specific actions, such as writing an email or speaking up at a particular meeting. though decisions about who should act and what action should be taken are a dynamic process that changes over time, the key point is that boundaries, inclusivity, potential consequences, and capacity benefit from being part of an open and continuous conversation to protect and support all members. additionally, by using teams and documenting our work with transparency, we can continue strategically working through our goals. for example, we documented our demands and our ongoing progress toward them, enabling us to share with incoming members. include all community members if we are to dismantle racism in social work, we all need to be involved, including students. if they are not already included, programs should incorporate student voices, and students should organize and plan to be included. additionally, we encourage students to resist the isolating nature of academia and organize together. if students are not involved or could be more involved, these organized groups can work together to approach the program administration about the potential for being included while planning to mobilize independently, if necessary. we hope that program administrators, faculty, and staff encourage inclusivity of all invested community members, including students. additionally, we hope programs can consider how to compensate students for their unpaid service work or include it as a part of paid duties. consider using a guiding framework we have shown that frameworks like the cfir can be used to help guide anti-racist work. though there are certainly many ways to mobilize efforts, we are finding that a framework like cfir will help us strategize and sustain our work over the long term. for example, it has helped us reflect on the facilitators and barriers we experienced over the last year and consider how we can continue to be effective in our work. additionally, by mapping the cfir constructs onto the levels of institutional racism, we can see the levels of our work more clearly. going forward this will enable us to be more organized about pursuing multi-level efforts, since working across levels of the social environment are a fussell-ware et al./using cfir 697 necessity for anti-racist efforts to succeed. conclusion the covid-19 pandemic challenged us to reimagine established routines and allowed us to bend the rules we once thought unalterable. as social workers and doctoral students committed to anti-racism, we recognized anti-black racism as a systemic threat that demands intervention. institutional racism is sustained by white supremacy and permeates all levels of our institutions. therefore, to begin dismantling it, a multi-level analysis and strategy is crucial. the cfir provided a valuable framework for analyzing barriers and facilitators to our efforts by adapting it to center the levels of institutional racism (see figure 1; griffith et al., 2007). there are limitations to our work, but we used cfir to illuminate not only the areas in which we were impactful and the factors that contributed, but also areas that need continued attention and pursuit of change. we chose to focus our change efforts at our social work program but have described our process in hopes of modeling our approach for other change agents. the characteristics of individuals included our knowledge and beliefs about anti-racist reform, our individual stage of change, and identification with social work. doctoral students involved in planning and executing this work have a history of success in engaging multiple community partners, working with diverse communities, and building strong professional relationships. we used these attributes to our advantage along with our individual areas of expertise such as critical race theory, pedagogy, and implementation science. because of these characteristics, we were able to collaborate well together, obtain support from faculty, and create products to disseminate. we encourage change agents wanting to do similar work in their setting to identify strengths within a team and start with relationship-building. it was additionally helpful to establish an organized and reliable mode of communication with ground rules to build relationships through discomfort, misunderstandings, and disagreements. thanks to our initial attention to relationshipbuilding amongst ourselves and others within our setting, we were able to rebound quickly and refocus when relational challenges required collective resolution in order to effectively proceed. our social work program comprised the inner setting. at this level, we balanced requests with commitment of our time and expertise. we communicated our concerns about anti-blackness to our administration through our list of demands while contributing an antiracist syllabus review guide to aid these efforts. we participated and helped guide the antiracist learning collective to continue improving the learning climate of our school and to further the development of an anti-racist climate and pedagogy. we participated in task forces while also understanding there were limitations to our participation as students. while acknowledging the unpaid labor of graduate students, developing and facilitating an anti-racist learning community and participating in community work were key facilitators in our ability to implement change. the outer setting included pressures, policies, and incentives from entities outside of our social work program, our university and professional bodies, like cswe and nasw. entities that govern and impact our social work education operate in the advances in social work, summer 2022, 22(2) 698 extraorganizational realm, upholding values of white supremacy through the promotion and rewarding of hierarchies, profits, policing, and exploitation of labor (nasw, 2021b). we identified facilitators within this potentially volatile system: the networks and connections we built across and within exterior organizations enabled us to strengthen our reach. trusted colleagues at other social work programs, the society for social work and research doctoral student committee, and student organizations at our university were key in spreading our message and building a coalition of change. this work requires building working relationships with a variety of people – fellow students, faculty members, colleagues from other disciplines, and others. though we often talk about building networks as doctoral students, this work showed the value of growing one’s professional network through service and beyond the constraints of one’s research area (i.e., the implementation benefits increased cosmopolitanism). broader relationships with rich and diverse social networks may better facilitate social justice work than those constrained by academic discipline or other boundaries. we remain committed to challenging ourselves, each other, our program, and the social work profession to live up to the values and principles to which we devoted ourselves upon entering the field (nasw, 2021a). our goal for the current paper is to support the work of other students to develop and lead anti-racism efforts within their social work programs. we found that aligning our experience with the cfir helps us to meet this goal. that said, we chose to focus on three of the five domains and only some of the underlying constructs. future efforts can and should expand the use of the characteristics of individuals, inner setting, and outer setting domains to also include intervention characteristics and process in addressing racism within social work programs. much more work lies ahead to invest in anti-racist transformation in the academy and fully acknowledge the value of social justice efforts for our students, our research, and our communities. this example is within a singular setting and should be tested and refined in other academic settings. the work of the ardpsc within our own school of social work and its alignment with the cfir is an example of how implementation science, specifically the cfir, 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(2013). dissemination and implementation research funded by the us national institutes of health, 2005–2012. nursing research and practice, 2013, 1-15. https://doi.org/10.1155/2013/909606 university of pittsburgh school of social work anti-racist doctoral program student committee. (2020, july). syllabus review: guiding questions [unpublished student committee recommendations]. https://www.socialwork.pitt.edu/sites/default/files/ardpsc_syllabu s_review_guiding_questions.pdf university of pittsburgh school of social work doctoral student organization, [@pittsswdso]. (2020, july 2). today 114 @pittsocialwork students sent the attached letter to @csocialworked, requesting action to address issues of antiblack violence, systemic racism [tweet]. twitter. https://twitter.com/pittssw_dso/status/1278818766403637249 wolf, t. (2020, april). order of the governor of the commonwealth of pennsylvania for individuals to stay at home. office of the governor. https://www.governor.pa.gov/wp-content/uploads/2020/04/20200401-govstatewide-stay-at-home-order.pdf zamalin, a. (2019). antiracism: an introduction. new york university press. author note: address correspondence to dashawna j. fussell-ware, college of social work, university of tennessee, nashville, tn, 37210. email: dfussel1@utk.edu. https://doi.org/10.1155/2013/909606 https://www.socialwork.pitt.edu/sites/default/files/ardpsc_syllabus_review_guiding_questions.pdf https://www.socialwork.pitt.edu/sites/default/files/ardpsc_syllabus_review_guiding_questions.pdf https://twitter.com/pittssw_dso/status/1278818766403637249 https://twitter.com/pittssw_dso/status/1278818766403637249 https://www.governor.pa.gov/wp-content/uploads/2020/04/20200401-gov-statewide-stay-at-home-order.pdf https://www.governor.pa.gov/wp-content/uploads/2020/04/20200401-gov-statewide-stay-at-home-order.pdf mailto:dfussel1@utk.edu using the consolidated framework for implementation research to promote anti-racism in social work higher education abstract: recognizing a clear call to dismantle traditionally racist structures within our nation, doctoral students at the university of pittsburgh school of social work formed the anti-racist doctoral program student committee (ardpsc) to push for s... background and theoretical framework anti-racism: a framework for transformation institutional racism in social work higher education consolidated framework for implementation research: a tool for implementation current aim catalysts for change characteristics of individuals definition & conceptualization implementation narrative individual stage of change individual identification with the organization self-efficacy facilitators and barriers technology meeting processes established structures & relationships inner setting: our social work program definition and conceptualization implementation narrative facilitators and barriers resources and service capacity implementation climate outer setting definition and conceptualization innovation narrative facilitators and barriers implications for social work build a multi-level, brave learning environment include all community members consider using a guiding framework conclusion references _______ marguerite deliema, phd, assistant professor, school of social work, university of minnesota, saint paul, mn. maruška sommers, msw, lcsw, therapist, cedar hill therapy, minneapolis, mn. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 231-254, doi: 10.18060/28172 this work is licensed under a creative commons attribution 4.0 international license. trauma-informed approaches to support victim-survivors of elder financial exploitation marguerite deliema maruška sommers abstract: elder financial exploitation, which includes scams, fraud, and financial abuse, is a growing elder justice issue that affects the health, financial security, and emotional well-being of older adults. social workers play a critical role in elder financial exploitation prevention, detection, and response, including helping victim-survivors heal from the traumatic loss of trust, feelings of shame, and financial loss. in this article, we summarize research on the social and emotional costs of elder financial victimization and advocate for person-centered and trauma-informed interventions. we highlight research on traumainformed interventions used to treat older adult victim-survivors in other contexts and communities such as domestic violence, older combat veterans, and older adults with other forms of past trauma. we describe how social workers can improve the lives of elder financial exploitation victim-survivors using trauma-informed psychotherapy, peer support groups, community engagement, care coordination, and advocacy within financial institutions and justice systems. this paper also showcases recent innovations in personcentered and trauma-informed care for elder mistreatment and offers recommendations for further research on and greater access to trauma-informed services. keywords: fraud, scams, financial abuse, aging, person-centered, multidisciplinary teams the united states will soon reach a demographic milestone. by 2030, all baby boomers will be age 65 and older, and by 2034, this population will outnumber children aged 17 and younger (us census bureau, 2023). as the population ages, social work practitioners will be challenged to meet older adults’ health and social service needs, including those who have experienced elder financial exploitation (efe). efe is defined as the illegal, unauthorized, or fraudulent use, or deprivation of use, of the property of a vulnerable adult with the intention of benefiting someone other than the vulnerable adult (us department of justice, 2022). efe can take many forms including scams, fraud, theft, embezzlement, abuse of power of attorney, forgery, coercion, and denial of access to assets. prevalence estimates suggest that 5.2% percent of older adults age 60+ are financially exploited by a family member each year (acierno et al., 2010) and 5.6% of older adults are victims of fraud and scams perpetrated by strangers (burnes et al., 2017). most instances of efe are never reported to law enforcement, adult protective services (aps), or consumer protection agencies (acierno et al., 2020), making it difficult to estimate the prevalence and cost of victimization. aarp (formerly the american association of retired persons) projected that older americans have $28.3 billion stolen each year, with most of these losses attributed to financial abuse by friends and relatives (gunther, 2023). using a range of assumptions about the extent of underreporting, the about:blank advances in social work, spring 2025, 25(1) 232 federal trade commission [ftc] (2023) estimated that in 2022, between $5.9 to $48.4 billion was stolen from older americans by scammers alone, not including exploitation by family and friends. while scams affect people of all ages, older adults report significantly higher median losses—$1,450 for those aged 80 and older compared to $450-500 for those aged 20 to 59 (ftc, 2024)—suggesting that financial scams and fraud cause the greatest financial harm to people who have largely exited the labor force and who may be unable to recoup stolen funds through paid work. as the population ages and criminals use more sophisticated communication and payment technologies to manipulate and steal from vulnerable older adults worldwide, the cost and prevalence of efe is sure to rise. beyond direct financial costs, efe victimization often results in shame, embarrassment, and anxiety, with some individuals reporting symptoms of depression and trauma (acierno et al., 2019; deprince & jackson, 2020; lavery et al., 2020; nguyen et al., 2021). for older adults, outcomes may include a loss of financial autonomy and poor physical and mental health (acierno et al., 2019). long-term effects may include poverty, homelessness, institutionalization, and isolation (dessin, 1999). study purpose while much attention has been given to identifying efe costs, prevalence, and risk factors, there has been comparatively little research on person-centered services and treatment approaches to address the trauma of victimization (ernst & maschi, 2018; jackson, 2021; lavery et al., 2020). in this conceptual article, we first review the literature on the conditions and personal risk factors that give rise to different forms of efe and discuss the social and psychological impact of victimization. we use the term “victimsurvivor” to describe people who have experienced various forms of elder financial abuse and fraud, as this term encompasses both types of financial victimization under the umbrella of efe and recognizes a person’s ability to thrive and recover following exploitation. after describing trauma-informed care in the context of efe, we showcase several trauma-informed interventions and treatments for older adults who have experienced other forms of trauma that may be adapted to support efe victim-survivors. we also identify recent studies on promising interventions for efe, such as peer support, service advocates embedded in multidisciplinary teams, financial social work, and advocacy through the legal process. last, we identify barriers to supporting and protecting older adult survivors of efe and offer suggestions for future research and social work practice. our aim is to elevate efe awareness among social work practitioners who are essential in helping older adults rebuild their lives and navigate the journey toward healing and justice. background and existing literature after neglect and self-neglect, efe is the most common type of elder mistreatment reported to adult protective services (aps), although it often occurs in conjunction with other forms of abuse (administration for community living, 2021). there are two primary forms of efe, largely differentiated by the relationship of the perpetrator to the victim. elder financial abuse occurs when someone close to the older adult, such as a family deliema & sommers/elder finaincial exploitation 233 member, friend, neighbor, or caregiver—a “trusted other”—intentionally misuses the older adult’s money and/or property for personal gain. fraud and scams, on the other hand, are largely perpetrated by predatory strangers who use deception and persuasion to manipulate the older adult to transfer money using false threats or promises (deliema, 2018). efe perpetrated by individuals close to the victim-survivor is often associated with dysfunctional family dynamics and co-dependencies in early life that evolve into financial dependence on the older person in later life (liu et al., 2017). family/friend perpetrators take advantage of older adults’ trust to gain access and control over their financial affairs. using tactics such as undue influence, threats to withhold care and companionship, and other methods of power and control, financial abusers may steal the older adults’ money or possessions, forge their signature, illegally transfer assets, cash unauthorized checks, and use the older adults’ resources without permission (chan & stum, 2020). many of these cases involve the misuse of legal tools intended to protect vulnerable adults who are unable to manage their finances independently, such as powers of attorney (poa), trusts, and guardianships (schmidt et al., 2022; steinman et al., 2020). unlike efe perpetrated by friends or family members, scams perpetrated by strangers involve a different set of risk factors and exploitation methods. most scams today are perpetrated by international crime syndicates that use mass marketing tactics to solicit as many people as possible using social media, text message, telephone, email, and postal mail (adorjan & colagouri, 2023). impersonation scams are some of the most common frauds targeting older adults (ftc, 2023). scammers may elicit trust by pretending to be government agents, tech support professionals, bank employees, new romantic interests, and even the target’s friends and family members. scam messages are designed to provoke an intense emotional response such as fear (e.g., “your bank account has been compromised,” “your grandson is in jail”), or excitement (e.g., “you won a sweepstakes drawing,” “this investment will double your money,” “we’ll be together forever”). research in psychology and behavioral economics demonstrates that high arousal emotions impair rational decision making because they draw cognitive resources and attention away from processing the deceptive cues in the message (kircanski et al., 2018; langenderfer & shrimp, 2001; wang et al., 2012). while adults of all ages are targeted using these tactics, older adults’ reasoning may be particularly affected by high arousal emotions due to age-related declines in processing speed and deception detection. for example, prior research shows that poor executive functioning, challenges with working memory, and even mild cognitive impairment are associated with greater susceptibility to scams (ebner et al., 2020; han et al., 2016; judges et al., 2017; lachs & han, 2015; spreng et al., 2016; yu et al., 2021). technological advances in generative artificial intelligence (ai) have the potential to drastically increase rates of fraud (king et al., 2020). recent news reports have chronicled the alarming use of voice and image “deepfakes” where the voices and likenesses of victims’ relatives and co-workers are cloned, deceiving them into transferring substantial funds (flitter & cowley, 2023). in the absence of forward-thinking regulations and enforcement to limit the deceptive use of ai, the prevalence and cost of these scams is sure to rise. advances in social work, spring 2025, 25(1) 234 as shown in table 1, risk factors vary based on the type of efe. for financial abuse perpetrated by family or friend offenders, negative interactions with close network members (liu et al., 2017) and functional dependency (acierno et al., 2020; beach et al., 2010) increase exploitation risk. in efe perpetrated by strangers (i.e., scams and fraud), risk factors typically vary based on the type of scam (deliema et al., 2023). prior research suggests that psychosocial and cognitive characteristics such as isolation, loneliness, financial insecurity, poor psychological well-being, financial risk seeking, and declines in financial decision-making capacity are associated with scam susceptibility and victimization in older adults (fenge & lee, 2018; james et al., 2014; liao et al, 2024; lichtenberg et al., 2019). there are few empirical studies on the characteristics of financial scammers, but research has documented characteristics associated with financial abusers who are relatives and friends. these include substance use disorders, mental health issues, a sense of entitlement, and personal legal and financial troubles that result in financial dependency on the older person (betz-hamilton et al., 2023; steinman et al., 2020). in a sample of cases reported to aps, conrad and colleagues (2019) found that reports of efe were associated with substance use problems by alleged perpetrators, but not alleged victims. based on qualitative interviews with family members of efe victim-survivors, betz-hamilton et al. (2023) described that substance use and mental health concerns were common among perpetrators. table 1. individual, perpetrator, and social and contextual risk factors for efe perpetrated by known offenders versus strangers perpetrator is… known* unknown** older adult characteristics cognitive impairment functional impairment older age poor mental health prior history of abuse financial insecurity financial risk seeking tendency lack of knowledge about scam types and persuasion tactics poor psychological well-being poor financial literacy poor executive functioning/poor financial decision-making capacity perpetrator characteristics access to older person's finances financial irresponsibility legal problems mental health concerns personal financial troubles sense of entitlement substance use disorders [lack of sufficient empirical evidence] social & contextual factors fairness conflict negative interactions with close network members social isolation loneliness *known perpetrator: relative, friend, neighbor, caregiver, etc. **unknown perpetrator: scammer, crime syndicate, other financial predator, etc. deliema & sommers/elder finaincial exploitation 235 variations by race and ethnicity efe prevalence and operationalization varies across race and ethnic groups. using survey data, yu and colleagues (2021) found that average scam susceptibility scores in older black adults were statistically lower than older white adults, however beach and colleagues (2010) found that the prevalence rate of efe since turning age 60 was 23% among black older people compared to 8.4% among non-black survey respondents. similarly, laumann et al. (2008) found that the black older adults were 77% more likely to experience financial exploitation relative to white adults. among low-income latinos living in urban los angeles, the annual prevalence of efe was very high—16.7%— although the efe measure had poor internal consistency (deliema et al. 2012). efe was found to have two dimensions in a mixed methods study of older chinese americans: financial exploitation and financial neglect, which refers to failure to provide financial support to an older person experiencing financial challenges. in that study, financial exploitation had a prevalence of 9.2% since turning age 60, and financial neglect had a prevalence of 1.5% (sun et al., 2022). unfortunately, most of these studies did not differentiate exploitation by strangers versus known individuals. studies of immigrant communities in the us suggest that definitions of what constitutes exploitation differs across cultures (e.g., choi et al., 2024; moon et al., 2002; sanchez, 1996). cultures that value collectivism and interdependence may be more accepting of resource sharing and believe in resolving interpersonal conflicts within the family rather than relying on formal intervention. an early study by moon et al. (2002) reported that among four cultural groups of asian americans, koreans reported the highest tolerance for financial exploitation and all cultural groups disfavored outside intervention. in a mixed methods study, lee and eaton (2009) found that although 92% of korean immigrant older adults perceived that efe constitutes elder mistreatment, only two-thirds intended to seek help. choi and colleagues (2024) reported that only 9.3% of chinese american participants responded that they would seek help from aps if they experienced financial mistreatment compared to 33.9% for koreans. because the etiology of efe and how it is perceived differs across race, culture, and immigrant status, treatment approaches to support victim-survivors and prevent revictimization must adapt to the needs, values, and expectations of the victim-survivor and their community. social and psychological impact of efe efe has a long history of stigmatization. feelings of shame and embarrassment are perhaps the most extensively documented outcomes of fraud and scams (cross, 2018, 2019; jackson, 2021). victim-survivors are often blamed for being too “gullible,” “trusting,” and “foolish,” and may be dismissed by police who perceive them as actively having contributed to their own victimization (cross, 2015). as a result, many victimsurvivors feel ashamed and blame themselves, which discourages help-seeking (mcguire et al., 2022). other research documents that scam victim-survivors experience severe emotional distress, persistent mental health problems, trouble sleeping, job loss, divorce, and advances in social work, spring 2025, 25(1) 236 prolonged indebtedness (button et al., 2014; cross, 2018). research has also identified severe anxiety, depression, and suicidality as outcomes of fraud (cross, 2018; deem, 2000), but these and prior studies were not all focused on older adults specifically. efe perpetrated by a trusted family member or friend can feel like a betrayal (hall et al., 2023), leading to enduring adverse consequences like depression, displacement, suicide, and early mortality (deem, 2000; jackson, 2021; lachs et al., 1998). it can be particularly difficult for an older adult to cut ties with an exploiter who provides care, and some victim-survivors choose to endure the abuse rather than risk losing the relationship (jackson, 2021). the impact of efe extends to victim-survivors’ families and society at large. some victim-survivors must turn to family members for financial support or enroll in public benefit programs such as medicaid if their resources are stolen (jackson, 2021). huang and lawitz (2016) highlighted the substantial financial cost imposed by efe in new york, including increased agency expenses ($6.2 million) and public benefit enrollment (over $8 million). efe as a traumatic experience numerous studies have identified the traumatic impact of efe (cross, 2015, 2018; ernst & maschi, 2018; freshman, 2012; hall et al., 2023). glodstein et al. (2010) coined the term “fraud trauma syndrome” (fts) to define an array of symptoms experienced by the victim-survivors of the madoff ponzi scheme which cost thousands of investors more than $64 billion. symptoms of fts include anger, rage, pain, hopelessness, depression, anxiety, fear, nightmares, shock, numbness, emotional despair and devastation. more than half of the victim-survivors in the glodstein et al. (2010) study experienced more than one symptom of fts. trauma experiences can have a lasting effect on some victim-survivors who develop persistent and debilitating symptoms associated with posttraumatic stress disorder (ptsd). ptsd symptoms include intrusive and distressing thoughts, images, and perceptions of the traumatic event, dissociation, avoidance of triggers associated with the event, numbing, and symptoms of reactivity and hyperarousal (american psychological association [apa], 2013). among older adults, ptsd can accelerate declines in cognitive functioning (schuitevoerder et al., 2013), increase loneliness (fox et al., 2021), and strain personal relationships (jackson, 2021). ptsd is also a risk factor for dementia (borson, 2010; günak et al., 2020) and is linked to accelerated cellular aging, poor health, and higher mortality risk (borson, 2010; katrinli et al., 2020). advances in social work, fall 2024, 24(3) 237 figure 1. six principles of trauma-informed care for efe victim-survivors figure 1. six principles of trauma-informed care for efe victim-survivors safety freedom from emotional & financial harm use nonjudgemental communication; avoid victim blaming language trust reliability, transparency, consistency, & boundaries confidentiality; empathetic listening; mirror client's word choice & body language; meet client where they are choice agency over situation and treatment plan explain client's rights; ask for consent; respect client's right to selfdetermination collaboration working together towards a shared goal with shared power information sharing; regular follow-up and check ins; mutual accountability empowerment validation and encouragement to take action advocacy with financial, legal, and criminal justice systems; peer support; education and awareness culture, history & gender background experiences, current context, identity consideration incorporate cultural values into treatment plan; acknowledge intersecting identities principles in practice when supporting efe victim-survivors six principles of trauma informed care for efe victim-survivors 1 2 3 4 5 6 deliema & sommers/elder finaincial exploitation 238 trauma-informed care for victim-survivors of efe re-traumatization is defined as “traumatic stress reactions, responses, and symptoms that occur consequent to multiple exposures to traumatic events that are physical, psychological, or both in nature” (duckworth & follette, 2012, p. 2). trauma-informed care is promoted as a method of preventing re-traumatization, as well as supporting clients through a traumatic experience and its long-term effects (wilson et al., 2013). as shown in figure 1, the core principles of trauma-informed care are (1) safety, (2) trust, (3) choice, (4) collaboration, and (5) empowerment (substance abuse and mental health services administration [samhsa], 2014; wilson et al., 2013). because a victimsurvivor’s personal background and experiences shape how they respond to traumatic events, a 6th core principle is the consideration of cultural, historical, and gender issues (samhsa, 2014). for older adults, historical circumstances like global conflicts, economic shifts, and policy change can impact healing from financial victimization, alongside the reliance on caregivers for some older people. therefore, trauma-informed responses to efe must consider aspects like age, gender identity, dependency, health status, and race (mckenna et al., 2020). in the following sections, we provide examples of promising trauma-informed services and programs for efe victim-survivors and offer recommendations for social work practitioners to integrate trauma-informed principles when working with older adults healing from financial victimization. applying the principles of trauma-informed care to efe as illustrated in figure 1, responses to efe should be client-directed and center on the strengths and goals as defined by the client (wilson et al., 2013). client choice (principle 3) is particularly important when systems, such as criminal justice and healthcare, are organized to prioritize practitioners’ expertise and the public’s interest rather than the victim-survivors themselves (mcguire et al., 2022; ramsey-klawsnik & miller, 2017). for example, in the interest of maximizing client safety, practitioners may aim to stop the victim-survivor from communicating with the alleged financial abuser, even if preserving this relationship is important to the older adult (fraga dominguez et al., 2021). traumainformed practitioners recognize the value of this relationship to the older person and will work with them, other trusted friends and family members, and perhaps the offender to enable positive social interaction while preventing financial access. the practice of balancing safety needs with client choice and autonomy is a critical component of personcentered, trauma-informed care. trauma-informed practitioners should be aware that trauma can cause confusion, inconsistency, and frustration, and that it can be harmful to push victim-survivors to recall details of the crime. when responding to initial reports of efe, social workers should convey warmth through word choice and tone of voice, explain the victim-survivor’s rights (including the right to refuse service), and assume competence until there is evidence of the contrary. many victim-survivors of efe are blamed for victimization and made to feel powerless by financial institutions and law enforcement (cross, 2018; nerenberg, 2008). to empower victim-survivors (principle 5), trauma-informed practitioners advocate on deliema & sommers/elder finaincial exploitation 239 behalf of their clients to ensure their rights are upheld by financial institutions, law enforcement agencies, adult protective services, court systems, and possible creditors. cultivating trust (principle 2) involves incorporating specific communication approaches in which the professional mirrors the language of their client, offers confidentiality, and meets them where they are on their recovery journey. for example, social workers should not refer to the incident as a scam or the perpetrator as a scammer unless these words are used by the victim-survivor. the give an hour (2024) organization advises practitioners to avoid victim-blaming language and phrases such as “the victim fell for the scam.” rather, practitioners should say “the money was stolen in a scam.” this person-centered approach builds trust to improve collaboration in goal setting and working toward recovery. other trauma-informed approaches include asking about the victim-survivor’s values and strengths before focusing on challenges (ramsey-klawsnik & miller, 2017; yatchmenoff et al., 2017). principle six urges trauma-informed practitioners to recognize the victim-survivor’s culture, history, and gender when collaborating on an intervention plan. for example, victim-survivors from cultures that value familism and believe that adult children are responsible for caring for older relatives in the home may harbor strong negative feelings about congregate care settings like skilled nursing facilities. traumainformed practitioners will work with the victim-survivor to identify safer care arrangements where assistance is still provided in the community but by trustworthy family or community members rather than the financially dependent relative. trauma-informed therapeutic approaches although there has been little research on trauma-informed interventions specific to efe, significant research has focused on psychotherapeutic treatments for ptsd in older veterans, adult victim-survivors of domestic violence (ward-lasher et al., 2017), and older adults with depression that may be modified to support older victim-survivors of financial crimes. like efe, domestic violence is also known for high rates of revictimization (cross, 2020; krause et al., 2008). trauma-informed psychotherapeutic interventions that have been found to be effective in reducing trauma symptoms and empowering victim-survivors of domestic violence include cognitive behavioral therapy (cbt), interpersonal therapy (ipt), and eye-movement desensitization and reprocessing (emdr; condino et al., 2016). cbt involves changing cognitive and behavioral patterns using problem-solving skills, reflection and processing, and building confidence (apa, 2017a). cbt is an effective treatment for older adults, especially when modifications are made to address physical health and spiritual or religious beliefs (cox & d’oyley, 2011). similarly, ipt is a time-limited treatment that focuses on improving interpersonal functioning by helping the client process the current context and its impact on relationships (center for addiction and mental health, 2024). research indicates that ipt and cbt are highly effective when treating adults with depression and ptsd (hinrichsen, 2018). more evidence is needed to assess how social workers can effectively adapt these interpersonal therapies to the specific needs of efe victim-survivors, including those with chronic health conditions, such as dementia, that can impact sensory functioning and advances in social work, spring 2025, 25(1) 240 information processing (pless kaiser et al., 2019). communication adaptations may include speaking more slowly, providing sufficient time for responding, and eliminating background noise (speros, 2009). interventions such as cbt can be modified using visual aids, and skill based interventions can be adapted to include increased repetition to make the information more salient and accessible (robinson & moghaddam, 2022). promising evidence from a systematic literature review of ptsd treatments for people with dementia found that clients experienced a decrease in ptsd symptoms after receiving interventions that included emdr, prolonged exposure therapy, and other treatments (ruisch et al., 2023). ramsey-klawsnik and miller (2017) recommend that when working with survivors of abuse in later life, practitioners may provide psychoeducation about common stress responses to traumatic events, such as the mental, cognitive, and physical health effects. recognizing these responses to trauma helps victim-survivors identify coping strategies. social workers can also encourage emotion regulation strategies like breathing exercises, journaling, reaching out to trusted people, going outside, and listening to music (jennings, 2008; ramsey-klawsnik & miller, 2017), as well as mindfulness interventions that use short, guided meditations and focus on one sensory input at a time (robinson & moghaddam, 2022). peer support groups there is emerging evidence that peer support groups can empower fraud victimsurvivors through mutual support and understanding. cross (2019) qualitatively documented the effects of an in-person peer support group for adult victim-survivors of romance scams. participants reported that engaging with their peers helped them reconcile with victimization and feel less alone. although some of the participants in the peer support group were younger than age 60 and all experienced the same type of fraud, findings suggest that the peer support model is a promising approach. recent work by give an hour (2024) suggests that peer support groups help victim-survivors recover from trauma through empathetic dialogue that reduces stigma, therapeutic storytelling to build resilience and control over the narrative, and learning practical financial and emotional recovery strategies from others. moreover, peer support groups may be effective tools in efe prevention because they promote co-learning about the warning signs of scams and exploitative behavior. peer support may also address the need for emotional connection and regular social engagement, further protecting older adults from financial harm. future research should assess the efficacy of peer support programs for older adults who have experienced financial abuse by friends/family. financial and legal advocacy many efe victim-survivors need help covering basic living expenses, affording medical care, navigating debt, safeguarding financial accounts, and maintaining their independence. while social workers should never promise that stolen funds will be recovered, they can assist victim-survivors with goals focused on financial protection and stability, including negotiating with creditors to alleviate financial burdens, applying for deliema & sommers/elder finaincial exploitation 241 public benefit programs, and connecting with legal representation. financial social work and financial gerontology offer person-centered frameworks to partner with clients to set goals and build financial resilience (sherraden et al., 2016). this may include providing guidance on budgeting, money management, estate planning, and financial literacy. one example of a holistic financial gerontology coaching program is successful aging through financial empowerment (safe). the program is designed to support older adults who have experienced efe and/or identity theft (lichtenberg et al., 2019). safe program staff offer one-on-one support with financial management, assist clients with filing consumer complaints, and educate victim-survivors on scam prevention tools such as closing compromised accounts and placing fraud alerts on credit reports. evidence suggests that older victim-survivors who receive safe services experience lower anxiety and are better informed about how to protect their finances (hall et al., 2022; lichtenberg et al., 2019). the safe program primarily serves urban african american efe victim-survivors. future research is needed to adapt safe services to other populations and cultures that practice different norms around the use of financial resources within families and who may express different financial goals, such as asian and hispanic efe victim-survivors. although very few efe perpetrators are criminally prosecuted (navarro et al., 2013), assisting victim-survivors with navigating the justice system is an important form of advocacy. social workers who work as victim service advocates are essential in ensuring that victim-survivors feel safe throughout criminal proceedings and that their needs are heard and respected (fried et al., 2014). although there is no empirical research on the effects of victim service advocates in efe, research in the field of domestic violence indicates that the presence of a victim service advocate increases survivors’ cooperation in prosecutions (camacho & alarid, 2008). given that many victim-survivors are not receptive to criminal prosecution, particularly minoritized older adults (enguidanos et al., 2014) and those exploited by close relatives (jackson & hafemeister, 2011), focusing on civil remedies instead can help empower and protect victim-survivors. however, given the cost of civil legal representation and the special expertise required, many clients need support from free and targeted legal services (sinha et al., 2021). beck et al. (2015) explored restorative justice interventions as a means to promote older adults’ self-determination, find closure for past harms, and heal from traumatic experiences. restorative justice modalities, such as victim-offender dialogue and family group conferencing, entail facilitated interactions between victims, offenders, and other relevant stakeholders. restorative justice approaches could be healing for victim-survivors exploited by close family members or friends by repairing bonds, promoting accountability, and ensuring relationship continuity. racial and ethnic groups that prefer to address conflicts within the family unit or that have historically been harmed by the traditional justice system may prefer restorative justice approaches to prevent efe. however, restorative justice in cases where perpetrators have no prior relational ties with the victim-survivor, such as in scams and fraud, is not advised. advances in social work, spring 2025, 25(1) 242 care coordination many efe victim-survivors present with underlying health, financial, and social needs, with efe being just one of many complex symptoms. addressing these underlying needs through coordinated care is essential to reducing the risk of future victimization. several of the most promising domestic violence interventions for both children and adults have involved a community-action approach where services are coordinated between community-based programs (e.g., legal advocacy, mental health) and criminal justice agencies (police and prosecutors). deprince and colleagues (2012) conducted a longitudinal randomized controlled trial and found that community-based outreach reduced reported distress in victim-survivors of domestic violence. care was tailored to the direct psychosocial needs of each victim-survivor and services were appropriately matched, resulting in significant psychological gains. by coordinating services, victim-survivors did not have to retell their story and experience re-traumatization as they sought help (deprince et al., 2012). multidisciplinary teams (mdts) have emerged as a model for addressing complex cases of elder maltreatment, including efe (e.g., deprince et al., 2019; ernst & smith, 2012). the composition of elder abuse mdts varies, but most include participants from aps, law enforcement agencies, ombudsman programs, public guardian offices, civil and/or criminal justice systems, and healthcare professionals. mdts specifically focused on efe—called financial abuse specialist teams (fast)—may also include a forensic accountant to help track stolen funds and support law enforcement efforts (dauenhauer et al., 2020). the goal of mdts is to facilitate interagency collaboration and information sharing across disciplines, enabling professionals to identify and work together on case-specific goals (deprince et al., 2019). a critique of the current mdt model is that teams tend to prioritize the values and case goals of the professionals, such as conservatorship referrals (gassoumis et al., 2015) and offender prosecutions (navarro et al., 2013), over the values and goals of victim-survivors who do not participate. while victim-survivors also want to be safe and well, they may prefer to remain in high-risk situations if the alternative is losing their relationship with the perpetrator and/or being moved to an institutional care setting. new collaborative intervention models are attempting to center the victim-survivors’ goals in the mdt case planning process (burnes et al., 2023; martinez et al., 2023). martinez and colleagues (2023) conducted a case study to assess the impact of embedding a service advocate within an mdt whose role is to build trust with the victim-survivor through longer-term engagement and to elicit their views on what help is needed. using a person-centered approach, service advocates help victim-survivors and professionals on the mdt negotiate tradeoffs between harm reduction goals and personal autonomy goals. reporting on a case study, martinez et al. (2023) documented how the service advocate helped a vulnerable adult feel empowered during the case planning process by ensuring that she maintained mastery and stability in her life and that her goals for staying connected to the alleged perpetrator were prioritized by the mdt. at the same time, the mdt’s goals for enhanced safety were met when the service advocate motivated the vulnerable adult to accept limited in-home professional care as well as health and financial decision-making deliema & sommers/elder finaincial exploitation 243 support from a trusted family member. more research is needed to assess whether embedding person-centered, trauma-informed practices within mdts is feasible and effective in empowering victim-survivors to accept protective interventions. barriers to trauma-informed care for efe victim-survivors ensuring that victim-survivors of efe have access to trauma-informed care is a substantial challenge given the lack of financial, criminal, and civil justice remedies available. nerenberg (2000) explains that the widespread perception that financial crimes are less serious or harmful than other crimes has led to a persistent lack of resources to prevent and respond to efe, particularly in areas that have scarce resources for older adults who need comprehensive social, psychological, and caregiving support. in addition to few trauma-informed services, many victim-survivors encounter a lack of understanding from friends, relatives, and law enforcement, which discourages helpseeking (cross, 2015; sinha et al., 2021). like in many other forms of elder mistreatment, efe victim-survivors may not know how or where to report (parti & tahir, 2023) and have little faith that reporting efe will improve their situation (nerenberg, 2008). reynolds and colleagues (2020) found that treatment refusal among older adults may also be associated with fear, mistrust, resistance to being labeled with a mental health problem, and difficulties navigating the help-seeking process. other reasons for resisting intervention are that victim-survivors may hold deep familial bonds with perpetrators, fear retaliation, and/or fear losing their independence (jackson & hafemeister, 2011). when a perpetrator provides personal care to the older adult at home, intervening can increase the likelihood that the victim-survivor will be moved to a long-term care facility. outright denial of victimization among older adults who have experienced scams may stem from a persistent belief that the scam or scammer are legitimate and an unwillingness to end a relationship with a scammer who may provide regular social interaction (cross, 2020; fenge & lee, 2018). new research suggests that motivational interviewing—a collaborative technique in which practitioners empower clients to facilitate change—may be helpful for elder abuse survivors who are initially ambivalent about changing an abusive situation (macneil et al., 2023). another perceived barrier is that victim-survivors with advanced dementia may lack capacity to actively participate in some forms of trauma informed treatment, however several studies on person-centered trauma-informed care have shown that many adults with cognitive impairment have capacity to reason through choices and express their goals (couzner et al., 2022; martinez et al., 2023). social workers should empower victimsurvivors with cognitive impairment by involving them in all aspects of treatment to the extent possible. last, although social workers are among the first responders to efe, most have insufficient training on crime victimization, especially on effective treatment approaches for older adults with underlying needs. this is despite that social workers are mandated reporters in most us states (ernst & maschi, 2018). most social workers also lack personal finance training and tools to build clients’ economic self-sufficiency and confidence (frey et al., 2017; stuart, 2016). in light of the growing older adult population and in pursuit of advances in social work, spring 2025, 25(1) 244 “financial capability for all”—one of the grand challenges for social work (huang et al., 2018)—more curriculum and training in financial social work are needed. recommendations for social work practice the 1984 victims of crime act (voca) established the crime victims fund to support victim restitution, counseling, advocacy, and support services. eligibility criteria were expanded in 1996 to include victim-survivors of financial crimes. programs that use voca funds can help efe victim-survivors with emergency shelter and food, mental health services, restitution advocacy, credit counseling, and other direct support, although voca funds cannot be used to directly reimburse stolen money or property. unfortunately, a recent study of victim compensation programs found that victim-survivors of elder mistreatment underutilize these programs relative to other victim groups (navarro et al., 2024). social workers can support victim-survivors by learning about organizations that provide voca-funded services and by making referrals. reducing efe stigma must be a core component of all trauma-informed services. social workers can debunk harmful myths about who is susceptible to efe by emphasizing that financial predators are experts in social engineering and undue influence tactics, meaning that people of all ages are vulnerable to exploitation. improving report writing practices to use affirming language and eliminate bias in official documentation is also essential. along with law enforcement, criminal justice agencies, victim services, and healthcare providers, social workers must continuously work to prevent victim blaming and ensure unbiased justice for survivors (cross, 2015; mcguire et al., 2022). studies on efe risk factors indicate that social isolation, negative interpersonal relationships, loneliness, and financial insecurity are common among victims (deliema, 2018; liu et al., 2017). these characteristics may be promising targets for efe prevention and treatment. social workers can help older clients address problematic social relationships in their lives, educate them about common scams and the need to protect resources from financially dependent relatives, and refer them to community organizations that provide social engagement and enrichment. other research suggests that increasing psychological wellbeing can reduce scam susceptibility among older adults (sur et al., 2023). using a trauma-informed approach that centers clients’ abilities and interests, social workers can help clients identify volunteer opportunities and other generative activities that promote wellbeing. to date, research has not addressed how social workers can help vulnerable older adults become more resistant to deception and identify harmful intentions in others. research from psychology, however, indicates that forewarning older targets about the tactics used in scams reduces vulnerability but that the effects of education and scam awareness diminish over time (scheibe et al., 2014). social work interventions may also target risky behaviors exhibited by efe perpetrators, such as providing mental health services and treatment for substance use disorders. a recent case study of a family-centered efe intervention showed that after engaging in treatment for alcohol use and a gambling disorder, a perpetrator was able to deliema & sommers/elder finaincial exploitation 245 rebuild relationships with family members, restore trust, and repay the older adult (kilaberia & stum, 2022). advance financial planning can also reduce opportunities for efe by ensuring that older adults have a legally appointed person or people to act as their agent(s) under power of attorney (poa). advance financial care planning is trauma-informed because it empowers the older adult to choose who they trust to help manage their money and property and make reasoned financial decisions (zheng & deliema, 2024). having a poa can reduce the potential for guardianship in which a decision-maker is appointed by the court, as well as reduce the risk of financial opportunists inappropriately gaining financial control. practitioners engaged in financial social work should encourage all aging clients to engage in advance financial care planning by highlighting the benefits of having a legally appointed person they can rely on. gaps and limitations of existing research there is very limited literature on the aftermath of efe, including the efficacy of trauma-informed interventions. given the complexity of efe, the field of social work needs to focus on the development and evaluation of holistic treatment approaches that address the victim-survivor’s underlying needs, which may incorporate services from social service agencies, healthcare providers, law enforcement agencies, financial institutions, and legal professionals. moreover, there is a significant absence of research on efe interventions tailored to victim-survivors from minoritized race and cultural groups who may hold different perspectives on the use of financial resources within families and how to address family conflict. researchers must evaluate the extent to which different treatment approaches support diverse victim-survivors’ social and emotional recovery, as well as their effectiveness at preventing revictimization and re-traumatization. conclusion elder financial exploitation is a growing economic and social issue that requires trauma-informed responses and preventative approaches to protect and support our growing older adult population. as mandated elder abuse reporters in most u.s. states, social workers need to be trained on the signs of efe and where to report exploitation when it is suspected (ernst & maschi, 2018). they also need access to trauma-informed treatment approaches that foster resilience and self-efficacy, reduce self-blame, rebuild trust, and provide a sense of community. social workers can also help victim-survivors navigate the financial aftermath of exploitation, advocate for restitution, and participate on multidisciplinary teams where members address legal and safety concerns while still prioritizing victim-survivors’ personal values and psychosocial needs. by offering comprehensive care that addresses both the practical and emotional needs of victimsurvivors, social workers play a vital role in advocating for justice and promoting the financial well-being of all older adults. advances in social work, spring 2025, 25(1) 246 references acierno, r., hernandez, m. a., amstadter, a. b., resnick, h. s., steve, k., muzzy, w., & kilpatrick, d. g. 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(2024). why plan ahead? a focus group investigation on barriers in advance financial care planning. journal of financial counseling and planning, 35(3), 400-409. author note: address correspondence to marguerite deliema, school of social work university of minnesota, saint paul, mn 55108. email: mdeliema@umn.edu author orcid: marguerite deliema, university of minnesota https://orcid.org/0000-0002-9807-5910 https://doi.org/10.1080/08959420.2021.1914884 https://doi.org/10.1080/08959420.2021.1914884 https://doi.org/10.1177/07334648231196850 https://doi.org/10.1177/07334648231196850 https://doi.org/10.1177/07334648231196850 https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html https://ieeexplore.ieee.org/abstract/document/6289402 https://ieeexplore.ieee.org/abstract/document/6289402 https://ieeexplore.ieee.org/abstract/document/6289402 https://doi.org/10.18060/21313 https://doi.org/10.18060/21313 https://doi.org/10.18060/21313 https://doi.org/10.1093/acrefore/9780199975839.013.1063 https://doi.org/10.18060/21311 https://doi.org/10.18060/21311 https://doi.org/10.1159/000515326 https://doi.org/10.1159/000515326 https://doi.org/10.1891/jfcp-2023-0061 https://doi.org/10.1891/jfcp-2023-0061 mailto:mdeliema@umn.edu https://orcid.org/0000-0002-9807-5910 ______________ lewis h. lee, phd, msw, assistant professor, the university of alabama school of social work, tuscaloosa, al. sung-ju kim, phd, mssa, assistant professor, north carolina state university school of social work, raleigh, nc. copyright © 2020 authors, vol. 20 no. 1 (spring 2020), 95-113, doi: 10.18060/23600 this work is licensed under a creative commons attribution 4.0 international license. the effect of government grants on private giving to east asian nonprofits: implications for social work managers lewis h. lee sung-ju kim abstract: for effective financial management, social work managers must clearly grasp the relationship between government grants and private contributions, which is frequently characterized as crowding-out effects. crowding-out effects have been investigated for various types of nonprofits in the u.s., and the results have been mixed. in spite of its popularity in nonprofit research, the theory has not been applied to nonprofits serving minority communities. this is the first pilot crowding-out study looking at east asian nonprofit organizations, including chinese, korean, and japanese-american nonprofits in the ny and nj metropolitan area (n = 410). through a panel analysis, the current study found a significant crowding-in effect for donations to east asian-american nonprofits (p < .01). the relationship between government grants and private giving was different for each east asian-american nonprofit organization. particularly, donors of chinese and japanese-american nonprofit organizations donated more money when their charities received more government grants (p < .05). in contrast, we found crowding-out effects for korean-american nonprofit organizations, but the result was not significant (p > .05). the estimated crowding-in effects of government grants on private giving by each of the east asian countries were explicated based on each country’s social, political, and cultural background such as the quality of the charity, transparency, and political trust. social work managers in ethnic nonprofit organizations should establish different strategies to help shape donor giving patterns according to the effect of government grants. keywords: crowding-out effect; east asian-american (chinese, korean, and japanese) nonprofit organizations; government grants; macro social work practice; private giving one of the important roles expected of social work managers in macro practice is effective management and leadership by generating big picture thinking (reisch, 2017). keen financial management, which is a core aspect of big picture thinking, is an especially needed skill of social work managers in human service organizations (meezan & mcbeath, 2011; wimpfheimer, 2004). a social work manager’s ability to accurately assess the financial needs of the organization is critical for efficient financial management (wimpfheimer, 2004). to assess such needs, macro practitioners, including those working in human services management, should be familiar with the mechanisms of financial inflows to promote the financial health of their organization (lohmann & lohmann, 2002; rapp & poertner, 1992). during the last several decades, human services nonprofit organizations in the u.s. have faced fiscal pressures due to various reasons, including dwindling government support, downsized private giving, and a decline in earned revenues (de wit & bekkers, 2017; young et al., 2010). among the identified financial sources for nonprofits, including government subsidies, private giving, service fees, and other investments, prior studies highlight that over three-fourths of nonprofit revenues came from either government funds or private giving defined as charitable donations from a single individual, family, corporation, https://creativecommons.org/licenses/by/4.0/ lee & kim/effect of government grants 96 and/or foundation (60% government funds, 19% private giving; boris et al., 2010; lohmann & lohmann, 2002; national council of nonprofits [ncn], 2010; rapp & poertner, 1992). due to these two sources of funding making up such a large portion of nonprofit revenues, the relationship between government grants and private giving in human services nonprofit organizations, known as the crowding-out effect, which is an economic theory suggesting when the government gives a grant to a private charitable organization, private giving will be driven down, has been examined through a body of literature in nonprofit studies (andreoni et al., 2014; heutel, 2014; kim & van ryzin, 2014; lu, 2016). tinkelman (2009) and de wit and bekkers (2017) reviewed prior studies related to the crowding-out effect using the meta-analysis method. tinkelman (2009) identified 46 empirical and non-empirical studies and summarized their findings. de wit and bekkers (2017) analyzed 70 studies that matched the crowdingout effect topic and identified 422 findings of crowding-out/in effects from the studies. the crowding-out effects have been investigated using various hypotheses, research methods, datasets, and different types of nonprofit organizations. despite a wide array of efforts that have been dedicated to examining the crowdingout effect between government grants and private giving to nonprofits, all of the prior studies on this topic have investigated nonprofit organizations in mainstream society. thus far, scholarly research has not examined the crowding-out effect for nonprofits serving culturally-specific communities in the u.s. asian-american nonprofit organizations have expanded along with the rapid growth of asian-american populations compared to other minority communities during the last two decades (hung, 2005; hung & ong, 2012). yet, asian-american nonprofit studies have not been highlighted by nonprofit researchers. like other nonprofits, financial management is a significant issue for asian-american nonprofit organizations. a lack of experience in securing public and private funding resources has a significant impact on asian-american nonprofits’ sustainability (hung & ong, 2012). this pilot study investigated the crowding-out effect targeting asian-american nonprofit organizations in the u.s. this paper seeks to fill the gaps in the literature by examining the relationship between government funding and private donations to asian-american nonprofits. particularly, we focus on east asian-american nonprofits like the chinese, japanese, and korean-american organizations in the new york and new jersey metropolitan area, given that east asian groups made up the majority of asian-american nonprofits (hung, 2005). the aim of this study was to expand our understanding of the nature of fiscal resources, particularly for those rooted in the macro social work perspective and social work managers serving in east asianamerican nonprofit organizations. literature review diversifying revenue sources is critical to an organization’s fiscal health (rebetak & bartosova, 2019). such fiscal sources are also known as a critical organizational domain in community practice (hardcastle & powers, 2004). rohayait et al. (2016) highlight that nonprofits need to recognize various factors related to financial management aligned with both internal and external environments that impact their funding mechanisms. there are four major mechanisms intertwined with such forces advances in social work, spring 2020, 20(1) 97 or trends for funding the organization, including government grants, private giving, service fees, and other investments (rapp & poertner, 1992). since a major focus of the current study is the relationship between government grants and private giving, given the fact that government funds and private giving are comprised of major financial sources of nonprofit revenues (ncn, 2010), a detailed discussion of other financial mechanisms is beyond the scope of this study. therefore, we examined the effect of government grants on private giving, which is typically guided by the theory of crowding-out effects as a major area of fund-raising (rebetak & bartosova, 2019). the relationship between government funding and private contributions as mentioned earlier, crowding-out effects theorize that an increase in one area is associated with a reduction in another area (i.e., increased government grants correlate with a decrease in private giving). the crowding-out effect assumes that the amount of charitable support changes over time as donors become aware of government grants being channeled to the organization (horne et al., 2005; lu, 2016). many studies on crowding-out effects have investigated the relationship between government grants and private donations using different analytical methods, focused on various nonprofit subsectors, and with particular subsamples (de wit & bekkers, 2017). according to de wit and bekkers (2017), there were mixed results in terms of the estimated coefficients of the relationship between government grants and private giving for nonprofit organizations. some studies reported a partial crowding-out effect (andreoni & payne, 2011; cuellar, 2004; dokko, 2009; hungerman, 2009; lindsey & steinberg, 1990), while others found a crowding-in effect, occurring when higher government grants lead to an increase in private giving (payne, 2001; smith, 2007). other studies revealed there was no significant relationship between government grants and private giving (khanna et al., 1995; lindsey & steinberg, 1990). tinkelman (2009) reported there were 134 crowding-out effects documented in 46 published and unpublished studies on the relationship between government funding and private donations. de wit and bekkers (2017) reported 262 crowding-out effects and 160 crowding-in effects in 70 studies. the estimated crowding-out coefficients varied, but approximately $0.17 of private giving decreased per dollar of government grant increasing across all of the prior studies with a 95% confidence interval (de wit & bekkers, 2017). ambiguous correlations between government funding and charitable giving were also reported in other studies (andreoni et al., 2014; kim & van ryzin, 2014). in sum, existing studies indicate the relationship between government grants and donations has been proven inconclusive in three ways: increased government funding is associated with private donors giving either less money, more money, or there is no statistically significant difference. in spite of such mixed results, what has been predicted more often in the relationship between government grants and private giving is the crowding-out effects at lower coefficient levels in the majority of the studies (heutel, 2014). a major reason for examining the crowding-out effect in nonprofit research is not only to identify the role of nonprofits as a service delivery system intertwined with policy through government subsidies, but also to strengthen nonprofit management to increase the number of private donors (tinkelman, 2009). particularly, the latter is more important for nonprofits, given that private contributions are considered a primary lee & kim/effect of government grants 98 source of revenues for many nonprofits (horne et al., 2005). if nonprofits are aware that government grants crowd out private giving, it is more likely that organizations would adapt strategies that motivate and inspire donors to give (heutel, 2014), rather than focusing on grant winning proposals. on the other hand, if government grants signal nonprofits’ quality of services, which brings about crowding-in effects, such background information would be strategically employed by the organization’s management (heutel, 2014). therefore, investigating the crowding-out effect allows for a clearer understanding of the relationship between the two components that may lead to more stable funding mechanisms for the organizations (tinkelman, 2009). in spite of such importance, however, the theory of the crowding-out effect has not been applied to nonprofits serving asian-american communities. this oversight has occurred even though asian american philanthropy is considered an emerging area in nonprofit research as the asian-american population and thus the number of organizations have been growing (hung, 2007; semple, 2013). background of asian-american nonprofit organizations the asian population in the u.s. grew 72% between 2000 and 2015, making it one of the fastest growing minority groups in the u.s. nearly 20 million asian-americans made up 6.3% of the total u.s. population in 2015 (lópez et al., 2017). as the population has grown, asian-american communities not only have initially developed informal organizations to create self-help networks, but also have provided formal and organized assistance by establishing nonprofit organizations (hung, 2007). according to hung, (2005), approximately 2,400 asian-american nonprofits were formed between the 1980s and the 2000s, which equate to a 350% growth rate. although hung’s study was published more than a decade ago, it remains a pathfinder that explores asian-american nonprofits’ nature including financial size and is still the most recent one to our knowledge. asian-american nonprofits can be categorized based on target populations for services: pan-asian americans, which refers to organizations established to enhance the interests of all asian-americans, and ethnic nonprofits, referring to organizations with a focus on a specific ethnicity (hung, 2005). among 2,404 asian-american nonprofits in 2000, the majority of the organizations were identified as ethnic-focused nonprofits, with 82.6% spread out among three east asian-americans: chinese, japanese, and korean ethnicities (hung, 2005). such results are consistent with the more recent study of hung and ong (2012), who reported that more than 75.1% of asian nonprofit organizations in the u.s. identified that their target populations for services were either chinese, korean, or japanese. organizational size as a determining factor for sustainability, often measured by fiscal resources such as annual revenue (hung & ong, 2012), is a limitation among asian-american nonprofits (hung, 2005). for example, hung (2005) assessed the general financial size of asian-american nonprofits to be small and that less than 750 of 2,400 asian-american nonprofits have filed form 990. form 990 is the internal revenue service (irs) document for gathering information about tax-exempt organizations and providing nonprofit organizations’ financial statements to the public. all registered nonprofits in the u.s. are required to disclose their financial information on form 990 by annually submitting it to the irs. among those that filed form 990, less than half had annual revenues in excess of $25,000, excluding religious institutions (hung, 2005). in addition, only a small portion of private grants have been awarded to http://www.pewresearch.org/author/glopez/ advances in social work, spring 2020, 20(1) 99 asian nonprofits in the u.s. the greenlining institute reported that only 1.5% of national foundation grants were awarded to asian-led organizations, while 92.3% of national foundation grants were delivered to white-led nonprofit organizations in 2005 (gonzalez-rivera et al., 2008). the prior studies highlight that asian nonprofits in the u.s. are more susceptible to challenge or failure (hung & ong, 2012). in a situation where developing fiscal resources has become a critical managerial issue (hung & ong, 2012; young, 2010; yung et al., 2008), asian-american nonprofits must equip themselves to adopt revenue strategies to stably acquire, effectively maintain, and strategically diversify financial resources to ensure organizational survival (chao, 1999; froelich, 1999). in the context of the growth in asian populations and nonprofit organizations in the u.s., one should note that the growth of the population also signifies an increase in private donations by asian-americans (semple, 2013). for example, according to tsunoda (2010), asian donors donated more than $120 million to various american higher educational institutes between 2006 and 2009. tsunoda (2010) points out some distinctive qualities between asian-american and non-asian-american donors, asserting that asian-american donors have different motivations for giving than western donors. expressly, asian charitable giving tends to be private, personal, and small while western donation practices are often public, large, and professional (tsunoda, 2010). these differences may be based on the fact that ethnic asian populations, especially those who are foreign-born, have a strong sense of cultural and political views influenced by the unique context of their respective home countries (pew research center, 2013), which implies giving patterns to asian-american nonprofits may vary based on these differences. regarding such cultural and political views, an important concept that should be understood is political trust, which is an indicator of political legitimacy and is vital to regime stability, particularly in asian societies (wong et al., 2011). political trust indicates citizens’ perceptional confidence in their government; such political institutions are evaluated by people’s levels of trust toward their political system based on their normative expectations (wang, 2016). a critical factor that is essentially and positively associated with the level of political trust toward government in asian societies is economic performance (wang, 2016). in some asian countries, such as china, singapore, taiwan, south korea, and japan, political trust is closely related to and interdependent with social trust (lee & yi, 2018; wang, 2016), which refers to a generalized trust that people will uphold shared social norms and rules defined by one’s society to create societal stability (vallier, 2019). political trust influences people to be more likely to trust any government-sponsored support (bosacianu et al., 2013). the current study a clear grasp of the nuances associated with enhancing financial resources is especially critical for asian-american nonprofits due to the small scale of their fiscal budgets. related to this, applying crowding-out effects to the organizations will provide a possible way to examine how much these organizations diversify their fiscal resources and depend on those resources. the present study scrutinized the relationship between government grants and private donations among the three east asianamerican nonprofit organizations (chinese, korean, and japanese nonprofits) in the new york and new jersey metropolitan area, which is home to the second largest asian population in the u.s after california (pew research center, 2013). we targeted lee & kim/effect of government grants 100 east asian nonprofit organizations in the new york and new jersey metropolitan area not only because prior studies on the profile of nonprofit organizations focused on major urban areas, including new york (wolpert et al., 2003, as cited in hung, 2007), but also because more than half of asian nonprofits are located here (hung, 2007). the main reasons why we focus on comparing these three groups are as follows: first, as previously explained, east asian groups made up most asian-american nonprofits (hung, 2005). second, it should be noted that understanding these ethnic groups is complex since both homogeneous and heterogeneous characteristics are embedded in these ethnic groups. for example, these groups are homogenous, in that they tend to share confucian traditions and similar immigration histories in the u.s.; the number of immigrants from these national origins grew rapidly since national origin quotas were eliminated by the immigration act of 1965 (okamoto, 2003; zong & batalova, 2017). on the other hand, they are also heterogeneous, in that the groups had antagonistic relationships in the past (e.g., korean and chinese historical antagonism toward japan due to the brutal nature and consequences of japanese imperialism), which still continues to affect each other (okamoto, 2003). with this in mind, there are intergroup dynamics within each ethnic boundary as well as intragroup dynamics within a larger, panethnic asian-american group boundary. independently analyzing the giving pattern of each ethnic group, thus, is necessary to essentialize differences among them. due to these reasons, our goal was not to generalize the findings, but rather identify possible variations in the relationship between government funding and private giving among three different ethnic communities. based on the assumptions of the crowding-out effect theory and prior studies on this topic (alpizar et al., 2014; andreoni & payne, 2003; andreoni et al., 2014), we formulated the following research hypotheses: hypothesis 1 (h1): the amount of private giving for east asian-american nonprofits will vary when the agencies receive government funding. hypothesis 2 (h2): the relationship between government funding and private giving will differ according to ethnic group. method data and sample financial information was collected from form 990, filed by the east asianamerican nonprofit organizations using the guidestar database, which provides key financial information on charities’ performance in a simple way. from guidestar, the most recent three years of form 990 were collected for this study, going back from 2016. however, not all agencies provided the forms from consecutive years (i.e., 20142016). that is, some agencies reported non-consecutive years, thus, the total range of years that were reported in the database varied from 2007 to 2016. we listed the organizations with chinese, korean, or japanese in their names to identify the three east asian-american nonprofits. organizations that did not identify their target populations in their names were not included in this study. since there was no dataset with only asian-american nonprofits, we believe that this was a simple and efficient method to sort out our target samples. in the results, a total of 1,481 east asianamerican nonprofit organizations were listed. among the listed organizations, 1,071 advances in social work, spring 2020, 20(1) 101 were ruled out because the form 990 was not reported. for the descriptive analysis in this study, a total of 410 east asian-american nonprofit organizations were analyzed. measures the dependent variable was the total amount of donations reported in each organization’s form 990. the independent variable was calculated with total government grants as reported in the subsection of “government grants” under the part viii statement of revenue in form 990. in calculating total government grants, we excluded the reimbursements for providing services by the organization under government contracts, as suggested by andreoni and payne (2011). andreoni and payne (2011) affirmed that the reimbursements for service provisions by the government should be excluded because it covers any payments received by the nonprofit for the services provided. these types of payments are reported on a nonprofit’s tax return under program service revenue. in our analysis to estimate the crowding-out effect, we used the lagged variable of the government grants as an explanatory variable to correspond to a possible endogeneity. in the econometric model, the lagged variable is used to predict the current value of the government grant based on previous value. achen (2000) suggested that lagged variables should be controlled because of the bias of exogenous variables in the panel data, especially for those with a small number of time-points. in the literature on crowding-out effects, the bias caused by omitted variables is considered a problematic issue for accurately estimating crowding-out effects. this could be solved by including the lagged government grants, even though the lagged variable model comes with new assumptions (wit & bekkers, 2017). we also included some key control variables in this model to control for endogenous effects that may influence the private giving variable. they were other types of revenue, location, and types of subsector. other types of revenue included all income categories in the “other revenue” section under part viii in form 990. location was defined as either “new jersey” or “new york.” type of subsector was identified based on the national taxonomy of exempt entities (ntee) code as reported on form 990. many were categorized as public and societal benefit organizations, such as the chinese association for science and business, inc. and the korean-american medical association, inc. others were categorized as art & cultural organizations or human service organizations, such as the korean community center, or japan performing arts, inc. based on the self-identification of the type of subsectors, all organizations were recategorized as either religious or secular in the current study. religious organizations were agencies that self-identified as religious organization for their ntee code in the guidestar database. secular organizations were agencies for all other categories. data analysis to examine the crowding-out effect between government grants and private giving, panel data analysis was conducted. by using the consumer price index (cpi) inflation calculator provided by the u.s. bureau of labor statistics, the collected data was adjusted to 2016 dollar values. again, the lagged variable for government grants was generated for the regression analysis to control for the spurious correlation between government grants and private giving. prior to estimating the crowding-out effect using panel analysis for this study, a hausman test was conducted to determine whether a lee & kim/effect of government grants 102 fixed or random effects model was appropriate (wooldridge, 2002). the hausman test is used to differentiate between a fixed effects and random effects model in panel analysis. if the statistical significance level of the hausman test is greater than .05, it indicates a random effects model is appropriate; if it is less than .05, a fixed effect model is indicated (greene, 2017). in our data, the hausman test results indicated that a random effects model was appropriate for our analysis, χ2(2) = .50, p > .05. in the random effects model, each intercept is a result of random deviation from some mean intercept. handling outliers to accurately estimate the crowding-out effects, it was essential to address outliers. to do this, first, we calculated the total amount of revenue by summing up government grants, private contributions, and other investments. then, we generated outliers from the total amount of revenue using the median absolute deviation (mad), known as a more robust method for detecting outliers (leys et al., 2013). the mad is useful, particularly when the data distribution violates the normality assumption (adekeye & azubuike, 2012; leys et al., 2013). the mad was computed based on the following formula: ∑ |𝑥𝑖−�̅�| 𝑛 𝑖=1 𝑛 , where 𝑥𝑖 = performance value for period i; �̅� = average value; and n = number of data using the formula, we used conservative criteria that any total revenues exceeding 95% (equivalent to three standard deviations from the mean) of the mad were considered to be outliers (leys et al., 2013). with the criteria, we found 47 outliers, which were excluded to estimate the crowding-out effects in this analysis (chinese = 22, korean = 12, japanese = 13). results descriptive analysis tables 1 and 2 summarize the descriptive data of the sample. among the 410 east asian-american nonprofit organizations, 190 (46.5%) were chinese, 151 (36.6%) were korean, and 69 (16.7%) were japanese. just over one-fifth (21.2%) of the east asian-american nonprofits received government grants (n = 87), including 40 chinese nonprofits (21.1%), 29 korean nonprofits (19.2%), and 18 japanese nonprofits (26.1%). a total of 100 (24.4%) nonprofits depended solely on private contributions, including 53 korean nonprofits (35.1%), 36 chinese nonprofits (18.9%), and 11 japanese nonprofits (15.9%). korean-american nonprofits relied heavily on private giving for their revenue compared to other east asian-american nonprofits. this might reflect that korean-american nonprofits administratively focus more on fund-raising efforts than their counterparts. advances in social work, spring 2020, 20(1) 103 table 1. revenue of east asian-american nonprofit organizations (n = 410) all (n = 410) chinese (n = 190) mean (sd) range mean (sd) range total revenue $1,700,260 (8,607,498) $0 $102,544,128 $2,177,068 (10,740,776) $0 $102,544,128 government grants $399,663 (4,022,729) $0 $56,118,619 $795,872 (5,879,556) $0 $56,118,619 private giving $414,484 (1,779,518) $0 $23,426,612 $255,601 (699,839) $0 $22,442,961 other revenue $719,518 (4,157,186) $0 $102,489,297 $1,125,594 (5,804,394) $0 $102,489,297 korean (n = 151) japanese (n = 69) mean (sd) range mean (sd) range total revenue $419,225 (1,258,872) $250 $14,136,894 $1,872,137 (4,635,920) $1,540 $23,426,612 government grants $52,244 (407,646) $0 $5,047,255 $68,950.90 (2,567) $0 $1,690,511 private giving $226,747 (720,529) $0 $13,998,950 $934,141 (3,039,950) $0 $23,426,612 other revenue $140,234 (638,288) $0 $5,492,331 $869,044 (2,859,876) $0 $19,126,531 table 2. funding sources, location, and subsector of east asian-american nonprofit organizations all (n = 410) chinese (n = 190) korean (n = 151) japanese (n = 69) receiving government grants 87 (21.2%) 40 (21.1%) 29 (19.2%) 18 (26.1%) 100% reliance on charities 100 (24.4%) 36 (18.9%) 53 (35.1%) 11 (15.9%) location new jersey 91 (22.2%) 34 (17.9%) 49 (32.5%) 8 (11.6%) new york 319 (77.8%) 156 (82.1%) 102 (67.6%) 61 (88.4%) type of subsector religious org. 48 (11.7%) 19 (10.0%) 27 (17.9%) 2 (2.9%) secular org. 362 (88.3%) 171 (90.0%) 124 (82.1%) 67 (97.1%) table 3. crowding-out effect with a random effects model for east asian-american nonprofit organizations (1) all nonprofits (2) chinese (3) korean (4) japanese b (robust se) b (robust se) b (robust se) b (robust se) lagged gov. grants .068** (.02) .074* (.04) -.529 (.43) .088***(.03) other revenues -.085* (.04) -.113 (.08) -.009 (.05) -.115 (.07) type of subsector -32609.13 (25030.30) -22385.19 (41447.13) -65029.63*(31600.27) 103170.33***(28638.38) location 36059.23* (16137.66) 60802.09 (31319.81) 19470.52 (19213.05) 35434.87 (55023.67) r2 (overall) .023 .023 .048 .035 # of observations 1183 682 387 114 # of organizations 410 190 151 69 note. *p < .05, **p < .01, ***p < .001. lee & kim/effect of government grants 104 crowding-out effects the crowding-out effects between government grants and private giving for east asian-american nonprofit organizations are presented in table 3. as stated previously, we used the random effects model to estimate the crowding-out effects after removing the 47 outliers generated by the mad method. given the fact that some variables are non-normal, we estimated the random effects model with robust standard errors. in column (1) we reported the coefficients on private giving for overall east asianamerican organizations using a robust standard error. in columns (2), (3), and (4) we reported the estimated coefficients for each ethnic nonprofit. as shown in table 3, for overall east asian-american nonprofits, when the organization increased government grants by $1.00 in the previous year, donors were significantly likely to increase their donations by approximately $0.07 in the current year (hypothesis 1; b = .068, p < .01). regarding hypothesis 2, the estimated crowdingout effects varied by each ethnicity. as presented in table 3, there were significant crowding-in effects for chinese and japanese-american nonprofits. specifically, private donors for chinese-american nonprofits significantly increased about $0.07 of their donations in the current year when the charity received government grants in the previous year (b = .074, p < .05). for japanese-american nonprofits, significant crowding-in effects were also estimated, suggesting that each $1.00 increase in government grants in the previous year was associated with an increase in of $0.09 in private donation in the following year (b = .088, p < .001). for korean-american nonprofits, however, government grants increasing by $1.00 in the previous year was associated with a decrease in private giving of $0.53 one year later, which was not statistically significant (b = -.529, p > .05). discussion to the best of our knowledge, this pilot study is the first to examine the association between government grants and private giving to east asian-american nonprofit organizations using publicly available data. thus, our main purpose was to contribute to the sparse literature on culturally-specific nonprofits and to develop possible suggestions for strengthening their financial management. our findings indicated government grants for east asian-american nonprofit organizations crowded-in private donations to the organizations. despite the estimated crowding-in effect being small, the results are supported by other studies reporting crowding-in effects (heutel, 2014; hughes et al., 2014). our findings are consistent with a hypothesis of authoritarian orientations and political trust in east asian communities. providing credibility or prestige to the nonprofit organizations with government partnerships is stronger in asian countries. according to chong (2011) and ma and yang (2014), overall levels of political trust in governments in asian countries remain higher than that of non-asian societies. indeed, the values of loyalty (to the king or nation) and filial piety (to the parents) are basic social norms of social behavior for east asians born and raised in confucian culture and societies. within confucian culture, a father in a family has absolute power to rule the family and the relationship between the government and individuals is seen as the extension of the father-son relationship (ma & yang, 2014). within this context, government funding in general may serve as a signal of quality with respect to the east asian-american nonprofit organizations’ abilities to provide services. in other words, government grants may imply a signal of trust for the charity for the donors, thus they donate more to their charity. advances in social work, spring 2020, 20(1) 105 mixed results: crowding-in/out based on ethnicity another finding in this study is the estimated relationship between government funding and private giving being different for each east asian-american ethnic nonprofit organization. government grants significantly lead to increased private giving to both chinese and japanese-american nonprofits, but an increase of government grants crowded out private giving for korean-american nonprofit organizations, though this finding was not statistically significant. although these three ethnic organizations have relatively long histories in the u.s. compared to other asian groups (hung & ong, 2012), we identified few english-language studies focusing on these nonprofit organizations, which limit our ability to assess our findings. therefore, to understand such differences among chinese, japanese, and korean-american nonprofits, it would be helpful to expand our explanations to the context of nonprofits in each home country. the context relating to the different environments in the home countries allows us to gain insights regarding the different patterns of each ethnic donor’s giving behavior in the u.s. the estimated crowding-in effects with chinese-american nonprofit organizations may stem from the nature of chinese donors’ motivations. according to wang (2014), interpersonal relationships and a strong sense of self-reliance are enormously significant for chinese donors. chinese individuals who believe they should play an important role in charitable giving rely on strong values of self-reliance. government is the foundation of self-reliance in china because the government has played a leading role in charity (han, 2016; wang, 2014; yang, 2012). crowding-in effects are also featured in the chinese nonprofit context and history. until 1978, government attitudes toward nonprofit organizations in china were negative, so the chinese government had prohibited private nonprofit involvement from providing social services (yuanfeng, 2016). even though the attitude has changed from distrust to relative trust and from restriction to encouragement, the chinese government emphasizes the government and nonprofit corporations to improve their legitimacy and trustworthiness (yuanfeng, 2016). within this historical context, chinese nonprofits are hardly fully private because many of the nonprofits in china are formal branches of state institutions. government involvement in nonprofit partnerships are, therefore, one of the characteristics of nonprofit organizations in china, due to the emphasis on state dominance (yuanfeng, 2016; zhang et al., 2011). also, the public in china has emphasized transparency and accountability toward nonprofit organizations since charity scandals occurred after the earthquake in the wenchuan area in 2008 (yuanfeng, 2016). for the transparency of nonprofits in china, governmental or government-sponsored foundations in china only are able to raise funds from the public according to the regulation on the administration of foundation in 2004 (zhang et al., 2011). within the long tradition of government control of all social organizations and historical background of nonprofit organizations in china, chinese donors recognize the government grants to their charity as signals of quality or signals of transparency, so they increase their donations to the charity. our findings also significantly confirmed government grants increased private contributions among japanese-american nonprofits. similar to the explanation of chinese-american npos, it is presumed the japanese-american crowding-in phenomenon might be also derived from their perspective of the government. there lee & kim/effect of government grants 106 may be two possible explanations stemming from two different settings. understanding japanese and japanese-americans’ different views toward nonprofits might be helpful in interpreting our findings. the first explanation is related to japan’s domestic standpoint. historically, state power has been also more pervasive than civil society in japan (akira, 2006). thus, japanese people have largely sought support from the government when they face difficulties, rather than receiving assistance from civil society organizations (hernon, 2016). in japan, legitimate nonprofits hardly existed until the act on promotion of specified nonprofit activities was passed in 1998 (akira, 2006; hernon, 2016). in spite of their growing numbers, nonprofits in japan remain in the beginning stages (hernon, 2016). the biggest challenge they face is the lack of trust from the general public toward nonprofit organizations due to the unclearness of the organizations’ mission and structure (hernon, 2016). if nonprofits in japan fail to show their clear vision and mission on who they are and what they do, it is hard to receive private contributions from the general public (hernon, 2016). given this home country context, it is likely that receiving government grants may signify the organization’s clear mission and trustworthiness, ultimately leading to a crowding-in effect. for the second explanation, we approached historical activities committed by japanese-american nonprofit groups, particularly the japanese american citizens league (jacl). although japanese who first immigrated to the u.s. before the second world war tended to show extraordinary loyalty to their new home country (jacl, 2011), the internment of japanese-americans started during world war ii and even continued after the war. the jacl has historically played an important role in seeking redress for the internment of japanese-americans (kitano & maki, 2003), which finally led president ronald reagan to sign the civil liberties act authorizing redress payments to japanese-americans in 1988 (jacl, 2011; kitano & maki, 2003). a series of historical achievements by both nonprofit organizations and the u.s. government might project a positive image of the cooperation to japanese-americans. borrowing from the kitano-maki proper alignment model (kitano & maki, 2003), receiving government grants signals to japanese-americans “the positive alignment of the mainstream society” (p. 418), which may lead them to give more private contributions to nonprofits. however, these explanations should be cautiously interpreted due to the relatively small sample size (n = 69), which may have affected the power of the analyses. future study needs to replicate this with a larger sample of japanese non-profits to draw more robust findings. the impact of government funding was negative for korean-american nonprofit organizations. even though it did not statistically support the crowding-out hypothesis, the crowding-out effect may be understood by korean donors’ motivations for charity and attitudes toward non-governmental organizations in korean society. korean immigrants are more likely to help people within their ethnic group to maintain their traditional social norms based on korea’s confucian traditions (moon et al., 2015). thus, people in the korean community in the u.s. who have stronger normative motives are more likely to donate to korean charitable organizations than to mainstream organizations (moon et al., 2015). also, individuals in korea are not motivated in their donation behavior by government policy changes on charitable giving because government involvement in charitable giving in korea has not been well-established (hur, 2006). therefore, korean donors may negatively view advances in social work, spring 2020, 20(1) 107 government involvement in ethnic nonprofit organizations in the u.s. in order to sustain their origin of traditional social norms. the negative impact of government funding on private giving to korean-american nonprofit organizations may be related to “too close for comfort” (kim, 2009, p. 888), describing the relationship between nonprofits and the government in their home country. nonprofit organizations used to be considered the most trustworthy institution than any other domestic and foreign institutions including government agencies in korea. however, the trust was weakened when the government and nonprofit relationship grew stronger in korea. according to kim (2009), increased government involvement in non-government organizations such as financial and political support led to the decline of ngo’s institutional trust in korea. from 1993 to 2003, the korean government was devoted to increasing the government partnership with the nonprofit sector. as a result of the engagement, some of the major nonprofit organizations in korea have received government funding for their activities and services. when nongovernment organizations in korea have received government funds, serious questions about conflicts of interest and the groups’ sincerity were raised. consequently, nongovernment organizations’ institutional trust in korea ranked as first in 2003 but dropped to fifth place in 2005 since the korean government drove strong support for the nonprofit sector. within these contexts, it may be plausible korean-american donors view government involvement as weakness or lost independence and autonomy, so they decreased their donations to their korean charities in the u.s. limitations the data used in this analysis are by no means without shortcomings. first, it should be noted that a relatively small percentage of our sample (21%) received any government grants. approximately three-quarters of the east asian-american nonprofits in the current study have not received government funding at all. this indicates securing an adequate number of qualified subgroup samples (i.e., nonprofits receiving government grants) is critical to assuring more valid findings. second, our findings could not provide detailed information regarding the relationship between different types of government funding and private giving because form 990 data only displays aggregated amounts funded from local, state, and federal governments. related to this, steinberg (1987) and kim (2014) demonstrate the impact of government grants on private giving may vary depending on the type of government grants. therefore, as steinberg (1987) suggested, future studies should use more rigorous data by combining individual aggregated data of the amount each donor has contributed to a charity with individual organization data reflecting each type of government grant through annual or audit reports. methodologically, this also implies the joint crowding-out effect may provide more rigorous results than the simple crowding-out effect. related to using form 990, other covariates that would potentially be correlated with the relationship could not be adjusted for due to data limitations. for example, agency level data such as staff hours and/or administrative decisions on fund-raising efforts and staff capacity to write compelling grants are important factors that should be included. future study needs to integrate these factors to accurately and empirically portray the relationship. lee & kim/effect of government grants 108 lastly, our method is solely based on a quantitative approach. given inconsistent findings of the association reported in the literature review, it might imply that a solely quantitative approach would not be an effective research design to measure the relationship and to reflect the respective ethnic perspectives of each organization. mixed methods will allow for the identification of some critical contextual factors related to fund-raising, but are not addressed in this study, including the effectiveness of agency services and programs, relationship with various levels of government and funders, and current government priorities for funding. in future studies, therefore, using mixed methods to reflect the realities from each ethnic community (or stakeholders such as donors, agency staff) is necessary to ensure a more accurate interpretation of the findings. conclusion examining the crowding-out effect has contributed to understanding the relationship between government funding and private giving, which is an important aspect of effective financial management for nonprofit managers. although our findings should be cautiously interpreted due to limitations derived from the data and research design, our main conclusion is that government grants crowd in private giving in east asian-american nonprofits in the new york and new jersey metropolitan area. however, our findings also reveal the complex nature of giving patterns depending on ethnicity when it comes to the mixed results of -in 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(2017, february 8). korean immigrants in the united states. migration policy institute. https://www.migrationpolicy.org/article/koreanimmigrants-united-states author note: both authors contributed equally to this manuscript. address correspondence to dr. lewis h. lee, the university of alabama school of social work, box 870314, tuscaloosa, al 35487. e-mail: lhlee@ua.edu acknowledgement: this manuscript is a revised version of a working paper that was awarded the grand prize for the 2019 best paper competition sponsored by the nanum research center on philanthropy in the community chest of korea. https://doi.org/10.1002/nvsm.1486 https://doi.org/10.1300/j147v28n01_04 https://doi.org/10.1177/0192512110378657 https://doi.org/10.1002/9781119176558.ch19 https://doi.org/10.1332/204080510x511229 https://doi.org/10.1007/s11266-016-9795-z https://doi.org/10.1016/j.evalprogplan.2008.08.001 https://doi.org/10.1080/12264431.2011.10805183 https://www.migrationpolicy.org/article/korean-immigrants-united-states https://www.migrationpolicy.org/article/korean-immigrants-united-states mailto:lhlee@ua.edu _________ dane minnick, phd, msw, cps, assistant professor, department of social work, university of south florida, sarasota, fl. shelby weathersby, msw, student, and kimberly hobson, msw, students, department of social work, ball state university, muncie, in. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 472-480, doi: 10.18060/27589 this work is licensed under a creative commons attribution 4.0 international license. the efficacy of team-based learning in social work education: a multiyear, cross-sectional study dane minnick shelby weathersby kimberly hobson abstract: this article details the findings of a multi-year (2019-2022), cross-sectional study that examined the utility of using team-based learning as an instructional pedagogy in social work courses. the study was conducted from august 2019 to december 2022 and was composed of surveys of 166 students from 15 individual bachelor and masters-level social work courses at a medium-sized university in east-central indiana. demographic data including race, gender, age, course number, and program level were collected for each student participant, with the purpose of the study centering on 1. identifying whether student participants preferred team-based learning or a different teaching pedagogy, and 2. assessing how well the students comprehended the course content delivered via teambased learning. the results of the study showed that 81% of the surveyed students preferred team-based learning to other teaching pedagogies, and that there were no significant differences in responses based on any of the demographic data collected. students also performed exceptionally well in the courses where team-based learning was implemented, as demonstrated by the 95% cumulative course average for all participating students. students additionally rated the courses highly (4.5/5 average) in anonymous course evaluations performed at the end of each semester. keywords: education; team-based learning; teaching; pedagogy; social work over the past 25 years, the field of social work education has experienced significant changes related to cultural shifts among scholars, changing needs in the populations served by the profession, and due to environmental challenges such as the covid-19 pandemic (wallengren lynch et al., 2023). notable changes such as the 2008 shift from curriculum content to competency-based accreditation standards by the council on social work education (cswe) serve to highlight the dynamic nature of social work’s educational system (apgar, 2019; larrison & korr, 2013). however, despite these changes and the subsequent research generated by them, one issue that remains less explored is the issue of teaching pedagogies among social work educators. currently, there are a myriad of ways that educational content can be delivered to students. instructors often use strategies such as traditional lectures and exams, and/or opt for more contemporary modalities such as immersive or experiential learning. given the constantly shifting academic landscape in social work and its reliance on instructors outside of the university system to provide critical training and knowledge to students via field placements, it is of significant importance that social work educators utilize teaching strategies that are grounded in evidence and that are adaptable to the needs of modern students. one pedagogy that meets this criteria is a teaching strategy called team-based about:blank minnick et al./team-based swk education 473 learning (tbl; robinson et al., 2013). tbl is a teaching pedagogy that emphasizes teamwork and collaborative learning as its principal approach for delivering content to students. to explore the utility of using tbl in social work education, a multi-year, crosssectional survey that included a mix of 166 bsw and msw students attending a university in east central indiana, was conducted. the purpose of the study was to assess whether tbl is a suitable teaching strategy for social work students, and to identify whether the students preferred tbl to other teaching pedagogies that they had experienced during their academic careers. team-based learning tbl is a teaching pedagogy that is rooted in a constructivist educational theory that suggests that students should be active and collaborative participants in the learning process rather than passively absorbing information (hrynchak & batty, 2012; sisk, 2011; ültanır, 2012). a typical classroom experience for tbl occurs in four stages: (1) pre-class reading, (2) readiness assurance tests (rats) that are composed of individual readiness assessment tests (irats) and team readiness assessment tests (trats), (3) a mini-lecture, and (4) a practical application lab (robinson et al., 2013; vanderbilt center for teaching, 2023). pre-class reading assignments can consist of anything from journal articles and textbook chapters to ted talks or youtube videos, and rats usually consist of 5-20 multiple choice or true/false questions (learning access management system, 2022). student teams generally consist of 5-7 students but can vary based on class size. with regard to the irats and trats, the questions posed on each assessment are identical. students initially take the irat to evaluate their individual knowledge of the subject matter. they then answer the same questions with teammates for the trat as a supplementary knowledge check. completion of the trats also facilitates an active learning process that utilizes peer-to-peer feedback to hold students accountable for completing pre-class content. following the rats, questions are reviewed by the class as a group, followed by a mini-lecture designed to reinforce the primary concepts covered by the rats. finally, students apply the learned concepts to application-based problems or during labs in their collaborative teams. these activities generally include some component of classroom debate or discussion to help facilitate the collaborative learning process. the objective of these activities is to help the students more thoroughly explore the finer nuances and intricacies of the learning material. (robinson et al., 2013; learning access management system, 2022; vanderbilt center for teaching, 2023). a meta-analysis of tbl conducted by sisk (2011) found evidence suggesting that tbl leads to higher tests scores, increased classroom engagement, and an increased sense of classroom ownership for students. research also shows that team-based collaboration skills can be translated from a classroom setting to the workforce, and often helps students that struggle in traditional classroom settings to improve their academic performance (haidet et al., 2014; sisk, 2011). specific to social work, a study conducted by minnick et al. (2023) demonstrated the capacity of tbl to produce universally high test scores and transferrable workforce skills for bsw students engaged in joint experiential and tbl courses centered on substance misuse education. advances in social work, summer 2024, 24(2) 474 outcomes related to educational ownership, self-directed performance, collaboration, and teamwork are also notably important with both contemporary academic and work environments shifting from in-person to online settings (badiyepeymaie jahromi et al., 2016; wildman et al., 2021). in relation to this shift and the need for self-directed performance outcomes and collaborative skills, a 2004 study by levine et al. found that psychiatric students performed significantly better on the national board of medical examiners psychiatry subject test and had more positive attitudes in regard to working in teams after learning via the tbl pedagogy. students also reported team-learning activities to be more effective teaching tools than individual learning activities. a 2010 study on the impact of tbl on medical students by koles et al. (2010) revealed that students had higher average scores on questions that assessed knowledge of content learned through tbl than on questions using other instruction methods. additionally, students ranked in the lowest quartile of the class showed the highest level of average improvement (7.9%) as opposed to all other students (5.5%). finally, zgheib et al. (2010) explored the impact of tbl on medical students in a pharmacology course and found that tbl was more effective for student comprehension of advanced content than traditional lectures. university and program demographics this study was conducted at a mid-sized university located in east-central indiana, with a student body of just under 22,000 enrolled students (u.s new and world report, 2023). according to m. moore (personal communication, december 12, 2022) the social work department where the tbl was implemented offers both undergraduate and master’s programs that, in 2022, had a combined total of 315 bsw students and 87 msw students. m. moore also noted that 28% of the bsw students were from underrepresented minority groups which included 12% black or african american, 7% hispanic, 7% two or more races, and 2% asian. the remaining 72% of bsw students identified as white. 51% of the program’s bsw students were first generation college students, and roughly 20% identified as a member of the lgbtq+ community. demographic data outside of student enrollment numbers were not available for the msw program for 2022. methods the study sample consisted of 166 students from 15 individual bsw and msw courses within the social work program. the study was conducted over the course of four years (2019-2022), and was composed of a short, anonymous qualtrics survey that was administered in class to each of the participants at the end of the semester. the original survey asked one question that directed students to identify whether they would prefer if their future courses utilized tbl, a different teaching pedagogy they had experienced at the university, or if they did not have a preference. students were provided with three response options that consisted of “team-based learning,” “other pedagogy,” and “no strong opinion.” demographic questions were added in year three of the study to account for variables related to gender, age, and race. the surveys were implemented in courses taught by one assistant professor in the department of social work at the participating university who was trained in tbl as part of their graduate education. the courses minnick et al./team-based swk education 475 followed the tbl framework of weekly readings and/or video assignments, rats composed of five true/false questions, a mini lecture (maximum 20 minutes), and a concept application lab that varied from debating contemporary social justice issues to designing public health social marketing materials and engaging in university environmental health promotion strategies. student participants in the tbl courses ranged from pre-major bsw social work students (i.e., students who had yet to apply to the bsw program which does not occur until the end of the students’ sophomore year at the participating university) to senior-level bsw students and first-year msw students. at the conclusion of the study, a fisher’s exact test was performed using spss to identify if student preference for tbl was associated with race, gender, program level, or individual course. age and the “other” response option for gender were excluded from the analyses due to the sample size and homogeneity of the sample (92% were 21-25 years old; 99% were male/female). data on student grades and course evaluation outcomes was also examined to assess the efficacy of the course in delivering the required content to students. the course evaluation data were collected from the university’s standardized course and teaching evaluation that is administered in every class provided by the university. these surveys are anonymous and administered externally via university email. they are not directly connected to tbl and are primarily used by departments for faculty evaluations and tenure decisions. the study received an exemption from the university’s institutional review board because it is considered a standard, anonymous teaching evaluation that regularly occurs in most college courses. results the results of the study showed that participants were skewed towards the undergraduate level (75%), and were primarily female (85%), white (70%), and 21-25 years old (92%). participation years were also slightly skewed towards years three and four, which accounted for 58% of the completed surveys. demographic data related to gender, age, and race were not collected for the first two years of the study, and 100% of students in participating classes completed the tbl questionnaire. in regard to tbl preference, the findings identified that a large proportion of participants (81%) preferred tbl to other teaching methodologies, and that none of the demographic variables tested had a statistically significant association (p < .05) with student preferences for tbl. cases with no strong opinion (n =12) were excluded from the analyses after it was determined that they had no significant correlations with any of the demographic variables. results from the fisher’s exact test showed that tbl preference was not significantly associated with race (p = .876), gender (p = .681), program level (p = .528), or course (p = .286). participant demographics and the descriptive survey results are provided in table 1. advances in social work, summer 2024, 24(2) 476 table 1. participant demographics & survey results (n = 166) n (%) program level (n = 166) graduate 41 (25%) undergraduate 125 (75%) gender (n = 94) female 80 (85%) male 13 (14%) non-binary or 3rd gender 1 (1%) age group (n = 78) 18-20 years old 2 (3%) 21-25 years old 72 (92%) 26-30 years old 1 (1%) 31-35 years old 1 (1%) 36-40 years old 41+ years old 2 (3%) race (n = 95) american indian or alaska native 0 (0%) asian 3 (3%) black or african american 14 (15%) hispanic, latino or spanish origin 8 (8%) middle eastern or north african 0 (0%) native hawaiian or other pacific islander 1 (1%) white 66 (70%) bi-racial 3 (3%) other 0 (0%) tbl preference (n = 166) other pedagogy 19 (12%) team-based learning 135 (81%) no strong opinion 12 (7%) survey year (n = 166) 2019 19 (11%) 2020 52 (31%) 2021 41 (25%) 2022 54 (33%) in addition to the survey findings, the study results also identified that the cumulative course average for all students enrolled in the tbl courses was a 95, or an a letter grade. descriptive course evaluations showed that the tbl courses received high evaluation scores with a cumulative average of 4.52 out of five (rated on a likert scale from 1 = strongly disagree to 5 = strongly agree) and a cumulative response rate of 77%. it is also notable that the descriptive course evaluation scores statistically favored “strongly agree” despite a disproportionate number of evaluations (4 of 15) coming from one of the historically more difficult classes in the bsw program according to m. moore (personal communication, december 15, 2022), research in social work ii. course demographics, average grades, and average teaching evaluation scores are provided in table 2, course descriptions for the tbl courses are provided in table 3, and the course evaluation questions that were answered by participants are provided in table 4. minnick et al./team-based swk education 477 table 2. course demographics & evaluation results courses (n = 15) % of sample students grade mean course eval. mean resp. rate course sections bsw social welfare policy i 11% 19 91 4.8 73% 1 hbse ii 11% 18 95 4.5 79% 1 social work practice iv** 27% 44 97 4.3 86% 3 research in social work ii** 27% 44 92 4.3 83% 4 elective addictions 4% 6 96 4.8 89% 1 msw social work practice ii 7% 11 96 4.3 67% 1 social welfare policies & programs 2% 4 98 4.8 86% 1 micro perspectives of hbse 4% 7 97 4.6 50% 1 macro perspective of hbse 8% 13 98 4.6 81% 2 * response rate for course evaluations **indicates an immersive learning course course descriptions are included because many new faculty, surprisingly, may not always have a solid grasp on msw or bsw courses and because we hope this article can be used by faculty from other helping disciplines who are not familiar with social work understand the curriculum. table 3. course descriptions courses description bsw social welfare policy i introduces the historical development, mission, & philosophy of social welfare in the united states with a focus on the analysis of current social welfare programs. hbse ii builds a foundational understanding of people & their social environments focusing primarily on factors that influence human behavior such as culture, class, race, ethnicity, sexual orientation, gender identity, gender, discrimination, economic forces, organizations, & communities. social work practice iv* introduces entry-level practice methods with organizations & communities. research in social work ii* focuses upon statistical measurement & data analysis used by a bsw degreed practitioner to evaluate practice & program effectiveness. elective addictions exploration of social work with selected client populations & types of practice with emphasis on individualized study, experiential learning, & group discussion. msw social work practice ii builds students’ knowledge & experience in macro practice & the process of engaging, assessing, intervening & evaluating outcomes with organizations & communities. social welfare policies & programs a social work foundation course which provides an overview of current social welfare policy & programs. students will examine historical, social, economic, political, organizational, environmental, & global influences on current social welfare policy & programs. micro perspectives of hbse micro perspectives of hbse focuses on the interaction between people & their environment with special emphasis on individuals, families, & groups. macro perspective of hbse macro perspectives of hbse focuses on the interaction between people & their environment with special emphasis on organizations & communities. *indicates an immersive learning course advances in social work, summer 2024, 24(2) 478 the course evaluation questions (table 4) are the standardized questions provided by the university as part of the universal teaching evaluations that all teachers in every class have their students fill out. they are grouped by instructor and course characteristics. table 4. course evaluation questions items instructor my instructor explains the course objectives clearly. my instructor explains course content clearly. my instructor effectively engages me in the learning process. my instructor treats me with respect. my instructor provides opportunities for students to engage in the learning process. my instructor provides timely feedback. my instructor is available for consultation (e.g., email, office hours, by phone, by videoconference, or by appointment). course this course has clear objectives. this course is effective in meeting its objectives. this course has assignments related to the objectives of the course. this course has a clear grading system. this course broadens my perspective and/or knowledge. overall, these findings suggest that tbl is an effective teaching pedagogy for social work education, and that a large majority of students preferred it to every other teaching modality that they had experienced in their academic careers at the time of the survey. limitations there are several limitations associated with this study. first, the courses were implemented by a single faculty member and without the use of a control group rather than by multiple faculty members in a randomized setting. therefore, there is a risk that the findings could reflect practices or features associated with the faculty member such as grading style or classroom environment rather than factors associated with tbl. however, this issue was addressed in the directions provided to the students prior to filling out the tbl survey in each of the courses. in the directions students were instructed to disregard any negative or positive bias associated with the current instructor and to identify their pedagogical preference for future courses which would involve other faculty members. a second potential issue is that the study occurred within a single social work program with some students participating in the study more than once. however, the course sequencing was distributed in a way that duplicate students were kept to a minimum (< 5% of the sample) due to the implementing faculty member’s teaching schedule. another limitation was that demographic data for the participants were not collected for the first two years of the study which reduces the reliability of the findings across demographic groups. finally, student tbl preferences could have been influenced by the course scores they expected to receive at the time they filled out the study (i.e., a high grade = a good review). however, the surveys were anonymous and originally completed prior to taking final exams or submitting final course assignments which composed a significant portion of the students minnick et al./team-based swk education 479 grades in each of the tbl courses. therefore, the students would not have had any assurances of a good or bad grade for the course when completing the survey which minimizes the risk of individual grades influencing the tbl survey outcomes. implications for social work the results of this study produced evidence that tbl could potentially be beneficial as a teaching pedagogy for social work education. the course outcomes were favorable with a 95% cumulative course average for participating students and a 4.52 cumulative course evaluation average. these outcomes are suggestive of the potential benefits for utilizing tbl as an educational pedagogy in social work. additionally, the fact that the courses were successfully implemented with a limited number of students with varying backgrounds and academic experiences further speaks to the possible utility of tbl as a teaching methodology. this is particularly noteworthy given that social work education currently has a large discrepancy in clinical licensure exam pass rates among race and age groups (association of social work boards, 2022). the finding that 81% of the participating students indicated that they would prefer to use tbl over other teaching methods in future classes also provides evidence of the need to further investigate the efficacy of tbl in future studies. given the results demonstrated in the study, it is recommended that the cswe, social work academic programs, and individual faculty members begin exploring tbl as mechanism for enhancing teaching practices in social work education. with regard to incorporating tbl, there are a large number of free resources located on youtube and through the team-based learning collaborative that can prepare interested faculty to implement tbl in their own courses. it is also recommended that social work researchers replicate this study using a larger and more nationally representative sample, as well as a more rigorous experimental design to strengthen the validity of the findings. conclusion overall, this study demonstrated the potential utility of utilizing tbl in social work academics. the results provided a preliminary evidence-base for incorporating tbl into existing courses and showed the need for conducting additional research with regard to tbl and social work education. more specifically, there is a clear need for further evidence of the efficacy of tbl as a teaching strategy, as well as a need for more studies on how tbl influences the outcomes of students from disadvantaged backgrounds and/or groups who have low licensure pass rates. finally, studies that investigate whether tbl is appropriate for students from minority cultural backgrounds is additionally warranted. references apgar, d. 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(2010). using team-based learning to teach pharmacology to second-year medical students improves student performance. medical teacher, 32, 130-135. author note: address correspondence to dane minnick, social work, university of south florida, sarasota, fl, 34243. email: dminnick@usf.edu https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4827760/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4827760/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4643940/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4643940/ https://doi.org/10.3109/0142159x.2012.687120 https://doi.org/10.1097/acm.0b013e3181f52bed https://doi.org/10.1097/acm.0b013e3181f52bed https://doi.org/10.1080/10437797.2013.768102 https://docs.lamsfoundation.org/tbl/tbl-process https://doi.org/10.1207/s15328015tlm1603_9 https://doi.org/10.1080/1533256x.2023.2235606 https://doi.org/10.1080/1533256x.2023.2235606 https://doi.org/10.1080/10437797.2013.812911 https://doi.org/10.1080/10437797.2013.812911 https://doi.org/10.3928/01484834-20111017-01 https://files.eric.ed.gov/fulltext/ed533786.pdf https://files.eric.ed.gov/fulltext/ed533786.pdf https://www.usnews.com/best-colleges/ball-state-university-1786#:%7e:text=it%20has%20a%20total%20undergraduate,a%20semester%2dbased%20academic%20calendar https://cft.vanderbilt.edu/guides-sub-pages/team-based-learning/ https://doi.org/10.1080/02615479.2022.2040977 https://doi.org/10.1080/02615479.2022.2040977 https://doi.org/10.1177/1046496420985185 https://doi.org/10.1177/1046496420985185 https://doi.org/10.3109/01421590903548521 https://doi.org/10.3109/01421590903548521 mailto:dminnick@usf.edu _________ tony faseeh salaam, dsw, lcsw, private practitioner. christina m. bruhn, phd, lcsw, professor, school of social work, aurora university, aurora, il copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 233-251, doi: 10.18060/27349 this work is licensed under a creative commons attribution 4.0 international license. impact of trauma on the lives of black men with multiple arrests: “i feel like that the violence needs to stop now” tony faseeh salaam christina bruhn abstract: a mixed-methods study was carried out to better characterize the life course experiences, with a focus on trauma, of men who had perpetrated gun violence and other violent crime, and who had multiple arrests and incarcerations. a small sample of 13 men with a history of a minimum of 12 arrests each as well as histories of gun violence, other violent crime, and incarceration was drawn from a social program providing cognitive therapy and job skills training in a major urban center. participants completed the adverse childhood experiences questionnaire and post traumatic stress disorder checklist for dsm-5 and completed an in-depth interview. results demonstrated that the participants had extraordinarily significant levels of trauma exposure but that they had minimal avowed trauma symptoms. the exception is that every participant demonstrated a clinically relevant score on the arousal subscale (criterion e). participants in interviews discussed a number of characteristics of their developmental years. they described near constant exposure to traumatic events, in some cases starting from very young ages. most participants described a personal experience of numbing or desensitization to their experiences. they described the impact of gangs on both protecting them from trauma and exposing them to trauma, and they described their subsequent experiences of incarceration. they offered recommendations for strategies to minimize violent crime in communities. keywords: gun violence, gangs, trauma, black men, aces, incarceration crime statistics demonstrate that, while violent crime has decreased since the 1990s, crime remains profoundly concerning and has been a key voting issue. moreover, while violent crime has declined overall, the number of gun deaths in 2021, at 20,958, was the highest on record (gramlich, 2023). the rate of gun murders, at 6.7 per 100,000, was the highest rate recorded since 1974 (gramlich, 2023). more child and teen deaths occurred in 2020 and 2021 due to guns than to any other source (mcgrough et al., 2023). data representing numbers and rates of gun injuries are less readily available, but the government accountability office estimates that there may be 30,000 hospital stays and 50,000 emergency room visits related to gun injury each year, costing over $1 billion (government accountability office, 2021). gun-related murders and injuries are a subset of gun-involved crime; for instance, firearms are implicated in 36.4% of robberies and 27.6% of assaults (federal bureau of investigation, 2019). gun-involved crimes are a subset of violent crimes. gun-involved crimes and other violent crime have profound impacts on the victims and their families, the perpetrators and their families, communities, and society. developing an increasingly nuanced understanding of the factors that underlie such crimes is an important public health priority and yet one that has yet to be substantially achieved. about:blank advances in social work, summer 2024, 24(2) 234 given these considerations, the authors sought to represent and resonate the lived experiences of men who have participated in gun violence and other violent crimes. the perspectives of these men must be identified and shared in order to inform the public discourse concerning the drivers of gun violence and violent crime, the contexts within which crime takes place, and ways to effectively prevent and respond to gun violence and violent crime. fundamentally, those who have committed crimes are the only ones who can describe their experience of the circumstances under which those crimes occurred and what they believe to have been the drivers of those crimes. this study represents a mixedmethods reflection of the trauma experiences of a small sample of black men who have perpetrated gun violence and other violent crimes and have experienced multiple arrests and at least one period of incarceration. the study explores their trauma histories from both quantitative and qualitative perspectives and examines the contexts surrounding the crimes for which they were incarcerated as well as their perspectives regarding public response to crime. the lived experiences of these participants can be shared to inform and educate those with a vested interest in planning social policy and programs intended to prevent and respond to gun violence and other violent crime. the study partially replicates and expands upon the work done by valdez (2021) regarding posttraumatic distress and treatment barriers among former gang members. review of literature while crime is clearly multi-determined, exposure to trauma has significant potential association with crime. trauma is a potential predictor that operates at micro, mezzo, and macro levels. this brief review of literature will present discussion concerning the complicated relationship between trauma and violence, specifically gun violence. in addition, the review will consider the degree to which the voices of those most affected by gun violence and other violent crimes those who are perpetrators and close affiliates of those who have been killed are represented in the study of gun violence and other forms of violence and responses to violence. one form of trauma that appears to be particularly operative with regard to crime is exposure to violence, whether through witnessing or experiencing violence. ross and arsenault (2017) explored the link between experiencing or witnessing a traumatic event before the age of 12 and being involved with violence in adolescence and young adulthood. the researchers found that there is a significant correlation between trauma exposure in youth and early violence initiation; the researchers found that this was true of children who had either witnessed or had been direct victims of trauma. aebi et al. (2016) also documented the relationship between exposure to trauma and violence in youth and found the relationship to be partially mediated by post-traumatic stress disorder (ptsd) symptoms in boys, specifically by anxious and dysphoric arousal symptoms. exposure to violence has also been examined specifically as it pertains to gun violence. wamswernanney and colleagues (2019) demonstrated an association between exposure to domestic violence and increased later likelihood of violent arrests and gun arrests. exposure to violence may be associated with risk of gang involvement, which may lead to further exposure to violence. frequent exposure to neighborhood violence and to salaam morgan & bruhn/impact of trauma 235 familial or personal trauma can lead youth to normalize violence. youth with this type of exposure to violence may seek gang membership as a means of personal protection and social support (quinn et al., 2017). however, the feeling of safety sought may be elusive, and gang membership may lead instead to further exposure to violence. leverso and o’neill’s (2021) study of youth gang members’ exposure to violence found that youth gang members were 22% more likely to experience simple assault victimhood and 31% more likely to experience aggravated assault victimhood than youth who were not affiliated with gangs. pyrooz and sweeten (2015) indicated that over 1 million youth between the ages of 5 and 17 are members of street gangs. such membership in adolescence has been found to be predictive of poorer outcome across a range of areas of adult functioning (gilman et al., 2014). engagement in violence also has the potential to engender symptoms of trauma. gray et al. (2003) studied the incidence of post-traumatic stress disorder in individuals who had committed serious sexual or violent offences. the researchers found very high rates of ptsd prevalence in the offender population studied, with roughly one third of the participants meeting diagnostic criteria for ptsd. ternes and colleagues (2020) sought to determine predictors of ptsd symptoms in male violent offenders. the researchers found that participants who had committed violent offenses against someone they had a close personal relationship with were at greater risk for developing ptsd symptoms than individuals who had committed a violent act against an acquaintance or stranger. similarly, kerig et al. (2016) modeled posttraumatic stress among gang members and found that, when controlling for a range of relevant characteristics (age, gender, race/ethnicity, trauma exposure), perpetration trauma acts as a significant predictor of posttraumatic stress. the incarceration that may result from participation in gun violence or other violence also has the potential to impact exposure to traumatic events that may or may not drive trauma symptoms. in prison, the assault rate for male inmates was found to be over 18 times higher than that of the non-incarcerated population, and the assault rate for female inmates was found to be over 27 times higher than that of the non-incarcerated female population (wolff et al., 2007). this may contribute to a general feeling of fear, anxiety, and unsafety in the prison population, contributing to trauma symptoms. hochstelter et al. (2004) studied the prevalence of trauma exposure and post-traumatic stress disorder symptoms through data collected from men who recently finished their carceral sentences and found a statistically significant relationship between victimization in prison and posttraumatic stress symptoms. while the literature concerning exposure to traumatic events, the emergence of trauma symptoms, and relationship to risk for gun violence and other forms of violence is emerging, one element of the study of these associations that remains relatively unexplored is the voice of those affected by these phenomena. several initiatives have been undertaken: quinn et al. (2017), as related, conducted qualitative interviews with gang members and found that gang initiation in the participants often occurred due to the drive for self-preservation. many participants indicated that, in the areas they lived in, gangrelated violence was virtually unavoidable. richardson and associates (2013) conducted qualitative research with young offenders to understand pathways to violence. they utilized anderson’s (1999) code of the street to theoretically frame their questions, and advances in social work, summer 2024, 24(2) 236 they found the answers youth gave resonated with anderson’s findings. this was particularly true in that youth spoke of the drive for respect as a principal determinant of decision-making. they documented fear and mistrust as perceived factors associated with risk of violent encounters. however in total, the voice of black men who have participated in and who have been affected by violence is not well-represented within the professional literature, and thus additional attention to adequately representing their experiences and perspectives is necessary. methods research questions the study was guided by several over-arching research questions which supported the development of the semi-structured interview schedule utilized for collection of qualitative data as well as of the selection of the two quantitative instruments. 1) how do the participants characterize their exposure to trauma? 2) how do participants reflect their understandings of the factors that have led to gun violence and other violent crime? 3) what are the primary recommendations of participants concerning public responses to gun violence and other violent crime? operational definitions because the primary purpose of the paper was to represent the lived experiences of those who have perpetrated gun violence and other violent crime as viewed through the lens of their trauma histories, few formal operational definitions were utilized. rather than impose pre-determined definitions upon the narratives of the participants, they were encouraged to represent these constructs according to their understanding. exposure to trauma was operationalized as the score on the adverse childhood experiences questionnaire (ace-q). trauma symptoms were operationalized as the score on the post traumatic stress disorder checklist for dsm-5 (pcl-5). research design the study used a mixed methods design. a total of two quantitative instruments were used: the aces questionnaire (felitti et al., 1998) and the ptsd checklist for dsm-5 (weathers et al., 2013). the qualitative data for the study were derived from a projectdeveloped interview schedule. all data were collected during the course of a single, extended interview with each subject. the analyses of the qualitative data were undertaken utilizing grounded theory methods (charmaz, 2014), and the interpretation of the findings was informed by consideration of the quantitative data. salaam morgan & bruhn/impact of trauma 237 instruments quantitative instruments the adverse childhood experiences questionnaire (ace-q) was developed by felitti et al. (1998) in support of the ace study. the psychometric properties of the ace-q have been assessed utilizing many approaches. for instance, dong et al. (2004) determined that the items on the scale demonstrate a high degree of interrelatedness, and internal consistency reliability was confirmed by bruskas (2013). a wide variety of studies, including the original felitti et al. study, have confirmed the criterion-related validity of the instrument. the post traumatic stress disorder (ptsd) checklist for dsm-5 (pcl-5) was utilized to assess symptom expression. this instrument has been assessed for internal consistency reliability (α = 0.94), test-retest validity, and convergent and discriminant validity and has been the subject of confirmatory factor analysis, establishing this as a psychometrically sound instrument. the pcl-5 includes 20 items, aligned with criteria a through e on the ptsd diagnosis as represented in the dsm-5 (criterion a is exposure, b is intrusion symptoms [intrusions], c is avoidance of stimuli [avoidance], d is negative alterations in cognitions and mood, and e is marked alterations in arousal and reactivity [arousal]). total scale scores range from 0 to 80. scores of 2 or higher on 1 item from criterion a, 1 item from criterion b, both items from criterion c, 2 items from criterion d, and 2 items from criterion e are suggestive of diagnosis of ptsd; alternatively, a cutoff score of 31 to 33 is indicative of likely diagnosis of ptsd (u.s. department of veteran’s affairs, n.d.). qualitative semi-structured interview schedule the qualitative interview schedule was developed based upon review of the literature, personal and professional experience of the first author of this manuscript, consultation with the dissertation committee, and testing. the instrument was tested at two different points with respondents who resembled those included in the sample but who were not included in the study. in both cases, the respondents indicated that the questions as written were appropriate to elicit the desired information and that no additional changes were needed. the questions related to experience with violent crimes and trauma, experience with gangs, circumstances relevant to the most recent incarceration for violent crime, personal experiences that influenced the occurrence of the crime, experiences with police during the most recent arrest, experiences with incarceration, and recommendations for reducing violent crime in the community. sample the sample was selected as a purposive sample. the individuals were selected because they were part of a group of people considered to be particularly knowledgeable about or experienced with the phenomenon under investigation (cresswell & plano, 2011). the sampling frame included men who were receiving services at a violence prevention program offering cognitive behavioral interventions and paid transitional jobs, and anyone from within that setting was invited to participate. the sampling structure therefore advances in social work, summer 2024, 24(2) 238 represents a “homogenous sampling” structure (etikan et al., 2015) with no effort to specifically recruit extreme or critical cases. information about the study was conveyed to potential participants by an employee of the organization (who was not a researcher) using a brief, verbal explanation of the study, its aims, and participation criteria. interested participants were given a brief, screening questionnaire and invited to reach out and contact the researcher, if they wished to arrange time for an interview. the screening questionnaire only verified the potential participant was an adult black male, had perpetrated violent crime and experienced incarceration, and was willing to participate in the interview and thus met the eligibility criteria. all of the subjects who participated are black men. this was due to the fact that this is the primary service demographic of the program from which participants were invited to participate. the participants were all previously convicted of a violent crime, including but not limited to: domestic violence, aggravated violence, assault, attempted murder, or murder. all participants had engaged in gun violence. all participants have served time in the correctional system. all participants had a minimum of 12 arrests on various different charges. these characteristics are consistent with those of other participants served by the program from which participants were invited to participate. the crimes for which the respondents reported most recently having been arrested included murder (15.4%), robbery (46.2%), and aggravated assault (53.8%). the age range was 19 to 35. a total of 13 participants completed the interview. data collection the primary author of the manuscript conducted all interviews. interviews were recorded with subject permission using audacity.com. data for the quantitative instruments was also collected verbally using question-and-answer during the interview process. interviews took place using either face-to-face at the program location or via zoom, based on preference of the interviewee. analysis of data quantitative analysis quantitative data were analyzed using univariate methods. scale scores were computed for the ace-q and the pcl-5, and these scores were examined relative to published norms for general and specific populations. qualitative analysis qualitative data were examined using grounded theory methods. qualitative methods, in general, and grounded theory methods, in particular, are appropriate when little is known about a phenomenon. the methods utilized were aligned with the traditions of grounded theory (glaser & strauss, 1967) in that theory was built from the data inductively. salaam morgan & bruhn/impact of trauma 239 data were auto-transcribed using nvivo, and transcripts were corrected based on the re-examination of audio recordings. then, the primary researcher, who is the first author of this manuscript, read over the data, building a robust personal understanding of the participants’ experiences and perspectives while paying close attention to common threads throughout the interviews. from these observations, the researcher identified a rudimentary set of repeated patterns through initial coding utilizing line-by-line coding methods. coding proceeded utilizing the constant comparative method. memoing was used within nvivo to track the decision-making process. intermediate, or focused coding (charmaz, 2014) was then used to refine the initial coding structure and elevate the codes that best served to organize and represent the data. charmaz (2014) describes this process as drawing out coding structures that “had more theoretical reach, direction, and centrality and treating them as the core” (p. 141). in the advanced, or theoretical coding phase, the researcher identified themes emerging from the data and the coding structure. the emergent themes represented the ultimate takeaways from the interview data. the themes were examined for their interrelationships, particularly as they related to the shared perceptions of similar events within the lives of the participants and their wider narrativization within their life-courses. the second author of this manuscript acted as a second coder, and the same thematic structure was elicited in the secondary coding process. researcher positionality the primary researcher is a black male who is a former gang member who was formerly incarcerated for a period of 10 years. he has since completed two master’s degrees and a doctoral degree and has served formerly incarcerated black men participating in a program delivering job skills readiness, cognitive behavioral therapy, and social services to promote post-release community integration and to reduce risk of recidivism. this author designed the study and carried out the interviews and the initial coding of all data. the primary researcher engaged in several techniques to support “bracketing,” or epoche, in order to reduce the influence of personal experience on the interpretation of the narratives of participants. the second researcher is a white woman experienced in qualitative research methods, and her role was to act as a second coder and to contribute to presentation of findings. human subjects protections the study was reviewed by the university irb. subjects participated voluntarily and provided informed consent. the irb granted a waiver of documentation of informed consent. copies of consent forms were provided to potential participants at the time when the study was introduced to them, and the consent form was read to participants at the beginning of each recorded interview, and subjects verbally consented at that time. results the results are presented in several parts. first, the findings emerging from descriptive analysis of the two quantitative instruments (the ace-q and the pcl-5) are presented. advances in social work, summer 2024, 24(2) 240 these findings are interpreted relative to normative data. qualitative data are presented as organized by theme. a total of five themes emerged, and each of these is described and substantiated with exemplar statements offered by participants. quantitative data table 1 reflects the number and percentage of respondents endorsing each ace item. table 1. frequency of endorsement of ace items item yes [n (%)] did a parent or other adult in the household often swear at you, insult you, put you down, or humiliate you or act in a way that made you afraid you might be physically hurt? 12 (92.3%) did a parent or other adult in the household often push, grab, slap, or throw something at you or ever hit you so hard you had marks or were injured? 13 (100%) did an adult or person at least 5 years older than you touch or fondle you or have you touch their body in a sexual way or try to actually have oral, anal, or vaginal sex with you? 8 (61.5%) did you often feel that no one loved you or thought you were important or special or your family didn’t look out for each other, feel close to each other, or support each other? 12 (92.3%) did you often feel that you didn’t have enough to eat, had to wear dirty clothes, or had no one to protect you or your parents were too drunk or high to take care of you or take you to the doctor if you needed it? 12 (92.3%) were your parents ever separated or divorced? 6 (46.2%) was your mother or stepmother often pushed, grabbed, slapped, or had something thrown at her or sometimes or often kicked, bitten, hit with a fist, or hit with something hard or ever repeatedly hit over at least a few minutes or threatened with a gun or knife? 13 (100%) did you live with someone who was a problem drinker or alcoholic or who used street drugs? 13 (100%) was a household member depressed or mentally ill or did a household member attempt suicide? 10 (76.9%) did a household member go to prison? 10 (76.9%) table 1 represents extraordinarily high levels of ace scores. the total number of aces ranged from 7 to 10 with an average of 8.38 and standard deviation of 1.3. yao et al. (2022) utilized the add health data to examine aces by region. yao et al. indicated that, overall, only 3.8% of people had four or more aces. the pcl-5 scores ranged from 9 to 18 with a mean of 14.5 and standard deviation of 2.4. this mean is exactly the same as that reported by valdez (2021), although she noted a higher degree of variation and more participants scoring positively for ptsd. most items were either not endorsed or endorsed as “a little bit.” the strong exception was the item, “being ‘superalert’ or watchful or on guard.” all respondents endorsed this item at either “moderately” or “quite a bit.” other stand-out items included “irritable behavior, angry outbursts, or acting aggressively” with 46.2% of respondents endorsing the item at “moderately.” an identical pattern occurred for the item, “taking too many risks or doing salaam morgan & bruhn/impact of trauma 241 things that could cause you harm.” in addition, 38.5% of respondents indicated they were having either “moderate” difficulty or “quite a bit” of difficulty concentrating. given a suggested cut-point range of 31 to 33, none of the respondents indicated symptomatology severe enough to suggest ptsd. one person scored positively to the intrusions subscale. no one scored positively for the avoidance subscale. one person scored positively for negative alterations in cognitions and mood. however, every single respondent scored positively on the arousal subscale (two items scored at “moderately” or higher for criterion e). thus, while the range of symptoms necessary for a ptsd diagnosis was not demonstrated, a prominent pattern of arousal was noted among respondents. qualitative data a total of five themes were identified through the close engagement with the qualitative data. the themes include exposure to trauma (which includes two sub-themes: early exposure and ongoing exposure); numbing; role of gangs; experiences in jail; and recommendations. these themes were, to a degree, consistent with the broad topics that formed the basis for the semi-structured interview questions, and yet they departed from those topics in some ways as well. in order to protect the identity of our respondents, we intentionally do not provide demographic attributes with their comments—this was an important feature of building rapport and trust with participants as well as adhering to our irb requirements. exposure to trauma despite the fact that all respondents endorsed items pertaining to child physical abuse and witnessing domestic violence, for the most part, respondents recalled their childhood homes fondly. exceptions did occur, as with one respondent who indicated, “i want to say like a three-bedroom apartment…we had like fifteen people in there you know how we doing…it was all cousins, aunties, and uncles and them. all that.” my mama passed when i was seven so then i moved in with my grandma…they already took care of their kids they ain’t really have time for us like that you know what i’m saying so.. we fell off into the madness me and my brothers and all of us…we was barely living you know i’m saying…there really wasn’t no love. however, while several respondents indicated they were not aware of their neighborhood characteristics when they were very young, every single respondent characterized their neighborhood growing up as rough. for instance, one respondent described the neighborhoods as, “shit, trenches. well, to put it better ghetto. people running the streets, crackheads in front of the store type stuff.” another indicated, “…grew up in (neighborhood name), (neighborhood name), around there it was tough. we’ve got gangs, drugs, violence every way you look– up, down the street. it was– it was, it was home though.” “i grew up in a project-ass neighborhood – abandoned, drug infested…project was rough you know, you used to – you got to survive, you know what i’m saying, we had to…steal to survive.” “…five, six years old…they was on their gang shit real hard, so they advances in social work, summer 2024, 24(2) 242 was teaching us that…so that was the culture…that…played a big role, you know what i’m saying in my upbringing.” participants also indicated that, as they became older, they became aware of and drawn to gang activities. i turned ten, eleven, twelve years old…i wanted to start doing…what i think the older guys and neighborhood doing you know? i started paying attention to it...i ended up hanging with the older cats, you know doing errands…holding this and holding that…like – it started off something small…like when it trickled off toward guns and like stealing cars, i think i was twelve, thirteen at the time. i was twelve when i…i like, got my first gun. within the trauma theme, exclusive of neighborhood descriptions, two sub-themes emerged. one related to early trauma. these were events related by respondents that seem to serve as seminal events that created strong emotional reactions and memories and that had significant developmental impact. in most cases, individuals related witnessing violence, although rarely they also related experiencing violence directly. my older cousin– you might know my older cousin he got killed, he got killed on (location). he used to be– he used to always be hanging in the projects…well he got killed, he got killed. he got killed on (location). well, they shot him on (location). and he ran to the house. they shot him off and then he ran to the house. and…like, man, that was messed up. because he was bleeding like a motherfucker, man. and he made it though. he made it to the house though. that's– before he died he made it. i was, i was hurt man. i was hurt man. that was my motherfucker– i looked up to him...he was rough but he wasn’t like that not for no motherfucker to kill him. he wasn’t like that. and they killed him. i had an uncle – at that time i was like six years old…i was in the car with him…his girl gets up out the car…she went in the house to go do something…he was like man go help her do something i went in with her…we heard all type of gunshots so and she told me to go get into the tub…you just heard like [imitates car screech]..so when we ran out, you know my uncle’s car was like right up the street and like somebody pulled up on the side of him and just shot him but he tried to get up out of there and he kept hitting cars and he just – he died like right there in the street. i felt like – i felt like – i feel hurt, like, i didn’t feel like i can…i can’t trust nobody now. participants also discussed personal experience of violence later in life, in part due to association with gangs or due to interaction with police. witnessed violence during that time was also discussed. trauma related to being incarcerated was also related and will be covered in that theme. i’ve been shot before, that traumatized me. when i…hear like, “pop” or anything, i’d be aware of it and over alert. i took, i started doing xans around that time…like the drugs helped me with my problems…i got, i got a bad addiction… salaam morgan & bruhn/impact of trauma 243 i got hit (shot) 10 times but one bullet hit me twice because it went in my shoulder came out the top and hit me in my neck and stayed in my neck like 18 months…what woke me up was an incident i had at (name of project)…like, i could have lost my life in them buildings and i'm here to tell the story why so many men ain’t make it out them buildings. numbing when asked how their experiences with trauma had affected them, a number of respondents indicated that they felt nothing. this was in some cases because they thought the violence was justified, and in other cases it was because they had become inured to it. in a minority of cases, participants indicated they were drawn to the violence. yeah, i seen it. i seen a lot of shit. i want to forget it, what i’ve seen. yeah, yeah…i was like man after a while after seeing it so long, i became numb to it…a lot of times you could give me like, a shot like a gunshot…i’d jump, shit…but now i got better with that i don’t do that no more because i’m used to it. when you living this life like that it’s best to keep that – it’s best to leave that shit out because you’ve got to realize you’re dealing with drugs, gangs, and all this other stuff so it’s best to leave that shit out unless they catch you for it, if they don’t catch you for it, fuck it, it’s on to the next one. when they catch you for it, then you go, “ah, damn, they got me.” i ain’t gonna – i really ain’t had no feeling at that time. it was like, i was numb to it because by this time i knew death, you feel me? …this was what i was trained on the streets to do, how to go about things…to be able to experience things like that it’s like, man fuck i’m gonna go get high, i’m gonna go get with my girl, i’m gonna go out to eat, or i’m gonna go get me some new shoes. i ain’t thinking about that. i mean, it was normal…like the crime i committed to me, was normal. like i had no remorse and none of that…i used to always tell myself if i can go back and change what i did would i do it? and i told myself nope. i have to fight even more every day…i ran at first because it kind of got to me, but it’s like, every time i fought it’s like sharks to blood. i wanted more...first i would…run…hoping that don’t anybody bother me or chase me. then it got to the point i wished they would. impact of gang involvement participants were asked about their involvement in gangs and their response to the fact that some people say gangs are like families. all participants indicated they had been involved in gangs, and they agreed with the idea that gangs were like families. several of the participants indicated that the gangs had provided for them when they were in need. several indicated that gangs, at one time, had positive influences upon neighborhoods by advances in social work, summer 2024, 24(2) 244 creating expectations for prosocial behavior such as going to school and caring for the elderly. several also indicated that the nature of the structure and activity of gangs has changed, that younger members are now exerting influence over gang structure and behavior and that, since this change, the gangs have become more unrestrained. the respondents expressed misgivings about these changes (“…and the gang ain’t the same no more because what they doing now is like totally crazy…”) i went to the gangs because i had no father figure in my life you feel me, like a father figure. so i went to the gang for that purpose, you know, a brotherhood, you know, somebody to look up to but you know, as you get into it, and you learn more about it…it be what it be. it do become a family, it become like that, like it’s an organization but we as one…this generation right here, i don’t like this generation of gangbanging. i like the old generation…all y’all go to school all y’all can’t be out during these hours…right now it’s like, there’s no remorse. nobody, don’t nobody care. impact of incarceration when asked about their experiences of incarceration, participants related narratives that diverged. some participants remained affiliated with gangs in carceral settings, and some did not. some described having been engaged in fighting, sometimes being placed in seclusion, and others did not. some related significant exposure to violence in jail or prison, and others did not. many related material hardship and deprivation, including the consequences of withdraw from substance use. many discussed the negative impacts of incarceration on their lives, particularly on their relationships with their children. the majority of the respondents indicated that their incarceration was justified or earned – “i mean, shit i reap what i sow. i know what i did. i know what i put myself into.” one surprising finding was that several of the respondents felt that their incarceration produced positive consequences for them in terms of allowing the opportunity to consider how their life course had resulted in incarceration and what they wanted for themselves after release. …when i first went there was violence, n…s fucking n…s all type of shit, you know what i’m saying. when i was in (location), n…s was hanging themselves, they had n…s throwing shit on the officers, they’d go in there, fuck them up, they’d come with the hoses, spray them with the hoses and all that shit. yea, i’ve seen all that (the participant indicated things had improved since that time). i have been on a lot of – not a few – i’ve been on like, i can count on two hands i’ve been…in different joints or whatnot…i done got stabbed three times…it’s so i always felt like hey man, i don’t ever have good luck. and i always felt like man, by the time the end of my bid come, i ain’t gonna make it – something’s gonna happen and i ain’t never gonna see the outside of this world again. my kids, me and my daughter got disconnected so bad for me being locked up and stuff…then like, with my other kids i love them in depth, but it’s hard for me to bond because i never get a chance to bond with my other kids…you know what i’m saying because man it’s rough. it’s really rough. salaam morgan & bruhn/impact of trauma 245 it messed me up but i can say it was like a gift and a curse, because i went to jail and…and i got to reading and i found (religious faith) in jail…i developed a conscience you know something i didn’t have and it made me want to do stuff different. …it made me distanced from a lot of people…but the good thing it taught me, when i get out of here man, i’m gonna make something of myself. so i won’t be in this position again, and make better choices and make better decisions…and the positive things i’m learning about jail is to like, actually care about someone…i actually understand. participant recommendations participants appeared surprised to have been asked for their recommendations to end violence in the community, and initially they sometimes seemed not to understand the question. once they understood the question, they still sometimes initially hesitated. answers offered presented a range of potential programmatic responses. several of the responses pertained to developmental opportunities and structure for youth. one area of emphasis in these responses had to do with the concept of early intervention – this represented the idea that social responses needed to focus on experiences of children and youth. additional areas of emphasis included jobs and counseling. a few responses had to do with outreach to the gangs themselves and pertained to community organizing. one participant advocated for gun control (“take all the guns away and let’s see who could fight with these motherfuckers, take away all the guns and let’s see who can fight”). …more programs like (program name), you now, more programs to open our minds and see things for the bigger picture…and teenagers…. instill the morals into them…as far as the generation up under 10, the children who was soaking up everything like a sponge…building their personalities before they reach (those) teenage (years) – i feel like we should reach them – make that a priority because if we don’t reach them the cycle will continue, you know? …young people have too much time on their hands…my grandma used to say that tv is the devil’s eyeball so now there’s social media…and, you know…they have no order, and when you have no order, it breeds chaos…so i believe at some point in time that if you don’t get a hold on it, it’s just gonna spread like wildfire…open up centers again for the youth…with people who actually care we can catch the kids while they young before they grow up and let all this other stuff influence them. giving up more jobs, more opportunities, get more people off the streets, get more kids, more like, places to be like more programs for children so they can be off the streets, better schooling, basketball, more careers, more job opportunities…i feel like that the violence needs to stop now. more, more jobs…like decent paying jobs too. because…don’t you know, it’s a brother already was…at a certain level in his life…he’s not gonna want to do that. why would a person you know, step down, you feel – you understand what i’m advances in social work, summer 2024, 24(2) 246 saying? (meaning, jobs created would have to offer compensation competitive with what people are already earning in order to incentivize people to change) you know what i’m saying, i believe a lot of people need…therapy, honestly…because the shit that people go through in the hood is so much that you can’t do nothing but just push it out. because people who live with it every day become drunks, they become drug addicts, do all that. i mean, shit, people don’t got no money right now, you know what i’m saying, people need shit…it’s the young people who really going through the most of it…i mean…they don’t know how to deal with all the shit that they doing. i mean shooting, jacking, all that shit. i think they need to bring the people…committing the crime in the community, i think they need to bring these guys together…somehow find a way to bring these guys together, and to…let (them) understand, no, like, man, there’s a lot of stuff going on. and…there’s…nothing positive coming out of what you’re doing. you know what i’m saying, y’all got kids…killing kids…i just saying i think you need to get the gangs…involved though. get them involved in, in trying to change the community – if they get involved in trying to change the community, they’ll feel more better…you know what i’m saying…there’s too many innocent kids getting killed and they ain’t even a target. discussion review of findings the findings suggest that the participants have been exposed to high rates of trauma. the average ace score was 8.38. over 76% of americans have only one ace. the prevalence of certain types of trauma, including childhood physical abuse, witnessing domestic violence, and living with someone with a drug or alcohol problem was 100%. participants described their neighborhoods as profoundly affected by gun violence, other forms of violence, gang presence, drugs, and poverty. participants described in detail having witnessed violent injuries and deaths at very young ages. participants indicated they had felt gang pressures as early as the ages of five or six and that they had participated in drug trade activities, stealing cars, and holding guns as early as age twelve. nearly all participants described cognitive strategies for distancing themselves from the impact of their experiences. they described justifying their actions as necessary to secure justice for deaths of family members and or gang affiliates, whom they also described as familial. they also described desensitization to violence, indicating that what had unnerved them at one time had become commonplace. they described learning how to block undesired thoughts in order to control anxiety. several indicated that they stopped trusting others. a few mentioned controlling their reactions with drugs. in many respects, these strategies appear to have been successful. no participant identified symptoms rising to the level of ptsd. none of the participants demonstrated a clinical level of symptoms on the intrusions, avoidance, or negative alterations in cognitions and mood criteria. however, 100% of participants endorsed items on the arousal subscale in a manner that salaam morgan & bruhn/impact of trauma 247 arose to clinical significance. moreover, only one respondent described having no problems with sleep. participants described a number of dynamics leading to gang involvement, the most common of which was absence of a father figure. participants also described noticing gang involvement in their communities and becoming intrigued and wanting to become like the older boys and men in their communities. while they described gangs as families, they also in several instances conveyed that they had felt resigned to the inevitability of gang involvement and that they sometimes felt betrayed or abandoned by their fellow gang members. their imprisonment brought about a wide variety of losses including financial losses, loss of home, and loss of connections to families, particularly children. surprisingly, some participants found the period of their incarceration to be an opportunity for selfexamination and commitment to change. research questions participants were quite clear with regard to the impact of trauma on their lives. they were aware of their sources of trauma and characterized these primarily as community violence and interpersonal violence experienced in gang-related encounters. they also discussed their exposure to violence in carceral settings. participants were also very clear about the impact that this exposure to trauma had on them and were aware that they were consciously avoiding processing their trauma experiences. what was not as prominent as expected in their answers was an awareness of a causal relationship between exposure to trauma and the gun violence and other violent crimes that led to the participants’ incarceration. the participants did discuss in detail the circumstances leading up to their arrests, but they tended to characterize their arrests as the result of happenstance. no clear, common threads were associated with the narrativization of these events, and the trauma histories that participants so clearly conveyed did not figure in to their attributions concerning arrest. specifically, the participants did not attribute their crimes or arrests to their trauma histories or appraise trauma as a factor predictive of crime. the participants were at first somewhat tentative in their responses to questions about what should be done to prevent crime; the sense was that they may not have been asked this question in the past. however, all participants contributed to this dialogue, offering a range of proposals with a predominant theme of early intervention. implications for social work policy, programs, practice the results of this study are significant in several regards. the population represented here is one that may not adequately be represented within existing literature. to win the trust of men who have experienced trauma, sometimes at the hands of authorities, and to enable them to share their personal experiences openly is not easily done. engaging with this population creates a means for sharing the authentic voices of those who have been most affected by gun violence and other forms of violent crime as well as those who have been primary perpetrators of such crimes. seeking their perspectives is necessary in order to instruct and inform public discourse concerning gun violence and violent crime in america. finally, creating a clearer understanding of the life experiences of those who advances in social work, summer 2024, 24(2) 248 experience multiple arrests, convictions, and incarcerations can help promote informed thinking about the developmental experiences that underlie gun violence and other violent crime and can create a more contextualized basis for decision-making concerning policy and programs to address these concerns. participants expressed a range of concerns about their communities when discussing their own early histories, and they discussed the need for community-based and youthfocused interventions when asked about how to deter future, violent crime. their concerns are borne out by other forms of evidence. james et al. (2020) utilized data from the gun violence archive and the fragile families and child wellbeing study to demonstrate that 21% of adolescents overall live or go to school within 500 meters of a prior-year deadly gun violence incident. the rate of exposure differs markedly by race and ethnicity and poverty with nearly 50% of poor, black children and only 2% of middle-to-high income white children exposed to gun violence in this manner (james et al., 2020). the strategies that participants offered as remedies for the violence they had seen and had perpetrated did not diverge from the types of social remedies often proposed for community violence. for instance, a qualitative study by parsons et al. (2023) also found that recommendations of community members to deter gun violence included community based mental health services and youth activities. participants indicated that a range of types of programs would be necessary to address the complex and multiply-determined problems faced by communities. they identified needs for jobs and for adequate income in order to allow parents to work less and to be available to adequately supervise their children. they identified needs for better educational opportunities. they identified needs for community-based programming, or centers, where children and youth could go and where they would be constructively engaged. they specifically identified a need for intervention that would take place with young children. they indicated that gang members themselves should be enjoined to engage in community organizing. finally, several participants cited counseling as a critical need in their communities. this study, while representative of only a limited sample, can serve as a call to social work to continue to engage, or to re-engage, with communities with known needs. research suggests social workers are eager to engage in gun violence prevention efforts (sperlich et al., 2022). failure to engage in evidence-informed investment in these communities has resulted in substantial cost in the quality of the lives of individuals and families as well as substantial public health costs. several individuals described observations that the problems are getting worse, not better. in the words of one participant, “…the violence needs to stop now.” limitations this study is subject to several limitations. first, the sample size is small, and the sampling frame was very specific. all of the participants were participants in a program offering cognitive therapy and jobs skills development opportunities. thus, while the participants had participated in gangs, had multiple arrests, had perpetrated gun violence as well as other forms violent crime, and had been incarcerated, they were all men who had decided to make a change in their lives. they may or may not represent others who are salaam morgan & bruhn/impact of trauma 249 similarly situated. reports are, however, that these programs are not able to serve all those who would like to participate and that many community members are eager for the kinds of opportunities that the programs may offer. thus, the sample might bear more similarity to the community at large than initial review would suggest. an additional limitation is found in the fact that the analysis of the qualitative data was an inherently subjective experience. because the first author of this manuscript has personal experiences that are similar to those of the participants, imparting some risk for misperception of subjects’ meanings, specific attention to bracketing, or epoche, was needed. the second author also examined and analyzed all of the data, and the remainder of the committee also offered supervision and guidance. implications for future research one intriguing finding from the research relates to the fact that, while none of the respondents scored positively for ptsd, they all scored positively for arousal symptoms. possibly, avoidance is simply infeasible in the settings in which participants live, and the cognitive strategies they have described for managing their experiences prevent intrusion symptoms or alterations of cognition and mood. nevertheless, consequences of consistently suppressing thoughts of and emotional responses to traumatic events are likely to be present, if unrecognized. further exploration could elucidate these mechanisms. similarly, several participants cited cognitive therapy as a valued resource and one they recommended for their communities. examination of the right form of therapy for addressing the symptoms of people with lifelong, intense exposure to trauma through a wide variety of vectors is an important clinical priority for social work. finally, participants discussed the need for additional community-based programs to prevent crime by proactively engaging youth and by providing adults with access to jobs. additional needs assessment and research concerning program delivery and outcomes is necessary to inform decision-making concerning program development and implementation in order to address the needs of community members. references aebi, m., bielas, h., barra, s., skrivanek, c., steinhausen, h. c., bessler, c., & plattner, b. 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(2022). regional prevalence of adverse childhood experiences in the united states using a nationally representative school-based sample. ssm population health, 19, 1-7. author note: address correspondence to christina bruhn, school of social work, aurora university, aurora, il 60506. email: cbruhn@aurora.edu https://doi.org/10.1016/j.ssmqr.2023.100258 https://doi.org/10.1016/j.jadohealth.2014.11.018 https://doi.org/10.1016/j.jadohealth.2014.11.018 https://doi.org/10.1002/ajcp.12123 https://doi.org/10.1002/ajcp.12123 https://doi.org/10.1002/ajcp.12123 https://doi.org/10.2105/ajph.2012.301160 https://doi.org/10.2105/ajph.2012.301160 https://doi.org/10.1177/0306624x17734798 https://doi.org/10.1177/0306624x17734798 https://doi.org/10.1080/26408066.2021.1980478 https://doi.org/10.1080/26408066.2021.1980478 https://doi.org/10.1080/14999013.2019.1643428 https://doi.org/10.1080/14999013.2019.1643428 https://doi.org/10.1080/14999013.2019.1643428 https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp#obtain https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp#obtain https://doi.org/10.1002/jts.22651 https://doi.org/10.1002/jts.22651 https://doi.org/10.1002/jts.22651 https://doi.org/10.1037/tra0000410 https://doi.org/10.1037/tra0000410 https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp https://doi.org/10.1177/0093854806296830 https://doi.org/10.1177/0093854806296830 https://doi.org/10.1016/j.ssmph.2022.101145 https://doi.org/10.1016/j.ssmph.2022.101145 mailto:cbruhn@aurora.edu _________ premela deck, jd, phd, licsw, family law attorney, clinical and forensic social worker, sd family services, canton, ma. sarah eisensmith, phd, lcsw, med, researcher, academic consultant, and clinical and forensic social worker, ahb forensics and consulting, durham, nc. brittany skinner, licsw, clinical mental health professional, west wareham, ma. jacqueline cafaro, msw, lcsw, forensic and clinical mental health professional, sd family services, canton, ma. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 392-408, doi: https://doi.org/10.18060/25294 this work is licensed under a creative commons attribution 4.0 international license. identifying indicators of high-conflict divorce among parents: a systematic review premela deck sarah eisensmith brittany skinner jacqueline cafaro abstract: the burgeoning field of forensic social work supports clients engaged in the legal system. forensic social work professionals working in family court will often be called upon to assess family dynamics, provide treatment to reduce maladaptation post-divorce, and advise divorcing parents as they navigate the complexities of court. of particular interest to the forensic social work field are the various risks and protective factors that escalate or mitigate interparental conflict throughout the divorce process. interparental conflict is a primary moderator accounting for psychological and physiological differences between children of divorced parents and children with intact parents. this systematic review examined the factors that contribute to conflict in divorcing parents and ways to identify high-conflict cases. peer-reviewed articles (n=11) were systematically selected using rigorous methods, including prisma-p protocols for systematic reviews and database searches using the search string “conflict and divorce*.” articles were extracted to identify themes of varying levels of conflict. there is no consistent definition of high conflict in pre-divorce parents, and recent articles offer new conceptualizations of this construct. all studies that met inclusion criteria for the review identified at least one of five themes of pre-divorce conflict: conflict resolution/communication, social network, parent characteristics, satisfaction with agreements, and pervasive mistrust. keywords: forensic social work, high-conflict divorce; high-conflict parents; highconflict separation; systematic review poor psychological and physiological outcomes in children of divorced parents compared to children of married parents are often due to the presence of interparental conflict (hald et al., 2019). children from traumatic divorces often have long-lasting effects, particularly in terms of their overall well-being and ability to maintain functional social relationships (van der wal et al., 2018; wolfinger, 2005). concerningly, research suggests approximately one-third to one-fourth of all divorces in the united states involve high levels of conflict (maccoby & mnookin, 1992; visser et al., 2017). this rate seems consistent with other countries with the netherlands, for example, reporting nearly 20% of divorce cases being high-conflict (van der wal et al., 2018). and while high-conflict cases may represent the minority for legal professionals, they require 90% of family court resources, delaying resolution and burdening the court system (neff & cooper, 2004; smyth & moloney, 2017). https://doi.org/10.18060/25294 about:blank deck et al./high-conflict divorcing parents 393 despite the attention to interparental conflict and knowledge of the negative impact of conflict on children, the literature still lacks a clear definition and conceptual model for identifying high-conflict divorce cases (polak & saini, 2018). instead, “high conflict” seems to be an ambiguous umbrella term used to describe divorce cases that evolve in a manner inconsistent with the majority of divorce cases. for the typical divorce case, interparental conflict is expected during the divorce process (birnbaum & bala, 2010). this expected conflict usually subsides within one to two years from separation as the family successfully adjusts to a post-divorce structure (buchanan & heiges, 2001; johnston, 1994; smyth & moloney, 2019). however, for the atypical divorce case, this conflict may remain high due to prolonged litigation, physical or psychological abuse, significant disruption in familial relationships (e.g., parental alienation), or post-divorce maladjustment (birnbaum & bala, 2010). in these atypical (i.e., high-conflict) cases, forensic social work professionals are called upon by the family court to assess the family system and advise on appropriate scaffolding measures in order to effectively support the minor children affected by the conflict. given the many reasons a case may be considered high-conflict, it is difficult to create specific criteria that equates a case to being high-conflict. as a result, many cases may be labeled high-conflict retrospectively as children exhibit poor outcomes often associated with high-conflict divorces, such as behavioral issues, poor academic performance, or mental health concerns (polak & saini, 2018). this retrospective labeling may also explain the literature’s focus on post-divorce rather than pre-divorce interparental conflict. a clear definition of high-conflict divorce and identification of predictors of high conflict during the divorce process will facilitate increased research opportunities that may ultimately lead to early recognition of these cases. such early recognition will allow forensic social work professionals to identify proactive interventions to safeguard against escalating family conflict and support children’s well-being. however, failing to address pre-divorce conflict and differentiate it from post-divorce conflict may contribute to negative outcomes for minor children in high-conflict cases. as discussed, defining high conflict for divorce cases requires an acknowledgment of the stage of divorce for the family, as certain levels of conflict are tolerated and expected during the divorce process, specifically during the pre-divorce stage. ongoing conflict in cases where divorce judgment was entered years previously, for example, but the family remains in court, may be considered pathological and deserving of the term high-conflict (johnston, 1994; ponzetti & cate, 2008). recognizing divorce is not a single event in time (namely, the receipt of a divorce judgment), but instead is a process of social, emotional, and legal separation that leads to varying levels of interparental conflict throughout each stage in the process may better equip forensic social work practitioners to interact and intervene with these families (ponzetti & cate, 2008). additionally, acknowledging that pre-divorce conflict may be high as a result of circumstances (i.e., the initial separation) rather than an entrenched, ongoing conflict with the propensity for increased risk of child maladjustment is critical in furthering the forensic field’s conceptualization of high-conflict cases. as noted, divorce is not a singular event, but rather a long-term series of stressors to which minor children are continually exposed. divorce fundamentally changes one’s family structure and can therefore have emotional and psychological implications for all advances in social work, summer/fall 2023, 23(2) 394 impacted family members (ferraro et al., 2016). mazur et al. (1999) note that in addition to the toll divorce takes on one’s mental and emotional state, other stressors such as, “parental depression, interparental arguments, reduced contact with and inconsistent visitation by the nonresidential parent, and a decline in the standard of living” deeply impact a minor child’s familial, social, educational and community systems (p. 231). as such, social workers—and those in the forensic space in particular—are uniquely positioned to examine the multiple systems at play and can recommend both clinical/mental health and macro/resource-based interventions to support the affected family and their minor children accordingly. stages of divorce research on divorce relies heavily on theories including family stress and coping theory, general stress theory, and risk and resiliency perspectives (booth & amato, 2001; ponzetti & cate, 2008; salts, 1985). with the stress perspective, marital dissolution is seen as a process that begins with parents intact and ends after a legal divorce decree or judgment (booth & amato, 2001). researchers have conceptualized stages during this process of divorce in various ways (ponzetti & cate, 2008; salts, 1985). divorce stage theory holds that there are three stages to divorce including pre-divorce decision-making, divorce restructuring stage, and post-divorce recovery stage (salts, 1985). the first two stages occur pre-divorce, meaning before the legal divorce decree. specific to the pre-divorce stage, ponzetti and cate (2008) describe four sequential time points in the process of marital dissolution, including recognition of marital dissatisfaction, serious discussion of the dissatisfaction, action to secure a legal dissolution of the marriage, and acceptance that the marriage will end. for pre-divorce parents, there are unique stressors that may affect the degree of conflict. immediately following the decision to separate, parents are faced with a number of stressful changes, including reorganization in income, housing and time spent with their children, their role within the family, loss of a spouse and extended family members, and the ultimate loss of a partnership (amato, 2005; cohen & finzi-dottan, 2012; johnston, 1994). despite these unique stressors, there is little research pertaining to the predictors of conflict for parents in the initial stages of divorce (cohen & finzi-dottan, 2012; saini & birnbaum, 2007). although there remains a scarcity of research that focuses on pre-divorce conflict, post-divorce conflict has received considerable attention by researchers and predominantly focuses on its relation to child adjustment (ponzetti & cate, 2008). further, there is considerable research on factors that contribute to prolonged post-divorce conflict, identifying sociodemographic features (amato, 2001; benjamin & irving, 2001), satisfaction with agreements pertaining to finances and custody (arditti & kelly, 1994; bonach, 2005), and social network supports (arditti & kelly, 1994). these two stages, preand post-divorce, have different social, emotional, and legal implications, and may have different factors that contribute to interparental conflict. accepting that divorce is not a single event, but instead a process, it makes sense to distinguish between 1) the pre-divorce transitional and restructuring phase of divorce, and 2) the post-divorce acceptance and recovery stage. ultimately, a distinction between deck et al./high-conflict divorcing parents 395 interparental conflict preand post-divorce may be necessary to determine whether the conflict is normal or pathological for that specific stage of the divorce process, and finally, whether intervention by a forensic social work professional is needed to facilitate successful familial adjustment and child well-being (cohen & finzi-dottan, 2012; finzidottan & cohen, 2014; johnston, 1994). current study the gap in our understanding of defining and recognizing high-conflict pre-divorce parents served as the primary rationale for this study. the literature indicates that prolonged interparental conflict correlates to child maladjustment post-divorce. undetermined is what, if any, contributing factors prior to the legal termination of the marriage result in prolonged high conflict. the purpose of this study was to provide a systematic literature review of the social science literature to determine the factors that contribute to high conflict in divorcing parents. the review was guided by the following questions: (a) what factors distinguish high levels of interparental conflict from typical conflict for divorcing parents? and (b) what factors predict or contribute to pre-divorce conflict? this review was specifically looking to identify social or mental health factors that influence high conflict and pre-divorce conflict and in turn may support forensic social work professionals in recognizing when early interventions are needed. the importance of early intervention identification cannot be understated. research has shown that interventions such as prevention programs and educational courses that provide support to divorcing couples early in the divorce process help to mitigate conflict, promote strong co-parent and parentchild relationships, and ultimately protect children from the negative impact of exposure to high-conflict divorce (grych, 2005). methods this review was developed using preferred reporting items for systematic review and meta-analysis protocols (prisma-p) for systematic reviews (moher et al., 2015). figure 1 contains a prisma flow diagram depicting the various steps in this study’s review process. the main goal of the review was to identify factors of interparental conflict for divorcing parents. following the practices outlined by litell and colleagues (2008), the following three methods were used to identify relevant conflict measurement tools: (a) database searches of peer-reviewed literature, (b) hand searches of relevant journals, and (c) reference harvesting. the electronic databases systematically searched were social work abstracts, psychinfo, and academic search premier. these searches used the following search string: “conflict and divorce.” after removing duplicates, this search yielded 4,126 articles for a title and abstract screen, of which 70 were advanced to a full-text screen, after agreement by two reviewers. conflicts were resolved by a third reviewer. articles were included in the review based on predetermined criteria: (a) specific to pre-divorce conflict, (b) printed in english, (c) focused on defining or describing conflict, and (d) could be either theoretical or empirical. articles were excluded for (a) testing instruments to measure conflict (n=3), (b) interparental conflict was a dependent variable in an article otherwise focused on a related advances in social work, summer/fall 2023, 23(2) 396 topic (e.g., child outcomes, categories of interventions, program evaluations; n=38), (c) the type of conflict discussed is not in relation to romantic relationships or divorce (n=1), (d) not in english (n=2), duplicate studies (n=4), and post-divorce focus (n=11). articles were not excluded based on publication date. ultimately, there were 11 articles included in this review. next, data were systematically extracted from the 11 articles included in the review using an extraction spreadsheet developed and piloted for this study. the spreadsheet captured areas relevant to the research questions guiding this review, including study design, theories and models, definitions of conflict, predictors of pre-divorce conflict, study objectives and research questions, relevant measures, as well as implications, strengths, and limitations. from the extraction spreadsheets, predictors of pre-divorce conflict were identified through thematic analysis (thomas & harden, 2008). textual summaries pertaining to predictors of pre-divorce conflict were created for each article. from the preliminary coding in the extraction spreadsheets, two reviewers organized the emerging themes into meaningful clusters, using hierarchical relationships to nest themes and relate them to one another. any discrepancies were resolved by the third reviewer (brooks et al., 2015). each article was then coded for the presence of these themes (thomas & harden, 2008). identification •records imported for screening (n=6,313) •records after duplicates removed (n=4,126) sceening •records for title/abstract screen (n=4,126) •records excluded (n=4,056) eligibility •full-text articles assessed for eligibility (n=70) •full-text articles excluded, with reasons (n=59): post-divroce focus [n=11]; factors of interparental conflict not explained ([n=38]; not parental conflict [n=1]; duplicate studies [n=4]; instrument testing [n=3]; not in english [n=2] included •studies included in qualatative synthesis (n=11) advances in social work, summer/fall 2023, 23(2) 397 table 1. summary of included articles (n=11) author (year) journal type of article theoretical framework factors of conflict discussed classification system offered anderson et al. (2010) american journal of family therapy conceptual n/a pervasiveness, defensiveness, aggression, escalation, negative attributes, dualistic thinking, strong negative affect, emotional reactivity, lack of safety, mutual distrust, triangulation 1) pervasive negative exchanges 2) hostile, insecure emotional environment bergman & rejmer (2017) journal of child custody empirical conflict of values; conflict of interest; life trajectory time with the child, communication, finances, child’s residence, childcare, cooperation, violence, addiction, child’s wishes, mental or physical illness, access sabotage, threat/risk of taking child abroad, sexual assault of child 1) conflict of values 2) conflict of interest cohen & finzidottan (2012) journal of social & personal relationships empirical adaptation processes (cramer, 2000) defense mechanisms, communication, negotiation n/a finzi-dottan & cohen (2014) journal of child & family studies empirical n/a communication, cooperation n/a johnston (1994) children & divorce conceptual n/a individual, interactional, external factors; nature of separation, vulnerability, legal conflict, hostility, distrust, & ipv, child factors 1) domain dimension 2) tactics dimension 3) attitudinal dimension malcore et al. (2009) journal of divorce & remarriage empirical n/a perceived relationship quality; level of conflict; communication; issues with children; continued court involvement n/a polak & saini (2018) journal of divorce & remarriage systematic review ecological transactional approach ontogenetic, microsystem, exosystem, & macrosystem factors 1) ontogenetic (individual) 2) microsystem (family) 3) exosystem (community) 4) macrosystem (culture) ponzetti & cate (2008) journal of divorce empirical n/a conflict, love, maintenance, ambivalence, trust n/a seirup (2014) umi dissertation publishing dissertation n/a contentiousness, conflict, personality n/a smyth & moloney (2019) australian & new zealand journal of family therapy conceptual n/a family law issues; ideological beliefs, attitudes, & values; family violence & abuse; mental health; substance, & alcohol abuse; other addictive behaviors 1) circumstantial conflict 2) entrenched or enduring conflict smyth & moloney (2017) family court review conceptual n/a reactive &entrenched hatred n/a advances in social work, summer/fall 2023, 23(2) 398 table 2. characteristics of empirical articles (n=6) sample research design author (year) n characteristics design method instruments used predictors assessed findings bergman & rejmer (2017) 33 none provided qualitative cross-sectional summons applications, statements of defense from parents, rapid information inquiries & custody investigations n/a parental disputes more mothers than fathers requested sole custody. majority of cases involved children under 9 years old. majority of cases were a conflict of values. cohen & finzidottan (2012) 71 mean age 41.5 for men & 37.5 for women; married average of 11.2 years; average 2.4 children; 38% men & women college degree; 46.45% of men & women “average” economic situation. quantitative cross-sectional hierarchical linear modeling analyses on questionnaires to israeli divorcing couples relationship between former spouses scale; conflict tactics scale; defense style questionnaire; life orientation test-revised; perceived social support & perceived social undermining scale; temperament survey for children & parental ratings coparenting via negotiation & defense mechanisms conscious use of negotiation & unconscious use of mature defense mechanisms were associated with better co-parenting. finzidottan & cohen (2014) 207 123 women & 94 men; mean age 39.8; mean length of marriage 10.8; mean # of children 2.4; 33% college degree; 49% average economic situation. quantitative crosssectional two stepwise hierarchical regressions on questionnaires to divorcing israeli parents n/a coparenting negotiation as a successful coparenting technique. negotiation & gender contributed to communication & cooperation. malcore et al., (2009) 280 147 women & 133 men; mean length of marriage 9.5 years; average # of children 1.7 quantitative crosssectional archival data multiple regression analyses using survey results administered to high-conflict parent class n/a perceived relationship quality; level of conflict; communication; issues with children; continued court involvement parents’ ability to agree, the inclusion of children in the parental conflict, & parental communication were significant predictors of high conflict ponzetti & cate (2008) 107 57 men & 50 women; mean age of 36.7; average length of marriage 10.2 years mixed methods cross-sectional 2 hour-interviews using retrospective interview technique & questionnaires; regression analysis dyadic trust scale (larzelere & huston (1980); braiker & kelley (1979) conflict, love, maintenance, ambivalence, trust as individuals move toward legal termination of their marriage, the level of conflict changes. levels of conflict peaked during discussion phase. dyadic trust, ambivalence, & maintenance were significant predictors of conflict. seirup (2014) 125 72 women & 53 men; average age 42.1; average length of marriage 10.9; 103 with children & 22 reported not having children. dissertation quantitative cross-sectional hierarchical multiple regression neo personality test; revised conflict tactics scales contentiousness, conflict, personality best predictor of level of conflict was the participant’s report that their partner’s personality was extremely different from their own. personality prototypes were not significantly correlated with the level of conflict. deck et al./high-conflict divorcing parents 399 results examination on interparental conflict for divorcing parents can be gleaned from social science literature and clinical literature, which is reflective in the range of journals publishing this research. these studies were found in nine journals: american journal of family therapy; journal of child custody; journal of social and personal relationships; journal of child and family studies; children and divorce; journal of divorce & marriage; journal of divorce; umi dissertation publishing; australian and new zealand journal of family therapy; and family court review. all 11 articles were published between 1994 and 2019. of the articles, six were empirical and five were conceptual. table 1 provides key information for each of the reviewed articles. the empirical articles included in this review are a mixed-methods study, a qualitative study, and four quantitative studies. one of the four quantitative studies was a dissertation. the range of predictors identified and tested in these studies is indicative of the multifaceted nature of high-conflict pre-divorce and the ongoing research on conceptualizing high-conflict pre-divorce. table 2 provides study characteristics of the empirical articles identified in this review. key findings distinguishing “high conflict” in pre-divorce cases among the articles included in this study, there was wide variability in the definition of “high conflict.” this finding is consistent with comprehensive reviews of the divorce literature conducted by anderson et al. (2010), polak and saini (2018), and stewart (2001) who noted that the lack of definitional clarity contributes to the difficulty professionals may face when creating successful interventions. many (n=5) of the articles included in this study offered a new categorization system to conceptualize and define high conflict. notably, of these five articles, three were published relatively recently (between 20172019), indicating ongoing dissatisfaction with the existing conceptualizations of “high conflict.” the seminal article by johnston (1994) elucidates three dimensions in categorizing conflict: the domain dimension, the tactics dimension, and the attitudinal dimension. the domain dimension includes disagreements over specific divorce-related issues, such as custody, financial support, and property division. the tactics dimension refers to how a couple resolves disputes, for example, through reasoning, avoidance, or aggression. the third dimension, attitudinal, refers to the negative emotions felt or expressed between the parties. next, anderson et al. (2010) state that couples with high conflict have distinct attributes that fall into one of two categories: “pervasive negative exchanges” and “hostile, insecure emotional environment” (p. 16). first, “pervasive negative exchanges” focuses on interactions between the couple. the authors state that these exchanges are dominated by conflict and offer “pervasive” to describe behavior between the couples that exhibit defensiveness, aggression, escalation, and/or negative attributions and dualistic advances in social work, summer/fall 2023, 23(2) 400 thinking consistently throughout their exchanges. next, “hostile, insecure emotional environment” addresses the strong negative affect, emotional reactivity, lack of safety, mutual distrust, and triangulation of others (often children) resulting from the consistent pervasive negative exchanges. in creating their categorization system, bergman and rejmer (2017) note that not all conflicts lead to court disputes and sought to understand why some conflicts were more difficult to settle than others. they offer two categories, conflict of interest and conflict of values, and further state that some conflicts may have elements of both categories. conflicts of values represent a difference of opinion, such as how to raise a child. conflicts of interest involve a scarce resource, for example, time with a child. in their study, the authors found that most conflicts (n=31/33) were conflicts of values. polak and saini (2018) conceptualize high-conflict disputes based on an ecological transactional framework. from their systematic review, the authors concluded that various systems are necessary to identify and understand conflict within families. the authors suggest considering risk factors and indicators for high conflict within ontogenetic (individual), microsystem (family), exosystem (community), and macrosystem (culture) categorizations. their review concluded that conflict is a complex construct that occurs in several systems, accounting for the observed definitional difficulties. finally, smyth and moloney (2019) recently conceptualized a two-category definition for high conflict involving “circumstantial conflict” and “entrenched or enduring conflict” (p. 8). the authors state that pathological hatred may account for why some couples continue their fighting for years after their divorce. circumstantial conflict, or reactive hatred, is time-limited, for example, initial reactions to the decision to separate. however, entrenched conflict is an enduring negative attachment that may be fueled by extreme differences in personality and dysfunctional interpersonal dynamics. although these five conceptualizations of conflict in divorce suggest a lack of agreement on how best to define and recognize high-conflict pre-divorce cases, these conceptualizations have some significant overlapping themes. for example, all of the conceptualizations consider conflictual communications between the parents as at least one component of high conflict. in fact, anderson et al. (2010) solely focus on verbal and nonverbal communication, underscoring the import of negative communication patterns to predict high conflict in divorce. secondly, four of the five studies acknowledge the divorce process as a contributor to heightened conflict, indicating some type of situational conflict (bergman & rejmer, 2017; johnston, 1994; polak & saini, 2018; smyth & moloney, 2019). essentially, these four articles indicate that the adversarial nature of divorce and the court system in which the conflict sits, particularly around the division of resources, can influence parents’ conflict and necessitate the involvement of a forensic social work professional. the consensus from these articles pertaining to negative communications and the divorce process’s influence supports further study of interparental conflict specific to the pre-divorce stage. deck et al./high-conflict divorcing parents 401 predictors of pre-divorce conflict as summarized in table 2, the articles included in this review focus on a number of predictors for high-conflict pre-divorce. the relevant predictor data from these articles were extracted through thematic analysis, and the predictors have been arranged in the following five themes: conflict resolution/communication, social network, dissatisfaction with agreements, parent characteristics, and pervasive mistrust. conflict resolution/communication. conflict resolution and communication are grouped in one theme to capture the idea that a couple’s communication practices impact their ability to resolve conflict. for example, a couple who communicates well may engage in calm reasoning to resolve their dispute (johnston, 1994). cohen and finzi-dottan (2012) further found that negotiation as a conflict resolution tactic contributed to successful coparenting during the divorce process. anderson et al. (2010) found that high-conflict couples engage in pervasive negative exchanges that escalate over time and hinder effective conflict resolution. additionally, high-conflict couples may use aggressive communication practices that focus on person-focused attacks rather than issue-focused conflict resolution (anderson et al., 2010). poor communication was also found to result in cooperation difficulties where one parent may be unable to contact the other to make decisions on behalf of their child, which may result in a parent filing for sole custody of a child (bergman & rejmer, 2017). this finding is consistent with the literature noting that cooperative communication is linked to greater paternal involvement after the divorce (cohen & finzi-dottan, 2012). social network. in their ecological transactional framework, polak and saini (2018) discuss the exosystem, or the community, as a critical subsystem in understanding conflict. they note that a parent’s perceived disapproval of a former spouse from their network is significantly related to more co-parenting conflicts. this network is further discussed as including family, friends, new significant others, and even professionals, including mental health and legal professionals, who may “cheerlead” and support a parent’s position. finzidottan and cohen (2012) also note that family may also become aligned with their relatives in a way that might interfere with the interparental relationship by bolstering one parent’s perspective rather than encouraging a second perspective. anderson et al. (2010) describe this phenomenon as triangulation, when a third person is brought into the relationship, perhaps through venting or gossip. unfortunately, anderson et al. (2010) note that children are often the target of the triangulation, which exposes them to a parent’s emotional distress or anger. nonetheless, a strong social support network may be crucial to improving parental well-being, leading to reduced interparental conflict (finzi-dottan & cohen, 2012). parents may find the emotional support of their friends and family, and even the additional childcare options may result in reduced stress and better adjustment post-divorce. dissatisfaction with agreements. johnston’s (1994) first dimension in their categorization of conflict is the domain dimension which includes disagreements over financial support, property division, custody, and access to the children. these disagreements can be further grouped into differences related to finances and to the children (bergman & rejmer, 2017). unsurprisingly, difficulties with access to finances advances in social work, summer/fall 2023, 23(2) 402 and access to the children lead to conflict between co-parents (malcore et al., 2009; polak & saini, 2018). indirect parent characteristics. the fourth theme noted in this review was the effects of indirect parent characteristics on interparental conflict. the term indirect parent characteristics is used to describe attributes of a parent that may influence their overt reactions to a conflict. examples of these attributes include a parent’s defense mechanisms, degree of hatred for the other parent, negative attributions, dualistic thinking, or personality characteristics. defense mechanisms result in a distortion of reality and are prevalent when an individual is motivated by self-protection rather than conflict resolution (cohen & finzidottan, 2012). cohen and finzi-dottan (2012) note that people with immature defense mechanisms, such as splitting and projection, tend to foster hostility, mistrust, anxiety, and poor communication that may increase interparental conflict. further, cohen and finzidottan (2012) found that mature defense mechanisms (e.g., humor or altruism) were associated with better co-parenting. these defense mechanisms may result in dualistic thinking. dualistic thinking occurs when a partner is rigid in their thinking and considers a situation as binary: right or wrong; black or white. anderson et al. (2010) state that dualistic thinking ultimately “vilifies the other and portrays the self as victim or under attack” (p. 18). hatred (smyth & moloney, 2017) and ambivalence (ponzetti & cate, 2008) were described as ways in which a former partner may project personal uncertainties toward a new dynamic. hatred reflects a strong, negative assessment of the former partner and may manifest as reactive to a situation or deeply entrenched hatred (smyth & moloney, 2017). ambivalence, however, reflects a feeling of uncertainty towards a former spouse. ponzetti and cate (2008) are unclear if the conflict leads to ambivalence towards one’s partner or if ambivalences escalate the conflict. finally, the literature suggests that personality characteristics should be considered in determining an individual’s impact on interparental conflict. polak and saini (2018) note that personality disorders and psychopathology have been found to be prevalent in highconflict parents. particular attention in the literature has been made to self-differentiation, narcissism, and attachment (finzi-dottan & cohen, 2012; malcore et al., 2009; polak & saini, 2018; seirup, 2014). pervasive mistrust. pervasive mistrust is the final theme identified in this review and is used to describe a parent’s distrust, for various reasons, of the other parent, and particularly in their ability to care for the couple’s child(ren); anderson et al., 2010; johnston, 1994). ponzetti and cate (2008) found that distrust was significantly negatively related to conflict noting that as conflict increased over the marriage dissolution process, dyadic trust decreased. this review revealed a number of reasons, though unlikely an exhaustive list, of why a parent may distrust the other parent, such as violence and general unfitness to parent. several articles refer to violence as an indicator of parental conflict in divorcing parents (anderson et al., 2010; bergman & rejmer, 2017; johnston, 1994; polak & saini, 2018; deck et al./high-conflict divorcing parents 403 smyth & moloney, 2019). these articles suggest that considering violence in a conceptualization of high-conflict parents requires understanding the difference between reactive violence and ongoing violent relationships. reactive violence may occur during the heightened emotional environment of the separation and divorce process as opposed to ongoing, severely violent relationships categorized by tactics of control, domination, fear, manipulation, and degradation of one spouse by the other (anderson et al., 2010). a further distinction is made between violence against a former spouse and violence against a child. violence against a child may come from one of the parents, or it may come from a parent’s new partner (bergman & rejmer, 2017). unfitness to parent is the final “catch-all” term to describe why a parent may mistrust the other. mental illness falls within this category due to its complex nature and potential influence on a parent’s distrust. other factors that fall within this term include aggression, lack of appropriate housing, and insufficient childcare (bergman & rejmer, 2017; polak & saini, 2018; smyth & moloney, 2019). additionally, misuse of alcohol and/or drugs was specifically identified by several articles in this review as a reason for a parent to distrust the other (bergman & rejmer, 2017; polak & saini, 2018; smyth & moloney, 2019). finally, it is worth noting that several articles (e.g., anderson et al., 2010; bergman & rejmer, 2017) describe children resisting or refusing to see a parent (the non-favored parent) as the source of conflict in divorcing parents. the literature on these resist-andrefuse dynamics is extensive, but it is worth noting that these behaviors may fall under the pervasive mistrust category both for favored and non-favored parents. for favored parents, it is possible that there is an underlying reason for a child refusing to see the other parent that has little to do with the favored parent, known as realistic estrangement, and this may increase the favored parent’s mistrust of the non-favored parent. in cases of parental alienation, the non-favored parent may rightfully distrust the favored parent as there is a pattern of the favored parent poisoning the child’s interactions, or sabotaging access to the non-favored parent (bergman & rejmer, 2017). these dynamics are of particular interest to the forensic field as professionals are often called by the court to assess resist-and-refuse dynamics, and determine how to mitigate further harm to the parent-child relationship. discussion the goal of this review was to analyze the state of the literature and identify the factors contributing to interparental conflict for divorcing parents. specifically, this study sought to determine: (a) what factors distinguish high levels of interparental conflict from typical conflict for divorcing parents? and (b) what factors predict or contribute to pre-divorce conflict? eleven articles were identified that met the inclusion criteria and critical findings of these articles are summarized in table 1. in the first key finding, this review notes that researchers are continuing to conceptualize conflict and distinguish typical conflict from high conflict. this is evidenced by the new categorization systems offered by several of these articles. of note, none of these articles categorize conflict by level (i.e., low to high). instead, high conflict is described as a unique and salient subtype of divorce-related conflict. this suggests that advances in social work, summer/fall 2023, 23(2) 404 identifying high-conflict cases may not be accomplished with one threshold, but may instead require consideration of a variety of factors, as well as what, if any, implications exist if multiple factors are present. for example, any case that has a history of intense domestic violence may be considered high conflict, regardless of how the parents score on a measurement tool or even how the parents perceive the conflict. in this instance, physically violent cases represent a subtype of the cases with conflict in divorce. however, the mere presence of physical violence may implicate several of the themes identified here, including conflict resolution, parent characteristics, and pervasive mistrust, suggesting that it may be possible to define high conflict based on the number of themes or indicators that are implicated in a case. similarly, the literature does not offer factors that apply to low-conflict couples versus high-conflict couples, but instead describes numerous factors that may indicate highconflict couples. as polak and saini (2018) write, conflict is displayed on many levels, from individual personality characteristics to involvement of macrosystems like child protection services. to thoroughly define high conflict would involve consideration of predictors across many systems. conclusively, determining a threshold or an identification system for high and low conflict cases would require additional research, including determining if some indicators are more predictive of high conflict than others or if the number of indicators present in any case is important in classification (i.e., if more indicators equate to more conflict). this review was also uniquely positioned as it sought to look at indicators of predivorce conflict, which is an under-researched area of study. this review ultimately synthesized the extant literature to identify five indicators to consider when evaluating predivorce conflict: conflict resolution/communication, social network, dissatisfaction with agreements, parent characteristics, and pervasive mistrust. implications high-conflict divorce cases—however defined—continue to receive significant attention from practitioners, researchers, and policymakers. social work education uniquely prepares social workers to engage in high-conflict family cases as social workers are educated to think systemically. social workers of clinical and macro inclinations are needed to support this population of families in crisis following a decision to divorce. correctly assessing the level of conflict prior to the divorce judgment may be instrumental in intervention research for forensic clinicians, legal professionals, and policymakers. correctly assessing and identifying interparental conflict can facilitate appropriate care and treatment needed to reduce the psychological and physiological effects of divorce on parents and children (amato, 1993). for researchers, this review suggests that a differential approach based on levels of conflict and stage of divorce are merited. further research is needed to conceptualize and implement these interventions and to design instruments that measure conflict and direct couples to appropriate supports. finally, for policymakers, high-conflict divorces present a significant burden on social resources. families in conflict may overuse social welfare services as allegations of child abuse or neglect are deployed as a litigation tactic (saini & birnbaum, 2007; scafadi, deck et al./high-conflict divorcing parents 405 2008). polak and saini (2018) note that allegations of child maltreatment in high-conflict cases are common and that police and child protection services are frequently involved in high-conflict families. future research is needed to explore the significance of the five aforementioned themes in identifying pre-divorce conflict. as this study included both empirical and conceptual articles, it will be important to determine if these five themes are empirically supported predictors of pre-divorce conflict. further, additional research should focus on identifying threshold markers for high and low-conflict couples. strengths and limitations of this review all studies included in this review were published in english in peer-reviewed journals. it is likely that additional studies exist that were conducted and perhaps published in other languages, or perhaps never published at all, that could have provided further insight into the factors associated with high-conflict divorcing parents. future research should include non-english and gray literature. the decision to exclude these potential articles from this review was made due to the potential unreliability of these findings and the potential bias in the intended audience. as this systematic review was an initial step in the development of a measurement tool, the literature needed to be peer-reviewed papers. it is also likely that there is much to learn from the broader conflict literature, not specific to divorce. however, an investigation of the larger construct of conflict was not the of this study because it specifically sought to develop the foundational and theoretical knowledge to create a new instrument to measure conflict in divorcing parents. future reviews could take a more general approach and synthesize the results from studies for all types of conflict literature. finally, this study reviewed articles published in the social science literature. it is possible that other disciplines, particularly the legal literature, may have other relevant articles. legal literature was excluded from this search as ongoing legal conflict is a known indicator of high conflict that is also discussed in the social science literature. this review sought to identify social and mental health indicators of highconflict divorce, in addition to continuous litigation and legal strategies which are currently recognized as high-conflict markers by legal scholars and within social science literature. despite these limitations, this review also has several strengths. first, this review closely adhered to prisma guidelines and used rigorous methods to identify relevant studies. in addition, two reviewers participated in the title, abstract, and full-text review to determine the studies’ eligibility. a third reviewer settled any conflicts between the reviewers. further, this study used multiple sources to identify relevant articles, including reference harvesting of relevant articles. in addition to the use of rigorous methods, this review offers a unique contribution to the divorce literature. to our knowledge, no review to date has systematically examined conflict factors specific to divorcing parents, which is a critical period in setting the tone for interparental conflict post-divorce. this review provides a valuable contribution to the field of divorce research and forensic social work by synthesizing the current state of the literature on divorce conflict for parents in the process of separation. this information can be used in the forensic space to identify mitigation factors and intervention strategies to de-escalate conflict and reduce a child’s advances in social work, summer/fall 2023, 23(2) 406 likelihood of maladaptation post-divorce. additionally, increasing a forensic social work professional’s access to 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(2005). understanding the divorce cycle: the children of divorce in their own marriages. cambridge university press. author note: address correspondence to premela deck, sd family services, 793 washington street, canton, ma 02021. email: pdeck@sdfsmass.com https://tspace.library.utoronto.ca/bitstream/1807/95335/1/unraveling%20the%20label%20of%20high%20conflict_saini.pdf https://tspace.library.utoronto.ca/bitstream/1807/95335/1/unraveling%20the%20label%20of%20high%20conflict_saini.pdf https://doi.org/10.1300/j287v01n03_03 https://doi.org/10.1300/j287v01n03_03 https://fluxconsole.com/files/item/441/56084/taxpayer-costs-of-divorce-and-unwed-childbearing.pdf https://fluxconsole.com/files/item/441/56084/taxpayer-costs-of-divorce-and-unwed-childbearing.pdf https://doi.org/10.1111/fcre.12294 https://doi.org/10.1111/fcre.12294 https://doi.org/10.1002/anzf.1346 https://doi.org/10.1002/anzf.1346 https://www.justice.gc.ca/eng/rp-pr/fl-lf/divorce/2001_7/pdf/2001_7.pdf https://www.justice.gc.ca/eng/rp-pr/fl-lf/divorce/2001_7/pdf/2001_7.pdf http://dx.doi.org/10.1186/1471-2288-8-45 http://dx.doi.org/10.1186/1471-2288-8-45 https://doi.org/10.1007/s10826-018-1277-z https://doi.org/10.1007/s10826-018-1277-z https://doi.org/10.1007/s10826-017-0821-6 https://doi.org/10.1007/s10826-017-0821-6 mailto:pdeck@sdfsmass.com discussion _________ jelena todić, msw, phd, assistant professor, department of social work, and m. candace christensen, msw, phd, associate professor department of social work, university of texas, san antonio, tx. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 389-415, doi: 10.18060/24972 this work is licensed under a creative commons attribution 4.0 international license. integrating critical, engaged, and abolitionist pedagogies to advance antiracist social work education jelena todić m. candace christensen abstract: the intersecting coronavirus, racism, and economic pandemics electrified u.s. social work organizations into creating long overdue antiracism initiatives. this necessary shift includes the council on social work education specifying that curriculums must consist of frameworks and practices that eliminate racism. social work educators will need to incorporate antiracism into their teaching. we argue that critical, engaged, and abolitionist pedagogies contain frameworks and practices that align with antiracism. one of our fundamental assumptions is that liberation, which is a collective state of freedom from racism and other intersecting structures of domination, is the end goal of antiracism. we integrate concepts developed by critical pedagogy scholars, black feminists, and abolitionist activists with our experiences to share ten lessons we learned through decades of collective praxis as social justice educators committed to liberation. keywords: critical social work, social work education, critical pedagogy, abolition, antiracism, prison industrial complex as the american academy of social work and social welfare (aaswsw) adds eliminating racism as the 13th grand challenge (teasley et al., 2021) and all professional social work bodies explicitly commit to antiracism (council on social work education [cswe], 2021; national association of social workers [nasw], 2021; mendez et al., 2021), social work educators must reconsider the pedagogy we use to prepare social work practitioners for uprooting racism. racism is "the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice" (bailey et al., 2017, p. 1453). these historically rooted and culturally reinforced patterns influence the distribution of resources, producing and reproducing racial disparities in life outcomes (bailey et al., 2017; cogburn, 2019; krieger, 2011). racism also intersects with and mutually reinforces other forms of oppression (e.g., sexism, ableism, or heterosexism; ahmed, 2016; collins, 2019). as such, social work departments and social work education also embody and perpetuate racism (olcoń et al., 2020; teasley et al., 2021). to prepare antiracist social workers who can fully grasp and disrupt processes that produce and reproduce inequities at the micro (individual and interpersonal levels), mezzo (organizational and community levels), and macro (institutions and policies) levels of society, the social work pedagogy itself must be antiracist. we wholeheartedly agree with kishimoto (2018), who argues that antiracist pedagogy is more than curriculum content about racism, requiring that educators see pedagogy as an organizing framework for social change and an approach to “how one teaches, even in courses where race is not the subject matter” (p. 540). a systematic review of 25 empirical about:blank advances in social work, summer 2022, 22(2) 390 articles examining the best teaching practices for preparing social workers to work with clients from historically excluded racial and ethnic groups found that the studies lacked methodological rigor and sound theoretical grounding (olcoń et al., 2020). also, less than half of the included studies reported findings related to racism. scholars suggest that social work programs should incorporate critical race and critical whiteness theories (olcoń et al., 2020) and prioritize critical consciousness development (morley et al., 2020) to prepare students for effective antiracist social work. of note, the recent advances in social work special issue on dismantling racism in social work education guest edited by charla yearwood, rosemary a. barbera, amy k. fisher, and carol hostetter made great strides in addressing these scholarship gaps. in this paper, we offer ten lessons we learned from integrating critical (freire, 1968/2000, engaged (hooks, 1994), and abolitionist (davis, 2003; rodríguez, 2010) pedagogies, aiming to further contribute to the operationalization of antiracist social work education. by critical pedagogy, we refer to freire's (1968/2000) participatory approach to education that emphasizes the development of critical consciousness, which is the ability to read the world critically; recognize how the larger social order conditions human life but does not determine it (giroux, 2010); and act to transform oppressive social conditions. engaged pedagogy, developed by bell hooks’ (1994), evolves freire’s critical pedagogy by highlighting that educators must see students as whole human beings, placing their wellbeing, healing, and joy at the center of pedagogical practices. lastly, abolitionist pedagogy challenges critical and engaged pedagogies to actively support abolition of the prison industrial complex (rodríguez, 2010), which is "a political vision" and "a set of strategies" aimed at eliminating the prison industrial complex (critical resistance, 2022; para. 3). the term prison industrial complex refers to the overlapping government and forprofit sectors' reliance on surveillance, policing, and imprisonment for racial and social control (critical resistance, 2022; jacob et al., 2021; schenwar & law, 2021). the prison industrial complex does not only include policing, jails, prisons, and immigrant detention centers (dettlaff et al., 2020; schenwar & law, 2021). its broad reach encompasses the coercive and punitive practices that other institutions (e.g., schools, healthcare, and social services) use to manage black, indigenous, other people of color, and poor people (dettlaff et al., 2020; jacob et al., 2021; schenwar & law, 2021) as well as the cultural apparatus that normalizes images of people of color as criminals and punishment as justice (alexander, 2012; critical resistance, 2022; jacobs et al., 2021; richie & martensen, 2019). while these pedagogical approaches have distinct features, all of them center on liberation. that is, all of them focus on education as a process aimed at supporting the struggle for freedom from racism, classism, heteropatriarchy, and other intersecting systems of domination that keep large groups of people from access to economic and social justice, self-determination, and “a full share of both the rights and responsibilities associated with living in a free society” (davis, 2003; phar, 2018, p. 604). in addition, all of them use educational processes that strive to reveal and counter individualism, hierarchy, ahistoricism, and power-blindness as ideological legacies of white supremacy and colonialism (bonilla-silva, 2018; davis, 2003; diangelo, 2010; feagin, 2020) embedded in education. todić & christensen /integrating critical, engaged 391 our positionality we are white, queer, feminist, social work educators, currently teaching as tenure track faculty at a hispanic serving institution. our students are mostly black, brown, indigenous, first-generation, or veterans. while we believe that these lessons are relevant to all social work educators, they may be especially relevant for white social work faculty who must actively work against centuries of socialization that normalizes white supremacy (kivel, 2017). we elevate the influence of black radical traditions and feminist epistemologies (collins, 2019; collins & bilge, 2020; combahee river collective, 1977/2014; crenshaw, 1991; davis, 2003; hooks, 1994; lorde, 1987/2020; robinson, 1983/2020) on our understanding of whiteness, intersectionality, racial capitalism, liberation, and antiracism. we offer brief descriptions of our own journeys to these pedagogies and antiracism. jelena todić my commitment to antiracism and prison industrial complex abolition began over 20 years ago with my commitment to ending violence against women. i immigrated to the united states from the socialist federal republic of yugoslavia in the mid-early 1990s, shortly before the dayton peace agreement. i am white and serbian. although i primarily identify as ex-yugoslavian, i claim my serbian ethnicity in light of my identification with the serbian long history of anti-imperialist struggles and my commitment to collective accountability for the atrocities perpetrated by the serbian forces during the balkan wars in the 1990s. i identify as ex-yugoslavian because i reject nationalism that resulted in these wars and value growing up in a socialist country that failed as a political experiment but gave me an embodied experience of nearly universal access to healthcare, quality education, and housing. aware of the ineffectiveness of the police to protect women in my immediate family from domestic violence and devastated by the serbian forces’ use of rape to brutalize bosnian women and their communities, i turned to feminism and peace studies during my undergraduate education to make sense out of the experiences. i was fortunate to begin my feminist journey by reading black feminist scholars, including bell hooks, patricia hill collins, and angela davis. the scholars introduced me to intersectionality and the reinforcing relationship between racism, patriarchy, and capitalism. immediately after graduating from college, i worked in san francisco, where i saw how organizations like haight ashbury free clinics and san francisco asian women’s shelter translated intersectionality to praxis in social services. it became clear that ending violence against women required the simultaneous focus on eliminating racism and other intersecting systems of oppression through global solidarity. during my msw in the early 2000s, i trained with a group of fierce advocates at assisting women with advocacy resources and education (aware), a hospital-based domestic violence program in st. louis, which advanced my understanding of antiracist and abolitionist praxis. in addition to deepening my knowledge about harm reduction and commitment to survivors’ self-determination, i learned how to translate intersectional analysis and incite!’s feminist abolitionist frameworks to social work practice, which have guided my practice and scholarship since then. through my work with bosnian and advances in social work, summer 2022, 22(2) 392 african american survivors of intimate violence at aware, which hired me after i completed my msw, i learned that supporting safety for the vast majority of survivors with multiple marginalized identities demanded a commitment to building deep relational trust and finding creative solutions outside of the legal punishment system that too often exasperated harms without ever addressing the survivors’ needs. this approach to advocacy through solidarity required reflexivity, attention to power and privilege, and accountability through ongoing dialogue with colleagues and people that used our services. simultaneously, i became involved with the national conference for community and justice, one of the oldest human relations organizations. there, i worked closely for many years with a multiracial group of people of all ages, genders, sexual orientations, and socioeconomic backgrounds to develop and facilitate social justice education. this experience deepened my understanding of the importance of organizing white people to engage in racial justice work while building accountable relationships with social justice organizations and movements led by people of color. finally, i am a first generation college graduate and i directly experienced the impact of surveillance and control associated with the us immigration system for nearly 30 years. from my arrival in 1994 as a tourist, through my “naturalization” in 2013, and finally my mother’s “naturalization” in 2021, my engagement with the immigration process has been a source of constant stress and fear, even with the protections that whiteness and economic resources provided. together these experiences were essential for ensuring that antiracism and abolition were central to my understanding of ethical, social work practice and, ultimately, my work as a social work educator at the brown school of social work, the university of texas at austin steve hicks school of social work, and the university of texas at san antonio (utsa). while the composition of the student body shifted from school to school (from majority white at the brown school to majority people of color at utsa), the critical, engaged, and abolitionist pedagogies remained relevant because they center power analysis and participants’ lived experiences in the intersecting systems of domination. m. candace christensen my commitment to antiracism and abolition is grounded in my personal experiences and dedication to dismantling values and norms that perpetuate interpersonal and structural violence. i grew up within a religious culture that positioned women, people of color, and sexual and gender minorities as a deviation from the ideal masculine, european, heterosexual norm. as an adolescent and young adult, i questioned this hierarchy and left this religious community, which allowed me to explore my intellectual and spiritual strengths as a queer, woman. eventually i landed in an msw program. for my advanced practicum i interned for a counseling center that employed a feminist multicultural approach to therapy. as part of this training, i was introduced to critiquing social problems through a critical, feminist, intersectional lens, which included the concept of whiteness as an attribute of white supremacy. this learning forced me to reflect on privileges and oppressions my whiteness perpetuated. also, i learned to view mental health problems as created or exacerbated by external forces, such as sexism, racism, homophobia, poverty, food insecurity, abusive employment, and interpersonal violence. once i graduated with my msw, i was excited to secure a position practicing therapy with families involved with todić & christensen /integrating critical, engaged 393 the department of child and family services (dcfs). i was enthusiastic about bringing my critical, feminist, intersectional lens to the range of challenges the families were experiencing. a few weeks into the job, i realized that the organizational objective was not to address the root causes of the harms my clients experienced, rather it was to quickly diagnose the children with a mental health disorder, so that the organization could receive payment via the contract held with dcfs. my values related to equity and justice would not let me stay in that job. instead, i chose a new path that i thought would grant me positional status to address the structural issues which created the trauma that caused these families to enter the family policing system. so, i pursued a ph.d. in social work. my goal in pursuing a ph.d. was to develop the skills and institutional status necessary to dismantle values and norms that perpetuate racialized, gendered, homo/transphobic violence. as part of my education, i took a course with professor dolores delgado bernal who introduced me to black and latinx feminist scholars (anzaldúa, collins, rigoberta menchú). this exposure reinforced my understanding of intersectionality and the role of whiteness and white supremacy in perpetuating racialized gendered oppression, which is often expressed through violence. eventually, as an assistant professor (now associate), i was able to further understand and apply critical theories (race, whiteness, queer) by continuing to read work produced by black, latinx, and queer feminist scholars. a key turning point was when jelena and another colleague, co-initiated an antiracist collective focused on transforming department structures. the collective activities have given me resources and skills for implementing antiracist and abolitionist pedagogies in the classroom. for example, the collective hosted a presentation by francisco peréz, the executive director of the center for popular economics, focused on racial capitalism (kundnani, 2020). that presentation led me to scholarship on the nonprofit industrial complex (incite, 2007/2017), which i now use in my teaching and research to critique the ways in which the nonprofit sector perpetuates whiteness and white supremacy. the ten lessons we describe embody our positionalities, commitment to antiracism, and extended engagement with critical, engaged and abolitionist pedagogies. including content on racism in all social work courses and assigning work produced by scholars of color is essential. however, given the pervasiveness of the white racial frame in the united states, which is “an overarching white worldview that encompasses a broad and persisting set of racial stereotypes, prejudices, ideologies, images, interpretations and narratives, emotions, and reactions to language accents, as well as racialized inclinations to discriminate” (feagin, 2020; p. 11), it is equally important, particularly for white social work educators, to make whiteness visible by assigning work that critically interrogates white supremacy and committing to a life-long process of questioning how whiteness operates in all areas of life beyond education (frey et al., 2021; kishimoto, 2018; ortegawilliams & mclane-davison, 2021; wright et al., 2021). the lessons here, however, focus on how to teach in a way that is antiracist because our experience and existing evidence (kishimoto, 2018; olcoń et al., 2020) indicate that this is where social work faculty may experience the most challenges. advances in social work, summer 2022, 22(2) 394 key assumptions we believe that social workers cannot engage in ethical social work or solve grand challenges for social work (aaswsw, 2022) unless we use an intersectional, critical analysis (ahmed, 2016; collins, 2019; collins & bilge, 2020; crenshaw, 1991; fook, 2003) to confront the complex legacies of colonialism and white supremacy in the society and the profession (jacobs et al., 2021; yearwood et al., 2021). this approach includes 1) a structural analysis of personal problems; 2) a focus on the role of social work and social welfare in social control; 3) an ongoing social critique that emphasizes power analysis; and 4) goal of personal liberation and change (fook, 2003). within this framework, we purport that a broad acceptance of power-over hierarchies, a false national narrative that people's individual choices explain their success, and a deeply ingrained belief in the u.s. as a place where everyone has equal chances to succeed, are ideological legacies of colonialism and white supremacy (bonilla-silva, 2018; davis, 2003; fook, 2003; combahee river collective, 1977/2014). these ideological legacies undergird the current racialized social and economic system, enabling the prison industrial complex and preserving white privilege and supremacy (bonilla-silva, 2018; davis, 2003; feagin, 2020) we further assume that racial capitalism, which refers to the idea that racialized exploitation and capital accumulation are mutually constitutive (robinson, 1983/2020), is a root cause of racial and economic inequities (laster pirtle, 2020). racial capitalism expresses the idea that american slavery grew out of pre-existing racism deeply embedded within european labor relations and consciousness, that framed regional, cultural, and language differences of slavs, irish, jews, and muslims as racial (kundnani, 2020; robinson, 1983/2020). capitalism economically expresses the white supremacy inherent in european culture, dividing workers of color and white workers ideologically and materially (kundnani, 2020). we also assume that racial capitalism interlocks with legacies of colonialism as well as systems of oppression based on sex, gender, sexual orientation, ability, citizenship, and other social group identities (collins & bilge, 2020; combahee river collective, 1977/2014; marable, 1983/2015; walia, 2021). therefore, it is vital to question individualism and strict power over hierarchies at the expense of interdependence and solidarity (davis, 2016). finally, we assume that social work is crucial in maintaining white supremacy through its implicit and explicit endorsement of racial capitalism and carceral logic. in a recent paper, jacobs and colleagues (2021) describe social work’s role in maintaining white supremacy through carceral social work, a term they refer to the field’s collaboration with police and social work policing practices. they detail coercive, punitive practices social workers use to manage black, indigenous, other people of color, and poor communities through the profession’s strong commitment to the criminalization of gender-based violence, participation in the surveillance and punishment of families through child protective services, and social work partnerships with the police in schools, and health services (jacobs et al., 2021). others have pointed to the role of the child welfare system in harming communities of color, calling for its abolition (dettlaff et al., 2020). these emerging critiques of carceral social work advance the existing critiques of social work’s embrace of neoliberalism, which emphasizes individual solutions and social service todić & christensen /integrating critical, engaged 395 provision rather than structural interventions that eliminate the need for social services (mehrotra et al., 2016; zelnick & abramowitz, 2020). critical, engaged, and abolitionist pedagogies provide a tangible approach to undermining the ideological dynamics central to white supremacy and racial capitalism. these pedagogies do not directly alter the material conditions produced and reproduced by racial capitalism outside of the classroom. however, these pedagogies expose the cultural apparatus that normalizes top-down hierarchical relationships, individualism, competition, and punishment, which leads to the acceptance of the prison industrial complex and racial capitalism as inevitable. naming the pedagogies in syllabi and discussing them in class as they shape courses allows students and instructors to reflect on how white supremacist, colonial and carceral logics inform their worldviews. consistent with the prison industrial complex abolitionist project, which demands envisioning the future world we want and practicing that future in our current contexts (kaba & hassan, 2019), the classroom becomes a space for praxis. the focus is on critical reflection and action to transform educational processes and relationships that normalize white supremacy and racial capitalism among students and faculty. after briefly describing critical, engaged, and abolitionist pedagogies, we share ten lessons we learned through 33 years of collective praxis, before and during the covid-19 pandemic, as social work and social justice educators deeply committed to liberation. we conclude with reflections on the inherent tension associated with bringing these transformative frameworks into institutional settings. critical pedagogy the role of critical pedagogy in social work education is to give students the ability to critically analyze social conditions that produce inequities (critical consciousness); link theory, reflection, and action (from here on referred to as praxis); and formulate collective responses to transform the unjust conditions at local and global levels. critical pedagogy asks, “how can the education process foster liberation?" in his book, pedagogy of the oppressed, freire frames critical pedagogy as “the practice of freedom” (hooks, 1994, p. 14). a core value is egalitarianism, which aims to flatten hierarchies and create social structures that foster individual and communal emancipation. this approach to teaching requires that educators shift from viewing students as passive recipients of expert knowledge and shift to a co-learning process through dialogue and solidarity. consequently, students become actors who take control of their learning. core critical pedagogical concepts include critical consciousness (conscientização) and praxis. critical consciousness emerges through individual and communal reflection on how current social conditions empower or disempower the collective. by answering these questions, communities develop theories of why oppression exists and how to dismantle the oppression. praxis is putting that theory of change into action. in social work education, critical pedagogy can create an affective, cognitive, and embodied connection to personal and collective suffering (pyles & adams, 2015); deconstruct the role of neoliberal social work and construct liberatory social work through anti-oppressive practice in the classroom (campbell, 2002; gutiérrez-ujaque & jeyasingham, 2021; redmond, 2010); and generate advances in social work, summer 2022, 22(2) 396 counter-narratives about what social work is and who does it (chapman, 2011; pennell & ristock, 1999). in that sense, critical pedagogy is consistent with social work’s primary mission “to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (nasw, 2021, preamble, para. 1). specifically, critical pedagogy’s emphasis on self-determination and human agency is closely aligned with the field’s commitment to enhancing “the capacity of people to address their own needs” (nasw, 2021, preamble, para. 2). engaged pedagogy in her book teaching to transgress (the first one in the trilogy), bell hooks (1994) embraces freire’s critical pedagogy but insists that pedagogy must go beyond engaging the mind. she calls upon thich nhat hanh's framing of teachers as healers who focus on "the union of mind, body, and spirit" (hooks, 1994; p. 14, para. 2). engaged pedagogy is "more demanding than critical pedagogy" because educators must teach in a manner that “respects and cares for the souls of our students" to "provide the necessary conditions where learning can most deeply and intimately begin" (hooks, 1994, p. 13, para. 1). for hooks, the goal is to nurture emancipation beyond education to secure a job, nurturing wholeness and an authentic voice (hooks, 1994). professors should value student expression and emphasize joy; therefore, the classroom must be a space that welcomes vulnerability and storytelling about experiences that affect students' daily lives (hooks, 1994). students should not be the only ones "confessing" and taking risks. hooks expects teachers to be vulnerable and reveal their own lived experiences as an approach to shifting unequal power distribution inherent in the hierarchical university structure (berry, 2010). social work scholarship references engaged pedagogy as an effective approach to building empathy to motivate antiracist work (abrams & gibson, 2013) and explore privileged social locations (nicotera & kang, 2009). in that sense, engaged pedagogy provides a foundation that social work students need to “advocate for human rights at the individual, family, group, organizational, and community system levels” and “engage in practices that advance human rights to promote social, racial, economic, and environmental justice” (cswe, 2022, p. 9). abolitionist pedagogy in addition to defining and outlining carceral social work, jacobs and colleagues (2021) recommend that social work education prioritize teaching about alternatives to policing, sharing and building alternatives with communities most impacted by the carceral system, and strengthening mutual aid traditions within social work. we add to these excellent recommendations one more key strategy: abolitionist pedagogy is critical for advancing anti-carceral, and therefore antiracist social work. as an extension of abolitionist politics, abolitionist pedagogy requires critical reflection on how mass incarceration, policing, and punishment are inseparable from socioeconomic/class repression, racism, indigenous displacements, and white supremacist colonization, and consequently entirely lacking any positive social function (rodríguez, 2010). educators must take on the role of political leadership in the classroom by taking an abolitionist stance (rodríguez, 2010). todić & christensen /integrating critical, engaged 397 according to rodríguez (2010), the abolitionist position is a manifestation of the revolutionary freirean pedagogy because it translates critical insight into action. in fact, there may be "no viable or defensible pedagogical position other than an abolitionist one" (rodríguez, 2010, p. 12). we would also say that abolitionist pedagogy aligns with hooks' (1994) guidance for educators to include self-disclosure and vulnerability when working with students, recognizing students as co-creators of the learning experience. by taking the pedagogical approach that "asks the unaskable, posits the necessity of the impossible, and embraces the creative danger inherent in liberationist futures'' (p. 12), social work educators model skills associated with anti-carceral social work. given the recent reckoning with social work’s role in maintaining white supremacy, abolitionist pedagogy is critical for the future of social work. ten lessons for antiracist social work education ten lessons emerged through translating these pedagogies into integrated classroom practices with supporting examples from diverse social work courses, including research methods, community practice, social justice, cultural competence, leadership, social determinants of health, and women's issues. the ten lessons are interconnected. together, they have the potential to build experimental learning communities that center mutuality and accountability, ensuring that social work students leave our programs prepared to work in solidarity with communities and organizations already engaged in antiracist liberatory efforts. embrace critical theory the ultimate aim of critical theory is to ask questions and seek answers that result in human liberation. critical theorists asserted that philosophy and theory should envision a world that meets the needs and cultivates the power of all human beings (collins, 2019). critical theory, which illuminates social problems through power analysis, forces us to go beyond individualist, ahistorical, and power-neutral perspectives that hinder accurately diagnosing the root causes of social injustice (collins, 2019; payne, 2021). it also seeks to eliminate injustice through praxis. in that sense, critical theory helps “discern meaningful patterns among both ideas and observations, and […] develop causal explanations” (krieger, 2014, p. 54) necessary for social transformation. all national social work professional organizations have embraced an explicit focus on antiracism in 2020-2021, which presents a significant challenge for the social work profession given the diversity of political philosophies that undergird social work practice (e.g., social cohesion, empowerment and liberation, and social change and development; payne, 2021). nevertheless, antiracism requires an understanding of racism as a structural issue and structural solutions that transform historically grounded inequities. given the structural nature of racism, we see the critical paradigm as the only lens that can inform social work actions to achieve social justice consistent with professional ethics (crudup et al., 2021; hanna et al., 2021; wright et al., 2021). a critical assessment of how racism is perpetuated at all levels of social interaction, is essential for dismantling the root causes of racism. advances in social work, summer 2022, 22(2) 398 on the first or second day of class, we define critical theory and its relationship to critical pedagogy, and we share scholars that influence our worldview. we explain that our goal is to help students develop a critical theoretical lens to view mainstream social work practice and expose our socialization into intersecting systems of domination. even if students do not fully embrace a critical social work paradigm in their practice, they must rely on critical theory to analyze evidence and organizational approaches to make ethical practice decisions. moreover, we ensure clear grading rubrics for all assignments so that students can trust that grading does not depend on their agreement with the critical tradition but their ability to articulate, critique, and apply it in the context of social work practice. question and interrupt manifestations of carcerality in social work education structural and cultural forces interact to sustain and expand the prison industrial complex. structurally, three interconnected patterns expand the reach of the carceral state, which is the “the spatially concentrated, more punitive [than the social welfare state], surveillance and punishment-oriented system of governance” (weaver & lerman, 2010; p. 818). these patterns include 1) increased investment in law enforcement responses that do not correspond to shifts in what is considered criminal behavior; 2) simultaneous divestment of resources from programs and services that would meet significant community needs; and 3) aggressive targeting of communities of color, poor people, and other socially marginalized groups that politically threaten current social power arrangements (davis, 2003; richie & martensen, 2019; schenwar & law, 2021). a cultural apparatus that includes the interconnectedness of white supremacy, the social construction of criminality, and the widespread acceptance of punishment as an approach to justice undergird these patterns (alexander, 2012; critical resistance, 2022; feagin, 2020; jacobs et al., 2021; richie & martensen, 2019). given this broad social context of carcerality, it is not surprising that social workers also practice surveillance, categorization, and punitive decision-making over access to services (jacobs et al., 2021). moreover, social work education socializes students into social work roles in these systems through standard pedagogical practices. for example, tracking class attendance and penalties for late assignments are common grading components in social work. professors typically unilaterally impose these policies as approaches to "teaching professionalism." however, tardiness has no intrinsic connection with students' understanding of the course material, and physical presence in the classroom does not constitute actual course work (close, 2009). instead, these policies rely on and normalize punitive deterrence (bosch, 2020). they emphasize technical aspects of professionalism while missing an opportunity to support students in exploring critical social work principles such as self-determination, autonomy, integrity, and interdependence (mullaly & keating, 1991; payne, 2021). another way to dismantle classroom carcerality would include engaging students in establishing grading criteria for assignments and overall course objectives. this effort would make students accountable to standards developed by the community rather than the measures that we create as instructors, further reducing the power differential. todić & christensen /integrating critical, engaged 399 “if you trust people, they become trustworthy” is an emergent strategy principle that guides our pedagogy (brown, 2017, p. 42). by experimenting with liberatory patterns at a small scale, we build the skills needed to create liberatory patterns at a large scale (brown, 2017). we trust students and firmly believe that they want to learn. instead of punishment (e.g., point deductions for absences or late assignments), we rely on relationships as motivation for learning. over years of implementing these policies with undergraduate and graduate social work students, we have not observed any increase in course absences or late assignments. we observe that up to 10% of students typically struggle with attendance and turning in assignments on time, which has not changed with the implementation of these policies. moreover, as evidenced by direct student feedback, course evaluations, and assignment submissions comparison across semesters, we have observed an increase in engagement and quality of student work. these policies also provided opportunities to discuss the meaning of self-determination and interdependence for social work practice, as students experienced their impact through the course structure. finally, we had several opportunities to support students who struggled with procrastination in getting the help they needed to address the underlying issues rather than punish them. firmly hold on to the centrality of reflexivity and accountability using these three pedagogies in an institutional setting requires deep commitment to reflexivity and self-evaluation, regardless of identity (hooks, 1994). for us as white higher education professors currently removed from the everyday impact of the prison industrial complex, engaging in rigorous internal work is critical (education for liberation network & critical resistance editorial collective, 2021). we also believe that accountability must accompany self-reflection. by accountability, we refer to “willingness to accept responsibility for one’s harmful actions or behaviors” (kaba & hassan, 2019, p. 64). we adopt this definition of accountability from abolitionists working within the transformative justice arena, which is an approach to creating safety, justice, and healing for survivors of violence that does not rely on the carceral state (jacobs et al., 2021). rather than “holding people accountable,” the transformative justice practitioners emphasize that people can only “take accountability” as it is an “internal resource” and an ongoing process of choosing to be responsible for one self and people we impact, for our choices and their consequences (kaba & hassan, 2019, p. 78). we approach reflexivity and accountability, through a firm commitment to both selfaccountability and accountability in relationships. again, we adopt the concept of selfaccountability from transformative justice practitioners. self-accountability refers to the ongoing process of reflection to align our actions in the classroom with our values, understand our past choices, and considering or changing future choices (kaba & hassan, 2019). it also includes genuinely being open to hearing from students about how our teaching choices affect them and demonstrating willingness to change based on the feedback. as white educators teaching predominantly students of color in the context of normative whiteness and white supremacy within social work education (bryant & kolivoski, 2021; ortega-williams & mclane-davison, 2021), rather than assuming trust at the beginning of each course, we work to earn trust through our actions throughout the semester. we also engage students at the beginning of the class to develop shared learning advances in social work, summer 2022, 22(2) 400 community values so that all of us can engage in the process of self-accountability as a building block of solidarity. our collective work includes our commitment to supporting each other though ongoing dialogue about these pedagogies and skill sharing, working with other white people committed to racial justice, and working in solidarity with people of color in our department and community. ongoing commitment to learning from critical race theory and critical white studies scholarship as well as mobilizing with other white people committed to antiracism is an essential aspect of our work (crudup et al., 2021; gregory, 2021; kivel, 2017). for example, in 2020 jelena participated in a summer-long white accountability dialogue group with staff and faculty from diverse university departments including anthropology, communication, physics, and student affairs, which provided insight into not only how whiteness operates within social work but within all academic environments and processes. finally, we seek and welcome feedback and accountability from our colleagues, community partners, students, and friends of color. for example, in 2020 we were the founding members of an antiracism collective in our department, which provides ongoing opportunities for dialogue and productive conflict that is necessary for transforming our program. students provide critical feedback as well through dialogue and evaluations. we continue to listen and amplify their voices, including supporting their agency and following their leadership. last year, we supported a group of students who noted that our curriculum lacked ongoing focus on critical history. we co-organized a lecture series focused on the history of racial capitalism to address this gap, which was widely attended by students, staff, faculty, and field instructors. this year, we worked with a group of students who voiced inadequate support for lgbtqia+ communities to organize queering social work: theory and praxis. this series of events was grounded in intersectionality, focused on challenging cis-hetero-patriarchy in the social work curriculum, and centered on indigenous and people of color perspectives. self-reflexivity also ensures that we notice our own evolution and growth in understanding and using these pedagogies. for example, jelena maintained strict point deduction policies for late assignment until 2018, despite her long-term commitment to abolitionist ideas. engaging in deep reflection on theory and action, results in these transformational moments that lead us to deepen our praxis. moreover, neither of us considered working with students to construct assignment rubrics until one of the reviewers of this manuscript suggested it. we offer these observations not as performative accountability, but to point out that personal ego is not compatible with collective struggle (education for liberation network & critical resistance editorial collective, 2021). feedback is a gift. teach prison industrial complex abolition to stimulate courage, creativity, and hope needed to solve grand challenges beyond decarceration the key to prison industrial complex abolition is that it is not only about absence; it is about the presence (wilson gilmore as cited in kushner, 2019). abolition demands not only dismantling the prison industrial complex but also building models today that represent the equitable life-affirming future that we want (kaba & hassan, 2019). as such, todić & christensen /integrating critical, engaged 401 abolition provides the framework for solving social work grand challenges beyond promoting smart decarceration. it points to imprisonment and policing as “solutions” to problems rooted in unjust economic systems, racism, and other forms of oppression. imagining a world without prisons and policing, forces us to address issues we ineffectively address through incarceration. for example, in a social determinants of health course, students responded to arundhati roy's (2020) invitation to see the covid-19 pandemic as a portal to another world by considering how prison industrial complex abolition, as a transformational praxis, might direct social work efforts to eliminate health inequities. students answered the following questions during one of the class activities: “what does the world look like if we abolish the prison industrial complex? feel like? sound like? how may this new world impact health? provide one image and up to 100-word description.” one student answered: the abolition of the prison industrial complex would feel like a world without walls. a world without borders. endless possibilities. limitless opportunities. constant growth and movement towards a more equal world. a community of grace and forgiveness, of communal knowledge and support. where one mistake does not ripple out into a lifelong struggle that affects generations to come, but instead creates a wave that communities ride to adapt and serve the most vulnerable people in their circles. brown's (2017) emergent strategy provides a valuable framework for understanding how today’s choices can shape the abolitionist future we want. it asserts that "how we are at the small scale is how we are at the large scale," emphasizing the importance of celebrating small shifts and understanding that they serve as a foundation for subsequent ones (p. 52). this principle suggests that our relationships are "a front line, a first place we can practice justice, liberation, and alignment with each other and the plane" (brown, 2017, p. 53). even though the higher education context limits how much true democracy is possible in the classroom, we see each class as an opportunity to practice mutuality and accountability as values and processes that undermine racial capitalism and white supremacy. these classroom practices at a small-scale are shifts that gradually "set the patterns for the whole system" (brown, 2017, p. 53). in other words, overtime, as students and instructors carry these skills and experiences into areas of practice beyond the university, they have the basic skills and knowledge to build decentralized and interdependent spaces in which carceral and white supremacist logics are not “common sense.” consequently, an abolitionist classroom may be best understood as what foucault (1986) referred to heterotopias or “spaces that provide an alternate space of ordering while paradoxically remaining both separate from and connected to all other spaces” (topinka, 2010, p. 55). because they combine and contrast multiple spaces and ways of knowing in one site, they create an “intensification of knowledge” that may not entirely “free us from power relations,” but “can help us re-see the foundations of our own knowledge” (topinka, 2010, p. 70), making white supremacy and racial capitalism more legible and therefore changeable. advances in social work, summer 2022, 22(2) 402 develop the circle process skills as instructors, we strongly believe in relationships as vehicles for change and invest a significant amount of effort in building a relational ecology (vaandering, 2014) within our classrooms. one tool we use to accomplish this throughout the semester is the circles process. the circle process is rooted in the talking circles that many indigenous peoples in north america have used for centuries and incorporates contemporary understandings of intergroup dialogue, consensus building, change theory, and transformative justice (ball et al., 2010). the circles have two essential elements: 1) they incorporate the values that participants feel are important for a healthy process and outcomes that are good for everyone; and 2) they reflect indigenous teachings about interconnectedness, a balance between inner/outer work and individual/community, and the inherent dignity and worth of every person. this process provides a structured form of dialogue, setting time to build relationships, offering space for expressing different viewpoints and strong emotions, and making difficult decisions. dialogue, relationship building, and offering space for strong emotions align with antiracist social work education. students can use these skills to identify and call out racism in the classroom and in practice settings (cruddup et al., 2021; whitaker, 2021). simply put, circles are one way to practice classroom democracy and antiracism (ball et al., 2010; davis, 2019). circles as a physical structure reflect shared power and disrupt institutional power over hierarchies, which reflect the broader social conditions resulting from intersecting systems of oppression. symbolically, all participants are equally distant from the circle center, representing that each participant has an equal voice (umbreit & armour, 2010). in that sense, the circles embody shared obligation and mutual accountability associated with interconnectedness (umbreit & armour, 2010). however, given the formal authority that instructors hold in the context of the neoliberal university hierarchy, it is critical to embed circles in the context of other pedagogical changes we describe. in the context of a punitive and hierarchical classroom, the circles are a gimmick. as we discuss in the other nine lessons, the instructor must value and model interdependence, mutuality, and accountability. there must be alignment between what we espouse to and what we model (education for liberation network & critical resistance editorial collective, 2021). that said, after experiencing and practicing circles, students also have an opportunity to reject them through reflection about the classroom process or anonymous mid-semester evaluations. based on our mid-semester and final course evaluations, however, students do report that the circle process is among the most valued aspects of our courses. while we do serve as circle facilitators (“circle keepers”), this role includes guiding the process but not controlling it (pranis et al., 2013). in the sequential circle, everyone gets a turn, and those who want to respond to something must be patient and wait until it is their turn to speak. if sequential, the circle is at times structured around topics or questions we raise as facilitators. however, students also take on roles of facilitators and circle-keepers. for example, in one course, after receiving the initial training, students took full responsibility for facilitating ongoing small group discussion, which amounted to approximately one-third of the class time. students facilitated independently and received coaching based on the reports of their discussion experience. although, not eliminating the todić & christensen /integrating critical, engaged 403 formal authority associated with the instructor role, this process does reduce the power differential. students’ evaluations indicated that this process was valuable and they learned from and with their peers. in non-sequential circles, such as problem-solving circles, a conversation may proceed from one person to another without a fixed order. regardless of the circle format, deep listening is its essential feature. strive to practice non-hierarchical ways of working in all aspects of your work modeling critical and engaged pedagogy (campbell, 2002; redmond, 2010) involves shaping the classroom to exemplify antiracist approaches outside the classroom. this work diminishes the power difference between the instructor and students, centering student lived experiences as legitimate knowledge and making learning experiences accessible (gutiérrez-ujaque & jeyasingham, 2021). in the liberatory classroom, we are transparent about our pedagogical choices, always ensuring that students understand how activities relate to desired learning outcomes. within existing higher education systems, it is not possible to diminish power differences to create true equity. for example, instructors can fail students, but students cannot fail instructors. however, within that hierarchy, instructors can diminish power differences in the classroom. for example, we use a formal mid-semester evaluation to solicit feedback from students about the course progress, which allows us to address issues and make changes. students also comment on our work (e.g., surveys, grants) and read the often-critical reviews we received from peers. by striving for non-hierarchical approaches in all aspects of our work, we deepen our praxis, making it easier to model it in the classroom. we have a shared research project focused on restorative and transformative justice with another colleague where we use the circle process to conduct our team meetings. we begin each meeting with check-in by sharing what is going on in our lives or answering a reflective question (e.g., “what is one area of personal struggle in your life where you could ease suffering?”) and use the circle format to report on our progress. we close each meeting with a check-out, which focuses on sharing insight from the meeting or answering another question (e.g., “what is one thing you are looking forward to in the next two weeks?”). this relational environment supports accountability and motivation to complete projects in a way that is similar to our relational classrooms. we have created conditions that allow us to take accountability when we make mistakes, provide direct feedback, apologize, ask for help, or overcome procrastination because we care about our individual and collective success. realize that critical, engaged, and abolitionist pedagogies are adaptive before the shelter-in-place order in response to covid-19, we used critical pedagogy methods in our courses. however, the three pandemics that converged in 2020 deeply affected our students. many students lost their employment or housing, had to homeschool children, and struggled with accessing a home computer or reliable internet. the continued police violence against the black community deeply affected all of us. these three pandemics intersected and widened social disparities (bailey & moon, 2020; gould & wilson, 2020), including exposing the dramatic differences between how the pandemic affected us as childless, white, tenure track professors and our students who are primarily advances in social work, summer 2022, 22(2) 404 people of color, many of whom are parents and essential workers. critical, engaged, and abolitionist pedagogies were more relevant than ever. the circle process we established before the pandemic, as in-person instructors, extended this liberatory environment into a virtual space. antiracist, critical, and abolitionist pedagogies foster reflexivity, self-determination, mutuality, collective responsibility, and praxis. because these pedagogies insist on the dignity of all people and assume that no one is disposable, they already embody an ethic of care that centers the needs of students who experience marginalization, what hooks (2000) referred to as the from margin to center approach. in fact, while the transition to remote teaching challenged us, we actually had to change very little in our course structures. for example, during the initial months of the covid-19 pandemic, we modified the circle process by including an asynchronous use of google docs, which allowed us to join our students in a supportive community while continuing relational teaching. we started each week with a circle prompt and alphabetized student list. this way, students could check in whenever they could access technology or as their hectic lives allowed. some of the prompts that bolstered cohesion were, "share something you have read, seen, or heard that portrays how this pandemic is affecting us in a humorous light" or "please say hi and check-in by looking up your name on the list below and letting us know what has been the hardest for you since you last checked in." students also suggested prompts and provided feedback about the process, which resulted in subsequent prompts. for example, hi all. this week, we have a 2-part check-in. • part 1: inspired by the code switch podcast, d. suggested checking in by sharing a song giving you life during the pandemic. • part 2: i am also thinking about k.'s comment that checking in through the google doc circle may feel like talking to an empty room. • check-in using one of the heart emojis: o [green] = i am doing great, o [orange] = i am okay, o [yellow] = i am okay-ish, o [purple] = things are tough, o [blue] = i am in a bad place and would not mind if someone reached out to me. continuing the circle process after we transitioned to online teaching forged a vital bridge between pre-covid learning experiences and mid-covid, virtual learning. encouraging students to connect their personal pandemic experiences to the course content aligned seamlessly with the weekly circles. understand that not all students will appreciate this way of learning while these pedagogies work for the majority of students, they do not work for all students. many factors contribute to the resistance, and educators should prepare for working with it. first, all students and faculty have received hegemonic messaging from elected officials, public intellectuals, media, schools, families, and religious communities about liberation as utopian or unrealistic. this paradigm posits liberatory praxis as the todić & christensen /integrating critical, engaged 405 dissolution of all things wholesome, safe, and pure, limiting “the political imagination” and perpetuating a fear-based worldview (rodríguez, 2010, p. 16). second, even though these pedagogies create experimental liberatory spaces, the courses still occur in the context of a neoliberal university that emphasizes job market skills, competition, and individualism that students experienced during their undergraduate and likely their graduate social work courses (whynacht et al., 2018). given this context, uncertainty about grades and "doing things right" in a more collaborative emergent space with liberatory rules of engagement can be unsettling for students. these concerns reveal the limitations and inherent tensions in the liberatory approach to teaching, reminding us that liberation requires organized efforts beyond education. on one occasion, several students could not submit assignments by the deadline and approached their instructor to ask for an extension. when the professor referred the students back to the syllabus, reminding them that they did not need permission, students explained that they did not believe this policy and were “waiting to be tricked.” moreover, conflicting experiences in the liberatory classroom and neoliberal social work practices in their field placements may exacerbate these tensions. social work students may struggle to reconcile the dissonance between the state-involved practitioner who surveils and controls citizen behavior (through punitive social welfare policies and organizational practices) and the radical activist who dismantles oppressive state systems (morley et al., 2020; saleebey & scanlon, 2005). we incorporated antidotes to these barriers into our teaching. for example, we were transparent with students about our approach to education, and we encouraged students to share their misgivings. we reminded students that we aim to flatten the hierarchy, and for that to happen, students need to give us honest, direct, and timely feedback; however, we also dialogue with students about the limitations of this approach in the context of the academic hierarchy. nevertheless, the feedback loop included creating a space for students to share their fears and frustrations about critical, engaged, abolitionist teaching and learning. as instructors, we recognized these feelings, conveyed respect for them, and challenged students to remain open to new ways of understanding social problems, relationships, and solutions to these problems. we also included diverse forms of data demonstrating the personal and political benefits that a liberatory approach could yield. be aware of the invisible work of “making the academy a better place” developing growth-fostering relationships based on mutual empathy and our visible commitment to anti-oppressive praxis suggests to students that we are accessible and that they can trust us with experiences beyond class content (jordan, 2013; lenz, 2016). as such, students often approach us for mentoring, support around issues of social injustice, or advice for how to pursue social change efforts in the department, their practicum placements, or community. a substantial body of literature suggests that, not surprisingly, this work of "making the academy a better place" (social sciences feminist network research interest group, 2017) is most often taken up by those who occupy marginalized social group identities (e.g., people of color, women, queer people, first-generation faculty; reddick et al., 2020). while some may argue that these activities fall within one of five advances in social work, summer 2022, 22(2) 406 functions of faculty jobs – research, administration, teaching, advising, and service – it is also widely recognized that universities do not value or reward these activities equally (thomas-davis, 2020). investing a substantial amount of effort into teaching, advising, and service, which liberatory praxis demands, may harm one's promotion and tenure (catterall et al., 2019; stanley, 2020). this tension creates a powerful ethical dilemma for faculty who use critical, engaged, and abolitionist pedagogies, emphasizing praxis. while we have not mastered how to resolve this tension, a few strategies have worked for us. being transparent with students about the nature of our roles and building a supportive community (see the next lesson) can ease the burden of the tension; however, advocating for structural changes to assign value to this work and setting expectations that all faculty are responsible for making the academy a better place is critical. “freedom is a constant struggle”: organize with people like you and people different than you our final lesson may be the most important one. in a recent compilation of essays, freedom is a constant struggle, angela davis (2016) reminds us that the path to freedom is long. this is particularly the case for people with marginalized positionalities. we recognize that our white positionalities protect us from the violence and emotional labor that bipoc people experience doing this work (davis, 2016). as faculty in different stages of the tenure process (assistant and associate), we have supported each other in principled struggle (brown & lee, 2021). we strive to be honest and direct, take responsibility for our feelings and actions, and support each other through conversations that deepen our analysis of a situation while avoiding organizational gossip (brown, 2017; brown, 2018). we have also collaborated on teaching and research projects that have ensured that we can do more than we would have been able to do as individuals. for example, every year, we co-host an event where students in our courses, department, and the community come together to dialogue about social justice issues that impact our community. one year, we hosted an artist, mark menjivar, and his project, migration stories, after attending a listening session in the community. another year, we hosted a viewing of healing justice, facilitated by several community organizations, which explores the intersection of historical trauma, prison industrial complex, and racism, as well as abolitionist alternatives like restorative and transformative justice. finally, we are the founding members of a multiracial group of the faculty and staff that formed an antiracism collective in 2020, which has allowed us to focus on antiracism with intention and intensity. as kishimoto (2018) states, antiracist pedagogy is more than curriculum content about racism, requiring us to see pedagogy as an organizing framework. all of these projects have enabled us to deepen our political analysis and engage in praxis, build meaningful relationships, meet our research productivity expectations, and foster hope that change is possible. final reflection over the past several years, we have observed with enthusiasm an increased focus on antiracist, critical, and liberatory pedagogies. the advances in social work summer 2021 special issue on dismantling racism in social work education features a number of todić & christensen /integrating critical, engaged 407 innovative approaches to antiracist, critical, and liberatory social work pedagogies. for example, gregory (2021) outlines an introductory, three-unit, eight-lesson historically accountable critical whiteness curriculum “to facilitate informed participation in the pursuit of racial justice" (p. 616). moreover, jemal and frasier (2021) describe a course in critical social work informed by the critical transformative potential development (ctpd) framework that aims to bridge the micro-macro divide through engaging students in actively dismantling ideologies and practices of dominance. polk and colleagues (2021) offer lessons learned from a five-year systematic campaign to move all levels of their social work program beyond multicultural orientation towards critical race theory. this effort, driven by a self-organized cross-racial committee, bridged the field and tenure-line faculty hierarchy and mobilized institutional support. we are excited to learn from and build on these scholars' strong foundation by offering our take on what critical, engaged, and abolitionist pedagogies can offer to social work education as the profession adopts antiracism. table 1 outlines the implications that emerged from our ten lessons. to successfully implement these radical pedagogies, it is critical to accept the discomfort, risk, and messiness of working within the tension between a neoliberal emphasis on outcomes and liberatory teaching focused on the process. using these pedagogies in the context of a department that does not universally subscribe to them is complicated. for example, students who see value in these pedagogies sometimes comment on our colleagues who do not use these pedagogies. we had to ensure that we supported our students' critique of punitive systems embedded in social work educations while not undermining our colleagues. therefore, we recommend that the entire social work programs implement these pedagogies collectively, learning from the process that polk and colleagues (2021) used to transform their department from multiculturalism to the critical race perspective. educators should also carefully consider how institutions coopt emancipatory ideas in service of maintaining the status quo (incite, 2007/2017). in a recent “lessons in liberation: an abolitionist toolkit for educators,” education for liberation network & critical resistance editorial collective (2021) underscore the importance of bringing abolition to education, while cautioning educators to not obscure its explicit aim to dismantle the prison industrial complex through campaigns and organizing outside of education. making a transparent commitment to these pedagogies and inviting critique from students and community members working within radical traditions could help prevent cooptation and generate empirical data about the effectiveness of pedagogical efforts to be antiracist. finally, building alternative spaces that deepen critical analysis and give us access to what is possible in our future is vital. at the same time, we engage in the slow process of broader institutional change. our classrooms are spaces where coenvisioning and co-realizing that future, in the present, makes it possible to remain focused, persistent, and resilient in the pursuit of a scaled-up liberated future for all. advances in social work, summer 2022, 22(2) 408 table 1. ten lessons: practical implications lesson implications for educators embrace critical theory read up on critical theory; have a book club; take a class; explore variations (critical race theory, critical feminism, critical queer theory). question and interrupt manifestations of carcerality in social work education remove punitive practices from teaching; instead, engage students with creating accountability standards through identifying shared values, codeveloping course syllabi, and creating assignment rubrics. firmly hold on to the centrality of reflexivity and accountability regardless of identity, commit to honest and deep reflection and self-evaluation about how you internalize white supremacy, carceral logic, and other dysfunctional power dynamics inconsistent with social work values and aims. build skills for self-accountability and community accountability. teach prison industrial complex abolition to stimulate courage, creativity, and hope needed to solve grand challenges beyond decarceration learn about prison industrial complex abolition and the role it plays in solving serious social problems. teach it. develop circle process skills attend a training. develop relationships with community-based practitioners who use restorative and transformative justice processes. this may mean participating in community circles or inviting community organizations to facilitate circles. strive to practice non-hierarchical ways of working in all aspects of your work integrate elements of non-hierarchical approaches into faculty meetings, research collaboratives, and committee work as a way to experience their benefits. realize that critical, engaged, and abolitionist pedagogies support liberation regardless of the circumstances gather and incorporate student feedback into teaching methods and into revising courses. as an example, the circle method successfully transferred from in-person to online. understand that not all students will appreciate this way of learning provide structured feedback loops where stakeholders can air their concerns to work with resistance that emancipatory processes may engender. be aware of the invisible work of “making the academy a better place” build solidarity among faculty working within these frameworks, provide opportunities to receive peer feedback and coaching from experienced peers, and advocate for structural changes to assign value to liberatory praxis in academia. set expectations that all faculty are responsible for making the academy a better place. “freedom is a constant struggle”: organize with people like you and different from you construct intentional spaces that cultivate critical, engaged, and emancipatory organizational practices (e.g., faculty meetings, committee work, engaging with students). todić & christensen /integrating critical, engaged 409 references abrams, l. s., & gibson, p. 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(2020). the perils of privatization: bringing the business model into human services. social work, 65(3), 213-224. https://doi.org/10.1093/sw/swaa024 author note: address correspondence to jelena todić, department of social work, the university of texas at san antonio, san antonio, tx. email: jelena.todic@utsa.edu author acknowledgment: the authors wish to thank rowen pemberton, msw, bshsph, cd(dti) for granting them the permission to quote their course assignment exploring the relationship between prison industrial complex abolition and health. they also thank three anonymous reviewers whose generous and rigorous feedback significantly improved the article. https://doi.org/10.22439/fs.v0i9.3059 https://doi.org/10.1891/9780826122599 https://doi.org/10.1111/curi.12057 https://doi.org/10.1017/s0003055410000456 https://www.uh.edu/socialwork/news/racial-justice-symposium/part-two/ https://www.uh.edu/socialwork/news/racial-justice-symposium/part-two/ https://www.jstor.org/stable/pdf/26873828.pdf https://doi.org/10.18060/23946 https://doi.org/10.1093/sw/swaa024 mailto:jelena.todic@utsa.edu microsoft word 07_reay_24758_pandemic_roadmap _________ susan reay, edd, licsw, assistant professor, grace abbott school of social work, omaha, ne. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1178-1192, doi: 10.18060/24758 this work is licensed under a creative commons attribution 4.0 international license. a pandemic road map: creating social work student wellness plans in field placement susan reay abstract: during the unprecedented early stages of covid-19, few protocols were established to support overall student wellness in social work field placements. in response to the overwhelming need for a contextual framework to promote wellness and determine the next steps in mitigating health risks, faculty developed a unique solution in a dynamic situation. rooted in the university-sponsored dimensions of wellness, bsw and msw students developed wellness plans that were integrated into the field placement course. these plans were intended to enhance students' ability to evaluate their well-being and encourage them to plan wellness activities. the wellness plan was critical in determining a student's ability to continue their planned learning activities amidst broad systemic factors, which impacted their social work field placement experiences. developing the wellness plan encouraged students to articulate unmet needs and provided a mechanism for faculty to offer relevant university-sponsored resources. this model provides a framework with implications for social work education. the prioritization of student wellness during field placement creates a road map for the future. given that wellness is an essential component of social work practice, social work students must have the tools to evaluate and implement wellness strategies, which can be applied throughout the student's social work career. keywords: self-care, wellness, field placement, social work social work student stress under normal conditions, navigating college life can be challenging. life transitions and academic pressure have been demonstrated as predictors of stress among college students (karaman et al., 2019). the changes that students experience can be overwhelming, and students are sometimes ill-equipped to manage the vast number of duties that they are tasked to complete (chao, 2012). students' struggles can lead to opportunities for tremendous personal and cognitive development (newell & nelsongardell, 2014). however, personal growth can push students outside of their comfort zone and lead to stressors that the student cannot manage independently. as far as “normal” college experiences are concerned, the stressors described above are typical and to be expected. however, professional academic programs, like social work, typically lead to higher stress rates than other educational programs due to combined academic and professional requirements (dziegielewski et al., 2004). much like other college students, social work students complete assignments to satisfy course requirements. in contrast to students in some other academic programs, social work students have the additional requirement of demonstrating competency at performing practice skills such as interviewing, assessing, and evaluating individuals, families, and groups (council on social work education [cswe], 2015); sewpaul & jones, 2005). these essential social reay/a pandemic roadmap 1179 work skills are nurtured in the curriculum and demonstrated through in vivo learning experiences in a field agency setting. seen as the critical linkage between classroom and practice, field placements are a social work programmatic requirement and are necessary to successfully transition into professional practice (caspersen & smeby, 2020; cswe, 2015). field placements provide students with exposure to professional work in the "real world" while getting academic support. the academic support provided to social work students during field placements includes faculty advising, educational supervision, and liaisons designed to observe, review, and guide the student's clinical decision-making skills (cswe, 2015). as the signature pedagogy of social work education (cswe, 2015), field education is essential to increasing each student's understanding of themselves and how to relate with client systems (bogo, 2015). with academic support, students can better integrate classroom knowledge with what they are learning in the field placement (bogo, 2015; caspersen & smeby, 2020; royse et al., 1993). the experiential learning opportunities and academic support provided to students as part of the course are why many students and social work professionals view field placements as the most valuable and essential part of social work academic programming (smith et al., 2015). the importance of field placements in student learning is well-established. however, it is also seen as the most challenging aspect of social work education for students (papadaki et al., 2012). social work field placement has long been associated with increased anxiety and stress among students (rompf et al., 1993). most placements are not funded; therefore, many students maintain part-time or full-time employment while completing their field placement (johnstone et al., 2016). consequently, many students manage other commitments during field placements, such as additional classes and family obligations, while completing the required hours at the field agency. as a result, students have greater demands with limited time. the experience of juggling life demands while in field placement is one component of social work student stress. however, students are also experiencing the demands of developing professional social work skills, such as learning how to navigate complex caseloads, work with challenging client situations, and manage high volumes of work (hansung & stoner, 2008). these professional social work skills require a level of emotional complexity that students may not have fully developed. students may find it challenging to cope with mixed emotions such as feeling excited about the learning experience and feeling sadness when observing clients struggle with the challenges of life (grossman et al., 2016; newell & nelson-gardell, 2014). this emotional phenomenon may be new to students who are inexperienced in processing intense feelings. when ill-equipped to deal with intense reactions brought on by direct-care clinical work, secondary trauma symptoms and compassion fatigue may emerge. these symptoms could include chronic fatigue, sadness, emotional exhaustion, and detachment from the client system (figley, 1993; sabin-ferrell & tupin, 2003; sansbury et al., 2015). optimally, students should have support and a wellness plan during field placements to critically analyze any uncomfortable thoughts and feelings that may arise due to the field placement experience (collins et al., 2010; iacono, 2017; johnstone et al., 2016). advances in social work, fall 2021, 21(4) 1180 self-care and managing stress many organizations and universities point to self-care as the primary tool to manage stress, secondary trauma, and burnout in social work settings (miller et al., 2018; newcomb et al., 2017). self-care is defined as taking steps to preserve and improve one's health, wellbeing, and happiness, especially during times of stress (oxford english dictionary, 2020). in stressful situations, self-care is a critical part of managing and coping with circumstances out of one's control (diaconescu, 2015; newell & nelson-gardell, 2014). for students, self-care, coupled with other academic and organizational supports such as the development of a wellness plan has proven to be an effective strategy for managing student stress (cohen & collens, 2013). therefore, it is logical that self-care be an essential part of advising, teaching, and supporting students while completing a field placement. however, msw programs do not consistently teach students how to effectively engage in self-care activities (bloomquist et al., 2015). o'neill and colleagues (2019) found that while 86% of surveyed social work students had a self-care plan, only 28% of those students engaged in daily self-care activities. when a wellness plan is developed and implemented, it may positively influence a student's ability to cope with stressors during field placement and promote self-care activities during future times of stress in their social work career (collins et al., 2010; griffiths et al., 2019). stress during the covid-19 pandemic stress for social work students in field placements has burdened students before the covid-19 pandemic (johnstone et al., 2016; rompf et al., 1993). naturally, during a time of global crisis, student stress increases immensely (brooks et al., 2020). students experienced increased levels of stress during the covid-19 pandemic (american psychiatric association [apa], 2020). the substantial and unpredictable systemic factors that all americans experienced due to covid-19 were particularly impactful to students' social work field placement experiences due to the need for safe and alternative learning activities during the pandemic (cswe, 2020). in 2020, daily behavior in the united states was dramatically altered by the rapid emergence of the covid-19 pandemic and subsequent state and federal safety measures. individuals were forced to navigate sudden school closures, employment insecurity, financial concerns, and social behavior changes (park et al., 2020). during the early months of the covid-19 pandemic, many students were unable to work at their part-time or fulltime jobs, some of which were in the service industry, therefore losing income (brooks et al., 2020). reading and hearing about the severity of covid-19, uncertainty about quarantine protocols, and changes to social and daily personal care routines were reported as stressful for many americans (park et al., 2020). inadequate coping and adverse effects on mental health resulted in the centers for disease control (cdc, 2020) emphasizing the need for individuals to manage stress and protect mental health during the pandemic. due to covid-19, the majority of universities in the u.s. rapidly shifted to webbased distance learning midway through the spring 2020 semester. university students were significantly affected by fears of infection, work and learning changes, lack of access reay/a pandemic roadmap 1181 to reliable information and resources, and interruptions in daily routines (brooks et al., 2020). like all students, social work students were impacted by the disruptions in their learning. however, they also experienced adjustments in their field placements because of changes with the agencies in which they were placed. community agencies were grappling with implementing safety measures to meet the ever-evolving covid-19 precautionary requirements. a ripple down effect occurred that influenced students in field placements. some field placements were terminated when the agencies struggled to identify solutions to maintain service delivery while ensuring client safety. as a result, many students were unable to complete the field placement course. project framework during the pandemic, many contextual factors influenced bachelor and master of social work students’ wellness during field placement. environment and health information, regulations, and policies were subject to constant revisions during this tumultuous time. many variables were continually changing at the local, state, and federal levels regarding well-being guidance and safety precautions. large systems such as the council on social work education (cswe), the centers for disease control, the state department of health, and the university provided updates routinely to procedures based on the most up-to-date health information. grounded by available information across these systems, field education faculty communicated with field agencies about policies that impacted student participation in social work field placements. in this project, the field faculty worked closely with the field agencies to communicate about changes due to covid-19. each placement had varying levels of risk in exposing students to covid-19 because each one was unique in the population served, location, and number of employees (cswe, 2020). based on the information gleaned from the communication with the field agencies, faculty worked with students in developing individualized wellness plans based on relevant systemic and individual factors. while discussing wellness with students was not new, a more formalized approach was created because of the pandemic. after developing the student wellness plan, collaborative decisions that involved the student, field placement, and faculty were made about adjustments to social work field placement experiences. changes to field placement learning activities were typical as a result of this evaluative process. in some instances, adjustments to learning activities included video conferencing or phone calls instead of in-person client activities. when neither in-person nor virtual client contact was possible, alternative learning activities were provided. in other cases, the student's social work field placement was postponed by one or two semesters. the wellness plan was integrated into the student's field placement goals. the goals were evaluated regularly throughout the field placement experience through communication with the student and the field agency supervisors. adjustments to the goals were made as needed in conjunction with the student's academic and supervisory support. advances in social work, fall 2021, 21(4) 1182 project description the grace abbott school of social work responded to social work field placement changes and increased academic stressors triggered by the covid-19 pandemic by assisting students in creating individualized wellness plans. each plan was developed within the context of broader systemic factors that influenced students' ability to complete learning objectives for their field placement. student wellness plans were developed based on university-sponsored wellness indicators. the plans were connected to cswe competencies and the nasw code of ethics (cswe, 2015; nasw, 2017). the student wellness plans served as a guide to assist students, field supervisors, field agencies, and field faculty in shared decision-making regarding adjustments to field placement activities that would align with cswe social work competencies amidst the pandemic. state laws and regulations many contextual factors influenced the development of the student's wellness plan. these factors included "stay-at-home" directives, which many state and local governments enacted at the onset of the covid-19 pandemic. these orders primarily urged citizens to stay home as much as possible. by april 2020, 45 of 50 states had either state-wide or local stay-at-home orders in place (mervosh et al., 2020). some students were completing the field course in different states, which required field faculty to assist students in determining the orders that were relevant in each state. complicating the process, at the time, there was not a stay-at-home order issued in the state in which the grace abbott school of social work is located (nebraska department of health and human services, 2020). the lack of a stay-at-home order made in-person social work field placements possible but not necessarily safe for students. with no official state-mandated stay-at-home order, field faculty relied on local and state health officials' policies, university leadership, and cswe to drive decision-making. state social work licensing msw students were particularly impacted by contextual factors associated with the covid-19 pandemic due to state social work licensing regulations. nebraska, the state in which the grace abbott school of social work is located, requires that msw graduates seeking provisional mental health licensure complete 300 direct, virtual or in-person, faceto-face client hours in social work field placement before graduation from a csweaccredited msw program. this further complicated field placement accommodations amidst the covid-19 pandemic for students seeking provisional mental health licensure. the state's public health licensing department did not issue a covid-19 executive order, reducing the 300-hour requirement (nebraska department of health and human services, 2020). although unsuccessful, university field faculty advocated for the state to issue an executive order to reduce the 300-hour requirement because, in some situations, it was not safe or possible for students to interact face-to-face with client systems. a reduction in the state's statutory 300-hour requirement would have been more compatible with the cswe policy indicating that completion of 85% of the required social work field placement hours reay/a pandemic roadmap 1183 at a satisfactory level could be considered sufficient in meeting social work field placement requirements during the covid-19 pandemic (cswe, 2020). the state's required 300 hours of direct face-to-face client contact, accompanied by a lack of a state-mandated stay-at-home order, led to additional stressors for msw students planning to graduate the semester of the covid-19 pandemic outbreak. students were faced with a decision to either postpone graduation or risk the health of themselves and others. the grace abbott school of social work prohibited all in-person interactions between students and clients in social work field placements for 30 days following the initial covid-19 pandemic outbreak. upon expiration of the policy, field faculty assisted students in evaluating their wellness plans and procedures to mitigate risks in social work field placement. if deemed appropriate, students were permitted to resume face-to-face inperson client interactions in social work field placements. placement and student factors evaluating students' safety to continue in field placement during the covid-19 pandemic was a collaborative process between the students, their field supervisors, the field agency, and field faculty. virtual meetings occurred with field agency directors and field supervisors to evaluate health and safety risks. it was essential to assess the risk that each student brings to the field placement and the risk that each student assumes from the field placement. in turn, this process assisted in the student's evaluation of their overall physical wellness, and it informed decisions about the overall field placement experience. for example, a student employed at a daycare that does not practice pandemic-related preventative health and safety measures may bring risk to a field placement that provides services to elderly patients with comorbid health conditions. conversely, a student with lung disease may assume risk in a field placement that provides services to clients in a homeless shelter. this evaluative process was completed conjointly with the student, field supervisor, the field agency, and field faculty. other health professionals, such as physicians and mental health therapists, were part of the wellness evaluation as needed. communication among field placement agencies, students, and field faculty focused on preventative health measures and student wellness. determining the next steps in meeting the course learning objectives involved assessing the agency's capability of providing a safe and quality educational experience given the broader systemic contextual factors. any changes to the students’ learning goals caused by the pandemic were evaluated on a case-by-case basis, considering levels of covid-19 risk and the required safety measures to mitigate any risks. changes in the student's expected learning activities were incorporated into the student's wellness plan and the student's field placement learning goals. advances in social work, fall 2021, 21(4) 1184 table 1. student indicators of wellness and associated covid-19 resources wellness indicator resources provided pre-existing resource added during the pandemic physical health  university primary healthcare clinic  medical withdrawal from field placement courses for students with underlying health conditions  food pantry providing food, hygiene, & personal care products  state & university developed apps to monitor the health & provide covid-19 resources & testing   emotional health    university mental health clinic with a virtual walk-in individual therapy session  university-sponsored virtual support groups  university-sponsored virtual alcoholics anonymous (aa) & substance abuse meetings  virtual "connection" group hosted by social work faculty environmental health  homeless outreach & support  housing support when university housing was closed  wifi hot spot devices  laptops  "de-stress" gift baskets from the university financial health  hardship scholarships provided by the social work department  homeless support  cares act emergency financial aid grants  free financial literacy courses intellectual health  assignment extensions  some courses provide pass/fail  virtual writing, language, & library support  modification of course materials  free three-month virtual language learning through rosetta stone  alternative field placement learning activities in lieu of restricted in-person contact hours  courses moved to a virtual format occupational health  remote work for student workers  adjusted field placement hours to accommodate changing work schedules  support for military personnel & veterans regarding changes in benefits & online tuition waivers social health  zoom accounts provided by the university to connect with friends & family  virtual "hangouts" with social work faculty  competitive e-sports, virtual bingo spiritual health  connection to social work partnered religious organizations in the community  connection to religious studies student association virtual experiences note. adapted from the university of university of nebraska at omaha's wellness model. reay/a pandemic roadmap 1185 student wellness plans during the covid-19 pandemic outbreak, field faculty communicated with each student in field courses to help them evaluate their overall well-being in light of the covid-19 pandemic, assess for necessary academic or additional support, and make joint determinations with the student and field supervisor about the continuation or modification of learning activities. this communication occurred over zoom, by phone, or through email. the number and type of contacts with each student to communicate about wellness depended on the student’s desire and needs. if the student identified an unmet wellness need during the communication with faculty, university-sponsored support and resources were provided. faculty followed the outline of the university-sponsored dimensions of wellness as specified in table 1 to review wellness activities and needs within each dimension. the university of nebraska at omaha recognizes eight indicators of wellness to help students evaluate their wellness needs. these wellness indicators are the physical, emotional, environmental, financial, intellectual, occupational, social, and spiritual aspects of a student's life (university of nebraska at omaha [uno], 2020). the wellness indicators support the whole student and create a complete picture of student wellness within the covid-19 pandemic environment (uno, 2020). in the development of the wellness plan, students were asked to evaluate their status within each domain. faculty worked with the student to identify informal and formal supports for each area of identified need. for example, a student with underlying health conditions may receive the support aligned with the university-sponsored wellness domains of "physical health" and "intellectual." in this scenario, a student may be offered an opportunity to withdraw from their social work field placement for health reasons. in some cases, students were provided modified course materials, assignment extensions, or alternative learning activities in their social work field placements. studentworkers were allowed to work remotely, and social work faculty held virtual "connection" groups to bring students together. hardship scholarships were made available for students who were suddenly unemployed. additionally, all university students were eligible to receive a "de-stress" gift basket delivered to their homes. all university students were encouraged to use the university primary healthcare clinic for covid-19 testing and were provided information on how to access the campus food pantry. housing assistance was provided to students who moved out of student housing, and eligible students received emergency financial aid grants. laptops and wi-fi hotspot devices were provided to students in need, as well as other technical support. universitysponsored resources were provided to fit each student's individual needs during the time of the covid-19 pandemic. in late march 2020, the faculty began advising students seeking field placements in the upcoming summer and fall semesters. during the regularly scheduled field advising meetings that occurred over zoom, the faculty and each student engaged in discussions about evaluating the student’s overall health and well-being amidst risks related to the covid-19 pandemic. the discussions were anchored in the university-sponsored advances in social work, fall 2021, 21(4) 1186 dimensions of wellness as shown in table 1. the eight dimensions were used as a checklist to provide structure to the conversations and to encourage the student to observe the entire picture of wellness as articulated in each section. since students were not yet placed in field, this process was proactive, with the dimensions of wellness being used as a framework to obtain a complete picture of the student’s needs before entering field placement. table 2. learning plan goal: professional conduct, values, and ethics general field tasks assignments & experiences/projects specific to your agency target date progress/status date examine & apply the nasw code of ethics to the practicum setting. based on the evaluation of wellness completed in advising, the student articulated assignments in this column. the student & the supervisor reviewed the plan weekly in supervision. adjustments were made as needed. handle stress effectively by using supportive appropriate self-care & developing supportive relationships with colleagues, peers, & others. discuss with supervisor personal issues/obstacles that impact the student’s agency performance. exhibit knowledge of how one’s values, attitudes, beliefs, emotions & past experiences affect thinking, behavior, & relationships. show willingness to receive & accept feedback & supervision in a positive manner, as well as use such feedback to enhance professional judgment. note: this is one of seven goals for bsw & msw foundation students & one of nine goals for msw advanced students. reprinted from university of nebraska at omaha (2020). the wellness goals that the students developed as part of the advising process were integrated into their field learning plan, which is linked to the cswe educational policy and accreditation standards (epas; cswe, 2015). as demonstrated in table 2, the wellness activities identified as part of the advising process were integrated by the student into their field learning plan under the goal that aligned with the epas competency of “professional conduct, values, and ethics.” this goal is one of seven learning plan goals for bsw and msw foundation students and one of nine goals for msw advanced students. reay/a pandemic roadmap 1187 students were graded on the completion of these student-identified goals by the field supervisor and faculty. field supervisors and faculty graded bsw and msw students who completed wellness plans in the spring, summer, and fall semesters of 2020. aggregate data from the student assessments of learning in field placement indicate that the students who completed wellness plans exceeded expectations on this goal. additionally, after completion of the field placement, students self-assessed their performance using the same grading tool used by the field supervisors and faculty. similar to the ratings provided by supervisors and faculty, the average rating for students was above average. case study the following case studies provide examples of the wellness planning project. case study 1: elena, virtual field placement elena was a bachelor of social work (bsw) student seeking advisement. she was requesting information and support to identify agency field placement options in the upcoming semester. elena was interested in working with older adults. she desired to be placed in a nursing home or an assisted living facility to hone her skills in working directly with individuals and groups. as part of the advising process, the faculty inquired as to her wellness in each domain of the universitysponsored dimensions of wellness. through consultation concerning the physical and occupational health wellness domains, elena reported working at a daycare. at the daycare, she was exposed to up to 60 children and ten adults on any given shift. the daycare had minimal covid safety precautions. elena was advised of covid-19 safety precautions. the field placement faculty arranged a virtual consultation meeting with a field placement supervisor at a nursing home. through consultation, elena determined that she might be best suited for virtual field placement experiences with the nursing home that would limit cross-exposure to covid. elena's wellness plan included covid education, testing, and adjustments to field placement expectations to include virtual learning experiences. case study 2: jose, policy placement jose was seeking advisement for an upcoming master of social work (msw) field placement. jose was interested in a field placement focusing on social work policy and advocacy for minority groups. through the advising process, jose was informed of the university-sponsored dimensions of wellness. jose reflected on his needs and overall health. he reported that he lived in a homeless shelter and did not have a laptop or wi-fi capabilities. before covid-19, he was completing his homework at the university library which was now closed. the development of his wellness plan centered on financial, environmental, and physical health domains. jose was linked to resources through the university to provide a laptop and wi-fi advances in social work, fall 2021, 21(4) 1188 capability. additionally, he was referred for housing services. jose was placed in field at a public policy center and his wellness plan was monitored regularly. case study 3: alex, challenging living environment alex was midway through his bsw field placement course. alex lived in an apartment with several roommates who did not institute any safety precautions for covid-19. gatherings frequently occurred at alex's apartment with more than ten people. alex was struggling with completing his coursework on time, and his grades were low. alex's wellness plan focused on the university-sponsored wellness dimensions' physical, social, and intellectual health domains. through the advising process, alex was educated about covid-19 health precautions. as a result, he restricted the number of people allowed in his home to reduce his potential exposure. additionally, he was engaged in virtual student social activities and provided academic support to improve his grades. alex integrated activities within these domains in this wellness plan. the activities were reviewed by the field supervisor and field faculty regularly throughout the remainder of his field experience. implications for practice the model described in this article was developed in a time of tremendous stress for students and field faculty across the country. during the early months of the covid-19 pandemic, field faculty were responding to the ever-evolving health policies and regulations that impacted student experiences. outside of the parameters provided early in the pandemic by cswe, there was no road map for the field placement process due to the unprecedented nature of covid-19. the wellness model allowed faculty to listen and learn about student needs so that university-sponsored resources that aligned with wellness indicators could be provided. interestingly, the pandemic provided an opportunity to educate students about stress management and directed decision-making for the next steps in the field placement. this process promoted student wellness and self-care strategies that were evaluated throughout the student’s field placement. by creating a mindset of reflection on self-care behaviors, faculty may increase the likelihood that self-care strategies would be used during times of stress in the student’s life (newcomb et al., 2017). instituting wellness plans was unique to the early months of the pandemic, but it has broader implications for how we work with students moving forward. wellness plans that are consistently integrated into the overall field placement advising process and evaluated on an ongoing basis can increase student learning about health promotion and maintenance which students can use throughout their social work career (iacono, 2017; mack, 2020). conclusion supporting students in a social work field placement during the covid-19 pandemic involved communication between several large systems, including cswe, state public health officials, and university leadership. based on the most up-to-date information from large systems, university field faculty supported students in developing individualized reay/a pandemic roadmap 1189 student wellness plans based on university-identified dimensions of wellness. communication between systems was essential to supporting students amidst so many challenges in the broader contextual framework. the faculty offered a wide range of resources that aligned with the university-sponsored dimensions of wellness. discussions with students about wellness addressed concerns, alleviated stress, and identified challenges for students who were feeling overwhelmed by the enormity of managing their lives, courses, field placement obligations, and the pandemic. by calming students’ worries and clarifying expectations for safety precautions in the field, the faculty created an opportunity to increase the likelihood of success in field placement. once information about the student's wellness was discerned, informed decisions could be made to meet the student's needs. more research is needed in this area. for instance, experimental research design measuring student performance and perceived wellness may further explore this essential area of social work practice. this study can serve as a foundation for these future studies. the intense and stressful nature of the covid-19 pandemic created an opportunity for faculty to evaluate ways to integrate a formalized process of addressing student wellness needs during field placements during the pandemic and moving forward. this process provided the roadmap for faculty to pilot the wellness model described in this article, anchored in a structured dimensions of wellness framework. starting with advising before the student’s placement in field settings, a formalized process of evaluating wellness provided an opportunity for growth and self-reflection. the student’s wellness evaluation flowed into a concrete, written plan that was reviewed as a component of their field placement learning goals. outcomes indicate that the integration of the wellness plans effectively met the 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(2020). what is wellness? https://www.unomaha.edu/student-life/wellness/what-is-wellness.php author note: address correspondence to susan reay, grace abbott school of social work, university of nebraska at omaha, omaha, ne, 68182. email: sreay@unomaha.edu _________ jessica averitt taylor, phd, msw, professor, caroline macke, phd, msw, interim director and professor, reiko ozaki, phd, msw, assistant professor, and megan lindsey, edd, msw assistant professor, school of social work, northern kentucky university, highland heights, ky. angela anderson, msw, building community well-being systems connector, brighton center, newport, ky. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 454-474, doi: 10.18060/24963 this work is licensed under a creative commons attribution 4.0 international license. the intersection of sense of belonging and financial hardship among university students: social work educators’ response jessica averitt taylor caroline macke reiko ozaki megan lindsey angela anderson abstract: this study examines the largely unexplored connection between sense of belonging and financial hardship among college students. previous research indicates that a variety of demographic factors can impact sense of belonging, including ethnicity, gender identity, sexual orientation, and age. one demographic factor that has not been sufficiently examined within the context of sense of belonging is financial status. this cross-sectional study collected data from 958 students at a single midwestern university. approximately half of the student participants reported experiencing financial hardship. furthermore, students who had experienced financial hardship reported a significantly lower sense of belonging as compared to students who had not experienced financial hardship. analyses also revealed that even when controlling for other demographic factors, financial hardship remained a significant predictor of students’ sense of belonging. we posit that academic success is connected to both sense of belonging and financial hardship among students, as experiences of financial hardship negatively impact the sense of belonging within university communities. social work educators are ideally suited to design, implement, and evaluate necessary support services which promote financial wellbeing, and consequently sense of belonging and academic success. as such, social work educators are presented with the opportunity to pivot and embrace new opportunities to serve financially disenfranchised students. keywords: sense of belonging, campus climate, financial hardship, socioeconomic status, student support, retention, success higher education is heralded as a gateway to opportunity for economic advancement (u.s. department of education [us doe], 2016b). undergraduate education is related to financial outcomes that include higher wages and earning potential (hout, 2012; krueger et al., 2019; rouse, 2017). indeed, college degrees contribute to social mobility, a tenet of societal mores related to self-determination and the equality of opportunity. universities have long sought impactful, evidence-based practices to improve student success through increased recruitment, retention, and persistence (hurtado et al., 2012). access to higher education is an area of continued development for colleges and universities, particularly as related to the recruitment and retention of a diverse student body. universities have explored existing definitions of diversity, and current definitions may include factors such as racial and ethnic identity; lesbian, gay, bisexual, about:blank averitt et al./intersection of sense of belonging 455 transgender, queer, intersex, asexual, plus (lgbtqia+) identity; disability status; and socioeconomic status (ses; phillips, 2019). with an increased focus on the recruitment and retention of a diverse student body, the available student support must also be diversified. against this backdrop, sense of belonging has emerged as a critical factor in college student persistence over the last two decades. sense of belonging refers to students’ psychological sense of connection to their community (museus et al., 2018). sense of belonging is a key component of the current perceptions, attitudes, and expectations that define the institution and its members (hurtado & ponjuan, 2005) as perceived by students, which is also known as campus climate (garcia et al., 2019). while not federally mandated, campus climate studies are a vital part of efforts to identify the factors that impact student success (united states government accountability office [gao], 2020). campus climate data provide insight regarding sense of belonging on college campuses as linked to student success (vaccaro & newman, 2016). this sense of belonging may differ for individual students depending on student background and characteristics, particularly with regard to factors related to diversity such as financial hardship. one unique component of the purpose of the social work profession is to particularly serve people who are oppressed and experience financial hardship (national association of social workers, 2021). understanding the experiences of financial hardship among increasingly diverse college students should inform how social work practitioners and educators contribute to the academic success, and subsequently the social mobility, of marginalized students. the following section provides a review of literature related to the importance of sense of belonging and the factors that may influence university students’ sense of belonging. these factors include ethnicity, lgbtqia+ status, and age. subsequently, this study explores the impact of financial hardship on students’ sense of belonging. this is an area that has not yet been sufficiently examined and may provide insight into the roles of social workers within the institute of higher education. literature review importance of sense of belonging sense of belonging refers to students’ psychological connection to the university community (museus et al., 2018) and is considered to be a universal, foundational need that is especially critical in terms of university students’ success (means & pyne, 2017). student experiences with sense of belonging contribute to their perceptions of the social and academic environment. a significant amount of research has demonstrated that sense of belonging is associated with positive academic outcomes (diehl et al., 2019; means & pyne, 2017; silver wolf et al., 2017; tinajero et al., 2020). for example, sense of belonging positively influences academic achievement, retention, and persistence to graduate among college students (hausmann et al., 2017). often, students’ experiences in academic and social settings influence their sense of belonging on campus and vice versa (strayhorn, 2019). frequent, positive interactions with others allow students to establish meaningful relationships within the campus community. advances in social work, summer 2022, 22(2) 456 ideally, students experience sense of belonging through interactions and connections with other students, support services, student organizations, faculty, and staff (baker & robnett, 2012). these interactions affirm that students are seen, cared about, and needed by others (strayhorn, 2019). connecting to peer groups and being able to share similar experiences enhances students’ sense of belonging (allen & alleman, 2019; means et al., 2016; mishra, 2020). however, many marginalized groups, such as students from racial and ethnic minority groups, older students, and students who identify as lgbtqia+, remain underrepresented on university campuses (means et al., 2016). the lack of representation of certain student populations poses a challenge for forming peer relationships and thus sense of belonging. this underrepresentation can influence sense of belonging, and consequently academic success. each of these demographic factors will be discussed next. sense of belonging among racial and ethnic minority groups a recent national study shows that graduation rates are significantly lower for hispanic (54%) and black (40%) students compared to their white counterparts (64%; national center for education statistics [nces], 2018). these graduation rates evidence a clear achievement gap for students of color, a point of concern that leads to the necessity of vital initiatives to support student success. one factor that may be contributing to this achievement gap is sense of belonging. students from racial and ethnic minority groups report a lower sense of belonging based on experiences and perceptions related to prejudice and representation (hurtado & ruiz, 2012) as well as social capital (hussain & jones, 2021; walton & cohen, 2007). research indicates that both students of color in general and black students specifically report a lower sense of belonging as compared to white students (duran et al., 2020; johnson et al., 2007). notably, this prior research focused on a variety of collegiate environments but did not focus on historically black colleges and universities (hbcus). this suggests that institutional commitment to diversity is essential to the cultivation of sense of belonging among students of color (hurtado & guillermowann, 2013; hurtado & ruiz, 2012; hussain & jones, 2021). sense of belonging among students who identify as lgbtqia+ a strong sense of belonging is also a critical aspect to success for students who identify as lgbtqia+ (garvey et al., 2017). on college campuses, lgbtqia+ students must cope with a unique set of challenges related to family background, sense of belonging, and financial hardship (vaccaro, 2012). beyond navigating academic and financial challenges, lgbtqia+ students may also encounter harassment, social isolation, and physical and sexual violence within the campus community (kellerman & krauss, 2018). these challenges, including students’ compromised sense of belonging, are directly related to lgbtqia+ student success (vaccaro, 2012). averitt et al./intersection of sense of belonging 457 sense of belonging among older students the number of older students attending colleges has increased; however, the majority of college students remain in their 20’s (ellis, 2019; mcgivney, 2004). only 26.6% of all college students in 2017 were over the age of 25 (nces, 2019). as a result of the relatively small number of older students on college campuses, social engagement opportunities for older students are often limited, thereby decreasing their sense of belonging and level of social support (simi & matusitz, 2016). sense of belonging among students experiencing financial hardship academic outcomes, including successfully obtaining an undergraduate degree, are associated with students’ family background and financial status (krueger et al., 2019; witteveen & attewell, 2017). family background influences college students’ financial status, as well as their foundational knowledge, capital resources, and social and cultural connections (allen & alleman, 2019; baker & robnett, 2012; diehl et al., 2019; hout, 2012; witteveen & attewell, 2017, 2020). differing social capital results in financial hardship and provides a disadvantage for students from a lower ses (baker & robnett, 2012), as navigation of family and community connections is an inherent privilege for students from a higher ses. students from those privileged backgrounds may access tacit advantages and assets, including more rigorous academic preparation (yee, 2016), fewer financial constraints (allen & alleman, 2019), and increasing responsible financial behaviors that influence adjustment to the university community (cole et al., 2014; hout, 2012; shim et al., 2013). these students are less likely to experience financial hardship and more likely to be engaged in various ways, including active communication with faculty and staff as well as utilization of campus resources (yee, 2016). on the other hand, students from lower ses are more likely to experience financial hardship, live off-campus, attend classes part-time, and work full-time jobs (stebleton, et al., 2014a). family background, along with restricted economic resources and financial concerns, contributes to a broad range of academic outcomes, such as diminished grades, attendance, and graduation rates (witteveen & attewell, 2017; yee, 2016). furthermore, experiences of financial hardship are dynamically tied to students’ sense of belonging, influencing their ability to adjust socially and academically to higher education (soria & stebleton, 2013). consequently, experiences of financial hardship, sense of belonging, and academic outcomes are all interconnected (means & pyne, 2017). an exploration of financial hardship among students must include careful attention to food insecurity, as students are likely to experience both challenges concurrently. the past decade has contained an array of university initiatives to address food insecurity, including increased public attention and the development of and reliance upon university food pantries as regular sources of food for students (feeding america, 2011; schroeder & smaldone, 2015). in a recent national assessment of college students’ basic needs, 45% of respondents reported that they experienced food insecurity over the prior 30 days (goldrick-rab et al., 2019). students from low-income families, students from firstgeneration families, and students of color all experience decreased opportunities to access advances in social work, summer 2022, 22(2) 458 higher education due to a confluence of social mobility factors including college affordability (us doe, 2016a). college students who experience food insecurity are at increased risk of lower academic performance (morris et al., 2016). the core of this issue seems to be a financial hardship, as the cause of both the food insecurity challenges experienced by students and as related to sense of belonging in the university community. literature on the relationship between financial hardship and sense of belonging is sparse. in an effort to add to this body of literature, the current study seeks to examine two research questions: (1) how does sense of belonging differ for students who have and who have not experienced financial hardship; and (2) what is the relative contribution of financial hardship in predicting sense of belonging when controlling for other demographic variables? method research design and procedure this irb approved, cross-sectional study examined students’ sense of belonging at one regional, midwestern university—northern kentucky university-in 2019. specifically, the purpose of this study was to examine the relationship between sense of belonging and financial hardship by comparing the sense of belonging between students who experienced financial hardship and students who did not experience financial hardship. these survey items were one component of a larger campus climate survey administered through qualtrics. this study hypothesized that students with financial hardship would have a lower sense of belonging as compared to their financially secure counterparts. a self-report, 15-20 minute electronic survey was used to measure overall campus climate. to encourage participation, an announcement email was sent out to all students via the university president’s listserv. this email informed students that they would be receiving an invitation to participate in the campus climate survey the following week. the survey link was subsequently emailed out twice, with one week between each email. the emails informed students that participation was voluntary and confidential. in addition, the email informed students that they could choose to be entered into a drawing for a $50 gift card if they participated in the study. after completion of data collection, a total of 10 email addresses were randomly selected to receive the $50 gift cards. in order to protect the confidentiality of the participants, no internet protocol (ip) addresses were collected. after emailing the survey link twice within a two-week data collection period, survey data were collected from 958 students from the total spring 2019 student population of 14,795 (northern kentucky university [nku], 2020). this translates to a 6.5% response rate, which is fairly typical for online campus climate surveys (e.g., de heer & jones, 2017; johnson et al., 2014). measures the self-report survey used in this study was created specifically for the purposes of this study. a multidisciplinary team of 18 university students, faculty, and staff created the averitt et al./intersection of sense of belonging 459 survey. the survey contains demographic variables including age, gender, sexual orientation, ethnicity, and financial hardship. additionally, the survey includes 46 campus climate items. participants were asked to respond to these items using a 4-point likert scale (1=strongly disagree; 4=strongly agree). as displayed in table 1, the 46-item campus climate scale contains four subscales/dimensions of campus climate. these subscales were created based on a factor analysis, and in-depth discussion of the multidisciplinary team pertaining to the theoretical construct of campus climate and sub-constructs contained within. the use of a factor analysis was indicated by a kaiser-meyer-olkin (kmo) value of .936 (factor analysis is useful if kmo value is greater than 0.50) and a bartlett’s test of sphericity p-value of .000 (factor analysis is indicated if significance level < 0.05; ibm knowledge center, 2021). the factor analysis revealed 2 primary factors; however, within factor 1, the multidisciplinary team identified 3 sub-constructs of campus climate. this then resulted in four total subscales: (1) respectful and fair treatment (loaded on factor 1); (2) sense of belonging (loaded on factor 1); (3) commitment to diversity (loaded on factor 1); and (4) inequitable treatment (loaded on factor 2). since the findings from this study focus specifically on the sense of belonging subscale, the factor loadings for each of the items in this scale are also provided in table 3. reliability analyses were also conducted for each of the subscales. the number of items in each subscale and the internal consistency reliability of each subscale are detailed in table 1. this psychometric data suggests that the subscales’ reliability ranges from acceptable (α > .7) to excellent (α > .9; royse, 2020). table 1. psychometric data for campus climate subscales subscales no. of items cronbach’s α respectful and fair treatment 20 .952 sense of belonging 11 .770 commitment to diversity 3 .892 inequitable treatment 12 .963 sense of belonging measure sense of belonging was measured using the above-described 11-item sense of belonging scale. this scale is created by calculating the simple mean of the 11 items. a list of the items contained in this scale is provided in table 2. the reliability analysis and factor analysis outlined in the prior section provide initial support for the reliability and validity of this scale. the principal components analysis revealed the presence of 3 items with eigenvalues exceeding 1, explaining 31.8%, 14.8%, and 9.3% of the variance respectively. aside from measuring sense of belonging with this scale, this study also measured sense of belonging using one single survey item. this item asked participants to indicate their level of agreement (on a four-point scale) with “i feel as though i belong at northern kentucky university”. averitt et al./intersection of sense of belonging 460 table 2. sense of belonging: a comparison of students with and without financial hardship using the mann-whitney u test sense of belonging financial hardship u p effect size (cohen’s d) factor loading no yes n mean rank n mean rank entire subscale 342 376.09 357 325 52123 .001** 0.13 individual items prejudice among faculty/staff is a problem on campus. 404 389.04 436 449.65 75360 <.001*** 0.14 0.670 prejudice among students is a problem on campus. 404 390.96 437 448.77 76137 <.001*** 0.13 0.767 i feel safe being on campus. 408 454.02 437 394.03 76490 <.001*** 0.14 0.540 i feel i need to minimize various characteristics (i.e. language, dress, sexual orientation) to be able to fit in at northern kentucky university. 384 363.30 410 429.53 65588 <.001*** 0.16 0.680 i am comfortable being with people whose backgrounds are different from my own. 384 388.74 410 405.70 75356 .209 0.310 i am comfortable saying what i think about issues faced by minority and/or oppressed groups. 382 382.56 411 410.42 72984 .067 0.351 my interactions with others since coming to northern kentucky university have led me to become more openminded. 369 377.97 386 378.03 71206 .997 0.313 people who consider themselves part of an underrepresented group on campus do not experience any fear related to their minority status. 361 391.90 382 353.19 61766 .009** 0.10 0.523 underrepresented groups experience negative consequences as a result of their identity. 358 346.30 382 393.18 59713 .002** 0.12 0.571 i feel as though i belong at northern kentucky university. 356 380.70 366 342.83 58314 .007** 0.10 0.600 i feel i need to hide parts of my identity in order to be accepted within the campus community. 355 343.95 366 377.53 58914 .022* 0.09 0.654 *p<0.05; **p<0.01; ***p<0.001 advances in social work, summer 2022, 22(2) 461 financial hardship measure participants were asked to share whether they had experienced 6 different indicators of financial hardship, via yes/no response options. a list of the items contained in this scale is provided in table 2. these items were: (1) “i have been hungry at least once in the past week and was unable to buy food for myself”; (2) “within the past year, i couldn’t afford to eat balanced meals”; (3) “within the past year, i have struggled to find a stable place to sleep during the school year and/or during holiday breaks”; (4) “within the past year, i have struggled with paying my monthly bills”; (5) “within the past year, i have received some form of government assistance”; and, (6) “within the past year, i have qualified for need-based financial aid to pay for my college education.” for the purpose of this study, if a participant responded “yes” to experiencing at least one of these indicators, then they were categorized as having experienced financial hardship. in addition, the sum of these six indicators was calculated to assess the extent to which a student was experiencing financial hardship. a factor analysis was conducted to examine the validity of this financial hardship measure. the use of a factor analysis was indicated by a kmo value of .708 (factor analysis is useful if kmo value is greater than 0.50) and a bartlett’s test of sphericity p-value of <.001 (factor analysis is indicated if significance level < 0.05; ibm knowledge center, 2021). the principal components analysis revealed the presence of 2 items with eigenvalues exceeding 1, explaining 37.8% and 18.4% of the variance respectively. the factor analysis revealed 1 primary factor. the factor loadings for each of the 6 items are provided in table 2. data analysis data were compiled and analyzed using spss version 24 computer software. descriptive statistics were used to examine demographic variables. subsequently, mannwhitney u tests were used to examine group differences in sense of belonging between students who are and who are not experiencing financial hardship. finally, in an effort to examine the relative explanatory significance of financial hardship and demographic variables, hierarchical regressions were conducted. findings significant at the .05 level are reported. findings descriptive statistics: sample demographics and financial hardship data were collected from 958 students enrolled at one midwestern university. most of the student participants (85% [n = 816]) identified as undergraduate, while 15% (n = 142) of the participants identified as graduate students. the mean age of participants was 23, with a range from 17 to 80. the majority of participants identified as caucasian (81.2% [n=774]), while 8.6% (n=82) identified as african american, 1.7% (n=16) identified as latino/hispanic, 3.3% (n=31) identified as asian, and 5.2% (n=50) identified as other. in advances in social work, summer 2022, 22(2) 462 terms of gender, 68.2% (n=651) of participants identified as female, while the remaining 29% (n=276) and 2.8% (n=27) identified as male and other respectively. for sexual orientation, 76.6% (n=731) of participants identified as heterosexual; 4.8% (n=46) as lesbian, gay, or homosexual; 10.2% (n=97) as bisexual; and 8.4% (n=80) as other. these demographics are fairly comparable to the demographics of the overall student population at nku during the spring 2019 semester, though students of color and women are slightly overrepresented in this sample (nku, 2020). financial hardship was measured by asking participants whether they had experienced any of the 6 items listed in table 3. the prevalence with which students experienced each indicator of financial hardship is depicted in table 2. within this sample, 48% (n=460) of participants reported experiencing at least one of these forms of financial hardship. table 3. indicators of financial hardship financial hardship items n (%) factor loading i have been hungry at least once in the past week and was unable to buy food for myself. 116 (12.1%) 0.676 within the past year, i couldn’t afford to eat balanced meals. 189 (19.7%) 0.773 within the past year, i have struggled to find a stable place to sleep during the school year and/or during holiday breaks. 34 (3.5%) 0.485 within the past year, i have struggled with paying my monthly bills. 245 (25.6%) 0.698 within the past year, i have received some form of government assistance (e.g., food stamps, medicaid, ssi, health care subsidies, wic). 99 (10.3%) 0.443 within the past year, i have qualified for need-based financial aid to pay for my college education. 267 (27.9%) 0.519 indicated experiencing at least one of the above indicators of financial hardship 460 (48%) it is also important to look at the extent of financial hardship experienced by the students in this sample. this was accomplished by examining how many different indicators of financial hardship students experienced. over half (52%) of students (n = 498) didn’t experience any of the indicators of financial hardship; 19.8% (n = 190) reported experiencing one of the indicators; 13.5% (n = 129) experienced 2 indicators; 8.6% (n = 82) experienced 3 indicators; 4.5% (n = 43) experienced 4 indicators; 1.3% (n = 12) experienced 5 indicators; and 0.4% (n = 4) experienced all 6 indicators. relationship between variables: financial hardship and sense of belonging the median values indicated that those with financial hardship scored lower on the sense of belonging scale (mdn = 3) than those not reporting financial hardship (mdn = 3.09). mann-whitney u tests were conducted to further examine the differences in sense of belonging for students who have and have not experienced financial hardship. the mannaveritt et al./intersection of sense of belonging 463 whitney u test was selected over independent samples t-tests due to the lack of a normal distribution within the variables. the findings from the mann-whitney u, which are displayed in table 3, indicate statistically significant group differences for 8 out of the 11 items on the sense of belonging scale. it should be noted, however, that the effect sizes are very small, as can be seen in table 3 (cohen, 1988). the items with significant findings include: • prejudice among faculty/staff is a problem on campus. • prejudice among students is a problem on campus. • i feel safe being on campus. • i feel i need to minimize various characteristics (i.e., language, dress, sexual orientation) to be able to fit in at northern kentucky university. • people who consider themselves part of an underrepresented group on campus do not experience any fear related to their minority status. • underrepresented groups experience negative consequences as a result of their identity. • i feel i need to hide parts of my identity in order to be accepted within the campus community • i feel as though i belong at northern kentucky university. findings from the mann-whitney u then suggest that individuals experiencing financial hardship have less favorable perceptions of sense of belonging, but that this relationship is not very strong. relative contribution of financial hardship to the prediction of sense of belonging as was noted in the literature review section of this manuscript, demographic variables have been found to impact students’ sense of belonging. in order to determine the relative explanatory significance of these demographic factors and of financial hardship, hierarchical regressions were conducted. in particular, 2 hierarchical regressions were completed, one for the sense of belonging scale, and one of the single sense of belonging item (“i feel as though i belong at northern kentucky university”). these hierarchical regressions are provided in tables 4 and 5 respectively. each hierarchical regression consists of 2 models: • the first model includes the demographic variables that were deemed relevant in the literature (gender, sexual orientation, ethnicity, and age). • the second model includes the demographic variables from model 1, as well as the financial hardship variable. by conducting these hierarchical regressions, it can be determined whether the addition of the financial hardship variable improves the models’ ability to predict sense of belonging. further, the regressions indicate the relative explanatory significance of each variable. the hierarchical regressions are outlined in detail below. the main findings of these regressions show that, when taking into account the demographic variables, financial hardship is a significant predictor of students’ sense of belonging. advances in social work, summer 2022, 22(2) 464 table 4. summary of hierarchical regression analysis for variables predicting sense of belonging scale model 1 model 2 unstandardized coefficients β t unstandardized coefficients β t b se b se constant 3.168 .071 44.660*** 3.182 .071 44.910*** gender -.024 .043 -.025 -.573 -.015 .043 -.015 -.352 sexual orientation -.048 .045 -.046 -1.070 -.030 .046 -.028 -.660 age .000 .002 -.004 -.084 .000 .002 .003 .075 ethnicity -.206 .048 -.182 -4.289*** -.188 .048 -.166 -3.877*** financial hardship -.034 .014 -.106 -2.415* r2 .037 .047 f 5.100*** 5.284*** *p<0.05; **p<0.01; ***p<0.001; note: dummy variables are coded as follows gender: male 0 female 1; sexual orientation: heterosexual 0 lgbtq 1; ethnicity: caucasian 0 ethnic minority 1. financial hardship is a ratio level variable with 0 indicating that the student didn’t experience any of the 6 indicators of financial hardship, and 6 indicating that the student experienced all 6 of the indicators of financial hardship. table 5. summary of hierarchical regression analysis for variables predicting sense of belonging item model 1 model 2 unstandardized coefficients β t unstandardized coefficients β t b se b se constant 3.375 .120 28.041*** 3.402 .121 28.201*** gender -.044 .074 -.025 -.592 -.031 .074 -.018 -.412 sexual orientation -.034 .079 -.018 -.435 -.006 .080 -.003 -.072 age -.002 .004 -.021 -.495 -.002 .004 -.018 -.413 ethnicity -.220 .083 -.113 -2.660** -.191 .084 -.097 -2.275* financial hardship -.053 .025 -.093 -2.134* r2 .014 .022 f 1.988 2.511* *p<0.05; **p<0.01; ***p<0.001; note: dummy variables are coded as follows gender: male 0 female 1; sexual orientation: heterosexual 0 lgbtq 1; ethnicity: caucasian 0 ethnic minority 1. financial hardship is a ratio level variable with 0 indicating that the student didn’t experience any of the 6 indicators of financial hardship, and 6 indicating that the student experienced all 6 of the indicators of financial hardship. averitt et al./intersection of sense of belonging 465 hierarchical regression: sense of belonging subscale the linear regressions revealed that model 1 and model 2 were both significant (see table 4). within model 1, ethnicity was the only significant predictor of sense of belonging, with ethnic minorities reporting a lower sense of belonging. in model 2, this demographic variable remained a significant predictor. furthermore, financial hardship was also a significant predictor, with higher levels of financial hardship resulting in lower levels of sense of belonging. the addition of the financial hardship variable improved the model. hierarchical regression: sense of belonging single item (“i feel as though i belong at northern kentucky university”) as was the case with the previous hierarchical regression, the linear regressions revealed that the models were significant (see table 5). within model 1, ethnicity was a significant predictor of sense of belonging, with ethnic minorities reporting a lower sense of belonging. in model 2, ethnicity remained a significant predictor. the addition of the financial hardship variable improved the model. financial hardship was also a significant predictor of sense of belonging, with greater financial hardship resulting in a lower sense of belonging. discussion students with a strong sense of belonging are more likely to achieve higher grades (mishra, 2020), intend to persist, and to actually persist to graduation (stebleton et al., 2014b). students' sense of belonging is vulnerable to influence by peer interactions, especially as many communities remain underrepresented on campuses. students from families with lower ses, students from racial and ethnic minority groups, older students, and students who identify as lgbtqia+ are all underrepresented on college campuses (means et al., 2016). this lack of representation impacts perceptions of sense of belonging as related to peer groups and experiences (allen & alleman, 2019; means et al., 2016). past research suggests that sense of belonging may be a challenge for students of lower ses (goplanan & brady, 2020). this study sought to investigate the impact of financial hardship on students’ sense of belonging at one midwestern university and examined the intersections of demographic factors, financial hardship, and sense of belonging among university students. the findings from this study indicated that approximately half of participants experienced some form of financial hardship. it is noteworthy that approximately one-fifth of participants reported food insecurity, one-fourth struggled to pay their monthly bills, another one-fourth qualified for need-based college financial aid, and one-tenth qualified for government assistance. the findings also revealed that students with financial hardship reported a significantly lower sense of belonging than their counterparts without financial hardship. although the results were statistically significant, the small effect sizes indicate that these differences advances in social work, summer 2022, 22(2) 466 may not be of practical significance. when examining the relative contributions of financial hardship and various demographic factors in predicting sense of belonging, it was found that race/ethnicity and financial hardship were significant predictors of students’ sense of belonging, with ethnic minority status and financial hardship predicting a less favorable sense of belonging. there are two particular points of significance in these findings. first, they demonstrate the relative importance of financial hardship as a predictive factor in students’ sense of belonging on a university campus. and second, these findings suggest that students’ sense of belonging can be impacted simultaneously by several demographic factors. for instance, students who identify themselves as a racial/ethnic minority and are experiencing financial hardship may report a particularly low sense of belonging. this leads to intersectionality, which is the experience of multiple layers of oppression and marginalization (crenshaw, 1991). as a profession that focuses on serving marginalized people, social work is responsible to serve students who experience intersectionality of oppression within the university community. it is noteworthy that, within this study, gender, sexual orientation, and age were not predictors of sense of belonging. it is unclear why these demographic factors were not predictors. the literature on these demographic factors’ impact on sense of belonging is less developed. while quite a few studies have clearly shown that race/ethnicity impacts sense of belonging, fewer studies have examined the impact of gender, sexual orientation, and age on sense of belonging. one possible explanation for why these demographics were not predictors in this study could be related to the effectiveness with which nku serves these demographic groups. nku, for instance, has received national recognition for its lgbtqia+ programs and services. in addition, nku has extensive programming specifically for adult/non-traditional students. perhaps these services have been more effective at promoting an inclusive and welcoming environment for older students and lgbtqia+ students than the university’s efforts to create an inclusive and welcoming environment for our ethnic/racially diverse students. additional research is warranted at nku and across university campuses to better understand the relationship between sense of belonging and these demographic variables. limitations this research is based on data collected solely from students at one university. student participants may have self-selected based on investment in the topics, existing commitment to the university community, and overall time availability. students with many competing time commitments may have been less apt to participate. this then resulted in a biased sample that lacks normal distribution. data were also collected using a newly created scale, which therefore lacked pre-existing psychometric data. additionally, the self-reported perceptions may have been influenced by social desirability. the results are also limited by the small effect sizes and small r-squared. given the limitations, the findings must be viewed as a limited, initial contribution to the state of knowledge. averitt et al./intersection of sense of belonging 467 implications for the social work profession students’ sense of belonging provides a useful framework for understanding the experiences of low-income students, and then exploring related outcomes and success measures. although each student is a unique individual with varied and multifaceted experiences, money is frequently identified by students as a foundational requirement to participate in an “ordinary college experience” (nguyen & herron, 2021, p. 434). while the findings from this study suggest that there is only a minor association between financial hardship and sense of belonging, the findings certainly suggest that further exploration is warranted, both in terms of the impact of financial hardship on sense of belonging, as well as the impact of alternate factors on sense of belonging. additionally, larger scale, more geographically diverse research studies are needed to further examine the impact of financial hardship on sense of belonging. if future research provides additional support for this relationship, then there are several implications for universities, particularly for social work practitioners and educators on campus. first, it is essential that colleges and universities provide various support services for students experiencing financial hardship. student support services should include options for free food and toiletries such as (masked pantry name) in order to support well-being and cultivate sense of belonging. due to increasing awareness of food insecurity among college students, food pantries have recently become increasingly visible on university campuses (goldrick-rab et al., 2018). over 700 university food pantries are currently registered with the college and university food bank alliance (cufba; 2020). these types of support are intended to improve the persistence of students toward long-term positive benefits. university food pantries must actively engage in awareness and continued outreach initiatives to combat negative perceptions among students, as many students experiencing financial hardship will otherwise avoid accessing available services due to perceptions of stigma (dubick et al., 2016). creating welcoming environments to increase access and utilization of the pantries is essential in encouraging sense of belonging. universities may use innovative strategies to improve service awareness on campus and expand pantry hours (el zein et al., 2018). aside from providing immediate access to free food, pantries could also provide case management services. these services could focus on connecting students with on and off-campus resources that may provide immediate and long-term relief from students’ financial hardship. social work professionals on campus are particularly suited to advocate for these needs because of the knowledge of available services in the community as well as the professional network they possess. second, it is also essential that universities provide prevention measures such as helping students manage their student loans (mckinney et al., 2014). these strategies could include solicitation of grants, scholarships, or apprenticeships. finally, universities should have thorough knowledge of their students' financial struggles and innovate ways to access needed resources, such as providing tax services and financial advising through community partnerships (chaplot et al., 2015). all of these measures will directly address the noted challenge of financial hardship and ses, while also supporting a sense of belonging among vulnerable student populations. advances in social work, summer 2022, 22(2) 468 additionally, universities can encourage students to maintain their cultural identity and improve sense of belonging by practicing cultural responsiveness through providing culturally validating environments, cultural community services, and cross-cultural engagements (musues et al., 2017). further, campus support services, such as ethnic student organizations as well as lgbtqia+ affirming campus resources, can nourish an institutional subculture with positive impacts on sense of belonging for students (hong et al., 2016; museus, 2008). conclusion this study revealed that more than half of the student participants experienced financial hardship; and among them, sense of belonging was significantly lower as compared to their counterparts. the findings also demonstrate the relative importance of financial hardship as a predictor of students’ sense of belonging along with race/ethnicity. based on past research, it is reasonable to then conclude that academic success is connected to both sense of belonging and financial status of students, as experiences of financial hardship negatively impact sense of belonging within university communities. the recruitment, retention, and persistence of a diverse student community, therefore, depends, to an extent, on the availability of various support services for students experiencing financial hardship. this project highlights an open opportunity for social work educators to develop student support services that then connect to student field placement experiences. through oncampus student support services, such as campus food pantries, social work educators can both train social work students in practicum placements and create a supportive campus community for students in need. social work faculty and practitioners on campus are urged to advocate for and provide 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(2017). family background and earnings inequality among college graduates. social forces, 95(4), 15391576. https://doi.org/10.1093/sf/sow109 wittiven, d., & attewell, p. (2020). reconsidering the ‘meritocratic power of a college degree.’ research in social stratification and mobility, 66, 1-14. https://doi.org/10.1016/j.rssm.2020.100479 yee, a. (2016). the unwritten rules of engagement: social class differences in undergraduates’ academic strategies. journal of higher education, 87, 831-858. https://doi.org/10.1080/00221546.2016.11780889 author note: address correspondence to jessica averitt taylor, professor, school of social work, northern kentucky university, highland heights, kentucky 41099. email: taylorj28@nku.edu https://doi.org/10.1093/sf/sow109 https://doi.org/10.1016/j.rssm.2020.100479 https://doi.org/10.1080/00221546.2016.11780889 mailto:taylorj28@nku.edu _________ hye-kyung kang, phd, msw, associate professor, department of social work, seattle university, seattle, wa copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 360-388, doi: 10.18060/24953 this work is licensed under a creative commons attribution 4.0 international license. re-envisioning social work education: building and living a social justicefocused clinical social work curriculum hye-kyung kang abstract: social justice is a central principle of the social work profession and education. however, it can become a hollow ideal unless it is specifically addressed in all applications of social work practice. scholars have long questioned the social work profession’s commitment to putting social justice into practice. clinical social work has been particularly criticized for its lack of attention to social justice and for failing to address the concerns of the oppressed by relying on individual intervention while overlooking system-level changes. given that clinical social work is the largest specialization in social work practice, clinical social work programs must re-envision their curriculum to fully address this criticism and educate future social workers to pursue social justice at all levels of practice. this paper presents the collective work of the social work faculty at a clinical social work program to construct a social justice-focused clinical social work curriculum, which culminated in a statement on social justice commitment in their curriculum, illustrates the iterative process of this work, and discusses the lessons from this experience. implications include the importance of shared understanding of social justice and articulating how it operates in all aspects of social work practice as well as in social work pedagogy. keywords: social justice, social work education, clinical social work, social work curriculum social justice is a central principle of the social work profession and education (council on social work education [cswe], 2015; international federation of social workers [ifsw], 2018; national association of social workers [nasw], 2021). however, scholars have long questioned the profession’s commitment to putting social justice values into practice (bowles & hopps, 2014; corley & young, 2018; mclaughlin, 2009; schiele & hopps, 2009). clinical social work has been particularly criticized for its lack of attention to social justice and for failing to address the concerns of the oppressed (mclaughlin, 2009). one prominent criticism of clinical social work is that it often relies on individual intervention and fails to take on system-level changes or advocacy (apgar, 2020; corley & young, 2018; epple, 2007). despite the criticism, clinical social workers do consider social justice as essential to clinical practice and recognize the connection between social justice, advocacy, and clinical practice (mclaughlin, 2009; varghese & kang, 2019). however, extant research on clinical social workers’ engagement in advocacy indicate that social workers spend little time for advocacy in practice (mclaughlin, 2009). there are many external barriers to clinical social workers’ engagement in advocacy, such as rigid organizational structures, constricting job descriptions, and experiences of marginalization within organizations when social workers do engage in advocacy (mclaughlin, 2009). another barrier seems about:blank kang/re-envisioning swk education 361 to be internal. some clinical social workers in mclaughlin’s study were concerned about social justice advocacy taking the focus off individual clients. this concern evokes the historical macro-micro tension of the social work profession where micro and macro practices are conceptualized as separate domains, creating a false binary for social workers (epple, 2007; apgar, 2020). one contributor to this false binary seems to be that practice models and frameworks do not prepare for social work students and practitioners to make a clear link between clinical practice and social justice (mclaughlin, 2009). in fact, one of the most frequent questions that social work faculty receive from social work students is how to apply social justice values in practice at their practicum. students and practitioners often complain that their clinical supervisors are not apt to explain how their agency work connects to social justice (garran et al., 2022). this phenomenon is puzzling since social work scholars and practitioners have been making specific efforts to promote social justice in clinical practice (e.g., asakura et al., 2020; fook, 2016; harrison et al., 2016; kang, 2013; mclaughlin, 2011; morgaine & capous-desyllas, 2014; parker, 2003; swenson, 1998; varghese & kang, 2019). one contributor to this challenge may be the ways in which social justice and advocacy are taught in the social work curriculum. often, social justice is taught in stand-alone courses and advocacy is confined to macro practice courses; they are not fully integrated into clinical courses and the clinical social work curriculum (mclaughlin, 2009; mehrotra et al., 2017). given that clinical social work is the largest specialization in social work practice (apgar, 2020), clinical social work programs and educators must re-envision their curriculum to fully address this criticism and educate future social workers to specifically integrate social justice at all levels (micro, mezzo, macro) of intervention. authors such as apgar (2020), corley and young (2018), epple (2007) and mclaughlin (2009) call for recognizing the interdependence between clinical practice and social justice and situating advocacy as an integral part of clinical social work. the seattle university (su) social work department faculty is answering this call to action by creating a clinical social work curriculum that integrates a clearly delineated set of social justice principles across all courses, taught by all instructors. in the following sections, the collective work of the su social work faculty to construct a social justicefocused clinical social work curriculum, which culminated in a departmental statement on social justice commitment, is presented, and the iterative process of this work is described. the lessons from building and “living” a social justice-focused clinical social work curriculum and implications for social work education are shared. process the su social work department faculty had a unique opportunity to re-envision a clinical social work program from a social justice focused and community-based perspective when creating a new msw program in 2015. reflecting the social justice principle of the social work profession and the need for equitable clinical care in advances in social work, summer 2022, 22(2) 362 marginalized communities, the inaugural director (the author) proposed the following mission for the new program, which was enthusiastically adopted by the faculty in 2016: the mission of the su msw program is to educate students for social justicefocused and community-based advanced clinical social work practice. the program seeks to advance equity in access to excellent clinical social work practice for historically marginalized populations by preparing competent and effective practitioners who restore, maintain, and enhance human and community wellbeing with unwavering attention to social and economic justice. the program is committed to respectful engagement and collaboration with community partners in its scholarship, teaching, and service.(( seattle university master of social work program, n.d., para. 2) with this mission, the faculty engaged in steadfast work to re-envision clinical social work. this work took an iterative process where the faculty developed the clinical social work curriculum with an explicit focus on social justice, implemented the curriculum, engaged in regular discussions around what social justice-focused and community-based social work meant in application, and shared our continuous research and experience with one another as we revised the curriculum. when the bsw and msw programs transitioned out of an interdisciplinary department and established an independent department of social work in 2017 the department adopted an expanded department mission statement. while the initial focus was on the explicit curriculum, we also worked to develop the implicit curriculum and departmental policies and processes to be consistent with the social justice mission. this manuscript focuses on the explicit curriculum. the faculty recognized that this work must be done with intentional dedication of time and energy and that both the process and the product (curriculum) must reflect our social justice values. therefore, the faculty implemented the following meetings where all fulltime faculty participated (and part-time faculty were invited, but not required, to participate): 1) social justice meetings and retreats: two initial full-day retreat sessions followed by monthly meetings to continue to develop a shared conceptualization of social justice and to delineate how it is demonstrated in our curriculum and teaching, which culminated in the departmental statement on social justice commitment; 2) critical pedagogy meetings: monthly meetings to share how social justice is explicitly applied in each course so that faculty could build on one another’s classes to achieve vertical and horizontal integration of social justice in our curriculum; 3) critical pedagogy consultation sessions: informal meetings where professors can seek and receive consultation, feedback, coaching, and support from their department peers on classroom issues regarding power and privilege, equity, microaggressions, etc. (garran et al., 2014); and kang/re-envisioning swk education 363 4) assessment sessions: dedicated time at year-end retreats to assess how we are progressing on implementing our social justice commitment as a department (including reflection on the results of the student experience survey). these dedicated meetings served as opportunities for faculty to collaborate on the continuous process to develop, implement, analyze, reflect on, and revise the ways in which social justice is demonstrated in our syllabi, learning materials, application assignments, and teaching practices. such articulation of a shared conceptualization of social justice in the curriculum was essential, and “living” this conceptualization meant a process of constant evolution and mutual adaptation. the social work department grew from five full-time faculty to nine between 2016-2019. given our equity principle, we did not want the ideas of original five faculty to impose on the new faculty. as new faculty members joined the department, they contributed new perspectives, and faculty discussed, debated, expanded upon, and revised the social justice statement until consensus was reached. again, consistent with our equity principle, part-time faculty were not expected to take on extra workload such as participating in social justice meetings, and they typically did not attend them. to ensure that the implementation of the social justice-focused curriculum is consistent across the msw and bsw courses, the program director of each program discussed the social justice principles and their applications in particular courses with adjunct faculty. the msw curriculum was developed before the program launched and admitted students. however, since the program was launched the department regularly sought feedback from students through student experience surveys on diversity and social justice in our explicit and implicit curricula, which were analyzed and used for improvement and future planning. see table 1 in appendix for samples of student surveys. the msw program director also holds regular informal meetings (“director’s tea”) with msw students to gain their perspective and direct feedback throughout the academic year. in addition, the department seeks feedback and consultation on its explicit and implicit curricula (including educational policies) from community members through quarterly meetings with the community advisory committee and the practicum advisory board whose membership includes representatives from current students, alumni, practicum instructors, and community organizations. the feedback and consultation from students and community members are applied to continuous improvement of the msw curricula. finally, the department’s progress on social justice commitment (along with other educational outcomes) is reported yearly to the department’s community advisory committee members who serve as our accountability partners. social work department statement of commitment to social justice in our curriculum (seattle university dept of social work, 2020) the departmental statement of social justice commitment, adopted in september 2020, reflects our work since 2016; it explicates our conceptualization of social justice and illustrates how it is implemented in our curriculum and in our pedagogy. the statement, shared in its entirety here, is a collective work of the department faculty. advances in social work, summer 2022, 22(2) 364 our commitment the social work department is committed to educating students for social justicefocused social work practice by integrating a social justice lens throughout our undergraduate and graduate programs. all courses in our curriculum, rather than one or two designated “diversity” courses, examine issues of social justice. the department seeks to prepare competent and effective practitioners who restore, maintain, and enhance human and community well-being with unwavering attention to social and economic justice. as we do so, we integrate four central facets of social justice: (i) an equity lens, (ii) antioppressive analysis and practice, (iii) critical pedagogy (including multiple critical theories), and (iv) decolonizing framework. in this document, we introduce our definitions of social justice and explain how we incorporate it into our department. why social justice? the social work department’s commitment to social justice builds off the mission of seattle university (su). the university is committed to value-oriented education. su is committed to teaching, learning, and growth of the whole person through a process of formation for leadership to improve the well-being of others and work toward “a just and humane world” (seattle university master of social work program, n.d., why social justice, para. 1). the department prepares its students with knowledge, values, and skills to analyze social inequity and oppression in its manifest forms, and to seek systemic change as effective advocates for social and economic justice. in addition, the social work department’s focus on social justice is in keeping with the values of the social work profession: the purpose of the social work profession is to promote human and community well-being. guided by a person-in-environment framework, a global perspective, respect for human diversity, and knowledge based on scientific inquiry, the purpose of social work is actualized through its quest for social and economic justice, the prevention of conditions that limit human rights, the elimination of poverty, and the enhancement of the quality of life for all persons, locally and globally. (cswe, educational policy, 2015, 2015, p. 5) social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. social workers’ social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. these activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity. social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people. (nasw, code of ethics, 2008, preamble, para. 1) social workers have a responsibility to promote social justice, in relation to society generally, and in relation to the people with whom they work. this means: challenging negative discrimination… recognizing diversity… [and] distributing resources equitably. (ifsw, statement of ethical principles, 2018, p. 4) kang/re-envisioning swk education 365 justice is clearly an essential value of the social work profession and social work education; however, it can inadvertently become a hollow ideal unless it is specifically addressed in all applications of social work knowledge and skills. consequently, the concept of justice anchors the curriculum, and is central to the department’s mission. our conception of social justice introductory notes our bsw program prepares students for generalist practice while our msw program has a clinical specialization. the following ideas and plans about social justice will be applied in ways that correspond with the focus of each program. in addition, these definitions and goals may change as we continue to grow and learn and as we respond to changes to the higher education landscape, and changes in scholarly, socio-political, cultural, and activist thinking. this document is ever evolving, and it reflects our current thinking about the current landscape. as faculty, we are in process with this work. the following is an articulation of our goals and commitments. however, we are not there yet. our curriculum will be revised on an ongoing basis, and our faculty constantly strives to learn more, so that we can achieve the goals stated on the following pages. sometimes we succeed and sometimes we fail, but we continue trying. this is a lifetime of work, and we will not ever be done with it. we are always working to live up to the aspirational goals and values described in the following sections. finally, although this document focuses on our curriculum, we have also been incorporating a social justice analysis to the implicit (non-curricular) aspects of our program. this includes admission and enrollment, advising, course scheduling, hiring, mentoring, scholarships and allocation of resources, etc. our four-facet framework the social work department is committed to integrating a social justice lens throughout our programs. we understand social justice as a concept involving multiple dimensions. as such, we integrate four central facets of social justice: 1) an equity lens, 2) anti-oppressive analysis and practice, 3) critical pedagogy, and 4) decolonizing framework. social justice facet 1: equity lens in this department, the concept of justice is examined through the lens of equity, rather than equality. while equality guarantees equal rights and access under the law, it does not address the reality that some people need more than others,or have been denied equal access throughout history. on the other hand, equity is concerned with addressing need and restitution, rather than mere equality. equity requires equality under the law but also advances in social work, summer 2022, 22(2) 366 requires the remedying of material hardships. equity involves economic, political, social, and human rights and opportunities. our department operates from the assumption that social justice is not measured merely by legal equality or by simply an equal distribution of social and economic goods. yes, social justice includes legal equality and equal distribution of goods, but it also encompasses whether people are able to reach their full capacities, how decisions are made, which and whose perspectives are represented, and to what extent. consequently, seattle university’s social work department defines equity as consisting of four components: (a) distribution; (b) representation and recognition; (c) process and participation; and (d) capabilities. students in our department can expect to be required to interrogate these four concepts: distribution throughout history, many influential thinkers considered the distribution of wealth, resources, and goods to be a key component of social justice (reisch, 2002). distributive justice is the idea that resources should be distributed equally, and social and economic systems must be arranged and redistributed so that they most benefit the least advantaged members of society. consequently, systems of economic oppression or structural discrimination must be challenged in order to create social policies directed toward a more just distribution of social goods. poverty and economic inequality are the result of structural economic oppression and the systematically unequal distributions of resources. equity that is focused on distribution is based upon the redistribution of goods and resources as determined by need, rather than by class, merit, or identity. one example of how we utilize this aspect of equity can be seen in how we distribute scholarships to our students. in our department, scholarships are based upon need, rather than on merit, because too often merit is measured by criteria that are more easily achieved by students with resources. representation and recognition equity that is focused on issues of representation and recognition is concerned with how marginalized groups are treated in the public sphere (e.g., the media, literature, research, or the law), and whether/how they are granted access to certain social institutions (e.g., schools, marriage, public accommodations, voting, etc.). representation and recognition require full equality under the law for all social identity groups, as well as their fair, accurate, and multi-dimensional representation in cultural and educational domains. in the pursuit of social justice focused on representation and recognition, our department centralizes the concept of intersectionality. originating from black feminists such as patricia hill collins (2002), the combahee river collective (1977), kimberlé crenshaw (1989), bell hooks (1990), and audre lorde (1983), intersectionality requires the examination of any issue through the lens of multiple identity groups. feminists of color have argued that there are multiple oppressions, along lines of social identity groups such as gender, race, and class (as well as ability, age, citizenship, ethnicity, religion, and kang/re-envisioning swk education 367 sexual orientation). intersectionality posits, among other things, that it is impossible to understand any one experience of discrimination without understanding how it is impacted by all other systems of oppression and privilege (racism, capitalism, sexism, heterosexism, xenophobia, able-ism, etc.). an intersectional analysis recognizes that people have both advantages and disadvantages due to their locations in multiple systems of oppression. thus, they can receive privilege from their position in one system (e.g., racism), but be disadvantaged because of their position in another overlapping system (e.g., homophobia). true justice requires liberation from all of these oppressions, none of which can be assigned a place of primacy over the others. by virtue of their positions on society’s “margins,” certain groups have unique and important perspectives that must be centralized in social justice work. centering the margins is the process of prioritizing the needs of those people who have been marginalized. building off of the ideas of bell hooks (1990), many social justice activists engage in “trickle up social justice work,” which operates from the assumption that social justice trickles up, but it does not trickle down (defilippis & anderson-nathe, 2017; flanders, 2012). in other words, if policies are made with the intention of helping the most dominant members of society, the benefits rarely trickle down to also support the most marginalized. however, policies designed to help those at the margins usually trickle up and also provide benefits to those with more privilege. centering the margins is the commitment to serving everyone by prioritizing the needs of those placed at the bottom of structural hierarchies. one example of how we operationalize this aspect of equity is through our commitment to representational equity in our curriculum. at least 50% of the learning materials in all social work classes (and other classes designed by social work faculty) will reflect nondominant perspectives, knowledge and authorship of people of color, and/or knowledge and authorship of other marginalized populations. process and participation we believe that equity cannot be measured only by outcomes, but also by the systems of process and participation that lead to the outcomes. equity that is focused on process and participation draws from long-standing notions (going back at least to jean-jacques rousseau, 1762/1993) that the people must come together to function and legislate as a collective, and that decision-making must be made by the people, not the elite. to do this, equity efforts must focus on increasing the ability of subordinated groups to access power and control in all areas of society. social justice requires a society where all people have access to, and control of, various systems and institutions, such as voting, government, education, media, economics, social services, etc. examples of how we operationalize this aspect of equity can be seen in various courses taught at the undergraduate and graduate level. in the community practice course, learning activities are designed so that students work on community development or organizing issues in collaboration with community partners. community partners determine the issue that they would like students to understand and collaborate on, develop collaborative learning/project work plans that are mutually useful to the community and the students’ advances in social work, summer 2022, 22(2) 368 learning, and help evaluate and/or reflect on the project. such assignments provide pertinent opportunities for students to deepen their engagement with the community in the learning process. in the program evaluation course, students work on an impact evaluation for a selected agency using community-based research methodologies. in the policy courses, students get an opportunity to participate in advocacy and lobby events, such as the nasw lobby day. capabilities we also believe that equity requires that all individuals be able to live up to their own capabilities. we draw on the ideas of amartya sen (1985, 2011), martha nussbaum (2003), and others who examine social justice through the lens of capabilities. capabilities can be described as the opportunities that an individual has in order to achieve their fullest potential or do what they believe adds value to their own life. these capabilities are impacted by social, political, economic, and cultural structures that individuals are embedded in and interact with. we believe this framework is connected to the social work value (described in the nasw code of ethics) of the dignity and worth of all people. social workers promote clients’ self-determination and seek to enhance clients’ capacity to change and to address their own needs. because of this, we believe that social justice requires the need for all individuals and communities to get equitable opportunities to reach their full potential. with our department, we operationalize this aspect of equity in our pedagogical framework as well as the contents that we teach the students. for example, all professors utilize a diverse set of teaching tools and close mentorship so that students from all backgrounds and learning styles can be supported to achieve their fullest potential. in addition to this, our hallmark course on social justice ensures that students understand the inequities at micro, mezzo, and macro levels, and how it impacts an individual or community’s ability to access opportunities to achieve well-being. our department defines equity in all four of these ways, and we believe that without a careful and critical investigation of the mechanisms and sources of inequity in distribution, representation and recognition, process and participation, and capabilities, inequities may go unnoticed. or worse, inequities may be blamed on the marginalized. as are result of the above, we are committed to teaching about social justice in ways that: • look beyond the usual questions of diversity and equality, to examine the more complex issues of distribution, representation and recognition, process and participation, and capabilities; • emphasize and explore equity (including all of the above dimensions of equity) in the classroom discussions, readings, assignments, and through field practice. kang/re-envisioning swk education 369 social justice facet 2: anti-oppressive analysis and practice. we begin with an anti-oppressive analysis. our understanding of social justice includes a critical anti-oppressive analysis (morgaine & capous-desyllas, 2014). an anti-oppressive curriculum examines the dynamics of power that produce economic oppression (poverty, homelessness, exploitation, and class disparities) as well as inequities, discrimination, and oppression based upon identity (race, gender, ability, immigration status, religion, sexuality, etc.). our department is committed to respect for diversity, and to considering the impact of human diversity and intersectionality on human development and functioning. to prepare students for practice with diverse individuals, families, groups, organizations, and communities, the department emphasizes a critical consideration of the impact of intersectionality on human development and functioning, and the social work practice setting. an anti-oppressive analysis emphasizes the consequences of structural injustice and socioeconomic oppression on the lives of vulnerable populations, and the importance of equity-based practice. such an analysis must centralize the historical, economic, and structural contexts that produce oppression. see tables 2-4 in appendix for examples of assignments. as a result of this analysis, we are committed to the following as we teach students how to engage in social work practice: in the classroom and in the field, we educate students to bring an anti-oppressive analysis into their practice. anti-oppressive practice (aop) requires the social work practitioner to critically examine the various power imbalances that are found in society, within organizational structures, and between the social worker and their clients. aop requires that social workers strategize ways to diminish all three of those power imbalances, promoting equity and empowerment for their clients in all contexts. the department emphasizes the interconnection between individual struggles, structural inequalities, and historical oppression. we also emphasize how those struggles are connected to human diversity and intersectionality. all of these areas of study must be integrated in order to understand human development and functioning, and to engage in empowering practice. a vital aspect of aop is critical analysis of client and social worker relationship. building on the concept of critical reflexivity (d’cruz et al., 2007; fook, 2016; lay & mcguire, 2010), social workers are compelled to locate themselves and their clients within the larger sociopolitical and historical dynamics of power in analyzing and understanding not only the client-worker interactions but also the interactions between the worker, the client, and the larger systems (including organizations and social and economic policies). from the basis of that critical analysis social workers are called to co-create, with clients, interventions that consider changes at all (micro, mezzo, macro) levels. we train our students to think critically about both the strengths and limitations of their agency-based practice, and to be informed of the important critiques of the non-profit industrial complex that has been offered by a range of activists and scholars (incite: women of color against violence, 2007). these critiques contend that when social service advances in social work, summer 2022, 22(2) 370 work is completely disconnected from large social change work it has the potential to calcify social problems. they also argue that many nonprofits are structured like for-profit corporations and may function in ways that do not promote social justice values. and yet, these critics also recognize that most social service workers and social service agencies are operating from the best of intentions and frequently do very important work, despite the reality of working within the significant legal, funding, and structural limitations of 501(c)3s. consequently, our faculty help students to wrestle with these tensions, and to identify ways that agency-based work can be conducted in alignment with the social justice principles we have identified throughout this document. in the classroom and in the field, we educate students to make the connections between the problems facing an individual and the structural issues that may be contributing to those problems. furthermore, such analysis of power is required at all levels of interaction—micro, mezzo, and macro—including in client-social worker interactions. it also encourages seeking interventions that integrate micro, mezzo, and macro level changes, including activism. our goal is to train our students to develop strategies for creating a just society, free from oppression, racism, exploitation, and other forms of discrimination in the larger society by engaging at the community, legal and political levels, while also delivering services with individuals and families in an inclusive manner. in the classroom and in the field, we educate students to make advocacy a central part of their practice. promotion of human and social well-being involves all levels of practice, including advocacy for human rights, social justice, and economic justice. the department explicitly aims to educate students to understand manifestations and mechanisms of oppression. these forms of oppression may include the larger policies, norms, or laws that can impact the ability of social work agencies to provide effective services, as well as those manifestations of injustice that can occur within direct social work practice. students are thus prepared to understand the impact of the organizational realities in which they practice as it affects clients and community members, as well as social workers, and their relationships with each other. with this understanding, students can collaborate with clients or community members as partners with whom to advocate for policies and practices that advance human rights and social, economic, and environmental justice. in the classroom and in the field, we educate students about evidence-based practice. in the classroom and in the field, we introduce students to a wide range of thought, modalities, interventions, programs, adaptations, and ideas that are thought to enhance well-being. we train students in the knowledge and skills related to evidence-based practice but also acknowledge the limitations and need for further model and intervention development to meet the unique needs of communities, particularly marginalized and diverse communities. we understand that the evidence for these practices is not applicable for all individuals, families and communities. we consider how many interventions, services, and programs are not accessible, even to those they were designed to serve. we recognize that some communities are underserved or unserved, and therefore requirements kang/re-envisioning swk education 371 of evidence-based practice can stifle or prohibit the ingenuity and creativity needed to develop programs for them. therefore, we teach students to think about ways that interventions can be adapted and developed. we also teach students to consider other research-informed interventions and promising practices. we teach students about clinical skills from a place of curiosity and compassion— understanding that just as individuals, families, and communities have unique reactions to systems of oppression, students also may have unique reactions to learning the material. we believe that students should be equipped with a wide range of therapeutic tools in order to provide choice in their practice. what may provide regulation, connection, and calm for one, may be triggering and dysregulating for another. the on-going impact of systems of oppression cannot be ignored in every aspect of clinical work and therefore a trauma sensitive approach is woven through courses. we work to destigmatize social work and mental health by both understanding the complex systems within we are living and our natural reactions to those systems. we consider how harm happens in each system in unique ways for different people. we, along with students, challenge ourselves to find many different ways to connect. because critical self-reflection is an integral component of anti-oppressive practice, students have opportunities to self-reflect on not only the material presented, but on how the material sits with students and how reactions are often connected with the lens of their experience. our goal is for this self-reflection to be done with compassion and patience and to be on-going throughout the program in a supportive environment and a life-long practice. we understand that ultimately this helps us to show up authentically in our work. social justice facet 3: critical pedagogy our philosophy of teaching centers social justice-focused content and process the department’s commitment to social justice is carried into teaching and learning; as such, educational content and process must be congruent with each other. deeply influenced by freire’s (1970/2018) critical pedagogy, the department strives to foster an equitable environment where students and instructors co-construct critical knowledge. we believe that students’ own lived experiences and life knowledge can help inform class discussions and practice. deconstructing where ideas or facts come from helps students uncover unstated assumptions, biases, or values, and examine the role of power in the creation of knowledge. we consider critical thinking an essential skill for social work practice an important aspect of critical pedagogy is critical thinking. in this philosophy of teaching, critical thinking incorporates critical analysis that questions normative discourses and excavates dynamics of power that undergird such discourses. social work knowledge is necessarily complex and equivocal because the lives that social workers are entrusted to work with are complex and heterogeneous. furthermore, social workers can unintentionally participate in maintaining repressive normative discourses if they lack advances in social work, summer 2022, 22(2) 372 critical analysis. this critical perspective of knowledge, which is practiced and reinforced through class content and process, helps students understand that critical analysis is an essential tool and process for social justice practice. instructors actively promote the development of multiple perspectives in students’ analyses through class discussions, instructor feedback, and peer feedback. equipped with critical thinking, critical reflection, and respect for diverse paradigms of knowledge, students are prepared to engage in research-informed practice with unwavering attention to social and economic justice. we believe that students should be exposed to a range of theories that foster critical thinking we believe that there is no one all-purpose theoretical approach to our practice. understanding the strengths and limitations of multiple theories will give students a range of perspectives and options from which to draw in their academic work and in their practice. therefore, we are committed to doing the following in our classrooms: • the department fosters critical and complex thinking in students through its education, and this principle is infused and explicitly present throughout the curriculum. in order to foster critical thinking skills, instructors encourage students to question what may be taken for granted/normalized and what may be silenced or “othered” in all aspects of learning, including textbooks, articles, and lectures. to prepare students for practice in today’s diverse world, the department underscores the importance of multiple perspectives in understanding diverse realities. • we help students deconstruct dominant ideologies and behaviors. • faculty invite students to take ownership of their learning rather than assume a traditional role of a passive receiver of education. • faculty and students are encouraged to bring themselves into the course content, putting their lived experiences in the contexts of the class material, and learning from each other’s practice and lives. instructors often urge students to be accountable to the collective’s overall learning by actively participating in all aspects of the learning process. facilitating this active adult learning stance may include opportunities for students to take active leadership in class, such as a class discussion leadership assignment where students assign themselves to lead a brief class discussion. • students are encouraged to extend their critical thinking skills to reflect on the ways in which their assumptions, social locations, and actions influence a situation and how this reflective process in turn changes their thinking and practice. • we are also committed to helping students explore how marginalized communities define justice for themselves. for example, the concept of “restorative justice” comes out of the work of various subordinated groups, including american indigenous populations (zehr, 1990). it is a framework that kang/re-envisioning swk education 373 approaches justice by focusing on the needs of the victims, the offenders, and their communities. it is more focused on healing than on punishment. victims take an active role in the process, while offenders are encouraged to repair the harm they have done. restorative justice is just one example of the different conceptions of social justice to which our department is committed to exposing students. • critical thinking and analysis guide the department’s approach to learning social work theories. the department employs a multi-theoretical model and emphasizes robust and critical understanding of contemporary social and psychological theories that inform social work knowledge and practice. • the department is grounded in the person-in-environment framework. this framework informs the department’s use of ecological and systems perspectives to conceptualize social work practice, which locate the focus of work within the person-in-environment interaction. together these perspectives influence and inform the elements of practice by situating difficulties and interventions within and between the systems at the micro, mezzo, and macro levels. this holistic view of the client or community member allows for comprehensive assessments that interrogate interactions and mutual influences between the person and the environment. in doing so, students learn how larger issues of economic or social injustice can impact the immediate well-being of clients and community members. • we encourage students to consider theories that look critically at how society is constructed, as well as how knowledge is produced and disseminated. for instance, critical race theory puts race at the center of critical analysis by focusing on how endemic and pervasive racism is in society and its institutions and emphasizes multiple and varied voices of people of color (williams, 1991). similarly, feminist theories, marxist theories, queer theory, postcolonial theory, and other critical theories also focus on structural analyses of society, while elevating the voices and lived experiences of various marginalized groups. our classes may combine these critical theories with more dominant social work theoretical frameworks to help students develop complex and nuanced theoretical understandings of their work from multiple perspectives. • theories are not assumed to be authoritative or unequivocal but understood as always evolving and enriched by diverse perspectives of participants. thus, the department encourages students to engage in deep interrogation of knowledge paradigms and contextual examination of relevant theories. the emphasis is not on finding the “right” theory that works for every case but rather on critical understanding of theoretical tenets and their applications, moderated by contextual appraisal for just practice. course contents and assignments are designed to foster this learning process. advances in social work, summer 2022, 22(2) 374 social justice facet 4: a decolonizing framework preface we acknowledge that there is no one, unified conceptualization of decolonization in scholarly literature. in fact, decolonization is a controversial issue. indigenous scholars such as tuck and yang (2012) warn against turning decolonization into a metaphor and contend that decolonization must “bring about the repatriation of indigenous land and life” (p. 1), and that the project of decolonization is distinct from the project of social justice. we also heed the distinction between colonialism and settler colonialism as argued by scholars of settler colonialism such veracini (2011) and steinman (2016). we interrogate the continuing impact and practice of global colonialism and settler colonialism and our practice as social work educators and practitioners. in this endeavor we use the lens of coloniality (quijano & ennis, 2000) to understand global colonialism: the historical and continued modernist production of eurocentric global hegemony that includes european conquest and occupation; racialization (omi & winant, 2012) and formation of “racial” hierarchy of the world population; re-identification of geocultural regions from the european dominance perspective; production of global capitalism through subjugated labor, resources, and products; and establishment of eurocentric dominance of production of knowledge and culture. veracini (2011) and steinman (2016) distinguish settler colonialism from colonialism in that the project of settler colonialism is displacement and elimination of the indigenous people and world (as compared to domination and extraction of labor and resources of the colonial project). thus, steinman argues, that decolonization and settler decolonization are different projects. in this context, we are aware that the decolonizing framework that we are engaging here is in the sense of global colonialism. this view also at least partially reflects the makeup of our faculty; more than half of us are from nations that are historically, formally, and/or culturally and economically colonized. but more than that, we are thoroughly aware that coloniality is deeply implicated in the system of education, including social work education, within which we were educated and also currently located. in our efforts to avoid reducing decolonizing into a metaphor, we follow the guidance provided by gray et al. (2016): decolonizing social work requires that the [social work] profession acknowledge its complicity and ceases participation in colonial projects, openly condemns the past and continuing effects of colonialism; collaborates with indigenous peoples in engaging in decolonizing activities against public and private colonizing projects, and seeks to remove often subtle vestiges of colonization from theory and practice. (p. 7) kang/re-envisioning swk education 375 background we know that universities are often sites of the colonial project edward said (1978) described how western nations have dealt with the peoples they have colonized: by not merely settling and ruling over them, but also by authorizing views of those people that define how they are understood. gayatri chakravorty spivak (1999) argued that colonized people are forced to engage in discourse, knowledge, laws, and norms that have been developed by the colonizers. western countries perpetuate these views through their educational systems, where western thought becomes the standard – assumed to be universally relevant, valid, and applicable to all. often what we understand as scientific and rational/objective knowledge actually serves the hidden agenda of assuming european superiority and non-european inferiority. universities often center the experiences of white, western people, making them the invisible norm against which all other races and groups are compared. by perpetuating the idea that whiteness is normal, all other people are implicitly (or explicitly) understood to be different, exotic, dangerous, and/or inferior. there is a “direct and material relation between the political processes and social structures of colonialism on the one hand, and western regimes of knowledge and representation on the other . . . western epistemology and systems of knowledge have been integral to the internal colonial domination suffered by indigenous and nonwhite peoples” (tejeda et al., 2003, p. 24). for seattle university, the act of colonization is not merely metaphorical; it is also quite literal. we are on occupied coast salish land, and seattle university is on the homelands of the duwamish people. and we continue to benefit from this settler colonialism and occupation. we know that social work is also often a site of the colonial project. we recognize that the social work profession has often contributed to colonizing and oppression. the profession began, in part, by sending “friendly visitors” to try to change the alleged moral failings of the poor, and by creating settlement houses where immigrants were taught dominant norms and behaviors (addams, 1899; katz, 1996; lasch-quinn, 1993; park & kemp, 2006). the profession also has a history of working with the government to monitor, target, regulate, and discipline communities of color. this has occurred in such areas as the welfare system, child protection services, and the criminal justice system, among others (schiele, 2010). because of social work’s partnership with the state, we recognize that, in the words of freire and moch (1990), “the social worker, as much as the educator, is not a neutral agent, either in practice or in action” (p. 5). in addition, we recognize that social work has often served to uphold economic inequality in the united states. piven and cloward (1971/2012) have documented how social welfare policy functions to support capitalism, rather than supporting poor people. kivel (2006) has argued that social service programs can institutionalize and professionalize serving and controlling the poor instead of working to eradicate poverty. and reisch (2013) has written about the ways in which neoliberal economic policies have shaped and limited social work practice. these and other scholars contend that social workers often blame the victims of economic exploitation and inequality for their own poverty, and focus on “fixing” poor advances in social work, summer 2022, 22(2) 376 people, instead of working to challenge the systems that cause the exploitation and inequality. social work education can perpetuate oppression as well. students are often taught cross-cultural competency that assumes static and generalized conceptions of the cultures being studied. cross-cultural competency frameworks rarely position white experiences as a cultural phenomenon under study, which results in whiteness remaining invisible or the “norm” while simultaneously othering different racial groups. cross cultural competency also puts social work students of color in the untenable position of assuming the social worker is a white american, and thus situates their own communities as “other” and in need of help from white people. this approach only propagates marginalization and internalized racism for students of color, and upholds the worldviews, knowledge bases, and experiences of dominant white society. finally, su’s social work faculty recognize our own culpability. we know that we have been trained in the same oppressive paradigms as the dominant culture, and have internalized many problematic ideas. consequently, we are committed to thinking critically about our own practices and pedagogies. we must also be open to feedback from each other and from students, in order to continue the ongoing work of liberating our teaching. we know that social work also effectively responds to oppression and enacts change. despite the oppressive history described above, the social work profession also contributes to liberatory work, when done thoughtfully and with a focus on social justice. some forms of social work (anti-oppressive practice, strength-based practice, radical social work, critical social work, anti-colonial practice, indigenous social work practice, traumainformed practice, etc.) focus on working with clients and community members in ways that prioritize their autonomy and dignity, and in pursuit of social and economic justice (morgaine & capous-desyllas, 2014; mullaly & molgat, 2002; reynolds, 1942). through clinical practice, social workers respond to the complexities of people’s lived experiences by practicing from equity and anti-oppressive lenses. throughout our country’s history, at times social workers have been actively involved in various social justice movements (antiwar, civil rights, immigrant rights, economic justice, welfare rights, education reform, etc.) and built coalitions with numerous social justice activists and organizations (reisch & andrews, 2014). the profession of social work has made important contributions to social justice. our commitment to decolonizing our curriculum. as a result of all of the above, we are committed to decolonizing our curriculum. • the faculty recognizes from our collective teaching experiences that the lack of representation of non-dominant perspectives as the source of knowledge has been a perennial problem. not only is this shortfall problematic in terms of equity in representation but also it seriously limits students’ ability to learn and use multiple and critical perspectives. kang/re-envisioning swk education 377 • decolonizing knowledge in academia requires challenging oppressive knowledge, pedagogies, and methodologies. social justice requires a relationship between the dominant and the subordinate that allows voices to be heard from the ground up. the dominant must be willing to unlearn domination and embrace their duty to others. • we are committed to training our students to become leaders in dismantling unjust and unequal colonial legacies of power. in order to liberate the classroom, we require faculty and students to reflect on our dominant values and beliefs and to consider alternate ways of knowing, while examining how certain groups of voices, ideas, values, and peoples are marginalized, while others are privileged. • we are committed to training social worker students to attack the systemic roots of poverty and economic inequality, rather than blaming the victims of those systems. this requires educating students about the role that neoliberal economic policies play in the lives of their clients and community members, as well in the design and delivery of social work programs and services. • we are committed to beginning to liberate our profession by looking at social work practice, theory, research, programs, and policy through a critical, decolonized lens. • we are committed to utilizing culturally relevant forms of scholarship and education that resist frameworks and paradigms that serve to universalize. • finally, for all of the above reasons, the social work department has made an explicit commitment to representational equity in our curriculum. at least 50% of the learning materials (defined as required and suggested readings, videos, guest speakers, and exercises) in all social work classes will reflect: • non-dominant perspectives • knowledge and authorship of people of color • knowledge and authorship of other marginalized populations. lessons learned and implications for social work education presented below are the lessons we learned from our department’s work to create and implement a social justice-focused clinical program and their implications for social work education: 1) it is imperative to have a collective commitment to a mission. re-envisioning a curriculum is rarely a smooth process and takes significant time and energy; our process was no exception. however, while the process of re-envisioning clinical social work from a social justice perspective was complicated, sometimes challenging, and demanding (especially since faculty’s workload is already full), the collective commitment to our mission brought us together and inspired us to re-dedicate our time and energy to this necessary work. 2) developing and implementing a social justice-focused clinical social work curriculum is a continuous and iterative process. there is no “end point” as we are all work in progress. faculty regularly examine our effectiveness and advances in social work, summer 2022, 22(2) 378 limitations in integrating social justice and collaborate on continuous assessment, revision, implementation, and reflection. through this process, faculty practice critical analysis and pedagogy, demonstrating consistency in our philosophy and practice. 3) social justice must be addressed and its applications must be articulated in each course (rather than only in a stand-alone course on justice or in policy courses). vertical and horizontal integration of social justice concepts and applications throughout the curriculum enhances students’ comprehension of social justice as an integral part of clinical social work. furthermore, social justice must be addressed in each stage of clinical practice (engagement, assessment, intervention, and evaluation), and multi-level (micro/mezzo/macro) analysis and intervention should be required. assignments can be designed so that students are challenged to make explicit connections between social justice concepts and practice (atteberry-ash et al., 2019). see tables 2-4 in appendix for sample assignments. 4) social justice commitment should be consistently present in both explicit and implicit curricula and in departmental policy and processes. while the department’s primary focus was on the explicit curriculum, it guided our implicit curriculum as well as how we operated as a department. for example, the department took leadership in social justice issues within the college of arts and sciences, such as offering social justice teach-in sessions, writing open letters about institutional racism, sponsoring campus-wide events to promote social justice, and supporting student activism. consistent with equity principles, the department elected to allow all full-time faculty (tenured, tenure track, and non-tenure/clinical track) and staff equal voting rights on all departmental decisions except those prohibited by the university’s policies, such as tenure and promotion decisions. allocating resources, such as student scholarships, is guided by the equity principles. the department’s social justice focus also impacted student recruitment as well as faculty and staff hiring since we were unambiguous about our social justice commitment in our communications with prospective candidates. 5) evaluating our progress has been more difficult than we thought. we had instituted social justice and diversity survey for every course in the program to gain student feedback, but the response rate fell low after a few quarters even with incentives like a drawing for gift cards. students complained that they felt over-surveyed since this survey was in addition to the regular, university-based course evaluation survey and the msw program year-end survey. the program put the social justice and diversity survey on hold at this time and is researching a better way to gain student feedback for every course. in the meanwhile, the program is relying more on other avenues of feedback (e.g., director’s tea, community advisory committee, and practicum advisory board). kang/re-envisioning swk education 379 6) evaluating the impact of re-envisioning a clinical curriculum on clinical practice in a systematic manner is challenging. we have received anecdotal information from practicum instructors and alums about how our curriculum is influencing their practice in the field. however, our current alumni survey does not capture this information sufficiently. in addition, since the program has been in existence for only five years the long-term impact is yet to be seen. the program is currently researching a better way to gain this perspective. 7) institutional context is important. as discussed in the social justice statement section, the department’s effort is consistent with the institution’s social justice mission and goals. the university supports the department’s work on social justice because it helps the institution achieve its overall goals. lack of congruence between the department and the institution may pose additional challenges. in this paper, i shared the process of building and living a social justice-focused clinical program, the departmental statement of social justice commitment, and implications for social work education. as indicated, the work is continuous and will evolve as we continue to grow and learn and respond to changes to the higher education 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(1990). changing lenses: a new focus for crime and justice. herald press. author note: hye-kyung kang, seattle university, department of social work. email: kangh@seattleu.edu https://doi.org/10.1093/sw/54.3.195 https://doi.org/10.1177/2332649215615889 https://doi.org/10.1093/sw/43.6.527 https://doi.org/10.4324/9780203465547 https://clas.osu.edu/sites/clas.osu.edu/files/tuck%20and%20yang%202012%20decolonization%20is%20not%20a%20metaphor.pdf https://clas.osu.edu/sites/clas.osu.edu/files/tuck%20and%20yang%202012%20decolonization%20is%20not%20a%20metaphor.pdf https://doi.org/10.1080/00377317.2019.1702344 https://doi.org/10.1080/2201473x.2011.10648799 mailto:kangh@seattleu.edu advances in social work, summer 2022, 22(2) 384 appendix a table 1. sample student surveys: social justice & diversity survey & year-end survey table 2. sample assignments overview table 3a. paper 1: engagement table 3b. paper 1: assessment table 4. paper 2: research & theory informed intervention table 1. sample student surveys: social justice & diversity survey & year-end survey social justice & diversity survey* the su master of social work program strives to practice social justice & embody diversity in every aspect of the program from the way we administer to how we teach. this survey will help us to identify the extent to which both are practiced in the classroom. please answer all of the likert scale questions & use the comment box to supplement your responses. 1= none at all, 2= a little, 3= a moderate amount, 4= a lot, 5= a great deal q1. to what extent did the course content (reading materials, activities, assignments etc.) in the seminar portion of socw 5010 "foundation field practicum," promote social justice? q2. to what extent did the course content (reading materials, activities, assignments etc.) in the seminar portion of socw 5010 "foundation field practicum," promote diversity? q3. how effective was your instructor in the seminar portion of socw 5010 "foundation field practicum," in addressing social justice in his/her/their instruction (teaching methods, facilitation, etc.)? q4. how effective was your instructor in the seminar portion of socw 5010 "foundation field practicum," in promoting diversity in his/her/their instruction (teaching methods, facilitation, etc.)? q5. please share additional comments regarding social justice & diversity in the seminar portion of socw 5010. *the same survey was conducted on every msw course. year-end survey [diversity section]** please rate the following statements from "strongly disagree" to "strongly agree". 1= strongly disagree, 2=disagree, 3= neither agree nor disagree, 4=agree, 5=strongly disagree q1. social work classes encourage discussions about diversity & difference. q2. i feel free to raise issues about diversity that are important to me in my social work classes. q3. the social work program demonstrates a commitment to diversity in its: a. curriculum b. selection of field sites & clientele c. faculty d. student cohort q4. i am treated with respect in the social work program: a. by faculty b. by administration & staff c. by my fellow classmates q5. please share additional comments about diversity in the program. ** this survey is part of a larger year-end survey. only the section on diversity is shown here as an example. kang/re-envisioning swk education 385 table 2. sample assignments overview assignment 1: engagement & assessment (part 1 of the case study assignment) course: socw 5610 advanced practice i: clinical social work with individuals case study assignment this three-part paper assignment is designed to help you build a complete case study. while this assignment is divided into three parts, they collectively form an integrated case study. therefore, you must use the same case for all three assignments. the assignment takes you through the process of change: engagement, assessment, intervention, & evaluation. in this assignment, you are strongly encouraged to integrate knowledge & skills from generalist curriculum courses (e.g., human behavior in the social environment, human development, social justice, policy, & research) as well as courses that are concurrently taken in this quarter (mental health diagnosis & specialized practice practicum). this assignment supports integration between course content & field learning. it also enhances horizontal & vertical integration of learning as students are expected to build on the generalist practice curriculum knowledge & skills as well as the mental health diagnosis course (which is concurrently taken) content. read the following instructions carefully & address all items on the list in your paper. all identifying information must be removed and/or disguised. use pseudonyms for individual names, agency names, etc. graduate-level writing is required for this assignment & will be considered in grading. i urge you to consult with the writing center in advance to get editing support before you submit your paper. paper 1: engagement, assessment, & case formulation paper 2: research & theory informed intervention paper 3: evaluation, ethical consideration, & self-reflection table 3a. paper 1: engagement section objective(s) a. description of client • who is the client? document brief identifying information including name (a pseudonym), age, gender identification, racial identification, & ethnic identification. b. referral • who referred the client? self-referral? voluntary? involuntary? • when was the referral made? what was the referral process? c. engagement process & use of self • what is the context of client engagement? (e.g., community-based mental health agency setting? school setting? medical setting? etc.) • when was the context of your initial contact with the client? (at intake? after intake & then assigned to you? transferred from another worker to you?) • what is your role with the client? how was the relationship negotiated with and/or explained to the client? • what are your strengths in terms of working with this client? • what are your initial fears & assumptions, especially in regard to intersectional identities/positionalities? • what are some possible transference/counter-transference issues? • what power dynamics have you anticipated/observed/experienced? • reflect on the engagement process. what have you learned about your use of self in this process? what are some contextual issues you might have missed in the early phase of engagement? how would you use this insight in the continuous engagement with the client? advances in social work, summer 2022, 22(2) 386 table 3b. paper 1: assessment section objective(s) d. presenting concerns/ issues & history a. what are the presenting issues from the client’s perspective? b. what are the presenting issues from others’ perspectives (family, friends, referral source, etc.)? c. what is the history of the issue(s)?  when did it begin? is there an identifiable incident?  how has the client been coping with it? what has been helpful? what exacerbates the issue? d. has the client experienced similar issue(s) before? what happened? e. has the client had similar issues before? what were the results? f. what would the client most want help with? e. contextual intersectional analysis (biopsychosocialspiritual assessment) a. what is the client’s age? in which activities & responsibilities does the client engage in accordance with his/her/their life stage (e.g., school, job, etc.)? what are the resources & barriers related to the client’s life stage? b. how does the client identify in terms of race & ethnicity? what is their impact on his/her/their life? (e.g., how does the client experience structural & institutional privilege or marginalization due to his/her/their identities? what is the client’s relationship with his/her/their racial & ethnic identities? how does the larger community support or marginalize the client’s identities?) c. how does the client identify in terms of gender? how does the gender identification impact the client’s life? (e.g., how does the client experience structural & institutional privilege or marginalization due to gender identification? what is the client’s relationship with his/her/their gender identity? how does the larger community support or marginalize the client’s gender identity?) d. how does the client identify in terms of sexual orientation? how does the sexual orientation impact the client’s life? (e.g., how does the client experience structural & institutional privilege or marginalization due to sexual orientation? what is the client’s relationship with his/her/their sexual orientation identification? how does the larger community support or marginalize the client’s sexual orientation?) e. what is the client’s socio-economic status, & how does it influence his/her/their life? (what are the client’s income sources? are the client’s basic needs met? what impact does the socio-economic status have on the client’s ability to access material or social capital resources? how does the client experience structural & institutional privilege or marginalization due to socio-economic status?) f. how is the client’s physical health & how does it influence his/her/their life? are there any health/medical problems (including substance abuse)? does the client have access to culturally appropriate medical & dental care (including routine care, chronic or short-term illness care, emergency care, rehabilitation care, & long-term care)? g. if the client has disability issues, how is the disability understood in the client’s community contexts? how adapted/accessible are home, neighborhood, workplace, school, etc.? what are the client’s specific needs, challenges, or strengths related to disabilit(ies)? h. what does spirituality mean in the client’s life? does the client follow a religious or spiritual tradition? does the client have other connection to spirituality (such as a moral or philosophical values/beliefs)? how do the client’s spirituality and/or religion shape the meaning of the client’s life? i. what is the client’s immigration and/or citizenship status & history? how does the client’s (or client’s family’s) immigration status or history influence the client’s life (including structural & institutional privilege or marginalization)? kang/re-envisioning swk education 387 section objective(s) j. what is the clients’ family context? who does the client identify as his/her/their family (family of origin, chose family, etc.)? what is the relationship dynamic between family members? use a family genogram to illustrate. k. what is the client’s community context (e.g., how does the client identify & feel about his/her/their communities)? who are the client’s support system, important friendships or relationships, & what are their impact on the client’s life? use an ecomap to illustrate. how does the larger community support or marginalize the client’s communit(ies)? l. what is the client’s developmental history (including intellectual, physical, emotional, etc.)? include all significant developmental/childhood experiences, markers, & challenges. what is the impact of the client’s developmental history on his/her/their current life? m. does the client have any relevant intimate relationship history? what is the influence of the relationship history? n. strengths & challenges. what are the client’s key strengths? how does the client protect themselves from anxiety & stress? what self-soothing or self-regulation strategies does the client use? what resources or obstacles facilitate or inhibit the client’s management of current issues? o. does the client have any previous experiences with clinical or psychological services? how did he/she/they experience them (strengths, challenges, etc.)? describe relevant history & current contexts. p. does the client have any involvement in legal or social services? describe relevant history & current contexts. what is the impact of the legal/social involvement on the client’s life? q. which social, institutional, & local policies are implicated in this case? what is the impact of these policies on the client’s ability to cope with the current issue(s) or to access necessary services or resources? what is the client’s understanding of this impact? f. safety assessment. is the client in danger to self or others? if so, has the safety plan been constructed, documented, & implemented? (students must report any safety concerns to the practicum instructor & follow the agency protocol regarding safety.) table 3c. paper 1: theoretical case formulation section objective(s) g. theoretical case formulation the main task of this section is to draw a theory-informed analysis of the case, i.e., “i think this is what is going on in this case, & these are theories that help me understand what the client is experiencing.” which theories (use theories from hbse, human development, and/or social justice classes) help you understand what this client is experiencing? use no more than three theories so that you can engage in deeper analysis. briefly summarize what the theory says (i.e., what are some tenets that are relevant in this case?) & describe how it helps you better understand what the client may be experiencing & the context of his/her/their experience. advances in social work, summer 2022, 22(2) 388 table 4. paper 2: research & theory informed intervention sample assignment 2: research& theory-informed intervention (part 2 of the case study assignment) paper 2: research & theory informed intervention section objective(s) a. theoryinformed intervention discuss how the theories you used in the case formulation section inform you about the direction of intervention. please make a specific link between the theory & the intervention. b. the best research evidence conduct literature review of relevant literature (library research) to find the intervention models/strategies that are most likely to be effective for the client. discuss how they may be applied to your intervention with this client. include critical analysis of evidence-based interventions in the context of social justice & cultural relevance for the client. c. drawing upon the theories & the research evidence, describe your plan for intervention. a. identify & discuss your treatment goals & treatment methods, separating immediate from long term. how would you collaborate with your client on the treatment planning? what would be the core elements of a treatment contract with this client? are these interventions likely to be accepted by the client? are there elements that might be uncomfortable or unacceptable to the client? are the interventions realistically available & can they be funded? b. what social justice-oriented social change goals can be part of, or related to, your work with the client? what resources might you mention to the client as ways to promote the changes they wish to help make? what resources might you help connect the client with to promote these changes? what clientcentered advocacy would you engage? how might you work to promote social changes, including policy changes, related to this client & case? c. use your agency’ treatment plan template or sample templates discussed in class to write up a treatment plan that would be appropriate for your agency’s context. d. what support would you need from your practicum instructor? schiele, j. h. (2010). social welfare policy: regulation and resistance among people of color. sage publications. _________ frederic g. reamer, phd, professor emeritus, school of social work, rhode island college, providence, ri. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 375-391, doi: 10.18060/26358 this work is licensed under a creative commons attribution 4.0 international license. social work boundary issues in the digital age: reflections of an ethics expert frederic reamer abstract: throughout social work’s history, practitioners have faced challenging boundary issues. boundary issues occur when social workers encounter actual or potential conflicts between their professional duties and their social, sexual, religious, collegial, or business relationships. today's social workers face a wide range of boundary challenges that are unprecedented because of practitioners’ and clients’ widespread use of digital and other forms of internet-enabled technologies. this article presents a typology of boundaryrelated challenges arising out of social workers’ and clients' use of technology; reviews and applies emerging ethical and practice standards; and discusses risk-management protocols designed to protect clients and social workers. the author offers practical recommendations to protect clients and practitioners, including compliance with state-ofthe-art ethics standards related to technology use and development of a comprehensive social media policy. keywords: dual relationships, ethics, professional boundaries, technology, values throughout social work’s history, practitioners have faced challenging boundary issues. for many decades, social workers have navigated boundary dilemmas involving self-disclosure of personal information to clients, living and working in small communities, responding to clients' social invitations and gifts, hiring former clients as employees, and performing favors for vulnerable clients, among others. over time, the profession has produced increasingly comprehensive ethical standards pertaining to dual relationships and potential conflicts of interest (reamer, 2021a; zur, 2017). boundary issues occur when professionals encounter actual or potential conflicts between their professional duties and their social, sexual, religious, collegial, or business relationships (reamer, 2021a). today's social workers now face a wide range of boundary challenges that are unprecedented because of practitioners’ and clients’ widespread use of digital and other forms of technology. digital technology has transformed the ways in which social workers are delivering services to clients, including distance counseling using video, live chat, avatars, smartphone apps, and text messages, among other tools; communicating with clients using social media and social networking sites (e.g., facebook); searching online for information about clients (e.g., facebook, google, and linkedin); storing sensitive information (e.g., in the cloud); permitting clients to access their electronic records remotely; and being the subject of online searches by clients (e.g., when clients seek personal information online about their service providers). these phenomena have created new forms of boundary issues that could not have been imagined by earlier generations of social workers (banks et al., 2020; freddolino et al., 2022; pascoe, 2021). following are several (disguised) examples drawn directly from the author’s experience as an expert witness in social work litigation and licensing board cases. about:blank advances in social work, summer/fall 2023, 23(2) 376 • a clinical social worker in private (independent) practice communicated with several of her clients via text messages and email. some messages concerned administrative matters, such as scheduling; others included clinical content, especially when clients contacted the social worker remotely during a crisis. the social worker received an increasing number of electronic messages on her personal smartphone account from clients after traditional working hours, sometimes late at night and on weekends. the social worker wondered whether communicating with clients outside of traditional working hours was introducing boundary issues in his relationships with them. • a clinical social worker at a mental health center provided services to a woman who was involved in a protracted child custody dispute with her estranged husband. over the course of several counseling sessions, the client reported instances when her husband allegedly abused her and was arrested by the police. the social worker noted several inconsistences in the client’s version of these events and considered looking online for information about these incidents to verify the clients’ reports. the social worker reflected on whether it is ethical to conduct an online search for information about clients without their knowledge or consent. • a clinical social worker was active on a facebook group whose members advocated in the local community for women’s reproductive rights. over time, the social worker developed meaningful online relationships with several group members. on occasion, the social worker shared information with members of this facebook group about her personal journey, including the fact that, during her college years, she had an abortion. one of the facebook group members learned of the social worker’s clinical practice after conducting a google search on her, reached out to her online, and asked to become a client to process some “personal relationship issues.” the social worker wondered whether it is appropriate for her to provide clinical services to someone with whom she has had a personal facebook relationship. • at the onset of the covid-19 pandemic, a clinical social worker began serving clients remotely using video software, which generated novel privacy and boundary issues. during counseling sessions, the social worker often saw the interiors of clients’ homes and, on occasion, met clients’ children, spouses, partners, and pets who entered the room where the client was located and were on camera briefly. on two occasions, the social worker’s four-year-old child wandered unannounced and uninvited into the social worker’s home office and introduced herself to clients who appeared on the social worker’s computer screen. • a social worker in a substance use disorders treatment program was in recovery and participated actively in an online support group. occasionally, the social worker posted details about her own recovery. she discovered that one of her clients, who was also in recovery, gained access to this online reamer/boundary issues 377 support group and read several of the social worker's postings about the practitioner's personal life. the evolution of scholarship on boundary issues the subjects of boundaries and dual relationships in the behavioral health professions emerged in the 1980s. the pioneering work of bograd (1993), brodsky (1986), epstein (1994), gabbard (1996), gutheil (1989), schoener (1995), and simon (1992), among others, laid the rich conceptual foundation for contemporary practitioners' thinking about the complex nature of boundary crossings and boundary violations. since then, behavioral health professionals—including social workers, psychologists, psychiatrists, mental health counselors, marriage and family therapists, psychiatric nurses, and substance abuse counselors—have deepened their analyses of potential and actual boundary challenges (celenza, 2007; reamer, 2021a; syme, 2003; zur, 2017). until recently, the scholarly literature on boundaries and dual relationships presumed that the practitioner and client engaged in traditional face-to-face professional encounters and communicated in person. for example, the literature is filled with discussions of sexual boundary violations that developed between clinician and client that had their origins in their intense psychotherapeutic discussions that occurred in the clinician's office (celenza, 2007; lazarus & zur, 2002; peterson, 1992; reamer, 2003, 2021a; syme, 2003). recently, however, newer forms of boundary crossings and boundary violations are emerging as a direct result of social workers' increasing use of digital and other technology to serve and communicate with clients (reamer, 2017, 2021b). practitioners' remote contact with clients, via technology, has created new opportunities for boundary confusion (reamer, 2021a). as with longstanding boundary issues that first emerged before the advent of digital technologies, these newer forms that have emerged in the digital age have great potential to harm clients and imperil social workers' careers if these lead to boundary confusion and inappropriate dual relationships. remote, online, and electronic contact— including social workers’ greatly expanded use of distance counseling services—has led to unprecedented uncertainty and ambiguity about the elasticity of professional boundaries, including questions about the appropriateness of electronic communications outside of normal working hours and outside the office setting. according to drum and littleton (2014), "because the client and clinician are now capable of communicating through means typically reserved for social and personal interactions with family and friends (e.g., through e-mail, instant-chat, and video conferencing), telepsychology interactions can occur at any hour of the day or night, and both parties can now virtually enter each other’s homes, there is the potential for an increased sense of intimacy between client and therapist which could lead to boundary challenges" (p. 310). social workers’ use of hipaa-compliant software may limit social workers’ access to high-risk technologies in the workplace and prevent confidentiality breaches, but it does not necessarily prevent the introduction of complex boundary issues. current social work services include a wide range of digital and electronic options, including online, telephone, text-based, video, email, and avatar counseling (barsky, 2017; barak & grohol, 2011; chester & glass, 2006; finn, 2006; graffeo & la barbera, 2009; advances in social work, summer/fall 2023, 23(2) 378 gutheil & simon, 2005; kanani & regehr, 2003; kolmes & taube, 2016; lamendola, 2010; lannin & scott, 2013; menon & miller-cribbs, 2002; midkiff & wyatt, 2008; mossman, 2012; reamer, 2021a; recupero & reamer, 2018; santhiveeran, 2009; zur, 2017). digital and online communications with clients may be appropriate in some contexts (for example, coordination of services in case management and peer support programs) and inappropriate in others (for example, protracted informal evening online chats between a clinical social worker and her psychotherapy client). these newer forms of service delivery provide novel opportunities for boundary challenges. in addition, social workers' and clients' pervasive use of social networking sites and online search engines, such as facebook and google, have also created new boundary-related issues. boundary issues in the digital age: a typology novel boundary and dual relationship challenges encountered by social workers in the digital age are appearing in three forms: ethical judgments, ethical mistakes that do not involve misconduct, and ethical misconduct (herlihy & corey, 2015; reamer, 2021a; zur, 2017). although these patterns have been addressed previously in the context of traditional in-person professional relationships between social workers and clients (reamer, 2021a), they have not been applied in-depth to social workers’ digital and remote or virtual relationships with clients. ethical judgments in some instances, competent, principled, and well-meaning social workers find themselves faced with ethical decisions about whether and how to use technology in their relationships with clients, in light of potential boundary challenges. in these scenarios, social workers recognize that technology has the potential to enhance their delivery of services to clients—especially among those clients who have crises, live in remote geographic areas, cannot meet in person during a pandemic, or struggle with severe disabilities that limit their ability to travel. these practitioners must make deliberate ethical decisions about how to use technology in ways that maintain clear, ethical professionalclient boundaries. here are several (disguised) examples based on the author’s work as an ethics consultant and expert witness in licensing board cases and lawsuits filed against social workers: • a clinical social worker provided counseling services to a couple that was experiencing marital tension. one of the clinical issues the couple identified was their chronic distress about their lack of sexual intimacy. the social worker, who specialized in sex therapy, considered sending the couple an email message containing links to a number of websites that offer advice on ways to enhance sexual intimacy. the clinician was unsure about whether it was appropriate for her to send clients an online message containing sexually explicit material. the clinician realized that the clients would be able to forward the social worker's message to others electronically, and that other recipients might misunderstand the nature of the relationship and the purpose of the message. reamer/boundary issues 379 • a social worker terminated counseling services he had provided to a client who was coping with the death of his teenage daughter. fourteen months after the termination of services, the social worker received a facebook “friend” request from the former client. the social worker was unsure about whether it is ethical to become facebook friends with a former client. • a social worker counseled a sixteen-year-old teen who was struggling with depression and sexual orientation issues. during one session, the teen talked with deep emotion about the intense distress in her life. later that night, around 10:30 p.m., the social worker decided to search the client’s facebook site to see whether there was any evidence of suicidal ideation in the teen’s online postings. the social worker was concerned about several postings, sent the client private facebook messages inquiring about the client’s emotional state, and exchanged online messages with the teen for nearly two hours. ethical mistakes some competent, principled, and well-meaning social workers have found themselves accused of inadvertent technology-related errors that created boundary problems in their relationships with clients. some of these errors, which do not involve blatant misconduct, have led to licensing board complaints and lawsuits filed by disgruntled clients or third parties. here are several actual examples: • a social worker received an unsolicited facebook request from a client who had sought treatment for her struggles with depression. the client had searched for the social worker’s facebook site and discovered several of the social worker's postings about his recent divorce. the social worker thought he understood how to use facebook's privacy settings to limit access to such postings to his closest friends. however, the client was able to access many of the social worker's postings about his personal relationships. before the social worker blocked the client's access to his facebook site, the client had sent the clinician a series of flirtatious, intrusive, and intimate facebook messages about the social worker's personal life. because of these boundary complications, the social worker decided to terminate the clinical relationship, against the client's wishes, and refer the client. the client became enraged and filed a licensing board complaint alleging that the social worker had abandoned her. • a social worker employed in a public child welfare agency provided services to a mother who allegedly neglected her children. the social worker was frustrated with the mother who, according to the social worker, frequently cancelled appointments and did not follow through with the social worker’s recommendations. one evening the social worker vented her frustration with this client on the social worker’s personal facebook site. the social worker did not identify the client by name, but did include some case-related details. shortly thereafter, the mother conducted an online search for information advances in social work, summer/fall 2023, 23(2) 380 about the social worker. the mother came across the social worker’s facebook site, access to which was not limited, and read the social worker’s comments about the mother’s case. the mother was incensed and filed a licensing board complaint against the social worker alleging a breach of confidentiality. ethical misconduct as in all professions, some social workers—a distinct minority—engage in ethical misconduct. a disturbing percentage of misconduct cases involve boundary violations of a sexual nature (celenza, 2007; reamer, 2015, 2023; syme, 2003). social workers' use of technology has expanded the ways in which unscrupulous social workers can engage in sexualized relationships with clients. in some instances, the unethical conduct is limited to online communications. in others, electronic communications are a prelude to a sexual relationship. in some cases, evidence suggests that electronic communications were part of a deliberate, calculated effort by social workers to groom clients for an eventual sexual relationship. here are several actual examples: • a social worker at a prominent outpatient mental health clinic provided counseling services to clients with co-occurring symptoms (substance use and mood disorders). most of his clients had trauma histories that contributed to their challenges. over time, the social worker engaged in sexual relationships with two of his clients. one of the clients disclosed the relationship to the police after the social worker suddenly ended their intimate relationship. the clinician's arrest was publicized in the local media, after which the second client disclosed her sexual relationship with him. the social worker was charged in criminal court and sued by the two clients. during the criminal and civil trials, the prosecutor and plaintiffs' attorneys introduced a collection of "electronically stored information" (esi), including text messages and email messages between the social worker and his clients that included sexualized content, that provided compelling evidence of the social worker’s unethical conduct. the social worker—who was not aware that his electronic communications left a digital footprint—was convicted, sentenced to prison, lost his professional license, and was found liable for professional negligence. • a social worker provided counseling to a young woman who struggled with symptoms of depression and anxiety. during the course of the counseling the client ended a long-term romantic relationship. the client often talked about her intense loneliness. the social worker told the client that he could help fill the emotional void in the client's life. the social worker began sending text messages to the client, allegedly to check on her well-being. over time, the text message exchanges between the pair became increasingly informal. on several occasions, the pair met for coffee. eventually, they began a sexual relationship. the intimate relationship ruptured and the client filed a licensing board complaint. the board revoked the social worker’s license. reamer/boundary issues 381 • a social worker worked at a school sponsored by a mental health center. the school served adolescents who had difficulty functioning in traditional high school settings; all of the students struggled with behavioral health issues. the social worker spent most of an academic year counseling an eighteen-year-old student who became clinically depressed following the sudden death of his mother due to brain cancer. over time, the social worker and student developed an intense emotional connection; at times the social worker shared with the student details about her marriage and children. the social worker encouraged the teen to text her for support when he was feeling despair. one day, the teen sent the counselor a text message in which he shared his "loving" feelings toward her. the social worker responded with her own text message that told the teen how much she cared about him and how special he was. gradually, the social worker and teen spent time together away from the school and, eventually, engaged in sex. the teen's father disclosed the relationship to the school's director after discovering inappropriate text messages on his son's phone, including several graphic, explicit photos that the social worker and teen had exchanged ("sexting"). the principal fired the social worker and notified her licensing board. the licensing board revoked the counselor's license. boundary dynamics in the digital age research suggests that, historically, there are several dynamics in boundary challenges that arise in social work and behavioral health (herlihy & corey, 2015; reamer, 2021a; zur, 2007, 2017). these include boundary issues related to intimate interactions between practitioners and clients; practitioners' own emotional and dependency needs; personal benefits to practitioners; practitioner altruism; and unanticipated circumstances. more recently, these dynamics—which can lead to inadvertent ethical mistakes, challenging ethical decisions, and ethical misconduct—have become evident in emerging boundary issues in the digital age. intimacy many dual relationships between social workers and clients involve an intimate component. the most extreme cases involve sexual contact (celenza, 2007; lazarus & zur, 2002; peterson, 1992; pope & bouhoutsos, 1986; syme, 2003). other intimate encounters include having physical contact (such as hugging or caressing), providing counseling services to a former lover, and accepting very personal gifts from a client. however, in the digital age, newer forms of intimate contact between social workers and clients are possible. these include online and other electronic messages and website postings (for example, on social networking sites) that contain very personal, intimate, and sexual content and images. algorithms used by online social networking platforms may generate intimate-sounding messages among parties with similar interests and shared contacts (based on artificial intelligence), even when they are not initiated directly by a social worker or client. in addition, remote service provision using video may provide social advances in social work, summer/fall 2023, 23(2) 382 workers with opportunities to peer inside of clients’ homes and meet clients’ family members and acquaintances who happen to wander onto the screen during an otherwise private and confidential discussion. clients may have an opportunity to peer inside a social worker’s home when practitioners serve clients remotely from their residence. this access may provide clients and social workers with information about each other’s personal lives that would not have been revealed during traditional in-person meetings; this can lead to boundary ambiguity and confusion (recognizing that such information sharing might also personalize their professional relationship in a positive way). emotional and dependency needs some boundary issues arise from personal issues in social workers’ own lives. what many of these circumstances have in common is that they are rooted in the social worker’s emotional needs, such as those stemming from childhood trauma, marital or relationship issues, health challenges, aging, career frustrations, or financial and legal problems. these various stressors can impair social workers’ judgment, which may lead to inappropriate dual or multiple relationships and boundary violations. historically, one common manifestation has been social workers' inappropriate selfdisclosure to clients during face-to-face counseling sessions (barglow, 2005; farber, 2006; knox & hill, 2003; roberts, 2005; stricker & fisher, 1990). although limited and judicious self-disclosure may be appropriate for therapeutic purposes, research suggests that social workers’ self-disclosure can be a prelude to sexual relationships with clients (celenza, 2007; gabbard, 1996; gutheil & simon, 1995, 2005; reamer, 2021a; simon, 1995; syme, 2003). in the digital age, these disclosures are sometimes embedded in text messages, email messages, and online social networking exchanges between social workers and clients; some of this content may be introduced intentionally by the users, some may be generated by algorithms used by online social networking platforms, and some may be the product of default privacy settings that encourage the disclosure of information to known and unknown parties based on interest or proximity. the unique informality of online and digital exchanges can exacerbate boundary confusion and risks in ways that are less likely in traditional office-based encounters. personal gain some dual relationships entail a personal benefit for social workers. examples include social workers who receive services (for example, house painting or computer repair) or favors from a client (for example, use of a client's vacation villa). social workers who communicate online with clients inappropriately may also experience personal gain, particularly when those online interactions are for social workers’ self-serving purposes, such as obtaining online advice from a client who has specialized knowledge (for example, medical advice) or linking clients electronically with products sold online by social workers (for example, herbal products or self-help manuals written by the social worker). altruism reamer/boundary issues 383 some boundary issues arise because of social workers’ sincere altruistic inclinations. most social workers are dedicated, caring, and principled professionals who would never knowingly exploit clients (reamer, 2023). ironically, social workers who are extraordinarily kind and humane may unwittingly foster challenging dual and multiple relationships by engaging in informal online and other electronic communications with clients. digital communications that begin quite innocently, perhaps to provide clients with emotional support and access outside of traditional office hours (including late-night online exchanges), can sometimes lead to intimate or other inappropriate exchanges. on occasion, altruistic gestures made electronically may be misinterpreted by clients and create boundary confusion. for instance, this can arise when social workers use short-video software such as tiktok or instagram reels to educate the public and clients on topics related to mental health, bystander interventions, sexual health, and relationship management (javaid, 2023). unanticipated circumstances during the course of a career, many social workers encounter unanticipated, sometimes unavoidable, dual relationships. these are especially common when social workers live and work in small communities, such as rural areas or on military bases. digital technology has produced novel and unprecedented opportunities for such inadvertent encounters. in one case, a social worker sought advice online from parents of children who struggle with a particular childhood disease. in her online posting, the social worker shared considerable personal details about her parenting struggles. coincidentally, one of the parents who responded to the social worker was a current client. in another case, a social worker who specialized in treatment of anxiety symptoms posted several websites with resources for anxiety management. unbeknownst to the social worker, several of the hyperlinks were hijacked and sent users automatically to pornography websites. some users concluded that the social worker knowingly directed them to these websites. what is known as dns (domain name server) hijacking is a type of malicious attack in which an individual redirects queries to a web-based domain name server by overriding a computer’s settings. this can be achieved through the use of malicious software or by modifying a server’s settings. emerging ethical standards in recent years, social workers have embarked on development of rigorous and comprehensive standards pertaining to practitioners' use of technology to serve and communicate with clients. a number of these standards specifically address potential boundary crossings and violations. recognizing the profound impact that technology is having on social work practice, in 2013 the association of social work boards (aswb) board of directors appointed an international task force to develop model regulatory standards for technology and social work practice. aswb developed these new ethicsrelated standards in response to requests from regulatory bodies around the globe for guidance concerning social workers' evolving use of technology and the ways in which advances in social work, summer/fall 2023, 23(2) 384 regulatory standards might be updated. the aswb task force included representatives from prominent social work practice, regulation, and education organizations throughout the world. the group developed model standards, a number of which focus explicitly on boundary issues (association of social work boards, 2015). these model regulatory standards state that social workers who choose to provide "electronic social work services" shall, for example, "communicate with clients using digital and other electronic technology (such as social networking sites, online chat, email, text messages, and video) only for professional or treatment-related purposes and only with client consent" (standard 4.03); "refrain from soliciting digital or online testimonials from clients or former clients who, because of their particular circumstances, are vulnerable to undue influence" (standard 4.09); and "refrain from accepting 'friend' or contact or blog response requests from clients on social networking sites. exceptions may be made when such contact is an explicit component of a treatment or service-delivery model and meets prevailing standards regarding the use of digital technology to serve clients" (standard 4.10). these model standards are now influencing the revision of licensing and regulatory laws around the world. in 2015, nasw appointed a task force to determine whether changes were needed in its code of ethics to address concerns related to the use of technology. the last major revision of the code was approved in 1996. since 1996, there has been significant growth in the use of smartphones, tablets, email, texting, online social networking, monitoring devices, video technology, and other electronic technology in various aspects of social work practice. in fact, many of the technologies currently used by social workers and clients did not exist in 1996. in 2017, nasw adopted a revised code that includes extensive technology-related additions, a number of which specifically address boundary issues (national association of social workers, 2017). examples of boundary-related standards include "social workers should avoid communication with clients using technology (such as social networking sites, online chat, e-mail, text messages, telephone, and video) for personal or nonworkrelated purposes" (standard 1.06[e]); "social workers should be aware that posting personal information on professional web sites or other media might cause boundary confusion, inappropriate dual relationships, or harm to clients" (standard 1.06[f]); and "social workers should be aware that personal affiliations may increase the likelihood that clients may discover the social worker's presence on web sites, social media, and other forms of technology. social workers should be aware that involvement in electronic communication with groups based on race, ethnicity, language, sexual orientation, gender identity or expression, mental or physical ability, religion, immigration status, and other personal affiliations may affect their ability to work effectively with particular clients" (standard 1.06[g]). also in 2017, following unprecedented collaboration among key social work organizations in the united states—nasw, aswb, council on social work education, and clinical social work association—the profession formally adopted new comprehensive practice standards, including extensive ethics guidelines that focus on social workers' use of technology (national association of social workers, association of reamer/boundary issues 385 social work boards, council on social work education and clinical social work association, 2017). these transformational comprehensive standards address a wide range of compelling ethical issues related to social workers' use of technology, focused especially on practitioners’ use of technology to provide services to clients remotely, record sensitive information in electronic records, and communicate with clients electronically between appointments. a significant number of these state-of-the-art standards focus explicitly on boundary issues in the digital age. examples include, "social workers who provide electronic social work services shall maintain clear professional boundaries in their relationships with clients" (standard 2.09); "social workers who use social media shall develop a social media policy that they share with clients" (standard 2.10); "social workers shall consider the implications of their use of personal mobile phones and other electronic communication devices for work purposes" (standard 2.11); and "social workers who work with communities and organizations shall ensure that they maintain appropriate boundaries when they use technology" (standard 2.19). the onset of the covid-19 pandemic led to some temporary modification of federal rules concerning use of non-hipaa compliant technology to enhance practitioners’ ability to serve vulnerable people when face-to-face services are not advised for public health reasons (u.s. department of health and human services, 2021). this policy change may lead to more elastic online boundaries in practitioners’ relationships with clients. for example, in 2020 the federal office for civil rights in the u.s. department of health and human services, which oversees hipaa compliance, promulgated a policy that stated “ocr will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the hipaa rules against covered health care providers in connection with the good faith provision of telehealth during the covid-19 nationwide public health emergency. this notification is effective immediately. a covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the covid-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients. ocr is exercising its enforcement discretion to not impose penalties for noncompliance with the hipaa rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the covid-19 nationwide public health emergency. this exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to covid-19.” although this rule modification has expired, it provides a compelling example of shifting norms related to technology use. implications for practice: risk management in the digital age social workers who violate boundaries in conjunction with their use of digital and other technology, whether unintentionally or intentionally, can cause great harm to clients and expose themselves to the risk of litigation, licensing board complaints, and criminal charges. disgruntled clients may file a lawsuit against their social worker alleging advances in social work, summer/fall 2023, 23(2) 386 professional negligence or file a licensing board complaint alleging violation of ethical standards adopted by the board. in extreme cases, social workers may be charged in criminal court because of their conduct involving boundaries. criminal codes in a number of jurisdictions consider sexual relationships between a mental health professional and client a felony. social workers' sexualized email messages, text messages, postings on social networking sites, and other electronically stored information may be introduced as formal evidence against them. social workers who engage in unethical conduct involving digital and other electronic communications fall into two groups (reamer, 2021a; zur, 2017). first, some social workers find themselves immersed in boundary confusion unwittingly and without malice. their elastic sense of boundaries leads them to engage in informal, chatty, seemingly innocuous online and electronic communications with clients. these may include afterhours exchanges that resemble messages shared between friends about personal challenges, social events, recreational activities, restaurant visits, vacations, and family intrigue. these practitioners often have the capacity to learn from their boundaries-related mistakes, especially when their attention has been heightened after being named as a defendant in a lawsuit or a respondent in a licensing board complaint (reamer, 2023). with the benefit of competent ethics consultation and continuing education—which are frequently required as elements of a licensing board resolution—these social workers are often able to gain impressive insight and move on to productive careers once they resolve the formal complaint. the second group, however, includes a much more challenged and challenging group of social workers. these practitioners are exploitative and use clients to meet their own needs. nontherapeutic and unprofessional electronic exchanges with clients are often a deliberate, calculated, and self-serving effort to groom vulnerable clients, luring them with cleverly worded, seductive messages of endearment, support, and praise (reamer, 2023). some social workers who groom clients via online and digital exchanges struggle with impairment. research on impairment among professionals suggests that many struggling practitioners do not seek assistance, and colleagues who are concerned about them may be reluctant to share their concerns (kilburg et al., 1988; reamer, 2021a; sonnenstuhl, 1989). some impaired social workers may find it difficult to seek help because of their mistaken belief in their competence and invulnerability; they believe that an acceptable therapist is not available or that therapy would not help; they prefer to seek help from family members or friends or work problems out by themselves; they fear exposure and the disclosure of confidential information; they are concerned about the amount of effort required and about the cost; they have a spouse or partner who is unwilling to participate in treatment, or they do not admit the seriousness of the problem; or they believe that they should be able to work their problems out by themselves. licensing boards and professional associations that discipline social workers who violate boundaries (including digital and online boundary violations) sometimes encourage or require them to enroll in therapeutic programs designed specifically to treat impaired practitioners (schoener, 1995; vandenbos & duthie, 1986). reamer/boundary issues 387 on occasion, social workers become aware of a colleague's inappropriate use of technology in their relationships with clients. for example, they may receive reports from clients about a colleague’s inappropriate online conduct during a prior counseling relationship with that social worker or from third parties who know of social work colleagues' salacious facebook postings. according to current ethics standards in social work, when feasible social workers who learn of colleagues' unethical online conduct should approach them for frank discussion about the behavior and its implications, as mandated by the nasw code of ethics (standards 2.08 and 2.10). social work supervisors, especially, should broach these issues when they arise and address them directly, using what sonnenstuhl (1989) describes as "constructive confrontation" (p. 533). one practical way to reduce the risk of boundary problems arising out of social workers' and clients' use of technology is for practitioners to develop a social media policy that practitioners review with clients. social media policies inform clients about their social worker's professional use of social networking sites, email, text (sms) messaging, electronic search engines, smartphone applications, blogs, business review sites, and other forms of electronic communication (kolmes, 2010). a typical social media policy informs clients that their social worker cannot be their "friend" on social networking sites (such as facebook or linkedin) and why this is important in order to maintain clear professional boundaries. such policies also set limits on practitioners' and clients' use of text messaging and emails. further, social workers should develop keen instincts about when they should consult with knowledgeable colleagues and supervisors about ambiguous boundary challenges, especially those related to sexual boundaries. practitioners’ malpractice insurers and, for nasw members, nasw’s office of ethics and professional review and chapter offices also can offer practical guidance. when necessary, social workers should consult an attorney who specializes in defending social workers in malpractice and licensing board matters. conclusion boundary challenges in social work have existed throughout the profession’s history. the widespread use of digital technology has introduced novel and unprecedented opportunities for boundary challenges. informal, casual, and spontaneous online and digital communications between social workers and clients—in the form of text messages, email messages, online postings, and instant messages on social networking sites—can lead to a loosening of what would otherwise be firm boundaries in the professional-client relationship. the fact that digital and other electronic communications can occur so easily outside of customary work hours and the controlled context of office-based services can lead to uncertainty and confusion about the nature of their relationships. some social workers engage in extracurricular electronic communications with wellmeaning intent, perhaps to enhance clients' access to services and to offer emotional support to clients during times of crisis. what may begin as truly innocent communications may lead to boundary ambiguity and, ultimately, inappropriate contact, both in person and remote. in extraordinary instances, unscrupulous social workers use online and electronic advances in social work, summer/fall 2023, 23(2) 388 communications with clients as a manipulative tool, and as a calculated grooming strategy designed to seduce clients. to enhance social workers’ understanding of boundary challenges in the digital age that can lead to ethical mistakes, nuanced ethical judgments, and ethical misconduct, social work educators can add content on boundary issues in the digital age to curricular offerings on ethics and field placement supervision. further, continuing education programs can feature presentations on these emerging and challenging issues. in addition, it is imperative that social work scholars undertake empirical research on boundary issues in the digital age, focusing especially on various manifestations, social workers’ ability to recognize these issues when they emerge and understanding of pertinent ethics standards, and practical strategies designed to prevent boundary confusion and violations related to technology use. the digital age has brought with it many impressive benefits for both clients and social workers. digital technology has greatly expanded clients’ access to services, broadened social workers’ service delivery options, and facilitated out-of-office communication. yet, these developments have also generated unprecedented boundary-related risks and challenges. to protect clients and themselves, social workers must be alert to potential risks, earnest in their efforts to learn about the responsible use of technology, and diligent in their efforts to prevent boundary confusion. references association of social work boards. 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(2017). multiple relationships in psychotherapy and counseling: unavoidable, common, and mandatory dual relations in therapy. routledge. author note: address correspondence to frederic g. reamer, school of social work, rhode island college, providence, ri 02908. email: freamer@ric.edu https://doi.org/10.7312/ream20830 https://doi.org/10.7312/ream20830 https://doi.org/10.7312/grif18330-014 https://doi.org/10.1111/j.1545-5300.2005.00041.x https://doi.org/10.1111/j.1545-5300.2005.00041.x https://doi.org/10.1080/00981380802231216 https://doi.org/10.1080/00981380802231216 https://doi.org/10.3928/0048-5713-19950201-08 https://doi.org/10.3928/0048-5713-19950201-08 https://doi.org/10.3928/0048-5713-19950201-07 https://doi.org/10.3928/0048-5713-19950201-07 https://doi.org/10.1177/002204268901900407 https://doi.org/10.1177/002204268901900407 https://doi.org/10.1007/978-1-4899-3582-3 https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html https://doi.org/10.1037/10056-011 https://doi.org/10.1037/10056-011 https://doi.org/10.1037/11563-000 https://doi.org/10.1037/11563-000 https://doi.org/10.1037/11563-000 mailto:freamer@ric.edu _________ dennis cornell, dsw, lcsw, bcd, adjunct instructor, school of social work, indiana university southeast, new albany, in. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 278-294, doi: 10.18060/26267 this work is licensed under a creative commons attribution 4.0 international license. teaching anti-racism to white social work students: a practical approach dennis cornell abstract: social work education has traditionally been focused on whiteness with evidence-based anti-racism practices not commonly taught in social work courses. utilizing the six anti-racism intervention categories found in the literature review, while incorporating the anti-racism frameworks of learning/unlearning socially conditioned racism, this practice application article focuses on developing an anti-racism msw course for a university. additionally, suggestions to infuse anti-racism practices throughout the entirety of an msw program are introduced. this approach will allow students to develop a more anti-racist mindset throughout their msw studies. a two-day anti-racism workshop is also proposed which can be used for students or professionals in schools, organizations and companies for community teaching or continuing education. keywords: anti-racism, white students, racial bias, white learning, teaching white students, implicit racial bias social work education and practice in the u.s. have been dominated by western ideologies since their inception (tascon & ife, 2020). the influence of western culture is intrinsically racialized to lean toward colonialism and the supremacy of whiteness (tascon & ife, 2020). consequently, the profession of social work was born into white privilege, “white world views and white knowledge systems” (tascon & ife, 2020, p. 1). for example, the national association of black social workers (nabsw) was formed in 1968 after the members left the largest national social work organization at the time to more formally address social and political issues related to the black community (nabsw, 2022). also, most settlement houses (established to help immigrants) were segregated and often had separate houses for black people (hansan, 2011). while many social work educators are keenly aware of the racism that exists in society today, many social work students are still taught curricula from a white perspective leaving the cultures of black, indigenous, and people of color as an afterthought or sidelined altogether (tascon & ife, 2020). the black panther organization formed the black student alliance in 1972 to have colleges be more aware and more responsible to the oppressed communities of color around them (chiles, 2015). the general lack of racial awareness has resulted in racialized cultural knowledge being left out of traditional social work education and expertise. barriers to social work education adding anti-racism perspectives into its curricula include a lack of “established teaching methods for teaching anti-racism during a standard 14-week semester” (hamilton-mason & schneider, 2018, p. 337). if white social workers are not able to acknowledge the whiteness of the education they bring to their practices, then they continue to preserve the colonial and racist dominance that the profession has maintained since the beginning (tascon & ife, 2020). thus, racialized clients continue to suffer from the same racism in their practice found in the rest of u.s. society. clients of color are then forced to conform to the standards, values, and treatment of the white privileged social work profession. about:blank cornell/teaching anti-racism 279 since the resurgence of the black lives matter movement in the summer of 2020, many colleges and universities have begun offering more opportunities to learn about racial justice and anti-racism (stewart, 2020). some have mandated incoming freshmen take an anti-racism course, while california requires all state university system students to enroll in a racial studies class (stewart, 2020). these anti-racism university courses are designed to counter the whitewashed upbringing of most white students. due to growing up in the u.s., children are socially conditioned to white values and ideals (hjerm et al., 2018; stewart, 2020). thus, the need for anti-racism courses and workshops is paramount. recently, many states and school boards have banned the teaching of critical race theory (crt) and the real history of the u.s. including the loathsome prejudiced actions and discrimination that has occurred and continues to happen to people of color at the hands of white people (kingkade et al., 2021; stewart, 2020). these state legislatures and school boards want to depict a history that has no consequences in today’s society thus whitewashing history and promoting the idea that racism is a thing of the past (crenshaw, 2021). when the experiences of people of color are omitted from the history of the u.s., white students develop a sense of entitlement and privilege that is perpetuated beyond the classroom (hughes et al., 2007; stewart, 2020). this white supremacy has seeped into laws, policies, institutions, and individuals’ psyche. providing anti-racism courses at educational institutions can begin to change those conditioned beliefs learned in childhood (stewart, 2020). following the height of the racial justice movement in the summer of 2020, the national association of social workers (nasw) published an official report on ending racism in june 2021 (nasw, 2021b). this was not their first statement on racism. nasw (2007) published a statement on institutional racism in 2007 but did not take responsibility for not de-centering whiteness in social work. it also only focused on institutional racism and not individual racism because “the assumption is that people enter the profession with good intentions and the desire to help” (nasw, 2007, p. 3). this gave the impression that all social workers didn’t need to work on cultivating their anti-racist mindset. in the opening statement of the 2021 report, nasw acknowledged the social work “profession has not always lived up to its mission of pursuing social justice for all” (nasw, 2021a, p. 2). the writers of the report then apologize for the social work profession’s support of racist policies and interventions that have caused harm to racialized people (nasw, 2021a). they admitted wrongdoing and acknowledged that whiteness blankets all social work education and practice. in august 2020, the council on social work education (cswe), the national association that has set the standards for social work education since 1952, created the task force to advance anti-racism in social work education (cswe, 2021). this anti-racism task force will provide recommendations based on “curriculum; faculty, student and program equity; educational policy and accreditation standards; and conferences and faculty development” (cswe, 2021, para. 3). cswe has listed topics for a proposed action plan ranging from improving data collection, developing anti-racism resources, adding anti-racism commitments to field placements, deepening the use of critical race theory, decolonizing the curricula and research practices, adding more professional development, and providing more support to historical black colleges and universities (cswe, 2021). advances in social work, summer/fall 2023, 23(2) 280 in all of the proposed topics for the anti-racism action plan, nowhere does it mention anything about evidence-based anti-racism practices or interventions. traditionally, empirically-based anti-racism practices have not been taught in social work courses (cswe, 2021). this practice application article will focus on creating an evidence-based (critical review of research literature presenting practice shown to be effective) anti-racism course, infusing empirically-tested anti-racism practices throughout the coursework of the entire msw program, and constructing a professional development/community anti-racism workshop for students and professional community members. literature review social work programs across the u.s. have implemented courses and curricula around multiculturalism, diversity, and inclusion based on the cswe’s educational policy and accreditation standards (epas) in diversity and justice (abrams & gibson, 2007). the 2015 epas diversity competencies state that social work education needs to “engage diversity and difference in practice,” and “advance human rights and social, economic, and environmental justice” (cswe, 2022, para. 2-3). these epas competencies do not mention anything about anti-racism or anti-oppression. typically, this type of diversity education taught students to be more culturally sensitive to racialized groups so social workers could work more adequately with racially diverse populations (abrams & gibson, 2007). this is not anti-racism and typically does not bring lasting systemic or individual change. in june 2022, cswe approved a new set of epas competencies. two competencies refer to diversity and anti-racism: “advance human rights and social, racial, economic, and environmental justice,” and “engage anti-racism, diversity, equity, and inclusion (adei) in practice” (cswe, 2022, pp. 9-10). these social work competencies appear to be more aligned with conventional anti-racism and anti-oppressive theories and practices. all studies discussed in the literature review exhibited the following criteria: first, the studied population had to include white adults. children were not incorporated into these studies. second, the studies had to be of qualitative or quantitative design. the studies also had to include an intervention that was examined and positively shown to be effective for eliminating an aspect of racism (e.g., racial implicit bias training, white privilege elimination workshops, anti-racism techniques, anti-oppressive training, etc.). social and educational disciplines were included. the studies needed to have been conducted at schools and universities, medical centers, training centers, public organizations, government offices, etc. all studies examined were in english. the university of kentucky library database search webpage was used to employ the literature search engines. the databases utilized during september 2021 were assia, eric, proquest dissertations and theses global, psychinfo, and web of science. hand searching from previous studies and citation chaining were also used. the university of kentucky libraries databases were used to conduct the review. a systematic literature review search in prospero did not find anything similar to this current review. the search terms were “anti-racism,” “racial bias,” “diversity,” “white learning,” “adult interventions,” “white teaching.” the filter of cornell/teaching anti-racism 281 “peer-reviewed” was used to identify publications with quality assurance. date filters were “2003-2021.” the studies were broken down into six intervention categories based on how the interventions were delivered or the methods used. the review of the literature highlights six types of evidence-based, anti-racist education. there have been multiple studies with anti-racist interventions revolving around the following categories: anti-racism classes or educational groups, anti-racism teaching methods, the implicit association test (iat), pro-black stories/perspectives, interracial dialogue sessions, and meditation. each category will be explored in detail. two of the 43 articles in the advances in social work (aisw) summer 2021 special edition met these criteria. individual anti-racism classes or educational groups just having one anti-racism class or educational group yields positive results in antiracism practices for the participants. classes that incorporate racialized communication, advocacy, racialized respect, cultural knowledge of white and racialized cultures, empathy for out-group races, and white self-reflection have brought up the confidence of white students in developing a greater awareness of anti-racism skills (singh, 2019). anti-racism classes have been shown to help white participants develop a white identity and social activism that was not formalized in the past. this has been done by teaching students about the racist history of the u.s. resulting in an increased awareness of white privilege among white students (berg & simon, 2013). courses designed around self-reflection on white guilt and privilege can help students eliminate that barrier that keeps them from moving towards an anti-racism mindset (paone et al., 2015). teaching cognitive behavior therapy (cbt) skills have helped students to reframe their racist thought patterns (berg & simon, 2013; devine et al., 2012). cbt comes into play as a means to replace previously learned racist thoughts and ideas by reflecting and challenging those thoughts with new alternative responses. this begins to re-train the brain over time when done consistently, thus reframing the white brain to recognize a racist thought and turn it around into non-racist thought/action (berg & simon, 2013; devine et al., 2012). in using the “5 column thought record,” the white student first focuses on what unpleasant emotion they may be feeling around the racist thought, for instance, white guilt, empathy, or rage. next, they think through what situation led to the unpleasant emotion (e.g., seeing a black man interact with a white cashier thinking that he is robbing her). the third step is to examine what racist thoughts went through their head, how much they believe them, and what racist cognitive thought distortion they were using (e.g., black men are thieves and robbersovergeneralization/jumping to conclusions). the next step is for the white student to decide how much they believe the racist thought now knowing that it was a cognitive thought distortion created by their mind due to social conditioning. the outcome should be a lighter, more pleasant emotion and thought that comes forth (e.g., “my socially trained brain learned these racist thoughts and now i recognize them and can avoid giving into them”; berg & simon, 2013; devine et al., 2012). it is not enough for participants to develop anti-racism practices by attending a multicultural diversity class or training. for a course or training to be considered anti-racist, advances in social work, summer/fall 2023, 23(2) 282 the elements of privilege and power/oppression need to be included (robbins, 2016). the self-reflection and self-critique of white people need to take place, as well as discussions with people of color to work through the white racial discrepancy (see interracial dialogue sessions; robbins, 2016). however, we must remember that “asking black people in the united states to discuss race is asking them to relive every moment of pain, fear and outrage they have experienced” (wilson, 2020, para. 23). there are people of color willing to talk to groups about their racial experiences and they should be compensated accordingly (e.g., monetarily) (williams et al., 2019). anti-racism teaching methods the teacher or facilitator of the class can have a tremendous impact by using antiracism interventions with students. getting students to conduct self-reflection on various aspects of the anti-racism curriculum throughout the course or training gets students to move beyond an academic pedagogical approach to a more reflective, experiential approach (feize & gonzalez, 2018). students can learn to stop thinking with their head and more with their heart. learning about the real and true history of racism in the u.s. assists students in realizing what was omitted from their learning as a child and the detriment of having been conditioned to racist and privileged thoughts and feelings (feize & gonzalez, 2018). teachers should teach comprehensive and accurate historical accounts and have white students reflect on the real racist history of the u.s. (bussey, 2021). teachers who self-disclose their racist thoughts and failures can be role models or mentors for the students as they can help to channel those guilty feelings into positive antiracism actions (kordesh et al., 2013; linder, 2015; malott et al., 2021; sue et al., 2009). student fears of appearing to be a racist (because of their ingrained racist thoughts) may be alleviated when white teachers share their struggles with developing an anti-racist mindset (linder, 2015). when teachers discuss intersectionality (acknowledging that everyone has unique oppressive experiences based on the social groups in which they belong and the compounding nature of oppression for those with multiple marginalized backgrounds), then white students who do not have privilege in one or more social categories (e.g., sexual orientation, class, etc.) can increase their empathy for people of color more than white students who are privileged in most, if not, all social categories (paone et al., 2015). educators should have participants explore their white privilege through formal and informal assessments which makes them more aware of their own unconscious bias (boatright-horowitz et al., 2013; hayes et al., 2008). being racist and becoming anti-racist should be presented as a continuum (a life-long process) instead of having a beginning and an end (heinze & decandia, 2011; linder, 2015). students can, then, gradually locate the racist tendencies within themselves in which they have been socially conditioned (heinze & decandia, 2011; linder, 2015). completing a racial autobiography can sensitize students to their racial imperfections more intimately so that they know where their triggers are to interrupt them. instructors sharing their racial autobiography first can help students feel less intimated about sharing their racist thoughts and feelings (gooden & o’doherty, 2015). this method aligns well with freire’s (2005) problem-posing model where there is a dialogue between the instructor and cornell/teaching anti-racism 283 students and they learn alongside each other. this creates an anti-oppressive atmosphere of shared equality (freire, 2005). implicit association test (iat) the implicit association test (iat) was established in 1998 by researchers from harvard as a way to gather knowledge about implicit bias towards certain groups/social categories of people (project implicit, 2011). the race iat requires participants to “distinguish faces of european and african origin. it indicates most americans have an automatic preference for white over black” (project implicit, 2011, p. 2). there have been criticisms of the iat in that it may measure associations that come from the culture rather than associations coming from within the person (arkes & tetlock, 2004). nonetheless, there are empirically-based articles supporting its efficacy. iat continues to be used widely in social research. using the iat within a classroom setting has been shown to enlighten students regarding their racial prejudices and reveals that some of those prejudices are unconscious or unacknowledged (ghoshal et al., 2012; morris & ashburn-nardo, 2010). when taking the iat, students who already embrace social justice values will want to change their bias (devine et al., 2012). pro-black stories/perspectives listening to black perspectives and testimonies of racism are transformative moments for white participants in reducing racial bias and stereotyping (singh, 2019). participants are more likely to reduce their implicit bias toward racialized people when they are taught to think of those in their out-group (racial group they do not belong to) as being helpful and their in-group (the racial group they belong to) as the adversary within the context of the presented scenario/intervention (gonzalez et al., 2021). for example, white students can participate in interventions (vivid counter-stereotypic scenarios) where they take on the role of the main character of a story that includes a positive, high involvement of an out-group character especially when the out-group character saves the student’s character while the in-group characters are the antagonists (gonzalez et al., 2021; lai et al., 2014). the story is written where something negative happens to the student’s character and the out-group character steps in to save them in some way within the context of the story. another intervention has white participants, especially older white participants, partaking in exercises where they are instructed to walk in the shoes of racialized people to reduce racial stereotyping and prejudice (castillo et al., 2011). an example of this type of intervention would be for white students to watch a video where black characters are being mistreated by a white server at a restaurant. then the white students take on the role of the black characters in the video and write a letter to the manager of the restaurant explaining how they were treated, what they felt, the emotions that surfaced, and the thoughts going through their minds. this puts the white students in the shoes of the black character and helps to develop empathy and reduces racial implicit bias. advances in social work, summer/fall 2023, 23(2) 284 interracial dialogue sessions white students who participate in interracial dialogue sessions will likely have a reduction in racist thoughts and implicit bias (nagda & zuniga, 2003). while some white students will feel intimidated by racial dialogue, the benefits outweigh the risks (maxwell & chesler, 2019; neel & shapiro, 2012; paone et al., 2015). in general, white people are not taught to talk effectively about race growing up, and they are afraid of making a mistake or appearing racist (maxwell & chesler, 2019; neel & shapiro, 2012; paone et al., 2015). while having a white-only dialogue group is safe and comfortable for white participants, it does not challenge their internal racist thoughts and feelings (buehler et al., 2021; maxwell & chesler, 2019). being safe and comfortable is a white privilege that allows participants to avoid examining racism from an emotional level (maxwell & chesler, 2019). interacting with racialized people in a setting that allows the white participants to learn about the racialized person (instead of through their stereotypes) is critical in reducing intergroup prejudice (nordstrom, 2015). it should be noted that not all people of color are going to want to talk about their experiences dealing with racism and their preferences need to be respected. but there are some people of color that do want to share their experiences and research says when white people listen to them, it reduces racial bias (nordstrom, 2015). meditation the final empirically-based anti-racism category is meditation. white people who participate in loving-kindness meditation, compassionate transformation, or mindfulness meditation while thinking of people from their out-group (a racialized group to which they do not belong but have an implicit bias) have been shown to reduce implicit racial bias (lueke & gibson, 2015; stell & faresides, 2016; tarakali, 2006). for a loving-kindness meditation, white students are asked to “imagine people who cared deeply for them standing on either side of them, sending them love” (stell & faresides, 2016, p. 143). they are then directed to place “those feelings of love towards a gender-matched black person shown in a photograph in front of them, and then wish them health, happiness, and wellbeing” (stell & faresides, 2016, p. 143). seven minutes of loving-kindness meditation directed towards a person of color was enough to reduce racial prejudice towards that racialized group while increasing controlled, not automatic, processing of racial bias (stell & faresides, 2016). having more racially specific meditation used during the class will be beneficial for the white students in reducing their internal racist thoughts. anti-racism education interventions a review of the literature illuminated the six practice categories that empirically support anti-racism interventions among white students. three different academic interventions, grounded in the six practice categories, are proposed and discussed: an antiracism course, anti-racism practices infused into all msw courses, and a two-day antiracism professional development workshop. due to the nature and content of these interventions, the andragogical teaching and learning approach is suggested versus the use cornell/teaching anti-racism 285 of traditional pedagogical teaching. many of these interventions are designed around dialogue, discussion, critical thinking, and reflection. the andragogy theory of adult learning from knowles resonates as it is the “art and science of helping others to learn” (brown, 2006, p. 707). adult learners want to know why they are learning this specific material and how it can be applied to their real-world practice. as in critical social theory, learners want to learn by continually “reflecting and acting on the transformation of their world so it can become a more equitable place for all to live” (brown, 2006, p. 710). these anti-racist educational interventions function well with this approach. the teaching style of the critical paradigm of learning uses critical questions, circular debates and discussions, hands-on exercises, and minimal lecture which is at the heart of these anti-racism interventions (graham, 1997). the goal is to engage the higher-order thinking skills, the critical thinking of the learners through various modalities and methods. personal development including subject matter comprehension is best engaged through a variety of means (graham, 1997). converting the classroom from a more traditional approach to a circular style will aid in the discussions and dialogue that need to happen to make these interventions effective. anti-racism course a 15-week semester anti-racism proposed course has been created using the six antiracism practice categories (see table 1 for additional details). this curriculum meets the new 2022 cswe epas for diversity and anti-racism. research indicates that having cofacilitators/educators for anti-racism courses is ideal, especially co-educators that are diverse along several social identities/categories (e.g., race, gender, sexual orientation, etc.; buehler et al., 2021; curiel, 2021; garran et al., 2015). co-teaching allows for a more vibrant model of teaching social justice and allows for more than one viewpoint to consider (curiel, 2021; garran et al., 2015). when teaching an anti-racism course for mostly white social work students, one of the co-educators should be white and the other a person of color (buehler et al., 2021; curiel, 2021; garran et al., 2015). white educators should selfdisclose to students certain examples of how they have struggled with their white privilege in their ongoing journey toward being more anti-racist (kordesh et al., 2013; linder, 2015; malott et al., 2021; paone et al., 2015; sue et al., 2009). willing educators of color should discuss with the students their experiences with racism on an individual and societal level. advances in social work, summer/fall 2023, 23(2) 286 table 1. anti-racism course curriculum: evidenced-based weekly topics week topic evidenced-based categories 1 ● ground rules (brave space/calling in) (fuller & meiners 2020; haslam, 2015; lopez-littleton et al., 2018; maxwell & chesler, 2019; nagda & zuniga, 2003) ● what is anti-racism vs multicultural, diversity, equity, & inclusion? ● design a racist community exercise (gonzalez et al., 2021; katz, 2003; lai et al., 2014) ● begin racial autobiography (gooden & o’doherty, 2015) ● teaching methods ● pro-black stories/perspectives ● interracial dialogue 2 ● prejudice, racism, power, discrimination, & oppression ● cultural humility (yeager & bauer-wu, 2013) ● modern-day racism through statistics (berg & simon, 2013; bussey, 2021) ● class/educational group ● teaching methods 3 ● implicit racial bias ● take implicit association test (race iat; devine et al., 2012; ghoshal et al., 2012; morris & ashburn-nardo, 2010; project implicit, 2011) ● iat usage 4 ● critical race theory, racism continuum scale, becoming anti-racist (feize & gonzalez, 2018; gonzalez et al., 2021; kolivoski et al., 2014; lai et al., 2014; maxwell & chesler, 2019; nagda & zuniga, 2003) ● pro-black stories/perspectives ● interracial dialogue sessions 5 ● the real history of the u.s., part 1 (berg & simon, 2013; bussey, 2021) ● class/educational group ● teaching methods 6 ● the real history of the u.s., part 2 (berg & simon, 2013; bussey, 2021) ● class/educational group ● teaching methods 7 ● pro-people of color perspectives ● vivid counterstereotypic scenario (lai et al., 2014) ● taking on out-group perspectives exercise (burant & rios, 2010; castillo et al., 2011; todd et al., 2011) ● pro-black stories/perspectives 8 ● cognitive behavior techniques to reduce racial bias: 5 column thought record & racist thought distortions (berg & simon, 2013; burns, 1980; devine et al., 2012) ● individuating: the voices project (devine et al., 2012; nordstrom, 2015) ● class/educational group ● teaching methods ● pro-black stories/perspectives 9 ● meditations to reduce racial bias (lueke & gibson, 2015; stell & faresides, 2016; tarakali, 2006) ● meditation 10 ● white cultures of england vs african cultures (katz, 2003) ● classic american ideology/white cultural norms & values (berg & simon, 2013; katz, 2003; paone et al., 2015; singh, 2019) ● class/educational group ● teaching methods 11 ● institutional/systemic racism ● design a racist community exercise revisited (burant & rios, 2010; castillo et al., 2011; katz, 2003; todd et al., 2011) ● drawbridge exercise (katz, 2003) ● class/educational group ● teaching methods ● pro-black stories/perspectives 12 ● cultural racism ● shifting group affiliations under threat exercise (lai et al., 2014) ● shifting group boundaries through competition exercise (lai et al., 2014) ● pro-black stories/perspectives 13 ● individual racism: privilege/social categories ● social learning theory (chuang, 2021; hjerm et al., 2018) ● connecting with white culture (berg & simon, 2013; boatright-horowitz et al., 2013; feize & gonzalez, 2018; hayes et al., 2008; heinze & decandia, 2011; linder, 2015; paone et al., 2015; robbins, 2016) ● privilege: privileges for sale exercise (safe zone project, n.d.) ● microaggressions ● class/educational group ● teaching methods ● pro-black stories/perspectives ● interracial dialogue 14/15 ● anti-racism talking points ● self-assessment of anti-racism practices (katz, 2003) ● costs & benefits of being anti-racist ● design an anti-racist community exercise (burant & rios, 2010; castillo et al., 2011; katz, 2003; todd et al., 2011) ● class/educational group ● teaching methods ● pro-black stories/perspectives ● interracial dialogue cornell/teaching anti-racism 287 this gives white students, in particular, a first-hand account of someone experiencing racism which then raises their racial awareness, and leads to mutual understanding and empathy (maxwell & chesler, 2019; nagda & zuniga, 2003). the co-educators set the ground rules for the anti-racism course at the beginning of the semester by creating a “brave space” for the students (lopez-littleton et al., 2018). a “brave space” is different than a “safe space.” a “safe space” is where students are polite and safe which creates a level of comfort for white students (lopez-littleton et al., 2018). change does not happen when there is comfort (singh, 2019). “safe spaces” do not allow for difficult dialogues to take place which is what is needed to have any sort of change happen especially around race (lopez-littleton et al., 2018; maxwell & chesler, 2019). “brave spaces” allow for contrasting and dissenting views to be heard (lopez-littleton et al., 2018). with “brave spaces,” everyone in the class agrees to openness for understanding around race, and to be receptive to their views being challenged (or “called in”) by the co-educators and other students (lopez-littleton et al., 2018). being “called out” is different than being “called in.” when someone is “called out,” the person informs the one being “called out” that their words or actions were not acceptable, and they are being interrupted to avoid further harm (fuller & meiners 2020; haslam, 2015). when someone is “called in” (which is more conducive for the classroom), the one “calling in” a student takes the opportunity to explore a deeper and more meaningful understanding of the person’s racist statements or actions (fuller & meiners 2020; haslam, 2015; nagda & zuniga, 2003). “calling in” focuses on reflection and reaction and provides other perspectives to consider which can lead to productive interracial dialogue (fuller & meiners 2020; haslam, 2015; nagda & zuniga, 2003). perspectives of people of color should be used throughout the semester, through video clips or in-person narratives, to show people of color in a positive light (gonzalez et al., 2021; lai et al., 2014). these can come from students of color in the course (if they are willing), from the co-educator of color, or from outside guests brought in to tell their stories. stories that attribute positivity to people of color are effective in reducing racial bias (lai et al., 2014). in weeks one to two, the co-educators set the stage for the ground rules of “brave space” and “calling in.” students are placed into the shoes of people of color and begin to consider their whiteness through critical thinking and various hands-on exercises. they also learn the current history of racial bias. in weeks three to four, learners will delve into their own racial bias and how racism is systemic through theory and the personal perspectives of people of color. weeks five to six are book-ended by learning the real, racist history of the u.s. building upon their learning in the initial four weeks, students will participate in empirically-based interventions to reduce racial bias in weeks seven to nine. in week 10, white critical self-reflection becomes more in-depth. institutional, cultural, and individual racism through various hands-on exercises and theories are the focus of weeks 11-13. finally, in weeks 14-15, the semester comes to a close with an anti-racist self-assessment and evaluations. anti-racism infusion of the msw curricula masters of social work (msw) curricula should infuse an anti-racism mindset into students by adding the following proposed anti-racism practice interventions into each advances in social work, summer/fall 2023, 23(2) 288 course so that it becomes a major theme throughout the entire msw program (cswe, 2022). by the end of their msw studies, students would have developed and cultivated an anti-racist identity through exposure to empirical anti-racism practices integrated into each msw course (refer to table 2 for specific course examples). table 2. traditional social work (msw) program courses with empirical anti-racist practice interventions course empirical anti-racist practice interventions practice with individuals/ families ● use case studies with specific people of color telling their stories about microaggressions in the practice setting, etc. (e.g., videos, guest speakers). discuss through interracial dialogue. ● use scenarios where students take on the perspectives of people of color in a practice setting. discuss through interracial dialogue. ● take iat for race to discuss their implicit racial bias when working with different racial groups. ● use historical examples of how practice has worked against & for people of color. ● discuss how a practitioner’s white privilege & culture may hinder practice. discuss through interracial dialogue. ● white educator role model’s past racism mistakes. practice with organizations/ communities ● use case studies with specific people of color telling their stories about how they have been affected by systemic racism (e.g., videos, guest speakers). discuss through interracial dialogue. ● use scenarios where students take on the perspectives of people of color involving systemic racism. discuss through interracial dialogue. ● take iat for race to discuss their implicit racial bias when working with different racial groups. ● use historical examples of how practice has worked against & for people of color. ● discuss how a practitioner’s white privilege & culture may hinder practice. discuss through interracial dialogue. ● white educator role model’s past racism mistakes. theory ● use critical race theory (crt) to discuss systemic racism & emphasize the tenet of listening to the voices of people of color. ● use case studies from people of color discussing when a practitioner used the foundation of crt to assist them. discuss through interracial dialogue. ● discuss how cognitive behavior theory can be used as an anti-racism intervention. ● examine social learning theory as a way that americans are socially conditioned to racist thoughts & actions. social justice ● use scenarios where students take on the perspectives of people of color such as the “drawbridge exercise,” “privilege for sale,” etc. discuss through interracial dialogue. ● use “the voices project” for students to interview & present a person of a different race. ● teach the real racial history of the u.s. ● take iat for race to discuss their implicit racial bias when working with different racial groups. ● white educator role model’s past racism mistakes. ethics and behavior ● use racism-based case studies of ethical dilemmas where the student takes on the role of the person of color. discuss through interracial dialogue. ● white educator role model’s past racism mistakes. social policy ● use “design a racist community” exercise & discuss which policies, past, & present, contribute to racism. discuss through interracial dialogue. ● use historical examples of how race-based policies have worked against & for people of color. cornell/teaching anti-racism 289 course empirical anti-racist practice interventions practicum ● conduct anti-racism assessments on practicum organizations to evaluate their anti-racism policies & practices. research methods ● use research articles involving anti-racism interventions as examples of certain types of research. ● use historical examples of how race-based research has worked against & for people of color. psychopathology ● use case studies to show the mental health disparities that people of color encounter especially around certain cultural diagnoses. discuss through interracial dialogue. ● role-play scenarios where the students take on the role of a person of color & how they are met with racist disparities. discuss through interracial dialogue. assessment and treatment ● use case studies to show the mental health disparities that people of color encounter. discuss through interracial dialogue. ● role play scenarios where the students take on the role of a person of color & how they are met with racist disparities. discuss through interracial dialogue. ● use anti-racism meditation as an intervention method. ● discuss how cognitive behavior therapy can be used as an anti-racism intervention. ● use historical examples of how race-based treatment has worked against & for people of color. ● discuss how a practitioner’s white privilege & culture may hinder assessment & treatment. discuss through interracial dialogue. ● white educator role model’s past racism mistakes. when possible, educators can discuss the interventions through interracial dialogue with the students in the course. in addition, white educators can self-disclose their past racism mistakes to encourage students to do the same (kordesh et al., 2013; linder, 2015; malott et al., 2021; sue et al., 2009). using specific case studies (from videos or books) with people of color in which they voluntarily tell their stories would be beneficial in promoting interracial dialogue in many courses. scenarios where students take on the perspectives of people of color in various social work settings will help to enlighten white students about the plight endured by people of color. adding the iat for race into various courses can help put the students’ racial bias in context. since the teaching of the true, racist history of the u.s. has been lacking in school settings, any opportunity an educator can find to discuss a relevant racial historical example for a particular course is encouraged. adding theories such as critical race theory, social learning theory, critical action learning, and cognitive behavior theory to various courses where appropriate can emphasize how americans were conditioned to racism and how to begin to unlearn it. with some creativity, anti-racism practices can be blended into every msw course (refer to table 2 for course-specific examples). two-day anti-racism professional development workshop the final academic intervention is a two-day anti-racism professional development/community workshop which is currently being facilitated by the author. all of the components of the anti-racism course are used but condensed drastically to fit into a two-day (14-hour) workshop. the topics from the course will be discussed but will not be as in-depth as within the semester-long course. as with the anti-racism course, two advances in social work, summer/fall 2023, 23(2) 290 facilitators/educators are encouraged to give more robust viewpoints toward social justice teaching. all six empirical practice intervention categories are incorporated into the workshop for two seven-hour sessions. participants will be exposed to the basic principles of each category and how to integrate them into their professional and personal lives to begin to develop an anti-racist mindset. ceus are encouraged to be offered through professional licensure boards. this workshop could also be a prerequisite to entering the msw program if there is not an anti-racism course in the curricula. in addition to professional development, this workshop can be utilized with community organizations (e.g., government, local businesses, schools, large companies, etc.) to educate members of these institutions within the community, thus making the dissemination of this knowledge ubiquitous. conclusion these interventions add to the growing body of literature on anti-racist social work education. more research will need to be conducted to see if the proposed course/curriculum guide/workshop can be found to have evidence of statistically significant positive impact in and of themselves. social work education and practice have come a long way since its founding, but they still has a long way to go. decolonization and disrupting its ingrained whiteness is the correct path to begin fulfilling the important social work values of equity, justice, and diversity. taking a step further to enact anti-racism courses, workshops, and the msw anti-racism curriculum guide directs social work into a new phase of fairness, integrity, and authenticity. to fully assist people of different races and ethnicities, integrating education to have a more anti-racist mindset is the inevitable and socially just route. tascon and ife (2020) stated, “to have been part of the problem but then to refuse to be part of the solution, is, to me, morally irresponsible” (p. 26). may educators and instructors be part of the solution and not hold back the social work profession any longer. references abrams, l. s., & gibson, p. 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(2020, june 8). i’m your black friend, but i won’t educate you about racism. that is on you. the washington post. author note: address correspondence to dr. dennis cornell, school of social work, indiana university southeast, new albany, in, 47150. email: dennis@antiracism4u.com https://doi.org/10.1080/19496591.2016.1143834 https://doi.org/10.1080/19496591.2016.1143834 https://thesafezoneproject.com/activities/privilege-for-sale/ https://doi.org/10.1080/02615479.2019.1592148 https://doi.org/10.1080/02615479.2019.1592148 https://doi.org/10.1080/02615479.2019.1592148 https://doi.org/10.1007/s11031-015-9514-x https://doi.org/10.1007/s11031-015-9514-x https://www.insightintodiversity.com/ethnic-studies-and-racial-justice-courses-become-more-popular-benefiting-all-students/ https://www.insightintodiversity.com/ethnic-studies-and-racial-justice-courses-become-more-popular-benefiting-all-students/ https://doi.org/10.1177/0011000009340443 https://doi.org/10.1177/0011000009340443 https://doi.org/10.4324/9780429284182 https://doi.org/10.1037/a0022308 https://doi.org/10.1037/a0022308 https://doi.org/10.1016/j.apnr.2013.06.008 https://doi.org/10.1016/j.apnr.2013.06.008 https://doi.org/10.1111/soc4.12658 https://doi.org/10.1111/soc4.12658 https://www.washingtonpost.com/outlook/2020/06/08/black-friends-educate-racism/ https://www.washingtonpost.com/outlook/2020/06/08/black-friends-educate-racism/ mailto:alex.redcay@millersville _________ beverly a. wagner, assistant professor, department of social work, texas woman’s university, denton, tx. sharon bowland, associate professor and director of the dsw program, university of tennessee, knoxville, tn. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 219-232, doi: 10.18060/25236 this work is licensed under a creative commons attribution 4.0 international license. using a flipped classroom approach to teach research: case examples from a bsw and a msw course beverly a. wagner sharon bowland abstract: challenges abound in assisting social work students to comprehend the value of scientific inquiry and to use research to inform their practice. student research anxiety and low levels of research confidence are often at the heart of this reluctance. this article offers a conceptual rationale and strategies for developing a flipped classroom approach in teaching research. kolb’s experiential learning cycle provides a theoretical lens to understand the importance of hands-on experiences for student learning and how these experiences can assist student development of research-related competencies. the authors propose a conceptual model and application of kolb’s cycle through case examples at both the bsw and msw levels. the authors recommend application of a flipped classroom approach to increase opportunities for self-paced learning and as a useful strategy for students who are second language learners. keywords: social work research, experiential learning, flipped classroom approach, evidence-based practice, second language learners despite the council on social work education (cswe) mandate on research competency, assisting social work students to use research to inform their practice and to draw from practice to inform empirical inquiry remains an ongoing challenge for social work educators (maschi et al., 2013; vinjamuri et al., 2017). common struggles are lack of interest in social work research and research-related anxiety (natland et al., 2016). student anxiety that presents upon beginning a research methods course can be detrimental to student-learning (maschi et al., 2013). while students from other disciplines also experience this phenomenon, some studies point to higher levels of research-related anxiety among social work students based on students’ low confidence in their research abilities (maschi et al., 2013; natland et al., 2016). low confidence and high anxiety often result in the marginalization of research as merely an academic exercise as opposed to a critical practice competency. this suggests the importance of effective teaching strategies that lower anxiety and increase engagement. research courses do appear to positively impact student research competencies, but teaching strategies are needed to enhance student confidence (unrau & grinnell, 2005; venema et al., 2015). strategies that deliver hands-on experiences may help reduce student anxiety by providing opportunities for real-world exposure. kolb's theory of experiential learning emphasizes the importance of hands-on learning or experience that are “translated through reflection into concepts, which in turn are used as guides for active experimentation” (healey & jenkins, 2000, p. 186). a flipped classroom approach offers a structure to implement kolb’s experiential learning cycle, which can assist students in understanding, using, and ultimately conducting research. about:blank advances in social work, spring 2022, 22(1) 220 a flipped classroom or inverted approach is a pedagogical strategy where traditional content taught in the class, often through lecture, is moved outside the classroom and delivered online (bergmann & sams, 2012). in a flipped classroom, students are able to engage in self-paced and autonomous learning prior to coming to class and then apply this learning in class through active learning techniques. this frees synchronous online or faceto-face class time to be used for collaborative group work and other application activities. while the flipped classroom approach has consistently been a popular pedagogical approach within education and stem courses, less is written about its use in social work and more specifically in social work research courses (bishop & vergler, 2013; holmes et al., 2015). in this paper, two social work educators share case examples of using a flipped classroom model at both the bsw and msw levels. differences and similarities in how kolb’s learning cycle approach was adapted are offered, as well as recommendations and implications for social work research education. literature review students’ experiences in traditional research courses as students enter both social work undergraduate and graduate education, there is evidence that requirements to complete a research course generates anxiety and distress (adam et al., 2004; green et al., 2001; maschi et al., 2013; whipple et al., 2015). anxiety includes student experiences of fear, anxiety, and avoidance related to learning research methods (maschi et al., 2013). green et al. (2001) found that compared with other disciplines, social work students exhibited more anxiety about research and ascribed a lower value to research knowledge for the profession. this included anxiety upon reading a research text or interpreting study results. other investigators traced the historical roots of student reticence to embrace research to the development of the profession itself (adam et al., 2004). critics of social work have repeatedly challenged that social work cannot be a profession without a commitment to draw from a theory base, use systematic methods in their work with clients, employ research evidence, and evaluate their practice (adam et al., 2004). however, this recognized need for an empirical research base may have unintentionally created situations where educators dogmatically embraced the value of research and left out the inherent tensions between research and practice. adam et al. (2004) suggested that traditionally there has been a lack of attention to embracing student skepticism and anxiety as valid, and factoring this into the teaching process. indeed, teaching the evidence-based practice process (ebpp) is more recently viewed as a correction for an overly rigid embrace of the value of research without considering practice wisdom and client preferences (okypych & yu, 2014). maschi et al. (2007) reported using an array of activities in the classroom, including discussing student anxiety (emotion-focused strategies), relating research to students’ current lives (cognitive-focused activities), and having the students complete several hands-on assignments (action-focused strategies). using a different approach, whipple et odera et al./de-centering whiteness 221 al. (2015) completed focus groups with students in their school who chose to complete a student research project. students reported that they struggled more with the uncertainty of what would be required of them and did better when they had clear tasks and steps to accomplish. students in the whipple et al. study felt strongest in their abilities when they were completing focus groups or data analysistasks with clear outcomes, rather than literature reviews, where they struggled to develop a bigger picture perspective on the research area. multiple studies confirm that students learn the most about research and have the best attitudes about it when their learning is enriched by hands-on experiences (green et al., 2001; maschi et al., 2007; whipple et al., 2015). employing a flipped classroom approach even as technology applications and the use of novel pedagogical approaches such as a flipped classroom have rapidly increased in higher education, there is a dearth of literature on the use of a flipped model within social work research courses (robbins et al., 2016). one of the only examples of using a flipped classroom within an undergraduate social work research course was matich-maroney and moore’s (2016) exploratory qualitative study that included research teams and readings plus short videos viewed outside of class. the investigators emphasized that empowering students to apply readings during class time assisted them in building research knowledge and skills. within research courses in other disciplines, van der zwan and afonso (2019) noted that the outcome of their blended flipped research course was improved assessment scores. use of active learning techniques and opportunities for feedback provided a structured flexibility during face-to-face and synchronous learning that they found positively benefited student learning (van der zwan & afonso, 2019). this finding was similar to doi (2016) who noted that the flipped approach worked particularly well for “addressing aspects of creativity and hands-on learning” (p. 116) in a music research methods course. in contrast, nouri (2016) found that it was actually the video lectures and the opportunity for students to rewind and review lectures that provided students, particularly low achieving students, with the opportunity to succeed. self-pacing was identified as the most positive aspect of a flipped classroom in this study. finally, blazquez et al. (2019) found that social work students enrolled in a randomized trial had higher academic achievement in a group work course when compared with a traditional lecture course. theoretical framework kolb’s (1984) theory of experiential learning emphasizes the importance of experiences and active engagement in learning. moreover, it also highlights the diversity of the learner through emphasizing the importance of their personal and unique involvement and experiences in the learning process (healey & jenkins, 2000; svinicki & dixon, 1987). experiential learning in social work research methods courses increases success in making connections between theory and practice. in courses that are concept dense such as research, venema et al. (2015) argued, “to successfully bridge the knowledge learned in the classroom to research practice—a key goal in competency-based advances in social work, spring 2022, 22(1) 222 education—it is important to understand the effectiveness of a more hands-on approach” (p. 475). in kolb’s four-stage model, learners first engage in a variety of experiential learning methods such as problem-based learning, project-based learning, learning by doing, service learning, and/or collaborative learning (healey & jenkins, 2000). the first stage, concrete experimentation, often happens during synchronous or face-to-face class time (thuente & batteson, 2016). learners are then asked to reflect on their learning, so they can assess and examine their experiences. the second stage, reflection, may begin during class and can include instructor feedback and group discussions, but could extend to the digital environment with the use of thought questions. a key to reflection is encouraging its continuous use (cheung & delavega, 2014). from these initial experiences and reflections, learners draw conclusions that build on or contradict their previous experiences. abstract conceptualizations or explanations of learning can be further formulated through video lectures outside of class, readings, and reporting and/or processing group activities during class. during this phase, the learner makes links between abstract knowledge and practice (cheung & delavega, 2014). finally, these new and integrated conclusions guide future decisions, and shape new behaviorsand actions (svinicki & dixon, 1987). these can culminate in final projects or active experimentation where the social work student applies knowledge by “creating new interpretations or dimensions to the knowledge or skills that are now integrated” (cheung & delavega, 2014, p. 1072). while course activities could be used to support each phase of kolb’s cycle, a structure optimally provides for the cyclical use of these activities and ensures their consistent application. a structure for the active learning cycle: the flipped classroom approach a flipped classroom approach is an instructional strategy that offers a functional structure for kolb’s active learning cycle and practical application of experiential learning (natland et al., 2016; venema et al., 2015). the flipped classroom approach typically has two components: active learning strategies during class and digital individual instruction outside of class (bishop & verleger, 2013). interactive group learning inside the class, for example, provides opportunities for the concrete experimentation portion of the active learning cycle. in one of the few studies on social work flipped classrooms, holmes et al. (2015) emphasized “the flipped classroom contrasts with the traditional teacher-centered approaches and embraces collaborative student active learning” (p. 216). in-class time is often used for concrete activities and for active experimentation, collaboration, and reflection. the instructor adopts a stronger facilitative role, meeting with groups, and individually with students to provide feedback and encourage reflection informally or through small or large group discussions. reflection can also include formal activities such as reflective reports. sage and sele (2015), for example, used a flipped classroom approach in undergraduate, social work, generalist courses to encourage reading and reflections on readings through the use of online reflection reports. while abstract conceptualization or the ability to explain learning, can be built in during class activities, it is also a potential outcome of digital, autonomous learning (svinicki & dixon, 1987). the traditional lecture is often moved to online spaces and odera et al./de-centering whiteness 223 provides distinct benefits to students. for example, students may benefit in challenging courses such as research methods, from the ability to self-pace their learning. with this approach students have the opportunity to review portions of their learning that may not be clear or in need of further review (bergmann & sams, 2012; han, 2015; wagner & bogiages, 2020). this is particularly beneficial for a variety of student learning needs. for example, students who are learning in a second language, students with learning differences, or students who need additional time in understanding complex concepts benefit from digital, autonomous learning (bergmann & sams, 2012; wagner & bogiages, 2020). additionally, online lectures are typically chunked or drilled down to their salient points, assisting students with making links to course concepts (arnold-garza, 2014; matich-maroney & moore, 2016). indeed, studies indicate that online lectures can be more effective than in-class lectures (holmes et al., 2015). students view lectures or participate in other online activities prior to coming to class. kolb’s final segment of the active learning cycle is active experimentation, where students apply concepts or as hoffman (2014) explained, students practice the skill we want them to develop. final or culminating active learning research projects engage students in all phases of the research process. interactive class time can provide the space and opportunity to garner instructor feedback for project development. yet, an important component of final social work research projects includes their practical application to broaden student understanding of what is often perceived as only an abstract undertaking (zeitlin, 2018). as zeitlin argues, when students are engaged in creating a final project “the connection between research and practice may seem less remote” (p. 569). thus, final projects could include research projects or proposals in an area of research interest or community-based research projects. when considering competency-based social work education, a flipped approach provides a promising structure and route to implement an active learning format that assists students in mastering the council on social work education (cswe) research competency: “engaging in practice informed research and research informed practice” (cswe, 2015, p. 8; matich-maroney & moore, 2016). in the following case examples, we illustrate the use of a flipped classroom approach and active learning format with social work students enrolled in one bsw and one msw course. flipped classroom approach in research methods courses: case examples setting assisting students with gaining practical, hands-on experience in social work research was a goal of two social work educators teaching research methods within one bsw and one msw course. although the two instructors taught at different north texas public universities, the msw program was a joint program between their institutions. the bsw program historically offered one required research course. past issues included a lack of faculty qualified to teach this course, so professors from outside the department or adjunct instructors taught it. the research methods course offered in the joint msw program was offered in the generalist track, or to students entering the msw program who did not have advances in social work, spring 2022, 22(1) 224 a bsw or a masters’ degree from other disciplines. challenges for the msw course included the range and diversity of previous research experiences of students, with some students having little to no research knowledge. others coming from outside disciplines had previously completed joint or group research projects. both instructors had prior experiences with implementing experiential learning projects and some or all of kolb’s active learning cycle within social work research methods courses. moreover, both instructors identified challenges given the diversity among student learners’ previous experiences with research and the time needed to help students understand research concepts. when discussing these challenges, they agreed to use a flipped classroom approach because it is a pedagogical model that offers an active learning structure and helps to “emphasize the link between research and practice” (natland et al., 2016, p. 49). retrospective faculty observations bsw flipped classroom approach the bsw research course was developed using a hybrid model with students attending class one time per week (1 hour 20 minutes) and completing online assignments (including discussion boards) for a second weekly class session. the in-class session was originally conceptualized as a lecture/discussion. class size was 42 students and was held in a theater style lecture hall. this required course was often students’ first exposure to research of any type and there was wide variation in the interest of students in the course, including those who were curious about the subject matter, those who acknowledged they did not comprehend the concept of research, and those who viewed the course as an obstacle to be surmounted. during initial interactions in class, some students identified concerns that research was disconnected from their real-world experiences. to make the course more relevant and experiential, the instructor implemented a flipped classroom approach by completing panopto powerpoint video lectures for review before each class session. classes employed experiential and collaborative learning in small groups to learn the evidence based practice process (ebpp). exercises completed in real time included: developing classroom groups with various practice interests, creating a research question based on research interests, participating in a sampling exercise, searching the literature for evidence-supported treatments (ests), applying criteria to evaluate both quantitative and qualitative research studies, reporting the results of an interview held with an expert in their interest area, triangulating the data from the literature review with the expert practitioner interviews, searching the public domain for assessment measures, critiquing a survey measure, and completing a literature review project in an area of their own interest. during the project each student formulated a research question in consultation with the instructor and their own small group, and secured feedback from the small group over several weeks to develop a powerpoint presentation and final paper. at the end stage the student presented their findings to their small group with discussion of applicability of the findings to their own practice. table 1 depicts examples of classroom experiential learning activities. odera et al./de-centering whiteness 225 table 1. bsw flipped classroom experiential learning examples bsw examples and activities • develop classroom groups focused on similar practice interests. these groups become the working groups for classroom activities, literature critiques and final presentations. • formulate individual research questions in consultation with group and instructor. • participate in a sampling activity. • engage in a personal literature review and engage in peer critiques in the classroom work group. • apply established criteria to evaluate sample quantitative and qualitative research studies. • search the public domain for assessment measures and critique a survey measure. • conduct interviews with an expert in student interest area and report results to peers. triangulate the data from the literature review with expert practitioner interview. • receive feedback from peers (small groups) over a period of several weeks to develop a powerpoint presentation and final research paper. • student presentation of findings in small groups includes student-led discussions of applicability of findings to practice. msw flipped classroom approach the msw research course began as a modified flipped course using kolb’s active learning cycle. a three-hour, face-to-face course met once a week with a class size of 23 students. the course was initially designed to accommodate active learning strategies with some instructor lectures during class. student experiences with research ranged from students who had previously written a thesis or participated in group research projects to those students with no previous history of taking research courses. during the seventh week of a fifteen-week semester, the msw instructor implemented an informal classroom assessment, in which students were asked to anonymously provide informal feedback (brookfield, 2017). the overwhelming student feedback was feeling distanced during the micro lectures, or the opposite, asking for more time spent on the lecture and concept explanations. thus, students had very different responses. after a class discussion, the instructor placed lectures online using panapto powerpoint video lectures. this provided students with more autonomy in determining how much time to spend on the lectures, and provided students who were asking for more explanations the opportunity to stop, rewind, and re-listen to portions of the lecture that they needed more time to understand (bergmann & sams, 2012; nouri, 2016). class time was structured in the following way. during the first hour of class, students worked collaboratively in groups on different weekly research topics to assist them in becoming users of research. literature critiques provided the basis for these activities, and student groups focused on segments of the research process highlighted in assigned readings. the second hour included other collaborative or experiential activities that aligned with the weekly modules such as peer and group critiques of student research questions and proposal topics, searching the public domain for assessment measures and critiquing them, and practice with research software. the final portion of class was advances in social work, spring 2022, 22(1) 226 designated for small groupwork sessions in which students answered questions based on the week’s readings. later in the semester, additional active learning time was also used to provide peer and instructor feedback for the student’s final project: a research proposal in their area of interest. this final project was designed to assist students in becoming developers of research. throughout the semester, students worked on drafts of different stages of their proposals and had opportunities to receive extensive feedback from their groups and the instructor. this culminated in a final research proposal class presentation. table 2 depicts examples of the msw flipped classroom experiential learning activities. table 2. msw flipped classroom experiential learning examples msw examples and activities • develop classroom groups randomly. • group literature review critiques corresponding to readings and focused on weekly research topics. • class reflection of group critiques in which groups describe their readings and their conclusions. • group critique of member research questions, proposal topics and methodology. • search the public domain for assessment measures and critique these measures. • interview a peer during class and transcribe the interview. • lab practice using spss and nvivo. • weekly group written assignments based on the readings. • create a research proposal in an area of interest and present the proposal to the class. figure 1 provides an illustration of kolb’s active learning cycle and activities that could support each segment of the cycle (p. 9). discussion blazquez et al. (2019) argued that social work professors’ pervasive reliance on traditional and didactic approaches makes them ineffective in helping students see the relevancy of research in applying learning to real world problems. moreover, they provided initial evidence that experiential learning techniques can positively impact student learning in social work courses and specifically in social work group work courses (blazquez et al., 2019). in order to do this in a content heavy course, however, something has to give. giving students the opportunity to review lecture content before class reserves the time in class for experiential learning. providing hands-on experiences to apply research knowledge and skills, increases student insight into the links between research and practice, and develops student research capacity (natland et al., 2016; whipple et al., 2015; zeitlin, 2018). moreover, vinjamuri et al. (2017) emphasized the importance of thoughtful teaching strategies as a primary component in fostering positive student attitudes toward research. in particular, using experiential strategies during class can potentially increase student confidence and encourage them to use evidence-based research in practice. odera et al./de-centering whiteness 227 adapted from kolb (1984) and openlearn (2022) kolb’s active learning cycle provides a lens and framework for understanding the role and steps involved in active learning. it follows then that courses need a structure for relevant active learning experiences. a flipped classroom model provides this type of structure with added benefits of offering students autonomy in pacing their learning. the following recommendations provide guidance for designing a flipped social work research kolb's active learning cycle concrete experimentation bsw: sampling activity & conducting interviews with experts msw: group literature critiques & group research question critques reflection bsw & msw: large group discussions, feedback & reflection during small group work abstract conceptualization bsw & msw: self-paced autonomous learning in a digital environment active experimentation bsw: literature review & application to practice msw: research proposal in area of interest figure 1. kolb’s active learning cycle implemented within a bsw and msw course advances in social work, spring 2022, 22(1) 228 course that implements the four phases of kolb’s active learning cycle. these recommendations could be implemented at either the bsw or msw level of instruction. recommendations students may need an orientation to assist them in understanding expectations and acclimating to a research course that uses a flipped classroom approach (findlaythompson & mombourquette, 2014; wagner & bogiages, 2020). a standardized online course design that is easy for students to navigate and is structured in a way that students know what to expect each week benefits a diverse range of learners. activities in class can assist students in becoming both users of research (e.g., through critiquing research articles, developing research questions, sampling activities, and library activities and speakers) and developers of research (e.g., through culminating research projects). table 3 highlights some key recommendations for flipping bsw and msw research courses. these recommendations can be utilized for hybrid, face-to-face, and online courses with remote, synchronous components. table 3. recommendations for bsw/msw flipped research courses recommendations • implement an orientation at the beginning of a flipped research course that includes expectations for face-to-face/synchronous and online learning. this could include online navigation and other technology guidance. • provide a standardized online course design and in-class schedule, so students know what to expect each week. • create shorter, micro lectures to assist students in understanding the salient points. this provides students with a diverse range of learning styles to gain a deeper understanding of the material. students watch lectures outside of class so they come to class prepared to engage in activities. • develop methods for holding students accountable for viewing online lectures and/or readings. these include low risk quizzes or discussion boards (matich-maroney & moore, 2016). • provide active learning strategies that assist students in becoming users of research such as learning research vocabulary. this could include small group work critiquing the literature and/or discussing the use of evidence-based interventions in practice. • provide active learning strategies that assist students in becoming developers of research. this could include final group or individual projects in areas of interest or connected to community agencies. • the more facilitative role of the instructor provides increased opportunities for feedback. feedback is essential to assisting students in gaining research competency. implications for teaching social work research using a flipped classroom approach provides social work students with opportunities for self-paced learning, enabling them to take the time needed to comprehend concepts. students are in charge of using their time actively in class to advance their skills in a subject that often evokes anxiety and uncertainty. in research courses where vocabulary and concepts are more likely to be new or complex, this is an added benefit. this may be odera et al./de-centering whiteness 229 especially true for students who need multiple exposures to master concepts. furthermore, this on-demand access provides students with the time needed to understand research concepts and develop a new vocabulary necessary to engage in effective practice and evaluation of practice. utilizing class time for active and experiential learning assists students in making connections between their online learning and practical application of this learning (bergmann & sams, 2012). nouri (2016) speculated that the flipped classroom approach was a teaching strategy that empowered students, particularly those who had academic challenges. a key benefit of using a flipped classroom approach is its versatility in meeting the learning needs of a wide range and diversity of learners. both university settings for this project were hispanic-serving institutions where there were greater numbers of students learning in a second language. students learning in a second-language may experience problems keeping up with the pace of a traditional lecture due to language-related challenges (wagner & bogiages, 2020). while this approach can benefit students whose primary language is not english, it can also benefit students who have academic challenges or those who find research courses especially unfamiliar. nevertheless, the flipped classroom approach does require additional commitments outside of class. informal and formal msw course surveys administered by the msw instructor and the instructor’s university indicated that some students did not like the outof-class commitment to watch video lectures and preferred in-class lectures. other studies have reported similar student perceptions of increased workload in a flipped class, while some research has emphasized differences across groups in student perceptions of online lectures (findlay-thompson & mombourquette, 2014; nouri, 2016). nouri (2016) found that students who were low achievers had more positive attitudes towards video lectures than high achievers due to the flexibility of being able to slow down and review the lecture as needed. students also experience difficulties in making connections between online and in-class activities, thus it is important to clearly align and connect face-to-face and online portions of a flipped classroom (kim et al., 2014). informal class teaching assessments indicated that some students desired additional in-class explanations of weekly concepts. the instructor addressed concerns by incorporating micro-lectures and a review of concepts in real time. competency in understanding how to apply research evidence in practice and in evaluating one’s practice is one of the cswe competencies for both undergraduate and graduate education. hands-on learning, then, also becomes possible in the flipped classroom and can energize students. a predictable course layout is replaced with active learning, and students may look forward to a class environment where they can engage in a non-threatening dialogue with peers about research. during experiential exercises they are thrust into the problem-solving role rather than assuming a passive role where professors are the sole source of disseminating information. professors become facilitators of learning rather than dispensers of knowledge, and their classes become opportunities for exploration and discovery (bergmann & sams, 2012). a final insight that emerged from the authors’ work with this teaching method, with implications for teaching research, is the importance of addressing the gap between research and practice. students intuitively perceive this gap and need to grasp why research is so critical for effective practice. advances in social work, spring 2022, 22(1) 230 rethinking how we teach research will likely serve to increase the number of graduates who apply the evidence-based practice process in their work. references adam, n., zosky, d., & unrau, y. 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(2020). using culturally responsive teaching to adapt a flipped class for undergraduate, emirati learners, journal of teacher action research, 7(1), 126-146. http://www.practicalteacherresearch.com/uploads/5/6/2/4/56249715/using_culturally_r esponsive_teaching_to_adapt_a_flipped_class.pdf whipple, e., hughes, a., & bowden, s. (2015). evaluation of a bsw research experience: improving student research competency. journal of teaching in social work, 35(4), 397-409. https://doi.org/10.1080/08841233.2015.1063568 zeitlin, w. (2018). teaching note-innovations in teaching research: learning by doing. journal of social work education, 54(3), 568-575. https://doi.org/10.1080/10437797.2018.1434429 author note: address correspondence to beverly wagner, school of social work, psychology and philosophy, texas woman's university, denton, tx, 76204. email: bwagner4@twu.edu https://doi.org/10.1080/10437797.2016.1218222 https://doi.org/10.1080/10437797.2015.1076274 https://doi.org/10.1080/87567555.1987.9925469 https://pubmed.ncbi.nlm.nih.gov/29504014/ https://doi.org/10.1080/02615470500185069 https://doi.org/10.1017/s1049096519000581 https://doi.org/10.1080/08841233.2015.1087934 https://doi.org/10.1080/02615479.2017.1362379 http://www.practicalteacherresearch.com/uploads/5/6/2/4/56249715/using_culturally_responsive_teaching_to_adapt_a_flipped_class.pdf http://www.practicalteacherresearch.com/uploads/5/6/2/4/56249715/using_culturally_responsive_teaching_to_adapt_a_flipped_class.pdf https://doi.org/10.1080/08841233.2015.1063568 https://doi.org/10.1080/10437797.2018.1434429 mailto:bwagner4@twu.edu microsoft word 15_kennedy_25335_one_and_done _________  teri kennedy, phd, msw, acsw, fgsa, fnap, associate dean and professor, university of kansas school of nursing, professor, department of population health, university of kansas school of medicine, the university of kansas medical center, kansas city, ks. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1316-1333, doi: 10.18060/25335 this work is licensed under a creative commons attribution 4.0 international license. avoiding one and done: development and application of a model to sustain interprofessional practice and education initiatives teri kennedy abstract: this article presents the development of the kennedy model of sustainability (kennedy model), a research-based model of sustainability, and its subsequent application to interprofessional practice and education (ipe) initiatives. the national mixed methods, multiple case study of geriatric education centers that led to the development of the model and resulting four core components of sustainability and related strategies is described. the model is discussed in the context of implementation science and the know-do gap and applied to an ipe initiative and center. finally, implications for further research are presented including opportunities to incorporate the model as a valuable tool in implementation science. application of the kennedy model to ipe initiatives has provided opportunities for model testing, supporting the model’s core components, and providing additional strategies to foster sustainability of ipe initiatives. keywords: implementation science, interprofessional practice and education, ipe, knowdo gap, sustainability the nearly fifty-year long and winding road of interprofessional practice and education (ipe) has been paved with good intentions and worthy grant-funded projects and initiatives that have not been sustained (national center for interprofessional practice and education [national center], 2017). numerous barriers to sustainable ipe efforts persist (brandt, 2015; djukic et al., 2012; lawlis et al., 2014). ideally, “sustainability must be prepared in advance, concomitantly with implementation” (pluye et al., 2004, p.121), yet planners of ipe projects and initiatives lack a research-based model and tested strategies to successfully pursue sustainability. this article describes the kennedy model of sustainability (kennedy model), a practical, research-based model of sustainability originally developed through a national mixed methods, multiple case study of geriatric education centers (gecs). a brief description of the original gec research and resulting four core components of sustainability and related strategies are explained, followed by a discussion of the model in the context of implementation science and the know-do gap. the model is then applied to the development of an ipe initiative and center. finally, opportunities and implications for further research embracing an implementation science perspective is presented. the kennedy model was officially adopted by the national center for interprofessional practice and education (national center) in 2017 to support the sustainability of national ipe initiatives (brandt et al., 2019; national center, 2017). kennedy/avoiding one and done 1317   background the kennedy model of sustainability had its origins in a doctoral dissertation exploring geriatric education centers (gecs) and their pursuit of sustainability (kennedy, 2008), and was later published as a book (kennedy, 2009). gecs were established to promote and deliver interdisciplinary geriatric education and training for more than 35 health profession disciplines including social work, nursing, pharmacy, medicine, and dentistry (kennedy, 2008), and charged with the goal of becoming self-sustaining beyond the initial period of funding. the health resources and services administration (hrsa), which funded the national initiative, required grantees to provide a plan for sustainability. this requirement was notably unique among federally funded programs of the time. the goal of sustainability was to maintain the structure and activities of gecs beyond the period of hrsa funding. despite this charge, there was no established model for gecs to successfully plan for sustainability. further, health professions education did not prepare gec faculty for the entrepreneurial activities that might facilitate sustainability (l. phillips, personal communication, june 16, 2004). directors of new gecs sought guidance through mentoring with directors of more experienced centers (kennedy, 2008), yet those directors similarly lacked a research-based model of sustainability to guide their efforts. a national mixed methods, multiple case study of gecs sought to define and explore the concept of sustainability and examine gecs’ pursuit of sustainability over time (kennedy, 2008). after obtaining human subjects’ approval from the doctoral-granting university and assuring compliance with standards for informed consent, structured interviews were conducted to explore the definition and concept of sustainability with 13 administrators, business and fiscal officers, faculty, and advisory board members of seven publicly funded gec sites across three regions. interviews included leadership representing two national gec organizations: the national association of geriatric education centers (nagec) and the national association of geriatric education (nage). in addition to interviews, gecs’ pursuit of sustainability was explored through on-site observations; in-depth document analysis of publicly available uniform hrsa longitudinal and fiscal data, and related programmatic reports, and financial analysis of changes in gec administrative structure, managerial capacity, and revenue streams. a multiple case study approach facilitated concentration on sustainability as a specific condition and identification of interactive processes essential to the success or failure of an initiative (bell, 1999). grounded theory, utilizing both qualitative and quantitative data, fostered examination of a phenomenon about which little was known at the time and generated data-grounded results (tie et al., 2019). this deductive process facilitated a thematic content analysis of the topic of sustainability informed by open and axial coding techniques to move from concept to categories (strauss & corbin, 1998). the content analysis resulted in the identification of a sustainability model containing four core components and related strategies. the components included maintenance of mission and activities, institutionalization of organizational infrastructure, community visibility, and strategic response to change. each component is defined below and presented along with related strategies to foster sustainability. the model is then considered in relation to implementation science and the know-do gap. advances in social work, fall 2021, 21(4) 1318 kennedy model of sustainability four components and related strategies to foster sustainability each of the four components of sustainability resulting from the study of gecs is defined in figure 1. importantly, sustainability is not just about a stable funding base, but involves a comprehensive approach that creates a culture, structure, network, and environment to support sustainability of initiatives. figure 1. kennedy model of sustainability   (kennedy, 2008) it is essential to think of the four components of the kennedy model not as isolated parts but as a suite of interrelated, multiple paths toward sustainability. additionally, the study of gecs identified specific strategies related to each component designed to foster sustainability of geriatric education initiatives (see table 1). each core component and related strategies will be briefly summarized, with specific examples derived from the study of gecs. the relevance of each of the four core •become "the source"  for information and  therefore integral to the  culture of both the university  and broader academic and  practice communities over  time.  •ability to maintain  operations and structurally  morph, as needed, to  maintain activities in the  midst of change.  •existence and  institutionalization of  sufficient fiscal support for  space, positions, and  administrative support to  provide a framework  within which operations  can effectively  function.  •ability to maintain the focus  of the mission and related  activities with or without  funding. maintenance of  mission and  activities institutionalization  of organizational  infrastructure community  visibility strategic  response to  change kennedy/avoiding one and done 1319   components and related strategies to interprofessional practice and education (ipe) initiatives can begin to be understood by substituting interprofessional or ipe with references to geriatric education in the original model. to facilitate this transition in thinking, specific references to geriatrics are removed. instead, the following descriptions will focus generically on educational content and initiatives. table 1. core components of the kennedy model and strategies to foster sustainability core components of sustainability strategies to foster sustainability maintenance of mission and activities  administrative support  institutional infusion efforts  decentralizing involvement of faculty, staff, and students  infusion/embedding activities at the level of the culture (acculturation) institutionalization of organizational infrastructure  fiscal/administrative support  maintain basic operations  cobbling staff time/positions  co-location of programs  symbiosis between programs/units  diversify funding streams community visibility  creation of markets/circuits of knowledge  attract consumers through relationship building  lead the market by creating demand strategic response to change  maintain stability of mission and purpose amidst changing conditions  respond to changing environments  proactive response to change (anticipate change)  respond to changing priorities (kennedy, 2008) maintenance of mission and activities maintenance of mission and activities, the first of four core components of sustainability, is the ability to maintain the focus of the mission and related activities with or without funding. related strategies include administrative support; institutional infusion efforts; decentralizing involvement of faculty, staff, and students; and infusing and embedding activities at the level of organizational culture. administrative support, including the presence of leadership at various levels, can assure continuation of initiatives with or without external funding. institutional infusion involves weaving desired content into competencies, assignments, and activities within a discipline and department at the course or overall curriculum level. decentralizing the involvement of faculty, staff, and students involves the co-creation of shared competencies, assignments, and activities across disciplines and departments, thereby weaving change across programs and curriculum. such change efforts can be effective if planned intentionally and co-created with support from interdisciplinary faculty and practice partners, with academic and practice leadership as a guardrail against sudden advances in social work, fall 2021, 21(4) 1320 change. while preserving the distinctions central to each discipline’s unique knowledge, practices, and identity, it is crucial to avoid developing content with a siloed approach and important to build a deep bench of support across faculty and practitioners. acculturation explains the process and changes resulting from two or more disciplinary cultures working in collaboration to co-create and infuse shared competencies, assignments, and activities, and develop a culture of interdisciplinary collaboration. the ultimate goal is for an initiative to become part of the dna of the organization. institutionalization of organizational infrastructure institutionalization of organizational infrastructure, the second of four core components of sustainability, is the existence and institutionalization of sufficient fiscal support for space, positions, and administrative support to provide a framework within which operations can effectively function. related strategies include fiscal and administrative support; maintenance of basic operations; cobbling staff time and positions; co-location of programs; and symbiosis between programs and units. fiscal and administrative support within the organization assures a baseline of resources to address critical needs required to maintain the viability of initiatives. this can include support for indirect costs and the institutional match for operational costs. cobbling staff time and positions involves combining portions of faculty and staff time across programs and funding and leveraging summer salary. co-location of a program, such as a center and office working collaboratively and sharing fiscal and human resources, supports the infrastructure of each unit. finally, symbiosis between programs and units is a condition in which each unit benefits from the resources, skills, experience, and end-users of the other. it is important to diversify funding streams, with the goal of reducing dependence on a single source of support. notably, there is no one-size-fits-all structure to support the success of an initiative. form must fit culture. the existence of a center or office does not guarantee the sustainability of initiatives, as centralization can work to coalesce the authority of a leader and can suppress creativity and collaboration in the name of quality control outside of its boundaries. to be sustained, an initiative is ideally everyone’s purview. community visibility community visibility, the third of four core components of sustainability, involves becoming “the source” for information and therefore integral to the culture of both the university and broader academic and practice communities over time. this includes whether the initiative is known within its own institution and community as the place to go for information (i.e., internal visibility), in addition to whether the initiative is known nationally due to dissemination through conferences and publications (i.e., external visibility). examples of related strategies include the creation of markets and circuits of knowledge, attracting consumers through relationship building, and leading the market by creating demand. kennedy/avoiding one and done 1321   an example of markets and circuits of knowledge is the development of content and activities that address initiative-specific competencies across disciplines for students and the current workforce. essentially, it translates to developing a product or service that others could benefit from and creating need by demonstrating the importance of the work to the organization and community. just as in marketing, educational initiatives attract new and repeat consumers. strategies to attract and retain customers focus on building and maintaining relationships, networking, and responding to demand for educational and practice needs. while it is necessary to respond to demand, it is not sufficient. it is also important to lead consumer demand by being on the forefront of initiatives, demonstrating their value through research, and sharing expertise with the current and future workforce. as the visibility and value of educational initiatives increase, consumer demand pulls supply. students who participate in initiatives central to their educational experience seek employment with, and are sought out by, employers who value the knowledge, skills, and competencies they have achieved. strategic response to change strategic response to change, the fourth and final of the core components of sustainability, is the ability to maintain operations and structurally morph, as needed, to maintain activities even in the midst of change. related strategies include maintaining the stability of mission and purpose amidst changing conditions, responding to changing environments, maintaining a proactive response to change, and responding to changing priorities. maintaining the stability of mission and purpose amidst changing conditions includes sustaining activities through changes in leadership and funding, as well as the ability to respond to changing environments whether market, funding, or political in nature. this requires initiatives to be nimble, and sometimes requires organizations to let go of a specific program structure in which they have been invested. in such instances, organizations must be willing to structurally morph, including significant restructuring or downsizing, to maintain mission focus through changing landscapes. in extreme cases, it may require an initiative or organization to dissolve, with the potential of rising from the proverbial ashes in a different form like the mythological phoenix bird. developing a proactive response to change is accomplished by building institutional and community capacity through networks and consortia. this can be facilitated by developing or joining local, statewide, or regional networks and consortia that can provide an additional bulwark of support for training and educational initiatives across academic and practice sectors. finally, while being proactive, it is crucial to be aware of the changing priorities of funders, academic institutions, policy-makers, and employers. as organizations seek out funding that supports the core values of the initiative, they must remain mission focused. advances in social work, fall 2021, 21(4) 1322 implementation science and the know-do gap following its development in the context of interdisciplinary geriatric education, the kennedy model was subsequently applied to ipe initiatives, consistent with implementation science that seeks to utilize and apply knowledge in new situations. implementation science refers to “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices” (eccles & mittman, 2006, p. 1). stated succinctly, “implementation matters” (durlak & dupre, 2008, p. 327) and the quality of the implementation is as important as the quality of the program (dubrowski et al., 2018). a major barrier to implementation is referred to as the know-do gap, “the gap between what is known and what gets done in practice” (pablos-mendez & shademani, 2006, p. 81). this gap is widened by overly complex models and practices that are difficult to disseminate and scale, difficult to reproduce, or do not apply across settings. the know-do gap can be effectively bridged by models that focus on core features common across sustainability models and that can be easily implemented and tailored across programs and settings. the kennedy model serves as a research-based, “practical model of sustainability” (national center, 2017, para. 2), with four core components reflecting features found in the sustainability literature (hooyman, 2006; scheirer, 2005; schell et al., 2013; shediac-rizkallah & bone, 1998), that can be leveraged as a suite and tailored to support the sustainability of programs and initiatives across settings. application of the kennedy model of sustainability the macy project and caiper: transitioning from ipe initiative to center the first formal application of the kennedy model of sustainability to ipe occurred in 2015, in tandem with the strategic planning efforts of the interprofessional primary care curriculum: implementation and evaluation (macy project) team in the college of nursing and health innovation at arizona state university (asu). funded by the josiah macy jr. foundation, the project brought together faculty, students, and preceptors in nursing, social work, medicine, and pharmacy from asu and the university of arizona-phoenix to advance interprofessional primary care practice and education. using examples directly relevant to the sustainability of ipe mined from strategic planning sessions with the macy project team (kennedy, 2015), session note content was reviewed for categories and sorted by theme. the results fit effortlessly into the four core components of sustainability resulting from the original gec research and yielded iperelated strategies (see table 2). application of the kennedy model and a description of sustainability strategies specific to the macy project and subsequent development of the center for advancing interprofessional practice, education and research (caiper), follows. maintenance of mission and activities specific to the macy project, strategies to foster maintenance of mission and activities included developing interprofessional learning modules and infusing them within existing courses, initiatives, and events. ultimately, eight elearning modules, four foundational kennedy/avoiding one and done 1323   interprofessional modules, and four interprofessional primary care modules were created and disseminated between 2015 and 2017. these elearning modules were designed to be open-access and “easily integrated in classroom and clinical rotations” (caiper, 2020, para. 5) and have since been translated into mandarin chinese (caiper, 2021). embedding ipe content across faculty and preceptor development activities was addressed in part through the development and publication of a guide to support interprofessional preceptors for health professions students and teams. in addition to preceptors, the guide was designed to help clinicians and healthcare organizations interprofessionalize their organizational culture. this guide also served as a resource for educators to better understand and infuse ipe content into health professions courses and curriculum (caiper, 2018). the strategy of harnessing student participation in governance demonstrated valuing “the unique voice” of students in the development and delivery of ipe (senecal et al., 2016, para. 1). this strategy translated into student involvement in the review and revision of interprofessional elearning module content to gain the perspective of end-users. table 2. application of the kennedy model to the macy project and caiper core components of sustainability_ strategies to foster sustainability maintenance of mission and activities • infusing ipe modules within existing courses, initiatives, and events • embedding ipe content across faculty and preceptor development activities • harnessing student participation in ipe governance institutionalization of organizational infrastructure • achieving critical mass (e.g., center) • centralizing core functions • identification of stakeholders and teams • inviting interested collateral partners community visibility • branding • dissemination • outreach strategic response to change • noting and tracking ripples • assessing and responding to readiness (kennedy, 2015) institutionalization of organizational infrastructure strategies to advance institutionalization of organizational infrastructure included achieving a critical mass of ipe initiatives through a gradual evolution from an externallyfunded initiative to a university-recognized center. as the macy project leadership and team pursued the university designation of a formal center, garnering administrative support at college, campus, and university levels became a key strategy to foster the development and sustainability of ipe initiatives. the dean of the asu college of nursing and health innovation offered to serve as the host site for the new center. the director of the asu school of social work agreed to share a portion of a position with the center to advance interprofessional academic-practice partnerships. the dean of the college of advances in social work, fall 2021, 21(4) 1324 public service and community solutions supported a partnership with nursing and the promise of increased community-based practice and research collaborations. centralizing core functions under the macy project involved bringing together representatives from discipline-specific curriculum committees to map and identify gaps in interprofessional content, as well as explore joint strategies to collect interprofessional competency-based outcome measures from graduates. evaluation of project outcomes was centralized under a project co-investigator. the emergence of caiper facilitated further streamlining of roles and functions including the creation of leads for evaluation, clinical partnerships, faculty development, and marketing communications, thereby reducing redundancies and supporting efficiencies. identification of stakeholders and teams involved recognizing academic and practice representatives essential to the goal of advancing ipe in education and healthcare. during the macy project phase, faculty members and practice sites were identified and recruited to collaborate in a faculty coaching model designed to facilitate intersections between students’ classroom and clinical experiences. core to the model was embedding a faculty coach with an interprofessional perspective within a specific practice site and included online educational “bursts” (i.e., concise presentations of applied ipe content), in-person internship site-specific meetings, conceptand case-based student gatherings (i.e., educational events offered in-person and virtually, recorded and archived on the website for later viewing), and interprofessional coach team meetings (bonifas et al., 2015). a distinct, yet parallel and equally important, strategy involved inviting interested collateral partners to participate in a range of activities. the new caiper team was gradually formed with a combination of select members of the macy project team and newly invited members. the macy project team members offered the strength of shared knowledge and experience to inform strategic planning and sustainability. newly invited team members offered the benefit of new experiences, skills, approaches, networks, and ways of thinking about ipe. community visibility the importance of community visibility was pursued by the macy project team through intentional branding efforts. branding is a “marketing practice of creating a name, symbol or design that identifies and differentiates a product from other products” (entrepreneur, n.d., para. 1). in this case, the official project name (interprofessional primary care curriculum: implementation and evaluation) was shortened to the moniker, the macy project, and a project logo was developed to serve as a branding symbol on all communications, products, and presentations developed by the team. the same strategy was later employed by the center substituting center for advancing interprofessional practice, education and research for the moniker, caiper, and developing a consistent branding symbol. more recently, the caiper team officially registered their brand, now known as caiper interprofessional by design ® (caiper, n.d.). the macy project team pursued a targeted dissemination strategy through conference presentations at national (i.e., nexus summit) and international (i.e., all together better health and collaborating across borders) ipe-focused conferences. the elearning kennedy/avoiding one and done 1325   modules developed under the project were widely distributed through the caiper website and the online resource center of the national center for interprofessional practice and education. additionally, the macy project team led and convened a statewide academicpractice collaborative, the arizona nexus, facilitating state and regional dissemination efforts by the caiper team through the 2018 inaugural arizona nexus conference (lamb et al., 2018). outreach was achieved through a concerted focus on externally-facing communication strategies. the macy project team included two members specializing in instructional design who supported development of a website, webinars of conceptand case-based student gatherings, and online access to elearning modules. this facilitated a successful external messaging campaign publicizing project initiatives and accomplishments. these efforts were significantly accelerated through the establishment of caiper, which included members specializing in instructional design, communications, and marketing. website features expanded over time to include caiper’s vision and mission, team member profiles, news and events, collaborative team practice initiatives, educational resources, education and training services, research, blog posts, and a resource hub which included archived webinars, reports, videos, curricula, tools, and presentations. in 2018, caiper launched a new podcast series branded as caiper confabs designed to facilitate national and global ipe connections and dissemination. as the macy project was winding down and transitioning into the establishment of caiper, the strategy of identifying and inviting university and community stakeholders was essential to advancing sustainability through community visibility and the broadening of academic-community partnerships. these efforts culminated in a three-day training event in 2016, educating health professionals in interprofessional care (ehpic), in phoenix, arizona. fifty university and healthcare representatives were identified and invited in a highly intentional team process that sought a balance between university and healthcare participants representing leadership, mid-level administrators with supervisory roles, educators, practitioners, and students. training was collaboratively planned, designed, and tailored by members of the caiper and university of toronto centre for interprofessional education teams (senecal et al., 2017). strategic response to change strategic response to change requires a proactive approach to anticipating and responding to change and a focus on mission and continuation of activities in the midst of change. as part of its evaluation process, the macy project team regularly utilized a process of noting and tracking unanticipated program outcomes referred to as “ripples” (hall, 2004, p. 345). assessing and responding to readiness was another strategy employed by the macy project team, utilizing a developmental evaluation framework. “this framework enhanced capacity for sensing undulating tides of rapid-cycle change while riding the…waves of its ipe/ipcp interventions and allowed the capture of small ripple actions with the resultant capacity to catalyze large reactions and impact” (saewert et al., 2015, p. 1). advances in social work, fall 2021, 21(4) 1326 the macy project director and team recognized the usefulness of the kennedy model, adopting it as a framework to support sustainability planning and program evaluation for this ipe initiative. “we discovered that we were inadvertently attending to each of these factors since the inception of this project. we now are systematically planning for each…[using the model as a] framework to guide…[the] analysis and evaluation of our sustainability efforts” (lamb, 2015, p. 9). the 2016 annual program report for asu’s macy project stated: from the inception of this project, our team recognized the importance of planning for sustainability with a shared goal that the integrated interprofessional curriculum endure and advance beyond the period of grant funding. we have adopted a framework to guide the analysis and evaluation of our sustainability efforts that identifies four key factors associated with sustainability of grantfunded initiatives…we evaluate our key accomplishments contributing to sustainability through this lens. (lamb, 2016, p. 13) the macy project final report noted, “we have used the kennedy sustainability model to guide and benchmark progress in expanding and sustaining learning and impact. each component of this model…has been embedded in the dna of this project” (lamb, 2017, p. 9). discussion since its emergence in 2008, the kennedy model of sustainability has been extended well beyond its interdisciplinary geriatric education center origins. since its first application to interprofessional practice and education initiatives, the kennedy model has demonstrated resonance and relevancy to support the sustainability of ipe initiatives and address their related challenges (bonifas, 2017; brandt et al., 2019; dinkel & tucker, 2020; harrell & saewert, 2016; lamb, 2015, 2016, 2017). in 2012, the national center for interprofessional practice and education (national center) was established as a unique public-private partnership and continues to serve as a neutral convener addressing micro, meso, and macro conditions that foster and hinder cross-sector practice, education, policy, and research collaborations to advance ipe (kennedy et al., 2022). national center leadership is well-aware of the littered path of unsustained initiatives along the nearly fifty-year long road to ipe (national center, 2017), and has a vested interest in identifying models and tools to support the development and sustainability of ipe initiatives. to avoid the one-and-done phenomenon, the national center announced formal adoption of the kennedy model to support sustainability of a 16 site national academic-practice initiative, the accelerating community-based interprofessional education and practice initiative (accelerating initiative) (national center, 2016). “the kennedy model…provides a practical way to address sustainability to support strategic planning” (national center, 2017, para. 2). in 2018, the national center formally adopted the kennedy model of sustainability as part of their nexus learning system and included it as one of a collection of 11 nexusipe© learning system tools selected and tested during the accelerating initiative (brandt et al., kennedy/avoiding one and done 1327   2019, slide 14). an introduction to the kennedy model is available as a featured national center webinar (kennedy, 2017) and the model is featured as one of 11 tested tools in the accelerating initiative webinar series (dinkel & tucker, 2020). the kennedy model is currently planned for inclusion in a book and related resources under development through the national center, designed to support the sustainability of interprofessional academiccommunity (nexus) partnerships. implications for research a perennial challenge to the study of sustainability is limited funding for program monitoring following initial implementation. while use of the kennedy model with the 16 site accelerating initiative supported the four components of the original model, provided useful examples of additional strategies to foster sustainability, reinforced the usefulness and fit of the kennedy model, and supported its extension to ipe initiatives, it is important to revisit these sites to evaluate sustainability beyond the completion of initial program funding. to meet this challenge head-on, the national center plans to embark on a follow-up study of the 16 accelerating initiative sites, to include a review of the status of each site’s program sustainability. follow-up interviews with site participants will offer additional opportunities for model testing and generate additional data through a national, multiple case study approach to explore application of the kennedy model of sustainability as a tool in implementation science. application of the kennedy model to the accelerating initiative, including additional case examples and strategies, will be explored in future publications. conclusion ipe holds promise to advance the triple aim, improving the experience of people and care of populations while reducing the price of care (berwick et al., 2008); the quadruple aim, improving the experience of providers (bodenheimer & sinsky, 2014) and increasing resilience and retention of the healthcare workforce (advisory committee on interdisciplinary, community-based linkages [acicbl], 2019); and the quintuple aim, focusing on achieving health equity (itchhaporia, 2021), which translates as social justice in health (see figure 2). while progress is being made in research supporting the value of ipe, the use of standardized, validated instruments and pooled data tied to triple and quadruple aim outcomes demonstrating the science of interprofessional teams is a critical strategy to sustain ipe initiatives (brandt et al., 2014; lutfiyya et al., 2017) and advance the quintuple aim. ultimately, while a promising and popular initiative, ipe requires evidence to survive. advances in social work, fall 2021, 21(4) 1328 figure 2. ultimate aims of ipe conditions at the national level have been shifting steadily, sometimes dramatically, towards fostering ipe initiatives including the harmonization of ipe accreditation (health professions accreditors collaborative, 2019), national data collection strategies (lutfiyya et al., 2017), and coordination by the national center to advance and sustain ipe nationally with academic, practice, policy, and research leaders. barriers to ipe continue to exist in the form of reimbursement mechanisms. however, payment reform efforts are beginning to move in the right direction, including shifts from volume to value and meaningful measures (acicbl, 2019). concepts and language have shifted over the past fifty years from interdisciplinary education, to interprofessional education (ipe), to interprofessional education and collaborative practice (ipe/cp), and more recently to interprofessional practice and education (the new ipe) (national center, 2015). amidst these changes, the kennedy model of sustainability has accounted for the dynamic interplay between health professions disciplines, between economic sectors, between academic institutions and the broader practice community, and within academic-community partnerships. coming full circle, the exhortation that “sustainability must be prepared…concomitantly with implementation” (pluye et al., 2004, p. 121) affirms the significance of implementation science. in this spirit, the kennedy model serves as a practical, research-based model that can be leveraged and tailored to bridge the know-do gap and support the goal of “optimizing program implementation and achieving maximum impact” (dubrowski et al., 2018, p. 104) in support of the sustainability of interprofessional practice and education programs and initiatives. references advisory committee on interdisciplinary, community-based linkages [acicbl]. (2019, august). preparing the current and future health care workforce for interprofessional practice in sustainable, age-friendly health systems. 17th annual report to the secretary of health and human services and the u.s. congress. https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/community-basedlinkages/reports/seventeenth-2019.pdf bell, j. (1999). doing your research project: a guide for first-time researchers in education and social science (3rd ed.). open university press. 1 .improve  consumer  experiences 2. improve  care 3. reduce  costs 4. improve  providers’  experiences 5. achieve  health equity (adapted from itchhaporia, 2021, p. 2263) kennedy/avoiding one and done 1329   berwick, d. m., nolan, t. w., & whittington, j. (2008). the triple aim: care, health, and cost. health affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759 bodenheimer, t., & sinsky, c. 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(2021). the evolution of the quintuple aim: health equity, health outcomes, and the economy. journal of the american college of cardiology, 78(22), 2262-2264. https://doi.org/10.1016/j.jacc.2021.10.018 kennedy, t. (2008). geriatric education centers and the academic capitalist knowledge/ learning regime. unpublished doctoral dissertation, university of arizona, tucson, az. kennedy, t. (2009). geriatric education centers: the academic capitalist knowledge/learning regime. vdm verlag. kennedy, t. (2015, may 7). sustainability: lessons from national gerontological initiatives [workshop]. interprofessional primary care curriculum: implementation and evaluation (the macy project), college of nursing & health innovation, arizona state university, phoenix, az. kennedy, t. (2017, november 29). avoiding one and done: a practical model for sustaining ipe programs [webinar]. minneapolis, mn: national center for interprofessional practice and education. https://nexusipe.org/informing/resourcecenter/national-center-webinar-avoiding-one-and-done-practical-model-sustaining kennedy, t., harrell, l., dieter, c., & brandt, b. f. (2022). accelerating interprofessional community-based education and practice: leveraging systems thinking to address the needs of vulnerable populations. in d. joosten-hagye & h. khalili (eds.), interprofessional education & collaborative practice: international approaches at micro, meso, and macro levels (pp. 123-140). cognella. lamb, g. 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(2018). the arizona nexus: the first five years. journal of interprofessional care, 1-4. https://doi.org/10.1080/13561820.2018.1505715 lawlis, t. r., anson, j., & greenfield, d. (2014). barriers and enablers that influence sustainable interprofessional education: a literature review. journal of advances in social work, fall 2021, 21(4) 1332 interprofessional care, 28(4), 305-310. https://doi.org/10.3109/13561820.2014.895977 lutfiyya m.n., schicker t., jarabek a., pechacek j., brandt b., & cerra f. (2017). generating the data for analyzing the effects of interprofessional teams for improving triple aim outcomes. in c. delaney, c. weaver, j. warren, t. clancy, & r. simpson (eds). big data-enabled nursing: education, research and practice (pp. 103-114). springer. https://doi.org/10.1007/978-3-319-53300-1_6 national center for interprofessional practice and education [national center]. 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(1998). planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. health education research: theory and practice, 13(1), 87-108. https://doi.org/10.1093/her/13.1.87 strauss, a., & corbin, j. (1998). basics of qualitative research: techniques and procedures developing grounded theory (2nd ed.). sage. tie, y. c., birks, m., & francis, k. (2019). grounded theory research: a design framework for novice researchers. sage open medicine, 7, 1-8. https://doi.org/10.1177/2050312118822927 author note: address correspondence to teri kennedy, university of kansas school of nursing, university of kansas medical center, 3901 rainbow blvd., mail stop 4043, kansas city, ks, 66160. email: tkennedy4@kumc.edu, https://orcid.org/0000-00019822-6013 acknowledgment: the author received funding as a member of the macy project team and was granted access to internal grant documents cited in the manuscript and served as a member of the center for advancing interprofessional practice, education and research (caiper) team. the activities related to the interprofessional primary care curriculum: implementation and evaluation (macy project) were supported (in part) by the josiah macy jr. foundation [proposal no. b13-04, april 1, 2013 – march 31, 2017]. the author is grateful to the macy project team (gerri lamb, principal investigator) and original caiper team (gerri lamb, founding director; karen saewert, nina karamehmedovic, jinnette senecal, yvonne price, and michael moramarco) for their creativity and collegiality, and the opportunity to collaboratively advance interprofessional practice, education, and research. the author also thanks the national center for interprofessional practice and education (barbara brandt, founding director) for adoption of the kennedy model of sustainability as a tool to advance ipe. _________ anna ortega-williams, phd, lmsw, assistant professor, silberman school of social work, hunter college of the city university of new york, new york, ny. denise mclane-davison, phd, associate professor, school of social work, morgan state university, baltimore, md. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 566-587, doi: 10.18060/24475 this work is licensed under a creative commons attribution 4.0 international license. wringing out the “whitewash”: confronting the hegemonic epistemologies of social work canons (disrupting the reproduction of white normative) anna ortega-williams denise mclane-davison abstract: in the 21st century context of violent racial divides, dismantling racism in social work education requires deep trust that social transformation and healing is possible. “wringing out the whitewash” metaphorically captures the heavy labor of interrupting the rigid eurocentric epistemological hegemony undergirding the pedagogy, research, and praxis canons of social work. it requires rigorous attempts to unsettle and decenter entrenched white supremacist ideology, assumptions, and values. in this labor, we create space for the multiple identities and worldviews that students and professors occupy to reshape educational encounters. in this paper, we present our critical pedagogical approaches as black social work educators committed to liberation and healing. we articulate how our positionalities as black cisgender women at urban universities, one a northeastern historically black college and university (hbcu) and another at a northeastern public university, facilitate our intentions to honor truthtelling and intergenerational interdependence. we present differences and similarities in how we use assignments to disrupt the institutional reproduction of racism, provide solace for repair and healing, and re-center collective identity as strength. we present transdisciplinary frameworks shaping our pedagogical choices, namely historical trauma and urban womanist social work pedagogy. implications for the future of social work education will be discussed. keywords: anti-black racism, womanist, historical trauma, dismantling white supremacy “…the function, the very serious function of racism…is distraction. it keeps you from doing your work. it keeps you explaining, over and over again, your reason for being. somebody says you have no language and you spend twenty years proving that you do. somebody says your head isn’t shaped properly so you have scientists working on the fact that it is. somebody says you have no art, so you dredge that up. somebody says you have no kingdoms, so you dredge that up. none of this is necessary. there will always be one more thing. (morrison et al., 1975) what is predominantly known as mainstream american social work education is often focused upon the contributions of the founding white mothers of social work, such as jane addams and mary richmond (carlton-laney, 1999; johnson, 1991). their stories, while significant, do not represent the full story; it’s part of a historical “whitewash” of social work to be wrung out to see the full legacy of social work education and practice, while reimagining what is possible today. schools of social work about:blank ortega-williams & mclane-davison/wringing out the whitewash 567 at the turn of the 19th century in the u.s. were primarily designed by white women to address the social ills promulgated by white men who were early capitalist industrialists (carlton-laney, 1999; reid-merritt, 2010; reisch, 1998). educational practices in these institutions were informed by the cultural values, priorities, religious bents, assumptions and interests of white women, presented as universal and objective, centering a medicalized model (bowles el al., 2016; reisch, 1998). additionally, these institutions were mostly inaccessible for black, indigenous, and other racial groups due to de facto and de jure racial and class segregation (reisch, 1998). the concept of social work birthed through the black community centers the ideas of health, wealth, and well-being through a cultural lens of principles, values, and purposes (carlton-laney, 1999). social work developed by blacks was a form of mutual aid which promoted collective efficacy for community survival, racial pride, and advancement (carlton-laney, 1999; crewe et al., 2008; gary & mclure, 1969). the legacies of black and indigenous people, and people of color (bipoc) in social work and social work education emerged from a need for not only representation but grounding in values, practices, and ways of knowing that reflected these ethnic and racial groups. the marginalization of these historical contributions is a loss for contemporary practice. in this paper, we explore the use of historical (carlton-laney, 1999) and contemporary frameworks created by black social workers to disrupt white supremacy in social work education. through our duoethnography we discuss how womanism (maparyan, 2012; phillips & mccaskill, 1995) and historical trauma frameworks (brave heart, 1998) as well as black liberation pedagogy (king, 2017; jennings & lynn, 2005; perlow et al., 2018) can support social work educators to deconstruct, antagonize, reconstruct, and re-center narratives of social problems. as black cisgender women who are social work educators, we utilize the collective intellect of lived experiences, public scholarship, cultural history, and transdisciplinary knowledge to “wring out the whitewash” of the educational process that attempts to erase the contributions of black and brown lives. we present differences and similarities in how we alchemize the social work classroom in our respective institutions through assignments and activities at northeastern urban universities, one a historically black college and university (hbcu) and the other a public urban research university. we discuss examples of how we create transformative spaces for interrogating institutional reproduction of racism, provide solace for repair and healing, and re-center collective identity as strength to (re)locate power and knowledge production through a mutually-engaged space (dillard, 2016; huckaby, 2013; jennings & lynn, 2005; mcgee & stovall, 2015). we explore how students navigate and respond to the core content of social work education juxtaposed alongside their lived experiences of systemic violence, historical trauma, and anti-black racism (mclane-davison, 2017). in sharing how we honor truth-telling and intergenerational interdependence within the classroom, we explore how lived experiences become products of knowledge and power. lastly, implications for the future of social work education will be discussed. advances in social work, summer 2021, 21(2/3) 568 our positionalities our blackness embodied in academic spaces as black women in the academy, confronting white supremacy is embodied in our very existence. our positionalities, defined as factors influencing our identities, social locations, access to power, targeting for oppression, cultural legacies of strength, and dynamic historical compositions, inform our definition of education. black women’s positionalities are shaped by the material consequences and rewards of their lived experiences at the intersection of critical race, class, gender, and power constructs. neither monolithic nor mutually exclusive, a collective identity is molded through historical resistance of oppression and domination as a result of colonialism, imperialism, slavery, apartheid, and other forms of white supremacy. positionality affords a sense of consciousness that intentionally centers black women’s agency of self-definition and worldview (collins, 1998; huckaby, 2013; mullings, 2000). our pedagogical approaches and the histories that we lean upon to engage and prepare our students is informed by our positionalities. who we are, as represented in our positionalities, shapes why and how we teach and the aspirations that move us beyond the classroom or institutional walls. ortega-williams: i identify as a black, queer, cisgender woman with family lineages stemming from greensboro, north carolina and barbados. my family roots, by way of the great migration of southern and caribbean blacks to new york city (nyc), brought my people to harlem and the bronx, ny, where i was born and raised in low-income public housing in the late 70s and 80s. my heritage is relevant as an educator because people like me were often clients, not social workers. my mother, labeled a “recipient” of public assistance, carried the war on poverty on her back. our encounter with subpar institutions and systemic violence, including wage theft, labor exploitation, and divested dilapidated housing was not theoretical. my grandmother, who worked as a maid in highrise hotels in manhattan, migrated to nyc from the south at 13 years old without her parents; we never fully knew her story or the harm she encountered during segregation, her silence about racialized terror was common--she was taught, like so many others to keep going to survive. as an organizer and activist, education for me is alchemy--it is a key ingredient for how we decalcify, heal, and transform the world in which we are living. mclane-davison: i create freedom fighters! my teaching pedagogy is centered in black feminist/womanist/africana (bfwa) epistemologies and informed by my positionality as a first-generation college graduate from the streets of chicago’s south side. my teaching pedagogy is furthermore enhanced and developed through my research, scholarship, and professional service to both the national association of black social workers (nabsw) and the council on the role and status of women in social work education, with the council on social work education. graduation from the nabsw’s african-centered academy in 2001, where i learned culturally-specific methods of social work practice by african american scholars, as well as teaching and contributing to the curriculum of hiv/aids through the american red cross (1993ortega-williams & mclane-davison/wringing out the whitewash 569 2000) are essential benchmarks in my understanding of the unique strengths of adult learning. our professional contexts ortega-williams works at a large public school of social work in nyc. the student body there, in particular in the bachelor of social work program (bsw), is majority working-class. our students are resilient, vocal, and powerful. often they are juggling many responsibilities while managing coursework, internships, and family obligations. racially, ethnically, and financially diverse, many students are also international, leaving their home countries and support networks. some students have physical, mental, and developmental health needs or are facing food and housing insecurity. many students transfer from associate degree programs and describe fighting their way into a bsw or masters of social work (msw) program and are proud of their accomplishments. most express that they want to give back to the communities and countries from which they come, inspired by their personal and collective legacies of survival, power, and historical contribution. mclane-davison teaches at a 153-year-old hbcu (historically black college & university) in the heart of a northeastern urban community which boasts an abundance of black and brown neighbors. the 45-year-old school of social work prioritizes the alleviation of human suffering through ethically proficient services grounded in the strengths of its urban residents both locally and throughout the african diaspora (mclane-davison, 2017; wells-wilbon et al., 2016). graduates of the bsw, msw, and phd programs champion the intergenerational resilience, research, and strength-based strategies which promote social justice, and improve the quality of life for diverse urban populations. while the campus faculty and staff have become more ethnically and racially diverse over the years, the majority of the students in the msw social work program self-identify as first-generation college students, cis-gender females of african ancestry, and from working class families. most recently, the global reach of the university as a “premiere urban research university” has produced a welcoming home for social work students also self-identifying as non-binary, lgbtq, latinx, veterans, and recent immigrants from african and middle eastern countries. the signature competency of urban social work advances ethically inclusive concepts and theories of the africancentered perspective, cultural competency, empowerment, and advocacy, and also strength and resilience as critical concepts and theories (wells-wilbon et al., 2016). undergirding the concept of urban social work is the implied accountability of disrupting the nuances of race, gender, and class divisions which have reproduced systems of policies that reproduce historical discrimination. literature review white supremacy within social work education is a self-reproducing whitewash deeply woven into the content and approach to learning. our strategies for wringing out the whitewash are to situate our social work pedagogy within the legacy of bipoc social work scholars, researchers, and freedom fighters. for the scope of this paper, we focus advances in social work, summer 2021, 21(2/3) 570 on the contributions to our educational approaches of 1) the historical trauma framework, 2) principles and practices of black historical social work leaders, 3) womanist social work pedagogy, and 4) black liberation pedagogy. historical trauma and social work education students and educators enter the educational space carrying not only their lived experiences, but also the journeys of their people. educational frameworks that acknowledge the collective historical pain, strength, and hopes that inform students and educators create a wider frame for growth and deep learning. historical trauma has been defined as a soul-wound, cumulative trauma, unresolved grief, and compounded losses experienced at the collective mass group-level, such as a racial and ethnic group, during oppression (brave heart, 1998). dr. maria yellow horse brave heart, a lakota social worker, sought to theorize why there were disparities in health among the lakota (brave heart, 1998). she extended the social determinants of health framework by accounting not just for proximal factors, such as lack of access to sustainable housing, but also distal factors such as intentional genocide, exploitation, and purposeful cultural disruption (brave heart, 1998). one of her contributions with the historical trauma framework was that the collective harm experienced at the mass group-level from subjugation had negative impacts intergenerationally upon the psychological, spiritual, physical, behavioral, and social well-being of lakota people (brave heart et al., 2011). empirical evidence is emerging about the consequences of historical trauma upon health and wellbeing. for example, psychological and physiological distress connected to the loss of language and access to cultural lands has been documented through measuring historical loss and unresolved grief (whitbeck et al., 2004). additionally, disruption of original instructions for diet during subjugation has impacted diabetes rates (walters et al., 2020). as measures and frameworks continue to be developed, the connection between distal factors such as historical traumas upon proximal factors in stress process models can be explored (walls & whitbeck, 2012). lastly, more robust interventions can be designed, including supporting community connectedness and land reclamation to address the harm from historical trauma (harvey, 2018; kaur, 2020; schultz et al., 2016; walters et al., 2011). the historical trauma framework is an important lens for social work education to support transformation among students and faculty. in particular, it makes social work education more responsive to the needs of african americans and other racial and ethnic groups that have experienced racial subjugation and oppression. in the historical trauma framework, contemporary injustices from systemic racism compound the pain of an intergenerational trauma response (brave heart, 1998; degruy-leary, 2005; walls & whitbeck, 2012). the intergenerational impact of historical trauma is maintained socially. sotero (2006) conceptualized that there are four primary social pathways that initiate and maintain a historical trauma response, which are segregation, systematic physical and psychological violence, economic destruction, and cultural dispossession. additionally, colorism, discrimination based on skin tone, and in particular conferring social privileges for phenotypical proximity to whites including skin color and facial features, is theorized to be a key mechanism of historical trauma and racism (ortegaortega-williams & mclane-davison/wringing out the whitewash 571 williams et al., 2019). for example, several studies found patterns suggesting that african americans with what is considered deeper skin tones are more likely to experience increased racial discrimination, which has been associated with psychological distress, increased school pushout, harsher prison sentences, and increased likelihood of being killed by police (alexander, 2012; crutchfield et al., 2017; hunter, 2007; viglione et al., 2010). the historical trauma framework offers an additional lens for understanding patterns of systemic violence and social injustice, as well as the intergenerational harm from oppression. the historical trauma framework disrupts the dominant social work educational canon, which primarily trains social workers to respond to contemporary environmental stressors or psychological harm within the lifespan (hutchinson, 2015). preparing social workers to investigate the intergenerational patterns of oppression and mechanisms that sustain intergenerational harm shifts the focus, pedagogically. it also offers social workers who identify with racial and ethnic groups that have experienced historical trauma a new frame for self-understanding and healing. the historical trauma framework within social work education shifts the purpose of the educational encounter. in a white supremacist context, education is not fundamentally designed to support the power and healing of bipoc, who have been historically subjugated and marginalized. social work education, as an institution founded within a white supremacist, heteronormative, patriarchal context, has assumptions, values, practices, and priorities that also reflect a racist paradigm. often, the legacy of social work which prioritizes and emphasizes the contributions of white foremothers simultaneously erases the strengths, cultural resources, and leadership of bipoc social workers (carlton-laney & burwell, 2014; johnson, 1991; schiele, 2017). social work education has the opportunity to not only interrupt white supremacy ideologically, but also work to repair the harm social workers have been trained to enact, which violates our stated ideals. white supremacy within social work education “distorts, erases, excludes, stigmatizes, stereotypes, renders invisible, impotent, or makes [bipoc] hypervisible while whites are depicted as noble, brave, innocent, and establishes rationale for the current order” (king, 2017, p. 96). dismantling white supremacy within social work education, using the historical trauma framework, encourages educators to interrogate how our pedagogical approaches maintain systemic violence and reinforce historical trauma. emphasizing the historical contributions of bipoc within one’s curriculum is a strategy to disrupt white supremacy while embracing cultural strengths and resources. rinsing the stain of racism: a black social work historical attempt black social workers, from the pioneers of the progressive era (bowles et al., 2016; carlton-laney, 1999; martin & martin, 1985) to those active in the black lives matter movement today, have understood the dynamic production of oppression as a result of racialized capitalism and patriarchy (gilbert, 1974; howard, 2017; schiele, 2017; brice & mclane-davison, 2020). training social work students in the legacy of black social advances in social work, summer 2021, 21(2/3) 572 workers strategically decenters the narrative of white supremacy within the profession (harvey, 2018). the 1968 position statement of the nabsw challenged the directional impact of social work at the national conference on social welfare’s (ncsw) 95th annual forum and exposition program (jaggers, 2003; johnson, 1978; reid-merritt, 2010). nabsw demanded “black people who speak, write, research and evaluate be black community and be black people who are experts in this area” (jaggers, 2003, p. 20). this assertion of self-determination represented academically trained professionals, as well as the collective resistance of community stakeholders, government and non-profit representatives, social welfare experts, faith leaders, and social workers addressing structural racism (reid-merritt, 2010; brice & mclane-davison, 2020). additionally, nabsw confrontationally addressed the governing of ncsw’s dual loyalty to the political state of social welfare systems under the nixon administration as simultaneously serving “as a tool for oppression of black people as well as social workers providing services” (jaggers, 2003, p. 20). nabsw in its 1968 founding operationalized its earlier position statement by insisting on the integration of the black perspective (johnson, 1978; reid-merritt, 2010) into schools of social work curriculum as a national priority. this content was to include “the black community and social policy, the black community and behavior, the black community and methods, and the black community and research” (chunn, 1975, p. 5) as sequential areas in methods, behavior, policy, and research (chunn, 1975). the significance of these demands captured the urgency of the social work profession to recognize the unique cultural resilience and competency of populations external to european western values and norms. the nabsw declarations especially called attention to the critical ways that social welfare and public policies intersected with black lives to reinforce messages of pathology and systems of structural racism (jaggers, 2003; martin & martin, 1995; reid-merritt, 2010). whitney m. young, jr., executive director of the national urban league at the 1968 ncsw meeting affirmed the position of nabsw through his closing address, “reason and responsibility in the elimination of bigotry and poverty” (young, 1968, p. 141). he asserted the need for social workers to redirect their attention from “pathologies and problems” and “the stereotyped projection of black people throughout history; the lack of inclusion of black people in a dignified and correct place in history” (young, 1968, p. 144). young (1968) insisted that the social workers and social service systems take seriously the findings of the 1968 report of the national advisory commission on civil disorders, also known as, “the kerner commission report” which specifically names “white racism” as both the perpetrator and weapon. “white racism means that the large majority of white people in this country do, in fact, believe deep down inside in a concept of white superiority” (young, 1968, p. 144). young furthermore attends to the impact of white racism and its devastating impact on essential welfare agencies of education, housing, and economics for populations caught in the crosshairs. notably social workers are called out as an enabler in the reproduction of systems of oppression which locate the problem in person without social accountability. young, similar to the nabsw, called for an atonement of the profession to recognize ortega-williams & mclane-davison/wringing out the whitewash 573 the dignity, worth, and rights of poor people, “mexican americans, indians, puerto ricans, appalachian whites” (young, 1968, p. 146) and black power by aligning with their need for social and political action. in summary, historically black social workers maintained a collective resilience by insisting on their right to self-define and determine their path towards liberation. as professionals entering a field with financial loyalty to a political system of structural racism, they knew that they would need to preserve the narrative about black humanity, by disrupting pathologizing messages imbedded in the training and practice of social work (bowles et al., 2016; jaggers, 2003; reid-merritt, 2010; brice & mclane-davison, 2020). womanist social work and black liberation pedagogies womanist pedagogy emboldens the practice wisdom of lived experiences along with the cultural research and theory that antagonizes the normalcy of oppression (collins, 1998; marr, 2015; phillips & mccaskill, 1995). womanist pedagogy privileges “her” voice as the authority of “her” narrative (marr, 2015). this transformative pedagogy nestles itself in the human liberation of black women’s labor, struggle, leadership, and knowledge production at the intersection of multiple structures of inequity (phillips & mccaskill, 1995). honoring truth-telling through multimedia forms of communication, womanist pedagogy invites an interconnected and intergenerational way of capturing the rituals, values, tradition, and heritage of producing education (mclane-davison, 2017). black liberation pedagogy, like womanist social work pedagogy, prepares black people to not just participate in society but transform it and oneself in the process towards collective healing and freedom (fanon, 1963). education in a white supremacist social context serves to maintain the status quo; it is not benign, innocent, neutral, universal or objective (king, 2017). education, as a social institution, reproduces society, including its hierarchies of power. historically, the dominant educational values and priorities in the united states justified and served the interests of enslavement and oppression (asante, 1991; schiele, 1996; williams, 1987; zinn, 2003). ideologies of racial inferiority and superiority were reified in the canons taught to all children, no matter how detrimental (asante, 1991). therefore, black liberation pedagogy is a requirement for true education for black people in a white supremacist context; it creates the conditions to recover from miseducation that distorted one’s people’s history, legacy, contribution, power, and even existence (byrd, 2016; king, 2017). in summary, the historical trauma framework, the principles and perspectives of historical black social work leaders, and the womanist social work and black liberation pedagogies can be used for a multidimensional liberatory lens. in our experience, the lenses can be integrated into the explicit and implicit curriculums to disrupt white supremacy in social work education that fulfills the educational policy and accreditation standards (epas), see table 1. advances in social work, summer 2021, 21(2/3) 574 table 1. pedagogical approaches to shift white supremacy in social work education pedagogical approach principles and priorities assignment example social work competencies womanist social work pedagogy • confronting the hegemonic epistemology of social work canons. • interrogate the dominant theories written by white men, often prioritized in social work. • collectively elevate students’ lived experiences as authoritative knowledge-bases. • nommo assignment is an autoethnographic assignment which invites students to engage in the exploration of their birth through the origin of their name. • self-determination & self-naming are explored as we talk about the multiple interpretations of parenthood, black motherhood, & family. • unpacking the fear of being “too black” through a name & the invitation of discrimination. • engage with individuals, families, groups, organizations, & communities (cswe, 2015, p. 8). • apply knowledge of human behavior & the social environment, person-inenvironment, & other multidisciplinary theoretical frameworks to engage with clients & constituencies. grounding in historical education about black social workers • non-oppressive social functioning • economic development • political empowerment • institution building • self-determination • mutual aid • pan-africanism • black alliances & national coalitions • civic engagement • strength of black families • liberation • exploring the significance of “the black experience” through voice & labor. • social workers’ complacency in white racism through the definition of “problem & pathology” of black & poor lives & any group outside of whiteness. • engage diversity & difference in practice (cswe, 2015, p. 7). • apply & communicate understanding of the importance of diversity & difference in shaping life experiences in practice at the micro-, mezzo-, & macro-levels. black liberation pedagogy • create the conditions to recover from miseducation that distorted black people’s history, legacy, contribution, power, & existence. • eject white supremacist values, priorities, & practices • rediscovering, restoring, & remixing black cultural resources & technologies to advance collective healing & freedom. • review erik erikson’s psychosocial developmental theory in juxtaposition to kimberlé crenshaw’s intersectionality theory to explore implications of discrimination upon development based on race, class, gender, & orientation. • investigate culturally-rooted practices & heritage, especially when working with those who are bipoc. • advance human rights & social, economic, & environmental justice (cswe, 2015, p. 7) • apply their understanding of social, economic, & environmental justice to advocate for human rights historical trauma and social work education • acknowledge distal & proximal social determinants of health, beyond the lifespan (intergenerational) • expand awareness of historical trauma: mass group-level harm from oppression & mass group-level strengths from survival & healing. • identify social work’s historical & contemporary role in perpetuating white supremacy & oppression. • work to undo these practices & policies to interrupt the historical trauma response within the classroom. • build historical timelines to challenge white supremacist dominant narratives. • investigate the time period when theories gained popularity to understand their role in the social environment. • visibilize & examine positionalities, including power & privilege of the theorists. • intervene with individuals, families, groups, organizations, & communities competency (cswe, 2015, p. 9) • critically choose & implement interventions to achieve practice goals & enhance capacities of clients & constituencies ortega-williams & mclane-davison/wringing out the whitewash 575 confronting the hegemonic epistemology of social work canons the labor of “wringing out the whitewash” as black social work educators requires a systematic and intentional approach to the selection, cultivation, and development of knowledge. it is a process in which educators and students: 1) interrogate the dominant theories written by white men, often prioritized in social work, and 2) collectively elevate students’ lived experiences as authoritative knowledge-bases. the activities and assignments used in our respective educational contexts, applying the theoretical perspectives described, will be presented below with brief examples. interrogating the dominant theories written by white men "a pedagogical activity that supports wringing out white supremacy is interrogation. for example, the dominant theoretical perspectives in human behavior and the social environment (hbse) such as the developmental, social constructionist, psychodynamic, humanistic, behavioral, systems, exchange and choice, and conflict perspectives, are rooted in the theorizing of white men (hutchinson, 2015). whitewashing erases and marginalizes bipoc contributors and universalizes white male theorists. in hbse, using theories, worldviews, values and perspectives that are rooted in bipoc scholarship, research, and lived experiences de-centers white supremacy. for example, when reviewing erik erikson’s psychosocial developmental theory, kimberlé crenshaw’s (1991) intersectionality theory is used in juxtaposition to explore the implications of discrimination based on race, class, gender, and orientation on development (hutchinson, 2015). students investigate structural racism’s impact at micro-, meso-, and macro-levels to further their understanding of development, which is not commonly addressed in erikson’s theory. historical timelines are also critical when challenging white supremacy within the classroom. collectively students and faculty investigate the time period when certain theories gained popularity and examine the positionalities of the theorists. additionally, the class analyzes macroand meso-level events that mark the time period inside and outside of the united states. for example, when our white-centered texts talk about the white-led settlement house movement, with jane addams at the forefront, students were asked to compare this with the mutual aid societies that were black-led institutions, such as the national association of colored women clubs (carlton-laney, 1999; carlton-laney & burwell, 2014). a white middleand upper-class historical narrative of social work is insufficient and destructive when analyzing the roots of contemporary issues, especially regarding the outcomes of white supremacist and elitist priorities, nationally and internationally. in our classrooms, macro-level contemporary patterns are examined to explore relationships to colonialism, genocide, displacement and enslavement. it helps students understand that the past informs the present and using a person-in-environment perspective requires that it reaches beyond the lifespan or individual. in this type of investigation, an intersectional womanist lens disrupts the championing of whiteness and anti-blackness as “normative,” which stems from the eugenics movement (garver & advances in social work, summer 2021, 21(2/3) 576 garver, 1991). interrogating these theories that are often unquestioned and memorized as facts supports our students to de-center whiteness. elevating students’ lived experiences as authoritative knowledge-bases creating sanctuary and inviting discourse “being too smart is to invite trouble”bell hooks (hooks & west, 1991, p. 149) “smart-mouth,” “you think you’re smart,” “too smart for your own good” are common childhood taunts synonymous with being abnormal or outside of one’s peer group. to be smart, to think for oneself and have dreams exceeding one’s societally defined place, in a white supremacist context, has erroneously been associated with whiteness (kelley, 2002). historically, to be perceived as too smart and black could invite consequences of physical harm or marginalization from one’s family and community, separated from spaces of safety and comfort (i.e., busing black children to white schools). therefore, a survival strategy through black identity, female gender, and low economic status includes not being perceived as “too smart” for fear of being outcast (hooks & west, 1991). however, in a womanist-centered educational environment (marr, 2015; mclane-davison, 2017), authentic engagement and delight in learning for the sake of edification is welcomed and rewarded. the student experience is a portal through which students engage in the liberatory practice of finding their voice and testing their intellectual prowess (bostic & manning, 2013; jones, 2015; mcgee & stovall, 2015). learning is mutually exclusive to taking tests as validation of self-worth. in this space, learning signifies the resistance of assigning intelligence to one’s ability to regurgitate and conform to epistemologies with limited relevance to liberation for black and brown communities (carter & college, 2005; marr, 2015; mcgee & stovall, 2015; vakalahi et al., 2007). in fact, to be a lifelong learner as a component of education is reclaimed through the cultural production of intergenerational knowledge that centers black and brown scholarship, research, and ontology as pathways to healthy black and brown ecologies. our students arrive at the classroom eager for restorative and transformative strategies to disrupt centuries of damage caused by social-political policies (bostic & manning, 2013; carter & college, 2005stevens, 2003). “i want to help people” is a familiar outcome statement. social workers help. social workers identify the problem, and they fix it. social workers are saviors. yet, rarely have black and brown students been offered an opportunity to locate the source of the problem outside of individual failure (hooks & west, 1991; mcgee & stovall, 2015). for many urban students this requires a delicate deprogramming of harmful messages about their racial identity and their community (kelley, 2002; sy, 2013). locating the origin of the problem external to their biological or moral fabric has not been their understanding. in fact, issues of poverty, crime, violence, sexual abuse, school failure, underand unemployment, substance abuse, and dysfunction have all been a product of their “inner city” living and “ghetto life” (gilbert, 1974; marr, 2015; young, 1968). these internalized messages are ortega-williams & mclane-davison/wringing out the whitewash 577 consistently reinforced through person-to-person communication and the powerful tools of social media and entertainment (mclane-davison, 2017). drawing from the cultural ethos of black church traditions, in the classroom students are able to collectively “name” the antagonist of their lived experiences. oppression, addiction, poverty, shame, disease, brutality, unworthiness; these terms are deconstructed and neutralized as threats to well-being and self-determination (marr, 2015; mcgee & stovall, 2015; phillips & mccaskill, 1995). through storytelling (baker-bell, 2017), research, investigating primary documents, and including community cultural scholarship, we are “wringing out” the “robotic” memories of how it feels to have black life defined as “the problem” (bent-goodley et al., 2017; dillard, 2016; jaggers, 2003; mcgee & stovall, 2015; brice & mclane-davison, 2020; wellswilbon et al., 2016; young, 1968). through our indigenous rituals of call and response (bostic & manning, 2013), we resist and replace a pathology diagnosis. our truth opens the opportunity to reimagine communities that include a new world order and center power and control in our communities of origin. the title of scholar is located parallel to the title of friend, family, and community as educators (bostic & manning, 2013; huckaby, 2013; phillips & mccaskill, 1995). these scholars broker a lifelong lesson of how to navigate a world that does not welcome your humanity, and definitely not your right to determine your life path (phillips & mccaskill, 1995; young, 1968). these communal scholars are fortified with the strength and resilience to “re-image” spaces of joy, celebration, and success which the academic community has defined as deficit (carter & college, 2005; mullings, 2000; phillips & mccaskill, 1995). therefore, combined with the formal education of academe, the classroom is transformed into an incubator for creating new memory of problem solving, defining family, and understanding equations of power. nommo and bleaching out blackness a key activity for dismantling white supremacy in mclane-davison’s culturallycentered classroom is starting with the “nommo” of racism as a bleaching of black heritage, rituals, and traditions. students are introduced to the west african term “nommo,” meaning to name through the dogon culture to understand the essence of the practice (diop, 1974). imagine being so fearful of the power of white supremacy for future generations that you avoid names that may be associated with your human identity. as a result of their lived experiences black parents have already imagined spaces where their child’s name will not obstruct them from opportunities in school, employment, and the rights of full citizenship. through this assignment we begin to reclaim the joy of black motherhood, fatherhood, and the nommo of family. “who dreamt of you before you were you?” “how have you grown into your name?” we talk about how their names are derived from popular celebrities, family and friends, tv shows, music, and the influence of black spirituality. as an initial assignment in a course on social work clinical practice with black families in urban environments we center black lives in love, culture, and futurism (mclane-davison, 2017). this assignment requires the application of an advances in social work, summer 2021, 21(2/3) 578 autoethnographic methodology to describe the application of “nommo” to their life. the first task is to tell the story of their parents’ courtship and their mother’s pregnancy. through these first two questions students reveal rituals of relationships, family traditions, folklore, and descriptions of family. students are then asked to talk about the ontology of their name, including “who named you?” or “describe your birthing process and the day you were born.” similar to the intimate stories of their parents' courtship and their mother’s pregnancy, they speak to the legacy, and sometimes funny narratives about their names. as we unpack these powerful narratives through primary documentation, as well as family and friend interviews, students unpack the significance of heritage and the filaments of whiteness. this assignment requires a great amount of trust and confidentiality. students aren’t pressured to share information that they aren’t comfortable sharing. surprisingly for many students, including those who were adopted, they have little knowledge about this part of their life. some students elevate the shame of being born to teen or unmarried mothers, while others tell stories of their parents being high school sweethearts. other students reveal the grief of parents dying due to drug addiction, incarceration, violence in their community, as well as through service in the armed forces. but more often, students talk about how their families were afraid to name them something “too black.” i listen as students recall being told by teachers and peers that their names were “ghetto” or “hood.” for many of my african immigrant students they share how they are given generational family names and also “christian” names so that they might better assimilate into the white “american” culture. nommo invites the correct naming through cultural symbols, self-identity, self-definition, and self-naming to “capture the life force that causes spirit into being” (mclane-davison, 2017, p. 477). in the dogon culture, nommo signifies the ancestral connections of expectations, value, and power (diop, 1974). this one exercise opens the opportunity for students to name the strength of their families, the resilience of their communal networks, and the manifestation of their parents’ dreams. through their autoethnography students express a sense of power in connecting the generational fortitude of their families to will them into their present time and space to become the first person in their family to have a graduate degree. honoring, validating, and debunking our worldviews pedagogically, once the white male canon is interrogated and whiteness is decentered as the cornerstone authority in the classroom, there is literal and energetic space for the curriculum to hold the wisdom and insight of our students’ lived experiences. students are actively invited to center their insights as immigrant, black, indigenous, trans, femme, latinx, asian diaspora, people of color, queer, disabled, international global citizens to not recede, to assert, to question, and to uplift their great-grandparents’ wisdom. they are also invited to call sources of knowledge into question as well, bringing a critical lens to the schemas and paradigms that have shaped their worldviews. it creates space to validate as well as examine and debunk. rigorous liberatory education invites transformation while unearthing assumptions. ortega-williams & mclane-davison/wringing out the whitewash 579 for example, students explored the person-in-environment perspectives in ortegawilliams’ hbse class, which emphasizes the impact of the environment upon a person’s behavior and well-being, as parts of an ecosystem (hutchinson, 2015). after examining the personal, environmental, and time dimensions, students watched a film clip about the indigenous-led movement against the dakota access pipeline at standing rock (rivas, 2017). they heard community members from various indigenous nations speak about water being life and relatives including the water itself as well as the four-leggeds and insects. they expressed deep curiosity as we identified that the person-in-environment perspective did not represent this community’s worldview, priorities or values, since it imposed an assumption of separateness of human beings from other living creatures and nature. upon further examination, they were able to see that the person-in-environment perspective is estranged to communities that saw the physical environment as intimately related to their cultural ways of life. it was jarring for some because they saw the theory as universal and applicable. the exercise inverted the usual educational paradigm of text as authority, to incorporate their ways of knowing, which embraced methods that were not only constricted to thinking (mclane-davison, 2017). the investigative approach that was taken validated what community members sensed, felt, experienced, and intuited as a valuable part of knowledge development (mclane-davison, 2017). white supremacy, when internalized, shapes one’s ability to be culturally responsive (king, 2017). in educating social work students, we train them to undo racist socialization beginning with unearthing the stereotypes that block one from seeing assets and strengths. bipoc cultural norms that have been marginalized, vilified or co-opted can be reclaimed as strengths fueling community survival, resistance to annihilation, and ability to create futures that we deserve (bent-goodley et al., 2017; mcgee & stovall, 2015; richards, 1994). we train students to detect and interrupt the hypnotic lure to value and regurgitate whiteness on the path to professionalization, while surveilling and criminalizing bipoc family structures or communities. students get to feel the pride, joy and power from discovering their strengths while ejecting the debilitating impact of white supremacy, fostering a more robust view of contemporary issues. in summary, interrogating the white male canon, de-centering whiteness, and elevating students’ lived experience as authoritative knowledge bases facilitates not only a brave space within the social work educational environment, but also a healing and authentic space. our approach to wringing out the whitewash in social work education prepares students to interrupt white supremacy in their lives and agencies, boldly, when no one is looking. it pushes the profession toward the radical ideals within the nasw code of ethics (nasw, 2017) and the type of practice communities deserve. implications for social work the complexity of structural racism and white supremacy are like washing clothes in the latest automatic washing machine. the mechanism has been updated but the function of scrubbing and wringing are the same. the historical trauma caused by white supremacy and structural racism creates the same functional impact on each generation, yet the delivery and language are what is updated, automated, and repackaged. the social advances in social work, summer 2021, 21(2/3) 580 work classroom, reimagined, can be a space of repair, joy, reconciliation, liberation, and uplift. white supremacy ideologically constricts the flow of ideas and critical thinking, while truncating the possibility of authentic relationships. white supremacy as the foundation of oppression in our society operates like a “virus” for which critical consciousness along with committed action can be an “antidote” (freire, 1993; jemal, 2018). fulfilling the nasw (2017) code of ethics and the epas (council on social work education [cswe], 2015), as well as the nabsw code of ethics (nabsw, n.d.) requires a commitment to undoing white supremacy in the implicit and explicit curriculum (cswe, 2015). a concerted daily commitment to anti-racism as social work educators is fundamental to preparing social work students for the profession. racism is pervasive and has a deleterious impact at the micro-, meso-, and macro-level across the lifespan and intergenerationally. wringing out the whitewash as educators creates the possibility for our students and ourselves, to transform who we are in social work practice, and in our everyday lives. social work is an applied field. the evidence-informed practices that we use must be relevant and connected to people’s actual lived experiences of survival. implementing the pedagogical priorities articulated here creates the opportunity for students to be equipped for the actual demands of their 21st century global context. classrooms committed to undoing white supremacy are creative spaces, open for the redistribution of power and restoring balance. shared power, voice, and intellect with our students, while incorporating historical and contemporary frameworks created by bipoc, is pivotal. as social work educators, we can tap into the technological tools and cyberspaces that can invigorate social work education, if we are willing to risk our positions as authorities, including that of our most longstanding canons. transforming social work education brings into view the solutions our volatile times require, from ensuring communities survive covid-19 and future pandemics to conceiving policies able to interrupt the normalcy of police brutality. the time for shifting our educational priorities is now. conclusion: hanging out the wash to dry the hour has come for everybody, for all institutions of the public sector and the private sector to work to get rid of racism. and now if we are to do it we must honestly admit certain things and get rid of certain myths that have constantly been disseminated all over our nation. (martin luther king jr., remaining awake through a great revolution, 1968, p.270) generational knowledge has provided a toolkit and blueprint of resistance and transformation. how do we get rid of the stain of racism? we work continuously to rub out ideologies that invite us to trade our humanity. we utilize the collective historical wisdom of coalition building and positionality to demand action. in the 1800s less than 20 years into freedom, black women became the backbone of the black economy as “washerwomen” (st. julien, 2020). scrubbing and scouring, pushing and pulling, wringing and twisting, to restore the garment back to its original state with handmade lye soap, a tub, and a wooden board. as betye saar depicted, washboards were also “sites ortega-williams & mclane-davison/wringing out the whitewash 581 of insurrection” (small, 2018, para. 1). they self-defined and affirmed their worth as they endured long hours of domestic work in unsanitary and often hostile spaces for little pay in order to provide for the welfare of their families (wang, 2004). in atlanta in 1881, 3000 black washerwomen held a strike and won better wages as well as autonomy over their labor (st. julien, 2020). we pay homage to black washerwomen who challenged the violence of white supremacy in their fight to make their labor and humanity visible. it is our hope that social work educators continue this historic fight to wring out the whitewash as we prepare social work students to do the same. references alexander, m. 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(2004). race, gender, and laundry work: the roles of chinese laundrymen and american women in the united states, 1850-1950. journal of american ethnic history, 24(1), 58-99. https://www.jstor.org/stable/27501531 wells-wilbon, r., mcphatter, a., & vakalahi, h. o. (eds.). (2016). social work practice with african americans in urban environments. springer publishing. whitbeck, l. b., adams, g. w., hoyt, d. r., & chen, x. (2004). conceptualizing and measuring historical trauma among american indian people. american journal of community psychology, 33(3-4), 119-130. https://doi.org/10.1023/b:ajcp.0000027000.77357.31 williams, c. (1987). destruction of black civilization: great issues of a race from 4500bc to 2000ad. third world press. young, w. m. (1968, may 26). reason and responsibility in the elimination of bigotry and poverty. in proceedings of the 95th annual national conference on social welfare (pp. 141-156). columbia university press. zinn, h. (2003). a people’s history of the united states. harper collins. author note: address correspondence to anna ortega-williams, silberman school of social work, hunter, college of the city university of new york, new york, ny. email: anna.ortega-williams@hunter.cuny.edu https://www.jstor.org/stable/27501531 https://doi.org/10.1023/b:ajcp.0000027000.77357.31 mailto:anna.ortega-williams@hunter.cuny.edu “…the function, the very serious function of racism…is distraction. it keeps you from doing your work. it keeps you explaining, over and over again, your reason for being. somebody says you have no language and you spend twenty years proving that you ... __________ frederic g. reamer, ph.d., professor, school of social work, rhode island college, providence, ri. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 14-32, doi: 10.18060/25719 this work is licensed under a creative commons attribution 4.0 international license. managing ethics challenges in social work organizations: a comprehensive strategy frederic g. reamer abstract: social workers are keenly aware of ethical challenges in professional practice. formal ethics education strives to acquaint social workers with common ethical dilemmas in practice and decision-making protocols and frameworks. however, the social work literature includes relatively little information about practical resources promoted in allied professions that can be useful to social workers who encounter ethics challenges. this article discusses the role of four principal resources: informal ethics conversations among social workers and other colleagues (“curbside consults”), formal ethics consultations, agency-based ethics committees, and ethics rounds. the author includes illustrative examples demonstrating social workers’ use of these resources to manage ethics challenges skillfully. keywords: ethical, ethics, ethics committees, ethics consultation, ethics rounds in many key respects, ethics has come of age in social work. unlike earlier generations of social workers, today’s social work educators are expected to include comprehensive ethics education in undergraduate and graduate programs, and in continuing education throughout their careers (congress et al., 2009). according to the council on social work education’s (cswe; 2015) educational policy and accreditation standards, social work education programs must ensure that students have the ability to make ethical decisions; use reflection and self-regulation to manage personal values and maintain professionalism in practice situations; demonstrate professional demeanor; use technology ethically and appropriately to facilitate practice outcomes; and use supervision and consultation to guide professional judgment and behavior. ideally, core content includes understanding the nature of social work values, ethical dilemmas, ethical decision-making frameworks, and ethics risk management (managing ethics challenges in a way that protects clients and prevents ethics-related litigation and complaints). ethics education in allied professions—including psychology, psychiatry, mental health counseling, marriage and family therapy, medicine, and psychiatric nursing—has matured similarly (martin et al., 2017). one key difference, as evidenced by a comprehensive search of the social work literature, is that the social work profession has lagged behind other professions—especially health care professions—in its efforts to establish routine, systematic mechanisms in agency settings to identify, assess, address, and monitor challenging ethical issues. this discussion highlights and reviews the ways in which social work agencies can address ethical issues systematically and on an ongoing basis through four strategies: ethics conversations, ethics consultation, ethics committees, and ethics rounds. about:blank reamer/managing ethics 15 the evolution of social work ethics ethics knowledge and education in social work have evolved since the profession’s formal inauguration in the late nineteenth century, though not always in a linear fashion (banks, 2012; barsky, 2019; dolgoff et al., 2012; reamer, 2014). there have been several key stages, including the morality period, values period, ethical dilemmas and decisionmaking period, risk management period, and digital period. morality period social work’s historical literature suggests that, during its earliest years, beginning in the late 1800s, the profession was focused much more on the morality of clients rather than of practitioners. in many discussions, one finds references to concern about the moral fiber, or the alleged lack thereof, of clients who struggled with issues such as poverty, unemployment, alcohol use, or poor health (reamer, 2018). the phrase “professional ethics” did not exist. some of the discussions of clients’ morality during this period had a rather paternalistic tone. values period as social work matured in the early and mid-twentieth century, a handful of scholars and practitioners began exploring and writing rich commentaries about the profession’s core values, such as client dignity, respect, self-worth, self-determination, and confidentiality (banks, 2012; gordon, 1965). these important discussions and analyses sought to explore the implications of social work’s central values, especially when there were conflicts among the profession’s values, the broader society’s values, and social workers’ personal values. during the turbulent 1960s and early 1970s, several social work authors wrote about the complex connections between social work values and contemporary controversies surrounding civil rights, women’s rights, welfare rights, discrimination, and abortion (vigilante, 1974). ethical dilemmas and decision-making period the scholarly winds began to shift significantly during the late 1970s and early 1980s, largely because of the dramatic emergence of the broader field of applied and professional ethics, especially bioethics (barsky, 2019; dolgoff et al., 2012; reamer, 2018). during this period, increasing numbers of scholars and practitioners in a wide range of professions (for example, medicine, nursing, psychology, social work, journalism, business, law enforcement, engineering) focused explicitly for the first time in their respective histories on the nature of challenging ethical dilemmas facing practitioners. during this period, scholarship burgeoned on the subjects of ethical dilemmas in practice and ethical decision-making protocols (barsky, 2019). the richest discussions identified links between ethical theory, drawn from the discipline of moral philosophy, and real-life challenges faced by professionals, particularly those involving conflicts between professional duties and obligations (bryan et al., 2022; reamer, 2018). textbooks in diverse professions included, for the first time, in-depth overviews of ethical dilemmas and conceptual frameworks practitioners could use to address them advances in social work, spring 2022, 22(1) 16 (beauchamp & childress, 2019; bryan et al., 2022; martin et al., 2017). in social work common topics concerned the nature of professional paternalism, the limits of clients’ confidentiality rights, managing informed consent challenges, complicated boundary issues, dual relationships, conflicts of interest, allocation of limited resources, and compliance with allegedly unjust laws, among others. over time, social work education programs developed curricula to teach students about ethical dilemmas and decision-making (congress et al., 2009; reamer, 2001). it was during this period when the concepts and practice of formal ethics consultation, ethics committees, and ethics rounds—the focus of this discussion—first emerged, primarily in health care professions and, more modestly, in social work. these were deliberate efforts to help practitioners make sound ethical judgments when dilemmas arose. over time, social work scholarship has explored the importance of high-quality ethical decision-making (mertens & ginsberg, 2008), including the use of heuristics and subjective assessments to make difficult judgments (devlieghere & roose, 2020; taylor, 2017). ethical risk management period in the early 1990s, the winds shifted yet again. although many social workers sustained their interest in ethical dilemmas and decision-making, new concerns emerged regarding ethics-related risk management (reamer, 2018). data began to circulate concerning increases in lawsuits and licensing board complaints that raised ethical issues (phelan, 2007; strom-gottfried, 2000). increased publicity circulated by the national association of social workers, association of social work boards, and state licensing boards alerted social workers to relatively new information about the ways in which social workers’ ethical judgments could lead to litigation and complaints filed with licensing boards and professional social work associations. social workers discovered how disgruntled clients and others could file formal complaints alleging, for example, mismanagement of clients’ confidential and privileged information, boundary and dual relationship violations, conflicts of interest, negligent service delivery, and inappropriate termination of services (gricus, 2019). for the first time in social work’s history, literature emerged about the links between social workers’ ethical judgment and potential malpractice, negligence, and professional discipline (barsky, 2019; reamer, 2015). licensing boards developed publicly available websites listing social workers who were sanctioned because, for example, they committed fraud, had sex with clients, and disclosed sensitive confidential information without proper authorization (gricus, 2019). professional ethics no longer were limited to questions such as “what’s the right thing to do in this complicated situation?” for many social workers, ethics now included questions such as “can i be sued or have a licensing board complaint filed against me if i . . .?” this became especially relevant as social work licensure and regulation expanded throughout the united states, beginning with the formal registration of social workers in california in 1945. the formal regulation of social work created boards’ authority to sanction social workers who violated ethical standards (dyeson, 2004). in addition, beginning in the 1990s social workers became increasingly concerned about the risk of being named in a lawsuit (reamer, 2015). thus, ethics-related risk management became a reamer/managing ethics 17 relatively new component of social work education and training. during this period, the focus of ethics consultation, ethics committees, and ethics rounds narrowed to explore the connection between ethical decision-making and prevention of litigation and formal ethics complaints. digital period social workers are now in the midst of what can best be described as the digital period. today’s social workers can provide services online or via video counseling or text messages to clients they never meet in person (lamendola, 2010; menon & miller-cribbs, 2002). they may receive facebook friend requests from clients or former clients that lead to boundary challenges. in this digital era, social workers can use e-mail as a therapeutic tool and provide clients with specialized smartphones that enable them to record and transmit summaries of their moods to their clinicians and caseworkers, receive therapeutic messages and alerts, and communicate with other people in their digital network who face similar life challenges (a virtual support group). social workers’ sudden pivot to remote delivery of services due to the onset of covid-19 in 2020 greatly expanded practitioners’ encounter with technology-related ethical issues, particularly concerning issues of informed consent, privacy, confidentiality, and professional boundaries (banks et al., 2020; reamer, 2021). strengthening social workers’ ability to identify and manage ethical issues can no longer be delegated to undergraduate and graduate student classrooms and sporadic postgraduate continuing education workshops, seminars, and webinars. it is time for social workers to learn from longstanding initiatives in allied professions to enhance practitioners’ ability to regularly identify, assess, address, and monitor challenging ethical issues in work with individual clients, families, couples, groups, organizations, and communities. these efforts can include a range of protocols, including (1) informal ethics conversations among colleagues, (2) conferring with an ethics consultant, (3) consulting with an ethics committee, and (4) presenting at ethics rounds. ethics conversations in some instances, social workers who encounter ethical dilemmas can choose to confer with colleagues informally, or what is known as a “curbside consult.” these conversations typically occur “off the record” during conversations in a colleague’s or social worker’s office, on the telephone, or on a videoconferencing call. ordinarily, these informal ethics conversations are not documented in the client’s record or chart (jiwani, 2017; jonsen et al., 2015; kuczewski et al., 2018). in some instances, social workers, especially those in private (independent) practice, may consult informally with members of their peer consultation groups (golia & mcgovern, 2015). ethics consultation ethics consultation—first provided primarily in hospitals—began in the late 1960s and early 1970s (fletcher et al., 1989; la puma & schiedermayer, 1991). in the late 1970s, pelligrino (1978, 1979) and siegler (1978, 1979) published several influential papers that advances in social work, spring 2022, 22(1) 18 proposed a role for “clinical ethics” as a discrete and unique field of expertise, and in 1985 the university of california, san francisco, and the national institutes of health cosponsored a conference on ethics consultation (bermel, 1985). by 1990, ethics consultation in health care had developed so substantially that a professional journal, the journal of clinical ethics, began publication. recent systematic reviews of pertinent research provide evidence that ethics consultation in health care settings can have a significant impact on key outcomes, such as decreasing length of stay in an intensive care unit and increasing family and healthcare provider satisfaction (au et al., 2018; crico et al., 2021). over the years, ethics consultation has assumed a variety of forms and tasks that can be usefully incorporated into social work settings (aulisio et al., 2003). ethics consultation is typically available to practitioners who encounter a challenging, sometimes deeply troubling, case-specific ethical dilemma. in health care settings, for example, ethics consultation is often sought when a staffer feels caught between family members’ wishes concerning treatment of a gravely ill relative and accepted medical practice which suggests an alternative course of action (beauchamp & childress, 2019). typically, ethics consultants obtain formal training in ethics theory, core ethics concepts, and what has become known as applied, professional, or practical ethics, to supplement their substantive expertise in their respective professions (jiwani, 2017; jonsen et al., 2015; kuczewski et al., 2018). these are individuals who are trained to identify, analyze, and help resolve ethical challenges. occasionally, an organization will retain a moral philosopher who specializes in professional ethics. in large human service agencies, such as hospitals, ethics consultation may be provided by formally trained staff members. although these individuals tend to have expertise with respect to bioethical issues (with regard, for instance, to ethical decisions about end-of-life care, organ transplantation and allocation, genetic engineering, and reproductive rights), in principle, staff social workers could be trained to provide ethics consultation. using inhouse social workers may be appropriate in other settings as well, such as school systems, mental health centers, child welfare agencies, and the military. this may require social workers to enroll in ambitious ethics-related continuing education to ensure appropriate knowledge and skills germane to ethics consultation. realistically, many social workers are likely to be employed in settings that do not have ethics experts on staff. social workers in modest-sized family service agencies, clinical group practices, substance use disorder treatment programs, group homes, and correctional facilities, for example, are not likely to have resident ethics experts. they may need to reach out to social workers who specialize in professional ethics for consultation services. these may be available at departments and schools of social work and through a professional social work organization, such as the national association of social workers or the clinical social work association. ethics consultants can serve several different roles, depending on the employment setting, responsibilities, and particular training and expertise. these roles include those of professional colleague, educator, mediator, advocate, and case manager (goldman et al., 1983; la puma & schiedermayer, 1991). as a professional colleague, the ethics consultant’s mission is to provide a coworker with a thoughtful assessment and reaction to reamer/managing ethics 19 ethics challenges, similar to traditional clinical consultation. in this respect, the social work ethics consultant would help tease out important ethical issues and, while drawing deliberately on relevant ethics concepts and standards, think through options. this consultation, which is typically documented in the client’s record or an administrative file, may include a focused discussion of a complex ethical issue, perhaps related to a coworker’s dilemma related to disclosure of a client’s confidential information to protect a third party from harm or whether it is appropriate to search online for information about the client without the client’s knowledge or consent. an ethics consultant can also be an effective educator (aulisio et al., 2003; jiwani, 2017). it is common, for example, for an ethics consultant to provide in-service training on ethical challenges that agency staffers are likely to encounter. through lectures, case illustrations, simulations, and group discussions, the social work ethics consultant can enhance colleagues’ ability to recognize and address ethical issues in that particular work setting. the ethics consultant may acquaint staffers with common ethical challenges relevant to the agency’s mission and client population, key concepts and resources, and decision-making models and options. as a mediator, the social work ethics consultant can help staffers and clients resolve differences of opinion, drawing especially on social workers’ mediation skills (goldman et al., 1983; la puma & schiedermayer, 1991). for example, in this role the social work ethics consultant might facilitate discussions between a client who believes the agency violated her confidentiality rights and an administrator who is responsible for responding to clients’ complaints. as an advocate, a social work ethics consultant can assist a client or colleague who believes their rights have been violated in some manner (jonsen et al., 2015; kuczewski et al., 2018). this might be appropriate if an ethics consultant is contacted by a colleague who believes she has been unfairly disciplined by the employer because she inadvertently disclosed protected health information in an email message to the parent of an adolescent client or to an attorney representing one parent in a child custody dispute. finally, an ethics consultant can also function as a case manager. in these instances, for example, a social worker may assist a colleague who has been sanctioned by a licensing board for an ethics violation. under the terms of the licensing board’s consent agreement or consent order, the disciplined practitioner may be required to arrange a series of sessions with an ethics expert to discuss and assess the ethical issues that gave rise to the board’s concerns; ultimately, the ethics consultant would be expected to file a report with the licensing board summarizing the consultation, assessing the practitioner’s fitness to practice, and offering any relevant recommendations. in this sense, the ethics consultant is helping the disciplined colleague manage the licensing board case. in the united states, members of the national association of social workers can also obtain ethics consultation from the national office of ethics and professional review and from some state nasw chapters that offer ethics consultation. according to the national office’s policy, advances in social work, spring 2022, 22(1) 20 the office of ethics and professional review provides individual ethics consultations as a benefit of nasw membership. ethics consultations are a free resource for members who encounter ethical dilemmas and/or have ethics related questions. consultation services are intended to guide members through the applicable standards in the code along with other pertinent considerations and resources that address their concerns and allows them to make reasoned ethical decisions. while we can discuss ethical issues, we cannot provide definitive answers for a particular situation or make decisions for members. (nasw, 2022, paras. 1-2) in canada, for example, the newfoundland and labrador college of social workers, the provincial regulatory body and professional association, also offers ethics consultation to practitioners. according to the organization’s website, ethics consultations draw directly on the canadian association of social workers (casw, 2005a) code of ethics, casw’s (2005b) guidelines for ethical practice, newfoundland and labrador college of social workers standards for practice (2020), and the social workers act (2010). ethics committees the concept of ethics committees (also known as institutional ethics committees) first emerged in 1976, when the new jersey supreme court ruled that karen ann quinlan’s family and physicians should consult an ethics committee to help them decide whether to remove quinlan from life-support technology (post & blustein, 2015). in 1975, after being out with friends, quinlan unexpectedly lapsed into a coma. upon arrival at a hospital, doctors could find no specific reason for the coma, and started life support, which included a respirator. quinlan’s health steadily deteriorated and very soon her coma was diagnosed to be irreversible. in a landmark lawsuit, quinlan’s parents asked that the respirator be disconnected and that their daughter be allowed to die ''with grace and dignity,'' (mcfadden, 1985, para. 10) because there was no hope she would recover. a superior court judge denied the parents’ request, but the decision was reversed in an appeal to the new jersey supreme court. the court determined that quinlan, who was in a persistent vegetative state, had a constitutional and common-law right to refuse treatment, even if the refusal would result in her death. nonetheless, her physicians were unwilling to remove her from a ventilator unless they were reassured that they could not be sued for this action. the court ruled that if a hospital ethics committee agreed with their prognosis—that there was no reasonable possibility of quinlan returning to a cognitive, sapient state—the physicians would be immune from any legal liability for removing her ventilator at her parents’ request (in re quinlan, 1976). ethics committees, which have been most prominent in healthcare settings (hospitals, nursing homes, rehabilitation facilities, hospice, and home healthcare programs), and typically include representatives from various disciplines and positions, such as nursing, medicine, social work, the clergy, and agency administration (hester & schonfeld, 2012). some ethics committees include a formally educated ethicist—either an agency employee (for instance, in large teaching hospitals) or an outside consultant—who has formal training https://journalofethics.ama-assn.org/2006/09/hlaw1-0609.html reamer/managing ethics 21 in applied and professional ethics, moral philosophy, and ethics consultation. some ethicists are trained philosophers or theologians with a special interest in professional ethics, and some are members of a human services profession (such as social work, nursing, or medicine) who have supplemental education related to ethics. many ethics committees provide agency staff with case-related consultation services and nonbinding advice, particularly when staff members or clients want assistance thinking through difficult ethical decisions. for example, in hospital settings ethics committees may offer consultation and nonbinding advice on issues related to termination of life-support technology, the use of aggressive care with terminally ill patients, patients’ right to refuse treatment, and patients’ eligibility for organ transplantation. although ethics committees are not always able to provide definitive advice or guidance about complex ethical issues, they can offer colleagues and clients a forum for organized, focused, explicit, and principled exploration of ethical dilemmas. this can provide participants with a greater understanding of the issues and options they face and enhance the quality of their decision-making. many ethics committees also serve other functions. some are responsible for reviewing existing ethics-related policies and suggesting revisions, sometimes in response to controversial case-related issues that arise in the agency. for example, an ethics committee in a family service agency may review agency policies and guidelines related to complicated confidentiality issues (such as disclosure of confidential information to the parents of clients who are minors, disclosure of information about deceased clients to their relatives, and disclosure of information in response to subpoenas or informal requests from law enforcement officials). an ethics committee in a community mental health center may review and suggest revisions of the agency’s policies concerning the termination of services to clients who do not comply with treatment recommendations. ethics committees also draft new ethics-related policies and procedures for more formal review and approval by agency administrators and boards of directors. for example, in a program that serves clients who have serious drug and alcohol challenges, the ethics committee may draft new guidelines concerning the hiring of former clients as staff members. an ethics committee in a nursing home may draft new guidelines concerning consensual sexual relationships among residents, and an ethics committee in a residential treatment program for children with serious disabilities may draft new guidelines concerning the handling of gifts given to staff by the children’s parents or guardians, or how staffers should manage online communications with clients and former clients in order to maintain clear professional boundaries. ethics committees also sponsor ethics-related training and education for agency staff. this may include continuing education seminars for licensed practitioners and various types of in-service training on a range of ethics-related topics. ethics committees may help develop the training and education curriculum, develop teaching material, and recruit presenters. agency ethics committees provide social workers and their colleagues with a valuable resource when they encounter complex ethical issues. social workers should not assume, advances in social work, spring 2022, 22(1) 22 however, that ethics committees function as final arbiters or judges of what is ethically right or wrong. although ethics committees are sometimes approached about relatively simple ethical matters, more typically they are asked to consult on remarkably difficult and controversial issues that resisted easy resolution by line staff and their supervisors before reaching the ethics committees. in such instances, as one may expect, ethics committee members themselves may disagree about what is ethically appropriate. ethics rounds health care professionals are familiar with the age-old tradition of grand rounds. typical grand rounds consist of presenting the medical problems and treatment of a particular patient to an audience of doctors, physician assistants, nurses, pharmacists, residents, and medical students. grand rounds are designed to keep participants up-to-date regarding important developments and provide a forum for comment and consultation on complex cases. grand rounds have been a staple in medical education for more than a century. in the late nineteenth century, the johns hopkins medical school, led by sir william osler, introduced bedside teaching as a new approach to clinical education. residents learned as faculty moved from patient to patient, explaining their methods of diagnosis and treatment. over time, these rounds moved from the bedside to an auditorium, leading to the inauguration of grand rounds. during the earliest years of the grands round tradition, patients were present. this practice waned by the 1980s due to concerns about patient privacy and to encourage candid discussion among practitioners and other participants (sandal et al., 2013). ethics rounds in health care settings (hospitals, rehabilitation and long-term care facilities, and nursing homes) emerged soon after the emergence of the bioethics field in the 1970s. modeled after grand rounds, ethics rounds typically include presentations and discussions of complex cases or more didactic presentations on key topics (airth-kindree & kirkhorn, 2016; silen et al., 2016; teti, 2020). case examples social workers’ use of informal ethics conversations, formal ethics consultation, ethics committees, and ethics rounds should not be limited to health care settings and can be implemented fruitfully in a wide range of social work organizations and programs. the professional literature suggests that these strategies and resources are not used routinely in many social work settings (banks, 2012; barsky, 2019; reamer, 2018). here are several real-life examples that can model the use of these strategies and resources in social work, based on the author’s experience: community mental health agency a social worker served as a clinician in a community mental health center serving people who struggle with severe and persistent mental illness. most of her clients have been diagnosed with schizophrenia, bipolar disorder, depression, and anxiety. https://en.wikipedia.org/wiki/residency_(medicine) reamer/managing ethics 23 one of the social worker’s clients struggled with co-occurring issues, including bipolar disorder and heroin use. during one clinical session, the client, who was in long-term recovery, told the social worker that “i have something i need to get off my chest. it’s been eating away at me.” the client explained that he has been experiencing “overwhelming” guilt because of a murder he committed seven years earlier when he was actively using and selling heroin. the client told the social worker that one night, when he was selling heroin, one of his customers grabbed bags of heroin and fled without paying. the client reported that he chased after his customer, fired warning shots in the air using the gun he routinely carried, and, when the customer continued to run, fired his gun at him to scare him. the client told the social worker that his poorly aimed shot killed the man instantly. the client said he ran from the scene and was never caught. the police consider this to be a “cold case.” the social worker was unsure about how to handle the client’s confidential disclosure, particularly considering that, at the time of the disclosure, the client was stable and did not pose a serious, imminent, or foreseeable threat. one decision concerned whether to include explicit details about the client’s disclosure in the case record. a second decision concerned whether the social worker had a duty to disclose this information to law enforcement officials or protect the client’s confidentiality. as a first step, the social worker sought out a trusted social work colleague at the mental health agency. they discussed the situation informally (a “curbside consult”) but were not able to reach consensus about the appropriate course of action. during their conversation they struggled to reconcile the social worker’s duty to protect the client and the social worker’s gut instinct that she may have an obligation to disclose information about the unsolved murder based on her understanding of “duty to protect” guidelines she had learned in graduate school. nonetheless, the social worker found the discussion helpful because it reinforced her hunch that this was an unusually complex ethical dilemma. as a second step, the social worker contacted her former social work professor who specializes in professional ethics. they reviewed all of the relevant details. the professor, who served as an ethics consultant to this social worker, systematically applied relevant standards in the nasw (2021) code of ethics concerning exceptions to clients’ confidentiality rights, federal law governing confidentiality disclosures in mental health settings (health insurance portability and accountability act [hipaa]), a state statute governing protection of confidential health care information and disclosures to law enforcement officials, and the state’s social work licensing regulations, which include a section on social workers’ duty to protect clients’ confidentiality and related exceptions. the professor offered his advice and, out of an abundance of caution, encouraged the social worker to present the case to the mental health center’s ethics committee, which had been established about two years earlier. the professor told the social worker that consultation with the agency’s ethics committee would serve two purposes. first, the social worker would have the benefit of review by a cross-section of colleagues who had received inservice training in ethics consultation and decision-making. second, in the event that a third party raises questions about the social worker’s judgment, she would be able to cite her consultation with the agency’s ethics committee as evidence of her good faith effort to manage this ethical dilemma responsibly. advances in social work, spring 2022, 22(1) 24 based on these consultations with the social worker’s colleague, the social work professor who served as an ethics consultant, and the agency’s ethics committee—along with careful review of the nasw (2021) code of ethics (especially standard 1.07[c] concerning confidentiality exceptions) and relevant federal and state laws—the social worker concluded that her case notes should be vague (referring only to the client’s disclosure of a “past traumatic event”) and that she was not permitted to disclose the information without her client’s consent, particularly since, at the time of the disclosure, there was no evidence that disclosure of this confidential information would likely prevent serious, imminent, and foreseeable harm. the mental health center’s clinical director recognized that this case offered a valuable teaching opportunity for agency staffers concerning management of a complex ethical dilemma. about one month after the acute dilemma, the social worker and her supervisor assembled the agency’s entire clinical staff and presented the case during an ethics round. following the case presentation, staffers discussed the scenario’s unique features and the social worker’s decision-making process. substance use disorder treatment program a social worker was employed at a large family services agency. his principal responsibilities included counseling adolescents who struggle with mood disorders. one of the social worker’s clients, a 16-year-old boy, had been referred by the boy’s school-based counselor. the client told the agency’s social worker that he was feeling depressed primarily because of his parents’ impending divorce. after seven counseling sessions, the social worker concluded that the boy was using alcohol and marijuana excessively and in dangerous quantities. the boy agreed that he had developed a substance use problem and asked for help. the family services agency recently received a federal grant to provide state-of-the-art counseling services to adolescents who have been diagnosed with co-occurring issues (mental health and substance use disorder issues). the boy’s social worker told him about the substance use disorders program at the agency and offered to make a referral. the boy jumped at the chance, in light of his eagerness to get his substance use under control. however, the boy refused to give the social worker permission to inform his mother—his primary caretaker—about his substance use challenges and enrollment in the agency’s substance use disorders program. the social worker used his clinical skills in an effort to get the client to consent to disclosure to his mother. unfortunately, these efforts did not succeed, yet the boy reiterated his eagerness to enroll in the agency’s substance use disorders treatment program. the social worker was unsure about his duty to protect the boy’s confidentiality and whether the agency could enroll him in the substance use disorders program without parental consent. the social worker conferred informally with his colleague in the agency’s substance use disorders treatment program (a “curbside consult”). after considerable discussion, the two agreed that they were uncertain about the minor’s right to consent to treatment without disclosure to his parents. shortly thereafter, the two contacted a local social worker who frequently conducted ethics trainings at local human services agencies. the ethics consultant helped the two staffers identify key guidelines that are relevant to reamer/managing ethics 25 this decision. these included the nasw code of ethics standard 1.03(c) that advises social workers to consider whether clients have the capacity—legal or otherwise—to consent to services: “in instances when clients lack the capacity to provide informed consent, social workers should protect clients' interests by seeking permission from an appropriate third party, informing clients consistent with the clients' level of understanding” (p. 8). additional guidelines recommended by the ethics consultant included provisions in hipaa regarding minors’ privacy rights; the federal regulation entitled confidentiality of substance use disorder patient records (title 42 c.f.r. part 2, 2017), which state that “if a minor patient acting alone has the legal capacity under the applicable state law to apply for and obtain substance use disorder treatment, any written consent for disclosure . . . may be given only by the minor patient” (section 2.14); and applicable laws in the social worker’s state governing minors’ right to consent to substance use disorder treatment without notification and consent of parents/guardians. during this discussion, the social workers and ethics consultant discovered that these various guidelines may clash with each other. for example, hipaa generally permits parents and guardians to access otherwise confidential information concerning their minor children. however, the law in the social workers’ state permits treatment of a minor for substance use disorders without parental or guardian knowledge or consent if there is evidence that disclosure to the parent or guardian would be deleterious or harmful to the minor. in an effort to further analyze this ethical dilemma, the social workers requested consultation with the ethics committee that the family services agency recently formed to provide staffers with consultation. the ethics committee also consulted with a local health care law attorney with whom this agency’s administrators typically consult when complex ethical issues arise. in the end, the ethics committee and attorney agreed that state law—to which federal regulation title 42 c.f.r. part 2 directed them—permits the agency to provide services to the adolescent without parental notification under some narrowly defined circumstances. they advised the social worker to carefully document in the case record his consultation and the rationale for his decision. recognizing that the social worker’s employer might not protect the social worker if, for example, the parents challenged the employer’s judgment, out of an abundance of caution the social worker sought external consultation from a local social work ethics expert and another attorney who specializes in health care law and risk management. the chair of the agency’s ethics committee asked the social worker for his permission to share the case at an upcoming all-staff training on ethics—the equivalent of ethics rounds—as an exemplary illustration of sound ethical decision-making. school a social worker served adolescent students enrolled at a school sponsored by a pediatric psychiatric hospital. all of the students had difficulty succeeding in their local school due to their severe psychiatric diagnoses and behavioral health challenges. one of the students—who had been diagnosed with reactive attachment disorder—also received mental health counseling from another clinical social worker in the same hospital’s outpatient clinic. https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=aa173e270b5d7c2093bfe50f1a2d0c00&term_occur=999&term_src=title:42:chapter:i:subchapter:a:part:2:subpart:b:2.14 https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=a78e098f12f0351f4a265a6f68823e4e&term_occur=999&term_src=title:42:chapter:i:subchapter:a:part:2:subpart:b:2.14 https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=61a953a9609c7df53daccf0883c43204&term_occur=999&term_src=title:42:chapter:i:subchapter:a:part:2:subpart:b:2.14 https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=c7acafb2978c42d2e3be10d443769d74&term_occur=999&term_src=title:42:chapter:i:subchapter:a:part:2:subpart:b:2.14 https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=aa173e270b5d7c2093bfe50f1a2d0c00&term_occur=999&term_src=title:42:chapter:i:subchapter:a:part:2:subpart:b:2.14 advances in social work, spring 2022, 22(1) 26 one afternoon, a local police detective contacted the hospital following a shooting at a nearby shopping mall. the two social workers’ client, the student, was the principal suspect based on several eyewitness reports. the detective learned from one of the eyewitnesses that the student attended the school sponsored by the psychiatric hospital. at the time, the student was a fugitive. the detective asked the social workers for information about the student, including the date of their last contact, the student’s last known whereabouts, and their clinical impressions. the social workers told the detective they needed to confer with each other about disclosing confidential (protected health) information to her. the social workers spoke privately, away from the detective, about whether these circumstances warrant disclosure (a “curbside consult”). the social workers were unsure about the “rules” germane to management of this ethical dilemma. the social workers told the detective they needed to consult with hospital administrators and arranged to contact the detective later that afternoon. the social workers then contacted their immediate supervisor, who then contacted the hospital’s ethics consultant and the chair of the hospital’s ethics committee. the five of them conferred for an hour; the chair of the ethics committee called a local social work ethics expert for consultation. the ethics consultant systematically reviewed the potential implications of (1) standards in the nasw code of ethics governing disclosure of confidential information without client consent, (2) hipaa (which would apply only to the social worker who provides outpatient counseling to the student, not the school-based social worker), (3) the federal family educational rights and privacy act (ferpa), which would apply only to the social worker assigned to the hospital’s school, (4) state laws governing confidential health care information, (5) social work licensing regulations governing client confidentiality, and (6) hospital policy governing management of protected health information. after considerable discussion, which ultimately included the hospital’s attorney and risk management officer, the group agreed that all key relevant guidelines included language permitting disclosure of confidential information without client consent to the detective to address an imminent health or safety emergency. the hospital sponsors an annual ethics conference for all health and behavioral health employees. the chair of that year’s conference invited the two social workers, the chair of the hospital’s ethics committee, the community-based ethics consultant, and the hospital’s attorney to serve on a panel that presented this case scenario in the format of an ethics round. private (independent) clinical practice a clinical social worker in private (independent) practice provided services to a 20year-old college student who attended a nearby university. the student sought counseling to help her cope with a longstanding eating disorder. nearly seven months after in-person counseling began, the student’s university suddenly closed all dormitories due to the onset of the covid-19 pandemic and required students to return home or some other destination. the student moved back home with her parents in another state, approximately 225 miles away. reamer/managing ethics 27 the student contacted the social worker soon after she returned home and informed her about the move. the student, who reported feeling “very fragile and vulnerable,” told the social worker that she was eager to continue the counseling remotely and was not interested in finding a new therapist in her home community. the social worker was unsure whether she could provide services to her client remotely, particularly given the client’s reportedly fragile condition and the fact that the social worker was not licensed in the student’s home state. the social worker conferred with members of her peer consultation group, who recommended that she contact a former professor of hers who teaches social work ethics for informal consultation. the ethics consultant identified several key guidelines for the social worker to consider. these included (1) 2017 additions to the nasw code of ethics concerning remote delivery of services across jurisdictional lines, (2) provisions in technology-related practice standards adopted jointly by the nasw, association of social work boards, cswe, and clinical social work association (2017) concerning provision of remote services across jurisdictional lines, (3) provisions in the licensing regulations in the social worker’s state and in the client’s home state concerning provision of remote services across jurisdictional lines, and (4) an executive order issued by the governor of the student’s home state shortly after the onset of the covid-19 pandemic permitting clinical social workers licensed in other states to deliver services remotely to residents of the student’s home state, in an effort to enhance citizens’ access to services. the ethics consultant also advised the social worker to contact her malpractice insurer to ensure proper coverage for interstate provision of remote services and to contact the social work licensing board in the student’s home state to confirm that the governor’s executive order was still in effect and that the social worker was permitted to provide clinical services to the student remotely, across state lines. out of an abundance of caution, the ethics consultant also advised the social worker to call the nasw office of ethics and professional review, which offers ethics consultation to nasw members. following the consultation, the ethics consultant invited the social worker to present her ethical dilemma and decision-making during a national ethics education webinar for social workers facilitated by the ethics consultant, a form of ethics rounds. implications for practice during the course of their careers, social workers are bound to encounter ethics challenges. common ethical dilemmas concern management of confidential information, informed consent, conflicts of interest, boundary issues and dual relationships, documentation, termination of services, use of technology, professional paternalism, whistle blowing, and allocation of limited resources, among others. to supplement the foundation-level ethics knowledge social workers should acquire during their formal education, many social workers expand their knowledge as a result of post-graduation continuing education. it is critically important for social workers to build on this foundational knowledge and broaden their systematic use of protocols designed to assist practitioners who encounter complex ethical dilemmas. a number of allied professions have cultivated practical mechanisms to enhance practitioners’ ethical decision-making, advances in social work, spring 2022, 22(1) 28 including informal ethics conversations, formal ethics consultation, ethics committees, and ethics rounds. it is time for social workers to embrace this same fruitful approach. they can do so by taking several practical steps. social workers employed in agency settings can identify colleagues who are keenly interested in professional ethics and meet to discuss the development of agency-based protocols. this can include identifying staffers who have indepth ethics knowledge and expertise who would be willing to serve as both informal (“curbside”) and more formal consultants when ethical challenges arise. if necessary, social workers can explore ways for staffers to gain comprehensive ethics knowledge and skills by attending widely available institutes, conferences, and webinars designed for this purpose (for example, sponsored by the association for practical and professional ethics, nasw, and various professional ethics centers). further, social workers employed in organizations can take the initiative to form an ethics committee in settings where one does not exist. these committees can provide staffers with case-based consultation, review existing ethics-related policies, and develop new policies when the need arises. in addition, social workers can organize ethics rounds that feature complex and timely ethical issues for discussion among agency staffers. these ethics rounds can include case presentations and panel discussions, highlighting the relevance of social work values and ethical standards. social workers in independent practice can take deliberate steps to raise and address complex ethical issues during peer consultation meetings. they can also ensure that they and their colleagues—including those who are members of social work clinical societies— are familiar with consultation resources such as local and national ethics experts, and nasw (both the national office of ethics and professional review and state chapters that offer ethics consultation to members). social workers’ use of these strategies and resources—ethics conversations, ethics consultation, ethics committees, and ethics rounds—does not necessarily occur linearly. these options can be used selectively—mixed and matched—as needed, depending on the nature of the ethical issues that must be addressed, the practice setting, and available resources. in some instances, informal ethics conversations may suffice. in others, social workers will find it necessary to seek more formal consultation from ethics experts and ethics committees. in particularly complex cases, social workers will want to gather colleagues and present challenges during an ethics round in an effort to learn and think through responsible handling of difficult circumstances. what is vitally important is that 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(1974). between values and science: education for the profession during a moral crisis or is proof truth? journal of education for social work, 10(3), 107-115. https://doi.org/10.1080/00220612.1974.10671310 author note: address correspondence to frederic g. reamer, school of social work, rhode island college, providence, ri 02908. email: freamer@ric.edu https://doi.org/10.7312/ream16782 https://doi.org/10.7312/ream18828 https://doi.org/10.4300/jgme-d-12-00355.1 https://doi.org/10.1001/jama.1978.03280370047023 https://doi.org/10.1001/archinte.1979.03630450056016 https://doi.org/10.1177/0969733014560930 https://www.assembly.nl.ca/legislation/sr/statutes/s17-2.htm https://doi.org/10.1093/sw/45.3.251 https://doi.org/10.1093/bjsw/bcw084 https://pubmed.ncbi.nlm.nih.gov/32213689/ https://doi.org/10.1080/00220612.1974.10671310 mailto:freamer@ric.edu _________ mitchell rosenwald, phd, lcsw, professor and director of doctoral studies, and fabio a. naranjo, phd, msw, assistant professor, school of social work at barry university, miami shores, fl. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 779-796, doi: 10.18060/24901 this work is licensed under a creative commons attribution 4.0 international license. the other side of the dais: strategies for social workers vying to serve in public office mitchell rosenwald fabio a. naranjo abstract: this article articulates a reinvigorated vision for social workers to be elected and appointed to serve in public office and an array of strategies to achieve this vision. coupling the current and divisive political climate with the pressing inequities of marginalized populations, an urgent imperative exists for social workers to “re-envision” and expand their macro practice options more deliberatively by serving in public office. included in this challenge is the necessity for social workers to assume legitimated macro power by holding elected and appointed positions in government – a sub-branch of “political social work.” to that end, this article articulates five components of political social work practice in elected and appointed office: 1) the roles and skills of elected and appointed officials, 2) making the decision to seek office, 3) campaigning and networking, 4) serving in office; and 5) enlisting social workers to assist others who seek public office. it concludes with recommended strategies to strengthen these components that both social work education and social work professional associations should consider. keywords: political social work, electoral politics, elected office, appointed office this article articulates a reinvigorated vision for social workers to be elected and appointed to serve in public office. coupling the current and divisive political climate with the pressing inequities of marginalized populations, an urgent imperative exists for social workers to “re-envision” and expand their macro practice options more deliberatively by serving in public office. when social workers occupy positions of power and authority on the dais, their perspectives and skillsets will bring hope and opportunity for vulnerable populations. given a decades-long sweep of waning interest in macro practice (friedman, et al., 2020; reisch & jani, 2012; rothman, 2013), social work education sought to reverse this trend, expand macro practice curricula, and increase student interest in macro specialization by 20% by 2020 (council on social work education [cswe], 2018). included in this challenge is the necessity for social workers to assume legitimated macro power by holding elected and appointed positions in government – a sub-branch of “political social work” that also encompasses empowerment of social workers’ clients to vote and social workers supporting pro-social work candidates holding office (friedman et al., 2020; lane & humphreys, 2011; pritzker & lane, 2016). background since the early days of the social work profession, social workers have engaged in the policy-making process and electoral politics (friedman et al., 2020; national association of social workers [nasw], 2021a; weiss, 2017). the political engagement started with early social work pioneers. jane addams engaged in local organizing often political in about:blank advances in social work, summer 2022, 22(2) 780 nature around hull house in chicago, and mary richmond, who authored social diagnosis in 1917, sought to understand the root causes of poverty after seeing its consequences in individuals’ plights (social welfare history project, 2011). in 1916, social worker jeanette rankin was elected to congress (lane et al., 2018; lane & humphreys, 2011). indeed, [b]eginning with theodore roosevelt’s progressive party in 1912, social workers have been active in presidential campaigns, including those of franklin delano roosevelt, lyndon johnson, bill clinton, and barack obama. [national association of social workers] nasw has been active in local and state elections since 1976. social workers show a growing willingness to enter the political arena in all capacities—as voters, party officials, political professionals, candidates, and officeholders. (nasw, 2021a, p. 95) likewise, social workers have been appointed to federal and state cabinet positions and on the boards of directors of private non-profit and for-profit organizations. social workers have served on such bodies for the better part of a century (friedman et al., 2020; weiss, 2017). apart from co-founding hull house in chicago, jane addams was a co-founder and board member of the american civil liberties union; she helped create the new progressive party in 1912, which supported the candidacy of theodore roosevelt (hamington, 2019). president franklin delano roosevelt appointed frances perkins as secretary of labor, and she remains the longest-serving labor secretary to date. similarly, social worker and civil rights activist, dr. dorothy i. height, was appointed in 1974 to the national commission for the protection of human subjects of biomedical and behavioral research—which produced the belmont report (department of health, education, and welfare, & national commission for the protection of human subjects of biomedical and behavioral research, 2014), and served as chairperson of the executive committee of the leadership conference on civil rights until she died in 2010 (the editors of encyclopaedia britannica, 2019). in the 1980s and 1990s, william waldman served under three new jersey state administrations as commissioner of human services. in 2021, shevaun harris was appointed as secretary of the department of children and families in florida. over one hundred years since the profession’s birth, the crucial role for social work advocacy with the populations left vulnerable by oppressive structures has long commanded social workers to make significant inroads by having a “seat at the table” in macro policymaking (abramowitz, 1998; abramowitz & sherraden, 2016; lane & humphreys, 2011; reisch & jani, 2012). yet, the literature suggests so much work is needed to realize social work’s full potential as elected officials (friedman et al., 2020; pritzker & lane, 2016). additionally, the literature on social workers seeking appointed office is virtually silent (lane & humphreys, 2011; friedman et al., 2020). furthermore, the impression from examining the profession’s chief messengers (nasw, cswe, schools and departments of social work) is that serving in public office occurs more by happenstance than by a deliberate, strategic, and ongoing plan that the profession has forwarded. rosenwald & naranjo/other side of the dais 781 therefore, the vision of social workers having a “seat at the table” should be elevated to a “seat on the dais,” in which the profession moves beyond social work advocacy with government decision-makers to social workers as government decision-makers. to that end, this article examines two areas of political social work practice: the landscape of social workers serving in elected office and the landscape of social workers serving in appointed office. within each of these two areas, five components of social work are articulated: 1) the roles and skills of elected and appointed officials; 2) deciding to seek office; 3) campaigning and networking; 4) serving in office; and 5) enlisting social workers to assist others who seek public office. finally, strategies are provided for social work education and practice – through organizations such as cswe, schools of social work, and nasw – to reinvigorate macro social work. the landscape of social workers in elected office at present, there are two united states senators (senators sinema, stabenow) and four united states representatives (representatives bass, davis, garcia, and lee) who are social workers (nasw, 2019). (in the past, at least one additional u.s. senator [senator mikulski] and at least three u. s. representatives (representatives dellums, rankin, and towns) have comprised this group). in addition, as of 2017, nearly 200 social workers were serving in elected positions in state and local government per nasw’s political action for candidate election (pace) committee (a current list does not appear on nasw’s website;; colby, 2018; nasw, 2021b). given this social work presence in the landscape of electoral politics throughout the nation, the following presents five essential components for understanding the process for social workers to hold elected office and the gaps that remain. the roles and skills of social workers as elected officials political roles await social workers from the local to the federal government (friedman et al., 2020; lane & humphreys, 2011). they can serve on town and city commissions/ councils, county commissions, and school boards at the local level. they can campaign for state representatives/delegates, state senators, and governors at the state level. at the federal level, of course, they can serve as representatives, senators, presidents, and vice presidents. in these roles, elected social workers provide leadership of the respective government they represent. they are the “public face” of a community and are identified as a role model. they are tasked to implement the authority accorded to them by law and purview based on federalism. federalism is the organization and separation of powers and policy oversight based on level of government; that is, elected social workers in federal office, for example, oversee immigration, defense, medicare, and federal tax policy while those in local office, for example, oversee planning and zoning, school policy, and public safety (robertson, 2012). therefore, social workers in their elected positions jurisdictionally provide a degree of decision-making over a particular scope of policy issues. they advances in social work, summer 2022, 22(2) 782 represent and resolve constituents’ needs, and in local government, they often supervise the chief executive officer. in these roles, it is incumbent for social workers to utilize their skill set to solve civic problems; fortunately, this skill set is well-suited for elected office in political social work. social work skills, including the “person-in-environment” assessment and cultural humility, provide elected social workers with keen insight into assessing a civic problem that needs examination. social work skills of advocacy, organizing, brokering, negotiation, education, facilitation, group work, and mediating are helpful in intervening to address a civic problem (friedman et al., 2020; kirst-ashman & hull, 2018). skills cited by elected social workers as most important in their service included (in order of use): “communication skills,” “active listening,” “conflict management and conflict resolution,” “bargaining and compromising,” and tied “forming and maintaining coalitions,” and “analytical skills” (lane, 2011). finally, the social work skill of ethical decision-making for assessment and intervention is critically important for elected social workers. it provides the foundation for their public leadership (nasw, 2021c). yet, the need for increased macro content in this area is discussed by lane (2011) and partially underlies the cswe’s (2018) specialized curricular guide for macro social work practice. however, there is no mention of social workers seeking elected office in this guide. the process of engaging in macro work is particularly complex and seemingly inaccessible (pritzker & lane, 2016). a growing body of research demonstrates that unless they are purposely encouraged by educators, students may struggle to find relevance, interest, and fortitude to learn about elected officials – and what they do – on their own (elmaliach-mankita et al., 2019; lustig-gants & weiss-gal, 2015). making the decision to seek elected office of course, deciding to seek elected office cannot be taken lightly. the enormity of time and funding makes this decision reflective and strategic. social workers need to consider the time it will take away from their families and friends, the ability to coordinate both regular employment and this enterprise, the psychological stress, and any financial strain it may take. conversely, social workers inherently know the call to service. this call toward public leadership provides the opportunity to make both sweeping and incremental policy changes, the ability to influence governments and communities, the chance to mentor new leaders, and the tremendous satisfaction of leadership itself. these are many of the considerations that social workers need to weigh when considering campaigning for public office, and the need exists for social workers and social work students’ exposure to candidates and elected officials for networking and mentorship (lane et al., 2018; lustiggants & weiss-gal, 2015). campaigning and networking the heart of a campaign involves campaigning and networking, and social workers seeking elected office are not immune from this. while operating with a person-inenvironment, these political activities are not necessarily intrinsically known to any social rosenwald & naranjo/other side of the dais 783 worker. campaigning is quite different from serving in elected office. campaigning demands the establishment of priorities, fundraising, financial reporting, messaging, volunteer coordination, interviews, and continued motivation and acumen. networking requires a savvy examination of the constituent base, influencers, supporters, and detractors in a geographic and digital milieu. as referenced by lane and humphreys (2011), the importance of “creat[ing] alliances with organizations, groups, and movements with similar goals” is paramount (p. 241). still, the need for helping social workers and social work students campaign and network for their campaign remains urgent. this very specialized macro method of political social work in social work education needs improvement (lane, 2011; lane et al., 2018). a notable exception is the nancy a. humphreys institute for political social work for social workers seeking elected office (university of connecticut school of social work, 2021). the nasw political action for candidate election (pace) does not keep a current list of local and state elected officials, and no working database with elected officials’ specific information is available (nasw, 2021b). while pace offers significant campaign donations and some campaign guidelines (from candidate college) for social workers seeking office, its interface with providing support and guidance to candidates seeking local and state offices could be strengthened. specifically, pace does not comprehensively provide non-financial campaign support to candidates, and consequently, pace’s infrastructure and assistance to candidates can be improved. more broadly, a national initiative from nasw calling for more social workers to seek office does not appear to exist. serving in elected office once the arduous process of the campaign is over, and a victory has been achieved, it is quickly time for the elected social worker to get to work. serving in elected office presents an opportunity for social workers to use their social work practice modalities of crisis intervention, case management, and advocacy to address constituents’ concerns and enact a policy agenda that addresses equity and social justice. research must test the assumption that social workers are “substantially different” from other elected officeholders (lane & humphreys, 2011). while in office, elected social workers will need support. while there should at least be adequate infrastructure (staff support for policy and administrative assistance), no formalized support network exists to support them. additionally, once elected, social workers could benefit from an array of professional development through certificate programs and custom-made professional development. a deficit may exist for social workers who have not been educated in trauma-informed care or practice as social policy is increasingly influenced by trauma. given the pandemic and the continued spate of mass shootings, service delivery for constituents impacted by such natural and human-created disasters necessitates the understanding of trauma and policy response (see substance abuse and mental health services administration, 2014). advances in social work, summer 2022, 22(2) 784 enlisting social workers to support campaigns social workers’ involvement may focus on helping others get elected rather than personally running for office (friedman et al., 2020; pritzker & lane, 2016). as mentioned, campaigns include various strategies that could appeal to social workers. when social workers help other social workers campaign for office, this synchronicity of connection – between social workers as campaign supporters and candidates can be lifted and magnified. social workers’ knowledge and skillsets relating to person-in-environment and strengths perspective, ethical reasoning, strategic planning, communication skills, and advocacy for marginalized populations can provide necessary campaign support. consequently, what is needed to spur social workers’ involvement is a catalyst – a school of social work and a professional association’s boost to provide the mechanism for the candidate’s social work peers to offer instrumental campaign support. this is challenging as more than 50% of social workers do not engage politically, let alone provide campaign support (rome & hoechstetter, 2010). therefore, a support mechanism of social workers supporting those seeking office is required (pritzker & lane, 2016; weiss, 2017). the landscape of social workers in appointed office extensive research on the numbers and levels of social workers appointed to voluntary positions on non-profit boards, councils, commissions, or in fully employed appointed positions in the u.s. did not yield any listing, database, or repository. also, a literature review of social workers appointed to public office yielded no results. notwithstanding the absence of such information, it is a fact that many social workers have served and serve as volunteers on countless boards of directors, councils, commissions, and as appointed leaders of public and non-profit agencies across the country (friedman et al., 2020; weiss, 2017). this article provides several examples of social workers who have served in such capacities, including some who currently occupy statewide, governor-appointed cabinet positions. we propose at least three types of social workers who may seek appointed office as an end goal or utilize appointed office as a training ground (i.e., minor leagues) for elected office. these include: 1) social workers serving as volunteers in boards, commissions, and councils, and who are not interested in seeking higher appointment or elected office; 2) social workers who intentionally seek to improve their skills in these minor leagues to seek a higher appointment (paid or unpaid); and 3) social workers in these minor leagues who have served or are currently serving on boards, commissions, councils or are employed as appointed officers and strategically plan to transition to elected office. again, the five components for understanding the context of social workers seeking appointed office and identifying existing barriers are examined. roles and skills as directors, administrators, managers, and high-level officers social workers have served in multiple policymaking roles on policy decision boards, elected offices, and organizational bodies (lane & humphreys, 2011). the range of roles rosenwald & naranjo/other side of the dais 785 includes volunteer boards of directors of small non-profits and cabinet-level positions at the federal, state, county, and municipal levels (friedman et al., 2020; lane & humphreys, 2011; weiss, 2017). these roles also vary from volunteer-board secretaries, treasurers, vice-presidents, presidents, and chairpersons to appointments as directors, managers, administrators, or commissioners and secretaries of cities and federal agencies, in charge of billionaire-dollar budgets and thousands of personnel or staff. with the latter’s higher appointments, social workers are appointed as paid staff accountable to the elected officeholders who appoint them. as referenced, the profession includes the names of social work luminaries, who have served as directors, managers, administrators, commissioners, and cabinet secretaries (e.g., jane addams, francis perkins, and dr. dorothy height). others have directed and currently run federal, state, and municipal agencies or serve on the board of directors of large and small organizations. their numbers keep growing as they continue to be appointed to these roles by presidents, state governors, county and city mayors, commissioners, and councilmembers. social workers gain valuable skills when charged to lead programs, projects, agency departments, or entire agencies and organizations in these multiple roles. among these skills are policymaking skills (e.g., creating organizational policies and procedures), administrative skills (e.g., how to develop and administer program budgets), and management skills (e.g., how to supervise staff and manage day-to-day program operations; feldman, 2020; nouman et al., 2020). in particular, feldman (2020) discusses resource-based policy practice. resource-based policy practice is reminiscent of the profession’s historical roots when community organizers skillfully created formal, professional community-based organizations (with bylaws, elected boards, mass memberships (feldman, 2020; nouman et al., 2020). these skills are easily transferable to positions of higher, appointed – and elected – office (kirst-ashman & hull, 2018). however, while political social work education, when practiced, educates students to transfer social work skills to elected office, the same is not often recognized for service in appointed offices. social workers’ prior volunteer experiences are less recognized as stepping-stones for higher appointed offices where their budgetary and policy experiences can have an even broader impact. further, while it is widely recognized that social workers’ prior volunteer activity serves as a training ground for higher-level policy work, the connection is not often made with future elected roles. even seminal social work texts such as kirst-ashman and hull’s (2018) generalist practice with organizations and communities neglect to direct social workers to transfer their skills in service as board members and other appointed officers. as argued earlier in this paper, the profession’s gradual move away from community practice has conversely resulted in a reduction in macro/policy practice skills. deciding to seek appointed office as evidenced by the relatively small numbers who served as cabinet secretaries at the state or federal levels, few social workers seek higher appointed offices. it is seldom the case that a social worker intentionally plans to use their volunteer board experience as a path to such higher appointments. most social workers begin by serving on small boards advances in social work, summer 2022, 22(2) 786 as directors often in small, community-based organization and progressively work their way up the management and administrative ladder in their chosen professional realm to the point of being noticed by an elected officeholder, who may, in turn, appoint them to the higher role. however, absent deliberate social work education or professional guidance, the realization that the path to a higher appointed office (e.g., state secretary of human services or child welfare services) may start with a volunteer board may never enter a social worker’s mind. planning to climb a ladder of power or influence may appear self-serving and may not appeal to many social workers. consequently, planning and strategizing how to seek and secure higher-office appointments are not typically part of a social worker’s education, theoretical conceptualization, training, or thought processes (feldman, 2020). thus, the process of social workers’ consideration of appointed office is frequently more the product of luck than a planned strategy to grow and serve in positions of higher power and influence. networking network development is a transferable skill that social workers often utilize in mezzo and macro practice (kirst-ashman & hull, 2018). social workers build extensive networks by employing their roles as enabler, mediator, analyst, broker, and advocate (friedman et al., 2020; kirst-ashman & hull, 2018). these networks provide platforms for social workers to explore and secure appointments for public office. many social workers, including this article’s authors, were recruited, encouraged, or volunteered through colleagues (via professional networks) to serve on boards of directors or seek a position as an nasw board officer. yet, these conversations also occur more by chance. while there are limited resources for social workers interested in running for elected offices (e.g., the campaign school and pace), no resources exist for social workers who may want to seek appointments to public or private entities. no such efforts, programs initiatives, support systems, or naswsponsored projects (nasw) can be found for social workers interested in appointed rather than an elected office. this absence is striking considering that social work education develops skills commonly used in administration, management, and politics (lustig-gants & weiss-gal, 2015). this divergence also creates a relative vacuum of experienced social workers ready to move from appointed to elected office. therefore, the need exists to promote a networking infrastructure to support social work students and social work professionals seeking public office as volunteers or professional administrators and managers. social workers serving in appointed public office once social workers are appointed to a board, commission, or other entity, they bring the roles and skills to the dais, as previously discussed. often, appointed officers serve at the discretion of the elected officials (e.g., presidents, governors, mayors, legislative bodies) in the capacities of policy and programmatic advisors from their seats on councils, rosenwald & naranjo/other side of the dais 787 commissions, or task forces (weiss, 2017; weiss-gal et al., 2017). in some cases, these roles include policy and programmatic decisions that require large budgetary allocations or reallocations. likewise, appointed office holders — employed in the public sector as agency directors, commissioners, secretaries, or assistant secretaries — have power and influence over social welfare policy, programs, and budgets ranging in the thousands to millions of dollars. in all cases, these appointed officials must develop expertise in areas essential to the competent exercise of their duties, including budget and staff management, programmatic administration, and policy and procedure development and implementation. working with other, more experienced social work professionals is critical to success for social workers serving in these capacities. still, this infrastructure of education and support currently does not exist. as discussed, a repository of experienced, appointed social workers that could provide such peer support is much needed. further, educational opportunities focused on social workers’ effectiveness in appointed offices are not available. enlisting social workers to assist others who seek public office social workers interested in an appointment to a policymaking body or a higher administrative or leadership position need a cohesive network of supportive and experienced professionals (social workers and non-social workers) for their successful appointment. for the social workers in their network, the potential appointee would rely on their knowledge and skillsets relating to person-in-environment and strengths assessment, ethical reasoning, strategic planning, budgeting, administrative supervision, communication skills, and advocacy for marginalized populations. these needs and potential skills gaps in certain areas (e.g., budgeting, organizational leadership) result in an unmet “demand” that warrants further attention. strategies to improve infrastructure for social workers and social work students seeking elected and appointed office based on the above discussion, both social work education (schools/departments of social work/ cswe) and the nasw should employ the following strategies to increase the profession’s “infrastructure” regarding providing support for social work students and social workers seeking elected and appointed public office. table 1 provides strategies to improve this infrastructure. rosenwald & naranjo/other side of the dais 788 table 1. strategies to help social workers succeed in elected and appointed office component social work education strategy nasw practice strategy the roles & skills of elected & appointed officials 1. increase content on this topic in introduction, policy, and macro practice courses at the bsw & msw levels. 2. add content on seeking elected & appointed office to cswe’s educational & policy accreditation standards & specialized curricular guide for macro social work practice. (pritzker & burwell, 2016). 3. inform students of the importance of participating in leadership development programs. 1. increase nasw professional development on this topic. 2. mobilize social workers – beyond social work students – to participate in annual legislative advocacy (“lobby”) days. 3. create a training series for social workers in the skills needed to serve on volunteer boards or in appointed & elected offices. 4. inform members & professionals on the importance of participating in leadership development programs & training. deciding to seek office 1. invite current or past elected or appointed officials (ideally a social worker) who share their stories of what motivated them to seek office. 2. create assignments on exploring a potential candidacy on which the students may wish to embark. 1. invite local candidates to speak at annual awards or special events tied to legislative advocacy, such as an “elected official” of the forums. 2. create a mentoring network for potential candidates & appointees to link with elected & appointed social workers. campaigning & networking 1. develop a “mock” campaign through the student social work association to understand the need & “how-to” of organizing a campaign. 2. create an elected official series in which local politicians come & speak to provide information & insight on how to run a campaign. 1. strengthen pace’s infrastructure by including campaign support & guidance with local & state social work candidates. 2. create a national database of current & former elected & appointed social workers. 3. develop a parallel “pace” entity for social workers seeking appointed office. 4. establish a feedback loop between national pace & the pace state chapter offices to coordinate the initiative. serving in public office 1. provide existing or custom-made certificates (for a fee) to elected social workers on trauma-informed policy, financial management, & administrative supervision. 2. supervise social work interns in macro field placement. 3. link social work faculty & students with relevant research or identified best practices with appointed officials in related areas. 1. develop a support “mutual aid” network for elected social workers. 2. provide education on elected & appointed officials’ roles during tenure in office. 3. create ongoing & streamlined policy briefs for elected social workers. 4. hire social work staff in elected & appointed social worker’s offices. 5. draw on a new database to identify & match professionals with expertise in specific areas with appointed officials working in those areas. enlisting social workers to assist others who seek public office through elected & appointed service 1. present campaign 101 in macro classes & articulate specific positions that social workers can fill. 2. invite a current or past appointed official (ideally a social worker) who can share their story of involvement. 1. link with peers at professional venues & workplaces (note hatch act) to introduce the campaign & attain support. 2. draw on a new database & mentoring network to enlist other social workers to assist those seeking elected & appointed office. rosenwald & naranjo/other side of the dais 789 the roles and skills of social workers as elected and appointed officials schools of social work should develop a more focused strategy on educating students on this macro practice method in introduction, policy, and macro practice courses at both the bsw and msw levels. providing students with information on both the available roles of elected officials and the skills used can make seeking elected and appointed offices accessible (lane, 2011; nouman et al., 2020; pritzker & burwell, 2016; pritzker & lane, 2018). the skillsets developed in mezzo and macro content (kirst-ashman & hull, 2018) are transferable to social workers seeking elected and appointed office. as social workers learn group and community needs assessment, consensus building, and problem-solving, instructors can teach social work students how these skills are transferable across this continuum of service. this can be required through the inclusion of “electoral activity” in the cswe educational policy and accreditation standards (pritzker & burwell, 2016). additionally, the cswe’s (2018) specialized curricular guide for macro social work practice should include a discussion and “roadmap” to seeking elected and appointed office. professional associations should include strategic planning to educate social workers on pathways toward elected and appointed office. leadership development begins with education. therefore, professional development on this topic can also be regularly scheduled through nasw and other professional venues. making increased efforts to include social workers and social work students at nasw’s signature lobbying and legislative days across the nation is an excellent place to begin. this provides firsthand experience to meet with legislators. nasw should also reference electoral politics in the code of ethics (naswc, 2021; rome & hoechstetter, 2010). external to professional associations (i.e., nasw), two other leadership development avenues are available to social work students and social workers – government training academies and non-profit designed programs. while explained next in more detail, nasw could create leadership training programs for social workers addressing the skills needed to serve on volunteer boards and as appointed or elected officials. in some political jurisdictions, local governments have instituted “government training academies” that help educate taxpayers and constituents on how government operates from an insider’s view. while the primary goal of these academies is to provide citizen education, an implicit goal is to cultivate a cadre of volunteers who may serve on advisory boards and make government more open, more participatory, and more efficient. undoubtedly, some government training academy graduates who serve in an advisory capacity in appointed offices may see it as preparation to transition to seeking elected office. in the non-profit sector, foundations and some grant-seeking non-profit organizations have played a critical but lonesome role in recruiting younger volunteers to serve in leadership development programs and auxiliary or junior boards. for instance, community foundations have created and funded leadership programs for the communities or localities they serve. examples include the miami foundation’s miami leaders, leadership greater chicago, and the kellogg foundation’s community leadership network with the center advances in social work, summer 2022, 22(2) 790 for creative leadership. others, like the ford foundation, have funded leadership development programs in response to demands by disenfranchised communities (e.g., women and communities of color/bipoc). in the 1980s, ford endowed the mexican american legal defense and educational fund (maldef) to develop leadership development programs for latinos in multiple cities across the u.s. these leadership development avenues have expanded the pools of those in the minor leagues interested in serving on boards, councils, commissions, seeking higher appointments, or running for elected office. nasw and schools of social work need to inform their constituencies of the significant importance of participating in these programs. making the decision to seek office to inspire students to run for elected and appointed office takes educators who are inspired themselves. this is how recruitment of social workers for public office can occur (lane & humphreys, 2011; pritzker & lane, 2016). as a strategy, educators can invite a current or past elected official (ideally a social worker) who can share their story of what motivated them to run and why they thought they were the right candidate for the right position at the right time. this education further demystifies the process, which may be the most significant barrier to running at all. when students meet elected officials, they see the candidate as a “real person” who is invested in their community, highly motivated, organized, and cares about their constituents’ needs. these meetings with actual elected officials can be compelling and inspire others to run. additionally, inviting social workers in appointed office to speak in a classroom is an important strategy to provide students with another path to serve in public office. social work educators can create assignments that explore the link between a potential candidacy or potential appointment and particular social justice issues (e.g., affordable housing; living wage). students can explore how serving in office provides the power or authority to “right” some wrong; that is, they want social justice in which resources are redistributed in society to provide more access and equity to marginalized groups (hoefer, 2019; lane, ostrander, & smith, 2018). this assignment provides for students to brainstorm on a potential elected position and a potential appointment with an accompanying rationale to run. similarly, through professional development, nasw local chapters and units can invite local candidates to speak at annual awards or special events tied to legislative advocacy. chapters and units typically designate an “elected official” of the year, and these forums provide additional opportunities for social workers to “access” elected officials. if known social workers are locally elected officials, the familiarity of both a shared profession and a local community may serve as inspiration (pritzker & lane, 2016). nasw chapters should create databases that track high-ranking government officials with social work degrees. rosenwald & naranjo/other side of the dais 791 campaigning and networking an explicit curriculum could focus on the structure and mechanisms of a campaign that students participate in a policy practice group assignment in the classroom. for implicit curricula, a “mock” campaign might be created through the student social work association to understand the needs and “how-to” of organizing a campaign concerning team creation, agenda-setting, marketing, fundraising, public speaking, constituent outreach, and messaging. further, implicit curricula could include an elected official series where local politicians come and speak (ideally but not necessarily social workers) to provide information and insight into running a campaign (pritzker & lane, 2017). pace’s infrastructure should be revamped and strengthened to fully support social work candidates – particularly at the state and local level (nasw, 2021b). specifically, providing a more hands-on approach to guiding social workers who are candidates for office would greatly assist in all aspects of campaigning (e.g., setting up a campaign, assembling a team, volunteer coordination, establishing campaign priorities, marketing, fundraising). creating a feedback loop from national pace and the pace state chapter offices would coordinate this initiative. establishing a database of verified current and former elected social workers for networking purposes would prove of great value. these strategies, in turn, would increase social work presence in public office and, by extension, further social work’s agenda through priorities, policies, and ethics. nasw should also consider creating a “parallel” pace for appointed social workers that provides a database, education, and support for those seeking appointed office. further, just as social workers must campaign for elected office, they should intentionally seek appointments to public and private governing bodies (boards, commissions, councils, advisory bodies) by developing strategic campaigns to reach their goals. whether it is by volunteering and serving on the board of a small community agency or by moving on to larger and better-resourced organizations requires planning and implementing a networking effort that is intentional and strategic (lane & humphreys, 2011). regrettably, few social workers consider the need to use such volunteer activities as a series of stepping-stones to move on to larger, more influential, or more powerful appointed positions. this is notwithstanding the profession’s ethos of commitment to improving society by addressing significant social problems while upholding the worth and dignity of all individuals. which merits the question: who better serves in appointed or elected office than a social worker? serving in public office schools of social work should develop partnerships with elected and appointed social workers and provide (for a fee) an array of trauma-informed certificate programs for professionals who may need them. additional certificate programs might include financial management and administrative supervision. it is important to note this training could already be developed or may need to be custom-made and in partnership with disciplines such as public administration, healthcare, and business. advances in social work, summer 2022, 22(2) 792 in turn, social workers can serve as field educators in this macro field placement (friedman et al., 2020; pritzker & lane, 2018). moreover, social workers can serve as speakers and mentors to students interested in macro practice in general, assisting with campaigns, considering a run for office themselves, or discussing the rationale for serving or seeking to serve on boards of directors or appointed office. as the largest professional association, nasw should create a network to provide substantive and reliable assistance to both elected and appointed officials; in essence, this can create a “mutual aid” system among social workers who are elected officials. specifically, nasw could provide education and support groups to appointed and elected officials. as there are different tiers of service (city, county, state, federal), the national office of nasw could provide such groups geared to varying levels of office. topics such as adapting to a public service role as an elected or appointed official, addressing constituents’ needs, working with staff, crisis management in social service delivery settings, and decision-making in times of stress could be the focus of such groups. additionally, nasw could create an office, or at least an extension of its policy division, from which it issues up-to-the-minute policy briefs (e.g., affordable housing, diversity, equity, and inclusion, sea-level rise) for elected social workers’ review. these policy briefs could even be tailored to a particular officials’ jurisdiction; coordination of this strategy could be examined and negotiated individually. this would be in keeping with nasw’s ethical obligation to political action (friedman et al., 2020; nasw, 2021c). the elected and appointed social workers can hire social workers to staff the official’s office by “giving back” to the profession. depending on the level of office, need for staffing, and office funds available, the elected or appointed officeholder can offer paid internships or employ social workers in a variety of positions such as chief of staff, legislative director, constituents’ affairs director, legislative aide, policy analyst, or research assistant (pritzker & lane, 2018). these positions match the knowledge and skillsets of macro-focused social workers. enlisting social workers to assist others who seek public office social work education plays a role by presenting the “what” and “how” of campaigning, and this education can start in macro practice classes in schools of social work. as mentioned earlier, successful campaigns necessitate a dizzying array of components; a course devoted to macro practice can introduce and review a campaign's foundation, so students appreciate campaigns and how to best participate. a student may find that their social media savvy can provide vital technical support in campaign website and social media presence. or a student could determine that canvassing for votes via the tried-but-true method of knocking on doors and introducing the candidate’s message is a preferred involvement strategy. this course would introduce students to the campaign process and help demystify working on a campaign. providing this content on electoral activity is essential to build social workers’ interest and capacity in political social work (pritzker & burwell, 2016). rosenwald & naranjo/other side of the dais 793 social workers also serve as an essential resource for campaign support. connecting with social workers at local levels, including nasw local units and colleagues, is an important place to start (lane & humphreys, 2011). colleagues at the candidate’s workplace can assist on campaigns but need to do so as private citizens and outside of work hours per the federal statute called the hatch act [u.s. office of special counsel, 2021]. such engagement with potential campaign members provides the necessary introductions and relationship building for candidates to complete their campaign staff and volunteers. for example, all campaigns require a treasurer, and a fellow social worker can undoubtedly fill this position. campaign manager, chief strategist, and volunteer coordinator are some of the positions that many campaigns have. these positions are well-matched by social workers’ education who precisely understand the campaign’s policy agenda and priorities. interested social workers may not have had political social work exposure in their education. the candidate and campaign team can orient and supervise social work students joining the campaign team. though the need for assistance from social work students and professionals is more significant for those seeking elected office, office-seekers need help in two specific areas. first, nasw could identify social workers who are experts in specific areas (for instance, mental health services or services to the homeless) and match them with appointed officials in local, state, or national boards, councils, commissions, or task forces in need of information from a social work perspective. this is not a new premise as social workers already assist policymakers in different capacities (weiss, 2017; weiss-gal et al., 2017). likewise, nasw and social work schools should help identify research areas and best practices that could be helpful to appointed officials as they discharge their duties. this “important role of social workers serving in staff positions for candidates and elected officials requires more attention” (lane & humphreys, 2011, p. 240). conclusion it is time the profession strategically plans to educate and train the future dorothy i. heights, jane addams, and frances perkins of our times. no doubt that some of them could consider becoming the next u.s. senators sinema and stabenow, or congresswomen bass, davis, garcia, and lee of their generation. as we look to re-envision and reinvigorate the social work profession, solidifying the profession’s stature and reach is paramount. this article presents a roadmap for cultivating the macro practice method of political social work and electoral politics. it introduces the macro practice method of seeking appointed office. strengthening the necessary infrastructure that supports these methods holds great promise to increase the profession’s prominence. this re-envisioning can occur with a more focused, national emphasis on identifying and engaging social work students and professional social workers to seek and occupy elected and appointed office. more social workers should be in public office – making policy decisions as elected and appointed office holders – so they can protect and empower marginalized clients and communities. with careful forethought, direction, and momentum, social workers can occupy these positions of power as more of them move to the other side of the dais. advances in social work, summer 2022, 22(2) 794 references abramovitz, m. 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(2017). teacher, researcher, and…policy actor? social work academics’ involvement in social policy. social policy and administration, 51(5), 776-795. https://doi.org/10.1111/spol.12196 author note: address correspondence to mitchell rosenwald, school of social work, barry university, miami shores, fl, 33161. email: mrosenwald@barry.edu https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4816.pdf https://www.britannica.com/topic/leadership-conference-on-civil-and-human-rights https://www.britannica.com/topic/leadership-conference-on-civil-and-human-rights https://ssw.uconn.edu/humphreys-institute/ https://osc.gov/services/pages/hatchact.aspx https://doi.org/10.1111/ijsw.12239 https://doi.org/10.1111/spol.12196 mailto:mrosenwald@barry.edu _________ michael l. clarkson-hendrix, phd, lcsw, assistant professor of social work in the department of sociocultural and justice sciences, and paula j. peters, mfa, is an associate professor of dance in the department of theater and dance at the state university of new york at fredonia, ny. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 136-153, doi: 10.18060/24432 this work is licensed under a creative commons attribution 4.0 international license. mixed methods evaluation of a movement and mindfulness empowerment workshop for adults with serious mental illness michael l. clarkson-hendrix paula j. peters abstract: for seriously mentally ill adults, empowerment is critical to maximizing participation in major life activities. although studies have identified interventions that have positively impacted empowerment, these interventions may not be applicable or amenable to all adults with serious mental illness. more interventions with other approaches are needed. therefore, this study evaluated the initial implementation of a movementand mindfulness-based workshop intervention. quantitative data were used to examine differences in empowerment before and after the workshop, and qualitative data were used to explore participants’ perceptions of the reasons for empowerment differences. ten participants completed the intervention, and nine of the ten participants also completed follow-up interviews. quantitative data were collected via preand postintervention surveys. qualitative data were collected through follow-up interviews with the participants. surveys revealed perceptions of optimism and control over the future increased between preand post-intervention. interviews uncovered that increases in optimism and control over the future may have been related to workshop accomplishments and reduced helplessness outside of workshop sessions. future research would benefit from the creation of a training manual along with a validated system to monitor intervention fidelity. keywords: serious mental illness, adults, empowerment, dance, mindfulness, movement about 11.2 million adults aged 18 or older in the united states are estimated to be living with serious mental illness (smi; national institute of mental health [nimh], 2019). in contrast to those with mild or moderate mental illness, adults with smi have mental, behavioral, or emotional disorders resulting in serious functional impairment, substantially interfering with one or more major life activities (nimh, 2019). major life activities may include caring for oneself, performing manual tasks, and concentrating, thinking, and communicating. impairment in the capacity to engage in major life activities could negatively impact adults’ performance of familial, spousal, and occupational roles. empowerment is critical to maximizing participation in major life activities. empowerment has been shown to be an essential component to the self-management of mental health symptoms (coulombe et al., 2015). effective self-management of mental health symptoms could positively affect concentration, thinking, and communication as well as the enactment of social roles. given that empowerment has been associated with the self-management of mental health symptoms, interventions to promote empowerment for adults with smi are needed. therefore, this study pilot-tested the efficacy of a movement and mindfulness workshop intervention, the empowerment through movement and stillness workshop (etmsw), to promote empowerment in adults with smi. about:blank clarkson-hendrix & peters/mixed methods 137 literature review this literature review focused on three aspects important to the etmsw intervention: (1) empowerment in adults with smi, (2) empowerment and dance movement, and (3) empowerment and mindfulness. empowerment in adults with smi self-determination has been identified as an essential component of empowerment for smi adults (okon & webb, 2014; sartorius, 2011). although multiple empowerment definitions have been identified in the mental health literature (barr et al., 2015; castelein et al., 2008), the etmsw intervention relied on rogers, chamberlin, ellison, and crean’s (1997) definition of empowerment: …a sense of self-worth, self-efficacy, and power. the empowered person recognizes use of anger as a motivating force to instigate social change and is optimistic about the ability to exert control over his or her life. he or she recognizes the importance of community to effect change, but the empowered person also values autonomy. (p. 1046) in line with this definition of empowerment, rogers and colleagues (1997) created an empirical model for empowering adults with smi comprised of five aspects: self-esteemself-efficacy, power-powerlessness, community activism and autonomy, optimism and control over the future, and righteous anger (see figure 1). empowerment has been shown to mediate recovery orientation and consumer satisfaction for adults with smi (barrett et al., 2010). several factors have been found to be associated with empowerment, including demographic, life satisfaction, mental health, and social and occupational characteristics. demographic characteristics that have been positively associated with empowerment include total monthly income (rogers et al., 1997, 2010), marital status, age, and educational attainment (rogers et al., 2010). life quality and satisfaction characteristics have also been positively associated with empowerment (rogers et al., 1997). quality of life for adults with smi (bejerholm & björkman, 2011; marchinko & clarke, 2011; rogers et al., 1997, 2010), overall life satisfaction (rogers et al., 1997, 2010), and self-rated health and client satisfaction (hultqvist et al., 2015) have comprised these characteristics. mental health characteristics have also been associated with empowerment among smi adults (rogers et al., 1997). empowerment has been positively associated with hope and sense of recovery (rogers et al., 2010), global assessment of functioning (hultqvist et al., 2015), and an attitude of controllability over negative circumstances (yamada & suzuki, 2007). in contrast, level of mental illness symptoms (bejerholm & björkman, 2011; rogers et al., 2010) and number of traditional mental health services received (rogers et al., 1997) have been negatively associated with empowerment. the self-esteemself-efficacy aspect of empowerment has also been negatively associated with depressive symptoms (bejerholm & björkman, 2011). advances in social work, spring 2021, 21(1) 138 figure 1. characteristics associated with empowerment for adults with smi note. (+) = positive associations with empowerment. (+/-) = both positive and negative associations with empowerment. empowerment has been positively and negatively associated with social characteristics for adults with smi. engagement in community activities (bejerholm & björkman, 2011; rogers et al., 1997), social acceptance, and objective and subjective social inclusion (rogers et al., 2010) have been positively associated with empowerment. however, experienced stigma has been negatively associated with empowerment (bejerholm & björkman, 2011). finally, empowerment (rogers et al., 1997) has been positively associated with occupational characteristics for smi adults. employed status versus unemployed or retired status (sá-fernandes et al., 2018), occupational engagement (hultqvist et al., 2015), and work rehabilitation (bejerholm & björkman, 2011) have been positively associated with empowerment. figure 1 summarizes characteristics associated with empowerment for smi adults. interventions have been developed to improve empowerment (rogers et al., 1997) for adults with smi. some of these interventions have focused on peer services (hutchinson et al., 2006; pickett et al., 2012; russinova et al., 2018; salzer et al., 2016) with mixed findings regarding improvements in empowerment. participants in a peer-provider training empowerment demographic (+) life quality & satisfaction (+) mental health (+/-)social (+/-) ocupational (+) clarkson-hendrix & peters/mixed methods 139 program (hutchinson et al., 2006), a peer-led education intervention (pickett et al., 2012), and a peer-run photography-based group intervention (russinova et al., 2018) reported gains in empowerment. however, a study of 99 participants with a schizophrenia spectrum or affective disorder that examined peer specialist services delivered through an independent living center did not find significant improvements in empowerment for those randomly assigned to receive peer services when compared to participants who received services as usual (salzer et al., 2016). a small group of studies that examined the impact of employment-oriented interventions found empowerment increased for the smi adults involved in the interventions (areberg & bejerholm, 2013; hutchinson et al., 2006, 2007; russinova et al., 2018). in contrast, significant improvements in empowerment were not found for 43 participants with psychosis who received a positive psychotherapy group intervention compared to 41 participants receiving services as usual (schrank et al., 2016). the impact of an intervention of a client-held medical record/crisis plan in booklet form was examined with 42 community mental health service participants. the researchers found that the dimensions of self-esteem-self-efficacy, community activism and autonomy, and optimism and control over the future increased between preand post-intervention (marchinko & clarke, 2011). however, power-powerlessness and righteous anger did not evidence significant increases for the study participants. additionally, research investigating a psychoeducational group empowerment program for adults with schizophrenia or a mood disorder found that the 25 participants receiving the group intervention, which was delivered by mental health professionals, significantly increased their empowerment when compared with the 38 control group participants (hyun et al., 2019). although studies have identified peerand employment-oriented as well as other interventions that have positively impacted empowerment, these interventions may not be applicable or amenable to all adults with smi. more interventions with other approaches are needed to accommodate variation in learning styles. arts-based approaches may be a promising source for additional interventions that support experiential learning styles. arts-based approaches have been shown to encourage active engagement and decisionmaking (morris & willis-rauch, 2014), which is facilitative of empowerment. for example, although russinova and colleagues’ (2018) intervention was focused on employment, the approach used was photovoice, a photography-based group intervention, and the intervention resulted in increased empowerment for the 24 participants with psychiatric disabilities who received the intervention. the increase in empowerment was maintained at 3 months post-intervention. additionally, travis et al. (2019) successfully implemented a music and empowerment-based group with homeless smi participants that resulted in positive social outcomes for the group participants. empowerment and dance movement dance, as a form of movement, has been identified as having both somatic and communicative features. this form of movement has been considered somatic in that the dancer consciously experiences their bodily self through movement (eddy, 2009). the advances in social work, spring 2021, 21(1) 140 dancer becomes engaged in an embodied awareness that is grounded in the moment and the body (purser, 2019). dance has also been considered communicative in that the dancer uses movements to convey symbolic messages to the observer (bannerman, 2014). studies of the use of dance as an empowerment intervention have focused on adolescents (cappel, 1995; duberg et al., 2016; kotin et al., 2013) and adult women (leseho & maxwell, 2010; moe, 2014; regehr, 2012). these interventions have linked increases in empowerment to improvements in mental health functioning for individuals with mild to moderate mental illness (duberg et al., 2016; leseho & maxwell, 2010; regehr, 2012). dance interventions have also resulted in decreased internalized sexism (cappel, 1995; moe, 2014; regehr, 2012), classism (cappel, 1995; kotin et al., 2013), racism (cappel, 1995; kotin et al., 2013) and ageism (moe, 2014). roberts (2016) conceptualized that the embodied experience of movement in dance can empower individuals to exercise choice in how they express and present their identities. empowerment and mindfulness mindfulness is “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (kabat-zinn, 2003, p. 145). various modalities have implemented mindfulness including psychotherapy (e.g., harris, 2013), in-home individual skill-building programs (e.g., brown & bellamy, 2017), and educational group sessions (e.g., dhanalakshmi, 2019; evans-chase, 2015). mindfulness has also been identified as a common practice element in evidence-based trauma treatment (strand et al., 2013). an essay describing a social work group intervention with six teen girls successfully implemented mindfulness techniques to not only improve emotional regulation and reduce maladaptive coping, but also to promote empowerment in group members (sakhat, 2017). additionally, training in mindful eating techniques has been applied to empower adults with smi to engage in healthy eating habits with positive impacts related to over-eating and emotional eating (gidugu & jacobs, 2019). description of the etmsw intervention based on the literature reviewed above, the authors developed the etmsw intervention to promote somatic awareness of empowerment and integrate this awareness into participants’ daily lives. movement and mindfulness techniques were used to promote somatic awareness while group discussion techniques were used to integrate somatic awareness into the participants’ daily lives. adults who received services from smi-serving programs were the population of interest for the etmsw intervention. smi-serving programs focus on a subset of individuals with mental illness who experience significant functional limitations due to their illness. day treatment, intensive outpatient mental health, community residential, and treatment apartment programs are some examples of smi-serving programs. clarkson-hendrix & peters/mixed methods 141 since this project’s purpose was to evaluate the preliminary intervention, the workshop was limited to three sessions. each session focused on one aspect of rogers, chamberlin, ellison, and crean’s (1997) empowerment model. the empowerment model aspects were self-esteem-self-efficacy, community activism and autonomy, and optimism and control over the future. the general structure of the 60-minute sessions involved the implementation of movement, mindfulness, and group discussion techniques. sessions took place at participants’ mental health programs and occurred once per week for 3 weeks. the intervention team the team was comprised of one dance specialist, one licensed clinical social worker (lcsw), and two dance students. the dance specialist, with a master of fine arts in dance and approximately 30 years of experience in dance performance, choreography, and dance instruction, developed and implemented the movement techniques. the lcsw developed and implemented the mindfulness and discussion techniques. the two dance students provided additional visual examples of movement shapes as part of the movement sequences. intervention techniques movement techniques. movement techniques implemented postmodern dance movement vocabulary by creating shapes aligned with cue words representing the session’s key concept. postmodern dance has employed “pedestrian” or everyday common shapes as its movement vocabulary to break down social binaries between dance movement and everyday movement (dempster, 2008). shapes were developed by adapting the idea of yogic postures through dance. similar to dance, yogic postures have been understood as psychophysical practices that are directly related with the development of somatic awareness (de campos et al., 2020; mccall et al., 2015). dance techniques sought to use the body to create shapes that reflected the concepts within the empowerment model. cue words were vocalized by participants as they enacted the shapes in a sequence. sequences were repeated several times to increase somatic awareness of the shapes. shapes were implemented alongside a variety of music based on workshop participant interest and included rock, soul, and country music. mindfulness techniques. two mindfulness techniques were implemented during the workshop sessions. first, participants were guided to close or rest their eyes in a place of their choice while cue words were repeated, and they were asked to notice how their body felt when the words were spoken. second, while still closing or resting their eyes, participants were asked to visualize themselves making the shapes while the cue words were repeated while again noticing how they felt in their body. discussion techniques. discussion techniques were used to process and reflect on the experience of movement and mindfulness. each session, participants completed a one-page worksheet with questions asking about their perceptions of the movement and mindfulness experience, how they felt, and what they noticed about their body. participants were then led through a facilitated discussion where they shared their responses and were asked to advances in social work, spring 2021, 21(1) 142 identify one thing they could do to bring the session’s key concept more into their day-today lives. the intervention process each session lasted approximately 60 minutes. table 1 presents the empowerment aspects and cue words for each session. table 1. session numbers, empowerment aspects, and cue words session empowerment aspect cue words 1 self-esteem-self-efficacy accomplished, capable, certain, confident, positive 2 community activism and autonomy select, prefer, opt, pick 3 optimism and control over the future limitless, optimistic, determined, action the first 10 minutes of each workshop session focused on the completion of gentle stretching activities, which were led by the dance specialist with the support of the dance students. then, the dance specialist along with the dance students progressed participants through the sequence of shapes for approximately 15 minutes. after implementing the sequence of shapes several times, the lcsw implemented mindfulness techniques for approximately 10 minutes. following the mindfulness exercise, the lcsw led a discussion for approximately 15 minutes. the workshop session concluded with the dance specialist, with the support of the dance students, implementing the same sequence of shapes with participants for approximately 10 minutes. figure 2 shows examples of the dance specialist enacting two shapes. figure 2. example shapes clarkson-hendrix & peters/mixed methods 143 note. top panel: “confident” shape from session 1. bottom panel: “limitless” shape from session 3. study purpose this mixed methods pilot study evaluated the initial implementation of etmsw. the movement and mindfulness techniques of etmsw were designed to promote somatic awareness of empowerment while the discussion technique was developed to foster integration of this empowered awareness into participants’ daily lives. if etmsw resulted in increases in empowerment, the intervention may also enhance smi participants’ capacity to engage in major life activities crucial to the enactment of adult social roles. quantitative data were used to examine differences in perceived empowerment before and after etmsw, and qualitative data were used to explore smi participants’ perceptions of the reasons any differences in empowerment. methods participants participants in the empowerment workshop were adults currently receiving services in either a mental health day treatment program or mental health community residence in a northeastern state. both programs exclusively served adults with smi. participants were enrolled in the study after meeting sampling criteria of being between the ages of 18 and 70 and could self-identify at least one mental health diagnosis. twelve adults initially volunteered to participate in the study. two participants dropped out as the study progressed. one participant exited the study prior to the first workshop session. the other participant dropped out after the second session. the 10 participants who completed the intervention were mostly women (n=7, 70.0%) and white (n=8, 80.0%). on average, participants were in middle adulthood (m=55.9 years). participants identified their most common mental health diagnoses as depression (n=9, advances in social work, spring 2021, 21(1) 144 90.0%), anxiety (n=5, 50.0%), and bipolar disorder (n=5, 50.0%). most participants completed 3 of 3 sessions (n=7, 70.0%) while the rest completed 2 of the 3 sessions (n=3, 30.0%). nine of the 10 study participants volunteered for and completed follow-up interviews. most interview participants were women (n=7, 77.8%) and white (n=7, 77.8%). on average, interview participants were in middle adulthood (m=55.25 years). participants who completed interviews identified their most common mental health diagnoses as depression (n=8, 88.9%), anxiety (n=4, 44.4%), and bipolar disorder (n=4, 44.4%). procedure after institutional review board approval was received by the state university of new york at fredonia, presentations were conducted at the residential group home and day treatment program to recruit participants for the project. after meeting screening criteria, prospective participants reviewed and signed informed consent forms. the consent forms reviewed the study purpose and procedures, and informed participants that they could discontinue their involvement in the project at any time without any penalties or loss of benefits associated with the residential or day treatment services they received. quantitative data were collected via preand post-intervention surveys. preintervention surveys included items on participants’ demographic characteristics, mental health diagnoses, and perceptions of empowerment. post-intervention surveys asked about perceptions of empowerment. narrative data were collected through follow-up interviews with the participants. interviews were completed approximately 2 to 3 weeks after the workshop sessions had concluded. an interview guide was used to structure the interviews (see table 2). the interviews focused on changes in participants’ conceptualizations of empowerment before and after the workshop and how they felt physically and emotionally after completing the workshop. interviews were conducted face-to-face, tape-recorded, and transcribed verbatim. table 2. follow-up interview questions (1) could you tell me a bit about what you thought empowerment was before you attended the workshop? (2) as you were going through the workshop, what, if any, changes did you notice in how you felt about yourself? (3) did anything change about your sense of power or choice? if so, what changed? (4) what about your sense of hope? what, if any changes did you notice as you did the workshop? (5) how do you feel now that the workshop is over? (6) have there been any changes you have noticed after doing the workshop? (7) how do you feel, in your body, now that you have done the workshop? (8) in closing, is there anything else you would like to tell me about the workshop? clarkson-hendrix & peters/mixed methods 145 instruments empowerment. three subscales from rogers et al.’s (1997) empowerment scale were used to measure participants’ self-perceptions of empowerment. these subscales were self-esteem-self-efficacy (9 items), community activism and autonomy (8 items), and optimism and control over the future (4 items). responses ranged from 1 (strongly disagree) to 5 (strongly agree). concerning pre-intervention surveys, 3 items from the selfesteem-self-efficacy subscale, 5 items from the community activism and autonomy subscale, and 2 items from the optimism and control over the future subscale were removed to improve internal consistency reliability (𝛼𝛼=.90, 𝛼𝛼=.96, & 𝛼𝛼=.75, respectively). for post-intervention surveys, 3 items from the self-esteem-self-efficacy subscale, 2 items from the community activism and autonomy subscale, and 2 items from the optimism and control over the future subscale were removed to improve internal consistency reliability (𝛼𝛼=.93, 𝛼𝛼=.88, & 𝛼𝛼=.64, respectively). data analysis quantitative. analysis involved examination of measures of central tendency and dispersion for the three empowerment subscales. due to the small sample size, steps were taken to improve power to detect significant differences. these steps included improving the precision of the empowerment measures, as described above. differences in empowerment subscales were examined using paired t-tests. research has shown that ttests are feasible for use with very small sample sizes (de winter, 2013). qualitative. thematic analysis was used to identify patterns of meaning from the perspective of the participants that could assist with understanding the quantitative results. richards and hemphill's (2018) guide to collaborative qualitative data analysis was followed with both the author and co-author analyzing the data cooperatively. throughout the coding process, consensus coding was used. in consensus coding, analysts compare coded statements from the same transcripts and resolve coding discrepancies until an agreement is reached. pseudonyms were used in describing the findings to ensure the confidentiality of the participants. results quantitative table 3 presents descriptive statistics for the empowerment subscales. concerning the pre-intervention empowerment subscales, on average participants rated themselves as moderately high in perceived self-efficacy-self-esteem (m=3.81 on a 5-point scale), community activism and autonomy (m=4.36 on a 5-point scale), and optimism and control over the future (m=3.67 on a 5-point scale). for post-intervention empowerment subscales, they rated themselves as moderately high inself-efficacy-self-esteem (m=4.41 on a 5-point scale), high in community activism and autonomy (m=4.48 on a 5-point scale), and moderately high in optimism and control over the future (m=4.40 on a 5-point scale). advances in social work, spring 2021, 21(1) 146 table 3. descriptive statistics for empowerment subscales subscale pre-intervention post-intervention n m sd range n m sd range self-esteem-self-efficacy 12 3.81 .62 2.44-4.89 9 4.41 .60 3.33-5.00 community activism & autonomy 12 4.36 .48 4.00-5.00 10 4.48 .55 3.83-5.00 optimism & control over the future 12 3.67 .98 1.50-4.50 10 4.40 .66 3.00-5.00 bivariate results. table 4 presents t-test results for empowerment subscales. perceptions of optimism and control over the future increased significantly between pre and post-intervention surveys, t(9)=1.89, p=.046, d=.598. perceptions of self-esteem-selfefficacy approached a statistically significant increase between preand post-intervention surveys t(8)=1.79, p=.056, d=.597. there were no statistically significant differences in perceived community activism and autonomy between preand post-intervention surveys, t(8)=0.28, ns. table 4. results for t-tests comparing preand post-intervention empowerment subscales subscale pre-intervention post-intervention t df p cohen’s d m sd m sd self-esteem-self-efficacy 3.81 .81 4.41 .60 1.79 8 .056 .597 community activism & autonomy 4.43 .50 4.48 .55 .28 9 .391 .090 optimism & control over the future 3.60 1.07 4.40 .66 1.89 9 .046 .598 qualitative two themes were inducted from the interview data. these themes revealed that increases in optimism and control over the future may have been related to workshop accomplishments and reduced helplessness outside of workshop sessions. workshop accomplishments. many adults who participated in the study discussed achievements within the workshop sessions that connected with a more positive outlook of themselves. when asked about what changed about her sense of hope as a result of the workshop, june stated, “i just felt more hopeful after the process, and it was very positive.” when probed to elaborate on her response, she stated, “i liked the choices of the words. the word choices were good.” she went on to state, “[the cue words] were making me look for the positive.” she then went on to summarize how the workshop promoted her positive outlook: “i feel like i accomplished something, that was something in the [cue] words, so i felt like i accomplished something and benefited something. it was really good and helpful for me, too.” when asked about what, if any, changes april noticed about how she felt as she participated in the workshop, she stated, “[i] felt better. oh ya, i was glad i was participating. i felt it was worth it…and i liked the moving attached to the thoughts.” when probed about her response, april reported that saying the words while implementing the movement techniques was beneficial for her. she further elaborated: clarkson-hendrix & peters/mixed methods 147 i felt more connected to life, to the moment, to that very day, and thinking about what i was gonna do that day, not overthinking about whatever problem or something bad, because i usually think about stuff that i would fail over, anyways, so it would be a waste of energy, but this made me focus and get more centered. a final example of this theme comes from john who stated, “at first, the movements were awkward. i felt goofy doing it. after that, i felt easier doing it.” with successive completions of the movements, he became more comfortable with them and successful in their execution. john stated, “you moved forward through it…i got used to it.” with additional prompting, he elaborated, “…it feels awkward, but you move, and you stay still, and think about it, and you move again. it is less awkward because you are used to it…” reduced helplessness. some participants discussed feeling less helpless outside of the workshop sessions, which was connected with an increased capacity to act. june also discussed this theme in her interview. she stated, “[before the workshop] i felt like i couldn’t make a choice, and i felt that i would fail, and now i feel that i can make choices, the right choices, and i can feel empowerment.” she elaborated, “i felt helpless before the empowerment [workshop], but now i feel like i am not as helpless, and hopeless.” when asked about any changes that she had noticed after doing the workshop, june stated, “i look forward to the day now, and i look forward to mondays now.” when asked to elaborate further on any changes she noticed after doing the workshop, she stated, “i volunteered for the church. i sang for the church, so just getting out there.” april also presented an example of this theme. when asked about changes in her sense of power or choice as a result of the workshop, april shared how she was able to ask for help in emptying her storage unit. as the workshop progressed, she stated she felt “better” and “felt it’s okay” to ask for help. in terms of her sense of hope, april stated: i am really more hopeful now that i can take it, one step at a time and actually do it. i am part of it, and flow, not try to control things i cannot control, and let people help, [to] be more open with that, be more open personally. i can talk, and i can talk to you about my stuff, no problem. it [the workshop] was helping. a final example of this theme comes from susan. when asked about any changes she noticed in her sense of hope as she participated in the workshop, susan stated she had a “stronger sense of hope.” this idea of “stronger” was repeated when asked how she felt after completing the workshop. however, susan also linked her sense of hope with increased assertiveness outside of workshop sessions. she stated, “i feel more stronger, a little more assertive.” when asked what assertive meant to her, susan stated, “it means getting your point across, kind of standing up for yourself without getting into swear words or fighting someone.” discussion the aim of this pilot study was to evaluate the initial implementation of etmsw. results of quantitative analyses show that optimism and control over the future, one aspect of empowerment (rogers et al., 1997), increased between preand post-intervention advances in social work, spring 2021, 21(1) 148 surveys. the workshop participants perceived a greater sense of determination over what would happen in their life and an increase in optimism about the future. narrative data revealed that participants perceive the increase in optimism and control over the future may be related to accomplishments in the workshop and reduced helplessness outside of workshop sessions. accomplishment has been identified as a central aspect of well-being (gander et al., 2017) and has been associated with positive affect (gabriel et al., 2011) and life satisfaction (gander et al., 2017). progressively achieving the movements may contribute to perceptions of optimism and determination. the theme of reduced helplessness outside of workshop sessions is important since reduced feelings of helplessness have been associated with more mature coping styles, such as problem-solving rather than avoidance (wang et al., 2017). the advancing physical repetition and mindful visualization of movements may show the participants that successive attempts can lead to positive outcomes, which may promote empowerment (rogers et al., 1997). these within-session positive outcomes may engender optimism for acting outside of workshop sessions. limitations several limitations should be noted. since this was a pilot study, more research is needed on the etmsw intervention. participants volunteered for the study. results may not represent the broader population of adults with smi. the study did not have a control group so the relative impacts of the intervention in comparison to other services participants received could not be disentangled. the design of the current study does not provide the capacity to understand where the change in optimism and control over the future stems from. the small number of participants limited the statistical power to detect significant differences in empowerment perceptions before and after the intervention and precluded multivariate analyses. empowerment measures were self-report, which makes them vulnerable to social desirability and interpretive biases. empowerment measures were not re-administered at a follow-up point post-intervention so maintenance of empowerment gains is unknown. potential also exists for mono-method bias since a single measure of empowerment was administered. consequently, sampling participants randomly, assigning them randomly to intervention and wait-list control groups, including a larger number of participants with one intervention group offered movement techniques only, a second mindfulness only, and a third both techniques, using multiple measures of empowerment, both self-report and objective measures, and re-administering empowerment measures at a follow-up point post-intervention are warranted. in considering the qualitative aspect of this study, in general, these methods are vulnerable to researcher bias and a lack of generalizability (creswell, 2014). additionally, although consensus coding with two analysts was used to identify the themes, coding with other groups of analysts may have resulted in different themes. clarkson-hendrix & peters/mixed methods 149 directions for future research this initial implementation study focused on three aspects of rogers et al.’s (1997) empowerment model. in the future, we intend to develop and include sessions for the other two aspects of the model (i.e., power-powerlessness, righteous anger) as part of the intervention. qualitative findings identified the themes of workshop accomplishments and reduced helplessness outside of workshop sessions. future research would benefit from including measures representing these themes to assist with determining whether they impact empowerment differences. creation of a training manual along with a validated system to monitor intervention fidelity is also needed. implications for social work practice social workers should seek opportunities to partner with dance instructors to develop mindful-movement interventions. dance’s somatic features can provide expansive resources to support mindfulness embodiment. mindful-movement interventions may be particularly beneficial for clients who have experiential learning styles. conclusion adults with smi live with severe functional impairments, and empowerment can be critical to maximizing their participation in major life activities. currently established interventions to promote empowerment may be useful for some smi adults, and not as beneficial with others. therefore, additional movement and mindfulness interventions need examination. we recommend social workers consider using mindful-movement interventions to maximize participation in major life activities for adults with smi. references areberg, c., & bejerholm, u. 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(2007). application of empowerment scale to patients with schizophrenia: japanese experience. psychiatry and clinical neurosciences, 61(6), 594-601. https://doi.org/10.1111/j.1440-1819.2007.01723.x author note: address correspondence to michael clarkson-hendrix, department of sociocultural and justice sciences, state university of new york at fredonia, fredonia, ny 14063. email: michael.clarkson-hendrix@fredonia.edu https://doi.org/10.1037/prj0000303 https://doi.org/10.3233/jvr-180971 https://doi.org/10.1080/01609513.2016.1217481 https://doi.org/10.1037/prj0000220 https://doi.org/10.1016/s0924-9338(11)73803-2 https://doi.org/10.1017/s2045796015000141 https://doi.org/10.18060/3052 https://doi.org/10.1080/01609513.2018.1486776 https://doi.org/10.2224/sbp.5825 https://doi.org/10.1111/j.1440-1819.2007.01723.x mailto:michael.clarkson-hendrix@fredonia.edu _________ alex d. colvin, ph.d., lmsw, chair of undergraduate programs, university of north texas at dallas, dallas, tx. m. sebrena jackson, ph.d., licsw, associate dean for education programs and student services, the school of social work, the university of alabama, tuscaloosa, al. angela n. bullock, ph.d., lmsw, associate professor, social work program, st. bonaventure university, st. bonaventure, ny. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 141-155, doi: 10.18060/27053 this work is licensed under a creative commons attribution 4.0 international license. beyond limits: exploring the possibilities for using the metaverse to teach social work practice skills alex d. colvin m. sebrena jackson angela n. bullock abstract: as social work is one of the fastest growing professions, it is crucial to provide future practitioners with the skills and tools needed to address global challenges. as a part of this initiative, social workers must be given the opportunity to take a leading role in the decision-making regarding the use of technologies such as the metaverse in the education of the next generation of social workers. to aid in this process, this article provides an overview of the metaverse and highlights its educational potential. a social work implication for the development of the metaverse can expose students of social work to opportunities to practice with individuals, families, groups, organizations, and communities without being limited by time and location. keywords: augmented reality, metaverse, social work, virtual reality, social work practice over the past decade, several universities have adopted online technologies, such as virtual simulations, for use in social work education (martin, 2017). some higher education institutions also rely on second life (sl) to augment clinical learning experiences, as this online multimedia platform allows users to create personalized avatars through which to interact with other users and user-created content within a multiplayer virtual world. developed by linden labs in 2003 as an e-learning tool, sl has also been used to facilitate the development of interpersonal communication skills in mental health. this and similar platforms have broadened the scope of student-centered learning (xie et al., 2022). guided by these recent advances, educators have also started to consider the use of metaverse as a learning platform in diverse fields, such as medicine, nursing, science, and manufacturing, as well as military training and language learning (choi & kim, 2017; díaz et al., 2020; jovanović & milosavljević, 2022; koo, 2021; siyaev & jo, 2021; tasa & gorgülü, 2010). the range of its applications is expected to increase, given that metaverse enables learners to experience, explore, learn, and teach, as well as practice various skills that can be later applied in the real world. for example, farjami et al. (2011), kanematsu et al. (2013), and han (2020) explored the development of real-life experiments where the metaverse system is used as a tool to solve problems. however, it can also be used to learn social skills, as users can interact in this virtual environment according to the rules defined by its creator (farjami et al., 2011; kye et al., 2021). as the metaverse could be explored within a virtual reality (vr) system or via augmented reality (ar) in real-world contexts (avila, 2017). ofgang (2022) proposed engaging educators in its further development to ensure that it can be leveraged in education. about:blank advances in social work, spring 2024, 24(1) 142 in the metaverse space, people can engage in social activities such as discussing social issues, collaborating on projects, playing games, and solving communal problems (bourlakis et al., 2009; jovanović & milosavljević, 2022; park & kim, 2022). yet, despite considerable research in this domain, little is presently known about the technologies behind the metaverse. additionally, little is known specifically about the developments needed to provide users with a fully immersive experience in social work education including the ability to create personalized stories through interactions with others. as noted by a scholar at the university of denver, “whether we like it or not, the metaverse is coming. will social workers have space in this metaverse from a practice standpoint, and should we? our industry will hurt if we don’t wake up to this quickly” (graduate school of social work university of denver communications team, 2021, para. 8). the purpose of this article is to explore the use of metaverse for teaching social work practice skills to future social workers. thus, in the sections that follow, we first provide a brief overview of this technology, including how it differs from virtual and augmented reality. this is followed by a brief discussion on the diffusion of innovation theory and the use of this framework as a guide to integrate the metaverse in social work education. lastly, we explore the possibilities for its adoption in social work education, including identifying potential challenges and future opportunities. brief overview of the metaverse the metaverse can be described as a hypothesized iteration of the internet, supporting persistent online 3d virtual environments through conventional personal computing, as well as virtual and augmented reality headsets. in its simplest form, the metaverse is an online, open, shared, persistent, three-dimensional virtual world that includes augmented reality, virtual reality, and 3d avatars. more specifically, in this space, users could freely access a 3d space that reflects the real world through digital agents (avatars) and interact with each other in all parts of their lives (smith, 2022; x. zhang et al., 2022). this goal is aptly captured by the term “metaverse”—first used by neil stephenson in 1992—as a combination of “meta” (meaning beyond; transcending) and “verse” (in reference to “universe,” cosmos; the whole world) which denotes a new virtual universe created beyond the real world (x. zhang et al., 2022). more specifically, it describes a world where virtual and reality interact. the metaverse concept was more vividly depicted in science fiction movies, such as ready player one, lucy, and the matrix (zhao et al., 2022). such a 3d virtual world allows users to create avatars, which are digital representations of the user (i.e., teachers, learners, friends, co-workers, etc.) (zhao et al., 2022). these avatars can be customized with details of the user's physical appearance and features (e.g., face, body, skin tone, hair, gender, dressing style, and even facial expressions, and gestures) (kocur et al., 2020; murphy, 2017; wei et al., 2004). in the virtual space, avatars can coexist and interact with the other players in a variety of activities (e.g., working, learning, training, socialization, and transaction) (park & kim, 2022; c. zhang et al., 2022). while user-created characters are not a new concept, they were previously mostly adopted in the gaming context. however, increasingly, avatars are being seen as extensions of users’ personas. using their virtual identities, users interact with others remotely through body movements, voice calls, and taking snapshots. this aspect colvin et al./beyond limits 143 has been particularly important to gen zers, millennials, and zoomers who consider their identities in virtual spaces just as important as that in the real world (park & kim, 2022). for these first generations of digital natives, who have come of age fully connected by technology, their behaviors, and attitudes influence metaverse experiences and developments (johnson, 2022). because these groups see themselves as technological pioneers, the metaverse presents a new frontier for engaging and learning. as the scope of the metaverse has widened and is continuously growing, various definitions and concepts have emerged. for instance, some would define the metaverse as a post-reality universe, a perpetual and persistent multiuser environment merging physical reality with digital virtuality (mystakidis, 2022). the metaverse has also been described as an embodied online world where people can work, play, and socialize with avatars, often in the form of headsets or glasses (bobrowski, 2021; zuckerberg, 2021). some people might consider the metaverse to merely be a new term for vr or ar; however, it is much more than that (park & kim, 2022). first, the metaverse relies on artificial intelligence (ai) for leveraging ar, vr, and other required elements (hwang & chien, 2022). that is, the metaverse includes both the items which already exist from the real world (augmented) and the creations produced in the virtual world (zhao et al., 2022). thus, unlike vr, the metaverse allows users to “live” for prolonged periods within the virtual world and engage in various activities such as working, owning, learning, interacting, creating, and entertaining (hwang & chien, 2022). most importantly, the metaverse will enable people to have authentic, immersive, and multimodal experiences as if they are in the real world (bourlakis et al., 2009; jovanović & milosavljević, 2022; nevelsteen, 2018). this could lead to a future means for generating sustainable content and social meaning (park & kim, 2022). to create, provide, and develop sustainable content and social meaning, the metaverse should be socially acceptable. for lee et al. (2021), privacy threats, user diversity, fairness, and user addiction define the sustainability of the metaverse. for example, fairness in the metaverse should be based on the principles of fair competition, transparency, and innovation. privacy threats, on the other hand, mean developing a community in the metaverse while ensuring a healthy and safe environment. this includes protecting the metaverse’s digital ecosystems and preventing the negative effects of technology on the metaverse environment. x. zhang et al. (2022), stated the most representative authentication technology in the metaverse is blockchain, which can provide transparent, open, decentralized, and reliable services and protect users’ privacy to keep the metaverse world a sustainable ecosystem. additionally, user diversity is important to generating a sustainable meta environment. this includes ensuring authentic user interactions through social networking that encourages the acceptance of each user's unique background and language. for speakers of different languages to use a metaverse, a service that interprets and provides natural expressions through translation is required (dwivedi et al., 2022). still more, sustainability should encompass an environment that operates with services that are seamless when used by many users even in relatively low-end mobile devices (dwivedi et al., 2022). this includes continuously developing open-source platforms and easy-to-use interface features advances in social work, spring 2024, 24(1) 144 which are composed of visual and auxiliary auditory forms. when these various sensors are commercialized, it is possible to create a more immersive and continuous world (dwivedi et al., 2022). ultimately, in theory, sustainability and the metaverse can exist together in a way that transforms and reshapes the world for the benefit of everyone. by prioritizing sustainability in the metaverse, a virtual world can be created that not only provides new and exciting experiences but also sets the foundation for a better future. in that sense, the metaverse can be considered a scalable environment in which users create their own content and events. for these benefits to be fully realized three components are necessary: (i) hardware improvements (e.g., gpu memory, 5g); (ii) development of the recognition and expression model that leverages the parallelism of the hardware; and (iii) availability of content in which users can immerse and participate (park & kim, 2022). lastly, in the metaverse, users can engage in an activity of their choice, while current vr and ar applications impose restrictions on the tasks that can be performed (hwang & chien, 2022). as the metaverse technology advances, it is also expected that the accuracy of vision and language recognition will improve, and the development of generative models will enable a more immersive environment and natural movement (park & kim, 2022). the processing time and complexity are already substantially reduced using multimodal models as e2e (end-to-end) solutions with a multimodal pre-trained model, allowing access to the metaverse anytime, anywhere via mobile devices connected to the internet (park & kim, 2022). description of the theoretical framework the diffusion of innovation theory everett rogers developed the diffusion of innovation theory to explain the process through which innovations are accepted and utilized in society (x. zhang et al., 2015). rogers (2003) defined innovation as “an idea, practice, or object that is perceived as new by an individual or another unit of adoption” (p. 11) while describing diffusion as “the process by which an innovation is communicated through certain channels over time among the members of a social system” (p. 5). he further posited that potential users would either adopt or reject an innovation based on the beliefs they form regarding its relative advantage, compatibility, complexity, trialability, and observability (agarwal, 2000). in this context, relative advantage refers to the degree to which an innovation is considered as being better than the idea it replaced in terms of economic benefits, social prestige, convenience, or satisfaction. it is also important that individuals perceive the innovation as advantageous. thus, the greater the perceived relative advantage of an innovation, the more rapid its rate of adoption will be (rogers, 2003). advantages of using the metaverse are global as it connects individuals, communities, and environments in an online world through ar and/or vr, and with unique 3d avatars that convey their personality and other relevant traits. compatibility refers to the degree to which innovation is regarded as being consistent with the potential end-users existing values, prior experiences, and needs (lee et al., 2011). colvin et al./beyond limits 145 essentially, compatibility represents the extent to which an innovation corresponds to the existing technical and social environment. the more an innovation incorporates the existing values and needs of potential users, the greater the likelihood of its diffusion and adoption (x. zhang et al., 2015). in this stage of innovation diffusion, careful planning and safeguarding are needed to protect the values and uniqueness of users, which requires exploring and addressing the obstacles to implementation. in the context of metaverse adoption, this is not expected to be an issue, as many of today’s learners already use platforms where they can connect with virtual worlds. therefore, adapting to increased integration of ar or vr communities would be second nature to them (carlson, 2005). complexity is the degree to which an innovation is perceived as difficult to understand and use (lee et al., 2011). some innovations are readily understood by most members of a social system, while others are more complicated and will be adopted more slowly. new ideas that are simpler to understand are adopted more rapidly than innovations that require the adopter to develop new skills and understandings. accordingly, implementers need to provide suitable guidelines for virtual and/or augmented applications (including metaverse) that are clear, concise, and inclusive of language common to potential endusers. trialability refers to the degree to which innovations can be tested on a limited basis (lee et al., 2011). new ideas that can be explored without complete commitment and with minimal investment are generally adopted more quickly than innovations that lack these features (x. zhang et al., 2015). therefore, if users can learn by doing and are given tutorials for experiencing the metaverse on a trial basis, they are likely to have fewer reservations regarding its adoption. lastly, observability is the degree to which the results of innovations can be visible to potential users (lee et al., 2011). if the results are perceived to be beneficial, the innovation will be adopted (x. zhang et al., 2015). accordingly, the more potential end-users can visualize the metaverse’s usefulness the more successful its adoption will be. challenges to metaverse adoption like online activity since the inception of the internet, the metaverse faces ethical issues and concerns (heider, 2022), as the increased opportunity for interconnectedness has some inherent risks. wheeler (2021) identified personal privacy, marketplace competition, and misinformation as the key “metachallenges” of the metaverse. on the other hand, signé and dooley (2022) are of the view that the core risks pertain to safety, work, resources, and equality. for example, in horizon worlds, up to twenty avatars can get together at a time to hang out in the virtual space. meta reported that a beta tester using the platform horizon worlds was groped by a stranger (basu, 2021). hence, when using the metaverse as a platform to teach social work practice skills, social work educators should consider the adverse impact on student safety and privacy. technology standards that guide social work practice call for practitioners to analyze the risk of providing services using technology and to ensure that electronic services are kept confidential (national association of social workers [nasw] et al., 2017). advances in social work, spring 2024, 24(1) 146 researchers warn that the safety and data privacy issues inherent in the current social media platforms will be magnified in the metaverse due to the immersive and hard-to-regulate adbased model that will be integrated deeper into many parts of users’ lives (gale, 2022). its other challenges might include perceived online user abuse and harassment in vr and ar environments, which can result in traumatic experiences (signé & dooley, 2022). according to dwivedi et al. (2022), as the metaverse concept is based on a gaming culture in which bullying, racist language, and harassment are prevalent and often encouraged, it is likely that these issues will persist, given that the high volume of personal, behavioral, and biometric data collected through metaverse technologies can result in major privacy challenges. the value of this data to malicious users creates major cybersecurity and privacy risks. along with analyzing client risks and ensuring client confidentiality, social work practitioners are charged with advocating for changes in policies, practices, and programs that address the unique needs of individuals and groups and that ensure that marginalized populations have access to technology (nasw et al., 2017). according to signé and dooley (2022), “as the metaverse attempts to create a virtual world that more accurately reflects the real world, already-existing power dynamics and inequality in the real world may be replicated in the metaverse” (para. 3). for instance, marginalized populations often experience the most harm and suffer from racial and gender biases due to the unintended consequences of new technologies that rely on algorithms that make decisions about the type of content users see and have access to (adeyemo, 2022). mathiyazhagan et al. (2022) noted that biased algorithms have denied access to services such as housing, jobs, and other social service programs. other equity questions can also be raised regarding the affordability of the technology and tools to access the metaverse. can people from impoverished communities afford the headsets and other tools that could be needed to access some versions of the metaverse? students who are first-generation college students may lack the resources to purchase equipment to fully engage in metaverse activities in the classroom. while these issues are widely recognized, limited efforts have been made to strengthen the knowledge and practices to design safe, accessible, and inclusive digital immersive environments such as metaverse (zallio & clarkson, 2022). another challenge that should be considered when adopting the metaverse is accessibility. the needs of both faculty with disabilities using the tool to teach as well as students with disabilities as a part of coursework require attention. for example, will faculty and students with disabilities have the option to select an identity that displays their disability? can the available assistive technology easily integrate with the metaverse so that users have a seamless experience? will a captioning system be available to accommodate deaf users? technology companies like meta have internal accessibility teams that are hopefully considering these questions and many others to ensure that users with disabilities can actively use this technology (haynes & alsaab, 2023). for example, meta boasts of using an inclusive design approach when developing new technology. virtual reality checks (vrcs) have been introduced to focus on ensuring that the applications on the platform are more accessible for people with disabilities (meta, 2022). colvin et al./beyond limits 147 opportunities provided by metaverse although the metaverse presents several challenges, there are also many potential opportunities for its use, especially in education. according to the diffusion of innovation theory, educators can opt to adopt or reject the innovation based on beliefs that are formed in connection with the innovation. kshetri (2022) identified six benefits that the metaverse offers to colleges and universities, noting that it (1) makes educational resources affordable, (2) enhances student performance, (3) makes virtual interactions more like real ones, (4) enables experimentation with hard to create phenomena, (5) increases accessibility for remote students, and (6) attracts young demographic. first, as colleges and universities grapple with budget cuts and limited funding, the metaverse may offer relative advantages through unique cost-effective learning opportunities for students. x. zhang et al. (2022) refer to this learning mode as virtual experiment learning. the metaverse could allow students to participate in virtual experiments featuring real-time interactions, which is particularly beneficial for experiments that are too expensive or could be risky or toxic in the real world. the medical school at fisk university created virtual cadavers for their students to practice (kshetri, 2022). similar approaches can be adopted in social work programs. for example, the university of kentucky’s school of social work created an ask-vr program using oculus virtual reality (vr) headsets as a platform to teach students to better engage and support foster and adoptive families. the purpose was to ensure that foster adoptive parents had a support service group (barnes, 2023). instead of having to purchase and establish labs for students to practice, those with limited funding can create interdisciplinary partnerships with medical programs to develop simulations in the metaverse. the in-person simulation labs often require the hiring of paid actors or standardized clients, which increases program costs. although there is a potentially heavy commitment of time and resources on the front end, research on virtual social work simulations has shown that virtual simulations save time and money (baker & jenney, 2023). the metaverse could be a more cost-effective way for social work programs to develop the practice skills students require. for example, students can practice in a rendered metaverse world (home scenes, community environments, and office spaces) that mimics visual realism. in these settings, students can practice their engagement with peers and colleagues as virtual clients. this type of simulation can be monitored by the faculty and immediate, real-time feedback can be provided. using this method can not only achieve better teaching results but also provide learners with an authentic supportive learning experience. the metaverse can also lead to enhanced student performance, given that using extended reality (xr) technologies in learning environments has been found to increase learners’ enjoyment, interest, and motivation to learn (pimentel et al., 2022). the direct experience given to students in the metaverse is immersive, which not only promotes teamwork and skill development but also engages students in classroom activities in different ways (tlili et al., 2022). according to kshetri (2022), students that took part in a metaversity piloted by morehouse college found vr classes more engaging and more satisfying and thus experienced increased achievement when compared to their peers who offered traditional and online classes. as the metaverse allows students to learn by doing, advances in social work, spring 2024, 24(1) 148 creating practice classes in the metaverse could prove beneficial in enhancing social work students’ knowledge and skills in key areas. this opportunity to further engage students in practice beyond what they experience in traditional in-person and online classrooms is compatible with the needs of social work programs. a third benefit of the metaverse suggested by kshetri (2022) is its ability to make virtual interactions more realistic. the author pointed out that “metaverse-related technologies bridge the gap between real-life and virtual interactions by allowing people to interact more naturally” (para 8). likewise, pimentel et al. (2022) are of the view that xr technologies used in the metaverse can facilitate a strong sense of presence, or the feeling of “being there,” in a place different from a physical location, as well as a strong sense of agency, which may be powerful for enabling learning. universities already use tools like gather to create virtual buildings where avatars interact and use video to allow those in these virtual spaces to see one another and interact as they move throughout the environment. gather also allows small groups to connect to hold separate conversations (kshetri, 2022). social work programs could use the metaverse to replicate their buildings and classrooms to create opportunities for online students to interact with students on campus as they develop practice skills. key to this innovation is the need to reduce the complexity of implementation as well as provide clear user guidelines for both faculty and students. experimentation with hard-to-create phenomena is a fourth benefit of the metaverse (kshetri, 2022). some real-world situations can be risky for students. virtual environments offer students safe spaces to make mistakes and hone critical skills needed in difficult practice settings (lanzieri et al., 2021). kim and hopkins (2017) reported that about 70% of child welfare workers in the united states have been victims of violence or threats while they work, while 90% of former child welfare workers reported that they had experienced some types of verbal threats, 30% had experienced physical attacks, and 13% had been threatened with weapons. field placements in child welfare settings are important for student learning, but as they are also inherently risky, these issues can be overcome through simulations in the metaverse. for example, faculty could create a community in the metaverse that allows students to investigate alleged abuse. during the home visit, students would have the experience of walking through the home and going room to room to complete a comprehensive assessment. family members could be in rooms in the home and require student interactions. the scenario could include students facing a person with a weapon or a person having a psychotic episode. students could be evaluated on their assessment skills, interviewing skills, crisis intervention skills, and safety skills. to fully leverage these new opportunities, field instructors and students should be allowed to experience metaverse learning on a trial basis, as this will enable developers to obtain valuable feedback for further improvements with the aim of full adoption of this highly promising innovation. fifth, as the metaverse increases accessibility for remote students (kshetri, 2022), it can be highly beneficial for offering education to those living in rural areas. jensen (2022) went further to suggest that the metaverse can expand the existing concept of online universities, offering students “unlimited access and trusted digital accreditations to meet specific regional curriculum requirements of the most cutting-edge campuses anywhere in colvin et al./beyond limits 149 the world” (para. 3). as the need for professional social workers grows, finding creative ways to increase access to quality programs for students, especially those in rural areas, is important. as social work programs grapple with student concerns regarding the costs associated with unpaid field placements, the metaverse may offer opportunities to engage students in skill-building exercises that reduce the cost of travel to agency sites. however, to accomplish these learning opportunities for students in rural communities, measures should be in place to assure they have adequate access to the bandwidth necessary to engage effectively in multimodal interactions. along with network access, measures should include ensuring that equipment, if any is required, be made available for student success using this space. finally, as metaverses provide experience-driven opportunities, they primarily attract a young demographic (kshetri, 2022). this provides an ideal opportunity for universities to create virtual tours of their campuses in the metaverse to promote their programs to prospective students. this idea can be expanded to include gaming opportunities or live concert events as a means of popularizing academic institutions. as these young users experience observable results from using the metaverse, they are more likely to desire more opportunities to engage with this technology. this is also consistent with roger’s construct of compatibility, as users that have positive experiences within the metaverse are likely to evaluate this innovation more positively. implications for social work education since clinical simulations already serve as powerful teaching and learning tools for social work students, the metaverse is expected to be the next iteration for skill development. for this reason, continuing the research efforts for expanding this virtual technology as a practice-based learning environment can take social work education to another level. as metaverse technology is further explored specifically in social work education, consideration should be given to its affordability, flexibility, and accessibility along with ensuring that it is a socially just space for practice. for instance, it will be important to ensure that users have access to well-designed and affordable infrastructure, hardware, and software. this includes adequate broadband, smart wearable devices, and computer technology to facilitate access to the metaverse world (parmaxi, 2020). as indicated by scholars (e.g., kang, 2021; yang et al., 2022; c. zhang et al., 2022), wireless communication and high-speed networks, such as 5g or 6g, are the basic requirements for the implementation and work of the metaverse world. with the support of high-speed networks, the metaverse can maintain fluency, steadiness, and low latency for data transmission, scene presentation, immediate feedback, and user connection (c. zhang et al., 2022). as stated by park and kim (2022), the smart wearable device is a basic hardware component that links the real world and the virtual world. smart wearable devices include headsets or head-mounted displays (hmd), smart glasses, etc., which can be divided into non-see-through, optical-see-through, and video-see-through (e.g., kang, 2021; taylor & soneji, 2022; zuckerberg, 2021). these smart wearable devices can help learners to teleport themselves from the real world into the metaverse and switch between the real and advances in social work, spring 2024, 24(1) 150 virtual worlds without restrictions. this hardware is now quickly enhanced because of technological advancement, but it still needs further improvement. measures should be available to ensure that social work students have access to well-designed, cost-effective headgear or have the capability to access the metaverse without requiring wearable headgear at all. an example of providing the metaverse without the use of headgear is the platform universe designed by viewsonic. users of this platform can access the metaverse simply by accessing the virtual world using their computers. no smart wearable headgear is required. additionally, software (e.g., edge computing, cloud computing, distributed computing) to process, compute, store, transmit, and interchange data and information between the virtual world and the real world, and among users is vitally important (e.g., kang, 2021; zhao et al., 2022). accessibility should also be considered to ensure that all users enjoy the same services within the same timeframe regardless of any diversity factors (e.g., ability, language, socioeconomic status, culture, religion) (gargiulo & metcalf, 2022; university of montana, 2022). it is further important to ensure that the metaverse provides a practice space that is inclusive, equitable, and socially just. to ensure this, the metaverse should be a space where all learners are to be able to independently acquire the same knowledge, and engage with the same spaces, interactions, and technologies. equitable access to learning experiences in the metaverse must further include adopting inclusive strategies for constructing the learning experiences. this can include social work paving a path for equity to prevent possible digital harm (mathiyazhagan et al., 2022). immediate implementation of the metaverse in the present non-regulated tech and social condition has the highest potential of amplifying existing social inequalities in the virtual universe. therefore, addressing the us federal technology policy gaps with social work principles related to the metaverse should be an urgent priority. this will prevent an exacerbation of existing concerns (mathiyazhagan et al., 2022). further development of the metaverse can expose students of social work to opportunities to practice with individuals, families, groups, organizations, and communities without being limited by time and location. this experience can be extremely empowering, particularly for students that do not live in multicultural settings (x. zhang et al., 2022). exposure to individuals from different cultures around the globe will create more well-rounded, culturally competent students while also exposing them to new methods of practice. moreover, the empowering nature of the metaverse can aid future social workers in breaking down barriers and strengthening cultural competencies. imagining these possibilities makes it imperative to place this initiative at the forefront of social work education. conclusion although the metaverse is a relatively new technology, as it develops further, it will have immense potential in diverse domains, education in particular. imagine the possibilities of enriching social work professionals' human interaction, communication, and social transactions using technology. metaverse has the potential to do just that. thus, considerations should be given for social work education programs to adopt metaverse colvin et al./beyond limits 151 technology in their teaching and training practices. to accomplish this, however, social work educators must ensure that all students have an equal opportunity to learn using this new technology. this will require universities and social work education programs more specifically, to make a commitment to invest in meta technology. along with this, social work programs should ensure that students have access to equipment and services that are affordable, efficient, reliable, and equitable. by training new students in the metaverse, the profession would pave the way for a future workforce that embraces and enhances future e-service delivery. this will only take the social work profession to another level and position it to be at the forefront of this emerging technology. for this reason, it is imperative that the social work profession not turn its back on the possibilities that this integration 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(2021). connect 2021: our vision for the metaverse. facebook. author note: address correspondence to alex d. colvin, 7300 university hills blvd, dallas, tx 75241-4605. phone: (972) 338-1354. email: alex.colvin@untdallas.edu author note: in memory of angela n. bullock, co-author, passed away before the publication of this article. we acknowledge and appreciate her contributions to the article. https://doi.org/10.1016/j.tele.2022.101909 https://doi.org/10.1016/j.tele.2022.101909 https://doi.org/10.3389/fpsyg.2022.1016300 https://doi.org/10.3389/fpsyg.2022.1016300 https://doi.org/10.3389/fmed.2022.904566 https://doi.org/10.3389/fmed.2022.904566 https://doi.org/10.1186/s12913-015-0726-2 https://doi.org/10.1186/s12913-015-0726-2 https://doi.org/10.1186/s12913-015-0726-2 https://doi.org/10.1016/j.visinf.2022.03.002 https://doi.org/10.1016/j.visinf.2022.03.002 https://tech.fb.com/ar-vr/2021/10/connect-2021-our-vision-for-the-metaverse/ mailto:alex.colvin@untdallas.edu _________ michele d. hanna, phd, msw, associate dean for diversity, equity, and inclusion and associate professor, and heather arnold-renicker, msw, clinical assistant professor, graduate school of social work, university of denver, denver, co. barbara garza, msw, denver metro area social worker, 2020 graduate, graduate school of social work, university of denver, denver, co. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 588-615, doi: 10.18060/24484 this work is licensed under a creative commons attribution 4.0 international license. abolishing whiteness: preparing msw social work students for antiracist practice michele d. hanna heather arnold-renicker barbara garza abstract: the power, privilege, and oppression paradigm that most schools of social work currently espouse to are often taught through an experiential approach to whiteness, privileging the majority of white students with the opportunity to explore their white identity at the expense of the learning of the black/brown, indigenous, people of color (bipoc) students in the classroom. many bipoc students experience these courses as a hostile environment, finding themselves and their racial group identified in contrast to whiteness – oppressed, marginalized, silenced, and powerless. this paper presents an innovative course outline using critical race theory and critical white studies as theoretical frameworks to decenter whiteness and attend to the learning needs of bipoc students. using these two theoretical frameworks, students will learn the history of the racial hierarchy of humans; the social construction of whiteness, the evolution of antiblack racism and the extension to other people of color; and the relationship between white supremacy and racism. keywords: anti-racist practice, whiteness, critical race theory, critical white studies, social work education covid-19, racial unrest, and the political divide created a perfect storm that will forever mark the year 2020 as a pivotal point in the history of the united states (u.s.) and the world. life will be forever defined as life before 2020 and life after 2020, before the pandemic and after the pandemic. for many black/brown, indigenous, people of color (bipoc) 2020 will be remembered as a time of white society’s awakening to the egregious, endemic racism that has always been and continues to be part of their everyday lives. this paper is the result of several conversations between the three authors (two bipoc, one white) over the last year regarding the impact of these events on our lives, our msw program, and our students. two of us are long time instructors of courses within our msw program related to power, privilege, oppression; and diversity, equity, and inclusion – a subset of our curriculum labeled “values courses” designed to help our students explore these issues in depth, focusing on populations we serve and social justice. critical race theory (crt) is a foundational theory for the majority of these courses. the third author is a recent graduate of our program who prompted our exploration of critical whiteness studies as she began to try to make sense of her experience as a bipoc student in our predominately white institution. with the racially charged events of 2020 as the backdrop, our conversations led us to question our approach. are we truly preparing our students to do this work in authentic and culturally appropriate ways? are we preparing all of our students or are we just preparing our white students actually causing harm to our bipoc about:blank hannah et al./abolishing whiteness 589 students? in what way can we do this without centering whiteness, recognizing that we are all co-conspirators (love, 2019) in this struggle. we concluded that a new approach, one that integrates the key constructs of the two theories, was one way we might address our concerns. a racial awakening the death of george floyd on may 25, 2020 at the hand of the police sparked unprecedented outrage and protests against racial injustice from people of all races, all over the world. george floyd’s death as well as the death of breonna taylor just six weeks prior highlighted the rate of fatalities from police shootings for black people in the united states is more than twice that of white people (32 per million for black people as compared to 13 per million for white people; statista research department, 2020). latinx persons are almost twice as likely to die from a police shooting (24 per million). according to the washington post (2021), since 2015 over 6000 fatal shootings occurred in the u.s. at the hands of an on-duty police officer with 998 people killed in 2020. of those killed in 2020, 43% were identified as bipoc – 27% black/african american, 19% hispanic/latinx, 2% indigenous, 2% asian, <1% other (washington post, 2021). of the over 6000 deaths recorded since 2015, nearly 287 have been female. in roughly 600 cases, the person was either unarmed or the presence of a weapon on the person was undetermined. covid-19 in addition to society’s awakening to racial injustices at the hands of the police, the coronavirus pandemic publicly unearthed the racial disparities and injustices within the us health system for bipoc. within a relatively short time frame, emerging data showed the coronavirus had disproportionately impacted bipoc across the nation (godoy & wood, 2020). by late summer 2020 data indicated that bipoc were between 1.1 and 2.8 times more likely to be infected with covid-19 – asian persons (1.1x); black persons (2.6x); latinx persons (2.8x) and indigenous persons (2.8x) than white persons (centers for disease control and prevention [cdc], 2020). indigenous persons were 5.3x more likely to be hospitalized, followed by black persons (4.7x), latinx persons (4.6x), and asians (1.3x). lastly, while there was no difference in the rate of death amongst asian persons in comparison to white persons, latinx persons were 1.1x more likely to die as a result of coronavirus, indigenous persons 1.4x more likely, and black persons 1.1x more likely. according to tai et al. (2020), the disparities of covid-19 seen in bipoc communities are most likely rooted in “medical, social, economic, environmental, and political contexts that predate the pandemic” (p. 705). social work education response these two pivotal racial moments in time highlight the need for culturally responsive, anti-racist social work practice. as schools of social work look to prepare msw social workers to respond to the new normal that will most likely exist after 2020, it is vital that curriculum related to issues of diversity, equity, inclusion, power, and privilege be advances in social work, summer 2021, 21(2/3) 590 reevaluated for its effectiveness and applicability. according to salsberg et al. (2017) the majority of the social work workforce with a master’s degree or higher is white (72.6%). most recent data indicate that msw graduates are 88% female, and surprisingly 43% bipoc (george washington university health workforce institute, 2019). however, disenfranchised, marginalized populations, who are more than likely to be bipoc, are overwhelmingly disproportionately represented within the client populations and systems social workers serve (fong et al., 2015; huggins-hoyt et al., 2019; mcintosh et al., 2018; salsberg et al., 2017). social work education is charged with designing competency-based curriculum with the goal of graduating social workers who have the “ability to integrate and apply social work knowledge, values, and skills to practice situations in a purposeful, intentional, and professional manner to promote human and community well-being” (commission on educational policy [coep] & commission on accreditation [coa], 2015, p. 6). more specifically, competency 2 of the 2015 educational policies and accreditation standards (coep & coa, 2015) states that: social workers understand how diversity and difference characterize and shape the human experience and are critical to the formation of identity. the dimensions of diversity are understood as the intersectionality of multiple factors including but not limited to age, class, color, culture, disability and ability, ethnicity, gender, gender identity and expression, immigration status, marital status, political ideology, race, religion/spirituality, sex, sexual orientation, and tribal sovereign status. social workers understand that, as a consequence of difference, a person’s life experiences may include oppression, poverty, marginalization, and alienation as well as privilege, power, and acclaim. social workers also understand the forms and mechanisms of oppression and discrimination and recognize the extent to which a culture’s structures and values, including social, economic, political, and cultural exclusions, may oppress, marginalize, alienate, or create privilege and power. (p. 7) this competency aligns with national association of social workers (nasw) second core value “social justice” and ethical principle “social workers challenge social justice”: social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. social workers' social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. these activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity. social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people. (nasw, 2017, p. 2) this paper presents a course outline using crt and critical whiteness studies (cws) as the theoretical frameworks. the power, privilege, and oppression paradigm many schools of social work currently espouse to is rooted in the idea that in the u.s. there is a socially constructed racial hierarchy that places white people at the top and black people at the bottom with other people of color in betwixt (lopez, 2013). this socially constructed hierarchy creates a culture of systemic and institutional racism rooted in white supremacy hannah et al./abolishing whiteness 591 and yields a power of whiteness that leads to the oppression of all others as a means of maintaining the status quo of white supremacy. unfortunately, many bipoc students in these courses experience micro/macro aggressions/assaults from their white peers – some of which may be “working through” their white guilt or shame towards their “awakening.” most importantly, while the bipoc student may leave the course feeling somewhat validated and hopeful that some of their white peers have learned what many of them have known all their lives – that race matters; many may also leave bewildered and perplexed as to how the content of the course will help them as they move forward into an overwhelmingly white profession as a bipoc social worker. in this paper, we argue that whiteness is not the product of white supremacy but rather that white supremacy is a construct of whiteness, which maintains the status quo and keeps racism alive. using two theoretical frameworks, crt and cws, we outline a course curriculum in which students learn the history behind the racial hierarchy of humans; the social construction of whiteness and the way this manifest differently for white people versus bipoc; the evolution of anti-black racism and its extension to other people of color; and the relationship between white supremacy and racism. historically, the profession of social work and social work education has mirrored the contemporary racial norms of society. for example, early social work followed the practice of separate but equal in the provision of services to white people versus black people (rabinowitz, 1974; seraile, 2011). social work activism and education related to diversity and racial justice has evolved overtime in response to the sociopolitical context of the time (jeyapal, 2016; schiele, 2007). the events of 2020 pushed systemic racism to the forefront of the sociopolitical discourse. this course presents an opportunity for social work education to lead the charge and equip msw students of all races for anti-racist practice that serves to dismantle whiteness across systems including systemic racism, entitlement, colorism, and cultural appropriation. theoretical frameworks critical race theory (crt) crt emerged in the mid-1970s during a time when the country seemed to have moved on after the civil rights movement of the 1960s. while much had changed, much remained the same, and in some cases, regressed (delgado & stefancic, 2017). frustrated with the status of racial reform in the united states, legal scholars, derrick bell, alan freeman, and richard delgado, began the critical race theory movement building off of critical legal studies and radical feminism. from critical legal studies, crt added racism as a critique of mainstream liberalism and adopted the postmodern concept that not every legal case has one correct outcome (i.e., there is more than one way to interpret the facts depending on the interpreter; delgado & stefancic, 2017; ladson-billings, 1998). from radical feminism, crt incorporates concepts related to power, the social construction of roles, and the invisible patterns of structural oppression. over the last few decades, crt has evolved from a legal theory to a movement, “a collection of activists and scholars interested in studying and transforming the relationship advances in social work, summer 2021, 21(2/3) 592 among race, racism, and power” (delgado & stefancic, 2017, p. 3). crt and social work are compatible in that both aim to promote social and racial justice through the dismantling of structural racism (abrams & moio, 2009; constance-huggins, 2012; kolivoski et al., 2014). the tenets of crt provide a critical framework or lens social workers can use to shine a light on race and racism that underlies societal structures and institutions. tenets of critical race theory the primary tenets of crt discussed here are 1) racism is endemic or ordinary, 2) the social construction of race, 3) whiteness as property, 4) differential racism, 5) intersectionality/anti-essentialism, 6) the unique voices of color, 7) counter-storytelling or counter narratives, 8) interest convergence, and 9) the critique of liberalism (decuir & dixson, 2004; delgado & stefancic, 2017). racism is endemic or ordinary means that racism is endemic to society and an ordinary part of the everyday life of bipoc. chester pierce (1970) identified the “offensive mechanisms” of racism, ranging from the more subtle, often unintentional microaggressions to the more “gross, dramatic, obvious macroaggressions such as lynching” (p. 266). sue et al. (2007), defines microaggressions as “brief and commonplace daily verbal, behavioral, environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults to the target person or group” (p. 273). chester noted that while these microaggressive offenses may not be crippling in isolation, “the enormity of the complications they cause can be appreciated only when one considers that these subtle blows are delivered incessantly” (p. 266). kendi (2019) goes further, stating i do not use “microaggressions” anymore. i detest the post racial platform that supported its sudden popularity. i detest its component parts – “micro” and “aggression.” a persistent daily low hum of racist abuse is not minor. i use the term “abuse” because aggression is not as exacting a term. abuse accurately describes the action and its effects on people: distress, anger, worry, depression, anxiety, pain, fatigue, and suicide.” (p. 47) these acts of racial abuse impact bipoc whether they are experienced firsthand, witnessed directly, or witnessed indirectly (through social media, mainstream media/news, or word of mouth). in 2020, the murders of ahmaud arbery and george floyd were recorded and witnessed repeatedly by all on social media and news outlets. the murder of breonna taylor was witnessed repeatedly through detailed reporting and reenactments based on eyewitness testimony, police, and court documents. each of these incidents had a profound and traumatic impact on bipoc across the country and around the world. kendi (2019) believes that one’s actions are either racist or anti-racist and that racism is the result of racist policies and ideas that perpetuate inequalities and discrimination. kendi holds that changing these policies and ideas from racist to anti-racist is the key to ending systemic racism. while racial realists agree that the key to progress is systemic, political change in the allocation of privilege, status, and resources; racial realists hold that “racial progress is sporadic, and that people of color are doomed to experience only hannah et al./abolishing whiteness 593 infrequent peaks followed by regressions” (delgado & stefancic, 2017, p. 183). in other words, the racial realist holds suspect any progress towards racial justice, anticipating the victory to be short-lived. the racial realist is not surprised when racism is unveiled as they have no reason to doubt that it is always there (decuir & dixson, 2004). this was never more evident than in the case of breonna taylor. in june 2020, breonna’s law was passed banning no-knock warrants in louisville, kentucky (riess & waldrop, 2020). three months later, the grand jury in louisville failed to charge any of the officers for their role in her death (donaghue, 2020). this case left many bipoc who were holding out hope that the justice system would work deflated and defeated (price, 2020). the social construction of race argues that race is a social construct, defined by society and maintained by its social structures. it is these social structures that create systemic racism that governs and affirms racist behaviors within our society. this can sometimes be a hard concept to grasp given that as a society we have been socialized to “see” race. we look at the color of the skin, the shape of the nose, the size of the lips etcetera, and categorize people into distinct racial categories that we have collectively accepted as true. anthropologists, geneticists, and other social scientists continue to debate the extent to which race is biologically, culturally, and/or socially constructed (anemone, 2019; hartigan, 2008; meloni, 2017; reardon, 2004). crt holds that while there may be physical characteristics passed down genetically, race is a very real construct with ascribed meaning constructed by society and codified by law in the u.s. this is most evident through the evolution of whiteness described below. whiteness as property refers to the idea that whiteness has value to those who possess it and comes with a set of benefits and privileges (delgado & stefancic, 2017). justice sutherland stated that the provision of the naturalization act which at the time granted access to citizenship to free white people and persons of african nativity of descent …is not that any particular class of persons shall be excluded, but it is, in effect, that only white persons shall be included within the privilege of the statute. "the intention was to confer the privilege of citizenship upon that class of persons whom the fathers knew as white, and to deny it to all who could not be so classified….” (united states v. bhagat singh thind, 261 u.s. 204 [1923], section 208) historically, the benefits and privileges granted to those who possess whiteness have been codified in the us through the coupling of whiteness with citizenship, land ownership, and other preferential treatment sanctioned by law. with property ownership comes the right of possession, use/enjoyment, disposition, transfer, and exclusion (decuir & dixson, 2004). differential racism refers to the ways the dominant culture racializes different nondominant racial groups at different times depending on the needs of dominant society (delgado & stefancic, 2017). racialization is the process by which a race is socially constructed, the creation of a dominant racial narrative by the dominant culture that serves to meet the needs of dominant society. slavery is a clear example of this. initially, slavery was justified as a means to save the soul of the african by converting them to christianity (tisby, 2019). however, once a generation of slaves were converted because it was illegal for christians to enslave other christians, africans became racialized as inferior, less than advances in social work, summer 2021, 21(2/3) 594 human, to justify chattel slavery. a contemporary example is the debate over mexican immigration. even though many mexican’s overnight found themselves to be living in a foreign land as the result of annexation of mexican territory in 1848, mexicans have historically been the target of immigration laws in the us while simultaneously serving as the primary workforce of agricultural labor. although the exact number is not known, it is reported that between 1929 and 1935 anywhere from 82,000 (u.s. citizenship and immigration services, 2020) to 1,000,000 (balderrama & rodriguez, 2006) mexicans (over 50% were us citizens) were deported due to the concern that they were taking american jobs during the great depression. seven years later, the bracero program began bringing millions of mexican men to the u.s. to meet the need for agricultural labor (bracero history archive, 2020). in 1954, many mexicans remained in the u.s. beyond their contractual time and the u.s. began operation wetback, deporting not only those who remained past the end of their contract but also their children who were born in the u.s. it was during this time that american workers became increasingly concerned about that the employment of mexicans was a deterrent to the employment of american workers. the program ended in 1964. today, latinx persons, particularly mexicans, are again racialized as “illegals” who are taking american jobs, described as criminals, rapists, and drug dealers, fueling the immigration debate (armenta, 2016). in reality, the majority of the undocumented persons living in the us are taxpaying and law-abiding citizens (green, 2016; obiokoye, 2018). intersectionality and anti-essentialism go hand in hand. members of a racial group are often essentialized down to the lowest common denominator or what is determined as the “unique essence of a group” (delgado & stefancic, 2017, p. 173) and these common attributes are mistakenly applied to all members of that population. many times, these essential attributes are grounded in stereotypes and societal myths about the population. crt acknowledges that each racial group as well as individuals within each racial group has their own origins and history. anti-essentialism recognizes that the experience of one member of a racial group cannot be generalized to the entire group. persons within the same racial group will have unique perspectives on the same experience because of the concept of intersectionality. while a person’s racial identity impacts how they view the world, so do the other, overlapping, intersecting, identities related to attributes such as class, gender, ability, and sexual orientation (delgado & stefancic, 2017). the tenet of the unique voices of color highlights the fact that people of non-dominant racial groups – bipoc – are in the best position to speak to experiences related to race and racism, more so than their white counterparts. while their experiences vary dependent on their unique racial identities and the history of their racial group with oppression and structural racism; the common thread, while not generalizable, is transferable to the experiences of other bipoc. as possessors of whiteness and its unearned benefits and privileges, white persons may speak about issues related to race and racism; however, they must be careful not to appropriate the experience of bipoc or the legitimacy of their discourse may be suspect. the unique voices of color can often “cast doubt on the validity of the accepted premises or myths” (delgado & stefancic, 2017, p. 171) held by the dominant or majority culture. dominant narratives often place the dominant culture in a more favorable light and hannah et al./abolishing whiteness 595 the non-dominant racial group in a less favorable one. counter storytelling or counter narratives challenge the dominant narrative by providing the “other side of the story.” for example, many of us grew up believing the positive dominant narrative of christopher columbus, his discovery of the “new world”, and the pilgrims joining with the indigenous people of the lands for a unifying celebration of thanksgiving. the counter narrative, as we now know, is that this “discovery” led to colonization of the new land and subsequent genocide of millions of people indigenous to the land through disease, murder, massacres, and war as they pursued western expansion and used the ideology of manifest destiny as justification (grand, 2018). challenging the dominant narrative often involves a reexamination of historical records, revisioning history, “replacing comforting majoritarian interpretations of events with ones that square more accurately” with the experience of minoritized populations (delgado & stefancic, 2017, p. 25). interest convergence, a crt principle coined by derrick bell (1980), simply put is the idea that “the interest of blacks in achieving racial equality will be accommodated only when it converges with the interest of whites” (p. 523). this concept is most understood in hindsight, through the reexamining of history, examining more closely the context in which significant gains in civil rights for bipoc were made. re-envisioning history or examining historical records, challenging the dominant narrative with counternarratives that more accurately reflect the experiences of bipoc will often “unearth little-known chapters of racial struggle” (delgado & stefancic, 2017, p. 25). the idea that the only way for change to happen is if there is convergence of interests between white people and bipoc places suspicion on all motives behind policy changes that on the surface appears to benefit bipoc. if racial equity is truly the mutual goal and neutral principle guiding these changes, then one would expect the racial majority to recognize that to equalize the unequal balance of racial power and privilege inherent in society would require altering their status. in other words, “true equality for blacks will require the surrender of racism-granted privileges for whites” (bell, 1980, pp. 522-523). lastly, crt holds a strong critique of liberalism, specifically the notion of colorblindness. crt holds that to be “color-blind” is to ignore or reject the impact of history and structural racism on bipoc (delgado & stefancic, 2017). a critique of the concept of professionalism serves as an example of this tenet. the council on social work education’s educational policy and accreditation standards (epas; coep & coa, 2015) states in the first competency that social workers “demonstrate professional demeanor in behavior; appearance; and oral, written, and electronic communication” (p. 7). through a crt lens, the concept of professionalism appears on the surface to be color blind, focusing on a set of behavioral expectations in the workplace not influenced by race or racism. what is not considered is the fact professionalism is a concept historically used as a tool of social control, designed to maintain dominant standards of behavior rooted in white supremacy culture (frye et al., 2020; jones & okun, 2001). this concept creates an intolerance to behaviors deemed as problematic such as diverse workstyles, timeliness, questioning, disagreement, anger, and resistance that if committed, are punishable by censure both informally and formally. this can include exclusion and isolation in the workplace, discrimination, as well as loss of pay or firing. racially or culturally based expressions of self, such as speech, dress or hairstyle may also be deemed problematic. in november 2020 advances in social work, summer 2021, 21(2/3) 596 colorado passed the crown act (creating a respectful and open work for natural hair act) after several incidents of discrimination based on natural hair type and race-based hairstyles made state and national headlines (wilbur, 2020). crt also challenges the liberal ideal of racial equality. kendi (2016) states that “when you truly believe that the racial groups are equal, then you also believe that racial disparities must be the result of racial discrimination” (p. 11). discrimination, disproportionality, and disparities would not exist as all racial groups would be impacted equally and proportionately by raced-based laws and policies. crt stresses that the goal is equity not equality. “in seeking equality rather than equity, the processes, structures, and ideologies that justify inequity are not addressed and dismantled” (decuir & dixson, 2004, p. 29). equity acknowledges the unequal playing field created through structural racism and strives for structural change that will have longer lasting impact and correct the balance. critical white studies (cws) cws, or the study of whiteness, is a relatively new field of study emerging in the 1990s. while crt centers race and focuses on the intersection of race, power, and the law, cws centers whiteness, the white race, and what it means to be white with an aim of dismantling racism and getting rid of white privilege (chen, 2017; delgado & stefancic, 2017). chen identifies two primary perspectives on whiteness that frame csw. the first, the historical perspective, looks at the history of whiteness, its evolution over time, and sees it as a fluid concept that is transformative. the experiential approach or perspective views whiteness as a hidden condition of white people that needs to be revealed and resisted. this approach sees the primary method to dismantle racism is at the individual level, helping white persons to understand the effects of white privilege and the imperative of overcoming whiteness as a condition. in this paper, we take a dual approach, recognizing that it is important to attack the problem at the macro and micro level. w. e. b. dubois (1920) was one of the first scholars to tie the concept of white supremacy to racism stating this “assumption that of all the hues of god whiteness alone is inherently and obviously better than brownness or tan leads to curious acts” (p. 34). when many people think about the term white supremacy, they envision extremist groups such as the kkk, the proud boys, and the aryan nations. while these extremes are indeed exemplars, white supremacy is rooted in the invention of the white race, the racial and social conditions that maintain the racial hierarchy, as well as the political and legal context that enforce white privilege and racial injustice (rabaka, 2007). dubois (1920) saw white supremacy as a global concept stating i do not laugh. i am quite straight-faced as i ask soberly: "but what on earth is whiteness that one should so desire it?" then always, somehow, someway, silently but clearly, i am given to understand that whiteness is the ownership of the earth forever and ever, amen! (p. 34) rabaka (2007) makes the case that white supremacy goes beyond race, impacting other forms of oppression and injustice: hannah et al./abolishing whiteness 597 white supremacy serves as the glue that connects and combines racism to colonialism, and racism to capitalism. it has also been illustrated that it exacerbates sexism by sexing racism and racing sexism, to put it unpretentiously. thus, white supremacy as a global racism intersects and interconnects with sexism, and particularly patriarchy as a global system that oppresses and denies women’s human dignity and right to be humanly different from men, the ruling gender. (p. 3) similar to crt, the social construction of whiteness is central to cws. whiteness is viewed as a socially constructed identity assigned to “european explorers and settlers when they came into contact with other ethnic groups, specifically the africans and the indigenous inhabitants of the americas” (roediger, 1991 as cited in chen, 2017, p. 15). the concept of race, specifically the black race, was constructed by the european whites to justify the enslavement of darker skinned person and ascribed to the africans. blackness was then racialized as savage, wild, subordinate to the europeans (chen, 2017). the concept of whiteness was constructed by these same europeans, in contrast to blackness, and ascribed positive superior attributes. as the europeans encountered other darker than white skinned people, the negative attributes assigned to black people were extended in contrast to the positive attributes of white people. the social construction of whiteness in the u.s. can be traced back to 1790 when congress passed the nation’s first naturalization bill limiting access to u.s. citizenship to free white people and white immigrants only thus making being a white person a criteria for citizenship (lopez, 2013). this criteria did not change until 1848 when the treaty of guadalupe hidalgo extended citizenship to the inhabitants of the land annexed after the war with mexico; however, it was not until 1870, two years after slavery was abolished, that former african slaves not born in the us were granted citizenship, and it was not until 1898 that any child born in the u.s., regardless of race or parent’s citizenship, was granted citizenship (national museum of american history, n.d.). indigenous persons were not granted u.s. citizenship until 1924 with the passing of the indian citizenship act. asians were excluded from citizenship by omission and in 1882 the chinese exclusion act specifically banned the chinese from citizenship. the immigration and nationality act of 1952 eliminated race as a criterion for immigration or citizenship (national museum of american history, n.d.). between 1790 and 1952, several non-white and non-black persons from a wide variety of backgrounds petitioned the courts, asked to be legally declared white so that they could become u.s. citizens (armenia, arabia, burma, china, hawaii, india, japan, mexico, syria; lopez, 2013). the results were inconsistent with some being declared white and others not. two famous cases were argued before the supreme court which seemingly struggled to define what it meant to be white: u.s. v. ozawa (1922) and u.s. v. thind (1923). ozawa, a japanese citizen who had settled in hawaii, argued that while he did not fit the scientific category of “caucasian” which was considered synonymous with white, his life reflected that of the white citizen (luconi, 2019). thind, an asian indian, argued that based on the science at the time, he fit into the category of caucasian and therefore should be allowed citizenship. both were denied citizenship as they were deemed not to be white. justice sutherland delivered the final opinion in u.s. v thind stating: advances in social work, summer 2021, 21(2/3) 598 what we now hold is that the words "free white persons" are words of common speech, to be interpreted in accordance with the understanding of the common man, synonymous with the word "caucasian" only as that word is popularly understood. as so understood and used, whatever may be the speculations of the ethnologist, it does not include the body of people to whom the appellee belongs. (united states v. bhagat singh thind, 261 u.s. 204 (1923), section 215) as a result of these rulings as well as the many that came before, the white race was not only socially constructed, “the courts constructed the bounds of whiteness by deciding on a case-by-case basis who was not white” (lopez, 2013, p. 779). race became constructed giving the common white man the power to define and decide who was white and those who were non-white. to be white one must be not non-white. a primary difference between blackness, brownness, and whiteness is visibility. in a country where white is seen as the norm, whiteness is rendered invisible whereas nonwhiteness is visible and distinguishable. in his opinion, judge sutherland clearly identifies physical appearance as the distinguishing characteristic between white persons and nonwhite persons it is a matter of familiar observation and knowledge that the physical group characteristics of the hindus render them readily distinguishable from the various groups of persons in this country commonly recognized as white. the children of english, french, german, italian, scandinavian, and other european parentage, quickly merge into the mass of our population and lose the distinctive hallmarks of their european origin. on the other hand, it cannot be doubted that the children born in this country of hindu parents would retain indefinitely the clear evidence of their ancestry. it is very far from our thought to suggest the slightest question of racial superiority or inferiority. what we suggest is merely racial difference, and it is of such character and extent that the great body of our people instinctively recognize it and reject the thought of assimilation. (united states v. bhagat singh thind, 261 u.s. 204 (1923), section 215) the invisibility of whiteness extends beyond the physical characteristics. flagg (1998) coined the term “transparency phenomenon” to describe the tendency of white people to be unconscious of their whiteness. race is something that belongs to the other – external to white people. until a person’s whiteness is brought to their consciousness, they do not think about their life experiences in terms of their race. unlike bipoc, most white people do not have an active consciousness of their racial identity that causes them to question every interaction with other races as whether or not their race had any impact on the interaction or outcome. whiteness is the norm; black and brown people are the ones who are different and thought of in racial terms (guess, 2006). as the norm, whiteness is not noticed as it is assumed to be the case. for example, until very recently, more often than not, when the media described a person of interest, they will only add a racial qualifier if the person is nonwhite. if they are white, other attributes may be discussed such as age, gender, hair color, eye color, height, yet the fact that this person appears to identify as white is not mentioned. while the media may be doing better, this phenomenon can often be seen in hannah et al./abolishing whiteness 599 personal conversations when we describe our friends or colleagues. often race is not mentioned unless the person is bipoc. for many peggy mcintosh’s (1990) essay white privilege: unpacking the invisible knapsack was their introduction to the concept of white privilege. mcintosh describes white privilege as “an invisible weightless knapsack of special provisions, maps, passports, codebooks, visas, clothes, tools and blank checks” (p. 1). those who espouse to the experiential approach to whiteness studies often use this essay or others like it to expose white persons to the concept in hope that they will recognize the deleterious effects of their privilege and be moved to battle racism, not taking into account the systemic nature of racism and white supremacy. this approach has been critiqued as one that takes the attention off of whiteness as a racist concept, instead viewing whiteness in a more favorable light with a presumption of innocence, unaware of these privileges therefore not responsible for the impact these privileges may have (chen, 2017). a similar critique can be applied to the often-used qualifier when racial microaggressions occur as “well intentioned white brothers and sisters [who] are generally unaware that they have committed an offensive racial act” (sue, 2009, p. 183). cws argues that whiteness is anything but innocent – but rather a subtle form of the racism endemic to our society as espoused by crt theorists. a relatively new concept to cws is the idea of white fragility (diangelo, 2018). as defined by deangelo “white fragility is much more than mere defensiveness or whining. it may be conceptualized as the sociology of dominance: and outcome of white people’s socialization into white supremacy and a means to protect, maintain and reproduce white supremacy” (p. 116). critique of this concept is in tandem with critique of whiteness studies overall. some argue that the experiential approach to whiteness, including educating white people about white fragility, assumes that all white people see race and racism the same (chen, 2017). they argue the heterogeneity of white people – stating that not all white people are privileged, that not all white people are oppressors, that some white people are oppressed, and that some are not racist. this critique loses sight of the primary definition of racism – a system of advantage based on race (wellman, 1977) – as individuals we commit racist acts and perpetuate a system of racism. on september 22, 2020, president trump issued an executive order that both exemplifies this critique while simultaneously serving as a prime example of deangelo’s definition of white fragility. the order claims to “combat offensive and anti-american race and sex stereotyping and scapegoating” (exec. order no. 13950, 2020, p. 60683). it defines race or sex stereotyping as “ascribing character traits, values, moral and ethical codes, privileges, status, or beliefs to a race or sex, or to an individual because of his or her race or sex” (section 2 [c]) and provides supporting examples of incidents involving “nonminority males.” in section 5(g) among other things, it disallows federal funding for any training that makes “any individual should feel discomfort, guilt, anguish, or any other form of psychological distress on account of his or her race or sex.” the irony of this statement being that an underlying truth for both cws and crt is that historically, the training and education most of american has received in the classroom and in the advances in social work, summer 2021, 21(2/3) 600 workplace results in bipoc feeling discomfort, anguish, and other forms of psychological distress on account of their race. president biden rescinded these training restrictions by executive order on january 20, 2021 (wagner, 2021). a central premise of cws is that whiteness is the central issue of racism and until white supremacy is abolished racism will not be absolved. in order to combat white supremacy, white people must make the invisible visible, deal with the “internal conflict at the core of white racial identity” (tanner, 2019, p. 183) and actively join the war. they must come to grips with the fact that racism is not just a problem for bipoc, it is also “a white problem” (tanner, 2019, p. 182). just as racism is a higher-level concept that does not solely impact or involve bipoc, whiteness is a higher-level concept that does not solely impact or involve white people. whiteness is a concept that is fluid, constantly changing, and adapting as society that needs to be unearthed and dismantled. just as racism is systemic, embedded in our institutions and perpetuated by individual racists acts, and maintained by society’s acceptance that this is just the way it is, whiteness is systemic, embedded in our institutions and maintained by society’s acceptance that this is just the way it is. kendi (2016) argues that race did not create racism but rather racism created race. race was created to justify and maintain the racial hierarchy. similarly, whiteness created a culture of white supremacy meaning that once the white race was identified in contrast to the other, the theory of white supremacy or superiority emerged to justify keeping white people at the top of the hierarchy. white supremacy is an attitude, a belief that whiteness is the norm, is the status quo, is the preferred state of being. laws, policies, cultural norms all serve to maintain this way of life. dismantling racism means dismantling whiteness and just as dismantling racism requires intentional, active, efforts of both bipoc and white people; dismantling whiteness requires intentional, active, efforts of both white people and bipoc. as social work educators we know that this work must be down at the macro and micro level. as we prepare msw students for anti-racist and anti-oppressive practice, we must simultaneously educate our students on the history and systemic nature of racism and whiteness while also guiding them as they grapple with their racial and ethnic identity. anti-oppressive and anti-racist practice and social work the social work profession has always and continues to practice within a racist society. as a result, social work is not exempt of charges of racism, having been complicit in racism, allowing the racial norms of society to guide practice (corley & young, 2018). social workers have been instrumental in perpetuating the myth that anyone who is not white, or wealthy is delinquent or deviant, unsuitable as parents, or uncivilized (kennedy, 2008). jane addams’ settlement house movement was more aware of the macro, systemic issues impacting immigrant communities and communities experiencing poverty; however, neither this nor the charitable organizational societies’ approach addressed the root causes of social problems and, as a result, arguably did more harm. due to this, social work professionals sought more systemic approaches rooted in social justice values with a focus on racial and economic justice. hannah et al./abolishing whiteness 601 while social work has expressly identified activism and advocacy for social justice for oppressed groups as a primary value, the inclusion of race, diversity, equity, and inclusion has evolved over time. in response to the civil rights movement, social work practice and social work education began to place emphasis on diversity and cultural competence in the 1960s and 1970s (abrams & moio, 2009; schiele, 2007); however, these early efforts were rooted in ethnocentrism and a universalist perspective that held that the theories and methods used were applicable to all, regardless of race/ethnicity. once race was identified as a significant consideration, issues facing ethnic minorities (i.e., bipoc) were essentialized and little attention was paid to the unique problems facing diverse populations. as racial diversity began to be addressed, social work moved towards a model of multiculturalism – expanding attention to other marginalized identities (schiele, 2007). in the 1990s, the idea of multiple and intersecting identities further expanded social work’s view of diversity, equity, and inclusion and social work education’s focus. according to schiele, this led to the emergence of the equality-of-oppressions paradigm leading social work education to focus on oppression and anti-oppressive practice. anti-oppressive social work practice uses a person-centered philosophy and attempts to address institutional and structural inequities; an approach that includes both process and outcome, and accounts for power and hierarchy (dominelli & campling, 2002). it attempts to address how power is used to oppress and marginalize people and how the power of communities can be used to work towards liberation (tew, 2006). fundamentally, anti-oppressive practice believes that society is inherently unequal and that we must work as social workers to address the imbalance at the roots. anti-oppressive practice is a broad umbrella category that does not always center race, racism, or anti-racism, and there is critique that anti-oppressive social work practice has not effectively involved impacted communities in determining what anti-oppressive practice should be. there are concerns that anti-oppressive social work practice has essentially co-opted community knowledge as “expert” knowledge and used it to label oppressed communities in ways that furthers their oppression and marginalization (wilson & beresford, 2000; wilson, 2016). in the current political context of covid-19, black lives matter, the march for our lives, the women’s march, #metoo, etcetera, social work has again shifted a focus on race and anti-racist practice. this time, intersectionality is at the forefront – recognizing that we are all complex individuals with multiple, overlapping identities. often misinterpreted, audre lorde’s (1983) essay there is no hierarchy of oppressions, is not supporting an equality-of-oppression paradigm but rather the reality that the oppression of one group is often a pre-cursor to the oppression of another; therefore, we must battle oppression of any kind when it presents itself. this aligns with the crt tenet of differential racialization – the target of racial oppression may be black people today, latinx people tomorrow, and indigenous people next week. if we are to successfully combat racism, we must fight it on all fronts regardless of the racial group being targeted. kendi (2019) identifies several aspects of racism, identifying the difference between how these may play out as a racist as opposed to an anti-racist. using these characteristics as a framework, anti-racist social workers: advances in social work, summer 2021, 21(2/3) 602 • espouse to the idea that all racial groups are equal, none is superior or inferior to the other, or needing to be developed. • acknowledge and accept that there are cultural differences among racial groups, rejecting efforts to equalize these differences and create cultural standards that result in a cultural hierarchy. • support policies that reduce racial and ethnic inequity, opposing racial capitalism, and protected racial spaces that support racial inequity. • work to defeat colorism and antiracist policies that produce inequity between lighter and darker skinned people. • acknowledge intersectionality and work to defeat policies that result in racial inequities for those with intersecting identities (i.e., gender, sexual orientation, gender expression, religion, class etc.) course development current course design currently, the course taught in the authors’ social work program centers a power, privilege, and oppression framework. crt is the theoretical foundation and students are led through a process of critical thinking as outlined in ore (2009). the course’s dual focus is on 1) individual identity and self-awareness, and 2) an understanding of systemic and institutional oppression dynamics. in this course, faculty and students work to make connections between individual themes of socialization, policies, and practices that perpetuate oppression. students are asked to do assignments of personal reflection, selfidentification, and cultural values related to their individual backgrounds. scenarios based on current events allow students to make connections between their personal identities and the broader societal context. students are asked to critically examine the ferguson report (u.s. department of justice civil rights division, 2015) and recent supreme court decisions on the voting rights act through a crt lens to gain better understanding of the institutional and systemic racism that exists in present day. the challenge is that the time frame of the class does not allow for an in-depth look at crt and each of the tenets. additionally, the course covers other forms of oppression such as ableism, sexism, heterosexism, classism, and transphobia. given that the program is on the quarter system with classes meeting once a week for only 10 weeks, the course is only a cursory glance at these broader societal issues. while the class approaches conversations about oppression from a lens of critical thinking and self-awareness, much of the focus ends up being on white people learning about their own and society’s racism, which places students of color disproportionately in a role of witnessing their white classmates having epiphanies around race and racism at their expense. like many schools of social work, the authors are affiliated with a predominately white institution in which black and brown students make up a small percentage. in the social work program, a class may have one to three bipoc students enrolled. the power, hannah et al./abolishing whiteness 603 privilege, and oppression class is a mandatory class taken by all students within their first quarter of the program. this means that students from a wide range of backgrounds are in class with people they do not know as they tackle these issues of racial and social justice. while the students come from diverse backgrounds, we know that statistically bipoc students are more likely to have taken a vastly different path to higher education than their white peers. many are first generation, having overcome significant challenges within a very short lifetime, whether financial, educational, or social. these challenges are often ongoing into young adulthood. for some, attending a predominately white institution, being the only bipoc in one or all of their classes is a new experience (mccoy, 2014). they come to campus believing they are welcomed only to be faced with racial realities that they may or may not be prepared for – definitely not within a school of social work that is supposed to be the embodiment of social work values, fighting for social justice for all marginalized and oppressed groups. our observations as instructors and student are that bipoc students often look forward to classes that focus on issues of diversity; however, in a class that is majority white, conversations around race and racism can quickly become frustrating and disappointing (curtis-boles & bourg, 2010; hubain et al., 2016). they often become audience to the experiential approach of cws – white students becoming aware of their privilege or the need to be aware of their privilege, learning about microaggressions as something they should not do without a full explanation as to why, and exploring their white identity. while the bipoc student completes the same assignments and is present for class discussions, rarely are the assignments or lesson plans developed with the bipoc student in mind. unfortunately, bipoc students are often witness to or the target of insensitive comments that may or may not be based on a lack of knowledge or understanding. while most instructors have learned not to tokenize students and ask them to speak as representatives of their whole group, bipoc students are often faced with the dilemma over whether not they should correct, educate, or allow misconceptions to go unaddressed because the instructor may or may not address it (hubain et al., 2016; linder et al., 2015). if they choose to address it, the bipoc student must understand that their contributions are only seen as valuable when whiteness is not threatened. once whiteness is threatened the voices of bipoc students are no longer valuable, but rather labeled angry and uncooperative. when whiteness is the primary focus of the class, bipoc students in the classroom are not seen as student learners, but rather audience members in attendance at the service of whiteness (cabrera & corces-zimmerman, 2017). this is further complicated when readings, videos, and assignments highlight the negative stereotypes or challenges faced by the racial group to which the bipoc student belongs (curtis-boles & bourg, 2010). bipoc students may feel that their white peers presume the composite picture of the racial group reflects their lived experience placing them in a vulnerable position. they can either confirm that this reflects their lived experience, disclose how their life is different or remain silent, allowing their white peers to reach their own conclusion through the lens of whiteness. the concepts of whiteness and white supremacy may receive a cursory nod within social work education. whiteness walks into the classroom with white students and their biases and racist ideas, that may or may not be challenged by their professor. depending advances in social work, summer 2021, 21(2/3) 604 on their level of awareness, bipoc students may or may not recognize whiteness in action, thereby allowing the whiteness to continue and go unchallenged. the role of whiteness has been influential in the dominant narratives about people of color, immigrants and those experiencing poverty; however, the dominant curriculum around power, privilege and oppression still presumes that whiteness is something that is largely invisible. in discussing whiteness in this way, we are falling into a trap that jeyasingham (2012) critiques stating “if whiteness studies seeks only to uncover evidence of a whiteness that is already assumed to be both dominant and invisible, then it is poorly equipped to examine whiteness when it is experienced by socially disenfranchised communities or visible minorities” (p. 674). by presuming whiteness is invisible, we are silencing the voices of bipoc who see the patterns of endemic racism and have to maneuver and navigate life through whiteness daily. by not addressing whiteness head on and in depth, social work education plays into the white supremacy that has resulted in structural and systemic racism. if we are to prepare social workers for anti-racist practice, we must educate about both racism and whiteness. the fundamental question in teaching at a predominately white institution is: how do we teach white students about racism without centering whiteness? using crt and cws as theoretical frameworks we offer a course outline that decenters whiteness while also interrogating it broadly, so that all students can see the role that whiteness and white supremacy play in u.s. culture and throughout the world. the curriculum outline considers the identities of bipoc students, the intersectional identities of all students, and attends to their learning experience equitability. in doing so, we believe that students will be better prepared to dismantle dominant cultural norms through anti-racist practice upon graduation as professional social workers. course outline ideally, we recommend a team-teaching approach with one instructor who identifies as bipoc and the other instructor who identifies as white. if this is not possible, we encourage the inclusion of guest lecturers to cover the materials that may not reflect the identity of the instructor of record. the course outline below in table 1 presents summary descriptions of suggested modules and activities in a recommended order that can be adjusted to meet a quarter or a semester long class. additional resources, that are not listed in the above text, are listed to assist instructors in developing the course, lesson plans, and reading lists. these resources are by no means exhaustive. we encourage instructors to research the literature, specifically seeking out bipoc scholars who have addressed anti-racist practice in social work and related fields. advances in social work, summer 2021, 21(2) 605 table 1. course outline: modules, activities, and additional resources module description suggested activity(s) additional resources 1: the social construction of race & whiteness starting with these two foundational tenets of both crt & cws helps students to understand the endemic nature of racism. the social construction of race often centers on the construction of non-white races starting with slavery in the america. kendi (2016) provides a preamerican historical overview of anti-blackness, helping students to understand the skin-color based racial hierarchy that was in place before the colonization of america. concurrently, providing the evolution of whiteness in the u.s. as outlined above helps students to understand the fluidity of the race & the purpose it serves in maintaining white supremacy. providing students with historical fact prior to diving into the experiential approach at the onset of the course provides an undeniable legitimacy to the experiences that students will explore later in the quarter or semester. a critical self-reflection of the students education on race, exploring the messages they have received about race & whiteness up to the present point in time from influential informants such as their parents, extended family, school, peers, social media, & other sources helps the students to connect the social construction of race & whiteness to their reality. this assignment can be structured by the instructor to guide the student either chronologically or topically. it can be a written narrative, a worksheet, or a small group discussion. it is also recommended that students view race the power of illusion, episode two “the story we tell” (adelman, 2003) as a part of this module. degruy (2017); delgado & stefancic (2017) 2: white supremacy & whiteness this module explores the constructs of whiteness & white supremacy & the behaviors that uphold these constructs. it is important to help the students understand that white supremacy created racism which in turn created race & whiteness. defining what is meant by white supremacy & white supremacy culture is pivotal to this module. the focus is on interrogating whiteness, recognizing themes of actions & behaviors grounded in white supremacy to identify ways to dismantle these systems through action. the performative nature of whiteness is also explored to help all students, both white & bipoc, to identify patterns of behavior in social work practice as well as their internal values & norms of social interaction that that uphold whiteness & white supremacy. this allows students to begin developing new patterns of behavior that challenge the status quo. have students read jones & okun (2001) the characteristics of white supremacy culture & answer the discussion questions posted at the end. through this activity students will explore not only the broad categories of behavior attributed to white dominant culture, but more specifically how those behaviors manifest in their daily social interactions. encourage them to think about these behaviors in others as well as themselves possibly using their field agency site, a previous or current workplace, the university, or school of social work as an anchoring point. this allows students to explore this at both the macro & micro level. delgado & stefancic (2017); messer et al. (2018); middleton et al. (2016); zucchino (2020) 3: racial identity & intersectionality in this module students learn about the various racial identity models (see rockquemore et al., 2009) & how they impact a person’s worldview. the concepts of intersectionality (crenshaw, 1990) & positionality (harley et al., 2002) are introduced & discussed throughout the remainder of the course to emphasize the concept of anti-essentialism (delgado & stefancic, 2017). in discussing identities with students, it is important to differentiate between role identities & social identities (hogg et al., 1995). role identities are “the role positions in society which we occupy” (hogg et al., 1995, p. 256) such have students self-identify racially & critically assess where they are developmentally according to the appropriate racial identity model. next have the students create an eco-map that identifies their intersecting & overlapping social identities & reflect on how this impacts their racial identity. reflections can be written assignments, discussion boards, in small groups or dyads. this activity works well if students share with someone who shares their racial identity so they can discuss how their world views may differ. if that is not possible, then cross (1995); helms (1997); poston (1990), metzl (2019) advances in social work, summer 2021, 21(2/3) 606 module description suggested activity(s) additional resources as daughter, father, social worker, activist. social identities are those identities that describe a social category such as race, gender, religion, socioeconomic class that we feel an affinity to or feel we belong to. “social identities are not only descriptive and prescriptive; they are also evaluative. they furnish an evaluation (generally widely shared or consensual) of a social category, & thus of its members, relative to other relevant social categories” (hogg et al., 1995, p. 260). simply put, social identities are those group identities that society has ascribed meaning to (i.e., race, gender, sexual orientation, ability etc.). for the purposes of this course & this module the focus is on social identities. have the students pair with someone that they share an intersecting identity. 4: antioppressive/ anti-racist macro practice this module offers a perspective on macro social work practice that is rooted in approaches that interrogate & challenge white-centered interventions. students look to indigenous practices, bipoc community centered approaches & practices around mutual aid. students use crt to examine social policies & the ways leadership & management can uphold patterns of white supremacy. provide students with macro case studies looking at organizations known for embracing anti-racist practices to engage in macro, social change work. consider providing them with macro case studies of organizations that do not embrace anti-racist practices to compare & contrast. using these case studies have students identify organizational solutions that are anti-racist, collectivist, & community centered. spade (2020); dixon & piepznasamarasinha (2020) 5: antioppressive/ anti-racist micro practice clinical skills are the focus of this module. it is important for students to see culturally responsive, anti-racist, anti-oppressive practice as a skill. in this module students explore & develop clinical skills that reflect a recognition of the historical trauma & present-day impacts of race & racism on physical & mental health of bipoc clients. students will challenge clinical behaviors that center the individual as the primary root of life challenges & circumstances & offer a perspective that merges micro & macro factors perpetuating inequity & injustice, placing the individual & the interventions in a person-in-environment cultural context. using kendi’s (2019) operationalization of an anti-racist as a guide, students can explore the level to which their own practice is anti-racist. this can be done through a selfreflection or a likert scale self-administered survey. in addition, students in clinical internships can present case studies from their internships & have the class collectively or in small groups critically assess how best to respond with cultural humility & using an anti-racist approach. graham (2000); graham & schiele (2010); menakem (2017) 6: contemporary application this module should highlight the application of the concepts of crt & cws to contemporary events. these will of course depend on what is going on in society at the time. these will be primary opportunities to highlight concepts such as differential racialization & the fluidity of whiteness. in addition, students may be encouraged to bring current events into weekly conversations as deemed relative by the instructor. students can be assigned a current event & be asked to critically analyze them using crt or cws. depending on the context of the event the students could debate the topic using the tenets of the crt & cws. advances in social work, summer 2021, 21(2) 607 in addition to the suggested readings and activities, we encourage instructors to integrate contemporary events in course assignments and discussions. it is clear as we write this in early 2021, that the impact of the events of 2020 is both long term and unknown. at this time, we are dealing with continued disparities related to covid-19 morbidity and mortality, testing, vaccine distribution, and now, the delta variant. according to the washington post (2021) 19% of the 552 persons shot and killed by the police between january and august 2021 have been black (101 males, 4 females). although the 2020 election is over, the events of january 6, 2021 made clear that the issues of race, racism, and the political divide cannot be disentangled (blake, 2021). it is no doubt that there will be numerous opportunities for instructors and students to apply the constructs of the two theories in real time. discussion the most recent attack on critical race theory presents a unique challenge to the teaching of the curriculum content presented here (sawchuk, 2021). added to the challenge is the underutilization of critical whiteness studies in social work education. both theoretical frameworks have been misrepresented as divisive and accusatory when in actually they both provide a unique lens by which to understand the already existing divisive nature of systemic racism and white supremacy. in order to create a truly transformative learning experience for students, instructors of this content must be securely grounded in the theoretical constructs of both crt and cws. a team-teaching approach is recommended; however, we recognize that having two instructors, one bipoc and one white, to teach the course may not be feasible for many social work programs. while not ideal, a single instructor could augment their teaching by calling upon learned guest speakers and/or recorded lectures freely available online from experts in the constructs presented. as academics, we understand that while readings and lectures are important components of the transfer of learning, in graduate school it is often the critical dialogue that occurs within the classroom that is the key to transformation. teaching this content not only requires knowledge, but also strong facilitation skills to handle often difficult and taxing conversations. social work is a profession that claims to be rooted in social justice and anti-oppressive practice. the events of 2020 have forced the social work profession and social work education to re-examine its complicity with structural and institutional racism. the time has come for social work educators to acknowledge the endemic nature of racism and shift the focus of their diversity curriculum from a broader anti-oppressive umbrella to an intentional anti-racist framework that centers anti-bipoc racism. recent events affirm this need as we daily see reports of the atrocities that bipoc face, including murder, forced sterilization, inequitable sentencing and incarceration, and voter suppression. teaching this content through the lens of crt and cws creates a meaningful and effective foundation for msw graduates to move forward in anti-oppressive and anti-racist practices. course content that does not center whiteness or the needs of the white students at the expense of bipoc students is vital. in addition, instructors must be intentional not to center whiteness in a way that caters to white fragility and prevents white students from sitting in their discomfort with the racial reality of the world. many of these students are victims of miseducation that narrowly taught a favorable, whitewashed dominant narrative and have advances in social work, summer 2021, 21(2/3) 608 never heard the documented counternarratives, the voices of color, that challenge and correct these long-held misbeliefs that are only a part of the story. teaching these historical truths not only serve to reeducate the white students but also to validate the experience of the bipoc students who may also be victims of miseducation; however, for these students, this content fills in the gaps between their formal education and their lived experiences. by changing the narrative and the practices within social work education we not only begin to disrupt racism and white supremacy but dismantle it. through application in practice, research, and policy courses, the goal would be for students to develop a practice of challenging, and interrogating content through an anti-racist lens that they can carry into their professional practice after graduation. it would be important to assess the effectiveness of this course in both the short and the long term for all students, prioritizing the experience of the bipoc students. ideally, a short-term assessment would be multifaceted including but not limited to student feedback different from teaching evaluations at multiple points in time – during class, after class, prior to graduation and post-graduation. conclusion the events of 2020 magnified the deadliest disease threatening our country – racism. it is flowing through all of our systems – social, political, and economic. as evident by the events of january 6, 2021, it is the greatest threat to our democracy. as social workers, we are the uniquely positioned to effect lasting change as our field is versatile and we are strategically located, serving at all levels of society. as social work educators, we must reconcile our complicated history with race and racism and acknowledge that the time is now to attack this disease head on – unapologetically calling out white supremacy culture, decentering whiteness in our classrooms, and preparing all of our students for anti-racist practice. references abrams, l. s., & moio, j. a. 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(2020). wilmington's lie: the murderous coup of 1898 and the rise of white supremacy. atlantic monthly press. author note: address correspondence to michele hanna, graduate school of social work, u 2148 s high st, denver, co 80208. email: michele.hanna@du.edu https://supreme.justia.com/cases/federal/us/261/204/ https://www.justice.gov/sites/default/files/opa/press-releases/attachments/2015/03/04/ferguson_police_department_report.pdf https://www.justice.gov/sites/default/files/opa/press-releases/attachments/2015/03/04/ferguson_police_department_report.pdf https://data.census.gov/cedsci/table?q=race%20percentages&tid=acsdt1y2019.b02001&hidepreview=false https://data.census.gov/cedsci/table?q=race%20percentages&tid=acsdt1y2019.b02001&hidepreview=false https://www.uscis.gov/about-us/our-history/history-office-and-library/featured-stories-from-the-uscis-history-office-and-library/ins-records-for-1930s-mexican-repatriations https://www.uscis.gov/about-us/our-history/history-office-and-library/featured-stories-from-the-uscis-history-office-and-library/ins-records-for-1930s-mexican-repatriations https://www.uscis.gov/about-us/our-history/history-office-and-library/featured-stories-from-the-uscis-history-office-and-library/ins-records-for-1930s-mexican-repatriations https://www.govexec.com/management/2021/01/biden-order-rescinds-diversity-training-restrictions-requires-review-agency-equity/171519/ https://www.govexec.com/management/2021/01/biden-order-rescinds-diversity-training-restrictions-requires-review-agency-equity/171519/ https://www.washingtonpost.com/graphics/investigations/police-shootings-database/ https://employmentdiscrimination.foxrothschild.com/2020/11/articles/general-employment-discrimination/race-discrimination/colorados-crown-act-bans-natural-hair-discrimination/ https://employmentdiscrimination.foxrothschild.com/2020/11/articles/general-employment-discrimination/race-discrimination/colorados-crown-act-bans-natural-hair-discrimination/ https://employmentdiscrimination.foxrothschild.com/2020/11/articles/general-employment-discrimination/race-discrimination/colorados-crown-act-bans-natural-hair-discrimination/ https://doi.org/10.1093/bjsw/30.5.553 https://doi.org/10.1093/bjsw/bcw114 mailto:michele.hanna@du.edu ______ sandra m. leotti, msw, phd, assistant professor, division of social work, university of wyoming, laramie, wy. erin p. sugrue, phd, assistant professor, department of social work, augsburg university, minneapolis, mn. miriam itzkowitz, msw, licsw, director or trauma informed care, institute to transform child protection, mitchell hamline school of law, st. paul, mn. kelly williams, msw, swlc, provisional therapist, sentinel mental health, billings, mt. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 1-25, doi: 10.18060/26350 this work is licensed under a creative commons attribution 4.0 international license. child welfare and social work education: from a pedagogy of oppression to a pedagogy of resistance sandra m. leotti erin p. sugrue miriam itzkowitz kelly williams abstract: social work has long been involved in child welfare practice. though lauded as wellintended and admirable work, the profession’s involvement in the child welfare system is fraught with contradictions, ethical tensions, and a legacy of historical trauma and deep mistrust in black and native american communities. challenging this legacy requires an honest look at how schools of social work participate in policies and practices that work to uphold racialized surveillance and forcible family separation. accordingly, this paper invites readers into a critical conversation regarding social work’s collaboration with child welfare systems via title iv-e training programs. to these ends, we draw on the conceptual framework of abolition as a useful tool for interrogating and disrupting social work’s relationship to child welfare. keywords: social work education; title iv-e; child welfare; foster care; abolition; critical social work social work has long been involved in promoting child welfare practice. though lauded as well-intended and admirable work, the profession’s involvement in the child welfare system is fraught with contradictions, ethical tensions, and a legacy of historical trauma and deep mistrust in black, indigenous, and people of color (bipoc) communities (evans-campbell, 2008; roberts, 2020). legal scholars and others outside of social work have critiqued the child welfare system for claiming to “protect children,” while its policies and practices are aimed at monitoring, punishing, and regulating families (raz, 2020; roberts, 2009, 2020, 2022). lawyers and advocates working in parent representation have drawn connections between the criminal legal system and the child welfare system, both with their roots in white supremacy, heteropatriarchy, and the social control of black, brown and indigenous bodies (clifford & silver-greenberg, 2017; cloud, 2019). although criticisms of the child welfare system have been circulating in marginalized communities and among activists for decades, it is only recently that the voices of social work scholars have joined the chorus naming the child welfare system as a source of racialized surveillance and forcible family separation (blakely et al., 2020; detlaff et al., 2020; eaddy et al., 2021; jones & haynes, 2020). in this paper, we expand on the existing critiques of social work’s relationship to the child welfare system. more specifically, we focus attention on the role that social work education plays in sustaining and reproducing child welfare as a system of “family about:blank advances in social work, spring 2023, 23(1) 2 regulation” (roberts, 2020, para. 3) through participation in the federal title iv-e training program. accordingly, we invite readers into a critical conversation regarding social work’s collaboration with child welfare systems via title iv-e training programs. the arguments presented in this paper are inherently controversial and are likely to spark debates among scholars in the field. we believe this debate is urgent, necessary, and generative. we hope our commentary will lead to meaningful discussions about how we can re-envision supporting children and families in need. we begin with an overview of title iv-e of the social security act, the title iv-e training program, and its presence in schools of social work. using an intersectional analysis, we illustrate how child welfare is implicated in broader systems and processes of racialized surveillance and control, emphasizing the ethical disconnect in training students to uphold the very injustices that our code of ethics charges us to eliminate (see: abrams & detlaff, 2020; fortier & wong, 2019; kim, 2013; richie & martense, 2020; social service workers united-chicago, 2020). we argue, alongside others (cloud, 2019; dettlaff et al., 2020; fitzgerald, 2020; harvey & whitman, 2020; roberts, 2022; williams, 2020), that social work must challenge the necessity of the child welfare system and the underlying rationale for family surveillance and the forcible removal of children – including the generally unquestioned practice of training students to become practitioners within the child welfare system. to these ends, we draw on the conceptual framework of abolition (ben-moshe, 2020; davis, 2003; gilmore, 2014; kaba, 2021). the paradigm of abolition can be a useful tool for interrogating and disrupting social work’s relationship to child welfare. infusing abolitionist thinking into social work requires us to examine the ways in which our profession upholds and contributes to carceral capture – carceral capture, as we conceptualize it, includes institutions that work to perform the punishing functions of the state, with child welfare being one such institution. we contend that title iv-e training programs serve to extend the punishing arm of the state rather than challenge it. in this way, title iv-e training partnerships represent a serious violation to our code of ethics and should be eliminated. title iv-e of the social security act since 1980, the two primary sources of federal funding for child welfare have come from the title iv-b and iv-e provisions of the social security act. title iv-b provides support for prevention and reunification; it is designed to pay for in-home services, prevent out-of-home placement, and includes a training component (raz, 2020; stoltzfus, 2014; zlotnik, 2003). title iv-e is an entitlement program that provides federal reimbursement to states, territories, and tribes for foster care, adoption assistance, and kinship guardianship assistance and also includes funding for training related to these services (congressional research service, 2012). emerging from the passage of the adoption assistance and child welfare act of 1980, title iv-e was created as a response to decades of “foster care drift” (kawam, 2014, p. 23). the conditions of foster care drift – increased entry into the foster care system, extended amounts of time spent in foster care, and the low chances of adoption or family reunification – began in the late 1960s after mandatory reporting laws were passed in all 50 states (myers, 2008; raz, 2020). the obligation of mandated reporting, coupled with vague and widely cast definitions of child abuse (raz, 2020), led to a rapid leoti et al./child welfare & sw education 3 increase in reports of child maltreatment throughout the 1970s and 1980s (thomas, 2012). child welfare agencies lacked the necessary staffing to respond to the significant increase in reports, and subsequently, record numbers of children entered the foster care system, many of whom were never adopted and never returned home (kawam, 2014). the training provision of title iv-e, which provides funding for the training and education of current and future child welfare workers, was created to help manage the workforce crisis in child welfare that emerged in the mid-1970s (zlotnik, 2003). while maltreatment reports were exploding in numbers, concurrent slashes to state and local budgets created a situation where the needs of child welfare outpaced the service system’s capacity to respond (ausbrooks et al., 2014; thomas, 2012; zlotnik, 2003). in an effort to manage increased caseloads, many public child welfare agencies reduced their hiring requirements, eliminating educational prerequisites for workers (ellett, 2014). doing so allowed agencies to quickly fill needed positions and resulted in a subsequent “deprofessionalization” of child welfare (ausbrooks et al., 2014; benton & iglesias, 2018; falk, 2020). researchers argue that the process of de-professionalization led to increased turnover, incompetent workers, and negative outcomes for children and families (ausbrooks et al., 2014; falk, 2020). title iv-e training partnerships between state child welfare agencies and university social work programs emerged in the late 1980s as an approach to bolster and re-professionalize the child welfare workforce (ausbrooks et al., 2014; scannapieco et al., 2012; zlotnik, 2003). title iv-e currently serves as the primary source of federal funding to train the child welfare workforce (benton & iglesias, 2018; griffiths et al., 2018) and “its growing use has helped create new bonds between social work and child welfare” (zlotnik, 2003, p. 7). the overall purpose of title iv-e is to move children through the foster care system in an effort to support permanency (zlotnik, 2003). importantly, iv-e funding exceeds that allocated for iv-b family preservation efforts (raz, 2020). this may be in part due to the fact that title iv-e funding is directly linked to the number of children in out-of-home placements. critics argue that this funding formula creates a misaligned incentive for states to prioritize child removal and foster care placement over in-home services and family preservation (raz, 2020). in response to concerns related to incentivizing the foster care industry, the families first prevention services act was passed in 2018. families first legislation aims to prevent foster care by allowing states to use iv-e funds to pay for prevention services, such as substance use treatment, mental health treatment, and parenting programs (lindell et al., 2020; torres & mathur, 2018). families first also provides financial incentives for states to reduce the number of children currently in foster care (lindell et al., 2020; torres & mathur, 2018). as the families first act was only recently enacted, studies of the implementation of and outcomes related to the law have yet to be published at the time of this writing. rigorous research studies and program evaluation are needed to determine if the families first act has led to meaningful changes in how states engage in child removal versus family preservation services (lindell et al., 2020). advances in social work, spring 2023, 23(1) 4 implementation of title iv-e training programs with title iv-e funding, the federal government provides a 75 percent match to states for shortand long-term training, including the attainment of educational degrees (ellett, 2014; social work policy institute, 2012; thomas, 2012). though implemented in 1980, iv-e training funds only became widely used among social work educational programs starting in 1990 (strand & popescu, 2018; thomas, 2012). since then, child welfare and university partnerships have developed across the country to prepare social work students for work in public child welfare (scannapieco et al., 2012; zlotnik, 2003). the national title iv-e website housed at the university of houston collects information on iv-e training programs; however, schools are not required to participate in data collection efforts, making it difficult to ascertain exact data on title iv-e training programs across the nation. the most recent data compiled by the university of houston indicates that over 220 schools in 37 states are accessing title iv-e funds to educate bsw and msw students (cheung, 2021). title iv-e training funds are administered at the state level and implementation varies widely between states (zlotnik, 2003). funds can be used for a variety of educational purposes including: curriculum development, instructor salaries, employee leave costs and replacement staff, field instructors, educational materials, program evaluation, and direct financial assistance to students (zlotnik, 2003). typically, students who are direct recipients of iv-e funding are offered tuition remission and stipends in exchange for a commitment to work in public child welfare for a specified period of time after they graduate (cheung, 2021; social work policy institute, 2012). advocates of the program argue that it serves as an important incentive for encouraging social work students to pursue a career in child welfare and has “revitalized federal investment in social work education” (zlotnik, 2003, p. 9). outcomes of title iv-e training programs the explicit goals of title iv-e education and training funding include: stabilization of the child welfare workforce and the enhancement of the competencies and skills of said workforce (ausbrooks et al., 2014; piescher et al., 2018; zlotnik, 2003). the education and training component included in title iv-e demonstrates consistency with the long-held belief among social work leaders and child welfare professionals that a highly trained child welfare workforce was critical to ensure positive outcomes for child well-being (thomas, 2012). available evidence indicates that title iv-e child welfare/university partnerships have aided in re-professionalization of the child welfare workforce, improving both preparation for work in child welfare and retention in the field (e.g., benton & iglesias, 2018; falk, 2020; greeno et al., 2017; slater et al., 2018). however, research has not been able to link those outcomes (e.g., retention rates, education level, skill and knowledge attainment) to improved outcomes for children and families in terms of safety, permanence, and well-being (hartinger-saunders & lyons, 2013). furthermore, little research has been able to specifically examine the relationship between participation in title iv-e child welfare agency-university training programs and actual outcomes for children and families who are involved in the child welfare system leoti et al./child welfare & sw education 5 (barbee et al., 2012; ellett, 2014; falk, 2020; hartinger-saunders & lyons, 2013; scannapieco et al., 2012). comprehensive studies linking iv-e training to child and family outcomes are difficult to undertake for a variety of reasons, including: inconsistent program implementation across states and universities, iv-e organizational complexity, high worker turnover, and challenges defining and assessing client outcomes (ellett, 2014; falk, 2020; social work policy institute, 2012). although a small number of studies have found a link between child welfare workers with msw degrees and positive outcomes for children involved in the child welfare system, (see: albers et al., 1993; littell & tajima, 2000; ryan et al., 2006), studies that specifically look at the relationship between worker participation in title iv-e training programs and child and family outcomes are exceedingly rare. one such study, conducted by leung and willis (2012), compared workers who participated in the iv-e training program and workers who did not and assessed five client outcomes: reoccurrence of maltreatment, foster care reentry; foster care stability; length of time to achieve reunification; and length of time to achieve adoption. their results showed a mild relationship between iv-e workers and reduced time to achieve reunification as well as a strong relationship between worker iv-e status and reduced time to achieve adoption. additionally, they found no statistically significant relationship between worker involvement in the iv-e training program and reduction in the recurrence of child maltreatment, reduction in re-entry into foster care, or improved stability in foster care. despite a dearth of research directly examining title iv-e’s impact on child and family outcomes, there is extensive data on the general experiences of and outcomes for children and families involved in the child welfare system over the 30 years since title iv-e child welfare agency-university partnerships began. when we look at this data (which is the subject of the next section), a picture emerges of a system of family regulation deeply rooted in racism, classism, and misogyny (davies et al., 2007; dettlaff et al., 2020; roberts, 2009, 2020, 2022; zhang et al., 2022). while iv-e training programs may help with worker preparation and retention, the oppressive aspects of child welfare are not due to retention issues. furthermore, retention of workers has not been shown to alter the oppressive landscape of child welfare. therefore, the common argument in favor of the iv-e training program that is, a better trained workforce can help improve outcomes for marginalized children and families remains unfounded. to be clear, we are not suggesting a causal connection between iv-e training and negative outcomes for families, and we recognize that there are a range of factors beyond child welfare (e.g., neoliberal capitalism, welfare entrenchment, punitive family policy in the u.s.) that contribute to the problems faced by children and families. rather, our argument, which will be expounded on in the next section, highlights that despite decades of iv-e training, the child welfare system continues to function in a harmful manner. child welfare and the intersections of race, class, and gender in this section, we provide an intersectional analysis of the current state of child welfare. we begin with a discussion of how the oppressive forces of racism, classism, and misogyny each operate within the child welfare system. we then illustrate how those whose lives exist at the intersection of racial, class, and gender oppression are most harmed by advances in social work, spring 2023, 23(1) 6 this system, despite the assertion that these are the children and families who the system is professing to protect. racialized inequity racial disproportionality and racial disparity, terms that respectively refer to the over or under-representation of a racial group compared to its representation in the general population, and the unequal experiences or outcomes experienced by one racial group compared to another, have long been documented in the child welfare system. this is particularly so for black and native american families (child welfare information gateway, 2021). studies have consistently shown that black and native american families are more likely to be reported to child welfare for suspected maltreatment than white families (putnam-hornstein et al., 2013). once a report is received, those involving black and native american children are more likely to be referred for investigation than those involving white children (fluke et al., 2003; harris & hackett, 2008; hill, 2007). in addition, during investigation, reports of maltreatment against black and native children are more likely to be substantiated than those involving white children (dettlaff et al., 2011; font et al., 2012; hill, 2007; maguire-jack et al., 2020). after making a determination of child maltreatment, one of the most severe responses that a child welfare agency can take is to remove the child (or children) from their parent(s), caregiver(s), or legal guardian(s). racial disproportionality is particularly notable within the context of child removal and foster care. while the majority of children placed in foster care are white, children of color are vastly overrepresented compared to their representation in the general population. at the end of fy 2018, there were 435,052 children in foster care in the u.s. (puzzanchera & taylor, 2020). black children made up 25.2% of these children, despite composing only 15.1% of children ages 0-17 in the general u.s. population (puzzanchera & taylor, 2020). thus, black children were 1.66 times more likely to be in foster care compared to their numbers in the general population. native american children made up 2.6% of the u.s. foster care population and only 1.0 % of the general population of children ages 0-17 (puzzanchera & taylor, 2020). native american children were thus 2.67 times more likely to be in foster care compared to their numbers in the general population. when the national foster care data is disaggregated by state, there is a wide range in disproportionality rates for blacks and native children. at the high end, in california, the percent of black children in the foster care system is 3.34 times higher than their proportion in the general population. in minnesota, the percent of native american children in foster care is 15.76 times higher than their representation in the general population (puzzanchera & taylor, 2020). racial disproportionality and disparity in the child welfare system first gained national attention in the early 1970’s (billingsley & giovannoni, 1972; dettlaff et al., 2020). in the last 50 years, as racial disproportionality and disparity have continued to be documented and studied, child welfare researchers, practitioners, and policy makers have debated their causes. the main question has been whether these racial differences are the result of racial bias in the child welfare system or evidence of a higher risk of maltreatment among black and native american families due to their greater exposure to poverty and other child leoti et al./child welfare & sw education 7 maltreatment-related risks (drake et al., 2011; dettlaff et al., 2020; miller et al., 2012). however, this argument appears to be tautological as the higher exposure to maltreatment risks (what is often referred to as “disproportionate need”) among black and native american families is itself a result of centuries of racism and structural oppression (dettlaff et al., 2020). as dettlaff and colleagues (2020) explain, “these issues of disproportionate need are then compounded by oversurveillance and over-reporting of black families in the child welfare systems, which begins their involvement in a system that exacerbates these inequities through racial biases in decision-making that disproportionately impact black children” (p. 507). class bias recent research has demonstrated a clear relationship between income levels and child protection involvement (e.g., fong, 2019; zhang et al., 2022). in a study of cps reports in connecticut between 1997 and 2015, fong (2019) found that, compared to children in lowpoverty neighborhoods, the risk of cps involvement was twice as high for children living in moderate-poverty neighborhoods and three times as high for children living in highpoverty neighborhoods. using national data, zhang et al. (2022) found that lower income families had higher risks of cps involvement and child neglect, but not higher levels of physical or psychological abuse than those with higher incomes. it is also important to note that the relationship between poverty and child welfare involvement may not be solely due to the correlation of poverty and maltreatment risks, but rather to a bias against families with lower incomes. studies have shown that physicians are more willing to consider abuse as a cause of a child’s injury if the child comes from a low-income family than for children in higher income families (lane & dubowitz, 2007; laskey et al., 2012; wood et al., 2010). additionally, realities of daily life for families in poverty, such as multiple siblings sharing small bedrooms or lack of consistent heating or electricity, can be labeled as evidence of “neglect” by judges and child welfare professionals and used as justification for family separations (roberts & sangoi, 2018). regulating gender in addition to its racialized and classed nature, child welfare is also a highly gendered system. in many states, child protection cases are filed under the mothers’ names, regardless of whether or not the mother is the accused perpetrator (brown et al., 2009; risley-curtiss & heffernan, 2003). in fact, information on fathers is often limited or completely absent in child protection case records (brown et al., 2009; coady et al., 2013; risley-curtiss & heffernan, 2003). even when children have two parents who are present in their lives, child neglect investigations often focus solely on the mothers’ actions and responsibilities (coohey & zang, 2006). charges of “failure to protect” have been applied against mothers who are victims of domestic violence who could not successfully protect their children from the actions of the batterer. similar charges have been applied to mothers whose children have experienced sexual abuse at the hand of a relative or acquaintance (azzopardi et al., 2018; risley-curtiss & heffernan, 2003). advances in social work, spring 2023, 23(1) 8 feminist scholars have long argued that “child protection” is a misnomer used to disguise the primary functions of child welfare, which is the surveillance and scrutinization of mothering practices (e.g., davies et al., 2007; risley-curtiss & heffernan, 2003; roberts, 2022; swift, 1995). davies and colleagues (2007) argue, “couched in such phrases as ‘the well-being of children’, ‘support for families’, and ‘least intrusive measures’, the capacity of women as mothers drives child protection practice while remaining largely implicit and invisible” (p. 24). legal scholars go further to make the point that rather than the protection of children, the primary outcome of child welfare involvement is the punishment of mothers, primarily low-income mothers of color (appell, 1997; roberts, 2012, 2022). advocates draw comparisons between child welfare and the u.s. criminal legal system, particularly in the way both systems engage in the institutionalized disruption of the black family (clifford & silver-greenberg, 2017; roberts & sangoi, 2018). the criminal legal system disproportionately engages in the punishment, control, and removal of black men while the child welfare system punishes and controls black women via the removal of their children (alexander, 2020; roberts, 2009, 2012). in this way both systems are used to enforce raced, classed, and gendered power structures (roberts, 2022). intersectional injustice the evidence presented in the preceding paragraphs clearly illustrates that the oppression and discrimination perpetrated by the child welfare system is intersectional (crenshaw, 1989). given the intersections of race, gender, and class oppression that operates at the core of child welfare, it is not surprising that many of the processes within the system deny families their expected civil rights and protections (appell, 2004; newport, 2022; pattison, 2016; roberts, 2003). child welfare cases are considered civil cases, not criminal, and thus they are not necessarily subject to the same standards and protections as those provided in criminal courts (child welfare information gateway, 2022). for example, in child protection investigations, parents who are investigated for suspected child maltreatment are not read miranda rights, despite the fact that anything they say to the investigating social worker can be used against them in civil court and could result in serious consequences to them and their families, including the loss of their children (easton et al., 2014; newport, 2022; texas public policy foundation, 2020). depending on the state, parents may not have the right to an attorney in initial or subsequent hearings, or their right to the provision of an attorney may be based on legal standards that are differentially enforced (duffy, 1982; sankaran & pollock, 2016). for example, in minnesota, the statute that governs whether a parent who cannot afford counsel receives court-appointed counsel reads “the court shall appoint counsel to represent the parent, guardian, or custodian in any case in which it feels that such an appointment is appropriate [emphasis added]” (minnesota courts, 2018, p. 2). states may also remove children from their parents with scant evidence of harm. local child welfare agencies typically draft a petition of allegations of abuse or neglect for court consideration. this petition, which is presented and reviewed at an initial hearing often referred to as a preliminary protective, emergency protective, emergency removal, or shelter hearing constitutes the only evidence that must be presented at the hearing and establishes whether or not a child welfare case will proceed (child welfare information leoti et al./child welfare & sw education 9 gateway, 2022). at this point, judges consider whether the petition establishes a prima facie showing that abuse or neglect has occurred. prima facie, or “on its face” implies that judges proceed based solely on the content of the petition, with no additional testimony or information, and under the assumption that the facts contained in the petition are true and accurate. judges then consider whether the facts in the petition meet the grounds for deciding that a child is in need of protection. each state has their own statute regarding these emergency protective care hearings, but the process and requirements are generally consistent across states (minnesota courts, 2018). the standard of proof necessary for a termination of parental rights is that of “clear and convincing evidence” (santosky v. kramer, 455 u.s. 745), which is less stringent than the “beyond a reasonable doubt” standard necessary for criminal conviction. finally, if families are separated, there are no firm, clear standards for reunification to which child welfare agencies are beholden. (child welfare information gateway, 2016c; gupta-kagan, 2010; kaiser, 2009). the federal title iv-e program requires state child welfare agencies to provide “reasonable efforts” (“active efforts” if the child qualifies for indian child welfare act [icwa) provisions] both to avoid removing children from their homes and, if they are removed, to reunify them with their parent (indian child welfare act, 1978; u.s. congress, 1980). the legal definition of “reasonable efforts” is broad yet relatively standard (child welfare information gateway, 2019). in practice, however, what constitutes reasonable efforts varies widely and can range from simply providing contact information to local community-serving organizations to highly detailed case plans (kaiser, 2009). families are required to adhere to their case plan, which becomes a legal document entered into court proceedings, but simply completing the written steps of a case plan may not be considered sufficient for reunification (gupta-kagan, 2010; roberts, 2022). unlike in other civil and criminal court hearings, once a child is removed from their parents, judges can make decisions about their permanency plans based solely on the opinions of government attorneys and social workers, without requiring actual evidence, and without allowing the parents to appeal the judge’s decision (gupta-kagan, 2010). gupta-kagan (2010) refers to this unique situation in child protection cases as a “due process donut hole” (p. 14) and argues that this type of judicial decision-making occurs because of a lack of meaningful due process procedures in current federal law regarding permanency planning and reasonable efforts. any evidence that child welfare involvement “protects” children from harm or promotes their well-being is scant – particularly when we consider the most draconian intervention of removing children from their parents (dettlaff et al., 2020; sugrue, 2019). for children who have experienced some form of maltreatment, out-of-home placement has been shown to provide little to no measurable benefit in terms of cognitive or language development, academic achievement, mental or behavioral health, or suididality (maclean et al., 2016). in fact, rather than protecting children, out-of-home placement is itself a source of harm (author, 2019; dettlaff et al., 2020). research has consistently shown that involuntary separation of children from their parents results in lifelong trauma (dettlaff et al., 2020). children involved in the child welfare system who have been placed in foster care have been shown to be at increased risk of juvenile and criminal justice involvement advances in social work, spring 2023, 23(1) 10 (doyle, 2007, 2008, 2013; yoon et al., 2018), mental health problems (baldwin et al., 2019; cote et al., 2018), and early mortality (gao et al., 2017). as we have illustrated, the child welfare system does not achieve its “well-intended” goals of ensuring child and family well-being. proponents of the iv-e training program assert that professional social workers can promote better outcomes for children and families. given social work’s own history in upholding gendered, classed, and racialized injustice, we should be wary of assuming the positive impact of good intentions (abrams & detlaff, 2020). despite the reality that child welfare intervention often does more harm than good, many schools of social work continue to rely on federal funding through title iv-e that supports and incentivizes the foster care industry (raz, 2020). furthermore, the rationale for title iv-e partnerships explicitly pivots on expanding the child welfare workforce (ausbrooks et al., 2014; zlotnik, 2003), thus bolstering the reach of a punitive system of control. this serves as a distinct violation to our code of ethics and erodes the connection between social work and social justice. as such, we believe the practice should be discontinued. to be clear, our argument is not about weaknesses with the training program itself. it is about what we see as a fundamental problem with training students to work in a system that we believe should no longer exist. we acknowledge the contested nature of our position and by the end of this paper, we will show that, while controversial, there are ways for social workers to address child harm and need without relying on state intervention. in addition to upholding a system of injustice, we are also concerned with the reality that many schools and states utilize iv-e funding (via the training program) to provide economic support to marginalized students. we recognize that providing students with support to pursue their education is of the utmost importance. however, we do not believe that coercing students, through financial incentives, into a relationship of complicity with state control is the answer to the economic precarity faced by many of our students. schools of social work, and the profession at large, have a responsibility to find ways to support students and to make social work education affordable and accessible without relying on funding that requires students to reinforce rather than disrupt the workings of the family oversight system. we suggest that the politics and praxis of abolition has much to offer social work education in its quest to promote child and family well-being. abolition, title iv-e, and social work education abolitionist frameworks bring forth an understanding of punishment and control as embodied in both physical spaces and institutional logics (meiners, 2016; o’brien et al., 2020). in this sense, sources of surveillance and control are understood to be located not only in the criminal legal system but are also infused into the doctrine of other institutions that dictate norms for behavior and institute practices that serve to enforce and regulate conduct. as we see it, child welfare is a primary and pervasive institution of surveillance and regulation that sits beyond, but often intersects with, the criminal legal system (fong, 2020; jacobs et al., 2021; schenwar & law, 2020). here we add to the cacophony of voices that name the child welfare system for what it is: an entrenched system aimed at the regulation of families (cloud, 2019; roberts, 2020; williams, 2020). further, we leoti et al./child welfare & sw education 11 conceptualize the child welfare system as an “integral part of the u.s. carceral regime” (roberts, 2020, para. 7) and a key manifestation and driver of white supremacy (bergen & abji, 2020; cloud, 2019; roberts, 2020). in other words, child welfare is a punitive system of capture rooted in white supremacy, heteropatriarchy, and neoliberal capitalism. an abolitionist framing requires us to move beyond instituting reforms and to critically analyze the underlying logic and rationalities that shape the child welfare system. meaningful change will not occur through diversifying the workforce, tweaking policy, or through providing bias awareness education to workers. indeed, after decades of reforms to the child welfare system including a systematic push to professionalize the workforce, little change has occurred (harvey & whitman, 2020; roberts, 2020). substantive change will only occur through processes and practices that question and “up-end” the underlying logic and rationale driving the existence of the system in the first place (detlaff et al., 2020). as we see it, a first step in up-ending child welfare is to refuse to supply it with the labor that it needs to function. many may assert that compared to other professions, (e.g., medical, criminal legal, and generic behavioral health professionals), social workers are better-positioned to improve the deep-seated issues embedded in the system of family regulation (briar-lawson et al., 2016; clark & yegidis, 2016; leung & willis, 2012). however, such arguments forsake social work’s own history in upholding gendered, classed, and racialized injustice (abrams & detlaff, 2020; jacobs et al., 2021; murray et al., 2023). arguments in favor of social work’s alignment with child welfare also cast aside data that show continued disparities throughout the child welfare system despite social work’s presence. we hold that social workers should absolutely be a part of meeting the urgent needs of children and families; however, history clearly shows that child welfare involvement is not the avenue through which need is met (roberts, 2022). an abolitionist framework helps us consider how social workers can work to co-create safety and wellbeing with families rather than working as representatives of the state. reformist reform vs. non-reformist reform scholars of abolition distinguish between “reformist reforms” and “non-reformist reforms” (ben-moshe, 2020; gilmore, 2014; kaba & duda, 2017). reformist reforms absorb critique through accommodation; they make changes within an existing framework without fundamentally altering (or questioning) the status quo (ben-moshe, 2020). nonreformist reforms, on the other hand, work to meet the pressing needs of the most marginalized but are “carried out with the broader goal of abolition” (hereth & bouris, 2020, p. 362). for example, fighting for substance use and mental health treatment for parents in need are supported by abolitionists and considered necessary non-reformist reforms. in contrast, other popular initiatives such as the use of drug courts are considered reformist in that they strengthen and expand, rather than displace, the reach of surveillance and control (ben-moshe, 2020; gilmore, 2018). similarly, foster care was a reformist reform that replaced orphanages and almshouses by placing children in the homes of distant strangers without addressing their family’s needs (roberts, 2022). we argue that title iv-e training is firmly entrenched in a reformist logic. iv-e training programs track the path of reform that social work has historically taken: to make advances in social work, spring 2023, 23(1) 12 conditions better for some people without fundamentally disrupting the status quo. the predictable result? more of the same. as dorothy roberts (2022) states, “reforming family policing results in more family policing” (p. 284). questioning the efficacy of the child welfare system, which served as the impetus for iv-e funding, and making tweaks in relation to the system’s downfalls (e.g., education and training initiatives) is different than questioning the underlying logic of the child welfare system, or the rationale for its existence. indeed, the iv-e training program relies on the logic embedded in the child welfare system that sees state intervention as a necessary and reasonable way to ensure the safety and well-being of children. thus, through the establishment of iv-e collaborations, schools of social work reinforce the legitimacy of state intrusion into the lives of children and families. abolitionist thinking involves both a strong social critique and an ability to imagine resistance and creation (ben-moshe, 2020; davis, 2003; kaba & duda, 2017; schenwar & law, 2020). critique is necessary in order to understand and deconstruct the current social, political, and economic conditions that contribute to the legitimation of systems of surveillance and control. abolition simultaneously requires an ability to envision responses that lie outside of the current systems and institutions. ben-moshe (2020) contends that abolitionist frameworks “imagine a different horizon and are not limited by a discussion of what is possible at present” (p. 16). in relation to child welfare, abolitionist thinking requires a critique of child maltreatment that centers an analysis of structural inequities rather than individual parental failings. further, it requires generating a social landscape in which children and families can thrive and imagining non-punitive, non-regulatory responses to the struggles they face. it means deconstructing colonial ideas of what “good parenting” and “protection” entails. it also means prioritizing the well-being of children and families over professionalizing the child welfare workforce (and using this as a trigger to legitimize social work), and ensuring families have the resources they need to keep their children safely in their homes without state intrusion. dis/epistemology of abolition ben-moshe (2020) offers a reading of abolition that we find particularly generative for social work education. she describes abolition as an “epistemology and an ethical position” (p. 111) about “knowing and unknowing” (p. 125). the epistemology of knowing generates a broad critique of history and the social conditions that frame certain bodies and subject positions as disposable. such critique includes an analysis of the neoliberal political economy that prioritizes “institutionalized budgets” over direct assistance/payments to families (ben-moshe, 2020). for instance, one of the biggest federal entitlement programs for children is the foster care system (cloud, 2019). what this means in practice is that rather than financial assistance and supportive services being provided directly to parents and families in need, resources are funneled toward punitive responses, including intrusive surveillance and the forcible removal of children from their families (cloud, 2019). an epistemology of knowing allows us to untangle the knot between child maltreatment (its unclear definitions and its relationship to poverty), the construction of “idealized” parenting (rooted histories of white supremacy and settler colonialism), and child welfare interventions. leoti et al./child welfare & sw education 13 the epistemology of unknowing (dis-epistemology) “invites us to abandon our attachment to knowing and especially to knowing all” (ben-moshe, 2020, p. 127) in order to generate new possibilities. ben-moshe (2020) describe three ways in which abolition can be understood as dis-epistemology: it is about letting go of certainty, professional expertise, and specific demands for what comes next. from this analytic viewpoint, we are encouraged to see not knowing and “disorientation as generative” rather than inhibitive because it is from this place of not knowing that we can begin to prefigure the world (benmoshe, 2020, p. 127). indeed, it is from this place that activists and abolitionists across the nation have begun to advocate for radical change in our country’s approach to child welfare, working to replace the current system with community-based responses to harm and need (roberts, 2022). application of an abolitionist framework to the child protection system is not a denial that there are children who experience serious harm and abuse at the hands of their caregivers. rather an abolitionist approach rejects simplistic narratives of safety and protection and refuses to accept that the well-being of children must come at the expense of social justice. when asked about how they would respond to those who argue that police abolition is harmful because police are needed to protect the public and prevent crime, the sociologist and police abolitionist, alex vitale, stated, “the police are not providing the kind of safety that we think that they are providing – not because of bad intentions; not because they don’t want to protect people. it is the wrong tool. the damage has already been done by the time they show up” (demby et al., 2022, 27:35). the same thing can be said of the child protection system. it is the wrong tool, and we have an ethical responsibility to imagine new ones. toward a pedagogy of resistance in this paper we have argued that child welfare is a system of family regulation (roberts, 2020) that implements punitive measures to manage and surveil the families caught in its sphere of influence. as such, title iv-e child welfare training partnerships are in direct contradiction to the profession’s guiding principle of social justice. reflecting on this ethical disjuncture, we have advanced an abolitionist analysis of iv-e and social work education. we are deeply troubled by the ways in which we, as social work educators, are implicated in the ongoing harm perpetuated by child welfare. so too, we worry for the well-being of our students. moral transgressions in child welfare work are virtually unavoidable and moral injury among workers is the inevitable outcome (haight et al., 2017). moral injury is a lasting psychological, spiritual, and existential wound that occurs when individuals perpetrate or witness actions that violate their moral beliefs and expectations (litz et al., 2009). research has shown that child welfare workers experience moral injury by virtue of their complicity with a system that is entrusted with helping families and instead causes them harm (haight et al., 2017). child welfare workers in haight et al.’s (2017) study questioned their own identities as moral and ethical professionals while working in a problematic system “steeped in human misery” (haight et al., 2017, p. 37). more crushingly, the participants advances in social work, spring 2023, 23(1) 14 in the study expressed that their participation in the child welfare system led them to doubt whether the world itself can be a good and moral place. as social work educators, we need to scrutinize the ethics of training our students to work in this type of environment, both for the harm it does to families and the harm it causes to social workers. the well-being and ethical integrity of students are compromised when they are relegated to work that actively enacts rather than resists harm. as rossiter (2005) states, “social workers as people suffer when the results of practice seem so meager in comparison to the ideals inherent in social work education, in agency expectations, and in implicit norms which define ‘professional’” (rossiter, 2005, para. 4). we can do better. rather than teaching our students to function within well-oiled machines of oppression, let us infuse the epistemology and ethics of abolition into our curriculum. this means teaching our students to question the actual functions of “common sense” systems like child welfare (among so many others) and sensitizing them to the immediate and long-term consequences of child welfare involvement for families. it means critiquing dominant practices such as mandated reporting and instead teaching frameworks of “mandated supporting” which offer approaches to ensuring child well-being by providing families with needed resources and support, rather than relying on state intervention (harrell & wahab, 2022; raz, 2020; social workers against mandates, 2021). it means helping them interrogate the foundation and logics of white supremacy, heteropatriarchy, and neoliberal capitalism which lie at the heart of much of child welfare (and social work) practice. it means teaching them to locate the cause of child and family distress in structural inequity rather than individual parental pathology. it means allowing students to embrace value systems and ways of thinking beyond those embedded in the neoliberal standards and agendas of our professional organizations (brady et al., 2019) and thereby emphasizing practices of movement building and resistance as legitimate forms of professional practice. a pedagogy rooted in abolition means giving our students the creative space to prefigure the world in an unforeseen direction. a common refrain against abolition (prison, institutionalization, child welfare) is “what’s the alternative? if not this, then what?” in simple terms, the alternative to family policing is the creation of a just and caring society in which the needs of families are prioritized and provided for without the threat of surveillance and separation. although this type of societal reshaping may seem like a fantasy, the early months of the covid-19 pandemic presented a tangible example of what this type of radical restructuring could look like (arons, 2022; roberts, 2022). during the early months of the covid-19 pandemic, much of the u.s. experienced what arons (2022) refers to as “an unintended abolition” of the child protection system. when the u.s. went into lockdown in march 2020, the country’s child protection systems did as well. while traditional forms of social services and government regulation were shut down in the early days of the pandemic, alternative forms of community support and mutual aid flourished. by the end of july 2020, there were 60 mutual aid networks operating in new york city alone, providing services such as grocery deliveries, childcare, and support groups (arons, 2022). these groups removed traditional bureaucratic intake procedures and eligibility requirements typically required by government and private charity organizations and made racial justice and collective care their founding principles (arons, 2022). leoti et al./child welfare & sw education 15 in addition to local mutual aid, the federal government also increased direct support to families without the ties of surveillance and control during the early months of the pandemic. in april 2020, congress passed the cares act, which included a one-time payment of $1,200 for adults earning less than $75,000 a year, $500 for each child under the age of 17 in the household, and $600 per week in extra unemployment benefits through the end of july 2020” (roberts, 2022). this was the largest federal direct aid to families in u.s. history and the money was distributed without any of the investigation, surveillance, and regulation required of the “supports” provided through child protection systems (roberts, 2022). data from new york city showed that, during the city-wide lockdown, child fatalities and reports of child abuse and neglect dropped significantly and once the city reopened in fall 2020, there was no surge in reports in child neglect or abuse nor an increase in the rate of abuse or neglect determinations (arons, 2022). arons (2022) concludes that, “though unintentional, this brief experiment shows that the outsized and reactionary family regulation system . . . is not necessary to protect children. . . abolition need not be a fantasy; new york city already made it, for a moment, a reality” (p. 5). lessons from the pandemic give us hope for “what next” could be, but the political, economic, and social reality of creating and sustaining this type of transformation longterm will be complicated and difficult work. yet as meiners (2016) reminds us “resolution is not a prerequisite for critique” (p. 192). we should not let fear of the uncertainty and complexity inherent in abolition work keep us stuck in the ongoing practice of supporting incremental, ineffective “reformist reforms.” rather than insist on certainty in our pursuit of justice and abolition, meiners (2016) encourages us to invoke the not this. “not this reorients the terrain and forces other imaginative possibilities. not this, as a tool of the marginal, firmly interrupts business as usual” (meiners, 2016, p. 192). following meiners (2016), we draw on the ethics of resistance embodied in abolition to say not this: not this to iv-e training partnerships in schools of social work; 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(2020). introduction to special topic on anticarceral feminisms: imagining a world without prisons. affilia, 35(1), 5-11. https://doi.org/10.1177/0886109919897981 pattison, b. (2016). when children object: amplifying an older child's objection to termination of parental rights. university of michigan journal of law reform, 49(3), 689-716. https://doi.org/10.36646/mjlr.49.3.when piescher, k. n., laliberte, t., & lee, m. (2018). the role of title iv-e education and training in child protection workforce diversification. journal of public child welfare, 12(3), 333-353. https://doi.org/10.1080/15548732.2018.1447529 putnam-hornstein, e., needell, b., king, b., & johnson-motoyama, m. (2013). racial and ethnic disparities: a population-based examination of risk factors for involvement with child protective services. child abuse & neglect, 37(1), 33-46. https://doi.org/10.1016/j.chiabu.2012.08.005 puzzanchera, c., & taylor, m. 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(2009). shattered bonds: the color of child welfare. civitas books. roberts, d. (2012). prison, foster care, and the systemic punishment of black mothers. ucla law review, 59(6), 1474-1500. https://www.uclalawreview.org/prison-foster-care-and-the-systemic-punishment-ofblack-mothers-2/ roberts, d. (2020, june 16). abolishing policing also means abolishing family regulation. the imprint: youth & family news. https://imprintnews.org/childwelfare-2/abolishing-policing-also-means-abolishing-family-regulation/44480 roberts, d. (2022). torn apart: how the child welfare system destroys black families and how abolition can build a safer world. basic books. roberts, d., & sangoi, l. (2018, march 26). black families matter: how the child welfare system punishes poor families of color. the appeal. https://doi.org/10.1177/0886109919897981 https://doi.org/10.36646/mjlr.49.3.when https://doi.org/10.1080/15548732.2018.1447529 https://doi-org.libproxy.uwyo.edu/10.1016/j.chiabu.2012.08.005 http://ncjj.org/afcars/disproportionality_dashboard.aspx https://doi.org/10.5149/northcarolina/9781469661216.001.0001 https://doi.org/10.1177/0886109919897576 https://doi.org/10.1177/0886109903257629 https://scholarship.law.upenn.edu/cgi/viewcontent.cgi?article=1584&context=faculty_scholarship https://scholarship.law.upenn.edu/cgi/viewcontent.cgi?article=1584&context=faculty_scholarship https://www.uclalawreview.org/prison-foster-care-and-the-systemic-punishment-of-black-mothers-2/ https://www.uclalawreview.org/prison-foster-care-and-the-systemic-punishment-of-black-mothers-2/ https://imprintnews.org/child-welfare-2/abolishing-policing-also-means-abolishing-family-regulation/44480 https://imprintnews.org/child-welfare-2/abolishing-policing-also-means-abolishing-family-regulation/44480 advances in social work, spring 2023, 23(1) 24 https://theappeal.org/black-families-matter-how-the-child-welfare-system-punishespoor-families-of-color-33ad20e2882e/ rossiter, a. 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(2012). professionalization in public child welfare: historical context and workplace outcomes for social workers and non-social workers. children and youth services review, 34(11), 2170-2178. https://doi.org/10.1016/j.childyouth.2012.07.016 schenwar, m., & law, v. (2020). prison by any other name: the harmful consequences of popular reforms. new press. slater, g., o’neill, m., mcguire, l. e., & dickerson, e. (2018). iv-e or not iv-e, that is the question: comparisons of bsw child welfare scholars and matched trainee confidence and retention. journal of public child welfare, 12(3), 300-316. https://doi.org/10.1080/15548732.2018.1444531 social service workers united-chicago. (2020, july 13). the nasw is failing us. either it changes, or we will change it ourselves. https://socialserviceworkersunited.medium.com/the-nasw-is-failing-us-either-itchanges-or-we-will-change-it-ourselves-b1da4c8a0096 social work policy institute. (2012). educating social workers for child welfare practice: the status of using title iv-e funding to support bsw & msw education. https://www.socialworkers.org/linkclick.aspx?fileticket=1m8ktutr9sq%3d&portal id=0 social workers against mandates. (2021). mandated supporting. https://static1.squarespace.com/static/5c8ad6374d546e4cda43d02e/t/61bba98df456a4 6da4ca4035/1639688591387/mandated+supporting+module+2021.pdf stoltzfus, e. (2014). child welfare: an overview of federal programs and their current funding. congressional research service, 7-5700. https://hdl.handle.net/1813/78279 strand, v. c., & popescu, m. (2018). an effective pedagogy for child welfare education. journal of public child welfare, 12(3), 398-410. https://doi.org/10.1080/15548732.2018.1447530 https://theappeal.org/black-families-matter-how-the-child-welfare-system-punishes-poor-families-of-color-33ad20e2882e/ https://theappeal.org/black-families-matter-how-the-child-welfare-system-punishes-poor-families-of-color-33ad20e2882e/ https://doi.org/10.22329/csw.v6i1.5654 https://doi.org/10.1016/j.childyouth.2005.10.013 http://civilrighttocounsel.org/uploaded_files/219/table_of_parents__rtc_in_dependency_and_tpr_cases_final.pdf http://civilrighttocounsel.org/uploaded_files/219/table_of_parents__rtc_in_dependency_and_tpr_cases_final.pdf https://doi.org/10.1016/j.childyouth.2012.07.016 https://doi.org/10.1080/15548732.2018.1444531 https://socialserviceworkersunited.medium.com/the-nasw-is-failing-us-either-it-changes-or-we-will-change-it-ourselves-b1da4c8a0096 https://socialserviceworkersunited.medium.com/the-nasw-is-failing-us-either-it-changes-or-we-will-change-it-ourselves-b1da4c8a0096 https://www.socialworkers.org/linkclick.aspx?fileticket=1m8ktutr9sq%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=1m8ktutr9sq%3d&portalid=0 https://static1.squarespace.com/static/5c8ad6374d546e4cda43d02e/t/61bba98df456a46da4ca4035/1639688591387/mandated+supporting+module+2021.pdf https://static1.squarespace.com/static/5c8ad6374d546e4cda43d02e/t/61bba98df456a46da4ca4035/1639688591387/mandated+supporting+module+2021.pdf https://hdl.handle.net/1813/78279 https://doi.org/10.1080/15548732.2018.1447530 leoti et al./child welfare & sw education 25 sugrue, e. 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(2018, march 8). fact sheet: family first prevention services act. first focus campaign for children. https://campaignforchildren.org/resources/fact-sheet/fact-sheet-family-firstprevention-services-act/ u.s. congress. (1980). h.r.3434 adoption assistance and child welfare act of 1980. https://www.congress.gov/bill/96th-congress/housebill/3434 williams, e. (2020, july 28). ‘family regulation,’ not ‘child welfare’: abolition starts with changing our language. the imprint: youth and family news. https://imprintnews.org/opinion/family-regulation-not-child-welfare-abolition-startschanging-language/45586 wood, j. n., hall, m., schilling, s., keren, r., mitra, n., & rubin, d. m. (2010). disparities in the evaluation and diagnosis of abuse among infants with traumatic brain injury. pediatrics, 126(3), 408-414. https://doi.org/10.1542/peds.2010-0031 yoon, m., bender, a. e., & park, j. (2018). the association between out-of-home placement and offending behavior among maltreated youth: a systemic review. children and youth services review, 95, 263-281. https://doi.org/10.1016/j.childyouth.2018.11.006 zhang, l., nepomnyaschy, l., & simmel, c. (2022). so close yet so different: neighborhood inequality and child maltreatment. child abuse & neglect, 130(4). https://doi.org/10.1016/j.chiabu.2021.104988 zlotnik, j. l. (2003). the use of title iv-e training funds for social work education: an historical perspective. journal of human behavior in the social environment, 7(1-2), 5-20. https://doi.org/10.1300/j137v07n01_02 author note: address correspondence to sandra leotti, division of social work, university of wyoming, 1000 e. university ave., laramie, wy 82071. email: sleotti@uwyo.edu https://doi.org/10.1086/701838 https://doi.org/10.3138/9781442676978 https://www.texaspolicy.com/press/tppf-miranda-style-notification-needed-in-child-welfare-investigations https://www.texaspolicy.com/press/tppf-miranda-style-notification-needed-in-child-welfare-investigations https://doi.org/10.1080/15548732.2012.709351 https://campaignforchildren.org/resources/fact-sheet/fact-sheet-family-first-prevention-services-act/ https://campaignforchildren.org/resources/fact-sheet/fact-sheet-family-first-prevention-services-act/ https://www.congress.gov/bill/96th-congress/housebill/3434 https://imprintnews.org/opinion/family-regulation-not-child-welfare-abolition-starts-changing-language/45586 https://imprintnews.org/opinion/family-regulation-not-child-welfare-abolition-starts-changing-language/45586 https://doi.org/10.1542/peds.2010-0031 https://doi.org/10.1016/j.childyouth.2018.11.006 https://doi.org/10.1016/j.chiabu.2021.104988 https://doi.org/10.1300/j137v07n01_02 mailto:sjo0034@illinois.edu _________ carol hostetter, lcsw, phd., editor and professor emerita, school of social work, indiana university, bloomington, in. valerie decker, msw, assistant editor, school of social work, indiana university, indianapolis, in. copyright © 2024 authors, vol. 25 no. 1 (spring 2025), i-iv, doi: 10.18060/29190 this work is licensed under a creative commons attribution 4.0 international license. spring 2025 editorial: navigating the academy, educational processes, and practice innovations carol hostetter valerie decker in the spring 2025 issue of advances in social work, we begin with a critical view of standard research practices in the academy. then we investigate racism, well-being, pedagogy, culture wars, executive coaching, and eco-friendly conferences in social work education. in our section on social work practice, 10 articles address aiding people from a wide range of backgrounds. authors write about issues for people who are elderly, transgender, incarcerated, marginalized, traumatized, struggling with recovery, considering self-harm, or needing child protection support. social workers ourselves are the focus of three articles, whether experiencing compassion fatigue, experiencing inequities in clinical supervision, or experiencing challenges in interprofessional teams. understanding ways to support the profession is valuable as the profession grows and develops. biases in research lauve-moon, devlin, lewright, lee, abbott, elizondo, and bacon raise concerns about the extent to which mainstream social work research investigates the lived experiences of lgbtq+ people and the systems that oppress them. through a content analysis of major journals, they reveal the alarming paucity of research on the lived experiences of lgbtq+ people. along the same vein, carlson, wright, bagwell-gray, mendenhall, diaz, mccall, williams, akin, and banda share what members of several research teams experienced while engaging in a research team practice that was intentionally anti-racist. the authors call for a critical understanding of the role of academia in oppressive systems so that social work research can disrupt racist systems in academia. the article by ogbonnaya, lechuga-peña, jiwatram-negrón, mitchell, crudup, ignacio, billiot, and mendoza provides evidence about the ways race and racism lead to undervaluing bipoc scholarship, and how bipoc scholars with intersecting identities are doubly undervalued. they call for social work educators to adopt anti-racist policies and practices. education education is consistently an area of investigation for advances in social work. in our first article in this group, by joseph-mccatty, goodkind, garrett, and joyner, the authors used classroom observations in a u. s. secondary education to reveal unequal discipline and classroom management practices for black girls. this is consistent with national trends about:blank advances in social work, spring 2025, 25(1) ii showing black girls are three times more likely to be suspended than their peers, and shows the pervasiveness of inequality based on racism. duhaney, lorenzetti, halvorsen, and han used survey methodology to center the voices of black college students’ views on racism on their campus. the case study revealed a variety of responses, notably, that 50% of respondents indicated that they had experienced anti-black racism on campus. the negative emotional consequences, such as losing a sense of belonging and self-confidence, are documented. surveys by shaffer, houser, and hembree measured the levels of anxiety and empathy of social work students, revealing a correlation between anxiety and empathy for the students. the authors recommend that social work educators keep this in the forefront when planning curricula and practicum placements. students can learn skills to manage their feelings so that they can be available to help others. critical relational pedagogies, which emphasize relationship-building and the cocreation of socially just spaces, are promoted by iacono and loveland. in this critical reflexive paper, the authors reflect on their practices with helping social work students in the mental health challenges discussed in the previous piece. they share insights and pragmatic strategies to enhance teaching in social work education. continuing the theme of facing the emotional and psychological stressors social work students often encounter, nahar, wagner, colvin, and ricks interviewed social work majors at two hispanic serving institutions. they sought to understand, through the lens of planned behavior theory, students’ perceptions and responses to the online learning required during the covid-19 pandemic. ortega-williams, mustaq, davoodzadeh, isles, anwar, hidalgo-ruiz, and soler reimagined the concept of rigor in social work education in the era of chatgpt. reflections from students and educators about the meaning of assignments that are alternative to papers were shared, with an eye to increasing creativity, social justice, and relevance to the field of social work. a reflection on the experiences of social work phd students who are preparing to teach was presented by goldsborough, champagne, and bietsch. through this collaborative autoethnography, the authors shared key themes such as navigating role and identity transitions, the value of community, the need for enhanced institutional support, and the role of educators as gatekeepers. culture wars appear to be everywhere in the u.s. these days, and social work education is no exception. davis and vancamp surveyed 35 social work educators to examine their perceptions of the effect of culture wars on programs, students, and faculty. their findings indicated significant implications for teaching where social work values clash with institutional values or political influences. watkins discussed the importance of executive coaching for social work faculty, purporting that social work faculty face unique challenges that demand academic expertise, strong leadership, and management skills. benefits for faculty’s research, teaching, and service responsibilities are presented. hostetter & decker/sping 2025 editorial iii kang, gounder, weatherly, jankowski, and reyes mason wrap up our section on education with their study of the environmental impact of attending academic conferences. using data from sswr 2023, they estimate that the average air travel carbon footprint for an individual presenter was 0.82 tonnes of carbon emissions. they provide alternative conference models, such as virtual and hub and node models, and state that our values for social justice and activism require us to consider the effects of our travel. practice switching to the group of articles which addressed issues in social work practice, we first find work by deliema and sommers. the authors summarized research on the costs of elder financial victimization and advocate for person-centered and trauma-informed interventions. they presented ways that social workers can improve the lives of elder financial exploitation victim-survivors using trauma-informed psychotherapy, engagement with others, and advocacy. luquet, redcay, counselman-carpenter, and gunn examined the impact of social, legal and medical transition psychological distress for transgender persons. using survey data, the authors found that each stage of transition can serve as a protective factor to increase overall well-being. they also found that improving access to services supporting transition can reduce psychological distress. scott’s article also addressed identity issues, although of a different sort. the conceptual paper asserted that culture and identity impact clients' experiences of trauma, and provided guidelines for the inclusion of identity-based factors in culturally responsive trauma assessment. scott also discussed culturally responsive trauma assessment approaches, which include an exploration of identity disruption and displacement as an important dimension. trauma was the subject of the next article, by baldwin-white. the concern was that students of color are at an increased risk of experiencing sexual assault, and are more likely to have worse outcomes due to the trauma compared to white students. secondary data analysis was used to reveal that there is a significantly higher prevalence of sexual assaults for students of color, and that the impact of trauma for students of color was greater as well. moulick, mukherjee, and abrams studied another type of trauma, that of burn injuries. this conceptual paper highlighted the need for a comprehensive approach acknowledging the importance of trauma-informed social work in addressing the complex physical and emotional needs of burn patients and survivors in both inpatient and community-based therapeutic settings. people who have been incarcerated face challenges returning to life outside the prison system. clarke and allen-mccombs interviewed returning citizens, with the results revealing that social stigmas and economic, social, physical, and psychological deprivations are interconnected and compound the difficulties in reintegration. the authors expressed the need for social workers to develop macro-level infrastructure in communities to help with these challenges. advances in social work, spring 2025, 25(1) iv much of social work practice deals with people experiencing substance use disorder. gallagher explained the key symptoms of substance use disorder when it is a brain disease and points out that not everyone who has a substance use disorder also has the brain disease. also, guidance was provided on when social workers should recommend abstinence or harm reduction as the recovery goal in clinical treatment planning, with examples of clinical treatment plans provided for curricula. heckert addressed the issue of suicidality by describing a practice model that social workers may adopt, which includes factors outside of the client in addition to the usual internal challenges. using a case scenario, an example is given, embracing an ecological systems approach for the various roles within social work practice. this qualitative study by tayebjee, lewkowicz, and isobel examined the integration of lived experience workers, called parent supporters, into a pregnancy family conferencing program designed for families facing child protection risks during the perinatal period. through thematic analysis of perspectives from families, supporters, and professionals, the study found that lived experience roles enhanced engagement and brought benefits across multiple levels of the system. the study by daşlı and şimşek investigated xenophobic attitudes among 436 healthcare professionals toward displaced migrants, using xenophobia and cultural intelligence scales. the findings showed that xenophobic attitudes were lower among those with diverse language skills, immigrant friends, relevant training, and high motivation, but higher among those concerned about disease transmission, with financial stress, or elevated metacognitive scores. the results underscore the need to consider these factors when designing social work interventions to reduce health inequalities for displaced populations. glassburn, lay, and canada’s interpretative phenomenological analysis explored the lived experiences of compassion fatigue and burnout among twelve social workers who had personally encountered these challenges. two central themes, moral distress and shame, emerged, highlighting underexplored emotional dimensions that can deepen the understanding and complexity of compassion fatigue and burnout. the findings suggest current approaches to social work education, self-care, and supervision may be insufficient to prepare or protect professionals from these deeply impactful experiences. clinical supervision is a critical requirement for social work licensure. the article by christensen explored its role in shaping professional advancement and equity within the field. barriers to obtaining supervision contribute to systemic inequities. regulatory structures and supervision functions were analyzed, and recommendations were given such as reducing costs, enhancing training, and integrating supervision content into social work education. lanteigne and iancu conducted a qualitative study exploring the experiences of 35 health care and social work practitioners working in interprofessional teams across urban and rural settings in new brunswick, canada. they sought to understand various aspects of the interprofessional collaboration experience for workers in different practice settings. findings identified individual, relational, organizational, and systemic factors influencing interprofessional collaboration. _________ katie lauve-moon, phd, associate professor, catelyn devlin, msw, graduate, cameron lewright, msw, graduate, karin lee, msw, graduate, kendall abbott, msw, graduate, eden elizondo, bsw, graduate, and nina bacon, bsw, graduate, texas christian university, fort worth, tx. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 1-17, doi: 10.18060/28403 this work is licensed under a creative commons attribution 4.0 international license. assessing the rainbow gap: a critical analysis of lgbtq+ inclusivity in social work research katie lauve-moon catelyn devlin cameron lewright karin lee kendall abbott eden elizondo nina bacon abstract: recent developments in american political and social life pertaining to the lived experiences of lgbtq+ people call for critical research examining the unjust systems perpetuating heteronormativity, heterosexism, homophobia, and transphobia. this study examines the extent to which mainstream social work research investigates the lived experiences of lgbtq+ people as well as the systems that perpetuate oppression and discrimination pertaining to gender and sexuality. the researchers conducted a content analysis of three peer-reviewed top social work journals (n=854) to determine the prevalence of lgbtq+ inclusive research. findings revealed that only 2.3% (n=20) of articles consider the lgbtq+ community or systems that perpetuate heterosexism, homophobia, and transphobia. findings show that even fewer articles (n=6) apply a critical theoretical frame of queer theory to understand the lived experiences of lgbtq+ people and even fewer examine gender and sexuality at the intersection of race (n=6, 0.7%). this article demonstrates a dearth of research pertaining to the lived experiences of lgbtq+ people and calls for more intentional social work research as it relates to this population. keywords: queer issues, social work research, lgbtq+, transgender issues, gay issues, critical theory, queer theory, queer methods since its inception, the social work profession has proclaimed a commitment to social justice, the dignity and worth of the person, and a consideration for how the socio-political environment impacts the lives of marginalized people. despite this commitment, the lived experiences and issues faced by lgbtq+ people have been largely absent in social work research. van voorhis and wagner (2002) demonstrate a dearth of research related to the lives of lesbian and gay people amongst articles published in three top social work journals between 1988 and 1997. these findings were later reinforced by a follow-up study examining the representation of lesbians and gay men amongst articles published in the same journals between 1998-2012 (pelts et al., 2014). given that sexuality and gender identity pervade almost any given social issue, this article calls on social work researchers to consistently consider the experiences of lgbtq+ people no matter the social issue studied. the current study utilizes content analysis to investigate the extent to which current mainstream social work research (n=854) centralizes the experiences of lgbtq+ about:blank advances in social work, spring 2025, 25(1) 2 people as well as discriminatory social phenomena such as homophobia, transphobia, and heterosexism. it additionally examines the extent to which queer theories and methodologies are utilized within social work research to critically examine the oppression and marginalization of this particular group. literature review status of lgbtq+ people in the united states the united states largely adheres to heteronormative norms, expectations, and values, which has perpetuated the marginalization and systematic oppression of people in the lgbtq+ community (pollitt et al., 2021). in 2023, an unprecedented 725 anti-lgbtq+ bills were introduced in state legislatures, and over 100 of those bills passed (movement advancement project [map], 2023). as of september 2023, gender affirming care is banned by law for minors in 22 states. bills proposed in 2023 have increasingly targeted transgender adults as well as minors, and nine states have banned medicaid coverage use for gender affirming care. additionally in 2023, ten states banned teachers’ and social workers’ abilities to use students’ and, in some cases, adults’ names, pronouns, and honorifics. several state and national efforts have also resulted in curriculum censorship laws targeting lgbtq+ and/or bipoc communities, the removal of anti-bullying and harassment protections for lgbtq+ youth, and the dismantling of diversity, equity, and inclusion programs, all of which limit social workers’ ability to speak with and serve clients (american library association, 2023; kline et al., 2022; map, 2023; see students for fair admissions, inc. v. president and fellows of harvard college, 2023). additionally, lgbtq+ people remain at-risk for discrimination on multiple fronts, including housing and employment. nineteen states have no explicit prohibitions for discrimination based on sexual orientation or gender identity in their housing laws (map, 2023). overall half of lgbtq+ adults report experiencing workplace discrimination (american civil liberties union, 2024). according to the williams institute, 17% of lgbtq individuals in 2021 were living in poverty, as compared to 12% of straight, cisgender individuals. these disparities were exacerbated for lgbtq+ black, indigenous, and people of color (bipoc; wilson et al., 2023). lgbtq+ people are at higher risk for suicide and other mental health concerns, which are found to often be a result of structural discrimination, marginalization, and exclusion (hatzenbuehler, 2014). according to the 2022 national survey on lgbtq health, an overwhelming 93% of transgender and nonbinary youth expressed concern about being denied gender-affirming medical care and 45% of lgbtq youth have seriously considered attempting suicide. this issue is compounded at the intersection of race, with greater disparities in mental health outcomes for lgbtq+ black, indigenous, youth of color (the trevor project, n.d.). lauve-moon et al./lgbtq+ inclusivity in swk research 3 queering social work while social work pioneers jane addams, mary richmond, and frances perkins all had documented, long-term, same-sex relationships (fredriksen-goldsen et al., 2009), the dominant trend in social work research, education, and practice skews toward heteronormativity and remains largely silent in changing the heterosexist status quo. some social workers argue that queer theories and perspectives are almost absent or misused in social work education (hicks & jeyasingham, 2016; mackinnon, 2011) thereby creating heterosexist blind spots in social work practice (burdge, 2007). in fact, some social work scholars argue that current social work curricula actually reinforce heteronormativity by relying on multicultural and/or anti-oppressive frameworks to identify and address issues of heterosexism, homophobia, and transphobia (mackinnon, 2011; poynter & tubbs, 2008; sumara & davis, 1999). mackinnon (2011) suggests that multi-cultural minority oppression frameworks centralize heteronormative practices as dominant and normal while othering queer practices. additionally, these frameworks situate queer (and heteronormative) sexualities as fixed and predictable thereby increasing potential to perpetuate stereotypes and rigid distinctions between these classifications as well as between queer and heteroexperiences. moreover, these frameworks often assume that “straight allies” may become competent in understanding queer experiences resulting in a reductionist understanding of sex, gender, and sexuality and reinforcing the practice of othering sexual and gender “minorities.” consequently, some social workers posit queer theory as an emancipatory pedagogical tool for teaching about sexuality, gender, and power relations in ways that “shift(s) the idea of sexual difference to include a variety of sexual practices” (mackinnon, 2011, p. 141) and expand beyond limited sexual categories by which heteronormativity is privileged. in relation to social work research, there proves to be a dearth of studies centralizing the lived experiences of lgbtq+ people in top social work research journals. van voorhis and wagner (2022) conducted a content analysis of publications from 1988-1997 in four major social work journals (i.e., social work, child welfare, social service review, families in society) investigating the extent to which top social work research journals are inclusive of lesbian and gay people and maintain methodologies that may be understood as free of heterosexist bias. results demonstrate that only 3.92% of the articles (n=1,964) focused on the lived experiences of lesbians and gay people with the vast majority of these articles focusing on hiv in the gay community or lg-related issues in social work practice. very few articles maintained a macro-focus. moreover, 90% of these articles were published in just two of the journals included in the sample. over a decade later, pelts et al. (2014) conducted a follow-up study with a similar design and purpose. this study reviewed publications from the same four journals over a 15-year time span and revealed a significant decrease in publications focusing on the lived experience of lesbian and gay people and, again, found only a few articles with a macro-focus. a decade later, our current study maintains a similar purpose and design as the two aforementioned studies but expands the inquiry to include articles focused on the lives of trans, bisexual, gender nonconforming, and queer people as well. advances in social work, spring 2025, 25(1) 4 in addition to filling this gap in research, social workers push for the integration of queer theories and methodologies in social work research (de jong, 2014; fish & russell, 2018; meyer et al., 2022). fish and russell (2018) argue that queer methodologies provide opportunities to redirect traditional research methods, which apply and reinforce dominant and privileged paradigms (e.g., heteronormativity). the authors further argue that adapting traditional research methods (e.g., positivist, empirical) to queer methods increases the potential for more diverse understandings of queer families, which is largely missing in current social work research. relatedly, meyer et al. (2022) demonstrate a dearth of nonprofit research centralizing lgbtq+ issues and positioning lgbtq+ people as central and active in the research process. the authors argue that understanding the experiences of queer people and how these experiences are impacted by unjust heteronormative power structures increases the potential to work toward equity and inclusivity, particularly within non-profit organizations. our research investigates the extent to which lgbtq+ lives, perspectives, and experiences are centralized within social work research as well as the extent to which queer theories and methodologies are utilized thereby providing additional variables to the ones presented in the van voorhis and wagner (2002) and pelts et al. (2014) articles. the following sections provide an overview of queer theories and methodologies as well as their relevance to social work research. what is queer theory? queer theory is a post-structuralist critical theory, which investigates power dynamics pertaining to gender and sexuality hegemonies. originating from the works of michael foucault (1978), eve sedgwick (2007), and judith butler (1990), queer theory challenges dichotomous conceptions of the world. specifically, queer theory questions sexual and gender binaries, which view “heterosexuality as ‘natural’ and homosexuality as its deviant and abhorrent ‘other’” (browne & nash, 2010, p. 20) and presents more inclusive and equitable conceptions of gender and sexuality. while defining queer proves antithetical to the expansive, fluid themes of queerness, the following include summaries of some of the key tenets of queer theory, which prove consistent with social work values: 1) queer theory provides a framework for critiquing and analyzing the historical, political, and systematic structures of what is seen as normal or pervert and questioning basic components of identity such as gender and sexuality (kara, 2020). 2) queer theory assumes that sexuality and gender are central, organizing phenomena of society, social relations and social institutions and are designed, utilized, and maintained to preserve the hegemonic power structures (sedgwick, 2007). 3) queer theory positions heteronormativity/heterosexuality as privileged and identifies ways in which expectations (or requirements) of heteronormativity are patterned throughout society thereby leading to marginalization and oppression. 4) queer theory is inherently intersectional and conceptualizes gender and sexuality at the intersection of other political categories such as race, class, age, ethnic culture, and ability (e.g., crenshaw, 1990; hill-collins, 2009). lauve-moon et al./lgbtq+ inclusivity in swk research 5 5) queer theory provides an emancipatory tool for re-imagining gender and sexuality in fluid, inclusive, and equitable ways (e.g., halperin, 2014). moreover, queer theory argues that understanding sexuality and gender along binaries proves too simplistic and limits understanding and freedom (sedgwick, 2007). queer theory provides a tool for identifying, analyzing, and addressing unjust power structures, especially in relation to the lived experiences of lgbtq+ people often at the intersection of other marginalized identities. it also offers a lens for broader conceptualizations gender and sexuality, which proves beneficial in researching the lived experiences of lgbtq+ people in more meaningful, expansive ways. additional lgbt+ related theories while theoretical frameworks falling under the umbrella of “queer theory,” specifically seek to uncover unjust or dominant systems and practices typically as they relate to gender or sexuality, there are several other types of theoretical frameworks that may not necessarily be considered critical but centralize the experiences of lgbtq+ people. for instance, the minority stress model offers a tool for understanding how marginalized groups experience unique types/levels of stress resultant of discrimination, violence, or harassment (brooks, 1981). brooks (1981) first coined the term “minority stress” demonstrating the stress and mental impact of internalized homophobia, harassment, and discrimination on lesbian women. the term “minority stress” was later adapted to a framework and gained popularity by applying it to other minority groups including gay and bisexual populations (e.g., meyer, 1995, 2003). hendricks and testa (2012) specifically adapted this framework in a way that centralizes transgender and gender non-conforming clients to shed light on stressors particular to this population such as internalized transphobia, gender-based violence or discrimination, and consequently, increased mental distress and suicidal ideation. relatedly, additional theoretical frameworks such as the minority strengths model (perrin et al., 2020) and resilience amongst the lgbtq+ population (bruce et al., 2015; hill & gunderson, 2015) prioritize the experiences of lgbtq+ people. the minority strengths model intends to demonstrate how the strengths of minority groups, including lgbtq+ groups, may positively contribute to resilience and mental health. similarly, the resilience model speaks to strengths of marginalized groups even in the face of systemic adversities (see bruce et al., 2015; hill & gunderson, 2015; meyer, 2015 for examples of this framework being applied to sexual and gender minorities). what are queer methodologies? developed from feminist methodologies, queer methodologies integrate the key tenets of queer theory and seek to repurpose dominant (positivist) approaches to research design in ways that challenge privilege and normativity. queer methodologists critique dominant, positivist methodologies, which “test” queer experiences as interactional or additive, and demonstrate how they fail to capture the specificities of lgbtq+ experiences, particularly advances in social work, spring 2025, 25(1) 6 at the intersection of race, class, ability, and age (fish & russell, 2018). conversely, qualitative and mixed methods may be used as an approach to queering research design as they “lend themselves more readily to understanding and deconstructing the intersectional systems of power and privilege that situate the experience and process of queer families” and people (fish & russell, 2018, p. 17). furthermore, qualitative methods offer more potential for understanding the distinctions between the experiences of gay, lesbian, bisexual, transgender, and non-conforming people because they provide more space for narrative and storytelling. despite the potential of qualitative and mixed methods (e.g., photovoice, semi-structured interviews, focus groups, critical ethnography, discourse analysis) to more meaningfully understand the experiences of lgbtq+ people, qualitative and mixed methods are used significantly less than quantitative ones in researching the experiences of lgbtq+ people as well as phenomena such as homophobia, transphobia, and heterosexism (fish & russell, 2018; hartwell et al., 2012). queer methods may also the guide the development of research question(s) and overall research design, thereby expanding conceptions of gender and sexuality as well as understandings of queer experiences. for example, a research study comparing queer people to heterosexual people holds a higher potential of reinforcing binaries and heteronormativities through its sampling and analysis (fish & russell, 2018). furthermore, this approach often misses additional social locations that may influence the experiences of lgbtq+ people such as race and class, and treats queer people as a monolith, while some queer people may have more in common with heterosexual people than with other queer people. conversely, a research study that centralizes the experiences of lgbtq+ people (e.g., participatory action research) allows for lgbtq+ voices to guide the research process in ways that are most relevant and meaningful to queer experiences and provide more potential for understanding the nuances between and within the lgbtq+ population (de jong, 2014). while more traditional researchers may critique the participation of those being researched in the research process, like other critical methodologists, queer methodologists utilize standpoint theory to argue that those experiencing oppression actually have a more objective understanding of oppression that those in the privileged group (lauve-moon et al., 2020, 2023; sprague, 2016). for this reason, queer methodologies such as photovoice, in-depth interviews, and discourse analysis hold a higher potential for centralizing the voices of lgbtq+ people as well as other marginalized groups situated at the intersection of race, class, nationality, and ability. methods research questions 1) to what extent does mainstream social work research investigate the lived experiences of lgbtq people and delineate between each group? 2) to what extent does mainstream social work research investigate the lived experiences of lgbtq bipoc? 3) to what extent does mainstream social work research investigate structural issues related to homophobia, transphobia, and heterosexism? lauve-moon et al./lgbtq+ inclusivity in swk research 7 4) to what extent does mainstream social work research explicitly utilize queer theories and lgbtq-related frameworks to guide or inform the research process? 5) what types of methods are used to explore the lived experiences of lgbtq people in mainstream social work research? method and sample similar to van voorhis and wagner (2002) and pelts et al. (2014), we conducted a content analysis of three mainstream social work peer-reviewed academic journals using a purposive sampling method (i.e., social work (j1), research on social work practice (j2), society for social work and research (j3)). mainstream was defined by the following: (1) did not focus on any particular sub-field of study within the field of social work but rather published across a wide variety of topic areas and levels of practice; (2) maintained a high impact factor relative to the field of social work and to other journals that met criterion one. additionally, we selected journals that emphasized “research” as an area relevant to the call of the journal as “social work research” proves key to our inquiry. the three journals included in the study maintain the three highest 5-year impact factors of all journals meeting similar criteria, i.e., 2.48, 2.0, 1.50). two of the journals emphasized social work research and one of the journals focused on social work research, education, and practice. the selection of these journals remained consistent with van voorhis and wagner (2002) and pelts et al. (2014) in that they are major social work journals with a national audience and general focus. like the aforementioned studies, we included social work in our sample as it has the highest impact factor of those included in their sample and is arguably the most influential journal with a general focus in the field of social work. however, we examined two different journals not included in their studies because these journals explicitly focused on research in social work, which was one of the main intentions of our study. moreover, examining journals that had not previously been analyzed strengthens the argument regarding the dearth of lgbtq+ related research. the first wave of data (2015-2018) was collected in the fall and spring 2019 and the second wave of data (2019-2022) was collected in the spring and summer of 2023. we examined every article published in each journal between the years 2015-2022. we began with the year that same-sex marriage was legalized and a backlash of discriminatory policies followed as well as the year following the publication of the pelts et al. (2014) article. articles not classified as research articles by the journal were not included in the study. we coded systematic literature reviews, scoping studies, and scoping overviews as research articles. the research team and co-authors include two white cisgender bisexual women, a latino transgender queer man, a white cisgender queer woman, two white cisgender heterosexual women, and an asian cisgender lesbian woman. the research team met consistently throughout the data collection and analysis process. we utilized a codebook to record all data collection rules and codes, and the codebook was saved in a shared folder and referenced throughout the research process (miles et al., 2014). we had an initial research team meeting for the principal investigator to provide a data collection and advances in social work, spring 2025, 25(1) 8 analysis process orientation. the co-investigators initially each collected data on 20 articles at a time for the first 100 articles using tools in excel. for the first 100 articles, the research team met after every 20 articles to establish reliability and consistency in data collection. at each of these meetings, the research team discussed any variables that remained unclear in relation to the codebook and established consensus on how to proceed. these modifications were recorded in the codebook. after the first 100 articles, the research team met less frequently (every 50 articles) to discuss unclear variables and reach consensus. we also conducted peer reliability checks on each other’s assigned datasets. by the end of the study, reliability rates ranged from 90 to 100%. all articles including lgbtq+ variables were reviewed by at least two researchers. variables and analysis we conducted a content analysis of variables and categorized thematically data in the following ways: (1) qualitative, quantitative, mixed methods, and “other” (including systematic literature reviews and scoping studies); (2) type of data (primary or secondary); (3) inclusion of lgbtq+ variable; (4) type of lgbtq+ variable/analysis of findings (structural or non-structural); (5) application of queer theory. articles classified as including an lgbtq+ variable had to meet at least one of the following criteria: (1) explored the experiences of lgbtq+ people in some way or (2) examined structural injustices related to the lgbtq+ population such as homophobia, transphobia, or heterosexism. the articles varied significantly in terms of the centrality of the lgbtq+ variable. we additionally categorized the presence of lgbtq+ variables into three categories: (1) the lgbtq community or discriminatory phenomena pertaining to sex, gender, or sexuality is only peripherally considered in that it was secondary or less to the primary focus on the article; (2) the topic of lgbtq communities is frequently discussed or prominently featured but not centrally positioned; (3) the lgbtq community or the prevalence of heterosexism/transphobia/homophobia is positioned as a central and leading subject of examination or research. given the extent to which lgbt+ related material remained on the periphery, we did not ultimately classify level 1 articles as meeting criteria for lgbt+ inclusion. see table 1 for examples of each category as well as which examples met inclusion criteria for the lgbtq+ variable. finally, we completed a summary description of all articles including an lgbtq+ variable to determine the specific population focus (e.g., lesbian, gay, bisexual, transgender, queer, non-conforming, nonbinary, genderqueer) of each article as well as the issue on which the article examined. lauve-moon et al./lgbtq+ inclusivity in swk research 9 table 1. examples of lgbtq+ variables and inclusion status level lgbtq+ variable status description 3 meets criteria the article examines the impact of the “don't ask, don't tell” policy on lgbtq+ military service persons and demonstrates continued discrimination and inequities in this context. it argues for continued institutional change. 3 meets criteria this study examines the prevalence and magnitude of discrimination of transgender and gender non-conforming (tggn) individuals and explores predictors of discrimination of this group is social service agencies. 2 meets criteria this article highlights a dearth of content on youth sexual identity development in social work educational curriculum. it argues for the integration of content on sexual development, sexual orientation, and sexual identities in social work education and discusses implications for working with lgbtq+ individuals. 2 meets criteria in pursuit of anti-oppressive social work practice, this article calls for a critique of the binary conceptions of gender in the social work profession and illustrates how a binary framework reinforces the subjugation of lgbtq+ groups. 1 does not meet criteria this article introduces the concept of healing justice. it does not explicitly include lgbtq+ variables but it does challenge the current white, heteronormative, patriarchal structure and argues that oppressed identities such as 'queer bodies' may engage healing justice in relation to marginalized experiences. 1 does not meet criteria this study examined risk factors pertaining to illicit drug use with sexual orientation included as a demographic category in the survey. those who identified as “non-heterosexual” represented a very small portion of the sample. results showed that those who identified as heterosexual were more likely to engage in illicit drug use. 1 does not meet criteria this article provides an overview of trends and interventions for girls in the juvenile justice system. it does not explicitly include an lgbtq+ variable, but the literature does occasionally point to ways in which lgbtq+ girls are more vulnerable in relation to the criminal justice system than hetero-youth. 1 does not meet criteria this article centralizes gender as a social construct that influences patterns in dating abuse. it does not explicitly focus on lgbtq+ relationships, but the literature included does note that most ipv research assumes a rigid gender binary and calls for further research examining partner/dating abuse in non-conforming relationships, particularly since studies show high rates of ipv in lgbtq+ relationships. we coded a total of 1,071 articles, which were categorized by the journal as research articles. we applied an additional filter to determine whether each article presented research using either secondary or primary data. of the 1,071 articles, a total of 854 were categorized as research articles and were included in the study. there were 406 articles advances in social work, spring 2025, 25(1) 10 included in wave 1 of the sample (2015-2018) and 448 articles included in wave 2 of the sample (2019-2022). results lgbtq+ variables amongst 854 research articles, 2.3% (n=20) focused on the experiences of lgbtq+ people and/or heterosexism, homophobia, or transphobia. we separated the dataset into each wave and found that there were 8 articles (0.9%) including an lgbtq+ variable in wave 1 while there were 12 articles (1.4%) including an lgbtq+ variable in wave 2 thereby suggesting a slight increase in the frequency by which lgbtq+ experiences are considered in social work research over time. however, when we examined the level of degrees, findings showed that 7 out of 8 (87.5%) of the articles including an lgbtq+ variable in wave 1 were categorized as level 3 while only 5 of 12 (41.6%) articles were categorized as level 3 in wave 2; this finding suggests that research explicitly centralizing the experiences of lgbtq+ people decrease over time. see figure 1 for a summary of results by year, journal, and level of publication. figure 1. number of lgbtq+ related articles published by journal by level by year of the articles including an lgbtq+ variable, 15 articles examined sexuality and/or gender identity in structural ways, which represents only 1.7% of the overall sample (n=854). of the articles including an lgbtq+ variable, only 6 articles (0.69% of the overall sample) explicitly applied queer theory or any critical theory pertaining to sex, gender, or sexuality. the vast majority of articles failed to delineate between specific groups within the lgbtq+ population (e.g., lesbian, gay, bisexual, transgender, queer) with only two articles focusing on the experiences of transgender people or transphobia 0 0.5 1 1.5 2 2.5 3 3.5 j1 j2 j3 j1 j2 j3 j1 j2 j3 j1 j2 j3 j1 j2 j3 j1 j2 j3 j1 j2 j3 j1 j2 j3 2015 2016 2017 2018 2019 2020 2021 2022 nu mb er o f a rti cle s journals by years level 2 level 3 lauve-moon et al./lgbtq+ inclusivity in swk research 11 exclusively. most of the articles identified gaps in knowledge, education, and services within the social work profession. however, most of the level 3 articles identified ways in which lgbtq+ people are more at-risk for experiencing systematic discrimination and harassment. table 2 provides summaries of level 3 articles from the sample. table 2. summaries of level 2 and 3 articles journal level description 1 3 this article centralizes the experiences of sexual and gender minority (sgm) youth. this article demonstrates the harm that can be caused by religious mental health practitioners who act on conservative ideas of gender and sexuality with sgm youth and the importance of cultural competence and gender affirming interventions. 2 3 this article presents a literature review that outlines increased prevalence of poverty among lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender minority groups (lgbtq2s+) in canada. this article applies an intersectional frame for understanding this phenomenon and recommends efforts for addressing this issue specifically in the lgbtq2s+ population. 3 3 this article examines predictors of harassment for lesbian, gay, bisexual, and queer adults with consideration for intersecting identities. 3 3 this article seeks to identify significant predictors of hiv risk for young men who have sex with men (ymsm) and makes recommendations for practice. 3 3 this study centralizes the experiences of “sexual and gender minority” emerging adults to determine if the companionship of an emotional support companion moderates the effects of gender-based victimization. 1 3 the article examines the impact of the “don't ask, don't tell” policy on lgbtq+ military service persons and demonstrates continued discrimination and inequities in this context. it argues for continued institutional change. 2 3 this study investigates homophobic attitudes of msw students in turkey and demonstrates that viewing gay-friendly movies helps to decrease homophobic attitudes amongst msw students. it calls for the integration of lgbtq+-friendly films in social work education. 2 3 this study demonstrates the effectiveness of using theater and dialogue to raise awareness about transphobia and homophobia. it calls for more macro level interventions for addressing lesbian, gay, bisexual, trans, queer, and questioning (lgbtqq) issues. 3 3 this study demonstrates that the sexual self-efficacy scale does not perform equally well amongst black lgbq and heterosexual youth as it does for white youth. 3 3 this study examines the prevalence and magnitude of discrimination of transgender and gender non-conforming (tggn) individuals and explores predictors of discrimination of this group is social service agencies. advances in social work, spring 2025, 25(1) 12 journal level description 3 3 this study demonstrates that transgender people experience higher rates of housing and employment discrimination than cisgender individuals. it suggests pathways for social workers to advocate against transphobic housing and employment policies. 3 3 this study centralizes the issue of discrimination amongst lgbtq+ older adults and caregivers. it offers recommendations for working with this population. 1 2 this article highlights a dearth of content on youth sexual identity development in social work educational curriculum. it argues for the integration of content on sexual development, sexual orientation, and sexual identities in social work education and discusses implications for working with lgbtq+ individuals. 1 2 this scoping study provides an overview of research pertaining to people in non-conforming relationships, particularly polyamorous relationships. this article emphasizes best practices for understanding this population, checking biases, and creating safe spaces with clients. while there is no explicit focus on the lgbtq+ population, the study notes that the majority of those in polyamorous relationships identify as lgbtq+. 1 2 in pursuit of anti-oppressive social work practice, this article calls for a critique of the binary conceptions of gender in the social work profession and illustrates how a binary framework reinforces the subjugation of lgbtq+ groups. 1 2 this article focuses on sex trafficking and demonstrates that lgbtq+ youth experience higher rates of engaging in survival sex. it argues that social workers must recognize the plurality of identities of youth who have been trafficked. 2 2 this scoping study explores pedagogical approaches to teaching social justice in social work education. for a portion of the paper, the authors direct attention to social justice approaches specifically related to lgbtq+ populations. 3 2 this study examines the prevalence of sexual assault on college campuses and finds that gender and sexual minorities experience higher rates than cisgender and heterosexual students. authors recommend interventions that seek to reduce homophobia on college campuses. 3 2 this study examines the relationship between having a child and drug usage among homeless youth. almost half of the sample identified as lesbian, gay, bisexual, or queer. findings showed that identifying as lgbq increased the odds of substance use for women. 3 2 this systematic review examines the effectiveness of school bullying policies. many of the key findings were specific to lgbtq+ students. applied methods of the overall research sample (n=854), 130 articles (15.2%) applied qualitative methods, 479 (56%) applied quantitative methods, 108 (12.6%) applied mixed methods, and 137 (16%) articles utilized “other” methods. of the articles including an lgbtq+ lauve-moon et al./lgbtq+ inclusivity in swk research 13 variable (n=20), only three articles utilized qualitative methods and no articles utilized mixed methods. intersectionality of the articles including an lgbtq+ variable (n=20), only 6 articles (0.7% of the overall sample) examined the intersections of sexuality or gender identity with race. moreover, the second wave of data contained fewer articles that met this criterion than the first wave. with the exception of one article that focused on the lived experiences of lgbtq+ older adults, no other intersectional identities were discussed in the sample. limitations this research is limited in scope in that it fails to examine all mainstream social work journals with a general focus. a study including all journals that meet these criteria would provide a more comprehensive understanding of the extent to which mainstream social work research focuses on lgbtq+ related issues and experiences. moreover, this study fails to capture the number of manuscripts centralizing the experiences of lgbtq+ people actually submitted to journals for publication as well as the barriers that researchers may face in publishing this type of work. perhaps the issue most contributing to the dearth of research in this area may be found within the publication or editorial processes rather than the type of work produced by social work researchers. this is a research question that remains unexplored. finally, this research fails to provide a thematic analysis of the articles identified, which would demonstrate gaps in research in this research area. discussion consistent with previous research (pelts et al., 2014; van voorhis & wagner, 2002), this study further demonstrates a dearth in social work research pertaining to the lived experiences of lgbtq+ people (e.g., fish & russell, 2018; meyer et al., 2022), thereby marginalizing (and in most cases silencing) the voices of queer and trans people in the field of social work and leaving social workers ill-equipped for practice (e.g., burdge, 2007). these findings illustrate that the experiences and voices of lgbtq+ people are almost absent from mainstream social work research despite recent policy efforts to further disenfranchise this population. findings show that the persistence of social justice issues such as heterosexism, homophobia, and transphobia remain largely under-examined within mainstream social work research despite social work’s commitment to the pursuit of social justice. in addition, these findings show that very few studies delineate between lgtbq+ groups offering more meaningful understanding of the experiences of each group separately. moreover, these findings suggest very little investigation into the experiences of black, indigenous, bior multi-racial, people of color who also identify as lesbian, gay, bisexual, transgender, or queer, which falls short of the tenets of queer theory and inquiry and the mission of social work. while the dearth of social work research related to the lgbtq+ population proves consistent with previous studies, we do observe an important shift in research content. van advances in social work, spring 2025, 25(1) 14 voorhis and wagner (2002) found that most of the articles included in the sample focused on hiv amongst lesbians and gay men while only one article in our sample focused on hiv. van voorhis & wagner also identified the trend of a problem-oriented view of lesbians and gay men in social work research with little emphasis on structural or systemic issues impacting the lives of lgbtq+ people. our findings illustrate slightly greater emphasis on various systems and modes of discrimination, marginalization, and harassment in relation to this population. however, this increase in a structural or macro focus still only represents less than two percent of the sample. more meaningful investigation may be achieved with the use of qualitative and/or mixed methods because they allow for those being researched to have more control over the narrative. however, our findings showed that only three articles including an lgbtq+ variable utilized mixed or qualitative methods, which limits even the possibility of centralizing lgbtq+ voices in the research process. additionally, only a handful of studies explicitly utilized queer theory or any theories pertaining to sex, gender, and/or sexuality, further demonstrating the underutilization of relevant critical frameworks for understanding queer and trans issues within the context of social work (e.g., burdge, 2007; fish & russell, 2018). implications this study suggests a lack of response within social work research to the consistently emerging societal barriers faced by lgbtq+ people. given that sexuality and gender identity pervade almost any given social issue, our work calls on social work researchers to consistently consider the experiences of lgbtq+ people no matter the social issue studied, thereby centralizing lgbtq+ research in social work journals with higher impact factors. furthermore, this work calls on social workers to better understand the distinct experiences of gay, lesbian, bisexual, transgender, and queer people including those situated at the intersection of race, class, nationality, age, and ability. alongside social workers who illustrate the utility of queer theory for identifying, understanding, and addressing issues of heterosexism, homophobia, and transphobia within the context of social work research, education, and practice (burdge, 2007; de jong, 2014; fish & russell, 2018; mackinnon, 2011; meyer et al., 2022; poynter & tubbs, 2008; sumara & davis, 1999), our findings provide an additional, urgent reason for taking intentional steps toward integrating intersectional queer theories and frameworks into social work research and curriculum and leading the way toward structural change. moreover, it provides justification for mainstream social work journals to prioritize publishing lgbtq+ related articles. our study calls on social work faculty to work toward integrating queer theories in social work curricula including practice, theory, and research courses so that social workers may be structurally competent pertaining to the lived experiences of lgbtq+ people, especially while conducting research. consistent with queer methodologies, our study pushes social work departments and schools to place priority on qualitative and mixed methods (e.g., participatory research, critical ethnography, in-depth interviews, discourse analysis) in bsw, msw, and phd research courses as well as in faculty research agendas through performance incentives and shifts in organizational cultures that value lauve-moon et al./lgbtq+ inclusivity in swk research 15 approaches to research that (often more slowly) seek to address “why” questions in addition to the “how” and “what” questions. conclusion with the recent developments in american political and social life pertaining to the lived experiences of lgbtq+ people and the established dearth of social work research focusing on this population, we call for critical education and research studies examining the unjust systems perpetuating heteronormativity, heterosexism, homophobia, and transphobia and centering the lives of lgbtq+ people. this call fits squarely into the anti-racist, equity, inclusion, and diversity competency put forth by the council of social work education (cswe, 2022, p. 9) and moves the profession closer to actualizing its values of social justice and the dignity and worth of the person. references american civil liberties union. 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(2023). lgbt poverty in the united states. ucla williams institute. author note: address correspondence to katie lauve-moon, department of social work, texas christian university, fort worth, tx, 76109. email: katie.lauve@tcu.edu funding acknowledgement: this project was funded by the office of sponsored programs at texas christian university https://doi.org/10.1037/sgd0000132 https://doi.org/10.1037/sgd0000132 https://doi.org/10.1177/08997640211021497 https://doi.org/10.1177/08997640211021497 https://www.lgbtmap.org/equality-maps/non_discrimination_laws https://doi.org/10.1093/sw/swu005 https://doi.org/10.1093/sw/swu005 https://doi.org/10.1002/jclp.22850 https://doi.org/10.1002/jclp.22850 https://doi.org/10.1002/jclp.22850 https://doi.org/10.1080/00918369.2019.1656032 https://www.tandfonline.com/doi/abs/10.1300/j524v05n01_10 https://www.supremecourt.gov/opinions/22pdf/20-1199_hgdj.pdf https://www.supremecourt.gov/opinions/22pdf/20-1199_hgdj.pdf https://doi.org/10.1111/0362-6784.00121 https://doi.org/10.1111/0362-6784.00121 https://www.thetrevorproject.org/survey-2022/#intro https://www.thetrevorproject.org/survey-2022/#intro https://doi.org/10.1093/sw/47.4.345 https://doi.org/10.1093/sw/47.4.345 https://williamsinstitute.law.ucla.edu/publications/lgbt-poverty-us/ https://williamsinstitute.law.ucla.edu/publications/lgbt-poverty-us/ mailto:katie.lauve@tcu.edu microsoft word 05_logan_and_negroni_25282_bilingual_professionals _________ isabel logan, ed.d, lcsw, assistant professor, department of sociology, anthropology, criminology, and social work, eastern connecticut state university. willimantic, ct. lirio k. negroni, phd, lcsw, full professor, department of social work, marieb college of health & human services at florida gulf coast university, fort myers, fl . copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1141-1160, doi: 10.18060/25282 this work is licensed under a creative commons attribution 4.0 international license. bilingual court professionals’ perceptions of their language skills: asset or liability? isabel logan lirio k. negroni abstract: bilingual professionals are considered an asset in the workplace. however, bilingual professionals at times perceive their language skills as a liability. this paper examined bilingual professionals’ perceptions of their language skills and the factors that influence their views. focus groups were used to capture the perspectives of 15 bilingual professionals who speak english and spanish and work in a court system in the eastern region of the united states. findings reveal challenges rooted in discrimination that convert bilingual professionals’ perceptions of their language skills from an asset to a liability. participants highlight unfair practices affecting limited english proficiency (lep) clients. these practices force bilingual professionals to become protectors and gatekeepers to prevent adverse outcomes and provide access to services in the court and across social service systems. ultimately, bilingual professionals’ perceptions of their language skills depended on how others used their language skills in the workplace. to support bilingual professionals and provide quality services to lep clients, social work administrators must evaluate structural supports and provide training specific to the cultural aspect of language for all employees. keywords: bilingual professionals, court system, language, and discrimination literature review bilingual professionals enhance services delivered in organizations, increase the number of individuals seeking assistance, and impact access to services. in general, bilingual skills are advantageous for both the workers and their employers (fry & lowell, 2013). courts, in particular, often depend on bilingual professionals to use their language skills to serve limited english proficiency (lep) individuals (dutton et al., 2013; logan, 2018; national center for state courts [ncsc], 2013). most employers specifically recruit bilingual professionals to help organizations meet the needs of lep populations, making it relatively easy for bilingual professionals to find employment (engstrom et al., 2009; fry & lowell, 2013). engstrom et al. (2009) refer to bilingual social workers as “critical service providers” (p. 168) who help organizations meet lep clients’ cultural and language needs. they educate clients on laws and services, and contribute to colleagues’ and supervisors’ cultural and linguistic competency development, resulting in more efficient services (bergman et al., 2008; logan, 2018). hall and valdeviezo (2020) assert social workers must have language competence to understand how language ties to power and personal identity impacting client-worker relationships. they point out that one does not need to be proficient in a language to have language competency and that someone can have language advances in social work, fall 2021, 21(4) 1142 proficiency and not have language competency. language competency is the combination of “cultural awareness” and “social diversity” that allows for skillful engagement and interaction with clients who speak a different language (hall & valdeviezo, 2020, p. 18). scholars have reported that bilingual professionals have positive experiences because of their language skills (bergman et al., 2008; engstrom et al., 2009). in past studies, bilingual professionals reported feeling pride and strong connections with their lep clients (logan, 2018; shu-wen, 2013; verdinelli & biever, 2009). generally, the link generated by their acculturation, language identities, and sharing of everyday experiences enhances the clientworker relationship (ando, 2017). bilingual practitioners can understand and effectively work with lep individuals (bergman et al., 2008; engstrom & min, 2004; shu-wen, 2013; verdinelli & biever, 2009). bilingual professionals provide lep clients with an outlet to express themselves in their native language. they also elicit emotional experiences unique to lep and bilingual clients (oliva, 2017). both lep and bilingual clients are more comfortable expressing themselves with professionals who communicate in their same language; thus, they are more inclined to seek services when agencies have bilingual providers (zambrana, 1996). nathanson et al. (2016) reported that health care agencies without bilingual professionals or translation services cannot meet the demands of the rising lep population and often deny services to lep clients. despite the unique and powerful contributions bilingual professionals make in their field, they are often not valued to the same extent as they are recruited. they face myriad challenges, such as differential treatment, assumptions, and unrealistic expectations (logan, 2018). disparities in assignments, workload, compensation, and professional development negatively impact bilingual professionals’ work. these conditions also affect workers’ satisfaction and their physical and mental health (arias & friberg, 2017; engstrom et al., 2009; logan, 2018; núñez et al., 2021). bilingual professionals’ work is often interrupted by language interpretation requests. at times they sacrifice their work responsibilities, identities, and comfort to assist monolingual co-workers and prevent them from feeling suspicious, threatened, distrustful, or excluded by bilingual professionals (bergman et al., 2008; engstrom et al., 2009). bilingual professionals not only use their language skills to help monolingual co-workers and clients but do more work than their monolingual counterparts and yet continue to be viewed as outsiders (bergman et al., 2008; logan, 2018). being a bilingual professional comes with unique pressures and challenges. cultural bonds linked to language add to this internal pressure. some may experience feelings of guilt and responsibility to give back to the community, either through clients or co-workers (logan, 2018; nielsen et al., 2019). the internal pressures felt by these professionals have led to physical concerns such as sleeplessness, body aches and tiredness, and psychological conditions such as depression, anxiety, forgetfulness, poor motivation, and low self-esteem (alleyne, 2005; bergman et al., 2008; engstrom et al., 2009; sue, 2010). furthermore, the pressures on bilingual professionals can result in dissatisfaction with work, mood change, absenteeism, lowered work performance, and a denial of language skills (logan, 2018). the extra work performed may also decrease their self-worth and abilities (bergman et al., 2008; logan, 2018). logan & negroni/bilingual professionals 1143 additionally, bilingual professionals are burdened with unrealistic expectations connected to their knowledge of professional terminology in languages other than english. often bilingual professionals are expected to know all terminology in several languages, sometimes even languages they do not speak. the expectation of being knowledgeable in several languages is a concern for many bilingual professionals who worry about issues of credibility, ethics, and miscommunication with clients (logan, 2018). in fact, social work ethical guidelines require that all clients receive culturally and linguistically competent services. yet, social work educators struggle with diversifying curriculum despite recognizing its importance (hebenstreit, 2017; national association of social workers, 2017). however, bilingual professionals are often expected to serve as interpreters regardless of language competency or training. in a quantitative study examining selfefficacy related to spanish language skills, arriaza (2015) found that out of 319 participants, 46.1% perceived their spanish language skills as inadequate when providing social work services. only 37.3% of participants perceived their spanish language skills as adequate when delivering social work services. there is limited literature about how bilingual professionals whose job description is not that of interpreting experience their language skills in the workplace. thus, this study examined whether bilingual professionals who work in the court system or with courtinvolved clients perceive their language skills as an asset or a liability and the factors that influence those perceptions. purpose of study in this study, the authors examined one aspect of a larger study that explored the quality of services provided to lep people within the judicial system. the bilingual professionals’ responses, specific to their ability to provide services in two languages, were the focus of this analysis. two research questions guided this study: 1) to what extent do bilingual professionals perceive their bilingual skills as an asset or a liability? 2) what factors influence bilingual professionals' perceptions of their language skills? methods this qualitative study focused on bilingual professionals with clients involved in the criminal and juvenile justice system in the eastern united states and the perspective of monolingual coworkers and supervisors. the original study used five focus groups (2 groups of bilingual professionals, 1 group of supervisors, 1 group of monolingual professionals, and 1 group of lep clients) to explore the challenges faced by bilingual professionals in the judicial system. for this paper, the responses from the two bilingual professionals focus groups about the use of their language skills in serving the lep population within the court system were analyzed. advances in social work, fall 2021, 21(4) 1144 participants' recruitment and selection the researcher, also the main author, used a snowball approach and purposefully selected the participants from her judicial colleagues and community agencies’ network. participants were selected based on their intersecting identities of being bilingual and employed by the court system or an agency that services court-involved clients. participants were recruited from different judicial locations within a 40-mile radius of where the focus groups were held. the focus groups were held in the private conference room of a courthouse within the heart of a city. the researcher emailed an invitation letter to prospective participants. those interested responded to the researcher by phone or email. participants in this study had court-involved lep clients who spoke spanish. none of the participants had interpreting as a job requirement. the 15 participants included 12 native spanish speakers and 3 non-native spanish speakers. in this study, native spanish speakers within the context of bilingual professionals, refers to individuals who learned to speak spanish before speaking english. non-native spanish speakers refers to individuals who learned to speak english before learning to speak spanish. participants were composed of five males and ten females. three of the participants were not latino, and twelve were latino. it is noteworthy to point out that this study is not about latinos serving lep populations but about bilingual professionals despite most participants being of latino descent. participants were also diverse across professional fields, consisting of three social workers, one attorney, six probation officers (one probation officer has a msw), two investigators, two clerical workers, and one care coordinator. data collection following krueger’s (2000) approach in developing focus group questions, the researcher developed the semi-structured interview questions based on her experience working in the judicial system for over 15 years. two social work research consultants assisted with the data collection. one of the consultants helped the researcher craft the interview questions. the other consultant, a bilingual interviewer unaffiliated with the court and the co-author, facilitated the focus group interviews. the interview questions concentrated on the provision and effectiveness of services provided to lep clients. all participants were asked the same interview questions that explored the positive and negative aspects of their role in assisting lep clients, the quality of services received by the lep clients, and how agencies and organizations can better serve lep clients. the focus group interview lasted 60 minutes in length and was audio-recorded. additionally, the principal researcher took notes at each focus group to capture non-verbal communication. analysis the co-authors analyzed the data by organizing, preparing, reading, coding, and categorizing the narrative data into themes. the researcher transcribed the interviews verbatim and reviewed the audio recordings twice. open coding generated main categories and themes from the transcriptions, and a web-based qualitative software program assisted logan & negroni/bilingual professionals 1145 with the organization of the data (bryman, 2012; creswell, 2009). the variations in themes and commonality between groups were compared and analyzed using dedoose qualitative software. the researcher used peer-inter-rater reliability to reduce researcher bias, review the codes and themes, and find connections. findings six main themes emerged as factors influencing bilingual professionals' perceptions of their language skills. three themes were categorized as assets: (1) strong connections, (2) satisfaction and appreciation, and (3) cultural bond, and three were categorized as liabilities: (4) terminology and miscommunication, (5) limited bilingual services, and (6) pressure and dissatisfaction. the theme of limited bilingual services included three subthemes: protectors, gatekeepers, and above and beyond. bilingualism as an asset all participants in this study perceived their bilingual skills as an asset when working in their professional roles and assisting their lep clients. the term “asset” in this study is defined based on participants’ viewpoints as a personal and professional value, benefit, or advantage in the workplace. participants thought that their language skills enhanced their work performance, resulted in favorable dispositions and outcomes of cases, and led them to feel satisfied both professionally and personally. for example, a probation officer stated, i think the best thing our agency did for this specific region where our office is, is give me the opportunity to work there. i think the hispanic population was almost unrepresented in part because there was never bilingual staff who worked in that area. by me being there now, i feel that they can connect and speak the language. they feel a little more comfortable. similarly, a clerical worker stated, i feel fortunate that i am in this position where people come to court for you. they know you by name. i feel fortunate that i am able to help people exercise their rights and stop this system where you are taken advantage of because they didn’t know [referring to lep clients]. the data reveals three factors that influenced participants’ perceptions of their language skills as an asset: (1) strong connections, (2) satisfaction and appreciation, and (3) a cultural identity bond. factor #1: strong connections participants perceived their language skills as an asset because their skills allowed them to develop connections with lep clients. strong connections in this study refer to a professional link or attachment between individuals that revolve around trust and vulnerability. strong connections led to developing a professional relationship and helping advances in social work, fall 2021, 21(4) 1146 clients to access services. strong connections allowed the client to express themselves freely, as stated by an investigator, i would say in my role what i enjoy the most is the fact that families feel so comfortable. they finally have someone they can relate to that knows their language and that they can feel free to express themselves the way they want to express themselves. a probation officer added, “i think you get to connect with the clients, and you form a trust level that helps you just be more successful when working with the families.” participants associated developing strong connections with positive outcomes. they credited strong relationships with lep clients to conducting more thorough assessments and serving more effectively as mediators and advocates between the clients, lawyers, and other service providers. as another probation officer shared, “all of my hispanic clients and i have a really good connection, and the attorneys get a lot of information too.” similarly, an investigator reported that, unlike their monolingual counterparts, he has “… seen a tremendous value when you are able to connect with a client because of the language barrier is the amount of information you can get from them.” participants raved about how their strong connections contributed to the success of their work with lep clients. strong connections helped reduce lep clients’ anxiety and made them feel more comfortable in the legal environment. as one probation officer stated, “i think you make the families and clients less anxious than they already are because they have a connection with us because we speak the same language.” participants saw their connections with their lep clients as necessary to meet the needs of lep clients. one social worker stated, i think you can help them find the right level of care too, then the necessary service because you speak the language and you’re able to figure out what their needs are too, to make their situation better, and help link the mental health or behavior health services for them. in addition to a strong connection, bilingual professionals experienced a sense of satisfaction due to their language skills. factor #2: satisfaction and appreciation participants reported feeling a sense of satisfaction and appreciation when they assisted lep clients. they noticed the positive outcomes and lep clients’ comfort level when assisted in their dominant language. in this study, a sense of satisfaction refers to positive feelings of contentment and fulfillment. appreciation represents gratitude, being valued and not taken for granted. satisfaction and appreciation transcended participants’ professional identities and impacted their experiences personally despite doing more work. a probation officer reported, there is a satisfaction in helping people and being able to be supportive and trying to make someone feel relaxed and try to give them more information. you do it, but that doesn’t take away from the fact that you are given more work because of the fact that you can do that. logan & negroni/bilingual professionals 1147 an investigator stated, “for them [referring to lep clients] to feel comfortable, i enjoy that.” they felt more motivated to serve, increasing their productivity. another probation officer said, for me working with spanish-speaking clients is one of my pride and joy, and i get lots of pleasure. when people don’t understand the system, i take the opportunity to educate them and just the whole appreciation. many times, we do this [referring to helping co-workers communicate], and we don’t get all that appreciation. but when you get, “oh wow, thank you very much, muchisimas gracias [referring to helping a client]”. you get that warmth; it encourages you to do more for that client because you connect. participants’ satisfaction also developed because using their language skills felt rewarding to them. as a social worker shared: “you get to make a difference in somebody’s life, that somebody else would not have made.” one investigator expressed himself by saying, “wow, it’s the reaction you get, and that is very rewarding. it makes you feel good.” a final factor, the cultural identity bond, influenced participants’ view of their language skills as an asset. factor #3: cultural identity bond the data reveals that for both native and non-native spanish speakers, the ability to serve lep clients’ in their dominant language contributed to developing a cultural identity bond that the authors consider can enhance or strengthen the helping relationship. in this study, “cultural identity bond” refers to the emotional attachments created by the sense of belonging to a community or group that shares a common language. in addition to sharing a common language, they also shared one or more of the following intersecting identities: cultural and ethnic background, social practices, traditions, beliefs, religion, history, trade, and knowledge and skills passed through generations. for example, a probation officer said, “they feel supported, they know that you are just like them, they feel that support and connection right away, in my agency compared to just english-speaking clients.” the cultural identity bond between the participants and lep clients was a main factor responsible for strong connections and satisfaction. participants credited the cultural identity bond for feelings of emotional attachment and responsibility towards lep clients. a social worker explained, “i think the cultural piece is important. you just find they connect with you. the reaction that i would describe is like giving candy to a kid.” another probation officer said, “it's great [referring to culture] because i feel like i’m helping my community.” all participants agreed that “it’s the look of relief that you see in other's face when they realize that you’re going to help them, and you can” speak spanish. participants recognized language as a critical component of the cultural identity bond that develops between them and lep clients. it is essential to understand language as a key component of the cultural identity bond. in its absence, the connections needed for positive client outcomes may not develop. advances in social work, fall 2021, 21(4) 1148 there was also the perception and assumption that a bilingual provider from the same culture facilitates an identification process that makes the lep client feel better understood and supported. a probation officer stated, i think the cultural connection is great...and i see in the client a positive attitude…wanting to change, wanting to successfully complete probation. i see that they can identify with me easily.there is something about the culture piece..if you can understand me as a latino. you definitely see success in these clients, and it is satisfying to see them leave your offices, successfully completing probation…and a few years later they thank you so much; i appreciate it. that's very satisfying; i think that is the best thing. the cultural identity bond between participants and their lep clients had a powerful emotional hold on the bilingual professionals. participants would go above and beyond their role because of their appreciation of the impact of language and cultural values on people, despite participants’ diverse racial backgrounds. for example, the importance of loyalty to and support of family, and the sharing and passing of knowledge and skills between generations were mentioned by participants. a native spanish-speaking clerical worker explained, i was raised here, but my mom does not speak english. so, when someone comes to the window and speaks to me in english, and i know that they are having a hard time… i'm not going to be like, oh well, let me have this person have a hard time and keep speaking english. no, i come up with spanish, and then at the end, they are like, oh thank you, and that makes me feel good because i see my mother there or my aunt, so i treat them like i would like my mom to be treated or someone else in my family. similarly, a non-native spanish-speaking social worker, aware of sociocultural factors, expressed taking on the supporting role of family when working with some lep clients who do not have family in the united states. she said, “our client’s family lives in honduras. we are the only ones that call them. no one else knows or cares about what is going on with them.” all participants reported that having a cultural identity bond through language made them feel good and motivated to do more when assisting lep clients. however, depending on the number of intersecting identities, participants had difficulty deciphering which of their identities had a stronger hold and whether their cultural identity bond was due to their shared language or other cultural identities. for example, a native spanish-speaking participant of latino descent claimed that because of the cultural value of “respeto” (respect), she felt more responsible for helping lep clients by using her language skills. there was a perception that for lep clients to be assisted by those who had the language skills was a way to show them “respeto.” participants felt it was their cultural duty to honor this cultural expectation. “respeto” was instrumental in the development of a cultural identity bond. a social worker said: it’s a sign of disrespect. if you have the skill set, i feel like i am more responsible for the things that may not be listed [referring to in the job description]. if you logan & negroni/bilingual professionals 1149 have the skill, then you should; coming from a person of that descent, they are going to think that is disrespectful. non-native spanish-speaking participants also felt a strong cultural identity bond to language that would not let them walk away. the attorney stated, “how can we say, no, though. i can’t, it’s amazing to me that you would sit there and watch somebody who can’t communicate, who wishes they could, you know you can, and just walk away.” ultimately, participants perceived their language skills as assets due to strong connections, satisfaction and appreciation, and cultural identity bond. these factors motivated them to do more and made them feel fulfilled professionally and personally. however, participants did not always view their language skills as an asset. bilingualism as a liability participants’ perceptions of their language skills seemed to change seamlessly from an asset to a liability if they did not set boundaries. one social worker stated, …there are other people [referring to co-workers] that don’t have it [referring to language skills] that ask you to make this phone call, can you go with me on this home visit, can you write this letter for me real quick? we really have to set boundaries. in this study, the term “liability” refers to a personal disadvantage or risk in the workplace due to language skills. participants’ perceptions of their language skills as a liability emerged when others made assumptions or had unrealistic expectations of their language skills. as a result, they felt their language skills hindered their work performance and led to dissatisfaction both professionally and personally. furthermore, they felt pressured and dissatisfied both professionally and personally because they knew if they did not use their language skills, it could result in unfavorable dispositions and/or outcomes of cases. the study found three factors that influenced participants’ perceptions of their language skills as a liability: (1) terminology and miscommunication, (2) limited bilingual services, and (3) pressure and dissatisfaction. factor #1: terminology and miscommunication in this study, participants discussed concerns that employers and colleagues assumed they could interpret for any lep individual seeking services at the organization. this assumption is problematic because appropriate interpretations entail knowledge of the professional concepts and terms used in the judicial system. interpreting is a professional job that requires special training. a probation officer asserted, “we weren’t trained to be a legal interpreter.” participants wanted to help but were worried about their preparedness, in the absence of proper training, to interpret or translate professionally and the problems that can arise from spanish dialect differences. an investigator shared a childhood story about miscommunication that plays a role in his comfort when interpreting others. he recounted, advances in social work, fall 2021, 21(4) 1150 there are certain words in puerto rico and how i was brought up; i never heard a cuss word in my life because my father was a minister. there are certain words that when i started learning spanish, i learned from venezuela. i think i’m the best thing since sliced bread. i come home, and i tell my dad some of the new spanish words i learned. he almost smacked me silly, ‘how dare you cuss and swear?’ i said i’m not swearing. i even took out my books, dictionaries; look, that’s what it says there. i’m trying to impress him because my father, whoever heard my father speak, is very eloquent in the way he speaks spanish. it’s the puerto-rican stuff. then i had to learn; there are certain words and phrases and even slang. it’s to the point that we are proficient enough to know, but we are not official interpreters. in the end, it can come back to bite you because the attorney either gives it to you or the client can give it to you. the different spanish dialects and lack of formal education in professional terminology led participants to question if their language skills were assets or liabilities. they felt concerned about the possibility of miscommunicating information in a high-stakes environment. errors in terminology or miscommunication, especially in an adversarial system, could affect clients’ legal dispositions, be a conflict of interest, or put their jobs at risk. a probation officer reported, i don’t think they (referring to monolingual individuals) realize how important it is to have someone who can interpret correctly…sometimes it’s a conflict of interest, so we cannot… and that’s a big problem because there is no true communication or a true understanding of the importance of having someone who is truly bilingual. another probation officer stated, “…we are efficient. we can have a conversation in spanish, but we weren’t trained with the lingo, and sometimes that’s a liability. they can come back and fire you because we translated something wrong.” the care coordinator reported monolingual colleagues also seek her language skills for languages she does not speak. she said, “they [referring to monolingual colleagues] hear somebody with a different accent or language, and they think it’s spanish, so they call me, i go there, and they [referring to lep clients] are talking to me in polish or italian.” participants asserted their monolingual counterparts lacked language competence and did not see potential conflicts of interest and implications that result from repurposing bilingual professionals to serve as interpreters or translators. participants also identified an additional factor that compounded this problem, limited bilingual services. factor #2: limited bilingual services in this study, limited bilingual services refer to agencies/organizations across systems that offer little to no services in languages other than english, restricting access to lep populations. limited bilingual services include but are not limited to bilingual forms, literature, bilingual providers, and bilingual specialized services. according to participants, limited bilingual services led to disparities and adverse outcomes, restricted access across service systems for lep clients, and caused lep cases to linger in the court system. as such, participants were forced use their language skills outside of their role to become logan & negroni/bilingual professionals 1151 protectors and gatekeepers and go above and beyond to ensure lep clients had an equal and fair due process. protectors. all participants understood the dangers of limited bilingual services for lep clients. their awareness of the disparities and adverse outcomes due to limited bilingual services in the court system led them to become protectors of lep clients. in their role as protectors, they were able to counteract adverse outcomes and disparities experienced by lep clients. a social worker said the lack of bilingual services was, …a very serious limitation because some of our clients are juveniles who have very serious needs, and when you refer them to a program where you know there isn't a spanish-speaking provider, they are not getting the services they need. but yet we are expecting them to improve and get to where they need to get; it's not really fair. participants reported that, at times, lep clients were treated differently due to limited bilingual services. therefore, if they did not intervene, the probability of a negative outcome was high. a probation officer shared a story of how she used her language skills to help a client whose family came from the dominican republic. the client, a juvenile, was accused of stealing the bike gifted to him by his father. she said, it was just discrimination after discrimination with this kid. he [the father] had all the paperwork, the kid wasn't even there [corner store], but he went to get a soda. when he got the soda, the cop arrested him on the scene. he [the cop] did not catch him driving the thing, but he got arrested and was sent here [juvenile court]. he [the father] had his own business, so he had to pay for his own attorney. so, he [the father] said, i'll be my own attorney. so, i had to educate him and intervene and got everything dropped. he was intelligent enough in spanish but couldn't navigate the system. in their role as protectors, not only did participants use their language skills to help monolingual co-workers with lep cases, but they protected clients from discrimination. in doing so, they could prevent lep cases from being overlooked or lingering in the system. they reported that if they did not use their language skills outside of their role, the work would not get done, and the client suffered the consequences. a probation officer stated, in the long run, it won't benefit the client either if you don't do it [use language skills outside of their role]. you keep waiting, right here [referring to the court system]; everything is time. you have someone's freedom in jeopardy. then, it's this person [referring to lep clients] who is going to sit in detention; they are going to sit in jail because this did not get done, and i'm responsible for him getting out. like other study participants, one investigator reported that he has often thought to himself, "wow, this is beyond my capability or beyond my job descriptions. but if you don't do it [use language skills outside of role], certain things are not going to get done." participants expressed the importance of using their language skills, not just in the court system but across systems, to help lep clients access services and prevent adverse outcomes. advances in social work, fall 2021, 21(4) 1152 gatekeepers. participants in this study were compelled to perform as gatekeepers of services. in the context of limited bilingual services, gatekeepers refer to participants using their language skills to facilitate access to services across systems due to limited bilingual services. the study found that if participants did not use their language skills outside of the court system, lep clients would not have their needs met, impacting their court cases. a probation officer explained, i think a lot of our families that are only spanish-speaking have a more difficult life; they have more struggles that directly impact our clients. whether they will be successful or not, if a parent comes in who doesn't speak english and needs help with section 8, a lot of times we do it. even though it's beyond our scope of really what we have to do because we think ahead, okay, if this family loses their apartment, then there goes the stability it's going to affect my client, and the case may fall apart. another probation officer explained her gatekeeping role outside of the court system to help lep clients in the school setting. she reported, i think we have all been at school meetings, or ppt's [planning and placement team meeting] where then, again, there is a lack of interpreters… so whoever is at the table who can somewhat speak the language would be expected to translate for the parents or for the child and… so it becomes difficult in almost every area that we are involved in because there is limited human availability for people to assist. the data showed that gatekeeping was a necessary role for participants in helping monolingual co-workers complete their jobs and ensure lep clients had access to an equal and fair due process. above and beyond. participants found themselves going above and beyond to assist co-workers with their cases. in this study, going above and beyond refers to participants overextending their language skills to perform extra work due to limited bilingual services. all participants agreed the limited bilingual services burdened them with extra work that forced them to use their language skills outside of their role, unlike their monolingual counterparts. a probation officer stated, “the biggest difference is that this [referring to his language skills] is our own responsibility, unlike others [referring to monolingual colleagues], their only responsibility is to provide services.” another probation officer asserted, i think we also sometimes go above and beyond trying to help our non-spanishspeaking coworkers and at times doing their [referring to their monolingual counterpart] jobs, whether it’s interpreting for them in an office visit, interpreting their voice mail, or calling people on their behalf. i’ve actually taken cases that are not in my geographical area to cover because it's a spanish-speaking family; not only are we going above and beyond in our caseload, but we are taking some of the caseloads of others as well. furthermore, participants reported going above and beyond hindered their ability to complete their work. as stated by a probation officer, “it comes to a point where i have to logan & negroni/bilingual professionals 1153 keep up with my paperwork. i have to be twice as busy as my peers. you have to do your work, and you have to do somebody else’s job.” limited bilingual services led participants to go above and beyond. they become gatekeepers and protectors for their lep clients and their monolingual co-workers’ lep clients. factor #3: pressure and dissatisfaction co-workers often pressured participants to use their language skills; for many, it was assumed and expected. in this study, pressure is defined as being forced or assigned to use language skills outside one’s job description without consent. for example, a social worker stated, “i feel that when you have the skill, that very often you are forced to use that skill.” similarly, a clerical worker said, “i have this big thing on my shoulders, where i have to make the branch look good.” a probation officer stated, i’m not an interpreter. i have a job, whether i am an administrator, a clerk, a social worker. i have a job. i have a caseload that is disheartening, and it varies within an agency. you are in a field capacity, i think sometimes, i am going to be very frank, i think in this position you feel that you’re it, and you have the weight of the world on you because you have concern, passion, and you need to bring about changes because you think about that client all the time. people around you don’t feel the same way about the client, and those kinds of issues. participants also reported experiencing attitudes from their monolingual professionals who expected and demanded that they use their language skills upon request to benefit others’ work at their expense. these attitudes led participants to feel dissatisfied and unhappy. the attorney said, “it's part of just an attitude, i think there is this awareness in the agency that you need to be doing this, and they feel it is something that they are looking for; it’s amazing that our agency seems to think we don’t have any problems with this.” a dissatisfied investigator stated, i’m only one person. i can’t help them all. i think that is the part that is not gratifying and is really disheartening because at times, you have to draw the line. because i can’t be all things to all clients. i think too it’s the attitude, it’s negative. the attitude that people in the office, co-workers and colleagues take. you’re there as an interpreter, no i’m not. participants reported perceiving their language skills as a liability when they observed and experienced those attitudes. they were not comfortable when superiors and co-workers expected or relied on them to attend to lep clients who were not in their caseloads. one probation officer reported dissatisfaction due to “…being relied upon too much by your non-spanish speaking co-workers. kind of taken advantage of at times.” as a result, participants encountered excessive workload conditions, which made them feel overextended. they considered that their language skills were the reason they were overextended, preventing them from completing their work. another probation officer asserted, we as professionals provide a service, and i think as professionals, the tendency is that for our co-workers and colleagues and agencies that we work for, we overextend ourselves. we are not there to do everyone’s job. it is great that we are advances in social work, fall 2021, 21(4) 1154 there to serve the client and help them. but you have your own job to do. you are pulled in a thousand different directions because you feel you need to help that client, but it cripples you; you become a jack of all trades and a master of none! participants described another conflict resulting from monolingual co-workers' unrealistic expectations. they explained a struggle between their desire to help lep clients and their discomfort and disagreement with those unrealistic expectations. this struggle made them feel dissatisfied and uncertain about how beneficial it was to have bilingual language skills. an investigator said, “as a professional, for me, it is disheartening because you feel like you want to help them all, but it is impossible.” a probation officer saw his language skills as “kind of a curse.” when bilingual professionals were repurposed as interpreters, they perceived their language skills as a liability, as stated by another probation officer, “…you’re asked, once again as a liability, to take two hours and do a home visit because my co-worker does not speak spanish.” ultimately, this study found that participants’ perceptions of their bilingual skills highly depended on how others used their language skills in the workplace. bilingual professionals encounter challenges rooted in discrimination disguised as assumptions, unrealistic expectations, and differential treatment that convert their language skills from assets to a liability. when bilingual professionals fully controlled their language skills, they viewed their language skills as an asset. however, when bilingual professionals were exploited and repurposed as interpreters, in essence, taken advantage of for having that extra qualification, they viewed their language skills as a liability. furthermore, the extra help they provided their co-workers further took them away from their cases and prevented them from doing their work, leading participants to see their language skills as a liability. limitations this study adds to the literature and the work of prominent scholars such as engstrom and min (2004), who assert more research needs to occur in this area to better understand the challenges faced by bilingual professionals. there are a couple of limitations. first, all but two of the participants worked in the judicial system. furthermore, the participants in this study spoke english and spanish. therefore, one must be cautious not to make generalizations regarding bilingual professionals across work settings or languages. additionally, collecting data via focus groups presents limitations in that participants’ answers may be influenced by other participants or may have been hindered their sharing of information due to their comfort level with others in the focus group (bryman, 2012). lastly, the researcher is a latina bilingual professional with 20 years of experience as a social worker in the judicial system. the researcher’s position could have influenced participants’ involvement and level of candidness. discussion bilingual professionals' perceptions of their language skills, as either an asset or a liability, depended on co-workers’ attitudes and the expectations about their use of those skills. participants acknowledged that being bilingual portrayed numerous benefits for the logan & negroni/bilingual professionals 1155 lep clients, their co-workers, and the agency. for the lep clients, the benefits included access to services and positive case outcomes. co-workers had the benefit of more effectively connecting with their lep clients despite the language barrier, and the agency was able to provide needed services in the absence of proper language resources. for the bilingual professionals themselves, the benefit entailed a sense of satisfaction and accomplishment. a profile among bilingual professionals emerged that merits further attention. the bilingual professionals carry out multiple duties where they not only communicate and serve lep clients but engage in roles such as protector and gatekeeper. the similarities between participants and their lep clients contributed to developing connections and trust that allowed for assessments to be completed as lep clients feel more comfortable sharing information. bilingual professionals not only facilitate assessments and service provisions but “more importantly,” advocate, mediate, and connect lep clients with resources within and outside of the court system. bilingual professionals’ ability to build strong connections was tied to the shared cultural identity with their lep clients. a significant finding is the notion of the “cultural identity bond” that develops between lep clients and bilingual professionals. naturally, individuals gravitate to those who are similar. social identification with a particular group is a necessary cognitive function embedded in our emotions (brown, 2000). this bond is a significant component in the development of a professional helping relationship. additionally, a secondary gain or reward consisted of supporting and validating lep’s and bilingual professionals’ cultural identities. this was meaningful to the participants and should be considered in professional development, client assessments, treatment, and the overall support provided to bilingual professionals. bilingual professionals experience personal and professional satisfaction when contributing their language skills to an lep client’s well-being within their caseload. through participant contributions, one could appreciate the presence of latino cultural values of "personalismo” (personal relationships), “familismo” (family-oriented), and “respeto" (respect). these values played a significant role in participants' decisions about how and when to use their bilingual skills and their perceptions of their language skills. the appreciation and satisfaction experienced by participants seemed to give them a sense of belonging that they did not find with monolingual employees and employers, who often imposed attitudes, assumptions, unrealistic expectations, and differential treatment. evidently, agencies serving lep individuals and families need to build a workforce of bilingual professionals who can communicate in the dominant language and develop a cultural bond. this study suggested that the cultural identity bond between lep clients and bilingual professionals is an essential contributor to a positive helping relationship. such observation implies that having professionals who have a deep understanding and share similar cultural identities with their service recipients can benefit the helping process and should be promoted and provisioned by agencies and administrators. there must be an awareness of the challenges bilingual professionals encounter in the workplace. failing to recognize these challenges may have adverse outcomes for both bilingual professionals and lep clients. in this study, participants reported feeling advances in social work, fall 2021, 21(4) 1156 pressured, dissatisfied, frustrated, and overextended in their work due to their co-worker’s unrealistic expectations, assumptions, and dependence on them beyond the scope of their job descriptions. logan (2018) asserts unrealistic expectations, assumptions, and differential treatment due to language skills are rooted in microaggressions. microaggressions are subtle forms of conscious and unconscious discrimination that communicate hostility and attitudes towards underrepresented groups, such as bilingual professionals (sue, 2010). employees’ perceptions, assumptions, and expectations of bilingual professionals must be addressed informally and formally within the agency setting. when others use their power to implicitly or explicitly control bilingual professionals’ language use, there are consequences to the bilingual professionals that result in discrimination. a power and control “dance” between bilingual professionals and other workers, including superiors, is dangerous and will eventually affect working relationships and service quality. essentially, participants' language skills become a weapon used against their will to benefit others' work. if bilingual professionals did not use their language skills, the lep clients would not be treated fairly. clients would be dismissed or ignored, and their needs may go unmet. in a way, the fair and just treatment of lep clients is used to manipulate bilingual professionals to use their language skills. in this study, participants felt responsible for helping the lep clients they identified with and cared about due to disparity in treatment. they felt obligated to go above and beyond to address lep clients' needs. with the pressure to use bilingual professionals as interpreters, there is potential to harm clients and service provisions if professionals have to perform without the appropriate training and knowledge of terms and concepts. participants in this study did not feel comfortable and feared the consequences. forcing bilingual professionals to be responsible for different terminology and possible miscommunications without organizational support was deemed inappropriate. likewise, going above and beyond their regular duties to bridge language gaps across social services felt unfair. ironically, in some instances, bilingual professionals could not complete their tasks without going above and beyond. for example, one participant needed to use her language skills to stabilize housing for her client to be released from detention. the extra work performed by bilingual professionals is often not accounted for and led to disparities between their workload and that of their monolingual counterparts. in this study, bilingual professionals tried to balance their feelings, desire to help, obligations, and responsibilities. in participants' opinions, monolingual co-workers and supervisors failed to recognize the problems they encountered as bilingual professionals. participants fell victim to attitudes, assumptions, expectations, and differential treatment because of their language skills. a participant alludes to organizational leaders being clueless or turning a blind eye to the challenges bilingual professionals face. the message embedded in participants' contributions highlight oppressive organizational structures and dynamics across systems that led bilingual professionals to perceive their language skills as a liability. in essence, bilingual professionals become the scapegoat across systems that are not culturally aware and ignore or refuse to accept responsibility for delivering quality, logan & negroni/bilingual professionals 1157 culturally and language-competent services to lep populations. participants reported being the sole person responsible for implementing bilingual services. expecting bilingual professionals to be accountable for meeting the diverse needs of lep populations without proper support is ineffective; diversity is everyone’s responsibility, bilingual and monolingual professionals alike (doering-white, 2020; milem et al., 2005). ignoring and passing the responsibility to bilingual professionals without adequate support to bridge the gap of services for lep populations continues the cycle of disparities across social service systems. glover and richardson (1997) assert that equal access to justice in the court system, fairness, and protecting public trust and confidence is all about diversity. conclusion monolingual professionals exert bias, power, and control over the use of bilingual professionals’ language skills, with no regard for their feelings or work responsibilities. despite the value placed on having language skills by the judicial system and other organizations, bilingual professionals are often taken for granted. they experience and witness discrimination towards lep clients from the point of arrest to the deposition of the court case. as a result, participants experienced both negative and positive feelings regarding their language skills depending on utilization and the changing contexts of dayto-day work. participants reported the lack of cultural and language competence is at the root of the misuse of bilingual professionals. the findings have numerous implications for organizational practice and future studies, especially in settings where disparities between demands to work with lep clients and the availability of bilingual professionals are prevalent. for example, administrators need to understand and recognize the ways bilingual professionals are misused, and assess and address the cultural climate, barriers, and organizational structures that prevent access and fair practices for lep clients and their providers. mederos and woldeguiorguis (2003) assert that administrators must have a sustainable strategic plan and support all professionals serving lep populations to impact employees' performance positively. administrators can help employees by implementing and enforcing anti-racist policies that protect language skills, offering financial compensation for extra duties, and hiring more bilingual professionals and professional interpreters. finally, to reduce discrimination for lep clients and bilingual professionals across systems, social work administrators and educators must develop practices and train specifically about cultural awareness, diversity, and language competence. future studies should explore monolingual professionals’ and supervisors’ perceptions of bilingual professional language skills and the impact on the workload of bilingual professionals. another area for further study is how lep clients perceive and are impacted by services provided by bilingual professionals versus monolingual professionals (with or without interpreters). additionally, identifying the types of 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(1996). the relationship of health perceptions, physical and mental health, and language use to usual source of care. in m. lillie-blanton, w. leigh, & a. alfaro-correa (eds.), achieving equitable access (pp. 75-98). university press of america. author note: address correspondence to isabel logan, department of sociology, anthropology, criminology, and social work, eastern connecticut state university, willimantic, ct, 06226. email: logani@easternct.edu ______ sarah c. johnson, mlis, lmsw, adjunct lecturer, school of information sciences, university of illinois at urbana-champaign, chicago, il. margaret ann paauw, phd, lcsw, adjunct instructor, loyola university chicago, and team lead, homeless outreach program, thresholds, chicago, il. mark giesler, phd, lmsw, professor, social work, saginaw valley state university, university center, mi. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 166-184, doi: 10.18060/26176 this work is licensed under a creative commons attribution 4.0 international license. “spending a year in the library will prepare you for anything": experiences of social work interns at public library field placements sarah c. johnson margaret ann paauw mark giesler abstract: many public libraries across the country have looked to the field of social work to assist in meeting the needs of patrons. oftentimes, libraries have limited resources to provide a social worker, so they are partnering with local universities to provide social work interns. the purpose of this study was to hear from the library social work interns themselves about their experiences of completing their social work field placement in a library setting. this study was conducted in two parts: an online survey with 35 respondents and semi-structured qualitative interviews with 14 participants. the online survey included demographics and questions regarding students’ experiences completing an internship in a public library. the follow-up interviews consisted of in-depth questions exploring the unique challenges and transferable skills learned while in their placements. the findings speak to the importance of role clarity, physical space, confidentiality, and supervision arrangements. this study also found that, regardless of the challenges of these placements, interns overall had positive experiences and spoke highly of their librarybased field experiences. recommendations include identifying field-specific challenges in a library-social work partnership for those who are in the field as well as future research involving other stakeholders, such as librarians, university staff, and supervisors. keywords: supervision, social work students, public libraries, social work field placements, internships partnerships between public libraries and schools of social work have grown exponentially since the first known collaboration in 2009 with the san jose public library (luo et al., 2012). in response, corresponding academic literature addressing the existence of social work library interns has also increased in recent years. while this coverage speaks to aspects of what social work library placements entail, there is a paucity of literature about these placements as told from the perspective of student interns themselves. the current research fills this gap by gleaning insights from bsw and msw social work students who conducted their field placements in public libraries throughout the united states between 2017 and 2020. literature review approximately 160 public library branches in the united states host social work students as interns (zettervall, 2023). while there are active partnerships in australia and canada (garner et al., 2021; schweizer, 2018), the bulk of known collaborations exist in the united states. scholars who consider this topic deem these collaborations as essential about:blank johnson et al./a year in the library 167 to help meet the needs of underserved patrons while offering quality generalist placement opportunities (wahler et al., 2021). social work student interns can help enhance public libraries’ capacity to address high-needs patrons through a holistic response of targeted programming that can benefit all library stakeholders (aykanian et al., 2020; kelley, et al., 2017). social work practice placements at public libraries can also engender a better understanding of similarities and differences between the two professions and thereby paint a fuller picture of library patrons’ needs (zettervall & nienow, 2019). previous studies on social work student library placements primarily focus on working with a specific population, such as patrons experiencing homelessness (aykanian et al., 2020; provence, 2018), a singular library branch (cuseglio, 2020), or one library system (provence et al., 2020; wahler et al., 2019), examine specific training for library staff (sharkey et al., 2021), or offer a broad review of such partnerships (johnson, 2019). soska and navarro (2020) report the development of social work education partnerships with libraries as an emerging and important phenomenon, but do not address the experiences of interns and their work. the present study delves deeper into topics examined by existing literature on the type of micro, mezzo, and macro tasks (johnson, 2021) social work students at libraries take on, including their responsibilities such as needs assessments (provence et al., 2020) and training librarians (sharkey et al., 2021). our research is unique as we spoke directly with an array of interns from all over the united states – beyond just one branch or library system – about their lived experiences. the current study answers the call to conduct further research on these interprofessional collaborations (soska & navarro, 2020) as it used both quantitative and qualitative research methods to better understand the perspectives of students about their experiences in library-based social work field placements. the current study used the following exploratory research question to address the aforementioned gap in the literature: "how do social work student interns placed in public libraries perceive their work?" methods the design for this study was a sequential mixed methods approach (creswell & creswell, 2018) that included a survey to collect demographic data followed by interviews. both of these quantitative and qualitative approaches were approved by the irb by saginaw valley state university. all participants were provided a consent form to complete and send back to the researchers prior to completing the survey. the consent form explained the researchers’ procedures for anonymizing and safeguarding the collection and storage of data. participant eligibility the sampling frame for the study was bsw and msw social work student interns who completed their field placements in a public library setting between the years 2017 and 2020. the researchers made no stipulations related to type of program (generalist or specialist) that participants attended. all eligible participants resided in the united states. advances in social work, spring 2023, 23(1) 168 quantitative procedures eligible participants were gathered from a list of already-established professional contacts gathered by one of the researchers. additionally, three professional listservs targeting both librarians and social workers were used to identify participants. the researchers determined, based on updated information from the whole person librarianship community of practice (2023) listserv, that this listserv had an accurate count of current and former interns and were thus contacted for this study. invitations to participate in the study were sent through email and postings via the professional listservs in october 2020. the survey was sent directly to 47 interns. in addition, 78 field supervisors were sent the survey link with instructions on how to forward it to eligible participants. to increase enrollment in the study, an additional email reminder was sent to both interns and field instructors after a period of two weeks. a total of 35 participants completed the survey. participants could opt to provide their email address if they wanted to participate in a follow-up qualitative interview. all but one participant had completed their field placement at a public library by the time they participated in this survey. one participant was conducting their field placement at the time of this survey. the quantitative portion of this study was a 28-item non-standardized qualtrics survey containing multiple-choice questions and two open-ended questions created by the researchers based on an extensive review of the literature. questions assessed demographics of participants and the libraries in which they were placed, as well as the tasks assumed in their roles. additionally, participants shared their perceptions of how challenging their tasks were in their library field placements. they also reflected on how their internship experiences affected the next steps in their social work career. finally, they rated their satisfaction levels on a likert scale. nearly all of the multiple-choice questions offered an open text option for participants to provide an explanation if warranted. qualitative procedures a semi-structured qualitative interview protocol allowed participants to elaborate on their quantitative survey responses. questions clarified participants’ perceptions about their tasks and duties, including challenges they encountered, resources they accessed, ways they connected with their universities, and the arrangement they made with their supervisors. participants were also asked to reflect on the collaborations they had with library staff and patrons. fourteen of the 35 participants who responded to the survey agreed to participate in the qualitative portion of the study. twelve of the 14 were masterslevel and two were bachelor-level placements. interviews were conducted and audiorecorded via zoom and then professionally transcribed. interviews lasted 60 minutes on average. johnson et al./a year in the library 169 data analysis quantitative survey survey data were analyzed using qualtrics software. qualtrics computed the results while protecting the privacy, anonymity, and confidentiality of all participants. demographic tables and basic descriptive measures, including mean, median, mode, and standard deviation, provided a summary of participants’ responses. qualitative interviews our process of analyzing and jointly reviewing the data served as a means of triangulation (padgett, 2017). we used corbin and strauss’ (2008) constant comparison process: "as the researcher moves along with analysis, each incident in the data is compared with other incidents for similarities and differences. incidents found to be conceptually similar are grouped together under a higher-level descriptive concept” (p. 73). transcripts of the interviews were divided among the researchers for review. an initial reading of these transcripts elicited the following codes based upon phenomena that directly correlated to themes identified in the literature review: tasks/duties of placement, challenges presented, supervision arrangement, and supports accessed. for the second iterative reading, the researchers reviewed different transcripts to validate the codes. a third and final reading of the transcripts allowed the researchers to place the interview data within the codes. from this reading, themes were determined. internal validity of qualitative component of study validity specific to qualitative research is “the correctness or credibility of a description, conclusion, explanation, interpretation, or some other sort of account” (maxwell, 2013, p. 122). contrasting this definition with the quantitative focus on objective truth, maxwell (2013) explains that a valid study contains results that accurately represent the phenomenon being studied. among the several techniques for ensuring validity that maxwell (2013) and other researchers (guba & lincoln, 1989) reference, the current study used three forms of validity: rich data, numbers, and peer debriefing. creswell (2013) refers to extracting “rich, thick descriptions” (p. 252) from study participants as a form of validity as others can transfer such information to other settings because of its shared characteristics. in stake’s (2010) words, “a description is rich if it provides abundant, interconnected details” (p. 49). in the current study, we provide details when describing a case or a theme, often using participants’ words to do so. second, maxwell (2013) notes many conclusions from qualitative studies have implicit quantitative components. counting incidences of comments related to a theme provides a clue to the evidence bearing on a particular conclusion. we used this approach in our reporting on the narrative data to support a theme’s viability. lastly, creswell (2013) notes intercoder agreement is a form of peer debriefing that contributes to the validity of qualitative research. in this study, we met after the interviews advances in social work, spring 2023, 23(1) 170 were completed to discuss our impressions and thoughts connected to the data. through an iterative process of independent and conjoint coding, we came to an agreement on the codes and categories elicited in the study. findings survey results the survey included sociodemographic items to describe participants’ (n=35) level of education, length of internship, and size and setting of their library site. twenty-nine participants (82.9%) were msw (master of social work) students. of these individuals, 41.7% were in their first year of a two-year program when they completed their library internship. the rest were either in their second year or in an advanced standing program. six participants (17.1%) were bsw (bachelor of social work) students. most participants (62.9%) were in an academic year (august-may) placement. four participants (11.4%) completed one semester placements. educational tracks of participants participants were asked what educational tracks they were following during their internships. over one-third of the msw participants (37.5%) had a macro focus, defined as “community organizing/macro” and “policy,” compared to three (12.5%) who were on a micro (“clinical or interpersonal practice”) track. a total of 16.7% of msw participants were on an “advanced generalist practice” track while other tracks included “children and families,” “leadership,” and “forensic social work.” bsw students do not have a defined track as they are considered generalists at the undergraduate level. participants were also asked to describe the size and setting of their library site. half (50%) designated their branches as “mid-sized,” twelve participants (31.6%) were at “large” libraries, and five (13.2%) described their branches as “small.” participants opted to self-describe from a pre-selected list of descriptions. there were no criteria for defining "small", "mid-sized" or "large" libraries. when asked to describe the type of community where the branch was located, 18 participants (48.7%) answered “urban,” 16 (43.2%) responded “suburban,” and three (8.1%) identified their communities as “rural.” duties assumed during placement survey participants also identified the duties assumed during their placements. they noted that they conducted needs assessments, facilitated staff training, and provided outreach to library patrons. needs assessments. nearly three-quarters (73.6%) of participants conducted some form of needs assessment as one of their internship duties while eleven (20.8%) did not engage in this task. table 1 lists the targets of the needs assessments for those who completed them. the 5.7% “other” responses indicate needs assessments were initiated but not completed due to covid-19 interruptions. johnson et al./a year in the library 171 library training topics. nearly half of participants (48.7%) provided, coordinated, or facilitated workshops for library staff. table 1 shows the topics addressed at these training sessions. workshops provided by participants that fell into the “other” category included “domestic violence prevention,” “child abuse awareness,” and “social services available for patrons.” table 1. focus of participants’ duties focus n (%) needs assessments (n=42)* library patrons 17 (40.5%) community members 10 (23.8%) library staff 7 (16.7%) community-based organizations 5 (11.9%) other 3 (7.1%) total 42* (100%) library training topics (n=30)** mental health 101 9 (30%) staff/patron self-care 7 (23.3%) other 6 (20%) trauma-informed principles 4 (13.3%) de-escalation tactics 2 (6.7%) impact of existing library policies 2 (6.7%) total 30** (100%) notes: * duplicate responses from participants. ** number of participants who responded to this question. outreach. the survey asked participants about the types of outreach they provided to library patrons. participants were able to select more than one option; therefore, there were 91 total responses to this question. thirty-four (37.4%) participants made referrals to local resources such as those that provide financial assistance and a similar proportion (35.2%) offered technical assistance with completing online applications or forms. twenty participants (23.1%) developed or modified programs for library patrons, such as programs to assist patrons experiencing homelessness. only one participant did not provide outreach as part of their job. amount of time spent with constituencies encountered by participants table 2 depicts the amount of time participants spent with various constituencies, scaling the length of time from 1 (small amount of time) to 5 (large amount of time). mean scores indicate participants spent most of their time with library patrons (m=4.09). library staff and supervisors ranked second (m=3.17) and third (m=3.03), respectively. participants spent the least amount of time with community agency representatives (m=2.97) and library administrators (m=2.63). advances in social work, spring 2023, 23(1) 172 table 2. amount of time spent with constituencies encountered by participants constituent mean std. v variance n library patrons 4.09 1.16 1.34 35 library staff 3.17 1.18 1.40 35 supervisors 3.03 1.11 1.23 35 community agency reps 2.97 1.04 1.09 34 library administration 2.63 1.24 1.55 35 note: scale: 1 = least amount of time; 5 = most amount of time. perception of how challenging tasks were table 3 shows participants’ perceptions of how challenging their duties were. participants rated their perceptions on a scale from 1 (not challenging at all) to 5 (very challenging). the three tasks that ranked as most challenging, all scoring above a mean score of “2,” were “developing programming,” (m=2.29) “developing library training,” (m=2.13) and “knowledge about (understanding the roles, tasks, and responsibilities of) the position” (m=2.09). the three items that ranked least challenging were “time management for tasks” (m=1.38), achieving buy-in from library staff about their role (m=1.34), and communicating with university staff/field directors about the field experience (m=1.14). table 3. perception of how challenging tasks were as reported by participants task mean std. v variance n developing programming 2.29 1.52 2.32 35 developing library training 2.13 1.52 2.32 30 knowledge about position (duties/ tasks/responsibilities) 2.09 1.73 2.99 35 helping library staff understand role 1.76 1.55 2.42 34 referrals to/relationships with community-based organizations 1.74 1.40 1.96 35 knowledge about surrounding community and its needs 1.69 1.35 1.82 35 support in your role as intern 1.66 1.66 2.74 35 interaction with library patrons 1.56 1.46 2.13 34 supervision of your work 1.40 1.5 2.24 35 time management for tasks 1.38 1.53 2.35 34 achieving buy-in from library staff about role or place at the library 1.34 1.39 1.94 35 communication with university staff field director about experience 1.14 1.62 2.64 35 note: scale: 1 = not challenging at all; 5 = very challenging. reports of satisfaction levels of interactions with constituencies survey participants were asked to report the title or status of the person designated as their social work supervisor. nearly half (48.7%) identified a university staff member as johnson et al./a year in the library 173 fulfilling this role. a similar proportion (43.2%) reported their supervisor was a social worker either employed at the library itself (21.6%) or contracted from a local agency (21.6%) while four (10.8%) answered “other” to this prompt. those individuals who answered “other" indicated a library staff member who is not a social worker, served in this supervisory capacity. participants were also asked to indicate how often they met with their supervisor. of the participants who responded to this prompt, 27 (67.5%) stated they met with their supervisor “weekly.” five participants (12.5%) indicated bimonthly meetings and seven (17.5%) responded they met on an “as needed” basis. participants rated their satisfaction with interactions they had with various stakeholders connected to their internships: university staff, supervisors, library staff, and library patrons. these findings are compiled in table 4. most participants answered they were either “very satisfied” or “satisfied” for all prompts. these perceptions matched responses to the prompt, “indicate the satisfaction level of your internship as a whole.” a sizable majority (83.3%) of those who responded to this survey item indicated they were satisfied or very satisfied with their internship experience. table 4. reports of satisfaction levels of interactions with constituencies constituent very satisfied satisfied neither s or d dissatisfied very dissatisfied university staff 13 (37.1%) 15 (42.9%) 3 (8.6%) 1 (2.9%) supervisor 20 (54.1%) 7 (18.9%) 2 (5.4%) 4 (10.8%) 1 (2.7%) library staff 17 (47.2%) 12 (33.3%) 2 (5.6%) 2 (5.6%) 2 (5.6%) library patrons 14 (37.8%) 17 (46%) 5 (13.5%) experience as a whole 18 (50%) 12 (33.3%) 5 (13.9%) 1 (2.8%) qualitative interview results analysis of the qualitative interviews cultivated four major themes: (1) a broad range of practice that spanned from micro-level interactions with patrons to macro-level program development; (2) challenges with tasks and responsibilities at the library; (3) primarily positive experiences with supervisory supports; and (4) obstacles related to the physical setting of the library. to maintain participants’ anonymity, a naming convention was adopted (e.g., “p1” for participant 1). full generalist practice experience though most participants were on a macro/advanced generalist track, they described their library placement experience as incorporating a combination of micro, mezzo, and macro tasks with an emphasis on micro-level. the following section offers examples of each level of practice that library social work interns experienced in their field placement. participants conducted micro-level tasks that included individual case management, resource navigation, assistance with completing forms, vocational assistance, conflict resolution, and crisis intervention. participants assisted a variety of library patrons, including people experiencing homelessness, adolescents, immigrants, older adults, middleand working-class individuals, persons who were deaf and hard of hearing, persons advances in social work, spring 2023, 23(1) 174 who were low-vision/visually impaired, and patrons experiencing mental illness. participants indicated that this micro-level work involved a significant amount of relationship-building that included supportive listening and initiating contact with individuals. several participants noted that partnerships were crucial for providing proper referrals to community agencies. learning about community programming and local services was identified as a useful mezzo practice while in placement. participants reported collaborating with a myriad of community partners, such as police officers, domestic violence centers, homeless shelters, churches, adult education programs, and re-entry programs. other mezzo tasks included facilitating events, the most common of which was “coffee & conversation,” wherein social workers invite community members to the library to discuss what is on their minds. additional mezzo tasks included organizing resource fairs, creating community resource flyers, and training library staff on trauma-informed approaches to working with patrons. lastly, participants engaged in macro-level tasks, such as attending library board meetings, helping create or modify library policies and procedures, writing grants to obtain or secure funding, and developing and/or implementing needs assessments. challenges related to participants’ tasks and responsibilities: “an ideal mix” the challenges participants encountered related to their placement duties primarily involved unmet expectations, lack of role clarity, and differing philosophies between social work and librarianship. expectations. though all 14 participants engaged in a blend of micro, mezzo, and macro tasks, several anticipated doing more macro work than they experienced. two participants expected more direct guidance from library staff: “i was expecting a little more hand-holding and someone watching over me all the time...whereas this offered no direct supervision and no social worker on site. it was just like ‘here you go’” (p13). others noted they did not have any expectations as they were the first interns at their branch or from their university: “i didn’t put up any expectations because i was a guinea pig…i was the one creating this. we didn’t know what we were doing so i didn’t put up a lot of expectations” (p11). role clarity. one of the biggest challenges reported by participants was the absence of role clarity and understanding of their duties. over half of the participants said their daily tasks were unclear, as p8 noted: "nobody knew what i was supposed to do so my basic duties were what i made up as i went along.” others relied on their prior work experiences to carve out their duties and even participants who were not the first interns at their site described their roles as “ambiguous” (p7). this lack of clarity, per participants, also confused library staffwhich led to inappropriate referrals and expectations. to alleviate this concern, one participant spent significant time educating librarians about what social work entails. participants also spoke of restrictions about the type of tasks they were allowed to conduct. some felt confined by services they could offer due to being at a library placement johnson et al./a year in the library 175 versus a traditional social service organization. p5 stated there was “a lot of hesitancy to let us be social work interns because there was no clinical social worker onsite to supervise.” this student also noted their library administrators expressed concern about liability and would not allow them to generate referrals to social service organizations. throughout the interviews, participants reported struggles with navigating bureaucracy and confidentiality that inhibited social work services, such as maintaining basic documentation and anonymous data collection from library patrons. differing philosophies. some participants further determined that because public libraries are nontraditional host sites--where the primary purpose is not for social services or standard social work practice--the dynamic between library staff and social work students was complicated. some experienced minor conflicts over values, such as confidentiality, which highlighted for them philosophical differences between the two professions. one participant described the arrangement as a “tug-of-war,” where social workers saw themselves as meeting the needs of the community while librarians were concerned that having a social worker present “scared people away” (p1). p5 sensed their role was “rubbing up against the system” and experienced a lack of resources and crosscollaboration resulting in “missed opportunities.” responses to challenges: skills developed. though participants faced challenges pertaining to expectations, role clarity, and differing philosophies, they spoke of pivoting and overcoming obstacles through transferable skills they took with them after their placement. participants described library placements as ideal for those who are self-starters and adept at taking initiative: “what you get out of this internship is what you put into it” (p12). for those who did not embark on their internship with this mentality, many found they were pushed to hone such skills. one participant, who had little role clarity, decided to create a job description to help future interns navigate what their responsibilities would look like. another participant who anticipated more macro work still found the challenge of unmet expectations worthwhile: i was gaining all the competencies i needed for macro practice and i was also doing micro casework which was the perfect balance for me. i love people but i also love being able to provide something for them. that was an ideal mix. (p11) library placements offered participants valuable experiences working directly with patrons, including skills with advocacy and navigating systems, de-escalation, approaching and networking with community partners, and flexibility with adapting to the needs at hand. p8, for example, determined that “spending a year in the library will prepare you for anything.” experiences related to support and supervision per the council on social work education (2022) requirements, all participants obtained supervision from an individual trained as a social worker. each participant also had a librarian assigned to them as their “task supervisor” to oversee daily work in the library. furthermore, all participants met with a professor and fellow classmates during a advances in social work, spring 2023, 23(1) 176 weekly field seminar class and others found support through online connections. all four formats provided a mode of supervision for the interns. while mostly positive, some participants noted aspects of supervision were challenging, whether due to the absence of a professional social worker at the library, a contracted supervisor that was unavailable, or an unresponsive library task supervisor. social work supervision. though only three participants had a library-based social worker to provide them social work supervision, the remaining eleven participants were supervised by an external social worker either from their university or contracted by the library or a community agency. p10 found the latter “very helpful in developing my basic clinical skills of building rapport and establishing trust with patrons,” while p6 noted the highly collaborative work with their supervisor who helped them lead staff trainings. five participants noted the absence of a library-based social worker as a key challenge during their internship. this lack of immediate social work direction and structure was difficult to navigate, particularly for three participants who encountered patrons struggling with mental health crises. five participants voiced appreciation for their supervisors’ hands-off approach in guiding them, which allowed for a degree of freedom that was positive, particularly when those supervisors were responsive and available for support. task supervisors. nearly all participants were assigned a librarian who was designated as their “task supervisor.” such individuals operated as the point-person for participants while at the library, which was especially important for those who had no professional social worker on site. though some participants mentioned receiving minimal support from these librarians, most acknowledged the exceptional support of library staff, regardless of whether they had a formal orientation or any prior knowledge about libraries in general. participants’ descriptions of their successful collaborative work with librarians included: providing them with “all the support in the world” (p11); being “super open to me working things in the way i thought would be best” (p5); being “completely supportive of anything we wanted to do” (p13); and being “very, very supportive” (p2). examples of collaborative work with task supervisors included creating opportunities to reach immigrant patrons (p5) and providing psychoeducation to staff about traumainformed approaches to working with patrons (p3). sometimes these trainings focused on a particular patron population, such as individuals experiencing homelessness (p5) or patrons who were deaf or hard of hearing (p7). de-escalation tactics and modeling personfirst language were taught (p3), as well as being a support for librarians’ job-related stressors. one participant reflected that librarians were “very receptive” to training about when to refer patrons to the social work intern (p13). university-based support. nearly all participants obtained regular supervision from university-based field advisors and professors. several participants found this type of supervision to be adequately supportive even when navigating crises at their placement. p7 mentioned their field instructor was the most helpful support in their role as an intern. over half of participants mentioned support garnered from fellow library interns or students in their field seminar class. these classmates generated connection, as one intern who described her class as: johnson et al./a year in the library 177 a place to process my colorful and impactful experiences...it was definitely a good support and it helped illuminate the need of having social workers in libraries to the rest of my class...i still bonded with my classmates even though they weren’t in libraries...this class was essential. (p9) student cohorts also provided valuable group supervision for minimizing the isolation some participants experienced as the sole interns conducting their placements in a library setting. online support. despite these challenges, all participants acknowledged the help received from one or a combination of the aforementioned sources, including online networks. one participant noted, “i don’t feel that i got the support from my university, but i didn’t feel like i needed it because of how much i was getting from the library and my social work supervisor” (p 11). two participants initiated research about and contacts with social work librarians and student interns across the country through networking websites such as whole person librarianship. this resource was particularly useful for participants who transitioned their placements online due to the covid-19 pandemic. p11 said, “i had built this network outside of the library for support within the social work realm of things, outside of my supervisor. that was so critical in fostering the success that we had.” obstacles related to library spaces: “space was definitely tight” one challenge particular to these placements related to the physical setting of the library. participants reported a lack of material resources hindering their ability to adequately serve patrons, some of which were caused by covid-19 restrictions. additionally, they noted obstacles connected to the physical set-up of the library itself, including lack of confidentiality and isolation, some of which potentially jeopardized their safety. participants responded to these barriers by focusing on patron engagement and challenging themselves to develop micro-level skills. lack of material resources. four participants cited a lack of resources in conducting their work. they noted the absence of a private phone line or a library computer as hindrances to executing their duties. these participants found it problematic that they had no choice but to use their personal cell phones and computers. p9 viewed the inability to print documents as a drawback to working with patrons. other participants discussed the difficulty of remote work in fulfilling their tasks due to covid-19 restrictions. p11, for example, was uncomfortable engaging with the elderly population through a virtual platform. two participants asserted covid-19 precluded their work in changing policy. p14 noted the inability to change a banned person policy at her facility, while p3 found collaboration with city management officials to review homelessness policies was curtailed. physical space challenges. nearly all participants identified the spatial arrangements of their work as a challenge. several noted the absence of a designated, private, and reliable space to meet with patrons. participants reported having to check out office spaces that were not always available when needed: “space was definitely tight. when i had an advances in social work, spring 2023, 23(1) 178 appointment with a patron, i would have to make sure the case management office was free” (p9). another participant noted the structural barriers to patron engagement: “i would have to reschedule if the room wasn’t available and if the patron didn’t feel comfortable meeting in an open space” (p2). confidentiality. one consequence of spatial challenges was a concern about confidentiality and privacy of patron information. participants observed the discomfort of sitting in an open space while speaking to patrons as others were in hearing range. one participant found they could not follow up with patrons because they were unable to retrieve basic information and another participant noted the lack of private spaces precluded effective supervision. p8 explained, “i couldn’t even use a sign-up sheet for appointments” adding: i couldn’t have conversations with people because there was no privacy and the security guards would come and tell me to be quiet. it was this crazy situation where i couldn’t do my job because it was against all the rules they had. isolation. another consequence of navigating limited physical spaces was a sense of isolation. because one participant had “no office space” and “wasn’t allowed to approach patrons,” they “would sit in the library with a little sign saying, ‘social worker’” (p8). this participant also identified minimal access to the library administration as “i was very siloed in my own little world...there wasn’t a sense of someone having your back or that you could collaborate with anyone and that was tough as a first-year student.” safety. two participants identified more serious concerns connected to the spatial arrangements of their work. they cited safety issues precipitated by the physical set-up and isolation from other staff. one expressed concern about being a “young female intern working with older homeless men” (p3) and described her experience with such patrons as “sexual harassment.” another noted the difficulty of de-escalating people who were physically violent until the police arrived, a situation worsened by the fact that the participant’s clinical supervisor was not situated in the library (p8). responses to physical space challenges. in response to the difficulties presented by the physical layout of the library, participants directed their efforts toward patron engagement. in doing so, they experienced an increase in confidence and comfort interacting with vulnerable, marginalized populations. most participants viewed the absence of designated workspaces as opportunities to engage patrons in both informal and formal ways. p6 viewed “developing relationships” as key to the work completed on the library floor. p11 walked outside the perimeter of the library property, interacting with patrons – providing them with water and snacks – with the intention of inviting them inside. p14 also offered free food to individuals and informed patrons about social work services offered by the library. three participants discussed the formal programming they instituted to engage with patrons. p3 established a “coffee and conversation” program that fed persons experiencing homelessness, provided hygiene supplies, and offered information about local social service agencies. p13 coordinated a program for teens to provide them “a chance for them johnson et al./a year in the library 179 to talk with each other and the social worker and to play games...” another set up a table for patrons “to come up, eat sweets, and ask questions about the program” (p14). participants reflected on how the lack of adequate space enhanced their engagement skills. p1 learned to take initiative and become more self-directed. p12 concurred: “you really have to have your head screwed on well and have to talk to people and collaborate and take action. you can’t just wait for them to come to you.” six participants noted their experiences increased their comfort level with unpredictability. one recognized their ability to “walk up and talk to anyone…i walked away having experienced more, and learning more, than probably anyone else in my class” (p8). p9 reported becoming more comfortable working with persons experiencing homelessness and those living with mental illness. another found the library placement opened their eyes to the needs of underresourced and marginalized community members (p5). p7 developed a greater awareness of their surroundings and “noticing when people may need help.” discussion the present study adds to the growing literature about library-social work collaboration by presenting firsthand accounts of experiences of social work interns placed in public libraries. a mixed methods approach revealed specific duties these participants assumed, as well as challenges related to their tasks. despite concerns related to supervision, differing philosophies between disciplines, lack of role clarity, and the library’s physical space, participants did share examples of the support and resources they used to make for an overall satisfactory field placement experience. during the qualitative interviews, we asked our participants what advice they would give to social work supervisors, public librarians, and potential student interns about library-based field placements. our aim was to provide a space for participants to offer a blueprint for social work supervisors, public librarians, and social work students who may consider social work/public library collaborations. the following discussion comes in the form of recommendations stemming from participants’ feedback and existing literature on social work library placements. social work supervision and supports supplementary support participants who noted and appreciated their supervisors’ hands-off approach aligns with aykanian et al.’s (2020) recommendations that library field placements are best suited for “mature, resourceful students who were open to a nontraditional placement setting and [can] work somewhat autonomously with minimal day-to-day supervision” (p. 75). for participants without onsite social work supervision, it is important to connect them with quality supplementary support from their university professors. many participants also found their field seminar class especially helpful and contributed to them feeling more connected to the university. as mentioned earlier, others accessed online networking advances in social work, spring 2023, 23(1) 180 groups such as whole person librarianship. we recommend that supervisors and universities explore how to facilitate extraneous support for library social work interns. focus and flexibility intentional focus must be paid to library-based interns by regularly connecting with and actively listening to their needs as “consistent supervision and support can be challenging for social work interns in a library setting” (zettervall & nienow, 2019, p. 53). participants requested social work supervisors be open to modifying initial learning contracts, as library social work “is so new for so many people that you have to adjust the learning agreement and your expectations to the unknown” (p13). we concur with sharkey et al. (2021) that social work supervisors must heed the “iterative process of developing and adjusting protocol” (p. 4). as one student noted, “there are so many things that i did that never fit in those boxes because we couldn’t make them fit” (p11). librarians participation we consider participants’ feedback that task supervisors and library staff should interface more intentionally and directly with social work interns and be more open to the collaborative opportunities the placement can offer. two participants encouraged librarians to inquire about the perspectives of social workers, noting that hosting students is a worthwhile endeavor because “we bring lots of ideas and skill sets that can be an asset to the community and library branch” (p3). we concur with wahler et al. (2022) that librarians can support student placements by asking students questions about their role and ways they anticipate meeting the needs of patrons. communication it is critical for librarians and administrators to maintain clear and open communication with both the student and their social work supervisor, particularly about any restrictions on the type of tasks interns can conduct. this is especially pertinent in library settings due to variations among the two professions regarding confidentiality and privacy (aykanian et al., 2020; zettervall & nienow, 2019). such transparency can be achieved by delineating expectations of the intern prior to commencing placement. we agree that the lack of guidance some participants experienced speaks to the need for paying “attention to the clarity of roles from the various university and library partners to provide the appropriate support to msw students” (sharkey et al., 2021, p. 3). funding for library social workers for existing programs and collaborations to continue, participants suggest that library administrators maintain support of existing partnerships and secure funding for social workers in libraries. we concur with our participants’ unanimous affirmation of having social workers in libraries, which aligns with cuseglio’s (2020) suggestion that “placing johnson et al./a year in the library 181 msw interns in public libraries can be beneficial in addressing patrons’ various needs...these valuable field placement opportunities...have the potential for positive longterm outcomes in their community, and its members'' (p. 681). library social work interns interdisciplinary opportunities participants found their confidence increased through engagement with community organizations and challenging populations. unique to this setting, however, is that participants recognized a challenge with the different philosophies among librarians and social workers. field placements in public libraries can provide good training for effectively engaging in interdisciplinary work (johnson, 2019) and social work programs should provide a solid orientation to librarianship and its culture (zettervall & nienow, 2019). student characteristics study participants reported that “taking risks by putting their ideas out there” (p1), “being open and flexible and creative” (p3), as well as exhibiting “maturity” (p4) and “humility” (p12), are ideal traits for work in a library setting. given these recommended skills, we assert that library social work is best suited to students who either already have these tools or have the capacity to build them. field placement personnel should consider these characteristics when recruiting students for library placements. our recommendation mirrors sharkey et al.’s (2021) experience that their program “carefully selected and interviewed generalist and specialization students with prior social service experiences to alleviate potential challenges” (p. 3). safety related to the need for more consistent and present supervision is attention paid to support systems for the safety of social work interns. given the prevalence of offsite supervision and student interns often being the only social work presence on site, our study confirms aykanian et al.’s (2020) assertion that library administrators and staff should implement protocols that protect the physical and emotional well-being of social work interns. at the very least, policies and standards for emergency protocols need to be clearly outlined. needs assessments one participant advised future interns to “research resources ahead of time so you don’t have to look it all up when you are actually meeting a patron” (p9). another recommended that students “explore as much as you can because the library is a great reflection of the community as a whole” (p2). these comments suggest the importance of making community needs assessments a primary and initial task for interns. other researchers advances in social work, spring 2023, 23(1) 182 concur that needs assessments are necessary for orienting the intern to the library and the community in which it exists (cuseglio, 2020). zettervall and nienow (2019) also suggest that assessments can help interns and librarians understand specific community needs, which are important to know before collaborating with community partners. limitations and areas of future research the main limitation of this study is the generalizability of both our quantitative and qualitative data. because public libraries in one locality have needs specific to the community in which they reside, it can be difficult to generalize recommendations to all public libraries based on the experiences of the social work students we interviewed who completed their fieldwork at public libraries. the small number of research sites in the present study preclude generalizing to all library systems. there are also limitations related to the recruitment protocol. non-probability-based methods of recruiting participants inevitably leads to biased sampling (shaw & holland, 2014). participants who had positive experiences may have self-selected to participate in the study. similarly, it is possible that individuals who had unsatisfactory experiences chose not to participate. as library social work internships become more prominent, larger sample sets will mitigate this bias. further, our sample size consisted of participants within the author’s professional network of contacts, adding a potential bias based on convenience sampling. it is also important to acknowledge potential bias in the data analysis. cultivating narratives from a single and narrow population does not consider the complexities of library/social work partnerships. a future study could assess the perspectives of library staff, administrators, social work faculty, and social work supervisors separately, thereby triangulating the data and offering perspective to participants’ perceptions. we also recommend that future studies incorporate information learned from research on other nontraditional social work host sites or multidisciplinary practice, such as school social work, and compare them to traditional social work field placement sites. conclusion the current research is unique in its quest to garner insights directly from social work students about their experiences completing field placements at public libraries. in addition to existing literature on this topic in general, we aimed to enrich the discussion of best practices of libraries as social work field sites. it is worth noting that, despite the challenges interns faced, not only were they satisfied with their experience but most support the need for continuing library social work internships, in addition to hiring professional social workers at public libraries. participant 8 – who noted his library placement was considered one of “the worst” by fellow students in his cohort – said he “walked away thinking it was one of the best internships...it was very, very difficult but i think i learned so much more than many of my other classmates.” johnson et al./a year in the library 183 references aykanian, a., morton, p., trawver, k., victorson, l., preskitt, s., & street, k. 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(2019). the changing role of libraries: how social workers can help. families in society, 101(1), 34-43. https://doi.org/10.1177/1044389419850707 wahler, e. a., provence, m. a., johnson, s. c., helling, j., & williams, m. (2021). library patrons’ psychosocial needs: perceptions of need and reasons for accessing social work services. social work, 66(4), 297-305. https://doi.org/10.1093/sw/swab032 wahler, e. a., ressler, j. d., johnson, s. c., rortvedt, c., saecker, t., helling, j., williams, m. a., & hoover, d. (2022). public library-based social work field placements: guidance for public libraries planning to become a social work practicum site. public library quarterly, 42(2), 1-14. https://doi.org/10.1080/01616846.2022.2044264 whole person librarianship. (2023). whole person librarianship community of practice [listserv]. https://groups.google.com/g/wpl-cop zettervall, s. (2023). map. whole person librarianship. https://wholepersonlibrarianship.com/map/ zettervall, s. k., & nienow, m. c. (2019). whole person librarianship: a social work approach to patron services. libraries unlimited. author note: address correspondence to sarah c. johnson, university of illinois at urbana-champaign. email: sjo0034@illinois.edu https://doi.org/10.1080/01616846.2020.1730738 https://prism.ucalgary.ca/handle/1880/106632 https://doi.org/10.1080/10437797.2021.1978913 https://doi.org/10.18060/23690 https://doi.org/10.1177/1044389419850707 https://doi.org/10.1093/sw/swab032 https://doi.org/10.1080/01616846.2022.2044264 https://groups.google.com/g/wpl-cop https://wholepersonlibrarianship.com/map/ mailto:sjo0034@illinois.edu participant eligibility quantitative procedures qualitative procedures survey results qualitative interview results full generalist practice experience though most participants were on a macro/advanced generalist track, they described their library placement experience as incorporating a combination of micro, mezzo, and macro tasks with an emphasis on micro-level. the following section offers example... challenges related to participants’ tasks and responsibilities: “an ideal mix” experiences related to support and supervision obstacles related to library spaces: “space was definitely tight” social work supervision and supports supplementary support focus and flexibility librarians participation communication funding for library social workers library social work interns interdisciplinary opportunities student characteristics safety needs assessments limitations and areas of future research wahler, e. a., provence, m. a., johnson, s. c., helling, j., & williams, m. (2021). library patrons’ psychosocial needs: perceptions of need and reasons for accessing social work services. social work, 66(4), 297-305. https://doi.org/10.1093/sw/swab032 _________ adrienne baldwin-white, phd, assistant professor, school of social work, and spit for science working group, institute for research on behavioral and emotional health, virginia commonwealth university, richmond, va. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 296-310, doi: 10.18060/28137 this work is licensed under a creative commons attribution 4.0 international license. differences between students of color and white students in prevalence and trauma effects of sexual assault adrienne baldwin-white spit for science working group abstract: sexual assault is a public health issue, particularly among college students. college students have a risk of perpetrating sexual assault and being victimized. students of color are at an increased risk of experiencing sexual assault and are more likely to have worse outcomes due to the trauma compared to white students. however, very little research has sought to understand the differences in prevalence and negative trauma outcomes. the following secondary data analysis sought to find out if there are differences in rates of sexual violence, where those differences are, and whether students of color have different outcomes. results showed significant differences in the prevalence of sexual assaults and the effects of trauma for students of color, with students of color consistently demonstrating higher risk. keywords: sexual violence, racial identity, racial differences and sexual assault, race and trauma, race and violence outcomes twenty to 25% of women attending college or a university report experiencing a sexual assault (conley et al., 2017; sutherland & hutchinson, 2018). further, college-aged men have a relatively high likelihood of committing sexual assault, with recent studies demonstrating a perpetration rate between 23% (zinzow & thompson, 2015) and 45% (malamuth et al., 2018). sexual assault has a unique and profound impact on survivors, including physical and mental health concerns (beaujolais, 2023). for college students, it detracts from the quality of their college experience (fisher & cullen, 2013). survivors may have difficulty resuming their regular daily activities, perform poorly academically (banyard et al., 2020), and may not be able to carry a full course load (molstad et al., 2023). they are more likely to drop classes, have lower institutional commitment, and have higher stress (banyard et al., 2020). the higher likelihood of not finishing college also means a potential reduction of lifetime income earnings (hershbein & kearney, 2014). college students who experience sexual assault are also at an increased risk for developing an eating disorder or posttraumatic stress disorder (dubosc et al., 2012), at an increased likelihood of participating in risky sexual behavior (kaufman et al., 2019), at an increased risk of developing anxiety and depression (goodarzi et al., 2020); and are more likely to have suicidal ideation or attempt suicide (dworkin et al., 2020). among undergraduate college students, individuals of color have a higher risk of experiencing gender-based violence, including sexual assault (gill, 2018). current studies report that women of color have higher rates of sexual assault compared to white women (us department of justice, 2013). students of color are even more vulnerable to the negative effects of sexual violence (klein & martin, 2021; sigurvinsddottir & ullman, 2016). for example, one study demonstrated that survivors of color were more likely to about:blank baldwin-white & spit for science/trauma & sexual assault 297 screen positive for posttraumatic stress and have more symptoms of depression (lindquist et al., 2013). however, there are few studies on differences in the prevalence of sexual violence and its effects on the survivor based on racial identity. it is important to explore how racial identity impacts a person’s risk of victimization, and the types of trauma effects survivors experience after an assault. historically, marginalized communities have been excluded from sexual assault prevention programming that typically center the experiences of white straight cisgender women (karunaratne & harris, 2022). the studies that examine the effect of race and sexual assault primarily focus on the race of research participants rather than the race of survivors. for example, previous research has explored the role of the race of the study participant in adherence to rape myths, with previous studies demonstrating that persons of color are less likely to adhere to rape myths (baldwin-white & elias-lambert, 2016). previous studies have also demonstrated the link between the race of someone and their empathy toward survivors; with a previous study indicating that white participants were less likely to have empathy toward a survivor who is a person of color (franklin & garza, 2021). research that does explore the influence and role of racial identity is limited in number and scope. for example, there is research that examines the role of race in bystander behaviors. previous research has shown that women have more empathy for rape survivors of their same race, with one study finding that white women had more positive attitudes towards white victims (jimenez & abreu, 2003). participants are also more likely to blame the perpetrator when victims are white (gravelin et al., 2019). one study demonstrated that white women who had more prejudiced beliefs were less likely to intervene to prevent a sexual assault of a person of color (katz et al., 2017). although this research is important, it does not provide the larger picture of the risk of experiencing sexual assault and its effects if you are a person of color compared to a white student. this information is needed to better inform prevention and intervention efforts that address the unique experiences of students of color. because women of color have higher rates of sexual violence compared to white women (decker et al., 2019), the context of someone’s experience is needed to identify and address the needs of those who have experienced this violence (gill, 2018). the negative consequences of sexual violence, including negative mental health and physical outcomes, are heightened due to racism and oppression (hope et al., 2018). research has shown that people of color experience disproportionate adverse mental health problems when they experience a sexual assault (turchik & wilson, 2010). in addition, research demonstrates that race plays a role in the intensity of the mental health effects of sexual assault, with black women being at a higher risk of experiencing mental health issues after experiencing sexual trauma (bryant-davis et al., 2009). people of color may experience racism and bias when they contact individuals for support or report an assault to law enforcement due to systemic racism and bias (burton & guidry, 2021). therefore, they may not seek help when they experience a sexual assault because they fear they will not be taken seriously (guidry et al., 2020); leaving them at higher risk of having detrimental mental health outcomes due to trauma (fogle et al., 2020). advances in social work, spring 2025, 25(1) 298 current study there is an emerging need to address the differential experiences of individuals because of their racial identity. it is imperative to consider how racial differences affect the perpetration of sexual assault and how survivors are able to cope with trauma. there is a history of both racial and gender discrimination that have impacted people’s individual and institutional experiences after a sexual assault (decker et al., 2019). oppressions are interconnected (crenshaw, 1990); gendered violence is intertwined with other forms of oppression, including racism (shahrokh, 2015). but to begin to understand how these oppressive systems and individual beliefs affect students of color, there needs to be more foundational information to provide a sense of the prevalence of sexual assault and its effects on people of color. the purpose of this study is to explore if there are potentially any differences in experiences of sexual violence and trauma effects based on race. this study seeks to begin to provide information to help understand the experiences of students with marginalized racial identities. this study sought to answer the following research questions: 1. are there differences in the prevalence of sexual violence among college students based on racial identity? 2. are there differences in the effects of sexual violence on mental health, relationships, and academics based on racial identity? methods this study is a secondary data analysis using data that were collected in the first semester of the first year of college from fall 2011 to fall 2017 (across 5 cohorts) as part of a larger longitudinal campus-wide project, spit for science (dick et al., 2014). this project sought to understand the behavioral and psychological health of undergraduate students. approximately two weeks before first-year students were scheduled to arrive on campus, spit for science mailed information about the study to all incoming first-year students and (separately) their parents. the week before welcome week, first-year students aged 18 or older received an email inviting them to participate in the project. survey reminders were sent weekly for the first 4 weeks and intermittently for the remaining 6 weeks. students turning 18 during data collection were invited to participate after their birthdays. the invitation email contained a link to an approximately 30-minute online survey with questions about health behaviors, mental well-being, and substance use. all students who initiated the survey were led through a consent process that further explained the study and their participation. upon completing the survey, students went to a central site at the university to collect monetary compensation and a free “spit for science” t-shirt. study data were collected and managed using redcap, an electronic data capture tool (harris et al., 2009). the institutional irb approved this study. baldwin-white & spit for science/trauma & sexual assault 299 measures demographics students were asked demographic questions (see table 1). they were asked about their gender (e.g., male, female), racial identity (e.g., american indian/native alaskan, asian, black/african american, hispanic/latino, more than one race, native hawaiian, unknown, and white), and gender identity (e.g., cisgender woman, cisgender man, transgender woman, transgender man, genderqueer, questioning or i choose not to answer). sexual assault students were asked two questions from the life events checklist (gray et al., 2004). the first question was whether, in the past 12 months, they had experienced sexual assault (rape, attempted rape, made to perform any type of sexual act through force or threat of harm), with “yes” or “no” as response options. students were also asked if, in the past 12 months, they had experienced other unwanted or uncomfortable sexual experiences, with “yes” or “no” response options. effects of sexual assault students were asked questions from the national intimate partner and sexual violence survey (centers for disease control and prevention, 2015). they were asked to identify “yes” or “no” to whether they had experienced certain things as a result of the sexual assault, including fearfulness or fearing about safety, missed days of work or school, need for medical care, need for advocacy services, need for legal services, suicidal thoughts, and self-injurious behavior. additionally, questions about ptsd symptoms included identifying “yes” or “no,” whether they experienced avoiding situations that remind you of it, were constantly on guard, watchful, or easily startled, and felt numb or detached from others, activities, or your surroundings (prins et al., 2016). support to assess the level of support students had, they were asked questions from the medical outcomes study social support measure (sherbourne & stewart, 1991). they were asked on a 4-point scale from “none of the time” to “all of the time” how often they had someone available to give good advice about a crisis, get together for relaxation, or confide in or talk about problems. analysis crosstabs with chi-square or odds ratio analyses were completed to examine racial differences in experiences of sexual violence and the effects of sexual assault. analysis of variance (anova) or independent t-tests were used to examine racial differences in social support. racial differences were examined using two methods. the “race” variable was used as the original variable with 8 categories and collapsed into a variable with 2 options: people of color (poc; all racial identities not white) and white. table 1 describes the gender and racial identity of the samples used for the analysis. advances in social work, spring 2025, 25(1) 300 table 1. demographics n (%) gender identity (n=2,131)a cisgender woman 1603 (65.9%) cisgender men 759 (31.2%) transgender woman 2 (0.1%) transgender man 16 (0.7%) gender queer 47 (1.9%) questioning 36 (1.5%) choose not to answer 41 (1.7%) gender (n=10,653)b female 6036 (61.5%) male 3777 (38.5%) racial identity (n=10,653) american indian/native alaskan 63 (0.5%) asian 2056 (16.9%) black/african american 2384 (19.6%) hispanic/latine 813 (6.7%) more than one race 814 (6.7%) native hawaiian 84 (0.7%) unknown 41 (0.3%) white 5924 (48.6%) notes: all variables were collected in the first semester, first year of college; a gender identity was collected in cohort 5 (n= 2,131); b gender and racial identify were collected in cohorts 1-5 (n=10,653) results sexual assault overall, results showed that there are racial differences in experiences of sexual violence. see table 2. of the 247 students who stated they had experienced a sexual assault in the previous 12 months, 45% were students of color: 3 were american indian, 17 identified as asian, 54 identified as black, 17 identified as latine (i.e., hispanic/latino), 16 identified as more than one race, and 4 identified as pacific islander or native hawaiian. there were similar patterns when responding to the question of whether they had experienced another unwanted or uncomfortable sexual experience. of the 921 who responded yes, 41% were students of color: 6 were american indian, 107 identified as asian, 132 identified as black, 57 identified as latine (hispanic/latino), 78 identified as more than one race, and 5 were pacific islander/native hawaiian. results of the chi-square analysis with all eight categories demonstrated there are significant differences in the number of sexual assaults students experienced based on their racial identification p=.002. there were also significant differences in other unwanted sexual experiences based on racial identification, p<.001. using the collapsed person of color variable, an odds ratio analysis was also completed to understand how likely it would be for a person of color to experience sexual violence compared to a white person. there was not a significant difference in the odds of being sexually assaulted as a person of color compared to a white person. however, there was a significant difference in the odds of experiencing unwanted or uncomfortable sexual experiences as a person of color compared to a white person (or=1.42 95% ci [1.248, 1.643]. advances in social work, spring 2025, 25(1) 301 table 2. racial identity by sexual violence and effects item area question american indian/ native alaskan asian black/african-american hispanic/latino yes no total yes no total yes no total yes no total sexual assault (n=10,653)a sexual assault 3 (6%) 47 (94%) 50 17 (1.1%) 1584 (98.9%) 1601 54 (3%) 1766 (97%) 1820 17 (2.6%) 633 (97.4%) 650 uncomfortable sexual experience 6 (12.2%) 43 (87.8%) 49 107 (6.7%) 1492 (93.3%) 1599 132 (7.3%) 1679 (92.7%) 1811 57 (8.8%) 591 (91.2%) 648 effects of sexual assault (n=3,985)b fear for safety 3 (18.8%) 13 (81.3%) 16 44 (10.2%) 388 (89.8%) 432 44 (9.2%) 435 (90.8%) 479 32 (15.4%) 176 (84.6%) 208 missed school 1 (6.3%) 15 (93.8%) 16 9 (2.1%) 423 (97.9%) 432 9 (1.9%) 470 (98.1%) 479 9 (4.3%) 199 (95.7%) 208 medical care 0 (0%) 16 (100%) 16 5 (1.2%) 427 (98.8%) 432 4 (0.8%) 475 (99.2%) 479 5 (2.4%) 203 (97.6%) 208 advocacy 1 (6.3%) 15 (93.8%) 16 2 (0.5%) 430 (99.5%) 432 4 (0.8%) 475 (99.2%) 479 3 (1.4%) 205 (98.6%) 208 legal services 0 (0%) 16 (100%) 16 6 (1.4%) 426 (98.6%) 432 2 (0.4%) 477 (99.6%) 479 4 (1.9%) 204 (98.1%) 208 suicidal thoughts 1 (6.3%) 15 (93.8%) 16 19 (4.4%) 413 (95.6%) 432 18 (3.8%) 461 (96.2%) 479 17 (8.2%) 191 (91.8%) 208 thoughts-self injury 2 (12.5%) 14 (87.5%) 16 15 (3.5%) 417 (96.5%) 432 8 (1.7%) 471 (98.3%) 479 14 (6.7%) 194 (93.3%) 208 ptsd symptoms (n= 1,854)c avoidant 1 (16.7%) 5 (83.3%) 6 76 (38.8%) 120 (61.2%) 196 69 (33.3%) 138 (66.7%) 207 27 (35.1%) 50 (64.9%) 77 on guard 4 (57.1%) 3 (42.9%) 7 70 (35.7%) 126 (64.3%) 196 61 (29.5%) 146 (70.5%) 207 24 (31.2%) 53 (68.8%) 77 numb or detached 2 (33.3%) 4 (66.7%) 6 49 (24.9%) 148 (75.1%) 197 46 (22%) 163 (78%) 209 20 (25.6%) 58 (74.4%) 78 note: all items were collected in the first semester, first year of college; a collected in cohorts 1-5 (n=10,653); b collected in cohorts 4 and 5 (n=3,985); c collected in cohort 4 (n= 1,854). item area question more than one race native hawaiian & other pacific islander white all racial identities yes no total yes no total yes no tota l yes no total sexual assault (n=10,653)a sexual assault 16 (2.6%) 605 (97.4%) 621 4 (6.3%) 60 (93.8%) 64 136 (2.8%) 4679 (97.2%) 4815 247 (2.6%) 9374 (97.4%) 9621 uncomfortable sexual experience 78 (12.6%) 543 (87.4%) 621 5 (7.8%) 59 (92.2%) 64 536 (11.1%) 4284 (88.9%) 4820 921 (9.6%) 8691 (90.4%) 9612 effects of sexual assault (n=3,985)b fear for safety 36 (18.5%) 159 (81.5%) 195 3 (15.8%) 16 (84.2%) 19 284 (25.5%) 831 (74.5%) 1115 446 (18.1%) 2018 (81.9%) 2464 missed school 9 (4.6%) 186 (95.4%) 195 0 (0%) 19 (100%) 19 69 (6.2%) 1046 (93.8%) 1115 106 (4.3%) 2358 (95.7%) 2464 medical care 6 (3.1%) 189 (96.9%) 195 0 (0%) 19 (100%) 19 19 (1.7%) 1096 (98.3%) 1115 39 (1.6%) 2425 (98.4%) 2464 advocacy 6 (3.1%) 189 (96.9%) 195 0 (0%) 19 (100%) 19 37 (3.3%) 1078 (96.7%) 1115 53 (2.2%) 2411 (97.8%) 2464 legal services 1 (0.5%) 194 (99.5%) 195 1 (5.3%) 18 (94.7%) 19 28 (2.5%) 1087 (97.5%) 1115 42 (1.7%) 2422 (98.3%) 2464 suicidal thoughts 17 (8.7%) 178 (91.3%) 195 1 (5.3%) 18 (94.7%) 19 141 (12.6%) 974 (87.4%) 1115 214 (8.7%) 2250 (91.3%) 2464 thoughts-self injury 13 (6.7%) 182 (93.3%) 195 1 (5.3%) 18 (94.7%) 19 128 (11.5%) 987 (88.5%) 1115 181 (7.3%) 2283 (92.7%) 2464 ptsd symptoms (n= 1,854)c avoidant 27 (32.5%) 56 (67.5%) 83 5 (55.6%) 4 (44.4%) 9 244 (36.3%) 428 (63.7%) 672 449 (35.9%) 801 (64.1%) 1250 on guard 25 (30.9%) 56 (69.1%) 81 4 (44.4%) 5 (55.6%) 9 235 (35%) 436 (65%) 671 423 (33.9%) 825 (66.1%) 1248 numb or detached 18 (22.5%) 62 (77.5%) 80 2 (25%) 6 (75%) 8 203 (30.2%) 469 (69.8%) 672 340 (27.2%) 910 (72.8%) 1250 note: all items were collected in the first semester, first year of college; a collected in cohorts 1-5 (n=10,653); b collected in cohorts 4 and 5 (n=3,985); c collected in cohort 4 (n= 1,854). baldwin-white/trauma & sexual assault 302 effects of sexual assault an odds ratio analysis was also done with the two groups to see if there were differences in the likelihood of experiencing certain effects of trauma. there were significant differences in the odds of having fear for your safety as a person of color compared to a white student (or=2.54 95% ci [ 2.025, 3.097]), with students of color at a higher risk. there were also significant differences in the odds of exhibiting self-injurious behavior (or=3.171 95% ci [2.278, 4.414]) and suicidal thoughts (or=2.530 95% ci [1.885, 3.397]) with white students less likely to participate in self-injury or suicidal thoughts. there were significant differences in the odds of needing advocacy services (or=2.860 95% ci [1.582, 5.168]) and legal services (or=2.456 95% ci [1.287, 4.689], with students of color more likely to need advocacy and legal services. there were significant differences in the odds of missing school, with students of color more likely to miss school [or=2.339 95% ci [1.556, 3.516]. there were not any significant differences in the odds of avoiding situations that reminded them of the assault, feeling numb or detached from others, activities, or surroundings, or seeking medical care. table 3. support by racial identity support by racial identity total none of the time some of the time most of the time all of the time someone to give advice about a crisis american indian/native alaskan 28 1 (3.6%) 5 (17.9%) 10 (35.7%) 12 (42.9%) asian 873 39 (4.5%) 225 (25.8%) 278 (31.8%) 331 (37.9%) black/ african american 1068 45 (4.2%) 200 (18.7%) 340 (31.8%) 483 (45.2%) hispanic/ latino 351 10 (2.8%) 73 (20.8%) 110 (31.3%) 158 (45%) more than one race 338 17 (5%) 60 (17.8%) 115 (34%) 146 (43.2%) native hawaiian & other pacific islander 40 3 (7.5%) 4 (10%) 13 (32.5%) 20 (50%) white 2970 61 (2.1%) 512 (17.2%) 989 (33.3%) 1408 (47.4%) all 5668 176 (3.1%) 1079 (19%) 1855 (32.7%) 2558 (45.1%) someone available to get together for relaxation american indian/native alaskan 28 3 (10.7%) 1 (3.6%) 14 (50%) 10 (35.7%) asian 901 41 (4.6%) 225 (25%) 318 (35.3%) 317 (35.2%) black/african american 1078 65 (6%) 253 (23.5%) 370 (34.3%) 390 (36.2%) hispanic/latino 353 12 (3.4%) 83 (23.5%) 118 (33.4%) 140 (39.7%) more than one race 342 10 (2.9%) 84 (24.6%) 123 (36%) 125 (36.5%) native hawaiian & other pacific islander 41 0 (0%) 9 (22%) 16 (39%) 16 (39%) white 2994 73 (2.4%) 576 (19.2%) 1085 (36.2%) 1260 (42.1%) all 5737 204 (3.6%) 1231 (21.5%) 2044 (35.6%) 2258 (39.4%) someone available to talk to confide in your problems american indian/native alaskan 28 2 (7.1%) 5 (17.9%) 8 (28.6%) 13 (46.4%) asian 903 43 (4.8%) 216 (23.9%) 268 (29.7%) 376 (41.6%) black/african american 1090 63 (5.8%) 228 (20.9%) 314 (28.8%) 485 (44.5%) hispanic/latino 350 14 (4%) 69 (19.7%) 89 (25.4%) 178 (50.9%) more than one race 344 15 (4.4%) 59 (17.2%) 107 (31.1%) 163 (47.4%) native hawaiian & other pacific islander 41 1 (2.4%) 6 (14.6%) 13 (31.7%) 21 (51.2%) white 2995 67 (2.2%) 491 (16.4%) 867 (28.9%) 1570 (52.4%) all 5751 205 (3.6%) 1074 (18.7%) 1666 (29%) 2806 (48.8%) note: support items were collected first semester, first year of college in cohorts 1-3 (n=6,111). baldwin-white & spit for science/trauma & sexual assault 303 supports table 3 presents the frequencies for the three support variables separately by racial identity. the same mixed results were evident when examining the differences in having a support system. results of an anova demonstrated there were significant differences in having someone to give good advice during a crisis, f(7, 5682)=9.696, p<.001, with someone to confide in (f(7, 5765)=8.855, p<.001), and someone to get together for relaxation (f(7, 5752)=7.163, p<.001), between black (m=3.18, sd=.88; m=3.12, sd=.93); m=3.01, sd=.92) and asian (m=3.03, sd=.90; m=3.08, sd=.92; m=3.01, sd=.89), and white (m=3.26, sd=.81; m=3.32, sd=.92; m=3.32, sd=.88; m=3.18, sd=.82) and asian students. using t-tests to compare the two groups, there were significant differences in students of color (m=3.26, sd=.88) and white students (m=3.13, sd=.89) having someone available to give good advice about a crisis, t(5666)=-5.741), p<.001. there were also significant differences in students of color (m=3.14, sd=.92) and white students (m=3.32, sd=.82) having someone to confide in t(5749)=-7.784), p<.001. there were also significant differences in having someone to get together for relaxation t(5735)=6.634, p<.001 between students of color (m=3.03, sd=.891) and white students (m=3.18, sd=.82). discussion the results of this study demonstrate the need to consider the unique experiences of sexual assault and its effects based on racial identity. overall, this study showed that selfidentified race was significantly associated with sexual violence and its effects. this result aligns with the current literature (coulter & rankin, 2020). college students of color may be more vulnerable for multiple reasons. first, there may be cultural norms among people of color that make them more vulnerable to experiencing sexual assault. for example, some say a cultural norm in latin cultures is machismo, which is the idea that men should be aggressive and dominant (halim et al., 2016). this may lead male-identifying students to pursue sex even with a non-consenting partner due to a belief that they are entitled to sex. this same idea may lead women to comply with what their partner wants despite their own reservations. this same subordinate social positioning of female-identifying people may exist in other cultures (applin et al., 2023) that could have similar effects. second, racism and oppression may play a role in students of color experiencing both sexual violence and its effects. for example, suppose you have a white student in a socially advantageous position pursuing a student with a marginalized identity. in that case, the student of color may feel pressure to say yes because of their less dominant position. the student of color may also be hesitant to report if an assault happens because of this racial dynamic. structural racism may also play a role in the higher prevalence of sexual assault among students of color. sexual assault prevention programming is typically based on the experiences of white women (karunaratne & harris, 2022). therefore, most programming is not culturally informed and sensitive. students of color are participating in programming that is not responsive to their unique needs, experiences, or cultural norms, and they do not advances in social work, spring 2025, 25(1) 304 have the tools to maintain consensual relationships within the context of their beliefs and perceptions. racism plays a role in yet another way. as previously mentioned, black women are less likely to be aided to prevent an assault than white women; people are less likely to be active bystanders with black women (katz et al., 2017). therefore, black women are at a higher risk of experiencing sexual assault. because of their shared status as people of color, the same could be assumed for latine, asian, indigenous, and mixed-race individuals; however, future research needs to be done to confirm this higher risk due to less bystander intervention. third, students of color may be more likely to have other risk factors that put them at higher risk of experiencing sexual assault, including childhood sexual trauma (papalia et al., 2021), current or previous poverty (gillum, 2019), intimate partner or dating violence (bagwell-gray, 2021) or homelessness (santa maria et al., 2020). racism and oppression also contribute to these risk factors for sexual violence victimization (mosley et al., 2021). therefore, addressing racism and oppression can play an important role in reducing sexual assault in communities of color. students of color are more vulnerable to experiencing uncomfortable or unwanted sexual experiences. previous studies have demonstrated that after experiencing sexual violence, survivors of color are more likely to disclose to an informal source like a friend prior to or instead of a more formal one (lindquist et al., 2013; cusano et al., 2024). perhaps there are cultural artifacts within these informal sources in communities of color that serve as protective factors against the negative mental health, relationship, and academic effects of experiencing sexual assault. because of structural racism, communities of color often had to rely on informal resources when experiencing challenges (comeaux et al., 2021); therefore, those more informal sources may be substantive and provide better support. future research can explore those factors that may allow these communities to provide social support that may be protective against sexual violence and provide adequate help for survivors. results also demonstrated that there are nuanced results when looking at differences among specific racial groups. for example, there were only significant differences among latine students in fear for their safety and whether they have broken relationships, with latine students experiencing more fear and more broken relationships. although this provides information that can be used to inform culturally responsive prevention programming, there is no consistency in the type of trauma effect, with one variable about mental health (i.e., fear of safety) and another about support (i.e., broken relationships). despite some inconsistencies, some patterns emerged. for example, asian students were less likely to have mental health or relationship effects or to miss school than other students of color. the average for having support was also the highest for asian students. perhaps future research can investigate the specific racial or cultural practices or belief systems that potentially lead asian student survivors to have better outcomes. being culturally responsive and having cultural humility means individuals do not assume expertise in other cultures and do not support the idea that all of those who share a racial identity have a homogenous experience. with that in mind, rather than using this space to make assumptions about why racial differences exist in the prevalence of sexual baldwin-white & spit for science/trauma & sexual assault 305 assault and other unwanted sexual experiences, it is important to use research to explore the unique cultural beliefs, practices, and perceptions that may increase the risk of sexual assault victimization. limitations there are multiple limitations to this study. first, there is no timeline established, meaning we do not know if the sexual assault occurred prior to the trauma that led to helpseeking behaviors. however, the prompts of the survey do ask respondents to specifically think about the effects of sexual violence. second is how sexual violence is assessed. the questions used to assess the prevalence of sexual assault are not in line with the most widely used measure of experiences of sexual violence, the sexual experiences survey (johnson et al., 2017). using the most widely used validated measure may lead to more accurate results. there may be underreporting of instances of sexual violence because even though what a student experiences is a sexual assault, their definition may not align with what they perceive to be sexual assault. therefore, it is possible that surveys are not capturing all experiences of sexual violence and its effects. this is one of the limitations of using secondary data; there is a lack of control over how the questions are asked. and because the best survey question was not used, the results may not represent the population. third, there is a 60% chance of a false positive due to the number of statistical analyses that were performed. the limitations of self-reporting and social desirability also impact the likelihood that the responses reflect college students' beliefs, perspectives, and experiences. some variables were only available in a subset of the sample rather than the full sample, which may also limit the representativeness of those findings. even with these limitations, the larger sample can be used to embed protective factors in the larger community that could serve to reduce the risk of sexual assault; this information can benefit more than survivors. conclusions issues of power and oppression, including race, are not often considered contributing factors to the prevalence of sexual violence and survivor response to trauma. to have a fuller understanding of the issue of sexual violence, an intersectional and social justice approach must be utilized to understand the experiences of minoritized students (klein et al., 2021). this intersectional approach must also be used in social work education when discussing issues such as gender-based violence and sexism. because sexual violence is so prevalent and can have such profound effects on mental health, this work also reinforces the need to have more educational content around gender-based violence, with particular emphasis on racial disparities. social work education must also consider the intersection of race and gender during discussions about developing intervention and prevention strategies. current sexual violence prevention services do not take an intersectional approach and consider how racial inequity and racialized experiences lead to the perpetuation of violence. because of this deficit, this study will impact how program developers create comprehensive 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(2015). a longitudinal study of risk factors for repeated sexual coercion and assault in us college men. archives of sexual behavior, 44(1), 213-222. author note: address correspondence to adrienne baldwin-white, school of social work, virginia commonwealth university, richmond, va, 23284. email: baldwinwhia@vcu.edu. acknowledgments: spit for science, part of the institute for research on behavioral and emotional health, has been supported by virginia commonwealth university, p20aa017828, r37aa011408, k02aa018755, p50aa022537, and k01aa024152 from the national institute on alcohol abuse and alcoholism, ul1rr031990 from the national center for research resources and national institutes of health roadmap for medical research, as well as support by the center for the study of tobacco products at vcu. redcap support provided by ctsa award um1tr004360 from the national center for advancing translational sciences. the content is solely the responsibility of the authors and does not necessarily represent the views of the respective funding agencies. data from this study are available to qualified researchers via dbgap (phs001754.v4.p2) or via spit4science@vcu.edu to qualified researchers who provide the appropriate signed data use agreement. we would like to thank the spit for science participants for making this study a success, as well as the many university faculty, students, and staff who contributed to the design and implementation of the project. https://doi.org/10.1007/s10508-013-0243-5 https://doi.org/10.1007/s10508-013-0243-5 mailto:baldwinwhia@vcu.edu _________ veronica l. timbers, phd, lcsw, mdiv, assistant professor, college of social work, university of utah, salt lake city, ut. will ward, lcsw-s, mdiv, phd candidate and part time faculty, baylor university, waco, tx. sarah ballard, lmsw, clinical social worker in private practice, msw graduate, boise state university, boise, id. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 220-232, doi: 10.18060/26373 this work is licensed under a creative commons attribution 4.0 international license. grassroots activism impacting rural lgbtqia+ communities: implications for social work veronica l. timbers will ward sarah ballard abstract: in 2022, the american civil liberties union tracked over 200 anti-lgbtqia+ bills in the legislative session. policy protections for lgbtqia+ people can only advance when large numbers of people push for change, which requires greater public awareness of the implicit and explicit barriers for lgbtqia+ persons. one promising practice for increasing visibility and public awareness is through grassroots activism. grassroots work spans micro, mezzo, and macro social work practice as it builds local power to influence improvements in services and the well-being for a particular group or issue. lgbtqia+ grassroots activism provides visibility and community and builds relationships with local resources and leaders to address specific needs. this paper looks at the impact of rural grassroots work on policy change, specifically emphasizing the influence of lgbtqia+ people leading local efforts to establish greater equity in their communities. the authors provide three examples of lgbtqia+ organizations doing grassroots work in rural areas in order to increase attention to this foundational level of policy change. these organizations and many more across the country must be acknowledged and supported by social workers to increase the important momentum of self-represented movements for justice. keywords: policy; activism; grassroots work; lgbtq+; rural communities for historically minoritized groups, lobbying for change starts with obtaining basic human rights. for the lgbtqia+ population this has meant policies that protect the right to marry, to foster and adopt, to receive equitable treatment in medical settings, to be served by private businesses, and for transgender and gender expansive individuals to use the bathroom of their choice. despite huge strides forward in these areas, in 2022 over 200 anti-lgbtqia+ bills were proposed in the u.s. (american civil liberties union [aclu], 2022). these bills proposed limits to lgbtqia+ protections in non-discrimination policies, access to affirming transgender care, and sports participation (aclu, 2022). other proposed legislation included non-affirming policies related to gender markers on ids, limitations to affirming school or curriculum, and religious exemptions for services (aclu, 2022). not all of these bills were adopted into law, but the success of some and the threat of others was felt in the lgbtqia+ community (aclu, 2022). looking to the next few years, there are also concerns that previous supreme court precedents protecting lgbtqia+ rights, such as the right to marry, may be reconsidered (stolberg, 2022). grassroots organizations as well as larger advocacy groups have been and will continue to be hard at work organizing for increased protections (aclu, 2022). about:blank timbers et al./grassroots activism 221 another factor to consider in the on-going work to secure basic protections for lgbtqia+ people is geographical location. the movement advancement project (map, 2019) has found that lgbtqia+ individuals located in rural areas have not benefitted from protections and social progress in the same ways as urban located lgbtqia+ people. in rural areas, there are fewer lgbtqia+ elected officials and fewer nondiscrimination policies in place (map, 2019). consequently, in these areas there is a greater need “to focus on more basic public education about lgbt+ people” in order to gain support for more equitable policies (map, 2019, p. vi). using an intersectional lens, this paper provides an overview of rural grassroots work on lgbtqia+ policy change at the community level. intersectionality is a framework that considers how overlapping aspects of identity like race, ethnicity, gender, sexuality, religion, and location can impact access to power, health, opportunities, and resources (cho et al., 2013; gkiouleka et al., 2018; hooks, 1984; meyer, 2003). intersectional perspectives bring awareness to the nuances of lived experience based on many parts of one’s identity. in this paper, the authors seek to bring attention to the slow, hard, and empowering work of rural lgbtqia+ people, who are engaging with community organizing in pursuit of equity and liberation. social workers are required by the code of ethics to acknowledge the dignity and worth of all people and to enhance social justice (national association of social workers [nasw], 2021). beyond these ethical values, the code is clear that social workers are to be politically active, and the council on social work education (cswe, 2022) requires that all social workers receive training in mezzo and macro interventions. in the current socio-political moment, social work practitioners, educators, and researchers should be aware of lgbtqia+ led activism in rural areas in order to support increased power and protections at the local level. the authors provide an overview of the grassroots work being done at this intersection, discussing the influences of the community context, challenges related to gaining a powerbase for change, and the importance of lgbtqia+ leadership at the forefront of this work. rural america and lgbtqia+ experiences a 2019 report by the movement advancement project (map) states that approximately 2.9 to 3.8 million lgbtqia+ people live in rural areas. the report states the lgbtqia+ individuals living in these areas may feel they stand out more or will be outed due to the interconnected nature of rural communities (map, 2019). this interconnectedness can also compound experiences of social isolation. for instance, map (2019) notes that since family and faith are at the core of many social relationships and networking in rural areas, exclusion from one or both based on lgbtqia+ identity can limit overall well-being and opportunity. other intersectional identities for rural lgbtqia+ persons can lead to varied experiences of discrimination in schools, the legal system, and social interactions, creating economic and emotional hardship (daley, 2015; map, 2019). the rural setting also compounds these hardships because there are usually fewer support structures and alternatives when faced with discrimination in healthcare, employment, or housing (map, 2019). advances in social work, spring 2024, 24(1) 222 a survey by the pew research center (2018) sheds light on why lgbtqia+ people in rural communities in the united states have different struggles compared to their urbanbased peers. rural communities typically hold more conservative opinions on social issues than those in urban or suburban settings and have a higher concentration of republican voters (54%), compared to suburban areas (45%) and urban areas (31%; pew research center, 2018). moreover, pew research center (2018) found that republican voters in rural areas are more likely than urban republicans to hold conservative stances on social issues. conversely, rural and urban democrats were not as divided in social views but did report some differences in regard to supporting same-sex marriage and other lgbtqia+ protections (pew research center, 2018). this research shows evidence of intersectional power differences that rural lgbtqia+ people may face. another factor affecting lgbtqia+ populations in rural communities is the influence of religion. religion has greater influence in rural areas (daley, 2015; pew research center, 2018), and religious beliefs frequently affirm only cisgender heterosexual relationships (daley, 2015). when traditional moral and religious views of sexuality and gender are embedded in a community, lgbtqia+ people may feel the need to remain invisible in order to protect their physical and emotional well-being (daley, 2015). research has also found that religion can increase risk for suicidality and trauma for members of the lgbtqia+ community (gibbs & goldbach, 2015; james et al., 2016; lytle et al., 2018; paceley et al., 2017). since religious and moral beliefs are typically slow to change, social advancement for lgbtqia+ individuals in highly religious communities can originate in relationship building through grassroots advocacy. considering the cultural and political makeup of these rural communities, it can be said that local power is often held by community members that emphasize traditional views on family, gender roles, and faith. although this information appears discouraging, rural lgbtqia+ individuals are making great advances in political and social change through grassroots work. rurally located lgbtqia+ people are fostering relationships among themselves and with community stakeholders, resulting in an increased sense of agency, interpersonal protections against minority stress related health disparities, and greater political influence (bain & podmore, 2020; scheadler et al., 2022). to consider the purpose and role of grassroots work in policy change, it is important to understand the varied goals of equality, equity, and liberation. moving from equality to liberation equality is defined as having equal access to opportunities and resources (annie e. casey foundation, 2021; milken institute school of public health, 2020). equality assumes that all people have the same starting point; therefore, justice is achieved by ensuring equal opportunity for basic rights. equal opportunity is an important aspect of progress but achieving equality alone fails to address the historical minoritization of certain groups (annie e. casey foundation, 2021; milken institute school of public health, 2020). equity goes a step further by striving to ensure distribution of resources to reach equivalent outcomes by all (annie e. casey foundation, 2021; milken institute school of public health, 2020). from this perspective, justice is achieved through policies that allocate timbers et al./grassroots activism 223 resources based on the varied needs and barriers of individuals (annie e. casey foundation, 2021; milken institute school of public health, 2020). intersecting identities and one’s cultural location are factors that require consideration when addressing equity across a variety of circumstances (pew research center, 2018). going one step further, there has been a return to the language of liberation (crook, 2018; gutierrez & condor, 2007; hooks, 1984; kurtis & adams, 2015; taylor, 2016). liberation is a term that has been used throughout history in social movements for racial equality, women’s rights, lgbtqia+ rights, and even religion-based struggles for justice (gutierrez & condor, 2007; hay, 1997; kurtis & adams, 2015; taylor, 2016). liberation is a call for social change that emancipates people, personally and politically, from dominant power structures that seek to maintain social influence and control (gutierrez & condor, 2007; hay, 1997; kurtis & adams, 2015; taylor, 2016). bell hooks, a distinguished author who led from her lived experience as a queer black feminist, said the dominant power structure could be defined as the imperialist, white supremacist, capitalist heteropatriarchy (medine, 2022). hooks (1984) wrote that liberation must consider the complexity of overlapping power structures in order for all to flourish. through this lens, liberation goes beyond equality and equity to prioritize self-determination, human thriving, and the power of participation in all realms of society (gutierrez & condor, 2007; hooks, 1984; kurtis & adams, 2015). kurtis and adams (2015) say that “personal liberation necessitates broad societal transformation, and in another sense, that any theory of the person is simultaneously a theory of and an intervention into political space” (p. 391). consequently, the goal of liberation is to end legal and social discrimination of lgbtqia+ people, which requires a complex combination of policy change, advocacy, education, and local-based movements (crook, 2018; kurtis & adams, 2015). understanding grassroots organizing community organizing is a powerful tool in striving for equity and liberation. community organizing is defined as a process in which localized groups and individuals come together to build social power and to leverage that power in systematic change efforts (christens et al., 2021; speer et al., 2021). when community organizing is established by those outside a community and does not allow for leadership and participation by those most affected by an issue, it becomes a top-down approach that creates a sense of “pretend power” (mcalevey, 2016, p. 199). in contrast, when those most impacted by an issue are able to be the center of their own activism, real power is generated (mcalevey, 2016). thus, when rural lgbtqia+ people are leading change in their own community, power structures upholding discriminatory policies are dismantled alongside policy change wins (kitafuna, 2022; mcalevey, 2016; speer et al., 2021). this type of bottom-up approach is the core feature of grassroots community organizing. community catalyst (2022), an organization that supports grassroots movements, defines grassroots work as: a process of building power by involving a constituency in identifying both the problems they share and the solutions to those problems; identifying the targets that could make those solutions possible; engaging with those targets through advances in social work, spring 2024, 24(1) 224 negotiation, confrontation and pressure; and developing the capacity to take on further problems. (community catalyst, 2022, para. 2) since policy change requires public awareness and motivation, minoritized groups have successfully used grassroots activism to increase the society’s receptiveness to change and to shift social relationships for progress (christens et al., 2021; kitafuna, 2022; mcalevey, 2016; speer et al., 2021). grassroots organizing is particularly effective in rural areas because the work is very relational and community connections are already embedded in the culture (daley, 2015). the term rural, or non-urban, is typically defined as any area with a population under 50,000 (health resources & services administration, 2021). according to an interactive map available through the u.s. department of agriculture (2021), rural concentrations are largely in the midwest and south. thus it is not surprising that a survey conducted by the harvard t.h. chan school of public health et al. (2017) found that only 47% of lgbtqia+ people in the midwest report feeling well-represented by their local government, while nearly three-quarters of lgbtqia+ residents in the western (72%) and northeastern parts of the us (71%) reported the same. as the rural and urban divide widens on lgbtqia+ rights, rural grassroots activism serves to increase lgbtqia+ visibility, leadership of lgbtqia+ persons and allies in government positions, and advocacy efforts for interpersonal and political inclusion, which are essential for reaching the collective goal of liberation (scheadler et al., 2022). moreover, grassroots activism and organizing has been found to address interpersonal discrimination and policy change through its relational nature and location-specific work (auyero et al., 2019; christens, 2010; unsay, 2020). in looking for peer-reviewed articles that focus on grassroots work by and for lgbtqia+ people in the united states, the authors found limited peer-reviewed sources. this gap in the literature is likely due to difficulty in measuring causal impact and outcomes from grassroots work, but also suggests that researchers may be overlooking the connection of local organizing on larger shifts in state and national policy. the few articles and dissertations that were identified show that lgbtqia+ grassroots work has a synergetic effect, progressing policy and providing immediate positive effects for the lgbtqia+ community. one of the main positive effects beyond policy change was increased access to safe spaces for identity exploration, affirmation, and synthesis (bain & podmore, 2020; handschy, 2021; scheadler et al., 2022). specifically, scheadler and colleagues (2022) found that lgbtqia+ participants in grassroots work experienced an increased sense of community and resilience. their participation also fostered a culture of healing, personal growth, adaptive coping skills, ownership in the movement, and a self-reported sense of hope for the future (scheadler et al., 2022). furthermore, bain and podmore (2020) studied two communities in canada, finding that grassroots work had an immediate impact on the availability of safe spaces in both communities. for instance, a few passionate lgbtqia+ activists in one of the communities, discovered they “lack[ed] the critical mass to leverage large demonstrations and rework institutions” (bain & podmore, 2020, p. 1515), so they focused their efforts on securing more safe spaces. in the other community, lgbtqia+ activists were met with timbers et al./grassroots activism 225 more mutuality and were able to work for both increased visibility and policy change (bain & podmore, 2020). this research highlights the uniqueness of each community and the flexibility of grassroots work to respond to their specific needs (bain & podmore, 2020). the authors identified several organizations from their home or practice regions as examples of grassroots work at this intersection of rural location and lgbtqia+ identity. the organizations include equity north carolina (equality nc, n.d.), country queers, and the center for artistic revolution. these organizations are building capacity for lgbtqia+ individuals to become leaders in their communities while also providing resources, safe spaces, story projects, education, and visibility to these communities and shifting some of the cultural patterns reflected above. the stakeholders supporting these programs include: lgbtqia+ individuals and allies living in rural areas, advocacy organizations and non-profits in their state and local communities, allied religious leaders and organizations, and followers garnered through social media and crowdsourcing. below is a brief overview of each program, showing the similarities and unique purposes of each organization as they work toward equity and liberation in their context. though research is needed to understand the specific impacts of each organization, our purpose in highlighting these organizations is to expand the social work profession’s understanding of grassroots community organizing and policy change as well as to call social workers to locate and support similar organizations in their areas. organizational models for grassroots work for lgbtq equity in rural areas equality north carolina equality nc is a nonprofit organization committed to the macro and micro level work of policy change for lgbtqia+ people in the state of north carolina. the organization was founded in 1979 to provide legal services to those who were criminally charged related to their lgbtqia+ status (equality nc, 2020). over time, the group expanded its focus to include education programs about lgbtqia+ issues, support for state pride events, and the development of locally-based lgbtqia+ organizations throughout the state (equality nc, 2020). in the 1990’s, the organization began to support policy advocacy and political candidates in order to extend the rights of lgbtqia+ individuals in the state (equality nc, 2020). the goal of equality nc is that “beyond legal rights and justice, we win ‘lived equality’ including safety and acceptance in the community at large for all lgbtq north carolinians” (equality nc, 2020, “vision”). the vision asserts that equitable treatment from social and systemic barriers, and not just basic rights, is the end goal. the program has a number of community and corporate partners ranging from legal and advocacy organizations, local lgbtqia+ centers, and faith-based organizations. one of the specific rural initiatives is the rural youth empowerment fellowship (equality nc, 2020). this program provides young people who identify as lgbtqia+ with a year of mentoring and training in macro level advocacy and community organization practices to help them carry out a social justice project in their rural communities. the advances in social work, spring 2024, 24(1) 226 website states that the goal of the fellowship program is to empower lgbtqia+ youth to name and create change for themselves (equality nc, 2020). the program provides stipends to help these youth carry out their projects (equality nc, 2020). recent projects have included programs to address ageism in the lgbtqia+ community through intergenerational relationship building, document the lived experience of lgbtqia+ folks in the appalachian region, create an online collaborative magazine focused on queer experiences in the south, and establish a rural safe space with an intersectional lens. these programs build lgbtqia+ visibility in rural communities which is an essential aspect to bringing change in rural communities. the stay project and the evolution of country queers the stay project began out of an appalachian studies association conference where youths in attendance reported that they did not know how to create meaningful social change in their communities (stay project, n.d.). stay stands for stay together appalachian youth (stay project, n.d.). the organization’s website notes that the appalachian region has seen many young adults leave the area due to limited educational and employment opportunities (stay project, n.d.). as a way to support youth and create leaders that would invest in the community, the stay project was started (stay project, n.d.). the goal is to have “youth ask each other what they want and need in order to stay and work in their home communities” and to connect them to resources to make those changes happen (stay project, n.d., “what we do”). though the stay project is not a specific lgbtqia+ organization, many of the leaders are members or allies of the lgbtqia+ community (nichols, 2020). it was through stay that rae garringer (they/them) initiated the idea for country queers in 2013. they work to create community and record the lived experiences of lgbtqia+ individuals in appalachia (country queers, n.d.; garringer, 2017). this regional project evolved into a project called country queers that now includes stories of rural lgbtqia+ individuals from 15 states (country queers, n.d.). country queers is a multimedia history project that seeks to capture the past and present experiences of rural lgbtqia+ individuals (country queers, n.d.). the goals of the project include: expanding narratives about rural communities, documenting the diverse experiences of queer people in those communities, challenging the belief that lgbtqia+ individuals can only thrive in urban areas, and building a sense of community among rural lgbtqia+ people to reduce social and emotional isolation (country queers, n.d.). currently, the project has completed 60 interviews with individuals identifying as country queers and “a traveling gallery exhibit featuring images and oral histories gathered through the project” (country queers, n.d., para. 3). the organization also launched a podcast in june of 2020 (country queers, n.d.). this project is supported through volunteers, stay project associates, and crowdsourcing through kickstarter, patreon, and gofundme. though the powerbase of the individual contributors may be small, there is power in the collective nature of the work, the independence of funding sources, and the geographical reach it has by extending across multiple states. this project’s grassroots nature and internet reach protects the advocacy timbers et al./grassroots activism 227 work from political and local challengers who want to interrupt or stop the work. the greatest threat opponents pose is through silencing those who would like to share their story but for whom sharing it in a public way would bring social, emotional, or even physical harm to themselves or their family. these social and emotional barriers relate specifically to the concerns expressed in the map (2019) report noted above. the center for artistic revolution the center for artistic revolution (car) in little rock, arkansas has been advocating for lgbtqia+ arkansans since 2003 (koon, 2013; little rock convention & visitors bureau 2021) and first organized against a legislative proposal to ban lgbtqia+ adoption and marriage in 2004 (center for artistic revolution, n.d.; zarco & romo, 2006). according to its founders, sabrina zarco and randi romo (2006), through the use of art and creativity, car “respectfully connects people to one another, encouraging them to see past prejudices and discover ways to work together for the benefit of their communities” (para. 1). though car is based in the little rock area, with an office located in the first presbyterian church, it is a statewide advocacy organization aimed at bringing awareness to the forgotten faces of lgbtqia+ individuals in arkansas (center for artistic revolution, n.d.; koon, 2013; zarco & romo, 2006). originating from the founders’ chicana heritage and their own identities as artists, car draws its approach from teatro campensino, a labor organizer in the 1960s. campensino used actors on the back of flatbed truck to tell the stories of farm laborers and to teach laborers ways to fight for their own rights (zarco & romo, 2006). art and music were also a part of this organizing work. inspired by the use of art for activism, in 2006 car organized a group painting of a mural during pride, which was the catalyst for conversations among those participating and those observing the mural creation (zarco & romo, 2006). after the 2000 census data showed arkansas had around 4,500 lgbtqia+ people, car organized an art installation entitled, “we the people.” the artists placed faces of lgbtqia+ arkansans on pink wooden triangles and left others blank to indicate how difficult and stigmatizing it can be to come out in the many rural areas throughout the state (zarco & romo, 2006). car clearly operates from an intersectional lens. both founders identify as chicana and, as stated above, draw from the heritage of teatro campensino. the work has led to car members who are of mexican heritage creating an altar for dia de los muertos, or day of the dead (zarco & romo, 2006). the altar was created at little rock unitarian church. through the art of creating an altar and cooking a dinner where guests were fed traditional mexican foods, participants were able to engage in a question-and-answer session designed to counteract misconceptions about lgbtqia+ residents in the state (zarco & romo, 2006). in addition to their activist work, the group also provides a safe place for lgbtqia+ youth and their ally friends to share and create together. this group is important to both empowering lgbtqia+ youth and reducing isolation. the organization combines activism, which is focused outwardly on society, with creating safe spaces, which is focused on the internal support for those in the lgbtqia+ population (center for artistic advances in social work, spring 2024, 24(1) 228 revolution, n.d.; koon, 2013; zarco & romo, 2006). currently, their social media shows the organization’s education, activism, and support around the anti-trans bills recently passed in arkansas (center for artistic revolution, n.d.). the power and role of grassroots organizing the outcomes of grassroots and community organizing are often hard to quantify. in a study by orsi (2014), leaders from a grassroots organization used a concept map to help quantify outcomes of their work. after brainstorming outcomes and clustering them into themes, five categories were developed to best capture the grassroots work—victories, personal development, public leadership skills, relationship with power structures, and benefits from a culture of civic engagement (orsi, 2014). victories were obviously successes that occurred with events, engagements, partnerships, policy development, or funding. personal growth was related to empowerment and self-awareness that developed in those who participated in the work. the theme of public leadership focused on refining and increasing skills in advocacy and public discourse. relationship with power structures included establishing relationships with people and organizations of influence to grow impact, and benefits from a culture of civic engagement reflected on participants’ positive experiences of being a part of something bigger than oneself. though more research is needed to see if these outcomes fit with other grassroots organizations and movements, there is anecdotal evidence that the lgbtqia+ grassroots programs are advancing some of the same outcomes found in orsi’s (2014) study. in general, these outcomes demonstrate how grassroots work can shift culture through on-theground policy work, increasing the empowerment of rural lgbtqia+ people, building relationships with power structures, and developing leadership skills that are essential to winning the local and cultural victories that are important for equity and liberation for the rural lgbtqia+ population. scheadler et al. (2022) demonstrates support of orsi’s findings, indicating that lgbtqia+ folks benefit immensely from engaging in the work of activism. the development of resilience and agency further enables them to effectively influence progress within their communities through actions that align with their personal values (scheadler et al., 2022). discussion and implications according to the social work code of ethics, “social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully” (national association of social work, 2021, standard 6.04). some ways lgbtqia+ allied social workers can support lgbtqia+ led grassroots movements is to be present at events, donate money and/or time, refer lgbtqia+ clients and acquaintances to events or resources, purchase products from these groups, and offer access for these groups to speak to one’s employment-based and/or social groups. another important way that social workers can engage this ethical standard is to educate themselves about this type of work in their area and celebrate the often overlooked progress being made by these groups in their social spheres of influence. timbers et al./grassroots activism 229 furthermore, mezzo and macro level social work practitioners and researchers should continue to find ways to document how grassroots work moves policy change for lgbtqia+ individuals beyond equality into the realm of equity and liberation. according to alicia garza (2020), one of the founders of the black lives matter movement, before we can know where we are goingwhich is the first question for anything that calls itself a movementwe need to know where we are, who we are, where we come from, and what we care most about in the here and now. that’s where the potential for every movement begins. (p. 4) the organizations presented in this paper reflect this important work of naming where and who rural lgbtqia+ people are and what is most important for their liberation. these organizations and many more across the country must be acknowledged and supported by social workers to increase the important momentum of self-represented movements for justice. additionally, social work educators are tasked with helping social work students obtain competencies related to advancing human rights (competency two), using an anti-racism, diversity, equity, and inclusion lens in practice (competency three), and engaging in policy practice (competency five; cswe, 2022). specifically, competency five of the education and accreditation policy states that social workers are to “identify social policy at the local, state, federal, and global level that affects wellbeing, human rights and justice, service delivery, and access to social services” and “recognize the historical, social, racial, cultural, economic, organizational, environmental, and global influences that affect social policy” (cswe, 2022, p. 10). grassroots organizing impacts local and state policies as well as considers the contextual influences of one’s particular community in barriers to policy change. social work educators can create assignments for students to locate these types of organizations in their area and learn about their work. educators may also use information and resources from this paper as reading assignments or to create discussion in their classroom about grassroots practices. finally, due to the gap in current research, we encourage social work researchers to use this paper as a resource for engaging and documenting the important work being done in this arena. the nature of grassroots work would be measurable by some quantitative outcomes; however, there are many gradual or implicit impacts that influence visibility and relationship building occurring in rural communities. program evaluations and research in this area should consider both qualitative and quantitative methods to provide more empirical evidence for the impact of this work. researchers should keep in mind the nature of shifting leadership and focus of these organizations. often leadership is based on volunteers and limited funding. as leaders, volunteers, and funding shifts so can the organizations’ focus and engagement. social work should continue to grow in its awareness and participation in important ground level policy work through grassroots activism for historically marginalized people in rural areas. advances in social work, spring 2024, 24(1) 230 references american civil liberties union. 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(2006, july/august). car merges art and change. resist. author note: address correspondence to veronica timbers, university of utah, college of social work, 395 1500 e, salt lake city, ut 84112. email: veronica.timbers@utah.edu https://www.lgbtmap.org/file/lgbt-rural-executive-summary.pdf https://www.lgbtmap.org/file/lgbt-rural-executive-summary.pdf https://doi.org/10.1037/0033-2909.129.5.674 https://doi.org/10.1037/0033-2909.129.5.674 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.nbcnews.com/feature/nbc-out/grassroots-groups-help-lgbtq-people-survive-thrive-appalachia-n1144881 https://www.nbcnews.com/feature/nbc-out/grassroots-groups-help-lgbtq-people-survive-thrive-appalachia-n1144881 https://doi.org/10.1002/jcop.21617 https://doi.org/10.1002/jcop.21885 https://doi.org/10.1002/jcop.21885 https://doi.org/10.1002/jcop.21885 https://www.pewsocialtrends.org/2018/05/22/urban-suburban-and-rural-residents-views-on-key-social-and-political-issues/ https://www.pewsocialtrends.org/2018/05/22/urban-suburban-and-rural-residents-views-on-key-social-and-political-issues/ https://doi.org/10.1080/00918369.2022.2040928 https://doi.org/10.1080/00918369.2022.2040928 https://doi.org/10.1002/jcop.22578 https://doi.org/10.1002/jcop.22578 https://doi.org/10.1002/jcop.22578 about:blank https://www.nytimes.com/2022/06/24/us/clarence-thomas-roe-griswold-lawrence-obergefell.html https://www.nytimes.com/2022/06/24/us/clarence-thomas-roe-griswold-lawrence-obergefell.html https://doi.org/10.1002/chem.202002474 https://www.ers.usda.gov/data-products/atlas-of-rural-and-small-town-america/go-to-the-atlas/ https://archive.ph/20130415234455/http:/www.resistinc.org/newsletters/articles/car-merges-art-and-change#selection-183.1112-183.1204 mailto:veronica.timbers@utah.edu _________ gio iacono, phd, lmsw, assistant professor, school of social work, university of connecticut, hartford, ct. emily k. loveland, phd, lmsw, assistant professor, school of social work, california state university, san bernardino, ca. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 114-127, doi: 10.18060/28052 this work is licensed under a creative commons attribution 4.0 international license. fostering critical relational teaching in social work education: reflections on shifting pedagogy to address the current college mental health crisis gio iacono emily k. loveland abstract: the u.s. is experiencing an unprecedented mental health crisis among college students as they return to classrooms from the covid-19 pandemic. social work students may be at an elevated mental health risk given their interest in the profession, often shaped by experiences of trauma and belonging to marginalized and excluded communities. this critical reflexive paper aims to draw on critical relational pedagogies, underscoring relationship-building and the co-creation of socially just spaces. we explore the fusion of relational and critical social justice approaches informed by bell hooks and paulo freire, examining their potential to shape social work education by centering power-sharing and love. we find utilizing a critical relational pedagogy enhanced our classroom experiences and learning, fostered stronger and more authentic relationships between students and instructors, and held space for the difficult but important generative conversations that often take place in social work classrooms. this paper includes pragmatic strategies to enhance teaching informed by this critical pedagogical framework. adapting a critical relational pedagogy can help mitigate the negative effects of the u.s. college mental health crisis and covid-19. doing so may help students experience a sense of belonging in the classroom and know that their voices are valued. keywords: critical relational teaching, college mental health, social justice pedagogy, social work teaching and practice although may 11, 2023 marked the end of the federal covid-19 public health emergency in the u.s., many important lessons arose from teaching in the pandemic. crucial lessons related to teaching and learning during the pandemic can be leveraged to enhance the learning environment and support best practices moving forward in higher education. changes in technology such as remote or blended delivery modes have been identified as effective and accessible to students (imran et al., 2023). college students also experienced significantly more mental health concerns during covid-19 (son et al., 2020). salimi et al. (2023) highlight the importance that academic support can play in addressing mental health concerns of college students. this is particularly important in social work, when classroom topics can include sensitive issues such as trauma, racism and child abuse. thus, social work educators must stay current on best pedagogical practices to engage students across all learning modalities so no learners are left behind, regardless of delivery mode. a critical relational pedagogy complements the current landscape, which places emphasis on relationships and the co-creation of social justice-oriented spaces. intentionally practicing within this pedagogical framework shifts from the trending about:blank iacono & loveland/college mental health 115 individualistic consumerist approach of social work education to the development of a more interpersonal and community approach that is sorely needed at this particular point in time (morley, 2016). uniquely building on existing relational pedagogies and highlighting them using a critical social justice lens, we aim to explore in this paper how to leverage an existing relational approach to social work education (edwards & richards, 2002) and apply a critical pedagogical approach that complements social work curriculum and core values (council on social work education [cswe], 2022; national association of social workers [nasw], 2021). importantly, this approach honors and prioritizes the relationship between student and instructor. we also aim to examine how critical relational teaching can be implemented across a variety of learning modes (online, in-person, hybrid) to deepen student learning and the relationship between student and teacher, particularly beyond the pandemic. given the ongoing challenges and uncertainty teaching instructors have encountered returning from the covid-19 lockdown into a college mental health crisis, our hope is to encourage social work educators to critically reflect on their own teaching practices and determine how critical relational teaching can better support students, cultivate deeper learning in the classroom, enhance a sense of belongingness, engagement, empathy and empowerment. finally, informed by our (social work doctoral student and junior faculty) teaching practice experience and feedback from msw and bsw students, we propose practical approaches and strategies that enhance teaching and student learning in an environment that is quickly changing (mclaughlin et al., 2020). background the social work profession places relationships as a critical driver for change (dolgoff et al., 2005). the relationship between teacher and student lies at the heart of effective teaching (fox, 2013). informed by relational-cultural theory (jordan, 2017), which centers culture and identity, relational teaching in social work emphasizes the importance of interpersonal connections and seeks to challenge the individualistic ideology that dominates western culture and education. relational teaching aims to foster the development of self-with-others through mutual engagement, empathy and empowerment (edwards & richards, 2002). extending relational teaching, and inspired by paulo freire’s (1994) critical pedagogy and bell hooks’ (2002) concept of love, a critical relational teaching approach infuses and centers social justice to deepen connection within the community so that learning can authentically develop in a shared space of belongingness (dillon & pritchard, 2022). this at times can be a challenge to social work education (liasidou, 2023; sethi, 2021). both hooks’ (2002) and freire’s (1994) pedagogies integrate social justice and relational teaching together, applying a critical lens to this student-centered teaching approach, which is integral for social work practice to pursue social change as codified in the national association for social worker’s code of ethics (nasw, 2021). beginning with the onset of the pandemic, cultivating a critical relational teaching approach has been essential as social work educators have been confronted with challenges. the necessity of online synchronous and asynchronous learning without much planning advances in social work, fall 2024, 24(3) 116 and preparation combined with the ever-changing nature of in-person learning during the pandemic has created barriers in cultivating deep and authentic relationships between students and educators and among student peers (bennett et al., 2021). instructors may have struggled to learn both the technical and pedagogical aspects of a new course modality in a short turnaround. these challenges have also thwarted a sense of belonging, which a critical relational approach to teaching could address (freire, 1994). with the advent of online social work education programs as a catalyst, the pandemic shifted the educational landscape toward remote learning. however, some social work schools were slow to embrace online learning, which may have provided additional challenges for social work educators in supporting students and navigating a new teaching modality to deliver content (lee et al., 2019; smoyer et al., 2020). additionally, many social work educators and learners found it difficult to cultivate relationships and belonging within an online learning environment, adding to these challenges (apostol et al., 2023; bennett et al., 2021; forgey & ortega-williams, 2016). as the college mental health crisis grows in light of these challenges, centering a teaching approach in social work that is relational and maintains a critical social justice-oriented approach has never been more important to address current issues in social work education. several studies have explored the current college student mental health crisis. data indicate this student crisis cannot be unmarried from the covid-19 pandemic. a systematic review of longitudinal studies examining college student mental health during covid-19 identified that the majority of studies report worsening mental health symptoms from pre-covid-19 levels, including anxiety, depression, mood and personality disorders, as well as increased distress and alcohol use (buizza et al., 2022). for example, the national healthy minds study examined mental health from 2013 to 2021 for over 350,000 students at 373 campuses and found nearly a 50% increase in self-reported mental health problems (lipson et al., 2022). more than 60% of students who participated in this survey reported at least one mental health problem. additionally, liu et al. (2022) outline priorities to combat the college mental health crisis. in addition to ensuring access to comprehensive mental health services, the authors suggest conducting intentional outreach for students with circumstances that may be affecting their studies such as stressors related to basic needs, caregiving, or forms of marginalization such as racism. a critical relational teaching approach is well-suited to addressing these needs. before delving into the specifics of a critical relational teaching approach, it is important to briefly note that critical theories inform social work education and practice. the theories include a diverse range of perspectives that scrutinize societal structures, power dynamics, and systemic inequalities to inform and guide social work education and practice (dominelli, 2017; fook, 2022; garran et al., 2022). critical theories in social work, such as feminist social work theory, critical race and queer theory, provide a foundation for critical relational teaching as they scrutinize dominant frameworks that inform social work education. while many scholars inform our practice, we recognize that three theoretical frames specifically inspire our work. paulo freire and bell hooks are central to this pedagogical framework because of their rejection of dominant or traditional methods of iacono & loveland/college mental health 117 teaching, emphasis on power-sharing and an intentional focus on love. relational cultural theory (edwards & richards, 2002) is particularly appropriate for social work education given its cultural lens and emphasis on mutuality. we explore each of these pedagogical influences next. critical relational teaching critical relational teaching places emphasis on cultivating an authentic relationship between individuals in the classroom. the goal is building and co-creating a pedagogical space using a social justice lens (e.g., attuned to power dynamics and addressing equity issues) to focus on the connection between the community. this allows learning to authentically develop in a shared space of belongingness. this approach can be applied across teaching delivery modes to prioritize the relationship between teacher and student so that learning environments may be optimized and more equitable. the following sections will briefly provide some of the theoretical underpinnings of a critical relational social work pedagogy. paulo freire: pedagogy of the oppressed freire (1994) famously challenged the “banking” model of education, seeing people as empty vessels to be filled with knowledge like a piggy bank. he argued that pedagogy should instead treat the learner as a co-creator of knowledge, which social work education espouses. he has also argued for an intentional focus on power, consciousness-raising, dialogue, and collaboration between teacher and student. this would enable people to create change in their lives, moving them towards liberation and social justice. freire’s theory of education also incorporates “love” as a conscious act in the pursuit of social justice through dialogue in the classroom: “dialogue cannot exist, however, in the absence of a profound love for the world and for people. love is at the same time the foundation of dialogue and dialogue itself” (freire, 1994, p. 89). in this way, freire’s emphasis on love highlights and centers the student-teacher relationship, and echoes some of scholar bell hooks’ most profound insights on teaching. bell hooks and the concept of love hooks (2002) posits that “love” is essential in teaching. without love, she argues that there is flatness and distance between teacher and students, which does not serve students and teachers well and hinders deep learning, particularly in the humanities and social sciences. hooks uses the word love not merely in a personal sense but rather as a profound state of graceful being. she goes on to say that meaningful love relations can empower students and deepen engagement in the mutual practice of partnership: “between teacher and student love makes recognition possible; it offers a place where the intersection of academic striving meets the overall striving to be psychologically whole” (hooks, 2002, p. 147). for hooks, love is a verb which facilitates social justice by fostering care, knowledge, and respect in the classroom. this means that teaching with love is profoundly political and central to a socially just approach, which is also conducive to maintaining appropriate advances in social work, fall 2024, 24(3) 118 boundaries between student and teacher. hooks fundamentally connects deep transformative social change to love and this can be modeled in the social work classroom with students. this emphasis on love may provide our social work students with the strength to sustain their work amidst deep political challenges, polarization and turmoil. relational cultural theory relational cultural theory (rct) highlights the importance of the relationship between the teacher and the student in the classroom. the central tenet of rct, which has its foundations in clinical practice, is the idea that relationships are central to fostering healing and growth (miller & stiver, 1997). edwards and richards (2002) apply this theory to higher education and the teacher-student relationship in social work education, emphasizing the importance of mutuality across the relationship. in the classroom, the goal of fostering the relationship includes mutual engagement, mutual empathy, and mutual empowerment. mutual engagement may include active listening from both the instructor and the learner. mutual empathy means an engaged, empathetic relationship, which is particularly important in social work when sensitive material is discussed. mutual empowerment can benefit both the instructor and the learner who will be empowered to learn and develop further insights regarding the course content. in this way, leading with the relationship can foster authentic learning. rct is also an effective framework to engage social justice movements, particularly when applied to the fields of counseling and psychology (comstock et al., 2011). using this theoretical approach across social work curricula is ideal to recognize in both the micro and macro environments. rct emphasizes the importance of the bond between the instructor and learner. with the development of the relationship, authentic learning and knowledge generation can follow. we undoubtedly appreciate the challenges in applying these critical pedagogical concepts to our teaching in social work. our current academic context and the stronghold of capitalist white supremacist structures and processes that diminish the focus on authentic relationships with students and colleagues make addressing issues of power in the classroom highly challenging. however, we contend that a critical relational teaching approach can help address these challenges. first, supporting anti-capitalist and anti-racist work in the academy can help focus on power dynamics, relationships and the interconnections between people working to collectively challenge oppressive structures in pursuit of social justice. critical relational teaching can also bring about the cultivation of deeper learning, a sense of empathy, engagement and belongingness, and ultimately empowerment among social work students and educators. in the following case studies, we explore how critical relational teaching can support teaching and learning within commonly used modalities (i.e., hybrid, online, in-person). these case studies exemplify how critical relational teaching adheres and deeply honors relationships and the core values of our profession, particularly social justice (cswe, 2022; nasw, 2021). iacono & loveland/college mental health 119 critical relational teaching case studies joining virtually: hybrid learning this was my, emily’s, first time teaching a hybrid course on human rights that met four times in person for five hours and had otherwise asynchronous modules. this was a unique structure, and after the first five-hour class, i had closely bonded with many of my 20 students. at the end of my first class, a student approached and mentioned that she had a bachelorette party scheduled for our third in-person classes and asked if she could join virtually. i was apprehensive to accommodate this because being a five-hour class i was scheduling many different classroom activities that might be difficult for a virtual learner to participate in. however, this student had already been a vibrant classroom participant and i could sense that she was committed to the material, so we discussed the potential challenges and agreed. sometime after the third class, this student reached out to let me know her father passed away very suddenly and she was able to see him one last time because she had been home for that bachelorette party. given this unexpected event, the student suffered many challenges that semester, including mental health barriers. while i couldn’t have predicted this tragedy would happen, i am proud that i led my decision making using a critical relational pedagogy: one that prioritized the relationship between myself and the student, that highlighted the learner as a co-creator of knowledge, and that emphasized love. in that way, this student was able to prioritize her mental health while remaining dedicated to her learning environment. the roleplay assignment: online learning as a third-year doctoral student at my university, we are required to teach for the first time. i, emily, taught a macro foundation practice course that took place online due to covid-19. the final assignment is a roleplay of a “force field analysis” where students sign up for different prescribed roles in an organization and then have the creative opportunity to see how a meeting where major changes are going to take place would play out. the outcome of this meeting depends on the choices that the students make so they can understand power dynamics and change in a macro setting. to allow for the most equity, i launched a google sheets document to all students at the same time so everyone had the same opportunity to sign up for a role. one student had not signed up and was left with the remaining role that would require significant contributions to the roleplay. this student had been shy all semester so i checked in to make sure everything was okay. at this time, she disclosed her father had been sick and she had a lot of anxiety about playing the remaining role. she requested that i swap her for a less participatory role. i wanted to embrace my critical relational teaching skills of mutuality, so while empathizing with her i explained that taking another student out of a role and placing her in a less intensive role would be unfair for that student. while respecting her feelings, i also wanted to balance the person to classroom environment. i asked if she would feel comfortable reaching out to her classmates and see if anyone else was willing to swap. this opportunity would allow her to engage further with the other students in the classroom and offer her an opportunity to build confidence in the classroom within boundaries we advances in social work, fall 2024, 24(3) 120 agreed upon and felt safe. as bell hooks (2002) says, imposing boundaries is an act of love. upon further discussion, the student decided to stay in the current role, but was empowered to participate more fully in the final assignment. can’t we all just get along? in-person learning while teaching a required first-year human oppression course that explores various forms of oppression, msw students can be particularly challenged and uncomfortable when they are tasked to deeply examine their biases, socialization and conditioning, and complicity in racism and other systems of oppression. engaging in conversations about systemic oppression and complicity can be difficult and uncomfortable for many students, particularly students who hold significant privilege (i.e., white, middle/upper class, male, able-bodied). i, gio, had been teaching human oppression in person during the later stages of the pandemic and had an older student enrolled in the course who came from a longstanding career in business and was new to the current language and discourse around social justice and social work. she would oftentimes espouse a “can’t we all just get along?” sentiment when contributing to class discussions around social injustices. while i did my best to prevent harm and address the discourses underlying this sentiment, at some point the student’s comments became disruptive to other students and tensions arose between her and her peers. while some tension and discomfort can be fruitful in engaging in deeper and more meaningful dialogue around social justice issues, i oftentimes felt activated and triggered in our class discussions, especially given the extra stress of teaching during this particularly challenging period (i.e., the pandemic). during this time, i regularly consulted with my teaching mentors and course lead, and engaged in significant critical reflection to support this student and the students in the class more generally. through the cultivation of both critical reflexivity and self-compassion, i developed the strength to further cultivate a critical relational stance, to critically reflect on the situation and how i was activated; ultimately, i came to realize the impact and vulnerability i experienced while teaching in the pandemic. by engaging in a critical relational process, extending kindness to myself, and receiving support from mentors, i slowly worked through my own reactions and found the courage to respond to the student with patience and understanding. it was incredibly uncomfortable to take a step back and determine how best to support the student despite their difficulty in engaging with the course material and dialogue within the classroom, as well as balancing the needs of other students. i realized that imposing boundaries in this instance was an act of love (freire, 1994; hooks, 2002) by respectfully moving dialogue towards a critical relational space, especially when seeing students struggle with their own critical reflexivity and boundaries. i was ultimately able to cultivate greater inclusivity and restore a sense of open and respectful collaboration and dialogue in the classroom community space, provided additional time and resources to the student to support their learning, and address power dynamics in the classroom. iacono & loveland/college mental health 121 discussion we believe that explicitly naming and utilizing a critical relational teaching approach in social work is crucial in today’s current sociopolitical climate and is an effective pedagogical approach given the mental health crisis that has erupted in the u.s. since the pandemic began (panchal et al., 2023). we join other scholars who have argued for this more nuanced approach (freire, 1994; hooks, 2002; schwartz, 2019) to teaching. often, particularly when there are mental health challenges, a classroom environment can be an impediment to learning and a sense of belonging. prioritizing relationships through mutuality and reducing power differentials between teacher and student in the classroom can create an environment that allows for greater inclusivity, safety and the collective consciousness to thrive, which can support student mental health (panchal et al., 2023). power-sharing was particularly prevalent from a doctoral student’s perspective, where the line between student and instructor is blended. in some ways, mutual empathy may come more easily for a doctoral student who was recently in the role of a student. keeping this “lifelong learner” mindset fresh by making a conscious effort to practice mutual empathy with students is one important way that all instructors can engage in a critical relational approach. given current neoliberal and consumerist trends in academia and social work education (morley, 2016; reisch, 2013), critical relational teaching is crucial and unique in that it challenges existing power structures and requires conscious and ongoing critical reflection. in the hybrid example, it would have been easy for an instructor to automatically deny the student’s request because the schedule was pre-posted and allowing a student to remote into an otherwise in-person class may require accommodations on behalf of the instructor. the “my classroom, my rules” approach is cognizant of the “banking” model of education that freire (1994) pushed back against. taking a moment to consider the learner and their circumstances in light of the accommodation request reflects the mutual relationship between instructor and learner and is reflective of the social work person-in-environment model. through this, trust and safety can be built to enhance student mental health and a sense of belonging. in the in-person example, not only was there opportunity to cultivate love towards students, but also an opportunity to include oneself, the instructor, as a recipient of love. a critical relational approach can also be an act of love for the instructor. this may serve in enhancing teaching effectiveness and relating to students in an equitable manner (hooks, 2002) by addressing one’s own needs as the instructor and allowing for inevitable difficult feelings to arise, and caring for them through a supportive community of educators and mentors. relationship building is hard work, and with students it can be particularly challenging at times, especially as they grapple with mental health stressors. although a critical relational teaching approach prioritizes relationships, it also prioritizes boundaries. imposing boundaries in the classroom and holding students accountable for their responsibilities is an act of love, according to hooks (2002). it is important to remember that the mutuality aspect of critical relational teaching goes back to the instructor as well. advances in social work, fall 2024, 24(3) 122 critical relational teaching is not a free-for-all where students completely run the classroom. setting boundaries can be a form of mutual empowerment. for example, in the online final assignment example, the instructor set a firm boundary not to reassign roles but offered the student to engage with her peers and swap roles. this sets a boundary, offers a potential solution, and provides opportunity for growth. the critical relational approach is also consistent with using a trauma-informed approach in the classroom (hitchcock et al., 2021). a critical relational approach in the classroom involves instructor recognition of the pervasiveness of trauma in the classroom, and building an environment where students feel a sense of safety, support and connection. this also includes acknowledgement of difficult situations or feelings when they arise. importantly, it is a context that provides compassion for diversity of struggle. as social work instructors, we are often in classrooms where conversations about race, diversity, and equity are discussed. knowing how to lead these conversations in ways that are mutually empowering, supportive, and honor an individual’s experience are critical given the subject matter of social work and the content that is frequently discussed. using a critical relational approach provides a foundation for this. how critical relational teaching supports social work students covid-19 reminded social work educators of the importance of creating a classroom that supports students and cultivates a sense of belonging. creating a culturally safe(r) classroom environment is one of the ways to do so and may support student mental health (bennett et al., 2021). culturally safe means being able to be open and transparent in a way that is honest and respectful. it does not necessarily mean that the classroom will be convenient or comfortable. fostering a sense of responsibility and commitment to student safety is pivotal during these critical classroom moments (archer-kuhn et al., 2020). although social work education has experienced challenges with incorporating a sense of belongingness into online spaces, there is area for growth (liasidou, 2023; richards, 2022). since curricula are not delivered in-person, the instructor must pay careful attention to the language and framing of content in online spaces so that it is equitable, inclusive, understood, and trauma-informed. in addition, making a genuine effort to create an online learning community is critical. a photovoice study by richards (2022) involving bsw students in a post-pandemic remote context elucidates the importance of building community at the university level. this study points to the importance of instructors being mindful of these dynamics when developing and designing remote content. fostering a virtual community for knowledge generation, inquiry and dialogue can offer students a sense of online community in a remote setting (liasidou, 2023). these factors can contribute to a sense of shared belongingness in online spaces, which is pivotal for a critical relational approach to social work education and may support student mental health and well-being (apostol et al., 2023). ultimately, social work values will guide classroom engagement, regardless of the delivery mode (nasw, 2021). teaching in recent years has compelled instructors to be flexible. instructors have adapted to quickly revising syllabi, learning new technology, and delivering materials via a new classroom delivery mode. iacono & loveland/college mental health 123 lessons learned from these challenges remain: the value of relationships should be a driver in the classroom to support student mental health and well-being. critics of this theoretical approach may be concerned with power-sharing in the classroom and fear of losing a sense of control or authority to manage classroom dynamics. however, hooks (2002) rejects this idea. a classroom with power-sharing does not equate to one without boundaries. students are still responsible for completing assignments, attending and participating, but given the collaborative nature of the classroom, they will be inclined to think critically and likely invest in their own learning. seasoned social work educators who have been educated within a more traditional positivist context may potentially reject this approach. however, it is important to acknowledge that, like in many other aspects of society and culture, the next generation of students is changing and challenging long-held assumptions about best practices in teaching. as educators we must also be open to new ideas that will help foster student success and well-being. interestingly, there is a lack of publications from the united states related to the value of relationships in social work education during this time (i.e., social work student mental health crisis; covid-19). rather, international social work scholars have focused on the importance of relational teaching during and after the pandemic (apostol et al., 2023; archer-kuhn et al., 2020; bennett et al., 2021; imran et al., 2023). cultivating more spaces to dialogue about these challenges, as well as having future publications focused on the value of relationships in the classroom are crucial given the future of higher education, and social work education in particular, in the united states. it was particularly striking for us when we presented on critical relational teaching at the 2022 cswe annual program meeting how much the presentation resonated with the audience. it was a well-attended presentation with a diverse range of educators and students in social work. exploring cultivating a sense of love and connection with students as social work educators appeared to require great vulnerability. it also became apparent how challenging it is to hold space for these types of conversations; in our presentation, we intentionally provided time and space to open up and do this kind of critical reflection, which felt like a time of mutual engagement and support in light of the difficulties teaching at this time. implications critical relational teaching can and should be implemented across learning modes. regardless of delivery mode, the priority must be establishing and fostering a relationship with the student. taking time to send a quick survey to gather people’s names, pronouns and interests before the first class, setting up a discussion board to chat with each other in an asynchronous format, or making an effort to actively listen to your student – even if you’re keeping an eye out for the guest speaker that’s about to arrive – are examples of relationship building that are impactful and can set the foundation for a greater sense of belonging and an effective co-learning environment. given the current college student mental health crisis, it is also imperative that students are connected to adequate resources and mental health supports; given the extra time and attention a critical relational teaching necessitates, centering this pedagogical approach may also help social work educators in advances in social work, fall 2024, 24(3) 124 carefully determining student needs and referring them to adequate supports on campus and in the community. table 1. examples of critical relational teaching across delivery modes intervention touchpoint modality inperson hybrid online in first class begin class with weekly check-ins: an open space to report about internships, class, or anything!  meet in person the first session.   go over instructions for any asynchronous activities during inperson meetings.  syllabus plan your syllabus intentionally & ahead of time.    consider hybrid flexibility to be your friend how can you take advantage of it?  what session topics are better online vs. in person? what would foster deeper & critical conversation?  student mental health be knowledgeable & aware of institutional & non-academic supports & ready to make referrals, if necessary    honor student requests, even if they divert from agenda.    recognize & honor the additional stressors that online learning may put on students.   technology prepare your technology ahead of time.    make a plan b (example: can you download a video in case the hyperlink is broken?).    have flexibility with camera rules.   engagement work on building trust & rapport with students.    take more “classroom time” to focus on relationship building & engagement.   acknowledge & name awkward or stressful classroom moments.    be transparent about awkward online interactions.   students’ needs be particularly mindful of underrepresented students’ needs.    instructor practice self-compassion.    critical relational learning may look different across delivery modes depending on the context (see table 1). for example, in a virtual classroom, offering camera flexibility may be extra meaningful to a newly nursing mother who elected to take a virtual class so she can balance motherhood with her dream of being a social worker. for a hybrid classroom, critical relational teaching may mean taking some time out of your in-person schedule to review the asynchronous activities to offer extra clarification and an opportunity for questions. an in-person example of critical relational teaching is honoring student requests to have an open dialogue on an important classroom topic, even if they divert from the instructor’s agenda. these are regular, day-to-day examples of choices that social work educators can make in the classroom, and likely already do. they may not be novel or messy case examples, but they are small and meaningful actions that build a relationship, trust and safety between the instructor and student. the difference lies in intentionally cultivating this critical relational stance in teaching, which can provide a renewed sense of focus and meaningfulness to social work educators during this time. iacono & loveland/college mental health 125 additionally, being knowledgeable and aware of available institutional resources is also critical. nonacademic supports can include available institutional and community health resources, child-care referrals, information about social services, graduation and licensure, emergency grants, and emotional and social support. particularly as social work educators, knowing when and how to refer students when they come to you in distress can provide relief and deepen the student-teacher relationship. critical relational teaching should also be the focus of social work research. understanding how students and instructors can benefit from this pedagogical approach can help strengthen the likelihood that critical relational teaching is used in social work classrooms moving forward. social work students may also benefit from a critical relational approach to mentorship and field instruction. approaching mentorship with this perspective can help students be at ease while also empowering them to build their skills and grow. conclusion critical relational teaching is a pedagogical approach that can support navigating higher education given the new pedagogical landscape of social work education after the onset of the pandemic and ensuing student mental health crisis. students of higher education, particularly social work students, may benefit from a renewed sense of focus by social work educators that prioritizes relationships and emphasizes power-sharing in the classroom, regardless of whether that classroom is a more traditional setting, online, or a blended environment. explicitly naming and utilizing critical relational teaching can benefit social work educators and students as they navigate particularly sensitive and challenging topics in education. the practice sets the stage for 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(2020). effects of covid19 on college students’ mental health in the united states: interview survey study. journal of medical internet research, 22(9), 1-14. author note: address correspondence to gio iacono, university of connecticut school of social work, 38 prospect st, hartford, ct 06103. email: gio.iacono@uconn.edu author orcid: gio iacono, university of connecticut https://orcid.org/0000-0001-5285-7020 emily k. loveland, california state university https://orcid.org/0000-0002-2107-0652 https://doi.org/10.1080/07448481.2020.1803882 https://doi.org/10.1080/07448481.2020.1803882 https://doi.org/10.1080/02615479.2020.1834545 https://doi.org/10.1080/02615479.2020.1834545 https://doi.org/10.1332/204986016x14519919041398 https://doi.org/10.1332/204986016x14519919041398 https://doi.org/10.1332/204986016x14519919041398 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.kff.org/mental-health/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ https://www.kff.org/mental-health/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ https://www.kff.org/mental-health/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ https://doi.org/10.1080/02615479.2013.809200 https://doi.org/10.1080/02615479.2013.809200 https://doi.org/10.1080/02615479.2022.2136156 https://doi.org/10.1080/02615479.2022.2136156 https://doi.org/10.1080/87568225.2021.1890298 https://doi.org/10.1080/87568225.2021.1890298 https://doi.org/10.1177/1473325020981075 https://doi.org/10.1177/1473325020981075 https://doi.org/10.1177/0020872820940021 https://doi.org/10.1177/0020872820940021 https://doi.org/10.2196/21279 https://doi.org/10.2196/21279 mailto:gio.iacono@uconn.edu https://orcid.org/0000-0001-5285-7020 https://orcid.org/0000-0002-2107-0652 background critical relational teaching paulo freire: pedagogy of the oppressed relational cultural theory joining virtually: hybrid learning the roleplay assignment: online learning discussion implications conclusion references _________ nickolas b. davis, phd, lcsw, assistant professor, and aloha vancamp, phd, lmsw, associate professor (retired), department of social work, university of detroit mercy, detroit, mi. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 687-702, doi: 10.18060/28616 this work is licensed under a creative commons attribution 4.0 international license. rethinking social work licensure: test-taker perspectives on fairness, relevance, and reform nickolas b. davis aloha vancamp abstract: the purpose of this study is to provide insight into the experiences of social workers who have taken an association of social work boards (aswb) licensing exam, while exploring the exam’s impact on individuals and offering recommendations for reform. the aswb exams have faced criticism due to disparities in pass rates, raising concerns about potential bias that disproportionately affects people of color and underrepresented groups. using a mixed-methods survey distributed via the national association of social workers (nasw) community board and the baccalaureate program directors (bpd) listserv, both demographic data and qualitative feedback were collected from 76 social work professionals. thematic analysis of the responses revealed five key themes: alternative assessment methods, the need for anti-racism, diversity, equity, and inclusion (adei) integration in the exams, calls for exam elimination, alignment with council on social work education (cswe) educational policy and accreditation standards (epas), and content relevance to practical skills. the results indicate a need for the aswb exams to evolve in response to the diverse requirements of social work practice, ensuring the exam protects the public while doing so equitably. this study underscores the importance of revising the licensing process to better align with the values of the profession and the realities of social work practice. keywords: social work licensure, aswb exams, equity, testing disparities, social work education, licensing reform before the early 20th century, only a few professional groups were regulated including medicine, law, and theology (law & kim, 2005). in 1915, abraham flexner delivered a speech titled, “is social work a profession?” in which he questioned whether social work holds a distinct knowledge base and practice autonomy. this critique prompted social workers to define the profession’s scope, values, and standards clearly and concisely (daley & pittman-munke, 2021; flexner, 1915). in the 1920s, social workers worked in child welfare agencies, hospitals, psychiatric clinics, public schools, and settlement houses. social work was largely unregulated although there were various standards and guidelines across regions. however, as the profession developed, the need for professional standards became more apparent, due to an increasing number of complaints and lawsuits. in 1955, the national association of social workers (nasw) was one of the earliest organizations to help centralize and establish the guidelines and standards for the profession. the united states constitution grants the states authority to establish laws and regulate professions to protect the health, safety, and public welfare of their citizens. currently, all fifty states have laws that govern the protection of public health and safety, encompassing the profession of social work. the regulation of social workers typically falls under the about:blank advances in social work, summer 2025, 25(2) 688 categories of registration, title protection, certification, and licensure (kleiner 2006; wolchik, 2015). registration is considered the least restrictive whereas licensure is considered the most restrictive. licensure enables states to track and verify qualified practitioners. in 1979, the association of social work boards (aswb) was established. it was originally named the american association of state social work boards and was created to build uniform licensing standards and regulations across the states as well as the provinces of canada. their mission was to create a standardized examination that assesses the competence of social work practitioners (aswb, 2021). the first exams were administered in the 1980s (aswb, 2021). although the aswb exams primarily serve the united states and canada, they are now recognized as global models for other countries that are seeking to establish social work licensing exams. aswb currently administers five examinations: the associate, bachelors, masters, advanced generalist, and clinical examinations. the associate examination is used in a limited number of jurisdictions that grant licenses to individuals without a social work degree. the bachelors examination assesses competencies for generalist social work practice, while the masters examination focuses on knowledge and skills necessary for social work practice with a master’s degree but without post-graduate experience. the advanced generalist examination is designed for individuals with a master’s degree and supervised post-graduate experience in non-clinical roles, including macro practice. the clinical examination is intended for those seeking licensure to provide clinical or psychotherapeutic services. the licensing examinations are designed to assess the minimum level of competence required for practice (aswb, 2025). as of 2023, the exam pass rate for first-time test takers was as follows: associate, 69.1%; bachelors, 67.9%; masters, 72.5%; advanced generalist, 61.4%; clinical, 73.4% (aswb, 2024). in 2022, aswb released data stratifying pass rates by several factors. when stratified by race/ethnicity, the first-time exam pass rates for the clinical exams taken in 2021 show marked disparities. white test‑takers achieved the highest pass rate (85%), followed by multiracial (80.7%), asian (74.9 %), hispanic/latino (65.8%), and native american (59.1%) test-takers, respectively, with black test‑takers recording the lowest pass rate (46.2 %). age‑related differences were also evident: participants aged 18–29 had an 80.1 % pass rate, those aged 30–39 had 77.2 %, those aged 40–49 had 67.4 %, and test‑takers 50 years and older had 62.8 % (aswb, 2022). based on the pass-fail rates, testtakers, educators and practitioners have advocated for reform as well as a reconsideration of the exam. despite those outcries, there has been limited research on the exam or the impact of the exam on test-takers. literature review licensing exams generally constitute one component of the broader process of professional or occupational licensure. generally, professional licensing helps to ensure a baseline level of competence and client protection. as nunn (2018) notes, licensed professionals often enjoy higher earnings, longer job tenures, and lower unemployment rates than their unlicensed colleagues. these advantages arise, in part, because licensing davis et al./swk licensure test-take perspec 689 restricts entry into a profession, thus creating a scarcity of qualified providers and a credential-based signal of quality (blair & chung, 2019; nunn, 2018). many professions and occupations are regulated in the united states and internationally. as such, many professions utilize licensing exams, of which social work is one. while critical discourse has emerged around the social work licensing exams, it is certainly not the only profession to face questions about exam fairness and relevance. research looking into the multistate bar exam (mbe) and state bar exams shows that administrators conduct psychometric and practice analyses to ensure fairness and relevance (raymond et al., 2021). similarly, research on the north american pharmacist licensure examination (naplex) has identified student-level predictors of pass rates, such as cumulative pharmacy gpa. this underscores that multiple licensing examinations are subject to systematic investigation, albeit often focused on predictive validity rather than solely on fairness metrics (park et al., 2021). similar research can be found when examining medical licensure in south korea. park and yang (2015) reviewed major controversies surrounding item disclosure in medical licensing exams: the tension between fairness and test validity, the impact of test item disclosure on passing thresholds, and the overall utility of disclosure, where empirical evidence is mixed regarding whether released items inflate pass rates or have little effect on performance. this study highlights that, as with other professions, concerns about fairness, validity, and the consequences for passing standards remain central to policy debates. this suggests that, across professions, licensing exams not only raise fairness concerns but also shape learners’ attitudes and preparatory practices. social work practice is regulated in all 50 states as well as canada, the united kingdom, puerto rico, and many european nations (davis, 2024; groshong, 2009). bibus and boutté-queen (2011) stated that social work regulation has become a “fixture” in social work practice. that said, donaldson et al. (2014) called for deeper understanding of how social work regulation influenced the profession. however, there is still no substantial literature on the effectiveness of social work regulation or its impact on the public's protection. kim (2022) and apgar and nienow (2022) report that there is a lack of research on the exam and its benefits and limitations. donaldson et al. (2014) also reported that there was a paucity of research on social work education and licensure. as mentioned above, there is limited research on the benefits and implications of social work licensing exams but more recently there has been a clamor of concerns regarding apparent disparities implicit in the exam (apgar & nienow, 2022; castex et al., 2018; kim, 2022; morrow, 2022; nienow et al., 2022). research involving social work students highlights both the perceived value and the inequities embedded in the licensure process. miller et al. (2015) surveyed 223 graduate students and found that, although most recognized licensing as a marker of professional legitimacy, many remained uncertain about its exact purpose and relevance to their future practice. a complementary large-scale analysis by senreich and dale (2021), which tracked roughly 5,000 students from a public university, uncovered stark disparities in actual licensure outcomes: white graduates achieved a 78 % licensing rate compared with 48 % for non-white peers, and younger students (ages 21-29) were far more likely to become licensed (73 %) than older students (40 years and older, 50 %). together, these findings suggest that while a social work license advances in social work, summer 2025, 25(2) 690 is broadly viewed as beneficial, systemic demographic and age-related gaps limit equitable access to the license, underscoring the need for targeted interventions that clarify the licensure pathway and address structural barriers. other studies surveying social work faculty reveals a mixed picture of support for licensure, licensing exams, and concerns about alignment with professional standards. glenmaye and bolin (2015) gathered responses from roughly 1,500 faculty members and found that, while the majority endorsed the idea of social work licensure, many expressed disagreements with the specific licensing requirements. a later study by apgar and luquet (2022) examined how well faculty translate the council on social work education (cswe) educational policy and accreditation standards (epas) into licensure exam content. the results revealed a weak correspondence between epas competencies and the exam questions. together, these findings suggest that faculty generally back the concept of licensure but remain skeptical about the rigor and curricular coherence of the current licensing framework, highlighting a need for tighter integration between accreditation standards and exam design. in a comprehensive review of the validity and reliability methods employed in the aswb exams, marson et al. (2009) aimed to demonstrate transparency in the examination’s development process. although the article primarily focuses on the technical processes of ensuring reliability and validity, it indirectly acknowledges concerns from the test-taker standpoint, particularly through discussions of readability for english as a second language (esl) candidates and the consistently high failure rates among repeat test-takers. recent scholarship has highlighted how these psychometric strengths mask deeper systemic biases. apgar and nienow (2024) document persistent systemic racial disparities in aswb pass rates, arguing that the exam functions as a gatekeeping mechanism that disproportionately disadvantages black social work candidates. their analysis links these outcomes to broader structural inequities, suggesting that the test’s reliability does not translate into equitable practice. together, these findings underscore the need to complement technical validation with policy reforms that address the exam’s disparate impact. in another study, victor et al. (2023) replicated a study by albright and thyer (2010) by evaluating chatgpt’s performance on 50 recently developed clinical questions by the aswb. chatgpt achieved a score of 73.3% across three rounds of testing, providing some evidence of construct-irrelevant variance and overall construct validity concerns. based on these findings, the authors recommended that state regulators suspend the use of the clinical licensure exam until the construct validity issue is addressed. other professional organizations are now considering generative ai in the review of their exams, including medical, legal, and business fields (hammer, 2023). in one example, a powerful chatgpt tool was used to pass law and business exams at the university of minnesota and university of pennsylvania wharton school of business, although the bot performed at a level of a c+ student (kelly, 2023). additionally, kung et al. (2023) found that chatgpt reached or nearly reached the passing levels on the united states medical licensing exam. davis et al./swk licensure test-take perspec 691 as of this writing, there is limited information and feedback from actual social work test-takers on the examination and their recommendations for improvement and revision. the purpose of the study is to gather feedback from social work licensing exam test-takers regarding the test’s reasonableness, usefulness, and potential improvements. particularly, participants were queried about specific changes or updates they would like to see for the content or format of the aswb licensing exams to better reflect the evolving landscape of social work practice. figure 1. thematic analysis process adapted from naeem & ozuem (2021) method a nonexperimental, qualitative research study employing thematic analysis was conducted to explore social workers’ perceptions of the social work licensing examination, including the effects of the licensing exams, its fairness, equity, and overall value. a thematic analysis of data was used because of its recognition for flexibility in analyzing data and its foundation in the data itself, allowing results to emerge organically rather than advances in social work, summer 2025, 25(2) 692 forcing preconceived categories on the data (naeem et al., 2023; nowell et al., 2017). the qualitative analysis followed a systematic process, involving several steps such as sorting the responses, identifying keywords, coding the responses, and developing themes. figure 1 highlights the thematic analysis process with a selection of participant responses. the institutional review board (irb) at the university of detroit mercy approved this study. table 1. participant demographic characteristics characteristic n (%) age 18 to 30 years 7 (9.1%) 31 to 40 years 24 (31.2%) 41 to 50 years 19 (24.7%) 51 to 60 years 11 (14.3%) over 60 years 15 (19.5%) missing 1 (1.3%) race/ethnicity american indian or alaska native 2 (2.6%) asian american/pacific islander 1 (1.3%) black or african american 7 (9.1%) hispanic 6 (7.8%) white/caucasian 55 (71.4%) multiple ethnicity 2 (2.6%) i prefer not to answer 4 (5.2%) social work degree bsw 1 (1.3%) msw 56 (72.7%) dsw 2 (2.6%) phd 17 (22.1%) missing 1 (1.3%) employment status full-time 69 (89.6%) part-time 7 (9.1%) retired 1 (1.3%) practice setting academia 21 (27.3%) active military 1 (1.3%) private practice 16 (20.8%) child/family welfare 3 (3.9%) school based services 1 (1.3%) forensics/criminal justice 1 (1.3%) community based mental health/social services 18 (23.4%) healthcare 12 (15.6%) other 2 (2.6%) missing 2 (2.6%) davis et al./swk licensure test-take perspec 693 participants social workers on the national association of social workers (nasw, approximately 120,000 members) community board and the baccalaureate program directors (bpd, approximately 800 members) listserv were invited to participate in the study. participants were social workers who had taken an aswb licensing exam. seventy-six participants completed and submitted their surveys. the participants ranged in age from 18 to over 60, with most indicating their age between 31 and 40 years (n=24, 31.2%). most study participants identified as white/caucasian (n=55, 71.4%). table 1 outlines the participants’ demographic characteristics including age, race/ethnicity, participants’ degree, employment status, and primary practice setting. participants also had an array of social work degrees, with most reporting an msw as their terminal degree (n=56, 72.7%). most participants reported being employed full-time (n=69, 89.6%). academia is the largest primary practice setting reported by participants (n=21, 27.3%), followed by community-based mental health and social services (n=18, 23.4%). most participants reported taking an aswb social work licensing exam immediately after graduating from their social work degree program (n=41, 53.2%). the aswb clinical level was taken by most participants (n=40, 51.9%). table 2 outlines the participant licensure exam characteristics. table 2. participant licensure exam characteristics n (%) took licensure exam immediately after graduation yes 41 (53.2%) no 36 (46.8%) type of aswb licensing exam bachelor’s 4 (5.2%) master’s 30 (39%) advanced generalist 3 (3.9%) clinical 40 (51.9%) findings the thematic analysis of responses regarding proposed changes to the aswb licensing exam revealed five key themes: alternative assessment methods, adei and social justice, exam elimination, alignment with cswe standards, and content relevance and practice skills (figure 2). these themes capture the diverse perspectives and concerns of the participants, highlighting the evolving landscape of social work practice and the need for the licensing exam to adapt accordingly. advances in social work, summer 2025, 25(2) 694 figure 2. key themes regarding proposed aswb licensing exam changes theme 1: alternative assessment methods some participants proposed alternative assessment methods to evaluate social work competencies (n=27) more effectively. one participant shared: the exam measures your ability to recite book knowledge that, in no way, correlates to social work practice in the real world. you almost need to take the exam immediately after graduating before you forget all the book knowledge and learn how to actually practice social work. plus, the exam is racist and sexist. suggestions included creating two different practice-focused tests, one focused on clinical work and another on macro practice, or developing new forms of assessment that go beyond traditional testing. participants expressed that the current structure of the licensing exam promotes only rote memorization and recall over practice-focused and content-specific knowledge. participants advocated for competency-based assessments such as simulations, real-world case scenarios, and portfolios, as these approaches may better reflect the practitioner’s ability to navigate complex client situations. this theme suggests a desire for more tailored and flexible approaches to evaluating social work professionals. theme 2: adei and social justice the themes of adei and social justice also emerged as crucial areas for inclusion in the exam content (n=10). for example, one participant reported: key themes alternative assessment methods adei and social justice exam elimination alignment with cswe standards content relevance and practice skills davis et al./swk licensure test-take perspec 695 more on diversity and cultural sensitivity. i don’t know what all the specific issues are that came out in the research but whatever those are that puts people of color and other minorities at a disadvantage, those things need to be addressed so the exam tests general knowledge but in a way that is culturally sensitive and fair for all who sit for these exams. participants raised concerns about the current licensure exams’ lack of attention to antioppressive practice, anti-racism, diversity, equity, and inclusion. participants stressed the importance of ensuring that the licensing exam reflects the profession's core values and ethical principles while suggesting that the exam should include questions and scenarios that address systemic issues and promote social justice. more specifically, participants noted that the licensing exams should include culturally grounded case scenarios while challenging implicit biases. additionally, participants noted that the licensing exams should directly assess knowledge about systematic racism, historical trauma, and health disparities. theme 3: exam elimination several participants challenged the assumption that a licensing exam is necessary and expressed a desire to eliminate the exams (n=9). one participant noted: i do not believe that exams like this prove competence or skill. i am not born in the us and in my country your degree and passing all the classes and clinicals is what proved your competence and ability. not a written exam. most of social work is interpersonal skills and complex multi-faceted decision making that exams cannot encompass. participants expressing this viewpoint argued that the current exam does not adequately measure the competencies required for effective social work practice. they believe that eliminating the exam could allow for more holistic and practical methods of assessing readiness for professional practice. those advocating for exam elimination criticized the current testing system as overly simplistic, favoring theoretical knowledge over the interpersonal, ethical, and situational judgment skills essential for effective practice. several participants suggested that the licensing exam might hinder entry into the profession—especially for individuals with test anxiety and diverse learning styles. theme 4: alignment with cswe standards some participants expressed concern that the aswb licensing exam should more closely reflect the educational standards set by cswe (n=5). a participant shared: it would be helpful to test-takers if aswb exam content and the cswe educational policy and standards were more closely aligned. there is a distinct gap between the aswb exam and cswe education standards. it is vital for future social workers that we close this gap. these participants argued that the exam should ensure that the competencies emphasized in social work education are adequately represented in the licensing advances in social work, summer 2025, 25(2) 696 assessment. by aligning the exam with cswe standards, they believe the exam could better validate the preparedness of social workers to meet the demands of the profession, ensuring that new practitioners are equipped with the essential knowledge and skills endorsed by the leading accrediting body in social work education. theme 5: content relevance and practical skills another theme was the need for the exam to focus more on content relevance and practical skills (n=3). for example, one participant reported: on one hand, i want it to be an exam which focuses more on content, such as the eppp exam psychologists take. however, i also worry that an actual competencybased exam would result in far less people passing it. participants emphasized that the exam should assess knowledge and skills directly applicable to real-world social work scenarios, particularly in clinical settings. this theme reflects a broader concern that the current exam content may be too theoretical and not sufficiently grounded in the practical realities of social work practice. discussion the findings from this study provide valuable insights into the concerns and suggestions of social workers who have taken an aswb licensing exam. as previously noted, the aswb exams have faced criticism in recent years for their perceived inequities, especially following the 2022 release of exam pass rates which indicated potential bias affecting people of color and other underrepresented groups (apgar & nienow, 2022). the results of this thematic analysis build on these concerns by presenting a detailed view of test-takers’ experiences and proposing pathways for reform that align with the evolving needs of the profession. participants' suggestions for alternative assessment methods reflect a broader conversation within social work education about the limitations of standardized testing as a measure of professional competency. since the development of the first aswb exams in the 1980s, social work practice has become increasingly diverse, encompassing a wide range of roles and responsibilities. therefore, the call for a more nuanced approach to licensure suggests a need for aswb to consider whether a "one-size-fits-all" exam still meets the profession's requirements or if more specialized testing approaches would better assess readiness for different social work domains. moreover, participants’ recommendations for incorporating competency-based assessments, which evaluate practical skills and decision-making abilities, align with previous critiques of the exam's relevance to actual social work practice. these suggestions reflect a shift in the profession towards emphasizing experiential learning and real-world application, resonating with donaldson et al.’s (2014) call for a deeper understanding of how social work regulation influences professional practice. incorporating alternative assessment methods could better prepare social workers for the complexities of their roles and potentially address existing disparities in exam pass rates. davis et al./swk licensure test-take perspec 697 the concerns raised about adei, and social justice aspects of the licensing exam highlight a need for aswb to ensure the exam upholds the profession’s commitment to these principles. there is a lack of literature on how the exam protects public interests without perpetuating bias, and the findings of this study appear to further substantiate these concerns. participants frequently pointed out that the current exam format and content may reinforce cultural biases, thereby disadvantaging candidates of color or those from marginalized backgrounds. this is in line with recent critiques that have called for licensing exams to be more culturally sensitive and reflective of diverse social work practices (kim, 2022; nienow et al., 2022). to address these issues, the inclusion of questions that address cultural humility and scenarios dealing with systemic inequities could help the licensing process reflect the values of social work more accurately. aligning the exam content with these principles could not only promote fairness but also signal a commitment to social justice, a foundational component of the profession (cswe, 2022; nasw, 2021). such reforms would align with the broader trend in social work education and practice toward integrating adei principles. the theme of exam elimination brings attention to deeper philosophical debates about the role of standardized testing in social work licensure. some participants argued for the complete removal of the exam, proposing instead a model based on supervised practice hours and ongoing education. the suggestion to eliminate the exam raises important questions about the most effective ways to ensure public protection and competency in the profession, echoing earlier critiques that question whether a high-stakes, time-limited test can adequately measure the complex skills required for social work practice. while some scholars have supported the need for standardized exams to maintain professional standards, others, like glenmaye and bolen (2015) have critiqued their potential to serve as gatekeeping mechanisms that may disproportionately exclude people of color. it is also noted that gatekeeping may be rooted in bias and inequality itself. the debate surrounding exam elimination highlights the tension between maintaining rigorous professional standards and adopting more inclusive and flexible credentialing methods that recognize different pathways to competency. the concern about aligning the aswb exams with the cswe standards underscores the disconnect between social work education, practice, and licensure. cswe standards seek to ensure that social work programs adequately prepare students for professional practice. however, participants noted a gap between the content taught in accredited social work programs and the material covered on the licensing exam. this gap may contribute to feelings of unpreparedness among test-takers and could be a factor in the disparities observed in pass rates (apgar, 2019). ensuring that the exam reflects the competencies outlined in the cswe standards would not only validate the skills taught in social work degree programs but also support a more seamless transition from education to practice. it would bridge the divide between theory and practice, helping to ensure that new social workers are equipped to meet the demands of the profession. advances in social work, summer 2025, 25(2) 698 the participants' call for more content relevant to practical skills echoes concerns about the current exams’ focus on theoretical knowledge rather than practical competencies. given that social work is inherently a practice-based profession, the ability to apply knowledge in real-world settings is crucial. the findings suggest that a shift toward including more situational judgment tests, which evaluate decision-making in practice scenarios, could make the exam more meaningful and reflective of actual social work practice. integrating practical skills into the exam would align with the recommendations for competency-based evaluations and could be achieved by revising exam content to include case-based questions or simulations. this would also complement the call for alignment with cswe standards by ensuring that the exam assesses not just knowledge, but also the ability to apply that knowledge in diverse and dynamic practice environments. implications for social work practice the findings of this study suggest several practical implications for policy changes to the aswb exams. addressing the identified themes through targeted reforms could improve the exam's fairness, relevance, and alignment with social work values. policymakers should consider incorporating alternative assessment methods, integrating adei principles into exam content, and aligning the exam with cswe standards. social work educators can support these efforts by integrating exam preparation into the curricula in ways that encourage and emphasize critical thinking, cultural humility, and real-world application. additionally, revising the exam to include more practical skills assessments could help bridge the gap between education and practice. limitations this study has several limitations that should be considered when interpreting the findings. first, the sample size is relatively small (n=76), which may limit the generalizability of the results to the broader population of social work professionals who have taken an aswb licensing exam. although the sample included participants from diverse demographic backgrounds, they are likely not representative of the current social work profession. many participants also primarily worked in academic settings, which is therefore not representative of the social work profession. second, the use of a mixedmethods survey distributed through the nasw community board and bpd listserv may potentially introduce selection bias. as this was a voluntary study, the voices of people who were less inclined to participate, or who had neutral or positive experiences with the exam, may be underrepresented. third, the thematic analysis involves subjective interpretation, which may influence the identification and categorization of themes. although the coding process was iterative and aimed to minimize bias, other researchers may potentially identify different themes or interpreted the data differently. additionally, while the study captures participants' perceptions and experiences, it does not include objective measures of the aswb exams’ content, structure, or scoring approaches. as a result, the findings reflect subjective views instead of empirical evidence about the exams. davis et al./swk licensure test-take perspec 699 recommendations for future research future research could further explore the impact of potential changes to the licensing process on both the diversity and competency of licensed social workers. it is also important to examine the effectiveness of alternative, experiential credentialing pathways that emphasize experiential learning. additionally, future research should consider using larger, more representative samples and incorporating longitudinal or objective data to better understand the impact of the aswb exams on social work licensure outcomes. the findings indicate a need for ongoing dialogue within the 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(2015). the economic effects of licensure of dietitians and nutritionists and social workers [doctoral dissertation]. lehigh university. author note: address correspondence to nickolas b. davis, department of social work, university of detroit mercy, detroit, mi 48221. email: davisnb@udmercy.edu orcid: nickolas b. davis https://orcid.org/0000-0002-8921-670x aloha vancamp https://orcid.org/0000-0002-5061-0937 https://doi.org/10.1177/10497315221114175 https://doi.org/10.1177/10497315221114175 https://doi.org/10.1108/itp-01-2021-0061 https://doi.org/10.1108/itp-01-2021-0061 https://doi.org/10.1108/itp-01-2021-0061 https://doi.org/10.1177/16094069231205789 https://doi.org/10.1177/16094069231205789 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://doi.org/10.1177/10497315221125885 https://doi.org/10.1177/10497315221125885 https://doi.org/10.1177/1609406917733847 https://doi.org/10.1177/1609406917733847 https://www.brookings.edu/articles/how-occupational-licensing-matters-for-wages-and-careers https://doi.org/10.5688/ajpe8591 https://doi.org/10.5688/ajpe8591 https://doi.org/10.3402/meo.v20.28821 https://doi.org/10.3402/meo.v20.28821 https://thebarexaminer.ncbex.org/article/spring-2021/the-testing-column-ensuring-fairness-in-assessment/ https://thebarexaminer.ncbex.org/article/spring-2021/the-testing-column-ensuring-fairness-in-assessment/ https://doi.org/10.1093/sw/swaa045 https://doi.org/10.1093/sw/swaa045 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231166125 https://preserve.lehigh.edu/lehigh-scholarship/graduate-publications-theses-dissertations/theses-dissertations/economic-effects https://preserve.lehigh.edu/lehigh-scholarship/graduate-publications-theses-dissertations/theses-dissertations/economic-effects mailto:davisnb@udmercy.edu https://orcid.org/0000-0002-8921-670x https://orcid.org/0000-0002-8921-670x https://orcid.org/0000-0002-5061-0937 this work is licensed under a creative commons attribution 4.0 international license. increasing social work’s stake in interprofessional practice: effectively preparing msw students for integrated care settings amy benton alejandro allen lindsey anderson erica nason abstract: integrated behavioral healthcare is becoming increasingly important and central to social work practice as the healthcare field shifts from a solely disease model of health to a more holistic approach. researchers have also noted the need for studies demonstrating effective models for incorporating integrated healthcare training into schools of social work. studies that demonstrate the effects of integrated training have the potential to provide legitimacy to these training programs, an important step in furthering their adoption within schools of social work in the united states and abroad. the training program described here was designed to increase the number of msw social workers who provide trauma-informed, culturally relevant, evidence-based behavioral health prevention and intervention practices at integrated healthcare settings. this study used a preand post-survey design with non-participating msw students as a control group. findings indicate significant increases in knowledge, skills, and attitudes for training participants. a recommendation for further research is to explore to what extent graduates transfer their enhanced knowledge to the workplace. keywords: integrated healthcare, social work education, bhwet programs, stipendsupported programs, quantitative method integrated behavioral healthcare is becoming increasingly important and central to social work practice as the nature of the healthcare field shifts from a solely disease model of health to a more holistic approach (fraher et al., 2018; zerden et al., 2018). this increasingly holistic approach calls for integrated teams of professionals from different specializations to come together to improve outcomes for individuals and communities. as a result, social work education needs to enhance and support the training of msw students to work effectively in interprofessional healthcare settings. this study provides positive results of one such enhanced msw training project. literature review integrated healthcare practice examples of professions included on interprofessional teams include medicine, nursing, occupational therapists, speech therapists, psychologists, social workers, among others. however, barriers have been identified for incorporating social work into interprofessional practice, including the need to fight for legitimacy in integrated healthcare settings, misunderstandings of what social work has to offer, social workers’ _________ amy benton, phd, associate professor, alejandro allen, ma, msw student, lindsey anderson, lcsw, lecturer, and erica nason, phd, assistant professor, school of social work, texas state university, san marcos, tx. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 976-992, doi: 10.18060/25624 about:blank benton et al./increasing sw stake in ipe 977 wide breadth of practice and skills, and difficulties associated with working in environments that still heavily rely on the medical model (ashcroft et al., 2018; fraher et al., 2018; tucker & webber, 2020; zerden et al., 2020a). social workers’ training and socialization to their professional field imbue them with strengths that can be added to interprofessional teams to improve outcomes for clients. in particular, social work’s focus on the social determinants of health and their importance for achieving equitable outcomes across populations, the ecological perspective, and systems theory have resulted in an understanding that the healthcare field “requires social work’s expertise to promote and renew health and wellness in the lives of individuals, families, groups, and communities as well as to impact policy development” (rubin et al., 2020, p. i). social workers’ understandings of the social determinants of health is particularly valuable for interprofessional teams, as integrated practice is being recognized as a way of effectively addressing healthcare disparities and achieving more positive outcomes for people of color (davis et al., 2015; stanhope et al., 2015). other areas of social work training that are highly relevant in interprofessional settings include group facilitation, culturally competency, family work and engagement, and ethics (jones & phillips, 2016). additionally, social workers are trained in other hard and soft skills that can be impactful for interprofessional teams and fill important gaps. for example, craig et al. (2020) found that social workers add value to integrated healthcare teams through their active communication skills, ability to educate others, and their familiarity with risk management strategies. zerden and colleagues (2020a) found that msw students who were placed in interprofessional settings for their field placements recognized a lack of communication, conflict management, and decision-making skills in the interprofessional teams they worked on. these three skills are important skills that social workers receive training on throughout their formal education experiences and beyond, meaning that social workers are efficiently equipped to improve the functioning of the interprofessional healthcare teams on which they work. integrated care training a large number of social workers already work in integrated healthcare settings (padykula et al., 2020). however, while integrated care education models have been welldeveloped in fields such as nursing, social work integrated care education models are comparatively younger and less developed (zerden et al., 2018). increasing social work’s stake in interprofessional practice requires improved education and training for social work students before going into the field post-graduation (zerden et al., 2018). where integrated healthcare education is being incorporated into social work curricula, evaluation results indicate that these efforts show demonstrable increases in feelings of preparedness to work in integrated healthcare settings (acquavita et al., 2020; mattison et al., 2017; zerden et al., 2020b). social workers require training in many areas to be competent interprofessional practitioners, such as team-based care, cultural competency, inter-team communication, trauma-informed care, and evidence-based practices for physical health assessments advances in social work, fall 2022, 22(3) 978 (horevitz & manoleas, 2013; mattison et al., 2017; padykula et al., 2020). in one study, social workers working in integrated care settings in canada identified specialized education and training to be vital for improving the social worker’s integration into integrated healthcare teams (ashcroft et al., 2018). however, healthcare professionals like social workers are not frequently provided opportunities for formal interprofessional education in their university programs (zerden et al., 2020a). past research demonstrates that social workers frequently lack formal training in integrated healthcare competencies skills and service delivery models (padykula et al., 2020). instead, many social workers report learning the skills that they use on the job without formalized training programs (horevitz & manoleas, 2013). in one study, only 10% of participants reported learning the interprofessional skills they use from their msw program (horevitz & manoleas, 2013). this finding is significant, as it points to a continuing need for trained social workers who are arriving in professional practice already possessing skills and knowledge they need to practice effectively. formal, specialized training during their education would not only prepare practitioners to be more effective when arriving to new positions but would also ensure that they are all consistently trained in the same integrated healthcare competencies. improving social work education models, and in particular field education, related to integrated care is essential for improving social workers’ ability to work, and competitiveness, in integrated healthcare settings (fraher et al., 2018; horevitz & manoleas, 2013; padykula et al., 2020; zerden et al., 2017). field education provides students opportunities to use the skills they have learned in real-world situations and provides crucial training that can only be achieved through hands-on experience with real people and populations. additionally, it provides students opportunities to experience working on interprofessional teams and helps them understand the skills necessary to work on such teams. however, training social workers in integrated care is limited by the number of field placements in these settings and the availability of field instructors who can supervise students in these settings. as such, efforts need to be made to identify more integrated healthcare field placements for students to practice in (mattison et al., 2017; padykula et al., 2020; putney et al., 2017; zerden et al., 2020b). still, increased field placements in integrated healthcare settings may not be sufficient for increased efficacy after graduation. researchers have also noted the need for studies demonstrating effective models for incorporating integrated healthcare training into schools of social work (mattison et al., 2017). studies that tangibly show the effects of integrated training have the potential to provide legitimacy to these training programs, an important step in furthering their adoption within schools of social work in the united states and abroad. stipend supported training programs stipend supported training programs are effectively being used in social work education to increase students’ knowledge and skills and better prepare them for practice in their respective subfields. the stipend-supported programs present in the literature reflect varied approaches to providing education beyond the msw curriculum, including workshops, seminars, specialized and relevant coursework, and specialized field benton et al./increasing sw stake in ipe 979 placements (acquavita et al., 2020; foster et al., 2013; putney et al., 2017; sampson, 2017; zerden et al., 2017). the majority of the literature on social work stipend-training programs focuses on programs related to child welfare work, such as the title iv-e and national child welfare workforce institute (ncwwi) training programs. both programs have consistently demonstrated increases in knowledge, increased feelings of preparedness for working in child welfare, and higher levels of retention in child welfare work following completion of the program (benton & iglesias, 2018; benton et al., 2020; gansle & ellett, 2002; leake et al., 2015; o’donnell & kirkner, 2009). however, studies examining these dimensions are limited, as they have also generally suffered from a lack of a control group to understand whether the results seen can be attributed to the stipend-supported programs. an exception to this is a study by bagdasaryan (2012), who found that title iv-e msw students scored significantly higher (p=.01) on knowledge tests than msw students who did not participate in the title iv-e program. behavioral healthcare stipend-supported training programs are beginning to gain traction in social work education. for example, the global leaders of behavioral health education (globe) training project provides participants with monthly stipends, specialized training, and field placements in behavioral health with the end goal of preparing graduates for work in behavioral healthcare settings (sampson, 2017). another program, the california social work education center’s mental health program (mhp), provided behavioral health training to students across 17 social work programs with a focus on increasing retention in the behavioral health field. in a post-graduation study, foster et al. (2013) found that 93.7% of those who participated in the mhp program remained employed in the behavioral health field. the authors credit curriculum development, financial incentives, and program evaluation as key factors in the success of the program (foster et al., 2013). other behavioral healthcare stipend-supported training programs have specifically focused on training students for practice in integrated settings, largely due to the health resources services administration (hrsa) recognizing the need and providing substantial funding. the behavioral health workforce initiative (bhwi) provided stipends to msw students in exchange for completing clinical electives and interprofessional seminars (putney et al., 2017). evaluation of the program showed increased knowledge about, and confidence in, working in integrated healthcare settings across two cohorts of students (putney et al., 2017). however, this study did not use a pre and posttest design, instead using a retrospective posttest design, which researchers note may have resulted in inflated assessment of levels of change (putney et al., 2017). the university of north carolina’s primecare (unc-primecare) program trained social workers to practice in integrated behavioral healthcare settings by focusing on interprofessional education and field experience. zerden and colleagues (2017) published findings evaluating the program, though the findings primarily focused on the process of developing new field placements in integrated care settings and the extent to which students were able to experience interprofessional collaboration at their field site. smith-osborne and daniel (2017) demonstrated that undergraduate and graduate participants in a stipendsupported integrated behavioral healthcare training program scored highly on tests demonstrating knowledge of integrated behavioral healthcare content, increased their sense advances in social work, fall 2022, 22(3) 980 of themselves as interprofessional team members, and were successful in using integrated behavioral healthcare concepts learned in the classroom. in a cross-site study examining growth in interprofessional knowledge, skills, and values among participants in a stipend supported training program, acquavita and colleagues (2020) found that msw-level students showed an increase in their selfperceived ability to work with others, value in working with others, and comfort in working with others following participation in the program. this study’s findings are limited, as it did not include a control group to draw conclusions about the effectiveness of the program. another study by zerden and colleagues (2020a) used a quasi-experimental matched group design to compare msw students who had field placements in integrated healthcare settings and participated in a training program to those who had field placements in integrated healthcare settings but did not participate in the program. results of this study varied. there was no significant difference between the two groups on a scale measuring participants’ attitudes toward collaborative care in integrated care settings. yet, results also indicated that students in the training program improved at a significantly higher rate on a scale assessing team collaboration skills (zerden et al., 2020a). further studies are needed to examine the effectiveness of programs which prepare social workers for integrated behavioral healthcare practice. more needs to be known regarding their attitudes, knowledge, and skills in working with diverse individuals, primarily in economically disadvantaged communities. additionally, despite a growing knowledge base of published research on behavioral health and integrated behavioral healthcare training programs, these findings often suffer from the same methodological pitfalls as the studies examining child welfare training programs, as they do not include control groups to accurately assess whether the changes seen result from the training program itself. research incorporating control groups are needed to provide key insights and help demonstrate the effectiveness of these programs in a more concrete manner. project description this project was funded through a behavioral workforce education & training (bhwet) grant from hrsa, and was housed in a school of social work at a large public university located in the southwest united states. it was designed to enhance students’ knowledge, skills, and professional development by providing a variety of learning opportunities in addition to their regular msw education. the goal of the project was to increase the number of trained social workers who provide trauma-informed, culturally relevant, evidence-based behavioral health prevention and intervention practices at schools, hospitals/clinics, and homeless serving agencies. the project recruited, educated, and trained 110 graduate-level social work students over a four-year period. participating students committed to working with vulnerable populations and in underserved areas in integrated behavioral health care and community settings. students also participated in experiential learning modules, training sessions, and related behavioral health workshops prior to and during the final field semester. these benton et al./increasing sw stake in ipe 981 learning opportunities furthered their knowledge regarding effectively serving vulnerable populations and underserved areas. the modules were designed to build behavioral health related knowledge and skills when working in integrated behavioral health settings. participants were organized into cohorts who collectively participated in the project’s enhanced learning opportunities in the semester prior to and during their final field semester of the graduate program. the intervention remained consistent across the project years. specific hypotheses guiding evaluation of the project were as follows: h1. project participants will reflect greater levels of knowledge, skills & abilities in project specific practice competencies (e.g., working in integrated care settings, trauma-informed care) than the control group. h2. project participants will reflect greater levels of cultural competency than the control group. method the researchers used a two-group pre-post design to evaluate the effectiveness of the project. quantitative evaluation data were collected at the initiation and completion of the project for each cohort in the training condition, with concurrent collection of survey data from control group members. all study participants completed surveys assessing their knowledge, skills, attitudes, and practices related to key project competencies based on standardized/validated measures described below. the study was approved by the texas state university’s irb. recruitment and sample approximately three months prior to the beginning of each project cycle, emails were sent to msw students who were projected to be eligible for final field in two semesters’ time, advertising the opportunity to participate in the project. interested students filled out applications which were then reviewed by a committee consisting of the project director, the project coordinator, and a volunteer member of the field faculty. initial criteria included a complete application, previous experience, and clearly stated interest in integrated behavioral healthcare. to learn more about potential students and their interest in the project, follow-up interviews with selected applicants began in spring 2019 and continued through december 2021. interviews provided an opportunity to screen for students who sincerely wanted more learning opportunities. selected students were notified of their acceptance into the project and invited to an orientation session. the total number of students in the training group was 110. each member of the training group received the $10,000 stipend as stipulated by the funders, with no additional compensation for participating in the research component. the quantitative analysis examines data for the sample that filled out both pre and post surveys (n=89), providing a response rate of 81%. students who did not apply or were not accepted into the project were invited to be in the control group. control group participants received a $20 egift card advances in social work, fall 2022, 22(3) 982 each for pre and post survey. a total of 74 students initiated involvement as a control group member. the total number of control participants who completed both pre and post surveys was 52 (70%). the majority of students in the training sample were white, female, with ages 23-32. similarly, the control group was primarily female and 23-32 years old. the control differed from the training group in that participants were roughly equal in terms of reporting white or hispanic for ethnicity. over a third of the sample came from economically disadvantaged backgrounds or rural settings. table 1 provides sample demographics. table 1. training and control group demographics demographic group n (%) training (n= 89) control (n= 52) gender female 81(91%) 43 (83%) male 5 (6%) 7 (13%) nonbinary 2 (4%) missing 3 (3%) ethnicity asian-american 1(1%) 2 (4%) african american 11 (12%) 8 (15%) hispanic 22(25%) 21 (40%) white 45 (51%) 19 (37%) multi-ethnic 7 (8%) 2 (4%) missing 3 (3%) bilingual yes 33 (37%) 20 (39%) no 53 (60%) 31 (60%) missing 3 (3%) 1 (2%) age 23-25 34 (38%) 20 (39%) 26-32 32 (36%) 21 (40%) 33+ 20 (23%) 10 (19%) missing 3 (3%) 1 (2%) rural yes 33 (37%) 15 (29%) no 53 (60%) 36 (70%) missing 3 (3%) 1 (1%) economically disadvantaged yes 34 (38%) 20 (39%) no 51 (57%) 31 (60%) missing 4 (5%) 1(2%) veteran status yes 4 (4.5%) 3 (6%) no 81 (91%) 49 (94%) missing 4 (4.5%) benton et al./increasing sw stake in ipe 983 measures two self-report surveys were employed to evaluate the project’s effectiveness in: 1) enhancing participant knowledge and skill attainment and 2) increasing understanding of attitudes and behaviors related to cultural competence. paper versions of the pre-surveys were administered by the project coordinator during orientation sessions. post-surveys were administered by the project coordinator approximately six months later, on the last day of field seminar. due to covid-19, changes were implemented to reduce the amount of face-to-face contact. starting in march, 2020 and through project end, preand postsurveys were sent electronically to participants via a secure link through the web-based survey tool, qualtrics. knowledge, skills, and abilities assessment (ksa). the knowledge, skills, and abilities instrument measured practitioners’ understanding and proficiency related to a series of competencies relevant to behavioral health prevention and intervention practices. the survey used was adapted from the knowledge, skills, and abilities assessment for youth practitioners (national collaborative on workforce and disability, 2004) in order to better reflect the project focus. for example, all questions regarding disability were removed as this was not a focus of the project. the other adaptation was including a competency on trauma-informed care, as this topic was a key component of the expanded education provided through the project. thus, the instrument assessed seven competency areas including 1) knowledge of the field, 2) communication with clients, 3) assessment and individualized planning, 4) relationship to family and community, 5) supervision, 6) administrative skills, and 7) trauma-informed care. items on the survey consisted of sample statements included with each competency to ensure shared definitions when assessing self in regard to each competency. for example, under the trauma-informed competency, one of the statements was “ability to help diverse clients make meaning of their trauma history and current experiences from a trauma-informed perspective”. there were a total of 24 items. participants rated each item within each competency area on a 4-point likert scale in knowledge, training, and relevance. knowledge ratings ranked participants’ level of skill and knowledge related to the competency (e.g., 1=i currently know little to nothing about this; 2=i have some knowledge or skill in this; 3=i know a good amount about this, but it would be useful to learn more; 4=i am very knowledgeable or skilled in this). training ratings ranked participants’ level of training in the selected competency (e.g., 1=i have received little to no training in this competency to date; 2= i have received some training in this competency to date; 3=i have received a lot of training in this competency to date; 4=i have received a certificate or degree in this competency). relevance ratings ranked participants’ belief in how relevant each competency is to job responsibilities (e.g., 1=i believe this competency has little to no relevance to my job responsibilities; 2=i believe this competency is somewhat relevant to my job responsibilities; 3=i believe this competency is very relevant to my job responsibilities; 4=i believe this competency is critical to my job responsibilities). means and standard deviations for the ksa are presented in table 2. advances in social work, fall 2022, 22(3) 984 table 2. means and standard deviations for knowledge, skills, and abilities assessment for practitioners competencies for two groups at preand post-assessments competency domain m* (sd) pretest posttest training group (n= 82) control group (n= 45) training group (n= 82) control group (n= 45) knowledge of the field relevance 3.86 (0.32) 3.67 (0.55) 3.91 (0.21) 3.67 (0.49) knowledge 2.81 (0.41) 2.92 (0.53) 3.50 (0.43) 3.13 (0.48) training 2.50 (0.53) 2.59 (0.54) 3.21 (0.59) 2.88 (0.57) communication with clients relevance 3.91 (0.19) 3.69 (0.55) 3.94 (0.19) 3.71 (0.43) knowledge 2.87 (0.50) 3.11 (0.62) 3.62 (0.46) 3.38 (0.44) training 2.62 (0.55) 2.67 (0.66) 3.31 (0.56) 2.88 (0.63) assessment and individualized training relevance 3.12 (0.48) 3.13 (0.56) 3.18 (0.43) 2.98 (0.65) knowledge 2.16 (0.55) 2.33 (0.73) 2.81 (0.54) 2.63 (0.66) training 2.01 (0.65) 2.02 (0.76) 2.63 (0.56) 2.31 (0.67) relationship to family and community relevance 3.72 (0.45) 3.70 (0.58) 3.82 (0.33) 3.46 (0.63) knowledge 2.61 (0.53) 2.89 (0.83) 3.40 (0.60) 3.05 (0.62) training 2.31 (0.62) 2.45 (0.78) 3.09 (0.60) 2.68 (0.78) supervision relevance 3.88 (0.31) 3.72 (0.57) 3.98 (0.13) 3.74 (0.45) knowledge 2.98 (0.74) 3.06 (0.72) 3.76 (0.43) 3.37 (0.54) training 2.59 (0.73) 2.74 (0.80) 3.38 (0.60) 2.88 (0.83) administrative skills relevance 3.92 (0.23) 3.79 (0.40) 3.93 (0.21) 3.72 (0.41) knowledge 3.11 (0.47) 3.24 (0.49) 3.66 (0.43) 3.47 (0.46) training 2.76 (0.58) 2.84 (0.55) 3.30 (0.49) 3.06 (0.58) trauma informed care relevance 3.90 (0.23) 3.75 (0.56) 3.92 (0.22) 3.55 (0.66) knowledge 2.37 (0.63) 2.43 (0.78) 3.41 (0.56) 2.76 (0.75) training 2.08 (0.71) 2.06 (0.89) 3.16 (0.65) 2.53 (0.92) * range=1-4 for all competencies and domains cultural competence (cc). participants also completed the promoting cultural and linguistic competency: self-assessment checklist for personnel providing primary health care services (goode, 1999). the cc is a self-assessment that includes three subscales assessing practitioners’ office environment, communication style, and values and attitudes in relation to cultural and linguistic competence. an example question from the office environment subscale reads, “i ensure that printed information disseminated by my agency or program takes into account the average literacy levels of individuals and families receiving services.” from communication style, an example is, “i understand the implications of health literacy within the context of my roles and responsibilities.” an example from the values and attitudes subscale reads, “even though my professional or moral viewpoints may differ, i accept individuals and families as the ultimate decision makers for services and supports impacting their lives.” in the cc measure, participants responded to each item using a 3 point likert scale (3=things i do frequently, or statement applies to me to a great degree, 2 =things i do occasionally, or statement applies to me to a moderate degree, or 1=things i do rarely or never, or statement applies to me to a minimal degree or not at all). both the ksa and cc benton et al./increasing sw stake in ipe 985 have good psychometric properties. average cronbach’s alphas for subscales of the cc instrument were .80 for physical environment (4 items), .92 for communication styles (13 items) and .83 for values and attitudes (24 items). for the ksa instrument, the cronbach’s alphas were .94 for relevance, .90 for knowledge/proficiency, and .93 for training (all had 24 items). means and standard deviations for the cc are presented in table 3. table 3. means and standard deviations for cultural competencies scale for two groups m* (sd) pretest posttest training group (n= 87) control group (n= 48) training group (n= 87) control group (n= 48) physical environment 1.91 (0.69) 2.00 (0.64) 2.31 (0.57) 2.15 (0.63) communication 2.40 (0.46) 2.47 (0.51) 2.81 (0.26) 2.52 (0.46) values and attitudes 2.62 (0.29) 2.48 (0.42) 2.85 (0.17) 2.68 (0.28) * range=1-3 for all scales analysis spss 26 (ibm, 2019) was used to analyze the quantitative data. subscales were created by summing the items and taking their average. the ksa had 21 subscales and the cc had three subscales. items on the cc scale were recoded so higher scores indicate that participants do the things related to cultural competence more frequently. mean differences on post survey responses were assessed using ancova. time (preversus post-test) was a repeated-measures factor in this model, and group (training versus control) was a between-subjects factor. the time-by-group interaction effect is key to testing whether the treatment is more effective than the control. a power analysis was conducted using the g*power software package (faul et al., 2007). in order to achieve a power of .80 to detect a treatment effect of medium size (f2=.15), 56 total participants would be required. we ran 24 ancovas for each individual scale of the ksa and cc. in each ancova, the covariate was the pre-survey subscale, the dependent variable was the postsurvey subscale, and the independent variable was the grouping variable (training or control). advances in social work, fall 2022, 22(3) 986 table 4. analysis of knowledge, skills, and abilities assessment with pretest as the covariate relevance knowledge treatment ss df f p ss df f p ss df f p competence one: knowledge of the field pretest 2.33 1 23.82 <.001** 2.96 1 16.30 <.001** 2.53 1 7.93 .006* treatment 0.85 1 8.67 .004** 4.80 1 26.48 <.001** 3.05 1 9.57 .002* error 12.11 124 22.50 124 40.17 126 competency two: communication with clients pretest 0.74 1 10.07 .002** 2.23 1 11.96 .001** 5.97 1 20.87 <.001** treatment 0.71 1 9.66 .002** 2.08 1 11.15 .001** 6.23 1 21.77 <.001** error 9.51 129 23.72 127 36.35 127 competency three: assessment and individualized planning pretest 17.98 1 133.39 <.001** 15.98 1 73.42 <.001** 16.15 1 78.04 <.001** treatment 1.51 1 11.65 .001** 2.10 1 9.63 .002* 3.77 1 18.24 <.001** error 16.63 128 27.43 126 26.07 126 competence four: relationship to family and community pretest 1.03 1 5.48 .021* 5.05 1 15.89 <.001** 5.55 1 14.16 <.001** treatment 3.84 1 20.46 <.001** 5.64 1 17.74 <.001** 6.87 1 17.54 <.001** error 24.41 130 41.03 129 50.14 128 competency five: supervision pretest 1.91 1 33.62 <.001** 2.41 1 11.51 .001** 5.78 1 13.74 <.001** treatment 0.66 1 11.68 .001** 4.30 1 20.50 <.001** 9.14 1 21.72 <.001** error 7.33 129 26.82 128 54.27 129 competency six: administrative skills pretest 0.18 1 1.96 .164 1.87 1 10.38 .002* 3.20 1 13.47 <.001** treatment 1.14 1 12.65 .001** 1.35 1 7.47 .007* 2.09 1 8.79 .004* error 11.67 129 23.28 129 30.15 127 competence seven: trauma-informed care pretest 0.43 1 2.46 .12 4.75 1 12.90 <.001** 13.51 1 30.93 <.001** treatment 3.15 1 18.07 <.001** 13.47 1 36.57 <.001** 13.89 1 31.80 <.001** error 22.69 130 0.37 129 56.68 130 note: *p < .05, ** p <.001 benton et al./increasing sw stake in ipe 987 results for the ksa, each of the seven competencies were rated three times in the following areas: relevance, knowledge, and training. the ratings on individual items ranged from 1 to 4 with higher scores meaning the participants thought the competency had relevance, their knowledge and skills level for the competency was high, and that they had a lot of training in the competency. results of the ancovas revealed that the relevance, knowledge, and training ratings were statistically significant for all 7 competencies. effect sizes ranged from small to medium. in all cases, the training group means were higher than the control group means indicating that participants in the training group thought each competency was more relevant, that they were more knowledgeable in all competencies, and they had more training in all competencies than the control group. therefore, the first hypothesis was supported. table 4 provides the statistical output for each subscale of the ksa assessment. for the cc assessment, results of the ancova analysis, two of the three subscales were statistically significant: communication styles and values and attitudes. for the two statistically significant subscales, the training group had higher mean scores than the control group, indicating that they increased their cultural and linguistic behaviors and attitudes as a result of the training they received (statistically significant at p <.001). there was not a significant difference between groups for the physical environment subscale. these outcomes only partially support the second hypothesis. table 5 provides the results for each subscale of the cc assessment. due to the demographic differences between the training and control groups with regard to ethnicity, ancova was used to assess for any demographic differences associated with scores on the ksa and cc. on the ksa, there were no demographic differences associated with competencies 1-4 and 6-7. however, scores for non-white students were higher than for white students on the relevance and knowledge subscales of competency 5 (supervision; p=.022 and p=.034, respectively). there were no significant findings related to demographics for treatment on competency 5. there were no differences based on ethnicity for any of the three cc subscales. table 5. analysis of cultural competence scale with pretest as the covariate scale ss df ms f p physical environment pretest 4.65 1 4.65 14.59 <.001** treatment 1.11 1 1.11 3.48 .065 error 42.04 132 0.32 communication pretest 2.18 1 2.18 20.76 <.001** treatment 2.97 1 2.97 28.32 <.001** error 12.05 115 0.11 values and attitudes pretest 0.25 1 0.25 6.01 0.16 treatment 1.00 1 1.00 23.57 <.001** error 4.62 109 0.42 note: ** p <.001 advances in social work, fall 2022, 22(3) 988 discussion study results reflect the value of the expanded training provided through the project. across almost all measures the training group indicated significant gains compared to the control group. these findings resulting from comparing the training group to a group that did not receive the training add to the literature that frequently lacks a control group (acquavita et al., 2020; benton et al., 2020). while it would be expected for participants of an enhanced training project to report higher levels of training than control group members, the finding of relevance is important. it reflects that training participants see the worth of their increased knowledge and skills specific to the competencies. of particular value to integrated care training projects is the increased knowledge and skills of training participants in cultural competency, trauma-informed care, and communication. research has noted these areas of training to be key for social workers entering interprofessional health settings (mattison et al., 2017; padykula et al., 2020). the one exception to significant findings was the physical environment subscale for the cc assessment. it is not surprising that this subscale would not see a significant improvement since all participants were students with little to no control of the environment of field placement. a potential impact to the project was the onset of the covid-19 pandemic. although adjustments needed to be made to the delivery of content and administration of preand post-test surveys, participant outcomes in these affected semesters were still positive. limitations the surveys used in the study were self-report, thus a social desirability or self-serving bias could have influenced participants’ responses in a desire to appear proficient in relevant competencies. still there was a significant difference in outcomes compared to the control group, reflecting that perceptions of proficiency and values were not as strong without participation in the project. as well, the study was conducted with one project at one public university in the southwest. therefore, the data may not be generalizable to other stipend training programs. additionally, the training sites where students participating in the project completed their field placements likely varied in the scope of training it provided to students. for example, all participants were not placed in hospitals. integrated care occurs on a spectrum, so learning is not always the same or similar between individuals when they are in the field. students also work with varied populations, each with their own unique needs addressed through integrated care, meaning that students typically receive specialized training relevant to their populations. and finally, the required and sudden shifting of practices at each field placement due to covid-19 also influenced the training participants experienced. these variations in training may explain differing levels of knowledge and a focus on different competencies. implications for social work education there are benefits to providing monetary support for an educational program that prepares graduates to work with vulnerable populations. the ability of students to focus benton et al./increasing sw stake in ipe 989 more intently on the final field experience, including class and academic assignments along with the full-time internship, is supported through the provision of the stipend. additionally, the number of hours worked in outside employment has been shown to negatively affects students’ gpas, motivation levels, and retention rates (tessema et al., 2014). students who receive stipends to support their final field experience may be less likely to seek or continue employment while completing internship hours. additionally, there is an ethical imperative to educate and train social work students as much as possible prior to their entrance to the field of social work. a core value for social work is competence (national association of social workers [nasw], 2021). this study supports the literature emphasizing the need to prepare social workers for integrated behavioral healthcare (fraher et al., 2018; horevitz & manoleas, 2013; walsh et al., 2022) and increases the participants’ competence specifically to work in these settings. a recommendation for social work educators and administrators is to explore and advocate for more funding to provide enhanced integrated care training projects. research has indicated barriers for integration of social workers into interprofessional settings (ashcroft et al., 2018; tucker & webber, 2020). specialized, stipend-supported training, such as those funded by hrsa, can support participant focus on necessary skills and the ability to educate others on what social work brings to the setting. implications for social work research one suggestion for increasing the research knowledge base is to track training participants’ employment after graduation. given that the bhwet project does not include a contractual work obligation, it would be relevant to understand how many participants continued their employment within integrated care settings. because the current study relied on self-reported evaluations of knowledge, skills, and attitudes, future research could also include the evaluations of participants’ supervisors and clients in order to triangulate the findings. longitudinal research also could examine the extent to which participants in a training program such as bhwet are more likely to seek out employment in certain types of practice setting or have an increased likelihood of taking on leadership or supervisory roles. another recommendation for further research is to explore to what extent graduates transfer their enhanced knowledge to the workplace. it has been estimated that only 1020% of knowledge gained in trainings is transmitted into practice behaviors (austin et al., 2006). the potential long-term impact of enhanced training programs could be evaluated through a longitudinal approach. this approach would provide information as to whether the training received has been helpful in their social work roles and responsibilities. a further component of effectiveness to track longitudinally would be to specifically explore transfer and sustainability of skills and attitudes regarding working with diverse, underserved, or disadvantaged communities. this focus could provide insight to what works and where project improvements should be made for the maximum impact to integrated care settings and the populations they serve. advances in social work, fall 2022, 22(3) 990 references acquavita, s. p., harley, d., lee, b. r., sacco, p., levy, m., & holmes, c. 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(2020a). interprofessional collaboration: an evaluation of social work students’ skills and experiences in integrated health care. journal of social work education. https://doi.org/10.1080/10437797.2020.1743219 zerden, l. d., kanfer, m., & levine, a. (2020b). integrated field and collaborative opportunities for msw students at campus health. field educator, 10(1), 1-10. https://fieldeducator.simmons.edu/article/integrated-field-and-collaborativeopportunities-for-msw-students-at-campus-health/ zerden, l., lombardi, b. m., fraser, m. w., jones, a., & rico, y. g. (2018). social work: integral to interprofessional education and integrated practice. journal of interprofessional education & practice, 10, 67-75. https://doi.org/10.1016/j.xjep.2017.12.011 author note: address correspondence to amy benton, school of social work, texas state university, san marcos, tx 78666. email: ab68@txstate.edu https://doi.org/10.18060/24406 https://doi.org/10.18060/24406 https://doi.org/10.1080/10437797.2017.1290564 https://doi.org/10.1080/00981389.2015.1025122 https://doi.org/10.5430/ijba.v5n2p50 https://doi.org/10.1093/bjsw/bcaa202 https://doi.org/10.18060/25564 https://doi.org/10.1080/10437797.2017.1288595 https://doi.org/10.1080/10437797.2020.1743219 https://fieldeducator.simmons.edu/article/integrated-field-and-collaborative-opportunities-for-msw-students-at-campus-health/ https://fieldeducator.simmons.edu/article/integrated-field-and-collaborative-opportunities-for-msw-students-at-campus-health/ https://doi.org/10.1016/j.xjep.2017.12.011 mailto:ab68@txstate.edu _________ autumn asher blackdeer, phd, msw, assistant professor, graduate school of social work, university of denver, denver, co. maria gandarilla ocampo, msw, doctoral candidate, brown school of social work, washington university, st. louis, mo. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 720-740, doi: 10.18060/24986 this work is licensed under a creative commons attribution 4.0 international license. #socialworksowhite: a critical perspective on settler colonialism, white supremacy, and social justice in social work autumn asher blackdeer maria gandarilla ocampo abstract: to date, social work continues to be a predominantly white-dominated profession; this is true across all levels of the profession’s current and aspiring membership, including students, practitioners, and faculty members. this racial composition is remnant of our profession’s history of upholding white supremacy and legacy of white saviorism. not surprisingly, foundational teachings of social work center and champion white women (e.g., jane addams) while neglecting the important contributions of black and brown social workers to the profession. the harm done by continuing and upholding these practices extends to all spheres that social work education touches, directly or indirectly. while the national association of social workers code of ethics would lead one to think of social work as a noble profession, the reality demonstrates that we continually fall short of that reputation. social work education is guilty of exploiting vulnerable and marginalized communities for the benefit of the profession under the guise of promoting social justice. for example, field placement, a cornerstone of social work education, continues to send mainly white students into communities of color for the purposes of learning, often treating the community as guinea pigs in the pursuit of white knowledge through experiential learning. although in the long run, field placements can have some benefits for communities, we need to be more critical about the practices we engage in and the ways in which they fail to advance social justice and reinforce the status quo. we are at a pivotal moment in our profession as we reckon with the dissonance between our preaching and practice. the purpose of this paper is to highlight the many ways in which social work education haphazardly 1) perpetuates colonialism and upholds white supremacy, 2) harms marginalized communities, and 3) fails to model our code of ethics. we make a call for serious introspection within the field of social work: to evaluate the power dynamics at play, reckon with our past, and plan for a profession that strengthens and lives up to its commitment to social justice. we conclude with recommendations for transformative change within the social work profession. keywords: social justice; white supremacy; settler colonialism; antiracism; social work education; social work practice; field education despite the supposed dedication to achieving social justice, the social work profession has continually perpetuated settler colonialism and white supremacy. several have pointed to the year 2020 as a moment of reckoning due to the global coronavirus pandemic and the national racial justice awakening spurred by state-sanctioned violence against black and brown lives. goode and colleagues (2021) posit that living in times of racial and political unrest requires social work activism; however, the social work profession remains largely silent as revolutionary social movements of our time unfold (jeyapal, 2017). if the social work profession were living up to its true mission of social justice, social activism would about:blank asher blackdeer & gandarilla ocampo/#socialworksowhite 721 be the norm and reactionary statements during times of civil unrest would be unnecessary from the profession. as part of the new generation of social workers, we refuse to remain silent. we add our voices to fellow social work scholars who have called for a reawakening of our profession and a radical confrontation of oppression (goode et al., 2021). social movements are a ripe opportunity to challenge the profession’s complacency and our notions of professionalism in favor of a more progressive social work that can challenge oppression and promote social justice (jeyapal, 2017). throughout this paper we will demonstrate how the social work profession 1) perpetuates colonialism and upholds white supremacy 2) harms marginalized communities, and 3) fails to model our code of ethics. we conclude with recommendations for transformative change within the social work profession. history of social work upon first glance the social work profession appears to be based upon specialized knowledge and a commitment to social justice, but the actually relies on authority and power (gambrill, 2001). scholars posit that in actuality very little evidence exists to support the social work profession’s supposed dedication to radical social change and structural transformation (brady et al., 2019). social work claims to originate from powerful social movements throughout time (reisch, 2013 as cited by brady et al., 2019); however, scholars have begun to delineate the following pattern regarding the social work profession’s actual involvement with social movements: as new social movements emerge, the field of social work begins to reject the social movement, including its leaders, members, and goals (brady et al., 2019). soon after, social work begins to lionize the social movement’s ideas, embracing its leaders, members, and goals, and attaches itself to its legacy (brady et al., 2019). finally social work uses the movements’ influential ideas and methods in order to co-opt any victories and subsequent icons for the credit of social work, not the social movement itself (brady et al., 2019). in other words, the social work profession opposes social movements as they emerge, and often will support them as they become successful as a means to attach the profession to its victories and leaders, without giving full credit to the movement itself. social work institutions formulate the backbone of the profession, and historically were not as grounded in social justice as one might think. social work has an extensive history of complicity, carrying out the government’s agenda and enforcing social control, from segregated settlement houses and social services; the removal, relocation, and genocide against indigenous communities; the incarceration of japanese americans; and the ongoing state-sanctioned violence against black and brown communities (brady et al., 2019; national association of social workers [nasw], 2021; tang yan et al., 2021). social work has been historically influenced by christianity, the doctrinal authority which upholds and justifies white supremacy (dyson et al., 2020), and deficit-based thinking (brady et al., 2019). early social work organizations were segregated, anti-native, and decidedly christian, with services primarily delivered through the church (brady et al., 2019). this heavy patriarchal influence on social work persists today in the paternalistic values and ethics imparted upon the profession. advances in social work, summer 2022, 22(2) 722 early social work saw different individuals as problems to be treated, a line of thinking that persists today through the medical model (brady et al., 2019). this deficit approach was carried out in the work of mary richmond and jane addams as they tied social problems to individual deficits and problematized individuals as people in need of treatment, often including institutionalization (brady et al., 2019). social work reproduces this line of thinking in treating marginalized communities, predominately those of color, as deficits or problems that need help integrating into white society, as social work promotes white civility as a benchmark of assimilation (fortier & hon-sing wong, 2019). social work and whiteness are further seen in jane addams’ 1910 words as she likened “pity for the poor” as charitable but juxtaposed “hatred of injustice” as radical (jeyapal, 2017). based upon this history, social work is actually founded more in charity than empowerment (lerner, 2021). this foundation of charity is perpetuated through hidden curriculum in social work education and manifests today as white saviorism. social justice while social justice appears as an explicit social work value, the actuality continues to reproduce racial and societal hierarchies (bhuyan et al., 2017). despite clear calls for social justice from the social work governing bodies such as the council on social work education (cswe), nasw, and the american academy of social work and social welfare, there is an evident lack of research on how to integrate social justice into the classroom through course content, syllabi, assignments, etcetera (atteberry-ash et al., 2021). previous research has shown that social work students start their programs with a strong social justice commitment and endorse that their education has a positive impact on that commitment overall; however, these students also report very little opportunities to learn or apply social justice theories and skills acquired in their msw programs (goode et al., 2021). research has found that social work students reinforce this dichotomy in viewing social justice as separate from clinical practice, stating social justice classes are too theoretical and fail to offer practical skills (bhuyan et al., 2017). schools of social work lack emphasis on social action overall (apgar, 2021). results also found an overall lack of social justice integration throughout the curriculum, reporting that a lack of institutional support reinforced whiteness as the dominant social work perspective and an overarching lack of practical social justice skills throughout the program (bhuyan et al., 2017). ultimately, social work students report a disconnect in curriculum and skills from the profession’s overall mission of social justice (goode et al., 2021). further, while social work purports to value social justice, the profession appears to stall in moving this ideal into motion through social action. social action, originating from community organizing, is essential to the social work mission of social change (apgar, 2021). the nasw says social work involves political and social action; however, recent work reports that social workers are largely not involved in efforts for systematic change (apgar, 2021). in fact, there has been a decline of activism within the field, with social workers spending less than 2% of their time engaging in macro practices such as community organizing or policy development (apgar, 2021). while there have been critical and influential voices throughout time, the entire social work profession itself falls short (brady et al., 2019), with some calling out the profession’s deep thread of insincerity asher blackdeer & gandarilla ocampo/#socialworksowhite 723 (gambrill, 2001). mainstreaming is defined as the combination of marginalized critical social work approaches with the institutionalized commitment to social justice (bhuyan et al., 2017). this reduces the discourse to creating a professional image or branding, rather than offering tangible skills in order to achieve social justice (bhuyan et al., 2017). social work as a field likes to “talk the talk,” yet proves time and time again that it lacks commitment to “walk the walk,” revealing this unchanging gap between our so-called dedication to social justice compared to the actual actions of activism (apgar, 2021). social work is guilty of mainstreaming social justice, reducing our mission to hashtags and virtue signals instead of an actual commitment to structural change. these conflicting ideas of valuing social justice versus taking social action lead the present authors to ask—is social work really committed to achieving social justice? settler colonialism present day discussions of white supremacy are remiss in the exclusion of the lasting impact of settler colonialism; this modern culture of whiteness is rooted in colonization, and must be named and addressed in order to dismantle white supremacy (lerner, 2021). coloniality is defined as the long-term patterns of power, seen throughout culture, labor, and knowledge production, that result from colonialism and survive beyond the colonial time period (almeida et al., 2019). coloniality is maintained in higher education through the criteria of academic performance of knowledge through which the experiences and values of marginalized populations become invisible (almeida et al., 2019). coloniality manifests through three key systems: hierarchies (racial division), knowledge (privileging white ways of knowing as “objective”), and societal systems (reinforcing hierarchy’s ability to regulate and segregate in order to uphold fellow systems; almeida et al., 2019). ultimately, controlling history, knowledge, health, and justice is coloniality in action (almeida et al., 2019). colonization is present in the classroom and is not merely something from the past (lerner, 2021). despite social work’s commitment to diversity and inclusion, social work continues to teach eurocentrically, perpetuating the colonization of indigenous peoples and knowledge and every other non-white population (dumbrill & green, 2008) through the continual invalidation and refusal of other ways of knowing (lerner, 2021). examples of this can be seen throughout social work curricula, including the teaching of eurocentric frameworks of research for knowledge building and of clinical models for assessment and treatment. social work teaches from an internalized colonial mindset, leaving students with little to no skills to decolonize their own education and organizations. such a mindset leads to the perpetuation of oppressive practice (lerner, 2021). further, social work is taught through an individualist lens, which posits that individuals make sense of their realities through reflection of their own social experiences, reinforcing how coloniality centers on individual issues such as identity development when in reality the entire system is causing harm (almeida et al., 2019). this coloniality is further seen in social work practice through the psychosocial assessment, a problematic and othering approach to an individual seeking help (almeida et al., 2019). specifically, the psychosocial assessment and like iterations (e.g., biopsychosocial assessments) do not fully consider how structural and systemic barriers manifest in the form of biopsychosocial problems and as a result, plans developed advances in social work, summer 2022, 22(2) 724 from such assessments place the onus of resolving often structural or systemic based issues (e.g., poverty, racism, etc.) on the individuals seeking support. we can decolonize this approach by situating the problem within the matrix of coloniality and considering frameworks like the social determinants of health rather than a “neutral” context (almeida et al., 2019). for example, using the social determinants of health – economic stability, education access and quality, health care access and quality, neighborhood and built environment, social and community context (healthy people 2030, u.s. department of health and human services, office of disease prevention and health promotion, n.d.) can provide a better understanding of how context, systemic, and structural barriers impact individual health, shifting the focus away from individuals and highlighting the need for social workers to address system issues more broadly. beyond the classroom, colonization is perpetuated by the profession through inaction to address systemic and structural harm to marginalized people and communities of color. recently the nasw published a report in which they outlined the numerous ways in which the social work profession has failed to promote social justice by actively “supporting policies and activities that harm people of color” (nasw, 2021, p. 2). a major manifestation of coloniality in social work is the practice and perpetuation of white supremacy. white supremacy we must name these structures of white supremacy and colonization in order to begin to interrupt them (almeida et al., 2019; lerner, 2021). white supremacy is a mechanism of social control and oppression originating from european imperialism (almeida et al., 2019; beck, 2019). there has been extensive work (peweward & almeida, 2014) on how white supremacy has become law in the formation and cementation of the united states as a nation (almeida et al., 2019). within the literature, these formative processes are known as the racial contract, referring to how whiteness has been translated into social capital through the definition of beliefs, values, and behaviors (almeida et al., 2019). beliefs around individualism, as opposed to collectivism, as well as ideas and behaviors around professionalism are an example of this in social work. hegemony is how colonizers dominate power in society through economic, education, media, and government by forcing eurocentric worldviews on everyone, presenting white power as beneficial to all (lerner, 2021). the hegemony of whiteness posits that white is normal, neutral, and objective (beck, 2019). this has direct implications for conceptualizing research in what counts as objective. if whiteness is the norm, then whiteness is the only true objectivity, thus black, indigenous, and communities of color (bipoc) can never achieve truly objective scholarship. scholars have described how the academy perpetuates knowledge production based upon white logic (zuberi & bonillasilva, 2008). consequently, this inability for bipoc scholars to achieve “true objectivity” impacts the ways in which their scholarship is evaluated to be deemed worthy for funding, knowledge building, and integration into the profession. ultimately, these circumstances result in the practice of erasing and devaluing the contributions and presence of bipoc people, which reinforces hegemonic whiteness (frey et al., 2021). through these practices asher blackdeer & gandarilla ocampo/#socialworksowhite 725 and others, social work is complicit in maintaining and perpetuating hegemony (yee, 2016). in a recent report, the nasw detailed how social workers have historically and currently been complicit in shameful practices such as blocking black enfranchisement, helping lead “indian schools”, and contributing to overrepresentation in child welfare systems (nasw, 2021). despite social work being a predominately female-dominated profession, the patriarchy inherent within white supremacy reigns supreme (almeida et al., 2019). even at the turn of the century, social workers were calling for a reexamination of social work learning and practice for the inclusion of feminist theory into the curriculum (freeman, 1990). scholars advocated for a shift from a “women’s issues” approach to a broad integration of feminist content into the curriculum (freeman, 1990) which has yet to be realized nearly three decades later. conversations of gender oppression have been diluted and lost into broad sweeping feminist frameworks that center individual empowerment over addressing structural issues that impact women (almeida et al., 2019). a content analysis of articles on women and social work conducted from 1998 to 2007 found a decrease in both women’s and feminist content in social work journals (baretti, 2011), with researchers demonstrating that the influence of feminism in social work has been largely constrained to individual projects or initiatives and not across the curriculum or profession as a whole (phillips & cree, 2014). #socialworksowhite social work reproduces whiteness daily (jeffery, 2005), through centering whiteness in education (e.g., teaching a white-based social work history and failing to provide counter narratives), practice (e.g., client surveillance and gatekeeping of resources), and scholarship (e.g., excluding bipoc knowledge; crudup et al., 2021; frey et al., 2021). white privilege is a product of white supremacy (beck, 2019), and privilege is the mechanism of oppression remaining invisible in dominant groups (simon et al., 2021). we bypass addressing white supremacy in social work by talking about white privilege instead of the structures that enable and maintain this supremacy throughout our profession. jeffery (2005) identified a paradox in social work and whiteness: whiteness is taught as a set of social work practice skills, so when we teach self-reflexivity and are critical of whiteness, we are inherently inviting a critique of social work. if you have to give up whiteness, by current competency standards, how can you be a good social worker? (jeffery, 2005). scholars recommend a decreased focus on marginalized groups and identities and more on privilege and resistance to change (yee, 2016). in doing so, we can avoid traps such as viewing whiteness as a monolith and perhaps even become braver about challenging institutions that reinforce oppression (yee, 2016). this shift away from a voyeuristic view of communities of color is an invitation to turn the focus inward and evaluate how one comes to the work. however, merely changing views of privileged individuals will not eliminate oppression, just as increasing the number of people of color in higher education does not equate to systemic change (yee, 2016). ultimately, introspection without action is not enough. social work must move from surface level evaluations of privilege to actively dismantling systems and structures of oppression. advances in social work, summer 2022, 22(2) 726 respectability politics are a tool of whiteness utilized to weaponize the denial of power (haley, 2020). used as a tool to manipulate and control communities of color, respectability politics define non-normative behavior as deviations from whiteness, focusing on individual behavior instead of structural issues (haley, 2020). white social workers participate in respectability politics through enforcing whiteness on their peers of color which ultimately silence and further oppress communities of color under the guise of inclusion (haley, 2020). for example, a study of black female faculty at a researchintensive school of social work found that these scholars were unable to present themselves authentically and engaged in self-management, code switching, and appearance regulating due to unspoken, white-based arbitrary rules of professionalism (fields & cunninghamwilliams, 2021). further, these scholars received messaging that indirectly or directly minimized their qualifications to secure employment by referencing that hiring practices to increase inclusion, instead of their qualifications, would make it much easier for them to secure employment in the academy (fields & cunningham-williams, 2021). interventions to address manifestations of whiteness, such as respectability politics, fall short in their approach to address white individuals and further harm communities of color. people of color have had to learn to deal with whiteness in order to succeed and sometimes just to survive, and as such do not have the same experiences in unlearning whiteness as their white peers (gregory, 2020). further, racial equity focused social work interventions perpetuate racial oppression by leaving whiteness intact through avoiding discomfort, taking a color-evasive approach, and continuing the notion of omnipresent whiteness (gregory, 2020), just as the majority of diversity, equity, and inclusion (dei) workshops consider to center white feelings, comfort, and worldviews. social work is and always has been complicit in the social construction of whiteness (gregory, 2020). educators and students alike wonder why social work education fails to teach skills to enact structural change against oppressive systems and undo colonialism (lerner, 2021). scholars call for the academy to ask ourselves about our own involvement in white supremacy (beck, 2019). to interrogate whiteness, individuals must view the entire picture of colonialism, white hegemony, logic, and knowledge production (beck, 2019). the social work profession must be intentional in unmasking the insidious nature of white supremacy and its legacy of harm (beck, 2019). we have an ethical mandate to confront the white-centered nature of social work education by helping students understand how they perpetuate whiteness, so they do not end up blocking antiracist work for the sake of white fragility (lerner, 2021). we must take a deliberate, consistent, and holistic approach to uprooting whiteness in the social work profession. the antidote to white supremacy: liberating the mind, body, and brain from oppression (lerner, 2021). manifestation of whiteness in social work social work education there are three pillars of social work education: explicit curriculum, implicit curriculum, and field education (bhuyan et al., 2017). explicit curriculum includes the core educational competencies set forth by cswe, which social work teaches through a colonial, color-evasive, eurocentric approach to maintain present power structures (tang asher blackdeer & gandarilla ocampo/#socialworksowhite 727 yan et al., 2021). implicit curriculum refers to how students are socialized into the profession, including mitigating classroom conflicts, and reinforcing professional behavior (bhuyan et al., 2017). the professionalization of social work is a manifestation of neoliberalism, as the profession shifts to focusing on providing services more than it encourages critical thinking, movement building, or social action (brady et al., 2019). further, this implicit curriculum often mirrors hidden curriculum as students are socialized not only into the profession, but into the dominant (white) group overall (bhuyan et al., 2017). tang yan and colleagues (2021) describe this hidden curriculum in social work as neoliberalism in which mainstream narratives of social justice are privileged and market values such as consumerism and managerialism reign supreme. this has shifted the profession from radical social change through collective action into a micro intervention focused field that helps clients adapt to the systemic oppression around them (tang yan et al., 2021). social work is notorious for providing band-aids to our clients rather than advocating for actual structural level change. finally, field education trains social workers in environments that limit advocacy, penalize disruption, or embody perspectives from marginalized groups – essentially views or beliefs that represent or embody minority communities (bhuyan et al., 2017). social work education and practice teach with a curriculum mainstreamed for white students and marginalizing non-western theory and knowledge (lerner, 2021). i. explicit curriculum: teaching diversity and cultural competence diversity. social work education sidesteps social justice and focuses on teaching diversity and cultural competence instead. social work education began to address diversity in 1973 through identity-specific classes, eventually adding group-specific courses over time across sexual orientation, ability, gender, and country of origin (alvarezhernandez, 2021). this model of diversity is inherently representative of white supremacy in social work education, namely through the nature of hegemony herein where white populations are considered the norm, and all other groups are now othered and considered “diversity” (dumbrill & green, 2008). this concept of diversity is mainstreamed for individuals to accumulate advantage for the already advantaged, providing students with their msw badges of honor, instead of truly challenging disadvantage (bhuyan et al., 2017). social work is more concerned with tolerating difference through teaching diversity rather than disrupting the status quo of settler colonialism and white supremacy. centering diversity instead of social justice is a direct implication of accrediting bodies. cswe mandates learning of diversity in social work education yet provides no details on implementation (franco, 2021). schools of social work have taken varied approaches toward adding diversity into their curricula (atteberry-ash et al., 2021). some take a parking lot approach, covering diversity in one foundational class only, thereby leaving it in the parking lot, while others infuse the content throughout their curriculum or offer a hybrid parking lot/infusion combination (atteberry-ash et al., 2021). newer approaches include offering mini courses or workshops on diversity, similar to ceu style events (atteberry-ash et al., 2021). it is unclear which model is best for integrating diversity into social work curriculum, but none truly account for intersectionality advances in social work, summer 2022, 22(2) 728 (atteberry-ash et al., 2021) or address the elephants in the room – colonialism and white supremacy. the problem of focusing on diversity as a proxy for social justice or social action is the omission of intersectionality in its entirety (atteberry-ash et al., 2021). diversity classes gloss over how intersecting identities are impacted by the institutional oppression embedded within systems, often failing to ask reflective questions or promote structural change (franco, 2021). social work can never be antiracist as long as we stay in diversity management and competency development (jeffery, 2005). diversity will never dismantle the master’s house. cultural competence. surface-level understandings of peoples’ lived experiences are known as cultural competence; academics use cultural competence as a way to avoid examining structural issues of dominance and oppression (almeida et al., 2019). current social work teachings on diversity and inclusion center on micro level practice, citing cultural competence as a key skill in order to demonstrate respect and respond to “difference” (craig et al., 2021). social work as a field has otherized diversity, collapsing in multiple concepts such as multiculturalism, intolerance, diversity, and cultural competence, humility, and sensitivity – all without an interrogation of colonization and cultural imperialism (almeida et al., 2019). overall, cultural competence lacks a social justice lens (franco, 2021). cultural competence remains the dominant social work framework (franco, 2021) despite critiques of perpetuating an individual focus rather than addressing systemic issues (craig et al., 2021). cultural competence has tried to save face with the addition of concepts like cultural humility and intersectionality; however, it continues to focus more on self-awareness rather than content that directly addresses oppression (craig et al., 2021). cultural competence is embedded within a mastery model that is underpinned by colonialism and the hegemony of white supremacy (franco, 2021). this notion of mastery pushes an all-knowing approach where individuals can develop expertise in another culture (franco, 2021). cultural competence norms whiteness and others communities of color while conflating culture with non-whiteness (franco, 2021; wagaman et al., 2019). cultural competence sets white students up to learn about the “other” without any critical reflection of their own racial identities or how they uphold racist systems (wagaman et al., 2019) and also overlooks intersecting identities within systems of oppression (franco, 2021). both of these haphazard pedagogical models of diversity, inclusion, and equity often utilize experiential learning, perpetuating harm against students of color while maintaining white privilege. experiential learning allows for students of color and other minoritized and marginalized students to draw from their lived experiences; however, white students are then able to absorb knowledge abstractly through others’ experiences (craig et al., 2021), often at the expense of their marginalized peers. the onus is always placed upon people of color to identify racism or “difference,” thus reinforcing the othering – allowing the dominant group to spectate instead of doing their own actual work (yee, 2016). research has shown that white comfort is linked to the pain and suffering of bipoc students, staff, and faculty (beck, 2019). social work perpetuates voyeurism and trauma tourism at the expense of students of color for the sake of white learning and comfort. asher blackdeer & gandarilla ocampo/#socialworksowhite 729 ii. implicit curriculum: neoliberalism in the academy the social work profession is embedded within the broader neoliberal system of the academy and continues to support the existing social order by enforcing the dominant (white) status quo (brady et al., 2019). there is substantial literature on the role of neoliberalism within the academy and how market-driven logic has changed institutional practices (yee, 2016). the academy is not culturally, politically, or ideologically neutral (dumbrill & green, 2008) and continues to reproduce inequality (bhuyan et al., 2017). the influence of the market system on the academy, seen through consumerism, professionalism, and capitalism, creates students as paying customers thus devaluing radical and transformative work for stakeholder fear of losing profit (bhuyan et al., 2017). capitalist market logic makes social work a commodity defined by standardized competencies and skills, thus narrowing the field to secure employment and reducing the profession to the logic of cultural capital production (bhuyan et al., 2017). social work has embraced the dominant narratives of capitalism and for-profit market-based solutions to social welfare problems (brady et al., 2019). neoliberalism is in direct opposition to the goals of social work and the curriculum taught within social work education (brady et al., 2019). neoliberalism encourages a onesize-fits-all approach (brady et al., 2019) instead of valuing the inherent dignity and worth of the person. further, neoliberalism devalues professional intellect and undermines the emancipatory nature and liberatory goals that social work strives to meet for its clients (brady et al., 2019). two main structures contribute to neoliberal social work education: governing bodies and the academy (brady et al., 2019). governing bodies in social work provide accreditation and licensure standards through competencies; these competencies are inherently behavior-focused and fail to encourage critical thinking and reflection (brady et al., 2019). the academy contributes to neoliberalism within social work through the increased corporatization seen through increases in tuition as financial support from the government decreases (brady et al., 2019). further, neoliberalism is seen in the professionalization of diversity and equity, in which students become consumers, assessed on their future contributions to the economy, thus rendering social justice as contradictory to the needs of the market (bhuyan et al., 2017). the influence of neoliberalism also manifests in social work in the form of symbolic anti-racism, which is purported through the notion that anti-racism, anti-oppressive, and anti-colonial work must be consumable and palatable, making colorblindness ideology preferrable and ensuring race is kept invisible (lerner, 2021). ultimately, whiteness and respectability politics reinforce settler colonialism and provide the foundation for the perpetuation of neoliberal policy (haley, 2020). iii. field education field education, the third pillar of social work education, is often described as the profession’s signature pedagogy, yet very little attention has been paid to addressing oppression within field education (razack, 2001). field education exists largely at the margins of social work education, often taught externally to the curriculum and the school (razack, 2001). the practice of field education overall can be oppressive to minoritized or advances in social work, summer 2022, 22(2) 730 marginalized communities as the profession sends emerging social workers to cut their teeth in these communities, often at the risk of those already most vulnerable. internships or practicum becomes a real-life lab in which marginalized individuals and communities become the guinea pigs with which up-and-coming social workers can try and fail, at times hurting these communities in the process, all the for the sake of the student’s learning and growth. some students can exhibit poor boundaries, behavior and attitudes that are incongruent with social work values, and other challenging behaviors (street, 2019), which ultimately affect the people whom they are supposed to work with. the revolving door nature of these positions is also inherently problematic. sending social workers in training into a community for a time-limited stay, ranging from a few months to about a year, can further perpetuate social problems and is the epitome of placing student band-aids rather than addressing radical social justice solutions. while having student interns or practicum students increases the capacity of social services agencies to serve vulnerable individuals and communities, there are inherent challenges and power issues with having students with varying training and skill levels practice with marginalized communities. students may lack investment in the agency or work, have wanting experience and skills, or have generally problematic behavior (street, 2019) which impact the experience and quality of service received by individuals and communities. these individuals and community members may have no choice or believe they have no choice but to accept subpar service, which can indirectly and directly reinforce marginalization and oppression. this is exacerbated by the fact that there are currently no requirements for agencies to seek client and community input on their experience working with interns. other harms in field education have been identified in the role of field instructors and at practicum sites themselves. field instructors play a significant role in facilitating harm against practicum students of color. field instructors can choose to avoid or hesitate discussions of diversity and identity and often take a color-evasive approach to field education by denying racial differences (gooding & mehrotra, 2021; johnson et al., 2021; razack, 2001). this approach can gaslight practicum students of color and further exacerbate systemic issues they may already be contending with. further, practicum sites can be potential triggers for internalized oppression among students of color (razack, 2001), as students describe experiences of code-switching to survive and display professionalism. social work students of color are forced to remain vigilant, even in field placement, to successfully navigate their environments (gooding & mehrotra, 2021; johnson et al., 2021; razack, 2001). social work practice the bifurcation of social work into micro versus macro practice reflects the broader debate in the field’s overall mission of achieving social justice. some say social work has an inherent contradiction between individual versus societal level change (edwards et al., 2006). social work is more concerned with symptom management and ignores structural influences (tang yan et al., 2021) as individuals would rather do recognition-based or representational work (e.g., identity-based politics) rather than examining structural issues and interlocking systems of oppression (yee, 2016). social work reproduces the settler state through social service delivery that supports white communities at the expense of asher blackdeer & gandarilla ocampo/#socialworksowhite 731 black, indigenous, and other communities of color (fortier & hon-sing wong, 2019). this can be seen in how social work and welfare are utilized as a mechanism of control to manage and assimilate communities of color into the dominant (white) society (fortier & hon-sing wong, 2019). the settler state replication in social work is best described as a structure of elimination and is readily apparent throughout the removal of indigenous children, extraction of natural resources from indigenous land, and the overall racialization and dispossession of indigenous peoples overall (fortier & hon-sing wong, 2019). as social work has become an increasingly regulated profession, it has shifted towards competency-based learning as opposed to evaluating students’ critical inquiry of and engagement with social injustice. (hurley & taiwo, 2019). social work competencies reinforce the split and eventual hierarchy between clinical work and social justice, devaluing social justice theory as a non-transferrable skill (bhuyan et al., 2017). competency-based social work centers on thinking and acting where critical social work hallmarked by critical reflective practice, critical consciousness, and reflexive thoughts values analyzing discrepancies between what is said versus what is done (hurley & taiwo, 2019). as social work moves away from critical theories in order to prepare students for clinical practice, the struggle to bridge the gap between critical theory and competencybased practice greatens (hurley & taiwo, 2019). while some support enhancing micro-skills for effective practice (katz et al., 2021), social work needs to get more involved in policy and macro practice in order to prepare students to be true agents of change in championing social justice to dismantle oppression at all levels (dyson et al., 2020). macro social work is often devalued as “too big” to tackle; however, when we view things as static or immutable, we collude with the dominance in systems, reinforcing the narrative that there’s “nothing we can do” (yee, 2016). we fail to teach students how to think critically about the relevance of micro skills; for example, micro skills are necessary to engage in advocacy work and political activism. overall, social work students are less exposed to macro content, with united states-based social work programs offering twice as many micro or clinical specializations than they do for macro social work (friedman et al., 2020). previous research has found that students report valuing knowledge that translated into micro or clinical practice more than they did macro or systems knowledge (bhuyan et al., 2017). scholars call for a more robust macro skillset but merely adding concentration competencies are not enough (apgar, 2021). macro social work, including work in the political realm, is one such avenue to advocate for societal-level change in the pursuit of social justice. social workers have debated throughout time how “professional” it is to advocate for social change, particularly in the political arena (brill, 2001), stating there is a thin line between policy practice and politics (friedman et al., 2020). social workers have been critiqued as lacking political sophistication and having limited aspiration toward systemic change (hurley & taiwo, 2019). social work has avoided social justice, inclusion, and equity conversations for fear of partisanship (goode et al., 2021) and has been de-politicized in favor of emphasizing micro resilience over structural change (tang yan et al., 2021). ultimately, the majority of social work political involvement stops with voting (apgar, 2021). scholars purport at the turn of the century to be moving away from the belief that political activity is unprofessional, with charlotte towle stating that the “role of social work is to mobilize the advances in social work, summer 2022, 22(2) 732 conscience of the community” (brill, 2001, p. 233). ultimately, social work cannot avoid political engagement if we are to challenge existing social inequalities (friedman et al., 2020). code of ethics social work has four distinct ethical periods throughout time: morality, values, ethics theory and decision-making, and ethical standards and risk management (chase, 2015). there were attempts as early at 1919 to draft a code of ethics in social work (reamer, 1998). starting in the late 1900s, the morality period is defined by jane addams’ hull house, a paternalistic approach to wayward individuals, and a shift in evaluating the client’s morality as opposed to the morality of the profession or practice (chase, 2015; reamer, 1998). the first code of ethics was adopted in 1960 by the national association of social workers (brill, 2001), and the values period began in the 1970s with the adoption of nasw’s new code that included more than 70 ethical principles (chase, 2015). the values period marked the shift in focus to professional values and ethics (reamer, 1998). the ethical theory and decision-making period began in the early 1980s and introduced ethical theory and ethical dilemmas (reamer, 1998). it was later revised and then had a major rewrite in 1996, which is when the first time nasw had an official mission statement (brill, 2001). also beginning in 1996, the nasw code of ethics extended social work guidelines and standards and ushered in the era of ethical standards and risk management (reamer, 1998). some scholars suggest we are entering a new period of ethics, the digital period, as the profession begins to reckon with the role of technology on values and ethics in social work practice (chase, 2015). there is a wide critique of social work values as ambiguous, privileging white epistemologies, and reinforcing colonialism (brady et al., 2019). codes of ethics are described throughout the literature as windows into a profession (brill, 2001), and the social work code of ethics leaves much to be desired. present social work ethical codes reflect the ambivalence of the profession. while originally developed to hold social workers accountable to the profession, they actually protect them from individual moral accountability (chase, 2015). how can our values be interpreted without a colonial lens? our lens determines how our ethics are interpreted and applied; the current lens is white supremacy and thus stipulates how social workers are seeing and interacting with the world. ethical codes are not synonymous with the morality or sanctity of a profession. for example, the german medical profession had one of the most highly developed ethical codes in their time, yet still participated in the holocaust (chase, 2015). the code of ethics prohibits discrimination by social workers and calls us to prevent and eliminate discrimination (lerner, 2021). how can we achieve the elimination of discrimination without centering social justice in our teaching, practice, and research? as such, it is imperative that the nasw code of ethics truly commit to social justice by explicitly calling upon social workers to actively confront and dismantle colonialism, white supremacy, and other forms of oppression. asher blackdeer & gandarilla ocampo/#socialworksowhite 733 implications for social work uprooting white supremacy scholars like craig and colleagues (2021) call for an increase in curriculum to focus on diversity and teach students to be allies. some have recommended models to develop allyship, such as the ally model of social justice (ally model) which centers on difference, oppression, and privilege and encourages a focus on self-awareness (craig et al., 2021). while beneficial for navigating allyship, these methods of training fall short in addressing structural and systemic issues in social work education. merely teaching students to be allies is not synonymous with dismantling harmful structures. from our experience, individuals may become hyper focused on demonstrating or proving their allyship, often to the point of being performative at best and white saviors at worst. to address colonialism in the classroom, scholars recommend social work pedagogy seriously and actively consider the matrix of colonization (almeida et al., 2019). social work pedagogy can disrupt coloniality by practicing critical consciousness within an intersectional framework by emphasizing critical consciousness, empowerment, and accountability (almeida et al., 2019). hudson and mountz (2016) recommend utilizing tools from intergroup dialogues such as identity-based caucusing, also referred to as affinity groups. these identity-based caucuses utilize a small group process to discuss privilege and oppression within an intentional space (hudson & mountz, 2016; lerner, 2021). these spaces allow open discussions without shame, guilt, or denial, and most importantly shield students of color from potential harm of having to witness their white peers process their whiteness (hudson & mountz, 2016). affinity groups are a great formative step to uprooting whiteness in social work education. several interventions and programs exist to help white people process their whiteness. combs and perron (2020) have developed a 12-step model of recovery from white conditioning and encourage white individuals to embrace their responsibility to undo the systems of privilege they benefit from, while others have formed antiracist alliances (blitz et al., 2014). some scholars recommend the acknowledgement and identification of bias in order to appreciate social justice in social work (rogerson et al., 2021); however, these individual actions are not enough. lerner (2021) has several recommendations for helping students reflect on their whiteness, including critical race theory, acceptance and commitment therapy, acknowledging mistakes, not comforting discomfort, countering white fatigue, and practicing cultural humility. social work must begin to address whiteness to fully acknowledge and uproot white supremacy. dyson and colleagues (2020) propose racial reconciliation and forgiveness as a path to healing and liberation. this reconciliation would eradicate both conscious and unconscious societal processes that perpetuate harm and encourage a grieving and mourning period to expose the denied effects of colonization (dyson et al., 2020). however, it remains unclear what truly counts as reconciliation and forgiveness. in a critique of canada’s reconciliation efforts towards first nations communities, fortier and hon-sing wong (2019) describe that this process did more to pacify white guilt and uphold a white savior complex in social work and the state while avoiding truly transformative change. ultimately, reconciliation advances in social work, summer 2022, 22(2) 734 is hard work, which can lead individuals to live in a state of injustice-related dissonance thus leading to immobilization (wagaman et al., 2019). uprooting whiteness in social work will require continued social action and must move beyond dissonance and discomfort. social work education i. explicit curriculum in order to reorient the profession towards dismantling systems of oppression, scholars recommend starting with social work education (goode et al., 2021). scholars recommend a critical pedagogy of white supremacy, involving more than theory-based discussions of privilege but analyzations of domination (beck, 2019). this pedagogy would credit ida b. wells just as much as jane addams (beck, 2019). further recommendations for teaching diversity and inclusion include creating an open classroom environment and reshaping the role of the instructor to be more caring in order to facilitate conversations (craig et al., 2021). others recommend teaching teams for an anti-oppressive approach to teaching social justice courses, centering power differences and a shared generation and production of knowledge (garran et al., 2015). some recommend adding a particular course to critically analyze structural barriers and client-centered interventions in order to form a critical-competency perspective (hurley & taiwo, 2019). finally, scholars recommend using the power, privilege, and oppression framework (ppo) to guide the integration of social justice into social work education; by incorporating ppo in addition to social justice and diversity, social work can reshape its trajectory and reckon with the power in training the future of the profession (atteberry-ash et al., 2021). ii. implicit curriculum scholars have made recommendations addressing the institution at large, such as disrupting eurocentric-dominated curriculum, removing mainstream concepts like cultural competence, neoliberalism, standardization, diagnosis, and the medical model (lerner, 2021). further suggestions call for social work schools to own up to their outdated, offensive, and inaccurate curriculum and shift values towards practice-based knowledge as much as academic training (lerner, 2021). to realign the social work profession, we must choose empowerment over charity and actually encourage students to engage with systems to produce meaningful change, not just accept or collude with existing structures (lerner, 2021). some recommend combining theories such as anti-oppressive practice and intersectionality in order to fix social justice shortcomings in the social work profession like the overemphasis on cultural competence (franco, 2021). this combination approach would address both implicit and explicit bias, racism, and oppression in social work curriculum by naming and addressing white supremacy, power, and privilege (franco, 2021). ultimately, white social workers and academics need to move over and make space for other ways of knowing (dumbrill & green, 2008). asher blackdeer & gandarilla ocampo/#socialworksowhite 735 iii. field education simulation-based learning can disrupt the harmful cycle of field education for both marginalized communities and social workers of color. research has found that simulationbased learning is effective to develop student competence without harm to the client (asakura & bogo, 2021). others have enacted simulations in order to bridge class knowledge with field education (bogo et al., 2017). this represents an innovative approach to circumvent the issue of white students harming marginalized communities for the sake of learning. simulated experiences encourage skill, knowledge, and attitude development while facilitating the demonstration of student understanding and competencies to instructors (fulton et al., 2019). simulation-based learning can also interrupt the experiential learning models which allow white students to learn about privilege, oppression, and power at the expense of their peers of color (craig et al., 2021). further, simulation-based practicums can provide a more equitable and flexible option for students who may be challenged with the logistics of completing traditional placements. while simulation-based placements can be used to establish and develop skills, real world placements can then be used to enhance or strengthen these skills once students have demonstrated sufficient mastery to engage in practice that does not create harm. social work practice we need to bring social action back to social work, especially in response to calls to reform systems (apgar, 2021). social work education can (and should) encourage students’ political involvement and engagement. crowell (2017) recommends encouraging students to explore their political interest, or lack thereof, by utilizing a teaching tool they call policy genograms. these genograms map political and civic engagement of the student’s family of origin as a pedagogical tool (crowell, 2017). the entire social work assessment process needs an overhaul. scholars recommend including a structural analysis of race, class, and gender in order to understand health inequalities (almeida et al., 2019) from a systems level rather than blaming the individual. this can be achieved through raising critical consciousness using the matrix of coloniality in order to assess dimensions of power, privilege, and oppression (almeida et al., 2019). scholars have recommended praxis as the way forward in abolishing the dichotomy between theory and practice by teaching students how to implement theory into practice (gregory, 2020; franco, 2021; ladhani & sitter, 2020). emphasizing praxis would encourage students to apply social justice theories to all areas of practice, not merely stopping at individual level clinical work. consciousness-raising is essential to liberation; however, we must overcome the overvaluing of practice and competency more than critical thinking and theory. praxis offers a pathway to disrupting the micro-macro divide and reorient the profession toward taking social action in order to achieve social justice. advances in social work, summer 2022, 22(2) 736 code of ethics most cswe-accredited curricula do not have a specific ethics course, but rather embed the ethical code throughout (groessl, 2015). we recommend instituting critical ethical conversations in each of these courses. these conversations should critically discuss the lens of white supremacy and how simply knowing the ethical standards is not enough. we must teach upcoming social workers how to critically think and apply these ethical standards in practice, through a decolonial, social justice-centered lens. instructors can present an ethical dilemma, process various pathways and action with students, and ultimately discuss and debrief implications of applying the code of ethics from these varied perspectives. conclusion in order for social work to live up to its social justice mission, our profession must lead in truth telling and challenging white supremacy. we must hold ourselves and the profession accountable (beck, 2019). by knowing our colonial history and learning about our current collusion with white supremacy, social work can reckon with our past, take a critical look in the mirror, and start to plan for a more equitable future centered on social justice. social work must be antiracist, anti-oppressive, and anti-colonial (lerner, 2021). once social work acknowledges our reality, we can re-envision a better future, one that lives up to our mission, through critical, progressive, and unflinching advocacy (brady et al., 2019). references almeida, r. v., werkmeister rozas, l. m., cross-denny, b., lee, k. k., & yamada, a.m. (2019). coloniality and intersectionality in social work education and practice. journal of progressive human services, 30(2), 148-164. https://doi.org/10.1080/10428232.2019.1574195 alvarez-hernandez, l. r. (2021). teaching note—teaching intersectionality across the social work curriculum using the intersectionality analysis cluster. journal of social work education, 57(1), 181-188. https://doi.org/10.1080/10437797.2020.1713944 apgar, d. (2021). developing the next generation of social work activists: support for eliminating the micro-macro divide. journal of community practice, 29(1), 62-78. https://doi.org/10.1080/10705422.2021.1881856 asakura, k., & bogo, m. (2021). editorial: the use of simulation in advancing clinical social work education and practice. clinical social work journal, 49(2), 111-116. https://doi.org/10.1007/s10615-021-00810-2 atteberry-ash, b., nicotera, n., & gonzales, b. 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(2008). white logic, white methods: racism and methodology (7th ed.). lanham, rowman, & littlefield publishers. author note: address correspondence to autumn asher blackdeer, graduate school of social work, university of denver. email: a2blackdeer@gmail.com https://doi.org/10.1080/02615479.2020.1868422 https://www.socialworkers.org/linkclick.aspx?fileticket=29ayh9qadxc%3d&portalid=0#:%7e:text=we%20apologize%20for%20supporting%20policies,work%20profession%20and%20in%20society https://www.socialworkers.org/linkclick.aspx?fileticket=29ayh9qadxc%3d&portalid=0#:%7e:text=we%20apologize%20for%20supporting%20policies,work%20profession%20and%20in%20society https://www.socialworkers.org/linkclick.aspx?fileticket=29ayh9qadxc%3d&portalid=0#:%7e:text=we%20apologize%20for%20supporting%20policies,work%20profession%20and%20in%20society https://doi.org/10.1080/02615479.2014.885007 https://doi.org/10.1080/02615470120044310 https://doi.org/10.1093/sw/43.6.488 https://doi.org/10.1080/02615479.2021.1910652 https://doi.org/10.1080/10437797.2021.1883492 https://doi.org/10.1080/02615479.2021.1924665 https://doi.org/10.1080/10437797.2018.1513878 https://doi.org/10.1080/02615479.2016.1170113 mailto:a2blackdeer@gmail.com _________ norma love-schropshire, dsw, lmsw, assistant professor, teaching and bsw program director, megan hicks, phd, assistant professor, shantalea johns, ed.d, lmsw, assistant professor, clinical, and director of continuing education, and fay keys, d.l., msw, mls, associate professor, clinical, and education technology coordinator, school of social work at wayne state university, detroit, mi. naimah n. wade, phd, program manager, digital inclusion, office of teaching and learning, wayne state university, detroit, mi. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 535-553, doi: 10.18060/27326 this work is licensed under a creative commons attribution 4.0 international license. michigan’s missing link: school social workers and firearm-access screening norma love-schropshire megan hicks shantalea johns fay keys naimah n. wade abstract: school social workers (ssws) support non-academic barriers to student learning by providing assessment, intervention, and prevention services related to social and material needs. this case study examines 3,725 michigan ssws’ methods for identifying, screening, and supporting students' needs. it analyzes referral types, frequencies, and ssws’ perceptions regarding the importance, feasibility, and readiness to screen and support students' social and material needs. responses exhibited variability, highlighting the need for an established screening protocol. the most surprising finding was that firearm access was the least discussed topic with students; 21.4% of ssws almost never inquired and only 25.5% sometimes asked. the majority of referrals (73.9%) addressed students' material needs, while only 10.5% targeted social needs, including mental health services, revealing a significant gap. notably, 15.6% of students received no referrals at all. the findings on referrals for social needs, including biopsychosocial factors such as mental health, coupled with the perceived lack of preparedness among ssws to screen for challenges like firearm access, underscore the pivotal role ssws can play in violence prevention. this emphasizes an urgent call to action for training, further research, dedicated policies, and resources to maximize the impact of ssw practice in schools, homes, and communities. keywords: gun violence, service delivery, school social work, practice model, michigan in the complex landscape of education, school social workers (ssws) play a pivotal role in providing evidence-based assessment, intervention, and prevention services (kelly et al., 2021). school social work (ssw) addresses an array of biopsychosocial, emotional, and material needs that directly impact a student’s academic performance (capp et al., 2021; kelly et al., 2020a; kelly et al., 2021). as in other states, many students in michigan experience various social, environmental, material, and economic challenges associated with poverty, physical and mental health, social isolation, attendance, and access to equitable, essential resources (singer, 2023). the challenges are confounded by safety issues that require more effective methods to mitigate firearm access and the prevalence of violence in schools (american psychological association [apa], 2013; haddad & kaufman, 2023). the urgency to connect students with community intervention services and support necessitates a deeper understanding of ssws’ service delivery (kelly et al., 2016; kelly et about:blank advances in social work, fall 2024, 24(3) 536 al., 2020a). despite the critical nature of ssw practice, there is a lack of recent studies examining michigan ssw service delivery approaches. this study focuses on michigan ssws working in k-12 schools and utilizes the school social work practice model (frey et al., 2012; kelly et al., 2016; school social work association of america [sswaa], 2013) as a guiding framework. the study offers new insights into ssw practices with assessment, intervention, and service delivery for student biopsychosocial challenges, material necessities, and safety issues. for the purposes of this study, the term “material” encompasses students' physiological, tangible, and economic circumstances, as well as external environmental factors and elements related to their basic needs (pichère & cadiat, 2015). the term “social” encompasses biopsychosocial and fundamental personal needs (engel, 1977), including the intricate interplay of biological, psychological, emotional, and social factors, such as safety concerns, that collectively impact human health and wellbeing. the study found that although ssws are charged with recognizing, assessing, and intervening in these multifaceted needs, the vast majority did not feel adequately prepared to fulfill a critical part of this service: screening for firearm access. this resulted in a surprisingly low frequency of student screenings related to firearms as a material factor impacting the safety of students and the school community. challenges and opportunities in school social work as providers of assessment, intervention, and prevention services, ssws navigate ways to best address non-academic barriers to student learning. to understand the obstacles faced in screening for student’s needs, the literature review focuses on six key factors relative to ssw practice: the national practice framework, a need for leadership development, consistent certification standards, the pandemic impact, the pursuit of racial equity, job satisfaction, burnout, and professional efficacy. national school social work practice model the school social work practice model is an integrated framework rooted in justice, a person-in-environment perspective, the national association of social workers (nasw) code of ethics, and data-driven practice (frey et al., 2012; kelly et al., 2016, 2020a; sswaa, 2013). this model provides ssws with the knowledge to apply evidence-based interventions within their scope of services, distinguishing their role from other school mental health professionals (frey et al., 2012; kelly et al., 2016; kelly et al., 2020a; sswaa, 2013). the model aligns with nasw’s (2012) standards for school social work services by focusing on the knowledge, values, and skills necessary to improve student success in four domains: “(1) home-school-community linkages, (2) ethical guidelines and educational policy, (3) data-based decision-making, and (4) education rights and advocacy” (kelly et al., 2016, p. 17). these domains support three key practice goals: (1) mobilize the evidenced-based, multi-tiered systems of support to provide social services, (2) improve learning experiences, and (3) augment resource access (kelly et al., 2016, p. 17). schropshire et al./mich school swk firearm screening 537 bridging the theoretical framework with practical experiences, recent research has examined the real-world application of this model, including its service ratio recommendations  typically one ssw per 250 students, reduced to1:50 for students with complex needs (frey et al., 2012; kelly et al., 2016; nasw, 2012; sswaa, 2013). however, kelly et al. (2020a, 2021) surveyed 1,275 ssws and found that in many high poverty, predominantly minority communities, most caseloads required mental health services (75.7%). additionally, many ssws frequently confronted extreme caseload ratios as large as 1 to 1,500 (capp et al., 2021; kelly et al., 2020b), often servicing multiple buildings with vastly different service needs. this misalignment of workload and capacity emphasizes the need for rapid-response teams, strategic investments in low-income communities, interdisciplinary collaboration and professional development, advocacy training and a national strategy to confront structural inequities (kelly et al. (2020b). implementing the school social work practice model provides a blueprint to target appropriate services for the most urgent factors impacting students in schools, homes, and communities. a need for ssw leadership leadership development programs tailored to ssws are critical role for navigating complex systems, advocating for systemic solutions, and promoting social justice (frey et al., 2012; kelly et al., 2016; sswaa, 2013). strong ssw leadership correlates with a positive school climate, trust and cooperation among faculty, students and families, and shared goals for student success (perry et al., 2022; sswaa, 2013). however, many ssw practices focus on micro interventions, limiting broader systemic impact and advocacy potential due to practitioners’ lack of confidence in using evidence-based practices (kelly et al., 2016; perry et al., 2022). specialized training and development programs can significantly enhance ssw leadership capabilities, enabling them to effectively support marginalized groups and contribute to a more equitable educational environment. such investment in leadership development training is vital for realizing the full potential of ssws as change agents in education (kelly et al., 2016; perry et al., 2022). certification requirements and professional standards national certification for ssws varies widely, with training programs and practicum requirements often deviating from best practices (koschmann et al., 2022). this inconsistency highlights the need for uniform national ssw certification requirements, revised curricula based on current evidence and alignment with the nasw standards for school social work services (nasw, 2012) and the national school social work practice model (koschmann et al., 2022; sswaa, 2013). this is especially crucial given ssws critical role in addressing non-academic barriers to student learning. school social work during the covid-19 pandemic during the covid-19 pandemic, the u.s. education system confronted unprecedented challenges that exacerbated community disparities, such as food insecurity, social advances in social work, fall 2024, 24(3) 538 isolation, economic stress, educational interruptions, and mental health declines (bailey et al., 2021; kelly et al., 2020a, 2020b). capp et al. (2021) found that ssws faced issues ranging from inequitable access to education for vulnerable students to concerns about basic needs, including food, housing, and technology. simultaneously, many ssws experienced professional isolation and sought guidance on how to provide remote service delivery. the pandemic's constraints underscored the need for systemic overhauls. recommendations included a national, equitable resource distribution plan, telehealth guidance, and robust ssw support (capp et al., 2021; kelly et al., 2020a, 2020b). despite ssws close work with students and families during the pandemic, their unique insights on social and material needs were often excluded from preparations for school reopening (kelly et al., 2020a, 2020b, 2021). addressing racial equity racial inequities demand a bold reimagining of ssw practices. scholars (jones et al., 2021; meza, 2020; villarreal sosa, 2021) advocate for transformative approaches, including the integration of anti-racist pedagogy, culturally responsive interventions, counterstories, and restorative justice. central to this effort is ssws’ self-reflection on, dismantling their own complicity in perpetuating racial inequities (jones et al., 2021; meza, 2020; villarreal sosa, 2021). addressing the white privilege embedded in ssw systems creates a more equitable foundation. counterstories empower students of color and amplify their voices in advocacy for systemic change (miller et al., 2020). culturally responsive practices, emphasizing cultural humility and diverse tools, equip ssws to better serve marginalized communities (jones et al., 2021; meza, 2020; miller et al., 2020; villarreal sosa, 2021). additionally, restorative justice fosters healing and trust through relationship building and accountability (jones et al., 2021; meza, 2020; miller et al., 2020; villarreal sosa, 2021). this multifaceted approach lays the groundwork for a more just and equitable education system. job satisfaction, burnout, and professional efficacy in ssw, job satisfaction and burnout are influenced by a complex interplay of factors, with professional efficacy playing a pivotal role. ssws report higher job satisfaction when they feel valued and supported by administrators, align their work with personal values and the school's mission, and engage in meaningful work that leads to positive outcomes (heberle et al., 2021). burnout is often triggered by heavy workloads, high caseloads, conflicts between program philosophy and organizational structures, and inadequate resources (heberle et al., 2021). however, ssws with high professional efficacy report lower levels of burnout as confidence in their skills and abilities helps mitigate workrelated stress (heberle et al., 2021). training and skill development, particularly in the context of an integrated student support model, significantly contribute to professional efficacy (heberle et al., 2021). this underscores the importance of interventions such as skill-building workshops, supervision and mentorship programs in enhancing professional efficacy and well-being (kryshtanovych et al., 2022; mack, 2021, 2022; maor & hemi, 2021; pittman, 2020). additionally, meaningful work, ovation, and social support serve as schropshire et al./mich school swk firearm screening 539 buffers against burnout (kryshtanovych et al., 2022; mack, 2021, 2022; maor & hemi, 2021; pittman, 2020). individual traits and positive organization climates, characterized by collaboration and shared goals, also play a crucial role in reducing burnout and enhancing job satisfaction (kryshtanovych et al., 2022; mack, 2021, 2022; maor & hemi, 2021; pittman, 2020). notably, following the national school social work practice model (kelly et al., 2020a, 2020b, 2021) enabled ssws to experience high levels of efficacy and perceive their work as having a broad, positive impact on students, families, and schools. this review of ssws roles and service delivery methods unveils their complexity, challenges, and practice opportunities, reinforcing the need for continued research, collaboration, and innovation. the literature underscores the rich potential for ssw practice to adapt, evolve, and contribute to a more just and equitable future, particularly in response to crises and unprecedented challenges, such as the covid-19 pandemic. it also provides the foundation for exploring the barriers ssws face in identifying, assessing, and implementing interventions to improve student safety while informing recommendations for removing those obstacles. drawing from the research of kelly et al. (2020a, 2020b, 2021), this study examines the practice methods michigan ssws employ to identify, screen, and intervene in students' social and material needs. it analyzes the types and frequencies of referrals made by ssws and their perceptions regarding the importance, feasibility, and readiness to conduct screenings and interventions that support students' social and material needs. methods guided by the school social work practice model as the primary driver (frey et al., 2012; kelly et al., 2016, 2020a, 2020b, 2021; sswaa, 2013), this study employed a survey method was employed to gather quantitative data on the service delivery practices of michigan ssws (n=3,725). practicing ssws from k-12 school settings across michigan’s seven peninsulas were invited to participate in the survey between march and september 2022. the primary recruitment channels were twitter, linkedin, and meta's social media platforms, including facebook, instagram, and messenger. secondary recruitment strategies involved direct emails to individuals, professional groups, and organizations affiliated with michigan ssws. all digital outreach materials contained embedded links directing participants to the survey. beyond the institutional review board’s approval, this research garnered support from a diverse array of stakeholders, including 15 letters of endorsement from private educational and professional entities, universities, educational service agencies, intermediate school districts, the school social work association of america (sswaa), nasw-michigan, and the office of educator excellence within the michigan department of education. survey instrument the survey instrument gathered data from michigan ssws about their service delivery methods and their perceptions of the feasibility and importance of screening for students’ social and material needs and the readiness of ssws to conduct the screening. the advances in social work, fall 2024, 24(3) 540 instrument was collaboratively developed by a research team composed of four social work faculty and a staff educator from the office of teaching and learning. the lead author, with over a decade of experience as a school social worker in michigan public schools, leveraged direct-practice expertise to refine the design and content of the survey measurements. the qualtrics online platform was used to create and disseminate the survey, which contained eight closed-ended questions divided into two primary sections: (1) service delivery and (2) student social and material needs. all responses were collected digitally, de-identified and securely stored on an encrypted server. as an incentive, survey participants had the option to enter a drawing to win a $50 gift card. the winner received the gift card after data collection was completed. table 1. survey instrument: service delivery demographics questions for section 1: service delivery demographics response type what michigan region do you work in? select one region: o central michigan (east) o central michigan (west) o northwest michigan o northeast michigan, o southwest michigan o southeast michigan. o upper peninsula o west central michigan (east) how would you describe the community you work in? o urban o suburban o rural what grade levels did you service? check all that apply. o k-5 elementary o k-8 elementary o middle o high school student population served: check all that apply. o general education o special education o alternative education o other section 1, titled "service delivery demographics," collected demographic information related to ssw service delivery in michigan (see table 1). respondents were asked to identify their workplace region from predefined michigan geographic areas and classify their service community as urban, suburban, or rural. the survey also captured the range of grade levels served including k-5 elementary, k-8 elementary, middle school, and high school. additionally, it gathered data on the student populations served, allowing respondents to select from general education, special education, alternative education, or other student groups. schropshire et al./mich school swk firearm screening 541 table 2. survey instrument: student social and material needs question and measure type response type service delivery do you have a process for identifying students' social and material needs, such as a screening tool that every student completes, a school needs assessment, or a teacher referral system? yes, no within the past 12 months, have you referred a student or their family to any of the following community resources? matrix: yes/no o childcare centers/providers transportation assistance o local food pantries/private charities o public food assistance o public health insurance enrollment assistance o mental health services o housing services o utility assistance programs. social and material needs how often do you routinely ask students about the following: matrix: likert scale: o barriers getting to/from school (i.e., reliable transportation) o food insecurity (i.e., enough food) o housing insecurity (i.e., safe place to live) o utilities/heating insecurity (i.e., ability to pay for utilities) o social support (i.e., support network of student) o isolation (i.e., loneliness) o depression o stress o violence victimization (i.e., threats or physical harm to student) o access to firearms how strongly do you agree or disagree with the following statements? matrix: likert scale: o it is feasible to screen for social and material needs routinely during contact with students. o it is important to screen for social and material needs routinely during contact with students. o i am well prepared to specifically address my students’ social and material needs. section 2 examined how ssws identified and addressed students' social and material needs, their views on the importance and feasibility of such screenings, and their readiness to assess and intervene (see table 2). ssws reported on the use of structured processes such as screening tools, school needs assessments, or teacher referral systems, with advances in social work, fall 2024, 24(3) 542 response options of "yes" or "no”. the survey also explored whether ssws referred students or families to community resources within the past 12 months, including childcare services, transportation assistance, local food pantries, public food assistance programs, public health insurance enrollment, mental health services, housing services, and utility assistance programs. responses were recorded using a likert matrix format. the frequency of screening for specific needs was measured using a likert scale, covering transportation barriers, food insecurity, housing insecurity, utility and heating insecurity, social support, isolation and loneliness, depression, stress, violence victimization, and access to firearms. lastly, ssws were asked to rate their agreement with three key statements using a 5-point likert scale ranging from "strongly disagree" to "strongly agree." these statements assessed whether they believed it was feasible to screen for social and material needs during routine student interactions, whether they considered such screenings important, and whether they felt well-prepared to conduct screenings and intervene for students’ social and material needs. measures the survey instrument encompassed two distinct categorical measures: (1) service delivery and (2) social and material needs. the eight closed-ended questions included dichotomous (yes/no), multiple choice, and "select all that apply" response options. service delivery ssw participants responded to two service delivery survey questions: (1) “do you have a process for identifying students’ social and material needs, such as a screening tool every student completes, a school needs assessment, or a teacher referral system?” (2) “within the past 12 months, have you referred a student or their family to any of the following community resources?” social and material needs the responses from ssw participants measured the connection between students' social and material needs. these needs, which informed the options for the closed-ended “multiple choice” and “all that apply” questions, were derived from biopsychosocial factors, interpersonal relationships, safety, equitable access to opportunities, and external resources and support across homes, schools, and communities. social needs included social support, or students’ support networks and mental health factors such as isolation, depression, stress, and violence victimization. material needs encompassed unsafe housing, insurance, utilities, transportation, food insecurity, and access to firearms. data analysis the qualtrics survey data was analyzed using spss 24 to examine the predominant community service referrals made by ssws, quantify the frequency of student screenings for both social and material needs, and evaluate ssws’ perceptions of the importance and feasibility of screening for student needs as well as their readiness to do so. descriptive statistics and frequency analyses were employed to generate and illustrate these findings. schropshire et al./mich school swk firearm screening 543 results to analyze the methods michigan ssws employ for screening and supporting students' social and material needs, this study examined the frequency of screenings conducted for various student needs, the extent to which systematic processes were implemented to identify social and material needs, and whether referrals to families for essential community resources such as transportation, food, childcare, insurance, mental health services, housing, and utilities were offered. the study also highlighted challenges ssws encounter in delivering social services. michigan ssw demographics among the ssws (n=3,725) surveyed in michigan, 7.7% served elementary grades, 38.1% served high school grades, 0.6% served “other” grade levels, and 16.5% did not specify a grade level. most worked in urban communities (61.5%), with fewer working in suburban (33.1%) and rural (5.4%) areas. special education students represented the largest population served (50.1%), followed by general education students (29.3%); 16.7% reported not serving a specific student population and 0.5% served “other” student groups. the data were consistent across grade levels, suggesting that the findings are broadly applicable to schools, irrespective of the age group served. service delivery frequency the analysis of service delivery focused on how michigan ssws assess and refer students based on their social and material needs. the data are organized into four categories: frequency of service delivery, screening for social needs, screening for material needs, and ssws’ opinions on the feasibility, importance, and preparedness for conducting these screenings. material needs include barriers to school transportation, food and housing insecurity, utility and heating concerns, and access to firearms. social needs include social support, isolation, depression, stress, and violence victimization. material needs accounted for 73.9% of referrals, while social needs including mental health services made up 10.5%. the frequency of screening for various social and material needs was fairly consistent, although firearm access was notably the least discussed topic. nearly half of the ssws felt that conducting these screenings was both feasible and important, but a significant portion also expressed a lack of preparedness. these findings underscore the need for more robust screening protocols in michigan schools to better understand and meet the diverse social and material needs of students. social and material needs referrals figure 1 represents the frequency of service referrals provided by michigan ssws in assessing the social and material needs of students. the data emphasizes the diverse methods utilized to identify student needs. approximately 97% of ssws employed multiple approaches, including screening tools, school needs assessments, or teacher referral systems. the data showed that most student referrals targeted material needs, advances in social work, fall 2024, 24(3) 544 accounting for 73.9% of cases. in contrast, only 10.5% of referrals addressed mental health services, while 15.6% of students received no referrals at all. figure 1. frequency of service referrals for social and material needs social needs screening in table 3, the frequency of screening for social needs varied, with stress emerging as the most frequently discussed issue. when combining the "usually" and "always" response categories, ssws reported discussing stress with 61.2% of students, followed by isolation (60.2%), social support (59.6%), violence victimization (58.8%), and depression (58.5%). the data indicate a relatively consistent approach to screening for social challenges. table 3. frequency ssw screened for students’ social needs screened social need n (%) almost never sometimes usually always violence victimization 538 (16.8%) 784 (24.5%) 1084 (33.9%) 796 (24.9%) social support 492 (15.3%) 757 (23.5%) 1164 (36.2%) 804 (25.0%) isolation/loneliness 497 (15.5%) 839 (26.1%) 1052 (32.8%) 824 (25.7%) depression 485 (15.1%) 796 (24.7%) 1187 (34.7%) 821 (25.5%) stress 520 (16.1%) 780 (24.2%) 1082 (33.6%) 839 (26.0%) material needs screening in table 4, screening for material needs followed a similar pattern, with firearm access being the least frequently discussed issue. only 53.1% of ssws reported asking about firearm access "usually" or "always," while 21.4% "almost never" addressed it, and 25.5% asked about it "sometimes." barriers with getting to and from school (e.g., reliable transportation), were the most frequently discussed material challenge. for most other material needs, more than half of ssws indicated they "usually" or "always" discussed them with students. table 4. frequency ssw screened for students' material needs n (%) screened material need almost never sometimes usually always barriers getting to/from school 457 (14.3%) 743 (23.3%) 1187 (37.2%) 806 (25.2%) food insecurity 802 (15.3%) 802 (25.1%) 1140 (35.7%) 761 (23.8%) housing 494 (15.4%) 793 (24.8%) 1153 (35.5%) 776 (24.3%) utilities 512 (16.0%) 796 (24.8%) 1137 (35.4%) 764 (23.8%) access to firearms 690 (21.4%) 825 (25.5%) 975 (30.2%) 739 (22.9%) no referral, 15.6% mental health services , 10.5% material needs, 73.9% advances in social work, summer 2024, 24(2) 545 table 5. comparison of ssws service delivery screening patterns and referrals for student needs screening (n=3,725) referrals (n= 3,143)* how often do you routinely ask? n (%) within the 12 months, have you referred? yes n (%) almost never sometimes usually/ always material needs material needs barriers getting to/from school 533 (14.3%) 868 (23.3%) 2324 (62.4%)  childcare centers/providers 11 (0.3%)  transportation assistance 15 (0.4%) food insecurity 570 (15.3%) 935 (25.1%) 2216 (59.5%)  local food pantries 38 (1.0%)  public food assistance 71 (1.9%) housing insecurity 574 (15.4%) 924 (24.8%) 2228 (59.8%)  housing services 700 (18.8%) utilities 596 (16%) 924 (24.8%) 2205 (59.2%)  utility assistance programs 1754 (47.1%) firearm access 797 (21.4%) 950 (25.5%) 1978 (53.1%)  (no referral) social needs social needs social support 570 (15.3%) 875 (23.5%) 2280 (61.2%)  mental health services public health insurance 392 (10.5%) 162 (4.3%) depression 562 (15.1%) 920 (24.7%) 2242 (60.2%) stress 600 (16.1%) 901 (24.2%) 2220 (59.6%) isolation 495 (13.3%) 972 (26.1%) 2179 (58.5%) violence victimization 626 (16.8%) 913 (24.5%) 2194 (58.9%) *582 (15.6%) did not make any student referrals advances in social work, summer 2024, 24(2) 546 comparison of ssws service delivery referrals and screening patterns for student needs in table 5, a comparison of service delivery, referral patterns, and screening frequencies revealed a high prevalence of referrals for material needs, with mental health and stress among the leading social needs. despite the importance of health insurance in addressing students’ well-being, 162 ssws reported making referrals for public health insurance even though there was no systematic screening process for this need. additionally, firearm access was the least discussed material concern, with no referral category provided, highlighting a gap in how ssws address this critical safety issue. student needs assessments: feasibility, importance, and preparedness in table 6, ssws provided feedback on the feasibility, importance, and preparedness for screening students' social and material needs. nearly half (46.8%) agreed or strongly agreed that screening for social and material needs was feasible, while 29.7% disagreed, and 19.6% remained neutral. when asked about the importance of these screenings and their preparedness to conduct them, the responses were similar, with 46.9% and 46.3%, respectively, agreeing or strongly agreeing that such screenings were necessary and that they felt prepared to carry them out. however, nearly one-third of respondents felt unprepared to screen and intervene effectively. table 6. screening for social and material needs: feasibility, importance, and preparedness aspect n (%) strongly disagree disagree neutral agree strongly agree feasibility 425 (13.4%) 515 (16.3%) 745 (19.6%) 898 (28.4%) 583 (18.4%) importance 428 (13.4%) 484 (15.2%) 778 (24.4%) 922 (29.0%) 571 (17.9%) prepared 422 (13.3%) 569 (17.9%) 718 (22.6%) 861 (27.1%) 612 (19.20) overall, the data show a spectrum of agreement levels regarding ssws’ perceptions of the feasibility and importance of screenings and their preparedness to conduct them and intervene. these findings highlight the need for a deeper understanding of social and material needs and the creation of robust screening protocols within michigan's schools. perceptions of feasibility, importance, and preparedness the results also reveal a discrepancy between ssws' perceptions of the feasibility, importance, and preparedness for conducting student screenings. while 46.8% of respondents viewed screening for social and material needs as feasible and 46.9% considered it important, nearly one-third reported feeling unprepared to conduct such screenings and intervene effectively. the gap between perceived feasibility, importance, and preparedness accentuates the pressing need for expanded training, additional resources, and a more structured screening protocol in michigan schools to ensure that students' schropshire et al./mich school swk firearm screening 547 diverse and urgent needs are adequately addressed (nasw, 2012, 2018) addressing ssws training gaps: a focus on mental health and firearm access ssws were least attentive to mental health and youth firearm access, exposing a critical gap in training. addressing this issue requires a stronger focus on preparing ssws for violence prevention (nasw, 2018). incorporating resources such as tools for social workers to prevent gun violence could provide an entry point for firearm-related conversations (lanyi et al., 2019). the school counselor’s response to school shootings– framework of recommendations offers a six-phase model designed for school mental health professionals responding to school shootings (katsiyannis et al., 2023). implementing such frameworks would equip ssws with the necessary training and tools to participate in school crisis intervention teams effectively. the findings of this study highlight the complexity of ssws’ roles and the multidimensional challenges they face. addressing student social and material needs requires standardized screening tools, equitable community interventions, and a wellsupported workforce (koschmann et al., 2022). the observed gaps in mental health referrals, the lack of attention to firearm access, and ssws' reported lack of preparedness to screen and intervene raise serious concerns. these findings contribute to a deeper understanding of the current state of ssw practice and provide a foundation for guiding policy changes, informing curriculum re-development, shaping strategic continuing education initiatives, and directing future research efforts. ultimately, these results have broader implications for ssw practice and reinforce the importance of creating safe, nurturing, and supportive educational environments (nasw, 2012). limitations the findings of this study come with several limitations that should be considered. one primary limitation is the reliance on convenience sampling, which focused exclusively on ssws in michigan. this geographical specificity may restrict the generalizability of the results (hazell & berry, 2023). future research should replicate this study across diverse regions and contexts to enhance the broader applicability of the findings. expanding the sample to include ssws from various locations would provide a more comprehensive understanding of service delivery methods and student needs. another limitation is the potential for self-report bias, as the data primarily reflect ssws' self-assessments. incorporating multiple data collection methods, such as administrative records, case studies, or third-party evaluations, would improve the reliability of findings and offer a more balanced perspective. additionally, the survey did not include open-ended questions, which limited the depth of qualitative insights. future research should integrate qualitative components to capture a more nuanced understanding of ssws' experiences and decision-making processes. a mixed-methods approach would provide a richer, more holistic analysis of student needs and ssws' strategies for addressing them. advances in social work, summer 2024, 24(2) 548 although prior research highlights firearm access as a critical issue among k-12 students (hilaire et al., 2023; kolbe, 2020; rajan et al., 2022; reeping et al., 2022), this study included only a single question on firearm access. given the significance of this issue, future studies should expand on this topic, incorporating more detailed measures to assess ssws’ screening practices, comfort levels, and training related to firearm access. these considerations are crucial when interpreting the study’s results and should be prioritized in future research initiatives. conclusion this study provides valuable insights into the practices and perceptions of michigan ssws, highlighting key areas for educators, policymakers, and researchers. existing research establishes a strong link between firearm violence and mental health, psychological stress, and trauma (bailey et al., 2021; common core of data, 2019; everytown for gun safety, n.d.; national center for education statistics; u.s. department of education). the findings underscore the need for a more rigorous and consistent screening process by ssws to address these challenges effectively. disturbingly, there is a well-documented correlation between firearm accessibility and increased suicide risk among adolescents (swanson et al., 2021). the study also aligns with national trends, noting a 33.4% surge in firearm-related homicides among children and youth between 2019 and 2020 (goldstick et al., 2022). despite recommendations from the american academy of pediatrics, many mental health clinicians do not routinely advise parents to remove firearms, even when children are in crisis situations (swanson et al., 2021). when compared internationally, u.s. firearm homicide rates are significantly higher, in some cases seven times greater than those of other developed nations (apa, 2013). since 1999, the u.s. has experienced 428 school shootings, disproportionately affecting youth of color (cox et al., 2025). among these, black boys face the highest rates of firearm-related deaths, while black girls also experience elevated levels of gun violence compared to other racial and ethnic groups (katsiyannis et al., 2023). the temporary decline in school shootings during the covid-19 pandemic was followed by a dramatic resurgence, with 2021 marking an all-time high in school shooting fatalities (katsiyannis et al., 2023). this increase suggests a possible link between school firearm violence and broader societal trauma, reinforcing the urgency of school-based threat assessment tools (katsiyannis et al., 2018). michigan faces particularly dire challenges related to firearm violence, with a firearmrelated death occurring every eight hours (weigend vargas et al., 2022). the state experiences an average of 14 mass shootings per year (centers for disease control and prevention [cdc], 2023; gun violence archive, n.d.), and between 1970 and 2022, there were 1,844 firearm incidents on k-12 school grounds, resulting in 610 fatalities and 1,727 injuries (center for homeland defense and security school shooting safety compendium, 2023; everytown for gun safety support fund [everytown], 2020). michigan attributes schropshire et al./mich school swk firearm screening 549 approximately 1,544 deaths annually to gun violence, with 60% classified as suicides by firearm (cdc, 2023; center for homeland defense and security school shooting safety compendium, 2023; everytown, 2020). the 2021 oxford high school shooting and the 2023 michigan state university shooting serve as stark reminders of the urgent need for intervention (figueroa, 2023; poindexter, 2023; walker & brown, 2023). beyond firearm violence, michigan also ranks fourth highest in the u.s. for chronic absenteeism in k-12 schools, an issue that is further exacerbated by students' unmet social and material needs (dee, 2023a, 2023b; kummer, 2023). while prevention strategies exist (everytown, 2022), many ssws lack the necessary training to effectively address these concerns (sperlich et al., 2019). this study confirms that a significant proportion of michigan ssws feel unprepared to conduct firearm-access screenings, further emphasizing the need for targeted professional development. despite historical barriers to improving school safety (bailey et al., 2021), recent legislative measures offer some hope (the white house, 2021a, 2021b). with the right tools, resources, and training, ssws are uniquely positioned to play a critical role in reducing firearm violence. a comprehensive, holistic approach that includes systematic screening, intervention, and remediation of students’ social and material barriers in schools, homes, and communities can significantly enhance efforts to prevent firearmrelated incidents. strengthening these areas within ssw practice can also help drive meaningful policy changes aimed at making schools safer and more supportive environments for all students. references american psychological association. 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(2019). state nonfiscal survey of public elementary and secondary education, 1998-99 through 2016-17; and national elementary and secondary enrollment by race/ethnicity projection model, 1972 through 2028. national center for education statistics. villarreal sosa, l. (2021). creating space for conversations about race: why it matters for school social work. children & schools, 43(4), 195-197. walker, h. m., & brown, g. (2023). school shootings: learning to look for the right signals. journal of disability policy studies, 33(4), 223-224. weigend vargas, e., kaucheck, l., & jordan, a. (2022, february 10). the impact of gun violence in michigan. center for american progress. author note: address correspondence to dr. norma love-schropshire, school of social work, wayne state university, detroit, mi, 48202. email: ar3183@wayne.edu ttps://nces.ed.gov/programs/digest/d18/tables/dt18_203.60.asp ttps://nces.ed.gov/programs/digest/d18/tables/dt18_203.60.asp ttps://nces.ed.gov/programs/digest/d18/tables/dt18_203.60.asp https://doi.org/10.1093/cs/cdab022 https://doi.org/10.1093/cs/cdab022 https://doi.org/10.1177/10442073221094796 https://doi.org/10.1177/10442073221094796 https://www.americanprogress.org/article/the-impact-of-gun-violence-in-michigan/ https://www.americanprogress.org/article/the-impact-of-gun-violence-in-michigan/ mailto:ar3183@wayne.edu _________ goutham m. menon, phd, ma, mba, professor, school of social work, loyola university chicago, chicago, il. maria e. torres, phd, associate professor, associate dean for academic affairs, school of social welfare, stony brook university, stony brook, ny. joan m. blakey, phd, msw, lmsw, director, school of social work, gamble skogmo endowed chair, university of minnesota twin cities, saint paul, mn. jayashree nimmagadda, phd, msw, licsw, professor, school of social work, rhode island college, providence, ri. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), i-x, doi: 10.18060/29374 this work is licensed under a creative commons attribution 4.0 international license. the dynamic landscape of licensing and credentialing in social work goutham m. menon maria e. torres joan m. blakey jayashree nimmagadda in 2022, for the first time in its history, the association of social work boards (aswb) published comprehensive pass-rate data for social work licensing exams disaggregated by race, age, and language—and the findings revealed disparities so profound that they could no longer be dismissed as statistical anomalies or individual variations in test-taking ability. among first-time clinical exam takers, 84% of white examinees passed, compared to 45% of black examinees, 65% of hispanic/latino examinees, and 72% of asian examinees (aswb, 2022; kim & joo, 2024a). these gaps persisted even after multiple attempts. eventual pass rates reached 91% for white examinees but only 57% for black examinees, 74% for indigenous examinees, and 77% for hispanic/latino examinees (aswb, 2022). the data forced an uncomfortable reckoning, were these exams measuring competence, or were they measuring access to privilege? the disparities extended beyond race. candidates aged 18-29 achieved a 91% eventual pass rate, compared to 64.8% for those aged 50 and older (aswb, 2022). the exam's english-only format erected additional barriers for multilingual practitioners, despite the availability of accommodations. most critically, research demonstrates that these disparities persist even when controlling for eligibility criteria, employment type, and practice setting (kim, 2022). this suggests that differences in educational preparation or professional experience cannot explain away the gaps. rather, they point to something more insidious: systemic barriers embedded within the licensure process itself. the question is no longer whether disparities exist—the data are unequivocal—but whether the profession will muster the courage to confront them. these findings arrive at a moment when the social work profession can ill afford to ignore them. the nation faces unprecedented demand for behavioral health services, workforce shortages that leave communities without adequate care, and mounting evidence that licensing barriers disproportionately exclude practitioners from the very communities most affected by these shortages. the persistence of exam disparities across multiple professions—medicine, law, teaching, nursing—suggests that the problem transcends any single credentialing organization (kim & joo, 2025). yet this broader context should not absolve social work of responsibility. on the contrary, it heightens the urgency for a profession built on principles of social justice to lead the way in dismantling inequitable gatekeeping mechanisms that harm individuals, communities, and our profession. kim and joo (2025) emphasize that exam performance is shaped by multi-level determinants at individual (e.g., gpa, exam timing), institutional (e.g., school resources, quality of preparation), and community levels (e.g., socioeconomic status, geographic location). this ecological understanding demands equally systemic interventions. for transparency, it is about:blank advances in social work, fall 2025, 25(3) ii important to note that the reports by kim and joo (2024a, 2024b; 2025) were funded by aswb. the licensure exam debate: protecting the public or perpetuating inequity? the question of whether standardized licensing exams should remain a mandatory component of licensure has catalyzed intense debate within the profession. at stake are competing commitments to public protection, professional credibility, workforce diversity, and—most fundamentally—the ethical integrity of a profession that espouses social justice as a core value. the arguments on both sides merit serious consideration. yet the debate itself reveals a deeper tension, between a profession's aspirational values and the exclusionary systems it has constructed in the name of quality assurance. the case for a standardized licensure exam as a requirement for licensure proponents of licensing exams frame them as indispensable safeguards for public welfare. their arguments rest on three pillars: protection of vulnerable clients, standardization of professional competence, and legitimation of social work as a regulated profession. first, advocates assert that licensure exams serve as essential quality control mechanisms, ensuring that only qualified practitioners enter the field (weinstein, 2022). in a profession entrusted with individuals and families during moments of profound vulnerability, such as child abuse investigations, addiction treatment, and suicide intervention, the stakes of incompetence are measured in damaged lives. before licensure laws were implemented, anyone could claim the title of social worker, creating risks for those most in need of competent care (stewart, 2023). licensure statutes enforce both title and practice protection, legally restricting who may use the social work designation and perform certain clinical functions (morrow, 2022). for proponents, removing exams would represent a dangerous regression, sacrificing decades of progress in safeguarding the public on the altar of expediency. second, standardized exams purportedly provide uniform benchmarks for assessing knowledge and skills, reducing variability across states and enabling interstate portability. this consistency is framed as increasingly vital as the profession emphasizes evidencebased practice and accountability. portability also addresses workforce shortages by facilitating practitioners' ability to relocate without redundant credentialing processes, a critical factor in ensuring adequate service distribution across geographic regions (beard, 2025). third, a licensure exam reinforces social work's professional identity and legitimacy. without rigorous entry standards, the argument goes, social work risks being perceived as less credible than psychology, counseling, or nursing, potentially eroding public trust and diminishing the profession's influence in policy and interdisciplinary settings. licensure exams thus function not merely as a legal requirement but as a symbolic affirmation of the profession's ethical and professional standards. menom et al./swk licensing editorial iii these arguments carry weight. yet they rest on assumptions that the current exam actually achieves these goals, assumptions that the disparities data fundamentally challenge. the case for abolition or fundamental reform critics argue that the purported benefits of licensure exams are undermined by their documented harms and by the absence of evidence linking exam passage to practice competence. their critique operates on multiple levels: empirical, ethical, and practical. most damning is the evidence of systemic inequity. the 2022 aswb data revealed that black candidates achieved only a 57% eventual pass rate compared to 91% for white candidates, a 34-percentage-point gap that persisted even after multiple attempts and could not be explained by educational background or employment factors (aswb, 2022; kim, 2022). these disparities are not marginal differences; they represent a structural barrier that systematically excludes practitioners from historically marginalized communities. for a profession that proclaims social justice as a foundational value, this outcome is ethically indefensible. the exam does not merely fail to promote equity, it actively perpetuates racial and economic stratification within the profession. the english-only format compounds these inequities, creating insurmountable obstacles for multilingual practitioners who may be most capable of serving linguistically diverse communities. at a time when cultural and linguistic concordance between practitioners and clients is recognized as vital to effective care, the exam's monolingual structure works directly against the profession's stated commitment to culturally responsive practice. beyond equity concerns, critics note a troubling absence of valid evidence. no clear empirical link exists between passing the licensing exam and demonstrating competence in practice. multiple-choice tests assess theoretical knowledge, yet effective social work requires skills—cultural humility, relational capacity, critical thinking, and ethical discernment—that defy standardized assessment (caldwell, 2024). moreover, morrow (2022) identifies a persistent misalignment between educational competencies defined by council of social work education (cswe) and the practice-oriented content tested by aswb exams, raising fundamental questions about whether the exam measures what practitioners actually need to know. if the exam does not validly assess practice readiness, its claimed role in public protection collapses. the economic burden of licensure further exacerbates inequity. exam fees ($230– $260), state applications ($60–$150), background checks ($25–$75), and study materials ($100–$300+) accumulate into substantial costs. for a social worker earning approximately $1,241 per week, a single exam attempt represents roughly 5% of weekly income. multiple attempts, necessary for many candidates from marginalized backgrounds, multiply these costs, creating disproportionate hardship that can delay or derail licensure entirely (aswb, 2022). beyond financial strain, repeated failures erode confidence, exacerbate stress, and deter otherwise capable candidates from remaining in the profession. this attrition reduces workforce capacity precisely when it is most desperately needed. advances in social work, fall 2025, 25(3) iv perhaps most troublingly, licensing barriers actively restrict workforce diversity and limit access to care. according to aswb's own data, current exams disproportionately reduce the number of licensed practitioners from historically marginalized racial and ethnic groups, the very communities experiencing the most severe mental health disparities and service shortages (aswb, 2022). this creates a pernicious cycle: communities with the greatest need have the least access to practitioners who share their lived experiences and cultural contexts. the misalignment between regulation and public health needs transforms licensure from a public protection mechanism into a public safety threat. evidence for change: when states dismantled barriers fortunately, reform need not proceed in the absence of evidence. several states have already eliminated the first-tier master’s exam, and their experiences challenge long-held assumptions about the relationship between licensure requirements and public protection. rhode island (nimmagadda, 2025), illinois (mina, 2022), utah (ribera, 2023), and colorado (haubner, 2024), have witnessed significant increases in the number of licensed social workers and demonstrable gains in workforce diversity. rhode island has not had a corresponding increase in reported ethical violations (nimmagadda, 2025). these natural experiments suggest that the exam may be dispensable without compromising public welfare. the implications are profound. if elimination of the licensure exam requirement as a component of licensure can expand the workforce and enhance diversity without measurable harm to clients, then the burden of proof shifts decisively to exam proponents. they must now demonstrate that the documented benefits of current licensure systems outweigh their documented harms, a case that grows increasingly difficult to sustain in light of mounting evidence. scholars have begun outlining alternative pathways forward. morrow (2022) recommends narrowing the gap between educational standards and regulatory requirements, improving transparency in exam development and validation, and creating inclusive pathways that recognize diverse forms of competence demonstration. major professional organizations, including the national association of deans and directors (nadd) and the national association of social workers (nasw), have called for solutions that balance accountability with equity, acknowledging that the status quo serves neither value adequately (nadd, 2022; nasw, 2023). the central challenge confronting the profession is this: how can we maintain standards that genuinely protect clients while dismantling barriers that exclude competent practitioners and perpetuate systemic inequities? more pointedly, can a profession committed to social justice continue to defend a gatekeeping system that systematically disadvantages the communities it claims to serve? this special issue: toward justice-oriented licensure this special issue brings together critical scholarship and innovative solutions that refuse to accept the false choice between rigor and equity. the assembled articles menom et al./swk licensing editorial v interrogate current practices from multiple angles, examining clinical supervision as a social justice issue, the psychometric flaws embedded in standardized testing, and the financial and structural barriers that disproportionately impact marginalized candidates. contributors explore alternative assessment approaches—including performance-based evaluations, portfolio assessment, and provisional licensure models—as well as abolitionist frameworks that call for fundamentally reimagining professional regulation. empirical studies rigorously examine the relationship (or lack thereof) between exam content and practice readiness, while policy analyses dissect how states are navigating the complex politics of reform. king-jordan, clossey, dilauro, and bey deploy critical race theory to interrogate the structural inequities embedded within social work licensure. moving beyond descriptive analysis, they advance a critical framework for understanding how licensing systems reproduce racial hierarchies under the guise of professional standardization. their intervention proposes concrete strategies for transformation: demanding aswb accountability through transparent validity studies, developing alternative licensing pathways that recognize diverse forms of competence, and pursuing regulatory reforms that center equity as a core public protection principle. this piece challenges the profession to recognize licensing inequity not as an unfortunate side effect but as a structural feature requiring systemic intervention. decarlo and nienow deliver a psychometric critique of the aswb examination, systematically documenting how it violates fundamental principles of fair testing. drawing on data from 2012-2021, they expose a pattern of professional negligence, such as, persistent disparities in pass rates by race and age that aswb has failed to adequately address, organizational self-interest that compromises validity claims, strategic omission of inconvenient data, shifting operational definitions of reliability without adequate documentation, and other practices that undermine the exam's credibility. this forensic analysis reveals that the problems with the aswb exam are not peripheral but foundational, challenging its fitness as a gatekeeping mechanism. in a companion piece, decarlo and nienow expose how aswb has constructed a self-serving narrative to deflect criticism following its 2022 release of damning disparities data. through critical discourse analysis of aswb publications and exam documentation, they reveal a strategic pattern. aswb funded researchers already affiliated with the organization to produce studies that attribute exam bias exclusively to "structural factors" external to the examination itself, thereby absolving the exam, and aswb, of responsibility. this analysis demonstrates how powerful institutions maintain legitimacy through manufactured consent, using the veneer of research to justify systems that serve their organizational interests while perpetuating harm to marginalized communities. heckert and pence challenge conventional assumptions about the relationship between educational specialization and licensure outcomes. analyzing 2022 board pass rates across advanced generalist and clinical and direct practice specializations, they find that specialized tracks exert less influence on exam preparation than widely assumed. these findings carry profound implications: if specialization does not significantly improve exam performance, then the micro/macro divide in social work education may be advances in social work, fall 2025, 25(3) vi reinforcing artificial distinctions that fragment the profession without corresponding benefits. the authors advocate for re-integrating microand macro-based programming, streamlining exam options, and fundamentally reframing how educators discuss and promote specializations. whaley, paule, and keeney reframe licensure as a gatekeeping mechanism that systematically excludes bipoc practitioners, directly challenging the "public protection" narrative that legitimates current systems. their analysis exposes a troubling irony; a regulatory framework ostensibly designed to protect vulnerable clients instead restricts their access to practitioners who share their cultural contexts and lived experiences. the authors issue concrete demands for aswb accountability, such as implementing comprehensive mentorship programs, providing financial support to reduce economic barriers, and expanding language options to reflect the multilingual realities of contemporary practice. this piece insists that equity in pass rates is not a peripheral concern but a fundamental prerequisite for legitimate professional regulation. tomaszewski, cox, and kaur call social work education back to its social justice foundations, arguing that educational institutions bear critical responsibility for addressing licensure inequities. their intervention highlights the multifaceted role of educators, which is conveying essential knowledge, recruiting diverse students, providing equitable education, preparing candidates for licensure, and, crucially, interrogating the micro/macro dichotomy that fragments the profession. like heckert and pence, they advocate for pedagogical approaches that resist artificial boundaries between practice modalities. this piece positions social work education as a site of both reproduction and resistance, challenging educators to determine whether they will perpetuate exclusionary systems or actively dismantle them. choi and handy provide crucial historical context by examining how social work licensure has shaped the profession's racial composition over seven decades. employing a quasi-experimental design with census data from 1930 to 2000, they document how licensure requirements function as mechanisms of "social closure," professional strategies that consolidate power by restricting entry. their longitudinal analysis reveals that licensing has systematically reinforced racial inequities in the profession, contradicting claims that standardized credentialing promotes meritocracy. this historical perspective demonstrates that contemporary disparities are not aberrations but continuations of longstanding patterns, challenging the profession to confront how its regulatory structures have perpetuated exclusion across generations. sejuit, hill, and dewitt expand the analysis beyond social work through a comparative examination of licensing and gatekeeping across helping professions. analyzing the cswe and the council for accreditation of counseling and related educational programs in south carolina, they reveal how similar gatekeeping mechanisms operate across professional boundaries. their comparative framework illuminates both shared challenges and missed opportunities for collaboration. the authors advocate for streamlining pathways to licensure to enhance professional mobility, coordinated efforts to address disparities in exam passage rates, and fostering interprofessional collaboration that could menom et al./swk licensing editorial vii strengthen collective capacity to serve diverse populations. this analysis suggests that reform efforts might gain traction through cross-professional solidarity. farr, wilson, duncan, dominguez, and stone advance the most radical intervention in this collection: abolishing the social work exam entirely. grounding their argument in an analysis of 2011-2021 pass rates that consistently fail black, indigenous, and people of color (bipoc) test takers, they reject reformist approaches as insufficient. critically, they investigate five alternative pathways—performance assessments, oral examinations, portfolios, jurisprudence exams, and provisional licensure—concluding that even these alternatives risk further marginalizing bipoc social workers if implemented within current power structures. their abolitionist framework insists that the problem is not merely how we assess competence but the assumption that standardized gatekeeping serves public protection. this piece challenges readers to imagine licensure systems built on fundamentally different principles. tetteh and smith examine the specific barriers confronting advanced clinical students as they navigate licensure, revealing how structural inequities compound at this critical professional juncture. through systematic analysis of barriers and biases within the licensing exam development process, they identify key intervention points, such as developing culturally responsive exam content, mandating cultural competence training for test developers, and establishing comprehensive support systems for non-traditional candidates. their recommendations balance pragmatic reform with transformative vision, recognizing that meaningful change requires both immediate interventions to support current candidates and structural reforms that prevent future harm. this piece demonstrates how diversity, equity, and inclusion must move from aspirational rhetoric to concrete operational practice. nienow, apgar, fink, and quiñonez provide essential insights into the political dynamics of licensure reform through interviews with 14 state chapter directors of nasw. their findings illuminate the messy realities of policy change. success depends on navigating complex political landscapes, marshaling adequate resources, and cultivating stakeholder investment. critically, they document variation in progress across states, revealing how context shapes reform possibilities. this analysis offers a realist perspective on change efforts, acknowledging that even when the evidence for reform is overwhelming, political will and strategic capacity determine outcomes. their work provides a roadmap for advocates seeking to translate critique into policy transformation. campbell, cullen, vlam, and myrick move from critique to innovation by documenting a clinical supervision program in pennsylvania explicitly designed to address social injustice in the profession. their pilot program provides supervision, mentorship, sustainability support, and community-building to practitioners navigating licensure barriers, with equity enhancement as its central aim. this intervention model recognizes that supporting practitioners through current systems while simultaneously working to transform those systems need not be mutually exclusive strategies. by demonstrating how clinical supervision can function as social justice praxis, they offer a concrete example of how institutions can leverage existing structures toward liberatory ends. advances in social work, fall 2025, 25(3) viii davis and vancamp center the voices often excluded from policy debates, the social workers who experience licensure exams firsthand. through thematic analysis of practitioners' perceptions, they document deep skepticism about the exam's effects, fairness, equity, and value to the profession. these findings carry particular weight because they come from those with the most direct stake in licensure outcomes. practitioners' critiques align remarkably with scholarly analyses, suggesting broad consensus that current systems fail to reflect social work values or practice realities. this study underscores the urgency of revising licensure processes to align with both professional ethics and practitioner experience, bridging the gap between regulatory structures and lived realities of practice. glassburn, henson, miller, saylor, staton, walsh, and wilderman provide rich qualitative insight into how new social workers experience the master's licensure exam. interviewing 22 recent graduates, they identify five revealing themes: the exam simultaneously "means everything and nothing," functions as an "arbitrary hoops and barriers," provokes intense emotional responses, requires "learning the tricks" rather than demonstrating competence, and demands "setting aside practice wisdom." the study's title captures a profound ambivalence: new practitioners recognize the exam's high-stakes consequences while questioning its relevance to actual practice. this disconnect between education, examination, and practice exposes a fundamental misalignment at the heart of current licensure systems, validating calls for fundamental reconceptualization rather than incremental reform. in conclusion collectively, these manuscripts challenge the profession to align its regulatory systems with its core values. they offer evidence-based pathways forward that refuse to sacrifice either public protection or professional equity. most importantly, they insist that the burden of proof now rests with those defending the status quo. in the face of overwhelming evidence of systemic harm, maintaining current practices requires affirmative justification—justification that must extend beyond tradition, convenience, or institutional inertia. the evidence kim and joo (2025) present suggests that if historically marginalized groups had equal access to the opportunities and supportive environments enjoyed by white examinees, gaps in exam pass rates would decrease substantially. this insight reframes the problem: the issue is not the capacity of marginalized candidates but the structural inequities that undermine their success. addressing licensing disparities, therefore, requires interventions that target the root causesof inadequate educational resources, economic barriers, biased assessment instruments, and exclusionary professional cultures, rather than treating symptoms through remedial exam preparation or repeated testing. the profession stands at a crossroads. one path leads toward incremental adjustments that leave fundamental structures intact while claiming progress through modest reforms. the other path demands transformation: reimagining licensure as a system that actualizes social work's commitment to human dignity, worth, and justice. the articles in this special menom et al./swk licensing editorial ix issue illuminate that transformative path, demonstrating that rigor and equity need not be opposing values but can and must be mutually reinforcing principles in a licensure system worthy of the profession's ethical commitments. the 2022 aswb data shattered any remaining illusions about the neutrality or fairness of current licensure exams. the question is whether the profession will respond with the courage and creativity that just practice demands. the answer will determine not only who can enter the profession but what the profession ultimately stands for. references association of social work boards [aswb]. (2022). 2022 aswb exam pass rate analysis: final report. author. beard, f. (2025, august 7). how the social work compact will make it easier for social workers to work across state lines. social work blog. caldwell, b. (2024, june 26). the social work compact is bad public policy. psychotherapy notes. haubner, a. (2024, june 27). new colorado law eliminates entry level social worker exam, hopes to remove barriers of entry to profession. cbs broadcasting. kim, j. j., & joo, m. (2024a). the determinants of licensing exam outcomes: the compounding effects of individual, institutional, and community factors. prepared for aswb. aswb. kim, j., & joo, m. (2024b). the effects of race/ethnicity on clinical exam outcomes: diminished (yet persistent) effects when other determinants are controlled. prepared for aswb. aswb. kim, j., & joo, m. 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(2025, february 4). support of house bill 5158, an act relating to business and professions, license procedure for social workers [letter to house https://www.aswb.org/wp-content/uploads/2022/07/2022-aswb-exam-pass-rate-analysis.pdf https://www.aswb.org/wp-content/uploads/2022/07/2022-aswb-exam-pass-rate-analysis.pdf https://www.socialworkblog.org/sw-practice/2025/08/how-the-social-work-compact-will-make-it-easier-for-social-workers-to-work-across-state-lines/ https://www.socialworkblog.org/sw-practice/2025/08/how-the-social-work-compact-will-make-it-easier-for-social-workers-to-work-across-state-lines/ https://www.psychotherapynotes.com/how-the-social-work-compact-works/ https://www.cbsnews.com/colorado/news/new-colorado-law-eliminates-entry-level-social-worker-exam-remove-barriers-entry-profession/ https://www.cbsnews.com/colorado/news/new-colorado-law-eliminates-entry-level-social-worker-exam-remove-barriers-entry-profession/ https://www.aswb.org/wp-content/uploads/2024/08/2.-kim-joo-2024-determinants-of-licensing-exam-outcomes-07-29-2024.pdf https://www.aswb.org/wp-content/uploads/2024/08/2.-kim-joo-2024-determinants-of-licensing-exam-outcomes-07-29-2024.pdf https://www.aswb.org/wp-content/uploads/2024/08/2.-kim-joo-2024-determinants-of-licensing-exam-outcomes-07-29-2024.pdf https://www.aswb.org/wp-content/uploads/2024/08/3.-kim-joo-2024-effects-of-raceethnicity-on-clinical-exam-outcomes-07-30-2024.pdf https://www.aswb.org/wp-content/uploads/2024/08/3.-kim-joo-2024-effects-of-raceethnicity-on-clinical-exam-outcomes-07-30-2024.pdf https://www.aswb.org/wp-content/uploads/2024/08/3.-kim-joo-2024-effects-of-raceethnicity-on-clinical-exam-outcomes-07-30-2024.pdf https://doi.org/10.1177/10497315251329521 https://doi.org/10.1177/10497315251329521 https://doi.org/10.1177/10497315211066907 https://imprintnews.org/top-stories/results-in-social-worker-exams-reveal-racial-disparities/173406 https://imprintnews.org/top-stories/results-in-social-worker-exams-reveal-racial-disparities/173406 https://doi.org/10.1177/10497315221114175 https://doi.org/10.1177/10497315221114175 https://naddssw.org/wp-content/uploads/2025/02/nadd-tfrl-press-release-task-force-9.26.22-v3.pdf https://naddssw.org/wp-content/uploads/2025/02/nadd-tfrl-press-release-task-force-9.26.22-v3.pdf https://www.socialworkers.org/news/news-releases/id/2611/nasw-opposes-association-of-social-work-boards-aswb-exams https://www.socialworkers.org/news/news-releases/id/2611/nasw-opposes-association-of-social-work-boards-aswb-exams https://www.rilegislature.gov/special/comdoc/house%20corporations%202025/02-04-2025--h5158--ric%20school%20of%20social%20work%20-%20jayashree%20nimmagadda.pdf https://www.rilegislature.gov/special/comdoc/house%20corporations%202025/02-04-2025--h5158--ric%20school%20of%20social%20work%20-%20jayashree%20nimmagadda.pdf advances in social work, fall 2025, 25(3) x committee on corporations, state of rhode island]. state of rhode island general assembly. ribera, d. (2023, february 16). bill that would change how social workers are licensed in utah advances to the senate. ksltv. stewart, c. (2023). why do california social workers need title protection? alliant international university. weinstein, s. (2022, october 13). a robust licensure system benefits the social work profession—and the public. association of social work boards. author note: address correspondence to goutham menom, school of social work, loyola university chicago, chicago, il 60611. email: gmenon@luc.edu https://ksltv.com/politics-elections/bill-that-would-change-how-social-workers-are-licensed-in-utah-advances-to-the-senate/525526/ https://ksltv.com/politics-elections/bill-that-would-change-how-social-workers-are-licensed-in-utah-advances-to-the-senate/525526/ https://www.alliant.edu/blog/social-worker-protected-title https://www.aswb.org/a-robust-licensure-system-benefits-the-social-work-profession-and-the-public/ https://www.aswb.org/a-robust-licensure-system-benefits-the-social-work-profession-and-the-public/ https://www.aswb.org/a-robust-licensure-system-benefits-the-social-work-profession-and-the-public/ mailto:gmenon@luc.edu _________ patrina duhaney, phd, rsw, associate professor, and liza lorenzetti, phd, rsw, associate professor, faculty of social work, university of calgary, alberta, canada. jeff halvorsen, phd, rsw, associate faculty, humanitarian studies, royal roads university, british columbia, canada. emily han, msw, registered social worker, ontario, canada. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 74-101, doi: 10.18060/27825 this work is licensed under a creative commons attribution 4.0 international license. black students’ experiences of anti-black racism on campus patrina duhaney liza lorenzetti jeff halvorsen emily han abstract: catalyzed by numerous high-profile incidents of anti-black police brutality within the context of systemic anti-black racism, a global movement advocating for racial justice for black lives has ignited conversations in academia. while universities across north america issued statements pledging commitment to racial equity, many lacked systemic mechanisms to enact meaningful change. with research on anti-black racism in academia primarily focused on the u.s., the experiences of black students in canada remain underexplored. in this context, activist scholars from a canadian university in alberta conducted a two-phase mixed-methods case study to examine black students’ experiences. this article presents findings from phase one, an online survey informed by critical race theory, completed by 113 self-identified black students. respondents shared insights on the university’s climate, incidents of anti-black racism, its impacts on wellbeing, and dissatisfaction with institutional responses. findings underscore the urgent need for systemic changes in representation, support, training, and curriculum development to address anti-black racism meaningfully. keywords: anti-black racism, critical race theory, racism, black social work students, social justice, social work education, edi against the backdrop of an unprecedented global pandemic that disproportionately impacted black, indigenous, and racialized communities (gaynor & wilson, 2020; khare et al., 2020; shadmi et al., 2020), along with multiple high-profile incidents of police brutality against black individuals (eichstaedt et al., 2021; stelkia, 2020; wu et al., 2023), the black lives matter movement emerged as a global phenomenon. the movement catalyzed a sharp focus on the historical legacy of slavery and the ever-present reality of systemic anti-black racism, both nationally (diverlus et al., 2020; potvin, 2020; walcott & abdillahi, 2019) and internationally (ransby, 2018; shahin et al., 2021; solomon, 2023). in response to protests, many universities issued statements of solidarity with black communities (university of toronto, n.d.; turpin, 2020) and declared their commitment to equity, diversity, and inclusion (edi, mcgill university, 2020); university of alberta, 2020; university of calgary [ucalgary], 2020), as well as anti-racism (dean, 2023; ucalgary, n.d.a; university of windsor, 2020). however, these surface-level responses from many post-secondary institutions lacked concrete mechanisms to address anti-black racism on campus, ultimately functioning to quell the growing calls for systems and sustainable change (ahmed, 2006). research consistently demonstrates that both overt and covert forms of racism persist at all levels of academia, in canada (grant et al., 2017; mohamed & beagan, 2019; stirling about:blank duhaney et al./black students’ experience 75 cameron & jefferies, 2021) and in the united states (u.s.) (ahmed, 2012; mwangi et al., 2018; smith et al., 2016). in the canadian context, the education system has historically served as a tool for advancing white supremacy (lopez & jean-marie, 2021). specifically, in higher education, black canadian students face multiple barriers, including a lack of institutional support, as well as racism from their peers, professors, and university administration (bombay & hewitt, 2015). despite this concerning evidence, until recently, minimal attention was paid to advancing racial justice within post-secondary education, placing the bulk of the burden to racialized and indigenous faculty, staff, and students who are forced to simultaneously navigate systemic barriers in relative isolation while advocating for change (adams, 2022; tomlinson et al., 2021). in the canadian context, the term racialized people refers to individuals or groups who are categorized and marginalized within societal structures based on socially constructed ideas of race, often tied to physical characteristics such as skin colour, facial features, or cultural attributes. the term emphasizes the systemic nature of racial categorization and its impact, rather than framing race as an inherent or biological reality. limited consideration of anti-racism in institutional decision-making, insufficient dedication of resources for edi and anti-racism work, and lackluster engagement with students in institutional anti-racism efforts are symptoms of institutional negligence (campbell & candler, 2020). however, the last three years have seen heightened demand for transformational change within academia (duhaney & el-lahib, 2021). while the term diversity, equity, and inclusion (dei) is commonly used in the u.s. and often centers on addressing historical racial inequities, this paper uses edi to reflect canadian usage. history and effects of edi implementation in canadian post-secondary institutions edi initiatives were first introduced in canadian universities in the 1980s (douglas, 2022). however, the topic resurfaced in 2017 for several reasons, including the black lives matter movement in the u.s., sparked by the murder of george floyd, and an increased focus on decolonization in canada (marom, 2023). in response, post-secondary institutions became more reflective about their policies and practices (marom, 2023). universities canada (2017) emphasized the importance of edi, stating: we believe our universities are enriched by diversity and inclusion. as leaders of universities that aspire to be diverse, fair, and open, we will make our personal commitment to diversity and inclusion evident. we commit our institutions to developing and/or maintaining an equity, diversity, and inclusion action plan in consultation with students, faculty, staff, and administrators, particularly with individuals from underrepresented groups. we commit to demonstrating progress over time. (para. 5) this commitment was further reinforced by the canadian federal government in 2017, which required institutions applying for canada research chair funding to have developed edi action plans (government of canada, 2022). this provided strong incentives for canadian universities to implement edi policies. canada’s dedication to addressing edi was further solidified by the development of the national scarborough charter on antiadvances in social work, spring 2025, 25(1) 76 black racism and black inclusion in higher education, signed by several canadian universities (marom, 2023). edi in canadian universities is generally strengthened through: “1) political commitment; 2) student recruitment; 3) programmatic supports; 4) research and scholarship; and 5) institutional climate” (tamtik & guenter, 2019, p. 51). despite these advancements, edi policies are not without flaws. many canadian universities lump all edi issues under singular policies and action plans, failing to consider the distinct challenges faced by different groups (tamtik & guenter, 2019). additionally, fewer than half of canadian universities explicitly define edi in their policies, which leads to inconsistent application (tamtik & guenter, 2019). this inconsistency can create challenges for racialized students and faculty, especially as some universities prioritize specific edi issues over others. although edi policies have been successful in increasing diversity through targeted recruitment, research has shown that they are typically developed by senior leadership, which remains predominantly white. furthermore, fewer than half of canadian universities have dedicated edi offices, and this number appears to be decreasing (tamtik & guenter, 2019). evaluating the effectiveness of edi policies is challenging due to variations among universities, the absence of tracking for students and faculty, and a scarcity of evaluative studies (mackenzie et al., 2023). furthermore, there has been resistance from right-wing political groups who label edi efforts as “woke culture” (marom, 2023, p. 1086). the increasing presence of black students at post-secondary institutions in midwestern provinces such as alberta highlights the urgent need for establishing long-lasting measures to extinguish anti-black racism on alberta campuses. limited inquiry into black students, faculty, and staff experiences of anti-black racism, however, has produced limited data from which to draw recommendations for systemic change. this case study seeks to advance and mobilize research on lived experiences of black students facing anti-black racism at all levels within the ucalgary by asking, “what are the experiences of anti-black racism at the university of calgary?” this research is part of a larger mixed-methods study aimed at understanding black students, alumni, staff, and faculty members’ experiences of anti-black racism at the ucalgary. the objectives of the study are to, a) examine black students’ lived experiences of anti-black racism; b) provide key recommendations that promote equity and anti-racism to enhance current policies and practices at ucalgary; and c) contribute to and advance canadian research on anti-black racism in canadian institutions of higher learning, informing future national research agendas. positionality in this study, we recognize the importance of situating ourselves as authors and researchers to provide transparency about our perspectives, motivations, and the lenses through which we approach this work. as a diverse team of scholars committed to addressing anti-black racism, our positionalities reflect varied experiences, identities, and commitments to social justice. understanding that our backgrounds, privileges, and social locations influence our research, we provide these positionality statements to acknowledge our roles and responsibilities in both perpetuating and challenging systemic oppression. our collective efforts are grounded in a shared dedication to promoting racial equity and duhaney et al./black students’ experience 77 justice, particularly within academic institutions, and to supporting the voices of those most impacted by anti-black racism. the first author is a black woman activist-scholar whose work is driven by a personal and professional commitment to eradicating anti-black racism in academia. an advocate for systemic change within the faculty of social work and the wider university, she has played a critical role in promoting racial equity and justice. her efforts are grounded in a belief in the power of activism and scholarship to transform institutional policies and practices that perpetuate anti-black racism. the second author is a 2.5 generation white italian settler and anti-racist activist scholar. her involvement in racial justice work focuses on challenging anti-black racism and amplifying the voices of black students and faculty in their fight for equity. she is committed to using her position to disrupt white supremacy and support meaningful, long-term changes within academic and community spaces. her work reflects an awareness of her own privilege and an unyielding dedication to dismantling systemic oppression. the third author is a white cisgender male settler of norwegian, german, and scottish descent, living on unceded t’souke territory. as an activist scholar, he focuses on social justice, allyship, critiques of whiteness, masculinities, and anti-racism. with over 15 years of community-based experience, his work is informed by a critical examination of his own positionality and a commitment to challenging racial hierarchies. he actively contributes to efforts aimed at eradicating anti-black racism and promoting equity within both academic and broader social contexts. the fourth author is a second-generation chinese immigrant and social worker whose research and practice are guided by anti-racist and intersectional feminist frameworks. her lived experiences of racism, combined with an awareness of anti-black racism within asian immigrant communities, drive her commitment to combating these issues. she approaches her work with an understanding of how various forms of oppression intersect and a dedication to fostering solidarity across racial and ethnic lines to address anti-black racism and promote systemic change. literature review anti-black racism anti-black racism is a system of racial injustice that has historically subjugated, marginalized, and dehumanized people of african descent (duhaney et al., 2022). rooted in the enslavement and the relentless systemic denigration of black identities (kendi, 2019), anti-black racism is evident across societies and employs blatant methods to undermine blackness while centring whiteness and asserting white supremacy (duhaney et al., 2022). anti-blackness is embedded in policies, practices, and social norms to propagate the inferiority of black people (kumsa et al., 2014; lopez & jean-marie, 2021). prevalence of anti-black racism in higher education in canada and the united states anti-black racism is prevalent across canadian university campuses (moore, 2021; stirling cameron & jefferies, 2021). however, empirical research on students’ experiences advances in social work, spring 2025, 25(1) 78 with anti-black racism often relies on studies from the u.s. research in the u.s. has demonstrated that black students experience negative campus climates characterized by inequitable treatment, microaggressions, lack of representation, and systemic racism; which contribute to feelings of isolation and lack of belonging (koo, 2021; mills, 2021) that impact students’ overall campus experiences and students’ outcomes in terms of retention, academic success, and graduation (campbell et al., 2019; hurtado & ruiz, 2012). the most common forms of racism reported by black post-secondary students are racial microaggressions (mccabe, 2009). anti-black and racial microaggressions are defined as: “commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color” (sue et al., 2007, p. 271). butts (2002) emphasized the complexity of racist aggression, which functions at the individual, community, and policy levels, reinforcing multi-faceted trauma. mwangi and colleagues (2018) examined the racial climate at a u.s. university campus. in their qualitative responses, students described a hostile climate where black students are often targeted by campus police and security; experience intensified police presence at events held by black student organizations; and endure fear and anxiety about walking around campus after seeing themselves reflected in the murders of black men and women in the news (mwangi et al., 2018). students in smith and colleagues’ study (2016) reported experiencing anti-black male stereotyping and hyper-surveillance. participants described being racially profiled and surveilled by police on and off campus (smith et al., 2016). in some instances, black males reported being perceived as a criminal/predator or assumed to possess “ghetto-specific” knowledge (smith et al., 2016, p. 1197). in canada, racial discrimination and anti-black racism on post-secondary campuses require further attention from researchers and institutional leaders (katchanovski et al., 2015). a key factor in an act of complicit invisibilization is the institutional neglect to collect race-based data from universities and colleges in canada. according to a 2017 investigation by the canadian broadcasting company, of the 76 canadian universities surveyed, 63 disclosed that they do not collect race-based data and could not provide a demographic breakdown of the ethnic and racial composition of their student bodies (mcdonald & ward, 2017). some universities providing explanations for not collecting race-based data indicated that they did not want to discriminate against certain racial groups. despite the lack of race-based data, there is an increasing body of scholarship within canada calling attention to the pervasiveness of racism against racialized students and faculty and the neglect of racial issues in the curriculum (hampton, 2016). for example, a qualitative study with 16 black students enrolled in or recently graduated from a canadian university (gosine, 2007) found that some students in fields such as math, sciences, and business, perceived the university climate as less hostile than students in the humanities, social sciences, and law. the latter group expressed concerns about eurocentric curriculum, biased treatment from racially insensitive faculty, conflicts with white peers, and a lack of black faculty (gosine, 2007). leath and chavous (2018) revealed in their study that black women students faced a more hostile racial climate and experienced decreased academic satisfaction, despite similar levels of academic knowledge when compared to women from other racial groups. similar results were documented by duhaney et al./black students’ experience 79 dortch and patel (2017), who found that black women students experienced persistent racial and gendered microaggressions, including isolation, exclusion, and having their intelligence and capabilities questioned and undermined. the authors further noted that black women experiencing anti-black racism may be reluctant to respond for fear of being categorized as the stereotypical “angry black woman” (dortch & patel, 2017). this same pattern was revealed in a study exploring the racialized students’ responses to racial microaggressions, where jones (2021) found that black women refrained from responding because they were the only black person in the situation or environment and feared that they would not be believed or supported. caxaj and colleagues (2021) drew parallels between black and other racialized students’ (e.g., black, asian, latinx, indigenous, immigrants, and refugees) experiences in a qualitative study examining how students navigate campus life in a mid-sized canadian city. racialized students in this study reported being perceived as “outsiders” or “threats,” and surveilled and questioned due to their racialized status (caxaj et al., 2021). students also pointed out that the onus for addressing racism was placed on them, and they had little institutional support, creating a pressure that these students felt their white peers did not have to deal with (caxaj et al., 2021). consequences of anti-black racism the impact or consequences of anti-black racism are significant for black students who may feel unsafe, experience depression, and self-police their own behaviours to avoid further targeting. corbin and colleagues (2018) reported that participants in their study policed themselves to avoid being labelled as angry, loud, irrational, aggressive, or argumentative. in maffini and dillard’s (2022) u.s. study of black and white undergraduate students between the ages of 18 and 30, black students reported feeling significantly less safe than white students on campus. a larger number of black students reported feelings of hopelessness, anger, and suicidality than white students (maffini & dillard, 2022). black students who reported feeling less safe also experienced disproportionately high rates of assault victimization (maffini & dillard, 2022). a lack of belonging and feelings of isolation were other impacts reported by black students who spoke of their university’s campus climate (hampton, 2016), which contributed to psychological distress. the depth of psychological harm was also uncovered in a study examining the relationship between racial microaggressions and symptoms of depression, in which marks and colleagues (2021) found that black students who reported feeling unwanted or discredited also expressed feelings of depression. blume and colleagues (2012) also examined the impact of microaggressions on racialized university students at a historically white institution in the u.s., where racialized students reported experiencing microaggressions more frequently than white students. their findings also suggested that experiences of microaggressions were linked to a greater risk for anxiety and binge drinking (blume et al., 2012). black students, in a study by smith et al. (2016), shared that they were subjected to hostile environments in their universities, describing psychological stress and symptoms of racial battle fatigue. racial battle fatigue has been defined as the accumulation of social and psychological effects of racial microand macro-aggressions, advances in social work, spring 2025, 25(1) 80 leading to negative health consequences, including physiological symptoms and psychological stress (smith, 2004, 2010; smith et al., 2006; smith et al., 2016). anti-black racism is prevalent across university campuses, leaving black students with little recourse or support. some researchers observed that black students experiencing racial microaggressions were tasked with dealing with the effects of racially oppressive encounters, correcting those perpetuating them, while also navigating the negative impacts of these racial microaggressions on their well-being (hollingsworth et al., 2018). this issue is further exacerbated by university administrations who are often more preoccupied with increasing the recruitment and matriculation of black students than with addressing the negative effects and impacts of anti-black racism on students within university campuses (maffini & dillard, 2022). maffini and dillard (2022) further emphasized that administrators are not paying sufficient attention to the actual day-to-day experiences that black students endure during their studies, nor to hostile campus environments that may decrease the likelihood they will enter university, persist with their studies, and achieve their degree. theoretical framework critical race theory (crt) was employed as both a theoretical framework and a methodology in this study. originating from u.s. legal scholarship, crt emerged as a critical response to mainstream liberal perspectives, and as a radical alternative to the faltering progress of traditional civil rights litigation in producing significant social reform (gillborn, 2006; taylor, 1998). crt conceptualizes racism as pervasive and deeply embedded within everyday life, culture, and longstanding sociopolitical systems and institutions (ford & airhihenbuwa, 2010; gillborn, 2006). the theory emphasizes the historical and contextual nature of racial dynamics and their impact on the present day (taylor, 1998). as a framework rooted in struggles for racial justice, crt rejects myths and claims of meritocracy, neutrality, objectivity, and racial colour-blindness (gillborn, 2006). grounded in social justice and praxis, crt seeks to promote racial equity and dismantle race-based oppression (graham et al., 2011). while it foregrounds race and racism, crt also critically examines the intersections of race, gender, class, and other social identities (graham et al., 2011). crenshaw’s foundational work on intersectionality is significant, highlighting how race and gender intersect to shape black women’s structural, political, and representational experiences (crenshaw, 1989, 2016). as a methodological approach, crt integrates theory, experiential knowledge, and critical consciousness to uncover and challenge systemic racism and its consequences (ford & airhihenbuwa, 2010). by “center [ing] in the margins” (ford & airhihenbuwa, 2010, p. s31), crt shifts the focus of discourse from the dominant perspectives to groups on the margins. it critiques the normative dominance of eurocentric perspectives, which has led to an “apartheid of knowledge” that marginalizes and erases the knowledges and experiences of racialized communities (malagon et al., 2009, p. 254). through methods like counter-narratives, crt focuses on the experiential knowledge of racialized communities (graham et al., 2011). researchers employing crt often include their own lived experiences with racism and racialization, as these personal narratives enrich the duhaney et al./black students’ experience 81 analysis and connect with the lived experiences of the communities being studied (ford & airhihenbuwa, 2010; parker, 2019). methods this study was conducted in the aftermath of george floyd’s murder and the global amplification of the black lives matter movement, an era marked by increased awareness of anti-black racism. the research employed a community survey methodology to examine the prevalence and experiences of anti-black racism among black students at ucalgary (berkowitz, 1996; halvorsen et al., 2022). petersen and alexander’s (2001) six-stage assessment protocol was adapted for the study, encompassing planning, strategy development, data identification, formulation of broad research questions, and implementation and analysis through consensus decision-making. this article reports on phase one of the study, which used an online survey method to capture quantitative and qualitative data. brief surveys increased response rates while respecting participants’ time constraints (kuechler, 1998). the inclusion criteria specified that participants must be current university students aged 18 or older. ethics approval was obtained from the ucalgary conjoint faculties research ethics board (reb20-1817). during survey design, the research team could not locate validated tools that aligned with the study’s needs assessment objectives. the lead researcher defined the research questions and broad topics, then developed the survey. five team members, chosen for their expertise in crt, anti-racism, and research methods, engaged in a peer-debriefing process (creswell, 2013). these members also had a history of activism against anti-black racism within the university community. participants were recruited using purposive sampling (e.g., student organizations, listservs from 13 faculties or departments at ucalgary, and referrals) and snowball sampling (e.g., personal contacts and referrals, patton, 2002). purposive recruitment also occurred through facebook, instagram, and twitter groups, local organizations (i.e., social work student association [swsa]; and the association of black social workers), as well as in classrooms, and public lecture visits. all recruitment materials included an overview of the study and a link to the survey, that was uploaded to qualtrics (2021) web-based software. the survey was administered over 16 months, from december 2020 to march 2022, yielding 304 responses from students using non-probability purposive and convenience sampling methods (creswell, 2013). due to the covid-19 pandemic, the research team extended the recruitment and data collection period to ensure students had ample opportunity to participate. of the total data collected, 191 surveys were removed for incompleteness (surveys where three or more questions were answered were kept for analysis), or because the participant did not identify as black. a total of 113 surveys were included in the final analysis. the qualtrics platform was used to select the analytic sample and perform univariate analysis. we focused our quantitative analysis on descriptive statistics and identified key themes through our qualitative analysis. tables and figures advances in social work, spring 2025, 25(1) 82 were produced in microsoft excel. qualitative data were exported to microsoft word, analyzed, and coded using thematic analysis (guest et al., 2012) by one team member. trustworthiness was ensured throughout the research process. the research team reviewed the survey and adjusted questions to minimize participant reactivity by removing affirming and non-affirming elements and using neutral language (padgett, 2008). trustworthiness was also established in the analysis stage. initial codes were confirmed through a consensus procedure to ensure agreement on their meaning (creswell, 2013). where consensus could not be reached, the qualitative comment was reviewed within the context of the entire survey response. if consensus remained unattainable, the comment was excluded from analysis. after the thematic analysis, relevant quotes were selected to illustrate recurring themes. the lead researcher and a co-researcher subsequently reviewed the findings to confirm that the quotes chosen accurately represented the themes. all authors involved in the analysis have academic training in crt, which informed the study’s interpretive framework and analytic approach. findings ucalgary student participants were invited to share their views on the university climate, experiences, and the impact of anti-black racism on their well-being, black representation, and institutional responses to reports of anti-black racism. several themes were identified below that encapsulate their responses. demographics all participants selected for the analytic sample (n=113) self-identified as black students. most (63%) identified their current level of study as undergraduate, while 29% were in graduate or post-graduate studies, and 8% reported that they were enrolled in continuing education. age was collected in six, five-year age categories beginning at 17 and ending at 43 and older. most students (42%) were ages 17-22. participants were primarily female (68%), with almost one in three (29%) males and a small percentage (3%) identified along the gender spectrum (transgender, gender fluid, non-binary). most participants identified as straight/heterosexual (79%), and the remaining indicated that they were sexually diverse (15%) or preferred not to answer (6%). an equal number of participants reported being born in africa and canada (36%, respectively), while 10% stated that they were born in the united states, 4% in the caribbean and bermuda, 4% in europe. the remaining 10% were born in places not listed in the survey (e.g., brazil, “middle east,” and venezuela). most participants (90%) identified english as their primary language. the remaining participants (2%) identified french as their primary language, while 8% did not specify their primary language. household income was collected in seven categories, beginning with under $10,000, increasing in $20,000 increments to $150,000 and over. most participants responding to this question (19%) identified their household income as $50,000 to $69,999 (see table 1 below). duhaney et al./black students’ experience 83 table 1. demographics (n = 112) n (%) education undergraduate 70 (62.5%) graduate 30 (26.8%) post-graduate 3 (2.7%) continuing education 9 (8%) age 17-22 47 (42%) 23-27 25 (22.3%) 28-32 14 (12.5%) 33-37 11 (9.8%) 38-42 7 (6.3%) 43 and older 8 (7.1%) gender female 76 (67.9%) male 33 (29.5%) transgender 0 (0%) gender fluid 0 (0%) non-binary 2 (1.8%) not listed, please specify 0 (0%) prefer not to answer 1 (0.9%) country of birth canada 40 (35.7%) caribbean and bermuda 5 (4.5%) africa 40 (35.7%) united states 11 (9.8%) europe 5 (4.5%) not listed, please specify 11 (9.8%) primary language english 101 (90.2%) french 2 (1.8%) not listed, please specify 9 (8%) household income under $10,000 11 (9.8%) $10,000 to $29, 999 18 (16.1%) $30, 000 to $49, 999 12 (10.7%) $50,000 to $69, 999 21 (18.8%) $70,000 to $89, 999 20 (17.9%) $90,000 to $149, 999 19 (17%) $150,000 and over 11 (9.8%) climate of anti-black racism at ucalgary participants were asked if, as black individuals, they believed that ucalgary was a welcoming environment, using a seven-point likert-type scale ranging from strongly disagree to strongly agree. sixty-two percent of participants agreed, while 23% disagreed. participants were then asked if they believed that as black individuals, they were valued at the university. most participants (54%) agreed, 27% disagreed, and the remaining participants neither agreed nor disagreed (19%). participants were also asked if they believed they were supported at the university. many participants (49%) agreed, and about a third (32%) disagreed, with the remaining (20%) neither agreeing nor disagreeing. participants were asked whether they generally felt safe on campus. most (67%) responded yes, while 34% were either “not sure” (19%) or indicated they did not feel safe advances in social work, spring 2025, 25(1) 84 (16%; see table 2). eight participants who reported feeling safe provided qualitative responses that shed light on the complexity of their feelings, such as “physically yes, not psychologically” or expressing “i need to justify my presence”; these responses elucidated the tensions experienced by black students in claiming to experience safety on campus. two participants who were “not sure” of their level of safety stated that they had not yet been to campus. those who indicated that they did not feel safe did not provide further details to explain their response. table 2. climate of anti-black racism question n mean* sd range ucalgary is a welcoming environment. 113 3.78 1.59 1-7 you are valued at the ucalgary. 113 3.55 1.62 1-7 you are supported at the ucalgary. 113 3.40 1.66 1-7 n % do you feel safe on campus? (n = 70) yes 47 67.1% no 10 15.7% not sure 13 18.6% *scale: 1= strongly disagree to 7 =strongly agree experiences of anti-black racism on campus fifty percent of respondents (n = 35) indicated that they had experienced anti-black racism on campus, while 8% were unsure if they had experienced anti-black racism. over half of respondents (n = 35; 51%) also shared that they had witnessed anti-black racism on campus, while 16% of participants were unsure if they had witnessed it. when asked where on the university campus they had experienced anti-black racism, students reported that they most frequently experienced it during interactions with peers (35%), on campus/online from professors (18%), and on campus/online from administrative staff (13%; see table 3). students also stated that they experienced anti-black racism in multiple spaces and circumstances while on campus, including the fitness centre, during intramural sports, while living in residence, in a clinic setting, in response to a program application, on public billboards, in the student life building, on campus transit stops, and in the library. some students described their experiences with anti-black racism in greater detail, ranging from daily aggressions to systemic erasure. one student shared that “in class, antiblack racism takes the form of micro-aggression and being silenced” most often, “they are not blatant racist acts.” another form of anti-black racism reported by students was how others dismiss their experience of being black. one student stated that “as a black person my opinion does not count when talking about social justice because i bring up racism too much. i am viewed as angry, and my comments are ignored.” in a further troubling statement, another student shared that they had experienced a racist attack on campus, noting that, “i was confronted/yelled at by a racist individual to leave.” duhaney et al./black students’ experience 85 table 3. experiences of anti-black racism question response n (%) have you experienced anti-black racism at the university of calgary? (n = 70) yes 35 (50.0%) no 29 (41.4%) not sure 6 (8.6%) have you witnessed anti-black racism at the university of calgary? (n = 69) yes 35 (50.7%) no 23 (33.3%) not sure 11 (15.9%) where on campus did you experience anti-black racism? (n = 83) on campus/online from peers 29 (34.9%) on campus/online from professor 15 (18.1%) on campus/online from administrative staff 11 (13.3%) university fitness centre 1 (1.2%) residence 2 (2.4%) not listed, please specify 16 (19.3%) prefer not to answer 9 (10.8%) students also provided structural and institutional examples of anti-black racism, related to a lack of representation of black students, faculty, and staff on campus, and the absence of afrocentric and black history and course content. one student shared that “my learning experience is not balanced. the perspective regarding the historical context of today’s societal issues is never fully explored.” some black students shared that they felt tokenized in certain classes, burdened with the expectation to represent their entire race. they described being treated as a monolith, with white professors often assuming they were less intelligent, which negatively impacted their academic performance. some students also noted that they had limited access to funding and awards. in this context, students observed that, while the university claims to be committed to diversity, “racist comments are not addressed” and that “inherent racial discrimination is rampant on the campus.” impacts of anti-black racism on student well-being all participating students were asked to identify the most significant impacts of antiblack racism they had experienced. impacts were multifaceted and profoundly harmful, with almost half (n = 50) stating that they lost their sense of belonging (48%). furthermore, 28% of the students reported experiencing reduced self-confidence, 22% reported experiencing mental health challenges, another 22% indicated reduced academic performance, and 4% shared that their social interactions were affected. one participant elaborated on the sense of exclusion, “i am the only one around and my pillars are white people who will never understand my life as a black person in 2020.” several other participants said the experience of anti-black racism did not affect them because they were “used to it” and another elaborated by saying that while it did not impact them, “it is wrong to have to go through that [anti-black racism].” advances in social work, spring 2025, 25(1) 86 responses to anti-black racism despite the pervasive and multifaceted ways that anti-black racism was experienced by black students on campus, only eight of the participants (12%) who responded to this question said yes. individuals who reported the incident shared their experiences with one or more of the following: the police, academic staff, friends, colleagues, supervisor, human resources, or the dean. although the office of equity, diversity and inclusion, and the protected disclosure and research integrity office serve as official channels for reporting incidents, only one student reported accessing these services. when asked if the reporting of anti-black racism had helped bring the issue to a resolution, only half (50%) of the participants said yes. in comparison, the remaining 50% indicated that the issue remained unresolved. furthermore, among those who stated that the incident was resolved, only one participant said they were satisfied with how the incident was handled, while two other participants shared that they were not satisfied with the outcome. of those who reported that the incident was not resolved (n = 4), none were satisfied with how the incident was handled and one student who reported an incident of anti-black racism did not disclose whether the report was resolved or if they were satisfied with the result. one student provided further detail, noting that they had reported two separate incidents to multiple people, including their supervisor and human resources, and they were not believed. they stated, “i was informed i did not understand the context and gestures clearly.” in summary, among the participants who reported experiences of anti-black racism, only one was satisfied with how the incident was managed (see figure 1). figure 1. responses to anti-black racism for most students, who did not report their experiences of anti-black racism, we asked them to expand on their reasons. of the 22 responses received, a majority (68%) indicated that they did not believe reporting would make a difference. underscoring the trauma associated with anti-black racism, others stated that they were discouraged from speaking out due to stigma, fear, guilt, and shame. one participant said, “i didn’t want to be labelled ‘that black girl’ before i got the chance to succeed.” reflecting on canada’s justice system, satisfied (n=7) were you satisfied with the way it was handled? resolved (n=8) was the issue resolved? reported (n=68) have you ever reported your experience of anti-black racism? was reported (n = 8, 11.8%) was resolved (n = 4, 50%) was satisfied (n = 1, 33.3%) was not satisfied (n = 2, 66.7%) was not resolved (n = 4, 50%) was satisfied (n = 0, 0%) was not satisfied (n = 4, 100%) duhaney et al./black students’ experience 87 one participant noted that, “hate crimes barely lead to convictions in canada; i have done my research.” considering the current environment, experiences, and impact of anti-black racism at ucalgary, we asked participants whether they believed the university was committed to addressing this issue. most students (57%) said no. in their responses, some participants shared further incidents of anti-black racism which went unaddressed by the university, and another student commented that they would like to see the metrics “used to evaluate the effectiveness of their edi [the university’s equity, diversity, & inclusion] strategy.” thirty-two percent of participants agreed that the university was committed to addressing anti-black racism. many of the comments from students who agreed the university was committed were cautious, as one student shared, “conversations have started, and i hope they will continue.” for one participant, appointment of the equity diversity and inclusion vp was “not something i thought would actually ever happen, and to see senior administrative staff take the recommendations of student activists seriously and implement their recommended changes was surprising and a positive step forward for the university.” when asked if there were appropriate supports to address discrimination and antiblack racism on campus, 73% said there were not appropriate supports. one participant perceived that existing programs were ineffective, commenting: “a lot of the programs on campus are window dressing of diversity and inclusion.” a second participant identified a need for further training in the student counselling office that addressed “self-esteem issues related to race, fear, and anxiety [and] the way the world receives black individuals.” table 4. perspectives of the university question response n (%) the university is committed to addressing anti-black racism. (n = 77) yes 25 (32.5%) no 44 (57.1%) not sure 8 (10.4%) do you believe you have appropriate supports to address discrimination or anti-black racism on campus? (n = 74) yes 17 (23%) no 54 (73%) not sure 3 (4.1%) are you aware of any current policies at the university of calgary that address inequities, in particular anti-racism? (n = 68) yes 26 (38.2%) no 42 (61.8%) if so, do you believe they are effective? (n = 26) yes 7 (26.9%) maybe 8 (30.8%) no 0 (0%) no opinion 11 (42.3%) how important is it to you that the university has policies that address inequities, in particular anti-black racism? (n = 68) extremely 39 (57.4%) very 15 (22.1%) moderately 5 (7.4%) slightly 3 (4.4%) not at all 6 (8.8%) in addition to programs and supports, the students were asked if they were aware of any current policies at the university that addressed inequalities, specifically, anti-racism. most participants (62%) were unaware of any policies, while approximately one-third advances in social work, spring 2025, 25(1) 88 (38%) stated they were aware. of those who knew of current policies, 27% expressed that they were effective, 31% shared that they may be effective, and 42% had no opinion. while most participants were unaware of equity and anti-racism policies on campus, a significant majority (79%) indicated that the existence of these policies was either very or extremely important (see table 4). discussion the demographic data highlights that black students at ucalgary represent a diverse group across age, gender, education levels, and geographic origins. however, the findings emphasize a need for tailored support structures, particularly for undergraduate students who make up the majority (63%) of the sample. the underrepresentation of students from regions such as the caribbean, europe, and latin america underscores a gap in fostering global inclusivity. at the same time, the predominance of english speakers suggests that students with diverse linguistic backgrounds may face additional cultural or linguistic barriers. addressing these nuanced aspects of diversity can help foster a more equitable campus climate. these findings underscore the complex and nuanced climate that black students experience at ucalgary, reflecting a broader pattern of anti-black racism that is prevalent across canadian campuses (mullings et al., 2016). although most participants viewed ucalgary as a welcoming environment, it is concerning that a significant portion of students did not feel welcomed, and many reported not feeling valued. this discrepancy highlights a disconnect between institutional claims of inclusivity and the lived experiences of black students, suggesting that the university’s climate may be more alienating than it appears at first glance. the issue of safety has emerged as a crucial concern, with more than one in three students unable to affirm that they felt safe at ucalgary. this aligns with findings from maffini and dillard (2022), who highlighted that black students often feel less safe compared to their white peers. responses such as “physically yes, not psychologically” and “i need to justify my presence” reflect the psychological and emotional toll that racism takes on black students, as they navigate daily environments where safety, both physical and psychological, is compromised. these contradictions underscore a broader societal pattern in which black individuals face “everyday racism” (essed, 1991), highlighting the urgent need for universities to address this normalized hostility in their campus environments. the prevalence of anti-black racism at ucalgary is alarmingly high, with half of the participants reporting direct experiences of racism and more than half witnessing such incidents. this finding echoes the broader climate of anti-blackness across canadian universities, where black students regularly encounter implicit and explicit racial discrimination (anderson, 2023; ng & lam, 2020). the uncertainty among some participants about whether their experiences could be labelled as racism reflects the insidious nature of these encounters. it aligns with the phenomenon of racial gaslighting, where individuals are made to question the validity of their own lived experiences. this normalization of racism within academic settings has been well-documented, with duhaney et al./black students’ experience 89 incidents often minimized or dismissed, reinforcing existing power dynamics and systemic inequities (bell et al., 2021). furthermore, many students reported that speaking out about racism often led to punitive reactions, such as being labelled as “angry” or “confrontational.” this response, in line with the concept of white fragility (diangelo, 2011), highlights how white individuals often evade responsibility for perpetuating racism by positioning themselves as victims. the resulting hostility during race-related discussions reinforces existing power imbalances, further marginalizing black students and hindering meaningful conversations about race. the impact of anti-black racism on students’ mental health was profound, with many participants describing feelings of isolation, diminished self-confidence, and ongoing mental health challenges. these findings align with research by arday (2018) and este and colleagues (2018), who document how race-related stressors create emotional and psychological trauma for black students. for many participants, the harm was not only individual but collective, with some noting the transgenerational impact of racism and the burden of carrying the weight of historical oppression. this underscores the need for universities to provide robust mental health supports that are responsive to anti-black racism and the structural harms black students endure across academic and social settings. in addition to mental health struggles, racism also significantly affected academic performance. one in four students who experienced racism reported a diminished ability to succeed academically, echoing findings from bombay and hewitt (2015) as well as edman and brazil (2009). interestingly, some participants stated that racism had become so normalized in their lives that it no longer affected their academic success. this normalization reflects the coercive socialization that black students undergo, where enduring systemic discrimination becomes part of their educational experience. it highlights the need for institutional change to break this cycle of racialized trauma and create a truly equitable academic environment. the findings from this study reveal that only 12% of participants who experienced antiblack racism at ucalgary chose to report their experiences to institutional authorities. participants described a deep skepticism toward reporting processes, citing concerns that their complaints would not be taken seriously or might result in retaliation. these concerns are echoed in broader scholarship. for instance, cranston and bennett (2024), in their review of over two decades of literature, highlight that racialized individuals often perceive institutional responses to racism as superficial or ineffective, leading many to question the usefulness of formal reporting. this perception closely mirrors the reactions in this study, where participants described existing systems as inaccessible or largely symbolic. further reflecting this distrust, hussain (2023) found that anti-racism and antidiscrimination frameworks at canadian universities are frequently implemented in fragmented and inconsistent ways. such institutional incoherence can result in students being unaware of available reporting avenues or feeling doubtful about their impact. these findings are also evident in this study, with many participants unfamiliar with ucalgary’s office of equity, diversity, and inclusion or the protected disclosure and research integrity office. among those who did file complaints, dissatisfaction with the outcome advances in social work, spring 2025, 25(1) 90 was common. while not exclusive to black students, oh et al. (2025) demonstrate that perceptions of absent or ineffective anti-racism efforts are associated with poorer mental health outcomes across student populations, including depression and anxiety. this suggests that when institutions fail to respond meaningfully to racism, they risk not only undermining trust but also contributing to psychological strain among students. beyond individual instances of harm, the study revealed systemic barriers within the academic structure. participants reported a lack of black representation in faculty and leadership positions and the absence of afrocentric content in the curriculum. cameron and jefferies (2021) highlight how canadian educational institutions often marginalize black knowledge and histories, reinforcing a eurocentric standard that sidelines racial equity. their findings align with participants’ frustration that, while symbolically present, diversity efforts often lack meaningful curricular or structural change. similarly, opini and radebe (2023) argue that “discourses on decolonization, antiracism and equity in the education system are sometimes taught in a manner that works to reproduce the status quo” (p. 465). one of the study’s most emotionally charged findings concerned how participants were treated as tokens. many felt expected to speak for all black students or to educate others about racism. james and asres (2024) explore this same dynamic, illustrating how black students are often cast as symbols of institutional diversity, a role that reinforces rather than challenges dominant power structures. the study also found unequal access to scholarships, research opportunities, and mentorship, which further entrenched racial inequities. participants described difficulty navigating financial aid systems or securing academic support. sangmen et al. (2023) report similar findings in their study of black graduate students, showing that institutional structures often fail to distribute academic opportunities equitably. their work reinforces this study’s conclusion that resource access is shaped not only by merit but also by entrenched racial hierarchies. these findings suggest that ucalgary’s current anti-racism strategies are perceived as inadequate by the students they are intended to support. while policy frameworks exist, implementation falls short. the evidence reviewed here supports a need for more profound institutional transformation, beyond performative gestures. this includes creating transparent, responsive reporting systems; diversifying leadership and curricula; and offering material and emotional support tailored to black students. without such changes, racial inequities will persist, and institutional trust will continue to erode. limitations this case study was conducted during the covid-19 pandemic, which may have influenced participants’ experiences and perspectives, particularly regarding their virtual educational experience. some students expressed uncertainty regarding the level of safety at ucalgary due to their absence from campus. the survey was designed to gain a broad understanding of student perspectives on anti-black racism at ucalgary, with the primary inclusion criterion being identification as a black student. while additional demographic duhaney et al./black students’ experience 91 information was collected, the impact of intersecting identities on students’ perspectives and experiences was not explicitly explored in this research. notably, the study had limited participation from black male students, and students from caribbean regions. future research should explicitly examine the intersectional lived experiences of anti-black racism and provide recommendations for institutional change that supports students facing multiple forms of marginalization. implications for social work and higher education and practice although the findings of this study have implications across postsecondary institutions, they are particularly significant for social work education and practice. social work programs are uniquely positioned to address anti-black racism through curriculum, field placements, and ethical practice frameworks. integrating these findings into social work pedagogy can equip students to critically assess systemic racism, challenge institutional harms, and develop anti-oppressive, trauma-informed responses in their future practice. the canadian association for social work education (caswe-acfts, 2021) outlines anti-racism and equity as core competencies, and social work regulatory bodies increasingly emphasize the importance of equity-informed, justice-oriented practice. as bernard and smith (2022) argue, transforming the profession requires confronting antiblack racism at all levels of education and practice. mullaly’s (2010) work further emphasizes that dismantling oppression must be central to social work education if it is to meet its ethical mandate there is often a significant gap in institutional responses and supports to address daily experiences of anti-black racism, which tend to be limited or ineffective. we discuss the implications of these findings for academia. like much of the historic and contemporary denial of racism in canada, many academic institutions continue to “vehemently deny and actively perpetuate racist beliefs” (ghoussoub et al., 2021, p. 4). many universities lack metrics to identify, measure, and address experiences of anti-black racism. additionally, there are a few mechanisms to enforce anti-racist policies or ensure accountability for remedying racist incidents (tomlinson et al., 2021). the homogenization of groups who are marginalized, without recognizing their diverse concerns, needs, perspectives, and histories does a disservice to all. universities must not only articulate but also fulfill their commitment to combatting anti-black racism. this includes developing and implementing comprehensive policies and procedures, creating mediation and complaint processes, and identifying situations where disciplinary actions should be enforced. representation increasing racial representation in the student body, faculty, and administrative positions is crucial. racial representation in faculty and administration enhances institutional innovation, exposes students to diverse perspectives that are often absent from eurocentric teaching, and fosters positive learning environments that increase retention of racialized staff and administrators (cukier et al., 2021; lim, 2021). representation in the advances in social work, spring 2025, 25(1) 92 classroom is equally important (gershenson et al., 2021). studies show that black students excel academically, are more engaged, attend classes more regularly, feel more fulfilled, and communicate more easily with black instructors (gershenson et al., 2021). black students also experience the effects of “racial battle fatigue syndrome” (smith, 2010, p. 266), which refers to the exhaustion of navigating persistent racial discrimination. at predominantly white institutions, black students “desperately need spaces that affirm their right to do more than survive—but also to matter” (daniel, 2021, p. 2181). creating “racial oases” on campuses, where black students can escape the pressures of predominantly white spaces could help facilitate open, brave spaces where they can address the harms caused by racism, engage racial socialization, develop mentoring relationships, and foster healthy racial identities (daniel, 2021). these spaces could allow students to discuss the deleterious effects of racial discrimination and create meaningful relationships to support one another (ijoma et al., 2022) these spaces can also benefit the broader campus community by enhancing the campus climate and offering educational resources on african and african american history and culture (pittman, 1994). supports black students often face barriers in accessing mental health services, particularly in predominately white institutions, where there is a shortage of black or racialized therapists with expertise in racial trauma (arday, 2018). it is critical to provide a continuum of supports to address anti-black racism on campus, including access to mental health services from providers with specialized knowledge of racial trauma. these supports can improve both social and academic outcomes for black students (moore & toliver, 2010). training on anti-black racism confronting anti-black racism requires both immediate and sustained institutional commitment to critical, anti-racist education. professors and instructors must be equipped to engage in discussions about anti-black racism that move beyond culturally competent or multicultural frameworks, approaches which often depoliticize racial harm and fail to address the structural nature of systemic oppression (wilcox, 2023). anti-racism training should be embedded into the core infrastructure of the university and made mandatory for all members of the campus community. this training must name whiteness, interrogate power and privilege, and align with the university’s responsibilities to uphold racial justice additionally, offering courses that focus on afrocentric and black centered content across programs and curricula helps create counterspaces that challenge dominant narratives and allow for critical engagement with systemic oppression. these spaces are vital for black students to interact with black peers and faculty, challenge previous miseducation about black histories and identities, increase awareness of their racial identity, and develop a critical racial consciousness (chapman-hilliard & beasley, 2018). duhaney et al./black students’ experience 93 conclusion the ucalgary recently restructured its institutional equity initiatives by establishing the office of institutional commitments (oic), which integrates equity, diversity, inclusion, and accessibility (edia), community mental health and well-being (cmhw), and sustainability under a single strategic framework (ucalgary, n.d.b). while the university frames this consolidation as a step toward more coordinated action, it remains unclear how this new structure will sustain the specific focus and accountability needed to uphold its commitments under the scarborough charter and meaningfully address antiblack racism. this exploratory case study is the first to explicitly center the lived experiences of black students at ucalgary, shedding light on how anti-black racism and white supremacy continue to shape post-secondary environments in alberta. although grounded in ucalgary’s context, the findings reflect a broader national pattern of systemic anti-black racism that undermines black students’ academic success and well-being across canada (joseph, 2020; ryerson university, 2020; schnarr & wehkamp, 2016; university of toronto, 2021). despite widespread institutional declarations of solidarity following the murder of george floyd, few universities have taken substantive action to redress these longstanding inequities. a major barrier is the chronic lack of disaggregated, race-based data, especially data that captures the specific experiences of black students. without it, institutions are ill-equipped to diagnose the problem, let alone implement meaningful solutions (mcdonald & ward, 2017). addressing anti-black racism requires more than symbolic gestures or general commitments to equity. it demands sustained, intentional, and data-informed interventions. canadian universities must prioritize the collection of racebased data to uncover systemic barriers and guide strategies that are both targeted and effective (campbell & candler, 2020). as ucalgary navigates this organizational shift, it must ensure that its commitment to the scarborough charter remains more than symbolic. only by centering black students’ voices and investing in the necessary institutional infrastructure can universities begin to dismantle the systemic conditions that enable antiblack racism to persist. references adams, r. 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(2023). say their names: resurgence in the collective attention toward black victims of fatal police violence following the death of george floyd. plos one, 18(1), 1-26. author note: address correspondence to patrina duhaney, faculty of social work, university of calgary, calgary alberta t2n 1n4, canada. email: patrina.duhaney@ucalgary.ca https://www.ucalgary.ca/equity-diversity-inclusion/literacy-and-education/anti-black-racism https://www.ucalgary.ca/equity-diversity-inclusion/literacy-and-education/anti-black-racism ttps://www.ucalgary.ca/provost/strategic-initiatives/office-institutional-commitments https://hrandequity.utoronto.ca/wp-content/uploads/2021/04/anti-black-racism-task-force-report_web.pdf https://hrandequity.utoronto.ca/wp-content/uploads/2021/04/anti-black-racism-task-force-report_web.pdf https://www.utm.utoronto.ca/edio/solidarity-black-communities https://doi.org/10.1037/pst0000446 https://doi.org/10.1037/pst0000446 https://doi.org/10.1037/pst0000446 https://doi.org/10.1371/journal.pone.0279225 https://doi.org/10.1371/journal.pone.0279225 https://doi.org/10.1371/journal.pone.0279225 mailto:patrina.duhaney@ucalgary.ca _________ samantha bates, phd, lisw, assistant professor, college of social work, the ohio state university, columbus, oh. aesha john, phd, lmsw, associate professor, department of social work, texas christian university, fort worth, tx. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 936-952, doi: 10.18060/26342 this work is licensed under a creative commons attribution 4.0 international license. media use and child development: the missing curricular link in child and family social work education samantha bates aesha john abstract: social work practice with children and families is one of the largest specialization areas in the profession. to prepare students for this area of practice, social work programs often offer several courses focused on child, adolescent, and family wellbeing. technology-related topics, however, such as the role of child and family media use on children’s developmental outcomes, are underrepresented in social work curricula, courses, and textbooks focusing on children and families. to highlight the importance of this content, our teaching note synthesizes evidence on the impact of two forms of media (television viewing and smartphone use) on children’s self-regulation and parent-child interactions. although we focus on only two forms of media, our research synthesis links media use to emergent issues influencing child development and family functioning— content highly applicable to direct and indirect social work practice activities with children and families. we further draw upon our translational findings to advance social work education and practice by offering lowand high-effort strategies to embed this content in child and family social work courses. we conclude with implications and future directions for social work educators, practitioners, and leaders that describe opportunities to prepare students for a technology-driven future and to use technology strategically to fulfill our profession’s mission and values. keywords: media use, technology, child and family social work, self-regulation, parentchild interactions child, family, and school social workers draw on their training to assist vulnerable children and their families in developing healthy interactions and navigating complex social service systems. according to the united states bureau of labor statistics (2022), there are approximately 340,000 child, family, and school social workers in the united states, with more than 25% of practitioners delivering individual services to children and their families. beyond the scope of social work practice, child and family social work is one of the largest educational tracks within the profession. in 2020, the council on social work education (cswe) reported that 61 of the 200 master of social work programs offered child and family social work specialization tracks, making this one of the top areas of specialized social work practice in the united states. high interest and enrollment in child and family educational tracks are promising and necessary, as this specialized social work practice area is expected to grow by 6% (roughly 19,000 new positions) by 2024 (united states bureau of labor statistics, 2022). given the reach and scope of child and family practice, social work programs are committed to ensuring that students have adequate knowledge, skills, and competencies to provide quality, evidence-based care. core courses and electives offered in social work about:blank advances in social work, fall 2022, 22(3) 937 programs help prepare students for practice with children and families. human behavior in the social environment and direct and indirect social work practice courses, for example, focus on theories and research that support and strengthen students’ child and family practice skills. many programs also offer a range of child and family electives such as child welfare, social work practice with children, school social work, and child and family intervention courses to prepare future professionals for this important practice area. these curricular efforts provide students with substantial knowledge and skills on theories and research that can inform their future practice with children and families. however, one important curricular topic, child and family media use, is often underrepresented in the social work curriculum and textbooks focusing on child and family practice. as teacher-scholars, we find the lack of attention to media use concerning, given that media use has undoubtedly become an integral part of the lives of children and families (coyne et al., 2017; rideout & robb, 2020). for instance, according to recent estimates, 25% of children under the age of 8 spend more than 4 hours daily with screen media, with a majority of time spent watching television. similarly, scholars estimate more than half of children in the 2 to 8 age range own a personal media device such as a tablet or smartphone (rideout & robb, 2020). adults with children also are engaging with media and using smartphones more prevalently. the pew research center (2021) reports that almost all adults in the 18 to 50 age group own and constantly use a smartphone. increased access to technology, combined with high usage among families, is contributing to a growing body of interdisciplinary scholarship on media use and child development. however, nissen (2020) highlights that only a small and robust number of social work scholars are examining how technological advances are influencing the social work profession. from our perspective as educators, this small and robust group of scholars is promising and essential yet also indicative of why translational research and an emphasis on media use is often sparse in child and family social work curricula. the profession is missing opportunities to link research on child and family media use to the social work curricula, especially evidence that sheds light on media use in supporting or inhibiting child development and family well-being. the ongoing covid-19 pandemic further underscores the importance of considering how media use influences children and families. online schooling, the cancellation of sports events, and work-from-home transitions have all resulted in dramatic spikes in media use (eales et al., 2021; mcclain, 2022). excessive, independent, and unsupervised media use among children has several implications for child development, including but not limited to poor self-regulatory skills, peer relationships, and social competence (e.g., jackson, 2018; wan et al., 2021). similarly, greater media use among parents likely has resulted in fewer high-quality child-parent interactions, which further exacerbates risks for behavioral difficulties in early childhood and later in life (see carson & kuzik, 2021). hence, future social work practitioners need educational opportunities to explore and learn how our reliance on technology influences children’s health and development. alternatively, researchers have also explored and noted the benefits of media use for child and family functioning. first, technology and media can connect families to social support, expand practitioners’ reach, and cut the costs of providing effective, evidencebates & john/media use & child development 938 based interventions to families, which in turn improves child and family outcomes (hall & bierman, 2015). second, utilizing media in the household can be a tool that supports early learning and development and allows families to build prosocial relationships. for instance, scholars that conducted a meta-analysis of the effects of sesame street found that watching the show has various cognitive and social benefits for young children (mares & pan, 2013). padilla-walker et al. (2012) also found that co-viewing of movies and other forms of joint media screening can promote parental involvement and closeness between children and their parents. likewise, watching certain forms of media as a family can become a family practice or ritual, contributing to optimal family functioning (jordan, 2002). coyne et al. (2014) also found that positive media use, such as using it as part of family tradition or as a reward, was associated with positive family functioning and high parental involvement. thus, for better or worse, media has become increasingly prominent in the lives of children and their families and continues to transform the practice landscape for child and family social workers. in response to the uptick in media use across all generations, especially among children and families following the covid-19 pandemic, we have curated this teaching note to address this missing curricular link and to connect research on media use and child development to social work curricula. we aim to do so by synthesizing research on media use and child and family outcomes and articulating strategies that social work educators, curriculum committees, and programs can draw upon to strengthen social work education in this area. given the breadth of information on media use, children, and families, we narrowed our research synthesis to the impact of media use on two specific and interrelated child and family outcomes: children’s self-regulation and parent-child interaction. although we focus on specific media formats and hone in on two child and family outcomes, similar templates can be used to synthesize and translate evidence for other media formats and for additional aspects of child and family well-being. our goal is to bring attention to how media-related research can help prepare future social workers to effectively practice with the current generation of children, who are considered “digital natives” because of the ubiquitous presence of media in their lives since birth (dingli & seychell, 2015; prensky, 2001). we then build off this research synthesis to raise awareness about integrating media and child and family well-being content into social work curricula using lowand high-effort strategies. we believe integrating emergent scholarship can enhance social work curricula and help prepare students for technology practice standards (national association of social workers [nasw], 2017) and competencies focused on culturally-responsive practice (cswe, 2022). synthesis of evidence on child and family media use media use research on the effects of media has become increasingly complex due to the diverse forms of media that children and families consume and their likely differential effects. in this research synthesis, we focus solely on the effects of media via televisions and smartphones, given their frequent and pervasive use among children and caregivers (see advances in social work, fall 2022, 22(3) 939 john et al., 2022 for the review criteria and process). as such, we reviewed and synthesized findings on various dimensions of television viewing, ranging from amount and duration (inoue et al., 2016; munzer et al., 2018) to the context of television viewing, which included solitary television viewing and co-viewing with parents (jackson, 2018; skalická et al., 2019). we also examined the content of television shows in the context of children’s self-regulation (lillard & peterson, 2011). likewise, evidence on smartphone use is examined from various vantage points. whereas some studies focus purely on the amount of smartphone use (hosokawa & katsure, 2018), others focus on the context and how smartphone use influences childparent interactions (mcdaniel & radesky, 2018a, 2018b). one notable difference between research on the effects of television viewing and that on smartphone use is that studies on television viewing tend to focus primarily on the link between children’s usage and their developmental outcomes (jackson, 2018), whereas research on smartphones has more systematically examined the effects of parental use on children’s outcomes (carson & kuzik, 2021). as linkages among children’s media use and their outcomes can be quite complex, we also sought to highlight evidence that points toward bidirectional or transactional effects, specifically how children’s lack of self-regulation could result in greater child or caregiver media use (mcdaniel & radesky, 2018a; radesky et al., 2014; thompson et al., 2013). media use and children’s self-regulation self-regulation is an important developmental construct, foundational to children’s academic success, peer relationships, and overall health and well-being (blair, 2002; edossa et al., 2018; galla & duckworth, 2015; pandey et al., 2018). in the context of media use, past research has examined various aspects of children’s self-regulation across social, emotional, behavioral, and cognitive domains. the social and emotional components of self-regulation are often operationalized through variables such as children’s emotional understanding (skalická et al., 2019) and social-emotional adjustment in school (jackson, 2018). from a behavioral perspective, self-regulation is often measured via internalizing and externalizing behaviors (mcdaniel & radesky 2018a, 2018b; sundqvist et al., 2020). among infants, scholars assessed self-regulation by measuring fussiness (thompson et al., 2013). others examine children’s executive functioning to explore how media use influences children’s cognitive skills (lillard & peterson, 2011; ribner et al., 2017). in brief, self-regulation is a multidimensional construct that is crucial for children’s overall healthy development and highly relevant to child and family social work practice. figure 1 illustrates our synthesis of translational findings denoting the relationships between media use and children’s self-regulation and provides a list of ways that research findings can inform how social workers engage with, assess, and intervene with children and families. bates & john/media use & child development 940 mobile devices research summaries for young children, regular mobile use was linked with conduct problems & hyperactivity/inattention (hosokawa & katsure, 2018). tv media exposure children’s screen time at age 4 & having a tv in their room at age 6 was linked to less emotional understanding 2 years later (skalická et al., 2019). -3to 5-year-old children who watched more than 4 hours of tv daily were likely to demonstrate dysregulated behavior at age 5 (inoue et al., 2016). -4-year-old children who watched fast-paced tv shows such as spongebob performed significantly worse on executive functioning tasks compared to children who watched slow paced shows like caillou or spent their time drawing (lillard & peterson, 2011). -among 4-year-old children from low-income families, duration of tv viewing was linked to lower selfregulation (munzer et al., 2018). -among low-income african american children, longer crying & fussiness predicted longer duration of daily tv viewing (radesky et al., 2014; thompson et al., 2013). -young children whose tv viewing exceeded 2 hours a day performed poorly on executive functioning tasks, & this link was stronger for children from low-income families (ribner et al., 2017). translational findings 1. populations at risk for high levels of technology use & poor self-regulation among children include children living in lowincome households & children who watch more than 2 to 4 hours of tv daily. 2. relationships among behavioral difficulties & technology use indicate that families may use technology as a behavior management tool for children with poor selfregulation, and/or that greater use of technology in the household increases risks for poor selfregulatory skills. 3. greater media exposure before age 6 may increase risks for behavioral difficulties that lead to social-emotional issues during school-age years. type of technology child & family social work practice implications -engage in diversity & difference by recognizing how life experiences, such as living in a low-income, single-parent, or two-parent household with adults working from home influence child & adolescent media use. -assess family access to resources such as books, games, same-age peers, out-of-school-time activities, sport programs, safe play spaces, early education, & childcare to explore interactive relationship among access, media use, & children’s self-regulatory skills. -assess whether technology serves as a behavior management tool & intervene to empower caregivers with other positive parenting & co-regulatory relationship strategies (e.g., positive reinforcement, process praise, offering choice, routines, or active ignoring). -intervene by providing psychoeducation on children’s developmental needs (i.e., serve & return interactions), increasing familial access to resources such as childcare, or identifying alternative activities safe for young children (e.g., imaginary play or art). figure 1. bidirectional relationship: children’s media use and self-regulation advances in social work, fall 2022, 22(3) 941 media use and parent-child interactions parent-child interactions are family outcomes that are closely related to children’s selfregulation and are an important area of engagement, assessment, and intervention for child and family practitioners (kennedy et al., 2016; maxwell & rees, 2019). as we reviewed the evidence on media use and parent-child interactions, we found an indirect pathway from media use to children’s self-regulation through parent-child interaction. since children develop self-regulation in the context of positive and high-quality interactions with adults, “technoference,” or interference in child-parent interactions triggered by technology use, can increase risks of developing poor regulatory skills (kildare & middlemiss, 2017). given the relevance of these findings for child and family social workers, we synthesize research findings from the growing body of research linking media use, children’s self-regulation, and parent-child interactions (see figure 2; mcdaniel & radesky, 2018a, 2018b; sundqvist et al., 2020). figure 2 also includes a list of implications for social work practitioners when engaging in assessment and intervention practices with children and families. strategies to integrate evidence into child and family social work curricula to complement our research synthesis and recommendations for social work practice at the intersection of media use, child development, and family well-being, we describe lowand high-effort strategies that social work educators can use to integrate this content into social work curricula. our goal is to help educators recognize ways to integrate media into training activities that support the next generation of child and family social workers. through intentional lesson plans and activities, low-effort strategies can easily be incorporated into existing and required social work courses. in contrast, high-effort strategies are more intensive and thorough, and are meant to help students identify ways to harness media and technology in their future practice with children and families. in articulating these strategies, we not only present ideas centered around our research synthesis, but also articulate how child and family social workers can respond to the unique and complex needs of the digital natives they will serve and support. bates & john/media use & child development 942 parental supervision & scaffolding research summaries young children’s unattended tv viewing was linked longitudinally to social difficulties with peers at school but was not predictive of conduct problems (jackson, 2018). parental scaffolding was linked to fewer hours of tv watching among young children, & also moderated the link between number of hours of tv viewing & children’s executive functioning. in other words, when parents used scaffolding behaviors, their young children’s tv viewing did not result in poor performance on executive functioning tasks (blankson et al., 2015). in children up to age 2, screen time was related to dysregulated & externalizing behavior, but this relationship was partially mediated by nonscreen child–parent play interaction (wan et al., 2021). parental media use among 3to 5-year-old children, technoference, or interruptions in parent–child interactions due to technology, predicted higher internalizing & externalizing behaviors & lower emotional regulation (carson & kuzik, 2021). problematic media use among parents of young children was linked to technoference, which in turn was linked to children’s internalizing & externalizing behaviors (mcdaniel & radesky, 2018b; sundqvist et al., 2020). infants displayed dysregulated emotions & behavior such as high negative affect, low positive affect, escape behaviors, & self-comforting when parents were distracted during the still-face paradigm task (stockdale et al., 2020). children’s externalizing behaviors triggered parenting stress, which was then linked to technoference. parents seemed to use media to withdraw from child–parent interactions when their children demonstrated difficult behaviors (mcdaniel & radesky, 2018a). translational findings infants older than 9 months demonstrate negative behavioral & social responses to parental use of smartphone. early development (up to 1 year of age) is critical to language acquisition, cognitive learning, & social bonding (centers for disease control & prevention, 2021). parent interaction/presence during children’s tv viewing & viewing developmentally appropriate content (i.e., content designed for children) may buffer risks for poor social & cognitive outcomes associated with technology use during early childhood. the use of media influences parent– child interactions. technology interference may be more prevalent among parents experiencing stress as a result of their children’s behavioral difficulties, and/or parental technology use alone may negatively affect children’s self-regulatory skills. parental behaviors child & family social work practice implications demonstrate ethical & professional behavior by respecting parents’ & caregivers’ right to self-determination regarding media use. engage with families to explore their digital health & future aspirations for their children. assess linkages among parental stress, access to resources/social support, & children’s independent use of media in the household. assess parent/caregiver engagement (i.e., co-viewing behaviors) as children engage with media, & the developmental appropriateness of media content. assess the presence & extent of technoference to gauge the impact of parental media use on parent-child interaction, & ultimately, children’s self-regulation. intervene by providing resources that allow parents/caregivers to leverage media to build social bonds & to help their children learn (e.g., sesame street, talk about how characters felt & behaved). intervene to strengthen bonds among parents/caregivers & children using evidence-based therapies (i.e., parent–child interaction therapy, child-centered play therapy, attachment-based therapy). evaluate changes in parent–child relationships, children’s self-regulatory skills, & prevalence of behavioral issues via observations & use of valid/reliable measure (e.g., attachment observations). figure 2.media use, child–parent interactions, and children’s self-regulation advances in social work, fall 2022, 22(3) 943 low-effort strategies we recommend two low-effort strategies: a) assessment of media use, and b) dissemination and application of research on media use to case studies and practice education. for example, students can reflect on ways to include media and technology in their assessment practices, such as asking about media use and screen time during mental health assessments with children, adolescents, families, and other adults (i.e., grandparents, kinship caregivers, etc.). one example of an activity relevant to assessment and practice courses includes having students work in groups to identify questions to ask children and families about their media or technology use. instructors can guide this discussion and help students reflect on how the following questions could inform assessment and intervention decisions: • how would you describe a typical day in your household? • what forms of technology does your child engage with on a day-to-day basis? • what do you estimate is your child’s daily time spent using technology? (probes for watching tv, engaging on mobile devices, or playing on tablets.) • how often, if at all, are you in the room with your child when they are watching tv? • what kind of shows does your child watch on tv? • how does technology influence your child’s behaviors? (probing for good or bad, such as use to quiet or comfort or as a reward.) • describe your most enjoyable interactions with your child. is technology present, and if so, how is it used? is technology absent, and if so, what about the interaction feels enjoyable? • how, if at all, do you safeguard various forms of technology used in your household (e.g., parent protections, time limitations, or digital logs)? these are just a few examples of questions relevant to a client’s or family’s health and well-being and relational dynamics that can be asked during the assessment or intervention phase of treatment. our synthesis indicates that media use may contribute to poor selfregulation among socioeconomically vulnerable children. the assessment questions mentioned above can help practitioners to better support families in identifying alternative activities for engagement, linkage to welfare programs for childcare or social support (such as head start or title xx services), or receipt of psychoeducation on media use, sleep, language development, behavioral issues, and the like. similarly, educators can infuse into social work courses timely and innovative peerreviewed research on the effects of technology on human behavior, mental wellness, and family life. for example, developmental theories such as bowlby’s (1980) attachment theory and bronfenbrenner’s (2005) bioecological framework, often taught in these courses, were developed when technology was not a prominent part of family life. recent studies have found that parents are less responsive to children when they are on their smartphones (abels et al., 2018). this lack of responsiveness may undermine parental behaviors that promote secure attachment in infants and young children (zayia et al., 2021). similarly, navarro and tudge (2022) propose a neo-ecological framework incorporating bates & john/media use & child development 944 technology as a crucial aspect of children’s microsystem. indeed, these theories can be made especially relevant and current by infusing into them the developmental effects of media use and helping students recognize the intersection of technology and development. further, educators can develop intentional case studies that direct students to consider theories and research on media use as possible factors underlying children’s emotional and behavioral dysregulation. social work educators can also encourage students to think critically about how families can use technology to develop stronger connections or social support. to do so, social work educators, practitioners, and students need to be well-versed in recommendations set forth by the american academy of pediatrics that provides guidance on media use for young children and adolescents (hill et al., 2016; reid chassiakos et al., 2016). then, social workers can lead the development of novel family interventions that align with the recommendations, such as encouraging children and parents to co-view specific television shows or movies. in prior research, scholars found that sharing developmentally appropriate media content can serve as a means to promote parental involvement and healthy parent-child interaction (coyne et al., 2014). media-centered family rituals, community games, or movie nights also can address family disengagement, enhance social support, and foster cohesion. furthermore, social work educators can engage students in role-playing exercises in which they ask parents and caregivers to reflect on their ideal media use. using resources such as the 3-6-9-12 rules that align recommendations for media use among children of different ages (young, 2017), educators can help practitioners prepare families to identify self-determination practices to improve their digital health. the 3-6-9-12 rules recommends no screen time before age 3, one hour of screen time a day before age 6, up to two hours of supervised screen time between ages 6 and 9, and up to two hours of responsible use between ages 9 and 12 (young, 2017). discussing social work innovations related to media also requires minimal effort for social work educators. for instance, social workers in the field are innovating and responding to the uptick in media by engaging families in interventions called “tech resets.” tech resets help families recognize and respond to their dependence on media, address children’s problem behaviors, and improve family communication (l. rae, personal communication, january 2019). given that media has become an essential and central aspect of family life, it seems incumbent upon social work educators to prepare future child and family social workers to support children and families in developing healthy relationships with this vital aspect of their ecosystem. students also can reflect on recent social movements related to technology, such as the wait until 8th (n.d.) campaign that advocates that children and adolescents should be in 8th grade or older before receiving a cell phone. instructors can design discussions and activities that enable students to examine the research evidence to weigh and discuss the pros and cons of this campaign and the campaign’s potential to support or harm child and adolescent mental health, or they may research the campaign’s underlying origin and potential as a public health campaign. notably, the wait until 8th (n.d.) website provides a synthesis of research and digital resources to help families monitor and safeguard technology use for adolescents and teens. social work students could work in groups and access the tools on this website to design psychoeducation lessons around media use and advances in social work, fall 2022, 22(3) 945 technology for clients and families. these learning opportunities would help students think critically about the ways technology aligns with assessment, intervention, and evaluation practices. high-effort strategies for high-effort strategies, we propose developing service-learning opportunities and course modules embedded in social work courses or provided as continuing education to practitioners. courses on children and families might include service-learning opportunities that require students to develop and deliver parent education modules that promote awareness among families of the various translational findings articulated in figures 1 and 2. family literacy on the effect of media use can be critical in promoting child and family well-being (terras & ramsay, 2016). families identified as high risk due to engaging in excessive amounts of media can benefit from learning about topics such as technoference and the link between media content and children’s executive functioning. these psychoeducation opportunities can also be offered to other target audiences, such as schools or community organizations like boys & girls club, that work closely with children, families, and policymakers. in addition to engaging with the community, such service-learning initiatives could support student competency development by requiring students to use evidence to inform family education and advocacy for childand familycentered policies. our second high-effort strategy centers around developing in-depth modules on the impact of media use on children’s socioemotional development and family processes, such as parent-child interaction. these may be housed in human behavior in the social environment classes and other specialized courses on children and families. beyond the research summarized here, scholars are beginning to understand the effects of screen time on sleep. for example, heo et al. (2017) found that screen time before bed reduced sleepiness and melatonin onset due to the blue light’s effect on the brain. thus, the modules can cover the impact of media on children’s sleep, physical activity, mental health, and other critical aspects of their development. in clinical and content-specific courses, social work instructors can develop modules that synthesize research on technology use and mental health and introduce students to new forms of therapeutic intervention to address technology challenges. for example, george et al. (2018) identified links between time spent using digital technology and attentiondeficit/hyperactivity disorder and conduct disorder symptoms. the findings pointed toward overuse of technology when attentional programs were high, suggesting that technology is a way in which adolescents may seek to regulate themselves, but that its use only exacerbates preexisting issues. including modules that summarize and advance what is known about behavioral health and technology use can enhance students’ understanding of how online or media activities affect attention, focus, memory, and other regulatory behaviors. moreover, instructors can adapt existing case examples or assignments and ask students to research how, if at all, technology and media use is linked to specific mental health concerns or diagnoses. given the prevalence of cyberbullying (wright, 2019) and bates & john/media use & child development 946 gaming addictions (paulus et al., 2018), and the critical role of school and family social workers in implementing prevention and intervention models around these issues, students and practitioners alike can undoubtedly benefit from comprehensive training on these technology-related topics (slovak & singer, 2014). finally, considering the vast literature on media and technology and their important role in family life and well-being, educators can develop social work electives centered around this critical topic. social work programs around the country offer a multitude of certificate programs and specializations such as global social work and forensic social work. certificate programs focused on technology could also be developed to help students specialize in serving children and families in the digital age. implications and future directions for social work education advancements in technology continue to influence social work education, practice, and research. according to berzin et al. (2015), technology integration can increase access to mental health services due to its flexible, on-demand, personal, and individualized nature. however, it is also important to link emergent research to social work training programs. this paper focuses on how translational research findings on child and family media use can be integrated into social work curricula, courses, and training activities. beyond curricular strategies to enhance education on child and family social work practice, we also believe there are opportunities to further promote and enhance technology-related content in social work curriculum and practice. accordingly, we describe future directions for social work education regarding media and technology. from a person-in-environment perspective, contemporary families are embedded in digital contexts, and it is imperative for both current and future professional social workers to competently navigate this context in how they engage with children and families, conduct holistic assessments, and intervene to promote positive child development and family functioning. indeed, curricular content on media use can contribute to developing student competencies in providing culturally-appropriate and responsive assessments and interventions to children and families in the 21st century. this point is further reiterated in the technology standards for social work practice developed through a collaboration among the four leading professional social work organizations: the national association of social workers, the association of social work boards, the council on social work education, and the clinical social work association (nasw, 2017). specifically, nasw’s technology standard 2.05 on “assessing clients’ relationships with technology” calls on social workers to consider the role of technology while assessing the environmental aspects of their clients’ psychosocial well-being. the standards deem technology, along with peers, neighbors, and colleagues, to be a crucial aspect of a client’s environment and thus of their well-being. additionally, many social work educators argue that the profession must learn how to harness technology for social good while adapting and responding to the challenges technology presents to children, families, and communities. berzin et al. (2015) advocate for gaming, mobile technology, social media, and robotics as just a few new avenues to advance social work practice using technology. enhancing training and education for practitioners to support adoption and innovation in this space could help bridge this gap. advances in social work, fall 2022, 22(3) 947 for instance, in 2018, the university of toronto offered a course entitled information technology in professional social work practice that focused on the intersection of social work and technology. this aligns with the 2022 educational and professional accreditation standards of the social work profession, which focuses more on technology as a future direction for social work practitioners and researchers (cswe, 2022). additional strategies to facilitate positive outcomes for social work practitioners and students include continuing education offerings to advance technology-based interventions, education, and training on technology in social work research (e.g., photovoice, digital storytelling, or online social organizing), and advocacy for interstate licensure. by training field receptors and licensed practitioners in technology-based practice, the profession will strengthen field education for future social work students to receive this content in the classroom and beyond. enhancing our focus, as a profession, on technology-based research methods can elevate the voices and perspectives of socially vulnerable populations. in addition, berzin et al. (2015) argue that social work instructors themselves can use media and technology to support new forms of teaching and learning. audio podcasts, avatars, online simulations, and classroom technology to reach and teach in creative ways are now accessible to instructors to enhance student learning. we are proponents of adopting tools such as kahoot!, padlet, online escape rooms, and quiz platforms to support our teaching practices and improve classroom activities, group discussions, and assessment practices. the use of technology by social work instructors has the potential to model to students how digital literacy can stimulate technology infusion into social work training and pedagogy. considered together, social work has an opportunity to do more to prepare students for our technologically-driven future. we agree that a paradigm shift around technology is necessary to make changes in the profession (berzin et al., 2015) and hope that this article advances our understanding of the need to better train child and family practitioners to think about technology and media use to achieve our profession’s mission and live out our social work values. ultimately, children and families are living in a rapidly evolving, highly individualized, and technologically advanced world. social workers can positively impact the future of child development by working with parents, teachers, and other providers to ensure media is used intentionally and creatively; does not displace sleep, exercise, and play; and families feel empowered to set healthy boundaries to safeguard their children’s health and development. after all, relationships are the bedrock of selfregulation and self-regulation is the foundation of a balanced and healthy life. references abels, m., vanden abeele, m. m. p., van telgen, t., & van meijl, h. 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(2020). infants’ response to a mobile phone modified still‐face https://doi.org/10.1111/j.1741-3729.2012.00710.x https://doi.org/10.1001/jamapediatrics.2018.0232 https://doi.org/10.1111/dmcn.13754 https://www.pewresearch.org/internet/fact-sheet/mobile https://doi.org/10.1108/10748120110424816 https://doi.org/10.1542/peds.2013-2367 https://doi.org/10.1542/peds.2016-2593 https://doi.org/10.1097/dbp.0000000000000425 https://www.commonsensemedia.org/sites/default/files/research/report/2020_zero_to_eight_census_final_web.pdf https://www.commonsensemedia.org/sites/default/files/research/report/2020_zero_to_eight_census_final_web.pdf https://doi.org/10.1111/bjdp.12283 https://www.proquest.com/openview/0750965a01f51f2c74d28106ba72da69/1?pq-origsite=gscholar&cbl=2035676 https://www.proquest.com/openview/0750965a01f51f2c74d28106ba72da69/1?pq-origsite=gscholar&cbl=2035676 bates & john/media use & child development 952 paradigm: links to maternal behaviors and beliefs regarding technoference. infancy, 25(5), 571-592. https://doi.org/10.1111/infa.12342 sundqvist, a., heimann, m., & koch, f. (2020). relationship between family technoference and behavior problems in children aged 4-5 years. cyberpsychology, behavior and social networking, 23(6), 371-376. https://doi.org/10.1089/cyber.2019.0512 terras, m. m., & ramsay, j. (2016). family digital literacy practices and children’s mobile phone use. frontiers in psychology, 7, 1-11. https://doi.org/10.3389/fpsyg.2016.01957 thompson, a. l., adair, l. s., & bentley, m. e. (2013). maternal characteristics and perception of temperament associated with infant tv exposure. pediatrics, 131(2), e390-e397. https://doi.org/10.1542/peds.2012-1224 united states bureau of labor statistics. (2022). occupational employment and wages, may 2021. https://www.bls.gov/oes/current/oes211021.htm wait until 8th. (n.d.). let kids be kids a little longer: wait until 8th. www.waituntil8th.org wan, m. w., fitch-bunce, c., heron, k., & lester, e. (2021). infant screen media usage and social-emotional functioning. infant behavior & development, 62, 101509. https://doi.org/10.1016/j.infbeh.2020.101509 wright, m. f. (2019). cyberbullying: prevalence, characteristics, and consequences. in z. yan (ed.), analyzing human behavior in cyberspace (pp. 167-191). igi global. https://doi.org/10.4018/978-1-5225-7128-5.ch010 young, k. (2017, june 29). children and technology: parent guidelines for every age. technology and society. https://technologyandsociety.org/children-and-technologyguidelines-for-parents-rules-for-every-age zayia, d., parris, l., mcdaniel, b., braswell, g., & zimmerman, c. (2021). social learning in the digital age: associations between technoference, mother-child attachment, and child social skills. journal of school psychology, 87, 64-81. https://doi.org/10.1016/j.jsp.2021.06.002 author note: address correspondence to samantha bates, college of social work, the ohio state university, columbus, oh 43210. email: bates.485@osu.edu https://doi.org/10.1111/infa.12342 https://doi.org/10.1089/cyber.2019.0512 https://doi.org/10.3389/fpsyg.2016.01957 https://doi.org/10.1542/peds.2012-1224 https://www.bls.gov/oes/current/oes211021.htm http://www.waituntil8th.org/ https://doi.org/10.1016/j.infbeh.2020.101509 https://doi.org/10.4018/978-1-5225-7128-5.ch010 https://technologyandsociety.org/children-and-technology-guidelines-for-parents-rules-for-every-age https://technologyandsociety.org/children-and-technology-guidelines-for-parents-rules-for-every-age https://doi.org/10.1016/j.jsp.2021.06.002 mailto:alex.redcay@millersville editorial fall 2020: advancing social work innovations margaret e. adamek in early march 2020, i was on a flight headed back from a sabbatical trip to ethiopia arriving in o’hare international airport in chicago. i was perplexed by the sight of some travelers wearing masks and others who were not. i managed to arrive home soon before international travel was all but shut down by covid-19. little did i know we were headed into a global pandemic that would take the lives of over 350,000 americans by the end of 2020. in a year where social distancing, mask-wearing, and quarantining have become daily practices, so much has changed in our society, including social work education and social work practice. as covid-19 catapulted social work education to online platforms, inequities in access to digital resources have been exposed. in a brief commentary following this editorial, pentaris, hanna, and north from the university of greenwich in london address the issue of digital poverty in social work education. in the fall 2020 issue of advances in social work, we are pleased to present 15 full-length papers (14 empirical, 1 conceptual) written by 40 authors representing different regions of the country, sweden, and two african nations—ethiopia and ghana. the first four papers constitute a special section on gender bias in employment and are introduced by dr. marquita walker, an associate professor of labor studies at indiana university. following the section on gender bias in employment, we present papers on a wide range of social work relevant topics including employability of individuals on probation, conducting research in mental health settings, and expanding mental health services by partnering with clergy. each paper is briefly introduced below, followed by our annual recognition of our reviewers. regular issue recognizing that stable employment decreases recidivism of formerly incarcerated individuals, capece examined the effects of probation stipulations on perceptions of employability among 170 people on probation in rhode island. capece asserts that despite their intentions, stipulations such as mandated meetings with probation officers, court appointments, and drug or mental health counseling may serve as a barrier to employment. based on the findings, capece calls for social work practitioners who work with people on probation to increase their clients’ perceptions of employability. to address stress, burnout, and the need for self-care among social workers, mack developed a resiliency-focused supervision model (rsfm). mack’s model aims to proactively address various types of stress experienced by practitioners before they get to the stage of burnout where client care may be compromised. a defining feature of the rsfm is prioritizing self-care during the supervisory process in order to build resiliency among social workers. in sweden, ryding used focus groups with family support workers to better understand how they integrated evidence-based practices and reflection into their work with families involved in the family check-up (fcu) program. fcu is an evidence-based model that aims to enhance family functioning and well-being. practitioners reported that the reflective approach of fcu not only empowered families but also contributed to professional learning and development of practitioners. using data gathered from 80 participants in two mental health courts, kondrat, sullivan, canada, and jaggers explored how various aspects of social networks were associated with participants’ quality of life. an unexpected finding about the number of family members in one’s network suggests that mental health court participants need supportive others in their social networks in addition to family. while the importance of social networks in recovery from mental health is well-documented, this study indicates that practitioners must pay attention to important nuances of social networks. based on their experiences conducting social work research in mental health settings, sapiro and matthews analyzed the advantages and challenges of conducting research in a clinical setting. among the issues identified were power dynamics in the research process, the risks of othering, and the challenges of straddling insider and outsider identities as scholar-practitioners in clinic settings. the authors offer a number of practical suggestions for navigating the dual identities of researcher and clinician. savino, bowen, irish, and johnson examined health care utilization data for 133 adults who participated in a housing first program offering in-home behavioral health services. use of acute health care was low overall, perhaps reflecting a stabilizing effect of housing. while empirically-supported assessment tools are needed to evaluate consumers’ unique needs, the results suggest that offering in-home behavioral health services may reduce racial health disparities in health care utilization. using an online survey, teater and chonody surveyed adults age 55 and older (n=417) to consider their definitions of successful aging. themes were considered separately for older adults who identified as aging successfully and those who identified as not aging successfully. for both groups, health and ability were important aspects of aging successfully. teater & chonody advocate for replacing the term “successful aging,” with the term “actively aging,” which focuses on aging adults actively choosing to define what aging means to them and challenging societal expectations of a “right” or “wrong” aging process. apgar questions whether increasing the proportion of social work students in macro specializations is an “impossible dream.” based on survey data from 474 master of social work students and graduates, this study identified both structural and attitudinal barriers to students choosing macro practice. interestingly, african american respondents were more likely to concentrate in macro practice, perhaps reflecting a recognition of the need for systems change to promote equal opportunities and rights for those who have historically been marginalized. to help rectify entrenched social inequities, apgar advocates for social work programs to reconsider offering macro content as a specialization rather than being integral to the overall curriculum. linton, stemegna, zepeda, watson, diaz, duncan, and van sant evaluated the impact of a 90-day, family-focused, care transition intervention on people with brain injuries (n=22) and their caregivers (n=20). both patients experiencing a brain injury and their caregivers benefited from home visits and coaching focused on hospital-to-home transitions, with fewer hospital readmissions than a usual care control group. based on the study’s findings, linton et al. strongly recommend that social work hospital discharge planning include extended home visitation to ensure patient and caregiver needs are met. using a national dataset, adzima tested the association of advanced math course-taking by american youth (n= 3,384) on subsequent receipt of public assistance. adzima suggests that a work-first policy has made it harder for some students to attend college while meeting the work requirements for aid. a probit analysis revealed that taking advanced math courses in high school is associated with a lower probability of receiving public assistance among recent graduates. these findings can inform the work of school social workers who collaborate with teachers and guidance counselors to help students achieve future financial independence. amenuke-edusei and birore conducted a study to examine the influence of various factors on women’s breast cancer screening in ghana. a cross-sectional survey of 194 ghanaian women revealed that only 14% of respondents had undergone mammogram screening. breast cancer awareness raising is needed in ghana to counteract negative personal and cultural beliefs relating to breast cancer and screening. amenuke-edusei & birore also recommend that social work programs in ghana offer oncology social work so that social workers in ghana can be trained to address challenges relating to breast cancer. analyzing national data on mental health use, hooley, wang, and hodge found that 25% of those who seek mental health care turn to clergy. most respondents who went to clergy (94%) reported satisfaction with their care. hooley and colleagues suggest incorporating clergy in mental health scale-up plans may be a viable option, particularly for addressing the mental health needs of underserved racial and ethnic minorities, as well as older adults. with this issue we would also like to thank the many reviewers worldwide who completed reviews for advances in social work this past year. in 2020, 97 individuals from 9 countries and 44 states and territories representing 170 colleges/universities and agencies served as aisw reviewers. we truly appreciate the voluntary efforts of our reviewers in enhancing the scholarly contributions of the journal. we are very proud of both the broad participation of authors and reviewers and of our legacy as an open access journal since 2008. reviewer appreciation with this issue we would also like to thank the many reviewers worldwide who completed reviews for advances in social work this past year. in 2020, 297 individuals from 9 countries and 44 states and territories representing 170 colleges/universities and agencies served as aisw reviewers. we truly appreciate the voluntary efforts of our reviewers in enhancing the scholarly contributions of the journal. we are very proud of both the broad participation of authors and reviewers and of our legacy as an open access journal since 2008. advances in social work 2020 reviewers and affiliations we would like to acknowledge the contributions of the following individuals who reviewed manuscripts for advances in social work in 2020. without their time and expertise, advances in social work would not be possible. advances in social work, fall 2020, 20(3) 1 adamek/editorial 1 ______ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2020 author, vol. 20 no. 3 (fall 2020), i-ix, doi: 10.18060/24866 this work is licensed under a creative commons attribution 4.0 international license. janet acker, the college of saint rose margaret e. adamek, indiana university (2) stephanie adams, eastern kentucky university keith adamson, university of toronto a. christson a. adedoyin, samford university (2) amy alberton, university of windsor karen m. allen, indiana university (3) susan allen, the university of mississippi (retired) skye allmang, rutgers university nina asaki, springfield college gifty d. ashirifi, indiana university gail m. augustine, indiana university stephanie baird, university of toronto adrienne baldwin-white, university of georgia jo ann m. bamdas, florida atlantic university mahasweta banerjee, kansas university carenlee barkdull, university of north dakota cathy beck-cross, grand view university (2) natalie bembry, rutgers university larry bennett, university of illinois chicago amy benton, texas state university rosalyn bertram, university of missouri renee betts, indiana university (2) christine bishop, stephen f. austin state university (2) jenny bonaventure, louisiana state university ashleigh borgmeyer, louisiana state university dara bourassa, shippensburg university nova j. bradford, university of minnesota shane ryan brady, university of oklahoma hannah britton, university of kansas marion brown, dalhousie university teri browne, university of south carolina bj bryson, james madison university stephanie bryson, portland state university angela n. bullock, university of the district of columbia barb j. burdge, manchester university jamie burgess-flowers, university of north carolina lauren busfield, doylestown, pa (2) helen cahalane, university of pittsburgh laura cardinal, university of southern california joan marie carlson, indiana university danny carroll, indiana university kala chakradhar, murray state university keith t. chan, university at albany (2) valerie chang, indiana university jennifer chappell deckert, university of kansas bethel college (2) jeannine chester, college at old westbury christina chiarelli-helminiak, west chester university of pennsylvania ga-young choi, california state university jill m. chonody, boise state university alberto cifuentes, university of connecticut michael clarkson-hendrix, fredonia state university of new york michel coconis, ohio university crystal collins-camargo, university of louisville susan a. comerford, university of vermont (2) monique constance-huggins, winthrop university lana cook, university of south carolina elisabeth counselman-carpenter, southern connecticut state university katherine j. crawford, auburn university travis w. cronin, california state university janeen m. cross, howard university (2) ann curry-stevens, portland state university (2) audrey davis, university of st. francis tamara sue davis, indiana university denise davison, morgan state university allison de marco, university of north carolina rhonda peterson dealey, washburn university megan deichen hansen, florida state university college of medicine bertha dejesus, millersville university ankita deka, augsburg university elena delavega, university of memphis zoila del-villar, new york university claire dente, west chester university of pennsylvania david s. derezotes, university of utah denise dews, university of north carolina mery f. diaz, new york city college of technology/cuny quincy dinnerson, norfolk state university jessica donohue-dioh, university of houston donna dopwell, middle tennessee state university karen c. ellinwood, university of arizona susan e. elswick, university of memphis rafael jacob engel, university of pittsburgh (2) sara english, winthrop university (2) anne s.j. farina, saint louis university phil farmer, jarvis christian college brandi jean felderhoff, university of texas thomas patrick felke, florida gulf coast university dan ferguson, yakima valley college amy killen fisher, university of mississippi colleen m. fisher, university of alabama karen a. ford, james madison university fran franklin, delaware state university (2) carly franklin, university of arkansas william frey, columbia university christine fulmer, liberty university dashawna fussell-ware, university of pittsburgh susan gair, john carroll university john robert gallagher, indiana university michelle d garner, university of washington trevor gates, university of the sunshine coast (3) carolyn s. gentle-genitty, indiana university (2) molly gebler, arizona state university susan l. glassburn, indiana university lauri goldkind, fordham university steven granich, lock haven university jillian graves, eastern michigan elizabeth jane greeno, university of maryland joshua gregory, university of california, berkeley virgil lee gregory, indiana university susan grossman, loyola university chicago kristen guskovict, heart (humanitarian empathy and refugee trauma) of aid work jodi hall, north carolina state university kristin hamre, indiana university (3) michele hanna, university of denver victoria hanson (2) kiva harper, university of texas barbara mary harris, creighton university evan harris, indiana university daphne henderson, the university of tennessee jocelyn clare hermoso, san francisco state university robin hernandez-mekonnen, stockton university janna heyman, fordham university anthony j. hill, winthrop university erin hipple, west chester university of pennsylvania steven hoffler, southern connecticut state university mark s. homan, pima community college cole hooley, brigham young university (2) carol hostetter, indiana university stephenie howard, howard university jeremiah w. jaggers, university of utah (2) sarah c. johnson, hunter college (2) brooke l. jordan, university of north carolina michael n. kane, florida atlantic university laura kaplan isaac karikari, university of north dakota (2) saliwe moyo kawewe, southern illinois university nancy kelley, university of omaha michael kelly, loyola university chicago teri kennedy, the university of kansas medical center lalit khandare, pacific university daniel kikulwe, york university peter kindle, university of south dakota taniko king-jordan, university of indianapolis (2) wayne kinney, university of cincinnati eileen klein, ramapo college julia kleinschmit, university of iowa karen m. kolivoski, howard university stacey kolomer, university of north carolina (2) david c. kondrat, indiana university (3) eric kyere, indiana university (2) walter la mendola, university of denver shannon lane, yeshiva university lisa lapeyrouse, university of michigan (2) julie anne laser-maira, university of denver shonda kaye lawrence, clark atlanta university stephanie lechuga-pena, arizona state university zulkipli lessy, sunan kalijaga state islamic university kathryn ann levine, university of manitoba younghee lim, university of mississippi megan lindsey, northern kentucky university (2) kristen faye linton, california state university (2) diane nicole loeffler, university of kentucky (2) mayra lopez-humphreys, city university of new york robert lucio, saint leo university john luk, university of texas phil mach, first nations health authority dale dagar maglalang, boston college virginia majewski, indiana university (2) arati maleku, the ohio state university gayle mallinger, western kentucky university michael a. mancini, saint louis university leslie margolin, university of iowa susana mariscal, indiana university (2) james marley, loyola university chicago michael massey, the catholic university of america elizabeth matthews, fordham university debra mattison, university of michigan maureen rubin, calming chaos co.* catherine mazzotta, buffalo state college heather a. mccabe, indiana university rebecca mccall, university of north carolina jennifer b. mccarthy, a.t. still university katie mccarthy, indiana university emily l. mccave, quinnipiac university irene searles mcclatchey, kennesaw state university henrika mccoy, university of illinois chicago cathy mcelderry, tennessee state university lisa elizabeth mcguire, james madison university (3)* michael e. mcguire, university of north carolina goutham menon, university of nevada reno lori messinger, university of knoxville alyssa middleton, university of louisville margaret miles, castleton university nakia miller, yeshiva university abigail adubea mills, university of ghana rebecca g. mirick, salem state university (2) carmen morano, university at albany amy b. murphy-nugen, western carolina university (2) zablon mutongu, st. paul’s university mitra naseh, portland state university ande nesmith, university of st. thomas jason newell, university of montevallo (2) gilbert nick, columbia university mary nienow, st. cathrine university kristina nikolova, wayne state university (3) jayashree nimmagadda, rhode island university jan nissly, university of southern california stephanie odera, virginia commonwealth university victoria osborne, sacred heart university nora padykula, westfield state university (2) meg panichelli, west chester university of pennsylvania kimberly pendell, portland state university panagiotis pentaris, university of greenwich ebony perez, saint leo university katherine perone, western illinois university liana petruzzi, university of texas (2) amy phillips, minot state university barbara pierce, indiana university (3) linda plitt donaldson, james madison university miriam potocky, florida international university gerald t. powers, indiana university mary a. provence, indiana university camille r. quinn, the ohio state university stephanie quiring, indiana university (2) hasan reza, indiana university dasha rhodes, morgan state university tonya kay ricklefs, washburn university (2) carrie w rishel, west virginia university victoria rizzo, university at albany anne s. robertson, university of denver (2) helen robinson, washington university in st. louis selena t. rodgers, york college of the city university of new york saleem saleem, capital university trina colleen salm ward, university of wisconsin (2) ceema samimi, university of minnesota (2) adriana sandu, anglia ruskin university mary angeline santhosam, university of madras beth sapiro, montclair state university allison schad, university of north carolina beverly cynthia sealey, simmons college dee ann sherwood, western michigan university erica shifflet, michigan state university brian sick, university of minnesota samuel lisenga simbine, midlands state university chris simmons, university of south florida jennifer e. simpson, university of northampton melissa singh, university of southern california (2) greta slater, ball state university alexa m. smith-osborne, university of texas fabienne snowden, medgar evers college tricia snyder, the college at brockport, state university of new york tracy m. soska, university of pittsburgh (2) yolanda d. spears, univeristy of iowa vincent r. starnino, indiana university kimberly stauss, university of arkansas jordan janger steiner, rutgers university erin stevenson, eastern kentucky university anne l. stewart, james madison university hannah stohry, miami university lynette studer, university of wisconsin sabrina sullenberger, belmont university (2) lin sun, indiana university michelle sunkel, capella university betty surbeck, west chester university of pennsylvania (2) suzanne taylor sutphin, university of south carolina peter szto, university of nebraska elizabeth p. talbot, concordia university wisconsin sarah tarshis, university of toronto (2) meredith tetloff, university of montevallo melissa thompson, university of south florida emily tillotson, walla walla university john tracy kristin trainor, ball state university wendy turner, university of southern indiana dr. valandra, university of arkansas (2) lea wolf, city university of new york (3) kelechi wright, university of kansas jessica yang, winthrop university grace yi, indiana university (2) jimmy young, california state university (2) lisa de saxe zerden, university of north carolina (3)* *special guest editor image1.png _________ justin e. lerner, phd, associate teaching professor, school of social work, university of washington, seattle, wa. angie kim, ma, phd student, school of education, university of michigan, ann arbor, mi. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 317-336, doi: 10.18060/26576 this work is licensed under a creative commons attribution 4.0 international license. back to the (not so) basics of anti-racist education and practice: the need for white social work students to learn how to create trust and relationships justin e. lerner angie kim abstract: this study sought to explore the skills white social work students need to develop in order to cultivate an embodied anti-racist practice. forty-one social work students (approximately half white and half students of color) at a public university participated in semi-structured focus groups to discuss their experiences with anti-racist education and practice in their social work education. a predominant theme observed from these focus groups was the difficulty that white social work students have developing trust and relationships. findings revealed that these students need guidance on how to build trust and develop relationships before they can engage in learning other anti-racist practice skills. the authors propose offering a future course that will help white social work students to develop these skills through pilot-testing a few embodied anti-racist competencies related to trust and relationship-building. these skills can contribute to the broader social work grand challenge to eliminate racism as well as the nasw code of ethics ethical principle of strengthening relationships as a vehicle for change. keywords: anti-racist practice, social work education, trust and relationships, racism, anti-racist competencies trust is an essential element in any educational setting (tschannen-moran & hoy, 2000). white supremacy is abundant in social work and social work education, leading to social work curriculum, research, and practice embedded in a culture that values consumerism, rigor, independence, work ethic, and intelligence over balanced relationshipbuilding, trust, communal sense of self, collaboration, and community engagement (abramovitz & zelnick, 2015; calvo & bradley, 2021; riley et al., 2021). as these priorities are often overvalued in schools of social work, it is not surprising that white students are overrepresented in schools of social work (bowie et al., 2018) and often serve clients with a different racial identity. for new msws in the profession (3 years or less experience) who identify as white, approximately two-thirds of their clients are below the poverty line, are medicaid eligible, and experience mental health disorders (salsberg et al., 2020). the large proportion of high-need clients highlights how important the skill of relationship-building is, particularly for white students. in order to understand how white supremacy continues to thrive in social work education and practice, we need to better understand the challenges white social work students face in building relationships. dr. ibram x. kendi (2019) defines an anti-racist as “one who is expressing the idea that racial groups are equal and none needs developing, and is supporting policy that reduces racial inequity” (p. 24). social work education that prioritizes an anti-racist pedagogy focused on relationality and its potential accompanying discomfort (tang yan about:blank advances in social work, summer/fall 2023, 23(2) 318 et al., 2021) is imperative for helping white students learn how to build relationships and to develop trust within themselves and among others. white students often perpetuate transactional relationships with others that are based on commodity and hierarchy rather than communal support and learning (tang yan et al., 2021). a shift in social work education from cultural competence, the idea that interpersonal relationships can be built to transcend cultural differences (cross et al., 1989), to cultural humility, which prioritizes a lifelong process of self-reflection, self-critique, and learning with clients, organizations, and oneself (tervalon & murray-garcía, 1998), can help reorient relationships from being transactional to more supportive and collaborative. cultural competence focuses more on knowledge acquisition while cultural humility focuses on a need for accountability on an individual and structural level. cultural humility can help social work educators ask difficult questions about organizational structure, curriculum content, and pedagogical practices (fisher-borne et al., 2015) that can teach white students how to build relationships and trust while also holding them accountable in institutions that have centered the experiences of white bodies, histories, cultures, and language (calvo & bradley, 2021) throughout their entire lives. schools of social work often struggle to build infrastructure and genuine partnerships with communities, particularly communities of color, due to historical neglect and systemic mistrust. white social work students may have difficulty building a cultural humility practice based on deep relationships and trust due to a lack of modeling on how to develop these connections from the ground up (garcia et al., 2022). when white students lack the skills to build these genuine relationships, their future clients, many of whom may be historically marginalized, will suffer the consequences of this major skill deficit (wingfield & adams, 2019). in one study of licensed social workers, 65% of participants indicated that possessing an understanding of one’s own racial and ethnic identity is critical to work with clients, particularly in building relationships and establishing rapport. only white participants made up the remaining 35% of participants who did not believe race and ethnicity were important, indicating they believe that their own race has no relevance for their work with clients (hall & jones, 2019). all of the participants of color indicated that their own race was important in the clinical relationship. this lack of understanding of the connection between whiteness and building genuine relationships is a skill set deficit that schools of social work need to address before sending social work students into organizations as emerging professionals. for example, if white therapists believe that race and ethnicity do not impact the therapeutic relationship, this belief can potentially invalidate the experiences of clients of color (hunn et al., 2015). this type of microaggression (known as microinvalidation) can compromise the integrity of the therapeutic relationship and can cause harm to the client (buser, 2009; nadal et al., 2014). white social work students commonly and unwittingly perpetuate microaggressions in the social work classroom, particularly impacting students of color (soc; hollingsworth et al., 2018). black students often report feeling that their white peers hold negative views of them, which show up in subtle verbal and nonverbal ways, thus negatively impacting their social work education (masocha, 2015). when called out on these microaggressions, white students commonly will feel discomfort, guilt, shame, anger, and/or embarrassment (smalling, 2022). these feelings inhibit their ability to build lerner & kim/back to (not so) basics 319 relationships with others, thus creating more exhaustion and labor for soc to have to work through the harm white students bring about in these interactions and to explain the impact these microaggressions have. if they do not learn how to work with their feelings and the impact these feelings have on relationship-building, then white students will continue to perpetuate these microaggressions in their agencies. since cultural humility and developing an expertise in interpersonal relationships, particularly handling conflict and difficult conversations, are core skills for social workers to embody in the profession, the absence of these skills in academia becomes problematic. the day-to-day interactions of social workers, their roles in the community, and their actions have a major impact on relationships with individuals, families, groups, communities, and organizations (palmer, 2010). king-jordan and gil (2021) report that black female faculty at social work programs across the u.s. have described their relationships with white colleagues as superficial, lacking depth, surface level, nonexistent, and without genuine connection, commonly attributing these superficial relationships to a sense of white privilege rooted in racism. black female faculty also report that collegial relationships with white faculty are inundated with microaggressions and racist behaviors. even though these faculty of color report that white faculty likely have the skills and training to develop meaningful relationships, they often choose not to use these skills to develop these deeper relationships with their colleagues of color due to a lack of wanting to understand their own white privilege steeped in racism. these colleagues of color are often hesitant to engage because they perceive their white colleagues as resistant to change. if white faculty are choosing not to build genuine relationships with these colleagues, it is not surprising that white students will have difficulty developing these types of relationships with their peers, since students often model what they learn from their instructors. if faculty have training but are choosing to not develop relationships, students will likely not develop relationships even with training. it is imperative, therefore, that white faculty develop genuine relationships with diverse faculty and students. white faculty can engage in self-study in order to develop their own anti-racist commitments and better understand the internal barriers to one’s own thinking and beliefs that impact their practices around relationship building (kenyon, 2022). as with faculty of color, soc are often distrustful of white instructors and educational institutions (yeager et al., 2014). white instructors typically are also motivated by a social concern of not appearing prejudiced rather than the actual internal motivation of being antiracist. this belief, known as primarily external race motives (perm), commonly undermines the ability of soc to build trust and to feel a sense of classroom belonging, particularly with white instructors. the more that soc judge their instructors’ behavior as performative rather than internal and personal, the less likely they are to trust their instructors and feel welcomed in class. white students are often unaffected by their instructors’ perm while soc must navigate this social identity challenge (kunstman et al., 2022). additionally, murray-lichtman and elkassem (2021) explain how academia often uses an academic gaze when addressing racism. this gaze commonly looks like an effort to extract the experiences and emotional labor of people of color while leaving out a call for systemic change and self-examination. this type of non-performativity of claiming advances in social work, summer/fall 2023, 23(2) 320 anti-racism without any sufficient action sustains the ambivalence of whiteness and dominance of white supremacy in academia. since much of social work education is about role modeling skills and behaviors for students, white students likely reinforce perm when interacting with students of color in the classroom; therefore, further isolating these students and sabotaging trust and relationship-building in the classroom. working through conflict is a common way to deepen trust and relationships. an avoidance of conflict, however, has become normalized in society. race and ethnicity commonly influence how conflict is approached and managed (parker, 2015). this normalization of conflict avoidance, particularly around race and ethnicity, often inhibits white social work students from learning how to restore and rebuild relationships when they need to be repaired. relational cultural theory (rct) posits that relationships are the principal component for understanding human development, and humans grow through and towards connection throughout the life span. disconnection commonly results when relationships lack authenticity, empathy, and empowerment (miller, 1986). conflict can be helpful for restoring this type of connection, but an avoidance of conflict allows disconnection to permeate and for trust and relationships to disintegrate. the current study arose from continual concerns from soc at a school of social work about white students’ lack of skill in developing an anti-racist practice. these students consistently reported to an instructor (one of the authors) that they would like instructors to teach white students how to engage with their whiteness and white supremacy so that soc did not feel as exhausted and as though they constantly had to educate these students in all of their classes. the current study aimed to address the following research question: what specific knowledge, skills, and competencies related to anti-racism and white supremacy do white social work students require to become practitioners who will engage in actionable behaviors to address racism in their personal and professional roles and functions? methods recruitment and sampling in april and may 2022, students (undergraduate level, master level, and doctoral level) from a school of social work at a public university were recruited to participate in focus groups to better understand their experiences with anti-racism education within their social work education. an email was sent out to the entire student body with a google form sign up link during the last week in april 2022 asking them to participate in a 60-90 minute focus group. the students were offered a $25 gift card redeemable at over 100 vendors for their participation in the study. from the initial email, 29 students signed up to participate. a week later, a follow-up email was sent out to the entire student body. additionally, the principal investigator (pi) asked student leaders as well as staff and faculty advisors from several identity-based student groups to personally send the recruitment email and link to their group members. this additional outreach obtained 19 more who signed up for a total of 48 potential participants. lerner & kim/back to (not so) basics 321 the pi followed up with all 48 students and attempted to sign them up for one of eleven virtual focus groups based on their availability. students received several reminders about the focus group meeting they were signed up to attend as well as calendar invites to help them remember when their focus group was meeting. some students did not show up to the focus group while others became sick or had conflicts the day of the meeting. the pi attempted to reschedule any participants who were not able to attend their initial focus group. after rescheduling, a total of 41 participants ended up participating in a focus group. seven students either had too many conflicts or eventually stopped responding to the pi’s follow-up communications. data collection eleven total focus groups consisting of approximately 3-5 students took place in may and june 2022. five of the focus groups consisted of white students, one focus group was comprised of white students and white students who also identified as biracial (these students requested to be placed in a focus group made up of white students), and five focus groups consisted of students of color. the groups were divided by race so that white students were less likely to perform in front of soc and that soc would feel more comfortable talking about their experiences with white students without having the pressure that they often feel in the classroom to monitor their language the authors conducted all focus groups virtually over zoom and were recorded with participants’ permission. one author identifies as a 1.5 generation korean immigrant, cisgender woman. the other author identifies as a white jewish american, gay, cisgender man. both authors have a long-standing relationship engaging in racial equity work together. the pi’s institutional review board (irb) determined the study to be exempt, so participants were allowed to verbally consent to participating in the study at the beginning of the focus groups. the participants received a written consent form emailed to them ahead of time explaining the purpose and procedures for the study. the participants were also asked if they had any questions about the study at the beginning of each focus group. the focus groups typically lasted about 75-90 minutes. the researchers used a semistructured interview guide to explore students’ life experiences around white privilege, white supremacy, and racism at the individual, family, and community levels. students were asked about their emotional, psychological, and embodied reactions to interactions they have experienced around race, ethnicity, and whiteness. students were asked to share their hopes, expectations, and concrete actions from their social work educational experience with regard to anti-racist knowledge and practice with a focus on desired outcomes vis-a-vis their specific educational program (basw, msw, phd). data analysis the transcripts of each focus group were downloaded and saved in ms word files. the pi reviewed every transcript and edited each one for accuracy. when a part of the transcript was unclear as to the intended meaning of the participant, the pi would review the specific audio recording to ensure accuracy of the transcription. after the authors reviewed all the transcripts, they created notes and memos about the major themes that applied to the advances in social work, summer/fall 2023, 23(2) 322 majority of participants. the authors met to discuss the major themes and then began to create a codebook that encapsulated these major themes. after creating codes and the codebook, the transcripts and codes were imported into dedoose version 9.0.62, a visual qualitative data management software. the authors each coded the first two transcripts and then compared the findings to ensure inter-rater reliability. the major themes documented included “classroom climate,” “practicum experience,” “white supremacy culture,” “school climate and culture,” “skills needed for white students,” “wellness/wellbeing,” “soc student experience,” and “racist incidents.” through this process, the reviewers noticed some codes that were not being used so they were dropped. they also noted other themes that were not being captured with the original codes. these codes included “students’ anti-racism journey” and “trust and relationships.” after identifying these codes and dropping some other codes, the researchers proceeded to split up the eleven transcripts and code the transcripts using these updated codes and codebook. when the researchers came back together, they noticed three major themes throughout all eleven transcripts. these themes included 1) the disconnect between anti-racism knowledge and praxis for white students (lerner & kim, in press1), 2) how white students’ lack of skill with anti-racist practice negatively impacts wellness for soc (lerner & kim, in press2), and 3) white students’ inability to create trust and relationships among themselves and with soc. the first two themes have been or will be written about elsewhere. the third theme is the focus of the current study. results sample the total sample consisted of 41 social work students enrolled in either the basw, msw, or phd program. slightly more than half of the participants (51.2%) self-reported as being a soc or biracial (n=21), while the remaining participants (48.8%) self-reported as white (n=20). in terms of ethnicity, about two-thirds of the white participants identified as white (65%), while the remaining third (35%) of the white participants identified as other ethnicities. almost all soc identified a unique ethnicity, except for two students selfidentifying as korean american and another two students identifying as filipino american (see table 1). the majority of soc, however, identified as asian. we, therefore, chose to use the term soc rather than bipoc (black, indigenous, people of color) in order to give voices to these students whose identities are often invisible. while asian students make up only 15% of the student body, they comprised 29.3% of study participants. students, however, commonly used the term bipoc in the interviews in order to mirror the authors’ initial language. therefore, the terms soc and bipoc reference the same groups when students use this term in the interviews. lerner & kim/back to (not so) basics 323 table 1. demographic characteristics for focus group participants (n = 41) characteristic n (%) race white 20 (48.8%) asian american 12 (29.3%) bi-racial 4 (9.8%) black 2 (4.9%) iranian american 1 (2.4%) latinx 1 (2.4%) afghani 1 (2.4%) ethnicity white 20 (48.8%) white 13 (31.7%) ashkenazi jewish 2 (4.9%) dutch 1 (2.4%) eastern european 1 (2.4%) european american 1 (2.4%) italian & irish 1 (2.4%) polish/czech/scandinavian 1 (2.4%) soc 21 (51.2%) korean american 2 (4.9%) filipino 2 (4.9%) bengali & punjabi 1 (2.4%) japanese & taiwanese american 1 (2.4%) japanese bi-racial american 1 (2.4%) japanese american & white 1 (2.4%) iranian american 1 (2.4%) white indigenous bi-racial 1 (2.4%) mexican american & white 1 (2.4%) south asian & european 1 (2.4%) multiethnic & filipinx 1 (2.4%) ecuadorian 1 (2.4%) haitian 1 (2.4%) afghan refugee 1 (2.4%) chinese vietnamese 1 (2.4%) vietnamese american 1 (2.4%) african american 1 (2.4%) indonesian 1 (2.4%) chinese cambodian 1 (2.4%) program msw full time 26 (63.4%) msw evening and weekend 8 (19.5%) msw advanced standing 4 (9.8%) basw 2 (4.9%) phd 1 (2.4%) pronouns she/her 23 (56.1%) he/him 6 (14.6%) they/them 5 (12.2%) she/they 5 (12.2%) he/they 2 (4.9%) in terms of programs, almost all the participants (92.7%) were enrolled in one of three msw programs, including full time, weekend and evening, and advanced standing (n=38). of those enrolled in the msw program, 68.4% (n=26) were enrolled in the full-time program, 21.1% (n=8) were part of the evening and weekend cohort, and 9.8% (n=4) comprised the advanced standing program. only two students (4.9%) were enrolled in the basw program. one student was enrolled in the phd program (2.4%). a little more than half the sample (56.1%) used she/her pronouns (n=23), more than an eighth of the sample (14.6%) used he/him pronouns (n=6), approximately a quarter of students (24.4%) used they/them pronouns (n=5) or she/they pronouns (n=5), and two students used he/they pronouns (4.9%). these pronoun usages may indicate that almost a third of the sample (29.3%) likely identified outside of a gender binary (n=12). no other demographic information was collected. see table 1 for more details. trust and relationships as described previously, one major theme we identified in the current project was the ability of white students to build trust and relationships among each other, with soc, and among themselves. we identified several subthemes within this larger category. lerner & kim/back to (not so) basics 324 performative relationships soc reflected on how white students’ performative behavior (meaning white students are externally focused on appearing unbiased and “saying the right thing” rather than having a sense that understanding their relationship with race should be internally motivated and personal) makes developing trust and building genuine relationships with white students feel challenging. one soc explained her experience getting to know white students in the program. she recounted: i think for me that shows up [building relationships with white students] in a very eager way of getting to know you [as a soc]...i think i hold back from a lot of my white peers and connecting with them until i've kind of seen how they act and show up in the classroom...i think that there's a lot of tokenism that happens where there are a lot of white kids running around trying to collect as many bipoc [black, indigenous, people of color] friends from grad school...and so, for me, [that is a] really big red flag and something i'm not interested in... i would say that that's generally the experience that i have with a lot of white students in the program. everything's really performative. (msw full time program, 1st year) another soc expressed how difficult it had been for her to develop genuine relationships because white students were so focused on performing their behaviors that they could not take genuine feedback. she explained: like the whole point of social work is advocacy...social work should not be performative because that is the wrong field. so i think if there's any way, shape, or form that we can ingrain it into our fellow [white] peers, who have good intentions that accountability and conversations about impact is very crucial, i feel that would make it easier on bipoc students to coexist when we're all learning about the same stuff...because it's not that we're always going to be responsible for the cleanup of the damage...i've only interacted with 2 white students who sat there like honestly that truly sat there and i told them straight up that was not okay and they're like okay i won't do it anymore. (advanced standing program) other socs similarly expressed how white students’ defensiveness and lack of accountability highlighted the performativity of their behaviors around anti-racist practice. one soc commented: white students tend to get really defensive. and they really lack in terms of holding themselves accountable...their sense of entitlement in how defensive they get...it's very performative...it's like this competition to who can say the most flowery academic jargon. and i think it's ironic because we talked about white supremacy and the tenants of it...it's almost amusing to just see it in action and to recognize the irony of talking about anti-racism yet dismissing bipoc [students] and acting performative all for the western academic...like seeking that external validation. (msw full time program, 1st year) lerner & kim/back to (not so) basics 325 in addition to identifying what a lack of accountability looks like among white students, soc highlighted how to identify when white students are performing. a soc shared: indicators in the classroom [for knowing when white people are performing] include things they agree with, the conversations that they have, where they're coming from, some of their responses, and how they interact with other bipoc students... their self-awareness about themselves and just kind of how their actions and things that they say may impact other people, especially if they're not in the room. (msw full time program, 1st year) white students also expressed a concern around developing performative relationships, particularly with other white students, as a hypervigilance for appearing woke and not saying “the wrong thing.” one white student explained the pressure of appearing “woke.” the student commented: when it's [building relationships] with other white people, it still feels like...i was just trying really hard to be the most woke. it's the word an instructor used. the phrase the ‘woke olympics.’ and that's what it feels like sometimes...but my experience thus far is that people are trying overly hard. not everyone. a lot of people are trying to over exaggerate how accepting they are. no one wants to say the wrong thing, myself included. (msw full time program, 1st year) another white student discussed how being hypervigilant creates difficulty in facilitating genuine relationships with others. the student explained: for me i feel it's been an attempt at hypervigilance not to say or do [anything racist]...but sometimes i feel it gets a little bit in the way of creating meaningful bonds because i'm sitting there like did i just say something that was wrong that could be perceived [that way]?...making sure that i haven't hurt their emotional world or hurt them or offended them, people in the program. sometimes in general i'm just hyper aware. [w]e're learning so much that's constantly in the forefront of our brains...but i guess that's a good challengedifficulties integrating those meaningful relationships. (msw full time program, 1st year) both soc and white students commented on how white students’ hyperfocus on performativity creates distance in relationship building and trust building. students commented on how the distance perpetuates even more performance so students do not build authentic relationships. these performative relationships can then lead to a lack of curiosity and self-awareness among white students. curiosity and self-awareness of white students several soc, however, discussed how when they did witness genuine curiosity and self-awareness among white students rather than performative behavior, they were more interested in building relationships with white students. one soc explained: when it comes to white folks who don't share that experience with you... i guess maybe if it could lead to engaging in conversation that i feel comes from genuine curiosity and actually wanting to hear my story. but not from the sense of pity or advances in social work, summer/fall 2023, 23(2) 326 feeling their guilt...i mean wanting to learn my personal story as it relates to me as a person and as a human, but maybe yes my asian identity is related to that and is a big part of my experiences, but it's not my whole experience. so like curiosity with the fact of you still just want to understand me as a human, but not exactly you want to understand because i am asian. (msw full time program, 1st year) other soc explained how white students’ self-awareness helps create an interest in forming relationships with white students. a soc explained: there are white students in the program that i really respect, and i really enjoy conversing with. it’s because they know when not to speak up and they know when to just sit back. [t]hey know when to uplift bipoc voices... in order for me to be vulnerable with others, i have to trust them. it goes down to just how self-aware they are [white students]. and beyond awareness, how much they're practicing that self-awareness. (msw full time program, 1st year) soc also commented on how co-creating space with white students in class is another way for white students to demonstrate curiosity and self-awareness that can lead to trust building. one soc recounted: but i've had good experiences with other white folks in the course and that's when they're really committed to what it means to be anti-racist and giving space for folks too. and then also being open to ideas on how the class is navigated that bipoc students bring up...so that's also been ways that we built relationships. inner group dialogue...was a really good experience because i actually got to learn more from a couple white folks and actually have to relationship build and make surelike this is a lot of trust. (msw advanced standing program) white students attempted to reflect on examples of how they have attempted to develop their own curiosity and self-awareness when in the classroom. one white student gave an example when she was able to demonstrate her own self-awareness with other soc when working on a group project. she recounted: i guess the one thing that i have done is recently i was put in a group [in one of my classes] with all black people. i asked them [if they wanted to have an all black group] because i know it's pretty rare to have all black spaces in school. so i just said you know i don't need to be in this group. if it's okay with you all i'm sure it's pretty special and rare for you to have a space like this working on a project, not just a caucus... it was actually over text and one person said i would really appreciate having an all black group. and then someone else said yeah that sounds pretty nice. so i said ok i'll coordinate it with the professor and hopped over...and so i switched over to another group, which happens to be all white. [f]or me it's just recognizing that i don't need to be in their space. (msw full time program, 1st year) conflict, accountability, and making mistakes in addition to white students developing curiosity and self-awareness, many students discussed the importance of being able to work with conflict, accountability, and making lerner & kim/back to (not so) basics 327 mistakes as a way to build trust and relationships. white students need to learn how to work with conflict in order to build trust and relationships. one soc discussed the importance of setting up expectations in the classroom around working with conflict. the student explained: you know how during community guidelines [at the beginning of a course] they'll talk about our intention versus impact? [t]here's no actual practice of that because in so many moments when those things are happening, the confrontation of it is people freak out. i think there should be an expectation that's probably going to happen, especially white students are still learning. you know you're not going to be perfect. but in reality the learning part is the conversation that happens from [making a mistake]. but these white students are so timid. or don't want confrontation about that stuff. how are they ever going to learn? (msw advanced standing program) other soc talked about the importance of establishing strong relationships so that working with conflict can feel easier. one student recounted an experience in class in which an instructor helped set up a classroom space in which students could learn how to address conflict. the student recalled: i feel there’s something about that relational piece as we think about possible conflict or we think about things that she [the instructor] even set up the course in a way, where she said at the beginning, like hey i’m human. if i say something that doesn’t sit right with you i’d really appreciate it if you let me know one on one. that’s how i learn best, and i’ll let the class know what i learned from our conversation without naming who taught me where i messed up...and i thought that was a really interesting way to even set up knowing that conflict is an ongoing thing and that people are human and things are changing. and also creating a relational piece to it that when you know somebody, conflict looks different than when you don’t know somebody. (msw full time program, 2nd year) white students also talked about the importance of learning to express disagreement in class, which could potentially lead to conflict. one first year basw white student commented, “is it just going to be an echo chamber of what we think is best and what we think is the right course of action if we’re working on something or just all in agreement with each other? this echo chamber really might be harmful.” another white student explained how practicing conflict in class with a small disagreement can help build skills to working with a larger conflict. the student discussed how in an intergroup dialogue course students felt more comfortable openly disagreeing with one another. the student explained: i’m in the community centered integrative practice concentration...there’s maybe 25 to 30 of us, so it creates the opportunity to build more trust within our concentration... they’re really good at disagreeing with you so then when bigger things come up, i feel like we already have practice. i have experienced people really openly disagreeing with me. i feel i can receive that better because we’ve disagreed about other things too. (msw advanced standing program) advances in social work, summer/fall 2023, 23(2) 328 students also discussed how conflict can lead into accountability conversations that can help soc want to maintain relationships with white students. a soc discussed an experience building a relationship with a white student focused on accountability. the student explained: i literally only made one white friend out of the whole year...and they have said some fucked up shit to people...but the fact that i’m able to check them and then we talked about it and then move forward... and the accountability part [enables me] to keep that relationship...if y'all don't want to be accountable and waste my breath because [as] bipoc students we are not responsible for everybody, so we have to pick and choose... (msw advanced standing program) one white student reflected on how history and the legacy of whiteness impacts accountability and trustworthiness, particularly when engaging in a disagreement with faculty of color. the student explained: i'm currently grappling with how to contend with the legacy of whiteness...any time i may present disagreement with a bipoc faculty or instructor i'm like hey we have different opinions...there's a paper i just read, one of [an instructor at the school]. it was talking about this historical loss scale. and one of the historical pieces they were asking folks about was distrust of whites due to broken treaties. and it's not something that i personally enacted, but i am responsible for that legacy and history and being cognizant of it and how it would shape my interactions of disagreement potentially with a bipoc professor [or a bipoc student]. [it’s] something that i'm trying to get better at. i don't think i'm good at being aware of what's carried with me as i present potentially in disagreement. (msw full time program, 1st year) white saviorism was another issue related to accountability that soc continuously discussed as something that interrupts building genuine relationships with white students. a soc discussed how white students need to take accountability when their white saviorism is showing up so that they can build more genuine trusting relationships with soc. one soc described an experience that felt all too common in class. the student explained: [a]nother thing that could be done to build more authenticity is white students not speaking on others’ experiences. it’s so common. i feel in all my classes whenever we're discussing material or issues, especially related to bipoc people, there's always so many ways [white] students say ‘when i worked at a shelter’ or ‘when i worked with the black family’ or ‘i worked with an asian immigrant.’ and then they use that experience to act as experts in that issue. and so many times i've had to call students in on certain problematic language they use. in their head they're being good allies by talking about racial issues when in reality they're making assumptions...[t]hey'll just hop on to something if they have an inkling of experience and by experience it's really just exposure and really just an example of them being a white savior... and there's just this refusal to acknowledge the work that needs to be done in the white community. (msw full time program, 1st year) lerner & kim/back to (not so) basics 329 white people also talked about the importance of building relationships with other white people who are dedicated to discussions about anti-racism as a form of accountability. one white student recounted how she only built close friendships with other white people who wanted to have these conversations. she explained: i feel most of my close friendships are white people...but i would say one thing that might get in the way [of making relationships with other white students] is just that i definitely have friendships with my people where we talk about anti-racism or racism often. and talk about how our jobs or our future jobs, how that might look and what positionality we take within systems. i think if they are not willing to have those kinds of conversations, i'm not interested in being in relationship with them or a close relationship. (msw full time program, 2nd year) in addition to conflict and accountability, making mistakes was another central theme around building relationships with other students, particularly for white students. one white student commented: it’s hard to make new friends when you're an adult. i think the anxiety connecting with students [of color] also applies to connecting with white classmates. like not wanting to say the wrong thing...i think i worry about saying the wrong thing in most situations. (msw evening and weekend program, 1st year) another white student discussed how a fear of making mistakes can lead to a fear of being cancelled in relationships. the student explained: [i’m afraid] of being cancelled...[a former classmate said something racially charged] seven months ago... i don't talk to her because that's in my head. i'm not going to forget what she said. it's there. and i don't think she was being malicious about it. i think she just didn't know better. sure she didn't and i think she does now. but i don't want that to be people's experience of me. that i say something that's just really dumb or misunderstood or something that i don't realize is [problematic]. and then that's all they [other students] can hear when they talk to me. so i tiptoe. (msw full time program, 1st year) a soc talked about white students’ lack of willingness to talk about mistakes they have made, which makes building relationships and trust with them feel challenging. the student recounted: [i]f we get into heavier conversations [such] as what's the last racist thing that you can remember doing, the majority of folks will be like i don't know i can't think of it...but when we're actually in the classroom and talking about examples, all of a sudden there's this blank...because they're so worried about being looked at as a bigot or racist... [y]ou can see folks just putting up a wall where they don't want to be vulnerable and it's also hard to be vulnerable when you know you’re in an academic space... so i've heard that from a lot of folks where they're like yeah i don't say that it's wrong because i'm worried that oh i'm going to get a bad grade next time. (basw, 1st year) white fragility advances in social work, summer/fall 2023, 23(2) 330 white fragility was another theme that created barriers for white students to work with conflict, accountability, and making mistakes. several soc commented on how these barriers inhibited the development of trusting relationships. one soc explained: the beginning of my advanced standing year wasn't that great because the one white person who befriended me, i gave them my number, and then they started calling me about like decompressing everything so i got really upset.... so when they're [white students] on their journey of understanding their own white fragility, that is the hugest barrier for me in my opinion. (msw advanced standing program) a white student described difficulty holding other white students accountable and talked about focusing on maintaining harmony between classmates, which is a way white students avoid conflict and reinforce white fragility. the student expressed: our community at the school of social work is just... incredibly intelligent and, therefore, i'm so glad i'm here and a part of that. but also equally very intimidating. and so to make that jump of calling it out or saying something i have to be damn sure that i am 100% right... i am attempting to be conscious of the harmony within the group and then i don't want to be categorized like i'm trying to cancel you because you said something wrong. i want to be practicing that calling out or calling in and that’s just hard with this group because everyone's so damn smart and very admirable in a lot of ways. (msw full time program, 1st year) soc commented on how white fragility became evident among white students when soc express to white students that they may not be interested in having relationships with them. one soc recounted the following story: for me the first person in our cohort who reached out to me in the summer was white. and that quickly became a little uncomfortable for me, because it kind of should have been a warning sign of what the rest of the cohort would be. but it was just a really weird kind of relationship where she was trying to prove herself. like prove her proximity to asian by telling me how she used to live in asia. and it was just really strange. so from the first quarter from the first month i had to put up boundaries. because i was also starting the quarter really overwhelmed by all the microaggressions. i was proud of myself for telling her look like right now i'm just kind of overwhelmed by the whiteness of the program and i'm trying to be more intentional about making connections. and she responded really defensively...but after that experience i was like ok i'm good with the white people... for my own protection and protecting my energy i just don't have capacity for liberal whites anymore. (msw full time program, 1st year) one more common theme that soc students talked about was the vulnerability of white students as an antidote to white fragility. one student discussed how important it feels for white students to take the first step in being vulnerable to build relationships with soc. a soc explained: i think it takes a lot of vulnerability again on the part of a white students to be able to see what a specific and situational needs or concerns might be. i think a lot of times i think there's a required first step on the part of white students to be able to lerner & kim/back to (not so) basics 331 make that reach out or to show a level of vulnerability to then create a sense of trust that bipoc people might be able to then turn towards white people again. (msw full time program, 1st year) implications for social work this current study sought to better understand how white students have difficulty creating trust and relationships among themselves and with soc as part of their anti-racist education and practice. soc and white students revealed many areas of white students’ anti-racist education that needs attention in order to build solid relationships and more trust with white students. these skills include: 1) decreasing performative relationships; 2) increasing curiosity and self-awareness; 3) leaning into conflict; 4) building accountability; 5) learning how to embrace mistakes; and 6) decreasing white fragility. it is imperative for white students to build these skills so that soc can feel safer in the classroom, less emotionally exhausted, and have more space to work with their own internalized racism. one of the major grand challenges for social work is to eliminate racism. this grand challenge “proposes to develop a model for eliminating racism by identifying evidence and practice-based interventions that will end racism and ameliorate the negative outcomes of our history of racism” (grand challenges for social work, 2022, para. 1). this current study can contribute to this aspirational goal by pilot-testing potential operationalized antiracist skills that can help white students learn to build trust and relationships. we plan to pilot a class for white social work students in which we can develop, operationalize, and test some competencies based on the results from the current study. this course will be open to all students, but we will encourage students who identify as soc to enroll in another course specifically focused on socs’ needs. our previous work has indicated that building these anti-racist competencies goes beyond knowledge acquisition (lerner & kim, in press1) but rather needs to be a living, breathing, and embodied anti-racist practice (menakem, 2017). this class would complement the school’s current required social justice and diversity class in addition to the school’s attempt to continually infuse antiracist content into each course and each level in all programs at the school. menakem (2017) provides many exercises for white bodies and bodies of culture (he uses this term as a way to reclaim power for people of color) to practice tempering and conditioning their bodies as they work with the charge of race. rather than head knowledge, menakem (2022) provides guidance on feeling the vibe, image, meaning making, behavior, affect, sensation, and imagination (vimbasi) of how race manifests in the body. he also recommends “soul scribing,” meaning writing out the vimbasis in a journal when working with the charge of race rather than writing out narrative from head knowledge. for example one author soul scribed, “i’m noticing a chill in my body, my shoulders are tightening, my breath is becoming shallow, a feeling of ‘i’m not good enough is present,’ i want to run and hide, my imagination is that i could learn to sit with other white bodies with the charge of race and not be terrified by it.” we also believe it is imperative for white students to learn how to work with their emotions as they are learning how race shows up in the body. brackett’s (2020) ruler method is an evidence-based approach to social and emotional learning that was developed advances in social work, summer/fall 2023, 23(2) 332 at the yale center for emotional intelligence that can help white students work with their emotions, particularly around race. ruler focuses on five key emotion skills of recognizing, understanding, labeling, expressing, and regulating emotions. both embodied anti-racism work (menakem, 2017, 2022) and ruler are two methods to help build operationalized anti-racist competencies for white students related to trust and relationshipbuilding. for example, utilizing embodied anti-racism and the ruler method will assist us in developing and assessing some of the following pilot items around emotions and body sensations related to race. we believe these items may provide insight as to how white students can practice building trust and relationship building: 1) i feel i am a bad person for racial harm i may have caused (shame); 2) i feel bad for racial harm caused by other white people (guilt); 3) i can identify when i am feeling defensive when discussing race; 4) i can identify when i feel fear in my body when discussing race; 5) in conversations about race, i tend to intellectualize issues and ignore emotions; 6) i notice when i am feeling anger stemming from my feelings of defensiveness in conversations about race; 7) i notice temperature shifts in my body when discussing race; 8) i notice when my body is feeling numb when discussing race; 9) i notice what is happening with my breath when discussing race; 10) i notice the “charge” of race in my body; 11) i notice when i need to move (e.g., shake, sway, rock) my body when discussing race. in our experience, students often ask to learn anti-racism skills but commonly lack more foundational skills of anti-racist practice, such as initiating a conversation with someone you do not know or do not know well, taking responsibility for the community rather than the individual, asking someone how they are doing and then actually listening for their response, sharing your own feelings when asked “how are you doing?” beyond answers of “i’m doing well,” or “i’m great,” and focusing on the process of an experience together rather than the outcome. we imagine these foundational skills can emerge in many ways in the classroom. students can become proactive to get to know one another each week in class and not wait for the instructor to facilitate an activity. instead of sitting in silence, scrolling on their phones, and avoiding eye contact with one another, they could actually learn to engage with one another before class starts (and to understand what a meaningful interaction feels like in their bodies), thus creating more relationship and trust with one another. when they notice that the room is not set up in a way that allows everyone to sit in a circle or communally, they can be proactive and take responsibility as a community for facilitating this arrangement. that way they create accountability as individuals to be attuned to the community’s needs. white students can also practice pausing and not simply responding with an automatic response when asked how they are doing. they can check in with their body and potentially not even have to give a verbal response but invite each other to just practice being in lerner & kim/back to (not so) basics 333 communal space together using some of the exercises menakem (2017) suggests, such as humming, belly breathing, chanting, singing, dancing, or moving their bodies together. as part of the process of the class, they can focus on the here and now rather than the content. if something emerges in class through soul scribing (menakem, 2022) or any other method, students can learn to allow the emergence rather than focusing on accomplishing the task at hand. we know that all of these suggestions may seem simple and foundational, but they are actually revolutionary in that they can provide a new and emerging way for white bodies to build a new anti-racist culture and way of being together communally. limitations several limitations exist for our current study. students who decided to participate may have had deep knowledge, interest, and experience with anti-racist practice, so students with this particular orientation may have self-selected into the study, thus not including students without this type of background. the study provided $25 gift cards for any student who participated in a focus group, so some students may simply have joined a focus group for this incentive and limited their participation while in a focus group. msw students overwhelmingly comprised the study, so the experiences of bachelor level and doctoral level students were not well represented in the study. lastly, one of the pis who served as the primary facilitator for the focus groups is also an instructor at the school and had previously been an instructor for several students who participated (but was not a current instructor of the study participants when the focus groups were conducted). the students may have signed up simply because they had a prior connection with the instructor, thus skewing who decided to participate in the study. perhaps this limitation could be minimized in the future by conducting focus groups over the course of a year with different cohorts with separate discussions with phd students and basw students rather than during a twomonth time period with students from all programs. spreading out the time period could have also increased the sample size. conclusion schools of social work continue to grapple with how to prepare students with an antiracist education that will prepare them to meet the standards of the national association of social workers (nasw, 2022, para. 2) code of ethics, which charges social workers to “end discrimination, oppression, poverty, and other forms of social injustice.” the current study revealed that part of this anti-racist practice is teaching white students how to build trust and relationships in an embodied way. we plan to pilot a course specifically designed with white students as our commitment to the profession’s ethical principle from our code of ethics (nasw, 2022, para. 20) that states that: social workers understand that relationships between and among people are an important vehicle for change...social workers seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities. advances in social work, summer/fall 2023, 23(2) 334 we deeply believe that in order for white social workers to help 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(2014). breaking the cycle of mistrust: wise interventions to provide critical feedback across the racial divide. journal of experimental psychology: general, 143(2), 804-824. author note: address correspondence to justin e. lerner, 4101 15th avenue ne, seattle, wa 93105. email: lernerj@uw.edu https://doi.org/10.18060/24117 https://doi.org/10.18060/24117 https://www.socialworkers.org/linkclick.aspx?fileticket=1_j2exvnspy%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=1_j2exvnspy%3d&portalid=0 https://doi.org/10.1080/13562517.2020.1725880 https://doi.org/10.1080/13562517.2020.1725880 https://doi.org/10.1080/02615479.2021.1924665 https://doi.org/10.1080/02615479.2021.1924665 https://doi.org/10.1080/02615479.2021.1924665 https://doi.org/10.1353/hpu.2010.0233 https://doi.org/10.1353/hpu.2010.0233 https://doi.org/10.1353/hpu.2010.0233 https://doi.org/10.1080/08878730009555259 https://doi.org/10.1080/08878730009555259 https://reflectionsnarrativesofprofessionalhelping.org/index.php/reflections/article/view/1753/1585 https://reflectionsnarrativesofprofessionalhelping.org/index.php/reflections/article/view/1753/1585 https://doi.org/10.1037/a0033906 https://doi.org/10.1037/a0033906 mailto:lernerj@uw.edu back to the (not so) basics of anti-racist education and practice: the need for white social work students to learn how to create trust and relationships justin e. lerner angie kim methods recruitment and sampling data collection data analysis results white fragility implications for social work references ______ zia tayebjee, msw, coordinator, and daniela lewkowicz, misd, graddip (couns), program coordinator, local health district & department of communities and justice, pregnancy family conferencing & statewide pfc clinical support & training, sydney, australia. sophie isobel, rn, phd, associate professor, faculty of medicine and health, university of sydney, camperdown nsw, australia. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 382-99, doi: 10.18060/28372 this work is licensed under a creative commons attribution 4.0 international license. introducing lived experience workers into a pregnancy child protection intervention: parent and staff experiences zia tayebjee daniela lewkowicz sophie isobel abstract: pregnancy family conferencing is a program to support families with identified child protection risks during the perinatal period. parents are often cautious about engagement due to mistrust of services and fear of having their babies removed if they discuss their difficulties. subsequently, the inclusion of lived experience parent supporter roles was piloted to support families with engagement. little is known about lived experience workers in child protection services and thus this qualitative study explored the experiences and perspectives of families, parent supporters and professionals, and of implementing parent supporter roles into the pregnancy family conferencing program. inductive thematic analysis identified benefits of lived experience inclusion in child protection processes for parents, families, staff, and services, and highlighted that introducing lived experience positions into systems requires significant reflection, structures, and flexibility to ensure wellbeing and sustainability for those working in the roles. recommendations are made for other child protection or social work services introducing lived experience roles. the inclusion of lived experience workers into child protection services has enormous potential for improving the experiences of people accessing services, enacting the values of social work, and balancing the inherent power dynamics embedded in practice. however, in introducing such roles into existing systems, there is a role for social workers and other practitioners in advocating for, and leading, the structural changes required to ensure the sustainability of positions and wellbeing of people working in these roles. keywords: child protection, lived experience, pregnancy, family conferencing, peer support effective child protection interventions during the perinatal period can support families to address safety concerns and reduce the need for long-term statutory intervention (tayebjee et al., 2024; waldfogel, 2009). inadequate engagement with families during this period can contribute to crisis responses at, or after, birth, as well as trauma for parents and families, and disrupted infant attachments (tayebjee & lewkowicz, 2019). however, engagement and the delivery of interventions during this period can be complicated by families’ understandable reluctance to engage with services due to fear of removal of infants into out-of-home care (taplin, 2017). pregnancy family conferencing (pfc) is a program offered in a public health service in sydney, australia to support families with identified child protection risks during the perinatal period. pfc is a strengths-based, trauma-informed program for expectant parents and their families where significant child protection concerns for their unborn baby have been identified. pfc is delivered and funded in partnership with the department of communities and justice (dcj). pfc aims to provide a forum for families and services to have open and transparent conversations about child protection about:blank tayebjee et al./lived exp in chil protection intervention 383 issues through a scheduled series of meetings and collaborative care-planning. participation is voluntary and meetings are facilitated by an independent professional from within dcj or health who helps interagency participants develop coordinated plans which attempt to meet families’ needs and address child protection risks. engagement in pfc aims to increase the likelihood that babies can remain safely in the care of their parents after birth. the meetings and associated discussions focus on existing and potential family strengths. in cases where child protection concerns are not adequately addressed and a baby needs to be taken into out-of-home-care, the process enables families to participate in planning for out-of-home-care placements and engages the service system to support restoration where possible. pfc has been successfully embedded into practice since 2012 with approximately 25-35 families referred to the program annually, typically navigating a combination of psychosocial difficulties such as domestic abuse, mental illness, insecure housing, homelessness, or problematic drug or alcohol use. the disparity in power between practitioners and families can create barriers to building the relationships required to form the foundation of effective collaborative work (cocks et al., 2021). parents are often cautious about engagement due to mistrust of services and fear of having their babies removed if they discuss their difficulties. subsequently in 2017, efforts began towards establishing lived experience or peer support roles in pfc. these roles were named and are referred to herein as the parent supporters (ps). the ps were intended to meet families with the facilitator prior to pfc, to explain the program and prepare families for the meetings. role development took a number of years, culminating in a pilot from 2020-2023. four parents were employed as ps, all of whom had lived experience of participating in pfc and retaining care of their infant. across child protection and child welfare services, the integration of lived experience positions is not new, however evidence is limited (saar-heiman et al., 2024) subsequently, much of the literature on integration of peer support positions into services comes from mental health settings where there is a large body of evidence demonstrating their importance and value. in mental health care, peer workers are known to enhance mutuality and autonomy for clients, while also drawing personal benefits from the work (wall et al., 2022). in australia, employing peer workers in child protection services is a new concept. subsequently this case study aimed to explore the experiences and perspectives of families, ps and professionals, of implementing the ps roles into the pfc program. methods design an inductive qualitative methodology with thematic analysis was used to explore the experiences of ps, families, and professionals. the methodology was driven by assumptions that knowledge is relationally produced within interactions between people within contexts (burr, 2015). the approach allowed for exploration of experiences and perspectives without preconceived frameworks (braun & clarke, 2022). ethics approval was received by the ethics review committee (rpah zone) of the sydney local health district. advances in social work, spring 2025, 25(1) 384 recruitment participants were recruited through pfc. the ps were provided with information about the evaluation and asked to contact the researchers if they wished to participate in an interview. families who met with a ps were informed about the study by the pfc facilitator. if the family was interested in participating, the facilitator sought consent to provide their details to the research team. they were subsequently contacted outside of the pfc process and invited to participate in an individual interview. professionals working in the program were directly invited to participate in two focus groups by the program coordinators. no demographic data were collected, in order to aid with participant confidentiality. data collection consistent with the qualitative approach, individual semi-structured telephone interviews were conducted with 11 family members and 4 ps. focus groups were facilitated for other non-lived experience professionals participating in the program. interviews lasted between 15 and 40 minutes, on average about 20 minutes. twenty professionals who had been part of pfc meetings during the pilot participated in two focus groups which were between 1.5 and 2 hours each. interviews and focus groups explored experiences of engaging with the pilot and perceptions of the integration of lived experience into pfc. see table 1 for guiding questions. table 1. interview questions parent supporters (individual interviews) 1. what has been your experience of working as a pfc parent supporter? 2. reflecting on your meetings with referred families, can you reflect on what it was like sharing your story? 3. what do you think the families you have met with would have taken away from meeting with you? 4. how has the preparation, education and support you have received met your needs for this role? 5. what have been the strengths and challenges of working within the pfc team? families (individual interviews) 1. what was your experience of meeting with a parent supporter and hearing their story? 2. what aspects of their experience did you find helpful or unhelpful? 3. how was hearing from a parent supporter similar or different to talking with a professional? 4. how did hearing from a parent supporter impact your perception of services or pfc? 5. how did hearing from a parent supporter impact your decision to participate in pfc? 6. would you recommend meeting with a parent supporter to another family, why/why not? non-lived experience professionals (focus groups) 1. what was your expectation of the parent peer support role? 2. how do you think the family’s meeting with a parent supporter impacted your ability to build a positive working relationship with them? 3. what aspects do you think worked well? 4. what aspects could be changed? 5. are there areas for growth in the parent supporter role? tayebjee et al./lived exp in chil protection intervention 385 interviews and focus groups were conducted by an experienced social worker external to pfc. all interviews and focus groups were audio recorded and transcribed. subsequently a reflective session was facilitated with pfc coordinators to reflect on the emergent findings. two coordinators participated in reflective sessions, facilitated by an independent researcher. data analysis data were thematically analysed guided by the methods of braun and clarke (2022). themes in inductive qualitative studies are broad and refined throughout analysis to describe patterns in ideas from the overall experiences of participants, through interpretation by the researchers (braun & clarke, 2022). all three researchers read all transcripts and highlighted codes within each. each were discussed individually and collectively with a focus on the perceptions and understandings of the participant groups. an external researcher (si) aided with analysis to enhance reflexivity. through reflective group conversations, themes were developed and refined for each participant group. illustrative participant quotes were interspersed in thematic findings to add depth (lingard, 2019) and stay close to the data. any qualitative analysis requires active engagement by the researchers in shaping analytical questions and findings, with reflexive activities serving to account for how subjectivity shapes inquiry and outcome, rather than presuming it doesn’t (olmos-vega et al., 2023). subsequently, the inclusion of reflections of the coordinators were a mechanism of iterative and reflexive analysis, which is known to aid in meaningmaking during qualitative analysis (srivastava & hopwood, 2009). the coordinator reflections on their experiences and the data aids in articulating the entwined positioning of the dual roles as clinicians and researchers present in much clinical research. findings the findings explore the experiences and perspectives of families, ps and professionals, of implementing the ps roles into the pfc program. findings are presented under each group: parents and families, professionals, parent supporters and program coordinators. themes generated from interviews are described and presented with illustrative quotes. the themes from each group are summarised in figure 1. parents and families interviews with families and parents resulted in four themes related to the parent supporter role: the ps role is very different from a professional, the ps roles foster hope in the program and hope for self, the ps roles disrupt power in the process and makes it real, and shame can be a complicating factor. tayebjee et al./lived exp in chil proct intervention 386 figure 1: themes from each participant group •role very different from a professional •fosters hope in the program and hope for self •disrupts power in the process and makes it real •shame can be complicating without sensitivity •lived experience is part of the role but also requires planning and structures •opportunities for workforce development •need for sustainability planning •presence changes power and speeds up trust •demonstrates the space for parents voices in the process •represents hope for now and the future •shine a light at the end of the tunnel •creates anxiety but it’s worth it •leads to enhanced sense of self •can create personal conflicts parent supporters professionals parents and families pfc coordinators tayebjee et al./lived exp in chil proct intervention 387 very different from a professional families and parents described the role of the ps as being different to that of professionals. they identified the importance of this difference, making them feel more engaged, trusting and hopeful about pfc overall. the lived experience of the ps enhanced trust and understanding of what was involved and put them at ease. trust with the ps was innate due to their shared experiences. i’m not afraid to ask her questions because she’s so open and i can get opinions from her as well because what she said to me it’s really so true. sometimes i feel like wow, you and i are going through exactly the same thing you know … makes me feel like we connect. (parent 1) knowing the ps had also been through the child protection system allowed for connection and identification. at times, having very similar experiences was beneficial, but families also observed they didn’t have to be the same to benefit from the shared experience. in talking with the ps, their problems felt shared and less burdensome. because we both are like victims ourselves so it’s actually different between talking to a professional. a professional is just there to hear your story but not to share their story or sharing other people’s stories to you but when you are talking to the person that actually experienced the same thing as you then you share the problem together. (parent 1) fosters hope in the program and hope for self families developed more hope and trust in the program when they spoke to the ps. they found the engagement personal and comforting. i thought that there’s no hope really and then i thought that it’s me, i’m the most complicated…person. but as i met [ps], and i heard briefly about her story i was feeling like wow she’s such a good inspiration for me. (parent 1) they felt inspired by the stories and experiences of the ps, both in navigating pfc but also in what they could do with their lives: “like it makes me think that’s something that i want to do if i get to take my baby home you know…to help other mums” (parent 1). engaging with the ps could lead to vicarious strength for parents and family members. this woman is standing there saying to my daughter “i have overcome the situation you’re in right now”, so you know it’s given my daughter so much more strength to do what she’s doing knowing that it’s been and done, you know what i mean the person standing before her has been there done that. (grandparent 4) families saw the ps as supporting parents to be able to speak up and find their own voice in pfc process. the ps were observed to demonstrate to parents that they did not have to just be quiet, they could voice their own concerns and needs “now i feel i have a backbone to face it all” (parent 3). advances in social work, spring 2025, 25(1) 388 disrupts power in the process and makes it real spending time with the ps was seen to disrupt power differentials between dcj and parents, which previously overshadowed any interaction. the altered power differential meant that families could ask more questions and trust responses, leading to the process seeming more authentic. the engagement raised confidence in the process of pfc for them as a participant: i just don’t feel comfortable [with professionals] because i just automatically like i get scared, i don’t really know how to speak up. whereas [ps] speaks to you in a different way that makes you feel comfortable and confident. (parent 6) however, families remained somewhat cautious as well: “she’s on both sides sort of you know because she’s there to help both of us” (parent 8). talking with the ps brought the pfc “to life” and helped families to understand what the process was really like. subsequently they felt more relaxed about the process and calmer. “i guess it’s kind of made me a little bit more interested in pfc and seeing what that brings alive if that makes sense” (parent 2). families described that the ps explained pfc process in a way that made it feel do-able: it’s such a massive relief and lift off my shoulders like really emotionally wise, mentally wise. she just basically told me how it goes, how the plan goes, and like i had no idea that i could have this chance of having so much support with me. (parent 3) she just explained everything in a way that i didn’t really get from like the other people that i was talking to…because she’s been down that road and she knows what they’re expecting me to do. (parent 5) while it didn’t necessarily change the outcome, it helped parents feel clearer on what was expected and more positive about pfc: “i don’t think it matters what anyone kind of says to you, it’s what you do. but as a positive, to keep positive, it’s a good thing” (parent 7). shame can be complicating without sensitivity for some parents shame made engagement with the ps complicated. shame related to being unsure how much of their information the ps may be privy to and how engaged they wanted them to be, as well as their cultural appropriateness. this largely arose when considering whether the ps should attend the meetings as a support, which would also mean they would hear all of the details of family situations. during initial encounters prior to meetings, parents felt they had control about how much to share but this would be lost if the ps attended the meetings. “some things is more private as well. i’d probably prefer just the professionals to discuss about my [life] if you understand what i mean” (parent 10). some identified it would be helpful for the ps to come to the meetings: [it] would be kind of like something in your corner, having that person to like -not back you up -but remind you and i guess you can just look at them and remember what they said” (parent 2) tayebjee et al./lived exp in chil protection intervention 389 for aboriginal parents, the importance of cultural relevance was crucial for minimising shame. parents identified that there could be challenges of shame within community and it was seen as essential that an aboriginal ps support aboriginal parents. an aboriginal ps was seen to understand the system, historical and ongoing issues for disadvantaged families and the importance of community it would be nice to hear it from an aboriginal support parent just because like i’m not like saying that us aboriginal mums go through a different type of system because it’s all the same but i kind of feel like in a lot of cases we kinda get mistreated. (parent 2) the deep mistrust of dcj in the aboriginal community was recognised to spread across generations, leading some families to not want to meet with dcj without an aboriginal person present. while not directly linked to shame, the engagement with the system caused deep distress and a sense of isolation which could be buffered by the ps. no body was walking beside me when i needed it but now that the other youngens didn’t have to go through that, they’ll have support from somebody from day dot now which is really good. (parent 3) professionals focus groups with professionals generated three themes related to the ps roles: the ps presence changes power and speeds up trust, the ps demonstrates space for parents’ voices in the process, and represents hope for now and the future. presence changes power and speeds up trust professionals felt they worked hard to establish rapport and show empathy, but they remained aware of power and saw the ps as allowing parents to engage in a more equal and equitable relationship. i think it's a very empowering model to try and balance out some of the power imbalances because i think you know whether we're health or dcj, there’s still this structure of having power over people, and i think the peer workers bring something different and more equal and equitable. (social worker 1) i can have empathy and attempt to build rapport, but i can't possibly, i think, connect in that kind of really visceral fear space. (antenatal social worker 1) the presence of ps was seen to “speed up” the process of building rapport with a family which was important when time was limited by the impending birth. professionals witnessed the power of shared experience with the ps explaining pfc and building the relationship between the families and dcj where trust could not be presumed. parents were often wary of dcj and found it hard to believe what was being said. the ps assisted with building trust. you can say it until you are blue in the face, but it seems someone who's actually achieved it is going to carry weight, ‘cause you know, life has taught them that what you hear isn't always what you get. (midwife 1) the engagement with the ps could also enhance trust with the professionals advances in social work, spring 2025, 25(1) 390 yeah, i think trust can be contagious and so if there's trust built with the person who's walked in the same shoes as the client and then you're connected to that person, there is that contagious sort of element of trust so it can be shared along just by the process of proximity and the fact that we have a similar goal. (midwife 1) demonstrates the space for parents’ voices in the process having the ps present in the process was a symbolic demonstration of the importance and valuing of the parents’ lived experience throughout the pfc: highlights the fact that we actually really think it's important to give a voice to the parent perspective and that like having that person who's been through that who's been able to use their voice through that process makes it so that…the parent can actually feel like what they're thinking is actually going to be heard and that their voice and their perspective will be valued. (antenatal social worker 3) having ps present made the process and language more easily accessible and made space for parents’ experiences, without the need for words or justification. “there's just all that kind of, sort of unspoken, subtle kind of connection and understanding that can't necessarily be put into words” (antenatal social worker 2). the role of ps was seen to be one of walking alongside the parent throughout the decision-making process in the lead up to pfc, in recognition of the vulnerability of this space. however, the role also had boundaries of how personal experiences were shared and how much the parent may want to hear. there's a little bit of expectation that i would hope that that person is going to be able to have professional boundaries when it comes to certain things or feel like they are able to be in a place where they're able to lend that support and a supporting role without making the other person feel like they also need to hold the weight. (dcj worker 1) information about pfc provided through the experiences of the ps were seen to be easier for parents to engage with than professionals’ descriptions. descriptions were realistic and not all positive but demonstrated a way through the process that may otherwise have felt overwhelming. even though, like some of those things i said or i would ordinarily say, i could just see there was so much more that looked like they took all those messages on board. (pfc facilitator 1) represents hope for now and the future the ps demonstrated hope to the parents. hope that they could get through pfc, that they could retain their baby and also hope that there was a future beyond this period of their lives. i think every one of our clients we have worked with who have had interactions with the parent supporters, now they all want to be peer workers and parent support workers. so it's obviously very empowering for them and it's nice to, tayebjee et al./lived exp in chil protection intervention 391 you know, have that confidence and be able to look ahead and say, ok, maybe i can do this as well. (nurse 1) professionals were incredibly supportive of the ps roles and recommended expansion, through expanding throughout pfc and beyond, and employing a male ps to support fathers. professionals had mixed feelings about whether the ps should attend the pfc meetings. concerns about doing so included exposure to vicarious trauma, shame within communities and too many people in the room. i just wonder whether adding someone else who's not really connected to the family but is connected because they've experienced the same thing… i don't know how valuable that is in the actual meeting. i think it's is really valuable before and perhaps even like post a meeting to kind of talk about some of the stuff that happened, but i'm just not sure what value it would add to the actual meeting 'cause that person is not going to be involved with the client in the long term, like unless they become friends, which i guess is another risk, right? yeah, i yeah, i don't know. i've got kind of mixed feelings. (pfc facilitator 2) ultimately professionals concurred that this may be best negotiated with the ps and parents allowing for choice. professionals could reflect on times when having the ps present in meetings would be beneficial and times when it wouldn’t due to confidentiality and amount of people in the room. professionals felt they held a responsibility for reducing risk for participants but also for reducing risk to the ps: it’s a very sensitive and challenging time…for people to hear some of the vicarious trauma…and thinking of our [pfc]…some of those risks that got presented probably wouldn't have been appropriate for a parent support worker to hear. (social worker 1) parent supporters interviews with the ps resulted in four themes about their roles: the ps roles shine a light at the end of the tunnel, the work creates anxiety, but it is worth it, it leads to enhanced sense of self and can create personal conflicts. shine a light at the end of the tunnel the ps saw their roles as showing parents hope beyond this point in time and that if they put in the work, they could have a “positive outcome” and regain some control over their lives and their baby. yeah there is a light at the tunnel…people don’t just have bad situations with child protection, people do have good outcomes and if possible, i also hope they can see that it’s not just about them saying “ok this is not what you’re doing we’re going to take your child you don’t even have a chance at doing things.” i don’t want them to see it like that, i want them to see…they are being the driver to their story. (ps1) creates anxiety but it is worth it the ps described feeling nervous before meeting parents but finding the work rewarding and meaningful. they felt anxiety about being perceived as representing the advances in social work, spring 2025, 25(1) 392 child protection system and also about sharing their own stories. they described feeling unsure how parents would respond and they didn’t want to say the wrong things. the work felt professional and personal as they were motivated by their own experiences and wanting to support others: i have my moments of anxiety and worry and stress because like i have so much passion and want to do something good and have something come out of my own experience…so it doesn’t feel like…i made all these mistakes for no reason, i can actually help someone else. (parent 1) despite their worries, the ps described that the work felt “worth it” when they saw benefits for other parents, such as parents engaging who may not have previously and parents retaining care of their infants at birth. leads to enhanced sense of self the ps work led to an enhanced sense of self as they saw what they had been through could be helpful and inspirational to others. beyond the work, this flowed on to feeling more confident in themselves as parents and as people. to help someone else, to be seen…it’s sort of an example of what can happen, it sort of gives you a positive feel. because hey…i must be a good parent because i can sit here and talk and be an example for this parent… to hopefully get them to understand the process and do what they need to do…i don’t feel like i’m having success unless i’m getting acknowledgment… it’s sort of a selfacknowledgment as well. (ps1) the ps drew strength from the work with benefits across their personal lives. “it’s actually been one thing that’s also helped me… to make the right decisions and choices even after i’ve already had my own success” (ps2). can create personal conflicts through their work with pfc, the ps had come to develop an enhanced understanding of the role and motivations of dcj which shifted their perspectives: everyone wants kids to stay in their parents’ care and i guess that’s a common goal and interest which makes it all work. everyone is working together towards the same place. (ps2) however, this perspective also created personal conflicts due to their own interactions with dcj. three of the four ps had had children removed by dcj prior to engaging with pfc and retaining care of their babies. while ps described feeling well supported and connected to pfc and dcj staff, they retained fear and anger from their own experiences which were difficult to resolve. i guess i have two sides of two feelings about dcj themselves [and what] takes place when you keep a child or have a child removed from your care. i guess i had a lot of angry emotions initially… the training has also given me the opportunity to see things from a different side… to be absolutely honest like me even doing this role is me working against my own feelings and emotions in regards to the department themselves… i’m not completely trustworthy of them either even doing this role and then i’ve got to sit in front of a family and tayebjee et al./lived exp in chil protection intervention 393 say ok this is my story this is what happened to me you can have a good outcome if you want to. (ps1) the ps described the importance of being genuine with families and their desire to ensure authenticity in what they promoted and supported. their own experiences could lead them to feel unsure of dcj, despite their support for pfc i was really concerned about what our position was actually like because we’re trying to make families feel comfortable with working and engaging with services. we’re trying to tell them to put your trust and faith in the system to do good for you and if you do that then it will. but at the same time i have concern that i have distrust for the service not doing the right thing by families. (ps1) the longstanding fear of services was hard to shake despite their positive experiences in the role. as parents they continued to observe the power of dcj and at times felt the personal effects of this power, not just the impacts on families: “i feel comfortable and supported but i guess i still am mindful… a challenge is i am working for an organisation that i have to watch what i say to” (ps3). program coordinators coordinators reflected on the findings in relation to the feasibility and sustainability of the ps program. coordinators reflected on the significant achievements of setting up the ps program and the benefits of having the ps workers, with a focus on opportunities for enhancing and sustaining the work. coordinators identified that delay in evaluating the program had allowed them to see past initial achievements of establishment to develop a more nuanced understanding of the challenges of embedding lived experience positions within systems such as health and dcj. if you had asked us initially [for feedback] we might have been incredibly positive…we might have said “lets expand, let’s involve them in everything.” but there has been value in seeing the challenges and seeing the cracks emerge…now i see the need to have things in place to support that process, rather than responding to it in a crisis. (program coordinator 1) their reflections resulted in three key recommendations related to ps roles: opportunities for workforce development; lived experience is part of the role but also requires planning and structure: and there is a need for sustainability. opportunities for workforce development coordinators identified that additional aspects of workforce development for the ps roles had become apparent over time. while the ps had a lot of support and education during role establishment, there were challenges that only emerged after the first year of operation. coordinators identified a need for increased ps positions to ensure a team and to ease burden on individual ps. a team would also create a collegial environment and ensure capacity for engagement in stakeholder commitments, service planning, education and contact with families. having more positions could enable continuity when the ps were not available. advances in social work, spring 2025, 25(1) 394 clarity of role and scope was identified as being necessary to include clear articulation of the period of employment including structured reviews and procedures. opportunities for more specific and targeted training were also apparent. many of the ps had not worked in such an environment before and there were identified needs for additional support around expectations of the workplace, ways to communicate, confidentiality, and boundaries. in addition, mechanisms of supervision required enhancement. supervision was built into the program but the tensions between mandatory and voluntary supervision meant that often the ps only engaged when needed. coordinators saw that regular ongoing supervision could be critical for managing the intersections between personal and professional. alongside professional supervision, they felt that there should be an additional organisational responsibility to ensure the ps have access to long-term therapeutic support externally to promote workforce sustainability and individual wellbeing during and beyond their employment. lived experience is part of the role but also requires planning and structures the lived experiences of the ps were recognised to be at the heart of the work. coordinators observed benefits of lived experience for guiding families through pfc. they also observed over time the challenges of supporting the ps and witnessed the significant changes since establishment in the lives of the ps. coordinators reflected on the risks of vicarious trauma for the ps and the need for trauma-informed strategies to prevent harm. this included ensuring the ps role was clear in its focus on purposeful disclosure of lived experience and not overly disclosing or sharing experiences of violence or harm. coordinators identified a lack of existing policies, procedures, and dialogue around how to best support the ps when challenges in their own lives impacted the work. coordinators identified a need for procedures to ensure the ps were able to be supported to take breaks from work when their own life challenges were interrupting their ability to workwithout this decision feeling unexpected or personal. coordinators identified a need for tools and escalation processes for when the ps may not be able to undertake their roles, as well as reintegration to work processes once the ps were ready to return. conversations about lived experience and expectations of current functioning could be difficult and required additional consideration and transparent communication. coordinators observed the entwining of the roles with the ps sense of self which also brought challenges: when part of the person’s identity is built on having got through, how do we make it safe to talk about when things aren’t going so well without amplifying a sense of failure? (program coordinator 1) coordinators felt that at times the ps did not disclose challenges they were facing in their own lives due to fear of judgement or reporting, but also due to a sense of shame and failure. this was distressing for the ps and coordinators. “when things are not ok…when we ask them to step aside…the response is ‘this is the only thing that's kept me going for a long time’” (program coordinator 2). tayebjee et al./lived exp in chil protection intervention 395 need for sustainability planning coordinators identified the need for careful reflection to ensure sustainability of the program and to ensure ongoing systems of support for the ps. they identified a need for development of governance and reporting mechanisms and tools as well as policies and procedures to support the ps wellbeing. sustainability planning would include consideration of the day-to-day functioning of the roles, as well as establishing clearer pathways of starting and ending the role. coordinators identified that clearer pathways could support the intake of new ps as there were many parents who participated in pfc who expressed an interest in becoming ps. in addition, coordinators felt a responsibility to ensure that the ps were supported at the completion of the employment period to minimise the impacts of the loss of meaningful employment. coordinators identified a need for consideration of how pfc could best support the ps throughout their period of employment and to ensure that pfc was enhanced through lived experience inclusion, while not compromising individuals or families with historical relationships with dcj and health and ongoing psychosocial vulnerabilities. discussion the findings of this case study show benefits of lived experience inclusion in child protection processes for families, staff, and services. the findings also highlight that introducing lived experience positions into systems requires significant reflection, structures, and flexibility to ensure wellbeing and sustainability for those working in the roles. parents engaged with pfc identified the importance of the ps in increasing trust and connection in the lead up to pfc, increasing parent agency and empowerment in the program and aiding understanding of what pfc involves and requires. benefits extended beyond the program, instilling hope for parents that they could get through this period of their lives and find meaning beyond it. professionals identified benefits of working alongside the ps, with the roles altering inherent power differentials that impeded parent trust and engagement, while speeding up their own rapport building through trust transfer. professionals saw the role as a partnership with parents that brought some complexity but demonstrated the importance of the parents’ experience in the process and embodied hope. the ps articulated their understandings of their positions as guiding parents through a difficult time and using their own lived expertise to demonstrate possibilities within and beyond pfc for parents to regain agency and meaning. the challenges the ps experienced in their personal lives at times created moral tensions, as their ps identity was based on having “overcome” their challenges and retaining care of their children and as such, when their personal circumstances changed, it could feel like a failure of role and self. however concurrently, the work was also seen to be worth the challenges due to the enhanced sense of self and meaning, both in the present and in relation to the past. program coordinators reflected on the experiences of the stakeholders, and their own experiences and identified the importance and benefits of the ps roles, while also noting areas requiring ongoing attention to ensure feasibility and sustainability beyond the initial successful implementation period. all stakeholders expressed commitments and desires to continue to support the ps roles as a crucial component of pfc unable to be achieved through other means. advances in social work, spring 2025, 25(1) 396 while peer support workforces have been identified as “best practice,” there remain policy and practice limitations on how to best integrate roles into existing services (rebeiro gruhl et al., 2016). while the benefits of peer support have been acknowledged in child welfare systems for over 20 years (e.g., cohen & canan et al., 2006; frame et al., 2006; lalayants, 2020), there remain significant gaps in evidence about their benefits and how best to integrate formal positions into services (saarheiman et al., 2024). a systematic review in 2022 identified only four papers researching formal peer support roles, none of which were from australia (saeteurn et al., 2022). certainly, the employment of lived experience workers within child protection services is an emerging field with more implementation, evaluation and research required. evidence from mental health settings, where peer workforces are more developed, shows that peer workers are known to experience challenges with vulnerability, boundaries and maintaining authenticity (byrne et al., 2017), as echoed by the parent support workers in the current study. it is important to recognise that these challenges are inherent to the roles and not reflections on the individuals. challenges with the use of self-disclosure and a lack of adequate support and supervision (kemp & henderson, 2012) have been recognised, alongside difficulties in maintaining authenticity with clients while conforming to organisational expectations (miler et al., 2020). boundaries are known to be a challenge for peer roles when there are only sole employees or isolated positions, in systems where there is limited understanding of the purpose of peer work, and where the scope of duties have not been clearly documented (rebeiro gruhl et al., 2016). a 2022 study and review of peer roles in mental health services (janoušková et al., 2022) identified that a lack of clarity of role expectations for peer support workers leads to challenges including discrimination, difficulties in transitioning from patient to peer worker and struggles with identity. the review identified that while roles evolve and change, there is a need for clear definitions, scopes and “rules,” otherwise peer workers experience a multiplicity of expectations with boundary challenges which can lead to stress, exhaustion and burnout. the current study also echoed the need for clear scope, however, any defined scope should retain flexibility, while being clear in expectations (shepardson et al., 2019). developing and articulating shared expectations are recognised as essential for supporting peer workers into the workforce and sustaining roles (berry et al., 2011). there are systemic implications of employing people with lived experience into the same systems from which they have historically or ongoingly received care. the challenges of boundaries and authenticity are not all the work of the incumbents and instead reflect a need for paradigmatic shifts to ensure lived experience is valued within the structures of employment. the coordinators in this study found themselves experiencing moral and professional tensions in responding to wellbeing concerns about their colleagues, without clear pathways or guidance. while early literature on peer work in systems such as mental health identified that the roles could be stressful and could lead to relapse (repper & carter, 2011), as research builds in the area it has become clear that when peer workers have acceptance, value and systemic support, they are no more likely to be negatively affected by the work than any other employee (gillard et al., 2022). yet, studies have described a tension that can occur for people with lived experience who are expected to both fulfil a role of experiential identity, tayebjee et al./lived exp in chil protection intervention 397 while conforming to professional rules and regulations (simpson et al., 2018; voronka, 2019). similarly to the findings of the current study, literature from mental health settings also identifies that undertaking peer roles can benefit the incumbents overall quality of life and sense of purpose (wall et al., 2022), however challenges have been noted by both peer workers and non-peer workers with identifying and responding to concerns about peer worker wellbeing, if they work at the same services from which they have received or are currently receiving services (miyamoto & sono 2012). one proposed strategy to address this concern requires support with the transition from client to staff member, with clear boundaries of who and how personal struggles should be communicated, with acknowledgement that the role sophistication required to enable this requires attention, proactive planning and direction at an organisational level (moll et al., 2009). clear delineated action plans are known to circumvent difficulties and worry before issues arise (moll et al., 2009). similarly, there are examples of readiness assessment processes for services, developed to support family violence victim survivors engaged as survivor advocates both for employees and organisations (parker et al. 2020). such tools could be adapted for the ps both prior to recruitment and regularly revisited during their period of employment. through a recovery lens, acknowledging the lived experience that forms the basis of peer support work also requires acknowledgment that experiences may be ongoing and stages of recovery nonlinear. engaging with both professionals and peers is known to benefit parents engaging with child protection service, with both offering complementary, but different aspects of care (frame et al., 2006). peer support can enhance trust and engagement with child protection services with benefits apparent for parent supporters, professionals, and parents. however, rates of secondary traumatic stress known to be high in child protection workers of all disciplines and potentially higher in those who have their own lived experience (bride et al., 2007). subsequently, care is required to ensure the wellbeing and sustainability of peer support workers working in systems in which they have recently been engaged as clients. despite being a small single site qualitative study undertaken within existing resources and led by pfc staff, this case study is the first of its kind to reflect on the inclusion of lived experience staff in a voluntary child protection intervention program in australia. the findings indicate meaningful benefits of doing so, alongside a need for establishment of clear scopes of practice supervision, workforce safety plans and governance. references berry, c., hayward, m. i., & chandler, r. 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(2022). experiences and challenges in the role as peer support workers in a swedish mental health context-an interview study. issues in mental health nursing, 43(4), 344-355. author note: address correspondence to sophie isobel, susan wakil health building, faculty of medicine and health, university of sydney, camperdown nsw australia 2050. email: sophie.isobel@sydney.edu.au acknowledgements: the authors wish to acknowledge the parent supporters whose commitment, willingness and work made the pilot possible, as well as all the families who generously gave their time and perspectives to this work. orcid: sophie isobel, university of sydney https://orcid.org/0000-0002-1027-5847 https://doi.org/10.3109/09638237.2015.1057322 https://doi.org/10.3109/09638237.2015.1057322 https://doi.org/10.3109/09638237.2011.583947 https://doi.org/10.3109/09638237.2011.583947 https://doi.org/10.5093/pi2024a5 https://doi.org/10.5093/pi2024a5 https://doi.org/10.5093/pi2024a5 https://doi.org/10.1037/ser0000242 https://doi.org/10.1037/ser0000242 https://doi.org/10.1111/inm.12351 https://doi.org/10.1111/inm.12351 https://doi.org/10.1177/160940690900800107 https://doi.org/10.1177/160940690900800107 https://doi.org/10.1016/j.chiabu.2017.01.007 https://doi.org/10.1016/j.chiabu.2017.01.007 https://doi.org/10.5334/ijic.s3091 https://doi.org/10.5334/ijic.s3091 https://doi.org/10.1080/0312407x.2024.2331743 https://doi.org/10.1080/0312407x.2024.2331743 https://doi.org/10.1080/0312407x.2024.2331743 https://doi.org/10.1080/09687599.2018.1545113 https://doi.org/10.1080/09687599.2018.1545113 https://doi.org/10.1353/foc.0.0037 https://doi.org/10.1080/01612840.2021.1978596 https://doi.org/10.1080/01612840.2021.1978596 https://doi.org/10.1080/01612840.2021.1978596 mailto:sophie.isobel@sydney.edu.au https://orcid.org/0000-0002-1027-5847 ________ juliana carlson, phd, associate professor and bsw program director, school of social welfare, university of kansas, lawrence, ks. kelechi wright, lcpc, lpc, assistant professor, school, university of houston, houston, tx. meredith bagwell-gray, phd, associate professor, and amy n. mendenhall, phd, vice provost of faculty affairs and professor, school of social welfare, university of kansas, lawrence, ks. april diaz, ma, msw, assistant professor, school of social work, fort hays state, fort hays, ks. sarah mccall, ma, undergraduate engagement librarian, libraries, nancy jo williams, phd, associate professor, and becci a. akin, phd, professor, school of social welfare, university of kansas, lawrence, ks. linda banda, phd, assistant professor, school of social work, university of vermont, burlington, vt. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 18-35, doi: 10.18060/28154 this work is licensed under a creative commons attribution 4.0 international license. an anti-racist practice in social work research teams: one story of germination and pollination juliana carlson kelechi wright meredith bagwell-gray amy n. mendenhall april diaz sarah mccall nancy jo williams becci a. akin linda banda abstract: social work researchers must intentionally and explicitly be anti-racist in commitments and actions if we are to disrupt, rather than simply acknowledge, racist systems and practices. this article, written by members of several research teams (including research staff, graduate research assistants, and principal investigators), describes an anti-racist team practice, which germinated in one research team and pollinated to others within a school of social work. we share our learnings and barriers, collected via an online, synchronous, anonymous platform, based on engagement in and implementation of the anti-racist research team practice. learnings regarding the antiracist research team practice clustered around three areas: professional individual experiences, takeaways, and ways the practice shaped our thinking about research teams. identified takeaways included the importance of developing an anti-racist lens; a critical understanding of the role of academia in oppressive systems; transferring anti-racist content to other (non-research) areas; and augmenting our sense of responsibility to take action to combat racism. anti-racist research team practices are one mechanism to disrupt “white logic, white methods” of normative research that is embedded in and perpetuates oppressive systems. furthermore, sprouting anti-racist practices at the research team level can create a stronger culture of anti-racism within the social work discipline. keywords: research team, anti-racist, social work, team practice social work researchers commonly work in teams to meet the aims of a specific research project or to collaborate on shared goals in a longer-term research trajectory. many factors shape social work research teams’ functioning, including team composition, the organizational culture of the team’s larger structure, and funding source. within the united states, white supremacy culture, defined as about:blank carlson et al./anti-racist swk research teams 19 the widespread ideology baked into the beliefs, values, norms, and standards of our groups (many if not most of them), our communities, our towns, our states, our nation, teaching us both overtly and covertly that whiteness holds value, whiteness is value. (okun, 2021, p. 4) this also manifests itself at the organizational level of all teams. for example, research teams, seen through the critique of white supremacy, are often plagued with a sense of urgency, get trapped within either/or thinking, or place greater value on team members’ written contributions compared to other equally valuable or more necessary contributions that sustain the project (okun, 2021). joining other social work researchers in naming that “most researchers in the united states do not practice antiracist research” (goings et al., 2023, p. 103), we assert that the persistent influence of white supremacy culture in social work research teams should compel research team leaders and principal investigators to seek out team-focused remedies and antidotes using anti-racist strategies. “anti-racist” is a term brought into the national vocabulary by dr. ibram x. kendi (2019) with his book how to be an anti-racist. being anti-racist within a research team means “being” so across all aspects of the research process (palmer et al., 2022). further, based on the clear axiom from kendi’s work: there is no such thing as “not racist,” there is either racist or anti-racist; an anti-racist social work research team actively pursues the embodiment of being anti-racist. furthermore people (or, in this case, teams) are not either racist or anti-racist; every team will make a combination of choices, some being racist and some being anti-racist, with a goal of shifting the balance towards a greater and more consistent combination anti-racist practices (kendi, 2019). this framing demands then that social work research teams take action to become aware of how racism is woven into every part of the research endeavor and perform regular practices to build that awareness and (re)design how they approach research from start to finish (goings et al., 2023). this manuscript tells the story of how social work research teams within one school of social work responded to this call for action. as the seeds for anti-racist practice began to germinate and grow within one team, they inspired others toward action through pollination across multiple teams. context setting in accordance with professional social work values and guiding ethical principles, “social workers challenge social injustice” (national association of social workers [nasw], 2017, para. 3). this is echoed in the council of social work education’s 2022 educational policy and accreditation standards, particularly explicitly naming an “antiracist and anti-oppressive" foundational orientation to social work education. with this call to action and professional commitment, it is essential for social work scholars to be explicitly anti-racist in our research praxis—that is, the iterative process of reflection and action within our research practices as we move between practice and theory (freire, 1985; leavy, 2017). anti-racist scholar activism—that is, choosing to use our positionality within academic institutions as a site of resistance by combining scholarship and activism— is “something we do, rather than something we are” (joseph-salisbury & connelly, 2021, p. 2). in the practice of anti-racist scholar activism, social work scholars can learn from and contribute to a robust and growing body of academic research and scholarship that advances in social work, spring 2025, 25(1) 20 interrogates and resists neo-liberal assumptions and methods of knowledge production, which reproduce systemic and structural racism (e.g., strega & brown, 2015; zuberi & bonilla-silva, 2008). within the authors’ home institution, a critical perspective guides our work as follows: we engage in deliberate and continuing examination of social conditions and solutions. we use critical inquiry to analyze and challenge existing structures and systems in order to advance the field and promote social, economic, and environmental justice. (university of kansas school of social welfare [kussw], 2020, p. 10) anti-racist scholar activism is an important, specific component of our more general antioppressive and critical focus. to set the context of our work of collectively growing in our service to communities of resistance through anti-racist research through research teams, we review principles of anti-oppressive research praxis more generally, apply them to antiracist research praxis more specifically, and identify core tenets of critical race theory (crt). this background provides context setting for how we applied the associated principles, practices, and theoretical constructs within and across our research teams. anti-oppressive research and anti-racist research praxis critical, indigenous, and anti-oppressive research have served (and can serve) as a model for anti-racist practice on research teams. anti-oppressive research can be defined as engaging in research praxis that intentionally avoids contributing to systemic harm towards people who have been marginalized and minoritized by systems of oppression while focusing efforts on systemic and institutional justice (lavallée, 2014). because critical, indigenous, and anti-oppressive frameworks are connected to a broader realm of combating harmful practices in research across all intersections of marginalized populations, they offer a foundation for employing racial and ethnic anti-oppressive research methodologies more specifically. potts and brown (2015) outline three tenets of anti-oppressive research. as the first tenet, anti-oppressive research is socially just in every step of the research process, thereby extending the goal of social justice in research outcomes to social justice in research processes. socially just research processes begin with asking research questions that shift our focus from studying people who are at the margin to people, systems, and structures that dominate. for example, according to the boston university center for anti-racist research (n.d.), conducting anti-racist research starts with asking anti-racist questions, which direct researchers’ gaze toward the root causes of inequity. specifically, antiracist questions ask, “what is wrong with policies?” as opposed to “what is wrong with people?” socially just research processes also question and interrogate power differentials between the researcher and those being researched, asking how research participants can also be the researchers and ensuring equitable distribution of credit, resources, and benefits of the research (potts & brown, 2015). second, anti-oppressive research rests on epistemological claims that all knowledge is socially constructed and political (potts & brown, 2015). people co-create knowledge carlson et al./anti-racist swk research teams 21 based on their social and political positioning—that is, based on aspects of their identity, such as race, class, gender, ability and so on—which speak to one’s relative power and privilege; therefore, “it is created within and through power relations” (potts & brown, 2015, p. 19). for anti-racist research specifically, deliberate attention is paid to race, ethnicity, and color with the intersections of these identities (kendi, 2019). third, anti-oppressive research foregrounds relationships and, in so doing, rejects the hierarchical and paternalistic research structures wherein researchers are “experts” and coauthors are objects of study (potts & brown, 2015). with this relational orientation, “constant attention is given to” key relationships and their attendant power relations, “and care is taken to try and shift the balance of knowledge-creating power from outside researchers to those with lived experience of the issue under study” (cegaloski, 2000, as cited in potts & brown, 2015, p. 21). relationships are also seen as long-standing rather than disposable upon the completion of the research project. in anti-racist research, this means relational accountability in terms of moving from critical reflexivity to action; for example, for white researchers, an important part of relationship building with racialized research participants is naming both one’s whiteness and one’s anti-racist stance with them as a part of the research process (mayor, 2022). anti-racist research is necessarily community engaged research: “without community input or intentional collaboration, research with communities becomes vulnerable to a myriad of oppressive practices that can derail social-justice oriented goals,” (palmer et al., 2022, p. 225). building and maintaining anti-racist researcher-community partnerships necessitates considerable time investment for transparent conversations about the purpose of the research and the researchers’ intentions at project initiation; learning about the community's history, including its history of trauma and resilience; identifying and connecting with key organizations and community leaders; and learning verbal and non-verbal nuances and cultural codes for communication (collins et al., 2018; flicker et al., 2007; palmer et al., 2022). primarily, anti-racist researchers should align their goals with the goals of the community (palmer et al., 2022). applying critical race theory to social work research teams’ work critical race theory (crt) has a long influential rhetorical and material history interrogating the academy and research (yosso, 2005). at the same time, crt has been used to question and transform the constructs and functioning of endeavors within and outside the academy. writing about this, yosso (2005) states, “crt finds that racism is often well disguised in the rhetoric of shared ‘normative’ values and ‘neutral social scientific principles and practices” (p. 74). this application of crt has also included social work research (constance-daftary, 2020), education (abrams & moio, 2009; constancehuggins, 2012), practice and policy (kolivoski et al., 2014; razack & jeffrey, 2002). while many crt formulas are offered in different fields and texts, for the purpose of this manuscript, we look to social work scholars for key tenets. kolivoski et al. (2014) provide five central tenets by which they examine social work practice and policy; they are “racism as ordinary, the critique of liberalism, whiteness as ultimate property, interest convergence, and the unique voice of color” (p. 270; see article for full review of scholarship supporting these tenets). with these tenets in mind, the application of crt advances in social work, spring 2025, 25(1) 22 to social work research teams fits well within an anti-racist approach. crt was applied to this research context in that it was the foundational theory used as an anchor to guide the various research teams in the work. crt provided a critical lens to engage and approach research related tasks and steer efforts towards an anti-racist approach. anti-racist practices in research teams while the literature on “doing” anti-racism in social work (and sister disciplines) research is on the rise particularly in the last few years (e.g., goings et al., 2023; waller et al., 2022), there still is a paucity of writing about how anti-racist practices occur or could occur in teams conducting research. in other words, strategies to make research anti-racist have been limited mostly to the research process, including sampling, methods, and dissemination. writing with explicit attention to the individuals making up an anti-racist research team is surprisingly thin. in their recent article, goings and colleagues (2023) provide a needed exception, describing clear research team roles in anti-racist research, including principal investigator and team personnel, as well as training and ethics. others have written about diversity, equity, and inclusion in research teams (hatterty et al., 2022), and about anti-racist or racial equity research that could be applied by research teams (e.g., hawn nelson et al., 2020; sukhera & palaniyappan, 2022), although this application is implied rather than described in detail to be utilized in team functioning. overall, documentation on developing and sustaining anti-racist research teams, within social work and beyond, is sorely lacking. aims and structure this article describes how an anti-racist practice germinated in one social work research team and through a natural pollination process bloomed in multiple research teams at the same school of social work and subsequently grew into their work with community partners. the aim of this article is twofold. first, by sharing this journey, including the practice itself, we seek to engage in direct dialogue and new learning with fellow social work research teams who are striving to be anti-racist in their research teams (and beyond). we have much to learn and welcome critique. second, we join with other students and researchers to move out of the “not racist” research team status quo by acknowledging that we were trained (without our full awareness) within a white supremacist system and structures, including, uniquely so, the academy. with these two aims in mind, we structure this article into five sections. first, we provide positionality statements as authors, motivated to define our positionality as a form of transparency in our writing and to make explicit the power, privilege, and team-level dynamics relevant to research teamwork including team roles (e.g., principal investigator, graduate research assistant, research staff). then, we describe the germination process for the anti-racist practice, including the history, context, and motivation for the practice, along with a description of the practice as it normed to become with one research team. next, we convey the pollination of the anti-racist practice. here, we outline the experience of two additional research teams with different principal investigators and a university research office. following that outline, all authors contribute to a synthesis of what we learned carlson et al./anti-racist swk research teams 23 through our engagement in and implementation of the anti-racist practice. this section is organized with our positionalities at the center to focus on learnings within our distinct roles relevant to the nature of research teams. finally, we identify our desire to join with other social work researchers in ongoing learning in anti-racist practice within social work research teams. positionality statement all authors at the time of writing are connected in one or more ways to the university of university of kansas. the authors are all cis-gender women. our racial/ethnic identities include three biracial (south or east asian and white), three black (african american, malawian, nigerian-jamaican american), three white, and one white mexican american. five are principal or co-principal investigators, three are (or were when they were on the teams) doctoral students/graduate research assistants, and one staff member. all authors were members of the research teams that implemented the anti-racist practice; of those, six were a part of the team where it originated. lastly, from a positionality standpoint, it is important to note two of the five principal or co-principal investigators are bi-racial, three are white, and three of the five principal or co-principal investigators hold administrative positions. germination in this section, we describe the germination of the anti-racist practice in the research team that originated the practice. the term “germination” is used to reflect the organic and dynamic nature of growing, literally speaking of the energy and conditions needed in the transformation from a hard small seed to a seedling and eventually, when the conditions are suitable, a plant. in this case, the condition for the germination of the anti-racist practice in research teams was a specific federally funded project. therefore, the history and purpose of that project is fundamental to understanding the germination of the practice. the following describes the federally funded project and the research team’s motivation to respond in action to the overall project’s principles over several years, including the onset of covid related impacts on the project. history and context setting: the qic-dvcw research team in 2016, the university of kansas school of social welfare (kussw) research team entered into a cooperative agreement for the five-year project, the quality improvement center on domestic violence in child welfare (qic-dvcw). the qic-dvcw developed six guiding principles of the adult and child survivor centered approach (acsca), to “provide the foundation for expanding the range of responses and improving outcomes of families who are experiencing domestic violence and are involved in the child welfare system” (carlson et al., 2023, p. 2). these principles are collaboration, connectedness, planning with survivors, unique strengths and challenges, equity (i.e., racial, ethnic, and gender), and healing and well-being. while each of the principles are foundational, equity surfaced early on as a location of both aspiration and struggle for the qic-dvcw management team and the technical assistance team, but also specifically for advances in social work, spring 2025, 25(1) 24 the kussw qic-dvcw research team. specifically, as planning for the project evaluation unfolded, issues surfaced regarding how systemic racism infiltrated every aspect of the project work and therefore the evaluation. namely, project partners brought forward concerns about selected measurement instruments, in that they reproduce white norms about core constructs of the project, including parenting, collaboration, domestic violence, and healing. concerns grew and led to tension within many of the project workgroups to develop instruments for the studies. during this initial development timeframe (2016-2018), the research team was led by three faculty members at the kussw and included a research associate/evaluation manager and several graduate research assistants. starting in 2018, all three principal investigators (including two coauthors, initials j.c., b.a.a.) were simultaneously a part of qic-dvcw based voluntary group with the specific aim of decreasing harm perpetrated by white folks within the projects. in addition, our analysis on how insidious racism and white supremacy culture was in research practices, including the work of the qic-dvcw team, grew to the level of recognition that we needed to have structure that would disrupt normative research and team practices and inform team norms and decision-making. although the team was beginning to understand how much we did not know and how many assumptions about fairness and rigor were baked into their work, we lacked the mechanisms and skills to act effectively within the overall project’s principles. motivation for and pathway to the anti-racist practice in 2018, informed by the above, the qic-dvcw research team initiated the development of “qic-dvcw evaluation team principles” to guide our work. the development work took approximately one year and occurred in phases as our team collectively wrote our principles through a process of reflection, discussion, and wordsmithing, culminating in our establishment of five principles: (1) pursue racial equity, (2) center the voices of families, (3) practice a collaborative approach, (4) conduct antioppressive research that translates to positive social change, and (5) be kind and courageous. during this principles work, i [j.c.] stepped into a greater leadership role as the primary pi in january 2019. based on my personal [j.c.] engagement in using the “antidotes” to “white supremacy culture characteristics” (okun, 2016, 2021), i started a time for sharing appreciations during research team meetings. the purpose of the appreciations time was to “develop a culture of appreciation, where the organization takes time to make sure that people's work and efforts are appreciated” as an antidote to the white supremist characteristic of perfectionism (okun, 2016, p. 2). the team identified the value of the appreciation practice. then, in fall 2019, i [j.c.] adapted a team-based activity of reading okun’s (2016, 2021) work for the qic-dvcw research team, thus contributing to the initiation of the anti-racist practice described below in our weekly research team meetings. carlson et al./anti-racist swk research teams 25 description of an anti-racist practice in a research team the qic-dvcw research team’s anti-racist practice was a weekly, prioritized activity that always included a chosen reading and reflection. sometimes the reading was paired with appreciations. each team meeting started with this anti-racist practice, lasting for approximately 20 minutes, and setting the tone for subsequent discussions about project decisions that occurred within this and other project meeting spaces. the choice to protect time can be challenging when faced with managing a logistics-heavy project with regular deliverables, therefore the practice becomes an act of resistance against white supremacy norms of a sense of urgency and quantity over quality (okun, 2021). the short-term loss of time was more than rewarded by deeper insights into how a team approaches their daily and weekly tasks, resulting in more gains over the long-term scope of a multi-year project. to offset the short-term discomfort of doing something different, the practice required a buy-in from all team members followed by a consensus-based, collaborative approach to shaping the practice, including how the team selected readings, engaged the readings, and engaged each other within this discussion space. the research team practice evolved and deepened overtime and through the onset of covid. the qic-dvcw evaluation team members worked together to identify possible readings and created a centralized “anti-racism readings” file folder within the project’s shared drive where any team member could add materials. we agreed to identify readings and other media sources that would be easy to engage in incrementally to facilitate deeper discussions related to research and scholarship. iteratively, we discussed and came to a consensus on what readings to focus on over the course of a few weeks to months depending on the length of the document. over several years, the team collected, selected, and read a wide selection of articles, sometimes choosing specific sections and other times reading the entire article. examples of what we read include: • black lives matter, and yes, you are racist: the parallelism of the twentieth and twenty-first centuries (mccoy, 2020) • how to embed a racial and ethnic equity perspective in research (selected sections; andrews et al., 2019) • ten counterproductive behaviors of well-intentioned people (charles, 2016) • transformational collaboration (from caminar latino/latinos united for peace and equity; white starr, 2021) • white supremacy culture (in dismantling racism workbook; okun, 2016) • why am i always being researched? (select sections; chicago beyond, 2018) the team also agreed upon a process of how to engage the readings. to help all members ground themselves in the materials and create a collective practice, the team read, processed, and discussed the readings within the time set aside during the weekly meetings. we agreed to limit outside reading, instead opting to read small sections of the material out loud during the meeting. given the intuitional and system issue of racist practice in research, this choice prioritized our collective accountability instead of shifting responsibility to individuals; it also ensured that all team members could fully participate in our anti-racist practice, regardless of their time constraints and responsibilities outside advances in social work, spring 2025, 25(1) 26 of our meeting time. team members also identified that hearing the words together as we read them aloud was powerful and familiar, as in an oratory tradition. during the reading time, team members agreed to take turns reading a small section of the material out loud, creating a shared sonic experience and slowing everyone down to be present with the text through visual and auditory cues. overall, the process was characterized by shared responsibility for facilitating the discussions, which was readily applied since the practice followed a clear, simple structure and relied upon reading in a round-robin format followed by reflections. like any new practice, the consistency of applying this process repeatedly helped the team build their anti-racist muscles; initially, it was new and uncomfortable to many, but with time, it was expected and appreciated. the qic-dvcw research team identified three beneficial components of the practice. first, the regularity of the practice was critical to reminding individuals that equity work is an on-going practice, not an outcome to be achieved. second, the team approached conversations using radical candor, allowing for honest and sometimes uncomfortable conversations, creating a culture that centered on dialogue, trust, and feedback. third, the practice was an ongoing reminder that all team members should be mindful of positionality when thinking about how we approach our own work and how the team approaches each stage of the research process. for example, there was open dialogue about how the team was meaningfully engaging interested communities and partners. as another example, the team had ongoing conversations about the appropriateness of validated scales to measure marginalized experiences and had to move into spaces of discomfort to find and create measures that both partners and researchers could agree upon. these conversations held during the anti-racist practice lent themselves well to ongoing reflection on how to approach the analyses and subsequent interpretations in a way that did not further harm families experiencing co-occurring child maltreatment and domestic violence. in summary, this specific anti-racist reading practice shifted the team culture by modeling how to show up to anti-racist practice within the team setting and, subsequently, to the evaluation work itself. pollination: spread and uptake by other project teams pollination of the anti-racist practice occurred in powerful yet unique ways and into multiple spaces because the research team leads (e.g., principal investigator) intentionally introduced it after exposure to the practice. here two such examples are provided. the first is within the kansas strong for children and families (kansas strong) and the second is within the work of child and family research team. first example: kansas strong for children and families the positive experience i [b.a.a.] had with the anti-racist practice, as well as the skills developed from applying it in the qic-dvcw team, served as a springboard for bringing it to other teams with which i work. also important were influences from my interactions with the qic-dvcw technical assistance (ta) team, another project’s work on racial disparities with kristin weber, then of the center for the study of social policy (cssp), and my personal anti-racism learning journey. i worked collaboratively with ms. mccall carlson et al./anti-racist swk research teams 27 to consider and plan for bringing the anti-racist practice to the project team of kansas strong. as with the qic-dvcw ’s evaluation team’s practice of sustained and prioritized anti-racist activities, the kansas strong team engaged in a weekly collective learning and listening practice around anti-racism and anti-oppression that, at the time of this writing, continues to develop, affirm, and further the team’s commitment to racial and social justice, and their capacity to understand and challenge norms, systems, and their own positionality and assumptions that uphold white supremacy (e.g., scrutinizing how being a white researcher trained in white normative universities influences processes). the fit and usability of the anti-racist practice with the kansas strong team were straightforward because of significant alignment with the project’s values, ways of work, and existing project activities, such as conducting an institutional analysis (ia) of racial disparities in child welfare and engaging parents and youth with lived experience in system-level initiatives. while the kansas strong research team adopted the practice without major revisions, applications of this practice rooted and grew with some variations. for example, the kansas strong team was comprised of faculty researchers, doctoral students, and staff. at the team level, antiracist discussion and reflection came from various sector-related lenses: research, evaluation, implementation, child welfare practice, project management, graduate student perspectives, along with team members’ personal and intersecting identities and power differentials. kansas strong’s antiracist team practice yielded additional offshoots at the community, systems, and practice/program level. kansas strong is governed by a 50+-person steering committee comprising child welfare managers, community-based leaders and advocates, and parents with lived experience of the child welfare system. with technical assistance from cssp, the project undertook an ia, aiming to center the experiences of black families involved in the child welfare system and discover ways institutions’ policies and practices misalign with black families’ needs and strengths (wright et al., 2022; weber & morrison, 2021). while inequities and disparities were markedly apparent for black, indigenous, and latinx families, the technical assistance providers strongly advised the steering committee to establish a focus on a specific, well-defined subpopulation of families. after multiple discussions, the committee decided to conduct the ia with a focus on the experiences of black families of young children in this specific community. in the process of conducting the ia, the steering committee adopted a covenant on racial equity in child welfare (laliberte et al., 2021), which laid out guiding principles as an accountability mechanism for taking firm action to address racial inequities within the community, instead of conducting extractive research that offers no tangible benefit to the community being studied. building on the momentum of the ia and the pledge of the covenant, a new initiative took root that aimed to provide infrastructure and support to a coalition led by black community members who are pursuing progress toward racial equity in a local child welfare system. at the systems level, the team was invited to be a founding member of the kansas racial equity collaborative, a statewide group that is building shared knowledge and accountability to achieve racial equity in child welfare. at the practice and program level, the wing of the kansas strong team that developed a strengths-oriented, skills-based coaching program included anti-racism as one of six priority topics for the program. in advances in social work, spring 2025, 25(1) 28 sum, the anti-racist practice at the team level nurtured an outgrowth of multiple initiatives and practices that created actions toward racial equity. second example: child and family research team upon hearing about the anti-racist practice being implemented in the qic-dvcw and kansas strong teams, i (a.n.m.) was eager to learn more to apply it in the child and family research team i was leading. in my role as associate dean, i invited the qic-dvcw research team to present about their anti-racist team practice at a school research conversation, which was open to all faculty, researchers, and doctoral students. the research conversation was a critical moment in the school, amplifying the importance of anti-racist work not just in the classrooms and in teaching but also in how social work scholars do research and scholarship. the qic-dvcw research team presented the antiracist practice described above that could be easily adapted into diverse projects and teams. after the research conversation, i adapted this practice for use in the child and family research team i lead, which includes students and staff from various projects. within that team, the practice has looked similar, with the team initially reading aloud and discussing some of the anti-racism readings mentioned above, and then expanding to also include readings related to broader anti-oppressive research design, with a different team member picking a reading each meeting. the primary difference with the practice in this team has been that the members represent multiple projects and did not come together except in the context of the bi-weekly multi-project team meeting. this difference meant that team learnings and reflections were brought back to various research projects for broad impact, but also meant that team discussions about direct application were more difficult because members did not work together daily or have knowledge about details of each project represented in the group. what we learned in drawing conclusions for this section, we coordinated a meeting as co-authors of this article to consider what we have learned and continue to learn from our experience with these anti-racist practices within our respective research teams. during our brainstorming session, we used an online, synchronous, anonymous forum to write down our lessons learned across three main categories: (1) professional individual experiences, (2) takeaways, and (3) ways the practice shaped thinking about research teams. three coauthors (k.w., j.c., m.b.g.) agreed to take these brainstorming documents and synthesize and summarize a written overview of themes from our collective experiences. then, all coauthors were given the opportunity to edit and add to the section to ensure it accurately reflected our experiences. professional individual experiences about/with the anti-racist practice reflecting on this work, we expressed an appreciation for our experiences engaging in the process. within the realm of process, elements such as the collaborative selection of reading materials and the power of reading texts aloud together were beneficial to building community and shared decision-making in the anti-racist work. many of us also felt that carlson et al./anti-racist swk research teams 29 reading aloud together was beneficial insofar as it allowed us to better gauge how others on the team were responding to and thinking about each reading’s content. this practice of reading aloud further removed any pressure to carve out time to read prior to meetings. as such, it became more feasible to incorporate and sustain anti-racist practice into the team priorities. enabling sustainability, the regularity of the practice and knowing that it would occur each week allowed us to stay grounded in intentionality and to carve out mental space for engaging in the content. this consistency in prioritization intentionality promoted the “infusion” of anti-racism in the research team—that is, focusing on permeating anti-racism into everything we do—as opposed to an “integration” approach wherein anti-racist practices remained outside of and additional to the team’s core work. from a student team member-co-author’s perspective, i (l.b.) appreciated the added benefit of learning from this experience in my early career. as such, the anti-racist practice provided a framework and foundation for my research that i can now build upon throughout my career and eventually take to other institutions. from my (l.b.) perspective as an international student, the anti-racist practice provided a space to learn about what antiracist practice looks like not only in research teams but also within the u.s. academic context. takeaways about the anti-racist practice we collectively identified four primary takeaways from our anti-racist practice including 1) the development of an anti-racist lens; 2) a critical understanding of the role of academia in promoting oppressive systems; 3) the ability to transfer the anti-racist content discussed to other, non-research areas of our lives; and 4) augmenting our sense of responsibility to take action to combat racism. the first takeaway was our development of an ever-present anti-racist lens. inherent in this work was a realization that we could not be neutral with regards to racism, necessitating that we actively work to be anti-racist in our research work specifically. members shared that we learned to devalue “objectivity” as a goal of research and learned to see how what we often defined as “knowledge” can reflect and further white norms and thus white supremacy. learning to see through an anti-racist lens further meant understanding how anti-racism could be incorporated into every step of their research. as one of us shared during the brainstorming and reflection session, “being anti-racist as a researcher ... is not just in my mind. it isn’t just in the way i construct variables, in the way i create an instrument, in the way i incentivize co-authors, in the way i write grant proposals; it is in all the spaces.” second, related to the ability to see through an anti-racist lens, we gained an understanding of how academia in general promotes racially oppressive systems. values within academia, including perfectionism and individualism stem from and reinforce what okun (2021) calls white supremacist culture. many of these values are ones we came to internalize as the normed, desirable values within society. engaging in the anti-racist practice, then, required us to unlearn these and become aware of where our “truth” about what is normal and expected was problematic and harmful. it also helped us to be more mindful of other scholars’ positionality when reading their works and reflect on potentially advances in social work, spring 2025, 25(1) 30 problematic assumptions that could inform what they present as “fact” or “evidence.” for example, the federal prevention clearinghouse, which espouses to identify child welfare interventions with the strongest evidence, and which does not require transparency of researcher positionality, has denied nearly all submitted culturally relevant interventions from being identified as having adequate evidence for their mark of approval (i.e., "well supported"). given our growing understanding of how academia supports and sustains racism if not interrupted and resisted, engaging in the anti-racism practice meant recognizing we did not and could not fix systemic racism in research alone; rather, we need to and can collectively work on changing the culture of academic research teams. this shift in perspective led to a decentering of the self and a greater focus on the collective and collaborative. third, we shared that the anti-racist practice can be applied to other areas of our work, such as in the classes we teach or in our work with community partners. for example, many of us now plan and budget for cultural consultation with other racial justice experts so that we can provide feedback and blind spots and to ensure practices align with anti-racist values. importantly, the practice also had implications within our personal lives. we recognize that these are the lenses we should use not only in our work and research, but also in our everyday lives. anti-racist practice should go beyond just writing about it, but also ensuring that in all spaces we are in, we should live it. as a fourth and related takeaway, we learned that to be anti-racist in our research praxis it is less important to think about what is racist about research in general and more important to think very specifically about what is racist about our own research and our own practices and decisions within academia. given the pervasiveness of systemic racism in all aspects and steps of the research process, we and our team members recognize that every member of the research team – students, research staff, principal investigators, etcetera – has a role in contributing toward infusing anti-racist practice in our research. however, as we name power dynamics within teams, the principal investigators stress here, how important being anti-racist in team leadership is for an anti-racist research team. the ways the anti-racist practice shapes our thinking about research teams the anti-racist research team practice shapes our thinking about research teams. fundamentally, the practice has supported our anti-racist process of “unlearning” beliefs, norms, and standards we have been taught about how research should be conducted and how research teams should function. those areas of unlearning include rejecting the importance and superiority of individual contributions and redefining the conceptualization of rigorous research. this understanding is grounded in our recognition that we have been taught guidelines that are often misaligned with being anti-racist. additionally, the anti-racist practice shapes our thinking about research teams as it relates to the importance of manifesting collaboration and collectivism in the research teamwork, identifying these as antidotes to white supremacy culture in research. it was clear to us that team discipline to an anti-racism practice was a powerful way to establish team identity and culture and thereby work more collaboratively. carlson et al./anti-racist swk research teams 31 lastly, we have experienced a growing awareness and have changed our behaviors related to our positionality as research team members, more directly attending to the inherent power differentials. the anti-racist practice was powerful in challenging and scrambling notions of authority, expertise, and attribution (e.g., who gets the credit for research works). namely, for those of us who are principal investigators of research teams, the implementation of and commitment to the anti-racism practice shapes our awareness that we have the power to change team culture. this power to change is directly linked to our accountability as social workers to the professional national association of social work code of ethics, which includes “challenging social injustice.” with an acknowledgement that research can be an oppressive enterprise, we have discovered ways in which research teams and our specific team practices can challenge the injustice within it. implications since social work research is deeply connected to social work practice as a mechanism to introduce and test practice and theory, creating norms of anti-racist research practices in research teams is past due in the social work field. rigorous research and training can be conducted with anti-racist approaches in mind. anti-racist research teams can question what used to be presumptively accepted (by ourselves and our profession) as okay and be open to new ways of conducting research that can make it more inclusive and relevant to a wider audience. this goes beyond “culturally relevant research.” anti-racist research is novel because it acknowledges the structural and systemic racism that permeates every us institution and its practices. without intentional unlearning and explicit practices to be antiracist (i.e., not neutral on racism), research will be racist. anti-racist research team practices, like the one described here, can disrupt the normative practices in research that are embedded in white supremacy and help to perpetuate oppressive systems. furthermore, germinating anti-racist practices at the research team level can create a stronger culture of anti-racism within the social work discipline since research disseminates into the practice level in overt and covert manners. observing the pollination and germination process described here suggests that antiracist research frameworks require more of an infusion at every level and stage of the research process rather than just inclusion. infusing anti-racist theory and methodology can help to ensure that an anti-racist and anti-oppressive lens is maintained throughout the research trajectory, and a team practice establishes a mechanism for promoting anti-racist actions and accountability in the research team. however, having established that there is a gap in the literature as it relates to anti-racist research teams, it is recommended that the generation of more scholarship is needed to continuously challenge research practices at the team level because of its role in the production of research. as the social work academy is constantly influenced by ever-changing institutional factors in society overall, anti-racist research literature in social work is especially needed, to continuously ensure that research practices over time are not complicit with oppressive practices that marginalize and harm as the research world evolves. it is also recommended that anti-racist research practices replace antiquated notions of cultural competence which advances in social work, spring 2025, 25(1) 32 assumes that expertise and proficiency especially in cross cultural/ethnic research can be mastered. anti-racist research bears more relevance in establishing that more productive means forwards are creating a culture of anti-racism rather than false beliefs of competency, that are often rooted in white supremacy. barriers: what we faced, what other research teams could face we identified many barriers to implementing and sustaining anti-racist practices in research teams based on our experience. some of these barriers are within our own teams and some barriers are within the larger academic and research apparatus (for a rigorous discussion of barriers within larger academic and research spaces in social work see: going et al., 2023 and waller et al., 2022). first, we experienced tensions associated with taking risks to infuse our work with anti-racist approaches, which we anticipated might not be well received by funders or institutional collaborators. a remedy for this was finding solidarity with those who were a source of encouragement amid opposition. the examples traced in this article showed how such efforts can have real earth-moving impact (one university and colleagues’ community garden) over time. second, the transient nature of research teams comes with the risk of leaving gaps in the accumulative knowledge of and engagement with an anti-racism practice like the one described. since research teams' function in collaborative spaces change with funding source transitions and when students and faculty move to other projects, team composition can rotate rapidly. therefore, consistently implementing an anti-racist stance at the research team level in an ongoing way (as opposed to a singular training or seminar) can ensure anti-racist practices are constantly being infused into the team. third, we also experienced that our research teams operate with gaps in various areas of diversity. for example, one of our research teams found that creating accommodating spaces like race caucuses can be helpful when there are few people of color on the team, with the goal to display radical empathy and candor. race caucuses created a sense of solidarity and reprieve to keep engaging material that was deeply personal and painful. additionally, we identified that people are at various levels of willingness to engage and challenge themselves and their positionality, and when individuals' levels are low it can be a potential barrier to the team overall and their participation in the anti-racist practice. in considering positionality, i [j.c.], as a white person, admonished that white people should do their own work inside and outside of multi-ethnic and racial groups engaged in antiracism work so as not to dominate conversations and engagements about their own experiences. this is particularly relevant to note, as mentioned above, given that half of the principal investigators were white, and given that this is the norm in social work research teams, with the disproportional number of white social worker academics (goings et al., 2023). lastly, some of us also acknowledged that it was difficult to engage materials that challenged our complicity with racism in the research field in the past. yet, after committing to embracing consistent anti-racist frameworks in research, what was formerly uncomfortable, later became more normal. one contributor even stated that it became uncomfortable to collaborate with teams that did not approach their research with an antiracist stance. carlson et al./anti-racist swk research teams 33 conclusion the social work discipline was generated, created and has been sustained in a society rooted in white supremacy and systems that racially and ethnically oppress (wright et al., 2021). since the massive and pernicious problem of racism remains at the roots of the discipline, the evils of these oppressive structures permeate through the entire field (wright et al., 2021). anti-racist research does not require uprooting the social work field, which is impossible from a crt understanding that asserts that racism is in the fabric of our society, but by radically changing and reforming our research framework, including how research teams function. this article provides a viable introductory model, which is one approach (not the only way), to an anti-racist research team practice, for social workers who seek to be anti-racist researchers. references abrams, l. s., & moio, j. a. 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(2008). white logic, white methods: racism and methodology. rowman & littlefield publishers. author note: address correspondence to juliana carlson, school of social welfare, university of kansas, lawrence, ks, 66045. email: jmcarlson@ku.edu funding acknowledgement: this work was partially supported by the quality improvement center on domestic violence and child welfare and the kansas strong for children and families projects, which are funded by the children’s bureau, administration on children, youth and families, administration for children and families, u.s. department of health and human services [respectively 90-ca-1850 and 90-co-1139]. the article’s contents are solely the responsibility of the authors and do not necessarily represent the official views of the children’s bureau. author orchids: kelechi wright https://orcid.org/0000-0002-0636-445x meredith bagwell-gray https://orcid.org/0000-0002-5485-5448 sarah mccall https://orcid.org/0000-0003-0097-7834 nancy jo williams https://orcid.org/0000-0003-2741-9293 becci a. akin https://orcid.org/0000-0003-0026-5730 linda banda https://orcid.org/0000-0002-0863-5049 juliana carlson https://orcid.org/0000-0003-0372-5552 http://www.jstor.org/stable/41669763 https://doi.org/10.1016/j.psychres.2021.114343 https://doi.org/10.1016/j.psychres.2021.114343 https://doi.org/10.1086/722974 https://doi.org/10.1086/722974 https://caminarlatino.org/wp-content/uploads/2020/12/transformationalcollaboration.pdf https://caminarlatino.org/wp-content/uploads/2020/12/transformationalcollaboration.pdf https://doi.org/10.18060/23946 https://doi.org/10.18060/23946 https://doi.org/10.18060/23946 https://www.jstor.org/stable/48663459 https://www.jstor.org/stable/48663459 https://doi.org/10.1080/1361332052000341006 https://doi.org/10.1080/1361332052000341006 mailto:jmcarlson@ku.edu https://orcid.org/0000-0002-0636-445x https://orcid.org/0000-0002-5485-5448 https://orcid.org/0000-0003-0097-7834 https://orcid.org/0000-0003-2741-9293 https://orcid.org/0000-0003-0026-5730 https://orcid.org/0000-0002-0863-5049 https://orcid.org/0000-0003-0372-5552 an anti-racist practice in social work research teams: one story of germination and pollination context setting aims and structure positionality statement germination history and context setting: the qic-dvcw research team motivation for and pathway to the anti-racist practice description of an anti-racist practice in a research team pollination: spread and uptake by other project teams what we learned professional individual experiences about/with the anti-racist practice takeaways about the anti-racist practice the ways the anti-racist practice shapes our thinking about research teams implications barriers: what we faced, what other research teams could face conclusion _________ isabel lanteigne, phd, associate professor, and penelopia iancu, phd, associate professor, school of social work, université de moncton, new brunswick, canada. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 454-474, doi: 10.18060/28145 this work is licensed under a creative commons attribution 4.0 international license. perspectives of social workers and other healthcare professionals on collaborative work to address complex situations isabel lanteigne penelopia iancu abstract: this article presents results from an original study on the experience of health care and social work (sw) practitioners within interprofessional (ip) teams. this qualitative research project is based on an interpretive paradigm and seeks to understand various aspects of the interprofessional collaboration (ipc) experience. participants in this study (n=35) work in different practice settings, both urban and rural regions of new brunswick, canada. research team used semi-structured interviews with open-ended questions for data collection. the results discussed in this article highlight aspects (individual, inter-relational, organizational, and macrostructural) that foster or hinder ipc as well as benefits of collaborative work for service users, professionals, and agencies. to conclude, we propose ideas for future research, as well as ways to think about education for health and sw programs. more specifically, it is important to foster a culture of collaboration and to develop learning opportunities with regard to complex situations and interprofessional collaboration by offering students as well as practitioners common spaces for collaborative work. keywords: interprofessional collaboration, social work, health care, complex situations complex situations and the need for ipc economic, social, political, and environmental factors as well as technological advances have contributed to complex societal changes. as many of these complex changes are occurring at a faster rate, they require rapid adjustment, adaptation, and learning (van robaeys et al., 2017). in certain fields, social work (sw) practice is challenged by the complexity of situations, the standards for quality of services, the limited resources, and the complex care system that often requires interprofessional collaboration (ipc; crête, 2019; nigushi et al., 2021). social workers must therefore adapt to organizational changes and address complex situations encountered in practice. in this article, we present an original study exploring collaborative experiences of health care and sw practitioners within interprofessional (ip) teams. first, we present complex situations that need ip collaboration, as well as common elements found when defining ipc, followed by certain of the challenges and advantages of collaborative work. methodological considerations with regard to epistemic stance, research design and data collection along with the analysis method are described. the results highlight collaborative experiences of different professionals, notably aspects that hinder and foster ipc. in conclusion, we focus on future research and sw education. some complex situations encountered in practice call for hybrid models of collaboration, such as ipc and integrated care (lanteigne & iancu, 2020). in health care settings, situations prove harder to solve in silos, thus requiring collaboration, coordination, and networking (reeves et al., 2018). when working collaboratively, ip about:blank lanteigne & iancu/swk & healthcare ipc 455 team members can benefit from the knowledge, values, and skills of various professionals (crête, 2019; stans et al., 2013). in the next section, we present different elements of ipc. defining ipc: common elements an overview of the existing literature revealed multiple elements defining ipc. first, collaboration is an interactive process where team members deploy efforts to achieve common goals effectively (aiguier, 2020; schot et al., 2020). second, negotiating roles, responsibilities, and tasks is necessary to attain these goals (bordeleau & leblanc, 2017). third, team members must agree on professional vocabulary, terminology, and knowledge integration (bordeleau & leblanc, 2017). fourth, having collaboration experience and displaying certain skills, such as negotiation, assertiveness, and problem-solving, can contribute positively to ipc (boland et al., 2021). however, finding a common ground can be challenging, especially in linguistic minority contexts (savard et al., 2013). benefits of ipc ipc can be advantageous both for service users and professionals. some benefits for service users include: greater access to professionals from multiple disciplines simultaneously; better ways to meet complex needs; increased access to services in their preferred language; enhancement of general well-being; and, higher success of intervention (bordeleau & leblanc, 2017; savard et al., 2013). literature review also showed some benefits for professionals doing collaborative work, such as: access to various disciplinary knowledge; support from other team members; use of collective approaches to overcome obstacles; greater professional satisfaction; better intervention outcomes; and a healthier work environment (bordeleau & leblanc, 2017; morin et al., 2018). with regards to organizations, benefits include cost-effective services, along with better continuity of care and quality of intervention (bordeleau & leblanc, 2017). challenges of ipc although ipc has numerous advantages, some challenges can occur at individual, team and organizational levels, creating barriers to collaborative work. challenges of ipc on an individual level at the individual level, challenges stem from team members’ personal traits, perceptions about other professions, as well as emotions and attitudes towards collaboration. some personal traits, such as the lack of flexibility, resistance to new ideas, and obstinacy, affect team dynamics and can result in negative experiences of collaboration (o’carrolla et al., 2020). lack of assertiveness also impacts ipc, especially when ideas or solutions are not shared with the team (huq et al., 2017). the perceived worth of other professions can also become an obstacle to ipc when there is a tendency to undervalue or overvalue some professions, thus generating disparities in status and power dynamics among team members (cole, 2018; robinson et al., 2021). some studies address the impact of negative attitudes on ipc and the presence of negative and positive emotions that can shape collaborative work (o’carrolla et al., advances in social work, spring 2025, 25(1) 456 2020). sometimes, professionals dread working in ip teams because they fear losing control of the intervention or showing vulnerability in front of others (bordeleau & leblanc, 2017). moreover, they can feel discouraged, less confident, and frustrated towards some decisions made by the team, making them reluctant to take part in ipc (huq et al., 2017). challenges of ipc on a team level when examining the challenges stemming from ipc, researchers often focus on roles and responsibilities of team members, professional identity of team members, decision-making processes, and divergent perspectives on intervention. one of the main challenges of ip teams is the lack of understanding regarding the roles and responsibilities of each professional, especially for new members (robinson et al., 2021). this can create inadequate expectations towards ip team members resulting in gaps or overlaps in tasks being performed (o’carrolla et al., 2020). furthermore, challenges associated with professional identity include conflicts regarding divergent approaches and goals, hierarchy and power inequities, undervaluing others’ contribution to intervention, and professional centrism (kelly et al., 2020; o’carrolla et al., 2020; sloane & haas, 2020). as a result, team members can feel disrespected, underappreciated, and insecure about their contribution to the team (boland et al., 2021). decision-making processes in ip teams are complex and are perceived both negatively and positively. some of the barriers to decision-making in ip teams include: failing to recognize the complexity of problems; having opposing perspectives when assessing situations; prioritizing solutions previously used or choosing the ones that stem from their professional knowledge; assigning a higher status and authority to certain professions; trying to maintain the decisional power held in past collaborative experiences; ignoring existing tensions among team members; and having difficulties when collaborating remotely (ambrose-miller & ashcroft, 2016; huq et al., 2017). ignoring unhealthy team dynamics can affect the collaborative environment and intervention outcomes (huq et al., 2017). challenges of ipc at the organizational level besides issues at individual and team levels, challenges also occur at the organizational level. some of these aspects involve changes in the environment and within the organization. when rapid and sudden changes are taking place in the environment of an organization, it can negatively affect the collaborative context. in such cases, it becomes more difficult for ip team members to adjust to new roles and responsibilities (hunger & schumann, 2020). this fast-paced dynamic, combined with the emergence of new or temporary ip teams, requires more effort to build and maintain relationships, which can be stressful (o’carrolla et al., 2020). certain organizational aspects, such as leadership, human resources management, and work relationships also affect ipc (bordeleau & leblanc, 2017). hierarchy within ip teams can impact collaborative interactions, being a source of tension especially when team members belong to different agencies (o’carrolla et al., 2020). power relations due to a hierarchical structure sometimes results in status inequalities and tensions among professionals (schot et al., 2020). moreover, not all leadership styles ensure an open and equitable participation of team members (bordeleau & leblanc, 2017). the management of resources, use of technology and allocation of funds also have lanteigne & iancu/swk & healthcare ipc 457 repercussions on ipc. other problems that impact teamwork are associated with different professional terminology and documentation styles, along with uneven case data sharing among professionals (ambrose-miller & ashcroft, 2016; o’carrolla et al., 2020). all these communication issues create gaps in documenting the progress of service users or produce delays in intervention, which have consequences on the quality of care (o’carrolla et al., 2020; robinson et al., 2021). aspects that facilitate ipc although participating in ip teams can be challenging, there are numerous aspects that facilitate collaborative work, such as personal characteristics of members as well as inter-relational, organizational, and macro-structural dimensions. personal/individual aspects personal characteristics of professionals play a catalyst role in collaborative intervention. some of these characteristics include leadership, negotiation and decision-making skills as well as understanding the principles of team dynamics, creating and nurturing alliances with other team members, communicating openly, solving conflicts, and contributing to the collective goals of interventions (bordeleau & leblanc, 2017; schot et al., 2020). when professionals share core values, it helps to build unity within the team and enhance collaboration (ndibu muntu keba kebe et al., 2020). certain beliefs held by professionals will similarly influence their attitudes and behaviors towards collaboration (ambrose-miller & ashcroft, 2016). furthermore, willingness to collaborate, professional humility, and valuing the contribution of all team members are aspects that promote ipc (schot et al., 2020; sloane & haas, 2020). inter-relational aspects of a team ability to function as a team, identity of team members and previous experience of collaboration are some components that facilitate ipc. many aspects improve the ability to function as a team, such as effective communication, strong relationships, leadership capacity, and openness to others’ perspective (huq et al., 2017; schot et al., 2020). avoiding professional vocabulary improves communication and creates greater equality among team members (huq et al., 2017). professionals can develop positive relationships by taking part in social gatherings, team-building activities, and training together to strengthen collaboration and foster trust (ndibu muntu keba kebe et al., 2020; schot et al., 2020). mutual trust creates a space where individuals are comfortable sharing their knowledge and feel valued by others (aiguier, 2020; ambrose-miller & ashcroft, 2016). managers and natural leaders can also promote greater equality by exploring all professionals’ perspectives equally, especially in decision-making processes (bordeleau & leblanc, 2017). openness to explore contradictory perspectives enables members to have a broader understanding of situations, which can be useful to find solutions and improve the quality of care (huq et al., 2017). when addressing negative reactions towards conflicts, it requires team members to engage in respectful and honest negotiations (sloane & haas, 2020). in addition to improving the ability of professionals to work together, team identity represents another dimension that can help members collaborate. employing strategies to build team identity will facilitate teamwork, especially when some members adhere advances in social work, spring 2025, 25(1) 458 strongly to their professional identity (ndibu muntu keba kebe et al., 2020). in linguistic minority contexts, a shared identity based on a common language and culture can also have a beneficial impact on consolidating team identity (savard et al., 2013). organizational aspects at an organizational level, aspects that promote ipc include the agency’s characteristics as well as its ability to provide resources and adequate support for employees. positivity, openness to diversity and genuineness are values that allow members to express themselves freely without fear of being judged, thus fostering ipc (regan et al., 2016). collaboration can also be improved by creating non-hierarchal structures inside the organization that favor democratic decision-making processes (källén et al., 2022). however, it is necessary to provide sufficient resources to promote ipc and occasions for collective reflection (schot et al., 2020). besides human resources, ip teams need collaborative spaces allowing team members to learn about each other and find a common ground regarding intervention goals (schot et al., 2020). moreover, organizations need to ensure adequate supervision and offer administrative support so teams can better coordinate services, improve communication, and manage resources needed for ipc (ndibu muntu keba kebe et al., 2020). macro-structural aspects ipc is impacted differently by various systems, notably, the educational system. in practice settings, power dynamics between professionals have both positive and negative consequences on collaboration (aiguier, 2020). professionals, such as social workers, have a legal mandate which influences their role, intervention priorities and hierarchical position in a team. social and cultural contexts can also foster values that influence ipc. therefore, it may be difficult to reconcile certain values (e.g., autonomy and authority) with those that are conducive to collaboration (e.g., equality and interdependence) (kosremelli asmar & wacheux, 2007). furthermore, collaborative intervention needs to address privilege and oppression that permeates larger and smaller structures (carey, 2020). method in this article, we present a study that explores the experience of social workers and other professionals with ipc in new brunswick, canada. this study aims to understand the situations that require ipc in different practice settings and to better comprehend communication within ip teams, conflict management, complex problemsolving strategies, and ethical issues. social constructivism and the interpretivecomprehensive paradigm were adopted as epistemological stances for this qualitative research. the participants (n=35) were health and social service professionals (nurses, psychologists, social workers, etc.) from seven urban and rural areas in predominantly francophone or anglophone communities. the sample included 21 social workers (18 women and 3 men) from health, child protection, school and community settings. the inclusion criteria to participate in the study were the following: a) health-related education (social work, psychology, nursing, medicine, etc.); b) at least two years of work experience in a field related to health or social services in new brunswick; c) at least six months of experience in interprofessional collaboration; and d) the ability to lanteigne & iancu/swk & healthcare ipc 459 communicate in either english or french. social workers’ experience in the field varied between two and 20 years. semi-directed interviews, field notes and researchers’ journals were used for data collection that took place between 2019 2021. the interviews were conducted in english or french, taking into consideration the language of choice of participants. the interview guide started with a sociodemographic section that included questions regarding work experience, practice context, collaboration experience, language used at work, and mother tongue. this section was followed by open-ended questions organized into six topics consistent with the research objectives. these topics were: intervention contexts where professional collaboration was needed; interprofessional communication (terminology, communication style, aspects that facilitate or hinder communication, strategies to address communication challenges); conflict management (nature of conflicts; impact of conflicts on the team, strategies to manage conflicts); problem solving and intervention plans (assessment of the problem, decision-making, solutions, tasks and responsibilities); ethical issues, and training on interprofessional collaboration. before proceeding with the analysis, interviews were transcribed verbatim and anonymized to ensure confidentiality. subsequently, thematic analysis (paillé & mucchielli, 2021) was employed by using an on-going thematization process allowing to identify themes and subthemes, followed by a transversal analysis leading to the construction of the thematic tree. data processing was carried out independently by the members of the research team, thus allowing for triangulation. intercoder reliability was applied to ensure the transparency and objectivity of the coding process. findings in this section, we will present some findings regarding the context where collaboration occurs alongside the collaborative approach adopted by professionals. to maintain confidentiality, we cannot offer more details about participants (the number of the male francophone social workers from predominately anglophone regions is limited and it can lead to their identification). complexity of situations: collaborative spaces and organizational resources participants shared many aspects that illustrate the collaborative context. professionals helping individuals, families, and communities were often faced with “big and complex cases” (p5) which required collaboration as a way of responding quickly to situations. however, when a situation was not evaluated as complex enough, it prevented service users from accessing integrated services, a complex form of ipc. additionally, professionals found it challenging to solve problems encountered by these families while working in silos. the type of collaboration among professionals depends on the complexity of each situation. in some cases, complex problems necessitated both intra and inter agency collaboration involving various professionals from different organizations or departments. in our study, a few participants raised the importance of providing spaces and organizing activities to improve collaboration. one participant identified the creation of a space at a regional level where managers from multiple departments discussed problems encountered during ipc to find solutions and another indicated the value of having many services sharing a physical space to facilitate both formal and informal contacts between professionals. a collaborative activity called a "huddle" where they meet every morning for 15 minutes for updates advances in social work, spring 2025, 25(1) 460 was also described by a participant (p9). finally, a professional emphasized the efforts deployed by the clinical coordinator to ameliorate the collaborative space. this coordinator employed team building strategies before starting a meeting, such as telling jokes, sharing positive experiences, or allowing them time to vent when an incident occurred, along with bringing coffee and pastries to meetings (p4). some challenging situations mentioned by the participants include problems related to policies, standards, and protocols, such as being unaware of procedures other professionals need to follow, thus creating expectations about service delivery. according to a social worker, some professionals believe that if they flag their request as urgent, it will necessarily speed up the process. the analysis of our findings also showed the importance of different types of resources for fostering collaborative work. participants in this study emphasized the role human resources play in ipc, namely the contribution of multiple professionals from various disciplines to address complex needs, especially in the context of integrated care. however, the lack of human resources can deeply affect collaborative intervention and the quality of care: often, these situations [...] will double professionals’ workload. [...] so they are less available for collaborative intervention plans. (p29) the time necessary for intervention is also an important resource. in certain situations, professionals need to manage heavy caseloads, and extensive administrative tasks, thus limiting the time for collaboration. participants also pinpointed the necessity of administrative support when the organizations are understaffed. to cope with these situations, some departments were obliged to share administrative personnel or to offer educational resources to their employees, such as tools for effective communication along with training about active listening, conflict management, collaborative work, and diversity, as mentioned by some participants. aspects impacting collaborative practice three themes regarding aspects that influence ipc emerged from data: characteristics of professionals, dimensions related to team functioning, and elements of the intervention process. characteristics of professionals data analysis allowed us to identify some aspects that foster collaboration. as such, many participants highlighted: knowledge about oneself; important values; and attitudes to adopt during collaboration. when talking about these aspects, participants described both challenges and advantages of ipc. knowledge about oneself. knowing oneself was a theme emerging from the interviews. self-knowledge is useful when needing to set limits, because the professional boundaries are sometimes blurred: i tell myself, if the staff does not have time to do it and it’s in the interest of the patient […] i will do it [but it’s not part of my role]. (p20) such situations create challenging environments that can impact intervention outcomes and work dynamics. lanteigne & iancu/swk & healthcare ipc 461 values facilitating collaborative work. in addition, important values were identified as other aspects necessary to ipc. participants mentioned respect as an essential value for good collaborative relationships, as illustrated in this excerpt: i think that respect is essential. you have the right to your opinion, i have the right to mine, […] so that “we can agree to disagree”. (p13) however, mutual respect was not always present when professionals worked together. one social worker described instances when this occurred with various professionals: there are situations when i didn’t necessarily feel respected, worse, when my opinion wasn’t worth much... (p20) sometimes, the absence of mutual respect is translated into situations where professionals feel undervalued by certain team members: we save lives, we can help people reconnect. but other professionals don’t see that. i think this is the biggest problem with social workers. no one knows what we do […] we are not recognized for what we do. (p9) other participants feel like they are at the bottom of the hierarchy within the team, making it hard to maintain healthy collaborative relationships and efficient team functioning. attitudes to adopt when collaborating. data analysis allowed us to identify attitudes that encouraged as well as hindered ipc. participants in our study considered willingness to change and openness to work with others as attitudes essential to ipc: you must develop this mentality that my profession complements others, not just that i’m a professional who does this or that... sadly, there are many practice settings that don’t teach you about what other professions do (p6) moreover, adopting a positive attitude is considered helpful when addressing challenging situations, for example, perceiving that team members are “trying to do their best” (p13). other attitudes can hinder collaborative relationships. for instance, one participant described a confrontational attitude that led to heated exchanges among team members (p20). another attitude having a negative impact on collaboration is the resistance to change, as indicated in this excerpt: …sometimes, there are work cultures where you would like to implement changes, but it is not well received because it is not the traditional way of doing things. (p6) resistance to change is usually expressed towards technological advances or the implementation of new ideas and often translates in rigid stances negatively impacting ipc (e.g., “it’s my way or the highway”). when confronted with negative attitudes, professionals habitually rely on helpful strategies, such as venting emotions to a colleague, discussing with their supervisor, or addressing the issues directly within the team along with using skills essential for collaborative work. elements related to team functioning analysis identified the following themes associated to team functioning: previous ipc experience; identity related issues; communication; team meetings; and group dynamics. for some themes, positive and negative aspects were noted. advances in social work, spring 2025, 25(1) 462 previous ipc experience. past experiences with collaboration can influence both the team and its members. despite obstacles encountered, professionals working together perceive past experiences as positive when the team acted in the “best interest of the child” (p22) or contributed to the “well-being of the patient” (p20). however, there are instances when ipc is seen negatively. when describing negative experiences, participants highlighted two aspects: challenging work relationships and their impact on team functioning. the following excerpt illustrates how negative experiences hinder collaboration: we know which professionals are difficult to work with, when a conflict dragged on and you hoped things would improve, but they were always closeminded. (p27) moreover, professionals beginning their career often perceive ipc as more demanding as they feel intimidated working with team members from other disciplines. identity-related aspects. the themes emerging from data analysis pertaining to identity-related issues included professional, cultural, gender and sexual identities. while three participants highlighted challenges linked to cultural biases, others identified conflicts stemming from professional centrism, as well as stereotypes associated with gender and sexual orientation. problems arising from identity issues can affect team cohesion. although organizations do not always directly address such issues, some make substantial efforts to improve team functioning by organizing team building activities: at work, we participate in activities allowing us to bond. once, we spent an afternoon at a sweat lodge. we go for lunch and supper regularly; we carpool to conferences, so we're creating bonds the whole time. (p6) our analysis revealed that these activities strengthen cohesion and create a sense of belonging. communication in ip teams. another predominant theme arising from analysis was team communication encompassing these aspects: frequency and styles of communication; strategies to improve exchanges; communication skills; language, vocabulary, and professional terminology. the ability to communicate effectively is essential when taking part in ipc. one participant identified problems that emerged when professionals lacked communication skills: some people aren't very good at communicating and like to do things their own way. so, when we don't have the same opinions about treatments and have trouble communicating, that creates problems. (p13) the language spoken during intervention both by professionals and services users was a topic raised by several participants. one of the issues mentioned when offering services in linguistic minority contexts was the need for bilingual professionals to act as interpreters both for service users and team members. furthermore, francophone professionals felt the pressure to communicate in english to accommodate colleagues. the analysis also showed that professionals often had to translate reports previously prepared in the language of choice of service users so their supervisors or team members could read them. one participant explained: lanteigne & iancu/swk & healthcare ipc 463 in my unit, there’s only me speaking french. there you are, stuck working five times as hard, because […] all the documentation is in english, unless i translate it into french. (p12) another participant differentiated between their ability to express themselves in a second language versus the skills necessary as an interpreter/translator: just because you speak french doesn't mean you can translate everything into french. (p15) ipc can bring together individuals speaking multiple languages and using different professional vocabulary, terminology, and abbreviations, which often create barriers to comprehension: i don't know all the medical terms in english and sometimes it is confusing. (p20) another participant described the consequences of using abbreviations and symbols specific to each discipline: medical reports are sometimes handwritten by doctors, so it's hard to read them. other times, it's the abbreviations used in reports, like a little heart with an arrow, that's high blood pressure. we didn't learn that [as social workers]. (p16) data analysis allowed us to identify divergent styles of communication or notetaking practices encouraged in certain disciplines (e.g., narrative vs. telegraphic style). there were also issues regarding the frequency of communication. for instance, participants mentioned that sporadic, partial, or absence of communication (e.g., withholding information or not replying to e-mails) can negatively affect ipc. to address some of these issues, professionals develop personal strategies: when there was a challenge in communicating, i would take the time to either write an email, call to clarify the situation, or take a coffee break [with them]. (p15) if these strategies fail, they had to find other solutions: we had to send an e-mail to the professional which was also copied to our supervisor. (p22). in addition, professionals can rely on organizational strategies to maintain regular exchanges. team meetings. coordination, structure, frequency, and availability of professionals are four themes deriving from data analysis with regard to ip meetings having an impact on team functioning. managers, supervisors, or professionals (from specific disciplines or with a higher level of qualification) are often responsible for coordinating ip teams creating a hierarchical structure: it's usually the doctor who leads our team meeting. we often go around the table to introduce ourselves. first, the doctor presents the medical report, followed by the occupational therapist, the nurse, and frequently the social worker goes last. (p7) advances in social work, spring 2025, 25(1) 464 planning regular meetings does not always increase the frequency of contact between professionals, as some meetings are often cancelled because of busy schedules as indicated in this excerpt: we try to meet once a month, but we're so busy that, unfortunately, it rarely happens. (p9). therefore, professionals try to find other ways to spend time together over coffee breaks (p9). in some cases, organizations also take specific measures to ensure that employees attend ip meetings. group dynamics. the last theme associated with ip team functioning was group dynamics which addressed the following aspects: interactions among professionals; power relations; and members’ reactions to conflict. with regards to interactions between professionals, analysis showed that some exchanges are more demanding, thus affecting team dynamics. the arrival of new members also changed interactions within the team as it seemed to question established practices. when new ideas were rejected by professionals resistant to change, this sometimes resulted in unhealthy dynamics: it is difficult for a new person in a team because there are dynamics established for many years, that are sometimes toxic. they're all nice people, but some always do things the same way, over and over, but at some point, it doesn't work anymore. (p15) the second theme associated with team dynamics refers to power relations and positions held by professionals in the hierarchical structure. analysis showed that existing power relations can affect the integration of new members to the team, the identification of team priorities, the space provided to express professional opinions, and the decision-making processes. these power dynamics have a negative impact on ip team as illustrated by this participant: the challenge is often with doctors. they have the last word, they run the show. even if you've studied medicine for 8-9 years, that doesn't mean you're capable of addressing all aspects of the case. (p13) when professionals ignore the opinion of others or dictate what actions to take, this led to frustrations: sometimes, i don't feel heard, because no matter what i say, they're going to make their own decisions, and then tell me what to do. (p11) collaborative dynamics can also be affected by the existence of a hierarchy among professionals from different disciplines or organizations: some professionals are higher in the hierarchy. psychologists are situated higher than social workers. with people [social workers] from community organizations, you feel more equality, but when you work with social workers from governmental departments, you feel the inequality in power. (p11) the ways professionals react to conflict was the third theme related to team dynamics and included the following aspects: disagreements regarding challenging situations, conflict management, and strategies employed. some conflicts are the result of diverging perceptions about incidents in the workplace and lack of clear procedures to manage team conflicts: lanteigne & iancu/swk & healthcare ipc 465 in some situations, there are differences of opinions about the integrated care plan. two professionals could not see the perspective of the other person. (p8) sometimes, conflicts among team members are difficult to resolve as illustrated in this excerpt: if it doesn't get resolved, it just makes it worse, because the frustrations pile up, pile up until you just hate the person, and then, you're not even willing to cooperate. (p16) seeking guidance from colleagues or supervisors, discussing issues, exploring different perspectives, and trying to find solutions as a team were strategies considered useful to solve conflicts. when strategies to manage conflicts fail, it will generate negative emotions that can put a strain on relationships over a long period of time. however, if strategies to solve conflicts are successful, this will have a positive influence on team functioning: the way we manage our conflicts brings us closer together, makes us more confident with each other, so we know we're able to give each other support, which is something i've never found in other teams. (p6) in the next section, we present findings related to ipc during intervention. aspects of the intervention process data analysis allowed us to identify these three themes related to collaborative intervention: professionals’ contribution to the team; intervention priorities; and roles, responsibilities and tasks performed. when different professionals work together, their disciplinary perspective and professional experience contribute to a better understanding of complex situations and to the development of integrated intervention plans: we often work with other professionals. i find that we need them, and they need us. this collaboration is necessary. (p17) another theme emerging from analysis pertains to the establishment of intervention priorities. according to participants, it seems easier to reach a consensus regarding care plan goals when team members stay focused on the best interest of service users, setting aside professional centrism that can interfere with ipc. moreover, certain difficulties arise when professionals have a limited understanding regarding the roles or responsibilities within the team, which can result in the duplication of services or gaps in service delivery. to address these issues, professionals are invited to describe their roles as well as review shared responsibilities and tasks: we discussed ways to divide tasks, and while doing this, we got to understand better each other’s point of view, our workload, and how we could work together. (p11) the findings presented in this section highlighted the need of ipc when addressing complex situations, characteristics of professionals, the functioning of ip teams and aspects of intervention that can have an impact on collaborative work. advances in social work, spring 2025, 25(1) 466 figure 1. aspects impacting collaborative practice discussion in this section, we address issues regarding the complexity of ipc. while complex systems and situations are often encountered in practice, the nature of complexity is not always easy to apprehend. within this context, ipc is both a type of collaboration employed by professionals to solve complex problems and an approach to intervention. a complexity theory framework is used to understand findings with regards to the following aspects: complex structure of ipc; complex interactions among team members and non-linear causality; rapid and non-linear dynamics of situations encountered; non-transparency as a characteristic of complex systems; and strategies to address challenges emerging from the complexity of practice in an ip context. complex structure of ipc participants in this study collaborated with many professionals to respond more rapidly to situations described as complex cases. valuing respect towards other team members and adopting a positive attitude are important characteristics of collaborative processes. working collaboratively with professionals from multiple disciplines, services, and organizations helped them meet the needs of service users while also complexifying their work. complex systems are larger structures with multiple elements that are interconnected in multiple ways, where the nature and number of such connections are not always easy to detect (funke, 2010; quesada et al., 2005). the environment where collaboration takes place also influences teamwork. in healthcare settings, the collaboration is rendered more complex depending on different aspects, such as services offered to clients, team size and its composition, and conflicting work schedules (aiguier, 2020). however, despite sharing an organizational culture, professionals working in the same department or agency can have different lanteigne & iancu/swk & healthcare ipc 467 perspectives on intervention. moreover, each professional contributes to the structural complexity by bringing their disciplinary knowledge, experience, and approach to intervention, along with their professional standards, and ethics. the work performed by ip teams is rendered more complex, not only by the number of professionals in a team, but also the collaborative work performed with multiple teams. the structure of the ip team will also become more complex if professionals in the team belong to different departments or organizations. for example, team members need to adhere to numerous policies and regulations both within their organization and the ipc team, in addition to answering to multiple supervisors. as a result, they can connect in complex and diverse ways forming numerous relationships that affect intervention processes and outcomes. as noted by allenbach (2015), complexity is an important source of challenge for professionals during intervention. complex interactions among members and non-linear causality results showed that many aspects had an impact on team functioning and the intervention process. more specifically, these included: previous experiences of ipc, both positive or negative; identity related issues (e.g., stereotypes about gender, sexual orientation, culture, and professional disciplines); issues with communication associated to frequency, styles, and terminology; regularity of contacts; professionals leading team meetings; and group dynamics stemming from power relations and conflicts. hence, ip team structure translated in complex interactions that were sometimes challenging due to unpredictable aspects, such as uncertainty about meeting outcomes, scheduling problems, and protocols regarding intervention priorities. in this context, collaboration consists of complex interactions that cannot always be explained by multifactorial linear causality. this type of causality consists of multiple aspects that contribute to a causative chain of events leading to specific effects that follow a linear process (chettiparamb, 2014). complexity theory brings a different perspective on causality by replacing “linear thinking of causal lines, paths or chains with non-linear thinking, with webs of conditions, […] contexts and contingencies and multiply interacting, multi-directional causality, which, in combination, exert an evolving and irreversible effect” (morrison, 2012, p. 25). the nature or number of interactions among elements of a complex system often depends on time and can lead to unpredictable results. in the case of ipc, interactions among team members follow a similar non-linear dynamic when they collaborate. moreover, disproportionate relationships between cause-and-effect results in unpredictable outcomes beyond short periods of time, which is referred to as the butterfly effect (bussolari & goodell, 2009; healy, 2005). for example, a minor conflict during an ip meeting due to divergent perspectives has a considerable impact on team dynamics and its members. similarly, a disproportionate cause and effect relationship can be observed when a larger benefit can come from a small encouragement, especially when some professionals have a higher status in the team (huq et al., 2017). unpredictability is another aspect of non-linear causality observed both in the situations professionals try to solve and in the dynamics of collaboration. because of this unpredictability, it is more difficult and even problematic, over larger periods of time, to anticipate behaviors or try to predict outcomes (morrison, 2012). thus, when advances in social work, spring 2025, 25(1) 468 facing complex and unpredictable events, ip teams need to reassess situations more frequently and act quickly, to positively affect service delivery (reeves et al., 2018). rapid and non-linear dynamics of teams and situations encountered in practice findings in our study revealed that some professionals tried to help other team members better understand the complex dynamics of collaborative work. for instance, they signaled sudden changes in situations encountered, emphasizing the need to respond quickly, and having more frequent contacts. although team members are not always able to name complex dynamics as non-linear, they often identify changes that urged them to act rapidly. however, several aspects affect professionals’ responses to practice, such as agencies’ lack of understanding regarding complex systems and situations, rigidity of some protocols and procedures, cutbacks in personnel along with scarcity of resources. these challenges associated with institutional constraints are also mentioned by allenbach (2015) and heron (2019). complex situations and systems entail changes that are often rapid, sudden, and unpredictable, therefore requiring constant adaptation (prigogine, 1987; walby, 2003). however, when these changes occur too quickly, it affects the system’s ability to rapidly process information and adapt to new conditions. in a collaborative system, changes also happen at a rapid pace due to its complex environment and non-linear dynamics. when members of ip teams encounter these rapid and unpredictable changes, they need to adapt both quickly and frequently depending on the rhythm and recurrence of changes (iancu & lanteigne, 2022). other authors (fischer et al., 2012; lindroos soggiu et al., 2020) also mention the importance of taking into consideration the unicity of individuals’ experiences, as well as the non-linear dynamics and the complexity of situations during interventions. when ip teams intervene in complex situations, the combination of different approaches, the intensity and timeline of services, the interactions among numerous professionals, and the presence of sudden and unpredictable changes can result in complex dynamics and disproportionate effects. for instance, during the covid-19 pandemic, many healthcare teams had to maneuver fast-changing and unpredictable conditions, to adapt to evolving policies and procedures as well as to find innovative ways to solve problems (hunger & schumann, 2020). frequently, stakeholders in the social service and healthcare system make informed decisions requiring continuous assessments of situations and adaptation to the collaborative work. therefore, ip teams need to show great flexibility when addressing complex, rapid, and non-linear dynamics in their work (allenbach, 2015). non-transparency as a characteristic of complex systems and situations results showed that many professionals recognize the limits of their knowledge base to grasp all aspects of a situation. while some participants had negative experiences with team members who were close minded or undervalued their knowledge, they still appreciated when other professionals offered their perspective. in such cases, the lack of integration of other viewpoints can prevent team members from assessing appropriately the complex nature of situations because of their nontransparency (i.e., intransparency or opacity). this characteristic of complex situations and systems, which describes the inability of solvers to fully perceive and understand lanteigne & iancu/swk & healthcare ipc 469 all elements of the problem or the multiple relationships among them was highlighted by several authors (dörner & funke, 2017; funke, 2010; funke & frensch, 1995). moreover, situations with a higher level of complexity can exhibit a greater degree of opacity (iancu & lanteigne, 2022). hence, when professionals are working in silos, it is more difficult to address the non-transparency of complex systems, which results in some aspects of the situation being ignored when trying to find solutions (lanteigne & iancu, 2020). however, not all team members have a silo mentality as many professionals see the need for ipc to access collective knowledge and skills. another aspect that hinders collaborative work and limits the ip team from overcoming challenges related to non-transparency is professional-centrism, which stems from the idea that one’s professional knowledge and experience is better than others (sloane & haas, 2020, p. 811). certain professionals feel uncomfortable sharing ideas in a team setting, which can prevent them from accessing the collective knowledge. furthermore, ip team members will often favor distinct intervention models that are rooted in different epistemological stances, affecting the ways they establish priorities as also raised by other authors (lee et al., 2013; williams, 2006). for instance, a team member adopting a constructivist stance may be more concerned with relationship building whereas another professional having a critical stance will be more focused on fighting for greater access to resources for service users. we argue that having divergent epistemological stances adds to the complexity of collaborative work. in addition, social services and health care systems have become more complex, especially with budgetary constraints, which puts a strain on professionals, such as social workers, nurses, and psychologists (gonzález-martínez & bulliard, 2018). thereby, the work performed by ip teams can be more demanding, aspect that was also stated by reeves et al. (2018). strategies to address issues related to the complexity of collaborative work our findings highlighted several strategies employed by ip teams to address complexity. both individual strategies (e.g., using humor, venting, clarifying issues, prioritizing the best interest of service users) alongside with organizational strategies (e.g., communicating frequently, having regular meetings, and adopting clear procedures to resolve conflicts) were mentioned. most of the conflict management strategies aimed to find solutions as a team, get supervisors involved, and negotiate with other service providers. topics of contention often included roles, responsibilities, and knowledge base. schot et al. (2020) also highlighted that knowledge base was a major source of conflict when working collaboratively, which “requires active work to get familiar with other knowledge bases and other professional values and norms” (p. 335). we argue that it is essential to create an environment allowing team members to integrate their knowledge and experience for a shared vision on intervention. knowledge integration and positive team climate are two aspects also conveyed by ndibu muntu keba kebe et al. (2020). furthermore, it is helpful for professionals to take part in activities that help members feel a sense of belonging to the ip team. by promoting team identity, professionals create an environment that is more conducive to collaboration, resulting in more positive experiences. as indicated by ndibu muntu keba kebe et al. (2020), when team members have positive experiences of collaboration, it encourages their empathic responses towards professionals from other disciplines. both the complex structure and non-linear dynamics associated with advances in social work, spring 2025, 25(1) 470 collaborative work addressed in this section have implications for sw education and practice. implications for social work education and practice many professionals have developed values, knowledge, and skills (e.g., patient centered values, knowledge about group dynamics and critical thinking) that are useful for ipc through education and work experience. however, they still require additional training for collaborative work (bordeleau & leblanc, 2017; comer & rao, 2016). organizational culture is a key factor that can both hinder and promote collaboration. for example, an organization that favors “learning in professional silos” can limit the learners’ collaborative experience, which can impact their future collaborative work with other professionals (o’carrolla et al., 2020). furthermore, professionals that prefer working in silos are less likely to fully comprehend the contribution of other professionals to the team and be reluctant to ipc. nevertheless, organizations can encourage a culture of collaboration by offering employees more opportunities to be involved in collaborative practice and nurture their openness towards different perspectives. professionals must be exposed to collaborative work as part of their continuing education, which can include knowledge about groups, teamwork, and ipc. more specifically, it is important to cover topics such as: structural characteristics of collaboration; roles of professionals in ip teams; effective ways of communicating with other professionals; approaches to address challenges when working in groups; strategies to resolve conflicts and solve complex problems; as well as how to undertake ethical issues (kelly et al., 2020). educational programs play an essential role in the development of students’ professional identity as they promote important values, knowledge, and skills for professional practice. the way individuals perceive their professional identity will further be transformed over time by the experience gained in various practice settings (crête, 2019; fitzgerald, 2020). references aiguier, g. 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(2003). complexity theory, globalisation, and diversity. in proceedings of the british sociological association conference (pp. 1-22). university of york. williams, c. c. (2006). the epistemology of cultural competence. families in society, 87(2), 209-220. author note: address correspondence to isabel lanteigne, school of social work, université de moncton, 18 antonine-maillet ave., moncton, new brunswick, canada, e1a 3e9. email: isabel.lanteigne@umoncton.ca acknowledgements: funding was provided by the national health training consortium as part of the official languages action plan 2018-2023. orcid: penelopia iancu, université de moncton https://orcid.org/0000-0002-5939-0993 https://www.lancaster.ac.uk/fass/resources/sociology-online-papers/papers/walby-complexityglobalisationdiversity.pdf https://doi.org/10.1606/1044-3894.3514 mailto:isabel.lanteigne@umoncton.ca https://orcid.org/0000-0002-5939-0993 complex situations and the need for ipc some complex situations encountered in practice call for hybrid models of collaboration, such as ipc and integrated care (lanteigne & iancu, 2020). in health care settings, situations prove harder to solve in silos, thus requiring collaboration, coord... defining ipc: common elements method in this article, we present a study that explores the experience of social workers and other professionals with ipc in new brunswick, canada. this study aims to understand the situations that require ipc in different practice settings and to better co... findings discussion implications for social work education and practice references _________ robin deluca-acconi, phd, lcsw, assistant dean, rfk human rights lead educator and research scientist; suzanne l. velázquez, phd, lcsw, director of the undergraduate program and clinical associate professor; stephen rabeno, phd, lcsw-r, clinical assistant professor; warren k. graham, lmsw, acsw, casac, director of field education and clinical assistant professor, stony brook university school of social welfare, stony brook, ny. copyright © 2020 authors, vol. 20 no. 2 (summer 2020), 371-393, 10.18060/23686 this work is licensed under a creative commons attribution 4.0 international license. educating the next generation of human rights advocates and defenders: an interprofessional partnership robin deluca-acconi suzanne l. velázquez stephen rabeno warren graham abstract: defending human rights requires professionals to be unrelenting in the pursuit of systemic change. it requires the collaboration of varied professions bringing together their expertise to challenge the system of domination that has led to subjugation. interprofessional education and collaborative practice (ipe) is a powerful tool where human rights defenders and advocates from different disciplines can learn from each other and advocate for change. this is an overview of an innovative collaboration between robert f. kennedy (rfk) human rights and stony brook university school of social welfare (sbussw) bsw program. it will illustrate the way the rfk human rights’ human rights education program, speak truth to power (sttp) is being adapted to baccalaureate social work education. included is the method that the sbussw incorporates the council on social work education (cswe) and interprofessional education collaborative (ipec) competencies in a human rights context through the partnership with rfk human rights. keywords: human rights, social work education, interprofessional partnership, social work & law, rights-based practice social work and human rights recent sociopolitical changes have made it an imperative for social workers to advocate for human rights and advance a human rights agenda as a core competency of u.s. social work education. the council on social work education (cswe; 2015) requires that social work students achieve competence in advancing human rights and social, economic, and environmental justice. human rights have become a significant part of the social work mission as social work broadens its reach in a cross-national perspective (mcpherson & abell, 2012). to address the need for educating future practitioners to contribute to a human rights agenda, there are concerted efforts to formalize the incorporation of human rights approaches into social work education (allensworth hawkins & knox, 2014; healy & wairier, 2014). the “three generations” or “waves” of human rights practice provide context for addressing social issues. civil rights have been identified as the first wave, economic, social, and cultural rights, social justice and freedom in the second wave, and collective rights for positive development and a universal stand against oppression in the third (ife, 2012; lombard & twikirize, 2014). while the profession of social work has addressed all three generations of human rights, the second-generation rights of special populations have https://creativecommons.org/licenses/by/4.0/ deluca-acconi et al./interprofessional human rights partnership 372 received particular attention by practitioners. however, it is concerted efforts of the thirdgeneration of rights, namely opposing universal oppression, building positive social and economic systems, and fostering healthy environments that social workers should engage in that may yield the most noticeable results for creating sustainable change. “social work can become a significant role player in promoting social and economic equality through its commitment to social justice and human rights” (lombard & twikirize, 2014, p. 313). supporting the universality of the third-generation human rights is a particular imperative for our interconnected global society. the history of human rights parallels social work’s efforts to promote social justice within a human rights context. in the 1994 united nations document, human rights and social work, the international federation of social workers (ifsw) acknowledged that from “inception social work has been a human rights profession” (un centre for human rights, international federation of social workers & international association of schools of social work, 1994, p. 13). the relationship between social work and human rights can be seen in two ways: with social workers joining broader human rights campaigns, as well as their achieving human rights through social work practice (ife, 2016). there exists a strong connection between fighting for human rights and social justice (burke, 2017; grant & gibson, 2013; reichert, 2003, 2011). according to the social work dictionary, social justice is “an ideal condition in which all members of a society have the same rights, protections, opportunities, obligations, and social benefits…” (barker, 2014, p. 398), while healy (2008) recognizes that “at the most basic level, human rights are those rights that belong to all just because we are human” (p. 736). as we strive to strengthen human rights, social work’s focus must integrate proactive responses while simultaneously addressing active violations. addressing social justice, as a subcategory of human rights, requires varied skills that necessitate interprofessional collaboration. social workers and human rights defenders lead allied lives, both working for equality, and against oppression. social workers and lawyers coming together as human rights defenders current violations of human rights, occurring on both the domestic and global fronts and associated with tumultuous political climates, have underscored the importance for social workers to work interprofessionally against these abuses. the treatment of migrant and immigrant, lgbtq+, and indigenous populations among others, ignite a need to unite the various professions, such as law and social work, in order to stand against the myriad of injustices prevalent today. social workers alongside other professionals must remain vigilant, advocating for change in the face of human rights violations, never losing sight of the international abuses, reinforcing the need for collaborative, and transformational change. for this reason, it is an opportune time to further the discussion of the importance of professional collaboration to address human rights violations and to change how we educate social work students. the world health organization (who; 2010) defines interprofessional education (ipe) as the process in which varied professions “learn about, from and with each other” and work collaboratively to “deliver the highest quality of care across settings” (p. 13). the who (2010) documented that ipe can be a powerful tool to help rectify the challenges of advances in social work, summer 2020, 20(2) 373 the healthcare system, reducing costs and improving patient satisfaction and outcomes. cswe became an institutional member of the interprofessional education collaborative (ipec) in 2016, committing to teaching social work students about the importance of collaboration to increase positive results in health care (cswe, 2016). ipe between social workers and health care providers has been well documented (blacker et al.; 2016; charles et al., 2011; de saxe zerden et al., 2018; jones & phillips, 2016). this article is a call to further the scholarship of interprofessional education and practice between social work and law. there are substantial opportunities for social workers to enact their commitment to the profession’s core values and competencies alongside other advocates, such as lawyers. this becomes essential in the current political climate. the trump administration’s withdrawal from the un human rights council demonstrates continued lack of commitment and leadership around human rights promotion of the u.s. government (mapp & gatenio gabel, 2019). the administration’s policies are clear violations of human rights, namely in the areas of immigration, healthcare, and the criminal justice system, which are discussed in detail in the next sections. these examples are used as an inspirational call to action for social workers alongside lawyers to fill the gap where the government has fallen short. it is an appeal for a coalition of professionals to be human rights advocates and defenders. immigration current u.s. immigration policies have led to practices resulting in a humanitarian crisis and evident violations of human rights. the practices demonstrated in the detention facilities on the us-mexico border illustrate this: according to the ap [associated press], there's not adequate food, water or sanitation inside. the report describes teen mothers and other younger kids being asked to care for infants and toddlers on their own, with little or no help from any adults…. short-term holding facilities were not designed to hold vulnerable populations and we urgently need additional humanitarian funding to manage this crisis. (public broadcasting service, newshour, 2019, transcript para. 3) article i of the convention and protocol relating to the status of refugees puts forth the rights of individuals who are fleeing their country “owing to [well-founded] fear of persecution” (un general assembly, 1951). the convention on the rights of the child (crc) delineates the special conditions under which children, as a protected class, should be treated (un general assembly, 1989). the protocol and the crc both can be used as tools for social workers who denounce harmful immigration practices, such as separating children from their caregivers. the school social work association of america (sswaa) has done so in their 2019 statement, school social workers stand up for migrant children’s human rights: a call to action. the sswaa quoted the crc noting, “uncrc states that migrant children should receive “appropriate protection and humanitarian assistance” (villarreal sosa et al., 2019, p. 2). in the call to action, school social workers are urged to use materials from the national immigration law center to help students and communities know their rights, ensuring that immigrants know what to deluca-acconi et al./interprofessional human rights partnership 374 do if there is an encounter with immigration and customs enforcement (villarreal sosa et al., 2019). the sswaa encouraged school social workers to work with lawyers and organizations to defend immigrant human rights and lobby for american dream and promise act (h.r. 6), deferred action for childhood arrival (daca), and temporary protected status (tps; villarreal sosa et al., 2019). all social workers have been called upon to denounce recent immigration policy with the national association of social workers (nasw) stating, “nasw encourages social workers to regularly contact their lawmakers to express their concerns about harmful and unjust immigration policies and to provide the much-needed social work perspective in stateand local-level immigrant advocacy coalitions and related justice efforts” (nasw, 2019, para. 4). ipec’s (2016) second competency, roles and responsibilities, underscores the importance of understanding the roles and responsibilities of each profession to increase positive outcomes of individuals and larger populations. in the case of social work and immigration law fulfilling ipec’s second competency, social workers should understand the role and responsibilities of lawyers to provide legal advice and representation at court proceedings to immigrants. conversely, lawyers need to understand the social worker’s role and responsibilities to advocate for immigrant rights and attend to and support access and fulfillment of these rights. achievement of ipec’s subcompetencies could be accomplished by working collaboratively on a project, such as immigration reform, with deliberate team meetings that set, distinguish, and communicate the boundaries and responsibilities of each of the professions involved in the effort. in this instance, the nasw suggested working closely with law and policy agencies, such as the center for law and social policy and national immigration law center, and “helping individuals and families understand or access resources that explain their legal options and when to speak with an attorney” (nasw, 2019, para. 10). healthcare the united states continues to be reluctant in providing universal health care. the 2010 passage of the affordable care act (aca), although progress towards offering access to medical care, continues to sustain a health insurance system rather than a health care system (gerisch, 2018). the decision about health care as a universal right remains on the forefront of policy debate, as the number of uninsured has begun to increase. according to tolbert et al. (2019), “the number of uninsured nonelderly americans decreased from over 46.5 million in 2010 (the year the aca was enacted) to just below 27 million in 2016” (p.1). however, between 2017 and 2018, the number of uninsured people increased by nearly 500,000 people (tolbert et al., 2019). conceptualizing healthcare as a privilege instead of a right justifies the capitalistic response that values profit above human well-being. the trump administration’s objective to completely dismantle the aca advances a neoliberal agenda and conservative ideology that benefits the top quintile of the u.s. population at the detriment of the bottom quintile. the disenfranchised are most affected as the absence of health care or the ability to pay for it literally costs them their lives. covid-19 has brought this structural inequality to the forefront. marginalized communities, historically segregated by income and race, advances in social work, summer 2020, 20(2) 375 are suffering from higher mortality rates during the pandemic (artiga et al., 2020; human rights watch, 2020). social workers and students alike share the profession’s core values and essential role in challenging the modus operandi of the country’s approach to providing medical services based on a system of insurance and pharmaceutical company profit. social workers are essential in challenging prevailing hegemony and questioning the status quo of corporate profit over human rights, using human rights and treaties as the basis of a campaign (deluca-acconi, 2017). for example, advocates must challenge the status quo of denying medical insurance by companies to the poorest americans due to their inability to pay, citing article 25 of the united nations (un, 1948), universal declaration of human rights (udhr) that does not place conditions on access to health care and identifies it as a human right. ipec’s (2016) competency three stresses the importance of interprofessional communication, supporting a team approach to the promotion of health and the prevention of disease. in this case, social workers would benefit from communicating with lawyers working toward the human right of healthcare so they both use human rights treaties and conventions as the basis of their campaign. lawyers would benefit from recognizing social work’s person-in-environment perspective and unique active listening and communication skills in their effort to defend healthcare as a human right. subcompetency cc4 addresses the importance of listening and encouraging “the ideas of other team members” (ipec, 2016, p. 13) while cc6 addresses the need for respectful language when dealing with conflict; all are skills that coincide with social work training and values. social workers can work with agencies, such as the national health law program, that “advocate, educate and litigate at the federal and state levels to advance health and civil rights in the u.s.” (national health law program, n.d., para.1). strong communication between social work and law can advance the movement for health care as a human right, ensuring that both professions use a human rights frame when they are approaching policy change. criminal justice system the united nations’ convention against torture and other cruel, inhuman or degrading treatment or punishment (un general assembly, 1984) was ratified to support rights deriving from the inherent dignity and worth of a person. this is the same language referenced in the nasw code of ethics (2017). the human rights language in the convention mirrors that of social work in working to eradicate inhumane practices such as solitary confinement, which was previously referenced as psychological torture (mcconnaughey, 2012). social workers against solitary confinement (swasc), a coalition led by social workers and concerned allies, and the vera institute of justice, who launched the segregation reduction project, are examples of contemporary efforts of collaborations of social workers and lawyers who work to abolish or minimize solitary confinement. these efforts have led to a planned scholarship with the cswe to teach about inhumane prison practices, which is to be introduced in social work education (swasc, 2019). in january 2015, president obama called for a department of justice investigation into the practice citing psychological harm. with the continued partnership with the law profession, several states have followed suit with statutes minimizing its use, as well as the deluca-acconi et al./interprofessional human rights partnership 376 eradication of the practice for 16and 17-year-olds (garcia et al., 2016). speaking to the need for continued interprofessional partnership between social workers and the legal profession from a human rights framework, efforts have also continued to address harsh criminal sentencing that results in disproportionate numbers of persons of color held under bail or disparately sentenced. those working in an interprofessional model, are not “restricted to his or her traditional discipline but is woven together and enhanced by the other” (jones & phillips, 2016, p. 19). immigration, healthcare and criminal justice policy are substantive areas that a human rights framework within an interprofessional partnership can make the work of social workers more effective. working with a coalition of human rights advocates is what is needed to challenge intractable problems and lead to lasting change (deluca-acconi, 2017). interprofessional education and practice of social work and law effective interprofessional practice (ipp) is predicated on effective interprofessional education (ipe). the social work and legal professions have benefited from the collaboration in both practice and education (aiken & wizner, 2003; critelli et al., 2017; madden & wayne, 2003; rand, 2018). this collaboration maximizes therapeutic results while maintaining due process and justice values. an interprofessional partnership provides each future professional valuable insight on how to effect change; for social workers, the legal system, and for lawyers, the implications of empowerment, selfdetermination, and the strengths perspective on client outcomes. zajac (2011) cited “that social workers are ‘sensitized to identify at-risk issues’ and ‘address them upstream,’ providing an integrated delivery model that provides education and empowerment to liberate clients from poverty” (p. 8). ipec (2016) competency four, teams and teamwork, highlights the need for interprofessional teams to work together to solve problems. as social work and law each has a commitment to eradicate human rights violations, they have a shared vision that can be realized by incorporating their respective knowledge and skills, such as engaging in policy advocacy that addresses implicit bias and institutional oppression that contributes to police brutality. it is essential to bring together respective professions to work effectively as a team to plan, deliver and evaluate how human rights are protected and promoted. ipec’s (2016) teams and teamwork competency, sub competency tt10, discusses the need to use “available evidence to inform effective teamwork and team-based practices” (p.14). for example, when collaborating on a team that is working against a human rights violation, such as police brutality, lawyers and social workers should be sure to recognize their process of group development, specifically progress through the forming, storming, norming, performing and adjourning stages (tuckman, 1965; tuckman & jensen, 1977). as the group progresses, an evaluation of the impact of the partnership on individual and communal human rights would address ipec’s (2016) teams and teamwork competency, sub competency tt9. evaluation of team processes may alleviate potential barriers that occur when varied professions come together through interprofessional education and practice (ipec, 2016; jones & phillips, 2016). while many challenges exist to collaborative partnership, the nasw has incorporated a human rights perspective and legal jurisprudence within social advances in social work, summer 2020, 20(2) 377 work practice to accomplish those goals and create a successful ipp team. the nasw has long partnered with lawyers to develop comprehensive social justice briefs, amicus briefs, and draft letters to local politicians supporting bills and measures to alleviate human rights abuses: the [nasw legal defense fund's] amicus brief database contains downloadable copies of 300 amicus curiae (friend of the court) briefs filed by nasw or on behalf of nasw since 1973. friend of the court briefs are accepted by courts as an aid to understanding aspects of issues that may not be fully addressed by the parties to the litigation, or where specialized knowledge may be helpful in reaching a conclusion in high profile cases. the goal of nasw and the legal defense fund has been to ensure that a social work perspective is represented in cases of interest to the profession. (nasw, n.d., para. 2) dual social work and law degrees can be invaluable for the advancement of human rights advocacy. for instance, msw/jd dual degree programs prepare graduates to “actively pursue a more just society, and to initiate and implement viable systems change by applying their training in both professions” (penn social policy and practice, 2019, para. 4). in the past, there were very salient risks associated with social workers in legal practice where state laws and professional standards conflict with navigating confidentiality (for social workers) and privileged communication (for attorneys). innovative solutions have been implemented to resolve this interprofessional conflict, such as making policy changes to allow an extension of attorney privilege to social workers working as part of the legal team (zajac, 2011). that extension maintains the spirit of confidentiality and privacy and privileged communication, while also allowing social workers to adhere to their professional obligations in the event that disclosure is made in furtherance of a crime or fraud, or someone is at risk of abuse (american bar association, n.d.; new york consolidated laws civil practice law & rules, 2012). this is just an example of how two professions can resolve the need for interdependence to address identified issues preventing those served from realizing the values of respect, dignity and worth of a person, in a holistic way. it is critical for varied disciplines engaged in interprofessional practice and education to understand that they hold similar values (jones & phillips, 2016). the partnership between social work and law, both professions where advocacy for equity and human rights is paramount, underscores the need for collaborative work among professionals. ipe and ipp train practitioners to problem solve and think collaboratively (de saxe zerden et al., 2018) and apply values and principles as a team to perform effectively (ipec, 2016). example of ipp and ipe with social work, law, and human rights practicing both social work and law from a rights-based framework becomes essential in order to create systemic change. thus, advancing the way we train social work and law students about human rights becomes an imperative. ipe teaches collaborating professions to understand the ethics and values of other occupations (jones & phillips, 2016). ipec underscored the importance of mutual respect and shared values in their first competency, values/ethics (ipec, 2016). deluca-acconi et al./interprofessional human rights partnership 378 there is a precedent for the integration of social work practice into legal settings that are designed to defend human rights (belenko, 1998; butts & roman, 2004; cooper, 2007). since the establishment of alternative court-based programs in 1989, criminal, family, and district courts have allowed the integration of social work practice to ground alternative case processing. drug courts integrate clinical process and legal jurisprudence, using an interdisciplinary team model consisting of the judge, prosecutor, defense counsel, clinician, coordinator, parents (in the case of juveniles) and community-based agencies to advocate for rights and consider clinical consequences of legal actions. family drug courts, juvenile drug courts, and mental health courts all acknowledge rights and the dynamics of addiction and trauma from an ecological (ecosystems) perspective (green et al., 2009). validated screening and assessment tools contribute to the utilization of biopsychosocial assessments to partner with community-based organizations utilizing evidence-based practices. harm reduction efforts and medication-assisted treatment are now viable opportunities for alternative court processing to support the legal community’s effort to guard against recidivism and support client’s rights. combining the knowledge and skills of social work and law can have a powerful effect when challenging rights infractions to vulnerable and marginalized populations (critelli et al., 2017). when both disciplines work toward common goals of creating systemic and sociopolitical change within a human rights framework, “a greater capacity to effect change” can occur (critelli et al., 2017, p. 132). ipe has been successful in creating positive outcomes when students are educated from multiple disciplines (charles et al., 2011; ipec, 2016) an interprofessional collaboration between the stony brook university school of social welfare’s (sbussw) bsw program and rfk human rights began in 2016, with the goals to: ● educate social work students about human rights, ● draw upon the expertise that lawyers and advocates bring to social work education, and, ● educate lawyers about the value of social work. the partnership originated when a clinical social worker realized the power that human rights education could bring to social work students. the sbussw’s bsw program entered a contractual agreement with rfk human rights to form a working partnership that would connect social work students and educators with human rights defenders, advocates, law fellows, and students. the partnership would also serve to adapt rfk human rights’ existing speak truth to power (sttp) curriculum to professional social work education. the adaptation of sttp makes specific linkages to the recommendations and competencies offered by cswe (2015, 2016) and the interprofessional education collaborative (2016). in addition, recommendations from the national task force on civic learning and democratic engagement, which are designed to strengthen students’ civic learning and democratic engagement as a core component of college study, are highlighted in the program adaptation (american association of colleges & universities [aac&u] national task force on civic learning and democratic engagement, 2012; council on social work advances in social work, summer 2020, 20(2) 379 education [cswe], 2015). the partnership allows sbussw students and faculty, as well as staff from rfk human rights, several opportunities to integrate the defense and advocacy for human rights into their professional development, practice and research. rfk human rights and speak truth to power rfk human rights is an organization led by robert f. kennedy’s daughter, kerry kennedy, that advocates and educates for a more peaceful and just world. their programs pursue justice through strategic litigation on key human rights issues, educate individuals about human rights advocacy, and foster a social good approach to business and investment (robert f. kennedy [rfk] human rights, n.d.a). kerry kennedy’s books, speak truth to power: human rights defenders who are changing our world (kennedy & adams, 2005) and speak truth to power: a guide to defending human rights (2017) serve as the basis for rfk human rights’ education program, speak truth to power (sttp). the program is rooted in the un’s principles of human rights education and are based upon the stories of human rights defenders around the globe. the lessons are designed for students to learn to self-identify as a human rights defender and to give them the tools in the global fight for justice. stony brook university school of social welfare one of the four university centers of the state university of new york (suny) system and a member of the association of american universities (aau), located in suburban long island, stony brook university (sbu) is home to an exceptionally diverse student body of more than 25,200 high-achieving students from nearly all 50 states and more than 100 countries. the sbu school of social welfare offers three degree programs: a bachelor of science with a major in social work (bsw), a master of social work (msw) and a phd. the msw and bsw programs are accredited by the cswe. the sbussw mission states: we recognize that structural inequality exists in multiple and overlapping layers of discrimination including class, race, ethnicity, gender, gender identity and expression, sexual orientation, religion, age and disability, among others. we therefore seek to remediate the impact of interpersonal and historical trauma, to foster human relationships that are grounded in social justice; human dignity and mutual respect; to develop new and just organizational forms; to transform already existing structures to reflect values that affirm and enhance human dignity and social diversity; and to identify new ways to influence social, economic and political systems to equitably distribute power, resources, rights and freedom. (stony brook university school of social welfare, n.d.) when faculty and partnership staff examined both the mission statements from rfk human rights and sbussw, advocating for human rights, social justice and challenging existing structural inequality were common themes. the focus of the partnership became working toward the development and integration of sttp for social work students, anchoring the bsw program in a human rights-based approach to social work practice. the second phase of the program would be designed to educate law fellows, human rights deluca-acconi et al./interprofessional human rights partnership 380 defenders and law students about social work and the importance of interprofessional work with social workers when advocating for human rights. a university and human rights organization interprofessional partnership the fundamental desired outcome of the stony brook university school of social welfare/rfk human rights (sbussw/rfkhr) partnership is to pilot and co-brand a replicable sttp program at the university level, within a social work program, which advances interprofessional education and competency-based social work education by incorporating a human rights-based perspective and language as the foundation for generalist social work. outcomes of the partnership are to map sttp content to professional competencies, and to develop replicable human rights education lesson plans appropriate for college and professional students and to strengthen ipe. in order to form a global citizenry of human rights defenders, the partnership aims to impart knowledge of human rights, increase empathy for those experiencing rights violations and provide the skills needed to make much needed systemic change (allensworth hawkins & knox, 2014). additional goals include: ● social work students will understand the need to create an interprofessional coalition toward a solution-focused path towards rights-based advocacy. ● law students, fellows, and lawyers will understand the importance of working with social workers to best serve clients and society, thus increasing the visibility of social workers in other disciplines. overview of partnership human rights education includes a three-stage process; first, knowledge acquisition about human rights conventions and treaties, second, awakening the consciousness to rights violations, and finally, providing the skills needed to be a human rights defender (allensworth hawkins & knox, 2014; gatenio et al., 2020; mihr & schmitz, 2007). the sbussw/rfkhr curricular program follows this structure whereas students are educated about human standards, treaties and conventions in all classes through the narrative of the sttp defenders. students are asked to identify human rights issues that are occurring locally and globally in order to educate students on the second emotional level with the goal of creating a “consciousness for human rights and its violations” (mihr & schmitz, 2007, p. 978). upon acceptance to the bsw program, students are assigned a common reader that is specifically selected based on its human rights content. students in the sbussw are introduced to sttp and human rights education during their new student orientation programming. an rfk human rights staff member and sbussw faculty give a brief overview of human rights and its application to social work. students and faculty are given time to discuss the common reader and what it means to view social issues from a rights-based instead of a needs-based perspective. the bsw seniors present excerpts from speak truth to power: voices from beyond the dark, playwright ariel dorfman's adaptation of human rights defenders’ stories. advances in social work, summer 2020, 20(2) 381 at the heart of the partnership’s first phase of work, the lessons in sttp are being connected to the nine social work competencies (cswe, 2015) and when appropriate, the four interprofessional education competencies (ipec, 2016), then integrated into all core bsw courses at the sbussw. each course syllabi includes the following statement regarding the partnership’s fundamental underpinning of defending human rights and advocating for social, economic and environmental justice: the stony brook university school of social welfare’s bsw program is partnered with rfk human rights to integrate human rights and social work education. the speak truth to power (sttp) curriculum, developed by rfk human rights and based on the un’s principles of human rights, is a human rights education program that strives to create a global citizenry dedicated to the highest standards of justice and equality. we believe this is a natural fit to incorporate into undergraduate social work education. as a result of this agreement, stony brook university school of social welfare bsw program serves as a pioneer for incorporating the united nations’ declaration of human rights, access to knowledge about globally-renowned defenders of these rights, and skill development to advocate for human rights into foundational social work education. students should become familiar with and refer to the un declaration of human rights for assignments and coursework across the bsw curriculum. (stony brook university school of social welfare, 2016, p. 7) sttp human rights defender lessons and assignments are integrated throughout the undergraduate social work curriculum. the sttp lessons and assignments allow students to develop all of the cswe competencies, well beyond the obvious competency 3: advance human rights and social, economic, and environmental justice. social work practice-designated courses draw upon the sttp defender stories as case studies and as a means for students to practice the application of theory and skills. targeted competency development is particularly focused on students engaging diversity and difference in their practice (cswe competency 2), engaging, assessing, intervening, and evaluating their practice at all client levels (cswe competencies 6, 7, 8, and 9), whilst demonstrating ethical and professional behavior (cswe competency 1) in their advancement of human rights and social, economic, and environmental justice (cswe competency 3). concurrently, when students of both professions engage in the lessons and activities, they are able to develop and strengthen the ipec (2016) competencies: developing and maintaining a climate of mutual respect and shared values (competency 1: values and ethics for ipp), use the knowledge of each profession’s role in addressing client needs (competency 2: roles and responsibilities), responsive and responsible communication (competency 3: interprofessional communication), and working effectively as a team (competency 4: teams and teamwork). for example, in a groupwork practice course, students learn about sttp defender, juliana dogbadazi. they learn about the types of groups, both task and treatment, and how organizations, such as the ngo she talks about in her interview, could develop to address the human rights issue of modern slavery. students then identify a human rights/justice issue that they are particularly passionate about, identify and interview an example of a human rights defender who is working locally in this area of practice, and plan a group intervention proposal. the story https://stonybrook365-my.sharepoint.com/personal/suzanne_velazquez_stonybrook_edu/documents/%20(stony deluca-acconi et al./interprofessional human rights partnership 382 of frank mugisha, a sttp defender advocating for lgbtq+ rights is used as a foundation for students to learn about social work with special populations and practice having rightsbased conversations, particularly around potentially socially divisive topics. they are continually instructed about human rights conventions and covenants and are taught to view issues from a rights-based perspective. students are asked to research appropriate laws that are applicable to the defenders’ narratives. social work policy-designated courses draw upon the sttp defender stories as a means to practice policy analysis and to understand the connection between practice and policy development, implementation and evaluation. for example, in a social political economy course, students learn about sttp defenders, kek galabru and muhhamud yunus. the lessons of sttp defender kek galabru, who helped to end the cambodian civil war and works against sexual tourism and child labor, teach students about negotiating and ending conflict, as well as standing up to those in power to advocate for the promotion of human rights. the story of sttp defender muhhamud yunus and his approach to addressing poverty through the use of microlending is used in a lesson that allows students to compare and contrast economic systems and traditional practices and develop and propose alternative solutions towards economic justice through law and policy change. students learn about the importance of political participation and struggles faced in the realization of udhr article 21: right to participate in government and in free elections and are tasked to conduct a political-social action group project that increases their own civic engagement and allows them to develop competency in policy practice (cswe competency 5) and teamwork (ipec competency 4). long understood as social work’s signature pedagogy, field education is where students are able to apply the lessons from the classroom into the field while developing and strengthening all nine professional competencies. in response to human rights abuses and violations, changing social work practice and education includes training social work interns how to be responsive to changing laws that perpetuate abuse and human rights violations. prepared with the lessons of the sttp defenders, students are better equipped to practice from a rights-based framework in their field placements. for instance, supervised internship experiences now include libraries from which services are provided to undocumented immigrants. considered safe spaces to congregate, social work interns are providing case management to library patrons, which include referrals to communitybased organizations for housing, job referrals, clinical services, and attorneys for immigration services. in our changing political climate, these efforts to provide a human rights framework to service provision also includes crisis intervention aimed at educating library staff how best to service immigrant or refugee populations in a dignified way, respectful of their orientation, experiences, and threats to liberty. coupling the sbussw’s underpinning of research around the social determinants of health with the sttp curriculum, social work courses utilize the sttp defender stories and lessons to develop students’ competency in research-informed practice and practiceinformed research (cswe competency 4). it has been documented that the u.s. views human rights infractions as global phenomena and does not acknowledge the abuses occurring on our own soil (mcpherson & abell, 2012). social work educators must challenge the belief of u.s. exceptionalism and the notion that the u.s. is a leader in the advances in social work, summer 2020, 20(2) 383 protection of human rights (healy & wairire, 2014; libal & harding, 2015). while discussing the examples of immigrant abuses as outlined above is important, it is also very powerful to educate about american human rights defenders in an effort to bring to life that human rights abuses happen within our own national borders; one of which is marian wright edelman. in her sttp interview about her work in the defense of children’s human rights, defender marian wright edelman, asserts, it’s shameful that we alone among wealthy, industrialized nations don’t see that our children get a healthy start. we have much higher rates of infant mortality and low-birth-weight babies than our industrialized counterparts. we lag in preparing our children in science, math, and reading compared to many of our competitor industrialized countries that they are going to be up against in the new global village. and we lag the world most shamefully in protecting our children against violence. american children fifteen and under are twelve times more likely to die from gun violence than children in twentyfive other industrialized countries combined. (rfk human rights, n.d.b, marian wright edelman, para. 3) social work students are asked to conduct further research about the human rights issues involved in each sttp defender story, define action steps towards a solution, and develop an evaluation plan for assessing the change strategy. after reading the story of marian wright edelman, they are presented with the statement on visit to the usa, by professor philip alston, united nations special rapporteur on extreme poverty and human rights (alston, 2017). they are asked to conduct research on the statistics in the report, connect it to social determinants of health policy and the mechanisms in which defenders, such as marian wright edelman, are fighting poverty in the united states a key component of the partnership is to link a defender’s work involving current advocacy initiatives to that of lawyers, social workers, and students. the connection between poverty, the special rapporteur’s report and pre-trial detention in the u.s. is made in conversations with a rfk human rights lawyer as part of the interprofessional partnership. students discuss the link between poverty and mass incarceration while examining the punishing policies and practices that lead to unconstitutional pretrial detention with a rfk human rights lawyer. one of the rfk human rights’ organizational goals is to reinvest in communities most impacted by mass incarceration, using the funds that have been previously used to run a jail. rfk human rights benefits from the relationship with social work students as they discuss ideas for programs designed to help those who have been released from prison integrate back into the community. conversations between social workers and lawyers become important as both sides work toward solutions. such conversations enhance the achievement of interprofessional communication competence (ipec, 2016). the extent of rights violations can be overwhelming to students from all disciplines, creating a sense of despair. however, when solutions to social problems are presented and discussed, students become empowered and a sense of hope replaces that despair (allensworth hawkins & knox, 2014). the power of this partnership has been that students and practitioners of both social work and law can see how working together in interprofessional collaboration challenges the status quo and deluca-acconi et al./interprofessional human rights partnership 384 advances human rights globally. lawyers and law students can begin to have an understanding from social work students about the way trauma may impact those who have undergone human rights abuses and a history of systemic oppression. a strength of ipe, particularly through ipec’s (2016) values/ethics subcompetency ve4 for interprofessional practice, is that other professions understand the value of social work, expanding and improving the reputation of social workers (charles et al., 2011). one rfk human rights lawyer remarked how she benefitted from working with social workers as they were able to engage with clients from an empowerment perspective lens. she recently contacted the school when looking for social work research on the developmental rationale against trying juveniles as adults. future goals include working with rfk human rights to integrate social work competencies into law practice and internships. practicing social work: human rights framework the research on human rights in social work education found that the emphasis lays in instruction of human rights instruments rather than on how to practice social work from a human rights framework (gatenio gabel & mapp, 2020). as stated above, the sbussw/rfkhr partnership educates social work students about human rights instruments early in the first year of the program, and then purposely teaches about how to specifically practice social work from the human rights framework in the second year. sttp illustrates human rights issues through the stories of human rights defenders and the adaptation into the bsw curriculum includes the purposeful inclusion of how to translate the defender’s work into social work practice, illustrating human rights issues through the stories of human rights defenders. by the end of the second year, students are taught the third level of human rights education, skills that are needed to be human rights advocates and defenders and to “effectively prevent and combat human rights violations” (mihr & schmitz, 2007, p. 978). the skills they cultivate include collaboration with lawyers to help advocate for the people and communities who have had their rights violated. allensworth hawkins and knox (2014) identify that it is not enough to teach about human rights infractions, but to help train students to identify solutions. the sbussw/rfkhr partnership is designed to help students identify the solutions to human rights infractions. the sttp defenders are working toward solutions to human rights problems and through the lessons social work students are able to begin to see the answers to what are complex issues. for example, librada paz is a rfk human rights defender in the sttp curriculum. she immigrated from mexico at the age of 15. her works highlight the cruel treatment that she experienced on u.s. farms: “for more than a decade, i experienced inhuman conditions working in the fields of the united states. i learned that farmworkers do not matter. our security doesn’t matter. our thoughts don’t matter. our dignity doesn’t matter” (rfk human rights, n.d.c, librada paz, para. 3). as a part of the human rights programming, librada presented to both bsw and msw students, tracing her road from a farmworker to rights activist, passing the first laws in new york to protect farmworkers: we have made promising advances in new york, including passing three new laws that protect farmworkers right to clean water facilities, sanitation facilities, and a advances in social work, summer 2020, 20(2) 385 standardized minimum wage. these protections were the first farmworkerinitiated laws in new york state’s history. (rfk human rights, n.d.c, librada paz, para. 9) through conversation with librada, social work students were able to conceptualize the process of problem identification to policy advocacy and change based on a human rights framework. social work students are able to actively engage in the farmworker’s rights campaign and translate such experience and skill development to all areas of practice. beyond the interviews and lessons from the speak truth to power books, the partnership allows for live interaction between human rights defenders, lawyers, and students, such as the campus visits of defenders such as librada paz, and will strengthen the development of interprofessional education and relationships to work towards solutions. program evaluation social work students are being taught the importance of advancing human rights through our partnership. the goals of the program are to increase knowledge, exposure and engagement with human rights and advocacy, so it is of interest to assess the outcomes of these goals. as this partnership is in the initial years of development and implementation, a program review is being conducted but the evaluation is not yet complete. after the program review is finished, a full board irb application will be submitted for a full research study for publication. data collection for program review and future research study includes students completing two self-report surveys at orientation before any exposure to the material and again immediately prior to graduation. the first instruments given to the students are the human rights exposure in social work (hrxsw) and human rights engagement in social work (hresw), which are valid and reliable scales that assess the impact of human rights education for social work students (mcpherson & abell, 2012). the hrxsw measures the extent that students have been exposed to human rights principles during their education. this measure was chosen since one of the program goals is to familiarize students with human rights principles. it is given to the students to assess prior knowledge and ascertain growth of knowledge. the authors are interested in the level of prior understanding of human rights entering the social work program and the increase in knowledge they incur upon completion of the interprofessional education and human rights instruction in the sbussw/rfkhr collaboration. defending human rights requires an energy and commitment to make much needed change. the hresw is designed to discover the extent of a student’s “passion for human rights and social work” (mcpherson & abell, 2012, p. 711). the hresw is being utilized to discover the extent that the sbussw/rfkhr partnership ignites students’ commitment to human rights in their social work practice. across the curriculum, each assignment associated with a sttp lesson has the student practice self-reflection about the human rights issue and impact of the lesson. the goal is to help students envision themselves as human rights defenders in their future social work practice when they read and interact deluca-acconi et al./interprofessional human rights partnership 386 with the stories of the defenders. students are asked to make specific connections to the cswe competencies they strengthen as a developing human rights advocate, and how they integrate a human rights framework into their social work practice. faculty have reported a noticeable shift in the language used in class discussions, particularly as students advance through the two-year curriculum, incorporating a rights-based perspective. specific questions added to course evaluations also provide valuable student feedback about their experiences and the knowledge, values, and skills gained during each course across the social work curriculum as it relates to their development as a human rights advocate and social work practitioner. additional course evaluation questions emphasizing ipec competencies provide feedback about students’ growth and understanding of the importance of interprofessional practice for social workers. future goals in addition to continual assessment of the partnership, a program evaluation of the partnership will be conducted to measure exposure and engagement of human rights principles and whether social workers see societal issues through a human rights lens (mcpherson & abell, 2012; mcpherson et al., 2017). future plans include researching the way graduates of the partnership use human rights by utilizing the human rights lens in social work (hrlsw) scale. the hrlsw’s purpose is to assess the way that a practicing social worker interprets both individual and social issues as emanating from human rights infractions (mcpherson et al., 2017). as one of the objectives of the partnership is to create a new generation of human rights defenders, it is of interest to the authors to see how graduates of the program practice from a rightsbased perspective. the goal is to measure the way graduates employ a rights-based instead of needs-based social work practice, viewing problems from “sociopolitical and structural contexts” that are the target of intervention (berthold, 2015, p.5). using the rights-based lens empowers clients to see their issues from a violation of their rights instead of individual pathology (berthold, 2015; mcpherson, 2016). future recommendations and goals include measuring the impact that the partnership has had on the lawyers, fellows and students at rfk human rights to ascertain their level of understanding of the social work profession and the need to work with social workers in the defense of human rights. elevating social work in the eyes of other professions is an important outcome of ipe and ipp (charles et al., 2011; de saxe zerden et al., 2018). it is also important to evaluate the ipec competencies to ascertain the strength of the educational partnership for lawyers, students and human rights defenders. dow and colleagues (2014) created an assessment tool derived from the ipec’s competencies. the goals of the assessment tool are: 1. inform curriculum planning with valid and reliable information 2. track the effects of degree programs on interprofessional competency, and 3. provide data that can be used within and between institutions to compare programmatic outcomes. (p. 299) advances in social work, summer 2020, 20(2) 387 hasnain et al. (2017) validated a tool for self-efficacy for interprofessional competence. the plan for this project is to examine both dow et al. (2014) and hasnain et al. (2017) instruments and to conduct research as to which can be adapted and validated as a tool to evaluate the human rights educational partnership. an objective is to adapt these healthcare-specific measures to evaluate other interprofessional partnerships, particularly for human rights defenders, lawyers, and students. conclusion as this interprofessional partnership continues to grow, conversations and opportunities for collaborative work between social work students, law students, fellows, and defenders will expand; thus, too, will their integrative learning. it is a reciprocal relationship. the goal is for non-social work partners to understand: the manners in which trauma impacts those who have undergone human rights abuses; the impact of systemic racism; and social work’s person-in-environment perspective. conversely, social work students learn about human rights law and agreements, and become better able to incorporate these into their practice while strengthening their advocacy efforts. this collaborative expertise demonstrates the power of interprofessional education and practice (ipec, 2016). the current geopolitical issues, human rights infractions throughout the globe and an unnerving rise in the number of demagogue leaders necessitates that advocacy networks from all professions band together. social workers understand the deep pain of those who have been silenced and those who have been forsaken. using a human rights framework helps those in interprofessional partnerships defend all who remain in the shadows, find their voice and amplify their cries for justice. the goal is to continue to grow this collaboration, working with human rights defenders and advocates around the world to join the fight against injustice. “and i believe that in this generation those with the courage to enter the moral conflict will find themselves with companions in every corner of the globe” (kennedy, 1966, transcript para. 36). references aiken, j. h., & wizner, s. 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(2011). social work and legal services integrating disciplines: lessons from the field. legal aid association of california. https://www.laaconline.org/wpcontent/uploads/social-work-and-legal-services-integrating-disciplines-lessonsfrom-the-field-1-1.pdf author note: address correspondence to robin deluca-acconi or suzanne l. velázquez, stony brook university, school of social welfare, health sciences center, l2-093, z-8231, stony brook, ny 11794-8231. email: robin.deluca@stonybrook.edu or suzanne.velazquez@stonybrook.edu https://www.ohchr.org/en/professionalinterest/pages/cat.aspx https://www.ohchr.org/en/professionalinterest/pages/crc.aspx https://docs.wixstatic.com/ugd/426a18_ab86096e967c46d785a199b07bc101b8.pdf https://www.who.int/hrh/resources/framework_action/en/ https://www.laaconline.org/wp-content/uploads/social-work-and-legal-services-integrating-disciplines-lessons-from-the-field-1-1.pdf https://www.laaconline.org/wp-content/uploads/social-work-and-legal-services-integrating-disciplines-lessons-from-the-field-1-1.pdf https://www.laaconline.org/wp-content/uploads/social-work-and-legal-services-integrating-disciplines-lessons-from-the-field-1-1.pdf mailto:robin.deluca@stonybrook.edu mailto:suzanne.velazquez@stonybrook.edu _________ mónica gutiérrez, msw, phd, assistant professor, university of denver graduate school of social work, denver, co. stephanie lechuga-peña, phd, msw, assistant professor, school of social work, arizona state university, phoenix, az. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 605-627, doi: 10.18060/24996 this work is licensed under a creative commons attribution 4.0 international license. latina/o/x critical race theory (latcrit) in social work praxis: a tool to dismantle racism and build racial equity mónica gutiérrez stephanie lechuga-peña abstract: we propose that the profession is theoretically at a point of convergence between crt and latcrit. both theories are united in the production of knowledge to dismantle oppression. this article provides a brief review of crt and a comprehensive understanding of latcrit as a starting point for critical social work education perspectives. we discuss implications for social work education by broadening the racial discourse to include latinas/os/x and suggest critical solutions and adaptations to current social work pedagogy to better prepare students to enter the social work field and respond to this growing population. we provide recommendations for reevaluating social work and find an exit from the loop of “band-aid” interventions that lack a fundamental basis for addressing the underlying causes of trauma, stress, and racism. we provide concrete examples for incorporating latcrit into social work education, practice. we close by calling on the professions leading organizations, nasw and cswe, to release statements addressing the recent assault on crt (and latcrit by way of its extension of crt) and join other social work organizations in condemning the unfair attacks on crt if social work is committed to the grand challenge to eliminate racism. keywords: latina/o/x critical race theory, critical race theory, racism, anti-racist pedagogy, social work policy, social work education in its current form, social work education fails to examine how the profession has operated to maintain white supremacy and white privilege, and to sustain the current racial social order (beck, 2019; bussey, 2020; ortega & busch-armendariz, 2013; teasley et al., 2021). given the profession’s history of coexisting within patriarchal systems, social work pedagogy has invariably tended to practice white saviorism (rangel, 2021).the profession’s omission of the historical and contemporary context of a racialized america does not absolve us from self-critique. wilson (2020) reminds us that frameworks of change in social work “are built from figure/ground dichotomies in which an object of interest is as somehow distinct – divided, purified, abstracted out – from everything else” (p. 41). this humanistic perspective establishes a social work praxis that reduces communities and people into objects within a larger system. while social work remains oriented towards a humanistic perspective, we must re-conceptualize the profession to incorporate contextual theoretical frameworks that provide a more complex structural lens. latina/o/x critical race theory (latcrit) is a framework that can guide social work praxis by offering insight into the ways that racism is more than racially biased attitudes and actions, but a hierarchical social structure established by white elites to preserve their social status. structural and institutional racism is present in the communities social workers advocate alongside, and is experienced by our clients. these key concepts about about:blank advances in social work, summer 2022, 22(2) 606 race and racism emphasize the latina/o/x experience of racism and not on how white people conceive of or intend to act around race. this theory presents racism as a collection of social, political, and economic circumstances that jeopardize the quality of life of latinas/os/x. latcrit, draws on the original tenets of critical race theory (crt) and expands the framework by including factors that are specifically a part of the latina/o/x experience. latcrit focuses on the positions latinas/os/x hold within multiple systems of inequality based on their intersectional identities such as race, ethnicity, gender, social class, sexual orientation, age, ability status, and migration status, while also examining their experiences with language, immigration status, and citizenship. the black/white paradigm inherent in crt does not speak to the experience of "others" and instead serves to perpetuate cultural and racial erasure. latcrit can be used to intentionally address the gap in social work praxis with latinas/os/x by increasing the understanding of the latina/o/x community and addressing this growing population’s needs. given the current devaluation of latina/o/x culture—including nativist and anti-immigrant sentiment that threatens the community’s well-being—addressing these conceptual limitations is especially important. thus, latcrit offers tools to direct our work to be increasingly responsive and match the level of entrenched racism in latina/o/x communities. this article begins by defining the terms used throughout this paper, followed by a brief historical overview of crt to provide a primer for the role of historical and contemporary race-based events contributing to latina/o/x skepticism and mistrust of various governmental and social service systems (these are simplified accounts that serve as poignant examples but do not convey the entire story). we then define, discuss, and review latcrit within the current social work literature. we conclude by offering specific implications that foreground a conceptual framework for social work praxis that interrogates the role of racism in the profession, which can serve to adequately prepare students to enter the field and respond to the experience and needs of the growing latina/o/x population. racism must be defined explicitly in social work praxis as teasley et al.’s (2021) call to action states, “the grand challenge to eliminate racism calls for the social work profession to focus on the centrality of racism and white supremacy, both within society and within the profession” (p. 1). predominant eurocentric definitions have shaped how social work understands race and racism. therefore, brown, black, and indigenous scholars have a particular responsibility to explicitly define these concepts according to our knowledge traditions, and to remain steadfast as part of our critique of the current production of knowledge and the potential harm to our communities created by these various approaches to knowledge. as brazilian critical education scholar paulo freire (1985) has reminded us, “washing one’s hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral” (p. 122). we must understand that racism and not race is a determinant of health, and is a fundamental cause of unequal outcomes for latina/o/x communities (lebrón & viruellgutiérrez & lechuga-peña/latina/o/x crt 607 fuentes, 2019). it is necessary to define the concepts covered in this paper in order to indicate the ways that race is socially constructed within society. these definitions are found in table 1. table 1. social work definitions utilizing concepts of critical race theory concept definition social work analysis of the interconnectedness between societal and institutional racism and social welfare systems, and willingness to challenge these systems. recognizes that individuals’ and communities’ concerns are deeply rooted in larger systems of power and are manifested as oppression, which leads to unequal health outcomes. understands that the personal is political. latina/o/x* the term latina/o/x is used throughout this article to capture the diversity within the racial/ethnic group and to prevent erasure of connections latinas/os/x have to distinct ancestral roots across the americas (northern, central, southern, caribbean, and africa). “in this context latinas/os/x can be native or foreign-born, citizens or non-citizens, authorized or unauthorized, and identify as afro-latina/o/x, hispanic, latino, latina, or latinx” (garcía, 2020, p. 393). race “race is a concept, a representation or signification of identity that refers to different types of human bodies, to the perceived corporeal and phenotypic markers of difference; in addition, it refers to the meanings and social practices that are ascribed to these differences” (omi & winant, 2014, p. 111) . racialization “races typically are identified by their phenotype, but the selection of certain human traits to designate a racial group is always socially rather than biologically based” (bonilla-silva, 1997, p. 469) racism “the state-sanctioned and/or extralegal production and exploitation of groupdifferentiated vulnerability to premature death” (gilmore, 2006, p. 247). white supremacy beliefs and ideas embedded in our institutions, social work theories, approaches to social work practice, and ideologies; “a hierarchy of any sort that prioritizes whites and whiteness over all other” (teasley et al., 2012, p. 1). praxis an “iterative process by which the knowledge gained from theory, research, personal experiences, and practice inform one another” (ford & airhihenbuwa, 2010). theory “lenses through which social scientists examine, evaluate, organize, predict, and interpret social phenomena. theories propose ways in which different factors relate and, in some cases, how one factor may be the cause of another factor or phenomenon.” (kulis et al., 2021). framework “a framework is the total, logical orientation and associations of anything and everything that forms the underlying thinking, structures, plans and practices and implementation of your work” (kivunja, 2018, p. 47). *it is important to note that latinas/os/x are not a homogenous group, and they may or may not view and experience anti-immigrant or racist rhetoric the same. that is to say, latinas/os/x who are immigrants may experience the consequences of racialized immigration policies while white middleand upper-middleclass or white-passing latinas/os/x may avoid personally being impacted. while not all individuals who identify as latina/o/x are impacted by racism, those that are racialized as non-white or that lack economic means are more likely to experience the racial state. advances in social work, summer 2022, 22(2) 608 critical race theory (crt) the debate over crt has been catapulted into the public discourse in the united states (us), as critics have deemed it anti-american and with marxist undertones (farber & sherry, 1997; posner, 1997; pyle, 1999). several republican lawmakers have proposed new bills regulating the discussion of race in the classroom (gabriel & goldstein, 2021). twenty-six states have either proposed legislation, taken other measures to restrict the teaching of crt, or placed restrictions on how instructors can address racism and sexism in the classroom (ray & gibbons, 2021). nine states—idaho, oklahoma, tennessee, texas, iowa, new hampshire, south carolina, arizona, and north dakota—have passed legislation primarily banning “the discussion, training, and/or orientation that the us is inherently racist as well as any discussions about conscious and unconscious bias, privilege, discrimination, and oppression” (ray & gibbons, 2021, para. 8). idaho and north dakota are the only states that passed a bill explicitly referencing “critical race theory” (ray & gibbons, 2021, para. 7). the attack on crt is evidence of the ways the system of white privilege attempts to silence those who experience racism and to attribute innocence to those who are active or complicit participants. so, what is critical race theory? and, as derrick a. bell (1995) asked, why are so many people afraid of it? given the range of misinformation, it is imperative to remember the movement’s foundation in the emancipatory work of scholars such as sojourner truth, ida b. wells, carter g. woodson, w. e. b. du bois, anna julia cooper, and zora neale hurston (crenshaw et al., 2019). the work of crt’s earliest authors was rooted in recognizing and calling for an end to racial disparities, including in the social order, income disparities, and the political system, all of which framed the concepts of oppression and exploitation that serve as the foundation for crt. as crenshaw et al. (1995) explained in critical race theory: the key writings that formed the movement, critical race research is united by two fundamental objectives: the first is to understand how a regime of white supremacy and its subordination of people of color have been created and maintained in america, and, in particular, to examine the relationship between that social structure and professed ideals such as “the rule of law” and “equal protection.” the second is a desire not merely to understand the vexed bond between law and racial power but to change it. (p. xii) crt offers analytical tools for reassessing the conditions under which race and racism have been constructed in the social structure of the us. crt scholars are grounded in a vision whereby the law may serve as a tool of liberation rather than domination. crt first came to the forefront in the us in the 1970s when attorneys, activists, and legal scholars recognized that the significant progress made during the civil rights movement of the 1960s was being overturned as leadership in the us moved from civil rights to law and order (delgado & stefancic, 2017, p. 2). this cadre of activist scholars proactively engaged in analyzing and attempting to alter the interrelationship between power, race, and racism between communities of color and the legal system. the fundamental principles laid out by bell (1980) and bonilla-silva (2014) continue to guide crt, which is built around five central tenets: 1) racism is normal: racism is not limited gutiérrez & lechuga-peña/latina/o/x crt 609 to isolated instances of blatant discrimination or violence but manifests itself in the implementation of laws and policies that affect millions of people, establishing expectations for individuals and communities of all races and ethnicities (delgado & stefancic, 2017). 2) interest convergence: governmental and public institutions enforce laws in order to protect the white majority's interests (bell, 1980). 3) race as a social construct: race is a category that has nothing to do with higher-order characteristics such as personality, intellect, and moral conduct (delgado & stefancic, 2017). 4) intersectionality: the identification of the many cross-sectional identities that individuals possess (crenshaw, 1989). 5) counter storytelling: stories do not have to follow the scripts assigned by society; they may be used to identify specific types of discrimination, which is the first step to addressing discrimination (ladson-billings & donnor, 2018). these five tenets provide scholars with tools to disrupt the long-standing paradigm of race that does not reflect the views of brown, black, and indigenous peoples, including latinas/os/x. finally, we end this section on crt by pointing out that despite the fact that crt makes use of the term “theory,” crt is not the same as social work theories (i.e., social learning theory, ecological systems theory, psychosocial development theory) intended to help students arrive at a more complex understanding of social relations and the learning process. instead, crt in social work is an iterative approach intended to assist scholars and practitioners in identifying and centering equality in social work praxis (ford & airhihenbuwa, 2010). historical context latinas/os/x as a social construct the concept of race is entrenched in power. including the power to dictate how racial categories are defined and used. as gomez (2020) states, racial categories “are political categories, reflecting the power of one group (whites) to define other groups as inferior to them, as less than fully human” (p. 6). those who identify as latina/o/x are forced to select their race as “white” on demographic questionnaires that utilize the us census bureau’s classification of written responses to the race question (e.g., white, black or african american, american indian or alaska native, asian, native hawaiian or other pacific islander; us census bureau, 2021). not until recently, has the ethnicity category expanded beyond “hispanic” to include “mexican,” “latin american,” “puerto rican,” etc. the expansion of the white racial category to include latinas/os/x does not indicate the elimination of racial hierarchy or the racial state. rather it remains a mechanism for whites to remain the dominant racial group. the first legal case involving a mexican seeking u.s. citizenship was the 1897 texas case known as in re: rodríguez (1897), which contested mexicans’ right to u.s. citizenship. in a texas federal district court, ricardo rodríguez, a mexican who had lived in texas for more than a decade, sought final approval of his application for citizenship which would also grant him the right to vote. local politicians opposed his petition, arguing that the fourteenth amendment provided for the naturalization [citizenship] of only whites and “blacks”. the texas federal court ruled in favor of rodríguez legally affirming advances in social work, summer 2022, 22(2) 610 mexicans’ in texas the right to u.s. citizenship and thus the right to vote (molina, 2014). by allowing mexican americans legal whiteness while denying it to other racial groups (i.e., pueblo indians), whites were able to bolster their dominance and interrupt any potential coalition between other oppressed and racialized groups. this newfound status of whiteness worked as intended and promoted the disassociation of mexican americans from other potential non-white allies (gómez, 2019). this racial categorization of latinas/os/x relegates them only to exist as an ethnic group perpetuating the stereotype of mexicans as foreigners. classifying latinos as ethnic minorities correlate with privileging white skin. “those with greater spanish ancestry have higher status than those individuals with more visible indigenous and/or african ancestry. despite the fact that the range in phenotype due to indigenous, african, and spanish roots exists in all latin american countries” (gomez, 2020, p. 14). latinas/os/x in the 21st century the latina/o/x population is the second-fastest-growing racial/ethnic group in the us, reaching 60.6 million in 2019. since 2010, latinas/os/x account for more than half of the entire population growth in the united states (noe-bustamante & flores, 2019). the population growth in this population is projected to increase by 62% through 2025 (noebustamante, 2019). latinas/os/x have made a myriad of contributions to the economic, social, and political success of the united states. for example, the overall economic contribution generated by latinas/os/x in the us increased from $1.7 trillion in 2017 to $2.3 trillion in 2010 (latino donor collaborative, 2020). another example is the fact that latinas/os/x represent the military's fastest-growing minority group and comprise approximately 16% of all active-duty service members (barroso, 2019). a final example of the material contributions latinas/os/x represent is the fact that agricultural workers are the backbone of the country’s agriculture, and they are a primary reason americans are able to put food on their tables. according to the national center for farmworker health (2020), there are nearly 2.5-3 million agricultural laborers in the us, 75% of whom are foreign-born, and 83% of whom self-identify as latina/o/x. despite the fact that research consistently shows the contributions of latinas/os/x, both immigrant and us-born, they continue to be stereotyped as criminals, drug lords, and predisposed to violence (chavez, 2020; huber pérez, 2010; menjívar & abrego, 2012; messinget al., 2015; romero, 2001). “within this context, racial difference became the rationale for discriminatory policies and practices of immigrant exclusion, naturalization rights, residential segregation, and forced sterilization” (omi & winant, 2014, p. 216). anti-immigrant and other racist rhetoric bolster the passage of laws and legislation that are punitive towards latino/a/x communities. recognizing the federally sanctioned racist immigration and health practices that target racialized communities provides context for understanding why latinas/os/x distrust these same systems (e.g., health care, social welfare, police, education), presumably intended to serve and protect them. this historical and contemporary backdrop is essential for social workers to understand as they engage with members of the latina/o/x community. gutiérrez & lechuga-peña/latina/o/x crt 611 the history of violence targeting latina/o/x communities between 2015 and 2020, latinas/os/x lost their lives as a result of police interactions at a rate of 23 per million (roberts, 2020). latino males were more likely than any other group to be murdered by police in gentrifying areas or communities with minimal diversity, according to a 2018 study conducted by washington university in st. louis (arellano, 2021). the violence against latinas/os/x is part and parcel of the ways that racialized and marginalized communities are targets of the police and other official institutions of us society. the united nations’ (2020) office of the high commissioner for human rights issued a devastating critique of the us’s handling of the recent protests against the police targeting of african american communities in particular. in what the unhchr calls these modern-day racial terror lynchings in the us after a recent spate of killings of african americans involving impunity, particular disregard or depravity toward human life, and the use of public spaces to assert racial control, each characteristic of lynching. (para. 2) the latina/o/x experience of the racial state dates back centuries, even as it is excluded from mainstream historical narratives of violence in the us. rodolfo f. acuña (2007) regarded as one of the academic fathers of chicano studies, recounts that “between 1848 and 1928, mobs lynched at least 597 mexicans in the united states. clearly the mexican population suffered lynching in lesser numbers than did the african americans, whose population was much larger” (p. 67). the year 1848 is pivotal for mexican “immigration,” as millions of mexicans were forcibly integrated into the us population after the us stole 1/3 of mexico’s territory after the mexican american war, and consequently with the signing of the treaty of guadalupe hidalgo two years later. carrigan and webb (2003) stated that “proportionately the number of mexicans lynched was striking. for instance, between 1848 and 1879 “mexicans were lynched at a rate of 473 per 100,000 of population. during these years, the highest lynching rate for african americans was in mississippi, with 52.8 victims per 100,000 of population” (p. 67). historians have documented that white militias functioned alongside official law enforcement. the same officers sworn to protect and serve citizens participated in racially motivated lynchings and created the circumstances for mexican citizens and prisoners to be exposed to additional state violence (acuña, 2007; martinez, 2018). crt helps to identify how these systematic and unofficially sanctioned forms of violence are present today in policing and other forms of institutional control in the us. forced sterilization of puerto rican and mexican-origin women in addition to recognizing the impact of policing and extra-state forms of violence on latina/o/x communities, social workers also need to be aware of these communities’ experiences with public health issues. latina reproduction and fertility, particularly amongst puerto ricans, mexican-americans, and mexican immigrant women, have long been at the forefront of governmental policies, legislation, and medical practice, all interested in controlling the fertility of low-income latina women (chavez, 2020). the advances in social work, summer 2022, 22(2) 612 idea of sterilization first came into prominence in the early 20th century as part of the social darwinist eugenics movement. eugenicists theorized that the united states could genetically engineer its racial composition by controlling the population (stern, 2005). forced sterilizations occurred in part due to the notion that immigrant families would put a strain on fiscal budgets, and thus sterilization offered a means of population control, as well as lifelong birth control. with support from the federal government and an influx of immigrants from mexico, california saw some of the highest rates of sterilization. in 1909, california performed onethird, or 20,000, of all reported forcible sterilizations under state eugenics legislation (stern, 2005). latina women continued to be unfairly targeted by eugenic sterilization legislation passed in the 1960s and 1970s (novak et al., 2018, p. 613). a recent study by novak et al. (2018) found that “17,362 individuals were recommended for sterilization in california state homes and hospitals between 1920 and 1945 and latinas/os were at the highest risk of sterilization for that entire period” (p. 612). simultaneously, 59% of latinas faced a higher risk of sterilization than non-latinas, and between 1920 and 1926, latino males faced a 23% increased risk of sterilization compared to non-latino men (novak et al., 2018). as gutierrez and fuentes (2010) explained, even if latina patients refused to undergo the procedure, many patients later discovered that they had been sterilized at subsequent gynecological appointments or when approached to participate in the madrigal v. quilligan (1975) trial. madrigal v. quilligan was a civil rights class action lawsuit filed by 10 mexican american women against the los angeles county-usc medical center for involuntary or forced sterilization. the california federal court ruled in favor of the county medical center, and held that sterilizations were the result of miscommunication and language barriers between the patients and the doctors (library of congress, n.d.). unfortunately, the forced sterilization of latina women is not an episode that is relegated to the more distant past. the american civil liberties union released a report on a recent lawsuit against authorities who illegally forced sterilization practices on immigrant women held in us immigration and customs enforcement (ice) detention centers (manian, 2020). according to the lawsuit, authorities transported prisoners to a physician who sterilized them, performed forced hysterectomies, and performed unwarranted gynecological procedures without the women's knowledge or consent (manian, 2020). when advocating alongside latina women to promote their well-being, social workers must recognize and respect the historical negligence women have experienced at the hands of the us government and medical practitioners. these histories are still alive in the distrust among latinas in relation to official institutions and policies. segregation and the education of latina/o/x students another manifestation of deep-seated racial segregation is manifested in latinas/os/x’s experiences of mistrust of the us education system, which can be traced back to the segregation of mexican students into all-mexican schools (delgado, 2019). in 1931, a statewide survey showed that 85% of california schools segregated children of mexican descent in either separate classrooms or schools (constitutional rights foundation, 2007). gutiérrez & lechuga-peña/latina/o/x crt 613 the arguments for segregating mexican students from white students were that: 1) mexican students were “culturally distinctive” compared to anglo-american children, contributing to their capacity to learn; 2) the spanish language mexican students spoke impacted their learning and kept them from advancing in school; 3) their iq was below that of the average white child; and 4) the patterns of their parents’ occupations prompted educators to emphasize a vocational education (delgado, 2019). rarely did mexican children receive an education equal to that provided to white students in the community. the experiences of mexican students in the us education system in the early 20th century set a precedent for using as a deficit understanding of mexican students’ ability to learn at the same level as their white peers in the present day, as bilingualism is seen as un-american and considered a barrier to learning (delgado bernal, 2002). latina/o/x students are still encouraged to consider vocational training to get them ready for a career, rather than promoting an academic track to higher education (fernández, 2002). many students respond to these expectations by missing school and disengaging, based on the low expectations projected onto them (fernández, 2002). these examples from both the present and the past demonstrate the continued distrust of the us education system among latina/o/x students, who still experience forms of segregation comparable to their predecessors in the early 1900s. the migrant as a threat the us immigration system subjugates immigrants in many ways, including the loss of rights over their body and their political status when detained by the us border patrol and placed in ice detention centers indefinitely and without legal counsel (chavez, 2020). research by becerra et al. (2017) argued that concerns among latinas/os/x about deportation have a major impact on their views of the legal system and law enforcement. latinas/os/x in the us who had a greater fear of deportation reported: 1) less confidence that police would not use excessive force; 2) less confidence that police would treat latinas/os/x fairly; and 3) a lower likelihood of reporting crime. mbembe (2019) described this as a “triple loss: loss of a ‘home,’ loss of rights over one’s body, and loss of political status. this triple loss is identical with absolute domination, natal alienation, and social death (expulsion from humanity altogether)” (pp. 74-75). ongoing research examines the impact of the past decades of immigration policies and practices on immigrant families and their well-being (becerra et al., 2017; dreby, 2015; hatzenbuehler et al., 2017; rubiohernandez & ayón, 2016). in spite of ongoing research about the ways latina/o/x communities are targeted, white people remain at the top of the social hierarchy and preserve their power (bonilla-silva, 2014), while simultaneously demonstrating the expendability of immigrants. despite the anti-immigrant rhetoric asserting that immigrants are a burden, to the justice system, schools, and the us economy, substantial research indicates that immigrants, in fact, contribute to the economy (becerra et al., 2012; gillula, 2015). moreover, studies have found no link between undocumented immigration and higher rates of criminality (green, 2016; light & miller, 2018). yet, these myths about immigrants drive decisions related to policy, public services, and deportations, and demonstrate the advances in social work, summer 2022, 22(2) 614 systematic exclusion of latina/o/x communities from participating with the same rights as their white counterparts. latina/o/x critical race theory (latcrit) and social work literature as the country’s largest and expanding racial and ethnic group, social work must critically revisit the ways in which the latina/o/x community has been harmed by the interaction between law and society in the us. the sections above give a cursory idea of the scope of discourses mobilized against latinas/os/x, historically and in the present day. given the likelihood that social workers will be involved with the latina/o/x community, latina/o/x critical race theory (latcrit) can usefully inform social work praxis. latinas/os/x are often excluded from the benefits of civil rights laws that were enacted to counter the legacy of slavery and jim crow segregation against african americans. in response to the black/white dichotomy inherent in crt, latina/o/x scholars (espinoza & harris, 1997; haney lópez, 1997; iglesias, 1996; perea, 1995; stefancic, 1997) have expanded the tenets of crt to provide a multidimensional framework for understanding latina/o/x communities' structural relationship to broader systems (e.g., education, immigration, deportation, nativist laws, immigrant identity, language, and citizenship) (gonzález & portillos, 2007). given that the ideals of the civil rights movement and the fight for chicana/o liberation of the 1960s and 1970s (chicana/o a self-identifying term used by many mexican americans residing in the united states; it is often used as a source of national pride, acuña, 2007) among other liberatory movements, serve as the foundation for crt, it is expected that latcrit would evolve as an extension of crt. this includes influence from dolores huerta, césar chávez and, by extension, the united farm workers, el movimiento chicano/the chicano movement, and the chicano moratorium, whose objectives included farmworker rights, return of land, and education reform, all of which remain urgent matters impacting the latina/o/x community today. latcrit is an epistemological approach that draws on the lived experiences of latinas/os/x by addressing issues associated with language, immigration, race, and nationality, which were previously absent in the crt framework (delgado bernal, 2002; iglesias, 1996; perea, 1997). daftary (2020) briefly mentioned latcrit as a way to build off the principles of crt by centering latina/ox perspectives, addressing issues, and creating knowledge not generally addressed in crt scholarship (e.g., immigration, citizenship, and language rights). according to valdés (1997), latcrit offers an interdisciplinary and critical methodological approach for studying the social and legal circumstances that affect latina/o/x communities. according to solórzano and yosso (2002), latcrit informs pedagogical approaches that elevate the lived experiences, perceptions, and voices of latinas/os/x by focusing on cuentos/counter-storytelling and testimonios/testimonials. solórzano and yosso (2002) described cuentos/stories and consejos/advice as tools of protection. one mainstream example is the cuento of la llorona, a ghost who roams bodies of water, searching for and mourning her drowned children (denzin & lincoln, 2018). as anzaldúa (1987) recounts, it is said that when la llorona appears, one should anticipate that something terrible will happen. these cuentos “were the culture's attempts to ‘protect’ members of the family, especially girls, from wandering” (anzaldúa, 1987, p. 36). some other cuentos are gutiérrez & lechuga-peña/latina/o/x crt 615 entrenched in culture and may be used to examine inequality and injustice via social analysis. anzaldúa (1987) presents these culturally entrenched cuentos as analogies that foster androcentric stereotypes in psychology and religion. she invokes olmec mythology when she proclaims the "earth is a coiled serpent” (p. 26), and she re-interprets the historical narratives of the virgin de guadalupe to portray her as a pre-columbian "coatlalopeuh," or "she who has dominion over serpents” (p. 27). anzaldúa provides the reader with potential feminist symbols by renaming mexican deities, which corresponds to the continuously changing identities of chicanas in the modern world. these cuentos provide latinas/os/x permission to decolonize the patriarchal interpretations of these deities through indigenous mythology that contradict mainstream narratives and viewpoints not typically included in the dominant scholarly discourse. testimonios are a qualitative technique in which the individual testifying uses their own lived experience as evidence (covarrubias et al., 2018; de la garza & ono, 2016; huber pérez, 2010). delgado (1989), goessling (2018), hodge et al. (2002), and solórzano and yosso (2002) have all cited testimonios as a pedagogical approach intended to heal and liberate as a knowledge tradition already embedded in brown, black, and indigenous communities and cultures. ortiz and nakaoka (2018) advocated for the use of critical race pedagogies while using testimonios to discuss their own lived experiences of microaggressions during their 40 years in social work education. they describe 1) students and faculty being “othered” in academic spaces; 2) the types of knowledge that are respected, who is qualified to teach, and how various epistemologies are valued; and 3) how people and communities of color are represented (or not) in the explicit curriculum in particular if/how their stories and history is valued. therefore, latcrit draws on cuentos and testimonios, as well as situated knowledge about latina/o/x communities to challenge white supremacy and privilege. while there have been advancements in applying crt within various disciplines (e.g., public health, education, and law), there remains a gap in social work literature that explicitly focuses on latcrit as a tool to guide praxis. there are, however, a few prominent studies that apply a latcrit perspective, such as an article by lechuga-peña and lechuga (2018) that examines the barriers and facilitators to educational success for latina/o students using a counter storytelling methodology. like many other latino/a/x students, they experienced barriers such as socioeconomic hardships and racial discrimination in school, which was challenged by facilitators that provided access to opportunities, including social activism, participation in college pipeline programs, mentorship and authentic caring, culturally relevant curriculum, and familism, an ideology that places priority on the family. lechuga-peña and lechuga (2018) recommend the contributions of latina/o practitioners in social work be incorporated in social work curriculum as latina/o students are enrolled in social work programs and many of the students are interning and working with latina/o communities. franco (2020) also used latcrit to discuss social work praxis, including culturally responsive practices among social workers and the importance of policy reform. franco (2020) has suggested that as social workers, we should be focused on teaching service users how to manage and survive oppressive and punitive systems but also be more active in policy reform through activism. advances in social work, summer 2022, 22(2) 616 discussion social work education across the nation is now actively engaging in anti-racist pedagogies in response to the continued killing of brown and black people at the hands of the police and other representatives of the so-called justice system. we contend that social workers must learn the history of violence and exclusion targeting latina/o/x communities in order to understand their distrust of various us systems. furthermore, it is essential to center critical race theory and latina/o/x critical race theory in anti-racist social work praxis in order to adequately respond to the social inequities experienced by our clients, their communities, and within academia. by transitioning from crt’s black/white paradigm to a more inclusive theory and praxis like latcrit, we expand the possibilities for social workers to directly address the conditions in which racism exists in their everyday practice. the recognition and incorporation of latcrit pushes the profession to: • name racism clearly and research it directly as a means for understanding how and why latinas/os/x experience disfranchisement, sub-par wages, or come into contact with the child welfare system. • create curriculum for social work education that is centered on the latina/o/x experience, cultivating this awareness in training social workers. • create research projects that are centered on the latina/o/x perspective. • encourage social workers to confront their unconscious and/or explicit biases and preconceptions in the field and in the classroom. advancing social work practice social workers often enter the profession with the intent of changing the world. this humanistic perspective is grounded in what the western world deems to be morally acceptable norms. as dubal (2018) stated, “this vision claims to align with justice, but it often contributes to injustice by distilling complex lives into simple moral judgments in ways that often reproduce racist modern imaginaries” (p. 212). this concept of white saviorism places white culture as the normative racial group against which all others are compared (ortega & busch-armendariz, 2013). this perspective has been the foundation of the social work profession since its inception. as a result, the social work profession has many hurdles to overcome in arriving at a social justice framework that moves beyond the black/white binary, both in social work education and praxis. we must reevaluate social work and find an exit from the loop of “band-aid” interventions that lack a fundamental basis for addressing the underlying causes of trauma, stress, and racism. we propose that latcrit is one important element of reconceptualizing race in the field of social work. latinas/os/x are far from a monolithic group, and the place of origin the individual identifies with matters, as evidenced in the variations of the spanish language, indigenous languages, and forms of creole spoken throughout the 33 countries in latin america and the caribbean (latino donor collaborative, 2020), not to mention the sub-regions and communities in each country. however, just as issues concerning language and cultural gutiérrez & lechuga-peña/latina/o/x crt 617 origin impact racial and ethnic groups differently, specific frameworks can guide our understanding of the unique experiences of individuals and communities. as dubal (2018) said, by treating individuals who manifest social problems instead of social problems manifesting in individuals, humanism misdiagnoses the signs and symptoms of a sick society as those of a sick human being, and thus offers ultimately ineffective, downstream treatments directed at the biological-individual. (pp. 222-223) latcrit aligns with the structural change practitioners must address so that we can focus on the multi-faceted issues faced by latinas/os/x. here we offer a few concrete ideas for how to advance social work practice. • social work literature should place a higher value on latcrit and recognize it as a valuable framework for advancing social work research and pedagogy. recognizing the validity of lat crit can lift the voices of academics of color. • move beyond a narrow focus on laws within the united states and address the needs of oppressed and racialized peoples globally, beyond the experience of latinas/os/x in north america. acknowledge the us’ continued domination in central and south american countries and beyond. social workers need to make connections between international social work and the traumatic experiences latinas/os/x endure prior to, during, and post-migration. policy implications for social work in september 2020, then president trump issued an executive order to combat offensive and anti-american race and sex stereotyping and training that included content on crt (vought, 2020). in response to this, the critical race scholars in social work (crssw, 2020), “a national network of over 100 scholars committed to confronting the united states' legacy of white supremacy and racism to create a more just society for all,” (para. 1) released a statement condemning this order. while president biden rescinded this order on his first day in office, efforts at the state level are in full motion as legislation has been passed to ban crt and penalize teachers and schools for teaching crt. if social work is committed to the grand challenge to eliminate racism, we call upon the national association of social workers (nasw) and the council on social work education (cswe) to release statements addressing these recent assaults on crt (and latcrit by way of its extension of crt) and join crssw in condemning the unfair attacks on crt. as teasley et al. (2021) state, “social work will have to address the racism in the room before meaningful change can happen, (p. 12), and “social workers must be equipped with tools to dismantle racism and white supremacy and build racial equity (p. 13).” while crt is one tool in doing so, we argue latcrit is an additional tool that should be included in the social work toolbox to combat and eliminate racism. advances in social work, summer 2022, 22(2) 618 social work education there are several ways that social work programs can integrate crt and latcrit into their program objectives and curriculum. for example, dr. lechuga-peña has incorporated crt and latcrit into the required msw diversity course since she began teaching it in 2014 and recently updated the diversity course textbook to include these theories (kulis et al., 2021). while it is more likely that students in social work are familiar with crt, most notably since multiple states have since banned its discussion, latcrit is rarely taught in the social work curriculum. we support the 2022 educational policy and accreditation standards (epas) for baccalaureate and master’s social work programs (cswe, 2022). as such, we endorse the proposed amended language used throughout the epas, which integrates the term “anti-racist” and “anti-racism.” we call upon cswe’s commission on accreditation and commission on educational policy to embed anti-racist frameworks like crt and latcrit (among other anti-racist frameworks) into the social work explicit and implicit curriculum. to establish continuity within the professional training received at the baccalaureate and master’s levels. the cswe implicit curriculum refers to the learning environment in which the curriculum is presented. explicit curriculum constitutes the program’s formal educational structure and includes use of a competency-based educational framework intended to prepare students for professional practice at the baccalaureate and master’s levels (cswe, 2021). this revision will support the programmatic expectations of competency 2: engage anti-racism, diversity, equity, and inclusion. as freire (1968/2000) reminded us, there is no such thing as a neutral educational process. education either functions as an instrument that is used to facilitate the integration of the younger generation into the logic of the present system and bring about conformity to it, or it becomes “the practice of freedom,” the means by which men and women deal critically and creatively with reality and discover how to participate in the transformation of their world. (p. 34) along with the policy recommendation as mentioned above, we believe that framing discussions within contextual paradigms that address race, racism, sexism, and intersectionality should not be exclusive to the current content in the diversity and oppression courses. all social work faculty should be expected to teach the diversity and oppression courses and address these issues in all their courses, and the onus should not be on faculty of color to exclusively discuss these frameworks. the invisible burden placed on faculty and students of color to “teach” white colleagues about racism, which is deeply rooted in their personal experience, often causes retraumatization. instead, the responsibility of this anti-racist work should be shared amongst all faculty and students if equity is truly at the center of professional social work training. finally, social work education should revise epas educational policy 3.3—signature pedagogy: field education to integrate a specific anti-racist and social justice-centered research project in their fieldwork. the requirements for field placement should be centered around the grand challenges for social work which are the 13 areas in which the gutiérrez & lechuga-peña/latina/o/x crt 619 profession could come together and collaborate on how best to take action, given the focus on the individual family well-being (micro), more robust social fabric (mezzo), and just society (macro). in this way, social work students will be more prepared to respond to the needs of communities of color, particularly latina/o/x. social work practice the profession has long considered micro, mezzo, and macro social work as distinct practice areas. it is imperative that micro, mezzo, and macro social work practice are integrated so that students and practitioners understand the ways in which various populations experience oppression as a result of their simultaneous interaction with these systems; these same structural and institutional systems that produce trauma for clients, specifically in the latina/o/x community. in practice, these systems do not function in isolation, nor should they be in social work pedagogy. as social work practitioners, it is critical to acknowledge and honor differences within latina/o/x communities and clients. by allowing latina/o/x to reflect on their own lived experiences, they can overcome challenges in their lives and become liberated by telling their own stories. conclusion although different disciplines are rooted in a broader social context, social work is perhaps the best-positioned profession among those that serve society to be a leader in the fight against racism (teasley et al., 2021). it is crucial that social work pedagogy acknowledges the past and present racist laws and policies targeting latinas/os/x in the united states. a path forward for social work includes enhanced strategic and effective engagement. we argue latina/o/x critical race theory (latcrit) is one of many frameworks that can guide social work praxis, as it enables us to better articulate the experiences of latinas/os/x through a more focused examination of the unique forms of oppression they encounter around language, immigration status, and citizenship. latcrit's integration of the elements of crt is also evident in the interdisciplinary expansion found in kanaka critical race theory (reyes, 2017), tribal critical race theory (tribalcrit; brayboy, 2005), asian critical race theory (asiancrit; chang, 1993), queer critical theory (queercrit; delauretis, 1991), and dis/ability critical race studies (discrit; annamma et al., 2013). the amplification of race and racism inherent in the process of "othering" those that experience oppression does not contradict crt's fundamental principles. as coates and gray (as cited in wilson, 2020) remind us, change takes time, and introducing anything new into the field of social work takes approximately 20 years. this time accounts for the ability to communicate a complex idea rationally and time for these ideas to be vetted via the peer review process. this entire process could be in excess of “25 years – a generation – and it is a longer relational duration than the short-term interventiontime that more often structures our disciplinary imaginations” (wilson, 2020, p. 42). the current state of social work research does not equate to the direct action required to advances in social work, summer 2022, 22(2) 620 transform the institutional and structural racist policies that impact our clients and communities daily. we must present public policies in all our work (i.e., field placement projects, dissertations, manuscripts), policies that center clients and communities most impacted. problem-solving and human causation are the traditional ways in which social work has supported and upheld the status quo. new methods that include latcrit are required to solve the complicated issues we face in a complex, changing environment (wilson, 2020, which requires an urgent call to action, one that cannot wait for a generation. a latcrit analysis in social work provides the lens to examine the ways in which race and racism explicitly and implicitly impact social structures, processes, and policy discourse that affect latinas/os/x. given that latcrit provides an analytical framework that addresses epistemological, methodological, and pedagogical approaches to the study of everyday inequalities for latinas/os/x, the inclusion of this framework in social work is a critical first step. references acuña, r. f. 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(2020, june 05). un experts condemn modern-day racial terror lynchings in us and call for systemic reform and justice. [press release]. https://www.ohchr.org/en/press-releases/2020/06/un-experts-condemn-modern-dayracial-terror-lynchings-us-and-call-systemic us census bureau. (2021, october 8). about the topic of race. . https://www.census.gov/topics/population/race/about.html valdés, f. (1997). latcrit consciousness, community, and theory. california law review, 85(5), 1087-1142. vought, r. (2020, september 4). training in the federal government [memorandum]. office of management and budget. https://www.whitehouse.gov/wpcontent/uploads/2020/09/m-20-34.pdf wilson, t. e. (2020). an invitation into the trouble with humanism for social work. in v. bozalek & b. pease (eds.), post-anthropocentric social work: critical posthuman and new materialist perspectives (pp. 32-45). taylor & francis group. https://doi.org/10.4324/9780429329982-4 author note: address correspondence to mónica gutiérrez, university of denver graduate school of social work, denver, co, 80208. email: monica.gutierrez2@gmail.com https://www.ohchr.org/en/press-releases/2020/06/un-experts-condemn-modern-day-racial-terror-lynchings-us-and-call-systemic https://www.ohchr.org/en/press-releases/2020/06/un-experts-condemn-modern-day-racial-terror-lynchings-us-and-call-systemic https://www.census.gov/topics/population/race/about.html https://www.whitehouse.gov/wp-content/uploads/2020/09/m-20-34.pdf https://www.whitehouse.gov/wp-content/uploads/2020/09/m-20-34.pdf https://doi.org/10.4324/9780429329982-4 mailto:alex.redcay@millersville __________ scott marsalis, mlis, social work librarian and director, sciences, agriculture & engineering, university of minnesota, minneapolis, mn. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 503-511, doi: 10.18060/27235 this work is licensed under a creative commons attribution 4.0 international license. steps to improve evidence synthesis reviews in social work scott marsalis abstract: evidence synthesis reviews, including systematic reviews and scoping reviews, are increasingly conducted in social work. with the goal of informing practice and development of policies, these reviews seek to synthesize all available evidence. yet the quality of published reviews often fails to meet methodological and reporting standards and may lead to incorrect conclusions. this article lays out practical steps review teams should take to assure their project is successful and avoid common errors. recommended resources for further exploration are included, as well as suggestions for editors and researchers for improving the quality of reviews conducted in social work. keywords: evidence synthesis, research methods, quality improvement, faculty librarian collaboration, systematic reviews evidence synthesis reviews are becoming increasingly common in social work, informing evidence-based practice as well as policy development. however, many published evidence synthesis reviews fail to meet basic methodological and reporting standards (littell & gorman, 2022; marsalis & brown, 2020). this article suggests ways to avoid common errors, particularly relating to reporting the literature search, and seeks to increase the quality of such reviews in social work and related disciplines. a range of methodologies is utilized in evidence synthesis reviews, most commonly systematic reviews, scoping reviews, meta-analyses, and evidence gap maps, but also less common methods such as qualitative interpretive meta-syntheses. these methods seek to synthesize, comprehensively and systematically, all previously conducted research on a topic and represent the highest level of evidence in research. a defining characteristic of these research methods is a reproducible and transparent methodology, which differentiates them from narrative reviews, which are neither comprehensive nor reproducible. they also differ from systemized reviews and critical reviews, which often are conducted by an individual as part of their graduate degree program. “a typology of reviews” by grant and booth (2009) is an excellent foundation for understanding the range of review types. assemble a team most evidence synthesis reviews are conducted by a team, because each team member will bring different skills and levels of expertise, and because it helps reduce risk of bias. members should be recruited for specific roles, including screening and data extraction, literature searching, project and data management, analysis, and writing. the level of involvement, time commitments, and level of acknowledgement of all the team members should be negotiated at the beginning of the project. one of the goals of evidence synthesis methods is to reduce bias, which is aided by having a team of reviewers independently double-screen studies for inclusion at both the about:blank marsalis/steps to improve evidence synthesis 504 title/abstract and full-text stages. since the literature search seeks to be comprehensive, the initial screening of titles and abstracts may look at thousands of records, and having a number of screeners can help lighten the load and expedite the review process. data extraction and coding also are typically performed independently by two team members, and inter-rater agreement reported. because the quality of an evidence synthesis review is dependent on the comprehensiveness of the search for relevant studies, most guidelines suggest that a librarian or information specialist be part of the team (gore & jones, 2015, table 1). an increasing number of social sciences librarians are being trained in supporting evidence synthesis and bring unique skills to the review team. when a librarian writes the searchrelated portions of the methods section and performs the searches, they should be offered co-authorship; if they perform the searches, but do not participate in the writing, acknowledgement is warranted (ross-white, 2021). if a librarian new to supporting evidence synthesis is part of the team, they should consider applying to the mentorship program of the acrl evidence synthesis methods interest group (acrl-esmig, 2024) which will pair them with a more experienced librarian. project management one of the team members should take responsibility for project management. potentially key to successful project completion is the manager sending out weekly or biweekly emails reminding the team of where they are in the process (townsend et al., 2019). if each team member needs to review 1000 articles in six weeks, being reminded weekly about how many they should have read at that point can keep the whole team on track. data management duties also should be assigned, with a single person responsible for creating a file structure and regularly backing up files. keeping a group document for tracking decisions and discussions of the team is helpful. evidence synthesis projects usually take at least 12 months to complete, and having a record of previous conversation not only keeps the team from repetitive discussions, it also can be a touchpoint when writing the article. register a protocol creating a protocol is an essential step in the evidence synthesis process and ensures that the review project is well-planned and that the plan is documented before the review is conducted (moher et al., 2015). the team should register the protocol, ideally before running the searches and definitely before commencing the screening stage, by placing it in a registry such as prospero or osf, or by publishing it in a journal. the team should reference the protocol in their article to allow readers to identify any deviations from the plan. registering a protocol improves transparency and reproducibility, reduces bias, and helps ensure that other research teams do not duplicate efforts (shamseer et al., 2015). the protocol states the rationale, hypothesis, and planned methodology for the review. the protocol will enumerate inclusion and exclusion criteria, and the team should refer back to the protocol as a guide as they conduct the review. when working with a librarian, the protocol provides background and documents the research questions as well as inclusion advances in social work, summer 2024, 24(2) 505 and exclusion parameters, and will help them in developing the search. finally, the work put into the protocol will help expedite the process when writing the final article or report. depending on the nature of the planned review, different options for registering are available. prospero accepts registrations of systematic reviews, rapid reviews and umbrella reviews for health outcome subjects. it does not accept registration of scoping reviews. osf registries is an open access database for pre-registering research across a range of methods, including evidence synthesis. other options are to register in a subject branded repository, or create an osf project for the review and include the registration there. the preferred reporting items for systematic reviews and meta-analyses (prisma) statement includes the preferred reporting items for systematic review and meta-analysis protocols (prisma-p) extension which provides guidance for writing and reporting the protocol (moher et al., 2015). a template that works especially well for evidence synthesis outside the health sciences is available in the osf (ghezzi-kopel & porciello, 2021). peer-review the draft protocol and search strategy conducting an evidence synthesis review is a significant investment of time and effort. inviting informal peer-review of the protocol, including at least one search strategy, early in the process can help avert errors before data collection, screening and extraction occur, and help assure a successful publication. the protocol should be peer reviewed before submitting to a repository. this is an ideal stage for someone outside the team to take a critical look at the inclusion and exclusion criteria, consider whether the review type is appropriate for the questions being asked, and make suggestions before the project advances. while prospero includes peer review, protocols are automatically advanced when a backlog develops, and other registries do not include peer-review. if a librarian is part of the team, ask if they will have their search for at least one database peer-reviewed before finalization. the academic social work librarians group (aswl@googlegroups.com) is a great resource for finding colleagues who have the necessary expertise and access to the same database on the same platform. if a librarian is not part of the team, ask a social work librarian if they will advise on and peer-review the search strategies before they are run. there are standards which can help with this review. the peer-review of search strategies (press) instrument (mcgowan et al., 2016) is designed for medline, but is also useful in guiding peer review of searches in other databases. prisma-s (rethlefsen et al., 2021) is a reporting guideline for the search strategy, and familiarity with it from the beginning will help assure that adequate records are kept to allow compliant reporting in the final article. be familiar with the relevant methods and standards it is not unusual to see published articles of evidence synthesis which misidentify the methodology used, use a method inappropriate to the questions asked, misstate adherence to relevant standards, or confuse reporting and methodological standards (marsalis & marsalis/steps to improve evidence synthesis 506 brown, 2020). because many editors and peer reviewers lack relevant expertise, these errors too frequently are missed during the publication process. one common error is to call a study a systematic review when it is actually a scoping review or systemized review. grant and booth (2009) compiled a typology of reviews that remains the standard reference for matching research questions to the appropriate method and helping differentiate designs, although the conceptual framework developed by julia littell (2018) is an important update and explanation and should also be consulted. another common error is for authors to inappropriately state that they conducted their review in accordance with prisma (sarkis-onofre et al., 2021). prisma and its extensions are reporting guidelines, rather than methodological standards. it is also common to see authors claim they followed prisma, yet only include a prisma flowchart while seemingly being unaware of the full standard. it is important to read and understand the relevant full reporting standard, including the statement, explanation and elaboration, and checklist. before writing the report of an evidence synthesis study, consult prisma-statement.org for the relevant documents and updates. prisma is the guideline for reporting systematic reviews or metaanalyses, but there are extensions for other methods and specific aspects of the process, including prisma-scr for scoping reviews, prisma-s for the search strategy report, prisma-p for protocols, and prisma for abstracts. equator-network.org is another resource for locating relevant reporting guidelines. methodological standards are less well organized, however commonly relevant standards for social work-related reviews are the methodological expectations of campbell collaboration intervention reviews (methods group of the campbell collaboration, 2019) and the jbi manual for evidence synthesis (aromataris & munn, 2020). for reviews of qualitative studies “qualitative interpretive meta-synthesis in social work research” (aguirre & bolton, 2014) is frequently used, although teams should also familiarize themselves with the work of the campbell collaboration qualitive evidence synthesis working group which is in the process of publishing guidelines. more resources relating to conducting and reporting social work evidence synthesis reviews are listed on the social work liaison's toolkit page regarding evidence synthesis and advanced reviews (american library association, 2020). one of the differentiating characteristics of a systematic review is the inclusion of quality appraisal of the evidence, yet many researchers are unfamiliar with the relevant tools. the quality assessment and risk of bias tool repository in the osf (ledbetter & hendren, 2021) and jbi critical appraisal tools (n.d.) are good places to consult when seeking an appropriate assessment instrument. tips for reporting the search evidence synthesis relies on identifying all relevant studies; an incomplete literature search may result in missed studies and introduce bias or lead to inaccurate conclusions, with potentially dire consequences. because of this, a complete and accurate reporting of the search strategy must be included. littell and gorman's (2022) commentary on a recently published campbell review elucidates critical errors, and is an excellent example of the type of scrutiny that reviews should be subjected to. advances in social work, summer 2024, 24(2) 507 include the full search strategy for all databases. prisma-s (rethlefsen et al., 2021), the reporting standard for literature searches, requires reporting the strategy for all databases, whereas earlier standards may have required only one. yet word count limitations in most journals preclude including even one complex strategy. one way to accomplish this is to clearly describe the strategy components in the article text, then link to a supplemental file with the full strategies. the author has seen multiple instances where the supplemental file has disappeared from a journal's website, however, or been omitted from the manuscript when sent for peer review. for these reasons it is recommended that the supplemental file be shared via a project in osf (osf.io.) or other repository instead. osf allows the creation of an anonymized url which should be included in the submitted manuscript, then updated to the non-anonymized url after peer review. when summarizing the search strategy in the text of the article a common approach is to list categories of terms that form the strategy, often relating to the question framework such as pico (population, intervention, comparison, outcome) or pcc (population, concept, context). it is important to be clear in the use of the term "keyword" does this refer to only terms in the title, abstract, and author-supplied keywords, but not official thesaurus terms, or refer to all searchable terms? do not use the term "included," (e.g., "search terms included…"), as this implies a non-exhaustive list. instead use a clear statement such as, "search terms were…" or "categories of search terms were…." make sure boolean logic is clear, even in summary. do not use commas or semicolons to imply boolean operators as these do not adequately report the logic. it is important to accurately list all databases and other resources searched, including those where no relevant studies were identified. when reporting databases, include the vendor name when it is available on more than one platform (e.g., "apa psycinfo (ovid)."). also include the dates the searches were conducted, and the dates covered by the database. do not confuse vendor names or platforms with a database. "proquest" or "web of science" do not accurately report specific databases. for web of science it is necessary to specify the component databases searched, and the years included for each. do not search aggregated databases or publisher platforms as the included searchable literature may vary from institution to institution, and therefore is irreproducible. for example, most research libraries have a "library search" box on their homepage, however the resources it searches, and the parameters of the search, are unique to each institution. likewise, a publisher's site may search all their content, or only that content subscribed to by the institution, so if this is part of the search strategy it must clearly report what was included. if google scholar is searched, great care must be taken in reporting as the search will most likely be irreproducible; it should only be considered for supplemental searching and not as a core resource (gusenbauer & haddaway, 2020; haddaway et al., 2015). when searching an individual journal ("hand searching") or seeking grey literature, report the search strings and sites used in the supplementary file. for very complex searches, or simply to assure comprehension or reproducibility, consider including an annotated strategy or a search narrative in the search supplementary file. cooper et al. (2018) provide guidance and examples of what these might look like. an example of a narrative explaining a complex search approach for a scoping review is included in the appendix of obschonka et al. (2021). marsalis/steps to improve evidence synthesis 508 table 1. resources and summary of process step resource description g eneral social work liaison’s toolkit (american library association, 2020) general guide to evidence synthesis with social work (sw) focus. training introduction to systematic review & meta-analysis (li & dickerson, n.d.) massive open online course (mooc) offered through coursera. covers information necessary to complete all stages of systematic reviews & metaanalyses. systematic reviews & meta-analysis: a campbell collaboration online course (valentine et al., 2022) mooc offered through the campbell collaboration focused on synthesizing quantitative studies. search acrl evidence synthesis methods interest group (acrl evidence synthesis methods interest group, 2024) networking & professional knowledge exchange resource for librarians supporting evidence synthesis. resource for mentoring & search peer review between librarians. academic social work librarians group (academic social work librarians group, 2021) aswl@googlegroups.com professional network for sw librarians. resource for search peer review between librarians. prisma-s (rethlefsen et al., 2021) standard for reporting searches. for all resources relating to prisma-s. peer review of electronic search strategies (press) (mcgowan et al., 2016) instrument for peer reviewing database search strategies. protocol r egistration prospero (national institute for health & care research, n.d.) site for registering & searching for protocols for health-related systematic reviews & meta-analyses. osf registries (center for open science [cos], 2024) open repository for registering & searching for protocols. evidence synthesis protocol template (ghezzi-kopel & porciello, 2021) a template for creating protocols in osf registries. prisma for systematic protocols (prisma-p) (moher et al., 2015) standard for the reporting of systematic review protocols. for all resources related to prisma-p. q uality a ssessm ent quality assessment & risk of bias tool repository (ledbetter & hendren, 2021) resource for finding & selecting tools for assessing quality or risk of bias. created & maintained by duke university's medical center library & archives. jbi critical appraisal tools (jbi, n.d.) critical appraisal tools developed by jbi for a range of study designs. r eporting welcome to the new preferred reporting items for systematic reviews & meta-analyses (prisma) website (prisma executive, 2024) website for prsima & related extensions. consult the statement paper, explanation & elaboration paper, as well as the checklist. equator network (uk equator centre, n.d.) repository of reporting guidelines for main study types, with focus on health research. https://acrl.libguides.com/c.php?g=1136527&p=8853726 https://acrl.libguides.com/c.php?g=1136527&p=8853726 https://www.coursera.org/learn/systematic-review https://www.coursera.org/learn/systematic-review https://oli.cmu.edu/courses/systematic-reviews-and-meta-analysis/https:/oli.cmu.edu/courses/systematic-reviews-and-meta-analysis-o-f/ https://oli.cmu.edu/courses/systematic-reviews-and-meta-analysis/https:/oli.cmu.edu/courses/systematic-reviews-and-meta-analysis-o-f/ https://oli.cmu.edu/courses/systematic-reviews-and-meta-analysis/https:/oli.cmu.edu/courses/systematic-reviews-and-meta-analysis-o-f/ https://acrl.libguides.com/esmig/evidence_synthesis_resources https://acrl.libguides.com/esmig/evidence_synthesis_resources https://sites.google.com/uncg.edu/aswl/home mailto:aswl@googlegroups.com https://doi.org/10.1186/s13643-020-01542-z https://www.prisma-statement.org/prisma-search https://doi.org/10.1016/j.jclinepi.2016.01.021 https://doi.org/10.1016/j.jclinepi.2016.01.021 https://www.crd.york.ac.uk/prospero/ https://osf.io/registries https://osf.io/registries https://osf.io/registries https://osf.io/nbyhk https://doi.org/10.1186/2046-4053-4-1 https://doi.org/10.1186/2046-4053-4-1 https://www.prisma-statement.org/protocols https://osf.io/ws824/ https://osf.io/ws824/ https://jbi.global/critical-appraisal-tools https://www.prisma-statement.org/ https://www.prisma-statement.org/ https://www.prisma-statement.org/ https://www.equator-network.org/library/ advances in social work, summer 2024, 24(2) 509 conclusion with the proliferation of evidence synthesis reviews in social work it is important that authors, editors, and peer reviewers become familiar with the relevant standards and best practices, and editors should consider including a librarian experienced in conducting evidence synthesis reviews as a peer reviewer. researchers should assemble a review team with the necessary expertise and clearly discuss roles and responsibilities. good project and data management practices will help ensure completion of the review in a reasonable time frame. evidence synthesis reviews can be critical in informing policy and practice that impact and improve lives and should be conducted with careful adherence to guidelines and best practices, including sharing a protocol, a comprehensive, exhaustive literature search, and reporting to aid reproducibility. it is hoped that this article will serve as an aid to this pursuit. references academic social work librarians group. 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(2015). the role of google scholar in evidence reviews and its applicability to grey literature searching. plos one, 10(9), 1-17. https://sites.google.com/uncg.edu/aswl/home https://acrl.libguides.com/esmig/evidence_synthesis_resources https://acrl.libguides.com/esmig/evidence_synthesis_resources https://doi.org/10.1177/1468017313476797 https://doi.org/10.1177/1468017313476797 https://acrl.libguides.com/c.php?g=1136527&p=8853726 https://doi.org/10.46658/jbimes-20-01 https://osf.io/registries https://doi.org/10.1002/jrsm.1315 https://doi.org/10.1002/jrsm.1315 https://osf.io/nbyhk https://doi.org/10.21083/partnership.v10i1.3343 https://doi.org/10.21083/partnership.v10i1.3343 https://doi.org/10.1111/j.1471-1842.2009.00848.x https://doi.org/10.1111/j.1471-1842.2009.00848.x https://doi.org/10.1002/jrsm.1378 https://doi.org/10.1002/jrsm.1378 https://doi.org/10.1002/jrsm.1378 https://doi.org/10.1371/journal.pone.0138237 https://doi.org/10.1371/journal.pone.0138237 marsalis/steps to improve evidence synthesis 510 jbi. (n.d.). jbi critical appraisal tools. ledbetter, l., & hendren, s. (2021). quality assessment and risk of bias tool repository. li, t., & dickerson, k. (n.d.). introduction to systematic review and meta-analysis [mooc]. coursera. littell, j. h. (2018). conceptual and practical classification of research reviews and other evidence synthesis products. campbell systematic reviews, 14(1), 1-21. littell, j. h., & gorman, d. m. (2022). the campbell collaboration’s systematic review of school-based anti-bullying interventions does not meet mandatory methodological standards. systematic reviews, 11, 1-9. marsalis, s., & brown, e. (2020, january). adoption of systematic and related review methods in social work and reporting quality of underpinning searches [paper presentation]. society for social work and research annual meeting, washington, d.c. the methods group of the campbell collaboration. (2019). methodological expectations of campbell collaboration intervention reviews: conduct standards. campbell policies and guidelines series no. 3. https://doi.org/10.4073/cpg.2016.3 mcgowan, j., sampson, m., salzwedel, d., cogo, e., foerster, v., & lefebvre, c. (2016). press peer review of electronic search strategies: 2015 guideline statement. journal of clinical epidemiology, 75, 40-46. moher, d., shamseer, l., clarke, m., ghersi, d., liberati, a., petticrew, m., sjekelle, p., stewart, l. a., & the prisma-p group. (2015). preferred reporting items for the systematic review and meta-analysis protocols (prisma-p) 2015 statement. systematic reviews, 4, 1-9. national institute for health and care research. (n.d.). welcome to prospero. obschonka, m., cai, q., chan, a. c., marsalis, s., basha, s. a., lee, s. k., & gewirtz, a. h. (2021). international psychological research addressing the early phase of the covid-19 pandemic: a rapid scoping review and implications for global psychology. appendices. center for open science. prisma executive. (2024). welcome to the new preferred reporting items for systematic reviews and meta-analyses (prisma) website. rethlefsen, m. l., kirtley, s., waffenschmidt, s., ayala, a. p., moher, d., page, m. j., & koffel, j. b. (2021). prisma-s: an extension to the prisma statement for reporting literature searches in systematic reviews. systematic reviews, 10(1), 119. ross-white, a. (2021). search is a verb: systematic review searching as invisible labor. journal of the medical library association, 109(3), 505-509. sarkis-onofre, r., catalá-lópez, f., aromataris, e., & lockwood, c. (2021). how to properly use the prisma statement. systematic reviews, 10(117), 1-3. https://jbi.global/critical-appraisal-tools https://osf.io/ws824/ https://www.coursera.org/learn/systematic-review https://doi.org/10.4073/cmdp.2018.1 https://doi.org/10.4073/cmdp.2018.1 https://doi.org/10.1186/s13643-022-01998-1 https://doi.org/10.1186/s13643-022-01998-1 https://doi.org/10.1186/s13643-022-01998-1 https://sswr.org/2020-conference-home/ https://sswr.org/2020-conference-home/ https://doi.org/10.4073/cpg.2016.3 https://doi.org/10.4073/cpg.2016.3 https://doi.org/10.4073/cpg.2016.3 https://doi.org/10.1016/j.jclinepi.2016.01.021 https://doi.org/10.1016/j.jclinepi.2016.01.021 https://doi.org/10.1186/2046-4053-4-1 https://doi.org/10.1186/2046-4053-4-1 https://www.crd.york.ac.uk/prospero/ https://doi.org/10.17605/osf.io/a9tpd https://doi.org/10.17605/osf.io/a9tpd https://doi.org/10.17605/osf.io/a9tpd https://www.prisma-statement.org/ https://www.prisma-statement.org/ https://doi.org/10.1186/s13643-020-01542-z https://doi.org/10.1186/s13643-020-01542-z https://doi.org/10.5195/jmla.2021.1226 https://doi.org/10.1186/s13643-021-01671-z https://doi.org/10.1186/s13643-021-01671-z advances in social work, summer 2024, 24(2) 511 shamseer, l., moher, d., clarke, m., ghersi, d., liberati, a., petticrew, m., shekelle, p., & stewart, l. a. (2015). preferred reporting items for systematic review and metaanalysis protocols (prisma-p) 2015: elaboration and explanation. bmj (online), 349(jan02 1), g7647-g7647. townsend, w., mann, j. d., & schildhouse, r. j. (2019, january 29). buried under systematic review requests? want to maximize the return on your review service? [webinar]. medical library association. uk equator centre. (n.d.). library. valentine, j. c., littell, j. h., & young, s. (eds.). (2022). systematic reviews and metaanalysis: a campbell collaboration online course. open learning initiative. author note: address correspondence to scott marsalis, university of minnesota libraries, magrath library, 1984 buford ave., saint paul, mn 55108. email: marsa001@umn.edu https://doi.org/10.1136/bmj.g7647 https://doi.org/10.1136/bmj.g7647 https://macmla.org/mla-january-webinar-buried-under-systematic-review-requests-want-to-maximize-the-return-on-your-review-service/ https://macmla.org/mla-january-webinar-buried-under-systematic-review-requests-want-to-maximize-the-return-on-your-review-service/ https://www.equator-network.org/library/ https://oli.cmu.edu/courses/systematic-reviews-and-meta-analysis/https:/oli.cmu.edu/courses/systematic-reviews-and-meta-analysis-o-f/ https://oli.cmu.edu/courses/systematic-reviews-and-meta-analysis/https:/oli.cmu.edu/courses/systematic-reviews-and-meta-analysis-o-f/ mailto:alex.redcay@millersville steps to improve evidence synthesis reviews in social work abstract: evidence synthesis reviews, including systematic reviews and scoping reviews, are increasingly conducted in social work. with the goal of informing practice and development of policies, these reviews seek to synthesize all available evidence... keywords: evidence synthesis, research methods, quality improvement, faculty librarian collaboration, systematic reviews assemble a team register a protocol peer-review the draft protocol and search strategy be familiar with the relevant methods and standards tips for reporting the search conclusion references _________ aritra moulick, phd, assistant professor, phyllis and harvey sandler school of social work, florida atlantic university, boca raton, fl. namrata mukherjee, phd, assistant professor, school of social work, boise state university, boise, id. thereasa abrams, phd, lcsw, assistant professor, school of social work, university of tennessee, knoxville, tn. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 311-334, doi: 10.18060/28000 this work is licensed under a creative commons attribution 4.0 international license. importance of trauma informed framework for social workers in burn care centers and the community a conceptual paper aritra moulick namrata mukherjee thereasa abrams abstract: burn injuries disrupt the dynamics of families and social networks, requiring interventions that strengthen these support systems. in the united states, the integration of trauma-informed social work into burn care is not only essential for individual well-being, it is also crucial for the optimization of healthcare outcomes and the reduction of public health costs associated with untreated trauma-related emotional and psychological challenges. trauma-informed social work recognizes that burn survivors have experienced trauma not only during the incident itself but also throughout their treatment and recovery. social workers trained in trauma-informed care are equipped to recognize these challenges and offer culturally responsive, empathetic and therapeutic support. they help burn survivors regain a sense of control over their lives, make informed decisions about their care, and navigate the complex healthcare and community-based rehabilitation systems post-discharge. this conceptual paper highlights the imperative need for a comprehensive approach to psychosocial burn care that acknowledges the importance of trauma-informed social work in addressing the complex physical and emotional needs of patients and survivors in both inpatient and community-based therapeutic settings while impact of burn trauma on family/caregivers is beyond the scope of the paper. such an approach aims to restore the physical, emotional and psychological well-being of this population, promoting their path to recovery and reintegration into society. keywords: burn injuries, stigma, policy barriers, trauma-informed framework, social work “burn injuries are an under-appreciated trauma that can affect anyone, any time, and anywhere” (jeschke et al., 2020, p. 1); burns can be caused by cold, heat, friction, radiation, chemical and/or electric sources however, most burns are caused by heat from liquids, solids, and fire. secondary to seminal technical progress in burn care, the long-term rehabilitation requirements among burn survivors have substantially changed over time. burn injuries can impact an individual’s somatic and psychosocial wellbeing. the path to recovery is a tenuous process that involves rigorous targeted therapeutic interventions in a specialized hospital burn unit, and years of lengthy rehabilitation and follow-up procedures (kornhaber et al., 2017). a body of empirical research carried out with burn survivors indicates that patients with extended hospital experiences tend to report higher prevalence of acute physical and psychosocial degradation, which varies based on burn severity and total body surface area (tbsa) affected (cleary et al., 2019; cleary et al., 2020; kornhaber et al., 2017; laggner et al., 2022; spronk et al., 2022). this highlights that severe burn injuries are associated with unintended morbidity, and it is of utmost importance that burn survivors have access to long-term burn support services across the care continuum (abrams et al., 2019; holavanahalli et al., 2016 zonies et al., 2010). nevertheless, ben‐tovim et al. (2008), about:blank advances in social work, spring 2025, 25(1) 312 assert that a burn patient’s journey within the hospital is highly precarious due to their incessant interactions with a plethora of healthcare providers; no one medical provider or service is involved in the entire treatment process which can result in inadequately coordinated support for the patient and their family members/support systems. individuals who endure a burn injury often report symptoms of acute stress followed by other psychological disorders due to trauma of burn injury and treatment (wallis et al., 2006). in addition, individuals also undergo changes in physical aesthetics (mclean et al., 2015), perceived social stigma (hoogewerf et al., 2014), and recurring pain and itching (pruritus) that are sustained beyond the healing process and continues long-term for many burn survivors (falder et al., 2009). anticipatory anxiety related to painful therapeutic interventions such as wound debridement (surgical removal of dead tissue), donor site harvest and grafting, hydrotherapy, physical/occupational therapy (controlled movement of burned joints), and daily dressing changes frequently become primary sources of both physical trauma and mental health disruptions (duke et al., 2018). addressing psychosocial burn trauma is an important consideration as the path to recovery from burn injury cannot be regarded as a purely physical process; unaddressed emotional trauma responses have been found to disrupt the natural process of physical and psychological convalescing, contributing to worsened sequelae over time requiring trauma informed assessment and care (kornhaber et al., 2014; kornhaber et al., 2015). trauma informed care recognizes the patient’s previous experience of trauma prior to the burn and how each impact the patient’s response (cleary et al., 2020). globally, nearly 11 million people sustained burns severe enough to require medical treatment and is the fourth leading cause in all injuries, behind road traffic accidents, falls, and interpersonal violence, and is higher than the combined incidence of tuberculosis and hiv, and just slightly less than the incidence of all malignant tumours (peck, 2011). the centers for disease control and prevention (cdc, 2022) report that over one million people in the united states (u.s) are treated for burn injuries per year and are associated with 1.5% of the total deaths reported due to unintentional injuries across all age demographics, with a higher percentage of burns occurring in rural and high poverty areas. it has been observed that individuals with a history of mental health disorders or individuals with pre-existing mental/behavioural health conditions have a higher probability of sustaining a burn injury in their course of lifetime (heath et al., 2018; logsetty et al., 2016; mclean et al., 2015; vetrichevvel et al., 2018). recurring episodes of trauma adversely affects a person’s inherent coping mechanisms, deterring their motor and sensory functions, and their ability to perform at their fullest capacity (cleary et al., 2020). therefore, it can be inferred that burn survivors tend to report higher incidences of psychological trauma and psychological disorders which medical practitioners and care givers need to acknowledge to ensure best practices in the burn continuum of care (duke et al., 2018). assessing pre-morbid trauma history by social workers or other mental health practitioners on the burn care team such as the patient health questionnaire (phq-9) as a standardized protocol (abrams et al., 2019) is often neglected when the priority is on patient survival and is excluded from inpatient treatment plans of care and outpatient referrals for burn survivors, even though many health concerns emerge directly or indirectly from the burn injuries (cukor et al., 2015; gardner et al., 2012; mclean et al., 2015; schneider et al., 2012). the national association of social workers (nasw, 2012) does not recognize burn injuries as a focus for intervention in the private sector moulick et al./trauma informed burn care 313 and not specifically with service members, veterans, and their families, although the nsw in australia does acknowledge burn injuries as an area of specialization (nsw agency for clinical innovation, 2011; thornton & battistel, 2001). while protocols set forth by the american burn association (aba) strictly mandate the criteria for referral of burn patients to regional burn centers based on burn severity (smolle, 2017), burn care medical practitioners often fail to recognize the importance of being trauma informed in burn care settings in the u.s. as focus has historically been on bio-medical treatment protocols (cleary et al., 2020; rose et al., 2012). cleary et al. (2020) mention that “despite the recognition of the impact of trauma and the recent trend and recognised need for tic services and implementation across health care, there lacks an overarching framework to support and sustain a tic model of burns care” (p. 1172). such practise of bio-medical treatment options excludes the opportunity to integrate patients’ and their support systems’ past and emerging episodes of trauma as part of assessment and treatment protocols for burn patients and survivors (cleary et al., 2019). despite the few empirical studies in recent years that have illustrated the pragmatic and seminal effects of a trauma informed care framework in burn care settings, there is still paucity in literature which addresses use of a trauma informed framework within psychosocial service delivery in burn care. the purpose of this paper is to explore the psychosocial sequelae associated with burn trauma, and how social workers may clinically prepare themselves for this important work, both in the hospital and in the community. this paper also suggests the importance of establishing a trauma informed care framework as a standard of care for social work practitioners which can be applied for the purpose of decreasing the impact of acute stress and trauma with a long-term objective of mitigating retraumatization of burn survivors. potential barriers while seeking burn care the national association of social workers (nasw, 2024a) identifies health conditions that necessitate social work interventions for health equity, reproductive health, epidemic management etcetera, however, they do not specifically address burn injuries. the next section outlines some of the plausible sources of trauma and stress that tend to impact a person’s well-being during burn treatment and post hospitalization. these indicators of trauma and stress are not exhaustive but instead inculcates important themes that often influence a burn survivor’s journey. a summary can be found in table 1 at the end of this section. a. burn trauma clearly et al. (2020) encapsulates “trauma” as an experience that causes physical, cognitive, behavioural and/or emotional symptoms in response to a devastating or distressing event, including accidents and physical injuries affecting the body, mind and emotional well-being. exposure to trauma can be primary (i.e., occurring directly) or secondary (i.e., being a witness of others suffering) (may & wisco, 2016). trauma can be perceived at an individual or at a collective level, and historical trauma has a tendency of permeating in different psychological and emotional forms over time, negatively impacting multiple generations unless addressed (bombay et al., 2009; ely et al., 2018). individuals with a history of trauma have a higher probability of sustaining a burn episode in their entire lifetime and are also highly liable to trauma responses and advances in social work, spring 2025, 25(1) 314 psychological disorders that both precede and proceed a burn injury such as substance abuse, depression, and symptoms of acute and post-traumatic stress (cukor et al., 2015; mclean et al., 2015; williams et al., 2020). in a cross-sectional study conducted by schneider et al. (2012), using a large sample of burn survivors from the station nightclub fire, the researchers state that burn injuries are strong predictors of psychological and physical trauma resulting in long-term adversities, leading to possible deterioration of occupational, functional, psychological capacities, and quality of life. research also indicates that eating disorders, substance abuse and schizophrenia spectrum disorders have been found to contribute to the risk of burn injury (abrams & mcgarty, 2021). additionally, empirical studies support that the prevalence of psychological effects from burn injury last well beyond the initial years following the injury and treatment procedures (dalal et al., 2010; gullick et al., 2014; oster & sveen, 2014). interestingly, it has been found that trauma survivors frequently deny preexisting traumatic experiences with healthcare professionals due to fear of selfincrimination, which creates hindrances for the burn care team to provide informed, targeted therapeutic interventions that incorporate patients’ traumatic pasts (jeffreys et al., 2010; roberts et al., 2010). many burn centers rely on self-reporting of pre-existing mental health conditions. however, self-report has been found to be a highly unreliable source of patient data (sakai et al., 2012). burn survival represents a unique and yet generalizable perspective on the impact of trauma in that burn treatment has a history of informing other sources of trauma (gilbran et al., 2022). the value of utilizing a trauma-informed treatment lens that recognizes trauma as “a defining and organizing experience that forms the core of an individual’s identity” (harris & fallott, 2001, pp. 11-12). burn care and rehabilitation are complex and difficult processes that require a multidisciplinary approach to care (young et al., 2019). today, u.s burn centers report a 97% survival rate from even the most devastating burn injuries, such as seconddegree burns (destroying the epidermis and damages the dermis) and third-degree burns (damage to the full thickness of the skin) impacting 97% tbsa (centers for disease control and prevention, 2022). with increased survival of burn patients, the historical narrative that once burn wounds are healed the patient is recovered is no longer considered valid. rehabilitation is recognized as one of the most important in the continuum of care (jeschke et al., 2020). survivors of major burn injuries may face physical trauma such as (a) amputation of extremities associated with damage to underlying bodily structures, (b) severe disfigurement, (c) loss of functional capacities and/or disability due to scar contractures, (d) symptoms of acute and post-traumatic stress, (e) risk of opioid dependence, (f) chronic pain, (g) chronic itching (pruritus), (h) fatigue, (i) photoand thermal sensitivity, (j) sleep disturbances. psycho-social implications for burn survivors include (k) depression and anxiety, (l) post-traumatic stress and post-intensive care syndrome (pics), (m) loss of income over an extended period of time and/or inability to return to their previous employment, (n) sexual issues, (o) substance misuse (p) agoraphobia (q) social stigma, (r) discrimination, (s) family distress, and (t) social isolation that may interfere with physical functioning, mental health, quality of life and social participation, even decades after their burn center discharge (abouzeid et al., 2022; carel et al., 2023; davydow et al., 2009; nelson et al., 2019; ohrtman et al., 2018; van loey & van son, 2003; waqas et al., 2016; young et al., 2019). moulick et al./trauma informed burn care 315 sirancova et al. (2022) assert that the psychological responses to burn injuries may be contingent on both personality and adult attachment styles. using the big five model for personality style, researchers found patients with higher neuroticism and lower extroversion experienced a higher number of post-traumatic stress disorder symptoms and worse emotional adjustment while optimism and extroversion were positively associated with psychological adjustment at six months to seven years. insecure adult attachment was associated with higher levels of psychopathologic symptoms of depression, anxiety, and perceived stress in early adjustment to burns. attachment anxiety was associated with neuroticism, harm avoidance, reward dependence, low novelty seeking, low self-directedness, low cooperativeness, and emotional instability; attachment avoidance was found to be associated with low reward dependence and low amicability. researchers suggest that recognition of these personality styles may help in understanding patterns and variations in patients’ symptom reporting (holt et al., 2019; sirancova et al., 2022; willibrand et al., 2006; woodhouse et al., 2015). research conducted by jeschke and colleagues (2020) report that burn-injured individuals, regardless of the severity of their injuries or age group, face increased risks of mortality and morbidity. they are more likely to experience hospital readmissions, prolonged stays for musculoskeletal diseases, and elevated risks for cardiovascular events. additionally, they show higher rates of diabetes-related hospital admissions within the first five years post-hospitalization. burn survivors face significantly higher mortality rates from trauma and mental illness, especially in the first-year post-injury. researchers find that their substantial care needs are not being adequately met in the community (jeschke et al., 2020). b. disproportionate alcohol testing practices during u.s. burn center admissions silver et al. (2008) state that alcohol testing upon hospital admission varies among burn centers across the u.s., with approximately 50% of trauma patients undergoing blood alcohol content (bac) testing upon arrival, showcasing inconsistent practices across facilities that may be racially motivated. according to jean et al. (2022), “multiple studies suggest that a patient labelled as an alcohol or drug user within the hospital is subject to stigma and negative perception by health care providers during their hospital stay” (p. 193). research analysing the aba’s national burn repository indicated that african americans have a higher probability of being screened for alcohol intoxication on admission to burn care centers (abrams et al., 2023). the binary analysis included burn patient demographics and if they were tested for alcohol on admission to an aba verified burn center. the sample included 16,129 caucasian cases and 16,129 african american cases and found that the probability being tested for alcohol use for african american/cases of color with a burn severity in the uppermost range were about 2 times more likely than caucasian burn cases. the overall chi-square for the logistic regression model based on robust maximum likelihood estimation was, χ2(55) = 3126.5, p. < .00001. the estimated overall r-square was .28 (se =.007, z = 42.2, p. < .001). the test of all interaction terms was, χ2(24) = 59.31, p. < .0001, results were consistent with race playing a role in deciding who is selected for alcohol testing above and beyond such factors as etiology of injury, severity of burn injury, and circumstances of the burn injury. abrams et al. (2023) propose that irregular assessment of alcohol intoxication in burn trauma patients based on demographics advances in social work, spring 2025, 25(1) 316 could suggest the absence of standardized protocols or potential cognitive biases among healthcare providers, both of which may contribute to inaccurate physical and behavioural health evaluations and care. on the flip side, there are significant dangers for burn trauma patients who aren't screened for alcohol misuse but are in fact intoxicated upon admission and go unidentified. this possible bias can have adverse effects on both shortand long-term outcomes, leading to delays in inpatient substance use interventions, and contribute to trauma recidivism (albright et al., 2009; cheever & barbosa-leiker, 2018). consequences of unidentified history of alcohol and substance abuse/misuse frequently manifest as intricate intraand interpersonal patient issues such as continued or elevated alcohol misuse/abuse, patient difficulties during hospital admissions, difficulty with pain control which exacerbates affective disorders and/or pre-existing mental health conditions as compared to the general population. c. policy barriers for burn rehabilitation while both paediatric and adult burn patients in the u.s. receive the same standard of inpatient care regardless of their ability to pay, once patients leave the hospital, their ability to pay either through insurance/third-party payor, state/federally funded medical coverage, or private pay, may inhibit patients’ ability to access necessary communitybased services. additionally, lack of community-based providers in the u.s. who are knowledgeable about the bio-psycho-social sequelae associated with burn injuries are few and far between, leaving patients who do not live within the catchment area of the burn center at a significant disadvantage. public health policy barriers emerge when the long-term needs of burn survivors are unrecognized, the gap which could be filled through social work intervention. healthcare services in developing countries, including burn care, are limited by financial and human resources. triage, the process of prioritizing patients based on the severity of their condition in relationship to available resources, becomes crucial in such situations. sadly, this often results in certain groups, such as children or those with higher status, receiving preferential treatment based on their potential for better long-term outcomes. these life-or-death circumstances of the burn patients shed light on an opportunity for social work to increase their impact and warrants further study. with decreased mortality of burn survivors, greater attention has been focused on social stigmatization associated with burn injuries; stigma has morphed to include both seen and unseen characteristics that mark an individual as somehow divergent from accepted norms that manifest as social shame that can spiral into social isolation and decreased quality of life (ross et al., 2021). the americans with disabilities act of 1990 (ada; 42 u.s.c. §12102(3)(1)a-c) and ada amendments act of 2008 (s.3406) recognize that disability is frequently a socially based identification rather than a purely functional criterion. these acts have far reached implications regarding access to public goods and services and provide opportunities for individuals with disabilities to enjoy the benefits available to the general public, such as recreation, transportation, housing, employment, and telecommunications (west & yell, 2023). the first two categories of the ada include: (a) a physical or mental impairment that substantially limits one or more of the major life activities of such individual, (b) a record of such an impairment; the third category, and (c) individuals perceived or regarded as having a disability which focuses on “perceived disability” and specifically moulick et al./trauma informed burn care 317 addresses burn survivors (ada.gov, 2020). although the definition of “disabled” was narrowed by the supreme court in its decision in the case of (toyota motor manufacturing, kentucky, inc. v. williams, 534 u.s. 184, 2002), upholding these three categories in the ada amendments act of 2008 (ada.gov, 2020). protection is extended to individuals erroneously viewed or treated as having a physical or mental impairment that substantially limits one or more major life activities. examples include a person whose current non-disabling condition, such as hypertension or facial scar as burn injury, is viewed as creating the risk of future disability, or an individual badly scarred from burns whom an employer perceives as unable to work in a position involving public contact because of concern about customers’ negative reactions. (united states, equal employment opportunity commission, 1992, p. 16). while identity is highly personal and intrinsic it is socially and historically constructed, encompassing aspects of gender, social class, age, sexual orientation, race and ethnicity and ability; identity is communal and shared because identity development is dependent on interactions with others to occur (forber-pratt & zape, 2017). burns, especially those to the hands and face, are complex and frequently result in significant scarring that may alter both function and appearance of the burned areas (ross et al., 2021). and yet, burn survivors frequently deny adoption of the label “disabled” in their self-identification (barokka, 2022; khanmalek, 2013; mccall, 2023). d. psychosocial support and financial burden severe burn injuries create significant distress for both patients and their families, requiring long-term follow-up to improve outcomes. therefore, it is recommended that social workers be fully integrated into multidisciplinary teams for both inpatient and outpatient care. (jeschke et al., 2020; maramaldi et al., 2014). financial barriers significantly impede burn survivors' access to essential support resources in the united states. the high costs associated with medical treatment, rehabilitation, and ongoing care can be overwhelming for many individuals, particularly those without adequate insurance coverage or financial means. these barriers often lead to delays in seeking care, reduced access to specialized burn centers, and limited participation in support groups and counselling services that are crucial for recovery. additionally, out-ofpocket expenses for transportation, housing during treatment, and necessary modifications to living environments further exacerbate the financial strain on burn survivors (keisler-starkey & bunch, 2020). it has been documented that individuals from low-income communities, ethnic or racial minorities, children, the elderly, people with disabilities, or those living in unsafe housing conditions are disproportionally burn injured; the burden from these traumatic injuries further marginalize these already disadvantaged groups (jeschke et al., 2020). a major challenge in burn care provision is that as high as 50% of the patients identified in burn injuries rehabilitation model system were lost to follow-up at 12-months post hospitalization, meaning they do not continue to seek healthcare services required to meet their full rehabilitative potential (holavanahalli et al., 2016); keeping patients motivated to adhere to treatment plans will improve health outcomes. expanded psychosocial resources such as burninformed community mental health and substance abuse services that are designed to meet the long-term needs of burn survivors are desperately needed, particularly in rural areas where burn-informed services are typically restricted by lack of proximity to regional burn centers. burn survivors may present in a variety of practice settings advances in social work, spring 2025, 25(1) 318 including home health, integrated healthcare systems, mental health and substance abuse treatment centers, employee assistance programs, and primary and secondary school counselling. jeschke et al. (2020) note that psychosocial rehabilitation for burn survivors has historically been neglected, or even ignored for some time. they add that the essential importance and value of good quality long-term outcomes after burn injuries have only recently come into focus and require change. burn injuries are a chronic, dynamic health condition, with complex and persistent health and psychosocial consequences (abouzeid et al., 2022). the best outcome will be achieved using a multidisciplinary team that emphasizes a dynamic approach to functional restoration through aggressive wound care, scar and contracture management, pain management, mobilization, and psychological support. (young et al., 2019, p. 129) with the advancements in burn patient care, survival rates have notably improved. nevertheless, burns can result in enduring complications and aesthetic issues, potentially leading to long-term social and psychological challenges, including diminished self-confidence and self-esteem (emami sigaroodi et al., 2019). patients who undergo severe trauma such as burns, along with the necessary intensive care treatments, experience profound physiological and psychological stressors resulting in reduced quality of life (davydow et al., 2009; lodha et al., 2020; van loey & van son, 2003; waqas et al., 2016). various studies across different demographics have consistently demonstrated the advantages of social support and relevance in clinical practice and its crucial role in the overall well-being (cleary et al., 2019; cleary et al., 2020. however, individuals who have sustained burn injuries often feel they receive limited support from society, which can have a detrimental impact on their health outcomes. providing education to the social support network, alongside traumainformed psychological and substance abuse care, could contribute to better overall clinical outcomes for burn patients (waqas et al., 2016). e. individual stigma the emotional needs of burn patients receive comparatively less focus in comparison to their survival and physical requirements (rubab & kalsoom, 2018). burns can be emotionally and psychologically scarring with physical transformations that challenge self-esteem. research focused on burn survivors observed that the extent of burn injuries was linked to their self-perception of physical appearance two years following a major fire incident, and depressive symptoms three years post-burn among the hundreds of affected individuals (picoraro, 2014). this adversely impacts the interpersonal relationships, concentration, emotions, and performance of individuals recovering from burns (gorbani et al., 2021). with the functional decline of burn patients that is associated with the site of the burn, type of burn, and burn scars that are affected by the depth of the burn, their ability to form new social connections and interact with others is negatively impacted (lawrence et al., 2004). the choice to withdraw from social interactions and activities because of disfigurement can result in social isolation and significantly affect the psychological well-being of burn survivors (haw & hawton, 2011; martin et al., 2017). a cross-sectional study of adult burn survivors conducted by ohrtman and colleagues (2018) points out that fatigue, pain, sensitivity to heat and light, and psychological challenges can restrict the range of activities in which burn survivors can moulick et al./trauma informed burn care 319 participate and limits their ability to engage in family and social activities. inability to participate in activities that contribute meaningfully to quality-of-life post-burn contributes to their isolation and the burden of trauma without social support. these challenges are exacerbated among older adult burn survivors as their burns contribute to further physical mobility decline (edgar et al., 2013). it is crucial that educational methods and values of care frameworks are used to mitigate the psychosocial challenges associated with burns, with a specific emphasis on enhancing self-esteem (mehrabi et al., 2022). f. community stigma post-burn stigma pertains to the circumstance in which an individual possessing a particular burn characteristic is unfairly judged in a negative manner within the social environment, as being beyond the usual societal norms (mercado et al., 2022; zhang et al., 2023). burn survivors frequently experience feelings of stigma, shame, guilt, or a diminished sense of self-esteem because of their altered appearance and the prejudice they encounter from others (link & phelan, 2001). due to significant alterations in their appearance, burn survivors frequently encounter discrimination and social exclusion. this resultant stigma can intensify psychological stress and render survivors more vulnerable to developing emotional disorders (zhang et al., 2023). a considerable number of burn survivors dress to cover burn scars and avoid being stared at (ohrtman et al., 2018). research has found that stigmatizing social behaviours, such as prolonged stares or being subjected to intrusive questions (martin et al., 2017; willemse et al., 2023), frequently happen in the aftermath of burn injuries and have been linked to dissatisfaction with one's body image (lawrence et al., 2012; thombs et al., 2008; willemse et al., 2023). burn survivors with noticeable scars often experience a range of stigmatizing and embarrassing actions from society, which may include being socially excluded, evoking startled reactions, hearing whispers, enduring teasing, and receiving pity (lawrence et al., 2012; maslakpak et al., 2022). there exists a lack of awareness among the general population about burns, leading to misconceptions and stigma in society (maslakpak et al., 2022). recognizing factors linked to how burn survivors perceive social stigma is crucial, as it is likely to have an adverse impact on their quality of life throughout the recovery process. this understanding can help in providing optimal psychosocial support for the patients’ rehabilitation (ross et al., 2021). g. potential impact of stigma on burn survivors the transformations in appearance that burn survivors undergo can heighten their expectations of unfavourable judgments and the fear of being rejected. this, in turn, can result in reduced self-awareness, leading to difficulties in expressing emotions (pearlin et al., 1990). burn injuries can profoundly impact individuals' lives, potentially limiting their employment prospects due to discrimination, physical limitations, and emotional challenges. if a person is unable to return to work promptly or experiences a delay in doing so, it can lead to a loss of income and support for their family (katsu et al., 2021). spronk et al. (2022) found that a significant portion of their study sample faced limitations in their activities and suffered reduced work efficiency, leading to unemployment or alterations in their employment status following their injuries; advances in social work, spring 2025, 25(1) 320 individuals with severe burns exhibited decreased productivity and had lower rates of employment. participating in sexual and romantic relationships are integral facets of social engagement and research has shown a noticeable decline in the sexual well-being of burn patients (ahmad et al., 2013; ohrtman et al., 2020;). the extent of burn injuries and the visibility of scars have been linked to stigmatizing social responses from others, which can consequently have adverse impacts on the mental well-being of individuals who have suffered burn injuries (cariello et al., 2021). it is advisable to maintain a perspective that recognizes the importance of social support from family, friends, healthcare providers, and other significant individuals in the life of the burn survivor. this perspective should also acknowledge the potential challenges that may arise throughout all stages of burn care (moi & gjengedal, 2014). h. access to care and social acceptance burn injuries disproportionately affect those populations living in poverty. inpatient protocols are designed for all u.s. burn patients to receive the same level of required care; however, once discharged, burn patients living in underserved communities may have limited access to specialized care as compared to those who live near the regional burn centers. issues related to transportation insecurity, lack of insurance coverage, loss of income due to extended hospitalization and rehabilitation from the trauma, comorbid behavioural health diagnoses, and deficits in health literacy have been found to be negatively associated with burn care follow-up, optimal wound healing, risk of disability, and social reintegration. burn center discharge planners are routinely challenged by the lack of community-based services and providers who are knowledgeable in burn specialty care, particularly in large hospital catchment areas that are primarily rural and may span large geographic areas that cover multiple states. increased survival of burn patients with as much as 97% tbsa burns also increases the intensity of community-based needs as patients must return to their home communities and attempt to rebuild their lives on their own. even the best inpatient burn treatment can be diminished when community-based aftercare services are lacking. based on ethical principles and educational policy and accreditation standards (epas) instituted by the counsel for social work education such as competency 4: engage in practice-informed research and research-informed practice; competency 6: engage with individuals, families, groups, organizations, and communities; competency 7: assess individuals, families, groups, organizations, and communities; and competency 8: intervene with individuals, families, groups, organizations, and communities; and competency 9: evaluate practice with individuals, families, groups, organizations, and communities (cswe, n.d.), social workers are uniquely positioned to provide community-based behavioural health and case management services for burn patients and their families post-discharge in that they have been trained in trauma-informed care, interprofessional collaboration, and issues relative to social justice. moulick et al./trauma informed burn care 321 table 1. potential barriers while seeking burn care potential barrier summary a. burn trauma people who have experienced trauma in the past are more likely to suffer a burn injury at some point in their lives. they are also more prone to trauma-related reactions and mental health issues—such as substance abuse, depression, and acute or post-traumatic stress symptoms—both before and after the burn incident. b. disproportionate alcohol testing practices during u.s. burn center admissions research indicates patients of colour have a higher probability of being tested for alcohol on admission to an aba verified burn centre in the u.s. c. policy barriers for burn rehabilitation all patients with burn injuries in the u.s. receive the same standard of inpatient care, regardless of their financial situation. however, after discharge, access to essential outpatient or community-based services often depends on their ability to pay; there is a shortage of community healthcare providers with expertise in the physical, psychological, and social effects of burns, creating additional risk factors for underserved populations. d. psychosocial support and financial burden burn injuries disproportionately affect vulnerable populations, including low-income communities, racial and ethnic minorities, children, older adults, people with disabilities, and those in unsafe housing. the impact of these injuries further deepens the marginalization of these already disadvantaged groups. e. individual stigma severity of injuries have been found to influence burn survivors’ body image after two years and depression levels after three years. these lasting effects harm relationships, emotional well-being, focus, and daily functioning during recovery. f. community stigma burn survivors with visible scarring frequently face social stigma, encountering exclusion, startled reactions, whispering, teasing, and pity from others. g. potential impact of stigma on burn survivors burn injuries often severely affect survivors' livelihoods, restricting job opportunities through discrimination, physical impairments, and psychological struggles. failure to quickly return to work can result in lost wages and family hardship. h. access to care and social acceptance barriers like transportation difficulties, uninsured status, lost wages from prolonged treatment, pre-morbid mental health conditions, and low health literacy impair burn survivors' follow-up care, recovery outcomes, and community reintegration. trauma informed interventions the substance abuse and mental health services administration (samhsa) defines “trauma-informed approach” as being upheld by six cardinal principles (i.e., safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; cultural; historical and gender issues) (samhsa, 2014). trauma-informed care, also called a trauma-informed social work, is a perspective in practice that provides holistic psychosocial support. it acknowledges the significance of past and present trauma and incorporates proactive measures and advances in social work, spring 2025, 25(1) 322 procedures into service delivery systems to address the onset, worsening, or recurrence of trauma, considering the individual and their surrounding circumstances (bowen & murshid, 2016; ely et al., 2018; knight, 2015). the nasw reports there are more than 708,000 social workers in the u.s., with the capacity to advocate for the implementation of trauma-informed approaches to service delivery across the continuum of care. the social work field aligns with trauma-informed principles by adopting a comprehensive approach to assessment, intervention, and practice (ely et al., 2018; hare, 2004). trauma-informed interventions facilitate the identification of trauma and specific triggers that could lead to potential re-traumatization and re-victimization. they also empower the implementation of preventive plans. a conceptual model of burn care social work through a trauma informed lens is proposed in figure 1. figure 1. conceptual model of burn care seeking experience through a traumainformed lens. stressors associated for burn survivors • burn trauma • psychological trauma • financial instability • provider bias in alcohol testing during admission • policy barriers • individual stigma • community stigma • social acceptance practice implications • cultural & gender sensitivity • race inclusive • social worker training • universal insurance coverage • interagency collaboration • evidence-based therapeutic interventions • community collaboration • acknowledgement • advocacy as shown in the figure 1, different forms of stressors influence a burn patient’s journey from the burn injury event, followed by admission to a burn center where demographics may influence implicit/explicit bias of the medical practitioners, and by the emergence of physical and psychological trauma as the patient navigates through different stages of care in a burn center. once the survivor leaves the hospital, policy barriers and lack of burn care services in semi-urban or rural areas negates the accessibility of wound care management alongside adequate psychosocial support. furthermore, the probability of encountering social stigma increases to a greater extent and is often interwoven with the dilemma of social acceptance, loss of employment, economic distress and long-term psychological trauma. social workers trained in trauma-informed care working in burn care settings play a crucial role as they engage with clients facing the complex aftermath of burn trauma. they bring a heightened sensitivity and understanding of the impact of trauma on individuals, considering the intersections of culture, gender, and race. by valuing evidence-based therapeutic interventions, they approach their work with empathy and a holistic intersectional perspective. it is also essential that the social worker acknowledges that their clients have the autonomy to establish their own recovery objectives, fostering self-determination. the emphasis should be on recognizing the client's potential recovery requirements, respecting their choices, and offering support with problem-solving. additionally, there is assistance provided for exploring diverse service options and engaging in self-advocacy to empower self-determination. moulick et al./trauma informed burn care 323 trauma-informed care framework for social workers in burn care centers the importance of trauma informed care in burn care settings cannot be undermined as it has the credibility to acknowledge the prevalence of trauma, its exposition and its impact which further lays the ground for supporting burn survivors psychologically in their recovery by significantly mitigating re-traumatization (cleary et al., 2018; cleary & hungerford, 2015). healthcare practitioners may become reluctant in addressing challenges (i.e., mental health problems) which may be beyond their areas of clinical expertise and might feel that they lack the necessary training in treating issues of trauma or loss (mclindon & harms, 2011). the unique positionality of social work practitioners within inter-disciplinary burn care teams, enables them to address a variety of psychological challenges faced by burn patients and their family members (abrams et al., 2022). using the trauma-informed framework as depicted in figure 2, social workers can use this as a foundation to approach all burn patients/survivors as though they have been impacted by trauma, encouraging interactions with clients in a way that minimizes the stressors post burn injury. figure 2. a trauma-informed framework for social workers in burn centers and the community social workers in burn care should consider the safety of burn patients/survivors by negating explicit/implicit provider bias and work closely with patients and their support systems to reduce anticipatory stress in their path to recovery and reintegration. social workers should consider re-enforcing patient autonomy in tertiary care decisions and provide opportunities to re-establish self-efficacy. they should partner effectively within burn care teams to make collaborative patient-provider decisions and work with community-based organizations to educate communities about the challenges faced by burn survivors post-discharge from hospitals for enhanced re-integration into society. throughout the care giving process, social workers are expected to maintain transparency when providing confidential and non-judgemental information to their advances in social work, spring 2025, 25(1) 324 clients and their family members as this exhibits the core principles of social work. this framework could prove valuable for social workers in social service environments, especially when clients unexpectedly seek referrals or information related to burn care. additionally, it is beneficial for social workers operating in medical settings where burn care services may be offered. social workers should advocate for race and gender responsive care in burn care centers in order to educate interdisciplinary teams about social justice issues to better serve diverse communities. they should also be responsible for promoting and advocating policies that are mindful of risks and impacts of burn injuries at the local (i.e., communities, schools and workplaces), state (i.e., state legislatures) and national (i.e., american burn association) levels. social workers should also accommodate themselves in educating burn care team members about trauma-informed theory and identify modalities to support psychosocial recoveries of burn patients. they should also utilize standardized methods to document patient progress to improve generalizability of patient outcomes across burn centers. implications of practice advancing the trauma informed framework in social work practice with burn patients the past decade has seen the benefits of trauma-informed care (tic) in multiple healthcare settings. the journey towards recovery after a burn extends beyond the physical realm, emphasizing the significance of addressing psychosocial adjustment and trauma in the caregiving process (cleary et al., 2020). implementing the traumainformed framework will guide social workers to address the psychosocial contusions that impede the healing process of burn survivors. trauma-informed care provides patients with the chance to actively participate in their healthcare plan, establish a trusting rapport with their healthcare provider, and enhance their overall well-being outcomes (raja et al., 2015). through this framework, social workers will find an evidence-based practice mechanism to empathize and develop trust with their clients to provide effective care. social workers will be able to carefully identify triggers associated with re-experiencing the trauma of burn injury among their clients and include burn survivors in a collaborative journey toward social integration. social workers may come into contact with burn patients and survivors in almost any therapeutic setting, both inpatient and/or the community. whether survivors’ scars from burn injuries are visible or “hidden” under clothing, anecdotally, the survivor knows the scars are there and believes everyone else knows as well. regardless of the depth of the burn or percentage of the tbsa that was affected, the trauma of the burn event and the days and years that follow remain a part of survivors’ positive and/or negative personal narratives. social workers can positively impact those personal narratives through empathy, clinical expertise, positive regard, and knowledge about the burn experience as survivors navigate their healing, rehabilitation, and re-entry. other implications of practice include policy changes in the form of implementation of universal insurance coverage across the country, inter-agency collaboration and community collaboration to enhance re-integration possibilities of the individual into the society post burn injury. it is also essential that the social worker acknowledges that their clients have the autonomy to establish their own recovery objectives, fostering self-determination. case management strategies and therapeutic modalities such as trauma-informed care will equip social workers to work with this growing population moulick et al./trauma informed burn care 325 as patients survive more destructive wounds that result in more devastating effects on individual, family, community, and social systems. importance of universal insurance coverage and burn survival there have been multiple commentaries and debates on the effectiveness of universal healthcare in the usa. the success of any trauma-informed framework needs to encompass three important social determinants access to care, environment, and healthy behaviours. the income inequality in the country is evident through the concentrated population in distressed neighbourhoods and high-poverty neighbourhoods which has seen a significant rise since 2000s (shrider & creamer, 2023). in a recent study of the us population, the likelihood of a patient experiencing burns showed a notable correlation with the percentage of poverty (patel et al., 2018). to mitigate the financial burden of uncompensated care among low-income populations in the country, medicare and medicaid offer disproportionate-share payments to hospitals with a predominant population of publicly insured or uninsured patients. apart from these public insurance initiatives, various programs for uninsured, low-income, and vulnerable individuals, commonly referred to as safety nets, receive funding from taxpayer dollars. as an example, the affordable care act (aca) augmented financial support to federally qualified health centers. these centers offer primary and preventive healthcare including burn care to over 27 million underserved patients, irrespective of their ability to pay (roosa et al., 2020). a rise in insurance coverage is linked to increased rates of discharging burn injury patients to inpatient rehabilitation programs (oh et al., 2021). the design of such programs has been to provide healthcare access to the entire population in the country. however, the poor alignment of the programs and monopoly given to pharmaceutical companies and medical service agencies does not allow the federal or state governments to set the prices that can be charged for any medical services. these take away autonomy from the hands of the patients to choose medical services that can be affordable to them. the predominant role of insurance as a key determinant for healthcare access in the usa creates barriers for uninsured individuals seeking primary healthcare services. the healthcare system in the united states tends to prioritize corporations and wealthy individuals over the general population, resulting in a lack of coverage for minorities and the unemployed. consequently, these groups are unable to access essential medical services (keisler-starkey & bunch, 2020). to reduce the gap between burn incidence among low-income groups and affordable healthcare accessibility, there is an urgent need for universal healthcare for all in the country. the united kingdom has a universal insurance plan for its population and the government strictly regulates healthcare delivery by setting the prices that can be charged for any medical services (grosios et al., 2010). providing universal healthcare coverage has the potential to enhance the overall health of the u.s. population. this would, in turn, lead to reduced government healthcare costs, ultimately resulting in lower overall government spending on healthcare (zieff et al., 2020). because most of the insured people in the usa avail employer-based insurance plans, with the implementation of a universal healthcare in the u.s., the need for employer health insurance would be eliminated, allowing the funds designated for it to be redirected towards employee compensation. though implementing a universal health insurance comes with its own challenges, this will provide the population to develop better helpadvances in social work, spring 2025, 25(1) 326 seeking behaviour related to burn care and rehabilitation and provide burn survivors with better post-hospitalization services. conclusion trauma-informed frameworks enable social workers to consciously approach client service delivery through socially equitable approaches to create a safe space for trauma management. this innovative framework was developed with consideration for the interdisciplinary aspects of burn care and rehabilitation. it empowers patients to actively participate in selecting the services that align with their preferences. in addition to burn centers, community based social service agencies must be able to design training to aid burn survivors in their physical, psychological, and emotional recovery. providing social workers with necessary tools for advocacy, this framework will help in mitigating the stigma around burn scars at multiple levels within the environment of burn survivors. supporting families as they navigate the emotional challenges associated with burn treatment and assisting them in addressing the heightened critical needs of patients affected by burn trauma will provide a conducive environment for better care and reintegration of burn survivors 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(2010). verified centers, nonverified centers, or other facilities: a national analysis of burn patient treatment location. journal of the american college of surgeons, 210(3), 299305. author note: address correspondence to aritra moulick, phyllis and harvey sandler school of social work, florida atlantic university, boca raton, fl 33431. email: amoulick@fau.edu author orcid aritra moulick, university of tennessee https://orcid.org/0000-0002-5733-9932 namrata mukherjee, university of tennessee https://orcid.org/0000-0003-2586-0720 thereasa abrams, university of tennessee https://orcid.org/0000-0003-3294-2150 https://doi.org/10.1080/08870446.2021.1970160 https://doi.org/10.1080/08870446.2021.1970160 https://pmc.ncbi.nlm.nih.gov/articles/pmc7486561/pdf/ijbt0010-0146.pdf https://pmc.ncbi.nlm.nih.gov/articles/pmc7486561/pdf/ijbt0010-0146.pdf https://doi.org/10.1016/j.burns.2005.11.005 https://doi.org/10.1016/j.burns.2005.11.005 https://doi.org/10.1016/j.janxdis.2015.07.002 https://doi.org/10.1016/j.janxdis.2015.07.002 https://doi.org/10.1016/j.pmr.2018.08.004 https://doi.org/10.1016/j.pmr.2018.08.004 https://doi.org/10.1016/j.burns.2022.12.018 https://doi.org/10.1016/j.burns.2022.12.018 https://doi.org/10.3390/medicina56110580 https://doi.org/10.3390/medicina56110580 https://doi.org/10.1016/j.jamcollsurg.2009.11.008 https://doi.org/10.1016/j.jamcollsurg.2009.11.008 https://doi.org/10.1016/j.jamcollsurg.2009.11.008 mailto:amoulick@fau.edu https://orcid.org/0000-0002-5733-9932 https://orcid.org/0000-0003-2586-0720 https://orcid.org/0000-0003-3294-2150 a. burn trauma b. disproportionate alcohol testing practices during u.s. burn center admissions c. policy barriers for burn rehabilitation d. psychosocial support and financial burden e. individual stigma f. community stigma g. potential impact of stigma on burn survivors h. access to care and social acceptance abouzeid, c. a., wolfe, a. e., ni, p., carrougher, g. j., gibran, n. s., hammond, f. m., holavanahalli, r., mcmullen, k. a., roaten, k., suman, o., stewart, b. t., wolf, s., zafonte, r., kazis, l. e., ryan, c. m., & schneider, j. c. (2022). are burns ... ada.gov (2020). questions and answers about the department of justice’s final rule implementing the ada amendments act of 2008. author. forber-pratt, a. j., & zape, m. p. (2017). disability identity development model: voices from the ada-generation. disability and health journal, 10(2), 350-355. may, c., & wisco, b. (2016). defining trauma: how level of exposure and proximity affect risk for posttraumatic stress disorder. psychological trauma: theory, research, practice and policy, 8(2), 233-240. _________ luis o. curiel, dsw, lcsw, california social work education center consultant, field faculty, and lecturer, department of social work at california state university, northridge, ca. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 730-749, doi: 10.18060/24176 this work is licensed under a creative commons attribution 4.0 international license. interracial team teaching in social work education: a pedagogical approach to dismantling white supremacy luis o. curiel abstract: this article aims to explore anti-racist social work education through interracial team teaching, where one instructor is white, and the other is black, indigenous, or a person of color (bipoc). this pedagogical approach is presented as an emerging conceptual model to consider in anti-racist social work education. as an anti-racist approach to teaching, this model aims to engage students and faculty in a more active and accountable role in dismantling systemic racism and white supremacy through social work education. a close examination of published articles on interracial team teaching revealed an absence of theoretical frameworks to guide this teaching method. critical race theory (crt) emerged as a compatible theoretical framework for teaching anti-racism within an interracial team-taught model. five crt tenets from sólorzano et al. (2005) align with previous studies to support this emerging pedagogical approach as a viable option. findings suggest that anti-racist education requires explicitly naming terms like white supremacy, racism, and colonization within the social work curriculum. interracial team teaching necessitates shared power and authority between instructors and calls for white educators to examine their white identity and resist performing allyship. academic institution hiring practices need a greater representation of bipoc faculty to reduce overburdening faculty of color. keywords: interracial team teaching, social work education, anti-racist pedagogy, social work curriculum, dismantling white supremacy, critical race theory the council on social work education (cswe) asserts that teaching social work students to be competent in engaging in diversity and difference in practice requires explicit and implicit curricula (cswe, 2015). “the explicit curriculum constitutes the program’s formal educational structure and includes the courses and field education used for each of its program's options” (cswe, 2015, p. 11), whereas “the implicit curriculum refers to the learning environment in which the explicit curriculum is presented” (cswe, 2015, p. 14). additionally, “the implicit curriculum is as important as the explicit curriculum in shaping the professional character and competence of the program’s graduates” (cswe, 2015, p. 14). the concept of a hidden or implicit curriculum refers to the tacit or unspoken values, behaviors, and norms that exist in the academic setting (alsubaie, 2015). educators may consciously or unconsciously use the implicit curriculum as a pedagogical strategy or method to influence student learning, including when teaching topics relevant to social justice (alsubaie, 2015). however, the term curriculum itself is often obscured within higher education literature (barnett & coate, 2004; smith, 2013). similarly, the 2015 educational policy and accreditation standards (epas) developed by the cswe for baccalaureate and master’s social work programs contribute to the erasure of specific and essential terms relevant to social work practice and education (cswe, about:blank curiel/interracial team teaching 731 2015). words omitted from the cswe epas lexicon include white supremacy, racism, and colonization. although muted, these terms are foundational for learning about social justice issues as a principal social work value (national association of social workers [nasw], 2017). authors such as barnett and coate (2004) argue that curriculum reproduces society and reflects the social context in which it is located, benefitting some over others. to address this erasure, social work educators must refrain from sanitizing the context for learning social justice to meet the profession's purpose. however, critical race scholars in education argue that some aspects of the implicit curriculum reinforce social inequalities related to racial hierarchies (bhuyan et al., 2017). for instance, jay (2003) explains that the “hidden curriculum of hegemony” (p. 6) enables academic institutions to socialize students to adhere to the dominant groups' interests, reinforcing dominant ideologies, despite the explicit promotion of social justice. social work education has an ethical responsibility to move beyond reproducing a cadre of vapid social justice groupies and moving toward developing anti-racist practitioners. with explicit education on anti-racism, social workers are more likely to be armed with the knowledge to confront and dismantle barriers that impede the human rights and dignity of black, indigenous, people of color (bipoc) resulting from a system of white supremacy. as an institution, academia is too often complicit in upholding systemic oppression. this reality positions conscientious social work educators to resist institutional curricular mandates by engaging in stealth pedagogical practices (i.e., through the implicit curriculum) and curriculum design (i.e., the explicit curriculum; barnett & coate, 2004). for students to become ethical leaders in their communities, leaders in higher education must model ethical decision-making with racial justice in mind (chenneville, 2017). students learn to behave like professional social workers, both explicitly and implicitly, by actively observing their teachers and adopting the norms, values, and professional conduct they see modeled by their instructors (anastas, 2010). one way to model professional practice behavior within the classroom environment is by team teaching. in social work education, team teaching may take several forms, including teaching the same course in pairs, teaching distinct modules of a similar class, or working in partnership with members of the field education team (dill et al., 2017). team teaching is the practice of at least two instructors engaging cooperatively with each other and sharing the responsibility for teaching a classroom of students (zapf et al., 2011). research exploring team teaching in social work education by pairing faculty who hold diverse backgrounds is scarce (garran et al., 2015; ouellett & fraser, 2011). even more limited literature specifically examines interracial team teaching in social work education (ouellett & fraser, 2011). although limited, the research on team teaching in social work education with instructors who hold diverse, intersectional identities shows that team-taught courses broaden student perspectives (zapf et al., 2011). this conceptual paper aims to explore anti-racist social work education through interracial team teaching, where one instructor is white, and the other is a bipoc. this pedagogical approach is presented as an emerging conceptual model to consider in anti-racist social work education. this model aims to advances in social work, summer 2021, 21(2/3) 732 engage students and faculty in efforts to dismantle white supremacy—propelling the field of social work to take a more active and accountable role in the direct support of bipoc. literature review anti-racism defined to conceptually define anti-racism, it is necessary first to define racism. giwa and mihalicz (2019) offer the following definition “racism, in its simplest sense, is the expression of racial prejudice by a white-dominant society against racial minorities based on phenotypic differences (e.g., race or skin color)” (p. 46). other researchers propose a more elaborate way to define racism within a socio-political context that provides additional details on how racism manifests: racism is a system of privilege, inequality, and oppression based on perceived categorical differences, value assigned to those differences, and a system of oppression that rewards and punishes people based on the assigned differences. it is manifested politically, socially, economically, culturally, interpersonally, and intrapersonally in the history of the united states. (scssw, n.d., as cited in o'neill & miller, 2015, p. 161) in direct opposition to racism, anti-racism, within the context of social work education and this paper, is interested in actions rather than inactions or mere cognitive understanding of how racism is defined and manifested within multiple social and political systems. furthermore, juxtaposing these definitions elucidates the rationale for explicitly teaching anti-racism within an interracial team teaching method in social work education: antiracism efforts involve intentional, strategic, and determined actions to undermine racism embedded throughout intersecting individual, interpersonal, structural, and institutional levels of society. antiracism necessitates an evolving critical awareness and analysis of social and structural location in relation to systems of power, privilege, and inequity (donner & miller, 2005). dismantling racism implies a pedagogy that fosters a critical consciousness (freire [1970]), including a critical analysis of systems of domination based on race and white supremacy (hooks [2003]). as well, antiracism seeks human connection over disconnection. (o’neill & miller, 2015, p. 161) these definitions help support foundational and contextual knowledge for the social work curriculum on anti-racism. they also offer further clarification for necessitating a teaching approach that includes an interracial pairing of instructors within this developing conceptual model. teaching diversity in social work education research examining the perceptions of who feels qualified to be a multicultural educator suggests that white, middle-class, heterosexual women feel more qualified to teach the subject than african american/black or other people of color (gorski et al., curiel/interracial team teaching 733 2012). and, among multiple personal and professional experiences, “life experiences” are the only factor associated with white women’s teaching self-efficacy (gorski et al., 2012). this finding raises questions regarding the experiences and perceptions of social work educators teaching diversity courses in the academy. according to delgado (1996, as cited in amos, 2010), “well-intentioned whites can actually do more harm than good without even realizing it” (p. 34). the field of social work is not dissimilar to teacher education, which aims to prepare professionals who are committed to the ideals of multicultural education and competence in their practice (amos, 2010; guyton & wesche, 2005). guyton and wesche (2005) noted that the need for teachers proficient in multiculturalism, much like social workers, has increased over time due to continued demographics and recruitment trends. as a result of these trends, the problem of educating teachers and social workers to teach cultural competence efficiently during pre-service training in college and universities will be that a majority are white, monolingual, and primarily female students (amos, 2010; cswe, 2019; guyton & wesche, 2005). teaching anti-racism in social work education the national accrediting body for social work education, cswe, mandates that cultural diversity and social justice be addressed as fundamental components of social work education (cswe, 2015). specifically, competency 2, set forth by cswe, requires that social workers understand systemic oppression and socio-political structures of power and privilege that serve to marginalize and discriminate some while empowering others (cswe, 2015). given this cswe mandate and the rise of publicized racist acts against bipoc, ladhani and sitter (2020) recognize that it is vital for social work education to shift from an appreciation of cultural diversity and move toward reviving anti-racism within its curriculum. social work recognizes the significance of both the implicit and explicit curriculum (cswe, 2015). therefore, both warrant further examination for ways to teach anti-racism as a method to dismantle white supremacy as an oppressive system of power and control. in a study examining the use of language in the curriculum to promote school change by comparing phrases like “culturally responsive” with the term “antiracist,” galloway et al. (2019) found that race-neutral language can lead educators to avoid critically examining racist systems and practices. they also found that applying the term “anti-racism” helps shift the educators’ focus from a race-avoidant practice to critically examining racism and white supremacy (galloway et al., 2019). according to beck (2019), the erasure of terms like white supremacy and racism from epas governing social work education reveals the social work profession’s discomfort with these specific terms and concepts. beck (2019) recommends that social workers intentionally unveil the invisible and sometimes subtle forms of white supremacy that exist without using a lack of recognition as an excuse for upholding racism. similarly, santas (2000) contends that racism persists to the degree that it is viewed as enduring. further suggesting that once racism is brought to light and recognized as constructed, it can also be viewed as a system that can be deconstructed and dismantled (santas, 2000). consequently, omitting anti-racism as a term within the social work curriculum holds advances in social work, summer 2021, 21(2/3) 734 implications for how social workers understand and engage (or not) with the construct of racism in the absence of its opposite (ladhani & sitter, 2020). as a profession that values social justice, social work educators cannot remain politically neutral when addressing systemic racism (kelly & brandes, 2010). team teaching in social work education as a phenomenon, team teaching has been studied primarily in elementary and middle schools (ginther et al., 2007; hanover research, 2012). the literature on team teaching specific to social work education suggests that further exploration is needed to determine how team teaching influences student learning (chanmugam & gerlach, 2013). it remains unknown whether specific social work education courses are a better fit for a team-taught approach or if other course implementation factors are more influential than the course content itself (chanmugam & gerlach, 2013). however, existing research on team teaching in social work education claims advantages related to professional development and an increase in confidence and self-efficacy of doctoral students preparing for academic careers (chanmugam & gerlach, 2013). additionally, team teaching promotes cross-training opportunities where professors learn by modeling their peer educators’ behaviors and learn alternative pedagogical styles (ginther et al., 2007). furthermore, team teaching has the potential to enhance teaching quality as multiple perspectives are applied within the course, holding several advantages over traditional solo teaching (garran et al., 2015). distinct approaches to team teaching exist within academic programs that include teams comprised of individuals holding various positions, such as the field education team comprised of field instructor and field liaison (curiel & ashley, 2020; dill et al., 2017; hanover research, 2012; meizlish & anderson, 2018). one team teaching method that assumes a high level of partnership and coordination is the co-facilitation or co-teaching model (duran & miquel, 2019; hanover research, 2012; meizlish & anderson, 2018). co-facilitation requires that instructors work closely in all aspects of the course, including selecting readings, creating assignments, teaching, and grading (duran & miquel, 2019; hanover research, 2012; meizlish & anderson, 2018). as noted by meizlish and anderson (2018), both students and teachers may benefit from a team-taught course's rich learning potential; however, it is unlikely to occur without proper planning and execution. additional challenges identified with team teaching partnerships include differences in teaching philosophies, individual values and beliefs, and a lack of attention to intersectional differences between instructors (hanover research, 2012; meizlish & anderson, 2018; zapf et al., 2011). an example of challenges encountered between diverse teachers identified by meizlish and anderson (2018) includes the added burden of labor bipoc faculty shoulder when disproportionately called upon as allies or advocates by bipoc students. recognizing the importance of mitigating power imbalances related to age, race, sex, and other intersecting identities between team teachers before teaching a tandem course is essential for a successful team teaching partnership (curiel & ashley, 2020; meizlish & anderson, 2018; zapf et al., 2011). curiel/interracial team teaching 735 interracial team teaching in social work education team teaching can serve as a model for students grappling with ways to manage difficult discussions by witnessing two instructors with distinct perspectives engage in mutual discourse while sharing power and authority in a classroom setting (curiel & ashley, 2020; garran et al., 2015; gollan & o’leary, 2009). similarly, interracial team teaching partnerships are a pedagogically sound teaching intervention for addressing antiracist education (gollan & o’leary, 2009; miller & garran, 2017; o’neill & miller, 2015). for example, in a study on interracial team teaching in social work by ouellett and fraser (2011), the authors found that the outcome of teaching in an interracial team, from the student’s perspectives, were that the observation of the instructor’s collegial relationship was determined to be far more significant to their learning than the formal curriculum. interracial teaching teams can serve as models of shared power within the classroom and help students visually experience successful, mutually respectful interracial interactions (ouellett & fraser, 2011). some benefits identified with interracial team teaching include teaching the instructor’s strengths in areas of expertise and fostering a deeper collegial relationship between team members (garran et al., 2015). another benefit is noted in the greater level of mutual support between team members in and outside the classroom (miller & garran, 2017). for instance, when discussing the concept of white privilege, if introduced by the white instructor, students may be more receptive to the discussion. in contrast, content on internalized racism may be best taught by an instructor of color (garran et al., 2015). interracial team teaching allows instructors to support one another and assist in buffering tensions if one instructor is triggered or becomes the target of student resistance (miller & garran, 2017). additionally, interracial team teaching partners can offer each other mutual feedback about unexamined biases related to race and racism (miller & garran, 2017). compared to traditional solo teaching, interracial team teaching, through modeling, contributes to students’ recognition of whiteness and racism and thereby supports their developing practice of self-accountability (gollan & o’leary, 2009). for example, amos’ (2010) study examined the interactions between students of color and white pre-service teachers in a multicultural education class taught by an instructor of color. amos’ (2010) research identified feelings of frustration, despair, and fear experienced by students of color due to whiteness's overwhelming silencing power in the class. even though students of color felt they had much to contribute to the class discussion, the hostility witnessed by these students from their white peers toward their instructor of color elicited fear of possible retaliation, influencing their silence (amos, 2010). amos (2010) argues that this is a condition that white students need not contend but students of color grapple with regularly. like the emotional labor identified by students of color in amos’ (2010) study, wingfield’s (2010) study showed that white students perceive black faculty members as inferior and unintelligent and consequently dispute black professors’ knowledge. as a result, black faculty perform emotional regulation of their anger and frustration to adhere to professional standards, unlike their white counterparts (wingfield, 2010). consequently, miller and garran (2017) offer cautionary advice about the risk of replicating racist patterns in the classroom if white instructors assert themselves in a advances in social work, summer 2021, 21(2/3) 736 dominant leadership position. they also acknowledge the comfort white students feel engaging with white professors, minimizing the role of the professor of color (miller & garran, 2017; wingfield, 2010). additionally, they warn of the threat of splitting that occurs when one teacher is idealized, and the other disparaged (gollan & o’leary, 2009; miller & garran, 2017; wingfield, 2010). gollan and o’leary (2009) posit that interracial team teaching partnerships between black and white instructors require white accountability to counter the threat of splitting. that is, white instructors must recognize their privileged position and understand the power of invisibility that whiteness and institutional racism wield in shaping relationships between bipoc and white people (campbell, 2002; garran et al., 2015; gollan & o’leary, 2009; ouellett & fraser, 2011; wingfield, 2010). by engaging in critical self-reflection, white instructors can encourage white students to take ownership of racism as a white problem and relieve bipoc from the burden of responsibility to eradicate systemic racism (beck, 2019; garran et al., 2015; gollan & o’leary, 2009). in so doing, white instructors can support white students with managing their discomfort and defensiveness that is likely to arise when naming white supremacy (gollan & o’leary, 2009). additionally, interracial team teaching partnerships between black and white instructors help bridge the gap between theoretical concepts of power and privilege into practice and personal-professional identity (gollan & o’leary, 2009; ouellett & fraser, 2011). the social work profession calls for social workers to serve oppressed and marginalized communities and to promote social justice and cultural and ethnic diversity (nasw, 2017). therefore, social work education is responsible for preparing students to work collaboratively in teams comprised of diverse individuals. theoretical framework critical race theory critical race theory (crt) guides this paper. crt offers a framework to engage the problem of racial injustice through social science research resulting in awareness about how racism functions and consequently inspiring social agency to create a more just society (johnson-ahorlu, 2017). crt as a “movement” explains ways to study and transform the relationship between race, racism, and power and offers insight into how these relationships maintain and support racial inequality (kolivoski et al., 2014). crt provides a lens to challenge societal assumptions that the united states is a meritocracy and that equal opportunities are afforded to all who are willing to “work hard” and that social institutions are “color blind” and, therefore, unbiased (patton, 2016). crt provides conceptual tools for cross-examining how race and racism have been institutionalized and are upheld (sleeter, 2017). activists and scholars of crt are interested in studying and transforming the relationship between race, racism, and power (delgado & stefancic, 2012). the crt movement considers similar issues as conventional civil rights and ethnic studies. however, it places them in a broader perspective that includes economics, history, context, group and self-interest, and feelings and the unconscious (delgado & stefancic, 2012). curiel/interracial team teaching 737 additionally, a central tenet of crt is the recognition of historical and current institutional injustices imposed upon marginalized status identity groups to benefit dominant status groups. in the context of research, scientific methods mimic the dominant norms of “color blindness” that produce results that justify oppression or deny its existence (johnson-ahorlu, 2017). crt positions itself in opposition to a positivist approach to research, arguing that quantitative methods perpetuate racist sentiment and action (valencia, 1997 as cited in johnson-ahorlu, 2017). to counter this, crt includes the voices of bipoc, their narratives, and context to bring meaning to explain the biased phenomenon. narratives are an essential component of crt research as quantitative methods alone cannot capture experiential knowledge valued in crt scholarship (johnson-ahorlu, 2017). crt provides the opportunity to effectively teach and research diversity issues because it requires the professional to examine social structures, institutions, and assumptions (johnson-ahorlu, 2017; ortiz & jani, 2010). crt's application to this conceptual paper is a good fit, given that universities are a bastion of euro-american values (ortiz & jani, 2010). universities are “vestiges of white privilege [and] continue to promote mediocrity on the one hand and demoralization on the other” (mohan, 2009, as cited in ortiz & jani, 2010, p. 180). crt moves beyond the superficial analysis of academic gaps between teacher education and bipoc students in school settings (sleeter, 2017). as an epistemological lens, crt can be applied to study and transform higher education as a macro-level social justice plan (patton, 2016). lastly, crt has been augmented and tested over time and across situations, adding to its strength, rigor, and heuristic value for research and practice (forte, 2014). thus, allowing for the researcher’s internal evolution and transformation to deepen their perspective and approach to research and practice. method the overarching question guiding this research was: what theoretical framework best aligns with anti-racism education via interracial team teaching? to address this, i examined a limited sample of published articles that describe interracial team teaching as a pedagogical approach to teaching anti-racism in social work education. as an emerging conceptual model for anti-racist social work education, i explored theoretical frameworks previously applied to anti-racist education within interracial teaching teams. following an extensive search for published articles on teaching anti-racism in social work education through an interracial team model, i aimed to analyze common theories applied in the studies. however, noting an absence of theoretical frameworks applied to the existing studies, i shifted my focus to explore crt as a compatible theoretical framework for an interracial team teaching model. to address this conceptual paper's goal and explore anti-racist social work education through interracial team teaching, i first identified publications that apply an interracial team teaching approach to anti-racist social work education. to achieve this, i applied the search terms: “interracial team teaching,” “co-teaching anti-racism,” “co-teaching diversity,” “team teaching diversity,” and “team [or] co-teaching anti-oppression.” i searched for articles using the search engines google scholar, eric, and psycinfo. i advances in social work, summer 2021, 21(2/3) 738 searched exclusively for published articles, books, and book chapters to limit the search scope, excluding doctoral dissertations and audio and video media sources. i relied on four specific criteria for selecting publications. one, the publication focused on social work education, including baccalaureate, master’s, and doctoral levels of education, and excluded all other academic and professional disciplines. two, the articles identified a team or collaborative approach to teaching that included at least two instructors teaching the same course. three, the course instructors shared distinct racial identities where at least one instructor was white and the other a bipoc. four, the course taught explicitly and specifically addressed anti-racism or anti-oppression—as these terms are often conflated. for example, i excluded articles that addressed courses focused on teaching diversity, cultural competence, and multicultural education if they did not address racism directly. additionally, i examined the reference list for each publication i found to locate additional articles that met these criteria. using this search method yielded three articles that met the criteria. notably, the limited sample produced is a limitation to this study. however, a strength is the precision of the search criteria that allow for a clear and direct focus on the existing publications. i engaged in a three-step process with each publication that met all four criteria: first, i reviewed the article to identify any explicit reference to a specific theoretical framework applied to the study. second, i listed the implications for social work education and practice the authors discussed or implied that corresponded to one of crt's five tenets. third, i aggregated the list from step two, combining all articles, and conducted a frequency count of these tenets. due to the limited number of articles found, i ran a manual count, colorcoding each distinct tenet i found to distinguish them from each other. when determining how to designate which crt tenets the authors employed in their respective studies, even if unintentionally, i identified the crt tenets based on the best match with each corresponding crt tenet definition. i define and describe all five crt tenets applied to this paper drawing from the work of sólorzano and colleagues (2005), examining educational inequities in higher education. findings using an exploratory qualitative systematic review approach, data gathered from three previously published articles regarding anti-racist social work education within interracial teaching teams were reviewed for their theoretical framework content. except for one article that briefly mentioned but did not expound on the person-in-environment perspective (garran et al., 2015), all three articles presented in these findings noted a glaring absence of theoretical frameworks. by extrapolating from the five central tenets of crt identified by sólorzano et al. (2005) to the three articles examined in this paper, i assumed that all five crt tenets, whether implied or explicitly stated, would be found within each study. the following sections describe the five crt tenets. they list the explicitly discussed, or implicitly stated, implications for social work education and practice addressed by the authors that correspond to each crt tenet. the crt tenets found within the secondary data are illustrated using direct quotations found in the published articles and are cited accordingly. curiel/interracial team teaching 739 crt tenet: centrality of race and racism “crt acknowledges as its most basic premise that race and racism are defining characteristics of american society. in american higher education, race and racism are imbedded in the structures, practices, and discourses that guide the daily practices of universities” (sólorzano et al., 2005, p. 274). by far, this tenet was the most frequently addressed by all three articles examined in this study—appearing in multiple sections throughout each of the publications. as the principal tenet for crt, it lays the theory's foundation, placing race and racism at the forefront for examining the phenomenon. for example, when describing the team-taught course, one article stated “it [the course] considers the history of racism in the united states … it considers the implications of racism for social work practice in agencies, communities, and clinical social work” (garran et al., 2015, p. 802). this course description explicitly acknowledges both the history of racism within the u.s. and its enduring legacies manifested in the prevalence of racism within social work practice settings. another article stated that “this course examines the individual, institutional, and cultural manifestations of race and racism and their implications for social work clinicians” (ouellett & fraser, 2011, p. 73). by making this declaration, the authors recognize the presence of racism that is endemic within the micro and macro levels of social work practice. in a third article, gollan and o’leary (2009) explain that “in developing this [interracial team teaching] approach we have had to overcome the challenges that the pedagogical methods underpinning this approach are not within the traditional frames of university education” (p. 708). the barriers described by the authors in developing an interracial team-taught course between a white and black pair of instructors highlight the pervasiveness of racism deeply entrenched within higher education. thus, aligning with the crt tenet of centrality to race and racism. crt tenet: challenges to dominant ideologies “crt in higher education challenges the traditional claims of meritocracy, objectivity, colorblindness, race, neutrality, and equal opportunity” (sólorzano et al., 2005, p. 275). each of the three articles described a perspective and approach to challenging dominant ideologies, including examining individual and social power inequities. for instance, in the context of explaining the team teaching approach to social work education, the authors of one article remarked “team-teaching requires a mindfulness about managing power differentials, so that societal power inequalities are not reproduced and, when they are, they are used in the service of everyone’s learning through transparency and self-reflection” (garran et al., 2015, p. 800). a second study challenged dominant ideologies and explained it like this: the aim here is to begin a learning process for white social workers to recognise [sic] and respond to the particular space they take up … application of this embodiment of knowledge in ways of relating in black/white partnerships is the advances in social work, summer 2021, 21(2/3) 740 critical contribution that indigenous knowledge makes to social work education in this approach. (gollan & o’leary, 2009, p. 708) similarly, ouellett and fraser (2011) described their approach to challenging dominant ideologies through interracial team teaching by stating “it was decided to use…one faculty member from the dominant culture and one from an ethnically diverse culture” (p. 73). they further clarified the purpose of this decision by stating “we used our relationship to model a respectful interracial dialogue. we modeled trust, risk taking, and a conscious acknowledgment of our respective social power and authority” (ouellett & fraser, 2011, p. 76). these studies illustrate how challenging color blindness and managing power dynamics between interracial teaching teams within the classroom setting align with crt. crt tenet: interdisciplinary “crt challenges ahistoricism and the unidisciplinary focus of most analyses in educational research. in the field of higher education, this framework analyzes race and racism in both a historical and contemporary context using interdisciplinary methods” (sólorzano et al., 2005, p. 275). all three articles explicitly acknowledged the history of race and racism and linked historical events to contemporary issues impacting bipoc. situating the context of the interracial team-taught course within a historical and current analysis of race and racism, one article noted: first it is important to set some of the historical legacy of social work and its relationship with indigenous people and the work of allied indigenous and nonindigenous social workers to improve this relationship. this history is not inconsistent with the experience of minority groups in other predominantly white societies. (gollan & o’leary, 2009, p. 709) another study challenged ahistoricism by situating the interracially team-taught course in history by explaining that “students have the opportunity to have robust conversations about oppression … focusing on the enduring effects of enslavement, race, and racism on african americans in the united states” (garran et al., 2015, p. 802). the same article also drew a link to contemporary racism by identifying current racist “incidents involving young men of color killed by police in cities across the united states” (garran et al., 2015, p. 802). a third article explained that students were required to learn about history by taking a course titled “racism in the united states: implications for social work practice” as a way to challenge ahistoricism (ouellett & fraser, 2011, p. 73). these articles demonstrate how interracial team teaching corresponds with crt as a theoretical framework by addressing past and present racism. crt tenet: experiential “the application of a crt framework in the field of higher education requires that the experiential knowledge of people of color be centered and viewed as a resource stemming directly from their lived experiences” (sólorzano et al., 2005, p. 275). curiel/interracial team teaching 741 the focus on bipoc experiences was described in both implicit and explicit ways within the three studies. in garran et al. (2015), the authors describe a team-taught course on racism as focusing on “the perspective of people who identify as people of color” (p. 802). in comparison, ouellett and fraser (2011) focus their attention on “a class that looks specifically at issues central for clinicians of color” (p. 73). also, gollan and o’leary (2009) describe an environment that promotes accountability among white people for restorative justice purposes in the following manner “this [white accountability] needs to happen in a climate that focuses on the experience of those who have been subjected to injustice, rather than a focus on the ‘good intentions’ or feelings of those from the dominant group (tamasese and [sic] waldegrave, 1993)” (p. 712). like crt, each article described, as essential for interracial team teaching, the decentering of whiteness and a shift in focus to address racism through the lived experiences of bipoc. crt tenet: commitment to social justice “in higher education, these theoretical frameworks are conceived as a social justice agenda that struggles to eliminate all forms of racial, gender, language, generation status, and class subordination” (sólorzano et al., 2005, p. 275). a commitment to social justice was the second-highest crt tenet identified among all three publications analyzed. gollan and o’leary (2009) demonstrate this tenet in reflection to maintaining a commitment to social justice among social work students stating that “students frequently spoke about what the learning from the course meant for them in the future … most of the responses gave positive indications that students had insight into their responsibility to integrate the approach into everyday practice” (p. 717). on the other hand, garran et al. (2015) focused on the faculty and institutional commitment to social justice beyond the interracial team-taught course on anti-racism, arguing the following: additionally, ouellett and fraser (2011) attributed the success of their interracial teaching team to the commitment to social justice adopted by their academic institution stating that “the success of our teaching team was the support of the institution, both financially and pedagogically. the school has consistently funded two instructors…even in the face of budget fluctuations and competing financial demands” (p. 74). this study shows that all five crt tenets, whether implied or explicitly stated, were found within each published article examined for this paper. despite the notable absence of theoretical frameworks within the published studies reviewed in the present study, the results yield preliminary evidence that crt is a good fit for anti-racist social work education delivered via an interracial team-taught model. moreover, as defined by sólorzano et al. (2005), crt tenets provide a natural fit for anti-racist social work education within the context of higher education. advances in social work, summer 2021, 21(2/3) 742 discussion anti-racist social work education and critical race theory a close examination of the existing studies on interracial team teaching reveals a lack of theoretical constructs to guide this emerging pedagogical approach. however, upon further investigation, crt emerged as a compatible theoretical framework for teaching anti-racism within an interracial team-taught model. all five crt tenets from sólorzano et al. (2005) examining educational inequities in higher education were identified within the existing literature on interracial team teaching in social work education as hypothesized. it is worth noting that crt focuses primarily on issues related to black and white racial differences. however, to address this limitation and expand the analysis to include other minoritized groups, other critical theories can be applied as guiding frameworks: latcrit (valdes, 2005), tribalcrit (brayboy, 2005), and asiancrit (an, 2017). some students enter social work education, believing that social work is a helping and benevolent profession, then become disappointed when they learn of its embeddedness in power structures and the reproduction of oppressive conditions (macias, 2013). they are troubled at the awareness of social work’s role in colonial practices, including removing indigenous children first to boarding schools and later to the child welfare system (macias, 2013). formal education teaches history from the perspective of the colonizers. consequently, reclaiming history as a critical and essential aspect of decolonization is necessary (sólorzano et al., 2005; tuhiwai smith, 2012). crt unveils racism while amplifying the voices of bipoc and confronts dominant ideologies through a commitment to social justice (sólorzano et al., 2005). to revive anti-racism within the social work curriculum requires the explicit naming of white supremacy, racism, and colonization (ladhani & sitter, 2020). doing so encourages social work educators to critically examine and interrogate politically, the institutions, and the social order within which we teach (galloway et al., 2019; macias, 2013). as an interracial team teaching model in social work education, the objective is to engage students and faculty in conscious and directed efforts to dismantle white supremacy through social work education. after all, an education that liberates engages with oppressive forces and consists of cognition acts, not solely transferring information (freire, 1968/2018). in so doing, social work may take a more active and accountable role in the direct support of bipoc both inside and outside of the classroom environment. as a non-politically neutral profession, “social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully” (nasw, 2017, p. 3). therefore, reforming the cswe epas to confront white supremacy and racism unambiguously provides social workers the opportunity to evolve into a revolutionary cadre of anti-racist social work educators, practitioners, and scholars. curiel/interracial team teaching 743 implications for social work education and practice freire (1968/2018) posits that there can be no genuinely liberating pedagogy that remains distant from the oppressed by treating them pejoratively—also arguing that the oppressed must actively engage in the struggle for their liberation. similarly, a social worker who proclaims a commitment to the cause of freedom but is unwilling to engage in communion with the people they regard with contempt is gravely self-deceived. according to hooks (1994), liberation and justice within education occur through an “engaged pedagogy” (p. 15) which promotes a mutual exchange between students and teachers. both give and take from each other’s knowledge, grounded in their lived experiences. social work education primarily occurs in an academic setting confined by rules and guidelines that predispose, reinforce, and perpetuate the instructor's power and students' subordination (campbell, 2002). like other helping professions, social work is hierarchical. the social worker (teacher) is the expert who imparts knowledge and skills to the service recipient (student) who receives the information. social workers' professional training and education provide expertise to help individuals, groups, and communities. however, how dominant ideologies shape perceptions about service recipients and how the professional role and title perpetuate power differentials in the helping relationship requires attention. as explained by sakamoto and pitner (2005), power itself does not mean aggravating power differentials between the social worker (teacher) and the service recipient (student). instead, it means social workers can select when and how to negotiate, relinquish, and exercise their power to help service recipients to empower themselves (sakamoto & pitner, 2005). consequently, an understanding of power is critical to antiracist practice, and modeling effective and responsible use of power and authority is an indispensable pedagogical strategy (campbell, 2002; garran et al., 2015; gollan & o’leary, 2009). in social work education, the classroom becomes the practice location, and interracial team teaching can model inclusion and the sharing of power and authority between instructors (curiel & ashley, 2020). it is the setting to demonstrate effective anti-racist practice and prepare students for action and abstractions (beck, 2019; campbell, 2002). utilizing the classroom environment as a site to model anti-racist practices, deconstruct foundational knowledge claims, promote self-awareness, and negotiate power and authority, serves as the precursor to facilitating students transfer what they have learned in the classroom to their practice (beck, 2019; campbell, 2002; curiel & ashley, 2020). to prepare burgeoning social workers for anti-racist practice, campbell (2002) suggests that social work educators maintain congruency between three pedagogical components: what is taught (explicit curriculum), how it is taught (implicit curriculum), and what students learn (learning objectives). without congruency between these components, students cannot bridge classroom education to their personal and professional lived experiences, making it impossible to contribute to racial justice, ultimately the goal of anti-racist education (campbell, 2002). moreover, to expect nascent social workers to adopt antiracist practices after graduation requires social work educators to model this practice before graduation (campbell, 2002). interracial teaching teams can offer mutual collegial support advances in social work, summer 2021, 21(2/3) 744 between social work educators to improve their anti-racist knowledge and practice skills— transferring their skills to students. central to anti-racist content is understanding the dynamics of white supremacy, racism, oppression, and power, and one's relationship to these dynamics (beck, 2019; campbell, 2002). developing awareness of one's contribution to oppression and power relationships and social work’s role in upholding racial inequity frequently generates feelings of anger, guilt, regret, or discouragement (campbell, 2002; macias, 2013). if ignored, these feelings can obstruct learning, but exploring and understanding them produces profound self-awareness and growth among students and faculty alike (beck, 2019; campbell, 2002). by modeling anti-racist methods via interracial team teaching, instructors can provide examples of specific actions that are consistent with anti-racist social work, with the aim for students to transfer their learning to other practice locations (gollan & o’leary, 2009; miller & garran, 2017; o’neill & miller, 2015). conclusion from the colonization of indigenous lands to the wholesale of enslaved black people, historical racist acts of violence against bipoc rooted in white supremacy's myth have indelibly influenced every major institution within the united states—including academia and the social work profession. the recent and widely publicized racist acts of violence and murders of black people (ladhani & sitter, 2020) should serve as a call to action to the social work profession and social work leadership. teaching a mere appreciation of cultural diversity is insufficient preparation for future social workers to dismantle systemic racism and white supremacy. although interracial team teaching and anti-racist curriculum are not the standards to social work education, evidence supports this emerging pedagogical approach as a viable option (gollan & o’leary, 2009; miller & garran, 2017; o’neill & miller, 2015). interracial team teaching pairs where one instructor is white and the other a bipoc requires white educators to critically self-examine their white identity and resist the temptation to perform allyship for recognition from bipoc in place of engaging in anti-racist practice (akamine phillips et al., 2019). to support interracial teaching teams, academic institutions will have to reevaluate their hiring practices to assure a greater representation of bipoc faculty to prevent overburdening faculty who hold ethnic and racial minoritized status identities (meizlish & anderson, 2018). failure to increase the number of faculty of color in social work education leaves the future of social work and its engagement with racial justice in the hands of a straight, white, middle-class, female majority (gorski et al., 2012). crt aligns with this emerging pedagogical approach to dismantling white supremacy in social work education as a theoretical framework for teaching anti-racism within an interracial team-taught model. however, the recent executive order issued by donald trump, banning anti-racist education and training to federal contractors, places crt and anti-racist education in a precarious situation (white house, 2020, combating race and sex stereotyping). as the research on interracial team teaching in social work education grows, attention to the efficacy of this emerging pedagogical approach to teaching antiracism is needed. a question to consider in future research includes how the complexity of curiel/interracial team teaching 745 teachers' and students' intersectional identities influences teaching and learning related to anti-racism and racial justice? references akamine phillips, j., risdon, n., lamsma, m., hambrick, a., & jun, a. 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(2011). team teaching in social work: sharing power with bachelor of social work students. journal of teaching in social work, 31(1), 38-52. https://doi.org/10.1080/08841233.2011.539135 author note: address correspondence to luis o. curiel, department of social work, california state university, northridge, northridge, ca, 91330. email: luis.curiel@csun.edu https://doi.org/10.1080/10383441.2005.10854554 https://www.federalregister.gov/documents/2020/09/28/2020-21534/combating-race-and-%09sex-stereotyping https://www.federalregister.gov/documents/2020/09/28/2020-21534/combating-race-and-%09sex-stereotyping https://doi.org/10.1525/sp.2010.57.2.251 https://doi.org/10.1080/08841233.2011.539135 mailto:luis.curiel@csun.edu _________ jessica chock-goldman, dsw, lcsw, adjunct lecturer, new york university silver school of social work, new york, ny. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1084-1095, doi: 10.18060/24604 this work is licensed under a creative commons attribution 4.0 international license. high-achieving asian american adolescents and suicide: the need for culturally sensitive suicide intervention approaches in schools, a case study jessica chock-goldman abstract: within the field of suicidology, high-achieving asian american adolescents are an under-researched at-risk population. the present paper reviews the existing literature on this topic, addressing the increase in suicidal ideation and suicide attempts within this at-risk group, and explores ecologically valid social work interventions. school social workers are first responders to these at-risk youth and must be well-versed in the riskfactors, including parental resistance to treatment, within the specific populations they serve. to illustrate the relevant issues, a case example is presented of an adolescent bangladeshi male who attempted suicide while attending school. finally, this paper recommends suicide prevention measures, including a culturally appropriate suicide assessment and family therapy. keywords: asian american, adolescent, suicide, high-achieving, high school, social work, intervention, prevention adolescent suicide is a national public health crisis (horowitz, et al., 2020). in 2017, 17.7% of high school students seriously considered attempting suicide, 14.6% planned their attempt, 8.6% attempted suicide, and 2.8% reported that their attempt required the medical attention of a nurse or doctor (kann et al., 2018). importantly, these statistics appear to vary by race. although the overall age-adjusted rates indicate a decrease in suicide rates between 2018 and 2019 for white and american indian or alaska native individuals, reflecting the decrease in total deaths, the rate increased for black and asian or pacific islander individuals (ramchand et al., 2021). asian american high school students are the majority population in high-performing high schools, which require a very competitive entrance exam. in fact, recent work has found that this phenomenon is increasing. a study by the brookings institute found that asian american students made up 60% of the high-performing high school population, up from 50% in 2015 (reeves & schobert, 2019). because of the high risk of suicide within the asian american adolescent population, clinicians, including social workers, school counselors and psychologists, working in high-achieving high schools need an understanding of the cultural context of suicidal thoughts and behavior, especially when assessing for suicidal behavior in this type of school setting. for example, ethnic minorities are less likely to express suicidal ideation than whites, a concept called “hidden ideations” (chu et al., 2010, p. 29). as it stands, the suicidology field has yet to provide systematized recommendations to advance culturally-relevant suicide science and practice due to a lack of theoretical grounding and familiarity with empirical research (chu et al., 2010). this article reviews the literature on how acculturative stress and asian culture relate to the increased rates of suicidal ideation in high-achieving asian american adolescents in about:blank chock-goldman/high-achieving asian adolescents 1085 a high school setting. when broken down by race, suicide is the first leading cause of death among asian american young adults age 15-24, which is not the case for any other racial group in this age range in america (noor-oshiro, 2021). we then present a specific case example of a bangladeshi adolescent, representing one subgroup of the asian-american population. finally, this article provides clinical recommendations for social workers engaging with asian american adolescents in a high school setting. as the population in high performing high schools are majority asian-american (reeves & schobert, 2019), it is vital that social workers are attuned to the suicidal risks of this specific population. further, social workers must be attuned to the way each individual client expresses suicidality, which is differentiated based on their culture (tummala-narra et al., 2016). the hope is that clinicians can use these suggested methods of intervention and tailor them to the specific asian-american subgroup they are working with, as asian-americans make up 5.9% of the population in the united states (u.s. census, 2020). asian-american communities consist of approximately 50 ethnic groups speaking over 100 languages, with connections to chinese, indian, japanese, filipino, vietnamese, korean, hawaiian, and other asian and pacific islander ancestries. as the national alliance of mental illness (2021) points out, it is important to note the diversity within this population and the multiple sub-groups. asian american adolescents, acculturation, stress, and suicidality individuals of asian ancestry are among the most rapidly expanding immigrant subgroups in the united states (tummala-narra et al., 2016). immigrants and their u.s.born children number approximately 85.7 million people, or 26% of the u.s. population, according to the 2020 current population survey (batalova et al., 2021). within the family context, there is often a cultural differentiation that emerges, commonly labeled as “acculturation,” which describes the psychological processes and subsequent adaptation associated with continuous exposure to one’s culture of origin and a new culture (miller et al., 2011). this experience can sometimes lead to maladaptive experiences, including high levels of stress. for example, “acculturative stress” has been defined by the american psychological association (2013) as the challenges or stress accompanying acculturation. others describe acculturative stress as stress specifically related to the process of adapting to the beliefs, practices, and values of a dominant culture (berry, 1998; gomez et al., 2011). this is particularly salient for asian individuals, as they report higher levels of acculturative stress than other racial or ethnic groups (gomez et al., 2011). acculturative stress impacts environmental factors experienced by the acculturating individual (e.g., racial discrimination), change in family relationships (e.g., conflicts between family values and those of the dominant culture), diminished quality of social relationships (e.g., difficulty with language, in forming friendships), and attitudes toward the country/culture of origin (gomez et al., 2011). importantly, these stressors may be important risk factors for suicidality among adolescents and emerging adults, as acculturative stressors have been associated with other known predictors of suicidal behavior, such as depression and suicidal ideation (cho & haslam, 2010; gomez et al., 2011). suicidality may present differently among asian americans than individuals of other ethnicities (whaley & noel, 2013). for most adolescents, depression is linked to suicidality, but for asian american https://doi.org/10.1037/a0032595 https://doi.org/10.1037/a0032595 https://doi.org/10.1007/s12310-018-9245-8 advances in social work, fall 2022, 22(3) 1086 adolescents, it is often depression along with the additional factors including achievementbased anxiety and acculturative stressors, which increase risk for suicidal ideation (kim et al., 2018). these findings suggest that the acculturative stress that asian american adolescents experience may exacerbate their likelihood of suicidal ideation and potential suicide attempts. in addition to acculturative stress, asian americans are often faced with stereotyping that may also negatively contribute to their mental health and risk for suicidality, including the term “high-achieving asian american.” asian americans are often labeled the model minority, as their significant presence at elite schools has contributed to the narrative of asian american exceptionalism (lee & zhou, 2015). in fact, there may be an assumption that asian americans are uniformly successful academically and professionally, minimizing the impact of the structural (i.e., social, cultural, economic) challenges and social injustices that may adversely affect their psychological well-being (tummala-narra et al., 2016). lee and zhou (2015) state that as opposed to a “stereotype threat,” which may dismantle the achievement ability of certain ethnic groups, a “stereotype promise” (p. 7) does the exact opposite. “stereotype promise can enhance the performance of even the most mediocre asian american students, leading them to work harder to excel in order to confirm the stereotype of asian american exceptionalism” (lee & zhou, 2015, p. 7). as the model minority myth and the pressure of stereotype promise is readily expressed both within the culture and externally through stereotypes, asian american adolescents are familiar with perceived expectations. unfortunately, when asian american students are perceived as outperforming their peers, their mental health needs are less likely to be addressed, as their high academic functioning may mask their depression or anxiety (kim et al., 2018). it is plausible that these same biased perceptions systematically reduce the likelihood that a suicidal symptomatic asian american student would be identified for a risk assessment (kim et al., 2018). this may also affect student’s own questions/perception of personal emotional distress. despite the stereotype of asian americans being consistent in their high achievements, research has found that asian americans are at a significantly higher risk for mental health issues and suicidal ideation compared to individuals of any other ethnicity (kim et al., 2018). recent research has indicated that asian american youth are at greater risk for mental health problems, such as depression, self-injury, and suicide as compared to white and african american youth (tummala-narra et al., 2016). however, compared to other ethnicities, asian americans’ mental health needs are also less likely to be addressed due to the underutilization of mental health services among these communities (tummalanarra et al., 2016). asian american families and suicidality while cultural context plays an important role in identifying and intervening with asian american adolescents at risk for suicide, understanding the familial context is also critical. among high-achieving students, familial pressures become particularly acute, instilling a sense of urgency to achieve due to a pervasive belief that unrealistic goals (such as achieving admission to all ivy league universities) are well within reach (luthar et al., chock-goldman/high-achieving asian adolescents 1087 2013). in an early study, luthar and becker (2002) found that asian american students who felt their parents disproportionately prioritized achievement dimensions were at a significantly greater risk for self-harm. chronic exposure to pressure has many negative psychological consequences. flett and colleagues (2016) have suggested that the tendency to be internally controlled provides the fuel for the urgent and relentless striving of adolescents who develop self-oriented perfectionism. this pressure can become overwhelming alongside frequent daily stressors, setting the stage for elevated anxiety, depression, and externalized behaviors. such requirements of perfectionism and familial pressures have become commonplace, particularly in high-achieving high school settings. these findings suggest that, in general, adolescents do not always have the skills to manage perceptions of familial obligation, and therefore may be more prone to suicidal ideation (luthar et al., 2013). research has also found that asian individuals who reported higher rates of familial acculturative stress had higher odds of making a previous suicide attempt (gomez et al., 2011). familial acculturative stress may interact with the parent-child relationship, considering that parent–child conflict is more strongly associated with suicide-related outcomes among less acculturated asian americans than among highly acculturated asian americans (wong & maffini, 2011). in fact, within acculturated asian americans, levels of distress, symptoms, and suicidal ideation have been associated with life stress, lack of parental support, and not living with both parents (cho & haslam, 2010). studies have also found that children of immigrants may have both cultural and language differences with their parents that impede their ability to communicate emotions (thapa et al., 2015). these findings have important implications for suicide prevention among immigrant adolescents and suggest that social and parental support may be protective. this work also indicates that the combination of a volatile household environment with the heightened stress and perceived academic requirements contribute to an increased cumulative stress model that asian american adolescents must learn to process. research has also found that asian american youth can be less emotionally expressive than other ethnicities, have difficulties discussing problems with their family members and do not disclose suicidal ideation, as emotional expressiveness is perceived to be an undesirable personality trait (komiya et al., 2000). this paper addresses the need for culturally-sensitive suicide intervention strategies that should be implemented by school clinicians working with high-achieving asian american youth. case example the author is a social worker in a large high school and has used one case example (using a pseudonym) to demonstrate how social workers can provide interventions with a suicidal high-achieving asian american adolescent of bengladeshi descent. ahmed, an only child, is a 16-year-old junior at a specialized high school with over 3000 students in a large east coast city within the united states. he is bangladeshi american, speaking bengla in the home, and english with his peers and in school. he stated that his parents consistently told him that they moved to the united states for him to go to an ivy league college. ahmed was feeling insecure because his grades were in the b range and he felt https://www.researchgate.net/journal/family-process-1545-5300#cr41 https://link.springer.com/chapter/10.1007/978-3-319-89842-1_23#cr42 https://doi.org/10.1017/s0954579413000758#cr41 advances in social work, fall 2022, 22(3) 1088 that he was not achieving the goals his parents had set forth for him. ahmed was introduced to the school social worker by his english teacher in the previous school year after he wrote an essay in his english class concerning his feelings of depression and anxiety about school, work, and his family, which were leading to acts of self-harm. when the social worker invited him into the office to conduct an assessment, he stated that he often had suicidal ideation (si) and was currently thinking about advancing his acts of self-harm from superficial wrist cutting (horizontal cuts) to vertical and deeper cuts. because of the highrisk indicators of his suicidal ideation, the social worker had him taken by ambulance to the school’s partnering hospital’s c-cpep (children's comprehensive psychiatric emergency program) to be evaluated by a psychiatric team. he was held overnight and the hospital recommended outpatient treatment. despite this experience, ahmed and his family did not follow-up with his post-crisis appointments at the hospital. one year later, the assistant principal (ap) of the counseling department at the school received a call from a school counselor at a sister high school. a student in that school showed her school counselor a text exchange in which ahmed stated that he wanted to die by suicide because his grades were going down and his parents had been expressing disappointment in him. he stated in the text that his parents were also angry because he had a girlfriend and they did not believe in any relations before marriage. he said in the text that he was going to “kill himself” in school. the in-school response team (school social worker, ap of counseling, ap of safety and security, and school police officer) went to find ahmed in his class to have him assessed. when the team got to his classroom, his backpack was in the room, but the teacher stated that he was in the bathroom. the response team proceeded to the boy’s bathroom. ahmed was found inside the bathroom with blood running down his arm from superficial cuts in horizontal strokes. scissors were taken from him and paper towels were pressed on his arms. he was crying and stated that he wanted to die. however, he was not cutting himself in a way that would have led to death, but instead in a non-lethal method of self-harm. ahmed stated that he has been feeling very lonely recently with his father in bangladesh and his mother working constantly and felt overwhelmed by the pressure of his falling grades. the team decided that ahmed must be evaluated in the hospital. mom was not in agreement, expressing that this was not the norm for bangladeshi children. shame was affiliated with this prospect as she did not want her family to once again be affiliated with the hospital for mental health reasons, which was not a perceived norm for her culture (gomez et al., 2011). after speaking with the social worker, ahmed’s mother finally agreed to leave work early and come to the hospital. the social worker and ahmed were taken by an ambulance to the child cpep unit where he was evaluated and a determination was made that he would be kept two nights and then released because he was able to create a safety plan. staff from the school and the hospital spoke numerous times to determine a suitable intervention that the family would follow-through with, unlike the previous hospital visit where they did not go to treatment. the hospital social worker suggested telling ahmed’s mother that if he did not come to follow-up care in the crisis outpatient clinic and subsequent outpatient counseling sessions, mobile crisis would be sent to their home. the school suggested that if ahmed did not provide a note demonstrating perfect attendance for his clinical sessions, child welfare would be called for medical neglect. chock-goldman/high-achieving asian adolescents 1089 these seemingly forceful interventions are sometimes felt necessary to ensure follow-up treatment and prevent another hospitalization. upon discharge, ahmed, his family, and the school staff agreed upon these protocols. however, ahmed’s post-hospitalization protocol was not implemented—there was no follow-up with the social worker in the school nor the hospital after the two-week critical care appointment. recommendations for clinical interventions the scenario highlighted in the previous case example is not uncommon within the asian american population. a recent study found that there are indeed disparities in rates of follow-up mental health services for asian american students assessed for suicide risk in schools (kim et al., 2018), with few families moving forward with outpatient care posthospitalization. mandated follow-up is extremely important to reduce the likelihood of future self-harm. in ahmed's case, mom felt both shame and a misunderstanding about the necessity of mental health care. family therapy is also vital, as an adolescent may perceive that they are required to be highly accomplished students and must prove achievements to their primary caretaker. this obligatory stress is one of the key factors that leads to suicidal ideation in this population (chu et al., 2010). it is also important to note that cultural norms in the family’s native country may also contribute to an adolescent’s perception of what they are required to accomplish. it is critical that clinicians understand cultural humility, or the “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person]” (hook et al., 2013, p. 354) when working with asian american adolescent clients. evidence also suggests that involving caregivers in each step of treatment, including psychoeducation about mental health disorders and intervention, and ongoing collateral sessions, are all necessary for robust treatment delivery and durability (kim et al., 2018). furthermore, successful suicide prevention and intervention strategies should acknowledge the role of culturally relevant factors, such as acculturative stress and perceived discrimination, to improve the identification of emerging adults who are at risk for suicidal behavior and to offer culturally competent treatment (gomez et al., 2011). gaining a greater understanding of cultural context may assist researchers and clinicians in developing more appropriate interventions to prevent suicidal behavior among asian american youth (gomez et al., 2011). past study findings highlight the importance of properly educating social workers concerning the cultural expectations and norms of the population they are serving, particularly when life is at stake. to mitigate potential barriers to service access, social workers should actively review and implement interventions that recognize the ethno-cultural diversity of the population they are serving. goals should be to reduce racial/ethnic disparities related to adolescent mental health problems, increase access to services, and assuage the component of shame that families may have when accessing outside services (kim et al., 2018). advances in social work, fall 2022, 22(3) 1090 clinical recommendations expanding on the clinical case presented above, the following interventions are the clinical recommendations for social workers and school counselors who work with asian and asian american youth and their families. in reviewing these clinical recommendations, please take the following into account: 1. this article focuses on clinical interventions in school settings, while acknowledging the importance of improving mental health awareness in asian american communities. 2. the recommendations use ahmed’s case as an example. therefore, social workers working with other asian american sub-groups are encouraged to carefully consider their clients’ specific cultural elements and tailor the recommended applications to their clients’ cultural group. cultural model of suicide research has found that the most comprehensive way to address suicidality is to be culturally specific to the populations with which you are working (chu et al., 2010). it is important to note that no other culturally specific suicide assessment model has been created. a modification of the modality, called cultural model of suicide (chu et al., 2010) addresses the ways that different subgroups may express suicidal ideation. there are three theoretical principles that encompass the framework of cultural assessment of risk for suicide (cars): 1. culture affects how suicidal ideation is expressed. this pertains to whether or not persons from a specific culture may feel comfortable sharing their suicidal thoughts. 2. culture affects the types of precipitating factors that may lead to wanting to act on suicidal thoughts. 3. cultural meanings and cultural sanctions include messages of acceptability associated with a stressor and moving forward with a suicidal act (chu et al., 2010). the cars method looks at four major categories when assessing suicide risk: cultural sanctions (acceptability of suicide as an option or shame affiliation with certain life events), idioms of distress (cultural variations in the expression of psychological symptoms), minority stress (particular stressors that cultural minorities may experience due to social identity or position), and social discord (interpersonal troubles, including conflict, alienation and lack of integration; chu et al., 2013). chu and colleagues (2013) found that a cars assessment provides substantial advancement in the field of culture and suicide and provides a viable method of assessing the ways in which cultural variation is manifested in suicide risk. the cultural sanctions that may have prevented ahmed from cutting in a vertical line might have been related to his religion, which promotes negative associations of suicide. ahmed’s idioms of distress may have been demonstrated by texting a friend about his ideation, rather than feeling safe enough to speak to a social worker or teacher. difficulty both regulating and expressing emotions was associated with increased severity of suicidal ideation through increases in hopelessness (polanco-roman et al., 2019). the shame affiliated with emotional expression in bangladeshi males may have prevented his feelings of transparency. acculturation was linked to ahmed’s minority stress, which was demonstrated through the shame and familial fighting affiliated with dating before marriage. this experience of familial acculturative stress caused much tension between ahmed and his parents. finally, familial conflict and fighting was the chock-goldman/high-achieving asian adolescents 1091 social discord that influenced ahmed to move towards suicidal ideation as his only option to escape from the volatility in his family because of his falling grades. because of this, a clinician may choose to incorporate a friend instead of a family member for social support within a safety plan, as asian americans may have familial conflict as a precipitant or trigger for suicide (chu et al., 2010). the integration of cultural specificity into suicide assessment is the key to successful suicide intervention and eventual prevention in schools with a large high-achieving asian american population. relational approach to family therapy the ackerman relational approach (ara) is a systematic approach to therapy that is designed to both strengthen and clarify relationships between family members and empower them to envision and create desired lives with the active support of their partners and/or families (brewster & sheinberg, 2014). this theory suggests that the therapists must be aware of their own family of origin and socio-political location and understand how this may influence their interactions with the family in treatment (brewster & sheinberg, 2014), who also has their own family of origin and socio-political location. location is critical to acknowledge in the family relationship, therapeutic relationship, and when navigating the relational practice. from the perspective of the ara, an acknowledgement of social location supports becoming a critically conscious systemic-relational therapist. because social workers’ experiences never perfectly match that of the student and family they are serving, cultural humility is crucial for establishing the most effective communication. cultural humility is needed when working with high-risk asian american adolescents and their families to break through barriers that might impede therapy in order to find relevant interventions. this is an ongoing internal and external conversation in the therapeutic relationship. by relationally exploring which components play into an adolescent's suicidal ideation as well as differences in openness to therapeutic treatment, clinicians who practice from this perspective allow family members to hear each other when working through a crisis. a clinician’s use of “critical consciousness” (verdon, 2020, p. 4) helps navigate this dynamic with the family. critical consciousness posits that recognizing the power imbalances in social relationships can foster a reorientation of power (freire, 1970; verdon, 2020). a professional must acknowledge their position in social structures and uncover any invisible power structure, privilege, biases, and inequities (verdon, 2020). clinicians must be continuously humble in the way that they address differences within the treatment room especially when parents are not immediately open to therapeutic treatment. with regards to ahmed’s mother, using “critical consciousness” would allow the social worker to hear what may have been barriers to treatment the first time around and what could alleviate some of these barriers. this humility allows for the parent-clinician dyad to be both constructive and fluid in helping address the potential resistance and facilitate therapeutic growth. intersection of cars and the ara for high-achieving asian american adolescents chu and colleagues (2010) found that when culturally competent tools are used to screen for suicide, better outcomes result from interventions. research has also found that advances in social work, fall 2022, 22(3) 1092 integrating families into care leads to better outcomes for the suicidal child (kim et al., 2018). based on the ethno/cultural diversity of high-achieving schools, the cars model, which incorporates an individual’s culture and ethnicity when assessing suicidal ideation, may be beneficial. the ara may also be an effective approach to implement when intervening with suicidal adolescents and their families, as clinicians must be conscious of all components brought into the room that may be influencing their therapeutic approach. had the social worker and hospital working with ahmed been conscious of the ways in which suicide assessment questions should be framed for asian american youth, ahmed may have been hospitalized the first time he made a suicide attempt. for example, one study had found that when asking an asian american adolescent to answer a written survey versus an oral questionnaire, their answers were more honest (okazaki, 2000). further, had the school social worker been aware of the parent’s shame affiliated with therapeutic interventions and had exercised critical consciousness in the initial referral, ahmed may never had made a second suicide attempt. ahmed eventually went to therapy and found a male therapist who he aligned with. two years after the suicide attempt, when he was graduating from high school, he thanked the social worker for being persistent with both him and his family about getting clinical services. he said that he would not have been alive had she not pushed for outside support. by integrating these two modalities, clinicians can become better practitioners of prevention and intervention for suicidal, high-achieving asian american adolescents. conclusion suicide in adolescence is a public health crisis, as suicide attempt and completion rates in adolescents are increasing every year in the united states (horowitz et al., 2020). because adolescents spend more time in school than any other place, it is important that prevention and intervention strategies are exercised effectively within this environment (singer et al., 2018). further, it is vital that prevention and intervention techniques are tailored to the population the social worker is serving. clinicians must continue to educate themselves about the cultural norms within the populations they work with. when working with high-achieving asian american adolescents, culturally specific screening tools may be particularly beneficial to use as this population may not be as open to verbally expressing suicidal ideation. it is crucial that clinicians negotiate the dynamic between adolescents and their families to understand their environmental context and deter suicide attempts. the cars method allows clinicians to adapt their suicide assessment questioning to the population they are serving, and the use of cultural humility and the ara strengthens the dynamic between the social worker and clients, enabling stronger more culturally sensitive support in complex situations. by moving away from a uniform approach to suicide prevention and intervention in schools, clinicians can best serve their specific populations and ultimately save lives. references american psychiatric association. 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(2011). predictors of asian american adolescents’ suicide attempts: a latent class regression analysis. journal of youth and adolescence, 40, 1453-1464. https://doi.org/10.1007/s10964-011-9701-3 author note: address correspondence to jessica chock-goldman, nyu silver school of social work, 1 washington square north. new york, ny 10003. email: jcg337@nyu.edu https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states-2020 https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states-2020 https://doi.org/10.1007/s10964-011-9701-3 https://doi.org/10.3390/bs5040547 https://link.springer.com/chapter/10.1007/978-3-319-89842-1_23 https://doi.org/10.1080/13575279.2018.1516626 https://doi.org/10.1007/s11218-012-9206-2 https://doi.org/10.1037/aap0000136 mailto:jcg337@nyu.edu microsoft word 10_presnell_and_keesler_25512_community_inclusion ________________ jade presnell, ms, lsw, phd candidate, and john m. keesler, phd, lmsw, assistant professor, school of social work, indiana university, indianapolis, in. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1229-1245, doi: 10.18060/25512 this work is licensed under a creative commons attribution 4.0 international license. community inclusion for people with intellectual and developmental disabilities: a call to action for social work jade presnell john keesler abstract: many people with intellectual and developmental disabilities (idd) are isolated and lack meaningful opportunities to participate and develop social networks within their communities. sharing membership with a community that fosters connection and belonging is essential to well-being. as a human rights profession, social work is uniquely situated to overcome the macro barriers that prevent full community inclusion for people with idd. however, the experiences and needs of those with idd have largely been left out of the profession’s discourse on diversity and oppression. this article presents a call-to-action for social work to engage in strategies and solutions to resolve macro barriers to community inclusion, to dismantle the injustices that people with idd continue to experience, and to move the promise of community inclusion from rhetoric to reality. social workers can promote community inclusion for people with idd through a variety of approaches, including using a human rights-based framework, aligning with personcentered planning, fostering evidence-based practices, using participatory action research, increasing disability content in social work curricula, and engaging in community action and advocacy. keywords: intellectual and developmental disability; community inclusion; human rights; social work practice; social work education; macro social work practice community inclusion is a universal human right (convention on the rights of persons with disabilities [crpd], 2006); however, for people with intellectual and developmental disabilities (idd), this right is often violated. since 1967, when deinstitutionalization began in the united states, extensive progress has been made for people with idd, including a shift to individuals living in their communities, a surge in the delivery of individualized services, and the development of federal policies like the americans with disabilities act (ada) that prohibit discrimination against individuals with disabilities in all areas of public life (scott et al., 2008). yet, although these advances have fostered equality and improved the quality of life for people with idd, physical inclusion in the community has been insufficient for their full, active, and meaningful participation in the community (macdonald et al., 2018; scior et al., 2020). the social work profession is uniquely situated to address this disparity through its strengths-based approach and the advancement of core values shared among the profession and people with idd, including social justice, dignity and worth of the person, and the importance of human relationships (john & schrandt, 2019; national association of social workers [nasw], 2020). despite this alignment, however, people with idd have been absent from the profession’s narrative (fuld, 2020). in 2016, the society for social work and research (sswr) released the 12 grand challenges for social work that identified advances in social work, fall 2021, 21(4) 1230 critical areas for the profession to address through a call-to-action (williams, 2016). two of the 12 challenges eradicate social isolation and achieve equal opportunity and justice – are central to the quality of life for people with idd. thus, it is important to consider: how can social work eradicate social isolation and strive to achieve equity for people with idd through community inclusion? this article presents a call-to-action for the social work profession to respond to these grand challenges. we identify and discuss a series of strategies for the profession to embrace as ways to overcome the historic and contemporary barriers to community inclusion that people with idd have encountered. before proceeding, however, the breadth of disabilities and inconsistencies in defining inclusion necessitate explicit definitions to ensure a common understanding across readership. definitions intellectual and developmental disabilities. according to the american association on intellectual and developmental disabilities (aaidd; 2021) intellectual disability is a lifelong condition characterized by limitations in both intellectual functioning and adaptive behavior that originates prior to age 22. more broadly, developmental disability is a term that includes intellectual disability, but is also inclusive of other cognitive and/or physical disabilities that present during development and are usually lifelong, such as down syndrome, autism, and cerebral palsy (arc of indiana, 2021). collectively, the trajectory of these disabilities, despite their pervasive nature, can be greatly enhanced with individualized supports and services, such that people with idd can live independent, productive, and meaningful lives (aaidd, 2021). community inclusion. community inclusion is defined as having full and equitable access to activities, social roles, relationships, and community belonging and membership (cobigo et al., 2012). inclusive communities fully embrace people with idd and their families, ensure equal opportunity for full participation in community life, and promote a sense of full belonging. this shared membership fosters connection and promotes physical and mental wellness, as well as optimal quality of life (dahan-oliel et al., 2012). social exclusion as a reality for people with idd community inclusion is a right for all people, however, for people with idd this right often goes unfulfilled. social movements, like the disability rights movement, and federal legislation, such as the ada, have fostered significant advances for persons with disabilities. collectively, they have fostered the recognition of the importance of community inclusion; increased physically accessible environments; and improved access to education, employment, and other community-based services that promote inclusion and well-being (mccarthy, 2003). yet, despite the individualization of supports and services and their integration of multiple life domains (e.g., education and employment; stancliffe et al., 2000), people with idd continue to experience discrimination, marginalization, and rights violations as evidenced by community segregation, poverty, healthcare disparities, and exclusion in education and the workforce (amado et al., 2013; glen, 2015; metzel & presnell & keesler/community inclusion 1231 walker, 2001; mitra et al., 2013; united nations, 2007). even after the passing of more than 50 years since the commencement of deinstitutionalization, many people with idd do not experience meaningful participation in their community and continue to lack supportive social networks and endure the ill-effects of exclusion (macdonald et al., 2018; world health organization, 2011). although most people with idd now live in the community, it is evident that physical inclusion has not translated to true, meaningful community inclusion (scior et al., 2020). a call to action for social work social work has served an integral role in advancing the quality of life for people with idd. from the early days of poor houses to contemporary practices of early intervention and parent training, advocacy and case management, and assessment and counseling, people with idd have benefited from many supports and services provided by the social work profession (john & schrandt, 2019; mackelprang, 2013). however, even with such supports and services, people with idd continue to be marginalized and excluded from full community inclusion (macdonald et al., 2018; scior et al., 2020). the fulfillment of their right to community inclusion is challenged by barriers of prejudice rooted in ableism and paternalism, systemic adherence to the medical model of disability, a lack of clarity in defining community inclusion, limited evidence-based practices to promote community inclusion, and a disconnect between disability-related policy and practice. each of these barriers is briefly reviewed in table 1. although the social work profession is integral in fighting inequality and injustices experienced by diverse populations, leading social work organizations like the council on social work education (cswe) and nasw give little acknowledgement to disabilities as social issues or as contributing to human diversity (kattari et al., 2017; mackelprang, 2010). likewise, social work curricula frequently lack disability content or opportunities for specialization in disabilities (john & schrandt, 2019; kim & sellmaier, 2020). although the profession has made some advances (e.g., curricular resource on issues of disability and disability-competent care; cswe, disability-competent care curriculum workgroup, 2018), additional efforts are warranted to bolster social work with the disability community (john & schrandt, 2019). through various domains and strategies, social workers can create significant momentum in furthering the quality of life and inclusion for people with idd. these domains include using a human rights-based approach, aligning with person-centered planning, fostering evidence-based practices, using participatory action research (par), increasing disability content in social work curricula, and furthering community action and advocacy. each of these domains with corresponding examples of practical strategies that social workers can use are described in table 2. advances in social work, fall 2021, 21(4) 1232     table 1. barriers to community inclusion for people with idd barriers considerations ableism  ableism is defined as the “beliefs or practices that devalue & discriminate against people with physical, intellectual, or psychiatric disabilities & often rests on the assumption that disabled people need to be ‘fixed’” (smith, n.d., para. 1).  ableism is embedded in many cultural beliefs, societal structures, & institutions, & has resulted in the othering & exclusion of people with idd across multiple domains (e.g., healthcare, employment, & education; friedman, 2019). paternalism  dignity of risk & the right to self-determination are often overshadowed by historical protectionist systems or superseded by caregivers’ duty to care (glen, 2015).  paternalism has resulted in the exclusion of people with idd from life decisions, directing their services, & from acting on their own behalf (glen, 2015); “everything for the people, but without the people” (román, 2010, p. 127). medical model of disability  disability is equated with physical and/or mental impairments that result in functional limitations that inhibit the ability of people with idd to function effectively in society (e.g., work, live independently, etc.).  the government’s role is to assist people with idd through financial support & rehabilitative services to overcome these limitations (scotch, 2000).  this model takes a needs-based approach, is diagnosis driven, & focuses on treating disability rather than removing structural barriers (degener, 2016).  the full realization of the social model of disability, which recognizes society as the primary cause of disablement continues to be compromised by the medical model that has endured over time (scior et al., 2020). lack of clarity in defining community inclusion  scholars & practitioners have failed to distinguish community inclusion from community integration, participation, & belonging (amado et al., 2013).  the absence of a clear definition has resulted in limitations with assessing the extent to which providers achieve inclusion for the persons they support (cobigo & stuart, 2010). lack of evidencebased practices (ebp)  ebp involve “a process in which the practitioner combines well-researched interventions with clinical experience, ethics, client preferences, & culture to guide & inform the delivery of treatments & services” (nasw, 2020, para 5).  interventions & practices have often originated in the general population & have lacked sensitivity to disability identity and culture. as such, they frequently require adaptations to be effective (andrews et al., 2019; keesler, 2020).  the efficacy of disability services in facilitating community inclusion is unclear due an absence of evaluation & research. ebp for community inclusion are needed to counter the effects of exclusion & its infringement on human rights (bogenschutz & amado, 2016; schalock et al., 2017). disconnect between policy & practice  community inclusion is often a primary goal for community-based services for people with idd; however, many services are provided in segregated spaces (e.g., day programs) for people with disabilities (merrells et al., 2019).  services tend to focus on community presence & often result in little interaction with the broader community (clement & bigby, 2008).  community inclusion for people with idd is often predicated upon support from family or paid caregivers. as such, numerous challenges can arise such as aging parents, & turnover & vacancies among paid caregivers (larson et al., 2016).  there is a systemic lack of understanding regarding disability & disability issues among community members & policy makers (amado et al., 2011). presnell & keesler/community inclusion 1233   table 2. practical strategies to advance community inclusion for people with idd call to action domains practical strategies apply a human rightsbased approach  dismantle segregation by actively engaging in evaluation of policies, practices, & programs that keep people with idd from being fully included in their communities & advocate for inclusive practices (e.g., advocate to end programs that segregate people with idd).  critically examine disability agency policies & practices to ensure they are in alignment with human rights standards (e.g., crpd; united nations, 2007).  provide rights-based training to people with idd to promote knowledge of rights & to foster self-advocacy in exercising rights & seeking retribution when their rights are violated (lord et al., 2007). intentionally align with person-center planning (pcp)  practicing pcp means respecting & upholding individual preferences & choices, even when these may conflict with agency policy & practice. this is critical as people with idd are often denied choice in where they live, who they live with, & how they participate in their communities (inclusion international, 2012; tondora et al., 2020).  elevate the voices of people with idd & respect them as the expert on their life (e.g., “do with, not for”). pcp opposes approaches that exclude people with idd from making life decisions & self-directing their services (tondora et al., 2020).  engage in supported decision-making when guardianship laws & practices conflict with pcp. supported decision-making is a tool that helps people with idd maintain their ability to make decisions on their own behalf & communicate these to their supports (shogren et al., 2017). foster evidencebased practices  advance ebp in the disability sector through the development of university-community partnerships that aim to foster stronger, more inclusive communities by bringing together the expertise & resources of multiple stakeholders (jones et al., 2016).  engage in person-centered outcome evaluation to ensure alignment among current values, understanding, & best practices (schalock & luckasson, 2021).  participate in professional development/trainings focused on neurodiversity to ensure the provision of support is culturally relevant & anti-ableist. conduct participatory action research  engage & partner with people with idd to develop inclusive research practices. as such, research materials must be accessible to people with idd (e.g., developing plain language research materials, designing inclusive recruitment strategies, using technology to decrease participation barriers, etc.; mcdonald et al., 2016).  recognize that people with idd may be reluctant to participate in research due to past harm/abuse, power differentials, & lack of existing relationships with researchers (banas et al., 2019).  understand that people with idd desire to be involved in & can benefit from participating in research. various strategies have been identified to foster their inclusion & participation, including obtaining informed consent (taua et al., 2014), as well as preparing individuals for participation, simplifying information, & improvising interview procedures (jen-yi et al., 2015). include disability in social work education  include neurodiversity in classroom discussions & content on diversity, ethics, & oppression, as well as information on the disability rights movement within content on social movements & systemic oppression (cswe, disability-competent care curriculum workgroup, 2018).  integrate disability studies into generalized & specialized course curricula to offer new opportunities for social work pedagogy to conceptualize disability in the context of a human rights framework (vs medical/rehabilitative models) & to better prepare social work students to competently support people with idd (goodley, 2010; fuld, 2020).  offer increased opportunities for students to become involved in the disability sector through internships and/or field placements (dinecola & lemieux, 2015). increase community action & advocacy  engage in individual, familial, & societal level strategies to challenge disability stigma. these can include empowering individuals with self-advocacy groups & education on legal & financial rights; parental education about idd & peer support for family members; educating society through anti-stigma campaigns & collaboration with community leaders to foster acceptance of people with idd in their community (jansen-van vuuren & aldersey, 2020).  work with local governments & businesses to ensure that all community spaces are accessible to people with idd.  advocate for laws & international standards that safeguard & protect people with idd from victimization and exploitation (scior et al., 2020). advances in social work, fall 2021, 21(4) 1234     applying a human rights-based approach. despite the often-perceived progressive nature of social work, the profession has frequently maintained a focus on the medical model and a needs-based approach (mapp et al., 2019; ogden et al., 2017). the medical model pathologizes disability as deviation from the norm, is diagnosis-driven, and focuses primarily on treating or rehabilitating disability. while the medical model remains deeply engrained in practices for people with idd, there has been some movement, albeit slow, to integrate the social model of disability (oliver, 1996) into social work education and practice (morgan, 2012). the social model considers disability as a social construct created through discrimination and oppression. understanding disability as a social construct shifts the focus from treating the individual to addressing societal barriers that keep people with idd marginalized. the social model of disability also acknowledges the importance of civil rights; however, it is not fundamentally a rights-based approach to disability. notably, the development of the united nations crpd in 2006 brought with it a shift to a human rights model of disability. in contrast to the social model, the human rights model encompasses all human rights: civil, political, economic, social, and cultural rights, and does not view disability as a hinderance to human rights. rather, the human rights perspective considers neurodiversity as a valued extension of the human experience (degener, 2016). as such, persons with idd are equal to others and are therefore entitled to community inclusion. any social or environmental barriers that prevent people with idd from realizing their right to inclusion are considered to be discriminatory and must be dismantled. within this approach, people with idd are recognized as experts and partners in their own care, rather than passive recipients of charity and servicesas is the case in needs-driven services (mapp et al., 2019). notably, the social model of disability has been criticized for denying the individual experiences of disabilities (e.g., pain, compromised quality of life, etc.). however, the human rights perspective acknowledges personal challenges associated with disabilities and requires that they be considered in the context of social justice (morris, 2001). further, this perspective extends beyond the social model’s focus on social power and recognizes the importance of cultural and minority identification (e.g., gay pride, deaf community, etc.), such that disability identity and culture is not only acknowledged but celebrated. similarly, a human rights model acknowledges that people with idd are a heterogenous group who often have multiple, intersecting identities (e.g., relative to race, gender, age, etc.) that impact their social status and experience of oppression and discrimination. as such, people with idd not only experience ableism, but also racism, genderism/sexism, ageism, and other forms of oppression that interfere with their right to community inclusion (degener, 2016). while social work has been identified as a human rights profession, it has not yet fully realized this assertion (mapp et al., 2019). as such, social work can promote community inclusion by more fully embracing a human rights-based approach to critically examine and enhance disability supports and services. echoing the international federation of social workers, in 2015 cswe charged the profession with advancing human rights, as well as social, economic, and environmental justice. within the human rights framework, presnell & keesler/community inclusion 1235   needs are reframed as rights. as such, social workers are charged with helping individuals to have ongoing access to their rights, rather than simply responding to or fulfilling an immediate need (mcpherson, 2018). by understanding the barriers and challenges to realizing one’s rights through a rights-based lens, social workers are directed toward setting goals that focus on justice and equity and “long-term commitment to social and political change” (mcpherson, 2020, p. 61). hence, social workers advocating for community inclusion not only assist persons with idd in exercising their rights but must also challenge larger systemic factors that infringe upon these rights (mcpherson & abell, 2020). intentionally aligning with person-centered planning. undergirded by the personin-environment framework and self-determination, the social work profession focuses on person-centered planning (pcp) as the hallmark of quality care for diverse groups (washburn & grossman, 2017). like social work, the idd field emphasizes pcp as its guiding philosophy “to reduce social isolation, promote friendships, and increase autonomy, competence, social contribution, and respect” (holburn et al., 2004, p. 64). pcp emphasizes and supports an individual’s vision for a preferred life through meaningful roles and active participation. through pcp, the individual is respected as the primary decision-maker and their choice and autonomy act as guiding forces in shaping how services and supports are delivered (american geriatrics society expert panel on person‐ centered care, 2016). this is an important shift away from hierarchical models of care that see the provider as the expert and primary decision-maker. this shift is integral to supporting the empowerment and self-determination of persons with idd and ensuring that systems of care do not further oppress and marginalize them. the common emphasis on pcp between social work and the idd field has the potential to create new opportunities for increased community inclusion for people with idd, particularly as pcp has been associated with improved social networks, increased contact with family and friends, and greater involvement in group activities (claes et al., 2010). at times, however, social work has fallen short with critical elements of pcp (e.g., respect for the personhood of the person being supported; washburn & grossman, 2017). scholars have noted that pcp requires an intentional emphasis on supporting individuals’ unique goals for social relationships and community participation (bogenschutz & amado, 2016). consequently, social workers need to purposefully align their practices with pcp to better support inclusion across settings. fostering evidence-based practices. although society has often proclaimed community inclusion for people with idd, research has suggested a disconnect between intentions and outcomes for inclusion (scior et al., 2020). bogenschutz et al. (2015) identified national research goals to advance social inclusion for people with idd. these goals included understanding contextual factors that influence social inclusion, building capacity for social inclusion, and identifying best practices for social inclusion (bogenschutz et al., 2015). notably, both social work and the field of idd have called for greater emphasis on best practices and ebp (schalock et al., 2017; thyer & myers, 2011). for people with idd, interventions and practices have often originated in the general population, and as such, they have lacked sensitivity to disability culture and therefore warrant adaptations to be effective (andrews et al., 2019; keesler, 2020). schalock et al. (2017) identified the importance of ebp in idd services and emphasized a multi-systems advances in social work, fall 2021, 21(4) 1236 framework with implications of various factors (e.g., support staff strategies and opportunities for participation) for individual outcomes. further, they stressed the need for cultural sensitivity, use of the social-ecological model, team collaboration and consultation, and the ability to work with limited resources. given these collective considerations, social work is well-situated to embark on the development, evaluation, and advancement of ebp for inclusion. using participatory action research. participatory action research (par) can be integral to developing ebp for community inclusion of people with idd (powers, 2017). well within the expertise of social work, par is an approach to scientific inquiry that actively engages members of an oppressed group in identifying critical issues and collaborates with them in creating solutions (tanabe et al., 2018). social workers can and must learn from the knowledge of persons with idd to have a more complete understanding of what barriers to inclusion exist and how to overcome them. while engaging persons with idd as key stakeholders is critical, they have largely been excluded from participating in the very research, policy development, and decision-making that intimately affects their lives (dinora et al., 2020). according to inclusion international (2012), what is missing is the voice of people with intellectual disabilities and their families who have lived the experience of exclusion and isolation, who understand the causes and impact of that exclusion and who have a vision for what living and being included in the community should look like. (p. 9) the voices of people with idd must drive the inclusion movement forward. “nothing about us without us” has been adopted by disability rights advocates to assert the importance of ensuring that persons with idd are at the forefront of decisions that affect their lives (charlton, 1998). persons without disabilities do not have the experience of living with a disability and therefore do not share the same level of knowledge and insight about the issues affecting persons with idd (tanabe et al., 2018). consequently, the experiences of people with idd must be valued and they must be leading discussions, decisions, and agendas surrounding services, accessibility, and rights-based issues (rios et al., 2016). over the past two decades, par has gained some interest from idd practitioners and researchers given its collaborative and inclusive nature; however, despite its promise, the approach remains under-utilized (rosner, 2015). criticisms of traditional research focused on disability suggest that it is not representative of people with idd, as it has largely been conducted by those without lived experience of disability, which may inaccurately reflect the experiences of people with idd and result in further disempowerment and alienation (rios et al., 2016). in contrast, par is empowering, inclusive, collaborative, authentic, and conducive to facilitating positive social change, especially for marginalized groups (baum et al., 2006). through this approach, persons with idd are valued as experts on inclusion by virtue of their lived experience and respected as key contributors and partners in the research process. by focusing on par and elevating the perspectives of people with idd, social work could foster a more accurate representation of the experiences of persons with idd and more effectively build inclusive communities. presnell & keesler/community inclusion 1237   including disability in social work education. education is a powerful tool in the movement toward community inclusion for people with idd. although the disability rights movement aligns with the profession’s emphasis on social justice and equity, social work education has fallen short in disability content to adequately prepare students for practice with people with idd (bean & hedgpeth, 2014). this is concerning from a few perspectives: (a) people with idd constitute a diverse population with intersecting identities and experiences; and (b) social work students become the next generation of social work practitioners, researchers, and advocates. despite developments in national and international policies related to idd, social workers have been rarely identified in the context of the idd field and have largely remained invisible (bigby & adkinson, 2010). unfortunately, few social work students express a desire to work with people with idd as their targeted client population (john & schrandt, 2019). in addition, differences among social work students in their attitudes toward people with different types of disabilities suggest a possible disability hierarchy (e.g., preference toward people with physical disabilities over people with idd), which is counter to equity and social justice in the field (keesler, 2019). the experiences of people with idd are underrepresented in social work curricula, such that neurodiversity and disability are often not considered in the context of diversity. like people with idd, people of color and people who are transgender have been marginalized. although extensive efforts have focused on upholding the dignity and worth of people of color and transgender people, people with idd continue to be largely excluded from discussion and activism on diversity and systemic oppression (mackelprang, 2010). further, when content does specifically address practice competencies with people with idd, these tend to be based on medical and rehabilitative models of understanding disability that fail to consider societal and environmental factors that create challenges for people with idd (meekosha & dowse, 2007). it is plausible that increased exposure to disability content in social work programs could ameliorate these concerns. kim and sellmaier (2020) suggested that social work programs assess the visibility of disability in their institutional practices, explicit curriculum (e.g., course content and assignments), and implicit curricula (e.g., policies and discourse). by increasing awareness of disability in social work education through expanded disability content, the profession could foster increased interest among burgeoning social workers to enter the disability field and better prepare those who have already decided to do so (john & schrandt, 2019; kim & sellmaier, 2020). notably, in collaboration with the cswe, the disability-competent care curriculum workgroup (2018) developed a curricular resource guide to support the integration of disability content in social work curricula. this guide provides support for educators in identifying and linking cswe competencies with disability learning outcomes and educational resources. increased community action and advocacy. although the social work profession has become increasingly focused upon clinical practices, its historic roots are in advocacy and societal change (mapp et al., 2019). the profession’s code of ethics calls social workers to action, “to prevent and eliminate” discrimination based on disability and to “promote conditions that encourage respect for cultural and social diversity…(and) promote policies and practices that demonstrate respect for difference” (nasw, 2021, advances in social work, fall 2021, 21(4) 1238 standard 6.04). hence, the profession is charged with meeting the needs of people with idd and challenging macro barriers, like ableism, that prevent full community inclusion. mackelprang (2010) noted that, “although nasw actively condemns racism, it is relatively quiet about ableism that places disabled people at risk" (p. 93). it is time for social work to partner with people with idd to actively challenge ableist practices and structures. scior et al. (2020) noted that social workers could actualize these responsibilities toward people with idd by developing resources and educating the public about idd, by addressing and seeking an end to disability stigma and discrimination, and by advocating for laws and international standards that safeguard and protect people from victimization and exclusion because of their disability. notably, however, social workers are also called to act within the scope of their training and expertise. further, advocacy is often influenced by interests and passion. collectively, expertise, interests, and passion, are often influenced by education. and, as previously noted, disability content is often limited within social work curricula. so, while social workers can and should engage in increased action and advocacy for people with idd, their abilities to do so may be compromised by their formative academic experiences until curricular amendments are made. conclusion persons with idd have the right to be fully included and treated as equitable members of their communities. their quality of life is contingent upon the quality of their supports, services, and interpersonal relationships; participation in educational and recreational activities; their ability to exercise choice and independence; having access to individualized supports (versus a “one-size fits all” approach); and, living and socializing within their communities (schalock et al., 2018). equitable communities are realized only when all their members are recognized, valued, and included. for people with idd, this requires the removal of all barriers that prevent them from fully exercising their right to community inclusion. if social work espouses to be a human rights profession, then social workers must step forward and dismantle the injustices that people with idd continue to experience. as social workers, we can no longer ignore the importance of inclusion and its positive impact on well-being. we must listen to the perspectives of those with lived experience. we must engage in creating, evaluating, and fostering effective strategies to increase community inclusion for people with idd. we must partner with people with idd and work alongside them, for disability rights are human rights. because simply being in a community is not enough. references american geriatrics society expert panel on person‐centered care. 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(2011). world report on disability. geneva, switzerland: author. https://www.who.int/teams/noncommunicable-diseases/sensory-functionsdisability-and-rehabilitation/world-report-on-disability author note: address correspondence to jade presnell, school of social work, indiana university, indianapolis, in, 46202. email: jadepres@iu.edu _________ luis h. zayas, phd, professor and sutherland chair in mental health and social policy, steve hicks school of social work, professor of psychiatry and behavioral sciences, dell medical school, university of texas, austin, tx. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 33-45, doi: 10.18060/25294 this work is licensed under a creative commons attribution 4.0 international license. social work advocacy in federal immigration courts: a consultant’s reflection on successful cases luis h. zayas abstract: advocacy for immigrant families undertaken by social workers, attorneys, and other supporters to protect against deportation, detention, and unfair government policies occurs mostly in immigration and federal courts. social workers bring unique knowledge and skills that enhance legal teams’ representation of immigrants. this paper provides case illustrations of social work’s contribution in three types of legal actions. one illustration from immigration court demonstrates the social work consultant’s role in cancellation of removal cases when undocumented immigrants have us-citizen children. a second case is a federal class-action lawsuit to end the detention of asylum-seeking families. the third case was a federal lawsuit to dismantle bureaucratic policies and procedures that undermined the legal rights and well-being of unaccompanied children. in each of these actions, social work knowledge influenced lawsuits that can have lasting policy impact. while this paper focuses on social work advocacy in immigration cases, social work extends to many other areas of advocacy in the legal system. social work consultants must have a clear understanding of what the attorneys are requesting to ensure that they have the requisite knowledge and skill to be optimally effective and to practice ethically within the scope of their expertise. other implications include maintaining familiarity with contemporary social and behavioral research and providing expertise confidently in written reports and oral testimony in court. when social workers bring their expertise to legal teams in immigration cases, they promote the profession’s expertise and help families facing oppressive policies. keywords: advocacy, deportation, detention, immigration courts, federal courts in today’s complex and highly charged immigration environment, effective advocacy occurs when interdisciplinary teams of immigration attorneys, medical and public health specialists, and behavioral scientists bring their unique perspectives to pursue legal remedies for immigrants. organized professional challenges to the government’s treatment of asylum-seekers, unaccompanied minors, and undocumented immigrants and their united states-born and foreign-born children can effect change in immigration policies and enforcement practices of federal agencies. to demonstrate how social work expertise can be brought to bear in advocacy collaborations, this paper presents examples of social work advocacy with immigrant and human rights attorneys to protect undocumented parents on the verge of deportation and children and mothers from central america seeking asylum in the u.s. as callous as the immigration debates appear to be in the 21st century, this is not the first time in american history that hateful vitriol has been spewed in the public square and the press. in fact, immigration has been a major battleground in the u.s. since the founding of the republic. as far back as 1751, benjamin franklin bemoaned the immigration of french, swedes, and others as insufficiently white. franklin questioned if german about:blank advances in social work, spring 2022, 22(1) 34 immigrants would “germanize us instead of our anglifying them,” predicting that they could never adopt our language or customs any more than they could acquire our complexion (rampell, 2015, para. 3). in 1882, the chinese exclusion act became the first significant law restricting immigration into the u.s. (davis & morrison, 2015; railton, 2013). the difference now is that the same mean-spirited, anti-immigration rhetoric and unwelcoming national policies are inflamed by a 24-hour television news cycle and social media that push false narratives, distorted facts, and conspiracy theories to the deepest corners of society. an example of harsh enforcement practices is the creation of “family residential centers” under the obama administration in 2014 to detain all female-headed families, including children, in secure, unlicensed facilities for the duration of their asylum hearings. the practice came from a misguided belief that doing so would deter other central american migrants from coming to the u.s. under the trump administration, the use of family detention centers was expanded and children’s “tent cities” were erected, including the notorious ones in tornillo, texas, and homestead, florida (fernandez & dickerson, 2018; jordan, 2018). perhaps the cruelest act of mistreatment occurred in the spring and summer of 2018 when the trump administration implemented a zero tolerance policy that separated children from their parents (u.s. house of representatives, 2019). in the period between may 5 to june 9, 2018, over 2,340 children were separated from 2,200 parents at the border (kates, 2018). the total numbers of families held in immigration detention is difficult to locate in government sources, but it is well in the tens of thousands (detention watch network, 2021). as an example of the magnitude of immigration detention, the u.s. held 69,550 migrant children in custody between 2018 and 2019, including infants, toddlers, children, and teenagers (sherman et al., 2019). such policies and practices compel social workers to engage in policy advocacy activities that are often indirect, nonconfrontational, episodic, and coalitional to fight the increasingly restrictive actions (roth et al., 2018). advocacy to help immigrant children and families requires engagement with a complex federal system of legal, bureaucratic, administrative, and political structures. but effective legal advocacy does not happen through the efforts of lawyers alone. in the case of immigration, legal action requires the contribution of behavioral scientists, such as social work scholars and practitioners, to make compelling arguments for preserving human rights and avoiding damage to immigrants. the courts are a means for social work to demonstrate its expertise in cross-system, cross-disciplinary collaborations (finnovelasquez & dettlaff, 2018). by bringing our unique expertise in human behavior, mental health, trauma, and family and community integration, social workers can enrich the effort of legal advocates (brabeck & xu, 2010; furman et al., 2015; hardina, 2014; jaggers et al., 2021). indeed, the contribution of social and behavioral sciences knowledge can be highly influential in the decision-making of immigration and federal courts. to illustrate how social work knowledge and practice can be used in collaborative advocacy practice, this paper presents social work contributions to lawsuits brought by or on behalf of immigrants and represent cases that reflect the salient and influential role of social work knowledge. one example involves advocacy in immigration court to prevent the deportation of parents whose citizen-children will experience exceptional hardship. a zayas/swk advocacy 35 second example illustrates advocacy in federal courts to end the practice of holding families requesting asylum in prison-like detention centers. the third case helped dismantle bureaucratic procedures of immigration detention that undermine the legal rights and mental health of unaccompanied children through federal courts, both under the u.s. department of justice. immigration courts: cancellation of removal hearings in mixed-status families, undocumented parents are subject to “removal” (i.e., deportation) by the government. immigrants have the right to appeal their deportation orders in immigration courts, operated by the executive office for immigration review under the department of justice. in immigration court, children who are u.s. citizens have no legal basis to protect their parents from deportation. but the presence of a u.s.-born offspring provides a starting point for requesting a cancellation of removal. deportees must act pro-actively to have the court consider the “exceptional and extremely unusual hardship” that would befall their children if the parents were deported. sadly, immigration courts do not observe the “best interest of the child” standard used in family court, which places the child’s welfare as the center of attention and decision-making. in immigration court, the best-interest standard is not present or observed; all decisions focus on the parent facing removal (thronson, 2011; wessler, 2011; woltjen, 2014). the burden is on immigrant parents, not the court, to raise the issue of their children and to prove the potential hardship and suffering. in proving hardship on citizen-children, legal teams will bring in at least two types of expert witnesses: country experts and behavioral science experts. the country expert brings knowledge of the public health issues, crime and violence, police and government functioning, and cultural, social, and economic conditions of the country that a u.s. citizenchild will face. the behavioral expert is the child mental health expert who can demonstrate why and how the removal of the parent will harm the citizen-child’s functioning and development. this expert must clearly articulate the potential damage of a parent’s deportation if the child must stay behind in the us or must move to a country the child has, in most instances, never known. in all cases, parents and child will be asked to consent to the evaluation and to have the evaluation entered into the court record and possibly augmented by testimony from the social work consultant. in this form of advocacy, the social work expert assembles clinical impressions with support from scientific evidence to support the conclusions and recommendations. such was the case of carlos, an eight-year-old boy whose mother challenged her deportation orders. carlos carried a diagnosis of attention deficit, hyperactivity disorder (adhd) for which he received medication and an individualized school program. his evaluation showed a sensitivity to changes in his environment that led to rule-breaking and aggressive behavior. social work expertise showed that without access to medication, psychotherapeutic intervention, school programs for children with special needs, and adequate parental monitoring, carlos could face daunting challenges. from the country expert, we learned that the town in mexico to which the family would return was a sixhour drive from adequate medical and behavioral care. if carlos stayed in the u.s., there advances in social work, spring 2022, 22(1) 36 was still the prospect that his father might be apprehended and deported. the report to the court stated, in part, that there is cause for concern with carlos’s capacity to handle dramatic change in his environment or in separation from either or both of his parents. he does best in familiar settings that provide him with emotional stability and do not tax his attentional and hyper-motor problems. carlos will be approaching puberty and adolescence soon. without parental and professional monitoring, children with untreated adhd risk developing conduct disorders under increased peer pressure and negative modeling of other youth. too drastic a set of changes (such as places, schools, people, geography) can place him at risk for additional negative social behavior. stability in his environment is essential for carlos. carlos benefits from medication and behavioral therapies, and these services cannot be overstated. they are critical for his growth and development, his sense of competency and selfefficacy, and his educational and occupational prospects. removing these supports will place him at risk for psychological and behavioral problems, affecting his long-term well-being. this knowledge is further supported by a recent scientific report on health and mental health services for children in mexico (benjet et al., 2009) which shows that even in mexico city, with its more abundant resources, pediatric and psychiatric services for children with emotional and behavior disorders are sorely lacking. the judge ruled in favor of carlos’ mother’s appeal, permitting her to remain in the us as a legal permanent resident. knowledge of the scientific literature and clinical insights that were conveyed in the evaluation, supported by direct court testimony, and strategically introduced by the family’s attorney were put to great effect in the case. of course, not all children carry diagnoses or behavioral problems, and the legal approach may require a different strategy. in such cases, the evaluator can bring the strengths perspective that is fundamental to social work. such was the situation in the case of 14-year-old miguel whose exhaustive psychosocial evaluation and review of school and pediatric records revealed a well-functioning high-school freshman. he had been raised by a single father, now facing deportation. miguel admired his father’s soccer playing and his father attended all his football games. miguel said, “how am i going to live out my life without him? he is the only one out there for me. without him, i don’t know where i’d be.” the report to the court concluded that this is a remarkably well-adjusted young man. he is a bright, engaging, and respectful teen who is full of life and respects and admires his father. it is a tribute to his father who raised miguel since toddlerhood with exceptional care. he is a very engaged father who has not relegated the care of his child to anyone else. his knowledge of miguel’s educational and medical histories, of miguel’s friends and whereabouts, and of his son’s emotional states is indicative of the solid parenting he has provided. in the absence of any other caregivers, his father’s deportation would have devastating effects on miguel. the judge ruled in favor of miguel’s father. these are just two examples of what competent legal and social work collaboration can achieve. our teams of attorneys zayas/swk advocacy 37 representing two or more legal aid organizations and for-profit law firms and social workers has prevailed in these and about 90% of cases in which an evaluation demonstrated the exceptional and extremely unusual hardships that u.s citizen-children would face if they were separated from their parents or were to leave the us with their parents to countries they had never known. federal court: class-action challenging detention of children and parents as noted earlier, in 2014 the u.s. department of homeland security (dhs) and immigration and customs enforcement (ice) detained immigrant families and refused to consider them for release on bond, recognizance, or other conditions (the “no-release policy”, the bronx defenders, 2020). this happened despite findings by immigration officers or judges that families had proven credible fear of persecution if they were to return to their home countries. almost immediately, class-action lawsuits were filed against the government. in response to the no-release policy, a class-action, r.i.l.r. v johnson 2014, was filed in u.s. district court in washington, d.c., by a coalition of legal advocates to challenge the idea of detention as deterrence. another lawsuit, flores v. johnson 2015, filed in the u.s. district court for the central district of california, asserted that, by detaining children and mothers for extended periods of time, the government was in violation of the “flores agreement” (center for immigration studies, 2019). this 1997 consent decree affirmed that the immigration and naturalization service must release a minor from its custody “without unnecessary delay” to ensure the minor’s safety or that of others. for the rilr case, a declaration was authored (i.e., a statement made under oath and signed under penalty of perjury) on the mental health impact of detention on children and mothers drawing on the author’s practice experience and the extant research literature. the declaration was comprised of two sections. one section drew from the findings from interviews with more than 20 mothers and children in an ice detention center located in karnes, texas. the other section contained a review of literature on the effects of detention on children. it was necessary to draw on neighboring social science literature because there was insufficient social work research specifically detailing the effects of immigration detention on children and parents. in addition to citing research on women’s imprisonment and juvenile detention, the declaration described a body of work on disrupted attachment and such consequences as maladaptive social and emotional development, cognitive impairments, academic failure, criminal involvement, and other behavioral, emotional, and psychological outcomes. disruptions in attachment affect general growth and development of the brain as well as social functioning, aggression, and reactions to stress (byrne et al., 2012; evans & kim, 2013; mclaughlin et al., 2014). focusing on children’s reactions to their mothers’ incarceration demonstrated the long-term damage to children’s capacity to make friends and navigate social situations, and that maternal incarceration predicted the children’s future antisocial and delinquent outcomes (murray & farrington, 2005; nesmith & ruhland, 2008). detention or institutionalized living, and child-rearing in prisons, is a major childhood traumatic stressor, even under conditions of short or brief detentions advances in social work, spring 2022, 22(1) 38 (foster & hagan, 2013). findings show that the childhood trauma from maternal incarceration increases depressive symptoms among children (abram et al., 2014). this has led researchers to conclude that incarceration-specific experiences place children at higher risk for maladjustment than exposure to general environmental risk in community settings (dallaire et al., 2015). in anticipation that the government attorney would argue that the typical stay for children in detention was but a few weeks and, therefore, not harmful, the declaration presented research showing that even short periods of detention constituted adverse childhood experiences. as such, the declaration concluded with an unambiguous statement about the harm of detention on children: i can unequivocally state that the children in the karnes facility are facing some of the most adverse childhood conditions of any children i have ever interviewed or evaluated. untold harm is being inflicted on these children by the trauma of detention. what’s more is that the children at karnes are experiencing trauma upon trauma upon trauma. that is, they not only suffered the trauma of having their lives threatened and disrupted by fleeing their native countries, but they also experienced, witnessed, and heard of violent, traumatic events in their crossing through mexico. on top of these two serial and often long-term traumatic experiences, the children are exposed to the deprivation and constant threat of living in a facility in which they have no sense of their future. . . . based on my professional background and expertise . . . i can say with certainty that detention is inflicting emotional and other harms on these families, particularly the children, and that some of these effects will be long-lasting, and very likely permanent (zayas, 2014, p. 15). in both r.i.l.r. v johnson and flores v johnson, federal judges found in favor of the plaintiffs and issued temporary injunctions. the government continued its practices by appealing and circumventing the judges’ orders. nevertheless, they were significant victories that forced the government to reconsider its approaches. federal court: dismantling bureaucratic practices the third example of collaborative advocacy in federal court is a 2018 class-action filed against the office of refugee resettlement (orr), u.s. department of health and human services (dhhs), and a residential treatment center. as an arm of dhhs, orr’s responsibility is to safeguard unaccompanied minor children who are found at the border or the interior of the country. the lawsuit, l.v.m. et al., v lloyd et al. 2018, filed in the southern district of new york by the new york civil liberties union, sought to rollback a policy instituted in mid-2017 by the orr director appointed by the trump administration. that policy dictated that the orr director would personally review all cases of children held in highly restrictive government-controlled facilities in new york state and approve release and reunifications decisions. the case went to the heart of whether orr was indeed protecting youth in its custody. my role as the social work consultant was to review the policy and youth’s case records to opine on its effectiveness and whether it represented typical best practices in child welfare. of the 107 adolescent zayas/swk advocacy 39 males identified, 35 randomly selected cases were reviewed, roughly a third of the cases. predictably, the excessive bureaucratic overreach had, by early 2018, resulted in the approved releases of a handful of boys. the policy was only slowing down the process of getting the youth discharged into the custody of their parents or other sponsors. furthermore, case records showed that the delays in release and reunification were causing severe, potentially irreversible, harm to the youth. three conclusions emerged from the review that were included in the declaration. 1. the orr director did not appear to be qualified to make release decisions. the director’s deposition showed that he did not have any professional credentials or experience to make determinations on children’s clinical conditions, readiness for release, or risk-of-harm. he had no previous history in the child welfare or child mental health system and held no academic degrees in a human service field. he was an attorney with no expertise in family law. a question for the court was how could this official make decisions that overruled mental health clinicians, social workers, case managers, and others with relevant expertise working with the youth, or even his own qualified, subordinate staff who had made recommendations to approve or disapprove releases of youth? as illustration, the review drew the impressions of a psychiatrist about a 16-year-old male written in the medical record: “i cannot find any clinical basis to determine that the patient is at risk for violence in the community. on the contrary, he seems to be violence averse [and] observed behaviors have not been violent.” in many cases, the director’s decisions were clearly contraindicated by the records and at odds with the recommendations of psychiatric and social work staff. moreover, the director did not explain his reasoning or provide any meaningful guidance to staff to ready the child for release. 2. the policy requiring director-level review is contrary to best practices. senior-level reviews of individual cases that occur—if they occur—in large, interstate health and social welfare organizations are, in general, time-consuming. when such reviews are practiced, the executive will frequently defer to the professionals on the ground, those most proximal to the cases. but it was clear that without competent child welfare knowledge brought to bear on the director’s decisions, best practices were not being used. the social work declaration read, in part, none of the children whose cases i reviewed that were elevated to the director level review exhibited behavior—either during or before custody—present the sorts of extraordinary circumstances that would warrant elevation of release decisions to senior management of such a large agency. having read the director’s deposition and his rationale for instituting the new policy, it is clear that he is not aware that the new policy represents a significant deviation from the manner in which such decisions are made at a variety of human services and child welfare agencies, such as foster care agencies, group homes, hospitals, and residential treatment facilities. . . . it is no surprise that the additional layers of review have contributed to significant delays in the rendering of release decisions. . . . the average length of time for a final review by the orr director was approximately 35 days from when it was received in washington but some cases took longer, advances in social work, spring 2022, 22(1) 40 from 86 days to 142 days. (zayas, 2018, para. 25) 3. the director release review policy causes children in orr custody severe and potentially irreversible harm. the declaration included reference to authoritative reports (american academy of pediatrics, 2017), including one by the advisory committee on family residential centers of the department of homeland security (2016). the advisory committee report advised that “the separation of families for purposes of immigration enforcement or management, or detention is never in the best interest of children” (p. 2). the declaration to the court concluded that having reviewed the orr policy documents, analyzed the lengths of stay, and the children’s case files, it is my opinion that institutionalization in orr facilities is, for all relevant purposes, detention. orr, even when contracting with [therapeutic residential facilities], restricts children’s movements, separates them from their loved ones, exacerbates any psychological challenges the youth might have, affects negatively their developmental trajectories, and causes more harm than good. . . . many of the children whose files i reviewed were detained for significant periods before their cases were even elevated for the director’s review and the delays in this decision-making process only served to increase the harm to the youth. . . . [in one case, sexual abuse and in the other increased suicidal behavior]. (zayas, 2018, para. 36) there was enough evidence to persuade the federal judge that poor communication and decision-making had led to delays, and that, had the director allowed professional staff on the ground to use their best judgement, the delays, psychological damage, and egregious incidents might have been prevented. the policy was discontinued. discussion and practice implications in the lawsuits described in this paper, behavioral science and social work practice knowledge were brought together to inform legal strategies and advocate for immigrant families and children. the paper demonstrates that legal teams are well-served when they incorporate social work experts to inform legal cases for the benefit of individual clients or classes of clients. each of the illustrations were familiar grounds for social work. in challenges to deportation orders, social workers provide insights into the mental health impact on the children born in the u.s. when undocumented parents are threatened with deportation. children’s reactions to loss of parents and major environmental changes could include loss of community and belonging. clinical and research knowledge has helped immigrant families with us-born children in appealing their deportation orders. the federal class-action to end the detention of children and mothers in prison-like settings was influenced by a combination of social work and behavioral science evidence. the deleterious mental health effect of detention or incarceration of any kind is a topic that the social work profession has long understood through its presence in the juvenile justice and other settings (garcini et al., 2020; huang, 2018; lorek et al., 2009). the action brought against orr was especially germane to social work since it challenged policies and practices that should have been guided by the best available child zayas/swk advocacy 41 welfare evidence, but were not. in this regard, social work’s presence on legal teams was not only indisputable, but it was also critical to the case. drawing from knowledge of the field of child welfare and therapeutic residential facilities, the social work consultant found that the director was unqualified to make decisions about youth in custody. moreover, the director was not qualified and should not have taken decision-making authority away from the clinicians on the ground. this too was contrary to best practices. the policy of directorlevel reviews had prolonged the stays of youth in highly restrictive custodial settings, causing and exacerbating severe, potentially irreversible harm to an already vulnerable group of immigrant children. in offering the opinion, the know-how of social work informed the judge’s decision to overturn an uniformed policy. social work expertise as well as knowledge borrowed from allied fields add to the strength of legal actions. there are several recommendations for social work education and practice that can be drawn from these examples. graduate social work education, curricular materials, and syllabi should include content and instruction on working with attorneys, developing expertise in federal and immigration court systems, presenting the content of psychosocial evaluations and declarations, and being ready to testify in court to support legal and social arguments. one means for graduate education is to work closely with immigration clinics in university law schools (margolin et al., 2010). this interaction can provide opportunities for student social workers to train with student attorneys in the litigation of individual cases or class-action cases in both federal and state courts. practitioners with the relevant degrees and credentials should establish close relationships with groups of immigration attorneys or local non-profit legal action groups (e.g., immigration, refugee, civil, and human rights organizations). experience and knowledge that social workers bring are unassailable in courts. preparing evaluations, declarations, and affidavits for litigators to introduce into the court record is a skill that grows with each new case, and each time the social worker is on the witness stand. the contributions that seasoned social work practitioners make in lawsuits cannot be overstated. conclusion social work consultants in immigration and federal courts, as in any court of law, must be well-prepared, confident, and self-assured. when testifying in support of their evaluations and reports, social workers should understand that opposing attorneys will attempt to undermine their motives for participation in the case. they will question if the expert witness is doing this for the money, or seeking public attention or acclaim, or always presenting findings that support immigrants, or even acting as a consultant who will testify for the highest bidder. this can cause anxiety and stress, perhaps an awkward moment on the stand. what social workers need to keep in mind is that the government attorney cannot impugn their knowledge of social and behavioral science or clinical skills and acumen. holding confidently to expertise will override any of the arguments thrown at the expert social work witness. finally, the skills and expertise discussed in this paper are not limited to immigration and immigrants. rather, social work consultants can extend their reach to juvenile court, advances in social work, spring 2022, 22(1) 42 international adoptions that are brought to courts, mitigation in capital punishment cases, civil and drug courts, and in courts where attorneys seek justice for their clients. in cases such as these, and many others, social work-legal collaborations will advance the cause of social justice that is at the heart of the social work profession. references abram, k. m., zwecker, n. a., welty, l. j., hershfield, j. a., dulcan, m. k., & teplin, l. a. 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(2014). unaccompanied immigrant children are most vulnerable. chicago tribune, june 27. http://theyoungcenter.org/stories/chicago-tribune-op-ed-bydirector-maria-woltjen/ zayas, l. h. (2014). declaration of luis h. zayas in r.i.l.r. v. johnson, 80 f. supp. 3d 164 (d.d.c. 2015). retrievable at https://chu.house.gov/sites/chu.house.gov/files/documents/declaration%20of%20lui s%20zayas_0.pdf. zayas, l. h. (2018). declaration of luis h. zayas in l.v.m. v. lloyd, 318 f. supp. 3d 601 (s.d.n.y. 2018). available at https://www.courtlistener.com/docket/6347254/lvm-v-lloyd/ author note: address correspondence to luis h. zayas, school of social work, university of texas, d3500, austin, tx 78712. email: lzayas@austin.utexas.edu https://www.immigrationresearch.org/system/files/applied_research_center---shattered_families.pdf https://www.immigrationresearch.org/system/files/applied_research_center---shattered_families.pdf http://theyoungcenter.org/stories/chicago-tribune-op-ed-by-director-maria-woltjen/ http://theyoungcenter.org/stories/chicago-tribune-op-ed-by-director-maria-woltjen/ https://chu.house.gov/sites/chu.house.gov/files/documents/declaration%20of%20luis%20zayas_0.pdf https://chu.house.gov/sites/chu.house.gov/files/documents/declaration%20of%20luis%20zayas_0.pdf https://www.courtlistener.com/docket/6347254/lvm-v-lloyd/ mailto:lzayas@austin.utexas.edu _________ anna ortega-williams, phd, lmsw, associate professor, silberman school of social work at hunter college, the city university of new york, new york, ny. saadia mustaq, msw, valerie davoodzadeh, lmsw, linden isles, msw, zainab anwar, bsw, sebastian hidalgo-roig, bsw, and elena soler, bsw, independent researchers, new york, ny. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 149-166, doi: 10.18060/28155 this work is licensed under a creative commons attribution 4.0 international license. rethinking reliance upon written assignments: students reimagining rigor in social work education anna ortega-williams saadia mustaq valerie davoodzadeh linden isles zainab anwar sebastian hidalgo-roig elena soler abstract: written assignments in social work education are often relied upon as tools to demonstrate knowledge gained in coursework, although evidence of their effectiveness is inconsistent. while more institutional effort and resources are being poured into detecting plagiarism on written assignments, especially in the era of artificial intelligence like chatgpt, educators could consider whether there are alternative assignments that could be more meaningful in preparing social work students for practice. in this conceptual paper, a collective of social work students and an educator from a human behavior in the social environment bsw course share their experiences with switching from written to alternative assignments during the height of the covid-19 pandemic—a change made from necessity and curiosity. reflections about the meaning of alternative assignments are discussed from a student and educator standpoint. topics addressed include: 1) promoting creativity as self-care in potentially triggering educational environments, 2) redefining rigor, 3) promoting social justice, and 4) increasing relevance with implications for the field of social work education. keywords: social work education, alterative assignments, chatgpt, ai written assignments in social work education often are relied upon to demonstrate knowledge acquisition, although a range of other assessments are used, such as exams, portfolios, and group presentations (archer-kuhn et al., 2020; crisp & lister, 2002). educators and students are invested in the outcomes of written assignments. educators want to know if students have increased skills, gained knowledge, expanded their confidence, and met competencies. students want to achieve high grades and know if they are prepared to make a difference (murphy, 2022). academic writing proficiency can operate as a gatekeeper, impeding the professional advancement of some students while privileging others (crisp & lister, 2002). moreover, very little is known in social work education about how meaningful written assignments are to students, personally and professionally, and evidence of the effectiveness of written assignments is inconsistent (cotton et al., 2023; crisp & lister, 2002; king & chatgpt, 2023). increasingly, entire student essays have been discovered to be products of artificial intelligence (ai) chat programs, such as chat generative pre-trained transformer (chatgpt), which are capable of producing high-quality writing and research (cotton et al., 2023; king & chatgpt, about:blank advances in social work, spring 2025, 25(1) 150 2023). while more institutional effort and resources are being used to detect plagiarism on ai-written assignments, educators and students could question first, are the assignments meaningful? what does the format offer to them as whole people and professionals in our times? how helpful are written assignments for them as learners with varying levels of exposure to and preparation for academic writing? does performance on written assignments equate to strength of social work practice? are there alternative assignments that could be more generative for their learning styles? in this conceptual paper, a collective of social work students and an educator from a human behavior in the social environment course share their reflections on the meaning of written and alternative assignments implemented at the height of the covid-19 pandemic. reflections about the meaning of alternative assignments will be discussed, specifically from a student and educator standpoint. topics addressed include: 1) promoting creativity as self-care in potentially triggering educational environments, 2) redefining rigor, 3) promoting social justice, and 4) increasing relevance. positionality we, the authors of this article, are deeply invested and anchored in hope for social work education. we worked on this article in between classwork, over the summer, in the evenings, on weekends, and across time zones. we represent the spectrum of social work education—bsw and msw students, future doctoral students, recent graduates, and social work faculty. we are rooted in our identities, which hail from the margins of many stories that require centering when exploring social work education. we are pakistani, muslim, caribbean, black, latine, white, straight, bisexual, and queer. we are immigrants and are born and raised in the united states. we have grown up with different access, privileges, and barriers to our education—some with roots in historical oppression, xenophobia, and erasure in our educational experiences. some of us are neurodivergent and navigate disabilities, while others of us benefit from unearned advantages in educational systems built for our particular learning styles. we intimately know the barriers intrinsic to our educational systems, while also being committed to envisioning what an equitable, just, and healing experience social work education can be. we write this paper from our lived experiences with alternative assignments, written papers, and other forms of assessment. it is through the lens of these embodied experiences, tensions, and strategies that we unpack the possibilities of alternative assignments in social work education. literature review creativity, health, and social work education social work education prompts students to think deeply about topics that may be triggering (carello & butler, 2015). for example, in the past two decades, research has shown that students’ exposure to traumatic material is associated with higher rates of symptoms of post-traumatic stress disorder (bride, 2007). social work students bear a ortega-williams et al./reimagining rigor in swk ed 151 double burden while they attempt to address the institutional impacts on client well-being, change unjust policies, unpack difficult family situations, and challenge oppressive social dynamics faced by communities because some simultaneously experience similar stressors in their own lives (carello & butler, 2015; gelman et al., 2024). using educational methods that are trauma informed can support growth, joy, and self-expression (cramer, 2018). for example, emphasizing self-care, self-reflection, and mental health support in social work education helps students navigate the emotional toll that may arise in their work (holley et al., 2024). students, when encouraged to prioritize their wellness through their education, can gain a deeper understanding of their emotional responses. this approach strengthens students' ability to effectively engage and empathize with clients facing similar challenges (holley et al., 2024). when we think of wellness, what typically might come to mind is diet or exercise. however, if we look at health from a bigger-picture perspective, the multidimensionality of human beings demands far more to live healthy lives and thrive in this world. creativity has the potential to transform health and well-being. for example, one study assessed the role of creative expression in the areas of music, movement, expressive writing, and visual arts in the healing processes of adults eighteen years or older dealing with various chronic illnesses and trauma (stuckey et al., 2010). the effects of each form of creative expression on psychological and medical outcomes all revealed improved mood, decreased levels of stress hormones, and improved blood pressure (stuckey et al., 2010). results from this study suggest that incorporating creativity in social work education—in the form of alternative assignments as compared to written assignments— could promote healing within students’ learning experiences as they are exposed to potentially triggering topics. every individual possesses the capacity to be creative; encouraging creativity holds space for one to realize their true potential. the theory of transformative coping (ttc) describes a mechanism where the use of creativity and spirituality provides individuals with amplified mental health benefits (correy et al., 2014) associated with positive transformation and effective long-term coping. ttc defines creative expression as a transformative coping strategy that can be implemented across various populations throughout the lifespan (correy et al., 2014). furthermore, this study found that creativity and spirituality were correlated with strengthening resilience, reducing stress in managing difficult emotions, promoting health and well-being, and fostering personal growth (correy et al., 2014). in the context of creativity, the way an individual approaches current life challenges enables them to cope with changes and negative emotions they may encounter in the future. for example, a significant benefit has been found for students who learn from educators utilizing creative strategies in the classroom, in particular those dealing with traumatic stress due to domestic violence, unstable living environments, or adverse childhood experiences (chafouleas et al., 2021; corcoran et al., 2018; cramer, 2018). engaging with students through art has served as a familiar and safe medium where students can build critical thinking skills as well as confidence in educational settings (corcoran et al., 2018; cramer, 2018). therefore, including creativity within social work education could support coping during the educational process, while offering an opportunity for students to practice self-care—a concept that is heavily reinforced within advances in social work, spring 2025, 25(1) 152 social work (lamb & peterson, 2024; mirick, 2022; nicotera et al., 2023). additionally, a shift towards creativity also creates a foundation for understanding the importance of trauma-informed practice in educational settings (nicotera et al., 2023). therefore, for the authors, there is an anticipation that the flexible learning environments offered by alternative assignments may provide a positive message about the importance of maintaining health and well-being as students, while acknowledging the impact of students’ real-life situations on their educational experiences. moreover, incorporating creativity is a powerful tool to engage students impacted by chronic stress due to various traumatic events. in her classroom, cramer utilizes artsrelated strategies to enhance creative thinking, along with other research-based approaches, to teach students impacted by the chronic stress of poverty (cramer, 2018). incorporating creativity in social work education offers students flexibility in how they participate and meet curriculum requirements and could promote positive self-care habits. there are gaps in research on creativity’s role in social work education and how methods of creative expression can be incorporated into curricula to cultivate a way of learning that is both healthful and trauma-informed. presenting students with creative options for how they express their understanding of various social work topics is supportive of both positive self-care habits and overall health and could make a profound difference as they move through their social work education. lastly, in embracing different thought processes in the classroom, students and instructors can fully capture the power of creativity. collard and colleagues (2014) examined creativity in education and found that creativity itself was thought of as a fixed trait and a sign of giftedness. however, researchers now believe that every individual is in fact capable of being creative (collard et al., 2014). additionally, gardner’s (2008) concept of multiple intelligences challenges the idea that intelligence is simply a set cognitive capacity within an individual. instead, gardner (2008) claims that intelligence is unique to each individual, and its forms include linguistic, musical, bodily-kinesthetic, and interpersonal intelligences. alternative assignments could be supportive of diversity in learning styles, intelligences, and abilities (patterson & perlstein, 2011). the universal design for learning (udl) framework emphasizes that not all learners are the same and highlights the need for educators to provide multiple ways for students to engage with content that showcase their strengths (lowenthal et al., 2020). offering various assignment formats could allow students to demonstrate their understanding of the material in a way that feels authentic to them, regardless of their different strengths and abilities. this approach can promote a more inclusive and supportive learning environment for all students (lowenthal et al., 2020). by using formats like art, poetry, infographics, and voice recordings, students could not only convey their understanding of various topics, but could channel their own unique creative identity in a way that is nourishing to them, as well. ortega-williams et al./reimagining rigor in swk ed 153 redefining rigor through alternative assignments alternative assignments as catalysts for critical thinking in social work education, especially in courses like human behavior in the social environment where theories undergirding interventions are examined, critical thinking is essential. at the core of social work education, as an applied science field, students are being prepared to make assessments and interpret complex dynamics to better intervene at the micro-, meso-, and macro-levels in their workplaces. we train students to use approaches informed by ecological, intersectional, and trauma-informed practice perspectives to be responsive social workers. alternative assignments act as catalysts for critical thinking amongst students because they have fewer constraints and more opportunities for expression. students, therefore, could have more options for choosing how they would like to apply what they have learned in class to tackle problems in the assignment, find innovative solutions, and establish their own ideas and perspectives. students can demonstrate what they have learned and can be challenged to go the extra mile and think deeper—even when difficulties arise because students may be uncomfortable with being presented with more options or being in active learning environments (cohen et al., 2019). gambrill (2013) addressed the topic of critical thinking in her book social work practice: a critical thinker's guide. she described the characteristics of critical thinking as “self-assessing” and “self-improving” and how a critical thinker can critically examine their own thoughts (gambrill, 2013, p. 95). alternative assignments, unlike written papers, do not have to come with a list of rules and instructions, such as the american psychological association’s style formatting. given the nature of alternative assignments, educators could forgo word limits, page length requirements, citations, or thesis statements. therefore, students could have the space to create in any format they desire and the chance to explore different parts of their brains to come up with their response to the assignment. the types of dilemmas and restraints that social workers ally with their clients to resolve often require nimbleness as well as strategic and creative thinking. assignments offering practice in this type of thinking could be supportive of social work graduates. written tasks, on the other hand, generally do not promote originality due to their more restrictive formatting style. gambrill emphasizes how critical thinking forces us to pay attention to how we think, ''...not only the product of that process” (gambrill, 2013, p. 96). alternative assignments provide opportunities for learners to showcase their talents and demonstrate creative and logical thinking. furthermore, these assignments can be used as a self-discovery technique, assisting students in understanding their own inclinations that they might not have previously recognized. the approach a student takes to an alternative assignment might provide important information about their cognitive preferences and abilities. lastly, alternative assignments can help students practice real-world skills. when students complete their education and enter the workforce, the goal is that they have already honed their critical thinking skills and are better equipped to generate novel ideas, hypotheses, and projects. advances in social work, spring 2025, 25(1) 154 social work education amidst chatbot fears in social work education, there are multiple ways to assess learning and determine preparedness. assignments such as case studies, process recordings, community assessments, group proposals, research papers, and written essays are some of the most common tools (archer-kuhn et al., 2020; crisp & lister, 2002). over the years, social work educators have also re-imagined how assignments are designed, especially given fears about online learning of practice skills (forgey & ortega-williams, 2016) and the influence of artificial intelligence (ai), such as chatgpt (king & chatgpt, 2023). the focus within higher education on ai and plagiarism appears recent; however, ai and programs using virtual reality have been incorporated into social work education, medical training, and other social services for decades (adamopolou & moussiades, 2020; king & chatgpt, 2023; roswell et al., 2020). in higher education, ai has also been seen as one component in an overall push for greater digital literacy among students and faculty, in which all begin to understand how to use computers, including software and hardware for personal, academic, and professional advancement (quaishi et al., 2024; romero-hall & cherrez, 2023). internet-supported technology, such as ai, has been lauded in some contexts as advancing new opportunities for student advancement and relevance (king & chatgpt, 2023). ai programs such as chatgpt evolved as entrepreneurial tools in the service industry to mimic human conversation while providing digital assistance to multiple users simultaneously (adamopolou & moussiades, 2020). chatgpt can sort through voluminous sources of information to rapidly produce text-based answers with citations for users, mimicking human writing (king & chatgpt, 2023). therefore, what might have taken social work students weeks to envision, outline, draft, and revise could take seconds with ai, even though at times there are inaccuracies and limitations in the information that may be more or less apparent (ciampa et al., 2023; king & chatgpt, 2023). social work educators, as well as instructors across higher education, have expressed concern about the threats of artificial intelligence and are exploring strategies to deter plagiarism (king & chatgpt, 2023). what if our redesign of educational processes in response to chatgpt was not aimed at defeating plagiarism but at shifting the conditions compelling plagiarism? we assert that rigor could look differently if preparedness for social work practice was not determined by assessment strategies that de-prioritize students’ whole selves (brock-petroshius et al., 2023; park, 2023). what if colonial paradigms and white supremacist canons were not the dominant foundation of social work education, but instead offered assignments that embrace multiple histories and cultural wisdom (ortega-williams & mclane-davison, 2021)? what if we decreased our emphasis on written assignments and instead, created an educational process allowing for co-design, creativity, critical thinking, and well-being? if working to keep chatgpt plagiarism out of written assignments is our best fight for increasing rigor and preparedness in social work education, then we might be missing an essential aspect of what is possible in our classrooms. perhaps we can reconsider expending so much effort trying to outsmart chatgpt and instead examine the nature of our educational reliance on written assignments and how rigor is measured (whitaker, 2016). ortega-williams et al./reimagining rigor in swk ed 155 alternative assignments may give us an opportunity to deepen learning in social work education. in bloom’s taxonomy of learning (bloom & krathwohl, 1956), the lowest level of learning is knowledge memorization. a social work educator’s hope in assigning students essays to write is that students will demonstrate higher levels of learning, such as comprehension, evaluation, interrogation, and critical thinking (aviles, 1999; bloom, 1974), which are essential in social work practice at the micro-, meso-, and macro-levels. however, when there are obstacles to expressing the depth of what one understands because writing cogent outlines is difficult, what is actually being measured? alternative assignments to written essays could employ widely available creative formats and internetsupported technologies that support learning which are part of students’ everyday lives. for example, free software applications and mobile apps that create infographics and podcasts can be utilized to mobilize their strengths and assets on platforms that can have a broad reach (ciampa et al., 2023). alternative assignments have the potential to make social work education assessment more accessible to students and more reliable as a measure for educators. essays, accessibility, and disability justice educational outcomes reflect more than student preparedness. for example, bias within the learning environment has been linked to performance disparities between students (mcnair et al., 2020; shedd, 2015). test-taking and essay writing, which are typically used as indicators of students' learning, have come under fire for essentially capturing students' memorization of material rather than their actual knowledge of the subject matter (au, 2022; tannenbaum, 1996). this issue is consistent with larger conversations in the field of educational research that draw attention to the shortcomings of conventional evaluation techniques. for example, in a systematic review by baird and colleagues (2017), evaluations that gave priority to deeper understanding and application of knowledge above rote memorization were found to be more impactful. moreover, black and wiliam (1998) contend that by emphasizing skill development and feedback rather than just memory, formative assessment techniques can measure student learning more accurately. criticism is a part of a wider continuous discussion on educational assessment. the need for ongoing assessment to reflect real learning outcomes more accurately is highlighted by the differences in assessment techniques and their efficacy within disciplines (pellegrino et al., 2016). although some students do well with written formats, other students might be unable to reflect their understanding of a topic that way. for example, students may struggle to find the correct words to articulate their knowledge or feel pressured by restrictions and time limits. students have different learning styles that help them comfortably absorb and comprehend new concepts—including visual, auditory, and kinesthetic learning (oluremi, 2015). several studies have attempted to understand which curricular changes, based on learning styles, could be effective. the results have been mixed. for example, massa and mayer (2006) conducted a study with 175 participants to examine the effects of different multimedia instruction on individuals with visual or verbal learning styles. they found that advances in social work, spring 2025, 25(1) 156 both verbal and visual learners performed well using tech-based options within alternative assignments (massa & mayer, 2006). findings such as this might be interpreted as evidence suggesting that changes in instructional methods are not needed. some may argue that the current system has resulted in countless passing grades despite not aligning with diverse learning styles—so why would there be a need to change it (pashler et al., 2008)? emerging evidence from oweini and daouk (2016) in examining the effects of learning styles on students' academic performance and attitudes towards school found patterns countering massa and mayer’s (2006) findings. in this study, educators who accommodated students’ learning styles found an increase in academic performance and positive attitudes towards education and school (oweini & daouk, 2016). additionally, in a study by pološki and aleksić (2020) of 99 generation y graduate students in a human management course, students with a creative learning style were found to have a higher correlation with learning from active teaching methods. these findings suggest that allowing students to learn in ways that makes them feel comfortable and creative may support them in thriving academically, enjoying their college experience, and possibly benefitting their mental health and motivation. in addition to differences in learning styles, students who come from educational experiences lacking sufficient resources could face barriers adhering to rigid requirements that come with written assignments within a higher education setting. due to unequal resources, there are gaps in literacy and education, which disproportionately impact communities of color and those with learning disabilities across schooling levels (bell, 2021; shedd, 2015); therefore, there is an urgent need for change. schools with more funding have access to resources that better prepare students for higher education (lombardo, 2019). for example, students coming from schools with limited funding have less access to qualified teachers, higher-level courses, and advanced placement classes (the commonwealth institute, 2021). due to this inequity, students are not acquiring the skills needed for higher education and may struggle to meet the demands of their college coursework, requiring them to work harder to reach the equivalence of peers coming from schools that had more funding, quality education, and academic support. students might feel disempowered using apa style and other traditional academic writing formats that are expected in college because of the lack of support in learning this skill. there are programs that teach these formats and help students throughout the process, but not all students have access to these resources or the extra time to dedicate to learning them. grammar, punctuation, and formatting are important for professional writing, and should be practiced by students to prepare them for their careers. however, students should not be penalized for mistakes, but instead given more opportunities to improve. additionally, students are expected to focus on writing in a specific academic format rather than learning how to write documents that are required of them when they enter the professional world—perhaps the focus needs to be reevaluated. rather than rigid, and sometimes outdated forms of assessment, alternative assignments, with more relevancy to daily practice in social work can be implemented. lastly, many students with disabilities face barriers to securing the accommodations needed to thrive under the same conditions as nondisabled students (mcnamara, 2019). accommodations can include taking extra time on assignments or making audio recordings ortega-williams et al./reimagining rigor in swk ed 157 of lectures (stefanakos, 2023). accommodations do not compromise critical thinking or content knowledge, yet students are required to go through extensive paperwork with documentation from physicians and psychologists to prove their disability in exchange for accessible education (mcnamara, 2019). one reason for this hurdle is the stereotype of “the disability con”—an assumption that people fake disabilities to receive benefits (dorfman, 2019). furthermore, some view accommodations for education accessibility as an unfair advantage that a select number of people receive. in reality, accommodations are not meant to create an unfair advantage, but rather to create equal opportunities for success (lombardo, 2019). alternative assignments allow students to be held accountable for their work, while also being given the opportunity to show their values beyond submission of assignments. rather than worrying about “the disability con” and creating more barriers for students with disabilities, adjusting the curriculum to accommodate all students could be impactful. instead of strict page limits and formats—which can be a barrier that further promotes ableism (eisenmenger, 2019)—students could be assessed on the quality of their work. assessing quality can include whether they are able to take away what they learn and integrate it into the real world. imagine if social work students were evaluated not just by successful completion of written formats but also how inspired they were by their work. what could be possible for innovation in social work practice if imagination and creativity were measured as often as apa formatting? in the authors’ experience, evaluation of alternative assignments has included rubrics related to theory application and one-page reflections (without suggested formatting), prompting students to consider takeaways that bridge learning from the assignment to their internships, social service jobs, or interests. adding alternative assignments does not mean eliminating written assignments—there are many students who prefer this form of evaluation and removing that option would restrict them. instead, students should have a choice depending on their individual needs (och & patterson, 2022). in choice architecture literature, providing choices when centering what is known about learners can encourage curiosity and inform decisions, while not burdening actual decision making (johnson et al., 2012). for social work educators, incorporating alternative assignments offers choices to students to support their full potential to maximize upon their different abilities, learning styles, and educational backgrounds. it could level the playing field for everyone to benefit while also challenging them in a creative way. alternative assignments can be beneficial within social work education, creating an opportunity for students to enjoy themselves as they incorporate creativity and passion into their work. this could be a source of motivation as they progress along their academic and professional journeys. advances in social work, spring 2025, 25(1) 158 our testimonies alternative assignments could increase the relevance of student work in society by promoting self-exploration. students are supported in experimentation with creative resources, particularly internet-supported and multimedia technologies, when given alternative assignments. these assignments could provide the opportunity for students to explore what they can do and how they can stretch—while also evaluating their knowledge. consequently, students can become more creative and better situated to generate new perspectives and ideas and raise questions relevant to resolving social issues (fredagsvik, 2023). scan the qr code for examples of alternative internet-based assignments used in our social work classroom. in this section, each author shares their personal experience with alternative assignments in a human behavior and social environment bachelor of social work (bsw) class. we present our testimonies to further exemplify the opportunities for students and educators made available through alternative assignments. linden: completing my blog allowed me to explore avenues to help end hiv stigmatization. i wrote an advocacy letter to congressman hakeem jeffries requesting support for the repeal hiv discrimination act. alternative assignments allow students to apply skills learned in the classroom to other endeavors, such as promoting social exploration. exploration initiatives enable students to pursue endeavors with societal relevance since they aim to address social issues. in this case, i utilized artwork by keith haring to highlight the need to increase awareness of hiv stigmatization. exploration of my knowledge of the hiv pandemic helped to sensitize community members to the need for increased awareness to manage the impact on society. students, like me, can pursue what they can do to address social problems using alternative assignments, which increases the relevance of our contribution to academia and society-at-large. alternative assignments can promote a sense of safety among students while providing scaffolding for exploration and integration into society. this could help to enhance their enthusiasm for collaborating with instructors and developing projects with social relevance (amerstorfer & freiin von münster-kistner, 2021). in addition, alternative assignments provide scaffolding for learning objectives as students interact with professionals to seek support. for example, in my blog, i shared how i collaborated with the hetrick-martin institute (hmi) to promote positive living among youths diagnosed with hiv. the collaboration enabled me to explore my values and perspectives on positive living in society. in the blog, i explained my struggle with sexual identity and relationships after being diagnosed, leading to self-stigmatization. my blog also elaborates on the importance of national youth hiv/aids awareness day (nyhaad), my participation, and how effective collaboration is essential for success. my example demonstrates the power of students seeking collaboration with professionals through alternative assignments and how it can increase participation, socially. link tree, n.d. https://linktr.ee/sw_ed_alternative_assignments?utm_source=qr_code ortega-williams et al./reimagining rigor in swk ed 159 valerie: the alternative assignment held space for me to create something purposeful. building on an existing passion, i created an infographic of a “survival guide” for students with disabilities transitioning from high school to postsecondary education. this process deepened my awareness of ableism, the prejudice many members of this population experience, and potential barriers for students in securing services and accommodations during this transition. i entered my current internship working with students with autism with new insights i gained through creating the guide. ultimately, the alternative assignment not only nourished my interest in addressing disability justice but opened my eyes to the power of incorporating creativity in social work education. during finals, i saw using my creativity to complete an assignment for hbse as a form of self-care amidst rigid assignments that my other courses required. i vividly remember professor ortega-williams encouraging our class to choose the alternative assignment as a way to demonstrate our “brilliance” in a way that a paper might not. even though i chose the alternative assignment, i was doubtful about my creative abilities. through the process, i experienced the power of my own creative outlet, which indeed is within all of us. i also recognized how expressing our brilliance in a way that is authentic can be a form of selfcare, a topic which has been emphasized greatly in all my social work classes. sebastian: i found a lot of joy and passion in my experience with alternative assignments. my facility with writing and with words is something i take a lot of pride in, and i do find joy in writing, but formal, academic writing was never just about the writing. i had to contend with aspects of academic paper-writing concerning word choice—specifically formality, tone, and formatting. writing and reading are effective and important, to be sure, but alternative assignments opened a new world for me, a new way to synthesize knowledge, and how to interact with and engage myself and the clients i worked with in my internships. the creative impulse is something we all have, and it proved to be an invaluable tool for reaching out to clients who did feel like artistic or creative pursuits were more accessible for them. creativity was a means of communicating insight, self-knowledge, and other embodied information that they did not feel capable of communicating through words alone. saadia: the concept of alternative assignments within social work education was new to me. throughout my educational journey, i rigorously submitted countless essays, powerpoint slides, and exams every semester as a testament to the knowledge i gained. i enjoyed intertwining my creativity into my work because it made learning more enjoyable—but i did not have many opportunities to do this. over time, i lost my sense of creativity and love of learning. instead, it became something i dreaded. with the pandemic, the transition into online learning was difficult for students and educators—but it was an opportunity to question what needs to change about the norms within academia. alternative assignments allowed me to realize my full potential as a student and created space for me to consider the kind of social worker i desire to be. advances in social work, spring 2025, 25(1) 160 some may see alternative assignments as an easy way to receive a passing grade, but i saw it as an opportunity to challenge myself. i wanted to incorporate something i love and present it in a way that forced me to work on my weaknesses. i collaborated with a colleague to create a podcast where we looked at the novel it ends with us, by colleen hoover, through a social work lens. we analyzed the traumatic experiences of the characters and how they carried that impact with them into adulthood. we looked at research that explained differences in behaviors and compared it to the stigma around trauma within our own culture that needs to be addressed. the entire process of making this was so enjoyable and memorable that we wanted to go above and beyond! alternative assignments can be both enjoyable and challenging. education should not feel like a chore for students and should not be something they dread. there are countless ways to cater to the needs of students and clients. it is our duty as social workers—and educators—to find and implement those methods. individuals should not be forced to lose their identity to conform to rigid systems—systems need to change to better support them. zainab: the alternative assignment presented a creative opportunity that pushed the boundaries of my thinking. it provided a platform to hone skills that might have remained dormant, otherwise. this project held a deep personal significance, as it involved collaborating on a podcast with a close friend from my class. together, we delved into a book she had gifted me during our first encounter—an act that became the foundation of our friendship and our shared passion for literature. this unique bond, built around our mutual love for books, is something truly special and not easily understood by everyone. working on an assignment that showcased our skills and understanding and connecting it to ourselves in such a personal way, we were able to create something very special. it felt like the best way to express our learning and individual thoughts. anna: my approach as a social work educator is rooted in a black, queer, womanist, pedagogical standpoint. as a social work educator, this means i want to create an educational context in which students support themselves and each other in healing, learning, and applying their education to real-life dilemmas, struggles, and joys. my hope is to prepare social work students to be allies in the communities in which they will work. my standpoint shapes my responsibility to marginalized learning styles and academic needs. it requires that i explore my own socialization and biases as an educator and take responsibility for them in my curricular design. for example, i wrestle with the traditional canon of human behavior in the social environment as i seek to acknowledge the many roots of social work practice. therefore, when instructing on development across the lifespan, my curriculum includes not only erik erikson (hutchinson, 2019), but also dr. maria yellow horse brave heart (1998) to address intergenerational harm and healing. at the height of the covid-19 pandemic, my students and i struggled with diagnoses, grief from loved ones dying from the illness, and other stressors. several students remarked that the assignments in my curriculum were too overwhelming and hard to accomplish, given all that was happening. cognitively, some described feeling too blocked to assemble ortega-williams et al./reimagining rigor in swk ed 161 strong essays, but they still wanted to demonstrate how deeply engaged they were in the readings and discussions. creating alternative assignments meant that we all had a fighting chance at succeeding in the learning process; we failed and won together as we remixed assignments. for example, one assignment that i originally designed as a paper, i revised to include a podcast, blog, or infographic. i needed to creatively maintain and revise grading criteria to assess learning using these new approaches. for some students, the change of assignment style was a relief. for others, alternative assignments posed new challenges. we engaged in several meetings to consider together how to translate their learning from class readings and discussions into an alternative format. additionally, we ran into technical obstacles on digital platforms, which were difficult to untangle at times. i managed these challenges by giving students additional time for assignments and encouraging mutual aid among students during class time. i also offered extensive feedback and gave students the opportunity to incorporate it before i finalized their grades. my approach to grading included giving a rubric in advance, reviewing student’s material, making suggestions for improvement, offering students 5-points for completing reflections on an assignment to consider how learning was integrated. grading included points for creativity, critical thinking, effort to integrate feedback, as well as content. formatting held less overall points for the mid-term and final, so judging students’ skills and knowledge was less about the format compared to the content. students expressed how helpful my flexibility was in accomplishing their assignments and achieving their goals within our class. overall, it was a learning experience for all of us that continues to shape my approach to co-designing transformative education. conclusion alternative assignments could redefine rigor by creating a space where students can apply critical thinking to demonstrate their knowledge by enabling new ideas, perspectives, and solutions without the barriers embedded in written assignments. in our experience, alternatives to written assignments offered fresh options to promote a higher level of learning that prepared the students and educator alike with new, beneficial skills. we believe research on alternative assignments could provide useful information to educators committed to promoting disability justice. equipped with a better understanding of which assignments are meaningful to students and support multiple learning styles educators could reimagine the possibilities for effective social work education. additionally, the data could be used to improve the relevance of assignments in the 21st century as preparation for the workforce in a society that is increasingly more reliant upon digital tools for practice. educators willing to partner with students in this research could fill the gap between academic content, assessment, and students’ real-world preparation for the social work profession. it is possible for educators to improve social work education by embracing alternative assignments that are student-driven to increase the impact of their students' work, thereby better equipping them for success in a field that is constantly evolving. we believe, given our research and lived experience with alternative assignments, that this might be a powerful way forward. advances in social work, spring 2025, 25(1) 162 references adamopoulou, e., & moussiades, l. 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(re)defining academic rigor: from theory to praxis in college classrooms. currents in teaching and learning, 8, 4-17. author note: address correspondence to dr. anna ortega-williams, silberman school of social work, hunter college, new york, ny, 10035. email: anna.ortegawilliams@hunter.cuny.edu https://www.understood.org/en/articles/types-of-college-accommodations-and-services https://doi.org/10.2105/ajph.2008.156497 https://doi.org/10.2105/ajph.2008.156497 http://files.eric.ed.gov/fulltext/ed395500.pdf https://thecommonwealthinstitute.org/research/unequal-opportunities-fewer-resources-worse-outcomes-for-students-in-schools-with-concentrated-poverty/ https://thecommonwealthinstitute.org/research/unequal-opportunities-fewer-resources-worse-outcomes-for-students-in-schools-with-concentrated-poverty/ https://www.researchgate.net/profile/manya-whitaker/publication/322665019_redefining_academic_rigor_from_theory_to_praxis_in_college_classrooms/links/5a677d540f7e9b76ea8f00fd/redefining-academic-rigor-from-theory-to-praxis-in-college-classrooms.pdf?_tp=eyjjb250zxh0ijp7imzpcnn0ugfnzsi6inb1ymxpy2f0aw9uiiwicgfnzsi6inb1ymxpy2f0aw9uin19 https://www.researchgate.net/profile/manya-whitaker/publication/322665019_redefining_academic_rigor_from_theory_to_praxis_in_college_classrooms/links/5a677d540f7e9b76ea8f00fd/redefining-academic-rigor-from-theory-to-praxis-in-college-classrooms.pdf?_tp=eyjjb250zxh0ijp7imzpcnn0ugfnzsi6inb1ymxpy2f0aw9uiiwicgfnzsi6inb1ymxpy2f0aw9uin19 mailto:anna.ortega-williams@hunter.cuny.edu mailto:anna.ortega-williams@hunter.cuny.edu positionality literature review creativity, health, and social work education redefining rigor through alternative assignments alternative assignments as catalysts for critical thinking social work education amidst chatbot fears essays, accessibility, and disability justice our testimonies conclusion _________ elizabeth j. goldsborough, msw, lmsw, phd candidate, lukas champagne, msw, phd candidate, and breana a. bietsch, msw, lmsw, phd candidate, school of social work, university of connecticut, hartford, ct. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 167-185, doi: 10.18060/28452 this work is licensed under a creative commons attribution 4.0 international license. shaping pedagogical identities: a collaborative autoethnography of a virtual doctoral student pedagogy peer mentoring group elizabeth j. goldsborough lukas champagne breana a. bietsch abstract: in this collaborative autoethnography (cae), we examine a virtual doctoral (phd) student pedagogy peer mentoring group’s experience within a social work program at a northeastern u.s. public research university. our focus is on the experiences of phd students who are preparing to teach. utilizing cae as our methodological approach, we identified themes salient to our group experiences. key themes include navigating role and identity transitions, the value of community, the need for enhanced institutional support, and the role of educators as gatekeepers. our findings underscore peer mentorship as a crucial component of doctoral training, not only for fostering camaraderie and reducing isolation, but also for enhancing teaching preparedness. we recommend implementing structured peer mentorship, expanding pedagogical training, and strengthening institutional support to better prepare doctoral students for teaching. keywords: doctoral education, pedagogy, peer mentorship, collaborative autoethnography, higher education, teaching preparation graduate school offers professional growth and a foundation for an academic career beyond dissertation preparation (fernandez et al., 2019). however, a primary role of doctoral education—preparing graduates for teaching (kurzman, 2015)—is often underemphasized in many doctoral (phd) programs (bonner et al., 2020; bullin, 2018). social work phd programs have been criticized for not adequately preparing students for this vital role (kurzman, 2015). this lack of preparation is evident as less than half of social work programs view educating phd students to teach as central to their curriculum or require a teaching course, and only 23% require a teaching internship (drisko et al., 2015). current recommendations—not requirements—for doctoral student-instructors suggest they teach at least one class independently (kurzman, 2015). in response we propose the implementation of pedagogy peer mentoring groups within doctoral programs. this innovative approach aims to address the identified gaps in pedagogical training and provide emotional support (meanwell & kleiner, 2014), enhancing students’ preparedness and confidence to teach. the transition from student to teacher during a phd program is full of challenges (meanwell & kleiner, 2014). first-time instructors often struggle with the emotional demands of teaching and may feel unprepared for the emotional labor involved, including managing student expectations, maintaining authority, and coping with intense feelings after particularly successful or difficult class sessions (meanwell & kleiner, 2014). these challenges relate to three common assumptions about first-time teaching. first, there is an assumption that teaching graduate students requires the same skills as teaching other about:blank https://orcid.org/0000-0002-6845-5429 advances in social work, spring 2025, 25(1) 168 educational levels (macleod et al., 2019). however, teaching graduate students requires fostering advanced, independent, academic thinking. many phd students lack training in these pedagogical methods, leaving them unprepared to support graduate students’ intellectual development (macleod et al., 2019). second, teaching is not always regarded as a “serious intellectual pursuit” (east & chambers, 2007, p. 811), leading to the misconception that phd students do not need formal teaching preparation. however, firsttime teaching can be emotionally demanding (caires et al., 2012; meanwell & kleiner, 2014), and phd students may be unprepared for the emotional demands, time commitment, and exhaustion that come with it (meanwell & kleiner, 2014). third, there is a tendency to overlook the role of instructors’ social identities—including age, race, ethnicity, sexual orientation, gender identity, class—in shaping their teaching experiences. doctoral student-instructors report a lack of respect from students (lu et al., 2019) even though evaluations suggest their teaching quality is comparable to that of other instructors (thyer et al., 2011). phd graduates receive little support in developing and managing their classroom identities (lu et al., 2019; morgenshtern & novotna, 2012). these assumptions may leave phd students unprepared for teaching. to assist phd students with teaching preparation, social work schools have implemented a range of teaching-related programs, including teaching seminars taken during students’ first semester of teaching (meanwell & kleiner, 2014; pelton, 2014), workshops (rinfrette et al., 2015), post-master’s field experience requirements for teaching core courses (kurzman, 2015), and assessments of teaching readiness (pelton, 2014). in our program, a teaching seminar is required for third year phd students to provide preparation for teaching social work courses. the seminar covers pedagogical theories, course development, classroom facilitation, and accreditation standards. students develop teaching philosophy statements, engage in structured reflections, and teach a class contemporaneously with the seminar. given that approximately half of social work doctoral programs require a teaching course, accredited programs have room for improvement in pedagogical preparation. u.s. higher education context the shift towards a business model and increased reliance on adjunct faculty have impacted teaching quality in u.s. higher education (burghardt, 2021; lucal, 2015). students are generally less economically well-off than prior generations, as bachelor’s degrees become necessary for entry-level positions, and are increasingly exhausted as they must participate in the labor market while completing degrees for stagnant wages (lucal, 2015). market demands amid rising inequality under neoliberalism has led to an increase in master of social work (msw) programs (burghardt, 2021), raising concerns about the educational quality in these expanding programs (karger, 2012). under neoliberal conditions, social work is dependent on a complex mix of funding from private and public sectors and is increasingly asked to comply with bureaucratic standards of evidentiary “success” focused on short-term, low-cost solutions to some of life’s more intransigent micro and macro problems (watkins-hayes, 2009). among these are poverty/inequality, discrimination/racism, child abuse and neglect/reforming a broken and racist foster care system, mental health and substance use disorders, and imprisonment/mass incarceration. goldsborough et al./doc student peer mentoring 169 due to philosophical and historical conflicts between the charity organization societies and the settlement house movement, significant changes in funding and oversight since the early 20th century, and the cyclical nature of our nation’s attitude toward the social safety net, the msw is a professional degree requiring skill sets that do not always cohere in meaningful ways (fisher et al., 2021). are we therapists? child welfare workers? policy advocates? community organizers? social change agents? social control agents? we have been all of them, at times, and to some degree, are all of them now, though rising numbers of us become individual and family therapists (specht & courtney, 1995). increasingly, msw degrees are offered through expedited programs, raising concerns among faculty and professionals about the preparedness of the coming wave of social work practitioners and academics (burghardt, 2021). the magnitude of the challenges we face, and the content of our code of conduct (national association of social workers [nasw], 2021), advance the “explicit expectation that the educational rigor required to meet them will be exacting” (burghardt, 2021, p. 74). yet pedagogy is increasingly de-emphasized with students and faculty. burghardt (2021) notes that “while a vast majority see teaching as a primary part of their job,… faculty ‘get little support in improving how they teach and spend less time in the class than in the past’” (p. 78). how do we reconcile the ever more challenging requirements of our work amid historic inequality, and the coming effects of a climate disaster, with the deskilling and deprofessionalization of social work? pedagogy peer mentoring groups although nearly all u.s. social work phd programs aim to prepare students for teaching, only half require completing a pedagogy course (maynard et al., 2017). our virtual pedagogy peer mentoring group was designed to provide a supportive and informal space for sharing experiences, discussing teaching strategies, and receiving peer feedback—a promising model for doctoral student-instructor success (katz et al., 2019). group mentoring is “a collection of three or more individuals, connected by their social relationship, distinctly gathered for the specific and shared purpose of intentionally challenging and supporting the others to enhance personal growth and professional skills/development of the others” (kroll, 2016, p. 56). peer group mentoring is a subtype of group mentoring that benefits its participants by providing collaborative input into personal and professional needs (huizing, 2012). canadian doctoral students have called peer mentorship “an under-utilized resource with great capacity to foster human and social capital within and between cohorts of graduate students” (preston et al., 2014, p. 63). although peer mentoring appears to have positive effects for graduate students, there is a paucity of literature that examines the utility of peer pedagogical support (joyce & hassenfeldt, 2020). in a study of graduate teaching assistants (tas), joyce and hassenfeldt (2020) found that tas were receptive to peer mentors and other teaching development opportunities. noonan et al. (2007) determined that relationships forged through peer mentorship provided phd students with meaningful professional and personal connections. doctoral student-instructors in canada developed a peer pedagogy group due to a perceived lack of institutionalized support for emerging instructors (bailey et al., 2016) and suggested that doctoral programs include teacher training in their curriculum. advances in social work, spring 2025, 25(1) 170 our program, housed in a northeastern u.s. public research university, requires a pedagogy course offered during students’ third year—the first semester they are expected to teach. historically, students have wanted additional pedagogical support before and after this required course. the group we participated in filled a gap identified by current and emerging doctoral student-instructors. those of us who joined the group desired peer mentoring to supplement what was provided by school administration and faculty mentors. peer support and isolation during the covid-19 pandemic the covid-19 pandemic has led to an increased sense of disconnect and isolation (pantell & shields-zeeman, 2020), highlighting the need for innovative support structures. in line with current literature, our reflections and conversations in our group highlight experiences of isolation that were exacerbated during covid and were discussed as a precipitator to starting our group. staying connected virtually can enhance social connectedness and decrease feelings of loneliness (pantell & shields-zeeman, 2020). during a phd program, support from peers, mentoring from advanced students, professional development opportunities, and informal interaction with peers are instrumental in providing emotional support to decrease isolation (janta et al., 2014). in line with literature on providing emotional support during phd programs, our group stayed connected virtually during a time when this was necessary, we built connections, received support from peers, supported each other professionally, and had an opportunity for advanced students to mentor junior students. group process the formation of our virtual pedagogy peer mentoring group arose from a need for enhanced pedagogical support among students. the group was formed by a third-year doctoral student-adjunct instructor who invited all current phd students in our program to attend. seven students participated, representing a third of our program. most group members were secondand third-year students, and all had msw degrees. the group met biweekly for one semester via videoconferencing due to covid-19. we began each meeting with a check-in. group members who were actively teaching discussed studentrelated issues that could benefit from group discussion, sharing their experiences and challenges openly with the group. those not yet teaching spoke candidly and provided a student viewpoint. at the end of the semester, we wrote about our individual and collective experiences related to the group. we split into two writing collectives: those currently teaching and those preparing to teach. this collaboration is authored by three students belonging to the latter collective. goldsborough et al./doc student peer mentoring 171 methods research design and approach autoethnography autoethnography (ae), as a method of research and inquiry, emerged from anthropology in the 1970s (chang, 2013). a subset among self-study research approaches, ae focuses on the self in a larger context, exploring sociocultural and political forces at work in the individual lives of authors/researchers (hamilton et al., 2008). according to chang (2013), among its common features are using the researcher’s own experiences as the primary data and an interest in explicating social phenomena. methodologically, ae is pragmatic. data are typically recorded as narratives, however, it is up to the author/subject how best to communicate their experiences to their audience (witkin, 2014). it is useful to underline that ae’s merits are not meant to be judged according to objectives like generalizability or reproducibility. instead, ae “resides in the interstices between research and literature” (witkin, 2014, p. 3). ae often includes a cultural component, revealing something about the group to which the researcher belongs—their professional identity, the way structural and societal forces are managed by their group, their common thoughts, and actions. collaborative autoethnography. collaborative autoethnography (cae) allows researchers to work in a community, typically in groups of two to four, to utilize ae in a social context. cae allows researchers to “work together, building on each other’s stories, gaining insight from group sharing, and providing various levels of support as they interrogate topics of interest for a common purpose” (chang et al., 2013, p. 23). researchers engaged in cae listen to one another’s views, reflect on their own assumptions, and challenge one another (chang, 2013). cae augments ae and addresses some of its methodological and ethical challenges by valuing others’ experiences and allowing greater anonymity (lapadat, 2017). phd students have employed cae to explore mentorship (gurvitch et al., 2008), identity formation among students of color (murakamiramalho et al., 2008), writing groups (vacek et al., 2019), immigrants’ teaching experiences (morgenshtern & novotna, 2012), and peer support (mcphail-bell & redmanmaclaren, 2019). additionally, cae was an appropriate methodological approach during covid-19 as it allowed for ethical qualitative inquiry through self-reflection and collaboration in an “unprecedented time of lockdown, self-isolation and social distancing” (roy & uekusa, 2020, p. 384). data collection to explore our experiences in a pedagogy peer mentoring group as phd students who were not yet teaching, we followed chang et al.’s (2013) concurrent and full collaboration cae model, which required all research team members to be engaged in every stage of the research. our preliminary data collection consisted of individual reflections written at the conclusion of the academic semester. the reflections were shared within the group and, inspired by ngunjiri and colleagues (2010), we employed a probing technique to elicit advances in social work, spring 2025, 25(1) 172 deeper insights. we engaged in group meaning-making, followed by individual meaningmaking, and concluded with group writing. throughout our iterative cae process, we met biweekly to discuss our individual reflections, focusing on identifying common themes and divergent experiences. memories and emotions provide useful data in autoethnographic work (poulos, 2021) and our data consisted of personal memory, recollection, and selfreflection (chang et al., 2013). data analysis we employed thematic analysis to identify and interpret key themes that emerged from our reflections. the process was collaborative, with each team member involved in the analysis to ensure multiple viewpoints. we used close reading methods to extract themes and gather insights from our experiences. close reading entails pulling out and interpreting important meanings that are suggested, or implicit, within a text (paul & elder, 2008). to ensure rigor, the first and second authors reviewed the reflections independently, identified themes, and convened to compare findings and agree on a list of codes. we manually checked coding for agreement to ensure consistency in our interpretations. to maintain critical reflexivity and acknowledge our positionality, we maintained awareness of our historical selves and shifting identities (denzin, 2002; england, 1994). data collection and analysis spanned one and a half years, allowing for a thorough and reflective exploration. the reflections and derived themes from this process are presented in the following section. results personal reflections student a even though there is an implicit expectation in my phd program that students will become professors, few assignments are designed to enhance teaching skills. as i entered my final semester of classes, i felt a need for additional pedagogical training. i will take a required pedagogy course when i start teaching, but part of me wishes i could complete it beforehand, even though it will be useful as i navigate teaching for the first time. after i received my first teaching assignment, i attended a seminar for rising doctoral studentinstructors. the seminar, however, provided minimal information on pedagogy. i was encouraged to attend university-wide professional training seminars that sounded useful. these, however, were located on a different campus an hour away from my school. attending this seminar heightened my desire for a dedicated space for rising doctoral student-instructors to discuss teaching-related concerns with current student-instructors. and i wanted to do this before i started teaching. the pedagogy peer support group exemplifies the supportive school culture amongst phd students that i have experienced in my program thus far. the group consisted of seven students: two from my cohort, three i had previously taken classes with, and one i met for the first time. folks spoke candidly about their teaching experiences and shared opinions freely. everyone seemed interested in cultivating a welcoming and supportive culture. and goldsborough et al./doc student peer mentoring 173 all of this was happening as covid raged through the country and world. our large public research university, along with many other schools in the united states, moved most learning online. group members were teaching remotely, and the group met remotely. videoconferencing made it easy to meet, especially since a handful of us do not live in the immediate school vicinity. a classmate a year ahead of me initiated the group. i immediately decided to join. i hoped to learn from my colleagues and get ahead on preparing to teach. during group meetings, doctoral student-instructors introduced dilemmas and difficulties they encountered, and they also shared what went well. i sometimes felt like a student peeking into the life of my professors. one ongoing discussion was about the need for balance between how much support, referred to as “handholding” by some, was helpful for students. we discussed instructor-related dilemmas such as burnout, the dual role of doctoral student-instructors, grading and class prep time-management, and feelings of isolation. as the semester carried on, discussions about students’ and instructors’ pandemic-related isolation became more frequent. group members shared incidents of students turning off their cameras during online class sessions while those who kept cameras on appeared distracted. covid-induced isolation and inattention affected students and instructors in various ways. group members remarked that the pedagogy group helped reduce these feelings of isolation. as i listened to my colleagues speak about their teaching experiences, i thought back to my undergraduate and graduate school years. as a poor immigrant and first-generation college student, i had to figure out college for myself. i was not socialized to the norms of academia, and i did not know how to approach professors and administrators. i felt grateful for the opportunity to be in college. now, as i approached the opportunity to teach, i faced fears about my self-perceived limited understanding of academia. although i completed college, the process proved challenging. i was academically dismissed during my second year of school. woefully unprepared, i did not know when or how to seek help. luckily, a mentor took an interest in me and helped me to better understand the academic world. they later inspired and supported me when i applied to msw programs. now, as i approached my first teaching assignment, i again felt like an impostor and was in search of support. i found myself asking: am i smart enough to teach others? do i have enough experience? will i be able to convey my sense of excitement about the subject matter to my students? as i grapple with impostor syndrome, i see how my experiences and various identities— first-generation college student, immigrant, queer, woman, lived experience of mental illness, class straddler (lubrano, 2005)—encompass all areas of my life, including here. i hope to provide mentorship for other class straddlers—first-generation students whose poor or working-class backgrounds make higher education an unfamiliar and uninviting space and result in feelings of not belonging to either group. hearing colleagues’ experiences normalized my feelings of “not knowing” what to do. i was not alone in not knowing, and i had a support system. my anxieties around the types of classroom issues i may encounter were eased and i learned about various teaching approaches—from “let students sink or swim” to “handholding” and everything in between. i realized i do not have to take the same approach with each student or with each assignment. as i considered what kind of instructor i aspired to be, i asked myself: how advances in social work, spring 2025, 25(1) 174 will i set boundaries for myself in a way that allows students to flourish? linking classroom assignments to practice experience resonated greatly for me, and it felt imperative in a practical master’s program. ultimately, the pedagogy peer group provided a space to stay connected during covid in a way that was structured yet not burdensome. it was not just another video call that i had to attend. the group was social, focused, and purposeful, and it got me thinking back to my days as an msw student over a decade ago. which professors do i remember? do i recall what they said or what they did? one quickly came to mind. their kind nature and ability to connect classwork to real-life issues was invaluable. i will try to emulate that for my future students as well. student b i'm not sure why i agreed to participate in a pedagogy peer support group. i do not experience much interest in doing things in groups. i am a horrible social worker in that respect. i tend to view exhortations to engage in self-care and to build community in graduate education as cynical on the part of faculty and administrators. there really is not much time, and there is a sense in which it is just the institution shirking its responsibility to support students emotionally and professionally (while it asks professors to focus their attention on pretty much anything but pedagogy). support each other, teach each other. this is not unique to my own institution, of course, this is just the state of modern academics. it is increasingly based on a business model, and the emphases are on maintaining accreditation, gaining a higher national ranking, and avoiding conflict. universities under neoliberalism must serve the customer—the students and their parents—not only from a pedagogical standpoint, but from a customer service standpoint. minimizing discomfort. making everyone feel uniquely important. there is also a very real sense in which i experienced a lot of trauma and watched a lot of sylvester stallone and clint eastwood movies as a kid. that is, my personality and self-image are part of the problem here. i sometimes imagine i am a self-made world beater beholden to no one. i'm a straight, white, cisgender man, and by all appearances have that surplus of confidence which those ascribed characteristics herald in a society that overvalues them. certainly, some part of my confidence stems from the advantages which accrue to those who tick those boxes. but we are all dynamic people who hold multiple identities, some more privileged than others. graduate school was not inevitable or expected for me. nearly all the men on both sides of my family worked in the local paper mill, dating back generations. i was a poverty-wage cook until i was 34 years old, which is when i earned my bachelor's degree. i do experience impostor syndrome, and very often feel like i do not belong. class is little discussed in graduate programs, even in social work graduate programs. in contrast to racialized status, however, there are no external markers of my class background. i appear for all the world to belong where i am. in addition to my privilege, my confidence also stems from an understanding that i have the skills most people have in an academic environment, and more besides. the poverty, addiction, and violence i emerged from are not strictly disadvantages. i know i can survive here because i survived there. i also might not have survived it or survived it with my freedom and voting rights intact, had i not looked like i do. goldsborough et al./doc student peer mentoring 175 to be frank, i cannot remember whether i had already agreed to do the peer teaching group when i experienced an administrative onboarding and airing of concerns meeting run by a professor/administrator and an administrative assistant. either way, from that meeting, it was very apparent we would have to do it ourselves—the discussions of pedagogy, maintaining discipline and collegial interactions, ground rules, discussion formats, ways to tweak and enable participation. the professor/administrator and the assistant grounded everything in processes related to administrative disciplinary procedures for students and suggested that we undertake a lot of unpaid training on our own time through the main university, which is physically quite distant from the school of social work. there were some suggestions about how to order instructor copies of textbooks, but honestly that was it. largely it was administrators anticipating logistical issues we might face that they might then have to resolve and clarifying the circumstances under which they could and should be bothered. i probably joined the group so i was not saying no to everything. and because those unpaid trainings are not set up for us as students at the school of social work in physical or administrative ways. and because summer is when phd students are supposed to work on articles for publication if they want to be competitive in the job market. and because i have a small child. i probably would not make it to many trainings, and if they do not care to mandate training and pay for it, if professionally trained teachers for msw students is not a budget line item, who am i to quibble? i am probably not nearly frightened enough of teaching. i figure i will just be good at it like john rambo would be good at it. if they're inclined to agree, so be it. and yes, i am both kidding and not kidding. i am motivated less by community, than by a sort of anger about the corporatization of education, and a sense of responsibility to students. preparing to teach is an interesting moment of role transition, of identification with the student in conceptualizing one’s role as an instructor. of responsibility. of wondering what it might be like to be taught by yourself. talking with people who might, like me, have never taught and are struggling with the same concerns; talking with people ahead of me who are teaching and who are pressed up against a lack of preparedness (and the details of that unpreparedness); with people who are several years in and still feel out of place—all of that has undeniable value. are there personalities like mine? philosophies like mine? am i a disciplinarian? is it easier to start stern and get “cool” than it is to start “cool” and gradually find your level as an agent of control? how is this school different from the school i attended for my msw? are my expectations for students’ seriousness and professionalism reasonable? i enjoy an approach to pedagogy that i think is in decline. i like teachers who know the material and can speak extemporaneously. i like teachers who have a plan, who keep things moving, and who challenge students’ assumptions. i like an expert. there are parts of the wildly popular freire/audre lorde approach that i admire and wish to emulate, in terms of facilitating class discussion, and of fostering involvement and the bringing of the “self” into the room, but i do not think that should be the whole class. i have felt at times in my own education that my teachers and professors were hiding behind their slides and their participation models, that they were not confident in their intellect and reasoning ability. this is not to say that people should be any further along than they are as scholars and advances in social work, spring 2025, 25(1) 176 teachers, but that they should know what they do not know, be upfront and comfortable with that, and have some confidence in their perspective and ability. i cannot really be as knowledgeable and fluent as i aspire to be, yet, without establishing familiarity with the material i will be teaching. still, i harbor ambitions not to be too dependent on slideshows and videos to get the material across. i want to challenge students who are likely, statistically, to be too micro-focused to think of their practice in the macro context. i was interested to see what my colleagues could offer in terms of personality and time management, culture building exercises, and establishing some balance of authority and horizontal engagement despite relatively novice-level experience. i received data on all of this, from colleagues with differing philosophies and levels of expertise, and that data will be valuable as i develop my own style. this engagement on the subject of pedagogy was not going to be offered to us by the faculty or administration ahead of time. if the third years, fully immersed in teaching, believed this was going to be helpful or necessary, i was inclined to agree. i was fortunate to be a year behind those of my colleagues whose first experience teaching was in the context of distance learning during the covid-19 pandemic, and behind those, too, for whom this was still a relatively new experience. some of the topics covered under the rubric of covid challenges may not be things i will experience directly when i begin teaching in person in the fall, though the future is uncertain. i believe, however, that pandemic conditions helped to center topics like student mental health; encouraging participation in creative, person-centered ways; and how to manage the modern, often at least partly digital classroom—something we will all likely be tasked with managing at some point given the corporate model of modern education. i walked away feeling very strongly that i needed clear expectations for students ahead of time, that i would need to state some fairly obvious things in the first class. i came away believing in the necessity of checking in personally with students early on when confronted with inattention or missed deadlines. we discussed the responsibility we have to the profession to act as gatekeepers, and to do so thoughtfully and with empathy—that is, to help populate the profession with compassionate, hard-working, competent people across identities. the group also seemed like an effective way to concentrate and organize our resources for the sharing of classroom exercises, useful readings, forms to better navigate gender identity in classrooms, as well as less sexy things like what university resources are available to us and what their phone numbers are. i know there are slides i can use, which are collaboratively assembled, when i ultimately fall short of my own unreasonable expectations as an orator. in a sense, while not compelled to join the group by the siren song of community, the pooling of information and effort that community affords us ended up being one of the most prized outcomes for me. student c when i heard that the upper cohorts in my phd program were starting a pedagogy peer support group, my first thought was that of excitement. a lot of this excitement was due in part to needing a connection to others. i had been feeling isolated for much of the year. i tend to think of myself as part of the “covid-19 pandemic cohort.” i am one of only two people in my cohort that started our phd program at the height of the pandemic. this year goldsborough et al./doc student peer mentoring 177 has been difficult being on a first-year island and i wanted to hear from the cohorts above me to build a connection to the program. a big part of my academic experience was missing due to not having met anyone in person. i lacked the needed support that comes from being in-person, running into each other in the halls or in the doctoral lounge. i needed to connect with peers, even virtually. an open forum online platform for peer support would be better than a constricted experience in a formal classroom setting. i felt that there was no open space being provided to us for teaching support. although a formal teaching course exists, it felt necessary to have something informal for peers to bounce ideas off one another. formal arrangements are not enough in academia and there needs to be an informal space to foster peer support, which i knew i was missing even though i had not experienced it yet. i kept thinking that having in-person support suddenly taken away must have been devastating for my peers. in my msw program, peer support was crucial in helping me make it through the program. in my graduate research assistantship, i served as a manager on a project that involved working with bsw and msw students. it was a virtual social work field placement that paired students with older adults in the community. i felt comfortable with the older adult population as my professional experience has been working as a geriatric social worker but felt myself lacking when it came to being confident in working with students. i needed support in this area but was unsure who to turn to. the peer support group seemed like the perfect missing link to help me with this support. i am nervous about teaching, but know that this is normal when experiencing something new. this nervousness should be talked about and normalized to help relieve feelings of isolation. although i was not teaching at the time, i was in a role that required teaching skills. i felt recognized, validated, and supported when a third-year doctoral student-instructor offered the group to all students in my program. being invited made me feel like my opinions and experiences mattered. it also felt great that the upper cohorts wanted to help the newer cohorts prepare for teaching. it appeared that they would have liked this sort of group when they were preparing to teach. i got the impression that my peers needed the support too, even if it had to be online, due to missing out on the experience of being in-person this academic year. although others may be hesitant to join the group due to a lack of experience in the academy, i only sometimes experience the “impostor syndrome” that other students talk about. i feel disconnected from it. i recognize this is because i feel comfortable in academic settings, having many family members with doctoral and other advanced degrees. i am also white and grew up well off. i know this makes me extremely privileged and may lead to confidence i have going into academia that others may not. others in the peer support group were also inexperienced, and this helped me feel like i belonged in the group. interestingly, my privileged identity and reconciling the guilt that comes with it overrides the feelings i have of oppression by being a queer woman. i realize that this privileged feeling and comfort in academic settings calls for a need to hone in on it and make sure i do not ever mistake my privilege and comfort for experience. self-awareness is important for professional social workers, and i attempt to keep my privileged identity in mind when providing and receiving peer support. privileged folks, including those in the social work advances in social work, spring 2025, 25(1) 178 field, should not ignore their backgrounds. i have used this self-awareness in our group, in the classroom, and as a social worker. social workers have historically been unaware of how members of oppressed groups may feel when we come in “to help.” social workers must study and critically examine this history. the pedagogy peer support group helped me feel more connected to my peers. i also gained knowledge about how to teach social work students. a theme that fostered our connection was the concept of social work professors as gatekeepers for the profession. one of my peers mentioned this throughout our group meetings and it stuck with me. we have social work values prescribed to us by nasw, such as the core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence (nasw, 2021). while these values are extremely important for social workers to uphold, we must engage with social work students to call into question our professional history and what we can do as future changemakers. to question and to be critical of our world is a way that things will progress for the better. as emerging social work gatekeepers and rising academics, we should balance not only holding our core values, but also encourage students to question, be critical of, and be innovative in the profession. in this manner, we can help shape a profession of individuals who think for themselves, create meaningful change, and treat others with dignity and worth. thematic findings we identified several themes within our reflections (see figure 1): (a) navigating role and identity transitions; (b) value of community; (c) need for enhanced institutional support; and (d) educators as gatekeepers. navigating role and identity transitions one key theme was the navigation of role and identity transitions during our shift from students to doctoral student-instructors. this transition, intertwined with our intersectional identities, brought opportunities and challenges. through an awareness of the impending transition, we consciously managed our expectations of ourselves with a sense of anticipation and preparedness. we conceptualized our future “professor” selves and drew upon positive experiences with professors and mentors to shape our aspirations. through autoethnographic methods, we identified the tension in this identity shift, and, similar to others (e.g., kumar, 2021), the process helped clarify our academic identities. a common theme was that our social identities would influence our future academic careers ambivalently—potentially leading to feelings ranging from imposter syndrome to reflections on privilege—and we hoped to mentor diverse student groups. the peer group provided a platform for self-reflection about personal and professional identity growth, suggesting that pedagogy groups can provide a space for identity development for aspiring instructors (murphy et al., 2014) and support multiple identity development. this theme highlights the transformative potential of becoming an educator through identity reflection and role transition development. goldsborough et al./doc student peer mentoring 179 figure 1. themes identified from doctoral students’ collaborative reflections value of community the value of community emerged as a theme, particularly the mentorship from senior students and the context of the covid-19 pandemic. the initiation of the peer group and invitation to join from a senior cohort member exemplified the supportive phd culture. the group served as a valuable resource for exchanging teaching approaches and philosophies, helping members in developing their own teaching styles. this peer-led initiative filled a gap that was not addressed by formal institutional support. the pandemic significantly influenced students’ experiences, as many were experiencing isolation due to a newly remote learning environment. the lack of casual encounters in academic settings due to pandemic restrictions left students with a need for connection. the group provided connection and helped us prepare for the challenges of the modern and sometimes digital classroom. it also provided us with a sense of belonging and reduced feelings of isolation. these experiences underscore the importance of fostering community and the value of peer-led initiatives. need for enhanced institutional support the theme of the need for enhanced institutional support emerged in our analysis. our reflections revealed perceived gaps in our pedagogical preparation. while we received administrative information, we were looking for more pedagogical training. this included the practical transition from student to instructor, which was not being addressed. the second gap was pedagogy in general. we expressed a desire for more comprehensive pedagogical support beyond the existing pedagogy course. the existing course was valuable but insufficient. there was a need for earlier and more practical training. our insights from a pedagogy peer support group for phd students navigating role and identity transitions value of community need for enhanced institutional support educators as gatekeepers advances in social work, spring 2025, 25(1) 180 reflections revealed a sentiment that institutional support around pedagogy was lacking. the lack of support was underscored by a suggestion that students undertake unpaid training on our own time. we also identified a need for informal spaces, as the existing formal structures seemed to lack collaborative learning needed for teaching. the peer group became a valuable resource for sharing teaching materials and filled the gap left by the institution. our reflections suggest a need for institutions to provide more comprehensive, practical, and accessible pedagogical support along with spaces for informal resource sharing. educators as gatekeepers the final theme was educators as gatekeepers. this theme encompassed our dual responsibility in shaping the future of the profession while addressing students’ needs and challenges. group discussions highlighted the gentle balance between providing support and fostering independence for students. the role of educators as gatekeepers was viewed as both an academic responsibility and an obligation to ensure a compassionate and dedicated social work field. this theme played an important role in fostering a deeper understanding of the function of gatekeeping in the interplay between teaching responsibilities and the duty of shaping the future of the social work profession, while maintaining reflexivity around identity and inequality and ensuring that gatekeeping not reproduce the inequalities our profession seeks to redress. discussion our cae explored how pedagogy peer mentoring groups help address gaps in phd teaching preparation. autoethnographic and reflective methods provided a valuable approach to understanding academic identities and identity transitions (kumar, 2021; sussman et al., 2004). these methods offered personal insights and a framework for integrating reflective practices into pedagogical practice, with broader implications for higher education and teaching training. the themes of navigating role and identity transitions and educators as gatekeepers demonstrated the group’s role in sharing experiences and strategies. we found peer mentorship to be vital in our journey of becoming educators. consistent with prior research, we found that peer mentorship fosters community and reduces isolation through social support (maher et al., 2013). it not only builds camaraderie between cohorts but also helps reduce isolation during the process of becoming academics. the value of community theme extends beyond individual experiences, suggesting a collaborative educational environment, while social work educators as gatekeepers has implications for how educators view their role in shaping the future of the profession. it suggests a need for a pedagogical approach that balances academic rigor with empathy and understanding. limitations our experiences, while insightful, have limitations. the cae method, rich in personal and contextual detail, may include subjective biases. our experiences occurred in a specific goldsborough et al./doc student peer mentoring 181 institutional context and may not be applicable to other phd students in social work, in other disciplines, or in universities with different resources, culture, and student demographics. recommendations for doctoral education in addition to the theoretical implications, we propose several practical applications for doctoral programs to enhance teaching preparation. first, structured peer mentorship should be formally integrated into doctoral training, including mentorship programs where senior students guide junior peers. research shows that structured mentorship improves academic confidence, teaching preparedness, and professional identity formation (lorenzetti et al., 2019; marx et al., 2021), and our experiences showed that mentorship from more senior students enhanced our own teaching readiness. programs can institutionalize peer mentorship by embedding it into pedagogy courses. second, comprehensive pedagogy training should be expanded beyond coursework and include applied experiences such as peer observation, co-teaching, and structured discussions on instructional strategies. programs should provide opportunities for doctoral students to refine their teaching approaches through peer-led engagement and feedback (lorenzetti et al., 2019; oddone paolucci et al., 2021). lastly, informal and virtual peer support networks should be recognized and supported as valuable spaces for professional identity development and knowledge-sharing. studies indicate that virtual mentorship reduces isolation and enhances academic engagement (webber et al., 2021), and peer-led initiatives provide sustainable mentorship structures when formal institutional support is limited (marx et al., 2021). institutions should facilitate these efforts by offering resources for peer groups, structured meeting spaces, and mentorship platforms to foster a comprehensive approach to teaching preparation. conclusion our experience highlights the crucial role of peer mentoring groups in enriching doctoral education, particularly in equipping phd students for future roles as educators. through our cae, we gained valuable insights into phd students’ needs and offered a model for integrating peer mentorship and pedagogy training into doctoral education. we advocate for formalized mentorship opportunities, particularly where institutional support is limited, as senior-junior peer mentorship can help students navigate role transitions, develop their academic identity, and refine their teaching skills. a peer-led model can complement formal pedagogical training by providing applied experiences such as coteaching and peer observation. overall, strengthening mentorship, teaching preparation, 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(2014). narrating social work through autoethnography. columbia university press. author note: address correspondence to elizabeth j. goldsborough, university of connecticut, school of social work, 38 prospect street, hartford, ct 06103, usa. email: elizabeth.goldsborough@uconn.edu acknowledgments: we thank the students who participated in the pedagogy peer mentoring group. we are especially grateful to the doctoral student-instructors who provided us with much needed support as we prepared to enter the instructor role. funding statement: goldsborough was supported as a predoctoral fellow in the behavioral sciences training in drug abuse research program at new york university with funding from the national institute on drug abuse (nida, 5t32 da007233). points of view are the authors’ alone. https://doi.org/10.47678/cjhe.v44i1.182924 https://doi.org/10.47678/cjhe.v44i1.182924 https://doi.org/10.1080/08841233.2014.990077 https://doi.org/10.1080/08841233.2014.990077 https://doi.org/10.1108/qrj-06-2020-0054 https://doi.org/10.1108/qrj-06-2020-0054 https://doi.org/10.1300/j067v24n01_10 https://doi.org/10.1300/j067v24n01_10 https://doi.org/10.1300/j067v24n01_10 https://doi.org/10.1080/08841233.2011.597674 https://doi.org/10.1080/08841233.2011.597674 https://doi.org/10.1080/0158037x.2019.1703670 https://doi.org/10.1080/0158037x.2019.1703670 https://doi.org/10.1080/0158037x.2019.1703670 https://doi.org/10.7208/chicago/9780226874937.001.0001 https://doi.org/10.7208/chicago/9780226874937.001.0001 https://doi.org/10.1080/0309877x.2021.1987401 https://doi.org/10.1080/0309877x.2021.1987401 https://doi.org/10.7312/witk15880 mailto:elizabeth.goldsborough@uconn.edu microsoft word 04 brady_et_al_17977_developing_ethical_guidelines_au_ce.doc ______________ shane r. brady, phd, msw. assistant professor, anne and henry zarrow school of social work, university of oklahoma, norman, ok. email: srbrady@ou.edu. david a. mcleod, phd, msw. assistant professor, anne and henry zarrow school of social work, university of oklahoma, norman, ok. email: damcleod@ou.edu. jimmy a. young, phd, msw. assistant professor, department of social work, california state university, san marcos, ca. email: youngja2@unk.edu copyright © 2015 advances in social work vol. 16 no. 1 (spring 2015), 43-54 developing ethical guidelines for creating social media technology policy in social work classrooms shane r. brady david a. mcleod jimmy a. young abstract: this paper discusses social media technology in the context of social work education. while social media technology is prevalent in social work education, most discourse about the ethical use of social media in the classroom has taken a prescriptive and overly cautious approach that neglects the context-dependent nature that social work educators teach in as well as the overwhelmingly positive potential of social media technology in the classroom. this paper utilizes social constructivist theory and the competing values framework to guide the development of an ethical decision-making framework for social work educators to use in order to create dynamic classroom policies related to social media technology. the authors strive to make a modest contribution to the existing literature related to social media technology and social work through the development of this new ethical decision-making framework and discourse related to social media technology, ethics, and social work education. key words: social work education, social media, technology, ethical decision-making social media technologies, which include many forms of electronic communication and information sharing, have steadily risen in the u.s. and internationally (shirky, 2009). these digital communication tools are drastically altering how people interact with one another across space and time (wesch, 2009). some have suggested that we are not only living in an era where vast amounts of knowledge are easily accessible to most people through smart phones, tablets, and other portable electronic devices, but also that this trend is changing the nature of how we think about social participation and participatory culture (jenkins, clinton, purushotma, robison, & weigel, 2009; watwood, nugent, & deihl, 2009). it is the participatory nature of today’s digital experience that is most intriguing, and at the same time, anxiety provoking for many social work educators (bailey & johnson, 2014; schoech, 2013). social work education has seen a sharp rise in the attention given to technology and social media in professional practice over the past decade (hick & mcnutt, 2002; hoefer, 2012; young, 2014). during recent years, the council for social work education (cswe), the major oversight and regulatory mechanism for social work education in the u.s., has created specialized presentation tracks related to technology in social work (cswe, 2012). the number of social work professionals and educators using social media sites such as twitter, facebook, youtube, and others to promote cross-cultural and intergenerational communication has grown exponentially (hitchcock & battista, 2013; young, 2014). despite the rise in the use of social media technologies, as well as a brady et al./developing ethical guidelines 44   greater acceptance of their use in social work practice, many educators are hesitant to make use of these technologies in the classroom, often due to a concern over the lack of ethical guidelines currently available (seamon, 2013). this paper will help guide social work educators in the development of their own ethical guidelines for social media use in the classroom by helping to identify critical issues and questions that educators should consider when developing social media policy. the goal of this paper is to make a modest contribution to the growing literature of technology and social work by contributing to the discourse on ethical use of social media in social work education. social media technologies in social work education social media technologies include virtual internet-based communications, applications, and tools that allow the user to interact with others in some way. social media technologies include well-known and accepted platforms: facebook, twitter, linkedin, and youtube, as well as general categories used for the open and social sharing of information such as blogs, wikis, petition sites, social bookmarks, and document sharing and publishing sites. the defining principle of social media involves applications or tools that allow the creation and exchange of user-generated content (kanter & fine, 2010; kaplan & haenlein, 2010). the wide accessibility of smart phones, tablets, laptops, and other portable electronic devices provides increasing opportunities for individuals to participate with others in digital spaces (deandrea, ellison, larose, steinfield, & fiore, 2012). given the rise of social media use by individuals in the u.s. and globally, it is not surprising that there is also a marked increase in the use of social media by instructors in higher education, including in social work programs (ahn, 2011; bennet & matont, 2010; dabbagh & kistantas, 2012). social work by nature of its professional commitment to advocacy, practice-oriented pedagogy, and social justice is a natural fit for using social media technology in the classroom (hick & mcnutt, 2002; robbins & singer, 2014). social work educators have stated that social media is best used in the classroom when it helps students meet learning objectives (robbins & singer, 2014). for instance, podcasts, google hangouts, and skype are all useful digital tools for exposing students to speakers from around the world and for keeping up with relevant policy topics (hoefer, 2012). wikis and blogs are already established tools in social work education for engaging in advocacy, promoting dialogue, and posting resources (bailey & johnson, 2014). despite the many positive uses of social media in social work education, challenges continue to exist for instructors and institutions (perron, taylor, glass, & margerum-leys, 2010; reamer, 2013). while issues such as instructor capacity, lack of institutional resources, negative perceptions about social media, and institutional culture are well-documented barriers to using social media in the classroom, the issue of ethical use of social media in social work education has received less attention in the literature (bailey & johnson, 2014; duncan-daston, hunter-sloan, & fullmer, 2013). much of the existing discourse on ethics and social media usage focuses on the practitioner-client relationship as opposed to the instructorstudent relationship (mishna, bogo, root, sawyer, & khoury-kassabri, 2012; perron et al., 2010; reamer, 2013). additionally, much of the existing discourse on ethics and social media in social work education takes a very cautious and restrictive approach to advances in social work, spring 2015, 16(1) 45 social media (duncan-daston et al., 2013; hill & ferguson, 2014; kimball & kim, 2013). scholars have made recommendations to social work educators that include only using university-sanctioned learning management systems for social media activities, abstaining from using outside social media, instructing students to maintain only a small personal social network, and recommending that instructors not include students in their social networks (duncan-daston et al., 2013). others suggest that social work educators, practitioners, and students consider the degree that information should be shared, to whom it should be shared, and how the nasw code of ethics, institutional, and federal/state policies impact how social media policies in the classroom are constructed (kimball & kim, 2013). despite the influx in the use of social media technologies among college students and in the context of higher education, the national association of social workers (nasw) and cswe provide minimal guidance about ethical use of social media in social work. while the nasw (2005) in partnership with the association of social work boards (aswb) created basic guidelines (currently under revision) for the ethical use of technology in social work practice, little focus has ultimately been paid to the ethical use of social media in the context of social work education. furthermore, technology and social media change at such a rapid rate that what is considered best practice at any give time will likely be outdated quickly, which creates major challenges for the governing bodies of professional social work (hill & ferguson, 2014; reamer, 2013; schoech, 2013). in order to contribute to the current discourse on the ethical use of social media and digital technologies in social work education as well as provide some helpful guidance to social work educators, the authors created an ethical decision-making framework rooted in social work values and social constructivism to help educators think through and develop their own policies for guiding social media technology use in the classroom. conceptual framework due to the many differing contexts and complexities impacting social work educators across schools of social work, the authors relied heavily on social constructivism and the competing values framework of policy analysis for guidance on developing the framework proposed in this paper to help instructors think through how to develop classroom social media policy. often times the topics educators are discussing one day are likely to change by the next, making the act of developing social media policies a challenge for educators and institutions (aragon, aldoubi, kaminski, anderson, & isaacs, 2014). these authors argue that many classroom policies are context dependent, subjective, and often dynamic documents that are best formulated from an interpretive or social constructivist paradigm (guba, 1990). using social constructivism as a guiding theory allows for differing policies to be created based upon the contextual factors known at that time and to be adapted as new information becomes available (biggs, 1996; o'connor & netting, 2008; stone, 2011). one of the benefits of using social constructivism in policy making is that it acknowledges the subjective values present in decision-making processes, including policy making (cramer & brady, 2013; quinn & rohrbaugh, 1981). brady et al./developing ethical guidelines 46   the competing values framework is the guiding theoretical framework for this paper. the competing values framework emphasizes that various sectors, dimensions, organizations, and individuals involved in policy making often have differing values that may conflict with one another (cameron, quinn, degraff, & thakor, 2007; quinn & rohrbaugh, 1981). these differing values may create tension between entities that strains relationships, growth, and progress (cramer & brady, 2013). nowhere is the presence of competing values and tension more apparent than in the realm of social media and social work education. while many social work educators view social media as beneficial in promoting social work values, others are concerned that social media use in the classroom could lead to violations of student privacy and confidentiality (duncan-daston et al., 2013). the family educational rights and privacy act, commonly referred to as ferpa, is the major policy in the u.s. that regulates the classification and sharing of student collegiate records and information (young, 2014). many educators view social media threats to student privacy as potentially breaching federal laws such as ferpa, which could cause undo harm to students already in a lower power position in the classroom (duncan-daston et al., 2013; kimball & kim, 2013). since no current frameworks exist for considering ethical decision making and policy development in the classroom from a social constructivist perspective, the authors created the framework below to help instructors think through how to develop a social media technology policy for use in the classroom. despite the desire and tendency of educators to develop and cling to concrete rules and best practices as they relate to curriculum and policy, it is difficult for such rules to be created with regard to social media usage in social work education as a result of the complexity of factors, values, and tensions that often vary greatly from classroom to classroom, school to school, and institution to institution. instead, the authors accept the subjectivity and context-dependent nature of ethics in social work education in order to offer educators some critical questions to consider as they think through the development of their own policies related to social media usage in the classroom. social media technology policy framework explained the table below presents a framework of considerations for helping social work educators think through various aspects related to social media technology use in the classroom. the dimensions included in the framework represent some of the major areas that could impact the policy-making process in social work classrooms. each dimension listed is accompanied by a definition of the dimension, common competing values, and guiding questions that instructors should consider when assessing what is possible and feasible in terms of social media policy in the classroom. advances in social work, spring 2015, 16(1) 47 table 1: an ethical framework for consideration when developing social media policies in social work education instructor dimension student dimension institutional dimension professional dimension dimension defined values and perspectives held by social work instructors about social media, technology, and teaching/learning that may promote or hinder the implementation of social media use in the classroom. values and perspectives held by social work students related to social media technologies, boundaries, education, and learning style that may promote or hinder acceptance of social media use in the classroom to varying degrees. values, policies, organizational culture, and capacity of organizations, schools, departments, and institutions related to social media technology use in the classroom. values and ethics related to professional social work and social work education (nasw, cswe) that could be promoted or threatened through using social media in the classroom. competing values innovation vs. resistance to change expanded learning milieu vs. role confusion risk management vs. student engagement duty to protect vs. selfdetermination; social justice vs. obeying policies; confidentiality and perceived privacy vs. importance of human relationships respect of student autonomy vs. access to learning opportunities guiding questions 1. how do you feel about using social media in the classroom? 2. what is your own comfort level with various social media technologies? 3. in what ways do you see yourself using social media in your classes, for what purpose, and with what anticipated learning outcomes for students? 4. what concerns do you have about using social media technologies in social work classes? 5. are your concerns applicable to the digital world and common practices in communications there? 1. what is your personal comfort level with social media technologies? 2. how do you, if at all, make use of various types of social media technology in your own life? 3. what has been your experience with using social media in educational settings? 4. what concerns do you have, if any, about having social media used in a social work class? 5. have you ever used or thought about using social media technology in the context of professional social work; if so, how do you envision using it? 1. does your institution, school, or department have formal policies related to social media/technology use in the classroom? 2. what is the institutional culture like in regards to social media use in the classroom? how do your colleagues and administrators seem to feel about social media use in the classroom? 3. how much of the curriculum for each class and overall is predetermined or mandated by the school (how much freedom do you as an instructor have to revise, change, and create assignments)? 4. how much does your institution use social media technology? 1. how might some uses of social media technology in social work courses potentially violate social work ethics/policy? 2. how do you see social media technologies in social work classes helping to prepare professional social workers? 3. what professional social work values could be in conflict with one another in a social media classroom policy? 4. how might you negotiate or resolve these potential conflicts between professional values in order to create a useful and ethical policy for using social media in the classroom? brady/developing ethical guidelines 48   instructor dimension. the first dimension listed, the instructor dimension, is one of the largest considerations for any educator considering a social media classroom policy. every social work educator has differing levels of experience and capacity for using social media technology (gee, 2010). additionally, instructors vary in their own values and perspectives about the benefits and drawbacks to using social media in the classroom. often times, instructors may desire to incorporate the use of social media technologies but also may be fearful in regards to student privacy or integrity (seamon, 2013). helpful questions in this dimension relate to self-reflection and awareness. instructors must be able to critically reflect on their own values, perspectives, and beliefs regarding social media and the best use of web-based communications and digital technologies in order to begin considering what is possible and appropriate for their students or within their institutions. student dimension. the second dimension provided in the framework above is the student dimension. in developing a social media policy for the classroom, instructors must consider and weigh the benefits of social media for the professional growth of social work students with the potential drawback that students may be confused about the role of social media in the classroom, concerned about boundaries, and unsure of the difference between using social media as a personal tool as opposed to a professional. instructors working through this dimension to develop social media policy should consider course objectives, learning needs of students, the purpose of using social media technologies, and how social media will be implemented and used in the classroom. additional consideration should also be given to how instructors will communicate social media policy to students in a clear and deliberate manner. institutional dimension. the third dimension proposed in table 1 relates to the institutional complexities that instructors face. institutional forces often have significant influence on the policies that social work educators create for their classrooms. some of the major forces that may influence educators include existing university or institutional policies that have historically been interpreted to dissuade or support social media technology use in the classroom (reamer, 2013). in some schools, instructors may readily use social media as a mechanism to encourage social participation, while in other schools, there could exist perceptions that social media use is discouraged or policies could exist that restrict the use of social media for learning activities (perron et al., 2010). the guiding questions posed for the institutional dimension of the framework above are meant to help instructors form a classroom policy in adherence with any existing institutional policies and in line with the culture of the school. professional dimension. lastly, as professional social workers and social work educators, instructors developing social media technology policies for social work courses must be attentive to the various codes of ethics and standards, including, but not limited to, the nasw code of ethics, international federation of social workers (ifsw) code of ethics, and cswe educational policy and accreditation standards (epas). when considering ethical codes and professional policies, social work professionals and educators will often find themselves forced to consider two or more values that may potentially conflict with one another (biggs, 1996; cramer & brady, 2013). for instance, the nasw code of ethics specifies that social workers have a duty to promote social advances in social work, spring, 16(1) 49 justice but also to protect the privacy and confidentiality of clients (nasw, 2008). social work educators must consider the benefits of promoting social work values (e.g., social justice, self-determination), while also considering other values and ethics that could be put at risk (e.g., privacy and confidentiality) through developing social-media-friendly policies for use in the classroom. future directions understanding the purpose and scope of ferpa one of the most regularly mentioned challenges to instructors and schools implementing more innovative uses of social media technology in classes is anxiety over violating the family educational rights and privacy act (20 u.s.c. § 1232g; 34 cfr part 99). ferpa was originally passed in 1974 as a means to protect the privacy of student education records (u.s. dept. of education, 2014). education records are defined as records such as files, documents, and other materials that directly relate to a student and are maintained by an educational institution (20 u.s.c. § 1232g; 34 cfr part 99.3). ferpa in higher education protects the privacy of students by regulating what information can and cannot be disclosed, to whom, and for what reasons. despite providing added protections to the privacy of student information in higher education settings where federal funding is accepted, ferpa does not restrict instructors or institutions from disclosing directory-based information, which commonly includes names, email addresses, addresses, attendance dates, and honors, as long as the school makes students aware of what directory information is kept and shared in a timely manner that allows students to make requests that institutions not disclose their directory information. ferpa has the potential to provoke anxiety in instructors. in regards to social media technology, many institutions and instructors fear that social media technology not restricted and maintained through university systems (e.g., blackboard, university advising systems, directories) may create more opportunities for student information to be shared and for privacy to be breached. despite these common fears, using social media in the classroom is not a violation of ferpa, but how one uses social media may have ramifications for students, instructors, and institutions (robbins & singer, 2014). additionally, ferpa does not prevent instructors from assigning students the creation of public content as part of their course requirements. ferpa is meant to protect a student’s educational records and should not be misconstrued to construct an impermeable barrier between institutions of higher education and the public. while the authors do not profess to have the expertise to provide a legal or formal interpretation of ferpa policy, they do recommend the following helpful ferpa hints: 1) instructors should become more knowledgeable of ferpa through attending institutional training; 2) instructors should consult with their institutional experts about ferpa; 3) instructors should design social media policies as if all students in the class may have requested that directory information be kept private; 4) instructors should consider the potential positive gains as well as potential drawbacks in considering social media policy in the classroom; and 5) brady/developing ethical guidelines 50   instructors should provide guidelines in the syllabus regarding how social media is to be used and for what purpose. promoting social-media-friendly environments in social work education one of the areas for future growth in social media technology use and ethical decision making in social work education is creating and promoting social-media-friendly spaces in institutions and classrooms. several steps can be taken by social work educators to improve the climate for social media technologies in their institutions. educators can open up greater dialogue about social media technology and ethics in institutions through mechanisms such as formal committees and task groups as well as informal discussions and forums. additionally, instructors can consider developing interdisciplinary digital learning communities with other departments, schools, and entities within their college or university as well as with other institutions in order to learn and process how to effectively use social media technology in classrooms and institutions. furthermore, instructors who are successfully using social media technology can partner with colleagues from information technology and related areas to hold trainings geared towards building the capacity of colleagues for using social media technologies. lastly, the first critical step in creating social-mediaand technology-friendly environments in social work education is to advocate to administration in social work schools, departments, and programs to formally commit to engaging in deeper level discussions about social media technology in the classroom. developing a knowledge base for social media technology in social work education another significant challenge facing instructors, schools, and others in relation to developing effective policies and practices for using social media technology in the classroom relates to the paucity of research and reporting available on social media and social work education. despite recent contributions made by social work educators, much of the literature related to social media still comes from other disciplines and fields. in order to advance discourse on social media technology in social work education, much more research and dissemination of knowledge is needed to develop informed practice standards or best practices for using social media in social work. more empirical research is needed to better understand how social media technologies are being successfully used in social work education, how social media is impacting student learning of curricular material, and what institutions are doing to embrace social media technologies. the authors recommend that social work educators and institutions using these tools in interesting and innovative ways consider formally evaluating and reporting on their efforts by way of conferences, social media platforms, and formal academic publications to further grow the knowledge base around social media and social work education. conclusion while the authors each utilize social media differently in social work courses, they are in agreement that there is no ideal, one-size-fits-all classroom policy for social media use. the multitude of factors discussed in this paper and the ethical framework for advances in social work, spring, 16(1) 51 consideration provided help to illustrate the complexity and importance of creating social media technology policies for the classroom. the authors hope to inspire others to create additional frameworks and tools to provide social work educators with additional guidance on utilizing social media and technology in the classroom. while the authors acknowledge the complexities involved in considering professional ethics, formal policies, institutional culture, student learning, and instructor values when developing social media policy for the classroom, they encourage instructors to also consider the benefits and potential of using social media in the classroom. recently, social media technologies have impacted the rise of social movements and social change in the middle east, helped to increase dialogue and action related to recent injustices in ferguson, mo, florida, and ohio, and been successfully used to raise millions of dollars for worthy causes, such as in the "ice bucket challenge." social media has shown to be a powerful tool with significant potential to facilitate communications and actions in social work practice and education. references ahn, j. 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(2014). ipolicy: exploring and evaluating the use of ipads in a social welfare policy course. journal of technology in human services, 3, 39-53. doi:10.1080/15228835.2013.860366 author note address correspondence to: shane r. brady, phd, msw, anne & henry zarrow school of social work, university of oklahoma, 700 elm avenue, norman, ok 73019. email: srbrady78@gmail.com     _________ allen zweben, phd, lcsw, professor emeritus and director, and mary piepmeier, ma, adjunct lecturer and program manager, motivational interviewing training program, columbia university school of social work, new york, n.y. kathryne leak, edd, lcsw, associate dean, office of field education, columbia university school of social work, new york, n.y. dcopyright © 2022 authors, vol. 22 no. 1 (spring 2022), 178-196, doi: 10.18060/25478 this work is licensed under a creative commons attribution 4.0 international license. training incoming social work students in motivational interviewing skills: an experiential lab model for advancing social work education allen zweben mary piepmeier kathyrne leak abstract: field practicum settings often do not have adequate resources, staff, and time to meet the extensive basic training and learning needs of master’s level social work students beginning their first year of field placement. an innovative, empiricallysupported motivational interviewing (mi) skills lab was created to provide students with supplemental skills training in preparation for field placement entry. the lab practice of mi strategies allows students to gain familiarity with effective methods for forming helping relationships, developing intervention goals, and understanding and resolving ambivalence about behavioral change. this paper describes the rationale for the experiential learning approach, addresses challenges encountered by students in learning mi skills, and demonstrates its potential effectiveness in addressing the learning needs of incoming social work students. we recommend that the mi lab be considered as a model for helping to prepare new students for agency practice. keywords: motivational interviewing (mi); experiential learning; field education; mi skillset; empirically-supported training students entering a master’s level social work program often come with little to no experience in effective engagement and communication skills that are central to forging collaborative client-practitioner relationships (tham & lynch, 2014). many come directly from undergraduate programs without having majored in social work nor having prior experiences with clients in social service and health care settings. concurrently, field placements are frequently understaffed and resourced, making it difficult to provide close mentorship and training in essential social work skills. this is especially relevant in agencies servicing high-risk or vulnerable populations. to address this limitation, social work educators have advocated and implemented skills-based training within the school curriculum for social work students entering their field placement settings (bogo, 2015; jackson et al., 2020; mumm, 2006). these skillsbased strategies have been necessary but not sufficient to address certain areas such as rapport-building with clients having difficulties in engaging in a helping relationship (gockel & burton, 2014). this paper describes the motivational interviewing (mi) skills-based lab program that was incorporated as part of first year msw students’ foundation curriculum. we present the rationale for the approach, address the challenges encountered by students in learning mi skills, and demonstrate its potential effectiveness in preparing students for about:blank zweben et al./training incoming swk 179 entry into field placement settings. we present a limited number of exercises to illustrate how they can be used by students to develop and improve a mi skillset. mi training in social work education to better prepare social work students for entry into their placement settings, motivational interviewing (mi) training has been incorporated into school curricula to help students learn essential mi strategies linked with behavior change (hohman, 2021; iachini et al., 2018; pecukonis et al., 2016). students learn how to employ such techniques as open-ended questioning, affirming, reflective listening, and summarizing (o.a.r.s.) to forge a collaborative partnership for shared decision-making and enhancing a commitment to change (hohman, 2021; miller & rollnick, 2013). studies of mi training with social work students have shown that the majority demonstrated an improved capacity in working with clients in their field settings (hohman et al., 2015). feedback on these programs has indicated that students have a deeper grasp of practical applications of core social work skills while opening up opportunities to expand their skillset in the field (greeno et al., 2016; hohman et al., 2015; iachini et al., 2018; pecukonis et al., 2016; phillips et al., 2018). the efficacy of mi with diverse, at-risk populations in a variety of contexts and settings is supported by an extensive literature (lundahl et al., 2010). at the same time, there is now empirical evidence supporting mi training methods for improving the capacity of practitioners to learn and sustain mi skills in routine everyday practice (schwalbe et al., 2014). what is most valuable about mi is that it can be adapted to various field placement opportunities. mi can be effectively employed as a stand-alone approach or in combination with other approaches such as cognitive behavioral therapy, case management, and pharmacotherapy to improve client outcomes (miller et al., 2019; zweben & piepmeier, 2020). for all of the stated reasons, we developed and implemented an innovative mi skillsbased lab program for first year master’s level social work students. the skills-based lab training program has been adopted from an empirically-supported, experiential learning approach that has been recommended by educators interested in improving field education (bogo, 2015; cheung & delavega, 2014; huerta-wong & schoech, 2010) and motivational interviewing skills training (madson et al., 2009; martino et al., 2011; miller et al., 2004; schwalbe et al., 2014). the lab model provides students an opportunity to try out new skills for forming helping relationships, developing intervention goals, and understanding and resolving ambivalence about behavior change (lewis & gibson, 1977). students learn how to use mi strategies to navigate challenging dialogues, address roadblocks, and soften discord in their interactions with clients and others (miller & rollnick, 2013). the lab offers the added dimension of improving students’ self-awareness and self-reflection in their communication with peers, faculty, field instructors, and clients. in other words, students are enabled to demonstrate a beginning familiarity with mi principles and practices, advances in social work, spring 2022, 22(1) 180 allowing them to implement a mi skillset into their field placements and educational settings. motivational interviewing skills lab the mi skills lab consists of weekly, two-hour sessions over a 7-week period. sessions are led by certified lab instructors who are required to complete 14 hours of training on the lab teaching model and content. lab instructors are comprised of faculty and advisors, field instructors, and social work practitioners from the community. the mi lab is offered to both residential and online msw students. since the spring of 2020, the lab is only offered to students in a synchronous online platform due to the ongoing covid-19 pandemic. the lab was originally considered a field seminar for incoming students. students were expected to participate in the lab during their field placement hours. this requirement was found to be impractical for many students. consequently, the lab became a noncredit course incorporated into the foundation year curriculum. this includes students enrolled in the two-year, 16-month, and five term international programs. full-time students in the two-year program have to complete two consecutive years of four semesters (fall and spring semesters). sixteen-month students begin fulltime study in january (spring semester) and fulfill the requirements for the msw degree in four consecutive terms by continuing through the summer. five-term international students attend the program over the course of five terms with courses over the summer between their first and second year. students who are advanced standing (hold a bsw degree) are not expected to participate in the lab given their one-year accelerated stay in the program. since 2018, approximately 1200 social work students and 61 certified lab instructors have participated in the lab program. the lab sections are generally comprised of 16-18 students. for example, in the fall 2020 semester, 403 students were assigned to 24 lab sections;. 67% of the labs were comprised of 18 students, 25% of the labs included 17 students; and 7% of the labs involved 15-16 students.. as part of the program, we have developed a comprehensive and detailed training manual which can be adopted by other institutions interested in developing a mi skillsbased training lab program. the training manual includes innovative instructional videos, interactive exercises, role-play scenarios, as well as coding sheets and other tools to measure student performance. the content covered has been drawn from the review of the literature on mi training (e.g., schwalbe et al., 2014) and our experiences in training professionals working in different organizational contexts. finally, two of the authors (az and mp) regularly meet with lab instructors to review student progress in the labs and obtain feedback on how to improve the program. this has helped to modify the content and exercises covered in the lab. zweben et al./training incoming swk 181 experiential learning approach for skills-based training. the mi skills-based lab is designed as a highly interactive training in an experiential learning environment. experiential learning is a “hands-on” approach toward knowledge and skill acquisition in which the focus is placed on students learning by doing. this is in contrast to a didactic method in which students passively take in information through lecture-based teaching. research has supported experiential learning as a well-grounded method in social work field education (bogo, 2015; cheung & delavega, 2014; huertawong & schoech, 2010) and in motivational interviewing trainings (madson et al., 2009; martino et al., 2011; miller et al., 2004). there are three distinct components to the experiential learning process in the mi lab (see figure 1): (1) practice exercises (role playing), (2) debriefing (self-reflection), (3) observational feedback, and (4) conceptualization (connecting experience to mi principles/terminology). these components are a reiterative process as each new skill is introduced over the course of the seven sessions. practice exercises. practice exercises can range in style and in format. the majority of exercises are performed as “real” plays where students perform scenarios from their own personal lives (e.g., “i need to find a balance between school and family obligations”). there are many advantages to real plays: practicality-wise, they are easier to implement, can be spontaneous, and give students a chance to be on the “receiving” end to understand the effects of the skills on interactions. furthermore, the speaker is able to provide an honest assessment of the impact of the exchange with the listener: did the speaker truly experience a sense of movement or change in a positive direction based on the listener’s behavior? students also perform “role” plays based on real client encounters derived from their field placement experiences. this gives students an opportunity to practice and reflect on what strategies and skills would be most useful and effective with the various populations with whom they are working. students can also consider what they could have done in past situations where they would have found mi skills to produce a better outcome. sessions are structured in such a way so that with each new skill, students must first experience the “feeling” of how to apply the skill effectively. most students come into the session with little to no familiarity with underlying technicalities of mi. as opposed to the instructor lecturing or modeling for the students why and how a skill may be used, students engage in a form of experimentation first by “testing” how they think this particular skill would be most useful and helpful in a situation and why. additional exercises that take on a different form of role/real playing are interactive videos that simulate an encounter with a hypothetical client. students are given a brief background on a particular client and their case. in all simulated exercises, the scenario takes place as their first encounter with the client. subsequently, the students watch and listen to the client provide a statement as if they were talking to them; the students are then prompted to generate a response using one or more of the micro-skills (open-ended questions, affirmations, reflections, or summaries). the exercise continues with each successive statement given by the client. interactive video exercises provide a advances in social work, spring 2022, 22(1) 182 standardized form of practice with a “realistic” component in the context of a clinical setting. skills can be practiced and applied toward problems or issues that may not arise in a peer-to-peer real play. reflection/observation/feedback. after each practice exercise, students participate in a debriefing phase during which they are asked to reflect on their experience and observations post-exercise. this debriefing encourages two forms of critical assessment: a self-awareness of one’s own growth and an ability to provide constructive feedback from observations of others engaging in practice. this helps students internalize the purpose, function, and impact of the skills. the instructor plays a facilitative role in the discussion and feedback phase. feedback is empirically supported as important not only for skill development, but also for the sustainability of proficiency and adherence of skills in trainees (kourgiantakis et al., 2019; roulston et al., 2018; schwalbe et al., 2014). figure 1. experiential learning model bridging practice and theory/concepts. a comprehensive training on skills-building connects the experiential component to established knowledge and understanding of the fundamental concepts and principles of mi. in similar fashion to mi, facilitators guide the students to articulate an abstraction of their experience in the previous phases (role/real playing and debriefing) to connect to broader themes of what it means to effectively communicate. this experience ultimately forms a summary or “take-home message” of what the students have expressed and learned from their debriefing. exercises role/real play reflect what did i experience? feedback what did i observe happen? conceptualization how would i define the experience? zweben et al./training incoming swk 183 log assignments. an additional component of the experiential approach is the introduction of a weekly log assignment. students maintain a weekly log to reflect on their experiences in exercises from the sessions and to record instances of practicing specific skills in their daily life and/or field practicum over the past week. the weekly logs are multi-purposeful: they allow the instructor to receive feedback on the course exercises and, in general, become more familiar with the student experiences in the lab. the logs inform the instructor on which skills and concepts students have grasped and which require more practice and instruction. instructors also learn what exercises have been most and least helpful. another purpose of the logs is to give students continuity in their practice outside of the lab; students are prompted to practice specific skills (e.g., reflections or open-ended questions) in-between sessions and then to reflect on the effectiveness and outcome of those skills. additionally, it provides students a chance to hone skilled, active listening – observing moments and exchanges relevant to motivational interviewing. engaging: understanding and forming a helping relationship most students who enter a social work program come without having a clear understanding of what it means to be involved in a helping relationship. many have limited knowledge and/or practice in employing skills required to foster a working alliance. forging a helping relationship is essential (but not always sufficient) to facilitate a person’s readiness and commitment to change (miller & moyers, 2021). mi spirit is the foundational component of effective mi practice (miller & rollnick, 2013). mi spirit gives a broader meaning/sense to the lab for all areas of specialization (e.g., substance use, mental health, and criminal justice). mi spirit is defined by four pillars of practice: (1) collaboration (working in partnership); (2) evocation (supporting and eliciting a client’s commitment to change); (3) acceptance (recognizing absolute worth); (4) and compassion (communicating genuine interest and concern). students are first introduced to mi spirit with an exercise in which they reflect on personal experiences with, and characterize the primary features of, what it means to be in a helping relationship (table 1-dilemma exercise). reflections vs. questions. reflections are considered the most fundamental and challenging tool in forming a constructive relationship between practitioner and client. reflections are more useful than questions for gathering relevant information about the client and guiding the client toward a deeper contemplation and exploration of their thoughts about behavioral change (miller & rollnick, 2013). asking too many questions can cause the client to feel burdened, defensive, exposed, and vulnerable which in turn can interfere or disrupt efforts toward establishing a working relationship. excessive questioning can inhibit a conversation from moving forward in the direction of exploring a client’s thoughts, feelings, and perspectives on their motivation for positive change. zweben et al./training incoming swk 184 table 1. motivational interviewing exercises assignment challenge learning objectives procedures e n g a g in g & f o rm in g a h el p in g r el a ti o n sh ip dilemma what does it mean to be in a helpful relationship? identify key rapport building skills & define mi spirit. students list characteristics of ideal person & non-ideal person to address personal dilemma. reflections vs. questions what is the function & importance of reflecting? practice accuracy & hypothesizing meaning behind a person’s words in giving reflections. in dyads, listener must give 3 reflections for every 1 question in discussing speaker’s desire for behavior change. open-ended questions what makes an openended question effective? practice creativity in formulating a question to evoke more information; to experience the effect of asking open-ended questions. students are given a closed-ended question to convert into an open-ended question. they pose the question to a partner to test effectiveness in eliciting clinically meaningful responses. affirmations how do we affirm “hidden strengths?” practice extrapolating from given information to reveal underlying strengths & validate the person as a whole. students are presented a series of vignettes containing situations with clients or friends. students come up with mi consistent affirmations to give to the person in the vignette. r es o lv in g a m b iv a le n ce a b o u t c h a n g e evoking & responding to change talk how do we elicit increased importance & confidence in change speech? develop a strategic skillset to evoke & respond to change talk in order move the conversation in the direction of positive change. in dyads, listener practices strategies that are deemed effective at evoking & responding to change talk. strategies are employed to move speaker along a continuum of change (from identifying goals to exploring & supporting reasons & options for change). reducing sustain talk how do we help facilitate a behavior change while keeping with “where the person is at?” demonstrate an understanding & acceptance of sustain talk; to learn how to slow down the process & employ strategies to reduce sustain talk; to experience how persuasion can negatively impact behavioral change. in a “round robin,” students take turns responding to a speaker’s sustain talk statements, using strategies that will help soften sustain talk & elicit positive speech about change. the rest of the group provides constructive feedback on what was effective/helpful at minimizing sustain talk. discord how do we address dissonance in a working relationship? employ strategies that reduce or do not invite further discord on the part of the client. learn how to demonstrate an acceptance of person’s perspective of their situation & support a person’s autonomy in the process. students are presented with hypothetical client statements that express discord with the working relationship. students come up with responses to each statement that are mi consistent with reducing or softening discord. planning how do we preemptively address obstacles to the planning process? develop fluency in employing elicitation & reflective skills as means for reducing or removing obstacles to the planning process. in dyads, listener guides the speaker to discuss their planning process as well as explore & address potential obstacles that could interfere with meeting behavior change goals. zweben et al./training incoming swk 185 in typical daily conversations, it is very common for students to rely on asking questions when forming relationships and getting to know someone. as part of the lab learning process, students gain a deeper understanding of this concept by actually experiencing and observing the downside of being caught in the “q&a trap”—a cycle of repetitive questions and answers with no specific direction for the conversation (miller & rollnick, 2013, p.61). practice exercises include having students role/real play a scenario in which they can only ask questions, then repeat the scenario but using only reflections. a more direct skills-based exercise has students follow the 3:1 rule in which they are only allowed to ask one question for every 3 reflections during a 5-minute role/real play (miller & rollnick, 2013). students debrief post-exercise to reflect on their experience to illustrate the effectiveness of reflections over questions in facilitating the rapport building process (zweben & piepmeier, 2020 table 1reflections vs. questions exercise) we also expend some time highlighting the importance of having a proper tone in clarifying the difference between reflecting and asking questions. students quickly learn that merely raising their voice at the end of the statement changes a reflection into a question thereby instilling a sense of distrust rather than support in the relationship. you are communicating to the other person that you are listening thereby strengthening confidence in the relationship. the example below demonstrates the difference: • “you didn’t want to come to our meeting today?” vs. • “you didn’t want to come to our meeting today.” we also spend some time demonstrating how a reflection can lead to a more meaningful response than a close-ended question. here is an example using the same content as the above. • closed-ended question: “you didn’t want to come to our meeting today?” • limited response: “no” vs. • reflection: “you didn’t want to come to our meeting today.” • elicited response: “right, because i don’t know if i am ready to talk about my drinking.” for many students, this is their first exposure to the reflecting strategy. as a result, students often feel intimidated or hesitant to give reflections thinking that they are making unsupported “assumptions” about the person. consequently, students need to exercise their listening “muscle” which often leads to accurately reflecting the person’s feelings, perspectives, and experiences in order to build trust and rapport in the professional relationship. as beginners to mi, students must first grasp the practice of simple reflections before building up to complex reflections. real/role plays in which students can give only simple reflections as the listener (meaning they cannot ask any questions at any point during the exchange), can help increase their ability to instinctively listen with purpose so they can accurately reflect on what the speaker is saying. eventually, students move on to practicing advances in social work, spring 2022, 22(1) 186 complex reflections which do not simply repeat what the person says, but offer hypotheses that capture a deeper meaning behind their words: • statement: “after a stressful day, i always end up drinking more than i should.” • simple reflection: “stress leads to excessive drinking.” • complex reflection: “you are concerned about how you are managing stress with alcohol.” effective questioning. students learn how to ask effective questions by distinguishing between open-ended and close-ended questioning. (table 1-open-ended questions exercise). close-ended questions do not require as much attention as open-ended questions since they require “yes” or “no” answers (e.g., requesting factual information). in contrast, open-ended questions require more attention (i.e., active listening) since the objective is to elicit as much information (e.g., feelings, thoughts, concerns and related matters) as possible from the person—giving them more flexibility to expand on the conversation. students often encounter difficulty in recognizing that a question will be effectively evocative. in training, easily identifiable open-ended questions are helpful in enabling the person to think about change: “tell me more about…” or “what would life be like if…?” students learn that common close-ended questions such as “have you ever…?” or “do you think…?”do not have the same impact. mi-consistent vs. mi-inconsistent affirmations. affirmations are reflections that build upon a client’s statements to emphasize their qualities, strengths, and/or accomplishments. they function as a way to strengthen autonomy and reinforce confidence and selfesteem/self-efficacy to enhance the client-practitioner relationship (magill et al., 2018). a major challenge is to have students distinguish between “mi-consistent” and “miinconsistent” affirmations. mi-consistent affirmations are accurate and specific reflective statements that are compatible with mi spirit (evocative, supporting autonomy and absolute worth, and demonstrating compassionate and genuine interest). evidence of miinconsistent affirmations are those that undermine the self-worth and confidence of the individual. these are characterized as conditional (“if you continue to show up on time you might really benefit from the program.”); patronizing (“i am surprised you made it thus far.”); or judgmental (“i believe you could do a good job if you put your mind to it.”). some affirmations are too vague or superficial (“sounds interesting”) to be of benefit to the person. mi-inconsistent affirmations are often associated with poor listening skills on the part of the practitioner and are counter-productive to rapport-building. another challenge for students is to employ affirmations that extrapolate positive qualities that go beyond what is explicitly shared by the client. these affirmations shed light on positive aspects of the client that lie just beneath the surface (i.e., "hidden strengths”) or are not immediately noticed, evident, or considered by the client. such affirmations are often described as having the client feel prized or celebrated (kirschenbaum, 2009). there are several activities that can be used to help students experience what it means to affirm “hidden strengths.” one activity involves students giving affirmations based on client vignettes (table 1 – affirmations exercise). some of the vignettes are clearer in zweben et al./training incoming swk 187 highlighting positives (e.g., client who was homeless found housing); other vignettes are more challenging in that they do not include information that is immediately obvious as positive. this activity has students expand their perspective on how we can validate a person’s absolute worth. based on our experiences in the labs, affirmations are often perceived differently among individuals coming from diverse backgrounds and experiences. students are encouraged to explore the implications of how cultural and other factors play a significant role in how we choose to apply skills to be helpful to the person. it is important therefore, to help students understand the considerations involved in making effective use of affirmations to facilitate behavioral change. focusing: identifying the target behavior and change goal in motivational interviewing it is necessary to identify a target behavior and a related goal to establish a direction for positive change. the goal must be a behavioral change the client is interested in pursuing that is specific and realistic and is consistent with the values of the client and the social work profession (e.g., becoming a better parent, becoming drug-free, having a healthier lifestyle, improving self-esteem, and related issues). focusing is the process of narrowing down from multiple areas of concern to a single behavior for which change is intrinsic to the client’s self-improvement/best interest and motivation. focusing occurs after a trusting relationship has been established between client and practitioner. the challenge for students is to set an agenda when there is little agreement between client and practitioner about the issues associated with the presenting problem and/or strategies needed to resolve these problems. for example, in discussing the presenting areas of concern such as marital or family conflict, other problems not initially recognized by clients may emerge, such as excessive alcohol use. in such situations, alcohol use may need to be addressed either concomitantly or sequentially in order to resolve the presenting problem. it is helpful to employ mi strategies such as open-ended questions, reflections, affirmations, and summaries to help clarify uncertainties and misunderstandings in order to establish clinically meaningful goals. for example, some students may be placed in settings where the supervisor tasks them to address the client’s substance use when the client is still uncertain, reluctant, or ambivalent about discussing the substance use. this is where the lab training is so pivotal for the student’s development in the field. the student now possesses a skillset to guide and elicit the client to explore priorities and concerns eventually opening up the opportunity for them to recognize and accept the need to address their substance use problems. using mi skills such as reflections, affirmations, and summaries, the student works collaboratively with the client to better prepare them to engage effectively in a helping relationship. advances in social work, spring 2022, 22(1) 188 understanding and resolving ambivalence about change resolving or reducing ambivalence is viewed as overcoming a struggle between two opposing sides that are associated with balancing the decision for making a behavioral change. ambivalence is expressed by change talk, speech that is in favor of resolving the ambivalence by moving in the direction of positive change and sustain talk, speech that is not in favor of moving in the direction of positive change or maintaining the status quo (miller & rollnick, 2013). one side of the dilemma represents a desire to change the target behavior: “i need to cut down on my drinking to maintain my job.” the other side represents no desire to change the behavior or a just wants to maintain the status quo: “i could cut down my drinking if i really had to, but i don’t see a reason to right now.” the goal here is to increase change talk and to reduce sustain talk to resolve ambivalence and achieve the behavioral goal. simply put, the more one talks about changing, the less likely one will talk about not changing (apodaca et al., 2016). research has shown that such a process leads to positive behavioral change (magill et al., 2018). importance and confidence in facilitating change talk importance and confidence. there are two issues that need to be considered in increasing change talk: (1) the perceived level of importance of changing a particular behavior (i.e., asking what matters) and (2) the perceived level of confidence in changing a particular behavior (i.e., doing what matters). increasing both perceived importance and confidence levels enhances the probability of changing the target behavior. the challenge for students is to learn and practice strategies that will increase levels of importance and confidence to facilitate behavioral change. students absorb these strategies by experimenting with them in dyadic exercises (table 1-evoking and responding to change talk exercise). these strategies are summarized below: • increasing importance (asking what matters): “what do you think might need to change? how important is it to you to make it happen?” • exploring values and priorities (asking what matters): “how do your values and goals concur with thoughts, ideas, and feeling about change?” • looking back/exceptions (doing what matters): “what did you do in the past to be successful?” • envisioning/looking forward (doing what matters): “what would life be like when (not if) change occurs?” • scaling question (doing what matters): “on a scale of 1-10 how confident/ready are you to change?”…“why did you not choose a lower number?” or “what would it take to move to a higher number? evoking and responding to change talk. once students hear change talk, it is important to reflect back what they hear and experience about the client’s change statements. other effective techniques include elaboration (“tell me more.”) and affirmations (“it is exciting to see how positive you have become” or “your hard work demonstrates a strong commitment to your family.”). the idea here is that students do not miss the opportunity for encouraging and reinforcing positive behavioral change zweben et al./training incoming swk 189 speech. in short, students learn that they become the mirror for change talk which in turn helps reinforce and support more change speech. reducing sustain talk. in reducing sustain talk, it is important to have students demonstrate an understanding and acceptance of the client’s ambivalence to change the status quo. students practice slowing down the conversation to enable the client to contemplate their thoughts, ideas, perspectives, and experiences about the target behavior. persons struggling with an aversive task may be better prepared to make a positive decision over time (miller et al., 1992). having more time enables them to process the information and a greater opportunity to receive support from concerned significant others resulting in more openness to change (zweben & zuckoff, 2002). students can do this by listening intensely, using open-ended questions to slow down the process, and reflecting back the essence and meaning of what is being said (e.g., “let’s slow down the conversation and take a step back. you are not really sure why you need to be here today. what is your understanding of the situation?”) in accordance with experiential learning, students exercise these strategies in the lab sessions before being introduced to the rationale for their use in mi. a major difficulty encountered by students is dealing with situations in which there is a lot of sustain talk. higher levels of sustain talk may be related to a disparity between practitioner and client with respect to understanding and accepting of the client’s readiness for change (prochaska & diclemente, 1992). students may try to implement some action steps when the client is still considering whether they are ready to take these next steps. in other words, the student may be too far ahead of “where the client is at” with respect to level of readiness for change. students can become frustrated with clients who are not clearly open or ready for change which often leads to their attempting to persuade or convince the client to make the change. in the above circumstances, it is important that students understand that their role as practitioner is not to persuade or convince the client to change. the person seeking help must be the one verbalizing the reasons, needs, commitment, and steps for change. one way in which students can visualize their roles is to have the group observe a real play between two classmates (i.e., listener and speaker) and then have the observing group provide feedback to their classmates (table 1reducing sustain talk exercise). for example, students are asked to comment on whether the listener (practitioner) was employing a mi effective strategy such as “remaining alongside” (accepting and collaborating) with the speaker (client) during the exchange or was moving too far ahead (miller & rollnick, 2013). another approach is to help students take a step back from the evoking process and return to one of the previous mi processes such as engaging (strengthening the client/practitioner relationship and supporting a safe and comfortable environment) or focusing (identifying, clarifying, modifying, or confirming the target behavior or goal). in some cases, it may ultimately be necessary to shift focus to another topic rather than continuing the difficult conversation (“what else can we talk about today that might be helpful?”). discord. discord in the professional relationship is indicative of a high level of negative reactivity toward the practitioner on the part of the client typically resulting in advances in social work, spring 2022, 22(1) 190 poor outcomes (miller & rollnick, 2013). in this context, the dissonance pertains to the client’s overall feelings that the practitioner is unable to (lacks competence), and/or unwilling (not motivated) to help them effectively address problematic issues. frequent use of mi-inconsistent responses to sustain talk including confronting, blaming, shaming, or sarcasm often lead to discord. students practice different strategies that reduce or do not invite further discord or defensiveness on the part of the client. for example, students are presented with statements by clients expressing discord and then are asked to generate their own miconsistent responses that they think would be most helpful in the situation (table 1discord exercise). this is accomplished by learning how to meet the person “where they are at” (acceptance) to encourage and support the person’s own ideas for change (supporting autonomy) and/or exploring options if the client is feeling stuck. students are reminded not to tell or persuade the person to change themselves. in this way, students are able to help the client avoid withdrawing precipitously from the sessions and move further away from sustaining the status quo (zweben & zuckoff, 2002). client: “these sessions are just a waste of time, they are going nowhere.” practitioner: “you are frustrated that we are not progressing at the same pace that you were hoping (reflecting). let’s work together on re-evaluating your options right now (options). ultimately, the decision to change is up to you.” (supporting autonomy) – or – “i am sorry if i am not hearing you correctly (accepting). you have a number of options that you might want to consider (exploring options). one option is to give the process more time. another might be to move to another topic that might be helpful to discuss. which do you prefer?.” (supporting autonomy) moving to planning students practice being attentive to clients who are ready to work collaboratively on a change plan. signs of readiness to plan include a significant increase in the frequency and intensity of change talk and a reduction or softening of sustain talk. listening for mobilizing statements signaling commitment, activation, and taking steps toward changing the status quo are all indicative of a high level of readiness to change (“i will graduate from high school despite the lack of support i am receiving from my family.” “i am ready to take these next steps so i can graduate.”) clients who are not ready to implement a change plan demonstrate increased levels of sustain talk or discord often resulting in canceled appointments without rebooking, no shows, tardiness, and/or guardedness in the sessions. any improvement in change talk is balanced by equal levels of sustain talk indicating that the person is still in an ambivalent state about change, and as a result, may likely raise questions about the timeliness of planning. persons exhibiting low levels of readiness about the change plan are more likely to exhibit poorer outcomes (zweben & piepmeier, 2020). zweben et al./training incoming swk 191 consequently, students practice reflective and listening skills to hear and reduce ambivalence about the change plan. no plan toward change will play out perfectly and consequently, students are instructed to explore the feasibility of the change plan. in dyadic exercises, students work together as speaker and listener to address unanticipated events or circumstances that might get in the way of an action plan (table 1-planning exercise). this will help prepare students to address setbacks if or when they occur. this approach is similar to a physician pre-emptively discussing potential side effects of a medication prior to the patient starting the prescription. in some cases, it may be more feasible to stay with the process of evoking change talk until the person meets the criteria for moving on to the planning stage. if the ultimate goal appears to be overwhelming for the individual, students can identify and practice incremental steps to pursue. consider the following examples: a person who is considering changing their drinking may be ready to set a goal of undertaking a brief period of abstinence (one week) before making a commitment to permanent abstinence; another person may decide to cut down on the amount of drinking before undergoing a sustained period of abstinence; and another individual may decide to drink at the local tavern rather than at home to avoid serious conflicts with family members which in many cases will exacerbate the drinking. in other words, goals and strategies need to be client-centered, i.e., continuously modified and affirmed to facilitate movement in a positive direction of change. evaluation dyadic interview recordings. at the end of the 7-week lab, all students are required to submit a 5-10-minute recording of themselves conducting a dyadic mi interview conducted with another student in the lab. each student takes a turn playing both the speaker and listener during the real play interviews. the speaker identifies a problem or concerning behavior that is interfering or in direct conflict with something they value and that they are considering changing while feeling ambivalent about making the behavioral change. for example, the target behavior may be poor sleeping habits that are interfering with school performance or struggling with balancing work and school obligations. the listener is responsible for strategically using mi strategies to facilitate and elicit readiness and commitment language from the speaker about the behavioral change. lab instructors assess students’ consistent use of mi strategies in the listener role using a dyadic recording coding scheme (drcs). the drcs applies a 3-point rating scale (mi-inconsistent, mi-somewhat consistent, and mi-consistent) to each of the following domains: (a) mi spirit, (b) emphasizing autonomy, (c) open-ended questioning, (d) affirming, (e) reflecting, (f) evoking/responding to change talk, and (g) reducing sustain talk. the coding scheme was adapted from the motivational interviewing skills code (misc; miller et al., 2003). final scores on the drcs are determined by summing the score on each rated item and calculating a percent average. the purpose of this assessment is to serve as a marker of a student’s progress in the lab. higher scores on drcs are indicative of greater adherence to the accurate and suitable use of mi strategies. the drcs codebook offers comprehensive definitions of the domain items. a minimum score of 80% is required to receive a certificate of completion in the lab. in advances in social work, spring 2022, 22(1) 192 addition to the scores, students receive written feedback on the items from the instructor to provide more detail on student strengths and areas of improvement. we received data on dyadic interview recording scores from 13 out of 14 lab sections held in the fall semester, 2021. of the 218 students participating in the 13 lab sections, only 1 student failed to meet the minimum required score. for students who met the minimum requirement on the drcs, scores ranged from 80-100%. the average score on the drcs was 92.4%, with a median score of 95%. student evaluations. all students complete a course evaluation at the end of each semester in which they rate the course and instructor performance. with regard to student ratings on the mi lab evaluations, we received data on 101 student responses from the spring semester 2020 course evaluations. across all lab sections 96% of the students “agreed” or “strongly agreed” that the labs have improved their “social work knowledge and/or skills” and 84% of the students rated the labs as “better than average” or “outstanding”. similarly, we received data on 323 student responses in the fall 2020 semester course evaluations; 95% of the students “agreed” or “strongly agreed” that the labs have improved their “social work knowledge and/skills” and 80% rated the course as “better than average” or “outstanding.” to obtain a better understanding of the impact of the labs on student learning, illustrative comments on the mi lab evaluations (spring and fall semesters 2020) are provided below: the lab forced me to zero-in on my speech and how to frame my questions. mi is important to anyone in the field that requires a dialogue with a client. super important for me to learn practical skills in order to apply in future counseling. most important class that i’ve probably ever taken. helpful for the foundation class especially for role plays. so useful for field work. finding this lab to be incredibly instrumental in my learning and i honestly wish that the class times and course duration through the semester were longer. this is especially true for those of us that didn't get a field placement on time. (note: this situation occurred during the pandemic). feedback from faculty and field instructors. the mi labs have also received a favorable response from academic faculty and field instructors. faculty teaching the foundation year courses report that students are more confident in conducting role/real plays and clearer in providing feedback on role/realplay assignments and video exercises using mi language (e.g., oars) to communicate their concerns and support to instructors and classmates. faculty also report that the mi labs have served as a “bridge” that connects field practice with classroom learning. field instructors indicate that mi labs have helped students to work more effectively with diverse, vulnerable populations seen in their field placement settings. students are better prepared to navigate challenging dialogues and cultivate working alliances with clients. zweben et al./training incoming swk 193 implications and conclusions we have developed and implemented an innovative, comprehensive mi skills-based training program for students entering an msw degree program. preliminary data derived on the drcs reveal high ratings on the consistent use of mi skills to facilitate readiness and commitment to change. ratings and comments on the mi course evaluations along with the feedback on the log assignments suggest that students were highly satisfied with the way in which the labs were conducted, helped to expand their repertoire of skill-building activities, and enabled them to become more confident, satisfied, and effective in addressing the needs of at-risk individuals seen in agency settings. both academic and field faculty affirm that the lab program has had a positive impact on student performance in their field placement opportunities and in their foundation year courses. students have learned how to address roadblocks and other challenges (e.g., discord) encountered in working with clients in agency practice. together, these preliminary findings show the labs to be an acceptable, feasible and valuable offering to incoming students and have a strong potential for improving the learning opportunities of social work students. we therefore recommend that the mi lab be considered a model for other schools of social work—many of whom are confronted with the challenges of preparing new students for agency practice. references apodaca, t. r., jackson, k. m., borsari, b., magill, m., longabaugh, r., mastroleo, n. r., & barnett, n. p. 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(2020). motivational interviewing and screening, brief intervention and referral to treatment. in m. d. cimini & j. l. martin (eds.), screening, brief intervention and referral to treatment for substance use: a practitioner’s guide (pp. 67-84). american psychological association. http://dx.doi.org/10.1037/0000199-001 zweben, a., & zuckoff, a. (2002). treatment preparation, induction and adherence. in w. r. miller & s. rollnick (eds.), motivational interviewing (2nd ed., pp. 299319). guilford press. author note: address correspondence to allen zweben, columbia university school of social work, new york, n.y. 10027, email: az173@columbia.edu http://dx.doi.org/10.1080/02615479.2014.881468 http://dx.doi.org/10.1037/0000199-001 mailto:az173@columbia.edu microsoft word popescu_and_alonzo_25090-creating_space _________ marciana l. popescu, phd, associate professor, and dana alonzo, phd, professor, graduate school of social service, fordham university, new york, ny. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1064-1082, doi: 10.18060/25090 this work is licensed under a creative commons attribution 4.0 international license. creating space: a conceptual framework for rights-based international social work and social development marciana l. popescu dana alonzo abstract: escalating conflicts, climate change, rising inequality, a global pandemic: complex emergencies are leading to a reconfiguration of the world as we know it. rapid flow of information allows increased visibility and understanding of the impact of these crises on the most vulnerable. yet at the same time, marginalized communities are rendered invisible, and their fundamental human rights are being erased. in such contexts, providing a framework that engages communities and ensures that they are at the core of any capacity building endeavor is an important professional mandate for international social work and social development. this paper introduces the strengths and participation to accomplish capacity and empowerment (space) conceptual framework for capacity building and community engagement in international social work practice. this conceptual framework builds on both the strengths perspective and empowerment theories, and promotes a rights-based approach for international social work and social development. space was first used to design and implement a training-of-trainers program in two communities in guatemala. the training’s effectiveness in building capacity was evidenced by the impactful networks strengthened or developed as a result of the training in developing covid-related responses. further applications of this framework can improve international social work practice and advance rights-based approaches to sustainable development. keywords: capacity building; empowerment; international social work; human rights; international social development; training of trainers complex problems and the need for innovative, interdisciplinary solutions global issues, including poverty, hunger, and food insecurity (action against hunger, 2020; roser & ritchie, 2013); armed conflicts (heidelberg institute for international conflict research, 2020); increasingly complex manifestations of violence (world bank, 2019; who, 2020a); raging inequality between and within countries and regions (un news, 2021; environmental hazards (world economic forum, 2020); and global health crises and pandemics (world health organization [who], 2020b) create complex challenges for policy makers and service providers and increase communities’ vulnerability through further marginalization and exclusion. these global issues function as adverse drivers, forcing people out of their communities and affecting large scale internal and international displacement. over 82 million people are displaced worldwide, of which over 26 million are refugees, 48 million are internally displaced people, and 4.1 million are asylum seekers, while another 3.9 million are venezuelans displaced abroad (united nations high commissioner for refugees [unhcr], 2021). popescu & alonzo/creating space 1065 on march 11, 2020, the world health organization declared covid-19 a global pandemic, creating further havoc and exacerbating many ongoing global crises. almost two years later, as of january 26, 2022, there are 356,955,803 confirmed cases worldwide, and a staggering 5,610,291 deaths (who, 2022). the economic, social, and political implications are further exacerbated in the context of rising nationalism and xenophobia (engelken-jorge, 2017), and pre-existing fragile social, economic, and political institutions. at the individual and community level, mental health challenges are rapidly increasing\ as a manifestation of the deeper-level impact of chronic structural problems (parks & thalheimer, 2020). lack of access to adequate health care in general, and to mental health care by qualified/trained professionals in particular, leads to alarming deterioration in the mental health of the people and communities most affected by these issues. recent studies show rising rates of suicidal ideation and behavior across age groups (centers for disease control and prevention [cdc], 2018; who, 2020b), as well as increased rates of depression and anxiety (global burden of disease [gbd], 2018 who, 2020b). the increasing complexity and the compounding of multiple global issues leading to protracted crises and complex emergencies (international rescue committee, 2021) stress the need to adopt a global perspective. since 2015, three global frameworks were developed and introduced, providing innovative, interdisciplinary and transnational, integrated solutions. the sustainable development goals (sdg; 2015-2030) provide a global strategy to address 16 interrelated issues using collaborations and partnerships to improve communities’ wellbeing. the global compacts on safe migration (international organization for migration [iom], 2019) and on refugees (unhcr, 2018) propose multilevel strategies to address the adverse drivers leading to displacement and forced migration. such frameworks provide a blueprint for engaging nation states in a collaborative effort to address these issues through active partnership with different representatives of the civil society (cs), including professional groups historically working at the intersection of governments, international organizations, and local communities. social work is a global profession that is anchored in local contexts to engage local communities. its core professional competencies and a well-rounded rights-based international code of ethics (international federation of social workers [ifsw], 2018) position social work at the forefront of addressing some of these issues by developing and piloting innovative solutions to many of the complex problems affecting local communities in diverse international settings. three key elements are fundamental for such international social work initiatives to be effective: 1) interdisciplinarity – working across disciplines to address the multiple facets of a complex problem; 2) community participation – working across communities and power divides to empower local communities to be the engine of any intervention or project; and, 3) sustainability incorporating programmatic leverage to influence lasting outcomes in terms of skills, resources, and/or structures (alexander et al., 2003; hacker et al., 2012; lennox et al., 2018). advances in social work, fall 2021, 21(4) 1066 these three elements align with the sustainable development goals (sdg) framework allowing for multiple perspectives and multi-level interventions to create sustainable solutions grounded in local capacity. the sdg framework engages multiple levels to develop, implement, and measure global strategies for addressing current complex issues. to ensure sustainability, we need to closely engage communities and contextualize responses based on the existing capacity at the community level. this paper introduces a conceptual framework, space (strengths and participation for achieving capacity and empowerment) for community-based capacity building, addressing the complex problems facing highly vulnerable communities. space was designed to provide the context for community-based intervention in communities facing multiple social issues. the initial application of the model focused on community and family violence and specific mental health issues contributing to suicide, particularly amongst highly vulnerable groups such as children/youth and women in an international setting. the model is anchored in social capital theories (bourdieu, 1986; coleman, 1988); empowerment theories (adams, 2008); the strengths perspective (saleebey, 2013), and the capability approach (nussbaum, 2000; robeyns, 2020; sen, 1985, 2005). the guiding principles are core human rights principles: universality; indivisibility; non-discrimination; participation; and accountability (androff, 2015; mapp et al., 2019; united nations sustainable development group [unsdg], n.d.). three issues within this framework will be discussed: the main factors contributing to the development and implementation of the model; the effectiveness of a training-oftrainers (tot) approach to building capacity at the community level; and the importance of network development in ensuring the continuity and sustainability of the model. we present an application of the model in building capacity for two highly vulnerable communities in urban areas in guatemala, and explore how the space framework contributes to addressing some of the limitations inherent to tot. we discuss the implications of this model for strengthening partnerships between professionals and community members and between higher education institutions and nongovernmental organizations at a global level and in local communities. implications for international social work are also explored. creating space: a conceptual framework for capacity building two main theories were used in developing the space framework: social capital theory (bourdieu, 1986; coleman, 1988;) and the capabilities approach (nussbaum, 2000; robeyns, 2020; sen, 1985, 2005), focusing on capacity building from the micro to the macro levels of intervention. based on these theories, communities actively participate in an initial capacity mapping, identifying specific resources within their midst, as well as resources they could access through existing local networks (assessing social capital). the capabilities approach engages communities in a systemic thought process focused on multiple levels of well-being and proceeds to collaboratively define specific capabilities they have and need to expand or enhance to effectively address the challenges they identify (nussbaum, 2000; robeyns, 2020). popescu & alonzo/creating space 1067 building on social capital theories and the capabilities approach, the space framework is grounded in the strengths perspective (saleebey, 2013; willetts et al., 2014) and empowerment theories (adams, 2008), the foundations of social work practice. furthermore, space follows basic human rights principles, promoting inclusion and maximization of choice at individual and community levels through policies and programs that recognize community capacity as an asset. figure 1: the space conceptual framework – building capacity through participation within a human rights paradigm the space framework builds on and expands kam’s eps model (empowerment, participation, and strengths) that integrated the strengths perspective as a theoretical basis with empowerment as a goal, using participation as the method. while the eps model was primarily applied to build capacity in an urban setting for older adults (kam, 2020), the space conceptual framework expands this model to highly vulnerable communities, maintaining the strengths perspective as the theoretical basis, grounded in social capital and the capabilities approach. the space framework shifts the ultimate goal to community capacity building. empowerment of communities, through the transfer of knowledge and skills from trainers to trainees is a goal depending on the achievement of full capabilities at both individual and community levels. participation is the underlying advances in social work, fall 2021, 21(4) 1068 principle determining the selection of specific methods and focused on engaging the community in shaping the capacity-building process. the model is fully anchored in a human rights paradigm and its guiding principles (see figure 1) the training-of-trainers method and its use in international social work the training-of-trainers (tot) method was chosen as the main tool for the participatory capacity building, to create the professional expertise needed to equip communities to address identified wicked problems (davidson, 2017), defined as complex problems that are difficult to approach and that require innovative multi-level intervention strategies. tot is currently used in international development for capacity building as an empowerment tool contributing to sustainable best practices (mormina & pinder, 2018). focused on training local professionals or community members to become trainers and expanding access to knowledge and skills in local contexts, tot methods aim to counter widespread neocolonial approaches utilizing western knowledge and experts to dictate the response to global development challenges. tot contributes to building local capacity and thus reducing the dependency of local communities on international “experts” which are limited by reliance on and restricted understanding of their own cultural, social, and economic contexts. however, based on the authors’ collective experiences, there are a few challenges with the tot method that are particularly relevant in the context of international social work: 1) the potential unidirectional transfer of knowledge, often based on a lack of intentional participatory methods used in the training; 2) the inconsistent participation of trainees in all aspects of the training process; 3) the lack of continuity and wastage of capacity, mostly linked to the inconsistent dissemination of knowledge and skills by participants and limited follow-up trainings; and, 4) the lack of fidelity in transferring the knowledge/disseminating the curriculum based on its initial adaptations for the communities’ needs. the proposed conceptual framework attempts to address these challenges in a number of critical ways including: adding participation as the core principle and approach; developing training materials as a resource for all participants; incorporating participants’ feedback in the training materials; providing follow-up web-based discussions, support, and feedback (to address any attendance/engagement issues); focusing on empowerment through network development (thus, facilitating ongoing collaboration between participants in the delivery/dissemination of knowledge and skills); and, creating mechanisms that facilitate the review/adaptation of training curriculum based on emerging needs in the participant communities. the networks facilitated and or/developed as a result of the capacity-building projects are thus positioned to serve as an important resource in ensuring sustainability of capacity beyond the life of the project. rights-based approach core guiding principles in creating space the shift from a needs-based to a rights-based approach is essential for any capacity building endeavor, as it allows us to start with a recognition of our shared humanity and build capacity to promote human dignity and worth which are at the core of the social work popescu & alonzo/creating space 1069 profession (mapp et al., 2019). a human rights paradigm is therefore the most appropriate framework for capacity building and sustainable community development. to adequately claim and protect human rights, we need to apply the core principles of a human rights paradigm to frame international development practices, in general, and community interventions and social work practice, in particular. such an approach emphasizes the role of social work education in training professionals to work within a human rights paradigm, beyond national borders and prerogatives, with a focus on individuals and communities as immediate participants in development and change processes (unsdg, n.d.). the first human rights principle we need to consider is universality (unsdg, n.d.): fundamental human rights apply to all people on the virtue of being human. it is this principle that supports the tot as the core method, as it maximizes access to better assessment and intervention tools. by facilitating access to professional development and achievement of full capabilities across local communities, we maximize choice and expand capacity, thus empowering communities. accountability is the next human rights principle (unsdg, n.d.) and is used to maximize capacity building by creating ownership at the community level, and identifying the mechanisms needed to ensure accountability at all levels. participants learn from each other through purposeful group activities and shared knowledge, engaging in interactive learning processes, and valuing each individual experience and perspective. they identify ways in which they can hold each other accountable to best apply acquired knowledge and skills to improve the lives of the communities in which they live and serve. at the same time, participants are empowered to hold trainers accountable to respecting the views of the community and respond to feedback and recommendations provided by the community. non-discrimination is the next guiding human rights principle (unsdg, n.d.), with an emphasis on inclusive approaches: purposefully engaging all community members (intentional participation mechanisms), and ensuring that no voices are excluded. to address non-discrimination the space framework promotes equal access to community trainings and purposefully engages community leaders to identify barriers to participation, and contribute to developing training methods that will promote inclusion. indivisibility of human rights is essential to consider for any interdisciplinary approach reframing the complex problems affecting communities as violations of human rights. it is not the violation of a single right that is reflected in these problems, but rather a constellation of rights that need to be addressed concurrently to provide an effective solution. through the recognition and subsequent application of the indivisibility principle (unsdg, n.d.), international social work can shift away from a needs-based/deprivation model and move towards a rights-based approach that operationalizes needs as barriers/obstacles that must be removed to fully protect and realize specific rights. a hallmark of the space framework--achievement of capabilities--can only be realized through shifting the paradigm and claiming/protecting community rights. participation is the core principle in the space framework. the tot, as its main tool, contributes to the goal of expanding capacity by disseminating shared knowledge. fully advances in social work, fall 2021, 21(4) 1070 informed by social capital theories, the space framework promotes network development to ensure diverse participation in all stages of training and capacity building. social workers become mentors for youth and social work students, engaging with them to support existing networks and to develop new networks of care. teachers and practitioners engage with youth to learn from them what needs to be addressed through the trainings provided and then use this knowledge to adapt and improve training materials. the space conceptual framework is anchored in the human rights paradigm to fully engage communities, recognize and support them in achieving their capabilities, and empower them to guide the interventions (from development to implementation and evaluation), and claim their rights. community members are rights-holders that actively engage each other, as well as other networks to maximize access to resources, and protect and realize the rights of each community constituent. the limitations of tot programs identified in the literature, as noted above, are directly addressed by the space conceptual framework: guided by human rights principles, it intentionally engages community members in a participatory training process aimed at strengthening existing capacity, fostering community wellbeing, and building sustainable networks to approach complex problems and participate in developing and implementing effective solutions. applying the space framework for capacity building: guatemala case study country characteristics guatemala is a central latin-american country that is part of the turbulent northern triangle (cheatham, 2021). the country faces multiple complex problems that directly affect communities throughout guatemala including: 1) displacement, disappearances and mass fatalities following the 36-year armed conflict (1960-1996) in which over 200,000 people either disappeared or were killed (sanford, 2003); 2) poverty (disproportionately affecting people in rural areas, indigenous groups, and women and children) with guatemala having the 2nd highest poverty rate in the americas, with approximately half of the population, and up to 79% of all indigenous people living under the poverty line (the borgen project, 2020; world bank, 2020); 3) violence, ranging from family violence and violence against women to street and gang violence (alvarado & massey, 2010; branas et al., 2013; ogrodnik & borzutzky, 2011; speizer et al., 2008); and 4) increasing mental health issues, with rising suicide rates among children and youth (branas et al., 2013; pengpid & peltzer, 2019; puac-polanco et al., 2015). highly vulnerable communities in and around guatemala city, characterized by rampant gang violence and drug trafficking, contributing to high instability, are categorized as red zone districts (rzd). the rzds rates of poverty, crime, gender-based violence (gbv) and community violence are the highest in latin america and among the highest in the world (alonzo et al., 2021; gerkin, 2020; human rights watch, 2020; puac-polanco et al., 2015; wilson, 2020). the guatemalan government is subjected to international pressures, following decades of complex geopolitical dynamics, with the united states heavily involved in addressing (or contributing to) the complex issues affecting central and south america in general, popescu & alonzo/creating space 1071 and the northern triangle countries, in particular (cheatham, 2021). the professional capacity in the country, particularly for caring professions (social work, psychology, health care) is scarce, and the socio-economic context limits access to health and social services (gragnolati & marini, 2003). the state of mental health in guatemala is another major issue of concern, with approximately 1 in 4 guatemalans experiencing a mental illness in their lifetime (branas et al., 2013), and only 2-15% of those with a mental illness being able to access needed psychiatric treatment ( puac pulanco et al, 2015; rissman et al., 2016). previous studies indicate prevalence rates of 40.7% for depression, 23.3% for alcohol-related disorders, and 50% for ptsd (branas et al., 2013). rates are even higher among particularly vulnerable groups such as women, indigenous groups, those directly affected by the country’s 36-year armed conflict and the urban poor residing in communities such as rzds (mercier, 2020; schwartz, 2020). the covid-19 pandemic added new levels of complexity to the existing problems (action against hunger, 2020). since the start of the pandemic, guatemala’s economic indexes sharply decreased, leading to over half a million job losses and an exacerbated food crisis, with over 1.2 million people in need of food aid by june, 2020, doubling the number since the beginning of the year (action against hunger, 2020). the added burden on an already weak health care system (with resources being shifted from maternal and child care to covid-related care), as well as the loss of remittances and the forced returns of guatemalan people from the united states, including unaccompanied minors, increased the sense of loss and despair, leaving communities with little resources or hope (action against hunger, 2020). guatemala has a predominantly young population, with over half of the total population under the age of 18 (central intelligence agency [cia], 2019; pan american health organization [paho], 2017). this is an element of capacity, taking into account that a young population is usually more amenable to change and more prone to innovation if adequate resources are provided. psychology and social work programs are provided by multiple higher education institutions (hei) in guatemala, yet only one university is a public university, which further marginalizes the majority of the population, limiting their access to higher education. among the private hei, two of the universities in guatemala city cater to lower-income youth by providing scholarships. they provide psychology and social work training to students with roots and/or direct interests in the more highly vulnerable communities. the civil society in guatemala depends greatly on the work of non-governmental organizations (ngos), often with international representation, that engage with communities and provide access to much needed resources. school participation in local decision-making is affected by the multiple issues hurting local communities and by a chronic lack of resources. therefore, it is the ngos, with their staff and volunteers, that work to address these issues where governmental programs do not have a presence. teachers and other school personnel also rely on ngos to provide additional training on issues they are not prepared for, such as suicide assessment and intervention, violence prevention, and community-school partnership programs (carter, 2012). advances in social work, fall 2021, 21(4) 1072 applying the space framework to developing a tot in guatemala applying the space conceptual framework, we adapted a tot model to design a capacity building project focused on two rzd communities in guatemala. the model was anchored in a capacity mapping conducted with key stakeholders in these communities that identified existing problems (problems affecting the communities for a longer period of time; triggering problems (escalating issues identified by key stakeholders as leading to current concerns); and resources (existing capacity/community assets). community #1: peronia peronia is a vibrant community consisting of 12 separate districts representing an urban sprawl of guatemala city. a microcosm of the country, peronia reflects its high levels of poverty. it is the third most densely populated city in central america, with a very young population – 76% being younger than 35 (merriman, 2020). according to united nations educational, scientific and cultural organization (unesco, 2020), literacy rates in the country reflect a significant gap between women and men, with the overall literacy rates for women being approximately ten percentage points lower than for men. the differences are starker in poor communities, with over 90% of children living in poverty and never graduating high school (guatemala literacy project, 2020). for indigenous communities, the literacy rates are significantly lower, with 33% of people in these communities being completely illiterate (idem). the community is impacted by gang violence, a wide-spread issue in guatemala particularly affecting urban areas (winton, 2004); as well as an increasing exodus, with people migrating towards the united states, in an attempt to escape gang violence and gender-based violence (smith, 2020) [existing problems]. schools are faced with teen pregnancy (wulfhorst, 2017), street and family violence, delinquency (overseas security advisory council, 2020), and a recent sharp increase in youth suicide rates (pengpid & peltzer, 2019) [triggering problems]. in this community, the natural partner was an elementary school [resource], that aims to prepare its teachers and staff [resource] to address some of these ongoing challenges by developing and growing its social capital; engaging with local capacity [resource], particularly in regards to social care; and creating interdisciplinary teams (psychologist, administrators, and teachers) that will be able to assess and respond to identified suicide risks. community #2: el limon el limon is a community at the outskirts of guatemala city, with high poverty rates and violence, particularly gang-related violence (black beans & bitterballen, 2017; fieser, 2010) affecting its youth [existing problems]. due to the high prevalence of violent behaviors and the risk of harm and self-harm among children and youth in this community [triggering problems], multiple health care providers and youth-centered organizations are present in the community [resource]. from a social capital perspective, the community capacity is high, yet not fully capitalized due to high levels of instability popescu & alonzo/creating space 1073 [challenge/triggering problem]. in this community, the mental health care providers [resource] were the main partners bringing the community together. the common threads between these two communities and the pillars on which this model was built are:  shared current issues and triggering issues;  a focus on increasing visibility and capacity of the social work profession locally through active international support provided by international social work solutions;  local leadership provided by hunger relief international, an international ngo very engaged with the local communities;  initiated partnership with social work educators facilitated by international social work solutions [isws]; and,  identified youth leaders and an emergent network of professionals focusing on core social issues (see figure 2). initial capacity mapping identified and validated several common issues, including community and family violence, as well as depression and suicidality, particularly among preteens and teens (ages 11-19). the common points of intersection concerning these immediate challenges allowed participants (teachers and school administrators in peronia, and mental health care providers, community health care providers, youth leaders, and social workers in el limon – see alonzo et al., 2020) to discuss the impact of these issues on education and development and related long-term implications. these common issues were used to guide their strategic planning work and establish how to use and expand existing networks to have a deeper impact and improve outcomes for their communities, particularly concerning health and mental health. applying the space framework, the work was anchored in the identified community capacity (professionals and community members in the two communities), using a participatory training-of-trainers focusing on assessment, prevention and intervention on family violence, community violence, and mental health issues. by training community health care providers, professionals, and youth leaders in the two communities, we provided support to the target communities in achieving a level of capacity that will equip them to address problems they identified in their communities. the goal was to empower the participants through providing needed knowledge and skills, and strengthening and expanding existing networks, thus improving the overall wellbeing of all community members. the tot engaged the community, inviting participants’ contribution to developing community-centered strategies to assess risks, identify protective factors, disseminate knowledge, and develop core networks allowing for sustainability of the model. the observed increased capacity as an immediate outcome of the tot (alonzo et al., 2020) was linked to the identification and connection of existing networks of care that later became a key resource in addressing the added problems raised by the covid-19 pandemic. the core human rights principles were anchoring the development and dissemination of the tot. the training-of-trainers followed the universality and non-discrimination advances in social work, fall 2021, 21(4) 1074 principles by engaging all interested participants to address community and family violence and mental illness as risk factors for suicide, while focusing on developing strong support networks as protective factors for at-risk youth. as human rights are indivisible, the right to life, health and mental health care, family, safety, as well as fair representation and free associations are the main rights scaffolding the approach. literacy, access to education, and other economic opportunities are seen as protective factors, leading to a comprehensive strategy that aims to address micro, mezzo, and macro level stressors to lower suicide risks among children and youth. the engagement of multiple stakeholders followed the participation principle. continuity and sustainability of capacity building was facilitated through the development of an additional network of support including social work educators, international organizations, and local ngos that initiated the tot. training materials were developed and provided for the newly trained professionals to support their work in continuing to empower local communities through training and specialized interventions. rather than proposing a traditional, manualized approach which is controlled by developers, often outsiders to the communities they train, the space framework facilitated the development of training materials that continue to grow and adapt as needs and contexts change, under the leadership and ownership of community representatives. accountability was intentionally built into the model through regular meetings, shared reports, and consultations on current challenges with the training materials participants use and disseminate, and the interventions they are working to develop. the trainers and partner organizations were accountable to the community in providing timely responses, integrating changes to training materials based on participants’ feedback, and organizing follow-up sessions to observe and respond to trainings planned and delivered to local communities. while the follow-up sessions schedule was disrupted by the covid-19 pandemic, the accountability structures were integrated throughout the implementation of the model. implications for international social development and social work practice the space conceptual framework addresses the weaknesses and limitations of both empowerment theory and the strengths perspective raised by kam in the development of the eps model, (kam, 2020), particularly in regard to the hegemony inherent in western approaches to community development and capacity building, resolving the empowerment paradox (adams, 2008). the use of the strengths perspective within a human rights paradigm shifts focus to the community, recognizing its capacity, and engaging with community members to develop and implement capacity building tools that make sense for their own understanding of the complex problems they are faced with. this framework highlights the importance of a rights-based approach for community interventions in an international context of practice, and prepares social workers to adapt existing capacity building tools through participatory approaches leading to community-driven responses to complex global issues. popescu & alonzo/creating space 1075 figure 2. stakeholder mapping in the tot in guatemala – using the space framework by using participation as the core principle of the space framework, the tot we developed fully involves the community and transfers training capacity to the trainees. the achievement of full capabilities/capacity as one of the primary goals becomes instrumental in empowering the community to take ownership of the sustainable solutions they design. in guatemala, that was exemplified by the full engagement of community members in using existing networks (as presented in figure 2) and developing new networks by connecting training participants to relevant groups, to improve responses and outcomes. advances in social work, fall 2021, 21(4) 1076 this level of community engagement will support dissemination of information and create local leadership. social workers and mental health care providers are actively engaged in these networks, either through participation in the training, or through newly established connections with schools of social work and psychology in two local universities, an indicator of increased professional local capacity (alonzo et al., 2020). the grounding of the model in core human rights principles also shifted the focus from the training itself (sole formation of professionals, through the transfer of specific knowledge and skills) to the role this training plays in maximizing the choices of trainees in regards to problem definition, intervention tools, and desired outcomes/measures of success. ultimately, creating a rights-based space is about facilitating the development and growth of networks of care that either existed prior to the training or were formed as a result of the training. it is such networks that bring community participants together, empowering them to frame the curriculum through their own lenses and transfer knowledge and skills in their own communities. space works across professional disciplines to engage all relevant stakeholders, creating spaces for growth and increasing community capacity. despite the advantages of the space framework, a few limitations need to be acknowledged: (1) the model was only tested in the specific context of the two highly vulnerable communities in guatemal; and the only participatory approach employed was the tot. to increase its applicability, the model needs to continue to be applied in different contexts, and possibly using alternative participatory approaches. (2) further testing of the model and its impact on sustainable capacity building is needed. we did schedule a follow-up that would have focused on the application of skills by newly trained participants in training other community members, yet due to the covid-19 pandemic it was postponed. the followup session would have provided us with important data on the effectiveness of the tot in preparing participants to train other community members following the participatory approaches prescribed by the model. (3) further exploration is needed on the impact of the intervention (tot) on network development, as an important indicator of increased participation, increased community engagement, and sustainability. such data will allow us to refine and improve this model. despite these limitations, in the context of a global pandemic, exacerbating all existing problems and depleting already scarce resources, the space framework can be an effective framework for developing interdisciplinary, sustainable solutions. on one hand, this is a framework that builds on core premises of international social work education, stressing the importance of starting where the people are, and using a holistic approach to engage relevant stakeholders at the micro, mezzo, and macro levels of practice. on the other hand, the model transcends social work education, providing an effective rights-based sustainable development framework. this framework does create space for safe, brave, popescu & alonzo/creating space 1077 and sustainable solutions, with communities at the core and at the lead. further research on the applications of this framework in international social work practice and social development should explore ways in which the interdisciplinarity and participatory approach can improve practice in international settings and advance rights-based approaches to sustainable development, ultimately facilitating community-driven solutions and increasing community wellbeing. references action against hunger. 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(2022). who coronavirus disease (covid-19) dashboard. https://covid19.who.int/ wulfhorst, e. (2017). teenage pregnancies rise in guatemala as girls are deprived of basic sex education, warn healthcare campaigners. independent, uk. may 3, 2017. https://www.independent.co.uk/news/world/americas/teenage-pregnanciesguatemala-girls-basic-sex-education-contraception-violence-healthcare-campaignersa7715406.html author note: address correspondence to marciana l. popescu, graduate school of social service, fordham university, new york, ny. email: popescu@fordham.edu _________ lisa rapp-mccall, phd, msw, professor, msw program at saint leo university, saint leo, fl. robert lucio, phd, lcsw, mssw online program director, college of social work, the university of tennessee, knoxville, tn. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 48-65, doi: 10.18060/27395 this work is licensed under a creative commons attribution 4.0 international license. firearm access and safe storage: what are social workers’ training and assessment practices with clients? lisa rapp-mccall robert lucio abstract: social workers often work with clients who are at elevated risk for firearm victimization or perpetration due to their personal risk factors. but are they talking to their clients about firearms? research on social workers’ firearm assessment or discussions with clients about safe storage is scarce. this study sought to better understand social workers' and students’ firearms training, beliefs, general knowledge, and application to practice. an anonymous, online, quantitative survey was completed by 139 social workers and students. most social work practitioners and students had zero hours of training regarding firearms in their social work programs, their internship, and/or from continuing education units (ceus). those that had training asked clients about firearms. besides asking suicidal and aggressive clients, most social workers were not routinely asking other highrisk clients about their access to firearms or their storage practices. over half of the participants said they would be interested in future training. social workers have unique skills and key connections with high-risk clients who are vulnerable to firearm-related risks. they have the potential to prevent gun violence, but only if they receive thorough, effective training on firearms assessment and safe storage practices. keywords: firearm access, firearm safety, social workers’ training, assessment of firearm risk, firearm violence firearm violence is among the u.s.’s leading causes of death and disability and has been deemed a public health crisis. in 2018, there were approximately 393 million firearms in the u.s. (ingraham, 2018) and firearm purchases escalated by 4.3 million or 64.3% more than typical purchases during the covid pandemic (schleimer et al., 2021). a national poll found approximately 44% of homes in the u.s. have a firearm (saad, 2020). a firearm in the home increases the risk of homicide by 170% and suicide by 460% (miller et al., 2016) and in a 2019 national survey, 65% of gun owners admitted to storing their firearm unlocked (berrigan et al., 2019). considering these statistics, it’s likely that social workers engage with many clients who own firearms or live in a home with them, and this drastically increases their risk for injury or death. in addition, many clients have an increased risk for firearm injury and death due to personal risk factors, such as trauma backgrounds, problems with impulsivity and emotional dysregulation, heavy alcohol use, aggression, dementia, depression, and suicidal ideation (betz et al., 2018; mcginty et al., 2016; wintemute, 2015). despite asking clients numerous assessment questions about other risky behaviors or sensitive topics like substance use, history of abuse, violence in the home, and sexual activity, studies have noted that social workers rarely ask their clients about firearm access or ownership (sperlich et al., 2022). however, studies have found most clients are willing about:blank rapp-mccall & lucio/safe firearm storage 49 to discuss gun safety in the context of their healthcare and safety (betz et al., 2016; pallin & barnhorst, 2021). most social workers report feeling uncomfortable about asking, are not familiar with firearm terminology and culture, or worry about the discussion devolving into politics or potentially affecting the client-worker relationship (slovak et al., 2008; sperlich et al., 2022). they are not alone, as nurses, physicians, pediatricians, and mental health professionals also report hesitancy in discussing this topic with clients and readily admit to having little training on the topic from their education and/or continuing professional workshops (fix & linsky, 2021; pallin & barnhorst, 2021; roszko et al., 2016; stanley et al., 2017; wolf et al., 2019). public health harm reduction model with many firearms already in possession by u.s. citizens and a strong constitutional support for gun ownership, the likelihood of drastically reducing national firearm ownership is small. a more realistic approach to prevention and safety may be to address firearm risks through a public health harm reduction approach. firearms are not the cause of violence, but they drastically increase lethality (rapp-mccall, 2022). the lack of education and/or misuse of a firearm can lead to greater injury and/or death in cases where someone uses it in a state of emotional dysregulation or while under the influence of a substance. the harm reduction model suggests that certain risk factors increase the chance for serious injury and/or death and therefore, reducing those risks may aid in reducing deaths and injuries (centers for disease control and prevention [cdc], 2022). nonjudgmental prevention is the goal, with risk factors being discussed in an educational way that empowers clients to own their ability to reduce harm. to mitigate risks from guns, social workers need to understand that firearms are a risk in and of themselves, but access to firearms for individuals with additional risk factors significantly increases the chance of serious injury or death. safe storage and competent use of firearms have been shown to reduce risks (dowd et al., 2012). social workers use strong interpersonal skills, effective communication, and advocacy skills to promote healing, resilience, and equity. as such, they are uniquely qualified to deliver harm reduction education and ultimately assist in preventing firearm injuries and death. the next section will explicate groups at higher risk for perpetrating or getting seriously injured and/or killed from firearms. groups who have elevated risks with firearms children and youth in 2020 (the most recent year with available data from the cdc), firearms were the number one cause of death for children ages 1-19 in the united states, surpassing motor vehicle accidents (cdc, 2020a; lee et al., 2022). children and youth are at higher risk around guns for several reasons, they do not completely grasp the finality of death, are impulsive, have quickly changing emotions and moods, and are inherently curious about their surroundings (solnick & hemenway, 2019). in a recent study regarding firearms in the home, one-third of adolescents aged 13-17 reported that they could gain access to the advances in social work, spring 2024, 24(1) 50 family firearm within 5 minutes, including firearms that were locked (salhi et al., 2021) and approximately 4.6 million children reside in homes with unlocked and loaded firearms (azrael et al., 2018). studies on school shooters have reported that 80% of the youth obtained guns from their home or family members outside the home (peterson & densley, 2021). firearms in a home where children reside and/or visit elevate the risk for youth and others in and outside the home due to accidents and purposeful violence. trauma occurring during childhood is a risk factor for future victimization and aggression and is an elevated risk factor for future firearm violence. in a recent study, youth who experienced multiple adverse childhood experiences (aces) reported a significantly greater likelihood of mental health problems, suicidality, substance abuse, and aggression than youth without trauma (meeker et al., 2021). specifically, youth with a history of aces were more likely than other youth to have suicide attempts, suicidal ideation, and carry a gun. childhood trauma survivors often develop impaired views of violence, cognitive biases toward aggression, difficulties with impulse control, emotional regulation, and lack of empathy (fox et al., 2015). according to a study by wamser-nanney et al. (2019), individuals who were exposed to domestic violence and/or community violence were more likely to carry and use a firearm. in addition, a history of bullying as well as fear from previous victimizations, also increases the risk of gun violence (sanchez et al., 2020). intimate partner violence intimate partner violence (ipv) is pervasive in the united states and access to firearms seriously increases the risks of lethality. adding a firearm into an ipv situation can escalate ipv to partner homicide (lynch & logan, 2018; spencer & stith, 2020). a study by sorenson and schut (2018) found that 4.5 million women have been threatened with a gun during their lifetime and one million have been shot by an intimate partner. most intimate partner homicides and homicide-suicides involve firearms (fox & fridel, 2017; graham et al., 2022). according to the bureau of justice statistics working with the federal bureau of investigation (2022), 34% of female homicide victims and 6% of male homicide victims were killed by their intimate partner. the perpetrator is not the only one who brings a gun into the home, victims may purchase a firearm for preemptive protection and that firearm in the home increases the risk to both partners (stansfield et al., 2021). likewise, children in homes with ipv are also at increased risk when a firearm is present. zeoli and colleagues (2016) found that non-fatal abuse increased with the presence of a gun in the home. ipv situations are dangerous, and the presence of a firearm can drastically escalate the danger for everyone. living in community violence firearm violence is present across all demographics and locations. however, according to the cdc (2020b) communities of color disproportionately experience conditions conducive to firearm violence including systematic racism and discrimination, lack of housing, concentrated poverty, few jobs, high transience, lack of access to healthcare, and poor educational systems. these experiences facilitate and perpetuate stress, fear, crime, and violence. carrying a firearm is often done for pre-emptive protection against the rapp-mccall & lucio/safe firearm storage 51 dangers of living in disadvantaged areas, such as gang activity, drug sales, assaults, and random shootings (wamser-nanney et al., 2019). but firearm carrying, according to wintemute (2015) increases one’s risk of being both a victim and a perpetrator of violence. living in these communities is considered an ace, as it can generate anxiety, depression, aggression, and increase youths’ chance for future victimization and the development of violence. unfortunately, the homicide rate in the u.s. has increased and people living in these vulnerable communities are disproportionately impacted (cdc, 2020b). depressed and suicidal clients according to the cdc, suicide is a leading cause of death in the u.s. across all populations accounting for about 46,000 deaths in 2020. suicide rates are increasing; growing by 30% since 2000 (cdc, 2020c), and the likelihood of a suicide attempt being fatal drastically increases when a firearm is present (conner et al., 2019; studdert et al., 2020). based on 2019 data from the american association of suicidology (2023), approximately, 50% of all suicide completions involve a firearm. depressive episodes are also strongly associated with suicide and gun ownership (perlis et al., 2022). a study conducted by caine (2022) found that 35% of the nearly 7,000 participants meeting the criteria for depression, had recently purchased a firearm within the past year. the vast majority (78%) were white males, which is the highest-risk group with fatal outcomes from a suicide attempt (american association of suicidology, 2023). kim’s (2018) study regarding the mental health effects on children of gun owners, found children who lived in homes with guns were significantly more depressed than children living without guns, especially for adolescent females. it is clear, from the magnitude and reliability of studies, that depression, suicide, and firearm ownership are closely linked (miller et al., 2016; perlis et al., 2022). comparing rates of u.s. adults who perished from firearm suicide in 2021, 72.2% were veterans and 52.2% were non-veterans (department of veterans affairs [va], 2023). when adjusting for age, veterans’ suicide rate was 2.1 times higher than non-veteran adults (tsai et al., 2020) and 69% of their suicides were completed by firearm (theis et al., 2021). tsai et al. (2020) found that veterans who had recently met with a va service provider had higher rates of suicides afterward than others. veterans constitute an extreme risk group within an already high-risk population for injury or death from firearms. elderly and dementia approximately 39%-49% of older adults live in a home with firearms (parker et al., 2017) and the most recent cdc reports indicate that firearm suicide rates are highest for adults 75 and older (cdc, 2022). sixteen percent of all u.s. firearm deaths in 2022 were among adults 65 or older (national safety council, 2022). cognitive, physical, and behavioral competence issues which we consider for driving a vehicle also relate to the safe use of firearms (mertens & sorenson, 2012). researchers have been studying the dangerous circumstances surrounding older adults owning firearms for over a decade with little reaction from health care providers. advances in social work, spring 2024, 24(1) 52 three concerning trajectories are currently happening. the elderly population is growing, the numbers of those experiencing alzheimer's disease and dementia are increasing, and the number of guns in the homes of these individuals is escalating (betz et al., 2018). these are ingredients for a dangerous outcome. despite the increases, few studies have focused on how clinicians can discuss these issues with clients, assess safety, and/or educate caregivers of this risk (betz et al., 2020). there are risks to owning and living with guns, but particular groups present higher risks to themselves and others when they have access to firearms. most social workers interact with one or more of these groups, making social workers pivotal in prevention. social workers’ beliefs about firearms training, knowledge, and practice behaviors only a few studies have sought to understand the current training on firearms for social workers and their attitudes toward training. slovak et al. (2008) conducted a survey with 697 respondents and found 76% had never received training or education about engaging clients on firearms. sperlich et al. (2022) found via focus groups and interviews with social workers that few had received formal training in their degree programs or on the job, but many wanted to gain information about how to recognize, assess, and intervene with clients. several studies found that formal training on firearms, whether in an educational program or as continuing education, increased clinicians’ likelihood of asking clients about guns (bandealy et al., 2020; bryan et al., 2021; roszko et al., 2016; slovak et al., 2008). studies which evaluated social workers’ knowledge about the risk and impact of firearms on vulnerable groups could not be found in the literature. this leaves a gap in information regarding social workers’ ability to differentiate between understanding the general dangers of firearms and how those dangers increase when working with members of high risk groups/communities. in 2019, the national association of social workers (nasw) joined with the brady campaign to create a toolkit for social workers’ to better understand the context of gun violence in the u.s, reaffirm the values of our profession, which match a harm reduction approach, and encourage social workers to talk with families about gun safety to prevent family fire (firearms in the home with children). no studies evaluating the effectiveness of the toolkit were found. to date, research has noted that social workers are not clear on their role or how to engage in discussions about firearms with clients and may not be doing so (slovak et al., 2008; sperlich et al., 2022). if we expect social workers to conduct assessments, engage in discussions regarding gun safety, and potentially intervene, it’s important to determine how many have received firearms training in formal social work programs or continuing education training. additionally, it is imperative to understand what social workers’ attitudes about training are, what are their current practice behaviors regarding firearms, and what is their knowledge about firearms. rapp-mccall & lucio/safe firearm storage 53 current study this study sought to better understand social workers’ training on firearms, their perspectives about training, their practices in assessing firearm access and safety with their clients, and their general knowledge about firearm risks. specifically, the authors addressed the following research questions about social workers and social work students to add to the literature: (1) how much training has been given on assessing firearm access, (2) what are their beliefs about obtaining trainings, (3) how do they integrate firearm assessment into practice, and (4) what is their general knowledge about firearm risks? methods procedures after the university’s irb approval was obtained, an online, anonymous, quantitative survey was posted on nasw’s “all member forum” inviting social work students and social workers of all degrees (bsw, msw, dsw, and phd) to participate in the study. the “all member forum” is only available online to nasw members. the survey was posted on three occasions over a six-month period. implied consent was used since it was an electronic, anonymous survey for adults. participants viewed the invitation post and implied consent form and if they were interested in participating in the study, they clicked the link taking them to the online qualtrics survey. they could stop the survey at any time. survey the research team created the survey to address four areas with training, beliefs about training, practice application, and knowledge of firearms. the survey was pilot tested with a convenience sample of ten social workers and their feedback was used to clarify and focus questions. demographic, familiarity, and comfort participants were asked for basic demographic information, such as gender, age, race, highest degree (bsw, msw, dsw, phd), and years of experience in the field. additionally, to gather more information about familiarity and comfort with firearms, they were also asked if they lived in a household with a firearm (“yes”/“no”), familiarity with procedures for safely storing firearms (“not familiar,” “somewhat familiar,” “extremely familiar”), familiarity with using a firearm (“not familiar,” “somewhat familiar,” “extremely familiar”), and comfort level talking to clients about firearms safety and access (“not comfortable,” “somewhat comfortable,” “very comfortable”). training participants were asked to identify how many hours of continuing education units (ceus) or clock hours of training on firearm safety they had in different environments. advances in social work, spring 2024, 24(1) 54 these included: during their social work program, during their internship, or through ceu/conference opportunities. for each item, participants were asked to note the range of hours from the following response options: “zero hours,” “one to five hours,” “six to ten hours,” or “eleven or more hours.” beliefs about training beliefs about firearm training were measured using three items which noted participants’ comfort in speaking about the issue with clients, the likelihood of attending a ceu event or conference to learn more, and perceptions about including firearm safety as a regular part of social work programs. participants were given three response choices specifically related to each item. for instance, when asked about the likelihood of attending future trainings on the subject, participants could choose from “not at all likely”, “maybe”, and “very likely.” practice application of firearm assessment and safety how participants integrate firearm assessment and safety into practice was ascertained using ten items that asked about firearm access and storage for all clients, youth (if parents), clients who are suicidal, clients who are aggressive, and survivors of ipv. there were five responses for each item ranging from 1 (never) to 5 (always). this provided a total scoring range of ten to fifty. for this study, the measure demonstrated strong reliability (α = 0.94). general knowledge participants were asked about their general knowledge of firearm access and risks. this was assessed using three items to gauge participants’ knowledge about firearm statistics. these included yes/no questions about firearms as the leading cause of death among youth, the percentage of unlocked/unsecured firearms in homes, and the impact of guns in the home on suicide and homicide. overall, these items showed good reliability (α = .67). analysis approach all analyses were completed using spss 26. general descriptive analyses were run on all variables to get an overall picture of the sample, as well as the level of previous training, general knowledge, and how often participants engaged in using firearm assessment and safety with their clients. second, correlations, t-tests, and anovas were run to identify any relationships between specific descriptive variables and the integration of firearm assessment and safety into practice with clients. rapp-mccall & lucio/safe firearm storage 55 results participants a total of 139 participants took part in the study. most participants identified as white (86.3%) and female (77.7%), with a mean age of 52.4 (sd = 13.3). the majority reported practicing with an msw (82.7%) and having almost 20 years of experience. fourteen respondents reported they were students pursuing a degree, including bsw (n = 2), msw (n = 10), dsw (n =1) or a phd (n = 11). the remaining participants noted they had already graduated. see table 1 for more information. familiarity and comfort most participants (62.2%) reported they were less likely to live in a household with a firearm, were at least somewhat familiar with the procedure for safely storing a firearm (83.7%) and using a firearm (54.1%), and at least somewhat comfortable talking to clients about firearm access and safety (85.8%). table 1. participant demographic information demographic mean (sd) n (%) significance age 52.4 (13.8) 137 r(84)= 0.03, p=.78 years of experience 19.4 (13.3) 137 r(77)=0.02, p=.87 live in a household with a firearm 1.62 (0.49) 135 t(82)=1.46, p=.15 familiar with storing firearms 2.21 (0.71) 135 f(2,81)=4.68, p=.01 familiar with using firearms 1.77 (0.80) 135 f(2,82)=2.44, p=.09 comfortable talking to clients about 2.27 (0.70) 106 f(2,81)=18.71, p<.01 knowledge of firearms 4.34 (1.15) 130 r(84)= 0.27, p=.01 practice integration of firearms assessment 34.02 (10.8) 84 gender f(2,83)=2.13, p=.13 female 108 (78.3%) male 27 (19.6%) non-binary/third gender 3 (2.1%) race/ethnicity f(5,78)=0.50, p=.74 american indian or alaska native 3 (2.2%) asian 1 (0.7%) black or african american 7 (5.1%) latinx 5 (3.6%) white 120 (87%) other 2 (1.4%) highest degree f(2,74)=0.66, p=.52 bsw 2 (1.6%) msw 115 (93.5%) phd 6 (4.9%) current student t(82)=0.14, p=.71 yes 14 (10.2%) bsw 2 (14.3%) msw 10 (71.4%) dsw 1 (7.1%) phd 1 (7.1%) advances in social work, spring 2024, 24(1) 56 previous and future trainings most participants reported receiving zero hours of training on firearm safety/ assessment in their social work program (89.6%), internship (72.6%), or at a conference or ceu training (68.1%). for those who did report receiving some training, 31.9% received it as ceus or by attending a conference session on the topic, 27.1% received some training at their internship and 10.4% received training in their social work program. most participants (85%) believed learning to talk to clients about firearm access and safety should be taught in accredited social work programs. finally, when asked if they would be likely to take a continuing education course or attend a conference session to learn best practices in assessing client’s access and storage of firearms, over half said they “were very likely” and an additional 43.8% responded “maybe.” see table 2 for more information. table 2. firearms assessment and safety training general knowledge when asked about firearms as the leading cause of death among children and teens, 65.4% (no = 34.6%) reported knowing this was accurate. almost half of participants (48.5%) responded that they were aware of the percentage of gun owners who have unlocked firearms, and they knew about the increased chance of suicide and homicide by having a gun present in the home (51.5%). practice application of firearm assessment and safety for the application of firearm assessment and safety responses, always and frequently were combined to give a broader picture of how often practices were performed. practitioners asked clients who are suicidal 89.7% of the time if they own or have access to firearms and asked them 80.0% of the time if they safely store their firearms. social workers asked aggressive clients about firearm access 60.4% of the time and about storing firearms 51.3% of the time. this was followed by ipv survivors who were asked about access 39.7% of the time and storing their guns 40.0%. it was not a regular practice to ask all clients about firearm access (27.9%) or safely storing firearms (29.0%). nor was it training venue training hours social work program internship ceu or conference 0 hours 121 (89.6%) 98 (72.6%) 92 (68.1%) 1-5 hours 14 (10.4%) 33 (24.4%) 33 (24.4%) 6-10 hours 2 (1.5%) 8 (5.9%) 11+ hours 2 (1.5%) 2 (1.5%) yes not sure no believe should be taught in schools 118 (90.8%) 10 (7.7%) 2 (1.5%) very likely maybe not likely would take a ceu course or conference session 68 (52.3%) 57 (43.8%) 5 (3.8%) rapp-mccall & lucio/safe firearm storage 57 common to regularly ask parents or guardians of youth about storage (31.1%) even though most social workers knew that firearms are the leading cause of death for children. relationship to practice application when looking at participants’ overall practice application of firearm assessment with clients, the scores ranged from 10 to 50 with a higher score indicating higher application. the mean score was 37.3 (sd = 10.5). examining each of the participant demographics and descriptive variables, five factors were related to including firearm assessments in practice. first, hours of training in continuing education or conferences were related to an increase in scores. those with any training beyond 0 hours were more likely to infuse this into their practice, f(2,103)=4.14, p = .019. second, there was a significant relationship between general knowledge and firearm assessment, r(84)= 0.27, p=.01, where those who reported more knowledge about firearms were also more likely to apply this to their practice. also, being extremely familiar with storing firearms, f(2,81)=4.68, p=.01, and being at least somewhat comfortable talking to clients about firearms safety, f(2,81)=18.71, p<.01, was related to being more likely to introduce the assessment into practice. finally, living in a household with a firearm was related to comfort level when talking with clients χ2(2, n=106)=23.96, p<.01. none of the other variables in the study were related to higher or lower scores on how this was integrated into regular practice, including age, gender, race/ethnicity, degree, years of experience, living in a household where there is a firearm, being familiar with storing or even using a firearm. discussion most social workers and social work students have received no firearm assessment and safety training in their cswe-accredited programs, continuing education, and/or internship. for those that had received training, it had most often been at a conference, for ceus or at their internship. this is consistent with prior studies (slovak et al., 2008; sperlich et al., 2022) which found that few had received any training. little progress has been made in training social workers for these practice skills and accredited social work programs are providing the least amount of training. most respondents believed that education and training during social work programs should be infused into the curriculum, and most were interested in receiving training. a novel addition to the literature was asking social workers and students about their general knowledge about firearm dangers and at-risk populations. most participants did not have a good working knowledge about firearm danger and at-risk populations, and this combined with little training on the topic helps us understand their practice behaviors. there was a significant relationship between having training and having general knowledge of firearms and applying it to their practice. this supports previous research which suggests that training and knowledge about the dangers of, and at-risk populations for firearms increases assessment and intervention with clients (bandealy et al., 2020; bryan et al., 2021; roszko et al., 2016; slovak et al., 2008). advances in social work, spring 2024, 24(1) 58 most participants do not live in a home with a gun but those that do reported feeling more comfortable talking to clients about firearms. likewise, those who were more familiar with storing and/or using guns were more likely to assess clients regarding firearms. if most social workers do not live in a household with a firearm, then education and training are essential to increasing comfort levels in assessing and discussing firearms. one interesting finding suggested that there was a portion of social workers who reported feeling comfortable about talking to clients about firearms but did not ask them about firearm access or safe storage. this is a disconnect which warrants further investigation as well as practical training for discussing safety and access. we could not locate any previous studies which specifically asked social workers if they assessed clients about firearm access and storage from high-risk groups. the vast majority of social workers and students asked suicidal clients about firearms, most asked aggressive/violent clients about them, but most did not ask ipv survivors, parents or guardians of children, or all clients regularly. this is concerning since 65% of the participants knew that the leading cause of death for children is firearms. this also suggests that the nasw’s brief intending to educate and change social workers’ conversations with parents about “family fire” (firearms in the home with children) posted on their webpage over 5 years ago has either not been viewed or applied to practice by most social workers. it is also interesting to note that no other variables affected the practice behaviors of social workers, not age, years of experience, gender, race, etcetera. practice application was driven by general knowledge about firearms, training, and/or comfort with a gun. the findings concur with prior studies and help strengthen our understanding of training and social workers’ attitudes toward it. novel additions to the literature regarding social workers’ general knowledge about firearms and their specific practice behaviors illuminate the concern that the field has made little progress toward training, understanding, increasing the comfort levels, or motivating social workers to implement firearm assessment universally or even with high-risk populations. limitations there are several limitations for this study. this was a small sample of social workers and social work students, and the sampling was conducted via an online forum for nasw members. so non-nasw members or others who do not engage in online forums were not aware of the study. the participants lacked diversity, as most identified as white females with an msw degree. the survey used to measure knowledge, practice application, or beliefs, was a self-report about practice, and participants may have felt social pressure to present themselves in a better light. it was also not standardized, though it did show good reliability (.67) between items for the general knowledge portion of the survey, generalizability of the findings is limited. implications this study reinforces previous research findings and confirms that practicing social workers are not assessing clients for firearm access or safe storage. this is worrying since rapp-mccall & lucio/safe firearm storage 59 social workers often work with clients who are at the highest risk of being a victim of firearm violence or hurting others with firearms. this omission places clients, their families, their communities, and social workers at risk and is a missed opportunity to reduce potential firearm violence. it is also a form of cultural incompetence, as many individuals view guns as a part of their family and/or community culture and an inability to discuss the access, use, and safety precautions surrounding guns is akin to not acknowledging firearm culture. the profession has fallen behind other medical professions regarding firearm discussions with clients/patients and there is much work to be done. several practical responses can be initiated to address this serious concern. training on firearm risks, general firearm knowledge, the culture of firearms, and effective practice behaviors need to be developed for accredited social work programs, internships, and ceus. support and involvement from cswe and nasw on these initiatives should be leveraged to move expediently. the establishment of gun safety assessment and counseling as a core of bsw, msw, and dsw education and continuing education requirements for licensed practitioners should be considered. some trainings and programs have been initiated. the be smart for kids program (thomas et al., 2019) is an example of a strengths-based program, developed by social workers, and intended to help parents, teachers, and mental health professionals protect children from gun violence. this program has yet to be evaluated but has been piloted for several years. other professions (pediatricians and emergency room physicians) have also begun training their students and practitioners about firearms, the gun talk by rozel et al. (2021) is an example from psychiatry which offers scripts for clinicians and suggests using motivational interviewing approaches. it has not been empirically tested at this time. the calm program (counseling on access to lethal means) has been found to be effective in improving clinicians’ knowledge, comfort, and practice behaviors in discussing firearms with clients evincing suicidal behaviors (johnson et al., 2011; sale et al., 2018). these materials could be adjusted for social workers and for universal screening. evaluation of these training programs and courses should also occur so that we can ensure their effectiveness. the nasw’s social justice brief in collaboration with the brady campaign about screening for family fire, has not been as effective as hoped, since most of our participants do not screen or discuss firearm safe storage with parents. this brief needs to be revised, updated, and expanded to include a broader group of clients (not just parents/guardians) and it should not be viewed as a substitute for thorough training. although this is a beginning step, it is inadequate in preparing social workers to engage with a wide variety of clients about firearms and their safe storage and danger. to ensure training programs are developed, offered, and evaluated, states should consider adding questions about firearm assessment and intervention to their licensing exams. it is a pertinent and critical component of current u.s. practice for social workers, and this could initiate and maintain changes in training and education. advances in social work, spring 2024, 24(1) 60 in february 2019 a large medical summit on firearm injury prevention was held with 44 major injury prevention and medical organizations, to create consensus and collaboration on goals to address the problem of firearm injury and death. unfortunately, nasw was not a part of this summit. but a consensus statement with a risk-reduction plan was created and several items can be addressed and expanded by social workers: 1. engage firearm owners and populations at risk; 2. counsel clients and families about firearm safety and safe storage; and 3. screen for high-risk clients (depressed, suicidal, intimate partner violence, etc.), and provide comprehensive resources and interventions. since social workers’ clients most often come from high-risk groups, social workers should universally screen all clients regarding their access to firearms and their safe storage. this should become a standard of care, just as some of our other safety questions like abuse, suicidal ideation, and current exposure to violence have become. studies have found that most clients are open to these conversations when they are asked without judgment and when they are embedded with other safety questions. the focus should be on safe storage, rather than removal unless there’s a crisis. resources on firearm safety need to be used and provided for clients in multiple languages. be smart for kids, the cdc, and project child safe, are a few examples of useful, non-threatening resources. in addition, there are free gun locks available for gun owners in most states and that information should also be made available to clients. in addition, social workers should have brochures about extreme risk protection order laws (red flag laws) or other relevant firearm state laws for clients to learn more about their responsibilities and options. research on social workers’ training, knowledge, and practices regarding firearm assessment and discussions about safe storage is sparse. funding needs to be provided and studies need to address the effectiveness of training, the outcomes of training, the capability and consistency of application of training in practice, and best practices for assessment and practice need to be examined and shared. additionally, we need to better understand the disconnect between social workers stating they’re comfortable discussing firearms but not actually doing so. firearm access and safe storage play an important role in many clients’ lives and it is highly likely that practicing social workers can contribute to preventing lethal violence by having conversations about access and safe storage, especially for high-risk groups. education and training need to occur during social work programs, as well as in ceu courses, and internships. this three-pronged approach will assist in better preparing social workers for their role in harm reduction regarding firearm violence. firearm safety discussions are essential and are the next phase of cultural competence and clinician safety practice. social workers have a unique skill set and hold key positions with access to highrisk, vulnerable individuals which makes them perfectly aligned to help prevent firearm violence. references american association of suicidology. 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(2016). risks and targeted interventions: firearms in intimate partner violence. epidemiologic reviews, 38(1), 125-139. author note: address correspondence to lisa rapp-mccall, graduate social work program, saint leo university, saint leo, fl. email: lisa.rapp-mccall@saintleo.edu https://doi.org/10.1016/j.jen.2018.09.010 https://doi.org/10.1093/epirev/mxv007 https://doi.org/10.1093/epirev/mxv007 mailto:lisa.rapp-mccall@saintleo.edu _________ colita nichols fairfax, phd, norfolk state university, norfolk, va. michele rountree, phd, university of texas at austin, austin, tx. andrea murray-lichtman, phd candidate, lcsw, university of north carolina, chapel hill, nc. rebecca maldonado moore, phd, lmsw, new mexico highlands university, las vegas, nm. michael yellow bird, phd, university of manitoba, winnipeg, manitoba, canada. travis albritton, phd, msw, mdiv, university of north carolina at chapel hill, nc. mitra naseh, phd, washington university at st. louis, st. louis, mo. elena izaksonas, phd, msw, licsw, metropolitan state university, saint paul, mn. tauchiana williams, msw, lcsw, university of north carolina, chapel hill, nc. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 262-277, doi: 10.18060/24989 this work is licensed under a creative commons attribution 4.0 international license. lessons learned from the cswe task force to advance anti-racism in the social work educational policy and accreditation standards: praxis in a racially volatile society colita nichols fairfax michele rountree andrea murray-lichtman rebecca maldonado moore michael yellow bird travis albritton mitra naseh elena izaksonas tauchiana williams abstract: on may 25, 2020, mr. george floyd, a black man, was brutally murdered by derek chauvin, a white police officer in minneapolis, minnesota. the covid-19 pandemic which immobilized the world ended up hitting asian, black, latino, and indigenous peoples the hardest. in response to such events, the council of social work education (cswe) established the cswe task force to advance anti-racism. the work of the group centers on advancing anti-racist social work education by identifying antiracism pedagogies and anti-racist learning environments. the task force members met to develop, discuss, and refine recommendations for cswe on educational policy and accreditation standards (epas). as a small subset of the task force, we engaged in a thematic analysis of the epas document to provide a systemic response and framing for intellectual engagement and curriculum development. this proved useful for a beginning discussion into how future epas documents should be formulated. the authors identified major themes that emanated from the work of the task force, including how racism and white supremacy underscores social work as an applied social science that maintains racist information structures, paradigms, theories, and practices. the praxis recommendations of the task force include adapting theoretical frameworks for antiracist social work education; incorporating anti-racism and theories such as critical race theory; updating social work competencies; promoting equitable approaches to hiring and retaining faculty of all racialized groups in different positions; and creating a new antiracism commission to prioritize and continue anti-racism work. keywords: george floyd; anti-racism; white supremacy; critical race theory; cswe the groundswell of black lives matter protests following george floyd jr.’s murder merged with those for ahmaud arbery, breonna taylor, and other african americans slain by the police which drove forth an unprecedented demand for racial justice by a “diverse range of protesters” from “different races and ethnicities” (sy, 2020). richmond, virginia, one of the three capitals of the confederacy from 1861 to 1865, became a flashpoint for public rage against white supremacy and systemic racism. thousands of people flooded the historic monument district to topple, dismantle, and reframe confederate monuments with protest slogans. demands for an end to racialized killings like mr. floyd’s and others about:blank fairfax et al./cswe anti-racist taskforce 263 galvanized the spirit of the protests. in response, the council on social work education (cswe, 2020a) leadership released a statement expressing its sympathies and condolences to floyd’s family and community. the cswe statement does not demand an end to police brutality, police budget reductions, policing, and other governmental structures and policies that are racist. the lack of a robust and critical response by social work calls into question social justice accountability within social work education, practice, and policy. this article examines how well social work education prepares students to confront, analyze, and challenge racism and white supremacy and engage in anti-racism work. anti-racism must be more than being against racism. anti-racism must fiercely oppose racist, damaging ideologies and actions with liberating and just policies and practices that are promoted and defended. “as social work leadership evolves, the reality of discrimination in the structures of services to persons needing assistance continues to impede the well-being of many citizens and requires examination” (o’neal, 2019, p. 109). thus, this examination responds to how social work students are socialized about racism and racist practices in social work. by summer 2020, the cswe leadership launched a taskforce to advance anti-racism with four work groups—a) curriculum development, b) faculty and student racial/ethnic equity, c) educational policy and accreditation, and d) conferences and faculty development (cswe, 2021b). each of the work groups were led by co-chairs and assigned sections to explore, discuss, analyze, and develop recommendations. the charge for all four work groups was to develop an action plan to make social work education stronger by adopting anti-racism pedagogies and establishing anti-racist learning environments (cswe, 2021b). the application of critical race theory (crt) allows us to go beyond an individualistic and non-racism stance, which does not challenge racism and whiteness, in order to explore how racism has impacted social welfare services and the social service industry (housing, mental health, residential, outreach, etc.). in fact, “social work has its own traditions of critical scholarship that challenge some of the historical practices of the profession and the larger society that serve to perpetuate institutionalized oppression, including racism” (abrams & moio, 2009, p. 252). an example may be found with the articulation of a racism-centered perspective offered by jerome schiele. schiele maintains that it is humanistic to employ a racism-centered perspective that is grounded in the historical and cultural reality of the black experience, and recognizes that while not all whites are equally protected, they maintain a reality of group-difference perpetuated by the way america has treated people who are not white and who live with unique racial experiences that white people have not had (schiele, 2020). for the purposes of the anti-racism work groups, including the unique and specific lived experiences of racial groups is significant in the curricula, as group experiences are marred differently by ideology and social policy. the “racial groups” identified in the united states are comprised of indigenous peoples, african people brought to the western hemisphere by force, mexican, latino, hispanic, asians, and racialized immigrants. the absence of curricula content of specific and unique racial group experiences in america that interrogates the racist social institutional construct of america have rendered social advances in social work, summer/fall 2023, 23(2) 264 work a discipline that maintains oppression. social work, in general, does not adequately address situations of trauma and survival (o’neal, 2019, p. 71) for specific racial groups in america. for this examination, the task force work group used a thematic analysis to examine the 2015 and 2022 educational policy and accreditation standards (epas) from a crt lens. content analysis was employed to specifically examine the presence of racism or antiracism concepts which trigger what is broadly taught in the curricula. crt posits that racism is an embedded social construct within systems and policies. specifically, crt exposes the appearance of racism and “whiteness” in educational policies and practices through critical analysis. crt is relevant in social work education, given the profession’s study of social institutions and social inequities. the theory can explicate the privatization of social service care and the role that capitalism plays in help-seeking and the service industry’s provision of care. as a framework in the field of law, crt explains that “when the law recognizes, either implicitly or explicitly, the settled expectations of whites built on the privileges and benefits produced by white supremacy, it acknowledges and reinforces a property interest in whiteness and produces black subordination” (crenshaw et al., 1995, p. 281). crt asserts that the organization of american society is in whiteness and race dominance, which has implications for how social work responds or ignores racism and whiteness in its methods and applications of social justice. “whiteness as property (ownership, power, citizenship, freedom)…is a ghost that has haunted political and legal decisions in which claims for justice have been inadequately addressed for far too long” (crenshaw et al., 1995, p. 290). from the crt lens, differential racialization maintains that racialized groups experience oppression differently. examples include immigration and social welfare policies, exclusions from healthcare policies, or employment benefits, exacerbating marginality through inequity in ownership, citizenship, and freedom. investigating social work’s racist, settler colonial history more work is needed for social work to be prepared to respond proactively with an anti-racist framework that guides, and puts in place, the claimed values and ethics of social work as a profession. the murder of george floyd “sparked a global reckoning” (hassan & noack, 2021, p. 1), for racial justice which we believe supports our call for greater social justice accountability within social work education, practice, and policy. with all that has happened, will the profession of social work address its own complicity in maintaining racism? social work has at its roots the violent state brutality heaped upon indigenous and african people as america evolved as a settler colony—a country settled by others on previously established settled territory. critical and analytical thinking are essential to the profession moving beyond the moment to join the movement. this discussion has real human implications “in every aspect of black life and reflected in the fact that black folks lead the states in poverty rates, incarceration rates and childbirth mortality rates for example” (farria, 2020, p. 22). how social work students are taught history is critical to their ability to create change for all citizens. for example, “enslavement, colonialization, segregation, and urbanization fairfax et al./cswe anti-racist taskforce 265 corrupted information and beliefs, to where cultural-specific beliefs and practices are absent or are rendered inadmissible in this age of evidence-based practice” (fairfax, 2017, p. 7). if students do not learn cultural histories and cultural empathy, their capacity to be impactful is truncated and diminished. the social work profession must be ready to examine the profession’s historical racist and settler colonial history, because “a curious hiatus exists in our thinking and knowledge about africa based on eurocentric racism so pervasive that it has blanked out at least seven millennia of history….yet black africans have made significant contributions to the advancement of humanity” (day & schiele, 2013, p. 60; see also adamo, 2001; bangura, 2011; carney & rosomoff, 2011; lovejoy, 2014; sluyter, 2012; weiner, 2018). this is an important point, because in the current american context, african americans (american-born black people), are typically viewed as descendants of enslaved people, versus world citizens who have contributed for time immemorial. yet exclusion of knowledge about the participation of people of indigenous and african descent in the development of world civilization reflects the setup of social construction that negates significant contributions by those other than europeans and white christians (o’neal, 2019, p. 71). hegemonic historical perspectives on race and racism have dominated the social sciences. however, these perspectives have often not included discussions on the oppressive policies and practices employed to colonize and repress ethnic and cultural diversity in this country. multiple historical “truths” exist that socialize and inform people about racialized individuals and groups, especially in the social work profession. add to this analysis the political mistreatment of latinx, asian, arab, and muslim groups who face racism in forms of hostile immigration and public welfare laws, educational opportunities, healthcare, and access to social services. social work must become much more actively engaged in how students are educated about anti-racist principles and practices. some examples, albeit not exhaustive, are listed below to illustrate how whiteness within the profession has historically been maintained without consideration for the deleterious impact upon communities of color. for example, the profession has minimized “race work,” which is the practice of community and institutional development, coupled with the constant struggle for social and economic justice and racial equality as fostered by early african american social reformers after the civil war (martin & martin, 2002). emerging out of the 19th century, race work offset the deleterious consequences of racial oppression (schiele & jackson, 2021). there is paltry inclusion of post-civil war african american social reform and community development strategies in historical content. early social work was driven by religious clergy, organizations, and religious social service organizations. adams’ hull house did not allow blacks in until the house could not be filled by whites. resistance and praxis strategies were employed by social reformers such as ida b. wells, a prominent journalist and advocate (duster, 2020). while social reformers did much to advance the conditions of european immigrants and expressed support for people of color, they also reinforced racial codes during the jim crow era and were timid about speaking out against lynching and other atrocities against black people. the application of racism in early social work is evidenced in the work of charles loring brace (1872), a minister who believed non-whites were dangerous and their children should be separated from their families to be raised as good christians. in advances in social work, summer/fall 2023, 23(2) 266 succeeding years, the children’s home society and its social workers engaged in the removal of children from multiple countries to the benefit of primarily white christian families in adoptions work (brace, 1872). social work practices have historically supported government and religious organizations in their efforts to “kill the indian in him and save the man” (pratt, 1892, as cited in adams, 1995, p. 52). this practice involved removing indigenous children from their homes of origin and placing them in private and reservation boarding schools across the country. the goal was cultural genocide through civilizing, christianizing, and farming (moore, 2002). social workers were complicit with the federal government in removing indigenous children from their families and communities to be adopted by white families (thiebeault & spencer, 2019). the child welfare league of america’s indian adoption project was supported by the bureau of indian affairs with the goal to place indian children into the homes of non-indian families to promote assimilation. furthermore, president roosevelt’s indian reorganization act (1934) was championed by john collier, a social worker, who envisioned social reform but did not consider the unique political needs or issues of individual tribal groups. social work’s pervasive hegemony over racialized groups continued well into the 20th century through active support of government policies, including the repatriation of mexican americans, many of whom were u.s. citizens. the hoover administration specifically targeted mexican americans for deportation. in 1925 welfare officials from detroit to los angeles colluded with immigration and naturalization services (ins) and with the newly established us border patrol to repatriate mexicans regardless of whether they were u.s. citizens or not. congress established the border patrol in may 1924 as part of the immigration bureau in the department of labor through the labor appropriation act of 1924 (balderrama & rodriguez, 2006). under county auspices, social workers collaborated in the repatriation of immigrants following armed “street sweeps” despite being ill-equipped to make assessments due to lack of cultural competence, language interpretation, or family considerations (balderrama & rodriguez, 2006; davis, 2017; humphrey, 1941). the forced removal and incarceration of japanese americans during wwii was accomplished through executive order 9066. social workers explicitly endorsed anti-asian political opinions during this time through registering, counseling, staffing, and “resettling” persons of japanese ancestry into concentration camps that housed approximately 120,000 people between 1942 and 1945 (park, 2008, 2020). to end the abduction of indigenous children by social workers and state authorities and keep indigenous children in their own communities, the indian child welfare act of 1978 was passed. based upon this historical context upholding whiteness, the next section is a call for the accrediting body of the profession to establish standards that incorporate crt perspectives within social work education. epas response to white supremacy and lack of anti-racism practices in academic programs to advance anti-racist social work education, the profession must examine the white supremacy and ethnocracy that underscores social work as an applied social science that maintains information structures, paradigms, theories, and practices ensconced in academia. the educational policy and accreditation standards have historically focused fairfax et al./cswe anti-racist taskforce 267 on a content perspective of cultural competence and multiculturalism. content areas encouraged students to recognize differences and diversity of clients and client systems. cultural competence focuses on acquiring knowledge and understanding of multiple cultures (national association of social workers [nasw], 2021, preamble). however, cultural competence comes with much critique of the ways it appears finite and focused on learning about other cultures. critiques of cultural competence illuminate its lack of interrogating personal biases, institutional discrimination, and historical inequalities (fisher-borne et al., 2015). a sense of accountability has been explored through an alternative approach to cultural competence through cultural humility which is about one’s “ability to recognize their own limitations in order to avoid making assumptions about other cultures” (sulaiman, 2022, para. 4) for example, though integration of crt across various facets of the social work curriculum has the potential to move social work students toward critical thinking, informed practice, and action around racism, privilege, and oppression, we also recognize its limitations. the major limitation is making space or time in an already crowded curriculum to include crt readings and application. (abrams & moio, 2009, p. 256) in 2008, the council on social work education modified the education policy and accreditation standards to include competency-based practice behaviors to increase students’ preparedness for social work practice. the competencies that cover diversity and social justice continue to explore diversity and difference in a broad scope. this leaves an alarming gap in providing specific standards within a framework for increasing students’ competence to challenge white supremacy, explore diversity in multiple levels, and center marginalized voices. social workers have the potential to experience an intense ethical crisis when remaining complicit and functioning as a part of systems that historically and presently perpetuate institutional discrimination (phillipo & stone, 2011). recognition and understanding of racism and social injustice are not sufficient for teaching application or action mechanisms to bring social justice and/or redress racism. practice competence has been the profession’s response to social justice issues, proffering a stance that the worker should implement on the micro level, but not a social justice mandate to implement change. “if awareness of and critical perspectives on racism are not applied to the fieldwork experience, students may lose sight of crt’s ties to social work problems, theories, and interventions” (abrams & moio, 2009, p. 256). an anti-racist perspective offers the notion that racism operates through individual, structural, and institutional levels (thompson, 2002). lynch et al. (2017) recommend approaches focused on illuminating systemic and structural racism, show ways that white privilege is complicit in maintaining systematic and structural racism, and provide strategies for transformation and dismantling racism. there are many advantages with the systems in place continuing with the status quo while the disadvantages continue to increase and gravely impact racialized groups tatum (2018) argues, “the dismantling of racism is in the best interests of everyone” (p. 77). given the discussion on structural racism, it is the premise of this article that anti-racism work begins with assessing those organizational systems that perpetuate discrimination and marginalization of racialized groups. specifically, cswe’s epas (2015) are complicit in how social work students are advances in social work, summer/fall 2023, 23(2) 268 trained to reify racist structures. a crt framework provides an opportunity: to better understand the role of whiteness in the development of policies and practices within the social work profession; to envision an equity-based cswe epas that explicitly addresses racism and oppression; and to establish policies and practices that reflect realities that african americans have historically experienced with contemporary life repercussions. given the badge of enslavement, black people have been cruelly subjected to violent, inhumane social policies that social work as a profession has often supported. further application of a crt framework unveils racist and oppressive practices toward native americans, latinx peoples, and immigrants. description of the process the thematic analysis included an application of content analysis of the epas document by a subset of the cswe anti-racist task force. the team created evaluative questions to uncover the presence of terms ‘racism and anti-racism’ during our analysis to provisionally code concepts to evolve into a codebook for this initial and future analysis. this qualitative descriptive approach included a participatory design [which is the subset of the task force] that sought to “arrive at an understanding of a particular phenomenon from the perspective of those experiencing it” (vaismoradi et al., 2013, p. 398), with an embedded descriptive methodology. this design collaboratively involved all members working toward the same vision of reviewing and analyzing epas content and ensuring co-constructed research results (spinuzzi, 2005). during the first meeting of stakeholders, each participant agreed to compile and review current and historical social work literature that explained racism, white supremacy, xenophobia and other agreed upon terms as shown in table 1. next, with common definitions and terms based on current and historical literature, each stakeholder was asked to take sections of the epas document for content analysis. specifically, each stakeholder was asked to review the directives included within the epas document to address racism, white supremacy, and xenophobia. a form of content analysis leading to a deeper examination of the meaning of concepts and themes, the relationship and inferred context, and impact upon the learner (vaismoradi et al, 2013). this type of qualitative analysis allows the examiner to uncover codes, emerging themes, and patterns generated from data sources including committee documents, dialogue, social work literature, and other related sources to ensure triangulation. applying a thematic analysis allows the researchers to use the same definitions of concepts in the coding process. researchers quantified and analyzed these items to assess messages and the context of specific texts, which is the epas document. given the current racial and political landscape that is framing virtually every aspect of life, content analysis provides a methodological way to examine educational content that underscores training and professional development of students (nair, 2014, p. 523). the team included a wide variety of social work academic stakeholders from the national community. the larger anti-racism task force included over 80 cswe members engaged in an analysis of what anti-racism might look like in social work education. the epas task force committee had 20 members with eleven (11) contributing members fairfax et al./cswe anti-racist taskforce 269 volunteering to participate in this analysis. members represented all racial groups who were faculty, clinical and tenure track levels, students, and community members. the co-leads and members of the respective workgroups were selected by the co-chairs of the cswe task force to advance anti-racism. co-leads added members who actively incorporated crt and anti-racist pedagogy approaches to social work education and social work practice. the aim of this analysis was to construct new meaning for anti-racism knowledge; develop strategies and outcomes; and to recommend new curricula to be articulated in the epas policy. the application of a participatory framework was at the exploratory level of the inquiry process. this is the first time cswe created an anti-racism task force to evaluate the presence of anti-racism data in the epas document. this phase of inquiry is important because there is no existing research or literature available about cswe’s intentional implementation of anti-racist and crt curricula in the epas document. the preparatory phase of our examination involved developing a template of concepts that communicate what is important in the profession. all concepts were clearly defined and identified. prior to any declarations about whether racism is a power structure that social work wishes to dismantle in its posture and documents, concepts were collected for a quantitative count. the identification of categories was next in the process of content analysis (neuendorf, 2019). the final phase of examination of the content was exploring the 2015 epas document for the following racial justice concepts: racism: an ideology of racial domination in which the presumed biological or cultural superiority of one or more racial groups is used to justify or prescribe the inferior treatment or social position(s) of other racial groups (clair & denis, 2015, p. 857); to include racial violence and racial hatred. white supremacy and whiteness: created to not only facilitate colonial administration, but to render racialization and subordination (or others) more or less permanent (saito, 2020, p. 44). xenophobia: fear or hatred of foreigners or cultural others (day & schiele, 2013, pp. 24-25). racial and cultural trauma: generations experiencing the same violent experiences in psychological and economic ways, though the forms of violence may be different (comas-díaz et al., 2004, p. 1). these concepts are not present or explained in the introduction, purpose, competencies, explicit curriculum, implicit curriculum, or glossary of the epas document. the data in table 1 shows the frequency of these important concepts in policy documents of 2015 and 2022. as we coded, we indicated the number of times that each concept appeared. where there is a negative line -, the section did not exist. the epas documents reveal that the discipline has focused more on individualized micro racist behavior, without acknowledging the full systemic assault of racism and white supremacy upon racialized groups. “social scientists have focused on single concepts related to racism, such as bias, prejudice, and stereotypes, but not on systemic racism” (o’neal, 2019, p. 128). it is advances in social work, summer/fall 2023, 23(2) 270 important to acknowledge the epas are constructed and revised within the context of the socio-cultural-political environment. this too is crt; “there is no perch outside the social dynamics of racial power from which to merely observe and analyze” (crenshaw et al., 1995, p. xiii). we observed that the prior epas documents neglected racial justice terminology that could reverse the profession’s century-old complicity, endorsement, and support of the country’s racial structure and inequities. table. 1. frequencies of concepts in 2015 and 2022 versions of epas content content race/racism/ racial antiracism white supremacy enslavement xenophobia 2015 2022 2022 2015 2022 2015 2022 2015 2022 table of contents 0 0 3 0 0 0 0 0 0 introduction 0 0 1 0 0 0 0 0 0 purpose 0 0 0 0 education statement 0 0 0 0 0 competency 1 0 0 0 0 0 0 0 0 0 competency 2 0 1 0 0 0 0 0 0 0 competency 3 0 2 0 0 1 0 0 0 0 competency 4 0 1 2 0 0 0 0 0 0 competency 5 0 1 3 0 0 0 0 0 0 competency 6 0 0 0 0 0 0 0 0 0 competency 7 0 0 0 0 0 0 0 0 0 competency 8 0 0 0 0 0 0 0 0 0 competency 9 0 0 0 0 0 0 0 0 0 program mission 1 1 0 0 0 adei statement 2 4 0 0 0 explicit curriculum 0 2 6 0 0 0 0 0 0 implicit curriculum 1 0 2 0 0 0 0 0 0 assessment 0 1 0 0 0 glossary 0 0 0 0 all task force recommendations were presented to cswe leadership prior to the annual program meeting in 2021. the collective drafted the findings from each sub-group (i.e., program mission/site visit protocol, explicit curriculum, implicit curriculum, and assessment). conclusion the evidence points to the social work profession’s negligence to include racial content in every phase of the educational process, in policy statements, and professional organizational values. an anti-racism posture cannot be taught or infused if indeed the guiding educational document omits terms that would present applied social scientific data differently. this evidence underscores the profession’s complicity in not educating students about racism and white supremacy. the consensus of the work group was to incorporate content on anti-racism, crt, and other relevant critical theories into the epas. racial justice terminology must be included in a newly developed epas document. fairfax et al./cswe anti-racist taskforce 271 tenure-track and non-tenure track faculty concentrating on teaching, service, and scholarship related to anti-racism provided insights to develop recommendations vital for schools of social work to create anti-racism environments and curricula. social workers should be trained to disrupt white supremacist and racist institutions, policies, and practices. the overall vision of the task force was to incorporate anti-racism, crt, and other critical theories in epas as follows: 1. epas to enhance faculty and students’ ability to recognize and critique racist structures, institutions, policies, and practices and to demonstrate selfreflexivity (goes beyond self-awareness) and skills to make changes so that power is redistributed and shared equally. 2. epas to enhance faculty and students’ ability to build solidarity across social identity groups, organizations, and social movement organizations to address racism and other forms of oppression. 3. epas to create inclusive and supportive policies and practices that could nurture the potential of colleagues who are of african-descent, indigenous, latinx, asian, and members of immigrant groups. incorporating critical theories into social work centers the experiences and voices that are often marginalized in conversations. for example, by applying crt, social work practice can uncover its white supremacy and ensure the multiple realities of people of color/minoritized groups are centered. another implication of expanding the use of critical theories is the opportunity to reconceptualize how social work education should be taught. the centering of critical theories offers opportunities for new paradigms that ask students to think differently about the individuals and communities they serve. “the use of theories to explain the discriminatory context is associated with efforts of the social work profession to respond to needs for well-being by all people and to those who have been excluded” (o’neal, 2019, p. 133). applying crt means deconstructing and transforming relationships of racism and power, which, in the context of this analysis, means purposefully infusing educational content that explores and teaches racism, whiteness/white supremacy, racial violence, xenophobia, and racial/cultural trauma. by not doing so, social work education maintains the status quo and accepts that current individually applied practice concepts of cultural competence and cultural humiliation are sufficient. cswe must begin a concerted move away from the 2015 and 2022 draft epas pedagogical methods and practices that center cultural competence and instead address accountability measures. the 2022 epas acknowledges anti-racism, diversity, equity and inclusion (cswe, 2022). the use of crt offers faculty and students alike the opportunity to think critically about race in ways to promote practices that dismantle racist systems of oppression. when thinking about the application of crt in social work curriculum, it is imperative that faculty and administrators incorporate such theories across several courses. too often social work programs relegate discussions of equity and antiracism to a specific course and fail to recognize that discussions of anti-racism must be foundational to every area of social work education. as such, the inclusion of critical theories must be seen as necessary throughout the curriculum. efforts to ensure that critical advances in social work, summer/fall 2023, 23(2) 272 theories are incorporated across social work curricula must start with a willingness by cswe to incorporate epas standards and goals that require social work programs to think about how faculty are engaging with issues of equity and anti-racism. as the body charged with accrediting social work programs, cswe has a responsibility to take the lead in furthering conversations related to equity and anti-racism. the preamble to the nasw (2021) code of ethics promotes cultural and social diversity paralleling cswe’s efforts to ensure and enhance “the quality of social work education for a professional practice” (cswe, 2021a, para. 1). each cswe program has a unique context that may or may not provide equitable resources with a goal of equal outcomes for all stakeholder groups. the truth is that systemic oppression, institutional racism, and whiteness has driven cswe’s educational policies and accreditation standards (epas) for decades. the “rules” were made by non-racialized groups, either overtly or covertly over time, resulting in whiteness defining implicit and explicit curriculum and accreditation standards. power dynamics have historically defined cswe, its programs, and who is hired to teach in those programs. as future epas documents are developed, faculty from racialized groups must be included in the process. faculty of color are underrepresented as full-time faculty in social work programs given the changing demographics of this country (cswe, 2020b). the council on social work education 2018 statistics on social work education in the united states did not report the racial and ethnic profile of social work faculty (cswe, 2019), thus it is difficult to determine the numbers of racialized faculty. likewise, the authors did not find the racial and ethnic breakdown of the representation within the leadership positions at cswe in the 2019 statistics on social work education in the united states report (cswe, 2020b). the survey does not pose quantitative or qualitative questions about the faculty tenure and promotion process or departmental or institutional climate. furthermore, the percentage of racialized faculty does not align with the percentages of social work students enrolled across bsw, msw or dsw/phd programs (cswe, 2020b). for faculty of color, biases often associate expertise with whiteness (rosette et al., 2008), where faculty of color experience racial-bias and are viewed as less capable and proficiently knowledgeable (mcgee & kazembe, 2016). using the lens of crt, the task force members call for aggregated and cluster data on recruitment, attrition, and retention of racialized and minoritized faculty and staff. cswe can include survey questions to collect such data and share the results with social work programs. programs need to be accountable to have plans to maintain or advance diversity, equity, and inclusion within their administrative and governance structure. besides reflecting on the numbers, considerations are needed within the social work programs and cswe about the decisionmaking power of racialized and minoritized members. diversity across ranks should be beyond fulfilling a quota, aiming to foster a supportive environment for the growth of racialized and minoritized faculty and staff. the task force identified intersecting issues regarding the lack of equity within the epas language. the content analysis revealed the absence of racial justice concepts in the epas document, uncovering the enduring presence of whiteness in undergraduate and graduate social work curricula and the profession. the authors make note of the social work fairfax et al./cswe anti-racist taskforce 273 identity as that of whiteness, structuring and socializing students to maintain whiteness in their professional practice. task force members offered their lived experience of the following examples of honoring whiteness and socializing students to whiteness within social work programs: the lack of attention given to the experiences of racialized students in mostly white spaces and the absence of the contributions of racialized groups to the history of social work and racialized voices in the syllabi, practicing ethnocentrism in relation to beliefs, language and behavior, and the inconsistency of hiring and successful promotion of racialized faculty and administrators. the team discussion also revealed the absence of instruction on how to apply racial justice concepts. our examination also revealed differential racialization among task force members, demonstrating that racialized groups are impacted in different ways. multiple historical “truths” exist that socialize and inform people about racialized individuals and groups, especially in the social work profession. add to this analysis the political mistreatment of latinx, asian, arab and muslim groups. for example, crt’s lens of differential racialization highlights the concerns raised by some task force members regarding a lack of an alternative to a master’s degree from a cswe-accredited program for immigrant faculty. according to epas, faculty teaching social work practice courses need to have a master’s degree from a cswe-accredited program. immigrant faculties with a baccalaureate or master’s degree from countries other than the u.s. might be able to get their degrees evaluated through cswe's international social work degree recognition and evaluation service (iswdres), a complex process with many limitations for those from conflict-impacted or sanctioned countries. only recently has cswe issued this recommendation, and it is partly the result of recommendations shared with cswe as part of the task force to advance anti-racism. consequently, many universities do not hire or are hesitant to hire faculty who are immigrants. cswe needs to consider an alternative evaluation system for international students and faculty. the task force made several recommendations to address these discrepancies which maintains white supremacy and fosters racist institutional behavior. limitations with regards to limitations of this exploratory analysis, there were time constraints to meet the deadlines of the cswe task force. there were limitations of available data regarding racial make-up of tenured faculty members in academia, as those statistics are unreported. only after the groundswell of black lives matter protests in the police murder of mr. george floyd did the profession address anti-racism, including a 2021 special volume offered in advances in social work. otherwise, the absence of anti-racism concepts in social work literature was apparent and limited the conceptual frameworks that the task force were able to coalesce around and utilize, prior to the covid 2020 health pandemic. implications for social work education social work education must teach that anti-racism is more than being against racism. the national climate of racism, race hatred, police brutality, voting suppression, housing shortages, and other systemic forms of violence where racialized people suffer disparately are emblematic of the human rights crisis we are facing today. anti-racism advances in social work, summer/fall 2023, 23(2) 274 education must fiercely confront damaging racist ideologies, policies, and actions. the 2015 epas document did not reflect social work's perpetuation of racism and white supremacy. based on task force recommendations, some changes were made to incorporate explicit language about racism and white supremacy in the 2022 epas document. students must be taught to identify systemic racist behavior. in order to meet the challenge of this moment, social work education’s guiding document must incorporate anti-racism policies, standards, and practices, or otherwise, the profession will not meet its mission of social and racial justice. while the murder of mr. george floyd was the impetus for the task force, it is an inflection moment for social work education to examine its complicity with white supremacy and white supremacy’s enduring legacy in america. references abrams, l. s., & moio, j. a. 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(2018). decolonial sociology: web du bois's foundational theoretical and methodological contributions. sociology compass, 12(8), 1-15. https://doi.org/10.1111/soc4.12601 author note: address correspondence to colita fairfax, ph.d., ethelyn r. strong school of social work, norfolk state university, 700 park avenue, norfolk, va, 23504. email: cnfairfax@nsu.edu https://repositories.lib.utexas.edu/bitstream/handle/2152/28277/spinuzzithemethodologyofparticipatorydesign.pdf https://repositories.lib.utexas.edu/bitstream/handle/2152/28277/spinuzzithemethodologyofparticipatorydesign.pdf http://blackmenheal.org/the-difference-between-cultural-competence-and-cultural-humility/#:%7e:text=cultural%20competence%20is%20the%20ability,making%20assumptions%20about%20other%20cultures http://blackmenheal.org/the-difference-between-cultural-competence-and-cultural-humility/#:%7e:text=cultural%20competence%20is%20the%20ability,making%20assumptions%20about%20other%20cultures http://blackmenheal.org/the-difference-between-cultural-competence-and-cultural-humility/#:%7e:text=cultural%20competence%20is%20the%20ability,making%20assumptions%20about%20other%20cultures http://blackmenheal.org/the-difference-between-cultural-competence-and-cultural-humility/#:%7e:text=cultural%20competence%20is%20the%20ability,making%20assumptions%20about%20other%20cultures https://doi.org/10.1086/706771 https://doi.org/10.1111/0362-6784.00035 https://doi.org/10.1111/nhs.12048 https://doi.org/10.1111/soc4.12601 mailto:cnfairfax@nsu.edu _________ goutham m. menon, phd, ma, mba., professor, school of social work, loyola university chicago, chicago, il. jacqueline mondros, dsw, dean & professor emeritus, school of social welfare, suny stony brook university, stony brook, ny. nancy j. smyth, phd, lcsw, professor & interim associate dean for faculty development, school of social work, university at buffalo, buffalo, ny. martell teasley, phd, msw, dean & professor, college of social work, interim senior vice president for academic affairs, university of utah, salt lake city, ut. carol hostetter, phd, msw, professor, iu school of social work, indiana university, bloomington, in. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), i-viii, doi: 10.18060/26630 this work is licensed under a creative commons attribution 4.0 international license. editorial: pivoting the profession as we approach the quasquicentennial goutham m. menon jacqueline mondros nancy j. smyth martell teasley carol hostetter the year 2023 marks professional social work’s quasquicentennial: the 125th anniversary of our profession since the first social work classes were offered in the summer of 1898 at columbia university. the profession has grown in its reach across many human service sectors over all these years creating opportunities for those who want to serve their communities in myriad and impactful ways. as we observe disruptions in the higher education sector, with profound implications to the mission of the social work profession, we are also witnessing many cross-sector opportunities for the future of the social work profession. given our changing environment, the time is right for us to re-envision social work education and practice in ways that center our professions’ commitment to social justice and the well-being of individuals, families, and communities. in our efforts to meet the needs of the people and communities we serve, we have seen several innovative and impactful expansions into areas that have augmented our original “scope of practice.” some have occurred to meet the needs of the time; others have morphed due to market conditions for jobs that have been encroached on by other professions/disciplines. and as we see more complex and vexing societal issues in our current environment, it is time for us to collectively discern our purpose, adjust our mindset, and be prepared to meet future challenges and opportunities. this special issue on “re-envisioning social work” provides a space for thought leaders to showcase meaningful and purpose-filled advances for the profession. this is consistent with the voices of others calling for constant vigil to ensure our profession’s focus matches our profession’s values. our roles can too often become entrenched in larger societal systems. as gibelman (1999) observed, “external economic, social, and political forces have been more influential in shaping the nature of practice than intraprofessional choices” (p. 298). lein et al. (2017) build on this in their editorial in social work research: social work research and education operate in an extremely dynamic environment…however, the profession of social work does not have a regular and systematic approach for scanning our environment, looking toward the future, and envisioning possibilities for the profession. (p. 68) while we pivot from one new shiny object to another every few years, and a rush to capitalize on grants and publications from initiatives that were popular but did not have the about:blank advances in social work, summer 2022, 22(2) ii sustainability to endure and move the profession forward holistically (e.g., person-inenvironment; strength's perspective; international; interprofessional and several more), we will continue to miss the opportunity to have a collective purpose leading to meaningful impacts in our communities. this is compounded with multiple national organizations working cross purposes with each other on very narrow and specialized missions and agendas. sheafor (2008) highlighted the promise of the 2007 wingspread conference and the resolution signed by representatives of several organizations to “create a unified profession with one social work organization by 2012” (para. 6). such an effort would have helped all of our voices, from big and small social work programs and their faculty, staff, and students and the practice and policy communities to work together, constantly looking ahead to what is coming as challenges or opportunities for the profession. the editors agree that the profession of social work needs much more open debate and sharing of ideas that can shape the future. since those avenues for critical discussions are often closed to several scholars, researchers, and practitioners due to opportunity costs associated with being in the academy, we strongly urge that disciplinary conferences and publication outlets put together calls every five years or so to get the best ideas out into the marketplace. towards that end (and beginning), for the summer 2022 special issue of advances in social work, we are pleased to present 30 papers written by 106 authors from 48 universities and organizations. the articles encompass three major themes: social work education; racial justice issues; and building a strong social work workforce. social work education the 14 articles in this section include 6 articles on education and technology, 4 articles on social justice and education, and 4 others addressing various educational issues. technology and education hooker jones, carter, and goshorn examined msw students’ readiness for remote social work practice (rswp) at the height of the covid pandemic. in the pilot study, 13 students indicated that embedding rswp broadly across the core curriculum is important and they would have felt more prepared to engage in rswp if they had increased exposure in a variety of courses—not just practice-oriented course. young and brady reimagine digital and new media literacies to overcome misinformation and promote civil discourse in social work education. they propose a framework for addressing misinformation and explicit marginalization of racial, gender, ethnic, and cultural minorities for classrooms and practice contexts within a critical theory driven epistemological framework. wolfe-taylor, khaja, wilkerson, and deck explore advances in technology, an increase in non-traditional students, a new generation of e-learners, covid-19 pandemic’s impact on education and practice, and the emergence of greater practitioner and client adoption of telebehavioral health present opportunities and challenges for curricular menon et al./pivoting the profession innovation in schools of social work. they provide a guide for educators and administrators on developing, implementing, and assessing online simulations (e-simulations) in social work education. keeney, lee, jayyousi, young, guarino, and turner examined students’ perception of their direct practice skills using virtual simulations and scripted role-plays in field education. using repeated measures of the counselor activity self-efficacy scales (cases), the authors found that significant differences were found in pre/post scores among msw students who participated in simulated client experiences within their field seminar. campbell, lucio, louis-caines, and wiest investigate building engagement in social work courses using grounded residencies as universities pivoted to online education during the height of the pandemic. grounded-residency is a hybrid of online and in-person education. using data from 131 msw students from a southeastern university, the authors explore bridging the gap between online and on-ground learning. they found a residency allowed students to foster behavioral, cultural, emotional, intellectual, physical, and social connections. social justice and education bohrman, neff, radis, mohr, ocean, lopes, and bailly-mompoint look at criminal records as civil disability and advocate for reducing social work education’s reliance on using those records for gatekeeping purposes. the article provides an overview of how records are used in higher education admissions, licensing, and employment, highlighting the limitations of criminal records as indicators of future harm. they argue that the broad use of criminal record checks harms marginalized individuals with records and is a disservice to clients who would benefit from the unique strengths derived from their lived experience. kang explores building and living a social justice-focused clinical social work curriculum. using a social justice lens, kang describes four central facets of social justice that the seattle university department of social work used in creating their new 2015 msw program: 1) an equity lens, 2) anti-oppressive analysis and practice, 3) critical pedagogy, and 4) decolonizing framework. the author offers seven lessons learned including that a social justice commitment should be consistently present in both explicit and implicit curricula and in departmental policy and processes. todic and christensen consider the intersections of coronavirus, racism, and economic pandemics that created long overdue antiracism initiatives in social work organizations. the authors argue that critical, engaged, and abolitionist pedagogies contain frameworks and practices that align with cswe directives to include antiracism in social work curriculum. they share 10 lessons on incorporating social justice in social work education including interrupting carcerality, advocating for abolishing prisons, embracing critical theory, and others. gatenio gabel, mapp, androff, and mcpherson examine social workers as human rights professionals tasked with delivering justice. they argue that over time, social work advances in social work, summer 2022, 22(2) iv has evolved into a conservative profession and call for us to return to our human rights roots through curricula that emphasizes participation, non-discrimination, transparency, and accountability. ferrera and crabtree-nelson consider collaborations between community partners and social work educators to promote social justice work and structural change. using examples from the neighborhood legal assistance project (nlap), pathways and the coalition for immigrant mental health, midwest human rights consortium, and a healing justice dialogue initiative, the authors discuss the learning experiences that allow students to internalize the value of critical empowerment work and human rights social work. other educational issues averitt, macke, ozaki, lindsey, and anderson look at the intersection of sense of belonging and financial hardship among university students. using data from over 900 students from a midwestern university, the authors found that over half reported experiencing financial hardships. those students facing financial hardship reported a significantly lower sense of belonging at the university. social work educators are ideally suited to design, implement, and evaluate necessary support services which promote financial wellbeing, and consequently sense of belonging and academic success. godwin, allen-milton, lassiter, and crocker-billingsley examine social entrepreneurship as social action that the profession of social work can use as a working model to propel the profession forward economically, professionally, and socially. they examine the history of social entrepreneurship in social work and advocate for entrepreneurship to help mitigate complex social and environmental issues, while creating larger social impacts and transformational shifts to social justice, through the social enterprise. werkmeister rozas, marrero-johnson, and davis describe a collaboration between a university bsw program and a state child welfare department to prepare spanish/english bilingual students in order to increase justice for both clients and workers. they recommend curriculum that includes spanish professional terminology, supervision in spanish, and the opportunities to integrate theory and practice. lewis, mcclain-meeder, lynch, and quartley look at how to incorporate traumainformed field education for msw students using qualitative surveys of 103 students. they found that a trauma-informed approach to field education entails creating safe environments where expectations and boundaries are clear, supporting students by processing and validating emotional responses, and using relational, collaborative approaches to supervision. the authors recommend adopting trauma-informed field education so that students can translate these experiences into practice. menon et al./pivoting the profession race the 11 articles on race include 3 articles on confronting racism, 2 on improving service delivery, 4 on supporting doctoral education, and 2 on supporting faculty. confronting racism using the color-blind racial attitudes scale, hsu, givens, bailey, wilson, rattliff, and ramseyer winter explore understanding individual and social environmental correlates of awareness of racism among 98 social work students. the authors found that liberal political views and alignment of black lives matter (blm) movement with social work core values were associated with greater awareness of racism across all domains. aligning all lives matter with social work core values was associated with unawareness of overall racism, institutional racism, and blatant racism. todic, simmons-horton, cruz, manning-thompson, christensen, and nevarez highlight strengths and limitations of antiracism collectives (arc) as a pathway to confront racism in social work educational institutions using a participatory evaluative case study at a hispanic serving institution (hsi) in the southern u.s. they found that the arc catalyzed change as evidenced by an increased sense of critical consciousness, struggle, integrity, and community. they also found that changes were primarily individual, with small but potentially significant departmental change and significant structural impact. using a vignette about a black mother engaging with child protective services, cogburn, allen, frey, filippone, brown, and witte explored the responses to real-world examples of racism and anti-blackness of 139 white mostly liberal identified first year msw students. students varied significantly on the level of analysis they provided in response to the vignette. the analysis examines patterns of racial projects (the tools used to construct meaning and value related to race) across 3 main response categories: 1) descriptive, 2) analytical, and 3) action. descriptive responses were sympathetic and empathetic focused while action responses included investigation and advocacy. improving service delivery gutiérrez and lechuga-pena examine latina/o/x critical race theory (latcrit) in social work. they call for broadening the racial discourse to include latinas/os/x and suggest adaptations to current social work pedagogy to better prepare students to enter the field and respond to this growing population. examples are provided for incorporating latcrit into social work education and practice. the authors call on leading organizations, i.e., nasw and cswe, to condemn the attacks on crt and latcrit in its commitment to the grand challenge to eliminate racism. building on the theoretical foundations of critical race theory (crt) and anticolonialism, elkassem and murray-lichtman provide a conceptual framework for practice and service delivery with bipoc clients through social work praxis. the framework has three overarching directives that include integrated critical race and antiadvances in social work, summer 2022, 22(2) vi colonial theoretical concepts for social work practice and service delivery. the authors also discuss the implications for applying the framework in practice and service delivery. supporting doctoral education mackey, hernandez, lechuga-pena, and mitchell use testimonios to reveal the experiences of women of color in social work doctoral education. from the insights of four bipoc women’s experiences, the authors contend that social work doctoral education continues to uphold white supremacy by promoting western epistemologies and theories above other equally valid forms of knowledge, including non-western schools of thought created by and for bipoc scholars. they offer seven additional theories to incorporate in social work doctoral education to disrupt white supremacy. fussell-ware, mangum, ballentine, ashcraft, flores, mackenzie, omowale, ballard, and thyberg map their experiences onto the consolidated framework for implementation research (cfir) using narrative data and documents produced by the university of pittsburgh school of social work. the school formed the anti-racist doctoral program student committee (ardpsc). the authors describe building the committee and efforts to move the school and profession towards anti-racism and reflect on how to continue the work to dismantle white supremacy and rebuild institutions. gandarilla ocampo and asher blackdeer discuss how to transform the social work academy to allow bipoc doctoral students to thrive rather than bearing the burdens of being oppressed, fighting racism, and trying to survive in a society that does not value their inherent dignity and worth. drawing upon their experience with creating a bipoc-centered support group at a predominantly white institution, they provide insight on how colleagues and administrators can take action to better support bipoc doctoral students and create an anti-racist academic culture free from all forms of oppression. asher blackdeer and gandarilla ocampo highlight the harm done by continuing and upholding white supremacy and teaching white saviorism that extends to all spheres touched by social work education, directly or indirectly. the authors argue that although the nasw code of ethics would lead us to think of social work as a noble profession, the reality is that we continually fall short of that reputation. the authors call for social work to reckon with the dissonance between our preaching and our practice. supporting faculty crutchfield, killen fisher, and plummer explore best practices for antiracist education in virtual settings. they encourage instructors and departments to combat racism in the online environment through instructor self-reflection and anti-racist course development and delivery practices. instructor self-reflection includes asking what biases we hold about race. course development practice involves asking if a course elevates nonwhite scholars. course delivery involves asking if the instructor considers and combats how white supremacy enters the virtual classroom. menon et al./pivoting the profession smith, aguilar, kozu, d'angelo, keenan, and monroe tomczak describe a voluntary, ad hoc group of faculty, composed of a diverse group members, who provide space for ongoing mutual aid, consciousness-raising, appropriate discomfort, and accountability in order to promote social justice, integrity, and the importance of human relationships as they strive for an anti-oppressive future. they believe it is important to harness and process discomfort as they critically examine the power dynamics within the profession and their own department. supporting the workforce the 5 articles on re-envisioning the social work workforce cover a range of topics including a call for social workers to seek political office, the potential for social workers to reform drug policy, mandatory reporting as an ethical dilemma, licensure and supervision, and coaching. rosenwald and naranjo call on social workers to seek political office. included in this challenge is the need for social workers to assume legitimated macro power by holding elected and appointed positions in government – a sub-branch of “political social work.” the authors offer five components of political social work practice that both social work education and social work professional associations should consider: 1) the roles and skills of elected and appointed officials, 2) making the decision to seek office, 3) campaigning and networking, 4) serving in office, and 5) enlisting social workers to assist others who seek public office. benjamin, ivy, santo, vakharia, and malinowska-sempruch examine social work’s role as agents for drug policy reform. instead of agents of social control in the war on drugs that contribute to the mass criminalization of people who use drugs, the authors call for social workers to focus on upstream advocacy for policies to reduce the scope of the criminal legal system. they suggest we recreate social work’s role in bringing about less punitive and carceral responses. harrell and wahab explore mandatory reporting of child abuse as a potential ethical dilemma for social workers since it can criminalize racialized and marginalized communities. using content analysis of social work textbooks the authors found that no textbook offered guidance for how to navigate competing social work commitments or treated mandatory reporting as an ethical dilemma. the authors argue that social work education should equip future practitioners to: a) have a nuanced understanding of mandatory reporting laws; b) contextualize mandatory reporting within broader discourses of criminalization, professionalization, and neoliberalism; and c) ground future practices in macro social work ethics. cooper bolinskey investigates the relationship between the number of hours of supervised experience and licensure violations. the purpose of the study was to explore if there is a measure of “enough” supervised experience without compromising protection of the public. the results question the practice of requiring higher amounts of supervised experience as a regulatory standard. advances in social work, summer 2022, 22(2) viii rondero hernandez and douglas examine coaching as a strategy for developing leadership and the workforce. the evolution of coaching from the corporate world into service delivery settings is reviewed. coaching has the potential to support the transfer of learning, improve practice implementation efforts, increase leadership development, and enhance organizational processes. we hope that these contributions add to the multi-faceted profession we are a part of and promote much needed dialogue amongst academic programs, practitioners, and organizations that exist to support the profession and its workforce. we thank all of the contributors to this special issue for their thoughtful work presented here and extend a deep sense of gratitude to several manuscript reviewers who ensured the quality of the papers and helped us to focus on a breathe of articles selected from over 130 submissions. a special word of thanks and appreciation to dr. carol hostetter, indiana university, for her talent and time to help edit several manuscripts in this issue. also, our deep respect and recognition for valerie decker, assistant editor, advances in social work, for their shepherding of all of us with patience, grace, and intellectual rigor and acumen. references gibelman, m. (1999). the search for identity: defining social work past, present, future. social work, 44(4), 298-310. https://doi.org/10.1093/sw/44.4.298 lein, l., uehara, e. s., lightfoot, e., lawlor, e. f., & williams, j. h. (2017). a collaborative framework for envisioning the future of social work research and education. social work research, 41(2), 67-71. https://doi.org/10.1093/swr/svx008 sheafor, b. w. (2008). organizations and associations. in encyclopedia of social work (20th ed.). oxford university press. https://doi.org/10.1093/acrefore/9780199975839.013.274 author note: address correspondence to goutham m. menon, professor, school of social work, loyola university chicago. email: gmenon@luc.edu https://doi.org/10.1093/sw/44.4.298 https://doi.org/10.1093/swr/svx008 https://doi.org/10.1093/acrefore/9780199975839.013.274 mailto:gmenon@luc.edu _________ sandy rao, phd candidate rsw, faculty of social work, university of calgary, alberta, canada. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 366-385, doi: 10.18060/27660 this work is licensed under a creative commons attribution 4.0 international license. resuscitating equality: bringing the heartbeat back to healthcare sandy rao abstract: within the evolving healthcare sector, the focus on health equity has led to interventions that, despite good intentions, often fall short. recognized by a broad spectrum of healthcare professionals, including numerous social workers, as marginally better than inaction—colloquially referred to as “better than nothing,” these efforts risk overshadowing deeper structural and systemic issues. consequently, they divert attention from the need for comprehensive solutions that genuinely address the roots of healthcare inequities. this manuscript delves into the nuanced interplay between health equity and equality through the methodology of critical analysis, drawing on the insights of critical social work and relevant theories of justice and power. while contemporary discussions increasingly restrict equality to uniform resource distribution, the core of social justice emphasizes equality’s deeper significance: recognizing the inherent worth of every individual, regardless of their background. the primary objective of this article is to advocate for the “resuscitation” of equality in healthcare, aligning it alongside health equity to ensure a comprehensive approach for individuals and families. a reductionist view of equality may cloud essential structural health determinants and compromise truly equitable care. the ramifications for social work are clear: a fervent advocacy for both equality and equity is indispensable. by embracing equity and equality in their most nuanced dimensions, we ensure that individuals, irrespective of their unique circumstances, receive care that is both just and tailored, elevating the benchmark in healthcare delivery. keywords: health equity, equality, structural determinants, social justice, utilitarianism social work, fundamentally guided by a set of core values, aims to define and achieve what is ethically right, just, and beneficial for individuals, families and society (adams et al., 2002; allan et al., 2009; mullaly, 2002). these foundational tenets offer a structured lens through which challenges are conceptualized and solutions derived (campbell & baikie, 2012; weinberg, 2019). yet, a troubling disjunction between these principles and their application in practice is palpable (dominelli, 2017; dore, 2019; dupré, 2012; houston, 2012). compounding this inconsistency is a burgeoning focus on health equity, often at the sacrifice of foundational notions of equality. this shift has fostered a pervasive mindset within healthcare, encapsulated by the sentiment of preferring minimal action over total inaction—commonly rationalized as better than nothing. such a stance, though superficially aimed at progress, inadvertently propagates apathy toward addressing the complex layers of structural injustices and systemic inequalities embedded within the healthcare system. this apathy towards deeper, transformative change not only undermines the pursuit of espoused equity but also implicates social work and other healthcare professions in the maintenance of the status quo, reinforcing existing disparities under the guise of incremental improvement (downey & thompson-lastad, 2023). about:blank rao/resuscitating equality 367 adopting a critical social work (csw) lens, this article dissects the perils and challenges inherent in the better than nothing ideology, thereby seeking to harmonize social work’s espoused values, principles, and practices. it foregrounds transformative interventions targeting oppressive, marginalizing, and exploitative structures and relations while outlining pathways toward such transformative shifts. the overarching ambition of this manuscript is to enrich healthcare social work discourse by cautioning against the perilous eclipsing of equality by an undue, sole focus on equity. by championing a balanced perspective, this article aims to reaffirm the quintessential importance of both equity and equality in the healthcare system, thereby resisting the facile allure of interventions that are merely better than nothing, and fall woefully short of grappling with the complex systemic underpinnings of prevailing issues. rooted in a canadian context, this article commences with a rigorous examination of the complexities surrounding health inequities. initially, it situates this critique within the broader paradigms of power and justice, elements quintessential to the discourse of social work. subsequently, the article narrows its focus to interrogate these issues within the healthcare domain, emphasizing the sector’s hierarchical structures and its original “spine” in the medical model. the article then widens its analytical lens to briefly consider the promises of health equity through socio-political theories, specifically utilitarianism, meritocracy, and neoliberalism. this expansion serves to unveil the often-overlooked ideological underpinnings that perpetuate health disparities. lastly, the article delineates key implications for transforming healthcare practices, thereby advocating for more equitable systems. in accordance with the ethical standards outlined by the canadian association of social workers (casw, 2024) code of ethics, this manuscript ensures a conscientious selection of language throughout the article. specifically, using the term “minoritized” (sottosantiago, 2019) as opposed to other potentially stigmatizing or victim-blaming terms to highlight that the marginalization experienced by these groups is not a consequence of inherent characteristics but rather the result of systemic discrimination and inequity. this linguistic approach is intended to displace the onus of systemic inequality from the individual and situate it within broader socio-political contexts. accordingly, the language in the article is selected to not merely describe but also to prescribe, utilizing terms such as “addressing structural inequities” and “challenging systemic discrimination” to signal the necessity of societal change. the language aims to both amplify the agency of minoritized communities and make it evident that the accountability for change lies with the overarching societal structures. moreover, intersectionality in the health and healthcare context is a critical framework for understanding and addressing health inequities that must be considered. the framework emphasizes the intricate ways in which multiple social identities—such as race, class, gender, sexuality, and ability—intersect at various levels of society to influence individual and population health outcomes. at its core, intersectionality examines how systems and structures of power, including laws, policies, and institutional practices, interconnect to create unique experiences of advantage or disadvantage (collins & bilge, 2016; crenshaw, 1990). advances in social work, summer 2024, 24(2) 368 ultimately, and perhaps most importantly, this article serves as a critical engagement with pervasive challenges in social work. extant scholarship has implicated the social work profession for its white euro-centric origins and colonial roots (khan & absolon, 2021) and its role in perpetuating structural inequalities that result in exacerbated health disparities among structurally-made-vulnerable (smv) groups, thereby raising ethical questions that cannot be ignored (charles et al., 2017; conner et al., 2009; weinberg, 2019). for instance, social workers have been shown to reinforce dominant cultural norms, thereby contributing to the stigmatization and minoritization of smv communities (fennig & denov, 2019). also, the attitudes, beliefs, and biases endemic among social workers manifest in inequitable treatment of clients, resulting in reduced access to essential healthcare resources and compromised quality of services (ben-harush et al., 2016; kubiak et al., 2011; mahabir et al., 2021). the manuscript thus bridges the gap between ethical imperatives and empirical findings, offering actionable strategies to improve the social work profession's contribution to more just, equal, equitable and inclusive healthcare systems. health equity the concept of health equity, far from being a modern invention, has historical roots that date back to the early 19th century, with the last decade witnessing a pronounced reemphasis. ministries of health (moh) across canada, as well as in other global jurisdictions, have increasingly advanced policies underscoring health equity (health quality ontario, 2016; mcfarling, 2021; mooney, 2009; yao et al., 2019). however, it should be noted that with the passage of time and amidst diverse policy contexts, the interpretation, communication, and operationalization of health equity have undergone nuanced shifts, occasionally leading to variations that deviate from their original conceptual underpinnings (yao et al., 2019). the forthcoming discussion will use an example from ontario, canada, where the health equity efforts were geared toward “maximizing positive impacts and reducing negative impacts” on the health of populations, stating health equity "allows people to reach their full health potential and receive high-quality care that is fair and appropriate to them and their needs" (ministry of health and long-term care, 2009, p. 7). these initiatives also explicitly demarcated a difference between equity, which involved distributing resources based on individual needs, and equality, characterized by a uniform allocation of resources (health quality ontario, 2016). substantial funding has been rechanneled that underscores the importance of health equity, as evidenced by the establishment of national collaborating centres for public health in canada, canadian institutes of health research’s research initiatives aimed at understanding and acting on social determinants and provincial strategies for poverty reduction. these efforts represent a concerted national commitment to incorporating social determinants into healthcare practice and policy, embodying a shift towards a more equitable healthcare system (edwards & cohen, 2012; low & theriault, 2008). images flooded social media feeds with captions stating, “it’s not about giving people shoes; it’s about giving them shoes that fit!” however, despite these shareable memes and funding rao/resuscitating equality 369 redistributions, the question of whether these policies have made a meaningful impact remains unanswered. recent data indicate that health disparities are not only enduring but also increasing (organization for economic cooperation and development [oecd], 2023). for instance, socioeconomic status continues to be a significant factor in infant mortality rates, a fact that has been well-documented since the early 20th century (hattersley, 2006; tawney, 1964). the overarching thesis of this article contends that canadian healthcare policies have not evolved sufficiently to tackle the deep-rooted structures causing health inequities. the rigidity of medicare, for instance, mirrors the 1968 model and has not kept pace with societal changes or the declining performance of canada's health system (tonelli et al., 2020). systemic barriers and the societal power dynamics that are deeply embedded in structural barriers, social identities, and cultural norms, which vary across different demographic groups, are frequently overlooked. these inequalities are intertwined and intersectional (collins & bilge, 2016; crenshaw, 1990) and arise from complex systems that dictate access to essential services. for example, work conducted by amis et al. (2020) found the organizational reproduction of inequality in which organizational practices are directly implicated in the burgeoning of social and economic inequality. this may include underrepresentation in decision-making roles, which often leads to policies that exacerbate existing inequalities, and language and cultural norms may act as powerful tools to uphold the status quo with terms and labels used to minoritize specific communities. “primum non nocer,” first, do no harm (shmerling, 2020), is attributed to the hippocratic oath and has surreptitiously infiltrated the fabric of healthcare (potts, 2020). in fact, primum non nocer is not actually derived from the oath (shmerling, 2020); nonetheless, it has become the axiom of healthcare which rests firmly on the medical model (luxford, 2016). do no harm fails to state explicitly but implicitly affirms power (zaner, 1988). potts (2020) describes it most clearly, it is naïve to believe that the misuse of medical power is not a temptation to people working in the medical profession. even in the ancient world, writers on the ethics of medicine recognized the danger of power used to harm, rather than to help. (p. 916) not only do physicians have more knowledge, resources and skills than the person seeking care, but they also have backing from considerable legal, social, and institutional legitimation, thus creating dependency and ultimately having control (illich, 1982; jewson, 2009; potts, 2020; zaner, 1988). however, this is no longer limited to physicians. the effects of this widespread dominance mean that other professions, such as social work, are almost wholly complicit in perpetrating the violence, racism, ableism, and sanism that are embedded in the fabric of healthcare and healthcare systems (beresford, 2016). do no harm may avoid being directly implicated in negative discrimination (solas, 2018b), but it does nothing to promote equality or equity, for that matter. the ethos of social work is not just to avoid negative discrimination but to actively engage in promoting social justice, equitable resource distribution, and challenging oppressive systems (sobočan et al., 2019). the csw lens pushes further, recognizing that mere non-maleficence without a proactive stance on social inequalities does little to advances in social work, summer 2024, 24(2) 370 address systemic issues. historical patterns show that despite social work’s commitment to ethical practice, actions informed only by ethics codes may not necessarily challenge existing social hierarchies. thus, the passive posture of do no harm is seen as insufficient within social work, which aims to be transformative and to ally with service users for systemic change (hugman et al., 2011). the medical model, upon which healthcare is based, focuses on individual pathology or disease rather than considering the broader social, economic, and political factors that contribute to poor health outcomes—which the inclusion of equity aimed to do. however, the responses from the healthcare system remain unchanged, often blaming individuals for their poor decisions rather than addressing the root causes of the problem. this same system then places healthcare providers as healers and saviours (shapiro, 2018) instead of addressing the sociopolitical context of oppression and promoting social change that will ultimately address the structural harms (bettache & chiu, 2019; brodie, 2007). the necessity to move beyond mere acknowledgment of these issues is evident. in the ensuing sections of this article, a critical analysis will be conducted, utilizing the theoretical frameworks of utilitarianism, meritocracy and, briefly, neoliberalism. this examination aims to interrogate and illuminate the values that undergird the prevailing models and frameworks of health equity in healthcare, particularly scrutinizing how power and justice are conceptualized and operationalized. utilitarianism most mohs indicate a mandate to address injustice in their public service announcements, equity plans, and subsequent taskforces with no plan for or explicit discussion on power or justice. implicitly, the assumed position is demonstrated through these types of utilitarian statements (solas, 2018b) alluded to earlier, maximize positive impacts and reduce negative impacts (ministry of health and long-term care, 2009). the main idea inherent in utilitarianism is that society is just when its major institutions are arranged so as to achieve the greatest net balance of satisfaction summed over all the individuals belonging to it (blackorby et al., 2002; brodie, 2007; crash course, 2016; solas, 2008, 2018b). the nuances are illusive, most unquestioningly assuming utilitarianism’s beneficence. solas (2008) advocates for a more critical approach, urging individuals to delve beyond surface-level appearances and examine the underlying architecture: the aim [of utilitarianism] is simply to maximize the allocation of the means of satisfaction, that is, rights and duties, opportunities and privileges, and various forms of wealth. however, when the principle of utility is satisfied there is no assurance that everyone benefits. in fact, the principle requires that some individuals should [emphasis added] accept lower prospects of life for the gratification of others. (p. 815) by this definition of justice, deprivation is not only tolerated but sanctioned. the principle of utilitarianism demands that some, usually those who are already less favourably situated, forego greater life prospects for the sake of others. many consider rao/resuscitating equality 371 utilitarianism as a means of facilitating the attainment of the ultimate advantage rather than perceiving it as an injustice (blackorby et al., 2002; hattersley, 2006; solas, 2018b). these ideas are further buttressed with perceived economic restrictions. thus, in a finite world, everything that anyone has is something that others cannot have. in the utilitarian view, good is defined independently from right so that whatever is judged good for people is good, whether right or not (solas, 2008). selecting equity, irrespective of the moh definitions provided, does not guarantee either “shoes” or “shoes that fit,” but it has villainized equality and chides people from interrogating the system further. social work embedded in the healthcare system is implicated in this approach— maximizing overall happiness. this has resulted in policies and practices that overlook the needs of minoritized and smv populations. for example, policies that prioritize economic growth and fiscal responsibility over social welfare programs can lead to cuts in funding for social programs that are essential for minoritized populations. these cuts can result in reduced access to critical services, such as healthcare and housing, that are necessary for the well-being of smv individuals. furthermore, the emphasis on measurable outcomes and evidence-based practices in social work can also contribute to minoritization, where the focus on measurable outcomes may prioritize interventions that are easier to measure and neglect interventions that are more complex and nuanced but may be more effective for individuals and communities. finally, the emphasis on individual responsibility and self-sufficiency in social work can also uphold ideas of utilitarianism that may harm smv individuals. this approach often fails to consider the structural barriers that prevent individuals from achieving selfsufficiency, such as systemic discrimination and lack of access to resources. meritocracy it is said health equity allows people to reach their full health potential (health quality ontario, 2016). hattersley (2006) and solas (2008, 2018a, 2018b) translate this message as the ability to rise. this is the premise of meritocracy, no more than a shell game, shifting inequalities to another place (bettache & chiu, 2019; hattersley, 2006; solas, 2008; yu, 2006). meritocracy’s promise is the allowance to reach full potential. this conversely implies that persons in situations of poverty, homelessness, and addictions did not try hard enough with the opportunities provided to them. these individuals are the “losers” of the meritocratic system (solas, 2018a). a practical example is the model minority concept, a direct by-product of meritocracy. the model minority is one of the cultural consensuses that serve the white elite, hegemonic control (bates, 1975; bettache & chiu, 2019). yu (2006) describes the model minority as one which emphasizes certain individual character traits: hard work, frugality, strong family, and high regard for education, which are hailed as the path to individual success and personal salvation; referred to as the “winners” of the meritocratic system. structural problems such as racism, sanism and oppression are otherwise inconsequential; what matters is your ability to rise once given the opportunity to do so—and if the model minority can do it, so can everyone else if they try hard enough (solas, 2018a). meritocracy advances in social work, summer 2024, 24(2) 372 glorifies individualism and a competitive ethos and falsely represents it as a model of social justice (hattersley, 2006; solas, 2008, 2018b). in their book, this is what inequality looks like (teo, 2018), a singaporean sociologist explores the lived experiences of low-income families in singapore. the book challenges the singaporean government's narrative that the country is a meritocracy and that those who work hard will succeed, arguing instead that poverty is often the result of systemic and structural inequality. poverty in singapore is often hidden and stigmatized, with many low-income families struggling to make ends meet despite working full-time jobs. the government's policies and discourse around poverty often blame individuals for their own circumstances rather than acknowledging the systemic and structural factors that contribute to inequality. teo (2018) argues for a more nuanced understanding of poverty and inequality and for policies that address the root causes of these issues rather than just treating the symptoms. healthcare and social work policies and practices that uphold meritocracy can contribute to systemic injustice by perpetuating the myth that individuals are solely responsible for their own success or failure and ignoring the systemic barriers that prevent certain individuals and communities from achieving their full potential. for example, many social work programs prioritize individual responsibility, stating that individuals who may not return for healthcare visits are unmotivated, lost to follow-up or are non-compliant, and may blame even individuals for their poverty or lack of success instead of recognizing the ways in which larger social, economic, and political structures shape opportunities and outcomes (dougherty, 1993; whitley, 2018). this approach in healthcare often results in a punitive and paternalistic approach and a focus on pathologizing individuals and families and treating symptoms instead of addressing root causes of poverty and inequality, leading to limited resources and support for systemic change. additionally, meritocracy can lead to policies and practices that prioritize privileged groups over minoritized ones, perpetuating existing power imbalances and inequalities (solas, 2018a). neoliberalism neoliberal thought has further entrenched this individualistic perspective, dislocating social assistance commitments and exacerbating social inequalities (bettache & chiu, 2019). what prevails in the neoliberal medical model is the view of distress as a disease and holds individuals and families responsible for fixing their own problems (peters, 2019). and here, the pattern begins to become clearer. in every case, whether health equity, determinants of health, utilitarianism, or meritocracy, the onus is placed on the individual to deal with the adversity. harvey (2007) in their book, a brief history of neoliberalism, describes it poignantly: for those left or cast outside the market system – a vast reservoir of apparently disposable people bereft of social protections and supportive social structures – there is little to be expected from neoliberalization except poverty, hunger, disease, and despair. their only hope is somehow to scramble aboard the market system rao/resuscitating equality 373 either as petty commodity producers, as informal vendors (of things or labor power), as petty predators to beg, steal, or violently secure some crumbs from the rich man’s table, or as participants in the vast illegal trade or trafficking in drugs, guns, women or anything else illegal for which there is a demand. (p. 185) this analysis necessitates a critical rethinking of the prevailing framework that, while recognizing individual needs, compels individuals to internalize and adapt to systemic shortcomings as personal failures. in instances where individuals overcome these vast challenges, it is the neoliberal paradigm that lauds them as exemplars rather than acknowledging them as exceptions to a deeply flawed system. neoliberalism should not be seen as separate from those who profit from it: the euro-white elite that, in a postcolonialist world, will always have a head start, open road and increased speed limit (bettache & chiu, 2019; brodie, 2007; solas, 2008, 2018a). for social work, upholding social justice is a complex, somewhat nebulous, and multifaceted task that involves grappling with various philosophical, ethical, and ideological perspectives (mullaly, 2007). if we are not careful, and if we are not critical and diligent, the foundations on which our profession stands are liable to shift. social work must prioritize systemic change, challenge power imbalances, and advocate for policies and practices that promote equality—in its fulsome definition, equity and justice for all individuals and communities. this article concedes that healthcare has shown a progressive shift from a purely biomedical to a more holistic understanding of health. this evolution embraces a broader understanding of health determinants, as illustrated by the lalonde (1974) report. this seminal document expanded the conceptualization of health determinants to encompass not only the biological but also environmental factors, thereby enhancing the comprehensiveness of health strategies and interventions (glouberman & millar, 2003). however, this shift came alongside the abnegation of responsibility, accountability or ownership of those structures, placing the inequality and injustice as personal rather than political (bettache & chiu, 2019; brodie, 2007; hattersley, 2006; solas, 2008, 2018a). at the core of social justice resides the principle of equality, which functions as an essential pillar in the formulation of a society characterized by fairness and justice. equality transcends the rudimentary idea of merely distributing resources or opportunities evenly among individuals. it represents a profound philosophical belief: irrespective of their background or circumstances, every individual possesses inherent value and worth (solas, 2018a, 2018b; tawney, 1964). consequently, each person merits respect, recognition, and equal treatment in every facet of life. it is imperative to elucidate that championing equality does not equate to enforcing a homogenous or uniform standard upon all. equality does not mandate that everyone receives identical resources or achieves similar outcomes. instead, it is about acknowledging the unique needs, aspirations, and hopes of each individual and ensuring that they are afforded equitable structures and systems for actualization. one example is health in all policies (hiap), which strategically evaluates the health and societal impacts of decisions made across all governmental sectors, aiming to enhance synergies for health and social outcomes. it is pivotal because it addresses the wide range of factors affecting advances in social work, summer 2024, 24(2) 374 health outcomes—such as structural determinants of health—which often fall outside the healthcare sector's purview. hiap emphasizes improving public well-being by requiring all governmental departments to consider the upstream influences on health and social conditions in their policymaking. this process encompasses analyzing both the direct effects of policies, like those altering taxation to support affordable housing, and the indirect implications of nonhealth-related policies, such as zoning laws that might encourage urban sprawl, thereby increasing pollution and fossil fuel use. at its core, hiap focuses on tackling the root causes of health disparities, including inadequate infrastructure, scarcity of clean water and sanitation services, limited social protections, and barriers to accessing essential services and healthcare (tonelli et al., 2020). other examples include universal basic services, universal health care, universal education, housing first initiatives, and universal childcare. the significance of grasping and integrating this principle into policies, practices, and academic discussions is paramount. neglecting or misinterpreting equality results in a fundamental misunderstanding of the essence of social justice and, consequently, hinders the journey toward a genuinely equitable society. when equality is absent, certain individuals and groups are denied access to opportunities and resources, leading to unfair advantages for some and disadvantages for others. this creates, perpetuates and sustains interrelated systems of oppression (solas, 2008, 2018a; tawney, 1964; teo, 2018). from these crosshairs, an individual could not possibly reach the promise of full potential. this promise requires more than an equal start; instead, an individual must have both an equal start and an open road (solas, 2008, 2018b). according to the international federation of social workers’ (2018) global social work statement of ethical principles, “social workers work to bring to the attention of their employers, policymakers, politicians, and the public situations in which policies and resources are inadequate or in which policies and practices are oppressive, unfair, or harmful” (ethical principle 3.4). it is incumbent upon social workers to actively champion and advocate for the realization of true equality in both policy and practice, fulfilling their duty to foster a more just society. implications for social work: health system transformation the healthcare system can play an integral role in the optimization of individual and family health. however, doing so requires radical self-reflexivity and moral courage (blackstock, 2020) by social workers, researchers and policy actors to ensure that those who shape the production of information that influences health system decisions are aware of their power, values, and position. awareness, however, is not enough; it must translate into the kinds of questions that are asked, the policies that are made, how research is conducted, and what and whose knowledges are used and implemented. justice-informed practice, research and policy transcends the mere description of health inequities and focuses on the goal of social justice as a mechanism for social change and transformation (cho et al., 2013; crenshaw, 1990; hankivsky et al., 2017; collins & bilge, 2016). rao/resuscitating equality 375 first, to truly transform the distribution of health and illness requires direct intervention in the fundamental social, economic, and political processes, relations, and systems of power that produce health inequities. these actions include, but are not limited to, the evolution of conceptual models of health to account for complex intersections of health and disease determinants that take power into consideration. figure 1 provides a visual representation to elucidate these intricate relationships, positioning them within an expansive framework of power, justice, and structural determinants of health. intersectionality, as depicted in the figure, roots itself in the understanding that identities, informed by categories like ethnicity, gender, and socio-economic status, do not operate in isolation. rather, they intersect in systemic ways, collectively influencing individuals' experiences. such intersections can either amplify or curtail their access to health resources and, consequently, their overall health outcomes. adjacent to this foundational concept of intersectionality is the closely intertwined ideals of equality and equity. the refined understanding of equality finds its articulation here, emphasizing the discernment of individual nuances but asserting that irrespective of one's background or external factors, each individual possesses an equal intrinsic value. such a belief necessitates the unequivocal recognition, respect, dignity and worth of every individual across various spheres of life. crucially, this comprehension of equality does not promulgate the notion of uniformity. equity underscores the need for tailored interventions that account for individual circumstances, all with the aim of achieving equitable outcomes. encasing these central tenets are the overarching constructs of power, justice, and structural health determinants. power emphasizes the societal dynamics that delineate access to resources and the capacities for decision-making. justice embodies the moral commitment to fairness in the distribution of resources and opportunities, all the while aspiring for optimal health outcomes for all. structural determinants of health refer to societal conditions, encompassing socio-economic factors, governing policies, and prevailing norms. this intricate configuration illuminates the fact that societal structures underpin the foundation, subsequently influencing the internal dynamics of power and justice. these dynamics, in turn, shape the intricate dance of equality, equity, and intersectionality. for social workers, academicians, policymakers, and other healthcare disciplines, this holistic perspective underscores the imperative for a deeper, integrative comprehension of health. it posits that genuine health equity can only be attained when these multifaceted components converge harmoniously. advances in social work, summer 2024, 24(2) 376 hankivsky et al. (2017) provide concrete examples of this conceptual model with a focus on research, suggesting if these dynamics were more systematically understood and prioritized in research, the conceptualization of health problems, diseases, and illnesses would be more accurately addressed at their root cause. in turn, treatment opportunities, effective interventions, and necessary policy changes will be more clearly delineated and pursued. another example, “medical deprofessionalization,” a term taken from illich (1982), empowers individuals and communities to care for themselves and each other. this calls for a shift away from the focus on medical technologies and towards a more holistic approach to health that emphasizes prevention and community-based care. it also advocates for greater patient autonomy, control over medical decisions, and the dismantling of the medical-industrial complex (amundson, 2005; cresswell & spandler, 2016; haegele & hodge, 2016; relman, 1980). this is not to suggest a rejection of the medical profession, but rather the integration of medical and healthcare advancements alongside traditional healing practices at the individual level that does not leave out the structural inequities that contribute to poor health outcomes for minoritized communities. a focus on individual empowerment is necessary but not sufficient to address these broader issues. to promote greater equality in healthcare, it is important to address these underlying structural and systemic issues. this can include expanding access to other health disciplines, such as physical therapy, psychotherapy and occupational therapy, for figure 1. the complementary dynamics of equality and equity in health rao/resuscitating equality 377 example, while continuing to address the root causes of health disparities. additionally, policies that prioritize equality, notably in the realm of universal healthcare, comprehensive drug coverage, and robust anti-discrimination laws, are foundational in affirming the inherent worth and dignity of every individual. for instance, the implementation of universal healthcare systems ensures that every citizen, irrespective of their socioeconomic status, has equitable access to essential healthcare services. this approach to healthcare is predicated on the principle that health is a fundamental human right, recognizing the equal value of every person's life and health. similarly, comprehensive drug coverage programs aim to eliminate financial barriers to necessary medications, ensuring that all individuals, especially those from minoritized communities, can manage and maintain their health without the burden of prohibitive costs (boozary & laupacis, 2020). together, these policies embody a commitment to equality not merely as sameness in treatment but as an affirmation of the equal worth of every individual. they operationalize the concept of equality by starting from a foundational belief in the universal worth and dignity of all persons, thereby facilitating access to resources and opportunities needed to achieve optimal health outcomes and societal participation. moving from clinical practice to critical practice the field of social work faces recurrent identity crises, often drifting away from its foundational ethos—respecting individual dignity, advocating for social justice, committing to truth and reconciliation, and valuing human connections, to mimic other healthcare professions (gitterman, 2014; hugman, 2009; longhofer & floersch, 2012). contributing to this issue are long-standing debates concerning the medical model of care. vic finkelstein, a pioneer of anti-oppressive approaches, contended that social workers were as entrenched as medical doctors (roulstone, 2013). oliver et al. (2012) extend this further to say that the medical field, by virtue of its authority, has engendered a cadre of pseudo-professions aimed at restoring normality—among which social work is included (oliver, 2009, 2016). moreover, disability activism has criticized social work for perpetuating, rather than challenging, ableism and capitalist ideologies (eiler & d’angelo, 2020). several factors contribute to this trend, chief among them are external pressures such as austerity measures and the biomedical orientation of the healthcare system (alderson, 2021; andrews et al., 2021; cresswell & spandler, 2016; danermark, 2019; eiler & d’angelo, 2020). these constraints lead to prioritizing cost-effective biomedical interventions over comprehensive social approaches, thereby reinforcing existing social work practices to the detriment of clients' economic and psychological well-being (fantecoleman & jackson-best, 2020; islam et al., 2017; iyer et al., 2015; mcgorry et al., 2007). to address these issues, dietz (2000) suggests transitioning from clinical practice to critical practice, which necessitates a political engagement aimed at helping clients contextualize their experiences within broader social and political frameworks. critical practice involves dismantling pathologizing discourses, identifying systems of inequality, and fostering transformative relationships (allan et al., 2009; ballan, 2008; elliott et al., advances in social work, summer 2024, 24(2) 378 2005; sanders, 2021). this approach shifts the practitioner's role from that of an expert to a co-collaborator (harvey & kitson, 2016; kitson et al., 2013; kitson, 2009). whether in community health social work or in a hospital setting, in critical practice, the focus should be on collaboration—as equal partners and acknowledging clients as an integral part of the interactive system that impacts their well-being (eiler & d’angelo, 2020; may & raske, 2005; oliver, 2009). a dedication to critical practice broadens the epistemological landscape, inviting a wider range of understandings and interventions for client distress. this aligns with social work’s core commitment to human well-being and emancipatory change (casw, 2022; dietz, 2000; dominelli, 2017; mullaly, 2002, 2010). hence, for effective and emancipatory practice, social workers must scrutinize both the knowledge they acquire and its application in practice, recognizing that knowledge wields power. the currently rising inequality is not a natural or inevitable phenomenon but rather a result of political choices and economic policies (atkinson, 2018). social workers resuscitating the heartbeat of healthcare at the core of justice are the structural and institutional arrangements that shape people’s life chances over time. injustice resides in the social order, not in people (hattersley, 2006). it is precisely that disorder in the social order that is responsible for turning the natural diversity of human beings into oppressive hierarchies (solas, 2018b). inequality, espoused by the mohs is not simply or primarily the result of unequal distributions of resources. this unjust distribution stems from unjust social structures, processes and practices. while concern about the end-product of distributional patterns is important, it offers no more justice than utilitarianism provides if the basic allocation structures responsible for producing and maintaining unequal shares of the social product go unchallenged. true egalitarians neither expect nor want to create a society of identical mediocrities (hattersley, 2006; solas, 2008, 2018b). the objection is not to natural endowments or unique personhood differences, but to the artificial differences conceived by people in privileged positions that propagate the opinion that the view of equality is utopic and unfeasible due to the diversity of people it aims to assist. if each individual is to achieve their full potential, economic as well as institutional barriers to progress must be eliminated. equality must be resuscitated in healthcare. we must resist the cancelling of equality by mistaking it for uniformity. it is not about shoes or shoes that fit, but why are people in a just society without shoes at all? equality must be accorded to every individual, and it must do so not because some innate or universal characteristic of individuals, but precisely because of the significant and tangible inequalities that exist between individuals. nothing more and nothing less. rao/resuscitating equality 379 conclusion in the realm of healthcare, marked by disparities that favour a select few, the call for systemic transformation is urgent. the existing inequities underscore the need for healthcare authorities to fundamentally reassess and reconstruct frameworks to guarantee access for all. this means addressing the structural and systemic barriers that prevent individuals from accessing opportunities and resources and promoting policies and practices that ensure everyone has an equal chance to succeed. this article returns full circle to the statement, “it’s better than nothing.” perhaps the origin of this statement is actually from the people who have learned to expect nothing from us in the healthcare system. this realization prompts a critical reorientation towards equality, affirming every individual's inherent right to health and well-being which includes healthcare treatment and opportunities. this paradigm shift, advocating for equality as the cornerstone of healthcare policy and practice, challenges existing norms and lays the groundwork for a new healthcare ethos that rejects complacency in favour of comprehensive and holistic solutions. at the heart of this academic discourse is the critical need for social workers to deeply understand the philosophical foundations that underpin current healthcare practices. utilitarianism, meritocracy, and neoliberalism often masquerade as benevolent, ostensibly promoting progress, while in reality, they solidify existing injustices. without critically engaging these concepts, social workers might inadvertently support the very injustices they seek to dismantle. the absence of a nuanced comprehension of these ideologies deprives social workers of vital tools for critical analysis, advocacy, and the pursuit of structural change. by acquiescing to minimalist interventions and an overarching sense of apathy, the status quo is inadvertently maintained, and the existing barriers are fortified, thereby obstructing meaningful progress and the realization of our professional and ethical commitments. without equality, justice cannot be achieved, and society will continue to be marked by unfairness, inequality, and injustice. a return to equality is called for. all people must be treated as equals. let that be the place we start with nothing sufficiently less than that. references adams, r., dominelli, l., & payne, m. 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(1988). ethics and the clinical encounter. prentice hall. author note: address correspondence to sandy rao, faculty of social work, university of calgary, calgary, alberta. email: sandy.rao@ucalgary.ca https://www.jswve.org/wp-content/uploads/2018/12/10-015-209-jswve-2018.pdf https://www.jswve.org/wp-content/uploads/2018/12/10-015-209-jswve-2018.pdf https://doi.org/10.15453/0191-5096.4120 https://www.jstor.org/stable/26894228 https://doi.org/10.1503/cmaj.190517 https://doi.org/10.1503/cmaj.190517 https://doi.org/10.22329/csw.v9i1.5761 https://doi.org/10.1177/0706743718758041 https://doi.org/10.1186/s12939-019-1058-3 https://doi.org/10.1186/s12939-019-1058-3 https://doi.org/10.1186/s12939-019-1058-3 https://doi.org/10.1080/10665680600932333 https://doi.org/10.1080/10665680600932333 mailto:sandy.rao@ucalgary.ca _________ jill m. chonody, phd, lcsw, professor, school of social work, boise state university, boise, id. barbra teater, phd, lmsw, professor, department of social work, college of staten island, city university of new, york new york, ny. katrina hannan, lcsw, practicing social worker and phd student, social welfare, graduate center, city university of new york, new york city, ny. katelyn hall, lmsw, practicing social worker and graduate, boise state university, boise, id. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1046-1065, doi: 10.18060/25790 this work is licensed under a creative commons attribution 4.0 international license. stress during the early months of covid in the u.s.: the role of fear and health status across the age spectrum jill m. chonody barbra teater katrina hannan katelyn hall abstract: the stress that the covid pandemic has caused is immeasurable and is likely to impact people for many years to come. service providers such as social workers are experiencing these impacts both personally and professionally. as new research emerges, a greater understanding of the emotional toll related to covid can help to inform social work practice. to add to this gap in the literature, an online survey explored the factors that contribute to higher stress reactions among individuals in the general population (n = 412) and across the age spectrum. bivariate analyses indicated a significant increase in stress from preto during-covid for the entire sample and across the three age groups. multivariate analysis revealed more conversations about covid, more alcohol use, knowing someone who had tested positive, increased fear, greater avoidance of reading/watching information about covid, decreased health status, and increased income contributed to stress duringcovid. increased fear and decreased health status were significant when stress was examined separately among the three age groups. the results indicated the importance of understanding and responding to fear during public health crises and illustrate how interventions may shift for clinical social workers as they seek to address multi-layered concerns. social workers can help manage the impact of the pandemic by providing clients with therapeutic services, psychoeducation, and case management. keywords: covid; stress; fear; health; age on march 11, 2020, the world health organization (who) declared the novel coronavirus (covid) a global pandemic. data from the centers for disease control (cdc, 2022a) indicate over 75,012,446 reported cases in the united states (us) and more than 884,853 deaths due to covid at the time of this writing. according to who (2022), more than 376 million cases have been reported globally and over 5,666,000 deaths. the severity and magnitude of this illness and public health crisis have led people to experience immense stress, fear, and uncertainty worldwide. greater demands on the social work profession have been reported as a result (cross & gonzalez benson, 2021), and social workers “are bearing witness to the struggles of the most vulnerable and isolated in our society” (abrams & dettlaff, 2020, p. 302). consequently, clinical social workers and other counseling related disciplines have shifted to account for these complex emotions (vostanis & bell, 2020), including promoting telehealth as best practice with therapeutic interventions focused on the social-emotional impact of covid. covid is a respiratory illness that causes fever/chills, coughing, and shortness of breath. while the virus expresses itself differently in different individuals, other symptoms may include fatigue, loss of taste and smell, headache, muscle or body aches, about:blank chonody et al./stress during early covid-19 1047 sore throat, congestion/runny nose, and/or diarrhea (cdc, 2022d). while many people recover from this illness, others struggle to survive. therefore, people remain alarmed and terrified of this virus and the public health crisis that has ensued and continues to threaten lives. the severity of the illness has an extensive range. while some individuals are asymptomatic, approximately 81% experience mild symptoms, 14% experience severe symptoms, and 5% experience a critical illness (cdc, 2021). moreover, the cdc (2022c) indicates that older adults and people with underlying health conditions have a greater risk for developing severe complications if they contract covid. preliminary data determined that older people are at higher risk of death from covid. the cdc (2022a) reported 75.6% of deaths in the us related to covid have been among adults age 65 years and older; 27.5% were among people who were 85 years and older. in an effort to minimize the spread of the virus, governments across the globe recommended or mandated specific guidelines, including stay-at-home orders, quarantine, social distancing, working remotely, vaccinations, and wearing masks. quarantining involves staying within one’s home and only going out when necessary. according to the cdc (2022b), social distancing is the practice of maintaining at least six feet between yourself and any people who live outside of your home. the use of masks decreases the virus transmission efficiency as it acts as a barrier for this airborne virus (li et al., 2020). vaccinations are highly effective, particularly in preventing severe illness, hospitalizations, and death (cdc, 2022b). these steps appear to effectively prevent transmission, slow the spread of the virus, and reduce hospitalizations and death. yet, at the time of writing this paper, the omicron variant had dramatically spread across the us, leading to surges in new cases, including breakthrough cases for individuals who have been vaccinated and additional or reintroduced mandates such as wearing masks, regular testing, and quarantining if exposed. the drastic life changes due to covid have profoundly impacted people in a multitude of ways and may continue to have lasting consequences. many people lost loved ones and some were unable to grieve appropriately. some people battled the virus, wondering whether they would survive, while others continued to quarantine and reduced socialization. some people were fortunate to continue working, and many transitioned to working remotely from home. meanwhile, others continue to report to work in person, especially essential workers such as health care workers. furthermore, many people have lost their jobs due to financial instability caused by the ripple effect of the pandemic. the stress that covid has caused is immeasurable (pearman et al., 2020) and is likely to impact people for many years to come, including social workers who are providing services in hospitals as well as clinical settings. to better understand the emotional impact of covid, the present study explored the factors contributing to stress reactions among individuals during this public health crisis and examined if differences in stress levels were present across the age spectrum. such knowledge can assist social workers in identifying preventative measures as well as interventions that can help minimize the stress experience. advances in social work, fall 2022, 22(3) 1048 literature review stress during public health crises people cope with crises, including public health crises in many different ways. some people have emotional reactions, including anxiety, sadness, and sleep disturbances, whereas others remain calm and seemingly less affected (fiorillo & gorwood, 2020; qiu et al., 2020; wang et al., 2020). a review of existing research suggests that feeling stressed during a public health crisis is a natural response, and heterogeneous responses to the pandemic are often related to pre-existing psychopathological factors (fiorillo & gorwood, 2020; freckelton, 2020; pearman et al., 2020; reznik et al., 2020; sepulveda-loyola et al., 2020; torales et al., 2020). moreover, loss is a central emotion as the pandemic continues and includes the loss of loved ones, the loss of physical contact and careers, and reduced socialization. all of these factors combined have created a “new normal,” and the uncertainty of never returning to the way the world used to be creates a magnitude of unknowns. trying to remain resilient while waiting to return to the old normal does not ensure any guarantees that it will occur, which in turn, is a basis for additional anxiety and stress (walsh, 2020). social workers play a crucial role in mitigating these fears and stressors. current clients as well as new clients may want to focus on the way that covid is affecting their life or the way in which it is exacerbating existing problems, such as anxiety or depression. discussing the impact of covid may be pertinent for older adults due to the particular impact that it has had on that age group as well as the dearth of gerontological social workers (berg-weger & schroepfer, 2020). clients need space and time to grieve their losses, and social workers are in a position to provide supportive and insight-oriented counseling to address these needs. interventions that support resilience and emotional well-being through skill development are particularly important (dorado barbé et al., 2021). moreover, social workers can focus some of their efforts on helping clients develop new coping skills, such as grounding techniques, and implement therapeutic interventions that incorporate psychoeducation regarding stress, covid, and the interaction between them. additionally, social workers may be in a position to provide psychoeducation to clients within their agencies and in the broader community. clarity of information related to public health crises is imperative given that it can significantly impact stress levels (lopez-pelaez et al., 2020). to stay informed when a community crisis occurs, people seek out event-related information, and the consumption of media has significantly increased as “92% of citizens actively consumed news about the virus” (casero-ripolles, 2020, p. 4). however, when information is inconsistent or unavailable, people may be exposed to misleading information, which leads to higher levels of stress and anxiety (freckelton, 2020; garfin et al., 2020; torales et al., 2020). a recent study established an association between obtaining information from quality sources and more accurate knowledge of covid, which in turn, was associated with lower stress levels (pearman et al., 2020). for example, recommendations on wearing a facemask in public to prevent the spread of covid were initially inconsistent, leading to further confusion, fear, and stress (goh et al., 2020). therefore, continuous and clear information provided by medical experts is critical to help reduce the stress people experience during times of public health crises. chonody et al./stress during early covid-19 1049 on the other hand, public messages can also lead to public alarm. for example, to protect oneself from covid, guidelines for wearing a facemask in public were recommended by the cdc, and “this information led to a panic buying spree by the general public” (goh et al., 2020, p. 3). additionally, people were also purchasing essential consumer items in a panic, such as toilet paper, first aid kits, bottled water, and hand sanitizer, which was a safety-seeking response due to ambiguous and fearinducing media reports (garfin et al., 2020). over time, wearing a facemask has aided in reducing stress and anxiety where the mask is present and is “perhaps the mostpowerful psychological symbol for the general public” (goh et al., 2020, p. 1). however, this can be dangerous because some people believe that wearing a mask is sufficient, and thus, may ignore social distancing guidelines and handwashing recommendations (goh et al., 2020). on the other hand, williams et al. (2020) found that participants in their study were adherent to social isolation and social distancing guidelines for covid. in fact, “participants were highly critical of such instances of non-adherence…[and]…stigma was more likely to be attributed to those who were failing to socially distance and isolate” (williams et al., 2020, p. 6). social workers may be a part of those teams that help disseminate accurate and up-to-date information to the community. while safety behaviors act to directly combat feelings of fear and stress related to virus contraction, research suggests that fear during public health crises can drive destructive and concerning social behaviors. torales and colleagues (2020) report, “in fact, fear of the unknown leads to higher anxiety levels in both healthy people and those with pre-existing mental health problems; unjustified public fear may lead to discrimination, stigmatization and scapegoats” (p. 319). people will likely experience extreme fear, uncertainty, and distorted perceptions of risk which will drive negative social behaviors (torales et al., 2020). thus, it is vital to recognize that fear makes people act unusually and often irrationally. some people shamefully take advantage of the vulnerability of others and make false advertisements about medications which can prevent, treat, or cure diseases (freckelton, 2020). this “vulnerability creates predatory opportunities for the unscrupulous,” such as the quackery which surfaced during the 1889-1892 russian flu, the 1918-1920 spanish flu, and the emergence of bogus claims in the present day covid pandemic (freckelton, 2020, p. 1). uncertainty incites stress and fear in regard to infectious disease since they lack clear and distinct boundaries and “are one of the most distressing forms of disaster to deal with psychologically because of the uncertainty they cause” (reznik et al., 2020, p. 1904). thus, infectious diseases can create a sense of vulnerability, risk, and stress (reznik et al., 2020). inevitably, when people feel vulnerable and at risk, they feel fearful. for example, research involving the sars (severe acute respiratory syndrome) pandemic in hong kong in 2003 found that people felt anxious and stressed about contracting the illness, and more than 75% of respondents avoided going out or visiting crowded places (lau et al., 2010). research related to the stress and psychological implications of previous infectious diseases, in particular, identified that health care workers and survivors suffered long-term consequences. for example, 27% of health care workers during the 2003 sars cov outbreak in singapore reported psychiatric symptoms (chan & huak, 2004), and medical staff in korea that performed mers-related tasks during the 2015 outbreak showed greater symptoms of posttraumatic stress disorder compared to health-care workers who did not perform mers-related tasks (lee et al., 2018). advances in social work, fall 2022, 22(3) 1050 similarly, medical staff in direct contact with infected patients reported high levels of anxiety and stigma both during the ebola outbreaks in sierra leone in 2014 and in the democratic republic of the congo in 2018 (park et al., 2018). social workers may be in a position to both be impacted by the stress of the pandemic as well as provide support to medical professionals (o’leary & tsui, 2020) and clients alike. their emotional responses also likely range from stress, anxiety, and fear. further research in this area can guide best practices and identify unique factors that may be associated with the social-emotional reactions to the covid pandemic. stress and covid people report experiencing stress, anxiety, depressive symptoms, insomnia, denial, anger, and fear all around the world in response to the ongoing covid pandemic (torales et al., 2020). in particular, anxiety related to developing covid has been found to lead to higher stress levels (pearman et al., 2020). people report severe anxiety in relation to covid with women reporting higher stress levels than men (jungmann & witthöft, 2020). research consistently finds that people feel significantly more stressed about covid (fitzpatrick et al., 2020; freckelton, 2020; pearman et al., 2020; reznik et al., 2020; sepulveda-loyola et al., 2020; torales et al., 2020; williams et al. 2020). when faced with extreme stress, individual coping strategies can range from healthy activities, such as exercise and yoga, to behaviors that may be more destructive, such as increased use of alcohol. resilience against mental disorders, particularly those associated with stress, may be supported by physical activity. for example, depression and anxiety disorders seem to have a “complex interaction of psychological and neurobiological mechanisms” (strohle, 2008, p. 781). given the correlation with improvement in depression and anxiety, exercise is thought to have advantages in lowering stress. exercise can also provide preventative care for other medical conditions, which can improve the quality of life overall (rafiq et al., 2019). social work interventions may integrate education about the positive benefits of exercise and encouragement for physical activities to help protect against detrimental impacts on mental health. on the other hand, increased alcohol use can occur in relation to stress, and alcohol consumption and mental health are negatively associated (e.g., jacob et al., 2021). increased psychological stress coupled with chronic alcohol use can change neurological pathways that lead to dependency. in a drug and alcohol dependence study, even social drinkers were found to increase alcohol use in correlation to stress (clay & parker, 2018). as such, risk-taking and impulsivity also increased with alcohol use, and if dependency occurs, it creates a long-term negative effect. for example, in a military setting where stressful deployments are common, increased alcohol use was seen as an avoidance coping behavior (bartone et al., 2017). thus, understanding the use of alcohol and its impact during a global pandemic is important, particularly in the us where a true “break” from covid has not occurred like in other countries, such as new zealand or iceland. furthermore, the effects of the pandemic may also be particularly disadvantageous to older people. current research suggests that social isolation during covid has negatively impacted the mental health and well-being of individuals of all ages, but older adults have been substantially affected (sepulveda-loyola et al., 2020). in particular, older adults have experienced increased anxiety and fear about contracting chonody et al./stress during early covid-19 1051 covid. however, older adults were also found to have better coping methods than younger adults and did not experience significantly higher stress levels as predicted (pearman et al., 2020). relatedly, a study examining loneliness and older adults’ social needs during social distancing found high levels of loneliness and social isolation across the sample; however, younger adults were experiencing higher levels of emotional loneliness compared to middle and older adults (teater et al., 2020). thus, the extent to which the pandemic affects different age groups may differ, and these differences may be relevant to social work practice when determining interventions or areas of assessment. gaps in the literature previous research has suggested that stress and fear (fiorillo & gorwood, 2020; freckelton, 2020; pearman et al., 2020; reznik et al., 2020; sepulveda-loyola et al., 2020; torales et al., 2020; walsh, 2020) are likely outcomes when in the face of health crises, such as the covid pandemic. emerging research specific to the pandemic has substantiated some of the social emotional reactions that people are feeling, including anxiety, sadness, sleep disturbances, social isolation, and loneliness (fiorillo & gorwood, 2020; qiu et al., 2020; sepulveda-loyola et al., 2020; wang et al., 2020). however, what is missing from our current understanding is how covid is impacting people across different age groups. the experience of lockdowns, social distancing, and the virus itself likely impacts people differently based on their age group due to various developmental milestones, such as retirement and other significant life experiences. greater insight into the reactions of individuals based on age can inform social work practice. that is, prevention and intervention can be tailored for clients or community groups to better address their needs. therefore, this study sought to add to the growing knowledge base on stress during the covid pandemic and the variables that are associated with stress in the general population and across the age spectrum (young adults; middle-aged adults; older adults) by asking the following research questions: (1) to what extent did stress levels change from pre-covid to duringcovid? (1a) how did this vary across the age spectrum? (2) what is the association between individual-level factors, coping factors, and covid restrictions and levels of stress during-covid? (2a) how do these factors impact stress across the age spectrum? greater knowledge and understanding about the impact of covid across the age spectrum can inform social work practice and shape the interventions that may be used to address those impacts. method setting and sample data for this study was collected from an online questionnaire distributed through mechanical turk (mturk), an amazon product that allows for participant recruitment for survey completion for a monetary reward ($0.75). the survey was also distributed through social media (facebook; twitter). survey participants are referred to as “workers” in mturk, and a large pool of these workers is available for possible participation. to ensure that the workers are not “fake” or are simply filling out the items without reading them, they will first pass through a series of unpaid questionnaires that will be checked to determine if they are completing the surveys mindfully. for this study, “master workers” (i.e., low survey rejection rate) were advances in social work, fall 2022, 22(3) 1052 selected for the sample, which means that past researchers have accepted their completed survey, and response bias was not suspected. in addition, the participants were required to provide a survey code at the end of the study to the researcher to receive the payment; this also helps to ensure against fake workers. mturk recruits study participants based on the study inclusion and exclusion criteria, which the researcher specifies. researchers posted the survey details for social media recruitment and encouraged participants to share the link or repost on their social media. study inclusion criteria were the same for both platforms and were specified as those aged 18+ and us residents. identifying information (e.g., name, contact details) was not recorded during survey completion. the survey was available in both platforms between june 17, 2020, and august 1, 2020. prior to data collection, approval was granted from the institutional review board at boise state university. the beginning of the survey started with the cover letter, which included the purpose of the study, the confidential and voluntary nature of the study, and the researcher’s contact information. survey completion served as consent for participation. about half of the total sample (n = 458) was gained from each of the two data collection strategies, mturk (n = 245) and social media (n = 213). instrumentation the survey was comprised of author-created items to measure the independent and dependent variables and was distributed to participants at one point in time. many of these variables were written to assess specific aspects of coping with the pandemic. stress (dependent variable) was measured by a single-item indicator that read: “during covid, how would you rate your stress on a scale of 1 – 10 with 10 indicating higher levels of stress?” fear was measured in the same way, except “fear” replaced the word “stress.” a previous study found that a single-item indicator of stress demonstrated content and construct validity (elo et al., 2003). participants were also asked to rate their stress prior to covid using the same rating scale. participants were asked to indicate the extent to which a number of activities may have changed during the pandemic (i.e., more, less, the same), including how much one was working, consuming alcohol, and exercising and if they were avoiding reading/watching information about covid and avoiding thoughts and feelings about covid (1 = strongly disagree to 6 = strongly agree). participants were also asked how much of their conversations with others were about covid (1 = none at all to 5 = a great deal). questions were included on the type of restrictions participants were under in their state (no activity restrictions/changes related to covid-19; voluntary quarantine due to fear of exposure; mandated self-isolation/quarantine by medical professional/government (not allowed to go out for any reason); stay-at-home orders by local government and/or employer urging people to stay at home (e.g., can still take walks and socialize outdoors while maintaining social distance); shelter-in-place order by local government (i.e., only permitted outdoors for essential purposes), the extent to which they were socially distancing (all the time, sometimes, not at all), and how often they were wearing a mask (same answers as social distancing). participants were asked if they knew someone who tested positive for covid (yes/no), and if so, who was this person to them (e.g., partner, friend). additionally, participants were asked sociodemographic questions, including age (written in as a number), identified gender, race/ethnicity, number of people in the household, total household income, the highest chonody et al./stress during early covid-19 1053 level of education, and the importance of religious/spiritual beliefs in one’s daily life. health status was rated using a 6-point scale (very poor, poor, fair, good, very good, excellent). additional data were collected on relationship status, sexuality, state of residence, and religious beliefs for descriptive purposes only. data analysis data were analyzed using ibm spss, version 24, software for descriptive statistics as well as bivariate and multivariate analyses. age was categorized based on petry’s (2002) classification of young adult (18 -35 years), middle-aged (36 – 55 years), and older adult (56+) to complete analyses of stress based on age groupings. paired-samples t-tests and one-way anovas were used to explore any difference in levels of stress from pre-covid to during-covid for the entire sample and by the three age groupings. anovas were used to examine the association between stress levels during covid and the three age groups, and post-hoc comparisons using the tukey test were performed to assess specific differences between groups. prior to conducting multivariate analyses (i.e., ordinary least squares regression), bivariate analyses were conducted to determine the direction and significance of the association using independent samples t-tests and pearson product moment correlations. variables found to be significant at the bivariate level were included in the multivariate analyses. alpha was set at .05. missing data were addressed through listwise deletion. results sociodemographic profile of the sample after removing participants with incomplete data, a total of 412 participants remained for analysis. the sample was on average 42 years old, and most identified as a woman (60.8%) and white (non-hispanic; 70.7%). most participants (60.6%) were married/partnered, with an average of 2.8 persons living in the household. the largest percentage of participants (23.8%) had a household income of $30,000 – $49,000, and the most commonly reported highest level of education was a four-year degree (47.9%). thirty-eight of the 50 states and washington, dc were represented. the top five states were idaho (n = 48; 12.4%), indiana (n = 48; 12.4%), ohio (n = 35; 9.1%), california (n = 33; 8.5%), and new york (n = 24; 6.2%). stress was moderately high on average (6.9 on a 10-point scale), alcohol use was indicated as the “same” by a majority of the participants (52%) as well as the amount participants were working (45%), and exercise was evenly divided between more, less, and the same. nearly half of the respondents (47.3%) reported knowing someone who tested positive for covid. table 1 provides the full details of the sociodemographic characteristics of the sample. table 1. sociodemographic characteristics of respondents characteristic n (%) gender (n=411) trans*/genderqueer/non-binary 3 (0.7%) woman 250 (60.8%) man 158 (38.4%) sexual orientation (n=402) bisexual 54 (13.4%) lesbian, gay 15 (3.7%) queer 5 (1.2%) straight 328 (81.4%) race/ethnicity (n=406) african american/black 20 (4.9%) asian american 67 (16.3%) bi/multiracial 8 (2%) advances in social work, fall 2022, 22(3) 1054 characteristic n (%) latinx 12 (2.9%) native american/pacific islander 9 (2.2%) white 290 (70.7%) highest degree (n=408) high school graduate/equivalency 26 (6.4%) technical training 7 (1.7%) some college 47 (11.5%) two-year degree (associate’s) 34 (8.3%) four-year degree (bachelor’s) 195 (47.9%) graduate degree (master’s or phd) 99 (24.2%) religious or spiritual beliefs (n=410) i’m not religious or spiritual 60 (14.6%) i’m spiritual, but not religious 80 (19.5%) atheist 33 (8.1%) jewish 10 (2.4%) muslim 6 (1.5%) protestant 84 (20.5%) catholic 62 (15.1%) buddhist 4 (1%) agnostic 24 (5.6%) hindu 37 (9%) other 10 (2.4%) relationship status (n=410) dating 42 (10%) single/widowed/divorced 117 (28.1%) married/partnered 252 (60.6%) household income (n=400) less than $10,000 24 (6%) $10,000 – $29,999 56 (14%) $30,000 – $49,999 95 (23.8%) $50,000 – $69,999 68 (17%) $70,000 – $89,999 63 (15.8%) $90,000 – $149,999 74 (18.5%) more than $150,000 20 (5%) alcohol use during covid (n=411) same 212 (51.6%) less 100 (24.3%) more 99 (24.1%) physical exercise during covid (n=411) same 149 (36.3%) less 131 (31.9%) more 131 (31.9%) working during covid (n=411) same 186 (45.5%) less 139 (34%) more 84 (20.5%) know someone who tested positive (n=412) yes 195 (47.3%) no 217 (52.7%) who tested positive (n=195) self 2 (1%) parent 4 (2.1%) friend 79 (40.5%) close relative 25 (12.8%) distant relative 28 (14.4%) coworker 26 (13.3%) other 31 (15.9%) restrictions due to covid (n=412) none 18 (4.4%) voluntary quarantine 60 (14.6%) mandated quarantine 14 (3.4%) stay at home 231 (56.1%) shelter in place 89 (21.6%) practicing social distancing (n=411) all the time 301 (73.2%) sometimes 96 (23.4%) not at all 14 (3.4%) chonody et al./stress during early covid-19 1055 characteristic n (%) wearing a mask in public (n=411) all the time 305 (74.2%) sometimes 81 (19.7%) not at all 25 (6.1%) mean (sd) age (range: 18-78 years) (n= 412) 42.1 (13.59) number of people in household (n= 408) 2.8 (1.43) physical health (n= 412) 4.3 (1) spiritual/religious beliefs importancea (n= 409) 3.6 (1.81) having conversations about covidb (n= 411) 3.2 (1.13) avoid reading/watching covid infoc (n= 410) 3.1 (1.71) avoid thoughts/feelings about covidc (n= 410) 3.3 (1.5) feard (n= 410) 5.8 (3.27) pre-covid stressd (n= 410) 4.8 (2.13) during covidd (n= 410) 6.9 (2.26) a theoretical range=1-6; b theoretical range=1-5; c theoretical range=1-6; d theoretical range=1-10. stress pre-covid and during-covid: entire sample and by age group a paired samples t-test was conducted to compare pre-covid stress levels with during-covid stress levels. the increase in stress for the sample was over two points greater from pre(m = 4.79) to during-covid (m = 6.86), t(408) = -18.35, p<.001. the effect size of this change was large (d = .94). paired samples t-tests were also conducted to examine how stress levels changed by age group and where each group started with regard to their stress. younger participants had moderate pre-covid stress levels (m = 5.09) and experienced an almost two-point increase during-covid (m = 7.01), t(155) = -10.89, p<.001. middle-aged participants also had a moderate stress level on average, albeit slightly lower than the younger participants (m = 4.70), and their during-covid average (m = 6.49) was significantly higher, t(177) = -12.63, p<.001. lastly, older participants had the lowest stress level pre-covid (m = 4.36), which increased exactly two points during-covid (m = 6.36), t(74) = -7.68, p<.001. stress during covid: bivariate results pearson’s product moment correlations indicated that greater avoidance of watching/reading information about covid, decreased health status, increased conversations about covid, increased fear, greater avoidance of thoughts and feelings, and increased income were statistically significant in relation to stress levels. the number of people in the household, the importance of religious beliefs, age, and educational status were not significant (see table 2). advances in social work, fall 2022, 22(3) 1056 table 2. correlations between continuous variables (n = 410) stress convos fear thoughts read health age house educ income stress -- convos .40a -- fear .59a .43a -- thoughts .25a .06 .32a -- read .19a .02 .12b .65a -- health -.16 b .04 -.04 -.04 .00 -- age -.09 .02 -.09 -.21a -.24a -.12b -- house .09 .10 .15b .23a .16b .06 -.26a -- educ .07 .25a .11b .02 -.06 .13b -.04 .08 -- income .15 b .13b .04 -.08 -.11 .18a .11b .12b .21a -- beliefs .03 .16b .08 .08 .04 .12b .12b .15b .12b -.03 notes. stress=level of stress during covid; convos=conversations are about covid; fear=degree of fear during covid; thoughts=avoiding thoughts and feelings about covid; read=avoiding reading and watching information about covid; health=physical health status; age=chronological age; house=number of people in household; educ=highest level of education; income=total household income; beliefs=importance of religious/spiritual beliefs;a p<.001; b p<.05 two t-tests were conducted to determine the relationship between stress and gender (women/men) and if participants knew someone who tested positive. compared to men (m = 6.20), women (m = 7.27) had higher levels of stress during-covid, t(404) = 4.78, p<.001. similarly, knowing someone with a positive test (m = 7.48) compared to not knowing anyone (m = 6.31) was associated with higher stress levels, t(408) = 5.41, p<.001. anovas were used to test for differences by the degree to which participants were working, drinking alcohol, and exercising along with the type of restrictions imposed in one’s state, relationship status, race/ethnicity, the individual who tested positive for covid, wearing a mask, and social distancing. those who were working the same had less stress levels than those who were working less or more, but the latter two groups were not statistically different. thus, those two groups were combined for the ols regression. those who were drinking more indicated greater stress than those who were drinking the same or less; however, the same and less groups were not statistically different and were combined for the regression. those who were exercising less had greater stress levels than those who were exercising the same or more, but the latter two groups were not different. again, they were combined for the regression. while those who were never wearing a mask and not practicing any social distancing were significantly different than those who were doing these things some or all of the time, the sample size for the two never groups was quite small (14 and 25, respectively); thus, meaningful conclusions could not be made with such small numbers. no differences in stress level were found by type of restrictions, the individual who tested positive for covid, relationship status, and race/ethnicity (see table 3). chonody et al./stress during early covid-19 1057 table 3. results of one-way anova for stress variable n m (sd) f(df) p alcohol usea same 211 6.51 (2.37) 10.82 (407) <.001 less 100 6.73 (2.00) more 99 7.75 (2.02) exerciseb same 149 6.52 (2.24) 4.11 (407) .02 less 131 7.29 (2.29) more 130 6.82 (2.20) workingc same 185 6.48 (2.34) 5.35 (405) .01 less 139 7.20 (2.91) more 84 7.21 (2.04) practicing social distancingd yes, all the time 299 6.87 (2.18) 4.49 (406) .01 sometimes 96 7.05 (2.35) no, not at all 14 5.14 (2.57) wearing a maske yes, all the time 303 6.93 (2.18) 5.43 (406) .01 sometimes 81 7.02 (2.37) no, not at all 25 5.44 (2.50) restrictions none 18 6.67 (2.50) 0.35 (405) .84 voluntary quarantine 59 7.08 (2.11) mandated quarantine by medical professional 14 7.21 (2.40) stay at home orders 230 6.86 (2.20) shelter in place 89 6.72 (2.50) person who tested positive self 2 4.50 (2.12) 1.48 (187) .19 parent 4 9.00 (1.41) friend 78 7.42 (2.00) close relative 25 7.52 (2.42) distant relative 28 7.64 (1.70) coworker 26 7.08 (1.92) other 31 7.77 (1.89) race american indian 9 7.33 (1.73) 1.48 (400) .17 asian american 67 6.36 (1.94) african american/black 20 6.15 (2.58) biracial/multiracial 6 7.33 (1.75) chicano/mexican american 5 7.00 (2.55) puerto rican 3 9.33 (1.15) white 288 6.97 (2.32) another race 10 7.10 (2.23) notes: asignificant differences between “more” and “less” and “same.” bsignficant differences between “less” and “same” and “more.” csignificant differences between “same” and “less” and “more.” dsignificant differences between “no, not all” and “yes” and “sometimes.” esignificant differences between “no, not all” and “yes” and “sometimes.” stress during covid: multivariate results the one-step ols regression results for the sample explained 47% of the variance in stress during covid, f(11) = 30.58, p<.001. seven variables were significant in the model: having more conversations about covid, using alcohol more, knowing someone who had tested positive, increased fear, greater avoidance of reading/watching information about covid, decreased health status, and increased income. table 4 has the complete results. fear was the greatest contributing variable advances in social work, fall 2022, 22(3) 1058 in this model (β = .44), which can be an indicator of the relative importance of the variable to the model (field, 2009). multicollinearity was not evident in the analyses as vif was below 10 and tolerance was above .25. durbin watson was 2. table 4. results of regression on stress: full sample (n = 387) variable (reference group) b se β constant 3.40 .79 conversations about covid .33 .09 .17*** alcohol use (drinking more) .29 .10 .11** work (working same amount) .14 .18 .03 exercise (exercising less) .08 .19 .02 know someone who tested positive for covid (yes) -.39 .19 -.09* degree of fear during covid .40 .04 .44*** avoiding thoughts & feelings about covid .01 .08 .92 avoiding reading & watching information about covid .18 .07 .13** physical health status -.40 .09 .17*** gender (men) .28 .18 .06 total household income. .09 .03 .13* r2 .47 *p<.05 **p<.001 ***p<.0001. to determine how these factors helped explain stress by age group, three regressions were completed by age—older, middle, and younger adults. the regression results for older participants explained the most variance (66%), f(11) = 7.42, p<.001. three variables were significant: more use of alcohol, increased fear, and decreased health status. in this model, fear has a higher contribution to stress when compared to alcohol use and subjective ratings of health. the model for middle-aged participants explained 52% of the variance, f(11) = 15.41, p<.001. four variables were significant: more conversations about covid, increased fear, decreased health status, and increased income with fear having a highest contribution to stress. lastly, the model for younger participants explained 37% of the variance, f(11) = 9.91, p<.001. results indicated three variables were significant: more conversations about covid, increased fear, and decreased health status with fear having the highest contribution to stress. table 5 has the full results. table 5. factors contributing to stress during covid variable (reference group) young (n= 149) middle (n= 170) older (n= 68) b se β b se β b se β constant 4.83 1.35 2.34 1.22 1.51 1.86 conversations .34 .15 .18* .33 .14 .16* .32 .21 .15 alcohol use (more) .34 .17 .14 .10 .15 .04 .79 .32 .22* work (same amount) -.01 .31 -.00 .21 .28 .05 .18 .40 .04 exercise (less) -.20 .32 -.04 .29 .30 .06 .30 .45 .06 positive test (yes) -.43 .32 -.10 -.35 .29 -.08 .20 .48 .04 fear .34 .09 .35*** .38 .06 .43*** .60 .10 .67*** avoid thoughts .01 .15 .01 .13 .12 .09 -.13 .19 -.08 avoid reading .19 .12 .15 .08 .10 .06 .31 .17 .20 health -.49 .16 -.21** -.27 .13 -.12* -.53 .23 -.20* gender (men) .36 .34 .08 .29 .28 .06 .26 .41 .05 income .05 .05 .07 .17 .04 .24*** -.01 .07 -.01 r2 .37 .52 .66 notes. young =18-35 years, middle= 36-55, older=56+; conversations = conversations are about covid. positive test = know someone who tested positive for covid. fear = degree of fear during covid. avoid thoughts = avoiding thoughts and feelings about covid. avoid reading = avoiding reading and watching information about covid. health = physical health status; income = total household income. *p<.05 **p<.01 ***p<.001 chonody et al./stress during early covid-19 1059 discussion results of this study add to the growing substantive literature regarding covid, emotional reactions, and coping strategies, with a particular focus of the impact across the age spectrum. fear was the biggest contributor in the regressions on stress in terms of effect size, followed by health status. these results also provide some interesting insight into specific variables that were only significant for certain age groups and not others. for example, income was significant only for middle-aged participants. perhaps the impact is felt most strongly here, given a traditional work trajectory. middle-aged people may be situated in the center of their moneymaking years, whereas older people are more likely retired and younger people may still be in the early stages (or even still in school). similarly, it was noteworthy that only younger people reported more stress when having more conversations about covid. perhaps having these discussions made the pandemic “more real” for them in that the messaging has been, at least in part, that young people need not worry too much about it since they would survive it. moreover, young people may be experiencing the pandemic as their first experience of social instability (vostanis & bell, 2020), which could contribute to greater stress. relatedly, increased alcohol use was significant for older people; however, identifying which behavior is the problem and which is the reaction to a problem is complicated. that is, maybe the drinking was a function of the stress, but in turn, it was creating more stress. further research into the role of alcohol use during the pandemic is warranted, particularly for older adults. stay-at-home orders and social distancing could contribute to more at-home drinking that only provides temporary relief from fear, stress, or uncertainty. assessing for changes in alcohol use and how it impacts stress levels are areas of focus for social workers across practice settings. moreover, these unique age-specific findings may be ways to tailor questions during assessment. future research should seek to investigate how these factors may be related to other behavioral changes. while no conclusions can or should be drawn from the small sample of participants who were “never” practicing social distancing or wearing a mask, it was an intriguing finding that their stress levels were around two points lower (on a scale of 1 – 10 with higher scores indicating higher levels of stress) than those doing these things “always” or “sometimes.” perhaps their lower stress level may be an artifact of the small sample, but future research should interrogate this idea further. perhaps these participants are generally not worried about contracting or spreading the virus or do not subscribe to the general guidelines, and in turn, their stress level is low as they are “operating as usual.” the results also speak to how different social work interventions and coping strategies may need to be modified by age group. while fear was the largest factor in elevated stress for all three age groups, understanding the source of that fear and how individuals address or avoid it is important for social workers. tailoring methods to our clientele, particularly around covid-related stress, can be an important way to support people during the pandemic. future research should also look at what stressors exist in people’s lives and how the pandemic exacerbated those areas. participants in this study had moderately low to moderate levels of stress prior to covid, but this increased by nearly two points across every age group. this change in stress level advances in social work, fall 2022, 22(3) 1060 represents a large and significant effect as stress was measured on a 10-point likert scale with higher values indicating higher levels of stress; thus, stress increased by approximately 20%. given the role of fear, future research should also investigate what behaviors may be related to fear. for example, risk-taking behaviors or even greater avoidance may be reactions to fear. greater insight into the association of these factors will further inform social work practice. social workers have historically been part of efforts to address societal hardship and attend to deficits felt in certain populations (berg-weger & schroepfer, 2020). responding to covid has called upon the skills and knowledge of the profession. clinicians made swift shifts to telehealth and remote working to provide clients with ongoing support and therapy (hirschi et al., 2022; rosten et al., 2022), and social work educators did the same for their students as classes moved to online platforms. social work students were also put in a position to rise to this challenge of learning during a pandemic, including innovation in field placements (e.g., morris et al., 2020). acknowledging and supporting this reflexivity is a teachable moment, given that it relates to what future practitioners will be called upon to do in their practice. more than ever, social work students need to be taught about best practices related to telehealth and how that influences practice in new ways, such as the support needed to be effective (funk, 2021; hirschi et al., 2022) and the necessity of professional flexibility (rosten et al., 2022). relatedly, students will need to be taught about the impact of covid, how to provide education about it, and the ways in which clients will need different kinds of support. part of this education should include emphasizing the specific needs of clients along the age spectrum and how covid has differentially impacted clients of different age groups, as well as student wellness and strategies that support self-care, which is crucial to social work practice (reay, 2021). limitations the findings of this study should be considered against several limitations. first, the use of convenience sampling and the demographics of the study sample, which consisted of individuals who are generally comfortable with the use of technology, generally healthy, predominately white, and highly educated, limit the extent to which the study results can be generalized. future research should continue to sample the general population to explore the effects of covid and should be purposive in recruiting individuals from different backgrounds, health status, including the mental health status of individuals, and varying identities. second, the authors constructed the measurement of the variables of interest and relied on self-report. for example, participants were asked to retroactively rate their stress levels prior to the onset of covid and then assess their current stress levels during covid. such retroactive assessment can contribute to the presence of recall bias in the study which can underestimate or overestimate the true effect or association found (althubaiti, 2016). despite the potential presence of recall bias, the self-reports by the participants are their narratives and lived experiences in relation to how they perceive themselves currently and in the past. additional research is needed to determine evidence of validity and reliability for items developed for this survey beyond face validity. in addition, future studies should consider both subjective and objective outcome measures, such as collecting cortisol levels for measuring stress, and should include additional variables reflecting protective factors such as social support, and measures of mental health. finally, as this study was exploratory in nature, there is a risk of type chonody et al./stress during early covid-19 1061 1 error in running many tests to explore relationships, yet we decided to include variables based on previous research, specifically, past pandemic research. conclusion covid has and continues to affect the world by interrupting education and employment, limiting social contact and opportunities to socialize, and playing the role of a silent and deadly threat that can be contracted unknowingly with unlimited possibilities of impact on one’s health and life. one result of this public health crisis has been an increase in self-reported levels of stress among individuals and across age groups. while individuals in this study all reported increased stress from preto duringcovid, the highest level of stress was reported among those in the young adult group, followed by the middle-aged adults, and then the older adult group. a strengthening of coping strategies as people get older may account for these age-related differences (pearman et al., 2020). a common factor among the three age groups was the contribution of increased fear and decreased health status in explaining levels of stress during-covid. such findings point to the need for clear messaging and leadership in preparing, navigating, and coping with public health crises with particular attention to messages and strategies to calm feelings of fear and ease stress and anxiety in the face of uncertainty. social workers play a key role in managing the impact of the pandemic by providing clients with therapeutic services, psychoeducation, and case management. expanding the knowledge base on how covid impacts the emotions of individuals will allow social workers to ask other assessment questions and tailor interventions to client needs. moreover, community efforts aimed at vulnerable populations are essential (o’leary & tsui, 2020) as this pandemic has further exposed systemic inequalities (abram & dettlaff, 2020; cross & gonzalez benson, 2021). references abrams, l. s., & dettlaff, a. j. 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(2022, february 2). global situation. who coronavirus disease (covid-19) dashboard. https://covid19.who.int/ author note: jill m. chonody, school of social work, boise state university, boise, id 83725. email: jillchonody@boisestate.edu https://doi.org/10.1080/10911359.2020.1835777 https://doi.org/10.1177/0020764020915212 https://doi.org/10.1002/capr.12325 https://doi.org/10.1111/famp.12588 https://doi.org/10.1080/13548506.2020.1746817 https://bmjopen.bmj.com/content/10/7/e039334 https://covid19.who.int/ mailto:jillchonody@boisestate.edu _____ maria joy ferrera, phd, lcsw, associate professor, and sonya crabtree-nelson, phd, lcsw, associate professor, department of social work, depaul university, chicago, il. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 436-453, doi: 10.18060/24965 this work is licensed under a creative commons attribution 4.0 international license. critical empowerment frameworks paramount to social justice work maria joy ferrera sonya crabtree-nelson abstract: as we continue to navigate the complex challenges of a pandemic and the urgent need for racial justice, social work faculty are well positioned to train the next generation of social workers in human rights work and structural change movements. authors discuss how engaging key critical empowerment frameworks that include critical race theory, structural competency, together with a decolonizing and transdisciplinary lens within community-engaged research and practice can provide social work students models for collective impact. leveraging university-community partnerships to directly provide faculty mentorship around human rights work will also be discussed. one author has been working with the institution’s law school and their neighborhood legal assistance project to provide support, legal resources, and advocacy. she has also co-founded and is developing a chicago-based coalition to address intimate partner violence-induced brain injury. the second author has helped start and develop two coalitions to advance a coordinated structural response involving the provision of mental health resource support and psychosocial forensic asylum assessments within immigrant communities. authors also discuss how students have been engaged in health equity work through a racial and healing justice initiative that values and provides training around healing circles within indigenous communities and communities of color. through these rich learning experiences, students internalize the value of critical empowerment frameworks that inform participatory approaches in collaboration and coalition building that are essential to social justice work and the process of social and structural change. keywords: human rights, social justice, transdisciplinary, structural competency critical empowerment frameworks we are in the midst of a health and human rights crisis. as we continue to navigate the complex challenges of a pandemic and the urgent need for racial justice, social work faculty are well positioned to train the next generation of social workers in human rights work and structural change movements. however, it can be argued today that the connection between human rights and social work is not evident to social workers (androff, 2018) and that we continue to be “unfaithful angels” who have abandoned the original social justice mission of social work working with the most oppressed individuals and communities who have experienced severe and mass human rights violations (specht & courtney, 1995). a general survey of the organizations, institutions, and contexts where social workers most work reveal more clinical or direct practice settings, with significant projected growth in child, family and school social work, healthcare, mental health, and substance use in the next decade (u.s. bureau of labor statistics, u.s. department of labor, 2021). competent social workers are desperately needed in these areas. these arenas enable social workers to witness some of the most oppressive structural and social conditions that have led to about:blank ferrera & crabtree-nelson/critical empowerment frameworks 437 community violence, poor education, child abuse and neglect, severely compromised mental health, and inequity in health and healthcare. as direct witnesses, social workers are then well positioned to engage equally in advocacy and social change efforts that are required of social justice work. to this end, we echo the work of scholars who have underlined the importance of conceptual frameworks that endorse an anti-oppressive, liberatory, action-oriented lens inherent in just practice (finn, 2021). we assert that as we collectively change the paradigm of social work education, research, and practice, fully engaging key frameworks need to be a large part of this change. the following paragraphs discuss the saliency of key frameworks that are critical to effective social justice work, including the utilization of a transdisciplinary lens and structural competency in solving complex social problems that stem from human rights violations; a more nuanced understanding of critical race theory and the need to decolonize our social work education and curriculum, research, and practice through community participatory action research and restorative justice approaches. we define and discuss these frameworks as it relates to social work and just practice, and then discuss how we have applied this in our teaching and practice as scholar-activists. engaging a transdisciplinary lens in social work social workers do well in considering and synthesizing various disciplines in research and practice. it is an inherently multidisciplinary and interdisciplinary realm of practice aiming to solve “wicked,” or complex humanitarian problems and social issues. although the concepts interdisciplinary, multidisciplinary, and transdisciplinary are used interchangeably to refer to the involvement of multiple disciplines, they are each distinct here, and can be regarded within a continuum (broersma, 2014). multidisciplinary draws from different disciplines while maintaining the boundaries of these disciplines (choi & pak, 2006). interdisciplinary involves integrating two or more disciplines to the degree that knowledge and conceptual frames are informed by the other discipline(s). transdisciplinary involves researchers and practitioners from different fields who not only work closely together on a common problem but also create a shared conceptual model of the problem that integrates and transcends each of their separate disciplinary perspectives (flinterman et al., 2001; rosenfield, 1992; soskolne, 2000). with this, collaboration is key, and the social worker expands their repertoire of knowledge and expertise and is also open to acquiring new skills beyond what they traditionally do. it is for this reason that dual degrees in law, public health, migration studies, critical ethnic studies, among others contribute to working knowledge in justice work. social workers are well positioned to engage a transdisciplinary approach to research, practice, and activism that embraces different perspectives on problems, and creates comprehensive research questions that lead to comprehensive responses and effective solutions. in this sense we are challenged to transcend the traditional boundaries of our social work knowledge and expand the array of strategies in intervention and addressing wicked humanitarian problems. the social worker moves well beyond generalist practice to specialization in multiple realms. indeed, social workers are not known to “stay in their lane” given the many hats they wear, but this transdisciplinary lens challenges us to delve deeper in disciplines from which we would not normally develop expertise. a transdisciplinary approach in both research and practice advances in social work, summer 2022, 22(2) 438 heightens the ability of social workers to grapple with complex societal problems and respond with a greater repertoire of theoretical frameworks from other disciplines that inform decision making in addressing these problems. a transdisciplinary team that involves social workers who engage cross-disciplinary collaboration can target interventions and coordinate response on multiple levels, including the individual, community, societal and structural levels (gehlert et al., 2017). later in this paper, we will discuss how we have engaged a transdisciplinary perspective in our community-engaged coalition building work with other disciplines, including law, medicine, psychology, and neuroscience. defining human rights to center social justice if social justice is at the core of our work, so is human rights. but how do we collectively define human rights? we start with the united nations universal declaration of human rights (undhr) that are fundamental and universal (united nations general assembly, 1948). it is not enough to be drawn to this field to “do good,” and with the best of intentions of helping others. to be human is to have implicit bias towards others. this reveals itself in how we are trained (e.g., adult psychopathology course, referencing the diagnostic statistical manual to categorize human “abnormal” behavior) to integrate a deficits perspective and diagnose the individuals we work with. although the field of social work has sought to broaden the lens when theorizing and contextualizing peoples’ lived experiences, the medical model is still the underlying core from which we “treat” and intervene in the “case” or the “client” (finn, 2021). in many contexts where social workers diagnose and treat clients, the social worker is placed in the position of power and individuals are not seen as participants or co-collaborators (finn, 2021). individuals, groups, and communities continue to be stigmatized for various reasons with social workers perpetuating harm by being part of systems that cause structural violence and harm. social work indeed recognizes the dignity and worth of every human being. in its mission and values, it is a human rights profession. social work can often be culture-bound in its ideas and practice so that social work in the united states, which still often centers on individual ideas about the self, can look different from social work in other developing nations where a collective personhood is the understood norm (finn, 2021). it can be argued that the social work presence in local and global human rights movements has been lacking in the past several decades (androff, 2018; healy, 2008). with more focus on human need than human rights, lack of visibility in social movements, as well as sustained global leadership in the social work field, social workers are challenged to contribute more to broader social change efforts. ensuring the explicit understanding among our students and practitioners of how we define fundamental and universal human rights enables us to be more pointed in these efforts. a rights-based lens endorses the main principles of human dignity, nondiscrimination, participation, transparency, and accountability (androff, 2015; mcpherson & abell, 2020) and affirms the rights of every individual to education, healthcare, and a standard of living adequate for health and well-being, including housing and medical care, etc. (united nations, 1948). we will discuss how our communityengaged transdisciplinary work has had particular focus on the universal right to adequate ferrera & crabtree-nelson/critical empowerment frameworks 439 medical care (article 25), freedom of movement between state and country borders (article 13), and the right to seek asylum from persecution (article 14; assembly, 1948). structural competency following the need to pursue broader, structural change to promote human rights and social justice are transdisciplinary strategic approaches that require structural competency. social workers are well aware of the structural violence that exists in our country the social structures economic, political, legal, religious, and cultural that prevent individuals, groups, and societies from reaching their full potential (galtung, 1969). perpetuated by oppressive systems of power, historical trauma and erasure, and the unequal distribution of resources, structural violence causes harm on a multitude of levels (e.g., police brutality, historical oppression through slavery or colonization, institutional racism, health disparities causing lower life expectancy in communities of color, etc.). we believe that the immensity of this harm cannot be addressed by cultural competency or cultural humility alone. while both may lead to an awareness of implicit bias in the clinical encounter, structural competency leads to diagnoses of economic and political conditions that produce health inequalities (metzl et al., 2018). metzl and hansen (2014) define cultural competency in structural terms, shifting focus away from an individual deficit lens inherent in the medical model, and pointing to neighborhood, policy, institutional and social conditions that regulate exclusion. more precisely, structural competency is “the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication “non-compliance,” trauma, psychosis) also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health” (metzl & hansen, 2014, p. 5). although the concept of structural competency is relatively new within the health and medicine arena, it is a perspective that is not new to the social work field, honing the idea that to combat structural violence, is to first study and understand its “social machinery of oppression.” (farmer, 2004 p. 307). while it is unnamed as such, this paradigm is at the heart of social justice work and its original mission, more often lost over time in the arena of struggle between individual need and social reform in the social work profession (abramowitz, 1998). structural competency and meaningful collaboration (e.g., coalition building) enabled by transdisciplinary approaches are necessary in building structures that promote individual health and community wellness and should be incorporated more stringently in social work education and training (downey et al., 2019). decolonization as a form of resistance decolonization can be defined as “the active resistance against colonial powers and a shifting of power towards acquisition of our own political, economic, educational, cultural, psychic independence and power” (movement for black lives, n.d., p. 19). decolonization demands an indigenous framework and a centering of indigenous land, indigenous sovereignty, and indigenous ways of thinking and is not a metaphor meant to relieve those advances in social work, summer 2022, 22(2) 440 of accountability and responsibility without giving up land or power or privilege (tuck & yang, 2012). in her book on decolonizing methodologies of research, linda tuhiwai smith (2021) discusses the detrimental effects research has had on indigenous communities and stresses the importance of interrogating what we have historically regarded as knowledge theories about where we come from, civilization, gender, culture, etcetera, stating “some theories are crap..there are decades and decades of rubbish about us” (american indian studies [ais] red tawks, 2021, 42:15). she prompts us to examine “who is documenting our realities?” “how can we recover ‘erased knowledge?’” her work urges us as researchers, educators, and practitioners to critically understand the history of empiricism and positivism that is entrenched in the study of white communities, and research findings that are based on the white experience. in essence, the realities and lived experiences of indigenous communities and people of color have not been documented and included in our collective memory because they have often been omitted in our education. how do young, emerging social workers then come to understand the weight and immense impact of historical trauma experienced by these communities? decolonization calls for deconstructing the systems that have historically and continually oppress black, brown, and indigenous communities. with this is a responsibility for us to engage in the process of “unlearning,” and embrace our role in questioning the status quo, examining how we ourselves are part of or perpetuate oppressive systems, pushing the boundaries of positivist perspectives; adopting the work and research of scholars and practitioners of color, and the importance of mixed methods and qualitative research that centers narratives and the lived experiences of diverse communities, is community-engaged, participatory, and action oriented (absolon, 2019; coates & heatherington, 2016; sinclair, 2004). the role of young researchers serves an important role in this endeavor as well as our own humility and openness to continually “unlearn.” it may involve challenging years of clinical training that in essence, endorses western approaches to therapy and community practice that is insensitive to the indigenous frame and to community realities, and engaging in what is often discomforting-humility, and being open to the need to educate ourselves on community-based forms of healing and indigenous practices that are strengths-based. as smith puts it, the process of decolonizing is emotional, healing, unsettling, and not for the faint hearted (aisw red tawks, 2021). critical race theory to decolonize is also to reject a colorblind lens. race and ethnicity still matter profoundly in the us and many countries around the world. with this, it is imperative for social work to endorse a critical ethnic studies perspective that holds up a more aggressive, race conscious position. critical race theory (crt), coined by kimberle crenshaw (2010) in the process of examining the relationship between race and law, defines race as a social construct, striking the idea of biological racial differences. highlighting the role of institutionalized racial power, she asserts that racism is deeply ingrained in legal systems and policies as well as within individual bias and prejudice (crenshaw, 2010). following this, we cannot underestimate the historical and present-day impact of racism that is institutionalized, internalized, and personally mediated (jones, 2000). crt, also regarded as a perspective or approach, is not static but evolving. the perspective of crt asserts that ferrera & crabtree-nelson/critical empowerment frameworks 441 in addition to the legal system, the fields of health and medicine are similarly sustained by social, political, and economic forms of governance that is racialized (bridges et al., 2017). the crt perspective promotes notions of social justice that involve interrogating systems where racial discrimination is present, and the resulting outcomes that impact (i.e., oppress, discriminate, deny the rights of) individuals and communities of color. crt informs social work in its emphasis on the use of narrative storytelling, naming one’s own reality, and giving weight to intersectionality involving, among others, race, sex, class, national origin, and sexual orientation, and how their combination plays out in various settings (crenshaw, 2010). the crt perspective is vital to structural competency work, as the discourse around crt is grounded in a legal context that examines the sources of racial oppression and the reproduction of racial hierarchy in various systems and structures (bell, 1995; crenshaw, 2010). restorative justice practice aligned with the decolonization perspective is challenging western ideologies, practices, and engaging in alternative forms of healing that intentionally draws from and builds on community strengths. restorative justice (rj) is an alternative paradigm that provides an opportunity for social workers to return to the original social justice mission. honoring the dignity and humanity of every individual, restorative justice practice recognizes all individuals involved in crime, and acknowledges the harms to victim, offender, and community. healing is therefore multi-tiered, involving dialogue grounded in the community where accountability and responsibility are essential and community members collectively identify and address harms, needs, and obligations in order to heal and put things as right as possible (zehr, 2002, p. 37). rj can be practiced in various contexts where community building is needed. grounded in indigenous practices, family group conferencing specifically honors the practice of maori people, and the practice of peace or talking circles has had a long history within native american communities in the us and canada. there is growing evidence of the positive impact of rj in violence prevention efforts and improved social relationships (katic et al., 2020; mills et al., 2019). the challenge with this framework is to move away from responses that are shaming, punitive, and corrective toward more restorative efforts that effectively address individual offender needs. with this, we better understand the factors that led the offender to cause harm. we then see the offender for who they are in their own humanity. understanding the structural violence that has impacted the individual offender is paramount, and thus, so is our own structural competency. restorative justice can also inform how we hold power structures that cause harm accountable and how we work with communities to facilitate healing from historical trauma (davis, 2019; o’mahony & doak, 2017; russo, 2018; waldram, 2014). although trauma informed approaches are valued in the social work field, increased discourse is needed around how therapeutic approaches can more thoughtfully respond to and be sensitive to the varied histories of trauma and oppression experienced by communities. social workers have increasingly engaged restorative justice practice within various contexts (gumz, 2009), but can certainly incorporate this practice even more by increasing discourse within our field and working to infuse rj more effectively within advances in social work, summer 2022, 22(2) 442 social work education (van wormer, 2006). unsettling ourselves we write this from our own lens. we recognize our own positions of privilege and power as well as struggle and vulnerability. we recognize our developing critical consciousness regarding the systemic and structural contexts in which we are embedded, including the academic and social service industrial complex (rodriguez, 2017; smith, 2007); and our responsibility to challenge the systems and structures which perpetuate oppression and violence. there is still much for us to learn. but we begin by holding ourselves accountable. we hold ourselves accountable to each other, our students, and the varied communities to which we belong and with whom we interact by engaging in constant critical self-reflexivity and the discomfort of recognizing our own biases (kondrat, 1999), and the practice of unsettling (finn, 2021). we ourselves are capable of causing harm and being complicit in systemic oppression, and to be engaged in socially just work, must practice taking accountability for our involvement in the perpetuation of oppression and violence (russo, 2018). we look to our colleagues, students, and the communities with whom we collaborate and work to check us. more broadly, our ideas of social justice are largely drawn from western philosophy and political theory as well as judeo-christian religious ideas (finn, 2021). in practice, this means that our ideas about what is just largely dovetails with our own moral values and beliefs. we agree with finn (2021) that it is our responsibility as social workers and educators to critique what we have been taught and to critically engage with varied perspectives that unsettle our certainties regarding what is true, good, and just. finn further posits that the social work profession could, and in fact should, do more to center justice in our profession. as a part of this action, we believe in the difficult and necessary work of going beyond the superficial notions of human diversity and instead address the structural and political processes in place that in fact produce differences and our ideas about difference (finn, 2021). community based and participatory action research approaches as researchers, we hold tremendous responsibility to the communities we collaborate with. as social workers, we often are in roles that identify community strengths and resilience, and participate in community building. just as important is to hold ourselves accountable for the potential harm we cause to communities, as social workers, educators, and researchers. as previously stated, smith’s (2021) work in decolonizing methodologies discusses the history of indigenous communities and communities of color traumatized by research, highlighting the importance of trauma-informed practices in the research endeavor. as social work educators and scholar-activists, we can thrive in an environment that is aligned with our social justice perspective and that nourishes the inherent value in promoting human rights. to a significant extent, we can claim that we are embedded in such an environment. both authors have been community-based research fellows of the ferrera & crabtree-nelson/critical empowerment frameworks 443 irwin w. steans center, a center within our university that is committed to “working toward, and reflecting upon, change in solidarity with those who struggle in our communities for freedom, justice, and equality” (depaul university, 2022, welcome, para.1). as fellows and through the training and support of the steans center, we have learned how to leverage university-community partnerships in order for communities to benefit from university resources and expertise. engaging community partners is heavily valued and seen as critical to social justice work. the question, “who does our research benefit?” drives our scholarship and holds us accountable for establishing and sustaining a right relationship with community members. this fellowship instills a commitment within us to be reflective of our own privilege, position of power as academics, researchers, practitioners and how we can cause harm. community action research or community based participatory research involves community members who are directly impacted in all levels of the research process (israel et al., 2017). it is a research approach that most explicitly holds us accountable to the community every step of the way in our research process. critical questions thus include: “what is the purpose of our research?” “what are the outcomes?” “how can our research process directly exploit and harm the communities that it centers on?” “are we asking the right question(s)?” “am i the right researcher to be engaging in this research?” to engage in these questions sustains our process of unsettling and centers the health and well-being of the community and its members in our work. engaging students in areas of action with community partners the authors’ social work program recently implemented its new concentration in forensic social work, with the understanding that social justice, and global and human rights are at its theoretical and practice core (maschi & killian, 2011). this concentration, dual degree/certificate programming with women’s and gender studies, critical ethnic studies, and peace, justice, and conflict studies, together with the program’s heavy focus on community practice, has allowed faculty to engage students in global human rights frameworks and structural competency work (metzl & petty, 2017). social work students practice the art of social work in their internship settings. however, we are aware that not all internships infuse social justice and macro level advocacy to the same extent. to that end, we believe it is essential for social work programs to engage in various activities that promote social justice and allow students to both witness this as part of the fabric of the program as well engage in these broader activities with the community and transdisciplinary partners. the following paragraphs discuss our work as scholar activists leveraging university-community partnerships and facilitating diverse learning opportunities for social work students. this community-based work directly informs course content, dialogue, and how we make connections between theory and practice as educators in the classroom. with these rich learning experiences within an academic environment, students effectively internalize the value of critical empowerment frameworks including structural competency, decolonizing and crt perspectives, transdisciplinary and participatory approaches in intersectional collaboration and community coalition building. in figure 1, we illustrate these key empowerment frameworks that are paramount to socially just practice. these community partnerships and meaningful engagement with diverse disciplines exposes students and allows them to advances in social work, summer 2022, 22(2) 444 participate in transdisciplinary, multi-institutional, and community-based organizing that is essential to the process of social and structural change. figure 1. critical frameworks paramount to social work justice the neighborhood legal assistance project (nlap) and pathways one author began a program in partnership with the msw student association and the law school. it is the msw resource desk that exists in partnership with the neighborhood legal assistance project. the msw resource desk at grace place soup kitchen provides social service information and referrals pertaining to housing, mental health services, social service benefits and medical treatment to guests of grace place a breakfast soup kitchen in the south loop. based on a model utilized at a legal aid firm in chicago, we have implemented a joint meeting with patrons of the soup kitchen in order to triage the situation and support one another’s services. the guest then does not need to tell the story numerous times. instead, both the legal and social work teams assess the situation, and supply support and referrals that are most appropriate. msw student volunteers serve guests who are homeless whose attempts to find work, housing, or public benefits have been stymied by their lack of information about or access to social services. although this may initially sound like a standard volunteer opportunity, it actually is a robust experience in a transdisciplinary setting that promotes social justice advocacy. msw students work alongside attorneys, law students, volunteers and staff who organize the soup kitchen. as critical empowerment frameworks in social justice work structural competency transdisciplinary critical race theory decolonization just practice (finn, 2021) critical frameworks paramount to social justice work human rights violations (wicked humanitarian problems) social and restorative justice (social and structural change) figure a ferrera & crabtree-nelson/critical empowerment frameworks 445 such, the students have opportunity to learn from others who are engaged in active social justice work at a micro, mezzo, and macro level. the attorneys and law students involved in the project work from a social justice lens similar to that of the social work students. one volunteer attorney works for a lobbying firm that is actively advocating for change that directly impacts the type of situations guests of grace place experience. social work and law students are challenged to connect the issues they see the guests faced with and to find ways to advocate on their behalf on a city, county, state, and federal level. this has led to many action items that include protests, calling and writing alderpersons, state, and federal representatives. students have stated that this experience feels like true social work to them. this truly is an example of individuals from different disciplines working together to create a shared conceptual model of the problem that integrates and transcends each of their separate disciplinary perspectives. this same author is a co-founder of the illinois coalition to address intimate partner violence-induced brain injury. unfortunately, the intersection between ipv and traumatic brain injury (tbi) is not well known to survivors, nor to those who provide services and assistance. services to assist survivors typically do not address the tbi symptoms, nor adapt their services to account for the neurological challenges that accompany a tbi. our society still struggles to understand the dynamics in ipv and often continues to blame the victims for the harm done to them. it is then no surprise that even though survivors of ipv generally experience prevalence of tbi estimated at 11–12 times greater than the published incidence of tbi from occupational, recreational, and accident events (lifshitz et al., 2019) that it is only now beginning to gain attention in the media. in 2018, we formed a group made up of individuals from depaul university and swedish hospital, part of the north shore university health system in chicago, who are dedicated to this issue. we collaborate with groups and individuals in arizona, ohio, massachusetts, and new york around four main areas: education, research, services, and advocacy. in addition, we have partnered with area organizations that work with survivors of ipv. this group personifies the important aspects of the transdisciplinary model. we are able to work with one another to create ideas and solutions that none of us would have been able to do in isolation. in addition, this collaboration is working towards structural competency as a network of diverse professionals and concerned community members to build structures that promote individual health and community wellness for a group that is one of our most vulnerable and often overlooked. this coalition has been a wonderful opportunity for students to participate in planning and action on a deep and meaningful level. one specific example includes students who participated in an elective on ipv in the winter of 2020. the author conducted the class in a community-engaged model where students had the opportunity to hear about the topic of ipv and tbi from area and national experts. the class then worked with the coalition to hold a symposium for professionals in the community who work with survivors of ipv. they participated in the planning, implementation, held small breakout groups, developed preand post-tests, and compiled all information from the tests as well as the breakout groups to disseminate to the coalition members. the symposium was a success with over 130 participants. students stated that this was the first class they had where they felt they put all of their social work skills together and were able to see the results of their efforts. many students have stayed advances in social work, summer 2022, 22(2) 446 involved in the coalition and the activities to educate and disseminate information on ipv and tbi. the coalition for immigrant mental health, midwest human rights consortium, and a healing justice dialogue initiative one author is a co-founding co-chair of the coalition for immigrant mental health (cimh), which was established in 2016 to foster a collaborative, community-based and research-informed initiative that is a partnership between, mental health practitioners, community organizers, researchers, allies, and community members regardless of immigration status. cimh works to promote awareness of, and access to, culturally and linguistically appropriate mental health services through education, advocacy, and resource sharing in order to improve and facilitate access to services for immigrants and their families regardless of their status (cimh, 2021). the forming of the coalition followed the experience of doing community-based participatory research within the immigrant community to document the impact of a health promotion program. it became clear through the narratives of immigrant youth and the staff of community partner organizations that amidst the election of the then presidential administration of donald trump, undocumented youth and many immigrant families were in severe distress. depression, suicidal ideation, and other mental health needs heightened during this time, and there was a mental health crisis that was prevalent among the immigrant community (artiga & ubri, 2017; flores & kirkos, 2016). resources and mental health services were scarce. it was clear that antiimmigrant sentiment, a hostile sociopolitical climate, and policies that have excluded refugees and undocumented immigrants in particular (executive orders, the muslim ban, lack of access to healthcare due to status, etc.) created layers of structural barriers and violations on the basic human rights of immigrants and refugees. members of the coalition have drawn from a critical race theory perspective to understand the role of race and ethnicity within institutions, and local and national policies that discriminate immigrant groups and categorically deny healthcare access based on immigration status. the coalition involved multiple academic institutions throughout the chicagoland area, community members directly impacted by immigration policies, organizers, leaders, advocates, researchers, and mental health practitioners deeply invested in the health and wellbeing of immigrants and refugees. annual convenings over the past five years have brought together hundreds of attendees to learn more about how to engage best practices as mental health practitioners, educators, and community organizers and the intersection of policy and practice. there was a banning together of resources and exchange of information on immigrant-friendly health clinics and hospitals, and culturally sensitive, multilingual mental health practitioners, and educational programs on various relevant topics, such as “know your rights.” since its inception in 2016, this virtual coalition has drawn over 600 individuals to its listserv and has galvanized its members to engage in calls to action and focused advocacy efforts that have included: submitting public comment; participating in rallies and marches; writing and talking directly to local government officials and legislators about the physical and mental health needs of immigrant communities. ferrera & crabtree-nelson/critical empowerment frameworks 447 scholar activist members have engaged in community-based research and have utilized findings to develop social policy reports that call for needed social and structural change. social workers and students have participated in these activities and all the while have been exposed to the various roles social workers and other clinical practitioners can play in developing structures that promote health and wellness. the coalition building has led to the recent merging of two prominent mental health taskforce entities in chicago with cimh, and the establishment of the midwest human rights consortium (mhrc), a network of medical and mental health practitioners responding to the needs of asylum seekers by providing forensic asylum assessments. housed by the illinois chapter, american academy of pediatrics, mhrc is now a coordinated network of institutional and individual collaborators, providing training and ongoing mentorship and case consultation, and facilitating a referral network to connect qualified medical and psychological forensic assessors with asylum seekers and their legal representatives. engaging a transdisciplinary approach, mhrc works toward structural change synchronized by psychologists, attorneys, physicians, social workers, and other mental health practitioners who work on behalf of the health and wellbeing of immigrants and immigrant families. through the work of both cimh and mhrc, social work students have received training around the legal aspects of seeking asylum, navigating the immigration court system, and how to conduct clinical asylum assessments that may be used to advocate for the asylum seeker’s ability to stay in the us and receive the health and mental health services that they need. given that both cimh and mhrc involves mental health practitioners, there have been opportunities to examine and discuss differences in training and incorporate diverse perspectives and approaches to clinical work. for example, social workers and social work students learn from psychologists how to utilize reliable testing instruments to inform the assessment, while psychologists may learn from social workers and other practitioners how to facilitate more restorative justice practice through healing or wellness circles conducted with and more importantly, by undocumented immigrants. experiential learning allows social workers and social work students to witness first-hand how healing can take many forms, and the benefits of healing that takes place within and builds community. integrating a decolonizing lens of practice, indigenous healing practices are honored, valuing the strengths, resources, and resilience within communities that allow its members to heal themselves in a collective way. through the work of cimh, social work students have been able to develop their expertise in various other disciplines, including social media, web development and digital design, geographic information system mapping of mental health resources, and legal advocacy. attorneys involved with mhrc have also shared their expertise on the legal process and documentation, and how practitioners can develop a strong affidavit for the court. through ongoing communication and consultation, a transdisciplinary lens has enabled the team working with the asylum seeker (e.g., attorney, practitioners, interpreter) to effectively engage a trauma informed approach and coordinated effort toward the common goal of securing asylum. through one author’s role as co-director of the center for community health equity (cche), which is a partnership between a major medical center and teaching hospital, and their university, social work students have had the opportunity to be exposed to and learn advances in social work, summer 2022, 22(2) 448 fundamental concepts in public health and health equity. cche utilizes transdisciplinary approaches to not only understanding the social determinants of health, but also to finding solutions to respond to the “death gap” (ansell, 2021) in life expectancy that is over 20 years of difference between the healthiest and wealthiest and the sickest and poorest of american neighborhoods (dwyer et al., 2017, p. 1009). through discovery and evidence in research, we best understand who is most impacted by the pandemic: where they live, and the social determinants of health that are salient. research then becomes a form of activism in design, informing multiple stakeholders, community members, and scholaractivists engaged in designing programs and actions that respond to the problems based on solution focused research. cche is a model of an academic center that has made conscious efforts to be an action-oriented center that is built on the collaborations between community members, researchers and academics, and the healthcare community. one of the many initiatives includes the formation of a healing justice dialogue series as a response to the social unrest heightened by the murders of george floyd, breonna taylor, adam toledo, and countless others who have been the victims of racial injustice and police brutality. this ongoing dialogue series aims to facilitate dialogue within and outside our university that: increases our understanding and consciousness around structural racism and violence; raises our awareness about the historical trauma and oppression black, indigenous and other communities of color experience, and how this has impacted individual and community wellness; helps us to learn from the resilience of diverse and indigenous communities and examine and experience nontraditional ways of healing; creates a community of healing and restorative justice; and heightens awareness and community activism. cche has joined forces with the university’s center for black diaspora, peace, justice and conflict studies program, and women’s center to establish and sustain this initiative. facilitated dialogue by outside guest speakers and local leaders in the field helps us to engage in difficult conversations that need to be had, encourages us to critically self-reflect, steep in our own discomfort, and acknowledge the healing many of our communities need amidst the anguish, rage, violence, illness, trauma, and loss they continue to disproportionately experience. this need was heightened by the impossibility of in-person gatherings amidst the covid-19 pandemic. the series is driven by a restorative justice perspective and follows the healing justice framework conceptualized by cara page, who envisions, “…how we can holistically respond to and intervene on generational trauma and violence and…bring collective practices that can impact and transform the consequences of oppression on our bodies, hearts and minds (and) continue to build political and philosophical convergences of healing…through interactive, daily practices that anyone can do” (transformharm, 2020, para. 1). through this initiative, social workers, social work faculty, and students have had the opportunity to learn about restorative justice practices that originate from indigenous communities, including skill building on circle keeping. peace, justice, and conflict studies has had a hand in exposing students to effective peace and circle keeping from a global perspective, and faculty from the women’s center share knowledge around feminist perspectives on empowerment and the role of accountability to ourselves and each other in building and repairing community (russo, 2018). ferrera & crabtree-nelson/critical empowerment frameworks 449 implications for social work we learn from paolo freire (1970) about praxis "reflection and action directed at the structures to be transformed” (p. 126). through praxis, people who are oppressed can acquire a critical awareness of their own condition, and, with teacher-students and studentsteachers, struggle for liberation. freire points toward our role in critical consciousness raising within ourselves, our students, and our profession highlighting the complexities within human agency and power. we assert that the heart of social justice work must involve the deconstruction and dismantling of structures and systems that have caused and continue to cause harm and violence to communities. developing structural competence and engaging in a transdisciplinary lens keeps us on a path that centers the examination and interrogation of these oppressive structures and systems in order to promote radical change. when we consider the communities that have been most impacted by recent racial violence and unrest as well as the pandemic, we hold a decolonization perspective, restorative justice practice and healing justice as a form of honoring these communities and their histories of trauma, violence, and harm. through community partnerships and community participatory action research approaches, we hold ourselves accountable to community members and are able to allow students to also do the same, simultaneously learning from the power and agency and the myriad of ways it is manifested in diverse communities. witnessing us as educators and practitioners 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(2002). the little book of restorative justice. good books. author note: address correspondence to maria j. ferrera, department of social work, depaul university, chicago, il 60604. email: mferrera@depaul.edu https://doi.org/10.1097/00001648-200007000-00293 https://transformharm.org/healing-justice/ https://clas.osu.edu/sites/clas.osu.edu/files/tuck%20and%20yang%202012%20decolonization%20is%20not%20a%20metaphor.pdf https://clas.osu.edu/sites/clas.osu.edu/files/tuck%20and%20yang%202012%20decolonization%20is%20not%20a%20metaphor.pdf https://www.un.org/en/about-us/universal-declaration-of-human-rights https://www.bls.gov/ooh/community-and-social-service/social-workers.htm https://www.bls.gov/ooh/community-and-social-service/social-workers.htm https://doi.org/10.1300/j067v26n03_04 https://doi.org/10.1177/1363461513487671 mailto:alex.redcay@millersville critical empowerment frameworks paramount to social justice work critical empowerment frameworks unsettling ourselves community based and participatory action research approaches engaging students in areas of action with community partners the neighborhood legal assistance project (nlap) and pathways the coalition for immigrant mental health, midwest human rights consortium, and a healing justice dialogue initiative implications for social work _________ çetin daşlı, ma, psychologist, department of psychiatry, başakşehir çam and sakura city hospital, başakşehir/i̇stanbul/türkiye. zeynep şimşek, phd, faculty of health sciences, trauma and disaster applied mental health program, istanbul bilgi university, beyoğlu/i̇stanbul/türkiye. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 400-417, doi: 10.18060/28346 this work is licensed under a creative commons attribution 4.0 international license. determinants of xenophobic attitudes towards displaced migrants among healthcare workers çetin daşlı zeynep şimşek abstract: displacement increases inequalities by preventing access to basic rights, especially the right to health. this cross-sectional study explains the level of xenophobic attitudes of healthcare professionals towards displaced migrants and related factors. a total of 436 health workers across varied health professions completed a socio-demographic information form, a xenophobia scale, and a cultural intelligence scale. approximately 60% of the participants were female, with an average age of 29.7±7.32 years. the mean score obtained from the xenophobia scale, which has a maximum score of 66, was 52.8±11.03. the results showed that knowing a foreign language, having immigrant friends, receiving training on the healthcare needs of immigrants, and possessing high motivation scores were associated with reduced xenophobic attitudes. in contrast, immigrants having inadequate income or an elevated metacognition score was linked to xenophobic attitudes (p<0.05). in order to prevent inequalities in health and to ensure that displaced populations have access to the right to health, these findings are taken into consideration in the planning of social work interventions. keywords: health workers, displaced migrant, xenophobic attitude, cultural ıntelligence, predictors over the past decade, displacement reached record numbers, while complex geopolitical, economic, and environmental factors contributed to escalating current challenges (popescu & libal, 2018; mcauliffe & triandafyllidou, 2021). in 2020, an estimated 3.6% of the world’s population—roughly 281 million individuals—lived as international migrants. of this global movement, about 89.4 million were forcibly displaced due to armed conflicts, violations of human rights, or both natural and human-induced disasters (who, 2022). highlighting the growing urgency of this issue, the international organization for migration (iom, 2023) announced during the african climate summit that the era of climate-driven migration has officially begun. by 2022, sub-saharan africa witnessed a notable rise in internal displacement, with approximately 16.5 million people uprooted—a 17% increase from the prior year. alarmingly, the frequency of disasters in the region nearly tripled, contributing to a record-breaking 7.4 million people displaced within sub-saharan africa alone (internal displacement monitoring centre [idmc], 2023). research shows that displaced communities are at greater risk due to their forced or involuntary displacement and vulnerability (oxford monitor of forced migration, 2020; shen et al., 2021). it is well known that migrants who are forced to leave their countries experience poor living conditions, poverty, lack of access to healthy water and food, stigmatization, discrimination, low levels of education, language barriers, inadequate social support systems and difficulties in accessing basic human rights, especially the right to health (bogic et al., 2015; chang, 2019; ellis et al., 2022; esses, 2021; hacker et al., 2015; oberg, 2019; quinn, 2014; şimşek et al., 2018; who, 2021; about:blank daşlı & şimsek/xenophobic healthcare worker’s & displaced migrants 401 williams & hampton, 2005). in addition to the factors mentioned, it has been shown that racism, xenophobia, and discrimination are some of the main determinants of health and health inequalities, and it is therefore important to address these factors to improve health outcomes (ostapczuk et al., 2009; abubakar et al., 2022; devakumar et al., 2022). the incidence of depression, anxiety, post-traumatic stress disorder, suicidal and self-harming behavior, schizophrenia, and other psychotic disorders due to traumatic events experienced before, during, and after migration is high among refugee and migrant groups (bogic et al., 2015; dehnel et al., 2022; kurt et al., 2023; peconga & thøgersen, 2019; richa et al., 2020; rousseau & frounfelker, 2019; şimşek et al., 2018; sirin & rogerssirin, 2015; who, 2022; williams & hampton, 2005). xenophobia, which is the subject of this study, is defined as emotional, attitudinal, and behavioral prejudices against immigrants, refugees, asylum seekers, and people perceived as foreigners (yakushko, 2009). medical xenophobia is defined as the negative attitudes and behaviors exhibited by healthcare professionals and toward groups such as migrants and refugees (crush & tawodzera, 2011). studies have shown that xenophobic attitudes towards displaced migrants affect their access to health services, especially sexual and reproductive health services (delgado-gallegos et al., 2020; sheppard et al., 2014; zihindula et al., 2017). cultural intelligence is the ability to adapt to the values, beliefs, attitudes, and body language of people from different cultures and to use this knowledge effectively to interact with empathy and understanding in various contexts (ang et al., 2015). earley and ang (2003) discussed cultural intelligence in four dimensions. these are metacognitive, cognitive, behavioral, and motivational intelligence dimensions. the three sub-dimensions of metacognitive cultural intelligence, which refers to the cognitive control of the processes used to obtain and understand information, are awareness, planning and control. awareness is being in tune with what is happening in ourselves and others, planning is taking the time to prepare for an intercultural encounter, and controlling is monitoring our interactions to see if our plans and expectations are appropriate (livermore, 2009). cognitive cultural intelligence reflects the knowledge of practices and customs in different cultures gained from education and personal experiences. those with high cognitive and cultural intelligence have knowledge of the similarities and differences between cultures. motivational cultural intelligence triggers effort and energy to function in new cultural environments. behavioral cultural intelligence constitutes the entirety of one's behaviors in intercultural communication (ang &van dyne, 2008). it has been found that the lack of adequate knowledge and training of health personnel about cultural differences causes inequality while providing health services (dias et al., 2012). it has been reported that white, skilled, heteronormative dominant identities have higher access to health services than other cultures (braveman, 2006). social workers play a crucial role in supporting displaced populations and addressing xenophobic attitudes. knowing the factors that explain xenophobia is important in order to determine community-based social work interventions. therefore, this study aims to examine the relationship between health professionals' xenophobic attitudes towards displaced migrants and cultural intelligence, as well as other selected factors. advances in social work, spring 2025, 25(1) 402 methods the sample size for this cross-sectional study consisted of 436 health workers across all of türkiye. participants were recruited using a non-probability sampling method, specifically purposive sampling, by reaching out to all relevant professional organizations. a total of 48 health professional chambers and associations across 21 provinces in turkey were identified and individually contacted to request support for the study. additionally, healthcare professionals actively engaged in practice were directly reached out to for participation. these organizations facilitated the sharing of a link to an online survey, allowing data collection to take place from august to september 2023. data collection tools in this study, the sociodemographic information form, xenophobia scale, and cultural intelligence scale were used. the sociodemographic information form included 15 questions, including age, gender, occupation, educational status, marital status, knowledge of a second language, and thoughts about displaced migrant patients. xenophobia scale the xenophobia scale developed by van der veer and colleagues (2011) and its psychometric properties were conducted in turkey (özmete et al., 2018). there are 11 items on the scale with a 6-point likert type response scale (1=strongly disagree, 6=strongly agree). the lowest score that can be obtained from the scale is 11, and the highest score is 66. higher total scores obtained from the xenophobia scale indicate a negative attitude. in the psychometric evaluation of the scale in turkey, cronbach's alpha value was found to be 0.876 (özmete et al., 2018). in this study, the cronbach's alpha value of the xenophobia scale was calculated as 0.907. cultural intelligence scale the cultural intelligence scale was developed by ang et al. (2007). it comprises a total of 20 items, which are graded on a 7-point likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), assessing how effectively individuals are able to function in culturally diverse settings. the scale has four sub-dimensions, namely metacognition, cognition, motivation and behaviour. the cronbach's alpha reliability coefficient of the scale, which underwent a validity and reliability study in türkiye as turkish form, was found to be 0.85 for the entire scale. furthermore, the reliability study conducted by the test-retest method (i̇lhan & çetin, 2014) revealed no significant difference between the two measurements. in this study, the cronbach's alpha reliability coefficient of the cultural intelligence scale was calculated as 0.91. procedures ethics committee approval was obtained from istanbul bilgi university ethics board on may 22, 2023 (project no: 2023-20507-090). the research data were collected between 6 august 2023 and 10 september 2023. the research was conducted daşlı & şimsek/xenophobic healthcare worker’s & displaced migrants 403 online and the study questionnaire was sent to active healthcare professionals via various social media platforms, e-mail or messaging applications via google forms. the questionnaires were disseminated via whatsapp groups of healthcare professionals. the informed consent form emphasized that the participant’s data would be protected in confidentiality and that participation was voluntary. statistical analysis the research data were analyzed using statistical analysis techniques. the skewness and kurtosis indexes of the xenophobia scale, cultural intelligence scale, and its sub-dimensions fell within the acceptable range of -1.5 to +1.5, indicating a normal distribution. bivariate associations were estimated using chi-square tests (for categorical variables), and t-tests or analyses of variance were used for continuous variables. risk factors significantly associated with any of the outcomes of interest and covariates significantly associated with both risk factors and outcomes at p < 0.05 were retained for the multiple regression model to examine the relationships between dependent and independent variables by controlling the confounding factors. model fit was assessed using the durbin–watson test. results background characteristics of the respondents as shown in table 1, 60.1% of the 436 participants were female, with a mean age of 29.7±7.32 years. a total of 39% of the health workers were currently married, 48.6% had obtained a master's degree, 22.2% had obtained a bachelor's degree, 18.8% had obtained an associate's degree, 6% had received a doctorate degree, and 4.4% had obtained a high school degree. of the participants, 33% were nurses or midwives, 18.8% were physicians, 18.3% were mental health professionals (psychiatrist, psychiatric assistant, psychiatric nurse, social worker, psychologist), 12.2% were medical secretaries, 11.2% were other health professionals (pharmacist, dietician, audiometrist, laboratory, etc.), and 6.2% were health technicians. the health professionals involved in the study have professional experience ranging from one to 39 years, with a median of four years. the majority of respondents (70.6%) indicated that they had freely chosen their profession. furthermore, 67.7% reported working throughout the day without breaks, and 35.2% mentioned that their salaries covered their expenses adequately. more than half of the participants (50.7%) noted that they were monolingual, knowing only their native language. in the study, about 60% of healthcare workers believe that diseases could be transmitted from migrant patients. additionally, 53% of respondents indicated that the current interpreter support for migrant patients was inadequate. notably, nearly 73% of respondents admitted to lacking migrant friends. furthermore, a significant majority (93.1%) reported receiving no training on the healthcare needs of migrants. despite this, 45.4% of respondents did not perceive the influx of migrants as problematic, expressing confidence in the country's ability to provide adequate assistance. advances in social work, spring 2025, 25(1) 404 table 1. socio-demographic charecteristics of healthcare workers (n=436) charecteristics n (%) gender female 262 (60.1%) male 171 (39.2%) does not want to specify 3 (0.7%) age group 18-29 years old 285 (65.4%) 30-39 years old 103 (23.6%) 40-49 years old 37 (8.5%) 50 and above 11 (2.5%) marital status never married 206 (47.3%) currently married 170 (39%) in a relationship 48 (11%) divorced/widow 12 (2.7%) education status high school 19 (4.4%) associate degree 82 (18.8%) bachelor’s degree 97 (22.2%) master’s degree 212 (48.6%) doctorate degree 26 (6%) profession nurse or midwife 144 (33%) physician 82 (18.8%) mental health* 80 (18.3%) medical secretary 53 (12.2%) other* 49 (11.2%) health technician 27 (6.2%) freely chose profession yes 308 (70.6%) no 128 (29.4%) *psychiatrist, psychiatric assistant, psychiatric nurse, social worker, psychologist **pharmacist, dietician, audiometrist, lab, etc. charecteristics n (%) got breaks during the work day yes 141 (32.3%) no 295 (67.7%) salary covered expenses yes 153 (35.2%) no 283 (64.8%) knowing another language yes 215 (49.3%) no 221 (50.7%) thoughts of disease transmission yes 261 (59.9%) no 175 (40.1%) translator competence insufficient 231 (53%) partially sufficient 181 (41.5%) definitely enough 24 (5.5%) being a friend of migrant yes 119 (27.3%) no 317 (72.7%) having training of migrants’ health needs yes 30 (6.9%) no 406 (93.1%) thoughts about migrants i don't see it as a problem, but i believe our country has already provided sufficient assistance. 198 (45.4%) i want them all to go 135 (31%) i think we should help because they are in a difficult situation. 103 (23.6%) as shown in table 2, the mean score of the cultural intelligence scale was 96.2±19.2. after controlling for the number of items, the mean scores for the sub-dimensions of the cultural intelligence scale were as follows: metacognition, behavior, motivation, and cognition, respectively (p < 0.05). table 2. scores from the cultural intelligence scale and subscales scales total score±sd range # items per scale average score/ item±sd cultural intelligence 96.2±19.2 20-140 20 metacognition 22.5±5.3 4-28 4 5.6±1.06 cognition 24.9±7.92 6-42 6 4.2±1.32 motivation 23.7±6.56 5-35 5 4.7±1.31 behaviour 25.1±6.15 5-35 5 5.0±1.23 daşlı & şimsek/xenophobic healthcare worker’s & displaced migrants 405 bivariate analysis the scores obtained by the participants on the xenophobia scale ranged from 13 to 66, with a mean score of 52.8 ± 11.03. in bivariate analyses, it was observed that higher scores on the xenophobic attitude scale were associated with female gender, age between 18 and 29 years, employment as a midwife or nurse, lack of voluntary choice of profession, working in shifts, having insufficient income to cover expenses, being monolingual, lacking immigrant friends, not receiving training on immigrant healthcare needs, fearing disease transmission from immigrants, and perceiving interpreter support for immigrant patients as inadequate (p<0.05). the scores obtained from the xenophobic attitude scale were not found to be significantly associated with either marital status or years of experience in the profession (p>0.05). as illustrated in table 3, there is a notable positive correlation between metacognition score and xenophobic attitude score. this indicates that as the metacognition score increases, the xenophobic attitude score also rises (p < 0.05). conversely, there is a significant inverse relationship between motivation scores and xenophobia scores. this indicates that as motivation scores increase, xenophobic attitude scores decrease (p<0.05). nevertheless, no significant relationship was found between the cognition and behaviour subtests and the xenophobic attitude (p>0.05). table 3. relationships between the xenophobia scale and the cultural intelligence scale cultural intelligence scale xenophobia attitude scale r p metacognition 0.224** <0.001 cognition 0.991 0.001 motivation -0.159** 0.001 behaviour 0.008 0.860 multiple regression analysis presented are the results of multiple regression analyses conducted to ascertain the impact of independent variables associated with xenophobic attitudes in bivariate analyses and to control for confounding factors are presented in table 4. as can be seen in table 4, the following variables were found to decrease the xenophobia score independently: knowing a language other than the native language, having immigrant friends, receiving training on the health service needs of migrants, and motivation, which is a subtest of the cultural intelligence scale. conversely, the following variables were found to increase the xenophobia score independently: thoughts that immigrants will transmit diseases, the income not meeting the expenses, and metacognition. the gender of the respondents, their age (18-29), their educational status, their voluntary choice of profession, their working style, their occupational group, the adequacy of the interpreter when providing services to immigrant patients, and their thoughts about migrants, which were found to have a significant relationship in single analyses, were not effective alone and were found to be confounding variables (p>0.05). the variables in the table account for approximately 33.4% of the change in the xenophobia score (r²= 0.334). advances in social work, spring 2025, 25(1) 406 table 4. multiple regression results regarding socio-demographic variables explaining xenophobia and cultural intelligence scale sub-dimensions b. std. beta t p constant 30,368 6,601 4,601 <0.001 gender (female) 1,254 0.943 0.057 1,330 0.184 age (18-29) -0.113 0.063 -0.075 -1,794 0.074 education status -0.006 0.467 -0.001 -0.012 0.990 income not covering expenses -1.483 0.597 -0.104 -2,483 0.013 choosing profession willingly -0.333 0.656 -0.021 -0.507 0.612 working without shifts -0.623 0.493 -0.053 -1.265 0.207 professional group 0.406 0.318 0.053 1,278 0.202 not know another language 2,430 0.954 0.110 2,547 0.011 thinking that disease will be transmitted -5.751 0.942 -0.256 -6,104 <0.001 adequacy of interpreter support 0.203 0.758 0.011 0.268 0.789 not having a migrant friend 5,291 1,062 0.214 4,982 <0.001 those without training on migrant health 6,488 1,775 0.149 3,654 <0.001 thoughts about migrants 0.028 0.664 0.002 0.042 0.966 metacognition 2,482 0.451 0.239 5,501 <0.001 motivation -1.022 0.380 -0.122 -2,686 0.008 r=0.578; r² =0.334; durbin and watson=2.09 discussion the aim of this study was to identify factors explaining xenophobic attitudes toward displaced populations and to develop recommendations for social work interventions. the xenophobic attitude scale, with a maximum score of 66, was determined to have a score of 52.8 ± 11.03. a review of the literature reveals that the mean scores of healthcare professionals in turkey on the xenophobia scale typically range from 50.03 to 56.20 (aker & kartal, 2023; basaran & saylıgil, 2022; gündüz, 2019). the analysis of theories that explain xenophobic attitudes suggests that individuals may develop prejudice by perceiving their communities as superior to others. furthermore, communities with low social trust may exhibit heightened xenophobic tendencies, and economic competition for scarce resources may fuel xenophobia. these findings are supported by the findings of tajfel (1981), ekici and yucel (2015), and bobo and hutchings (1996). in the study, it was found that metacognition and motivation, which are subdimensions of the cultural intelligence scale, independently explained the xenophobic attitudes of healthcare professionals towards displaced migrants. metacognitive cultural intelligence is defined as the state of being aware of other cultures that are not one's own in intercultural environments (ang & van dyne, 2008). this suggests that the level of metacognitive cultural intelligence is effective in questioning the facts of one's own culture in intercultural interactions. from this perspective, metacognitive cultural intelligence is considered an important stage that will help individuals develop their intuitions and individual norms in the direction of the new culture while interacting socially (flavell, 1979; nelson, 1996). metacognitive cultural intelligence, or the capacity to be aware of and evaluate one's own cultural perspectives, can prompt individuals to adhere more strongly to the norms and values of their own group. this may result in increased discrimination against other groups and heightened xenophobia (brown, 2000; valles martínez, 2022). discrimination theory states that individuals tend to favourably distinguish their own groups and in this process may show prejudice daşlı & şimsek/xenophobic healthcare worker’s & displaced migrants 407 and discrimination against other groups. increasing metacognitive cultural intelligence may increase the tendency of individuals to see their own culture as superior, which may lead to the strengthening of negative attitudes toward other cultures (abrams & hogg, 1988; rubin & hewstone, 1998). in a study conducted by uludağ and mumcu (2023) involving 225 nurses, it was observed that as the metacognitive cultural intelligence score increased, the qualified care behaviors of nurses decreased. another study conducted with nurses determined that there was no relationship between metacognitive intelligence and respect for different cultures (durna & altay, 2023). it is thought that it would be useful to examine this relationship with qualitative research. in this study, it was found that xenophobic attitudes decreased as motivation scores increased. research shows that individuals with higher motivational cultural intelligence are more likely to have positive attitudes towards people from other cultures and to engage in intercultural interaction (ang et al., 2007). motivational cultural intelligence refers to the fact that individuals in intercultural environments direct all their energy towards understanding and learning this culture (ang & van dyne, 2008). individuals with this level of intelligence enjoy being in different cultural environments and are eager to experience new cultures (ang et al., 2007). in contrast, individuals with higher levels of xenophobia are more likely to have negative attitudes towards people from other cultures and avoid intercultural interactions (stephan & stephan, 2000). another study by chen et al. (2012) revealed that motivational cultural intelligence positively affects interactions between people from different cultural backgrounds. this study indicated that individuals with high motivational cultural intelligence have the ability to communicate and co-operate more effectively across different cultures. research shows that cultural competence and cultural intelligence are important to improve the quality of health care (majda et al., 2021). therefore, developing motivation-based cultural intelligence can be an effective way to reduce xenophobia and enhance intercultural understanding. no relationship was found between the scores obtained from the cognition and behaviour sub-dimensions of the cultural intelligence scale and xenophobic attitudes. although there are studies showing the positive effect of cultural intelligence level on the implementation of innovative approaches in the work of health workers, interpersonal relationships and mental well-being of the employee (jain, 2022), studies examining the relationship between xenophobic attitudes of health workers towards displaced migrants and cultural intelligence level was limited. xenophobic attitude and sociodemographic variables in order to control for confounders, multiple regression analysis was used in this study to determine the independent effect of all independent variables that were found to be significantly related in bivariate analyses. apart from the cultural intelligence discussed above, socio-demographic determinants explaining xenophobic attitudes were found. firstly, the xenophobic attitude of healthcare professionals who did not receive training on the healthcare needs of migrants was significantly higher. it was concluded that intercultural education received by nursing students in spain and portugal was effective in reducing negative attitudes towards the immigrant population and providing care (ugarte gurrutxaga et al., 2020). this finding shows the importance of training healthcare workers regarding the health needs of displaced people within the scope of social work interventions. advances in social work, spring 2025, 25(1) 408 in the current study, the xenophobic attitude score of healthcare professionals who thought that migrants would infect them was found to be significantly higher. this finding is similar to the results of other studies (ahuja et al., 2020; bil et al., 2019; prati & pietrantoni, 2016; rzymski & nowicki, 2020; troisi, 2020). it shows that as the perception of disease threat increases, ethnocentric attitudes increase, and disease avoidance sensitivity may affect xenophobic attitudes (navarrete & fessler, 2006). stigmatization and discrimination in healthcare settings continue to be a public health problem. as an example, according to the results of a quantitative study investigating hiv-related stigma and discrimination among 44 african migrant women in belgium, 25% of the women reported that they were subjected to stigma and discrimination in health institutions, and 15% reported that they witnessed behaviors they perceived as stigmatizing and discriminatory (arrey et al., 2017). this finding suggests that it is important for social workers to develop mechanisms to disseminate evidence-based knowledge about the ways diseases are transmitted and protected. another explanatory factor found in the study was that healthcare workers with migrant friends had lower levels of xenophobia than those without migrant friends. when the literature is examined, social psychologist allport's (1954) social contact hypothesis suggests that interpersonal contact between members of different racial or cultural groups can reduce prejudice and increase positive attitudes towards each other and thus reduce conflict between these groups. indeed, friendships with members of minority groups are associated with lower levels of discriminatory attitudes (mclaren, 2003). a longitudinal study conducted with school students in germany, belgium, and england showed that social contact between host majority members and migrant minority members increased the positive attitudes of majority members towards migrants (binder et al., 2009). pagotto et al. (2010), in a study conducted in a hospital in italy, showed that social interaction in the workplace between 167 health workers and foreign patients increased empathy and was effective in reducing general prejudices against migrants. in this study, it was determined that knowing a language other than the native language independently decreased the xenophobic attitude score. it was found that students who received bilingual education in 3 different schools in spain were more open to differences and new opportunities, had higher awareness, and opposed discrimination (doherty et al., 2022). it shows that multilingual individuals are more open to ethnic outgroups and that this is associated with cognitive flexibility and a change in worldview (mepham & martinovic, 2017). another factor explaining the xenophobic attitude is the economic status of healthcare workers. it was found that those whose salaries covered their expenses/salaries above their expenses scored lower than those whose salaries did not cover their expenses/who did additional work. looking at the literature, it has been shown that those with low economic status and unemployed exhibit more xenophobic attitudes towards refugees (al haj & mielke, 2010; hjerm et al., 2011; mayadas & elliott, 1992). in greece, it was revealed that the economic crisis fuelled hostile attitudes and racist behaviors toward migrants (carastathis, 2015). during the covid19 pandemic, it was revealed that the association of the virus with china and the emphasis on its economic consequences led to an increase in negative views and xenophobia towards asian americans in the united states (dhanani & franz, 2021). daşlı & şimsek/xenophobic healthcare worker’s & displaced migrants 409 the variables of gender (female), age (18-29), educational status, voluntary choice of profession, type of work, occupational group, adequacy of interpreter when providing services to migrant patients, and thoughts about migrants, which were found to be significant in bivariate analyses, did not predict xenophobic attitude and were found to be confounders. although there are studies in the literature showing the relationship between the variables mentioned with xenophobic attitudes, no comparison was made because their independent effects were not determined by multiple analyses (beller, 2020; deumert, 2010; güngör et al., 2021; zeisset, 2016). the findings of this study should be considered within the framework of its limitations. this cross-sectional study aimed to examine the relationship between xenophobic attitudes of health professionals towards displaced migrants and cultural intelligence. cross-sectional studies do not explain causality, but aim to reveal the relationship. despite its limitations, the findings of this study provide substantial insights into the design of efficacious social work interventions to mitigate xenophobic attitudes among healthcare professionals towards displaced migrants. implications for social work practice several implications for social work practice emerged from the study including those related to heathcare, network building, supportive services, and awareness of social work’s role in reducing stigma. see figure 1. figure 1. implications for social work practice integrating migrant health needs i̇nto professional training the study demonstrates that healthcare workers who receive training on the specific healthcare needs of migrants exhibit lower levels of xenophobia. social work practice should prioritize the integration of migrant health needs and cultural competence into both undergraduate and ongoing professional training programs for healthcare workers. this approach ensures that healthcare professionals are better prepared to address the unique challenges faced by migrant populations. heathcare •integrating migrant health needs into professional training •promoting accurate knowledge on disease transmission supportive services •supporting language learning and multilingual communication •addressing economic concerns through support services network building •facilitating social contact and interaction initiatives •encouraging friendships and social networks with migrant populations social work's role •building awareness of social work’s role in reducing healthcare stigma advances in social work, spring 2025, 25(1) 410 promoting accurate knowledge on disease transmission the dissemination of accurate information regarding the transmission of disease is of paramount importance in the mitigation of xenophobic attitudes and fears pertaining to health. it is incumbent upon social workers to implement educational initiatives that provide healthcare professionals with clear, evidence-based information regarding the transmission and management of diseases. the objective of this strategy is to mitigate the unjustified apprehensions regarding contagion, which can potentially give rise to discriminatory conduct towards migrants. supporting language learning and multilingual communication a correlation was identified between the ability to speak an additional language and a lower propensity for xenophobic attitudes. this suggests that language learning may facilitate greater openness to other cultures. it is recommended that social workers advocate for and provide support to healthcare workers in the acquisition of additional languages or fundamental communication skills that facilitate interaction with diverse populations. such programs can facilitate more positive engagement between healthcare workers and migrant patients, which may in turn lead to improved health outcomes. addressing economic concerns through support services the findings indicated a correlation between financial stress and higher levels of xenophobic attitudes, suggesting that economic insecurity can intensify discriminatory tendencies. social work interventions should consider incorporating economic support services, such as career counseling or financial literacy workshops, into their scope of services for healthcare professionals, particularly those experiencing financial strain. these efforts can indirectly contribute to a reduction in xenophobia by alleviating one of its contributing factors. facilitating social contact and interaction initiatives in alignment with the social contact hypothesis, which postulates that interpersonal contact between disparate cultural groups can attenuate prejudice, social workers can orchestrate programs to augment constructive interactions between healthcare professionals and migrant communities. potential avenues for such initiatives include joint cultural events, community health seminars, or mentorship programs that facilitate empathy through direct engagement with migrants, thereby reducing bias and fostering understanding. encouraging friendships and social networks with migrant populations the study indicates that healthcare professionals with migrant friends demonstrate lower levels of xenophobia. social workers can facilitate opportunities for healthcare providers to form social connections with migrant communities, such as through community engagement programs, volunteer initiatives, or professional exchange networks. encouraging such friendships may serve as an effective instrument in reducing prejudice. daşlı & şimsek/xenophobic healthcare worker’s & displaced migrants 411 building awareness of social work’s role in reducing healthcare stigma social workers have the potential to serve as pivotal advocates for antistigmatization practices within healthcare settings. they should endeavor to develop protocols and policies that actively discourage discrimination and promote respectful, equitable care for all patients, regardless of background. such practices can facilitate the delivery of healthcare services with cultural competence and empathy, which are essential elements in a socially inclusive healthcare system. conclusion in conclusion, these implications 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(2017). lived experiences of democratic republic of congo refugees facing medical xenophobia in durban, south africa. journal of asian and african studies, 52(4), 458-470. author note: address correspondence to zeynep simsek, faculty of health sciences, istanbul bilgi university, türkiye, 34440. email: zeynep.simsek@bilgi.edu.tr https://www.who.int/news-room/fact-sheets/detail/mental-health-and-forced-displacement https://www.migrationdataportal.org/sites/g/files/tmzbdl251/files/2023-09/world-report-on-the-health-of-refugees-and-migrants.pdf https://doi.org/10.1177/0011000008316034 https://doi.org/10.1177/0011000008316034 https://digitalcommons.iwu.edu/respublica/vol21/iss1/6 https://digitalcommons.iwu.edu/respublica/vol21/iss1/6 https://doi.org/10.1177/00219096155959 https://doi.org/10.1177/0021909615595990 https://doi.org/10.1177/0021909615595990 https://doi.org/10.1177/0021909615595990 mailto:zeynep.simsek@bilgi.edu.tr abstract: displacement increases inequalities by preventing access to basic rights, especially the right to health. this cross-sectional study explains the level of xenophobic attitudes of healthcare professionals towards displaced migrants and relate... keywords: health workers, displaced migrant, xenophobic attitude, cultural ıntelligence, predictors the research data were analyzed using statistical analysis techniques. the skewness and kurtosis indexes of the xenophobia scale, cultural intelligence scale, and its sub-dimensions fell within the acceptable range of -1.5 to +1.5, indicating a normal... results _________ patrick meehan, msw, phd, school of social work, university of michigan, ann arbor, mi. jason ostrander, msw, phd, school of social work, sacred heart university, fairfield, ct. shannon r. lane, msw, phd, wurzweiler school of social work, yeshiva university, new york, ny. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1-13, doi: 10.18060/25650 this work is licensed under a creative commons attribution 4.0 international license. who is a social worker? lessons on sampling from political participation research patrick meehan jason ostrander shannon r. lane abstract: defining social workers for the purposes of research is not as straightforward as it sounds. to date, researchers who have examined social workers as a group have used a variety of sampling methods. multiple methods speak to the variety of options for defining social workers. understanding membership within the profession is a precondition to understanding research about the behavior of those within the profession. this research note explores these sampling methods in detail. each has its advantages, but none are without their own disadvantages, some of which bias their view of the profession. as researchers who have considered the political behavior of social workers, we consider six methods for sampling social workers that have been used to understand their behavior in this specific domain. importantly, the sampling methods examined here can be applied to research about social workers outside of politics. these include sampling (1) members of professional organizations, (2) licensed social workers, (3) social work students, (4) graduates of social work programs, (5) social work faculty, and (6) members of social work-related occupations. after reviewing the advantages and disadvantages of each, we provide scholars a table for reference. the authors recommend that the council on social work education, national association of social workers, and several other professional associations pull together members to explore a unified definition of social work through integrated practice and refrain from focusing on what makes us different. keywords: political social work, macro social work, research methods, professional identity, sampling what makes someone a social worker? is it their education? job title? level of licensure? their own identification as a social worker? something else? while this may seem to be a philosophical question, those who study characteristics of social workers must answer that question as they develop their research. while we do not suggest we can answer the question in one definitive way, we recognize that researchers who want to identify behaviors, attitudes, and characteristics of social workers or the effects of interventions must determine the key characteristics that determine membership in the group as part of their research methodology. significance we are concerned with the question of how researchers define social workers to create their sampling for two reasons. first, diverse definitions of “social worker” can present challenges in comparing results across studies. second, without thoughtful considerations about:blank advances in social work, fall 2021, 21(4) 2 of the reasons for defining membership in the group in a specific way, the sampling approach may introduce additional bias into the research process. in this inquiry, we used studies of the political behavior and participation of social workers as a case study for understanding methods of identifying social workers for a study sample. in this research note, we describe the most common strategies used to sample social workers regarding political behavior. importantly, these strategies are applicable to research on social workers on topics outside of political participation. we explain some of the advantages and disadvantages of using each strategy, and where potential bias threatens the validity of the resulting research. at the conclusion, we provide a summary table that outlines these advantages and disadvantages. sampling in political social work research we have identified six ways of identifying social workers for sampling used in political social work research. individuals are identified as social workers based on membership in social work organizations, typically the national association of social workers (nasw); licensure; social work student status; holding a social work degree; social work faculty status; and employment in social work-related occupations. there is limited large-scale data available to researchers on the demographics of social workers. the association of social work boards (aswb) does not publish demographic information about test-takers, which would allow researchers to better understand social workers more broadly and compare research samples to the general population. the council on social work education (cswe) reports annual statistics on social work education; however, they omit demographic information on students. nasw does not publish demographics of their members. both nasw and cswe have supported workforce studies, including the most recent, a study of 2018 graduates (cswe, 2020). professional organization membership many professional organizations exist to work towards advancing the field of social work or a subfield, to develop guidelines for best practices, and to help social workers engage in activities such as collective action and legislative advocacy (davis et al., 2021). research that examines members of professional organizations has sampled members of national organizations such as the national network for social work managers (nnswm) and the association for community organization and social action (acosa; mary, 2005), the school social work association of america (sswaa; cuellar et al., 2018), the migration and child welfare national network, the national association of black social workers (nabsw), latino social workers organization, association of oncology social work, clinical social work association, and the national association of forensic social workers (park et al., 2011), and state-level organizations such as the minnesota association of macro practice social work (ampsw; hill et al., 2010). the most common membership association used by research into social workers’ attitudes and behaviors is the nasw and its state chapters on topics ranging from the use of evidence-based practice (tuten et al., 2016), perceptions about the relationship of firearm ownership to child meehan et al./who is a social worker? 3 neglect (jennissen et al., 2019), and the use of spirituality and religion in their practice (vetvik et al., 2018). the use of the nasw membership as a proxy for identification as a social worker in political social work research goes back at least to 1981, when wolk used a nasw list to sample social workers. sampling members of nasw has logistical ease and introduces a cross-section of fields of practice. wolk (1981) was curious to know the political behavior of social workers, and whether they lived up to the profession’s history and traditions of political activism. fundamentally, though, the decision to join nasw and the decision to be politically active are not necessarily independent of each other. as a result, wolk (1981) was sampling social workers who may have been more politically active than social workers in general. based on the responses from this sample, wolk (1981) concluded that political activism among social workers “seems to occur in the same degree as for other professional groups and business executives” (p. 287). however, the bias introduced into the sample through nasw membership makes this conclusion tenuous. consciously updating our understanding of the political behavior of social workers, ezell (1993) replicated wolk’s (1981) research with randomly selected members of the washington state chapter of nasw. he estimated that his sample of 500 represented 25% of the state’s membership. he received a total of 353 respondents, or a reported response rate of 63.8%, and found that african american and macro social workers, respectively, were more politically active than their colleagues. with a nod to wolk’s (1981) contention that the profession played a minimal role in shaping policies, ezell (1993) argued his results showed significant growth in political activism during the reagan era. addressing the geographic limitations of previous studies of nasw members, rome and hoechstetter (2010) sampled 3,000 nasw members nationwide. with 1,274 responses, they achieved a 43% response rate. in this sample, roughly half of respondents were politically active. the authors argued that participants engaged in either “passive” or “active” forms of political participation. activities categorized as “passive” forms of political participation included contacting elected officials via phone or letter, reading the news, and writing a letter to the editor. “active” forms of participation included testifying at a legislative hearing, campaigning for an elected official, participating in a rally or protest, and voting. because all three studies sampled nasw members, these results can be compared, but not generalized to other social workers. sampling methods using nasw membership have the advantage of cutting through the clutter of social work practice. as the largest membership organization in the profession, and the one that sets the code of ethics, it is an efficient way of reaching one subset of social workers. the primary disadvantage of nasw membership is that it represents a group who have self-selected into membership. the decision to join nasw may introduce bias and leave out significant groups of social workers of interest to the researcher (davis et al., 2021), and therefore this sampling method is not appropriate for many types of research about social workers. it should also be noted that joining nasw has a financial cost, so social workers who are not able to afford that cost will not be represented in the research. advances in social work, fall 2021, 21(4) 4 licensed social workers while wolk was the first to study political social workers who were nasw members, a trend that wolk could not have foreseen when he was writing in 1981 was the growth of social work licensure across the united states in the past four decades. the transition to licensure within the profession has had implications for social work practice and education, with an increased emphasis over time on interpersonal mental health counseling. social work today resembles more of a health profession than it did at the time of wolk’s study. licensed social workers have formed the basis of many studies about social workers, including examinations of secondary traumatic stress among social workers (bride, 2007) and attitudes toward sexual minority clients (alessi et al., 2015). hamilton and fauri (2001) were the first to use licensed social workers as a sampling pool to understand the political behavior of social workers. out of a sampling frame of approximately 32,000, they employed a random sample of 600 licensed social workers in new york state. they received 242 responses, or a rate of 48%. they hypothesized that nasw membership predicted political participation and may have introduced bias when used to understand the political behavior of social workers. based on their survey of licensed social workers, they found membership in nasw is indeed predictive of political participation. because their sampling frame included both nasw members and nonmembers, they were able to assess the relationship between nasw membership and political participation in a way other studies had not been able to do. however, their results were geographically constrained to new york state. ritter (2008), using a more diverse and richer sampling pool, compared the political participation of licensed social workers to the general public. ritter’s sampling frame included 95,000 licensed social workers from 11 states around the country and excluded states that licensed only clinical social workers. based on a random sample of 524 individuals, ritter’s research showed that, unlike the general public, social workers engaged in politics regardless of their access to resources (e.g., free time, family income, political skills). being a member of a recruitment network (e.g., religious organization, nasw) was also a predictor of political participation, based on the political activities scale, which asks respondents to record the level of involvement in various modes of political activity such as voting, civic engagement, electoral participation, and so forth. the recently completed national study of the political participation of licensed social workers (ostrander, 2020) illustrates how licensure can be used to obtain larger sample sizes than was possible using nasw membership. this study obtained licensure information for social workers in 25 states, yielding a sampling frame of over 144,000. from a random sample of 45,000, responses from 3,033 individuals (a response rate of 7%) were collected. a comparable sample from nasw member lists would have been onethird the size. many of the same advantages that apply to nasw members as a sample apply to licensed social workers as well, with one additional advantage. as with nasw membership, licensure cuts across occupations and practice areas within social work. the scale of licensure, though, dwarfs that of nasw membership. title protection in many meehan et al./who is a social worker? 5 states requires individuals to possess licensure if they want to call themselves a “social worker” professionally, although title protection in other states only requires a social work degree. although licensure allows for larger sample sizes than is possible through nasw membership alone, these samples are not without bias. the three biggest disadvantages with the use of licensure as a sampling frame are the underrepresentation of macro practitioners, potential for exam bias, and the cost of licensure. macro practitioners are less likely than others to obtain licensure, even in the few states with macro-focused licensure (donaldson et al., 2014). employers of macro social workers may not need or value licensure. for an in-depth discussion of macro practice and licensure see donaldson et al. (2014). overall, a sample developed from licensure will likely over-represent micro practitioners and under-represent macro practitioners and those in non-traditional social work settings where licensure is not required. the second disadvantage of using licensure to sample social workers is the potential bias in the licensure exam. we have no way to formally assess the bias within the exam given the lack of information provided by aswb, which devises and administers the licensing exam. however, castex and colleagues (2019) reviewed sample licensure questions and available data and expressed significant concerns about the bias within the exam. the final disadvantage is the significant cost associated with licensure, including the cost of the exam, initial and continuing licensure fees to the state, and the cost of continuing education credits to maintain licensure. these costs likely mean that social workers who are unable to afford to pay these fees will be unable to become licensed or maintain a license, and therefore may be underrepresented in resulting research. the aswb does not release demographic information that would allow outside researchers to assess whether “social workers with economically and educationally disadvantaged backgrounds have difficulty passing their licensing exams” (castex et al., 2019, p. 212). this is not true of licensure in other professions. social work students students represent another potential source of information about social workers. as a group, they offer advantages to researchers relative to nasw membership or licensure. for example, students have expressed interest in social work by pursuing it, but have often not yet professionally sorted themselves into micro or macro practice areas. likewise, students have not passed or failed the licensing exam. moreover, cswe accreditation standards ensure students receive exposure to similar content and curricula no matter what college or university they attend. a number of researchers have taken advantage of their access to social work students as research participants. for example, several researchers have examined students’ perceptions of the causes of poverty (castillo & becerra, 2012; delavega et al., 2017; sun, 2001). examples of political social work research with students includes swank’s (2012) sample of political behavior among social work students at a historically black college and advances in social work, fall 2021, 21(4) 6 the michigan law & social work study, which surveyed 545 msw students from four michigan universities regarding their interest in running for elected office (meehan, 2019). as with all methods, student samples present disadvantages. social work students are still establishing their professional identities and beliefs; their beliefs, attitudes, and behavior as students may not be representative of their later behavior as professionals. in addition, not every student who obtains a bsw or msw will practice as a social worker, stay in social work long term, or identify as a social worker. finally, most studies of students focus in on those who are in one program, limiting generalizability outside of that program. graduates of social work programs social work researchers frequently study graduates of social work programs. bloomquist et al. (2015) studied self-care and quality of life among social workers chosen from the msw alumni of a university, while bae et al. (2020) looked at compassion satisfaction and its relationship to factors such as emotional intelligence, organizational factors, and work-life balance. starr et al. (1999) surveyed msw alumni to learn about their career paths. given this, it is surprising that few studies in political social work have examined social work graduates as a whole, likely given the difficulties in establishing a sampling frame without relying on licensure or professional membership. one political social work study (lane & humphreys, 2011) used purposive sampling through available lists of elected social workers and internet searching, as well as snowball sampling to contact 416 social workers who met the study criteria (graduates of bsw, msw, phd, or dsw programs who had run for elected office); 270 (66%) responded to the survey. participants came from different programs, were both nasw members and non-members, and included those licensed and not licensed. the advantages of sampling graduates of social work programs are many. this group represents people with social work educations who would not be included in nasw or licensure sampling and who are past the student phase of life and more firmly into their professional identities. the largest disadvantage of this sampling is that it is very timeintensive. there is no existing sampling frame to draw from and no way to know how representative the sample is of individuals who have earned a social work degree. in addition, this approach may sample people with social work degrees who are not practicing or identifying as social workers. social work faculty social work faculty are rarely assumed to be representative of all social workers. researchers have surveyed social work faculty on topics relevant to their teaching of social work students, for example social work licensing (miller et al., 2017) and curricula (grady et al., 2010) or topics relevant to their own careers like mentoring (wilson et al., 2002) and being “out” in the academy (prock et al., 2019). a dearth of studies in political social work employ social work faculty—including field-based staff—as a sampling frame. one seminal study, mary et al. (1993), explored the political behavior of social work faculty meehan et al./who is a social worker? 7 and field instructors and was informed by the works of wolk (1981) and ezell (1993). mary and her colleagues used milbrath’s (1965) hierarchy of political activity scale, and demonstrated similar findings to both wolk’s and ezell’s studies. however, they also found that social work faculty questioned social workers’ engagement in politics. mary (2002) later replicated her earlier study with modifications, showing similar results. wolk and colleagues (1996) surveyed faculty and staff to understand the opportunities and barriers for political field placements. the authors found that only 20% of bachelor of social work programs and 43% of master of social work programs offer political placements. pritzker and lane (2014) surveyed field directors and found low numbers placing students in political placements. both studies reported the perception of faculty/field staff that students are not interested in such placements, but did not survey students for their perspectives. social work faculty are highly educated and generally have a significant amount of practice experience. this offers researchers the opportunity to understand what content is being offered in implicit (e.g., classroom and field) and explicit (e.g., trainings and student organizations) curriculum. the disadvantages of using social work faculty as a sample includes that faculty do not represent the larger social work profession, which limits generalizability. social work faculty may be overwhelmed and unlikely to respond to research requests. their perceptions of their programs may not match with students’ experiences. lastly, social work faculty may over-represent clinical specialists and underrepresent mezzo and macro specialists. related occupations another method of identifying a sample is to examine the occupations that typically define social work practice. these could include mental health counselors, child welfare officers, case workers, non-profit program managers, community organizers, and so on. these individuals are often considered to be practicing social work, whether they call themselves social workers or have a social work education or license. the major advantage to this population is representing a wider array of individuals who would otherwise be excluded through nasw membership or licensure. research about self-care targeting healthcare social workers was able to use this method by contacting employers who typically employ healthcare social workers, such as hospitals and nursing homes (miller et al., 2017). a 1999 study of social workers as a whole found that 22% of those who identify as social workers are african-american, compared to only 6% of those with a formal degree in social work (kadushin, 1999, as reported by castex et al., 2019), suggesting that this group may be significantly different from the other groups studied, all of whom have social work education as one of their core requirements. there are understandable disadvantages to sampling social workers in this way that also introduce bias. this group has varied educational and professional development experiences outside of the accreditation standards within the profession. this method further introduces bias through different ethical standards that might be applicable to these individuals. meehan et al./who is a social worker? 8 table 1. sampling methods used to study the political behavior of social workers social work identity sampling frame advantages disadvantages examples social work education graduates/alumni ● can interpret meaning of education to practice ● bridges micro/macro practice divide ● time intensive ● no known population from which to create sampling frame ● may include people not currently practicing social work lane & humphreys (2011) social work education current students ● convenient ● expressed interest in social work ● less defined micro/macro practice divide ● common curriculum ● lack professional practice experience or identity ● eventual practice or occupation is unknown fisher, weedman, alex, & stout (2001); hylton (2015); meehan (2019); mizrahi & dodd (2013); ostrander et al. (2018); pritzker & burwell (2016); swank (2012) licensure status license holders ● potential sample size ● satisfies title protection ● identifiable through state databases ● macro practice applicability ● exam creates barriers to entry that may be biased ● cost of licensure is prohibitive hamilton & fauri (2001); ostrander (2020); ritter (2007, 2008) professional association membership nasw members ● efficient ● bridges micro/macro practice divide ● common ethical training ● self-selective, therefore not broadly representative ● cost of membership is prohibitive dickinson (2004); ezell (1993); felderhoff et al. (2015); mattocks (2018); rome & hoechstetter (2010); wolk (1981) occupation child welfare workers, social service case workers, community organizers, etc. ● easily identifiable ● convenient and broadly available ● unknown education and training ● potential unfamiliarity with nasw code of ethics ostrander et al. (2019) schools of social work social work faculty ● up-to-date knowledge of social work curriculum ● highly educated, therefore not broadly representative mary et al. (1993); mary (2001); pritzker & lane (2014); wolk et al. (1996) meehan et al./who is a social worker? 9 conclusion there is no way to define a social worker that is without disadvantage or bias. whether researchers choose to study members of social work organizations such as the national association of social workers, licensed social workers, social work students, graduates of social work programs, social work faculty, or those in social work-related occupations, researchers who examine the behaviors, attitudes, and opinions of social workers should choose carefully from among the different options to maximize the representations of social workers relevant to their interests. table 1 summarizes the six options discussed here, their advantages and disadvantages, and provides examples of studies which have used those options for further reference. in addition to careful consideration of their sampling options, researchers who are examining social workers should be transparent about the reasons they chose their sample, and the ways in which that might bias their study. this transparency will allow readers to compare studies on the same topic, which used different samples to evaluate the results, with that information in mind. researchers should also consider replicating their studies with a different population or combining samples from multiple sampling frames to understand how well their results compare with other options. two important areas of concern across these methods are the underrepresentation of those who have financial constraints and those who practice macro social work. we encourage researchers to consider the costs involved in nasw membership and licensure when choosing to use those sampling frames, and to consider seriously whether other methods are necessary. we also encourage nasw and aswb to release as much demographic information as possible about nasw members and aswb exam takers, to allow researchers to assess their samples in relationship to those overall groups and allow for fuller consideration of possible bias, such as racial bias, within the aswb exam. one final note: most of these sampling choices involve the definition of social work by the researcher, which removes ownership of the term social worker from the participant and puts that power in the researchers’ hands, without allowing the participant to define it on their own terms. this threatens the internal validity of any such study, whereby the researcher prescribes a term to the research participant with which they do not necessarily identify. we encourage researchers to ask participants whether and how they identify as social workers as part of their research, in order to continue to develop our understanding of individual identification with the profession, as well as these proscribed group identities. the authors recommend that the council on social work education, national association of social workers, and other profession associations pull together members to explore a unified definition of social work through integrated practice and refrain from focusing on what makes us different. for far too long as a profession we have focused historical conflicts—micro vs macro practice, cause vs function, clinical vs policy—and should agree that social workers need a variety of skills to work at all levels of practice. this belief should appear more explicitly in professional association documents (e.g., code of ethics and educational policy and accreditation standards) if we are to work with marginalized and oppressed communities to improve practice and create more favorable policies. advances in social work, fall 2021, 21(4) 10 references alessi, e. j., dillon, f. r., & kim, h. m. s. 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(1996). political practica: educating social work students for policymaking. journal of social work education, 32(1), 91-100. https://doi.org/10.1080/10437797.1996.10672287 author note: address correspondence to patrick meehan, school of social work, university of michigan, ann arbor, mi 48109. email: pjmeeh@umich.edu https://doi.org/10.1080/10538720.2019.1584074 https://doi.org/10.1300/j508v06n04_05 https://doi.org/10.1093/sw/53.4.347 https://scholarworks.wmich.edu/jssw/vol37/iss3/7 https://doi.org/10.1300/j125v06n03_02 https://doi.org/10.1080/10437797.2001.10779044 https://doi.org/10.5175/jswe.2012.200900111 https://doi.org/10.1080/23761407.2015.1047109 https://doi.org/10.1080/15426432.2017.1422415 https://doi.org/10.1080/10437797.2002.10779100 https://doi.org/10.1093/sw/26.4.283 https://doi.org/10.1080/10437797.1996.10672287 mailto:pjmeeh@umich.edu _________ dana holcomb, dsw, lmsw is an associate professor in the department of social work at ferris state university, big rapids, mi. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 676-694, doi: 10.18060/27605 this work is licensed under a creative commons attribution 4.0 international license. the impact of covid-19 on formal mentorship: a qualitative study of social work faculty dana holcomb abstract: despite numerous benefits, formal faculty mentorship remains underutilized within academia. formal mentorship has been shown to aid faculty in acclimating to the expectations of higher education, assist in balancing work-life obligations, and provide professional and psychosocial support. these areas of formal support and connection are critical given the significant changes and disruptions caused by the pandemic. through use of a narrative approach, 10 social work faculty who were teaching during the pandemic, as well as mentees in a formal mentoring relationship, were interviewed to explore the impact the covid-19 pandemic had on their experiences with formal mentorship. all participants maintained a virtual connection with their mentor during the pandemic, though two experienced a decrease in communication. four themes that emerged were how mentors helped mentees frame professional development during the pandemic, the shifting focus and deepening of the mentoring relationship, the adjustment to virtual mentoring, and the impact of faculty and institutional leadership attrition. implications for higher education as it relates to the provision of formal mentorship as a means to increase a sense of faculty connection and support are explored, particularly within the virtual environment. keywords: formal mentorship, social work faculty, covid-19, virtual mentorship the covid-19 pandemic dramatically disrupted how faculty within higher education function and added enormous responsibilities to faculty workloads (fay & ghadimi, 2020). in march 2020, brick and mortar universities across the world swiftly transitioned to virtual spaces (fernandez & shaw, 2020; krishnamoorthy & keating, 2021). often with little experience or knowledge providing remote pedagogical best practices, faculty scrambled to move courses online while learning new software and technology (casacchia et al., 2021; mahmood, 2020). finding ways to read the zoom room, engage with disconnected students, and accommodate the increased time commitment required to provide online education became commonplace (brown, 2021; buckley, 2020; casacchia et al., 2021; kasymova et al., 2021). overall, faculty across numerous disciplines experienced negative job consequences because of the pandemic such as a decrease in ability to conduct research, less access to networking with colleagues to enhance scholarship, and a loss of campus, community, and professional service opportunities (aubry et al., 2020; melvin et al., 2021; vanleeuwen et al., 2021; zuo & juvé, 2020). research during the pandemic indicates that faculty felt increasingly frustrated and disappointed in their performance as they struggled to balance professional and personal duties (aubry et al., 2020; bender et al., 2022; hjálmsdóttir & bjarnadóttir, 2021; vanleeuwen et al., 2021). overall, faculty routinely reported experiencing fluctuating energies, overwhelming emotions, increased fatigue, change in sleep patterns, and heightened anxiety and stress in response to the pandemic (aubry et al., 2020; casacchia about:blank holcomb/covid-19 & faculty mentorship 677 et al., 2021; pereira, 2020; vanleeuwen et al., 2021). these challenges were compounded by expectations within higher education to achieve promotion and tenure which left some feeling isolated, disconnected, and unable to maintain a work-life balance (babcock et al., 2020; filho et al., 2021; pereira, 2020; smith & lim, 2020; vanleeuwen et al., 2021). prior to the pandemic, there was a significant body of literature that demonstrated the benefits of formal faculty mentorship. while there is no agreed upon definition of formal mentorship, components accepted within the research indicate it is a process where a more experienced faculty member (mentor) engages collaboratively with a less experienced faculty member (mentee) to serve as a guide in areas such as: career development, institutional knowledge, information and advice, work-life balance, and navigating challenges inherent in higher education (eby et al., 2008; ragins et al., 2000). these characteristics were utilized within this study as a basis to assess participants mentoring relationships. participants were considered to be part of a formal mentoring relationship if their university sanctioned engaging in this form of support. this criterion was applied to this research in determining whether participants were engaged in a formal mentoring relationship. research indicates formal mentorship helps to orient and acclimate new faculty, assist in developing curriculum, and define a clear scholarship agenda (brady & spencer, 2018; eby et al., 2008; schmidt & faber, 2016; sheridan et al., 2015). formal mentorship has been shown to increase collegiality, enhance departmental and institutional relationships, and bolster satisfaction with the tenure and promotion process (jackson et al., 2017; schmidt & faber, 2016). formal mentorship has also been shown to increase salary levels, promotion rates, and assist faculty in obtaining a work-life balance (allen et al., 2004; schmidt & faber, 2016). additionally, formal mentorship is considered particularly critical for women, underrepresented minorities, and those in non-tenure track positions as it serves to counteract the uneven political and power differentials, gender discrimination, implicit racial bias, and rank/status disparities within higher education (brady & spencer, 2018; denson et al., 2018; espino & zambrana, 2019). given these benefits, formal faculty mentorship is a critical source of professional and personal support to utilize particularly in responding to some of the challenges created by the pandemic (abelhamid et al., 2021; babcock et al., 2020; camacho & legare, 2021; melvin et al., 2021). as the pandemic has touched all parts of faculty lives, it is important to study what if any impact it may have had on the relationship between mentee and mentor. findings from this study could have implications for social work departments and higher education institutions as well as generate best practices for social work educators and mentorship more broadly. study objectives/aims while substantial research exists regarding formal faculty mentorship, there is limited literature on the impact the pandemic has had on these relationships, particularly from a social work faculty mentee’s perspective. understanding faculty perspectives on formal mentorship and the pandemic’s impact is critical to developing best practices and ensuring faculty support and connection. there is also limited research on social work faculty’s advances in social work, fall 2024, 24(3) 678 experiences transitioning to virtual mentorship during the pandemic. the aim of this article is to explore the impact of the covid-19 pandemic on formal faculty mentorship from social work faculty’s perspectives. method a narrative approach to inquiry was selected as it provides an understanding of participants’ lived experiences through capturing their perspectives (padgett, 2017). this approach allows for a deeper understanding of the human experience through the way individuals construct their story (butina, 2015; hickson, 2016). this method also allows for greater understanding of the person’s experiences and how they internalize the phenomenon into the story of the self (butina, 2015). the narrative approach lends a greater understanding of the larger social contexts which are highlighted throughout the stories (padgett, 2017). this approach is particularly relevant given the pandemic’s deep impact on all facets of our lives. in qualitative studies the researcher is the instrument (padgett, 2017). as such, it is critical to disclose the author’s background. this author is a 43-year-old white female who has been a practicing social worker for 20 years and employed within higher education for 13 years. during the pandemic this author was a faculty member, within a department of social work, at a mid-size public institution located in the united states with courses transitioned to an online format. this author accepted a position within that institution as a field director and continued to teach, though in a reduced capacity. this author has had personal and professional stressors during the pandemic and brings these lived experiences to this research. for example, during the pandemic this author navigated learning a new position and struggled to find/maintain student internship placements. additionally, this author parented children who were engaged in virtual schooling, navigated illness due to covid-19, and experienced personal loss due to the pandemic. throughout the pandemic, this author was not engaged in a formal mentoring relationship. participants the sample consisted of ten social work faculty from across the united states, all of whom identified as being mentees within a formal mentoring relationship (see table 1). the average age of participants was 41.1 years old (youngest 34 years old and oldest 47 years old). nine participants identified as white and one as african american. nine identified as female and one as male. three participants indicated their highest level of education was an msw and seven indicated earning a phd or dsw. five participants were in a tenure-track position, three were already tenured, and two were in non-tenure track positions. five participants reported being employed at public, teaching institutions; three at private, christian, teaching institutions; and two at a doctoral/very high research activity (r1) university. all participants indicated their institution had a formal mentorship matching process. five participants were matched with a mentor outside of their college; three indicated their tenure chair served as their mentor; and two reported their department chair was their mentor. holcomb/covid-19 & faculty mentorship 679 it is also important to note that each participant indicated being paired with an experienced mentor. experience was defined by participants as mentors having longevity within higher education, particularly at their institution. many mentors had been employed within higher education for over 20 years and all were employed for at least 8 years at their current institution. mentees indicated this longevity and experience were contributing factors to their satisfaction with the mentoring process and level of support. table 1. demographics of participants name age level of education position institution type mentor position amanda 44 phd assistant prof* public, teaching tenure chair emma 47 dsw assistant prof* private, christian faculty outside of college jane 46 phd associate prof, tenured public, teaching tenure chair kate 44 msw clinical faculty, non-tt position public, teaching faculty outside of college lori 34 dsw assistant prof* private, christian faculty outside of college mary 46 msw associate prof, tenured public, teaching department chair matt 40 dsw adjunct prof, non-tt position public, teaching faculty outside of college maya 36 phd assistant prof* public, research 1 faculty outside of college melissa 34 dsw assistant prof* private, christian department chair sara 40 msw associate prof, tenured public, teaching tenure chair *tt=tenure track notes: emma was black, all other participants were white; matt was male, all other participants were female. recruitment and sampling an invitation to participate in this study was sent to three widely utilized social work faculty listservs: the association of baccalaureate social work program directors (bpd), msw-ed, and field director. email invitations for participation were sent to listservs in october and november 2021. invitations were also posted to several facebook groups the author belonged to (early career social work educators, doctoral mom group, tenuretrack moms, and doctor’s of social work international). eight participants responded via listserv invitations and two responded via the tenure-track moms facebook group. a total of ten participants responded to the invitation and all completed interviews. participants were considered eligible to engage in the study if they were currently employed as a social work faculty member in a council on social work education (cswe) accredited program, the mentee in a formal mentoring relationship, and began their mentoring relationship face-to-face but transitioned to a virtual format due to the pandemic. purposive sampling was used as the invitation was sent directly to each listserv and social media group (rubin & babbie, 2016). to increase the response rate, snowball sampling advances in social work, fall 2024, 24(3) 680 was utilized as participants were encouraged to forward the listserv invitation and facebook post to colleagues. the study was approved by the author’s institutional review board (irb). no compensation was offered to participants. data collection data were collected in a series of one-time, recorded interviews conducted via zoom. interviews began in october 2021 and concluded in december 2021. participants engaged in a 22-question semi-structured interview. participants were asked demographic questions, role and job duties, and institutional information. questions were asked about the matching process and the mentee’s experience with the mentoring relationship. questions were asked about the professional and personal impact of the pandemic; the participant’s perspectives on their institution’s response to the pandemic; and how connected participants felt to their mentor, colleagues, and institution. interview questions, and relevant probes, were constructed by this author and prior to the interviews, a pilot test of the interview guide was conducted. minor changes in the ordering of questions occurred because of feedback. interviews were conducted in a private setting to ensure confidentiality. upon agreeing to be interviewed, participants were sent a consent form via email. before interviews began, participants were asked if they had questions about the consent form or scope of the study and signed consent forms were obtained. all participants completed the interview, therefore attrition was not a factor. interviews were transcribed and member checking occurred to ensure accuracy and resonance with their experiences as well as to correct any discrepancies that occurred during transcription. interviews were held for 48 to 68 minutes, with the average interview time of 50 minutes. interviews were ended after the tenth interview due to reaching saturation. issues of reflexivity were considered throughout this study (padgett, 2017). this author examined personal beliefs and experiences related to previous mentoring relationships as well as the impact of the pandemic. when discussing the impact of the pandemic, the author ensured objectivity to the extent possible through debriefing with a colleague, particularly after conducting interviews where participants disclosed difficult stories. for example, participants disclosed their experiences with loss during the pandemic, feelings of isolation, and challenges navigating professional expectations which were all areas that resonated with this author. to further solidify what was shared during the interviews, and the impressions and feelings this author had, a separate log was kept. this log was reviewed throughout the study by the author to identify biases (padgett, 2017). analysis thematic analysis was used to identify recurrent themes in the data. this analysis was done across the entirety of the data to provide a rich overall description of participants’ experiences. inductive analysis of data was used when coding. this process followed braun and clarke’s (2006) six phases of thematic analysis. each interview was transcribed using the zoom transcription feature and pseudonyms were used to protect the confidentiality of participants. this author listened to each recording, corrected holcomb/covid-19 & faculty mentorship 681 discrepancies in the transcript, and coded them in their entirety. repeated rounds of reading the transcripts occurred, and during this process notes were made to document initial codes that were generated as well as observations and initial trends (padgett, 2017). this author and a second coder used open coding to organize, collate, and sort content into potential themes. the second coder is an assistant professor of social work at an institution located in the midwest. the codes that were generated were derived from the data themselves, rather than from specific theoretical underpinnings (braun & clarke, 2006). these potential themes were ultimately organized into a larger outline and were refined through repeated investigation of patterns of commonality and anomalous examples until consensus was reached between coders (boyatzis, 1998). each theme was shared multiple times throughout the interviews with various examples provided. direct quotations from the data were grouped under the thematic headings to illustrate each theme in the participants own words. throughout this iterative process, this author utilized peer debriefing, journaling, and the creation of an audit trail of generated codes and decisions made throughout analysis. this process considered issues of trustworthiness, credibility, and reliability through the use of peer debriefing, member checking, thorough re-reading of the transcribed interviews, and reflexive journaling (boyatzis, 1998; braun & clarke, 2006; padgett, 2017; o’connor & joffe, 2020). findings this study was conducted to explore the impact the covid-19 pandemic had on social work faculty experiences with formal mentorship, from the perspective of the mentee. all participants reported experiencing stress, anxiety, grief/loss, and difficulties balancing work-life obligations during the pandemic. six participants expressed challenges with childcare, working while children were attending school virtually, and lacking a private workspace at home that was conducive to teaching. all participants experienced an increase in their workload and professional roles and identified feeling overwhelmed due to the uncertainties of the pandemic. the analysis resulted in four themes: 1) framing professional development during the pandemic, 2) shifting focus and deepening of mentoring relationship, 3) adjusting to virtual mentoring, and 4) impact of faculty and leadership attrition (see figure 1). figure 1. mentoring during the pandemic *pd = professional development impact of faculty & leadership attrition framing pd* during the pandemic shifting focus & deepening relationship adjusting to virtual mentoring advances in social work, fall 2024, 24(3) 682 theme 1. framing professional development during the pandemic one of the main roles mentors occupy is to guide mentees in forming professional development goals and connecting them to opportunities. these opportunities are centered on the three pillars of the professoriate: teaching, scholarship, and service. pre-pandemic teaching looked different for many of the participants, and multiple options existed for faculty to engage in scholarship and service. however, during the pandemic, opportunities were substantially limited. as per the participants, this posed significant challenges, particularly for new faculty or those applying for tenure or promotion. one of the themes that emerged was the importance of mentors’ feedback in how to frame mentees’ professional development during the pandemic. participants indicated seeking feedback on providing quality instruction, addressing student concerns, and navigating opportunities for professional advancement. one participant, sara (40, associate professor) recalled struggling to engage with students via zoom, particularly as many had their cameras off and were not providing feedback on course material. sara indicated sharing this with her mentor who provided her with tangible ways to increase student engagement using technology. “my mentor used activities such as kahoot games, digital field trips, and zoom polls to increase student engagement. so, i used these suggestions and their cameras turned on more. these activities helped us to have good discussions.” another participant, amanda (44, assistant professor) recalled similar situations and said she went to her mentor to discuss how to engage with students virtually: i was transparent with her [mentor]. i was concerned about my end of the semester teaching evaluations. she gave me tips such as using breakout rooms and having students present information so it wasn’t just me talking at them all the time. she told me not to worry because we were all in the same boat. that was reassuring. kate (44, clinical faculty) recalled a difficult classroom situation she had with students who did not agree with the covid mitigation strategies the university implemented. she indicated students were mad at her because she was adhering to the mitigation strategies, but other professors were not. kate sought advice from her mentor and recalled: it was hard. i didn’t want to throw my colleagues under the bus and tell students they weren’t doing what they were supposed to do but i didn’t want them to be mad at me. i got done teaching and called my mentor. i needed to vent. she shared how she handled a similar issue, and we figured out how i would handle it next week. the next time i saw the class, i was open with them about what the university was requiring, why i chose to adhere to the mitigation strategies, and the challenges i faced when i heard other colleagues weren’t. we talked about how these issues can come up in the workplace and the tension it can create between doing what the university or agency says we have to do and the relationship difficulties you can encounter if it is not applied by all. i think having this discussion changed how the class perceived me and probably helped my end of the semester evaluations. holcomb/covid-19 & faculty mentorship 683 all participants indicated their mentor provided feedback on written work for tenure, promotion, or yearly evaluations which was challenging to complete during the pandemic. jane (46, associate professor) indicated fewer students completed their course evaluations so her mentor suggested she address the impact of the pandemic in her tenure binder by sharing feedback she received in class through the use of student quotations and zoom poll results. melissa (34, assistant professor) shared that her mentor was previously a program director. that experience helped her as she assumed the program director role, which was a daunting task to undertake during the pandemic: just knowing that she had done what i was doing, and had that experience was helpful. she had a lot of expertise and she made sure to share things she thought would be helpful to me. she was always available to talk through new issues as a result of covid which helped me feel more confident and overall do my job better. maya (36, assistant professor) indicated she could not conduct research because of university and state restrictions, so her mentor suggested she collect class data which ultimately helped her comply with her tenure research requirements. amanda indicated her mentor suggested she publish research from her dissertation since she could not conduct research. both participants indicated this creative thinking helped them to continue developing professionally and stay within the pandemic response requirements. kate indicated she was overwhelmed by meeting her tenure requirements during the pandemic but her “mentor gave me feedback and we created a plan of action. without her support i don’t know how i would have gotten through the pandemic in one piece.” the feedback all participants received from their mentors highlights the power of mentorship, particularly in response to the challenges presented during the pandemic. theme 2. shifting focus and deepening of mentoring relationship another theme that emerged was the amount of attention mentors paid to the impact of the pandemic on the mentees’ lives as well as the deepening, in many instances, of the mentee-mentor relationship. participants expressed gratitude for their mentors’ investment and commitment to their relationship which proved to be critical during the pandemic. jane recalled, “my mentor cared about me as a whole person and started every conversation by asking how i was holding up. this was different. before the pandemic, there was less of a focus on my overall well-being when we connected.” amanda indicated having similar conversations with her mentor noting, “we always devoted a huge chunk of time to talking about covid and how i was doing inside and outside of the classroom. we talked about stress and coping a lot.” maya shared her mentor, also a mother, spent significant time focusing on work-life balance: i was working remotely, homeschooling my daughter, and trying to do everything. it was a lot, especially living in a new area. my mentor really validated my experiences and how hard everything was. she talked a lot about setting boundaries and taking time for myself and my family. advances in social work, fall 2024, 24(3) 684 matt stated his mentor encouraged him to spend time focusing on his overall well-being as well as taking breaks from work. mary (46, associate professor) shared her mentor focused on extending grace to herself: we all had so much going on and working harder wasn’t solving all of the problems that everyone was experiencing. she reminded me that this wasn’t a failure on my part, rather it was just the outcome of the situation and the pandemic. she reminded me to extend the same grace to myself that i was showing to my students and colleagues. i don’t think this would have been a focus in mentorship before the pandemic. perhaps because of these shared stressors and challenges, many participants noted a deepening in their relationship with their mentor. sara indicated: we had a close relationship before the pandemic, and she was highly supportive of me in my personal life. my mentor cared about me, but covid added to our informal communication. we were both dealing with our own stuff, so we checked in a lot just to see if each other was doing okay. that really strengthened our bond. several participants also shared that while their mentoring relationships started off as professional in nature, they grew into a friendship. melissa shared that she appreciated the friendship she established with her mentor. matt (40, adjunct professor) stated, “i liked my mentor before the pandemic but grew to appreciate her much more during the pandemic. our relationship turned into a friendship that i cherish.” these experiences demonstrate the ways mentors focused more deliberately on mentee mental health, self-care, and utilizing positive coping strategies during the pandemic. theme 3. adjusting to virtual mentoring another theme that was identified was the ways mentees adjusted to virtual mentoring. all participants began their mentoring relationships face-to-face, but due to the pandemic, switched to a virtual platform to maintain connection. participants utilized text messaging, email, phone calls, and zoom to connect with their mentors. sara recalled: i did a lot of zoom meetings just to stay connected to my mentor because i couldn’t see her in person. but what i found myself doing more often was going for walks so i could be out of the house and away from my computer. i was so sick of technology and being stuck at my desk. when i would walk, i would call my mentor and we would have meaningful conversations. melissa stated she connected with her mentor more frequently during the pandemic: we would call and text each other a lot. we scheduled zoom meetings but those were not as frequent. we stayed in touch with each other in real-time. we would quickly touch base about a problem or check in to see how each other was doing. this was nice and more helpful than previously scheduled monthly check-ins especially as i was assuming a new role. i found myself having lots of questions and those more frequent check-ins helped me grow in confidence and stay on top holcomb/covid-19 & faculty mentorship 685 of things. we also had a teams space for important documents and things that would be helpful for me as i started this new role. lori (34, assistant professor) shared that being able to send her mentor an email allowed for her to have almost real-time answers and information. lori indicated these quick responses helped her to gain confidence by having more immediate answers, versus saving her questions for monthly check-ins with her mentor. lori also indicated, “my mentor and i had regularly scheduled zoom meetings which helped answer my questions. but these meetings increased during covid because we didn’t have to be on campus at the same time. so, virtual meetings worked great.” most participants indicated remaining connected to their mentor in a virtual capacity during the pandemic at the same or at an increased rate; however, two shared that their communication decreased because of not being in the same physical space. jane indicated her mentor began teaching online just before covid and was not in the office. when everyone transitioned to online the two connected though not as much as when they were in the same physical space. maya indicated she connected with her mentor online but felt a deeper connection in person. maya stated, “as soon as we were back to in-person teaching, my mentor and i met on campus. we met outside on a park bench and had coffee. we tried to do the social distancing thing. i appreciated being in person.” jane and maya highlight that receiving mentorship virtually was difficult in large part due to their preferences of connecting in person. the participants experiences highlight various levels of comfort and preference around virtual connection and mentorship. theme 4. impact of faculty and leadership attrition a final theme that emerged was the significant attrition in faculty and leadership at the participants’ institutions during the pandemic. while none of the participants experienced their mentor leaving, many indicated the constant change of faculty and leadership impacted the mood and general feelings of their mentor, which may have impacted the mentoring relationship. kate noted, “during the pandemic we hired a new department chair, dean, and president. my mentor was unsure how those changes would impact my program and this weighed on her. i felt anxious because i was just getting used to things.” melissa indicated her university hired a new president during the pandemic. she shared, “my mentor said she didn’t know anything about the new president because faculty were not part of the selection process. this made her uneasy and unsure what his new initiatives would be and how that would impact faculty.” emma (47, assistant professor) shared similar feelings indicating: we lost our chair and hired two new faculty who came and left during the pandemic. it felt like people were coming and going and there was no consistency in my department or throughout the whole university. when i talked to my mentor about this, she would listen but didn’t know how to help me. she felt like she didn’t know anyone at the university anymore and that things were going to change. it made her nervous which made me nervous. advances in social work, fall 2024, 24(3) 686 sara and jane both indicated their department chair changed during the pandemic. jane stated: it was hard when the new chair started. i liked the old one. my mentor didn’t have a good relationship with the new chair, so i wondered if the advice she gave me was influenced by this. like i wonder if her advice may be shaped by her relationship or if there are some bigger political issues that might be playing out, so that was a concern. while mentees did not indicate that the attrition in faculty and leadership directly impacted their ability to access mentors, participants did indicate the unease and anxieties produced by these changes and that those weighed heavily in the conversations they had with their mentors. discussion overall, the importance of mentorship in supporting mentees’ acclimation to, and navigation of, academia and the professoriate expectations are highlighted within the results. formal mentorship, particularly during unprecedented events such as the covid19 pandemic, can provide critical supports to faculty. participants voiced formal mentorship as critical to understanding how to achieve tenure and promotion during unprecedented times; to acclimate to new leadership roles and departmental responsibilities; and to seek feedback on creative ways to engage in teaching and scholarship. the benefits expressed by participants are consistent with much of the literature on formal mentorship, though limited research has been conducted on how these relationships morphed during the pandemic (allen et al., 2004; brady & spencer, 2018; jackson et al., 2017; schmidt & faber, 2016; smith et al., 2016). many participants identified the mentoring relationships focused heavily on their overall well-being, selfcare, work-life balance, and issues of caregiving during the pandemic. perhaps because of this acknowledgement, intentional focus, and the collective trauma being experienced, these mentor-mentee relationships were deepened. from this, friendships were said to be formed. the relationships established seemed to help mentees feel less isolated and more connected in general to their colleagues, department/program, and overall work. the participants shared how they adjusted to connecting with their mentor in a virtual environment. all participants began their mentoring relationship in a traditional, face-toface modality, though they had to transition abruptly to virtual mentorship due to the pandemic. while all participants did not prefer meeting virtually, mentees indicated that being able to use technology to connect and gain resources and support was helpful. one participant switched to in-person mentoring as soon as their university resumed face-toface teaching while others continued to use virtual platforms as spaces to connect. many participants noted receiving responses quickly from their mentors. participants noted the ease of exchanging messages, connecting on the phone, or having a virtual meeting as being a source of comfort, helping to boost their confidence. the research is limited currently regarding faculty’s adjustment to virtual mentoring relationships, particularly in social work. research from the medical/allied health fields holcomb/covid-19 & faculty mentorship 687 suggests mentorship in a virtual environment has been beneficial in reducing anxieties and stressors particularly related to work during the pandemic; increasing levels of confidence and satisfaction in performance; decreasing burnout and isolation; and becoming acclimated to the program and larger institutional culture (bhakta & medina, 2021; junn et al., 2023; shermont et al., 2022). while it is acknowledged that building meaningful relationships for some can be challenging in a virtual environment, virtual mentorship has been noted to be just as effective as in-person mentoring and is an area for further exploration in social work (junn et al., 2023). having an easy method of asynchronous communication such as email, chat, or teams space; a reliable method of synchronous communication such as phone or videocall; and a repository to share information are noted as keys to success in virtual mentorship and should be considered when implementing such relationships (junn et al., 2023). further, it is important to assess the mentor’s and mentee’s level of comfort with online technology and connecting in a virtual environment. while many faculty have gained confidence and comfort using virtual platforms, attention should be paid to any areas of discomfort and support should be provided to ensure barriers are removed. ultimately, anticipating and mitigating any issues will assist in establishing and maintaining a mentoring connection in a virtual environment. regardless of modality, quality mentoring relationships should be formed using a goodness of fit model where mentors are intentionally engaged in relationally-based interactions focused on supporting the mentees’ personal and professional development (alvarez & lazzari, 2016; brady & spencer, 2018; denson et al., 2018; johnson, 2016; ragins, 2016; schmidt & faber, 2016). in these relationships, mentorship transforms both the mentor and the mentee’s lives through dynamic engagement and high levels of mutual learning, growth, generativity, and empowerment (johnson, 2016; ragins, 2016). as the relationship grows, mentors and mentees experience deeper levels of trust, sharing, and loyalty that build levels of self-efficacy, compassion, and overall career competency (johnson, 2016). all participants in this study indicated feeling supported by their mentor. all participants shared their interactions were relationally based; though it should be noted there was a wide variation in how institutions matched mentees and mentors, which is an area to be explored further. in this study, five participants indicated a faculty member outside of their department was their mentor; three shared their tenure chair was their mentor; and two stated their department chair was their mentor. it is beyond the scope of this article to address the nuances of the matching process; however, it is important to note that there could be benefits as well as challenges when matching mentors/mentees within the same department. having a mentor within the same department may indicate mentors have a deeper understanding of the discipline, professional expectations particularly as it relates to research, and the overall function of the department. however, being in the same department may impede the mentee’s ability to share openly about political challenges or issues with specific faculty members without fear of reprisal, particularly if the difficulty may be with a person holding a leadership position. the matching process is multi-faceted and institutions approach this differently given their unique focus and needs. supervisory roles, rank, status, and other hierarchical considerations should be reflected on when matching mentors and mentees. finding the right fit is a critical step in predicting mentee advances in social work, fall 2024, 24(3) 688 satisfaction and should be thoughtfully and intentionally considered (eby et al., 2008; ragins et al., 2000; smith et al., 2016). additionally, several participants indicated that they formed a deeper connection and friendship with their mentor. participants indicated they engaged in more personal conversations with their mentors often related to their emotional and physical well-being as a result of the pandemic. participants also reported sharing about their home and family life as well as engaging in more informal and non-work-related conversations. while none identified this as an area of concern, particular attention should be paid to ensuring professional boundaries are clear and that any challenges encountered within the friendship do not spill into the workplace. there may be some challenges related to balancing multiple roles (such as a friend and mentor) particularly if there are unrealistic expectations placed on this relationship (blake-beard, 2001; meeuwissen et al., 2019). having a clearly defined scope of mentoring and a relationship based on respect and transparency, particularly when multiple roles exist, could mitigate any difficulties that arise (bozeman & feeney, 2007; egege & kutieleh, 2015). it is important to consider best practices to guide mentoring experiences during unprecedented events such as the covid-19 pandemic. while some of these best practices have been addressed earlier in this section, arguably the most important may be the approach the mentor takes when entering into this relationship. it is imperative that the mentor adopt a person-first, holistic approach, particularly during times of crisis. mentors should approach these relationships from an empathic and compassionate perspective by modeling vulnerability and acknowledging the emotional toll times of heightened anxiety, change, and fear can create (haidusek-niazy et al., 2023). mentors should commit to frequent, intentional, and consistent contact with mentees that focus on overall well-being first and work productivity second (irish et al., 2023; junn et al., 2023; nocco et al., 2021; sela-vasiliu et al., 2023). engaging mentees in discussions on coping strategies as well as acknowledging specific challenges that may be present, particularly as it relates to groups who have been disproportionately impacted by the pandemic (i.e., women and black, indigenous, and other people of color) should be a focus (nocco et al., 2021; sela-vasiliu et al., 2023). mentors should extend opportunities to mentees to collaborate on creative or scholarly endeavors and embrace the use of technology as a means of connection (haidusek-niazy et al., 2023; nocco et al., 2021). from an institutional perspective, universities should assess their current systems and invest in virtual spaces that provide opportunities for meaningful connection. virtual spaces should be used to connect both synchronously and asynchronously as well as serve as a repository for resources (irish et al., 2023; junn et al., 2023). while in-person mentoring paradigms have historically been the norm, institutions must value and employ alternative ways to connect and build community. creating space for and encouraging mentors to connect with mentees as well as acknowledging the challenges faculty face is imperative to relationship-building. institutions should recognize and celebrate both mentor and mentee accomplishments as a way of fostering this connection (sela-vasiliu et al., 2023). institutions can demonstrate a commitment to overall faculty well-being by providing tangible supports and resources as well as reviewing policies to ensure inclusive and flexible approaches to shifting faculty needs (dempsey et al., 2022; haidusek-niazy holcomb/covid-19 & faculty mentorship 689 et al., 2023; irish et al., 2023; mclaughlin et al., 2020). finally, institutions must prioritize and invest in formal mentoring relationships and seek input on ways to improve these types of critical supports (holcomb, 2024). despite these recommendations, further research regarding best practices in developing and implementing institutional mentorship models that promote full engagement and collaboration, particularly in a virtual environment, should be explored (toner et al., 2022). additionally, considerations on how to foster engagement and connection within mentoring relationships in the physical and the virtual space are critical to mentee satisfaction and should be further explored (schwartz et al., 2016; toner et al., 2022). implications for social work education the impact of formal mentorship cannot be overstated and has been repeatedly demonstrated within the literature though limited research is available regarding mentorship during the pandemic. when formal mentorship is intentionally employed, research indicates there is a more positive department and institutional work culture in which faculty are engaged and satisfied. it is critical to provide formal mentorship for faculty as a means to support professional success. formal mentorship can serve as a lifeline for connection and relationship building with colleagues as well as the broader institution. this is crucial given current challenges related to access, faculty support, financial constraints, and political pressures within higher education. many of these challenges have been exacerbated by the pandemic. therefore, providing formalized mentorship for all faculty is a critical investment that institutions should prioritize. it is imperative that social work educators advocate for formalized mentorship practices at department and institutional levels, as well as create and expand opportunities for virtual connection and supports. limitations the topic of formal mentorship is complex in nature, as is the changing landscape and responses of institutions to the pandemic and after, which could have impacted participants’ ability to recall all nuances of the mentoring relationship. as the pandemic is a more recent phenomenon, this is an emerging area of study and new information related to its impact continues to be explored. faculty were able to share their experiences on mentorship; however, varying degrees of stress, fatigue, loss, grief, and other extenuating factors may have impacted what participants shared or remembered specifically as it relates to the mentoring relationship. further, the use of virtual mentorship pre-pandemic versus the forced shift to a virtual environment during the pandemic would most likely produce vastly different experiences particularly as the level of comfort with technology has grown for many. additionally, the length of mentoring relationships was not asked of participants, which could impact the success, or lack thereof, in continuing connection in a virtual environment. it should be noted that the sample size was small and that nine of the ten participants identified as female and only one identified as a faculty of color. finally, it is unclear how caregiving responsibilities may have impacted the mentee/mentor advances in social work, fall 2024, 24(3) 690 relationship. there is some evidence within this study indicating that mentees and mentors shared struggles in navigating the additional caregiving and work responsibilities during the pandemic though this area could benefit from further exploration, particularly as it relates to the impact from the mentors’ perspective. future research while formal mentorship is not a new concept within higher education, further studies are warranted regarding mentorship during the pandemic and the lessons learned from this. there is a lack of literature exploring faculty experiences in higher education with mentorship delivered virtually, particularly within the field of social work. there is also a lack of research on topics related to mentors’ experiences balancing personal and professional stressors while also supporting mentees during the pandemic. as the impact of the pandemic on higher education is only beginning to be studied, understanding ways to maintain connection and community in mentoring relationships, particularly during times of change and stress, is critical. understanding faculty experiences with formal mentorship may inform practices within higher education which could lead to approaches that positively impact faculty retention, morale, and overall satisfaction. references abelhamid, k., elhawary, h., gorgy, a., & alexander, n. 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(2020). transitioning to a new era: future directions for staff development during covid-19. medical education, 55(1), 104-107. author note: address correspondence to dana holcomb, department of social work, ferris state university, big rapids, mi 49307. email: danaholcomb@ferris.edu https://doi.org/10.1097/nnd.0000000000000866 https://doi.org/10.1097/nnd.0000000000000866 https://doi.org/10.17031/phrp3022008 https://doi.org/10.17031/phrp3022008 https://doi.org/10.1002/tia2.20033 https://doi.org/10.1002/tia2.20033 https://doi.org/10.1080/10437797.2021.1957737 https://doi.org/10.1080/10437797.2021.1957737 https://doi.org/10.1111/bjet.13065 https://doi.org/10.1111/bjet.13065 https://doi.org/10.1111/bjet.13065 https://doi.org/10.1111/medu.14387 https://doi.org/10.1111/medu.14387 mailto:alex.redcay@millersville _________ maría gandarilla ocampo, msw, doctoral candidate, brown school of social work, washington university, st. louis, mo. autumn asher blackdeer, phd, msw, assistant professor, graduate school of social work, university of denver, denver, co. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 703-719, doi: 10.18060/24987 this work is licensed under a creative commons attribution 4.0 international license. we deserve to thrive: transforming the social work academy to better support black, indigenous, and person of color (bipoc) doctoral students maría gandarilla ocampo autumn asher blackdeer abstract: the summer of 2020 saw a racial justice awakening among predominantly white scholars. while this “awakening” or reckoning regarding the long-standing racism in society is welcomed and necessary, we must recognize the stark differences in how this work is felt and ultimately in how the work needs to be done by different groups in society. while bipoc scholars worked to balance the need to process and recover, self-preserve, and advocate, white peers formed book clubs and posted black squares to their social media sites. this distinction describes the frustrating reality that many bipoc scholars experience in the work of undoing racism. we bear the unrelenting burdens of being oppressed, fighting racism, and trying to survive in a society that does not value our inherent dignity and worth. for bipoc doctoral students who simultaneously navigate the roles of being a student, peer, and instructor, these burdens are threefold. we are expected to do the invisible work of mentoring and holding space for fellow bipoc students while also educating white students and faculty/administrators on racial justice issues and contending with faculty expectations. these burdens are exacerbated as we see anti-racism quickly go in vogue and then fall out of favor soon after. the aftermath: unfulfilled promises and commitments by self-proclaimed anti-racists, leaving bipoc scholars to pick up the pieces and solely shoulder the never-ending work of anti-racism. there is a continued lack of sustained commitment to achieving racial equity across the board. the steps that have been taken are often characterized by quick fixes that fall short of the real work that will lead to a racially just, equitable and inclusive community. the purpose of this paper is to bring attention to the challenges within the academy experienced by bipoc social work doctoral students. drawing upon our experience with creating a bipoccentered support group at a predominantly white institution (pwi), we provide insight and recommendations on how colleagues and administrators alike can take action to hold space, bolster, and better support bipoc doctoral student scholars by creating inclusive educational environments, offering tailored, concrete, and formal supports, and ultimately creating an anti-racist academic culture free from all forms of oppression. keywords: social work doctoral education, bipoc doctoral students, antiracism the year 2020 was tumultuous. the covid-19 pandemic nearly brought the world to a halt as it cast a whirlwind of conflict and despair that brought to bear the fragility of our healthcare, economic, and sociopolitical systems. for racial and ethnic minorities, the impact of covid-19 was far more pronounced, as the pandemic exacerbated existing inequalities and created additional burdens that worsened the quality of life and well-being of our communities. amid this backdrop, there was a burgeoning racial justice awakening, which was re-ignited following the long list of murders of black community members by police including but not limited to george floyd, breonna taylor, and atatiana jefferson. about:blank advances in social work, summer 2022, 22(2) 704 this awakening brought an increasing public awareness and acknowledgement of the racism that black people experience on a day-to-day basis. it also called attention to the white supremacy and white privilege that prevails in society but is often ignored as it is considered the default or “normal” way of the world. a societal call was made to dismantle systems of oppression that to this day continue to contribute or cause the inequities experienced by black community members, as well as by indigenous people and people of color. among the social work profession, which espouses a value and commitment to social justice, and arguably should include abolishment of anti-black racism and racism more broadly, “doing the work” of promoting social justice took many forms. for example, several schools of social work released statements announcing their commitment to denounce anti-blackness and racism more broadly. some schools held listening circles and hosted webinars, trainings, or conferences centered on marginalized communities. some universities even announced a commitment to strategic diversity faculty recruitment and an establishment of centers focused on race and/or equity work. additionally, many black, indigenous and persons of color (bipoc) scholars finally began to receive the platform and attention that their work deserved. for part of 2020 and early of 2021, there was a semblance that progress and cultural shifts that would improve the lives of bipoc people were possible. however, like previous awakenings, the “high” of this awakening did not outlast the pandemic. by march of 2021, public opinion polls demonstrated that trust in the black lives matter (blm) movement to promote justice and equality had decreased and trust for the police to promote justice and equality had increased (ipsos, 2021). while there was semblance that institutions of higher learning continued to make efforts to move toward equity, there were also exposés in which bipoc scholars in the academy began to acknowledge the mistreatment and discrimination they experienced and/or were experiencing by white peers and their institutions. the social work profession was not excluded as schools of social work, the same institutions which are tasked with preparing future social workers to promote social justice and other social work values, were exposed as engaging in blatant injustices, mistreatment, and outright discrimination of black scholars (davis, 2021). the attention to the failings of schools of social work and the profession as a whole to bolster black scholars and more broadly scholars of color led people to mobilize and discuss ways in which the profession and schools of social work could become anti-racist. for example, the social work coalition for anti-racist educators (swcares), a nonprofit with a mission to “dismantle white supremacy in social work education” was created (swcares, n.d., para.1) and began programming, collecting, and disseminating resources. graduate students circulated a petition to have the council on social work education (cswe) standards include language that outlined the profession’s commitment to anti-racism education in its curriculum (ipetitions, n.d.). furthermore, doctoral students led efforts, with the support of the group for the advancement of social work doctoral education (gade) and the society for social work and research (sswr) to understand how anti-racism could be integrated into social work doctoral education (mendez et al., 2021). most recently, the national association of social workers (nasw) published a ocampo & blackdeer/we deserve to thrive 705 report along with an apology for the profession’s role in harming marginalized communities (nasw, 2021). while this racial justice “awakening” or reckoning by schools of social work and the profession regarding the long-standing racism in society is long overdue, necessary, and welcomed; a broad acknowledgement of the fact that the burden of anti-racism work is not and has not been distributed equally among different communities in society is seldom present. such an acknowledgement is necessary as there are stark differences in how antiracist work is felt, how the work has been done, and ultimately how the work needs to be done by different groups in society. this current racial awakening provided numerous examples of this reality. for example, while bipoc scholars did the unavoidable work of processing, self-preserving, recovering, and advocating, many of their white peers engaged in optional activities, such as forming and participating in book clubs, posting black squares to their social media sites, and listening to webinars. at a system level, institutions made hollow acknowledgements of the existence of racism and commitments to becoming antiracist, however, follow through is yet to fully be seen. despite this institutional commitment, microand macroaggressions, and racism by institutions did not disappear in the academy. this distinction describes the frustrating reality that many bipoc scholars experience in the work of eradicating racism. bipoc scholars bear the unrelenting burdens of being oppressed, fighting racism and discrimination, and trying to survive in a society that does not seem to value their inherent dignity and worth. although bipoc individuals often have their own community in which they can commiserate and rely on to survive and cope with racism in society, this community is not as often available in higher education due to how few bipoc scholars are present in the academy (national center for education statistics, n.d.) one often overlooked group under the bipoc scholars umbrella for which this phenomenon is further compounded but often not as well researched (chin et al., 2018) or understood is bipoc doctoral students, many who find themselves simultaneously navigating the roles of student, peer, and instructor. along with completing a rigorous educational program and advancing their own scholarly work, bipoc doctoral students are also often doing the invisible labor of mentoring and holding space for fellow bipoc students, educating students, faculty and/or administration on diversity, equity, and inclusion issues, contending with faculty expectations, and participating in unpaid diversity, equity and inclusion (de&i) service work. these burdens are often further exacerbated by experiences of microand macroaggressions from their institutions and peers, lack of administrative and/or institutional support, and more broadly, the trauma of observing anti-racism quickly go in vogue and then fall out of favor soon after. bipoc students have recognized that in this anti-racism awakening roller coaster there is often a lack of sustained commitment to achieving racial equity across the board. the steps that have been or are typically taken, such as hollow statements of solidarity or listening sessions and panels, are often characterized by quick fixes that fall short of the real work that will lead to a racially just, equitable, and inclusive community. not surprisingly, the aftermath of this roller coaster is frequently unfulfilled or half-heartedly met promises and commitments by self-proclaimed anti-racists. because achieving anti-racism is a matter affecting the well-being and livelihood of bipoc scholars, they do not have the option to advances in social work, summer 2022, 22(2) 706 opt out. they are often left to pick up the pieces and solely shoulder what feels like the never-ending work of anti-racism. this paper aims to bring attention to the bipoc doctoral student experience in the academy. drawing upon the authors’ lived experience as bipoc social work doctoral scholars and with creating a bipoc-centered support group at a predominantly white institution (pwi), the authors provide insight and recommendations on how colleagues and administrators can take action to hold space, bolster, and better support bipoc student scholars. the social work phd program before we begin discussing experiences of doctoral bipoc students, it is important that the reader understand and appreciate the context in which these experiences take place. we focus on social work phd programs due to the authors’ lived experiences in a social work phd program. while we recognize that not all social work phd programs are structured in the same way, there is sufficient overlap in phd program structures and milestones which can contribute to potentially similar experiences of the phenomena described. additionally, we acknowledge that some of the programmatic differences between phd social work programs and doctor of social work (dsw) programs may lead to a different program culture. while this distinction is made, we hold that the challenges faced by bipoc doctoral students in phd social work programs may overlap and be relevant to bipoc doctoral students in dsw programs, and more broadly to bipoc doctoral students in other disciplines. social work phd programs are typically housed within schools or departments of social work and may be one of several degree programs (bachelor of social work [bsw], master of social work [msw], etc.) offered (in person, online, or hybrid) within the school. being situated within a school that has an undergraduate and/or graduate social work program can impact the doctoral student experience as it may increase the likelihood that a doctoral student is expected to serve as a teaching assistant or an instructor during their doctoral education. this potential expectation has several implications and demands on a student, which we discuss further later. unlike bachelor’s and master’s level social work educational programs, social work phd programs do not fall under the purview of cswe and its accreditation standards. instead, social work phd programs often follow the quality guidelines provided by gade, an organization whose membership is made up of 80 social work doctoral program directors (gade, 2022). the gade quality guidelines are not meant to be proscriptive and instead, doctoral programs’ structure vary depending on institutional policies around doctoral education. however, the overall expectation is that doctoral programs will “prepare students to be scholars who function as stewards of the discipline” (gade, 2013, p. 1). also, unlike bsw and msw programs, social work phd programs do not consistently focus on providing education or training on foundational social work concepts, practice, or ethics (bradshaw et al., 2021), yet the expectation is that doctoral students will be knowledgeable about the profession, teaching, and research (gade, 2013). this lack of educational emphasis on foundational social work concepts coupled with the expectation that a social work doctoral student be knowledgeable in these concepts creates a peculiar tension for some students given that not all social work doctoral students have formal foundational education, training, or practice experience in social ocampo & blackdeer/we deserve to thrive 707 work. while most entering doctoral students will have an msw degree upon entering a doctoral program, few do not (cswe, 2020). an exact number of students who enter with a master’s degree in a discipline other than social work is unknown. regardless, most social work phd programs require that students have a master’s degree prior to admission, with only a handful of doctoral programs providing an msw along the way (cswe, 2020). the length of time to complete a social work doctoral program varies, however, many phd programs encourage students to graduate within a 4-to-5-year timeline. completion time is in part related to the availability of funding, which also varies. programs might offer partial or full tuition remission, stipends (with or without stipulations), or no funding besides loans. in 2019, 89% of social work phd programs provided some type of funding to incoming students (bradshaw et al., 2021). the availability and quality of funding can have a large impact on the doctoral student experience as many students find themselves in financially precarious positions during their doctoral education. cohort sizes and structures can vary widely from institution to institution and year to year. gade reported that in their 2019 survey, out of all responding research doctoral programs, on average cohort sizes of accepted students was 9, with about 6 being the average of first-time enrolled students (bradshaw et al., 2021). it is important to note that smaller cohort sizes often result in less opportunities for student racial and ethnic diversity. in 2019, the racial and ethnic composition of students enrolled in responding social work research doctoral programs were 46% non-hispanic white, 22.1% non-hispanic black, 11.6% hispanic/latinx, 9.9% asian, 2.8% biracial or multiracial, 0.8% american indian/alaska native, 0.3% native hawaiian/pacific islander, and 6.5% were unknown (bradshaw et al., 2021). yet, the racial and ethnic composition in specific programs can be lower or higher for any institution and cohort. it is not uncommon for bipoc doctoral students to be the only person from their respective community represented in their cohort, as were the authors who entered with a cohort of 9 and 14 students. this lacking diversity can be a source of stress and feelings of isolation for bipoc doctoral students, which impact the doctoral experience significantly. beyond formal coursework and select milestones (qualifying exams, dissertation proposal, dissertation, etc.), many doctoral programs encourage or require students to partake in paid or unpaid research and teaching assistantships, placing students in multiple roles across their programs. in these multiple role situations, doctoral students are first and foremost students, however, they may also serve as teaching assistants or instructors for courses (bachelor’s, master, or doctoral level) and research assistants or research coordinators for research projects. in such projects, doctoral students might oversee other students or work as peers with other faculty. this creates a duality of relationships that is particularly important to note because it creates concurrent shifts in the power dynamic between doctoral students and their doctoral peers, other undergraduate or graduate students, faculty, and administration. further, these dynamics occur in addition to one of the most significant relationships for a student in doctoral education – the advisor/advisee or mentor/mentee relationship. the importance of the advisor-advisee relationship is best captured by the fact that some consider advisors to be a student’s academic parent. the relationship with an advisor advances in social work, summer 2022, 22(2) 708 is defining to the doctoral experience as the mentoring received “has the power to support effective program navigation, enhance student resilience, and improve a variety of professional outcomes” (katz et al., 2019, p. 311). an advisor will often play an important role in socializing a student into what howard (2017) calls the “unique and nuanced culture” (p. 518) of doctoral education. the advisor-advisee or mentor-mentee relationship varies across and within institutions, though typically, students select their advisor based on shared research interests. due to this shared substantive interest, the advisor tends to be the chair of their students’ dissertation committee. doctoral students may also find themselves working on their advisor’s research or collaborating on projects. ultimately, the advisor role is to support the student in building social capital and knowledge that will help them navigate academia and become an independent social work scholar. beyond the professional support, some advisors may also provide students with emotional and psychological support, though the quality of such support will vary from one advisor to another. not surprisingly, the mentoring experience and quality of the relationship between a student and their advisor can also impact a student’s mental health (evans et al., 2018). the doctoral student experience now that we have discussed the social work doctoral student context, in this section we discuss the doctoral student experience broadly, and then center in on the bipoc doctoral student experience. research on diversity in social work doctoral education is wanting (chin et al., 2018). we cite social work doctoral education research when it is available and refer to other bipoc doctoral student research when social work research is unavailable. despite the limited research on social work bipoc doctoral education, we have found that our lived experiences are adequately captured in bipoc doctoral research. being a doctoral student can be a challenging and isolating experience. throughout a doctoral program, students juggle multiple demands (e.g., completing coursework, engaging in scholarly work and its dissemination, teaching, maintaining their well-being, networking, and maintaining relationships) all while navigating a new cultural environment. completing a phd involves milestones and activities that can be distinct from those required for most undergraduate and graduate degree programs so doctoral students may feel like not many other people can understand their experience. in fact, only a small percentage of the general population experientially understand the challenges and demands a doctoral student might face through doctoral study. in 2018, less than 5% of people in the united states held doctoral degrees (u.s. census bureau, 2018). given the racial and ethnic composition of the academy, the sense of isolation may be further compounded for bipoc doctoral students, many of which may be first generation college students and who may not have peers or faculty who they identify with in the academy. in 2020, around 40% of the 6,300 full time faculty in social work programs were bipoc faculty (cswe, 2020). historically, white students and in particular, white males have earned the biggest proportion of doctorate degrees across the board (nietzel, 2019) which suggests that for generations, the culture of academia has been shaped by a white, mainly male lens. this reality has created a culture within the academy that may not feel familiar nor welcoming to bipoc doctoral students or students with marginalized identities. ocampo & blackdeer/we deserve to thrive 709 doctoral students often lack a sense of belonging, which can have an adverse impact on their well-being and sense of self. for example, lacking a sense of belonging has been associated with the presence of impostor syndrome (sverdlik et al., 2020). imposter syndrome, a phenomenon where individuals may feel that they are “frauds” or “imposters”, attributing any successes or accomplishments to external factors (luck, chance, undeserved opportunities, etc.) instead of internal ones (ability, hard work, etc.) (clance, 1985) is common among doctoral students and it has been associated with mental and physical health concerns (sverdlik et al., 2020). not surprisingly, graduate students, including doctoral students are six times more likely than the general population to experience mental health concerns, specifically depression and anxiety (evans et al., 2018). bipoc doctoral students have worse physical and mental health outcomes, in part due to experiences of racism and racial aggressions (microand macroaggressions) throughout the course of their doctoral education (gildersleeve, 2011). racism has been found to negatively impact physical and mental health (paradies et al., 2015). racialized experiences can be a great source of stress to bipoc doctoral students, and as a result, these scholars often engage in self-censorship to moderate this racialized stress (gildersleeve, 2011). this self-censorship is not only counterintuitive to the well-being of bipoc doctoral students, but it can also stifle their voice, sense of self, and creativity, which ultimately negatively impacts the profession. beyond an impact on health, experiences of racism can also negatively affect all aspects of bipoc doctoral students’ educational experiences. for example, bipoc doctoral students “are less likely to receive adequate support for their research, be taken seriously as academic scholars, and be included in collaborative projects with faculty and even their white peers” (brunsma et al., 2017, p. 8). this differential quality of support and mentorship for bipoc doctoral students can make it more challenging for bipoc students to navigate the academy, in large part because mentoring plays an integral role in helping doctoral students socialize into the academy (katz et al., 2019). socialization is particularly important for doctoral students to succeed in a “publish or perish” culture that is common in phd social work programs, especially among those with carnegie classifications of r1 (very high research activity) or r2 (high research activity). the “publish or perish” culture, which essentially suggests that a scholar must have a high level of productivity of quality publications to survive and thrive in the academy, adds pressure to doctoral students early on in their educational journey. germani (2020) found that the highest rated source of stress for participating doctoral students was the pressure to publish in high impact journals. the level of support a doctoral student receives in moderating that pressure to publish and in achieving that expectation is in part closely associated to a student’s advisor and/or informal and formal faculty mentors. for example, advisors and faculty mentors can teach students about the publication process and culture, provide opportunities and resources to make publishing attainable, and ensure that students produce high quality work. because bipoc students do not receive the same quality of support compared to their white peers, their level of productivity in their program may suffer, which could impact how “competitive” they are perceived to be in the job market. advances in social work, summer 2022, 22(2) 710 bipoc doctoral students and interpersonal experiences of racism as previously mentioned, doctoral students simultaneously hold multiple roles (student, peer, colleague, instructor, supervisor, etc.), some of which can create natural tension. for example, a doctoral student is expected to be in a student/learner role while also in an instructor role in which they have faculty expectations placed on them. while these multiple roles can in general create stress, the stress is further exacerbated for bipoc doctoral students who might have to contend with racial aggressions from their professors, colleagues, peers, and students in these various roles. because of the values of the social work profession and its imperative to address racism, oppression, and inequity, discussions around these topics tend to be more prominent within social work education. the presence of these conversations, however, does not mean that these discussions are carried out well or in ways that do not cause harm. for example, predominantly white faculty may not be equipped to handle discussion around anti-racism and might engage in micro and macro aggressions, such as expecting a bipoc doctoral student to become the spokesperson for their racial or ethnic group. as instructors, bipoc doctoral students may be responsible and expected to effectively carry out discussions around racism, power, and oppression, while also experiencing microaggressions from students. these racial aggressions can present in many ways, including students questioning the credibility or qualifications of a doctoral student or giving the doctoral student instructor poor evaluations because of the instructor’s identity. previous research has found that scholars of color are more likely to receive lower formal and informal evaluations than their white peers (chávez & mitchell, 2020; reid, 2010). in the peer relationships, racial aggressions may occur in the ways in which white peers evaluate their bipoc peers’ accomplishments and awards. for example, peers might make off handed comments around bipoc doctoral students receiving preferential treatment in competitive fellowships or even on the job market due to their racial or ethnic identity as opposed to their qualifications and excellence. in a collegial relationship, a colleague might be biased and invalidate or question the qualifications or worth of a doctoral student’s ideas and work. this can be a common experience that can contribute to low self-worth (gildersleeve, 2011). in the advisor-advisee relationships, racialized aggressions can present themselves in advisors providing minimal or unequal support to a bipoc doctoral student. it can also present themselves in an advisor invalidating or dismissing experiences of racialized aggressions that a student brings to the advisor’s attention for support. a frustrating aspect of these co-occurring dynamics is that it is rarely acknowledged that doctoral students must navigate all these roles and the politics that are associated with this positionality. bipoc doctoral students seldom have informal or formal spaces in which they can process their experiences and discuss how they navigate and cope with racialized aggressions from their multiple dual relationships or from the institutions of learning. in social work this is especially necessary because it is frustrating and painful for bipoc doctoral students to experience repeated racialized harm from white individuals who tout themselves as and are elevated as “anti-racists scholars” or “allies”. when bipoc doctoral students might want to address or bring attention to the racialized harm they are experiencing, there are seldom effective systems or supports to address them. while some institutions might have formal bias reporting structures or systems, the nature of racialized ocampo & blackdeer/we deserve to thrive 711 aggressions make it difficult to gather the evidence warranted by these systems to substantiate their experiences. there is also a lack of transparency around how the issue addressed will contribute to overall institutional culture change. these realities force bipoc doctoral students to make difficult decisions that impact their well-being. a bipoc doctoral student might decide to zealously advocate and do what is often unpaid structural work to push their school of social work to become anti-racist. a bipoc doctoral student might decide to simply survive and self-censor to minimize the race related stress they experience. or simply, a bipoc doctoral student might decide to quit their doctoral program. while the dropout rate of doctoral education is generally high, it is more pronounced among underrepresented minorities, 36% of which do not complete their programs (yared, 2016). implications for social work as the profession and the academy begin to contend with their roles in upholding white supremacy and harming bipoc individuals and communities, they must also take important steps to ensure that they are 1) upholding social work values and 2) supporting and bolstering the individuals who will be stewards of the profession. because racism is antithetical to social justice and to promoting the dignity and worth of a person, any conversation, commitment, or action must move our profession toward becoming antiracist and anti-oppressive. anything less than that is a failing of our profession. while we will specifically advocate for and provide a non-exhaustive list of recommendations for how schools of social work can better support bipoc doctoral students, these recommendations can directly or indirectly benefit all doctoral students and the profession overall. practice what we preach one of the most well-known and valuable adages within the social work profession is “meet the client where they are at.” this adage is incredibly important in social work practice, and highly applicable within academic social work settings. in the doctoral program ecosystem, doctoral students can be considered the clients of schools of social work doctoral programs. good social work practice would dictate that a social worker do research to have some grounding understanding of what dynamics may be at play given the client’s background and circumstances. the social worker would then further inquire and listen to the client to understand what the client prioritizes to understand how to best support them. after synthesizing all this information, the social worker would collaborate with a client to develop a plan that will promote the client’s self-determination and wellbeing. currently, schools of social work recruit bipoc doctoral students, yet across the board, it unclear whether schools are collectively researching what might create a supportive environment that will ensure that bipoc doctoral students have what they need to thrive and not just survive. if such research was done, there would be at least a foundational understanding that bipoc doctoral students need concrete support to deal with racialized aggressions, and better yet, an understanding that the culture within the academy must change to truly be anti-racist, welcoming, and inclusive of bipoc doctoral advances in social work, summer 2022, 22(2) 712 students. while administration may engage in some of these activities to some degree, we highlight this as a collective task that needs to be carried out by an entire school of social work (faculty, staff, administrators, etc) because 1) doctoral students will interact with all these actors during their doctoral journey and 2) all these actors contribute to the culture of a school and potentially toward racialized aggressions that bipoc doctoral students may experience. questions that schools might want to consider are, does the school collectively know what research says about the needs of bipoc doctoral students? in what ways are the school and individual actors within the school planning to ensure that those needs are met, and that challenges and barriers are eradicated? if there is resistance within the school, how are administrators engaging and holding those accountable that might not want to engage in this work? what resources is the school making available to ensure that their programs are integrating best practices to support bipoc doctoral students? by doing this at a minimum, bipoc doctoral students might be able to enter academic spaces feeling as if there is an intention and potentially a commitment to create a welcoming and nurturing space. once that research is done, schools of social work must start where bipoc doctoral students are. consider, at any point in the process of welcoming new cohorts, do schools of social work conduct assessments or have conversations to understand what students’ understanding is of what a doctoral journey will entail, including the politics and power dynamics? or do schools understand how a specific student learns and adapts to a new environment best? while many schools assume that these conversations are happening with individual advisors, they may not happen across the board. when the conversations do occur, they are not all handled equally well, leaving it to chance whether the school understands what a student needs to thrive and subsequently, whether a student receives the support needed. it is unacceptable for administrators to assume that these conversations will happen or to leave it to chance that they will happen. since the quality of mentoring for bipoc doctoral students is not as adequate as the mentoring received by their white peers (brunsma et al., 2017), such assumptions can further disadvantage bipoc doctoral students. a key piece to ensuring that bipoc doctoral students are supported is intentionality. doctoral education is often considered to be individualized, at least in terms of research focus and some coursework. it is important that schools of social work recognize that individualization of the education experience extends beyond those domains and that doctoral education needs to be intentionally tailored to each student’s needs. this intentional tailoring requires “starting and/or meeting a doctoral student where they are at” and then collaborating with the doctoral student to develop a plan that will optimize their successful integration into and navigation of the academy. culture transformation one of the largest hurdles toward becoming anti-racist and truly supporting bipoc doctoral students is transforming the existing culture in academia. khinduka (2002) argued “how we teach, how we interact with students and with each other, the seriousness of our scholarly work, and our overall comportment as social work academics play a crucial role ocampo & blackdeer/we deserve to thrive 713 in shaping the culture of our schools” (p. 689). because academia continuously engages in cycles that are counterproductive toward becoming anti-racist and inclusive, anti-racism cannot be achieved in the current academic culture. an example of such a cycle is the difficulty to recruit and retain bipoc scholars to the academy, which is already lacking in diversity and representation. according to a cswe survey on social work education, in 2020 full time faculty in responding schools of social work were 59.5% white, 26.8% were african american or black, 7.8% were latinx, 2.5% were asian and 1.4% were biracial or multiracial, 0.8% were native american, and 0.3% were native hawaiian/pacific islander (cswe, 2020). like bipoc doctoral students, bipoc faculty are disproportionately tasked with the onus of doing anti-racism work with minimal support or acknowledgement (rideau, 2021). bipoc faculty also face racialized aggressions from students and peers, and they often are the ones holding space for bipoc students. these realities place undue burden on bipoc faculty and may impact their ability to achieve tenure and/or desire to remain in the academy (azhar & mccutcheon, 2021; garrisonwade et al., 2012; rideau, 2021). low retention or engagement of bipoc faculty in return can impact bipoc doctoral students’ desire and ability to enter and remain in the academy. disrupting this seemingly never-ending cycle that limits the advancement toward inclusivity requires that schools of social work become intentional about creating a culture that is anti-racist, safe and welcoming for bipoc scholars. this can happen in different ways, however, some opportunities involve: acknowledging the racism and systemic oppression that exists within the academy and formalizing mechanisms that will dismantle these in practice and culture on an ongoing basis. schools of social work need to invest in faculty development to ensure that they can integrate an anti-racist approach and fully support and mentor bipoc doctoral students in a non-biased and anti-discriminatory way. simply put, this is asking social work faculty to engage in the same practice approaches that we teach social work students to do when they practice as social workers. while this can be achieved in many ways, a simple recommendation is preparing faculty to engage with doctoral students in conversations regarding racism, privilege, and oppression. such preparation involves faculty having the humility of not being an expert on a topic while also having sufficient knowledge to call attention to the dynamics at play in the racialized experiences of bipoc doctoral students and holding space for them. additionally, faculty, particularly white faculty, should be willing to leverage their privilege and seniority to step in on behalf of their students when necessary. leveraging privilege to advocate for bipoc students should involve conversations with the student to ensure that the faculty member is displaying thoughtfulness around the student’s comfort and the potential intended or unintended consequences of said advocacy. the faculty member, as much as possible, should respect a student’s self-determination on whether advocacy, if any, should be carried out. it is possible that a bipoc doctoral student may not want to discuss such experiences with a faculty member. however, knowing that a faculty member is equipped to have those conversations in a manner that is validating and supportive will allow bipoc doctoral students to feel supported and can allow other faculty to share the burden of anti-racist work that bipoc scholars tend to heavily shoulder. advances in social work, summer 2022, 22(2) 714 an important way to change the academic culture and support bipoc doctoral students and scholars involves schools being mindful of the seemingly innocuous ways that they burden bipoc scholars with the responsibility of addressing systemic oppression and racism on their own. for example, the way self-care is preached in schools of social work often fails to recognize the legitimate harm that systemic oppression and racism causes bipoc scholars. by not acknowledging those power dynamics, we place the responsibility on bipoc scholars to address factors beyond their control and to be well in spaces that are not conducive to their well-being. schools of social work can also formalize supports for bipoc doctoral students. for example, does the school of social work or institution have support groups or other opportunities for bipoc doctoral students specifically to process their experiences while being their authentic selves? schools should invest in such spaces as they are needed and asked for by bipoc doctoral social work students (mendez et al., 2021) and because bipoc only spaces facilitated by skilled individuals can be restorative and can create community. it should be noted that the group participation is optimized by matching facilitators with group membership. for schools that do not have many bipoc doctoral students, advocating and investing in partnerships among institutions to create such a space can result in opportunities for networking, collaboration, and community building. the coauthors began an informal bipoc doctoral support group due to their administrations inability to effectively respond to bipoc doctoral students request for support with racialized experiences and stressors brought up during a town hall. the group became a safe space for bipoc doctoral students, and it was expanded to include a doctoral student from another school of social work that had no bipoc peers in their cohort. while this is an example that these spaces can be created, and often do exist, formalizing such supports will demonstrate schools of social works’ acknowledgement of and commitment to the needs of bipoc doctoral students. the formalization of such spaces will also remove some of the unpaid labor that bipoc doctoral students take on to ensure that doctoral education is survivable. another type of formalized support for bipoc doctoral students is offering payment for the unpaid labor (e.g., committee work, developing de&i programming, etc.) bipoc doctoral students typically engage in to promote anti-racism and inclusivity for schools of social work. schools that are well resourced might want to consider providing de&i fellowships that provide funding and professional development opportunities. finally, schools can support bipoc doctoral students and move toward a culture of anti-racism by establishing protocols to handle racial aggressions in a way that involves transparency, accountability, and clear communication. while we recognize that employee protections may limit what is disclosed regarding potential incidents of racism and consequences to employees, schools of social work should think about ways in which issues of racism and bias can be addressed more broadly to ensure that the culture of the school does not enable such behavior to occur again. as such, schools should treat incidents of bias or racialized aggressions as opportunities to inform preventative measures so that these or similar incidents do not occur again. schools might want to consider, what does a particular incident suggest about the culture of the school and its role in enabling this incident to occur? what were the dynamics at play and how might the school address these ocampo & blackdeer/we deserve to thrive 715 to ensure that such incidents do not happen again? engaging in this reflection allows schools to shift from seeing racism and bias as solely an individual problem to the systemic problem that it is. schools should follow this reflection with clear steps on how they plan to address potential issues. engaging in this communication and transparency will demonstrate that the school is committed to anti-racist work. it will also give schools the opportunity to be held accountable to its students and to be in a position in which conversations can lead to growth. in summary, structural change happens at all levels. it takes individual actors to do their part, but institutions must match with policies, messaging and general commitments that facilitate faculty in doing this work and facilitates cultural change. table 1 provides identified needs, questions for reflection, and recommendations to address the needs of bipoc doctoral students. table 1. needs, reflection questions, and recommendations to support bipoc doctoral students need questions for reflection recommendations an educational environment that is inclusive, free from racialized & other forms of aggressions • what is your/your institutions approach/framework to creating an inclusive, antiracist & anti-oppressive environment? if you do not have one, what needs to happen to adopt one? • do you & your institution know what the research says about the needs of bipoc doctoral students, & the barriers faced in navigating the academy & a doctoral education? • in what ways are the school & individual actors within the school planning to ensure that bipoc doctoral student needs are met, & that challenges & barriers are eradicated? • what resources is the school making available to ensure that their programs are integrating best practices to support bipoc doctoral students? • if there is resistance within the school, how are administrators engaging & holding those accountable that might not want to engage in this work? • adopt an anti-racist, anti-oppressive & decolonial approach. • ensure faculty & staff understand & apply approaches that promote inclusivity. • engage in productive discussions to address resistance & provide education/training as needed. • research & understand the bipoc doctoral student experience regarding needs & barriers to success. • invest in resources at the individual, administrative, & institutional level to ensure that bipoc doctoral student needs are met. • develop a plan to address identified issues & engage in ongoing quality improvement to ensure that issues are resolved, at the school level, conduct confidential climate assessments, tailored support • do you or your institution conduct formal assessments or have conversations with incoming students/advisees to assess their understanding of what a doctoral journey will entail, including the politics & power dynamics? • do you or your institution understand how individual students learn & adapt to a new environment best? • are there expectations & formalized opportunities to engage students in discussions around how their marginalized identity is impacting their presence in academia. • meet students where they are at. • formalize opportunities (e.g., require individualized goals & plan to achieve the goals for each doctoral student) to ensure students receive individualized support that addresses their needs & barriers. a key piece to ensuring that bipoc doctoral students are supported is intentionality behind individualization of educational journeys. • collaborate with doctoral students across the board to develop a plan that will optimize their successful integration & navigation of the academy. advances in social work, summer 2022, 22(2) 716 need questions for reflection recommendations academic institutions free from all forms of oppression • what is your/your institutions approach/framework to creating an inclusive, antiracist & anti-oppressive environment? if you do not have one, what needs to happen to adopt one? • in what ways are you preparing yourself or is your institution preparing faculty to engage with doctoral students in conversations regarding racism, privilege, & oppression? • in what ways are you measuring if your faculty has humility & sufficient knowledge to call attention to the dynamics at play in the racialized experiences of bipoc doctoral students & holding space for them? • how are faculty, particularly white faculty, leveraging their privilege & seniority to step in on behalf of their students when necessary? • are faculty members displaying thoughtfulness around the student’s comfort & the potential intended or unintended consequences of said advocacy? • what is your school preaching & what are the direct & indirect messages/sentiment/values around addressing systemic oppression & racism within the school? • how do your actions & your institutions actions align with your messages & values regarding addressing systemic oppression & discrimination? • how does your institution handle issues of racism or discrimination? • when issues of bias or discrimination occur, what does a particular incident suggest about the culture of the school & its role in enabling this incident to occur? what were the dynamics at play & how might the school address these to ensure that such incidents do not happen again? • be intentional about creating a culture that is anti-racist, safe & welcoming for bipoc scholars • acknowledge the racism & systemic oppression that exists within the academy & formalize mechanisms that will dismantle these in practice & culture on an ongoing basis. • invest in faculty development to ensure that they can integrate an anti-racist approach & fully support • mentor bipoc doctoral students in a nonbiased & discriminatory way • faculty members should be displaying thoughtfulness around the student’s comfort & the potential intended or unintended consequences of advocacy on behalf of a student. the faculty member, as much as possible, should respect a student’s selfdetermination on whether advocacy, if any, should be carried out. • be mindful of the seemingly innocuous ways that you or your institution might burden bipoc scholars with the responsibility of addressing systemic oppression & racism on their own. • establish protocols to handle racial aggressions in a way that involves transparency accountability, & clear communication. • institutions should engage in clear & transparent communication, as allowable by privacy laws, when incident of bias or discrimination occurs & provide follow up on how this will be addressed & prevented in the future to demonstrate that the school is committed to anti-racist work. concrete and formal supports to navigate the academy and doctoral education • in what ways does your institution embed formal supports throughout the doctoral student educational journey to help bipoc doctoral students navigate the academy & build social capital? • does your institution have support groups or other opportunities for bipoc doctoral students specifically to process their experiences while being their authentic selves? • if your school does not have many bipoc doctoral students, how is your institution advocating & investing in partnerships among other institutions to create spaces that can result in opportunities for networking, collaboration, & community building for bipoc doctoral students. • how is your institution leveraging resources to support students & eradicate barriers to successful learning (financial support, paid service work?). • understand what concrete & formal supports students need to thrive. (this information should be available through the literature as well as through early assessments of needs). • if not in place & if identified as needed & beneficial by students, invest in support groups or other opportunities for bipoc doctoral students to process their experiences while being their authentic selves. these bipoc only spaces should be facilitated by skilled individuals, ideally with shared understanding of the bipoc doctoral student experience & should be restorative & create a sense of community. • offer payment or some benefit for typically unpaid labor (e.g., committee work, developing de&i programming, etc.). ocampo & blackdeer/we deserve to thrive 717 conclusion the social work profession is at a defining moment. will it continue to be complicit in upholding white supremacy and causing harm to bipoc communities? or will it decide to rise to the challenge and embody the code of ethics it espouses? we offered recommendations on how schools of social work can support the doctoral students who will be the future stewards of our profession. while these recommendations are not exhaustive, they provide important first steps that can make a difference in how bipoc doctoral students navigate the doctoral journey and in how anti-racism work is done in the academy. we hope to impart the message that schools of social work must be ready to invest time and resources to truly create a culture of anti-racism. quick fixes or band-aids, such as boilerplate statements of support and reactive formation of committees in response to current events, can be temporarily beneficial but these alone will not move schools of social work to the anti-racist praxis and culture that we need to be in. bipoc doctoral students need sustained commitment, actions, and accountability in order to move beyond merely surviving to thriving. references azhar, s., & mccutcheon, k. p. d. 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(2021). anti-racist pedagogy in social work doctoral education: a compilation of reports. http://www.gadephd.org/portals/0/docs/antiracist%20pedagogy/2021%2005%20anti%20racist%20pedagogy%20in%20sw% 20doc%20ed%20report%20and%20presentation.pdf?ver=ljvps6r2eswlfmxq87 xszg%3d%3d national association of social workers [nasw]. (2021). undoing racism through social work: nasw report to the profession on racial justice priorities and action. https://www.socialworkers.org/linkclick.aspx?fileticket=29ayh9qadxc%3d&port alid=0#:~:text=we%20apologize%20for%20supporting%20policies,work%20profes sion%20and%20in%20society. national center for education statistics. (n.d.). fast facts: race/ethnicity of college faculty. https://nces.ed.gov/fastfacts/display.asp?id=61 nietzel, m. t. (2019, august). five long-term trends in u.s. research doctorates. forbes. https://www.forbes.com/sites/michaeltnietzel/2019/08/06/five-long-term-trends-inus-research-doctorates/?sh=4c21cad0638d paradies y, ben j, denson n, elias a, priest n, pieterse a., gupta, a., kelaher, m., & gee, g. (2015). racism as a determinant of health: a systematic review and metaanalysis. plos one 10(9), 1-48. https://doi.org/10.1371/journal.pone.0138511 reid, l. d. (2010). the role of perceived race and gender in the evaluation of college teaching on ratemyprofessors. journal of diversity in higher education, 3(3), 137152. https://doi.org/10.1037/a0019865 rideau, r. (2021). “we're just not acknowledged”: an examination of the identity taxation of full-time non-tenure-track women of color faculty members. journal of diversity in higher education, 14(2), 161-173. https://doi.org/10.1037/dhe0000139 sverdlik, a., hall, n. c., & mcalpine, l. (2020). phd imposter syndrome: exploring antecedents, consequences, and implications for doctoral well-being. international journal of doctoral studies, 15, 737-758. https://doi.org/10.28945/4670 social work coalition for anti-racist educators [swcares]. (n.d.). about swcares. https://www.swcares.org/about u.s. census bureau. (2018). annual social and economic supplement to the current population survey. https://www.census.gov/programs-surveys/cps.html yared, l. s. (2016, april). a broken pipeline: minority students and the pathway to the ph.d. the harvard crimson. https://www.thecrimson.com/article/2016/4/27/minoritystudents-phd-pipeline/#:~:text=yared,a%20broken%20pipeline%3a%20minority%20students%20and%20the%20pathwa y%20to%20the,numbers%20and%20experience%20at%20harvard author note: address correspondence to autumn asher blackdeer, graduate school of social work, university of denver. email: a2blackdeer@gmail.com http://www.gadephd.org/portals/0/docs/anti-racist%20pedagogy/2021%2005%20anti%20racist%20pedagogy%20in%20sw%20doc%20ed%20report%20and%20presentation.pdf?ver=ljvps6r2eswlfmxq87xszg%3d%3d http://www.gadephd.org/portals/0/docs/anti-racist%20pedagogy/2021%2005%20anti%20racist%20pedagogy%20in%20sw%20doc%20ed%20report%20and%20presentation.pdf?ver=ljvps6r2eswlfmxq87xszg%3d%3d http://www.gadephd.org/portals/0/docs/anti-racist%20pedagogy/2021%2005%20anti%20racist%20pedagogy%20in%20sw%20doc%20ed%20report%20and%20presentation.pdf?ver=ljvps6r2eswlfmxq87xszg%3d%3d http://www.gadephd.org/portals/0/docs/anti-racist%20pedagogy/2021%2005%20anti%20racist%20pedagogy%20in%20sw%20doc%20ed%20report%20and%20presentation.pdf?ver=ljvps6r2eswlfmxq87xszg%3d%3d https://www.socialworkers.org/linkclick.aspx?fileticket=29ayh9qadxc%3d&portalid=0#:%7e:text=we%20apologize%20for%20supporting%20policies,work%20profession%20and%20in%20society https://www.socialworkers.org/linkclick.aspx?fileticket=29ayh9qadxc%3d&portalid=0#:%7e:text=we%20apologize%20for%20supporting%20policies,work%20profession%20and%20in%20society https://www.socialworkers.org/linkclick.aspx?fileticket=29ayh9qadxc%3d&portalid=0#:%7e:text=we%20apologize%20for%20supporting%20policies,work%20profession%20and%20in%20society https://nces.ed.gov/fastfacts/display.asp?id=61 https://www.forbes.com/sites/michaeltnietzel/2019/08/06/five-long-term-trends-in-us-research-doctorates/?sh=4c21cad0638d https://www.forbes.com/sites/michaeltnietzel/2019/08/06/five-long-term-trends-in-us-research-doctorates/?sh=4c21cad0638d https://doi.org/10.1371/journal.pone.0138511 https://doi.org/10.1037/a0019865 https://doi.org/10.1037/dhe0000139 https://doi.org/10.28945/4670 https://www.swcares.org/about https://www.census.gov/programs-surveys/cps.html https://www.thecrimson.com/article/2016/4/27/minority-students-phd-pipeline/#:%7e:text=yared-,a%20broken%20pipeline%3a%20minority%20students%20and%20the%20pathway%20to%20the,numbers%20and%20experience%20at%20harvard https://www.thecrimson.com/article/2016/4/27/minority-students-phd-pipeline/#:%7e:text=yared-,a%20broken%20pipeline%3a%20minority%20students%20and%20the%20pathway%20to%20the,numbers%20and%20experience%20at%20harvard https://www.thecrimson.com/article/2016/4/27/minority-students-phd-pipeline/#:%7e:text=yared-,a%20broken%20pipeline%3a%20minority%20students%20and%20the%20pathway%20to%20the,numbers%20and%20experience%20at%20harvard https://www.thecrimson.com/article/2016/4/27/minority-students-phd-pipeline/#:%7e:text=yared-,a%20broken%20pipeline%3a%20minority%20students%20and%20the%20pathway%20to%20the,numbers%20and%20experience%20at%20harvard mailto:a2blackdeer@gmail.com _________ laura lewis, phd, lcsw, clinical associate professor and assistant dean global partnerships, kathryn mcclainmeeder, lmsw, clinical associate professor, michael lynch, lmsw, clinical associate professor, and marjorie quartley, lcsw-r, assistant director, field education, school of social work, university at buffalo, buffalo, ny. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 517-532, doi: 10.18060/24941 this work is licensed under a creative commons attribution 4.0 international license. defining a trauma-informed approach to social work field education: a path forward for the profession laura lewis kathryn mcclain-meeder michael lynch marjorie quartley abstract: despite the recognized importance of social work field education, concerns about its dependence on already strained service delivery systems for student learning persist. the growing complexity of student needs, and the deleterious effects of covid-19 on service systems adds to the problematic landscape. a trauma-informed approach, because it applies to individuals and environments, presents a useful framework for exploring these concerns. a trauma-informed framework to field education, once defined, could edify the profession's response to these challenges. a qualitative survey (n=103) was developed to aid in understanding trauma-informed practices that support student learning. key findings are that a trauma-informed approach to field education entails creating safe environments where expectations and boundaries are clear, supporting students by processing and validating emotional responses, and utilizing relational, collaborative approaches to supervision. strategies for each area are delineated. barriers to promoting trauma-informed field education include lack of time, and lack of organizational support. authors recommend the adoption of trauma-informed field as a universal precaution approach, ensuring that students experience the principles and atmosphere of a trauma-informed field setting, enabling them to translate these into practice. social work programs are called upon to better support placement agencies and assume more responsibility for training. keywords: field education, trauma-informed, social work education, msw students, supervision social work field education, widely recognized as the profession's signature pedagogy, plays a vital role in the preparation of students for practice (bogo & mcknight, 2006). despite its importance, concerns about its dependence on already strained service delivery systems for student learning and the availability of adequate supervision and support for students while in field persist, leading many to call for alternative models (bogo, 2015). the growing complexity of student needs, and the deleterious effects of covid-19 on service systems exacerbates these challenges. supportive organizational cultures and other elements of a trauma-informed (ti) framework when applied to field education could suggest mechanisms to improve outcomes for social work students, but a ti approach to field education has not yet been well defined. the context of field education: problematic trends in service delivery the current social work field education model relies on practicing social workers to volunteer their time to mentor and teach msw students through agency-based field about:blank advances in social work, summer 2022, 22(2) 518 placements. historically, this model has been sufficient, with practicing social workers agreeing to mentor msw students for a variety of reasons, including their commitment to the profession (bogo, 2015). however, social and economic trends increasingly threaten the prevailing paradigm (bogo, 2015), and practicing social workers face growing demands due to budget cuts and higher caseloads (bogo & mcknight, 2006). social workers are also becoming more at risk of burnout, cynicism, or compassion fatigue due to growing caseloads and intensified needs of clients (knight, 2013; morse et al., 2012). morse and colleagues estimate that 21-67% of mental health workers, including social workers, experience high levels of burnout, defined as higher levels of mental health issues, significant depressive episodes, adverse physical health outcomes, high levels of emotional exhaustion, and low levels of personal accomplishment. these authors note that worker burnout, in turn, has negative consequences for organizations, leading to higher levels of staff turnover and greater levels of absenteeism. greater demands and higher caseloads for social workers results in less available time to supervise students, and less organizational support for permitting practicing social workers to provide field education to msw students (george et al., 2013). student vulnerabilities: changing and diverse student needs the context of field education also presents challenges for students, and the field portion of the social work curriculum is widely known to be a significant source of anxiety (carello & butler, 2015; gelman, 2004). issues of power and hierarchy, for example, can lead to anxiety and to feelings of isolation (litvack et al., 2010), and students with high levels of self-reported pre-placement anxiety may find their learning in field to be negatively impacted (gelman, 2004; gelman & lloyd, 2008). gelman and lloyd (2008) note that preplacement anxiety has the potential to positively impact students, preparing them to overcome perceived obstacles, and exposing them to new client populations, interventions, and programs. at the same time, however, they acknowledge that field can be emotionally challenging and potentially triggering for social work students, impacting their overall experience. social work students come to the profession with higher-thanaverage prevalence rates of trauma compared with the general population (negrete, 2020). once in field, students are often faced with difficult, disturbing, and even traumatic events (didham et al., 2011; litvack et al., 2010), and are more likely to experience retraumatization and report higher rates of indirect trauma, particularly where placements include exposure to intimate partner violence (knight, 2010; tarshis & baird, 2019). the higher levels of stress they experience related to field is predictive of high burnout and secondary traumatic stress symptoms (butler et al., 2016). the growing complexity of student needs in general, not specific to social work, is further cause for concern. students entering higher education are often experiencing or at risk of experiencing mental health issues (auerbach et al., 2018). the world health organization found that 35% of students in higher education reported having a mental health disorder, with depression and anxiety being the most common (auerbach et al., 2018). higher education is often a time of significant changes for students, including changes in self-identity, supports and roles, increased instability, and fluid social structures lewis et al./defining a trauma-informed approach 519 (auerbach et al., 2018). at the same time, students face various competing stressors, including feeling overwhelmed, isolated, and stress about coursework (gruttadaro & crudo, 2012). covid-19's impact on social work though there are no specific studies published at the time of this writing on the impact of covid-19 on field education, logic would suggest that a further taxed social service system would further erode the potential for student learning. the pandemic has exacerbated the difficulties faced by nonprofits in the social sector. despite government support and corporate donations, a third of nonprofits are at risk of closing in the next two years, and approximately one million nonprofit jobs have been lost (candid & center for disaster philanthropy, 2021; hrywna, 2021). since the start of the pandemic, many nonprofits have struggled to keep up with the increased demand for their services and changing operating expenses (candid & center for disaster philanthropy, 2021). for individual social workers and other behavioral health workers, covid-19 has highlighted existing issues across service systems that create high levels of burnout (morse & dell, 2021). while experiencing the shared trauma of covid-19, social workers were expected to provide more services to more people (cohen-serrins, 2021). according to cohen-serrins, social workers are particularly at risk due to factors unique to the profession, including the expectations to navigate complex service delivery systems, the perceived value of social work related to other healthcare professions, and the wide range of services social workers are expected to provide. of note is that morse and dell (2021) found that collaboration and supportive supervision – factors associated with ti approaches – buffered the degree of stress experienced by workers. trauma-informed approach harris and fallot (2001) first proposed a model of trauma-informed (ti) care in response to what was at the time a growing understanding of the high prevalence of trauma (in the general population and among service recipients in particular). rather than acknowledge the ways in which trauma plays a role in the lives of people seeking treatment, service systems had largely ignored trauma as an important factor. the ti principles set out by harris and fallot safety, empowerment, trustworthiness, choice and collaboration – provide a framework for transforming services away from one-size-fit-all models of care to ones that take the individual into account, acknowledge the impact that trauma may have in an individual's life, and are more holistic. ti systems of care are better able to accommodate the needs of trauma survivors, but also provide a better quality of services for all program recipients. some have argued for their universal adoption in recognition of this, likening ti approaches to the universal precautions applied in healthcare settings (e.g., raja et al., 2015; reeves, 2015) and applying the same ti standard of care and intention regardless of whether an individual's trauma history is known. trauma-informed approaches have been discussed in the social work literature in relation to social work practice, and supervision. studies have also demonstrated the need advances in social work, summer 2022, 22(2) 520 for a ti lens in higher education classrooms (e.g., butler et al., 2016; carello & butler, 2015). largely absent in the literature, however, is attention to ti approaches in social work field education (knight, 2018). a ti approach, because it applies to individuals and environments, presents a useful framework for addressing these problematic elements of field education. according to knight (2018), a ti approach in field encompasses: 1) the field instructor-student relationship; 2) environmental elements that are conducive to learning; and 3) responses to the emotional reactions of students. a ti approach, with its emphasis on principles of choice, collaboration, trustworthiness, safety and empowerment (harris & fallot, 2001), aligns well with paradigms that emphasize the field instructorstudent relationship as a potential mitigating factor to field placement challenges (e.g., bennett et al., 2008), as well as those that emphasize the need to normalize and respond to student emotional reactions (e.g., berger & quiros, 2016). knight (2018) advocates for ti approaches to social work field instruction, asserting the importance of relationships, collaboration, trust, reflective supervision, and self-care for student success, and emphasizing the need to normalize student difficulty in field. she offers several case examples of the way in which the principles can be applied as a starting point. trauma-informed supervision and the field instructor-student relationship ti principles have also been applied to models of social work supervision. berger and quiros (2016), for example, found that a collaborative, relational style of supervision, one that was respectful, caring, and supportive of workers, translated to a greater sense of emotional safety and empowerment. according to knight (2019), ti approaches to field education make central the field instructor's role in supporting students. knight asserts that field instructors can mitigate the harmful effects of indirect trauma by developing supervisory relationships that foster feelings of safety and trust, and by normalizing and validating student reactions. this is accomplished by attending to the relational aspects of supervision, and incorporating mutually reflective dialog. unfortunately, work by previous authors suggests that students tend to seek support from friends and family rather than through their assigned field supervisor (litvack et al., 2010). students in this study reported feeling marginalized by placement settings and disillusioned with the profession. while research on ti supervision has not yet been applied to students, the centrality of the field instructor-student relationship has been well documented in the field education literature. fortune and abramson (1993) noted the benefits of a positive, collaborative relationship for improving student satisfaction. others have focused on the specific role supervision plays in supporting students (litvack et al., 2010), and the role the supervisory relationship can play in lessening the impact of indirect trauma on students (bennett et al., 2008). the present study attempts to build on knight's work by defining further how field instructors interpret and apply ti principles in field education. generally missing from the literature are strategies for teaching and supporting students that attend to organizational context, the supervisory relationship, and student factors such as self-care. a survey instrument was administered to field instructors to uncover: 1) practices used to support lewis et al./defining a trauma-informed approach 521 student learning related to trauma and ti principles; 2) the ways in which ti principles are integrated into their teaching and supervision of students; and 3) the challenges associated with the implementation of ti practices in field. instructors were presumed to have a greater knowledge of ti approaches as it is a core component of the student's curriculum. methods participants were 103 field instructors from a school of social work located in the northeastern united states. the convenience sample was recruited via email and asked to complete an anonymous survey related to their role with students. a majority, 67%, were alumni of the social work program. participants were also asked about their practice areas, their primary scope of practice, and the number of students supervised. participants chose from various practice areas with the following being most prevalent in their work: 43% children and youth, 54% mental health, 24% school social work, 23% addictions. micro, mezzo, and macro scopes of practice were all identified, with the majority, 73%, primarily micro practice. participants were asked to report on the number of students they had supervised and 53% had five or fewer. the authors developed the survey with input from social work faculty and field liaisons considered knowledgeable about ti approaches. participants were asked to respond to a series of open-ended questions. these were: 1) “in what ways might you be promoting some or all of the above principles into field education?”; 2) “how do you balance providing continuous positive support while also challenging student learning and providing constructive feedback?”; and 3) “what obstacles do you believe are present in attempting to implement ti principles in field education?” a final optional question allowed for any comments. open-ended responses were analyzed using a consensual qualitative methodology which allows for the integration of multiple viewpoints in data analysis, systematically verifying the meaning of data to build consensus (hill et al., 2005). responses were read closely and coded line by line to identify the salient themes and concepts. the next phase of analysis involved developing connections and relationships between the codes to construct the overarching themes and categories that corresponded with the questions on the interview guide. throughout the analysis, the research team came together to discuss the themes and categories, compare the data across cases, and clarify meaning within the material to enhance the reliability and validity of the findings. see appendix a for the complete survey instrument. results several themes emerged from the qualitative responses, including providing a physically and emotionally safe learning environment for students (orienting to agency expectations, creating clear expectations and boundaries, and field instructor openness and availability), and relational and intentional supervision between student and field educator (processing experiences and emotional reactions, fostering self-reflection and self-care, and normalizing feedback and the learning process). obstacles to employing a ti approach advances in social work, summer 2022, 22(2) 522 include a lack of time, lack of knowledge among other agency staff, lack of institutional support, and student lack of experience. a physically and emotionally safe environment for the student one theme that emerged was the need for safety within the field environment, relating to both physical and emotional safety. a sense of safety is essential for clients in servicedelivery systems to progress with their goals and treatment. findings suggest that establishing a safe field environment was also deemed essential for students, contributing to student learning and development. field instructors reported promoting ti field education through creating a "safe working environment physically and emotionally" and "creating a supportive and uplifting environment." several practices were reported that promote safety for students in field. orienting to agency and expectations field instructors discussed the importance of orientating students to field the agency and agency expectations. these practices included allowing students to attend agency trainings, orientations, and in-services, educating students on assessment and other agency practices, allowing students to shadow the field instructor/colleagues until the student develops skill and confidence, and professional development opportunities offered to the student. key components that field instructors reported in terms of orienting students are "letting students know about what to expect," equipping students with information about the agency, processes, people, and placement activities, and asking about student's comfort levels with activities, and talking about good professional and personal boundaries. one field instructor reported that they "establish clear responsibilities, tasks, and roles while empowering the student – leaving out judgment and building confidence." clearly orientating students to their field organization and expectations helps build confidence, and a sense of safety and predictability for students. creating clear expectations and boundaries in addition to orientating students to the field agency and to organizational expectations, an important element of a ti field environment involves creating clear expectations and boundaries for students. students need to know what is expected of them and how success is measured in the setting. as with any new learning experience, people learn best when information is scaffolded, and experiences build upon each other. a student, for instance, is not able to thoroughly perform therapeutic interventions before learning basic psycho-social assessment skills. field is a learning experience in which information and activities need to be built upon one another. one field instructor described their process of providing intensive training at the beginning of the internship, which "allows students to become independent early on during their field placement. providing them with training on basic skills of the job allows them to build confidence in day-to-day tasks as they continue to grow and learn more complex and client-orientated tasks through the year." other field instructors reported continuous conversations with their students lewis et al./defining a trauma-informed approach 523 about the student's comfort level for tasks and skills. many field instructors reported allowing their students to go through an orientation and shadowing phase before assigning independent and more challenging tasks. one field instructor reported, "through the year the student gains more access to challenging activities. i am there to support them through that process." clear boundaries are another important component in creating a safe field environment for students and promoting ti field practices. one field instructor discussed the connection between client boundaries and student: "i try to find a balance between helping students develop and refine the professional skills necessary to be an effective social worker while also emphasizing the need to recognize the humanity in ourselves and the clients. clear boundaries and expectations are essential between the student and field instructor as well as the student and her clients. one reinforces the other." creating clear and professional boundaries with students is good social work practice and helps students understand their role. one instructor described their process of setting expectations from the beginning in terms of a mutual commitment to a supportive, professional relationship, "with continuous 'modeling' provided through [out the] year." field instructor openness and availability (beyond supervision) the student and field instructor relationship is critical to the educational process and to promoting a ti field environment. a key theme that emerged was building rapport and establishing an emotionally safe relationship between student and field educator. many field educators indicated that this was achieved through the field educator being open and available to students. there is much literature on the importance of the supervisory relationship on field learning and development, but field instructors reported that it is also important to be available and intentional beyond the requisite supervision time. "…there is an open-door policy for students to ask questions frequently." another field instructor reported that they are providing "constant consultation, communication, and guidance." others reported checking in before the start of each day, feelings check-ins with students, making a conscious effort to process difficult experiences immediately (or as quickly as possible), close daily communication, and positive support. relational and intentional supervision the second main theme that was very clear throughout the data was the importance of supervision in promoting a ti field experience. having regular supervision was the primary way that field instructors reported that they are promoting the principles of ti care within field education. field instructors highlighted a few essential elements to supervision that support a ti environment. processing experiences and emotional reactions supervision serves as an important space for students and field instructors to process experiences in field and discuss emotional responses and reactions, especially in light of the fact that students are often faced with difficult, disturbing, and even traumatic events. advances in social work, summer 2022, 22(2) 524 the importance of supervision in allowing students to process and discuss difficult experiences was a strong message from field instructors. "as a supervisor, after client meetings (especially with those that are anticipated to be difficult or triggering), i meet with interns to check-in/process the experience. we then meet for a longer time at supervision to really ‘unpack’ the experience." another field instructor stated that they "have weekly team meetings where student interns can process their events from the week and give each other feedback." other field instructors reported being intentional about discussing trauma and its impact (on both the clients and student) within supervision, encouraging students to talk about their own reactions to client situations they encounter, and normalizing these reactions. another important component of being able to process field experiences is the consistency of supervision. several field instructors reported the importance of having regularly scheduled and structured supervision time with their student. fostering self-reflection and self-care another important component of supervision reported by field instructors was creating a supervisory environment that fosters self-reflection for the student. asked how they balance providing positive support while challenging student learning, one responded, "lots of listening, affirming positive skills, and asking what they might have done different if they could do it again." to foster self-reflection, field instructors also used strategies such as asking open-ended questions, offering students an opportunity to explore different options or scenarios, encouraging dialogue, and rehearsing situations with supervisors. self-care was another important component that field instructors were emphasizing with students. along with fostering an environment for self-reflection, field instructors were utilizing strategies to foster an environment that prioritized student self-care as well. several field instructors reported including discussion about student self-care on their weekly supervision agenda, providing self-care training to students, completing a multilevel self-care plan, and connecting the practice of self-care to good social work practice. normalizing feedback and the learning process many field instructors reported normalizing feedback and the learning process for students. field instructors validated students' experiences as learners and not experts: "as a field instructor i can give them permission to take in the full experience of being a professional learner." several field instructors discussed the importance of positive dialogue and feedback without judgment. "during supervision, i remain non-judgmental and reflect my observations, probe for their thoughts, inquire if there are ways to approach differently, look at things from another angle, etc., give statements that learning is life-long for all." other field instructors stressed the importance of establishing a pattern and expectation of receiving feedback from the beginning of placement, highlighting strengths and opportunities for growth during supervision, and discouraging perfectionism (normalizing making mistakes, and problem-solving). several instructors highlighted feedback as professional development, including one who stated, "i instruct my students in the importance of preparing themselves to seek out lewis et al./defining a trauma-informed approach 525 and to crave constructive feedback as a means of professional growth and development." another field instructor reported that being direct and providing feedback in the moment is a helpful strategy, "this way the constructive feedback is happening in the moment and doesn't feel like anything other than a response to the situation being discussed." highlighting students' strengths, as well as areas for growth was also an important message. one field instructor describes providing a "feedback sandwich! making sure to praise as often as possible, providing feedback in a constructive manner and sooner [rather] than later to allow students time to make corrections and move forward smoothly." barriers to trauma-informed model of field education several barriers were identified by field instructors in terms of the challenges that are present in implementing ti principles into field education. these included many issues relating to organizational structure, culture, and mission. ti system change happens best when adopted by a whole agency or organization (substance abuse and mental health services administration [samhsa], 2014), but many individual clinicians/service providers experience tension with systems of care that are not ti. field instructors reported resistance within their organization to a ti model, staff who are not trained in ti care and who are working with field students, inconsistency in terms of staff approaches to ti service delivery, and a general lack of awareness of the ti model. in short, many service systems have not fully committed themselves to being ti in terms of their culture and practices (both with clients and staff). additional barriers included time (to train people and receive training), and financial and resources constraints. it is not surprising that agencies that were more familiar with ti care and treatment models were more likely to be modeling these practices with students. additional barriers identified by field instructors included (msw) students' lack of experience and knowledge about ti care and practices. many students enter their field practicum without any prior knowledge of or training in ti principles or practices. field instructors suggested that greater training of students is also needed. discussion this study aimed to identify: 1) practices used by field supervisors to support student learning related to trauma and ti principles; 2) the ways in which field supervisors integrate ti principles into their teaching and supervision of students; and 3) the challenges associated with the implementation of ti practices in field. most participants reported being knowledgeable about the impact of trauma on service recipients and reported that they understood the way secondary and indirect trauma can impact themselves and students. the authors anticipated this result because participants were all affiliated with a school program where ti principles are central to the curriculum. these preliminary findings suggest that the survey instrument may be a useful tool in assessing knowledge of ti approaches. several themes emerged from the qualitative responses, including the importance of physical and emotional safety for students (orienting students to agency expectations, advances in social work, summer 2022, 22(2) 526 having clear expectations and clear boundaries, and field instructor being available and open to students), a strong and trustworthy field instructor-student relationship (processing experiences and emotional reactions, fostering self-reflection and self-care, and normalizing feedback and the learning process), and the need for quality supervision, including supporting and normalizing students' emotional reactions to difficult situations. obstacles to employing a ti approach include a lack of time, lack of knowledge among other agency staff, lack of institutional support, and student lack of experience. support was found for knight's assertion that a relational model of supervision is a key factor in advancing ti field education and that student feelings should be validated. table 1. strategies for trauma-informed field education principle field instructor reported strategies additional practices to promote principle safety promoting an open relationship; open-door policy; orienting students to field, letting students set the pace of placement (take on activities when they are comfortable) intentional conversation about safety concerns students may have; discussion of what might make them feel safe, review of safety protocols within agency choice allowing students to choose placement activities and/or clients (when appropriate) soliciting student input into scheduling of field placement; providing opportunities to shadow other staff/departments and/or talk with colleagues collaboration orientating students to field (like that of a new employee); viewing and conducting supervision as collaborative process collaborating on the learning contract development; working collaboratively with a student on a case and/or project; providing student access to other staff/resources within the agency trustworthiness open and honest relationship between field instructor and student; honest and timely feedback to students; scaffolding learning to promote success; promoting selfcare; open door policy (conveying your interest in and support of students) appropriate self-disclosure about your experience as student and early professional; fostering informal ways to connect/interact (lunch together, coffee breaks, etc.) empowerment promoting student success; allowing students increased responsibility within the placement; agency trainings; scaffolding student learning and experience allowing students input into the direction/focus of their placement and learning contract, prioritizing what skills they are hoping to develop ensuring cultural competence processing experiences and emotional reactions; inviting student input regarding difficult experiences understanding the individualized needs of students, paying particular attention to issues of race, gender, and other forms of oppression experienced by a student lewis et al./defining a trauma-informed approach 527 this study was helpful in further defining a ti approach to field education, and uncovered strategies that field instructors are currently using. table 1 below highlights ti principles of safety, empowerment, trustworthiness, choice, collaboration, and ensuring cultural competence (harris & fallot, 2001; samhsa, 2014) and related strategies field instructors reported utilizing with students. further suggestions from the authors of how to operationalize the principle in field education are included. while the above findings further the profession's understanding of ti principles in relation to field education, there are several limitations. first, participants were drawn from a convenience sample of one social work program's community of field instructors, and as such may not be representative. field instructors who participated in the survey may have been more knowledgeable than those in other communities because of their connection to a school with elements of ti care incorporated into its curriculum. secondly, it is possible that response bias influenced results. because of their relationship to the social work program, participants may have responded in ways they perceived to be favorable. finally, while research on students' perspectives on challenges and support in field was cited, student perspectives were not solicited here. the inclusion of students in future research could refine further approaches to field education that enhance students' feelings of support and satisfaction. this current study aimed to uncover ti field education strategies that one group of field educators are already using. further work around trauma-informed field education could strengthen support for a specific ti framework for social work (and other professional training programs). students’ understanding and experiences of a ti practicum should also be considered. a well-established framework could then be used to investigate whether causal relationships exist between ti strategies and student learning, and feelings of support. despite these limitations, results from this study illustrate how ti principles can be applied to field education, calling attention to best practices for supporting students, and helping to identify obstacles that may be present in organizational environments. implications of these findings for social work education are discussed in the following section. implications for social work education: call to action fallot and harris provided a framework for service delivery that considered for the first time the potential for traumatic histories in the lives of individuals seeking treatment, leading to the model’s designation as a universal precaution for service delivery. despite the high stress related to field and the greater vulnerability of social work students to the effects of indirect trauma, the model has yet to be applied to msw field education. we recommend adopting a ti approach to social work field education, establishing this model as a universal precaution for students. this approach honors the student position of learner and asserts the importance of student well-being. the application of a ti approach to field education has the additional benefit of exposing students to the very circumstances we hope they will promote for service advances in social work, summer 2022, 22(2) 528 recipients once they are practicing social workers. emotional and physical safety, collaborative relationships, engaging in self-reflection and self-care; these elements of ti field education mirror the ti approaches now considered best practice in the social work profession. because barriers to ti field education are pervasive in organizations, social work programs will need to assume more responsibility for assessing, training, and supporting agency partners and students. specific suggestions for social work programs are outlined below. assessing and supporting agencies results suggest the need for high levels of supervisory availability and student support and reveal the need for organizational level buy-in. this may be best achieved when the responsibility of educating a student is embraced by the organization (including administrators, supervisors, and other professionals) and not solely the responsibility of the field instructor. social work programs need to assess more than the credentials of individual field instructors and their ability to provide activities that allow students to demonstrate competencies. they need to find ways to better evaluate the organizational culture and commitment to ti learning environments. identifying assessment tools/checklists may help to better evaluate where organizations do well and where they need additional support. social work programs should re-evaluate how they develop and monitor placement sites and the expectations they hold existing organizations accountable to when placing students. social work programs can also assume a greater role in training students, supplementing agency-based field placements with school-based placements, perhaps with faculty in the role of field instructor, establishing and coordinating cross-agency partnerships around student placement, and developing project-based activities that could be useful adjuncts to traditional agency-based placement models. orientations for field instructors, faculty liaisons, and students could be augmented by integrating best practices of ti field education. highlighting the principles of traumainformed care and operationalizing them into tangible strategies in field education will lead to rich learning environments where students, educators, and organizations are equipped and supported. social work programs could provide concrete tools that can be used to promote safety, collaboration, trust, choice, empowerment, and ensuring cultural competence within the supervisory relationship and overall placement experience. orientations would stress the significance of and provide tools for fostering physically and emotionally safe environments while providing relational and intentional supervision. adding ti field education principles and strategies could lead to more rich learning environments and greater support for everyone involved. recognizing the vulnerabilities of students, and the tendency noted by litvack et al. (2010) for students to seek support from friends and family rather than through their assigned field supervisor, social work programs could create alternate structures and opportunities for support. students could be encouraged to meet with other students, for example, to process field experiences, provide support, and empower each other to make the most of their placement experiences. this could include strategies on self-care and lewis et al./defining a trauma-informed approach 529 effective problem-solving. schools could also help to create similar peer support opportunities for field instructors to share experiences and best practices with one another. whenever service delivery systems are impacted, so too is social work field education. thus, social work programs need to develop new and creative ways to add value to our agency partners, better equipping them to respond to the growing needs of students. a ti approach to field education can inform these efforts and provide a path forward for the profession. references auerbach, r. p., mortier, p., bruffaerts, r., alonso, j., benjet, c., cuijpers, p., demyttenaere, k., ebert, d. d., green, j. g., hasking, p., murray, e., nock, m. k., pinder-amaker, s., sampson, n. a., stein, d. j., vilagut, g., zaslavsky, a. m., kessler, r. c., & who wmh-ics collaborators. 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(2019). addressing the indirect trauma of social work students in intimate partner violence (ipv) field placements: a framework for supervision. clinical social work journal, 47(1), 90-102. https://doi.org/10.1007/s10615-0180678-1 substance abuse and mental health services administration. (2014, october). samhsa’s concept of trauma and guidance for a trauma-informed approach. u.s. department of health and human services (hhs publication no. (sma) 14-4884). https://store.samhsa.gov/product/samhsa-s-concept-of-trauma-and-guidance-fora-trauma-informed-approach/sma14-4884 author note: address correspondence to laura lewis, school of social work, university at buffalo, buffalo, ny 14260. email: lalewis@buffalo.edu. https://doi.org/10.1080/07325223.2017.1413607 https://doi.org/10.1007/s10615-018-0661-x https://doi.org/10.1007/s10615-018-0661-x https://doi.org/10.5175/jswe.2010.200900007 https://doi.org/10.1080/00981389.2021.1904315 https://doi.org/10.1007/s10488-011-0352-1 https://scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?article=2156&context=etd https://doi.org/10.1097/fch.0000000000000071 https://doi.org/10.3109/01612840.2015.1025319 https://doi.org/10.1007/s10615-018-0678-1 https://doi.org/10.1007/s10615-018-0678-1 https://store.samhsa.gov/product/samhsa-s-concept-of-trauma-and-guidance-for-a-trauma-informed-approach/sma14-4884 https://store.samhsa.gov/product/samhsa-s-concept-of-trauma-and-guidance-for-a-trauma-informed-approach/sma14-4884 mailto:alex.redcay@millersville advances in social work, summer 2022, 22(2) 532 appendix a 1. what is your primary role with students? � field educator � faculty liaison � task supervisor 2. what areas of practice does your agency focus on? (check all that apply.) � administration/leadership � addictions � aging � child and youth � child welfare � community development/planning � correction/criminal justice � developmental disabilities � displaced persons/homeless � domestic violence � global/international social work � health/medical � immigrant/refugee work � lgbtq � mental health � military social work � occupational social work or rehabilitation 3. what is your primary scope of practice? � micro � mezzo � macro 4. are you a graduate of (this social work program)? ________ 5. what year did you obtain your msw degree? ________ 6. how many years have you been a field educator? ________ harris and fallot (2001) propose core principles of a trauma-informed environment (safety, choice, collaboration, trustworthiness, empowerment, and cultural competence). the next set of questions will ask the strategies you are currently using in your field sites to promote these principles. • safety: ensuring a physically and emotionally safe environment • choice: emphasizing and encouraging individual choice and control • collaboration: focusing on collaborative approaches and sharing power • trustworthiness: establishing trust, making roles, responsibilities, and tasks clear; and maintaining appropriate interpersonal boundaries • empowerment: prioritizing skill building and empowerment • ensuring cultural competence: understanding how cultural context influences one's perception of and response to traumatic events; respecting diversity in what ways are you promoting the above principles (for students) into field education? how do you balance providing continuous positive support, while also challenging student learning and providing constructive feedback? what obstacles or challenges do you believe are present in attempting to implement trauma-informed principles in field education? other comments: abstract: despite the recognized importance of social work field education, concerns about its dependence on already strained service delivery systems for student learning persist. the growing complexity of student needs, and the deleterious effects o... results this study was helpful in further defining a ti approach to field education, and uncovered strategies that field instructors are currently using. table 1 below highlights ti principles of safety, empowerment, trustworthiness, choice, collaboration, an... implications for social work education: call to action whenever service delivery systems are impacted, so too is social work field education. thus, social work programs need to develop new and creative ways to add value to our agency partners, better equipping them to respond to the growing needs of stude... _________ carol hostetter, phd, msw, editor, advances in social work, professor (retired), school of social work, indiana university, bloomington, in. valerie decker, msw, assistant and managing editor, advances in social work, school of social work, indiana university, indianapolis, in. copyright © 2023 authors, vol. 23 no. 2 (summer 2023), i-vi, doi: 10.18060/28025 this work is licensed under a creative commons attribution 4.0 international license. fall/spring 2023 editorial: learning to improve in anti-racism, health care, practice, and education carol hostetter valerie decker in the summer/fall 2023 issue of advances in social work, we are pleased to present 14 original articles and recognize our 2023 reviewers. the articles, related to learning to improve in anti-racism, health care, practice, and education, are written by 48 authors from 25 universities and organizations originating from across the u.s. and finland. we offer five empirical studies and nine conceptual/advocacy pieces for readers to explore new learning in social work practice, policy, and education. we also recognize and thank our 2023 reviewers. the 122 reviewers, representing 87 universities and organizations from 31 states and 7 countries, completed 142 reviews of 74 submissions. anti-racist social work practice addressing anti-racism learning, keenan encouraged white social workers to engage in the re/un/discover heuristic, by which they hold themselves accountable for moving into awareness of personal barriers such as shame and denial as a way to become active anti-racists. when white social workers grow personally into their anti-racist commitments, their social work practice benefits, according to keenan. in response to ongoing blatant and violent racial injustices in the u.s., particularly the murder of george floyd in 2020, cswe established a task force to advance anti-racism in social work education. in this article, fairfax, rountree, murray-lichtman, maldonado moore, yellow bird, albritton, naseh, izaksonas, and williams—nine members of the task force—described the process followed by the task force and presented a participatory exploration of themes in the work of the task force. the paper culminated with several recommendations to advance anti-racist social work education, including calling for a new anti-racism commission at cswe to ensure that anti-racism work persists. fairfax and colleagues concluded that the epas must incorporate antiracism policies, standards and practices, or otherwise, the profession will not meet its mission of social and racial justice. cornell reviewed the literature on anti-racist interventions to compile guidelines for three ways of learning: a course for master’s students, a programmatic design to infuse anti-racist pedagogy throughout the msw curriculum, and a two-day anti-racism workshop. using six anti-racism intervention categories found in the literature, cornell laid out ways to enhance both education and implicit curriculum. additional practical ideas to aid faculty in increasing their own awareness, capacity, and abilities to teach anti-racist pedagogy were seen in buzard’s article. along with an acknowledgement of the oppressive history of the social work profession and its effect on social work education, accreditation, and the lived experience of educators, buzard about:blank hostetter & decker/editorial summer/fall 2023 ii presented strategies to help social work educators improve their personal awareness, deal with resistance, advocate for anti-racist policies, and develop anti-racist pedagogy. lerner and kim conducted a study on students’ experiences with anti-racist education and practice. forty-one students from a bachelor's, master’s, and doctoral program participated in focus groups to reveal themes such as the importance of trust, the challenges of performative relationships, and working with conflict, accountability, and the consequences of mistakes. suggestions for a future course to help white social work students develop skills for developing trust and improving relationships were offered by lerner and kim. innovations in health care health was the focus of the next two articles. simmons, fisher, mcneish, greene, thompson, and galea studied the interprofessional education experience of 38 bsw students working in a student-run free healthcare clinic. students reported improvement in their written and verbal communication skills, confidence, and professional identity. considering the need for free healthcare in our communities, as well as the need for skill building through service learning before the practicum, simmons and collaborators advocated for more social work programs to provide similar opportunities for their students. another health-related need was identified by pattanaik, schueths, lawrence, apenteng, and dounis, through their qualitative study about oral health in rural communities. they interviewed twenty-two older adults to learn how their communities had affected their oral health. barriers such as transportation and lack of services were apparent, yet participants tended to blame individual choices for a lack of oral health participation. pattanaik and collaborators advocated for policies that lower barriers and increase social supports for oral health care in rural areas. social work practice innovations the next six articles addressed issues in social work practice. reamer developed a typology of boundary-related challenges faced by social workers, especially with the increasing use of digital and internet-enabled technologies. these challenges were differentiated by severity, from judgment issues to mistakes and actual misconduct. reamer offered recommendations that can protect both clients and practitioners. deck, eisensmith, skinner, and cafaro provided a systematic review of the literature on parents experiencing high-conflict divorce. social workers who practice in the forensic arena at times must provide assessments or treatment to divorcing parents, and thus find themselves working with conflict resolution, mistrust, and communication challenges. working with divorcing parents also brings the importance of understanding parents’ characteristics, social networks, and satisfaction with agreements, according to deck and collaborators. they advocated the importance of assessing the level of conflict to aid in both practice and policy development. advances in social work, summer/fall 2023, 23(2) iii another article about social work practice addressed client safety, as written by koskiniemi, syyrilä, mäntymaa, ranta, säilä, vehviläinen-julkunen, pehkonen, and härkänen. in finland, social service workers have the responsibility of assessing risks faced by clients, in areas such as physical, psychological, social, or economic safety. koskiniemi and colleagues stated that this legal responsibility in finland goes beyond what is found in other countries, which generally focus on abuse and neglect. in an analysis of four years of reports, the authors found clients’ rights and physical safety to be two of the most-reported categories, and encouraged the development of a strong reporting system and culture for social service agencies. pierce and black sought to connect the long-standing person-in-environment perspective of social work practice with the newly-emerged field of human neuroscience. pierce and black connected understandings of our nervous system and our environment through a new theory they called neurosocial interdependence, situating human neuroscience into the framework of the person-in-environment perspective. the authors advocated the use of neurosocial interdependence in both social work practice and research. social workers who practice in immigration will be particularly interested in the article by epps and organista, who wrote about the promise of community-based case management as a noncarceral approach to immigration proceedings. epps and organista stated that social workers can utilize community-based case management as a way to confront the mass detention crisis in the united states, positioned on social work’s grand challenge of smart decarceration. collaboration between refugee resettlement case managers and social workers can provide strong support to noncitizen clients, consistent with our social work values. examining the trajectory into professional practice was the task of the article by apgar and dolan. taking a developmental perspective, the authors explored the professional evolution of social workers. apgar and dolan discussed the opportunities and challenges faced by social work professionals in early, middle, and late stages of their careers. the effects of education and regulation on social work practitioners were also addressed, with a call for social workers to be change agents for supporting their own careers. covid-19 and social work education the final article by boys and swafford returns us to the height of the covid-19 pandemic, in order to examine its effects on social work students in their educational experience. a combination of msw and bsw students (43 total) were surveyed with both open-ended and quantitative questions for this exploratory study. data collected in january of 2022 during the surge in the omicron variant revealed a mix of student opinions and concerns about the disease. about half of the students were worried or extremely worried about the spread of covid-19, and about half were only a little or not at all worried. students reported a similar mixture of concerns from faculty, as seen in widely varying attendance policies. boys and swafford recommended that social work faculty engage in policymaking at the university level. hostetter & decker/editorial summer/fall 2023 iv 2023 reviewers and affiliations we would like to acknowledge the contributions of the following individuals who reviewed manuscripts for advances in social work in 2023. without their time, commitment, and expertise, advances in social work would not be possible. margaret e. adamek, indiana university roberto aspholm, university of st. thomas (2) amy benton, texas state university joan blakey, tulane university daniel boamah, western kentucky university richard brandon-friedman, indiana university allison buzard, trevecca nazarene university ryan camire, city university of new york (2) danny carroll, indiana university willa casstevens, buena vista university kala chakradhar, murray state university edson chipalo, university of alabama michael clarkson-hendrix, fredonia state university of new york lana cook, university of south carolina elisabeth counselman-carpenter, adelphi university amy cressman, tulane university tianca crocker, university of north carolina anna maria curry, university of maryland erick da luz scherf, university of alabama valerie d. decker, indiana university claire dente, west chester university mark a. dixon, us air force laura donavon, aurora university saadet durmaz, indiana university amy killen fisher, university of mississippi karen a. ford, james madison university trevor gates, university of the sunshine coast cynthia george, tennessee state university lara gerassi, university of wisconsin karina gil, our lady of the lake university virgil lee gregory, indiana university ginger gummelt, lamar university, texas kristen guskovict, klg consulting services, llc and heart of aid work max guttman, mental health affairs amy habeger, delaware state university (2) alicia hawley-bernardez, our lady of the lake university (2) melissa hirschi, utah valley university (2) ariel hooker jones, southern illinois university carol hostetter, indiana university emily ihara, george mason university nia johnson, west chester university (2) hye-kyung kang, seattle university khadija khaja, indiana university mohammad mostafizur rahman khan, indiana university tobias kindler, eastern switzerland university (2) eric kyere, indiana university zulkipli lessy, sunan kalijaga state islamic university advances in social work, summer/fall 2023, 23(2) v patricia levy, fort hats state university patricia logan-greene, university at buffalo (3) robert lucio, university of tennessee robin machattie, siena college mavis major, walden university james marley, loyola university chicago suzanne marmo, fairfield university catherine mazzotta, buffalo state college jessica m. mccallister, university of new england katherine mccarthy, indiana university henrika mccoy, university of texas at austin (2) lisa elizabeth mcguire, james madison university (3) denise mclane-davison, toronto metropolitan university ashley meisner toland, tulane university kelly melekis, university of vermont julie e. miller-cribbs, university of oklahoma (2) rebecca g. mirick, salem state university amy b. murphy-nugen, western carolina university andrea murray-lichtman, university of north carolina laura mutrie, quinnipiac university matthew myrick, widener university tammi l. nelson, indiana university jason newell, university of montevallo priscila norris, university of kentucky mackaully parada vanessa parker, indiana university veronica pear, university of california ebony n. perez, saint leo university phu tai phan, california state university kate phillippo, loyola university chicago barbara pierce, indiana university gerald t. powers, indiana university (2) suzanne pritzker, university of houston brie radis, west chester university mary e. rauktis, university of pittsburgh susan reay, university of nebraska at omaha andrew repp, st. ambrose university dasha rhodes, university of south florida johnny rice ii, coppin state university jacoba rock, boise state university virginia rondero hernandez, california state university jennie ryding, university west linda f. samuel, north carolina agricultural & technical university edward scanlon, university of kansas alice schmidt hanbidge, university of waterloo peter simonsson, temple university karen slovak, capella university (3) andrya soprych, northeastern illinois university tracy m. soska, university of pittsburgh (2) rebekah spiers, louisiana state university cheryl stern, lcsw/ phd candidate icsw anne l. stewart, james madison university paul h. stuart, florida international university sabrina sullenberger, belmont university betty surbeck, west chester university brianna suslovic, university of chicago (2) maria teahan, barry university mark d. thomas, indiana university veronica l. timbers, university of utah hostetter & decker/editorial summer/fall 2023 vi jelena todic, university of texas at san antonio john tracy kristin trainor, ball state university joseph villarama, central luzon state university april viverette beverly wagner, texas woman's university amy ward, east central university lisa werkmeister rozas, university of connecticut david wilkerson, indiana university nicki williamson, indiana university shanika wilson, north carolina central university samantha wolfe-taylor, indiana university valerie wood, simmons university (2) lisa de saxe zerden, university of north carolina (2) amy skeen, simmons university moh. zamili, universitas ibrahimy _________ jandel crutchfiled, phd, lcsw, assistant professor, school of social work, university of texas at arlington, arlington, tx. amy fisher, jd, lcsw, associate professor, department of social work, university of mississippi, oxford, ms. sara plummer, phd, msw, associate professor of teaching, school of social work at rutgers, the state university of new jersey, camden, nj. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 741-757, doi: 10.18060/24962 this work is licensed under a creative commons attribution 4.0 international license. best practices for antiracist education in virtual settings jandel crutchfield amy killen fisher sara plummer abstract: in 2020, resources proliferated for 1) teaching in virtual settings in response to educational disruptions; and 2) antiracist education practices. resources that combined these subjects to suggest antiracist education practices for the virtual setting were comparatively few. in this article, the authors propose ways to connect antiracist practices to virtual education. we begin with an exploration of racism and antiracism. next, we explore existing literature for how racism shows up in the virtual classroom. literature suggests instructor bias, course planning, and course delivery practices can work to uphold racism and manifestations of white supremacy in these virtual settings. drawing from the work of scholars in the area of antiracist pedagogy, we suggest processes educators can engage in for increasing awareness of instructor bias, and for increasing the use of antiracist practices in course planning and delivery to help begin (or continue) the process of implementing antiracist practices in the virtual classroom. keywords: antiracist, white supremacy, virtual education, best practices in the spring of 2020, as society began to adjust to a “new normal” in the wake of the covid-19 pandemic, higher education programs across the u.s. transitioned to virtual learning (maragakis, 2020). in the summer of 2020, a number of universities announced they would offer only online instruction through the rest of 2020, while others formulated plans that included some form of hybrid virtual and face-to-face instruction (inside higher ed, 2020), a circumstance that would persist throughout the following academic year in many cases. while still reeling from the impact of the novel coronavirus, the u.s. witnessed renewed demands for racial justice in 2020, following the intense media coverage of the police killings of ahmaud arbery, breonna taylor, and george floyd (andone, 2021; naacp justice in public safety project, n.d.; taylor, 2020). for months following george floyd’s death, cities across the country witnessed daily protests in various forms that were organized in large part by the black lives matter movement (black lives matter, n.d.) to fight against racist structures and policies embedded in u.s. society (ansari, 2020). these protests were “the most recent manifestations of black dissent” in what is “a history marked by injustice, humiliation, exploitation and the denial of freedom, equality and selfrepresentation” (eduarda gil vicente, 2021, abstract). although the issues and protests were not novel, social work activists and scholars have since issued a renewed call for social work educators, researchers, and practitioners to seize the moment and examine our practices for ways in which antiracist ideas and practices can be incorporated into social work practice, education, and research (hudson & mehrotra, 2021; yearwood et al, 2021). about:blank advances in social work, summer 2022, 22(2) 742 one area that is ripe for examination is the connection of antiracist practices to virtual education (migueliz valcarlos et al., 2020). although resources for either virtual instruction or antiracist education have proliferated (e.g., nichols, a guide to equity and antiracism for educators, 2020; university of mississippi, 2022), comparatively few resources have explicitly applied antiracist educational practices to the online environment. we note here, as explained in more detail below, our conception of antiracism is not the same as equity, inclusion, or diversity in the online setting. in this article, the authors propose ways to connect specifically antiracist practices to virtual education. this is particularly salient given the recent addition to the grand challenges for social work. eliminating racism is a call to social work to confront its history of racist actions and policies with the profession and society as a whole (teasley et al., 2021). encouraging best practices to promote antiracist teaching in the virtual setting would be incomplete without an acknowledgement of our own positionalities (milner, 2007). the first author identifies as a cisgender, straight, lighter skin african american woman who has taught online, face to face, and hybrid courses for the past 6 years at various public, predominantly white, research institutions. the second author identifies as a white, cisgender, straight woman who has been teaching online, face to face, and hybrid social work courses since 2012 at a small public, predominantly white, research institution. the third author identifies as a white, cisgender, straight woman who has taught both online and face to face courses for over 15 years at a large public, predominantly white, research institution. our research collaboration began as a result of our meeting each other through shared experiences at institutions as well as through an organization committed to dismantling white supremacy in social work education. we acknowledge the potential for the privileged aspects of our positionalities to reify white supremacist and oppressive ideologies. we have endeavored in our personal and professional lives to incorporate antiracist actions and ideology. we have also attempted to foreground the voices of bipoc scholars throughout this manuscript. racism and antiracism racism is the manifestation of white supremacy (cross, 2020). white supremacy describes the dominant norms and ways of being that serve to support and maintain institutional and structural racism (davis, 2019; kuilema et al., 2019; leonardo, 2004; minarik, 2017). social work scholars have long argued for the recognition and correction of the influence of white dominant culture and the mechanisms of white supremacy in social work education (abrams & gibson, 2007; almeida et al., 2019; beck, 2019; iglehart & becerra, 1995; longres, 1972; martin & martin, 1995; tascón & ife, 2020). without deliberate intention to do so, whiteness and white supremacy go unseen and unmarked, as they embody the unspoken norms that govern daily life (almeida et al., 2019; beck, 2019; leonardo, 2004). white supremacy is also described as “a mechanism of social control that originated in european imperialism” (almeida et al., 2019, p. 151). in the u.s., race was constructed in order to justify slavery and the eradication of indigenous peoples; the superiority of whiteness was enacted through law (almeida et al., 2019; ortiz & jani, 2010). the odera et al./de-centering whiteness 743 continuation of these effects is apparent in the treatment of mexican and central americans and of muslims (ortiz & jani, 2010). concurrent with the rise of white supremacy, norms and biases emerged (sue et al., 2016). on the surface, physical characteristics such as light complexion, blond hair, and blue eyes are preferred in u.s. society. individualism, the protestant work ethic, and capitalism are normative (sue et al., 2016). characteristics such as the use of standard english, control of emotions, and the written tradition of knowledge transmission are privileged (sue et al., 2016). however, leonardo (2004) reminds us that a critical pedagogy of white supremacy “revolves less around…the state of being dominant, and more around the direct processes that secure domination and the privileges associated with it” (p. 137). this concept will be central to the discussion of best practices for the online classroom that follows below. dominelli (2018) conceptualized antiracism as the bridge between where we are (societies embedded in racist social relations) and the goal of being non-racist societies. in her book on anti-racist social work, dominelli (2018) conceptualized antiracism as action—both personal and collective in organizations and institutions. others have conceptualized antiracism as actions that lead to the dismantling of all forms of racist ideas and policies (national museum of african american history and culture, n.d.; kendi, 2019). antiracism is more than simply being not racist (kendi, 2019). social work scholars have advocated for the use of antiracist teaching practices and content in the field of social work for some time, including teaching students about whiteness and white racial identity (abrams & gibson, 2007) and how to facilitate antiracism discussions within their own communities (loya & cuevas, 2010) and have shown evidence of the effectiveness of these practices (loya & cuevas, 2010). we draw from the work of scholars david humphrey and camea davis (2021) that directly connects antiracist education practices to virtual education to frame our ideas, as well as provide examples of best practices. humphrey and davis (2021) use critical black theory, a metatheory used to examine anti-blackness that underlies many theories, even critical theories. critical black theory also highlights “the ways in which blackness signifies a being and deep embodied knowing” (humphrey & davis, 2021, para. 6). they argue that online learning is an under-recognized and underutilized space for “addressing anti-blackness and engaging in antiracist praxis” (p. 2). nonetheless, they state: white supremacy and its chief actor, whiteness, still maintain a hegemonic hold on online learning. more explicitly, race-neutral language transposes whiteness to educational technology as normative, reifying that white people are the standard for humanity, thus relegating blackness to sub-human. online education operates with race-neutral rhetoric that obscures how race informs everything. (p. 2) how racism plays out in the online environment in order to begin developing an antiracist approach to online learning, the mechanisms that maintain white supremacy must be identified and dismantled. white supremacy privileges white experiences and creates dominant norms against which other experiences are judged (almeida et al., 2019; pewewardy & almeida, 2014). students of color can feel their experiences are not valued, or are co-opted for the purpose of educating their white advances in social work, summer 2022, 22(2) 744 classmates (bernard et al., 2014; blackwell, 2010; ortiz & jani, 2010). virtual experiences of racism are often faced by students of color beyond the classroom as well. they may experience racism from a barrage of sources like print, news, and social media. students may experience racism from other students as demonstrated in instances where white students have called police on students of color simply for sleeping in their dorm rooms or other public places on campus. these broader threats of racism can impact the online environment as well. bias in virtual education technology is not and has never been objective (benjamin, 2019; migueliz valcarlos et al., 2020), yet the general belief is that the virtual classroom is a “non-threatening, unbiased, safe environment” (conaway & bethune, 2015, p. 162). however, without deliberate intention to do otherwise, decisions made about education are filtered through a lens of white supremacy culture and thus reflect it (humphrey & davis, 2021; kuilema et al., 2019; ortiz & jani, 2010). just as educators need to guard against racism in traditional brick and mortar settings, so must social work educators review and reflect on racism in its virtual settings. without a clear exploration of the impact of unconscious bias and racism in these very different settings, and deliberate work toward creating antiracist practices, our field runs the risk of placing students in a dangerous and debilitating virtual environment (hopson, 2014; humphrey & davis, 2021; ortega et al., 2018). this includes the need for self-reflection that examines one’s privilege and power. not only taking stock of one’s privilege in the world based on one’s positionality, but how your privilege can be used to “disrupt the status quo” in the classroom and institution (fellmayer, 2020). beyond implicit racial biases favoring the dominant norm, faculty and administration can hold negative perspectives of virtual learning in general (levin et al., 2018). many social work faculty members have been opposed to remote instruction from its inception and continue to object to this form of education (levin et al., 2018). we saw that the covid-19 pandemic left those in academia who had previously refused to engage in remote instruction without a choice of whether or not to engage. faculty members’ skepticism of the online educational model could impact their interest and ability to explore the current best practices in online learning management systems (lms) including the ways to avoid racist and oppressive approaches online. these biases may include an assumption on how a classroom environment should be “managed.” a sense of control in the physical classroom can mean calling out students’ behaviors deemed negative or disruptive or even disrespectful. this level of control extends to the online setting where students are required to turn on cameras (finders & muñoz, 2021). virtual course development the consideration of antiracist virtual course development must begin with these questions: who is responsible for the creation of online coursework in social work? the characteristics of institutions of higher learning can influence the ability of instructors to implement anti-racist perspectives to social work education. for example, some universities outsource course development or utilize quality assurance agencies to odera et al./de-centering whiteness 745 streamline courses. this may limit the ability to infuse nuanced and diverse material into online courses. other institution-based influences include the financial stability of the institution and whether the funds to hire more faculty and adjuncts to diversify the lens with which courses are taught. some universities lack funds to invest in curriculum innovation in this way. other universities rely on instructors, whether adjunct or full-time faculty, to add relevant sources and material as part of course delivery. when asking, telling, or incentivizing the conversion of face-to-face to online offerings by administration begs certain questions. who gets this opportunity? is it viewed as an opportunity or perceived as a chore? what types of training and resources are provided for the shift in how course content is delivered? what is the racial makeup of the individuals working on these conversions? as stated above, explicit biases against online education and implicit biases connected to race, ethnicity, sexuality, and disability status can operate to maintain structural racism/white supremacy culture if not acknowledged and addressed by educators while developing content for virtual environments. just as traditional on the ground (otg) classrooms should be founded on principles that demand the ethical and non-discriminatory treatment of others, virtual courses need particular and unique attention to this goal (hopson, 2014; humphrey & davis, 2021; ortega et al., 2018). social work education must acknowledge that with the introduction of new and exciting technologies, there is also the potential for innovative ways to enact racial violence (ortega et al., 2018). further, programs are often entwined with course development businesses such as plagiarism checkers and automated online proctoring that are not only lacking antiracist approaches but encourage practices that use online platforms as areas for policing and discipline (finders & muñoz, 2021). content and authors choosing topics and the texts used to convey the principles within these topics is a first step in the planning and creation of a course. traditional literary choices are made based on canon, most often dominated by white, cis/het (cisgender and heterosexual), wealthy men (ortega-williams & mclane-davison, 2021; swcares, 2020). one of the biases of white supremacy central to education is the all-too-often unnamed assumption that only white voices have epistemic authority, which results in the rejection of people of color’s knowledge about their own lived experiences as valuable to learning (almeida et al., 2019; longres, 1972; ortiz & jani, 2010; snowden et al., 2021; tascón & ife, 2020). indeed, ortiz and jani (2010) described universities as the “bastion of euro-american values” (p. 180). the works of writers of color are typically excluded or minimized and offered only during diverse and special weekly topics. this exclusion also comes from a false binary between “quality writers” whose work has been published widely and are often white and those who are authors of color. the underlying message is based on the dominant discourse that white authors offer the standard of writing that is given elevated status in our society (longres, 1972; pewewardy & almeida, 2014; tascón & ife, 2020). the oppression and erasure of articles and texts by people of color not only maintains the status quo, largely advances in social work, summer 2022, 22(2) 746 built by the norms of white supremacy culture, but also alienates the students in the classroom who do not identify as white (longres, 1972). having authors that reflect the diverse student makeup of the class offers them representation and a confirmation of their lived experience (chavez, 2020). this is particularly salient in virtual learning, where students’ interaction with course material is foregrounded, as opposed to interaction with the instructor and others in the classroom setting. meeting students where they are how one views their role as professor will impact how they plan and deliver the content. educators in higher education tend to follow what freire (1970) termed a banking system of learning that assumes students are an empty vessel prepared for the professor to pour knowledge into. this form of education can be described as a form of indoctrination into white supremacy/dominant culture that academia promotes and expects from its students (almeida et al., 2019; chavez, 2020; migueliz valcarlos et al., 2020). the virtual environment exacerbates the potential harm of this model by removing the natural lines of communication between student and instructor made possible by face-to-face instruction. in face-to-face instruction, there is give and take, and the ability to see and address misunderstandings in real time. students in virtual settings can be unaware of how to contact the instructor in case of emergency. if they find themselves falling behind, the anonymous nature of online instruction can enable them to more easily disengage from the course. as students began to wrestle with new expectations of online learning and the additional mental and emotional health concerns, universities have become more aware of the need to focus beyond grades and due dates. programs are emphasizing self-care and work life balance (abdi et al., 2020). faculty are encouraged to seek compromise and understanding as students present with multiple personal and professional stressors that interrupt their ability to complete assignments. yet this push for a more community-based approach to teaching, largely co-opted from communities of color (abdi et al., 2020), may be a temporary salve that will expire once the pandemic subsides. while much is focused on the individual response and exchange between educator and student, these responses are embedded within systems overseen and managed by administrators. faculty are not stand-alone creators of content and curriculum. much of what is deemed professional and suitable for classroom experiences and oversight are led by a leader who sets the tone for the entire school. further, each school or program administration is concurrently led by the larger university leadership that creates a desired culture of academia – one that can focus on community care or maintain steadfast in white supremacy ideals of “objectivity,” “rigor,” and a “maintenance of expectations.” educators are now continually assessing students’ situations during this time. we are called to expand our understanding of how students are experiencing not only their class time but their whole existence in this world. it is necessary to heed these words: “to assume the primacy of the educational institution over the student is regressive” (rorabaugh, 2020, p. 14). administration prefers the status quo, and any changes made tend to be couched in what “can” be done, with specific guardrails that do not allow for messy and uncomfortable odera et al./de-centering whiteness 747 discussions and decisions (fellmayer, 2020). while schools are now introducing “diversity” committees, the use of this term and the need to publicize these changes can actually indicate a lack of true commitment to antiracism and only offer a space to further hide inequities (ahmed, 2012). in true bureaucratic form, policies can be suggested and even adopted, but if practice is not followed this support rings empty. this creates a performative stance that gives the illusion of change without a true commitment to change. furthermore, a committee decision that places antiracism at the foundation of their program can be quickly usurped by authority figures in administration that can simply deny policy changes out of concern for resources (ahmed, 2012). course delivery practices course delivery practices reviewed here are those that can contribute to the maintenance of white supremacy if not critically examined. the virtual environment toprak et al. (2010) explored the necessity for educators to create norms and expectations for interacting with others in the virtual setting. this can be a particular concern when discussing topics such as diversity and oppression (deepak & biggs, 2011). people are in fact more likely to be hurtful, disrespectful, and racist in the virtual environment due to the phenomenon of sharing unfiltered thoughts because a person is behind a screen (ortega & marquart, 2016; ortega et al., 2018). this false sense of anonymity positively correlates with racist actions in the form of responses that are defined as microaggressions. microaggressions experienced by students of color can impact their psychological well-being and academic success (nakaoka & ortiz, 2018), particularly in the virtual environment (ortega et al., 2018). further, a virtual learning situation creates the additional challenge of “reading the room” during which in-person interactions that consider one’s body language, are largely missing (abdi et al., 2020). more generally, the traditional online course may rely heavily on the written word for content, ignoring the wide range of learning styles and ways to conduct knowledge creation. it may ignore the need for context and real-world application, reducing its meaning for those who need to learn in more creative ways (chavez, 2020; migueliz valcarlos et al., 2020). this is particularly important to review when considering grading and how one assesses a student’s capacity to demonstrate what they have learned. the use of virtual teaching spaces may reinforce a focus on content over community as people learn to interact at a distance. a lack of cohabited space and interpersonal interaction may cause instructors to depend solely on content and deadlines (abdi et al., 2020). other features of white supremacy that may arise during virtual course delivery include fear of open conflict, individualism, and the rejection of alternatives to objectivity (brookfield, 2018; katz, 2003; longres, 1972; ortiz & jani, 2010), and these may be particularly difficult to manage in the virtual setting. fear of open conflict may lead instructors to avoid tackling issues of racism when they appear in the classroom. advances in social work, summer 2022, 22(2) 748 individualism may reduce the amount of classroom interaction and groupwork between students reflecting the idea that students rise or sink by themselves. the rejection of alternatives to objectivity can often hamper the voices of historically excluded groups whose beliefs are not reflected in many course textbooks and materials written from a predominantly white perspective. what instructors and departments can do to combat racism in the online environment combining the available scholarly literature with other publicly available sources of information, as well as the current authors’ own experiences, we derived a set of best practices for antiracist virtual social work education, which we present here. we use the term “best practices” with a certain amount of hesitation. antiracism is a critical framework, and critical frameworks seek to encourage users to engage in a process rather than providing prescriptive solutions (leonardo, 2004; mehta & aquilera, 2020). these recommendations are presented as questions so that in the planning and preparation of the virtual coursework and throughout course delivery, instructors can engage in the ongoing reflection necessary to implement these antiracist practices in the online classroom. additionally, we reiterate the process of antiracism due to the potential existence of structural limitations within institutions that may limit the implementation of antiracist practices even as instructors reflect, plan, and prepare for antiracist course delivery. instructors do not all have the same resources due to these structural challenges and this cannot be a one-size-fits-all checklist. instructor self-reflection prior to beginning course development, instructors should take time to reflect on how their own worldviews shape their thinking about students, learning, knowledge, and virtual education. • what biases do i hold about race? am i biased against virtual education? how might these biases impact my course development and delivery? • do i understand and acknowledge the ways in which my own racial and ethnic identity impacts how i see the world? consider how privileges impose blinders on lived experiences and thereby, teaching. one tool instructors can use to help illuminate their own unconscious biases regarding race, skin tone, age, sexuality, disability, and more is the implicit association test (iat) (project implicit, n.d.), which can be found with a quick internet search. course development practices during course development, there are questions educators should answer honestly about themselves and their course in order to avoid supporting and maintaining white supremacy in the virtual classroom setting. if the answers to these questions require adjustments, make them during the process of course development. odera et al./de-centering whiteness 749 content and authors 1. does this course elevate non-white scholars? while preparing the required readings for the course, find non-white scholars and voices on the subject to include (harper & davis, 2016; migueliz valcarlos et al., 2020). as noted above, non-white scholarship often gets stuck on the supplemental readings list. instead, move some of these into the main texts and readings of the course. also, critique the “seminal” works of your course for lack of focus on diversity or perspectives from people of color. in addition, the virtual environment can create many opportunities for providing diverse scholarship and thinking that are not present in face-to-face teaching, such as links to the vibrant and disruptive discourses available through virtual platforms such as twitter, facebook, tiktok, and others (almeida et al., 2019; humphrey & davis, 2021). many social media platforms open up access to talented and thoughtful discourse that may operate under the institutional radar of social work programs and instructors. many social workers engaged in practices, research, and leadership use these platforms for elevating voices of historically marginalized groups. in doing this they are often providing contemporary examples of social work in action. meet students where they are 2. how can i give students grace throughout the course as crises arise, due to either major world events such as the covid-19 pandemic or the vicissitudes of daily life? there is a need to balance giving students all the rigor required with making sure they are not overburdened. part of the ecological approach includes meeting students where they are and allowing them the self determination of their depth of engagement with course material. this is quite easily created in the virtual environment, particularly with asynchronous materials that students can work through on their own time. open lines of virtual communication during crises can provide for allowing grace as long as students are communicating with you. plan clear communication policies about availability, the reality of crises and unpredictability, and the desire not to cause undue stress (clark, 2020). some educators recognized the unparalleled times and chose a more humanistic approach that allowed for a holistic view of a student and their contribution to the classroom beyond what is evidenced in the lms threaded responses. this includes being more open to listening to students’ concerns, extending deadlines, and providing a space to reflect as a community on the effects of what is happening in society (abdi et al., 2020). offering grace and requesting it can help to build a learning community based on reciprocal care, joint community, and rapport building. course delivery practices ongoing self-reflection on how educators are conducting their courses is really the main strategy to avoid maintaining white supremacy in the virtual teaching environment. routinely asking these questions and implementing the recommended steps paves the way for antiracist education in the virtual environment (sulecio de alvarez & dickson-deane, advances in social work, summer 2022, 22(2) 750 2018). if we are going to continue to practice and potentially rely on a digitized education, it is essential we seek to offer an experience that is empowering and offers “opportunities of human connectivity” (rorabaugh, 2020, p. 13). the virtual environment ● does the course offer a welcoming virtual environment that is inclusive of all student identities? the implicit curriculum is as important as the content of the course and can impact how both students (is it safe to express my feelings?) and professors (will they acknowledge me, praise me, or embarrass me?) perceive the classroom. the council on social work education (2015) outlines the necessity to provide an implicit curriculum that is manifested through “the culture of human interchange; the spirit of inquiry; the support for difference and diversity; and the values and priorities in the educational environment, including the field setting, [which] inform the student’s learning and development” (p.14). getting to know students and allowing space for them to bring their authentic selves, including all of their identities, is crucial to ensuring equity in the online environment (harper & davis, 2016; humphrey & davis, 2021; migueliz valcarlos et al., 2020). as chavez (2020) suggests, “first impressions matter” (p. 23). as part of the learning management system introduction, educators can model for students an introduction that includes how their own racial identity is brought forth in their teaching (katz, 2003; sue et al., 2007) and ask students to introduce themselves acknowledging their identities as they feel comfortable. humphrey and davis (2021) offer an explicit and detailed introductory exercise that can be used in both synchronous and asynchronous virtual settings. the exercise has three goals: 1) to allow students a soft entry into the semester and get to know each other; 2) to demonstrate that teaching and learning are not neutral acts—racial, gender, and class identities matter in the classroom; and 3) to allow students to share what is important to them and what they believe is important to learning. the authors provide the detailed assignment guidelines in their article. ways in which white supremacy manifests in the classroom ● do i and the course acknowledge and combat how white supremacy enters the virtual classroom? to combat the privileging of white experiences, ensure that you allow student experiences to be valued in the course and don’t restrict their freedom to engage in the topics (clark, 2020). this can be an especially rewarding experience in the virtual environment as students engage with a wide range of virtual sources outside the learning management system (humphrey & davis, 2021). to address over-reliance on the written word, ensure varied types of assignments beyond papers and discussion boards (e.g., creating videos, role plays, and presentations) odera et al./de-centering whiteness 751 so that value is placed on critical thought even when expressed in ways other than writing (rodgers & summers, 2008). addressing fear of open conflict can be a particularly delicate balance in the virtual setting. set norms and expectations that acknowledge that conflicting ideas are often conducive to learning, while ensuring racial violence will not be tolerated (jones et al., 2018). welcome conflict as an opportunity to model respect for differences and appropriate handling of conflict in the classroom environment. be intentional in naming what is happening (humphrey & davis, 2021). to work against individualism and foster collectivism, encourage students to work together to solve problems and emphasize the multidisciplinary nature of solutions to the world’s problems (harper & davis, 2016). the ways to do this in the virtual environment are myriad—breakout rooms and other tools can be used to successfully encourage group work. humphrey and davis (2021) offer another detailed example of creating collaborative work that is also grounded in students’ experiences. they offer a description of a research methods course that employs critical ethnography tools to design research studies that contribute to creating equity, amplify minoritized participant voices, and humanize the act of research. the rejection of alternatives to objectivity is another way white supremacy invades the learning environment, and in which student’s subjective views are devalued. do your best to lift up student perspectives and expertise in addressing the course content (harper & davis, 2016; ortega-williams & mclane-davison, 2021). ● do i identify and challenge issues of power and privilege within course interactions? use covert, overt, explicit, and implicit incidents as teaching moments for students (harper & davis, 2016). when a student inappropriately uses privilege in the virtual setting, use it to teach about how power and privilege work in and out of the classroom. if we aren’t willing to “go there” with the conversation and stretch our students’ comfort levels, then we are doing a disservice to our profession and future colleagues. this is particularly relevant to online discussions—set norms and expectations at the beginning of the course that allow for this kind of teachable moments. ● how do i allow for mistakes in class when discussing difficult topics? students are scared of making mistakes when having conversations about race/racism, particularly in the virtual environment, where “conversations” occur via discussion board, or are recorded for students not present to view later. explicitly set expectations that mistakes are learning opportunities and are expected as well as integral to the learning process (clark, 2020). conclusion this paper identifies strategies to integrate antiracist practices into virtual education. rather than present an exhaustive list of best practices, the framework and examples given advances in social work, summer 2022, 22(2) 752 are meant to open the door to further examination by educators, and to differing lines of inquiry. antiracist education, we propose, is like antiracism itself—a matter of lifelong learning. becoming antiracist and recognizing where oppressive and biased systems function within the planning and creation of an online course, depends on a shift in thinking that recognizes this as a process and not a product. all syllabi should be considered living documents that change as the professor and the profession grows to embrace an antiracist perspective. considering the history of our professional education as well as the current context will further allow for a more nuanced integration of antiracist content and delivery. references abdi, n. m., gil, e., marshall, s. l., & khalifa, m. 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(2021). we build the road by walking [editorial]. advances in social work, 21(2/3), i-vii. https://doi.org/10.18060/25652 author note: address correspondence to jandel crutchfield, school of social work, university of texas at arlington, arlington, tx. email: jandel.crutchfield@uta.edu https://www.nytimes.com/article/george-floyd-protests-timeline.html https://grandchallengesforsocialwork.org/eliminate-racism/ https://files.eric.ed.gov/fulltext/ej898005.pdf https://coronavirus.olemiss.edu/keep-teaching/ https://coronavirus.olemiss.edu/keep-teaching/ https://doi.org/10.18060/25652 mailto:jandel.crutchfield@uta.edu _________ saanà a. polk, msw, assistant director of field education, school of social work, california state university, long beach, ca. nicole vazquez, msw, mpp, vazquez consulting, los angeles, ca. mimi e. kim, phd, msw, associate professor and yolanda r. green, phd, msw, associate professor, school of social work, california state university, long beach, ca. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 876-897, doi: 10.18060/24472 this work is licensed under a creative commons attribution 4.0 international license. moving from multiculturalism to critical race theory within a school of social work: dismantling white supremacy as an organizing strategy saanà a. polk nicole vazquez mimi e. kim yolanda r. green abstract: the continued presence of racism and white supremacy has risen to a crisis level as today’s global pandemic, police abuse targeting black, indigenous and other people of color (bipoc) communities, and mass urban uprisings rock the nation. this article presents a case study of a west coast school of social work that has carried out a five-year systematic campaign to move all levels of the program beyond a multicultural orientation towards critical race theory. this study reveals the results of a self-organized cross-racial committee within a school of social work, motivated by an ambitious goal to implement a racial justice orientation throughout the school’s personnel, practices, policies, and curricula. the committee has been further characterized by its commitment to engage across the power-laden divisions of field faculty, tenure track faculty, and administrative staff. the article offers documented stages of development, narratives from across differences of identity and professional role, and thick descriptions of strategies that led to the adoption and infusion of an intersectional critical race analysis throughout the school’s curricula. the organic development of the campaign and the leveraging of opportunities throughout the campus and across campuses offer important lessons for other schools of social work undergoing transformational change. keywords: critical race theory, racism, white supremacy, intersectionality, social work education we in the united states are undergoing a period of reckoning regarding the centrality of race and the enduring embeddedness of white supremacy across our institutions of governance and undergirding many u.s. cultural traditions. academic institutions have not been immune to this reckoning as their role as the nation’s educators and guardians of democratic values have continued to be subject to contentious debate and policy struggles. while academia has always served as a battlefront for the ideological tug-of-war between the political divides that shape and reshape this nation, the words white supremacy have emerged as signifiers of the “problem,” on the one hand, and the framework of critical race theory (crt) as a possible pathway to repair, on the other. in the dizzying context of mass awakenings and rapid-fire backlash, they have also become ideological and policy targets launched from the highest levels of governance. the school of social work (ssw) at california state university, long beach (csulb), like many other academic programs, faced its own moment of reckoning during the summer of 2020. as cities across the country erupted in mass uprisings, the streets of about:blank polk et al./moving from multiculturalism 877 long beach, with a long legacy of police violence concentrated in its black, latinx, cambodian, and samoan neighborhoods, were occupied with protestors outraged with the killings of george floyd, breonna taylor, ahmaud arbery, and others, but also local conditions in which 90% of the 33 police shootings from 2014 to 2019 targeted people of color (rasmussen, 2020). students at the csulb ssw demanded a response from the school, leading to a series of three town halls addressing the state of white supremacy in the nation, long beach, and within the ssw. the results of the town hall aligned with the school’s move towards a crt framework already in progress and amplified the urgency for these transformations. by summer 2020, the school’s field seminar instituted an entirely revised curriculum, centering the creation of brave space (arao & clemens, 2013), a just practice model (finn & jacobson, 2003), the approach of liberatory supervision (rivera et al., 2013), and storytelling exercises that encouraged each student to connect their lived experience to social work education. the first formal day of the fall semester 2020, the director of the ssw held a meeting that was mandatory for staff and full-time, part-time, and adjunct faculty. at that meeting, the director of ssw announced that crt was to be centered across the ssw curricula. core student organizers of the summer’s town halls also requested their presence to read a letter outlining their recommendations for necessary changes in the school including transparency about the role of white supremacy within social work and the incorporation of crt throughout all courses. later that week, a group of 16 faculty and two student organizers met to share the specific ways crt was already planned to be incorporated into the curriculum. by fall 2020, courses in field seminar, policy, human behavior in the social environment, advanced social work practice, and a new elective on latinx issues in social work centered crt in central readings and content, integrating race and intersectional perspectives throughout each section of the course. what made this rapid incorporation of crt possible, some paralleling the time frame of the summer uprisings and town halls? this paper chronicles the shift of this social work program from multiculturalism to crt as a long-term organizing project, one that started in fall 2015 when an item prioritizing diversity in the school’s strategic plan translated into an ad hoc voluntary diversity committee that first met in february 2016 by late january 2020, just a month before in-class instruction ground to a halt due to covid-19 and four months before the uprisings in response to police violence, the csulb ssw faculty had formally agreed to the exploration of crt as a central feature of a curricular revision, one that could more effectively address not only race but other issues of intersectionality. by the time the summer town halls brought to attention what many students addressed as the woeful lack of preparation of some social work instructors to address issues of race within the classroom and the failure of its curricula to effectively address contemporary issues of racism and white supremacy, the ssw had already engaged in a process to bring about these changes. while covid-19 stopped short a planned series of meetings set for spring 2020 to move these changes forward in what the school hoped to be a methodical and coordinated effort, initial efforts by faculty had already been underway and continued, albeit in a context of crisis, throughout the spring and summer of 2020. in this case, this process was not the response to a set of demands nor a mandate for accreditation. rather it has been a slow, determined, and strategic organizing effort advances in social work, summer 2021, 21(2/3) 878 spearheaded by a tenacious group of field and tenure-line faculty. this cross-racial group, primarily made up of black, indigenous, and other people of color (bipoc), had been motivated by personal and academic workplace concerns from such standpoints as race, sexuality, and immigration status, but united by a common vision, that is, to center racial justice through changes in curriculum, recruitment, and ssw-wide policies. the collective drive has been for a school of social work that can genuinely provide social work education that is relevant to the realities of the enduring inequities and injustices that plague our academic institutions and communities, and welcoming to students who represent those most impacted and who should be positioned as effective agents of social change. as the csulb ssw continues its journey to this ambitious goal, this case study serves as a vehicle for self-reflection and an opportunity to share lessons learned. critical race theory and social work although some academic disciplines have centered white supremacy and the concept of crt for decades, social work as an academic discipline has been a late comer to these discussions. the expansive literature on crt includes many interpretations and applications across disciplines. core tenets of crt include: (1) race as a social construction, (2) racism as an everyday occurrence, (3) critique of liberalism, (4) importance of counternarratives, and (5) intersectionality (crenshaw, 1991; delgado & stefancic, 2001; razack & jeffery, 2002), all described below. critical race theory’s tenets provide a framework for understanding the white supremacist structure in the united states and can be used as the foundation for racially just social work practice. the first tenet of crt is race as a social construct, invented and used to reinforce and maintain white supremacy (delgado & stefancic, 2001). second, due to the embeddedness of white supremacy throughout the structures of u.s. society, racism is an everyday, not aberrant, experience for bipoc (delgado & stefancic, 2001). bipoc experience this racism at both individual and systemic levels. crt further challenges liberalism’s myth of meritocracy, the notion of an equal playing field that places the praise or blame on the individual for their successes or failures in life, rather than rooting inequities in systems and institutions (razack & jeffery, 2002). another key tenet of critical race theory that is integral to anti-racist social work is the importance of counternarratives (delgado & stefancic, 2001), which focus on stories directly narrated by those most impacted by social inequities or systems of domination. kimberlé crenshaw’s landmark 1991 article introduced the concept of intersectionality, in which she asserts that people from historically marginalized groups do not all share the same experiences of interpersonal and systemic oppression – nor is there a single pathway to liberation. intersections of multiple identities such as race, gender, class, sexuality, and ability are subject to differing dynamics of power and privilege, and must be taken into account in the analysis of individual and systemic oppression. crenshaw (1998) also insists that the ultimate aim of crt is social transformation. although social work is not entirely new to this dialogue (abrams & moio, 2009; kim, 2019; constance-huggins, 2012; kolivoski et al., 2018; ortiz & jani, 2010; razack & jeffery, 2002), the field’s handling of issues of race has been grounded in a looser polk et al./moving from multiculturalism 879 framework of multiculturalism, the name, itself, suggesting the prioritization of the term, culture, as opposed to race (nadan & ben-ari, 2012; park, 2005). multiculturalism, while offering an initial opening to discuss categories of race and ethnicity as early as the 1980s when it first became popularized within social work, fosters a pluralistic diversity approach rather than one firmly rooted in the notion of power (aldana & vazquez, 2020; gollan & o’leary, 2009; gorski, 2006). the endurance of this limited framework within the social work field has stifled the explicit naming of white supremacy and the primacy of patriarchy, propertied class domination, heterosexism, cisgender privilege, ableism, and nativism not only as bedrocks of u.s. society but also as dynamics underlying social work as an academic field and as a profession (abrams & gibson, 2007; kim, 2019). the csulb ssw, similar to many schools and departments of social work across the united states, is guided by a loose definition of social justice as a tenet of the national association of social work’s (nasw; 2017) code of ethics and a commitment to vulnerable people. similarly, the council on social work education’s (cswe; 2015) educational policy and accreditation standards (epas), which guides accreditation for all schools of social work, employs the language of diversity without specifically addressing race or racism – until the just announced 2022 proposed revisions (cswe, 2021). the multicultural frame embedded within the two primary organizations of the social work field promotes the acknowledgement of differences, disparities, and the prioritization of vulnerable populations and until recently has fallen short of identifying racism, white supremacy, and their intersections with other categories of identity as systems of ongoing oppression (abrams & gibson, 2007; jeyasingham, 2012). this stance of inclusion often reduces to an occasional mention of specifically named marginalized others, leaving unstated the centrality of race-neutral, implicitly meaning white-centered, perspectives on social work and its sub-disciplines (abrams & moio, 2009; nadan & ben-ari, 2012). because of the endurance of the multicultural framework and the relative newness of crt into the social work lexicon, schools of social work have remained largely murky regarding the centrality of race and intersectionality within their curricula and overarching practices and policies (abrams & moio, 2009). in fact, a review of the literature reveals a paucity of examples in which schools of social work have concretely integrated racial justice into their programs, with an exception highlighting the sibling school featured in this paper (nakaoka et al., 2019). given the exploratory nature of the inquiry into transformational change in schools of social work, we use this case study to: (1) highlight the centrality of crt as a guiding framework for our social change work, centered on internal transformations within our ssw; (2) employ the use of counternarratives as an example of a crt tenet that informs this paper’s methods, and (3) draw out lessons learned from our on-the-ground experience that echo crenshaw’s insistence that crt not remain an intellectual exercise but, rather, serves the greater goal of social change. method this case study (yin, 2018) presents a five-year evolution of one social work program, csulb ssw, from a multicultural frame to its initial adoption of a crt and broader advances in social work, summer 2021, 21(2/3) 880 critical pedagogical framework. while the narrative centers a chronological timeline from fall 2015 to fall 2020, the case study is also embedded within a time period in which u.s. political shifts form an important context in which change takes place. the focus on the trajectory of an intentional strategic or organizing process intersects with key political events which also influence the perceived relevance of and receptiveness to greater emphasis on issues of race and white supremacy which underlie the move towards a crt lens. the paper also incorporates an explicit reflexive perspective (arday, 2018; maxey, 1999). in alignment with the crt tenet of counternarratives (delgado & stefancic, 2001), that is, the need for bipoc to tell their stories, often in contrast to the dominant narrative perpetuated against oppressed groups, this case study is authored by actors critical to the events described. three of the study’s authors are among the key participants in the csulb ssw diversity committee, which was a key driver in the activities leading up to and including the implementation of crt, still in its early stages as of the time of this paper. one author is the former field director and chair designee of a sibling master of social work program at california state university, dominguez hills, known for being the only school of social work founded on crt. all of the authors are cisgender women who identify as field, former field, or tenured faculty of color, with the latter having started participation before achieving tenure. the data are derived largely through their personal notes, meeting minutes, informal surveys and evaluations of events, interviews with key participants, and their reflections on the meaning derived from their participation in the development of the adoption of crt as a critical lens through which the csulb ssw curriculum would be organized. the diversity committee: an organizing strategy unfolds centrality of organizing by the fall of 2015, a conjuncture of seemingly insignificant factors came together to fuel the beginning of the ad hoc diversity committee in february 2016. individuals driven by diverse motivations stepped up when eyeing an opportunity and chose to turn to each other for solidarity. the construction of this case study reveals how the dynamics of collective action, in this case, built upon a disparate group of people with a vision of racial justice, joined to create a critical mass that gathered in strength, waned to near exhaustion, and gradually gained energy and traction. this is ultimately a story of organizing– identifying problems, recruiting like-minded people, taking advantage of opportunities while creating new ones, and deploying a variety of tactics to reach a goal that, as it turns out, many more now hold as their own. key elements of community organizing such as identifying common goals, building trust across differences, and working within and pushing against cultural and structural constraints, were used both consciously and instinctively. polk et al./moving from multiculturalism 881 foundational building blocks: the strategic plan in the case of the csulb ssw, the principles of social justice, commitment to vulnerable populations, and framework of multicultural diversity offered some scaffolding upon which to build. in recognition of the need for ongoing institutional commitment, the ssw’s strategic planning committee crafted within its strategic plan 2012-2015 the creation of a “comprehensive diversity plan” and the goal to build a more “inclusive environment among faculty, staff and students” (california state university, long beach, school of social work [csulb ssw], 2015, p. 12). within that plan was the stated hiring of diverse faculty and staff and recruitment of diverse students in addition to curriculum development, internal trainings, cultural exchanges, and the exploration of a standing diversity committee among its activities, using language firmly within a multicultural framework. the strategic plan 2015-2018 (csulb ssw, 2018) repeated the comprehensive diversity objective verbatim (p. 12). by fall 2015, the new ad hoc diversity committee was created to carry out the strategic plan’s diversity efforts. the initial committee consisted of a cross-racial group of faculty. of the eight initial committee members, four were field faculty, and four were tenure-line faculty with two still pre-tenure. yolanda green, an african american tenure track professor, now tenured and co-author of this paper, took the helm as the chairperson of the newly formed ad hoc diversity committee. the director of field, a white woman who was well respected as an anti-racist ally and strong proponent of field, also played an important role in the early formation of the committee. this study reveals varied motivations; for some, this represented a long-awaited opportunity to address a history of shortcomings particularly with regard to race. while the language of the strategic plan and the written charge of the diversity committee, including its name, reflected the multicultural framework, the majority if not all of the committee members understood the activities through the lens of racial justice. leveraging university-wide resources established in the 1970s, the office of multicultural affairs (oma) had long served as the csulb’s hub for trainings, professional development, and other types of support to address diversity among the campus’s student, staff, and faculty bodies. while the very name of the center connotes the multicultural era in which the oma was born, the content and spirit address race and racism as well as homophobia and heterosexism. diversity committee members who had a longer history on campus were familiar with the personnel at oma and urged the committee to reach out to connect to the resources that the oma might offer. this collaboration was auspicious. oma staff provided an “outside” yet familiar set of actors who could deliver educational trainings while also touching upon personal issues that could expose tensions and vulnerabilities. the ssw director and assistant to the director also accommodated the trainings which needed to be voluntary by attaching them more conveniently to faculty meetings and offered refreshments, not easily procured in a resource-poor environment, as an enticement. advances in social work, summer 2021, 21(2/3) 882 by late fall 2016, the school’s director stepped down from the committee to allow for its autonomy. oma staff worked closely and collaboratively with the diversity committee to customize workshops, the first in what was called the “diversity series” entitled “unpacking diversity: creating a common language.” this provided a beginning, one where the staff and faculty could start to be vulnerable with one another and consider the varying identities that they, as well as their students, bring. part of the success of the oma-led workshops was due to careful advance collaborative preparation and close attention to the specific needs and characteristics of the ssw. during the workshop, the oma also elicited feedback on the perceived barriers to diversity trainings, and yielded responses that revealed negative connotations associated with such trainings based on the fear of exposure and discomfort, and a presumption that these trainings would offer only surface level engagement, making little difference in the status quo. in fact, the combination of didactic and personal activities provided opportunities for self-reflection and collective sharing that the ssw found informative and energizing. a list of future topics elicited interest across intersectional categories, offering the diversity committee ideas for future trainings and, as important, an iterative process that would ensure relevance and foster ownership across stakeholders. the precedent for data collection and evaluation set by the oma is something that would be repeated throughout the activities of the diversity committee. perseverance through difficult times the direction of the next workshop came after the review of the first workshop’s data and the discussion of student feedback regarding their experiences in the classroom. the annual evaluation of student, alumni, staff, and faculty experiences revealed high levels of satisfaction with the program overall. but feedback on classroom experiences where instructors were unable to respond to challenging questions or situations regarding race and other intersectionalities remained troubling. as a result, the diversity committee felt it important to discuss the topic of microaggressions and again partnered with oma to broach this topic. this workshop began to unveil an emerging theme where faculty wanted practical ways to engage their students in the classroom around what they perceived to be challenging or sensitive topics. they wanted to know how to create spaces for this type of discourse and then how to navigate these conversations should they arise. this was fueled even more so as our nation grappled with the leadership change and the climate brought with it. with the surge in white supremacist ideologies and fear being purported against people of color, particularly those of latinx descent, the ssw overall had an even greater responsibility to address issues around race and action in the classroom. in february 2017, the diversity committee reached out to the campus dream center, a resource for undocumented students, to provide rapid response information on the california dream act and its impact on the deferred action for childhood arrivals (daca) program. one month later, the ssw held the training on microaggressions. throughout this period, a beleaguered but determined team continued to meet, no longer on a regular monthly basis but with enough frequency to maintain once-a-semester staff and faculty workshops. the director of ssw and the steadfast assistant to the director polk et al./moving from multiculturalism 883 continued to accommodate and encourage the trainings, creating space by continuing extended time of 60 to 90 minutes at the beginning or end of at least one faculty meeting per semester. in the next training on intersectionality during the spring 2018, faculty again wanted to know how they could operationalize what they were learning. considering the context of the climate, the feedback from students and the request from faculty, it became clearer that now would be the time to introduce the concept of crt. the desire for practical techniques was partially spurred by the need for a framework that moved from diversity and multiculturalism to a spirit of critique and reflection. from multiculturalism to critical race theory: reaching out to a sibling program at this point the committee dwindled to two members, both initial participants of the ad hoc diversity committee, saanà polk and mimi kim, two of the co-authors of this paper. saanà polk, who had been field faculty at csulb ssw since 2013 and was a former assistant director of field at california state university, dominguez hills (csudh), began to reach out to her former colleague, nicole vazquez, who at that time was the director of field education at csudh. vazquez, an expert in crt and its application within a social work context, had already let polk know, informally, that she would be willing to share her knowledge with csulb. at the invitation of the diversity committee and with the support of the ssw director, nicole vazquez provided what was meant to be a one-off crt training in spring 2019. given that crt has characterized the core of csudh since the inception of the program, the training provided an effective balance of information while also modeling how its content could be shared in an instructional classroom setting. the faculty erupted into engaged discussion as she introduced the concept of brave space, inviting openness into the workshop, and shared a brief history of crt along with its fundamental tenets. the previous workshops prepared staff and faculty for vulnerability and self-reflection, also offering some preliminary language on race but often cushioned under a more understated language of diversity, microaggressions, and intersectionality. in a school of social work long embedded within multiculturalism, these initial dialogues prepared staff and faculty for the notion of brave space and the more radical language of white supremacy. evaluations revealed a high degree of excitement over the crt training and the desire for more hands-on application. while opportunities for extensive in-depth training by nicole vazquez were limited, the team considered how capacity could be built internally. how could the shift be made from a model of skills building that relied upon outside consultation to one that could be sustainable, that is, offered from within the internal resources of the ssw? looking to the diversity committee’s original goals and turning to the foundations of community organizing, the remaining committee members consulted with vazquez to formulate the idea for a year-long intensive training for ssw volunteers interested in gaining more expertise in crt. the team of two also hoped that what they envisioned to be a handful of participants might take on the role of renewed diversity committee members. with the advances in social work, summer 2021, 21(2/3) 884 support of the ssw director, a contract was negotiated with vazquez for what was planned as a year-long series of in-person and remote consultations. as a team of two, saanà polk and mimi kim had also been struggling to identify a way to re-energize the committee. at the same time, the high degree of participation and enthusiasm during what had been over three years of consistent trainings indicated considerable interest within the broader body of staff and faculty. what vazquez was able to contribute was an anti-racist framework that appealed to the growing desire for an alternative to an outmoded multiculturalism and concrete examples of its application to a school of social work setting. evaluation results revealed a demand for more detailed content, vignettes of classroom situations, and examples of exercises, indicating a readiness among much of the faculty for the potentials for implementation within the csulb ssw. in the fall of 2019, vazquez returned with a practice-based crt workshop where the staff and faculty could practice critical conversations with students. vignettes featuring challenging and realistic classroom situations revealed an unevenness of comfort and the need for more opportunities for practice and skills sharing. in the faculty meeting following the second crt workshop, the team of two were ready with sign-up sheets for a proposed year-long study with vazquez. surprisingly, over 21 people signed up, and 17 people attended an in-person meeting in december 2019 in which initial plans were drawn up. remarkably, the volunteers also represented each of the curriculum sequence areas. the level of enthusiasm and urgency was palpable. participants generated a long list of ideas, strategies, and internal resources that could be mobilized towards not only an improved climate for diversity and equity but a more radical transformation of the ssw. because of the already existing ad hoc diversity committee, the name, diversity task force, was adopted to distinguish it from what appeared to be a more coordinating and logistical body and to prevent any bureaucratic constraints that might squelch the energy of a flexible, voluntary formation. a request for new members for the diversity committee elicited an enthusiastic response from three of the newer field faculty members, all women of color. in fact, the composition of field faculty which had been at two out of eight members in 2012 shifted to all eight field faculty identifying as bipoc by january 2020. a follow up meeting facilitated by vazquez in january 2020 resulted in a consensus among diversity task force members to incorporate crt content into the coursework, provided that the overall faculty would accept the recommendation. on january 28, 2020, a diversity task force member, in fact, the chairperson of the curriculum committee, presented the proposal at the faculty meeting. based upon the reasoning that the crt was aligned with a long-term trajectory already set in motion and that they met the anticipated 2022 changes in the cswe’s epas for more responsiveness to race and equity, the ssw approved the shift to crt content throughout the curriculum. the diversity task force was slated to meet in march of 2020 to engage around strategies of support for faculty and to continue the year-long study, but due to covid-19 plans were halted and the focus quickly shifted to supporting student’s current learning needs. by early june, the police murders of george floyd, breonna taylor, and other black people rocked the nation and the world as protests ensued across the globe. the country had reached its tipping point, and the issue of race exploded yet again. polk et al./moving from multiculturalism 885 as many struggled to manage their own pain, the school began to hear an outcry from students for a response and a call to action. as staff and faculty began to connect with students, it became clear that although the diversity committee had been working on efforts to strengthen the curriculum and instruction, these efforts had not been communicated to the students. a cadre of students emerged and expressed their disappointment. an uneasy and unprecedented level of partnership between students and faculty moved towards the organization of three critical town hall meetings and ways to impact structural change within the ssw. the students were explicitly clear about including more required readings by authors of color and the need for unapologetic conversation about white supremacy woven throughout society as well as in the field of social work. they spoke volumes about the need for transparency, more student involvement, and accountability at the level of faculty and the administration. in response to their call, a compilation of themes and action items from the summer’s town hall meetings were put together and posted on the school’s website. the students’ statement read at the fall semester’s first staff and faculty meeting set the tone for a new responsive and radical direction in the csulb ssw – signaling a reckoning with social work’s legacy in upholding white supremacy and its commitment to racial justice. the narrative outlining the shift from multiculturalism to crt reveals the long-term, uneven, and ever-persistent course underlying what can be described as an organizing campaign to transform ssw’s orientation towards race and other categories of intersectionality. however, it is the police terror of the summer of 2020, the global uprising that reached every street and campus across the country, and the organizing power of the ssw’s student body that brought the ssw to the level of mobilization that is now bringing sweeping changes at long last. the story told through intersectional positionalities in the spirit of the counternarrative tenet, three authors share their personal narratives below. saanà polk my involvement in our diversity committee was birthed out of a place of reflection. the journey began long before i entered the ranks of csulb faculty. it began with my experience as a black student in the social work program at csulb, years before. i have always been proud to say that i received my msw from csulb; however, i do remember as early as my first day of graduate school being confronted with the image of seeing very few students like myself sharing the space around me. as i began to become more keenly aware of my intersections (primarily because they were not addressed), it fueled a sincere desire to create an environment where other black students could find a place to connect, belong, and have impact on the very program that helped to shape us. when an opportunity became available for me to join the ranks of the very faculty who helped create my foundation as a social worker, i was beyond grateful. i entered the field faculty in the summer of 2013, with so many emotions. i recall a profound sense of advances in social work, summer 2021, 21(2/3) 886 anticipation of what was before me. how would i yet again find my place to connect or belong? there was genuine pride and gratitude as well as trepidation about the journey i was getting ready to embark upon. these were the people i respected and admired as a student, and i was honored to join them. as i entered the space, i was quickly confronted with the familiar image of my days as a student where i looked for myself in those around me. but who would i share these feelings with? my intersections continued to be places of discovery for me in this new, yet familiar environment. i was moving into a wellestablished team that was very familiar with one another, with the exception of the newly established field director. as we both sought footing in this environment, it was clear that she was committed to bringing everyone’s voices in the room, and mine was no exception. as i began to read more and more admissions files and witness the installation of classes each fall, it appeared that time was repeating itself (or so it seemed). now that i was here, i thought i would be a source or a familiar place to land for students who looked like me, yet those opportunities were infrequent at best. one of the few black faculty members encouraged my involvement in the student organization, called tessie cleveland, dedicated to issues in the black community. throughout my involvement, what became even more apparent was the need for other black students to have a place where they could connect and process their experiences and decide how to take their collective gifts and share them with their community. i was so excited when the racially diverse ad hoc diversity committee was born. it was clear by the list generated that there was a need for growth, development, and change. this became the place where we explored gaps in our program and missed opportunities for student engagement. this was the place where we could discuss my desire to increase the recruitment and retention of black students and faculty. this became the place where we could talk about student concerns around curriculum and the need for more engagement around race, gender, and immigration status in the classroom. this was the place where we could explore microaggressions experienced both by faculty and students. the decision became clear that we wanted to start with us as a faculty. however, this internal call to action would be one of strategic efforts. we would have to consider the fluidity of perspectives across our faculty. how many of us already believed we had arrived; how many of us were waiting for this very moment to occur where we could turn our very foundation on its head. after all, we had very recently gone through a curriculum shift, and now we were slowly, yet consistently being confronted with the need for more. over the next few years in the midst of strategic planning and reaffirmation we would confront our biases, explore our shortcomings and embrace one of the hallmark tenets of social work, “engaging in life-long learning.” our delicate dance between confrontation and realization led us to the deconstruction of our multicultural framework and the search for a more reflexive critical lens. as faculty recognized their need to create a space for such practice, the decision to reach out to my former colleague, nicole vazquez, from csudh became evident. nicole would join us for our first installment of trainings on a framework that some were familiar with and others newly introduced to – critical race theory. although i was quite familiar with crt, i believed that seeking external support via the diversity committee would allow for greater absorption among faculty. nicole’s trainings allowed for the reaping of fertile soil thus creating an unexpected momentum. polk et al./moving from multiculturalism 887 faculty were called upon to begin the incorporation of crt in the fall of 2020. i could not believe we were just five years out from a curriculum change, and the school of social work was acknowledging that it needed to adjust its framework to fit the context of our students and our environment. as i consider the path before us, i think it will be critically important to offer support to faculty as they find their way throughout the implementation of this curriculum. providing spaces where they can process their ideas, concerns, successes, failures, and strategies will be essential. i think it will be equally important to engage students throughout the process as well to identify what is working and what may not be working as we consider our new lens. it is important to note that there are years of history and ways of knowing that are being challenged, and it will take a side-by-side approach to effectively rebuild it. mimi kim when i first started teaching at the csulb school of social work in the fall of 2014, just upon graduation from my ph.d. program, i had come from many years of cross-racial organizing in the arena of gender-based violence. i had been a co-founder of the social justice organization, incite!, a radical feminist of color organization that was established in 2000 and has over the past two decades confronted the intersections of gender-based violence and police violence. incite! has been instrumental in the development of transformative justice and (prison) abolition feminism. i began my study within social work as an msw student and later as a ph.d. student, learning that my feminist of color work that formed the center of my political activism did not fit easily within the field of social work with its clinical focus and emphasis on evidence-based research. however, i was drawn to social work’s embrace of practice and the idea that interventions could make a change in the lives of individuals, families, communities, and society, at large. i had also been exposed to academic social work and knew that an emphasis on professionalization and close and uncritical ties with law enforcement and other “systems,” that were so often oppressive to communities of color, queer communities, immigrants, poor communities, people with disabilities, and other historically marginalized people, had long been core features of social work. i felt in many ways that i was living a double life, one not of my own making, but one imposed by the adherence of academic social work to the rules and regulations of the status quo, the marginalization and devaluing of viewpoints of bipoc which i had long considered central to my understanding of the world, and a framework for race and intersectionality barely evolving from variations on the “melting pot” or “salad” metaphors of multiculturalism. when i started as a full-time tenure track professor at csulb school of social work, i was heartened by the embrace of the traditions of community organizing which i knew from the job search barely held legitimacy in academic social work. the elevating of a community organizing lens demonstrated promise; it was a solid foundation from which i felt i could build. had i not had the camaraderie of saanà in the committee and what i knew was the solid commitment of the field faculty at csulb, i doubt that this work would have continued. if we had not had such full engagement with the staff, the field faculty and fulladvances in social work, summer 2021, 21(2/3) 888 time tenure track faculty in the trainings that we offered throughout the years, i would also have lost hope. despite the ever-thinning constitution of the diversity committee, dipping for so long to two people, the level of engagement of the staff and faculty in their participation in ongoing trainings and the commitment of our director to support our work kept us going through seemingly bleak times. finally, saanà’s relationship with nicole vazquez with her deep knowledge of crt and her experience with its application within a sister social work program really gave us the push we needed. what none of us guessed at the time of the school’s decision to integrate a crt lens to the curriculum in january 2020 was the blm uprisings of the summer of 2020. the powerful mobilization of school of social work students, who had inspired our diversity committee work but who had not been participants, led to a set of town hall conversations that frankly raised honest and searing evaluations not only of our nation but of our school. this student mobilization transformed years-long strategies into demands. their disappointment with our response to the uprising, their insistence that social work squarely address these issues of racial inequality in society, in governance and within our own school of social work, added fuel to the slower build-up that we had been developing over the previous five years. as we are writing this paper, the slower, deliberate forces of change and the uprisings of the summer of 2020 have come together to push us into a promising and already visible integration of crt into the ssw. as a professor of a policy course that sets a foundation for incoming msw students, i have just begun with the tenets of crt and the class agreements of brave space. i have already witnessed the change in the students as the tenets resonate with their lived experiences and their expectations for social work to be a catalyst for social change. i have also witnessed my own change, my own confidence to meld two discordant worlds of political activism, on one hand, and the more staid constraints of academic life, on the other. the potential to challenge the white supremacist and neoliberal legacy of social work with a much more radical, vibrant and relevant future is vast. arundhati roy (2020) has referred to the present moment as a portal, one through which we could drag our outdated and, in many ways, harmful past – or one through which we can carry that which is necessary for a life-affirming future. i feel hopeful that we can work together collectively towards the latter. nicole vazquez i was introduced to crt in the final term of my first year of my msw program in a student-initiated, student-led course on the theory within a school of public affairs. it is by no means an understatement to say that the course changed my life. it flipped on its head the way i experience everything: from movies to tv and commercials, billboards, anything i read, and daily interactions with friends, family members, and acquaintances. crt has impacted me on a deeply personal level, has made me a better, more compassionate social worker, and laid the foundation for helping me understand so many aspects of my life and our u.s. society. i felt, much like my own students would feel years later, liberated once i learned that race is socially constructed, why it was created, how it has been used to maintain a global white supremacist society and how that structure has polk et al./moving from multiculturalism 889 played out in the united states, what that meant for me as an afro-latinx, queer, cisgender woman in this country, and what it meant for my current and future clients who also most often come from historically oppressed groups. i was also emboldened to take up the activist component of crt and pursue justice with my new-found knowledge. i felt so fortunate therefore to have landed as part-time faculty in csudh's msw program that is rooted in crt just a few years out of graduating, and a few years later as the field director. the student population in csudh’s msw program is 90% students of color, with the majority hailing from the geographic region surrounding campus which include some of the most underserved populations in the area. our students and alumni have shared that the program gives them a vocabulary to articulate their lived experiences and validates the feeling of being gaslit for their entire lives. in turn, when the veil created by the dominant narrative is lifted, and they learn that the conditions in which they grew up (crowded classrooms, more liquor stores than grocery stores in their neighborhoods, limited green spaces to name a few examples), were created that way and not “just the way things are,” they are understandably upset and the weight of being cheated in life falls with a thud on their already oppressed bodies. it’s a revelatory and liberating, yet, painful experience with which the program continues to grapple in how to best support students through this process. it’s an ongoing and necessary challenge worthy of taking on, as it’s also a beautiful experience to witness students reacting to it, making connections, and engaging clients and approaching their social work practice through a critical race lens. when saanà polk, my former colleague at csudh, reached out to me to explore workshop opportunities with csulb’s ssw faculty around applying crt to social work pedagogy, i was more than happy to take on this work pro bono in addition to my duties at csudh because i believe in the transformational power of crt. i jumped at the opportunity to share my knowledge and show fellow faculty members how a crt framework can be applied to social work pedagogy. during my first training i found csulb’s faculty to be open, engaging, and willing to dive in to do the work. i must note here that though i agreed to conduct the training probono, i was truly touched to find cash in my thank-you note as i walked back to my car. i think they literally opened their wallets and put together a small honorarium for my time that day. it is so affirming to be recognized beyond a thank-you note to demonstrate the worth others feel for you, even when organizational budgets prevent adequate compensation. mimi kim conducted a training post-survey that yielded positive data regarding the training and requested more. csulb’s ssw director found funding for me to continue engaging faculty in critical race pedagogy over the period of a year, and i conducted my second training with the goal of an even more explicit classroom-focused experience. again, i found the vast majority of the faculty to be fully engaged and ready to go all in with the role-plays, and to openly share and reflect during the all-group debrief. i felt a shift towards the end of the training in which it seemed that faculty were moving towards really latching on to crt as a frame they could see themselves using in the ssw. during my last and what was to be final (due to covid-19) meeting with faculty, i contained my advances in social work, summer 2021, 21(2/3) 890 excitement upon hearing that they were committed to formally moving to integrate crt in the ssw. i wanted to be clear that their decision was not wholly influenced by me. it may seem like i came in and facilitated three trainings and poof! csulb ssw was adopting critical race theory as a theoretical framework. that most certainly is not the case. as this story shows, this ultimate decision was five years in the making. it was the diversity committee that did all the important and intense pre-work. the main part of the success of the diversity committee and the ssw’s formal adoption of crt is due to the relentlessness and unwavering drive to move forward in spite of dips in commitment and resources over time. i just had to come in and put the bow on the gift they handed me: a faculty primed and ready to take the deep dive. lessons learned: implications for social work education the strategies employed by the ssw diversity committee and key elements of success employed by the ssw outlined below can serve as a model and learning opportunity for social work educators and administrators wishing to infuse an anti-racist framework in all aspects of their programs, from climate and culture to pedagogy and curriculum. the discussion sections below provide lessons learned and implications for best practice (see figure 1 for a summary of csulb ssw’s key factors to success). organizing at the speed of trust in the spirit of crt’s counternarrative, this study became a vehicle for reflection and storytelling – a way to recall our personal and collective journeys to where the ssw is today and a marker on the course towards tomorrow. while schools across the country are scrambling to address the long unacknowledged legacies of white supremacy underlying institutions of academia, schools of social work, and the profession of social work, the csulb ssw has been undergoing its own journey. as organizers of color and the wisdom of the disability rights movement now document, deep change and transformation happens when we move at “the speed of trust” (brown, 2017, p. 42). academia is not known as a trust building institution. bureaucratic struggles, competition, and professional distancing are common attributes of academia. for some of us, our trusted communities lie outside of academia, not inside. however, all of those who have participated in the diversity committee and the diversity task force have been driven by the knowledge that moving from multiculturalism to crt takes a willingness to be vulnerable, to expose how one is privileged and how one is devalued. each end of that continuum can be associated with shame. partnership with the oma provided some level of buffering; exercises were built with attendance to tenderness around personal exposure; and knowledge was scaffolded in recognition of uneven familiarity with race-related content. these all contributed to spaces that moved slowly from unsafe to safe and even to brave. voluntary participation at all levels also meant that members were not there because they were assigned; workshop participants did not gain points; nor did being a committee member afford any level of status. advances in social work, summer 2021, 21(2) 891 figure 1. key factors to success for transformational change in a school of social work advances in social work, summer 2021, 21(2) 892 so too did a cross-racial mix of organizers, bridging across traditionally separated expanses of field faculty and tenure-line faculty, take time to build trust. the frame of multiculturalism encourages us to look across race, ethnicity, and culture, acknowledge differences, and build tolerance. but it does not give us the tools to build solidarity. for some of us, our work built over years, not always under the slow conditions of trust building, but under the rapid conditions of making something happen. even so, the bonds of trust – even if it was the knowledge that someone would be there to get the necessary work done – played a strong role in the persistence and longevity of the diversity committee under conditions of precarity. organizing from the inside what distinguishes this work has been organizing not as outsiders in the alynskian tradition or even in the tradition of jane addams, but as insiders inspired by ida b. wells, grace lee boggs, and, more recently, adrienne maree brown (2017). as people of color, we have been driven by the change that we want to see for ourselves, for our communities, for our futures. we recall our trials as msw students or as ph.d. students. these are experiences that we will never forget. we are driven to make things different for our students and for the field of social work. this has been an organizing campaign to make the csulb ssw one that could represent the realities of enduring inequities, center those most impacted by oppression, and lead social work not only towards reforms within an unjust system but changes to those systems themselves. importance of institutional support while organizing can happen and often does happen without institutional support, organizing to move from multiculturalism to crt could not have happened without some level of support. the ssw’s strategic plan prioritized a diversity plan from 2012 to this day. even if adherence to the plan may have been shallow at times, having that stated goal served at the minimum as a placeholder. more significantly, it documented the school’s commitment to such things as diverse hiring of staff and faculty, contributing to a significant change in the racial make-up of tenure-line faculty and an even more dramatic change among field faculty. this change cannot be underestimated. although the diversity committee itself fell to numbers as low as two, workshop attendees and the eventual members of the diversity task force consisted of ever higher numbers of bipoc. this is not to discount the considerable work of white staff members and faculty in advancing the work to integrate crt into the agenda. however, using a crt lens, a mapping of power within the ssw demonstrates a growing base of people more representative of the student body and more attuned to the lived experience of bipoc. the support of the director of ssw, her encouragement, accommodation in scheduling, and commitment to find resources in a resource poor school were enormously helpful in keeping up momentum. the availability of the oma and the many years of experience they had in providing education on the sensitive topics of race and intersectionality were absolutely critical to the success of our efforts. the fact that our sibling school, csudh, fostered the development of a social work program so deeply rooted in crt and the polk et al./moving from multiculturalism 893 willingness of one of its faculty to lend her assistance to csulb provided a model and evidence that the incorporation of crt is not only possible but serves as a gold standard. data collection and evidence the data collection and evaluation strategies of the oma set a standard for the diversity committee work. their creative use of data collection, for example, allowing people to write down their quick evaluation responses and crumple them into indistinguishable balls on the floor (they were later collected and documented) allowed for a disarming and visibly anonymous way to share opinions. the oma also followed their trainings with a written report which they shared with us as their stakeholders and used them to inform future work. once reliance upon the oma was loosened, the diversity committee continued to use quick surveys to engage staff and faculty both before trainings, to gain information on preferences, and to provide quick and convenient ways to evaluate trainings right after they were given. data were carefully used to determine future workshops. data collection also demonstrated accountability to our colleagues as we shared back at faculty meetings a summary of the responses and illustrated how these results also informed the course of the diversity series. bridging the hierarchy of field and tenure-line faculty throughout schools of social work, field faculty and tenure-line faculty are notoriously divided. the csulb ssw has not been immune from the privileged position of tenureline faculty. over the years, the ssw has been increasingly committed to its field faculty, eventually voting to eliminate barriers to voting within the faculty meeting, a long-time feature of the school. this also contributed to an ease in which field faculty and tenure-line faculty have worked together collaboratively to establish and then to drive the diversity committee. perhaps it is not surprising that a committee committed to equity would exercise more collaboration across these divides. it has been clear that the camaraderie among field faculty, their culture of collaboration, their commitment to brave space, and their dedication to student well-being have established the vital core of the diversity committee. while ongoing work has continued among tenure-line faculty throughout the history of the committee, it has been the field faculty who have always stepped forward to energize the work. and as the ratio of field faculty of color has moved from an isolated minority to become now the majority, the capacity to integrate crt into the overall curriculum has increased. the fact that 50% of the eight field faculty are african american has further strengthened the capacity to integrate crt and, in particular, to emphasize what has remained a goal unachieved, that is, an increase in the recruitment of african american students. advances in social work, summer 2021, 21(2/3) 894 the importance of long-term struggle finally, a central tenet of organizing is the importance of a long-term vision and organizing for the long haul (horton, 1998). while this study chronicles five years of organizing, it also finds that the conditions for success pre-dated the start of the diversity committee. the study demonstrates that the seemingly overnight incorporation of the crt was made possible because of the slow and methodical work dating back to at least 2015. knowing that white supremacy dates back to the beginnings of this country also tells us that this struggle will not be over. incorporation that has started now has already been uneven. some may simply have had fewer opportunities to learn about and fully integrate crt into one’s own consciousness, much less syllabus. understanding the persistence of white supremacy and the embeddedness into the very fabric of our culture also tells us that resistance and even backlash will be dynamics we will always encounter. conclusion during the early years of our work at ssw to move from multiculturalism to crt, we scanned social work programs for models of anti-racist curriculum development and challenges to white supremacy and racism within the overall institution. we found very few. since summer 2020, we know that examples have and will continue to multiply. we also know that our work may stand as unique in its long-term nature, its leadership by a bipoc dominant collective with strong white solidarity, and a school-wide agreement to incorporate crt that predates the uprisings of the summer of 2020. while we are still at the early stages of implementation, early anecdotal evidence shows that those courses that have more fully integrated crt have resulted in engagement by students, high levels of interest in course materials, and the rapid development of critical thinking. the work, however, has only just begun. while it seems difficult to imagine a significant backwards movement in progress made thus far, it is easier to imagine a slowdown and satisfaction with partial changes made. it is also easy to see how certain goals of the diversity committee such as recruitment of black students may run into bureaucratic barriers or an inability or unwillingness to institutionalize what may be the labor intensive and trust-building work necessary to make these changes effective. as of the writing of this study, we are also facing the results of our success. the new strategic plan 2020-2023 recommended that the diversity committee become a standing committee, moving from its ad hoc status. approved as a standing committee in november 2020 and now subject to by-laws and administrative controls, fears of bureaucratic death overshadow hopes for greater legitimacy. the lessons of community organizing and legacies of incorporation into the rigid systems that we have also challenged stand to institutionalize initial progress while dampening the kinds of autonomy needed to push for radical change. the new committee’s adoption of less conventional, more open membership rules and its culture of collaboration have already modeled more equitable and participatory practices that push against neoliberal and white supremacist traditions. however, the passion 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(2020, april 3). the pandemic is portal. financial times. https://www.ft.com/content/10d8f5e8-74eb-11ea-95fe-fcd274e920ca yin, r. k. (2018). case study research and applications: design and methods (6th ed.). sage. author note: address correspondence to dr. mimi kim, school of social work, california state university, long beach, ca 94602. email: mimi.kim@csulb.edu https://doi.org/10.5175/jswe.2010.200900070 https://scholarworks.wmich.edu/cgi/viewcontent.cgi?article=3090&context=jssw https://www.gazettes.com/news/crime/majority-of-long-beach-police-shootings-people-of-color/article_6f823b42-bd41-11ea-942f-5391910a3ff9.html https://www.gazettes.com/news/crime/majority-of-long-beach-police-shootings-people-of-color/article_6f823b42-bd41-11ea-942f-5391910a3ff9.html http://www.jstor.org/stable/41669763 http://lchc.ucsd.edu/mca/mail/xmcamail.2015-04.dir/pdfkrfgoukjls.pdf http://lchc.ucsd.edu/mca/mail/xmcamail.2015-04.dir/pdfkrfgoukjls.pdf https://www.ft.com/content/10d8f5e8-74eb-11ea-95fe-fcd274e920ca mailto:mimi.kim@csulb.edu _________ john orwat, phd, lcsw, professor and co-director of center for field innovation, research, strategy, and training (cfirst), michael p. dentato, phd, professor and co-director of cfirst, and katrina herweh, masw, lisw-s, research associate and doctoral student, school of social work, loyola university chicago, chicago, il. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 455-471, doi: 10.18060/27718 this work is licensed under a creative commons attribution 4.0 international license. certificate in advanced behavioral interventions among multiple populations: an effective model for interprofessional education john orwat michael p. dentato katrina herweh abstract: this manuscript describes the curricular and instructional approaches utilized in the composition and delivery of the certificate in advanced behavioral interventions among multiple populations (cabisam) created by the school of social work at loyola university chicago. cabisam is a social work led interprofessional education (ipe) model where students from social work, nursing, and medicine engage in didactic and experiential activities to advance clinical and leadership knowledge of interprofessional approaches to screening, brief intervention, and referral for treatment (sbirt) with diverse populations. an interprofessional team of faculty from each discipline was involved throughout the development and planning process to consider accreditation, cultural, and logistical issues unique to each profession. cabisam engages students in an evidencedbased interprofessional education (ipe) experience with exposure to cutting-edge topics relevant to health professionals: training in interprofessional practice, substance use in unique settings with diverse populations, and clinical implementation skills. this manuscript presents an adaptable and generalizable interprofessional education approach to other undergraduate and graduate programs across disciplines. keywords: interprofessional education, interprofessional practice, student training, workforce preparedness professional schools are incorporating interprofessional content and experiences into their curricula and field practicum to effectively prepare students for interprofessional health care practice. interprofessional practice (ipp) improves the quintuple aims of health care that include improving population health, care experience, reducing health care costs, addressing healthcare professionals’ burnout, and advancing health equity (nundy et al., 2022). accreditation standards across professions increasingly include interprofessional education (ipe) competencies tied to promoting the five aims of health care. improving health care through the quintuple aims is important for all recipients of health care services including minority populations, as they are at an increased risk for being unnecessarily harmed in health care settings when compared to the general population (chauhan, 2020). such safe and affirming health care approaches are often provided through ipp. this paper presents an exemplar for an ipp certificate and training program, referred to as cabisam, based on the current research in conceptualizing ipe. in this paper, we review specific approaches to ipe and curriculum development, learning models, opportunities, and challenges. the ipe model examined in this manuscript has four key components including a training day, simulated patient practice experience, direct practice in community-based field work, and an interdisciplinary team poster presentation. students about:blank advances in social work, summer 2024, 24(2) 456 attending the program receive a certificate from the institute for transformative interprofessional education (itie) upon completing the ipe certificate program. this educational model has adaptability and generalizability to various interprofessional settings, topics, populations, and education formats. interprofessional education and practice interprofessional education is defined as “occasions two or more professions learn together with the object of cultivating collaborative practice” (vanclay, 1997, p. 19). the caipe task force extended this definition by adding that interprofessional competence is attained through interprofessional learning grounded in evidence while respecting each profession’s perspectives and skills (barr et al., 2017; ford & gray, 2021). relatedly, the national center for interprofessional practice and education (ncipe; 2023) notes: we use the phrase "interprofessional practice and education" (ipe) as a way to create a shared space between interprofessional education, interprofessional practice and collaborative practice. the “new ipe” does not replace the principles related to these concepts rather, it embraces them. (para. 2 & 3) this focus is imperative for ipe as each healthcare profession has its unique educational accreditation processes that incorporates ipe requirements within their accreditation standards. therefore, sustainable and impactful ipe programs require an implementation strategy that includes key stakeholders from each profession (barr et al., 2017; world health organization [who], 2010). ipe is important in both pre-licensure and post-licensure education because it teaches the student to successfully function in and enhance interprofessional teams as students and within their professional healthcare careers (jones & phillips, 2016). furthermore, while engaging in ipe, educators draw attention to similarities across each respective professions’ knowledge, skills, and values (jones & phillips, 2016). ipe provides opportunities to maximize logistics across professional schools such as schedules and creative approaches to teaching and learning, such as the use of cutting-edge technology. ipe & ipp connections to curriculum the topic(s) chosen for an ipe experience should be relevant to the overall institutional strategy in a way that considers strategic goals and objectives as well as ipp competencies (interprofessional education collaborative [ipec], 2023). a topic for any ipe experience should include ipe competencies, such as those described by ipec within the domain of interprofessional collaboration, including topics from the four competency areas: a. values and ethics, b. roles and responsibilities, c. interprofessional communication, and d. teams and teamwork (ipec, 2023). ipe curriculum should take a long view, be designed to accommodate the unique schedules and cadence of the professionals involved, measure outcomes, and plan subsequent training based on this evaluation (khan et al., 2016). the success of ipe occurs when the education is planned, recognized, and accessible (barr et al., 2005). each orwat et al./ipe certificate 457 profession should view specific clinical issues from within their professional scope, ultimately coming together with a collective perspective on how to best move forward. ipe topics related to a specific clinical issue also provide opportunities for innovation and collaboration. challenging clinical issues that do not have a universal or well-researched solution may provide an opportunity to utilize interprofessional competencies to teach students a method and process for addressing real-world issues that clinicians often face. this may result in an important opportunity where content delivery and ipe on a unique clinical topic and interprofessional practice skills can be universally explored. screening, brief intervention, and referral to treatment (sbirt) a topic of ipe that is relevant to healthcare professionals across the u.s. is alcohol and substance use. in 2021, 16.5% of people 12 years and older in the u.s. met the diagnostic criteria in the 5th edition of the diagnostic and statistical manual of mental disorders (dsm v) for either a substance or alcohol use disorder (united states department of health and human services, 2023). the screening, brief intervention, and referral to treatment (sbirt) model is an approach used in screening for alcohol and substance use and identifying individuals at risk for developing a substance use disorder (thoele et al., 2021). the approach is applicable in a variety of settings and with populations across the lifespan as universal screening for substance use followed by brief interventions can result in identifying important client goals, values, and increased readiness and/or motivation for change (office of addiction services and supports, n.d.). sbirt is perceived and practiced by healthcare professions differently, therefore the approach is often enhanced by an interprofessional collaborative delivery approach that underscores each professions’ strengths (wamsley et al., 2018). however, the sbirt model has been identified as an underutilized intervention in a number of practice and educational settings (thoele et al., 2021). in fact, a systematic review found that only 29% of published studies on sbirt were focused on training social work students (mcafee et al., 2022). therefore, incorporating the sbirt model in undergraduate and graduate social work education can better equip students for identifying and screening for risky substance use in interprofessional teams and clinical practice alike. advancements in teaching and learning common ipe experiences include simulated-based learning, games and role-play; exchange-based learning, case discussion; action-based learning, problem-based learning; practice-based learning; placements and work-based assignments; collaborative inquiry; observation-based learning, joint home visits; or received learning, lectures and other didactic teaching (west et al., 2016). simulated learning experiences include case-based discussions, game simulations, scenario-based simulation, and standardized patients (reeves & van schaik, 2012). additionally, in simulated-based learning students can participate as a member of their own profession, as a patient, patient’s family member, or represent another profession (barr et al., 2005). there is a vast array of simulated experiences that can provide students with practice skills and the opportunity to think about advances in social work, summer 2024, 24(2) 458 collaboration, experience different roles and responsibilities, and experience some of the stressors associated with working in collaboration (reeves & van schaik, 2012). feedback by peers, simulated patients, and professionals is a vital element to ipe. interprofessional clinical supervision, as identified by copenhaven and crandell-williams (2020), is a critical component of ipe regardless of the educational model employed. supervision, in general, enhances clinical skills and autonomy while decreasing burnout rates (knudsen et al., 2008). key responsibilities of ipe supervisors and educators include promoting an affirming environment for students based on respect, using active listening skills, and valuing their unique personal and professional experiences (barr et al., 2005). special consideration must be given during supervision efforts that attend to the students’ interprofessional education, interprofessional practice skills, and the learned intervention(s). communication processes & attitudes toward other professions ipe competencies among healthcare professions include improving patient health, advocacy, person-centered care, communication, teamwork, and ongoing learning (kangasniemi et al., 2020). to achieve ipe competencies, students need opportunities to prepare, practice, and engage in clinical supervision and debriefing sessions. as indicated, teamwork and collaboration are vital to ipe and ipp experiences. attitudes toward other professions in interprofessional experiences are essential to effective and impactful ipe. starting ipe within academic settings results in students having positive attitudes toward ipe and increases the chances of students engaging in additional ipe opportunities (ruebling et al., 2014). students may realize they have misinformed notions, assumptions, or stereotypes of other professions’ roles and responsibilities (barr et al., 2005). students engaged in ipe might also result in an overlap in professional roles and poorer understanding of one another’s roles, such as prescribing authority with physicians, nurse practitioners, and physician assistants. role misconception may be due, in part, to poor leadership failing to clarify roles and the importance of communication and collaboration, which is beneficial to discuss in ipe (kangasniemi et al., 2020). another significant communication challenge among professionals is using their own terminology, jargon, and knowledge base (hansen et al., 2020; ramgard et al., 2015). for example, all professions in ipe may not know or incorporate the other discipline’s terminology(ies). in ipe experiences, students can practice the use of standard or familiar terminologies and new language to gain a clearer understanding of one other’s responsibilities and unique perspectives. research findings suggest that students have a more positive attitude of their own profession and need for collaboration after completing an ipe session as they felt more confident through their work with real patients (murphy & nimmagadda, 2015; swinnen et al., 2021). ipe has also been credited with increasing male students’ feeling of competency of their own profession and value for other professions (goelen et al., 2006). a unique element of ipe that enhances learning is the use of debriefing. debriefing processes among team members provides students with an environment encouraging orwat et al./ipe certificate 459 constructive feedback, participation, and support from team members, simulated patients, and ipe trainers and supervisors. challenges and opportunities to consider with ipe despite significant research that demonstrates ipe’s positive impact on ipp across various settings, universities struggle to implement ipe for various reasons (khan et al., 2016; west et al., 2016). these challenges include uncertain decision-making around content, different academic calendars, logistics of professional school placements, and a focus on other investments (west et al., 2016). khan et al. (2016) indicated limited access to facilities, training sites, and other healthcare professionals as unique challenges for ipe. securing faculty or administrators as “champions” to lead and support ipe can also be difficult due to other workload demands and expectations for teaching, scholarship and research, promotion and tenure (etc.). another challenge specific to ipe in training students prior to meeting program qualifications or licensure, is prioritizing content relevant to all professions involved and generalizable to different populations, care settings, and practice situations. it is also difficult in organizing and scheduling ipe because of different schools or universities coming together (either physically or remotely) to engage in the experience (reeves & van schaik, 2012). for example, the schools or universities might not be physically located within proximity to one another, which may be a barrier for in-person ipe experiences. the requirements for interprofessional experiences might also vary depending on the professional school’s needs, background, or intentions. lastly, ipe requires coherence and understanding between educators for which specific professions (e.g., social work, nursing, medicine) should be included and ensure equal commitment from students and professionals throughout the experience (reeves & van schaik, 2012). unequal commitment from the students and professionals involved may lead to a disruption in effective and impactful ipe. there are limitations specific to simulated learning experiences. a specific limitation to simulated learning is the difference between team composition and roles during ipe versus ipp (reeves & van schaik, 2012). additionally, simulated ipe may not accurately reflect students’ authentic responses due to performance-based anxiety and discomfort while being observed (lee et al., 2018). for example, students may be concerned about their participation in the simulated experience related to academic feedback or peer interactions and may not display realistic responses. recognizing challenges and predicting obstacles to ipe and simulated learning is important for professional schools when designing ipe curricula and simulations to ensure seamless ipe delivery. a case example of ipe: cabisam the certificate in advanced behavioral interventions among marginalized populations (cabisam) was developed by a team of interprofessional faculty members who collaborated at a large midwestern university after being funded as part of a threeyear samhsa grant (2017-2019) to infuse the screening, brief intervention, and referral to treatment (sbirt) model into the nursing, medical, and social work curricula. current literature points to the need for more substance use addiction education and training in all advances in social work, summer 2024, 24(2) 460 professional programs nationwide, with attention on use of alcohol, opioids, and other lesser-known substances (muzyk et al., 2020). as the institution was already committed to providing sbirt training for all students in several of its schools, there was strong faculty knowledge and commitment to teaching and using the sbirt model, which positively assisted implementation efforts for this interprofessional program. the ipe curriculum was designed based on pedagogical best practices for teaching pre-licensure health professionals via an interprofessional practice model. therefore, this ipe model was developed based on existing literature and research, institutional priorities, funding, and best practices related to creating an sbirt training program. faculty leads from the three professional schools were first trained together in the sbirt model as part of a national training program and then worked closely to develop cabisam while fostering relationships with one another, sharing tasks, defining roles, responsibilities, and leading recruitment efforts within each respective school. each student who completed the program received a certificate from the university’s institute for transformative interprofessional education (itie). the value of the certificate for each student was more meaningful when issued by itie as opposed to solely being issued by one of the professional schools providing greater impact and visibility on their resumes rather than a simple annotation on their academic transcripts. expansion beyond the university to a state-level and nationally recognized cabisam certificate program remains a future goal. the program initially ran over the course of three years including a semester-long course, with modifications based on a formal and informal evaluation process including faculty, simulated patients, and peer-based observation of students, in addition to a variety of formal and informal student feedback mechanisms, and an overall mixed-method program evaluation. as the three-year samhsa grant partially funded cabisam, one aim was to incorporate rapid-cycle evaluation to modify future activities. additional modifications of the model occurred during the second and third cohorts, when the cabisam structure was amended to include direct observational feedback during simulation and in-person practice experiences by faculty members, simulated patients, and fellow students. the cabisam educational model of delivery changed to an online format in march 2020 due to the covid-19 global pandemic. ongoing development of cabisam and faculty involvement will be examined from an interdisciplinary perspective, with specific implications for clinical practice and implementation. key role of faculty. an interdisciplinary group of faculty members known as the interdisciplinary development team (idt) was led by social work, nursing, and medical faculty who served as their respective school’s representative and champion to accommodate each school’s logistical and curricular requirements and incorporate stakeholders from each profession, as indicated in the literature review. the idt was essential to cabisam’s success as each faculty representative brought unique knowledge of their curriculum (e.g., content, gaps, accreditation requirements), logistics of their professional school (e.g., academic calendar, class schedule), while serving as a champion (e.g., for faculty within their school, to coordinate student recruitment), and to provide input from the perspective of their profession related to the development and infusion of the new interprofessional curriculum. orwat et al./ipe certificate 461 each member of the idt was charged with developing some aspect of the curriculum based on their unique scholarly and research interests, teaching background, and knowledge base. challenges included developing a program for each profession that fit the unique academic calendar of each professional school, delivering content that was current, relevant, and engaged students, ultimately resulting in a greater understanding of each profession’s roles. the idt also spent time inventorying the existing substance use curriculum (if any) within each school, and identified students in each program (e.g., medicine, social work, and nursing) that would receive education on the basics of sbirt as a part of each program curriculum, realizing that some students may have additional and advanced exposure resulting from attending cabisam, or practicum experiences, and/or elective coursework focused on substance use and addiction. members of the idt modified elements of the curriculum and simulated practice experiences based on student responses to cabisam course evaluations, feedback obtained from the optional focus groups, and preand post-test results utilizing the revised interprofessional collaborative competency attainment scale. a total of thirty students (ten from each profession per cohort) were recruited by the idt faculty champion at each school and had to submit applications for the certificate program. members of the idt were key to student recruitment as well as the “word of mouth” promotion about cabisam. the purpose of the application was to assess the student’s level of interest in learning the sbirt model and brief interventions related to substance use, and their appreciation and understanding of the importance of interprofessional practice. initially, cabisam was only open to graduate students (msw and graduate-level nursing and medical students) while some exceptions were granted to safeguard equal representation from each school. it was important to focus on graduate students since they are more likely practicing independently post-graduation and the nature of the program required a higher level of individual and group level skills and learning. preference was given to students with supervised clinical experience in coursework and practicum. additional attention was given to the specific program concentrations, especially those from nursing and social work who were already at the point of specialization (e.g., health, mental health, schools, addictions, etc.). interprofessional teams of three were created that ideally included one medical, nursing, and social work student. members of the idt had integral roles during the cabisam one-day training by modeling ipp skills and interactions. for example, each faculty member represented their profession in ad hoc discussions (e.g., answering questions, small group work) and demonstrated interprofessional skills during role-plays, which were an important part of student learning. didactic learning via role-plays modeled by faculty allowed students to test and expand their skills during live simulated patient practice experiences. the idt also engaged in a lively discussion during a panel presentation on ipp in which anecdotal stories, successes, and challenges from the field were shared, followed by a question-and-answer session. advances in social work, summer 2024, 24(2) 462 the ipe model: cabisam cabisam is a semester-long program with four key requirements (see table 1): a. an initial one-day training including pre-work (e.g., readings, videos, online simulation practice), b. interprofessional practice experiences (e.g., at a social service organization), c. creation of an implementation poster by the interprofessional team of students, and d. attendance, participation, and poster presentation at the university/community-based conference. key requirements for cabisam were designed in response to the literature underscoring significant limitations in classroom-only based learning activities and the benefit of engaging students in “real world” practice activities (who, 2010). in this case, “real world” activities included an interdisciplinary student team (ist) consisting of one student from each profession engaging in practicing the sbirt model in a practice setting and working together to develop a poster about sbirt implementation opportunities and challenges. the ist provided a unique way for pre-licensure students to work collaboratively together and learn about each discipline’s perspectives pertaining to practice in the field of substance use and addiction. so, the overall sequence of events for students was to first learn the model, then practice the model, and finally to teach the model. table 1. timeline of cabisam certificate program month december january february march april activity time prework 3.5 hours training day 5 hours practice experience 3 hours group poster collaboration 2 hours university conference 3 hours initial one-day training. the initial one-day training included ist introductions via an icebreaker, didactic instruction via lectures, small and large group discussions, and practice with simulated patients (see table 2). prior to attending the full-day training, students completed prework activities, including readings, videos, and stimulated practice experience (via the kognito simulated platform). these educational activities covered each aspect of the sbirt model of screening, brief intervention, and referral to treatment with a focus on motivational interviewing, the basics of substance use, and materials about interprofessional practice. didactic presentations were delivered in the training by each faculty member on advanced sbirt topics such as the stages of change model, screening and assessment, the brief negotiated interview, motivational interviewing, an overview of alcohol and drugs (specific emphasis on alcohol and other drug effects on the body), dsm criteria for diagnosis, navigating resources for referrals to treatment and care, and impactful engagement skills via role plays by faculty. in the observation of role plays by faculty, students completed sbirt observation forms (see appendix: brief intervention observation sheet) that guided their observation of the role-plays and feedback. the bios forms were used throughout cabisam to guide student assessment and feedback of themselves and their peers. ist members worked collectively, and efforts were made during didactic components to engage in small group activities, so teams had the opportunity to practice content and learn from one another. a panel of interprofessional faculty with practice and academic experience capitalized on previous student knowledge about ipp (e.g., collaboration, orwat et al./ipe certificate 463 communication) and provided deepened context related to their professional experiences while underscoring the value of ipp. the panel also provided students with an opportunity to directly observe faculty discuss issues concerning effective utilization of the sbirt model, and practice with medically underserved communities and marginalized populations, among other relevant topics. ist members were given time to formally educate one another about their unique profession and informally promote bonding and relationship building. table 2. cabisam certificate program training day schedule topic(s) description welcome introduction of cabisam faculty idt & review of agenda review of cabisam requirements introductions & ice breaker sbirt educational presentations introduction to the sbirt model overview of alcohol & drugs overview of the stages of change model screening & screening tools (e.g., audit, dast) brief intervention & motivational interviewing referral to treatment questions & answers faculty role play examples students observe faculty role plays of interprofessional practice & utilization of the sbirt model practice with standardized patients opportunity for students to practice with members of their interprofessional student team. other teams watch & provide feedback. this is the first time the ist worked together with time to process strengths & weaknesses of interactions & the model of delivery panel on interprofessional practice interprofessional faculty panel from various schools discuss interprofessional education, practice experiences, barriers, & opportunities conclusion review next steps & closing remarks students engaged in simulated practice opportunities via alcohol and substance use scenarios with standardized patients, developed by the idt and based on contemporary issues in the field. each ist would engage in a simulated patient experience while fellow students and faculty members observed using the bios form to guide them. this was a crucial component of cabisam as it provided the ist a chance to work together as a team before the actual field experience and other activities throughout the semester. it also provided an opportunity for students to ask questions and receive direct feedback from faculty, students, and the standardized patients themselves (both in character and out of character). for example, students were often fascinated about the utility and usefulness of sbirt as an appropriate intervention when substance use has not yet reached a diagnostic threshold and the impact of using motivational interviewing skills. as an example of interprofessional learning, social work faculty and students found significant value in the use of standardized patients, a strategy which has not been widely used in social work education because educational methods tend to focus on classroomadvances in social work, summer 2024, 24(2) 464 based role-plays and field-based practice experiences (neuderth et al., 2019). on the other hand, there is a long history of using standardized patients in nursing and medical clinical education and training (neuderth et al., 2019; talwalkar et al., 2020). ultimately, all professions found new opportunities related to training and learning via standardized patients, the sbirt model, motivational interviewing, substance use, and behavioral health topics. interprofessional field practice experience. interprofessional student teams (ist) engaged in three to four-hour field practice experiences, supervised sbirt screenings and brief interventions at a community-based primary care clinic or social service organization. this practice experience required all members of the ist to put into action stages of the sbirt model and motivational interviewing skills that were initially practiced at the training day with an actual client. we found that providing such experiences in nonmedical settings (e.g., community-based health clinic and an evening meal program for unstably housed clients) provided more direct practice opportunities, had fewer barriers in terms of scheduling, and allowed students to be on the front line of working with diverse and marginalized individuals in underserved areas. implementation poster. each ist was required to develop and present a poster at the annual university sbirt conference. the poster’s content was to outline implementation opportunities and challenges of using the sbirt model during the interprofessional field experience. the goal was for students to engage with one another in an interprofessional activity by first developing an implementation-related question, interviewing a stakeholder about challenges and opportunities with utilizing sbirt in a unique practice setting, and collaborating on designing a poster reviewed by faculty members of the idt. students subsequently presented the poster at the annual conference in front of peers, faculty, and community members (e.g., alumni, social service staff members). students reported that the poster presentation and conference component of cabisam was helpful for strengthening their knowledge and presentation skills with a faculty-reviewed presentation at a university conference attended by faculty and community-based clinicians while providing a valuable way to understand the barriers and challenges of implementing cutting edge clinical interventions as they embark upon their post-graduate careers. further, students were encouraged to submit abstracts of their presentations to local, regional, and national professional conferences. this resulted in a number of students being accepted at conferences including the annual program meeting of the council on social work education and the international association of social work with groups conference. annual conference. finally, students presented their posters at an annual ceu bearing university conference attended by clinicians, faculty, alumni, and staff from local community-based organizations. the conference agenda included viewing the student poster presentations, processing the experience of community clinicians working with patients, and advanced mentorship training by nationally renowned leaders in the field of sbirt and substance use. the program also incorporated a plenary lecture as well as small breakout groups. the conference was modeled closely after the one-day training. however, students engaged in a leadership role in creating the overall conference theme, presentations, and providing feedback to attendees after they engaged in simulated patient practice experiences. the conference’s theme ranged from sbirt implementation orwat et al./ipe certificate 465 challenges; to sbirt and the opioid crisis; to sbirt opportunities with interprofessional teams. one of the conferences created a unique venue for learning more about the opioid crisis in the region and underscored how clinicians approach large-scale problems without evidence-based tools. this topic directly addressed the lack of strong evidence of sbirt utility with patients diagnosed with opioid use disorders (kaczorowski et al., 2020). relatedly, a notable sbirt training in a bachelor’s level nursing program found a decrease in students’ stigma after completing sbirt training and education on patients with opioid or alcohol use disorders (mahmoud et al., 2019). pivot to online delivery in march 2020, the u.s. experienced its first wave of the covid-19 pandemic which has undoubtedly influenced ipp in healthcare settings, including role changes and recognition of all healthcare workers as vital team members (goldman & xyrichis, 2020). additional challenges due to the pandemic included moving select health services to an online delivery model and determining which ipp was essential for in-person care (goldman & xyrichis, 2020). although there was online ipe occurring prior to the pandemic, a large majority of schools, universities, and healthcare settings across the country moved to a completely online format. students enrolled in online ipe reported that online delivery was comparable to in-person ipe related to content, course involvement, and individual learning (jones et al., 2020). additionally, the convenience and flexibility, no additional travel required, interpersonal connections, open learning format, engagement, and reflection were all reported strengths of online ipe delivery. on the other hand, limited face-to-face interactions and interpersonal connections, busy work, inconclusive directions, delayed feedback, and technology issues were indicated as barriers to online ipe (jones et al., 2020). similar to other ipe courses during the pandemic, cabisam pivoted to an online delivery format. all training components, including the one-day training, simulated patient experiences, field practice experience, poster presentations and conference, were held synchronously online via zoom. the faculty leads continued to monitor the online delivery and topics to ensure that the professional scope was appropriately addressed and implemented. each training component experienced a slight adjustment due to the online delivery. the initial one-day training included online breakout rooms to enhance bonding within the ist. a specific change to the field practice experience was made for ist members to utilize interprofessional skills through three-hour online experiences with simulated patients (sps). the sps were provided with character descriptions and scenarios to professionally and impactfully facilitate the online practice experience. another change to cabisam was the online conference, which changed to a capstone practice seminar. this revised format allowed students to hear from a trans person in recovery, reflect upon their cabisam experience, and learning related to ipp skills. the capstone seminar also focused on the influence of the covid-19 pandemic and work-related stress and burnout in healthcare settings. despite the obstacles of transitioning to online delivery, the new capstone seminar format expanded cabisam’s student base nationwide, which enhanced the ipe experience with diverse students (e.g., age, gender, racial/ethnic, lgbtq+) from urban and rural backgrounds. advances in social work, summer 2024, 24(2) 466 sustainability challenges barriers to the establishment and ongoing success of cabisam were environmental and curricular in nature. the three schools from the university that led the program are separated by geographically distanced campuses, each about 10 miles apart with limited access via public transportation at the health sciences campus. while technology aided in bridging this distance, faculty interactions on the idt and student interactions on the ist (especially concerning poster development) may have been better served in person, which would have allowed for the development of more interpersonal cohesion and connections. curricular challenges were related to the various academic schedules of each school and differing levels of academic requirements for each discipline. notably, initial grant funding provided the opportunity to develop, evaluate, and refine cabisam, which included logistical needs working with community-based agencies to expand practice opportunities for students. however, sustainability has proved challenging, as sustaining the program post funding necessitated institutional “buy-in” from the deans of each school, and the academic provost. thankfully, tuition revenue generated by the cabisam credit-bearing course helped fund the program over the past few years. however, it is unknown if this course will be offered in the future, possibly limiting funding-generated opportunities for cabisam’s continuation. in years past, continuing education credits (ceus) were offered free of charge to practitioners attending the annual conference, while in forthcoming years, we will need to charge for ceus, which may limit participation. discussion faculty from each school who acted as champions were present from conception to development and implementation stages, and all equally engaged in leadership roles best representing their professional expertise. recently, and most notably, faculty created a credit-bearing cabisam course, offering students an enhanced semester-long version delving more deeply into the clinical components of using the sbirt model, motivational interviewing, and brief negotiated interview. the offering of this class also allowed for hiring an adjunct using tuition dollars from the cohort of cabisam students who completed the course. an adjunct instructor was selected because of their professional expertise in the field concurrent to teaching. nursing faculty members have recently been working with social work faculty to utilize the cabisam model within new health resources and services administration (hrsa) interprofessional grant applications such as one recently funded to train students on interprofessional practice with indigenous and rural populations via telehealth. cabisam can serve as a model of ipe for other schools of social work to lead ipe initiatives within their universities. incorporating ipe has many opportunities and barriers as outlined in this manuscript along with the model’s own limitations, but healthcare delivery within the u.s. is beginning to utilize collective approaches for health care, including ipp. social work students, among all other health care students, must be prepared for real-world ipp skills and relationships to better serve patients and enhance healthcare orwat et al./ipe certificate 467 outcomes. additional research on the impact of graduate level social work ipe is needed to better inform ipe curriculum and activities. the successful use of interprofessional practice is vital for patient engagement and satisfaction in health care, follow through with treatment recommendations, and ease in the continuity of care across practice settings and patient populations (who, 2010). using an ipe model focusing on marginalized populations is significantly crucial in enhancing the health and wellbeing of such underserved communities. incorporating ipe across undergraduate and graduate curricula is vital to effectively prepare students across professions for impactful ipp in their post-graduate careers. without successful ipe, healthcare teams will continue to struggle to maximize collaboration, leading to failure in attaining the five aims of health care. conclusion this camisam training model presented in this manuscript focused on using the sbirt model in an interprofessional team of social work, nursing, and medical students, while providing a certificate and course structure that may be adapted for other schools and professions. while cabisam was found to be effective and impactful based on student course evaluations, focus group feedback, and preand post-test results utilizing the interprofessional collaborative competency attainment scale, this manuscript solely outlines the model and not an evaluation of the program. regardless, we believe that cabisam is thorough and replicable as it incapsulates didactic learning, observation of role-play, simulated practice and education, and participation in a university conference. although the cabisam model was created for use with pre-licensed or pre-certified students focused on substance use interventions and one key model, the model and structure can certainly be modified among post-licensure community-based professionals for continuing education purposes. references barr, h., ford, j. gray, r., helme, m., hutchings, m., low, h., machin, a., & reeves, s. 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(2010). framework for action on interprofessional education & collaborative practice. author. author note: address correspondence to katrina herweh, school of social work, loyola university chicago, chicago, il 60611. email: kherweh@luc.edu https://www.hhs.gov/about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-illness-substance-use-levels-2021.html https://www.hhs.gov/about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-illness-substance-use-levels-2021.html https://www.hhs.gov/about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-illness-substance-use-levels-2021.html https://www.caipe.org/download/caipe-bulletin-no-13-1997-2/?tmstv=1717078806 https://doi.org/10.1097/adm.0000000000000410 https://doi.org/10.1097/adm.0000000000000410 https://doi.org/10.1097/adm.0000000000000410 http://dx.doi.org/10.1016/j.xjep.2016.05.002 http://dx.doi.org/10.1016/j.xjep.2016.05.002 https://iris.who.int/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf?sequence=1 https://iris.who.int/bitstream/handle/10665/70185/who_hrh_hpn_10.3_eng.pdf?sequence=1 mailto:kherweh@luc.edu orwat et al./ipe certificate 471 appendix. brief intervention observation sheet did the provider … yes/no provider #: rater: date: comments 1) explain role and respectfully ask permission to have a discussion about alcohol/drug use yes/no 2) review patient’s alcohol/drug use patterns yes/no 3) share the patient’s audit/dast scores and zones yes/no 4) review low-risk guidelines relevant to his/her sex and age group yes/no 5) explore possible connection to health, social, work issues and express concern(s) (if relevant) yes/no 6) ask patient to select a number on the “readiness ruler” yes/no 6a) what was the number? 7) ask patient: why didn’t you pick a lower number? or ask patient: how would your drinking (drug use) have to impact your life in order for you to start thinking about cutting back? or discuss patient’s pros and cons of use yes/no 8) provide a summary of readiness (you said ...) yes/no 9) negotiate a goal with the patient based on his/her response to: what steps would you be willing to take? yes/no 10) offer a menu of choices for change, provide recommendation, secure agreement yes/no 11) to what degree did the provider use a motivational style (open-ended questions, reflective listening, not confrontational)? not at all 1 2 3 4 5 6 7 very effectively adapted from the bi adherence/competence scale, and oregon brief observation sheet. 12. additional comments about provider performance: (1): raise the subject (2): provide feedback (3): enhance motivation motivation (4): negotiate a plan interprofessional education and practice ipe & ipp connections to curriculum advancements in teaching and learning pivot to online delivery microsoft word deidentified poh manuscript_final.docx __________ *erin hipple, ma, lcsw, abd, assistant professor, graduate program in social work, west chester university, west chester, pa. lauren e. reid, phd, assistant professor, graduate program in counseling, arcadia university, glenside, pa. shanna m. williams, lcsw, med, clinical assistant professor, widener university, pa. judelysse gomez, phd, assistant professor, psychology, connecticut college, new london, ct. clare d. peyton, ba candidate, psychology, connecticut college, new london, ct. jack wolcott, ba, cps, msw candidate, west chester university, philadelphia, pa. note: all authors contributed equally to the manuscript. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 460-480, doi: 10.18060/24465 this work is licensed under a creative commons attribution 4.0 international license. disrupting the pedagogy of hypocrisy: how do we move beyond teaching students how to survive white supremacy? erin hipple* lauren e. reid* shanna williams* judelysse gomez* clare peyton * jack wolcott* abstract: this article discusses the ways that four educators experience the impacts of white supremacy in classroom spaces. we discuss the ways we navigate the tension created when we desire to foster antiracist spaces but are required to work within an academic system that is underpinned by white supremacy. using tenets of griot storytelling, we describe our points of origin, provide narrative examples of student interactions, and detail the reflexive lenses through which we processed these interactions. our narratives specifically seek to center black, indigenous, people of color (bipoc) and discuss the ways that our training and education has limited our ability to support them in academic spaces. we conclude with an invitation for the reader to sit with us in this space of tension, and some reflexive questions to consider as we exist in this space together. we hope to offer this as a way to continue dismantling the internalizations of supremacy. we also offer this as an opportunity to move away from the problem-solving mentality often applied to issues of racism in favor of fostering a continued, collective healing from the wounds created for all of us by white supremacist systems. keywords: cultural competence, white supremacy, case studies, social justice, multicultural training while training students to be multiculturally competent mental health practitioners, we train them how to survive white supremacy rather than deconstruct it. as a colonized nation, the default space is white. white cultural values underpin our definitions of professionalism. from our program interviews to our practical experience, the standard is whiteness. this is white supremacy. multicultural competence was developed in the mental health field in 1992 (sue et al., 1992) and is becoming a core part of our training (american counseling association, 2014; american psychological association [apa], 2017; national association of social work [nasw], 2017). there is a range for how integrated multicultural curricula is in mental health programs (pope, 2014), yet it tends to focus on training students to understand and work with cultural others. in other words, multicultural competence training uses white-, heterosexual-, cisgender-, middle-class-, christian-, patriarchal-, nondisabled-, western(typically u.s. citizen), anglophone-centered cultural experiences and define these as the standards by which all “others” are compared (stewart & nicolazzo, 2018). we train students on the importance of diversity and inclusion; however, we continue to center white cultural standards. the result of this approach and pedagogy is hypocrisy. the focus of this paper, our critique of this status quo in academia, is not a road to understand how to survive white supremacy, but rather a road of deep and about:blank hipple et al./disrupting the pedagogy of hypocrisy 461 ongoing reflexivity and its associated messiness; an invitation to engage in decolonial action (tuck & yang, 2012). white supremacy in multicultural competence training white supremacy is the foundation upon which multicultural competence and training is built. therefore, attempting to disentangle white supremacy from social work education as is currently situated within our neoliberal, capitalist system is messy and seemingly impossible (kidman, 2019). as multicultural training within the mental health and social service fields attempts to build students’ individual multicultural competence, the hypocrisy in this pedagogy arises, which leaves structural oppression unnamed, unacknowledged, and unchallenged. rather than developing the necessary skills to develop critical reflexivity for those with power to unravel systemic oppression (almeida et al., 2019), the lives and experiences of black, indigenous, people of color (bipoc), and queer and trans people (qtbipoc) become learning points in a classroom setting, often lacking nuance (brown et al., 2017). our use of the terms “bipoc” and/or “qtbipoc” is to acknowledge political identities and experiences with various interconnected systems of oppression; it is not an attempt to lump together a heterogeneous group of individuals. by reflexivity (theory translated to action) we mean the critical analysis and consciousness skills needed to interrogate one's and one's cultural group’s relationship to, and the systemic benefits associated with, white supremacy, in order to inform action and address systems, ideologies, and practices at the macroand micro-level that perpetuate and maintain “isms,” oppression and marginalization. as we ourselves engage in that critical analysis and consciousness building, we are speaking to these topics in cultural terms: who gets to create and reinforce culture and knowledge in academia generally, and in the mental health and social service professions specifically. in multicultural training, specifically, the typically structured instruction format attempts to move away from “tolerating” to “appreciating” and “celebrating difference” (jay, 2003; sue et al., 1992), which serves and reinforces established and essentialist beliefs about bipoc and/or qtbipoc, their cultural beliefs and practices and relation to health and mental health beliefs, attitudes, and behaviors (utt, 2018). if we do not also prepare our students to develop a structural analysis, critical consciousness, and reflexivity, this too serves to reify historical notions of whom, what culture, and what beliefs, attitudes, and behaviors are considered the “standards” for comparison. in so doing, we ––instructors and others vested in academia–– teach our students and supervisees to perpetuate and maintain systems of oppression (i.e., white supremacy). this informs students’ training, how they interact with clients in practicum and future clinical practice, and ultimately maintains disparate health and mental health treatment and outcomes (pope, 2014). further, we do not prepare them to disrupt unethical practices ––white supremacy-based psychological theory and interventions–– increasing the risk for psychological harm to students, and future clients, who embody marginalized identities; this includes bipoc and qtbipoc (apa, 2017). advances in social work, summer 2021, 21(2/3) 462 does multicultural competence center whiteness? there exists an assumption that difference is a deviation from the presumably objective and universal “norm,” with the implicit aim of helping “cultural others” assimilate to u.s. and western-imperialist hegemonic standards of “normalcy” (i.e., individualistic social orientation and psychological worldview). although frameworks for multicultural training were developed to bring awareness to exclusionary practices in the mental health field (sue et al., 1992; pope, 2014), our textbooks, sample syllabi, and conferences on multiculturalism continually focus on marginalized populations without acknowledging our respective field’s foundation in white supremacy. curricula operates under the assumption that white students need to be trained to work on populations different from themselves, specifically to help these populations adopt white-normed ways of being. this type of instruction and practice centers the experience of white people, who make up the majority of evidence-based focus psychological intervention studies (joseph et al., 2020), and white students who benefit the most from “cultural competence” based instruction in our classrooms. competence-based instruction, we will make the case here, paradoxically maintains implied standards and further perpetuates the marginalization, minoritization, and oppression of bipoc and/or qtbipoc. it reinforces the notion that we are able to identify and “solve” differences by quantifying them and placing people in boxes that fit the schemas we have formed throughout our lives. as a result of this instructional focus, bipoc students are not allowed to be students in the same way that white students are. the current orientation to “appreciate and celebrate” difference and develop “competencies” or be “culturally sensitive” does not allow for the development of a structural analysis (shaia et al., 2019) that challenges the field itself and our internalization of its established (and harmful) norms, worldview, and historical assimilationist practices. additionally, it does not allow students to engage in needed critical self-inquiry related to how their own beliefs, attitudes, and behaviors reinforce these norms and potentially harmful practices. this sets up a fallacy of innocence (hemphill, 2019), which allows white students in particular (and those who benefit the most from systemic privilege) to rely on the “not knowing:” “not knowing” that the foundation of the social service and mental health fields, as well as the knowledge that we rely on for our training and practices, are informed in large part by scientific racism. thus, this framing is not a road to purity. it is not innocence; it is quite the opposite – at the very least, it is complicity. the emphasis on “fixing” multicultural competence training can be framed as a continuum, with one end being superficiality in practice and the other end being social justice (writer, 2008), and while its goals overlap with the tenets of critical race theory (crt), in practice, crt often remains absent from the curriculum and enactments in our training (jay, 2003). crt examines the relationship between race, racism, and power. as a pedagogy tool it allows us to analyze and acknowledge the inequities that exists in all aspects of our society and lives (e.g., education, economics, housing, healthcare, law, etc.), and how these are socially constructed, racialized and baked into historical systemic arrangements (i.e., power hipple et al./disrupting the pedagogy of hypocrisy 463 hierarchies) so that we can do the work of transforming these arrangements toward equity (delgado & stefancic, 2001). it aims to make visible the invisible, it informs action in order to redistribute the power to create and inform “culture,” outcomes, and relationships in ways that are non-oppressive. one way this is done, is by bringing marginalized stories and voices to the forefront of conversation through what is called counter-storytelling, which at its core aims to do the work of healing. however, in postsecondary education and learning institutions, as most of these spaces are predominantly white, this healing process gets interrupted by the ongoing suppression of racially marginalized students’ voices (patton, 2016; tom et al., 2017). attempts to shift toward sitting with the tension it is important to recognize that many frameworks have already been developed in an attempt to address the tension that emerges when multicultural competence continues to center white supremacy and white cultural experiences in the classroom (dawson, 2020; faison & mcarthur, 2020; kidman, 2019; matias & mackey, 2015). while critiquing the complicity of educators in predominantly white institutions (spaces which often heighten students’ experiences of racialized trauma), cultural justiceand abolitionist-based pedagogical theory have been offered as strategies to help meet bipoc students’ needs in the classroom (faison & mcarthur, 2020). in addition to the breadth of research conducted on the effects of racism, neoliberalism, and capitalism in educational environments, more attention has also recently been focused on how this relationship is enacted in settlercolonial societies which hold a history of imperialism and violence (kidman, 2019). while indigenous academics have formed scholarship that speaks to decolonization and indigeneity, their inclusion in the academy has often been as “diversity partners,” keeping indigenous voices out of the conversation and in the institutional margins (kidman, 2019). this is just one example of many cases being built by scholars for transformative resistance “within, against and beyond” the historical and ongoing westernization of higher education (dawson, 2020, p. 82). the westernized university or institution is entrenched in both colonialism and neoliberalism, and thus the scholarly efforts towards transformative resistance are and must continue to be anti-colonial and anti-neoliberal (dawson, 2020). scholars have argued that in order to pursue greater equity and anti-racist practices and futures, both microand macrosystems must name and subsequently work to dismantle the deep-seeded roots of dehumanization that has been enacted and maintained through capitalism and colonization (dawson, 2020). multicultural competence training can be viewed as one manifestation of the work to dismantle the overwhelming power that white supremacy holds. however, while the creation of pedagogical frameworks and teaching strategies for critical whiteness studies involving self-interrogation and deep introspection adds to the existing field of crt (matias & mackey, 2015), it continues to place white students’ experiences of unpacking their white racial identities at the center of the classroom conversations, which highlights the tension that arises amidst our efforts, as educators, to ultimately practice racial and social justice informed teaching. this very tension presents: the pedagogy of hypocrisy. advances in social work, summer 2021, 21(2/3) 464 naming white supremacy in multicultural competence training for this paper, we are naming and acknowledging the professional gatekeeping practices and professor pitfalls that are a byproduct of the white supremacist air we breathe. in our work with students, we have observed the following professional gatekeeping practices: the pendulum of expectations for students, social passes, white cultural standards of professionalism and politeness, and professional jargon as class privilege. the tension arises when we tell students to disrupt white spaces yet develop gatekeeping policies around professional behaviors that maintain white spaces. additionally, there are a variety of ways that professors may perpetuate oppression within classroom settings. professors, particularly white professors, may find themselves operating somewhere at either end of a pendulum of expectations for black students and students for whom english is a challenge: possibly enforcing paternalistic and rigid attitudes that fallaciously equate intelligence to a student’s ability to use edited standard written english (eswe), or being overly lenient on students of color out of fear of the conflict that might arise if the student gets a poor grade. both mentalities are derived of white saviorism and often educators are not encouraged to reflect on their lens of experience within the context of the classroom. this protects white teachers and further marginalizes bipoc students (miller & harris, 2018). the language of social justice is rapidly evolving, with terms like diversity, inclusion, and equity showing up in everything from job titles to cultural competency workshops. similarly, terms like “intersectionality” (crenshaw, 1989) and “decolonizing” (brayboy, 2005) are being more widely used. while these terms describe processes that are based in the liberation of marginalized people, it is difficult to ascertain whether changing our language has begun change processes or has become merely the rebranding of oppressive ideals, given that this language is often used in academic spaces that still operate under the dominant, class privileged educational industrial complex. this sort of “performative wokeness” is dangerous, it is misleading to students, and often promises safety that is not backed up by a robust understanding of the systemic and interpersonal issues that marginalized people face in academic spaces. moreover, being a disruptor in academic spaces is often a privilege for some and a risk for others: individuals who have racial or gender privilege are seen as “mavericks” while individuals with one or more marginalized identities are identified as “problems.” the privilege of disruption is also related to faculty rank. a professor with tenure is more likely to have the power to subvert systemic norms, but even tenure practices in the u.s. favor cisgender, white men (croom, 2017; hanasono et al., 2019). reflexivity and storytelling in an effort to move away from colonized approaches to learning and education in academic writing, we will be utilizing an african centered approach to discussing our experiences. what follows is an introduction to the authors who currently work and teach in academia, with an emphasis on who we are as a collective versus the individual (traoreé, 2003). personal narratives will be written in the oral tradition of the west african griot, serving as stories to explain and offer commentary regarding the experience of education hipple et al./disrupting the pedagogy of hypocrisy 465 in academia (world affairs council of houston, n.d.). this effort serves to disrupt the way we routinely approach multicultural training as we center our individual stories as firstperson anecdotes detailing what is noted in our literature review. this storytelling contributes to our healing as practitioners navigating the ongoing traumatization in american academic settings (chioneso et al., 2020). the collective academia determines that when we live in our truth and when we speak it, when we dare to live in joy and thrive, this makes the “good white folks” too uncomfortable. so, we are forced to code-switch, that is, speaking, behaving, engaging and relating in ways that align and collude with whiteness (in ways that make us more palatable to white people), forced to fragment, disintegrate, reintegrate, shut up and teach, and write, and smile. we are forced to deny and question our reality: we are not seeing, feeling, or experiencing the things we are. this process of maintaining and perpetuating whiteness forces some of us to leave academia, because we refuse to (or decide to stop), play(ing) their game, we refuse to stop asking questions, we refuse to shut up and teach, write, smile, and repeat. we seek to share our collective narratives as an offering for consideration and reflection, for ourselves, each other, and the reader. the following reflexivity statements and shared stories are intended to demonstrate the different ways we show up in academic spaces, and as such, the reader might experience some lack of fluidity in them, as we have chosen not to homogenize the way we use words to construct our experiences and have instead chosen to allow our collective to be constructed in a culmination our own unique styles of writing. she wears the mask. i identify as an african american, christian, heterosexual, cisgender woman. i grew up in a small city in the mid-atlantic region of the eastern coast of the united states. the city has a history of racial unrest, which resulted in segregation between predominantly white, affluent suburban areas and predominantly black and brown inner city neighborhoods. a decade of gentrification has altered the racial makeup of the city, yet lingering and unaddressed racial trauma manifests in episodic violence within disempowered communities. the area of the inner city in which i was raised was challenged by issues of poverty and community violence. due to educational desegregation in the 1960s, children in the inner city were bussed out to suburban, mostly white schools. i was forced to assimilate in many ways, including learning to engage in code switching by altering african american vernacular english with american english, and identifying which aspects of myself were deemed inappropriate or offensive to my mostly white peers and teachers. the need to assimilate was learned through a never-ending series of macroaggressions and microaggressions which often left me feeling embarrassed and ashamed. i was subsequently placed in “honors” classes during the day, with a largely white cohort of students. the combination of my school and life experiences resulted in a dichotomous view of my community, where i simultaneously feared community violence and empathized with its perpetrators. still, this view of my community did not overshadow the experience of racial trauma i experienced in suburban classrooms and neighborhoods with white peers. safety felt elusive under either circumstance. advances in social work, summer 2021, 21(2/3) 466 these experiences have informed my professional journey as both a social worker and academian. i maintain a therapy practice specializing in serving in bipoc families, while working full time at a predominantly white institution as a program administrator and professor. much of my experience in academia has been colored by not only my past, but my current perspective as a therapist and professor. a common experience of faculty of color, bipoc students often request my guidance and emotional support as they navigate the program and their future careers. i am privy to their private pain in a predominantly white academic space, as they learn to navigate the field of social work, where their predominantly black and brown clients are feeling the impacts of systemic oppression. me in fragments. to tell my story, i’d have to do it in fragments. it’s the only way words come to me. it’s painful to write, and i guess that’s where the story could start. my paralyzing fear related to writing. the thing that will make or break “my career,” the thing that i say i love so much yet have so much fear about. even writing about myself, my position, my locations, my identities, feels like a process that could destroy me. i have internalized that voice that is not mine, but sounds like me, “you are not good enough,” “your words don’t matter...and by extension you don’t matter,” “the concerns you bring up don’t matter, therefore your people and the work you do does not matter.” being a black-identified latina (afro/black dominicana), i hear that voice echoing in the halls of academia, from the time i was a student as far back as i can remember. this is not my only identity, yet when inside academic walls it seems the only identity that shows up, front, center, ready for battle. yes, there are other parts of me that, truth be told, i am still in the process of accepting: i am a bisexual woman, internally i feel less femme sometimes than what i present to the world (so i am told). i’m just now in my early forties focusing on this, but it has always been with me. the majority of my life lived in the space of bi-bye erasure. bear with me, as i bare my soul. this is trauma work... it’s the work of liberation. the work of liberation. in order to teach my students how to do the work of liberation, i have to not only “list” my identities, but situate myself in them, this work cannot be done without embodiment (owens, 2020). i cannot do this work without acknowledging my trauma(s), because while they do not define the whole of me, they most certainly inform who, how, what and why i am. my people were enslaved: kidnapped, held captive, transported, exploited and raped in what is now known as the dominican republic and haiti, the island that goes by the colonized name “hispañola,” named by its pre-colonial indigenous inhabitants as ayiti. it is important for me to name historical trauma, as it continuously shows up in our, my, fragmented cultural and personal narrative. it shows up as anti-blackness based socialization, intergenerational racialized-, sexualand genderbased trauma. i have personal and intimate experience with all of this, undisclosed and unresolved. and so, in a toxic environment like academia (inside and outside of the classroom), and given the political landscape we are currently in, i feel constantly on loop, endless repetition: surfacing and suppressing trauma-based content because i have to do the work of survival. writing and narrative-storytelling is trauma-processing work. while my work is traumafocused and informed, i push against viewing blackness (bi-ness, woman-ness, hipple et al./disrupting the pedagogy of hypocrisy 467 etc.) only through the lens of trauma, as this (these) aspect(s) of who i am are also tied to joy. and i cannot talk about my work in academia, without its acknowledgment. inside these walls, our stories are ignored and/or cannibalized –– consumed –– for the benefit of white people’s learning. our voices silenced via denials and complaints. light, bright, but not quite white. there are many identities that feel salient as i think about this article. my social identities, as a biracial, black, and jewish, cis-woman of color, who is currently able-bodied, middle class, but raised upper-middle class, in my midthirties, identifying as spiritual not religious, straight, and u.s. born. i am racially ambiguous and most often assumed to be “other,” however, this has always been context dependent. most often, i get asked “what are you?” whether it is at dentist appointments, doctors’ appointments, on the street or even a doctoral program interview. i’m often expected to serve as a voice for bipoc faculty and students in majority white spaces on campus. my parents both experienced oppression and survived corporate america by assimilating, which showed up in their shared emphasis on education. secondly, as an assistant professor working toward tenure who coordinates the multicultural curriculum for a master’s program in counseling and practices as a licensed psychologist serving women of color. my clinical approach is feminist and trauma-informed, social justice oriented, and relationally based. and lastly, i cannot disentangle my approach to this work with my motherhood as i am continually aware of my responsibility to the next generation and juggling the demands of childcare while expected to meet the same tenure expectations as my non-parenting and cis-male counterparts. as a breastfeeding mother, i experienced the impact of how “equal” parental leave was not equitable. the invisible queer. as a white, queer, nonbinary femme with thin privilege who lives with invisible illnesses, and who is from a working to middle class background, my ways of existing in in the spaces that i inhabit are influenced by the interactions between my privileged identities, many of which are visible, and my oppressed identities which are largely invisible. while the invisibility of my gender identity, my queerness, and my disability can leave me feeling unseen, that invisibility also affords me privilege in spaces where invisibility means that students, colleagues, or clients don’t read me as “other” unless i choose to inform them. the theoretical lenses through which i try to conceptualize my teaching and practice also influence the ways i experience professional spaces. in my work as a trauma therapist and educator in social work and psychology, i am increasingly informed by frameworks that are rooted in abolition and collective liberation, but it is difficult to resolve the dissonance i experience when trying to apply these frameworks within the confines of neoliberal professional spaces. these are some of the components of my identity that influence my position in this topic. as i considered sharing my example for this paper, i found myself having to resist creating neat headings to detail the events, analysis, and reflexivity. this is one of the ways that my academic training has limited my ability to fully language the messiness of these experiences. i have been trained to identify gaps, provide clarity, analysis, and critique, and to make neat that which is tangled by identifying patterns – structuring that can at times minimize the depth and complexity of the affective process that inevitably influences the advances in social work, summer 2021, 21(2/3) 468 structure of knowledge building in this topic. i have been versed in a language that has limited my capacity to address the impacts of structural oppression in the academe. in fact, i feel at times as though this language only allows me to continually create the same faulty structures. collective narratives just as our positions in this work are diverse, our narratives are as well. we have each given our story a title and seek to share it in a way unique to our own perspective and style. as such, each story is self-contained, and not edited for homogeny as we believe that our individual voices must be honored in this work for us to contribute to a dismantling collective. our aim is to sit in a space without answers, so our stories do not offer “solutions” as we believe that while solution seeking is a tempting course to take, it is an illusion that allows us to perpetuate the notion that white supremacy is a “problem” easily “solved,” when many of the solutions are wrapped up in the same expert mentality that perpetuates these issues in the first place. instead, we invite the reader to grapple with the loose ends and sit with ourselves and with each other in the messiness of this work. preserving white comfort as multicultural training. my story is told from the perspective of my multiple identities in the room: our program’s multicultural curriculum coordinator, junior tenure track faculty, a mentor, and a biracial black woman. i share my reflexive process within the interaction with the student and faculty. this particular scenario captures professor pitfalls as i navigate academia and being responsive to the student. in my role as the multicultural curriculum coordinator, i’m grappling with a dynamic where white students receive a different training experience around race than bipoc students. for white students, the focus is on increasing awareness through vulnerability and sharing biases. however, bipoc students regularly receive feedback about developing professional skills to support white people in developing their awareness. when meeting with a black student in mentoring, we were reviewing her feedback from her multicultural lab and she pointed out that she was being given feedback on how to hold space for white classmates’ vulnerability. specifically, she was told that her comments expressing frustration with the expectation that she has empathy for a classmate’s racist white family members might impede her classmates from sharing. while the student voiced her feeling conflicted about this feedback, she kept reiterating how she tried to sit with it. internally, i was cringing, it didn’t sit well with me that this student was being asked to preserve white comfort. outwardly, my face told on me, a quizzical expression prompted me to disclose that i could understand her feeling conflicted. the student then shared more of her frustration that she felt like she was being told not to be “the angry black woman,” but felt like she had the “right to be angry.” i was nodding and verbally affirming her reaction with, “i can understand that.” my reactions in the moment stemmed from my personal identities (where i was considered “angry”) as well as my mentor role with the student. we spent a few more moments collaborating on a plan for me to bring it up with our faculty before we moved back into other mentoring topics. in reflection, when meeting with the student, i felt hipple et al./disrupting the pedagogy of hypocrisy 469 grounded and connected to what she was sharing with me. i was honest in reflecting back to her that i could see the difference in the expectation that she created space for people to share while her white counterparts were invited to share vulnerably. on the faculty side, my role as junior tenure track faculty, the multicultural curriculum coordinator, and my value of boosting students’ voices were salient. in the faculty meeting, i shared the students’ observations, and it was suggested that the student go back to the instructor (a white woman) who gave the feedback to process the student’s reaction. this suggestion did not sit well with me so i voiced my concern and was told that i could also meet with the professor. internally, discomfort around how to proceed arose. the student gave me the feedback and we collaborated on a plan for sharing this with the faculty. the pressure to conform to the culture of the faculty impacted my next steps. it is the program’s view that students should be redirected to share feedback with the instructor. self-doubt crept in, was i missing something? was i participating in a student’s avoidance as it is sometimes framed when students go to another faculty member rather than provide the feedback directly to the instructor? i didn’t question the instructor’s receptiveness to the feedback, but rather our curriculum. i ended up meeting with the instructor as well as following up with the student. the student was open to following up with the instructor, but i couldn’t help but feel like i failed her by bringing the ball back to her after she thoughtfully and meaningfully handed it to me. why did she have to do the extra work because our curriculum was rooted in white supremacy and protecting white comfort? eventually, i was invited to re-envision the curriculum and whether affinity groups would be appropriate. this work was hindered by the disparity in the number of white students to bipoc students who would be taking the course each year. we named it yet the system cannot respond to it. also, there was additional workload placed on me as a junior faculty member to meet with two professors individually and the student again. where is the space for rage? why is vulnerability welcomed while anger is silenced? how can we change our training when we are beholden to the limitations of our academic systems? the illusion of “safe space” in the classroom. the following experience i share is intended as a way to present the multi-tiered, difficult-to-capture processing of an email interaction that i had with a bipoc student regarding the difficulty they had with a white professor. the intent of my structure is to present a view of the messiness of the analysis and reflexivity happening in tandem with the event itself, as separating them out feels to me like making neat that which is inherently not. i will detail the events in bold print, with my [thoughts/observations] in square brackets and my {reflexivity/feelings} in curly brackets. i invite you to read only the bold text first, reflect on the “facts” of the interaction, identify how you might have responded to this interaction, and return to the beginning to read my bracketed internal processes. i wonder how our processes might converge or diverge and what components of our identities or experiences might account for these similarities or differences. a bipoc undergraduate student who was in one of my classes first reached out to speak with me via email about an experience they had that semester where a white professor who was discussing lgbtq issues equated the historical use of the word advances in social work, summer 2021, 21(2/3) 470 “queer” with the use of the “n-word.” {i roll my eyes as i read that this comparison was made.} [this comparison is familiar. i recognize the pattern and having heard similar arguments when i was a student.] {unsurprised. a little smug?} [we are often taught to make comparisons to attempt to anchor knowledge in mutual understanding and how do we walk the line between creating connection for the sake of clarity and implying homogeneity of experience that results in the minimizing of people with one or multiple oppressed identities? is this the result of being taught in binary and valuative hierarchical frames?] {tangled.} [i think back on the ways that white, queer people perpetuate racism and how we/they often (mistakenly) presume that being part of an oppressed group allows us/them to understand the experiences of racially oppressed individuals.] {satisfaction at identifying something complicated, gratitude at being a person this student reached out to.} [am i gratified because i want to be the “good” white professor?] {guilt.} the bipoc student explained that they asked for clarification from the professor about this comparison and attempted to express their thoughts regarding why they did not agree. [i recall doing work to move away from comparing oppressions. at one time, i would have done this.] {guilt.} the student specified that they felt they were respectful in the way they presented their counter argument [would a white student have qualified this? is this related to respectability politics? is the person defining “respectful” a professor who is unable to recognize the ways that white supremacy influences the concept of “respectful conversation?” this creates an unwelcoming space for bipoc students.] [i want to tell the student this while also telling them that knowing it is useless if the person who has the power isn’t willing to hear it]. [will my job be threatened if i advocate?] {powerless.} according to the student, the professor became defensive and shut down the conversation [a memory of seeing this happen in classes before.] {disappointment.} {but it fades quickly, like the ghost of something i thought i should feel but then remember is not new or unusual.] {unsurprised. jaded.}, leaving the bipoc student to feel unheard in addition to inhibiting their willingness to attempt discourse in future classes. [shutting down the discourse clearly invalidated the bipoc student’s thoughts in the classroom, stifling a conversation instead of encouraging one. it showed other bipoc students in the classroom that speaking up isn’t welcome. it showed white students that the white professor’s comfort was more worthy of protection than the bipoc student’s viewpoint was worthy of consideration.] {frustration, but unsurprised; like anger without teeth.} {anxiety.} [is this what the illusion of expertise does to us? is this one professor’s fragility? can i find the origin point to disrupt the ways these individual manifestations are fed by white supremacy?] {uncertainty.} [how is this showing up in my classes? what am i still not seeing?] {curiosity. guilt. judgment.} [i cognitively reframe, attempting to resist judgment, knowing that {fearful that} distancing myself will only serve to create the illusion that i can distance myself from a system that i am inextricably a part of.] [it’s tempting to intellectualize and point out the pattern but doing so also seems useless. it’s so embedded. it twists and turns into other things.] hipple et al./disrupting the pedagogy of hypocrisy 471 the student went on to say that they felt fearful but committed to seek resolution for the sake of creating change but worried it would impact their treatment in the class or their grade. [i think this is a common fear, but also think back to a bipoc student who told me once that similar interactions are the reason they don’t participate in class. how does this influence participation grades? how does that thereby influence student outcomes?] it was clear to the student, by their report, that the professor did not have the ability to tolerate conflicting views in the classroom. the student wanted to address this for the sake of other bipoc students in addition to their own need to feel heard and understood. {hopeless.} [i want to tell the student that they will be heard and not penalized, but i have no way of assuring that.] [a memory of a bipoc student telling me once that “‘safe spaces’ in the classroom are for white people.”] the student stated they were experiencing tension between wanting to have the matter addressed and uncertainty about whether they wanted to meet with their [white] advisor and/or the [white] chair of the department about it [it’s understandable why after this experience and others like it, this student doesn’t expect support in a meeting with a room full of white academics. i think of all the times that bipoc students have been silent in my classes. i wonder how we expect them to participate when they have experiences like this.] {frustration.} [i reflect on my fear –– is it just a fear? –– of not being asked back to teach as a result of my advocacy for the student.] {fear.} [i think about how i rely on the health insurance from the university, having to grapple with limited time and an overloaded schedule to assist this student.] {frustration. guilt.} [am i showing up enough?] i offer to attend the meeting with them, but we are unable to find a time in our collective schedules that works for the chair of the department. due to my schedule, i am unable to attend the meeting with the student. [is this another failure for the student? does my willingness to advocate matter if my obligations under capitalism limit my ability to show up? is it white saviorism to be so attached to needing to be a support for them?] trigger warning for academic interactions. what follows is a scenario in which i detail an instance in which my personal identity impacted my role in academia as both an educator and gatekeeper. the scenario will be described in detail, to include the complexities of my personal reactions and internal dialogue. an african american faculty member and i were concluding an activity with a group of students, when one of the participants requested to meet with us privately. the student, a young black male reported that while eating in the lunchroom at his internship, one of his fellow interns began to make self-deprecating comments about her body aloud. the male student, reportedly to attempt to lighten the mood, responded by complimenting her body. he stated that as soon as the comment was spoken, he noticed an immediate and significant shift in the energy of the room. the student stopped at this point in the story to emphasize to us, that he had been the sole black, male identified person in a room with a group of white female interns at the time of the incident. at the time, he stated that he had not responded to the tension and instead chose to make a quick exit from the room. however, upon reflection he now felt making the comment was a professional mistake on his part that could negatively impact his relationships at his field placement. he now was seeking advice regarding how to advances in social work, summer 2021, 21(2/3) 472 rectify the situation. i could empathize with this experience. as an african american, i too have a nervous system that bears the weight of generational racial trauma, which is attuned to sense discomfort of white people, and seek to soothe it in an attempt to minimize likely consequences (menakem, 2017). my colleague and i validated his concerns. my colleague, also a black male, offered to schedule a time to talk with him at length about how he might approach the issue. my colleague and i later discussed how the impact of this student’s interaction with his young, white colleague activated us to reflect on the generational history of centering of white women’s feelings, in spite of potential harm to black people. prior to the meeting between my colleague and the student, the student’s field professor, a white woman in her early seventies, approached the two of us regarding the incident in a faculty meeting. unbeknownst to the black male student, the white female intern had reported him to the internship supervisor, citing the reported comment as sexual harassment. the other young white women present when the comment was made corroborated her story, stating they had experienced the black male student leering at them in a manner that had made them uncomfortable. after a meeting with his internship supervisor, the field professor had decided to speak to us about the incident, due to our relationship with the student in our activity group. she directed my black, male colleague to have a talk with him, letting him know that he was “big and scary” and needed to be mindful of how he might make women uncomfortable in his presence. my colleague and i shared a look of shock with one another, non-verbally communicating our discomfort with the racial undertones of the statement. neither of us responded in the moment, and the professor turned and began to chat innocently with our colleagues. following the incident, my colleague and i met privately and discussed our feelings about the exchange. although we had to acknowledge we only had our student’s perspective of the incident, we both knew this student well. nothing beyond the stereotype of him living in a black, male body qualified him as scary or intimidating. what initially was understood as a professional misstep, now had potentially serious academic, professional and legal implications. it was clear to us that the female intern and her peers' perception of events were taken as fact. protecting their well-being was the focus of the professor and his supervisor, resulting in my colleague being called in to teach the student how to make his fellow white, female interns comfortable. therefore, our student was being impacted by generations of racist ideology, lending itself to a view that the black body is hypersexual, dangerous and needs to be controlled for the safety of white bodies (menakem, 2017). hearing our black, male student referred to as “big and scary,” elicited memories of emmitt till, the recent news stories surrounding botham jean, christian cooper and countless other black men who had their lives endangered due to white women’s perceptions of being unsafe in their presence. knowing the implications of what had occurred, my colleague and i had to confront our silence when our student was alluded to as “big and scary” why had this caused our nervous system to “freeze” in this moment of being triggered by this phrase? we acknowledged that in addition to this freeze response embodying a “traumatic retention” or generational trauma response, the dynamics of academia complicated this issue (menakem, 2017). it felt unsafe to address this, due to this particular professor’s former hipple et al./disrupting the pedagogy of hypocrisy 473 administrative position in the faculty and observed instances of her utilizing this power to cause emotional or professional harm to other faculty members. following our conversation, my colleague decided to follow through with his conversation with the student but chose to eliminate conversation about how he should alter his “scariness.” instead, he emphasized authentic validation and psychoeducation regarding how to navigate racial dynamics within our field. we also identified the somatic methods of pausing and intentionally creating “reprieve spaces,” free of white supremacy to strengthen ourselves to engage in intentional confrontation with this professor in future racist interactions (menakem, 2017). liberation work and professional gatekeeping. this section will draw from my experiences (observations and reflections) since i started as an assistant professor 4 years ago. most will be tied to my development as a professor, which in a white institution, is inextricably linked to my racial identity process as this aspect of my identity is the most salient when i am doing teaching, service, and research within academic walls (the brickand-mortar ivory tower). i will be pulling from critical autoethnography for this section, and because i am not a person who thinks, speaks or writes linearly i will be using parentheses, italics, and, when needed, brackets to provide readers with a sense of my internal process (sheth & croom, 2021). my first encounter with “professional gatekeeping” as an assistant professor at an undergraduate institution came very early post-hire. as someone who values learning from others, i decided to observe two courses that i would be teaching that coming fall. one of these courses was our clinical practicum/internship course (hereafter referred to as “the practicum course”), which i ended up revamping and have been teaching every fall semester since. this practicum course offers undergraduate students the opportunity to engage in fieldwork for 8-10 hours a week in mental/behavioral health-, school-, residential-, and hospital-based settings. during practicum (fieldwork), students interested in pursuing graduate school or post-bachelor careers in behavioral/mental health, school, and health/medical fields engage in skills-development work in a variety of direct service community-based agencies/settings. additionally, they engage in a 2.5-hour seminar focused on readings related to main course objectives and goals: student intern development (personal), development of basic skills (attending/listening, development of empathy, trust/therapeutic alliance building), multicultural responsive/cultural humility development, and self-care (these last two being my additions to the course). during a debrief after a course session i observed, i experienced what would be the first of many instances of white faculty wanting to help bipoc students “manage” their emotions related to injustices experienced in their schooling (including at my institution), and those they were witnessing in their practicum placement (and presumably in seminar). at the time i was not as adept at responding to these “well-meaning” comments from white faculty, and responded by saying “well... isn’t this a justified response to what they are experiencing?” at least, i think this is what i said (recall can be tricky), i know for sure i said something similar to this taking care not to sound too “emotional” myself. i was after all a new (black-latina) assistant professor developing a relationship with a white advances in social work, summer 2021, 21(2/3) 474 colleague who would thereafter become a mentor, friend, and what i would consider an ally to co-conspirator (“to” here denotes my perception of said colleague’s white racial and allyship developmental process). there were, and continue to be, many examples of this. to my surprise, at the time there were no requirements related to developing culturally responsive skills before students enrolled in the practicum course and were sent to the field. this to me was an ethical issue, specifically, students were not being taught to work within the bounds of their “competence.” what was then known as cultural psychology (now “multicultural psychology” used hereafter), was the only course in the curriculum that focused on “culture,” and not a pre-requirement for the clinical practicum course. the necessity of this as a prerequisite became apparent to me when i started teaching the course as the work students were learning to do, in my professional opinion, was the work of saviorism. thereafter, i petitioned the department to make multicultural psychology part of the required courses for practicum. my rationale for petitioning the prerequisite was that we as a department were not helping students (many who were interested in further study in the helping professions) develop the necessary skills and/or theoretical foundation to engage in ethical practice (e.g., standard of working within the bounds of one’s competence; apa, 2017). i developed multicultural psychology in 2016, during my first semester at the college. in the development of this course, i borrowed elements from the previous professor who taught it as an adjunct, from a course a colleague of mine taught at a different institution, and further informed it by evidence-based multicultural and social justice informed pedagogy (singh et al., 2020). the main objective was/is to help students develop critical consciousness in order for them to understand their identity development (including their professional identity) as happening within a specific social, cultural and political context (i.e., positionality), as well as to develop critical thinking skills as it relates to the consumption of knowledge and knowledge production (theories, scientific research, and practice) in the field of psychology. i used the awareness, knowledge and skills (sue et al., 1992) model for counselor education and development, and janet helms’s (2020) racial identity model to inform the critical (e.g., racial) consciousness development aspects of the course, which are main components of course goals and objectives. while teaching this concurrently with the practicum course a question popped in my head that became louder as the semester progressed (and as white student’s displeasure with how i taught both of these courses grew): “how are we sending students out into the field without requiring them to think critically about their identity and how this identity impacts how they interact with community-members most of whom are not white?” i definitely had my work cut out for me. in helping students engage in a systemic and critical analysis of the field, to understand how psychology is inextricably linked to systems of power, oppression and marginalization, i was in essence emphasizing that we have to acknowledge “color/power” (syed et al., 2018) if we are to engage in developing culturally responsive skills. this alignment with apa’s multicultural guidelines (2018) challenges students to not only be critical consumers of psychological science, but also helps them understand the importance of engaging with and developing critical awareness/analysis of their own worldviews. this hipple et al./disrupting the pedagogy of hypocrisy 475 approach intentionally creates dissonance for students, which then propels them to make informed choices about how they consume, understand and/or engage with what they learn. this dissonance is centered in processand content-aspects of the course, which i then help guide them through. this process, while difficult for students who benefit from systemic privilege, allows them to work in the service of what they personally define as social justice, while also helping them develop and engage in cultural humility (openness to learning and being ok with “not knowing”; rogers-sirin & sirin, 2009; tervalon & murray-garcia, 1998), ethical practice (apa, 2017) and liberation-based praxis (merging of theory and reflexive practice; singh et al., 2020). in my experience thus far, white students in particular have had the most difficulty engaging with the critical consciousness process. as evidenced in my early course evaluations, some did not see why we talked “so much” about “culture,” others saw this as a “personal” thing i was doing to them, or that i was intentionally trying to make them feel guilty about who they were and their upbringing. to say that the first three years as an assistant professor was a long and drawn-out uphill struggle, does not fully capture how it felt to navigate this process and the impact (physically, psychologically and morale-wise) it had on me. what these student reactions indicated to me was that they were not being prepared to think about, or engage with, their personal identities and the internalization of whiteness, inculcated in them via their schooling and other socialization, much less do the work that is called for if we are truly engaging in the service of social justice and liberation. what about students with marginalized/minoritized identities? a question that comes up for me every semester is: “what about our students of color, and those with other marginalized identities (bipoc, queer, trans students), in my attempt to ‘decenter’ whiteness, am i centering it?” as an educator in an institution that markets itself as “highly selective and elite,” where white supremacy is reflected in the curriculum, interactions on campus and in our classrooms, and where “diversity and inclusion,” “multicultural competence,” “full participation,” and “equity pedagogy,” (most recently “anti-racism”) have become buzzwords, i often grapple with this question: what are we to do? this is the edge i am constantly navigating. what about my students who are not white, cis, middle class, heterosexual, documented, etc.? am i really teaching them what they need to know? i believe that part of the work i take on is helping to counter (at least i would like to believe) the burden marginalized students (bipoc & qtbipoc) have to take on (am i acting as a “savior?”); keeping them from having to carry the learning for their white counterparts and those who benefit the most from systemic privilege. in my attempts, i’d like to believe that i am interrupting/disrupting the cannibalizing of their stories, narratives, and learning. whose experience is centered in our (my) attempts at “decentering” whiteness in the classroom? this is a tough question to ask, because it is a tough question to answer. yet, i know this is the work of reflexivity and liberatory praxis (bonilla-silva, 2015; owens, 2020; sheth & croom, 2021; williams et al., 2016); perhaps arriving at an answer is not the point. perhaps the point is to be in that in-between space, the space where my edges feel the sharpest. is this not praxis? i inhabit this space in a context where i am perceived as knowing, and expected to do my “expertise,” yet encounter push back seemingly at every advances in social work, summer 2021, 21(2/3) 476 turn. as i ask this question, i think of the students who sat and bore witness to their white peers’ racial identity process unraveling before them. i would like to think that there was learning in this, but their earnest learning did not happen in the classroom, their learning really occurred during my office hours, away from the white gaze. all bipoc and qtbipoc students had different experiences, yet their process coalesced (for me) around a central question… “what about us? how do we learn to navigate and negotiate ‘cultural differences’ in our daily lives, practicum, and eventually for some of us, as therapists/practitioners?” i do not fully have the answer to this, but each semester i work hard at making my pedagogy more responsive to their needs. this is my edge. our collective edges the process of transformation in our current institutions will be an ongoing struggle and is, by its nature, more time-consuming and complicated than the solutions offered in diversity and multicultural competence initiatives (davis, 2020). in order to continue on the path of transformation, we must show up with a willingness to be accountable to the ways we have internalized and perpetuated white supremacy in classroom spaces. we offer the following questions to move toward this transformation together and we hope to sit in these spaces of discomfort with you, as a community, compassionately holding space for our collective pessimism of intellect and optimism of will (antonini, 2019). questions for continued reflection: deconstructing the pedagogy of hypocrisy 1.) how is our awareness training structured? do we focus on supporting white students in their process of identifying their biases while telling students of color how to change professionally? 2.) does our terminology reflect our educational and career practices, or are we merely paying lip service to the increasing market for social justice? 3.) how can we as professors disrupt these systems to foster robust change? how can we reimagine an educational system that seeks to dismantle oppressive forces as opposed to reifying them? conclusion in west african tradition, griots were oral historians, storytellers and entertainers whose messages served the societal "duty of ..."tell[ing] the people who they are, where they came from, and where they’re supposed to head to...by dealing with the reality [of] things that happened within the society in the past". (webster, 2017). we encourage educators to engage in a reflective process regarding their classroom and program curricula. the questions for continued reflection are a starting place, but the process never ends. our stories and collective edges are examples of where we are at the time this article was written. however, they are not resolutions or templates. our hope is that this article and concluding reflection questions serve as an entry-point (and/or mechanism), to (start) the honest, arduous and intentional work of valuing (our) oft-marginalized narratives and experiences. the historical legacy and art of story-telling is not only a healing technology, but so too valuable and effective pedagogy. hipple et al./disrupting the pedagogy of hypocrisy 477 references almeida, r. v., werkmeister rozas, l. m., cross-denny, b., lee, k. k., & yamada, a.m. (2019). coloniality and intersectionality in social work education and practice. journal of progressive human services, 30(2), 148-164. https://doi.org/10.1080/10428232.2019.1574195 american counseling association. 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(n.d.). the oral traditions of africa. teach africa. houston, tx: world affairs council of houston. https://static1.squarespace.com/static/53cfd0e5e4b057663ea1bc61/t/57b1e0b746c3c4 06dd172afd/1471275383444/oral+traditions+of+west+africa.pdf writer, j. h. (2008). unmasking, exposing, and confronting: critical race theory, tribal critical race theory and multicultural education. international journal of multicultural education, 10(2), 1-15. http://dx.doi.org/10.18251/ijme.v10i2.137 author note: address correspondence to erin hipple, graduate program in social work, west chester university, 700 s high st, west chester, pa, 19383. email: ehipple@wcupa.edu https://doi.org/10.1086/690219 https://doi.org/10.1080/1467598032000117042 https://clas.osu.edu/sites/clas.osu.edu/files/tuck%20and%20yang%202012%20decolonization%20is%20not%20a%20metaphor.pdf https://clas.osu.edu/sites/clas.osu.edu/files/tuck%20and%20yang%202012%20decolonization%20is%20not%20a%20metaphor.pdf https://doi.org/10.1525/esr.2018.411205 https://www.audible.com/blog/arts-culture/this-man-embodies-a-thousand-years-of-west-african-oral-history https://www.audible.com/blog/arts-culture/this-man-embodies-a-thousand-years-of-west-african-oral-history https://static1.squarespace.com/static/53cfd0e5e4b057663ea1bc61/t/57b1e0b746c3c406dd172afd/1471275383444/oral+traditions+of+west+africa.pdf https://static1.squarespace.com/static/53cfd0e5e4b057663ea1bc61/t/57b1e0b746c3c406dd172afd/1471275383444/oral+traditions+of+west+africa.pdf http://dx.doi.org/10.18251/ijme.v10i2.137 mailto:ehipple@wcupa.edu judelysse gomez* erin hipple* clare peyton * lauren e. reid* jack wolcott* shanna williams* abstract: this article discusses the ways that four educators experience the impacts of white supremacy in classroom spaces. we discuss the ways we navigate the tension created when we desire to foster antiracist spaces but are required to work within... does multicultural competence center whiteness? the emphasis on “fixing” attempts to shift toward sitting with the tension naming white supremacy in multicultural competence training reflexivity and storytelling the collective collective narratives the bipoc student explained that they asked for clarification from the professor about this comparison and attempted to express their thoughts regarding why they did not agree. [i recall doing work to move away from comparing oppressions. at one time,... our collective edges questions for continued reflection: deconstructing the pedagogy of hypocrisy references _________ paddy farr, lcsw, private practice, eugene, or. scott wilson, lcsw, private practice, oregon city, or. katia duncan, lcsw, assistant clinical professor, the ballmer institute for children’s behavioral health, university of oregon, portland or. jonathan dominguez, lcsw, private practice, portland, or. delmar stone, lmsw, executive director at national association of social workers, oregon/idaho, nampa, id. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 620-639, doi: 10.18060/28603 this work is licensed under a creative commons attribution 4.0 international license. from alternative pathways to abolition: abolish the association of social work boards exam paddy farr scott wilson katia duncan jonathan dominguez delmar stone abstract: in 2022, the association of social work boards (aswb) provided for the first time the demographics on all five of its examinations between the years 2011 and 2021. the pass rates demonstrate a foundationally discriminatory system that routinely fails black, indigenous, and people of color (bipoc) while passing white social workers. implementing critical race theory and abolitionist social work practice to analyze the foundations of the aswb exam, this article investigates five routes to social work licensure including performance assessments/simulations, oral examinations, portfolios, jurisprudence exams, and provisional licensure. however, the analysis demonstrates that each of these alternatives produces inequitable overall outcomes leading to further marginalization of bipoc social workers. instead, the authors advocate for the abolition of the social work exam. abolition would establish the most equitable overall outcome for social workers within the social work licensure examination process, for all social workers, while simultaneously challenging white supremacy within the social work field. keywords: critical race theory, abolitionist social work, aswb exam licensing social workers is a central regulatory task of social work boards (thyer & biggerstaff, 1989). across the united states, social work boards are tasked with regulating social work practice. the purpose of such social work regulation is “to protect the public from incompetent or unethical practitioners by ensuring a minimal level of competence” (nienow et al., 2021, para. 1). thyer and biggerstaff (1989) identify this phase of stateregulated social work practice as the highest stage of development within the profession (association of social work boards [aswb], 2021). regulations for the practice of social work began to take shape in the 1930s, however, the current makeup of social work regulation within the united states really was formed in the 1960s and 1970s with social work licensing profession (aswb, 2021; nienow et al., 2021). in this context, the association of social work boards formed in 1979 “to provide support and services to the social work regulatory community to advance safe, competent, and ethical practices to strengthen public protection” (aswb, 2021, p. 6). representing sixty-four regulatory boards across the united states and canada (aswb, 2022c), the aswb developed the examination process as an “assurance that people who are licensed to practice social work share certain competencies” (aswb, 2025, p. 2). it provided its first examinations in 1983 in oklahoma, new york, and virginia, and has since offered licensing examinations in all fifty united states, and the district of columbia (aswb, about:blank farr et al./abolish the aswb exam 621 2022c). widely considered a critical part of the licensure process (hirsch et al., 2023), the aswb now administers five examinations offered including the associate, bachelor, master, advanced generalist, and clinical exams for more than fifty thousand test takers every year (aswb, 2022a). the purported drive for assessment is to ensure public safety, however, social work activists have long worried that the aswb exam leads to racially inequitable outcomes for black, indigenous, and people of color (bipoc) (senreich & dale, 2021). although the aswb had “been unwilling to release [the demographics of pass rates] for decades,” in the wake of social activism following the murder of george floyd, social workers across the us joined together in a concerted effort to push the aswb to release the data (nasw, 2022b, para. 1). finally, after decades of activist calls for transparency, in 2022 the organization relented and provided for the first time the demographics on all five of its examinations between the years 2011 and 2021 (aswb, 2022a). confirming the accusations of bipoc social work activists, the numbers demonstrate extreme racial disparity in social work licensing exam pass rates (nienow et al., 2022). for brevity, the following covers the three most common of aswb’s five exams: the clinical, master, and bachelor exams. the aswb (2022a) reports that between 2011 and 2021 there has been a steady increase of test takers. the clinical exam increased from 9,100 in 2011 to 20,657 in 2021, the master level exam increased from 11,260 to 21,650, and the bachelor level increased from 3,164 to 3,494 (aswb, 2022a). according to their report, the clinical level exam first time pass rate is 76.1%, the master level exam is 78.5%, and the bachelor level exam is 74.4%. however, not everyone passes these exams even after multiple attempts: the eventual pass rates of these are 87.7%, 85.9%, and 80.7% respectively (aswb, 2022a). while 12.3% never pass the exam, these pass rates look very different after uncovering the racial demographics underlying these scores (aswb, 2022a). whereas 83.9% of white clinical test takers passed, only 72% of latinx, 62.9% of native americans, and 45% of black social workers passed the first attempt (aswb, 2022a). on the master level exam, whereas 85.8% of whites passed their first attempt, only 64.4% of native americans, 63% of latinx, and 44.5% of black social workers passed their first attempt (aswb, 2022a). finally, regarding the bachelor level exam, whereas 76.2% of white test takers passed their first attempt, 63.6% of native american, 52.8% of latinx, and 33.3% of black social workers passed their first attempt (aswb, 2022a). the eventual pass rate looks even worse (aswb, 2022a). eventual pass rate means the rate of examinees who ever pass even after multiple attempts. the following eventual pass rates signify the rates at which a group ever passes the exam, meaning a large portion of these demographics are forced out of the profession. whereas 90.7% of white clinical test takers eventually pass, only 76.6% of latinx, 73.5% of native americans, and 57% of black social workers eventually pass (aswb, 2022a). on the master level exam, whereas 90.8% of whites eventually pass, only 72.2% of native americans, 71.2% of latinx, and 51.9% of black social workers eventually pass (aswb, 2022a). finally, regarding the bachelor level exam, whereas 81.6% of white test takers eventually passed, only 70.9% of advances in social work, summer 2025, 25(2) 622 native american, 58.5% of latinx, and 33.8% of black social workers eventually passed (aswb, 2022a). social work is not alone in this problem. the nasw of ohio notes that “disparities in pass rates across oppressed populations exist in other professions’ licensure exams but at a less alarming rate” (nasw-oh, 2022, 3). they provide the example, “nationally, the disparity in pass rates for the bar exam for attorneys is 85% for white test takers and 60.89% for black test takers [and] for pharmacists, the pass rates are 72.2% and 60.2%, respectively” (nasw-oh 2022, 3). also, like social work, the american bar association has identified massive racial disparities in passage of the bar exam (rosciglione, 2024; sloan, 2023; ward, 2022). however, the problem is more acute in the social work profession, and “the aswb exam’s racial inequities are substantially worse than these comparable professional examinations” (nasw-oh, 2022, 3). key within this lack of diversity are the artificial barriers to licensure established within the aswb examination (hirsch et al., 2023). the present article is a revised report to the oregon board of licensed social workers (oblsw) from the alternative pathways to social work licensing committee (farr et al., 2024). following the release of the aswb exam pass rate data, the oblsw began discussions on the impact of the aswb exam on racial equity in oregon. in march of 2024, scott wilson, former certified social work associates (cswa) board member, and paddy farr, current lcsw board member, proposed a new committee to the board to confront this issue, the alternative pathways to social work licensure committee. the following month, in april of 2024, board approved the committee, naming farr as the chair of the committee and wilson as committee member. with authority from the board, the alternative pathways committee began forming its membership the following month in may of 2024. wilson and farr began searching for candidates by canvassing faculty of universities, leadership of advocacy organizations, and staff of social work agencies. initial interviews were selected for three candidates. in late may, the committee had taken shape with membership as voting members including katia duncan, clinical professor in the ballmer institute at the university of oregon, delmar stone, executive director at the national association of social workers oregon chapter, and jonny dominguez, lcsw therapist in private practice. the group met for four sessions in june of 2024. during these meetings, the committee investigated current aswb pass rate demographics, surveyed current policy propositions, and identified a standard for assessment of licensure requirements. in september of 2024, farr submitted the report to the oblsw (farr et al. 2024). as a theoretical lens, the committee harnessed the insights generated through critical race theory. implementing an analytic of critical race theory and a praxis of abolitionist social work, the group assessed the historical development of racism in oregon, investigated current aswb pass rate demographics, surveyed current policy propositions, and identified a standard for assessment of licensure requirements. from this research, the committee recommended to the oblsw that an alternative pathway to licensure would be discriminatory, and instead, the board should adopt an abolitionist position against the aswb exam that eliminates the requirement for all oregon social workers. in the following, the authors of the recommendations to the oblsw cast a wider net to confront farr et al./abolish the aswb exam 623 the problem of white supremacy within the aswb exam across the us. in the first section, the research investigates how the aswb exam has maintained systems of white supremacy through the social work licensure while restricting and blocking a vision of anti-racist social work. in the second section, the research assesses six possibilities for alternative routes to social work licensure, including performance assessments/simulations, oral examinations, portfolios, jurisprudence exams, provisional licensure, and abolition. like the recommendations to the oblsw, the article concludes that only abolition will confront the white supremacy at the heart of the aswb exam. theoretical framework the present article implements a theoretical framework of critical race theory to analyze the development and administration of the aswb exam. as a development from critical legal studies, critical race theory originated as a method of investigating the reproduction of racism within the criminal justice system (crenshaw et al., 1995; delgado & stefancic, 2012). today, it represents a collection of related theories focusing on “the ways in which racial oppressions are concealed through color blind policies in the postcivil rights era” (gomez & farr, 2023, p. 172). in its most basic formulation, critical race theory includes six tenets: 1) race is socially constructed, 2) racism is real and ordinary, 3) context determines race and groups may experience differential racializations, 4) racial progress has represented an interest convergence that maintains racial oppression in the interest of white supremacy, 5) race is not an essential characteristic of a person but instead is determined in relation to other power dynamics of gender, class, sexuality and others (i.e., intersectionality), and 6) narrativity provides a means to grasp racism in a way that is not possible through quantitative means (delgado & stefancic, 2012; gomez & farr, 2023). in conjunction with critical race theory, the present article implements an abolitionist social work praxis focused on eliminated the vestiges of white supremacy within the social work field. the abolition movement has been at the forefront of social activism against us systems of white supremacy since the antebellum period (critical resistance, 2022; davis, 2003; dettlaff, 2023). as a direct line from the tradition of american abolitionists fighting to end slavery and dismantle white supremacy, the abolitionist movement continued to grow through reconstruction, jim crow, and the colorblind era to confront the systems of racialized power maintained today (alexander, 2010; davis, 2003; detlaff, 2023). beginning from the position that the systems built through chattel slavery were never truly abolished and that the reconstruction was arrested through white supremacist power grabs (alexander, 2010), the abolition movement opposes the reproduction of white supremacy in contemporary society (gomez & farr, 2023). this has had a tremendous impact on contemporary social work theory and practice. abolitionist social work builds on the critical methods employed through critical race theory and the abolitionist movement to interrogate the reproduction of racialized oppressions within social work practice evidenced by child welfare, domestic violence advocacy, sexual assault, forensic psychotherapy and others (brock-petroshius et al., 2022; dettlaff, 2023; james, 2021; kaba & nagao, 2021; kim et al., 2024). advances in social work, summer 2025, 25(2) 624 social work as white supremacist project it is uncontroversial to state that colonization and chattel slavery played a central role in the formation of the united states. racism is an ordinary part of american life (crenshaw et al., 1995; delgado & stefancic, 2012; gomez & farr, 2023). the land on which sits the united states is native land stolen through white settler colonialism and maintained through mass genocide of native peoples (churchill, 1997; lewis, 2014, 2023; lewis & connolly, 2019). the wealth on which the united states is built was facilitated by mass enslavement and human trafficking of black people (blackmon, 2008; perry, 2020). the contemporary structure of the united states has maintained a continuity of black and indigenous subjugation through systems of white supremacy inherited by liberal democracy (blackmon, 2008; churchill, 1997; hartman, 1997; perry, 2020). following the reconstruction era, many of the race-based practices of enslavement and colonization were continued through first jim crow and then through surface level color blind enforcements targeting bipoc communities (alexander, 2010; blackmon, 2008; hartman, 1997). during this period of the post-bellum us, the prison system was created as a means to reenslave black people through the exception clause of the 13th amendment (alexander, 2010; farr, 2022). the history of social work is enmeshed within this history of white supremacy. racism is ordinary even in social work (crenshaw et al., 1995; delgado & stefancic, 2012; gomez & farr, 2023). across the country, the social work field is guilty of grave racial injustices and has a long history of collaboration with us based settler colonial, white supremacist, and eugenicist social programs (farr, 2021). social workers have run segregated settlement shelters, worked to prevent black suffrage, recruited black participants in the tuskegee atrocity, and removed native children from their communities placing them in boarding schools, among many other violent injustices (nasw, 2021a, 2021b, 2022a). all the while, social work had hidden itself behind a veil of pseudoscientific eugenic explanations on racial disparities (kennedy, 2008). kennedy explains that “social workers, including leading visionaries such as [mary] richmond and [jane] addams, as well as members of the rank and file, were intimately involved in furthering the eugenics agenda” (kennedy, 2008, p. 33). through the embrace and propagation of eugenics-based practices, the social work profession was established as a central practice within white supremacist social policy designed to disempower and control black, indigenous, and people of color (kennedy, 2008; o’brien, 2022). in contemporary social work, the profession has embraced the social construction of race and implemented measures for ensuring equal access, opportunity, and outcomes. yet, like other areas of american society, these changes have represented a mere interest convergence with white supremacy (crenshaw et al., 1995; delgado & stefancic, 2012; gomez & farr, 2023). in our contemporary era, social workers maintain the fundamental design of eugenic and white supremacist practices through seemingly innocuous colorblind policies. examples of social workers’ continued responsibility in these practices abound. today, maintaining the violence against black population originating under conditions of enslavement, social workers are enmeshed within the criminal justice system in the united states boasting both the largest imprisoned population and largest population farr et al./abolish the aswb exam 625 under supervision in the history of the world (detlaff et al., 2023; kim et al., 2024). again, the black and indigenous family separations begun during enslavement and colonization continued through the purposeful development by social workers of child welfare policies that target black and indigenous families (dettlaff, 2023; detlaff et al., 2023). anti-sexual assault laws, of which social workers have been instrumental in creating, have been and continue to be harnessed to target black and native men while allowing whites to assault black and native women with impunity (alexander, 2010; hartman, 1997; kim et al., 2024; thompson-miller & picca, 2017). while each of these practices are drawn up as race neutral and color blind, concealed beneath the façade of a formal equality in social work practice is the same eugenic and white supremacist design endemic through the history of the profession. in truth it is this history of racism and violence that has created a public health crisis that can only be confronted through a movement for racial justice (russell, 2021). this brings the discourse back to the professional regulations of social work. racism is ordinary and the appearance of progress hides an interest convergence that benefits white supremacy (crenshaw et al., 1995; delgado & stefancic, 2012; farr, 2022; gomez & farr, 2023). even in the administration of social work professional education, certification, and licensure, social work has a long sordid history of preventing bipoc from entering the profession by using eugenics as a pseudoscientific strategy for public safety (baker-gary & gary, 1994). this began with the early development of the profession with foundational theorists and practitioners such as jane addams advocating for eugenics social policies through a white supremacist social work practice (hall, 2022; o’brien, 2022). the barriers built through these policies have led to increasing disparities in certification and licensure rates for bipoc social workers (senreich & dale, 2021). today, unbeknownst to many, what began as outright eugenic based practices meant to maintain the purity of social work continues to direct the social work profession as an interest convergence maintaining racism through the professional regulations established in this dark page of social work history. here, the standardized testing implemented by the aswb is a key moment in this thread of white supremacy wherein the purported objectivity and fairness of the examination grew directly out of the eugenics movement as a method designed to establish whites as a superior race. early pseudoscientific advocates of this practice believed that widespread standardized testing would help promote white superiority in society in two ways: first by maintaining whites in positions of power and second by providing empirical data justifying racial hygiene (au, 2020a, 2020b; stoskopf, 2002, 2012). this problematic practice gained steam across multiple dimensions of psychological testing, education, training, and licensure examination. in public education, this practice has established a system in which white students are advanced and promoted while black and brown students are disenfranchised (gillborn, 2010). the outcome forms a thread from this history through the color-blind era resulting in the contemporary racial disparities in standardized educational assessment scores for bipoc students (au, 2020a, 2020b; rosales & walker, 2021). at the same time, parallel to educational assessments, professional practices began developing standardized assessments based on this eugenic science (himelfarb, 2019). professions as varied as law, engineering, medicine, and education professionals use advances in social work, summer 2025, 25(2) 626 standardized testing as a means to assess the preparation of a professional for independent practice. just as in the educational testing of youth, standardized testing has created barriers for many bipoc to enter these professions thus maintaining the same racial disparities created in educational settings. researchers have found racial disparities in pass rates across professional examinations such as the bar exam, the american board of family medicine exam, and the association of social work boards exams, among many others (himelfarb, 2019; senreich & dale, 2021; wang et al., 2022; ward, 2022). as with standardized testing in education, this racial disparity within professional examinations can be traced directly back to the eugenic theories used as foundations for the development of standardized testing. while for nearly a century many professions have implemented standardized testing, the aswb has provided the social work exam only since 1983 (aswb, 2022c). hence, compared to many of the other professions, the aswb exam is a late addition to the standardized assessment of professions. at the same time, where standardized assessments in educational settings have demonstrated racial disparities in pass rates, the aswb is a microcosm of a much larger issue of interest convergence papered over with colorblind policies. hence, although a late comer, the aswb relies on the same theories used to establish standardized assessments within education and across industries to launch the aswb examinations as a requirement of social work practice. and like standardized assessments generally, this has created a racialized system privileging whites. this fact can be witnessed in the pass rate demographics of the aswb exam: the current pass rates disclosed by the aswb are indicative of how colorblind practices maintain systems of white supremacy even within the profession of social work. although the purpose of the aswb examination is to protect the public (aswb, 2021, 2024; nienow et al., 2021), instead it has led to racially inequitable outcomes for bipoc social workers (aswb, 2022a, 2022b). the root of the problem is the standardized assessments which maintain an ordinary racism benefiting white supremacy across systems. an assessment of alternative pathway models outrage ensued following the release of the aswb pass rate demographics, and a grassroots movement took hold across the us led by black social workers. activists began canvasing their local social work licensing boards and their state legislatures for changes to licensing requirement. leading the country, black activists in illinois fought and won an alternative pathway to licensure that has greatly increased access to licensure while making an impact on social work across the country (nasw-il, 2023). in august of 2023, illinois became the first state to provide an alternative pathway to social work available for all (nasw-il, 2023). the movement spread to minnesota, and in october of 2024, the state became the second to provide an alternative path to licensure, offering anyone with a social work degree in minnesota to apply for an alternative pathway (minnesota board of social work, 2024). currently, multiple other states are following the lead of illinois and minnesota to investigate their own alternatives to aswb examinations including oregon, virginia, and michigan. at the same time, parallel to social work, similar movements for change have pressed for licensing requirements of attorneys with states such as oregon, wisconsin, and new hampshire establishing alternative pathways and others preparing farr et al./abolish the aswb exam 627 alternative pathways including california, minnesota, utah, nevada, and south dakota (rosciglione, 2024; sloan, 2023; ward, 2022). confronting the history of exclusion and increasing diversity of the profession is critical to increasing the social work labor force. to this end, the present article implements a theoretical framework of critical race theory and abolitionist practice. as mentioned in the introduction, the present article is a revised report to the oregon board of licensed social workers (oblsw) from the alternative pathways to social work licensing committee (farr et al., 2024). using gooden’s (2014) social equity analysis for assessing racial equity in government programs, the committee’s critical race analysis and abolitionist proposal builds on the licensure policy analysis developed in “alternative pathways to social work licensure: a critical review and social equity policy analysis” (hirsch et al., 2023). below is described the assessment tool. gooden (2014) includes the following social equity criteria: a) procedural fairness, b) access, c) quality, and d) outcomes. gooden uses the definitions of keehley et al. (1996) for these criteria. procedural fairness signifies due process, equal protection, and equal rights (gooden, 2014; keehley et al., 1997). access signifies equity of distribution across the population (gooden, 2014; keehley et al., 1997). quality signifies equity of process across groups (gooden, 2014; keehley et al., 1997). outcomes signify the impact of a policy across groups and individuals (gooden, 2014; keehley et al., 1997). these four criteria are rated as a) poor, b) fair, c) good, or d) excellent. together, the four criteria inform an overall outcome for the policy as a) equitable, meaning “excellent performance on each of the four equity dimensions” (gooden, 2014, p. 159) b) minimally inequitable, meaning “at least good performance on each of the four equity dimensions” (gooden, 2014, p. 159) c) moderately inequitable, meaning “at least fair performance on each of the four equity dimensions” (gooden, 2014, p. 159), or d) inequitable, meaning “below fair performance on one or more equity dimensions” (gooden, 2014, p. 159). the present analysis of the alternative pathways committee, however, diverges slightly from gooden’s (2014) overall outcomes in order to provide a more generous assessment of the alternative pathways. aligned with the analysis of hirsch et al. (2023), the overall assessment instead takes averages of the ratings: a) an inequitable overall outcome results from poor rating across each dimension, b) a moderately inequitable overall outcome results from an average rating of fair across dimensions, c) a minimally inequitable overall outcome results from an average rating of good across dimensions, and d) an equitable overall outcome results from excellent ratings across dimensions. hirsch et al. (2023) assessed portfolios, oral exams, performance assessments, simulations, jurisprudence exams, and provisional licensure. the committee identified these alternative pathways as nearly exhaustive with the exception of an abolition of the examination requirement. as such, the committee added this proposal to the list of alternative pathways. in june of 2024, the committee met on four occasions to discuss and evaluate policy options for the state of oregon. the sessions were open to the public and announced on the oblsw website following oregon public meeting law. after the meetings, minutes were submitted for the public record. the chair, paddy farr, presented the proposed alternative pathways provided by hirsch et al. (2023) and the theoretical framework of critical race advances in social work, summer 2025, 25(2) 628 theory after which the committee proposed the addition of abolition. during sessions, the committee investigated each of the alternatives through discussion while chair farr took notes. following the theoretical foundation of critical race theory and with abolition as a policy option, the alternative pathways committee reevaluated the alternatives thereby finding different results from hirsch et al. (2023), particularly on the provisional licensure, and providing a final recommendation for abolition. concluding the committee’s sessions, chair farr collated the deliberative results into a format matching gooden’s (2014) racial equity analysis and hirsch et al.’s (2023) assessment of alternative pathways. the committee voted to submit these results to the oblsw. in september of 2024, these recommendations were submitted. the following sections are broken into three parts. the first describes portfolios, oral exams, performance assessments, and simulations. the second section describes jurisprudence exams and provisional licensure. the final section, concluding this article, describes abolition of the social work exam as a step toward an abolitionist social work practice. the ratings and overall outcomes found by the alternative pathways committee are included in table 1. table 1. equity analysis of alternative pathways and abolition pathway to licensure social equity criteria procedural fairness access quality outcomes overall outcome performance assessments/ simulations poor poor poor poor inequitable oral exams poor poor poor poor inequitable portfolios poor good fair poor moderately inequitable jurisprudence exams good good good good minimally inequitable provisional licensure poor good fair poor moderately inequitable abolition excellent excellent excellent excellent equitable portfolios, oral exams, performance assessments, and simulations under the first group of alternatives are portfolios, oral exams, and performance assessments or simulations. these alternative pathways are grouped together because each of them faces very similar problems and inequities. following hirsch et al. (2023), the committee used the definitions provided by the american educational research association (aera), the american psychological association (apa), and national council on measurement in education (ncme) (2014). portfolios are defined as a collection of real-life work submitted for examination and assessed under a rubric (aera et al., 2014). oral examinations are defined as an examination before a panel of examinees scored with a rubric, similar to a thesis or dissertation defense (aera et al., 2014). performance assessments are defined as assessments in real life situations with clients that are scored on a rubric (aera et al., 2014). simulations are nearly identical to performance assessments, defined as simulated situations with clients that are scored on a rubric (aera et al., 2014). each of these were tested and explored within the present article based on gooden’s (2014) social equity analysis. the alternative pathways committee brought each proposal forward and reviewed the requirements for completion. the committee found many of the farr et al./abolish the aswb exam 629 same problems and pitfalls in these forms of assessments as are present with standardized assessments such as the aswb exam, namely the process of standardization reproduces an effect on racial equity that maintains heteropatriarchy and white supremacy. furthermore, in line with hirsch et al. (2023), the committee identified a new difficulty of unconscious bias apparent with oral exams, and performance assessments or simulations. the committee identified an addition barrier to implementation around cost for social work boards. the committee identified four primary problems with these forms of assessment, three of which align with hirsch et al. (2023). first, because the rubrics are developed and scored in order to maintain the same conditions for each examinee, the knowledge base implemented maintains the same white supremacist and heteropatriarchal vision of proper social work as does the aswb exam. this is the case with all four pathways described above. as demonstrated through the demographic data in education and the professions, bipoc test takers pass at lower rates across standardized assessments (au, 2020a, 2020b; gillborn, 2010; himelfarb, 2019; nasw-oh, 2022; rosales & walker, 2021; senreich & dale, 2021; stoskopf, 2002, 2012; wang et al., 2022; ward, 2022). from this mass of data produced through standardized assessments, it is deduced that these alternatives do not provide a pathway that challenges the fundamental difficulties with the aswb exam around standardization. second, because the testing environment will reproduce a high-stakes exam mimicking aswb testing environments, the barrier to entry will for bipoc social workers will likewise maintain. this is the case with oral exams, performance assessments, and simulations but possibly with portfolios as well depending upon if they are scored live in an oral exam format. a key difficulty identified within research into standardized assessments demonstrates that the high stakes nature of the assessment is a major factor in low pass rates for bipoc test takers is (del carmen unda & lizárraga-dueñas, 2021; nienow et al., 2022; spurlock, 2013; steedle & grochowalski, 2017; vasquez-heilig et al., 2018). where each of these alternatives provide the same high stakes environment as does a traditional multiple choice standardized assessment, the same inequities are reproduced through the process of assessment. third, regarding assessments through oral exams, and performance assessments or simulations, because unconscious bias can play a key role in the rating of a particular examinee, bipoc social workers will continue to suffer under these conditions and possibly at a more extreme rate than the aswb exam. this is the case particularly with oral exams, performance assessments, and simulations but possibly with portfolios as well depending upon if they are scored live. a wealth of evidence has been provided by researchers on unconscious bias and its negative effects on bipoc students. enough evidence of this has been generated to produce a metanalysis in grading and in assessments of students (malouff & thorsteinsson, 2016). where these alternative forms of social work assessment require the test taker to be present before a panel, the evidence points to these biases becoming a barrier for bipoc examinees. finally, the alternative pathways committee identified an additional difficulty around cost of implementation. this is the case with each alternative including oral exams, performance assessments, simulations, and portfolios. social work boards across the advances in social work, summer 2025, 25(2) 630 united states function on tight budgets through state funding. implementation of any of these alternatives would require significant logistical effort and funding in order to produce and manage. the alternative pathways described in this section would likely become the responsibility of the state boards to administer in addition to other logistical efforts. in this way, it is not realistic to push an additional function of a new assessment system on state boards. whereas the current system of aswb examination provides a system of assessment, development, management and administration of an assessment system is outside the capabilities of state boards under current funding levels. the history of white supremacy and eugenic science in the development and implementation of standardized testing across education and the professions should give social workers pause before implementing a new standardized assessment to replace the old (au, 2020a, 2020b; gillborn, 2010; himelfarb, 2019; nasw-oh 2022; rosales & walker, 2021; senreich & dale, 2021; stoskopf, 2002, 2012; wang et al., 2022; ward, 2022). portfolios, oral exams, performance assessments, and simulations do not meet the goal of a more equitable examination. in truth, each is an interest convergence in which the standards for white supremacy maintain within the social work licensing system. the committee thus assessed, reproducing the findings of hirsch et al. (2023), that oral exams, performance assessments, and simulations are all inequitable, however, as long as portfolios are not presented in vivo then these may be rated as moderately inequitable. for ratings and overall outcomes of the equity analysis, see table 1. jurisprudence exams and provisional licensure the second group of alternatives includes jurisprudence exams and provisional licensure. the committee used the definitions provided by hirsch et al. (2023). jurisprudence exams are defined as an examination on knowledge of rules, laws, and ethics regulating the social work profession. these may be open book evaluations taken online or via printed pdf. colorado, indiana, new mexico, vermont, oregon and texas are states currently using jurisprudence exams at varying levels of licensure (hirsch et al. 2023; farr et al., 2024). for example, in the state of oregon, a jurisprudence is administered to cswa through an open book pdf evaluation. provisional licensure is defined as any form of licensure that is provided without requiring the aswb exam. while this practice of provisional licensure is common among states at the bachelor and master/associate level during the period a candidate is attempting to pass the associated aswb exam, provisional licensure is less common at the clinical level. only two states currently have alternative pathways toward independent clinical licensure via provisional licensure, namely illinois and minnesota (minnesota board of social work, 2024; nasw-il, 2023). the committee’s assessment of these alternatives is provided below. regarding jurisprudence exams, the committee found that this alternative pathway is a minimally inequitable alternative pathway to licensure. because they are provided in a cost-free and open book assessment on local rules and laws as they are written, jurisprudence exams are easily accessible to social workers, have little chance of cultural bias, are free of charge, and are directly applicable to the tasks of a regulated social worker within a jurisdiction. furthermore, because many states already use a jurisprudence exam farr et al./abolish the aswb exam 631 for prelicensed social workers under supervision, e.g. licensed master social workers or cswas in oregon, the social work boards would have little to no development costs associated with expanding the exam to cover other licenses and certifications. despite these promising results, the committee found three difficulties with jurisprudence exams that diminish their desirability. these are described below. first, in many locales, jurisprudence exams are scored by hand which increases the labor cost for assessment. a potential work around for this difficulty may include computer-based assessment and scoring, thereby becoming even more efficient and sustainable. however, this comes with its own difficulty of internet access. second, hirsch et al. (2023) identified one single potential pitfall with jurisprudence exams: in some jurisdictions, where the jurisprudence exam is administered over the internet, a lack of internet access may present a barrier for exam administration. as currently practiced in oregon, because the jurisprudence exam is completed on a printable pdf that can be mailed if requested, internet is not required for administration. however, this again circles back to the problem of labor costs for manual scoring. third, the committee found that although the jurisprudence exams provide a more equitable and fair entrance into licensure that assesses the knowledge social workers require in order to practice within a state, the knowledge base itself is uncritically accepting of the norms and standards preserved in law rather than critical thinking skills required for breaking down white supremacy. this marks a deeper issue with jurisprudence exams. a strength of social work ethics, as laid out by the nasw (2021c) code of ethics, is to distinguish law and ethics such that legal frameworks may prove to be harmful and unjust (reamer, 2008). as pointed out by fredric reamer (2008), key author of the nasw code of ethics (nasw, 2021c), “in some instances, blind obedience to the law can be shortsighted and harm clients, particularly when laws seem to be unjust” (reamer, 2008, para. 12). as such, the present research proposes that the jurisprudence exam is a viable alternative pathway to social work licensure providing minimally inequitable outcomes for bipoc social workers and the social work profession, however, it is a second best to the final recommendation. regarding provisional licensure, the committee found that this alternative pathway results in a moderately inequitable overall outcome. because provisional licensure eliminates the need for examination, many of the inequities of the examination process are mitigated. while the alternative pathways committee found that eliminating the exam requirement does greatly improve access to social work licensure, the present research identified a deeper inequity within provisional licensure. the committee thus assessed this pathway as moderately inequitable. the present research finds significant barriers established through provisional licensure evident within the states that have enacted this alternative. the illinois model for alternative pathways to licensure requires an associate to fail the aswb clinical exam at least once and then to complete an additional 3,000 hours of supervised practice beyond the required 3,000 hours of supervised practice currently required (nasw-il, 2023). minnesota follows the illinois model but can be done at any level of licensure and requires 37.5 hours of additional supervision over 1-3 years in lieu of exam passage (minnesota board of social work, 2024). advances in social work, summer 2025, 25(2) 632 however, provisional licensure demonstrates that it is at a major financial cost to the social worker that will negatively impact bipoc social workers the most. first, many social workers are not provided supervision as a benefit of their employment and instead must pay a private supervisor (suttle, n.d.; thom & norris, 2023; walker & bruhn, 2023). mojozy, an organization that helps early career clinicians navigate education and licensure, estimates that clinical supervision can cost between $50 to $250 or more per hour for those who have to pay (mojozy, 2025). given that a social worker is required to complete 100 hours of supervision, every social worker who is unable to secure supervision as a benefit of their employment is required to pay thousands of dollars to complete the requirements of licensure. this places a greater financial burden on social workers who take the provisional licensure option. black social workers have pointed to difficulties finding supervision due to the high costs, often for poor quality supervision from white supervisors (walker & bruhn, 2023). because the option is developed to alleviate the inequities produced through the aswb exam, this pathway to licensure will force social workers to pay more in supervisory costs, and because bipoc social workers will be more likely to take this pathway to licensure, this will create a racially inequitable system of payment for supervision. second, in many agencies, a social worker’s pay is tied to the status of their licensure. for example, in the us federal government, the social worker job series has multiple grade determinations including gs-07, gs-09, gs-11, and gs-12, each with specifications on licensure and experience (united states office of personnel management [usopm], 1964). as an example, in 2025, an unlicensed social worker with an lmsw is designated a pay grade of gs-09 and can expect to earn an annual salary beginning at $52,205 whereas a licensed social worker with an lcsw is designated a pay grade of gs-11 and can expect to earn an annual salary beginning at $63,163 (federalpay, n.d.a, n.d.b; usopm, 2025). hence, those without an independent clinical license are paid at a lower rate than those with an independent license. provisional licensure is not an independent license, and hence, those under the conditions of the provisional license will be paid less than those with a full independent license. because the alternative pathway is meant to provide greater equity for bipoc social workers, the program will end up costing them thousands of dollars in lost wages. finally, because provisional licensure is an alternative to traditional licensure specifically aimed at bipoc social workers (hirsch et al., 2023), a social worker who has elected the alternative outs themselves as not taking the aswb exam. although it is widely acknowledged passage of the exam is correlated to race and not ability to perform professional tasks, there are still both conscious and unconscious judgements against social workers who have failed the aswb exam. thus, a social worker who takes the alternative pathway may suffer judgement of their professional ability taking the alternative pathway. this can cause psychological harm to the social worker while also potentially affecting their consideration for employment. because the pathway was designed for racial equity, this outcome will do the greatest harm to bipoc social workers. for ratings and overall outcomes of the equity analysis, see table 1. farr et al./abolish the aswb exam 633 abolish the aswb exam while the goal of regulation is to create assurances for public safety of social work practice, there is currently no evidence that the aswb exam achieves public safety (apgar, 2019; apgar & nienow, 2023; hirsch et al., 2023; nasw-il, 2023; nasw-oh, 2022). assessing the many locales where the master and bachelor level exam is not required for licensure, this has not created a public health hazard (nasw-il, 2023; nasw-oh, 2022). for example, illinois, rhode island, and delaware removed the requirements for master and bachelor level exams for dependent licensures after requiring them for many years, and the result was greater access to licensure without any significant harms to the public (nasw-oh, 2022). today, the lessons from illinois and minnesota are clear: an exam is not required to demonstrate an ability to practice, and eliminating exam requirements increases the diversity of the workforce through more equitable assessments. nevertheless, as outlined in table 1, each alternative assessed thus far results in an inequitable state of affairs. according to the shortcomings of these various designs for an alternative pathway, a truly equitable alternative to the current model of licensure is not yet apparent. on this issue, cassandra walker, an activist leader for the #stopaswb coalition in the effort for the alternative pathways in illinois and coauthor of “alternative pathways to social work licensure” (hirsch et al. 2023), stated: the reckoning around aswb has been coming for decades, and i am happy to see this first step signed into law here in illinois. we fought long and hard for those social workers who have been unjustly barred or pushed out of clinical work in their communities. despite the abuse and attacks used against us, we will keep working to make social work live up to the promises it makes on paper. i hope that other professions and states follow our example and push this work further as it is clear that these kinds of tests are not making us safer, don't measure what they claim, and generally weaken our ability to properly staff organizations in professions which already have massive shortages (nasw-il, 2023, para. 9). walker is articulating that in order to make a lasting impact on equity in the social work profession, a more daring strategy than proposing system reforms is in order. following the critical race theory analysis provided above, a mere reform of the examination system would constitute an interest convergence insufficient to eliminate white supremacy within the profession. a reformed system of licensure that maintains the vestiges of white supremacy through color blind racism is still a system that is white supremacist at its core. as social workers investigating the aswb exam, an abolitionist paradigm regarding the aswb exam would outright end the exam from requirements for licensure, creating the most equitable state of affairs for all social workers. hence, although the options described above are nearly exhaustive of possible alternatives, the authors of this article argue that a truly equitable alternative for all social workers is instead the abolition of the aswb exam. this abolition would mean not an alternative pathway but instead a single pathway that does not discriminate or segregate bipoc social workers from the licensure process. advances in social work, summer 2025, 25(2) 634 functionally, as the lowest bar to clear, what abolition of aswb examinations means is eliminating the exam from requirements while maintaining the current licensing and certification structure required by social work boards. currently, state boards have robust mechanisms for gate keeping the social work profession including requirements for supervision, holding a degree in social work, and maintaining professional ethics (nienow et al., 2021; thyer & biggerstaff, 1989). these robust standards may provide oversight, however, there is no evidence the aswb examination provides any level of public protection (apgar, 2019; apgar & nienow, 2023; nasw-il, 2023; nasw-oh, 2022). hence, maintaining the standards already set by social work regulation would provide a low-risk strategy for eliminating the examination. although the focus of alternative pathways to licensure has been on licensed independent clinical practice, the demographic pass rates for each of the aswb exams demonstrate racial inequities (aswb, 2022a). as discussed above, the pass rates across each aswb exam—i.e., master, generalist, clinical, associate, bachelor—contribute to the ongoing racial inequities in the social work profession and are based in the same white supremacist and settler colonial methodology as is the clinical exam. as such, abolition of aswb examinations should include not only the clinical exam but also the bachelor exam, the master exam, and all other exams used by states to maintain barriers for social work licensure. in short, rather than establish a new alternative for bipoc social workers, the social work field should abolish all aswb exams. whereas establishing an alternative pathway to licensure through one of the routes analyzed by hirsch et al. (2023) would maintain inequities within the social work field, abolishing the aswb exam would have the effect of establishing an equitable state of affairs within the social work licensing process. see table 1. abolition would improve procedural fairness by establishing the same path for every social worker regardless of ability to perform on standardized assessments. abolition would increase access to licensure by creating a route available for every supervised associate social worker without barriers beyond supervision. abolition would produce the same high standard of social work knowledge equal to that of the current system. abolition would create a system designed for excellent outcomes for every social worker who completes supervision. and abolition would ground licensure in a target of equitable overall outcomes for a new social work field. although, as assessed within the equity analysis, an alternative pathway might improve conditions from inequitable to moderately or minimally inequitable, alternative pathways miss the mark. nothing less than abolition can achieve an equitable pathway to licensure. nevertheless, abolition of the aswb examination may be only the beginning of a larger process of abolition within social work. as demonstrated through the history of social work, the profession has aligned with white supremacy, and this collaboration is at the heart of the social work project (dettlaff, 2023; detlaff et al., 2023; kim et al., 2024). here, professionalization of social care has aimed to sever bipoc communities from traditional practices while claiming sole legitimacy to help those communities (dettlaff, 2023; kim et al., 2024). as the bureaucratic adminstration of social work professionalism, social work regulation plays a central role in the function of this process. future research and activism farr et al./abolish the aswb exam 635 should focus on the ways professionalization of social work has maintained white supremacy and abolitionist visions against social work regulation. references alexander, m. 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(2022, may 2). in recently released data, aba parses out bar passage rates by race, ethnicity and gender. aba journal. accessed august 14, 2024. author note: address correspondence to paddy farr, lcsw, private practice, 541 willamette st., eugene, or 97402. email: pmfarr@email.arizona.edu https://csorwvu.com/wp-content/uploads/2023/08/excellence-project-norris-thom-updated.pdf https://doi.org/10.1177/1077801216654016 https://doi.org/10.1177/1077801216654016 https://www.opm.gov/policy-data-oversight/classification-qualifications/classifying-general-schedule-positions/standards/0100/gs0185.pdf https://www.opm.gov/policy-data-oversight/classification-qualifications/classifying-general-schedule-positions/standards/0100/gs0185.pdf https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2025/general-schedule/ http://dx.doi.org/10.58464/2168-670x.1389 http://dx.doi.org/10.58464/2168-670x.1389 https://doi.org/10.1080/26408066.2023.2276117 https://doi.org/10.1080/26408066.2023.2276117 https://doi.org/10.22454/fammed.2022.873033 https://doi.org/10.22454/fammed.2022.873033 https://www.abajournal.com/web/article/data-on-bar-passage-rates-by-race-released-by-aba https://www.abajournal.com/web/article/data-on-bar-passage-rates-by-race-released-by-aba mailto:pmfarr@email.arizona.edu ______ ingrid m. cordón, phd, research scientist, department of psychology, university of california, davis (uc-d), ca. jia y. chong, ms, doctoral student, university of illinois, urbana-champaign, champaign, il kevin grimm, phd, professor, department of psychology, arizona state university, tempe, az. catherine christo, phd, professor emerita, department of psychology, california state university, sacramento, ca. macaria mendoza, ma, assistant specialist, department of psychology, uc-d, ca. amanda clinton, phd, senior director, office of international affairs, american psychological association, washington, dc. gail s. goodman, phd, distinguished professor, department of psychology, uc-d, ca. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 85-108, doi: 10.18060/25770 this work is licensed under a creative commons attribution 4.0 international license. identifying learning disability screens for spanish-speaking adults: a helpful tool for social work and welfare practice ingrid m. cordón jia y. chong kevin grimm catherine christo macaria mendoza amanda clinton gail s. goodman abstract: the successful screening for possible learning disabilities (ld) is a crucial first step in the process of identifying signs of ld, gaining assistance and/or accommodations, and obtaining a more complete ld assessment. although latino people are the largest ethnic minority in the united states, and more specifically in california, there remains a clear need for a valid ld screening measure that is appropriate for adult spanish speakers, particularly low-income individuals. this study evaluated the validity of three brief measures to screen for ld among low-income spanish-speaking adults: empire state screen, welfare-to-work [wtw] 18, and matilda-r. the study also provides an initial estimate of ld risk in the low-income spanish-speaking population. to estimate the predictive utility of each screening measure, 1,040 spanish-speaking adults were administered each of the three screens and then assessed for indications of ld using multiple scoring methods (bateria discrepancy diagnosis [bdd], pattern of strengths and weaknesses [psw], and dsm-5). the translated wtw 18 screen and the matilda-r appeared most promising. a culturally-sensitive, validated ld screen will help ensure that social workers and other helping professionals have access to appropriate and legally required interventions for this marginalized population. keywords: learning disabilities, spanish-speaking adults, screening, low-income, americans with disabilities act learning disabilities (ld)--generally defined as a heterogeneous group of disorders that include substantial difficulties in such abilities as listening, speaking, reading, writing, reasoning, or mathematical abilities--are lifelong conditions that interfere with individuals’ ability to understand and retain information (swanson et al., 2013; see individuals with disabilities education act, 2004). estimates of ld among adults are generally sparse (gerber, 2012) and vary widely from 2% to more than 50%, depending on the segment of the population studied (e.g., adult education students, general population, prison population), the age range, and the method employed to determine the prevalence rate (bronson et al., 2015; corley & taymans, 2002; cortiella & horowitz, 2014; gerber, 2012). about:blank advances in social work, spring 2023, 23(1) 86 moreover, deficits in areas of functioning associated with ld (e.g., attention, working memory) persist into adulthood (gerber, 2012; klassen et al., 2011) and may lead individuals with ld to struggle with navigating through adult responsibilities and roles. for instance, individuals with ld have high school drop-out rates that are 2 to 3 times higher than that of their peers (cortiella, 2013; horowitz et al., 2017), are less likely to be enrolled in postsecondary education (though rates are increasing; lightfoot et al., 2018; newman et al., 2010; wagner et al., 2005), are more likely to lag behind their peers in postsecondary completion rates (cameto et al., 2011; lightfoot et al., 2018), and are more likely to be unemployed than individuals in the general population (gerber, 2012; holliday et al., 1999; skellern & astbury, 2014). due to the challenges faced by adults with ld, individuals below the poverty line were twice as likely to self-report ld than those living above poverty (cortiella & horowitz, 2014). thus, providing appropriate instructional methods, programs, and accommodations may help to increase the probability of successful outcomes among ld adults. screening for learning disabilities successful screening for ld identifies characteristics or signs of ld through a preliminary, systematic procedure. this is a crucial first step towards obtaining a more complete assessment from a qualified professional. by undergoing screening and assessment for ld, individuals are then able to access appropriate instructional methods, programs, and accommodations that can increase successful outcomes (gerber, 2012; shapiro & rich, 1999; taymans, 2009). there is, however, a great need for the development of screening procedures for non-english speaking individuals. although ld occurs in diverse cultures and economic groups (jiménez & garcía de la cadena, 2007; sideridis, 2007), and the individuals with disabilities education act (idea act) gives all children regardless of culture, or economic or social disadvantage, the right to full educational opportunity, little research exists on ld among minorities and nonenglish speaking adults in the united states. for many young adults in the united states, identification of ld may occur during the school-age period. however, not all individuals with ld are correctly identified during childhood (miles, 2004; moats & dakin, 2008. it is less likely for individuals to be identified as having ld if they were born and educated in developing countries where ld is neither fully recognized nor defined (e.g., latin america; agrawal et al., 2019). of note, individuals of latino ethnicity represent a large part of the u.s. population (19%) and, in california, latinos make up 39% of the state’s population (u.s. census bureau, 2021). in 2020, latinos comprised 36% of all temporary assistance for needy families (tanf) recipients in the u. s. and as many as 59% of all calworks (california’s tanf program) recipients (california department of social services, 2019; u.s. dhhs, 2021). furthermore, an estimated 8% to 18% of the adult welfare population may have learning disabilities, with some estimates as high as 40% (dondorf-brooks et al., 2020; kauf, 2008; loprest & maag, 2001; sweeney, 2000). adults with ld are more likely to be sanctioned and lose their benefits than those without ld (pavetti, 2018). yet, a diagnosis of ld may entitle them to time-limit exceptions in tanf programs, preventing cordón et al./identifying learning disability screens 87 the loss of much needed assistance (e.g., california ab-1728 calworks, 2022). given that the prevalence of ld among low-income adults is considerably higher than in the general population, many spanish-speaking adults living in poverty in the u.s. may not have been identified as ld due to the lack of a valid ld screening measure, keeping them and their families living in poverty (goldberg, 2002; kusserow, 1992; young & browning, 2005). thus, these individuals may not be fully benefitting from services as outlined in the americans with disabilities act. diagnosis of learning disabilities there are no federal regulations regarding the assessment measures required to identify adults with ld. generally, assessment involves the examination of patterns of strengths and weaknesses in performance and/or achievement relative to age, as reflected across various tests, such as standardized tests of ability and achievement, and questionnaires of functioning (gregg et al., 2006). when public law 94-142 was enacted in 1977 (guaranteeing free appropriate public education to children with disabilities), ld was identified by a statistically significant discrepancy between an intelligence quotient (iq) and achievement (iq-achievement discrepancy method; fletcher & miciak, 2019; grigorenko et al., 2020). although the individuals with disabilities education act (idea, 2004; public law 108-446) states that “a local educational agency shall not be required to take into consideration whether a child has a severe discrepancy between achievement and intellectual ability,” (section 1414(b)(6)) historically the key concept of a discrepancy between intellectual potential and academic performance or achievement continued to be used in the assessment process (e.g., fletcher & miciak, 2017; gregg et al., 1999; seo et al., 2008). a non-severe iq/achievement discrepancy, for instance, can be part of the ld identification process for vocational rehabilitation services (u.s. department of education, 2022). research on individuals with ld often includes standardized measures of intelligence and achievement (e.g., wechsler intelligence scale for children, stanfordbinet, woodcock-johnson tests of cognitive abilities) as part of the assessment procedure (e.g., johnson et al., 2010; williams et al., 2016). in addition to the pattern of profiles on standardized tests, a key factor in the accurate assessment of ld involves the judgment of a trained clinician (fiorello et al., 2014; fletcher et al., 2018; franz et al., 2017; maki et al., 2015; miciak & fletcher, 2019), who considers the environmental, biological, cognitive, language, and behavioral factors influencing an individual’s ability to learn tasks in a specific context (fiorello et al., 2014). overall, when determining the presence of a learning disability, clinicians must consider the interaction of multiple factors that impede learning, foster learning, or mitigate the influence of those factors that impede learning. clinicians would consider, for example, that individuals with similar cognitive profiles might have different levels of academic success due to factors such as supportive environments, behavioral characteristics, and personality traits. gregg and colleagues (2006) argue that a balance between statistical data (as provided by standardized measures) and clinical judgment is needed to assess ld (but see fletcher & miciak, 2019; miciak & fletcher, 2020). advances in social work, spring 2023, 23(1) 88 it is important to note that, during the course of this study, the american psychiatric association (apa, 2013) revised the criteria for determining ld, as delineated in the diagnostic and statistical manual of mental disorders, 5th edition (dsm-5). the new criteria place less emphasis on discrepancies in iq/achievement than did the previous version (i.e., dsm-4) and require evidence of a childhood history of ld. we anticipated that this change in the dsm criteria would reduce the number of adults, specifically spanish-speaking adults, who might have been diagnosed with ld, given that most of our participants were from latin america (primarily mexico) where ld is not fully recognized and/or screened for in childhood (agrawal et al., 2019; stough & aguirre-roy, 1997). to address the change in criteria established by the 5th edition of the dsm, both the dsm-4 and dsm-5 criteria were used in the present study to determine the clinical ld status of participants and to evaluate the pilot ld screens. overview of the present study we were asked by the california department of social services (cdss) to test various ld screening measures that could be used with spanish-speaking calworks (california tanf) clients. a spanish-language screening measure would allow cdss to identify clients needing further ld assessment and thereby identify clients who could benefit from additional cdss services (see also holcomb & thompson, 2000). the current study, therefore, evaluated the predictive utility and validity of three pilot screens of ld among low-income adult spanish-speakers, specifically those with calworks eligibility. moreover, the study provides an initial estimate of the prevalence of ld risk in this population. to increase the likelihood of finding a sufficiently large subsample of spanishspeaking ld adults, recruitment focused on individuals who were likely to meet california’s welfare (i.e., calworks) eligibility requirements (i.e., 18 years of age or older, low family monthly income, being pregnant with or the caretaker of one or more children). three screens were selected from the existing literature: the empire state screen, the welfare-to-work (wtw) 18 calworks ld screen, and the mississippi assessment technique for identifying learning disabilities in adults (matilda-r). these screens were chosen based on their statistical properties, brevity, and ease of administration, scoring, and interpretation. tests of intellectual ability and achievement are often still core components of assessing ld. thus, eligible participants for our study were administered two standardized assessments measuring general intellectual ability (bateria iii and test of nonverbal intelligence, 4th edition [toni-4]) to determine each participant’s ld status and the accuracy and predictive utility of the screens within this sample. in addition, a clinical ld specialist diagnosed each participant using two different methods (the patterns of strengths and weaknesses [psw] and dsm-5 approaches). the overall aim of the study was to identify a culturally-sensitive, validated ld screen that would help social workers and others ensure legally required interventions. in the following sections, the term significance refers to statistical significance. cordón et al./identifying learning disability screens 89 methods participants a total of 1,107 spanish-speaking, low-income adults participated in the current study (884 females; mage = 36 yrs, sd = 8.34). data collection occurred between january, 2012 and january, 2014. data for 67 participants were not included for the following reasons: substantial disruptions during testing (e.g., distracting environmental noise), participant illness during testing, incomplete tests, errors in testing administration, and participants who were found ineligible after the testing session. participation criteria were as follows: 1) age 18 years or older; 2) parent of at least one child or currently pregnant; 3) if married/cohabitating, partner was unemployed or worked less than 100 hours per month; 4) renter (not homeowner); 5) spanish as their native/dominant language; and 6) lowincome status. to ensure the participants were of sufficiently low income, these criteria, as well as the testing of a predominantly female sample, were used due to being consistent with calworks eligibility determination at the time. the majority of the participants were born outside of the united states (97%), primarily in mexico (89%). on average, participants were educated up to an 8th grade level in a non-u.s. country. most of the participants also indicated that they did not speak or write english well (81%). about half of the sample was married (54%), with a mean family income of $851 per month and an average of 2.83 children per household. seventy-two percent of the participants were unemployed, and more than half of the participants reported receiving some form of public assistance. all procedures were approved by the university of california, davis’ institutional review board. written informed consent in spanish was obtained from all participants, and they were compensated for their time. materials all study materials were either originally developed in or translated into spanish for this study. materials included a demographic questionnaire to determine eligibility for enrollment and to obtain background information, three pilot screening measures (empire state screen, wtw 18, and matilda-r), and two standardized measures of general intellectual ability (bateria iii and toni-4). to ensure the accuracy and appropriateness of the translated screens, a focus group of fluent spanish speakers was first conducted. changes to the language of the screen were made based on focus group feedback and finalized by native spanish-speaking postgraduates. in addition, each pilot screen was backtranslated to verify the reliability of the translation. demographic (eligibility) questionnaire. a demographic questionnaire was developed to obtain background information and determine participant eligibility. background questions covered, for example, age, birthplace, marital status, highest education, and number of children. advances in social work, spring 2023, 23(1) 90 empire state screen. the empire state screen is a composite of 11 items selected for their statistical diagnostic utility from four candidate screening measures (abwender, 2005). the screen was written in spanish and tested on spanish-speaking, low-income adults. because the empire state screen measures both learning disability and marginal intellectual functioning, it was not designed to differentially diagnose ld. therefore, the final screen is more accurately described as identifying “learning needs” as opposed to specifically being a screen for ld. the empire state screen is comprised of “yes/no” statements concerning learningrelated problems. for scoring, the weighted point values associated with each participant’s responses are summed and a constant value (i.e., 614) is subtracted from the sum. scores above 50 after subtracting the constant value are considered to reflect the presence of learning needs. according to abwender (2005), the empire state screen is 83% accurate (83% sensitivity, 84% specificity) in the identification of learning needs in adults. reliability for our sample was α = .72. welfare-to-work (wtw) 18. this tool is based on the washington state screen (wss) developed by payne & associates in collaboration with the washington state department of social and health services, to identify learning needs in low-income english speakers (dshs, 1998). the wss was translated into spanish (wtw 18) for the present study. the original screen consists of 13 “yes/no” questions regarding learning-related problems that were divided into four differentially weighted sections. scores at or above 12 are considered to reflect a high risk of ld. the wss has an overall diagnostic accuracy of 74% (70% sensitivity, 79% specificity) for learning needs within an english-speaking population (dshs, 1998). although the reliability for the wtw 18 was only .42 overall, fortunately, reliability for a key wtw 18 index (13 items from the wtw, unweighted), called the washington unweighted score (wus), was .76 for our sample, and thus an acceptable score. the wtw was therefore included in the analyses, but with a focus on the wus index. matilda-r. the mississippi assessment technique for identifying learning disabilities in adults (matilda; dorsett, 2000; grubb et al., 1997; lancaster, 2002) consists of both “yes/no” questions and several tasks (e.g., writing the numbers 1-20). scores at or above 13 suggest a risk of ld (see matilda scoring guidelines; grubb et al., 2001). the matilda, developed for use with college-level, english-speaking students, was revised for our study (the matilda-r) to better reflect the educational level, language, and culture of the target population. modifications to the matilda included changes to the instructions (e.g., “write the spanish alphabet”), an additional example in the organizational skills section, shortening the paragraph participants were asked to reproduce, more culturally representative protagonist names, and simpler math problems. the screen was then translated into spanish. to ensure the accuracy and appropriateness of the translated screen, it was presented to a focus group of spanish-speaking participants for review and feedback. following the translation, the revised screen was tested on a small group (n = 10) of bilingual (english and spanish-speaking) participants to test the face validity of the revised screen against the cordón et al./identifying learning disability screens 91 original screen. reliability for the matilda-r ranged from .20 to .73 across sections. permission to revise, translate, and use the modified screen was obtained from the lead researcher, dr. grubb. woodcock-johnson bateria iii. the bateria iii, developed for spanish-speakers who are 2 to 90+ years of age, is a comprehensive set of tests that measures both cognitive abilities and achievement levels. the bateria iii interpretive plan is based on cluster (grouped items) interpretation. most of the bateria iii subtests and clusters show reliabilities at .73 or higher (muñoz-sandoval et al., 2005). the bateria iii also provides two major types of discrepancy scores: ability/achievement discrepancies and intra-achievement discrepancies. the ability/achievement discrepancy is the most commonly used method of diagnosing ld. generally, ld is indicated if there is a difference of at least 15 points (≥ 1.5 sd) between the ability and achievement subscales, which are based on comparisons to age-normed groups upon which the bateria iii was developed. information gathered from intra-ability discrepancies help professionals determine an individual's strengths and weaknesses and diagnose and document language and learning disabilities. test of nonverbal intelligence, 4th edition (toni-4). the toni-4 assesses general intellectual ability (abstract reasoning, figural problem-solving) without allowing factors such as poor language or lack of cultural knowledge to conceal an individual’s intelligence. the toni-4 showed a reliability of α = .92 in our sample. convergence in the estimates of intellectual ability of the bateria iii and the toni-4 suggest that the bateria iii, despite its greater reliance on language, provides a relatively accurate representation of participants’ intellectual ability. procedure recruitment. participants were recruited from multiple agencies in california, across 13 west coast counties, that provide services to spanish-speaking, low-income adults, including community health clinics, head start centers, adult education schools, family resource centers, and county social services offices. potential participants were approached by trained spanish-speaking research assistants (ras) at the various recruitment locations. the ras briefly explained the study to potential participants as they waited for or left appointments. interested persons provided a number for call-back and/or were given a flyer with our contact information. although the vast majority of participants (approximately 90%) were actively recruited into the study, additional participants were added using a snowball sampling method (a non-probability method used to locate hard-to-reach populations; johnson, 2014) as a means of recruiting this hard-to-reach population. all potential participants were contacted by phone and administered a demographic questionnaire. if interested and eligible, an appointment for testing was scheduled. at the end of the session, participants received a $150 gift card. screen and assessment administration. the ras administering the screens and assessments received an intensive, week-long training with a certified bateria iii trainer who provided training on the administration, scoring, and interpretation of the bateria iii advances in social work, spring 2023, 23(1) 92 and modeled all testing procedures. the ras practiced with the trainer and with each other. finally, the ras were given additional practice and training by the co-principal investigator, a highly experienced psychologist in testing and assessment (interrater reliability κ = 0.76, p < 0.001). fidelity of all testing measures and procedures, in terms of adherence, exposure/duration, and quality of delivery, was established for each ra prior to permitting the ra to collect data. the fidelity of the screens and assessments were also monitored throughout the project. participants were tested individually in spanish in a quiet room by two graduate-level, spanish-speaking ras. because the full administration took about 4 hours, participants were given breaks to minimize fatigue. the three screens were administered first by one of the ras, with screen order counter-balanced across participants. following the screen administration, a different ra who was unaware of the screen results administered the two counterbalanced full-battery intelligence assessments. materials were read to participants in spanish. screen scoring procedures. the screens were scored in accordance with guidelines provided by the test developers. the screens were selected to be appropriate for low-income spanish speakers and to be easily scored, requiring only 0 (incorrect) or 1 (correct) scoring per participant answer. to increase flexibility in examining various scoring methods that could potentially maximize the screen’s possible predictive function, two or more scores were derived for each screen. these scores included the recommended clinical guidelines provided with each screen and one or more total raw scores. empire state screen scoring. two scores were derived from the empire state screen data, the empire state diagnosis (esd) and empire total score (ets). the esd was derived from the total number of weighted “yes” responses. a recommended clinical cutoff score of 51+ points (abwender, 2005) was employed to determine the predicted ld status. the ets is the sum of weighted “yes” responses plus the sum of weighted “no” responses, minus 614. wtw 18 screen scoring. three scores were derived from the wtw 18 screen data: the washington state diagnosis (wsd), the washington weighted score (wws), and the washington unweighted score (wus). the wsd is derived from the weighted total number of “yes” responses (dshs, 1998). accordingly, a weighted score of 12 or more is indicative of ld. the wws is the total number of “yes” responses to the four weighted scoring sections. the wus is the total number of “yes” responses to the 13 questions (unweighted). matilda-r scoring. four scores were derived from the matilda-r data. the matilda-r diagnosis (mrd) concurs with the english matilda screen guidelines (grubb et al., 2001) and is derived from the total number of “yes” responses. an mrd score of 13 or more is indicative of ld risk. matilda-r total yes responses (mtyr) is the total number of “yes” responses to the scoring form of this study. matilda-r total errors (mte) is the total sum of participants’ errors on the matilda-r. matilda-r error diagnosis (med) was derived from the mte scores; a clinical cut-off of 13 or more errors was used to derive the med. the 13+ error cut-off was based on preliminary analyses of the matilda-r, which suggested a significant association between the med cordón et al./identifying learning disability screens 93 (on the one hand) and the bdd and psw diagnoses (on the other hand) when using the 13+ cut-off score. scoring the bateria-iii and toni-4. for the bateria-iii and toni-4, each test question is scored as 0 = incorrect and 1 = correct, and the scoring was conducted during testing. the correct answers are in the scoring booklets and only require that the tester enter 0s and 1s. at the end of each testing section, the 0s and 1s were summed. diagnostic methods. historically, a key component of making a diagnosis of ld is the discrepancy between intellectual potential (ability) and academic performance (achievement; e.g., seo et al., 2008). although no federal regulations exist for mandatory assessment measures for identifying adults with ld, assessment of adults in clinics has generally followed the dsm-4-tr (american psychiatric association, 2000) recommendation of examining patterns of strengths and weaknesses in performance and/or achievement in relation to age and educational level as reflected across various tests (taymans, 2012). standardized measures of intelligence and achievement are often included in assessment procedures in ld research across all age groups (fletcher & miciak, 2019; holliday et al., 1999; seo et al., 2008). change in diagnostic criteria. during the latter half of the current study, the american psychiatric association (apa, 2013) released the 5th edition of the dsm, which changed the classification criteria for determining ld. included in the dsm-5 is a change in category from “learning disability” to “specific learning disorder,” or sld. the new criteria place less emphasis on discrepancies in iq/achievement than the dsm-4 version and require evidence of a childhood history of ld. because the choice regarding the most appropriate screen might depend on the diagnostic procedures used in the field, we chose to use three scoring procedures (bateria discrepancy diagnosis [bdd], clinical diagnosis, and patterns of strengths and weaknesses [psw] approach) to assess the diagnostic utility of each screen. these scoring procedures reflected both the dsm-4-tr and dsm-5 criteria, as well as a standard clinical approach. bateria discrepancy diagnosis (bdd). raw scores from each of the bateria iii subscales were entered into a standard bateria iii software program. the software produces a summary report of standardized scores, discrepancies, and significance probabilities, including: 1) general intellectual ability (gia), which represents a measure of iq; 2) achievement, which represents level of academic achievement; 3) standardized scores on the cognitive subtests and cluster that combine to form the gia score; 4) standardized scores on the achievement subtests and cluster that combine to form the achievement score; 5) intra-cognitive and intra-achievement discrepancy scores; and 6) ability/achievement discrepancies, which provide information regarding discrepancies between the various cognitive and achievement subscales and, if sufficiently large, are indicative of the specific type of ld the participant may have. based on the information computed by the bateria iii software, the bdd was created by examining whether any significant (≥ 1.5 sd) discrepancy among the ability/achievement subscales was observed. the bateria iii software generates eight ability/achievement subscale comparisons (e.g., ability vs. math achievement). in the present study, a significant discrepancy among any of the eight comparisons was advances in social work, spring 2023, 23(1) 94 considered indicative of ld. clinical diagnosis. a clinical specialist received the following de-identified information: 1) summary reports computed by the bateria iii software, 2) toni-4 results, 3) scanned copies of the bateria iii and toni-4 response form, and 4) demographic information. using these materials, the ld specialist provided a clinical diagnosis and a brief clinical report for each participant. due to change in dsm criteria, the ld specialist employed two methods: the psw and dsm-5 approaches (described below). two dichotomous (0 = not ld, 1 = ld) decision scales were developed for the psw and dsm5 diagnoses for each participant’s ld status. patterns of strengths and weaknesses (psw) approach. the psw approach is based on research recommendations, guidelines for the bateria iii, and consistency with dsm4-tr criteria. first, it is determined if the participant is performing significantly (i.e., 1 sd) below peers in an academic area. this is accomplished by examining the broad academic scores and selected academic clusters to see if any academic area is below the 15th percentile or a standardized score of 85. academic sub-skills are also reviewed. if a participant is performing below the average range in an academic area, the protocol is reviewed to determine areas of weakness. in addition, the level of academic performance is compared to the educational level to see if it is substantially lower than expected given the education level attained. after reviewing academic performance and contextual factors, the cognitive scores are examined to determine if any cognitive processes are significantly below peers in expectations for age and education level. if so, the intra-individual pattern of scores is analyzed to determine if a substantial difference exists between an area of weakness and other cognitive processes. response patterns are also examined. the pattern of cognitive processes is reviewed for evidence of a cognitive weakness that could contribute to ld. if the participant shows an area of significant cognitive weakness, that cognitive score is compared to the area of academic weakness to determine if the two areas of weakness are known to be related. if so, then an overall analysis of the academic and cognitive scores in the context of educational, experiential, and employment factors is undertaken to determine if the profile fits a pattern of strengths and weaknesses indicative of a specific ld. the psw method considers all assessment data available. it relies on clinical appraisal and reflects the current method of considering the entire pattern of performance to determine ld. to help ensure diagnostic accuracy, 10% of the sample was randomly selected for a second clinical ld specialist to independently diagnose using the psw approach. the diagnoses of the two clinicians were significantly correlated (r = .75, p < .001). moreover, inter-rater reliability statistics indicated that the two clinicians were reliable in their coding (icc = .86, p < .001). disagreements were discussed and resolved. one of the clinicians then coded the rest of the data. dsm-5 approach. the main clinical specialist also provided a diagnosis based on the dsm-5 criteria. the dsm-5 method used information obtained from the standardized tests, demographic information, and participants’ responses to two questions on the wtw 18 screen regarding learning problems in primary and secondary school. cordón et al./identifying learning disability screens 95 to help ensure diagnostic accuracy, 10% of the sample was randomly selected for the second clinical ld specialist to independently diagnose using the dsm-5 method. the diagnoses of the two clinicians were significantly correlated (r = .66, p < .001). inter-rater reliability statistics indicated that the two clinicians’ codings were reliable (icc = .79, p < 001). results the bateria iii and toni-4 use a standardized score of 100 (+/15 points) as representing an average iq. based on the bateria iii gia score, the mean iq for participants was below average (78.48, sd = 10.55). scores on the achievement portion of the bateria iii suggested that the mean level of achievement was within the average range of intellectual achievement (88.98, sd = 8.68). the mean iq score derived from the toni-4 was 8 points higher (85.74, sd = 6.75) than the bateria gia score, indicating an iq within the low average range, closer to the participants’ achievement scores on the bateria iii. a paired t-test indicated that the difference in iq scores was significant, such that the bateria iii iq score was significantly lower than the toni-4 iq score, t(1039) = 26.91, p < .001. to develop the predictive models of ld for each screening measure within this sample, univariate logistic regression was used to predict each case of ld from the scores and diagnoses available from each screen test. for each logistic regression, one of the scoring variables (e.g., esd, ets, wus) was entered as a predictor of each of the ld diagnosis methods (bdd, psw, dsm-5). tables 1 through 5 provide descriptive statistics, correlations, and a summary of each screen’s overall accuracy, sensitivity, and specificity rates across the three methods of determining ld. estimates of ld risk is provided per screen and per assessment (table 2). table 1. correlations among ld status criteria and pilot screen scoring methods (n = 1,040) bdd psw dsm-5 esd ets wsd wws wus mrd mtyr med mte bdd 1 psw .343** 1 dsm-5 .181** .382** 1 esd .248** .150** .169** 1 ets .232** .153** .140** .827** 1 wsd .188** .050 .194** .354** .312** 1 wws .244** .066* .232** .446** .414** .832** 1 wus .247** .071* .271** .463** .428** .800** .969** 1 mrd .329** .265** .199** .353** .327** .314** .379** .389** 1 mtyr .367** .257** .174** .420** .388** .385** .479** .486** .820** 1 med .285** .270** .092** .302** .282** .258** .313** .316** .660** .683** 1 mte .284** .187** .047 .286** .275** .267** .323** .316** .596** .739** .735** 1 note.* p < 0.05 ** p < 0.001. bdd = bateria discrepancy diagnosis. psw = pattern of strengths & weaknesses dsm = diagnostic & statistical manual. esd = empire state diagnosis. ets = empire total score. wsd = washington state diagnosis. wws = washington weighted score. wus = washington unweighted score. mrd = matilda-r diagnosis. mtyr = matilda-r total yes responses. med = matilda-r error diagnosis. mte = matilda-r total errors. advances in social work, spring 2023, 23(1) 96 table 2. number of participants identified as potentially learning disabled (n = 1,040) diagnosis criteria based on screened for ld [n (%)] negative positive empire state scoring guidelines provided by empire state screen (abwender, 2005). 734 (70.6%) 306 (29.4%) washington state scoring guidelines provided by washington state screen (dshs, 1998). 888 (85.4%) 152 (14.6%) matilda-r scoring guidelines provided by matilda (grubb et al., 2001). 661 (63.6%) 379 (36.4%) identified [n (%)] not ld ld bateria discrepancy bateria iii ability/achievement discrepancy scores computed by bateria iii software. 806 (77.5%) 234 (22.5%) psw clinical diagnosis using psw method. 868 (83.5%) 172 (16.5%) dsm-5 clinical diagnosis using dsm-5 criteria. 917 (88.2%) 123 (11.8%) empire state screen results the esd resulted in 306 of the 1,040 participants being recommended for further testing for ld. this identification of ld was significantly associated with the bdd, the psw diagnosis, and the dsm-5 diagnosis. the ets was examined to determine if there was a more optimal cut-off score in our population. this scoring variable (m = 57.32, sd = 101.55) explained 7% of the variability in the bdd and had a peak accuracy of 77.7%; however, this cut-off score had poor sensitivity (2.6%) as most of the accuracy was based on its specificity (99.5%). if we look to obtain a higher level of sensitivity, there is a cutoff (i.e., 10) that provides an overall accuracy rate of 67.0%, with 58.5% sensitivity and 69.5% specificity. the ets was also significantly associated with the psw diagnosis and the dsm-5 diagnosis. the ets explained 3% of the variability in the psw diagnosis and 3% of the variation in the dsm-5 diagnosis. the accuracy of the ets is maximized when no participants are recommended for further testing; however, such a decision has 0% sensitivity. there was no “good” cut-off based on the psw or dsm-5 diagnosis because the ets explained little variance in these diagnoses. overall, the ets and esd were significantly associated with the bdd, psw diagnosis, and dsm-5 diagnosis. however, the empire state scores had poor sensitivity ratings and explained less variability in these diagnoses compared to the other two screens. wtw 18 state screen results the wsd resulted in 152 adults recommended for further testing for possible ld. this diagnosis was significantly associated with the bdd and the dsm-5 diagnosis but not with the psw diagnosis. the wws (m = 4.89, sd = 6.07) explained 8% of the variability in the bdd and had a peak accuracy of 78.3%; however, this cut-off score had poor sensitivity (11.5%) and its accuracy was mostly based on its specificity (97.6%). if we look to obtain a reasonable level of sensitivity, a cut-off score of 3 provides an overall accuracy rate of 61.7%, with 63.2% sensitivity and 61.3% specificity. the wws was also significantly associated with the psw diagnosis and the dsm-5 diagnosis. the wws explained 1% of cordón et al./identifying learning disability screens 97 the variability in the psw diagnosis and 9% of the variation in the dsm-5 diagnosis. the accuracy of the wws is maximized when no participants are recommended for further testing; however, such a decision has 0% sensitivity. there was no “good” cut-off based on the psw diagnosis because the wws explained little variance in this diagnosis. cutoff scores either had high accuracy (i.e., > 70%) and little sensitivity (i.e., < 30%) or low accuracy and high sensitivity. for the dsm-5 diagnosis, there were cut-off scores that were fairly accurate with adequate sensitivity and specificity. a cut-off score of 6 yields an accuracy of 70.3%, a sensitivity of 63.4%, and a specificity of 71.2%. the wus (m = 2.40, sd = 2.67) explained 8% of the variability in the bdd and had a peak accuracy of 78.0%. however, this cut-off score had poor sensitivity (5.6%) as most of the accuracy was based on its specificity (99.0%). if we look to obtain a reasonable level of sensitivity, there is a cut-off score (i.e., 2) that is 59.3% accurate, with 66.7% sensitivity and 57.2% specificity. the wus was also significantly associated with the psw diagnosis and the dsm-5 diagnosis. the wus explained 1% of the variability in the psw diagnosis and 12% of the variation in the dsm-5 diagnosis. the accuracy of the wus is maximized when no participants are recommended for further testing; however, such a decision has 0% sensitivity. there was no “good” cut-off based on the psw diagnosis, because the wus explained little variance in this diagnosis. for the dsm-5 diagnosis, however, there were cut-off scores that were fairly accurate with adequate sensitivity and specificity. an example cut-off score of 3 had an accuracy of 68.8%, a sensitivity of 73.2%, and a specificity of 68.3%. overall, the results from the wtw 18 screen showed that the scores it produced were statistically significant predictors of having ld based on the bdd, the dsm-5 diagnosis, and to a lesser extent the psw diagnosis. the wus had the most predictive power of the wtw 18 screen scores. this score had lower predictive power than the matilda-r diagnosis when the bdd and the psw diagnosis were the outcomes of interest but had greater predictive accuracy for the dsm-5 diagnosis. our recommended cut-off on the wus is a score of 3 or more. this cut-off score explained 14% of the variation in dsm-5 diagnosis and had an accuracy of 68.8%, a sensitivity of 73.2%, and a specificity of 68.3%. matilda-r results the mrd is based on the mtyr, with a cut-off score of 13 or more as indicative of a risk for ld. based on the mrd, 379 participants would be recommended for further ld testing. this diagnosis was significantly associated with the bdd, the psw diagnosis, and the dsm-5 diagnosis (tables 3 to 5). because the recommended cut-off score of 13 may not be optimal for our population, the mtyr was also examined. the mtyr (m = 11.71, sd = 4.32) explained 18% of the variability in the bdd and had a peak accuracy of 79.6%; however, this cut-off score, which optimizes accuracy, had poor sensitivity (18.8%) as most of the accuracy was based on its specificity (97.3%). for a more reasonable level of sensitivity, there is a cut-off (i.e., 12) that is 65.6% accurate, with 75.2% sensitivity and 62.8% specificity (in addition to the cut-off score that was used for the mrd). the mtyr was also significantly associated with the psw and dsm-5 diagnoses (tables 4 to 5). the mtyr’s accuracy is maximized when no participants are recommended for further testing; advances in social work, spring 2023, 23(1) 98 however, such a decision has 0% sensitivity. when an acceptable level of sensitivity is obtained (e.g., 60%), accuracy is 68.6% for the psw diagnosis and 66.5% for the dsm-5 (using a cut-off score of 13). the med score indicated that 334 participants should be recommended for further ld testing. this diagnosis was significantly associated with the bdd, the psw diagnosis, and the dsm-5 diagnosis (tables 3 to 5). the med score has a cut-off of 13 and is derived from the mte. because this cut-off score may not be optimal, we examined the mte as a scoring option. the mte (m = 12.66, sd = 12.57) explained 10% of the variability in the bdd and had a peak accuracy of 78.8%; however, this cut-off score, which optimizes accuracy, had poor sensitivity (9.8%) as most of the accuracy was based on its specificity (98.8%). for a reasonable level of sensitivity, there is a cut-off (i.e., 9) that is 62.2% accurate, with 74.8% sensitivity and 58.6% specificity (in addition to the cut-off that was used for the med). the mte was significantly associated with the psw diagnosis, but not with the dsm-5 diagnosis. the mte explained 5% of the variability in the psw diagnosis and 0% of the variability in the dsm-5 diagnosis. the accuracy of the mte is maximized when no participants are recommended for further testing; however, this decision would result in 0% sensitivity. when an adequate level of sensitivity is obtained (e.g., 60%), accuracy is 66.3% for the psw diagnosis. we do not report accuracy for the dsm-5 diagnosis because the matilda error score was not significantly associated with it. overall, the results from the matilda-r showed that the mrd was a significant predictor of having ld based on the bdd, the psw diagnosis, and dsm-5 diagnosis, and that this measure (along with the mte) was more predictive than the med or the mtyr. when attempting to optimize the cut-off score on the mtyr, we obtained similar results to the med. the mrd (rather than the other three matilda-r indices) would be the best matilda index for making recommendations for further ld testing, at least within this sample. table 3. bateria discrepancy diagnosis (bdd): screen accuracy, sensitivity, specificity, and variance explained accuracy sensitivity specificity variance explained empire state screen empire state diagnosis (esd) 70.8% 50.4% 76.7% 9.0% empire total score (ets) 77.7% 2.6% 99.5% 7.0% wtw 18 screen washington state diagnosis (wsd) 75.0% 26.9% 89.0% 5.0% washington weighted score (wws) 78.3% 11.5% 97.6% 8.0% washington unweighted score (wus) 78.0% 5.6% 99.0% 8.0% matilda-r matilda-r diagnosis (mrd) 70.7% 65.8% 72.1% 15.0% matilda-r total yes responses (mtyr) 79.6% 18.8% 97.3% 18.0% matilda-r error diagnosis (med) 71.0% 56.8% 75.1% 11.0% matilda-r total errors (mte) 78.8% 9.8% 98.8% 10.0% cordón et al./identifying learning disability screens 99 table 4. pattern of weaknesses and strengths (psw) clinical diagnosis: screen accuracy, sensitivity, specificity, and variance explained accuracy sensitivity specificity variance explained empire state screen empire state diagnosis (esd) 68.8% 44.8% 73.6% 4.0% empire total score (ets) 1 ---3.0% wtw 18 screen washington state diagnosis (wsd) 2 ---0.0% washington weighted score (wws) 1 ---1.0% washington unweighted score (wus) 1 ---1.0% matilda-r matilda-r diagnosis (mrd) 68.6% 65.1% 69.2% 11.0% matilda-r total yes responses (mtyr) 60.0% 68.6% 51.4% 10.0% matilda-r error diagnosis (med) 71.3% 60.5% 73.5% 11.0% matilda-r total errors (mte) 60.0% 66.3% 53.7% 5.0% notes. 1 variance explained was too low to permit the selection of a cut-off score that would allow reasonable calculation of accuracy rates. 2 association between the wsd and pws was not significant table 5. dsm-5 clinical diagnosis: screen accuracy, sensitivity, specificity, and variance explained accuracy sensitivity specificity variance explained empire state screen empire state diagnosis (esd) 70.7% 50.4% 73.4% 5.0% empire total score (ets) 1 ---3.0% wtw 18 screen washington state diagnosis (wsd) 81.4% 33.3% 87.9% 6.0% washington weighted score (wws) 70.3% 63.4% 71.2% 9.0% washington unweighted score (wus) 68.8% 73.2% 68.3% 14.0% matilda-r matilda-r diagnosis (mrd) 66.5% 62.6% 67.1% 7.0% matilda-r total yes responses (mtyr) 60.0% 66.5% 53.5% 5.0% matilda-r error diagnosis (med) 66.4% 43.9% 69.5% 2.0% matilda-r total errors (mte) 2 ---0.0% notes. 1 variance explained was too low to permit the selection of a cut-off score that would allow reasonable calculation of accuracy rates. 2 association between the mte and dsm-5 diagnosis was not significant. important considerations in selecting a screening measure overall, the three ld screening measures provided the highest percentage of explained variance in the bdd relative to the psw and dsm-5 diagnoses. this is partly because the bdd had a higher base rate for ld. thus, the greatest accuracy was achieved when using advances in social work, spring 2023, 23(1) 100 this outcome measure. the matilda-r was associated with all three ld diagnosis methods: it was the best predictor of the bdd and the psw diagnosis. the previously recommended cut-off score on the mtyr was useful for our population. the wtw 18 screen was not as useful as the matilda-r when the outcome of interest was the bdd or the psw diagnosis; the wus from the wtw 18 screen was most predictive of the dsm-5 diagnosis. therefore, the screen selected depends on which ld diagnosis method is most appropriate. if the bdd or the psw diagnosis is used, the matilda-r (using mrd scoring) is the best option. if the dsm-5 diagnosis is selected, the wtw 18 screen (using the wus with cut-off of 3 or more for scoring) may be more useful. of note, determining the best cut-off scores can be chosen based on objective (e.g., mathematical approaches; dunstan & scott, 2019) and/or subjective factors (dunstan & scott, 2020). for instance, recommended cut-off scores can be based objectively on the highest accuracy without consideration for sensitivity and specificity, or subjectively giving more prominence to sensitivity or specificity to meet an overarching goal (e.g., keeping false positives low; bujang & adnan, 2016; dziak et al., 2020). the cut-off scores in the present study were data-driven consistent with quantitative approaches in screen and diagnostic development (bujang & adnan, 2016). we place a good bit of importance on correctly classifying participants who are ld, while acknowledging practical, clinical, and cultural considerations in determining cut-off scores (e.g., costs of further assessment, overdiagnosis, disproportionality of diagnosis; shifrer et al., 2011; zimmerman & galione, 2011). we thus suggest trying to balance accuracy with sensitivity and specificity while obtaining an adequate level of sensitivity where possible. discussion we tested three screens for ld in spanish-speaking, low-income adults. our findings suggest that the wtw 18 screen and matilda-r are viable options for identifying lowincome spanish speakers who may benefit from a clinical ld assessment. all three screens, regardless of our scoring methods, were significantly associated with the bdd, with explained variance ranging from 5% to 18%. matilda-r was associated with the highest percentage of explained variance (10% to 18%), perhaps due to similarities in task structure between the bdd and matilda-r. all three screens were significantly associated with the psw (except for the wsd scoring option), but the wtw 18 screen demonstrated low explained variance, making it impossible to establish a cut-off score to determine ld status. this was also true for the empire state screen when using the ets scoring option. when the psw determined ld status, the matilda-r demonstrated the highest percentage of explained variance (5% to 11%). the screens were also significantly associated with the dsm-5 approach, except for the mte scoring option. the ets scoring option on the empire state screen and the mte scoring option on the matilda-r had explained variances too low to establish cut-off scores to determine ld. the wtw 18 screen had the highest explained variance (6% to 12%) with dsm-5 determination. regarding each screen’s sensitivity rating, the empire state screen lacked adequate sensitivity to correctly identify individuals who might be ld regardless of the ld determinant. even though the empire state screen did attain a relatively reasonable overall cordón et al./identifying learning disability screens 101 accuracy rate, it was not a viable option for identifying low-income spanish speakers with ld as it did not appear to have adequate precision, at least given the set of individuals we tested. overall, the wtw 18 screen also demonstrated low sensitivity when the ld status determinants were the bdd and the psw diagnosis. however, when the ld status determinant was the dsm-5 diagnosis, the wtw 18 screen demonstrated the highest level of sensitivity compared to the empire state screen and the matilda-r. thus, we would recommend using the wtw 18 screen with the wus method of scoring (i.e., unweighted total score with a cut-off of 3 or more points) if the dsm-5 determinant is considered of primary importance. of the three screens, the matilda-r showed a more consistent pattern of accuracy and sensitivity across the three ld assessment methods, particularly when the ld status determinant is the psw diagnosis. thus, the matilda-r would provide a relatively moderate level of accuracy and sensitivity across the three ld status determinants depending on the scoring method employed. when we examine the psw as the criterion, the matilda-r was the only measure to provide a reasonable level of sensitivity. thus, based on our findings, matilda-r would be the best option if a clinical interview approach is preferred for diagnosing ld. screen choice considerations on a practical level, the choice of a screening tool should take several factors into consideration. one is the uniqueness of the target population. given differences in educational systems among various countries, it is unclear how strongly the u.s. educational standards and outcomes correspond to those of other nations, including those represented in the current sample. for example, the dsm-5 requires, for diagnosis of learning disorder, that the individual has a history of childhood learning problems. it may be particularly problematic to use this approach with the current population, as most of the participants completed their schooling in latin america and had either a limited educational history (averaging 8th grade) or were never formally educated. memories of childhood learning problems from early years may be particularly limited. moreover, the current sample characterizes a unique segment of the spanish-speaking population in the u.s. to an extent, research with the study sample reflects uncharted waters with respect to ld. because of the scarcity of studies available involving participants with characteristics like those in this sample, there is little other research to guide the selection of an ld screen for this population. still, the specific characteristics of our sample should be kept in mind. another factor is the method of ld diagnosis that clinical ld specialists use to determine ld status, which may vary depending on training and licensing requirements. because the performance of each screen is dependent upon the ld diagnostic method, gaining information about commonly used clinical approaches will be important for making an informed decision about screen choices, including options for future research studies. advances in social work, spring 2023, 23(1) 102 moreover, the three screens were selected in part to be easy to administer, score, and interpret, which can be important considerations. little training is required to administer, score, and interpret the wtw 18 screen, with a cut-off score of 3 “yes” responses (unweighted). in contrast, the matilda-r requires more time to administer and score than does the wtw 18 screen. the scored portion of the matilda-r consists of 8 “yes/no” background questions and 7 “yes/no” math-related questions. the matilda-r involves administration of 8 tasks that the individual is asked to complete. on average, the process takes 5 minutes. to administer and score the matilda-r, 3 to 4 hours of training and practice are required. implications for social work our findings are of interest to social workers (e.g., those in the field and those in policy positions) concerned with the americans with disabilities act not being restricted from full implementation by assessments based on english language assumptions. as the u.s. has considerable language diversity (national academies, 2017), it is likely that the full range of u.s. adults (and children) have not been screened accurately for possible learning disabilities, as many do not speak english well enough to demonstrate their disabilities on current screens and assessments (e.g., chernoff et al., 2021). one important issue of relevance to social workers is the development of ld screens for spanish-speaking adults who have the legal right to be appropriately assessed, as benefits (e.g., welfare) can be affected. without appropriate screening and assessment, spanish-speaking adults with ld cannot fully benefit from the protections afforded legally, nor the employment training and resources available to people with disabilities. limitations and conclusion developing a brief screen to accurately predict ld status specifically (e.g., vs. “learning needs” or intellectual disability) is difficult. the overall accuracy rates of the screens here were generally 65% to 70%. modifying the wording or scoring of test items may improve the precision of the screens. moreover, the clinical specialist in our study did not interview participants. clinical diagnosis of ld, traditionally, is a complex, expensive process that requires in-person testing and interviewing by a highly trained ld specialist. thus, individuals identified as ld herein may not strictly meet federal guidelines for defining ld. we recognize, also, that linguistic equivalence through translation is often insufficient to guard against cultural bias and validity threats. there is a need to establish functional equivalence, cultural equivalence, and metric equivalence when assessments are translated to ensure validity and reliability of an ld screen. we do not assume that our translated measures are optimal indicators of ld. instead, we attempted to examine their predictive validity (among this sample) regarding an ld diagnosis. we empirically tested whether these translated versions are appropriate for use as a screening measure for ld. we limited the target population by using criteria for calworks enrollment. minimum snowball sampling (not strict probability sampling) was necessary to recruit eligible participants. inferential statistics with data from a non-representative sample are fairly common in social science research (rothman et al., 2013; tenhouten, 1992; cordón et al./identifying learning disability screens 103 trafimow, 2019). it can be questioned if inferences can be made beyond this sample. finally, ras were highly trained, but inter-rater reliability was not assessed. future research should determine the findings’ generalizability. nevertheless, this study provides an initial estimate of the prevalence of ld risk in this population (m = 21.9%; range =12% to 36% depending on screen and cut-off method). to conclude, the translated wtw 18 screen and the matilda-r appeared most promising. a culturally-sensitive, validated ld screen will help ensure appropriate and legally required intervention and facilitate research for this understudied and underserved population. references abwender, d. a. 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(2005). after high school: a first look at the postschool experiences of youth with disabilities. sri international. http://files.eric.ed.gov/fulltext/ed494935.pdf williams, j. l., miciak, j., mcfarland, l., & wexler, j. (2016). learning disability identification criteria and reporting in empirical research: a review of 2001–2013. learning disabilities research & practice, 31(4), 221-229. https://doi.org/10.1111/ldrp.12119 young, g., & browning, j. (2005). learning disabilities/dyslexia and employment. in g. reid & a. fawcett (eds.), dyslexia in context (pp. 25-59). whurr publishers. zimmerman, m., & galione, j. n. (2011). screening for bipolar disorder with the mood disorders questionnaire: a review. harvard review of psychiatry, 19(5), 219-228. https://doi.org/10.3109/10673229.2011.614101 author note: address correspondence to gail s. goodman, department of psychology, university of california, one shields avenue, davis, ca 95616. email: ggoodman@ucdavis.edu http://lincs.ed.gov/publications/pdf/l2aliteraturereview09.pdf https://doi.org/10.1177/0022219411426857 https://doi.org/10.1177/075910639203700102 https://doi.org/10.1080/00031305.2018.1537888 https://www.census.gov/library/visualizations/interactive/racial-and-ethnic-diversity-in-the-united-states-2010-and-2020-census.html https://www.census.gov/library/visualizations/interactive/racial-and-ethnic-diversity-in-the-united-states-2010-and-2020-census.html https://sites.ed.gov/idea/regs/b/d/300.307 https://www.acf.hhs.gov/ofa/data/characteristics-and-financial-circumstances-tanf-recipients-fiscal-year-2020 https://www.acf.hhs.gov/ofa/data/characteristics-and-financial-circumstances-tanf-recipients-fiscal-year-2020 http://files.eric.ed.gov/fulltext/ed494935.pdf https://doi.org/10.1111/ldrp.12119 https://doi.org/10.3109/10673229.2011.614101 mailto:ggoodman@ucdavis.edu identifying learning disability screens for spanish-speaking adults: a helpful tool for social work and welfare practice abstract: the successful screening for possible learning disabilities (ld) is a crucial first step in the process of identifying signs of ld, gaining assistance and/or accommodations, and obtaining a more complete ld assessment. although latino people... table 2. number of participants identified as potentially learning disabled (n = 1,040) table 3. bateria discrepancy diagnosis (bdd): screen accuracy, sensitivity, specificity, and variance explained table 4. pattern of weaknesses and strengths (psw) clinical diagnosis: screen accuracy, sensitivity, specificity, and variance explained table 5. dsm-5 clinical diagnosis: screen accuracy, sensitivity, specificity, and variance explained _________ jung ho choi, mpp, phd candidate, and femida handy, phd, professor, school of social policy and practice, university of pennsylvania, philadelphia, pa copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 576-593, doi: 10.18060/28621 this work is licensed under a creative commons attribution 4.0 international license. social closure in social work: the racial implications of licensure requirements jung ho choi femida handy abstract: this study empirically examines the relationship between social work licensure and the racial composition of the profession in the united states through the lens of max weber’s theory of social closure. by leveraging the variation in the timing of state-level licensure implementation, it employs a quasi-experimental setting to assess the effects of licensing on minority representation in social work. the research analyzes decennial census data from 1930 to 2000 using a staggered difference-in-differences design to investigate the extent to which licensure implementation relates to the proportion of nonwhite social workers at the county level. the findings suggest that social work licensure is associated with exclusionary patterns, limiting access for racial minorities. specifically, the implementation of licensure is linked to a statistically significant decline in the proportion of non-white social workers, with an observed decrease of 2 percentage points that increased to a 9-percentage point decrease over 40 years. these results suggest that licensure requirements may reinforce social closure within the social work profession, perpetuating racial inequities. this study underscores the pressing need to reconsider the licensure framework to foster inclusivity and equity within the field of social work. keywords: social work licensure; social work workforce; racial inequity; social closure; staggered difference-in-differences scholars have identified two main functions of social work licensure: ensuring the quality of service and enhancing the professional status of social workers (marks & knox, 2015). first, licensure establishes minimum qualifications and standards for practitioners, which instills client confidence in the services provided by licensed social workers. in addition, licensure bolsters the professional standing of social workers. following flexner’s influential 1915 address at the national conference of charities and corrections, where he argued that social work did not possess the traits of a profession (flexner, 1915/2001), social workers have advocated for licensure to elevate their professional status (thyer & biggerstaff, 1989). at first glance, social work appears to be a well-established and legally recognized profession. however, not all social workers have benefited equally from this professionalization. concerns have emerged about whether licensure requirements disproportionately disadvantage racial minorities. this is an issue that has become increasingly relevant in ongoing discussions about racial equity within the field. scholars have raised significant concerns about unequal access to licensure across racial groups (bloxom & anderson, 2024; castex et al., 2019; kim, 2022; nienow et al., 2023; senreich & dale, 2021). research suggests that racial minorities face multiple challenges on the path to becoming licensed social workers. these obstacles include the requirement to about:blank choi & handy/social closure 577 graduate from accredited social work programs, the difficulty of navigating licensure exams, the racially biased nature of these exams, and broader systemic barriers that disproportionately disadvantage racial minorities (bloxom & anderson, 2024; hirsch et al., 2024; kim, 2022). these disparities have significant implications for the profession. racial representation among social workers is closely tied to the well-being of clients from minority backgrounds. studies have shown that racial congruence between clients and social workers can enhance trust, improve communication, and ultimately lead to better client outcomes (cabral & smith, 2011; cox & ephross, 1998; sue et al., 1991). in this context, it becomes important to examine whether social work licensure is associated with a decline in the representation of racial minorities within the profession. this study investigates whether, and to what extent, the implementation of social work licensure is associated with a decrease in the proportion of racial minorities within the workforce. the theoretical framework underlying this research is the concept of “social closure,” as introduced by max weber. weberian sociologists expanded this concept into “occupational closure,” which refers to the mechanisms by which professional groups create barriers to entry, often through licensure, to limit participation to those who lack specific credentials (larson, 1977; murphy, 1984; weeden, 2002). the dynamics of occupational closure are complex and often deeply intertwined with issues of race and socio-economic status. it is argued that as the prestige of a profession rises, often because of licensure, dominant groups such as whites may seek to protect their interests by restricting access to the profession (goff & le feuvre, 2017; tomaskovicdevey & avent-holt, 2019). this exclusion can take various forms, such as increasing the costs or simply limiting access to the resources necessary to obtain a license. consequently, this creates an environment wherein aspiring social workers from marginalized groups may face significant disadvantages, reinforcing existing systemic inequities within the profession. as noted above, existing literature has begun to explore the drawbacks of social work licensure for minorities. however, there remains a significant need for further empirical studies to substantiate these claims over time. this study uses decennial census data from 1930 to 2000 and employs a staggered difference-in-differences design to estimate the effects of the social work licensure implementation on the racial composition of the workforce. this design is particularly effective in isolating the specific impacts of licensure from other confounding variables, as it compares changes in workforce composition between areas that implemented licensure and those that did not, both before and after its adoption. the findings indicate a troubling trend. spanning seven decades of data, the analysis reveals that the implementation of licensure was associated with a decrease in the representation of non-white social workers. these results contribute to the ongoing discourse advocating for a transformation of current social work licensure practices (hirsch et al., 2024; morrow, 2023; zajicek-farber, 2024). this study calls for an inclusive system that not only recognizes the importance of professional standards but also actively dismantles barriers that hinder racial minorities from entering and thriving in the profession. advances in social work, summer 2025, 25(2) 578 the rest of the paper is structured as follows: the next section provides an overview of social work licensure and introduces max weber’s social closure theory as the theoretical foundation guiding this study. next, it details the data and methods utilized in the study. the following section presents the analyses using a staggered difference-in-differences design. finally, the paper concludes with a discussion of the findings, highlighting their implications for the field of social work. background the evolution of social work licensure in the united states social work licensure in the united states has developed gradually over the past century. since california passed the initial statute for social work licensure in 1945, all 50 states enacted their own licensure laws over the following five decades. without federal standards guiding social work licensure, each state developed its own licensing procedures which varied in terms of the title of the social work license and the requirements for exams. nevertheless, there are two common criteria for licensure shared by all states (donaldson et al., 2014). first, it involves passing a mandatory licensing exam to obtain the title of “licensed social worker.” second, applicants for this title must graduate from a program accredited by the council on social work education (cswe). in addition, obtaining advanced licenses typically involves acquiring two or more years of post-graduation experience under the supervision of a qualified professional (donaldson et al., 2014). thyer and biggerstaff (1989) outlined five key stages in the historical development of social work licensure. the first stage, termed the era of “friendly visitors,” reflects a random entry into the field. in the second stage, social workers began forming professional organizations, beginning with the national conference of charities and corrections established in 1874. the third stage saw these organizations imposing stricter requirements on social workers, emphasizing the need for educational credentials. this led to the fourth stage, where social work practice became self-regulated, marked by the establishment of standardized accredited educational programs. finally, individual states started to implement their own licensure systems, with california paving the way in 1945. the momentum for licensure accelerated from the 1960s to the 1990s, ultimately resulting in licensure laws across all 50 states and the district of columbia. the importance of social work graduates obtaining licensure in the u.s. is recognized and promoted by professional organizations such as the cswe, the association of social work boards (aswb), and the national association of social workers (nasw). these organizations advocate for licensure as an essential component of professional development. indeed, the cswe recently published a curriculum guide to assist in teaching students about the importance of regulation (cswe, 2018). similarly, the aswb developed the path to licensure (n.d.) to help social work programs prepare students to recognize the importance of regulated practice. grise-owens and colleagues (2016) underscore that licensing is not merely a procedural hurdle; rather, it is a critical element of the professionalization process and aligns with social work education’s aim of achieving professional competency. choi & handy/social closure 579 the impact of “whiteness” on the development of social work licensure however, the development of social work licensure did not occur in a vacuum; it was heavily influenced by social dynamics, particularly the impact of “whiteness.” the origins of professional social work organizations date back to the charity organization societies established in 1877, primarily comprised of wealthy white christian women serving as social workers (abrams et al., 2023). these women focused on assisting vulnerable urban populations; however, their efforts predominantly catered to white individuals from specific european backgrounds, such as ireland and italy, rather than addressing the needs of the broader vulnerable community (del-villar, 2021). the emphasis on aiding specific groups served to reinforce existing social hierarchies, as the predominantly white women determined who received services and who was deemed qualified to provide them. this process not only marginalized racial minorities but also solidified the social and material privileges associated with whiteness within the profession. consequently, the exclusionary practices that emerged during this formative period established a pattern that would persist over time. despite a growing demand for social workers in the 20th century, opportunities for non-white individuals to enter the profession remained constrained due to various systemic barriers (del-villar, 2021). in the 1960s, during the civil rights movement, social workers began to recognize the effects of institutional racism and marginalization (abrams et al., 2023). however, the profession struggled to move beyond white-centered social work theories and practices that sidelined racial minorities (abrams et al., 2023). black social workers frequently faced racist attitudes and actions within professional organizations, culminating in a protest at the 1968 national conference of social welfare. this event ultimately led to the formation of the national association of black social workers (iglehart & becerra, 1996). they also advocated for reforms in social work curricula at historically black colleges and universities (abrams et al., 2023). despite these efforts, the demographic composition of social workers has remained predominantly white. a 2006 study by the nasw conducted a comprehensive analysis of licensed social workers and found that 86% identified as white non-hispanic, while only 7% were black (national association of social workers, 2006). more recent data from the cswe in 2020 indicates slight progress, with whites making up 66% and blacks/african americans representing 22% of recent social work program graduates (salsberg et al., 2020). however, it is important to note that this study only examines recent graduates and not the broader population of licensed social workers. scholars have pointed out that the standardized social work license test, administered by the aswb and available to social work program graduates, may pose a barrier for nonwhite test-takers. they argue that white individuals have greater access to resources that help them perform better on standardized tests than economically and educationally disadvantaged non-white individuals (castex et al., 2019; hirsch et al., 2024). from this perspective, societal, educational, and economic barriers continue to hinder non-white individuals from obtaining social work licensures and pursuing careers in the field (castex et al., 2019; zajicek-farber, 2024). advances in social work, summer 2025, 25(2) 580 a weberian perspective on racial disparities in social work licensure these patterns of exclusion can be theoretically understood through max weber’s concept of “social closure,” which provides a framework for analyzing how professional barriers perpetuate racial inequalities. weber describes social closure as how certain social groups monopolize advantages by limiting access to resources and opportunities (flemmen, 2017). according to weber, society is not homogeneous but is instead internally divided by social closure. for instance, some groups, organizations, or institutions are open to all, while others impose specific criteria for membership eligibility (mackert, 2012). these criteria may include race, gender, education, and religion, among others, and serve to establish boundaries that determine who is included and who is excluded (weber, 1922/2013). occupational closure is a specific type of social closure that focuses on how groups organize around certain occupations in the labor market (parkin, 1979). to gain membership, individuals typically must meet educational requirements and/or pass licensing exams. this fosters a shared identity among qualified members, who may choose to exclude or favor others based on these criteria. such social closure has significant economic implications, creating a monopoly that benefits only those who meet the requirements and leading to higher economic returns regardless of individual effort (sørensen, 1996). these increased returns stem from market control, allowing professional associations to raise prices for goods and services at their discretion (redbird, 2017). specifically, weeden (2002) outlines several mechanisms by which licensure increases these returns. first, barriers to entry, such as licensure, reduce the labor supply, making it difficult for individuals to enter the profession due to strict educational prerequisites for exam eligibility. second, licensure limits the supply of professional services by preventing other professions from offering certain services. third, licensure acts as a signal of highquality skills to customers, ensuring consistent demand for licensed professionals’ services. in addition, third-party payers, like insurance companies, typically reimburse only licensed providers, further restricting consumer choice and increasing demand for licensed services. in summary, licensure raises entry barriers, lowers market supply, drives up wages, limits workforce mobility, and reduces consumer choice and service accessibility (alvarez, 2012; zajicek-farber, 2024). these mechanisms are particularly relevant to social workers in the u.s. for instance, social workers must graduate from cswe-accredited programs and pass background checks to apply for licensure. each state sets its own requirements, which ultimately constrain the overall labor supply of social workers. furthermore, certain social work services are legally restricted to licensed professionals, preventing other professions from offering them. this regulatory framework is compounded by the practices of many thirdparty payers, who typically reimburse clients only for services provided by licensed social workers, further increasing demand for licensed professionals. empirical evidence supports this dynamic, showing that licensed social workers consistently earn more than unlicensed social service workers (kim et al., 2023). choi & handy/social closure 581 in this context, licensure for social workers acts as a form of occupational closure, placing those without a license at a disadvantage and limiting their access to better economic opportunities. simultaneously, this closure not only restricts entry into the profession but also allows socially dominant groups, often those who are already wellestablished in the field, to monopolize the advantages associated with the occupation (goff & le feuvre, 2017). the dynamics of occupational closure extend beyond professional credentials, intertwining with factors such as race (weeden, 2002). as licensure elevates the economic and social status of the profession, dominant groups, such as whites, can exploit this advantage further by raising the barriers to licensure, which hinders other groups from entering the field. despite concerns about occupational closure, some scholars maintain optimistic views on its outcomes. for instance, redbird (2017) argues that the privileges of occupational closure could represent “a net gain for historically excluded workers” (p. 618) by creating a more equitable licensure process. individuals from marginalized groups often face challenges like discrimination and nepotism when trying to enter unlicensed occupations. however, redbird (2017) suggests that licensure may establish a fairer entry process, thus increasing opportunities for historically marginalized workers (drange & helland, 2019). however, the history of social work licensure illustrates that the licensure system itself has created new barriers that disproportionately affect racial minorities. research indicates that licensure in social work has led to the systematic exclusion of these groups, ultimately reinforcing existing inequalities rather than alleviating them (castex et al., 2019; kim, 2022; morrow, 2023; nasw, 2006; nienow et al., 2023; senreich & dale, 2021; zajicekfarber, 2024). for instance, kim (2022) points out that racial disparities persist across different racial groups due to underlying socioeconomic injustices, even when controlling for inherent differences. despite adjusting for factors such as education level, state of residence, fields of practice, and demographic characteristics, significant disparities remain in the rates at which individuals of different races obtain social work licenses. utilizing data from the current population survey, kim illustrates a notable gap in licensing rates between white and non-white social workers. however, it is important to note that her study does not address the broader impact of licensure on the overall number and proportion of practicing minority social workers. this highlights the need to examine systematically and empirically whether and to what extent the implementation of the licensure system has been related to inclusivity and diversity in the social work profession over time, particularly within a quasi-experimental setting. to address this, this study tests the following hypothesis based on the theoretical arguments regarding occupational closure: hypothesis: social work licensure is associated with a decrease in the proportion of non-white social workers in areas where licensure is implemented compared to those where it is not. advances in social work, summer 2025, 25(2) 582 methods and data staggered difference-in-differences to isolate the effect of licensure and evaluate its impact over time on the proportion of social workers from minority backgrounds, this study utilizes a quasi-experimental setting that leverages the variation in the timing of state-level licensure implementation. the traditional difference-in-differences method assumes simultaneous policy implementation. however, when policies are implemented at different times, a more generalized approach is required. specifically, this study employs a staggered difference-in-differences method. this method is commonly used to evaluate policy effects in observational studies by comparing changes in outcomes between treatment and control groups (rüttenauer & aksoy, 2024). the staggered difference-in-differences method shares some key assumptions with the traditional difference-in-differences method, notably that the average outcome among treated and control units would follow parallel trends in the absence of treatment (roth et al., 2023). it also assumes that the treatment has no causal effect prior to its implementation (roth et al., 2023). these assumptions facilitate the identification of the average treatment effect on the treated (att). a common approach for implementing this method is through a two-way fixed effects model. however, recent discussions in econometrics suggest that this standard approach may not adequately capture treatment effect heterogeneity, especially when the effect varies over time or across treatment cohorts (baker et al., 2022). to address this limitation, wooldridge (2021) proposes the extended two-way fixed effects model, which incorporates all possible interactions between the treatment, time fixed effects, treatment cohorts, and other covariates (rüttenauer & aksoy, 2024). by doing so, this approach allows for the identification of heterogeneous treatment effects over time and in terms of duration (kalbfuss et al., 2024). table 1. social work licensure enactment by states state year state year state year state year ca 1945 ar 1975 nh 1983 ms 1987 ri 1961 co 1975 nc 1983 nv 1987 ny 1965 md 1975 nd 1983 pa 1987 ok 1965 sd 1975 ga 1984 wa 1987 va 1966 de 1976 ia 1984 ak 1988 il 1967 id 1976 oh 1984 az 1988 sc 1968 al 1977 wv 1984 hi 1989 me 1969 ma 1977 ct 1985 mo 1989 la 1972 or 1979 dc 1986 nm 1989 mi 1972 tn 1980 ne 1986 in 1990 ut 1972 fl 1981 vt 1986 nj 1991 ks 1974 tx 1981 wy 1986 wi 1992 ky 1974 mt 1983 mn 1987 choi & handy/social closure 583 the extended two-way fixed effects model is well-suited for this study’s context. since california enacted the first state social worker licensure in 1945, all 50 states and the district of columbia subsequently implemented their own licensure regulations by 1992. thus, the treatment variable in this study is the implementation of social work licensure, which occurred in a staggered manner. furthermore, given the varied implementation timing and regional differences, it is reasonable to conclude that treatment effects are unlikely to be homogeneous across all contexts, contrary to the assumptions of the standard two-way fixed effects model. the precise timing of social work licensure enactment by each state is provided in table 1. data this study utilizes decennial census data from 1930 to 2000, which contains information on the social worker workforce dating back to the early 20th century. each decennial year’s data has different sampling sizes. this study prioritizes using the 5% sample if available as it contains more individuals who identify themselves as social workers. however, if there is no available 5% sample, this study chooses the 1% sample. table 2 presents the sampling size for each decennial census dataset used in this study. table 2. sampling size of decennial census data sampling size decennial census 1% 1950, 1970 5% 1930, 1940, 1960, 1980, 1990, 2000 following each decennial census, this study reconstructs all variables of interest at the county level. however, as the focus of this study is on individuals with a specific occupation (social workers), it is possible that the census data might not include any social workers for a particular county each year. to address this missing data issue, this study employs multiple imputation. multiple imputation is a recognized strategy for dealing with missing data, endorsed by scholars in many social science fields. specifically, this study utilizes the decision tree algorithm for imputing the data. in this algorithm, the data are iteratively split into two nodes based on variables and values that optimize predictions (rodgers et al., 2021). variables outcome: the outcome of interest is the proportion of social workers who identify as non-white. to determine this, the 1950 census bureau occupational classification system is utilized, available across census data spanning from 1930 to 2000, to identify social workers in each census year. subsequently, the number of identified social workers is weighted using personalized sampling weights, enabling the estimation of the total number of social workers in each county. the non-white proportion is then calculated by dividing the number of non-white social workers by the total number of social workers in each county for the respective year. advances in social work, summer 2025, 25(2) 584 treatment: the treatment of this study is the implementation of social work licensure. this process began when california passed the first social worker licensure law in 1945. subsequently, all 50 states and the district of columbia completed the enactment of social worker licensure laws, with wisconsin being the final state to do so in 1992. covariates: a total of six covariates are used for this study: (1) the log-transformed total number of social workers in each county, (2) the proportion of non-white population in each county, (3) the log-transformed value of total population, (4) the unemployment rate of each county, (5) the poverty rate of each county, and (6) metropolitan status of each county. the descriptive statistics of the variables can be found in table 3. table 3. descriptive statistics (before multiple imputation) n mean sd outcome proportion of non-white social workers 5936 0.13 0.18 covariates number of social workers 2275 825.12 1768.65 proportion of non-white population 3174 0.13 0.15 total population 3174 272815.6 533536.8 unemployment rate 3174 0.07 0.04 poverty rate 1698 0.01 0.01 metropolitan status (metropolitan=1) 2659 0.54 0.50 findings the findings presented in table 4 show the overall effect of the implementation of social work licensure on the proportion of non-white social workers estimated using an extended two-way fixed effects model. coefficients are tested using z-tests with standard errors clustered at the county level. given that all states eventually enacted social work licensure laws (the last in 1992), the comparison group in this model comprises counties that had not yet been treated at the time of observation. table 4. extended two-way fixed effects estimate of the overall treatment effect estimates (standard error) z statistics confidence intervals implementation of social work licensure -0.02** (0.01) -2.49 -0.03 -0.00 county fixed effects yes year fixed effects yes significance level: **<.05. standard errors are clustered at the county level. the estimate shows that the implementation of social work licensure is associated with a decrease of 2 percentage points in the proportion of non-white social workers, with a 95% confidence interval from 0 to 3 percentage points (p < .05). thus, the hypothesis of this study, which suggests a negative association between the implementation of social work licensure and the proportion of non-white social workers, is supported in terms of the choi & handy/social closure 585 overall effect. following that, figure 1 presents the findings from event-study analyses that focus on dynamic difference-in-differences estimates. figure 1. dynamic effects of social work licensures by extended two-way fixed effects note: zero pre-treatment effects for illustrative purposes only in figure 1, time 0 refers to the year each county implemented social work licensure. the post-treatment estimates for the time of implementation exhibit negative coefficients. specifically, at the time of implementation, social work licensure is associated with a decrease of 1 percentage point in the proportion of non-white social workers, with a 95% confidence interval ranging from 0 to 3 percentage points (p < .05). it is important to note that these estimates are relative to areas that had not yet implemented licensure. this early decline suggests that the introduction of licensure creates immediate barriers, likely due to stringent educational and credentialing requirements that may not be equitably accessible to all racial groups. the dynamics shift further in subsequent decades, with the negative impact of licensure magnified to a decrease of 7 percentage points after 30 years and 9 percentage points after 40 years. the confidence intervals for these time frames are 4 to 9 percentage points and 5 to 12 percentage points, respectively (p < .01). this escalating decline highlights that as the licensure framework becomes more established, the effects of occupational closure intensify. table 5 provides a summary of the dynamic effects from the extended two-way fixed effects model. advances in social work, summer 2025, 25(2) 586 table 5. dynamic effects of social work licensures by extended two-way fixed effects years post implementation estimates (standard error) z statistics confidence intervals 0 -0.01** (0.01) -2.11 -0.03 -0.00 10 -0.01 (0.01) -0.70 -0.02 0.01 20 -0.02 (0.01) -1.43 -0.04 0.01 30 -0.07*** (0.02) -4.72 -0.09 -0.04 40 -0.09*** (0.02) -5.28 -0.12 -0.05 county fixed effects yes year fixed effects yes significance level: **<.05, ***<.01. standard errors are clustered at the county level. discussion although previous research has raised concerns about how licensure may disadvantage racial minorities, only a few studies have empirically examined its relationship with the racial representation of the profession. this study addresses that gap by using a staggered difference-in-differences approach to evaluate whether the adoption of licensure laws is associated with a decrease in the proportion of non-white social workers. the empirical findings support the hypothesis that the introduction of social work licensure is associated with a decrease in the proportion of non-white social workers in areas where licensure is implemented, compared to those where it is not. specifically, the proportion of non-white social workers dropped by 2 percentage points in counties with licensure. further analysis reveals that the effects of licensure become more pronounced over time. using the extended two-way fixed effects model, the study found that counties with social work licensure for three decades had approximately 7 percentage points fewer nonwhite social workers compared to counties without licensure. this gap widens to 9 percentage points after four decades. this trend likely reflects the retirement over time of social workers who began their careers without needing a license. as these experienced practitioners retired, they left a gap that may not have been filled by new entrants from non-white backgrounds, particularly as licensing requirements became increasingly costly, stringent, and difficult to meet. the cumulative impact of these systemic barriers may have limited access for aspiring social workers from marginalized communities and thus intensified the underrepresentation of non-white professionals, resulting in a workforce that is less representative of the diverse populations it serves. this pattern of increasing exclusion aligns with theoretical predictions about occupational closure. max weber’s social closure theory offers insights into the exclusion of minorities from social work licensure. weber argued that social groups strive to enhance their advantages by restricting access to opportunities for outsiders (weber, 1922/2013). this exclusion choi & handy/social closure 587 often occurs through licensure requirements. in this regard, scholars suggest that occupational closure functions as a social mechanism through which dominant groups can exclude marginalized ones, thereby securing the benefits and privileges associated with this monopoly (goff & le feuvre, 2017). as demonstrated in the study’s findings, the racial demographics of the social work profession reflect a declining diversity among practitioners since the implementation of licensure. according to recent data, although there are some notable increases in diversity, social workers continue to predominantly identify as white, highlighting persistent racial disparities. this study indicates that the licensing process may be a significant contributing factor to this declining diversity. importantly, these findings must be interpreted considering the broader historical context spanning the dataset’s time frame. this seventy-year period encompassed major shifts in racial politics, civil rights legislation, and the professionalization of social work itself. these shifts shaped both the adoption and the effects of licensure policies, making it essential to consider them when evaluating the study’s findings. to be specific, early licensure laws were introduced during the jim crow era, when legal segregation and institutional racism shaped access to education and employment. although the civil rights movement of the 1950s and 1960s brought about significant progress in dismantling formal barriers, structural inequalities persisted, especially in access to graduate education, a common requirement for licensure. these persistent disparities in the historical context may help explain the empirical findings, particularly the negative coefficients observed immediately after licensure was introduced. furthermore, beginning in the late 1970s and accelerating through the 1980s and 1990s, u.s. social policy experienced a significant neoliberal turn. this was an ideological shift that prioritized market logic and the retrenchment of the welfare state. scholars have observed that this restructuring coincided with growing economic inequality between white and non-white individuals (jacobs & dirlam, 2016). since social work licensure often requires a graduate degree, these changes likely made it even more difficult for nonwhite aspiring social workers to access and complete the necessary education. in this way, licensure requirements may have compounded the effects of neoliberalism by reinforcing existing structural barriers. these broader historical dynamics are important for understanding the empirical findings in this study, which show a marked decline in the proportion of non-white licensed social workers in the decades following the initial implementation of licensure. as with any research, there are several limitations to this study. one important limitation of this study is the possibility of unobserved confounding variables. while the analysis controls for a range of observed factors and utilizes a difference-in-differences design to mitigate bias, it is possible that unobserved factors such as changes in public education funding or welfare policy that coincided with licensure implementation may have influenced access to the profession in racially uneven ways. in addition, broader economic transformation, including deindustrialization and shifts in the labor market, may have shaped racialized pathways into social work over time. while time and county-fixed effects help account for local characteristics and temporal trends, they cannot fully capture these dynamic, context-specific influences. advances in social work, summer 2025, 25(2) 588 furthermore, it should be noted that the data analyzed in this study are based on selfreported occupational classifications. the u.s. census relies on respondents to select the occupation they personally identify with and does not differentiate between individuals holding a bachelor of social work and those with a master of social work, grouping all under the general category of “social worker.” despite these limitations, this study makes significant theoretical and empirical contributions by showing the extent to which social work licensure has likely changed the racial profile of professional social workers. theoretically, by framing licensure as a mechanism of weberian occupational closure, the research clarifies how professional restrictions reinforce systemic inequities within the social work field. this theoretical lens emphasizes the intersection of race and professional regulation, suggesting that licensure is not merely a credentialing process but a tool that can and does perpetuate exclusionary practices. the findings support the notion that licensure serves the interests of dominant groups by limiting access for marginalized communities, thereby offering a deeper understanding of how institutional structures can influence workforce diversity in the field. methodologically, the extended two-way fixed effects model facilitates a nuanced analysis of the temporal impacts of social work licensure on the racial composition of the workforce. this approach allows for the examination of variations over time, accounting for unobserved factors that might influence the outcomes. by utilizing a staggered difference-in-differences design, this research effectively isolates the effects of licensure, establishing a clear relationship between the implementation of licensure and changes in racial representation within the social work field. implications for the social work profession licensure acts as a tool for controlling the supply of services and creating a monopoly that benefits only those who meet the established criteria (redbird, 2017). by imposing specific educational, training, and examination requirements, licensure creates barriers that limit entry to those who can meet these standards. as a result, only individuals who fulfill these established criteria gain access to the profession, creating a closed market that privileges a select group. this monopolistic dynamic disproportionately affects marginalized groups, particularly non-white individuals, who often face systemic barriers that hinder their ability to meet licensure requirements. consequently, aspiring social workers from marginalized communities may struggle to navigate the licensure process, highlighting the systemic barriers that limit their entry into the field (castex et al., 2019; kim, 2022; nienow et al., 2023). for instance, a report by the aswb (2022) revealed significant disparities in exam pass rates between white and racially diverse test takers. critics argue that the aswb, which monopolizes social work licensing exams, operates in a manner that conflicts with core social work values (joseph, 2024). in addition, states with more intricate licensing tiers showed lower overall pass rates, indicating that these complex structures may further exacerbate racial disparities in licensure outcomes (ricciardelli et al., 2024). these findings raise concerns about systemic barriers limiting entry and advancement for racial minorities, contributing to their underrepresentation in a profession designed to serve choi & handy/social closure 589 diverse populations. to address these disparities, nasw and other social work organizations need to critically examine and reform licensure requirements to create more inclusive pathways for credentialing, particularly for candidates from racial minority groups. for example, modifications to exam content and structure that are more inclusive could positively impact the performance of both white and non-white candidates. furthermore, exploring financial support mechanisms for non-white social work students may shed light on how economic factors influence diversity in the field. systematic investigation of these initiatives could yield actionable policy recommendations aimed at addressing racial disparities within the profession. in practice, social work practitioners should be encouraged to engage in discussions with accrediting bodies about the impact of licensure on workforce diversity and advocate for reforms that promote racial equity. given the increased national focus on institutional racism, addressing disparities within the social work profession has become more urgent than ever. the diverse racial backgrounds of the clients and communities served by social workers further highlight the necessity of confronting these racial disparities in licensure (nienow et al., 2023). as bloxom and anderson (2024) emphasize, “it remains vital for those in the social work profession and beyond to engage in advocacy efforts regarding licensure and other issues impacting both the profession, and the overall health and wellbeing of our nation” (p. 255). to support these advocacy efforts and inform evidence-based reforms, future research should investigate the specific mechanisms through which licensure affects racial representation in the social work profession. for instance, qualitatively examining the experiences of non-white individuals navigating the licensure process and comparing their challenges to those faced by white individuals would help pinpoint the specific barriers that non-white candidates encounter. this could enable the development of targeted strategies to alleviate these obstacles. in addition, given the recent rise of women of color to leadership roles in accrediting and regulatory bodies such as cswe, nasw, and aswb, future research could investigate how leaders’ social identities influence institutional priorities and equity initiatives. research in this area could examine whether and how diverse leadership translates into meaningful policy changes, such as revisions to accreditation standards, curriculum requirements, or examination content that better reflect the needs of diverse communities. future policy evaluation studies should also explore ways to lower barriers to entry while maintaining practice quality. for instance, recent policy changes offer natural experiments for research. some states have eliminated licensure exams, creating opportunities to evaluate whether these reforms increase workforce diversity without compromising service quality. rigorous evaluation of these changes would provide critical evidence for designing equity-centered reforms. the evidence presented in this study reveals that social work licensure has been associated with declining racial diversity over seven decades. this pattern reflects systemic advances in social work, summer 2025, 25(2) 590 barriers embedded within credentialing processes that disproportionately exclude racial minorities. addressing these entrenched inequities will require coordinated action across policy, practice, and research to create a social work profession that truly reflects the communities it serves. references abrams, 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(2024). social work licensing: then and now. clinical social work journal, 52(4), 368-381. author note: address correspondence to jung ho choi, school of social policy and practice, university of pennsylvania, philadelphia, pa, 19104. email: chjho@upenn.edu https://doi.org/10.1093/oso/9780190624422.001.0001 https://doi.org/10.1086/344121 https://doi.org/10.1086/344121 https://doi.org/10.2139/ssrn.3906345 https://doi.org/10.2139/ssrn.3906345 https://doi.org/10.1007/s10615-024-00953-y _______ panagiotis pentaris, phd, associate professor of social work and thanatology, sue hanna, phd, senior lecturer and academic portfolio lead, gemma north, phd, lecturer, school of human sciences & institute for lifecourse development at the university of greenwich, greenwich, london, uk. copyright © 2020 author, vol. 20 no. 3 (fall 2020), ix-xii, doi: 10.18060/24859 this work is licensed under a creative commons attribution 4.0 international license. commentary: digital poverty in social work education during covid-19 panagiotis pentaris sue hanna gemma north abstract: the use of technology in social work education is neither new nor without debate. the conversation has been gradually informing us of the challenges and controversies, as well as benefits in education, practice, policy, and research. yet, in the face of covid-19 and associated quarantine measures, social work education has been tasked with a fast-paced adjustment to online, and where feasible, hybrid learning. this reflection raises the argument that the pace of organisational adjustment is not always the same as those studying social work. this leaves many students in digital poverty and generates inequality gaps that may need addressing, with more inclusive curricula and alternative methods of practice learning. keywords: social work education; digital poverty; digital literacy; covid-19; pandemic social work education and practice have not always connected to ‘digital professionalism’ (taylor, 2017). in other words, both educators and students experience difficulties with digitisation. without a doubt, online social work education has been previously challenged for its effectiveness and appropriateness (kurzman & littlefield, 2020). covid-19 has further provoked this debate by imposing education at a distance, while requiring students and faculty alike to quickly adjust to a virtual environment of knowledge exchange and assessment. social work programmes have had to quickly adjust the delivery of education material, assessment, and practice-based learning. over the last six months, programmes in the united kingdom have suspended most of student’s practice-based learning and adopted online assessment methods, which challenges fairness in the assessment process, considering variations in it skills and access, and adapted almost universally to online methods of teaching (social work england, 2020). in other words, social work education has been faced with two options, as with everything else during this period: either pause and wait until it is possible to restore previous functionalities, or adjust to the new reality, one which requires virtual presence and digital literacy. the demands of social work education, though, require educators and students to react, adapt, and evolve in challenging situations. at a time when higher education is largely influenced by information and communication technologies (ict), covid-19 has exacerbated digital inequalities (beaunoyer et al., 2020) and emphasizes a greater gap in accessibility of education between various student groups (e.g., younger and mature students; students in rural and urban areas). these ineualities are commonly discussed in the context of the interchangeable concepts of ‘digital illiteracy’ and ‘digital poverty’ (norris, 2001). the former refers to the skills and abilities to make use of ict, but the latter is inclusive of the issues of accessibility and acceptability of ict methods as alternatives. according to barrantes (2007), digital poverty is defined as the lack of ict and can be characteristic of any segment of the population regardless of economic poverty, while https://creativecommons.org/licenses/by/4.0/ pentaris /commentary xi the concept of digital divide is predominant in conversations referring to inequalities in accessing and using ict. those in higher education are expected to be at lower risk of digital poverty, with the assumption that they are primarily of the younger generations. it is often the case, however, that social work student cohorts include those from a wider range of backgrounds, for example ‘mature’ students attending or returning to education later in life. drawing on the classifications of digital poverty (barrantes, 2007), social work students during covid-19 may be ‘connected’ but lacking in skills and knowledge about e-education and content creation features (e.g., online presentations) which constitute digital wealth. a desktop analysis of 20 countries’ higher education response to covid-19 (crawford et al., 2020) found that among developed economies (e.g., australia, germany, and the uk) semester/term breaks were not extended, campuses were closed, and teaching was moved online. only some institutions in the us, such as in texas, chose not to follow suit. to the contrary, in developing economies (e.g., brazil, jordan, malaysia, and south africa), there was a varied response. responses, either from developing or developed economies, that wanted students to start following content and be assessed online place the demand on students to have access to electronic devices and online platforms, as well as to be literate enough to make use of ict altogether. these two requirements are essentially what can increase student satisfaction in online education (chen et al., 2020). despite the many and varied efforts to accommodate digital student needs during covid-19, the gap between the digitally poor and wealthy is widening, with emerging inequalities that social work education needs to address moving forward. two main challenges have emerged from this situation. first, how will social work education bridge this gap and enable all students, regardless of ict knowledge, to pursue their commitment to education. the second challenge is a longer-term one--how do we monitor and understand the impact of the ict gap on students who were undertaking their degree course when measures to combat the spread of covid-19 were implemented? should we expect a change in the quality of practice in future social workers compared to those whose education was impacted by covid-19, and how will this reflect on other stakeholders (including experts from experience/clients/service users)? finally, if digital poverty characterizes social work students, and soon to be practitioners, then how is gibson et al.’s (2020) argument that social workers are responsible (along other professionals, we argue) for eradicating the digital divide among clients/services users/experts-from-experience a possibility? these are only a few questions that this commentary wishes to raise, to highlight a key challenge that social work education and its students continue to face in these times of ongoing quarantine measures for protection from covid-19 and the challenges to student learning that arise as a result. references barrantes, r. (2007). analysis of ict demand: what is digital poverty and how to measure it? in h. galperin & j. mariscal (eds.), digital poverty: latin american and caribbean perspectives (pp.29-53). intermediate technology publications. https://doi.org/10.3362/9781780441115.002 beaunoyer, e., dupéré, s., & guitton, m. j. (2020). covid-19 and digital inequalities: reciprocal impacts and mitigation strategies. computers in human behavior, 111, 1-9. https://doi.org/10.1016/j.chb.2020.106424 https://doi.org/10.3362/9781780441115.002 https://doi.org/10.1016/j.chb.2020.106424 advances in social work, fall 2020, 20(3) xii chen t., peng l., yin x., rong j., yang, j., & cong, g. (2020). analysis of user satisfaction with online education platforms in china during the covid-19 pandemic. healthcare, 8(3), 200-226. https://doi.org/10.3390/healthcare8030200 crawford, j., butler-henderson, k., rudolph, j., malkawi, b., glowatz, m., burton, r., magni, p., & lam, s. (2020). covid-19: 20 countries' higher education intra-period digital pedagogy responses. journal of applied learning & teaching, 3(1), 1-20. https://doi.org/10.37074/jalt.2020.3.1.7 gibson, a., bardach, s. h. & pope, n. d. (2020). covid-19 and the digital divide: will social workers help bridge the gap? journal of gerontological social work, 63(6/7), 674-676. https://doi.org/10.1080/01634372.2020.1772438 kurzman, p. a., & littlefield, m. b. (eds.). (2020). online and distance social work education: current practice and future trends. routledge. https://doi.org/10.4324/9781003016557 norris, p. (2001). digital divide: civic engagement, information poverty, and the internet worldwide. cambridge university press. social work england. (2020). social work england: a specialist regulator focused on enabling positive change in social work. https://www.socialworkengland.org.uk/ taylor, a. (2017). social work and digitalisation: bridging the knowledge gaps. social work education, 36(8), 869-879. https://doi.org/10.1080/02615479.2017.1361924 author note: address correspondence to panagiotis pentaris, school of human sciences & institute for lifecourse development, university of greenwich, old royal naval college, park row, greenwich, london se10 9ls, uk. email: p.pentaris@gre.ac.uk https://doi.org/10.3390/healthcare8030200 https://doi.org/10.37074/jalt.2020.3.1.7 https://doi.org/10.1080/01634372.2020.1772438 https://doi.org/10.4324/9781003016557 https://www.socialworkengland.org.uk/ https://doi.org/10.1080/02615479.2017.1361924 mailto:p.pentaris@gre.ac.uk _________ christopher j. heckert, dsw, licsw, assistant professor, school of social work, eastern washington university, cheney, wa. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 364-381, doi: 10.18060/28180 this work is licensed under a creative commons attribution 4.0 international license. re-imagining social work’s role in suicidology: embracing an ecological practice approach christopher heckert abstract: suicide continues to impact individuals and communities at alarming rates, with many vulnerable populations being at a disproportionately higher risk. as a profession, social work is well matched to address the comprehensive and intertwined risk factors that perpetuate acute and chronic risk for suicide. this conceptual article introduces a developing practice model that social workers may adopt to address suicidality for some vulnerable populations. within this model, external processes beyond intrapsychic functioning are notable, and social workers can prioritize integrating additional systems into intervention planning. a case scenario illustrates an example of embracing an ecological systems approach that emphasizes various roles within social work practice. introducing an applied approach to conceptualizing suicidality offers social work education and research an opportunity to advance its positionality in suicidology. keywords: suicide, ecological systems, ecology, social work suicide is an ongoing social and behavioral health issue in the united states, with approximately 49,000 individuals dying by suicide each year (centers for disease control and prevention [cdc], 2025) and more than 1.5 million individuals attempting suicide each year (substance abuse and mental health services administration [samhsa], 2023). although a preventable form of mortality, between 1999 and 2018, the rate of suicide among the general population in the u.s. increased from 10.5 per 100,000 to 14.2 (hedegaard et al., 2020), while the rate among adolescents and young adults increased from 6.8 per 100,000 to 10.6 between 2007 and 2017 (curtin & heron, 2019). worldwide, the covid-19 pandemic exacerbated many risk factors for suicide, thereby leading to noticeable increases in reports of suicide attempts (pathirathna et al., 2022). in western medicine, suicidality is primarily understood and treated using a medical model. the medical model views suicide as a symptom of psychiatric illness, with implicit understanding that minimizing the presenting symptoms of such a psychiatric illness will, in turn, reduce the suicidality. this model is grossly congruent with psychological theories of suicide, such as the interpersonal theory of suicide (ipts), hopelessness theory, escape theory, emotion dysregulation theory, and psychache theory. ipts, for example, understands suicidal behavior to be a result of the individual’s perceived burdensomeness, thwarted belongingness, and capability to engage in suicidal behaviors (chu et al., 2017), with these concepts arguably viewed as symptoms when examined through the lens of the medical model. these theories generate a necessary understanding of targeted aspects of psychological functioning. this offers value for specific clients or certain conversations about suicidality. for instance, these psychological theories generally draw upon the internal mechanisms of the individual, such as one’s perception of self, psychological pain, or the desire to inflict about:blank heckert/suicide & ecological treatment approach 365 self-injury. therefore, the primary emphasis on intrapsychic functioning places noticeable attention on the individual. fitzpatrick and river (2018), however, critique this approach as iterating the pathology of the individual. through the medical model and aligning with psychological theory, suicide is addressed by treating the underlying psychiatric illness via psychotropic medications and psychotherapy. commonly recommended psychotherapeutic interventions to address suicidal behaviors or reduce acute risk include collaborative assessment and management of suicidality (cams), safe alternatives for teens & youths (safety), cognitive behavioral therapy for suicide prevention (cbt-sp), and dialectical behavior therapy (dbt). with substantial literature on these treatments, they are commonly recommended and referenced in best practices, as they target symptom reduction—an intended outcome of the medical model. however, these theories and practices do not comprehensively acknowledge that external factors—the environment and societal structures—also impact suicide. despite a broad scope of research on these practices, there remains limited evidence that these interventions demonstrate an overall reduction in suicidal behaviors (michel et al., 2017). additionally, some results may not be statistically significant (riblet et al., 2017), and some studies may not be generalizable (tarrier et al., 2008). since deaths by suicide remain high, current practice approaches exhibit questionable effectiveness in reducing overall numbers, especially for vulnerable populations and those with chronic histories of suicidality. interventions grounded in the medical model often focus on symptom reduction, overlooking the importance of improving one’s quality of life (chavez et al., 2018), as the medical model lacks the capacity to be attentive to the individual’s personal values and needs (fitzpatrick & river, 2018). additionally, singer et al. (2017) highlights that “differences in theoretical assumptions have important implications for how and when to intervene” (p. 104). thus, while prevalent, the medical model may not be the most valuecongruent practice approach for social work. conceptualizing an alternative model, this paper embraces an ecological approach and offers social work educators and practitioners a framework for teaching and intervening with suicide. in training the next generation of social workers, social work must identify, define, and refine how social work understands suicide as a problem. it is just as important that social work approaches its practice in working with suicide using theories and concepts that align with its core values, ethics, and practice standards. in this paper, i argue that using an ecological lens in the assessment and intervention with clients who may be at acute or chronic risk for suicide, social workers may be better equipped to reduce the rates of suicide in the u.s. and throughout the world. social work and suicidology according to joe and niedermeier (2006), between 1980 and 2006, social work contributed limited knowledge to the study of suicide. more recently, maple et al. (2017) similarly found that social workers contribute relatively minimally to research on suicide. advances in social work, spring 2025, 25(1) 366 additionally, levine and sher (2020) stated that social work research around suicide is limited, and they iterated the importance of social work enhancing its role in suicidology and building upon pre-existing interventions. social work students historically receive minimal formal education in suicide prevention and treatment (feldman & freedenthal, 2006), and additional training focusing on the integration of knowledge and skills is warranted in social work curriculum (osteen et al., 2014). given that most professionals rely on the literature of their own profession as a primary reference for practice (joe & niedermeier, 2006), it is necessary to question the degree to which social work practitioners have access to practice models that utilize an ecological approach in working with suicidality. singer et al. (2017) also acknowledges the importance that social workers understand how to approach working with suicidality in a manner that demonstrates consistency between the social worker’s theoretical orientation and the selected interventions. since ecology is a core principle of social work education and practice, the use of this theory in conceptualizing a client’s suicidality and how to intervene accordingly is warranted as a contribution to the literature. social work has yet to clearly define or describe how it utilizes ecology in its conceptualization of and intervention with client suicidality. furthermore, social work requires a practice model that comprehensively embraces its person-in-environment perspective; its ethics, values, and practice standards; and the unique functions of its various roles—specifically those that lie outside of a clinical function. bringing forth these aspects of the social work profession, social work may be able to shine new light on understanding, preventing, and treating suicidality. roles of social work given its vast array of practice settings, social work identifies with a variety of practice roles. since social work fulfils several functions across these settings, these various roles offer the social work practitioner guidance and direction on their approach to implementing a plan for intervention. these roles may include, but are not limited to case manager, advocate, clinician, facilitator, organizer, manager, administrator, and educator. harris and white (2018) referred to this as functional specialization, where the role of a social worker is determined by their specific function in any given setting. however, they also warned that the functional specialization of social work may lead to fragmentation or compartmentalization of a social worker’s understanding of their role in addressing the well-being of individuals, families, groups, communities, and organizations. for instance, a clinical social worker may only see their role as a therapist or counselor, thus overlooking the functions of other roles, such as advocates, educators, and case managers. integrating the variety of social work roles with a central social work theory—ecological systems— may support practitioners in better understanding how to bring a social work perspective to its practice with suicide. heckert/suicide & ecological treatment approach 367 moving social work towards an ecological systems approach in suicidology the theoretical concept of ecology is widely used and applied in natural and social science literature. in the height of its conceptualization in social sciences, psychologist urie bronfenbrenner developed the ecological systems theory. contemporary iterations of ecology include the life model, ecosystems model, deep ecology, and social ecology. while bearing nuanced differences, each model illustrates the concept of the person-inenvironment as the critical lens through which human behavior should be understood. in its application, here, the concepts of ecology are discussed, and a case scenario illustrates the potential benefit in establishing an ecological systems practice framework for suicide. contextualizing human behavior the ecological model, in general, is supported by the following assumptions: (a) an interdependence exists between all living organisms and their environment; (b) individual behavior occurs within physical, social, and cultural environments; (c) only ecological, or non-linear, thinking can help practitioners to understand more complex phenomena; and (d) successful development and adaptive functioning over the life course depend on the level of fit between the individual and their environment (gitterman et al., 2021). bronfenbrenner (2005) proposed a series of defining properties that are foundational to the ecological model. since bronfenbrenner was primarily interested in understanding human behavior within the context of child and adolescent development, these distinctive properties reflect development across the life course and include the following propositions: • human development is driven by both objective and subjective elements; neither, on its own, is sufficient. • human development occurs through highly complex, reciprocal interactions between the individual and their environment. these enduring forms of interaction are referred to as proximal processes. • characteristics of the developing person and environment, the nature of developmental outcomes, and changes occurring over the course of time vary systematically. • intellectual, emotional, social, and moral development requires routine participation in progressively more complex activities over an extended period of time. given these assumptions and propositions, individual behavior can be understood through a thorough examination of the environment within which one’s behavior is embedded. this includes individual characteristics, relationships, and larger social constructs, all of which are embedded within a temporal factor. advances in social work, spring 2025, 25(1) 368 ecological systems applied within the context of bronfenbrenner’s original ecological systems theory, factors impacting human behavior are reflected within a series of complex systems: microsystem, mesosystem, exosystem, macrosystem, and chronosystem. these systems, together, represent an ecosystem, within which transactions between the individual and their environment are continuously occurring. as such, human behavior cannot be understood, and thus treated, in an absence of understanding the environment, or ecosystem, within which the individual and the consequential behavior (e.g., suicide) is embedded. the microsystem refers to the activities, roles, and interpersonal relationships within proximity of the developing individual (bronfenbrenner, as cited in cecconello & koller, 2019). this may include the family, peer and social groups, neighborhood, and occupational or educational establishments. the mesosystem refers to the relationships that exist between microsystems (bronfenbrenner, as cited in xia et al., 2020). while the individual is not involved in these relationships, the relationships still impact the development of the individual. examples may include the relationship between peer groups and work or between caregivers and school. these two systems have a direct impact on the individual. environments or social structures that have an indirect impact on the individual and their development are referred to as the exosystem (epp, 2018). a common example within the context of social work practice is the individual’s access to community-based resources, such as programs and services, or the influence of mass media. another system with indirect impact on the individual and their development is the macrosystem, which refers to “overarching patterns of ideology and social institutions common to a particular culture or subculture” (bronfenbrenner, 1979, p. 9). examples may include social and gender norms, policy and law, or religious values. the final, contextual element of bronfenbrenner’s ecological systems framework is the concept of time—referred to as the chronosystem. this system focuses on the events and expectations of the larger society (bronfenbrenner & morris, 2007). within the chronosystem, three successive levels exist—micro-, meso-, and macro-time (lerner, 2005). micro-time refers to the continuity versus discontinuity of ongoing proximal processes; this may include pertinent lived experiences of the individual (e.g., trauma, life transitions). meso-time refers to the periodicity of these proximal processes (e.g.., isolated expectations, chronic events). macro-time focuses on the events within and across generations (e.g., historical trauma, socio-historical events). this developmental theory proves useful to social work practice, as social work relies, in part, on psychological theory to inform its practice (ungar, 2002). in considering its applicability to addressing high suicide rates, individuals presenting with suicidality ought to be understood through their own ecosystem, and treatment should be provided according to an individual’s personal ecosystem. from an ecological systems perspective, factors impacting suicide are distributed across these various systems, and the following section provides a brief overview of examples. heckert/suicide & ecological treatment approach 369 ecological systems of suicide individual at the individual level, suicide is prominently understood through biological and psychological factors. examples of biological factors include age, sex, and health conditions. for instance, steele et al. (2018) noted that suicide is the second leading cause of death among individuals 10-24 years old in the u.s., with lgbtq identity increasing risk among this age group. among adult populations, individuals who identify as male, caucasian, and are over the age of 65 are at an increased risk for death by suicide (steele et al., 2018). additional factors impacting suicidality include various health conditions, such as copd, asthma, cancer, diabetes, spine disorders, and heart disease (crump et al., 2013). neurobiological factors, such as neurotransmitter dysfunction (michel et al., 2017), genetic associations (ludwig et al., 2017), and the structure of frontal neural systems (cox lippard et al., 2014) are also associated with increased risk for suicide. known psychological risk factors include mental pain, difficulties with communication, impulsivity, and aggression (gvion & levi-belz, 2018). these factors likely increase one’s susceptibility to developing psychological disorders. common psychiatric problems related to increased suicidality include mood disorders, psychosis, personality disorders, anxiety, trauma-related disorders, and substance use (bachmann, 2018). while these biological and psychological factors exist within the individual system, the emergence of suicidal behaviors occurs through a bi-directional relationship between the individual and larger systems of that person’s ecosystem, which moderates the impact of various conditions and risk factors that contribute to suicidality. microsystem within the microsystem, risk factors related to suicidality pertain to the adequacy and quality of one’s access to adaptive supports. this may include family, peers, work or school, and community involvement (e.g., sports, church, volunteering). for instance, gender and sexual minorities may benefit from more peer support due to the additional stigma associated with their gender and/or sexual identities (williams et al., 2018). according to frey et al. (2019), accessing social support can directly impact one’s posttraumatic growth following a suicide attempt. furthermore, individuals who disclose their experience with suicidality to family members exhibit an increased likelihood of improved mental health outcomes (frey et al., 2015). as such, the impact of social support in preventing suicide may be even more critical than previously understood. therefore, in practice, social workers need to evaluate the meaningfulness of one’s support system, considering ways in which support may be reinforced and strengthened. mesosystem in consideration of suicidality, the mesosystem captures the concept of social cohesion—the connectedness of social structures within one’s environment. for instance, neighborhoods exhibiting a lack of social cohesion are associated with a higher probability advances in social work, spring 2025, 25(1) 370 of suicidal ideation among older adults in korea (kim & park, 2021). however, neighborhood cohesion can serve as a protective factor against stressful life events and mental or behavioral health problems among adolescents—both of which are known to impact suicidality (kingsbury et al., 2020). additionally, the degree to which a family system exhibits cohesion (e.g., whether a partner is integrated into the individual’s family system) is another meso-system example, as family cohesion is one moderating factor for suicidality. this is especially relevant for individuals experiencing psychotic spectrum disorders or those identifying as a person of color (lopez & weisman de mamani, 2022). exosystem within the exosystem, consideration must be given to one’s access to healthcare and means for suicide, while also acknowledging the influence of mass media (e.g., suicide contagion). for instance, social media can impact suicidal behavior (luxton et al., 2012), and the reporting of deaths by suicide of celebrities has had a meaningful impact on the suicide numbers among the general population (niederkrotenthaler et al., 2020). additionally, paladhi et al. (2021) found that firearm-owning households had more access to healthcare, but those with risky firearm storage practices had less access to healthcare. one barrier to accessing healthcare relates to healthcare insurance policies, yet lang (2013) noted that states enacting mental health parity experienced significant decreases in suicide rates. macrosystem the macrosystem addresses factors of suicide that pertain to societal views and cultural values, including social norms. prominent examples in suicidology include stigma, societal views regarding gender and sexuality, and military culture. for instance, according to mayer et al. (2020), anticipated stigma from disclosing one’s history of suicidality increases risk for suicide, due to concern for the potential reactions of others. the role of stigma, then, is one that is inhibitory to the efforts intended to reduce suicide, and stigma may hinder or limit the access to and receptibility of prevention and treatment efforts. furthermore, military personnel are less likely to verbally express their mental health concerns (cox et al., 2011), and they are more likely to experience difficulties with transitioning from deployment (lusk et al., 2015) due to the culture of the military. among lgbtq+ communities, youth are twice as likely to attempt suicide compared to heterosexual peers (the trevor project, 2021), and a hostile environment is a contributing risk factor to suicide for this community (cdc, 2016). thus, factors outside of the individual—such as those within societal structures and cultural values—may moderate the recovery trajectory of individuals experiencing suicidal behaviors. chronosystem in working with suicide, the chronosystem offers a temporal context that impacts an individual’s ability to adapt within their ecosystem. micro-time examples may include having a previous suicide attempt, exposure to isolated traumas, or various life transitions. heckert/suicide & ecological treatment approach 371 identifying individuals with multiple suicide attempts could be useful in predicting one’s risk for suicide, as well as in designing ad hoc prevention strategies (berardelli et al., 2020). major life events, such as financial problems or relationship difficulties, are other examples of micro-time factors, as they also contribute to suicidality (gvion & levi-belz, 2018). meso-time factors related to suicide include chronic events, such as the covid-19 pandemic. additionally, adolescents who present with a higher risk for suicide include those who have a history of exposure to trauma (e.g., domestic violence or child abuse/neglect) and have a family history of suicide or psychiatric illness (steele et al., 2018); these events are likely to have long-lasting effects on an individual. considering an example of macro-time, nix (2021) iterated the importance of understanding historical trauma and its relation to indigenous mental health and suicide, as indigenous populations are at an increased risk for suicide (chachamovich et al., 2015; qiao & bell, 2017). figure 1. case scenario excerpt case scenario jaime is a 16-year-old, gay male with a history of depression and anxiety. jaime experiences recurrent episodes of major depression, which includes feeling hopeless, anhedonia, lethargy, isolating behaviors, and chronic thoughts of suicide, all of which are exacerbated by anxious distress. he recently discharged from a temporary hospital stay following a non-lethal suicide attempt. at discharge, he is prescribed venlafaxine, gabapentin, and alprazolam. jaime also has a history of low vitamin d, and his thyroid functioning is unknown. his medications will be managed by his primary care provider, as the closest psychiatric prescriber with a specialty in pediatrics is a two-hour commute from his home. while his mother and brother are “more accepting,” jaime often feels that he cannot openly express or be himself in the presence of his family. his father often conceals jaime’s sexual orientation to extended family members and members within their community. additionally, jaime’s family has not talked with him about his previous suicide attempt, and his parents keep firearms in the home. at school, jaime is involved in the gay-straight alliance (gsa), for which he is frequently bullied by both peers and school staff. his parents are not actively involved in his education, and jaime is at-risk of not graduating due to poor academic performance—a result of missing school and low motivation. during covid-19, jaime’s access to peer support significantly decreased. jaime’s rural community is predominantly conservative with “traditional” values. jaime is required to attend church with his family, even though the church views lgbtq+ identities as sinful. while jaime does not identify with his churches’ values, he does identify as christian and feels disconnected from his spirituality. furthermore, jaime is exposed to media depictions of suicide (e.g., popular television shows, movies, and news) at home and school. jaime’s insurance provider network has limited adolescent therapists who are lgbtq+ affirming, and his health coverage does not provide out-of-network benefits. although he engaged in a brief episode of inpatient treatment, jaime continues to experience suicidal ideations. during the prior authorization process, jaime’s insurance asks, “why is he still suicidal? is he not using the skills he learned during inpatient treatment?” advances in social work, spring 2025, 25(1) 372 translating ecological systems into direct practice within suicidology, the extensive knowledge regarding factors that increase one’s risk for suicide demonstrates that there is a complexity to suicide that incorporates individual characteristics, as well as environmental factors, such as social and cultural considerations. to illustrate this, the case scenario is a condensed culmination of a variety of clinical encounters (see figure 1). it highlights the complex nature of suicide, emphasizing the importance of considering external risk factors that may hinder an individual’s ability to adapt within their environment, thus increasing risk for suicide. it also exemplifies how social work can utilize its numerous roles to intervene with suicide more comprehensively. jamie’s case offers insight in understanding how an ecological approach can support social workers with translating ecological thinking into practice when designing interventions for clients presenting with suicidality. from an ecological perspective, as jaime’s goodness of fit with his environment improves, his overall risk for suicidality should decrease. therefore, treatment should focus on improving the fit between the person and environment by targeting key factors across the systems that compose the client’s ecosystem. table 1 provides an ecological systems breakdown of associated risk factors pertinent to jaime’s presenting suicidality; direct practice recommendations and associated social work functions are identified. jaime’s case demonstrates the importance of acknowledging the depth of multiple systems that exacerbate both acute and chronic risk for suicide. at the individual level, jaime presents with both physical and mental health risk factors. this includes psychiatric conditions (i.e., depression and anxiety), as well as physical health considerations (i.e., low vitamin d and unknown thyroid functioning), which can impact the severity of depressive symptoms. the interaction between physical and mental health factors will require the social worker to be mindful of care coordination functions within practice. for instance, it will be critical to jaime’s recovery that their primary care provider, who is also serving as the prescribing provider, be frequently updated regarding jaime’s progress and response to treatment. while jaime presents with these individual risk factors, the transactional processes between environmental sub-elements perpetuate and sustain his suicidality. this includes jaime residing in a rural, conservative community; experiencing invalidation at church and school—two critical microsystems within his ecosystem; and the impact of healthcare coverage limitations. using an ecological framework requires consideration of the synergy between and within the individual and environmental elements (xia et al., 2020). the impact of prolonged exposure to these proximal processes may exacerbate his suicidality and overall development, as he emerges into adulthood. thus, in suicidology, social work must look beyond just the individual, which will likely require considerations of functions beyond clinical practice. heckert/suicide & ecological treatment approach 373 table 1. case scenario: ecological systems practice recommendations system risk factor practice recommendation social work role individual mental health • provide individual psychotherapy clinical • coordinate with psychiatric prescriber case management physical health • coordinate with primary care case management microsystem family • provide psychoeducation to parents regarding lgbtq+ identities & increased risk for suicide clinical/education • provide family/conjoint psychotherapy clinical school • provide education & resources regarding bullying, lgbtq+, & increased suicide risk education church • problem-solve & process value incongruence between client & church clinical mesosystem parent-school • empower parents to be more involved in client’s education to increase awareness of schoolrelated issues advocacy exosystem rural community • provide referrals for lgbtq+ affirming providers case management • advocate for telehealth services where clinically appropriate advocacy service access • negotiate a single-case agreement with insurance if outof-network advocacy media • process pop-culture depictions of suicide in psychotherapy clinical macrosystem stigma • decrease stigma through validation of client’s lived experiences & social identifiers clinical social & gender norms • provide psychoeducation regarding impact on mental health clinical/education • provide parents with referral to pflag case management • provide client with referral to lgbtq+ support groups case management chronosystem suicide-attempt history • develop safety plan clinical • administer trauma screening clinical covid-19 pandemic • problem-solve using coping skills & accessing social support clinical advances in social work, spring 2025, 25(1) 374 jaime resides in an environment that is incongruent and not a “good fit” with his own personal identity and values. environments that do not match an individual’s needs are more likely to lead to dysfunction (bronfenbrenner & morris, 2007). focusing solely on changing jaime’s individual thoughts and behaviors through psychotherapy and psychotropic medications may decrease acute suicidality, but it is unlikely to produce the necessary change to reduce his overall or chronic suicide risk. using an ecological framework to assess the contributing factors to jaime’s suicidality will increase the likelihood of a more accurate intervention plan. it will also allow the social worker to consider the role and necessity to integrate additional systems beyond the individual in their intervention. one approach to integrate additional systems is for the social worker to consider other roles and functions of direct practice, such as case management, advocacy, and education. clinical, advocacy, case management, and education (cace) social work practice model for suicide assessment and intervention developing a practice framework that emphasizes the importance of non-clinical functions in social work allows providers to distinctly target treatment needs throughout an individual’s ecosystem. following a comprehensive assessment emphasizing a thorough understanding of the multiple ecological layers impacting one’s presenting suicidality, only then can the most effective treatment plan be developed in collaboration with the client. figure 2 demonstrates a practice model for suicide assessment and intervention that outlines the integration of social work roles that embrace clinical, advocacy, case management, and education functions. the clinical function highlights the role of providers in addressing individual and relational issues, commonly through the provision of psychotherapeutic interventions. this might include any combination of individual therapy (using processing and skill building techniques), family therapy, and/or group therapy. for licensed social workers, the clinical function is often perceived as a specialty, and it can come at the expense of more generalized social work practices. thus, integrating additional social work roles may offer a more holistic approach to supporting suicidal individuals. clinical •assessment •psychotherapy •skill building advocacy •service access •empowerment case management •linking •referral services •care coordination education •psychoeducation •parent education •partner education social work figure 2. cace social work practice model for suicide assessment and intervention heckert/suicide & ecological treatment approach 375 the advocacy function acknowledges the role of systemic issues within a client’s ecosystem, and it can intervene with service system access and empowerment. through advocacy, social workers may act on behalf of, in support of, and/or alongside the client in mitigating larger systemic issues affecting suicidality. efforts of advocacy may include addressing healthcare access, navigating barriers related to service delivery, or empowering clients with the knowledge and skills necessary to self-advocate. the function of case management allows the social worker to address communication needs between systems. with this function, the social worker provides referrals or coordinates care with providers. this role increases in importance for more complex cases. for instance, individuals with several service providers or those experiencing numerous acute stressors (e.g., housing, financial problems, unemployment) will benefit from supplemental case management that accompanies the clinical function of the practitioner. finally, the social work function of education allows for increasing insight and awareness by offering the individual and their microsystems with information about suicide. this might include providing education to important microsystems, such as parents, a partner, or other family members. this function additionally allows for increasing the client’s understanding of the intersectionality between specific vulnerable identities and suicide, as well as the potential and very real consequences of not addressing these issues. thus, the cace practice model offers a defined framework by which social workers can support clients in both establishing and sustaining stabilization by targeting specific risk factors throughout the client’s respective ecosystem. discussion while suicide is commonly viewed as a sole symptom of intrapsychic functioning, ecology informs us that suicide may be better understood as a symptom of the context within which an individual is developing. according to lerner (2005), a piecemeal analysis of isolated aspects and attributes is insufficient, and perhaps misleading, in understanding human behavior. for instance, the concept of social cohesion is acknowledged in other theories of suicide, such as ipts and durkheim’s theory of suicide, but understanding the co-existence and complexity of this concept as it is embedded in other levels of the ecosystem warrants a more comprehensive model from which to base social work practice. while existing models of intervention maintain relevance and usefulness, considerations for alternative approaches more distinctly grounded in social work values offer additional opportunity to support clients who may not benefit from current assessment and intervention practices. since social workers are the highest percentage of mental health providers in the u.s. (american board of clinical social work, 2022), it is urgent to plainly recognize the complexity of factors impacting assessment and intervention. given the high rates of suicide among adolescents and young adults, and since developmental theory and ecology offer a context for human behavior, developmental science may be key in addressing client suicidality. in clinical practice, the limitations of the medical model leave social workers to navigate, without certainty, how to best address factors external to the individual in a clinical setting. although clinicians may primarily work with individuals, families, and groups, value remains in the ability of a social worker advances in social work, spring 2025, 25(1) 376 to identify, assess, and integrate broader systems impacting an identified client. even if a clinical social worker may not be able to immediately or directly change societal stigma, for instance, the social worker can acknowledge the role that stigma plays in perpetuating behavioral health symptoms and overall suicidality. in doing so, the social worker may be able to mitigate the impact of larger systems through problem-solving, processing, and providing education and resources to the individual and their microsystem. in preparing social workers for direct practice, social work education may find benefit in offering a unique perspective to understanding and working with suicide. instead of deferring to the medical model and hyper-focusing on sole changes at the individual level, emerging social workers may be better equipped to assess the complex ecosystem of individual clients and tailor treatment planning accordingly. since populations often deemed more vulnerable are only partially supported by predictions of current theories of suicide, such as ipts (e.g., barzilay et al., 2015; khazem et al., 2015; pisetsky et al., 2017), preparing social workers for the field requires the use of theories that can be generally applied to various populations and identities. in turn, embracing ecology and publishing specifically in social work journals may also increase the available research and scholarship of social workers in suicidology, paving the way for social work to develop its own framework through which it best understands and works with suicide. the introduction of the cace practice model offers social workers a concrete framework from which to guide their direct practice, including interventions beyond the clinical function of social work. it is worth iterating that the application of ecology within this model is not indicating that the social worker is to directly intervene with each system. rather, the social worker continues to intervene directly with the individual, microsystem, and mesosystem, while simultaneously addressing the impact of the exosystem, macrosystem, and chronosystem on the individual. thus, while the social worker is intervening with microand meso-interventions, these are tailored to uniquely reflect the risk factors throughout the individual’s ecosystem. the application of the ecological systems theory to treatment planning in direct practice highlights the importance of utilizing ecology to conceptualize a client’s suicidality. in its practice with other public health and social problems—such as child welfare and substance use—social work contributed to advancing direct practice by utilizing ecology to enhance its knowledge, treatment planning, and subsequent service interventions. since social work embodies multiple practice roles, embracing an ecological approach allows the clinician to tap into additional practice functions and interventions that may prove beneficial to suicidology. standardized assessments, such as the columbia-suicide severity rating scale (cssrs), and treatments, such as cbts, tend to iterate psychological risk factors, along with some temporal factors (e.g., suicide attempt history). while the standard methods may be helpful in assessing and treating some factors of suicidality, the effectiveness of these approaches may overlook immediate risk factors relevant to marginalized populations, such as systemic discrimination, lack of resources, and community values. thus, in deferring to theories and practice approaches aligned, at least in part, with the medical heckert/suicide & ecological treatment approach 377 model, social workers may unintentionally overlook critical factors impacting a client’s presenting suicidality. given that social work emphasizes the importance of integrating more just practices into the profession, ecology is more congruent with social work values, as “[bronfenbrenner’s model] may be the frame within which human decency and social justice may prosper” (lerner, 2005, p. xxiv). ungar (2002) additionally iterates that ecology reminds social work to celebrate diversity, deconstruct the power of traditional discourse, and to emphasize the needs of special groups—critical components lacking in other frameworks. transitioning to a practice model that embraces ecological thinking, such as the cace practice model, may offer social work an opportunity to forge its own position within suicidology. references american board of clinical social work. 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(2020). operationalizing urie bronfenbrenner’s process-person-context-time model. human development, 64, 10-20. author note: address correspondence to christopher j. heckert, school of social work, eastern washington university, cheney, wa 99004 united states. e-mail: checkert@ewu.edu https://orcid.org/0000-0001-9159-2096 https://doi.org/10.1111/1556-4029.13519 https://doi.org/10.1111/1556-4029.13519 https://doi.org/10.1111/1556-4029.13519 https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/national%20report/national%20report/2023-nsduh-annual-national.pdf https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/national%20report/national%20report/2023-nsduh-annual-national.pdf https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/national%20report/national%20report/2023-nsduh-annual-national.pdf https://doi.org/10.1177/0145445507304728 https://doi.org/10.1177/0145445507304728 https://www.thetrevorproject.org/research-briefs/estimate-of-how-often-lgbtq-youth-attempt-suicide-in-the-u-s/ https://www.thetrevorproject.org/research-briefs/estimate-of-how-often-lgbtq-youth-attempt-suicide-in-the-u-s/ https://doi.org/10.1086/341185 https://doi.org/10.1037/ort0000334 https://doi.org/10.1037/ort0000334 https://doi.org/10.1159/000507958 https://doi.org/10.1159/000507958 mailto:checkert@ewu.edu https://orcid.org/0000-0001-9159-2096 _________ john r. gallagher, phd, lcsw, lcac, full research professor, schar school of policy and government, george mason university, fairfax, va. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 353-363, doi: 10.18060/28348 this work is licensed under a creative commons attribution 4.0 international license. substance use disorder is a disease, but not everyone who has a substance use disorder has the disease john r. gallagher abstract: social workers commonly work with individuals, families, groups, and communities to support substance use disorder recovery. substance use disorder is prevalent in many social work settings, including child welfare, criminal justice, healthcare, policy advocacy, and, of course, clinical social work. therefore, schools of social work and students must be prepared to treat substance use disorder through multiple avenues using contemporary science to guide practice. this conceptual article supports the work of social work educators and student learning by highlighting the key symptoms of substance use disorder as a brain disease and emphasizing that not everyone who has a substance use disorder also has the brain disease. additionally, guidance is provided on when social workers should recommend abstinence or harm reduction as the recovery goal in clinical treatment planning. examples of abstinence and harm reduction clinical treatment plans are provided, and schools of social work can incorporate these examples into their curricula, which is especially important for schools that offer concentrations in substance use and mental health disorder treatment. the article ends with implications for social work and suggestions for future research to advance the evolving science of substance use disorder recovery. keywords: addiction, substance use disorder, harm reduction, recovery, clinical social work as a starting point, it is important to mention that there is ongoing debate professionally and academically with terminology used in this article. key terms such as substance use disorder, addiction, and the brain disease model often have different definitions, presumably due to many factors, such as the tools used to make diagnoses, professional training, and discipline-specific ideology surrounding substance use disorder. for instance, when a social worker uses the dsm-5-tr to make a diagnosis and assess severity, they will use the terminology substance use disorder because that is consistent with the language used in the diagnostic manual (american psychiatric association [apa], 2022). conversely, when using the addiction severity index (asi) to assess the need for treatment, severity, and the impact of drug and alcohol use on major areas of life (e.g., family relationships, employment, health), the terminology used is addiction (cacciola et al., 2011). the discrepancies in terminology are best noted by the recovery research institute (2024) where they mention 10 different definitions of recovery. these discrepancies, unfortunately, have created barriers to developing interventions and policies that help those with substance use disorder (kelly & hoeppner, 2014). for this article, the term substance use disorder is used because the hypothetical clinical treatment plans, diagnoses, and severity of diagnoses are based on the dsm-5-tr (apa, 2022). about:blank advances in social work, spring 2025, 25(1) 354 it is also important to emphasize that the author is not suggesting that substance use disorder is not a disease. substance use disorder is a disease for some. the author is proposing, as suggested in the title, that some people who have substance use disorder based on dsm-5-tr diagnostic criteria (apa, 2022) have symptoms of the brain disease while others do not. as will be demonstrated in this article, patients who have a diagnosed substance use disorder that includes symptoms of the brain disease will, most likely, respond best to abstinence as a treatment goal. conversely, patients who have a diagnosed substance use disorder that does not include symptoms of the brain disease may achieve recovery through harm reduction, such as reducing their drug use to the point that it no longer has a negative impact on their functioning. with this said, however, disagreements underlying the brain disease model cannot be ignored. just as there are contradictions in terminology (e.g., recovery), so too do inconsistencies exist in whether or not substance use disorder is a disease. this ongoing discourse has been emphasized through national news outlets (hoffman, 2024) and academic avenues (goldberg, 2020). in some instances, substance use disorder is viewed as a disease and others see it as a choice, which goldberg (2020) describes as the brain disease model versus the choice model. to fully understand substance use disorder, hoffman (2024) argues that personal choice, environment, social support, and other non-neurological factors must be assessed, and this approach seems to be consistent with the person-in-environment underpinning of social work (kondrat, 2013). over the past few years, there has been more discussion on the potential benefits of using harm reduction approaches to minimize the negative impact of substance use disorder. harm reduction interventions that are commonly discussed are needle exchange programs, distributing safer smoking supplies, making naloxone available in communities, using fentanyl test strips, and mobile services to treat opioid use disorder with methadone and other medications (substance abuse and mental health services administration [samhsa], 2023a). harm reduction, unfortunately, is rarely discussed in the context of treatment planning, such as clinical social workers collaborating with patients to develop treatment goals based on reducing drug use or using less lethal drugs (drucker et al., 2016). historically, harm reduction treatment planning was seen as taboo because the substance use disorder profession was largely guided by programs that dictated abstinence as the treatment goal (drucker et al., 2016; gallagher & bremer, 2018; gallagher et al., 2019). it is essential that clinical social workers and others who treat substance use disorder are skilled in developing a range of treatment plans. the author claims that it is equally as important that clinical social workers make treatment recommendations, such as abstinence or harm reduction, based on the presence of symptoms that indicate the brain disease. this is especially important as the profession continues to experience a paradigm shift from abstinence as the key outcome to a holistic view of recovery, which includes improved physical and emotional health, having meaningful relationships and social connectedness, and a lifestyle guided by purpose and hope (samhsa, 2023b). method conceptual articles can be guided by many approaches, such as theory synthesis, theory adaptation, typology, and model, as described by jaakkola (2020). these approaches are often not mutually exclusive and there is no one-size-fits-all methodology to explore gallagher/abstinence or harm reduction? 355 phenomena from a conceptual lens. reese (2022) emphasizes this point by stating that there is no single way to write a conceptual article. rather, conceptual articles should center on developing logical insights that can be transferred to practice settings and tested rigorously through future research. accordingly, an aim of this conceptual article is to present clinical treatment plans that are guided by abstinence and harm reduction approaches to substance use disorder recovery. these treatment plans can be transferred to social work practice settings, particularly to schools of social work that prepare students to deliver best practices in substance use disorder treatment. suggestions for future research are also discussed to test the conceptual topics that emerged from this article. this article in best aligned with a typology conceptual model (jaakkola, 2020) because it has the concrete goal of creating clinical treatment plans to visualize the terms abstinence and harm reduction which, as mentioned previously, can be abstract and inconsistent across disciplines. typology articles connect constructs to usable products (cornelissen, 2017; doty & glick, 1994; jaakkola, 2020). in this case, the constructs are symptoms of substance use disorder (apa, 2022) and the products are examples of clinical treatment plans that could be used to guide contemporary substance use disorder treatment. additionally, typology is recommended when there are inconsistences, or fragmentations, with the conceptualization and operationalization of key terms (jaakkola, 2020). as shared previously, there is division in how important terminology, such as addiction, recovery, and the brain disease, is understood and used across professions. to accomplish the goals of this typology conceptual article, the methodological approach was to: (1) review existing literature related to diagnostic symptoms of the brain disease; (2) formulate hypothetical clinical treatment plans that are guided by abstinence and harm reduction recovery; and (3) discuss implications, including recommendations for future research, for social workers and other human service professions that treat substance use disorders. first, the three types of substance use disorder (mild, moderate, and severe) are compared and contrasted to highlight that some patients who have substance use disorder present with symptoms of the brain disease while others do not. moreover, the author proposes how harm reduction, such as reducing drug use, may support recovery for those who do not have the brain disease, and how abstinence should be recommended for those with symptoms of the brain disease. second, a hypothetical clinical treatment plan is presented of a patient who has a mild substance use disorder, presents with no symptoms of the brain disease, and chooses to reduce their drug use as part of their recovery. alternatively, another hypothetical clinical treatment plan is developed for a patient who has a severe substance use disorder, presents with symptoms of the brain disease, and chooses abstinence as their treatment goal. third, implications for social work and future research agendas are discussed to advance the knowledge base in this area. this includes longitudinal studies to better understand the progressive nature of substance use disorder and qualitative research to give patients a voice related to their paths to recovery, whether that be through a harm reduction or abstinence lens, or perhaps a combination of both. advances in social work, spring 2025, 25(1) 356 hallmark symptoms of the brain disease there are eleven diagnostic criteria for substance use disorder; a mild disorder includes 2 to 3 criteria, a moderate disorder meets 4 to 5 criteria, and a severe disorder has 6 or more criteria (apa, 2022). diagnostic criteria are also grouped into four categories: impaired control; social problems; risky use; and drug effects (apa, 2020). the number of criteria met indicate the severity of the substance use disorder (e.g., mild, moderate, or severe) and the author suggests that the categories can help identify whether or not a patient has the brain disease. substance use disorder is a disease that affects the brain, particularly the functionality of neurotransmitters such as dopamine, serotonin, and gamma-aminobutyric acid (gaba), to name three. the author advocates that not everyone who has a substance use disorder also has the brain disease. this is important to distinguish because the profession has historically defined substance use disorder as a chronic disease where abstinence is the treatment goal. for those who do not have the brain disease, substance use disorder may not be chronic and multiple pathways to recovery are possible, including reduced and controlled drug use. put another way, the author proposes that some patients with mild substance use disorders may be immune to developing the brain disease. not everyone who uses drugs, even those who use drugs frequently and in high dosages, will develop a substance use disorder, let alone symptoms of the brain disease. the same phenomenon applies here; having a diagnosed substance use disorder does not automatically equate to having the brain disease. patients with mild substance use disorders will experience a pattern of problems related to drug use, but they may never develop hallmark symptoms of the brain disease, such as tolerance, withdrawal, loss of control, and craving. to be more specific, the author claims that the two categories that clearly correspond to the brain disease are impaired control and drug effects (apa, 2020). findings from modern neuroscience (erickson, 2018) that examine symptoms of the brain disease align best with these two categories. in these categories, symptoms of tolerance, withdrawal, loss of control, and craving are present. these symptoms are evidence of the brain disease, and when evidence of the disease is present, the author proposes that best practices for clinical social workers is to recommend abstinence as a treatment goal. a practitioner would never see these four symptoms together (tolerance, withdrawal, loss of control, and craving) with a mild substance use disorder because, as shared previously, a mild substance use disorder only has 2 to 3 diagnostic criteria. if a patient does not present with symptoms of tolerance, withdrawal, loss of control, or craving, this may suggest that they do not have the brain disease. in this case, harm reduction through reduced and controlled drug use may be possible. abstinence is recommended for patients who have severe substance use disorders (6 or more diagnostic criteria) that include symptoms of impaired control (e.g., craving) and drug effects (e.g. withdrawal). recommendations are less clear for those who have moderate substance use disorders (4 or 5 diagnostic criteria). substance use disorder, for those who have the brain disease, is progressive, so if untreated, a moderate substance use disorder may progress to a severe substance use disorder. regardless, when evidence of tolerance, withdrawal, loss of control, and craving are present, abstinence is the best recommendation to support recovery. gallagher/abstinence or harm reduction? 357 over a decade of research has supported these recommendations. the dsm-5 was released in 2013 and research related to diagnostic criteria for substance use disorder has shown that certain criteria tend to cluster together. these clusters differentiate between those who have a mild, moderate, or severe substance use disorder and can be used to develop treatment goals. for instance, kopak and colleagues (2014) discussed how some diagnostic criteria, such as having withdrawal symptoms when trying to reduce or stop drug use, inability to reduce or stop drug use despite having a desire to do so, and experiencing cravings to use drugs, are almost always clustered together and associated with severe substance use disorder. impaired control is a key symptom of the brain disease and diagnostic criteria related to impaired control (e.g., using more of the drug than intended, unsuccessful attempts to control or stop drug use) are often found with those who have severe substance use disorder (apa, 2022). actually, impaired control seems to be the strongest predictor of having a severe substance use disorder and the brain disease (belin et al., 2013). harm reduction in the form of reduced and controlled drug use would, logically, not be recommended for those who have the brain disease and severe substance use disorder. this type of harm reduction requires control and those who have the brain disease and severe a substance use disorder have demonstrated an inability to control their use. from a practice standpoint, treatment courts, such as drug courts, are a good example of how contemporary substance use disorder science guides programming. specifically, a goal of drug court is to support patients who are involved in the justice system in achieving abstinence as a treatment goal (all rise, 2024). recommending abstinence is best practice for this population because drug courts are designed to serve those who have the brain disease. specifically, drug courts treat those who …have a moderate to severe substance use disorder that includes a substantial inability to reduce or control their substance use, persistent substance cravings, withdrawal symptoms, and/or a pattern of recurrent substance use binge episodes (i.e., use often substantially exceeds the person’s intentions or expectations) (all rise, 2024, p. 7). as mentioned beforehand, drug courts are designed to serve those who present with hallmark symptoms of the brain disease, such as withdrawal symptoms and craving (all rise, 2024). accordingly, and aligned with the position of this article, the best practice would be to recommend and support patients in achieving abstinence as a treatment goal. to further conceptualize this topic and offer social work practice examples, the next section presents hypothetical clinical treatment plans based on harm reduction or abstinence as the treatment goal. clinical treatment plans: harm reduction and abstinence harm reduction clinical treatment plan below is an example of a harm reduction treatment plan for a patient who has a mild stimulant use disorder (apa, 2022) with no evidence of symptoms of the brain disease. as mentioned previously, a patient with no evidence of the brain disease means they do not advances in social work, spring 2025, 25(1) 358 meet diagnostic criteria for tolerance, withdrawal, loss of control, and craving. when a patient has a mild substance use disorder with no evidence of the brain disease, harm reduction to include reduced drug use or using less lethal drugs may be recommended. of course, though, even with a mild substance use disorder and no evidence of the brain disease, if a patient wants abstinence as their treatment goal, as clinical social workers, we support that. presenting problem ashley reported that she referred herself to substance use disorder treatment because, for the past year or so, her cocaine use has been having a negative impact on her employment, as evidenced by her missing workdays and being less productive when she is at work. additionally, she discussed that due to her cocaine use she stopped participating in hobbies and social events that she enjoys, such as going to yard sales with friends, playing bingo, and doing art. based on the findings from an assessment, ashley has a mild stimulant use disorder, as indicated by meeting two of the eleven diagnostic criteria. specifically, using cocaine has had a negative impact on her ability to fulfill the responsibilities of her job and she stopped participating in social activities and hobbies that she previously enjoyed doing. based on ashley having a mild stimulant use disorder that includes no symptoms of brain disease, harm reduction and abstinence treatment goals were explored with her. she reported that she did not want to abstain from cocaine; rather, she was motivated to reduce her cocaine use which she felt would improve her quality of life. treatment goals ashley wants to reduce her cocaine use from approximately five days a week to two or fewer days a week, and she feels that this reduction in use will improve her work performance and give her an opportunity to attend yard sales and reengage in other activities she enjoys doing. she also wants to improve her overall health and wellbeing by developing an exercise routine and volunteering in her community. to ashley, exercising and volunteering are two behaviors that will help her reduce her cocaine use and support her recovery. treatment objectives 1) ashley will learn about the symptoms of substance use disorder, develop cognitive coping skills that align with her treatment goals, and discuss what recovery means to her. this will be measured by her ability to identify the symptoms of substance use disorder that she has experienced, process cognitions that support her treatment goals, and articulate her definition of recovery. 2) ashley will reduce her cocaine use to two or fewer days a week, and she will plan to use cocaine on friday and saturday evenings because this will not gallagher/abstinence or harm reduction? 359 impact her work schedule or performance. this will be measured through her self-report. 3) ashley will develop and utilize a recovery support system that is supportive of her treatment goals. her recovery support system will include reengagement in activities that she previously enjoyed doing, such as playing bingo, as well as exploring other activities that she feels will be helpful, such as joining a gym to improve her health and volunteering to support her community. this will be measured by her ability to discuss how utilizing her recovery support system helps her meet her goals of reduced cocaine use and improved functioning in major areas of her life, such as work. interventions the clinical social worker will facilitate individual therapy with ashley one time per week. motivational interviewing and cognitive behavioral therapy will be used to support ashley in identifying her motivations for recovery, developing cognitive and behavioral coping skills that support her recovery, and creating a recovery support system that is conducive to her treatment goal of reduced cocaine use. abstinence clinical treatment plan below is an example of an abstinence treatment plan for a patient who has a severe opioid use disorder (apa, 2022) with symptoms of the brain disease. as mentioned previously, a patient with the brain disease means they meet diagnostic criteria for tolerance, withdrawal, loss of control, and craving. these diagnostic criteria tend to cluster together, and when a patient has a severe substance use disorder and these clustered symptoms, abstinence should be recommended as a treatment goal. presenting problem mike reported that he wants substance use disorder treatment because he is unable to stop using heroin. mike shared that, for the past 2 to 3 years, he has tried to stop using heroin but has not been able to do so. he has tried to stop cold turkey and by using other drugs, such as alcohol and marijuana, but those approaches have not worked for him. heroin has caused serious problems for mike, including a recent overdose where he was revived by naloxone and hospitalized for a week. furthermore, mike reported that his heroin use has negatively impacted his ability to be a father and husband. based on the findings from an assessment, mike has a severe opioid use disorder, as indicated by meeting nine of the eleven diagnostic criteria. notably, mike reported symptoms of the brain disease, including tolerance, withdrawal, loss of control, and craving. based on mike having a severe opioid use disorder that includes symptoms of the brain disease, abstinence from heroin was recommended as a treatment goal and mike agreed with this recommendation. advances in social work, spring 2025, 25(1) 360 treatment goals mike wants to abstain from heroin and other drugs, including alcohol and marijuana, to prevent another overdose and possible premature death. he also wants to develop a recovery support system of peers and behaviors that will help him sustain his recovery and improve his relationship with his children and wife. treatment objectives 1) mike will learn about the brain disease and develop cognitive and behavioral skills to prevent relapse and cope with symptoms of his disease, such as craving, in a manner that supports his treatment goals. this will be measured by his ability to identify the symptoms of the brain disease that he can relate to and practice healthy coping skills to sustain his recovery. 2) mike will abstain from heroin and other drugs to improve his health, eliminate his risk of overdose and death, and improve his family relationships. this will be measured through his self-report. 3) mike will attend narcotics anonymous (na) meetings five to seven days a week where he will learn about the recovery support group and work the 12step program with a sponsor and other peers. he will also familiarize himself with literature related to na, such as the na textbook. this will be measured by his ability to discuss how participating in na supports him in meeting his treatment goals of abstinence and improving his relationship with his children and wife. interventions the clinical social worker will facilitate group therapy three times a week and individual therapy one time per week with mike. motivational interviewing, twelve-step facilitation therapy, and cognitive behavioral therapy will be used to support mike in abstaining from heroin and other drugs, learning about the brain disease, and utilizing na to develop a recovery support system. implications for social work and future research the content of this conceptual article has implications for social workers and other disciplines that treat substance use disorder. the most noticeable implication is that schools of social work can incorporate the abstinence and harm reduction clinical treatment plans into their curricula. this will support student learning in several ways, such as offering them examples of clinical treatment plans which they may be required to complete for assignments or at their internships, educating them on abstinence and harm reduction models of treatment, and offering them an opportunity to share their independent thoughts and experiences related to the disease model. moreover, service learning is an important part of social work education, and gallagher (2015) shared several benefits of this gallagher/abstinence or harm reduction? 361 pedagogy, including promoting civic engagement and collaboration with other disciplines, to name two. students could complete service-learning projects where they hold townhalls or similar events to educate community members on modern substance use disorder topics, such as harm reduction. common knowledge on substance use disorder treatment has been dominated by an abstinence-only model (vakharia, 2024) which may have left many communities misinformed about harm reduction. students, through service-learning and community engagement, may help bridge the gap between modern substance use disorder science and vintage approaches to treatment (e.g., abstinence-only model). next, a limitation of this conceptual article is that confusion, discourse, and debate remain with important language used in the substance use disorder profession. the author offered a model that examines the interplay between substance use disorder severity, treatment recommendations, and evidence of the brain disease. however, this alone does not create consensus among the many disciplines that treat substance use disorder. the article concludes that substance use disorder is a brain disease for some, but once again, it is important to note that some professionals simply disagree that it is a disease at all (goldberg, 2020). next, the most obvious limitation of this article is that it is not empirical, which is consistent with conceptual articles, but this needs to be noted. only future research can test the ideas and themes that emerged from this article. three areas for future research are recommended to advance the science of substance use disorder treatment and recovery. first, research findings tend to center on those who have mild or severe substance use disorders (boyd et al., 2020); therefore, less is known about those who have moderate substance use disorders. johnson and colleagues (2020), for instance, examined treatment outcomes across the spectrum of substance use disorder severity, but statistically significant findings were mostly specific to those who had mild or severe substance use disorders. they found that individuals with severe opioid use disorder had the highest odds of receiving treatment and those with mild alcohol use disorder were least likely to receive treatment (johnson et al., 2020). as shared throughout this article, for those who have the brain disease, it is progressive, so presumably a moderate substance use disorder, if untreated, will progress to a severe substance use disorder. future research should complete longitudinal studies to learn more about the progressive nature of the brain disease. it seems that the substance use disorder profession has, fortunately, moved beyond a strictly abstinence, one-size-fits-all approach to treatment (vakharia, 2024). with this shift comes the need to better understand why some patients respond well to reduced drug use while others will achieve recovery through abstinence. longitudinal studies are going to be the best method to track substance use disorder symptomology over time and to further assess why some patients develop the brain disease and others do not. second, qualitative research methods are recommended to give patients and clinical social workers an avenue to share their thoughts, opinions, and experiences related to harm reduction and recovery. individual interviews, for instance, would be a great avenue to assess how patients view recovery, their understanding of the brain disease, and their process in deciding if they are going to abstain from drugs or reduce their drug use. focus groups with clinical social workers could be used to explore their thoughts related to the advances in social work, spring 2025, 25(1) 362 role of harm reduction in substance use disorder treatment and identify potential barriers to implementing harm reduction treatment plans. third, more research is needed on the use and effectiveness of harm reduction treatment plans (e.g., reduced and controlled drug use) to support substance use disorder recovery. it is unknown how often harm reduction treatment plans are used and how they are implemented. there is a plethora of research on other harm reduction approaches, such as needle exchange programs, but, unfortunately, harm reduction treatment planning appears to be excluded from the literature. abstinence has historically been the goal of substance use disorder treatment, so less is known about the effectiveness of treatment goals based on reduced drug use. it is also important to measure outcomes beyond drug use, which may include 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(2024). the harm reduction gap: helping individuals left behind by conventional drug prevention and abstinence-only addiction treatment. routledge. author note: address correspondence to john r. gallagher, schar school of policy and government, george mason university, 4400 university dr, fairfax, va 22030. email: jgalla9@gmu.edu https://doi.org/10.1080/02615479.2015.1025737 https://doi.org/10.1080/02615479.2015.1025737 https://doi.org/10.1080/07347324.2017.1355223 https://doi.org/10.1080/07347324.2017.1355223 https://doi.org/10.1080/07347324.2017.1355223 https://doi.org/10.1080/07347324.2019.1571877 https://doi.org/10.1080/07347324.2019.1571877 https://doi.org/10.1080/07347324.2019.1571877 https://doi.org/10.1007/s12152-019-09424-5 https://www.nytimes.com/2024/09/03/health/addiction-disease-choice.html https://doi.org/10.1007/s13162-020-00161-0 https://doi.org/10.1016/j.drugpo.2019.10.009 https://doi.org/10.1016/j.drugpo.2019.10.009 https://doi.org/10.3109/16066359.2014.930132 https://doi.org/10.1093/acrefore/9780199975839.013.285 https://doi.org/10.1007/s40429-014-0020-0 https://doi.org/10.1007/s40429-014-0020-0 https://www.recoveryanswers.org/resource/recovery-definitions/ https://doi.org/10.1080/21670811.2021.2009353 https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf https://www.samhsa.gov/recovery https://doi.org/10.4324/9781003301745 https://doi.org/10.4324/9781003301745 mailto:jgalla9@gmu.edu _________ rebecca g. mirick, phd, lcsw, associate professor, school of social work, salem state university, salem, ma. stephanie p. wladkowski, phd, lcsw, associate professor, department of human services, bowling green state university, bowling green, oh. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 156-174, doi: 10.18060/26938 this work is licensed under a creative commons attribution 4.0 international license. “people will judge you…so be ready”: advice to pregnant doctoral students rebecca g. mirick stephanie p. wladkowski abstract: doctoral program attrition is a significant issue, with 50% of doctoral students leaving their program before completion. personal life events, such as marriage and children, are risk factors for attrition, but little research has focused on factors that positively affect persistence and success through these life events. in a nationwide survey project, individuals who had been pregnant during their doctoral program in the united states (n=626) suggested strategies and approaches that pregnant students could implement to support continued success in doctoral education, highlighting the voices of those with lived experience with doctoral education and pregnancy. thematic analysis identified four primary themes in the responses: the creation of systems that support success, the need for clear expectations, the importance of productivity, and the feasibility of success. implications for doctoral programs and social work educators include the need to identify ways that programs can activity support students through pregnancy, remain informed about supports and accommodations for pregnant students, and consider options to allow for a slow-down in productivity without penalty to the student. keywords: doctoral education, pregnancy, persistence, doctoral students, qualitative research doctoral attrition is a major problem in higher education. in the first seven years of a research doctoral program, approximately one-third of students graduate, one-third remain in their program, and one-third leave their programs before graduation (sowell et al., 2015). while some go on to finish, about half of doctoral students will never complete their program. completion rates vary by gender and field of study (sowell, 2008). in social work, the number of research doctorate degrees conferred decreased by 12.7% between 2010-2020, but there are no gender differences (council on social work education [cswe], 2021). in contrast, in science, technology, engineering, and math (stem) fields, women are more likely than men to drop out of doctoral programs (cabay et al., 2018; sowell, 2008). students who have a major life event, such as a pregnancy, birth, marriage, or death have an elevated risk of attrition (gardner, 2009a; maher et al., 2004; spaulding & rockinson-szapkiw, 2012). in the united states, more than 25,392 women students graduate from phd programs every year (national science foundation [nsf], 2021). in social work, 75% of research doctorate students are women between the ages of 25 and 44 years [cswe, 2021). with so many women of childbearing age in doctoral programs, including social work, many students experience a pregnancy or the birth of a child. little is known about the reasons why some students persist through a major life event such as pregnancy, while others leave academia. this is an important, but little studied, aspect of understanding doctoral student persistence and attrition. about:blank mirick & wladkowsi/pregnant doc students 157 although title ix provides legal protection to pregnant students (office for civil rights [ocr], 2021), gender equity remains an issue in higher education. gender differences exist in publications, salaries, workloads, grant funding, and promotion across fields, including social work (casad et al., 2022; johnson et al., 2022; tower et al., 2019). in social work, base salaries are significantly higher for men in faculty roles than women and women are more likely to work in undergraduate only programs, which may be perceived as less prestigious and offer lower salaries (tower et al., 2019). in social work, women faculty perceive the climate of their program as more negative than men, including on measures such as gender discrimination, sexual harassment, gender insensitivity, and work/life climate (tower et al., 2019). pregnancy is a gendered, embodied experience that visibly highlights the decision to engage in caregiving alongside doctoral education. pregnant doctoral students face challenges including a bias against caregiving, mentorship challenges, and the implicit pressure to demonstrate commitment and capability despite pregnancy (mirick & wladkowski, 2018; wladkowski & mirick, 2019). additional challenges include expectations that pregnancies be timed to be minimally disruptive (crawford & windsor, 2021; trepal et al., 2014), insufficient family friendly policies and supports (mirick & wladkowski, 2020; mansfield et al., 2010), negative consequences of using familyfriendly policies (e.g., loss of financial aid, funding, health insurance, or access to university services; holm et al., 2015; lynch, 2008; windsor & crawford, 2020), insufficient access to affordable childcare (maher et al., 2004), negative responses from faculty and administrators (cabay et al., 2018; kaler et al., 2020), and limited access to essential professional development opportunities (mirick & wladkowski, 2018). some of these challenges are immediate issues, due to pregnancy, and others are anticipatory stressors, as pregnant students plan for the postpartum period, and beyond. there is a dearth of information about the strategies and protective factors that support pregnant students’ persistence in doctoral education. more research highlighting the voices of students with lived experience will expand our understanding of these experiences. literature review individuals in all levels of academia, from doctoral students to full professors, engage in their work within the broader context of societal values, beliefs, and assumptions, and the culture and expectations of academia. for women with children, academic culture can present unique challenges. ward and wolf-wendell (2016) explain: ideal workers are dedicated to the job, meaning they are not supposed to take into account things that are non-job related (i.e., family) …yet contemporary norms associated with motherhood and parenting still assume a dedication to family that excludes devotion to work. academic women can find themselves in a bind that stands at the intersection of ideal worker norms that assume a complete focus on work, intensive mothering norms that assume a total dedication to family, and societal norms that grant unprecedented access to women in the workplace while limiting what they can achieve if they want to be a professional and a parent. ideal worker norms expect women to approach work as if they do not have children and advances in social work, spring 2024, 24(1) 158 intensive mother norms expect women to parent as if they do not have careers. (p. 12) doctoral students find themselves in a particularly vulnerable position, as they have fewer policies to support them during pregnancy and the postpartum period than full-time faculty (bodkin & flemming, 2021; crawford & windsor, 2021; springer et al., 2009). for example, they are often ineligible for the family leave and medical act (fmla) or other ways to access a maternity leave (springer et al., 2009). social work students are not exempt from these issues, with many social work doctoral students describing a lack of institutionalized support for pregnant students (wladkowski & mirick, 2020). program administrators often have little information about policies pertaining to pregnancy, resulting in confusion, lack of information, or misinformation which can lead to lack of access to supports or unintentional negative consequences of using supports (kent, 2020; romero-hall et al., 2018; springer et al., 2009; windsor & crawford, 2020). due to ideal worker norms, pregnancy is problematic as it interferes with the 24-7 availability of the ideal worker (mason et al., 2013; ollilainen, 2019). pregnant students describe comments and feedback illustrating assumptions that they are less committed to their doctoral studies than non-pregnant students (mansfield et al., 2010; mason et al., 2013; ollilainen, 2019). these beliefs create anxiety and fear about how pregnancy might affect a student’s professional identity, academic work, reputation, and academic career (hopwood & paulson, 2012; mansfield et al., 2010; wilkins-yel et al., 2022). students carefully consider pregnancy disclosure and may remain silent about pregnancy to avoid negative assumptions about their motivation or commitment (kaler et al., 2020; mansfield et al., 2010; romero-hall et al., 2018). often, students describe working harder to demonstrate they can still do the work during pregnancy and the postpartum period (mansfield et al., 2010; romero-hall et al., 2018). navigating these challenges can cause anxiety, concern, guilt, and stress (mansfield et al., 2010; wilkins-yel et al., 2022). support from faculty, peers, and mentors can mitigate these negative feelings and ameliorate negative experiences (maher et al., 2004). attrition and persistence in doctoral education the culture of a doctoral program is critical to doctoral student persistence. doctoral students need to learn the norms, expectations, and implicit rules of their specific field and doctoral education. this socialization into a doctoral program is associated with higher rates of persistence, while a lack of integration increases risk of attrition (lovitts & nelson, 2000). a positive climate supports students’ success. in contrast, when the doctoral program fosters an environment in which negative interactions with students occur, attrition rates increase (cabay et al., 2018). lovitts and nelson (2000) argue that “many students who depart are conducting a referendum on the department culture; they are voting with their feet” (p. 47). the literature on doctoral student persistence has emphasized the importance of good executive functioning skills, such as organization, discipline, flexibility, internal motivation, for student success (byers et al., 2014; gardner, 2009a; martinez et al., 2013; spaulding & rockinson-szapkiw, 2012). faculty tend to emphasize the importance of the mirick & wladkowsi/pregnant doc students 159 academic preparation of the student, but often there is no difference in academic performance between students who leave and students who stay (gardner, 2009b; lovitts & nelson, 2000). one qualitative study of pregnant and parenting students’ experiences in social work and other health care fields found that along with determination, organization, and persistence, students attributed their success to good luck in terms of fertility, pregnancy timing, supportive mentorship, and positive programmatic climate (wladkowsi & mirick, 2019). the concept of pregnancy timing is well-established in academia (armenti, 2004; windsor & crawford, 2020), but the role of luck and fertility in timing is rarely discussed. mentorship a strong relationship with a mentor supports students’ progression through a doctoral program (maher et al., 2004) and is the strongest predictor of a student’s decision to remain in a program or leave before graduation (lovitts & nelson, 2000; wilkins-yel et al., 2022). good mentorship supports students during personal crises and is pivotal in determining student retention when a negative life event or health issue occurs (wilkins-yel et al., 2022). pregnant students identify the importance of supportive advisors who provided them encouragement, support, and advocacy such as checking in with a student, providing or offering support, listening, and other demonstrations of caring (hopwood & paulson, 2012; kent, 2020; lynch, 2008; trepal et al., 2014). characteristics of effective mentors include empathy, availability, flexibility, warmth, and trustworthiness (kent, 2020). mentor acceptance of a student’s pregnancy and advocacy for accommodations create a supportive foundation for students (holm et al., 2015), while fear of mentors’ responses can lead to students’ lack of disclosure of challenges to mentors (wilkins-yel et al., 2022). the current study there are known factors that contribute to doctoral student persistence (byers et al., 2014; gardner, 2009a; martinez, 2013; spaulding & rockinson-szapkiw, 2012). while a few researchers have explored the intersection of motherhood and doctoral education, identifying challenges associated with these dual roles (mason et al., 2013; trepal et al., 2014), limited research has explored factors that affect doctoral program persistence and success for this population. this study builds on a previous small qualitative study on the topic of pregnancy with healthcare students (e.g., social work, nursing; mirick & wladkowski, 2019), further expanding and deepening our understanding of this topic by highlighting the voices of students with lived experience of pregnancy in doctoral education and eliciting their understanding of the factors that support success as a pregnant doctoral student. advances in social work, spring 2024, 24(1) 160 methods study design and sampling this paper reports results of a larger mixed-methods research project that explored women’s experiences with pregnancy and motherhood during their doctoral education in the united states. quantitative and qualitative findings specific to parenting are reported elsewhere (mirick & wladkowski, 2020). the analyses reported in this paper are limited to a qualitative subset of the data, the open-ended responses to a survey question that asked for guidance and recommendations to current doctoral students about managing pregnancy as a doctoral student. this question was only answered by participants who themselves had been pregnant during their doctoral programs. following irb approval, participants were recruited through professional and personal networks, social media groups devoted to academic motherhood, and direct outreach to doctoral programs. to reach current students, directors of doctoral programs were contacted from six intentionally diverse fields: sociology, social work, english, biology, nursing, and computer science. the recruitment materials asked that “women who had experienced a pregnancy or had a child during their doctoral program” consider study participation. gender was not included as a screening question or on the survey itself. unintentionally, language choice may have discouraged gender-diverse students from participating, leading to a sample that was predominately cisgender. data were collected via an anonymous survey using qualtrics online survey software. no incentives were offered for study participation. demographic questions were asked. these included age, race, sexual orientation, field of study, region of country, current employment status, number of pregnancies during the doctoral program, experience of pregnancy loss, and experience of medical complications due to pregnancy. data on participants’ advice and guidance to current pregnant doctoral students was collected through the following open-ended question: what advice would you give a woman doctoral student who is planning to become pregnant or has just found out she is pregnant? data analysis data was analyzed using braun and clarke’s (2006, 2012) six steps of thematic analysis, an iterative process of identifying themes in a data set. in this study, a set of responses to the following open-ended survey question was analyzed, “what advice would you give a woman doctoral student who is planning to become pregnant or has just found out she is pregnant?” two members of the research team conducted the first steps of the analyses independently. first, they read the responses multiple times to become familiar with the data. then, they independently created a set of initial codes based on analysis of the first 20% of responses. after comparison and discussion, a final set of codes was created, and the remaining responses coded. for responses with coding discrepancies or ambiguities, the responses were discussed until full agreement was reached. following the initial coding process, the coding team met to discuss areas of commonality and difference between the preliminary codes and to group similar codes into larger themes. exemplars are used to illustrate these themes in the participants’ own words. advances in social work, spring 2024, 24(1) 161 findings participants participants (n=626) ranged in age from 24 to 55 years (m=34.55, sd=4.70). most participants identified as white (70.8%, n=443) and heterosexual (86.4%, n=541) and had been pregnant only once in their doctoral program (61.7%, n=386). the majority (84.0%, n= 526) had been pregnant in the past five years. most participants were current doctoral students (57.2%, n=358), with 13.6% (n=85) in tenure-track or tenured academic positions. the most heavily represented fields were healthcare (27.3%, n=171), life sciences (23.0%, n=144), social sciences (17.7%, n=111), and arts/humanities (16.0%, n=100). participants attended doctoral programs in the south (29.1%, n=182), midwest (22.2%, n=139), pacific coast (13.9%, n=84), midatlantic (13.4%, n=84), northeast (11.8%, n=74), and west (9.1%, n=57) united states. see table 1. factors affecting persistence, success, and experience as a pregnant student in an open-ended question, participants shared recommendations for pregnant doctoral students. four themes presented from the data: 1) the value of pregnancy as a time to create systems that support success (n=412); 2) the need for clear expectations (n=167); 3) the importance of productivity (n=135); and 4) the feasibility of pregnancy and parenting within doctoral education (n=123). see table 2. table 1. sample (n=626) characteristic n (%) race white 443 (70.8%) asian/pacific islander 34 (6.3%) latina 31 (5%) black/african american 19 (3%) multiracial 8 (1.3%) american indian/alaska native 1 (0.2%) undisclosed 90 (14.4%) sexual orientation heterosexual 541 (86.4%) lgbtq+ 62 (9.9%) prefer not to disclose 23 (3.7%) field of study healthcare 171 (27.3%) life sciences 144 (23%) social sciences 111 (17.7%) humanities & arts 100 (16%) education 49 (7.8%) math/computer science 21 (3.3%) physical/earth science 18 (2.8%) engineering 11 (1.7%) undisclosed 1 (0.1%) role current doctoral student 358 (57.2%) full-time tenure track faculty 70 (11.2%) full-time non-tenure track faculty 46 (7.4%) full-time non-academic position 46 (7.4%) post-doctoral fellow 36 (5.8%) tenured faculty 15 (2.4%) full time parents 13 (2.1%) on leave from doctoral program 9 (1.4%) dropped out of program 7 (1.1%) unemployed 1 (0.2%) prefer not to answer 35 (5.5%) number of pregnancies one 386 (61.7%) two 192 (30.7%) three 39 (6.2%) four + 9 (1.4%) advances in social work, spring 2024, 24(1) 162 table 2. themes from advice to pregnant doctoral students (n=626) theme n (%)* subtheme n (%)* create systems that support success 412 (64.8%) social support system 167 (40.5%) active role 153 (37.1%) planning for baby 150 (36.4%) communication 95 (23.1%) mentorship 61 (14.8%) set expectations 167 (23.9%) realistic 79 (47.3%) anticipate negativity 77 (46.1%) productivity 135 (21.2%) work ahead 97 (71.9%) maintain 61 (45.2%) feasibility 123 (19.3%) encouragement 89 (72.4%) choose between motherhood & academia 34 (27.6%) *% add to more than 100% because participants could provide multiple answers create effective support systems participants (n=412) believed pregnancy represented a critical time to create systems to support their success during the postpartum period and beyond. this process included creating a social support system (n=167), taking an active role in the creation of this system (e.g., research, advocacy, confidence; n=153), planning (e.g., childcare, organization, finances, maternity leave; n=150), using clear communication (n=95), and accessing good mentorship (n=61). create a support system. participants (n=167) emphasized the importance of intentionally creating a support system during pregnancy, so students did not have to manage the dual roles of student and parent alone after their baby was born. one participant said, “do not think you can/should do it alone, so make sure your spouse is there to help, that family is there to help.” this personal support was valued and seen as critical. support systems included friends, family, partners, peers, colleagues, or faculty. many saw these support systems filling multiple roles, including emotional support, guidance, and childcare. including academics who were parents in this support system, such as “a friend in your department who is a mom too,” was identified as important to success. creating a professional support system outside of the department was seen as a necessary option if the department was not supportive of the pregnancy. a support network was perceived as an essential component of success as a doctoral student mother and creating a network was an important task during pregnancy. active role. participants (n=153) advised students to spend their pregnancy taking an active role in shaping the system to meet their needs by researching their rights, advocating for themselves, and “owning” their decision to have a child. students need to “determine policies around pregnancy” and ensure they are “well informed of the resources available to…a pregnant student and new mother.” research is necessary because staff do not always have correct information. one participant said, “don’t trust that financial aid is telling you fully researched information …i spoke with a financial aid representative…affirmed there would be no problem, yet…now, there is.” students need to advocate for themselves, to mirick & wladkowsi/pregnant doc students 163 “push for the space and support you should receive.” this can mean accessing support outside the department such as the graduate student union, legal representation, or the title ix office. some resistance was assumed, as is illustrated by this advice to “fight for every rightdon’t give up” and “advocate for yourself even if you receive a bad reaction.” one aspect of the ability to advocate was confidence in their decision to be pregnant. participants recommended that students “own it!” and “not apologize to anyone for being pregnant.” participants recommended trying to avoid negative feelings about pregnancy, as one participant shared: resist any internalized shame around becoming pregnant. i am queer and intentionally got pregnant. i had some internalized homophobia/sexism/misogyny about making this “choice.” i feared others would judge me and say, “why did she decide to do this now?” as opposed to a straight-identified person “accidentally” getting pregnant. participants encouraged students to be confident in their decision, spending their pregnancy researching their rights and pregnancy policies, and advocating for their right to use these policies without negative consequences to their reputation or career trajectory. planning. participants (n=150) identified the importance of spending pregnancy planning for future academic success. planning spanned topics such as finances, childcare, routines, goals, and coursework as well as tasks such as reassessing priorities and building organizational skills. planning for childcare was essential and included advice such as “get on a daycare list now.” another common aspect of planning was arranging parental leave. many participants believed a leave was important, although some qualified this advice with comments such as “if possible.” planning also included setting and achieving goals and prioritizing tasks. one participant advised “organize your priorities around productivity targets and be very diligent about meeting targets.” pregnancy is a valuable time for planning for success during the postpartum period. good communication. during pregnancy, participants (n=95) recommended being “honest,” “open,” and “upfront” in communicating needs, goals, timelines, and plans with faculty and mentors. for example, one participant said, “go to the chair with your plan and see if they might be on board with it. it is better to go with a plan in hand…. don't wait too long…it is better to plan ahead than surprise them.” the communication should be professional, careful, and assertive. one participant said, “be very open…but don't complain. just be transparent about what is going on.” good communication during pregnancy was seen as supporting student success. mentorship. participants (n=61) reported that good mentorship during and after pregnancy is important because mentors “can guide you through the process in your department.” planning for the long-term, the most important criterion for a mentor is being supportive of not just the current pregnancy, but also parenting doctoral students. one participant recommended finding a mentor who was “supportive of parenting in graduate school, even if their research interest does not exactly line up with your own.” most emphasized the added value of the mentor being a woman with children, offering advice such as “find at least one mentor who is also a mother.” faculty mothers were perceived as more likely to be supportive and could also “understand the extra challenges pregnant advances in social work, spring 2024, 24(1) 164 doctoral students face.” besides offering support, mentors could be role models, sharing the strategies they found supported their successes. one participant suggested, “find a female mentor who has a child. talk about how she made work/research/career possible.” setting up mentorship during pregnancy that would continue to be supportive after the birth of a child was highlighted as critical to student success. expectations having clear expectations was considered important to success (n=167). participants identified the need to have realistic expectations (n=79) and to anticipate negative responses to pregnancy (n=77). realistic expectations. participants (n=79) reported that it was important for pregnant students to have a realistic understanding about the challenges of pregnancy, and eventually parenting, as a doctoral student. they emphasized the unpredictability of pregnancy, which can require students to shift plans unexpectedly. they recommended a pregnant student expect unanticipated barriers and challenges, offering advice such as “realize that everything won’t work out as planned—stay as flexible as possible.” the reality of the physical challenges of pregnancy was acknowledged. one suggested strategy was “schedule more time to complete tasks (start tasks earlier) because you may have an emergency or feel tired one day.” having a realistic vision of parenting an infant as a doctoral student was identified as a key part of effective planning for the postpartum period. one participant said, “verbal support [from faculty] is certainly positive, but you will still be expected to produce, present, teach…it’s really, really difficult.” being realistic about the need to plan for substantial childcare was at the center of this advice, with participants offering reminders such as “you can’t work and care for a child” and “do not expect to get things done when you are at home with your child.” one participant suggested, “anticipate the first three to four months of infancy to be very hard…it will be next to impossible to do anything other than infant care.” this advice was not limited to the future parenting challenges faced by new parents, but included the need to expect that the structure of academia will not support work life balance. one participant said, “work life balance is a lie. there is no such thing, so accept that. systemic change is needed to produce anything close to that.” she went on to advise, “for now, we all have to set our own priorities based on our values and live with the fall out.” participants recommended realistic expectations in terms of the challenges of pregnancy and the need to prepare for the difficulties of balancing infant care with doctoral education. negativity. participants (n=77) advised students to be prepared for a negative response to pregnancy from faculty, administrators, and/or peers counseling: “even in femaledominated disciplines, don’t be surprised by tremendous misogyny.” participants recommended avoiding some negativity by refraining from talking about pregnancy. for example, one participant recommended not “put[ing] pregnancy front and center or else you will be viewed as a mom first and scientist second.” another participant expanded, saying, “make sure you still act like a professional in your field. don't turn into a babycrazy, always-focused-on-the-pregnancy, type of person. that turns everyone off.” mirick & wladkowsi/pregnant doc students 165 another participant said, “in my experience, it is better to keep most discussion of family private and to continue to talk only about work-related topics as much as possible.” it was acknowledged that no strategy completely protects a pregnant student from pregnancy bias. one participant shared her feeling of inevitability about negativity and bias, saying: there is an enormous amount of bias against pregnant women in academia today. you need to grow thick skin to be able to brush off unwanted comments about your pregnant body, and pregnancy hormones that influence behavior during pregnancy. people will judge you, and so be ready. advice centered on the need to expect negativity when pregnancy, especially if a student talks a lot about their pregnancy. productivity productivity (n=135) was a common theme in advice to pregnant students. participants provided advise to pregnant students to maintain productivity levels during pregnancy, spend their pregnancy strategizing for a productive postpartum period, and if possible, increase productivity during pregnancy to compensate for a slow down during the postpartum period. participants advised maintaining productivity levels through pregnancy, emphasizing the importance of remaining productive and engaged in doctoral work throughout pregnancy. one participant advised, “as hard as it is, try your best to be productive during your pregnancy because you will almost certainly experience a slump in productivity in the postpartum period when you are sleep-deprived and caring for a newborn.” some participants saw pregnancy as a time to prepare for a productive postpartum period. for example, participants recommended planning research so that there was work to do during the postpartum period. one participant shared this advice, “get as much writing and experiments done as possible while pregnant, so you have data to analyze and stuff to help keep you busy while away [on maternity leave]. this way you can hit the ground running when you come back.” another participant suggested a pregnant student organize their research so that they are ready to collect data during the postpartum period, saying, “don't allow yourself to completely disengage…i used my maternity leave to collect data. that way, i didn't have to put a lot of brain power into it, but i was still engaged enough to keep a foot in the door.” others recommended that students use their pregnancy to develop new strategies to maintain productivity that are unique to parenting students, such as “focus on working fewer hours more productively” or “think about work differently…. doing just one-half page a day.” pregnancy was seen as a time when students could increase their productivity to plan for unexpected pregnancy complications or an inevitable slowdown in the postpartum period. for example, one participant advised to work ahead and “finish expected work as early as possible” since pregnancy could be unpredictable. working ahead during pregnancy was seen as a strategy to be able to briefly pause for the baby’s arrival. for example, one participant said, “hurry and get everything possible done before the baby comes. do everything possible to allow yourself sufficient time to recover and enjoy your advances in social work, spring 2024, 24(1) 166 baby.” many participants recommended students “get as much work done while pregnant as possible,” including assignments, journal articles, dissertation chapters, and conference presentations. other advice included “complete and draft manuscripts before the baby comes” or finish a major doctoral program benchmark, such as, “try to take your exams, finish your prospectus, or have at least one chapter draft done and approved by your committee” or “finish your dissertation before the baby comes. do not delay.” some participants hedged this advice, offering caveats such as “do as many assignments and classes when pregnant as possible, within reason and sanity.” these recommendations implicitly acknowledge the inability to halt program expectations, even for a major life event. feasibility the final theme centered on the feasibility of combining pregnancy, and ultimately parenting, with doctoral work (n=123). some (n=89) focused on encouragement, and the belief that it was ultimately possible to be both a doctoral student and parent, while a smaller group (n=34), highlighted the necessity to choose between the two roles. there was an implicit assumption that pregnant students were considering these issues during their pregnancy with some considering whether to remain in doctoral programs or academia. encouragement. participants (n=89) offered words of encouragement, such as “you can do it” and “it’s possible” in conjunction with the belief that holding these dual roles was not easy but often worth it. participants used descriptors such as “hard,” “challenging,” “rewarding,” and “beautiful.” one participant offered, “being a new parent is tough enough before adding the high stress of a phd program. it is very possible, and rewarding, to do both, just try to be as strategic as possible.” although all agreed it was possible, there was not a consensus that students should persevere in their doctoral studies. for example, one said, “know that you are not alone you can do this! but also know that if you change your mind and want to quit grad school, that's ok too.” encouragement often seemed an attempt to balance more negative feedback received elsewhere, such as this comment, “it’s not the end of the world or your academic career.” make a choice. some participants (n=34) advised students to choose between academia and having a child, because it was not possible to manage the dual identities successfully or not worth the sacrifice and work required. for example, one participant said, “if you want to be a successful doctoral student, don’t be pregnant. if you want to be a good mom, don’t be a doctoral student because it is just impossible to be successful in both careers.” for some, the advice was starker, such as, “drop out-it's not worth it.” the advice to make a choice applied to all of academia, as is illustrated by this participant, “academia is a shitty place for women and especially for pregnant women-get out of academia asap” perhaps by graduating “as quickly as possible and begin thinking about alt-ac work.” while only a small group gave this type of advice, one participant described the result of these beliefs, saying, “i know of one other female who became pregnant besides myself …both of us decided to terminate our first pregnancies because we didn't think that we could handle it and school at the same time.” although some participants mirick & wladkowsi/pregnant doc students 167 provided encouragement, highlighting the excitement of pregnancy and ultimately, parenting, others recommended pregnant students leave academia. discussion these findings provide a rare exploration of the lived experience of pregnant doctoral students, a group whose perspectives have historically been missing from the literature on higher education. the large sample size of this project – that spans humanities, stem, and healthcare fields – offers a unique look at the factors students identify as affecting doctoral student success for pregnant doctoral student mothers, based on their own lived experience. these findings clearly demonstrate the diversity of pregnant students’ experiences. while some participants focused on the ways to be successful as a pregnant student, including the importance of consistently producing academic work and progressing in the program, others emphasized the need to set expectations and consider feasibility. this advice may reflect the unique nature of their own experiences, based on field of study, programmatic culture, advisor/mentor, or availability of external resources (mirick & wladkowski, 2018). although historically motherhood has been perceived as incongruent with academia (armenti, 2004; drago et al., 2006; mason et al., 2013), only a small group of participants highlighted explicit negativity towards pregnant students. instead of blatant, intentional discrimination and bias, most participants described doctoral education as a context that is a poor fit for doctoral student mothers, making pregnant students vulnerable to caregiving bias and requiring them to spend their pregnancy planning, increasing productivity, setting up a support system, and for some, considering leaving academia. while pregnant students could find success, it required intentional, organized work during pregnancy, the constant production of academic work, even on maternity leave, and active engagement with the university to research and advocate for accommodations to which they were legally entitled. doctoral work is difficult, exhausting work, and unsurprisingly, a small group shared the belief that remaining in academia was not worth the required effort. these findings highlight a critical equity issue in terms of access to doctoral education. the advice highlights the immense amount of energy, motivation, and drive a pregnant student must expend to shape their environment to support their success. while figuring out how to create a supportive system (maher et al., 2004), students must simultaneously research policies and support, advocate to obtain these (windsor & crawford, 2020), cope with staff and faculty who may be unfamiliar with them and/or provide inaccurate information (springer et al., 2009), find supportive mentors, work ahead to manage a decline in productivity following childbirth, communicate their plans and needs to faculty, and plan for the baby (e.g., childcare, finances). they must engage in their doctoral work with confidence, ready to combat or avoid possible negative responses from faculty and staff. these are high expectations for students during a period where they may experience pregnancy symptoms like fatigue or nausea, need to cope with an unanticipated pregnancy, or may be kept busy with doctoral work, such as data collection, preparation for a conference presentation, or difficult coursework. this guidance highlights previous research emphasizing the importance of motivation, determination, perseverance, and advances in social work, spring 2024, 24(1) 168 organizational skills for doctoral student success (gardner, 2009a; martinez et al., 2013; spaulding & rockinson-szapkiw, 2012). the focus on productivity emphasized the ideal worker norms which persist in academia, which often values productivity and the prioritization of academic work while dismissing those who value both the personal and professional aspects of their lives as less committed, less successful, and less desirable academics (fox, 2020; sallee et al., 2016). further, it highlights a lack of space in doctoral education to pause for life events. participants’ emphasis on the importance of planning for sufficient childcare likely also reflects this necessity and is supported by previous research findings on the role of childcare responsibilities and other family-related issues on their slow progression through a doctoral program (maher et al., 2004). for some students, creating and maintaining this high level of productivity during pregnancy may be unappealing or infeasible. these students are forced to decide whether to push back against accepted cultural ideals or leave academia (fox, 2020; sallee et al., 2016). the importance of a good support system was emphasized by many participants, and they advised students to spend their pregnancy building a support network that serves a variety of purposes, including providing childcare, emotional support, and advice for navigating a doctoral program as a mother. access to a supportive mentor who was a mother was highly recommended, supporting previous findings of the importance of the mentoring relationship to doctoral student success (holm et al., 2015; hopwood & paulson, 2012); kent et al., 2020; mansfield et al., 2010). previous research has emphasized that a mentor can ameliorate or accentuate the challenges a student faces while pregnant (wladkowski & mirick, 2019; wilkins-yel et al., 2022). additionally, some offered support and encouragement to pregnant students, telling them they can navigate both roles successfully, and to be proud of their pregnancy. these messages suggest a sense of solidarity and support amongst students who have experienced pregnancy as doctoral students. this advice was uniformly cisnormative, with the implicit assumption that pregnant students identify as women and mothers. while this might be a result of a primarily cisgender sample, it highlights the need for research on the experiences of gender-diverse pregnant students and increased awareness that students experiencing pregnancy are not all women. of concern were descriptions of an unwelcoming climate for pregnant women in academia, reinforcing earlier research findings that academia can be a difficult place for academic mothers, who can face caregiver bias, microaggressions, and a lack of access to the professional development opportunities necessary to be competitive on the academic job market (armenti, 2004; drago et al., 2006; windsor & crawford, 2020) and suggesting that these challenges may begin during pregnancy. participants anticipated bias and negativity about pregnancy. they offered strategies to avoid being affected by caregiving biases, such as avoiding talking about their pregnancy or carefully choosing mentors, pis, and advisors (drago et al., 2006; holm et al., 2015). this negative climate may partially explain the need for a strong support network (byers et al., 2014) and the belief for some that combining the dual roles is not feasible (abetz, 2019). mirick & wladkowsi/pregnant doc students 169 limitations limitations to the study design include an inability to determine a response rate, making it difficult to assess the possible impact of a response bias. it is possible that individuals who had a negative experience were more likely to complete the survey. the research question relies on participants’ personal perspectives on success, which are likely not uniform across responses. as these responses reflect only individual students’ perspectives, there is no evidence these strategies would effectively improve persistence of doctoral student mothers or increase their chances of academic success. additionally, the questions ask participants about their prior experiences with pregnancy. due to the timing of these surveys, these pregnancies occurred prior to the covid-19 pandemic. it is unknown how the pandemic may have shifted and changed these experiences. there are some limitations to the sample. first, the initial recruitment email asked for participants who were women who had experienced a pregnancy during their doctoral education. this choice of language may have inadvertently restricted the responses to cisgender women. because gender was not asked as a demographic question, the presence of gender-diverse participants in the sample is unknown. further, the sample has limited racial and ethnic diversity, with 71% identifying as white. while it is important to develop a better understanding of intersectionality in doctoral education, including the ways in which race, ethnicity, and gender intersect, the limited racial/ethnic diversity in the sample means these findings may more accurately represent white cisgender women’s experiences. the emphasis in participants’ advice about finding support from other academic mothers emphasizes the cisnormative bias in these findings. future research should address this gap, so women of color and gender-diverse individuals are better represented in the doctoral student literature and we develop an understanding of the ways that social identity intersects with pregnant students’ experiences (wilkins-yel et al., 2022). even with these limitations, these findings provide information on the little studied area of pregnancy in doctoral education. implications findings of this study emphasize that in many doctoral programs, the responsibility for achieving success while simultaneously managing the physical challenges and stigma associated with pregnancy belongs to the pregnant student, not faculty, administrators, or the university. instead of the program being responsible to provide reasonable accommodations for a pregnant student, as title ix requires, these findings emphasize the student’s responsibility to manage through careful planning and hard work. a requirement for a high level of work, confidence, motivation, and energy creates inequities in terms of who can be successful. students who cannot do the expected level of work, due to perinatal depression, lack of social support, financial instability, pregnancy symptoms, or medical complications of pregnancy, are at a disadvantage. these factors are independent of the ability to be an academic. the persistence of these inequities within doctoral education, across fields of study, is a social justice issue and a concern for all educators. social justice issues at all levels of education are social work issues, and concerningly, there is no evidence social work doctoral programs are immune to these issues. advances in social work, spring 2024, 24(1) 170 to address these systemic issues, doctoral program leaders and administrators could consider ways to take a more active, intentional role in supporting pregnant students. by taking on some of the tasks participants identified as essential tasks for pregnancy (e.g., research policies, advocate, create support system, communicate needs), program administrators could lessen the emotional load carried by pregnant students, allowing them to focus their time on their doctoral work, their pregnancy, and their family. for example, the doctoral program coordinator could meet with external departments in the university (e.g., human resources, financial aid, title ix) to research policies and accommodations, so they have accurate information to provide to any pregnant student, include in the student handbook, and share at student orientation. previous research reflects this study’s findings, that many administrators and faculty are unaware of accommodations for pregnant students (springer et al., 2009). creating a culture where students do not have to advocate or “fight” to get access to these accommodations could save many students anxiety, energy, and time, as well as allow these accommodations to be equitably available to all students. program coordinators could take up these responsibilities in other domains as well, such as mentorship, communication, and a support system. it is more difficult to imagine how to challenge the ideal worker norm that does not allow for a break in productivity, even for a major life event such as pregnancy (sallee et al., 2016). these norms and expectations are persistent, implicit, and often invisible to those in the academic system, and therefore are not questioned, or interrogated. shifting expectations away from unrelenting productivity would likely benefit all students but this is a challenging undertaking. students can experience many types of life events that require a pause in productivity, such as physical illness or death of a family member. supporting students’ ability to balance personal and academic needs supports all students. in the current system, some students, like the 5% reported in this study, decide remaining in academic is not worth the effort and sacrifice or believe it is impossible, leading to fewer graduates entering academia (abetz, 2019; wilkins-yel et al., 2022). there is evidence that women of color are particularly vulnerable to feeling not welcomed by academic culture and more likely to leave academia, especially in the face of a major life event (ong et al., 2017; sowell et al., 2015; wilkins-yel et al., 2022). when these students leave academia, then important diversity of thoughts, experiences, and beliefs are lost. social work educators must consider their role within this system and think through how to take action to address existing social justice issues about success. conclusion although academic institutions have increased the number of women enrolled in doctoral programs (nsf, 2021), being pregnant as a doctoral student requires a substantial amount of energy, planning, and determination to create the supportive system necessary for success. based on these findings, it is unsurprising that having a child can shift a student’s career trajectory, often moving them away from academia and prestigious tenure track positions at research-intensive universities, and towards jobs outside of academia and teaching intensive jobs at non-research-intensive universities, four-year colleges, and community colleges (kulp, 2016; mason et al., 2013). it is time for higher education to recognize, name, and 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(2020). supports and recommendations for pregnant and newly parenting doctoral students in health professions. journal of social work education, 56(2), 312-326. author note: address correspondence to rebecca mirick, school of social work, salem state university, salem, ma, 01970. email: rmirick@salemstate.edu https://doi.org/10.1080/26379112.2019.1654394 https://doi.org/10.1080/26379112.2019.1654394 https://doi.org/10.1080/10437797.2019.1656580 https://doi.org/10.1080/10437797.2019.1656580 mailto:rmirick@salemstate.edu ________ taniko king-jordan, dsw, lmsw, director, community engagement, fremont, ca. laurene clossey, phd, lcsw, professor, michelle d. dilauro, phd, lcsw, professor, and hanif m. bey, dsw, lsw, assistant professor, east stroudsburg university, east stroudsburg, pa. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 475-494, doi: 10.18060/28520 this work is licensed under a creative commons attribution 4.0 international license. licensing inequities in social work: financial barriers, test bias, and implications for professional education taniko king-jordan laurene clossey michelle d. dilauro hanif m. bey abstract: the social work profession stands at a critical juncture where financial and regulatory mechanisms intersect with its core values of equity, justice, and empowerment. this think piece examines these intersections through the lens of critical race theory (crt), focusing on the tenets of intersectionality and interest convergence. it explores the inequities in licensure pass rates, shedding light on the compounded barriers faced by marginalized groups, where race, class, gender, and other social identities intersect to exacerbate disparities. specifically, it analyzes how factors such as exam construction, educational preparation, and financial barriers disproportionately affect these groups, contributing to their lower pass rates. the historical context of how learning is acquired in social work is framed within an understanding of systemic oppression, emphasizing the tension between transactional operations and the profession’s commitment to transformative impact. the tenet of interest convergence highlights how changes in licensure processes may only occur when the interests of marginalized groups align with those of dominant groups, underscoring the need for structural reform that addresses systemic inequities and professional advancement opportunities. the discussion proposes strategies to mitigate these inequities, ensuring that licensure processes are accessible, just, and equitable for all social workers, particularly those from historically underrepresented communities. keywords: licensure system reform, transformational educational practices, alternative testing options, educational inequities the social work profession is at a pivotal juncture where financial and regulatory mechanisms intersect with core values like equity, justice, and empowerment. it is essential to ensure these mechanisms support the profession while driving transformative change. this paper examines the disparities in licensure pass rates, exploring exam construction, education, and financial barriers. it also reviews the historical context of educational inequities and the tension between transactional operations and the profession's commitment to fostering enduring impact (jones & truell, 2012). the conclusions address the implications for the profession and suggest strategies to improve access for demographic groups with lower first-time pass rates. to address licensure issues, we must first examine inequities in social work education. acknowledging the intersectionality of race, gender, ethnicity, social class, ability status, sexual orientation, and other societal factors that shape lived experiences is necessary for understanding how the licensure process presents inequities for black, indigenous, and about:blank advances in social work, summer 2025, 25(2) 476 people of color (bipoc). inequity begins with the education process and then moves into test construction, cultural fairness, and the transactional costs of licensure. this paper will address these areas. critical race theory (crt) aids in framing this conceptual work. this perspective recognizes that racial identity cannot be separated from the broader systems of oppression that impact bipoc individuals and communities. crt is a pedagogy and practice model designed to empower students and practitioners. it prepares them to confront the psychological, social, spiritual, and economic challenges disproportionately experienced by bipoc individuals while also addressing the broader systemic inequities affecting marginalized populations. through this lens, social workers are not just service providers but agents of transformative change, fostering solutions that uplift and sustain bipoc communities for generations to come. this frame encompasses and anchors the areas of inequity that this paper examines: educational inequities, cultural fairness in exam test item construction, and the transactional costs of licensure. theoretical framework to interpret the long-awaited pass-rate analysis conducted by the association of social work boards (aswb, 2022a, 2022b), which revealed significant disparities among bipoc, we employed a crt framework. this approach allowed us to explore how race and other forms of social inequality, such as class and age, intersect and exacerbate one another. crt, initially developed in the 1970s by prominent legal scholars, seeks to illuminate the ways in which racism is an intrinsic and foundational aspect of us society (bell, 1992; crenshaw et al., 1995; delgado & stefancic, 2008). it provides a lens for examining power structures—both individual and systemic—that sustain racial inequities. key tenets of crt include the notion of race as a social construct, the persistence of endemic racism, interest convergence, differential racialization, intersectionality, and counter-hegemonic narratives (crenshaw et al., 1995; delgado & stefancic, 2008). for the purposes of this think-piece, we specifically focus on the concepts of intersectionality and interest convergence. these frameworks are particularly relevant given that the only intersectional analysis conducted in the aswb study—race and age—demonstrated that test-takers who identified as “white”, regardless of age, were significantly more likely to pass the exam on their first attempt (aswb, 2022a, 2022b). intersectionality is often seen as a key tool within crt, providing a more nuanced understanding of the experiences of marginalized groups. intersectionality allows crt to move beyond a focus on race alone and to examine how other social categories like age and class intersect to shape experiences of inequality. interest convergence, another key tenet of crt, argues that racial progress for marginalized groups occurs only when it aligns with the interests of the dominant group, typically white individuals. this concept suggests that gains in racial equality are often temporary or superficial unless they also serve the broader interests of those in power. in this case, the continued requirement and maintenance of biased licensing exams serve the economic interests of those in positions of power. king-jordan et al./swk licensing exam inequity 477 crt frames the areas that contribute to lower pass rates by bipoc individuals, which this paper examines. the educational system is the first important area to consider. this system has been wrought with systemic inequities impacting bipoc students, which affects their success in passing licensing exams. this theoretical perspective reveals how systemic racism and white normativity are embedded within educational institutions, laying the groundwork for persistent inequities that extend into professional licensure. the next section will examine the institutional biases implicit in the educational system. the history of advancing social work professionalism through regulation social workers are integral to advancing social justice at multiple levels-individuals, families, groups, organizations, and communities (national association of social work [nasw], n.d.). in the us, most states regulate the title "social worker" through licensing, ensuring safe, ethical, and competent practice (house bill 1693, pa congress 2007-2008). licensure, a critical gateway into the profession, requires passing standardized exams that assess competencies. in the united states, social work title protection is not governed by a national standard, as each state has its own regulations regarding using the title "social worker." presently, at least 36 states have license protection (nasw, n.d.). for instance, pennsylvania recently granted title protection (nasw-pennsylvania chapter, n.d.). while macro-level activities such as advocacy may not require licensure, direct practice with clients does. however, financial and bureaucratic barriers limit access to licensure, especially for emerging professionals. concerns about inequities in licensing exams necessitate examining potential disadvantages based on socioeconomic status, race, and ethnicity (aswb, n.d.; kim & joo, 2024). integrating a crt framework requires us to question the ideological neutrality of licensure exams and to expose how they perpetuate disadvantage along intersectional lines of race, class, and language. the regulatory framework for social work emerged with the establishment of the aswb in 1979, which was created to implement and standardize licensure practices across jurisdictions (kim, 2022). however, a disconnect between social work education and licensure persists, with some schools of social work not adequately preparing students for the exams (apgar, 2022). in 2022, aswb published licensure pass rates by demographic group, revealing significant disparities. for example, black candidates' clinical exam pass rate is 57%, compared to 90.7% for white candidates (mina, 2022). the social work profession is not alone in reliance on licensure exams. comparably, gaps in pass rates for bipoc individuals are not unique to social work. these gaps for bipoc individuals also manifest in professional license/certification rates in other professions. in 2023, a study by harris and eberman concluded that there is an achievement gap between white candidates and other ethnic groups in passing the athletic training certification exam. kim and joo (2024) compiled data in an aswb report and provided pass rates for other professions' license attainment. in medicine, a 2019 study that kim and joo cite reports that black license exam takers scored lower than caucasians license exam taker by 16.52% and hispanics scored lower than whites by 12.1% on the us medical advances in social work, summer 2025, 25(2) 478 licensing exam. kim and joo report that the american bar association (aba) license pass rates for first time test-takers reported in 2023 have a pass rate of 83% for whites, 57 % pass rate for blacks, and 69 % pass rates for hispanics. historically marginalized groups show disparities in professional exam pass rates when the professions report these. these disparities are a significant concern in social work, a profession concerned with social justice. as a profession, we must wonder why this is happening. the trends identified here represent what crt identifies as “interest convergence” which means these setbacks for bipoc individuals are advancing the interests of white hegemony (bell, 1980). this analysis will examine disparities in exam licensure pass rates, exploring exam construction resulting in test bias, the educational process of social work higher education, and financial barriers to licensure. examining these aspects of cultural fairness and resource accessibility aims to uncover systemic barriers that impede equitable licensure access (council on social work education [cswe], 2022). k – 12 historical educational inequities bipoc students enter higher education burdened by historical inequities. crt emphasizes that disparities in k-12 education that include inequitable funding, de facto racial segregation and access to quality academics are the result of historically and structurally racist policies (king-jordan & gil, 2021). these are brought into focus by the crt frame which helps develop an awareness of intersectionality where it is clear these issues rooted in race, are compounded by poverty and other “ism’s.” in higher education, bipoc students face limited financial aid, a lack of mentorship, and an underrepresentation of diverse faculty (gregory, 2021). moreover, the curriculum often fails to address the needs of bipoc students, reinforcing their marginalization in the profession. current systemic issues compound these challenges, particularly in licensure pass rates. kim and joo (2024) highlight disparities across racial and ethnic groups, citing test bias and cultural insensitivity. standardized exams emphasize a narrow set of knowledge and testing formats that may disadvantage individuals from marginalized communities, including first-generation college students, non-native english speakers, and social workers educated at historically black colleges and universities (hbcus) or other minority-serving institutions (msis). the higher education curriculum lacks the cultural competence necessary to reflect the realities of the communities that social workers serve (hirsch, 2024). as such, standardized testing methods risk becoming barriers rather than gateways to the profession, reinforcing systemic inequities and limiting the representation of underrepresented groups in licensed practice. in a field committed to anti-oppressive frameworks, cultural competence, and serving diverse populations, it is critical that licensure pathways reflect the very values social work aims to uphold. castex et al. (2019) highlight how microaggressions and racial privilege are embedded within the social work licensing process, creating additional barriers for bipoc candidates. they illustrate this by giving an example of a licensing exam test item that uses a case example. the case involves a social worker visiting a 45-year-old grieving latino client. king-jordan et al./swk licensing exam inequity 479 in the scenario, the client's home contains culturally significant items like candles, a photo of the deceased, and an altar, which are reflective of traditional mourning practices within some latino communities. while these elements aim to demonstrate cultural awareness, castex et al. (2019) argue that their inclusion can unintentionally reinforce ethnic stereotypes. when presented without depth or context, such portrayals risk being experienced as microaggressions, reducing rich cultural expressions to generalized assumptions. understanding the importance and complexities of cultural competence, along with the challenges faced by educators and licensing bodies, emphasizes the urgency of moving beyond tokenistic representations toward authentic and respectful engagement with cultural practices. considering these concerns, a critical first area of consideration is whether social work education adequately prepares students for licensure. social work students should be prepared by their education for the test. apgar (2019) observed that once cswe moved in 2008 to focus on student outcomes, curricula readying students for the licensure exam were less likely. ultimately, the profession must assess competencies and outcomes, but knowledge, such as that needed for the exam, is important to impart (miller et al., 2022). the historic educational inequities faced by bipoc students, amplify the importance of adding preparation for the exam in schools of social work there is a trend in today's higher education to operate the university like a business. clossey et al. (2024) argue that prioritizing market-driven objectives over educational values can compromise the ethical foundations of social work education. this model often perpetuates biases in curriculum design and evaluation, further disadvantaging marginalized groups. to counter this, institutions must ensure that their practices align with the profession's commitment to diversity, equity, and inclusion (dei) rather than being driven solely by financial incentives. the research conducted by clossey et al. (2024) surveyed faculty in accredited social work programs in the northeast to ascertain faculty perceptions of student preparedness, market-driven pressures, and whether they felt students were leaving their programs prepared to practice effectively. one of the questions was open-ended, asking the faculty whether there was anything about social work education not asked that they would like to share. many faculty shared serious concerns about what it meant to offer an educational challenge. there were concerns about cultural sensitivity, bias, and fairness. one respondent to this item asked when educators emphasize "writing well," what do they mean? is that "white english?" to the credit of many educators, concern with equity in social work education is on the minds of faculty. it was clear that almost all the open-ended questions addressed this issue. faculty, as noted in this study, feel the market pressures but struggle to maintain social work values, including sensitivity to diversity. social work education sits at the nexus of licensure's financial and regulatory mechanisms. educators are tasked with preparing students for the profession's practical realities while instilling a commitment to social justice. the current trend toward businessoriented models of higher education, which prioritize efficiency and marketability, raises concerns about the potential erosion of the profession's ethical foundations (clossey et al., advances in social work, summer 2025, 25(2) 480 2024). social work education needs to be transformative; it needs to develop practitioners who will create a better world. another significant barrier is the exam's probable ethnic/racial bias. lower percentages of bipoc test takers are passing compared to whites, and those numbers are concerning. these groups are already represented less in the overall population, and when their license passing rates are low, their representation in the profession is significantly compromised. this is detrimental to social work clients and the professionals who worked hard to attain their degrees. the next section will consider test bias as another inequity contributing to lower pass rates for bipoc test takers. licensure exam questions and cultural fairness crt focuses attention on questioning whether items on the licensure exam are biased and if so, how that bias perpetuates disadvantage (aswb, n.d.; kim & joo, 2024). inadequate preparation and inequitable exam content are barriers to licensure for bipoc individuals. while aswb strives to eliminate bias by recruiting diverse test question writers and conducting readability analyses, concerns remain (castex et al., 2019). the piloting of test items has been criticized for insufficient scrutiny of demographic differences (castex et al., 2019). additionally, microaggressions within test items reflect subtle racial and cultural bias, further disadvantaging bipoc candidates. these microaggressions reinforce deficit narratives about bipoc candidates and reflect what crt scholars describe as the normalcy of racism in institutional practices (delgado & stefancic, 2017). by framing questions through dominant white, middle-class lenses, the licensure exam marginalizes knowledge grounded in non-dominant cultural realities and thus perpetuates systemic exclusion. torres et al. (2024) conducted a survey of 1,045 individuals who had taken the aswb licensing exam and found that white respondents in the sample had the highest first attempt passing rates. the hispanic and african american respondents were asked how they felt their race and ethnicity affected their experience of the exam. respondents who felt prepared noted they believed that sense was due to their privilege as educated, financially comfortable, white individuals. some of the critiques reported in the study included the exam seeming disconnected from the reality of bipoc individuals and confusing to someone for whom english was a second language. licensing exams often reflect dominant white western norms, leading to the underrepresentation of diverse perspectives in the content (hirsch, et al. 2023). this bias disproportionately affects marginalized candidates, reinforcing inequities in the profession. brown and patel (2024) stress the need for cultural humility in exam design to ensure that questions are relevant to diverse populations and contexts. test bias arises when an exam systematically disadvantages specific groups, and this is a significant concern in social work licensing, particularly regarding cultural fairness. test bias is not seen as incidental in crt; indeed, it is a way of enforcing racial gatekeeping. for instance, microaggressions in licensure exams manifest subtly through language, cultural assumptions, and normative frameworks that favor dominant groups (sue et al., 2007). for example, multiple-choice questions may contain culturally biased king-jordan et al./swk licensing exam inequity 481 scenarios or terminology unfamiliar to candidates from diverse backgrounds, signaling implicit messages about “correct” ways of thinking or behaving. these microaggressions can erode candidates’ confidence, increase test anxiety, and negatively impact performance. licensing exams, such as those administered by the aswb, have been criticized for their reliance on standardized questions that may not adequately reflect cultural differences in knowledge, values, and practices (blaine & mcclure brenchley, 2020). the standardized format of licensing exams further exacerbates test bias. as hirsch et al. (2023) reveal, standardized tests often reflect the dominant culture's knowledge and thought processes, which may not align with the lived experiences of marginalized groups. for instance, questions that assume familiarity with specific cultural references or socioeconomic contexts can inadvertently disadvantage candidates from different backgrounds, reinforcing existing inequities in the profession (miller et al., 2022). transactional costs financial barriers to licensure are significant, with application fees, background checks, license verification, and exam fees creating obstacles for many applicants (knepper et al., 2022). costs begin with application fees, criminal background checks, and license verification fees, especially when seeking reciprocity. applicants must also pay for the aswb to send previous exam scores to other states and for jurisprudence exams required to understand state-specific laws (aswb, 2025). for each attempt, the aswb charges $230 for licensure exams, further compounding the financial burden, whether for the licensed bachelor social worker (lbsw), licensed master social worker (lmsw), or licensed clinical social worker (lcsw). this fee must be paid for each attempt, with a required three-month waiting period between attempts, which can result in quickly accumulating costs if multiple attempts are needed (aswb, 2025). beyond initial licensure, ongoing costs include fees for continuing education units (ceus) and other professional development necessary to maintain a license (cswe, 2022). the costs of licensure add to the significant financial burden of student debt. graduates with a master of social work (msw) degree typically incur more than $30,000 in student debt, while those with a bachelor’s degree accumulate an average of $29,000. as a result, many new social workers enter the profession owing more than $60,000 in student loans, while earning an average starting salary of $41,000 (national association of social workers [nasw], 2022). these fees can have a disproportionate impact on historically marginalized groups. despite advocacy efforts by the nasw for student loan debt relief and public service loan forgiveness, the financial burden of student loans may influence career decisions and affect long-term financial stability for social workers (hanson, 2025). these transactional costs exist within a broader context of educational debt that disproportionately affects students from historically marginalized communities. these costs can discourage prospective social workers, particularly those from marginalized backgrounds. we must raise critical questions about the license test fees: where do these funds go, and how do they support active practitioners? what are the implications of these costs for the profession of social work? these questions are essential, as the financial burden of licensure can affect the accessibility and diversity of the field (aswb, n.d.; kim advances in social work, summer 2025, 25(2) 482 & joo, 2024). understanding the allocation of these funds is vital to ensuring they are used to enhance the profession and support ongoing development. this reflection is crucial to aligning the licensure process with social work's commitment to social justice, equity, and the well-being of practitioners and their communities (jones & truell, 2012). licensing and public protection in social work the effectiveness of social work licensing in protecting the public remains contested. critical race theory (crt) encourages questioning the premise of “public protection” by acknowledging whose interests are being safeguarded, and against whom? research indicates limited empirical evidence that the benefits of licensure outweigh its significant costs (kincaid et al., 2024; magiste, 2020). some studies suggest that licensing may not substantially improve public safety but instead serve private interests (merritt et al., 2023; sobel & dove, 2016). while licensed social workers are held accountable, the aswb itself faces limited oversight. from a crt perspective, the rhetoric of “public protection” often obscures how licensure upholds racialized control of professional access and perpetuates the marginalization of bipoc candidates through exclusionary practices. at its most problematic, licensure can function as a structural barrier, reinforcing existing power dynamics and restricting who is allowed to enter and shape the profession. aswb accountability since 1979, the aswb has administered competency exams for social workers seeking licensure (propublica, 2025). while the organization provides services and resources to the profession, concerns have emerged about biases in its exams and the allocation of its $41 million in net assets according to aswb’s form 990, the organization is governed by 10 voting members, supported by 52 staff, and assisted by 128 volunteers. aswb’s report on disparities in licensure pass rates highlights systemic inequities that disproportionately impact bipoc candidates (propublica, 2025). structural barriers, including historical racism in education, socioeconomic disparities, and unequal access to test preparation resources contribute to lower pass rates among marginalized groups. from a critical race theory (crt) perspective, these disparities cannot be reduced to individual effort or preparation. instead, they reflect broader patterns of racial capitalism, where professional gatekeeping mechanisms restrict upward mobility for historically marginalized populations (propublica, 2025). from a transformative justice lens, this report emphasizes the need to move beyond mere data analysis to actively dismantle exclusionary policies in licensing. equity in social work requires alternative assessment models that recognize diverse learning experiences, de-emphasize standardized testing, and prioritize practice-based competency over rigid exam performance could be a thoughtful solution. without substantive reform, licensure remains a tool of gatekeeping rather than a pathway to ensuring a diverse, competent workforce that reflects and serves historically marginalized communities. applying a crt king-jordan et al./swk licensing exam inequity 483 lens reveals how social work licensure reforms often reflect the interests of dominant groups, exemplifying interest convergence (bell, 1980). provisional licensing pathways, while seemingly equitable, may only advance when aligned with professional or institutional goals, such as addressing workforce shortages. this reflects the need to center marginalized voices genuinely and disrupt entrenched power structures that sustain inequities in access and recognition within the profession. the aswb has recently integrated an option entitled fifth theory test mastery, designed to support test-takers through mindset development, coaching guidelines, and guided journaling in preparation for the social work licensure exam. while this initiative acknowledges the psychological and emotional toll of standardized testing, it does not fully address the structural inequities embedded within the licensure process. the history of social work is fraught with complacency in perpetuating harm, particularly in relation to who gets to demonstrate professional mastery and how knowledge is assessed. the existing system has long served as a gatekeeping mechanism that, rather than ensuring competency, has disproportionately disenfranchised bipoc social workers and those from marginalized backgrounds. financial transparency further complicates questions of accountability. as shown in table 1, aswb reported revenues of $22.6 million and expenses of $21.1 million in 2023, with total assets of $47.2 million (propublica, 2025). executive compensation, exceeding $300,000 for top administrators, raises questions about how organizational resources are prioritized considering inequities in exam outcomes. referencing these financial patterns emphasizes the need for deeper scrutiny into whether aswb’s allocation of resources aligns with its stated mission of protecting the public and supporting the profession. table 1. aswb revenue and expenses aswb 2023 budget revenue $22.6m expenses $21.1m compensation chief operating office $311,176 sr. director of member services $202,640 sr dir of finance & operations $202,268 total assets $47.2m total liabilities $5.73m adapted from propublica (2025) alternative licensing pathways the documented gap in licensure test pass rates of bipoc individuals necessitates alternative assessment methods that more accurately reflect the diverse realities of all advances in social work, summer 2025, 25(2) 484 candidates. considering alternative pathways could propose potential solutions to this performance gap (miller et al., 2022; zajicek-farber, 2024). competency-based assessments and portfolio evaluations, for example, offer more inclusive approaches that align with the diverse experiences and skills of bipoc students. in addition, we must also interrogate whether licensing is effective in providing public protection and consider how to reallocate the steep fees the aswb collects. reforms in social work licensure are essential to balancing public protection with workforce development. for example, in minnesota, a provisional licensed graduate social worker (lgsw) is a temporary master's-level license for individuals without a current social work license (minnesota board of social work [mn board], 2024). to qualify for this provisional license in minnesota, applicants must have a master's degree in social work from an accredited program, complete a criminal background check, and adhere to ethical standards. the licensee must complete 2000 hours of supervised practice and 37.5 hours of supervision within three years. a provisional license is valid for three years, and upon completion of requirements, individuals may apply for a standard license. fees and additional requirements vary based on the specific application (mn board, 2024). in michigan, the nasw-michigan (mi) is working to modernize michigan’s social work licensure process to eliminate barriers and increase the number of licensed social workers. proposed changes include simplifying licensure tiers: licensed bachelor social worker (lbsw), licensed master social worker (lmsw), and licensed clinical social worker (lcsw; nasw-michigan chapter [nasw-mi], 2024). these updates aim to address workforce shortages, eliminate obstacles like the six-year license renewal cap and exam bias, and strengthen supervision standards. michigan already requires extensive supervised post-graduate hours, which ensure competency better than standardized exams. nasw-michigan seeks input through legislative committees and listening sessions (nasw-mi, 2024). in illinois, house bill 2365, senate amendment 1 (hb2365 sa1) seeks to provide an alternative to the biased aswb clinical exam for licensed clinical social worker (lcsw) licensure (nasw-il staff, 2023). initiated by advocates addressing the exam's inequities, hb2365 sa1 allows applicants who fail the exam to opt for an additional 3,000 hours of supervised work experience instead of retaking the exam. the bill retains the current licensure requirements, including a master's degree, 3,000 hours of clinical supervision, and the aswb exam, while offering an alternative path for those impacted by the exam's barriers (nasw-il-staff, 2023). this legislation aims to diversify the profession, reduce inequities, and create a more inclusive licensure process. national reform efforts for the aswb exam continue, and the bill will be reviewed in four years. while change is challenging, upholding the profession's values and ensuring equitable access to licensure is necessary. in new york state, the licensing fees nurses pay for their exams are used to support peer assistance programs. social work could do something similar. licensure reforms must also address the disparities faced by bipoc in higher education. challenges like biased testing, inadequate preparation, and systemic inequities disproportionately affect bipoc students. social work educators must confront these issues and ensure that licensing exams king-jordan et al./swk licensing exam inequity 485 do not perpetuate existing disparities (victor et al., 2023). artificial intelligence may provide a means to assist with test item construction and evaluation. ai and social work licensing generative ai is a type of artificial intelligence that can create new and original content across various domains such as text, audio, video, and images, among other types of data, using machine learning techniques such as "deep learning" (singer et al., 2023; victor et al., 2023). it produces data and mimics patterns similar to or inspired by the input it was trained on. large language models (llms), such as the widely used chatbot chatgpt (chat generative pre-trained transformer) developed by openai, is a specific type of generative ai that uses natural language processing (nlp) techniques leveraging sophisticated algorithms to understand, interpret, and generate human language (asakura et al., 2020; dron, 2023; singer et al., 2023). llms are designed to work on text-based tasks and have extensive training data such as books, articles, and webpages that are used for translating language, chatbots and other conversational ai applications, content creation, answering questions, evaluating responses, among other tasks (victor et al., 2023). these models continue to evolve as research on these technologies’ advances. recent advances in artificial intelligence (ai) have prompted discussions on its potential use in social work licensure. generative ai, such as chatgpt, has been studied for its ability to understand social work concepts and pass licensing exams. some studies have shown comparable or even superior reasoning compared to traditional methods (victor et al., 2023). ai tools offer the potential for more inclusive, equitable exams, reducing biases related to race, language, and age. researchers suggest exploring new formats, such as short written responses, which could provide a more holistic assessment of social work competencies (victor et al., 2023). other research has identified covert racism in large language models (llms). hoffman et al. (2024) states, "the lack of awareness of covert racism also manifests during evaluation, where it is common to test language models for overt racism but not for covert racism" (p. 152). similarly, ai models trained on biased data risk perpetuating covert racism by reinforcing these subtle inequities within exam construction and scoring algorithms (hoffman et al., 2024). without intentional anti-oppressive practices, such tools risk invisibly reproducing systemic disparities, emphasizing the need for critical equity frameworks and community accountability in ai integration. the authors caution that measures need to be put in place to restrict covert racial prejudice when training, testing, and evaluating the models. crt reminds us that these risks reflect deeper structural concerns: if ai is used to replace the flawed systems of human evaluation, it will only entrench existing disparities in new, less visible forms. therefore, the integration of ai into licensure assessments must be accompanied by explicit equity frameworks, anti-racist quality assurance protocols, and ongoing community oversight. ai should be seen not as a substitute for human judgment, rather as a tool for illuminating and correcting the structural flows in assessing readiness for professional practice. advances in social work, summer 2025, 25(2) 486 global perspectives on ai in licensing victor and colleagues (2023) assessed the performance of chatgpt on 50 practice questions for each level of the aswb social work exams, with 70% being an approximated pass rate. chatgpt scored 76% on the bachelors, 80% on masters, and 64% on the clinical exam. the researchers concluded that there was "strong evidence that chatgpt can recognize social work-related text patterns, consider contextual information, and generate decision-making rationales while accounting for safety and ethics in social work practice" (p. 513). the researchers also compared differences between chatgpt's answers and the aswb answer key and found that "chatgpt performed better than or equal to aswb on several discrepant items" (p. 513), bringing into question the validity of the exam. interestingly, they found several answers that were marked incorrect. however, chatgpt provided a "compelling" or even "better rationale" to the question than aswb, suggesting a higher-performance rating of chatgpt than what was scored on the test. they also found that some questions lack "enough contextual information" to be able to make an "informed decision." in contrast, other questions did not have "sufficient empirical support to inform practice" (p. 514). these findings bring into question whether social workers taking the exam are also underestimated for their performance on the exam. these researchers highlight the limitations of a multiple-choice exam where questions can be ambiguous and restrict responses to one course of action. suggestions are made to move to a new format that includes short written responses where exam takers must employ a decision-making process based on scenario-based questions (victor et al., 2023). generative ai tools show promise in not only creating exams from its vast collection of text data related to social work practice but also having the ability to grade the exam fairly and ethically. the question of continuing with the traditional form of the social work licensing exams is more than just an issue that the united states is grappling with. another study in slovakia examined how chatgpt would fare on their undergraduate state final social work exam (markovič, 2024). this exam includes an oral examination consisting of a defense of the bachelor's thesis and answering three questions on topics related to social work theory, methods, and practice. chatgpt's responses were in written form (unlike the students) and were scored by the same committee members who scored the real-state thesis. the committee concluded that the chatbot earned the second-highest grade of b and "passed the final exam successfully and earned a grade that surpassed most students who graduated with a bachelor's degree in social work in 2023" (markovič, 2024, p. 6). they noted that chatgpt received a lower grade due to answering in "general terms," failure to "link knowledge between social work disciplines," and lack of "knowledge of slovak social work practice." these researchers propose delivering an exam that can show social work competencies that language models do not master; however, they question if such a format exists. llms continue to evolve and be utilized in education, research, and clinical settings in the helping professions. other disciplines, such as medicine and law, have noted the potential of generative ai, which has succeeded in passing their required exams as an interactive tool to support learning, education, and delivery of services. (gilson et al., 2023; king-jordan et al./swk licensing exam inequity 487 katz et al., 2024). dron (2023) writes that generative ais are "contributing to and reflecting the collective intelligence of our species." authors agree that generative ai tools can assist social workers but must overcome several limitations to replace them (brown & halpern, 2021; markovič, 2024; victor et al., 2023). however, the social work profession must ponder some questions: can we use the strengths of this technology to better assess the competencies of the diverse array of practitioners in the field of social work? will generative ai provide us with a way to better honor each person's unique "professional use of self" in practicing clinically sound and ethical social work? will this new technology help us support the authenticity and genuineness of future social work practitioners while maintaining the profession's values? with the growing efficiency and proficiency of generative ai tools, the profession must seriously consider the application of such technology in assessing social work competency for practice while at the same time ensuring that llms are not contributing to the prejudice of race, language, or age, which has prevailed in the social work licensure exams. implications for social work social work education and licensing face challenges related to access and equity. current testing mechanisms disproportionately disadvantage certain groups, while higher education's business-oriented model may prioritize profit over student readiness (clossey et al., 2024). social work education must evolve to be transformative, fostering critical thinking and social justice rather than merely transactional. the profession is at a crossroads around entry to more lucrative careers that rely upon possessing a license. certain groups disadvantaged by these exams are being excluded from the careers where they are desperately needed. many authors have considered the disparity between the license exam and the educational environment. this paper has reviewed the literature regarding bias in the test items, transactional costs that overburden test takers financially with a disproportionate impact on historically disadvantaged groups, and barriers within education itself. the implications include a need to scrutinize social work education and contemplate alternatives to the current licensing exam. provisional licensure allows social workers to practice without passing a standardized exam, offering an alternative pathway for those unable to pass. historically, state boards have used this mechanism to enable new social workers to continue practicing while retaking the licensing exam. this approach, however, lacks systematic studies on its outcomes. notably, minnesota and illinois have developed provisional licensing pathways for clinical social workers who fail the exam. minnesota’s model addresses the need for hmong-speaking practitioners, while illinois provides additional supervised practice hours. although provisional licensure aims to promote fairness and access, the requirements for an initial exam and extra supervision may inadvertently perpetuate existing inequities, particularly for those from marginalized communities. from the perspective of crt’s tenet of interest convergence, these provisional licensure pathways reflect the intersection of professional needs with the interests of dominant groups. while provisions like minnesota’s focus on hmong-speaking practitioners indicate a recognition of the needs of underrepresented communities (mn advances in social work, summer 2025, 25(2) 488 board, 2024), they also demonstrate that such reforms occur only when they align with the broader professional or institutional goals—such as meeting a demand for a specific workforce or improving service delivery. similarly, illinois’ emphasis on additional supervision hours could be viewed as a response to the need for more qualified practitioners but may perpetuate a system that requires more scrutiny and labor from those who already face barriers to licensure (nasw-il-staff, 2023). the "two-year" rule for supervised hours, which was established over a century ago, reflects a historical system that lacks empirical support and may disproportionately burden candidates from marginalized communities. as states like new hampshire and oregon explore alternatives to supervision-based licensure, these potential reforms highlight how true equity in licensure can only occur when the interests of marginalized groups—such as social workers from diverse linguistic or racial backgrounds—are no longer seen as secondary. the reforms indicate a shift toward greater equity when systemic changes align with the broader professional interests of increasing accessibility and fairness in licensure processes. social work education gatekeeping and regulatory reform gatekeeping in social work education is vital to ensure students' readiness for practice. however, current approaches may inadvertently disadvantage marginalized students. fear of accusations of racism can lead to leniency, compromising academic standards and student preparedness (king-jordan & gil, 2021). regulatory frameworks could be reassessed to ensure they serve as gateways to equitable practice rather than barriers to entry. the aswb could contribute by redistributing revenues to support test takers and creating more inclusive pathways to licensure. therefore, to counter business-oriented trends in higher education that operationalize profit over teaching, social work education must emphasize transformative experiences over transactional operations. this involves fostering critical consciousness, promoting cultural humility, and encouraging students to engage with the complexities of systemic oppression and social change (blaine & mcclure brenchley, 2020; crenshaw, 1989). by prioritizing these values, social work education can cultivate professionals who are technically competent and deeply committed to driving authentic and sustainable change. we must also be free to gatekeep within our educational programs rather than pass everyone along due to market pressures to recruit and retain all paying individuals. we cannot send out committed professionals who have had their consciousness about social justice raised if we are pressured to graduate everyone for the university's financial gain. gatekeeping in social work education involves assessing students' readiness for effective practice. however, current practices can inadvertently disadvantage students from marginalized backgrounds. there is concern that faculty may fear accusations of racism when enforcing academic policies or failing students of color (king-jordan & gil, 2021). this fear can lead to leniency that undermines academic rigor and inadequately prepares students. while maintaining rigorous standards is essential for ensuring all graduates meet professional competencies, this must be balanced with supportive measures to help students overcome barriers. king-jordan et al./swk licensing exam inequity 489 social work education and licensing bodies must critically evaluate regulatory frameworks to drive transformative change. this involves addressing the content and format of licensing exams and considering the broader implications of these mechanisms on access and equity. dismantling the embedded privileges within these structures, as explored by king-jordan and gil (2021), is essential to ensuring that regulatory mechanisms do not serve as gatekeepers but as gateways to a more just and inclusive profession. the aswb can help by reconsidering how to redistribute the revenues generated from their fees in ways that can aid test takers. conclusion it is both intriguing and disheartening to observe the inconsistencies in licensure fees across the field, especially when considering the significant wage disparities for many social workers, even those with advanced degrees. these disparities are particularly pronounced for bipoc practitioners, who are often underpaid and undervalued within the profession. the integration of crt in this conceptual paper effectively illuminates systemic inequities, racialized gatekeeping, intersectionality, and interest convergence within institutional structures. crt offers the social work profession a critical framework to develop and sustain anti-oppressive practices by confronting how race and power intersect to shape access, privilege, and marginalization. it reinforces the importance of collective responsibility in addressing structural barriers—such as state-sanctioned violence against bipoc communities, inequitable access to education, healthcare, and economic opportunities—that continue to perpetuate disparity. given these challenges, crt challenges us to dismantle these oppressive systems and advocate for policies that promote equity and inclusion. furthermore, it questions the profession’s continued reliance on western cultural norms to define professional worth and success, urging a shift toward culturally grounded, community-informed measures of competence and value (blaine & mcclure brenchley, 2020). the reliance on western cultural norms to determine our worth as professionals profoundly impacts social work, a field grounded in principles of equity, inclusion, and justice. this paper has considered the regulation of the social work profession via licensure, the costs of testing, and bias within the test. the process of higher education for social work has also been addressed. part of the problem with the costs of social work licensure is the reality that the profession does not pay well. these norms often reinforce systemic inequalities, contributing to the devaluation of bipoc social workers and perpetuating the financial inequities they face. the issue extends beyond individual compensation; it reflects a broader structural problem in which bipoc professionals are marginalized despite their critical contributions to the field. for a profession committed to social justice, the persistent undervaluation of bipoc social workers is a troubling contradiction. the disparities in wages and recognition undermine the values of empowerment and equity that are central to social work practice. addressing these disparities requires a critical examination of how value is assigned within the profession, as well as an intentional effort to dismantle the systemic barriers that prevent bipoc social workers from receiving fair compensation and recognition for their work. this includes a reform of a licensure system that disadvantages bipoc test takers. advances in social work, summer 2025, 25(2) 490 as agents of transformative justice, we must move beyond performative solutions that burden individuals to "master" an exam while failing to dismantle the institutional barriers that restrict access to licensure and professional advancement. the ability to flourish within the social work profession should not be contingent upon one's ability to navigate a structurally flawed testing system but rather on equitable access to diverse and inclusive methods of assessment that align with social work values, critical consciousness, and antioppressive practice. social transformation in licensure demands a radical reimagining of what it means to assess competency in social work. current testing strategies reinforce systemic barriers disproportionately impacting test-takers based on race, socioeconomic status, and institutional access to preparation resources. as ricciardelli and colleagues (2024a) highlight, racial disparities in exam pass rates are not coincidental but rather symptomatic of a larger system of racial capitalism that commodifies knowledge, privileges certain educational experiences, and systematically excludes those already burdened by oppression. the social work interstate compact legislation (ricciardelli et al., 2024b) offers a framework for mobility and reform, but without intentional efforts to dismantle the racialized barriers to entry, such policies may reinforce existing inequities rather than eliminate them. the allostatic load associated with licensure extends beyond individual stress. it has material consequences for the communities served by social workers. when diverse practitioners are systematically excluded through biased licensure practices, the profession fails to reflect the populations it is meant to serve. the impact of these flawed testing strategies is not merely academic; it erodes confidence, induces anxiety, and disrupts professional trajectories, disproportionately affecting those who already experience compounded structural oppression. addressing these barriers requires a collective responsibility from social work educators, licensing boards, and institutions. collaboratively, we must all engage in dismantling exclusionary practices to ensure that the profession truly embodies its commitment to equity, justice, and representation. as we seek to reform social work licensure, we must advocate for alternative pathways to competency assessments that prioritize lived experience, practice-based knowledge, and antiracist frameworks. the profession cannot claim to uphold justice while replicating exclusionary barriers that harm those it is meant to uplift. true transformation requires not just revising test preparation strategies but actively dismantling the mechanisms that reinforce inequity in the first place. to create meaningful change, it is essential to advocate for policies that ensure equitable pay and professional advancement opportunities for all social workers, regardless of race or cultural background. this includes advocating for standardized licensing fees that do not place an undue financial burden on those entering the profession and addressing the broader issues of wage inequality and professional recognition within the field. within social work education, we must adhere to the licensure processes, prepare them for the exam, engage in transformational educational practices, and redress historic educational inequities that follow bipoc individuals from k-12 into the higher education environment. as social workers, we are responsible for challenging these inequities and working toward king-jordan et al./swk licensing exam inequity 491 a profession that genuinely reflects the values of justice and fairness for all. this also means interrogating license exam costs, content, and how we test. all viable alternative options should be considered while honoring our commitment to professionalism and ensuring that competent individuals enter the field. references apgar, d. 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(2024). social work licensing: then and now. clinical social work journal, 52, 368-381. author note: address correspondence to dr. taniko-king jordan, dsw, lmsw director, community engagement, sound thinking. 39300 civic center drive suite 300, fremont, ca. 94536. mobile: 317-941-0892 email: tking-jordan@soundthinking.com https://doi.org/10.1093/sw/swae018 https://doi.org/10.1093/sw/swae018 https://research.ebsco.com/c/jzkghg/search/advanced/publications/swr?selecteddb=hbhjnh&isdashboardexpanded=true https://doi.org/10.1080/10437797.2023.2189878 https://doi.org/10.1080/10437797.2023.2189878 https://doi.org/10.1177/1091142114557723 https://doi.org/10.1177/1091142114557723 https://doi.org/10.1177/1091142114557723 https://doi.org/10.1037/0003-066x.62.4.271 https://doi.org/10.1037/0003-066x.62.4.271 https://doi.org/10.1093/sw/swae001 https://doi.org/10.1093/sw/swae001 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231166125 http://www.soundthinking.com/ mailto:tking-jordan@soundthinking.com nasw-il staff. (2023, august 4). nasw-il advocacy at work: gov. signs hb 2365 providing alternative to aswb exam. nasw, illinois chapter nasw-michigan chapter. (2024, november 14). update on michigan’s social work licensure modernization act: what’s next for hb 5184 and hb 5185. author. ________ peter simonsson, phd, msw, lcsw, assistant professor, director of violence prevention, department of urban health and population science at lewis katz school of medicine, temple university, philadelphia, pa. patricia logan-greene, associate professor and associate dean for academic affairs, school of social work, university at buffalo, buffalo, ny. karen slovak, phd, lisw-s, lgsw, dsw core faculty, social work, school of public service leadership, capella university, minneapolis, mn. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), i-vi, doi: 10.18060/28430 this work is licensed under a creative commons attribution 4.0 international license. special section editorial: improving the social work response to the gun violence epidemic peter simonsson patricia logan-greene karen slovak firearm violence remains a critical and significant social problem in the united states, causing harm and distress across systems to victims, their families, and larger communities. this special section focused on manuscripts from social work scholars that could encapsulate the status of research on firearm violence within our discipline. in this introduction, we will describe the manuscripts we received, as well as discuss emerging themes in the broader firearm violence research community and the importance of social work scholars’ role in the literature and prevention efforts. despite recent increased scholarship and policy focus on firearm violence, rates of homicide and suicide involving firearms remain high in the us. in 2021, deaths involving firearms reached an all-time high of nearly 50,000, with suicide accounting for 54% of those firearm deaths (gramlich, 2023). while firearm-related suicides primarily involve rural white males ages 40 and above, community firearm violence has a greater impact on inner-city black and hispanic/latino males between ages 16 and 24 (office of the u.s. surgeon general, 2024). however, the debate about firearm violence and the primary victims is often politicized, resulting in skewed perceptions regarding the causes of and remedies for this widespread, challenging, and complex social problem (simonsson & solomon, 2021). moreover, public attention to firearm violence usually spikes amid media coverage following public mass shootings, which only account for a tiny proportion of the total annual firearm deaths and injuries (schildkraut et al., 2015), despite being tragic and terrifying to the populace. this disproportionate media attention on mass shootings warps the discussion of policy remedies and also minimizes the true toll that firearm violence takes on vulnerable communities – often precisely the communities that social workers are dedicated to and trained to serve. social workers are optimally positioned to address firearm violence for several reasons. first, considering that a confluence of underlying factors contributes to both firearm perpetration and victimization, the social work profession’s utilization of the bio-psychosocial-spiritual framework and historical positioning in trauma-informed care and social justice is well suited to the comprehensive approach that addressing firearm violence requires (e.g., lee et al., 2018; saad et al., 2017). for example, community firearm violence can be understood as stemming from multiple factors that all increase the risk for violence: biological factors including intoxication or head-trauma tendencies; psychological factors such as trauma and antisocial tendencies; social factors including unemployment, exposure to violence, and poverty; and/or spiritual factors like alienation, the loss of hope, and detachment from a cause larger than one’s individual life. second, social justice is a core about:blank advances in social work, spring 2024, 24(1) ii tenet of the profession, and this perspective is critical when situating firearm violence in larger historical and political factors. for example, the role of trauma as a risk factor for violence perpetration is well established (e.g., sharpe, 2015) and certain communities in the us are more likely to suffer trauma due to generational poverty, historical racism, and growing up in disinvested areas. in addition, the demographics of those involved in firearm violence (primarily males) makes the social justice lens increasingly important in firearm violence research, and social worker scholars have both an opportunity and an obligation to ensure that the production of firearm knowledge includes emphasis on relevant social justice perspectives and relevance for all those impacted by firearm violence (e.g., conrick et al., 2023; swanson, 2020; webster et al., 2020). from a more practical perspective, social workers have unique insights into the needs and vulnerabilities of those who are at risk for firearm violence. for example, macro social workers provide services and advocate for policies across multiple systems (e.g., child welfare, criminal-legal settings, mental health facilities, community organizations), engaging with stakeholders in each of these domains. this experience, coupled with micro social workers’ clinical expertise in engagement and trust building, singularly positions social workers to elevate the perspectives of those directly impacted by firearm violence, a much-needed perspective in this area. in addition, their community embeddedness allows them to engage communities often determined to be difficult to reach by other generalist social scientists (arsovska, 2012) in more participatory, social justice-oriented research. furthermore, academic research still heavily favors traditional quantitative methodologies as those best suited to generate “evidence-based practice.” however, for many vulnerable communities, the stories about firearm violence, its harms, and remedies are most powerfully told using qualitative research such as narrative approaches. social work’s skill set and emphasis on active listening and understanding individuals within their social environments positions social workers as especially adept qualitative researchers who can deeply explore the lived experience of individuals and families who have been impacted by firearm violence. with recent focus on narrative methodologies, social workers who focus on interpersonal engagement and contextual understanding are ideally situated to capture rich and nuanced data about vulnerable people’s lives. as we hope we have made clear, social work is in a perfect position to conduct and lead developments in firearm-violence research and advocacy, and this special section showcases some meaningful and exciting examples of our profession’s capacity for thoughtful and nuanced contributions to the field. in the first article, aspholm, aguilar, and st. vil examine the structural conditions that have created economic hardships and despair among vulnerable middle-aged white men, who have the highest rates of suicide, and younger black males, who have the highest rates of homicide. the findings suggest that the social forces that result in despair can lead to firearm violence for both groups, and that the remedies need to involve macro solutions to reach the roots of the economic and social conditions that create dislocation. epperson, cinque, and lee examine the impact of a prosecutor-led gun diversion program in chicago and factors associated with illegal gun-carrying among program participants. the growing interest in prosecutor-led and other gun diversion programs simonsson et al./swk & gun violence epidemic iii which seek to reduce the burden of incarceration on vulnerable young people emphasizes the need for evaluation and research efforts. epperson et al. found that participants in such programs who recidivate often resort to gun-carrying due to past trauma and fear of being victimized in dangerous neighborhoods. the impact of social workers’ knowledge about firearm access and safe storage is examined by rapp-mccall and lucio who found that social workers do not routinely ask high-risk clients and program participants about firearm safety and storage. the authors recommend that social workers receive further training in assessing and discussing firearm storage and safety with all clients, not only those at-risk for suicidal or homicidal ideations. in nugent and khalil the focus was on the impact of violent political rhetoric on police killings of civilians. they utilized time series analysis with controls and found increases in lethal force against civilians following violent rhetoric from politicians. in an era of increasingly heated politics, this has implications for populations in frequent contact with police. taken as a whole, these selected articles highlight the expertise and knowledge of social work scholars who focus on firearm violence, showcasing social work’s contribution to both research and practice in this area. while this special section helps to demonstrate social work’s promise for firearm violence research, there are other trends that point in a positive direction for social work scholars as contributors to this field. for example, in recent years, social work scholars have presented firearm-related research at the american society for criminology conference, the national conference for the prevention of firearm related injuries, and, of course, the society for social work and research conference, where 25 posters and presentations focused on firearm violence in 2024, compared to fewer than 10 abstracts each year from 2009-2017. finally, the recent formation of a grand challenge in social work specifically devoted to preventing gun violence reflects the growing interest and commitment of social workers to engage and address the impact of firearm violence on society (logan-greene & gutterman, 2023). while still new, this grand challenge has attracted significant attention, with promising signs that it will galvanize and synergize social work scholars’ efforts related to firearm violence prevention grounded in social justice, strength-based, and person-in-environment perspectives. however, these efforts should not undermine future initiatives to further increase social work’s investment in firearm violence research and practice, and there are several areas where social workers can meaningfully contribute. first, community-violence interventions (cvi) are expanding in scale and funding in urban communities as a response to elevated homicide rates. while community firearm violence is increasingly framed as a public health concern, social workers could add value in this space by emphasizing how community-based firearm violence remains situated in poverty, mass incarceration, alienation, lack of realistic and feasible opportunities, and that historical legacies such as institutional racism and oppression remains factors that contribute to street violence in urban communities. public health frameworks are important, but often tend to focus on violence from a disease perspective while de-emphasizing the systemic, institutional, and historical conditions that contribute to problems like community firearm violence. social advances in social work, spring 2024, 24(1) iv work can add perspective and lend wisdom, especially since social work is rooted in the belief that people and their environment interact in complex ways and thus, any solutions must address the social conditions in which vulnerable individuals are embedded as much as individual interventions. second, social work can play a critical role in studying and addressing rural suicide among white males suffering from disinvestment and alienation. here social work has a unique opportunity to engage communities and raise awareness about suicide as well as addressing the systemic factors that make rural communities vulnerable to suicide (mohatt et al., 2021). by organizing workshops and outreach, social work can also provide support and help reduce the stigma around help-seeking and mental health that often hinders middle-aged males from seeking services. at the micro level, social workers can provide counseling, offer emotional support, mental health screenings, and crisis intervention for those at-risk of suicidality. third, current discussions of firearm violence place substantial emphasis on individual-level risk and protective factors of those involved as either perpetrators or victims. for example, psychological scholarship can sometimes over-emphasize individual-level factors, such as criminogenic risks and needs, at the risk of undervaluing the influence of social environments and institutions in the life of vulnerable individuals. here, social work has an opportunity to contribute via the bio-psycho-social-spiritual lens, and as a discipline social work is sensitive to how individual lives are shaped by their institutions, communities, and opportunities. thus, studying suicide prevention in rural communities or homicide prevention in urban communities needs to account for how disinvestment in rural areas and alienation and lack of employment opportunities in the inner city contributes and interacts with a confluence of biological and psychological factors. finally, progress on issues related to firearm violence will require building meaningful relationships with the communities most impacted by it. because social workers are embedded in vulnerable communities, as well as within institutions designed to serve them, they have a unique opportunity to address firearm violence both in terms of practice and scholarship. however, although social work already has a long history of engaging in qualitative and narrative-focused work, scholars with interest in firearm violence research should adopt and advocate for more participatory methods. a step away from traditional positivist methodologies toward more actions-focused and participatory research that involves community voices will also aid in dismantling systemic biases that plague both rural and urban communities. social work should ensure that the next generation of social work scholars are well-equipped to engage in participatory action research and utilize those with lived experience at all stages of research and in the development of interventions to address firearm violence. in conclusion, it is evident that social workers, both as scholars and practitioners, play a critical role in contributing to the prevention of firearm related deaths and injuries. while we believe the articles in this special section also demonstrate the value of social work’s continued (and growing) attention to firearm violence, we also believe there are still more opportunities for meaningful engagement from social workers. by leveraging the unique simonsson et al./swk & gun violence epidemic v strengths and values of the social work profession, we can produce research with depth and alignment to social work values, that is also relevant for practitioners and policymakers. references arsovska, j. 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(2020). the color of risk protection orders: gun violence, gun laws, and racial justice. injury epidemiolology, 7, 1-6. webster, d. w., mccourt, a. d., crifasi, c. k., booty, m. d., & stuart, e. a. (2020). evidence concerning the regulation of firearms design, sale, and carrying on fatal mass shootings in the united states. criminology & public policy, 19(1), 171-212. author note: address correspondence to peter simonsson, department of urban health and population science, lewis katz school of medicine, temple university, philadelphia, pa 19140. email: peter.simonsson@temple.edu https://doi.org/10.1186/s40621-020-00272-z https://doi.org/10.1186/s40621-020-00272-z https://doi.org/10.1111/1745-9133.12487 https://doi.org/10.1111/1745-9133.12487 mailto:peter.simonsson@temple.edu ________ sh'niqua l. alford, dsw, lcsw-s, associate professor of professional practice, department of social work, texas christian university, fort worth, tx. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 304-320, doi: 10.18060/27340 this work is licensed under a creative commons attribution 4.0 international license. implementation of strength reimagined: a therapeutic well-being framework for african american women to counteract the strong black woman stereotype sh'niqua l. alford abstract: the strong black woman (sbw) stereotype has been consistently linked to poor mental health for african american women and its endorsement leads to anxiety, depression, and stress. african american women unknowingly subscribe to this stereotype through the exertion of strength and independence found necessary to combat oppression and gendered racism. this article explores existing literature on the sbw stereotype and suggests strategies for leveraging this stereotype to enhance mental health interventions for african american women. utilizing an integrated conceptual framework that draws from the lens of black feminist thought, intersectionality, and social constructivism theory, strength reimagined: a therapeutic well-being framework for african american women is proposed. this treatment framework incorporates five key aspects: therapist awareness, psychoeducation, culturally responsive psychotherapy, trauma-informed complementary interventions, and mutual support to improve mental health outcomes among african american women. keywords: strong black woman stereotype, african american women, mental health, psychotherapy interventions african american women, as a result of positionality in the united states, may exhibit behaviors and characteristics associated with the strong black woman (sbw) stereotype. while deemed a response to societal pressures and a means of resilience, the sbw stereotype may hinder well-being as african african women strive to overcome societal detriments related to physical and mental health. substantial literature explores the sbw stereotype and its association with anxiety, depression, and stress, however, limited research investigates how the schema impacts mental health help-seeking behaviors and treatment retention among african american women. the focus of this article is to provide an extensive review of the literature on the sbw stereotype while identifying gaps in the context of african american women engaging in psychotherapy treatment in the united states. strength reimagined: a therapeutic wellbeing framework for african american women is proposed to improve mental health outcomes among african american women. this framework significantly contributes to scholarly literature, the social work profession, and the mental health treatment of african american women. implementation of strength reimagined: a therapeutic well-being framework for african american women contributes to optimal holistic mental health. about:blank alford/strong black woman stereotype 305 literature review african american women in the united states must navigate the intersection of gendered racism, employing survival tactics to overcome this complex form of oppression. the strength of the african american woman is conceptualized as the sbw stereotype (davis & jones, 2021). the sbw stereotype will be defined, and a historical overview will shed light on its origins and perpetuation. while the resilience of african american women is widely acknowledged, it is important to recognize that this strength can also have detrimental effects. the negative consequences of the sbw stereotype will be examined, particularly its association with increased mental health issues and trauma-related symptoms. additionally, this leads to a discussion of how the sbw stereotype influences help-seeking behaviors among african american women. the methodology employed for this literature review involved a search of scholarly databases, including psycinfo, socindex, sage premier, and psycarticles, to retrieve relevant articles, books, and other academic sources. keywords and search terms relevant to the topic were strong black woman stereotype, african american women, black women, psychotherapy, social work, and mental health treatment. inclusion criteria were established to ensure the selection of studies met the objectives of the review, publication in peer-reviewed journals, and availability of full text. the search was limited to english language publications and studies published within the past 15 years, except for seminal work, to capture the most current research in the field. finally, the findings from the selected studies were synthesized and analyzed to identify key themes, trends, and gaps in the literature. this methodology aimed to ensure a comprehensive review of the existing literature, providing a solid foundation for developing the treatment framework. the strong black woman stereotype within the african american community, the conceptualization of womanhood as a “strong black woman” is perceived as an idealized representation that becomes a protective factor (watson & hunter, 2016). similarly, walker-barnes (2009) identified “strong” as likely the most frequently used word to describe an african american woman. the sbw stereotype is defined as a set of cognitive beliefs coupled with behaviors depicting how african american women represent themselves, care for themselves, and provide care for others (watson & hunter, 2016). research further suggested that african american women who subscribe to the sbw stereotype have an internalized belief that they must constantly possess qualities of strength and caregiving, often to their detriment (donovan & west, 2015). examples of these perceived characteristics include resiliency, the ability to handle adversity with ease, handling challenges with no assistance, independence, self-sufficiency, providing for the needs of others before their own, and lack of reliance on others for emotional or financial support (donovan & west, 2015; jones et al., 2020; walker-barnes, 2009). these characteristics are a result of the sbw stereotype, as well as society's response to perceptions of african american womanhood as defined by this stereotype. additional perceptions of this trait indicate that african american women should suppress feelings of fear and weakness and avoid vulnerability and dependence, depicting an unrealistic image that views african american women as advances in social work, summer 2024, 24(2) 306 superhumans void of emotions and needs, thus the stereotype (stanton et al., 2017). similarly, watson and hunter (2016) identified this stereotype as a complex social construct that embodies strength and caregiving capabilities. strength is depicted as perseverance despite obstacles, limited resources, and support (watson & hunter, 2016). caregiving capabilities are understood by the frequent occurrence of african american women prioritizing the needs of others before their own (watson & hunter, 2016). rooted in the history of enslavement, and the intersectionality of racism, sexism, and classism, the sbw stereotype contributes to poor, unmanaged self-care among african american women (watson & hunter, 2016). historical origination of the stereotype the historical significance of the sbw stereotype must be explored to understand its prevalence in the african american community. decades of unrealistic expectations for african american women have contributed to this stereotype. researchers revealed that strength is an imperative aspect of the identity of african american women (nelson et al., 2016; walker-barnes, 2009; west et al., 2016). it is not believed that african american women intentionally set out to overextend themselves and reject help because of the sbw stereotype, but it is more likely a subconscious response engrained in african american women from childhood due to generational trauma. researchers suggested the sbw stereotype was developed during chattel slavery as a means of survival from violence and oppression and has been passed down through generations of women to young girls through socialization (donovan & west, 2015). nelson et al. (2016) offered similar insight. they elaborated on the historical significance of strength, referencing the strength of an african american woman as a coping mechanism in response to adversity during the enslavement of african american people during the 17th and 18th centuries. during these times, and arguably continuing today, it was falsely believed that african american women possessed greater physical and psychological strength than white women, implying that african american women could tolerate heightened pain and suffering (anyiwo et al., 2018). in turn, african american women have historically adopted the need to demonstrate superior emotional strength, like the legacies of african american ancestors (anyiwo et al., 2018). nelson et al. (2016) corroborated this insight, offering that strength was seen as crucial for survival, forcing african american women to conceal negative emotions to avoid drawing attention and instead, facing the harsh consequences of the brutal mistreatment they endured. donovan and west (2015) elaborated further that characteristics of strength and caregiving during chattel slavery were necessary for personal survival and to preserve family and community existence. walker-barnes (2009) noted the same, indicating the characteristics of strength among african american women as a cultural stipulation for survival. these experiences began the cycle that has resulted in african american women utilizing strength to lessen the detrimental effects of racism, oppression, and discrimination (nelson et al., 2016). liao et al. (2020) supported the same notion, stating that the sbw stereotype benefits african american women navigating an oppressive society. walkerbarnes (2009) classified this further as strength evolving into resilience to combat suffering. oshin and milan (2019) took a deeper dive into the assessment of the sbw stereotype, highlighting specific attributes of self-reliance and emotional strength. alford/strong black woman stereotype 307 historically, due to the enslavement of african american people and the dismantling of the african american family through the separation of male partners, african american women assumed multiple roles to provide for their families (oshin & milan, 2019). as a result, african american women were expected to mask their emotions and develop a shield of resistance from these circumstances (oshin & milan, 2019). other studies have found commonalities in how the sbw stereotype has developed in young african american girls. socialization from parents, mimicked behaviors of ancestors, and the media are sources that explain the development of the sbw stereotype among african american girls (anyiwo et al., 2018). nelson et al. (2016) explained how commonly african american mothers focus on the socialization of their daughters to exhibit strength and resilience as a mechanism to exist in a society that will devalue and demean them and their culture. nelson et al. (2016) further revealed differences in these practices among daughters and sons, with african american mothers demanding stricter rules and responsibilities for their daughters. according to jones et al. (2020), this schema is developed through what is referred to as gendered-racial socialization. through this process, young african american girls are given intentional messages of survival by their mothers and matriarchal figures to prepare them for life as african american women, essentially learning traits of the sbw stereotype. epigenetics research further explains how environments influence genes, resulting in trauma being transmitted through generations (degruy, 2005). through seminal research on the post traumatic slave syndrome, degruy (2005) discussed how african americans enduring chattel slavery faced experiences of trauma and stress, which was stored in their genetic memory. though chattel slavery does not exist today, deoxyribonucleic acid (dna) contains biological memories of trauma and stress and this is passed down through generations (degruy, 2005). kumsta (2019) corroborates these findings by explaining how mental health disorders have a substantial developmental origin and how epigenetics may explain the long-term effects of early adversity. negative consequences associated with stereotype superficially, characteristics of the sbw stereotype are deemed positive and affirming because african american women are viewed as strong, independent, and self-sufficient. however, african american women who subscribe to the sbw stereotype are susceptible to negative consequences impacting their physical and mental health. empirical findings demonstrate a correlation between the sbw stereotype and anxiety, depression, and stress. additionally, the neurophysiologic effects of stress are explored, emphasizing the impact of stress on the brain and the negative ways the body responds to stress. finally, the sbw stereotype adversely affects the mental health help-seeking behaviors of african american women. anxiety, depression, and stress there is increasing evidence suggesting the sbw stereotype is not conducive to the wellness of african american women (jones et al., 2020). furthermore, the sbw advances in social work, summer 2024, 24(2) 308 stereotype results in detrimental consequences on the mental health of african american women (oshin & milan, 2019). these consequences are exacerbated by the intersectional effects of racism, sexism, and classism. researchers indicated through qualitative evidence that there is a correlation between the sbw stereotype and poor mental health outcomes, such as increased levels of stress, anxiety, and depression (donovan & west, 2015; stanton et al., 2017; woods-giscombé, 2010). additionally, abrams et al. (2018) found that women who subscribe to the sbw stereotype display increased anxiety and depressive symptoms. west et al. (2016) suggested a relationship between increased depression and a lack of help-seeking and self-care behaviors in women who internalize the sbw stereotype. as a result of the seemingly altruistic behaviors identified in the sbw stereotype, many african american women find themselves affected by negative physical health and mental health outcomes that include anxiety, depression, and stress (donovan & west, 2015). empirical research has shown that when african american women exhibit the strength and self-reliance behaviors characteristic of the stereotype, there is an increased risk of psychological distress (watson & hunter, 2015). increased psychological distress leading to increased depression is of particular concern for african american women because depression is often undertreated (nelson et al., 2022). neurophysiologic effects of stress to effectively articulate the negative consequences of chronic stress on mental health, particularly toxic stress, it is essential to understand the effects of stress on the brain. sporleder and forbes (2016) described toxic stress as a constant state of hardship or prolonged exposure to stress in which the body’s physiological response is to stay in the fight, flight, or freeze mode. continued exposure to stress is damaging and becomes toxic to the human body. frequently, african american women are viewed as strong, tenacious, and capable of overcoming all obstacles encountered. while help may be sparingly available, if offered, african american women may find it challenging and even unreasonable to accept. this belief is exacerbated when african american women are praised for accomplishing difficult tasks without receiving help. african american women often internalize this superwoman identity as a badge of honor and may minimize or overlook the effects of stress, anxiety, and depression on the body. according to bloom (2013), toxic stress weakens the architecture of the brain, resulting in damaging consequences on cognitive, emotional, and social functioning. when in a constant state of stress, the ability to think clearly and process the consequences of decisions and behaviors is affected (bloom, 2013). beyond its impact on cognitive processes, toxic stress has profound effects on the body’s overall health, particularly at the cellular level. one key area where this damage manifests is in the length and function of telomeres. telomeres, which are protective caps found at the end of chromosomes, play a crucial role in maintaining cellular health by preventing the chromosomes from fraying. their main function is to protect the genetic material in cells from damage during cell division. each time a cell divides, telomeres shorten slightly. over time, as telomeres become too short, the cell can no longer divide effectively, which contributes to premature aging and the gradual breakdown of cellular function (bayly, 2013). naturally, telomeres shorten as people age; however, stress accelerates the shortening of telomeres. toxic stress rapidly alford/strong black woman stereotype 309 shortens the telomeres, which may lead to the formation of cancerous tumors, an example of how stress detrimentally affects physical health (bayly, 2013). stressors, as defined by osório et al. (2017) are challenging experiences that cause physiological and psychological reactions in the body. these stressors can contribute to a state of allostatic load, which refers to the cumulative physiological burden placed on the body due to chronic stress and the repeated activation of the body’s stress response systems (guidi et al., 2020). woods-giscombé (2010) notes that excessive psychological stress increases allostatic load, resulting in dysregulation and impaired functioning. when the body’s stress response systems are overtaxed due to excessive or chronic stress, allostatic overload can occur, resulting in a range of negative health consequences (arden, 2010). health implications of allostatic overload include increased risk of cardiovascular disease, mental health disorders such as anxiety and depression, metabolic disorders such as obesity and diabetes, and impaired immune function (guidi et al., 2020). one may argue that women from all races experience challenges due to allostatic load/overload; however, thomas et al. (2019) highlighted disproportionately higher levels of allostatic load among african americans when compared to other racial and ethnic groups, and it was found to be significantly higher for african american women. osório et al. (2017) further explained the fight, flight, or freeze response, also referred to as acute stress response, as our body’s reaction to stressors. when we perceive danger or experience challenging or stressful situations, our body responds with a specific set of protective capabilities (bloom, 2013). when enduring chronic stress, these systems become hyper-aroused, resulting in less effectiveness when necessary (bloom, 2013). demanding career responsibilities, unreasonable caregiving expectations, and lack of selfcare are common experiences of african american women subscribing to the sbw stereotype. these factors may contribute to chronic stress. bloom (2013) identified a correlation between chronic stress and poor health outcomes. this predictor is concerning, as the primary causes of death among african american women include heart disease, cancer, stroke, and diabetes (centers for disease control and prevention, national center for health statistics, 2024). chronic stress on the body leads to a constant state of activation in the autonomic nervous system, contributing to negative health outcomes such as hypertension, asthma, headaches, and ulcers (bloom, 2013). likewise, endorsers of this stereotype experience heightened rates of obesity and disproportionate rates of cardiovascular disease (stanton et al., 2017). the literature strongly suggests chronic stress leads to physical and mental health disorders among african american women and a linkage between the stereotype and poor mental health outcomes (donovan & west, 2015). as african american women subscribe to this stereotype, chronic stress can ensue, resulting in increased physical and mental health symptoms and disorders. influence of the stereotype on help-seeking behaviors historically, stigma exists in the african american community surrounding mental wellness and mental health treatment, hindering african american women in their quest for mental health care. in turn, these barriers affect the mental health help-seeking behaviors of african american women (ward et al., 2009). studies dating back to the advances in social work, summer 2024, 24(2) 310 1980s reflect that african american people in the united states hold more negative beliefs and attitudes towards people with mental illness than other racial and ethnic groups. ward et al. (2009) revealed that when compared to white people, african american people exhibit feelings of shame toward friends or family who seek mental health treatment; thus, the associated shame surrounding mental illness results in avoidance of mental health treatment. events of historical significance, such as the tuskegee experiment, also shaped the negative beliefs that african american people hold regarding health and mental health care (ward et al., 2009). other historical factors to note include the eugenics movement, segregation in healthcare, misdiagnosis, and disparities in treatment. cultural mistrust is a contributing factor to the stigma of mental health treatment in the african american community (shelton, 2022; ward et al., 2009). despite 60% of african american women reporting depressive symptoms, african american women utilized outpatient mental health services less than white women and african american men (ward et al., 2009). more recently, 10.3 percent of african american women utilize mental health services, which remains considerably less than the 25 percent of white women receiving mental health treatment (shelton, 2022). borum (2012) suggested african american women are distrusting of psychiatry and the medical system, resulting in less frequent treatment of depression when compared to white women. additionally, the pattern of mental health treatment in the african american community reveals lower rates of outpatient treatment and higher rates of emergency room care (ward, 2005). this demonstrates how many african american women wait until their needs are dire before seeking care. african american women commonly relied on other coping methods, such as confiding in friends, family, and the church, while upholding deeply rooted convictions within the african american community that familial issues should not be disclosed to outsiders (ward et al., 2009). these cultural beliefs, coping mechanisms, and the portrayal of the sbw stereotype may serve as barriers, reducing the likelihood that african american women seek mental health care (ward et al., 2009). internalization of the sbw stereotype resulted in some women upholding the image of the stereotype (davis & jones, 2021). stanton et al. (2017) suggested that the sbw stereotype may prevent african american women from seeking and engaging in mental health treatment due to the beliefs of the stereotype. additionally, a qualitative study revealed that some african american women admitted that the sbw stereotype prevented them from acknowledging depressive symptoms, diagnosis, and treatment (west et al., 2016). watson and hunter (2015) also explained that african american women might not disclose somatic symptoms often indicative of anxiety, such as headaches, digestive issues, or pain, due to the stereotype’s expectation to hide emotional discomfort. west et al. (2016) mentioned that race, racialization, and ethnic disparities further impact the role of stress related to physical health and mental health outcomes. african american women who identify with the tenets of the sbw stereotype show increased symptomology of stress, namely due to the belief that they must abide by the societal pressures of self-reliance, emotional suppression, and enhanced strength. west et al. (2016) also identify additional findings from anecdotal and empirical research that support the sbw stereotype as a method of ineffective coping, in turn generating poor mental health outcomes. woodsgiscombé (2010) noted that the “legacy of strength in the face of stress among african alford/strong black woman stereotype 311 american women might have something to do with the current health disparities that african american women face” (p. 669). literature gaps wojtalik (2018) noted social workers deliver the majority of mental health care in the united states and play a key role in integrating cognitive neuroscience and mental health interventions. wojtalik further suggests that social workers have the ability and responsibility to educate clients about the neurobiology of mental illness to reduce the stigma surrounding diagnosis and symptoms. while there is substantial literature identifying effective strategies for social workers providing mental health treatment, there is limited knowledge or awareness of implementing these strategies with african american women susceptible to the ideals of the sbw stereotype. additionally, while there is significant research identifying various components of the sbw stereotype and its impact on help-seeking behaviors, there is limited research on the sbw stereotype in the context of psychotherapy (west et al., 2016). african american women experience challenges identifying the need for mental health treatment or therapy due to an internal belief that it is necessary to always demonstrate strength (nelson et al., 2016). additionally, there remains a gap in the literature for identifying ways to counteract the sbw stereotype to increase mental health treatment retention. due to the sbw stereotype, african american women frequently encounter obstacles when it comes to participating in and sustaining psychotherapy sessions. these challenges are often linked to struggles in recognizing the necessity of support and prioritizing self-care (west et al., 2016). additional barriers to psychotherapy treatment include culturally incompetent therapy and a lack of accessible and affordable therapy. furthermore, substantial research exists identifying the harmful effects of the sbw stereotype on the physical and mental health of african american women (nelson et al., 2016) yet there is a lack of scholarly literature identifying specific strategies to overcome this barrier for african american women. the rationale to address literature gap there are compelling reasons to further explore this issue and address the existing gaps in the literature. the sbw stereotype is deeply embedded into the existence of many african american women and as a result, must be understood and incorporated into aspects of psychotherapy treatment. in doing so, physical and mental health risks and impairments may be mitigated and decreased among african american women. african american women should be educated on the importance of prioritizing healthy stress management strategies and establishing a self-care regimen to effectively cope with the challenges of daily life. this may look like establishing healthy boundaries, cultivating self-compassion, prioritizing physical activity, nourishing the body with quality food, and fostering supportive relationships. it is crucial to communicate to african american women that wellness is not solely an attitude or belief, but encompasses a series of behaviors and actions that necessitate a strategic approach to follow. advances in social work, summer 2024, 24(2) 312 african american women have witnessed generations of women as pillars of strength and perseverance in the face of challenging obstacles. consequently, failure to provide and adequately perform is seen as a weakness (stanton et al., 2017). mirror neurons are brain cells possessing multiple functions, including imitative learning of social behavior and social interaction (farmer, 2014). these neurons play a crucial role in how individuals learn and internalize social norms and expectations by observing others, which may influence the propagation of social behaviors and stereotypes. abrams et al. (2014) identified the transmission of the sbw stereotype through verbal communication, modeling, and direct and indirect conditioning. it is deemed a desirable quality to be revered as an african american woman who is strong, goal-oriented, and capable of meeting her needs independently (watson & hunter, 2015). stress is heightened when one feels or perceives that their environment cannot be controlled. to mitigate the transmission of the sbw stereotype ideals as it passes through generations, psychotherapy interventions must strategically educate african american women about the effects of the sbw stereotype. by raising awareness of the detrimental impact of the sbw stereotype, effective psychotherapy may help african american women overcome the need to constantly present themselves as strong and resilient to manage the adversities they face in their environments. treatment framework in psychotherapy treatment with african american women, the sbw stereotype is rarely discussed or addressed. alternatively, if the sbw stereotype is discussed in psychotherapy, the approach generally insists that women relinquish these beliefs and inherent behaviors without the skills or strategies to do so effectively. this presents a challenge due to how the stereotype is embedded in the very existence of many african american women. liao et al. (2020) stated the sbw schema does not need to be discredited among african american women due to it being seen as a source of resilience. instead of working with african american women to dispel the sbw stereotype, it is more important to utilize the stereotype as a source of resilience and empowerment. created as a holistic therapeutic approach, strength reimagined: a therapeutic well-being framework for african american women utilizes an understanding of the sbw stereotype and transforms the negative connotation of its key aspect of strength to improve mental well-being. strength reimagined offers specific strategies for psychotherapists working with african american women to improve psychotherapy treatment outcomes. utilizing an integrated conceptual framework that draws from the lens of black feminist thought, intersectionality, and social constructivism theory, strength reimagined: a therapeutic well-being framework for african american women is proposed. strength reimagined incorporates five key aspects: therapist awareness, psychoeducation, culturally responsive psychotherapy, trauma-informed complementary interventions, and mutual support to improve mental health outcomes for african american women. the emergence of black feminist thought arose during a time when mainstream feminism, while advocating for gender equality, often overlooked the unique experiences, struggles, and perspectives of african american women. black feminists argued that traditional feminist theories and movements failed to adequately address the intersecting alford/strong black woman stereotype 313 oppressions of race, gender, and class faced by historically marginalized african american women, leading to a need for a distinct and intersectional feminist framework (borum, 2012; collins, 2009). black feminism emphasizes the importance of centering african american women's voices, perspectives, and experiences in feminist discourse and activism, and argues that the liberation of all women requires addressing the unique forms of oppression faced by african american women (bryson & lawrence-webb, 2000). key figures associated with the black feminist movement include sojourner truth, anna julia cooper, patricia hill collins, audre lorde, and kimberlé crenshaw. intersectionality is a concept developed within feminist theory to describe how various aspects of social identity, such as race, class, gender, sexuality, ability, and other factors, intersect and overlap, creating unique experiences of oppression and privilege for individuals who hold multiple marginalized identities (collins & bilge, 2020). coined in 1989 by legal scholar kimberlé crenshaw, intersectionality recognizes that individuals are shaped by multiple social identities that interact with one another and cannot be understood in isolation. for example, the experiences of an african american woman are not solely shaped by race or gender individually, but when viewed through the lens of intersectionality, are influenced by the intersection of race and gender, as well as other factors such as class, sexuality, and ability (collins & bilge, 2020). the sbw stereotype can also be analyzed through the lens of social constructivism theory, which posits that a person’s perceptions of reality are influenced by social and cultural contexts, rather than being determined by objective facts or innate characteristics (nelson et al., 2016). social constructivism theory provides a framework for understanding how the sbw stereotype is socially constructed and maintained, which is critical in offering effective mental health treatment for african american women. therapist knowledge and awareness although the united states is becoming increasingly diverse, african american women continue to face significantly higher rates of adverse mental health outcomes and obstacles to accessing care. however, the mental health workforce remains predominantly white. shelton (2022) reported only two percent of psychiatrists and four percent of active psychologists in the united states are african american. similarly, the bureau of labor statistics reported in 2023 that approximately 70% of social workers and 76% of mental health counselors were white (u.s. bureau of labor statistics, 2024). this strongly suggests that african american women who seek mental health treatment may encounter difficulties in finding a mental health clinician who shares their racial background. many african american women desire a connection with a therapist who shares their racial and gender identity, thus meeting these preferences may improve therapy outcomes (shelton, 2022). before working with african american women in treatment, psychotherapists must seek to understand and recognize the complexities of the sbw stereotype, its ideals, and its beliefs. failure to do so is detrimental to the success of mental health treatment for african american women. nelson et al. (2016) emphasized the importance of mental health professionals seeking to understand how african american women endorsing the advances in social work, summer 2024, 24(2) 314 sbw stereotype may conceptualize mental health treatment. this is especially important due to its impact on depression, mental health help-seeking behaviors, and overall mental health treatment (nelson et al., 2016). stanton et al. (2017) recommended therapists and counselors acknowledge that african american women who identify with the sbw stereotype may experience adverse mental health effects. it is crucial not to generalize or assume that all african american women will exhibit mental health symptoms. however, these findings underscore the importance of thoroughly assessing african american women in psychotherapy for negative beliefs associated with the sbw stereotype. instead of perpetuating harmful stereotypes, therapists should assist them in understanding the drawbacks of the stereotype and in developing effective coping mechanisms. to provide effective mental health support to african american women, psychotherapists of all races and genders should acquire essential knowledge about the sbw stereotype. enhancing this knowledge is critical to meet clients where they are in their experiences. social workers, guided by the value of competence in the profession, can demonstrate this by engaging in a comprehensive review of scholarly literature on the sbw stereotype and concepts of intersectionality. psychoeducation african american women participating in psychotherapy may find it beneficial to explore and comprehend the sbw stereotype. although many african american women may conform to this stereotype, they often do so unconsciously and without knowledge of its consequences. those who adhere to the sbw stereotype may find value in receiving psychoeducational insights into the compounded effects of stress, anxiety, and depression. additionally, psychoeducation must encompass an understanding of the adverse effects of the sbw stereotype on both physical and mental well-being. from a social constructivist lens, psychoeducation about the sbw stereotype acknowledges the diversity of african american women’s experiences and can be used to deconstruct the socially constructed meanings and beliefs surrounding strength and resilience. this encourages african american women to question and challenge the dominant narratives and stereotypes that are inherited. culturally responsive psychotherapy interventions within the african american community, women are frequently portrayed as symbols of strength, determination, perseverance, and resilience. while these characteristics may initially seem positive, embodying them often leads to a reluctance to accept help, ultimately fostering feelings of shame and stigma. research has indicated that african american women who subscribe to this trope experience increased symptoms of stress, anxiety, and depression. unfortunately, many african american women fail to recognize the correlation between their symptoms and this belief system. as a result, many african american women find themselves overwhelmed, experiencing mental anguish, and grappling with psychological distress. when these individuals seek psychotherapy with a readiness to confront issues such as anxiety, depression, and longstanding unresolved alford/strong black woman stereotype 315 trauma, psychotherapists must employ culturally sensitive interventions for optimal treatment outcomes. knowledge gleaned from the literature identifies ethical treatment practices that enhance mental health services for african american women. psychotherapy interventions identified for use with african american women generally emphasize the importance of mental health professionals possessing cultural competency skills, which leads to culturally sensitive therapy (cardemil, 2008). social work, psychology, and counseling professional organizations require mental health professionals to engage in cultural competency knowledge and practice (shelton, 2022). cardemil (2008) defines cultural competence as a learned or taught skill encompassing an awareness of different cultural and ethnic backgrounds and an understanding of power, privilege, and oppression. cultural competency improves outcomes for diverse client populations (cardemil, 2008). cultural competency involves knowledge about different cultures, awareness of one's own cultural biases and assumptions, and the skills to adapt interventions and services to be culturally appropriate. cultural humility is a lifelong process of self-reflection, critical selfawareness, and acknowledgment of one’s limitations, biases, and assumptions (shelton, 2022). as a result of the pervasiveness of strength among african american women, research further indicates that psychotherapists providing mental health services to african american women must specifically exhibit competence and sensitivity to the cultural aspects of the sbw stereotype (nelson et al., 2016). scholarly literature identifies interventions that are culturally responsive or traumainformed, but it is challenging to find interventions that incorporate components of both. culturally responsive, trauma-informed therapy acknowledges that individuals hold multiple intersecting identities that interact to shape an individual's experiences of privilege and oppression. by recognizing and validating the complexity of client identities, therapists can better understand their lived experiences and tailor interventions to meet their diverse needs. african american women would benefit from psychotherapy interventions such as mindfulness-based cognitive behavioral therapy (mb-cbt) and culturally responsive cognitive behavioral therapy (cr-cbt). cognitive behavioral therapy (cbt) is a wellresearched evidence-based treatment that is highly effective in the treatment of anxiety, depression, bipolar disorder, and other mental health diagnoses (zigarelli et al., 2016). by learning to restructure negative thought patterns, clients can change how they feel. historically, much of the research and clinical trials for psychotherapy interventions have focused on samples of white participants, resulting in a lack of racial and ethnic representation. cr-cbt aims to resolve this, by integrating ethnic and cultural values, beliefs, and considerations into treatment delivery (zigarelli et al., 2016). mindfulnessbased interventions promote stress regulation, increase overall health symptoms, and improve coping skills (watson-singleton et al., 2019). therefore, mb-cbt further expands traditional cbt by incorporating mindfulness meditation practices such as body scan, mindful breathing, and mindful movement. the positive benefits of culturally responsive psychotherapy options are well documented and show that therapy is most effective for racially and ethnically diverse clients when individualized to their specific needs (zigarelli et al., 2016). in addition, psychotherapists working with african american advances in social work, summer 2024, 24(2) 316 women must take extreme caution to avoid therapeutic ruptures related to a lack of cultural competency, such as possessing racist attitudes, clients feeling misunderstood, clients being misdiagnosed, and lack of connection (turner et al., 2022). trauma-informed complementary interventions meditation and yoga practices are specific interventions to reduce allostatic load and engage the parasympathetic nervous system, ultimately calming the amygdala (lazar, 2017). these strategies relieve stress by turning off the body’s stress response and offering the benefit of calmness, increased well-being, decreased depression, and improved mood and cognition (lazar, 2017). the use of these techniques empowers clients to enhance their self-care practices and achieve balance, thereby averting the risk of reaching allostatic overload and experiencing adrenal exhaustion or depletion. though psychotherapists are not commonly trained in complementary interventions, these recommendations for african american women may improve engagement in psychotherapy and reduce symptoms of anxiety, depression, and stress, highlighting the need for investment in these interventions. as stated, the use of yoga and meditation as complementary interventions is a fundamental aspect of psychotherapy. yoga poses are a form of alternative medicine that promotes a connection between the mind and body (javnbakht et al., 2009). furthermore, yoga effectively reduces and manages stress-related symptoms (javnbakht et al., 2009). trauma-sensitive yoga may be helpful for use with african american women to eliminate skepticism of yoga. this form of yoga does not include physical assistance or touch without permission, does not use sanskrit words, which is the ancient language of india used in yoga practice, and does not use words like relax or play to avoid re-traumatization of traumatic experiences. trauma-sensitive yoga emphasizes empowerment and cultivates a sense of agency within the healing process, offering tools and practices that empower individuals to reclaim control over their bodies, minds, and narratives. examples of such are the trauma-conscious yoga method and the trauma center trauma-sensitive yoga (tctsy). tctsy has foundations in trauma theory, attachment theory, neuroscience, and hatha yoga, emphasizing body-based yoga forms and breathing practices. mutual support the concept of mutual support involves individuals using their own lived experiences to offer assistance, encouragement, and solidarity to one another. social relationships represent important aspects of support among african american women and are viewed as a vital stress-coping mechanism (nguyen et al., 2019). furthermore, research indicates that social relationships, family, and church support protect against depressive symptoms (nguyen et al., 2019). examples of support include emotional support, which demonstrates empathy, compassion, and concern for others. information support includes offering advice and guidance. appraisal support involves sharing information helpful for self-reflection, and instrumental support is administering tangible aid, such as financial assistance, childcare, or transportation (nguyen et al., 2019). mutual support through a social constructivist lens involves recognizing the role of social interactions, shared meanings, cultural contexts, and building community. therapeutic examples of mutual support may alford/strong black woman stereotype 317 include group counseling and peer support groups or may involve african american women seeking and developing affinity support groups of choice with a focus on offering and receiving support from one another. conclusion the sbw stereotype is characterized by a model of strength, and while initially perceived favorably, results in increased symptoms of anxiety, depression, and stress among african american women. psychotherapy treatment with african american women requires a comprehensive understanding of the social, cultural, and systemic factors that shape their mental health experiences. thus, psychotherapists are charged with identifying these complex needs and utilizing the most effective interventions. strength reimagined: a therapeutic well-being framework for african american women leverages the concept of strength woven into the sbw stereotype and enhances resilience and empowerment among african american women. utilizing strength reimagined can enhance the scope of psychotherapy treatment available to african american women, addressing detrimental help-seeking patterns and enhancing treatment continuity and effectiveness. by embracing a holistic approach to mental health, encompassing physical, mental, emotional, and social dimensions, strength reimagined empowers psychotherapists with the necessary tools and insights to foster holistic well-being among african american women. implications for social work practice include adopting a client-centered approach by prioritizing the needs, preferences, and strengths of african american women. social workers must acknowledge the intersecting identities and experiences of african american women and how they may influence their mental health and well-being. social workers should advocate for systemic changes to address the 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(2016). culturally responsive cognitive behavioral therapy: making the case for integrating cultural factors in evidence-based treatment. clinical case studies, 15(6), 427-442. author note: address correspondence to sh’niqua l. alford, texas christian university, department of social work, tcu box 298750, fort worth, tx 76129. email: s.l.alford@tcu.edu https://doi.org/10.5040/9798400661587.ch-008 https://www.bls.gov/cps/cpsaat11.htm https://www.bls.gov/cps/cpsaat11.htm https://www.bls.gov/cps/cpsaat11.htm https://doi.org/10.1179/jpt.2009.19.1.002 https://doi.org/10.1037/0022-0167.52.4.471 https://doi.org/10.1037/0022-0167.52.4.471 https://doi.org/10.1177/1049732309350686 https://doi.org/10.1177/1049732309350686 https://doi.org/10.1037/cdp0000015 https://doi.org/10.1037/cdp0000015 https://doi.org/10.1037/cdp0000015 https://doi.org/10.1177/0095798415597093 https://doi.org/10.1177/0095798415597093 https://doi.org/10.1016/j.ctcp.2018.11.013 https://doi.org/10.1016/j.ctcp.2018.11.013 https://doi.org/10.1080/02703149.2016.1116871 https://doi.org/10.1080/02703149.2016.1116871 https://doi.org/10.1086/697566 https://doi.org/10.1086/697566 https://doi.org/10.1177/1049732310361892 https://doi.org/10.1177/1049732310361892 https://doi.org/10.1177/1534650116664984 https://doi.org/10.1177/1534650116664984 https://doi.org/10.1177/1534650116664984 mailto:s.l.alford@tcu.edu __________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2022 author, vol. 22 no. 1 (spring 2022), i-iv, doi: 26335 this work is licensed under a creative commons attribution 4.0 international license. spring 2022 editorial: supporting diversity and discovering the virtues of virtual practice margaret e. adamek in the spring 2022 issue of advances in social work, we are pleased to present 14 papers written by 40 authors from different regions of the u.s. the articles in this issue include a selection of empirical studies (n=6) and conceptual pieces (n=8). while the 14 articles cover a wide range of topics, two underlying themes include supporting different aspects of diversity in practice and in social work education and discovering the virtues of virtual practice. this issue begins with an important letter to the editor from four social work colleagues, jessica aldrich strassman, sara schwartz, eugenia weiss, and ann petrila, who call all social work professionals to be prepared to address the retraumatization that the war in ukraine is having on people globally—especially those who experienced similar trauma from world war ii and other major conflicts. the mental health impact of war trauma and forced migration, even intergenerationally, is something that all social workers need to be informed about. who’s considered a social worker? as producers and consumers of social work research, it is incumbent upon each of us to be aware of who is being classified as a social worker in published studies. drawing on studies of social workers’ participation in the political process, meehan, ostrander, and lane bring attention to the important issue of how researchers define social workers for inclusion in study samples. in order to make comparisons across studies involving social workers and to draw accurate conclusions, meehan and colleagues call us to be informed about how each study defines and samples social workers—are social work students included, social work graduates, members of nasw, social work faculty, licensed practitioners? are we paying attention to who is considered a social worker and how are they being compared? practice innovations after providing an overview of different historical periods in the development of social work ethics, reamer draws from other health care professions in proposing a progressive approach to managing ethical challenges faced by social work practitioners: informal conversations, formal consultations, ethics committees, and ethics rounds. reamer uses actual cases to illustrate the use of each approach to resolving ethical conflicts in social work practice situations. as reamer concludes, it is “vitally important” that “social workers who encounter challenging ethical issues are fully aware of the deliberate steps they can take to act responsibly in an effort to protect clients, third parties, and themselves” (p. 28). extending the call for ethical practice, in this case on behalf of immigrants in the u.s., zayas provides three case illustrations of social work advocacy in federal immigration courts. in all three types of cases, social work advocacy positively influenced the outcome of immigration cases, helping to bring about lasting positive policy changes. zayas shares https://creativecommons.org/licenses/by/4.0/ advances in social work, spring 2022, vol. 22 ii insider wisdom about how social workers can be effective in testifying in court, whether on behalf of immigrants or other client populations. in a qualitative study conducted in rural indiana, lopez, galindo, viramontez anguiano, corkill, jacob-bellowe, and weaver take an in-depth look at how religious leaders can fill in the gap between the needs of newcomer immigrant families and the services available in destination communities. the social capital provided by latino churches and religious leaders as they served as cultural and language brokers was absolutely instrumental in assisting families in adapting to their new communities. lopez and colleagues call for social workers to partner with local religious leaders to better serve latino immigrant families as they resettle, pursue education, and seek employment. an enduring and perhaps growing challenge in the u.s. landscape is the struggle with substance misuse. one of the populations who have been the most stigmatized by their substance misuse is pregnant women. with this in mind, trainor surveyed health care professionals from a variety of disciplines, including social work, about their perceptions of patients struggling with maternal substance use disorder. trainor’s findings underscore the importance of health care providers refraining from judgmental attitudes and actions and instead engaging new and pregnant mothers in the care of their infants. the covid-19 pandemic forced a major transition in how social services are delivered. to learn how social service agencies managed to continue meeting client needs in the midst of the pandemic, hirschi, hunter, neely-barnes, malone, meiman, and delavega interviewed the leaders of 37 social service agencies in the mid-south. despite initial challenges with the transition to telehealth services, many agencies found that virtual delivery of services had some unexpected advantages over face-to-face services. consequentially, technology has become an integral aspect of delivering many types of social services going forward. with virtual services becoming an enduring medium for delivering support to clients, hirschi and colleagues call for careful consideration of ethical issues and educational approaches to teaching telehealth to current and future providers. with a similar concern about the changes in service delivery as a result of the pandemic, rosten, gaitan, shah, and walls chose to document the perspective of 10 frontline social workers using a multi-method approach including photo elicitation. their analysis revealed three prominent themes: professional flexibility and creativity, connection, and recentering generalist social work skills. going forward, rosten and colleagues urge providers and agencies to embrace and continue the flexible approach to service delivery necessitated by the pandemic. innovations in social work education in a concise yet powerful paper, levine and ghezzi propose new pedagogical approaches to teaching the dsm that center diversity and equity. while the dsm-5 task force endeavored to improve cultural awareness and sensitivity, levine & ghezzi assert that the 5th edition of the dsm falls short of the goal of providing guidance to support and empower diverse clients. to overcome the shortcomings of the dsm-5, levine & ghezzi provide practical suggestions for promoting students’ critical thinking about the cultural dimension of formulating client problems and the application of dsm diagnoses and adamek/editorial iii processes. for social work professionals, the goal must be, as eloquently stated by levine & ghezzi, to advance “understanding of mental health assessment and intervention that is inclusive and equitable for all” (p. 140). in another innovation to social work teaching, harden and jones call for instructors to adopt principles of brain-based learning in schools of social work. according to harden & jones, brain-based learning has been around in primary and secondary educational settings for decades and is more recently emerging in higher education. in this contribution, harden & jones review the 12 principles of brain-based learning and illustrate how each principle can be applied in social work education to enhance not only student learning but students’ overall well-being. schwartz and curran offer an informative paper describing technical standards and explaining why they are increasingly important in social work education. in short, technical standards are non-academic criteria for admission to and continuation in social work degree programs. schwartz & curran distinguish technical standards from other non-academic standards such as “essential requirements” and point out the nature of challenges that may arise in implementing technical standards. drawing from legal cases to illustrate the use and importance of technical standards, schwartz & curran urge schools of social work to adopt technical standards to help “to manage the delicate and often difficult balance between serving as student-focused educators and professional gatekeepers” (p. 173). an ongoing challenge of schools of social work is to prepare new msw students to enter their field practicums with at least a basic level of clinical skills. zweben, piepmeier, and leak propose an experiential lab model to teach motivational interviewing (mi) skills to new msw students. the skills-based mi lab is described in detail and touted as a successful model for enhancing students’ clinical skills and preparing them to enter their field practicums ready to effectively engage clients. in an interesting qualitative inquiry, sherwood, vandeusen, diaconu, and jones describe a project that integrated service-learning, disaster social work in puerto rico, environmental justice, critical theory, trauma, and resilience. using critical reflection as a pedagogical tool to reveal the dynamics of power, privilege, and oppression in a postdisaster context, sherwood and colleagues describe key lessons learned by msw students who travelled from the midwest to puerto rico to engage with grassroots community organizations and local social workers. based on critical reflection about their experiences in the service-learning course, several students found themselves drawn to macro-level practice opportunities. in response to the age-old challenge of engaging social work students in mastering research concepts and principles, wagner and bowland propose a flipped classroom approach that emphasizes self-paced learning and hands-on experiences in the classroom. drawing guidance from kolb’s active learning cycle, wagner & bowland provide practical suggestions for using flipped classroom strategies to promote interest and engagement in research among both bsw and msw students. while interprofessional practice education is widely touted as a critical approach to training social work students, there has been less attention to figuring out how to make advances in social work, spring 2022, vol. 22 iv field experiences interprofessional. in this paper walsh, jaggers, satre, and hall present student feedback on a short-term interprofessional field practicum as part of a hrsafunded training program. while the study revealed various barriers to implementing ipefocused practicums, students were able to gain valuable exposure to interprofessional consultations on actual cases. _________ carol hostetter, phd, lcsw, editor and emerita professor, school of social work, indiana university, bloomington, in. valerie decker, msw, assistant editor, school of social work, indiana university, indianapolis, in. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), vii-viii, doi: 10.18060/28431 this work is licensed under a creative commons attribution 4.0 international license. spring 2024 editorial: social work education, advocacy, and our response to the epidemic of gun violence carol hostetter valerie decker in the spring 2024 issue of advances in social work, we have embedded a special section for a concentrated look at social work and gun violence in the united states guest edited by peter simonsson, patricia logan-greene, and karen slovak. the other 10 papers address a variety of topics in three formats – empirical, conceptual, or advocacy. social work education is in the forefront, with six articles set in bsw, msw, or phd programs. one of these is a conceptual piece, the other five are based on empirical research. social work education authors lozornio, sanchez, vidal de haymes, sanhueza, cardozo, and arreola present a mixed-methods study of an online spanish-english bilingual master of social work (msw) program. with a curriculum designed to address issues faced by latinx and immigrant students, along with multiple assessment measures, the faculty were encouraged by the results. with the increased focus on teaching anti-oppressive theory and practice, social work education benefits from assessing students’ perceptions of this learning. fisher, allen, and washington use thematic analysis of student writings and focus group interviews to describe the difficulties, hopes, and applications of knowledge for msw students. political practice and policy practice are generally seen as challenging for undergraduate social work students. using a preand post-test methodology, berkowitz recommends experiential learning techniques to engage students in policy practice in class and in the future. colvin, bullock, and jackson write a conceptual piece about how social work students’ abilities to deal with societal challenges might be better developed using the metaverse. potential benefits and implications for practice provide insights into this promising technology. the importance of supportive doctoral education cannot be overstated for the growing social work academy. in a nationwide survey, mirick and wladkowsi find that a major lack of support is reported by doctoral students who are pregnant during their education. survey results provide knowledge social work doctoral programs can use to better support their students. grand challenges pulling back the educational lens a bit, apgar and zerrusen studied msw students’ views on the grand challenges for social work and society. in addition to finding that about:blank advances in social work, spring 2024, 24(1) viii many schools do not teach about the grand challenges, and many students have not heard of them, apgar and zerrusen dive into the nuances of students’ views of these issues. a specific grand challenge is ensuring healthy development for youth. a mixedmethods study using survey and focus group data examines how latina adolescents see their strengths, assets, and societal contexts. weiss, enrile, smith-maddox, cohen, and davis provide suggestions for preventive social work and positive youth development. social work advocacy our international lens is focused on migrant women in the middle east in an article by baltimore and kim. in their efforts to improve access to mental health support for this group of individuals who face many barriers, the authors advocate for the promotion of mental health literacy in research and practice. another group of people who face many personal and societal barriers are people who identify as lgbtqia+ and are living in rural communities. timbers, ward, and ballard provide three examples of the grassroots work provided by organizations which serve lgbtqia+ people, which can help inspire other communities to build their movements. evidence synthesis reviews in social work with the increasing interest in systematic reviews and scoping reviews, which comprise the category of evidence synthesis reviews, marsalis presents practical advice for authors. the explanations, steps, and resources provided can aid researchers as well as journal reviewers and editors in improving the literature base. appreciation of reviewers we would like to acknowledge the contributions of the many individuals who review manuscripts for advances in social work. journal publishing is one of the many places in social work where we rely on the work of others to move forward, and we deeply appreciate the time that our reviewers give us. if you would like to join their ranks, please let us know. _________ jashawn hill, lcsw, executive director at chicago survivors, chicago, il. andrya soprych, dsw, lcsw, assistant professor, social work department, northeastern illinois university, chicago, il. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 269-285, doi: 10.18060/27353 this work is licensed under a creative commons attribution 4.0 international license. beginning the healing journey: re-storying violent loss through tree of life narrative groupwork jashawn hill andrya soprych abstract: storytelling is a pathway to healing for youth, families, and communities impacted by gun violence. it allows survivors to re-story the devastation and trauma into narratives that re-member the person lost and find purpose and meaning from the painful experience. tree of life is a group storytelling intervention developed in southern africa and rooted in narrative traditions that is emerging as a powerful starting point for addressing the traumatic impact of homicide in chicago. this case study weaves together the narrative of the first author in her work at chicago survivors with research on gun violence, homicide bereavement, and tree of life in order to make an argument for its relevance in treating survivors of community gun violence in the united states. we contend that tree of life has potential to work across systems levels as youth and families find purpose through the pain generated from violent loss. we encourage social work clinicians to bring narrative practices and the tree of life approach into their practice and challenge social work researchers to develop partnerships with community organizations such as chicago survivors to develop a research base for this promising approach. keywords: narrative practice; community gun violence; grief support; tree of life community gun violence has had a devastating impact on the city of chicago, leaving many individuals and communities struggling to cope with the trauma and loss caused by these incidents (hendershot, 2022). community gun violence refers to interpersonal firearm violence entwined with structural violence. within this framework, interpersonal firearm violence transpires among unrelated individuals, regardless of their familiarity, while structural violence hinders the community from accessing meaningful opportunities to meet their fundamental health and safety needs (buggs et al., 2023; krug et al., 2002). community gun violence is pervasive and unevenly “concentrated in racially and economically segregated communities” that are overwhelmingly black, latinx, and economically divested (buggs et al., 2023, p. 2). media platforms throughout the nation are inundated with a single narrative of violence within chicago communities that fails to honor the lives and humanity both of those who have been lost to community gun violence and those who survive the murder of their peers and loved ones. as a profession committed to advocating for social and racial justice across system levels, social workers are uniquely situated to respond and challenge the single story (adichie, 2009) of community gun violence. the primary author is a black clinical social worker and executive director of chicago survivors (2023). she grew up in chicago, and is a survivor of community gun violence. the second author is a white woman raised in the suburban midwest who has learned, about:blank advances in social work, summer 2024, 24(2) 270 practiced, taught, and supervised social work across chicago’s diverse neighborhoods for the better part of two decades. through this narrative, we share how the primary author has seen tree of life, a narrative groupwork approach, unlock the capacity for marginalized communities to re-story their losses and access alternative narratives of healing, hope, and advocacy. in doing so, we challenge social workers to advocate for social and racial justice and offer a framework for engaging with survivors of community gun violence using the tree of life approach as a starting point. we begin by examining the impact of community gun violence using research literature and the first author’s experience with chicago survivors. from there we situate social workers as responders to community gun violence and introduce the tree of life as a good fit for social workers who engage with survivors. the primary author then shares her reflection on the first four tree of life groups facilitated by chicago survivors. we wrap up with implications for future social work practice and research. examining the impact of community gun violence survivor experiences research on homicide bereavement in the united states offers insight into the experiences of people who have lost loved ones to community gun violence. key findings include experiencing the loss as trauma (pabon & basile, 2022), facing stigma (bailey et al., 2013), isolation (metzger et al., 2015), loneliness (hava, 2023), and undergoing a shift in one’s worldview as a result of the violent loss (englebrecht et al., 2016). homicide bereavement can be a deeply traumatic experience, with a significant impact on mental health and well-being. survivors are at a heightened risk for post-traumatic stress and complicated grief (aldrich & kallivayalil, 2016; sharpe, 2015). violent loss as trauma through advances in neurobiology, we know that trauma has a physical impact on the brain (van der kolk, 2015). when trauma occurs, such as exposure to violent death, the ability of the survivor to access the parts of their brain that allow for feelings of safety, emotional regulation, and language for processing the violence are restricted (van der kolk, 2015). for participants at chicago survivors, feelings of being unsafe and disconnected from the world around them often overshadow their ability to connect with alternative narratives and consider present and future possibilities. from a neurobiological perspective (oberle et al., 2021), the tree of life intervention can be seen as attempting to interrupt the trauma reactive part of one’s narrative by providing a pathway to explore additional parts of the participants’ story in order for them to first feel safe, calm, and regulated. social work facilitators support participants as they move from a single-story narrative of violence and loss to second stories of connection, relational support, individual strengths, and begin to see potential pathways for an autonomous future. hill & soprych /healing journey 271 anticipatory trauma in addition to grieving the loss of their loved one, survivors of community violence are also often navigating ongoing threats to their own safety, which creates a complex web of ongoing and anticipatory trauma to work through (armstrong & carlson, 2019; smith, 2015; smith lee et al., 2020). armstrong and carlson (2019) define anticipatory trauma as practices and discourses grounded in fear of future events. smith (2015) found that “homicide deaths of close peers crystallized the lethality of neighborhood violence” (p. s486) creating both a sense of personal vulnerability to their own violent death as well as a bracing of oneself for additional encounters with traumatic loss. the reality of ongoing and anticipatory trauma is exemplified by a youth engaged with chicago survivors who while mourning her brother’s murder was being assailed with threats to her own safety. she was inundated daily with both psychological triggers and physical threats. advocacy and safety planning were needed in conjunction with therapy to help restore her sense of safety. stigma, isolation, and loneliness the grief and trauma of violent loss can be exacerbated and become disenfranchised as survivors face the stigma of gun violence and judgment from outsiders for being in a neighborhood with ongoing community violence (aldrich & kallivayalil, 2016; bailey et al., 2013; hava, 2023). doka’s (2008) definition of disenfranchised grief, which is grief that “is not openly acknowledged, socially validated, or publicly mourned” (p. 223) offers a useful framework for understanding the grief of losing someone to community gun violence. bailey et al. (2013) found that black mothers faced assumptions that their sons were violent and engaged in criminal activity. regardless of the truth, this stigmatization led black mothers to feel embarrassment and shame, unable to grieve publicly. pabon and basile (2022) considered disenfranchised grief as a common experience for black youth who were perceived as “professional grievers” (p. 75) not in need of services as a result of living in a neighborhood with high rates of violence. this assumption of resilience is where the lead author has seen youth push back and cry out asking to be treated with compassion and understanding. youth living in neighborhoods plagued by violence have no choice but to be resilient. it is not a badge of honor or an achievement to be celebrated. it comes out of the depths of despair and trauma. to be resilient for these youth is to be reminded of the significant loss, too often losses, they have faced. the stigma of gun violence can lead to isolation and loneliness as the bereaved navigate personal narratives of loss that differ significantly from the public narrative of senseless community violence (bailey et al., 2013; hava, 2023). some survivors choose to remain in their homes due to deep positive community ties despite experiencing judgment and blame for staying in a neighborhood with high rates of violence (aldrich & kallivayalil, 2016). others, many of whom have reached out to chicago survivors to request emergency relocation, want nothing more than to leave but lack the resources and support to move. the violent, startling loss of a loved one or peer to gun violence can shatter one’s worldview, forever changing the way survivors see the world (englebrecht et al., 2016; sharpe, 2015). advances in social work, summer 2024, 24(2) 272 survivor needs research on homicide bereavement in the united states also offers insight into the needs of people who have lost loved ones to community gun violence. in the wake of a homicide, survivors have a heightened need for meaning-making, culturally appropriate treatment and social support. meaning-making meaning-making is consistently highlighted as a crucial element of grieving homicide (bailey et al., 2013; johnson et al., 2022; johnson & zitzmann, 2021; smith lee et al., 2020; sharpe, 2015; zakarian et al., 2019). participants at chicago survivors continuously expressed a need to re-define their purpose over the pain of the incident. meaning-making can be searching for answers (sharpe, 2015), a cognitive-emotional process influenced by racism and stigma (bailey et al., 2013), a spiritual endeavor (johnson & zitzmann, 2021; smith lee et al., 2020), and grounded in action to help others (johnson et al., 2022). one mother, supported by the primary author, created the organization where do we go from here in her attempt to make sense of senseless violence through action. meaning-making is a deeply personal process, and in the wake of a homicide is rarely about closure or moving on, but instead about persevering and finding a way to engage in the present (aldrich & kallivayalil, 2016). chicago survivors has found that working with survivors to explore newfound purposes beyond their painful losses is a critical component for meaning-making. culturally appropriate treatment culturally appropriate treatment is essential for individuals who have lost a loved one to community gun violence. a culturally appropriate treatment approach recognizes that the experience of grief and trauma is deeply rooted in cultural and social contexts, and that the ways in which individuals cope with these experiences may be shaped by their cultural and historical backgrounds. community gun violence disproportionately affects marginalized and under-resourced communities “that have been affected by and subjected to historical and present-day structural racism and inequity” (buggs et al., 2023, p. 2). in chicago, just five out of 25 police districts, all of which are marginalized and underresourced, made up over 40 percent of all homicides in 2021 (hendershot, 2022). treatment approaches ought to reflect and honor the cultural, social, and historical factors inherent in grief and trauma due to community gun violence (johnson et al., 2022; sharpe, 2015; smith lee et al., 2020). a culturally appropriate approach to community gun violence works both individually and structurally at the intersection of race, stigma, and violence rejecting “the idea that any community is inherently or inevitably violent and instead centers the many strengths of community” (buggs et al., 2023, p. 2) hill & soprych /healing journey 273 social support given the risk of isolation and loneliness, social support is a crucial element in homicide bereavement (aldrich & kallivayalil, 2016). research has shown that social support can play a key role in promoting healing and resilience as well as having important implications for long-term mental health outcomes (hava, 2023; metzger et al., 2015). englebrecht et al. (2016) found that relationships were impacted because of homicide and survivors found support from others with similar experiences. losing a loved one to homicide can be a devastating and traumatic event. social support can provide a sense of comfort, validation, and connection during this difficult time particularly among people who can relate to the unique devastation of homicide loss. realizing the need for social support, chicago survivors created the community of survivors program, which is available in perpetuity for families impacted by community violence. this program offers ongoing peer-to-peer support that continues to evolve in order to address the needs of the community. research on homicide bereavement and gun violence in the united states suggests that addressing the needs of survivors requires a comprehensive and holistic approach that considers the traumatic impact of homicide, the importance of social support, and the need for culturally appropriate services. social workers, with a strengths-based, person-inenvironment orientation, called to social and racial justice, are positioned to address the individual and collective trauma caused by community gun violence. social workers as responders to community gun violence social workers can offer a compassionate and understanding space for individuals to process their grief, navigate the emotional turmoil, and rebuild their lives in the aftermath of the devastating loss of loved ones and peers to community gun violence. social workers also play a crucial role in connecting survivors with vital resources and collaborating with local organizations, law enforcement, and mental health professionals to establish comprehensive, culturally sensitive interventions that address the unique needs of those affected by gun violence. additionally, social workers can engage in advocacy efforts aimed at addressing systemic issues contributing to gun violence, advocating for policy changes, and fostering community to address the root causes of violence. through their commitment to social justice and their ability to provide holistic support, social workers serve as invaluable allies in the healing journey of those mourning the loss of loved ones to community gun violence. when a social worker shows up in a person’s life after they suddenly and violently lose someone they loved, the social worker arrives on the scene entering into their most vulnerable and heartbreaking moments. at chicago survivors, social workers and crisis responders are called upon to stand with survivors, bear witness to their unimaginable pain, and guide them along the many paths of healing that often feel tedious, unfair, relentless, and misappropriated. as one mother told the primary author, “this doesn’t belong to me, i did not sign up for this club.” narrative practices offer a compelling and effective framework for social workers to employ as they support survivors of violent loss. narrative advances in social work, summer 2024, 24(2) 274 approaches provide social workers a way to recognize and respect the unique stories and lived experiences of survivors, thereby fostering a more person-centered and empathetic approach to intervention (yuen, 2007). through narrative practice, clients reclaim authorship of their stories, promoting a sense of agency and self-determination in the face of adversity (white & epston, 1990). moreover, narrative practices facilitate a deeper understanding of the complex interplay between personal, cultural, and societal factors that shape individuals' lives (mctighe, 2018). through collaborative storytelling, social workers can uncover strengths, resilience, and untapped resources within clients and communities, creating a pathway for more targeted and sustainable interventions (yuen, 2007). ultimately, the integration of narrative practices aligns with the core principles of social work, promoting inclusivity, cultural sensitivity, and a strengths-based perspective, while contributing to the overarching goal of empowering individuals to rewrite and reclaim their narratives in the pursuit of positive change. the adults, youth, and families impacted by gun violence, often remain in their community while engaging in services. many psychological interventions assume the survivor is in a place of safety when they begin therapy, which is often not the case for people who are at risk for and experience ongoing community violence. group-based interventions that create safe spaces for discussing and reconstructing personal narratives and identify personal and community coping tools have been found to support healing from past trauma amidst ongoing violence (mpande et al., 2013). the tree of life framework is a promising approach for social workers supporting survivors of community gun violence because it begins by having participants create a safe place from which they can explore their trauma despite ongoing civil disturbance in the neighborhoods in which survivors reside. additionally, the narrative-based intervention intentionally addresses trauma, through social support, in a culturally appropriate way, thereby aligning with the key research findings on responding to homicide bereavement. tree of life approach the tree of life approach uses the metaphor of a tree and the forest to support participants in decentering their problem story and creating a counternarrative as more than their trauma-driven hardships that is grounded in their strengths, hopes, and dreams. figure 1 depicts an image of chicago survivors’ tree that identifies the components participants develop as they create their own tree. survivors of violent loss are at heightened risk for complicated grief which involves being stuck in or consumed by the loss and unable to move on (burke & neimeyer, 2013). the tree of life approach begins to address the social and emotional needs of participants by using holistic and integrative approaches that honor the person lost and helps the participant connect to and find strength in their ancestry and identities using figure 1. chicago survivors’ tree of life: the component parts hill & soprych /healing journey 275 creative arts expression and narrative informed techniques. this connection to one’s ancestry highlights how tree of life is a culturally attuned approach encouraging each participant to celebrate and find strength in their heritage. the approach was first introduced by ncazelo ncube in southern africa to support children orphaned by hiv/aids (ncube, 2006). ncube (2006) incorporated ideas from narrative therapy through consultation with the dulwich centre. training with the narrative therapy centre teaches social workers how to facilitate as participants transition out of problem stories and into second stories of their lives using art, music, poetry, and monologue. skills for reframing negative self-perception and creative techniques for increasing positive interpersonal connection and developing a sense of community in healing from the trauma of violent loss can be developed. in the following section, we explore how the tree of life approach has the potential to honor the experiences and begin to meet the needs of community gun violence survivors. the fit between tree of life and community gun violence in the united states as seen in the literature on homicide bereavement and gun violence, and witnessed by the primary author, violent loss is a trauma often accompanied by stigma, isolation, loneliness, and a disruption to one’s worldview. in the aftermath of the devastation, survivors need social support and culturally appropriate services as they strive to make meaning from the loss. meaning-making while originally developed to work with children orphaned by aids in southern africa and then adapted to work with refugees, tree of life appears to be a promising approach for survivors of community gun violence in the united states. underpinning the tree of life approach is an understanding that traumatic experiences can shatter individuals' assumptions about themselves, others, and the world, leading to a sense of disorientation and loss of meaning. survivors are encouraged to explore their personal narratives and the stories that make up their identity through tree of life. this process helps participants gain insight into the meaning they attach to their experiences and identify their strengths and resources. as survivors construct a second story that honors but does not center the loss and is grounded in their identity and cultural and spiritual resources, participants begin to regain a sense of control and agency as they develop their own meaning-making process that fosters a renewed sense of purpose and meaning in life. through this process, individuals can gain a deeper understanding of themselves and their experiences, and work towards healing and growth. a review of the components of the tree of life approach shows how it addresses the needs and experiences of community gun violence survivors. advances in social work, summer 2024, 24(2) 276 cultural appropriateness the approach recognizes that witnessing a homicide or surviving the death of a loved one due to gun violence is a traumatic event that can have long-lasting effects on individuals and their families. noticing that retelling the death narrative looking for some catharsis to move on was not only unhelpful but also retraumatizing youth and their caregivers, ncube (2006) emphasized the importance of creating a safe place to stand before re-storying devastating loss. in this first phase, creating a secure foundation is accomplished as participants craft the main elements of their tree (hughes, 2014; jacobs, 2018; lock, 2016; ncube, 2006). drawing the roots of their tree involves connecting to their ancestry and drawing their origins along with the things and people important to them. the ground represents where they live now and what they do on a daily basis. the trunk is where participants highlight their skills and abilities. branches reflect their hopes, dreams, and wishes, while leaves represent people who are important to the participant. fruits signify both tangible and intangible gifts they have been given. this first phase of the group work emphasizes the strengths and positive community of each participant. beginning from strengths instead of the loss helps to decenter the problem story and remind participants they are so much more than the trauma they have faced. not only does the creation of their tree establish a safe and supportive environment for survivors to process their trauma and promote healing, but it also allows individuals to draw on their own cultural resources and experiences to cope with their grief and trauma (hughes, 2014). tree of life offers community members an opportunity to explore their narrative outside the social norms and stigmatizations related to the death of their loved ones. through the use of storytelling, visualization, and art-based activities, tree of life group work encourages facilitators to use culturally relevant and age-appropriate approaches to help survivors identify and strengthen their internal and external resources. participants create their tree with any combination of words, colors, shapes, textures, and images empowering the survivor as they choose how to share their tree and allow others to become curious about their narrative. participants are encouraged to explore their cultural and spiritual beliefs and practices through the creation of their roots and fruits, which can provide a sense of comfort and meaning during difficult times (hughes, 2014; lock, 2016; ncube, 2006). social support as a group intervention, the approach emphasizes the importance of social support and fosters a sense of community, which can combat the isolation and loneliness community gun violence survivors often face (ibrahim & allen, 2018). the primary author has witnessed this collective work between family systems as a freedom to connect and identify their community, caregivers, and self-assigned “family” as a restorative way to work together, while designing and defining their unique tree. it is a journey of exploration within their present narrative, historical background, and future aspirations. when the trees are constructed and designed from roots to fruits, the finished work is displayed in a shared space (jacobs, 2018; lock, 2016; ncube, 2006). participants tell the story of their tree while also reflecting and commenting on others’ trees demonstrating a forestry of hill & soprych /healing journey 277 connection and community. the primary author has witnessed a residence of joy and intentional presence that vibrates through the room when the stories of each tree are shared, and the members affirm and validate each other’s narratives. the lived experiences shared are diverse in physical presentation but when arranged and aligned together provide a view of a collective communal identity. examples of the diversity of completed trees are shared in figure 2, which depicts a forestry of trees that includes adult, adolescent, and child trees. figure 2. example of a forestry of trees having built a secure base, the group is ready to talk about their losses in ways that are not re-traumatizing. in the tree of life approach, this is called when the storms come (ncube, 2006). storms are a metaphor for the difficult times and traumas participants have faced. the conversation around storms is collective and encourages community members to share their ideas and skills with each other as they talk about weathering the storms (lock, 2016). discussing storms can involve acknowledging the stigma survivors have faced due to public perceptions of gun violence and community violence as well as identifying the shifting or disrupted worldview many survivors experience. additionally, the tree of life approach holds space for participants to recognize the social and systemic issues that can contribute to gun violence, such as poverty, racism, and lack of access to mental health resources. participants can explore these issues as they define their storms and find ways to address them, not just in their personal lives but also on a community and societal level. considering societal and systemic issues in relationship to the storms participants face can help survivors reframe their experiences and promote post-traumatic growth. at the completion of the group and development of their counternarratives, a celebratory moment is shared among participants and facilitators to symbolize survivors’ progression and the capacity to see themselves differently in this world. certificates are provided as an offering of passage into their second story. the certificates record their abilities, hopes, and dreams, and represent tangible evidence of movement in the individual and the collective community. participants are offered a chance to provide feedback, and congruent with the primary author’s experience, facilitators report that participants have found the group overwhelmingly positive (dickson, 2009; hughes, 2014; ibrahim & allen, 2018; jacobs, 2018; ncube, 2006). coming into the group, participants describe feeling stuck and unable to escape the negative impact brought by reminders of their loss. the shift in perspective surrounding senseless gun violence, reduction in feelings of meaningless living, and community created through tree of life group work creates an entry point to burgeoning hope and healing. the certificate is a reminder of what life means and can mean beyond violent loss. advances in social work, summer 2024, 24(2) 278 this approach to addressing bereavement due to homicide is particularly useful for participants who are living within communities of violence, where the sense of control and safety in one’s daily functioning can be limited. reflections from the primary author who was the facilitator for the first four tree of life groups for survivors of community gun violence in chicago are shared below. community members’ need and willingness to break out of isolation, and reach beyond the trauma reactive features associated with those who grieve the horrific losses they have faced, is demonstrated in their engagement in the initial groups and ongoing requests to run more groups, which is a testament to tree of life as a good fit for responding to community gun violence in the united states. reflections from the first four groups responding to the survivor community’s needs for gathering and seeking alternatives to cope with the pain of violent loss, four groups were organized to introduce the tree of life intervention in chicago. two groups were set up for families enrolled in the community of survivors program, chicago survivors’ peer-to-peer support group for families looking to connect with fellow survivors of violent loss. length of time since the homicide ranged from 30 days to five years. enrollment was voluntary. community of survivor participants were sent a flyer that outlined the group’s purpose and included an invitation to participate. both groups filled quickly and were diverse. the age span included children as young as three years old through a grandmother in her seventies. there were families as small as one and as large as six who came together each week to participate in the structured series of sessions to discuss their experience, their identities, and stories of their heritage. two additional groups were set up in chicago public high schools for youth who had direct exposure to homicide loss. length of time since the loss ranged from 30 days to one junior whose parent was killed when she was three years old. students were recommended by the school social workers and both parents and students consented to student participation. all four tree of life groups were facilitated between march and june of 2022. preparing for triggers recognizing the different timelines of loss and different trajectories of grieving for those who signed up, additional clinical staff from chicago survivors were present during group sessions to ensure the emotional support needed would be readily available to members. in the event that a member experienced amplified triggers through the group work either due to the fresh wounds surrounding parts of their story or because they were reliving events they had not yet processed, clinical staff were prepared to offer additional support. chicago survivors emphasized providing survivors safety in the group space so that the acknowledgement of sensory activation could be felt and not re-traumatize the participants. fortunately, no one in any of the groups required additional interventions while the groups ran. hill & soprych /healing journey 279 community of survivors group as the lead author reflects on what she witnessed in the two groups run for community of survivors members, what stands out above the rest is the impact of having multiple generations in the same group processing trauma and loss together. multiple generations within one family had the opportunity to share how they were impacted by the violent loss from an age-appropriate perspective and as congruous for the generation they were born within. this cross generational approach appeared to be particularly powerful for families who were mired in the ruthless effects of multiple gun violence homicides across generations. generational divides were bridged as mothers and grandmothers told stories of opportunity, prosperity, and community in their decision to move to chicago in the fifties and sixties. their younger daughters and granddaughters who wondered why they lived in communities plagued with violence were gifted tales of their community that began to restory the narrative of their neighborhood as more than the present-day violence. providing a safe space for curiosity and exploration in this intergenerational space, the primary author witnessed family members owning their stories individually and collectively through the design and definition of each segment of their tree. for example, in his branches, a son began to describe his hopes and dreams, and because he had lost his dad to gun violence that past spring, those hopes and dreams began to speak to how he would make his father proud. he was the fifth of his name and honoring that, the dreams of his father became his dreams, and the legacy of his name took on new meaning. his mother, who lost her brother when she was a teenager to gun violence, heard his narrative filled with hope and began to believe in her son’s ability to heal and experience what she called “the good life” after such a tragedy. she saw healing for him that she never had for herself. as these examples show, one generation influenced and impacted another generation and it went back and forth in this way as the commonalities of unburdening their grief and loss experiences, while simultaneously exploring and gaining from their skills, gifts, and creative mindsets gave a pathway to counternarratives. high school group the two high school groups were distinct from the community of survivors groups in part because there were no intergenerational exchanges. when discussions of the roots of the trees were presented, many of the youth expressed limited access to historical experiences and initially were not sure why it mattered. some felt vulnerable requesting the information from their elders and wondered if it would be seen as dishonoring or disrespecting the family. others were not in the care of biological family and did not know who to ask. this was a learning curve for the session series, which the primary author responded to by exploring with the youth the value of ancestry. once they were interested, they discussed how to approach their elders in a respectful way. they practiced through mock conversations and many of the youth were able to find joy in discovering and sharing the narrative of who they were connected to and how these connections came to be. advances in social work, summer 2024, 24(2) 280 without the intergenerational component, the homogeneity of the high school group seemed to lead to powerful cohesion and support among participants. perhaps most impactful in these groups was bearing witness as the youth navigated the presence of ongoing community violence while trying to heal from past gun violence. exposure to homicide was a requirement for enrollment and as our groups ran, participants were beset with sudden shootings and school lockdowns due to violence both at school and in the surrounding neighborhood. recognizing that the likelihood of being shot and killed before their high school graduation is statistically more likely than dying in a car crash can drain the ability to hope and aspire for positive beliefs (national safety council, 2023). the students were not deterred and while they pushed back against being called resilient, they are survivors. the primary author saw relationships formed through the years that involved checking in on each other’s safety at home, supporting each other through additional losses, and providing accountability to graduate or go to a new school setting. as they moved into their presentation segment, the pride and joy expressed was sacred. the sharing of hopes and dreams, gifts and talents, history and family may seem like ordinary messages to be explored. however, in the lives of those facing the negative impact, bias, and stereotypes that go along with living in communities of violence, these are rare occurrences that deviate from the dominant narrative. the youth were able to present their completed projects and relate to each other’s losses as well as the nature of the pain due to community violence as they constructed their forest of trees. hearing them affirm and express gratitude for the art of expression through the visual aids of a tree was momentous. in this stage of the group’s cohesion, the primary author felt more like a witness than a facilitator. she could see them open themselves to experiences they had so often avoided sharing and the group responded with support helping each other reauthor their own and collective narratives. the completion of the program was met with requests for chicago survivors’ return next year, and requests to support the youth in improving their ability to share their stories in more meaningful ways. social work practice implications social workers are encouraged to incorporate tree of life into their practice and are reminded that it is just the beginning of addressing the complex trauma caused by witnessing gun violence and loss due to homicide. it opens the door as an entry point (dickson, 2009) for continued therapeutic work as survivors build their narrative and restory their experiences. therefore, tree of life fits best within a series of trauma-conscious narrative-focused interventions. with this approach, the social worker can build rapport with clients through person centered dynamics and designate safe spaces of exploration as it relates to their lifelong experiences that are inclusive of their trauma narrative. the pressure to take deep dives into the tragedy that brought the survivors together is not presented as paramount for their healing, but it is positioned as a potential next step if the survivor seeks to develop that part of their story in ways that matter and make sense to them. tree of life work acknowledges where and how traumatic experiences have impacted a survivor and their community and supports the self determination of the survivor in moving forward. we cannot emphasize enough; tree of life work is not a panacea and is not expected to resolve all grief and trauma symptoms for participants. it is, hill & soprych /healing journey 281 however, a powerful starting point that is particularly well suited in communities that may be reluctant to engage or find traditional western psychotherapy approaches inadequate. recognizing tree of life as an entry point, social workers can craft a series of trauma conscious narrative practices for survivors of community gun violence. for example, for work within school systems, chicago survivors will be piloting a continuum of support that will include a social worker on site for weekly treatment planning and therapy. after completing the tree of life group, youth will begin an eightto twelve-week series entitled the power of storytelling, which was developed by the primary author. the power of storytelling uses a narrative based framework that supports participants as they continue to explore pathways of possibilities connected with post-traumatic growth. walking with the bereaved in the wake of violent loss requires bearing witness to their grief. listening to and supporting individuals who have experienced trauma can be both rewarding and challenging and can take a toll on the emotional and psychological wellbeing of the social worker. the concept of trauma stewardship, as introduced by van dernoot lipsky and burk (2009), offers a framework for engaging in the self-care necessary to remain in this line of work. trauma stewardship brings self-care into the how and why we do our work. as social workers, we have the honor of providing a safe and supportive space for individuals to share their stories and to work towards healing. we also have a responsibility to ensure that we are not contributing to the re-traumatization of individuals with approaches that are not only ineffective but also harmful (garo & lawson, 2019). by attending to our own needs and framing our work as trauma stewards, we are better able to support and bear witness to the trauma of others, while also protecting ourselves from burnout and compassion fatigue. in this way, trauma stewardship and selfcare are essential components of the healing process, not only for those who have experienced trauma, but also for social workers who are committed to supporting them. for social workers interested in being trained in narrative practices broadly and the tree of life specifically, chicago survivors group facilitators were trained by and offer connections to the narrative therapy centre (n.d.) in ontario, canada. for more intensive courses and certification programs social workers can explore partnerships with the founding narrative practices organization, the dulwich centre in adelaide, australia, which offers both virtual and in person training opportunities (dulwich centre publications pty ltd & dulwich centre foundation inc., n.d.). lastly, we have collaborated with jill friedman of evanston family therapy center (n.d.) to receive grief specific narrative practice tools. social work research implications opportunities for research around tree of life abound. in stiles et al.'s (2021) review of the existing literature, they found no scientifically rigorous studies on tree of life, noting that all prior studies had insufficient sample sizes. similarly, stubbs (2022) in her exploration of facilitators’ experiences of tree of life found only 10 empirical articles, with similarly small sample sizes except for one thematic analysis with 93 participants. stiles et al. (2021) developed the roots and wings questionnaire for children and youth in concert with a proposal to study the effectiveness of tree of life in work with refugee advances in social work, summer 2024, 24(2) 282 youth across the united states, canada, the united kingdom, and south africa. no empirical studies of tree of life work specifically with survivors of gun violence in the united states were found. to begin to build the research base of tree of life for survivors of community gun violence, the authors propose a university or research center collaboration with chicago survivors to examine the participant experience of the tree of life approach and develop a research agenda built off themes from clinical feedback collected from the first four cohorts. social workers who are using or begin to use the tree of life approach are encouraged to engage in practice-based research examining the impact of the intervention. conclusion in weaving the primary author’s narrative around her work at chicago survivors with research on gun violence, homicide bereavement, and the tree of life approach, we have attempted to write a counternarrative that honors the unimaginable work of surviving the murder of one’s peers and loved ones amid community violence and shows social workers ways to engage in this work. initial tree of life groups hosted within the survivor community, have shown us that though it is an entry into the work of addressing the trauma narrative, especially around difficult experiences such as community violence, it may be an ideal methodology for accessing challenging sectors of their story in a trauma informed way. providing a safe space, compassionate communication, and a culturally conscious response through the tree of life framework gave community members a look into the benefits of a therapeutic experience and left them ready for more. it extended a bridge into more ways to belong and envision themselves outside of the single story of community violence. the youth and families served through the initial four groups found relevance in seeing the whole tree, even while noticing the parts that brought sadness, separation, or discomfort. the power of shared experiences, demonstrated in the forest of the trees, no matter how difficult, brought people together through their pain, grief, and willingness to heal. it was transformative, relational, and therapeutic. join us in embracing the potential of the tree of life narrative groupwork approach to enrich our social work practice and empower individuals and communities towards healing and collective growth. references adichie, c. n. 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(2019). relations among meaning making, ptsd, and complicated grief following homicide loss. journal of loss & trauma, 24(3), 279-291. author note: address correspondence to andrya soprych, social work department, northeastern illinois university, chicago, il 60625. email: asoprych@neiu.edu https://doi.org/10.1007/s40653-019-00286-w https://doi.org/10.1007/s40653-019-00286-w https://doi.org/10.18745/th.25319 https://doi.org/10.18745/th.25319 https://dulwichcentre.com.au/wp-content/uploads/2021/02/discovering-childrens-response-to-trauma.pdf https://dulwichcentre.com.au/wp-content/uploads/2021/02/discovering-childrens-response-to-trauma.pdf https://doi.org/10.1080/15325024.2019.1565111 https://doi.org/10.1080/15325024.2019.1565111 mailto:asoprych@neiu.edu _________ saija koskiniemi, msc, doctoral researcher, and tiina syyrilä, phd, post doctoral researcher, department of nursing science, university of eastern finland, kuopio, finland. mia mäntymaa, msc, development consultant, jouko ranta, mnsc, quality manager, and minna säilä, msc, special designer, city of helsinki, helsinki, finland. katri vehviläinen-julkunen, phd, professor, department of nursing science, university of eastern finland, and kuopio university hospital, kuopio, finland. aini pehkonen, dsc, professor, department of social sciences, and marja härkänen, phd, associate professor, department of nursing science, university of eastern finland, finland kuopio, finland. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 409-424, doi: 10.18060/26488 this work is licensed under a creative commons attribution 4.0 international license. observed risks of client safety by social care professionals in finland: trend analysis for 2016–2020 saija koskiniemi tiina syyrilä mia mäntymaa jouko ranta minna säilä katri vehviläinen-julkunen aini pehkonen marja härkänen abstract: to promote client safety, finland’s social welfare act requires social services employees to notify superiors of the observed risks in implementing clients’ social welfare. this study provides the first retrospective trend analysis of reports from a care reporting system (spro-system) in finland. reports (n=1,433) were made by social work employees in the city of helsinki in finland, from october 2016 to december 2020. the statistical analysis focused on investigating trends in the reports. most commonly reporters were practical nurses or other care workers (31.0%, n=444) or social advisors or other advisors of social work (23%, n=329). the total of observed risks or threats increased annually, except in 2019. the content of reports mainly related to a lack of realization of the status and rights of clients (32.5%, n=475) with the consequence for clients being moderate harm (28.3%, n=406). information and discussion about client safety events (55.1%, n=860) were perceived as the most important ways to prevent the recurrence of such incidences. more empirical research is needed on client safety from the social work perspective. risks in social care are diverse, but professionals’ observations may help to prevent them. thus, reporting practices relating to client safety risks should be strongly encouraged, if not mandated. keywords: social care, risk, incident reporting system, client safety voluntary patient safety incident reporting is common practice in most developed health-care systems worldwide (world health organization [who], 2020b). a similar system is less common in social care and client safety. in finland, when employees of social care services detect risk or threat in the implementation of clients’ social welfare, the social welfare act (2014) requires them to report observations to superiors. the risk or threat is an undesired event that can affect a client’s social welfare implementation. the obligation to report started on 1 january 2016 and reports can be made notwithstanding confidentiality provisions. the reporter must not be punished for reporting risks or threats (social welfare act, 2014), and the professionals involved should be supported (ministry of social affairs and health, 2022a). the report’s recipient shall immediately initiate action to remedy the risk or threat thereof (social welfare act, 2014). this reporting obligation applies to all employees of social services; however, clients or relatives cannot report the risks or threats to a similar system. the aim is to introduce a reporting system for clients over the next few years (ministry of social affairs and health, 2022a). a similar reporting system was introduced in health care in finland in 2007 to report patient safety incidents on a voluntary basis. in health care, patients or anyone who notices patient safety incidents can report to the system about patient safety incidents in many hospital districts in about:blank advances in social work, summer/fall 2023, 23(2) 410 finland. the aim is to further expand to report possibilities of safety incidents for clients in social services (ministry of social affairs and health, 2022a). finland's social welfare and health-care system is funded by the government and implemented by municipalities. non-urgent social and health-care services are provided in a person’s home municipality; however, urgent services must be provided regardless of the home municipality. after the health and social services reform, the responsibility rests on well-being services counties as of january 2023, in which case funding comes mainly from the government. the private sector also provides social and healthcare services (ministry of social affairs and health, 2022b). the social protection system includes social security and social welfare. in finland, everyone who cannot obtain the means necessary for a life of dignity has the right to social security (constitution of finland, 1999). social welfare includes social services, related support services, and other measures that social welfare professionals adopt to promote and maintain the social well-being, functional capacity, safety and inclusion of individuals, families, and communities (ministry of social affairs and health, 2022b). social care services are intended to promote clients’ social well-being and functional capacity and prevent, reduce, and eliminate social problems (social welfare act 2014,). social care includes a wide range of services, from child welfare, family caregivers’ support, family social work, and housing services to substance abuse and mental health services (social welfare act, 2014). the organizations involved in social services are very complex systems (gibson, 2014; sicora, 2017). clients of social care services are of all ages, and the non-urgent need for services is based on assessing the demand for services (social welfare act, 2014). social care services expenditures accounted for 39% of the overall social protection expenditure in 2020. social protection is financed by the state, municipalities, employers, insured people, and the returns on social protection funds (finnish institute for health and welfare, 2020). improving client safety the reporting obligation under the social welfare act (2014) promotes client safety (ministry of social affairs and health, 2022a). client safety refers to the principles and functions of persons and organizations acting in social care to ensure the safety of treatments and services, and to protect clients from harm. client safety in social care signifies the organization, production, and implementation of services so that the client’s physical, psychological, social, or economic safety is not compromised (ministry of social affairs and health, 2022a). the social welfare act (2014) aims to ensure that the clients’ legal rights are fulfilled. the obligation to report makes it possible to develop the quality of services; however, the reporting obligation also contributes to monitoring the implementation of the client’s legal rights. responsibility in the detection of risks is central. detecting risks can prevent harm and facilitate the development of safer practices. being aware of risks or threats also enables the development of professional skills of social service employees (sicora, 2017). individual employees can learn about the risks they have observed by themselves, but all other employees and management can learn only about observed, reported, and shared risks. therefore, all social service employees have a key role in developing client safety and recognizing this responsibility is essential to every professional in social services. employees must evaluate clients’ rights and service needs. implementing a client’s care plan follows the laws (social welfare act, 2014) and ethical guidelines of the field (national association of social workers, 2021). koskiniemi et al./social care professionals finland 411 employees who work with clients are expected to follow the law, principles, and practices that are ethically sustainable. risks in social care various risks are associated with social care. risks may be avoidable or unavoidable and may differ in various ways (gambrill, 2017). the risk or threat in implementing a client’s care plan involves abuse of the client. professionals must be trained to identify signs and symptoms of abuse and how to report abuse (who, 2020a). victims of all ages are vulnerable to abuse, including physical, mental, sexual, or neglect (lo et al., 2018; who, 2020a). abuse can also be financial (johannesen & loguidice, 2013; who, 2020a) or a combination of different forms of abuse (lo et al., 2018; who, 2014), such as verbal and financial. a client may encounter inappropriate conduct or use of language (karlsson et al., 2019; liegghio & caragata, 2016) which may be why social service employees report the observed risks or threats. when the risk or threat in the implementation of a client’s social welfare is related to abuse, neglect, inappropriate conduct, or use of language, the abuser may be the employee of social service (myhre et al., 2020), the client (enosh et al., 2013; radey & wilke, 2021; stroebaek & korczynski, 2018), other service users (björne et al., 2021; myhre et al., 2020) or a person close to the client (lo et al., 2018; myhre et al., 2020; välimäki et al., 2020; yan, 2014) with whom the client typically has a confidential relationship (who, 2015). the abuser can be a child (attar-schwartz, 2008) or an elderly person (stroebaek & korczynski, 2018), but typically is an adult (johannesen & loguidice, 2013; liegghio & caragata, 2016; lo et al., 2018; myhre et al., 2020; radey & wilke, 2021). the work culture may be harmful and even contribute to abuse (karlsson et al., 2019). social care services should be clientoriented, and client relationships must be kept confidential, according to the status and rights of social welfare clients (2001). clients have the right to receive quality services and treatment (status and rights of social welfare clients, 2001). the risk or threat thereof may be the failure to fulfil the law. based on our understanding, similar reporting obligations and systems related to risks or threats in implementing clients’ social welfare do not exist internationally. most social care reporting systems are for reporting only abuse and neglect (lo et al., 2018), but in finland, reported risks under the social welfare act are in many ways related to difficulties in implementing the client’s social care. the obligation to report in finland covers all social services (social welfare act, 2014), and the observed risks or threats can vary substantially. internationally, reporting obligations in social care can be applied only to some specific areas, such as the care of people with disabilities (björne et al., 2021). this study was the first to use the reports to their full extent from the social care reporting system called spro-system. the spro-system is a web-based tool for reporting risks or threats in the implementation of clients’ social welfare under the law (social welfare act, 2014). the reporting system innovation originated in the city of helsinki. the developer and administrator of the spro-system is the it company awanic (ltd; awanic, 2022). the city of helsinki conducts continuous system development work in co-operation with awanic. this study was conducted for several reasons. first, finland is one of the nordic welfare states, and its social services, public and private social care systems, have considerable opportunities to develop and improve services. second, client safety has been under-researched, and more empirical studies are needed to obtain new knowledge. third, nationally we do not have a advances in social work, summer/fall 2023, 23(2) 412 congruent picture of the fulfilment of clients’ rights, client safety, and the reporting obligation in social services. in addition, policymakers need new knowledge to support decision-making. thus, this study aimed to contribute knowledge about client safety in social care, such as describing abuses and other cases where clients' safety and rights are jeopardised. methods aim of the study this study aimed to describe the observed risks or threats in the implementation of clients’ social welfare reported by employees of social services in a large urban region of finland. the research questions were: 1. what types of risks are reported by professionals in social care? 2. what was the pattern of risk reports over time? 3. what kinds of actions have been recommended by professionals to prevent the observed risks or threats in the reports? design and setting this study provides a retrospective trend analysis of reports using the spro-system. the data were obtained from the spro-system, which is used in social services in a large urban region – the city of helsinki, finland. social service entities are divided into three units in the city of helsinki: 1) hospital, rehabilitation, and care services, 2) family and social services, and 3) health care and substance abuse services. hospital, rehabilitation, and care services include, for example, home care, elderly people’s daytime activities and social work, support for informal care, 24-hour service housing, and institutional care for older adults and those who are multimorbid. family and social services take care of, for example, social and healthcare services for families with children, student health services, and health education for unemployed young adults who are not students. health and substance abuse services are responsible for organizing, for example, mental health and substance abuse services and psychiatric specialised health care for adults and primary health care. some of these services include health care services, where the spro-system is not used. currently, the sprosystem is used by 615 units (such as wards of organizations) in the city of helsinki: 280 units of family and social services, 53 units of health care and substance abuse services, and 282 units of hospital, rehabilitation, and care services. however, the organizational structure has changed since the study period and is not reported in more detail in this study. mostly social care professionals in social services are social workers and social and other advisors. however, finnish social services, social, and health care professionals collaborate in multi-professional work communities. social advisors have university of applied sciences or college degrees, while social workers have master’s degrees. koskiniemi et al./social care professionals finland 413 data the data included all reports (n = 1,433) made in the web-based spro-system from october 2016 to december 2020 by social care professionals. the original dataset contained 17 variables. the data included a structured section: registration number, date of the report, unit of reporter, unit covered by the report, reporter’s occupational group, date and time of the event, risk or threat of risk, event’s day of the week, type of the report, a consequence of the event for the client, a measure to prevent recurrence of the event, and a detailed proposal of measures to prevent recurrence of the event. reporters classify observed events as either risks or threats, selecting the type of reports from six predefined options. a handler of reports, who is often a unit manager, defines the consequence of the event for the client. therefore, for example, classifying events as risks or threats results from the reporter’s consideration. risks are considered situations in which the implementation of the client’s care plan may put them in danger. as an example of risk: a home visit was not carried out because the home care worker was not informed about the client's discharge from the hospital. as an example of threat: a home visit would not have been carried out without a relative who called to home care during discharge from a hospital. in the latter case, the risk did not happen due to some issue that prevented it. the free text was written in four sections: a description of the event, a reporter’s view on remedial measures, a proposal for action following the reported risks or knowledge of why the action was not needed, and a description of the implementation of measures. the handler of reports writes a description of the implementation of measures. in other respects, the social service employee who detected the risk or threat thereof writes the report under the professional’s name. the free text of reports contains detailed descriptions of events and managers’ actions and requires separate in-depth analysis. therefore, this quantitative study did not include an analysis of the narrative data. ethics approval according to the guidelines of the finnish national advisory board on research ethics (finnish national board on research integrity tenk, 2019, 20, the use of existing anonymous (register) data does not require approval from the national committee of research ethics. the study and use of data from the spro-system was approved by the city of helsinki. the names of the reporters and all clients’ identification information were removed from the data before the data were assigned to the research group. data analysis the data, in microsoft excel format, were assigned to the research group in january 2022. the analysis focused on the quantitative contributions of the data. the variable date of the report was reclassified according to year. the event time associated with the report was reclassified as morning (from 6 a.m. to 11.59 a.m.), day (from 12 p.m. to 4.59 p.m.), evening (from 5 p.m. to 9.59 p.m.), or night (from 10 p.m. to 5.59 a.m.). in some reports, the event time was missing. trends from 2016 to 2020 were analysed. the data were analysed using statistical methods, presented in figures, and described advances in social work, summer/fall 2023, 23(2) 414 as frequencies and percentages. statistical analysis was performed using the r software (version 3.6.1). results a total of 1,433 reports from the spro-system covering 336 social service units were analysed. about half of the reports were submitted to hospital, rehabilitation, and care services (48.2 %, n = 690) with nearly a third submitted by practical nurses or care workers (31.0 %, n = 444), and about a quarter by social advisors (23.0 %, n = 329). occupational groups that submitted the least reports (1.1 %, n = 15) were physicians, students, trainees, and rehabilitation and therapy staff. the reporter’s occupational group was missing from 18 reports. most of the events occurred in the morning (24.6 %, n = 353) or in the daytime (25.2 %, n = 361; table 1). table 1. background information of the reports (n=1,433) background of the reports n (%) the division’s units hospital, rehabilitation, and care services 690 (48.2%) family and social services 512 (35.7%) health care and substance abuse services 231 (16.1%) reporters’ occupations practical nurses or care workers 444 (31%) social advisors or other advisors of social work 329 (23%) social workers 255 (17.8%) other 185 (12.9%) registered nurses 151 (10.5%) public health nurses 36 (2.5%) unknown 18 (1.2%) physicians, students, trainees, rehabilitation, or therapy staff 15 (1.1%) time of the reported event/incident day 361 (25.2%) morning 353 (24.6%) unknown 341 (23.8%) night 230 (16.1%) evening 148 (10.3%) reported risks and threats of social care over the period 2016-2020 all reports must be classified in the spro-system as either a risk or a threat of risk in the implementation of clients’ care plans. observed risks accounted for 87.2% (n = 1,257) of the reports and 12.3 % (n = 176) were threats of risks. reports of risks clearly increased over the five-year period (figure 1). koskiniemi et al./social care professionals finland 415 figure 1. development of observed risks and threats of risks in client safety in social care in the spro-system for the period 2016–2020 the type of report was indicated in 99.4 % (n = 1,424) of the reports. the reporter chose the type of report from six options: 1. inappropriate confronting/insulting the client with words (4.9 %, n = 71); 2. actions harmful to the client owing to the work culture (6.6 %, n = 97); 3. abuse of the client (12.3 %, n = 180); 4. lack of client safety (26.0 %, n = 380); 5. lack of realization of the status and rights of clients (32.5 %, n = 475); and 6. others (17.7 %, n = 259; figure 2). a maximum of three different types of reports can be chosen in one report. in total, 1,424 reports mentioned 1,462 types of reports. in the study period, the type of report “lack of realisation of the status and rights of client” showed the highest increase. figure 2. the content of reports on client safety for the period 2016–2020 2016 n = 23 2017 n = 163 2018 n = 415 2019 n = 384 2020 n = 448 risks (n = 1,257) 21 145 368 343 380 threats of risk (n = 176) 2 18 47 41 68 0 50 100 150 200 250 300 350 400 2016 n = 23 2017 n = 166 2018 n = 427 2019 n = 387 2020 n = 459 inappropriate confronting/insulting the client with words (n = 71) 5 9 21 18 18 action harmful to the client due by working culture (n = 97) 1 7 27 28 34 abuse of the client (n = 180) 5 28 58 45 44 other (n = 259) 4 31 91 68 65 lack of client safety (n = 380) 2 51 97 112 118 lack of realisation of the status and rights of client (n = 475) 6 40 133 116 180 0 50 100 150 200 250 300 350 400 advances in social work, summer/fall 2023, 23(2) 416 consequences of events for the client were assessed on the following scale: no harm (20.7 %, n = 296), mild (24.5 %, n = 351), moderate (28.3 %, n = 409), and serious harm (7.9 %, n = 113;)figure 3). information on the consequences of events for the client was missing in 18.6 % (n = 267) of the reports. the proportion of moderate harm was the highest among all types of harm in the period 2018–2020. figure 3. consequences of the event for the client actions that were recommended to prevent the recurrence of risks all reports (n = 1,433) included suggestions to prevent the recurrence of the event. reporters chose one or more of four structured options: 1. no measures (8.2 %, n = 117); 2. inform/discuss what happened (55.1 %, n = 860); 3. a development action is planned concerning the event (16.5 %, n = 257); and 4. notify the upper management (28.4 %, n = 443; figure 4). event recurrence prevention was not perceived necessary in 8.2 % (n = 117) of the reports. the most necessary measure was to assess the information and discuss what had happened. figure 4. proposals to prevent the recurrence of the event 2016 n = 19 2017 n = 136 2018 n = 347 2019 n = 308 2020 n = 356 no harm (n = 296) 2 47 78 73 96 mild harm (n = 351) 11 50 101 94 95 moderate harm (n = 406) 4 29 136 113 124 serious harm (n = 113) 2 10 32 28 41 0 50 100 150 200 250 300 350 400 2016 n = 28 2017 n = 199 2018 n = 496 2019 n = 443 2020 n = 511 no measures (n = 117) 0 19 29 25 44 inform / discuss what happened (n = 860) 19 100 247 245 249 a development action is planned concerning (n = 257) 2 33 79 62 81 notify to the upper management (n = 443) 7 47 141 111 137 0 50 100 150 200 250 300 350 400 koskiniemi et al./social care professionals finland 417 nearly three-quarters (74.2 %; n = 1,063) of the reports included detailed proposals for prevention of recurring events (table 2). a report could have more than one detailed proposal. the total number of detailed proposals in the 1,063 reports was 1,462. more than a third (37.7 %) of the detailed proposals suggested consideration of the case within the unit. table 2. breakdown of the 1,462 detailed proposals of a measure to prevent recurrence of the event (n= 1,063 reports) detailed proposals for events’ recurrence prevention n (%) handling within the unit (for example, departmental or team meetings) 551 (37.7%) discussion or negotiation with other parties involved in the process 179 (12.2%) a serious or recurring problem 155 (10.6%) handling outside the unit 150 (10.3%) mode of operation and procedures 119 (8.1%) other reason 74 (5.1%) support is needed to deal with the case 73 (5%) otherwise anomalous situation 58 (4%) communication and contact 40 (2.7%) other development action 29 (2%) information technology and technology systems, appliances, & equipment 12 (0.8%) education 12 (0.8%) management 10 (0.7%) total 1462 (100%) discussion in finland, we know that the distribution of health and social welfare services and access to services are relatively good at the macro level (pulkki et al., 2015; vaarama et al., 2014; valkonen et al., 2014). even though most clients feel that the accessibility of social services is at a good level, some clients repeatedly reported that client payments were too expensive, services could not be accessed quickly enough, or there were other difficulties with the accessibility of services (ilmarinen et al., 2016). finnish municipalities organize social services within the legal framework imposed by the state. this causes regional variation, for example, in client payments and accessibility of services. abundant research exists on various vulnerable groups and their welfare problems, as well as on public sector interventions to alleviate these problems. however, the client safety risks that employees observe or face in social care are not fully understood. the relative importance of these mechanisms is unknown. however, the dynamic nature of the interaction between individual needs and the welfare system is not always recognized when reforms are planned (tammelin & mänttäri-van der kuip, 2022). client safety is essential in strategic socio-political thinking in finland (ministry of social affairs and health, 2022a). however, tension exists between the different elements of client safety. for example, from an ethical viewpoint, the autonomy of clients contradicts the goals of the policy on ageing. identifying risks and threats thereof should be understood as part of employee professionalism. both the employee and the work community can learn to recognise risks, which leads to the possibility of preventing as many risks as possible. social service employees must identify their responsibilities in promoting client safety so that all observed risks will be reported. work communities’ support for reporting the advances in social work, summer/fall 2023, 23(2) 418 observed risks is essential. the previous study (tiitinen & silén, 2016) shows that the implementation of risk reporting is not adequately discussed. in addition, social service employees have noticed varying attitudes toward professionals who made the reports (tiitinen & silén, 2016). assigning blame is not included in positive safety culture, whereas management should support and commit to safety. observing and reporting risks is an entity that extends to many dimensions of safety culture (churruca et al., 2021). open communication and trust are parts of good safety culture. enhancing safety culture positively affects patient safety outcomes (o’donovan et al., 2019). the reporting process must be seen as a whole, and the safety culture as an integral part of reducing risk of client harm. it is necessary to consider safety culture to improve the implementation of the reporting obligation because even reporting obligation under the law is not alone enough to resolve risks in social care. if we do not pay attention to safety culture, reports might not be handled in a way that improves client safety and supports professionals’ willingness to report in the future, or reports are not made at all because professionals do not want to expose themselves to blaming. this study aimed to describe the observed risks or threats in the implementation of clients’ social welfare reported by employees of social services in a large urban region of finland. this is the first study to use data collected to its full extent from the sprosystem, which has been used in social services in the city of helsinki since 2016. this study describes trends in reports from the introduction of the spro-system until the end of 2020. based on our understanding, we did not find a similar comprehensive social service reporting system related to observed risks or threats in implementing clients’ social welfare. internationally, most social care reporting systems report only abuse and neglect (lo et al., 2018). as this study’s findings show, collecting only reports related to abuses is not enough to get knowledge of risks in social care. in addition, internationally social care professionals have reporting obligations that apply only to a specific area of social care, such as care of the disabled (björne et al., 2021). in the city of helsinki, the spro-system is in use in each social service unit. reporting systems are often organization-specific and are not part of an official, nationally coordinated system (who, 2020b). the spro-system is currently organization specific and not widely used in finland but has the potential to expand nationally. focusing on the knowledge gained through practical work is essential in social and healthcare work. practical knowledge, that is, implicit knowledge, forms a large part of the knowledge applied by employees (evans et al., 2010; fook et al., 2000). the implicitness of practical knowledge is focused on practical wisdom, in which employees transfer knowledge gained through many individual client cases from one problem to another. one concern is that a large share of the practical wisdom remains undocumented. thus, by using reporting systems and analyzing the data generated, we can critically examine for whom and from whose perspective the knowledge is produced and collected. who gathers knowledge, and how and for what purpose is the gathered knowledge used? this study gives an overall view of the finnish reporting system. the results contribute to discussion of the spro-system’s content compared to other systems used internationally and how the content of the spro-system meets the need for knowledge in practical social care. practical nurses or care workers made most of the reports. this result is congruent with a previous study conducted in the home care context where data were based on the patient safety incident reporting system called haipro (kivimäki et al., 2022). haipro and spro were both developed by an it company named awanic (ltd), and koskiniemi et al./social care professionals finland 419 thus have similar structures (awanic, 2022). all reports in the spro and haiprosystems are classified as actual or near-miss events, which, in this study, are called observed risks or threats thereof. the proportion of observed risks was greater in this study than that in studies based on the haipro-system (kivimäki et al., 2022). most of the events occurred in the morning and during the day, whereas in a previous study most patient safety incidents in specialised care settings occurred at night (kinnunenluovi et al., 2014). in the first years after the introduction of the spro-system, reports of observed risks or threats thereof in social welfare implementation increased. in the last three years, the number of reports remained the same with a slight decrease in the fourth year. several social welfare units produced no reports during the study period. social care is a complex field (gibson, 2014; sicora, 2017) and the detection of risks should be constant because risks are a constant reality (sicora, 2017), and the law requires their observation and reporting (social welfare act, 2014). this study shows that reporting systems like the spro are necessary even if not all risks are reported. the findings of this study make it possible to realize the extent and types of risk in social care. however, underreporting remains a challenge. further investigation may reveal if there are some system-related reasons for underreporting. based on our knowledge, front-line professionals have not been involved in developing the spro-system. since professionals are key elements of the successful implementation of reporting systems in social care, it would be helpful if they were involved in the development processes of systems. the spro-system enables accurate data collection of observed risks or threats in the implementation of clients’ care plans which employees of social services are obligated to report. in social and health care, it is important to invest in reporting systems; however, data collection should lead to real utilization of reports (macrae, 2015). in finland, the resources for client safety development need to be raised to the same level as the resources for patient safety development (ministry of social affairs and health, 2022a). in this study, more than one in ten reported events represented a serious or recurring problem, and approximately 80% caused harm to the client. in the home care context, one-third of reported incidents caused harm to the patient (kivimäki et al., 2022). in the spro reports, the harm was most often estimated as moderate, whereas in incident reports from healthcare, the harm is most often mild or no harm (härkänen et al., 2020). over 90% of the reports suggested actions to prevent the recurrence of harmful events. the measures taken were not investigated in this study; nevertheless, examining actions taken from the data is possible. at best, after reporting and analysis of reports, all corresponding units would check their practices (macrae, 2015); however, patient safety incident reports (liukka et al., 2019), as well as incident reports in the social care context (björne et al., 2021) rarely lead to recommendations. social service employees who have reported observed risks or threats under the reporting obligation have noticed the same: reporting rarely leads to visible changes (tiitinen & silén, 2016). tiitinen and silén (2016) have noticed that organizations are not defined whose responsibility is to lead change processes related to risks observed and reported by professionals. root causes of risks can be deep in the units’ working culture and changing them can seem hopeless in units (tiitinen & silén, 2016). advances in social work, summer/fall 2023, 23(2) 420 strengths and limitations the strength of this study lies in the overall sampling (n = 1,433) of reports in the spro-system for the period 2016–2020. nevertheless, it has some limitations. the data were collected from one city; hence, the results cannot be generalized to other areas. although the socio-cultural context of our study is finland, the research findings can still inform systems in other cultures. additionally, self-reported data have some wellknown limitations, such as the fact that the data are not collected for research purposes. in addition, professionals classify events based on their observations and the training they have for reporting. for that reason, it is possible that different professionals classify the same event in a different way. this study did not include other explanatory variables for client safety indicators. the results have important implications for future client safety research. it is necessary to emphasize that risk is a threat to client safety. implications for social work practice employees are responsible for the quality of work with clients and families, their work community, and co-operation networks. still, it has remained unclear how client safety is realized in social work settings. this study provides knowledge of risks from employees’ perspectives and fulfilment of reporting obligations in social care. this study indicates how implementation of reporting obligations based on the law has not been successful in all units in the city of helsinki. reporting volumes describe that in the units or settings where reporting was incorporated as a part of work, the frequency of reporting increased strongly in the first three years. more information is needed about units where no report has been made during the reporting obligation period under the social welfare act. reasons behind non-reporting must be identified and the necessary steps to promote reporting in all settings. most likely cultures of work communities have a central position (sicora, 2018). in addition, the content of the reports requires further study: what kind of events occur and how can they be prevented? this study provides that there are reports of harmful work culture, abuse and inappropriate confrontations with clients in social care. professionals’ observations of abuse are not unprecedented. previous studies have noticed that over half of care workers (gil & capelas, 2022) and employees of institutionalised care (yon et al., 2019) had seen abuse or neglect in elder care during the previous 12 months. risks of client abuse exists also in social services in finland and the situation must be taken seriously. it is essential to make sure that professionals are trained to identify warning signs of abuse as well as how to report abuse (who, 2020a). finally, it would be important to show professionals that reporting matters and can lead to real concrete changes. this could increase reporting activity. for that reason, superiors’ actions taken after receiving reports need to be investigate. how effective are the measures being used and do the measures demonstrate the importance of reporting? these issues must be investigated in any units where reports are made. conclusion based on the reports examined in this study, the observed risks or threats in the implementation of clients’ social care plans by social services employees have mainly koskiniemi et al./social care professionals finland 421 increased annually. the broad reporting system covering all social service units enables comprehensive client safety research, but currently only at the organizational level. risks in social care are diverse. even if a risk is exposed just once in a unit, it may be part of a larger problem across the organization; thus, reporting all observed risks is critical. the importance of reporting should be realized from the perspectives of both professional growth and service development. in practice, the development of reporting could be the unit's theme for the year and include jointly set goals. the results of the strong reporting system and culture can be seen in the increase in the number of reports, but also in the ethical development of the unit's operating culture, the better realization of customers' rights, the creation of a positive development atmosphere (i.e., continuous learning, and in the growth of professional responsibility). more information about units where no report has been made during the reporting obligation period under the social welfare act is needed. more empirical research is needed on client safety from the perspective of social workers, especially how to define it more clearly and what it means in practice. in addition, it would be essential to investigate what concrete actions 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(2019). the prevalence of elder abuse in institutional settings: a systematic review and metaanalysis. european journal of public health, 29(1), 58-67. author note: address correspondence to marja härkänen, department of nursing science, university of eastern finland, yliopistonranta 1 c, 70210 kuopio, finland. phone: +358 40 355 2614. email: marja.harkanen@uef.fi acknowledgements: the authors thank the funding of the finnish nursing education foundation. we also thank the city of helsinki for the research idea and the access to the data. https://apps.who.int/iris/rest/bitstreams/835463/retrieve https://apps.who.int/iris/rest/bitstreams/1282412/retrieve https://apps.who.int/iris/rest/bitstreams/1282412/retrieve https://apps.who.int/iris/rest/bitstreams/1303416/retrieve https://apps.who.int/iris/rest/bitstreams/1303416/retrieve https://doi-org.ezproxy.uef.fi:2443/10.1002/gps.4092 https://doi-org.ezproxy.uef.fi:2443/10.1002/gps.4092 https://doi.org/10.1093/eurpub/cky093 https://doi.org/10.1093/eurpub/cky093 https://doi.org/10.1093/eurpub/cky093 mailto:marja.harkanen@uef.fi _________ annie j. keeney, phd, msw, assistant professor, and amanda lee, lcsw, director of field education, school of social work, san diego state university, san diego, ca. sarah jayyousi, lcsw, lpcc, lecturer, jimmy a. young, phd, msw, mpa, associate professor, and jeannine guarino, lcsw, director of field education, department of social work, california state university, san marcos, ca. katie b. turner, phd, lecturer, school of theatre, television, and film, san diego state university, san diego, ca. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 303-317, doi: 10.18060/24929 this work is licensed under a creative commons attribution 4.0 international license. social work students’ self-efficacy toward direct practice skills in field education using virtual simulations and scripted role plays annie j. keeney amanda lee sarah jayyousi jimmy a. young jeannine guarino katie b. turner abstract: simulations with professional actors and scripted role plays with peers are effective methods to increase direct practice skills. however, little is known about how simulations or scripted role plays conducted virtually can influence social work students' practice self-efficacy. msw students enrolled in field seminar courses across two universities were invited to participate in an exploratory, repeated measures assessment utilizing the counselor activity self-efficacy scales (cases). one university (n=100) implemented the use of standardized clients, played by professional actors within field seminar; the other university (n=61) implemented scripted, peer-led role plays. significant differences were found in pre/post scores among msw students that participated in simulated client experiences within their field seminar. simulations and scripted peer role plays may need to be more integrated into social work curricula when opportunities for inperson direct practice skill development are limited due to hybrid or fully remote field placements. applied learning in social work education must be re-envisioned so programs can prepare msw students to be effective practitioners in today’s rapidly changing environment. keywords: social work students, simulations, scripted peer role plays, direct practice skills, self-efficacy, virtual environments, covid-19 educational disruptions due to the global covid-19 pandemic placed limitations on social work students’ ability to learn and apply direct practice skills in traditional curriculum methods (kourgiantakis et al., 2021; menon et al., 2021). of concern were the lost opportunities for skill development within field education learning experiences. field education, considered the signature pedagogy in social work education, allows students to integrate knowledge and practice skills in real practice situations (council of social work education [cswe], 2015). field settings provide opportunities for students to demonstrate social work competencies with clients, families, groups, organizations, and communities. it is in these supervised, in-vivo experiences, that students can integrate theory and practice in hands on interventions with actual clients. when the covid-19 pandemic quickly transitioned social work programs and field work to an online format during the 2019-2020 academic year, in-person learning experiences were largely altered, or eliminated altogether, thus significantly impacting direct practice skill development for social work about:blank advances in social work, summer 2022, 22(2) 304 students. responses to the pandemic included taking measures to prevent the spread of the coronavirus, physical distancing measures and finding practicum opportunities for students that involve direct practice with clients. some schools moved to virtual practice fridays and utilized simulation-based learning (kourgiantakis et al., 2021; lee et al., 2020); online simulation-based learning activities have positive preliminary findings and implications for social work education and practice, and can help fill the gap when there is a shortage of in-person practice opportunities in the field (kourgiantakis et al., 2021). additional research is needed to determine effectiveness of simulation-based learning specifically in the field of social work education. context and rationale the southern california field directors’ consortium is composed of 12 universities that collaborate and coordinate throughout the academic year to ensure equity among placement opportunities for all social work students in the region within their respective field education program. given the lost opportunities for in-person experiences in field education, two social work programs in the consortium sought to enhance direct practice skill development for the 2020-2021 academic year by virtually implementing simulations or scripted peer role plays within field seminar classes. simulation and role plays are two empirically supported pedagogies that are found to be effective at increasing assessment, communication, and intervention skills (bhattacharjee, 2014; bogo et al., 2014; kettula & berghall, 2013; kourgiantakis et al., 2020). however, little is known about how effective these two pedagogies are when implemented virtually in the context of social work education. the programs had differing student populations and program structures such that a robust comparison study was not warranted. instead, we conducted an exploratory assessment with repeated measures to understand how these two pedagogies, when implemented virtually, impacted msw student’s direct practice self-efficacy. background online learning distance education, virtual or online learning in social work has an interesting past from the use of satellite television to ipads, social media, and avatars (hitchcock & young, 2016; vernon et al., 2009; wretman & macy, 2016; young, 2014). the use of technologies has been met with resistance for a variety of reasons including learning outcomes and the efficacy of an online format (wretman & macy, 2016; york, 2008). however, the social work tech literature has greatly expanded in the past several decades with evaluations of online learning, indicating this method produces similar results to traditional classroom learning models (cummings et al., 2012; wretman & macy, 2016). additional research has shown that virtual environments help students increase cultural awareness (stauss et al., 2018), clinical skills (rizzo et al., 2019), and increase student preparedness for practicum (phillips et al., 2018). more research is needed to fully understand the ways technology can support or impede social work education, but the covid-19 global pandemic has shown how important it is for social work education to be flexible, adaptable, keeney et al./swk students’ self-efficacy 305 and open to utilizing virtual learning methodologies. these methods can incorporate simulated or scripted peer role plays to help increase student self-efficacy. simulations with actors “simulation-based learning is an experiential method that utilizes actors portraying simulated clients in scenarios designed to emulate social work practice” (kourgiantakis et al., 2020, p. 434). the use of simulated learning and training is well developed in medical education and medical personnel evaluation (issenberg & mcgaghie, 2013; motola et al., 2013). the seminal work of bogo and colleagues (2014) has influenced the social work profession’s adoption of such learning techniques. simulations are a promising pedagogical method for teaching social work practice in the classroom (kourgiantakis et al., 2020), and can be implemented in a variety of formats such as online, with actors or clients, or small group formats (goldingay et al., 2018; osborne et al., 2016; wilson et al., 2013). simulation-based learning can provide social work education programs with the ability to evaluate student competencies effectively (lee et al., 2020; sewell et al., 2020), and virtual simulations have been shown to help increase clinical skills, develop cultural competence, and further prepare students for the field (lee, 2014; phillips et al., 2018; rizzo et al., 2019). there is very limited research on the use of professional actors in social work education. however, some exploratory studies found that social work students described their experience with the actor-simulated clients in very positive terms and described the experience as close to real-life (petracchi, 1999; petracchi & collins, 2006). using professional actors brings the experience closer to reality due to actors having greater professional background in role play, whereas peers may feel uncomfortable, awkward, and unfamiliar with acting in role plays in a client role. students may also find it difficult to play the role of the client in the beginning of their social work education due to lack of confidence and familiarity. role plays role play pedagogy has been shown to be effective in meeting learning outcomes in a variety of contexts and content areas (allemang et al., 2021; jones & conner, 2021. the efficacy of role plays in learning environments is often cited outside the discipline of social work. role playing is widely recognized as an important experiential teaching method in higher education across a range of disciplines such as education, nursing, clinical psychology, counselling, pharmacy, veterinary medicine, and medicine (fulton et al., 2019). in role plays, students are given opportunities to simulate specific scenarios to help prepare students and increase their level of readiness for the field. in a safe environment with their peers and instructors, they observe others and practice developing their competence. scripted role plays provide a structured framework that is often tailored to learning outcomes by providing written lines for all participants to use as they act out scenarios (hargreaves & hadlow, 1997; villadsen et al., 2012). compared to more traditional advances in social work, summer 2022, 22(2) 306 teaching methods such as direct instruction, memorization, or recitation of knowledge/skills, the literature supports the idea that scripted role plays may better meet the learning needs of today’s students (bobbit et al., 2001; elmore, 2021; jones & conner, 2021; osborne et al., 2016; rosa, 2012). for social work students, scripted role plays allow students to problem solve and practice decision-making in relation to intervention and assessment skills in a low-stakes environment. these role play learning experiences are then further developed when students can critically reflect on their or their peers’ performance/engagement within the activity and construct linkages to how these experiences can transfer to the field (jones & conner, 2021). this combination of role play and reflection can be an effective assessment measure that enables increased self-efficacy and awareness. jones and connor (2021) assert that reflection of role play experience supports students’ exploration at both the cognitive and affective levels. furthermore, allemang and colleagues (2021) affirmed previous findings that experiential learning strategies such as role plays enhance perspective-taking, provide an opportunity to practice skills in a safe space, and is perceived positively by students and instructors. self-efficacy self-efficacy refers to an individual’s belief in their capacity to demonstrate specific skills, knowledge, or abilities (holden et al., 2017). given the remote or hybrid option of their field placement, it was assumed that our social work students had decreased opportunities to practice counseling skills (i.e., direct practice) with in-person clients. as such, it was warranted for our field programs to understand how students perceived their ability to deal with client issues and perform various counselor behaviors taught within their direct practice coursework, which were also conducted remotely. direct practice skills in social work involves helping clients through challenging situations by assessing clients’ needs and directing them to resources. it is imperative that more research is done to evaluate the adoption of virtual practice methodologies within social work education generally and field education specifically. methods a purposeful sample of msw students from san diego state university (sdsu) and california state university san marcos (csusm) that were concurrently enrolled in practice and field seminar courses in 2020-2021 academic year were invited to participate in the study. data collection was administered twice during the fall 2020 semester, once at the beginning of the semester (august 2020) and again at the end of the semester (december 2020) through qualtrics, an online survey platform. all research was in accordance with the ethical standards of the san diego state university institutional review board. this study was verified as exempt by the institutional review board (number: hs-2020-0185). keeney et al./swk students’ self-efficacy 307 field seminar format the purpose of the field seminar is to build a collective understanding of the profession of social work through the mutual and purposeful sharing of students' experiences at their various internship sites. for the 2020-2021 academic year, all courses within the california state system were required to be virtual, including field seminars. given that many field agencies continued remote or hybrid internships for the 2020-2021 academic year, our field education programs expanded content to compensate for the potential loss of direct practice skill building opportunities by implementing simulations or scripted peer role plays in field seminar classes. simulations. simulated practice experiences utilizing standardized clients portraying scenarios commonly encountered in social work were implemented in field education seminars for foundation and advanced year msw students at sdsu. students were concurrently enrolled in direct practice courses focused on teaching evidence-based practices such as motivational interviewing (mi), cognitive behavioral therapy (cbt), and solution focused therapy. all simulation practice experiences were conducted on a virtual platform (zoom). each student had the opportunity to conduct a one time, 15-minute assessment with the standardized client (professional actors or school of theatre, film, and television students). students selected and employed evidence-based practice skills in their assessment that they believed were appropriate given the information they received about the “standardized client” on the assigned case vignette. other students in the class not interacting with the standardized client were asked to carefully observe the live exchange and provide constructive feedback to their peer after the simulation activity. this provided an additional professional development opportunity for students to learn how to give appropriate feedback to their peers as they are often called to do in the profession. scripted peer-role plays. scripted peer-role plays were implemented in field seminar classes for advanced and foundation year msw students at csusm. scripted peer role plays were utilized to provide a more standardized experience among role play activities. all scripted role plays occurred over zoom. initially, a role play demonstration was conducted with the entire class; then, students utilized small breakout sessions to practice skills in smaller groups. students playing the role of the client were given specific scripts and vignettes and were coached to remain consistent and avoid deviating from the information provided. the scripted role plays addressed various competency areas, including engagement, assessment, and intervention. finally, the students playing the social worker and client roles were given time to discuss and reflect on the role play experience. additionally, field faculty and peers provided immediate feedback to highlight student strengths and areas of development. measures we used the three scales that comprise the counselor activity self efficacy scales (cases) to assess student’s self-reported efficacy on therapeutic skills, session management, and handling of challenging counseling situations. cases were administered prior to the first scheduled field seminar in august 2020 and the last advances in social work, summer 2022, 22(2) 308 scheduled field seminar in december 2020. cases was designed for student populations and focuses on beginning practitioner skills (e.g., reflection, listening) that directly translate to social work learning competencies (lent et al., 2003). as such, we felt this was an appropriate measure to understand how virtual experiences with role play and simulations can contribute to social work student’s practice self-efficacy. however, these scales are only designed to understand student perceptions of their own counseling capabilities and should not be considered an objective measure of how well students function in counseling sessions. counselor activity self-efficacy scales. the cases questionnaire consists of 41 items (lent et al., 2003). the three subscales are: helping skills self-efficacy (15 items), session management self-efficacy (10 items), and counseling challenges self -efficacy (16 items). for each item, respondents are asked to use a nine-point likert scale (0= no confidence, 9= complete confidence) to indicate their perceived confidence in their ability to perform various counseling tasks. each subscale can produce a mean by summing all the corresponding items together and dividing by the number of items. sample items include, on a scale of 0-9 (0= no confidence, 9= complete confidence), “how confident are you that you could work effectively over the next week with a client who is clinically depressed?” and “how confident are you that you could use restatements effectively with most clients over the next week?” internal reliability estimates for each scale ranged from α=.91 (helping skills) to α=.92 (session management skills) to α= .95 (counseling challenges skills). the full cases scale produced an alpha coefficient of α=.97, which is consistent with previous research (bagheri et al., 2011; lent et al., 2003). analysis data collected from the online surveys (august 2020 and december 2020) were uploaded into spss (v. 25) for analysis. because one of the goals of this study was to describe the perceived effectiveness of direct practice skills over a semester, we used univariate analysis to explore the overall characteristics of each scale (helping skills, session management, and counseling challenges). for simulation participants, pre/post responses were linked together by student id. we used a repeated measures within-group analysis to explore differences in self-efficacy regarding direct practice skills from august 2020 to december 2020 and between advanced year and foundation year students. for scripted role play participants, no same students participated in the august 2020 and the december 2020 data collection (though all were current students in the department’s msw program). as such, paired sample t-test to establish mean differences from pre/post could not be computed because there were no valid pairs in the data. therefore, we combined all august and december data for the scripted role play participants and conducted independent samples t-test to compare the cases scale means of foundation and advanced year students. keeney et al./swk students’ self-efficacy 309 results scripted peer role plays the csusm department of social work implemented scripted, peer-led role plays within field seminars. foundation and advanced year msw students, for a total of n=61, completed the questionnaires for a response rate of 40%. of the 61 total respondents, 42 respondents completed the questionnaire in august 2020 and 19 completed the questionnaire in december 2020. foundation level students accounted for 49% of respondents (n=30) and advanced year level students accounted for 51% of respondents (n=31). demographic data were not collected in the current scripted role play student sample; however, student demographic data are available for the department as a whole. nearly half (49%) of the department’s students identified as hispanic/latino, with smaller percentages identifying as asian american (3%), african american (3%), or multiple races (4%). additionally, many students identified are bilingual and first-generation college students (california state university institutional research & analyses, 2021). cases subscale means by student level means of the cases subscales by student level (advanced or foundation year) for august 2020 and december 2020 are found in table 1. for all three subscales, in december 2020, advanced year students had higher means of perceived self-efficacy than foundation year students. there were no statistically significant differences between foundation and advanced year students’ self-efficacy scores for all three sub-scales at either the august or december cases data collection times. table 1. advanced and foundation scripted peer role play students cases sub-scale scores in august 2020 (n=42) and december 2020 (n=19) subscale august 2020 (n=42) december 2020 (n=19) m (sd) pvalue m (sd) pvalue foundation advanced foundation advanced helping skills 6.11 (1.68) 5.87 (1.0) .547 6.23 (1.54) 6.79 (.94) .398 session skills 5.81 (1.55) 6.25 (1.50) .688 5.98 (1.14) 6.87 (1.01) .346 counseling skills 5.12 (1.98) 5.69 (1.82) .345 5.93 (1.82) 6.30 (1.13) .632 helping skills self-efficacy. this cases sub-scale consists of 15 items. participants were asked to indicate how confident they felt in using general skills effectively with clients at their field placement over the next week. the lowest item mean was related to participant’s confidence to assist the client to role play or rehearse behaviors in session, (m=4.68). differences between foundation and advanced year students for this item was not significant (p=.068), though approaching significance at the .05 level. the highest item mean (m=7.20, p=.296) was related to the counseling skill of listening (e.g., capture and understand messages the client is communicating). no significant differences were found between foundation and advanced year students. session management self-efficacy. this cases subscale consists of ten items specific to session management tasks. the lowest item mean in the session management subscale advances in social work, summer 2022, 22(2) 310 was related to participant’s confidence in building a clear conceptualization of the client’s counseling issues (m=5.48, p=.774). difference between advanced year and foundation year students was not significant. the highest mean item was for “helping your client to explore their thoughts, feelings, and actions” (m=6.65, p=.160). no significant differences between the highest item means between foundation and advanced were found. counseling challenges self-efficacy. this cases subscale consists of 16 items specific to displayed client behavior or client symptomology. participants were asked to indicate their confidence level in working with clients who displayed various challenging behaviors. the lowest perceived confidence means were for working with clients that show signs of severely disturbed thinking (advanced, m=4.45, p=.204). the highest mean item (i.e., highest perceived confidence) was related to working with clients that differ from you in major ways (e.g., race, gender, age; (m=7.25, p=.884). no significant differences between foundation and advanced year students were found on these items. simulation participants foundation and advanced year msw students enrolled in field seminar courses were invited to participate in the study. the school of social work implemented standardized clients, played by professional or student actors, within each field seminar for fall 2020. a total of 100 msw students completed the questionnaires for a response rate of 50%; responses were linked by student id. of the 100 participants, 54% were advanced level, 41% were foundation level, and 4% did not indicate their program year. demographic data for the current simulation student participant sample are unavailable, but school-wide student demographic data are available. most of the school’s graduate students identify as white (37%) or of hispanic/latino (31%) ethnicity and 22% are first generation college students (san diego state university institutional research & analyses, 2021). pre and post cases subscale means simulation participants perceived self-efficacy across all cases sub-scales increased from august 2020 to december 2020. means increased for all items within each sub-scale (helping skills, session management, and counseling challenges). for the helping skills sub-scale, the most considerable mean difference from pre (m=3.40) to post (m=6.95) was for the item “immediacy (disclose immediate feelings you have about the client);” p<.001. the session management sub-scale item “remain aware of your intentions during sessions” had a significant mean difference among simulation students from pre (m=4.42) to post (m=8.00), p<.001. for the counseling challenges sub-scale item “how confident are you that you could work effectively over the next week with a client who is extremely anxious” had the most significant mean difference from pre (m= 4.05) to post (m=7.42), p<.001. a paired or correlated samples t-test indicated that the students that participated in simulations had, on average, significantly more confidence in their helping skills, t (19) =15.1, p<.001, d=.89, session management skills, t (18) =-5.47, p<.001, d=2.43, and counseling challenges t (18) =-6.48, p<.001, d=1.93. the difference for all subscales, though statistically significant, is small using cohen’s (1988) guidelines. see table 2. keeney et al./swk students’ self-efficacy 311 table 2. paired sample t-tests for cases sub-scales for simulation participants sub-scale pre (n=52) post (n=48) t p cohen’s d helping skills 4.60 (1.03) 7.35 (1.41) -15.06 <.001 .89 session management 4.50 (1.61) 7.40 (1.48) -5.47 <.001 2.43 counseling challenges 4.30 (1.56) 7.18 (1.41) -6.48 <.001 1.93 cases subscale means by student level an independent-samples t-test was run to determine if there were difference in cases subscale scores at pre and post between advanced and foundation year simulation students. advanced year students had less perceived self-efficacy with counseling challenges at baseline (pre), a statistically significant difference of .91 (95% ci, -.05 to 1.89), t (44)=1.92, p=.031. means of the cases subscales by student level (advanced or foundation year) for simulation participants are found in table 3. for both groups of students, means increased from pre to post. at pre-assessment, foundation year students had more perceived self-efficacy than advanced year students in session and counseling skills. however, at post assessment, advanced year students had slightly more mean increases in session skills and counseling challenge skills than foundation year students. table 3. independent sample t-tests for advanced and foundation simulation students cases sub-scale scores skill subscale time foundation m (sd) advanced m (sd) t p-value helping pre 4.52 (1.0) 4.59 (.97) -.533 .291 post 7.18 (1.34) 7.45 (1.53) -1.10 .136 session pre 4.9 (1.72) 4.26 (1.57 1.20 .118 post 7.31 (1.40) 7.41 (1.57) -.790 .217 counseling pre 4.80 (1.64) 3.89 (1.48) 1.91 .031 post 7.11 (1.33) 7.18 (1.50) -.703 .243 discussion this study aimed to explore msw students' perceived self-efficacy by the virtual learning method of two pedagogies. results indicate an increase in student confidence in using direct practice skills following participation in both simulation and scripted role play from august 2020 to december 2020. scripted role play participants appeared to have higher confidence levels at the beginning of the semester when compared to simulation participants; additionally, simulation participants had larger mean increases compared with scripted role play participants from august 2020 to december 2020. the variability in demographic makeup between the two universities may have impacted the higher baseline confidence levels for csusm students. additionally, students’ simulation was recorded and shared with their respective internship supervisors, providing another opportunity for feedback and reflection, while scripted role play students did not have the opportunity for additional reflection with their field supervisors. this may have contributed to the higher increase in mean scores for simulation participants overall. most notably, cases means advances in social work, summer 2022, 22(2) 312 did increase for all students regardless of pedagogy. it should also be noted that the results from the cases questionnaire among advanced-year scripted role-play students were collected from a different group of participants than the foundation year students within the scripted role play group in august and december. moreover, there were no significant differences between advanced year and foundation year students on any of the cases subscales for either scripted role play or simulation participants. implications for social work due to the covid-19 pandemic, most student internships at both csusm and sdsu utilized most or some aspects of telehealth service delivery, which was not the typical experience for student interns at either university prior to the pandemic. the virtual simulations and scripted peer role plays provided an opportunity for supplemental practice of telehealth services, which will most likely be a service delivery method to stay in the post covid-19 era. we offer the following observations and next steps given our study’s findings: 1. we did not collect any demographic information from the participating students. therefore, race/ethnicity, age, and part-time/full-time status may contribute to mean differences among participants. future research exploring the effectiveness of these pedagogies in virtual environments should account for individual student demographics. 2. though some role plays and skill-building demonstrations are included in field seminars, gaps exist within students’ ability to fully engage in role play while effectively demonstrating skills such as rapport building, active listening, conveying empathy, and reflecting content. standardized clients through virtual simulation may have a more realistic learning opportunity that further facilitates active student engagement above and beyond what can be achieved during a peer-to-peer role play. 3. in our study, the student’s field instructor and standardized client provided structured feedback to each student engaged in the simulation practice experience because the simulation was recorded and shared with their respective internship supervisor (i.e., field instructor). for scripted role play students, feedback was only received from their peers and field faculty, not their supervisors in the field. these additional opportunities for feedback and reflection may help explain the significant differences of pre/post self-efficacy among simulation participants overall and not by student level. however, since pre/post analysis could not be conducted with scripted role play participants, it will be important for future studies to examine effectiveness of virtual scripted role plays pre/post. the covid-19 pandemic quickly shifted service delivery to virtual environments, which limited or reduced in-person service delivery as individuals moved towards more virtual service delivery. we recommend that social work programs, including field education programs, enhance students' direct practice skill learning opportunities. furthermore, real-life situations rarely afford a student the opportunity to elicit in-depth keeney et al./swk students’ self-efficacy 313 performance feedback from a client as it may not be ethical or appropriate, bearing in mind inherent power differentials and that the focus should be on the client’s needs. therefore, it can be a powerful learning experience to be able to hear how the standardized client or peer perceived the student’s performance. for example, all students were able to receive immediate feedback on how the “client” (actor or peer) perceived the student’s direct practice skills in relation to areas such as: efforts to make an authentic connection, efforts to demonstrate understanding and empathy, opportunities to collaborate, respecting client’s right to self-determination, and efforts to approach the session with cultural humility. despite the hopeful return to more in-person experiences, intentional efforts to increase simulated or scripted role play opportunities in field seminars and practice courses would allow for thoughtful skill development focused on telehealth training, which will move social work education into a future that is becoming more and more technologically reliant. moreover, another noteworthy approach that was utilized in this study is the interprofessional collaboration between the school of social work and the school of theatre, film and television. creating interprofessional learning opportunities for students using role play and drama can be an effective pedagogic method in interprofessional education (villadsen et al., 2012). not only does this provide social work students a chance to practice with individuals who have greater role play expertise, it additionally gives acting students an opportunity to play the client role and develop their own work experience. limitations the results of this study should be carefully considered. first, the reliability and validity of the cases instrument are still considered “under construction,” psychometrically speaking, despite initial promising findings (lent, 2020). it is important to note that self-reported measures, especially in field education can be inaccurate. overestimates of skills, knowledge, and abilities in relation to the cases could have happened among the study’s participants. this phenomenon and taking into account student’s learning in other aspects of their program could have influenced student’s increases in self-efficacy. therefore, we cannot be certain to what degree that the virtual pedagogies of focus in this study contributed to participants increased self-efficacy. however, our study found sufficient reliability that will contribute to these efforts. second, due to the covid-19 public health orders, our recruitment and data collection efforts were altered, limiting both universities to virtual methods. for students experiencing “zoom fatigue” and other academic stressors, our findings should not be considered representative of the department or schools’ entire social work graduate student population. these methods also likely recruited students that were more comfortable with online activities and who likely had higher computer literacy skills. additionally, it was not possible to conduct a repeated-measures analysis of the scripted role play group due to having different groups who completed the preand post-survey. this impacted the ability to compare both simulation and scripted role play groups statistically. further studies are needed to determine if there are significant differences among msw students participating in scripted peer role plays. advances in social work, summer 2022, 22(2) 314 conclusion the covid-19 pandemic quickly shifted service delivery to virtual environments, which limited or reduced in-person service delivery as individuals moved towards more virtual service delivery. the covid-19 pandemic also highlighted the vast injustice of the digital divide among higher 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(2012). the use of role play and drama in interprofessional education: an evaluation of a workshop with students of social work, midwifery, early years and medicine. social work education, 31(1), 7589. https://doi.org/10.1080/02615479.2010.547186 wilson, a. b., brown, s., wood, z. b., & farkas, k. j. (2013). teaching direct practice skills using web-based simulations: home visiting in the virtual world. journal of teaching in social work, 33, 421-437. https://doi.org/10.1080/08841233.2013.833578 wretman, c. j., & macy, r. j. (2016). technology in social work education: a systematic review. journal of social work education, 52(4), 409-421. https://dx.doi.org/10.1080/10437797.2016.1198293 york, r. (2008). comparing three modes of instruction in a graduate social work program. journal of social work education, 44(2), 157-172. https://doi.org/10.5175/jswe.2008.200700031 young, j. (2014). ipolicy: exploring and evaluating the use of ipads in a social welfare policy course. journal of technology in human services, 32(1-2), 39-53. https://doi.org/10.1080/15228835.2013.860366 author note: address correspondence to annie j. keeney, school of social work, san diego state university, ca, 92182, email: akeeney@sdsu.edu acknowledgements: we would like to acknowledge all the field faculty that helped implement the simulations and scripted role plays in their field seminars, the students that participated, and the professional and student actors that worked tirelessly to perfect their respective client roles in the simulations. additionally, the school of social work would like to acknowledge san diego state university’s instructionally related activities grant program that provided the funding to make this project possible. https://doi.org/10.1177/0273475311430802 https://doi.org/10.1080/02615479.2020.1727875 https://doi.org/10.1080/10437797.2018.1434432 https://doi.org/10.18060/236 https://doi.org/10.1080/02615479.2010.547186 https://doi.org/10.1080/08841233.2013.833578 https://dx.doi.org/10.1080/10437797.2016.1198293 https://doi.org/10.5175/jswe.2008.200700031 https://doi.org/10.1080/15228835.2013.860366 mailto:akeeney@sdsu.edu _________ priscila llamosa, msw, dsw, lcsw, visiting clinical assistant professor, college of social work, university of kentucky, lexington, ky. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 344-365, doi: 10.18060/27466 this work is licensed under a creative commons attribution 4.0 international license. reclaiming social justice: using a metatheoretical supervision model to (re)orient clinical practice to social work's core value priscila llamosa abstract: a central tenet of the social work profession is its commitment to social justice. this commitment is outlined by the major governing bodies across social work education and practice, intraand internationally. however, clinical social work has historically been influenced by the evidence-based movement and broadly adopted medicalized models of practice by focusing on treatment model adherence and symptom reduction. consequently, clinical practitioners have been criticized for not adequately addressing systemic oppression and social injustices affecting vulnerable and historically marginalized populations. the absence of a social justice orientation to clinical practice not only lacks alignment with social work's core values but, in the current socio-political environment, may further perpetuate oppression. clinical supervision, a staple in developing professional skills for graduate students and novice clinicians, offers an ideal pedagogical space for developing the cognitive, emotional, and behavioral skills and competencies needed to engage in social justice-focused practice. the aim of this article is to offer a supervisory framework, the critical relational model (crm), grounded in a metatheory that integrates principles from critical theory, critical pedagogy, and antioppressive and decolonizing frameworks, applied through a relational lens. a second aim is to demonstrate how the crm can be immediately applied to practice with novice clinicians, graduate students, and any other clinical practitioner wishing to enhance their effectiveness and participation in creating a more equitable and just society for all. keywords: clinical supervision, social justice, anti-oppressive practice, clinical social work social justice is a core value and guiding principle of the social work profession. this is affirmed by the international federation of social workers (ifsw; 2018), the council on social work education (cswe; 2022), and the national association of social workers (nasw; 2021). however, the development of clinical social work as a practice specialty has been influenced by the professional regulation movement of the 1980s (jani et al., 2011), which promoted managerialism and treatment fidelity, and by the evidence-based movement, which centers positivism as its main episteme (drake & hodge, 2022; tosone, 2013). often adopting a medicalized model of mental health, practitioners became largely concerned with individual-level issues. as a result, clinical social work practice has drifted away from intentionally addressing social injustices, structural and systemic oppression, and their impact on the lived experiences of individuals (apgar, 2020; specht & courtney, 1994), leading to what scholars and researchers refer to as the macro-micro divide. social work education has both contributed to and been affected by this divide. since the 1960s and for at least 30 years, modernist thought, specifically positivism, was the dominant episteme in social work education and research (drake & hodge, 2022; jani et al., 2011). modernist theories promote normative standards, generalizations, and about:blank advances in social work, summer 2024, 24(2) 345 assimilative assumptions about culture and difference and "fails to capture the complexity of human experience… [and] inadvertently undermines the profession's goal to promote greater understanding of social and cultural differences" (jani et al., 2011, p. 284). because a commitment to challenging social injustices requires understanding them through individuals' subjective experiences and a critical analysis of the systemic and cultural influences on them, the centering of modernism in social work education was and continues to be arguably inadequate. in a committed effort to advance the profession toward this critical analysis of the systemic and cultural influences on social injustices, the author intentionally uses throughout this paper the more inclusive and anti-racist term ‘practicum’ to refer to the community-based training that social work students receive. the term replaces the term ‘field,’ which may carry oppressive and stigmatizing connotations related to slavery, immigrant, and otherwise unpaid work that is part of u.s. history. social justice and social work although a commitment to social justice is recognized as a central tenet of the social work profession (clinical social work association [cswa], 2016; cswe, 2022; nasw, 2021), the construct is not consistently addressed in all areas of social work education and practice. for instance, though it's been 15 years since cswe first included specific language regarding the commitment to promoting social justice among the educational competencies in the education program accreditation standards (cswe, 2008; jani et al., 2011), concrete changes in social work curricula have been slow at best. content analyses of social work syllabi and program surveys have demonstrated notable differences in if and how msw programs incorporate social justice concepts in their implicit or explicit curricula (mehrotra et al., 2017), and when they do, most of the focus on social justice themes is found in macro practice-oriented courses (gatenio & mapp, 2020; salas et al., 2010). however, over 90% of msw students seek practicum placement in clinical settings (mcbeath, 2016, as cited in kiesel & abdill, 2019). thus, graduate students and novice practitioners in clinical settings often lack the foundational skills needed to embrace the ideology of social change (apgar, 2020; mclaughlin, 2009; salas et al., 2010). several reasons exist for the challenges of centering social justice in social work education and practice. one is the lack of an agreed-upon definition of social justice by scholars, theorists, and researchers (kiesel & abdill, 2019; nicotera, 2019; rountree & pomeroy, 2010). for example, kiesel and abdill (2019) found that the variability of definitions in the literature includes understandings of diversity, multiculturalism, challenging power structures, empowerment, human rights, equity, or social change. this lack of cohesion makes social justice challenging to contextualize and apply to clinical practice (asakura & maurer, 2018). another possible reason for discrepancies in how social justice is addressed in education and practice is an assumed relationship between acquiring knowledge about social justice and developing practice skills necessary to engage in social change (mehrotra et al. 2017) or knowing how to actualize social justice in practice (hair, 2015). llamosa/reclaiming social justice 346 recently, there has been increased energy within the social work literature calling for more attention to social justice in social work education (e.g., gatenio & mapp, 2020; mehrotra et al., 2017; vincent, 2012) and clinical supervision (e.g., asakura & maurer, 2018; fickling et al., 2019). this reflects renewed intentionality of the profession to return to its core ideological values and mission. however, as rountree and pomeroy (2010) noted, straightforward methodological approaches and strategies for actualizing social justice in practice are sparse. moreover, addressing social, economic, and environmental injustice in clinical practice can be particularly difficult (asakura & maurer, 2018). nonetheless, growing racial and political tensions in the united states, the health disparities exacerbated by the coronavirus pandemic, and recent legislative developments such as the "don't say gay" bill (johnson, 2020) have highlighted racial and economic inequities, systemic oppression, and discrimination on the basis of culture, race, gender, ability, sexual and romantic orientation experienced at the individual level. thus, there has never been a better time for clinical social work practitioners to re-orient toward their commitment to promoting social justice by adopting a critical macro-orientation to their micro-level work. clinical supervision offers such an opportunity, as will be discussed in the following sections. social justice and clinical supervision supervision has been recognized as an essential tool in the professional development of social workers (kadushin & harkness, 2014; saari, 2012). although much of the conceptualization and discussion that follows may be relevant to all social work supervision across all levels of systemic practice, this paper focuses on the supervision of social workers in clinical settings. clinical practitioners are especially vulnerable to bypassing social justice issues in the name of mental health treatment protocols, as noted earlier, and consequently perpetuating the medicalization of clinical practice. as both graduate students and novice practitioners are required to receive supervision during their practicum education (cswe, 2022) and clinical practice (nasw & aswb, 2013), clinical supervision offers the ideal pedagogical space to develop a social justice orientation in clinical practice (asakura & maurer, 2018; chang et al., 2010 hair, 2015; hair & o'donoghue, 2009). a review of the recent literature has revealed a small number of supervisory models that coherently offer clinical and practicum supervisors a framework for addressing social justice themes in supervision (e.g., dollarhide et al., 2021; fickling et al., 2019; lee & kealy, 2018; mitchell & butler, 2021; o'neill & fariña, 2018). the profession has historically relied on supervisory models that follow the expert-trainee framework common to modernist developmental models (nickson et al., 2020), are deficit-based, patriarchal (kahn & monk, 2017), and perpetuate euro-western theories and conceptualizations of clients' needs (falender & shafranske, 2014; nickson et al., 2020; o'neill & fariña, 2018; simpson-southward et al., 2017). these models are typically concerned with treatment model fidelity and do not offer sufficient opportunities to critically reflect on various social, economic, environmental, and political injustices affecting clients. arguably, these models may also serve as a form of epistemic oppression (fricker, 2007) by subjugating and excluding the voices and experiences of supervisees while enforcing the supervisor's advances in social work, summer 2024, 24(2) 347 epistemic power. this is particularly problematic when working with supervisees and students of marginalized, minoritized, and intersectional identities. as such, it is imperative that social work clinical supervisors re-orient their practice to align with social work values. to help address this need, this paper seeks to contribute to the current literature promoting clinical supervision as the ideal space to develop a social justice orientation in clinical practice. the critical relational model (crm) offers an approach that can be used in clinical supervision to promote critical conceptual understanding and practical engagement with social justice issues. the following sections provide descriptions of the model’s main components, its underlying theories and frameworks, and how it can be applied in clinical supervision with graduate-level students and novice practitioners. first, the epistemological and ontological assumptions undergirding the model are explained. critical relational model for clinical supervision: conceptual framework the critical relational model is grounded in a social constructionism ontology. social constructionism offers that reality is constructed socially through a relational exchange of ideas and experiences, which are culture and time-bound. that is, one's experiences (feelings, social dynamics, inner thoughts) are shaped by the cultural and social space in which they occur and through relational exchanges that legitimize or delegitimize them (cooper, 2001; shaw, 2016). as such, social constructionism recognizes the primacy of the relational perspective in co-creating one's reality (i.e., individual strengths, experiences, perspectives, and needs). consequently, the relational perspective is the primary epistemology for how the crm is used in supervision to enact a social justice orientation that is sensitive to the social, cultural, and political environments. there is a natural alignment and preference for postmodern frameworks and epistemologies among scholars who promote a social justice orientation in clinical supervision. for example, mitchell and butler (2021) argued that attending to intersectional identities can facilitate engagement with culturally relevant practices. several others have offered that a relational lens can facilitate safety, empowerment, and reflexivity in the supervisory relationship (e.g., lee & kealy, 2018; o'neill & fariña, 2018). additionally, several scholars have cogently grounded their clinical supervision frameworks in critical theory (e.g., gentile et al., 2010; rankine, 2017). despite the variability in theories and frameworks in the literature addressing social justice in supervision, these theories share a common threat of postmodern thought. they center reflexivity, recognize the importance of cultural identities in the supervisory triad, and encourage critical analysis of the interactions between individuals and the social environments, including the therapeutic and supervisory contexts. effective social work practice requires critical reflection on theory and practice and how they mutually inform each other (forte, 2010). through an analysis of the models and approaches in the salient literature and critical reflection on this author’s supervisory practice, a metatheory emerged. metatheories are higher-order theories that include different theoretical assumptions, frameworks, and bodies of ideas (american psychological association, 2018). the crm is a metatheory informed by five conceptual llamosa/reclaiming social justice 348 bodies of ideas: (1) critical theories, (2) critical pedagogy, (3) a relational approach, (4) anti-oppressive framework, and (5) decolonizing framework. critical theories provide the backdrop for developing critical thought and culturally relevant awareness of the deleterious effects of structural oppression and systemic injustices, including power and racial dynamics (gentile et al., 2010; rankine, 2017). freire's and bell hooks' critical pedagogies inform the gap between knowledge about social injustices and action toward social change to produce engaged practice (davidson & yancy, 2009; diemer et al., 2016; glosoff & durham, 2010). additionally, because a fundamental goal of the crm is to go beyond conceptual understanding and encourage social justice-related behaviors, the model adopts anti-oppressive and anti-colonial frameworks. the application of an anti-colonial framework within the crm is further informed by foucauldian philosophy, which helps understand power dynamics in the supervisory relationship associated with the use of discourse (foucault, 1972). integrating theory and practice with enough practical specificity can be challenging. therefore, the crm is intended to be flexible in integrating these frameworks and theories, allowing for a dialogical process, ongoing reflection on practice, and adaptability to the supervisee's needs. figure 1 provides a visual representation of the model’s metatheory. each of the remaining components of the metatheory is represented in a dynamic configuration, with the arrows around the center of the diagram illustrating their non-static integration and the relational approach as the central epistemology. specific concepts and skills from each component that help develop a social justice orientation are listed. finally, the perforated circular line represents the flexibility of the model and its potential for further integration. critical relational model for clinical supervision: application of the model the crm is predicated on conceptualizing supervision as a critical pedagogical process, not a developmental one; therefore, it is not structured in a way to teach skills or competencies procedurally. instead, it focuses on facilitating meta-competence, which can be understood as higher-order cognitive, critical, and self-reflective capacities (bogo et al., 2013). the model can enhance specific practice procedures, such as developing joining or alliance-forming skills, setting treatment goals, and forming clinical conceptualizations, as supervisors foster meta-competencies, such as critical thinking, reflexivity, and cultural humility. the following sections discuss how applying the model in clinical supervision can foster specific aptitudes to reach this goal. orienting supervisees to social justice the initial phase of the supervisory relationship and process focuses on the supervisory dyad engaging in alliance building, clarifying roles and expectations, and discussing the supervisee's needs and the supervision goals. nickson et al. (2020) noted that creating a supervision agreement that includes clarification on the limits of confidentiality, fees, cancelation policy, and the responsibilities of each party in the supervisory process helps to create a safe space for both supervisors and supervisees. supervisors utilizing the crm are encouraged to present the supervisory relationship as a collaborative and supportive advances in social work, summer 2024, 24(2) 349 space; one where supervisees can enrich the process by sharing their perspectives and experiences. in this orienting phase, supervisors might ask about goals for supervision and expectations of what the supervisory process should look and feel like, and discuss agencyspecific concerns when applicable. supervisors could set the tone of collaboration by inviting the supervisee to help brainstorm a list of individual and shared responsibilities and expectations. figure 1. critical-relational model of social work clinical supervision lee and kealy (2018) suggested that in addition to a supervisory agreement, agenda setting helps clarify supervision's focus and goals to ensure a productive process. therefore, the orienting phase of the supervisory engagement provides opportunities to discuss what it means to orient the supervision process toward social justice concepts. this includes collaboratively considering the potential contributions from the organizational, social, and systemic contexts in which supervision takes place and attending to salient cultural differences in the dyad. for example, the supervisor might ask: “which social work values are most important to you?”, “what do you see as your role in promoting social work’s ideals and values?”, “what particular social work concepts do you consider your strengths and which require more reflection and development?” the crm invites the supervisory dyad to develop clinical praxis by critically and intentionally drawing from theoretical and empirical knowledge and practice wisdom to llamosa/reclaiming social justice 350 develop complex social-political conceptualizations of clients' experiences. this requires that supervisors continuously assess the supervisee's strengths and areas where they need to enhance their professional development. for example, the supervisor might ask the supervisee to consider the possible impact of social inequities, power dynamics, and racial or gender discrimination on a client’s affective and functional presentation, what cultural identity aspects can inform the dyad’s understanding of the client’s experiences, and how they can inform the therapeutic engagement to as a means of validating and legitimizing the client’s intersubjective reality. in sum, the orienting phase of the supervisory process is essential to establish the supervisory process as a purposeful and collaborative endeavor, to establish expectations and roles, and to orient the supervisee toward the importance of incorporating social justice themes in supervisory discussions. relational approach collaboration and support characterized by placing the supervisory relationship at the center of the process, the relational approach emphasizes mutuality and the contextual nature of truth co-created through interpersonal interactions (peled-avram, 2017; tosone, 2013). the benefits of adopting a relational epistemology in supervision include reducing the power differential, common to supervisory dynamics, through collaborative dialogues, validating the supervisee's subjective experiences, and facilitating shared understanding and meaning (hair, 2015; rasmussen & mishna, 2018). this egalitarian, supportive, and culturally affirming stance is particularly important when working with supervisees with minoritized, oppressed, or disenfranchised identities, whose perspectives have likely been silenced or invalidated by dominant culture dynamics in academic and professional settings. furthermore, a relational stance in supervision serves as a parallel process for how the therapeutic relationship is, as tosone (2013) described, “the principal vehicle to affect change in the client’s systemic functioning” (p. 256). reflexivity although there is some debate on the definitions of reflexivity in social work practice and research, within the relational-critical metatheory, reflexivity assumes the qualities of being the process of critical reflection on knowledge and practice (taylor & white, 2001) and the product of how this process influences a practitioner’s meaning-making within the practice context (fook & gardner, 2007). whereas reflectivity is generally understood within relational and psychodynamic theories as an introspective practice leading to the subjective understanding of the self as the mechanism for change (mcwilliams, 2021), reflexivity also involves considering the subjective other, placing the self as an object of critical study alongside the other (client/supervisee), and both self and other as agents within the sociocultural and systemic context (rasmussen & salhani, 2010). advances in social work, summer 2024, 24(2) 351 therefore, reflexivity promotes critical awareness of power dynamics, privilege, and implicit biases (o'neill & fariña, 2018), and provides opportunities for understanding how sociocultural positionality and values inform assumptions related to clients’ issues and experiences (lusk et al., 2017; tarshis & baird, 2021). as such, reflexivity may lead to uncomfortable conversations about race, privilege, and power (o'neill & fariña, 2018), and bring to light affective reactions, enactments, and transferences impacting the meaning-making process (fook & gardner, 2007; peled-avram, 2017; rasmussen & mishna, 2018). trust and safety become essential facilitative features in difficult conversations and impasses. safety and a trauma-informed approach safety and trust in the therapeutic relationship are particularly important when difficult conversations around race, culture, and social injustices arise. "enactments of racial and social injustice, prejudice, power, and privilege… can be misunderstood or avoided in social work supervision [creating] negative consequences [that] not only impede learning for the supervisee and supervisor [but also] affect clinical understanding of client care, perpetuate social and power injustices" (o'neal & fariña, 2018, p. 298). harrell (2014) noted that compassion and empathy could help mediate the exploration of emotionally charged conversations. in addition, kadushin and harkness (2014) indicated that the quality of the supervisory relationship, which is mediated by trust, heavily influences the supervisee's openness and receptivity to learn from the supervisor. additionally, given the prevalence of trauma histories in the american population (national council for behavioral health, 2022), particularly among people of minoritized identities, engagement in trauma-informed practices is essential to foster safety and trust (peled-avram, 2017). within the supervisory relationship, a trauma-informed approach can help to ensure that supervisees are given the opportunity to not only process traumarelated client material but also to evaluate and address if and how their personal experiences with trauma impact their work with clients. although the supervisory relationship is not meant to be therapeutic, and the supervisory encounter should not be used to process previous trauma (berger & quiros, 2014; ladany, 2014), supervisors are reminded of the critical role of basic relational safety. clinical supervision can serve its supportive function by providing a space to share affective reactions and their effect on practice, share difficulties and ask questions without fear of criticism (egan et al., 2017). as noted by miehls (2010), in the same way in which clinical work with clients who have survived trauma needs to be based on an empowering and validating relationship with the clinician, therapists also need the same qualities in their supervisory relationship as they may also play out unconscious dynamics during supervision. thus, insofar as it intentionally is on safety and trust, trauma-informed supervision can help supervisors navigate supervisees’ resistance to learning, mistrust, defenses, hostility, and prevent projective identifications (peled-avram, 2017). creating safety and trust in the supervisory relationship can parallel the therapeutic relationship in that supervisors provide an authentic, welcoming, empathic, and non-judgmental supervisory space that can nurture a strong and growth-enhancing supervisory relationship (stargell et al., 2020). llamosa/reclaiming social justice 352 application of critical theories critical theories are a fundamental component of the crm in promoting social justice engagement and social change within clinical social work practice. concepts drawn from critical theories include attention to power dynamics, culture, and systemic issues. attention to power dynamics power is manifested in clinical supervision in various ways, including positional authority, professional expertise, and referent power, deriving from the endorsement of the practitioner’s professional and relational competence (noble et al., 2016). supervisors attend to these interpersonal spheres of power by critically considering the manifestation of power dynamics inherent in the supervisory relationship and intentionally working to mitigate them. the collaborative nature of the relational approach can be an effective mechanism to navigate issues of power. power structures can also influence the supervisory process within the agencies or organizations where supervision occurs when they reflect inequities and oppressive practices. for example, hierarchical power structures may dictate how and when supervision occurs. in addition, as noted by noble et al. (2016), supervisors may face challenges negotiating policies and priorities against their professional values or the supervisee's needs. therefore, the crm encourages supervisors to explicitly name and discuss with supervisees any dynamics of power that influence the supervisory process and relationship and to elicit their collaboration in identifying effective ways to mitigate their impact. for example, supervisors may empower supervisees to seek reasonable adjustments to their schedule or workload or seek needed funding or resources to support their supervisory and learning experience. more importantly, the crm provides a framework for actively listening to supervisees as they bring topics and issues for discussion in clinical supervision while intentionally identifying, questioning, and addressing issues of power, sexism, racism, ableism, and classism expressed consciously or unconsciously by the supervisee. as the supervisor approaches the discussion with openness and curiosity, they can ask probing and clarifying questions to engage in the supervisee’s sense-making. in doing so, supervisors evaluate how biases and privileges may be embedded in the therapeutic relationship and how they impact the supervisee’s understanding of the client’s subjective experience. examples of how supervisors may broach these conversations include: “could you tell me more about how you understand the client’s perspective?”, “what are some differences in how you and your client interpret this issue/event?”, “i am curious about specific client characteristics that can help us understand this event/dynamic/experience.”, “what are some of the feelings that the interaction/dynamic arose in you?” awareness of systemic issues adjunctive to awareness of power dynamics in supervision, raising supervisee awareness of systemic inequities is essential to a social justice-oriented supervision advances in social work, summer 2024, 24(2) 353 practice. experiences with rights violations, unfair and discriminatory treatment, marginalization, and inequities are present across all systemic levels. they require practitioners to understand how their deleterious effects adversely impact the well-being of the populations they serve. in fact, dean and poorvu (2008) argued that practitioners should not only consider the impact of social justice and oppression on client suffering but to locate its cause. as noted by rasmussen and salhani (2010): social workers must be willing to explore how the psyche adapts to oppressive forces and the deep, lasting effects of trauma, not to mention our own inherent capacity to oppress others, as well as the possible independent contribution of the psyche to the ways in which we interact in the social world. (p. 211) adopting an equity lens in the conceptualization of social justice enables supervisees to look beyond the presenting problem and recognize oppression through differences between need and historically unequal access to power and resource distribution, cultural representation, and social and political participation in a group's history (kang, 2022). as a result of viewing social justice from an equity perspective, supervisees can immediately attend to imbalances in the therapeutic relationship caused by the epistemic power inherent to the “expert” by inviting client insight and collaboration in all phases of the clinical work, promoting self-determination, and empowerment to address needs. this process mirrors the supervisory relationship in which the supervisor seeks direct input from the supervisee on agenda items for supervision and topics of interest that can be explored and seeks to understand and integrate the supervisee’s individual characteristics, temperament, skills, and preferences. additionally, supervision can help supervisees problematize oppressive institutional practices (chenfeng et al., 2017) and identify avenues for advocating for institutional and systemic policy changes that enhance equitable opportunities for clients to achieve their full potential. for example, by advocating for the agency to provide a longer grace period for a client who may be late for their appointments due to chronic pain or mobility issues. other examples of such social justice behaviors are facilitated by anti-oppressive and decolonizing approaches, which are discussed later. cultural relevance and humility feminist theory, critical race theory, queer theory, and intersectionality framework further inform the theoretical grounding for implementing the cmr by framing supervisory conversations within cultural-relational dynamics manifested within the larger systemic environment. the intentional application of the intersectionality framework helps the dyad to attend to the unique experiences of marginalization among clients with intersectional identities by attuning to their social positions (catlin & mizock, 2021; chang et al., 2010; dollarhide et al., 2021) and to increase supervisees’ use of culturally relevant practices. for example, supervisors can ask supervisees about their client's sociocultural identities in ways that foster curiosity about how these identities intersect to create unique experiences. they also promote critical thinking about how sociocultural inequities, racism, and microaggressions may be present in the client's lived experiences and impact their well-being. llamosa/reclaiming social justice 354 cultural relevance in practice requires a holistic understanding of culture and its manifestations. rather than seeking the limited and inadequate idea of cultural competence, which situates communities of color as "other" (hair & o’donoghue, 2009), cultural humility decenters white culture as normative. similarly, cultural humility also decenters gender normative and heteronormative cultures and promotes participatory equity among individuals especially vulnerable to marginalization and discrimination. the crm encourages supervisor humility by promoting flexibility and adopting a not-knowing stance. the not-knowing stance was characterized by dean (2001, as cited in noble et al., 2016) as the best starting point for attempting to understand another through their lived experience. additionally, supervisors seek alternatives to academic and research-based knowledge to further support cultural humility in supervision, leverage epistemic resistance, such as supervisee lived experiences, artistic, intuitive, and indigenous knowledge, and promote epistemic justice by inviting supervisees to share their perspectives and practice experiences, and feedback. when difficult conversations lead to ruptures in the supervisory relationship, supervisor humility is "preeminently pivotal in making rupture/repair possible and rendering reparative interventions" (watkins et al., 2019, p. 284). examples of how to engage supervisees' perspectives include asking questions such as, “what does it mean to you to be a member of xx culture/group/religion?”, “can you help me to understand how your cultural/religious/familial values play a role in your life now?” critical pedagogies contextual analysis and theorizing the concepts drawn from critical pedagogy to inform the crm are based mainly on the work of paulo freire and bell hooks and help to center clinical supervision as a pedagogical process. proponents of education as a source of political resistance, liberation, and social change, both freire's and hook's pedagogy conceptualized the human experience as an object of critical reflection fundamental to praxis (davidson & yancy, 2009; freire, 2000). likewise, clinical supervision is a pedagogical space for supervisees' educational and professional development, and is therefore concerned with both content and process. in the context of supervision, graduate students and novice practitioners learn to reflect critically on their client's subjective experiences in the social and political contexts and develop an awareness of how immediate and larger social contexts mediate these experiences. additionally, supervisors facilitate dialogues that help deconstruct assumptions, biases, and ideologies in theorizing about clients’ needs that may be pathologizing or “othering.” through these conversations, supervisees and supervisors apply critical thinking to generate increased awareness of the intricate dynamics between individuals and their environments. supervisors can model how to apply critical thinking by posing critical questions about the supervisee’s frame of reference, theorizing about clients' needs, using analogies, probing for unstated assumptions and inferences, identifying and challenging themes and patterns in thinking, and exploring how the supervisee’s lived experiences and practice wisdom can help inform their work with the client. advances in social work, summer 2024, 24(2) 355 critical consciousness sharpening the supervisee's critical thinking and awareness of the interplay between the social context and the client's experiences are two of the goals of the crm. to effectively align with the profession's goal of promoting equity, justice, and human rights, supervision must move beyond content and clinical competency development to promote supervisees' politicization of their learning and promote self-efficacy toward social change. the crm offers a framework that enables critical consciousness through focused conversations and reflective interventions (glossoff & durham, 2010). critical consciousness, a concept from freire’s pedagogy, comprised of critical motivation and critical action, is both a process and a product of analyzing social inequities impacting clients' lived experiences and developing motivation and action toward social change (diemer et al., 2016). in terms of application, supervisors need not require that supervisees engage in any particular political action, such as formalized advocacy initiatives, but may encourage it. supervisors can engage in a dialogic process that deconstructs dominant ideologies in social work practice by critically analyzing their origin and impact on clients and help supervisees to situate difficulties and interventions holistically (within and between micro, mezzo, and macro levels). for example, discussing how educators can embody epistemic resistance in client assessments, lee (2022) suggested encouraging students to “interrogate the everyday practice of assessment and rethink the notions of professional, institutional, ideological, and political power that have shaped their daily practice” (p. 562). as a result of critical practice analysis and politicization in learning, supervisees develop critical motivation to question structural injustices and feel empowered to engage in transformative social action in meaningful ways. knowledge as power developing knowledge and awareness of social justice issues and modeling a justice orientation in supervision leads supervisees to spend more time discussing social justicerelated themes and experiencing increased social justice advocacy attitudes and behaviors (ceballos et al., 2012). one example of how supervisors can model and encourage a justice attitude is informed by bell hook's "back talk" as an act of social and political empowerment (davidson & yancy, 2009). talking back means sharing the perspectives and voices that would otherwise remain silenced and "othered" by oppression and marginalization (davidson & yancy, 2009). the crm values knowledge co-constructed by the supervisory dyad as power to challenge epistemic domination, deconstruct the hegemony in ways of knowing, and promote knowledge beyond theory or the supervisor's expertise. armed with knowledge and provided with deliberate and intentional opportunities for back talk, supervisees experience increased perceived self-efficacy to engage in social change (kassan et al., 2015). llamosa/reclaiming social justice 356 anti-oppressive and decolonizing frameworks discourse analysis in supervisory conversations, supervisors and supervisees are engaged in what foucault referred to as discourse, that is, the process by which the expression of ideologies produces knowledge and truth within a society (foucault, 1972). through social exchanges of ideologies, discourses become more widely accepted. discourse produced or adopted by those who hold more social, intellectual, economic, or political power is more widely accepted and likely to become the dominant truth. in this manner, the more power one holds, the more their ideologies become accepted as truth. in traditional models of clinical supervision, the supervisor has epistemological power by virtue of their position in the supervisory dyad as “expert” (hair & o’donoghue, 2009; tsui, 2017). however, according to foucault (1972), ideological irregularities, or biases, also sometimes become part of the accepted truth in subtle ways. the supervisory dyad is not immune to this phenomenon. thus, the crm incorporates discourse analyses as one of its central components to help to expose conceptualizations that may intentionally or unintentionally perpetuate oppression and discrimination. concerning centering non-dominant perspectives, the crm seeks to elevate the voices of marginalized groups that may otherwise be silenced or “othered.” supervisors who engage in discourse analyses explicitly and intentionally consider non-dominant perspectives in their understanding of the issues supervisees bring to supervision. for example, they may elicit culturally specific interpretations and processes that inform the subjective experiences of diverse clients and supervisees. they also deconstruct dominant ideologies by inviting supervisees to critically consider whether everyday clinical language, taken-for-granted practices, popular interventions, and dominant culture rituals embedded in the therapeutic encounter fit with the client’s sociocultural identity or whether they perpetuate oppression and marginalization. a practical example is the common ideology of not accepting client gifts, still taught in social work programs. this practice is mainly based on the ideologies that stem from dominant psychoanalytic and psychodynamic perspectives of gift-giving as an unconscious expression of clients’ neurosis or attempts to please or bind the analyst (knox et al., 2003). however, a critical analysis of this ideology points to the importance of awareness of the client’s culture around gift-giving as an expression of gratitude and the potentially disenfranchising effect of refusing the client’s gesture. using anti-oppressive and decolonizing language anti-oppressive practice requires that social workers recognize how the profession has remained complicit in cultural marginalization and epistemic injustice by adopting language that perpetuates colonial ideologies in education, policy, and practice (lee, 2022; noble et al., 2016). a primary way in which the crm promotes anti-oppressive practices is by questioning the euro-western cultural status quo and intentionally attending to the use of normative, blaming, and disenfranchising language. when supervisors pay close advances in social work, summer 2024, 24(2) 357 attention to the language used by supervisees (and their own), they can bring to light conscious and unconscious beliefs, biases, values, prejudices, and preconceptions about the self, the other, and the social, political, and systemic contexts with which they interact. for example, mental health-related normative discourse often relies on stigmatizing language such as “the schizophrenic client” in discourse, “the patient did not comply with treatment” in service documentation, or “the mother was an alcoholic” in client history documentation. in addition, normative discourse may perpetuate epistemological and cultural hegemony and dominance in the production of racialized knowledge and culture. participation and equity anti-oppressive and anti-discriminatory approaches in social work practice are used in response to social divisions. they are rooted in several theories that offer conceptualizations for inequalities, power, and marginalization practices (hodgson & watts, 2017). in the crm, the hypotheses about the client or system's needs are systematically formed by critically examining inequities and social divisions that contribute to the problems experienced by individuals and groups. as noted earlier, when supervisees take an equity-based perspective to clinical practice, they can better identify opportunities to advocate with and on behalf of their clients for equitable access to the resources they need to improve autonomy and capability. for example, supervisees can ensure that their clients participate in developing therapeutic goals, advocate for a reduced fee or pro bono services for clients who struggle with financial independence or conduct outreach to community partners to help secure resources such as food, housing, and transportation. although the implementation of the model in clinical supervision will be influenced by specific supervisor characteristics, supervisee needs, and cultural and organizational practices, the crm provides a practical framework for how supervisors can engage in explorations of culture, positionality, race, and systemic and structural power dynamics to orient supervision toward addressing social justice issues embedded in the lives and experiences of the individuals seeking and receiving services in clinical settings. having discussed how the crm is implemented as an intentional, dialogic, and reflective pathway to supervision that aids in exploring social justice issues of discrimination, colonialism, and marginality, the following section turns to some of the implications of using the crm in the clinical supervision of novice practitioners and msw students, along with strengths, limitations, and recommendations for future developments. implications for clinical supervisory practice clinical social work supervision offers the ideal pedagogical space for developing novice practitioners and msw students during their practicum education. the crm was created to help reclaim social justice as a core value in clinical social work practice by supporting supervisees to develop practice skills needed to embrace social justice and change ideologies. to accomplish this goal, the crm was designed by integrating five theories or frameworks identified in the clinical supervision literature as essential in llamosa/reclaiming social justice 358 providing ideological grounding and conceptual understanding of the complex impact of systemic forces on individuals and groups. the resulting metatheory guides the supervisory process in developing supervisees’ orientation toward equity, inclusion, justice principles, and practice behaviors. strengths critical theories are an essential part of the model to promote the capacity for critical awareness of how human rights violations, systemic inequities, structural oppression, and discrimination can negatively impact well-being and be the primary cause of human suffering (kang, 2022; noble et al., 2016). they offer grounding for supervisory conversations within cultural-relational dynamics (o’neal & fariña, 2018) and reflexivity, (rasmussen & salhani, 2010) and encourage cultural humility and culturally relevant practices (hair & o’donoghue, 2009). in order to actualize the full potential of supervision as a transformative and pedagogical space, the crm draws from critical pedagogy to promote politicizing knowledge as a source of power against epistemic injustice and hegemony resulting from centering euro-western ways of knowing (davidson & yancy, 2009; noble et al., 2016). additionally, critical pedagogy informs supervisees’ development of critical consciousness, which is essential in problematizing oppressive organizational practices and policies that misalign with the profession’s ethos and developing motivation for social change (diemer et al., 2016; glossoff & durham, 2010. the impetus of anti-oppressive and decolonizing practice frameworks supports the crm by deconstructing dominant group ideologies through discourse analysis, centering historically “othered” perspectives, rejecting normative, blaming, disenfranchising language, and adopting equity-based attitudes in practice and advocacy (foucault, 1972; lee, 2022; noble et al., 2016). the crm centers the relational approach as the primary epistemological lens in supervision. therefore, as suggested by kennedy et al. (2018), the supervisory relationship is seen in the crm as a relational encounter wherein the process of learning, growth, and change takes place through safe and affirming interpersonal connections. moreover, the relational perspective equalizes power and builds mutuality in the supervisory relationship (hair, 2015; peled-avram, 2017), allowing the supervisory process to facilitate the critical and reflexive capacities needed to engage in conversations about discrimination, colonialism, and marginality inherent to today’s socio-political climate. because all components are interrelated, the model offers a holistic approach to deepening supervisees’ skills for critically analyzing contextual, social, cultural, political, and environmental injustices affecting clients' lived experiences and well-being. unlike developmental models, in the crm, the role of the supervisor is not of expert (kahn & monk, 2017) but of facilitator of the supervisee’s learning by promoting reflexivity, critical inquiry, problem-posing, cultural humility, and relational mutuality (hair, 2015; rankine, 2017; stargell et al., 2020). additionally, as the crm is predicated on supervision being a co-constructed process, the model seeks to “meet supervisees where they are,” allowing supervisors to work collaboratively with supervisees to identify practice areas requiring focus. whilst recognizing the supervisor’s relationship in upholding ethical and advances in social work, summer 2024, 24(2) 359 professional standards, the crm requires flexibility and adaptability to acknowledge the constant interplay between the supervisory dyad and the system in which they operate. in addition to its value as a framework for clinical supervision, the crm may also be used in non-clinical supervision. although the literature clearly indicates a more robust focus on social justice themes in macro-oriented courses, it should not be assumed that explicit curriculum competencies consistently translate to practice. students and novice social workers in macro and mezzo practice areas may also benefit from the model. school social workers, for example, would benefit from interrogations of how the social and educational systems affect the students they support and of their own biases about the youth and the educational system they are a part of. limitations there are some challenges associated with the implementation of the model. the crm requires supervisors to have a sufficient grasp of the theories undergirding the model, including the frameworks and theories deriving from critical theory, such as feminist, intersectionality, critical race, and queer theories. the crm also requires that supervisors have a healthy understanding of the relational perspective and its underpinnings in psychodynamic theory to fully embrace its reliance on mutuality and collaboration in cocreating knowledge and truth. supervisors interested in applying the crm may seek continuing education in all theories and frameworks that comprise the model. additionally, select readings on psychoanalytic supervision (e.g., mcwilliams, 2021) may be particularly helpful in attuning to the relational nature of supervision. the most significant limitation of the model is the lack of evidence regarding implementation. although the metatheory components are supported by the contemporary literature for their alignment with a social justice orientation in clinical practice and supervision (e.g., glosoff & durham, 2010; mitchell & butler, 2021; o’neal & fariña, 2018), the model requires implementation as an integrated metatheory. additionally, as mehrotra et al. (2017) have alerted to the assumed relationship between knowing about social justice issues and developing practice skills necessary to engage in social change, research on the model’s efficacy in promoting supervisee social justice behaviors is needed. future research directions include those pertaining to social justice attitudes and behaviors due to receiving supervision utilizing the crm. empirical explorations could use the social justice scale (torres-hardin et al., 2012), or similar assessments would be welcome. there are additional potential implications for supervisor efficacy and training. supervisors can be the receiver of a range of strong emotional reactions as they support supervisees in processing experiences that elicit conscious and unconscious feelings and thoughts (kennedy et al., 2018). this requires that the supervisor have insight into their own internal processes and relational patterns, and have a capacity for reflexivity. furthermore, because supervision involves the exploration of supervisees’ feelings, less experienced supervisors may lose sight of the pedagogical and evaluative aspects of supervision, and have difficulty differentiating between a therapeutic and supervisory focus on supervisees’ learning and growth (kennedy et al., 2018). supervisors are responsible for continuously assessing their supervisory dynamic’s relational boundaries llamosa/reclaiming social justice 360 and should seek professional and ethical consultation whenever there is an impasse in the supervisory dynamic. finally, state licensing boards, who typically delineate the educational and experience requirements for providing supervision, should consider more specificity in the types of continuing education and professional development required from supervisors. topics such as professional boundaries and self-care should be included in supervisory qualification requirements, given their recognition as essential for professional quality and longevity in social work. conclusion the historic macro-micro dichotomy in social work education and practice has led some scholars to argue that the profession has failed to capture the complexities of systemic influences on human experiences (jani et al., 2011), and has abandoned its core value of promoting equity, justice, and human rights (specht & courtney, 1994) in pursuit of clinical practice. however, if there has ever been a time for social workers to reclaim the notion that the personal is political, that time is now. growing socio-political and racial tension in the us and emerging debates over the many manifestations of injustice, oppression, marginalization, discrimination, and human rights violations our communities face not only contribute to subjective suffering but may also be the cause of such suffering. to effectively recognize and attend to complex and dynamic interactions between individuals and the wider systems and their effects on the human psyche, clinical practitioners must re-orient toward a justice-informed practice. the crm was developed to offer a practical way to connect theory and practice, and to center the supervisory relationship in the process of learning and growth. but beyond a supervision model, the crm is a call to action. it seeks to challenge the notion that clinical practitioners are immune from adhering to the profession's core values of promoting human rights, equity, and justice. whereas clinical social work has failed to acknowledge macrolevel issues in the therapy room, this practice application paper demonstrates how the crm can be immediately applied to practice with novice clinicians, graduate students, and any other clinical practitioner wishing to enhance their effectiveness and participation in creating a more equitable and just society for all. references american psychological association. 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(2019). humility, ruptures, and rupture repair in clinical supervision: a simple conceptual clarification and extension. the clinical supervisor, 38(2), 281-300. author note: address correspondence to priscila llamosa, college of social work, university of kentucky, 619 patterson office tower, lexington, ky, 40506. email: priscila.llamosa@uky.edu https://doi.org/10.1002/johc.12144 https://doi.org/10.7312/shaw16640 https://doi.org/10.1002/cpp.2084 https://doi.org/10.1002/cpp.2084 https://doi.org/10.1002/cpp.2084 https://doi.org/10.1080/07325223.2021.1919949 https://doi.org/10.1080/07325223.2021.1919949 https://doi.org/10.1177/146801730100100104 https://doi.org/10.1177/146801730100100104 http://doi.org/10.1007/s10464-011-9478-2 http://doi.org/10.1007/s10464-011-9478-2 https://doi.org/10.1080/02650533.2013.818941 https://doi.org/10.1093/bjsw/bcx006 https://doi.org/10.1093/bjsw/bcx006 https://doi.org/10.1093/bjsw/bcx006 https://doi.org/10.5175/jswe.2012.200900130 https://doi.org/10.5175/jswe.2012.200900130 https://doi.org/10.1080/07325223.2019.1624996 https://doi.org/10.1080/07325223.2019.1624996 mailto:priscila.llamosa@uky.edu _________ terra rosten, msw, mph, linkage and retention in care coordinator, university of colorado health infectious diseases group practice, georgianna gaitan, lmsw, msw, family advocate ii, ron wood family resource center, pari shah, lcsw, phd candidate, graduate school of social work, university of denver, and n. eugene walls, phd, professor, graduate school of social work, university of denver, denver, co. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 110-132, doi: 10.18060/25561 this work is licensed under a creative commons attribution 4.0 international license. social work practice in the time of quarantine: a photo elicitation study of experiences of remote work during covid-19 terra rosten georgianna gaitan pari shah n. eugene walls abstract: using quantitative, qualitative, and photographic data that were collected early in the covid-19 pandemic, this study examined the reflections of ten u.s. social workers on their experiences migrating to remote service delivery. participants were asked to share strategies, opportunities, coping mechanisms, self-identified professional values, and predictions for the future of social work. three primary themes professional flexibility and creativity, connection, and recentering generalist social work skills – emerged with numerous additional subthemes. the study’s findings underscore the critical importance of contextualizing service delivery moving forward – neither adopting a one-size fits all approach for the sake of financial efficiencies nor failing to incorporate the lessons learned during the pandemic. as such, service delivery systems should adapt in such a way as to incorporate increased flexibility in meeting client needs. keywords: social work, covid-19, pandemic, telehealth, remote service delivery, photo elicitation in the early spring of 2020, many americans were overwhelmed with fear about their health and economic stability as a result of the covid-19 pandemic. confronted with quarantine regulations and isolation from others, u.s. residents were tasked with exercising protective behaviors and avoiding risk-related activities for their safety and the safety of those around them (twenge & joiner, 2020). in the months that followed, millions of u.s. residents lost income or employment resulting in hardship even meeting primary needs such as paying for housing or other essentials (orgera et al., 2021). the onset of stress during disease outbreaks can result in the exacerbation of existing mental health conditions and chronic illnesses as well as an increase in the use of addictive substances (panchal et al., 2021). social isolation as a result of public health quarantines can additionally increase the risk of adverse mental health consequences, such as depression and anxiety (tulane university, 2020). during the current public health crisis, the drastic rise in mental health diagnoses, symptoms, and emergency healthcare usage has raised the question of whether sufficient resources have been deployed (walter-mccabe, 2020). one way in which many health care providers can respond to community health and social service needs during pandemics is through a shift to remote service delivery. however, for the delivery of efficient and effective health care and social services, scholars have emphasized the importance of therapeutic presence and its components (crawford, about:blank rosten et al./swk practice 111 2021). to preserve therapeutic presence, the attributes of compassion, validation, and empathy must be integrated into remote practice (crawford, 2021). fortunately, technological advances have enabled social workers and other professionals to interface with clients through audio and visual expression that, at a minimum, can emulate these necessary attributes (geller, 2020). remote service delivery is not, of course, without its issues. while certain populations may find remote service delivery favorable, including individuals who struggle to arrange transportation for service visits or individuals living in rural areas (cristofalo, 2021; hedrick et al., 2022), other populations may not have the resources (i.e., internet), equipment (i.e., computer/phone), or environment (i.e., stable housing) to accommodate appointments through remote delivery options (cristofalo, 2021; funk, 2021). further, specific populations may have barriers relating to language and communication, such as individuals who are hard of hearing or individuals who rely on language interpretation services (cristofalo, 2021; lew et al., 2021). these populations may be burdened by the process of connecting with social workers through electronic and distance mediums. there is the additional concern that remote assessments can become more complicated if clients are managing crises relating to behavioral health or domestic violence (cristofalo, 2021). as the rise in telehealth as a medium of service delivery is not expected to decline in the near future (crawford, 2021), social workers have been encouraged to take on the perspective of populations in need when deliberating how remote service delivery should be facilitated (cristofalo, 2021; spelten et al., 2021). social work’s role during the covid-19 pandemic as was the case with the current pandemic, national emergency response plans in the u.s. have historically included social workers in their frontline staff to implement mental health services, to manage distress, and to relay accurate information to community members (u.s. department of health & human services [us dhhs], 2005). as such, social workers – as part of the essential workforce – have continued to support clients and communities during the covid-19 pandemic. in response to the pandemic, the national association of social workers (nasw, n.d.) strengthened the use of remote service options, such as telehealth appointments, to reduce the likelihood of virus transmission while also sustaining social workers’ ability to continue to deliver services. policy amendments were necessary to enable telehealth to be utilized to expand service access and to avoid service disruption (us dhhs, 2020). consequently, the discipline is beginning to understand the potential of telehealth to advance service delivery, when its use is suitable, and how it should be delivered. in addition to remote service delivery during the covid-19 pandemic, social workers have not lost sight of vulnerable communities and have continued to offer care and respond to critical client and community needs (redondo-sama et al., 2020). many social workers have been a lifeline to older patients living in facilities with visiting restrictions as well as to hospice patients. social workers have continued to visit these patients as permitted, offering connection and comfort (gewirtz, 2020). to address the issue of food insecurity among children and youth, social workers have organized alternative lunch programs for advances in social work, spring 2022, 22(1) 112 students who previously depended on school-provided meals (gewirtz, 2020). as scholars have highlighted and these examples demonstrate, social workers are applying the values of the profession (e.g., compassionate service, importance of human relationships, and social justice) to continue to deliver essential services during the public health crisis brought on by the pandemic (kamnitzer et al., 2020). gaps in current research as the social work workforce has been preoccupied with attending to emergency conditions and the urgent needs of patients and clients, and many in the social work academy have been focused on shifting teaching and research to an online format, it is not surprising that the literature on the practice of social work and the experiences of social workers during the covid-19 pandemic has primarily been commentary pieces (e.g., editorials and letters). nevertheless, the lack of empirical studies limits the discipline’s ability to adapt practice for the current and future pandemic environments. the absence of studies addressing the profession’s response to covid-19, including representation and discussion of social workers employed in fields in numerous practice areas (e.g., child welfare and school-based social workers) also presents a gap within current literature (redondo-sama et al., 2020). finally, even though many practitioners have been forced to migrate to remote service delivery by necessity, an evaluation of the ongoing utility of mechanisms (e.g., telehealth), particularly in response to the needs of diverse populations, is largely absent. the purpose of the current study was to investigate how social workers have adapted practice during the pandemic, to explore how social workers perceive shifts in their professional role, and to understand what social workers are considering as the possible long-term outcomes of the response to covid-19 on the discipline. method as the pandemic necessitated drastic changes in the delivery of social work education in early 2020, one co-author who is a faculty member in a school of social work joined with colleagues in raising questions about how best to support practitioners and graduate level interns in continuing to deliver critical services when face-to-face contact was no longer an option. extant literature on telehealth services was primarily limited to certain practice areas, and, even then, did not address how to effectively navigate required and urgent shifts to remote service delivery. this gap in the existing scholarship motivated one co-author to develop a research project to capture data as these processes were unfolding in the discipline to better inform social work practice, and to integrate students into the project to support their research skill development as well as to help inform these processes in their own emerging practice careers. project co-authors represent one msw student, one msw-mph student, one phd student, and one faculty member. while the project team embodies diversity in terms of race/ethnicity, gender, sexual orientation, age, geographic location, years of practice experience, and practice area interests, all team members identify as cisgender, non-disabled, and u.s. citizens. the use of photographic data to enhance qualitative interviewing is a methodological approach known as photo elicitation (thomas, 2009) and has been used successfully in a rosten et al./swk practice 113 wide range of research studies (mannay, 2013). photo elicitation integrates visual images that capture metaphoric responses to the research questions into the interview process. the use of these visual images engages the parts of the human brain that process visual information which are different and evolutionarily older than the parts of the brain that process verbal information. this combination of images with words evokes “deeper elements of human consciousness than do words” alone (harper, 2002, p. 13). as the goal of the project was to co-create knowledge with social work practitioners and to deepen those practitioners’ reflections on the issues they experienced as they undertook the migration to remote service delivery, the decision was made to use photo elicitation. using this approach allowed the project to capitalize on photo elicitation’s benefits that result in strengthening the rigor of qualitative research. it allows for triangulation of data and can bring additional insights that interviews alone may not garner (bigante, 2010). during the interview process, images can evoke powerful emotions and memories that add depth and layers to the engagement with the participant (harper, 2002). finally, the interview in photo elicitation is a collaborative process between the participant and researcher and fosters joint creation of knowledge (glaw et al., 2017). while photographs can be generated by either the researcher or by research participants in this approach, having participants photographing their own images can increase participant comfort in the interview process as they know beforehand what the content of the interview will be focused on (glaw et al., 2017). this approach also gives respondents more power to direct the interview process (noland, 2006). methods and procedures data for the study were collected early in the covid-19 pandemic, between march and july of 2020. announcements about the study were posted on social media focused on social work and shared through the authors’ professional email lists. interested participants were contacted by one of the project researchers and provided additional information about the study, given an explanation of what participation would entail, and given an opportunity to ask questions. from there, participants who agreed to proceed were emailed a link to an online survey that secured the informed consent, gathered basic demographic data, and collected information regarding the participant’s perspectives on shifting to remote service delivery. once consent was received and the participant had completed the online survey, a 1:1 meeting was scheduled with a project researcher during which information regarding the primary research questions, logistics of taking photographs and developing captions were discussed, and information was shared about how to upload photographs and captions to a secured data storage site. we asked participants to take their photographs and develop their captions over the period of the two weeks following their 1:1 meeting. in terms of captions, participants were told, “for each of the photographs included in the project, you will decide on a caption or brief narrative about the photograph that explains how the photograph answers the research question to you.” advances in social work, spring 2022, 22(1) 114 once participants completed the process of taking and uploading photographs and had developed captions for each photograph, an open-ended interview was scheduled. in the qualitative interviews, participants were debriefed on their experience and invited to discuss their photographs and finalize their captions. the photographs were used as prompts around which to engage the participant. the debriefing interviews lasted from 30 to 90 minutes, were conducted by the two msw coauthors, and recorded via zoom. the zoom meeting recordings were automatically transcribed by the software, but project researchers reviewed the transcripts while viewing the recorded interviews to correct any mistakes in the transcription. data for the study included the completed online survey that captured both demographics and general perspectives about shifting to remote service delivery, the photographs taken and their corresponding captions, and the transcripts from the interviews. the university of denver institutional review board approved the study. analytic sample a total of 14 social workers indicated interest in participating in the study. of those, 2 did not complete the consent process, while 2 others completed the consent process and online demographic survey but did not respond to requests for the initial 1:1 project meeting. the final analytic sample for the project consists of ten social workers whose modality of service delivery was primarily face-to-face prior to the advent of the covid-19 pandemic and whose modality shifted to at least some remote service delivery in response to the pandemic. while the authors’ networks include professionals involved in many areas of social work practice, most are employed in community-based service delivery with significant representation in health-related and child welfare-related areas of practice. this pattern of representation is reflected in the final analytic sample where 60% (n=6) of respondents were in a health-related sector, 30% (n=3) in child welfare, and 10% (n=1) in services for older adults. all respondents are u.s.-based practitioners. measures a number of closed-ended questions were asked on the online survey to understand the context of service delivery. to capture the modality in which services were primarily delivered prior to the covid-19 pandemic, participants were asked, “prior to the covid19 pandemic and quarantine, which of the following best describes the format that you provided services? online/remote format can include delivery of services by telephone, videoconferencing, and other online platforms such as zoom, skype, etc.” next, participants were asked, “prior to the covid-19 pandemic and quarantine, which describes your plans for the future format of delivery of social work services?” to understand how prepared the participants felt, they were asked, “how prepared would you say you were to shift services to an online/remote service delivery format?” finally, to assess the ease at which the shift in service delivery was made, participants were asked, “now that you have been required to shift to an online/remote service delivery format because of the covid19 pandemic and quarantine, which best describes how you would rate that experience?” all questions had likert-type scale response sets (e.g., ranging from (1) not at all prepared rosten et al./swk practice 115 to (4) very prepared, and ranging from (1) much easier than i thought it would be to (7) much harder than i thought it would be). four open-ended survey questions were also asked initially of participants. they included, “briefly describe your perspective on shifting to an online/remote service delivery format prior to the covid-19 pandemic and quarantine. for example, when you thought about shifting to an online/remote service delivery format or increasing your use of online/remote formats for service delivery, were you excited about it, anxious about it, resistant to it, etc.?”, “briefly, what has been the most positive aspect of shifting to an online/remote service delivery format for you?”, “briefly, what has been the most negative aspect of shifting to an online/remote service delivery format for you?” and “are there any things that you would like us to know about your shift to an online/remote service delivery format?” finally, during the initial information session, participants were given the five primary research questions that they were to answer using photographs and captions (see table 1). table 1. photo elicitation guiding questions 1. what strategies have you used to shift your in-person delivery models to distance/ remote/ online delivery models? 2. how has the shift to distance/remote/online delivery affected your understanding of your role in the lives of your clients and your value as a social worker? 3. what unique opportunities have presented themselves either directly or indirectly related to the changes you have had to make to deliver services in a distance/remote/online approach? 4. how have you coped with the experience of migrating to distance/remote/online services in such a quick manner? 5. what long-term impact do you think the required changes related to the covid-19 pandemic will have on the discipline of social work? data analysis responses to the close-ended online survey questions were examined using descriptive statistics. qualitative data from the online survey and from the debriefing qualitative interviews (both photographic data as well as transcripts from the discussion) were organized by questions asked prior to coding. all four co-authors were involved in data analyses. we used a domain analysis (spradley, 1979) methodology to code and highlight themes found in the qualitative and open-ended survey data. domain analysis is a qualitative approach that emerged out of ethnographic research and seeks to understand larger units or clusters of knowledge and is an approach that can be used for different source types of data (onwuegbuzie et al., 2012). while the responses were organized by question asked, no a priori assumptions were made, and responses were examined for emergent themes across the various questions. four total coders were involved to decrease researcher bias. all the qualitative and photographic data from each question were reviewed and coded independently by a combination advances in social work, spring 2022, 22(1) 116 of two of the four research team members. from there, each pair met to identify any discrepancies in their coding, combine coding categories that were similar, and identify preliminary themes and theme definitions. following that process, the full research team met to discuss the codes and preliminary themes that emerged to identify commonalities across respondents until consensus was reached among team members on the final themes and their definitions. a clinical social worker was brought onto the team to support analysis and enhance clarity of the data and themes as they relate to practice. photographic data were examined in relation to the textual themes that emerged, and exemplars were chosen to best illustrate those themes. results descriptive characteristics of sample all study participants identified as female, with experience in social work practice ranging from 6 to almost 27 years and a mean of 10.7 years. the majority of participants reported having an msw degree (80%, n=8) with the remaining two having a bsw. participants ranged from 30 to 49 years old with a mean age of 39.7 years. in terms of service delivery modality prior to the pandemic, 40% (n=4) indicated that all services were delivered in a face-to-face format, 30% (n=3) indicated that services were delivered mostly in a face-to-face format with minimal delivery in a remote format, and 20% (n=2) indicated a 50/50 split between face-to-face and remote service delivery. the participant in aging services indicated a response of other and noted that home visits were done once a year in each client’s home. all participants indicated that they were not planning on any shifts in service delivery modality prior to the occurrence of the pandemic. in response to how prepared they felt to shift services to a remote delivery modality, the largest group (50%, n=5) indicated that they were “slightly prepared.” twenty percent (n=2) reported they were “not at all prepared” and 20% (n=2) reported that they were “somewhat prepared.” only one of the participants (10%) reported being “very prepared.” finally, in response to how difficult they would rate the experience of having shifted to remote service delivery, the largest group (40%, n=4) reported that the shift was “much harder” than they had thought it would be, followed by 20% (n=2) reporting that the shift was “much easier” than they had thought it would be. the remaining four participants were evenly spread across the remaining four categories from “somewhat easier” to “somewhat harder.” themes turning now to the overarching themes that emerged from the narrative data, we identified three primary themes across responses from the various questions: professional flexibility and creativity, connection, and recentering generalist social work skills. within each of these overarching themes, a number of subthemes emerged. some of these subthemes address the way in which social workers migrated to remote services and adapted service delivery, some addressed lessons that emerged in delivering services in a remote format, rosten et al./swk practice 117 and some raised concerns about the way in which the discipline moves forward. themes and subthemes are summarized in table 2. professional flexibility and creativity social workers in the study illustrated the importance of flexibility across numerous domains in their work during the shift to remote service delivery. this included being creative and flexible in the way they assessed, intervened, and evaluated their work with their clients. table 2. summary of themes and subthemes theme subtheme definition professional flexibility and creativity assessment manner in which assessment of clients shifted, including who the primary client was and a needed shift to focus on primary needs intervention manner in which service delivery shifted as well as how resources needed for service delivery were deployed evaluation critical questioning that emerged regarding complexity of system requirements that impeded service delivery, including ideas about future of service delivery connection with colleagues and other professionals shifts that occurred in day-to-day relationships with one’s professional network with family and to self shifts and increased flexibility that occurred as result of impact of remote service delivery with clients shifts and boundary changes in social workerclient relationship that emerged as clients increased awareness of social worker’s life outside of work context recentering generalist social work skills attending to basic needs necessity of responding to increased client need around basic issues of living regardless of other job responsibilities loss prevalence of pandemic-related issues of grief and loss in work with clients assessment. the participants shared that the ways in which they had to assess their clients shifted. first, for some, who they considered to be their client changed due to the pandemic. for example, if a social worker’s primary client was a patient in the healthcare setting and the pandemic created a barrier between the social worker and patient, the primary client shifted to the family members. one participant noted, “right now our role has shifted, you know, we're not able to really provide patient care. it shifted to more mostly...family support as most of...our patients have cognitive impairments.” next, assessment shifted from mental health work to a prioritization of clients’ basic needs and physical health safety. for example, one social worker reported, “i would say linking patients to food in record numbers," and also noted, “i am getting multiple calls a advances in social work, spring 2022, 22(1) 118 day to help with linkage to unemployment claims, insurance claims, and i'm getting them from a lot of doctors who are feeling overwhelmed.” intervention. the way in which social workers were intervening with their clients during the transition to remote delivery of services required the social workers to be flexible and creative due to the limited availability of resources as well as shifts in service needs and delivery modalities. this included aspects of both deployment of resources as well as delivery of services. deployment of resources. there was variability across participants in terms of how their agencies supported the shift to remote services. for some, the agency’s response suggested that social work services were not a priority for the organization, while others experienced their agency deploying significant agency resources to support the shift. this included technology (e.g., cellphones, computers, digitization of files, access to zoom), as well as protective equipment to enable safe interaction with clients. one participant noted, [u]nfortunately, [health agency] was not able to provide any equipment to me or anything for work from home. so that is all the things i've had to purchase or just using what we have right at home and then having to like purchase other things because we were not given priority for...like the loaner laptops. but i just was told that in my role that i was not on the list…to get a laptop. they said they didn't have enough resources. across the participants, sacrificing space in their homes and being creative in using personal resources that were purchased or that already existed were commonplace (see figure 1). some participants expressed that offering services from their home was a positive in the shift to remote service delivery. responding to what she liked about working from home, a participant noted, “it’s just the comfort of being home and being surrounded by things that make you happy.” another chuckled, reporting, “the commute is wonderful from home.” other participants discussed making homemade masks until their agency was able to provide ppe (see figure 2). one participant reported, you know, our clinic went without ppe for, like masks, for about three days. this was a few weeks ago, this was not this week, but still. it's just, when they're asked, like ‘why can't we get more masks’, ‘no, you already got masks. you should have been able to make do with what you had’. figure 1. the home office will become a more relied upon workspace. rosten et al./swk practice 119 the lack of ppe equipment was a common experience: it was the wild, wild, west, and there was no ppe. there were only gloves. like, i took gloves out of patients’ rooms and stuck them in my backpack, like just didn’t take their whole box, but i took some...i remember one of the nurses gave me like four masks one time because i just didn’t have any, and those were not the n95, they’re just paper surgical masks. that’s all we had at the beginning…lysol wipes…my best friend brought those to me because i couldn’t find any. she just brought them. she told me, she called me and said, ‘i’m bringing these over’, and i burst into tears. i was so grateful that she was bringing them to me. i was going out and going into places that i didn’t have anything to clean my tablet or phone with. delivery of services. the shift to remote service delivery required creativity on the part of the social worker and while the requirement for how quickly shifts had to occur was not seen as positive, some of the actual modifications were ultimately viewed in a positive light. participants talked about converting face-to-face trainings to online trainings using technology which enabled efficient delivery of training content to a geographically dispersed audience, and how the elimination of the need to travel enabled social workers to better reach clients who had difficulty or were unable to travel to the agency’s office as well as freeing up time in the workday for other services. home visits became porch and window visits and at times social workers were able to bypass some systems that had historically been obstacles. a health agency social worker described, ...we've had unique opportunities for some of our patients. that we can't physically go into their home or see them, but we've been figure 2. there's different mask for different situations. that's why i put all the different ones we have. figure 3. i’m still connected with the outside and with clients through technology, but there is still a barrier, so i can’t always get the full picture. advances in social work, spring 2022, 22(1) 120 able to arrange with the family to like visit while we sit on the porch and they sit on the other side of the screen door or another side of the window to still kind of have face-to-face visits. on the other hand, the shift to remote service delivery had negative impact for some on the quality of the work and on certain clients. for example, working with clients who needed support in understanding and completing forms became significantly more difficult than it had been when done in person. because of language differences, difficulty with using technology, or being hard of hearing, communication with some clients was quite challenging, creating frustration and decreasing the quality of the interactions (see figure 3). describing one example of those difficulties, one social worker noted, “so communication has been a little difficult…you know, trying to translate things and then the call gets choppy. so, we have to start over...it definitely can be a challenge to, you know, the flow of our communication.” additionally, the inability to meet with clients face-to-face created significant limits in monitoring clients’ well-being and in gathering assessment data (see figure 4): i'm not being able to see the client because of the type of interviews that we do…a lot of it is based off of like behavioral [observations]. you know, the client is acting out at the moment, or he's unable to do like a daily skill. so, we see that in person. we kind of work off of that with the home visit suspended, it's made our reports a little less detailed, i would say just because we're not able to see the child there. evaluation. the participants in the study critically questioned the complex systems and processes that had been in place for social workers and clients to implement and access some services. they described many situations in which the requirement of systems in place to provide services for their clients were overly complex or served as gatekeepers to services rather than making services easy to streamline and implement. “it opens up a lot of ways to deliver services in a non-traditional way...like being creative in the way that we service our families and…being efficient…we don't even have docusign…we need docusign, we have too many documents.” for example, insurance policies for medicare and medicaid require face-to-face visits, which became impossible during quarantine. given some of the successes of remote service delivery, the social workers began to recognize overkill in bureaucratic requirements and to question the way they had always done things. “[administrators] write policy, but have no idea how it's going to pan out, you know. it's very honestly like, you're not listening to the people that do the job. that's the one thing, i hate it.” figure 4. i think that there're barriers with using zoom or phones for that matter when you are talking about the population that i work with. rosten et al./swk practice 121 the participants additionally shared ideas on the future of social work and how the experience of remote service delivery during the pandemic might inform future practices. some expressed concern that agencies will focus solely on efficiencies that emerged during remote service delivery, failing to contextualize and, as such, offer models of service delivery that are not effective at serving all clients. others raised concern that services will return to pre-pandemic models without taking advantage of the lessons learned. while the reliance on technology offers one of those efficiencies, without considering the type of clients served, social workers expressed concern moving forward: “[when t]here’s some cognitive decline and so people look at the video screens, even if the most familiar people are there on the screens, their families, they can’t figure it out. so, there’s barriers…it doesn’t work for everybody.” contextualizing is critical moving forward so that the practice and service models that emerge address efficiencies along with appropriateness based on the client’s needs. connection the second theme that emerged is that of connection and how connections have changed during the pandemic. included under this theme are connections with other social workers and professionals, connections to self and with family, and the shifting of connection with clients. connections with other social workers and professionals. many participants reflected on the way in which the shifts in service delivery changed their relationships with their day-to-day colleagues and their broader network of colleagues. for some, this manifested in a stronger sense of solidarity on their work teams, and they worked to find the best ways in which to support clients, frequently in a way that was more collaborative. the importance of celebrations and food as well as the staff spaces were underscored by some participants. the shift to remote offerings of professional development trainings broadened the reach of some organizations and expanded their working network. a social worker responsible for training in the child welfare system reported: what’s been an unintended benefit, i guess you could say, is now that we're doing zoom training, any worker from any region can attend any class. so, with that, we've increased the diversity of who's in the classroom because now we have people from all over the state like interacting and learning together. figure 5. i am able to be more present for my daughter and my dog. it has helped that i can be here to help her through distance learning and work at the same time. my dog is loving the extra attention as well. advances in social work, spring 2022, 22(1) 122 connection to self and with family. the time saved in commuting and making visits to clients’ homes along with the flexibility in scheduling that emerged provided opportunities for increased self-care. for some this resulted in the ability to take a walk in the middle of the day, or to pursue personal aspirations in terms of growth or hobbies. one participant reported, now, i’m able to go out every morning and stretch. i haven’t started yoga, but i’ve been kind of easing my way back and doing stretches every morning. sometimes, i’ll wake up my daughter, and she’ll come out and do that with me and my dogs out here running around, so it’s nice to start off the day like that because you get some fresh air and it’s calm. the flexibility has allowed them to spend more time in a space with their family even as family members worked on their own activities or took care of their own responsibilities (see figure 5). one parent reported, “this has actually helped a lot with my daughter being home schooled or distance learning.” similarly, another noted, “it’s an opportunity to spend more time with kids in their school but also working at the same time.” finally, the flexibility allowed them to attend to household responsibilities: “i am able to be working and doing my laundry like throwing in some laundry at the same time, and now the thing is that usually my weekends are packed with things that i can’t get done during the week.” shifting of the connection with clients. in many ways, the shift to remote service delivery seemed to humanize the social worker to clients. clients got a glimpse into the homes of social workers, met their animal companions, and at times witnessed interactions with participants’ family members. the ubiquitous experience of grief and loss, frustration, anxiety, and uncertainty that are part of living in the pandemic fostered a shared connection between social workers and clients. clients frequently inquired as to how the social worker was doing and reciprocity developed in a way that was not previously a part of the relationship. for some participants, this moved the relationship to one that was more meaningful and that reached beyond just providing resources to clients (see figure 6). recentering generalist social work skills the final theme that emerged underscored some of the central aspects of social figure 6. this represents the word, ‘intertwined’ where the roles are blurred. this experience has allowed me to connect with my foster parents in a new way. we are finding connection beyond our occasional in-person visits. rosten et al./swk practice 123 work practice and, at times, a return to these foundational skill sets for the participants. this included the need for practitioners to attend to some of the very basic human needs of their clients, the importance of active listening to support the relationship with the client, and the centrality of addressing loss as part of the human experience. attending to basic human needs. the pandemic created a high demand for basic needs to be met for the clients that were being seen by social workers. the concerns surrounding clinical interventions and support services, while still relevant, often took a back seat as client needs around food, housing, transportation, insurance, and connection to services became more pressing. social workers whose jobs did not typically entail a focus on case management or connecting clients to community resources to meet their basic needs found themselves called upon to center the brokering aspects of social work practice (see figure 7). one participant commented, it's like the linkage to some resources that i am using and i mean, using in record numbers like i'm not used to using food resources. i mean, you know, food stamps, sure we refer. but this i feel like, this is food bank, like in record numbers. people that do not have food to get through the day. so that's what i'm seeing…a lot of seniors. active listening. the fundamental skill of building rapport is frequently one of the first skills that social work students learn and it became even more critical as service delivery shifted to rely on remote strategies. participants discussed the power of a single telephone call in building connection and trust, often reminding them of how central active listening and conveying their ability to hear and reflect clients’ experience was in solidifying their connection and building a working alliance. as the pandemic took away many resources and strategies for intervening with clients, social workers relied on active listening to support clients in a time of heightened fear and uncertainty. illustrating this theme, one social worker talked about her calls with clients: my phone calls and my communication was a little bit deeper. i was asking more questions. i've stayed in the home for two hours, and i should have been there an hour or 45 minutes...i found myself just having more thoughtful conversations and being able to connect with people in that way during these last two months. so that's kind of a good thing just making them feel, i think, just taking the extra step, help them feel a little bit more supported. addressing loss. clinical interventions around grief and loss became very relevant for social workers during the pandemic (see figure 8). many clients were experiencing figure 7. i'm getting them from a lot of doctors who are feeling overwhelmed …they're like, is there anything you can do to help them get connected to unemployment. advances in social work, spring 2022, 22(1) 124 some aspect of loss. one respondent identified much of the grief that was experienced during the pandemic as disenfranchised grief, that is, the grief that one experiences that goes unacknowledged or unaccepted by societal norms. the idea can be mapped onto the narratives shared by many of the clinicians about their work with their clients. despite the public health concerns of the pandemic overshadowing issues of grief and loss, grief was ever-present in the social workers’ practice. these losses included loss of employment, shifts in the meaning of one’s home, isolation, and loss of loved ones to death. knowledge about and skills in using trauma-informed (knight, 2015; levenson, 2014) strategies were relied upon heavily. a participant noted, so, i think that i've heard a lot about, in the social work field, about how like the trauma that people are experiencing, especially like medical social workers and doctors and nurses and things like that. but...i think kind of some of the trauma has been focused on, but i don't believe that people have really focused on the grief and loss component of how much people have had to lose, both tangible and intangible losses that we may never get back. and how even when it goes back to quote un-quote normal, it won't be the same normal, it's going to be a new normal. and we're all going to have to deal with all the losses of what used to be and that's not going to be that way anymore. and so, i think that that is something that, within me, within my team, within our learning community, within the world, is all of this related to grief and loss. discussion and implications the findings from our study provide insight into the experience of social workers transitioning their practices to remote service delivery early during the covid-19 pandemic and quarantine. the consequences and implementation of this transition were captured in this photo elicitation study. the social workers had to shift the way they conducted their work through adapting the assessment, intervention, and evaluation perspectives and procedures. the participants shared the importance of relying on foundational social work skills in times of crisis and how this continually appeared in their practices during quarantine. through their images, the social workers further shared the importance of connection. figure 8. grief and loss is universal and it is one thing we all have in common from living through this pandemic. rosten et al./swk practice 125 in short, the pandemic has forced social work to evolve as a profession in reconsidering and recrafting our understanding of our clients’ needs. these findings have implications for practice, policy, and research. specifically, the implementation of telehealth and other remote practices is central to the understanding of how social workers shifted their practices rapidly during a global crisis. prior to the pandemic, there had been discussion surrounding the need for remote services; the covid-19 pandemic accelerated the implementation of these services. the participants shared how the shift happened almost overnight, which led to minimal or no training in how to adapt their practices to be suitable for an online delivery model. many of the participants later discussed receiving ongoing training from their organizations or nationally on how to most effectively implement social work services online. however, the initial implementation of remote services occurred haphazardly due to the urgency of the global crisis. moving forward, social work remote practices will likely remain as a modality of providing services, and emerging research and evaluation has suggested who may benefit most from remote services. preliminary studies have demonstrated success of remote social work and mental health services with young people, adults, couples, and families (sansomdaly & bradford, 2020). further, remote services are an important resource in accessing services for individuals coping with chronic illness or health concerns (jhaveri et al., 2020), who have parenting or caregiving responsibilities (sharma & vaish, 2020), or who live in rural areas (nagata, 2021). while we are seeing many benefits of remote services for social work practice, we are also seeing how remote services are not always beneficial with children when play therapy and kinesthetic application is important (hoffnung et al., 2021). similarly, the provider should evaluate each individual’s ability to use technology, as remote services vary in effectiveness based on the ability to use and access technology (sorinmade et al., 2020). further, equity in practice must be considered when implementing remote social work interventions. from a practice sense, when an individual is accessing remote services from home, we must remember that they may not have the same privacy or safety that they would when coming into a social work setting. many social work services are most efficacious when the individual feels safe and understands that their information is confidential. we must also consider accessibility to technology when implementing remote services. questions that social workers might ask include, “who am i excluding when implementing remote services?”; “what unintended costs am i placing on my clients with remote services?”; and “what will i miss from not having face-to-face interactions with this client?” the social work participants in this study have indicated that remote mental health and other social services are likely not going away. the pandemic has forced the technology evolution to quickly be integrated into the way in which we work. thus, a large gap remains in research that needs to be conducted to not only further understand when remote service delivery is best indicated and in what contexts, but also how remote service delivery can be implemented in an effective way. further, the content and structure of social work services in an online setting must be better understood. for example, one study found that as one parenting support group moved to an online setting, the facilitator felt that the core advances in social work, spring 2022, 22(1) 126 lessons were not being conveyed in the online setting. participants however felt that they not only received the core elements of the program but the barrier of finding transportation or childcare to access these services were eliminated, allowing them to focus on the services being offered (cook et al., 2021). the incongruence between the facilitators’ and participants’ perspectives warrants a need for further research to understand how services are best implemented and received in online modalities. additionally, the efficacy of our study demonstrates how photo elicitation as a methodology may be beneficial for studying the effectiveness of remote service delivery modalities in social work. regarding service delivery, the participants highlighted that many policies had to be immediately changed for social workers to implement their services without violating existing rules and regulations. the participants also noted that many policies that were in place made services more bureaucratically difficult to implement rather than streamlining service provision. for example, one social worker said that the required signatures on documents often delayed services from being implemented. another explained that face-toface mental health visits required by medicare and medicaid made implementation and billing of services difficult. in november of 2020, the congressional research service released a report summarizing the behavioral health treatment policy changes that occurred due to the pandemic (duff et al., 2020). this report summarized the policies that removed barriers preventing telehealth services from being implemented, such as requirements of face-to-face visits for both mental health services as well as substance use disorder medication treatments. further, the centers for medicare and medicaid services (cms) updated their reimbursement policies to include telemedicine modalities for individuals receiving services with these insurance plans (duff et al., 2020). policy amendments were made to the hipaa privacy rule to include clear protection of patient health information in an online service modality (duff et al., 2020). while all these policy changes were rapidly made, they are considered temporary, creating an obstacle for future telehealth services to be implemented should these provisions go away. further policy advocacy is needed to create permanent legislation that reduces or eliminates the barriers to accessing telehealth services from social workers. beyond the remote services implications of covid-19, social workers must re-evaluate the core of their practices moving forward. this collective traumatic event will be a part of many individuals’ narratives moving forward, and social workers, as they have been doing during the pandemic, must incorporate trauma-informed practices into their work. additionally, social workers must lean on the values of flexibility and adaptability in their future work, since we are unsure of the long-term mental health implications of the global pandemic. to proactively address the shortcomings of remote service delivery, social workers should examine a multitude of approaches to acclimate their clients to the most beneficial modality of receiving services. for instance, the use of supportive technology trainings for older adults has been proposed as helpful (gibson et al., 2020; leedahl et al., 2018). individuals residing in restricted living arrangements, such as long-term care residents, have also been identified as benefitting from telehealth when visits from loved ones have been rosten et al./swk practice 127 limited (tsai et al., 2010). as previously mentioned, recent literature has cautioned the use of telehealth when assisting individuals experiencing urgent mental health issues (cristofalo, 2021). to ensure that remote service delivery is in the best interest of clients, social workers should evaluate the use of the modality on a case-by-case basis. the pandemic and the findings of this study further highlight the critical importance of social work’s commitment to social justice and to understanding the structural nature of inequalities. to this end, u.s. society has recognized that social workers are indeed essential workers, connecting populations in need to health treatment and primary resources such as food assistance in the time of the pandemic (fraher et al., 2020). social workers have also been credited with performance beyond these duties, and as telehealth and remote services expanded, members of vulnerable groups who have critical needs have received behavioral health care because of social workers (abrams & detlaff, 2020). in the interest of their own health and the health of clients and patients, social workers have adopted remote technology and advanced the use of remote service delivery for the profession’s future (gewirtz, 2020). the universal nature of covid-19 is also an opportunity to challenge the individualist narratives of social problems that frequently monopolize sociopolitical discourse in the u.s. and run counter to the values and ethics of our profession. new narratives and imagery can have the power to challenge society to conceive of and construct new ways of living (boggs et al., 2012). if history can teach us anything, it is in the context of widespread crisis – such as that of the great depression (martin, 2012) – where opportunities exist to challenge the rootedness of explanations that pathologize individuals and to reimagine and humanize social structures. while early evidence suggests some attitudinal shifts from individualistic to structural understandings of social problems as a result of covid-19 are occurring, that shift is small and uneven across demographics (frameworks institute, 2020). even so, it is an opportunity for the profession to further our commitment to equity through policy advocacy and social movement support. lastly, this study highlights the impact that photo elicitation as a methodology can have on shaping the discourse that emerges between researcher and study respondent as well as vividly illustrating the study findings. the photographs taken by the social workers participating in the study engaged their creativity in answering the research questions, deepening the thoughtfulness of their responses and, at times, clarifying tensions and nuances in their responses that strengthened the study’s results. the photographic data gave dimension to the social workers’ responses and enabled the interviewer to more fully engage the research respondent in the co-creation of knowledge. given the time of the data collection occurring at the beginning of the pandemic, photo elicitation provided an additional avenue of communication in a context when finding words to describe personal experiences could be challenging. limitations as the sample size for this study was small and non-random, and the goal of qualitative research is not generalizability, the findings should be interpreted in that light. additionally, the social workers who participated in the study are primarily from health-related and advances in social work, spring 2022, 22(1) 128 child welfare practice areas and the themes that emerged may not translate to other fields of social work practice. given the context of the study is specifically about the covid-19 pandemic, the findings may be unique to this specific health crisis and may not be applicable to other motivations for shifting to remote forms of social work practice in other contexts. finally, all study participants were social workers, and the responses were likely shaped by the values of the discipline as well as the educational training of practitioners. conclusion the social workers in this study offered varied responses about the opportunities, strategies, and coping mechanisms that emerged as part of the shift to increased remote service delivery. these social workers also shared varied perspectives on future implications for practice based on the experience of the pandemic. social work values were central as the participants emphasized the importance of flexibility and creativity in service, as well as concerns about how remote service delivery differentially impacts vulnerable populations. their reflections also reinforced that existing privilege and disparities have been further amplified during the covid-19 pandemic. to bolster the national workforce of social workers and other health professionals delivering care in this state of emergency, several sectors of society repealed bureaucratic regulations (fraher et al., 2020). permanent legislation is needed to prevent pre-existing limitations on remote service delivery from returning. social workers should be able to reach their clients, patients, and communities by various methods rather than operating within an antiquated, one-size fits all approach. conversely, social workers across the globe have argued that local and national governments have implemented pandemic regulations that are impractical, inadequate, and not clearly understood (banks et al., 2020). to remedy undesirable policies from being enacted in response to emergency conditions, the social work profession should play a role in informing policy development. social workers are highly aware of disparities at the individual and community level (banks et al., 2020). the discipline may advance by examining the perspectives of vulnerable populations and their attitudes about remote delivery of services (e.g., telehealth) and leverage these findings to dismantle inefficient approaches. additionally, community-based projects and programs may harness the insights of populations served and reimagine practices that are 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(2020). coronavirus pandemic calls for an immediate social work response. social work in public health, 35(3), 69-72. https://doi.org/10.1080/19371918.2020.1751533 author note: address correspondence to n. eugene walls, graduate school of social work, university of denver, denver, co, 80208. email: eugene.walls@du.edu.edu https://doi.org/10.1080/13607863.2010.501057 https://publichealth.tulane.edu/blog/effects-of-social-isolation-on-mental-health/ https://publichealth.tulane.edu/blog/effects-of-social-isolation-on-mental-health/ http://doi.org/10.1002/jclp.23064 https://www.cdc.gov/flu/pdf/professionals/hhspandemicinfluenzaplan.pdf https://www.hhs.gov/coronavirus/telehealth/index.html https://doi.org/10.1080/19371918.2020.1751533 mailto:eugene.walls@du.edu.edu _________ suzanne marmo, phd, lcsw, associate professor, department of social work, fairfield university, fairfield, ct. manoj pardasani, phd, lcsw, provost, hunter college, city university of new york, new york, ny. david vincent, phd, lcsw, graduate school of social service, fordham university, new york, ny. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 386-402, doi: 10.18060/27238 this work is licensed under a creative commons attribution 4.0 international license. keeping community during a pandemic: lgbtq+ older adults and the virtual senior center suzanne marmo manoj pardasani david vincent abstract: the purpose of this qualitative exploratory study was to better understand how lgbtq+ senior centers created virtual communities and implemented organizational adaptation in the earliest stages of the pandemic. three focus groups (n=22) were conducted with program facilitators and senior center employees to better understand how these key stakeholders contributed to the transition from in person senior center to virtual senior center programming in march of 2020. the experiences of lgbtq+ program facilitators and senior center staff varied based on the nature of their assigned roles. latent pattern content analysis of the focus groups unveiled both shared and divergent categories and themes from the two cohorts. themes identified for program facilitators included: adaptation, interconnectedness, some not served, and virtual preference. themes identified for senior center staff included: communication, the blurring of the personal/professional, urgent needs, and future planning. keywords: lgbtq+, senior centers, covid-19, organizational adaptation in the initial stages of the pandemic, the spread of the virus that causes covid-19, sars-cov-2, increased the need for rapid adaptive processes in human service organizations and nonprofits (christensen, 2021). organizations dedicated to serving older adults needed to facilitate operational changes in an environment of uncertainty and fear, with the added complexity of serving the needs of not only homebound seniors, but also homebound staff members. older adults in urban settings such as new york city, widely considered the epicenter of the pandemic in the united states, were most at risk for experiencing fatal outcomes, with 70% of deaths occurring amongst those individuals who were 65 and older within the first months after the declaration of state of emergency (garret et al., 2020). orders to shelter in place, and fear of contracting the virus created unprecedented barriers for seniors who needed access to basic needs such as meals, groceries, medicine, and support services (garba et al., 2022 williams et al., 2021). widespread fear of not being able to have basic needs met placed unexpected emotional, physical, and psychosocial burden on many older adults and the workforce dedicated to serving this population (voinea et al., 2022). impact of covid-19 on lgbtq+ older adults older adults from the lgbtq+ community are more likely to live alone, experience loneliness or have less immediate family support systems when compared to non-lgbtq+ about:blank marmo et al./lgbtq+ older adults 387 older adults (moreno et al., 2024; yang et al., 2018). additionally, lgbtq+ seniors are at risk for experiencing much higher rates of isolation and disconnection from community supports (fortune & butler, 2023; griffin et al., 2023). a dedicated lgbtq+ senior center has been shown in previous research to serve as a social resource, or protective factor, against experiencing isolation and loneliness and improving perceptions of social support (fortune & butler, 2023; mcgovern et al., 2016). early in the pandemic, the center for disease control (cdc) recommended that adults 60 and over should stay home as much as possible and avoid face to face contact (cohen & tavares, 2020). new york city based lgbtq+ older adults were at even greater risk of being underserved, experiencing isolation, and experiencing difficulties in meeting basic needs (griffin et al., 2023; hay, 2020; paremoer et al., 2021). the principle of intersectionality (crenshaw, 1991) underscores how multiple social identities can intersect to shape experiences and contribute to cumulative disadvantage. for lgbtq+ older adults, intersecting disadvantages, such as being part of a racial or ethnic historically marginalized group, living in communities with high rates of poverty or experiencing housing instability, contributed to increased likelihood of developing severe covid and experiencing additional negative health outcomes (berg-weger & morley, 2020; dietzel et al., 2023; kuehn, 2021). the utilization of technology for social good has emerged as focus within the field of social work, aligning with the grand challenges (american academy of social work & social welfare, 2017). older adults who experience intersecting disadvantage, are less likely to have access to technology. this “digital divide” is the gap between those who have access and can use information and communication technologies, and those who cannot (dimaggio et al., 2004). older adults in particular, often face barriers to utilizing digital technology due to factors such as limited digital literacy, financial constraints, and age-related physical or cognitive limitations (oh et al., 2021). organizational transition to the virtual senior center sufficient resources, adaptive efficiency, and strong community connections are recognized as pivotal components for successful organizational change and restructuring during times of rapid change (hitt et al., 2020). despite the closure of many senior centers, some senior serving organizations had sufficient resources and were well positioned to strategically utilize these pre-existing resources to serve the community of older adults within their area of service during the initial days of the pandemic (pendergrast, 2021). some senior serving organizations also demonstrated adaptive efficiency, or a capacity to use creative and flexible strategies to restore stability in their operations after experiencing significant disruptions (hitt et al., 2020). some centers also had robust community connections through workers who were highly embedded in the communities that they serve, which has been shown to contribute to higher rates of proactive work behavior and enhanced ability to provide needed service to the community (ng & feldman, 2009). senior centers that were most able to adapt to the needs of their communities during the early stages of the pandemic, transitioned quickly to becoming virtual senior centers (new york city [nyc] department of aging, 2020). the concept of a virtual senior center advances in social work, summer 2024, 24(2) 388 has been documented in research literature predating the pandemic, referring to digital initiatives offering social and health promotion services for older adults unable to access physical facilities (kaplan, 2012; wihry et al., 2017). pre-pandemic a small number of virtual senior centers were created to provide services and reduce social isolation for homebound older adults in urban areas (kaplan, 2012) and in rural areas (wihry et al., 2017). participation in virtual senior centers and interacting with peers has been shown to contribute to perceptions of safety and social support and has also been suggested to serve as a protective factor against the development of depression and anxiety (kotwal et al., 2021). one organization, sage advocacy and services for lgbtq+ older adults, was one of the first nyc senior centers to transition from an in person to a virtual senior center model within weeks of the closing of all senior centers, arranging for delivery of meals, conducting community outreach, making regular wellness calls, and providing case management (morgan & yuan, 2020; nyc department of aging, 2020). organizations such as sage, who employ members of the community they serve, benefit from their unique insights (dreyfus & wareing evans, 2020). immediate and longterm innovative organizational changes were required to pivot operations from an in-person model to virtual programming. workers who were able to adapt to virtual work, and organizations that were able to support these workers, became valuable resources to the community, providing specialized and inclusive lgbtq+ senior care. impact of covid-19 on social service organizations research on how social service organizations responded to the covid crisis and its impact on administrators, staff and the public served by these organizations is still emerging. much research has highlighted experiences of shared trauma, fear and anxiety between both clients and direct care staff (öner et al., 2023; stahnke & firestone, 2024). bender et al. (2021) highlighted the stress of staff in healthcare facilities and the critical need for emotional connectedness with colleagues and loved ones during crisis. essential workers who experienced previous trauma and lack of therapeutic alliance were more likely to experience shared trauma and less likely to experience post traumatic growth (stahnke & firestone, 2024). holmes et al. (2021) and mittal et al. (2023) described how social workers and other mental health workers faced significant grief and secondary trauma during the pandemic, contributing to higher levels of burnout, resignations and diminished quality of work. holiday et al. (2020) found that those who worked with people experiencing homelessness, experienced increases in stress related to their perceived inability to meet the needs of clients. dopp et al. (2024) found increased frequency of discrimination and stigma against vulnerable populations such as sexual and gender minority (sgm) individuals who needed to access supportive housing programs. there were some organizations that adapted to the changes causes by the pandemic and demonstrated organizational resiliency. to better understand how complex organizational change occurs, applying a framework of multiple theories can help conceptualize how organizations adapt to unforeseen disruptions, such as those experienced by public serving organizations during the pandemic. lewin's theory of marmo et al./lgbtq+ older adults 389 organizational change (lewin, 1947) focuses on the process of change involving three stages: unfreezing (undoing old practices), change (implementing new practices) and freezing (establishing new practices). while lewin's framework provides a foundational understanding of the process of organizational change, it does not explicitly address change caused by rapid and unpredictable disruptions, such as those that occurred due to the pandemic. dynamic capabilities theory (teece et al., 1997), extends lewin's theory, emphasizing an organization's ability to continuously sense, seize, and reconfigure its resources and capabilities. agility, flexibility, and innovation are characteristics of organizations that are able to adapt to uncertainty (teece et al., 1997). the framework of organizational resilience builds upon dynamic capabilities theory by highlighting how resilience is crucial for facilitating lasting change that aligns with an organization's purpose or mission (duchek, 2020). this implies that organizational resilience is not just about responding to challenges but also about driving meaningful and sustainable transformations within the organization. studying organizations that have effectively navigated disruptions and flourished in the face of change can help identify resources and capabilities that promote organizational resilience during crises (duchek, 2020; hitt et al., 2020). now that we have potentially entered the phase of living with an endemic situation, positive changes, policies, and practices implemented by organizations that have demonstrated resilience need to be better understood to continuously improve organizational culture and prepare for potential future crises. this research study was conducted in the summer of 2021 to better understand how one organization adapted to serving their population by transitioning to a virtual community. this research aimed to document the process of organizational change from the perspective of key stakeholders of a lgbtq+ senior center, the direct care staff and program facilitators of sage. methods this qualitative exploratory study was conducted with six senior centers primarily serving lgbtq+ older adults in new york city. during the early stages of the pandemic, two distinct groups of staff were acting as virtual frontline workers for the senior center, each with unique roles and responsibilities to clients and the organization. one of the groups comprised staff who were paid employees of the organization. their responsibilities include intakes, comprehensive assessments, care coordination, linkages to services and benefits, and the day-to-day operations of the organization. the second group comprised program facilitators, who are mostly volunteers and contributed to leading various programs and groups (exercise, creative arts, book clubs, discussion groups, etc.). program facilitators do not have day-to-day service responsibilities like direct care staff. two groups were intentionally chosen for the focus groups, utilizing a purposive sampling technique, to be representative of the perspective of key organizational resources serving as senior center participants’ primary connections to the organization. purposive sampling is often used in qualitative research as it allows the researcher to select participants based on specific criteria, in order to collect rich and meaningful data related to the research objectives (creswell, 2018). the study was approved by the institutional review board (irb) at the primary authors’ university (irb#200713bp). advances in social work, summer 2024, 24(2) 390 email invitations were sent to all senior center frontline staff and program facilitators. to ensure confidentiality, email invitations were sent by sage requesting participation in a focus group that would be facilitated by researchers who were not employed by sage. in the summer of 2021, three focus groups were held: one with frontline staff (n=8) and two other focus groups were conducted with program facilitators (n = 9; n = 5). demographic information was intentionally not collected for participants to preserve confidentiality, as unique social group identities in this sample could identify participants. a semi structured interview protocol was created to guide discussion and encourage detailed responses, reflection, and interaction amongst participants (see table 1). table 1. semi-structured interview 1) i want you to recall back to when the decision was made to move senior center programming to virtual programming. what was that experience like? a. how was this decision communicated to the members of the senior center? b. how was this experience for you, as a staff member/program facilitator? 2) for those of you who were involved in the first stages of contacting seniors after the stayat-home orders, what worries and challenges were expressed to you? a. can you tell me about what the senior center members reported that they needed, during these calls? b. were you able to meet these needs? how so, or how not? c. how have these needs changed over time? d. were you familiar with the technology needed, and did you have the technology needed to continue the program or class? who trained you on the technology? e. were all members of the senior center able to access needed technology? f. do you think there was a “digital divide” meaning that some seniors had access to technology, and some did not? data analysis following completion of the focus groups, audio files for qualitative data were obtained from the cloud recording and checked for accuracy by the researchers who conducted the interviews. data were then imported into atlas.ti (version 7.5.4) for data management and analysis. interview transcripts were analyzed using inductive content analytical methods, specifically, latent pattern content analysis (kleinheksel et al., 2020; patton, 1990). this methodology allowed for the researchers to establish a pattern of characteristics in the text of the data, rather than the researcher’s interpretations of the meaning of the text (kleinheksel et al., 2020). step one in analysis involved having two of the researchers read the text several times to immerse themselves in the data and detect emergent codes through identification of meaning units related to the shared experience of transitioning to a virtual lgbtq+ senior center in the early stages of the pandemic. in step two, each researcher utilized open coding to independently code 25% of transcript excerpts and label textual codes (campbell et al., 2013; lincoln & guba, 1985). to reduce potential bias, two investigators then compared textual codes and refined conceptual categories via consensus-building discussion to establish intercoder agreement on codes for the codebook, including code descriptions and examples of codes. (corbin & strauss, 1990; kleinheksel et al., 2020). in step three, following completion of coding for the remainder marmo et al./lgbtq+ older adults 391 of the transcripts, second-level coding and first-level meaning units were then sorted and placed in categories of similar codes, separating dissimilar codes to create distinct categories. in step four, these categories were then analyzed for themes and patterns, comparing, and contrasting within and across groups, to allow for data reduction through categorization of themes and the discovery of similarities and differences in the data (kleinheksel et al., 2020; peterson, 2017). in step five, both researchers iteratively reached consensus on the list of four finalized themes and representative quotes for program facilitators and four finalized themes and representative quotes for senior center staff. results data from program facilitators and staff were analyzed separately to better understand diverse perspectives related to the transition of virtual programming (see table 2). table 2. themes participants theme program facilitators adaptation micro mezzo macro interconnectedness virtual benefits some not served staff communication blurring of personal/professional urgent needs future planning in the analysis of the program facilitator focus groups, perceptions were primarily focused on the population of lgbtq+ seniors with whom they had connections with from the community and from in person programming pre-pandemic. transitioning to virtual and telephonic group programming contributed to the ability to maintain community connection and create mutual support. being part of the larger lgbtq+ community and having both group participants’ and their own needs met, framed the overall discussion. the open coding process for facilitators revealed four distinct themes, including: 1) adaptation (with subthemes of micro, mezzo, and macro) 2) interconnectedness 3) virtual benefits and 4) some not served. program facilitators adaptation the first theme adaptation was the most common theme identified in the facilitator focus groups. participants described how different adjustments and adaptations were made to create a new normal for virtual programming. this required both technological and nontechnological adaptation of methods from their previous in person groups. thematic coding further revealed how this process had to occur at a micro, mezzo, and macro level. advances in social work, summer 2024, 24(2) 392 micro level. most program facilitators in the focus groups were very experienced in group work and included former social workers, teachers, and chaplains. to maintain their groups during this uncertain time, they had to develop new capabilities rapidly, often creating their own processes for initiating virtual communication. facilitators took personal responsibility for checking in and creating networks of connection and support, performing their own outreach, and engaging in self-instruction to create mechanisms for virtual and telephonic connection with the group. as demonstrated by the data, facilitators consistently articulated their unwavering commitment to learning digital technology for the purpose of sustaining group cohesion, further emphasizing the integral role of these participants as members of their own community. i did it on my own, there was a former member who had drawn up a voluntary contact sheet years back. so, i contacted everybody, i made phone calls, and found other contacts for newer members, so that's how i started. i've also done individual phone calls one to one, with sage participants who felt like they wanted to talk to someone during this time, so those also went really well. i probably spent without exaggeration, 100 hours learning about video conferencing…but it had to be done, individually and had to be done with a lot of research, because the answers about how to get around that were not easy. mezzo level. the contribution of the organization was also identified as an important resource for adaptation, with the organization providing a method of connection, technological support, and establishment of a consistent platform for virtual programming. in addition, the groups themselves often organically developed protocols within the group, so that virtual or telephone meetings could proceed smoothly. the crucial role of organizational support in facilitating the transition to virtual platforms for group interaction was essential for the development of protocols and adjustments to ensure effective communication and participation. i think what's been most helpful is the support of sage, of the organization, of having somebody, i mean a. was you know, the person that sent out the emails, provided the link...and that allowed me to just really focus on group process, you know intimacy in the group. we were all very, very saddened when everything stopped. but sage quickly responded, and i think by may, we were already linked with zoom and everybody who used to come to the meeting practically…everybody participates in zoom now. we all developed the protocols about how to speak in zoom, everybody knows that everybody gets a chance to speak at the first go around, the facilitator is the one who calls on people, people raise their hands. it was a challenge at first, it was kind of nerve wracking and a little bit frustrating. setting up rules like, mute yourself, unmute yourself, you know i can't see you people...and you can only see half their head, and the group kept saying you know if you can't see yourself, we can’t see you... marmo et al./lgbtq+ older adults 393 macro level. several facilitators discussed how the groups needed to adapt to the context of the political landscape and reflect issues that were impacting lgbtq+ and minoritized persons disproportionately. additionally, policy changes were needed to better address those who may be part of a digital divide or without access to reliable internet. while many of the groups were themed as educational, supportive, exercise, or dedicated to the arts, the shared experiences of being a member of the larger lgbtq+ community and homebound during the pandemic influenced group processes. several program facilitators also discussed new groups formed, attracting new members in response to the shifting political and sociocultural climate: many of the older people in certain communities do not have an internet connection and so it's a big challenge. i know there are lots of politicians and people who have been addressing this, we need to have citywide internet, or they're just going to get more and more disconnected. and there was pandemic, politics, and protest, and out of that came a brand-new group to sort of respond to all that was happening. it is still going now called “america's burning” it is very much about black lives matter, very much about lgbt rights. interconnectedness program facilitators emphasized the importance of community and connection for not only the participants, but also for themselves. overall, most facilitators identified how they felt that the groups not only helped the members who attended each week, but also provided program facilitators with connection to their community, as a sense of mutual support. program facilitators described their connectedness and sense of belonging to the groups they led as relationships of reciprocity, with the groups serving to mitigate their own feelings of isolation and providing a sense of purpose and focus during the early stages of the pandemic. my group has been meeting now for 13 years, i think. it used to meet at sage and now it is online, and it's the highlight of my week. for me it was incredible...i mean facilitating the group was also incredibly supportive for me...so i got so much out of it also you know, in terms of my own isolation and my own, we all struggled with this, what it did, for me, to be able to be engaged with those participants in this really meaningful way. and that's what these groups do for us. you know, it keeps us connected to our community...these women are our family. so, it's very emotional. some not served an additional theme described by facilitators was the theme of some not served. this represented an awareness that there were some members of the lgbtq+ community who were not able to access virtual programming. some spoke of members they lost due to technological challenges, but also some others in the community who were more of an advances in social work, summer 2024, 24(2) 394 unknown population, and they were not exactly sure who or how to engage these older adults. for most it was seamless, but one person dropped out because they couldn't handle zoom i do worry a lot about who's getting left out...who do they have to turn to, so it's almost like people who are disconnected become even more disconnected and more isolated and people who are connected have more opportunities to connect. most of our spanish speaking population was a big challenge for us in regard to whether they had technology, and those who were older, like at 75, 80, 90 where they might not have been ready for a virtual world. virtual benefits as these focus groups were being conducted, the nyc office of aging was in initial phases of permitting senior centers to resume some in-person programming. however, a surprising theme expressed by the program facilitators, was a preference (by some) for the new experiences they discovered with virtual programming. facilitators reported that certain types of groups, such as writing, art, and foreign language were improved by the virtual component, and they had intentions of continuing either fully virtual or a hybrid version of some in person and some online meetings. i can say we are comfortable enough so that people actually prefer zoom to meeting in person, given the various advantages that zoom does have from home…because it's a thing at home. we have read 12 plays now and i would say the transfer to zoom has not made that much of a difference because we spend our sessions with our heads buried in the book, so we may just continue on zoom. certainly, for the moment. it's been a real joy and the participants don't want to really go back to in person. we turned the classes into discussion about the artwork that we are prompted to make during the week...people think about and meditate on projects to do during the week, so they stay really busy and focused. staff in the analysis of staff focus groups, staff perception of the transition to virtual programming seemed very focused on the population of lgbtq+ seniors who presented with the highest amount of need, describing how challenging it was when they felt they could not help the most disadvantaged individuals enough. staff described feelings of distress, frustration, and uncertainty for the future, for both their clients and potentially for themselves. staff initially struggled to acknowledge the positive influence they exerted on seniors in the community, including those they were able to reach through virtual platforms. while program facilitators were somewhat aware of service access disparities, staff faced personal and professional challenges in forming connections, particularly during the early stages of the pandemic. the open coding process for staff revealed four marmo et al./lgbtq+ older adults 395 themes of 1) communication 2) the blurring of personal/professional 3) urgent needs and 4) future planning. communication staff members discussed ways to improve communication following the closure of in person programming. not being at the workplace, and working out of their homes, created concrete challenges to communication and a need to increase and change methods of intraagency communication and communication with center participants. during this time, staff and volunteers were valuable resources to the organization, engaging in creative and complex problem solving and using diverse methods for facilitating communication both within their organization and with the community. as site managers we met virtually once per month pre-pandemic. for the duration of the pandemic, we met two times per week and collaborated and problem solved together a lot. i know for me, that really meant a lot, because of the many losses, it really became almost a support group during the first weeks. especially at the beginning, a cohesive strategy needed to be developed around making sure we could contact our diverse community of elders in ways that were digital, we definitely tried to share information over social media. one way that we were able to pivot pretty quickly…is that our friendly visitor volunteers who are trained in pure support, took on an enormous amount of work in supporting clients calling them sometimes as much as every day, to make sure that they had the support they need. as we were sending out our first virtual program calendar, we also had to develop a method of how someone should register for these virtual workshops, so it was sent to my email address, for like 1500 participants, so you can see, it was kind of high stress, so i know how to use smartsheet and i built it...that was what we adopted and actually, that's what we're still using. some staff discussed how virtual programming positively impacted their capacity to communicate with traditionally harder to reach lgbtq+ seniors who did not attend if they were only offering in person services. staff members discussed the increase in transgender members accessing support: i also found it (virtual programming) a lot more productive to engage with a transgender community. i'm surprised with how huge the trans group has grown, they usually don’t like leaving the house, they get harassed often. some members of the trans population, it's challenging for them, so in the virtual space, it’s welcoming, there were new participants that joined our groups that perhaps we wouldn't have reached had we not been virtual. advances in social work, summer 2024, 24(2) 396 blurring of personal/professional staff spent a great deal of time discussing the blurred line between professional and personal life in the early stages of the pandemic. direct care staff, who mostly identified as members of the lgbtq+ community themselves, were uniquely positioned to provide trusted support and help. however, staff also described the challenges they experienced creating boundaries between work life and home life, and the parallel process between the experiences they were having, and their clients were having. staff expressed feeling overwhelmed at times, expressing feelings that were consistent with a vicarious trauma response to the pressure of working during times of high crisis, perceived danger, and fear. we knew definitely what our clients were saying about feeling isolated and being at home and fears of not being able to get what they needed, because we were thinking the same things too. the fact that there was a parallel process of our own experience with our clients’ experience. it is really a big deal in terms of how we're able to sustain the work and not burn out. where do you create that balance between personal and work? they were calling late at night, or on the weekends, i kept saying this is the first time that i've worked in a space where there is no separation between what i'm going through personally and what the participants are going through personally. i feel like my experience with it was very frenzied and that's what i expected in the beginning, because everything felt, really, really, new but you can't be frenzied for a year and a half that's not sustainable. urgent needs staff were very focused on the population of seniors who they felt had the most vulnerability and were at highest risk. such participants did not always have reliable means of communication and utilized the center pre-pandemic for in-person concrete service needs and meals. staff described the needs of their participants and fears of not having needs met. there was a lot of anxiety and a lot of worries, how are they going to see the doctors, how are they going to get their medication. you know how they're going to see their friends how they're going to get the groceries. there really is a diverse range of people that interact with the centers. in the very immediacy when lockdown happened, food was probably the number one concern for most people and we were finding those first few days, a lot of the services across the city were just like, nope, no can-do kind of thing. so just a lot of anxiety for participants, and for staff. for some of our participants, maybe they're getting food, but they're having serious mental health issues or drug and substance abuse and coming to the center marmo et al./lgbtq+ older adults 397 was how they had kept from you know, falling into those things, and now they must stay home. they’re home all the time. in addition to client needs, staff also spoke of their own personal and professional needs. the need for additional training and feeling unprepared to engage in case management work if that was not their initial job function. many of the non-care management staff had never experienced that kind of crisis calling and weren't trained in it. and so, that was a whole other issue as well. i think that clinical support was provided by us as managers of the programs, we try to run support for our teams. but what we also needed was how we deal with constant death and loss, and how do we talk to clients every day, who have these enormous needs. future planning. as staff reflected on initial stages of the pandemic response, it was clear they wanted to make sure that there were concrete strategic plans in place should the situation become more severe. most wanted contingency plans ready to implement in case further organizational change was needed. staff discussed the need for further organizational preparedness so that direct care staff wouldn’t again have to develop new procedures as the crisis was happening. we just didn't necessarily have all the infrastructure initially, and we now know we need to create the time and figure out how to do it, because something you know, something like this could happen again. i think in that aspect we need to tighten up and make sure we get on the same page, it was sort of thrust upon us and not to pat all of ourselves on the back, i think we did an excellent job, given those parameters. you have to let the staff help you develop what it's going to look like because really, they have to figure out our services now what does this look like now post pandemic, that's the question that has to be answered. discussion staff at human organizations, are often a part of the community that they serve. especially at an organization like sage, many staff members and program facilitators also identify as part of the lgbtq+ community. this seemed to make the experience extremely personal and emotional for them. for program facilitators and staff, the community connection was often both location-based and population-based. similar to other research with essential workers, an additional observation from several of the staff respondents was how traumatized they felt related to working through the crisis (stahnke & firestone, 2024). for some staff respondents, secondary trauma seemed to occur from being witnesses to clients getting sick, losing their housing, not being able to make ends meet and at times, dying from covid-19. the sense of helplessness was palpable, as was a tendency to at times hold themselves responsible for not being able to meet the overwhelming need for help. one other critical finding was how moving to the virtual world blurred the division between personal and professional space. staff worked extremely long hours which seemed advances in social work, summer 2024, 24(2) 398 to add to distress and negative impact on their well-being. several staff expressed challenges with “turning off” when they needed to. these experiences need to be addressed and supported to prevent burnout and emotional distress as we transition to the new “normal.” on the other hand, the way the frontline staff and volunteers rallied to assist older adults and provide for their physical, emotional, and social needs was noteworthy. quick adaption to emerging needs for services, socialization, and connectedness occurred through teamwork, selfinitiative, and innovative change, demonstrating organizational resiliency. programs and services pivoted to the virtual realm to ensure that their participants’ needs would continue to be met. additionally, as the staff and facilitators reported, organizational silos between departments were often deconstructed and staff worked collaboratively on innovative and sustainable solutions for the clients. as was common in other human service organizations during the pandemic, management incorporated “bottom-up” leadership from front line staff using their direct experiences with clients to inform changes in operations (holiday et al., 2020; stahnke & firestone, 2024). this increased staff and facilitators’ perceptions of strength and commitment amongst colleagues towards the organization and their clients, while also helping to establish a pathway for the development of an effective new paradigm of service provision within the organization. from an organizational perspective, the study yielded some critical findings about culture and practices. in many large social service organizations like sage, professional services are highly specialized and delineated. based on the parameters set by various funding streams and the need for specifically trained personnel, organizations are often highly compartmentalized both virtually and horizontally. this organization structure can work seamlessly if there is an effective communication and collaboration mechanism in place. if this system was not functioning smoothly prior to the pandemic, that could contribute to an exacerbation of divisions within an organization. staff mentioned the need for timely and consistent communication between departments and personnel, as well as improved connectedness between staff and administrators. similarly, the need to be flexible and adapt to the rapidly changing scenario was identified as the need of the hour. these concerns have not receded as staff/facilitators are still unsure of what the new system of operations will look like in the coming months. finally, some limitations on availability of resources (support, technology, financial) for staff/facilitators and clients was highlighted by study participants. programs and services could move seamlessly to the virtual realm, but the providers and consumers needed to have both ability and acumen in this new method of service provision. limitations this study explored the experiences of frontline staff and program facilitators within sage. respondents were voluntary and self-selected from purpose sampling invitations. this sampling method may have influenced the findings of the study, along with the impact of the aftermath of this crisis. we believe that providing a safe and confidential space for the respondents and having the focus group led by non-sage employed facilitators, helped minimize these limitations. one limitation of utilizing focus groups as a data collection marmo et al./lgbtq+ older adults 399 method is the potential for social desirability bias. however, as a method for gathering data through group interaction, focus groups can also unveil patterns of engagement among participants, leading to a deeper understanding of the topic (morgan, 1997). the perspectives and values of the authors may have also influenced the analysis of the data. a codebook and iterative consensus building techniques were used to help increase credibility (lincoln & guba, 1985). conclusion our study makes a small but significant contribution to the literature about lessons learned and critical needs for lgbtq+ senior social service organizations. unresolved grief, trauma, and emotional distress are pervasive among frontline workers, necessitating robust support mechanisms such as counseling, peer support groups, and psychoeducation (bender et al., 2021; holiday et al., 2020; holmes et al., 2021; magruder et al., 2022; stahnke & firestone, 2024). additionally, organizational resilience can be fostered by implementing team building and conflict resolution workshops to restore relationships and promote staff well-being (folger et al., 2021; white et al., 2020). amidst these challenges, sage exemplified adaptability by innovating service delivery methods to meet client needs. drawing on lewin's change management framework (1947), sage has successfully navigated organizational transitions by discarding outdated practices (unfreeze) and institutionalizing new approaches (freeze). 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(2018). predicting perceived isolation among midlife and older lgbt adults: the role of welcoming aging service providers. the gerontologist, 58(5), 904-912. author note: address correspondence to suzanne marmo, department of social work, fairfield university, 1073 n benson road, fairfield, ct 06824. email: smarmo@fairfield.edu https://doi.org/10.1080/00918369.2023.2169851 https://doi.org/10.1080/00918369.2023.2169851 https://doi.org/10.4135/9781412984287 https://www.washingtonpost.com/national/coronavirus-hiv-aids-new-york/2020/04/02/9e7f8728-74f4-11ea-87da-77a8136c1a6d_story.html https://www.washingtonpost.com/national/coronavirus-hiv-aids-new-york/2020/04/02/9e7f8728-74f4-11ea-87da-77a8136c1a6d_story.html https://doi.org/10.2196/26145 https://doi.org/10.2196/26145 https://doi.org/10.1002/smi.3325 https://doi.org/10.1002/smi.3325 https://doi.org/10.1002/smi.3325 https://doi.org/10.1136/bmj.n129 https://doi.org/10.1136/bmj.n129 https://doi.org/10.1177/0733464821991026 https://doi.org/10.1177/0733464821991026 https://doi.org/10.1177/0733464821991026 https://doi.org/10.1177/0733464821991026 https://doi.org/10.1002/(sici)1097-0266(199708)18:7%3c509::aid-smj882%3e3.0.co;2-z https://doi.org/10.1002/(sici)1097-0266(199708)18:7%3c509::aid-smj882%3e3.0.co;2-z https://doi.org/10.1007/s11673-021-10164-6 https://doi.org/10.1007/s11673-021-10164-6 https://doi.org/10.1186/s12888-020-02923-3 https://doi.org/10.1186/s12888-020-02923-3 https://doi.org/10.1093/geroni/igx004.3165 https://doi.org/10.1093/geroni/igx004.3165 https://doi.org/10.26099/mqsp-1695 https://doi.org/10.26099/mqsp-1695 https://doi.org/10.26099/mqsp-1695 https://doi.org/10.1093/geront/gnx092 https://doi.org/10.1093/geront/gnx092 mailto:smarmo@fairfield.edu methods _________ krisztina baltimore, phd, research associate, department of psychiatry, boston medical center, boston, ma. wooksoo kim, phd, associate professor, school of social work, university at buffalo, state university of new york, buffalo, ny. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 205-219, doi: 10.18060/27061 this work is licensed under a creative commons attribution 4.0 international license. mental health service use among middle eastern migrant women: social work's role in promoting mental health literacy krisztina baltimore wooksoo kim abstract: migrants who relocate to the united states from the middle east are more likely to face a host of structural and individual barriers that can significantly contribute to their mental health issues and affect their psychological well-being. addressing mental health problems and incentivizing help-seeking behavior is important among women who are more likely to face daily stressors in childcare, household responsibilities, and marital relationships. in this paper, we discuss factors that impact help-seeking for mental health problems among middle eastern migrant women including english language proficiency, structural challenges, and cultural factors such as shame and stigma. we argue that when considering its potential effectiveness, targeting mental health literacy may serve as the best direction for future research and social work intervention in order to enhance helpseeking behavior among this population. recommendations for social workers include using community-based partnerships to provide educational resources regarding mental health services through healthcare centers, social service agencies, and local muslim and arab organizations. keywords: immigrants and refugees; middle eastern women; mental health literacy; mental health; social work healthcare use; help-seeking behavior historically, migration channels from the middle east to the united states were established in the latter decade of the 1800s following political unrest in syria, lebanon, and israeli regions (cumoletti & batalova, 2018; slewa-younan et al., 2014). in 1880, approximately 50,000 arab immigrants resettled in the u.s., most of whom were predominantly christian, in an initial wave of migration that concluded in the early 1900s (harjanto & batalova, 2022). subsequent political upheavals across iraq and syria in the 1950s ushered in another surge of middle eastern immigrants shortly thereafter (connor, 2016). the term “migrants” combines two groups of foreign-born individuals: immigrants, generally defined as persons residing in a country other than their own, and refugees, defined as persons forced to flee their country of origin for their own security and survival (paarlberg, 2023). revisions to the 1965 immigration act have contributed to a steady stream of immigrant and refugee arrivals from the middle east, many of whom aim to better their occupational and scholastic prospects or seek refuge from war and persecution by migrating to the u.s. (cumoletti & batalova, 2018). middle eastern migrants are often subsumed under the larger category of arab americans who are generally defined as having “ancestral, cultural, ethnic, linguistic, familial, or heritage ties to one or more of the 22 arab league countries” (abuelezam et al., 2018, p. 2). however, not all middle easterners are arab. the middle east refers to a geopolitical region encompassing the southern and eastern borders of the mediterranean about:blank advances in social work, spring 2023, 24(1) 206 sea and the arabian peninsula. countries in the middle east including bahrain, cyprus, egypt, iran, iraq, israel, jordan, kuwait, lebanon, oman, palestine, qatar, saudi arabia, the syrian arab republic, the united arab emirates, and yemen (gul et al., 2015). this paper concentrates on middle eastern migrants as its population of focus as they may be particularly vulnerable to mental health conditions as a result of sustained exposure to war and political turmoil. an estimated 1.2 million middle eastern immigrants and refugees presently reside in the united states, the vast majority of whom originate from muslim-majority countries (u.s. census bureau, 2019). current rates of admission differ by country as iraqis (250,000) were reported to account for the majority of refugees admitted to the u.s. in 2019, followed by 120,000 migrants from lebanon, 93,000 syrians, and 59,000 migrants from yemen (harjanto & batalova, 2022). in the years of the trump administration, records indicate low acceptance rates that include 481 syrian, (baugh, 2022) 537 iraqi, (monin et al., 2016) and 18 yemeni migrants (radford & connor, 2017). the growing number of migrant populations in the u.s., including a large number of more recent migrants from the middle east, underscores the importance of providing reliable and adequate support after resettlement to promote positive health outcomes within this population. newly resettled migrants are subject to a host of structural and interpersonal barriers that can make it difficult to adjust to the policies of their new host country. compared to the general population, middle eastern migrants are more likely to experience difficulties with language barriers and encounter cultural disparities that contribute to negative employment trajectories and health problems (wei et al., 2015). additionally, accessing and navigating local legal, educational, and healthcare systems can be made difficult as a result of insurance and transportation barriers (elsouhag et al., 2014). in light of these challenges, middle eastern migrants, and women especially, are at significantly higher risk of developing mental health conditions, particularly in consideration of daily stressors such as household, childcare, and employment responsibilities. prevalence rates of mental health symptoms among middle eastern migrants vary across the literature ranging from 13% (kulwicki & ballout, 2015) to 50% (amer & hovey, 2012). however, most studies indicate significant levels of depression and ptsd among arab americans including iraqi migrants with a refugee background (kira et al., 2007; may et al., 2013; taylor et al., 2014). these findings demonstrate the importance of examining ways to improve help-seeking for mental health treatment within this population. current research suggests that the prompt detection and treatment of mental health symptoms are critical to the maintenance of psychological and emotional well-being over time (roberts et al., 2018; world health organization, 2021). while in recent years, important strides have been made to address prominent mental health problems among migrant populations (hasan et al., 2021), barriers that impact the ability of resettled migrant communities to access treatment remain. baltimore & kim/middle eastern migrant women & mental health 207 gender while all migrants face challenges to their psychological well-being, it is important to acknowledge the gendered factors that uniquely influence the experiences of women from the middle east and their role in help-seeking behavior. in particular, middle eastern migrant women experience higher levels of mental health problems in comparison to men. for example, a study in dearborn, michigan suggests a 50% prevalence rate of ptsd among iraqi women (abuelezam et al., 2018) with a third of women meeting the threshold for anxiety and 14% reporting severe symptoms in a similar study in the u.s. (hassouneh & kulwicki, 2007). this area of focus is particularly important as studies suggest that despite reporting higher levels of mental health symptoms than men, muslim women in particular are less likely to use mental healthcare services (ciftci et al., 2013). first, in marital contexts, middle eastern women report high levels of intimate partner violence (ipv), sexism, and sexual violence (knifton, 2012; vu et al., 2016). in particular, middle eastern women are likely to be victims of ipv due to a host of factors that include a male-dominated culture, dependence on their male partners for financial security, and a lack of non-marital support (abuelezam et al., 2018). ipv has detrimental effects on the psychological well-being of the victims as rates of depression are significantly linked to domestic violence among arab american women (douki et al., 2007). subsequently, despite being more likely to be in need of mental healthcare, middle eastern women who experience ipv may be less likely to seek help due to a fear of consequences that may arise in the marriage. additionally, in comparison to men, middle eastern women are more likely to be valued as caretakers and viewed as the primary head of household chores (jamil et al., 2007). among this population, women are likely to be preoccupied with childcare, domestic, and employment duties leaving less opportunity to engage in health-promoting behaviors (fakhr el-islam, 2008; wieland et al., 2012). given their role in the household, an admission of mental illness may carry a social stigma that creates a perception of a woman as incompetent or unable to engage in her role as a caretaker (chaleby, 1988). therefore, women may be less incentivized to seek mental health treatment in order to maintain a positive reputation as a mother and to protect the reputation of her family as a whole. mental health literacy mental health literacy, a construct that refers to beliefs about mental disorders which aid their recognition (jorm et al., 1997), management, and prevention, plays an essential role in help-seeking for mental health conditions among middle eastern migrant women. the use of mental health services is best precipitated by a knowledge and understanding of how to effectively maintain an optimal level of emotional well-being (choudhry et al., 2019). under a general umbrella, mental health literacy can be partitioned into three main categories: beliefs regarding the etiology of mental illness, stigma and attitudes towards those with mental illness, and the ability to access services when necessary (may et al., 2013). due to its modifiability, improving mental health literacy among middle eastern advances in social work, spring 2023, 24(1) 208 migrant women is an important area of study with several implications for the field of social work and improved mental health outcomes among this population. the purpose of this review was to discuss factors that impact help-seeking for mental health problems among middle eastern migrant women. the discussion focuses on prominent factors that affect help-seeking behavior including english language proficiency, structural challenges such as a lack of knowledge and transportation barriers, as well as cultural factors such as family, community, and religion. challenges in mental health service use limited english proficiency limited english proficiency (lep) is a prominent barrier to help-seeking for mental health conditions among minority populations (villatoro et al., 2018). recent estimates indicate that middle eastern migrants largely report either arabic or a similar dialect as their primary language with only 10% of immigrants identifying as solely english speakers (u.s. census bureau, 2019). subsequently, lep significantly affects the ability of middle eastern migrants to set up and maintain medical appointments as well as to communicate and convey medical problems to providers. lep among middle eastern migrant women can create barriers to understanding health information and accessing mental health services (simpson & carter, 2008). approximately 40% of middle eastern migrants report lep, a slightly lower estimate than what is found among immigrants in general. furthermore, lep tends to be higher among iraqi (50%) and syrian (47%) immigrants in comparison to immigrants from other middle eastern countries such as lebanon (28%) (harjanto & batalova, 2022). this finding may be explained by the higher level of concentration in economic, educational, and industrial institutions with western foundations such as the american university of beirut (aub) and lebanese american university (lau) in countries such as lebanon in comparison to iraq and syria (abi doumit et al., 2019). thus, women with higher english proficiency who migrate from countries such as lebanon may experience fewer challenges with communication while navigating systems of mental healthcare in the u.s. the effects of lep on help-seeking begin with the ability to simply set up an appointment with a healthcare provider. initially, lep can limit access and engagement with healthcare systems when migrants experience difficulties making necessary appointments. calling and booking medical consultations with healthcare receptionists has presented difficulties for migrant women with lep across all cultural groups (cheng et al., 2015), particularly when accessing mental health services (donnelly et al., 2011). these obstacles can be partly attributed to a lack of available interpreters. to begin with, challenges with finding adequate interpreters for securing provider appointments may deter migrants from actively engaging in healthcare services (asgary & segar, 2011). in the context of mental health, these challenges are exacerbated by the conceivable shame and sensitive nature related to the disclosure of mental health problems (al-omari et al., 2022; im & rosenberg, 2016; knifton, 2012). baltimore & kim/middle eastern migrant women & mental health 209 after initial appointment setup, migrant women may be unable to communicate the full details of their medical and social history when they visit a doctor’s office. in a qualitative study examining muslim women's experiences with healthcare providers, women with higher levels of english proficiency were better able to communicate medical problems and obtain necessary health information from providers (simpson & carter, 2008). in comparison, women with lep are more likely to adopt a passive role in the patient-provider relationship and are less likely to inquire about their health information (kang et al., 2016). healthcare visits can result in middle eastern women experiencing difficulties conveying medical problems or asking questions that are necessary to fully evaluate their physical or mental health status. thus, in order to maintain optimal health, the importance of being able to communicate and obtain basic medical information cannot be understated. structural challenges lack of knowledge as they adjust to the norms and policies of the u.s. healthcare system, middle eastern migrant women may experience difficulties locating providers, comprehending healthcare coverage, understanding differences between generalist and specialist practitioners, and knowing the functions of hospitals and primary care centers (simpson & carter, 2008). in a study examining muslim women’s experiences with the u.s. healthcare system, several women reported difficulties choosing providers and understanding the nuances of health insurance coverage (khan et al., 2019). for example, women reported not knowing the difference between private and public insurance, what specific benefits are covered under their insurance plan, and the role of copays in medical appointments (simpson & carter, 2008). furthermore, some migrant women report using emergency services in cases where an appointment with a provider is more appropriate (samra et al., 2019). thus, the ability to navigate structural challenges to healthcare begins with having a sufficient understanding of the services that are available. transportation barriers women who do not reside within close distance of formal mental health services may experience challenges accessing and attending necessary appointments due to lack of transportation (kang et al., 2016). consequently, findings of a study examining healthcare utilization suggest that iraqi and other arab migrants with transportation barriers are less likely to access healthcare services (elsouhag et al., 2014). while these findings specifically pertain to medical care, one can imagine that when transportation difficulties play a role in attending medical appointments and routine check-ups, the incentive to manage transportation difficulties for the use of mental health services is much lower. cultural competence in healthcare systems when examining the structural role of healthcare systems in perpetuating barriers that prevent migrant women from engaging with the formal services, cultural competency emerges as a significant factor. arab-muslims in the u.s. have reported feelings of distrust toward medical professionals as a result of experiences with broken healthcare systems in advances in social work, spring 2023, 24(1) 210 their countries of origin (khan et al., 2019; padela & zaidi, 2018). likewise, immigrants across various populations report being wary of healthcare professionals, such as social workers and counselors, particularly in the field of mental health (amri & bemak, 2013; kakoti, 2012). specifically, middle eastern migrants describe fears that providers may brainwash their children or introduce them to behaviors that are religiously taboo (alhomaizi et al., 2018). thus, it is important to view mental health service use through a holistic lens that accounts for the structural barriers that uniquely affect service use among this population. cultural factors: shame and stigma several studies suggest that among collectivistic communities, the mental health of an individual family member is a reflection on the entire family (aarethun et al., 2021; amri & bemak, 2013; ciftci et al., 2013; walpole et al., 2013). many women may avoid seeking help for mental health conditions out of fear of negative evaluations from family members (alissa, 2021). additionally, studies demonstrate that arab muslims are able to recognize the presence of social stigma (attitudes towards those with mental illness maintained by a social group) and associative stigma (attitudes towards those related to someone with a mental illness) among their families and communities as well as its potential for negative consequences in relation to an admission of mental health problems (al-laham et al., 2020; alhomaizi et al., 2018; burford-rice et al., 2022). therefore, a fear of community abandonment may also deter help-seeking behavior among this population (abu-raiya et al., 2015; youssef & deane, 2006). in middle eastern cultures, help-seeking is often viewed as a family decision with individuals placing their personal needs aside for the sake of maintaining a positive reputation for the family as a whole (alhomaizi et al., 2018). for example, findings of a study examining muslim views on mental health showed that participants expressed dubious attitudes towards treatment practices when questioned about the relevance of mental health services (weatherhead & daiches, 2010). however, among those that felt that services were necessary, respondents cited the importance of being able to use mental health services to treat conditions particularly experiencing prejudice from their own communities (weatherhead & daiches, 2010). middle eastern migrants may be at risk of being stigmatized from their communities in the form of judgement and social isolation in response to an admission of mental health problems, addiction, or suicide ideation (rassool, 2015). furthermore, the effects of shame and stigma in relation to mental illness can be especially detrimental to women. considering gender, an admission of mental illness may be viewed as shameful and may lower a woman’s potential for marriage (chaleby, 1988; corrigan & miller, 2004). this notion can be partly attributed to the increased cultural value that is placed on a woman’s role in the home in some arab cultures (wieland et al., 2012). thus, an admission of mental health struggles may place a woman’s reputation as a caretaker in jeopardy as perceived by other members of the community (khan et al., 2019; tobah, 2018). in a study examining women’s mental health in the muslim world, women stated that in addition to regular employment, they also felt accountable for household responsibilities including baltimore & kim/middle eastern migrant women & mental health 211 childcare and housecleaning duties (douki et al., 2007). therefore, in many cases, a woman may be incentivized to avoid seeking mental health treatment, when necessary, in order to avoid family and community judgement as well as to maintain her own reputation as a wife and mother. mental health literacy: implications for social work considering the array of barriers to help-seeking, targeting mental health literacy is an important direction for future research in the field of social work as this approach may serve as the best method for addressing help-seeking behavior among middle eastern migrant women. recognition of mental health disorders. addressing mental health literacy can serve as a mechanism for increased help-seeking behavior among migrant women by improving upon the ability to recognize mental health symptoms when they arise. the first component of the etiology of mental health problems demonstrates a direct link between beliefs about what causes mental illness and rates of mental health service use among arab migrants with a refugee background (fakhr el-islam, 2008; wieland et al., 2012). in an evaluation of factors affecting the attitudes of muslim americans towards help-seeking, findings suggest that cultural beliefs significantly account for the way in which perceptions of those with mental illness are formed (khan et al., 2019). in collectivistic cultures and arab muslim communities, mental health issues may be conceptualized through alternative religious-based perspectives (aloud & rathur, 2009; weatherhead & daiches, 2010; youssef & deane, 2006). specifically, mental illness can be viewed as the result of a lack of faith, as punishment or a test from god, or a product of supernatural forces such as “jinn” (spirits) and “seher” (magic; knifton, 2012). on the contrary, it is important to note that many middle eastern migrants also attribute mental illnesses to genetic, environmental, and social causes such as the availability of community networks (abuelezam et al., 2018; bagasra, 2014). subsequently, peer-led interventions aimed at improving the recognition of mental health literacy may be effective when implemented across group and community settings. studies assessing peer-led interventions provide support for the use of migrant leaders and community social workers in disseminating information related to mental health among migrant communities (im & rosenberg, 2016; piwowarczyk et al., 2013; yun et al., 2016). migrant women across all cultures are more likely to trust and absorb health information from people with congruent cultural, ethnic or lingual backgrounds as their own (perry et al., 2014). peer-led interventions that take place in communal settings such as mosques or community centers can effectively disseminate curriculum content by allowing a space for migrant women to form social networks that spread information throughout the community (im & rosenberg, 2016; pejic et al., 2016). this method of intervention may prove particularly beneficial in collectivistic cultures where stigma towards mental illness can lead to an internalization of negative attitudes that results in shame and de-incentivizes help-seeking. reducing shame and stigma. the second component of mental health literacy, stigma towards mental disorders, may serve as a barrier to help-seeking as a result of negative advances in social work, spring 2023, 24(1) 212 attitudes and discrimination towards those in need of mental health services (wei et al., 2015). for example, arab muslims who endorse alternative religious perspectives of mental illness are more likely to have negative attitudes towards the use of mental health services. subsequently, they are more likely to have lower rates of help-seeking as a result of internalization of shame in relation to mental illness (aloud & rathur, 2009). likewise, qualitative findings among arab-muslim populations confirm that the presence of social stigma dissuades help-seeking behavior among this population as women may avoid treatment services to evade the shame of being labelled as a person who has something “wrong” with them (alhomaizi et al., 2018). subsequently, these beliefs may affect their willingness to seek mental healthcare when needed. in order to decrease shame and stigma in relation to mental health among middle eastern women, family-based interventions, as implemented by social service agencies, appears to be effective (murray et al., 2010; qadir et al., 2013). multi-educational group interventions, often comprised of presentations followed by informal discussions between family members (qadir et al., 2013), have been found to increase mental health service utilization and medication adherence among participants (weine et al., 2008; yun et al., 2016). by targeting the family system as a whole, these interventions can address the stigma towards mental illness found among families in collectivistic communities. additionally, considering the ubiquity of technology, future research examining the effectiveness of web-based phone applications can serve to assess alternative ways to decrease stigma in relation to mental illness using psychoeducational methods. for example, as demonstrated using the step-by-step (sbs) app, the anonymous nature of phone applications has been found to increase knowledge regarding depression, anxiety, and ptsd as well as help-seeking behavior among migrants with refugee backgrounds (burchert et al., 2019). future studies can therefore assess whether phone applications can be used to normalize mental health terminology and decrease stigma among middle eastern migrant women. exploring and addressing the use of digital technology through needs assessments can improve the access and dissemination of health information among migrant populations (paarlberg, 2023). systems knowledge. the third component of mental health literacy refers to an individual’s familiarity with the mental health services in their community. studies across various groups of migrant women demonstrate that women face difficulties knowing where to make appointments for mental health care, who to call, and how to find out what benefits they are eligible for under their insurance plan (clark, 2018; simpson & carter, 2008; tulli et al., 2020; whittaker et al., 2005). these findings indicate a need for education regarding the practical steps that constitute the process of getting connected with formal treatment services. cultural competence (i.e., the ability to acknowledge the values, customs, and beliefs of other cultures) of service providers may help improve knowledge and familiarity of mental health services among migrant communities. this method of intervention seeks to place the onus on the healthcare centers that engage with migrant communities by strengthening patient-provider relationships (cheng et al., 2015; kakoti, 2012; nazzal et al., 2014). higher levels of cultural competence are often associated with greater levels of trust in the patient-provider relationship (islam et al., 2017). thus, providing a space for baltimore & kim/middle eastern migrant women & mental health 213 migrant women to explore conversations related to mental health in a way that is culturally sensitive can improve knowledge of services that are available and ways to access necessary treatment through discussion and information giving with providers (hassouneh & kulwicki, 2007). suggested approaches to fostering a culturally competent environment include employing social workers in the provision of adequate interpreter services, appropriately translated health materials, and access to websites with mental health related information, all of which are methods that may increase engagement with the healthcare system (im & rosenberg, 2016; laverack, 2018). furthermore, when examining mental health literacy and help-seeking through a structural lens, it is important to encourage collaborations between social workers employed at primary care centers and resettlement agencies to promote familiarity and engagement with the mental healthcare system (cheng et al., 2015; nazzal et al., 2014). for example, community-based partnerships can be used to provide informational resources regarding the availability of mental health services, insurance eligibility, and the importance of addressing mental health through webpages, appropriately translated handouts, and community point persons. these resources can be disseminated throughout primary care and mental healthcare centers, social service agencies, mosques, and local arab and muslim organizations. furthermore, through these connections, coordinated efforts can be made to mobilize resources, create outreach programs for mental health education, and facilitate referrals to specialists for women in need. conclusion addressing mental health literacy to improve mental health outcomes can alleviate symptoms that affect middle eastern women across all facets of their daily lives including household chores, childcare, and marital relationships. promoting educational awareness as to what constitutes mental illness can aid women and other family members in initiating and supporting the treatment process. recognition of symptoms is therefore critical to the prevention and treatment of various mental health disorders. for example, social workers in primary care settings can advocate for training providers to ask patients general questions about stress, emotional health, and interpersonal violence during routine appointments. additionally, social workers at immigrant and refugee social service agencies can organize workshops facilitated by community leaders to promote mental health literacy. these workshops can be implemented in community centers, mosques, or other shared spaces where women can form social networks to support help-seeking among their communities. in conclusion, it is imperative to increase levels of knowledge and understanding of mental health and care options in order to promote healthy psychological outcomes among middle east migrant women. enhancing mental health literacy among migrant middle eastern women can result in the early detection and treatment of psychological and medical health conditions as well as improvements in familial and social relationships that result in positive long-term outcomes in overall health and well-being. advances in social work, spring 2023, 24(1) 214 references aarethun, v., sandal, g. m., guribye, e., markova, v., & bye, h. h. 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(2016). help-seeking behavior and health care navigation by bhutanese refugees. journal of community health, 41(3), 526-534. author note: address correspondence to krisztina baltimore, school of social work, university at buffalo, state university of new york, buffalo, ny 14260. kbaltimo@buffalo.edu https://doi.org/10.1348/147608309x467807 https://doi.org/10.1348/147608309x467807 https://doi.org/10.1186/s12888-015-0681-9 https://doi.org/10.1186/s12888-015-0681-9 https://doi.org/10.1111/j.1752-0606.2008.00061.x https://doi.org/10.1111/j.1752-0606.2008.00061.x https://doi.org/10.1177/1359104505051210 https://doi.org/10.1177/1359104505051210 https://doi.org/10.1177/1359104505051210 https://doi.org/10.1016/j.whi.2011.10.002 https://doi.org/10.1016/j.whi.2011.10.002 https://doi.org/10.1016/j.whi.2011.10.002 https://www.who.int/publications/i/item/9789240031029 https://www.who.int/publications/i/item/9789240031029 https://doi.org/10.1080/13674670512331335686 https://doi.org/10.1080/13674670512331335686 https://doi.org/10.1007/s10900-015-0126-x https://doi.org/10.1007/s10900-015-0126-x mailto:kbaltimo@buffalo.edu _________ matthew p. decarlo, phd, assistant professor, school of education and human development. saint joseph’s university, montgomery county, pa. mary nienow, phd, lcsw, assistant professor, school of social work, new mexico state university, las cruces, nm. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 495-514, doi: 10.18060/28573 this work is licensed under a creative commons attribution 4.0 international license. uniquely biased: how aswb exams violate psychometric best practices matthew p. decarlo mary nienow abstract: after publication of the 2022 pass rate analysis demonstrating that minoritized social workers pass at less than half the rate of white social workers, the association of social work board (aswb) examination guidebook (aswb, 2023a), revised its psychometric reporting of exam fairness from “statistically free from race and gender bias” (aswb, 2022a, p. 3) to “differences in exam performance for…different demographic groups…is influenced by many factors external to the exam,” upstream of the examination in the workforce pipeline (aswb, 2023a, p. 9). focusing only on factors external to the exam ignores the possibility that the internal properties of the exam may be invalid, unreliable, and unfair. race, class, culture, and other structural factors have not impacted aswb exams the same over time, with aswb’s 2022 exam pass rate analysis reporting 10-13% reductions in bachelor’s and master’s examination pass rates after introducing the 2018 exam blueprint. using extensive references to aswb’s public statements, this article will demonstrate how aswb elided evidence of examination flaws and presented external factors as the only possible explanation for disparities in pass rates. beginning with the policy paradox created by national organizational disagreement on the cause and next steps on exam score inequities, this article will demonstrate how bias is encoded in the language and theories underlying the examination, as well as review the extant empirical evidence on psychometrics addressing shortcomings in aswb’s exam validation process, which converge to create a uniquely biased exam. keywords: association of social work boards, licensure, exams, ethics, psychometrics, regulation the 2022 aswb exam pass rate analysis: final report (exam pass rate analysis) produced by the association of social work boards (aswb, 2022b) represents the first publicly available assessment of equity in social work exam scores using data from realworld aswb examinations. until 2022, aswb both publicly denied collecting the relevant equity data and stated they were unwilling to make such data available (hymans, 2020; nasw, 2020). specifically, the data revealed lower pass rates for black, latine, and older test takers and those for whom english is a second language. despite committing to “investing in a robust analysis of examination pass rate data” in the examination guidebook (aswb, 2023a, p. 9), the 2022 exam pass rate analysis (aswb, 2022b) contained no hypotheses or statistical tests. the last documented procedure for how aswb engaged in exam validation was in 2011 (marson et al., 2010). after release of the data, no third-party researchers were contracted to confirm the validity and reliability of the exams themselves. the release of the exam pass rate analysis (aswb, 2022b) inspired the president of the national association of deans and directors of social work (nadd) to declare about:blank advances in social work, summer 2025, 25(2) 496 aswb exams part of “jim crow licensing because we don’t know what’s in the test” (decarlo, 2022a, 20:35). indeed, aswb has never published a study demonstrating the validity of their examinations and given the centrality of fairness to the psychometric definition of validity (bean, 2022; gómez-benito et al., 2018), the exam pass rate analysis (aswb, 2022b) provides important evidence the examinations may be invalid and unreliable. this article seeks to excavate the political and methodological causes of the exam disparity. it interrogates the rhetoric used by aswb to prioritize exogenous causes of exam pass score disparities and recommends greater adherence to established psychometric standards, a values commitment to data democracy, and a re-centering of the empirical and lived experiences of those taking the exam in the early-career workforce. exam pass rate disparities to date, aswb has not made public raw statistical outputs for its validity and fairness tests, nor the underlying methodology used to assess their exams. in 2010, marson and colleagues (2010) briefly addressed fairness by reporting that less than 1% of aswb test bank questions (i.e., items) were removed due to biased functioning across racial and gender groups. ten years later, aswb’s item developmental consultant, stacey owens (2021), provided another brief report on fairness, demonstrating that “less than 5%” of all aswb items per year were removed due to biased functioning (para. 3) –a 5x increase over 11 years. these figures are a rough one-line summary in the report and do not provide a comprehensive view of the functioning of aswb exams. as this paper will detail later, this cursory reporting directly violates gold standards governing adequate testing documentation (american educational research association [aera] et al., 2014). because of this “information suppression” (woodcock, 2015, p. 225), researchers have attempted to address concerns about exam equity and validity through indirect means. for example, senreich and dale (2021) matched data from the city university of new york student database with licensure records in new york state. table 1 compares the percentage of those attaining master’s-level licensure in new york with the national pass rates for the master’s exam reported by aswb. table 1. concordance of msw exam pass rates and licensure rates social worker demographic group us msw exam pass rate* ny msw licensure rate** race (any age) white 86% 78% black 45% 48% latine 64% 60% older black 30% 31% latine 45% 39% msws (any race) 65% 50% notes: *exam pass rates as reported by aswb (2022b) in the 2022 exam pass rate analysis report. **msw licensure rates as reported by senreich & dale (2021) using ny social work board and public college records. decarlo & nienow/uniquely biased 497 table 1 demonstrates a pattern of exclusion for aspiring social workers from oppressed racial and ethnic groups, and those disparities increase substantially with age. older social work aspirants are both less likely to pass examinations and become licensed, but only for minority races and ethnicities. whereas 91% of white test takers eventually pass the licensed master social work (lmsw) exam, only 52% of black test takers and 63% of people whose first language is not english eventually pass the exam (aswb, 2022b). this pattern is mirrored in the undergraduate social work practice exam, in which 82% of white test takers eventually pass the licensed bachelor social work (lbsw) exam, while only 38% of black test takers and 50% of test takers whose first language is not english pass the exam eventually. aswb: external factors cause exam disparities upon release of the exam pass rate analysis, and in anticipation of it, aswb (2022b) maintained a strange truth for an exam developer: that all standardized tests are unfair. then-ceo dwight hymans stated in a 2020 roundtable, “what we do know about standardized testing is that generally speaking, across any exam, whether it is a licensing exam or a college entrance exam… it is fairly common knowledge that there are disparities in outcomes'' across demographic groups (nasw, 2020, 18:01). he elaborated “aswb has a very extensive system internally” to ensure examination items are not biased. aswb’s (2023a) examination guidebook states that it follows the “nationally recognized testing industry standards set by the joint commission on standards for educational and psychological testing, the american psychological association [apa], the american educational research association [aera], and the national council on measurement in education [ncme]” (hereafter, joint standards) to “ensure validity, reliability, and fairness” (p. 6). according to the present ceo, the joint standards require “robust antibias measures with extensive psychometric tools" which aswb employs while "working with a diverse group of practicing social workers at every stage of development and eliminating any question that shows signs of bias” (hardy-chandler, 2023, p. 224). “despite those efforts,” dr. hardy chandler states, “disparities persist” (hardychandler, 2023, p. 224). because of the integrity and psychometric rigor of their exam development process, aswb confidently tells test takers in their guidebook that although “there may be differences in exam performance outcomes for members of different demographic groups'' it is only “because exam performance is influenced by many factors external to the exams” (aswb, 2023a, p. 12). in the exam pass rate analysis (aswb, 2022b), aswb lists professions that measured equity data prior to social work–nursing, pharmacy, and law–and found similar disparities in exam scores. aswb interprets this data as indicating systems of domination cause unfair scores across the entire standardized testing sector, not just aswb exams. aswb seems to be arguing that unfair pass rate disparities are the price of rigorous, objective measurement in an unfair world. national organizations: aswb tests violate industry standards despite the contentions of aswb, all other major national social work organizations, including the national association of deans and directors (nadd), the council on social advances in social work, summer 2025, 25(2) 498 work education (cswe), and the national association of social workers (nasw), have publicly dismissed the psychometric integrity of the examinations. for example, cswe sent a letter to every social work jurisdictional board urging them to “suspend the use of the aswb exam” for bachelor’s-level licensure (lbsw) and master’s-level licensure (lmsw), citing 2022 illinois legislation. they also demanded that aswb conduct “further analysis of the descriptive data” (caldwell, 2022, para. 2) before continuing with the use of the clinical-level (lcsw) examination because, as cswe concluded in a separate statement, “we believe the descriptive data released by aswb to be incomplete and contains flaws” (cswe, 2022, para. 2). nadd (2022) called for the suspension of testing fees, immediate rebate of fees, and reparations for test takers from the most impacted demographics. nasw argued against the inclusion of examinations in the social work licensing compact because “the current exam does not conform with industry testing standards” (butts & goodenough, 2022, p. 7). this conflict in positions leaves social workers in the unenviable position of divining truth based on aswb’s assurances about the “rigorous exam development protocols that aswb meets and exceeds” (aswb, 2022c, para. 4). although leading social work organizations disagree, psychometric testing standards and measurement equivalence literature is not a commonly understood part of social work practice, making it difficult to assess and intervene appropriately. industry standards for licensing exams aswb maintains its exams “meet or exceed” psychometric standards and “reflect the highest standards of validity and reliability” (aswb, 2022b, p. 66). for this reason, aswb cites the joint standards (aera et al., 2014), which are open access and available for any social worker to examine. the standards were published in 2014, and their purpose …is to provide criteria for the development and evaluation of tests and testing practices and to provide guidelines for assessing the validity of interpretations of test scores for the intended test uses... the standards provide a frame of reference to ensure that relevant issues are addressed. all professional test developers, sponsors, publishers, and users should make reasonable efforts to satisfy and follow the standards and should encourage others to do so. all applicable standards should be met by all tests and in all test uses unless a sound professional reason is available to show. (p. 1) when aswb examinations conflict with the joint standards, they must provide a sound professional reason. although there is no enforcement body for the joint standards, it has been repeatedly recognized by regulatory authorities and courts as setting forth the generally accepted professional standards that developers and users of tests and other selection procedures follow. compliance or noncompliance with the standards may be used as relevant evidence of legal liability in judicial and regulatory proceedings. (aera et al., 2014, p. 2) decarlo & nienow/uniquely biased 499 for example, a recent federal court decision found new york city teacher examinations to be unlawful, in part, due to a lack of compliance with the joint standards, resulting in $1.2 billion in payouts (new york city comptroller, 2023). why some groups perform worse on aswb exams the central claim of exam critics is that aswb exam scores are impacted by factors unrelated to social work competence. this is called construct-irrelevant variance, or “the degree to which test scores are affected by processes that are extraneous to the test’s intended purpose” (aera et al., 2014, p. 12), which “may give an unfair advantage or disadvantage to one or more subgroups” (p. 24). aswb (2023a) admits that its examination scores are impacted by things other than social work competency in its examination guidebook: “there may be differences in exam performance outcomes for members of different demographic groups because exam performance is influenced by many factors external to the exams” (p. 9). thus, aswb agrees construct-irrelevant invariance is present and may contribute to systematic bias in passing scores, but it disagrees that internal exam factors can cause these biases, and instead focuses its empirical study entirely on factors external to the examination (aswb, 2023d; kim & joo, 2024). social privilege and guessing correctly construct-irrelevant variance is a threat to validity because, as albright and thyer’s (2010) study of the aswb exam noted, if an answer is “readily guessable, then the validity of the practice examination–and by implication, that of the actual examinations–as a legitimate measure of the professional knowledge needed to practice social work competently and safely is called into question” (p. 231). their 2010 experiment demonstrated msw students could guess 52% of answers correctly without “even knowing what the question was” because the correct answer options on the clinical exam were “exceedingly transparent” (p. 231). in a replication using generative artificial intelligence, victor and colleagues (2023b) found that chatgpt could correctly guess the answer to an aswb practice exam question 73% of the time without looking at the question, likely enough to pass the clinical licensing exam. these findings suggest chatgpt and albright and thyer’s (2010) msw students were able to pick up on “cues and patterns within the answer choices themselves” and intuit the correct answer (victor et al., 2023b, p. 217). this intuition is not shared equally among all demographic groups, encoding bias through invalid and unreliable test items. parochial practice theories aswb questions are uniquely worded and rely on practice theories not all social workers use. some questions have multiple correct answers. they ask the respondent to follow aswb’s theoretical model on what a social worker should do “first” or “next,” as well as the “best” or “most likely” answer (aswb, 2023a, pp. 24-26). as victor and colleagues (2023a) note, this leads to ambiguities. in a practice exam question about reducing the concern of a domestic violence survivor that the social worker will judge her advances in social work, summer 2025, 25(2) 500 for returning to an abusive partner, aswb scored the correct response as “encourage the client to further discuss their decision” while chatgpt selected the incorrect response “allow the client to continue guiding the conversation,” explaining in its reasoning that it was important for the social worker to “demonstrate acceptance of the client’s choice,” remove “further barriers to the client’s engagement,” and “build trust and rapport” (victor et al., 2023a, pp. 514-515). aswb cites self-determination as the rationale for their correct answer choice, though it appears to be consistent with chatgpt’s, as well. ignore practice wisdom other aswb exam questions reify practices social workers might find objectionable. in a practice question in their examination guidebook, aswb claims telling “an adolescent client who expresses remorse about engaging in sexual activity while drunk…may indicate alcohol use disorder” is education, not confrontation (aswb, 2023a, p. 34). the clinician’s actions may require confrontation and providing education on alcohol use when a sexual assault may have occurred could be considered inappropriate, if not unethical. aswb has included this example question in its exam documentation for years, demonstrating how it aligns with their thinking over time. the test-taker must ignore their practice wisdom and substitute aswb’s practice theories to glean the “correct” test answer. for this reason, tip #1 in test preparation handbooks advise that “when selecting an answer, you should base it upon the content that you studied from this guide and what you learned in the classroom,” not “how we might act in practice based upon practice wisdom and clinical judgements” (apgar, 2022, p. 12). the gaps between examination and practice will continue to widen as aswb examinations test clinical social workers on an outdated version of the diagnostic and statistical manual of mental disorders (dsm) until 2026 (aswb, 2023e). although the test preparation advice to “review clinical vignettes to understand the thought process of the test (train yourself to think like the test does)” appears culturally neutral (shersher, n.d., para. 7), a test-taker’s cultural or linguistic background may make it difficult to intuit the correct answer according to aswb’s parochial theories of practice. a large language model like chatgpt, on the other hand, can use linguistic cues to guess the correct answer without looking at the question (victor et al., 2023a). a test taker’s ability to comprehend and apply the content outline for aswb exams can be the determinative, rather than the latent trait the examinations are meant to measure–first-day competence. test takers who find that content outline and its implementation counterintuitive, foreign, and irrelevant to practice may agree with woodcock (2014b) that, aswb translated real-life tasks from the survey [of practitioners] into the chaos of the content outline and…aswb then translates parts of the content outline back into real-life situations constituting exam questions…the content outline complicates the process without adding coherence or rigor. (para. 100) woodcock (2015) further noted that “exam-takers sharing the worldviews of aswb question-writers might enjoy particular advantages, for purposes of guessing which answers those writers might prefer” (p. 229). decarlo & nienow/uniquely biased 501 cultural incompetence more troubling than ignoring one’s practice wisdom is the embodied epistemic erasure that emerges by privileging specific theories, models, and buzzwords within licensing exams. when exam questions ask test takers to inform authorities–including supervisors, the criminal legal system, and the family policing system–a person with lived experience in these systems may have an embodied reaction to the aswb’s correct answer because they know it might endanger a client’s life or violate their practice wisdom and community lens. thus, the burden of ignoring one's personal and professional context is not spread equally across all test takers. although invalidity and unreliability impacts all test takers, “construct-irrelevant variance may result from” test questions that do not match the experiences of “examinees from diverse racial/ethnic, linguistic, or cultural backgrounds;” for example, a test taker “may be poorly assessed by a vocational interest inventory whose questions disproportionately ask about competencies, activities, and interests that are stereotypically associated with particular subgroups” (aera et al., 2014, p. 55). in classifying the examinations as “jim crow licensing,” dr. teasley stated “people shouldn’t have to second-guess the knowledge of their community…what about critical race theory, what about african-american perspectives, what about afrocentric theory?” (decarlo, 2022a, 20:35). some practice theories are central to the exam, while others are marginalized. testtakers surveyed by torres et al. (2024) linked social privilege with being “highly trained in how to tell the dominant culture exactly what it wants to hear,” (p. 190) and that the most effective test preparation advice was to “think like a middle-aged white woman” (p. 191). similarly, castex et al. (2019) found racial microaggressions in their study of aswb exam practice questions. in assessing exam validity and fairness, according to the joint standards (aera, 2014), it is important to ascertain the consistency of a concept’s meaning across demographic and cultural groups because: evaluation of the underlying construct and properties of the test within one country or culture may not generalize across borders or cultures. this can lead to invalid test score interpretations. careful attention to bias in score interpretations should be practiced in such contexts. (p. 52) because of the lack of adequate psychometric documentation about aswb exams, their empirical validity, reliability, and fairness are generally a matter of faith rather than evidence-informed workforce policy. according to woodcock (2014a), aswb examinations are a matter of convenience, as “aswb had discovered that everyone was willing to treat its several different exams as though they did have distinct and important purposes, despite the reality of an inordinately unfocused profession, its practitioners scattered among myriad careers” (para. 31). furthermore, “given the organization’s refusal to share its testing data, stakeholders (including test-takers, licensing agencies, clients, and the public) have been forced to accept aswb’s assurances,” an asymmetry that persists a decade later (woodcock, 2014b, para. 165). advances in social work, summer 2025, 25(2) 502 2018 blueprint exams: lower pass rates aswb’s (2022b) exam pass rate analysis noted that pass scores declined after the 2018 blueprint was introduced, regardless of race. the bachelor’s examination first-time pass rate for all social workers went from 77.5% in 2011 to 68.7% in 2021. a comparable reduction was noted in first-time pass rates for the master’s exam from 82.5% to 73.0% across the 11 years reported. despite marketing all examinations as comparable across years, aswb (2022b) directly attributes the 10-13% drop in exam pass rates “between 2017 and 2018…most likely occurred because of the introduction of a new exam blueprint” (p. 8). the 2018 blueprint differs from the previous exam iteration in many ways. one potential reason is that the 2015-2016 job task analysis survey, upon which modern exams were built, may not represent all social workers. more than 22% of new social workers are black and 14% are hispanic or latino (salsberg et al., 2020); however, the aswb’s practice analysis sample included only 13% black and 7% hispanic or latino respondents, halving their representation (aswb, 2017b). deficiencies in the racial and ethnic representativeness in the sample of the job analysis for teacher examinations in new york city was a crucial factor demonstrating the test was invalid and discriminatory in federal court (croft, 2017). to date, aswb has not provided any research or public statements to explain the global reduction in social worker competence after release of the 2018 blueprint. aswb’s examination guidebook (2023a), request for research proposals (2023c), and exam pass rate analysis (2022b) all maintain that systematic biases in exam scores are the result of “external factors,” but these “pipeline” factors like education, “early childhood experiences," and others would not have magically appeared in 2018 to create systematic measurement error in pass scores. the most logical explanation is that construct-irrelevant variance (i.e., invalidity, unreliability) was substantially worse in the 2018 blueprint, whose introduction aswb (2022b) attributes to causing a global reduction in test scores. in its exam pass rate analysis, aswb (2022b) does not report data prior to 2017 because “the introduction of a new exam blueprint can result in slight changes to exam content. focusing on test-takers between 2018 and 2021 allows for more direct comparisons across similar testing experiences” (p. 3). this explanation is confounding, as scores on 2017 and 2018 examinations are required to be directly comparable according to aswb’s examination guidebook, which states that “no test-taker receives an advantage or disadvantage because of the version of exam received” (aswb, 2023a, p. 26). while the omission of 2011-2017 data is unfortunate, we can compare demographic pass rates with the mean. with a 12.5% reduction in global exam scores, white multiracial test-takers reported higher than average pass rates on both the bachelor’s exam (figure 1) and master’s exam (figure 2). a similar pattern is evident for language, as test-takers whose primary language is english maintained above-average test scores. consequently, only minoritized social workers were impacted by the construct-irrelevant variance introduced by the 2018 blueprint. decarlo & nienow/uniquely biased 503 similar patterns were not observed in the clinical test scores, likely due to survivorship bias. social workers who cannot pass the required examinations for their lbsw and lmsw can never take the clinical examination. figure 1. impact of 2018 blueprint on bachelor’s exam pass rates by demographic figure 2. impact of 2018 blueprint on master’s exam pass rates by demographic decarlo & nienow/uniquely biased 504 table 2. first-time and repeat test-takers test-takers 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 lcsw 1st 9,100 9,604 10,879 12,217 13,044 14,007 16,095 16,022 17,207 16,801 20,657 lmsw 1st 11,260 12,732 13,110 14,184 15,214 15,496 16,884 16,812 18,231 16,716 21,650 lbsw 1st 3,164 3,251 3,595 3,873 4,083 4,113 4,462 3,711 3,583 2,709 3,494 repeat no data no data no data no data 11,457* 11,127* 12,617* 13,478* 19,526* 15,521* 20,720 to calculate repeat test-takers, researchers subtracted first-time test-takers reported in aswb’s 2022 exam pass rate analysis from the total testtakers in aswb’s annual report from the corresponding year. *because 2021 was the only year that aswb reported the number of first-time test-takers for the advanced generalist and associate social work exams, it is the only year for which repeat test-taker figures are based on the exact reporting from aswb. for other years listed, the number of test-takers for associates and advanced generalist from 2021 was imputed in place of the missing data. table 3. aswb revenue, assets, and profit aswb 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 revenue publishing ----$1,686,190 $1,489,956 $1,562,915 $1,704,718 $1,751,079 $1,684,234 $2,123,620 exam ----$11,345,503 $11,689,451 $12,996,484 $13,277,694 $14,410,319 $13,735,930 $17,659,247 total $9,461,425 $10,279,908 $11,492,614 $12,692,553 $13,964,190 $13,767,709 $15,565,636 $16,344,808 $17,595,886 $16,234,758 $24,599,963 net assets $8,995,137 $10,612,898 $13,079,412 $15,680,159 $17,750,104 $19,693,116 $23,289,150 $24,046,614 $28,831,413 $33,841,553 $40,273,169 profit margin 10.61% 14.57% 20.64% 22.26% 19.47% 8.45% 14.85% 16.52% 15.56% 18.46% 29.08% note: financial information is reported from aswb’s tax returns, as published in the propublica nonprofit explorer. advances in social work, summer 2025, 25(2) 505 educated but excluded population grows based on aswb financial interests testing license-seeking social workers is a booming business. in 2015, there were 44,278 examinations delivered (aswb, 2015). by 2021, that number was 67,001—an increase of 51%. of those examinees, 30% were repeat test takers. by subtracting the total number of test takers in aswb’s 2015 annual report from the first-time test takers in the exam pass rate analysis (aswb, 2022b), table 2 provides the first national estimates of the “educated but excluded” subgroup of repeat test takers. the number of repeat test takers has nearly doubled since 2015, from 11,457 to 20,720 (+86%)–twice the rate of overall growth in test-takers (+43%)–indicating a growing pool of educated yet excluded social workers. in 2019 and 2021, the number of repeat test takers eclipsed the number of firsttime lcsw test takers, as shown in table 2. aswb’s financial self-interest joseph (2024) highlights that aswb operates according to “a business-oriented approach incompatible with the…integrity of its licensing exams” (p. 400). aswb is a peculiar kind of business, a national testing monopoly whose product is purchased by its own members. although funded by licensees and license-seekers, they have no oversight of the aswb examination program. aswb negotiates with itself and adopts closed, monopolistic data practices (woodcock, 2015). as a result, aswb is best understood as a self-interested market actor. aswb’s 2021 exam revenue was $17.6 million, from which they extracted a 29% profit margin, and paid over $1 million in executive compensation, according to their 2021 tax report (propublica, n.d.). in addition to compensation, aswb holds a $30 million portfolio of stocks and bonds managed by morgan stanley (aswb, 2018). table 3 reveals aswb has been extracting profits from social workers for a long time. since albright and thyer wrote in 2010 “the multimillion dollar testing industry is big business [requiring] greater transparency and accountability with respect to [the exam’s] legitimacy,” aswb assets have increased by 450% (p. 229). this windfall is sustained by an industry-shattering 17% average profit margin across the examined period (propublica, n.d.). aswb’s profitability, as a nonprofit, is assured well into the future (propublica, n.d.). indeed, $10 million is dedicated to an examination defense fund (aswb, 2019), sustained by three revenue sources: examination administration, by far the most lucrative, publication of examination resources, and their portfolio of stocks and bonds. in illinois, aswb’s financial resources allowed them to direct lobbying support for state-level coalitions, again introducing a conflict of interest which put supposedly independent organizations into a position of dependency and therefore more readily aligned with the specific policy agendas being supported by aswb (social work activist collective, 2023). advances in social work, summer 2025, 25(2) 506 aswb ignores inconvenient data aswb funds robust social science but does not act on the clear inequities in the data. kim (2022) used the current population survey data to analyze what factors predicted licensure across racial groups. her analysis revealed the black-white licensure disparity for lbsws was explained by “none of those external factors: [emphasis in original] variations in state regulations, the field of practice [i.e. specialty], the type of employers, and social workers’ demographic vulnerability” (kim, 2022, p. 382). according to kim’s analysis, black social workers were 43% less likely than white social workers to hold a license, and 56% less likely to hold a license required by their employer or state regulations. although kim did not find similar results at the master’s level or for latine practitioners, the study of new york licensees, cited previously, did find significant disparities among these groups (senreich & dale, 2021). unexplored in kim’s analysis is the abysmal performance of the lbsw examination, and the inequitable barriers it imposes on minority groups. although 75-81% of white test takers pass it on their first time, less than 40% of black test takers under 30 pass the lbsw examination on their first attempt, and only 22% of black test takers over 50 pass the lbsw examination on their first attempt (aswb, 2022b). kim and joo’s (2024) report used aswb’s proprietary data, funding, and publishing. it found that black social workers are 6x less likely to pass the clinical exam than white social workers; moreover, asian and latine social workers were 2x and 3x less likely to pass the clinical exam. no policy or research actions were taken as a result of these findings. the examination guidebook continues to advise test takers that external factors cause biased scores (aswb, 2023a), despite aswb funding multiple research studies finding external factors were a small part of why minoritized social workers’ competence is not assessed accurately by examinations. states remove exams without public protection issues aswb maintains that its examinations measure competence associated with safe and effective practice. much like its external factors research, aswb has not integrated empirical outcomes from state policy experiments like minnesota, in which englishlanguage learners and immigrants who failed the examination were provided an exception and monitored over time. dr. karen goodenough, nasw-minnesota executive director, describes in an interview why an exception to the aswb examination was required after: several years ago, we had a significant influx of hmong refugees, and not enough hmong-speaking practitioners to meet their needs, as the exams were proving to be a barrier to obtaining licensure. this prompted us to explore alternate pathways to licensure for hmong practitioners. our state developed a provisional licensure option for all trained social workers who speak english as a second language and are foreign born who have failed an aswb exam once. rather than having to take the exam multiple times, they are able to apply for provisional licensure and receive supervised practice hours, which, once complete, allow them to hold a regular license. there is no indication these practitioners are any less skilled or decarlo & nienow/uniquely biased 507 ethical than those who have passed the exams in our state. (skeen & goodenough, 2023, para. 14) after a successful pilot, the alternative pathway was opened to all social workers, regardless of language or country of origin, without the requirement of failing the examination first. minnesota, therefore, became the first state to no longer require taking the aswb examination for clinical licensure. alternative pathways are also available in illinois, although one must fail the examination prior to starting the additional period of supervision used in lieu of testing. nasw-illinois grounded their policymaking in prior focus groups with “marginalized communities throughout the state” who identified “the aswb exam [as] the single greatest barrier to existing social work graduates” entering the profession of social work (nasw-illinois, 2023, para. 10). currently, 10 states do not require bachelor’s examinations for their licenses, 5 states do not require master’s examinations for licenses, and 2 states allow alternative pathways to clinical licensure via additional supervision. many states have never used bachelor’s or master’s exams, and no studies demonstrate practitioners are less ethical or more likely to endanger public protection. when the illinois department of financial & professional regulation consulted with nasw-illinois about exam removal, they benchmarked states like california, which had never required the master’s exam, and determined that the public safety risk for generalist practitioners was low (singer, 2023). whether states stop using examinations or never adopted them for licensure, aswb exams have no documented empirical impact on public protection. changes to reliability tests and reasoning state boards contracting with aswb for competency examinations receive very little public documentation on the psychometric properties of the exam. at present, aswb’s contract with the california board of behavioral sciences (bbs) stipulates only that “aswb will provide… the number of exams administered; the total number of items on the examination; the range of scores (lowest to highest); the mean and standard deviation taken from the annual technical report; and the kuder-richardson formula 20 (k-r-20) reliability coefficient” (california bbs, 2021, p. 6). the use of classical test theory is surprising because, prior to 2018, aswb’s psychometricians used far more sophisticated approaches to measuring reliability of examinations than current exams. aswb’s psychometricians, marson and colleagues (2010), stated aswb “preferred [their] advanced irt model (decision consistency in pass/fail decisions)” to “the less relevant classical standards (k-r-20)” (p. 89). aswb’s exam reliability tests now assume reliability of its examination does not vary based on the test-taker’s ability level; whereas, previous irt-based approaches measured conditional reliability. aswb changed their reliability procedure for the 2018 blueprint introduction, accompanying a 10% decrease in master’s and bachelor’s exam scores across all groups (aswb, 2022b), although white test-taker scores remained above average. advances in social work, summer 2025, 25(2) 508 inadequate documentation it is difficult to find information about the psychometric properties of aswb examinations. the same summary is reprinted in many locations with different wording, for example, the examinations “continue to meet the highest standards of validity and reliability” (aswb, 2022a, p. 66). however, no procedure or empirical results are reported. if boards want more information than the range, mean, standard deviation, and internal consistency reliability, they are unable to request it. according to aswb’s contract, board members with concerns are only entitled to “an overview of the examination development and administrative processes to familiarize the board with the defensibility and validity issues of the examination program” (california bbs, 2021, p. 12). by the plain language of the joint standards, this constitutes inadequate documentation: the reporting of indices of reliability/precision alone— with little detail regarding the methods used to estimate the indices reported, the nature of the group from which the data were derived, and the conditions under which the data were obtained— constitutes inadequate documentation. general statements to the effect that a test is “reliable” or that it is “sufficiently reliable to permit interpretations of individual scores” are rarely, if ever, acceptable…test constructors and publishers are obligated to provide sufficient data to make informed judgments possible. (aera et al., 2014, p. 41) in 2023, aswb held a webinar on psychometrics, but it provided very little information on aswb examinations. figure 3 is a screenshot of the only slide that addressed the statistical properties of aswb exams, providing a top-line summary of cronbach’s alpha and the percentage of items flagged for differential functioning (aswb, 2023b, 45:37). figure 3. most recent and comprehensive psychometric data on aswb exams decarlo & nienow/uniquely biased 509 reading the joint standards, this is in plain violation of documentation standard 2.19, which requires aswb to report “each method of quantifying the reliability/precision of scores… expressed in terms of statistics appropriate to the method…the sampling procedures used to select test takers for reliability/precision analyses and the descriptive statistics on these samples” (aera et al., 2014, p. 47). the comment elucidates: because there are many ways of estimating reliability/precision, and each is influenced by different sources of measurement error, it is unacceptable to say simply, “the reliability/precision of scores on test x is .90.” a better statement would be, “the reliability coefficient of .90 reported for scores on test x was obtained by correlating scores from forms a and b, administered on successive days. the data were based on a sample of 400 10th-grade students from five middle-class suburban schools in new york state. the demographic breakdown of this group was as follows: . . .” (aera et al., 2014, p. 47) aswb does not follow the joint standards template for sharing psychometric data. for example, in addition to reliability, aswb does not publish the sample size they use to assess the validity and fairness of their examination, which can impact both item and testlevel analysis (aera et al., 2014). in the 2022 report, the only intersectional analysis performed was age-by-race, which itself was limited to only four of the ten years analyzed (aswb, 2022a). aswb’s procedure for dif is not described in detail, and they do not share data on the slopes and intercepts of the regressions used to calculate dif. thus, in addition to suppressing negative information about examinations, the psychometric properties and methodology remain a scientific lacuna. implications for social work: seize the means of regulating our profession social workers lacking competency in psychometrics and item response theory may instinctively trust aswb’s assurances of exam quality and fairness. however, a thorough analysis of aswb’s public statements and empirical studies of the examination reveals an examination whose biases are empirically evident and unaddressed. the united states department of education, office of civil rights (2000) clearly spells out how social work boards must assure exam equity: when tests are used as part of decision-making that has high-stakes consequences for students, evidence of mean score differences between relevant subgroups should be examined, where feasible. when mean differences are found between subgroups, investigations should be undertaken to determine that such differences are not attributable to construct underrepresentation or construct irrelevant error. (p. 32) aswb’s mantle of positivism seems to gloss over the invalidity, unreliability, and monoculturality of their examination program. when they finally publish data showing deep cultural, linguistic, racial, and age bias (e.g., aswb, 2022a; kim & joo, 2024), they adopt the posture “that significant racial and ethnic disparities exist across many professions, including medicine, nursing, and psychology, suggesting that outcomes reflect broader advances in social work, summer 2025, 25(2) 510 societal challenges” (aswb, 2024, para. 9) while ignoring mandated and best psychometric practices assessing and minimizing measurement bias. historically, the social work profession supported the aswb examination program because it was implemented to protect public safety and was expected to align with psychometric best practices. unfortunately, stakeholders in the profession never checked whether exams were based on sound science and promoted equitable outcomes for all groups. now, no regulatory power can require aswb to adequately document its psychometric procedures or update them to mitigate bias. for nearly 40 years, the social work profession has treated aswb as trustworthy scientific communicators and practitioners about exam psychometrics. however, a reading of relevant joint standards cited by aswb reveals glaringly obvious gaps in compliance. these unexamined test properties need to be investigated for their role in the vast disparities in test scores. the unfairness, invalidity, and unreliability of exams deters members of historically and presently excluded groups from entering the profession. it erodes the ability of the workforce as a macrosystem to perform evidence-based and culturally responsive practice. it is no longer tenable–and indeed it was never tenable – for social workers to rely on aswb to self-report the fairness of its examinations. in addition to immediately publishing an updated and complete set of psychometric specifications consistent with the joint standards, aswb should provide unconflicted psychometricians access to study exam data. the results of these studies must be published openly and honestly, so that any test user (i.e., board, employer) and test taker can view them–as the joint standards require. open practices can start to undo the harm caused by one of social work’s darkest open secrets. the question remains whether the profession will continue to support an exam it knows is biased and lacking compelling evidence that it can accurately assess competency and protect the public. the profession of social work is at a crossroads and requires new and innovative thinking in order to move forward. the work of some states to remove exam requirements or provide alternative pathways to licensure, without subsequent rises in ethical complaints, is one area that will require future attention and research. watching other professions navigate similar issues in their licensure processes may also be instructive to future efforts. the profession should also consider the legal and financial risks for social work employers who use examinations to make employment decisions, given that large financial awards for teacher examinations were not imposed on the test-maker but rather the test-user, the new york city department of education (croft, 2017). while this article has focused primarily on the institutional level, it is critical to acknowledge the individual and community costs of the exam. the direct impact, financially, professionally, and emotionally on individuals not able to pass the exam has not been a focus of social work regulatory research. qualitative studies such as torres and colleagues (2024) and nasw-illinois (2023) echo the stories of social workers testifying in favor of licensure reform bills, such as those in maryland, many of whom reported spending thousands of dollars on preparation materials, courses, and re-examinations (e.g., testimony in favor of sb0871 and sb0872, 2023). epistemic justice calls social work researchers to establish more generalizable truths about occupational closure. decarlo & nienow/uniquely biased 511 using secondary data, aswb-funded research (kim et al., 2021) estimated a 10.6% earnings premium for licensed practitioners, and kim subsequently noted: being excluded from these license-related earnings premiums may mean a substantial loss in expected lifetime earnings for non-licensed social workers (kim et al., 2021). this indicates that a racial disparity in licensing rates should be interpreted as an economic equity issue; those with more privileged backgrounds are more likely to benefit from earnings premiums associated with license-holding, whereas the less privileged are not. (kim, 2023, p. 115) thus, there is clear evidence that deleterious impacts accrue to aspiring social workers excluded from the profession by licensing examinations, but empirical trends have not been investigated in detail. aswb contends that occupational closure is the price of objective measurement in an unfair world, and it is correct that licensure exams and other standardized tests are generally known to be systematically biased (nasw, 2020). however, aswb’s test validation methodology violates psychometric best practices, rendering its examinations uniquely biased. references albright, d. l., & thyer, b. a. (2010). a test of the validity of the lcsw examination: quis custodiet ipsos custodes? social work research, 34(4), 229–234. american educational research association, american psychological association & national council on measurement in education. (2014). standards for educational and psychological testing. american educational research association. apgar, d. 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(2015). abuses and mysteries at the association of social work boards. research on social work practice, 26(2), 225-231. author note: address correspondence to matthew p. decarlo, school of education and human development, saint joseph’s university, philadelphia, pa 19131. email: mdecarlo@sju.edu orcid: matthew p. decarlo https://orcid.org/0000-0002-6326-1780 mary nienow https://orcid.org/0000-0001-9269-0122 https://socialworklicensure.org/articles/social-work-licensure-exam/ https://alswe.simmons.edu/article/the-conversation-the-aswb-licensing-exam-pass-rates-and-bias/ https://alswe.simmons.edu/article/the-conversation-the-aswb-licensing-exam-pass-rates-and-bias/ https://www.socialworkpodcast.com/2023/02/naswil.html https://www.socialworkpodcast.com/2023/02/naswil.html https://mgaleg.maryland.gov/cmte_testimony/2023/fin/15084_03102023_125030-166.pdf https://mgaleg.maryland.gov/cmte_testimony/2023/fin/15084_03102023_125030-166.pdf https://doi.org/10.1093/sw/swae001 https://doi.org/10.1093/sw/swae001 https://doi.org/10.1093/sw/swae001 https://doi.org/10.1093/sw/swae001 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231188305 https://doi.org/10.1177/10497315231188305 https://doi.org/10.1177/10497315231188305 https://files.eric.ed.gov/fulltext/ed456173.pdf https://files.eric.ed.gov/fulltext/ed456173.pdf https://files.eric.ed.gov/fulltext/ed456173.pdf https://sweduc.wordpress.com/2014/07/12/aswb-abuses/ http://sweduc.wordpress.com/2014/07/16/aswb-questions/ https://doi.org/10.1177/1049731515574346 https://doi.org/10.1177/1049731515574346 mailto:mdecarlo@sju.edu https://orcid.org/0000-0002-6326-1780 https://orcid.org/0000-0001-9269-0122 uniquely biased: how aswb exams violate psychometric best practices abstract: after publication of the 2022 pass rate analysis demonstrating that minoritized social workers pass at less than half the rate of white social workers, the association of social work board (aswb) examination guidebook (aswb, 2023a), revised ... exam pass rate disparities aswb: external factors cause exam disparities national organizations: aswb tests violate industry standards industry standards for licensing exams why some groups perform worse on aswb exams social privilege and guessing correctly parochial practice theories ignore practice wisdom cultural incompetence 2018 blueprint exams: lower pass rates educated but excluded population grows based on aswb financial interests aswb’s financial self-interest states remove exams without public protection issues changes to reliability tests and reasoning inadequate documentation implications for social work: seize the means of regulating our profession _________ jelena todić, phd, msw, assistant professor, department of social work, university of texas at san antonio, san antonio, tx. sherri simmons-horton, phd, msw, assistant professor, department of social work, university of new hampshire, durham, nh. elizabeth cruz, msw, community practitioner and adjunct faculty, amy manning thompson, msw, director of field education, candace christensen, associate professor, and lucinda nevarez, associate professor, department of social work, university of texas at san antonio, san antonio, tx. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 553-573, doi: 10.18060/25001 this work is licensed under a creative commons attribution 4.0 international license. awakening the antiracism collective through transformative organizational praxis: a participatory evaluative case study jelena todić sherri simmons-horton elizabeth cruz amy manning-thompson m. candace christensen lucinda nevarez abstract: dismantling structures that impede social work professional and organizational growth begins with social work educational institutions. in 2020, the convergence of three pandemics – covid-19, economic injustice, and, notably, structural racism, catalyzed a group of social work staff and faculty at a public hispanic serving institution (hsi) in the southern u.s.. the group relied on community organizing and organizational change strategies to form the antiracism collective (arc). we employed a participatory evaluative case study (merriam, 1998) methodology to answer two questions: 1) how has arc accelerated one social work department's integration of antiracist praxis (theory, reflection, action) into all aspects of the department to support the department's mission?; and 2) how can arc dismantle structures which impede social workers' ability to confront racism? we find that arc 1) catalyzed department transformation as evidenced by the increased sense of critical consciousness, struggle, integrity, and community; and 2) achieved primarily individual impact, with small but potentially significant department impact, and small but potentially significant structural impact. we highlight strengths and limitations of antiracism collectives as a pathway to confront racism in other social work educational institutions. keywords: antiracism, collective, organizational change, social work grand challenges the newly added social work grand challenge to eliminate racism (teasley et al., 2021) underscores the urgency of dismantling racism and white supremacy in the us and social work. the grand challenge authors call for evidence and practice-based research that can uproot racism at the individual, organizational, community, professional, and societal levels. among recommendations for how to move forward with addressing what dr. larry davis (2016) referred to as “america’s original grand challenge,”, the authors recommend "professional revision of social work education," policy agendas to "eliminate racism and white supremacy from organizations and institutions," and "continuous evaluation with accountability" (p. 401). to demand that practicing social workers take on this critical challenge, social work educational institutions (swei) must also begin to uproot racism embedded in our organizational structures. despite claims of valuing social justice, social work has played a significant role in maintaining white supremacy (beck, 2019; davis, 2021; jacobs et al., 2021; teasley et al., 2021). still, sweis can and must be sites of transformation. this case study describes the first year of forming and operating an antiracism collective (arc) in one social work department in a public hispanic serving institution in about:blank advances in social work, summer 2022, 22(2) 554 the southern u.s. in 2020, the country witnessed a renewed uprising against systemic racism following the murders of ahmaud arbery, breonna taylor, and george floyd. the convergence of three interconnected pandemics – covid-19, economic injustice, and, notably, structural racism – catalyzed a group of social work faculty and staff to form a collective. in this manuscript, we chronicle our activities, share first-year evaluation findings, and offer lessons we learned as founding members and co-facilitators of the collective. first, we describe the case study context, theories guiding the collective, and the collective's activities. next, we present the case study methodology and findings. we conclude with the lessons learned and implications for our department and sweis in general. we also highlight strengths and limitations of arcs as a pathway to confront racism in other sweis. several vital assumptions frame this case study. we firmly believe that we cannot prepare students for antiracist social work praxis (theory-reflection-action cycle) consistent with social work ethics unless we, as faculty and staff, engage in antiracist praxis. social work departments and schools provide an obvious setting for this work. by racism, we refer to a system that produces and reproduces racist discrimination by historical and contemporary "laws, rules, and practices, sanctioned and even implemented by various levels of government, and embedded in the economic system as well as in cultural and societal norms" (bailey et al., 2021, p. 768). broad cultural endorsement of competitive individualism normalizes power hoarding and power-over hierarchies as the only way to organize a safe and productive society (walker, 2010). this cultural apparatus also enables white supremacy in all institutions, including academia (bailey et al., 2021; bonilla-silva, 2018; davis, 2003; davis, 2021). by antiracist, we refer to a person supporting an antiracist policy through taking actions or expressing an antiracist idea (kendi, 2019). finally, by antiracist social work praxis, we refer to actions grounded in theory and knowledge aiming to eradicate racist social relations, racialized dynamics, and racial disparities from society and the social work profession (aldana & vazquez, 2020). case study context in may 2020, with the murder of george floyd, ahmaud arbery, breonna taylor, and many other black people, two department-wide email exchanges ignited a group of faculty and staff to start an antiracism collective. in the first email, a white assistant professor asked colleagues to prioritize discussions about racism in the summer classes and offered resources for supporting black students through that process. in the second email, an african american assistant professor shared personal fears as a mother of black sons and outlined concrete actions for the department's antiracist activities. shortly after, the two faculty initiated a workgroup, with 11 racially and ethnically diverse faculty and staff attending the first meeting. through the initial exploration of values that brought people to the first meeting, the group agreed that an antiracist praxis was the only approach that could rise to meet the needs and obligations created by structural racism. arc's members decided that the aim was to "assess and accelerate the integration of antiracist praxis into all aspects of the social work department and department's work to support our mission. we prioritize growth and accountability as we advance our antiracist praxis" (arc, 2020, p. 1). given our assumption that hierarchy and power-over dynamics are central to academia todić et al./awakening antiracism 555 and white supremacy, the group decided to function as a collective, using a power-with model. by “power with,” we refer to an intentional choice to center interdependence, mutuality, and solidarity as we take collective actions to achieve our stated aim (walker, 2010). moreover, in a collective, leadership is shared or rotated, people are assumed to be capable and can be trusted to do the right thing, and that success comes from the skills of many (o'neill & brinkerhoff, 2018). the immediate community surrounding arc and our department provides daily reminders of structural racism. the west side neighborhoods, which are adjacent to the campus and more than 90% latino, experiences high rates of poverty, lower levels of educational attainment, fewer opportunities for economic growth and mobility, and higher incidences of crime (community information now, 2017). even though at its inception the university’s stated goal was to establish a physical presence near the westside to foster a relationship with the community and promote higher educational engagement levels (olivo, 2018), the goal did not come to fruition. rather than creating community growth, our institution has fostered feelings of displacement and uncertainty among the community (wang, 2019). only recently, the university established the westside community center and created the westside community partnership focused on developing collaborative projects (the university of texas at san antonio, 2022), aiming to live up to our institutional mission of community support and accessibility. similar to other higher education institutions in the area, incidences of discrimination, hate, and harassment have also occurred at our university. these incidents include white nationalist signs in prominent areas of the campus, hate groups infiltrating black student group meetings with hate speech, and targeting immigrant students with materials threatening deportation or removal (zielinski, 2017). in addition, a highly publicized incident involving a white faculty member using police to remove an african american student from a classroom setting for a perceived minimal infraction (mendoza, 2018; kong, 2018) touched off critical conversations about policing, race, and the academic environment throughout the institution. the university has responded to these racialized acts through investigations, community conversations, and creating a new department focusing on race, ethnicity, gender, sexuality, and invitations to leaders such as dr. angela davis to campus. in this context, arc was motivated by the idea that in a racist society, we must take an antiracist stance, which must begin with self-evaluation to understand our complicity in systemic racism and translate into persistent ongoing actions. this selfevaluation and action cycle also must occur at the university level, college level, department level, and beyond. theory arc relied on two frameworks to inform our work: emergent strategy (brown, 2017), and kotter's (2014) 8-step organizational change. emergent strategy, grounded in the work of octavia butler, grace lee boggs, margaret j. wheatley and others models adoptive and relational leadership (brown, 2017). it includes practices and philosophy for humans to be in "right relationship" with each other and the planet, “practice complexity,” build movements, and “grow” a just future (brown, 2017, p. 17). some of the main principles https://nonprofitquarterly.org/author/cassandra-oneill/ https://nonprofitquarterly.org/author/monica-brinkerhoff/ advances in social work, summer 2022, 22(2) 556 that support “right relationships” are: 1) new patterns at a small-scale change patterns at a large scale; 2) change is constant; 3) movement happens at the speed of trust and 4) critical connections are more important than critical mass (brown, p. 27). consequently, as arc members evolve towards antiracist praxis, so does our department of social work, and potentially our academic institution. additionally, kotter’s (2014) 8-step process for leading change provided a roadmap through the complexity of organizational change. kotter's model is a widely used organizational change model, which includes eight steps: 1) create a sense of urgency; 2) build a guiding coalition; 3) form a strategic vision and initiatives; 4) enlist a volunteer army; 5) enable action by removing barriers; 6) generate short-term wins; 7) sustain acceleration; and 8) institute change. we used the acceleration version of the model, which assumes that these steps are not linear; requires the mobilization of volunteers from up, down, and across the organization to be and implement the change; allows volunteers to function in a network flexibly outside of, but in conjunction with, a traditional hierarchy; and ensure that volunteers seek opportunities, identify initiatives, and complete them quickly (kotter, 2014). structure over the summer of 2020, 10 out of 11 individual who attended the initial arc meeting met every two weeks to dialogue and plan activities. we incorporated poetry or artistic images into each session, started with a check-in (a simple meeting opening activity enabling participants to voice their needs and transition into the collective space), and ended with a check-out (a simple closing activity to gather insights and exit the collective space). the goal was to develop meaningful relationships and a sense of community antithetical to the larger societal context. we also used an action-oriented meeting agenda, took minutes, and kept track of action items. we planned events and intentionally collaborated across academic roles, engaging students, staff, and faculty in the process. activities during the first year, arc drafted a framework for organizational change (came & griffith, 2017) and organized several successful events with students, staff, faculty, and field instructors. we a) developed an antiracism resource guide; b) drafted an evidenceinformed framework for department transformation; c) hosted two book clubs and one film discussion; d) co-organized “social work so white with rachel cargle” (social work coalition for antiracist educators, 2020) watch party and “radical roots: history of racial capitalism 3-part lecture series” with students; and e) conducted a first-year evaluation of our progress, including writing this manuscript. in addition, individual members have taken actions in numerous ways, including presenting nationally and internationally about antiracist praxis, embedding antiracism into teaching, providing guidance to the university's diversity, equity, and inclusion (dei) efforts, and engaging in community action. a university publication about our new college and the department’s council on social work education (cswe) re‐accreditation report prominently featured arc’s activities. one of the arc’s founding members received a university-wide, todić et al./awakening antiracism 557 prestigious employee recognition award, in part due to her efforts in arc. another one received a nomination for the president's distinguished diversity award. as the group's mission took hold, the collective engaged the internal and external social work community by leading discussions on antiracism and the role of social work. in the fall semester of 2020, an administrator approved a 30-minute session at the monthly faculty and staff meeting for arc to engage the broader department in antiracist work. our aim for these sessions was to build a department culture committed to antiracism. while it has been challenging to find sufficient time in the faculty meeting to focus on antiracist praxis, the department continued to work collaboratively to maintain a portion of the faculty meeting to arc. similarly, arc was active at the university level, indirectly addressing issues of racism and discrimination, which we describe in the findings. this engagement with the swei highlights the potentially symbiotic relationship between arc members' evolution towards antiracist praxis and the swei's integration of this perspective. thus, as arc grows in its capacity for antiracist praxis, it may also grow the sweis capacity to nurture diversity and promote social justice. method this paper employs a participatory evaluative case study (merriam, 1998) methodology to answer two questions: 1) how has arc accelerated the social work department's integration of antiracist praxis (theory, reflection, action cycle) into all aspects of the department to support the department's mission?; and 2) how can arc dismantle structures which impede social workers' ability to confront racism? the case study methodology is appropriate because we are interested in a bounded system (merriam, 1998)—an antiracist collective inside one swei. a case study is descriptive and heuristic, illuminating a mezzo-level phenomenon (merriam, 1998). the methodology was participatory because the six authors of this paper each facilitated arc meetings and events, generated interview data for this project, and collectively analyzed the data. we used six sources of data: arc facilitator interviews (manuscript co-authors, n = 6), arc survey (completed by remaining arc members [n = 1] and non-arc faculty and staff [n = 7]), an administrator interview (n = 1), observations, arc documents (e.g., minutes, agendas, event evaluations), and department documents (cswe re-accreditation report). we conducted the analysis using several steps. first, the lead author conducted training on qualitative research and analysis for the co‐author team. next, we transcribed all interviews using auto transcription services (e.g., zoom, panopto). we checked all transcriptions for accuracy against the interview recordings. the administrator who participated in the interviews also read and edited their interview transcript for accuracy and provided additional context for parts of the interview. next, we developed a provisional coding book (saldaña, 2021). using the person‐in‐the-environment model (gitterman et al., 2018), we developed a deductive coding process (gilgun, 2019). all co‐authors applied preliminary codes to one randomly selected interview, discussed codes, and agreed to use the codebook as was. preliminary codes included: individual impact, department impact, structural impact, strengths, challenges, and future. two authors then used the codebook to analyze the remaining data, developing new sub‐codes to answer the two research advances in social work, summer 2022, 22(2) 558 questions. they used descriptive matrices (averill, 2002) to analyze data across interviews and across sources of data to develop themes. descriptive matrices enabled organization of quoted content from participants’ responses in individual cells across two dimensions preliminary codes as horizontal axis and individual participants as vertical axis enabling researchers to see patterns and trends across participants (averill, 2002). we kept an audit trail throughout the process because in qualitative research, while one should not expect to replicate an account, one should see how the researchers arrived at the findings (merriam, 1998). all authors reviewed and approved the final themes. credibility and trustworthiness literature suggests that being an insider offers a distinct advantage in accessing and understanding the case; however, these advantages are not absolute, presenting several ethical and methodological dilemmas associated with entering the field, positioning, shared relationships, and disengagement (labaree, 2002). instead of "going native" to gain the most accurate picture of the organization as insiders, we needed "to go observationalist," that is, "to distance ourselves introspectively from the phenomena so that a more complete understanding of the community's reality can be obtained" (labaree, 2002, p. 116). as insiders, we needed to be hypersensitive to our previous knowledge assumptions and positionalities throughout our "entry" into the field of study. the entry came with obligations and responsibilities to the study participants that an outsider may never experience (labaree, 2002). for example, we had to negotiate relationships with colleagues in this department that negative findings could harm. conversely, the relationships may influence our ability to present certain findings out of consideration for colleagues or department reputation. furthermore, relationships are complex and multidimensional, often based on the unequal distribution of power, which influences the degree of one's “insiderness” (labaree, 2002). in addition, at the time of this evaluation, three of us were people of color already navigating complexity associated with institutional racism, two were assistant professors navigating the tenure and promotion process, and two were staff navigating complex power dynamics as university employees who are not faculty. these positionalities are associated with various levels of vulnerability inside of a hierarchical university system. we negotiated these power dynamics by being transparent about our research throughout the process, providing multiple opportunities for participation to all in the department, and sharing that the primary purpose of our research was to discover ways to improve arc’s work and therefore the department. finally, terms of disengagement are particularly challenging for insiders because we remain in the community we study and may experience repercussions from those who may feel that our conclusions misrepresent the department or individuals (labaree, 2002). we carefully considered our ethical responsibilities and obligations to the department, our colleagues, our students, our profession, and our community before and throughout the study (mays de perez as cited in labaree, 2002). to address these concerns, we employed several techniques recommended by merriam (1998) throughout the design, data collection, and data analysis stages to enhance the credibility and dependability of our findings. first, we triangulated data using multiple todić et al./awakening antiracism 559 investigators, multiple sources of data, and multiple methods to confirm findings, which allowed us to gain a holistic understanding of the case. second, we conducted a member checking session to present findings to staff and faculty (n = 9) and a follow-up survey to attendees to provide additional thoughts (n = 2). we presented our themes with verbatim quotes, directly connecting our interpretations to the voices of participants. third, we engaged in long-term observation. all of us were actively engaged with arc since its inception as active members and co-facilitators. fourth, we engaged in a peer debriefing. one co-author also shared findings with a colleague from a near-by university who indicated that our main themes resembled experiences in their swei. results two main themes in the data were: 1) arc catalyzed department transformation as evidenced by the increased sense of critical consciousness, struggle, integrity, and community; and 2) achieved primarily individual impact, with small but potentially significant department impact, and small but potentially significant structural impact. arc catalyzed department transformation as evidenced by the increased sense of critical consciousness, struggle, integrity, and community across all six data sources, there was a clear sense of difference before and after arc related to department-wide discussions about racism. participants felt that "racism was on the table" and that "it was not going away." there was a universal sense of change in that arc's activities resulted in an increased focus on racism as an issue important to the profession and to the mission of the program. the following four subthemes, which are present across data sources, explain the complexity of that change. critical consciousness. critical consciousness, a term coined by a brazilian educator paolo freire (1973/2018), refers to developing critical insight about the nature of oppression through dialogue and reflection, then translating that insight into action to transform the oppressive conditions through praxis. this theme is present among arc and non-arc members; however, one difference is that arc members were more likely, although not exclusively, to give examples of praxis compared to the other evaluation participants, which were more likely to focus on learning. as one white arc member noted, arc has had a huge impact on me. i always thought i was very open and not racist, until becoming part of this. it's really opened my eyes to see it [as a] humongous problem, racism in our country. and also looking at myself and doing a lot of selfreflection to see ways that i've bought into that system freely, unfortunately. and i know i've been a racist in the past, unknowingly. but also learning that i can use my voice too, and then with the collective to help try to dismantle the system. to become antiracist in everything i do. several arc and non-arc participants described that arc impacted other people in their lives. a white non-arc participant shared the following in the survey, “personally, arc advances in social work, summer 2022, 22(2) 560 has had an impact not only on me but also my family...we read as a family ibram x. kendi's book how to be an antiracist and processed interactions and implications for our family.” struggle. to struggle is to "make great efforts in spite of difficulties; to contend resolutely with (a task, burden); to strive to do something difficult " (oxford english dictionary [oed], 2022c, para. 4). struggles related to internal growth or not knowing what to do, interpersonal conflict – often across racial differences, and disparate views of social work and its underlying political philosophies accompanied the increased sense of critical consciousness in the department. the following quote from a non-arc member (participant did not disclose race/ethnicity) survey responder expresses disagreements with arc’s strategies: to reach or engage more people, perhaps the arc can consider embracing social work values of “meeting people where they are,” that is, expressing nonjudgement for the different experiences and backgrounds people may have. yes, perhaps it is important for people to be “uncomfortable,” yet sometimes that is not always the best way to help someone open their mind to a new way of seeing something because it causes them to be defensive as a natural reaction to a judgement that they are perceiving...certainly, there is value in working and striving toward a commitment to antiracismat the same time, continual use of the term “antiracist” can also create a “if you are not for us you're against us” division that does not meet each person where they are. the newly emerged department-wide struggle also created a new management challenge for a white administrator, who needed to figure out how to respond to the diverse staff and faculty needs. the following quote exemplifies some of the challenges: sure enough, there were a couple of times during the year when people came and talked to me...about something related to arc...most of the time triangulation is bad...here's a direct relationship and you're diverting it through a third-party, and the more you do that, the more that prevents you from directly confronting whatever it is [you are dealing] with...because of the nature of my role,...i felt like i couldn't shut the door to people [who] want to talk to me, but it was a little bit of a challenge to figure out how to redirect the energy back. you know how could this be communicated directly? this is where for me in my role, that open door, the permeable boundaries, was really, really important that arc kept restating that. these struggles were a source of intense heartbreak for arc members, especially for people of color. an arc member who is a person of color noted: when the pushback is coming from white faculty, then really, the reaching out needs to be done by the white staff and faculty, because it's so triggering. just seeing how that shows up in the faculty and staff meetings, and where people of color are continuously experiencing this deeply disrespectful, deeply invalidating, deeply violent process. another white arc member expressed uncertainty about the department's ability to move through the struggles and heartbreak successfully. todić et al./awakening antiracism 561 i feel like now, the issues of racial justice are so explicitly on the table…people are bringing themselves to the table more fully, and i think that's causing strain in a way that can deepen our relationships, if we can work through it. but also, it can be fracturing if we don't figure out a way to work through it. and i think that's really important. tension can be growth-producing, and it is growth-producing, but you have to move through that process, and that requires time and skill and willingness. there's a part of me that wonders if we have what's needed to actually get to the other side of that. integrity. integrity refers to "the condition of having no part or element taken away or wanting; undivided or unbroken state; material wholeness, completeness, entirety” (oed, 2022b, para. 1). in moral sense, it refers to the “soundness of moral principle; the character of uncorrupted virtue, esp. in relation to truth and fair dealing; uprightness, honesty, sincerity.” (oed, 2022b, para. 3). arc's activities contributed to the sense of integrity to arc and non-arc members in several ways. an arc member who is a person of color stated: so, for me, because we're social workers, this is what we should be about...i know initially when we started, i recall just feeling such a, a sense of urgency...as the mother of a black man, as the wife of a black man. and it's just, as the grandmother of boys that are going to grow up to be black men, that sense of urgency that i want to, if it takes my everything, to work towards change. and we are the educators of future social workers, we, we are the gatekeepers of future social workers, there should be some antiracist foundation for every student leaving our program. a white non-arc member shared that they "felt that there was more space to be recognized as an imperfect yet growing individual." another white non-arc member noted how arc contributed to the department's ability to fulfill its mission. antiracist thinking naturally fits within the broader transformative, culturally competent mission of our program, but the work of arc has helped to serve as a tip of the spear, providing focus and energy around making antiracist strategies a more explicit part of faculty and community dialogue and general program thinking. finally, a white administrator who navigated multiple demands related to leading through the pandemic, renewed uprising against systemic racism, cswe re-accreditation, and the new college structure appreciated the role that arc played in leading the department's response to racism in summer 2020: so, part of my internal dialogue, i do remember briefly thinking, "oh good the president wrote a statement,” but then after a couple of days, thinking like “no, i need to write a statement,” but feeling isolated in that...i know there are some other universities…where the faculty is on it right away…i came in on monday morning after the whole weekend of protests and i sent something out to everybody like, "what, what should we, what can we do? and nobody ever responded to me, but that's ok…because it was right at the exact same time s. sent something else advances in social work, summer 2022, 22(2) 562 that was very, very, very personal about looking at her son and wondering about his safety...i felt a real relief and kind of a break from isolation [when arc started] but almost in a mechanical way...i almost felt like, "oh good. i'm feeling overloaded in this, in the leadership role, but here people are taking care of this," and so that's just kind of like a confession. like last summer was kind of checked off the list, people are working on this in a way that's beyond the statement. community as a sub-theme reflects "the state or fact of being shared or held in common; joint ownership, tenure, liability, etc.” (oed, 2022a, para. 10).; as well as “the fact of having a quality or qualities in common; shared character, similarity; identity; unity” (oed, 2022a, para. 11). in an ecological sense, it also refers to "a group of interdependent organisms of different species growing or living together in a specified habitat" (oed, 2022a, para. 12). arc members expressed a strong sense of community and belonging that developed through working under the shared vision, camaraderie, truth-telling, conflict, and witnessing each other's growth. for people of color, it was a place to be heard, valued, and seen as a leader. for white members, it was a place to take accountability and interrupt hegemonic whiteness through working for racial justice. one arc member who is a person of color describes the experience: one of the most profound ways [that arc has impacted me] has been in creating a place. working in a department where you feel like your voice is kind of very minimal, it's not really acknowledged, you know? it doesn't weigh as heavily as you might hope. to go from that space to a space where you feel like you know, you can share that voice...and it's, it's actually integrated as meaningful and powerful…can feel really important, all of a sudden. non-arc members also experienced an increased sense of community, although not as intensely as arc members. a white non-arc participant noted: this kind of energy or new connection or excitement, there's more bonding in the department...i was trying to think, when that went away?...we had been more in our faculty and staff relationships, just very mechanical [focusing on] program logistics and things like that. and we talked about things, we talked about courses, or whatever, things in isolation, but i don't feel like we had been energized by talking about big issues, big ideas like antiracism. there's a new level of engagement, again. let's talk about something important and central to our field, and what we can do about it. during the year, different views of social work and their underlying political philosophies emerged during arc activities. arc members generally align with the social changeoriented social work, which expresses the critical theoretical tradition, centering power analysis and transformation of unjust systems to achieve the professions’ goals (payne, 2020). at least three non-arc members expressed views more aligned with social cohesion-oriented social work, which expresses the neoliberal political philosophy, centering meeting individual people’s needs in order to recover stability within the current system (payne, 2020). even within these differences, there was a general sense of community. one white non-arc member reported, "[arc] created a stronger sense of todić et al./awakening antiracism 563 collegiality, especially as i voiced some points of view that were not in direct alignment with kendi's work, and these were received respectfully and with kindness." primarily individual impact, with small but potentially significant department impact, and small but potentially significant structural impact across data sources, participants observed arc's most significant impact to be at the individual level. they noted strengthened relationships among arc members. these relational changes, with observable cross-racial organizing and an unwavering focus on antiracism, also shifted conversations and relational dynamics at the department level. moreover, arc members shared activities and lessons learned with other university groups working on antiracism, offering a model and inspiration for action within the broader institution. however, arc and non-arc members primarily viewed arc’s impact at the structural level as minor one year after its inception, noting its potential for future structural impact should arc continue and make recommended changes (see future section). the following quote from a white non-arc member summarizes it well: the biggest opportunity is to take the next step through praxis thinking into action. much of the work of arc up to this point has been in reflecting on and promoting an antiracist approach. this is powerful and essential. if we leave it there, though, i'm not sure it reaches the level of transformational. the next steps in this direction from my perspective will be to use the perspective. i think it is already being incorporated somewhat into teaching, depending on the faculty member. a powerful next step would be to explore what it means on the policy and practice level. i envision the creation of explicit defining practical principles that can be used to evaluate policy decisions, curriculum choices, and more. however, of note is that one non-arc member indicated no individual impact and two were unsure about the department or structural impact. in addition, in the follow-up survey after the member checking process, one faculty (undisclosed race/ethnicity) stated that this theme: seems to reflect a series of subthemes to which i agree with the first, partially agree with the second, and feel unable to assess the third given the limited time during which this has been discussed as a faculty at large…arc's impact may have been at the individual level since individuals chose to be involved…i feel that the department impact may have been somewhat small, but definitely notable given the attention given to this topic for our student body (e.g., film series [documentary 13th]) and time set aside to discuss during faculty meetings. strengths amidst the data sources, engagement across stakeholders (faculty, staff, students, and field instructors), strengthening relationships, and focusing on praxis were strengths. arc’s collective approach asserted antiracism into the department dialogue that was impossible before the collective formed. arc members also noted that the relationships among members deepened through the collective's work, supporting their voice and growth advances in social work, summer 2022, 22(2) 564 and allowing them to translate their values into actions as educators, researchers, and community members. arc members also noted that arc is future-oriented, leading the department toward the professions' emerging commitment to antiracism. the cswe (2021) site visit report also identified this department movement "beyond cultural competence" toward antiracism as a strength in the cswe site visit report (p. 1). challenges arc faced many challenges at individual, collective, departmental, university, and structural levels. as one arc member who is a person of color simply said, "systemic racism is a challenge." across the six sources of data, five main challenges emerged: lack of a clear strategic plan, resistance, differences in the view of social work and its underlying political philosophies (which reflected different views about antiracism and strategies for how to address racism), conflict avoidance, and time. data sources showed a clear need for a multi-year strategic plan. arc's immediate goal was to work with an experienced antiracism consultant, who would first facilitate a retreat and help the department develop a strategic plan. arc received a proposal from the consultant and had a meeting with a senior department leader in the first few months of the collective to discuss the next steps. at the time, the resources were not available to engage in this process. despite missing this goal, arc proceeded with many outlined activities for the first year but never developed a multi-year plan. furthermore, even though arc had a theory of change and plan for activities, they were never clearly communicated to the department. this white non-arc survey participant’s response reflects this well: i am not clear on the specific strategies arc is using to reach its ambitious goal the "how" (for example, in comparison to other groups that have developed antiracism plans laying out the map). as opposed to a collection of events and conversations...i believe arc's vision is achievable but there is a mismatch between its grandness and the lack of specifics so far. resistance was also a theme across the data sources. among arc members, resistance showed up primarily, although not exclusively, among white faculty around whether to include students in the book club discussions. they were concerned about how students may perceive their internalized racism. on another occasion, faculty of color were resistant to white faculty starting a white accountability group. these sources of resistance were also sources of conflict that eventually led to transformation for the collective, deepening relationships and trust. arc members also perceived resistance to their work from senior leadership and other faculty members at the department level. while the department senior leadership supported and appreciated arc's work, including attending arc events, arc members expressed a concern that the leadership “did not own it." for example, while arc did receive a 30minute slot on the monthly faculty and staff agenda, the allocated time was rarely honored. arc asked for resources to work with an antiracism consultant during the annual retreat and develop a strategic plan. the resources were not available at the time, and the senior leadership never revisited them. during the member checking session, a senior leader was todić et al./awakening antiracism 565 surprised to hear these findings and countered that monthly meeting reports during faculty and staff’s meetings about department’s funding challenges indicated that funding for the antiracism work with a consultant was not possible. furthermore, a senior leader explained that they valued “giving credit where credit was due.” their strategy was to “step into the background and promote others,” mainly because "arc's collective nature was a strength and one embraced by arc itself and a good model to promote in the college, university, the world." there were also differences in the perception of who has the power to make changes in the department. although several senior faculty acknowledged past challenges that junior faculty experienced with advocating for racial justice in the department, they still felt that, for example, arc members were dispersed throughout the curriculum committees and could change the curriculum. on the other hand, arc members who were junior faculty had at least two examples of attempts to make changes consistent with antiracism but experienced resistance from white senior tenured faculty. for example, a junior faculty experienced intense resistance from a senior faculty member to integrate intersectionality throughout the cultural competence course, which primarily relied on the multicultural rather than the critical theoretical framework. as a result, the official course syllabus reflected individual class sessions dedicated to african americans, latinos, or american indians until the senior faculty left the department. in response, the junior faculty developed "a shadow" syllabus to teach the course from an intersectional critical perspective. in fact, the only arc member that was able to make official changes as a course lead was the one who did not have to collaborate with a senior faculty member on their committee. at the department level, differences in underlying political philosophies emerged, reflecting different views about antiracism and strategies for addressing racism. three faculty members expressed concerns related to arcs work. in the member checking follow-up survey, the same faculty (undisclosed race/ethnicity) who observed that “the department impact may have been somewhat small, but definitely notable (see quote above),” expressed concerns about arcs perceived ideology. they note: whereas once a matter of personal liberty, this ideological framework is now being discussed here and at other universities in a way that creates clear imposition on alternative viewpoints both among faculty, staff, and students. although the arc's specific impact on the student body at [the university] is largely unknown, i know of at least one student who no longer wants to be in social work due to this shifting ideology. of note, this student is a black female. other concerns were related to strategies that generated discomfort rather than working with people where they were. two faculty expressed concerns about using the term "antiracism" because it signaled a particular ideology which is not universal to all social workers or may cause people to feel defensive because of feeling judged if they are not constantly working to dismantle racism. a faculty (undisclosed race/ethnicity) offered the following approach: perhaps rather than asking questions that assume a specific ideological framework and are pretty open-ended (i.e., how are you doing the work of advances in social work, summer 2022, 22(2) 566 antiracism?), questions along the lines of the following might allow for more unpacking/rumbling: what do you perceive as the benefits and/or disadvantages to using a term like “antiracism” versus other terms such as “diversity and inclusion”? what are the key tenants of “antiracism” as you understand them? let's talk about these starting with x… (probably would need time each meeting to just discuss just one – e.g., with regard to policing, capitalism, affirmative action, focus on equal processes vs. outcomes etc.) what is clear? what is not? what might be some of the benefits and challenges to adopting kendi's antiracist framework within our department? what is viewpoint diversity and how does it matter to this conversation? conflict avoidance was also consistent across the data sources. even arc members, who embraced and engaged in generative conflict, struggled at times with offering critique to each other or asking clarifying questions about arc processes. arc's conflict avoidance also got in the way of figuring out how to effectively integrate arc into the department. while members had concerns about the impact of rotating leadership or decision-making processes on the advancement of arc’s goals, they did not bring them up. in addition, a few non-arc faculty or staff members went to the department leadership to discuss concerns related to arcs activities. still, they never attended arc meetings to discuss their concerns. moreover, senior leadership struggled with finding the right way to respond to these grievances, given their administrative role and procedural responsibilities related to needing to listen to employees' grievances carefully. finally, time was a constant challenge. arc members struggled to move antiracism forward within the department, having to remind themselves constantly that undoing racism is a long-term process. time on the department meeting agenda to engage in a meaningful conversation, even when the 30-minutes were honored, was never long enough. finally, a white non-arc participant noted that "a major challenge is that we already have a lot of service requirements and not much bandwidth, so it's hard always to give these conversations our full attention." arc’s internal infrastructure problems exacerbated the described challenges. rotating arc leadership promoted diverse leadership voices but was inefficient. it impeded progress and negatively impacted access to the allocated staff and faculty meeting time. this arc member who is a person of color describes some of the challenges of operating as a collective with unclear processes: arc is, at times, it can feel directive, and it can feel like, you know, we're generating these ideas and then it's kind of like, you known, “just do this.” and so, for me, sometimes it gets confusing because i get confused about, okay, where, where is my opinion and, and my idea about how we're supposed to do this. and when am i supposed to hold that back and say, okay, no i gotta wait for collective agreement on this? because sometimes it feels like we're working with collective agreement, and sometimes it feels like we're working from a more directive approach. and so, for me, that's a challenging area, because sometimes, i'll hold back and i will not do something. and then, you know, it won't have, something won't happen in arc, and then i'll say “oh well, i could have done that” but i don't todić et al./awakening antiracism 567 feel comfortable all the time stepping in. but then at other times it feels like, you know, we can go based off of opinion, you know, and so it's for me that's kind of confusing. forces external to the department and arc added complexity to the context and presented additional challenges. mid-level senior leadership roles at our institution require simultaneous attention to leadership, administration, dei issues, legal issues, student issues, community relations, and teaching in the classroom. the university support for their role in advancing complex dei initiatives is limited. finally, the past year was challenging in new ways. in addition to the normative hierarchical, individualistic academic culture that embodies structural racism, the department was also going through cswe re‐ accreditation, establishment of a new college structure, and a global covid‐19 pandemic. future two themes were consistent among all sources of data: that arc should continue its activities, including working across stakeholders (faculty, staff, students, field instructors), and that it should develop a clear strategic plan. other recommendations from participants, which do not necessarily reflect arcs plans, included: determining the scope of work (department vs. university vs. community), including outlining how arc’s work in the department of social work relates to the broader university and community equity efforts; developing principles for advancing antiracism; outlining concrete actions (e.g., curriculum and teaching strategies; white accountability group); developing skills for operating as a collective; developing sustainable collective infrastructure; defining collective membership/boundaries; embedding antiracism in performance evaluation for staff, faculty, and leaders; and using formal department structure to advance arc goals. of note is a comment by a faculty (undisclosed race/ethnicity) who expressed appreciation for arc's work but voiced significant concerns for the future: it will be important to lay the groundwork regarding definitions, to “rumble” (to quote brené brown) about this ideological framework and the extent to which there is agreement with its various facets, and how the department can move forward in a spirit of collegiality, unity, and in respect of diverse viewpoints…some of the future plans should be carefully reconsidered– e.g., tying an antiracism framework to pay, evaluation, retention, and promotion is not only discriminatory and divisive, but inhibits free thinking and speech. discussion this evaluative case study follows the first year of an antiracism collective in one social work department located at a hispanic serving institution in the southern u.s. we found that arc 1) catalyzed department transformation as evidenced by the increased sense of critical consciousness, struggle, integrity, and community; and 2) achieved primarily individual impact, with small but potentially big department impact, and small but potentially big structural impact. while our findings have implications for arc, our department's mission, and our local context, we believe these results are transferable to other sweis committed to antiracism. given that structural racism is embedded in all advances in social work, summer 2022, 22(2) 568 institutions (bailey et al., 2021; bonilla-silva, 2018; davis, 2003; davis, 2021), starting a collective inside sweis may be a step toward beginning to undo that structure. arc was a source of wellbeing for both faculty and staff of color and white members, positively influencing their work as professionals and community members. furthermore, strengthening interracial relationships through truth telling, accountability, and solidarity are new patterns at a small scale that can begin to shift patterns at a large scale (brown, 2017). while it reflects the larger pattern – we assume that internalized racism still exists within arc members and therefore the collective – new ways of engagement at the small interpersonal scale signal a possibility for the large institutional and structural scale (brown, 2017). however, operating as a collective requires skills and frameworks that most social workers do not learn. faculty and staff who consider starting a collective should invest in developing skills and knowledge for collective leadership. while limited and mostly focused on worker cooperatives, the existing literature suggest that governance challenges that arc experienced are common (basterretxea et al., 2022). this is not surprising, given that faculty and staff, even as trained social workers, have internalized competition, hierarchical work structures, and focus on individual success that are key to the u.s. culture and white supremacy. staff and faculty considering starting an antiracism collective within their departments should invest in developing the necessary skills – communication, meeting and decision-making, conflict resolution, and teamwork. contacting a local cooperative incubator that also centers racial justice, exploring the resources of a cooperative such as roundsky solutions, and learning about mutual aid projects (spade, 2020) are potential avenues for obtaining the necessary skills. internal groups for white faculty and staff that focus on critical whiteness and white accountability is essential for moving the antiracism work in the department forward. such groups have been extensively, and for good reasons critiqued for performative activism that continues to center whiteness (ahmed, 2006; wooldridge, 2019). still, it is also clear that white people must engage individually and collectively in cautious and careful antiracist praxis that interrupts hegemonic whiteness (frey et al., 2021; kivel, 2017; swan, 2017). arc work in the department frequently resulted in painful conversations that did not deepen relationships in a way that conflict did in arc meetings. therefore, ensuring that white faculty and staff engage in exploration of white ignorance and white complexity with each other, while also being in accountable relationships with people of color within the department is key (swan, 2017). there are many resources that can help with developing white accountability groups, such as paul kivel’s book uprooting racism: how white people can work for racial justice, other social work programs experimenting with approaches to interrupting hegemonic whiteness (see frey et al., 2021), or a national organization showing up for racial justice (surj), which mobilizes white people to work for racial justice and emphasize accountability through collective action. evidence suggest that leadership is a critical factor in implementing successful organizational change (stouten et al., 2018). given the social work field's only recent move towards antiracism, it is inevitable that ideological differences (payne, 2020) will emerge. developing processes and skills to express and discuss these differences through generative conflict will be essential. leaders are key in implementation success because they can todić et al./awakening antiracism 569 ensure that staff and faculty develop change-related knowledge and skills, including how to engage in transformative conflict. transformative conflict centers reflexivity, feedback, harm-naming, listening, mutuality, accountability-taking, and repair (creative interventions, 2012; kaba & hassan, 2019; ross & ghadbian, 2020). they can normalize internal and interpersonal conflict as a critical element of ongoing growth and lifelong learning, which is an ethical imperative (national association of social workers, 2021). this framing, in turn, can reduce stress, skepticism, and the sense of threat that conflict and change might bring (stouten et al., 2016). dei leadership that centers antiracism is vital for organizational transformation (todić et al., 2022); however, many social workers do not have these skills. rather than generic leadership training, social work leaders need opportunities to develop dei leadership skills and receive ongoing support in the context that is sensitive to how their positionality (e.g., intersection of race, ethnicity, gender or sexual orientation) contributes to their vulnerability and agency. leaders must have a deep understanding of how white supremacy, structural racism, and their intersections with other forms of oppression operate inside their institutions (davis, 2021). more importantly, they must have the skills, resources, and support to lead in a way that undermines and ultimately uproots them. therefore, cswe, national association of social workers (nasw), and the national association of deans and directors of schools of social work (nadd) must support social work administrative leaders in learning, confronting and leading through these challenges. literature also indicates that organizational change benefits from multiple visible leaders (stouten et al., 2016), indicating that sole reliance on formal leadership in sweis is not sufficient for a meaning change however, antiracism collectives must be clear on their sphere of influence. with senior leadership taking an explicit antiracism stance, antiracism collectives can partner in the organizational change process. with leadership hesitant to assume or resistant to an explicitly antiracist stance, collectives can serve as a source of support and empowerment for faculty and staff committed to antiracism, serving as a space where they can carefully consider their collective change strategies. knowledge gained from movement building and organizational change theories provide helpful tools for navigating complex organizational dynamics. finally, it is essential to acknowledge the nature of change in the neoliberal university context, undermining and co-opting anti-oppression work (todić et al., 2022). being realistic about the length of time it takes to create change and adequately preparing for the journey is critical. however, there should be a clear understanding that the slow process comes at a cost, especially to people of color. since the initiation of the antiracism collective, four people of color resigned their full-time positions in the department, including two co-authors of this study who are women of color. clear strategic plans for antiracism work can help (polk et al., 2021). in addition, sweis can advocate for resources and technical support from university dei departments, which can support the departmentlevel momentum (polk et al., 2021). these resources can also enable leadership development skills, work with consultants to develop strategic priorities, and assistance with organizational change. although arc made small advances within their swei, much work remains ahead. broader discussion around the role of critical race theory and incorporation of antiracist advances in social work, summer 2022, 22(2) 570 pedagogy in academic settings have become a point of the political divide used to generate controversy. similar to arc, schools of social work across the country are grappling with how to actualize social work standards of social justice in their departmental and institutional activities while preparing future social workers to engage social systems as well (see examples in advances in social work summer 2021 special issue on dismantling racism in social work education guest edited by charla yearwood, rosemary a. barbera, amy k. fisher, and carol hostetter). this has presented some challenges, with at least one institution indicating an inconsistency between its institutional mission and the social work accrediting board's guidelines for practice standards (lauer, 2021). collectives similar to arc can play a critical role in developing individual, departmental, and institutional capacity to address these issues by ensuring life-affirming spaces for faculty and staff committed to pursuing liberation efforts within complex institutional environments. references ahmed, s. 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(2017, november 20). utsa officials respond to white nationalist banners removed from campus. san antonio current. https://www.sacurrent.com/thedaily/archives/2017/11/20/utsa-officials-respond-to-white-nationalist-bannersremoved-from-campus author note: address correspondence to jelena todić, department of social work, the university of texas at san antonio, 501 w. cesar e. chavez blvd. san antonio, tx, 78207. email: jelena.todic@utsa.edu author acknowledgements: the authors thank their colleagues for participating in the evaluation. they also thank anonymous reviewers and matthew bakko whose helpful feedback improved the article quality. https://doi.org/10.1111/gwao.12165 https://grandchallengesforsocialwork.org/wp-content/uploads/2021/05/eliminate-racism-concept-paper.pdf https://grandchallengesforsocialwork.org/wp-content/uploads/2021/05/eliminate-racism-concept-paper.pdf https://doi.org/10.1097/acm.0000000000004680 https://www.census.gov/library/visualizations/interactive/2018-poverty-rate.html https://sanantonioreport.org/westside-residents-slam-utsa-officials-during-downtown-campus-master-plan-meeting/ https://sanantonioreport.org/westside-residents-slam-utsa-officials-during-downtown-campus-master-plan-meeting/ https://digitalcollections.sit.edu/cgi/viewcontent.cgi?article=4220&context=capstones https://doi.org/10.18060/25652 https://www.sacurrent.com/the-daily/archives/2017/11/20/utsa-officials-respond-to-white-nationalist-banners-removed-from-campus https://www.sacurrent.com/the-daily/archives/2017/11/20/utsa-officials-respond-to-white-nationalist-banners-removed-from-campus https://www.sacurrent.com/the-daily/archives/2017/11/20/utsa-officials-respond-to-white-nationalist-banners-removed-from-campus mailto:alex.redcay@millersville _________ dee sherwood, phd, msw, mpa, associate professor, karen vandeusen, psyd, lmsw, professor, and mioara diaconu, phd, msw, associate professor, school of social work, western michigan university, kalamazoo, mi. courtney jones, msw is a doctoral candidate in the school of social work at michigan state university, lansing, mi. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 197-218, doi: 10.18060/25255 this work is licensed under a creative commons attribution 4.0 international license. "the problem is that puerto rico does not have a say": students' critical reflections on service-learning in post-maria puerto rico dee ann sherwood karen vandeusen mioara diaconu courtney jones abstract: this study explored the reflections of graduate social work students from a public university in the midwest region of the continental united states, following a servicelearning course in san juan, puerto rico during the aftermath of hurricane maria. the course linked academic study and civic engagement through organized service with proyecto enlace, a public corporation that unites eight communities and twelve grassroots organizations located along the estuary banks of the el caño martín peña. nine students and two faculty members repaired and painted a community center building. faculty facilitated opportunities for critical reflection on the dynamics of power, privilege, and oppression in the context of working with communities during the reconstruction phase of the disaster. students met with puerto rican community members and social workers to learn about their experiences and perspectives. qualitative analyses of a student focus group revealed themes in students’ learning processes, students' perceptions of trauma and resilience among community members and disaster relief workers, environmental justice in puerto rico, and the increased visibility of macro-level practice opportunities. we recommend critical reflection as a valuable pedagogical tool for social work education and requisite for skill development and transfer learning. keywords: service-learning; disaster social work; environmental justice; puerto rico; critical theory; trauma; resilience natural disasters result in personal and collective trauma (bauwens & naturale, 2017; fernando & hebert, 2011; jha, 2015; jones et al., 2012; lowe et al., 2015; pintar, 2006; prewitt diaz, 2017). despite being viewed as acute events, natural disasters can irrevocably change the lives of the people that they affect. disasters may also be protracted and compounding, particularly in the era of covid-19 (garriga-lópez, 2020). a traumainformed and culturally responsive understanding of trauma and resilience requires an awareness that the impact of a traumatic event or events (e.g., natural disasters) on individuals and communities cannot be separated from an understanding of systems of power, privilege, and oppression (sherwood et al., 2021). over a decade ago, pintar (2006) wrote of hurricane katrina, “the trauma people suffered was caused not only by wind and water but also by entrenched poverty, governmental neglect, systematized corruption, and institutional racism” (p. 54). similarly, jha (2015) observed that individuals who are oppressed, impoverished, and disadvantaged are disproportionately impacted. in 2017, hurricane maria reportedly “lifted the veil” that obscured social and economic inequality on the island (rivera, 2018, para. 4). about:blank advances in social work, spring 2022, 22(1) 198 following a natural disaster, individuals may be subjected to personal suffering and bear witness to the suffering of others. displacement, loss of property, and disruption of employment and life activities can further complicate recovery (fussell & lowe, 2014; vasterling, 2008). in puerto rico, survivors of hurricane maria reported feelings of intense grief, guilt, vulnerability, disbelief, and fear; a sense of confusion and disorientation; loss of order, routines, and familiar environments; loss of dwellings and built structures; and loss of personal and familial identity that is derived from cherished personal and sentimental items (prewitt diaz, 2017). in the aftermath, survivors described time as “before maria” and “after maria” (torres, 2018, p. 11). an individual’s ability to utilize personal resources to cope with disruptive events such as a disaster is referred to as resilience (richards & dixon, 2020). six months after hurricane maria, torres (2018) observed that 40% of the population still had no electricity, thousands of homes were without roofs, and communication networks remained impaired or non-existent in remote locations. these factors, in combination with weak infrastructure, poor water quality due to a lack of power at water treatment facilities, and an already overstressed economic system, would be expected to result in a low level of resilience. however, low levels of personal resiliency can be mitigated by community-level resilience (patel et al., 2017). patel and colleagues (2017) credited puerto rico’s resilience to having a “strong, unified, and skilled” community: hours after the hurricane passed the island, individuals went out into the streets to help each other, and nonprofit organizations adapted their agendas to incorporate relief into their work plans. in the absence of government aid, the third sector assumed responsibility for providing help to the island—it is thanks to them that puerto rico has been able to lift itself up at all despite the challenges. (torres, 2018, p. 14) context hurricane maria made landfall on puerto rico on september 20, 2017, with winds over 155 mph, just below category 5 (pasch et al., 2017). the island was inflicted with 30 inches of rain in a day. only two weeks after hurricane irma had saturated the ground with water, wind and rain continued for 30 hours. damages were catastrophic, with the entire island losing power, the destruction of homes, buildings, and roads, and the loss of access to lifesaving resources, medical equipment, and services. it is estimated that over 4,965 people died as result of hurricane maria and its aftermath (kishore et al., 2018). many of the people of puerto rico live in precarious social, economic, and environmental conditions. prior to hurricane maria, puerto rico’s debt situation escalated to a financial crisis. a sizable portion of the debt is owed to predatory vulture hedge funds in the united states (us), further exacerbating puerto rico’s colonial condition (stanchich, 2017). congressionally imposed austerity measures intended to correct the debt crisis were implemented in 2016. according to us census data from 2018, of the 3.2 million people living on the island, over 43% are living in poverty, more than twice the rate in mississippi (19%), the poorest state in the us (glassman, 2019). health care is similarly inaccessible to many people of puerto rico, leading to elevated rates of chronic conditions (e.g., sherwood et al./the problem is 199 hypertension, diabetes, and asthma), and to more people reporting fair to poor health (35% compared to 18% in the us overall; michaud & kates, 2017). power outages caused by hurricane maria detrimentally impacted the economy in general and, more specifically, the ability of puerto rican health care professionals to care for their patients. electricity is crucial for “powering dialysis and oxygen machines, to enabling hand and water sanitation, equipment sterilization, and refrigerated storage of vital medications” (johnson, 2017, para. 13). puerto rico continues to suffer from the compounding impacts of covid-19, hurricanes, a crushing debt crisis, and numerous earthquakes. one of the critical problems that puerto ricans face during the coronavirus pandemic is that the us federal government does not see puerto rico as a priority, in large part because residents of puerto rico cannot vote for us presidential candidates in national elections (garriga-lópez, 2020). “puerto ricans also know that little or no help is forthcoming, in part because shipping restrictions mean that puerto rico is effectively embargoed – the island is unable to trade with or receive aid from any country other than the usa” (garriga-lópez, 2020, p. 269). course development the first author, a faculty member at western michigan university, taught servicelearning courses in puerto rico on an annual basis between 2013 and 2018. within these courses, one activity was to have students meet with social work faculty and students at the universidad del sagrado corazón, school of social work, in order to learn about the experiences of social workers in puerto rico. additionally, students participated in a guided bike tour (bici-caño) of the g-8 communities where they were able to interact with el caño martín peña (ecmp) community leaders and learn about the community organizing work of proyecto enlace. in the context of established relationships, a service-learning project following hurricane maria was identified by proyecto enlace staff. service work was planned for students to remove debris, resurface the exterior walls, and paint a community center structure. this work served as preparation for ecmp youth to design a new mural on the front of the building. the mural would depict images of homes with roofs and reflect the new vision for the center to address home reconstruction. the center, formerly a site for literacy programs, rapidly transitioned to a site to distribute water, food, supplies, tarps for covering damaged roofs, and a place for residents to charge their cell phones during prolonged power outages. the mural would serve as an important symbol that the center was responding to the community’s needs. service-learning course the service-learning course in puerto rico was a 15 week, three-credit graduate social work elective course. the course included online, in-person classroom, travel, and servicelearning components. nine msw students from western michigan university participated in classroom and online activities for 10 weeks prior to engaging in service-learning activities. the service component occurred over a period of seven days in march of 2018. advances in social work, spring 2022, 22(1) 200 when the course was developed and scheduled, faculty had not anticipated a disaster occurring in puerto rico. hurricane maria had not yet occurred, and therefore the course content and assignments were not intentionally designed with a focus on trauma and resilience. students reviewed assigned readings and videos on the history, culture, diversity, and political status of puerto rico and a reading focused on the process of critical reflection. course readings were augmented to include content on disaster relief work. course objectives included that students would: 1. explore cultural self-awareness and “other culture” awareness demonstrating a level of attentiveness, respect and open-mindedness with competing ideologies, different cultural behaviors and new experiences. 2. acquire an appreciation for the diversity in “ways of being” among different cultures. 3. engage in individual, small and large group activities to assist with managing personal conflict and tolerating ambiguity in intercultural settings. 4. analyze and discuss the challenges and opportunities that arise from dynamics that impact communities (e.g., historical, political, social, public opinion/ perception, power/ control, and resources/ capital/ assets). 5. practice intercultural understanding, empathy and sensitivity through experiential activities that support skill development. the council on social work education competencies for the course were: 1) demonstrate ethical and professional behavior, 2) engage diversity and difference in practice, and 3) advance human rights and social, economic, and environmental justice (cswe, 2015, p. 7). the cswe competencies were aligned with course activities and evaluated through graded discussion posts, a journaling activity, and a final self-reflection paper. the final papers were not included as a data source for this study. formation of the ecmp, the g-8, and proyecto enlace the ecmp community was formed in the aftermath of a hurricane. in 1928, hurricane san felipe sagundo destroyed the homes, lives, and livelihoods of the island’s farmers. as a result, san juan experienced rapid emigration of people moving to the urban areas of the island in search of a better quality of life. along the ecmp canal, substandard dwellings were built on top of mangrove wetlands. today, the ecmp community is densely populated and home to over 26,000 people who live along the 3.75 miles of estuary waters. the ecmp lacks infrastructure needed to address wastewater, causing the canal to frequently flood homes, schools, and businesses in the region, often with water up to six feet deep. over 3,000 structures still discharge raw sewage into the remains of the canal (brodine, 2017). despite being located in the highly developed financial district of san juan, the ecmp community has a long history of poverty, marginalization, unsafe living conditions, and environmental hazards, resulting from decades of exploitation and social exclusion. in 2004, a community-based non-profit organization, the grupo de las ocho comunidades aledañas al caño martín peña (g-8, 2021) was formed to promote community development and prevent involuntary relocation and gentrification of ecmp residents by sherwood et al./the problem is 201 developers. the g-8 brings together the leadership of eight communities and 12 grassroots organizations to promote “real and effective” participation of residents in eight communities in collective decision-making (g-8, 2021, paras. 3-5). working closely with the g-8, proyecto enlace is a public corporation established to coordinate “policies and projects aimed at the restoration of the caño martín peña” waterway and to promote “the urban, social and economic equitable and comprehensive development of the adjacent eight communities” (urban waters learning network, 2021, para. 1). proyecto enlace has gained international recognition, developed hundreds of millions of dollars in grants, and received numerous awards, notably the united nations (2015) world habitat award for their work in establishing a community land trust to prevent gentrification of ecmp residents. critical reflection and study purpose this study explored the reflections of graduate social work students from a public university located in the midwest region of the continental united states who participated in a service-learning course in san juan, puerto rico following hurricane maria. the course linked academic study and civic engagement through an organized service-learning experience in collaboration with proyecto enlace. proyecto enlace is a public corporation that connects eight communities and twelve grassroots organizations located along the estuary banks of the el caño martín peña. students repaired and painted a community center building. students also met with puerto rican community members and social workers to learn about their experiences and perspectives. faculty structured opportunities for students to engage in a process of on-going critical reflection, concurrent with and following service learning activities through group debriefing sessions and individual written assignments. critical reflection was focused on making connections between the disaster in puerto rico following hurricane maria and puerto rico's colonial condition. critical perspectives examine how power operates and is created within a society, "especially how power functions through individual people's implicit thinking to maintain unequal social relations and structures" (fook, 2008, p. vii). critical reflection is a method for “uncovering this implicit thinking” to address power imbalances and inequalities, and as such is an integral component of social work education (fook, 2008, p. vii). for example, students critically reflected on first-person accounts of the history of social, economic, environmental assaults perpetrated on puerto rico. students noted the distinction in language use made by a community member who asserted that columbus "arrived" but did not "discover,” because –he was "lost." the people of puerto rico existed before and independent of european conquest. similarly, "slaves" were not taken from africa. rather, "people” of africa were stolen, trafficked, and enslaved in puerto rico. in modeling critical reflection during debriefing sessions, we made connections between current and historical realities in puerto rico and the use of discursive power. in the reflective process students became conscious of the colonial oppression inflicted upon the indigenous and african people of the island, a form of power that is embedded within and functioning through the language of dominant narratives. advances in social work, spring 2022, 22(1) 202 method this hsirb approved qualitative study was conducted on-site in san juan, puerto rico following a service-learning course. guba and lincoln (1998) identified four knowledge paradigms: positivism, postpositivism, constructivism, and critical theory. the epistemological assumptions of each paradigm have implications for the selection of methods for social research. our research relies on a critical, phenomenological approach to explore the lived experiences of students participating in a service-learning course following hurricane maria. we examined the interplay between meaning-making, social interaction, social location, and systems of power and privilege. critical theory assumes that reality is produced through historical and on-going social and political processes; social circumstances that exist now are understood as reflections of deeply embedded structures that serve the purposes of the powerful (williams, 2006). applications of critical theory aim to expose, deconstruct, and challenge dominant narratives. sampling and data collection participants included graduate-level social work students enrolled in an elective social work course (n=8), seven identifying as female and one identifying as male. one student identified as african, one as african american, and six students identified as caucasian. study participants engaged in a focus group in san juan, puerto rico, in march of 2018 on the last day of the service-learning component of the course. participation in the focus group was voluntary, and participants provided written informed consent. one student enrolled in the course declined participation in the focus group. the importance of confidentiality was emphasized before the start of the focus group and was also included in the informed consent document. the focus group was 90 minutes in length. participants were asked four open-ended questions focused on the service-learning component of the course: 1) “what were the high points of your learning experience?” 2) “what were the low points in your learning experience?” 3) “in what ways do you think that communities in puerto rico have been traumatized?” 4) “in what ways do you think that communities in puerto rico are resilient?” the focus group discussion was facilitated by a co-instructor not involved in the grading process. a research assistant documented when each participant spoke, utilizing their participant number. data were stored in password-protected files. data analysis audio recordings were used to create a verbatim transcript for analysis. data were deidentified (e.g., participants were assigned numeric codes). initial lists of codes were developed using an inductive coding process and a manual review of transcript data by two independent coders. to minimize researcher bias, an external coder was used (rubin & babbie, 2017). initial codes were based on the relevant literature, observations during the research process, and the researchers’ content-related expertise. the two coders compared code lists, discussing discrepancies and points of incongruence. through a collaborative process, the coders came to consensus on a revised set of codes. during the second cycle sherwood et al./the problem is 203 of coding, the transcript was mined for exemplary quotes, with special attention to negative cases. in the third stage, codes were written on index cards, using the tabletop method of individual theme development (saldaña, 2016). we achieved consensus on the six categories which form the basis of our themes (see table 1). table 1. categories of major analytical concepts category subcategories variables/terms 1 – challenging assumptions about puerto rico 1.1 political status taxes, exploitation, colonial, representation, voting, say 1.2 cultural norms collective, individualism, self-expression, passionate 1.3 economic conditions inequality, finances, debt crisis, poverty, 1.4 lack of awareness live in a bubble, “forgotten americans,” ignorance 2 – power dynamics of an inadequate disaster response 2.1 ineffective relief efforts fema, delays, anger, frustration 2.2 opportunism vultures, taking advantage, saviors, heroes 2.3 lack of consultation making assumptions, know/knowledge, experts, listening/not listening 3 – encountering trauma from natural disasters and marginalization 3.1 disaster-related trauma triggers, rain, vulnerable, destruction, survivors 3.2 poverty-related trauma poor, infrastructure, sewage, tough 3.3 emotional responses cry/not cry, tearful, guilt, afraid/fear, anxious, anger, numb 4 – experiencing self-determined and resilient communities 4.1 community selfdetermination empowering, self-reliance, action, fight, challenge 4.2 community resilience resilience, resist, strength, stay, together, abandoned 5 – environmental justice and puerto rico 5.1 climate crisis climate, hurricanes, mother nature, global warming 5.2 disproportionate impact ecmp, vulnerable, stratifying lower, flooding 6 – increased visibility of macropractice 6.1 need for macro-level skills need, demand, critical, policy 6.2 visibility of macropractice eye-opening, seeing, community, mobilize 6.3 broadening of career goals explore, change, macro, clinical, future results narrative data gathered from a student focus group were organized around six themes representing students’ reflections on their experiences in the service-learning course. the themes were: challenging assumptions about puerto rico, the power dynamics of an inadequate disaster response, encountering trauma from natural disasters and marginalization, experiencing self-determined and resilient communities, environmental justice and puerto rico, and the increased visibility of macro-level practice opportunities. advances in social work, spring 2022, 22(1) 204 challenging assumptions about puerto rico in the process of critical reflection, students reported that their assumptions about puerto rico were challenged, consistent with the pedagogical approach to the course. students described learning for the first time the complex and contradictory nature of social, economic, and political relations between puerto rico and the us. puerto rico is a part of the us, while it also maintains a unique national and cultural identity. puerto rico is an occupied territory of the us with limited autonomy for self-governance. at the same time, puerto ricans pay taxes as citizens, but are denied voting privileges and representation in congress, contributing to further colonial exploitation. students acknowledged their limitations in understanding and expressed their sentiments that puerto ricans are the “forgotten americans.” students also adopted terminology from the perspective of puerto ricans, identifying themselves as living on “the continent” while using “on the island” as a new center or point of reference. i believe that in the continent we live in a bubble…basically, unaware of what is going on in puerto rico. the federal government has made the debt crisis here so much worse…these laws imposed on the economy prevent puerto rico from taking control of its finances…the problem is that puerto rico does not have a say in how it is governed from congress. students found this opportunity challenged their thinking. ecmp community members imparted new perspectives. the experience afforded students the opportunity to reflect upon social subordination and the need for consciousness raising. students noted the following: i love what carlos [pseudonym] said about what needs to happen to make this right, to bring a solution. he was like “you need to change people’s minds. you have to transform their paradigms.” i was like, awwww man, that’s deep. the older we get, the more indoctrinated we get…[we] find our place in the ranking and, ya know, don’t step out of line, because you might lose what you have. where kids [by comparison] don’t have all that conditioning and social scripting so they’re like, “yeah, i’m calling bs... i’m going to push back on this.” students developed an appreciation for the collective values of puerto rico, as well as an awareness of the individualistic values embedded in hegemonic us culture. one student reflected on what she learned: i think a lot from yesterday, in talking with a community member, a lot of that really did hit pretty hard and there were points where i did feel like i was tearing up. he had a lot of wisdom and a lot to share in his 70 years of experience… because we’re so individualistic as states-people [continental us], and to see his involvement in his community and that perception of “we’re in this together.” sherwood et al./the problem is 205 students also found new reference points for assessing the value of authenticity and emotional expression. by comparing their own implicit ways of thinking and reacting with what they observed in puerto rico, they gained perspective. students described how they experienced interactions with puerto rican social workers involved in community organizing. another thing …was seeing how passionate everyone was, all the social workers. i don’t know whether saying “[expletive]” was really part of their language, but they got loud, and i really appreciated that because seeing such passionate people and how they’re angry, they’re pissed off, they should be that way! they shouldn’t be complacent…they were angry about the things that were going on before the hurricane. [after the experience] i guess i feel more free to express my opinion. i feel like in the states—the mainland, we’re taught to suppress our opinions and don’t challenge authority and so i learned to conform. students also became aware of the limited rights and resources that puerto ricans have in the us congress and were able to reflect on the increased level of structural oppression of puerto ricans, considering hurricane maria. power dynamics of an inadequate disaster response students expressed frustrations over the relationship of the us with puerto rico and the mismanaged governmental disaster relief efforts following hurricane maria. one of the most frequently discussed skills that students reported developing was listening. students expressed that fema agents, and non-puerto rican volunteers, who came to help with disaster relief assumed they knew what puerto ricans needed and failed to listen to them. it really pissed me off hearing about all the stuff that was delayed, like he was saying. you know, ‘40 days for fema’… and they didn’t come until after a month… and then all these people just taking all this money that’s getting donated instead of helping the people. vultures? yeah. it just really struck me. students critiqued the opportunism of “vultures” who came to take advantage of the crisis in puerto rico at a time of vulnerability. for example, non-local contractors such as whitefish energy company, llc, located in whitefish, montana won a lucrative federal contract to repair the electrical grid in puerto rico and were considered “vultures” by local community members. students came to understand that while individuals and organizations may have been well-intentioned, the services were not always beneficial, reasonably priced, or culturally responsive to the community. moreover, people and organizations with local expertise could have been better employed in disaster relief efforts. students shared that this was a powerful learning opportunity, revealing the importance of empowering clients to direct services based on what they need. students also discussed advances in social work, spring 2022, 22(1) 206 their awareness of the privilege of disaster relief workers who came in the immediate aftermath. it’s just infuriating that people come here, they take hotel rooms, they take supplies, or they come here with tablets… like, really? there was just a major hurricane. no one really has power. it’s just mind-blowing how inconsiderate people can be. they [community members] are saying “people come here, and they think they’re helping and they’re not.” that can make us check ourselves before we go do something in our own town that might not be so helpful as well. i realized the last thing the people in puerto rico need was someone to come in acting like they know what they’re doing, because odds are, they don’t… what probably would have been more beneficial is if the people who came to help actually asked what needed to be done or what was already set into motion. through reading and preparation for the travel component of the service-learning course, students understood that they would work with the community and recognize the expertise and knowledge that is already present, rather than seeing themselves as experts, saviors, or heroes for puerto rico. and what i got from this experience is i’m not necessarily going to go home and be like “wow, i helped puerto rico so much” we learned from them. it’s not what we give to them, it’s what they give to us, type of experience, because there’s so much knowledge to be found here. encountering trauma from natural disasters and marginalization one of the more challenging aspects of the students’ experience was hearing about the trauma from hurricanes occurring in close succession (irma and maria). students spoke about how damaging the hurricanes were to not only physical structures on the island, but to the people who could not escape. students noted the willingness and vulnerability of survivors to share their experiences of trauma. you talk to people here that are so willing to tell their trauma, to tell their experiences and that’s a really vulnerable part of their lives that they’re letting us into that space… i think it’s incredible because i don’t think a lot of other people and other places would be so willing. students expressed that they felt honored to hear the trauma narratives of community members. they also shared their understanding of trauma triggers. six months after hurricane maria, what would typically be perceived as an ordinary experience (e.g., rainfall) became trauma triggers for survivors. one student empathized with a puerto rican social work student who shared her experience with trauma triggers. janelle [pseudonym for puerto rico social work student] told us about the destruction she witnessed, just how scary it was to be somewhere in the midst of a natural disaster with no way of escaping…that to this day even when it rains sherwood et al./the problem is 207 really hard, she gets anxious … afraid that she will have to face that same situation again. students also acknowledged the chronic trauma of being poor and marginalized in puerto rico, a situation which was present before hurricane maria. the ecmp community has no wastewater infrastructure. sewage overflows and enters into people’s homes. children wade through polluted water en route to school. families routinely go without electrical power and sanitation for long periods. a student described how an ecmp community member used emotional suppression as a trauma survival strategy. when jose [pseudonym] said yesterday, “you learn from the time you’re a small child…there’s no time to cry, you just need to survive,” i was like, “aww,” you know…that hit me. likewise, students observed the unrepaired damage to signs, buildings, and roadways that lingered for months. one empathized with the triggering dimension of daily activities, living among the structural ruins of hurricane maria. to see some of the damage as if it were just last week… and to know that people who live here have to see that and be reminded everyday of what they went through, i can just assume that that’s really triggering. you know, to see billboards completely caved over, signs…on the highway they were bent and moved 90 degrees from the winds… and to see that still. that’s rough. in addition to identifying traumatization, students also found that they encountered resilient and self-determined communities. in particular, students found the community of ecmp to be a model in this regard. experiencing self-determined and resilient communities as the students spent time in puerto rico and met with community leaders and citizens, a recurrent message they encountered was one of self-determination and community resilience. when discussing disaster relief in puerto rico, many ecmp residents expressed that if they did not have a self-determined mindset and take action themselves, then nothing would be done. more broadly, puerto ricans described how the government has left them to solve problems and find solutions on their own. i think one of the highs is how determined the people are to fight for their equality and, you know, fight for their homes. that’s just really empowering to me. they want to stay…they want to make things better. despite receiving limited support from the puerto rican and us governments for disaster relief efforts, the puerto rican citizens who stayed relied on each other, as well as on community-based organizations to fight for their homes. there is so much resilience and so much pushing forward… they’re going to persist…yeah, a lot of people did leave the island after the hurricane…but the people that are here, are here for the long run. advances in social work, spring 2022, 22(1) 208 the following exchange between students reveals how they felt empowered to critique systems that oppress vulnerable communities. they observed how the ecmp community organization with whom they interacted taught youth and teens to challenge the status quo through consciousness-raising and action. but i definitely think, seeing how they are instilling in the children to speak up for themselves is so amazing and i think it’s something we can bring back and that we can start—we had a big talk about it the other night, a bunch of us… about how we don’t feel like in the states that they’re teaching you that’s it’s ok to have your own voice. to criticize the establishment? yes. and it might take you a little while until you’re older to start really questioning…questioning for yourself, thinking for yourself, and questioning everything around you. so, i definitely think that that is something we could take with us and something that we can start to change. i think it starts with us… it’s not going to start with our parents. students learned that teaching youth to critically reflect and act was instrumental to creating and sustaining social change. through dialogue and critical reflection, students also made connections between their experiences with community members, hurricanes in puerto rico, and climate change. environmental justice and puerto rico climate change and the disparate impact on marginalized communities is increasingly viewed as a human rights issue (benevolenza & derigne, 2019; chen et al., 2020). environmental justice is predicated on the notion that those who are most vulnerable to the adverse impacts of climate change are also those that are contributing the least to global warming (chen et al., 2020). this understanding enabled students to contemplate the impact of global warming and how it is contributing to the marginalization of vulnerable communities. i think one of the lows is just what we are doing, as a world…global warming. that’s what’s causing their flooding and their hurricanes and that’s just adding more to their poverty… that one lady we were talking to the other night, she said the islands in the caribbean are going to be gone. and these people’s homes are going to be gone forever… they’re not going to have the chance to fight. there’s a wealth in all this knowledge of how we are interacting with people, how poverty works, how these social injustices are stratifying them even to lower and lower situations after every major storm. upon reflection, students found bitter irony in what they came to understand from talking with puerto rican community organizers. they learned that “nature” was not the enemy and hurricanes are anything but a natural disaster. sherwood et al./the problem is 209 when he [community member] said that “hurricanes are not our greatest enemy…or disaster…they don’t create the biggest disaster. it’s the people.” so, i was like, “whoa!” you know? mother nature was not their biggest enemy… it was the people. that will haunt me forever. students were able to not only recognize the power that the us has over puerto rico, but also the privilege that political leaders and wealthy individuals in puerto rico have over the community of the ecmp. despite being a low-wealth community located along a waterway, they have resisted pressures to gentrify their homes. they’ve [developers]created this narrative of it being dangerous, or it being poor, they’re trying to put pressure on those communities to move so they can gentrify the area. and they’ve [ecmp community members] hunkered down, and now they have the land trust, they’re like “we are not moving! we know, even though it’s polluted, this can be cleaned up and it can be rebuilt.” it [conversations with community members] made me aware that political leaders abandoned the citizens…in doing what they needed to survive the storm, these leaders, you know, selfishly hoarded all the resources for their own use. in addition to identifying environmental justice issues, students found that they saw new opportunities for macro-level social work practice. students were able to envision a future that included macro-level opportunities. increased visibility of macro-level practice social work students place emphasis on the micro-practice career paths; 82% of new social workers report securing employment in direct or clinical work (salsberg et al., 2020). however, professional competencies include political engagement, advocacy for marginalized communities, and the advancement of social change. participation in servicelearning was an opportunity for students to see “what macro social work might look like,” by interacting with community leaders, organizers, and puerto rican social workers engaged in disaster relief efforts. being in school i’ve always thought i wanted to do interpersonal work, but now i’m more open to macro and it’s just something i really want to explore after being here. knowing that the demand for macro social work is so much higher in many other parts of the world, to come with an education from michigan in macro social work…i feel like that is a skill that i can bring and something that’s valued. for me, i think it has definitely changed my social work career. i’m in the very early stages of studies and such, but from the classes i’ve taken so far, micro has really been emphasized, but being here and seeing that macro, macro is an option and that it’s something that i think i would really want to do…it has been eyeadvances in social work, spring 2022, 22(1) 210 opening. just seeing how people come together in this organization and how they mobilize themselves and how critical the social workers are to that. in times of political instability and increasing social and economic inequality, macrolevel practice skills are needed. structural oppression is arguably more evident in times of disaster. exposure to disaster relief contexts can expand one’s sense of professional identity as it is constructed through dialogue and action. discussion it can be challenging to teach social work students how to confront oppressive assumptions that are embedded within dominant discourses. social workers must first engage in self-examination to confront the oppressor within themselves, in order to effectively confront oppressive systems (quiñones, 2007). latin american educator, paulo freire reminded us that oppression is an inevitable component of any helping profession (freire, 1968/2018). in the present study, students reported that their assumptions were challenged by a process of critical reflection consistent with the aims of the course and the pedagogical approach. similarly, students observed the traumatic impact of hurricane maria and chronic marginalization, as well as self-determined and resilient communities. students reflected on the power dynamics of disaster relief work in puerto rico, the environmental assaults on the island, and the expanded visibility of macro-level practice opportunities. for social workers to effectively assess, engage and intervene with others, we need to continually reflect on how we intentionally or unintentionally collude with systems of power, privilege, and oppression. “those who authentically commit themselves to the people must reexamine themselves constantly” (freire, 1968/2018, p. 60). pedagogy that engages students in on-going critical selfreflection and action is necessary to empower communities and promote human well-being. in this regard, the ecmp community serves as a model, with deep expertise and experience to offer social workers, community organizers, and disaster relief workers. cultural immersion (e.g., within a service-learning course) involves episodes of decentering or dissonance resulting from cultural experiences for which one has no frame of reference (cordero & rodriguez, 2015; pittman & gioia, 2019; samavar et al., 2007; sherwood et al., 2018). these uncomfortable experiences, sometimes described as disorienting dilemmas contribute to transformational learning (mezirow, 2000). cultural immersion experiences combined with consciousness-raising activities challenge students to examine themselves, their own biases, and their roles as oppressors. newfound selfawareness, skills, and transfer knowledge (see diaconu et al., 2018; gray & schubert, 2011) are not quickly converted to mastery, but rather, emerge as a result of questioning and practice. faculty, field instructors, and mentors play key roles in facilitating transfer knowledge into new contexts. within the service-learning experience, students acknowledged limitations in their knowledge about the social, economic, and political status of puerto rico. some reported confusion and disbelief that puerto ricans, as american citizens pay taxes, and yet are not sherwood et al./the problem is 211 represented in congress. examination of this contradiction, (e.g., the tenet of american history that “taxation without representation” is unjust) opened a space for examination of other knowledge deficits. awareness of the limits of one’s knowledge helps to build a foundation for humility and professional growth. in listening to puerto rican social workers, students began to understand exploitative elements of disaster relief. those seeking to benefit monetarily from the crisis were identified by community members as “vultures.” similarly, students observed that communities experienced fema as slow, inept and presumptuous, failing to consult with local experts and recognize the knowledge and strengths of the people of puerto rico. students recognized that the people of puerto rico did not have a “say.” students were able to translate or transfer this new knowledge to their work “at home.” one student related the need to “check ourselves before we go do something in our own town that might not be so helpful, as well.” students reflected on the chronic and acute traumatization of communities in puerto rico, resulting from economic exploitation, marginalization, and lack of infrastructure, as well as from the suffering and destruction caused by hurricane maria. trauma was viewed as a collective experience, consistent with the findings of prewitt diaz (2017). as one community member put it, “you learn from the time you’re a small child…there’s no time to cry, you just need to survive.” students bore witness to trauma narratives as well as protective strategies for coping with trauma. sounds of rainfall or viewing toppled structures triggered trauma responses in hurricane survivors. social capital, or “the resources available to the individuals within the community undergoing a threat to their resilience,” can be used to bolster an individual with fewer personal resiliency factors (kulig et al., 2013, p. 762). students experienced communities as self-determined and resilient in their reconstruction efforts following hurricane maria. in particular, they observed the work of proyecto enlace and its agile pivot from community organizing to prevent gentrification to community organizing to provide immediate and long-term disaster relief. students learned that hurricane maria was a disaster, but anything but “natural.” they noted that it was “people,” and not “mother nature” that was the problem. students and community members co-created an understanding of the connections between climate change, colonial oppression, and extreme weather events such as flooding and hurricanes. the service-learning experience also made visible opportunities for macro-level social work practice. while micro-practice with individuals and families conjures specific images of working with clients in therapeutic settings, images of how one would work with client systems in macro-practice work are more diffuse. some students conveyed that prior to the course, they did not fully comprehend what macro-level practice could “look like.” students reflected that their experiences in puerto rico led them to appreciate the value of macro-level practice skills focused on community organizing, disaster relief work, and advocacy for structural change. their discussions with organizers from proyecto enlace and puerto rican social workers enabled students to expand their sense of professional identity to include macro-level practice. advances in social work, spring 2022, 22(1) 212 limitations limitations of this qualitative study include the small and somewhat homogenous sample that does not reflect the diversity of students in social work. additional expenses associated with a service-learning course may have influenced the resultant sample and limited student accessibility. potential participants with physical disabilities may have been excluded due to the physical demands of the service-learning component. another limitation includes the researchers’ presence during the focus group, which may have influenced participant responses. a strength of the study is that even with these limitations to accessibility and inclusion, the use of thick description improves the trustworthiness of the data by deemphasizing generalizability. instead, the study offers enough detailed information that readers can determine the “fittingness” or “transferability” of the findings to their own context (lincoln & guba, 1985; rubin & babbie, 2017, p. 452). implications for social work education whether man-made or natural, disasters will continue to inflict destruction, human suffering and trauma around the world, while disproportionately impacting vulnerable communities. increasingly, the distinction between natural and human-made disasters is becoming immaterial because all disasters, whatever the cause, have a human component (dominelli, 2015). hurricanes, earthquakes, and flooding are a result of the cumulative impact of climate change (chen et al., 2020). the global agenda for social work and social development places emphasis on “the social challenges of climate change and environmental degradation and the need for human environments which support life and well-being” (international association of schools of social work, et al., 2020, p. 8). there was a failure of governmental responses to hurricane maria. lack of investment in infrastructure, electrical, stormwater and sanitary systems led to the social, economic, and environmental disaster that befell the island after hurricane maria. non-profit organizations such as the g-8 adapted their agendas to incorporate disaster relief efforts into the scope of their work. on-going financial and service investments are needed in local organizations such as proyecto enlace. local knowledge, leadership, social networks, and governance structures should be central to disaster relief work (patel et al., 2017). the ecmp community has much to teach us about disaster response, trauma, and resilience. the ecmp was among the most vulnerable communities in puerto rico due to longstanding poverty and the lack of infrastructure. however, the ecmp “barrios” built extensive social and community networks prior to the hurricanes through their collective work to establish a public land trust and their efforts to abate recurrent flooding. their work helped build a foundation of community resiliency factors as well as a strong philosophy that “we’re in this together.” the dynamics of power in disaster relief work are complex and contradictory. humanitarian aid has become a profitable endeavor that exploits local communities (dominelli, 2015; jha, 2015). students analyzed the power dynamics of disaster relief and political relations between the us and puerto rico. significant challenges face those who respond to disasters, including social workers, who are among the array of professionals sherwood et al./the problem is 213 that provide vital care (sweifach et al., 2013). social workers intervene to assist in immediate and long-term recovery, working with individuals, families, communities, organizations, and governments. social workers may be victim-survivors, many ignoring their own needs to help others (dominelli, 2015). social workers may imagine themselves as heroes or saviors, conflating their own needs with the needs of those whom they serve (flaherty, 2016). social workers may also oppress people in circumstances of disaster when they fail to acknowledge individual agency and community strengths, listen to their expressed wishes, respond in culturally responsive ways, and understand local political structures. faculty facilitated opportunities for consciousness-raising and collective action (service-learning work), following interactions with puerto rican social workers and ecmp community members. in response to their experiences, students examined their implicit thinking and the ways in which dominant narratives serve to create and maintain power structures. contradictions within their own internalized dominant narratives became more apparent, enabling students to challenge their assumptions. without critical reflection, social work interventions may be ineffective, or worse detrimental (flaherty, 2016). service-learning in the aftermath of a disaster afforded students unique opportunities to apply critical perspectives and critical reflection, develop new skills and knowledge, and engage in action to advance social justice. well-planned service-learning programs can stimulate academic inquiry, promote interdisciplinary learning, civic engagement, career development, cultural humility, and other professional and intellectual skills. teaching in the aftermath of a disaster presents unique opportunities and challenges (chansky, 2019; findley et al., 2015; yordan-lopez et al., 2018). opportunities may include an impetus to rethink teaching approaches, leverage resources in a new manner, and increase empathy. students and faculty may also experience trauma, secondary traumatic stress, risks to physical safety and well-being, and culture shock (mcauliffe et al., 2019). it should be noted that no adverse impacts were identified during the time period of this study. the faculty investigators provided close observation and support to students. data related to secondary traumatic stress effects were not collected in this study, although it is recommended as a variable in future research. learning in the context of disasters may also reveal previously unacknowledged social and economic inequalities and power imbalances. in the era of covid-19, the world is reckoning with the legacies of racism, colonialism, and violence. collective consciousnessraising is also occurring within the social work profession. social work educators must reckon with the intergenerational impacts of social and economic inequality, climate change, personal and collective trauma exposure, covid-19 and the inadequacy of international responses to these intractable social problems. we contend that the increased visibility of underlying structural factors in the context of disasters (see jha, 2015; pintar, 2006) aligns with the increased visibility of opportunities for macro-level practice. we emphasize the need for 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(2008). the aftermath of hurricane katrina: a trauma researcher’s perspective. traumatology, 14(4), 21-26. https://doi.org/10.1177/1534765608323444 williams, c. (2006). the epistemology of cultural competence. families in society, 87(2), 209-220. https://doi.org/10.1606/1044-3894.3514 yordan-lopez, n., hernandez-suarez, d. f., marrero-ortiz, w., marshall-perez, l., & lopez-candales, a. (2018). challenges and opportunities after hurricane maria: university of puerto rico medical students' perspectives. journal of graduate medical education, 10(4), 382-384. https://doi.org/10.4300/jgme-d-17-01024.1 author note: address correspondence to dee sherwood, school of social work, western michigan university, kalamazoo, mi,49008. email: dee.sherwood@wmich.edu https://doi.org/10.1177/1534765608323444 https://doi.org/10.1606/1044-3894.3514 https://doi.org/10.4300/jgme-d-17-01024.1 mailto:dee.sherwood@wmich.edu _________ annie benjamin, msw, harm reduction program associate, aids united, washington, dc. ashton e. santo, lmsw, associate therapist at mywellbeing, new york, ny. sheila p. vakharia, phd, msw, deputy director, department of research and academic engagement, drug policy alliance, new york, ny. kasia malinowska-sempruch, drph, msw, director, drugs policy, global programs of open society foundations, and part-time faculty, international affairs of the new school, new york, ny. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 797-817, doi: 10.18060/24950 this work is licensed under a creative commons attribution 4.0 international license. social workers as potential agents for drug policy reform annie grace benjamin kendra m. ivy ashton e. santo sheila p. vakharia kasia malinowska-sempruch abstract: there is a growing recognition that our society must address systemic racism, mass criminalization and violent policing with alternative responses to crises in communities. reform advocates have increasingly proposed that social workers, equipped with the skills and training to de-escalate tensions and respond to mental health and substance use crises, should work in teams alongside police officers. despite broad support by community stakeholders, law enforcement, and the national association of social workers (nasw), this approach remains fraught if we do not critically examine our role as agents of social control in such systems. a clear case study is the war on drugs, wherein social workers have assumed the role of frontline enforcers through our employment in the criminal legal and child welfare systems, health care, and coercive drug treatment programs. the harsh and punitive laws stemming from the war on drugs have contributed to the mass criminalization of people who use drugs, devastated communities, separated families, and so much more. our focus should shift towards upstream advocacy for policies to reduce the scope of the criminal legal system altogether. we propose suggestions to reenvision social work’s role in less punitive and carceral responses. keywords: drug policy, harm reduction, criminal legal system, child welfare, decriminalization, social workers although many mark the beginning of drug criminalization in the u.s. with president nixon’s comprehensive drug abuse prevention and control act of 1970, the foundations of punitive drug control policy were first laid at the turn of the 20th century with san francisco’s local ordinance against opium smoking (davenport-hines, 2001). in fact, the 1970 act was unique because it was the first federal drug policy that tied funding for drug control and law enforcement with funding for drug treatment and research. however, far more resources were spent on enforcement versus treatment: between 1985 and 2000, “drug offenses accounted for two-thirds of the rise in the federal inmate population” (netherland & hansen, 2017, p. 217), disproportionately affecting black and brown people despite comparable rates of drug use across racial groups (koch et al., 2016). the anti-drug abuse act of 1986 was passed to address a perceived crisis of drug use in general, but the sale and use of crack cocaine in poor black neighborhoods and the births of “crack babies” were particularly sensationalized in the media (beaver, 2010; reinarman & levine, 1997). controversially, the act specified new minimum sentencing laws that applied differentially to crack cocaine and powder cocaine (beaver, 2010; davenportabout:blank advances in social work, summer 2022, 22(2) 798 hines, 2001; reinarman & levine, 1997). the penalties for possessing crack cocaine were 100 times those for powder cocaine (i.e., 10 grams of crack cocaine would lead to the same penalties as 1,000 grams of powder cocaine). crack cocaine was allegedly more addictive, more harmful to users and fetuses, and more associated with violent crime than powder cocaine, but subsequent research and advocacy has both disproven these myths and highlighted their impact on racially disproportionate sentencing practices (beaver, 2010). eventually, president obama’s fair sentencing act reduced the penalty ratio from 100:1 to 18:1 and created pathways for individuals with crack cocaine convictions to have their sentences reviewed. in recent years, lawmakers and the public alike have come to view drugs as a public health issue, leading to meaningful steps to reduce our reliance on punishment and incarceration to address drug use and addiction. however, racial and economic disparities remain in who gets treatment and who gets criminalized: the most privileged people who use and sell drugs remain minimally impacted by the legal system, while those most marginalized are disproportionately criminalized and face insurmountable barriers to adequate healthcare (camplain et al., 2020; netherland & hansen, 2017). there were more drug-related arrests in 2019 in the united states than for any other offense: nearly 1.6 million arrests in total, and more than arrests for all violent and property crimes combined (federal bureau of investigations [fbi], 2020). roughly 20% of all people incarcerated in jails and prisons – 450,000 people – were convicted of drug offenses, half of whom are black or latinx (prison policy institute, 2020; the sentencing project, 2018); an additional 700,000 people are on parole or probation due to drug-related charges (bureau of justice statistics, 2020). meanwhile, national estimates suggest that 20.4 million people in the united states met criteria for a substance use disorder (sud) in 2019, yet only 10.3% received treatment for it in the past year—a rate which has not increased in recent years (substance abuse and mental health services administration [samhsa], 2020a). clearly, a criminal approach to drug use still impacts a significant number of people while most people with suds remain disconnected from treatment and other services. “cogs in the wheel” of the criminal legal system as reisch and jani (2012) highlight, social work practice has been shaped by institutional and ideological forces whose values and aims are often antithetical to those of the social work profession itself. staffed in various sectors of the prison industrial complex—such as jails and prisons, probation and parole programs, and re-entry services—social workers act as “well-intentioned cog[s] in the wheel” (buser, 2020, para. 6). while we enter these spaces with the best of intentions, it is critical to address the ways that criminality, social norms, and constructions of “appropriate behavior” are defined by white, protestant, middle-class, colonialist ideals. leotti (2020) addresses this notion in her analysis of racism and social work practice, citing “social work’s professional identity of helper is built upon colonial scripts of whiteness,” and therefore “serves as a centralizing, organizing principle for practice” (p. 470). consequently, social workers are forced to focus on client situations as being the result of individual choices and decision-making, rather than oppressive structural barriers, systemic racism, and the influence of history and social environments on people’s lives (leotti, 2020; reisch & jani, 2012). embracing an benjamin et al./swk as agents 799 ecological perspective can further gear social work practice towards centering the interactions between systemic racism, the criminal legal system, and individual experience to better understand how our clients are impacted by these intersections and more effectively determine our role in our work. in doing so, we can better serve systeminvolved clients by critically examining connections between existing racialized societal arrangements and marginalization—including how we may uphold such notions and the implications for addressing clients’ needs. in probation and parole, social workers carry out duties associated with law enforcement, serving as “synthetic” parole or probation officers (miller, 2013)— combining social work and law enforcement tactics to maintain surveillance and supervision of their clients through drug testing, monitoring client whereabouts, and programmatic compliance. despite our commitment to advancing human rights and social justice (nasw, 2017), when working within a system focused on social control and oppression, social workers often act as gatekeepers and enforcers to the characteristic coercion and violence of these systems. when faced with “dual loyalty” (buser, 2020, para. 11)—responsibility to employer versus responsibility to clients—challenging the human rights violations we bear witness to (such as extended use of solitary confinement, lack of access to medical care and substance use treatment, and so on) comes second to prioritizing bureaucratic processes and compliance requirements imposed upon us as social workers (jarldorn, 2019). in such a position, “social workers’ ability to exercise these choices is constrained by the priorities of others, particularly the political and economic interests of individuals and groups with different goals, such as policy makers, foundations or individual donors'' (reisch & jani, 2012, p. 1137). in examining these constraints, the conflict perspective can guide us in questioning and challenging the structural functions of incarceration and community surveillance to evaluate who it is we are truly serving, as this perspective calls on social workers to confront the disconnect between so-called criminal justice and social justice to work towards meaningful change on a systemic level. by working in carceral and punitive systems without challenging the structural forces dictating our work, we uphold the values of oppressive systems while failing to adequately serve our clients. the “civilizing violence” of drug courts and mandated treatment in light of the rampant issues in the criminal legal system and a recognition that drug use is a public health issue, many have advocated for alternatives to incarceration for people charged with low-level drug offenses. drug courts have emerged as the one of the most prominent criminal justice reforms with broad bipartisan support, numbering over 3,000 across the united states (office of justice programs, 2020) and processing over 120,000 people per year (marlowe et al., 2016). from their inception, drug courts have been hailed as low-cost alternatives to incarceration that engage people in necessary substance use treatment and interrupt the cycle of “revolving door nature of justice” (flores et al., 2018, p. 7). drug court participants are subjected to “a significantly more intensive case management approach,” incorporating regular drug testing, mandated individual and/or group therapy sessions for addiction treatment, workforce development programs, and a variety of other interventions (witkins & hays, 2019, p. 973). by building a advances in social work, summer 2022, 22(2) 800 multidisciplinary team of actors from the criminal justice system and social service field, drug courts supervise every aspect of participants’ lives to ensure abstinence from drugs and accession to employment. drug court scholars and program providers have referred to this synthesis of criminal proceedings with therapeutic practice as therapeutic jurisprudence. therapeutic jurisprudence is “both a legal perspective and a social movement” that examines how legal actors and systems can have a restorative (or detrimental) impact on “criminal offenders” (madden & wayne, 2002, p. 488). in theory, practitioners of therapeutic jurisprudence utilize aspects of the person-in-environment (pie) perspective, addressing participants’ substance use in the larger context of their physical and mental health, economic stability, and social environment (kondrat, 2013). in practice, however, judges with little to no addiction expertise wield ultimate decision-making power over participants’ treatment course, often barring people from evidence-based treatments such as methadone or buprenorphine due to stigma (friedman & wagner-goldstein, 2016). the drug court philosophy is based on a “carrot-and-stick” approach: reward good behavior and punish bad behavior (kaye, 2019). staying abstinent and obtaining employment – no matter how painful the withdrawal or how menial or low-wage the work – are examples of good behaviors that judges reward with verbal praise (gallagher et al., 2019). the failure to maintain sobriety or employment, drug courts promise, will be met with “swift and certain sanctions” (fisher, 2014, p. 761). punishments can include apology letters for misbehavior; mandated work details; and even shock incarceration, a period of confinement ranging from 24 hours to a week or more at a time (fisher, 2014; lilley, 2017). incarceration in the context of drug courts is often constructed as a “therapeutic move” or a “timeout,” where relapsing participants detox in jail when they struggle to remain sober on the outside (gibbs et al., 2021, p. 41). sanctions are not uniform across drug courts, and in fact may vary from participant to participant within a single court: drug court providers reject strictly regimented sanctions, yet discretionary sanctions “are not always levied in a progressive manner” (gibbs et al., 2021, p. 40), disproportionately falling on participants who struggle to meet the court’s standards (gibbs et al., 2021). in addition to directly participating in the sanctioning process, social workers and case managers who work with drug courts are compelled to report any instance of program non-compliance so their clients receive “appropriate” punishment. the combination of carceral and non-carceral sanctions often extends the time that participants spend under criminal supervision far beyond that of a traditional jail sentence (drug policy alliance [dpa], 2011). while “successful” participants may spend less time behind bars, “any benefits realized from a lower incarceration rate are offset by the long sentences imposed on participants when they fail the program” (sevigny et al., 2013, p. 416). this pattern is particularly insidious, considering that low-income and black individuals are more likely to be arrested for low-level drug offenses; disqualified from participating in drug courts in the first place; and expelled from drug court treatment programs, thus sentencing them to the maximum jail or prison time dictated by their initial conviction (dpa, 2011). these differences are not immutable, but a result of both individual and structural biases that lead providers across disciplines to treat “some addicts — who just happen to be poorer and/or members of communities of color — [as] sicker benjamin et al./swk as agents 801 than others, requiring a more forceful dose of medicine to recover” (whetstone & gowan, 2017, p. 109). this punitive approach to problematic drug use deprives clients of their right to self-determination and perpetuates racist notions of criminality and delinquency. court-mandated treatment undermines the establishment of trust and a collaborative spirit between social workers and their clients. an investigation of “strong-arm” rehab centers in the united states found that many social workers and case managers view their clients as not only addicted to drugs, but also “addicted to the lifestyle” (whetstone & gowan, 2017, p. 91). the “drugs lifestyle” is characterized by tardiness, impulsivity, defiance, and disrespect for authority; while seemingly colorblind and class-blind, this collection of traits harks back patrick moynihan’s manifesto on the “culture of poverty” supposedly instilled in black youth by their absent fathers and overbearing mothers (kaye, 2019, p. 71). social workers and counselors in “strong-arm” rehab centers often view themselves as agents of “habilitation,” treating their clients as “deceitful, manipulative, impulsive, and openly defiant… criminal-addicts [who] had not been properly socialized and needed to be remade rather than restored” (whetstone & gowan, 2017, p. 92). kerwin kaye (2019) has referred to this punitive treatment as a kind of civilizing violence, akin to the brutality enacted against enslaved africans and indigenous peoples under the guise of inducting them into proper personhood. this context of coercion and punishment breeds hostility between social workers and their clients. therapist-client confidentiality is necessarily waived as in-session interactions are routinely submitted for judicial review (roberts et al., 2015). all disclosed drug use or urge to use drugs is reported to the court to ensure “swift and certain sanctions,” up to and including jail time (fisher, 2014, p. 761). behaviors and attitudes brought up in counseling sessions, regardless of their direct relevance to a participant’s drug use, are frequently introduced in court proceedings and scrutinized for adherence to the court’s recommendations (tiger, 2011). through these proceedings, social workers become key decision makers in all aspects of a participant’s life, controlling where and with whom they live and spend leisure time; what jobs they take and how long they stay; when they can see their children; whether they can pursue a ged or other educational requirements; and their self-conception as full human beings (kaye, 2019). the drug court paradigm rests on racist ideology. the so-called “drugs lifestyle” and “culture of poverty” are not intractable social problems, but oppressive social constructions that drug court professionals weaponize against impoverished and racially marginalized individuals. no social worker should intentionally or negligently promote such ideas, for they are anathema to social workers’ ethical mandate to uphold the dignity and worth of every person (nasw, 2017). relying on the criminal legal system to coerce people into treatment is unjustifiable when voluntary, holistic services provide comparable or better outcomes (american public health association [apha], 2013). social workers must critically consider our roles in legitimizing racist drug war mythologies and challenge punitive measures against people who use drugs within drug courts and the programs that serve them. social work and separation in the family regulation system advances in social work, summer 2022, 22(2) 802 approximately half of all social workers in the u.s. serve families and children, largely in the context of child protection, child welfare, and foster care agencies (bureau of labor statistics, 2020). the child welfare system is a clear example of a call for help that leads to the dispatch of a social worker, rather than a law enforcement officer: yet, the harmful consequences are just as devastating. most reports to child welfare agencies are for neglect (administration for children & families [acf], 2020), often due to drug use or the possibility of it. insufficient evidence links drug use with child maltreatment (i.e., neglect) and compromised parenting skills, yet any trace or suspicion of marijuana use (or any illicit substance) by the parent can lead to an investigation with the risk of losing custody (hart, 2021). this is a crude instrument at caseworkers’ disposal, as it assumes the use of any drug is cause for neglect. furthermore, substantial research has demonstrated the determinative role of race in child removal (siegel, 2021). when a neglect case is opened, the relationship between social worker and parent can become punitive in nature, rather than collaborative and supportive. caseworkers assign parents rigorous and cumbersome family service plans that typically include parenting skills classes and other interventions which may incorporate surveillance, such as drug testing and family court conferences—all in addition to their caregiving responsibilities. rather than identifying family attributes and assets and strengthening them with the provision of resources (such as childcare and/or in-home supports targeting root causes of neglect to promote family preservation), “at-risk” children are typically removed and placed into foster care without prevention measures implemented or after punitive interventions are deemed unsuccessful (roberts & sangoi, 2018). family regulation systems disproportionately target black, brown, and indigenous families (roberts & sangoi, 2018) and their involvement can inflict significant long-term trauma and disruption for the children and families (acf, 2020). for the families in which marijuana use is involved, it is particularly significant as it may be the sole reason their case is opened and intensely investigated (ketteringham, 2019). in the name of child safety and well-being, social workers act as a surveillance mechanism in the regulation and control of families of color. the criminalization of drugs and poverty perpetuated by the child welfare system directly conflicts with our profession’s mission—and often results in greater harm to the children and families under the system’s microscope. not only do children suffer poorer physical and mental health when separated from parents, but parents suffer as well: women of color with substance use disorders whose children are forcibly removed from their care are uniquely vulnerable to relapse and overdose (thumath et al., 2021). in areas with high overdose rates, child removal has increased significantly in recent years, yet treatment and support services to parents are significantly lacking (waite et al., 2018). this is a crucial issue, especially as multiple states are at capacity for foster care, leading to children being placed in remote out of state locations, making reunifications less likely (child welfare information gateway, 2017; the imprint, 2017). furthermore, the criminalization and stigmatization of substance use during pregnancy leads people to avoid seeking treatment for fear of losing their child and/or being incarcerated (stone, 2015). placing emphasis on punishment rather than support and connection, social workers involved in the family benjamin et al./swk as agents 803 regulation system are putting children and parents at greater risk of physical and mental health complications. recommendations for change action step 1: join the movement to advance drug policy reform the fifty year-long war on drugs has not eliminated drug use, addiction, or overdose, but has actually created the conditions for an unregulated drug market, a violent underground drug economy, and stigma that deters many from seeking help (coyne & hall, 2017). one of the most important aspects of ending the drug war is decriminalizing drug use and possession. nearly 87% of all drug-related arrests are for personal possession, entrenching over a million people into the criminal legal system annually while saddling them with lifelong criminal records (fbi, 2020). many of these individuals have substance use disorders that will go unmanaged as long as they are faced with the trauma of arrest rather than given access to harm reduction services, medical care, or substance use treatment. in fact, drug enforcement sabotages efforts at achieving recovery by inhibiting access to housing, employment, and public benefits; stripping individuals of their citizenship and/or deporting them; and impeding their ability to retain custody of their children and provide for their families. it is by no coincidence that the majority of those ensnared in the ever-widening net of the drug war are from low-income communities of color, locking in generational trauma and impacting their ability to accumulate intergenerational wealth (siegel, 2021). criminalization is especially harmful in the context of the current overdose crisis killing people by the thousands. it is essential that people who use drugs feel safe contacting the authorities to seek help, report an overdose, or alert them to dangerous batches of drugs—for example, heroin adulterated with the powerful synthetic opioid fentanyl (lohman & malinowska, 2019). provisional us overdose data indicate that there were an estimated 102,568 drug overdose deaths in the united states during the 12-month period ending in november 2021, an increase of 15.7% during the same period the year before (ahmad et al., 2022). in 2020, oregon approved the first all-drug decriminalization ballot measure in the united states, which removes criminal penalties for drug possession while expanding the state’s network of harm reduction and evidence-based addiction treatment services (health justice recovery alliance, 2021). a racial impact study found that this could reduce drug convictions among oregonians of color by 90% (oregon justice commission, 2020). a study conducted by the oregon health authority on outcomes at the one-year anniversary of implementation found that 67 organizations and 11 tribal organizations received over $30 million of funding for substance use treatment, peer support, harm reduction and housing and over 16,000 people accessed services (2022). this could serve as a model piece of legislation to show that when people are not punished and services are affordable, accessible, and evidence-based, people will seek help. marijuana legalization also remains an important area of drug policy reform, since onethird of all drug possession arrests are for marijuana, and black people are over three times more likely to be arrested than white people despite comparable rates of use (american advances in social work, summer 2022, 22(2) 804 civil liberties union, 2020; fbi, 2020). state campaigns for legalization have gained increasing support as public opinion has shifted in recent years, and revenues from regulated markets have been used to increase funding for prevention and treatment services. by advocating for drug policy reform, we are actively alleviating the burden of punitive systems that harm our clients. in eliminating criminal sanctions related to drug use, we can break down barriers to housing, treatment, employment, and many other resources that contribute to one’s dignity, worth, and well-being. as professionals who are ethically obligated to support our most vulnerable and marginalized communities while challenging social injustice, social workers must advocate for policies that contribute to the end of the war on drugs. action step 2: reinvest in communities through expanded treatment options and harm reduction services successful implementation of decriminalization is contingent on reinvesting in communities most impacted by the drug war. we must ensure equitable access to an evidence-based continuum of care for people who use drugs – from harm reduction services, to low-threshold outpatient treatment, to intensive residential treatment. the availability of a broad range of services serves to improve health and well-being and reduce contact with the criminal legal and other punitive systems among people who use drugs. this will particularly benefit those who are most at risk of drug-related harms and in the greatest need of services, such as people who inject drugs (pwid) and people experiencing homelessness (apha, 2013). as noted earlier, 90% of people with suds did not utilize substance use treatment services: among those who perceived an unmet need for treatment, the top reason for not seeking treatment was an unwillingness to pursue total abstinence (samhsa, 2020a). many harm reduction interventions reduce the likelihood of fatal drug-related consequences without imposing sobriety, including syringe service programs (ssps), naloxone access initiatives, overdose prevention centers, and drug checking services. unfortunately, due to the criminalization of drug paraphernalia and stigma against illicit drug use, most of these interventions are inaccessible in most of the united states, particularly in politically conservative states, rural communities, and communities of color. many states still do not have legal ssps, and those that do cannot meet demand; there are only two functioning legally sanctioned overdose prevention centers in the entire nation; and harm reduction is absent from most addiction treatment programs. increasing access to ssps, overdose prevention centers, and harm reduction services can increase referrals to addiction services as well as transform addiction treatment to accommodate a wider range of drug use behaviors and desires. social workers can expand access to drug treatment for underserved populations by connecting clients to harm reduction services as well as becoming harm reduction practitioners ourselves. harm reduction and social work are ideologically aligned, centering client self-determination, meeting the person where they are at, and working collaboratively to advance autonomy and client-defined goals (vakharia & little, 2016). benjamin et al./swk as agents 805 in acknowledging a client as the sole expert on their life experiences, social workers collaborate with clients in treatment planning and goal setting: treatment evaluations are based on quality-of-life factors and individual signs of progress, rather than on paternalistic definitions of progress determined by a judge or program. social workers should connect clients with harm reduction services that can provide safer use education and supplies relative to the client’s expressed interest. equally important — if not more so — is the active participation of social workers in the harm reduction sphere as educators, providers, and advocates. though harm reduction closely aligns with the social work ethic of client self-determination, social work education on people who use drugs has thus far failed to meaningfully integrate harm reduction practices and encourage social workers to become harm reduction specialists. action step 3: employ a critical race theory lens to repair the harms of the drug war to truly challenge anti-drug stigma perpetuated by institutional racism and advance the health and safety of those we serve, social workers should incorporate critical race theory (crt) into practice. as a framework aimed at transforming the relationship between race, racism, and power which uphold racial inequality, crt challenges the ways society and social processes reflect the white experience (kolivoski et al., 2014). this is especially crucial at a time when black, latinx, and other people of color are less likely to receive medication-assisted therapy (mat) despite increasing rates of opioid overdose fatalities (jordan & jagede, 2020). to adequately expand services for all who wish to receive them, social workers employing a crt lens can better understand how these populations continue to be disproportionately harmed by drug war enforcement and are therefore systematically less likely to access existing treatment options for opioid use disorder (jordan & jagede, 2020, p. 415). employing crt in practice is vital to justly reinvesting in low-income and communities of color that have been devastated by the war on drugs, where too often an emphasis on criminalization prevents funds from being allocated to community-building resources and public entities (chung & pearl, 2020) such as schools, parks, and healthcare facilities. through a crt lens, reinvestment efforts include building capacity among community members to collaboratively address community-defined social problems. to address the varying aims of reinvestment, we must not only do work in marginalized communities, but commit to doing long-term, collaborative work with community leaders and local advocates. instead of ushering in predominantly white, licensed (and therefore graduate-educated) social workers to define and control essential social services, repairing harm must be centered on the voices and knowledge of local stakeholders. crt acknowledges that historically, the voices and experiences of people of color have been systematically left out of mental health and substance use treatment systems (kolivoski et al., 2014). as reisch (2019) points out, “social work’s response to the challenges faced by marginalized populations frequently reflected a seemingly intractable cultural divide that separated social workers from the people with whom they worked” (p. 595). commonly led by state and local governments, community reinvestment advances in social work, summer 2022, 22(2) 806 efforts have been found to often reflect the priorities of policymakers and local officials, failing to take into consideration the needs of residents (chung & pearl, 2020). incorporating crt into social work practice requires uplifting the voices of affected communities through establishing trust and working with local community-based organizations, drug user advocates and people who use drugs, and outreach workers on the ground who are already doing harm reduction work. by centering as experts those most impacted by the harms of drug policy, social workers can better ensure access to services is not only expanded but done so in a way that amplifies the demands of the communities we serve (kolivoski et al., 2014). action step 4: support community-based justice & public safety initiatives social workers should support and advance efforts to implement public safety initiatives that divert crisis intervention duties from police to community organizations. without the presence of law enforcement, mental health practitioners and community members can effectively deescalate conflict while demonstrating respect, dignity, and humanity toward those in crisis. rather than threatening incarceration and perpetuating the harms of the carceral system, crisis intervention teams can connect people to the resources they need to live fulfilling lives, including stable housing, childcare, and employment. police have become default responders to all types of emergencies due to the absence of appropriate non-police options in most communities (friedman, 2020). currently, there are over 6,000 independent call centers, including fire departments, emergency management and law enforcement, in the u.s. (911.gov, n.d.), and most calls placed to these centers are unrelated to crime (neusteter et al., 2020). though mental health crises comprise only 10% of all 911 calls, they have been the pretext of 25% of all fatal police shootings over the past six years (coles et al., 2021). 911 calls for behaviors not presenting as threats to public safety must be diverted to professionally trained behavioral health practitioners and community public safety teams, as police involvement – particularly for black, latinx, and indigenous people in crisis – is far too often a matter of life and death (samhsa, 2020b). diversion and alternative response models law enforcement assisted diversion/let everyone advance with dignity (lead) began ten years ago in seattle to counter the disastrous impact of the war on drugs by responding to low-level drug and public order offenses with referrals to harm reduction and other social services (lead national support bureau, n.d.). with 50 parallel programs operating across the country and numerous more in progress, lead’s model engages a range of stakeholders, such as civil rights advocates and community leaders, to create preemptive interventions aimed at interrupting the cycle of arrest, incarceration, and recidivism. referred individuals participate in an intensive harm reduction case management program that is premised upon a trauma-informed model that addresses problematic substance use and mental health issues as well as unstable access to employment, housing, and other resources individuals need to thrive. in lieu of abstinenceonly edicts, lead practitioners offer participants a full array of interventions, including benjamin et al./swk as agents 807 mat. that said, prosecutors and police remain present in lead programs, intervening should a participant be re-arrested. a study comparing lead participants to a comparison group found that lead clients had 1.4 less yearly average jail bookings, over 40 less days per year in jail detention, and were 88% less likely to be incarcerated (collins et al., 2019). there were significant governmental budgetary savings as well: legal fees for non-lead participants rose to nearly $6,000, whereas legal costs for participants in lead declined by $2,100. while this framework represents an important step towards a gentler war on drugs, future iterations of this model should strongly consider eliminating police involvement. based in austin, texas, integral care's expanded mobile crisis outreach team (emcot) began as a "dispatch and co-response" pilot program in 2013 prior to achieving full operational capacity in 2014 (arellano, 2020). emcot aimed to provide a more appropriate response to mental health crises via 911 calls by adding mental health clinicians to work in tandem with emergency medical service (ems) responders and, subsequently, the austin police department (apd). in february 2021, the county's 911 call center became the first in the country to add a separate prompt for mental health calls: if the operator believes no safety risk is present to the caller or public, the call is diverted to a mental health team from integral care, a long-standing community-based mental health center (integral care, n.d.). emcot clinicians can potentially address concerns via phone or dispatch a mobile crisis unit until they can arrive to conduct a mental health assessment and connect a person in crisis to behavioral health services on a voluntary basis. for a 90day period after the crisis assessment, emcot keeps in touch with clients to ensure continual access to case management, counseling, and addiction treatment, which take place at client-preferred community-based locations (the meadows mental health policy institute for texas, 2019). nearly 100% of emcot participants avoided jail time; almost 80% also avoided inpatient stays at hospitals or psychiatric units. compared to the cost of $700 per police officer dispatch, emcot dispatches cost only $400 (delaus, 2020). emcot’s incredible success has led to a budget increase to $3 million annually, enabling clinicians to provide around-the-clock diversion services (thornton, 2020). furthermore, austin’s newly created reimagine public safety fund aims to provide funding for alternatives to policing initiatives throughout the city. operated by white bird clinic, a federally qualified health center and entrusted community institution providing services for both emotional and physical health in eugene, oregon for more than half a century (white bird clinic, n.d.), cahoots (crisis assistance helping out on the streets), a pioneer in community-based alternate public safety responses to law enforcement when established over 30 years ago, functions as a 24/7 free, voluntary, and confidential program using mobile crisis teams comprised of medics and highly trained behavioral health practitioners to respond to non-violent emergency calls. it has perhaps become the most influential model of its kind due to the abundance of media attention over the years spotlighting its positive impact (gerety, 2020). funded primarily by the city, teams de-escalate and stabilize individuals with emergencies related to substance use and mental health among others, humanely using the least amount of intervention while relying on existing partnerships with a network of resources in the local community to ensure continuity of care following the immediate crises (program in advances in social work, summer 2022, 22(2) 808 criminal justice policy and management, 2021; white bird clinic, 2020a). in 2017, 17% of calls to the eugene police department were answered by cahoots (white bird clinic, 2020b). over a 5-year period, 2014-2019, cahoots' on the ground response levels nearly doubled (9,646-18,583; eugene police department, n.d.), and in 2019, police back up was requested in only 1% of the 24,000 calls. the cahoots program in eugene yielded an approximate annual cost savings of $8.5 million in public safety funds in addition to an estimated $14 million savings in both ambulance transport and emergency room services for 2019 (white bird clinic, 2020a). for fiscal years 2018-2021, a more than 20% increase in funding allocation from the city was realized (eugene police department, n.d.). the cost of preventing the potential harms from law enforcement, though, cannot be understated (white bird clinic, 2020a). as communities continue to grapple with reimagining public safety, the groundbreaking cahoots act, sponsored by two members of congress, was incorporated into the $1.9 trillion american rescue plan 2021 signed by president biden in march 2021 (butler & sheriff, 2021). the act is premised upon the cahoots mobile crisis team model, thereby serving as a powerful impetus for the development and implementation of similar initiatives to counter the criminalization of emergency responses to mental health crises in the u.s. as alternatives to law enforcement in the public safety domain progress, states using mobile crisis intervention units will be eligible to receive an enhanced matching medicare rate of 85% for three years, likely spurring a proliferation of these programs across the nation (butler & sheriff, 2021). public community safety approaches and models with limited to no law enforcement contact can be achieved through diverted funding from restructured police budgets (pearl, 2020). these models should fall under the auspices of a separate civilian-led governmental office of public safety with its own designated emergency response call number. not only will this communicate a meaningful message from the government about its commitment to safer emergency response systems, particularly to those most impacted by police violence, but it could increase the likelihood of a sustainable funding stream from the government (pearl, 2020). one such program in development is the albuquerque community safety department, a cabinet-level civilian department of community safety premised upon a public health framework. it is slated to have a 911 public safety diversion option for calls involving substance use and addiction, mental health issues, and homelessness that are deemed non-violent at point of phone contact, and staffing will include social workers and violence prevention specialists, among others (city of albuquerque, 2020). additionally, we advocate for drug reform decriminalization laws coupled with harm reduction centered approaches that fall within the public health sphere, thereby avoiding the trauma of further criminalization of public order behaviors (sherman, 2020). best practices for planning public safety initiatives public safety initiatives must begin with the assembly of a diverse task force composed of a wide range of stakeholders, including faith/community leaders, civil rights advocates, restorative/transformative justice activists, and behavioral health providers (denver task benjamin et al./swk as agents 809 force, 2021). task forces should elevate the contributions of people with lived expertise on drug use, police brutality, and mass incarceration, centering their vision of what safety means in their communities (policing project & the justice collaboratory, 2021; virani & gasser-ordaz, 2020). essential to this process is the task force’s independence from the influence of elected officials and meaningful power over program development and implementation. task force members will be charged with developing comprehensive training for call center operators; staffing of behavioral and mental health specialists; and creating emergency response protocols adaptive to a wide variety of situations. community-based public safety initiative planners would do well to incorporate funding streams and safeguards (pearl, 2020; virani & gasser-ordaz, 2020); program evaluation and intervention; and advocacy for complementary policy proposals, including all-drug decriminalization (sherman, 2020). as the movement towards reimagining public safety progresses, the next generation of social work students should be at the forefront of critically analyzing existing models and programs as well as those in the pipeline, while gaining an essential appreciation of historical underpinnings (gregory, 2021; jacobs et al., 2021). through first-hand experiential learning, students should be challenged to devise innovative alternative models through participation in the creation of initiatives with communities served via field placements and/or arrangements offered by schools (jacobs et al., 2021). applying the core ethical principles from the nasw code of ethics, such as challenging social injustice and respecting the inherent dignity and worth of the person (nasw, 2017), in addition to racial justice, those on the path to professional practice will thereby acquire valuable and necessary knowledge and skills to inform their practice (reisch & jani, 2012). our actions require efforts towards relinquishing our role in systems of oppression; social workers must embrace preventing and mitigating harm rather than participating in its infliction (jacobs et al., 2021). discussion and conclusion the values and principles outlined in the social work profession’s code of ethics must not continue as merely words on a document. striving for social justice, respecting the dignity and worth of all clients and communities, and addressing the root causes of social problems must be inherent in social work practice, especially when working with populations historically marginalized and oppressed by the very institutions we represent. it is not enough to denounce stigma and discrimination when we are actively contributing to it. at a time when calls for anti-racism, police reform, and social change are becoming mainstream we must look inward at the role of social workers, past and present, in creating today’s social conditions to determine how we can better contribute to creating an equitable society. in other words: we must examine our positionality to hold ourselves accountable to take social work’s guiding principles from print to practice. in the drug policy sphere, until we not only recognize, but challenge the oppressive rules, regulations, and practices that often come before our clients in the criminal justice, drug court, and family regulation systems (among others), we are merely enforcing our own form of social control. by advocating for and enacting decriminalization, harm advances in social work, summer 2022, 22(2) 810 reduction, community reinvestment, and community-based public safety initiatives in our practices and policies, we can begin to detract our complicity in maintaining the status quo and instead provide anti-carceral, person-centered social work services. critical to this approach is incorporating the voices of those disproportionately impacted by social, economic, and racial injustices. as we commit to looking within our profession to improve social work practices and principles, assessment and evaluation along the way will be tantamount to ensuring the sustainability of services rooted in human rights, anti-racism, and social justice. references 911.gov. 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(2019). drug court through the eyes of participants. criminal justice policy review, 30(7), 971-989. https://doi.org/10.1177/0887403417731802 author note: address correspondence to annie benjamin, aids united, washington, dc, 20006. email: abenjamin@aidsunited.org https://whitebirdclinic.org/wp-content/uploads/2020/06/cahoots-media-guide-20200626.pdf https://whitebirdclinic.org/wp-content/uploads/2020/06/cahoots-media-guide-20200626.pdf https://whitebirdclinic.org/what-is-cahoots https://whitebirdclinic.org/about/ https://doi.org/10.1177/0887403417731802 mailto:abenjamin@aidsunited.org _________ nancy digby franke, phd, msw, assistant professor, department of social work, la salle university, philadelphia, pa. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 185-203, doi: 10.18060/25825 this work is licensed under a creative commons attribution 4.0 international license. understanding privilege and engaging in activism: elevating social justice in social work nancy digby franke abstract: in order to best serve clients and be effective “social change agents,” social workers must unpack their own privilege, learn about injustice, and work to dismantle interconnected systems of oppression. one way to do so is through engagement in social activism. this cross-sectional study examined intersectional demographic identities and knowledge of racial and heterosexual privilege as related to participation in political and social activism among a sample of 310 msw students. knowledge of heterosexual privilege was positively associated with engagement in political and social activism. people who identified as bisexual, gay, lesbian, or queer, as well as macro-focused students, reported significantly more activism engagement. a statistically significant difference was found in activism according to an intersectional race and gender variable and a race and sexual orientation variable as well. the study highlights the importance of including a critical approach to social work education that centers discussions about systems of power as oppressive forces that impact marginalized people and communities. msw curricula must encourage engagement in advocacy and understanding of privilege for clinical and macro students alike. keywords: social justice; social work; activism; privilege; intersectionality social workers have an obligation to question and oppose systems of oppression that perpetuate social injustice and racial inequality. on the individual level, that begins with an understanding of privilege—both one’s own privilege and the ways that privilege is created and maintained through cultural norms and structures. dissecting systems of power and how those systems of power impact people on a variety of levels is at the heart of enacting sustainable, long-lasting change. since privilege and oppression do not exist one dimensionally, an intersectional approach to privilege is needed. from a more macrofocused perspective, engagement in broader policy and system change is often demonstrated through participation in social action. tenets of social justice and racial equality are explicit in social work values and must be instilled in social workers during their educational tenure. intersectionality defining intersectionality is a challenge, as it bucks clearly delineated classifications (collins, 2015), opting for a more inclusive both/and approach. it is a way to consider a person as a whole made up of overlapping and sometimes clashing identities that are impossible to disaggregate (crenshaw, 1991; hancock, 2013). intersectionality also requires a thorough examination of the ways that systems of oppression interact with one another to control and subjugate people of different identities. at its core, intersectionality is about the relationship between people in different coalitions as they relate to power and about:blank advances in social work, spring 2023, 23(1) 186 privilege. intersectionality requires a rejection of clean, distinct categorizations of different people. audre lorde (1984) expressed her frustration of “constantly being encouraged to pluck out some aspect of myself and present this as the meaningful whole, eclipsing and denying the other parts of the self” (p. 120). in a seminal work, crenshaw (1991) explained these aspects as coalitions—and sometimes future potential coalitions—that exist within individuals. presenting these aspects of the self as coalitions requires that we consider the shared space of solidarity and heterogeneity (carastathis, 2013; cole, 2008). this is in opposition to an identity focus, which is centered on the idea of harmonious homogeneity and belonging (carastathis, 2013). in spite of—or perhaps because of—the world’s complexities, social workers need to approach the world through an intersectional lens. social workers must recognize interacting systems of oppression and how those systems impact people’s lives (simon et al., 2022). in other words, social workers must interrogate the “matrix of domination” (collins, 1990, p. 227) as it relates to individuals and communities. only by understanding and addressing interlocking oppressions can real change happen. otherwise, individual client lives may only improve in one-dimensional, superficial, and temporary ways. as is done with an intersectionality lens, social workers must center relationships and the ways that identities are connected to privilege, power, and oppression. social work pushes its workforce to center clients as the experts in their own lives, recognizing that an outsider has a limited understanding of someone as they affect and are affected by their environment (national association of social work, n.d.). while social work’s values are clear, the theoretical framework through which to approach those values remains less so. cultural competency, diversity, and multicultural approaches have all been applied to social work education, but have failed to address the nuanced, multi-leveled needs of the populations we serve (pulliam, 2017). critical race theory (crt) aligns with the professional values of the national association of social work (nasw) and council on social work education (cswe) and moves beyond social work’s false micro/macro dichotomy (pulliam, 2017). intersectionality is one of crt’s core tenets (delgado & stefancic, 2012). privilege one way that social justice commitment can be considered on an individual level is through understanding the role of privilege in the social worker’s own life, the lives of clients, and the world more broadly. privilege protects people in the dominant group from “many kinds of hostility, distress and violence” and works to “systematically over empower certain groups” (mcintosh, 1989, p. 11). without discussions about privilege and power, education about diversity and social justice falls short. when the latter occurs without the former, the learner is able to ignore personal responsibility and imagine privilege as merely a theoretical concept enacted by a distant other (abrams & gibson, 2007). addressing privilege is an important first step for social workers. acknowledging one’s own privilege is often met with resistance within master of social work (msw) classrooms (abrams & gibson, 2007; abrams & moio, 2009). garcia and van soest (1997) surveyed 43 msw students enrolled in a required course on diversity and franke/privilege & engaging in activism 187 oppression and found that 71% of white students identified white privilege as a barrier to understanding and learning about oppression. social work is based on the idea of meeting people where they are, which requires social workers to be knowledgeable and reflective about the historic and current systems of oppression that impact clients’ lives while maintaining a firm understanding of themselves and their own positionality. this is true for social workers in all fields, as intersecting systems of oppression impact clients’ lives in child welfare, education, criminal legal, substance use interventions, financial social work, and in all other systems and institutions. unless social workers unpack their own privilege, they will not be able to be open to clients as experts of their own lives. instead, their interpretation of clients will be done through an unexamined, yet omnipresent lens of privilege and unconscious biases unchecked without that examination (abrams & gibson, 2007; keenan, 2004). the intersection of privilege and power influences knowledge and becomes action. deliberate, social justice-oriented practice can only be realized once privilege and power are acknowledged and explored. this exploration must be a continual process for social workers interacting with individuals, communities, and institutions, especially given social work’s history of contributing to and compounding control. though social work began with a concern for black people, that concern largely deteriorated until the civil rights movement. the profession has continuously failed to investigate and be transparent about that complicated history or the way white people and/or social workers have been complicit in at best ignoring and at worst attacking black people’s well-being (snowden et al., 2021). centering conversations about privilege is not a new idea. in the seminal work, “white privilege: unpacking the invisible knapsack,” mcintosh (1989) explained that white people are often taught about racism as something that disadvantages people of color, but not that benefits white people. this lack of understanding and acknowledgement of privilege begets unconscious oppression and bias. thus, white people are taught to see themselves as the neutral ideal and so understand their goal to be to lift up people and communities of color to be more like them (mcintosh, 1989). given the common racial, gender, and economic differences between social workers and social work clients, this elitist perspective cannot be ignored. social workers need to manage personal bias and individual values through self-awareness and self-regulation in their work with marginalized communities. they must first acknowledge their own biases, privilege, racism, and power, and recognize the complex ways that systems and structures construct and are constructed by such influences before they will be able to address them in their work. though these types of processes and courses are necessary, it is important to recognize the harm they may inflict on non-white students. in courses about racism—a standard in many msw programs—white students learn about white supremacy and consider their own whiteness critically, perhaps for the first time and perhaps while their black and brown peers are forced to witness microand macro-aggressions, clumsy “awakenings,” and white guilt (hanna et al., 2021). advances in social work, spring 2023, 23(1) 188 activism social activism is one avenue through which social workers can apply their knowledge of and dedication to addressing systemic oppression. activism provides a through-line for various levels of social work and illustrates social workers’ understanding of strategies to address structural, marginalizing barriers that impede equality and justice. activism is also connected to intersectionality, which requires a broader view of how people and systems interact to create and reinforce power and privilege (crenshaw, 1991; hooks, 1984). allyship is an iterative, perpetual process that requires going beyond self-reflection and towards actively disrupting racism and other forms of oppression (gates et al., 2021; massey & johnson, 2021). aguilar and counselman-carpenter (2021) caution us against the assumption that actions done with good intentions are more than a mirage, and point out that white female heterocentric social workers have used certain strategies (e.g., hiding behind the data, participating in anti-racist book clubs, and crying) to avoid impactful discussions and actions about combating racism and other forms of oppression. activism must dismantle the systems that perpetuate marginalization and oppression, with social workers engaging as “woke disruptors” who center social justice (donohue-dioh et al., 2021, p. 1045). despite clear assumptions by both nasw and cswe that social activism is a requirement for all—and not just macro-focused social workers—few studies have examined msw student participation in social activism (mizrahi & dodd, 2013). social activism participation among social work practitioners seems to range from 44% to 99%, depending on the measures and definition of activism used, which suggests that individuals generally report engagement in activism, but there is a lack of clarity around type or amount of such engagement (domanski, 1998; mizrahi & dodd, 2013; rome, 2010). studies regarding the impact of social work education on one’s social activism are limited and discordant. mizrahi and dodd (2013) cited two diverging studies of social work populations. in the first, lane (2011) found that 63% of political social workers surveyed stated that their msw education contributed to their political activism. earlier, in a study of licensed social workers, ritter (2008) reported that 21% of respondents agreed that their msw coursework increased their political activism. these differences may reflect how post-msw employment influences one’s view of the impact of their education, or may illustrate a difference between macro and clinical social workers. in a study of msw students before and after completing their degree, mizrahi and dodd (2013) found that background and demographic characteristics, curricula, and msw program culture all contributed to students’ social activism. a study of bachelor of social work (bsw) students identified the strongest predictor of social activism was simply receiving an invitation to participate in a political event (swank, 2012). hsu and colleagues (2022) also found social networks to be important: social work students who reported discussing racism with their networks had greater awareness of racism. two recent studies identified sexual orientation and gender identity as factors associated with social work students’ political activism. atteberry-ash and colleagues (2022) found more frequent protest participation among lesbian, gay, bisexual, and queer social work students; students with lgbq friends; individuals who participated in classes or activities about lgbq issues; those who were in advocacy groups; and students who franke/privilege & engaging in activism 189 had a strong activist identity compared to heterosexual students who did not engage in those activities. this study found that the most important factor in protest participation was belief in their identity as someone who works towards social change (atteberry-ash et al., 2022). another article written about the same study reported that having more transgender and non-binary (tnb) people in their network, a clinical/macro focus, and taking a course on power, privilege and oppression were all associated with an increase in engaging with tnb activism (holloway et al., 2022). outside of social work students, prior research shows that lesbian, gay, and bisexual (lgb) people participate in more social movements than heterosexual people (swank, 2018). in fact, studies have shown that lgb individuals are more likely to participate in feminist (fisher et al., 2017) and other movements beyond lgb rights movements (anderson & jennings, 2010; carroll & ratner, 1996). one study showed that lgb people were more likely than heterosexual people to participate in lgb, peace, environmental, and economic justice movements (swank, 2018). swank and fahs (2013) considered intersectional identities as they related to activism and found that white lesbians were less likely to attend protests and vote than lesbians of color, but noted that race was less of a predictor of activism for gay men than were experiences of discrimination. those researchers also found that personally experiencing heterosexist discrimination and publicly revealing their sexual identity were also associated with more queer rights activism (swank & fahs, 2013). one study of nearly 200 college students found that awareness of heterosexual privilege and resistance to heteronormativity were both associated with greater engagement in gay and lesbian rights activism (montgomery & stewart, 2012). researchers also found that, among a sample of college students, heterosexual privilege awareness predicted activism for women, but not for men (montgomery & stewart, 2012). another study asked people of color to identify white allies as well as friends (who they did not believe to be strong allies), the distinction being that the friends were not people they felt they could depend on for support if confronted with a race-related issue (ostrove & brown, 2018). ostrove and brown (2018) found that allies reported more awareness of white privilege, greater willingness to confront white privilege, and more remorse related to white privilege than did their friends. the people of color who nominated these participants reported that allies displayed more affirmative behaviors and a greater willingness to engage in social change (ostrove & brown, 2018). ezell (1993) and rocha (2000) found that african american msw students and social workers were more politically active than white students and social workers, but other researchers (andrews, 1998; parker & sherraden, 1992; ritter, 2008) found that race was not a factor in students’ electoral activities. a more recent study of black and latino college students concluded that prior activism, immigration status, experiences of microaggressions, and political efficacy all contributed to participation in racial justice and immigrant rights protests (hope et al., 2016). advances in social work, spring 2023, 23(1) 190 social work and social justice while some studies have examined how identity and social networks are associated with engagement in activism, no recent studies have investigated how knowledge of privilege and intersectional identities are associated with activism. exploring how social work values are being manifest in social workers themselves necessitates consideration of the factors associated with knowledge of privilege and engagement in activism. both knowledge of privilege and engagement in activism are aligned with social work values and an intersectional approach. this study examined the question: are msw students’ age, race, sexual orientation, gender, clinical/macro concentration, knowledge of heterosexual privilege, and knowledge of racial privilege associated with greater involvement in political and social activism? method this exploratory study used a cross-sectional survey design to investigate the relationship between various demographic characteristics, knowledge of privilege, and involvement in activism in a sample of msw students and recent graduates. sampling procedures participants were drawn from a convenience sample of students from five of the top 20 msw programs in the united states, as identified by u.s. news and world report (2019). those five schools were included because msw program staff agreed to participate when contacted by a research team member. the schools are located in geographically diverse, mostly urban parts of the united states. a professor or school administrator from each school sent a survey link embedded in an e-mail to the target population, which provided an additional level of trust for recipients (dillman et al., 2014). additionally, 100 respondents, selected at random, received a $20 amazon gift card. university of maryland baltimore irb approval was received. measures the web-based survey took about 15 minutes to complete, and questions were deliberately ordered to be “like a conversation,” starting with broader demographic items and progressing towards more sensitive topics (dillman et al., 2014, p. 230). although the survey consisted of eight different standardized justice-oriented scales, this analysis focused on three standardized scales dedicated to knowledge of privilege and participation in activism, along with demographic items. demographics. a variety of demographic information was collected in this survey. this inquiry focused on age, race, gender, sexual orientation, and social work concentration. age was maintained as a continuous variable. participants were asked to select all races with which they identified. options included white/caucasian, black/african american, asian, native american, non-hawaiian pacific islander, “other” (with a space to specify), and prefer not to say. for this analysis, race was dichotomized, franke/privilege & engaging in activism 191 with white/caucasian as the reference group, and a general people of color (poc) category created for all others and those who identified as more than one race. participants who chose not to disclose their race were excluded from the analysis. a question regarding gender included options for cismen, ciswomen, trans men, trans women, non-binary, prefer to self-describe (with a space to specify), and prefer not to say. gender was dummy-coded for this analysis, with cismen as the reference group, ciswomen in one category and trans, genderqueer, and non-binary people in another. one participant did not disclose their gender identity and was excluded from the analysis. the question regarding sexual orientation included options for people who identified as straight/heterosexual, gay or lesbian, bisexual, other (with a request to specify), and prefer not to say. sexual orientation was dummy-coded, with straight/heterosexual as the reference group, bisexual as one category, and queer (which included gay, lesbian, queer, pansexual, asexual, and questioning) as a third category. participants indicated their social work concentration in a question that included four options: micro/clinical, macro/policy, combination of both, and undecided. social work concentration was dummy-coded, with clinical and undecided combined as the reference category (combined to reflect that undecided may indicate that they are a first year student and because undecided usually defaults to clinical training), and macro and dual as the two other categories. two intersectional variables were created and considered in bivariate analyses. one reflected the intersection of race and gender and the other the intersection of race and sexual orientation, both using the categories described above to create six new categories for each variable. therefore, the race and gender variable included cismen who were white, cismen who were poc, ciswomen who were white, ciswomen who were poc, trans/non-binary white people, and trans/non-binary poc. the race and sexual orientation variable included heterosexual white people, heterosexual poc, bisexual white people, bisexual poc, queer white people, and queer poc. knowledge of privilege. two measures, the privilege and oppression inventory (poi; hays et al., 2007) and the color-blind racial attitudes scale (cobras; neville et al., 2000), were used to measure knowledge of heterosexism and racial privilege in this study. the heterosexism awareness poi subscale was used to measure one’s heterosexism awareness through ten questions on a 6-point likert-type scale. the heterosexism awareness subscale included items about the lack of power of lesbian, gay, and bisexual (lgb) people in the legal system and in general, and lgb people’s safety, opportunities, value, and experience with discrimination overall. hays et al. (2007) validated the poi with counselors and counselor trainees and had a cronbach’s alpha of .95 overall, with .81 for the heterosexism awareness subscale (hays et al., 2007). in this study, the cronbach’s alpha was .91 for heterosexism awareness. scores for the poi subscale were summed, and higher scores indicated greater awareness of heterosexism. the racial privilege cobras subscale consisted of summed values and was used to examine knowledge of racial privilege. the subscale consisted of seven questions on a 5point likert scale. questions addressed participants’ beliefs about white people having advantages, racial and ethnic minorities having equal opportunities as white people, the role of race in who is incarcerated and who receives social services, and white people’s role in racial discrimination. neville and colleagues (2000) validated cobras with advances in social work, spring 2023, 23(1) 192 college students and community members, with a cronbach’s alpha of .91. for this study, cronbach’s alpha was .84 for racial privilege and .91 for cobras overall. lower scores indicate more knowledge of racial privilege. engagement in activism. in order to measure participants’ engagement in activism, the political and social advocacy (psa) subscale of the social issues advocacy scale (sias; nilsson et al., 2011) was used. sias had a cronbach’s alpha of .93 for the overall scale and psa (nilsson et al., 2011). for this study, the cronbach’s alpha was .87 for the psa. sias was validated with undergraduate and graduate students from counseling, psychology, nursing, education, and medicine (nilsson et al., 2011). the psa subscale includes eight items using a 5-point likert scale. psa items ask about a participants’ participation in demonstrations, meeting with policymakers, volunteering, and financial contributions regarding political and social issues as they relate to participants’ personal and professional values. higher summary scores indicate more engagement in political and social activism. data analysis all analyses were performed using spss version 25. a multiple regression was done to determine the association between age, race, sexual orientation, gender, social work concentration, and knowledge of racial and heterosexual privilege as related to political and social activism. all assumptions for this analysis were met. an a priori power analysis conducted with g*power using an alpha of .05, power of .80, determined that a sample of at least 118 participants was needed to detect a medium effect size (f2=.15; cohen, 1988). missing data were addressed through listwise deletion, leading to a slightly smaller sample (n=297) included in the multiple regression. bivariate tests, including t-tests and anova, were conducted for relevant variables, as well as for two intersectional variables that were not included in the multiple regression. anova tests, with tukey’s post hoc tests, were conducted to examine differences in participants’ engagement in political and social activism. results sample characteristics the only inclusion criteria for this study was completion of at least one semester of coursework in an msw program in 2018 or 2019. therefore, participants consisted of parttime and full-time students, as well as graduates who completed their msw degree in 2018 or after. nearly 2,500 students from five msw programs received a link to the online qualtrics survey. while there was an initial response rate of 18% (n=453), only 13% (n=310) met the inclusion criteria. study respondents had an average age of 29 (sd=7.9), were mostly ciswomen (86%) and white (74%; see table 1). the majority of respondents identified as heterosexual (69%) and the most common msw concentration was clinical (48%). franke/privilege & engaging in activism 193 table 1. sample demographics (n = 310) variable m (sd) age (years) 29 (7.9) n (%) gender ciswoman 267 (86%) cisman 24 (8%) trans/non-binary/genderqueer 19 (6%) race white 230 (74%) black/aa 35 (11%) asian 11 (4%) other 17 (5%) multiple 13 (4%) prefer not to say 6 (2%) sexual orientation straight/heterosexual 211 (68%) gay/lesbian 20 (6%) bisexual 50 (16%) queer/pan/asexual/questioning 23 (7%) prefer not to say 6 (2%) concentration clinical 150 (48%) macro 41 (13%) both 107 (34%) undecided 14 (5%) bivariate associations results from bivariate analyses are shown in table 2. the t-test did not show a statistically significant difference between political and social activism (psa) subscale means by race. in terms of gender, the analysis of variance (anova) model was significant, f(2, 306)=3.37, p=.036, with tukey’s post hoc test indicating that the mean score for cismen (m=21.5, sd=7.5) was significantly lower than the mean score for trans/non-binary people (m=27.1, sd=6.7, p=.033). the anova test for sexual orientation and psa was also significant, f(2, 300)=14.07, p<.001, with the post hoc test indicating significantly lower mean scores for heterosexual people (m=22.0, sd=7.0) than for both bisexual people (m=26.9, sd=7.3, p<.001) and queer people (m=26.1, sd=6.0, p=.001). there was no difference in political and social activism between people who identified as bisexual and those who identified as queer. for social work concentration, the anova test was significant, f(3, 306)=6.6, p=.029, with tukey’s post hoc test indicating significantly lower mean psa scores for clinical students (m=21.8, sd=7.1) than for both macro (m=26.8, sd=5.9, p<.001) and dual macro/clinical respondents (m=24.3, sd=7.0, p=.026). the anova test for the race and gender intersectional variable was also statistically significant, f(5, 297)=2.77, p=.018, and tukey’s post hoc test indicated that white trans/non-binary people (m=28.7, sd=5.0) had significantly higher mean psa scores than white cismen (m=21.0, sd=7.3, p=.032) advances in social work, spring 2023, 23(1) 194 and white ciswomen (m=22.8, sd=7.3, p=.030). lastly, in terms of the intersection of race and sexual orientation, the anova model was significant, f(5, 292)=6.24, p<.001. tukey’s post hoc test showed that heterosexual white people (m=21.6, sd=7.2) had significantly lower mean psa scores than bisexual white people (m=26.6, sd=7.3, p=.001), bisexual poc (m=27.7, sd=7.7, p=.028), and queer white people (m=25.6, sd=6.1, p=.024). age was not associated with greater political and social activism (r= .038, p=.251), but heterosexism awareness (r=.259, p<.001) and knowledge of racial privilege (r= -.235, p<.001) both were. table 2. mean differences by demographics and political and social activism sias-psa scores n mean (sd) t/f(df) p race white 228 23.0 (7.3) -1.55 (302) .121 people of color (poc) 76 24.5 (6.7) gender cismen 24 21.5 (7.5) 3.37 (2, 306) .036* ciswomen 266 23.2 (7.1) trans/non-binary 19 27.1 (6.7) sexual orientation heterosexual 209 22.0 (7.0) 14.07 (2, 300) <.001** bisexual 50 26.9 (7.3) queer 44 26.1 (6.0) concentration clinical 148 21.8 (7.1) 6.60 (3, 306) .029* macro 41 26.8 (5.9) dual 107 24.3 (7.0) undecided 14 22.4 (8.8) race + gender white cismen 17 21.0 (7.3) 2.77 (5, 297) .018* poc cismen 6 24.0 (8.7) white ciswomen 196 22.8 (7.3) poc ciswomen 65 24.7 (6.4) white trans/non-binary 14 28.7 (5.0) poc trans/non-binary 5 22.4 (9.2) race + sexual orientation white heterosexual 151 21.6 (7.2) 6.24 (5, 292) <.001** poc heterosexual 53 23.2 (6.3) white bisexual 37 26.6 (7.3) poc bisexual 13 27.7 (7.7) white queer 35 25.6 (6.1) poc queer 9 27.9 (5.8) * p < .05, ** p < .001 factors associated with political and social activism a multiple regression analysis was conducted to evaluate whether msw student age, race, sexual orientation, gender, macro concentration, knowledge of heterosexual privilege, and knowledge of racial privilege were significant predictors of political and social advocacy. the overall regression model was significant (r2=.17, f(10, 286)=5.89, p<.001). many of the factors in this model were significantly associated with political and social activism (see table 3). specifically, compared to heterosexual people, individuals who are gay, lesbian, queer, pansexual, asexual, or questioning (β=.15, p=.021) and people who are franke/privilege & engaging in activism 195 bisexual (β=.20, p<.001) reported more political and social activism. macro-focused students (β=.18, p=.002) and dual clinical/macro students (β=.13, p=.032) reported higher psa scores than clinical and undecided students. lastly, respondents who reported more heterosexism awareness (β=.18, p=.015) reported being more politically and socially active. table 3. multiple regression model for political and social activism (n=297) variable b se b β p 95% ci (constant) 10.40 5.19 .046 age .04 .05 .04 .441 [.92, 1.09] people of color 1.76 .92 .11 .055 [-.06, 3.57] queer1 2.93 1.27 .15* .021 [.44, 5.41] bisexual 3.96 1.11 .20** <.001 [1.78, 6.13] ciswomen 1.16 1.50 .06 .440 [-1.79, 4.10] transgender/genderqueer 1.06 2.22 .04 .633 [-3.31, 5.44] macro 3.86 1.21 .18* .002 [1.48, 6.24] macro/clinical combination 1.90 .88 .13* .032 [.16, 3.64] heterosexism awareness .17 .07 .18* .015 [.03, .30] racial privilege knowledge -.04 .11 -.03 .735 [-.259, .183] model statistics r2 .171 f 5.89** * p < .05, ** p < .001 1 includes gay, lesbian, pansexual, asexual, queer, and questioning controlling for all other predictors, people who identified as queer and bisexual reported 7% and 10% (respectively) more political and social activism than heterosexual people. compared to clinical and undecided students, and controlling for all other predictors, dual students reported a 5% increase and macro students reported a 10% increase in psa scores. for every one point increase in respondents’ score on the privilege and oppression inventory (poi) heterosexism awareness (ha) subscale, there was a .17 (.4%) increase in psa score, controlling for all other predictors. race, age, gender, and knowledge of racial privilege were not associated with political and social activism in the model. discussion although some individual factors were associated with greater political and social activism, an intersectional view provides a more nuanced understanding. in this study, sexual orientation was significantly associated with political and social activism. controlling for all other predictors, people who are bisexual and people who are gay, lesbian, queer, pansexual, asexual, or questioning reported more political and social activism than heterosexual people. the relationship between bisexual identity and social activism is especially interesting from an intersectional lens, which requires considering the complicated, overlapping advances in social work, spring 2023, 23(1) 196 dimensions of the world. almost definitionally, bisexual people occupy the liminal space in between heterosexual and gay and lesbian worlds. they are not considered to be full members of either group, but continue to be seen as “other” by both. this perspective offers a consistent outsider view of the world, while also providing some inroads into both groups. the fluidity and flexibility of this position leads people who are bisexual to report being less judgmental, more accepting, and less interested in creating strict categories for others (rostosky et al., 2010). it may also help them to develop a more nuanced view of oppression and privilege, and to be uniquely situated to value coalitions—within themselves and in social justice work. macro and dual social work concentrations were also strong indicators for political and social activism in this study. students with a macro or combined macro/clinical concentration reported significantly more political and social activism than clinical or undecided students. this was not surprising, given the focus of macro social work to consider the ways that systems and policy impact marginalized people. there have been studies linking macro students to a greater understanding of structural concerns and connecting their social work practice to policy and social change (mizrahi & dodd, 2013). students with a dual clinical/macro concentration may feel more comfortable with the necessary both/and intersectional approach. it may be that their dedication to understanding both the clinical and the systemic concerns of the world as related to marginalized communities has encouraged an investigation into their own privilege and the ways that systems of oppression impact individuals. in macro social work, the focus is not only on how policy and social structures function. instead, macro social work requires an interpretation of the relationship that policies and social structures have with marginalizing people. if clinical courses concentrate on clinical interventions that impact an individual, without fully centering person in environment—as social work requires—clinical students may be unaware or unversed in the power of organizing and activism. there is a certain privilege of not having to think about privilege. if a person believes that the world is generally a fair, just place, then it becomes easy to imagine that individual successes are deserved and that people who have struggled are somehow lacking. this pertains to all types of privilege. by not considering society’s underlying oppressive forces, a person does not have to think about the multitude of ways that those oppressive forces marginalize others. in this mindset, there is no need to unpack the complexity of matrices of oppression. the fact that heterosexism awareness was significantly associated with activism in this study was not surprising. what was noteworthy was the small effect found in this study. this may require a more nuanced examination of coalition variables and privilege than was possible in this study. the lack of a significant association between knowledge of racial privilege and activism in this study was also notable. this may reflect an educational experience that includes discussions of racial privilege but a lack of belief in the necessity to engage in activism. it may also be the case that social workers rate themselves more highly on measures of knowledge than marginalized groups would rate them—which could be useful knowledge for addressing this gap (ostrove & brown, 2018). in their study of social work students, hsu and colleagues (2022) found that individuals with liberal political affiliation franke/privilege & engaging in activism 197 who supported the black lives matter movement had move awareness of various types and levels of racism. however, the researchers did not examine protest involvement. it was also unexpected that, controlling for other predictors, race was not associated with social and political activism. this lack of statistical significance is also surprising given the long history of black political social workers (see shepherd & pritzker, 2021 for a detailed history). that said, previous studies have been inconclusive about the relationship between race and activism (andrews, 1998; ezell, 1993; parker & sherraden, 1992; ritter, 2008; rocha, 2000). activism has increased in the united states in recent years, including activism among black people, both prior to and during the summer 2020 protests in response to the police killings of george floyd and breonna taylor (auxier, 2020; towler & parker, 2018). studies have shown that white people who feel that they can affect change are more likely to participate in social movements that support black people (blankenship et al., 2017). it could be that social workers are more likely to believe that they can affect change on a broader scale, which may make students of different races equally likely to participate in social and political activism. across all races, this sample scored very highly on the awareness of racial privilege scale. lack of variation among that indicator may have made it difficult to determine the relationship between knowledge of racial privilege and activism. the assumption that the people of color racial category was homogeneous may also be a concern, which crenshaw (1991) noted as a common problem generally. this category aggregated people who identified as black or african american, asian, “other”, and multiple, which are, of course, not identical identities or categories. even without collapsing this variable, there was not a statistically significant difference in reported political and social activism. a more diverse sample may have helped to better understand this association. a social worker’s job should be to work towards creating a socially just society that eliminates the need for social work. this is only possible if all social workers are aware of the interlocking systems of oppression that create inequity and dedicate themselves to dismantling oppressive structures. this cannot be done if each social worker only considers individual clients or even a single system of oppression, as may be the case with some, especially clinical, social work students. social workers must interrogate their own part in subjugating ideologies and systems, from both a personal and professional perspective. only through identifying their own positions within the historic and current world can social workers challenge those positions and address privilege and oppression (suárez et al., 2008). they must understand themselves as part of a greater whole, and heed indigenous activists’ words often credited to lilla watson (1985): “if you have come here to help me, you are wasting your time. but if you have come because your liberation is bound up with mine, then let us work together.” implications this study has many important implications for social work. given the association between heterosexism awareness and social and political activism, social work educators should consider the ways that heterosexism and other isms are taught in the classroom. perhaps pushing students to more deeply understand and critically examine large systems advances in social work, spring 2023, 23(1) 198 of power will galvanize them to be more active in advocacy efforts for clients in broader and more diverse ways. additionally, the strong association between macro social work and activism is important to highlight. this shows a clear need for clinically-focused social work students to incorporate advocacy and activism into their toolkits, which aligns with recent appeals (kang, 2022). in light of the calls from nasw and cswe for social workers to be engaged in activism and policy change, msw programs may need to include more macro-focused components in clinical or generalist courses. additionally, given the level of engagement in social and political activism by lgbq people, perhaps social work educators need to find ways to learn and build from the activism of those communities. perhaps this finding is an indication that a more intersectional perspective leads to greater political and social activism. in which case, social work programs must incorporate more intersectional perspectives in readings, classrooms, and assignments. additional research is needed to better understand the ways that coalitions are related to knowledge of privilege and engagement in activism. furthermore, having people from communities of intersecting marginalized identities—like social work clients—report their perceptions of social work students’ knowledge of privilege may add a useful and nuanced dimension to the field. limitations although there were many important findings in this study, there were some limitations as well. several additional topics could have been included in the survey to provide additional explanatory power for political and social activism behaviors. for instance, political affiliation, socioeconomic class, and questions regarding social networks could have been helpful to create a more complete view of participants’ social activism. there is also a concern regarding this study’s ability to fully consider knowledge of privilege. an additional subscale that measured awareness of sexism was included in this study but was excluded from analysis because of a strong ceiling effect with little variability among the sample of msw students. there were no scales in the study used to determine knowledge of privilege as it relates to cisgender people, certain religious groups, class, ablebodiedness, or any other area of identity. though the sample for this study had over 300 respondents, it may not have been diverse enough to allow for a comprehensive view of intersectional identities, which could have provided a more nuanced analysis. for instance, the list of the top 20 msw programs according to u.s. news and world report was used as the study’s sampling frame, but none of these programs was based in a historically black college or university, hispanic-serving institution, or tribal college or university. inclusion of those institutions would have added greatly to the study’s racial and ethnic diversity. lastly, it is challenging to determine the temporality of some of the relationships examined here, like heterosexism awareness and macro social work as they relate to social and political activism. it may be that people who are more politically active are more likely to engage in macro social work or they may develop a better understanding of heterosexism through their activism. this study was created from a critical race theory (crt) perspective, which includes intersectionality as a core tenet (delgado & stefancic, 2012), but the study did not center crt or intersectionality as much as it could have. respondents were not asked about their experiences, attitudes, or behaviors related to group membership and marginalization, franke/privilege & engaging in activism 199 which would have allowed for an interpretation that did not assume subjugation (or privilege) based solely on categorization (bowleg, 2008; cuadraz & uttal, 1999). though intersectional variables were created for bivariate analysis, they were not included in the larger model. additionally, while some researchers present coalition specification as appropriate for analysis of intersecting experiences of oppression (carastathis, 2013; cole, 2008), there has been opposition to an additive approach that assumes that each stigmatized identity adds to a person’s oppression (bowleg, 2008; hancock, 2007, 2013). lastly, there is the issue of assumed similarity within groups that were considered in this analysis (e.g., aggregating all people of color), which may have resulted in the loss of important variation. conclusion as a profession, social work and its workforce must be dedicated to end injustices on both individual and macro levels. social and political activism is an important tool for affecting broader social change. if msw students are to become the “social change agents” that msw programs purport to produce, there must be a push for students to have better understandings of privilege and power. being unaware of 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(1985). decade for women conference [speech]. united nations, nairobi, kenya. author note: address correspondence to nancy d. franke, department of social work, la salle university, philadelphia, pa 19141. email: franken@lasalle.edu https://doi.org/10.1080/10437797.2000.10778989 https://doi.org/10.1080/19419899.2010.484595 https://doi.org/10.18060/24135 https://doi.org/10.1080/10437797.2021.1883492 https://doi.org/10.18060/24469 https://doi.org/10.1606/1044-3894.3766 https://doi.org/10.5175/jswe.2012.200900111 https://doi.org/10.1016/j.ssresearch.2018.04.002 https://doi.org/10.1007/s11199-012-0168-9 https://www.usnews.com/best-graduate-schools/top-health-schools/social-work-rankings https://www.usnews.com/best-graduate-schools/top-health-schools/social-work-rankings mailto:franken@lasalle.edu _________ dawn apgar, phd, lsw, acsw, associate professor, department of anthropology, sociology, social work, and criminal justice, seton hall university, south orange, nj. mackaully parada, lcsw, graduate of seton hall university and the university of michigan, and phd student, university of utah. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 876-899, doi: 10.18060/25748 this work is licensed under a creative commons attribution 4.0 international license. missing the mark? reframing nasw's ethical mandate for self-care as a social justice issue dawn apgar mackaully parada abstract: the 2021 revision to the ethical code for social workers mandated engagement in self-care. a review of workforce data suggests that the need for self-care in social work is largely due to poor working conditions, inadequate pay, unavailability of quality supervision, and lack of professional recognition. thus, making self-care largely a personal responsibility is adopting a “blaming the victim” mentality that the profession has historically rejected in its approach to client problems. social work is rooted in examining the social conditions of people within their environments and focusing on making macro level changes to remedy systemic problems. though not intentional, the ethical mandate for social workers to remedy the stress, trauma, and burnout resulting from environmental stressors is misplaced, though not surprising. in recent years, social workers have focused more on working with individuals to fix their problems rather than making contextual changes that are largely responsible for the ills. this article reframes the emotional and psychological problems experienced by social workers as a social justice issue, requiring mezzo and macro, rather than micro, level intervention. embracing this alternative perspective requires a commitment to mobilization, advocacy, and political engagement—approaches that have been deprioritized by many within the social work profession. keywords: self-care; burnout; social justice; ethics; macro practice in 2021, the national association of social workers (nasw) mandated self-care by social workers in its ethical code. the addition memorialized content from a 2016 presentation at its national conference that touted self-care as an “anecdote” to the professional fatigue witnessed in social workers (pace, 2017, p. 5). proponents of the changes cite the rationale for self-care as the nature of the profession, placing those in social work practice at higher risk for fatigue and professional impairment (hardy et al., 2021). other professions, such as medicine, nursing, psychology, and counseling, have also prioritized the need for self-care with much written about the impacts of secondary trauma on those who work with people who are ill or experiencing hardships (dirik et al., 2021; kelly, 2020; lakioti et al., 2020). research indicates that those who repeatedly listen to the problems of others are at high risk for burnout (michelson & kluger, 2021). the effects of distress are so profound that even those who study the topic have been negatively impacted by “trauma-by-proxy” (van der merwe & hunt, 2019, p. 10). the overall literature on self-care is abundant, with a major focus on enhancing professionals’ awareness of the impacts of stress and setting personal self-care goals to mediate its impacts (hricová, 2020). yoga, mindfulness, journaling, and guided imagery about:blank apgar & parada/missing the mark 877 have been cited as effective strategies to assist practitioners across disciplines (blackburn et al., 2020; ofei-dodoo et al., 2020). self-care in social work has predominantly been viewed as a personal responsibility of professionals, with remedies focused on individual protective factors. however, this focus appears misplaced, ignoring the impact of the substandard mezzo and macro conditions in which many social workers are employed. social work has historically viewed individual problems as primarily resulting from larger systemic dysfunction, though some have criticized the profession for deviating from this perspective (specht & courtney, 1995). for example, the proportion of social workers practicing clinically, primarily with middle-class, professional, white clientele, has increased significantly over the last three decades with most entering the profession wanting to eradicate problems through the provision of psychotherapy (holden & barker, 2018). the commitment to social justice of those doing psychotherapy has been questioned (mclaughlin, 2011). however, the number of social workers wanting to do clinical work far outweighs those who want to specialize in mezzo or macro practice methods (apgar, 2021). this problem is compounded with the increasing privatization of mental health care among social workers. data show that social workers prefer to start their own private practices to have greater control over their working conditions and be liberated from agency bureaucracy that was thought to interfere with the treatment of clients (slater, 2020). as currently framed, self-care in the recent nasw code of ethics revisions makes social workers responsible for problems that are largely not their fault. though it acknowledges that much of the strain placed on social workers comes from the nature of their work and the systems/organizations in which they are employed, the responsibility for well-being is placed on workers. “professional demands, challenging workplace climates, and exposure to trauma” warrant social workers to maintain personal and professional health, safety, and integrity (nasw, 2021, p. 4). agencies are also encouraged to promote policies and practices that support self-care. this article reframes workplace stress as problems that are significantly caused by conditions under which social workers are socialized and employed and provides evidence to support the use of mezzo and macro, instead of micro, methods to properly address burnout. remedies for addressing systemic problems that have plagued the profession for years require social workers and their employers to view self-care as a social justice issue rather than one rooted in the pathology of those impacted. without addressing the root causes of stress and strain that warrant social workers prioritizing self-care, little progress can be made and social workers will continue to feel responsible for the effects of issues that they do not control. literature review self-care as a social work priority articles about self-care are prevalent in the social work literature with a google scholar search of “social work” and “self-care” yielding 17,500 articles published since 2017, 11,400 of which went into circulation since 2020. the topic is deemed so important advances in social work, fall 2022, 22(3) 878 to the profession that nasw recently dedicated a special issue of its journal to the subject (miller & grise-owens, 2020). a recent survey of social workers found that they highly value self-care but were not taught how to engage in self-care by their employers (bloomquist et al., 2016). the vast majority of scholarship on self-care focuses on the need for educators to prepare those entering the profession to meet the professional demands of practice (demarchis et al., 2022) and determining the effectiveness of individual self-care techniques such as mindfulness (mccusker, 2021), yoga (cheung & leung, 2020), and even coloring (matto & sullivan, 2021). in recent years, nasw published several books on self-care (cox & steiner, 2013; smullens, 2015) that have viewed stress by social workers as predominantly caused by working with clients who have experienced trauma and/or are in crisis. self-regulation, self-awareness, and self-efficacy are identified as essential personal strategies for avoiding burnout and dealing with professional stress (apgar & cadmus, 2021). few articles have acknowledged the need for mezzo and macro changes to combat stress (scheyett, 2021; stuart, 2021; williams, 2015) despite social workers citing workplace characteristics, including extreme workloads, lack of recognition of performance and professional commitment, and value incongruence between individual workers and their employing organizations as the largest contributors to burnout (wilson, 2016). quality supervision has been a mezzo level characteristic that is well-cited in the literature as critical to mediating workplace burnout and maintaining self-care, though its widespread availability for social workers remains a concern (mack, 2020). self-care in other helping professions and its importance overall exploration of self-care practices can be seen throughout the literature in psychology, nursing, medicine, and education (andrews et al., 2020; baker, 2020; moore, 2021; wei et al., 2020). many professional associations have promoted self-care through making resources, such educational articles, guidelines, and toolkits, publicly available (american medical association [ama], 2021; american nurses association [ana], 2021; american psychological association [apa], 2021; oncology nursing society [ons], 2021). skovholt and trotter-mathison (2016) acknowledge the agonizing pull between caring for others and caring for oneself as a significant contributor to burnout among helping professionals. to mitigate the tension, efforts have been made to assist those entering helping professions to recognize stress so that it can be addressed before causing professional impairment (posluns & gall, 2020). over the past two years, the covid-19 pandemic also led to a heightened push towards self-care promotion generally (miller & cassar, 2021; omrani et al., 2021). social science researchers have widely studied and documented the biopsychosocial impacts of isolation, illness, financial stress, and fear on quality of life, citing self-care as a major requirement for overall mental health. public agencies, such as the centers for disease control and prevention (cdc) and the world health organization (who) have contributed to the growing self-care conversation, further demonstrating its importance to personal well-being in the united states (u.s.) and internationally (cdc, 2021; who, 2022). apgar & parada/missing the mark 879 self-care as an ethical mandate social work in 2021, nasw added language to its ethical code requiring social workers to “maintain personal and professional health, safety, and integrity” due to “professional demands, challenging workplace climates, and exposure to trauma” (nasw, 2021, p. 4). while there was encouragement for social work organizations, agencies, and educational institutions “to promote organizational policies, practices, and materials to support social workers’ self-care,” additional language focused on requiring social workers to engage in trustworthy professional behavior, mandating that “social workers should take measures to care for themselves professionally and personally” (nasw, 2021, p. 6). while some see the inclusion of self-care as an ethical mandate as progress (griseowens & miller, 2021), others question the practicality of enforcing the new language or worry that it might further exacerbate an existing problem by making social workers more vulnerable to being blamed for substandard performance caused by lack of resources and poor working conditions (scheyett, 2021; ubinger, 2021). the nasw code of ethics serves six purposes including socializing new practitioners into the field, articulating standards to which the general public can hold social workers accountable, and determining whether social workers have engaged in unethical practice (nasw, 2021). by framing self-care as a primary responsibility of social workers themselves, those entering the field will likely see the ability to combat stress in the workplace as a professional duty. the public will now also be able to hold social workers accountable for not engaging in selfcare, even charging them with unethical practice for not doing so. nursing the american nurses association (ana) established their first ethical code in 1950 with the most recent revision occurring in 2015 (ana, 2015). the ana code states, “the nurse owes the same duties to self as others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth” (ana, 2015, p. 32). examples, such as diet/exercise, healthy relationships, sufficient time doing enjoyable activities, and meeting religious/spiritual needs, are provided as good self-care activities (ana, 2015). representing 20 million nurses globally, the international council of nurses (icn), in its own ethical code, identifies self-care as a professional and ethical responsibility (icn, 2021). one ethical standard focuses specifically on the promotion of personal health, regardless of workplace setting. additionally, nursing codes for countries outside of the u.s. contain self-care obligations, including those for nurses in japan, canada, australia, and the united kingdom (linton & koonmen, 2020). there has also been increasing interest in combatting compassion fatigue and burnout in the nursing profession over the past 10-15 years, though – like social work – approaches have mainly focused on individual responsibilities or the training of nurses to recognize signs of stress. many employers provide evidence-based education training programs to advances in social work, fall 2022, 22(3) 880 teach nursing professionals about self-care skills with many programs focusing on detection of stress and remedies falling to nurses themselves (dreher et al., 2019). as in social work, there is a recognition that more needs to be done generally to ensure the wellbeing of nurses since professional mental health is viewed as essential to the provision of quality care. psychology the american psychological association (apa) has its own ethical code, with the 2016 revision being the most recent (apa, 2016). the apa code does not directly reference an ethical obligation for psychologists to engage in self-care practices, unlike the one crafted by the canadian psychological association (cpa) which set a clear expectation to do so (cpa, 2017). however, scholars argue that attentiveness to the provider’s physical and mental health in the apa code is an indirect allusion to the importance of self-care. for example, barnett and cooper (2009) state that the apa code is very clear in instructing professionals to be both (1) cognizant of their well-being and (2) active in the pursuit to correct issues that arise when their physical or mental health impacts the therapeutic process. wise et al. (2012) link the ethical obligation of competence to an implied self-care mandate. additionally, psychologists have an ethical obligation to obtain professional consultation or assistance and consider the need to limit, suspend, or terminate their work in light of personal problems/conflicts. though these actions are not framed as forms of professional self-care, they focus on professional well-being, though at the tertiary rather than the preventive level (barnett & cooper, 2009). recently labeled as a core foundational competency in the field of psychology, selfcare has become a hot topic in the professional psychology literature over the past 20 years (santana & fouad, 2017). scholars have advocated for educational institutions and professional organizations to implement proactive self-care training, with some even advocating for psychology licensure boards to mandate self-care training as part of ongoing continuing education requirements (barnett & cooper, 2009; wise et al., 2012). support groups, clinical supervision, and student engagement in psychotherapy have been identified as critical self-care activities, with research indicating that these strategies reduce stress and increase mood, overall well-being, and performance when implemented successfully (maranzan et al., 2018). social work workforce and employment conditions the increased call for social workers to engage in self-care coincides with heightened attention on the workforce issues of the profession. in 2015, the council on social work education (cswe) convened an advisory committee that devised a national workforce study encompassing all levels and fields of social work practice (cswe, 2021). the effort resulted in several reports over the last few years that gave the profession access to workforce data that was previously elusive (george washington university, 2017, 2019, 2020). data reveal that social workers disproportionately represent vulnerable populations apgar & parada/missing the mark 881 and are operating with low wages and in environments that are extremely stressful, coupled with high loan debt incurred during their professional education. unlike nurses and teachers, many social workers are not unionized (farr, 2021) and therefore conduct their work with few protections. while the reasons for the current state of affairs are debatable, there is no doubt that there are systemic issues that have situated social workers in positions in which they are called upon to care for others while barely meeting their own basic needs. workforce composition recent workforce data indicate that the vast majority of social workers are female (83%; george washington university, 2017). while the social work workforce tends to be predominately white (69%), nearly a quarter (22%) identify as black/african american. additionally, 11% of social workers are hispanic or latino, though the percentage appears to be growing as 14% of those entering the profession more recently identified as such (george washington university, 2020). the proportion of those entering the social work workforce from traditionally marginalized populations is much higher than in most health professions (george washington university, 2020). for example, nurses from all minority backgrounds represent 19% of the registered nurse (rn) workforce (smiley et al., 2019), compared to 31% of degreed social workers. recent msw graduates are predominately engaging in clinical work with individuals, families, or groups (82%); fewer recent graduates are holding positions in macro social work (7%), and even fewer are working directly with communities (6%; george washington university, 2020). data also reveal that the majority of social workers (69%) are accepting jobs after graduation in settings that are traditionally not unionized (george washington university, 2020). pay, student loan debt, and job growth though salaries differ across practice setting and geographic region, according to the u.s. bureau of labor statistics (bls), the median salary for social workers is $51,760 (us bls, 2021c). the bls reported that practitioners in the lowest 10% earned less than $33,020 annually while the highest 10% earned more than $85,820 (us bls, 2021c). hawaii, massachusetts, nevada, rhode island, and virginia have the highest social work compensation (us bls, 2021c), but these states also have high costs of living (u.s. news, 2021). pay varies significantly between social workers with bachelor’s and master’s degrees with the median annual salary of the former being about $11,000 less than the latter (george washington university, 2017). about three-fourths of bsw and msw students reported having student loan debt that averaged around $29,323 (bsw) and $46,591 (msw), respectively (cswe, 2020). this debt does not include other school-related fees such as room and board, food, and books. while efforts to assist with loan debt have been undertaken, the u.s. department of education (2021) reports that over 98% of applicants from october 2017 through november 2020 were deemed ineligible for the loan forgiveness program, meaning that only 1.6% of the thousands who applied were actually able to see the process through, advances in social work, fall 2022, 22(3) 882 complete all of the requirements, and eventually receive the promised relief after 10 years of public service. hughes et al. (2018) found that social work students take an average of nine years to repay their loan debt. loan debt of social workers is so problematic that two of four witnesses asked to testify to the senate at a recent hearing on the lived experiences of student loan borrowers were social workers (senate banking, housing, and urban affairs committee, 2022). the burden of debt is far worse for social workers of color. huerta (2020) writes that the increasing burden of social work student loan debt particularly impacts first-generation college students, students of lower socioeconomic levels, and students of color, as these groups are not only more likely to take on education loans, but they also have more difficulty paying them back (huerta, 2020). a recent study found that debt from social work education was, on average, substantially higher for blacks/african americans than for whites ($66,000 vs. $45,000) and for hispanics compared with non-hispanics ($53,000 vs. $48,000; george washington university, 2020). the total mean educational debt for social workers was $92,000 for blacks/african americans and $79,000 for hispanics. there are also differentials in educational attainment by race. social workers with bachelor’s degrees are more likely to be black or african american than social workers with graduate degrees (george washington university, 2017). thus, about a quarter of all social workers, those who are black/african american, have higher debt and less educational attainment, resulting in more financial strain and less opportunity for career advancement. some posit that the low pay and financial strain on social workers could lead to an allout labor shortage (hughes et al., 2018). however, the bls views social work as a fastgrowing profession, far exceeding the average projected growth trend (4%) for all occupations in the u.s. (us bls, 2021c). social work is expected to have an average projected growth of 13% between 2019 and 2029 (us bls, 2021c). specialties such as mental health and substance abuse may have the largest gains with a 17% growth projection. while the growth is promising, the looming question remains around whether compensation practices will be able to continue attracting new professionals and retain current ones. additionally, the growing number of social work graduates may be suppressing wages as there is a continual supply of workers competing for jobs, allowing employers to keep wages low and still fill openings. the poor salaries paid to social workers, coupled with their student loan debt, has been linked to decreased quality of services for clients and high burden placed on those entering the profession (hughes et al., 2018; leung et al., 2020). working conditions the bls (2021c) asserts that social work has one of the highest rates of injuries and illnesses of all occupations. several factors contribute to this reality, including the highrisk settings in which social workers are employed and the nature of the problems for which they are tasked to intervene. nearly half (44%) of social work professionals identify personal safety issues on the job (nasw, 2006). the highest reports of safety concerns are apgar & parada/missing the mark 883 in the settings of criminal justice (67%) and child welfare/family addictions (52%) (nasw, 2006). while client-on-staff violence is disproportionately higher in social work than other allied professions, spencer and munch (2003) presume that the number reported does not truly represent the magnitude of the problem, with the actual prevalence being much higher. underreporting of incidents occurs for a variety of reasons including fear of judgement by colleagues, lack of support from management, and the perception that dangerous situations are expected hazards that come with the job (spencer & munch, 2003). in addition to unsafe work environments, there are other organizational stressors present for social workers including, but not limited to, a lack of funding, insufficient staffing, and inadequate support (lloyd et al., 2002). the most common stressors cited in the literature are the large, often unmanageable, workload compounded by lower pay than other helping professionals, lack of adequate supervision, and reduced autonomy in the workplace which results in social workers reporting lower mental well-being and more work-related anxiety/depression compared to those in other occupations (quinn et al., 2019; us bls, 2021c). importantly, improved clinical supervision, higher income levels, and lower workloads have been found to decrease negative well-being among social workers (quinn et al., 2019). additionally, barck-holst et al. (2021) found that reducing the work week by 25% (while maintaining full-time pay) translated to lower emotional exhaustion, better opportunities to engage in self-care activities like exercise and rest, and an increase in quality time with friends/family. these studies demonstrate that improvements in the working conditions of social workers can have significant positive impacts on their psychosocial health and well-being. unpaid internships cswe has deemed field education as the signature pedagogy in undergraduate and graduate education (cswe, 2022). bsw students are required to participate in 400 hours of supervised field education while msw students must complete 900 hours of practicum experience (cswe, 2022). while internships can be paid, there is no mandate to do so in the accreditation standards, causing social workers to recently petition the u.s. department of labor (us dol) to investigate the issue (richardson, 2021). this advocacy occurred after unsuccessful legal action by students for unfair labor practices mandated by cswe, who vehemently defend the legality of their unpaid internship requirements (cswe, 2014). as most social work internships are unpaid (rogers et al., 2021), those who receive both their bachelor’s and master’s degrees in social work will perform at least 1,300 hours of uncompensated service by the time of graduation. while nursing and medical students also complete internships that are likely to be unpaid, they earn significantly more than social workers after graduation (us bls, 2021a, 2021b). the expectation for pro bono work in social work extends after graduation as social workers “are encouraged to volunteer some portion of their professional skills with no expectation of significant return” as specified in their ethical code (nasw, 2021, p. 5), a provision that does not appear in the ethical standards of any other allied profession. advances in social work, fall 2022, 22(3) 884 great debate has arisen around the legality of unpaid internships generally, with the us dol (2018) citing criteria that must be met in order to justify unpaid internships. the criteria include that the internship experience is for the benefit of the intern, it is not meant to displace regular employees, and that the employer derives no immediate advantages from the intern. social work internships meeting these criteria have been called into question by students who report that roles, responsibilities, and expectations of interns often shift from learner to provider in such a way that field sites not only benefit from, but in some instances rely upon, intern contributions (harmon, 2017). over time as interns receive ongoing training in their agency, they often become entrusted with assignments and work-product expectations that employees would produce. some students have even reported taking on the entire workload of their supervisors during maternity leaves (harmon, 2017). such arrangements are ripe for exploitation with few alternatives given since internships are required for degree attainment, raising questions of whether social work students are being forced into the unpaid labor market (burke & carton, 2013). in addition to their legality, unpaid social work internships have many ethical considerations. first and foremost, unpaid internships have been found to disproportionately impact lower-income and minority students (burke & carton, 2013; gillen et al., 2021). students with higher socioeconomic statuses are more likely to have the resources to buttress their financial needs and avoid large cost-of-living lending demands while in unpaid positions, meaning that successful completion of the degree requirements comes with fewer loans and less financial insecurity. with reduced financial pressure comes less general stress, which directly translates to increased focus, energy, and enthusiasm in field placements. paid internships have a positive impact on the life quality of students by increasing financial stability and decreasing overall student loan debt (gillen et al., 2021) and are linked with overall higher work satisfaction (rogers et al., 2021). contrarily, unpaid internships result in feelings of exploitation and not being assigned “meaningful work” (burke & carton, 2013, p. 107). while there are some ethical concerns about paying students who have not yet graduated and demonstrated competency to practice, there is a sound justification to do so given the undue burden placed on women and minority students, as well as the overall financial strain on those preparing to enter the profession. reframing self-care as a social justice issue all agree that self-care is important for the social work profession. however, when the social work profession decided to include self-care as an ethical mandate, it had the opportunity to appropriately focus on the macro causes of burnout, such as unsupportive and exploitative work conditions, rather than view stress as a problem to be remedied by those who work in oppressive situations. instead of calling for the social work profession to mobilize to rectify employment problems that have plagued the profession for years, the new ethical standards direct social workers to maintain their personal and professional health. based on the value of integrity, social workers are, for the first time, called upon to “take measures to care for themselves professionally and personally” in order to be deemed “trustworthy” (nasw, 2021, p. 6). apgar & parada/missing the mark 885 while framing self-care as a personal responsibility has been criticized in the broader literature (kaplan, 2019), the recent inclusion of self-care in the nasw code of ethics appears to support this approach. appropriate remedies to address the problems of burnout and stress largely revolve around whether they are viewed as issues that lie in individual pathology that are best assisted by the stress reduction techniques or systemic problems that have to be changed by collective action of social workers overall. while an “either or” approach is not needed, the language used in the revised nasw code of ethics helps to oppress social workers by having them take responsibility for the negative consequences of practices and structures that they did not create. the social work profession’s “missing the mark” on mandates about social work selfcare is not surprising as the profession has consistently moved away from working on the macro level to promote fair wages, redistribution of wealth, and access for all to embrace a more individualized form of social work, known as casework, based on individual need (richmond, 1917; specht & courtney, 1995). social work was originally rooted in affecting social policies and community environments to improve conditions for those adversely impacted. central to that effort was a belief that the focus of change should be the environment, not the individual. social workers were charged with promoting a collectivist approach to policy, focusing on societal improvements that allow full participation by all. recent work on social determinants of health reinforces the principle that social and political factors in larger society are the primary influencers of citizen wellbeing (paro et al., 2021). it is essential that self-care be reconceptualized as a problem needing to be remedied by collective intervention. no language was added to sections in the nasw code of ethics that focus on public participation, organized action, participation in labor unions, or social and political action, though all would be needed to remedy working conditions that result in added stress and burnout of social workers. social workers are trained to intervene at the root cause of a problem. data clearly indicate that social workers, who are predominantly women and more likely to be people of color than allied professionals, have low wages, high loan debt, and often face safety issues on the job. while the profession identifies dignity and worth of people as a core value of the profession (nasw, 2021), social workers are asked to make extreme sacrifices by working for free during their educational preparation and even being called upon to volunteer their time as an ethical mandate after graduation. research shows that micro level self-care assists with alleviating symptoms of burnout and work-related stress and there is value in continuing to promote individual practices such as mindfulness, yoga, and guided imagery (dalphon, 2019). however, these techniques do not address the root causes of stressors from workplace deficiencies (moss, 2020). the nasw code of ethics clarifies that self-care is necessitated by the struggles associated with the nature of the profession and its challenging work environment (i.e., employer and client demands, traumatic exposures, and workplace issues). an emphasis on self-care as an individual responsibility not only charges the practitioner with remedying the problem, but it also discounts the occupational hazards that are the root causes. requiring employees to cope with workplace challenges without holding employers advances in social work, fall 2022, 22(3) 886 accountable ignores the person-in-environment perspective to problem-solving that has been so central to the social work profession. the reasons for reconceptualizing self-care as a social justice issue are many. when the cause of the problem is properly identified, recommendations can be appropriately made to collectively advocate for policy changes that impact the well-being of social workers overall. additionally, viewing self-care as a social justice issue helps fuel conversations that have long been overdue. diversity of practice and employment settings have made uniting difficult. additionally, social workers, like others, have been particularly isolated due to covid-19, without professional conferences and meetings where momentum around mobilization typically occurs. social work has long struggled with its identity and public image (gitterman, 2014). though well-meaning, the new language in the nasw code of ethics reinforces the belief that individual actions (“self-care”) reduce the harm associated with the stress that social workers are likely to suffer. social workers should not be blamed for or asked to eradicate the ills from work conditions as doing so will not to help raise the reputation of the profession and will do little to eradicate the problems. though not exhaustive, the following section identifies recommendations that could greatly assist and are consistent with reconceptualizing self-care using a social justice perspective. table 1. mezzo and macro approaches needed to remedy oppressive work conditions collective action and advocacy organizational change health and safety in the workplace unionization policy and educational reforms title and practice protection paid internships recommendations social workers have at times been characterized as bureaucratic employees who act mechanically, often without second thought, routinely doing their jobs (mattsson, 2014). critical or radical social work has challenged social workers to consider their actions and think about whether their behavior could be oppressive and generate inequalities (bailey & brake, 1975). given that social workers are predominantly women and more likely to be people of color than allied professionals, the concept of intersectionality should be explored to better understand the extent to which gender, race, and ethnicity contribute to the oppressive salaries and working conditions of social workers. intersectionality has been used as an analytical approach to understand how social structures affect people’s living conditions (simon et al., 2022). additionally, intersectionality has been cited as a useful tool for critical reflection (mattsson, 2014). this article deconstructs social workers’ experiences to provide mezzo and macro recommendations for addressing oppressive work conditions, as summarized in table 1, rather than micro self-care approaches which perpetuate inequality by placing the burden on workers. through collective action, apgar & parada/missing the mark 887 advocacy, policy improvements, and educational reforms, social work could see transformational change that could enhance safe, ethical, and effective practice. collective action and advocacy organizational change the nasw code of ethics states that social workers should advocate for change on behalf of those whose living conditions do not enable the fulfillment of basic needs (nasw, 2021). though advocacy for livable wages and safe working conditions is fundamental to fulfilling the mission of the profession (reisch & andrews, 2001), there has been limited advocacy to enhance the wages and conditions of practicing social workers. social workers must be encouraged to view themselves as their primary clients (reidy, 2021). social workers must advocate with both educational programs and field agencies for paid internships, arguing that the failure to foster environments in which students are able to cover the cost of living expenses while in school is a direct violation of the nasw code of ethics (harmon, 2017). more schedule flexibility, better training structures, and increased access to interdisciplinary collaboration are cited as impactful changes that maximize social work satisfaction (johnco et al., 2014). cswe, nasw, and other professional groups need to work together to publicly acknowledge the negative impacts of unmanageable workloads and inadequate agency support (reidy, 2021). central to a coordinated campaign would be pressure for organizational policies aimed at adequate staffing to meet appropriate clientto-clinician ratios, fair and livable wages, sufficient time off, and supportive leadership. burghardt (2021) states that social work has been far too complacent as the erosion of the welfare state, inadequacies in the academy and educational preparation, systematic racism, and failure of leadership have eroded the professional legitimacy of social work, negatively impacting its professionals and those served. under burghardt’s leadership, a social worker equity campaign has emerged, calling for collective action against inadequate working conditions and financial insecurity that impact practitioners who ironically work against those very issues in their clients’ lives daily (s. burghardt, personal communication, september 26, 2021). despite the documented need, however, collective action aimed at improving organizational conditions may be difficult as it would require a transformative shift in social work’s focus to the mezzo and macro levels, areas which have not been the focus of the profession in recent years. greater participation in burghardt’s effort and others focused on collective action will be needed to be a formidable threat to the status quo. health and safety in the workplace personal safety is a right that should be afforded to all workers; it is an essential component of a healthy professional environment and one that drastically affects work experience and performance. investing in personal safety remedies, such as assembling safety teams who report, record, and address workplace violence incidents (and provide advances in social work, fall 2022, 22(3) 888 support to impacted staff), revitalizing employee training programs, and improving protocols for field visit safety (such as mandating pre-visit safety assessments and creating safety plans when deemed necessary), are vital steps in reducing the trauma associated with feeling and/or being unsafe in the workplace. safety training for students within the social work curriculum is also an important preventative strategy, as is researching ways in which technology can be used to reduce risk. funding will be essential to increase the safety of social workers so legislative action is needed to realize intended goals. in order to lead safety teams, new employees must be hired or current employees will need to be reassigned. training staff on preventive safety and self-defense requires that current supervisors have access to reliable training courses or certifications. technology such as safety cameras, global positioning system (gps) tracking devices, and upgraded mobile phones will be beneficial; however, additional technology requires enhanced funding. there is also a need for increased punitive charges for attacks on social services employees, with violators automatically facing felony charges when harming social workers on duty. mental health, resilience, and professional endurance could be significantly improved when the potential for life-threatening harm is reduced and social workers have greater assurance that they are safe and supported at work. unionization despite a strong interest in unionization (lightman, 1982) and historical recognition that social workers should be taught more about labor relations (shaffer, 1979), the profession has stayed largely outside of this movement (farr, 2021). while there is some concern about the ethical issues associated with striking or other collective action that could result from unionization, there appears to be a consistent belief that unionization aligns with social work values (douglass, 2016). in fact, jane addams, a pioneer of the social work profession, supported labor unions’ efforts to defend workers (shields, 2017). between 1931 and 1944, thousands of social workers joined unions, though their attempt to create an independent social work union was unsuccessful. in the 1950s, the improved post-wwii economy, as well as the growing desire to identify as professional clinicians as opposed to labor workers, started to draw social workers away from what once attracted them to unionization (scanlon & harding, 2005). labor unions have made a positive contribution to society by successfully combating abusive working conditions, long hours, and inadequate pay (leigh & chakalov, 2021). providing opportunities for social workers to join unions or developing an independent union for the social work field would better serve practitioners. within large systems like education, healthcare, and justice systems, unions would provide protection for social workers who may not have direct access to upper-level decision-makers who govern the rules, requirements, wages, and employment permissions that impact their daily jobs. unions are designed to represent the interests of their professionals – including appropriate pay, fair and safe working conditions, and adequate benefits/time-off – which would give a voice to the workforce and protect against structural and environmental abuses that inhibit self-care. apgar & parada/missing the mark 889 policy and educational reforms title and practice protection unlike some allied professions, social work has not had the same success of uniform title and practice protection across states and jurisdictions, making it possible for those without social work degrees to call themselves “social workers” and practice without accredited degrees and requisite training. while achieving nationwide regulation for physicians occurred by 1900, teachers by 1930, and attorneys by 1940 (law & kim, 2005), it was not until 1974 that nasw advocated for a social work regulatory board (cswe, 2015). four years later, in 1978, what is now recognized as the association of social work boards (aswb) was formed, administering its first licensure exam in 1983 (aswb, 2022). today, social work practice is still not uniformly standardized on a federal level. each state/jurisdiction is responsible for formulating its own regulatory guidelines of practice (cswe, 2015). according to the aswb laws and regulations database, lack of uniformity has resulted in many different social work titles (aswb, 2023). aswb (2018) has begun a push towards title standardization, proposing that all jurisdictions utilize three categories of licensure: licensed baccalaureate social worker (lbsw); licensed master social worker (lmsw); and licensed clinical social worker (lcsw). such uniformity in title, along with thorough, standardized practice protection, is an important step in social work policy reformation that can provide great benefit to the profession and those served. title and practice protection ensures that those without degrees, who may be willing to accept lower salaries, are not allowed to call themselves and work as “social workers.” continued advocacy for policy uniformity across states/jurisdictions is needed with a focus on removing licensure exemptions that threaten universal standards in professional social work practice. paid internships many trades operate under an apprenticeship model, much like an internship where trainees get hands-on work experience under the supervision of skilled professionals (vaughan, 2017). a key difference, however, is that students in trade industries learning to be plumbers, electricians, or mechanics, for example, are compensated for their work as apprentices. cswe should consider modifying field education requirements to adapt the apprenticeship model. when students are paid for their contributions, they devote their time, attention, and efforts to learning as opposed to being burdened with the need for additional paid employment to cover expenses associated with unpaid internships. by paying student interns for their work, employers receive added productivity at a lower cost, freeing up social work supervisors to focus on larger, more complex projects (lilly, 2020). while identifying financial resources to pay social work interns will not be easy, it is necessary as the current system is only sustainable at the expense of the well-being of social workers entering the profession. agencies need to recognize the contributions of social work students by advocating with funders to increase budgets to allow them to be paid during their internships. if the labor provided by social work interns was considered in advances in social work, fall 2022, 22(3) 890 agency operations, it is likely that organizations would find themselves in structural deficit if students were compensated. being truthful with funders about the “true cost of care” is essential and needed to assist social workers who are currently personally feeling the impacts of larger systemic issues beyond their control. conclusion self-care must be reframed as a social justice issue, with full recognition of the environmental strains that contribute to stress and burnout of social workers. this conceptualization is much more consistent with the person-in-environment perspective that has been the hallmark of social work. the profession has a long history of illuminating systemic problems and combating them with macro level solutions. while nasw appropriately brought attention to self-care, the revised ethical code misplaces the burden of responsibility onto social work professionals who must learn to cope with work-related stressors instead of employers and funders who should eradicate the injustices that are the sources of stress. consistent with the social work profession’s increasing focus on addressing problems through micro-level interventions is the mandate of practitioners to be responsible for their own well-being. while there are merits to yoga, mindfulness, journaling, and guided imagery to manage personal stress, it is not appropriate to use these techniques to address low salaries and poor working conditions that are the root causes of much hardship experienced by social workers currently. rather educational programs must help social workers entering the field to understand that personal self-care practices are methods to address the impacts of underlying stressors, not the stressors themselves. the literature has almost exclusively focused on the importance of evidence-based micro practices to manage stress of social workers without properly recognizing the need to employ mezzo and macro methods to eradicate the sources of stress. the former are necessary coping skills but not means to address the root causes of stress and burnout. recent workforce studies (george washington university, 2017, 2019, 2020) have highlighted the low salaries and high student loan debt, as well as other hardships, experienced by social workers. however, these data are not readily promoted to employers and service funders. the profession must reconsider unionization and revisit educational standards that allow students to engage in unpaid internships, graduating with substantial student debt. specific organizational changes, improved workplace conditions, and title and practice protections are additional mezzo and macro level interventions that would help remedy the problems that necessitate the need for self-care. in order to realize changes, collective advocacy and political action will be required. mandating coping strategies as methods of self-care is a reactive approach that can never be truly monitored or enforced. social work has the opportunity to use a social justice lens to examine the inequities within professional work environments. this approach will likely have a more significant impact on the performance, retention, longevity, and mental health of social work professionals than yoga and mindfulness. returning to the roots of the social work profession appears essential to ensuring its survival as all agree that stress and burnout of the workforce are real problems, but fundamentally disagree on the proper approach to apgar & parada/missing the mark 891 move forward to address them. references american medical association [ama]. 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(2022). who guideline on self-care interventions for health and well-being, 2022 revision. https://apps.who.int/iris/rest/bitstreams/1440452/retrieve author note: address correspondence to dawn apgar, department of sociology, anthropology, social work, and criminal justice, seton hall university, south orange, nj, 07079. email: dawn.apgar@shu.edu https://doi.org/10.1037/tra0000414 https://doi.org/10.1080/13636820.2017.1326516 https://doi.org/10.4037/ccn2020621 https://doi.org/10.1093/sw/swu053 https://doi.org/10.1080/23761407.2016.1166856 https://doi.org/10.1037/a0029446 https://apps.who.int/iris/rest/bitstreams/1440452/retrieve _________ carmela fusciello smith, edd, lcsw, associate professor, department of social work, southern connecticut state university, new haven, ct. jemel p. aguilar, phd, mph, lcsw, associate professor, school of social services, fordham university, new york, ny. shuei kozu, phd, mha, licsw, assistant professor, karen a. d’angelo, phd, msw, assistant professor, elizabeth king keenan, phd, lcsw, professor, and stephen monroe tomczak, phd, lmsw, associate professor, department of social work at southern connecticut state university, new haven, ct. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 758-778, doi: 10.18060/24646 this work is licensed under a creative commons attribution 4.0 international license. if anti-racism is the goal, then anti-oppression is how we get there carmela fusciello smith jemel p. aguilar shuei kozu karen a. d'angelo elizabeth king keenan stephen monroe tomczak abstract: many schools of social work around the united states of america wrote antiracism statements because of the recent murders of black and brown people. in this contribution, the authors describe a challenging and tense discussion of racism and antiracism leading to a group process about oppression and anti-oppression in the social work profession. for some, the urgency to address racism led to tactics and strategies that got in the way of social workers engaging in anti-oppressive practices. while the structure of higher education often reinforces traditional hierarchies of power, the profession of social work calls us to promote our core values of social justice, integrity, and the importance of human relationships as we strive for an anti-oppressive future. consequently, social work faculty may experience role conflict as we navigate these tensions. we believe it is important to harness and process such discomfort as we critically examine the power dynamics within our own department, and our own profession. this voluntary, ad hoc group, composed of a diverse group of faculty members, provides space for ongoing mutual aid, consciousness raising, appropriate discomfort, and accountability. if anti-racism is the goal, then anti-oppression is how we get there. keywords: anti-oppression practice, oppression, higher education, white supremacy, restorative justice despite the history of police and other mostly white american citizens shooting and lynching black individuals, some multi-ethnic segments of american society clamored loudly after watching derek chauvin kneel on george floyd’s neck for nine minutes and twenty-nine seconds. derek chauvin, however, was aided by thomas lane, another white man, as well as tou thao, a hmong american, and j. alexander kueng, a mixed ethnicity black identified man. essentially a multi-racial team of men black, hmong, and white, aided in the murder of george floyd, and its attempted cover up. the murder of george floyd sparked anti-racism statements among some businesses, academic institutions, and professional groups as well as calls to recognize that “black lives matter.” while the murder of george floyd certainly enacts racist beliefs about black men, a larger system of oppressive beliefs about many populations have guided actions in the united states of america in which one group leveraged their power to massacre, imprison, restrain, or lessen the value of other populations. examples in american history include the trail of tears, boarding schools for native americans, enfranchisement laws that were about:blank smith et al./if anti-racism is the goal 759 differentially applied to white women and women of color, the eugenics movement in america, military conscription during the vietnam war, prohibition against gay and lesbian’s marriage equality, “bathroom bills” targeting transgender men and women as well as sundown towns across the united states. many populations have been subject to oppressive political actions and legally sanctioned discrimination (ferber et al., 2009). the aim of this paper is to draw upon our insights and experiences within our voluntary, ad hoc anti-oppression committee, in order to name and discuss the contradictions within social work and higher education regarding values and practices; in doing so, we apply a theoretical framework of social dominance and oppression, discuss structures that reinforce oppression within higher education as well as common emotional and intellectual responses to oppression, and make recommendations for meaningful action. in this first section, we briefly explore concepts used to examine or explain oppression in american society including how and why some people adopt anti-oppressive language yet act in ways that subordinate groups. to that end, we draw on our experiences forming and participating in a voluntary, ad hoc anti-oppressive committee, as well as the tensions and missteps that did and did not fuel new understandings of social dominance, hierarchies, intersectionality, multiple social categorizations, socialization processes, and consequently oppression to further illustrate how oppression trickles down from structural systems to interpersonal interactions. while structural systems permit discriminatory interpersonal interactions, these systems also create modes of being described as privilege that shape how dominant groups judge their actions and the actions of subordinate groups. added to the complication of conceptualizing oppression is the dynamic nature of oppression in that interactions are shaped by the social context and identities of social groups interacting in the social context. to elucidate oppression, we start by explaining social dominance theory and applying that to oppression and then the creation of hierarchies of oppression. social dominance theory social dominance is an arbitrary system in which one social group dominates other social groups (pratto et al., 2006). social domination occurs on the group-level while also permitting interpersonal dominance at the interpersonal level and cognitive aspects of dominance at the individual level. thus, social dominance is a multi-level framework that includes several terms, such as privilege and discrimination, used to describe aspects of social domination. social domination is explained through myths about the appropriateness of domination like, for example, that a management committee made up of all white people can write a letter about the murder of george floyd without including the voices and perspectives of the black or indigenous people of color. this incident occurred in our department, sparking arguments about oppression laid against many marginalized identities in the department coupled with complicity with oppressive actions by people that identify as social justice advocates. during these arguments, questions arose about one’s positionality in relation to social justice as well as people who are marginalized because of their identities and/or social locations. these arguments revealed that the social hierarchies advances in social work, summer 2022, 22(2) 760 that stack different populations into more-oppressed or less-oppressed groups are not as uniform or linear (amosa & gorski, 2008; clark, 2010; marshall, 2009). to broaden the identities and complexity that exist among social groups, some diversity scholars employ intersectionality to address multiple identities (carbado, 2013; crenshaw, 1989; ghavami & peplau, 2013). intersectionality proposes that multiple grouplevel identities interconnect or converge and contribute to unique forms of oppression and represent multiple positions in a social hierarchy. while intersectionality is subject to critiques based on interpretation and application, the concept is widely used, and empirical evidence supports portions of the concept with different marginalized populations (ghavami & peplau, 2013). in contrast, social psychologists apply multiple social categorizations to group-level multiple identities to explain how cognitive, affective, and motivational factors influence group-level social interactions (curtin et al., 2016; riggio, 2013; pratto et al., 2006). additionally, multiple social categorizations include aspects of oppression that are not accounted for by intersectionality alone, such as colorism. thus, even when people are committed to anti-oppressive work, they may still contribute to oppressive behaviors. examining the multiple social categorizations of members of our group lends itself to understanding how the dominant and subordinate social groups dynamically interact to create hierarchies that maintain and reshape social hierarchies and social dominance (remedios & snyder, 2018). as we are born into multiple social categories, we are then socialized into an inequitable social system, which is pervasive, consistent, circular, self-perpetuating, and invisible (harro, 2013). unless something occurs that disturbs the cycle, the cultural, social, and institutional socialization processes continue, making it difficult for individuals to reflect, question, and challenge what is the “norm” to them. this leads to the creation of a culture within an institution to perpetuate the white norm/white supremacy. in the instance of white management committee members writing a letter in response to george floyd’s death without inviting faculty of color to share their perspectives, multiple faculty members of color challenged the appropriateness of the situation. white tenured faculty is not a monolith, either, and their actions differed greatly. many remained silent, both verbally and through non-action, while others exhibited behaviors that diangelo (2018) termed “white fragility.” while some tenured and non-tenured white faculty engaged in activism, working for and with faculty of color to reflect everyone’s voices. oppression oppression is “a set of policies, practices, traditions, norms, definitions, and explanations, which function to systematically exploit one group to the benefit of another group” (sensoy & diangelo, 2017, p. 84). despite the clarity of sensoy and diangelo’s definition, oppression is a confusing concept because many times scholars, practitioners, and laypeople equate oppression with the systemic oppression laid against groups in society, namely racism, sexism, heterosexism, ableism, and other “isms.” mcdonald and coleman (1999), in contrast to sensoy and diangelo, include a more expansive conceptualization of power in their definition when they state, “oppression is also discrimination systematically enforced through use of social/economic/political power, in smith et al./if anti-racism is the goal 761 such a way that the status quo is maintained, and inequity is legitimized in domination” (p. 20). while racism, sexism, ableism, and heterosexism describe oppressive relations between dominant and subordinated social groups based on a social identity such as ethnicity, sexual orientation, and gender identity, the overarching concept of oppression foregrounds examination of power relations, including subordinate and dominate, center/margin, and invisible and visible. oppression, thus, is backed by social power that dynamically creates ingroups and outgroups in social contexts. for example, faculty groups on some u.s. college campuses are divided into professor, associate professor, and assistant professor social groups. the system of higher education endows each of these social groups with a level of power based on their position within the social and educational hierarchy. therefore, in faculty meetings the power relations between the faculty members operates “in the background” as professors, associate professors, and assistant professors interact. at times, power relations are made overt through tenure in that assistant professors – typically untenured – might be reminded of their place in the academic hierarchy and tenure process (dews & law, 1995). faculty members in professor or associate professor social groups might espouse values associated with egalitarianism, particularly in professions such as social work, while relationships between professor groups enact social hierarchies prevalent in american society that rank people with different ethnic identities, sexual orientations, abilities, and gender identities among many other identities (dessel et al., 2012; di palma, 2005; harris & nicolazzo, 2020; wong & jones, 2018). while professor social group and tenure status play roles in social hierarchies, other social groupings also come into to play and create additional groupings and subgroupings that add to complex social hierarchies within academic settings. staff and adjunct faculty are often ignored and not invited when decisions are made for the department, as these additional social groups are often overlooked and under-appreciated. additionally, in the social work profession, the division between direct practice social workers such as clinical, case management, or direct client care positions and community practice social workers such as community organizers and policy advocates is an additional facet of social groups that can further group social workers in academic settings (feldman et al., 2021; liddel & lass, 2019; robinson et al., 2020). thus, dominant social groups in an oppressive regime will differ based on social context and are more dynamic and complex than simple ranking of faculty from assistant to full professor. while this example has focused on our social work department that is located within academia, the ideas and assertions laid out in this section are transferable to other social contexts and social groupings, explaining how hierarchies of oppression are structured and maintained. hierarchies of oppression as unpacked in the previous section, oppression is a multi-faceted and interconnected social process. hence to practice an anti-oppressive approach effectively, the multiple facets of social grouping across social contexts should be addressed. this will be a conceptual leap for some and for all, a non-linear and dynamic process. advances in social work, summer 2022, 22(2) 762 the united states of america, for example, was established by 56 white, affluent males. many of these men owned slaves, subjugated women, and disenfranchised poor people all while writing, we hold these truths to be self-evident, that all men are created equal, that they are endowed by their creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness. that to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed. (national archives, 1776/2022, para. 2) the social structures that followed the establishment of u.s. society afforded subsequent white, wealthy men unearned privileges by virtue of their status in the u.s. over time, voting was established for white men, slaves were freed, attempts to decimate native americans occurred, men of other ethnicities were permitted to vote, other forms of subjugation were established to maintain divisions between black and white people, laws punishing the sexual assault of women, mostly white, were enacted and years later protected black women, quota systems for immigration were enacted limiting nonnorthwestern europeans entrance to the united states, gay and lesbians advocated for equal civil rights, women advocated for equal rights as part of an equal rights movement, people with disabilities were afforded protections under the individuals with disabilities act, and many other events by subjugated social groups have challenged the dominant status of social groups in american society. while cisgender, heterosexual, able-bodied, white men have historically maintained a high social status in american society (kimmel & ferber, 2017), other groups maintain a subordinate status. however, to this day, cisgender, heterosexual, able bodied, white men’s status in american society is the pinnacle of the hierarchy of oppression. as stated earlier, the dynamic and contextual nature of oppression inhibits the static ranking of subordinated groups because the context changes the ranking of subordinate groupings. the dynamic and contextual nature of the hierarchy of oppression, thus can create tactics and strategies used by both dominant and subordinate social groups during interpersonal interactions and social actions striving to be anti-oppressive. while tactics and strategies will be discussed later in this paper, features of the hierarchy of oppression will be discussed further in this section. privileged or dominant social groups within a hierarchy hold power and social status as well as the maximum access to necessary commodities. subordinate groups, in contrast, must either conform to the rules and desires of those at the highest levels or resist conformity (mcdonald & coleman, 1999). in most academic departments, necessary commodities include tenure status, the ability to assert one’s position without risk of retaliation that might results in job loss, priority selection of courses including dates and times, on campus and professional social capital, and differential access to sabbaticals and other workload resources. subordinate social groups must decide whether to engage in a constant struggle with those in privileged or dominant groups status as well as others within subordinate groups (mcdonald & coleman, 1999; pratto et al., 2006). resistance and conformity have both positive and negative implications for subordinate social group members. for some subordinate group members, conformity is participating in their own smith et al./if anti-racism is the goal 763 oppression in exchange for shadow privilege, a privilege that is extended to another because of their relationship with a privileged person. conformity might ebb and flow in that digression in response to direct experiences of oppression might lessen conformity, while witnessing oppression towards other subordinate social group members might increase conformity. conformity can also occur through status maneuvering which involves subordinated social groups creating similarities between those with privileged status to align themselves with dominant social groups (oselin & barber, 2019). this might explain, to some extent, why non-white police officers do not intervene when black citizens are brutalized by white police officers. non-white police officers might be benefiting from shadow privileges due to their close relationships with white officers, or they might be finding being police officers or being male as their similarities. in the case of derek chauvin and three other officers who are responsible of george floyd’s death, derek chauvin is the oldest of the four, and likely the most senior officer amongst them. by challenging officer chauvin, the rest might have feared retaliation or loss of privilege they have benefited. both shadow privilege and status maneuvering can create conflicts among subordinated social groups as those subordinate social group members resisting oppression conflict with subordinate social group members that conform with the oppression by dominant group members. when conflict disrupts subordinate social group relationships, as mcdonald and coleman (1999) point out, groups further up the social hierarchy benefit, especially as subordinate social group members fight amongst themselves rather than pull together to challenge the social hierarchy. freire (1965/1973, 1968/2014) suggests that dominant groups stimulate conflict among subordinate groups as a way of maintaining an oppressor and oppressed relationship. manipulating social groups, inciting conflict among subordinated social groups, and presenting a mirage of helpfulness and solidarity while simultaneously inhibiting oppressed groups from rising up – essentially reaching out with their hand to help them up while putting their foot on them to keep them down – redirects attention from social hierarchies towards other social groups and the struggle for limited resources. therefore, it is crucial to address all forms of oppression in order to practice anti-racism. if we allow the culture where we remain silent when a marginalized group is targeted, other forms of oppression will persist. structures that support oppression an example of a structure that supports oppression is silence particularly related to white supremacy. on its face, the term “white supremacy” sparks memories of enslavement, lynching, and violent control of africans and african americans. at one time, this was the primary mode of maintaining white supremacy but since the civil rights movement the strategies for maintaining white supremacy have changed. white supremacy during the covid-19 pandemic, for example, has permitted many people in the united states of america to authoritatively rename covid-19, the “china virus” and then viciously attack asian americans and asians in response to perceived infringement on their rights (jeung et al., 2021), and the hate crimes against many other social groups such as gay men and lesbians, transgender men and women, non-binary people, as well as advances in social work, summer 2022, 22(2) 764 people with various abilities and disabilities. thus, white supremacy has evolved to account for more than overt acts of murder of african americans to include subversive acts of subjugation of perceived subordinate social groups (mccoy, 2020). in the social work profession, prominent social work reference texts do not define white supremacy (barker, 2014; harris & white, 2013; mizrahi & davis, 2020; rowe & rapp-paglicci, 2008; thyer, 2008; timms & timms, 2016; white, 2008), which is a form of silence by a profession that espouses social justice values. the merriam-webster dictionary (2011), however, defines white supremacy as “the belief that the white race is inherently superior to other races and that white people should have control over people of other races and the social, economic, and political systems that collectively enable white people to maintain power over people of other races” (p. 1429). white supremacy, however, is not limited to subjugating one color or ethnic group into slavery but includes a dynamic assimilation of groups into a “white” category, the establishment and domination of subordinate groups, and a reshaping of overt violence and enslavement of marginalized populations towards whitewashing of the domination, as well as insidious infiltration into judicial, political, economic, cultural, cognitive, somatic, metaphysical spheres of society and human development (gillborn, 2006; hooks, 2004; kendi, 2019). white supremacy, therefore, is a multi-dimensional social construct that is embedded in overt and covert aspects of society in ways that emphasize power dynamics between dominant and dynamically situated subordinate social groups. white supremacy gives birth to and rears hierarchies of oppression. white supremacy is best understood as a system of power and control that uses systems of oppression such as capitalism, patriarchy, ethnocentrism, and heterosexism to dominate and exploit marginalized populations in the interest of maintaining privilege for whites, and most particularly whites who control most of the income and wealth in society. social groups can also support white supremacy through policies or plans that bolster whiteness as superior, also known as strategies, as well as tactics or ways of enacting strategies that uphold whiteness as superior over other groupings. strategies can include rewriting memory or history or cultural appropriation as well as tactics like stimulating conflicts among subordinate groups and tone policing, meaning one focuses on the tone and not the content of what is being said (biddle & hufnagel, 2019; curtin et al., 2016; nuru & arendt, 2019; quinones, 2017), white tears (hikido & murray, 2016; patton & jordan, 2017; phipps, 2021; tate & page, 2018), and status maneuvering (oselin & barber, 2019). several scholars have written about many of the strategies and tactics used in oppressive contexts (pewewardy, 2003; smith et al., 2021). among our department and committee conversations, for example, some white faculty members subjugated subordinate groups through tone policing of black indigenous people of color (bipoc), interrupting women, and speaking for all members of the faculty when discussing oppression. simultaneously, some bipoc engaged in status maneuvering by steering conversations exclusively towards race and racism despite the multiple social categories among the people that are marginalized in social work, academia, and society. thus, strategies and tactics operate within a power structure that emphasizes overt and covert mechanisms for a system of social control. covert strategies are more insidious and have included the use of what herman and chomsky (1988) call the manufacture of smith et al./if anti-racism is the goal 765 consent, which employs techniques of advertising and other methods of manipulation to normalize white supremacy, and its assumptions about bipoc people. tactics are employed to subordinate populations through interpersonal interactions such as those described above but also through media and educational institutions. these interpersonal tactics contrast with overtly violent structural intimidation and terrorism tactics that are typified by groups such as ku klux klan and more recently by “alt right” groups such as the proud boys, promise keepers, and qanon (kendi, 2019). these interpersonal and structural tactics are important – individually and combined – facets of maintaining white supremacy, normalizing whiteness, instilling conformity to whiteness, promoting conflict within marginalized groups because of status maneuvering, and adhering to a dominant and subordinate social order. moreover, reactions to these interpersonal and structural tactics produce further reactions among those with social identities matching dominant social groups or subordinated social groups. during the spring of 2020, a faculty member analyzed the distribution of student advising among all full-time faculty in our department. as part of this analysis, they submitted their report that compared faculty demographics with participation in undergraduate, graduate, and doctoral student advising and reported that 100% of cisgender, heterosexual, white men were tenured. in contrast, 42% of white women and 20% people of color (including one female) were tenured. additionally, 88% of men compared to 40% of women were tenured and no queer faculty were tenured. highlighting the demographic differences among the tenured faculty does not reflect other differences that play a role in the social relationships among faculty members. social work is a professional field consisting mostly of cisgender women with the aim of promoting justice, yet these statistics reflect a set of advantages based upon gender, race, and sexual orientation. additionally, 71% of the white male tenured faculty refused to advise undergraduate students leaving advising to faculty comprised primarily of groups of faculty members that are marginalized because of their identities and social locations. hence, like many structures in u.s. society, our social structure benefits cisgender heterosexual white men. when confronted with this data, many white male faculty members defended and denied these inequities and positioned themselves as victims to the resistance of faculty members that are marginalized because of their identities and social locations who spoke up during an anti-oppression committee meeting. to address the situation, many faculty members, both tenured and non-tenured, voted for all faculty to advise undergraduate students. even those who voted against the matter participated in the training sessions. this is not indicative of their acceptance of the change in the department for an anti-oppressive approach. it is our hope, however, that through the process of training, advising, coaching and consultations, non-tenured and tenured faculty will share the common goal of an improved student education, and bring us closer to achieving the goal. emotionality and resistance: the oppression continuum emotionality is an important facet of both tactics and strategies used by dominant and subordinate social groups. as discussed, white tears, tone policing, conformity, and resistance are emotional ways that both dominant and subordinate social groups contend with oppression. to explore and explain emotionality in the context of oppression, we advances in social work, summer 2022, 22(2) 766 employ and adapt carr’s (2003) theory of empowerment through a feminist lens and then illustrate aspects our conceptualization by applying our experiences in the department and with each other. carr (2003) draws on feminist thought on positionality, interpretation, identity building, and mobilization for change to examine the process of empowerment. our individual and communal responses to oppressive experiences range from intellectualization or emotional detachment to emotionalization or intense personal feelings. should we respond emotionally as the oppressor, then we might exhibit a sentimental attachment to a worldview that protects our self-image, social status, and power (ahmed, 2004; diangelo, 2018). such emotionality shifts attention away from those who are oppressed towards the oppressors and allows oppressors to avoid accountability for the harm this social group causes. should we respond emotionally as the oppressed, we may grieve for lost opportunities, the possibility of hope, and the imposed limitations on one’s value and success in society (gitterman & knight, 2019). we all participate in oppression, moving fluidly on a continuum from oppressor to oppressed. we contribute to oppression as individuals, as communities, and as the social work profession (jones, 2020). therefore, we need to be mindful of tactics used to oppress others, such as deny, attack, and reverse victim and offender (darvo) in order to deflect the blame (second city works, 2020), but to take responsibility of our own words and actions. while we cannot escape from the oppression continuum, we can become aware of our positionality, reflect on our emotionalization, and support one another in effecting social transformation (carr, 2003), thus, eliminating bystanders and creating amplifiers. figure 1. oppression continuum oppression, like trauma, is timeless in that it is both historical and vicariously situated. all forms of oppression must end. mullaly & west (2017) suggests that an anti-oppressive approach requires a shift in thinking regarding who must change, a move away from blaming those who are oppressed for their reactions to oppression they might have smith et al./if anti-racism is the goal 767 experienced since birth, and a stop to the demand that victims change by assimilation or being told to speak in a way that is comforting to the oppressor. we believe in the notion that an attack on one oppressed group is an attack on all oppressed groups. while there are hierarchies of oppression within our society, most people identify with multiple privileged and marginalized groups simultaneously, and their experiences differ even though they may belong to the same social categories. this leads to oppressive practice within a group toward each other (david & derthick, 2013). systemic and structural oppression also reinforce each marginalized group pitting against each other to maintain the power of the privileged groups. wherever we find ourselves on the oppression continuum, we might respond to oppression with anger, fear, loneliness, and grief, or numbness (laub & allard, 1998; sortero, 2006). some anti-oppressive advocates argue that social groups should reflect on our response to oppressive experiences to locate and regulate our emotions (hooks, 1993), integrate thoughts and feelings, and empathize with the feelings of others (gerdes & segal, 2009). alternatively, some anti-oppression advocates argue that anger, rage, and frustration are useful tools that should not be diminished in favor of the emotional and cognitive needs of dominant groups (falck, 1988; gonzalez, 2017; hamad, 2019). the authors of this paper can be placed along the continuum of regulating emotions to emotions as tools, which is common among the social groups with different relationships to oppressive structures. figure 2. action to social transformation white persons and others who are positioned as oppressors can reach beyond their emotional discomfort “into the prolonged emotional investment in humanity, so necessary to undoing racism” and oppression (matias, 2016, p. 61). emotional investment, however, requires dominant groups to forgo the tactics and strategies used to resist displacing ownership for the groups’ oppressive tactics and strategies while facing the emotionality of oppressed groups and their own reactions. when called to confront dominant social groups’ participation in oppression, dominant social groups might react by resisting change known as negative resistance or may act by resisting oppression known as positive resistance. social group members might feel empowered to move from negative to positive resistance to build a sense of social belonging, hopeful thinking, and commitment to common purpose (freire, 1968/2014; rowe, 2015; synder, 2002), but this takes significant advances in social work, summer 2022, 22(2) 768 personal and social effort to undue considerable socialization, intellectualization, and emotionalization training over one’s lifetime. the effort to change a lifetime of socialization into an oppressive power structure illuminates the challenge when social groups neglect deep rooted and identity-challenging self-reflection to participate in the power dynamic within the social structure and continue the process of multiple marginalized groups continuing to hurt other subordinated groups instead of uniting. in response to the discussions of oppression and oppressive structures within our department, different dominant and subordinate social group members attempts at intellectualization and emotionalization, and the legacy of oppression rooted in our social structure of the department, one of the authors used his social capital to invite a restorative justice expert to identify how this intervention might bring interpersonal and social change. restorative justice practices are targeted as means to balance social transformation, action, resistance to change, and resistance to oppressions (armour & umbreit, 2018). the process of incorporating restorative justice practices into our response to oppression will be discussed in the implications section, but for now we will explain how the restorative justice practices we are incorporating strive to balance all forms of oppression embedded within our social structure and relationship while attending to the harms that subordinate populations have encountered in our department. for example, faculty in our social work department identified inequities in the distribution of faculty work. untenured faculty of color had heavier responsibilities for academic advising than tenured white men. when the disparate impact of advising assignments was framed as a matter of social justice, some faculty members reacted with surprise and denial. in meeting conversations and emails, some cisgender heterosexual, white male tenured faculty demonstrated emotionalization through angry outrage, intellectualization through efforts to reframe the issue as academic elitism, reversing victim and offender by focusing on the amount of labor put in with students, and silence. in contrast, many faculty members from marginalized groups felt emotionally assaulted by these egregious actions, and some white faculty experienced anger, outrage and disappointment. while some tenured white faculty continued to engage in oppressive behaviors such as stimulating conflict and victim identity, other tenured white faculty engaged in antioppressive approaches. these activities included calling in, to provide education and space for their colleagues to reflect on their own actions. they also powered with marginalized groups: this is a use of interpersonal power, privilege, and relationship, yet differs from addressing the social structure that enabled the cisgender heterosexual white male tenured professors from considering the harm that subordinate populations would experience that adds to the harms brought into the social interactions from living in a society that maintains a hierarchy of oppression. at the same time, in anti-oppression meetings, we reflected on our own actions where we remained silent when we could have spoken out, to remind each other that we can all engage in oppressive actions while being oppressed. although the department voted to revise the policy on advising, some faculty were left exhausted by the effort of effecting change because the policy might not change the factors that lead to disproportionate numbers of advisees. smith et al./if anti-racism is the goal 769 understanding and altering oppression is not an easy process. based on our experiences, in the next section we attempt to answer the question: how do we assure that anti-oppressive work leads to constructive and hopeful action rather than destructive alienation and despair? intentional action in order to address oppressive practices in our department, which were strongly undergirded by white supremacy, patriarchy, and the antiquated, hierarchal power structure of academia, faculty sought out to work collaboratively in order to determine how we may meaningfully work towards creating a truly anti-oppressive departmental culture. the aim was to avoid tokenizing and symbolic demonstrations of solidarity or social justice, and instead to promote an active, anti-oppressive culture, in which all members of our team feel heard and valued. this process began with a voluntary meeting, where the group identified aims and initially agreed to meet weekly. this group then hosted regular meetings in which a group of about ten faculty met virtually over the summer of 2020, to discuss strategies for change; meetings were always open to all department staff. this group included tenured faculty, non-tenured faculty, and one adjunct faculty member; it was facilitated by two non-tenured faculty of color. the aim for this group was to provide mutual aid, raise critical consciousness, provoke appropriate discomfort, and promote shared accountability. space was intentionally created to allow for a participatory group process; participants were encouraged to be honest and vulnerable in sharing their perspectives and experiences, as well as to actively listen, with humility, and personally reflect on what was shared. through this process, faculty identified both policies and processes that reinforce traditional and oppressive power structures within our department and discussed strategies for change. faculty of color and faculty from other marginalized groups shared painful, personal experiences of feeling marginalized and/or exploited by others in the department, and at times this process helped other colleagues gain awareness of the complex nuances to their privileged experiences and reflect about personal behavior that essentially led colleagues to experience oppression. however, these difficult conversations did not always feel productive. at times, despite our collective best efforts, the group dynamic replicated oppression as dissenting voices dominated the discussion which inhibited further growth or reconciliation. the group also grappled with the fact that, though it was open to all, fewer than half of our departmental faculty and staff participated in the process. these contradictions were hard to understand, given that this is a department of social work, and that we are all trained and aligned with a profession that overtly is committed to social justice, integrity, and the importance of human relationships (national association of social workers [nasw], 2017). after meeting for about 12 weeks, and in the face of escalating tensions and growing concerns about the potential implications of this discord on students and the broader community, the group explored external supports to help our department better facilitate this work. struggling with how to effectively instill anti-oppressive practices within the cooperative processes of our department, and foster a culture of shared accountability, our advances in social work, summer 2022, 22(2) 770 anti-oppression group chose to proceed with a restorative justice approach. with the support of our department chair and dean, we sought the assistance of external consultants that are experts in restorative justice interventions, and familiar with both social work and academia. we chose a restorative justice approach because it ultimately aligned best with our group’s aims and embraced our humanistic values as social workers. according to the university of san diego (usd) center for restorative justice (2021), restorative justice is “a philosophical approach that embraces the reparation of harm, healing of trauma, reconciliation of interpersonal conflict, reduction of social inequality, and reintegration of people who have been marginalized and outcast” (para. 1). stemming from indigenous culture and practice, restorative justice practices facilitate transformative change through community empowerment, engaged participation, active accountability, and social support. the methodology intentionally brings community stakeholders together to build trust, acknowledge harm and accept responsibility for wrongdoing, and repair relationships (usd center for restorative justice, 2021). although peripheral in the professional literature, restorative justice has been used in social work practice for decades to address different types of injustices (gumz & grant, 2009; van wormer, 2006); these most often have included victim offender mediation (choi et al., 2010; umbreit, 1994), and therapeutic family interventions (van wormer, 2003). restorative justice has also been suggested as a way for social work to actualize a restorative process towards social justice (gumz & grant, 2009), and reconcile its dual functions as agents of social change and social control (burford & adams, 2004). while restorative justice has been widely applied to school settings, we are not familiar with it being applied to a social work department within a university setting. the pivot or shift from demeaning and subjugating power dynamics towards the social work ethical principle of social justice in which social workers pursue “social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people” requires attention to individual, interpersonal, organizational, and professional changes (nasw, 2017, p. 2). these multilevel and multidimensional changes can lead towards centering the humanness of all peoples as social workers come into their fullness as a human being and accessing one’s full capacity in an embodied manner. pivoting encompasses conflict, social stress, strategies and tactics to maintain white supremacy and oppression, as well as attempts to realign the power structures through stimulating conflict among people with identities and social locations that are marginalized in the department, academia, and society. not all group members were or are comfortable walking through the coppice of thorny conflicts, however, some argue that pivoting requires a deep anchor that acknowledges and values the vibrancy of all living creatures as social beings, who desire and need each other to become our best selves. eventually, a collective antioppressive mindset believes that individuals thrive when social groups and organizations thrive because no one group dominates at the expense of other groups. we have a long way to go, but we have just entered the coppice of thorny conflicts. smith et al./if anti-racism is the goal 771 creating a process intrapersonal. social workers develop awareness of the ways they have internalized privilege from their specific positionality – internalized dominance, internalized oppression, or a combination of dominance and oppression. exploration of how one has been socialized into their privilege and biases, the beliefs and assumptions one has of self and others, and the costs to self and others are examined. specific reflection on moments where harm has occurred can potentially spark intense emotions and reactions. this work optimally occurs in tandem with practices that build muscle for sitting with intense emotions, ground one within one’s body, and utilize body practices that heal and nurture one’s affirming relationship with self. social workers cultivate awareness of how they engage in centering and distancing behaviors in relationship to their positionality, and practice how to assess and respond to psychological harm in various settings. intrapersonal requires the following: awareness of centering and distancing behaviors (menakem, 2017); develop muscle to acknowledge harm done (saad, 2020); and develop muscle to speak up in the moment (haga, 2020). interpersonal. social workers intentionally use a humanizing interdependent mindset when interacting with others to identify which groups are being centered, marginalized, or devalued. intrapersonal practices support social workers’ ability to speak in ways that disrupt complacency when others are indifferent or are fostering a “negative peace,” and create spaces for restorative practices when harm occurs. providing opportunities, in a safe space, with a trained outside professional/consultant with restorative practice experience, to respond to conflicts and harm. affording opportunities for everyone to share their thoughts and/or experiences and to listen. interpersonal requires the following: accountability and disrupting complacency (menakem, 2017; saad, 2020); restorative practices for harm done and decentering whiteness (haga, 2020). organization. a humanizing, interdependent mindset helps social workers plan activities that build relationships within and across multiple groups within an organization. existing structures and ways of working are examined for the degree to which people impacted by decisions are meaningfully included in deliberations and decisions. an equity mindedness framework is also utilized with policies, programs, and procedures to identify and intentionally address inequities. to do this, some of the tasks would include providing a space to build up faculty and staff relationships, building a community of trust and respect, establishing a space to develop policy and procedures, addressing conflicts to change and prevent an oppressive culture, and developing a method to track progress and accountability. ultimately, organizations require an equity mindedness lens for policies and procedures, relational activities, and accountability (university of southern california center for urban education, n.d.). professional and institutional level change requires examination of underlying beliefs and assumptions to uncover biases and a culture of oppression. the non-profit industrial complex has promoted white saviorism without significantly redistributing resources or improving the well-being of low-income, distressed communities where many bipoc live. social work’s investment in licensure and the delivery of clinical social work services keeps the profession dependent on an individually based fee for service reimbursement advances in social work, summer 2022, 22(2) 772 funding stream by for-profit health insurance companies. while clinical social work services are necessary for individual and family healing, an over-reliance on this only perpetuates a culture of oppression since most social workers are dependent on that for their financial security. student loan debt further perpetuates social workers’ reluctance to challenge existing funding streams. institutions must question beliefs and assumptions, such as white/male saviorism and non-profit industrial complex. implications there is no escape from the oppression continuum. fighting for social justice is a continuous process of raising awareness of oppression, reflecting on our responses, and working together towards a common goal. by calling in, eliminating bystanders, and powering with others, we can transform the oppression continuum into a virtuous cycle of change. figure 3. common goal how do we assure that the pain of anti-oppressive work leads to constructive and hopeful action rather than destructive alienation and despair? our department’s experience exemplified the importance of group work for anti-oppressive social work education and practice. social justice group work (garvin & ortega, 2016; ortega, 2017) and restorative practice are effective means for building community, fighting against institutional and interpersonal oppression, and promoting individual and communal healing. however, the challenges of building trust, setting norms, and facilitating mutual aid call for specialized group work knowledge and skills. by restoring the prominence of group work in social work education (simon & kilbaine, 2014), we can build our profession’s capacity to resist oppression and contribute to a socially just world. summary this article describes the process that portions of our department of social work went through in responding to the exposure of oppressive practices in our program. in response to the murder of george floyd, our all-white management committee sought to write a letter as did many other organizations in the u.s. the department realized we were unable to write a meaningful letter directed toward external stakeholders until we first grappled smith et al./if anti-racism is the goal 773 with issues of racism and other inequities within our own department. initially, some came to address anti-racism and racial justice while others redirected our efforts towards oppression and anti-oppressive practices that included dismantling white supremacy and racial injustice. framing our purpose as anti-oppression challenges the social work profession to strive for social justice for each and every oppressed group, instead of repeating the legacies of a hierarchical oppression, which focuses on one group while allowing others to languish. to that end, we had to challenge our own terminology, concepts, fears, and interpersonal differences to upend our roles in the department, our roles with each other, and our perspectives of the goals and purpose of the social work profession. this article has attempted to describe a group process in response to instances of racism, sexism, and other forms of oppression in our organization. the shift from a focus on anti-racism to antioppression allowed us to create processes to address oppression through anti-oppressive practices. this central insight reveals that if anti-racism is the goal, then anti-oppression is how we get there. references ahmed, s. 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(2018). students’ experiences of microaggressions in an urban msw program. journal of social work education, 54(4), 679-695. https://doi.org/10.1080/10437797.2018.1486253 author note: address correspondence to carmela fusciello smith, department of social work, southern connecticut state university, new haven, ct, 06515. email: smithc57@southernct.edu https://reflectionsnarrativesofprofessionalhelping.org/index.php/reflections/article/view/1858 https://reflectionsnarrativesofprofessionalhelping.org/index.php/reflections/article/view/1858 https://doi.org/10.1207/s15327965pli1304_01 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1350062 https://doi.org/10.1080/17449642.2018.1428718 https://doi.org/10.4324/9781315625904 https://www.sandiego.edu/soles/leadership-studies/restorative-justice-facilitation-and-leadership-certificate/ https://www.sandiego.edu/soles/leadership-studies/restorative-justice-facilitation-and-leadership-certificate/ https://cue.usc.edu/about/equity/ https://doi.org/10.1606/1044-3894.127 https://doi.org/10.1300/j067v26n03_04 https://doi.org/10.1080/10437797.2018.1486253 mailto:smithc57@southernct.edu _________ alex redcay, phd, lcsw, associate professor, department of social work, millersville university lancaster, pa. beth counselman-carpenter, phd, lcsw, associate professor, department of social work, adelphi university, garden city, ny. wade luquet, phd, lcsw, professor, department of social work, and john gunn, phd, assistant professor, department of psychology, gwynedd mercy university, gwynedd valley, pa. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 255-276, doi: 10.18060/27640 this work is licensed under a creative commons attribution 4.0 international license. the impact of social, legal, and medical transition on psychological distress for transgender persons alex redcay beth counselman-carpenter wade luquet john gunn abstract: psychological distress is a major health concern for transgender persons undertaking the transition process. the purpose of this secondary data analysis of the united states transgender survey (usts) compiled by the national center for transgender equality (ncte) was to explore the relationship between the three stages of transition (social, legal, medical) and levels of psychological distress. while much of the current social work research focuses on risk factors related to psychological distress, particularly around discrimination, this study explores how each stage of transition can serve as a protective factor to increase overall well-being. independent sample t-tests, anova, and regressions were completed to determine if social, legal, and/or medical transition had a significant effect on psychological distress. findings indicated that improving access to services supporting transition can reduce psychological distress. implications for practice include the need for client psychoeducation related to factors of resilience and protective factors that accompany each step in the transition process, and the importance to collaborative care with trans-affirming medical providers. similarly, implications for social work education include an increased need for integrated coursework with an inclusive and affirmative lens applied to all levels of social work for all lgbtqia+, but particularly related to trans individuals and their families. keywords: transition, transgender, psychological distress, protective factors psychological distress among transitioning transgender persons has been well documented (brecht et al., 2021; timmins et al., 2017). the dsm-5-tr diagnosis of gender dysphoria is the term used to describe the sense of unease a person feels when their gender assigned at birth does not match their gender identity and/or their expressed gender. this unease can continue during the transition process and result in the psychological distress experienced by many transgender persons and its accompanying mental health concerns. the purpose of this secondary data analysis of the united states transgender survey (usts) (james et al., 2016) compiled by the national center for transgender equality (ncte), is to explore the relationship between the three stages of transition, which include social, legal and medical transition related to gender affirmation, and how these varying layers of transition may serve as protective factors from psychological distress. we open this article by discussing some of the commonly accepted definitions related to the transition process and gender identity. about:blank advances in social work, spring 2025, 25(1) 256 sex, gender, and gender identity gender and sex are distinct constructs that are highly related but not interchangeable. sex is assigned at birth, typically by medical professionals and parents at the time and is often based on visibly physical characteristics, such as external genitalia. medical professionals often do not examine hormones, chromosomes, internal sex organs, or the white matter microstructure of the brain around the birth of a child (redcay et al., 2019). gender identity, however, is an internal emotional and cognitive awareness about oneself and one’s gender and has been observed in the white matter microstructure of the brain (redcay et al., 2019; spizzirri et al., 2018; uribe et al, 2020). for this analysis, participants in the united states transgender study self-identified as transgender or one of the many expressions of gender diversity, including but not limited to genderqueer, gender expansive, nonbinary, agender, third gender, and two-spirit. transition social workers should understand that the process of transition is multi-layered, polydimensional and may have different meanings for different clients. there are several models of transgender identity development, including but not limited to devor’s (2004) 14-stage model of transsexual identity development and gagne et al.’s (1997) four themes of gender identification, however, this research focused specifically on the process of external transition. in earlier literature, transition was often referred to as the process or steps a transgender person (in historical literature, often referred to as a transsexual person) engaged in, particularly medical steps or interventions such as hormones, surgery, or voice therapy. this article aligns with the definition of transition outlined by budge et al. (2013a): the process through which all transgender persons experience to identify as transgender with a particular focus on three structural steps including social, legal, and medical. • social transition refers to the process of socially using one’s name, clothing/external appearance, hairstyle, and pronoun that match one’s internal gender identity rather than the sex assigned at birth (sherer, 2016). • legal transition refers to the process of changing one’s identified sex on legal documents, such as one’s driver’s license, identification materials, and birth certificate. • medical transition includes puberty blockers/suppression, hormone therapy, speech/voice therapy, and surgical procedures. the experience of transition is non-linear, allowing a series of steps and/or stages to occur separately or concurrently. typically, social transition occurs first and may be required for a certain period to secure structural support for legal transition and finally medical intervention, which due to multiple factors such as access to health care, cost, and authorization for reimbursement of services, usually occurs as a last step in the transition process. however, legal, and medical transition are not required for one to identify as transgender or as gender expansive. see chang et al. (2018), hodax et al. (2023), mallon (2021), and tsai et al. (2021) for a deeper exploration into the steps towards transition, luquet et al./transition 257 identified family, community and structural barriers and strategies for providing affirming collaborative care when working with gender expansive youth. there is much discussion around the diagnosis of gender dysphoria found in the diagnostic statistical manual of mental disorders (dsm-5-tr), published by the american psychiatric association (2022) and the international classification of diseases (icd-11) published by the world health organization (2019), which classifies a cluster of symptoms that are experienced in such a way that meets criteria for formal diagnosis from a medical or behavioral health professional. we acknowledge the history of pathologizing transgender persons through this diagnosis, as well as the concurrent reality that receiving this diagnosis can also facilitate access to services and health care. in may 2019, the world health organization made the historic decision to change the term “gender dysphoria” from a mental health diagnosis to “gender incongruence” to de-pathologize those identifying as transgender, which is reflected in the icd-11, but this change was not recognized in the dsm-5-tr. however, for most steps in the medical transition process to be covered by insurance, a diagnosis of gender dysphoria is required and continues to represent confusion around the process of transition. there remains a significant gap in the research related to each of the categories of transition, although, for the most part in the studies that do exist, each of the three categories of transition studied individually has been found to lead to improved outcomes for transgender persons. few studies have been conducted on the importance of social transition for transgender individuals, particular trans youth, and the ones that exist have been identified as having significant design issues. the design issues came particularly because most studies on the mental health and wellbeing of trans youth were conducted before social transition. there is one positive study, however. durwood et al. (2018) has found that trans youth who had completed a full social transition did not demonstrate increased depression or impaired self-worth when compared to a matched control sibling or peer. it is critical to note that much of this literature around social transition focuses exclusively on youth and not on those who socially transition as adults. there remains an enormous gap in the literature around social transition for transgender adults. legal transition appears to be the least discussed in current literature, although it relates to a critical and defining characteristic for all people one’s name. the ability to legally change one’s name has been found to improve access to health care, socioeconomic stability, and feelings of self-worth (collazo et al., 2013; hill et al., 2018; white holman & goldberg, 2006). medical transition, the third category, for youth can include puberty blockers/suppression, affirmation-related hormone therapy, and affirmation-related surgeries, all of which have been found to mitigate gender dysphoria. however, studies have not yet clarified the importance or differential effect of each medically related step (austin, 2018; de vries et al., 2011). medical interventions improve feelings of personal satisfaction with one’s identified gender and in “passing,” which is being accepted by others as one’s identified gender (fien et al., 2017). medical transition at any age also improves overall medical care (wilson et al., 2015) and quality of life (murad et al., 2010). however, medical transition for youth, often referred to as gender-affirming medical care, advances in social work, spring 2025, 25(1) 258 is under attack. as of april 2024, 24 states have enacted laws that limit or ban genderaffirming medical care (gac) and 22 states have professional and/or legal penalties for providers serving minors if they provide gender-affirming care. this is a five-fold increase since 2021 on limits of gac and affects nearly 40 percent of all transgender youth (dawson & kates, 2024). social work educators, students, and practitioners should explore and understand the research that looks at the systemic change process and explores the role of risk and protective factors in the process of transition. these include individual and family coping (budge et al., 2013b; sanchez & vilain, 2009) and social support (budge, et al., 2013a; budge et al., 2013b). however, few studies have looked specifically at the overall effect of transition on psychological distress of transgender persons. budge et al. (2012) looked at the intersection of social support, coping mechanisms, and the individual transition process from a qualitative perspective. this research found that those participants in earlier stages of transition showed higher levels of avoidant coping, which then led to higher levels of psychological distress. white et al. (2017) explored the mediating role of avoidant coping related to victimization and depression and found that while avoidant coping has a temporary effect on reducing stress related to victimization, it can lead to poorer mental health outcomes over time. other studies that explore the process and phenomenon of transition found gender binary differences within the transition process, such as transwomen reporting more loss of social capital, role clarity, social connections, and emotional support than transmen when progressing through the transition process (gagne & tewksbury, 1998). budge et al. (2012) found once the process of transition has been completed, within the post-transition phase, negative emotional experiences were not as prominent. tordoff et al. (2022) also found that gender-affirming medical care can lower rates of depression and suicidality over a 12-month period. psychological distress transgender individuals experience rates of depression and anxiety at up to two times the rate of cisgender individuals. within the united states, rates of depression within the transgender community can range from 50-62%, while the entire u.s. population reports rates of 16.6% (budge et al., 2013; hajek et al., 2023; nemoto, bodeker & iwamoto, 2011; nuttbrock et al., 2010) as well as high rates of comorbidity with anxiety. psychological distress for transgender individuals is often related to higher levels of violence and discrimination. research has shown that transgender youth appear to experience significantly higher rates of psychological distress when compared to cisgender youth. this psychological distress includes a higher risk of suicidal thoughts, attempts, depression, and anxiety disorders (aitken et al., 2016; millet et al., 2017; spivey & edwards-leeper, 2019). one mitigating factor for youth specifically is that risk appears to be lower for those who receive emotional and social support throughout the transition process versus those who do not (de vries et al., 2011; durwood et al., 2018; mclaughlin & olson, 2017; steensma et al., 2013). for the purposes of this study, psychological distress is conceptualized through luquet et al./transition 259 the markers of the kessler scale (kessler et al., 2002), which looks at sensations of feeling fidgety, anxious, hopeless and/or depressed. the united states transgender survey the 2015 united states transgender survey (usts) is the largest survey to date that explores the experiences of transgender adults in the unites states and was recently readministered in 2023, although findings have yet to be released. this survey was completed by 27,715 transgender and gender-expansive persons and included respondents from all fifty states as well as guam, puerto rico, american samoa, and united states military bases abroad. the online survey, which was completed anonymously, asked questions regarding employment, education, family life, physical and emotional health, interactions with the criminal justice system, and housing (james et al., 2016). the general findings of the survey presented some bleak results. nearly a third of respondents reported employment discrimination, including being harassed at work, being denied a promotion, or being fired (james et al., 2016). additionally, 10 percent had experienced violence from immediate family members after coming out to them, and for those in school, over 50% reported some form of harassment. also, almost 50% experienced verbal harassment, nearly 10% experienced physical assault, and almost half had a history of surviving sexual assault. in terms of social conditions, one-third of respondents reported living in poverty, with fewer than 20% identifying as homeowners. nearly 40% of respondents shared that they experienced psychological distress, and 40% reported attempting suicide at least once in their lifetime. this study highlighted the complex and difficult challenges that transgender persons living in the united states experience on a daily basis at the micro, mezzo, and macro levels and deepens the call for providers to work hard and advocate for their clients to create a safer and more inclusive world while exploring the possibility of developing factors of post-traumatic growth. this secondary analysis of the usts data sought to find if social, medical, and legal transition lowers individual psychological distress for the transgender person. based on the literature reviewed, our study examines three research questions: (1) does social transition reduce psychological distress? (2) does legal transition reduce psychological distress? (3) does medical transition reduce psychological distress? methods data the united states transgender survey (usts) resulted in the largest dataset of transgender and gender expansive adults over 18 years of age. the usts was conducted by the national center on transgender equality (ncte), as an evolution from the 2008/2009 national transgender discrimination survey (ntds), with an intention of closer alignment to federal surveys, inclusion of new questions, and allowing participants to use skip logic throughout the survey. usts data is released for secondary analysis through an application and review process by key stakeholders at ncte. usts includes advances in social work, spring 2025, 25(1) 260 nearly 1,500 variables and 28,000 observations (james et al., 2016). the usts includes data on mental health, family life, socialization, health, sexual orientation identity, and spirituality. as indicated in table 1, an anonymous sample of survey participants were recruited from approximately 800 locations, such as lgbtqia+ social groups, health centers, and online communities (n=27,715). table 1. sample characteristics by gender identity and sexuality n (%) total transgender genderqueer /non-binary gender identity 27715 (100%) 11493 (41.5%) 9465 (34.1%) heterosexual/straight 3363 (12.1%) 1603 (5.8%) 160 (0.6%) gay/lesbian/same-gender-loving 4617 (16.7%) 2254 (8.1%) 754 (2.7%) bisexual/pansexual 9185 (33.1%) 4053 (14.6%) 2940 (10.6%) queer 5706 (20.6%) 2043 (7.4%) 3106 (11.2%) asexual 2984 (10.8%) 867 (3.1%) 1671 (6%) sexuality not listed 1860 (6.7%) 673 (2.4%) 833 (3%) irb the original usts research was approved after a full review from the university of california at los angeles’ institutional review board. an institutional review board application for full review was also approved by southern connecticut state university institutional review board. predictor variables social transition social transition consists of two elements: living full time (dichotomous) and outness (3 continuous variables). outness was defined as how much participants were out to all people in all contexts, at what age they began, and length of time since they have lived full time as their gender identity. live full time. the participants were asked, “do you live full time as your gender identity?” yes=1, no=0. total outness. level of outness was a continuous variable measured by asking, “how many people...currently know you are trans?” in several different categories such as family, healthcare providers, friends (etc.), with none=0, some=1, most=2, and all=3. for spouses and children, the question was answered with yes=1 and each no=0 for a total score that ranged from 0-27 with higher numbers representing greater “outness” and social transition. two other variables were considered under outness: length of time and age of transition. length of time was assessed by asking how many years since they were living full time (continuous number of years). age of transition was assessed by asking what age they began to live full time (continuous age). luquet et al./transition 261 legal transition legal transition consists of two different elements: a legal name change and a gender marker change. name. the continuous variable regarding changing the legal name was created with three questions. first, “did you try or succeed in changing your legal name?” no=0, yes=1. second, “did the court grant your name change?” no=0, in process=1, yes=2. finally, “how many ids have your preferred name?” none=0, some=1, all=2. the final name variable has a minimum of 0 and a maximum score of 5 with higher scores indicating greater legal transition for name. gender. the continuous variable is regarding changing the gender marker. the only question is, “how many ids have your preferred gender?” none=0, some=1, all=2. legal transition total included the name variable plus the gender variable with a minimum of 0 and a maximum of 7 with higher scores indicating greater legal transition. medical transition medical transition consists of three different elements: puberty blockers, hormones, and surgery. puberty blockers. the puberty blocker categorical variable was created through two questions: “have you ever had a desire to take puberty blockers?” (yes=1, no=0) and “have you ever taken them?” (yes=1, no=0). this continuous composite variable has a minimum score of 0 to a maximum of 2 with higher numbers representing a desire and/or participation in puberty blockers. hormones. the hormone categorical variable was created through three questions. for example, “have you ever had a desire to take hormones?,” “have you ever taken them?,” and “are you currently taking either?” (yes=1, no=0). this continuous composite variable has a minimum score of 0 to a maximum of 3 with higher numbers representing a greater desire or participation in hormones. surgery. surgery was created through several questions that assessed what type of surgical interventions participants had desired or completed such as phalloplasty, electrolysis, vaginoplasty (etc.). each question was answered with, “do not want this=0,” “not sure if i want this=1,” “want it someday=2,” and “have had it=3.” since female and male surgeries consist of different procedures, two surgery variables were created: surgery-female (0=min, 30=max) and surgery-male (0=min, 15=max). higher scores indicated higher desire or completion of surgical intervention. surgery female indicates a person assigned male at birth who received surgery to affirm their female identity. surgery male indicates a person assigned female at birth who received surgery to affirm their male identity. advances in social work, spring 2025, 25(1) 262 dependent variable psychological distress. the kessler (2022) measurement tool has 6 items and assesses the degree of psychological distress. questions include, “during the past 30 days, about how often did you feel...nervous, hopeless, restless or fidgety; so depressed that nothing could cheer you up, that everything was an effort, worthless?” participants could respond on a 5-point likert scale (0=none of the time, 1=a little of the time, 2=some of the time, 3=most of the time, 4=all of the time). scores ranged from 0-24 points with a score of 13 as the cut off score for determining psychological distress. higher scores indicated greater levels of psychological distress. analysis using spss, an independent sample t-test (2 tailed), anova, and regression were completed to determine if there was a significant impact of social, legal, and medical transition on psychological distress. the t-test and regression analysis assessed if social transition reduced psychological distress. the anova analysis assessed if medical or legal transition reduced psychological distress. first, descriptive statistics will be presented and then the results from the research questions will follow. descriptive statistics social transition approximately 40% (n=11,135) of the sample reported that they did not live full time as their gender identity while 60% did (n=16,580). the mean age that participants started living full time as their gender identity was 26.7 years (sd=11.9, min=1, max=100). the mean number of years that participants had been living full time as their gender identity was 5.3 years (sd=6.9, min=0, max=98). see figure 1 for overview. figure 1. age started to live full time as their current gender identity 0 200 400 600 800 1000 1200 1400 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 77 fr eq ue nc y age began to live full time as gender identity mean = 26.72 std. dev. = 11.873 n = 16,524 luquet et al./transition 263 legal transition approximately 50% (n=13,769) of the participants reported that none of their identification had their preferred name while 29% (n=7,931) said that all their identification had their preferred name. on average, participants were 31 years old when they changed their legal name (min=1, max=75, sd=12.1). nearly 90% of participants who changed their name legally spent less than $500 to complete the process, with 6% spending $0, 21% spending less than $100, 37% spending between $100 to $250, and 26% spending between $250 to $500. most participants reported that none of their identification had their correct gender marker (67%, n=18,670) while only 12.2% (n=3,378) had the correct gender marker on all their identification. medical transition a minority of participants had wanted (15%, n=4,225) and received (1.3%, n=355) puberty blockers while a larger number of participants wanted (78%, n=21,598), received (47%, n=13,088) or were currently taking hormones (44%, n=12,095). most transgender male participants reported not wanting any surgical intervention including top surgery (49%, n=13,550), hysterectomy (54%, n=14,912), metoidioplasty (70%, n=19,497), or phalloplasty (76%, n=21,136). a majority of transgender female participants reported not wanting any surgical intervention including top surgery (68%, n=18,922), electrolysis (60%, n=16,498), silicone injections (84%, n=23,376), orchidectomy (69%, n=19,131), vaginoplasty (67%, n=18,468), trachea shave (74%, n=20,420), facial feminization surgery (68%, n=18,888), or voice surgery (80%, n=22,031). psychological distress on average, participants were not psychologically distressed (m=10.7, sd=6.1), since their overall average score did not exceed the cut off score threshold of 13. higher scores indicated a greater tendency towards mental illness or psychological distress. the cut-point of 13 was developed to operationalize a serious mental illness and someone experiencing significant impairment (prochaska et al., 2012). approximately six percent of u.s. adults report psychological distress with a score over 13 (prochaska et al., 2012). however, approximately 40% of participants had a score of 13 or more, with 29% having a score between 13 to 18 and 10% having a score between 19 and the maximum score of 24 whereas 60% had a score below 12 with 28% between 0 to 5 and 33% between 6 to 12. results social, legal and medical transition were significantly associated with lower psychological distress accounting for between 1 to 18% in the total variance of psychological distress. social transition, consisting of living full time as their gender identity and total outness, appeared to be a protective factor as it was associated with lower psychological distress. legal transition consisted of name and gender marker change, and it appeared to be a protective factor as it was associated with lower psychological distress. advances in social work, spring 2025, 25(1) 264 finally, medical transition consisted of puberty blockers, hormones, and surgery, and each was a protective factor associated with lower psychological distress. first descriptive statistics will be presented and then the results from the research questions will follow. social transition living full time approximately 40% (n=10,947) of the sample reported that they did not live full time as their gender identity while 60% did (n=16,255). an independent sample t-test compared the distress levels in individuals who reported that they lived full time as their gender identity compared to those who did not. individuals who reported living full time (m=10.1, sd=6.1) as their gender identity had significantly lower distress when compared to individuals who reported that they did not (m=11.4, sd=5.9) live full time as their gender identity t (27,200) =17.2, p<.001. living full time as their gender identity appeared to be a protective factor as it is associated with lower psychological distress. total outness a multiple regression was conducted to determine the predictors of age, years, and being out on psychological distress (see table 2). level of outness had an average of 14.9 out of a possible score of 27 (sd=0.56, min=0, max=27, percentiles: 25=6 points, 50=11 points, 75=16 points). the mean age that participants started living full time as their gender identity was 26.7 years (sd=11.9, min=1, max=100). the mean number of years that participants had been living full time as their gender identity was 5.3 years (sd=6.9, min=0, max=98). table 2. multiple linear regression results predicting psychological distress b s.e. β t p age began living full time in your gender identity -0.17 0.004 -0.32 -43.67 < 0.001 number of years since transition -0.18 0.006 -0.21 -28.96 < 0.001 level of outness -0.16 0.008 -0.15 -19.87 < 0.001 note. f (1, 16172) = 394.84, p < 0.001, r2 = 0.181 total outness significantly impacted distress and accounted for 18.1% of the variance of distress with all three elements were significant predictors (age of transition, years in transition, level of outness). age that individuals began living full time (𝛃𝛃= -.32, p<.001), number of years since transition (𝛃𝛃= -.21, p<.001), and level of outness (𝛃𝛃= -.15, p<.001) were significant predictors of psychological distress. when individuals began living full time at an older age, they had significantly lower levels of distress. the longer that the individuals had been living as their gender identity significantly lowered distress. finally, the more out they were in all contexts to all people, the lower the level of distress. concerns of multicollinearity were alleviated after examining the vip statistics which ranged from 1.0 to 1.06. any vip scores above 4 can be interpreted as problematic multicollinearity. luquet et al./transition 265 total outness appeared to be a protective factor as it was associated with lower psychological distress. legal transition an anova was completed to see if having the correct name and gender marker on identification significantly affected distress (see table 3). participants who reported that higher levels of legal transition (m=6.8, sd=5.7, n=1,808) had significantly lower distress when compared to no legal transition (m=12.3, sd=5.8, n=12,059), f(7, 27010) =386.9; p<.001, n=27,017, with a medium effect size (η2=.091; power=1.00). a small effect size is η2=.01, medium effect size is η2=.06, large effect size is η2=.14 (cohen, 1988). legal transition, specifically gender marker and legal name change, appeared to be a protective factor as it was associated with lower psychological distress. figure 2 shows the relationship between legal transition and psychological distress. legal transition was categorized as between 0 (zero) indicating no transition and 7 indicating the most amount of legal transition assessed. the more a person completed legal transition, the less distress they experienced. on average, the person who had no transition had a mean psychological distress score of 12.3 while the person who completed a legal transition score of 6 had a mean psychological distress score of 6.8. figure 2. the effect of legal transition on psychological distress advances in social work, spring 2025, 25(1) 266 table 3. anova results comparing psychological distress across levels of legal transition legal transition [m (sd)] f (7, 27010) (none) 0 1 2 3 4 5 6 7 (full) η2 psychological distress 12.3 (5.8) 11.7 (6.0) 10.9 (5.6) 10.3 (5.6) 8.6 (5.8) 8.1 (5.8) 6.8 (5.7) 7.3 (6.4) 386.9*** 0.09 note. ***p < 0.001 table 4. anova results comparing psychological distress across levels of medical transition puberty blockers medical transition (puberty blockers) [m (sd)] f (2, 27199) none desired had η2 psychological distress 10.4(6.0) 12.5(5.9) 9.8(6.1) 207.9*** 0.02 note. ***p < 0.001 table 5. anova results comparing psychological distress across levels of medical transition hormones medical transition (hormones) [m (sd)] f (3, 27198) none desired had taken currently taking η2 psychological distress 11.1(6.1) 12.6(5.7) 9.2(6.3) 9.1(5.8) 612.9*** 0.06 note. ***p < 0.001 table 6. simple linear regression results predicting psychological distress by gender b s.e. β t p surgery for females -0.10 0.01 -0.11 -17.35 < 0.001 surgery for males 0.14 0.01 0.07 11.12 < 0.001 note. surgery for females: f (1, 27200) = 301.1, p < 0.001, r2 = 0.01; surgery for males: f (1, 27200) = 123.7, p < 0.001, r2 = 0.01 advances in social work, spring 2025, 25(1) 267 medical transition blockers an anova was completed to see if having the desire for and having puberty blockers significantly impacted distress (see table 4). participants who reported that they had desired and received puberty blockers (m=9.8, sd=6.2, n=295) had significantly lower distress when compared to individuals who reported that they had desired but not received them (m=12.5, sd=5.9, n=3,909), f(2, 27199)=207.9; p<.001, n=27,202, with a small effect size (η2=.02; power=1.00). having a desire to and being on puberty blockers appeared to be a protective factor as it was associated with lower psychological distress. hormones an anova was completed to see if having the desire for and having hormones significantly impacted distress (see table 5). participants who reported that they had a desire for, had and were currently taking hormones (m=9.1, sd=5.8, n=11,617) had significantly lower distress when compared to individuals who reported that they did not have desire, never took them and were currently not on them (m=11.1, sd=6.1, n=5,698), f(3, 27198)=612.9; p<.001, n=27,202 with a medium effect size (η2=.063; power=1.00). having a desire to and being on hormones appeared to be a protective factor as it was associated with lower psychological distress. surgery a linear regression was conducted to determine the impact of surgery on psychological distress (see table 6). surgery for females significantly impacted distress but accounted for only 1% of the variance of distress (𝛃𝛃= -.11, p<.001). the more surgery desire or participation, the lower the psychological distress for individuals who were assigned male at birth and pursued female affirmation surgery. surgery for males increased distress but accounted for only 1% of the variance of distress (𝛃𝛃= .07, p<.001). here the pattern was the reverse of that for females, with more desire for surgery or participation associated with higher the psychological distress. individuals who were assigned female at birth and pursued male affirmation surgery had a small (1%) increase in distress. discussion each type of transition (social, legal, medical) was found to serve as a protective factor in lowering psychological distress with the exception of a small percentage of one group – those assigned female at birth experienced an increase in distress following affirmation surgery. while overall our findings support the protective nature of all factors of transition, further research is also needed to gain a better understanding as to why male affirmation surgery for those assigned female at birth increased distress. although the overall increase in distress accounted for just 1 percent of the distress variance, it is statistically significant. this small but statistically significant finding supports the work of crissman et al. (2019) advances in social work, spring 2025, 25(1) 268 who found that those who share the intersection of transgender identity and female natal sex identified at birth, even when adjusting for age, race, marital status, education and poverty, experience more frequent mental distress. we agree with crissman et al.’s (2019) hypothesis that this difference is most likely due to the intersection of multiple factors, social and biological, and may also relate to bockting et al.’s (2013) finding that transgender males are more likely to experience enacted stigma as when compared to transgender males, which may in turn, contribute to increased distress. we share crissman et al.’s (2019) suggestion to be cautious in all future research studies in recognizing there are gendered differences and significant gender heterogeneity even within the transgender and nonbinary community and that further research in the complex intersection of these factors is warranted (barbee et al., 2022; bustos et al., 2021; johnson et al., 2024). overall, our results support budge et al.’s (2012) call to address the positive aspects of transition in research and program development. having access to every level of transition appears to be important in minimizing risk related to psychological distress and potentially improving mental health outcomes regardless of age or phase of lifespan development (lewis, 2017). social workers can educate trans individuals and their families of these protective factors throughout the transition process to minimize psychological distress (austin, 2018; dentato et al., 2018; mccarty-caplan, 2018). social workers must also recognize that protective factors, including providing trans-inclusive health care, can significantly reduce negative mental health consequences and improve wellbeing (lewis, 2017; stanton et al., 2017; staples et al., 2018b). the longer that participants had lived as their identified gender, the lower they reported their psychological distress, which supports olson et al.’s (2016) findings that youth who are supported as they transition have lower rates of psychological distress. this provides the implication that when youth are allowed to live as their authentic selves, the greater the protective factors. the results also support olson et al.’s findings that youth allowed to socially transition show similar rates of internalized psychopathology as cisgender peers. one way our study is unique is that it captures the importance of social transition in adulthood. our finding that when individuals began living full time at an older age, they had significantly lower levels of distress. this supports stanton et al.’s (2017) findings that older age, higher education, and a greater sense of connectedness to the lgbt community led to greater levels of wellbeing. more research to explore the reasons why “latebloomers” or those who transition later in life experience less psychological distress is needed as it is unclear as to why this is the case (fabbre, 2016; stanton et al., 2017). while it may be related to the idea that the older one is, the less they care about perceptions of others, a deeper understanding of this protective factor is needed. for social workers in clinical practice, challenging one’s own biases or assumptions related to the age of the transition process, and providing appropriate referrals for clients interested in transitioning, particularly for elders who may be pursuing the transition process, is important in determining appropriate referrals (austin, 2018; fabbre, 2016; mccarty-caplan, 2018; staples et al., 2018a). our findings support the notion that protective factors that come with improving access to structural change, particularly those related to “outness” (such as a legal name change and gender marker change, which appear on public documents and identification, e.g., luquet et al./transition 269 one’s driver’s license) clearly have an important positive effect. increasing access to legal processes, psychoeducation around the paperwork needed and legal processes to change one’s name and identifying forms, and keeping legal costs down are important in reducing psychological distress and improving overall mental health outcomes. although half of the respondents did not yet have identification that demonstrated legal name change and most of all respondents had not yet changed their gender marker on identifying documents, our findings indicate that for those who had undertaken the process, their levels of psychological distress were significantly lower. being able to legally transition demonstrates an important protective factor, and social workers on the front lines of policy development along with local, state, and federal advocacy workers can serve as powerful allies in decreasing barriers to the transition process (austin, 2018; lewis, 2017). methods of minimizing or eliminating cost related to this process and improving access to the documents needed and psychoeducation around how to complete these forms is a critically important step in facilitating positive protective factors. this can be difficult in many states where anti-trans policies have been implemented preventing transition and access to care and legal advice (movement advancement project, 2017). these findings, and the question about increased distress, also support spivey and edwards-leeper’s (2019) call to tease out exactly which aspects of transition are the most helpful, as well as why they might be the most helpful. for example, individuals who both wanted to be on hormones and those who had access to hormones expressed less psychological distress overall. further social work research should explore if there are differences between the desire to be on and the process of starting and maintaining hormones as distinct protective factors. also, while there is often a focus on medical transition being the ideal, or “gold standard” of transition related to passing, these findings clearly demonstrate lower levels of psychological distress with all three stages. finally, the desire to transition also served as a factor mitigating against psychological distress. this implication should be explored deeply in further research and be a basic construct taught in social work education (staples et al., 2018a). social work students should receive accurate and current information about the transition process and protective factors in foundation, advanced, and elective coursework (dentato et al, 2018; mccartycaplan, 2018). directors of social work programs tend to be more confident in their curriculum when compared to those in faculty positions, but students report even lower levels of confidence in the competency of the lgbtqia+-related knowledge taught within the social work program (mccarty-caplan, 2018). while prior research supports that transgender persons demonstrate incredible resilience, particularly when transgender persons receive social support (grant et al., 2011), this study highlights the importance of allies, bystanders, and social work professionals helping to decrease barriers to any and all aspects of the transition experience, including minimizing gatekeeping policies, going through one’s own psychoeducation about the steps of the process, and serving as a facilitator to either guide someone through the steps of the process or to provide safe and supportive referrals to those who possess the needed knowledge and services (austin, 2018; mccarty-caplan, 2018; lewis, 2017). advances in social work, spring 2025, 25(1) 270 limitations our study had several limitations. first, we used secondary data analysis, so the research questions needed to fit the data collected. we also looked at all transgender and genderqueer/nonbinary folks as they primarily identified in the original study and did not differentiate in our analysis between these groups as per the original data collection process. also, to our knowledge, our study is the first to examine the effect of social, legal, and medical transition together, so it is unclear if these distinct categories would show a unique effect on mental health if other data sets were examined. finally, although we acknowledge the possibility for transgender youth and adults to experience a plethora of challenges, including but not limited to depression exclusively, suicidality, or substance use disorder, our study explained only general psychological distress. future research should examine the impact of social, legal, and medical transition on specific aspects of the mental and physical health of transgender youth and adults, particularly related to how each stage of transition provides unique protective factors that enhance overall resilience. it is also critically important to understand each client's needs, expectations, and desires for transition at each stage from a unique and client-centered perspective, rather than using a one-size-fits-all approach. conclusion social workers in health care and agency settings have an ethical obligation to work with transgender persons holistically to increase their protective factors against psychological distress. the national association for social workers (nasw) code of ethics (coe) states that the social worker has a commitment to the client (1.01) and the client has a right to self-determination (1.02; nasw, 2017). outside factors such as social stigma, lack of access to legal assistance, and lack of access to medical treatments often hinder the transgender person from achieving their desire to live their gender identity. this calls for advocacy from social workers in the public health sector. understanding how medical, legal, and social transitions work together to lower the psychological distress of transitioning transgender persons is an essential start to determining how and where social workers should advocate. the data suggest that social workers working with transitioning transgender persons should receive additional training in the following areas to increase protective factors to decrease psychological distress: 1. social: social workers should be able to refer clients to transgender support groups, especially those persons who lack support from family and friends. transitioning persons should have access to those who have been through the process and can offer support and guidance as they begin to fully live their gender identity. the trevor project (2025) offers a 24-hour support line as well as information on area support groups. 2. legal: social workers should be able to identify lawyers and legal teams that work with transgender persons to legally change their names, driver's licenses, wills, passports, and other documents to match their gender identity. there are luquet et al./transition 271 available resources, many at reduced cost, who can assist in this effort and lessen the person's stress at airports, mortgage companies, banks, and other places where it is important for the person's documents to match their identity. a good resource for information and advocacy is lambda legal (lambda legal, 2025). 3. medical: social workers should have a referral system of doctors, nurses, clinical social workers, and other medical personnel and resources so the transitioning person who so desires can make the physical changes to match their gender identity. medical transition is the most expensive; social workers should be aware of reduced rate services for hormone medications, mental health services, and surgical services. a knowledge of available health insurance that covers transgender care is important since many insurance companies will deny, reduce, or slow-walk services. a good resource for this would be the advocates for trans equity, health and healthcare webpage (2025). this study explores the three phases of transition and how they may individually affect psychological distress. findings indicate that the desire to transition and the transition process may increase protective factors. social workers and behavioral health providers should focus not only on the risk factors, but the protective factors as well when working with transgender clients. in addition to agency programming that focuses on enhancing protective factors, community organizations should provide programs that have a strong feature of psychoeducation, particularly when discussing legal transition, and inclusive programming that addresses all three levels of transition equally when possible. while the process of transition may be a precarious time emotionally, psychologically and physically for transgender persons, this data analysis indicates that there are opportunities to support and enhance someone’s journey through transition experiences that can minimize negative psychological effects. community agencies such as the mazzoni center in philadelphia provide not only individual care, but community education, legal advice, and sponsors the annual trans-health conference where thousands of transgender persons, their families, allies, and mental health professionals gather in support of the physical, emotional, and legal needs of transgender individuals. when gatherings of this magnitude take place, transgender individuals have the opportunity to realize that they are not alone in their social, legal, and medical journeys toward transitioning and living as their authentic, complete selves. references advocates for trans equity. 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(2019). international classification of diseases (icd-11). author. author note: address correspondence to alex redcay, department of social work, millersville university, millersville, pa, 17551. email: alex.redcay@millersville author orcid wade luquet https://orcid.org/0000-0003-2887-5389 alex redcay https://orcid.org/0000-0002-1778-3772 beth counselman-carpenter https://orcid.org/0000-0002-4260-5783 https://doi.org/10.1037/cou0000184 https://doi.org/10.1037/cou0000184 https://doi.org/10.1007/s11524-014-9921-4 https://doi.org/10.1007/s11524-014-9921-4 https://doi.org/10.1007/s11524-014-9921-4 https://icd.who.int/en mailto:alex.redcay@millersville https://orcid.org/0000-0003-2887-5389 https://orcid.org/0000-0002-1778-3772 https://orcid.org/0000-0002-4260-5783 _______ erin boyce, phd, msw, assistant professor, julie clockston, dsw, cert ed, assistant professor and dei cocoordinator, ann sullivan, phd, lcsw, lecturer, rebecca cottrell, phd, cpacc, online and hybrid course development analyst, department of social work, metropolitan state university of denver, denver, co. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 609-627, doi: 10.18060/27598 this work is licensed under a creative commons attribution 4.0 international license. an autoethnographic exploration of design justice as a framework for anti-racist, equitable curriculum design erin boyce julie clockston ann sullivan rebecca cottrell abstract: as higher education contends with the complexity of providing a more diverse and equitable education for students, we believe that social workers should lead this movement. this case study's purpose is to share the experiences of social work educators engaging in a justice-centered practice guiding curriculum development. in addition, we hope to inspire other faculty to consider implementing similar practices within their curriculum. the following study presents the experiences of four faculty and staff members at an urban-centered, generalist practice social work department in higher education. using an autoethnographic model, we engaged in an in-depth exploration of our own educational experiences, uncovering our own biases, and working towards more progressive and equitable models of education. we learned new ways of sharing content, grading, and accepting the expertise of others. there are important implications of this work, such that design justice can increase students’ engagement, sense of belonging, and ultimately degree completion. keywords: social work, higher education, curriculum design, adult learners, design justice as higher education contends with the complexity of providing a more diverse and equitable education for students, we believe that social workers should lead this movement. in response to these complex issues, a group of faculty and staff joined together to reimagine traditional conceptions of course design and share in an intellectual community of collaboration and fun. eight faculty members, a curriculum designer, and seven student consultants came together to participate in a course design institute (cdi), with each faculty member designing or redesigning a course. as faculty and social workers, attendees invested in intentional curriculum design using the framework of design justice (dj) principles. the goal of the cdi was to teach participants to design a social work course using dj and anti-oppressive curriculum, as they relate to social work values, while also infusing the experience with a structure informed by these principles. we held space for conversation, and considered together how we could build on what we know. we also started from the beginning of the cdi in a critical instructional design process (al-haija & mahamid, 2021; morris, 2018). problem statement power, oppression and privilege are deeply embedded in academic systems, often impacting the learning experiences for historically marginalized students (almeida et al., about:blank advances in social work, fall 2024, 24(3) 610 2019). in addition, these embedded elements can result in a tension between the designer, student needs, equity, and academic rigor and expectations. as luke (2013) indicates, classic models of curriculum development are “highly durable” to critique and in so create binary arguments between what are broadly accepted practices vs. models of antioppressive practices, creating a tension for those moving towards anti-oppressive practices (aop). in social work education, these structures replicate historical inequities that more significantly impact students with marginalized identities. curriculum design institute the instructional design process at the cdi was built on the theoretical framework of anti-oppressive curriculum (aoc) and dj. through these theoretical approaches with our community of peers, we were challenged to let go of the traditionally rigid course design structures (czerkawski & lyman, 2016; quality matters, 2025) such as the addie (analysis, design, development, implementation, and evaluation) model (branson et al., 1975) and bloom's taxonomy (anderson et al., 2001), into a more responsive approach that challenged these traditional models (moore, 2021) and/or embedded them using the aoc lens. by combining aoc and dj we were able to center historically-excluded voices and create a new sense of belonging in our curriculum design, informing our work towards the integration of the 2022 education and policy accreditation standards (epas 2022) set forth by the council on social work education (cswe, 2022). anti-oppressive curriculum while we are seeing an increase in diversity and responsiveness in social work learning environments, there is still an urgent need to incorporate anti-oppressive practices in social work education. anti-oppressive pedagogy involves “engaging students in discussions of privilege and racism and the systems that sustain them,” including specific direction on methods of critiquing injustice (galloway et al., 2019, p. 494). daftry and sugure (2022) note five ways to engage aop in education, we focus on their recommendations to challenge oppression and to modify the curriculum. they posit that challenging oppression can happen through curriculum modifications. as one participant noted, students need to not only see themselves in the curriculum but also see themselves positively represented. involving students in our course design (goff & knorr, 2018; mercer-mapstone et al., 2017) and inviting collaborative discussion between faculty and designers (hart, 2018) about strategies to dismantle oppressive structures will lead to faculty and designers providing more equitable and anti-racist learning environments. we propose it is critical for social work educators as we aim to train learners to engage with marginalized and vulnerable populations. aoc allows educators to scaffold an inclusive, universal infrastructure that fosters partnerships with students and colleagues. it is not a one-time event but a continual, progressive process that aims for quality improvement and best practice sustainability (connor, 2022). anti-oppressive curriculum design incorporates an educational shift from exclusive hierarchical standards to prioritizing the design's impact on the learning community over the course designer's intentions. each participant in the cdi focused on design impact and boyce et al./design justice 611 awareness, bringing equity to the classroom, and building rapport with the student community by engaging a student's expertise as a consultant (design justice network [djn], 2018). aoc development was achieved through the dj framework, which employed a series of principles methodically and intentionally scaffolded into their course. dj principles created in 2018, the design justice network (djn) provides ten principles intended to address inequities in the design process by centering individuals typically marginalized by design and by encouraging collaboration and justice in making design decisions (djn, 2018). these principles include: 1. we use design to sustain, heal, and empower our communities, as well as to seek liberation from exploitative and oppressive systems. 2. we center the voices of those who are directly impacted by the outcomes of the design process. 3. we prioritize design's impact on the community over the intentions of the designer. 4. we view change as emergent from an accountable, accessible, and collaborative process, rather than as a point at the end of a process. 5. we see the role of the designer as a facilitator rather than an expert. 6. we believe that everyone is an expert based on their own lived experience, and that we all have unique and brilliant contributions to bring to a design process. 7. we share design knowledge and tools with our communities. 8. we work towards sustainable, community-led and -controlled outcomes. 9. we work towards non-exploitative solutions that reconnect us to the earth and to each other. 10. before seeking new design solutions, we look for what is already working at the community level. we honor and uplift traditional, indigenous, and local knowledge and practices (djn, 2018, para. 3). while not originally created for use in instructional design, these principles address concepts relevant for curriculum and course design, encouraging collaboration and creating more accessible and sustainable solutions (costanza-chock 2018, 2020). by centering the voices of students and encouraging collaboration among faculty and an instructional designer, these principles enhance the course development process and introduce justice principles into instructional design in higher education. implementation to infuse these principles, this two-week institute involved structured morning gatherings with time in the afternoons for faculty to meet with each other, student consultants, or with the instructional designer. the primary goal of cdi was fully developing a course while implementing dj principles and aoc (cottrell & obermann, 2025). as such, our learning walked through all stages of the curriculum design process, from evaluating objectives, developing assessments, and creating course activities and advances in social work, fall 2024, 24(3) 612 structure in the learning management system (lms). while facilitating the cdi, the instructional designer left space for co-creation and faculty voice (dj principle #5). for example, faculty shared their strengths with the group (dj principle #6) by leading conversations around topics such as formatting and layout, teaching philosophies, ideas for class and warm-up activities rooted in dj and community building (dj principle #4). during afternoon meetings, faculty met with peers to share ideas according to their strengths and needs (dj principle #7). in addition to cross-pollinating ideas with colleagues, faculty participants each invited a student consultant to contribute to the design process (dj principle #2). each student contributed depending on faculty needs and was compensated for participation with a gift card. faculty also received a stipend for participation. this compensation motivated participation but also avoided exploitation of faculty and students by expecting them to provide free labor (dj principle #9). this case study explored the perceptions of faculty participants of cdi to understanding faculty insights and experiences. methodology the following project utilized a critical social work frame, to implement a model of autoethnography as articulated by jan fook (2014). this model highlights the role of critical social work as a means of understanding oneself and others through a holistic (whole person) model that accounts for their social position through three domains: learning, reflection, and reflexivity. the learning domain encourages us to not just engage in taking in new knowledge, but also to implement that knowledge into new understandings and actions. reflection invites us to question our deepest assumptions and biases and connect our personal experiences to how we perceive the world to be. finally, reflexivity encourages us to interrogate how our learning and reflection on our whole being influences our experiences and those of others. through this understanding fook (2022) defines this overall process as, “uncovering the fundamental taken-for-granted thinking involved in making meaning of personal experience, and remaking this (and further guidelines for living) in the light of new awarenesses of the political and structural influences in one’s life (pp. 5-6). fook (2022) goes on to add: “in my experience effective critical reflection even on one specific experience can induce a self-acceptance which frees a person’s ability to be accepting of other, very different experiences in other people” (p. 6). therefore, we sought to embody this model of critical reflection to explore our past lived experience as a way of understanding our responses and conceptualizations within our present lived experience. ultimately, we are striving to answer the question of who we are, and how that informs our evolution into becoming who we want to be. four (4) faculty and staff members from a social work department collaborated using the autoethnography model to explore and document the experience of participating in the cdi, which was designed to explore the dj model to rethink the social work curriculum. our group includes the department's curriculum developer, who guided this process and helped us to apply the model to our own classes, a clinical field faculty member who teaches in the master's program, a full-time faculty member and diversity, equity, and inclusion co-chair teaching primarily in our bachelor's program, and a full-time faculty boyce et al./design justice 613 member who teaches primarily in the master's program. among us, we have decades of experience within the higher education system, taking on multiple roles such as educators, advisors, advocates, and leaders, and we brought that expertise to this space. through our analysis, we will highlight contributions made by our colleagues and student consultants. we will not share any identifying information regarding those individuals, as the autoethnography is intended to focus on the individual experience and informed consent was not sought from collateral participants. table 1. autoethnographic participants demographics and alignment with design justice principles participant age gender race/ ethnicity years of experience alignment with principles curriculum designer 40s female white 10+ principle #4 we view change as emergent from an accountable, accessible, and collaborative process, rather than as a point at the end of a process. faculty 1 40s female white 10+ principle #2: we center the voices of those who are directly impacted by the outcomes of the design process. faculty 2 40s female white 10+ principle #6 we believe that everyone is an expert based on their own lived experience, and that we all have unique and brilliant contributions to bring to a design process. faculty 3 50s female black 10+ principle #3: we prioritize design’s impact on the community over the intentions of the designer. to start the process, as a team, we developed a set of questions built on fook's (2014) model and each day after engaging with the cdi we journaled our responses to the questions, considering the experience of the day and what impact that had on our growth. at the end of the cdi, each team member shared their journal. we developed a team coding scheme based in part on recommendations from clarke et al. (2023), that included identifying our purpose, planning logistics, and ongoing discussion. we used a first cycle descriptive coding method to code each other's journals (we did not code our own) (saldaña, 2021). once the first cycle was completed, we came together to begin the second cycle using a tabletop sorting method, reducing our codes to nine (9) core patterns. through a second round of second cycle coding, we developed four (4) overarching themes that captured our shared experiences (saldaña, 2021). below we share our own individual experiences with the cdi, leading into the themes of our shared pathway to growth. as a means of our own member checking, once we’d completed coding, we each developed a personal statement that outlines our individual process of critical reflection, of our identities and alignment with design justice principles (table 1. autoethnographic participant demographics and alignment with design justice principles), that guided the advances in social work, fall 2024, 24(3) 614 larger analysis. it is often the case with such reflection that individuals explore different areas of identity and experience; therefore, you may notice a lack of conformity among these statements. we argue that is necessary, as our stories and journeys that brought us here are not uniform, allowing us to honor the differences and the similarities of each story. personal statements curriculum designer my early educational life started in private schools for gifted students, a place where i first benefitted from my identities associated with power and privilege. i am a white, uppermiddle-class oldest daughter, and school was an area where i thrived. the joy of learning and the indulgence of academia has stuck with me through two master's degrees and a phd. traditional higher education works for me; i appreciate clear structure, guidelines, and rubrics. and yet i value creativity, diversity, and flexibility. in my work as curriculum designer in higher education, i feel like i simultaneously hold on to two opposing concepts: one is the structure and productivity, meeting benchmarks and standards. the other concept is justice, inclusivity, and diversity. i fight my own need to take up space with the desire to hold space for others. dj principles invite me to consider that tension, and to discover opportunities for growth, and i've begun to work harder to partner with faculty in course design, while also inviting students to collaborate in our work. these goals came together for me during our two summers of design institute. as i work with students, who are those most impacted by our course design decisions, i am constantly surprised with how beautifully they advocate for themselves. as they've been invited into the design space, they've developed book clubs, prepared video demonstrations, and suggested specific course content that is inclusive of diverse voices. i also collaborate with faculty members in course design teams. faculty are innovative, eager to learn from each other and from students, and leave space for exploration. collaborating with students and faculty has left room for meaningful personal and professional relationships. nearly all of my current scholarly work is in collaboration with these partners, and numerous colleagues have supported me through personal successes and challenges. working in collaboration with students and faculty through dj principles has enriched my life, improved the learning environment in our department, and left space to share that collegiality with other students and social workers. faculty 1 i entered my career in higher education with little formal training on instructional design and delivery. as a cis-gender, white woman, i was taught in the traditions of jesuit catholic education. the jesuit call to social action propelled me into a twenty-year career in social work with children and families. in moving into a career in higher education, i left the familiarity of community social work and jumped into teaching field education for graduate students. i was armed with years of social work practice, a joy of public speaking, boyce et al./design justice 615 past experiences supervising graduate students, and a desire to make learning fun. my zest for engaging adult learners has not faltered, my awareness about my own biases, privilege, and traditional academic assumptions have been challenged and changed over the past seven years. additionally, i have an emerging justice-informed philosophy of curriculum design and delivery. summer cdi was a free and fun space to reflect on my own assumptions. my traditional catholic school upbringing influences my teaching approach. in contrast to my experiences as a student, i seek to offer learners variety and choice and celebrate students as both learners and experts. through cdi i worked and learned alongside faculty colleagues in a new way. the institute structure allowed for intentional spaces for peer consultation and creative brainstorming. i discovered our diverse pedological approaches and teaching strategies. i enjoyed being a learning partner with fellow faculty members as reflected in dj principle #7, sharing our design ideas (djn, 2018). cdi both supported real connection with colleagues, while simultaneously refining my teaching and design skills. the tangible result was a thoughtful, well-designed course. more importantly, i had opportunities to critically examine my teaching approach, using principles of dj that included challenging my assumptions, advancing my understanding of accessible learning, and lasting collegial connections. in addition to faculty peer consultation, the student consultant proved a rich contribution to the course design process and to my evolving justice-centered pedological approach. the student was instrumental in encouraging design that centers the voices of those who are directly impacted, dj principle #2 (djn, 2018). the student pointed out duplication in course content across classes. they contributed to an assignment redesign with current content and choice. our conversations encouraged me to continue to let go of control and share the course design with the class. this invitation to design a course that promotes student-instructor collaboration feels exciting and in-line with dj; the designer is a facilitator, not an expert (djn, 2018). sharing power is a demonstration of the social work value of antiracist and equitable practice. i am committed to an ongoing journey of challenging my colonialized word-view. cdi offered a space to grow and share with colleagues using a shared framework and continues to have a significant impact on my evolution as an educator. faculty 2 while i will say that i began thinking about exploring more equitable perspectives of education, primarily due to my identity as a social worker, it was the dj summer institute that required that i dig deep. as a white, middle class, cis-gender woman with a doctoral degree, i bring a lot of privilege to the classroom, which needed to be interrogated, and the dj summer institute facilitated this. during the institute and through the process of the autoethnography, i was encouraged to think more deeply about my own biases and privileges and how those experiences were influencing the way i showed up in my classes and how i perceived student behavior and assignments. i quickly observed that the institute would not have been as successful without embracing the dj principles that center and value marginalized voices in the process. through this value, i was able to engage with my advances in social work, fall 2024, 24(3) 616 colleagues and engage in collaborative learning. we were able to share what has worked and what hasn't worked, we each walked away with new ideas, new perspectives, and new pedagogical practices. in addition, the student consultants were invaluable to the process. during my time implementing the dj model i had the privilege of working with four different students from diverse backgrounds. their advice, suggestions, and feedback gave me the courage to explore new ways to engage students in their learning journey. the students could advocate not only related to their own experiences but engaged with their peers to share a broader perspective. the feedback from the students was so influential that i am now conducting peer feedback sessions in my classrooms, specifically related to the course organization, content, and delivery. students want to be engaged in how they learn, if we just give them the space. overall, the dj summer institute changed me, as an individual and an educator. it taught me how to sit with my own educational biases and to determine if those biases were influencing the judgements i was making toward students and their capacities. it has allowed me to name those biases and work towards a more equitable pathway. it has allowed me to let go of oppressive ideals of what teaching and learning "should" be, to allow myself and the learners to have agency in the process. i look forward to my continued evolution as an educator and a social worker, striving to send prepared, valued, and engaged social workers into the world. faculty 3 since third grade, becoming an educator has been established inside my soul. my socialization in the public education system simultaneously and aggressively brought me a sense of purpose and doubt. all the things that make up my lived experiences brought me to my passion for social work. i am an eclectic academic. having a lived experience outside of the box as both a black woman and a neurodiverse human has reinforced my belief in the theory of multiple intelligences (armstrong, 2018; gardner, 1983; kallenbach & viens, 2001). i formally arrived in higher education with a blend of trades and degrees that range from cosmetology and real estate to therapeutic foster care, disability specialist, case manager, and clinician. from the moment i graduated from my msw (master's in social work) program, i began working with undergraduate students to mentor them. i am passionate about adult education, and my andragogy style involves an antioppressive, anti-racist, equity, and disability justice lens. this lens is deliberate and requires an openness to learn, grow, and consistent self-effort. i design my courses and interactions with students in a way that empowers learners to do their self-work by exploring and investigating themselves. this exploration and development of personal values and perceptions promote growth as a social worker. i encourage learners to assess who they are as they increase their knowledge of social work values, concepts, and ethics. course and curriculum design are active. it requires ongoing learning, growth, and development. cdi was a remarkable space of self-exploration and evolution that supported me as an educator in critically thinking about my courses while fostering and encouraging boyce et al./design justice 617 transformational learning. my teaching philosophy aligns with dj principle #6, that everyone is an expert with brilliant contributions to bring to a design process (djn, 2018). during the summer cdi, our facilitator recognized that individuals have a valuable bank of experience that can support the design process. dj principles delivered through the summer cdi reinforced my andragogical practice. life-long learning, general skill transference, meaningful learning, and critical thinking were all reinforced in summer cdi. my classroom structure is built upon a relational and reciprocal learning environment. summer cdi supported purposely designing the curriculum to include scholars who are neurodivergent, living with disabilities, and learners from diverse backgrounds with intersectional identities to minimize barriers to learning and maximize inclusion. in my culture, many are sustained by a philosophy we call ubuntu: the community's collective support. dj principal #3 reinforces the importance of community. community building was a substantial part of the cdi, from including equity statements, to providing expectations around microaggressions. i gained a more profound awareness surrounding equality in online spaces and inclusivity. through cdi, immersion with colleagues was an outcome: it was one of the most significant academic and professional development opportunities i have experienced. emerging themes through our research and coding process, we developed four (4) overarching themes that capture our shared experiences in cdi and in implementing dj principles. these themes are: (1) pathway to growth, (2) community and relationships, (3) social work values and (4) inclusivity and equity. these themes start with our individual growth and continuously expand outward to our individual relationships, social work values, and the impact on our university community. the final two themes have implications to broader social work practice as well as implications in considering issues of equity and empowerment. see table 2 for a snapshot. pathway to growth – where did we start and how did we evolve? the pathway to growth emerged as the first theme of the study findings. cdi encouraged participants to explore different identities and experiences that inform their perspectives as educators. this section explores two tenets of pathway to growth: socialization and growth tension. growth in socialized identities necessitates tension and discomfort as cdi members were challenged to stretch and grow. participants were asked to challenge held beliefs and to re-define their teaching pedagogy and design practice. advances in social work, fall 2024, 24(3) 618 table 2. explanation and brief examples of emerging themes and subthemes theme subtheme description example pathway to growth – where did we start & how did we evolve? socialization explains the ways in which we were socialized into our beliefs regarding education. my implicit bias has come from educational socialization, systemic hierarchy, & elitism has definitely impacted how i engage in the process. i was/am a student that followed all the professors’ rules & didn’t dare challenge or feel free to express anything outside the box in many spaces i was in. i have struggled to make things different than “traditional” ways of doing education… growth tension indicates that change is difficult & we experienced personal tension on our journeys. i feel like i am holding onto two opposing stonesone in each hand. one is the structure, the productivity, meeting benchmarks & standards. in the other hand, i hold a stone for justice, & inclusivity, & diversity. community & relationships: creating shared learning collaborating as colleagues describes the work we did between members of our staff & faculty. i learn so much from my colleagues. having this community is such a positive experience for me. i have worked siloed for so long that it is so nice to have others share ideas & information. collaborating with students describes the work we did with members of our student body. centering & prioritizing the student’s needs over the norms in academia. my perception of the impact is that students tend to become more engaged in the process. social work values service, integrity, & competence defines the use of or move towards the integration of social work values to the design justice model. it cultivated an instructional design awareness, strengthened an invaluable skill set, & was an essential investment in my professional development. dignity, worth & human relationships i want my classroom environment, online or in-person to be a community. a place of exploration & for learning. i also spend a lot of time building trust & fostering a sense of belonging. social justice justice provides a framework to support & help guide moving from centering of self to those marginalized & impacted. inclusivity & equity: making an impact refers to the ways in which models of inclusivity & equity have impacted our work & our students as we implemented new practices. so yes, a design process needs to be both the instructional designer & instructor’s ideas, but it also needs to stop being a binary process, to be more fluid in including more voices, with shared knowledge. maybe a better question is how do we move away from the binary in the course design process to incorporate more voices, & work collectively? advances in social work, fall 2024, 24(3) 619 socialization participants reflected on their socialization as learners and students before they became educators. an instructor's philosophy of education may be consciously or unconsciously impacted by their history and intersectional identities. members of the group examined their diverse backgrounds and socialization. faculty 3 acknowledged: i know what it is like to be an outcast, whether due to skin color, appearance, hair, weight, or learning disabilities. i know that barriers often stifle people, and their capabilities abound if we remove them. dj principle #6 reflects the value of diverse identities, valuing everyone’s expertise based on their own lived experience, with brilliant contributions to bring to the process (djn, 2018). even though we have our own experiences and perceptions, it is in sharing varied and diverse perspectives that we evolved through the learning process. growth tension growth tension is required when one moves into the stretch zone from long-held knowledge and beliefs into the new and the unfamiliar. the need to center the design on the voice and experiences of diverse students requires us to let go of assumptions to traditional learning approaches. faculty 2 explored this theme, stating, "when i think about my own intersectionality's [sic], it makes me feel like it requires an analysis not just of my current identities, but how my identities have changed through this learning process." this evolution and change over time and balancing of opposing forces was necessary as a pathway to growth. faculty 1 reflected: i feel like there is increasing tension between the dj principles such as a flexible, inclusive online course design, that is relational and supportive of those who are traditionally marginalized, versus an online course designed according to research-based best practices standards. i want to do both, and struggle with how to do this. as cdi participants, we spent time exploring this tension, challenging binary processes as we interrogated our own socialization and how that played out in curriculum design. the cdi inspired courageous personal growth for the faculty participants. community and relationships: creating shared learning as faculty 1 said in her journal, "i don't believe this process is possible alone or in isolation." in addition to personal growth, implementing dj principles invited us into a space of community where we were able to develop relationships with colleagues and students. developing relationships in and out of the classroom helped us to humanize individuals and provide space for voices of those directly impacted by course design. advances in social work, fall 2024, 24(3) 620 collaborating as colleagues dj principle six acknowledges the expertise that each stakeholder brings, while principle seven encourages sharing design knowledge within communities. it was clear during our work together that colleagues brought unique and brilliant contributions to the process, which helped us to develop relationships throughout the workshop. we felt that this collaborative relationship was a natural fit, and it was one of the strengths of designing in tandem. we had the chance to share ideas and were able to celebrate successes together. faculty 2 said about the process: "we are building a strong community that allows this work to continue on and on, we keep each other accountable to the ideas and commitments we've made to the process." through these collaborations, each participant gained practical knowledge that translated into usable information they could implement in courses. the curriculum designer described reciprocal interactions like this: "sometimes the process is slower, but ultimately is like a slow-cooked stewit's richer for the depth of conversation, expertise, ideas, and collaboration that were introduced over time." through an iterative process many of these ideas were more fully developed using the dj principles and implemented more widely throughout our department. what we learned from cdi was and is shared widely within our department and beyond, further expanding our collaboration and reach. collaborating with students connecting with colleagues and designing in community was an important part of summer institute, but building relationships with students was also beneficial. collaborating with student consultants ensured we honored dj principle 2, which centers the voices of the students (djn, 2018). faculty 3 explained "one purpose was to view the student as an expert with lived experience and a lens to be honored [and]… give their expert insight from a student's perspective." involving students also allowed us to care about our learners as humans as we drew on students' lived experiences and intentionally made space for them in our course design. as faculty 2 reflected: this work has also increased my own compassionate response to students in the classroom. i have learned to listen to them, to give them the benefit of doubt, to see them as full human beings, and not just students. i think that this creates an effective teaching and learning environment, where both the students and i feel as if we can take risks with one another. designing in community helped us to make connections with each other and with our students. we developed meaningful, lasting friendships that have allowed us to share what we've learned in our classes, in our department, and with the wider community. social work values as social workers, we are expected to act on a set of core values outlined by the national association of social workers (nasw). there are six values, aligned with six principles of practice: service, integrity, dignity and worth of the person, importance of boyce et al./design justice 621 human relationships, competence, and social justice (nasw, 2021). the principles of dj are aligned with the nasw code of ethics, which gave us the language to understand the intersections between the dj model and our ethical obligations as social workers. each of these core values was used as a means of understanding the implementation of this model in our course design and classroom interactions. as faculty 1 shared, the dj framework gave me a direct theoretical language to explain how i think social work values should be embedded in the design of a social work class. this was a lot more intentional and fun than just sitting down and re-working a class for sure. service, integrity, & competence for social workers, being of service to others is a core aspect of our identity. the language of service, integrity, and competence has helped us to better understand dj principles. faculty 4, the curriculum designer, described her experience as follows defining service, integrity, and competence not only as what we provide, but by leaving space for others to have a voice. this changes my design process but also enhances it. in some ways, it takes the pressure off of me to be the one providing ideas, while centering others who have wonderful ideas that they can share. it left space for inspiration and exploration in a way that wouldn't have happened if i was the central focus for the session. it also increases my repository of ideas for teaching, design, and curriculum development, as i hear from others and learn from them as well. competence stood out as critically important within the context of our exploration. competence as a social work value is focused on social work with others. as noted, we are a group of doctoral-educated social workers and curriculum designers, we are competent in the dictionary sense of the word. however, we learned quickly that competence with the dj model meant letting go of our sense of expertise and giving other lived experiences an opportunity to shine through. this is captured in dj principles 5 & 6, which focus on letting go of the idea of “expert” to disrupt power structures by expanding who can provide that expertise. as the curriculum designer shared, “... dj is a conscious letting go of the power and the hierarchy in the traditional course dynamic.” the cdi gave us that opportunity, a letting go of the past and seeking a future that recognizes the strengths of all involved in the process, an openness to learning new things, and new ways of being. to achieve this “letting go,” we reflected on our own educational experiences and socialization and truly explored the impact that those experiences had on our perception of education and what it means to learn. we found that although we each come to cdi with different experiences of educational socialization, we each relied on that socialization to define the “right” way to learn. as we let go of such biases and adjusted standards, we were better able to understand and meet the learning needs of our students, demonstrating our commitment to service, integrity, and competence. advances in social work, fall 2024, 24(3) 622 dignity, worth, and human relationships the value of the dignity and worth of all people, often informed by relationship, is interwoven into each of the dj principles. there is not one principle that doesn't capture these ideas. while we all came to this community believing in the dignity and worth of our students and sought to be in relationship with them, we thought more broadly about our own biases that might impact our ability to live up to this expectation. the curriculum designer shared this observation, there's enthusiasm, and welcome, and caring about students as humans. there are options for participation, for students and for affiliate faculty. there are intentional assignments and assessments that really allow students to explore their own lived experience as it relates to course content. when we think we know what students “should” know, we are often setting them up for failure. unspoken expectations without transparency can cause a disruption in trust between the student and instructor. however, if we come at design and instruction from a starting point of dignity and worth and engaging in relationship regardless of what knowledge a student brings to the classroom, we provide space for that student to ask for help, to seek out resources, and to gain the knowledge needed to move forward. faculty 2 emphasized, "we can be all of those things, as we continue to recognize and respect the humanity of our students, we can normalize the counternarratives and make larger changes." human relationships can be both difficult and rewarding, but this social work value reminds us that change happens in relationships. relationships take time, effort, and often encounter disruption, and yet they are easier when we see each other’s humanity. social justice to make the connection between social justice and dj is an easy step, as both are focused on justice as a core value of the practice. social justice in social work is concerned with supporting the most marginalized through service and advocacy while dj centers traditionally marginalized voices. both seek to give voice to those often silenced, and to explore, disrupt, and dismantle the systemic issues that impact individuals and communities' ability to thrive, and not just survive. faculty 3 summarized this beautifully, i consider myself a "justice" minded individual. i know that many components of higher education are not created or designed through a lens that seeks to bring equality to the classroom so that the students and the communities they serve benefit first. inclusivity and equity: making an impact inclusivity and equity are critical components of dj principles, which aim to ensure that design is responsive to the needs of all individuals and communities. the impact of the cdi was far reaching as all participants are encouraged to reflect on their positionality and express how oppression, power, and privilege impact their perspective. students are boyce et al./design justice 623 encouraged to explore their own socialization and learning needs. educators are further encouraged to be deliberate and thoughtful in incorporating student feedback, which in turn impacts decisions about the curriculum, course materials, and classroom procedures. in cdi, we grew and developed as educators by involving students in the design process, providing student voice in the curriculum process and reminding educators of student needs. through understanding these needs, we made our design choices transparent and provided students with options and alternatives to their learning journey. this included working towards providing course materials that are accessible and support empowerment regardless of students' socioeconomic status, race, gender, ability, or other identities. in considering the needs of diverse groups and designing for inclusivity. faculty 3 explained that, we were guided toward being mindful of community at every development step, from including equity statements to 'expectations around microaggressions.' i gained a more profound sense of awareness surrounding equality in online spaces and inclusivity. during the cdi we also focused on thinking about increasing equity by recognizing and respecting diverse cultural backgrounds, experiences, and perspectives within the classroom environment. many of the students at our university live with diverse, intersectional identities and brave the realms of academic institutions that were not originally created with an intention for the inclusivity of all. therefore, we saw our role as dismantling classic understandings and language paired with academic rigor to take a broader view of lived experiences, allowing students to see themselves in the classroom materials, and making space for often excluded voices. in relationship to this idea, faculty 1 asked herself, “how might i be using language to avoid rather than name the equity issues i see? interesting. academic language may be a tool to sidestep difficult topics or issues.” faculty 2 furthers this, we cannot progress by not naming educational trauma, by not naming oppressive traumas, by not naming learning difficulties and disorders, by not naming the mental health of students, all of which play a huge role in their ability to learn, engage, and process information, we cannot progress. i've been guilty of this so many times over my teaching career. in cdi, language was honored and became a focus across many aspects of course design. student consultants were encouraged to share their thoughts with faculty on the language used in the lms and the syllabus. faculty 2 shared that: i need to be clear about using "i" statements to describe what this means to me and respect the diversity of the learning community and our student population. it can be easy to use language to avoid equity issues; most often, it goes back to the "shoulds" that we think students should know. dj principles were essential to our process of understanding the dynamics that educational systems have perpetuated that contribute to academic and societal inequalities and, ultimately, injustices. educators participated in critical reflection about internal and external resistance when challenging traditional and sometimes harmful course structural advances in social work, fall 2024, 24(3) 624 issues. however, educators took time to recenter students, many of whom have marginalized identities and are often othered through curriculum design, using the lenses of inclusivity and equity. each instructor worked to gain awareness and identify design flaws that disregard and manipulate diverse lived experiences (djn, 2018; zinga & styres, 2019). discussion as seen through the cdi, and our own reflections on the process, dj is a new framework that is a compatible and viable framework for anti-oppressive curriculum design, particularly within the field of social work. its alignment with social work values, practices, and ethics allows us to engage in critical social work through learning, reflecting, and being reflexive not only in our teaching, but in our engagement with the larger institutional and systemic processes. dj gives us a language and a framework to empower students and ourselves to be changemakers. co-designing with students is a foundation of anti-oppressive practice, an intersectional activity that requires a cyclical approach to learning and growth. co-creation fosters partnerships between students and faculty, ultimately developing an educational environment that encourages faculty, staff, and students to be agents of social change while redefining competence as growth rooted in justice. these same skills of co-creation, fostering partnerships, and deconstructing power hierarchies will help students as they graduate and take on professional roles. by implementing dj in our classrooms, we model for students and others how to implement anti-oppressive practice in their agencies, communities, and educational work. having experienced these principles firsthand, students, faculty, and staff will be prepared to implement these concepts as they continue to develop partnerships and question power structures in their professional roles. an intentional cultural shift is taking place as educators become more conscious of and deliberate about dj and their impact on education. implications social work educators need a framework that aligns with social work core values to support anti-oppressive learning spaces. the design justice framework is one model that fosters critical reflexive practice and inclusive engagement in course design. at a mezzo and macro level, implementing a dj framework in course design allows for cultural transformation in an experiential and value-driven way. a small group of faculty and staff members, along with students, can then bring back those principles to the greater systems, creating courses that ultimately impact thousands of students over multiple years. designing in community allowed the benefits of dj to continue after the time together at cdi. we have researched, written, presented, and designed together over three years, as the relationships we built during our summers together have sustained us in doing critical design work. also, braiding dj principles into the work we do as educators, designers, and faculty has created opportunities for department culture to change. boyce et al./design justice 625 in one small but far-reaching example, faculty 2 shared a model of grading using a complete/incomplete method in our first year at institute. cdi participants asked questions and started implementing a similar anti-oppressive grading model in their courses. over time, other faculty in the department heard about this strategy and reached out to faculty 2 for examples and suggestions for implementation. these faculty are lead faculty for courses that have rolled out innovative grading models for all the sections of that course. implementing this inclusive and supportive practice has now influenced nearly all students in our social work programs. on a more micro level, as members of the cdi, we believe that it is our duty to advocate for change in oppressive and harmful systems, including those in higher education. dj is one step in that direction; in our department the impact is already being felt by our students. faculty 1 shared, "dj provides a framework to support and help guide moving from centering of self to those marginalized and impacted." as social work educators seek anti-oppressive approaches to course design, the design justice framework provides a model that aligns with social work values. the approach can serve as a guide for future social work design, with ample room for research on the value of the design justice model and how it relates to an evolving social work curriculum. references almeida, r. v., werkmeister rozas, l. m., cross-denny, b., lee, k. k., & yamada, a. m. 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(2018). critical instructional design. in s. m. morris & j. stommel (eds.), an urgency of teachers: the work of critical digital pedagogy (ebook, learning online sec.). pressbooks. mercer-mapstone, m., dvorakova, s., matthews, k., abbot, s., cheng, b., fetlend, p., knorr, k., marquis, e., shammas, r., & swaim, k. (2017). a systematic literature review of students as partners in higher education. international journal for students as partners, 1(1), 15-37. moore, s. l. (2021). the design models we have are not the design models we need. the journal of applied instructional design, 10(4), 13-23. national association of social workers [nasw]. (2021). national association of social workers code of ethics. author. saldaña, j. (2021). the coding manual for qualitative researchers (4th ed.). sage. quality matters. (2025). about qm. author. zinga, d., & styres, s. (2019). decolonizing curriculum: student resistances to antioppressive pedagogy. power and education, 11(1), 30-50. author note: address correspondence to erin boyce, department of social work, metropolitan state university of denver, denver, co 80204. email: eboyce3@msudenver.edu https://pressbooks.pub/criticaldigitalpedagogy/front-matter/acknowledgements/ https://doi.org/10.15173/ijsap.v1i1.3119 https://doi.org/10.15173/ijsap.v1i1.3119 https://dx.doi.org/10.51869/104/smo https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.qualitymatters.org/why-quality-matters/about-qm https://doi.org/10.1177/1757743818810565 https://doi.org/10.1177/1757743818810565 mailto:eboyce3@msudenver.edu _________ gashaye m. tefera, msw, ma, phd. candidate, school of social work, university of missouri, columbia, mo. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1096-1115, doi: 10.18060/25994 this work is licensed under a creative commons attribution 4.0 international license. “we feel powerless”: a social-ecological perspective on challenges experienced by social workers in addressing gbv in ethiopian refugee settings gashaye melaku tefera abstract: gender-based violence (gbv), especially sexual violence with a 90% prevalence rate, is a top concern in humanitarian settings. this qualitative study explored the challenges and experiences of social workers in addressing gender-based violence (gbv) in ethiopian refugee settings. in-depth interviews were conducted with eight social workers between the ages of 26-37 years who have had five to twelve years of experience in gbv prevention among refugees. data were analyzed thematically using a codebook and nvivo12 software. three major themes emerged: power and political interest, institutional barriers, and strategic barriers. the social-ecological model (sem) was used to guide the discussion of the findings. most of the challenges experienced by social workers were structural barriers emanating from the unbalanced power relationship and political interest between and within institutions, strategic/policy gaps, and organizational resource limitations. it is imperative that social workers are trained to function in a politicallysensitive practice setting and are prepared to embrace political activism to overcome structural challenges. adopting anti-oppressive and integrated developmental approaches is recommended to resolve the complex socio-economic and political factors behind the widespread gbv acts in ethiopian refugee settings. keywords: gender-based violence, challenges, social workers, refugee settings, ethiopia ethiopia hosts nearly one million refugees, the second-largest refugee population in africa, most coming from neighboring south sudan (48%), somalia (27%), eritrea (19%), and sudan (6%; adugna, 2019). in addition to the large refugee population, currently, there are more than one million internally displaced people in ethiopia (united nations high commissioner for refugees [unhcr], 2019). the highly volatile situation in the horn of africa, coupled with internal conflict and rapid urbanization, has led ethiopia to one of the worst humanitarian crises in the country’s history. refugees in ethiopia are faced with numerous challenges including lack of education, healthcare, access to clean water, and employment opportunities (tefera, 2022). refugees in ethiopia also experience several socio-cultural and economic hardships that include gender-based violence (gbv), harmful traditional practices, child marriage, food insecurity, and lack of legal protection services (unhcr, 2019). several studies reported high levels of gender-based violence (gbv) in humanitarian settings and conflict-affected populations around the world (hossain et al., 2018; marshall & barrett, 2017; wirtz et al., 2013). a systematic review of studies on gbv conducted from 1990-2017, which included reports from ethiopia, reported that sexual violence is the most reported type of gbv with a prevalence rate reaching up to 90% with women as the main victims accounting for 89% of the studies analyzed (araujo et al., 2019). the review about:blank tefera/we feel powerless 1097 also stated that intimate partners and agents of supposed protection are the top perpetrators of violence against women refugees (araujo et al., 2019). refugees in ethiopia, mainly women, suffer from an increased risk of poor sexual, reproductive, and mental health outcomes due to gbv. victims of gbv suffer from extended negative impacts in their lifetime including stigmatization, poor educational attainment, deterioration of social relationships and community participation, and increased risk of living in poverty (stark et al., 2017). due to its complex socio-cultural roots and sensitiveness, addressing gbv in humanitarian and refugee settings has been a challenging public health matter (vu et al., 2017). responding to gbv involves surmounting several barriers including stigma by the community and family members, uncertainty and fear of further violence, denial of service by legal and security forces, and feelings of hopelessness experienced by victims (muuo et al., 2020). despite the high prevalence of gbv in ethiopian refugee settings, there is no adequate research that reports on the efforts to address the problem at both macro and micro levels. the highly securitized and remote environment of refugee camps makes it difficult for researchers to collect data and engage with participants (mcalpine et al., 2020; tefera, 2022). hence, little is known about the barriers to addressing gbv in ethiopian refugee settings. most importantly, the challenges and experiences of social workers who are the primary responders to gbv cases are not adequately studied and reported. as nisanci et al. (2020) stated, listening to the voices of social workers is vital to understanding facts on the ground and devising attainable solutions in responding to the needs of refugees. accordingly, this study explored the challenges experienced by social workers in addressing gbv in ethiopian refugee settings using the socio-ecological model (sem) as a framework. first introduced by bronfenbrenner in the 1970s, the sem has been used as a conceptual model for understanding human behavior and development. later, the use of the sem was expanded to study various psychosocial and health issues (salihu et al., 2015). the sem is illustrated by nesting circles that start with the individual (knowledge, attitude, behavior) and expand to interpersonal (families, friends, social networks), community (partnerships between organizations), organizational (social institutions), and policy (national and local laws) levels/systems (kilanowski, 2017). the model assumes that interaction between individuals and their surrounding systems or environment is reciprocal, continuously influencing each other (salihu et al., 2015). due to its comprehensive nature, the sem provides a useful framework to understand barriers and facilitators in social and health service delivery that involve multiple systems. the model helps to study the dynamic interplay between service providing/service receiving individuals and their surrounding environment/systems as determinants of the nature, quality, or outcomes of services (sword, 1999). in this study, the sem was used as a framework to analyze and discuss the barriers and challenges social workers experience at each level of their surrounding work environment and interactions in addressing gbv. advances in social work, fall 2022, 22(3) 1098 method research design a qualitative research design was used to explore the challenges and barriers experienced by social workers in addressing gbv in ethiopian refugee settings. a qualitative design helps to understand the experiences and worldviews of study participants on the selected subject matter (creswell & poth, 2017). the use of a qualitative approach also helped to have a detailed and deeper understanding of how social workers experience, interpret, and respond to challenges when addressing gbv issues. participant recruitment non-probability purposive sampling was used to recruit seven female and one male social worker, aged 26-37, who work in the community wellbeing initiative (cwi). the participant selection criteria included working in the cwi as a social worker for at least two years and speaking amharic or english. the selected participants included one mba, two bsw, and five msw graduates. inclusive of their time of service in the cwi program, the participants had five to twelve years of experience working in refugee settings. the community wellbeing initiative (cwi) the cwi is a national-level collaborative intervention program designed to tackle gbv and ensure quality health services for victims of violence in ethiopia. the cwi is led and implemented by the international rescue committee (irc) through the support of the united nations high commission for refugees and other international partners. the program provides a wide range of services including socioemotional, clinical, and legal support in partnership with local and international partners (international rescue committee, 2021). the cwi is implemented in collaboration with the administration of refugee and returnee affairs (arra), a government body that controls and coordinates refugee assistance interventions in ethiopia. arra is responsible for providing legal and transportation support, supervision, and evaluation of the cwi on behalf of the government. data collection qualitative in-depth interviews were conducted in amharic with the recruited social workers focusing on their challenges and experience in addressing gbv in ethiopian refugee settings. the researcher, a bilingual native speaker, conducted the interviews. the interviews took place in 2018 during the growing political turmoil and internal conflict in ethiopia. a semi-structured interview guide was used to explore the barriers faced by the participants, their responses, and perspectives on the way forward. the interviews lasted from 45-60 minutes at places chosen by participants and were audio-recorded. participants were oriented about the purpose of the study, confidentiality and handling of data, and the overall process of the research. informed consent was gained from each participant before tefera/we feel powerless 1099 the interviews took place. the researcher collected demographic information using closeended questions right before each in-depth interview session. the proposal of the study was reviewed and approved by the advances program and research ethics committee of aalborg university. analysis a thematic analysis was employed to review the narrative data in search of themes and patterns (frost, 2011). after transferring the interview recordings to a computer, the researcher transcribed each recording and translated it to english, cleaned, and organized the transcripts. the researcher read each transcript repeatedly and carefully to develop familiarity with the data. initial codes were developed and examined based on the aim of the study and the content of the participant narratives. the initial codes were refined and clustered into main categories and sub-categories to develop the final codebook. the codebook and transcripts were imported into nvivo12 software to carry out the coding. the nvivo12 generated code reports were used to conduct the analysis and interpretation of data. to develop a full understanding of the data and avoid the risk of misinterpretation and overgeneralization, the researcher used immersion and thick description techniques during the analysis process (creswell & poth, 2017). findings eight social workers working in the community wellbeing initiative (cwi) participated in the study. participants were predominantly female (n=7) and aged 26-37 years. most of the participants held msw (n=5), and the rest held mba (n=1) and bsw degrees (n=2). the participants had 5–12 years of professional experience. the study explored the challenges and experiences of social workers in addressing gbv in ethiopian refugee settings. three major themes and eight sub-themes were identified and labelled: “power and political interest” (with arra officials, within the gbv program), “institutional barriers” (lack of qualified staff, attitudinal and moral challenges, lack of legal services), and “strategic barriers” (lack of men-inclusion, inattention to poverty, and time-insensitive approaches). power and political interest with arra officials participants stated that power inequality is a significant force in shaping gender-based violence (gbv) service delivery in ethiopian refugee settings. gbv programs involve various actors including the gbv program officers, implementing partners, and administration of refugee and returnee affairs (arra) officials. these parties collaborate in different areas and their interactions involve power imbalances and hinder program activities. as one study participant shared: advances in social work, fall 2022, 22(3) 1100 well, the power imbalance mainly happens between arra and the cwi program staff. as a government body in charge of controlling gbv and other programs in ethiopian refugee settings, arra exercises power by allowing or denying the execution of program activities. as we discussed earlier, the law [the 2009 proclamation] doesn’t allow us to engage in human rights issues although what we are doing is a human rights issue. so, we do not have the confidence to say no to arra officials whenever a conflict of interest happens. (social worker 5, female, msw) according to the participants, the main driving force behind arra´s exercise of power is the political interest of the government in making sure that things are under their control. the government wants to ensure that foreign and local ngos do not influence the local political atmosphere. the government’s stance in this regard is stronger in refugee settings that are located near the borders of the country. this is partly because of the highly fragile political state of the horn of africa and the instability in the surrounding countries like somalia, south sudan, and eritrea. as the participants reported, the ethiopian government is always sceptical about every activity in the area. the soft border which is accessible to different militant groups is also part of the concern for the government. according to the participants, the scepticism has no limits and stretches up to putting social work and aid programs under pressure, making the practice ground difficult to operate. one of the social workers noted: arra officials are politically sensitive, and we are expected to be selective of our words while interacting with them. sometimes, they use their state-affiliated power to execute their personal subjective judgments, and this affects our practice. i remember a time when a social worker had to arrange transportation for a survivor to go to the court located far by her own. it was arra officials who were supposed to do so but they rejected her and even accused the social worker of sending the woman to the court without their will. it is complicated. (social worker 2, female, msw) participants stated that the power imbalance and tension push the service users out of their central position in the service delivery process. as one of the social workers stated, “in order not to lose the game, we compromise our priorities and act according to their (arra officials’) interest which usually is stressful” (social worker 6, female, msw). the social workers also mentioned that the disruptive power relations usually happen with arra officials in the refugee settings, not with officials based in the headquarters. there are times where the social workers do not report to higher officials to avoid potential conflict between higher officials and those who operate at the field level. the social workers agreed that they are taking on extra responsibilities beyond their scope. in stating the extent of the power exercised by arra officials, one of the social workers stated, although arra takes the role of protection services, what matters for them is not gbv or survivors´ safety. they are politically driven, and their internal agenda is security. when you take a raped woman to them, they may say “are you kidding? there are thousands of people craving for the monthly ration and here you are bringing gbv issue” or they may simply say “we are handling a security threat tefera/we feel powerless 1101 from opposition groups, sorry.” then we feel powerless. (social worker 1, female, bsw) the testimonies of the participants demonstrate that instead of victims’ needs, social work practice is shaped by the political interests of government officials (arra). in the politically-driven refugee settings, the knowledge and expertise of the social workers are not valued and the arra officials have the upper hand in decision-making. within the gbv program the social workers stated that the power imbalance is also an issue within the gbv intervention program (the cwi) itself. according to the participants, because of the politically sensitive nature of the implementation, there is a lot of pressure on them to strictly follow what is set in the guidelines of the program. the cwi leaders do not challenge unjust decisions made by government officials. instead, they simply accept what is set by local government officials and pressure the social workers to follow the rules. according to the participants, they do not have options but to listen to the upper hierarchy of their organization and compromise their decisions in gbv service delivery. they often feel they have no authority to implement the program with a full sense of professional independence. as implementers, participants said they are treated as the “yes-man” in the program and have little say in strategic decision-making processes. as one participant shared: i believe that we don’t have room for bringing our actual field experiences and informing the approaches or standards of the program. it is nearly impossible to do so as it is considered the existing standards are the best and we should accept them without question. (social worker 8, female, msw) another participant added, although we are trained social workers, most of us with msw, i believe that we don’t have full professional autonomy because we are trapped between the political pressure coming from the government and the sensitivity of the gbv program’s leadership. we are just mere implementers, not decision-makers. (social worker 2, female, msw) the top-down approach followed by the gbv program not only limits the decisionmaking capacity of the social workers but also hinders creativity in implementing the program. in such a situation where social workers’ voices are oppressed by both the government and employing agencies, it is difficult to address gbv issues in a contextually relevant and sustainable manner. institutional barriers lack of qualified staff participants stated that the gbv response program is understaffed and lacks the needed quality in terms of human and material resources. the remoteness of the refugee camps advances in social work, fall 2022, 22(3) 1102 from the central part of the country make it difficult to hire and retain skilled professionals. as stated by the social workers, the poor infrastructure and unfavorable weather in areas where the refugee camps exist have aggravated the challenge. for example, one of the participants said: in the bambasi camp which hosts 16,000 refugees, there is only one gbv response officer. imagine, the work burden that gbv officer has. the magnitude of gbv, reported and unreported, is very high in the refugee camps. unfortunately, the professionals we have wouldn’t even be enough “even if they are smoked like incense” [an amharic proverb to express inadequacy]. not possible. (social worker 5, female, msw) the participants stated that the shortage of well-qualified professionals negatively affects both the coverage and quality of services. according to one participant, “because of the shortage of qualified staff, we are forced to hire people from the refugee community with just basic linguistic ability without professional certification” (social worker 3, female, mba). the social workers reported experiencing frustration and burnout emanating from the lack of human and material resources. attitudinal and moral challenges the gbv intervention program requires social workers to work with multiple partners and service providers. according to the participants, service providers/professionals mostly depend on their own subjective judgments rather than the needs of the victim. one participant said: i remember the day when the doctor refused to prescribe post-exposure prophylaxis for a rape survivor referring that hiv/aids prevalence is at zero levels in the camp. i was shocked by the situation but couldn´t do anything. how can i explain this to him [the doctor]? that was an obvious ignorance. (social worker 4, male, bsw) another participant said, “when an abused woman comes to apply for divorce, the legal officers may tell her to go back home, reconcile and continue living with the abusive husband” (social worker 1, female, bsw). participants agreed that such attitudinal challenges are deep-rooted in the socio-cultural orientation of the officers/professionals. efforts to address gbv in the refugee settings should also target changing social norms that provide a supportive shield for perpetrators and accomplices. the social workers also share that they encounter ethical dilemmas or moral challenges in working with some members of the refugee community. for example, when recruiting and engaging volunteers, they may not find the right person who fulfils both the technical and moral expectations. one participant shared: we don’t have proper media or information outlets to disseminate gbv educational materials. because we lack the means, we often try to rely on people within the refugee community to transfer our messages. although engaging members of the refugee community is important, we may not get perfect candidates tefera/we feel powerless 1103 to partner with. for example, the person i am working with to reach out to the refugee community has three wives. although it might be acceptable religiously, it has always been a mental and ethical dilemma for me to have him stand with me and campaign about gbv against women or women’s gender rights. (social worker 6, female, msw) the lack of properly trained professionals is a concern in both the cwi program and among the collaborating partners. the pressure hinders social workers’ ability to provide timely and ethically sound service for gbv victims and their families. lack of legal services participants revealed that the lack of legal services in the refugee settings is a crucial challenge in addressing gbv. first, there is no specific law in place to handle gbv cases in refugee settings. according to the social workers, the refugee camps are not treated based on the rules of the other parts of the country. there are no clear standards and laws set to address gbv cases. second, the understanding and motivation of legal officers towards ensuring social justice for gbv victims is very low. third, when gbv cases are reported, evidence is required, and the bureaucratic procedures to do so are very complex and frustrating to social workers. participants stated that, sometimes, seeking justice for a gbv victim can be like inviting another perpetration. gbv in the refugee camps has been given little or no attention with no legal infrastructure to help protect victims or mitigate potential gbv acts. one participant shared: when we report cases to the police, we are often told that there are no clear laws or regulations to handle gbv cases in refugee settings. the refugee settings, which are located near the borders of the country, are not given adequate attention as the other parts of the country. there are no clear legal procedures and services to help gbv victims or to ensure justice. (social worker 1, female, bsw) the problem is further galvanized by the lack of financial capacity and inadequate transportation services to transport victims to the remotely located courts. one participant said “getting justice and protection for gbv victims is simply unthinkable. it leaves me so powerless” (social worker 3, female, mba). the lack of legal services and justice not only leaves victims with a physical and psychological scar but sends a wrong message to the rest of the refugee community. it will discourage victims from seeking support, encourage perpetrators to commit further gbv acts, and normalize violence against women. strategic barriers lack of male-inclusion another factor limiting the effectiveness of the program is its exclusion of men. as the participants reported, given the patriarchal nature of the community, women are the primary victims of gbv among refugees in ethiopia and are the primary target of the program. however, this does not necessarily mean men, especially boys, are not subjected advances in social work, fall 2022, 22(3) 1104 to gbv. a participant said, “we almost exclusively focus on women and girls. this makes men and boys feel ignored. this is our limitation and is against the basic notion of community mobilization and participation of all members” (social worker 7, female, msw). participants stated that men and boys are culturally constrained from stepping forward and reporting sexual abuse. first, nobody would think that it is possible for male members of the community to be sexually abused. second, if they ever come out and report, they will be automatically labelled as ‘sodomists’ even though they are the victims of sexual abuse. one said: throughout my time in this program, i came across only one male case. this is not because of its inexistence; rather it is because of the lack of awareness and the almost zero level of reporting compared to women. people, including some service providers, think that the program is only meant for women and girls. for example, we have no safe spaces for men or boys. this says it all. (social worker 5, female, msw) according to the participants, in addition to the inattention to men and boys as targets of gbv, they also are side-lined from participating in the implementation of the gbv program. the practitioners believe this lack of male-inclusion hindered the effectiveness of the gbv program. the following quote from one of the social workers shows the concern: men´s engagement is the crucial segment we are missing in the program. imagine a woman reporting a case or getting gbv service and going back home. do you think she will live peacefully with her partner? no. whatever we do with the women, at the end of the day, decisions are made by men at home. so, engaging men in our intervention and developing their awareness is not an option but a necessity. (social worker 8, female, msw) in a setting where there is no adequate legal and institutional protection for victims, excluding men from the intervention program can exacerbate the problem. strategic decisions to train and collaborate with men can help in mitigating gbv acts and protecting victims. inattention to poverty participants reflected that the lack of adequate attention to poverty impacted the success of the gbv program and their work with gbv victims. according to study participants, poverty is one of the root causes of gbv among refugee communities in ethiopia. women, girls, and boys are economically dependent on men and this economic dependence increases the risk of vulnerability to gbv. as the participants stated, when gbv happens to them, victims will refrain from reporting it because they are dependent on the abusers and have nowhere to go. a participant said: men are the financial sources for their families. that gives them the upper hand in making any decision in the household. the economic power they have backed up tefera/we feel powerless 1105 by cultural expectations helps them to silence any gbv victim in the family, and outside. that is how the system works for the whole community. (social worker 6, female, msw) the social workers also reported that practices like child marriage (early marriage) have a strong link with the economic conditions of families. poor families are most likely to give their children away for underage and non-consensual marriage to gain economic benefits. as one of the social workers stated, “for families living under the yoke of poverty, giving their child to get married to an economically independent man is one of the economic survival strategies” (social worker 4, male, bsw). participants agreed that addressing gbv should go hand-in-hand with addressing poverty. the responses of the participants implied that soft services such as awareness creation and education are not adequate to bring sustainable solutions to the problem. economic empowerment of women should be part of the strategic direction followed by the gbv intervention program. time-insensitive approaches participants stated that the highly mobile nature of refugees makes it difficult to achieve the set program goals and objectives within the planned time frame. one of the social workers said, the refugees are highly mobile and reside here temporarily. it is difficult to implement a program that has more long-term strategies because the service users are not stable. implementing a phase-based long-term program in highly mobile target groups is very difficult. after getting trained, the voluntary activists may leave the refugee settings before starting to serve the refugee community. (social worker 2, female, msw) participants reflected that the guidelines require mandatory involvement of various parties from state and non-state actors in delivering gbv services. as the social workers stated, although working with multiple partners is important, it also delays service delivery for victims of gbv. a participant stated: especially, engaging with government offices is tough. you have to go through multiple layers of bureaucracy to report a case, get the necessary protection for the victim, and decisions about the future of the victim. services are located far apart, and we cannot serve people on time. they may leave with all the physical and mental trauma without getting proper treatment. (social worker 7, female, msw) the above testimonies indicate that the strategies of the gbv program are detached from the reality on the ground. in fast-changing refugee settings, lengthy procedures and bureaucratic collaborations cannot yield the needed results. curbing down unnecessary procedures and delegating social workers to make timely decisions can be helpful. tefera/we feel powerless 1106 figure 1. integrating findings with the sem note: adapted from “the social-ecological model: a framework for prevention violence prevention” (centers for disease control [cdc], 2019). policy/enabling environment organizational community interpersonal individual •national, state, local laws •[the 2009 proclamation] doesn’t allow us to engage in human rights issues although what we are doing is a human rights issue. so, we do not have the confidence to say no to arra officials whenever a conflict of interest happens. •organizational and social institutions •in the bambasi camp which hosts 16,000 refugees, there is only one gbv response officer. imagine, the work burden that gbv officer has. the magnitude of gbv, reported & unreported, is very high in the refugee camps. •relationships between organizations •the service is called protection and is run by arra. so, it all depends on the decisions of arra to refer the reported case to the remotely located police or court. it is not us who make the decision. •families, friends, social networks •men´s engagement is the crucial segment we are missing in the program. imagine a woman reporting a case or getting gbv service & going back home. do you think she will live peacefully with her partner? no. •knowledge, attitude, behavior •when an abused woman comes to apply for divorce, the legal officers may tell her to go back home, reconcile & continue living with the abusive husband. advances in social work, fall 2022, 22(3) 1107 discussion the following section presents the discussion of the findings using the social ecological model (sem) as a framework (see figure 1). social workers can play a significant role in addressing gbv in refugee and humanitarian settings. however, social workers, particularly those in the global south, experience a variety of challenges in their efforts to prevent and respond to gbv issues. they often face barriers from an individual level to the larger governmental and societal level that hinder their efforts to provide services to victims of gbv. besides the challenges social workers experience, their voices are ignored due to inattention from researchers and policymakers. social work researchers are in a better position to study and understand fellow social workers’ challenges and develop recommendations informed by the profession’s core values. this qualitative study explored the barriers in social work practice in the remote refugee settings of ethiopia and elevates unheard voices from the global south. the findings echo the understanding that addressing gbv is influenced by complex and interconnected factors. at the individual and interpersonal levels, participants experienced challenges that emanate from the attitude of professionals in addressing gbv. for example, the denial of medications, such as post-exposure prophylaxis for victims of rape, or the decision of legal officers to send victims back to live with the abuser, reflect the individual-level challenges, which also reflect the institutional culture and policies. previous studies from rwanda and tanzania also reported that limited knowledge and negative attitudes of professionals towards gbv, especially intimate partner violence (ipv), have been the top challenges in tackling the problem (ambikile et al., 2020; titilope, 2017). the attitudinal challenges faced by social workers were strongly connected with the cultural orientation of the individuals working as implementing partners. the barriers experienced by the social workers are not limited to a certain level but span all levels of the ecological systems theory (das, 2015). the findings further support research that has brought the role of culture to the fore in shaping professionals’ knowledge and attitude in addressing gbv acts through the traditions, religion, and norms of the community (fry et al., 2019; le mat et al., 2019). the individual and interpersonal level barriers contribute to as well as are reinforced by the community and organizational level barriers (cdc, 2019). as participants reflected, the highly politicized work environment and the relationship between the governmental body arra and the non-governmental organizations are characterized by distrust and skepticism. although the findings showed that the barriers experienced by social work exists at all levels, the community and organization levels contribute the most challenges in addressing gbv. unlike previous research (heijden et al., 2020; sloand et al., 2015) that mostly focused on cultural barriers, the findings of this study uncovered that organizational/institutional challenges and power imbalance are the biggest barriers faced by social workers. participants indicated that they often found themselves trapped in the power relationship between the politically-driven arra officials and the interest of their organization and implementing partners. the situation left the social workers powerless and compromised their professional autonomy, thus hindering their ability to make decisions in the best interests of gbv victims. the institutional barriers social workers advances in social work, fall 2022, 22(3) 1108 experienced resonates with bourdieu’s theorizing of symbolic violence that is manifested through the treatment of individual professionals or service users as inferior or having clients’ expectations be limited by systematic rules and guidelines (webb et al., 2002). as participants reported, their effort to help gbv victims are constrained by denial of legal and medical services and a lack of cooperation to provide protection services (morgan & björkert, 2006; schubert, 2012). in addition to the sem, the anti-oppressive practice (aop) framework is helpful for critically looking into the multiple forms of oppression that occur simultaneously throughout the micro, mezzo, and macro levels. as a social justice-oriented approach, the aop focuses on the structural origins of oppression and challenging power structures through collective institutional and societal changes (matthews et al., 2020). as discussed above, most of the barriers emanate from the power imbalance and oppressive nature of relationships between the social workers, the cwi leadership, and arra officials. the structure and procedures of the gbv service delivery in the cwi do not allow the social workers to engage in deep reflection and critical consciousness that will help challenge the oppression and promote justice for gbv victims (baines, 2011; sakamoto & pitner, 2005). participants also reported that they are faced with strategic barriers that belong to the policy/enabling environment section of the sem. from the federal to the local state level, there are no proper policies directed toward gbv among refugees. cases go unaddressed simply because of the absence of a specific legal framework. as participants indicated, the policy gap is further manifested in the limited human, financial, and material resource allocation. the findings confirm previous research that reported unclear legal and policy provisions as the main barrier in addressing gbv and reproductive health rights of refugees (chynoweth et al., 2020). such legal framework issues are not unique to social workers in developing nations like ethiopia. previous studies also reported that practitioners in both the developing and developed world are challenged by laws and procedures that disallow or complicate medical and protective services for survivors of gbv (asgary et al., 2013; keygnaert et al., 2014). at a program level, participants stated three major strategic issues hindering their effort in addressing gbv in refugee settings. first, the gbv intervention program lacks the inclusion of men due to resistance from the highly religious and patriarchal refugee community. activities and support that are exclusively aimed at helping women often fail to produce results because of the disapproval of their spouses or male community leaders. although previous research underlined the importance of the inclusion of men in addressing gbv, there are still gaps in interpreting and applying gender-inclusive approaches (müller & shahrokh, 2016; tolman et al., 2019; touquet & gorris, 2016). second, a singular focus on gbv without adequate attention to addressing poverty and economic issues has limited social workers’ ability to deal with the root causes of gbv in the refugee community. poverty and poor-quality living conditions have been reported as predisposing factors for gbv. interventions that follow an integrated developmental model have produced better results in tackling gbv (mcilwaine, 2013; serrano-argüeso et al., 2021). third, the highly mobile nature of refugees challenges the time-intensive and process-heavy approaches of the gbv intervention program. with poor infrastructure and an uncollaborative work environment, social workers are thwarted in responding to the tefera/we feel powerless 1109 time-sensitive needs of gbv victims in refugee settings. the findings substantiate previous studies that highlighted difficulties in referral services, sustainable case management, and solutions due to the fast-changing refugee situations (hossain et al., 2018; lilleston et al., 2018). from the findings, it is clear the challenges experienced by social workers in addressing gbv in the ethiopian refugee settings span every level of the sem. however, the challenges are interrelated and sometimes transcend every level of the sem. for example, the community and organizational pressure that stripped the participants’ of professional autonomy limited their capacity to influence the policy and strategies of the gbv program. in the same manner, the lack of a clear legal framework results in service denial at the organizational level and attitudinal bias at individual and interpersonal levels. implications for social work one of the key issues, evident at all levels of the sem, is the importance of social workers’ power and autonomy in their practice. from a personal level to policy/strategic issues, social workers’ practice was affected by the politicized environment and power relations. hence, social work practice in ethiopian refugee settings should not only focus on empowering service users but also the social workers themselves. to function and deliver services in a highly politicized practice environment, social workers need to be trained with the necessary political knowledge and skills. social work education and practice should embrace political activism as one of the primary strategies in an environment that hinders gbv services through unnecessary bureaucracies, political motives, and legal complications. experiences from other african countries such as liberia also demonstrated the importance of having an open political environment to expand legal services for victims of gbv and ensure the autonomy of practitioners (medie, 2013). social workers should maintain their professional autonomy to best serve the needs of service users and exercise reflective and innovative practice. to become effective agents of change in gbv survivors’ and victims’ lives, it is imperative that social workers engage in anti-oppressive social work and promotion of social justice (mmatli, 2008; sakamoto & pitner, 2005). to engage in the anti-oppressive practice (aop), social workers should critically reflect and work on their relationship with institutional power structures (including cwi leadership and arra officials), as well as their relationship with service users. establishing social work associations to advance their concerns, participating in local politics, lobbying, and social activism to collectively challenge structural oppression are all important strategies (matthews et al., 2020). social workers should also critically reflect on their own position in practice and its impact on their relationship with gbv victims. understanding the intersecting oppressive forces including gender, refugee status, poverty, culture, and politics on gbv victims’ lives is important. social workers should empower service users by treating them as partners and incorporating their views into assessments and solutions (braines, 2011; skamoto & pitner, 2005). given the complex socioeconomic factors, social work practice in ethiopian refugee settings and in the country at large should follow an integrated developmental approach advances in social work, fall 2022, 22(3) 1110 that advocates poverty reduction and economic empowerment of vulnerable groups, mainly women. as indicated in the findings and discussion, the remedial and clinical social work efforts that focus only on individual victims of gbv have not been effective because the issue is much bigger than the individuals involved. gbv is rooted in the cultural, social, and economic bases of the refugee community. addressing gbv in ethiopian refugee settings needs engagement in anti-poverty work to bring a more sustainable solution. advocating for equal access to resources, income-generating opportunities and fighting structural discrimination are equally important to bring sustainable solutions in addressing gbv. integrated developmental social work practice paves the way to address structural issues and press on social justice matters and poverty alleviation (muchacha & matsika, 2017). the gbv program in ethiopian refugee settings should expand services that respond to the economic needs of gbv victims and survivors in addition to the legal and medical referral services. ensuring the professional autonomy of social workers and adopting an integrated developmental approach paves the way to making strategic/policy changes that are needed in gbv interventions. social work practice in the refugee settings should engage in advocating for adequate human and material resource allocation to address gbv. besides resource allocation, advocating for expedited legal services and the protection of gbv survivors should be a critical part of the intervention. to respond to time-sensitive needs, social workers need more autonomy and decisional independence in delivering services. collaborative work with other partners need to be revisited to reduce unnecessary delays in the referral process. the findings of the study also showed that the unidirectional women-focused approach could not bring about the needed results as all the efforts aimed to support women were reversed by their male counterparts at the end of the day. hence, gbv interventions in ethiopian refugee settings should follow an inclusive path and create dialogue while engaging men from the beginning to the end of the program. expanding social work training and research that emphasizes the importance of working with men and highlights best practices can be vital in achieving inclusive practice (hansen et al., 2021). this inclusive effort should also target boys, who are often overlooked despite the underreported gbv they are experiencing in the refugee settings. as suggested by jewkes et al. (2014), including men as allies in gbv interventions paves the way for sustainable change in social norms and gender relations that reinforce violence and perpetration. the program needs to shape itself in a way that all vulnerable groups despite their age, religion, sexual orientation, and cultural affiliation are included without any discrimination. as demonstrated above and through the sem, the challenges in addressing gbv in ethiopian refugee settings are complex and intertwined at multiple levels. there is no single solution to resolve the barriers experienced by social workers in responding to gbv issues. hence, efforts to solve gbv problems should target every level from individual to higher-level policy systems in a coordinated manner. tefera/we feel powerless 1111 strengths and limitations of the study by bringing the unheard voices of social workers from remote ethiopian refugee settings, this study contributes to the social work literature about gbv. the in-depth interviews conducted with practitioners helped to uncover the structural and institutional challenges experienced by social workers in addressing gbv. unlike most research that tie gbv response issues to mainly cultural matters, this study was able to bring the structural, power, and political dimension of dealing with gbv into focus. based on the findings, the study proposes a more integrated and developmental approach to social work practice that is more meaningful to the local context of the refugee settings in ethiopia. however, the study has limitations in terms of generalizability due to its qualitative nature and small sample size. the findings can only be attributed to the participants involved in this study. further quantitative research is needed to include more participants and expand the findings. although the primary aim of this study was to understand the challenges experienced by social workers, it is equally important that the perspectives of other professionals and partners are investigated. conclusion social workers in ethiopian refugee settings experience various challenges in addressing gbv. although these challenges span all levels of the sem, most are structural and institutional in nature and are embedded in the unbalanced power relations within and between implementing partners. addressing these structural and strategic barriers requires adopting an integrated developmental approach and anti-oppressive social work practice that ensure the professional autonomy of social workers in dealing with gbv matters. references adugna, g. 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(2022). toward culturally relevant practice: combating gender-based violence among refugees in ethiopia. journal of ethnic and cultural diversity in social work, latest articles, 1-12. https://doi.org/10.1080/15313204.2022.2027311 titilope, a. o. (2017). healthcare workers’ knowledge on gender-based violence and utilization of services in kacyiru sector, rwanda [doctoral dissertation, mount kenya university]. http://repository.mkurwanda.ac.rw/handle/123456789/5606 tolman, r. m., casey, e. a., carlson, j., allen, c., & leek, c. (2019). global efforts to engage men and boys in gender-based violence prevention. global social welfare, 6(4), 215-218. https://doi.org/10.1007/s40609-019-00165-0 touquet, h., & gorris, e. (2016). out of the shadows? the inclusion of men and boys in conceptualisations of wartime sexual violence. reproductive health matters, 24(47), 36-46. https://doi.org/10.1016/j.rhm.2016.04.007 united nations high commissioner for refugees [unhcr]. (2019). ethiopia refugee crisis explained. https://www.unrefugees.org/news/ethiopia-refugee-crisisexplained/ vu, a., wirtz, a. l., bundgaard, s., nair, a., luttah, g., ngugi, s., & glass, n. (2017). feasibility and acceptability of a universal screening and referral protocol for gender-based violence with women seeking care in health clinics in dadaab refugee camps in kenya. global mental health, 4(21), 1-11. https://doi.org/10.1017/gmh.2017.18 webb, j., schirato, t., & danaher, g. (2002). understanding bourdieu. sage. wirtz, a. l., glass, n., pham, k., aberra, a., rubenstein, l. s., singh, s., & vu, a. (2013). development of a screening tool to identify female survivors of genderbased violence in a humanitarian setting: qualitative evidence from research among refugees in ethiopia. conflict and health, 7(1), 1-14. https://doi.org/10.1186/17521505-7-13/tables/2 author note: address correspondence to gashaye m. tefera, school of social work, university of missouri, clark hall, 732, columbia, mo, 65211. email: yenenardos@gmail.com https://doi.org/10.1353/fro.2021.0015 https://doi.org/10.1016/j.healthpol.2013.10.007 https://doi.org/10.1177/0020872807083913 https://doi.org/10.1093/inthealth/iht009 https://doi.org/10.21106/ijma.42 https://opendocs.ids.ac.uk/opendocs/handle/20.500.12413/7979 https://opendocs.ids.ac.uk/opendocs/handle/20.500.12413/7979 https://www.criticallyinfusedsw.com/antioppressive-practice https://doi.org/10.1177/0020872820940032 https://doi.org/10.1177/0020872820940032 https://doi.org/10.1177/0956247813477359 _________ ariel n. hooker jones, phd, lcsw, assistant professor, kimberly carter, phd, associate professor, and sarah goshorn, msw, alumna, department of social work, southern illinois university, edwardsville, il. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 251-269, doi: 10.18060/24994 this work is licensed under a creative commons attribution 4.0 international license. a msw curriculum analysis: preparing msw foundation level students for remote practice ariel n. hooker jones kimberly carter sarah goshorn abstract: as the pandemic surges, the need for remote social work practice (rswp) is urgent and ensuring that students entering practice are prepared to engage is paramount. students entering the workforce must be able to demonstrate competency and educators must explore how they are preparing students for rswp. a cohort of twenty-one msw students were invited to participate in this study exploring curriculum exposure to rswp and subsequent confidence and readiness to engage in practice. only a subset of this cohort (n=13) agreed to participate in the study. this study explored exposure to rswp concepts through a foundation-level msw curriculum, practicum, and other program contacts. results show that even though students were primarily exposed to rswp in practicum and courses that focus on basic interpersonal skills, other courses, such as research and policy also provided exposure. students reported that theory and diversity courses made no mention of rswp. this is concerning because these courses are meant to educate students on practice frameworks and service contexts for underserved populations, like those that are commonly served via rswp. although limited, this study has implications for how social work educators embed rswp throughout the curriculum, instead of siloing this topic in practice courses. keywords: covid-19, remote social work practice, e-social work, tele-social work, msw curriculum at the core of social work practice is enhancing the well-being of individuals, families and communities, particularly those who are vulnerable or oppressed, but often the ability to help is compromised by service accessibility challenges. thus, our core values are not fully realized if we do not address the myriad of accessibility challenges faced by our colleagues and clients in practice. remote practice modalities using information and technology have emerged as a way to circumvent these challenges (goel et al., 2020). across multiple disciplines, including social work, there is scholarly consensus that remote practice modalities advance access to care for a number of under-served populations (kraus, 2011), such as individuals residing in remote and rural communities and individuals who lack transportation or localized service options. as the covid-19 pandemic surged, these challenges were multiplied and the need for remote practice became essential. thus, social work programs were confronted with the need to critically examine how they prepare students to engage in remote practice (banks et al., 2020). the nasw code of ethics mandates that social workers demonstrate competence in practice, including competence in use of technology in practice (nasw code of ethics, standard 1.04d). consequently, social workers entering the workforce must about:blank advances in social work, summer 2022, 22(2) 252 demonstrate competence in varied areas of remote practice and educators must ensure that future practitioners are not only competent in using remote practice modalities, but confident in their use. competency and confidence may be impacted by the many monikers used and the lack of an agreed upon definition of remote practice. this is further compounded by the fact that these monikers are broad in context and refer to both the type of services being provided and the modality in which the service is being rendered. as mccarty and clancy (2002) so eloquently stated, “nearly anything a social worker does face-to-face could theoretically be done online. counseling, home health visits, consultation with colleagues, research, supervision of interns, and social work education are now being performed through telecommunication” (p. 153). they suggest that mental health care was the first social work service provided remotely by way of telehealth and at the time argued that it was the most important service to be provided by way of telecommunication (mccarty & clancy, 2002). in light of the pandemic and the evidence surrounding the implication on mental health, one could argue that this remains true. however, since 2002 the delivery of said services has expanded to include, but is not limited to, the telephone, videoconferencing, emailing, text messaging, fax machines, the internet, and social media depending on the research article you are reading. background telehealth services have become very important in the field of social work. telehealth, tele-behavioral health, tele-mental health, e-therapy, and cyber counseling are a few of the terms frequently used to describe virtual practice (langarizadeh et al., 2017). these terms are just the tip of the iceberg, as there are many more that hold technology term prefixes such as tele-, cyber-, e-, electronic-, online-, digital-, web-, web-based-, websupported-, as a part of their moniker. the social work and technology fields, like many professions, are flooded with terms that are ill defined, but so commonly used that they become jargon and serve as a source of difference versus consensus. for that reason, for the purposes of this study we define remote social work practice (rswp) as: intentional social work practice involving the use of digital information and communication technology such as computers, mobile devices, or digital applications to access or deliver services remotely. service provided can include, but is not limited to, clinical intake and assessments, telehealth, tele-therapy and other remote behavioral and mental health services, non-clinical client engagement, remotely held administrative or community engagement meetings, online work groups or gatherings, remote support group facilitation, or any other service engagement and linkage to referrals done through remote interactions. whether engaged in due to practice duress and emergency needs as occurred due to the covid19 pandemic or engaged in to ensure efficiencies or expansion of practice, the basic tenets underscoring the use of rswp remain the same to provide social work practice at a distance using digital technologies. research and literature regarding remote social work practice (rswp) is limited. that which does exist is scattered across many monikers and themes, including telecommunication (perron et al., 2010), e-social work (lópez peláez et al., 2018), odera et al./de-centering whiteness 253 technology enhanced social work (fitch, 2015; goel et al., 2020), e-therapy (cwikel & friedmann, 2020; earle & freddolino, 2021), digital social work (mishna et al., 2021), etcetera. even across this wide spectrum, most of the literature focuses on micro-level applications such as healthcare, therapy, counseling, and case management. references to rwsp in macro contexts are nascent. what can be gleaned from the current knowledge base is that the use of rswp modalities, along with academic and professional training, has become increasingly common —especially as a result of the covid-19 pandemic. research suggests that rswp produces positive service and client outcomes. there are clear indications that client satisfaction with both in-person and online counseling services are relatively equal, with some studies showing better outcomes through virtual engagement. based on a meta-analysis of online counseling services involving 92 studies from 64 different articles with over 9,700 participants, virtual service delivery is effective in the areas of “child psychiatry, depression, dementia, schizophrenia, suicide prevention, post-traumatic stress, panic disorders, substance abuse, eating disorders, and smoking prevention” (kraus, 2011, p. 55). similarly, weinberg (2020) reviewed research regarding online therapy indicating that individual therapy via telehealth has been found to be appropriate for reducing the mental health burden of covid-19. this study also indicates that video-based groups resulted in similar treatment outcomes to in-person groups, including improvements in coping. education and training of psychotherapists was also impacted by experience with technology. earle and freddolino (2021) conducted a survey of master of social work students and found that students are technology savvy and have accepted the use of etherapy as a whole. students indicate that they expect to continue to use internet and communicating technologies in social work practice outside of the covid-19 pandemic, they are confident in their abilities to establish a therapeutic alliance virtually, and they will consider e-therapy employment opportunities upon graduation (earle & freddolino, 2021). in an article written by mitchell et al. (2021), the necessity and experience of training msw students on rswp was presented. the authors describe the effects of covid-19 on the social work internship experience of social work oncology interns (e.g., practicum students) and the program redesign that occurred as a result of the pandemic in an attempt to transition to rswp. the authors describe how typical “in-office” on-the-ground intern tasks were significantly altered by the covid-19 pandemic. for example, interns were no longer able to engage in direct-patient contact, as only employees were allowed access to the facility. as a result, the program created online (virtual) training modules that emphasized the council on social work education’s core competencies, specifically the competencies of engaging, assessing and intervening with individuals, families, groups, organizations, and communities. the authors note that the virtual model developed as the result of the covid-19 pandemic should be utilized in the future to onboard new social work staff and with future interns (mitchell et al., 2021). johnson et al. (2021) analyzed the impact of transitioning from in-person to virtual interactions for a ptsd-focused study. johnson et al. (2021) found that recruitment for the study increased significantly with remote modalities, while the pool of eligible recruits remained the same. overall, it appeared that remote services increased access to mental advances in social work, summer 2022, 22(2) 254 health care and research. in studies conducted by békés and aafjes-van doorn (2020) and johnson et al. (2021), staff reported high satisfaction with remote work, indicating increased flexibility and improved work-life balance. a decrease in cost of supplies was also noted, which could be beneficial for many organizations. johnson et al. (2021) notes a need for additional research regarding remote work to “advocate for sustained change to administrative and regulatory policies to support virtual high-quality care delivered in the modality that best meets the needs and preferences of the patient” (p. 491). the aforementioned articles, (earle & freddolino, 2021; johnson et al. 2021; mitchell et al., 2021) clearly highlight the benefits of rswp and the need for it in the profession. the literature evidences that rswp has the capacity to produce positive outcomes for clients and staff (weinberg, 2020). clearly to achieve these positive outcomes means that social workers must be adequately trained on use of rswp techniques, as mitchell and colleagues (2021) attempted to do with the pandemic adjustments they made at a practicum site. and while their study clearly shows that practicum sites can assist in this student preparation, it is imperative that social work programs take up the baton and embed rswp education and training in their curricula (lópez peláe et al., 2018). remote practice research suggests improved knowledge, acceptance, and skills regarding this treatment modality following clinician training (bruno & abbott, 2015; chang et al., 2016; mccord et al., 2015). similarly, clinical training led to enhanced competence using remote practice technology (mccord et al., 2015; wood et al., 2004), increased levels of cultural competence (mccord et al., 2015), and increased satisfaction ratings from clinicians (gray & diloreto, 2016). thus, programs should consider the extent to which faculty, staff, community contacts, and other program partners can assist in providing knowledge and training on rswp to students. student learning can happen via multiple sources, and all should be considered as programs identify ways to prepare students for rswp. study theoretical framing the underpinnings of this study are rooted in social learning theory (bandura & walters, 1977) and roger’s diffusion of innovation theory (rogers, 2003). social learning theory (bandura & walters, 1977) explores the learning process which involves observing, experiencing, and imitating new behaviors that are introduced and reinforced by others within a persons’ environment. thus, new patterns of behavior and new knowledge can be acquired through direct experiences or observations. bandura emphasized the significance of attaining new knowledge and skills by paying attention, retaining the information observed, reproducing the observed behavior, and being motivated to continue the newly learned behavior (thyer & wodarski, 1990). with the sudden shift to remote learning and implementation of rswp due to the covid-19 pandemic, this research team was interested in ways msw students were exposed to the tenets of remote practice so that they could aptly use it in practice. social learning is a significant factor in changing systems (yarberry & sims, 2021). as such, we considered cultural attributions such as student demographic background, past educational experiences, and work background as factors underscoring student learning. the research team also considered how learning may have been influenced by the curriculum, the odera et al./de-centering whiteness 255 faculty, the practicum, and the field supervisor. we also considered the ways non-social work courses could have contributed to the learning of remote practice. similarly, rogers’ diffusion of innovation theory (rogers, 2003) was considered in our research design, as a means to help us understand the extent to which students were both exposed to and adopted the innovation of remote social work practice (rswp). this theory provides a framework for understanding the usefulness of integrating rswp into the curriculum. diffusion of innovation theory describes the process by which new information/innovations are adopted by a set demographic. this theory has been utilized by a variety of academic disciplines, including counseling, communication, public health, and nursing (doyle et al., 2014; murray, 2009; rogers, 2003) to understand the integration of new technologies and ideas into those fields. according to rogers’ (1995) diffusion of innovation theory, a practice innovation can be characterized by certain patterns of adoption. these patterns range from early to late adopters of innovations (cwiekel & friedmann, 2014). this theoretical framework aides in the conceptualization of the roadmap of learning to practice within the social work field and the extent to which msw’s can adapt remote practice skills into their professional repertoire after earning their msw. study aims the primary research aim of this project was to develop a pilot study that provides preliminary data on how an msw curriculum prepares students for readiness to adopt the principles and tenets of remote social work practice. the first goal of the study was to understand the extent to which foundation level msw students were exposed to rswp within the curriculum and outside of the classroom. the second goal was to understand their readiness to engage in rswp. desired outcomes of this study are to also contribute answers to core questions being posed by social work scholars such as: a) how are we teaching students to engage in remote practice? (berg-weger & schroepfer, 2020; wilkerson et al., 2020); b) how should we respond to calls, including the grand challenges call, to prepare social work students for use of technology in practice and remote practice modalities? (berzin et al; 2015; mcinroy, 2019); and c) are social work curriculums preparing students for entry into a new-age practice world that will expect them to utilize innovative tele-social work practice and are they abreast of the policies, ethics, and theories that inform this practice trend? the exploratory nature of this study begins to address this gap within the social work literature. sampling and study methods this study was approved by the university institutional review board (irb). study participants were sampled from a cohort of enrolled students (n = 21) who were completing their foundation curriculum year in a graduate social work (msw) program at a mid-sized state university. students currently enrolled full or part-time and actively engaged in the curriculum were invited to participate in the study. the only exclusionary criteria were (1) not being actively engaged in the curriculum such as being on “academic leave” or (2) being a transfer student such that the said student did not have previous exposure to the advances in social work, summer 2022, 22(2) 256 department’s social work curriculum. in this particular cohort, no students fit the exclusionary criteria, thus all enrolled students were eligible for the study. study questionnaires were distributed to all students in the cohort. there was a 62% (n=13) response rate. since the principal investigators for this study were faculty who had prior or existing direct connection or familiarity to the students in the cohort, because they had either taught or mentored them, care was taken in the study notification process to reduce the potential of undue faculty influence. in the early stages of this study, prior to irb approval, the primary faculty investigators identified and included a research assistant who had no connections to the current cohort to assist with the study. though the research assistant was familiar with the university, the social work department, and the expectations of a general msw social work curriculum, the research assistant had no current or prior knowledge of the sample population; nor did this research assistant have knowledge of the program’s current curriculum or faculty. the research assistant was on boarded as needed to assist with sample recruitment, survey tool distribution, and data analysis to ensure objectivity throughout the research process. to further ensure the integrity of the research process, the study team worked with the university information technology office to create a project email address that in name referenced only the social work department. this email could be used by the research assistant to send out digital surveys and communicate on behalf of the research team. this ensured that communication about the study for sampling purposes was not done through the associated faculty email addresses, which reduced the potential of unintentional influence that faculty might have over student participants. the sample received project communication and recruitment messages from this email address. student participants were recruited over a six-month period during the transition period that marked the ending of their time in the foundation curriculum program. during this six-month period, while they were wrapping up their core (e.g., required) foundation courses and practicum, a total of three recruitment solicitations were sent out. the recruitment email explained the purpose of the study and included the informed consent agreement. if students agreed to participate as designated by their response on the digital informed consent, they were then directed to the online survey tool. measurement the survey tool was distributed online via the university supported qualtrics platform. it is important to note that this study was conducted during the time of the covid-19 pandemic, during which state quarantine orders were in effect and the campus was closed to in-person, on-the-ground activities. thus, it was paramount to identify a survey distribution method that was both physically and economically feasible given the circumstances. as a result, the survey was only distributed online. while this survey approach was deemed the best choice, it poses limitations that must be acknowledged. students may lack familiarity with use of online survey tools, could run into technical glitches which could compromise survey completion, and/or may miss the opportunity to respond because they miss the survey email notification or mistake that email for spam mail (lefever et al., 2007). odera et al./de-centering whiteness 257 table 1. remote practice survey subscale categories survey subscales roger’s theory of diffusion, theoretical alignment # of items select study measures measure descriptions & response options exposure to rswp in msw foundation practicum stage 1: knowledge/ awareness 15 student learning or engagement in rswp at their practicum; extent to which the student was exposed to rswp in field supervision close-ended: categorical dichotomous; ordinal rating scale open-ended: short answer exposure to & assessment of remote practice knowledge/ skill in the required msw foundation curriculum stage 1: knowledge/ awareness 7 student recollection of being exposed to or taught about rswp in their msw foundation core courses & electives; student recollection of courses that provided them with assignments, engaged learning activities, trainings, or assessed their skills in rswp close-ended: categorical open-ended: short answer exposure to rswp from “other” non curriculum sources stage 1: knowledge/ awareness and stage 2: persuasion/ interest 10 student exposure to rswp topics from non-curriculum sources, such as academic advisors/faculty mentors, program directors, other department leadership, practicum supervisors, job supervisors, classmates, others; student rating of the level of support & training these other sources provided close-ended: categorical dichotomous; ordinal rating scales open-ended: short answer student remote practice supervision, & support stage 2: persuasion/ interest 5 the presence & level of training, supervision & support for remote practice (from the msw program administrators, faculty, staff, students, field supervisors, or others) close-ended: ordinal rating & level of agreement scales open-ended: short answer student familiarity with & use of rswp platforms stage 3: decision/ evaluation 4 familiarity with prominent clinical & client-management rswp platforms & student use of said platforms at their practicum close-ended: categorical dichotomous open-ended: short answer student confidence & readiness to engage in rswp 10 confidence & readiness to engage in rswp; satisfaction with & perception of academic exposure to rswp in the msw program open-ended close-ended: ordinal sample demographics 10 gender identity, race/ethnicity, age range, employment status during msw enrollment; other educational background (undergraduate degree, other graduate degree); practicum agency focus the survey tool used was a 61-item questionnaire with six subscales and demographic questions. the subscales were: (1) exposure to rswp in practicum; (2) exposure to and assessment of remote practice skills in the msw program curriculum, (3) exposure to advances in social work, summer 2022, 22(2) 258 rswp from other non-curriculum sources, (4) student remote practice supervision and support, (5) student familiarity with and use of rswp platforms, and (6) student assessment of their rswp preparation, including confidence and readiness to utilize. table 1 above presents select measures used for each category. face validity was confirmed for all questions and content domains for the subscales were established from literature reviews and expert-panel feedback. these experts were faculty and field practicum supervisors. creation of the subscale domains were framed by roger’s diffusion of innovation theory. according to this theory, in order to understand adaptation of new innovation, one must explore the process of innovation adoption (kaminski, 2011). in the context of this study the innovation is rswp. according to the theory, there is a five-step process to adopting innovation and key elements that must be considered. the questions in this study primarily align with the first three stages: the knowledge/awareness stage, the persuasion/interest stage, and the decision/evaluative stage. figure 1 shows the linkages between the subscales and the theoretical elements. the last subscale (six) where students are asked about their level of confidence and readiness moves the line of inquiry in the direction of stages four and five of the theory, which focus on full implementation and adoption of innovation. data analysis due to the small cohort and sample size, a robust comparative analysis was not possible. no pre-test survey was done prior to student enrollment in the program. the approach for this study was post-test single group analysis. only univariate analysis was performed. thus, the analysis only involved reporting of descriptive statistics including response frequencies. for all descriptive statistics, data were analyzed using excel. a number of short answer questions were also included in the survey. for these open-ended questions, responses were grouped into salient themes. study outcomes and results the sample consisted of msw students enrolled as full-time students in the foundation-level generalist practicum curriculum sequence. as previously mentioned, there were 21 students in the cohort and 13 consented to complete the survey. a review of the sample demographics revealed that the sample was predominantly white (64%) females (67%) with an age range of 24-49. a little less than half (45%) were employed in a social work agency during the time in which they were completing the msw foundation curriculum as full-time students. most (67%) reported that they had undergraduate degrees in a social science discipline such as psychology, sociology, human services and two reported having other graduate degrees. one reported having earned a graduate degree in fine arts and another reported a graduate degree in human services. inherent in the study aims was looking at how the practicum, as a core part of the curriculum, also informed knowledge of remote social work practice. these questions made up one of the survey subscales. as a result, student participants were also asked about basic information describing the context of their practicum. three-fourths of the students odera et al./de-centering whiteness 259 reported that their practicum had some type of micro-level clinical or case management focus. two students reported that their practicum focus was a blend of micro and macro foundation level work and one of the study respondents reported being at a practicum that focused on community practice and administration. overwhelmingly (over 90%), students reported that their practicum required a transition to “remote only” work during the first semester of their practicum, due to public health concerns brought on by the covid19 pandemic. when asked only one student reported that within three months after the transition to remote work, they returned to “traditional” in-person practice at their practicum. the rest of the students indicated that they continued to work remotely. when asked what kind of remote social work practice activities they completed at their practicum, students reported activities like engaging in phone or video-conference outreach, cofacilitating group session using tele-therapy principles, attending virtual seminars and trainings, conducting research, assisting with web-based social awareness campaigns and program evaluation activities, and participating in administrative and client case meetings. when asked to rate their level of agreement about the extent to which they felt their practicum taught them a lot about rswp, all participants (100%) indicated that they at least agreed with this statement. additionally, they all indicated that they were required to attend some type of training on rswp in their practicum and that their field supervisors discussed with them the ethical implications, diversity implications, and research frameworks underlying rswp. all student respondents also indicated that their field supervisors at some point in their practicum assessed and evaluated their remote practice skills. students did not qualify if the evaluation of their remote skills in practicum was related to their practice of emergency (pandemic) related remote work or related to practice of “traditional” agency remote work. the next subscale focused on the msw foundation curriculum (e.g., courses) this subscale has two components. component one asked about student exposure to rswp and component two asked about the extent to which students’ rswp knowledge was assessed and skills were evaluated during their foundation year. for component one, exposure was operationalized as becoming aware of rswp because it was casually, informally mentioned in a course or becoming aware because it was specifically, formally taught by the faculty in the course. for component two, knowledge and skill assessment were operationalized as having assignments, exams, remote-practice specific course assessments, or required engaged learning activities within the course. engaged learning activities were further defined as being required in a course to do any one of the following: a service-learning project related to rswp; attend events, conferences, or trainings related to rswp; listen to podcasts or watch videos; interact with some other rswp related digital or web-based content. for all questions in this subscale students were asked to consider all the cswe required core foundation level courses they had taken in the past year. there are nine courses that are required: (1) intro to social work practice basic skills course, (2) generalist practice with individuals and families, (3) generalist practice with communities and organizations, (4) generalist practice with groups (e.g., group work), (5) research methods, (6) social welfare policy, (7) diversity, (8) human behavior in the social environment, and (9) field practicum seminar (which accompanies practicum). table 2 provides an overview of the responses by course. advances in social work, summer 2022, 22(2) 260 table 2. subscale two: student exposure to remote social work practice in the msw curriculum, by course type students reported the following courses…. msw foundation (required) core curriculum courses intro to social w ork practice basic skills g eneralist practice w /individuals & fam ilies g eneralist practice w /c om m unities & o rganizations g eneralist practice w /g roups (e.g., group w ork) r esearch m ethods social w elfare policy d iversity h um an behavior in the social environm ent (h bse) practicum sem inar (w hich accom panies practicum ) mentioned a definition, description, or some basic information about rswp x x x x x x x formally taught them about rswp x x x x x x x provided training on rswp x x x x x assessed student use of rswp x x had required coursework on the topic of rswp x x required that the student participate in some type of enhanced learning activity related to rswp x x x x x x x provided some other type of learning experience related to rswp x x x as is presented in table 2, students reported that they were exposed to the idea of rswp in every core required course, except the human behavior and diversity courses. in fact, over 75% of students reported that their exposure to rswp was from direct-practice courses, including practicum. when asked to identify which of the nine required courses had some type of class assignment or engaged student learning activity related to rswp, students reported that only two courses (the research and field seminar courses) had assignments related to rswp and most all the courses (7 out of 9) had some type of engaged student learning activity embedded in it. the two courses that did not have any embedded student learning activity were diversity and the generalist practice with individuals and families course. to further understand what students were being exposed odera et al./de-centering whiteness 261 to in the classroom, the research team asked them to identify classes where they were actually trained on how to engage in rswp. students reported that five out of the nine courses taught them some type of remote practice skill. these courses were the introduction to social work practice skills course, the generalist practice with communities and organizations, research methods, the generalist practice with groups, and the practicum seminar. interestingly, they did not indicate that the generalist practice with individuals and families course provided any training on rswp; nor did they mention the research and policy course provided rswp training, even though they stated that these courses exposed them to the concept of rswp. finally, for this subscale, to understand if students' knowledge and skill level around rswp was being monitored, students were asked which courses had some component to assess their knowledge or skill of rswp. students indicated that the generalist practice with groups and the practicum seminar were the only courses that assessed their rswp knowledge and skill. in order to understand other contextual factors which may have contributed to student exposure to and understanding of rswp, the third subscale explored the extent to which students were exposed to (e.g., heard about or learned about) rswp from non-academic sources. students did not identify any non-social work electives that contributed to their rswp knowledge or skill. they were asked if they learned about any aspect of rswp from conversing with key individual staff or faculty in the social work department, namely their faculty mentor, the program director, or other non-teaching faculty. over half reported that they heard about or learned about rswp from the field director (67%) or their assigned faculty mentor (55%). only one student indicated that they learned from the program director. all student respondents reported that they heard about or learned about rswp from their classmates and one third (33%) reported learning about rswp from their place of employment. other common responses were seminar and graduate assistantships. the fourth subscale inquired about supervision and support students received. this subscale was an attempt to understand direct guidance or assistance related to rswp. all student respondents reported that their practicum field supervisor was the most instrumental in providing them with remote practice support. over two-thirds of the students also mentioned getting support from faculty mentors. students also mentioned getting support from their jobs or from connections and conversations with practicing social workers they knew. when asked to rank the top sources of support, they ranked practicum/field supervisors as one and courses as two. when asked what they think contributed to most of their training and knowledge regarding rswp, students ranked practicum first, then coursework and jobs, respectively second and third. students were also asked about receiving supervision to help them develop in rswp. when asked to rank the top source for providing them with direct remote practice supervision, they ranked practicum/field supervisor as the top source. faculty and non-descript “other” was ranked respectively as second and third in providing supervision. to understand adaptation and use of rswp, students were questioned about their familiarity and use of common rswp platforms. these questions made up subscale five. all student respondents indicated they know of at least one rswp platform and some students indicated they knew more. when presented with a list of options and asked to include any other remote platforms they were familiar with, students identified the advances in social work, summer 2022, 22(2) 262 following platforms: zoom, gotomeeting, doxy me, evisit, vsee, simple practice, microsoft teams, cisco webex, skype, and conference calling. they indicated that their practicum made them aware of all these platforms, except vsee. they also indicated that the msw program made them aware of five platforms, namely zoom, doxy me, simple practice, microsoft teams, and conference calling. when asked if they had used any of these platforms, they indicated they used zoom and conference calling for both courses and practicum. they also used microsoft teams and skype in practicum. finally, the last subscale asked about general confidence and readiness to use rswp in the field. questions in this subscale also asked students to reflect on how the msw program curriculum prepared them to use rswp, as a practice innovation. over half (55%), agreed that they felt ready to use remote practice skills as a result of their past year in the msw program. if asked to use it, all respondents (100%) felt some degree of confidence in their ability to use it if asked. a third were very confident and two-thirds were moderately or slightly confident. eighty-seven percent felt they have adequate skills to do rswp and 75% of them felt like their practicum provided them with these adequate skills compared to about 20% who felt like the program curriculum did. similarly, only a little over 20% agreed that the faculty helped them learn about rswp and only 33% were satisfied with the program's effort to teach them about rswp. despite this, students were hopeful and saw new curricular and staffing changes in the department headed in a direction that could provide more learning opportunities and support. the following student comment exemplifies this: “i think that the department is on the right track now with leadership headed by practice focused faculty...and student first faculty...who are actively seeking out new ways to ensure that students have resources to prepare for challenges of remote practice.” students clearly see the value of rswp. when asked the basic question about whether they felt that learning about rswp was important, 87% of students indicated it was. they mentioned specifically wanting to learn more about rswp ethics, engagement, etiquette, and technical issues. additionally, they also mentioned wanting to learn more about specific and varied rswp platforms. discussion study results show that students are exposed to the idea of rswp in the msw program through both formal and informal mechanisms. the curriculum would presumably be the primary way that students would learn practice concepts and methods. classroom activities, assignments, and lectures, particularly in practice courses, on the surface seem like the most obvious way that rswp knowledge would be imparted, skills refined, and support given. while the data reveals that students were exposed to rswp across the curriculum, their exposure was beyond just the practice courses. students received some information on rswp in other non-practice courses such as research, social welfare policy, and human behavior. interestingly enough, in this social work program during this particular academic year, students received no formal information, had no assignments, student engaged learning activities, or assessments regarding rswp in the generalist practice with individuals and families course, one of the more prominent practice courses in the cswe graduate curriculum. it is highly probable that this could be due to an increased focus on theoretical framing that can happen within some practice courses. in odera et al./de-centering whiteness 263 fact, assignments, student engaged learning activities, and skill assessments were most common in other prominent practice courses, such as the basic skills, generalist practice with groups, and generalist practice with organizations/communities. the other courses that had required assignments, student engaged learning activities, and skill assessments were research methods, human behavior, and practicum seminars. practicum was the dominant course that provided the most exposure, activities, support, and supervision in respect to rswp. given the practice orientation and hands on service-learning structure of practicum, its ability to introduce students to practice techniques and innovations is expected. thus, the prominence of practicum was not surprising. study data revealing rswp content in research methods and social welfare policy courses was more surprising. perhaps this is related to specific case-based assignments that incorporated a remote practice framework or that merely mentioned a rswp platform or activity. for instance, if an assignment in these courses talked about someone using skype or zoom then it is possible the students would have considered this as rswp exposure. the research team did not ask for course content details. having such information could have elucidated specifics about the courses that students felt incorporated rwsp. such details could have been illuminating. another course that stood out was the diversity course. students did not recall having anything related to rswp embedded in the diversity course. they did not report exposure, assignments, engaged active learning activities, or assessments. the diversity course is required in the social work foundation curriculum because it aims to help students become more aware of the ethno-cultural, socio-political, economic, and cultural contexts that shape human life (kohli et al., 2010). as these authors so eloquently put it, the diversity course is meant to sensitize students to diversity issues that shape services access and provision. remote practice strategies, such as tele-mental health (myers & turvey, 2013) have often been used with individuals who have linguistic, age, economic, geographic, or other unique cultural attributes and sometimes because of these attributes and how it informs access to care, remote practice is necessary to provide services. thus, rswp would align directly to content presented in a social work diversity course. use of rswp would have implications for engaging communities in rural/remote areas, individuals lacking access to care or lacking transportation, and potentially older adults or individuals who are home-bound and unable to be reached via traditional outreach efforts, because of geographic isolation, system of care restrictions, or social work agency limitations. no mention of rswp in the diversity course limits students' appreciation for how rswp aligns to diversity, equity and inclusion professional principles. the study revealed that student interactions and discussion with faculty mentors, classmates, other practicing social workers, the field education program staff, and field supervisor was instrumental in helping them learn about rswp. they found both support and supervision from these individuals. this highlights the recognition of rswp in the field. the fact that so many provide information and are supporting students in advancing their knowledge in this area, gives credence to the relevance and popularity of this growing area of social work practice. the most highly rated source of support and supervision was the practicum (including the practicum field supervisor). though students reported low satisfaction with how the curriculum (e.g., courses) has prepared them for rswp, they advances in social work, summer 2022, 22(2) 264 consistently reported practicum as being instrumental in exposure, support, and supervision. this is a nod to how important field practicum is in shaping knowledge and skill development around rswp. students felt confident and ready to use rswp in the field, despite their low satisfaction with how the program prepared them. similar sentiments that social work programs provide limited or poor preparation have been put forth in the literature (perron et al., 2010; mishna et al., 2021). students in the study were not in complete dismay, they were encouraged with new program directions that they felt would contribute to program improvements around rswp in the curriculum. overwhelmingly students thought that learning about rswp was important, and they had a desire to learn more. many of the areas students wanted to know more about (e.g., ethics, variety of rswp tools and techniques, etiquette, engagement) were all areas identified by other scholars as important in rswp adoption (bullock & colvin, 2015; cwikel & friedmann, 2020; perron et al., 2010). limitations the study was conducted with a small cohort of msw students at a moderate size state university with a social work graduate program consisting of less than thirty foundationlevel graduate students in any given academic year. even with a cohort size of 21 students eligible for this study, most were all white females (over 60%), only a fraction (n=13) consented to do the survey and even then, not all responded to all 61 survey items. given these unique sample demographics, the small sample size and low response rate, it is not possible to generalize the findings of this study to larger audiences. this study can, however, be seen as a pilot study that lends its findings to future research with larger samples. moreover, continued evaluation across multiple cohorts and multiple years in this social work program could enhance study merit and generalizability. replication of the study in other social work programs would be beneficial to determine the depth of how remote practice principles and skills are being taught in different size programs, different regions or environments (i.e., countries, rural environments, urban environments, etc.). rswp has been utilized to provide services in the past, but the present pandemic climate denotes its continued relevance now and in times to come as the field of rswp grows and adapts to the environment and its service needs. the study design has a few limitations that should be noted. first, due to the nature of how the pandemic and subsequent events transpired, there was no opportunity to develop a preand post-survey design to measure student’s preparedness and confidence in rswp. there was no way to do a pre-test given when the line of research started. the study sampled students enrolled in the foundation curriculum. they were not given a pretest upon enrollment because the researchers had not started or received irb approval to start the line of inquiry. moreover, data collection for the study began after the unexpected conditions created by the pandemic. the nature of these conditions meant that use of remote practice was the norm both in the classroom and in practice settings. thus, all students had some level of exposure due to the unprecedented nature of the life transitions odera et al./de-centering whiteness 265 presented by the pandemic. pre/post analysis with future cohorts should be considered if appropriate conditions present themselves. similarly, we were unable to create a control group. because of these factors, it is hard to determine if a true relationship exists between the curriculum provided in the msw program and the student research participant’s perception or responses in the study. a future longitudinal study might be able to explicate these potential variable relationships the study had no control for faculty. although academic freedom in teaching in higher education is revered and social work programs seek to have a faculty of varying backgrounds to provide different insights to students’ educations, this impacted the current study as the courses that were evaluated could not control for the way each faculty member considered, prioritized, referenced, or conceptualized remote practice while teaching one of the nine required courses. equally, it is not clear if the teaching faculty even know about remote practice aside from recent knowledge due to the covid-19 pandemic adjustments that had to be made mid school year. finally, the study and student recollection were most definitely affected due to the pandemic. the intensity of this global event and the gravity with which it impacted lives could have shaped recollection of pre-covid-19 times as the physical and mental health impacts are evident, but outside the scope of this research paper. it could have been that students did have more or less exposure, but because all were under the intense stress of living in the pandemic, and all were actively engaged in remote practice (at least in their practicum) because of the pandemic. both of these dynamics could have inadvertently influenced their recall. implications for social work practice remote practice has grown exponentially in the united states, and the shift toward remote care to align with social distancing guidelines is fueling this growth. however, several researchers have reported that training for remote practice is rarely addressed in social work programs (cwikel & friedmann, 2020; fitch, 2015; perron et al., 2010; robbins et al., 2016). the covid-19 pandemic has created an opportunity to incorporate remote social work practice training into curriculums in a timely and practical manner. when research participants were asked if they felt their exposure to remote practice increased as a result of the pandemic, a little over half (55%) agreed. given the rise of rswp, it is important to prepare future social workers to engage in this practice, through understanding best practices, ethical concerns, and policies. this study highlighted that exposure to the tenets of rswp should occur across the full core curriculum and should not be limited solely to practice courses. practicum clearly stood out as being invaluable for rswp, but due to the vastness of practicum opportunities, supervisor background and rswp comfort, and variability of practice settings, it is not possible that students will get all they need regarding rswp just through practicum. it clearly won’t be enough. thus, making sure that rswp is embedded robustly across the core curriculum is important. while contextual practice issues like etiquette can be applied in practicum through trainings and practice exposure, there is a need for in-depth coverage advances in social work, summer 2022, 22(2) 266 of theories, practice frameworks, policies, and issues related to diversity and ethics. having rswp in the core curriculum can ensure adequate coverage. results from this study indicate that embedding rswp broadly across the core curriculum is important as students felt more prepared to engage in rswp, if they had increased exposure in a variety of courses. thus, curriculum mapping may be beneficial to help embed the inclusion of rswp principles throughout the entire curriculum. this study not only has implications for curriculum and student exposure, but also for how we support and train field supervisors, who seem to provide quite a bit of support, knowledge, and training in this area. the rapid proliferation of technologies can be confounding, even for those working in the field. rswp can be expansive and include video conferencing, social platforms, virtual worlds, digital games, and immersive environments. it becomes important for students, supervisors, and faculty to understand— what are they? how are they distinct from one another? how do they or might they support remote practice? similarly, training for faculty would be useful, as we recognize the need to prioritize rswp as a burgeoning area of practice that students would need to be prepared for as they enter the field. the research team found it interesting that students reported that they were not exposed to rswp in diversity and theory courses but had some exposure in research and policy courses. this suggests that there is a great need to push for the prioritization of this content in all core classes. even though the majority of the sample reported a background (work or previous degrees) in human services and psychology, these background experiences were not rated highly as contributing to their exposure to rswp. this data suggests that entering the social work field is the place where students are exposed to the principles and tenets of rswp. thus, heightening the importance that rswp is addressed across social work curriculums. future studies needed to be conducted across multiple social work programs to allow for broader curriculum coverage and greater sample sizes. in conclusion, due to the rapid proliferation of technology, remote practice is growing across social work settings. yet, training is not formalized or fully embedded in social work curriculums. social work practitioners clearly see the benefits of engaging in rswp to expand their reach and serve broader audiences. they also see the potential of how rswp can expand and enhance practice accessibility. 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(2021). the impact of covid-19-prompted virtual/remote work environments on employees’ career development: social learning theory, belongingness, and self-empowerment. advances in developing human resources, 23(3), 237-252. https://doi.org/10.1177/15234223211017850 author note: address correspondence to ariel hooker jones, department of social work, southern illinois university edwardsville, edwardsville, il 62026. email: ajoneas@siue.edu https://doi.org/10.1002/j.1556-6678.2009.tb00556.x https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://doi.org/10.18060/241 https://doi.org/10.1080/10437797.2016.1218222 https://doi.org/10.1007/978-3-642-79868-9_2 https://doi.org/10.1086/603746 https://doi.org/10.1037/gdn0000140 https://doi.org/10.1080/02615479.2020.1807926 https://doi.org/10.1300/j067v24n03_03 https://doi.org/10.1177/15234223211017850 mailto:ajoneas@siue.edu _________ gerald myers, dsw, lcsw, adjunct instructor, department of social work, simmons university, boston, ma. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 286-303, doi: 10.18060/27472 this work is licensed under a creative commons attribution 4.0 international license. african american men and mental health: client and clinician therapeutic dyad gerald myers abstract: african american men face challenges that include internalized negative social identities, marginalization, oppression, systemic racism, invisibility syndrome, targets of violence, murder, and erasure. social workers may place the population at further risk of harm by using methods influenced solely by eurocentric values. there is a paucity of peerreviewed journal articles in the social work literature regarding the mental health of african american men. the literature fails to support social workers in acquiring the clinical skills required to provide services to african american men. this article will provide guidance to improve assessment, diagnosis, and clinician engagement with adult african american male clients. barriers to the care of this population include the stigma of receiving mental health services, avoidance of vulnerability, medical distrust, clinician bias, no knowledge culturally expressed symptomology of mental illness, and an absence of culturally responsive care. theories that inform the work with african american men in this article are the social determinants of health theory, intersectional theory, and narrative theory. keywords: afrocentric social work, african american men, black mental health the clinician collaborating with adult african american males must have knowledge of that person’s psychosocial development and the ability to discern behaviors designed to protect them from constant assaults from society (aymer, 2010). societal assaults such as workplace discrimination, health disparities, and exposure to daily microaggressions cause psychological distress in the lives of african american men resulting in damage to their physical and mental health (franklin & boyd-franklin, 2000; hankerson et al., 2022; lincoln et al., 2010). for the purposes of this article, “african american” and “black” shall be used synonymously, as both terms are acceptable for designating “people of african origin” (american psychological association, 2021, p. 143.) these terms include persons of african heritage born in the united states and those that selfidentify as such. persons of african heritage who identify with a national or ethnic origin such as caribbean, haitian, jamaican, ethiopian, or elsewhere would be excluded from the terms african american or black, when identified and quantifiable in the reviewed literature. it is understood that these people may also self-identify as black or african american. attempts at initiating the therapeutic dyad require intentional actions by the clinician with an awareness of factors that impact their interpretation of the client’s presentation (reigeluth & johnson, 2022). clinicians should also know of the social work profession’s eurocentric influence (schiele, 1997). social work methods, derived from european ethnocentrism, pathologize elements of the african american experience and invalidate possible solutions because african american cultural values have not been considered. for example, eurocentric definitions of family and family composition may differ from an afrocentric prospective. because eurocentrism is seen as the “standard,” anything not about:blank myers/african american men & mental health 287 matching is viewed as abnormal (schiele, 2000). this may inadvertently place african american clients at risk of greater harm from the application of flawed interventions derived from flawed case conceptualizations (skott-myhre & skott-myhre, 2022). the addition of afrocentric values to social work practice would improve clinician engagement with their adult african american clients and benefit treatment (aymer, 2010). african american men continue to suffer a long-standing mental health crisis because of the impacts of systematic oppression, structural racism, microaggregations, violence in communities, and murders by police (deangelis, 2021). these are in addition to factors that impact the mental health of the general public, such as the state of the economy (knapp & wong, 2020). social work peer-viewed journals do little to address the needs of african american men (watkins, 2014). data search the absence of african american men and their mental health from social work literature supports the maintenance of stereotypical ideas that negatively affect their proper diagnosis and treatment (robinson-dooley & skott-myhre, 2021; payne, 2012). four peer reviewed social work journals were the same as those used in a study of whether social work was racist (corley & young, 2018). that study’s journal inclusion criteria included (a) the journal being used in a previous content analysis; (b) major social work journal; (c) the journal does not represent a social work specialty; (d) journal with national focus; and (e) the journal provides material for the analysis coverage period. a “major” peered reviewed social work journal would be one that is highly rated by criteria that included citation counts and impact factors (openai, 2023: scimago, n.d.). the journals selected are social work, research on social work practice, journal of human behavior in the social environment, and social service review. university access was used to search the websites of journal publishers. each journal was searched using the term “african american men” for 11 years spanning 2012-2022. the journals were searched for articles providing interventions for working with african american men. the definition of “intervention” used here is “in social work, the term is analogous to the physician’s ‘term treatment’” (barker, 2013, p. 225). shown in table 1 are the number of articles found in each journal for the 11-year period. table 1. number of articles that included social work interventions for work with african american men per journal, 2012-2022 journal articles [n (%)] w/interventions with aa ♂ total social work 1 (0.14%) 703 (99.9%) research on social work practice 1 (0.15%) 646 (99.8%) journal of human behavior in the social environment 0 (0%) 833 (100%) social service review 0 (0%) 472 (100%) total 2 (0.04%) 2654 (99.9%) advances in social work, summer 2024, 24(2) 288 searches for “african american men” also produced results the included the term “black men.” these terms are not synonymous as the experience of african american men is unique, as are the experiences of black subgroups who emigrated from countries on the african continent, and black people from haiti, jamaica, and the british and u.s. virgin islands, etc. (watkins et al., 2014). the literature includes valuable information on black subgroups that show they may have poorer health and mental health outcomes than african american men (watkins et al., 2014). studies that include black subgroups with black men who are african americans may be diluting the experience of both black subgroups and african american men (deangelis, 2021). all african american men could be considered black men; however, all not black men are african american (american psychological association, 2020, chapter 5). even so, the terms must be used synonymously because the literature does (watkins et al., 2014). academic writers and journalist are currently using “black” as a deference to blacks reclaiming the right to name themselves and as show of solidarity with black people all over the world (mitchell, 2023; singh, 2024), all being members of the global majority (lee, et al., 2023) these findings make it clear that information to improve the mental health of african american men exists, but it is scattered, and difficult to find. what is less clear is why practice information related to the treatment of african american men does not appear in social work peer-reviewed journals with more frequency given the challenges faced by this population (green & secret, 1996; watkins et al., 2014). social work theory and african americans schiele (1996) provides a seminal criticism of the social work profession and its overwhelmingly eurocentric influence that makes treatment assumptions while excluding other world views. the social work profession also does not adequately incorporate the voices of african american social workers (parker, 2022). schiele (1997) conceptualizes two core problems of the social work profession. the first problem is related to the profession’s acceptance of the eurocentric worldview, which highlights a materialistic, individualistic, linear, rationalist mindset. this world view relies on materialism as reality, separating humanity from its spirituality. to balance this, schiele (1997) proposes that afrocentric social work theory be added to the social work cannon. schiele presents the afrocentric view as a more appropriate paradigm for social work practice with african americans and influencing ways to conduct social work research. the second problem of the profession, according to schiele (1997) is the under usage of the values of people of color while offering an ineffective and unfulfilling multicultural practice. multiculturalism encourages the social worker to understand how racism has negatively impacted african american opportunities, be sensitive to the different values of various ethnic groups and examine themselves for bias. eurocentric influenced social work focuses on ways in which people, groups and individuals are different and separate. afrocentrism concerns itself with people as members of communities, bringing attention to human connectedness. afrocentric social work is not just for african americans, it is a paradigm to be joined with others for the benefit of humanity (tascón & ife, 2019). myers/african american men & mental health 289 according to schiele (1997) afrocentrism makes three primary assumptions, the first being that an individual’s identity is part of an identity that is collective (gatwiri, 2020). the second assumption is that human spirituality is as valid as the material body. the third assumption is the epistemological validity of affective approaches. afrocentrism identifies the sources of societal problems as oppression and spiritual alienation. these sources manifest themselves in the world as materialism, objectification, individualism, and extreme competition. afrocentric social work calls us to fight against cultural, economic, and political oppression. changes to current social work practice are required to accommodate afrocentric social work. social workers should not shield their emotions when collaborating with someone, attempts at objectivity and aloofness are discouraged. afrocentric social work requires an emotional connection between the client and clinician (schiele, 1997; tascón & ife, 2019). afrocentric social work seeks mutuality between the helper and the help in ways that benefit both. schiele names eurocentric values such as materialism, objectification, and individualism, have found their way to social work theory and practice, greatly reducing their effectiveness when working with african americans (schiele, 1996; as cited in schiele, 1997). the cambridge academic content dictionary (n.d.) defines materialism as believing that the most important things in life are possessions and money; objectification as treating people as something to be used, like a tool, without respect to their personhood; and individualism as the concept that individual actions are more important than collective responsibility and effort. these eurocentric values create “invisibility syndrome” (franklin, 1999, p. 763) by creating double bind situations in which african american men are presented with societal definitions of success and at the same time, being denied the societal supports required to achieve this success. the african american man’s personhood is denied, resulting in his objectification and denial of material resources and rewards. some african american men struggle to incorporate these values into their identities with little success because of feelings that they are not valued and recognized in society because of racism and prejudice resulting in their “invisibility” (franklin, 1999, p. 761). more importantly african american men are seeking to embody the very values that have created the oppressive society in which they live (maiese, 2021). indivisibility syndrome as a framework details the social experience of african american men: • he feels that he is not acknowledged or recognized. • he feels no satisfaction or gratification from societal encounters. • he feels self-doubt about his legitimacy. • he is not validated by his experience causing him to question his worth. • he feels disrespected. • his sense of dignity is compromised and challenged. • his “basic identity is shaken, if not uprooted.” (franklin, 1999, p.764). key to the invisibility model is the understanding of african american men’s psychological process as they attempt to form identities in a society that continually marginalizes them (franklin, 1999 watkins, 2011). the african american community is seen as an important potential protective factor for african american men; however, the advances in social work, summer 2024, 24(2) 290 african american community is more often seen as a source of violence, homicide, and incarceration (watkins, 2011). powell (2008) shows us that african american men are victims of societal violence and, in return, often express that violence as perpetrators in their communities and relationships. african american men and mental healthcare the mental healthcare of african american men is rife with assessment errors that lead to misdiagnosis (payne, 2012). the disproportionate representation of african american men with a diagnosis of schizophrenia when compared with european americans is an example of this (merrit et al., 2023). african american men are presenting later in their episode of mental illness and are more likely to be diagnosed with a psychotic disorder than a mood disorder, experiencing symptoms of greater intensity and duration. african american men appearing earlier in their episode of care may have not been diagnosed with a mood disorder because culturally expressed somatic symptoms of depression where not recognized. blacks are diagnosed with schizophrenia at rates twice that of whites (merrit et al., 2023). the invisibility of african american men in evaluations, treatment, absence of research (franklin, 1999), willful ignorance and disregard for the circumstances in their lives show up in studies of violence in african american communities. this phenomenon has not been studied extensively and requires inquiry into the interactions of structural inequity, marginalization, masculinity, popular culture, poverty, and power (collinsanderson et al., 2022). in 2018, african american men killed 88% of homicide victims identified as african american women during episodes of intimate partner violence (federal bureau of investigation, 2018). african american men did not create intimate partner violence but learned this behavior from their european american enslavers (al'uqdah et al., 2016). “the cycle of violence” (powell, 2008, p. 321) posits that those being exposed to violence are more apt to use violence to express frustrations over powerlessness. these are feelings that are expressed in areas of concentrated poverty, creating a cycle the will continue until concrete actions are taken to change. african american men are exposed to the many social forces working against them (franklin, 1999; robinson-dooley & skott-myhre, 2021) and many african american men do not become abusers and murderers. society must take a role in empowering african american men that have expressed themselves using violence with acceptable ways to express themselves and accepting responsibility for their actions. communities must also act outside societal intervention. the oppressor has little interest in providing for the oppressed (powell, 2008; robinson-dooley & skott-myhre, 2021). treatment errors and culturally sensitive treatment african american men have barriers to mental healthcare that include medical mistrust, access to services, black masculinity constructs, experience of racism and bias in the healthcare system, and the absence of culturally responsive treatment (deangelis, 2021). the number of african american men seeking mental health treatment is unknown. myers/african american men & mental health 291 one report tells us that only 26 % of black and hispanic men experiencing depressive symptoms sought treatment (deangelis, 2021). black masculinity constructs include stigma against receiving mental health treatment, a bias shared within the african american community (earl et al., 2011). information specific to african american men is not available. the african american man’s avoidance of therapy can also be explained as him protecting himself from situations that mimic societal processes that cause him psychological distress. engagement with clinicians to receive care can be one of those situations (skott-myhre & skott-myhre, 2022). clinicians who do not manage the intake with intentionality risk the client not returning for services (reigeluth & johnson, 2022). african american men can view therapy as an admission of insanity as the result of the psychopathological orientation of clinical work. this orientation cannot meet the emotional needs of african american men (aymer, 2010). culturally sensitive assessment and treatment of african american men is needed (kayode, 2023). clinical work with african american men must contextualize the racial and cultural experiences of african american men. the intersectional identities of the african american men reflect a conflict between the patriarchal control of the environment versus their experience with invisibility syndrome that denies them control of their environments (franklin, 1999). coping mechanisms employed include “cool pose” (aymer, 2010, p. 23). african american men use this coping mechanism to lessen the effects of living in an oppressive environment. cool pose is a way of behaving that can be seen in their interpersonal dynamics, speech, manner of dress and walk, creating an identity that can survive in hostile environments. cool pose is also a strategy to suppress emotions that could be considered “weak” and a means for african american men to generate positive feelings about themselves and to project strength and calmness. african american men may use cool pose to project a mask of “friendliness” to avoid being characterized as a stereotypical “angry black man” (jackson, 2018, p. 5). this coping style can be misinterpreted. this coping style may also grow to become an expression of toxic masculinity (deangelis, 2021; jackson, 2018). in the absence of practice knowledge, clinicians form views of african american men from the media, which mostly portray them as dangerous (robinson-dooley & skott-myhre, 2021). african american men can also internalize these negative messages from society, causing him to question his own worth. it is these perceptions that result in african american men being misdiagnosed because of clinician bias or ignorance. clinical work should focus on how the client makes sense of their presenting concerns, which will engender trust (hankerson et al., 2022). african american men may have challenges emotionally expressing themselves because of the belief that this behavior is correlate with shame and weakness (campbell & allen, 2019). it is essential that clinicians employ empathy when confronted with tenderness and defensiveness present in their work with african american men. their subjective realities should not be interrogated. clinicians can use their knowledge of ego defenses and other methods to address the idiosyncratic issues of african american men (aymer, 2010). research suggests that black patients have more positive outcomes when treated by black clinicians (earl et al., 2011). black clients feel that their treatment by black clinicians to be collaborative and being satisfied are more likely to adhere to treatment advances in social work, summer 2024, 24(2) 292 plans and remain in care. black clients collaborating with black clinicians report feeling more accepted and understood. “nationally, 4% of psychologists, 2% of psychiatrists, 22% of social workers, 7% of marriage and family counselors, and 11% of professional counselors are reported to be black” (the association of black psychologists [abpsi], 2022, p. 8). these figures suggest that non-black clinicians will treat most black clients. to provide efficacious treatment for black clients, non-black clinicians must learn what factors predict patient satisfaction and replicate those factors when treating black clients (earl et al., 2011). black clients must feel comfortable, safe, trustful, listened to, and understood, and respected by their non-black providers to fully engage in treatment. it is suggested that non-black providers ask black clients specifically about possible negative clinical encounters in the past (bartholomew et al., 2021). the non-black social worker need not be an expert on racial matters. non-black clinicians should proactively mention the topic of racism which signals to the client the clinician's willingness to explore the area of the client’s experience. the clinician should have processed their own racialized feelings before inviting discourse on this topic (skott-myhre & skott-myhre, 2022). if not, the client will sense this and conclude the social worker does not have the skill to meet their needs (bartholomew et al., 2021). many human service interactions focus on the clients' individual actions. “it is not just that the client has a headache, but more a look at the variable conditions that may be causing the headache.” (braxton-newby & jones, 2013, p. 261). authentic engagement with african american men requires more than an understanding of environmental factors, but also an understanding of their historical treatment by society and the social work profession (corley & young, 2018; robinson-dooley & skott-myhre, 2021). clinicians are encouraged to use an afrocentric lens (schiele, 1997) as part of their case conceptualization, which could give them insights into the client's value systems. african american men should also be given space to tell their story, as they have been silenced by society at large, with others controlling the narrative about them (campbell & allen, 2019; mctighe, 2018). frameworks for social work practice social work clinicians consulting social work literature to acquire a better understanding of african american men and their experience in society, would have difficulty locating the information needed to improve their practice. clinicians are encouraged to consider the following theoretical frameworks when conceptualizing their work with african american men: social determinants of health theory, intersectional theory, and narrative practice. each of these frameworks is uniquely suited to guide the clinician's conceptualizations of their work with africa american men. social determinants of health the social determinants of health play significant roles in the mental health of african american men (anglin et al., 2021; ehntholt et al., 2022; payne, 2014; watkins, 2011). the social determinants of health are societal factors that require societal interventions that erase disparities implicated in creating mental illness in the population impacted by these myers/african american men & mental health 293 factors (anglin et al., 2021). our society has failed to adequately address environmental stressors that include community violence, underfunding of schools in oppressed communities, and limited community healthcare options (anglin et al., 2021). having no access to culturally appropriate mental health treatment options is one of the factors feeding the myth that african americans avoid treatment (deangelis, 2021). the u.s. department of human services have listed the social determinants as domains of economic security, education access and quality, neighborhood and built environment, and social and community context (u.s. department of health and human services, office of diseases prevention and health promotions, n.d.). the state of neighborhoods, access to quality education, access to quality medical and mental healthcare, poverty, and racism are systemic factors that negatively impact african american men and their mental health and do not appear to be addressed by the social work profession (watkins et al., 2014). one study showed how the social of determinants of health impacted african americans before they are even born (anglin et al., 2021). african american women exposed to damaging environmental factors can suffer negative impacts to their health and the health of their babies. these children could experience neurological changes associated with mental illness and developmental disabilities (anglin et al., 2021). children exposed to lead contamination in their homes from paint and water pipes suffer disproportionate occurrences of harm to their brains resulting in problems with behavior, hearing, learning and speech (court, 2021). african american communities with disproportionate lead exposure also experience higher incidences of homicide, rape, and other violent crimes (boutwell et al., 2017). connecting the social determinants of health to the mental health of african american men in the social work literature would better inform clinicians regarding the systems that impact their african american male clients. racism has been implicated in poor health and mental health outcomes for african american men (sellers et al., 2013). racism and other social determinants have been shown not only to cause mental illness but also impact symptom expression in african american men resulting in underdiagnosis and misdiagnosis (payne, 2014). clinicians unfamiliar in the cultural expression of symptoms may be unable to accurately assess the mental health of african american men. intersectionality the intersectional framework was popularized by crenshaw in her use of the concept to demonstrate how an african american woman suffered cumulative oppression by the intersection of her gender and ethnicity (simon et al., 2021). african american men have unique experiences related to their social identities. intersectional factors including race, ethnicity, gender identity, gender expression, sexuality, socioeconomic status, levels of education, age, and stage of development combine to form a greater stress, more than each factor individually that negatively impact african american men and their mental health (collins, 2019; collins-anderson et al., 2022; franklin, 1999). understanding the impact of intersectional identities on the behavior of african american men provides clinicians with additional tools to better provide accurate assessments and to inform engagement and treatment. african american men are negatively impacted by “structural, disciplinary, cultural, and interpersonal” domains of power that act on their intersectional social advances in social work, summer 2024, 24(2) 294 identities (franklin, 1999; hill collins & bilge, 2018, p. 62). notice how these factors align with the social determinants of health. clinicians should know that african american men have the highest death rate, adjusted for age, of any other group (sellers et al., 2013), and understand how systemic privileged and oppressive factors interact with their social identities to bring this condition into existence (collins-anderson et al., 2022) to appropriately evaluate a client’s circumstance using intersectionality, the worker should consider their own social identities. those aspects of our social identities that exhibit privilege can blind workers not only to how privilege functions in their experience but also can blind them to the client’s experience of oppression in that area (simon et al., 2021). consider how a worker might react to an unemployed, young, african american male interacting with the child welfare system. how would this father be treated as he applies for public assistance to care for his family? in some places he would be instructed to have the children’s mother apply for benefits. how would this impact him? the mother could receive benefits. he may receive a court order for child support to repay funds paid out to the family. he could be judged harshly by the child welfare system based on bias toward the combination of his social identities including socioeconomic status, age, gender, and ethnicity (cameron et al., 2012). the intersectional framework demonstrates how systems of power both privilege and oppress marginalized members of our society which includes african american men (hill collins & bilge, 2018). services provided without considering the intersectional identity of the client run the risk of replicating the oppressive process experienced by the client being ostensibly being addressed by the service being provided. narrative practice clinicians collaborating with african american men about their mental health should be aware of practices that address this population's specific needs. narrative therapy benefits the clinicians' understanding of their client as the client shares their narrative about their mental health (payne, 2021b). narrative therapy addresses the complaint of some african american men that clinicians do not listen to them or understand them (watkins et al., 2014). this method begins with the clinician respectfully listening to them as they share their understanding of their narrative and its impact on their life. the clinician then collaborates with the client to identify problem sources in their narrative and together, reframe the narrative of concern to a narrative that benefits the client (mctighe, 2018; payne, 2021b). narrative practice can assist african american men in forming a healthy racial identity (casares & gladding, 2019) reversing the damaging effects of racism (franklin, 1999). the use of narrative practice provides clinicians with the means to learn about the client from the client's perspective. narrative therapy externalizes negative aspects of the client’s experience, separating the person from the problem (mctighe, 2018). clients feel heard and can partner with the clinician to reframe past events and imagine a new, better functioning narrative for themselves about themselves (mctighe, 2018). myers/african american men & mental health 295 african american men and their clinicians can include afrocentric theory in their practice (aymer, 2010) as they formulate a useful narrative. an example of this could be the inclusion of the nguzo saba, the seven principles of kwanzaa, which are: • umoja (unity) • kujichagulia (self-determination) • ujima (collective work and responsibility) • ujamaa (cooperative economics) • nia (purpose) • kuumba (creativity) • imani (faith) afrocentric philosophical concepts of ubuntu, “...we are made human through the humanity of others” and sankofa, “it is not wrong to go back for that which you have forgotten.” (gatwiri, 2020, p. 66) should be added to the social work literature informing culturally sensitive practice approaches to when collaborating with african american men. when clinicians do not collaborate with african american men when they come to treatment, they are unlikely to stay. this cycle reinforces the myth that african american men do not participate with mental health treatment in the minds of clinicians and the correct belief of some african american men that they are not being offered appropriate treatment (reigeluth & johnson, 2022). voices counter narratives provide insights into the experiences of those we serve produced by those we serve. this increased insight informs culturally appropriate care, mitigating the possibility of misdiagnosis and the application of ineffective and potentially harmful interventions administered by clinicians influenced by damaging dominate narratives about those they ostensively seek to care for (campbell & allen, 2019). a study highlighted the experiences of four black men who shared their stories creating a powerful counternarrative (campbell & allen, 2019). each of the men relayed unique experiences that contained important commonalities. all the men had experienced some type of loss. these included negative changes in their finances and the loss of someone they cared for. these events preceded some depressive presentations because of the men not having the resources to deal with the challenges they faced (campbell & allen, 2019). all the men experienced unrecognized and untreated depression all their lives. they spoke of anger as a preferred emotion, rather than crying, and so masked their emotions (braxton-newby & jones, 2013; campbell & allen, 2019; walton & shepard payne, 2016). self -medication was a common coping strategy (campbell & allen, 2019; walton & payne, 2016). the men spoke of maintaining a strong appearance, but also expressed that this perception may lead others to believe that they did not need help. the researchers found that although the men were being asked about incidents of depression in the recent past, the men had been living with depression their entire lives (campbell & allen, 2019). a clinician observed the poor care being provided to african american men in their workplace which relied heavily on the medical model of treating mental illness. these advances in social work, summer 2024, 24(2) 296 clients were further harmed by the unethical behavior of their clinicians. the focus of the biomedical model is to define pathology in the individual and providing treatment in the form of pharmaceutical interventions the mental health industrial complex often financially profits from. any failure to thrive from medication is somehow victim blamed onto the client who has been convinced that they have an illness that is difficult to treat, without managing the environmental factors that produce mental illness (anglin et al., 2021; greene, 2019). included in this environment is the existence of poor mental health treatment provided by institutions rife with racism, classism, and client abuse (greene, 2019). mental illness is explained as a dysfunction of physiology and not in the context in which the individuals find themselves. problems that are sociopolitical in nature are converted into problems that are psychological and individualized (greene, 2019). societal mistreatment of african american men can lead to problems in racial identity formation, complicated by internalized stigma (campbell & allen, 2019; franklin; walton & payne, 2016). the constant negative messaging received by african american men and other oppressed populations can lead to mental illness (campbell & allen, 2019). african american men can take control of the internalized negative societal narrative, and with guidance, replace it with a narrative that reflects resiliency, strength, and supports the creation of a healthy racial identity (campbell & allen, 2019; payne, 2021a). positive narratives about african american men exist (hagler, 2015). african american men make up the largest percentage of people of color in the united states military. african american men are disproportionally incarcerated, however african american men in college double that amount (hagler, 2015). african american men living with their children are more likely to include childcare duties among their responsibilities. these are the unheard narratives and hearing them would help african american men and clinicians form a positive counter narrative. discussion the social work history of eurocentric values and racism (corley & young, 2018; schiele, 1997) is a cause for the inefficacy of social work interventions when collaborating with african american men. the inclusion of an afrocentric perspective into the social work cannon and education would improve the profession’s actions toward african americans (corley & young, 2018; schiele, 1997) and other marginalized populations. african american men receiving psychiatric services had the highest incidences of unemployment, homelessness, recent criminal activity, and having less than a 12th grade education (ehntholt et al., 2022). african american men have the shortest lifespans and are at risk for more medical concerns than any other group in the united states (robinsondooley & wade-berg, 2014). those african american men with lower socioeconomic status, education, and unemployment showed higher incidences of depressed symptoms than other african americans (lincoln et al., 2010). however, even affluent african american men still report experiencing higher incidences of problematic mental health symptoms than their european american peers (assari et al., 2018). african americans are not seeking mental health clinical services because of a stigma that equates help seeking with weakness, lack of trust in providers, not having their needs met in clinical setting, and the perception that their pain is normal (gaston et al., 2016). there is also the perception myers/african american men & mental health 297 among some african americans that “black people don’t get depression.” (campbell, 2017, p. 670). the social work profession continues to be interrogated as to the fit of its methods with african americans (schiele, 1997), and it has not addressed caring for this population in ways that reflect their needs. african american men are poorly represented in studies, and they have been blamed for not engaging in mental health services (watkins et al., 2014). the attention of the social work profession to the plight of african american men and their mental health is lacking (corley & young, 2018; watkins et al., 2014), as shown in the paucity of this topic in social work peer-reviewed journals. the literature agrees that african american men’s mental health is at risk from several factors that include microaggressions, violence in communities, systemic oppression, racism, internalized racism, murder by police, misdiagnosis, damage to racial identity formation and lack of clinician awareness (aymer, 2010; payne, 2012; powell, 2008; watkins, 2014). none of these factors are fully addressed in the social work literature (campbell & allen, 2019; watkins, 2014). gaps in the literature include complete demographic information for african american men and or black subgroups that are included in studies or are the subjects of articles. there were few studies that provide age ranges or the social-economic status of participants. there are also gaps in the literature concerning the possibility of differing clinical needs of african americans and black subgroups (gaston et al., 2016). the absence of afrocentric evidence-based treatment also represents a gap in the literature (gilbert et al., 2009). gaps in the literature also exist around the voices of non-african american clinicians who are overwhelmingly made up of european americans (council on social work education, 2020). including the experiences of european american clinicians and their learning journey to successfully collaborating with african american clients would provide other non-african american clinicians with a template to follow (bartholomew et al., 2021). non-african americans would also see themselves in the literature, giving voice to their challenges in collaborating with african american clients. the absence of non-african american voices on this topic gives the impression of a white supremacist worldview that assumes the flaws and damages in treating african americans is an african american problem and not a societal one (robinson-dooley & skott-myhre, 2021). skott-myhre and skott-myhre (2022) offer insightful instruction to european american clinicians about racism and the necessity of them decolonizing their practice with adult african american clients. this exclusion of voices is a function of the agenda setting ability of power. literature regarding african american men and mental health can be found in the literature of other professions, even written by social workers, but can be difficult to find given the interdisciplinary nature of the social work profession (watkins, 2014). the literature in general agrees overwhelming on the influence of the social determinates of health on the mental health of african american men (ehntholt et al., 2022; greene, 2019; lincoln et al., 2010; payne, 2014; watkins, 2012; watkins, 2014). the social determinates of health require system change interventions, but there is no evidence the social work profession is advocating on behalf of african american men and their mental health (watkins, 2014). the absence of balanced literature regarding african american men advances in social work, summer 2024, 24(2) 298 creates an overwhelming deficit view of african american men influences the existing social work literature and those that consume it (watkins, 2014). positive narratives of african american men exist, but are rare (hagler, 2015). information about differences in cultural expression of mental illness in african american men is an especially important topic in need of further exploration, reducing their invisibility (franklin, 1999) in social work literature (walton & shepard payne, 2016). implications for social work the social work profession is not addressing the needs of african american men and their mental health in peer-reviewed social work journals as shown by their absence of articles regarding this population (corley & young, 2018; watkins, 2014). the absence of subjects related to social work practice with african american men in the literature maintains negative stereotypes that may be impacting clinician perceptions. as a result, social workers have limited knowledge about behavioral strategies african american men might employ to protect themselves from a hostile environment (aymer, 2010), which could be misinterpreted as pathological behavior. the social work profession can respond to the needs of african american men by increasing the appearance of useful practice information in social work peer-reviewed journals. research is needed to understand culturally-expressed symptoms of mental illness. research is also needed to provide validated practice strategies that include afrocentric values to address the needs of this population. social work students should be introduced to afrocentric values and other ways of knowing through course work. clinicians in the field can be introduced to afrocentric values through continuing education courses. african american men are dissatisfied with their clinical encounters for reasons that include internalized racism, damaged racial and masculine identities, medical mistrust, clinician bias, not feeling heard, misdiagnosis, and the lack of awareness of their unique needs (aymer, 2010; payne, 2012). the literature clearly shows the impacts of systemic racism on this population. advocacy efforts should be led by the social work profession to improve the social conditions that are the true source of the pathology this population endures (watkins et al., 2014). when approached thoughtfully, clients who identify as african american men have a better chance of accepting what culturally sensitive social work interventions have to offer (reigeluth & johnson, 2022). references al'uqdah, s. n., maxwell, c., & hill, n. 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(n.d.). social determinants of health healthy people 2030. author. walton, q. l., & shepard payne, j. (2016). missing the mark: cultural expressions of depressive symptoms among african american women and men. social work in mental health, 14(6), 637-657. watkins, d. c. (2011). depression over the adult life course for african american men. american journal of men's health, 6(3), 194-210. watkins, d. c., hawkins, j., & mitchell, j. a. (2014). the discipline’s escalating whisper: social work and black men’s mental health. research on social work practice, 25(2), 240-250. author note: gerald myers, adjunct instructor, department of social work, simmons university, boston, ma. email: g2mjsw@outlook.com https://health.gov/healthypeople/priority-areas/social-determinants-health https://doi.org/10.1080/15332985.2015.1133470 https://doi.org/10.1080/15332985.2015.1133470 https://doi.org/10.1177/1557988311424072 https://doi.org/10.1177/1049731514526621 https://doi.org/10.1177/1049731514526621 mailto:g2mjsw@outlook.com african american men and mental health: client and clinician therapeutic dyad social work theory and african americans african american men and mental healthcare treatment errors and culturally sensitive treatment frameworks for social work practice voices implications for social work references _________ kayla m. whaley, msw, lcsw, lecturer, shelly paule, msw, lcsw, msw, graduate advisor and lecturer, and annie j. keeney, phd, msw, pps, associate professor, school of social work, san diego state university, san diego, ca. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 547-565, doi: 10.18060/28619 this work is licensed under a creative commons attribution 4.0 international license. licensure: client protection or practitioner gatekeeping? policy and practice recommendations for social work education programs kayla m. whaley shelly paule annie j. keeney abstract: the profession of social work is dedicated to the health and well-being of clients, with an emphasis on social justice and advocacy for vulnerable and oppressed populations. as social work professionals, we must uphold the highest ethical and professional standards outlined in the national association of social work (nasw) code of ethics. these standards must equally be held for the establishment of licensure for social workers. a 2021 analysis of licensed clinical social work (lcsw) pass rates noted significant testtaker pass rate disparities, particularly around race and ethnicity. unfortunately, for black, indigenous people of color (bipoc) lcsw candidates, their pass rates are significantly less than those of their white peers. this paper discusses the impact on community members when we have a professional shortage in behavioral health in both numbers of professionals and diversity in licensed clinical social workers. we highlight several strategies that social work programs can implement to mitigate some of the economic and societal barriers the future social work workforce faces, which could ultimately positively impact social work licensure pass rate outcomes and reduce disparities among licensing candidates. further, this paper calls to action the aswb to support improvements in licensing pass rates through implementing mentorship, financial support, and expanding language options for the exam to help increase equity in pass rates. keywords: licensure examination, test-taker disparities, barriers to equity, disproportionality, graduate students the association of social work boards (aswb) licensure exams have been found to have glaring disparities in pass rates, particularly around black and older test takers (board of behavioral sciences [bbs], 2022). as a result, in 2022, the council on social work education (cswe), the united states’ accrediting body for social work education, eliminated the option for social work programs to use licensing pass rates as a reportable program outcome for accreditation or reaffirmation purposes (cswe, 2022). as a profession that promotes social justice and change, exploring alternative pathways to licensure grounded in anti-oppressive principles and practices is imperative, perhaps now more than ever, given the us's current sociopolitical climate and the increasing scrutiny on diversity, equity, and inclusion efforts. this includes acknowledging the economic and societal barriers contributing to licensure gatekeeping that disproportionately affect historically marginalized communities, such as financial stressors, access to resources, and systemic inequities in education (flagg & campbell, 2021). social work programs can take steps to dismantle licensure gatekeeping and advance a more inclusive and equitable licensure process, one that ensures all candidates, regardless about:blank advances in social work, summer 2025, 25(2) 548 of background, have the opportunity to become licensed practitioners and serve their communities. as such, this paper discusses (1) bias within the aswb licensing exam and the need for structural reforms, and (2) the experiences of bipoc and marginalized students, including how msw programs can offer better support throughout the licensure process. though we recognize these are two distinct issues, we address both in tandem to increase academic discourse on how to improve licensure pass rates for all candidates. this paper focuses exclusively on licensed clinical social workers (lcsw) licensure. however, we recognize that other aswb exams exist for different licensure levels, and many social workers do not pursue clinical licensure but still play vital roles in behavioral health. background licensure in clinical social work social workers often provide services to society’s most vulnerable populations, such as those experiencing housing or food insecurities (national association of social workers [nasw], 2024). as such, holding social work providers accountable to ethical and professional standards is vital for protecting the well-being of the communities they serve. this accountability is especially critical for lcsws responsible for assessing, diagnosing, and intervening in mental health care. historically, this has been systematically done through licensure following other helping professions models, such as nursing or occupational therapy (greiner & knebel, 2003). licensure establishes clear standards of practice (e.g., billing practices), sets expectations for continued professional development, and ensures a minimum threshold for knowledge, skills, and abilities to intervene as effective community providers (nasw, 2024). further, these standards of practice increase the probability that licensed clinical social workers may interact with diverse populations across various geographical locations (nasw, 2024). a key part of social work ethics and expectations around practice focuses on ensuring communities are protected from potential harm (nasw, 2024). moreover, licensure allows for licensure reciprocity, which is beneficial to lcsws and the profession. this allows lcsws to transfer their credentials across state lines. for example, california permits out-of-state social workers to complete the california law and ethics exam to have their license recognized; in new york, lcsws can apply for licensure by endorsement if they have practiced for at least 10 of the last 15 years (bbs, 2024). in addition, reciprocity increases workforce mobility, ensuring that social workers, regardless of location, have comparable qualifications. professional flexibility is therefore enabled, making it easier to address workforce shortages. this can be instrumental in alleviating workforce shortages in some geographic regions. further, licensure reciprocity helps maintain consistent standards of practice across the united states. consistency is crucial for vulnerable populations such as bipoc, lgbtqia+, immigrants, and individuals with disabilities, who historically have been disproportionately harmed by the very systems intended to support them (barrita et al., 2023; bryant & kolivoski, 2021). whaley et al./licensure: protection or gatekeeping? 549 mental health workforce shortages the us behavioral health workforce faces critical shortages. over 122 million people live in mental health professional shortage areas (hpsas), highlighting a national crisis in access to care (national center for health workforce analysis [nchwa], 2024). hpsas are determined based on provider-to-population ratios, geographic accessibility, and demand, with california having the highest disparity in these shortage areas (health resources and services administration [hrsa], 2025). nationally, there are only 290,000 licensed clinical social workers (lcsws), and an additional 6,201 mental health practitioners are needed to meet existing community needs (hrsa, 2025; zippia, 2025). it is estimated that by 2037, the us behavioral health workforce will have a deficit of over 30,000 social workers, highlighting the need for licensure pathways that expand workforce entry (nchwa, 2024). racial and ethnic disparities in representation further compound workforce shortages. race and ethnicity disparities in the lcsw workforce among lcsws in california, only 29.6% are hispanic/latino and 6.8% are black, perhaps revealing barriers to licensure access for underrepresented groups (california department of health care access and information [hcai], 2023). over the past 30 years, hispanic lcsws have seen a 25% increase, while black lcsws have grown by only 3%, demonstrating slow progress toward a more representative workforce (hcai, 2023). however, white, non-hispanic lcsws remain disproportionately overrepresented in the workforce. in san diego county, for example, white, non-hispanic lcsws make up 62% of the workforce, despite only 41% of the county’s population being white (hcai, 2023; johnson et al., 2025; u.s. census bureau, 2024). statewide, 40% of californians are hispanic/latino, yet only 29.6% of lcsws identify as hispanic/latino (hcai, 2023; johnson et al., 2025). see figures 1 and 2 for the california lcsw workforce and general population disparities. these gaps are not isolated but reflect broader structural challenges within the licensure process that limit access for diverse candidates and restrict communities' ability to receive culturally responsive care (o'keefe et al., 2021). addressing these disparities requires systemic reforms to improve licensure accessibility and ensure the workforce better reflects the populations it serves (apgar & nienow, 2022; o'keefe et al., 2021). advances in social work, summer 2025, 25(2) 550 figure 1. california lcsw workforce data by race and ethnicity (hcai, 2023)* figure 2. san diego area lcsw workforce data by race and ethnicity (hcai, 2023)* *nh=non-hispanic, ar=any race white (nh) asian (nh) hispanic (ar) black (nh) multiraci al (nh) other (nh) pacific islander (nh) american indian (nh) ca license 49.1% 9.4% 29.6% 6.8% 3.3% 1.3% 0.2% 0.3% ca pop 35.8% 14.7% 39.5% 5.4% 3.6% 0.4% 0.3% 0.3% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% white (nh) asian (nh) hispanic (ar) black (nh) multiracia l (nh) other (nh) pacific islander (nh) american indian (nh) sd license 62.1% 6.6% 22.2% 4.1% 3.5% 1.1% 0.2% 0.3% sd pop 42.4% 11.1% 37.0% 4.5% 4.0% 0.3% 0.4% 0.3% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% whaley et al./licensure: protection or gatekeeping? 551 future workforce demographics qualified, well-trained, licensed clinical social workers help build trust and provide communities with the high standard of care they deserve (cellini & pavani, 2024; thomeer et al., 2023). research has shown that racially minoritized patients who are matched with mental health providers of the same racial or ethnic background report better perceptions of care and improved health outcomes (moore et al., 2023). this is imperative for the social work profession because it highlights a practical solution to begin addressing the historical and ongoing disparities in mental health care within communities of color. similarly, many schools of social work that are educating and training future mental health clinicians are seeing demographic changes reflected in their student bodies. for example, the san diego state university school of social work, where the authors teach, has seen a 15% increase in the number of black, latine, and indigenous students enrolled in their msw program over the last four years (analytic studies & institutional research [asir], 2024). moreover, many of these students may also hold additional marginalized identities, such as being lgbtq+, disabled, or foreign-born, which can further shape their experiences in both education and licensure processes. the increase in potential future lcsws of color and the mental health provider shortage put the social work profession at a crossroads in being able to make meaningful changes at the community level. unfortunately, bipoc lcsw candidates' pass rates are significantly lower than those of their white colleagues (kim & joo, 2024). the council of social work education’s decision to eliminate the use of licensure pass rates as a reportable program outcome reflects a recognition of exam bias and the need for a more equitable approach to licensure (apgar & nienow, 2022). the aswb exam disparities are discussed below. association of social work boards disproportionality standardized testing has a long history of being used to assess students' knowledge, including maintaining systemic inequities and the oppression of historically marginalized communities. for example, the scholastic aptitude test (sat) has been widely accepted among college admissions despite evidence that it disproportionately affects students from low-income backgrounds, bipoc communities, and those whose first language is not english (rosales & walker, 2021). these disparities have prompted ongoing debates about the fairness and effectiveness of standardized tests in measuring true academic potential and preparedness. in 2021, the aswb contracted with a third-party human resources research organization to thoroughly analyze the social work licensing exam pass rate data focused on lcsw candidates’ demographic information (bbs, 2022). the bbs found that the number of test takers has more than doubled in 10 years, from 9,100 in 2011 to 20,657 in 2021. of test takers, white females are the largest group, and males are underrepresented at about 13% of first-time test-takers. pass rates are highest amongst first-time white testtakers (83.9%) and decline for non-white test-takers, with the lowest pass rate for black test-takers at 45% (bbs, 2022). to address significantly disparate outcomes in pass rates, in 2022, the aswb board of directors launched a call to action to assess factors in pass advances in social work, summer 2025, 25(2) 552 rate variability, revisit the exam structure to increase equity in pass rates, and solicit input from stakeholders (bbs, 2022). gathering stakeholder input to explore these issues is an initial step in the call to action aimed at addressing disparities, an effort this paper seeks to support. practitioner and systemic gatekeeping given that systemic gatekeeping in the social work licensure process, whether intentional, disproportionately impacts practitioners and the communities they aim to serve, it is necessary to explore more equitable approaches to licensure. social work programs and educators are well-positioned to lead these discussions and develop solutions that help address these disparities. as a starting point, we briefly examine how current licensure requirements fail to adequately reflect the economic and social realities faced by today’s social work students and post-msw/lcsw candidates. please note, for this paper, we are only highlighting the financial hardship of the cumulative costs leading up to the aswb clinical social work licensure exam, and that barriers are cumulative, with initial licensure often filtering out candidates who might otherwise succeed with the proper support. moreover, we are not advocating changes to supervision/work requirements for licensure. economic realities the cost of the aswb exam, which varies depending on the level of licensure sought, can be a significant stressor for candidates who are still managing the costs associated with their msw education and may not be fully aware of the associated costs of the licensing process following their msw education. for example, candidates must consider the cost of state-specific exams, study materials, and supervised hours toward licensure. new social workers in the field can expect to receive clinical supervision hours toward licensure at their place of employment. however, they sometimes receive lower pay to account for agencies having to utilize a licensed colleague to provide the required hours of weekly supervision (mojozy, 2025). other candidates may have to pay for supervision independently, with the fee for supervised hours set by an lcsw practitioner who is usually working in a private practice setting (mojozy, 2025). these fees can vary widely. in california, 104 clinical supervision weeks are the minimum required for licensure, and supervision expenses, in total, could cost candidates between $5,200 and $26,000 (hourly rates approximately $50 to $250, respectively; mojozy, 2025). further, candidates may reduce their work hours or take unpaid leave to focus on exam preparation (walker & bruhn, 2024). coupling these costs with the potential loss of income during exam preparation, time off for testing, and travel expenses, the financial stress may become a systemic barrier to licensure. moreover, the cumulative financial impact of the licensure process can put undue pressure on candidates to pass the licensing exam on the first attempt amid fears of having to pay additional fees or loss of income to retake the exam. this can lead to increased stress and reduced preparation time, impacting a candidate's exam performance and effectively keeping them from clinical licensure despite sometimes years of frontline experience and knowledge (bloxom & anderson, 2023; national conference whaley et al./licensure: protection or gatekeeping? 553 of state legislatures, 2020). not to mention that failure to pass the licensure exam may also result in delayed employment, loss of job offers for some graduates, and even loss of employment, adding to the stakes and stress of the exam process (nelson et al., 2025). these added financial burdens, combined with existing systemic barriers and economic disparities, can reduce bipoc candidates' participation in the licensure process and worsen pass rate disparities. this highlights a broader systemic issue that disproportionately impacts bipoc and other marginalized individuals, while also demonstrating the need for proactive and transparent advising within msw programs to help students anticipate and plan for the full scope of licensure-related expenses. societal realities in addition to economic barriers, language and accessibility challenges can impact candidates during the licensure process. aswb exams are given only in english, which can contribute to the stress of the licensure process for english as a second language (esl) candidates. these candidates must also navigate the complexities of the english language while processing exam questions, thus leaving them disadvantaged. torres and colleagues (2024) found that esl candidates may experience slower test-taking, affecting exam performance and lowering pass rates. while the aswb offers qualifying candidates up to two extra hours for exams, and candidates may request a bilingual translation dictionary and/or one english dictionary, some states do not permit using these or accept scores from candidates who used esl accommodations for their exam (aswb, 2024). the lack of esl support not only decreases the opportunities for esl candidates to continue in the field of social work as licensed clinicians but also has the potential to limit the cultural and linguistic diversity of the social work workforce, which is essential for serving multicultural and multilingual communities. candidates with disabilities also face insufficient accommodations during the licensure process. while the aswb cooperates with state licensing boards to provide non-standard testing arrangements for those with disabilities or chronic health conditions, alternative testing methods are often limited in scope and fail to fully address their diverse needs (aswb, 2024). for bipoc candidates with disabilities, the challenges of navigating the licensure process can be further exacerbated by experiences of racism and ableism. while helpful for some, standard accommodations such as extended time, additional breaks, or separate distraction-free testing rooms do not account for the varying needs of candidates with more specialized disabilities, particularly those from marginalized backgrounds (association of social work boards [aswb], 2025). moreover, it is at the discretion of the aswb to approve accommodations for non-federally protected disabilities, which can create inconsistencies in the accommodations provided. this further intensifies the disparities that bipoc candidates face throughout the licensing process and leads to inconsistencies for candidates who may not qualify under federal guidelines but still face challenges. advances in social work, summer 2025, 25(2) 554 implications for social work msw education programs the cswe requires social work programs to advance anti-racism, diversity, equity, and inclusion (adei) practice and principles throughout a program’s curriculum. further, the nasw code of ethics calls upon social workers to “strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people” (nasw, 2021, p. 2). similarly, one of the grand challenges of social work is eliminating racism (teasley et al., 2021). given these guidelines and calls to action to address systemic racism, it is important to confront the inequities that contribute to disparities in licensure pass rates. moreover, the aswb licensure exam, as currently designed, may not reflect these same principles, creating a disconnect that students must navigate. the aswb has collaborated with social work educators to improve the licensure pathway for graduates (apgar & luquet, 2023). though we recognize that schools of social work play a fundamental role in teaching the skills, knowledge, and attitudes needed to be effective adei clinical practitioners, it should be noted that addressing the structural flaws in the aswb should not be the responsibility of social work education programs. figure 3. implications for social work with that said, we do believe social work programs are uniquely positioned to play an active role in both supporting marginalized students through their msw program and helping students achieve licensure post-msw. to that end, we offer some strategies that social work programs could implement to help improve licensure pass rates, within the post-msw during msw program mentorship & financial support msw program intentional integration of licensure preparation throughout curricula support mentorship and financial support should be seen as a process that begins in the msw program and extends post-msw whaley et al./licensure: protection or gatekeeping? 555 constraints of the current aswb exam. these strategies include (1) integrating licensure preparation into msw education curriculum, and (2) providing mentorship and financial support throughout the licensure process, from msw education to becoming an lcsw candidate, to better support the needs of bipoc and other candidates facing structural barriers (e.g., disabled, foreign-born, etc.). see figure 3. msw education curricula even though the 2022 cswe educational policy and accreditation standards (epas) brought a growing recognition of the importance of an inclusive, adei intentional and focused curriculum, and the cswe also went as far as eliminating licensure passing rates as an acceptable program outcome, cswe has yet to address licensing gatekeeping sufficiently (beasley et al., 2022; bryant & kolivoski, 2021; davis & mirick, 2022; lerner & kim, 2024). for example, the structure of social work education has often been slow to adapt to the evolving needs of the profession, particularly concerning the systemic inequities that bipoc and other marginalized students face, such as experiencing racial bias and ableism, limited access to mental health resources that understand and address racial trauma, higher financial burdens due to socioeconomic disparities, and curricula that inadequately address or even perpetuate racial injustices. while there is an increasing emphasis on social justice and anti-racist practices, many social work programs have not fully integrated these principles beyond their minimum requirements (bryant & kolivoski, 2021). this gap leaves students underprepared to navigate and challenge the institutional barriers they will encounter in their licensure and careers. further, this can disproportionately impact bipoc students, who may not have access to external resources or support systems that could otherwise help them navigate the nuances of aswb licensure exams. social work programs can aim to integrate licensure preparation into curricula using the adei principles outlined in the 2022 epas. this approach could help prepare students for the critical thinking skills necessary to navigate the licensure process. for example, in direct practice or clinical-focused courses, instructors could incorporate case vignettes that mirror the content from the aswb clinical exam, including human development, diversity, and behavior in the environment (fisher & setterlund, 2018). by including these exercises throughout the curricula, students could be better prepared for the critical thinking necessary for the aswb exam while gaining practical, real-world skills essential for serving diverse communities. however, without some intentionality on behalf of social work education programs to examine how their current curricula may help or hinder students post-msw, we may continue to see candidates struggling to pass their licensure exams on their first attempt, increasing the existing disparities in licensure pass rates. by incorporating resources such as test-taking strategies and integrating areas covered in aswb exams throughout core curricula, social work programs can help address some of the known gaps that disproportionately impact bipoc and other marginalized students. a strategy some universities use includes adding a one-unit graduate course focused on preparation for the cumulative experience of the comprehensive exam, which parallels the licensure exam. advances in social work, summer 2025, 25(2) 556 this course may increase students' confidence in passing the licensure exam. for schools of social work considering implementing this strategy, we encourage hiring bipoc lcsws to be the instructors on record. please note that the authors do not know how widespread these types of one-unit courses are across social work programs in the us. mentorship throughout the licensure process msw education mentorship bipoc candidates often face systemic challenges that begin well before and persist throughout their graduate social work education. these challenges include educational disparities rooted in implicit and cultural biases, microaggressions, and a lack of institutional support (barrita et al., 2023). these inequities are compounded during the licensure process, where bipoc candidates report feeling that the aswb exam content is biased toward white cultural norms, creating additional barriers (torres et al., 2024). further, many bipoc candidates struggle with an exam that reflects experiences and expectations disconnected from their lived realities (bloxom & anderson, 2023; torres et al., 2024). mentorship plays a critical role in this process. offering professional development, advocacy, and a support system that includes career advice, networking opportunities, emotional support, mentorship, and resources can help bipoc students address challenges and navigate systemic barriers (allen & joseph, 2018; bimper, 2017; tibbetts & parks smith, 2023). post-msw mentorship higher education can support mentorship opportunities during and even after graduation. we highlight two examples of mentorship that can span one’s academic career. first, the university of portland's buddy-up program is a peer-mentorship initiative in their school of nursing and health innovations (majors et al., 2022). it intentionally matches students based on shared backgrounds, such as race, ethnicity, and being firstgeneration college students, allowing mentors and mentees to connect on shared experiences and navigate academic and social challenges more effectively (majors et al., 2022). social work programs could similarly utilize community partnerships established through field education to create formal mentorship initiatives that engage students more actively. these partnerships could provide students access to a broader range of mentors who bring diverse experiences and perspectives, particularly those who understand the specific challenges faced by bipoc students. second, san diego state university’s school of social work received a grant to provide post-graduation mentorship support by funding the supervision required for licensure for msw post-graduates who are working at nonprofit organizations (sklar, 2023). by connecting recent graduates with experienced mentors who can offer guidance in clinical practice and exam preparation, social work programs help ensure that bipoc graduates receive sustained support as they navigate the challenges of licensure requirements. such initiatives address practical needs, such as acquiring supervision hours, and provide culturally responsive mentorship. whaley et al./licensure: protection or gatekeeping? 557 access to these types of tailored mentorship throughout one’s msw and post-msw education efforts brings invaluable insights and can potentially reduce the stress that many bipoc and other marginalized candidates face later in their professional journey, thus, perhaps improving their likelihood of passing on their first attempt. this in turn can lead to higher student satisfaction, improved retention rates, and more robust overall program outcomes. by connecting bipoc candidates with mentors who understand and can address their specific needs, social work programs can begin to address some of the systemic inequities inherent in the current aswb exam structure that have historically disadvantaged bipoc individuals. financial support throughout the licensure process msw education cswe has also formally recognized the financial burden on students by supporting initiatives such as payment for placements (p4p), which aims to reduce the cost of social work education through paid internships (cswe, 2024). many accredited social work programs require students to complete unpaid practicum hours, further exacerbating financial hardships, particularly for bipoc students who already face significant student loan debt. a 2020 report found that black and hispanic social workers graduate with disproportionately higher debt compared to their white peers, with black graduates averaging $92,000 in student loans and hispanic graduates averaging $79,000 (cswe, 2020). universities and practicum sites have responded creatively to the call for greater student support by providing resources such as parking vouchers, mileage reimbursements, necessary technology, and even stipends to offset internship costs (cswe, 2022). some practicum sites have even incorporated internship wages into their grant funding or offered employment-based practicums (cswe, 2022). legislative efforts are also being made, such as michigan's student mental health apprenticeship retention and training (smart) grant program, which provides paid internships for social workers interning within public school settings (student mental health apprenticeship retention and training [smart] internship grant program, 2022). p4p continues to advocate for paid internships at the local, state, and federal levels to ensure that social work students are fairly compensated (p4p, 2024). another approach could be implementing forgivable loans or work-study programs tied into service commitments, similar to the title iv-e stipend program, which many msw programs already have in place. title iv-e stipend program helps alleviate the financial stress many msw students face well after graduation, while ensuring that students gain applicable hands-on experience in child welfare social work (california department of social services, 2024). implementing something similar for current msw students and licensure candidates would offer substantial benefits. for example, students could receive funding in exchange for a commitment to high-demand areas such as mental health or substance abuse services, including rural communities often faced with a critical shortage of mental health providers (morales et al., 2020). this approach would help advances in social work, summer 2025, 25(2) 558 reduce the economic barriers to licensure and encourage graduates to contribute to areas of social work where their skills are most needed, further aligning with the profession’s commitment to social justice and equity. this could also include offering stipends to students from rural or underserved communities in exchange for returning to their communities to provide mental health and additional community support services (nelson & lang-lindsey, 2020). these types of programs could significantly improve access to mental health care in underserved communities while ensuring that social work students from these areas are supported throughout their licensure journey. by engaging in community partnerships and offering forgivable loans or work-study opportunities, social work programs are not only helping to create a more equitable pathway to licensure but are ensuring that students and future licensure candidates are prepared to enter the field of social work with the necessary skills, experience, and knowledge. post-msw financial support in addition to the financial strain of unpaid practicum hours, students face further economic barriers when accounting for the cost associated with licensure. these combined expenses can act as significant economic gatekeepers to successful licensure. to challenge this, social work programs should prioritize developing and implementing financial support designed to reduce economic barriers to licensure. establishing scholarships and grants for alumni facing financial hardship could alleviate the future costs of licensurerelated expenses, including aswb exam registration fees, study materials, and supervision hours required for clinical licensure. social work programs should also explore innovative strategies that could financially support students and future licensure candidates. for example, social work programs could establish funding partnerships with local agencies, health and mental health foundations, and alumni networks. these partnerships can result in the development of scholarships explicitly aimed at supporting future licensure candidates, including bipoc candidates who may face additional economic barriers, such as wealth and employment gaps (aliprantis & carroll, 2019; gramozi et al., 2023). reducing the financial burden on students allows them to focus on their studies and exam preparation, increasing their chances of passing the aswb exam on the first attempt. calls to action for aswb to promote licensing equity we offer several ideas on how the aswb can begin to take action to address the current lcsw exam rate disparities and promote licensing equity. see figure 4. whaley et al./licensure: protection or gatekeeping? 559 figure 4. call to action for the aswb to promote licensure equity promoting licensing equity: a call to action for the aswb multilingual exams implementing multilingual exam options is a tangible step toward dismantling the systemic barriers that have historically disadvantaged esl candidates. by providing licensure exams in multiple languages, the aswb can ensure that all lcsw candidates have an equal opportunity to demonstrate their knowledge and skills, regardless of their linguistic background, especially if these future lcsw practitioners will serve the communities in their native language. this would also include collaboration at the state level to work towards nationwide acceptance. this approach promotes equity within the licensure process and aligns with social work’s broader commitment to adei efforts. having a comprehensive policy framework would support the implementation of multilingual exam options. this policy should include clear guidelines for ensuring translation accuracy, cultural relevance, and the consistent application of multilingual options to maintain the integrity and fairness of the exams. a key model for such an initiative is the dental assisting national board (danb), which in january 2024 began offering its most-taken oral health credentialing exam in spanish as a move towards addressing workforce shortages, barriers to employment, and community needs (american dental association, 2023). the aswb should draw on this example of the danb to develop a nationwide strategy that accommodates the diverse linguistic backgrounds of lcsw candidates in the us. inclusive exam preparation many state chapters of nasw offer lcsw candidates aswb exam preparation; however, these services are not always tailored to the specific needs of bipoc and esl advances in social work, summer 2025, 25(2) 560 candidates (bloxom & anderson, 2023). to address this, the aswb could collaborate with nasw state chapters to expand current exam preparation resources that specifically consider the challenges faced by bipoc and other marginalized candidates. this includes developing culturally relevant study materials, including bilingual instructors, study resources for esl candidates, and preparation courses. preparation courses should offer interactive practice exams and peer support groups that allow lcsw candidates to share resources and strategies. by improving accessibility, these expanded resources can better support bipoc and esl candidates, ensuring they are equipped with the tools they need to succeed on the aswb exam. alternatives to the clinical licensing exam recognizing the limitations of standardized testing, the aswb and state licensing entities should explore alternative pathways to licensure. portfolios could comprehensively evaluate an lcsw candidate’s abilities by capturing the skills and knowledge that are not always transferable to standardized tests (hirsch et al., 2024). lcsw candidates would show evidence of their competencies through case vignettes, self-reflection essays, and references from supervisors, mentors, and colleagues. furthermore, simulations would provide an interactive way to assess an lcsw candidate's ability to apply theoretical and clinical knowledge in real-world scenarios, testing decision-making skills and ethical judgments that mimic real-world scenarios and client interactions (kourgiantakis et al., 2020; lee et al., 2020). an example of an alternative licensing is illinois public act 103-433, also known as illinois house bill 2365 (hb2365). the initiative started as a grassroots movement from the social work activist group #stopaswb, which focuses on inequity within social work (nasw-illinois chapter, 2023). illinois’ hb2365 provides a structured alternative to the aswb clinical licensing exam and allows candidates who have attempted the aswb clinical licensing at least once to qualify for licensure through the completion of an additional 3,000 hours of supervised professional experience (illinois department of financial and professional regulation, 2024). while this pathway aims to address disparities associated with standardized testing, there is currently limited research on its long-term impact, as hb2365 only went into effect on january 1, 2024 (nasw-illinois chapter, 2023). by emphasizing supervised professional experience, hb2365 acknowledges the diverse competencies social workers develop through hands-on practice, challenging the notion that exam performance should be the sole determinant of licensure. however, given the potential financial and logistical burdens associated with completing these hours, future research should examine how hb2365 affects lcsw candidates’ financial stability, career advancement, and overall professional development to ensure that it does not create new barriers while attempting to dismantle existing ones (hirsch et al., 2024; nasw-illinois chapter, 2023). conclusion social work education programs can meaningfully support students throughout the licensure process from msw through lcsw, which could diversify the future workforce whaley et al./licensure: protection or gatekeeping? 561 and be a strong predictor of increasing services to marginalized populations. while we recognize that universities and social work programs often face resource limitations, we strongly encourage them to systematically evaluate these areas and adopt strategies tailored to their specific needs. moreover, we recognize that this paper does not deeply explore the impact of these barriers on real people and communities. for this reason, additional research, resources, advocacy, and continued academic discourse on the systematic barriers embedded in the licensure process and exam are warranted. however, even with strong institutional support like mentorship, financial assistance, and exam prep, it depends on aswb's responsiveness to critiques of the exam and systemic change. some of the proposed strategies may have limited long-term impact without broader reform or alternatives to the current licensure model. the current lcsw licensing process presents significant barriers. state licensing entities and aswb control the exam content and how it is completed and ultimately hold the responsibility for creating an exam that results in equitable pass rates for all lcsw candidates. the decisions being made regarding licensure policies will shape the future of the social work workforce and determine how effectively it can meet the diverse needs of communities. addressing these issues now is critical for building a social work workforce that reflects the diversity of the communities it serves. we strongly recommend that the aswb explore using multilingual exams, inclusive examination preparation, financial resources, or relief for candidates, as well as alternatives to the current licensing exam. these efforts are not just about improving licensure pass rates; they represent a commitment to addressing systemic inequities that have long excluded marginalized groups from full participation in the profession. references allen, e. l., & joseph, n. m. 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(2025). clinical social worker demographics and statistics in the u.s.. author. author note: address correspondence to kayla m. whaley, 5500 campanile drive, san diego, ca 92182-4119 email: mmwhaley@sdsu.edu orcid kayla m. whaley https://orcid.org/0009-0003-8784-1610 shelly paule https://orcid.org/0009-0000-1457-5508 annie j. keeney https://orcid.org/0000-0002-0318-9772 https://doi.org/10.1080/02615479.2019.1620723 https://doi.org/10.1080/02615479.2019.1620723 https://doi.org/10.1037/ser0000358 https://doi.org/10.1037/ser0000358 https://doi.org/10.1037/ser0000358 https://www.census.gov/quickfacts/fact/table/sandiegocitycalifornia/pst045224 https://grandchallengesforsocialwork.org/wp-content/uploads/2021/05/eliminate-racism-concept-paper.pdf https://grandchallengesforsocialwork.org/wp-content/uploads/2021/05/eliminate-racism-concept-paper.pdf https://doi.org/10.1007/s40615-022-01435-y https://www.legislature.mi.gov/documents/mcl/archive/2023/june/mcl-act-180-of-2022.pdf https://orcid.org/0009-0003-8784-1610 https://doi.org/10.1080/10413200.2022.2055221 https://doi.org/10.1093/sw/swae001 background mental health workforce shortages race and ethnicity disparities in the lcsw workforce standardized testing has a long history of being used to assess students' knowledge, including maintaining systemic inequities and the oppression of historically marginalized communities. for example, the scholastic aptitude test (sat) has been widely... practitioner and systemic gatekeeping economic realities implications for social work msw education programs figure 3. implications for social work msw education curricula mentorship throughout the licensure process financial support throughout the licensure process post-msw financial support calls to action for aswb to promote licensing equity multilingual exams inclusive exam preparation alternatives to the clinical licensing exam _________ douglas j. epps, msw, doctoral candidate, school of social welfare, and kurt c. organista, phd, professor, harry and riva specht chair for publicly supported social services, school of social welfare at the university of california, berkeley, berkeley, ca. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 454-481, doi: 10.18060/26691 this work is licensed under a creative commons attribution 4.0 international license. mitigating the violence of mass immigration detention through community-based case management douglas j. epps kurt c. organista abstract: immigration detention causes psychological, physiological, and financial harm, primarily to noncitizens of color. following a mass release of “lower-priority" individuals, responses to the covid-19 pandemic provide an opportunity to envision a system more focused on freedom and pragmatism rather than retributive and ineffective notions of human warehousing and deterrence. utilizing community-based case management (cbcm), a majority of detained noncitizens could be immediately returned to their families and communities under agency discretion. while some alternatives to incarceration serve as extensions of the carceral state, cbcm maintains required court appearances and preserves occupational and familial obligations at a fraction of detention costs without the need for intensive surveillance or restrictions. drawing upon available research, theories of violence, and strengths-based case management, this article critically examines the emergence of mass immigration detention in the united states and considers a noncarceral approach to mitigate such state violence against detained noncitizens, as well as their families and communities. the profession of social work is uniquely positioned to implement cbcm to address the mass detention crisis and the grand challenge of smart decarceration. social workers are well-equipped to 1) advocate for sensible decarceration policy, 2) conduct action-oriented scholarly research on the impacts of detention and outcomes of cbcm, and 3) provide integrated case management for noncitizens in immigration removal proceedings. keywords: immigration detention, criminalization, strengths-based case management, state violence, decarceration, alternatives to detention the pandemic, while tragic, has shown that warehousing human beings may be less of a necessity than previously considered. as jails and prisons across the western world have released “lower priority” incarcerated persons from custody, so have immigration detention centers (waterman et al., 2021). in february of 2021, the average daily detention population reached its lowest since 1997 (kassie, 2019), with 13,258 noncitizens held in immigration and customs enforcement (ice) facilities (trac, 2021b), or about onequarter of the 2019 average daily detention population (ice, 2020). numbers are still lower than pre-pandemic counts, but this is only temporary, given that no meaningful change has yet to occur to detention infrastructure or policy (capps & meissner, 2021). furthermore, ice detains tens of thousands of noncitizens every day despite having no legal mandate to do so (schriro, 2021; trac, 2022b). while many scholars consider mass immigration detention a “crisis” (american public health association [apha], 2020 saadi et al., 2020; torrey, 2015) and suggest vital policy changes to curb its proliferation (das, 2018; garcia hernandez, 2014, 2017; schriro, 2021; about:blank epps et al./mitigating the violence 455 stumpf, 2006), less inquiry has focused on practical solutions to fill the policy vacuum left in the wake of reform. many effective alternatives to human confinement remain available to mitigate the current mass detention crisis. the community-based case management (cbcm) model is especially promising, offering an evidence-based, humane strategy that connects noncitizens to social and legal resources without major disruptions to caretaking and financial responsibilities (idc, 2015; sullivan et al., 2000). despite an intensifying call from scholars (capps & meissner, 2021; giustini et al., 2021; ly et al., 2021), legal advocates (american immigration lawyers association [aila], 2022), former ice detention administrators (schriro, 2021), and over 100 members of congress (jayapal et al., 2022) to utilize community-based alternatives rather than human confinement, government over-reliance on carceral methods persists. in an attempt to reconceptualize immigration management, we discuss a noncarceral approach for transitioning to community-based alternatives, built upon core social work principles of social justice and strengths-based case management, to mitigate the harm resulting from an over-criminalizing and punitive immigration detention system. social work is particularly well-poised to address the mass detention crisis given a workforce uniquely equipped to advocate for amending detention policy, conduct action-oriented scholarly research on community-based alternatives, and provide integrated case management to criminalized noncitizens facing immigration removal proceedings. addressing the myth of immigrant criminality since the late 20th century, the criminal legal system has become increasingly intertwined with civil immigration law (garcia hernandez, 2014; stumpf, 2006). deemed “crimmigration” by legal scholars, work in this field has deepened awareness surrounding the ways carceral logics have been infused into a “non-punitive” field of law that has expanded its exclusionary capabilities without granting rights of due process to those it targets (das, 2018; eagly, 2017). this article examines damaging federal laws and agency policies that use misleading notions of criminality and dangerousness to justify incarcerating vast numbers of noncitizens in ice detention centers. moreover, the “illegal alien” trope commonly repeated in media and political outlets that overstates noncitizens’ association with deviance and criminality is categorically untrue yet results in racialized mass detention (furman, lamphear et al., 2016). research investigating purported relationships between crime and immigration consistently reveals the lack of a relationship, or in some cases, an inverse relationship, indicating that as immigration increases, crime decreases (ghandoosh & rovner, 2017; ousey & kubrin, 2018; wong, 2017). despite this absence of empirical truth, the myth of immigrant criminality remains an unrelenting presence in political, legal, and mainstream rhetoric in the manufacturing of “criminal alienhood” to legitimize an overly punitive and racialized enforcement regime (abrego et al., 2017, p. 696). advances in social work, summer/fall 2023, 23(2) 456 racialized mass detention interaction with immigration law enforcement and the detention system is an inherently racialized and gendered process (golash-boza & hondegneu-sotelo, 2013). over 50% of the world’s displaced persons are women (united nations high commissioner for refugees [unhcr], 2022), who are at greater risk of abuse during detention (ellmann, 2019), as are detained transgender noncitizens (vogler & rosales, 2022). paralleling mass incarceration, mass detention disproportionately impacts communities of color and overwhelmingly targets latinx immigrants and asylum-seekers from central america and mexico (golash-boza, 2016; massey, 2020; sanchez & romero, 2010), but all newcomers of color are detrimentally impacted, including those from asia, africa, and south america as well as non-latinx caribbeans (e.g., haitians). while ice does not provide racial demographics on individuals in its custody, data obtained by the transactional records access clearinghouse (trac), an organization dedicated to bringing hard-to-access governmental data to the public, provides a data snapshot collected in july 2019 indicating that over 97% of noncitizens in ice detention facilities originated from non-white countries under united states census bureau demographic classification (trac, 2019; united states census bureau, 2022). race has been a dominant factor in immigration enforcement policy throughout history (johnson, 1998) and an enduring catalyst underpinning the legislative framework for today’s massive detention regime (lindskoog, 2018). during the pre-civil rights era, such policies as the chinese exclusion act of 1882 and operation wetback of 1954 broadcasted the influence of “animus towards chinese and mexican immigrants” (das, 2018, p. 181). however, the civil rights act of 1964 changed the way race could be used to exclude racialized others. explicitly exclusionary racist policy and rhetoric adapted to the new sociolegal generation, adopting an ostensibly colorblind yet duplicitously effective form of structural racism (armenta, 2017; bonilla-silva 1997, 2001). recent computational analyses of congressional and presidential communication from 1880 to the present indicate that dehumanizing and criminalizing rhetoric, particularly among republicans, are as present as ever, noting a “striking similarity between how mexican immigrants are framed today and how chinese immigrants were framed during the era of chinese exclusion in the late 19th century” (card et al., 2022, p. 1). indeed, federal (massey, 2020; sanchez & romero, 2010) and local immigration policy (jones et al., 2015), as well as internal enforcement practices (kohli et al., 2011; ray, 2011; waslin, 2011) and border control operations (slack et al., 2015; soto & martinez, 2018) have primarily targeted mexican and other latinx migrants in recent decades. while much of arizona’s sb 1070 was struck down in legal battles, it remains a poignant example of modern racially targeted anti-immigrant legislation. the bill authorized local law enforcement to investigate immigration status of anyone suspected of being unlawfully present in the state and has been widely criticized as state-sanctioned racial profiling aimed primarily at latinx residents (jones et al., 2015; selden et al., 2011). while outside the scope of this article, a vast body of evidence suggests that increases in punitive immigration enforcement policies, such as sb 1070, are associated with more than anti-immigrant rhetoric. latinx noncitizen communities face increased experiences of epps et al./mitigating the violence 457 discrimination, childhood trauma, limited financial opportunities, emotional stress, and poor physical health outcomes to name but a few (androff et al., 2011; ayón, 2015; becerra et al., 2018). containing the racialized threat prior to the 1980s, immigration detention was rarely implemented (garcia hernández, 2014). between 1954 and 1981, federal immigration detention was the exception, opting for a more humane policy of parole (lindskoog, 2018). yet, the reagan administration abruptly put an end to this restraint in 1983 by initiating the mass immigration emergency plan (miep), which mandated the ongoing availability of 10,000 detention beds (freedom for immigrants, 2018). initially applied exclusively to haitian asylum-seekers, increasing numbers of cubans prompted the reagan administration to expand its practice to “all inadmissible aliens” (lindskoog, 2018, p. 3; organista, 2023). the administration’s strict carceral response intended to send a message to deter would-be asylum seekers (bosworth & kaufman, 2011; ryo, 2019b). in a sense, the miep and the targeted use of detention as both a containment method and a deterrent mechanism for excluding racialized others (epps & furman, 2016; furman, epps et al., 2016b) was an ad hoc pilot program for the present mass immigration detention regime. creating the “aggravated felon” outcast the reagan administration not only piloted the first racialized mass detention regime but also codified a new american underclass into law. labeled the “aggravated felon,” a caste of noncitizens identifiable by race/ethnicity, immigration status, and criminal history was established through amendments to the immigration and nationality act (ina) via the anti-drug abuse acts (adaa) of 1986 and 1988 (das, 2018; garcia hernandez, 2014). it is worth noting that the aggravated felony provision is not a term borrowed from criminal legal doctrine, despite its resemblance to terminology indicating a serious crime. in fact, prior to 1988, it did not officially exist (tosh, 2022). the 1986 adaa expanded deportations related to drug offenses involving any federally controlled substance, while the 1988 adaa created the term “aggravated felony” to identify the few noncitizens convicted of murder and illicit trafficking in drugs or firearms for apprehension, incarceration, and removal (macías-rojas, 2016). noncitizens convicted of aggravated felonies could then be detained indefinitely while litigating their immigration cases (garcia hernandez, 2014). the magnitude of this new legal categorization cannot be understated. the adaas contained the initial building blocks of parallel legislative foundations infused with the war on drugs that emphasize human warehousing as a legitimate, and arguably preferable means of racialized social control and hierarchy (alexander, 2010). in the years to come, a legal architecture heavily reliant on carceral logics was engineered, establishing a nationwide detention infrastructure alongside the mass incarceration boom. the illegal immigration reform and immigrant responsibility act (iirira) and the antiterrorism and effective death penalty act (aedpa) of 1996 expanded the aggravated felony provision substantially. aedpa broadened the definition of aggravated felony to include relatively minor, nonviolent crimes such as theft, receiving stolen property, and tax advances in social work, summer/fall 2023, 23(2) 458 evasion, making it much easier to apprehend and incarcerate lawful permanent residents (i.e., green card holders), as well as undocumented persons, under federal law (brady, 2017; solbakken, 1997). the 1996 laws essentially stripped immigration enforcement “and immigration judges of their discretion” (torrey, 2015, p. 880), disproportionately affected legal permanent residents, and disqualified unauthorized immigrants from seeking relief from detention or deportation based upon their length of stay in the us (macías-rojas, 2016). heightened anti-immigrant moral panic following the terrorist attacks of september 11th provided an even more precarious sociopolitical situation for noncitizens, leading to the patriot act of 2001, which further amplified aedpa’s stringent mandatory detention and deportation criteria (massey & pren, 2012). subsequent pieces of legislation and the creation of dhs continued to increase the size, scope, militarization, and violence of immigration enforcement, making it one of the nation’s largest arms-bearing agencies, second only to the us military (massey, 2020). the ongoing chain of amendments to the ina signified the intensifying perceptions of anti-immigrant threat (torrey, 2015), giving rise to what noferi (2016) characterizes as a “noncitizen presumption of dangerousness” in which noncitizens are perceived to be more prone to crime and violence than citizens despite extensive evidence to the contrary (p. 13). propagated by racially charged political rhetoric and a nation unified against the racialized noncitizen threat associated with the war on terror, the “aggravated felon” caste broadened in scope to include a host of low-level crimes. the president and vice president of the national association of immigration judges explain the “perplexing conundrum” of immigration law’s mismatch between criminal and immigration law that developed as a result of inflating the definition of aggravated felony: “some dispositions that states treat as rehabilitative and non-criminal are treated as a criminal conviction under the immigration laws…” and “some non-violent, fairly trivial misdemeanors are considered aggravated felonies” (marks & noonan slavin, 2012, p. 92). immigration detention as state violence mass human confinement is perhaps the most recognizable form of punishment that has disproportionately inflicted violence on communities of color since its origins (alexander, 2010). aggravated felons in the custody of immigration enforcement face mandatory detention and an expedited deportation process in a legal realm devoid of constitutional protections. regardless of the misleading label, given that crimes do not have to be “aggravated” nor “felonies,” the likelihood of obtaining relief from removal is quite slim. similar in look and feel to criminal incarceration and an increasingly prevalent form of human confinement, immigration detention can be viewed as an instrument of violence enacted by a hierarchy of governing bodies (cleveland et al., 2018; esposito et al., 2019; garcia hernandez, 2017). informed by concepts of structural and symbolic interpretations, menjivar and abrego (2012) explain that the “complex manner in which the law exerts its influence and control,” deemed legal violence, inflicts harm that is not directly imposed upon the body but nevertheless subjects noncitizens to immediate and long-term damages that manifest in epps et al./mitigating the violence 459 physical and non-physical ways (p. 1383). human confinement is certainly experienced in the physical environment, yet it can typify psychological, emotional, political, and many other types of violence. the law and policies that uphold mandatory human confinement and arbitrarily detain noncitizens contain embedded power imbalances that subject migrants to macro-level violence (collins, 2009). koulish (2016) elaborates: mandatory detention is a violence that is exerted indirectly…harm is created for the noncitizen along a lengthy process of denying procedural and substantive justice. the violence can be tracked to immigration law’s harshly asymmetrical power dynamic, which diminishes the human dignity of noncitizens… much of the structural violence that diminishes the quality of life for the subset of noncitizens with prior crimes is concealed by assertions of legitimacy and due process. (p. 2) human captivity remains a brutally effective means to impose carceral control upon racialized groups in the united states and abroad (furman, epps et al., 2016a), especially in the ostensibly race-neutral legal environment of the post-civil rights era (hinton, 2016; kurwa & gurusami, 2022). impacts of immigration detention the consequences experienced by persons subjected to immigration detention are vast and far-reaching, extending beyond individual hardship into family systems and community well-being. the mere presence or threat of detention or deportation can leave adults and their children in a chronic state of vulnerability and fear (barajas-gonzalez et al., 2021; lopez & minushkin, 2008; rubio-hernandez & ayón, 2015), exacerbating an already pervasive fear of law enforcement (dreby, 2012). this threat also leaves noncitizens more likely to withdraw from their communities (kremer et al., 2009), and avoid social supports and activities (androff et al., 2011). detention can result in long-lasting mental health consequences for the person subjected to incarceration (zwi et al., 2017), including any remaining family members, especially children (dreby, 2012). during and after detention, adults have higher rates of depression, anxiety, ptsd, and lower quality of life than non-detained persons (coffey et al., 2010; von werthern et al., 2018), and their children experience poor eating and sleeping habits, higher instances of crying and anxiety as well as more withdrawn, angry, clingy, and aggressive behaviors (gulbas & zayas, 2017; zayas, 2015). children of detained parents are also affected physiologically, leaving them more susceptible to adverse health outcomes (wood, 2018). the detention of a caregiver leaves children much more likely to experience housing and food insecurity (chaudry et al., 2010), often leaving the remaining single parent dependent upon state assistance for basic needs (patler, 2015; scheuths, 2018). likewise, abruptly removing immigrant employees from the labor force negatively impacts local economies, especially in smaller municipalities (patler & golash-boza, 2017). furthermore, individuals in detention facilities often face deplorable conditions and human rights abuses. detained noncitizens often lack access to appropriate hygiene, advances in social work, summer/fall 2023, 23(2) 460 receive inadequate healthcare, and, in some cases, encounter severe illness and even death (grassini et al., 2021). medical abuses such as forced sterilizations (o’toole, 2021) and miscarriages due to unsafe restraint techniques (ellmann, 2019) have also been reported at multiple ice facilities. insufficient access to mental healthcare, inadequately trained staff, and lack of accountability also underscore issues in addressing and preventing suicides while in ice detention (marquez et al., 2021). an evaluative report by the office of inspector general (oig, 2019) supports these claims, finding that “...ice does not adequately hold detention facility contractors accountable for not meeting performance standards”(p. 7) despite thousands of documented “deficiencies and instances of serious harm to detainees that occurred at these detention facilities” (p. 15). legal coercion in addition to direct consequences, immigration detention can inhibit access to legal representation (eagly, 2017; eagly & shafer, 2020) and lead to a higher likelihood of receiving removal decisions that result in deportation (markowitz, 2009; marouf, 2017). detained noncitizens are also more likely to sign voluntary departure orders (kremer et al., 2009; ryo, 2019a). historical analyses suggest that detention may have been used to preserve agency resources and expedite deportation processes for over a century by prompting noncitizens to “self-deport” (goodman, 2021), even when they may have valid claims to remain in the country (martin, 2012; ryo, 2019b; taylor, 1997). detained migrants are thus often forced to choose from two potentially devastating outcomes: imprisonment or deportation. deciding to detain: discretionary or arbitrary? ice is granted prosecutorial discretion for “a broad range” of decisions “at all stages of the enforcement process,” including “whom to detain or release” (johnson, 2014, p. 2). in the case of detention, this discretion is most salient among noncitizens for whom mandatory detention does not legally apply (gao, 2022). ice claims to decide whom to detain on an individual basis by assessing criminal and immigration violation history, community ties, suspected flight risk, and assumptions about an individual’s threat to public safety (ice, n.d.). custody determinations are conducted through the risk classification assessment system under the premise of a fair and balanced weight of the factors mentioned above. however, in addition to being time-consuming and resourceintensive, the oig (2015) determined that the risk assessment was “not effective in determining which aliens to release or under what conditions” (p. 1, exec. summary oig15-22), and an evaluation by koulish (2016) found that noncitizens were frequently detained without justification. perhaps most telling is an account by dora schriro, former senior advisor to dhs secretary napolitano on detention and removal and ice’s first director of the office of detention policy and planning: ice has never assessed risk correctly or responded proportionately, and despite its unfounded exaggerations as to detainees’ dangerousness, many had never been convicted of a crime before they were detained, cause no trouble during their epps et al./mitigating the violence 461 detention, and do not engage in criminal activities of any kind after their release. (schriro, 2021, p. 2) tens of thousands of individuals are incarcerated in detention centers every day who are not subject to mandatory detention (trac, 2022b). according to immigration law, detention is mandatory for noncitizens convicted of specific subsets of felony and misdemeanor criminal convictions and criteria, although not all criminal convictions apply. not only was the average daily detention population accelerating annually before the onset of covid-19, but the number and proportion of detained noncitizens with no criminal convictions were as well. a report by trac (2019) shows that noncitizens with no criminal history were increasingly detained, from an average of 9,999 (39%) per day in 2016 to 31,778 (64%) in 2019 (see figure 1 below). further, recent data show that even though total detention numbers are lower since the onset of covid-19, approximately 70% of the detained population have had no criminal convictions or pending charges (trac, 2022b), underscoring ice’s authority to discretionarily incarcerate noncitizens. figure 1. daily detention population of noncitizens with no criminal conviction history (march 2015 april 2019) note. each data point consists of a “snapshot” of the total number of individuals in ice detention recorded on the month's final day as collected via trac’s foia requests. numbers for some months were unable to be obtained. data does not include persons detained by customs and border protection nor minors in custody of the office of refugee resettlement (trac, 2019). there is some indication of arbitrary detention practices alluded to in ice reporting documents as well, referring to internal agency-appointed bed quotas. for example, a 2015 advances in social work, summer/fall 2023, 23(2) 462 budget proposal to dhs indicates that some “lower-risk, non-mandatory aliens” may be “detained only to satisfy a higher mandated average daily detention level” (ice, 2015, p. 4). the passage shows that at least a substantial proportion of noncitizens are detained for reasons not pertaining to public safety or individual risk but rather to fulfill internal agency quotas, presumably to maintain desired budget appropriations. alternatives to mass human confinement many other viable means are available for managing immigration. once a person has been incarcerated in a detention center, they may be granted relief from deportation in their removal hearing and released (extremely rare), voluntarily depart the country, or, in most cases, be deported. otherwise, noncitizens will remain in custody unless approved for parole, bond, or release on either orders of own recognizance or orders of supervision, which may also be supplemented with enrollment in an alternative to detention (atd) program (gao, 2022). atds can be defined as “...any law, policy or practice by which persons are not detained for reasons relating to their migration status” and typically allow noncitizens in immigration proceedings to remain in the community until their case is decided (idc, 2015, p. ii). many variations have been proven effective at preventing flight and maintaining mandated court appearances, exhibit much lower operating costs than detention, and still allow the government to achieve various levels of compliance for noncitizen program participants (gao, 2018; schriro, 2009, 2015). common forms of alternatives may still include restrictive elements, such as location monitoring ankle devices (gps) as well as telephonic and facial recognition reporting technology, while others are less intrusive and stigmatizing such as release on one’s own recognizance or parole (schriro, 2009). the most promising method is, however, a case management approach that strives to minimize deprivation of individual liberty while maximizing the ability to comply with immigration court requirements (idc, 2009, 2015; national immigrant justice center [nijc], 2010; edwards, 2011). a continuum of least restriction is ideal, given that most noncitizens will be suitable for the least restrictive methods or require no supervision at all (schriro, 2021). as seen in figure 2, liberty is not conceptualized as a binary decision between confinement and no confinement. rather, it must be conceptualized along a continuum spanning the boundaries of no restriction through incarceration with a variety of alternative programming situated within. community-based case management is one of the least restrictive options currently available among known alternatives to incarceration. epps et al./mitigating the violence 463 figure 2. continuum of least restriction and supervision for alternatives to detention case management programs despite several promising studies conducted globally, the literature on case management-centered programs is still relatively sparse. while the united states has yet to adopt a full community-based case management model, a pilot program featuring some elements of the approach was trialed by ice between january 2016 to june 2017. the short-lived family case management program (fcmp) consisted of 952 heads of households with 1,211 children (2,163 total) noncitizen participants and was comprised of the following three features coordinated by a case manager: 1) referrals to resources such as english classes and legal, food, and medical assistance; 2) legal orientation programs; and, 3) frequent reporting requirements intended to reinforce important information to each individual’s immigration case (singer, 2019). fcmp was exceptionally efficient, demonstrating 99% participant compliance rates with both ice monitoring requirements and immigration court proceedings (singer, 2019). planned for five years, fcmp was terminated on the grounds that it was more expensive than other forms of high-surveillance alternatives even though it remains considerably less expensive than detention. the successes of fcmp influenced ice to incorporate case management into its other atd programs; however, it mostly supplements existing ice surveillance methods as opposed to being a standalone program. other examples include australia’s community assistance support programme which operates under the rationale that treating people with dignity and fairness will result in greater compliance and efficiency throughout the immigration process (edwards, 2011). the program manages asylum-seekers and other unauthorized migrants by assessing the individual’s needs and unique situation in addition to potential risks of flight or perceived dangers to the community (idc, 2015). the program implemented comprehensive case management, resulting in 93% (n=918) and 95% (n=596) compliance rates with mandated court hearings, all while maintaining operating costs that were less than one-third of detention (idc, 2009). consequently, the program expanded into a nationwide method of migration management in 2009 (nijc, 2010). of the various alternative models evaluated, programs providing accessible information about rights and responsibilities, access to legal support, and basic needs assistance while prioritizing dignified, humane treatment obtain the highest rates of compliance and cooperation (edwards, 2011; ly et al., 2021). pro-immigrant and human advances in social work, summer/fall 2023, 23(2) 464 rights organizations continue to advocate for case management alternatives in the face of formidable hurdles. yet, heightened polarization, poor governmental data collection methods, the limited scope of pilot programs, and lack of political will attached to the issue make for a challenging environment to implement large-scale change. alternatives “to” vs. alternative “forms of” detention community-based case management (cbcm) is not a model for surveillance or enforced compliance. rather, it is a comprehensive, client-centered program that promotes well-being while simultaneously increasing court compliance rates without additional coercive leverage or invasive supervision. the case management approach is deliberately dissimilar to other forms of supervised release because the level of support and concern for the client’s autonomy and dignity is a priority (idc, 2015). the majority of alternatives currently in practice use methods that are deeply infused with carceral logics, such as global positioning systems (gps) technology (ankle bracelets). such forms of surveillance and control can result in both material and social harm to those forced to wear them (martinez aranda, 2022; truong, 2022). these modes of release are more akin to alternative forms of detention. shortly after assuming office, the biden administration implemented the case management pilot program to provide resources for noncitizens in removal proceedings, including access to legal information and other crucial support (department of homeland security [dhs], 2021). the program adopts a similar framework as other successful community-based migration management programs with one exception. instead of implementing cbcm as a substitute for detention as intended, much of the case management provided by ice augments current alternative forms of detention (dhs, 2021). this is, by all means, intentional, as noted by the congressional research service: “according to dhs, these programs have enhanced ice’s ability to monitor more intensively a subset of foreign nationals released into communities” (singer, 2019, p. 6). thus, despite the modest reduction of overall detention numbers since the onset of the covid-19 pandemic, enrollment in various ice surveillance atds has more than tripled since january 2021 (see figure 3). these alternative forms of detention extend the carceral state’s reach into noncitizen communities of color and disrupt access to established social capital networks (martinez-aranda, 2022). in contrast, cbcm is a genuine, independent alternative to detention when carefully implemented as detailed in the following section. epps et al./mitigating the violence 465 figure 3. total enrolled in ice alternatives to detention programs: september 2019 to july 2022 note. ice’s atd programs consist of three different types of surveillance technologies: 1) gps monitoring, 2) facial recognition, and 3) voice recognition. (trac, 2022a) foundations of community-based case management case management for noncitizen individuals and families has been integral to the field of social work since its origins. indeed, mary richmond, one of the original proponents for the professionalization of social work, focused much of her efforts on developing immigrant integration strategies (lieberman, 1990; richmond, 1917) and much of early settlement house clients were newly arrived immigrants (nasw, 2018). the cbcm approach extends this tradition, incorporating key social work principles to alleviate the harm inflicted on individuals and families subjected to incarceration while undergoing immigration legal proceedings. the cbcm approach draws upon the international detention coalition’s community assessment and placement model (idc, 2015) and adopts a decision-making assessment on a spectrum from least to most restrictive (similar to the continuum shown in figure 2). most importantly, cbcm maintains a presumption against detention (sampson, 2015). community and respect for the person are at the heart of the model, centered around supportive resources, information sharing, and coordination with court-appointed requirements. advances in social work, summer/fall 2023, 23(2) 466 successful applications of community-based alternatives apply the strengths-based approach which provides a guiding, holistic framework for case management with persons facing detention and deportation. essentially, the strengths-based approach “is a strategy for seeing” in which the case manager aids the client in identifying the various intrinsic and extrinsic resources currently available in their lives (weick et al., 1989, p. 354). a comprehensive service plan is then co-developed with the client to preserve a degree of personal dignity and self-determination in an otherwise degrading process. the following is a brief outline of the cbcm approach as conceptualized in figure 4. figure 4. the community-based case management process intake intake is a preliminary screening process for collecting personal information to verify identity and previous criminal and medical histories. intake counselors also determine the immediate risks or needs unique to noncitizen clients. for example, some individuals may be at greater risk of abuse due to their gender identity or sexual orientation (vogler & rosales, 2022). as a general rule, a conditional release will initially be sought for asylum seekers, individuals without criminal histories, family units, and caregivers of children or other family members (secor et al., 2019). minors, older adults, pregnant or nursing mothers, and those with physical and/or cognitive disabilities also receive special consideration (capps & meissner, 2021). individuals assessed as high-risk, although less common, may be reassigned to other means of management if necessary, using the continuum of least restriction. program reassignments are relatively rare because most noncitizens in custody are best suited for cbcm. as the former director of ice’s office of detention policy and planning has stated, “most [noncitizens in ice custody] require little or no supervision” (schriro, 2021, p. 17). examples of questions addressed by case managers include: “is this individual in urgent need of protection (i.e., credible fear)?” “do epps et al./mitigating the violence 467 they have children or other dependents in the community?” “is there a legitimate and verifiable indication that this individual threatens public safety or national security?” strengths assessment in an immigration case management setting, the initial in-depth assessment should be implemented as soon as possible through a comprehensive process including a systematic evaluation of risk, individual vulnerability, and emergent need to avoid arbitrary detention practices (sampson, 2015). this should include an assessment of potential client strengths which are used as a foundation for case planning while incorporating principles of selfdirection, informal helping networks, community involvement, and building a strong professional relationship between the case manager and client (brun & rapp, 2001). client strengths may include established access to legal aid, steady employment with a living wage, a strong social support network, and community ties. a rare but possible outcome of the intake and assessment stages may involve the identification of an individual that must be reassigned to a more restrictive program option (schriro, 2021). however, resorting to human confinement should only occur under the most exceptional circumstances after all other options have been considered or attempted and due process afforded. service planning noncitizen clients may have a wide range of needs. in addition to housing or food assistance, survivors of violence may require access to trauma-informed medical and mental health services, which may impact one’s ability to function in the community or comply with legal obligations (capps & meissner, 2021). perhaps the most crucial support provided by cbcm is access to legal aid. a study analyzing immigration court data between 2008 and 2018 (n=1,829,049) observed that 96% of noncitizens who had legal assistance appeared for all of their court hearings (eagly & shafer, 2020). however, once someone is in immigration detention, access to legal aid is substantially inhibited (markowitz, 2009; marouf, 2017) and legal representation is not provided (tosh, 2022). very few legal resources are readily available to noncitizens facing deportation unless they have the financial capacity to hire a lawyer or are fortunate enough to procure pro bono services which are typically scarce and in high demand (irc, 2021). case maintenance a key element to successfully implementing a cbcm service plan relies on maintaining clear and consistent communication between the case manager, the client, and the immigration official(s) in charge of the removal case (sampson, 2015). the client’s risk of misunderstanding a requirement or missing a required court appearance is more likely without a strong link between these three parties throughout the service plan. it is also recommended that case managers be unaffiliated with governmental or for-profit contractors to fortify client trust and minimize conflicts of interest (schriro, 2021). advances in social work, summer/fall 2023, 23(2) 468 the service plan may take years to complete depending on court backlog and case specifics which take, on average, 859 days to complete (trac, 2021c). recurrent case audits are necessary to adjust for changes in the client’s support network or to maintain contact to ensure clients continue to understand court requirements (capps & meissner, 2021). case resolution upon reaching a final determination in the client’s removal proceedings, case termination proceeds. in the event that relief from deportation is granted, the case manager facilitates connections with local providers to maintain access to resources as necessary. if the client is appealing their removal decision, the service plan will re-open following a meeting between stakeholders and a full audit of the case. if all legal avenues to remain in the united states have been exhausted, the case manager assists the client until they depart the country, including contacting organizations in the destination country (if available) that may offer aid or protection to deported migrants (capps & meissner, 2021). return counseling is an option that several european countries have implemented in order to be certain that all options for relief have been considered and to assist clients with logistical and psychological preparation for return (sampson, 2015). multilevel implications for the field of social work the disenfranchised nature of non-citizenship, coupled with policies aimed at disrupting the livelihood of immigrant communities, results in a population of considerable precarity. given social work’s professional and ethical responsibilities to systematically oppressed and marginalized peoples, the mass detention crisis is of the utmost concern. accredited schools of social work train undergraduate and graduate students in competencies informed by the national association of social workers (nasw) code of ethics & principles (council on social work education, 2015; nasw, 2023). beyond the code of ethics, the grand challenges of social work were launched in 2016 to urge meaningful progress toward some of the world’s most pressing social injustices (uehara et al., 2014). several grand challenges stress the need to address the mass detention crisis, such as the eliminate racism and achieve equal opportunity and justice initiatives (grand challenges for social work, 2022). however, the promote smart decarceration challenge is most directly pertinent, which decidedly calls upon the field to “reallocate resources to community-based supports,” among other mechanisms, to meaningfully reduce the use of human confinement (epperson & pettus-davis, 2016, p. 1). redistributing resources from carceral modalities, such as immigration detention, to establish a community-based case management infrastructure is essential to achieving successful decarceration objectives. to answer the field of social work’s call to address the embedded systemic racism and inequality inherent to the mass detention and mass incarceration crises, we rely on several tenets of the profession to guide the pursuit toward transformative decarceration. these can be simplified into three multilevel imperatives to achieve a more effective and just immigration management system: 1) policy advocacy, 2) research, and 3) direct practice. epps et al./mitigating the violence 469 beyond this call to action, additional care must be taken to ensure that the voices of those directly impacted by the policies in question are preserved in the pursuit of reform. that said, social work’s professional values may directly conflict with federal immigration detention policy and practices, juxtaposing social workers between the law and their professional and ethical commitments to social justice (furman, ackerman et al., 2015). historically, the field of social work has had a mixed relationship with the carceral state, at times contributing to its proliferation while simultaneously advocating for its reform (toraif & mueller, 2023). referring to the domains of social work that have sustained harm through mechanisms of social control and white supremacist ideologies, carceral social work has perpetuated the subjugation of systemically marginalized and oppressed groups (jacobs et al., 2021). thus, a social work praxis that maintains a presumption against human confinement and a commitment to uphold the dignity and worth of the person, must be at the forefront of change. policy advocacy policy-focused advocacy, described as social work's "great tradition," has a rich history within the profession in which jane addams herself called upon social workers to concentrate efforts on influencing policy change (schneider & netting, 1999, p. 349). reducing the demand for detention by passing sensible legal immigration policies would alleviate much of the disruption and violence associated with mass detention and deterrent immigration enforcement policies. while elusive, the pursuit of comprehensive immigration reform that considers humanitarian responsibilities, as well as market demands of the us economy, is imperative. overall, a detention-focused advocacy agenda will address the immediate and long-term changes necessary to mitigate the current state of mass immigration detention. it is incumbent upon the field of social work to identify, challenge and advocate for the elimination of anti-immigrant and inhumane policies (franco, 2020). immediate priorities the mass release during the covid-19 pandemic emphasizes that incarcerating noncitizens for administrative purposes is: 1) a choice and 2) unnecessary. ice can return discretionarily detained people to their communities in the same way as at the height of the pandemic, which would not require an act of congress. therefore, the release of all whose incarceration is not mandated under current immigration law is an immediate policy priority. advocates can pursue the expansion of cbcm modalities to replace detention while opposing more restrictive surveillance technologies (e.g., ankle monitors) that serve as extensions of carceral control and "extended punishment" (martinez aranda, 2020, p. 74). as mentioned previously, the biden administration’s moderate reduction in immigration detention is overshadowed by tripling the number of enrollments in restrictive surveillance alternatives and continued growth of enforcement funding. for this change to occur, dhs must alter internal policy, practice, and budgeting. for example, resources earmarked to sustain detention center operations must be reallocated to develop and expand cbcm advances in social work, summer/fall 2023, 23(2) 470 infrastructure. given the much lower cost of cbcm methods, ice operating budgets should markedly decrease with these changes. agency procedures must also be altered, most notably the ice risk assessment, which has been dubiously restrictive and skewed toward confinement as a default (koulish, 2016; schriro, 2021). likewise, determining risk classification must not be the sole responsibility of ice as it presents a conflict of interest, given that agency funding often hinges upon the number of individuals detained (capps & meissner, 2021). long-term priorities ina amendment. primarily, policy advocates must focus on amending the ina to eliminate the aggravated felony construct and its companion, the mandatory detention and deportation provision. these laws systematically punish noncitizens, especially black and latinx immigrants from lower socioeconomic backgrounds, by funneling them into detention and deportation and reproducing structural inequalities (tosh, 2022). advocates can pursue revising the legal meaning of “custody” to encompass humane alternatives to detention programs (schriro, 2021). incorporating other forms of ice supervision would make compliance with restrictive legal statutes more realistic and offer more flexibility to reduce the number of persons incarcerated. some legal scholars suggest that dhs may have grounds to interpret the term more broadly, allowing the inclusion of alternatives into its meaning at the agency level without the need for legislative action (torrey, 2015). secondly, dismantling crime-based removal partnerships is also a necessary target of reform, as has been addressed by many municipal sanctuary ordinances. crime-based removal partnerships work in tandem with the inflated legal definition of the aggravated felony and mandatory detention provisions to establish a prison-to-detention-todeportation pipeline (das, 2018; macías-rojas, 2016). they also perpetuate the spurious good-versus-bad immigrant narrative and reinforce the false trope of associating dangerousness with immigrants (das, 2020). local legislation. given the challenges associated with amending federal legislation, particularly the polarization that has deadlocked the united states congress on many issues related to immigration, advocates may also pursue state-level reforms. while state legislation cannot eliminate mandatory immigration detention or change the aggravated felony construct, creatively enacting state-level laws may mitigate resulting harm. universal representation. due to the gravity involved with the revocation of an individual’s freedom and the personal and familial damages that can result, due process is a necessity. new york demonstrates how local governments can make meaningful changes in the lives of those directly impacted by immigration detention without amending federal legislation. funding for the new york immigrant family unity project began in 2013, offering universal representation for noncitizens in deportation proceedings if their income falls under 200% of the federal poverty line (stave et al., 2017). an evaluation of the program (n=1,772) found that representation was associated with favorable outcomes in removal hearings, considering that just 4% of noncitizens’ deportation cases resulted in relief prior, but increased to a substantial 48% for noncitizens represented by the program (vera institute of justice, 2017). legal representation also notably impacted detention epps et al./mitigating the violence 471 rates, nearly doubling the release of individuals who would have otherwise been confined in detention centers while litigating their deportation cases (stave et al., 2017). statewide ban. rather than appointing universal representation, the illinois way forward (iwf) act (sb 0667) prohibits local and state governments from contracting with ice to detain noncitizens (illinois.gov, 2021). many individuals who would have remained in custody without its passage were released. others were transferred to detention centers in neighboring states given that ice retains federal authority to transfer individuals for whom they deem confinement necessary (ballesteros, 2022). the first statewide ban on immigration detention, the iwf is an unprecedented advance in the pursuit of a more humane immigration management system. research ice data on immigration detention and alternatives are sparse and difficult to access (gao, 2018). currently, the most comprehensive and accessible data source on detention is provided by the transactional records access clearinghouse (trac) immigration project, which offers detailed information obtained from ongoing freedom of information act requests (2021a). however, agency data are inconsistently collected and enrollment in programs is often sporadic or terminated before removal decisions are reached, preventing sufficient evaluation of program efficacy. as a fundamental first step, ice must collect comprehensive data for thorough program evaluation, achieve more consistent enrollments in alternatives, and increase its availability to the public for greater transparency. second, at the organizational level, comprehensive systematic evaluations of all programming using case management as an alternative to human confinement are necessary (singer, 2019). findings will support cross-national comparative studies with the various case management versions implemented in other countries to identify successes and failures that may improve delivery and promote the expansion of cbcm programming domestically. however, researchers should approach programs implementing case management to supplement carceral methods cautiously given that they may impact the validity of results. the premise of cbcm relies upon its effectiveness as a standalone service to maximize the autonomy and dignity of persons, not as an auxiliary component to support restrictive surveillance and supervision technologies. third, at the individual level, lived experiences are an essential window into program performance. focusing research efforts on lived experiences, including family systems and practitioner insight, will pinpoint potential areas of improvement, including highfunctioning features that may be under-resourced. this inquiry must extend across demographic groups to holistically understand how the cbcm approach diversely impacts community well-being and cohesion. direct practice while the cbcm model may be new to social work per se, its case management roots are inextricably familiar. effective case managers will require a broad yet specialized understanding of the complex immigration laws and processes when working with advances in social work, summer/fall 2023, 23(2) 472 noncitizen communities (potocky & naseh, 2019). franco (2020) suggests that social work practitioners need to focus on fortifying community level bonds and cultivating a sense of empowerment among latinx clients who are subjected to the destabilizing stressors of deportation and detention threat. a wealth of knowledge exists among refugee resettlement case managers whose skills and experience would translate well to cbcm and bring many established resource networks. furthermore, social workers assisting noncitizens undergoing deportation proceedings “bring unique knowledge and skills that enhance legal teams’ representation of immigrants,” which may impact removal decisions (zayas, 2022, p. 33). as such, cbcm caseworkers can readily incorporate formal training to best support noncitizen clients in navigating their court requirements. such practitioners are ready for the unique challenges that cbcm may present. social work’s professional values, especially regarding immigration rights and decarceration, prepare workers for challenging federal immigration detention policy and practices, while grounding them in professional and 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(2017). the impact of detention on the social-emotional well-being of children seeking asylum: a comparison with community-based children. european child & adolescent psychiatry, 27, 411-422. author note: address correspondence to douglas j. epps, school of social welfare, university of california, berkeley, berkeley, ca, 94720. email: depps@berkeley.edu https://www.vera.org/downloads/publications/new-york-immigrant-family-unity-project-evaluation-summary.pdf https://www.vera.org/downloads/publications/new-york-immigrant-family-unity-project-evaluation-summary.pdf https://www.vera.org/downloads/publications/new-york-immigrant-family-unity-project-evaluation-summary.pdf https://doi.org/10.1093/socpro/spac022 https://doi.org/10.1093/socpro/spac022 https://doi.org/10.1186/s12888-018-1945-y https://doi.org/10.1186/s12888-018-1945-y https://www.americanimmigrationcouncil.org/sites/default/files/research/scomm_exec_summary_112911.pdf https://www.americanimmigrationcouncil.org/sites/default/files/research/scomm_exec_summary_112911.pdf https://doi.org/10.1192/bjb.2021.110 https://doi.org/10.1192/bjb.2021.110 https://doi.org/10.1093/sw/34.4.350 https://doi.org/10.1093/sw/34.4.350 https://www.americanprogress.org/article/the-effects-of-sanctuary-policies-on-crime-and-the-economy/ https://doi.org/10.1136/bmjpo-2018-000338 https://doi.org/10.1136/bmjpo-2018-000338 https://doi.org/10.18060/25294 https://doi.org/10.18060/25294 https://doi.org/10.1007/s00787-017-1082-z https://doi.org/10.1007/s00787-017-1082-z https://doi.org/10.1007/s00787-017-1082-z mailto:depps@berkeley.edu addressing the myth of immigrant criminality racialized mass detention creating the “aggravated felon” outcast immigration detention as state violence impacts of immigration detention legal coercion deciding to detain: discretionary or arbitrary? alternatives to mass human confinement alternatives “to” vs. alternative “forms of” detention foundations of community-based case management intake strengths assessment service planning case maintenance case resolution multilevel implications for the field of social work policy advocacy immediate priorities long-term priorities research direct practice ______ amy skeen, dsw, lcsw, pel, professor of practice and associate director; msw practicum education, simmons university, boston, ma. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 204-220, doi: 10.18060/26234 this work is licensed under a creative commons attribution 4.0 international license. field education as the signature pedagogy of social work: rhetoric or reality? amy skeen abstract: as the social work profession emerged, the primary method for training social workers was the apprentice model, now referred to as field education. in 2008, the council on social work education (cswe) declared field education the signature pedagogy of social work education in the educational policies and standards (epas), thus connecting it to accreditation. despite this prioritization over other areas of social work education, debate continues as to whether field education meets the criteria of signature pedagogy. this study applied a contextual analysis to determine the extent to which a sample of 16 undergraduate social work programs demonstrate alignment with the signature pedagogy designation. the tool for analysis was the epas self-study, a primary document required in the cswe accreditation process. the selected criteria for examination were two defining features of signature pedagogy: evidence of widespread recognition and routine inclusion across the curriculum. findings revealed significant variation in both criteria areas among the sample group, likely influenced by ambiguity regarding signature pedagogy found within the epas. while data within the epas self-studies substantiates the important role of field education, additional themes revealed an opportunity to re-define and expand the signature pedagogy of the profession that could benefit both social work education and the practice community. keywords: signature pedagogy, field education, transformational leadership, bidirectional integration greater than, less than, or equal to. the debate on the status of social work compared to other practice-based professions has endured since the first social work training schools emerged in the early 1900’s (bruno, 1944; flexner, 2001; gitterman, 2014; reisch, 2019; wayne et al., 2010). similarly deliberated is the primacy of field education in comparison to classroom instruction in preparing a student for professional social work practice (bruno, 1944; farber & reitmeier, 2018; garthwait, 2017; gordon, 1962; holden et al., 2010). the purpose of social work education extends beyond solely delivering education to students. more importantly, the intended outcome is equipping social workers to effectively lead the profession’s commitment to achieving economic and social justice for individuals, families, and communities (cswe, 2022. as such, further attention surrounding current standards and practices in social work education is called for. while field education has had long-standing recognition as an integral component of social work education, the council on social work education (cswe) pronounced field education the signature pedagogy of social work education in the 2008 educational policies and accreditation standards (epas), aligning the declaration to the accreditation process (cswe, 2008; garthwait, 2017; holosko & skinner, 2015). field education as the signature pedagogy of social work education was reaffirmed in the 2015 epas, the version that most accredited programs are currently operating under (cswe, 2015). over a decade about:blank skeen/field education 205 after the cswe elevation of field education, stakeholders within the field continue to debate the distinction (asakura et al., 2018; bogo, 2015; earls larrison & korr, 2013; holden et al., 2010; lyter, 2012; wayne et al., 2010). the term “signature pedagogy” refers to the characteristic features of teaching and learning that define and organize the ways in which future practitioners are educated for their specific discipline and is first attributed to shulman (2005a), a distinguished scholar on pedagogical content from the carnegie foundation for the advancement of teaching. a defining feature of a signature pedagogy is the provision of a framework that guides a discipline’s values, content, and competence (earls larrison & korr, 2013; shulman, 2005a). central to this definition includes the widespread recognition of the signature pedagogy as well as its consistent inclusion across fundamental instruction (shulman, 2005a). relative to field education, the associated framework is the epas, which includes the policies and standards required for program accreditation. as a condition of accreditation, recognition and inclusion of signature pedagogy should be apparent within a program’s epas self-study. the purpose of this study was to explore how accredited undergraduate social work programs, the first building block of social work education, demonstrate alignment with field education as signature pedagogy as a part of their accreditation process. while several researchers have examined field education as pedagogy, this article contributes to the literature by analyzing the presentation of field education in epas self-studies using two key criteria of signature pedagogy: widespread identification and inclusion across curriculum (shulman, 2005a). specifically, a content analysis was applied to examine the existence of the pervasive recognition of field education as the signature pedagogy and consistent focus on field instruction across the curriculum. literature review higher education, professional practice programs, and social work education over 100 years ago, the responsibility for training those within practice-based disciplines was moved from an apprentice-style model to higher education (day & tytler, 2012). prior to this, it was typical for students within professional practice programs to learn by doing (i.e., situated in the field as opposed to in a classroom). forging a relationship with academia provided leverage for practice-based fields seeking the recognition and status bestowed upon professional disciplines. flexner (2001), a major influencer in education, furthered this battle of legitimacy by singling out medical education as superior, citing the “deficient” curriculum and lack of scientific methods of other fields. findlow (2012) specified social work as one of the practice fields that shifted their hands-on training approach in search of an academic identity. attempts for social work to define itself ultimately deferred to the metrics used within the medical and science professions for validation (bruno, 1944; gitterman, 2014). however, those outside of the field still challenged the legitimacy of social work as a profession. addressing the national conference of charities and corrections in 1915, flexner (2001) concluded that social advances in social work, spring 2023, 23(1) 206 work did not meet the defining criteria of a profession. his claim, in part, was based on the breadth of roles that social workers fill and on the interdisciplinary nature of the field (flexner, 2001; tosone, 2016). flexner’s landmark attestation served as a catalyst that pushed the social work field toward professional stature and away from its communitybased roots (austin, 1983; gelman & gonzalez, 2016). as a result of moving practice fields under the auspices of higher education, a safety net was created for those disciplines yearning for the prestige associated with professional status. to maintain the validation as a worthy profession, practice disciplines have since sanctioned and participated in a variety of litmus tests such as the accreditation process and declaring a signature pedagogy. the litmus tests accreditation. accreditation was introduced into higher learning institutions in 1871 (hegji, 2020). within higher education and professional programs, accreditation processes are led by an independent body and include a self-assessment and external peer review. the accreditation standards applied to each profession are developed by experts in the field to assure the public that a program meets accepted standards and adheres to a process of continuous improvement. the 81 higher education accrediting bodies in the united states are recognized by either a governmental entity, the u.s. department of education, or a non-profit organization, the council for higher education accreditation (chea, 2020; u.s. department of education, 2006). while the influential oversight of the various accrediting entities provides the framework for american higher education, a review of the literature yielded little to no findings on empirical research done to validate the accrediting bodies themselves. in 2005, the u.s. department of education admitted a more transparent and accountable accreditation system was needed (u.s. department of education, 2006). in 2009, wiley, the chea board chair, contended there were many strengths to accreditation, but justified skepticism in the current self-regulatory system and urged for extensive improvements (chea, 2020). citing the significant time and cost related to the accreditation process within the medical field, van zanten et al. (2012) argued for increased research on and evidence to substantiate the standards. in order to ensure the reliability and validity of assessment standards used within the medical community to determine physician competence, multiple medical groups are now working in concert to test current approaches and to develop new models (american board of pediatrics, 2020). the medical field’s nature of scientific inquiry is widely regarded as a model for other professional fields. as such, dedicating a similar level of commitment to research and evaluation of accreditation standards and policy decisions should be considered by other fields as well. signature pedagogy. the term “signature pedagogy” was developed by shulman (2005a) to describe the distinct and consistent methods of a specific profession to impart knowledge and values of the field. within practice fields, the responsibility of identifying and applying these practice guidelines extends beyond the classroom and have real-life skeen/field education 207 implications for the specific profession and larger society. yet, many professional disciplines with a declared signature pedagogy are criticized for failing to meet shulman’s definition (crookes et al., 2020). crookes et al. (2020) suggested the need to better utilize research and evidence-based findings to authenticate alignment with shulman’s signature pedagogy framework. social work, accreditation, and signature pedagogy. furthering the pursuit of professional recognition, in 1930 the professional standards of education for social workers, a branch under the national conference of social work, was established (bruno, 1944). this group began oversight of social work education programs comparable to current day accreditation site visits (bruno, 1944). in 1952, the council on social work education (cswe) was founded and is the sole entity recognized by the chea with authority for present-day accreditation of social work education (thyer, 2009). despite the longevity of social work accreditation, a review of the literature reveals long-standing debate on the caliber of the process. arkava and brennen (1975) discussed early dilemmas faced by social work accreditation to simultaneously address both studentcentered priorities and the economic realities of institutions. this plight resembles current struggles facing social work education and higher learning today. for instance, karger and stoesz (2003) contended that the expedited growth of accredited social work programs has propelled universities to engage in a desperate competition for student enrollment and tuition. kagle and colleagues (2002) argued that cswe accreditation standards relating to the qualifications for program leadership are too restrictive and may jeopardize the future advancement of social work education. stoesz and karger (2009) further suggested that a different accrediting entity be established, alleging that cswe lacks accountability, offers inadequate research on its own standards, and advances negligible scholarship produced by cswe leadership or program deans and directors. watkins (2008) of cswe offered a response to the criticism explaining that the primary goal of accreditation is quality assurance, thereby providing the structural framework that defines quality while providing freedom for institutions to develop their own mission, goals, curriculum, and faculty expectations. while watkins also contended that the quality of a program extends beyond the number of published articles one produces, multiple researchers document the trend of universities to hire based on the production of scholarship and research (green, 2008; johnson & munch, 2010; thyer, 2009). thyer (2009) refuted the idea of establishing a new accrediting body and instead advocated that cswe strengthen current accreditation standards. several researchers recognized the ongoing improvement made to the cswe accreditation process. this includes a refinement of the competency standards and defining components of an integrated curriculum design, both reflected in the 2008 epas (petracchi & zastrow, 2010). poulin and matis (2017) noted that evaluation of student learning no longer includes student self-assessment and requires a higher level of validation from faculty and/or field supervisors. as well, the 2015 epas introduced competency-based learning standards, a new norm found within higher education social work (poulin & matis, 2017; rissi & gelmon, 2014). also aligned with the approach of other professional fields, cswe declared a signature pedagogy for social work education. shulman (2005a) argued that within professional advances in social work, spring 2023, 23(1) 208 fields there is a central and accepted method of teaching and learning to prepare one for professional practice and to socialize students to the values of the field. field education was elevated with this distinction and the 2008 epas was updated to reflect a signature pedagogy for social work education for the first time (boitel & fromm, 2014). yet, there is ambiguity regarding the status of field education as signature pedagogy found within the epas, the same document in which cswe has proclaimed the distinction. for example, in the 2008 epas education policy 2.3 and in the 2015 epas educational policy 2.2, field education is identified as the signature pedagogy while also equating, not elevating, its role to classroom instruction. in addition, delineated in the first line of each version of the policy, cswe appears to diminish the magnitude of signature pedagogy from serving as the “central form of instruction and learning” in 2008 (p. 8) to “elements of instruction” in 2015 (p. 12). this language raises questions about the alignment of field education, as shulman (2005a) asserted that signature pedagogies are “critical aspects” that “organize the fundamental ways in which future practitioners are educated for their new professions” (p. 52). while there is general consensus about the essential importance of field education to social work education, the status of field education has held shifting ranks of importance over time. even after the initial curriculum was established for social work education, the amount of time spent in field-related training versus classroom instruction remained inconsistent among schools (bruno, 1944). garthwait (2017) noted that cswe began developing standards for social work education upon inception, yet 20 years passed before field education was mandated at the undergraduate level. the early issues surrounding the relationship of field education to both classroom instruction and to social work education as a whole remain contemporary concerns. scholars, too, hold a difference in agreement as to whether field education embodies the role of signature pedagogy. multiple studies identified field education as the premier experience that socializes students to the field and prepares students for professional practice (bogo, 2010; globerman & bogo, 2003; lager & robbins, 2004; parker, 2006). wayne and colleagues (2010) noted that field education standards possess some consistent organizational mandates deemed important to signature pedagogy, such as a minimum number of hours and requirement of social work supervision to support student learning and socialization. yet, wayne et al. (2010) also remarked on the lack of consistency that exists within field education programs as well as a variance in the practicum experience, both contrary to defined pedagogy. earls larrison and korr (2013) argued that field education is not signature pedagogy, citing that the practicum is not distinct to social work education and is only part of the fundamental framework for instruction. others have contended that the fixation on molding social work education to fit a predetermined definition of professionalism endangers the fundamental role that the field education experience has in adequately preparing students for professional practice (bruno, 1944; farber & reitmeier, 2018). although scholars differ on many aspects of the field, there is little debate that cswe holds significant power over the entirety of social work education. cswe’s landmark decision to elevate field education as the profession’s signature pedagogy in the epas mandates programs to comply with related requirements as a condition of accreditation. skeen/field education 209 recognizing field education as signature pedagogy may influence how social work programs are designed and how students are educated to deliver critical social work practice to individuals, families, and communities. therefore, further exploration of the connection between accreditation and signature pedagogy in social work education is warranted. method content analysis is an accepted approach to examine textual materials in order to conceptualize explicit and implicit treatment of a subject and to identify patterns (hong & hodge, 2009; hsieh & shannon, 2005; mehrotra et al., 2017). as such, a content analysis using both deductive and inductive approaches was applied to explore the extent to which a sample of accredited undergraduate social work programs recognize field education as signature pedagogy in the epas self-study. the epas self-study component of cswe accreditation is a comprehensive self-review of program development, implementation, and evaluation which includes written detail and accompanying evidence of adherence to the standards (cswe, 2008, 2015). while qualitative in nature, conducting a content analysis of this textual document yielded outcomes that include quantitative data. although the quantitative data is descriptive in nature, and therefore may not be generalizable, it provides a type of analysis that is not available in the current literature. for this content analysis, field education includes both the field seminar, which is facilitated as a classroom course as well as the field experience or practicum, which is the hands-on training of students within an approved agency setting under the supervision of a qualified social work field instructor. as the data to be collected was publicly available online, this study was deemed exempt by the institutional review board (irb). data collection the accessed epas self-studies were publicly available online and were identified using general search terms such as “cswe self-studies”, “epas self-studies”, and “social work accreditation self-studies”. for purposes of this analysis, the selected epas selfstudies were from accredited undergraduate programs and dated after 2008, the year field education was first recognized as signature pedagogy in the epas. in total, the study sample consisted of 16 epas self-studies. although this study does not reveal the names of the involved universities, information was collected on whether the program operates as a separate school of social work or as a department as well as if field education is run as a block placement or concurrent to classroom instruction (see table 1). also, the university location is identified using the nine established cswe regions (see table 1). all regions, except for the northeast region, are represented. advances in social work, spring 2023, 23(1) 210 table 1. sample of social work programs by region, structure, and type id number cswe region structure program type bsw1 great lakes concurrent separate school bsw2 west concurrent separate school bsw3 new england concurrent department bsw4 rocky mountains concurrent department bsw5 mid-atlantic concurrent department bsw6 south central concurrent department bsw7 great lakes concurrent department bsw8 great lakes block department bsw9 southeast block separate school bsw10 south central concurrent separate school bsw11 south central concurrent department bsw12 northwest concurrent separate school bsw13 south central block department bsw14 mid-atlantic concurrent separate school bsw15 great lakes concurrent department bsw16 rocky mountains concurrent department the content analysis focused on two key criteria of signature pedagogy defined by shulman (2005a): the “pervasive” or widespread recognition of the signature pedagogy by the specific field and its “routine” or consistent use across the curriculum. first, data were collected to determine the extent to which field education is recognized as signature pedagogy in the epas self-studies across all four standards: program mission and goals, explicit curriculum, implicit curriculum, and assessment. the four standards remained consistent in title but not in identifying number across both versions. then, evidence was gathered to establish if a consistent focus on field education as the central form of teaching and learning was present in two areas: in the full section of explicit curriculum which contains the formal educational structure and curriculum, and in the faculty section of implicit curriculum, which details the educational environment such as policies and practices. data analysis nvivo was selected as the tool to collect, organize, and assess the data. to analyze the data, an inductive strategy was used to determine frequency and a deductive approach was applied to assess treatment. this content analysis provides the foundation for future research involving epas self-studies and other accreditation-related materials. determining widespread recognition to determine widespread recognition of field education as signature pedagogy across all four areas of the self-study document, the number of times the term “signature pedagogy” was linked to field education was examined. excluded was presence of the term when it was a predetermined title contained in the epas or referencing a cswe policy or standard. also excluded were references to pedagogy as a general practice of teaching or philosophy. skeen/field education 211 assessing for evidence of routine use the two pre-identified sections of the epas self-studies were assessed for evidence of field education as the central framework for teaching and instruction across program design. affirmative data was defined as language that prioritized field education as the fundamental way students are socialized to the profession and/or focused on field education in course descriptions, learning objectives, and/or across curriculum design. additionally, the rank or tenure status of the field director and the extent to which any social work faculty had published research related to field education were assessed; both indicators would support field education was embraced as a signature pedagogy. findings frequency of widespread recognition the number of times the sample epas self-studies included references to field education as signature pedagogy ranged from 0 to 15, with zero occurrences having a larger representation than the other groupings. overall, five programs (31%) had zero occurrences, four programs (25%) had a single occurrence, one program (6%) had two occurrences, two programs (12%) had three occurrences, one program (6%) had four occurrences, one program (6%) had five occurrences, one program (6%) had six occurrences, and one program (5%) had 15 occurrences. the 15 occurrences from the one program were all references that explained the connection of each course to field education. three patterns of frequency were found: those with zero occurrence, those where occurrence was found only in the explicit curriculum section, and those where frequency was found across multiple sections. of the three identified patterns, those with occurrence in only the explicit curriculum section was the largest group. of the 16 epas self-studies, five (31%) had a pattern of zero occurrence, seven (44%) had occurrence solely in the explicit curriculum section, and four (25%) had occurrences in two different sections. two (13%) of the programs with multi-section occurrences had one brief reference to signature pedagogy each in the mission and goals section. evidence of field education as central form of learning and instruction two themes were identified in the explicit curriculum section. the first was related to the way programs explained how field education was integrated into the curriculum and the second was the expressed equity communicated by programs between field education and classroom instruction. in the implicit curriculum: faculty section, two themes surfaced. one involved the connection between field education as signature pedagogy and tenure status of the field director and the second focused on the relationship between field education and faculty background and/or expertise. advances in social work, spring 2023, 23(1) 212 explicit curriculum direction of the integration of field education. in general, the sample epas selfstudies echo the language of the cswe educational policy 2.2 describing field education as the responsible entity for the integration of classroom knowledge and skill development. for example, the epas self-study of bsw13 credited field education as the “…richest component for discussing operationalization of curriculum content.” similarly, the epas self-study of bsw10 assigned the field practicum as the sole element to “offer students the opportunity to apply classroom knowledge to practice.” this one-way direction of curriculum integration, often occurring at the end of the educational experience, does not support shulman’s definition of signature pedagogy as pervasive or routine instruction, nor does it uphold the distinction as the fundamental component of curriculum design. in addition, there was a varying degree of structure to and frequency of the field seminar with the sample group, a component available to strengthen integration between theory and practice. eight of the epas self-studies provided evidence of partial integration of field education across the explicit curriculum design. specifically, this included the description of a bi-directional integration between field education and a limited number of classroombased courses. for example, the epas self-studies of bsw1 and bsw2 required that a practice course and field education be taken concurrently. the epas self-study of bsw14 revealed reasoning for requiring that a research course be taken concurrently with field placement stating this “…facilitates students’ application of theory and research to their practice.” other epas self-studies described the intentional use of assignments in select classroom courses that are based on experiences in the field practicum. a focus on student readiness for field education also was identified in relation to integration. typical solutions were the inclusion of a new course or the addition of a specific learning module within the existing field seminar. for example, the epas selfstudy of bsw12 stated, “…juniors were not ready for field in some cases so the program wanted to provide a bridge course…” in this program a new course was developed to prepare students for field experience as opposed to realigning all courses to support these efforts. of note is the mention that the newly developed course was “a very popular class…students wanted practical skills and foundational work…practice is essential and important.” two epas self-studies, bsw3 and bsw8, stood out with high and consistent levels of integration across the curriculum, supporting field education as signature pedagogy. the epas self-study of bsw3 described the level of integration of field and classroom instruction as “immersion,” pointing to “…a coherent and integrated curriculum…competencies serving as a primary vehicle for linking classroom curricula directly to field curricula and practice.” this program designed the field education component to occur over six semesters stating that this “facilitates translation of classroom learning into the field setting in real time.” while this level of integration supports shulman’s definition of signature pedagogy, the authors of the self-study then contradicted field education as signature pedagogy by contending “the entire bsw curriculum is the pedagogy of the field.” bsw8 required a 40-hour practicum as a part of the introduction skeen/field education 213 to social work course. here, the introductory course was described as the “gatekeeper” for students, as they must successfully complete the course before being allowed to declare social work as a major. the bsw8 epas self-study demonstrated alignment with signature pedagogy by explaining, “because field education is the signature pedagogy it is critical that students begin their studies with both classroom and field experiences, providing the opportunity to intellectually integrate learning from both.” distinct from all others in the sample, the epas self-study of bsw8 included course descriptions detailing how each class prepared students for field education. in some of the epas self-studies, the importance of integrating learning across the curriculum overlooked field education, and instead focused on specific professional behaviors, other social work courses, and even general education courses. for example, the epas self-study of bsw13 highlighted a commitment to “infusing through the curriculum” components such as ethics, diversity, and identifying as a professional. although the epas self-study of bsw13 acknowledged the ongoing assessment of and changes within their program to align with the 2008 epas, no information was provided on prioritizing the inclusion of field education across the overall curriculum. the epas self-study of bsw16 stated that the human behavior and the social environment course “is an integral part of the social work curriculum…the content undergirds subsequent practice, policy, and research courses…,” yet failed to mention the role of field education in relation to the integration of learning. while the content analysis revealed multiple variations in program design and structure of field education, all programs identified field education as the one course where each of the required learning competencies would be assessed. yet, the process for assessing how the competencies would be demonstrated was wide-ranging. expressed equity between field education and classroom instruction. a common theme across the sample epas self-studies indicated an equal standing between field education and other social work courses. for example, in the introductory paragraph of the explicit curriculum section, which clarifies the purpose and structure of social work education, the terms “courses” and “field education” were equally identified with no mention of a signature pedagogy. also, the epas self-study of bsw6 identified the five professional foundation areas as “hbse, policy, practice, research and field.” while this equity is consistent with the language of the epas standard, it does not distinguish field education as the signature pedagogy. in other areas, a de-prioritization of field education was found. for instance, of the three educational policies included in the explicit curriculum section, the one related to field education as signature pedagogy is listed last, seemingly incongruent for a discipline’s signature pedagogy. further, in reviewing the epas educational policy focused on field education as signature pedagogy, there was a weakening of the defining criteria for a signature pedagogy from “the central form of instruction and learning” in the 2008 epas to “elements of instruction” in the 2015 epas. in this same section of both epas documents, equal importance was assigned to field education and classroom instruction. advances in social work, spring 2023, 23(1) 214 implicit curriculum: faculty connection between field education as signature pedagogy and tenure status of the 16 field directors identified in the sample epas self-studies, seven (44%) were tenured field directors-six with a doctoral degree and one with an msw. yet, three of the seven tenured faculty were in programs whose epas self-studies had no references to field education as signature pedagogy. of those nine (56%) in non-tenure track positions, eight held both a msw degree and a social work license and one had a phd and a social work license. although doctoral status appears connected to tenure status, no apparent relationship exists between a program which demonstrated alignment with signature pedagogy and the tenure status of the field director. field education as signature pedagogy and faculty expertise. only four (25%) of the 16 social work program deans or directors had previous experience with field education as indicated on their resumes. three of these were program directors within social work departments and one was the director of a program that operates as a separate school of social work. the director of the separate school of social work was from one of the five programs with no references in the epas self-study to field education as signature pedagogy. the sample of epas self-studies showed varied topic areas of published scholarship among faculty. only one of the 16 field directors had any identified published research. this field director had two published articles; one focused on global opportunities in field education and the other was not related to field education. the vast majority of the social work program directors and other tenured staff had at least one published journal article, yet none were related to field education. although typically not regarded as scholarship, many field directors were involved in writing field education manuals, assisted with the accreditation process, and presented at conferences. discussion this study offers a novel perspective to the existing research on field education as signature pedagogy by considering how social work programs demonstrate alignment as a part of the epas self-study, a component of the accreditation process. as undergraduate programming serves as the foundational level of social work education, starting with an examination of this stage of education was deemed appropriate. although the small sample size of epas self-studies in this analysis presents some limitations, the ability for direct examination of explicit and implicit communication in a text allows for descriptive quantitative and qualitative analysis. as only one coder was involved in the data collection and analysis, the frequency assessment in nvivo was replicated to confirm data and ensure accuracy. to address validity, the analysis was framed using two of shulman’s defining criteria for determining signature pedagogy: widespread recognition and pervasive use. the self-study component of the epas is a primary document used as a part of accreditation, thus a strength of the study is the use of a readily understood tool for analysis. in addition, as many epas self-studies are publicly available on the internet, they provide skeen/field education 215 a replicable and inexpensive option for further analysis. the potential exists that the programs in the sample may not have adequately reflected their level of alignment to field education as signature pedagogy in the self-study. future analysis could be strengthened by increasing the sample size, including interviews with field directors or other key stakeholders, examining other relevant program material, or comparing current and archival data. the findings of the content analysis reinforced the important role of field education in social work education, yet it revealed a hesitance by programs to adopt language and action needed to affirm field education as signature pedagogy based on shulman’s defined criteria. this raises justified questions as to whether the distinction of field education as signature pedagogy is rhetorical language or if it exists in reality and can be substantiated by evidence. arguably, recognition of a signature pedagogy would be expected in the explanation of a program’s mission and goals. however, only two of the 16 sample epas self-studies had a reference in this defining section; both were brief mentions with no explanation. in addition, although all of the 16 sample epas self-studies were dated after the 2008 landmark decision by cswe to elevate field education as signature pedagogy, nearly one-third included no direct reference to this relationship. while written documentation may not fully capture what is being done explicitly within social work education programs, the inconsistent and/or nonexistent recognition of field education as signature pedagogy cannot be overlooked. regardless of the various misalignments, all the programs in the sample were accredited by cswe. this discrepancy, alone, suggests the need to further examine the expressed and applied definition of signature pedagogy within social work education. over a decade after cswe declared field education as the signature pedagogy for social work education, there remains ambiguous language within the cswe accreditation policies and standards themselves. this lack of clarity impedes the ability of a program to demonstrate alignment. for example, within the epas document is the required cswe standard that programs “develop a coherent and integrated curriculum for both classroom and field” (cswe, 2008, 2015, p. 11). the meaning of “integrated” is left vague and reinforces the generally accepted practice that field education assumes the primary responsibility for the integration of theory and practice. the continuum of what constitutes integrated curriculum in education was examined by drake and reid (2020). they contended a higher-level use of integration, either interdisciplinary or transdisciplinary, may yield better learning outcomes for students (drake & reid, 2020). additional research findings showed that in addition to advanced learning, the integration of a signature pedagogy across the curriculum in academia reinforced learning of required core competencies and improved faculty collaboration (uchiyama & radin, 2009; watts & hodgson, 2015). this bidirectional integration appears to be more aligned with shulman’s definition of signature pedagogy. the discrepancies within both the sample of epas self-studies and the cswe policies and standards reveal insufficient evidence to affirm field education as signature pedagogy based on shulman’s defined criteria. the additional connection of a signature pedagogy to accreditation exerts a consequential influence on how social work programs are designed advances in social work, spring 2023, 23(1) 216 and how future professionals are educated to deliver critical social work practice. this provides an opportunity to re-envision a signature pedagogy for social work education that better meets the charge to prepare future practitioners “to think, to perform and to act with integrity” (shulman, 2005a). instead of positioning either field education or classroom instruction as more central to social work education, cswe could maximize the relationship between them. this can be accomplished by upholding, not disregarding, the unique tenets of social work as a broad-based field that engages teaching, scholarship, and practice. many have called for a strengthening of social work education and an end to the separation often found between field education and classroom instruction, enabling authentic university-agency partnerships that extend beyond the field experience (buck et al., 2012; raskin et al., 2008; reisch & jarman-rohde, 2000). a bi-directional integration of field education and classroom instruction could include extending the use of the learning plan and the related evaluation of competencies across the entirety of the curriculum. additionally, the impact of field education could be advanced by ascribing a base level of standardization to the seminar component. shulman (2005b) suggests the seminar is the signature pedagogy of liberal education due to its similarity to the essential interaction and engagement among students and instructors of professional pedagogies. finally, implementing program-wide strategies could result in an expanded and more accurate framework of what constitutes an authentic signature pedagogy for social work education. these includes steps such as requiring all faculty to be involved in preparing students for field education, ensuring the learning objectives for all courses support the preparation for entry into field education, and updating program materials to clearly demonstrate a commitment to a bi-directional curriculum design. shulman argued signature pedagogies are not static, instead they must be able to respond to changes in the field and in the practice environment (shulman, 2005b). as such, engaging in ongoing curriculum mapping and regular evaluation could confirm program compliance and identify needed adjustments to ensure continuous alignment to the signature pedagogy. as the sole accrediting body, cswe can provide clarity in the next version of the epas on the function of a signature pedagogy and advocate for the full integration of field education and classroom instruction. beyond meeting a prescribed definition of a professional discipline or claiming a signature pedagogy, this reimaging has the potential to reconnect theory to practice and enhance the competencies needed by 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(2010). field education as the signature pedagogy of social work education. journal of social work education, 46(3), 327-339. https://doi.org/10.5175/jswe.2010.200900043 author note: amy skeen, simmons university, boston, ma. email: amy.skeen@simmons.edu https://doi.org/10.1080/15236803.2014.12001792 https://doi.org/10.1162/0011526054622015 http://files.eric.ed.gov/fulltext/ej697350.pdf https://doi.org/10.1177/1049731507313976 https://doi.org/10.1177/1049731508318632 https://doi.org/10.1080/10437797.2016.1174649 https://doi.org/10.1007/s10755-008-9078-8 http://files.eric.ed.gov/fulltext/ed493504.pdf https://doi.org/10.3109/0142159x.2012.643261 https://doi.org/10.1177/1049731508317255 https://doi.org/10.1080/02615479.2015.1048217 https://doi.org/10.5175/jswe.2010.200900043 mailto:amy.skeen@simmons.edu field education as the signature pedagogy of social work: rhetoric or reality? ____________________ nakita w. scott, dsw, lcsw, assistant professor, department of social work, southeastern university lakeland, fl. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 277-295, doi: 10.18060/28159 this work is licensed under a creative commons attribution 4.0 international license. addressing identity disruption and displacement through a culturally responsive ecological model of trauma assessment nakita w. scott abstract: identity is complex and embodies cultural, social, and place identity. these three parts of identity connect to an individual’s sense of belonging in the world. identity disruption or identity displacement can occur when trauma happens related to one’s culture. current methods of assessment fail to recognize the role of disruption or displacement among marginalized populations. furthermore, current validated trauma assessments are often not generalizable to racial and ethnic minorities. the primary aim of this conceptual paper is to provide guidelines for the inclusion of identity-based factors in culturally responsive trauma assessment. the secondary aim is to discuss culturally responsive trauma assessment approaches, which include an exploration of identity disruption and displacement as a dimension of adverse experiences. a culturally responsive, ecological approach to trauma assessment is then introduced with implications for social work education, practice, policy, and research. keywords: identity, trauma, displacement, disruption, assessment identity is multidimensional, as an individual can be connected to and comprised of multiple identity classifications. examples of personal or cultural identity include gender, race, ethnicity, religion, sexual orientation, migratory status, and ability (physical and intellectual). influences from one's environment (e.g., school, family, church, home, community, country of origin) define social identity, which connects to one's sense of belonging. identity encompasses culture as well as a variety of other aspects of who an individual is personally, such as their gender identity, level of education, religion, sexual orientation, and many others (bryant-davis, 2005). individuals can hold several identities, based on membership with diverse groups, which allows them to be affected by many diverse cultures (bryant-davis, 2005). understanding the identification of a client helps the therapist make more accurate assumptions about the significant cultural influences in that person's life (hays, 2008), yet how therapists assess cultural identity through a trauma lens is limited. additionally, current models of biopsychosocial assessment fail to include questions that explore identity and how experiences with trauma impact identity. the purpose of this paper is to explore the role of identity in relation to trauma, identify assessments and screening processes that address identity-based trauma experiences rooted in sociocultural and place identities, and offer an ecological model of culturally responsive trauma assessment. in actively exploring these matters, social workers can better equip themselves to understand how culture and identity impact clients' experiences of trauma and to provide culturally appropriate, trauma-responsive interventions. about:blank advances in social work, spring 2025, 25(1) 278 literature review an ecological perspective of identity and trauma a variety of interactions across system structures, including those in the family, cultural, social, political, and psychological domains, impact human development and mold one’s behavior, life choices, and well-being over a lifetime (backonja et al., 2014). bronfenbrenner's ecological theory strongly emphasizes how interactions between people and their surroundings can influence human development (keenan et al., 2016). bronfenbrenner’s ecological systems theory of identity states there are five interrelated environmental systems known as microsystem, mesosystem, exosystem, macrosystem, and chronosystem that help to support and guide human growth and development (bronfenbrenner, 1994). according to bronfenbrenner's ecological systems theory, these interrelated environmental systems, ranging from a person's immediate surroundings (such as their family) to more general social structures (such as culture), have an impact on how an individual develops and is influenced by cultural factors like socioeconomic status, wealth, poverty, and ethnicity (bronfenbrenner, 1994). consequently, people's views and perceptions about themselves, their identities, and how things are in the world may be influenced by the culture and contexts in which they are raised (bronfenbrenner, 1994). for example, experiences of poverty and homelessness may impact a child’s access to quality education, thereby impacting their ability to engage in classroom learning. social influences from families, friends, communities, and cultural norms, play a role in identity formation as individuals are influenced by both their innate characteristics and the social and communal environments in which they are raised (hoare, 2009; keenan et al., 2016). trauma and identity trauma is broadly defined as experiences or situations that cause long-lasting negative impacts while also being physically, emotionally, or life-threatening to the individual (substance abuse and mental health services administration [samhsa], 2014b). it is characterized by a eurocentric, monocultural bias, even in the face of a professed dedication to cross-cultural collaboration (craps, 2014). the ecology of an individual’s trauma is shaped by the interrelationship of the individual and their community, as the environment can influence an individual’s health and resiliency (harvey, 1996). this can directly impact identity formation. traumatic events can disrupt one’s identity by altering one’s values and beliefs of the world around them. due to the relationship between identity and trauma, identity can impact posttraumatic distress or posttraumatic growth (berman, 2016; berman et al., 2020). consequently, identity can impact the way the individual perceives, interprets, and experiences traumatic events (berman, 2016). identity, nonidentity, or pre-identity traumas, like parental abandonment and traumas caused by nature, can result in such cumulative trauma disorders (ctd) when experienced concurrently or consequentially by an individual (kira et al., 2011). scott/culturally responsive trauma assessment 279 identity, trauma, and culture the emotion, expectation, and belief that one fits in the group and has a place there, as well as a sense of acceptance by the group, all contribute to a person's well-being, sense of belonging, and identity (mcmillan & chavis, 1986; scannell & gifford, 2016). the development of a person's connection to a place is a dynamic, multi-layered process based on the articulation of at least three dimensions: subjective (a person's perceptions of a place), social (relationships with the local population), and physical (the surrounding environment; luci, 2020). positive emotional connections that form between individuals and their surroundings are usually understood as place attachments (jones & walker, 2023; lewicka, 2008; scannell & gifford, 2016). gender, race, ethnicity, social status, sexual orientation, age, physical or intellectual ability, and religion/spirituality shape how individuals experience life, as they intrinsically link with one another (alessi & martin, 2017; yakushko et al., 2009). person-environment interactions are supported by psychological ties to locations (jones & walker, 2023; lewicka, 2008). as children learn to distinguish themselves from, yet still be connected to, their physical environment, they begin to acquire a sense of what many researchers refer to as place identity (hauge, 2007). place identity is a component of social identity involved in self-categorization and social comparison and may include a connection or attachment to specific geographical locations or types of places such as beaches, mountains, urban areas, liberal cities, etc. (bernardo & palma‐oliveira, 2013; lewicka, 2008). it can also be described as the characteristics of a region—its people, inhabitants, and culture—that set it apart from others (paasi, 2003). like how gender and social class are substructures of self-identity, place identity is made up of perceptions and understandings of the environment (hauge, 2007). these perceptions and conceptions can be divided into two categories of clusters: the first category includes memories, thoughts, values, and settings, while the second category includes the interaction between various settings (hauge, 2007; proshansky et al., 1983). group membership in these identities may cause individuals to become marginalized and more prone to identity-based victimization or hate-based violence (allwood et al., 2021). hate crimes are becoming more common in the united states (federal bureau of investigation [fbi], 2019). in 2021, 7,287 offenses in the united states were perpetrated against individuals based on their membership in a marginalized identity group (fbi, 2022). a single trauma occurring once in a lifetime is unusual among cultural, refugee, and minority communities (kira et al., 2011). those who are marginalized or who experience stigma and discrimination, disabilities, homelessness, political repression, communal/societal violence (including gang, military, and paramilitary conflict), forced immigration (refugees, and asylum seekers), interrogation and torture, terrorism, genocide, and major disasters are especially vulnerable to experiencing traumatic stressors and developing posttraumatic stress disorder (ptsd) and related disorders (ford et al., 2015). identity threats are defined as events that highlight a tension between a person's current setting and a marginalized identity they possess (slepian & jacoby-senghor, 2021). hays (2008) discusses the concept of insidious trauma, a term developed by maria root. insidious trauma refers to the traumatogenic repercussions of oppression that harm the soul advances in social work, spring 2025, 25(1) 280 and spirit but are not always openly violent or harmful to one's physical well-being at the time and is based on the characteristics of an individual’s identity that is devalued by the dominant culture (e.g., race, gender, sexual orientation, disability; hays, 2008; root, 1992). it can also include the intergenerational transmission of trauma based on the traumatic experiences of one’s ancestors such as the holocaust, loss of sacred lands experienced by native americans, and slavery (hays, 2008). people who have directly or indirectly experienced identity-based trauma or hatebased violence may exhibit ptsd or complex ptsd symptoms, such as flashbacks, avoiding reminders of the event, and maintaining a mental state of high vigilance or being on guard out of concern for future acts of violence (bryant-davis et al., 2017). these symptoms are similar to those included in the diagnostic criteria for posttraumatic stress disorder (american psychiatric association [apa], 2022). the trajectory of identity development and its behavioral outcomes are determined by how the emerging identity responds to stressful or threatening internal and external stressors and traumas (kira, 2019). whether the attacks constitute a risk to one's life or physical integrity, non-life-threatening prejudice and discrimination events can be perceived as traumatic assaults on an individual's identity (bryant-davis & ocampo, 2005). trauma can be understood in the context of identity disruption and displacement. identity disruption occurs when a major life event, such as trauma, occurs and disrupts normal identity development, thereby altering one’s self-view (brown & mcgill, 1989; vartanian et al., 2022). the incongruence of social behavior causes disruption based on cultural expectations (boyle, 2017). disruptive occurrences might cause people to reevaluate their identities considering the new circumstances, forcing them to do so (mitchell et al., 2020). an individual's identity formation may be significantly impacted by an experience of displacement, which can also cause feelings of loss, disorientation, and a sensation of being out of place. multiple levels of trauma, loss, and transformation are present during the experience of displacement (odiaka, 2022). discrimination, marginalization, and communal exclusion can all be part of the displacement experience (odiaka, 2022). as people navigate various levels of identity, including their cultural, social, and personal identities, identity development after disruption or displacement can be difficult (odiaka, 2022). conceptualizing trauma in assessment the concept of trauma in assessment is often measured in terms of adversity. adversity is a broad concept that covers a variety of situations or occurrences that seriously jeopardize someone's physical or psychological health (dym bartlett & sacks, 2019). early adversity may interfere with one's sense of self because these early experiences are invalidating or because people are denied experiences (such as positive relationships with caregivers) that support identity development (vartanian et al., 2022). thus, exposure to adversity can lead to trauma. the variability of adversity often makes it scott/culturally responsive trauma assessment 281 difficult to conceptualize and measure in research studies (berman et al., 2022). in the past, measuring adversity in childhood has either used a specificity method or a cumulative-risk approach. approaches to conceptualizing adversity later included dimensional models (berman et al., 2022; gizdić et al., 2023; mclaughlin et al., 2021). the impacts of personal adversity, such as physical abuse, sexual abuse, neglect, parental death, parental divorce, and persistent poverty, are the focus of specificity models and the research they inspired (mclaughlin et al., 2021). specificity models ignore the cooccurrence of adversity and fail to recognize that some pathways may be similar for many forms of adversity that share similar characteristics; for instance, physical abuse and witnessing domestic violence may raise the chance of anxiety through comparable mechanisms involving altered threat-related processing (mclaughlin et al., 2021). cumulative risk models address the issue of co-occurrence adversity (mclaughlin & sheridan, 2016; mclaughlin et al., 2021). without considering the kind, diversity, duration, or intensity of the experience, cumulative risk calculates the total number of adversity exposures and experiences to get a risk score based on the assumption that all adversities have a comparable effect on human growth (berman et al., 2022; gizdić et al., 2023; mclaughlin et al., 2021). the dimensional model of adversity provides an alternative approach to the specificity and cumulative risk models of adversity (berman et al., 2022; gizdić et al., 2023; mclaughlin et al., 2021). dimensional models are predicated on the idea that it is feasible to pinpoint fundamental aspects of environmental experience that are consistent across a wide range of adversities and have similar characteristics (berman et al., 2022; gizdić et al., 2023; mclaughlin et al., 2021). different approaches to quantifying and comprehending the impact of adversity on evolutionary development and subsequent health and well-being have been suggested by dimensional models (berman et al., 2022; mclaughlin et al., 2021). smith and pollak (2020) disagree with the dimensional idea of conceptualizing adversity through categories due to their seemingly overlapping and vague distinction qualities. they suggest using a typological approach to conceive children's experiences from a more integrative, wide, and still biologically reasonable perspective (smith & pollak, 2020). dimensions of adversity dimensional models of adversity mainly focus on dimensions of threat, deprivation, maltreatment, harshness, and unpredictability. additional but not widely used dimensions of adversity include household or family dysfunction and peer victimization. all experiences, both inside and outside of the home that constitute a threat, involve either direct harm to the child, failure to protect a child from harm because the caregiver is endangered (e.g., exposure to domestic violence), or socio-contextual harm (e.g., being exposed to acts of community violence, being directly harmed due to racism, or being harmed by peers) because the caregiver is exposed to one of these experiences (mclaughlin & sheridan, 2016; mclaughlin et al., 2021; narayan et al., 2023). deprivation experiences entail a developing child's input, resources, or basic needs being diminished, limited, or absent (berman et al., 2022; mclaughlin & sheridan, 2016; advances in social work, spring 2025, 25(1) 282 mclaughlin et al., 2021; narayan et al., 2023). in some dimensional models, maltreatment is seen as partially overlapping with both threat and deprivation (mclaughlin & sheridan, 2016; mclaughlin et al., 2021; narayan et al., 2023). neglect, defined as the lack of intellectual and social stimulation during childhood, institutionalization, and a lack of committed caregiving because of caregiver absence (such as incarceration, abandonment, or death), scarce resources, or caregiver competence, are also evaluated in this category (berman et al., 2022; narayan et al., 2023). losing one's home in the case of homelessness in childhood is also considered a form of deprivation (mclaughlin & sheridan, 2016; narayan et al., 2023). harshness is often coupled with the dimension of threat and includes external causes of morbidity and mortality (berman et al., 2022). unpredictability includes a lack of temporal stability in caregiving and other facets of the early environment and is more difficult to evaluate due to less consensus on how to do so (berman et al., 2022). the dimension of family or household dysfunction covers five situations that expose the child to conflict in their surroundings without endangering them directly: exposure to domestic abuse, parental separation or divorce, and substance abuse, mental illness, or incarceration in parents or family members (sayyah et al., 2022). peer victimization, characterized by relational victimization (being left out or excluded), physical victimization (being pushed or hit), and verbal victimization (being called names or made fun of), can also be seen as a potential dimension of childhood adversity (finkelhor et al., 2015; sayyah et al., 2022). although each dimension represents a threat to the individual's physical and psychological well-being, they still neglect to address adversity from a cultural and identity perspective. socio-ecological approaches to assessment early perspectives erroneously assumed that psychological tests and assessments were objective and culture-free, even though most tests were standardized, validated, and found reliable primarily with white, middle-class, english-language samples (olmedo, 1981). identity with respect to assessment is typically addressed from a demographic standpoint. some researchers will utilize demographic analysis (the examination of a population based on variables including sex, age, and race) to comprehend mental health issues among the general public (kim & kim, 2017). ecograms and genograms have offered valuable ways to comprehend families in their surroundings by outlining connections between individuals or systems inside the microsystem as well as the nature of these interconnections (yasui, 2015). congress (1994, 2005) recognized the importance of incorporating culture into education and created the culturagram, a tool for family assessments that looks at the sociocultural background of the family in ten specific areas. the cultural ecogram (ce), in contrast to the ecogram, genogram, or culturagram, is a visual aid that uses a variety of pictorial signals to help the client recognize certain cultural and ecological influences and barriers that form their attitudes, beliefs, and behaviors in raising their child (yasui, 2015). while these assessment tools address aspects of experience with respect to culture and identity, they are limited to their focus on the family context. scott/culturally responsive trauma assessment 283 culture and identity in trauma assessment attention has been given to the need to address culture and identity in trauma. the harvard trauma questionnaire (htq) has been used to validate trauma assessments in a variety of languages and cultural contexts (bryant & njenga, 2006). in some instances, identity-related trauma has been evaluated with identity-specific scoring systems such as the adverse childhood experiences-international questionnaire (ace-iq), the gender and minority stress and resilience measure, and the race-based traumatic stress symptom scale (rbtsss). kira’s (2001) taxonomy of trauma matrix allows for the assessment of cultural and place identity in terms of personal and collective traumas, interdependence, or disconnectedness (social and place identity), survival traumas, historical traumas, and multigenerational transmission of structural violence. kira’s (2001) taxonomy of trauma matrix includes two classifications of traumasubjective experiences and objective characteristics of traumatic events. subjective experiences include five categories of trauma, one of which includes identity trauma. the second classification includes factitious, indirect, and direct traumas. kira’s (2001) matrix allows for assessing individual, cultural, social, and collective trauma experiences across the lifespan. pamela hays’ (1996, 2008) adressing framework is an approach for arranging and methodically considering the many cultural elements in counseling. the framework lists nine cultural influences of the adressing model that social workers and counselors must consider when collaborating with clients, the corresponding marginalized group impacted, and the biases of power each marginalized group may encounter. these cultural influences include age, disabilities (developmental and acquired), religion and spirituality, ethnicity and race, social status, sexual identity and orientation, indigenous identity, national origin, and gender identity (hays, 1996, 2008). in addition to drawing attention to the diversity among ethnic minority cultures, the adressing model emphasizes the commonalities between cultural aspects of an individual's identity (hays, 1996, 2008). literature gaps numerous studies have shown that people whose identity is described as marginalized can suffer from a variety of detrimental effects such as deficient performance, a loss of interest in the field, and worse health and well-being (slepian & jacoby-senghor, 2021). although the literature supports an intersection between trauma and identity, trauma assessments rarely include questions that account for threats to identity (berman et al., 2020; ford et al., 2015). while the literature regarding trauma recognizes sociocultural and systemic factors such as those experienced by ethnic and gender minorities, refugees, or low-income populations, this recognition has not yet yielded appropriate culturalecological assessments (hoshmand, 2007). assessments such as the gender and minority stress and resilience measure, the race-based traumatic stress symptom scale (rbtsss), and the harvard trauma questionnaire (htq) tend to assess trauma based on one aspect of identity or ethnic minority. trauma assessments often overlook the cultural experiences of healing and resilience because ethnic communities' experiences of trauma are not often addressed (garrow & wimsatt, 2021). place identity frequently goes advances in social work, spring 2025, 25(1) 284 unquestioned until there is change, like that caused by migration (akesson et al., 2017). although it may not be an aspect of identity typically explored within social work practice, it clearly represents an essential dimension of an individual’s environmental sources of and cues of strength, resilience, and safety. current policies in working with specific populations preserve the fundamental idea that different identities should be conceived of and seen as distinct elements rather than as forces that overlap inside each person (yakushko et al., 2009). by investigating identity threats encountered in daily life across many marginalized identities, a fresh approach can be taken to address this crucial focus in trauma research (slepian & jacoby-senghor, 2021). rationale to address literature gap identity stressors and traumas are components of the identity development equation and serve as both a context for and a prerequisite to identity development (kira, 2019). culture, ethnicity, gender, sexual orientation, and disability are all possible identity sources of resilience, but they can also result in long-term stressors including social oppression, prejudice, and stigma, which can worsen psychological trauma and ptsd (ford et al., 2015). a person's gender, color, ethnicity, socioeconomic status, sexual orientation, physical ability, and religion or spirituality are all unquestionably interconnected and do not exist in isolation (yakushko et al., 2009). the coexistence of racism, sexism, heterosexism, ageism, classism, religious intolerance, transphobia, and/or xenophobia can all be considered forms of intersectional oppression (bryant-davis, 2019). the cultural context of trauma is a crucial component because the meaning of trauma varies depending on the culture (van der kolk et al., 1996). religious and social rituals related to loss and disaster play a significant healing role in both individual and collective trauma (van der kolk et al., 1996). place attachment, similar to interpersonal attachment, offers a sense of safety and security (scannell & gifford, 2016). place identity can strengthen individual and collective identity that is simultaneously rooted in the unique cultural, historical, and political influences of one’s home, country, or region of origin (akesson et al., 2017). an ecological approach to trauma assessment should be considered based on the ecological nature of trauma, the reciprocal impact of identity and trauma, and the potential for identity-based trauma to result in symptoms of ptsd and other mental health disorders. therefore, this work will offer recommendations for developing an ecological approach to culturally responsive trauma assessment that includes understanding the impact of identity displacement and identity disruption. advancing social work clinical practice literature and practice agree that identity and trauma are intertwined and that questions regarding identity threats and a sense of belonging are rarely included in trauma assessments (berman et al., 2020; ford et al., 2015). all clients' identities and how the therapist's and the client's identities interact will inevitably facilitate assessment and therapy (hays, 2008). although the literature on trauma acknowledges the role of scott/culturally responsive trauma assessment 285 sociocultural and structural issues, such as those encountered by low-income communities, refugees, and members of ethnic and gender minorities, proper cultural-ecological assessments have not yet resulted from this acknowledgment although attempts have been made (hoshmand, 2007). one such attempt was the cultural formulation interview (cfi)a 16-item, structured interview questionnaire that was released as part of the diagnostic and statistical manual of mental disorders, fifth edition (dsm-5; apa, 2013). as part of the diagnostic and therapeutic process, this semi-structured interview tackles the patient's beliefs, customs, and identity while considering the patient's social and cultural background (brand et al., 2024). considering what identities might be pertinent for a particular client is the most fundamental level of attention in an initial assessment (hays, 2008). expanding on current models of cultural assessment creates an approach to framing questions from an ecological perspective. practice guidelines for a proposed ecological model of culturally responsive trauma assessment (crta), as shown in table 1 and table 2, involve client self-report of identity demographic information, adding the dimension of identity disruption and identity displacement to a dimensional model of adversity, incorporating elements of kira’s (2001) taxonomy of trauma matrix to include individual, cultural, social, and collective trauma experiences and hays’ (1996, 2008) adressing framework to address trauma experiences unique to identity, cultural influences, and minority groups. strategies for an ecological model of crta the proposed practice guidelines for an ecological model of crta, embedded into any clinical assessment, allow the therapist to engage with clients using a cultural humility lens and allow clients to tell a story about their identity. the model, along with training in cultural competence and cultural humility, can aid clinicians in building and enhancing the therapeutic relationship by creating a safe space where clients feel empowered to discuss the multiple elements of their identity as they relate to their trauma experiences. trauma-informed and trauma-responsive principles trauma-informed care includes the principles of safety, trustworthiness, peer support, collaboration, empowerment, and consideration of cultural, historical, and gender issues (substance abuse and mental health services administration [samhsa], 2014a). presenting issues are seen by a trauma-informed approach as dysfunctional coping (samhsa, 2014a). trauma is understood not as a discrete occurrence but rather as a framework for comprehending experiences that can define and profoundly impact an individual's fundamental identity (samhsa, 2014a). apart from maltreatment during early childhood and dysfunctional families, children can face traumatizing events like illness, bullying, the death of a family member, being placed outside the home, and poverty (levenson, 2017). additionally, historical traumas like discrimination or systemic oppression are common for minority groups (levenson, 2017). a trauma-informed strategy integrates essential trauma principles into the framework of organizational culture while also embracing trauma-specific therapies, such as assessment, treatment, and recovery supports (samhsa, 2014a, 2014b). when a system, program, or organization framework advances in social work, spring 2025, 25(1) 286 is trauma-responsive, it incorporates trauma knowledge into all aspects of its operations, procedures, and practices (samhsa, 2014a, 2014b). trauma-informed treatment principles view trauma through a sociocultural lens from the context of the client’s environment (samhsa, 2014b). using the healing value approach of traditional cultural connections, an organization’s framework actively becomes trauma-responsive when it moves past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, religion, gender identity, geography, etc.) (samhsa, 2014a). it provides access to gender-responsive services; integrates policies, protocols, and processes that are responsive to the racial, ethnic, and cultural needs of individuals served; and acknowledges and addresses historical trauma (samhsa, 2014a). developing an ecological model of trauma assessment that is both trauma-informed and trauma-responsive requires integrating key components. there are multiple ways in which an individual can experience trauma based on multiple identity factors and the ability for those trauma experiences to formulate across historical and generational influences and the individual’s lifespan. table 1. identity demographics client self-reported identity demographics • age • developmental disabilities • disabilities acquired (physical, cognitive, psychological) • religious/spiritual orientation • ethnic/race identity • social status: o highest level of education achieved o current occupation o work status in the last 12 months o current income level o current community habitat (rural, urban, suburban) • sexual orientation • indigenous heritage (indigenous, aboriginal, native, non-native) • national origin • gender identity o preferred pronouns • relationship status (single, married, divorced, widowed, other) • military affiliation (active, veteran, spouse, dependent) • political/civic affiliations • other identity factors not otherwise included note. this table demonstrates an ecological approach to capturing identity demographics. elements of the pamela hays adressing framework and the adverse childhood experiences international questionnaire (ace-iq) have been incorporated into this approach. identity demographics assessments generally include questions regarding client demographic information as part of the intake but not the assessment process. demographic survey questions provide researchers with information on the subjects of research studies (moreira et al., 2023). however, the quality of the questions posed will determine the caliber of information they acquire (moreira et al., 2023). when elements of an individual's identity are not accurately represented in assessment data, it might cause unnecessary psychological suffering and further alienate them from research and treatment (moreira et al., 2023). table 1 demonstrates elements of hay’s (1996, 2008) adressing framework to provide a model for clinicians to capture and assess identity in a more culturally appropriate approach. it scott/culturally responsive trauma assessment 287 allows for the inclusion of multiple sociocultural and place identity elements that can be shared by the client and addressed by the clinician throughout the assessment process, thereby enhancing the client-clinician relationship. an ecological approach to identity demographics allows for an expansion of demographic data to include both sociocultural and place identity elements. table 2. expanding dimensions of adversity with the addition of identity disruption and displacement dimensions of adversity recommended descriptions of trauma experiences to address under each dimension threat physical abuse, sexual abuse, emotional or verbal abuse, peer victimization or bullying, domestic or intimate partner violence, community violence, collective violence [wars, terrorism, political or ethnic conflicts, genocide, repression, disappearances, torture & organized violent crime such as banditry & gang warfare], or natural disasters deprivation/maltreatment caregiver absence; physical, medical, or emotional neglect; social isolation; lack of basic needs being met by primary caregivers; poverty; homelessness; peer isolation or rejection; being institutionalized household/family dysfunction exposure to domestic violence; caregiver divorce; caregiver or family member incarceration; exposure to caregiver or family member physical illness, mental illness, or death identity disruption & displacement a. have you ever experienced discrimination, oppression, exclusion/isolation based on elements of your identity? i.e., age, developmental or acquired disabilities, religion or spiritual orientation, social status, sexual orientation, indigenous heritage, national origin, or gender identity b. have you ever experienced abuse (verbal, emotional, physical, or sexual) based on elements of your identity? i.e., age, developmental or acquired disabilities, religion or spiritual orientation, social status, sexual orientation, indigenous heritage, national origin, or gender identity c. are there any historical events inflicted on a group that you identify or affiliate with on elements of your identity? i.e., age, developmental or acquired disabilities, religion or spiritual orientation, social status, sexual orientation, indigenous heritage, national origin, or gender identity d. have you ever experienced forced evacuation or migration due to poverty, community/economic development, policies meant to suppress or oppress marginalized groups, collective violence, or natural disaster? e. have you ever experienced the destruction of your home due to poverty, collective violence, or natural disaster? f. have you ever been forced or felt compelled to hide or denounce elements of your identity due to fear of oppression, discrimination, physical harm, or death? i.e., age, developmental or acquired disabilities, religion or spiritual orientation, social status, sexual orientation, indigenous heritage, national origin, or gender identity note. this table demonstrates the inclusion of identity disruption & displacement as a dimension of measuring adversity. the dimensions of threat, deprivation/maltreatment, & household/family dysfunction are not expanded due to the availability of various assessments on these dimensions. elements from the pamela hays addressing framework, & the adverse childhood experiences international questionnaire (ace-iq) have been included when formulating the questions related to identity disruption & displacement. advances in social work, spring 2025, 25(1) 288 expanding the dimensions of adversity in trauma assessment the more common dimensions of adversity utilized in trauma assessment include threat, deprivation, maltreatment, and household or family dysfunction (berman et al., 2022; mclaughlin & sheridan, 2016; narayan et al., 2023; sayyah et al., 2022). while the threat dimension can include socio-cultural wounds, some trauma assessments still discount psychological experiences of identity-based trauma represented by oppression, discrimination, marginalization, repression, and displacement (ford et al., 2015). other trauma assessments focus on single aspects of identity, such as race, ethnicity, or gender. adding a dimension of identity displacement and disruption to trauma assessment allows for a comprehensive evaluation of various components that comprise one’s sociocultural and place identities that could be a source of both trauma and resiliency. it also highlights the complex, overlying cultural influences, identities, and minority groups that have been historically disregarded, minimized, or overlooked by the counseling profession and the prevailing euro-american culture (hays, 1996). table 2 demonstrates a model for expanding the dimensions of adversity, including identity disruption and displacement. the recommended questions are meant to be used in a narrative approach during assessment to encourage client discussion and engagement in a conversational approach. practice guidelines for crta therapists can implement the following practice guidelines to ensure trauma-informed and trauma-responsive care to provide a safe space for clients to feel comfortable sharing and addressing their trauma experiences within their unique sociocultural perspective. therapists can provide transparent and open communication about confidentiality, organizational policies, the therapeutic process, and expectations of services. peer support should be a welcome part of the therapeutic process and based upon the client’s needs and preferences. therapists can demonstrate collaboration and client empowerment by recognizing clients as the expert in how they define their identity and how their identity has shaped or has been shaped by their traumatic experiences. therapists should address the unique treatment needs of clients from diverse identities by including considerations of historical and systemic oppression and integrating gender-affirmative care. this model allows clients to define their own identities by expanding standard demographic questions in assessment. by implementing this model, therapists can use open-ended questions that allow clients to share how they define their identity versus imposing identity labels or categories. therapists can demonstrate cultural humility by avoiding stereotypes, using inclusive language, and using the client’s preferred terminology for their identity, thereby creating an atmosphere of collaboration, support, and empowerment. a narrative approach using storytelling can encourage clients to explore the various layers of their identity and examine how their identity has developed and changed over time. therapists can use a strengths-based approach to encourage clients to explore how their identities have influenced their values, traditions, behaviors, health, and relationships; shaped their resiliency; and enhanced their well-being. this model can be used to acknowledge identity as a multifaceted concept, thereby ensuring that key dimensions of identity are not overlooked. the expanded identity demographics can be scott/culturally responsive trauma assessment 289 used to adapt and apply treatment interventions that are personalized, culturally relevant and align with the client’s values and worldview. the model should be reviewed and updated to reflect current understandings of identity and to ensure that it remains inclusive and applicable for diverse populations. implications for social work practice the person-in-environment principle of social work practice creates the foundation for ecological assessment and intervention. this principle can be expounded in social work education to include the broader context of cultural, social and place identity factors within ecological systems theory and how they can be applied to diverse populations. social work education can expand trauma theory and practice by incorporating trauma-informed care and trauma responsive approaches within practice, clinical, and field education courses. diversity courses can promote both cultural competence and cultural humility by expanding training on cultural identity development, the intersectionality of identity, and the systemic oppression that impacts marginalized identity groups. social work education can also enhance learning on comprehensive biopsychosocial-spiritual models of assessment that consider clients cultural and spiritual values in holistic treatment planning. the development of culturally sensitive diagnostic and treatment protocols can be improved by incorporating the trauma-informed principle of cultural, historical, and gender concerns in evaluation. providers could improve their cultural competence and cultural humility, reduce bias, and create a trauma-informed environment by allowing clients to interpret their trauma events through their unique ecological perspectives (wylie et al., 2018). by utilizing the crta model, practitioners can collaborate with clients to explore the meaning behind the person-specific, place-specific, and culture-specific facets of the client’s identity and how the meaning of these facets impacts or is impacted by trauma experiences. social workers and other mental health practitioners can also use the model to challenge their own biases, raise awareness of their own inexperience with and ignorance of diverse cultures, increase their awareness of specific cultural influences and minority identities that they may have failed to notice, gain an understanding of his or her own cultural heritage and identity, and become comfortable with discussing cultural issues with clients (hays, 1996). by concentrating only on the psychological level of the individual, it ignores the structural factors—such as racism, economic dominance, or political oppression—that made the traumatic abuse possible (craps, 2014). social problems that are fundamentally economic or political are medicalized, and those who are affected by them are pathologized as helpless victims with a psychologically treatable sickness (craps, 2014). thus, the focus remains on individual psychological healing instead of the reform of a damaged political, social, or economic system if these issues are not placed in their larger historical context (craps, 2014). a culturally relativistic perspective contends that, at its most extreme, culture acts as a mediating factor in the definition and expression of all pathology, making culture fundamental to our understanding of psychopathology (patel & hall, 2021). the utilization of an ecological model for trauma assessment could facilitate the investigation of cultural perspectives on mental health issues and the creation of a cultural advances in social work, spring 2025, 25(1) 290 framework for diagnosing criteria that apply to all circumstances and experiences that affect mental health (wylie et al., 2018). improved screening and assessment procedures can result in more successful and culturally sensitive treatment plans for individuals with culturally diverse identities dealing with mental health issues when transcultural approaches are used and where practices are guided by this more comprehensive sociocultural assessment (wylie et al., 2018). subsequently, future research could focus on the development of a socio-ecological trauma assessment tool and culturally modified applications of current evidence-based trauma interventions. research can also focus on the psychological impacts of displacement on mental health, identity formation, and social integration across various cultural groups; the impacts of historical trauma and intergenerational trauma on personal and collective trauma experiences; how place identity impacts vulnerability to trauma, resiliency, posttraumatic growth, and mental health; and how intersectional oppression (i.e., racism, sexism, ableism, ageism) compound trauma experiences. additional research could focus on exploring identity-based trauma as a dimension of adversity and refining dimensional models of adversity to include identity disruption and sociocultural factors into measurements of adversity. conclusion to effectively address the wounds caused by interpersonal trauma, it is necessary for both the survivor and those providing support to genuinely bear witness to the traumatic experiences that occurred within the survivor's cultural context (bryant-davis, 2005). to aid clients in their healing journey from trauma, it is crucial to recognize and honor the humanity and violation of another person by allowing for the strong influence of cultural traditions, experiences, and beliefs—influences that shape a person's identity and sense of place in the world (bryant-davis, 2005). earlier models of identity have previously focused on single social identities (ferguson, 2007). in doing so, they exclude experiences related to the merging of multiple identities within one individual (ferguson, 2007). the same is true for trauma assessments that focus on trauma through the lens of a single aspect of the client’s identity. developing an ecological model for crta provides the opportunity to expand the provider’s ability to understand, navigate, and treat the complex intersection of trauma 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(2022). testing the identity disruption model among adolescents: pathways connecting adverse childhood experiences to body dissatisfaction. journal of youth and adolescence, 52(1), 134-148. wylie, l., van meyel, r., harder, h., sukhera, j., luc, c., ganjavi, h., elfakhani, m., & wardrop, n. (2018). assessing trauma in a transcultural context: challenges in mental health care with immigrants and refugees. public health reviews, 39(1), 1-19. yakushko, o., davidson, m. m., & williams, e. (2009). identity salience model: a paradigm for integrating multiple identities in clinical practice. psychotherapy, 46(2), 180-192. yasui, m. (2015). the cultural ecogram: a tool for enhancing culturally anchored shared understanding in the treatment of ethnic minority families. journal of ethnic & cultural diversity in social work, 24(2), 89-108. author note: address correspondence to nakita w. scott, department of social work, southeastern university, lakeland, fl 33810. email: nwscott@seu.edu https://doi.org/10.1007/s10964-022-01683-5 https://doi.org/10.1007/s10964-022-01683-5 https://doi.org/10.1007/s10964-022-01683-5 https://doi.org/10.1186/s40985-018-0102-y https://doi.org/10.1186/s40985-018-0102-y https://doi.org/10.1037/a0016080 https://doi.org/10.1037/a0016080 https://doi.org/10.1080/15313204.2014.991980 https://doi.org/10.1080/15313204.2014.991980 mailto:nwscott@seu.edu ________ andrea joseph-mccatty, phd, msw, assistant professor, college of social work, university of tennessee – knoxville, knoxville, tn. sara goodkind, phd, msw, professor, school of social work, university of pittsburgh, pittsburgh, pa. kenyette garrett, msw, doctoral student, and corrina joyner, msw, graduate research assistant, college of social work, university of tennessee – knoxville, knoxville, tn. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 51-73, doi: 10.18060/28070 this work is licensed under a creative commons attribution 4.0 international license. restorative practices and disproportionate discipline of black girls: an intersectional and ecological analysis andrea joseph-mccatty sara goodkind kenyette garrett corrina joyner abstract: this mixed-methods study examines the disproportionate discipline of black girls attending a u.s. high school implementing restorative justice practices. grounded in ecological systems theory and intersectionality, this study presents overall and withingender disciplinary outcomes, with qualitative data providing context for these trends. quantitative analyses, including a relative risk index and pearson’s chi-square tests, confirm significant overall and within-gender disparities in disciplinary outcomes. qualitative findings reveal inconsistent discipline practices and classroom management challenges as pathways to inequity, exacerbated by subjective enforcement and punitive measures. the study underscores the need for consistent, equitable application of restorative practices and intentional relationship-building to address the complex interplay of race, gender, and discipline. we posit that school social workers can play a pivotal role in developing intersectional tier-2 restorative practices that center the lived experiences of black girls to reduce inequitable school discipline outcomes. keywords: disproportionate discipline, black girls, restorative justice practices, school suspension, intersectionality over 2.5 million u.s. students were subject to one or more suspensions during the 2017-2018 school year (united states department of education [usdoe], 2019). the rates of these exclusionary disciplinary practices result in over 11 million days of school missed across the k-12 schools (usdoe, 2019). often boys are the center of this conversation because of their high suspension rates; however, leaving the suspension outcomes of girls in the shadow of boys. girls of all races make up 30% of overall suspensions across the nation; further, almost three-quarters (73%) of girls suspended are girls of color (usdoe, 2019). specifically, black girls make up 44% of all girls suspended each year, despite accounting for only 15% of girls enrolled in schools (usdoe, 2019). suspensions are not simply missed school days, instead, they can result in poor academic outcomes (brown, 2007; toldson et al., 2015), repeat future suspensions (dupper et al., 2009), conflict that can lead to strained student-teacher relationships (darensbourg et al., 2010; yassine et al., 2020), and a greater likelihood for incarceration (cregor & hewitt, 2011; hill, 2018). this paper describes a need for an explicit focus on intervention strategies to address the disproportionate suspension of girls, and black girls in particular. attempts to reduce the outcomes of punitive discipline in schools have come through the implementation of multi-tiered interventions such as restorative practices (rp). while the use of school-wide interventions such as rp have had some success in improving about:blank advances in social work, spring 2025, 25(1) 52 relational bonds and reducing overall disciplinary outcomes (augustine et al., 2018; gregory et al., 2016), disproportionate suspensions have persisted (augustine et al., 2018; fallo & larwin, 2022; mansfield et al., 2018). however, school discipline research focused on black girls specifically is underrepresented in the literature. thus, this mixed-methods study contributes to the social work literature on school discipline by describing factors and processes contributing to the disproportional discipline of black girls. while the field of social work has acknowledged the issue of racially disproportional suspensions (teasley et al., 2023), social work has not delineated a clear response to discipline inequities impacting black girls. this research uses an intersectional framework to understand the disproportionate discipline for black girls, offering policy and practice implications for school social workers. background high and disproportional suspensions since the ruling of brown v. board of education, scholars have studied the lasting effects of both school and residential segregation on the educational outcomes of students of color (levine, 2019). four notable areas of concern that influence black students’ educational experience are residential segregation, access to school choice, inequitable educational pathways, and racialized discipline practices. these four influential areas leave students of color without the same quality of education their white counterparts receive (howell & caisey, 2019; lewis & diamond, 2015). boys overall, especially black boys, as well as students of color and those with disabilities, have historically and continue to be disproportionately suspended in u.s. schools (epstein et al., 2020; usdoe, 2019). while it is often assumed that school suspensions are a direct result of breaking school rules, other factors have the potential to exponentially exacerbate discipline disparities. these factors include cultural mismatch between students and educators (vavrus & cole, 2002), race and gender bias (morris, 2016; skiba et al., 2002), and punitive discipline policies and practices (hanson, 2005). nationally high and disproportional school discipline trends led to recommendations from the u.s. department of education and department of justice through a guidance package on school discipline (usdoe & united states department of justice [doj], 2014). this guidance package provided recommendations to address these discipline outcomes and, including the use of school-wide accountability and relationship building interventions such as positive behavior intervention systems and restorative justice practices (usdoe & doj,2014). additionally, initiatives such as the federally supported my brother’s keeper program gave national attention to address challenges faced by boys, especially the academic and discipline disparities experienced by black boys (u.s. commission on civil rights, 2019). while boys require attention and intervention, black girls are the only group of girls disproportionately suspended nationally (usdoe, 2019), yet their experiences are often missed or essentialized as they are grouped with black boys or girls as a whole (smith, 2019, p. 21). indeed, a systematic review conducted between 2010-2016 found that research on black girls represented less than 1% of published literature besides multicultural/urban education journals (young, 2020). as such, black https://www.rand.org/pubs/research_briefs/rb10051.html https://www.rand.org/pubs/research_reports/rr2840.html https://doi-org.utk.idm.oclc.org/10.1177/00220574221090286 https://journals-sagepub-com.utk.idm.oclc.org/doi/epub/10.1177/0013161x17751178 https://www-taylorfrancis-com.utk.idm.oclc.org/books/mono/10.4324/9780429027208/race-meets-class-rhonda-levine https://www-jstor-org.utk.idm.oclc.org/stable/pdf/26743831.pdf?refreqid=excelsior%3a681e18f05da254fd54f74f7c2fe4f948&ab_segments=&origin=&initiator=&accepttc=1 https://ebookcentral.proquest.com/lib/utk/detail.action?docid=2101588 https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201401-title-vi.html https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201401-title-vi.html https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201401-title-vi.html https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201401-title-vi.html https://www.usccr.gov/files/pubs/2019/07-23-beyond-suspensions.pdf https://www.usccr.gov/files/pubs/2019/07-23-beyond-suspensions.pdf joseph-mccatty et al./restoive justice 53 girls as a group are often under-discussed in the school discipline literature, with few evidence-based practice recommendations available. disproportional suspension of black girls data from the 2013-2016 academic years indicate that black girls accounted for 8% of students enrolled, and 13% who received one or more out-of-school suspensions (office of civil rights [ocr], 2016; usdoe, 2019). national data from the 2017-2018 academic year show that, compared to their white female counterparts, black girls were 4.19 times more likely to receive out-of-school suspension, four times more likely to be expelled, 3.66 times more likely to face school-based arrest, and 5.34 times more likely to be transferred to another school for disciplinary reasons (epstein et al., 2020). these trends are not solely driven by behavior but also by systemic inequities, racism, sexism, color-evasive practices, and punitive policies and practices (anyon et al., 2014; joseph et al., 2021; wallace et al., 2008). the literature demonstrates that black girls often receive school discipline for subjective interactions and infractions. examples include hairstyles, clothing, tone of voice, disrespect, temper tantrums and others (annamma et al., 2019; morris, 2016; smith, 2019). black girls also have a greater risk of experiencing the long-term consequences of school suspensions including lost instructional time, poor academic outcomes, stigmatization, juvenile justice involvement, and school drop-out (baumle, 2018; hill, 2018; morris, 2016). of note are black girls’ experiences with adultification, which may contribute to their disproportionate suspension. adultification is the tendency to superimpose negative and more mature characteristics on a child. for black girls, this practice begins as early as 5 years old and can lead to the perception that they are less childlike, more culpable and knowledgeable, and thus more deserving of blame and/or punishment (epstein et al., 2017). black girls’ vulnerability to adultification lies in the intersections of race and gender that render their experiences different than those of white girls (who are the default when sexism is considered) and black boys (who are the default when racism is considered). indeed, among girls specifically, a multi-year national study on adverse childhood experiences (ex. abuse, neglect, violence) documented that black girls had a greater risk for 6 out of 9 adversities compared with other girls of color and 7 out of 9 adversities compared with white girls (joseph-mccatty et al., 2024). the basis of disaggregating data across race and within gender is rooted in intersectionality, which kimberlé crenshaw (1995) describes as individuals experiencing greater disadvantages for holding multiple marginalized identities (crenshaw, 1995; suarez, 2021). the disproportionate suspension of black girls must be understood within the broader context of structural educational inequities, including residential segregation, inequitable school funding, inexperienced educators, high teacher turnover, and punitive discipline policies (gregory et al., 2010; kozol, 2012). these structural barriers compound the challenges faced by black girls, and can result in their unique needs being overlooked in schools. research highlights that interventions aimed at reducing school suspensions frequently fail to account for the intersection of race and gender, perpetuating disparities in discipline outcomes (joseph et al., 2020; annamma et al., 2019; morris, 2016). this gap https://genderjusticeandopportunity.georgetown.edu/wp-content/uploads/2020/06/girlhood-interrupted.pdf https://chicagounbound.uchicago.edu/cgi/viewcontent.cgi?article=1052&context=uclf https://www-taylorfrancis-com.utk.idm.oclc.org/books/edit/10.4324/9781351032223/handbook-critical-race-theory-education-marvin-lynn-adrienne-dixson advances in social work, spring 2025, 25(1) 54 in the literature underscores the need for educators and school social workers to not only implement school-based interventions like restorative practices but to also critically examine how these interventions are shaped by and interact with systemic inequities (anyon et al., 2014; joseph-mccatty et al., 2024). by addressing these underlying structural factors and incorporating an intersectional approach, practitioners can better mitigate the disproportionate suspension rates of black girls and foster more equitable educational outcomes. restorative practices as a means to address disproportionate school discipline restorative practices (rp) are a series of non-punitive multi-tiered interventions most recently used to curb high and disproportional suspensions. a core feature of the intervention is school-wide relationship-building to strengthen student-teacher relationships (gregory et al., 2016). these practices are also a proactive way to reduce conflict as relationship and respect building require active efforts to learn student characteristics and experiences to put behaviors into context. schools applying restorative practices seek to improve student accountability and ultimately address harm experienced between students and educators. an important framework for understanding how restorative practices (rp) can be effectively implemented in schools is the social discipline window (costello et al., 2009; wachtel, 2013). this model outlines four approaches to managing behavior based on the levels of control or support. the four quadrants are: "to" (high control, low support punitive/authoritarian), "for" (low control, high support permissive), "not" (low control, low support neglectful), and "with" (high control, high support restorative/authoritative) (costello et al., 2009; wachtel, 2013). the "with" quadrant is considered the most conducive to learning and positive development, as it fosters mutual respect, accountability, and student agency. integrating this model into school rp efforts helps educators align discipline strategies with a more relational and growth-oriented approach. some schools also follow the 80/20 rule of restorative practices, which indicates that 80% of restorative practices should include affective statements and/or affective questions, while the remaining 20% should consist of classroom circles or formal conferences (costello et al., 2009). affective statements allow educators to communicate the feelings they experienced in response to a student’s behavior. for example, when students are disruptive in class, a teacher may say, “when you are having side conversations while i am teaching, i feel frustrated because it interrupts the lessons and makes it hard for your classmates to pay attention.” similarly, affective questions can be used after an incident. an educator may ask, “what happened?” or “what were you thinking about at the time?” relationship building and/or responding to an incident can also take place in restorative practice circles. for example, check-in circles can be used so students can discuss current events or discuss how they are feeling about an event or the instruction they received (costello et al., 2009). when applied consistently and with fidelity, rp have been useful in establishing stronger relationships among educators and students (gregory et al., 2016; lewis, 2009; drewery, 2004). ultimately, these practices are used to support the development of stronger socio-emotional skills, strengthened relationships, and improved joseph-mccatty et al./restoive justice 55 behaviors, which in theory can help reduce infractions and the use of school suspensions (gregory et al., 2016; lewis, 2009; welsh & little, 2018). in addition, a study by lewis (2009) found that the use of restorative practices improved student attitudes, ability to apologize, reduced violence, and created a stronger academic culture. similarly, rp implementation in one school was associated with fewer suspensions for all, reduced punitive discipline ethos, as well as improved student-teacher relationships (gregory et al., 2016). in a study across 29 high school classrooms, use of rp was associated with positive teacher-student relationships and reduced use of discipline referrals compared to classrooms not using rp (gregory et al., 2016). additionally, a study in a large urban school district using restorative practices as a less punitive disciplinary option during term one was associated with fewer referrals in the following term (anyon et al., 2016). in a randomized control trial study across an entire school district, there was a reduction of overall and disproportional school suspensions for elementary school students (augustine et al., 2018). another study analyzed in-school suspension (iss) and out-ofschool suspension (oss) rates over 5-years of implementing of rp; it showed a 12% decrease in iss from 19% to 7%, and oss rates decreased from 12% in 2010 to 7% in 2015 (mansfield et al., 2018). overall, schools using rp observe less student misconduct, reduced number of injuries, decreases in suspensions, and overall improved behaviors (lodi et al., 2022). however, while restorative practices can reduce disproportionality, this remains largely inconsistent across studies (anyon et al., 2016; augustine et al., 2018; fallo & larwin, 2022; hashim et al., 2018; lustick, 2017; mansfield et al., 2018). lustick (2017) suggests that the same cultural misunderstandings that exist with traditional forms of discipline also are present within restorative practices. indeed, some educators may also have a lack of will to address how implicit and explicit forms of racism still inform persistent racial disparities (lustick, 2021). theoretical framework intersectionality efforts to understand the disproportional suspensions of black girls have been informed by frameworks such as intersectionality, which describes how multiple aspects of one’s identity interact within oppressive systems to create hyper-marginality (crenshaw et al., 2015). developed by kimberlé crenshaw, intersectionality as a framework has been used to understand black women’s experiences with domestic violence and inequitable employment opportunities. it underscores how they are marginalized as women in their homes and rendered invisible as black women in the workplace (crenshaw et al., 2015). applied to black girls in the school context, it is important to examine if girls are rendered invisible in initiatives such as restorative practices yet marginalized in practice through school suspensions. to be rendered invisible in practice refers to the use of one-size-fits all school-based interventions to address race and gender disproportionality which ultimately sustains discipline inequity and marginality for black girls. morris (2022) offers that, “behavioral protocols that mimic carceral systems, pedagogical practices that only http://www.antoniocasella.eu/restorative/gregory_rj_2015.pdf https://journals.sagepub.com/doi/full/10.1177/0013161x17751178#abstract https://mdpi-res.com/ijerph/ijerph-19-00096/article_deploy/ijerph-19-00096.pdf?version=1640255151 https://doi-org.utk.idm.oclc.org/10.1177/00220574221090286 https://journals-sagepub-com.utk.idm.oclc.org/doi/epub/10.1177/0013161x17751178 advances in social work, spring 2025, 25(1) 56 acknowledge eurocentric values as valid,…may be leading to the undesired effect of alienating students who are culturally and linguistically diverse, such as black girls” (p. 37). an intersectional investigation of discipline disproportionality requires that black students are not treated as a monolith. minimally, within analyses, demographic data should be disaggregated to understand the trends that are unique to black children across the gender spectrum. as such, an intersectional framework aids in framing how multiple axes of oppression (e.g., racism and sexism) across identity markers (e.g., race and gender) impact the lived experience of black girls within schools. in 2015, national attention focused on the treatment of shakara, a black female high school student and foster youth in south carolina. shakara was violently ripped out of her chair and desk by the school resource officer (sro) for not leaving the classroom for violating the cell phone policy (simonpillai, 2021). this interaction left shakara with a wrist fracture, and both shakara and her classmate who recorded the incident were arrested for disturbance (simonpillai, 2021).while the use of school resource officers is intended to maintain safety for students and educators, the use of a law enforcement officers for non-violent behavior has the potential to instigate violence, create punitive disciplinary action, and later incarceration (turner & beneke, 2020). in this case, this black female student was likely subject to marginality and hegemonic imagery related to her gender, race, and foster care status, all of which may have informed the violence towards her. thus, the application of interventions to address disproportionality for black girls must reject hegemonic imagery and the tendency to view black children as a monolith. instead, interventions such as restorative practices should contextualize race and gender at minimum and embrace an equity framework that seeks to transform schools into places where healing and transformation can be facilitated (morris, 2022). ecological systems theory ecological systems theory (est) was used to point to the relationship between developmental outcomes and the environment as developed by bronfenbrenner (1979). for example, a child’s physical, socio-emotional, and academic development can all be connected to the people and locations that create an environment for that child. to understand this relationship, ecological systems theory is used to capture the external influences on behavior that individual/person-level theories or practices do not capture (bronfenbrenner, 1979; rothery, 2016). within schools, est defines a school as an organizational social system which is based on interdependent individuals whose behaviors interact across spaces and power (bourdieu, 1984; greene, 2008). applied to school suspension research, it is vital to not only look at behavior, but also the environmental factors that influence behavior and associated outcomes. as such, a more equitable framing of discipline disproportionality would be to consider the role of school-level factors such as adult racial and gender dispositions, education policy, and overall school climate. school-level factors are also deeply intertwined and complicated by power relations within the setting (bourdieu, 1984; houston, 2002). therefore, est is used to frame systems of oppression such as racism and sexism as they joseph-mccatty et al./restoive justice 57 can have a significant bearing on one’s access to resources (rothery, 2016). school environments are not blank slates impervious to policy pressures nor are they neutral environments lacking belief systems that privilege or marginalize one group of students over another. instead, they are social systems that each student experiences differently based on their identity at the intersections of policy, practice, and power. since schools are nested settings that are affected by economics, the larger social system, and politics (bronfenbrenner, 1979; greene, 2008; rothery, 2016), schools adapt to external demands and pressure (ball, 2016; greene, 2008; rothery, 2016). most recently this has been demonstrated by politicians’ claims of teaching critical race theory in k-12 schools and the subsequent banning of diversity, equity, inclusion (dei) initiatives due to fears of social indoctrination (jayakumar & kohli, 2023). this can ultimately affect students who benefit from dei practices, educators who lead them, and practices aimed at reducing disparities. thus, schools seeking to use rp to reduce disparities cannot focus on student behaviors alone; instead, it is critical to address institutional norms, adult beliefs and dispositions about discipline and minoritized groups, and the role of structural influences (e.g., punitive and inequitable discipline policies and practices). we suggest this because even schools using discipline reform interventions can still perpetuate inequities when racial bias, limited classroom management skills, and punitive practices are unaddressed (ispa-landa, 2018). while inequitable discipline practices can affect any student, the intersection of race and gender bias, punitive discipline policies/ practices, and limited classroom management skills can make black girls structurally vulnerable to discipline and punishment. methods this study seeks to contribute to the social work literature on school discipline by examining the factors that contribute to the disproportionate discipline of black girls in the united states. using a mixed-methods approach, we employed a relative risk index to calculate disproportionality, semi-structured interviews to capture participants’ perspectives on discipline experiences, and critical race ethnography to frame classroom observations and contextualize data within the constructions of race and gender. this study draws on a larger study on school suspensions that received university and school-district irb approval. in this paper we ask, what are the within-gender discipline trends and practices at a school implementing restorative practices? additionally, what discipline practices and interactions inform the discipline outcomes for black girls? methodological approach research on racial disparities that do not adequately capture race and other identity markers risk producing results that are “colorblind” and inaccurate. therefore, in this study, we used critical race ethnography (cre) to bring attention to beliefs, values, and behaviors across race during observations (duncan, 2002). specifically, cre was used to contextualize race, racial bias, and behaviors at the intersection of policy, practice, and environment. we applied a critical race ethnography (cre) lens in our classroom observations to explore the conditions and contexts that shape when, why, and how specific advances in social work, spring 2025, 25(1) 58 events occur, with particular attention to their implications for race, gender, and class (emerson et al., 2011). observations were also useful to obtain participant meaning making related to their presenting behaviors and the extent to which they connected with social expectations and the classroom environment. to capture such nuance, jottings that included identity descriptors were converted into fieldnotes to capture contextual interactions. jottings allow for the writing of salient quotes and behaviors which assist in describing the social environment (emerson et al., 2011). where possible, dialogue was captured by writing down direct and indirect quotes to extrapolate meaning while avoiding summarization that could misrepresent the voice of participants in the setting (emerson et al., 2011). together, jottings, direct quotes, and indirect quotes were strategies used to understand how restorative practices and discipline practices intersected across race and gender and how this informed discipline outcomes. data collection and sample data were collected over a 9-month school year at a racially diverse mid-western high school implementing rp for the first time among 1,518 students. to recruit educators and staff participants, an email inviting research participation was first sent to all teachers (n ≈ 100) at the high school; however, no teachers responded. next, snowball sampling was used by asking the restorative practices leader to inform staff about the study, this resulted in seven teachers agreeing to participate, though two were lost due to attrition. lastly, requests for interview participation emails were again sent in the spring to teachers, administrators, and the school social worker. this yielded an additional 7 participants for a total of 12 participants (table 1.). to honor confidentiality, classroom observations and interviews took place at times and locations requested by the participant; additionally, all participant names were replaced with pseudonyms and also given generalized titles (ex. teacher or administrator). table 1. demographic profile of case study participantseducators, administrators, and staff name position* sex* race ms. holder teacher core academic female white ms. wentworth teacher non-core academic male white mr. ryan teacher core academic male asian ms. jackson teacher non-core academic female white mr. medina teacher core academic male black ms. jensen school leader female white mr. wainwright administrator male white mr. russell administrator male black mr. richmond school social worker male white ms. lawrence officer 1 female white mr. george officer 2 male black mr. stephen officer 3 male black * subject area and gender pronouns changed for anonymity joseph-mccatty et al./restoive justice 59 quantitative data were obtained through attendance and discipline data provided by the school district. total enrollment across sex was 797 boys and 721 girls—according to administrative data and not based on students' own gender identification not accounting for students who identify outside the gender binary. across race and ethnicity, enrollment was black (n=621), white (n=550), asian (n=182) latinx (n=74), and multi-racial, hawaiian, native-american which were coded as “other” (n=91; table 2.). quantitative analysis suspension data from the 2015-2016 academic year was used to examine disproportionate suspension outcomes across race and gender. a relative risk index (rri) was calculated for each student group. the rri is used by the office of juvenile justice and delinquency prevention, which describes a rri as a valid measure of disproportionality (tobin & vincent, 2011). in this study, an rri was calculated by first calculating a risk percentage dividing the number of students suspended by the number of students enrolled. subsequently risk ratios were calculated by dividing the percent of each group’s suspension outcomes by the percent of all other students who were also suspended (bollmer et al, 2014; iowa department of education, 2019). smaller groups of students were combined into an “other” category as bollmer et al. (2014) cautions statistical interpretation of small numerators. risk ratios greater than 1 indicated that the student group was disproportionately suspended while risk ratios under 1 indicated that the student group was underrepresented in suspensions (equation 1) (iowa department of education, 2019). equation 1: risk ratio equation 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅 = 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅% 𝑅𝑅𝑜𝑜 𝐺𝐺𝐺𝐺𝑅𝑅𝐺𝐺𝐺𝐺 𝑆𝑆𝐺𝐺𝑅𝑅𝐺𝐺𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅% 𝑅𝑅𝑜𝑜 𝑅𝑅𝑎𝑎𝑎𝑎 𝑅𝑅𝑅𝑅ℎ𝑆𝑆𝐺𝐺 𝑔𝑔𝐺𝐺𝑅𝑅𝐺𝐺𝐺𝐺𝑅𝑅 𝑅𝑅𝐺𝐺𝑅𝑅𝐺𝐺𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅 > 1 = 𝑂𝑂𝑂𝑂𝑆𝑆𝐺𝐺𝐺𝐺𝑆𝑆𝐺𝐺𝐺𝐺𝑆𝑆𝑅𝑅𝑆𝑆𝑆𝑆𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑆𝑆 qualitative analysis qualitative data included classroom observations (n = 37), interviews (n = 8), a focus group (n=1) and school-based artifacts (n=3) which were analyzed to inform the suspension data outcomes. to organize the data, all sources of data from the same participant were grouped together to create a comprehensive case in nvivo (bazeley & jackson, 2019). for each case, the lead author incorporated memos, several fieldnotes, an interview, and when relevant, photographs of artifacts from the school site. this structure allowed the lead author to identify data patterns chronologically. engaging deeply with the data involved reviewing transcripts, literature, fieldnotes, writing memos, and initiating a process of coding and reflection with the second author. the lead author then moved between raw data and supplementary sources, employing inductive coding to fracture the data and refine the analytic process, as outlined by bazeley and jackson (2019), galman (2018), and green et al. (2007). subsequently, pattern coding was used to generate meta-codes that drew advances in social work, spring 2025, 25(1) 60 meaning (saldaña, 2015) between behaviors, policies, and discipline outcomes. qualitative analysis was conducted using nvivo in which a hierarchical linear coding approach was used to develop parent and child codes (bazeley & jackson, 2019). four rounds of coding were carried out in an iterative process between the data, literature, and memo writing (bazeley & jackson, 2019). emergent themes indicated a lack of consistent and equitable discipline outcomes and classroom management difficulties as a pipeline to punitive discipline outcomes. pursuant to developing valid and trustworthy findings, we followed siccama and penna (2008) who recommend the use of interview recording and verbatim transcription, following interview protocols, and use of open-ended questions. to enhance the validity of the findings, we triangulated data by cross-verifying themes across multiple qualitative sources—classroom observations, interviews, focus groups, and school artifacts—alongside quantitative suspension data. this process ensured consistency in the observed patterns and provided a more robust, well-rounded understanding of the discipline practices and their impacts. quantitative results although black and white students had similar enrollment (table 2), black students had the highest suspension rates, with black males representing 32% of students suspended and black females representing 23% of students suspended during the intervention year. in contrast, white males and white females accounted for 16% and 11% of students suspended during the intervention year (table 3). table 2. 2015-2016 enrollment at restorative high school and unique student suspensions by race and gender race n (%)* enrollment at restorative high school unique student suspensions male female total male female total black 334 (22.0%) 287 (18.9%) 621 (40.9%) 119 (52.9%) 87 (58.8%) 206 (55.2%) asian 102 (6.7%) 80 (5.3%) 182 (12.0%) 19 (8.4%) 5 (3.4%) 24 (6.4%) hispanic 38 (2.5%) 36 (2.4%) 74 (4.9%) 15 (6.7%) 1 (0.7%) 16 (4.3%) white 278 (18.3%) 272 (17.9%) 550 (36.2%) 59 (26.2%) 40 (27.0%) 99 (26.5%) other** 45 (3.0%) 46 (3.0%) 91 (6.0%) 13 (5.8%) 15 (10.1%) 28 (7.5%) total 797 (52.5%) 721 (47.5%) 1518 (100%) 225 (60.3%) 148 (39.7%) 373 (100%) *percentage is based on the total enrollment (n=1,518) or unique student suspensions (n=373) **other = multiracial, hawaiian, native american examining suspension outcomes among all students during the intervention year, black males had 1.57 (36%) risk for suspension while black females had 1.24 (31%) risk of suspension. suspension risk for white males was .79 (22%) and .52 (15%) for white females. suspension risk for non-black and non-white males during the intervention year was .96 (26%) while non-black and non-white females had a .46 (13%) risk (table 3). joseph-mccatty et al./restoive justice 61 table 3. 2015-2016 high school enrollment and overall suspension risk race & ethnicity student enrollment [suspended] suspension riska ♀ ♂ total ♀ ♂ total black 287 [87] 334 [119] 621 [206] 30% 36% 33% white 272 [40] 278 [59] 550 [99] 15% 21% 18% otherb 162 [21] 185 [47] 346 [68] 13% 25% 20% total 721 [148] 797 [225] 1,518 [373] 21% 28% 25% notes: asuspension risk = suspended/enrollment; bother = multiracial, hawaiian, native american pursuant to our overarching research question to examine within-gender differences of suspension risk, a pearson’s chi-square test of independence was first used to detect for significant differences across race among females, χ2 (2, 721) = 28.18, p < .001, and males, χ2 (2, 797) = 16.49, p < .001, ever suspended during the intervention year (table 4). thereafter, within-gender risk ratios were calculated reflecting that black females were 2.17 times more likely to be suspended than all other girls. the risk of suspension for black girls was also greater than the risk experienced by black males who were 1.57 times more likely to be suspended than all other males (table 5). altogether, both black males and females were overrepresented in the overall disparity calculations (table 3) and withingender comparisons (table 5); the within-gender analysis more sharply illustrates the extent to which black girls faced heightened suspension risk at the case-study school. table 4. results of chi square test for suspensions within gender across race during intervention year suspension classification black white other race ♀ ♂ ♀ ♂ ♀ ♂ never 200 (70%) 215 (64%) 232 (85%) 219 (79%) 141 (87%) 138 (75%) ever 87 (30%) 119 (36%) 40 (15%) 59 (21%) 21 (13%) 47 (25%) table 5. 2015-2016 within gender suspension risk race & ethnicity suspension riska between race & gender within gender suspension risk all othersb risk ratioc suspension risk all other risk ratio ♀ ♂ total ♀ ♂ ♀ ♂ ♀ ♂ ♀ ♂ black 30% 36% 33% 23% 21% 1.3 1.66 14% 23% 2.17 1.57 white 15% 21% 18% 27% 25% 0.55 0.84 24% 32% 0.61 0.66 otherc 13% 25% 20% 26% 24% 0.5 1.04 23% 30% 0.56 0.86 total 21% 28% 25% 28% 21% 0.73 1.34 28% 21% 0.73 1.34 notes: asuspension risk = suspended/enrollment; ball other risk= risk of non-reference group; crisk ratio = suspension risk/all other risk; dother = multiracial, hawaiian, native american qualitative findings inconsistent discipline practices as a pathway for inequity between classroom observations, the lead author observed hallway interactions as these provided unique opportunities to witness how staff addressed students referred to as “chronic hall walkers.” these students were identified by name and grade on a list posted advances in social work, spring 2025, 25(1) 62 on the school’s hallway walls. since both restorative practices and traditional disciplinary actions could be applied in these scenarios, hallway observations became a crucial site for data collection. most notable in hallway interactions were inconsistencies in the way discipline was meted and the limited use of restorative practices. the lead author began to note the inconsistencies during a fall observation day where she noted the hall-to-classroom transition patterns and how staff applied school discipline policy. the bell rang and students continued to linger in the hallway, ms. lawrence, a female security officer stood at the top of the stairs while waving her hands and sarcastically asking, "so don't nobody have class? nobody has class?” a black girl standing in front of her sarcastically said “no.” the officer replied, “no, you got class but everyone is standing right here like it’s outside!” on this day, there were about 25 students in this section of the hallway landing. on other days, there could be nearly 100 students in the hallway after the final bell. the third and final bell indicates that class has just started and now any student in the hallway is late. while in the hallway, i hear another officer blow his whistle to get the students’ attention indicating that it was time to head to class. (field note) according to the student handbook, students caught in the hallways can receive a variety of disciplinary outcomes which include a warning or phone call to a parent for a 1st offense, use of restorative practices after school for 1-hour detention for a 2nd offense, inschool suspension with restorative practices for a 3rd offense, and finally suspension if a fourth offense were to occur. however, no students in the hallway during my observation that day received any such outcome reflecting an inconsistency between policy and practice. the concept of inconsistency was also apparent during a focus group interview with three high school security officers. officer lawrence described how students were able to get their suspensions reduced through parental advocacy. however, not all parents knew how to navigate the school discipline system successfully enough to reduce their child’s suspension length. in this interview, one officer stated: we had two boys fight here [and] they got 10 days [suspensions], but then their parents fought [it] so then they got 3 [days]. but their parents knew the steps to go through. they were white. we had black girls that were fighting, and they were honor roll, high honor roll and honor society students [who] got into a fight, which they shouldn’t have; but the girl is getting jumped so they jumped in they got 10 days. the parents didn’t know what to do so a teacher came to me and said this is not fair. can you say something….? so i talked to the administrator [who] said it would [be] taken off. i saw the parents, the administrator [only] called some of the parents... no one ever got back to them so the girls ended up doing the whole 10days. that’s not fair, because the boys have never been in trouble and the girls have never been in trouble. first mistake in all their career [in] high school and they’re good kids. and i said to the [administrator], “what can i do to make parents aware that these are the steps to take?” and the administrator was like, you can’t, you’re not allowed to tell them just like i am not. so how are they supposed find the information?...they should be able to find the information joseph-mccatty et al./restoive justice 63 because it’s out there somewhere. but the reality is they're not. so since we know that they're not and we know that the majority of the white kids’ parents know what to do, and the black kids don’t. how can we be a better help to get the information out, so it could be a fair playing ground, and…no answers. overall, both interview and observation data confirm the inconsistent application of disciplinary outcomes. these inconsistencies came both in the form of not regularly applying the restorative or traditional discipline outcomes as outlined in the student handbook. inconsistency was also demonstrated when black girls who got into a fight received a longer suspension then white boys who also got into a fight. together, the inconsistencies between policy and practice leave room for inequity. classroom management difficulties as a pipeline to punitive discipline outcomes classroom management strategies influence students' disciplinary experiences, especially when minor behavioral issues result in more severe disciplinary actions. educators' challenge in managing classroom behaviors can lead to consequences such as suspensions for behaviors like phone usage. in the case of black girls in this study, inconsistencies in the application of discipline practices, along with varying disciplinary approaches, were observed to affect their interactions with teachers and the outcomes of those interactions. specifically, during a rp circle conversation with the restorative practices leader, ms. holder, a teacher, mr. wentworth, described the behavior challenges he was managing: rp leader: so what is the most common issue that you are dealing with? mr. wentworth: phone usage for sure. i have a two-strike rule. if i ask them a third time they have to put it in the bucket upfront but many of them do not. so then eventually i have to call security. i honestly don't mind, but if admin walks in here, i can get in trouble. during this meeting, the teacher identified four black female students he felt were a part of this “core group” giving him a difficult time in the classroom. thus, in a separate circle apart from mr. wentworth, the restorative practices leader, and a central office equity team member attempted to understand the girls’ perspective. rp leader: so what’s going on in mr. wentworth’ class? nadiene: i don’t really like him, he needs to slow down, he does too much… courtney: he is nice but doesn't know how to manage the class, he thinks we're hard, but he stoops to our level. he rolled his eyes at me, so i thought “oh i quit.” michelle: he is trying to skip the student-teacher level, but he can't. i was doing better with the other teacher. i liked him when he was helping… rp leader: is he better one-on-one? students [in unison] yes! advances in social work, spring 2025, 25(1) 64 courtney: he gets really frustrated too easy. nadiene: he doesn't give us enough time to finish what he is doing. he erases the board so quick… this restorative circle highlighted a fundamental issue they experienced: the accelerated teaching pace of mr. wentworth. the girls also went on to describe the punitive nature of his discipline approach, stating: erica: [in a low tone with a smile] i don't like that he tries to take everyone’s phone. rp leader: but is that a school rule? erica: yes, but he is strict with it. he calls security on us! rp leader: are you ok if we talk with him later today? students: yes courtney: [with a slight smirk] he'll probably cry. overall, by observing this restorative circle it was revealed that mr. wentworth’s disciplinary style varied between calling school security for minor issues and showing a more permissive demeanor. this fluctuation in discipline was noted by students, who expressed frustration with his approach during their interactions the role of classroom management style and its relationship to discipline outcomes was also noted during afterschool detention. over the course of the school year, the lead author noticed a consistent presence of black girls in afterschool detention. these girls encountered detentions for behaviors like hallway roaming, cell phone use, and classroom disruptions which were behaviors witnessed across all students. of note, the very act of missing detention or breaking a rule during detention resulted in an automatic 1-day suspension. ms. jackson described that those suspended for such infractions were simply getting a “day off from school.” an instance of this was evident during a detention hall session when a black female student was expelled from the detention session and received a suspension for using her cell phone: [context: a black female student pulls out her phone during detention. she is sitting right next to ms. jackson the detention hall monitor.] ms. jackson: you got to be kidding! black female: my mom is calling to see if i am ok, she is worried about me. ms. jackson: doesn’t matter, you’re out! [said under her breath]. black female: [smiles and stays seated]. ms. jackson: out! black female: [hesitates to get up as though unsure. she then more assuredly gets up and walks out while saying] well i'm not getting suspended because you guys don't have my mom’s new number. joseph-mccatty et al./restoive justice 65 after the detention, the lead author asked ms. jackson about the student’s comment, and she said, “when the calls go to the homes of students that have detention, many house numbers are out of order or are old numbers. sometimes the kids erase the messages. so, her mother may not know if she has a detention or suspension because we don't have her number.” throughout the observations, classroom management and disciplinary practices varied, with some students, particularly black girls, receiving punitive responses for minor behavioral issues such as cell phone use. these disciplinary actions, combined with inconsistencies in how policies were applied, were frequently noted. even in a school implementing restorative practices, these inconsistencies were evident, suggesting that not all discipline was administered according to the established guidelines. discussion black girls are disproportionally suspended nationally (usdoe, 2019), and this trend was evident at the case-study school. quantitative analyses revealed that black girls were 1.24 times more likely to be suspended than all students and 2.07 times more likely than all other girls. these comparative suspension rates underscore the importance of examining both between-race and within-gender disparities to fully understand how race and gender intersect in school discipline. notably, the heightened suspension risk for black girls exceeded that of black boys, who were 1.57 times more likely to be suspended than their male peers. these findings suggest that schools implementing restorative justice (rj) must disaggregate discipline data by both race and gender to develop accurate baselines and effective interventions. while overt race and gender biases may not always be measurable, discipline outcomes—when viewed through an intersectional lens, offer critical insight into how black girls are perceived and treated within school systems. as demonstrated by the qualitative findings, undergirding the disproportional outcomes were the inconsistent application of discipline, the inconsistent and punitive application of restorative practices, and the punitive nature by which discipline was administered. research by arum (2003) suggests that when discipline practices are inconsistent, a lack of integrity is communicated, and administrators command less respect from the students who are adversely affected. it follows that when discipline practices are punitive and inequitable, not only do they not serve to change behaviors, but it is likely that students will be defensive because of the inequitable treatment they have experienced. this defensiveness was demonstrated when the black female student was asked to leave detention after answering a phone call from her mother, which exacerbated her original punishment into a suspension. as described by the student, her mother was unaware that she was in after-school detention and therefore was looking for her. yet, her abrupt dismissal from detention communicated the punitive nature of the discipline practices in the school which allowed her to be suspended for speaking to her mother concerning her location. therefore, receiving a suspension for answering her phone may have left the student feeling unfairly targeted for a minor infraction. in line with adultification, suspending this student focused on her culpability versus her need to ensure her safety to her guardian. within an ecological framework, we suggest that focusing on student advances in social work, spring 2025, 25(1) 66 culpability is connected to punitive discipline policies that focus on infractions versus supportive accountability. as a school with a restorative justice focus, the outcome of this interaction could have been altered had a restorative practice question, like the following were asked: “why do you think it is appropriate to answer a phone call during detention?” or an affective statement such as, “when you answer a phone call in detention, it makes me feel that you have no regard for the rules.” through statements and questions like these, the detention hall monitor can communicate that cell phones are not allowed in the afterschool detention hall while also learning that the student needed to communicate her location to her mother because she did not make it home yet. this exchange would have allowed for rapport building and mutual accountability as the detention hall monitor previously admitted that robotic calls to parents about after school detention did not always reach parents. thus, the subjective nature of school discipline practices coupled with inequitable discipline practices have deleterious effects on the outcomes of black girls. likewise, the subjective and inconsistent enforcement of discipline policies became a pathway of inequitable discipline impacting black girls. this was evidenced by the security officer that described how a group of black female students received a 10-day suspension while white males who had committed the same offense only received a 3-day suspension. ultimately, a culture of inconsistency can continue to foster inequitable discipline practices even in schools seeking to create reform through restorative practices. according to morrison (2018), “perceived unfairness contributes to noncompliance with discipline” (p. 22). it follows that when rp is administered in a way that is equitable, students will be more apt to understand and have respect for the established rules as opposed to engaging in what can be perceived as oppositional behavior. the impact of inequitable discipline practices also adversely affected the student/teacher relationships as demonstrated by the interaction between mr. wentworth and a group of black girls in his class. instead of maintaining control of his classroom environment and employing the relational tools of rp, mr. wentworth vacillated between a punitive and permissive approach which in turn correlated with a lack of respect from the “core group,” as he described them. while students should be accountable for showing respect to their teachers, inconsistent classroom management and punitive disciplinary styles can fracture relational ties between students and teachers, potentially spiraling into additional unwanted behaviors (darensbourg et al., 2010). consistent with the rp concept of the “social discipline window”, educators build robust student-teacher relationships and supportive classroom environments most effectively when their disciplinary strategies emanate from the “with/restorative/authoritative” quadrant, blending high control with high support (costello et al., 2009, pp. 7-8). conversely, a display of high control without adequate support lands educators in the “to/punitive/authoritarian” quadrant which can create further classroom conflict (costello et al., 2009, pp. 7-8). further, a few girls articulated his fast-teaching pace saying, “he needs to slow down” and “he doesn’t give us enough time to finish” which appeared to be a significant component of the conflict he had with this group of black girls. numerous studies have outlined that students who feel academically disengaged often manifest disruptive joseph-mccatty et al./restoive justice 67 behaviors (toldson et al., 2015; tyler-wood et al., 2004). ideally, had these girls felt more included within the instructional environment, they may have demonstrated fewer behavioral issues. overall, the literature establishes that relationship-building is a critical component of restorative justice practices (buckmaster, 2016; drewery, 2004). indeed, anyon and colleagues (2018) found that when relationships were built, exclusionary discipline practices were less utilized. instead, discipline was viewed “as an opportunity for growth and problem solving, rather than punishment” (p. 225). it follows then that when classroom relationships are adversarial, classroom disruptions and rule breaking are more likely to occur (yassine et al., 2020), particularly when students feel singled out as a core group of problematic students. by establishing meaningful relationships with the girls, the motivation behind their behavior may have been better understood and their relationship with mr. wentworth could have been strengthened, as opposed to increasing the rift between the teacher and the group of girls. practice implications as the only group of girls disproportionally suspended across the united states, schools implementing restorative justice practices with black girls may need to customize some elements of rp practices for black girls. as a multi-tiered intervention where universal practices are available to all students, tier two practices could be facilitated by school social workers and can include small group circles that focus on black girls’ lived experiences in the community and the school setting. the circle conversations can be data driven or be based on the topic requests from black girls. the goal would be to create a more inclusive approach to restorative practices that would allow educators to understand how black girls are interacting with each other, educators, policies, and the school environment. finally, just as restorative practices should incorporate the gendered and racialized lived experiences of black girls, discipline policies, practices, and analyses should account for their experiences as well. ideally, school social workers can help facilitate this and aid administrators by identifying policies and practices that perpetuate inequitable practices impacting black girls. limitations data for this study were collected during the first year that the case-study school implemented restorative practices. since whole school-change can take 3-5 years, data collected do not represent restorative practices at its optimal functioning. nonetheless, this research demonstrates how rj is permeable to ecological factors such as punitive discipline and unclear and inconsistent discipline practices. we contend that these barriers can be present in schools using rj practices at any year of implementation. conclusion reducing high and disproportional suspensions for black girls goes beyond reducing unwanted behaviors. high and disproportional school suspensions are a multi-faceted advances in social work, spring 2025, 25(1) 68 phenomenon enmeshed in policy, punitive practices, behavior, and social constructions of identity. as such, responses to these disparities must likewise be multifaceted and customized to the needs of the black girls. as the only group of girls disproportionally suspended across the country, a behavior-centered or one-size fits all 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(2020). black girls and women in k-12 educational settings: a content analysis of publications in selected journals from 2000-2015. the urban review, 52(3), 603-622. address correspondence: andrea joseph-mccatty, college of social work, university of tennessee knoxville, knoxville, tn, 37996. email: ajoseph7@utk.edu https://www2.ed.gov/about/offices/list/ocr/docs/school-climate-and-safety.pdf https://www2.ed.gov/about/offices/list/ocr/docs/school-climate-and-safety.pdf https://www2.ed.gov/about/offices/list/ocr/docs/school-climate-and-safety.pdf https://www2.ed.gov/about/offices/list/ocr/docs/school-climate-and-safety.pdf https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201401-title-vi.pdf https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201401-title-vi.pdf https://doi.org/10.1023/a:1015375215801 https://doi.org/10.1023/a:1015375215801 https://pmc.ncbi.nlm.nih.gov/articles/pmc2678799/ https://pmc.ncbi.nlm.nih.gov/articles/pmc2678799/ https://pmc.ncbi.nlm.nih.gov/articles/pmc2678799/ https://www-iirp-edu.webpkgcache.com/doc/-/s/www.iirp.edu/images/pdf/defining-restorative_nov-2016.pdf https://doi.org/10.3102/0034654318791582 https://doi.org/10.3102/0034654318791582 https://doi.org/10.1111/1467-9604.12317 https://doi.org/10.1111/1467-9604.12317 https://doi.org/10.1007/s11256-020-00582-y https://doi.org/10.1007/s11256-020-00582-y mailto:ajoseph7@utk.edu _________ charmaine clarke, phd, lmsw, adjunct assistant professor, department of sociology and anthropology, farmingdale state college, farmingdale, ny. jennette allen-mccombs, phd, lmsw, assistant professor, department of social work, city university of new york-york college, queens, ny. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 335-352, doi: 10.18060/28454 this work is licensed under a creative commons attribution 4.0 international license. social stigma and deprivation: a qualitative study of reentry experiences of formally incarcerated elderly individuals charmaine clarke jennette allen-mccombs abstract: in many countries worldwide, including australia, japan, the united kingdom, and the united states, older adults comprise the fastest-growing population in the prison system. this study aims to understand the reentry experiences of formally incarcerated elderly individuals in the united states through the lens of social stigma and deprivation theory. the authors use the term “returning citizens” instead of commonly used crimecentered terms like ex-offender to honor the dignity and worth of these individuals. twentysix elderly returning citizens, formerly incarcerated and currently residing in a major city in the northeast united states, participated in this qualitative research study. using a semistructured interview format allowed participants to be experts in their lives and attribute their meaning to their reentry experiences. thematic analysis was used to analyze interview data. the findings of this study revealed that social stigmas and economic, social, physical, and psychological deprivations are interconnected and compound the difficulties in reintegration, highlighting the need for targeted health interventions and support systems. participant responses suggest the need to develop macro-level infrastructure in the communities that will serve returning citizens, including vocational training in congruence with civil society to increase their employability, mental health services, and access to public health programs. keywords: social stigma, deprivation theory, elderly, formerly incarcerated, reentry in many countries worldwide, including australia, japan, the united kingdom, and the united states, older adults comprise the fastest-growing population in the prison system (psick et al., 2017). there are nearly 450,000 people released from prisons in the united states every year (carson & kluckow, 2023). approximately 18% of individuals incarcerated in federal prisons are age 50 and older, the age at which the national institute of corrections (nic), an agency of the u.s. department of justice, classifies an inmate as elderly (american civil liberties union [aclu], 2012; kim & peterson, 2014). in the last two decades, the u.s. correctional system has seen an explosive growth in the number of elderly offenders. between 1999 and 2016, the number of incarcerated individuals aged 50 and older increased by 280% to more than 186, 000 (carson & kluckow, 2023; pew charitable trust, 2018). experts have projected that elderly inmates will reach 400,000 by 2030 (aclu, 2012). these alarming statistics underscore the urgent need for action, prompting calls from advocates for the compassionate release of elderly, immunocompromised, or medically needy incarcerated individuals (berryessa, 2020). the sentencing reform act of 1984 established compassionate release, a process that allows for the early release of prisoners who are sick or elderly (williams et al., 2011). lawmakers created the policy with the idea that older and less healthy incarcerated about:blank advances in social work, spring 2025, 25(1) 336 individuals may be less likely to re-offend after release (berryessa, 2020). this approach addresses the issue's humanitarian aspect and offers a potential solution to reducing recidivism rates. advocates of the prison reform movement have increasingly called for the release of low-risk inmates to decrease the carceral population. in april 2020, the united states instituted the early release pilot program, which authorized the u.s. attorney general to designate prisons to identify elderly, nonviolent individuals who meet specific criteria for early release to residential reentry centers (i.e., halfway houses) and home confinement (james & foster, 2020) to reduce the population and slow the spread of covid-19. similar initiatives have been implemented worldwide (louden et al., 2021). in this paper, we describe the findings of a qualitative research study that explored the firsthand experiences of recently released elderly men and women in an urban metropolitan city in the northeast united states. the experience of being in prison exacerbates existing disadvantages and stigma by removing individual personhood, replacing names with inmate identification, and labeling individuals as criminals (lageson & maruna, 2018; sugie et al., 2020). we choose to use the term “returning citizens” instead of commonly used crime-centered terms like ex-offender or ex-convict to honor the dignity and worth of these individuals. moreover, research has shown that person-centered language may have the capacity to shape society's view of returning citizens and reduce stigma (jackl, 2023). this study aims to understand the meaning of reentry from participants' perspectives and contribute to the knowledge of program planners, service providers, agency leaders, and policymakers. in a correctional context, the term “reentry” refers to the process of returning to society after incarceration (jonson & cullen, 2015). the findings are significant in understanding factors that influence or impede the successful transition from prison to communities for elderly returning citizens who have served their full sentence, those released on parole, and those released to reduce overcrowded conditions. reentry challenges most returning citizens return to marginalized urban communities characterized by underresourced schools, inadequate healthcare resources, and weak labor markets, all of which present significant barriers to their successful reentry (zhang et al., 2019). in the case of elderly returning citizens, these disparities add further challenges to the reentry process, as they often experience age-related health problems, including impaired vision and hearing, poor mobility, and depression (greene et al., 2018; hooper et al., 2020). despite the growing number of elderly incarcerated individuals in the criminal justice system, there is a paucity of qualitative research on their reentry experiences. the available literature neglects the lived experiences of elderly returning citizens reintegrating into their communities, focusing primarily on their younger counterparts. considering the projected rise in elderly individuals leaving prison, more research on their perspective regarding reentry is needed to assist in future policy developments for this population. reentry experiences impact not only the returning citizens but also their families and the communities they return to. there may also be an increase in the demand for caretakers for those elderly returning citizens with chronic diseases that negatively impact their ability to live independently (pękala-wojciechowska et al., 2021). successful reintegration depends on communities providing accessible resources and inclusive spaces that honor returning clarke & allen-mccombs/rentry experiences 337 individuals' independence while supporting their health, social connections, education, and chosen activities (baidawi et al., 2011). these unmet needs foreshadow increased costs for affected communities; hence, by gaining knowledge of elderly returning citizens’ reentry experiences and needs, communities can anticipate and develop cost-saving programs targeted to this group (maschi et al., 2013). a successful transition from prison to the community is a formidable undertaking for elderly returning citizens. therefore, it is imperative to identify elements that ensure an effective return to society. ample research exists on policies and the challenges that returning citizens face, yet few studies focus on the lived experiences of this group. theoretical framework deprivation and social stigma theories formed the framework for the current study. we garner theoretical insights from sykes’ (1958) now classic development of deprivation theory in “the society of captive” to understand the experiences of elderly individuals who serve long-term prison sentences. sykes (1958) contends that the goal of imprisonment is not only to deprive individuals of their freedom but also to impose the “pains of imprisonment” that include the deprivation of liberty, intimate relationships, safety, access to goods and services, and autonomy (p. 63). similarly, pekalawojciechowska et al. (2021) maintain that the prison environment often worsens existing social, psychological, physiological, and sensory disorders and usually creates new conditions as a result of multidimensional deprivations in carceral institutions. deprivation theory posits that the systematic denial of basic human needs and normal social interactions during incarceration produces profound psychological and physiological consequences. as haney (2001) emphasizes, "at the very least, prison is painful, and incarcerated persons often suffer long-term consequences from having been subjected to pain, deprivation, and extremely atypical patterns and norms of living and interacting with others" (pp. 4-5). when deprived of fundamental needs, individuals experience heightened stress and may resort to risky behaviors to cope with their losses, ultimately compromising their health and well-being (haney, 2012). this framework particularly illuminates the challenges faced by elderly incarcerated individuals, who often struggle to access adequate healthcare both during imprisonment and after release (maschi & leibowitz, 2018). the theory extends to relative deprivation, where individuals experience distress when perceiving disparities between their current circumstances and societal standards (yang et al., 2019). for elderly returning citizens, this manifests in diminished quality of life due to limited social connections and meaningful activities, often leading to emotional, psychological, and physiological distress (haney, 2012). social stigma social stigma is a powerful social construct that profoundly affects individuals' lives, shaping their identities and experiences. we employ goffman's (1963) theory of social stigma to analyze how elderly returning citizens navigate societal barriers. many face discriminations in housing and employment due to criminal records while also confronting stereotypes about being dangerous or untrustworthy. age-related challenges further advances in social work, spring 2025, 25(1) 338 compound these stigmas, as elderly returning citizens may encounter prejudice about their productivity or healthcare needs. understanding the intersection of age, criminal history, and social stigma reveals the complex challenges faced by this group as they navigate reintegration into society while contending with the lingering effects of their past. according to goffman (1963), society has negative attitudes and beliefs about individuals and groups who deviate from social norms. the process of stigmatization takes one of three forms: persons or groups may be stigmatized for external deformation, deviations in personal traits (mental illness, imprisonment, addiction), or for the group to which they belong (race, ethnicity, nationality, or religion; goffman, 1963). elderly returning citizens often grapple with character stigma, as their criminal records mark them as deviant, overshadowing their identity and past experiences. this stigma can manifest in various forms, including discrimination, social exclusion, and internalized shame, complicating their reintegration efforts (anazodo et al., 2019; lebel, 2011; moran, 2012). furthermore, the intersection of aging and criminal history creates a unique and challenging dynamic for elderly returning citizens. when an individual with a criminal background reaches old age, they confront an amplified stigma, as society may perceive them through a dual lens of deviance and vulnerability. this intersection can lead to profound feelings of isolation and hopelessness that can perpetuate a cycle of despair, making it difficult for them to access support networks crucial for successful reintegration (hirschfield & piquero, 2010). building on goffman's foundational research, contemporary studies have documented how stigma systematically damages individuals' social, economic, and psychological wellbeing (pescosolido & martin, 2015). link and phelan (2001) contend that the stigmatization process unfolds through five distinct yet interconnected stages: first, certain human differences are identified and labeled within society. these labels then become associated with negative stereotypes, leading to social division that separates stigmatized individuals from the broader community. as this separation deepens, the labeled group experiences status loss and discrimination, resulting in diminished opportunities and outcomes. finally, institutional power structures legitimize and reinforce these inequities, perpetuating the cycle of stigmatization through formal and informal mechanisms. several studies exist that explore the experience of stigma among those who are reentering society after incarceration (lebel, 2011; rade et al., 2016; sinko et al., 2020). there is an emerging interest in the intersection of age, stigma, and reentry (maschi & leibowitz, 2018; prost et al., 2019). scholars have also applied deprivation theory to examine prisoner experiences and behavior (aranda-hughes et al., 2021; marcum et al., 2014). however, to our knowledge, the theory has not been used to examine the range of potential effects for elderly returning citizens. this current study aims to give voice to the experiences of reentry from the elderly participants' perspective. methods the current qualitative study used a constructivist phenomenological approach. the study included 26 formerly incarcerated individuals who had served time in state and federal prisons and lived in a major u.s. city at the time of participation. these men and clarke & allen-mccombs/rentry experiences 339 women were released after the age of 50 and were at least one year post-incarceration at the time of the interview. using a semi-structured interview format allowed participants to be experts in their lives and attribute meaning to their reentry rather than meaning being ascribed by outsiders. this study addresses the research question: “how do elderly returning citizens experience the reentry process?” more specifically, • what are the housing experiences of elderly returning citizens? • what are the employment experiences of elderly returning citizens? • what are the physical health maintenance experiences of elderly returning citizens? • what are the mental health maintenance experiences of elderly returning citizens? • what are the substance use and treatment experiences of elderly returning citizens? data for this study were collected prior to the onset of covid-19. this pre-pandemic timeframe provides important context for understanding participants' reentry experiences, as they occurred before the unprecedented global disruptions to employment, social support networks, and community services that characterized the pandemic period. while our discussion considers potential implications of post pandemic reentry processes, it's important to note that our findings reflect conditions and experiences that preceded these pandemic-related challenges. participants we utilized a purposive sampling method to recruit initial participants from agencies that provide programs targeted to returning citizens. these agencies were generally very responsive to our inquiries for research participants, allowing researchers to place recruitment posters at their locations and discuss the project. our purposive sampling strategy, which focused on recruiting through agencies providing reentry services, was deliberately chosen to access participants who could speak to reintegration challenges and their experiences with support services. since this approach might have limited our access to individuals who were not connected to services, a snowball method was also employed, where recruited participants recommended their acquaintances as potential interviewees. the addition of snowball sampling helped expand our participant pool, capturing individuals who were less engaged with formal support services. in sum, 26 elderly returning citizens consented to participate. of all participants, 23 were male, and three were female. eighty percent (n=21) of the sample identified as african american, 8% (n=2) identified as white, and 12% (n=3) identified as hispanic. the mean age was 60.4 years, and the mean age at the time of release was 56.6 years (range = 51-71 years sd = 6.66). the variation in participants' time served, ranging from 10 to 38 years, reflects the diverse experiences within the elderly returning citizen population and strengthened our findings by capturing how reentry challenges manifest across different lengths of incarceration. though participants served varying sentences for various types of offenses, they shared common experiences of age-related challenges and stigma during reentry, suggesting that these issues transcend the length of incarceration. advances in social work, spring 2025, 25(1) 340 procedure several sites provided the setting for semi-structured interviews, including agencies where participants received services related to their reentry, returning citizen advocacy institutions, and public libraries. we clarified to participants that they did not need to answer any questions they were uncomfortable answering and that they were free to terminate the interview at any time. participants were informed that there were no known risks beyond the discomforts of recalling potentially unpleasant events. we also informed participants of mental health resources they could contact if they felt emotionally or psychologically uncomfortable afterward. data collection included demographic information regarding ethnicity, age, education, health status, incarceration history, and the nature of the crime. the interview also included questions regarding their reintegration experiences and post-release services utilization; the open-ended format explored their reentry through their lens. the researcher used a non-directive style of interviewing that allowed participants to control the pace and substance of the interview. each interview lasted between 90 minutes and two hours. interviews were transcribed verbatim with corresponding notes and securely stored to ensure confidentiality. the institutional review board (irb) provided ethical approval for the study. data analysis we used clarke and braun’s (2017) thematic analysis framework to analyze the interview data. the analysis process began by reading the verbatim interview transcripts several times to search for and compile emergent patterns and meanings. nvivo 11, a computer-assisted qualitative data analysis software (caqdas) program, organized and managed text from uploaded interview transcripts. thematic coding involved pursuing related words or phrases mentioned by the interviewees and provided the basis for selecting patterns and codes that captured meaningful experiences. in the findings section, pseudonyms are used for all participants to maintain confidentiality while preserving the authenticity of their individual voices and experiences. findings housing the stigma of a criminal history is another hindrance to a returning citizen securing housing. in the united states, neighborhood residents often resist transitional and supportive housing in their communities, leading to a shortage of stable, safe, and affordable housing (fontaine & biess, 2012). additionally, potential landlords frequently reject applicants with criminal histories (evans & porter, 2015). participants in the current study reflected similar struggles with finding suitable housing. sixteen of the 26 participants indicated that they spent their first night after release at a homeless shelter. there was a general view that the shelters were worse than being in prison when accounting for personal safety, cleanliness, and controlling potential health concerns. clarke & allen-mccombs/rentry experiences 341 a study participant who was 19 months post-release at the time of his interview commented regarding his experience in the shelter system, that was crazy. you think being in jail is crazy? that was weird. it was worse than being in prison…i had to sleep with an individual, and the room it stunk; it was filthy. it was a young kid so i had to keep my eye on him, i don’t know who he is...i didn’t know what was going on, so i didn’t sleep that night. (james, male, age 52, served 29 years in prison) similarly, charles, a 62-year-old male who served 38 years for a violent crime, reported that he had to sleep in shelter facilities with up to six people in a small room. insufficient housing assistance services before release limits returning citizens' ability to access permanent housing and maintain health and safety. nevertheless, many u.s. states are not lawfully required to provide housing assistance since sentences are mandated by legislation and not by parole boards (mckernan, 2017). another participant reported experiencing eight chronic illnesses and described being ejected from his family’s home: i was sleeping in a van the whole last winter. the whole winter. my sister would tell me to come over…i would be there two days, and she would say, “oh, it is getting too crowded in here. y'all have got to go back out in the car.” (paul, male, age 62, 36 years incarcerated) the current housing shortage in major u.s. cities creates significant barriers to successful reentry for elderly participants (hamlin, 2020). after enduring eighteen months sleeping on a cot in the kitchen of an overcrowded halfway house, chris, a 68-year-old participant who had spent a total of 37 years in prison, wrote a letter to the governor pleading with him to send him back to prison. employment economic deprivation is a significant challenge for elderly returning citizens. they often face additional barriers to economic reintegration since many have limited access to employment opportunities due to their criminal records, age-related health issues, and lack of contemporary job skills (nguyen et al., 2023). slightly more than a quarter of adults incarcerated in state prisons participate in academic, career, and technical education programs (turner, 2018). yet, these programs have shown no effect on reducing recidivism or leading to post-release employment (bozick et al., 2018; visher et al., 2005). furthermore, elderly returning citizens are at an even greater disadvantage than their younger counterparts for further stigma, including age discrimination, having one or more chronic illnesses, and outdated technical skills. alex, a 57-year-old male with a history of chronic incarceration since the age of 18, commented, “i was taking up air conditioning refrigeration, and it was obsolete because when i came out, everything was computerized.” one of the three female participants discussed her lack of marketable skills, as far as women go we don’t have the same opportunities in vocational training as men do. they have very outdated vocational training, things that we really advances in social work, spring 2025, 25(1) 342 cannot do on the outside…they started on computer repair, but all their equipment is 10 years behind and they won’t let you work on laptops because they think you will steal parts to make weapons. (sandra, female, age 62, served 10 years) many study participants were released believing that the training they received would enable them to find jobs. instead, they learned that their acquired skills were obsolete, leaving them without the means to support themselves and their families. in recent times, the unemployment rate for formerly incarcerated individuals has been nearly five times higher than that of the general us population during this time (couloute & kopf, 2018). the unemployment rate in the united states at the height of the pandemic was 18.5% for those with a high school diploma compared to 7.2% for those with a college degree (kochhar, 2020). studies show that individuals who experience prolonged unemployment are more susceptible to chronic stress, mental health issues, and health-related problems (blustein, 2019). mental health society often stigmatizes returning citizens, leading to social exclusion and discrimination in various aspects of life (bos et al., 2013). social deprivation encompasses the isolation and lack of social support experienced by elderly returning citizens. upon release, many face estrangements from family and friends due to the stigma of their criminal past and the extended period of separation. this lack of social connections can lead to feelings of loneliness, rejection, and low self-worth, but building new social networks is challenging for elderly returning citizens, who may struggle to find communities that accept them (brown & greco, 2024). these can significantly hinder their ability to reintegrate into society, perpetuating a cycle of deprivation and marginalization. it is rare for newly released returning citizens to seek community-based mental health services following their release. those who seek help find that the care they receive is inadequate to fully address their complex and comorbid conditions (hamilton et al., 2015). participants self-reported stable mental health status but displayed and described evidence of ptsd, depression, and anxiety. when asked if he had any mental health issues, will, a 52-year-old male, quickly replied, “no, i am not crazy.” he excused himself from the interview but later returned. he admitted to suicidal ideations and cried during most of the interview. will was unwilling to seek professional help, even though he acknowledged he needed someone to speak with about his emotions and thoughts. he commented: i mean, being in jail, you are going to have some mental problems, but not to the point that i have to take meds for it. but if i had to, i don’t think i would because ain’t nothing wrong with me. i have some trauma. i don’t sleep under the covers because, in jail, that is dangerous. i still take showers with underwear on by myself. like those types of things. (will, male, age 52, chronic recidivist since age 17) another study participant acknowledged his mental health diagnosis and history, but a lack of trust based on prior experience made them reluctant to seek services. clarke & allen-mccombs/rentry experiences 343 i forgot the name of the diagnosis, something like ptsd. sometimes, i think people are talking about me or looking at me. i get a little paranoid sometimes. certain situations, i don’t like being around a lot of people. i witness some serious stuff while in prison, stabbings and so forth… like i was saying, there are times when i isolate myself and stay away from people. (gregory, male, age 55, served 2 ½ years) notably, the few women in the study reported positive experiences with mental health services. mary, a 51-year-old female participant who was diagnosed with clinical depression and incarcerated 17 times, commented, “i think i have struggled with depression since i was a little girl, but i was not old enough to know what it was…once i found out, they put me on medication, and i felt better.” another female participant reported: in prison, i was so fortunate to have this wonderful specialist that came there who is a trauma specialist...i took advantage of that…i do have the tools that i learned how to deal with it [mental health issues]. i struggled and still struggle with mental [health] issues. i am just well-equipped now to work with [it]. (sandra, female, age 62, diagnosed with ptsd, agoraphobia, and borderline personality disorder) the relationship between incarceration and mental health is complex and multifaceted. while prison conditions often exacerbate mental health challenges through deprivation and social isolation, it is important to recognize that many individuals enter the correctional system with pre-existing mental health conditions, as illustrated by the participant's reflection on experiencing depression since childhood. moreover, for some individuals, prison may represent their first opportunity to access consistent mental health services and treatment, which could explain why sandra reported benefits from prison-based mental health care. this is not necessarily contradictory to the negative impacts of incarceration on mental health but rather highlights the complicated reality that prison can simultaneously be a source of psychological harm through deprivation while also serving as a point of intervention for addressing pre-existing mental health needs. this finding underscores the critical importance of ensuring continued access to mental health services during the reentry process. substance use kim and peterson (2014) estimated that the average prisoner in the united states over the age of 50 has a physiological age of up to 15 years more than the chronological age due to stressors of incarceration and prior lifestyle choices, including substance use and factors associated with criminal activities. study participants reported past substance use, including alcohol, marijuana, cocaine, heroin, and crack cocaine, which often led to probation and parole violations. most indicated that they received services relating to substance use disorder rather than overall mental health upon release. only one participant reported an issue with substance use post-release. caesar, a 55-year-old male, had been incarcerated seven times since the age of 16 and was homeless on the day of the interview. when asked about sobriety, he unabashedly replied, “[being sober is] not important. i love to be drunk...i feel more comfortable drunk...[then] i don’t worry about nothing.” caesar’s advances in social work, spring 2025, 25(1) 344 posture can be understood in the context of deprivation theory, which suggests that individuals who experience various economic hardships, social isolation, or emotional neglect are more likely to engage in substance abuse as a coping mechanism (yang et al, 2019). physical health elderly returning citizens often experience severe physical health challenges exacerbated by the deprivation of adequate resources and support (maschi & leibowitz, 2018). physical health outcomes highlight the direct impact of deprivation on the wellbeing of elderly returning citizens, emphasizing the need for comprehensive health interventions and support systems (kaiksow et al., 2023; maschi & leibowitz, 2018). participants reported significant health challenges, with nearly half (48%) reporting two or more chronic diseases and 22% having three or more chronic conditions. the most prevalent health issues were hypertension, affecting 38.5% of participants, and diabetes, impacting 34.6% of the sample. other conditions included musculoskeletal problems (19.2%) and asthma (11.5%). several participants reported conditions such as heart disease, kidney disease, sleep apnea, hepatitis c, glaucoma, prostate issues, gout, emphysema, and cirrhosis of the liver, each affecting 3.7-3.8% of participants. researchers suggest that these illnesses are often due in part to environmental influences, lifestyles before incarceration, personal habits, their response to the stress of imprisonment, and previous healthcare utilization (greene et al., 2018). the personal accounts of participants illustrated various approaches to health management after release. gregory, though not under physician care, proudly reported that weed gained access to healthcare through the affordable care act post-release, stating, “yes [i have healthcare], obama did that, and it was easy getting it online.” similarly, mary showed strong initiative in managing her health conditions, explaining, “i went and got me a primary care physician; i got an orthopedic surgeon, a gyn.” she also highlighted the health challenges faced during and after incarceration, as she described her weight management journey, "“i was almost 400 lbs. and now i am down to 260…you don't realize how much weight you are gaining wearing them loose clothing [in jail].” all participants reported having some form of healthcare coverage. since socialized health care is not an option in the united states, many states have adopted public health insurance (medicaid) enrollment initiatives for returning citizens. nevertheless, sixteen state prison systems still have no provision for medicaid enrollment at release (hopkin et al., 2018). clarke & allen-mccombs/rentry experiences 345 figure 1. stigma and deprivation effects on elderly reentry outcomes advances in social work, spring 2025, 25(1) 346 summary findings from this study integrate stigma theory and deprivation theory to explain the outcomes facing elderly returning citizens. figure 1 shows how these interconnected theoretical perspectives help explain the challenges in housing, employment, substance use, and health outcomes. the model (figure 1.) merges stigma theory (labeling, stereotyping, discrimination) with deprivation theory (material, skill, social losses during incarceration) to explain the challenges faced by the elderly returning citizens in this study. these theoretical frameworks operate through age-specific moderators like cumulative disadvantage, physical vulnerability, and depleted social capital, creating distinct barriers for participants. these interactions produced consequences throughout several interrelated areas in their lives, including housing instability resulting from discrimination and financial constraints, employment challenges because of skill gaps, substance use as coping amid limited support, physical health deterioration from accelerated aging, and mental health challenges from internalized stigma. these outcomes form reinforcing feedback loops. for example, housing instability undermines employment, which further restricts housing options. the model identifies interventions at the macro, mezzo, and micro levels and provides a framework to address the complex reentry challenges affecting elderly formerly incarcerated individuals. discussion the narratives analyzed for this study are replete with the institutional and societal stressors elderly returning citizens face in their reentry process. our analysis of this unique population has contributed new insights into much-needed services and the barriers present during reintegration into their communities. the intersection of deprivation theory and stigma theory provides a compelling framework for understanding how elderly returning citizens experience multiple, overlapping challenges during reintegration. the findings show how these various forms of deprivation (economic, social, physical, and psychological) work in concert with different categories of stigma (public, self, and cultural) to create a complex web of challenges for elderly returning citizens. their subjective experiences of these challenges are reflected in their expressed feelings of despair over lost opportunities and their perception of having wasted their lives, demonstrating how the theoretical concepts of deprivation and stigma manifest in deeply personal ways that impact their reintegration process. this study reveals how economic instability and housing insecurity serve as concrete manifestations of deprivation while simultaneously functioning as visible markers that trigger social stigma. these material hardships appear to interact with and amplify psychological deprivation, as evidenced by participants' experiences with depression, ptsd, and other mental and physical health challenges. the findings highlight how selfstigma operates within this population, especially among african american males, who demonstrate a reluctance to acknowledge mental health struggles due to cultural stigmas. participant responses support research that suggests that suffering from mild depression or clarke & allen-mccombs/rentry experiences 347 anxiety is often viewed as being “crazy” in the african american culture (jacoby et al., 2018, p. 784). this internalization of negative stereotypes, as referenced by bos et al. (2013), illustrates how public stigma transforms into self-stigma, creating additional psychological barriers to seeking help for some participants. addressing stigmas is essential for improving the well-being and successful reintegration of elderly returning citizens into society. by acknowledging and mitigating the impacts of deprivation, policymakers, and social service providers can better support this vulnerable population, fostering a more inclusive and just society. policy implications insufficient reentry resources for formerly incarcerated individuals in the united states is a critical issue that undermines efforts at successful reintegration and rehabilitation. despite the rhetoric surrounding prisoner reentry, the resources allocated to these programs are woefully inadequate. wacquant (2010) argues that “the so-called reentry movement” is merely a minor bureaucratic adaptation that fails to address the fundamental contradictions of mass incarceration and urban poverty (p. 614). reentry programs have expanded since the early 2000s, but support services continue to fall short of addressing the complex challenges of post-incarceration reintegration and poverty (petrich et al., 2022). the second chance act reauthorization of 2018 increased funding authorizations to $340 million annually (council of state governments justice center, 2023), yet this represents less than 0.4% of the nearly $85 billion spent annually on corrections in the united states (sawyer & wagner, 2023). when distributed across the approximately 500,000 people released from state and federal prisons each year, this amounts to roughly $45 per person per month for reentry services. this amount remains inadequate for meeting basic needs like housing, employment assistance, and healthcare (western, 2018). effective reentry would require significantly more funding and the restoration of previously existing programs such as furloughs, educational release, work release, and halfway houses, which have been drastically reduced over the past three decades (byrne, 2020). the findings of this study suggest a holistic, interdisciplinary approach to reentry planning that is tailored to the needs of elderly returning citizens, utilizing specialists from the various contexts that they will negotiate in the process of reintegration. consequently, pre-release programs should include technology training to adequately prepare reentrants for the day-to-day demands of an information technology-driven society to increase their employability. since elderly returning citizens are likely to suffer from one or more chronic illnesses and lack the financial resources to acquire private insurance, submission of applications for public health care should be made before their release to prevent gaps in coverage. education on mental health services and benefits should be offered in correctional facilities to address stigma. lawmakers should consider reforming the u.s. parole system to increase sensitivity to elderly returning citizens with significant chronic health issues that impact their mobility by reducing the number of parole office visits or replacing face-to-face visits with remote video technology. advances in social work, spring 2025, 25(1) 348 implications for social work practice with the expected rise in the number of elderly returning citizens, social work practitioners must be aware of this group and their needs. elderly returning citizens are a stigmatized group and, therefore, may come to the therapeutic relationship with a devalued sense of self. social workers can advance the profession’s commitment to the dignity and worth of a person and social justice for returning citizens through several concrete actions: (1) developing specialized assessment tools that account for age-related needs and incarceration history, (2) establishing partnerships with community organizations to create comprehensive discharge planning that addresses housing, healthcare, and social support needs, and (3) implementing trauma-informed care approaches that specifically address both the psychological impact of long-term incarceration and age-related challenges. social workers should also advocate within their organizations for dedicated programs addressing elderly returning citizens' unique needs, such as peer support groups, specialized job training programs that account for physical limitations, and coordinated care services that help navigate complex healthcare and social service systems. clinical interventions must consider the trauma caused by the “pains of incarceration” and the impact of age, incorporating both individual counseling and group work approaches that build resilience and combat internalized stigma. further research this study represents an exploratory look at the phenomenon of elderly returning citizens’ reintegration into their communities. research with elderly returning citizens in other urban and rural areas is needed to enhance knowledge of the commonalities and differences in experiences by population density. there is also a need for follow-up studies to track long-term outcomes for permanent housing acquisition, employment acquisition, and mental health treatment service utilization. further research is required to examine elderly returning citizens’ social identity, and the efficacy of holistic pre-and post-release programs targeted to this group is also needed. further research should explore issues of race, ethnicity, gender, and systemic racism within the experiences of elderly returning citizens, given that a majority of participants identify as male and african american, which also reflects the overrepresentation within the u.s. carceral system. limitations there are a few limitations to consider when interpreting this study's findings. while sufficient for qualitative inquiry, the sample size may not capture the full range of experiences among elderly returning citizens. female voices are particularly underrepresented in our sample, limiting our understanding of gender-specific challenges in the reentry process. the findings also reflect a heteronormative perspective, with the voices of lgbtq+ and nonbinary individuals notably absent from this analysis. additionally, our reliance on self-reported data, while valuable for understanding lived experiences, may be subject to recall bias and social desirability effects, particularly when discussing sensitive topics such as mental health and institutional experiences. clarke & allen-mccombs/rentry experiences 349 furthermore, the study's geographic focus on an urban area in the northeastern united states may limit the generalizability of findings to elderly returning citizens in other regions with different service landscapes and community contexts. future research should address these limitations through larger, more diverse samples and multiple data collection methods to triangulate findings. references american civil 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(2019). successful reentry: a community-level analysis. the harvard university institute of politics criminal justice policy group. author note: address correspondence to jennette allen-mccombs, department of social work, school of health sciences and professional programs york college of the city university of new york 94-20 guy r. brewer blvd., jamaica, ny 11451. email: jallenmccombs@york.cuny.edu orcid: jennette allen-mccombs https://orcid.org/0009-0003-3335-4315 https://doi.org/10.1080/13607863.2019.1693976 https://doi.org/10.1080/13607863.2019.1693976 https://doi.org/10.1108/ijph-09-2016-0053 https://doi.org/10.1108/ijph-09-2016-0053 https://doi.org/10.1177/0093854816655837 https://doi.org/10.1177/0093854816655837 https://www.prisonpolicy.org/factsheets/pie2023_allimages.pdf https://doi.org/10.15453/2168-6408.1610 https://doi.org/10.15453/2168-6408.1610 https://doi.org/10.1111/1745-9125.12228 https://doi.org/10.1111/1745-9125.12228 https://doi.org/10.1007/s11292-005-8127-x https://doi.org/10.1007/s11292-005-8127-x https://doi.org/10.1007/s10624-010-9215-5 https://doi.org/10.7758/9781610448710 https://doi.org/10.7326/0003-4819-155-2-201107190-00348 https://doi.org/10.7326/0003-4819-155-2-201107190-00348 https://doi.org/10.1016/j.ssresearch.2019.03.011 https://doi.org/10.1016/j.ssresearch.2019.03.011 https://doi.org/10.1016/j.ssresearch.2019.03.011 https://iop.harvard.edu/sites/default/files/2023-02/iop_policy_program_2019_reentry_policy.pdf mailto:allenmccombs@york.cuny.edu https://orcid.org/0009-0003-3335-4315 _________ dana dehart, phd, research professor, and aidyn iachini, phd, msw, associate dean for research, college of social work, university of south carolina columbia, sc., l. bailey king, msw, grants and corporate giving officer, aid atlanta, atlanta, ga. elana lecleir, lmsw, wish assist coordinator, make a wish foundation, honolulu, hi. melissa reitmeier, phd, lmsw, field director, and teri browne, phd, nsw-c, interim dean, college of social work, university of south carolina, columbia, sc. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 953-975, doi: 10.18060/26157 this work is licensed under a creative commons attribution 4.0 international license. benefits and challenges of telehealth use during covid-19: perspectives of patients and providers in the rural south dana dehart aidyn iachini l. bailey king elana lecleir melissa reitmeier teri browne abstract: social workers and other health care researchers have examined benefits and challenges of telehealth in rural communities before the covid-19 pandemic. yet, experience with virtual platforms and other technologies have rapidly evolved during the pandemic. the research team interviewed 14 health care providers and 17 patients after the onset of the pandemic in a predominantly rural state to examine perceptions of telehealth. maxqda analytic software was used to identify benefits and challenges in the use of telehealth. findings identified commonly discussed benefits of telehealth including convenience for patients, increasing patient access to care, improved patient experience of care, and ability of telehealth to attract/retain patients. challenges identified in this study included concerns about quality of care being compromised, patients’ comfort and access to technology, policy challenges for providers, and the impersonal nature of telehealth visits. persistent issues warrant research, education, and policy advocacy to improve access for rural populations. social workers should play a key role in educating the emerging and existing workforce around barriers such as quality of care and patient comfort with technology, convening professionals and patients to establish sustained and effective reimbursement models, and advocating for structural access via enhanced broadband and other resource allocations. keywords: telehealth; covid-19; rural health care; patient perspectives the covid-19 pandemic generated a rapid proliferation of telehealth as social workers and other health care providers attempted to maintain continuity and quality of services amidst stay-at-home orders, isolation of infected persons, quarantining of exposed persons, and social distancing (adepoju et al., 2021; meyer et al., 2020). the pandemic and its corresponding expansion of telehealth services resulted in disparate impacts across urban and rural communities, with rural communities suffering from the digital divide in access to technology due to limited broadband connectivity, scant community resources, and a larger population of aging residents who often have limited familiarity with technology (funk, 2021; lieneck et al., 2021; meyer et al., 2020; segal et al., 2021; wilson et al., 2021). social work and other health care researchers have examined the benefits and/or challenges of telehealth implementation in rural communities before the pandemic (e.g., dehart et al., 2022; graves et al., 2021). for instance, dehart et al. (2022) identified about:blank advances in social work, fall 2022, 22(3) 954 benefits of increased coordination among providers and time savings, as well as challenges in organizational capacity and patient/provider skills. yet, experience with virtual platforms evolved during the pandemic as schools and services went online and the public increasingly relies on digital communication. in the current study, the research team examined perceptions of telehealth after the onset of the pandemic, with interviews conducted in the summer and fall of 2021 among a sample of social workers, other health care providers, and patients in a predominantly rural southeastern state. telehealth defined telehealth is a term used to describe a spectrum of methods to provide health care services, education, and administration through telecommunications technologies (chang et al., 2021; chen et al., 2020; wosik et al., 2020). examples include phone or video consultations, apps or computer programs that enable scheduling or medication refills, messaging through emails or secure portals, and remote monitoring of patient vital data (chang et al., 2021; substance abuse and mental health services administration [samhsa], 2021). a growing body of evidence suggests that patients are generally satisfied with the convenience and accessibility of telehealth (bashshur et al., 2020) and that telehealth can improve quality and costs of delivery (chen et al., 2020). in a prepandemic qualitative study of patients in a primary care setting, powell et al. (2017) noted patients enjoyed the convenience of not having to miss work, travel, or change clothing, as well as decreased wait times relative to in-person visits. convenience and collaboration among patients and providers were prominent benefits in a variety of pre-pandemic studies of social work and other telehealth settings, ranging from schools (reynolds & maughan, 2015) to behavioral health (saeed, 2015) and video group support (serwe et al., 2017). telehealth may support treatment engagement and empower patients by allowing more time for quality health discussion and collaborative planning from the familiarity of the patients’ home environments (gerber et al., 2020), while giving social workers and other health care providers a glimpse into patients’ living conditions. accessibility of care importantly, telehealth is designed to improve accessibility of care, which is crucial in the context of addressing health care gaps for rural populations. approximately 72% of the united states’ land mass is considered rural, yet it is inhabited by only 15% of the total population (chen et al., 2020). researchers have noted that the rural population of approximately 46 million people tend to be older and more medically vulnerable (myers et al., 2021) with greater likelihood of chronic medical conditions, suicidality, substance use disorders (douthit et al., 2015; young choi, 2012), and decreased physical access to primary and specialty care (shura et al., 2021). higher incidence of health disparities in rural areas (chen et al., 2020) are further perpetuated due to a shortage of local providers, as less than 12% of primary care physicians and 8% of specialists practice in rural settings (hempel et al., 2015; rosenblatt et al., 2010). rural communities also have a shortage of psychiatrists, psychologists, and master’s level social workers (mohatt, 2018; new american economy, 2017). given geographic isolation, significantly reduced economic dehart et al./benefits & challenges of teleheath 955 opportunities, and more reliance on public insurance (samhsa, 2021), telehealth may enable rural residents to receive care when resources such as transportation, money, and time are limited. telehealth expansion in rural communities may also reduce stigmatization of seeking care (samhsa, 2021) and improve access to primary care while facilitating better integration with specialty care (nagata, 2021). health care delivered via telehealth may also foster greater compliance in care management (almallah & doyle, 2020) and greater adherence to care when rural residents may otherwise postpone or forego care due to economic, geographic, cultural, or technological barriers (bashshur et al., 2020). in a pre-pandemic study, we surveyed social workers and other health care providers, examining perspectives on telehealth in the rural south (dehart et al., 2022). the study identified benefits of increased interand intra-agency coordination and savings in time and travel for both patients and providers. however, barriers for rural social workers and other providers persisted, including those pertaining to organizational capacity to implement telehealth (e.g., broadband connectivity, office space, sustainability), limitations in rural patient comfort with technology, and limitations with the providers’ own technological skills. similarly, in a systematic review of telehealth across a range of providers working with rural tribal communities, kruse et al. (2016) found that telehealth reduced time and costs and increased accessibility of health services for indigenous communities, but that lack of technological infrastructure, problems in connectivity, and frustrations with usability by both patients and providers were challenges. thus, improvements in infrastructure are a salient need for rural communities, but even with such improvements, training and education for both patients and providers are essential. telehealth and the covid-19 pandemic with the onset of covid-19, there have been striking changes in health care, which likely has affected perceived benefits and challenges of telehealth utilization in rural communities. telehealth utilization was historically low and limited in scope and range prior to the pandemic (guitton, 2021), often attributable to logistical and financial limitations, limited access and skills related to technology, and low rates of reimbursement coverage for both patients and providers (tewksbury et al., 2021). a duke university study examined statistics from u.s. healthcare organizations, including its own (wosik et al., 2020). these researchers concluded that even systems with relatively high telehealth use prior to covid-19 typically conducted less than 100 video visits per day, which during the pandemic rose to greater than 600 video visits daily (wosik et al., 2020). the pandemic also resulted in less restrictive regulatory conditions for reimbursement of services provided via telehealth (lieneck et al., 2021). such rule changes allowed telehealth visits to be reimbursed at the same rate as in-person visits, expanded services that could be delivered via telehealth, and no longer required patients to be in a licensed facility to use telehealth (meyer et al., 2020). under the confluence of pandemic conditions in the united states in march of 2020, telehealth claims were 4,347% higher than in march of 2019, and almost half of all medicare primary care visits occurred via telehealth in april of 2020, which was a 350% increase from pre-pandemic medicare data (chang et al., 2021). advances in social work, fall 2022, 22(3) 956 this drastic, unexpected shift to telehealth has potential for both benefits and challenges for rural communities. segal et al. (2021) note that rural communities may face more severe impacts of covid-19 due to older populations with more chronic conditions, residents who may be required to work in close quarters for industrial jobs, geography requiring further travel for in-person care, reduced community capacity for receipt of testing and supplies, and hospitals operating on smaller margins of finances and staffing. similarly, bashshur et al. (2020) note the threat presented by covid-19 to stability of rural hospitals, but these researchers see promise in the benefits that might necessarily arise from regional collaborations to help distribute health resources across urban-rural networks. purpose of the study since the pandemic’s onset, there have been few in-depth examinations of how perceptions of telehealth may have changed for rural social workers, other rural health care providers (e.g., counselors, nurses), or patients, with most of the extant studies instead addressing general rates of telehealth usage or customer satisfaction levels. the purpose of the current study was to examine the perspectives of social workers, other health care providers, and patients regarding telehealth usage in a predominantly rural southeastern state after the onset of the covid-19 pandemic. given the evolution of technology use during the pandemic, the research team wanted to examine: 1) what are current perceptions of benefits of telehealth among providers and patients? and 2) what are current perceptions of challenges of telehealth among providers and patients? methods all procedures were approved by the university of south carolina institutional review board. recruitment members of the research team were doctoral and master’s level social workers who received funding from a state center on rural and primary health care to perform a statewide needs assessment. the funding agency had previously conducted an online survey of telehealth implementation by health care providers across the state. the research team was tasked with recruiting providers for interviews from among interested participants who completed that survey. the research team also asked these providers to post a study flyer on-site in their offices as well as to share the interviewers’ contact information with any patients they thought would be willing to share their experiences about receiving telehealth services. several additional patients were recruited via word-of-mouth and through one of the authors’ related social work studies (browne, in progress) which embedded identical prompts in a broader interview. thus, the research team used a non-probability sampling method called snowball sampling to recruit providers and patients for these virtual interviews. to be eligible for participation, both patients and providers had to have used telehealth since the onset of the pandemic. participants were practicing social workers and dehart et al./benefits & challenges of teleheath 957 other health care providers (n = 14) and telehealth patients (n = 17) recruited from hospitals, clinics, and counseling centers. participants were interviewed during summer and fall of 2021. measures all participants provided informed consent prior to the interviews, and all completed a demographic survey which was orally administered at the time of the interview and noted sex, age, race, and highest level of education. providers also responded with their field of practice, practice setting, and number of years in practice. for providers, interviews were held via zoom video conferences. most were interviewed individually (n = 9). additional staff attended group zoom conferences for two agencies (group 1, n = 3; group 2, n=2). patients were provided the option of choosing phone or video interviews, with all being completed individually (n = 17). interviews included approximately 15 major prompts with some follow-up questions and ranged from 18 to 87 minutes (m = 40 minutes). prompts addressed experiences and perspectives of telehealth prior to and throughout covid-19, challenges with telehealth implementation, thoughts on what would support continued telehealth use, and lessons learned. example prompts for providers included “what were your biggest challenges in initiating telehealth?” and “describe any major changes in your use of telehealth since covid-19.” example prompts for patients included “i’m going to ask you to think about your most recent telehealth visit. how did the telehealth visit experience compare to in-person appointments for you?” and “what do you wish was different about your recent telehealth visit?” all participants received a $25 visa gift card for their participation. analyses analyses of sociodemographic data were conducted via spss v.26 (ibm), while narrative interview data were audio-recorded, transcribed, and coded via maxqda software (verbi). early coding began with provisional codes corresponding with interview prompts followed by further open coding of emerging themes and subthemes. axial and selective coding were used next to allow differentiation and organization of codes (saldana, 2009) with specific attention to the benefits and challenges of telehealth implementation. several benefits and challenges to telehealth use were identified by providers and patients. findings begin with the most discussed themes across the data set; this can include multiple mentions per interview. however, to shed light on the representativeness of themes across interviews, findings provide a dichotomized tally of whether the theme was present or absent in each interview, represented by percentage of provider interviews or patient interviews that mentioned each theme. multiple strategies were used to promote trustworthiness. first, the research team used established interview and analytic methods including qualitative content analysis (schreier, 2012) and built upon our team’s previous qualitative needs assessment and expertise in rural social work, health care, and telehealth use (browne et al., 2016; dehart et al., 2022; iachini et al., 2015). while members of the research team did not have prolonged interaction with participating patients and providers, the funding organization did have advances in social work, fall 2022, 22(3) 958 established relationships with providers. both patients and providers willingly chose to participate, promoting genuine and forthright responses. shenton (2004) indicates that engaging a range of interviewees from a variety of settings and backgrounds supports triangulation of individual perspectives and geographic locales, resulting in a diverse set of responses for analysis. frequent team reflections and iterative data coding provided additional opportunities to refine codes and thoroughly describe our conclusions in connection to the raw data. some quotes have been minimally edited for increased clarity and to remove identifying speech patterns (e.g., “you know”). characteristics of the sample are reported to enable a better understanding of the context of the findings (shenton, 2004). findings participants of the 76 health care providers contacted via email, 14 providers responded and participated in an interview (see table 1 for provider sociodemographic characteristics). of those, three identified as male and 11 identified as female with the mean age of participants being 47 years. providers self-identified as white (86%) or african american (14%). all providers reported having a bachelor’s degree (7%) at minimum, while most had a graduate degree or professional license (93%). while some of the providers’ offices were located in rural and urban communities, 92% indicated providing services to rural populations. the providers worked in a range of six practice settings, with most working in community non-profits (29%) or mental health services (29%). the practice fields of the providers included social work (36%), mental health counseling or therapy (21%), health administration (21%), public health (7%), nursing (7%) and special education (7%) within health care settings. the majority of providers had worked in their field for 20 years or more (57%). table 1. provider demographic characteristics (n=14) provider demographics n (%) sex female 11 (78.6 %) male 3 (21.4%) age (years) 20-29 1 (7.1%) 30-39 3 (21.4%) 40-49 4 (28.6%) 50-59 4 (28.6%) 60-69 2 (14.3%) race black 2 (14.3%) white 12 (85.7%) highest level of education bachelor’s degree 1 (7.1%) master’s degree 13 (92.9%) field of practice social work 5 (35.9%) counseling or therapy 3 (21.4%) health administration 3 (21.4%) nursing 1 (7.1%) public health 1 (7.1%) special education 1 (7.1%) practice setting community non-profit 4 (28.6%) mental health services 4 (28.6%) children’s hospital 2 (14.3%) hospital community services 2 (14.3%) community health clinic 1 (7.1%) veteran health administration 1 (7.1%) time in practice (years) 0-1 0 (0%) 2-5 1 (7.1%) 6-9 1 (7.1%) 10-19 4 (28.6%) 20+ 8 (57.2%) table 2. patient demographic characteristics (n=17) patient demographics n (%) sex female 11 (64.7%) male 6 (35.3%) age (years) 20-29 1 (5.9%) 30-39 4 (23.5%) 40-49 4 (23.5%) 50-59 3 (17.6%) 60-69 4 (23.5%) 70-79 1 (5.9%) race black 10 (58.8%) white 7 (41.2%) income less than $20,000 6 (35.3%) $20,001-$40,000 3 (17.6%) $40,001-$60,000 1 (5.9%) $60,001-$80,000 2 (11.7%) $80,001 or higher 5 (29.4%) marital status single 6 (35.3%) married 6 (35.3%) divorced 5 (29.4%) highest level of education some high school 1 (5.9%) high school diploma 2 (11.7%) some college, no degree 2 (11.7%) associate degree 2 (11.7%) bachelor’s degree 4 (23.5%) master’s degree or professional license 6 (35.3%) employment status employed full time 7 (41.2%) employed part time 1 (5.9%) employed part time & on disability 1 (5.9%) unemployed & on disability 4 (23.5%) unemployed & looking for work 1 (5.9%) unemployed & not looking for work 1 (5.9%) retired 2 (11.7%) health insurance coverage medicare 2 (11.7%) private employer insurance 6 (35.3%) government insurance 1 (5.9%) medicare & gov’t insurance/va benefits 1 (5.9%) medicare & medicaid 3 (17.6%) medicare & private insurance 2 (11.7%) medicaid 1 (5.9%) medicare, medicaid, & private insurance 1 (5.9%) advances in social work, fall 2022, 22(3) 960 the research team interviewed 17 patients who received telehealth services in the preceding two years from across the southeastern state (see table 2 for patient sociodemographic characteristics). twenty-nine percent resided in rural areas, and all resided in health-professional shortage areas. of the patients interviewed, six identified as male and 11 identified as female, ranging in age from 26 to 70 with the mean age of 49. patients self-identified as african american (58.8%) or white (41.2%). patients’ incomes ranged from less than $20,000 (35.3%) to greater than $80,000 (29.4%), with the mean income falling in the $40,001-60,000 range. their marital statuses included single (n = 6), married (n = 6), and divorced (n = 5). the patients’ levels of education varied, with a majority having a bachelor’s degree (23.5%) or master’s degree/professional license (35.3%). most patients reported their employment status as employed full-time (41.2%), unemployed on disability (23.5%), or retired (11.7%). patients disclosed a wide variety of health insurance coverage. benefits of telehealth use the most commonly discussed benefits of telehealth use included convenience for patients, increasing patient access to care, improved patient experience of care, and ability of telehealth to attract or retain patients. convenience convenience was the predominant facilitator discussed by both providers and patients, and this theme was mentioned in 100% of provider interviews and 95% of patient interviews. providers spoke of convenience for patients, who—because of the covid-19 pandemic—were faced with the decision to use telehealth or forego appointments. they literally freaked out and said, “if i can’t come in and see you in person, then i don’t know how this is going to work.” and so i said, “i don’t know how it’s going to work either, but be my guinea pigs and let’s give this thing a try.” but probably 85% embraced it right away, and some got really smart and started doing the math—and the math was, “i drive 45 minutes to your office to meet with you for an hour, and i drive 45 minutes back at $3.00 a gallon.” they started doing that and thinking…“let’s make every session online.” (provider 001) patients noted that telehealth provided the opportunity to make appointments easier to attend while taking little time out of their day. i think that would end up saving a lot of time if it was like oh i could just run to my car and immediately get on the teleconference versus you know, go to the provider, stand in line, et cetera and then a lot of times you’re waiting in the waiting room. (patient 004) i mean, i didn't have to get in the car and drive out there and go through the traffic and do all that stuff. i just could be in my house and if there's anything i needed, i could just tell her over the phone; medications, refills, or any of that stuff. (patient 010) dehart et al./benefits & challenges of teleheath 961 for patients, the pandemic played a central role in considerations around convenience and being able to save oneself from a face-to-face visit. because a) it's hard for me to get there. and b) that's a fairly crowded lobby. i'm in the middle of a surge [pandemic]. i'm not all that thrilled about going in among those people where i'm already—i've got my own health issues to deal with. (patient 001) well, due to covid, i liked it because i didn't have to actually go into the office and possibly expose—well, i'm vaccinated, but i have an eight-year-old that's not vaccinated, so i didn't have to potentially expose her by going into the office, having to sit in the waiting rooms with other patients. that made me feel better. (patient 005) many providers and patients described telehealth as meeting a need along a tiered progression of service options. here, a provider, and then a patient, provide perspectives on when the use of telehealth may be suitable. it's not designed to be emergency [care]. it's not designed to take the place of a medical home. what it does is allow the student [patient] to get a diagnosis while they're there, because the school nurse—all they can do is really just treat a symptom and recommend a treatment plan, but they don't have access to diagnose or to write a prescription. that's where we come in with telehealth. (provider 005) i would use it for pretty much anything that didn’t need necessarily hands-on evaluation. i definitely think, like i’ve used mental health services before in person. i think that that would be a beneficial thing, and also anything, like i said, that didn’t require physical, hands-on type of evaluation. (patient 004) several patients mentioned the convenience of their health care provider’s telehealth app (e.g., mychart) in scheduling appointments and coordinating care. a lot of the regular communications is already being handled by mychart. "i need a prescription refill" or, "is there a problem with taking this medicine with that." you put that in there and they respond fairly quickly. (patient 006) with mychart, i can go in and request medication refills from my doctor. i can see when upcoming physical therapy appointments and all that are. (patient 001) increased access for patients the next most discussed theme was that telehealth increased access for patients. this theme was overwhelmingly discussed by providers (100% of provider interviews), but also was mentioned by nearly a third of patients (30%). providers noted, in particular, that telehealth facilitated access for patients who were in geographically remote locations. i'm able to reach more people…i think it's a lot more convenient. because there were a couple times where, especially like, with college kids that they went home. so instead of them having to come all the way back… it was accessible for them to do that instead of trying to schedule. (provider 014) advances in social work, fall 2022, 22(3) 962 geographic access was mentioned by a few patients, as well. you have to take time off from work, take time to drive there, and in the rural setting—driving anyways—it’s going to take 30 minutes at least. it was much more convenient and time-effective for me to just get on the phone since i really did need to see [the doctor]. (patient 007) beyond geography, telehealth also allowed for increased access to services for underserved populations such as persons for whom english is not their primary language, persons with disabilities, or persons with certain medical conditions. this was noted by both providers and patients. we have a number of bilingual staff. and so for us, we also targeted not just rural kids or kids who are not able to get into services, but we targeted kids that had language access challenges and were able to use telehealth to extend that arm across the state. (provider 011) right now i've just had surgery on my left leg. i can't drive so until that heals up. i have a stick shift car with a clutch. (patient 001) improved experience of patient care the bulk of providers (82% of interviews) and some patients (18%) noted that telehealth improved the experience of patient care. one such area of improved patient experience of care was for services directed at families, mentioned here by providers. typically, it might just be the mom or the dad, so telehealth has made it made it easier or more conducive maybe to doing the whole family. (provider 014) families that in terms of learning social skills to be in a meeting or be in a discussion with a doctor or a health care provider—a lot of people with autism or the virtual environment need to really take advantage of the turn-taking that occurs. you can't talk over each other, and there's embedded set of rules in this virtual conference, which makes them way more successful than if they're in person. so really for a lot of them, they really liked this environment. once they got comfortable with it, it really benefitted them. (providers 002, 003, 004) attracting and retaining patients a theme discussed only by providers (82%) was the importance of telehealth in attracting and retaining patients. we're seeing a lot of kids across the state, but we definitely increased our reach with adults. (provider 011) if you're thinking about canceling because you can't get out here, telehealth is still an option for you. so i do remind them of that. and that gives them more flexibility. and it really helps me to be able to retain clients, because sometimes you lose them. (provider 010) dehart et al./benefits & challenges of teleheath 963 challenges to telehealth use challenges included concerns about quality of care being compromised by telehealth, patients’ comfort and access to technology, policy challenges for providers, and the impersonal nature of telehealth visits. limitations on quality of care the most frequently mentioned barrier to telehealth use centered on quality of care, which both providers (64%) and patients (70%) felt could be compromised compared to face-to-face visits. providers often discussed this in terms of serving population-specific needs, like those of young children, teens, or older adults. maybe you could do play therapy, but i think that would be really hard. (provider 014) there is one population that it’s not worked well with, and that is teenagers. teenagers have not wanted it. they want to see me in person, and i think i know why. i think it’s being at home, there’s not privacy. (provider 001) we had an independent living skills class that was just switched right over online. the problem is that i would assess their abilities and assess their strengths and weaknesses, where i really couldn't do it. we would cook weekly, and i couldn't ask them to do that. and trying to do that… we'd sent the recipe the week ahead, asked everyone to get the stuff and make sure to ask the parents to be involved that first night, because we're gonna use the oven and we're going to bake cookies. (provider 006) patients discussed limitations on what could be addressed without face-to-face contact. most often, this was not seen as a major barrier, but rather a decision point in whether to use telehealth for specific types of visits. i felt a little limited because you would like for them to hear your lungs, but there were questions regarding, "how's your breathing?" and that sort of thing. so i guess that kind of substituted in there. (patient 006) for some patients or specific types of visits, the lack of hands-on services posed greater challenges. especially with the endo doctor, when you have a monitor for your blood sugars and things like that—trying to give them that data is really hard that way—trying to explain to them on this [zoom]…they can just download the information when you go in the office, but when you have to break it down—so i checked my blood sugar six times today, and they want all the numbers and information. that’s really hard. (patient 016) we have a scale here at home, so we had to do the weight [for my child’s telehealth visit] here at home…and i had a tape measurer. i had to measure her myself so we advances in social work, fall 2022, 22(3) 964 can make sure she was growing properly, and that was kind of a challenge, doing a well-child visit at home. (patient 005) at the height of the pandemic, there were no vaccines yet or anything, and my wrist had been bothering me really badly. and there was a lump on it… she did a video call with me, and she's like, "oh, it's a ganglion cyst, and there's nothing really you can do about it unless it hurts, then we can cut it out," and i'm like, "well, i don't think that's what it is." it turned out not to be what it was. she was wrong because she just looks at things and goes, "oh, what's the most common thing?" and then you get charged $200 for that 38 seconds of time that you talked to her on the thing. (patient 003) patient comfort, hardware access, and connectivity to technology technology issues for patients were also viewed as a substantial barrier, both by providers (100%) and patients (59%). providers were particularly concerned about connectivity (e.g., broadband, wi-fi) or hardware (e.g., smartphones, computers). bandwidth across the state still is something that we struggle with that a bit. and i know the legislature is working on that. but that is definitely something that i think needs improvement so that it's clean, clear, no matter where people are located. (provider 011) reliability of service, and that is so dependent on so many factors. if someone is using a hand-held phone, its memory capacity is not like the computer. so, the computer is going to have a way better system to maintain a signal—maybe it could be the age of the computer. (provider 001) providers also noted concerns about patients’ technology skills and/or comfort with technology. some of our children, it was challenging, at first, to have to sit in front of the computer, which they've never done before. but they learned how to do that because of school as well, and it was a whole different world for them. (providers 002, 003, 004) the first time you logged on with someone, you just knew it was going to take 45 minutes. and then i got more and more detailed on the way that i'm going to explain it…“this is going to be hard. we're going to follow step-by-step and work together to get it…click this link. you're going to try it on your phone, or you're going to try it on your computer, and there's going to be a problem. you need to download it, and your internet is too slow.” there's always so many of those problems. (provider 006) patients also described technology challenges associated with telehealth visits, but these were usually spoken of as part of the learning curve and as something that would not persist after one or more visits. dehart et al./benefits & challenges of teleheath 965 first you get the email, then you have to click on the link. and i know with this current day and age, it's always nerve-wracking. you don't want to install anything on your phone. you don't want to click a link in a text.... once the app's installed, the doctor calls and then it takes you through what you have to click on, and then finally you do connect. and then the next challenge is to hold the phone such that you always see the doctor and she sees you. so you don't really know, "can the doctor see me the way that i'm holding my phone?"…and sometimes the doctor's not quite calling yet because she's probably finishing off with another patient, et cetera. so you're kind of wondering, "oh my goodness, what now? did i do something wrong? is the app not installed correctly?" (patient 007) some patients mentioned that links were sent via text, necessitating that they use their phone when they would have preferred to use a tablet or computer monitor for the visit. screen size and getting phones to view at a proper angle were mentioned by patients in several instances. i wish that she could've gotten a better view of it because i just did like this [shows wrist]... i held it up to the camera ... and you know as well as i do, but it's going to look not the same as what it looks like in person. so i can see how she could've made a bad diagnosis. (patient 003) policy challenges for providers policy challenges to telehealth were uniquely mentioned by providers (73%). many providers noted challenges in reimbursement of telehealth services, but some of these had been alleviated by temporary adaptations due to the pandemic. especially with reimbursement—like in the beginning [of the pandemic], we did the business not knowing if we’d even get paid, because things were changing by the week and by the month, especially with cms and medicare. (provider 007) our anticipation right now is we will probably see most of our patients virtually-if it works within insurance reimbursement, which is going to dictate some of it, unfortunately. right now, medicaid is reimbursing. but prior to the pandemic, they didn't pay for social workers or psychologists to see telehealth patients. (provider 011) several providers noted policy issues that were longstanding issues in state and national politics. probably one of the challenges before [the pandemic] was just some of the regulations in place—as far as what types of telehealth visits are 1) covered by insurance, 2) what's allowed—what providers can conduct telehealth visits, what types of visits, where the patient can be versus where the provider must be. (provider 007) payment parity is one…some plans are not paying at the same rate. so, that does become an issue in the long run. we have business, and we have to take care of patients in order to do that. we have to at least break even or make some money advances in social work, fall 2022, 22(3) 966 somewhere. so we don't have a payment parity law in [state], and if you're aware of that, some states do. there's no telehealth parity law here. so that's something that we advocate for. (provider 007) impersonal nature of telehealth visits finally, 36% of provider interviews and 53% of patient interviews mentioned impersonality of telehealth relative to face-to-face visits. this tested patient comfort with technology-mediated communication and sometimes left patients wondering whether providers were really engaged with them in the visit, noted here by two patients. it’s quick… it’s on the [patient] to speak up about any issues, otherwise they would just breeze through the questions, ask if you have any other outstanding questions, then move on. whereas if you have an appointment with a doctor, there’s usually like two to three levels of people before you even get to the doctor. so whatever nurse is coming in or if i’m at sick call, it’s usually some sort of medic and then a provider. or it’s like a nurse practitioner and then a specialist or whatever the situation is. so you have a lot more opportunity to ask questions and you have different sets of people asking you questions that they think are necessary. so i feel like there’s more opportunity in the in-person appointments to either have your questions answered or there’s just more opportunity for other people to ask different questions. (patient 004) seemed impersonal. it didn’t seem adequate, i guess ‘cause you know, we go into a doctor’s office, you can see body language and eye contact—which i’m not saying we didn’t make eye contact, but i couldn’t help but wonder, were they jotting things down, were they even listening or were they just playing a part?....i like to know that when i’m in a doctor’s office my doctor is 100 percent attentive to me, and we can talk face-to-face where i was talking to them, but the whole time again it seemed so coerced. she just sat there, never really moved. it was weird, it was a really different experience. (patient 016) discussion the research team sought to understand provider and patient perceptions of the benefits and challenges of telehealth use. our findings reveal numerous benefits and challenges, including some factors that may have been elucidated due to the covid-19 pandemic. social workers, other health care providers, and patients agreed that convenience was a key driver of telehealth use. patients, in particular, enjoyed the convenience of telehealth, in that it saved them time, travel, and did not necessitate taking off work or procuring childcare for a brief appointment. this replicates the pre-pandemic work of dehart et al. (2022), demonstrating that some benefits of telehealth have remained steadfast, despite the rapid implementation necessitated by covid-19. some patients specifically mentioned not wanting to risk exposure to covid-19, thus not needing to sit in waiting rooms extended beyond mere convenience to include risk-reduction. both patients and providers also viewed telehealth as an option among a tiered array of services, and while it presented dehart et al./benefits & challenges of teleheath 967 some limitations to hands-on care, they felt its benefits outweighed the challenges. as noted in lieneck et al.’s (2021) systematic review of telehealth during the pandemic, the role of telehealth in triaging patients who needed in-person versus video visits seemed salient in our sample. these authors underscored that virtual visits might be interspersed with in-person visits to create touchpoints for service. social workers and other health care providers overwhelmingly found telehealth to increase access to care, and they appreciated the access that telehealth brought to services. this was particularly helpful to providers in keeping services continuous throughout the pandemic. many providers noted aspects of telehealth that they believed improved the patient experience. providers described benefits of telehealth to overall service experience, particularly in serving families, as telehealth can be used with a range of family members, including the whole family unit. they also noted that expanding telehealth technology allowed them to gain new patients as well as to retain those in their current services. providers felt telehealth was an important technology for attracting and retaining patients, and many had concerns about policy limitations that restricted use. reimbursement was an overarching concern; social workers and other health care providers noted that pandemic adaptations had alleviated some previous reimbursement issues (i.e., allowing reimbursement for telehealth services that had not been reimbursable pre-pandemic). however, there was uncertainty if these adaptations would continue postpandemic. several providers underscored longstanding struggles with legislative and policy change that would facilitate greater telehealth implementation. segal et al. (2021) suggest payment analyses be conducted to examine efficacy of the pandemic policy adjustments in order to provide recommendations on those that should become permanent in order to improve care in rural areas. they note that permanent policy changes would resolve uncertainty regarding the types of services that could be provided via telehealth and could assist provider organizations in planning for post-pandemic care as well as future public health emergencies. researchers argue that patients, payers, boards, and regulators need to be engaged in reevaluation of regulations, policies, and reimbursement models post-pandemic, particularly around the assumption that health care must be provided faceto-face to merit compensation (lieneck et al., 2021; wosik et al., 2020). both providers and patients also had concerns about the limitations in how telehealth could be used, fearing that its use sometimes compromised quality of care. providers tended to frame this in terms of services for specific patient populations, such as young children, teens, and older adults. patients viewed this more as a decision point in when to use telehealth versus face-to-face services. patients were also more vocal about the related concern that telehealth sometimes seemed impersonal, and they wondered how engaged their providers were in the interaction. similarly, in a pre-pandemic study of persons with diabetes enrolled in veterans’ health care, gordon et al. (2020) found that patients were concerned about the potential for errors in care from video visits due to perceptions that the visit was more difficult to complete and that providers paid less attention. these patients also felt there were barriers to asking questions and establishing rapport with providers. the patients reported feeling less involved and sometimes felt rushed through the virtual appointment. such concerns are exemplified by the disparity in perceptions of providers (82%) versus patients (18%) who felt that telehealth improved the experience of advances in social work, fall 2022, 22(3) 968 care, laying bare the need for providers to make concerted attempts to support greater comfort among patients and engage in an active and responsive way while using telehealth technologies. accordingly, gordon et al. (2020) suggested that providers might address these issues through measures such as encouraging patients to speak up, providing verbal and nonverbal cues of attention as well as when looking away from the camera (e.g., “i’m going to look up your results”), providing patients with pre-appointment educational materials, and developing a “webside” manner for virtual interactions. patients’ comfort, access, and connectivity with technology were concerns for both patients and providers. this aligns with concerns expressed in studies both before and during the pandemic (e.g., hermes et al., 2021; lieneck et al., 2021). while patient hardware access could be ameliorated by technology “loaner” programs (e.g., tablets, phones), patient comfort might be addressed through real-time coaching and education, not only regarding use of technology, but also regarding the safety mechanisms in place to protect patient privacy on virtual platforms. respondents also mentioned more substantial challenges involving access to broadband technology in rural areas. the latter, noted by providers, include policies that impact availability of state-level funding for broadband and types of restrictions on municipal broadband and cooperatives, which have been demonstrated to impact broadband availability (whitacre & gallardo, 2020). further, internet and telecommunications companies operate on business models that are not set up to support deployment in low-density population areas (stone, 2022). the lack of broadband service in rural areas has been noted in prior studies and is particularly a limitation for tribal communities (graves et al., 2021). this crisis necessitates advocacy at a policy level to facilitate change, and fortunately, many groups are now actively addressing the issue (e.g., broadband connects america, rural assembly’s rural broadband policy group, brookings institute). the pew charitable trusts have developed a state broadband policy explorer referencing state statutes, executive orders, and governing directives addressing broadband access (whitacre & gallardo, 2020). the federal communications commission has also established a universal service fund for rural and low-income improvements (campbell et al., 2021), and many states are developing startup grant programs (stone, 2022). new deployment options that move beyond fiber (e.g., satellite technology, fixed wireless) also create potential for internet expansion (and thereby expansion of telehealth) to rural communities (stone, 2022). implications for social work despite advances made in the use of telehealth during the covid-19 pandemic, many of the barriers to using telehealth that were identified in this study highlight areas in which social workers can lead the way to improve the telehealth experiences of health care providers and patients. the most frequently mentioned concern regarding telehealth was quality of care, particularly for vulnerable populations such as children, teens, and older adults. given social workers’ extensive training and expertise in addressing the needs of such patients, social work researchers, practitioners, and educators can play a central role in identifying and implementing strategies to enhance skills of both providers and patients dehart et al./benefits & challenges of teleheath 969 in these telehealth interactions. this could begin in u.s. schools of social work accredited through the council on social work education (cswe). cswe (2022) already acknowledges in its educational policy and accreditation standards the need and relevance to train our future generation of social workers in technology for delivery of social work services. emphasis on patients living in rural areas deserves focused education due to their unique challenges and barriers. if points of discomfort and concern can be clarified, the emerging workforce and those working in the field can be educated around the most effective strategies for delivering services to these populations, encouraging patient engagement through verbal and non-verbal strategies, and ensuring appropriate follow-up to ensure health care options and next steps were understood and accessed. similarly, overcoming the related challenge regarding impersonality of telehealth services (e.g., improvement in trust of telehealth and how to use it by those living in rural areas) could be a focal topic for workforce training going forward, and social workers might play a crucial role in helping patients grow to become more comfortable with technology. specifically, social workers could assist in defining ways to better engage with patients around trust in telehealth providers and technology, particularly around privacy of the interaction, security of data, and rapport-building by providers. this may also require special training programs for patients in rural areas on how to use technology in their homes and communities. social work schools must also be providing students with telehealth training in order to equip graduates with the skills needed to deliver telehealth. in considering structural barriers to telehealth use, social workers’ interprofessional ties as well as their depth of knowledge regarding policy advocacy are particularly salient strengths. the issues of broadband connectivity in rural areas as well as barriers posed by reimbursement schemes seem particularly suited to social work advocacy in this respect. social workers are ideally situated to take the helm in convening patients, payors, boards, and regulators—as suggested by wosik et al. (2020)—to examine reimbursement models, identify effective paths for moving forward, and facilitate implementation plans for postpandemic services. while prior to the pandemic, vendors required hipaa compliancy of videoconferencing technology as well as licensure in the location of both the social worker and the patient, these limitations were suspended during covid-19 (camper & felton, 2020). further, through the council on state governments, with funding from the department of defense, the association of social work boards has worked with the national association of social workers (nasw) and the clinical social work association to develop model legislation to ensure licensure portability and interstate practice. their efforts specifically address reexamination of how and where social workers engage with clients, including via telehealth. the effort has included input from organizational and state stakeholders and is anticipated to yield the model legislation prior to 2023 legislative sessions. efforts such as these are essential to expansion of telehealth beyond the pandemic (nasw, 2022). limitations the findings herein are limited, in that the research team spoke with a convenience sample of social workers, other health care providers, and patients—all of whom had utilized telehealth. given that our interviews were conducted via distance technology, it is advances in social work, fall 2022, 22(3) 970 likely that those who are less comfortable with such technologies did not choose to participate in the interviews. further, our sample of providers included a mix of social workers and other health care providers, and patients were those who may have sought a range of services. understanding concerns unique to telehealth use in social work practice is essential to improving delivery by providers, access by patients, and education of the emerging workforce. the research team spoke only to persons from a single, predominantly rural, southeastern state, so findings may not generalize to social workers, other health care providers, or patients in other locales or who use telehealth, as provider norms, patient comfort and access, and technology vendors are likely to vary regionally. while most of the health care professionals in this study provided care to rural communities, only about a third of the patients recruited through these networks resided in rural counties. it is possible that rural patients were less comfortable participating in the study or did not have access to technology to do so. thus, future research might seek to recruit a more homogenous sample of rural patients or seek a larger sample for comparative analyses of rural and urban patients to examine convergence or divergence of perspectives. this might include targeted outreach including mobile interview sites for in-person patient interviews in rural locales, or setting up interview outreach within existing rural settings such as rural clinics, federally qualified health centers, or rural libraries. stratified sampling of participants from rural and urban locales across the u.s. could also provide insights into geographic and other demographic variations in telehealth experiences. access to technology for rural populations is also likely to increase due to infrastructure commitments from state and federal governments as well as internet service providers, with the home state for this study adding broadband to an estimated 100,000 homes via pandemic relief packages and other funding (green & phillips, 2022). this provides researchers with unique opportunities for examining how such efforts impact perceptions of telehealth in rural areas across the nation, including both before and after technology upgrades. future research further research is needed to ascertain challenges perceived by rural patients and providers who have never tried telehealth, despite pandemic conditions. probability sampling of patients would likely yield advantages over our snowball sampling technique regarding representativeness of those sampled, as would garnering a larger sample size of rural providers and patients across the u.s. ascertaining how geographic and policy variations across locales influenced perceptions of telehealth would have strong implications for infrastructure and policy enhancements. researchers may also wish to sample social workers and patients from dedicated types of agency settings, as this could yield insights into how setting-specific factors (e.g., school-based services) influence perceptions. comparative research on social workers across settings could also improve understanding of how different agencies promote benefits or struggle with challenges in the delivery of telehealth. further, given our limited sample size, larger comparative studies of rural versus non-rural patients and providers could elucidate a more nuanced understanding of the geographic variations in perceptions of telehealth. dehart et al./benefits & challenges of teleheath 971 conclusions as in pre-pandemic studies, some benefits and challenges of telehealth remained consistent, despite widespread implementation of distance technologies during covid19. convenience was still an overarching benefit, with many patients and providers now recognizing that telehealth facilitated more of a triage or tiered system in which users could determine whether in-person visits were necessary, particularly in navigating risks of a highly communicable illness. technology—including comfort, hardware access, and connectivity—was still a barrier for many. the pandemic elucidated the potential for telehealth to engage families in social work services and other health care, and the temporary regulatory changes created conditions that increased access to care for many. thus, while telehealth helped social workers, other health care providers, and patients maintain some continuity of service during the pandemic, there were nevertheless conditions requiring sustained 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(2012). a portrait of rural health in america. journal of rural social sciences, 27(3), 1-16. https://egrove.olemiss.edu/cgi/viewcontent.cgi?article=1439&context=jrss author note: address correspondence to dana dehart, phd, college of social work, university of south carolina, columbia, sc 29208. email: dana.dehart@sc.edu author note: this work is funded by the south carolina center for rural and primary healthcare as part of the state’s rural health initiative. the points of view or opinions in this project are those of the authors and do not necessarily represent the official position or policies of the center or the university of south carolina school of medicine. for more information, please visit the center’s website at http://sc.edu/ruralhealthcare. https://doi.org/10.1093/jamia/ocaa067 https://egrove.olemiss.edu/cgi/viewcontent.cgi?article=1439&context=jrss mailto:dana.dehart@sc.edu http://sc.edu/ruralhealthcare ___________ william r. nugent, phd, professor, and angie khalil, bssw, college of social work, the university of tennessee, knoxville, tn. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 66-83, doi: 10.18060/27231 this work is licensed under a creative commons attribution 4.0 international license. the relationship between violent political rhetoric, murder rate, gun ownership, and police deadly encounters with civilians william r. nugent angi khalil abstract: police kill around 1,000 persons annually in the united states. this is a significant issue for social work because of the effects these killings have on individuals and communities. recent research has shown a positive relationship between violent political rhetoric (vpr) and mass shootings. this study aimed to investigate if a relationship exists between vpr and police violence that results in the death of civilians. this was a secondary analysis of publicly available data on police killings of civilians. the dependent variable was a measure of the number of police violence killings of civilians. three control variables were included in analyses: monthly gun ownership, monthly average temperature in the u.s., and the annual murder rate in the u.s. an auto-regressive distributed lag error correction time series analysis was used in data analyses, and as a sensitivity check a poisson time series regression with robust standard errors was also employed. the results showed a positive relationship between vpr and police violence killings of civilians. the principal implication of these findings for social work is that social workers collaborate with professionals in other disciplines to find ways to reduce the use of vpr by politicians and others in the media. keywords: police shootings of civilians; police killings of civilians; violent political rhetoric; police violence; deadly encounters throughout united states’ history, police violence has been endemic. historical evidence suggests this form of violence has roots, among other things, in jim crow laws and it has been argued that this violence has helped perpetuate white supremacy and racial control (bailey et al., 2021; edwards et al., 2019; university of michigan carceral state project, 2021). this form of violence frequently ends in the death of one or more private citizens, persons henceforth referred to as civilians. this is an important issue for social work since police violence killings of civilians have significant deleterious effects on individual persons as well as communities (ang, 2021; bor et al., 2018; devylder et al., 2020; edwards et al., 2019; obasogie & newman, 2017; sewell, 2019). it is unclear exactly how many civilians have been and are killed by police violence. according to data from the gun violence archive (2024), about 2,000 civilians have been shot, and 1,000 killed, annually by police violence. there are several online sites dedicated to counting the numbers of civilians killed by police violence, including mapping police violence (2024b), the gun violence archive (2024), fatal encounters (2024), and the counted (the guardian, 2024), among others. the data sets from these online sources give differing numbers of numbers of civilians killed. for example, between january 2014 and the end of september 2019, the time period covered by the current study, 9,946 civilians were killed by police violence according to the fatal encounters data, while according to the about:blank nugent & khalil/violent political rhetoric & guns 67 data at the mapping police violence site 6,267 civilians were killed, a difference of 3,679 persons. prior research numerous studies of police shootings and killings of civilians have been done in recent years, and much of this research has been guided by the speculation that police violence towards civilians has been at least to some extent racially motivated (phillips & kim, 2021). edwards and colleagues (2019) concluded black men have a 2.5 times greater lifetime likelihood of being killed by police violence than white men; black women have a 1.4 times greater likelihood of being killed by police violence than white women; nativeamerican men have a 1.2 to 1.7 times greater likelihood of being killed by police violence than white men, and native-american women a 1.1 to 2.1 times greater likelihood of being killed by police violence than white women. they further estimated latino men have a 1.3 to 1.4 times greater likelihood of being killed by police than white men, and latina women are 0.90 to 0.80 times less likely to be killed by police than white women; and the odds asian/pacific islander men and women are killed by police are about 0.50 times as likely as white men and women. mekawi and bresin (2015) in a meta-analysis also found evidence of differential shooting rates by police against black civilians. the global burden of diseases (gbd) 2019 police violence us subnational collaborators (2021), let et al. (2021), schwartz and jahn (2020), and wertz et al. (2020), report similar findings. a study by the gbd 2019 police violence us subnational collaborators (2021) made a sophisticated effort to quantify how many civilian deaths due to police violence in the u.s. are underestimated by the center for disease control and prevention’s (cdc) national vital statistics system (nvss). the results of this study suggested, “across all races and states in the usa, we estimate 30,800 deaths (95% uncertainty interval [ui] 30,300–31,300) from police violence between 1980 and 2018; this represents 17,100 more deaths (16,600–17,600) than reported by the nvss” (p. 1239). this represented an estimated 55.5% undercount of civilians killed by police violence between 1980 and 2018. other research has focused on situational factors and their association with police violence, especially police shootings of civilians. these studies have focused on such situational factors as whether the civilian was in possession of a weapon, whether the civilian attacked the police officer(s), and the type of call that sent the officers(s) to investigate the civilian (jennings et al. 2019; jetelina et al., 2020; menifield et al., 2019; nix & shjarbak, 2021; wheeler et al., 2018). for example, jennings and colleagues (2019) found that police were more likely to shoot a civilian if they were in possession of a deadly weapon. worrall and colleagues (2018) found police violence more likely when a civilian was behaving aggressively. gun ownership has also been found to be associated with police shootings of civilians, with greater firearm prevalence associated with more police shootings of civilians (e.g., hemenway et al., 2019; nagin, 2020). other studies have investigated the link between police violence and shootings of civilians and the characteristics of where the shooting incident occurred. these have included such factors as the crime rate, poverty rate, and makeup of the population (e.g., nicholson-crotty et al., 2017; wheeler et al., 2018). for example, research has suggested advances in social work, spring 2024, 24(1) 68 police shootings of civilians may be more likely in contexts of high levels of gun violence and violent crime such as murder (jacobs & britt, 1979; klinger et al., 2016; macdonald et al., 2001; phillips & kim, 2021; sorensen et al., 1993). research has also found a relationship between temperature and gun violence (lyons et al., 2022; reeping & hemenway, 2020). as temperature increases, gun violence tends to increase. police violence is a specific form of violence. several variables have been found to be associated with violence in general. hate speech has been found to be associated with violence (e.g., ezeibe, 2021; relia et al., 2019; soral et al., 2018). it has been conjectured that violent, incendiary political rhetoric, arguably a specific form of hate speech (murphy, 2021; piazza, 2020), may be a causal factor for violence (kalmoe, 2014; kalmoe & mason, 2018). kalmoe’s (2014) study offered support for a causal effect of incendiary political rhetoric on violence. across three experiments, kalmoe (2014) found violent metaphors increased support for violence, especially among young adults. survey research has also found evidence suggestive of a relationship between vpr and violence. according to research by the washington post and the university of maryland’s center for democracy and civic engagement, polls in 2010 showed about 16% of us public condoned political violence; by 2015 this had risen to 23%; and between 2020 and 2022 this percentage had risen to 34–40% (the washington post, 2022). this increase in attitudes supportive of violence coincided with the increase in violent political rhetoric measured by zeitzoff (2019). recent research has found a positive relationship between violent political rhetoric (vpr) and mass shootings, another prevalent and specific form of gun violence (nugent et al., 2022; nugent & conway, 2021). this research found that as vpr increases, mass shootings increase, controlling for such variables as gun ownership and contagion or imitation effects. income inequality has also been found to be associated with mass shootings (cabrera & kwon, 2018; kwon & cabrera, 2019). it has been speculated that income inequality may also be associated with police shootings of civilians (leopold, 2014). the recent findings of a relationship between hate speech and violence, and a relationship between vpr and mass shootings, implied the possibility that vpr might be associated with police violence and killings of civilians. in the remainder of this article, police killings of civilians will be referred to as fatal civilian encounters with police, abbreviated as fcewp. violent political rhetoric zeitzoff (2019) defined vpr as, “…any type of language that defames, dehumanizes, is derogatory, or threatens opponents” (p. 5). zeitzoff identified two types of vpr, specifically name calling, for example referring to persons who are members of a targeted group, such as immigrants, as “corrupt” or “traitors”; and the second making explicit or implicit threats. an example of vpr via implicit threats was exemplified by zeitzoff by means of the example of politicians using metaphors, frequently dehumanizing representations, to disparage groups or individuals. one example is of persons or groups depicted as an “infestation of cockroaches”. by describing groups as an infestation, the implication is those so described need to be eliminated. nugent & khalil/violent political rhetoric & guns 69 zeitzoff (2019) measured the rates of vpr in the u.s. from before 1858 through september of 2019 (figure 2, p. 15). the rates around the civil war period were exceedingly high. the rates from about the 1880s to around 2016 were quite low, other than small occasional spikes. around 2016 the rates of vpr rose very rapidly, and their 2019 figure 3 (p. 17) gives a more detailed picture of the rise in vpr in the u.s from january 2011 through september 2019. it is possible the observed rapid increase that appears to begin in 2016 was associated with the 2016 presidential campaign. while zeitzoff (2019) did not report vpr rates between late 2019 and the present, given the current political context we speculate it is possible the rates of vpr have remained at 2019 levels or even increased. their figure 2 suggests vpr in 2024 may be at civil war levels in the u.s. with the attendant possibility this may be a “new normal”. zeitzoff (2019) elaborates on several reasons u.s. politicians use vpr. while evidence he cites supports the notion the use of vpr tends to punish the user, it simultaneously increases the attention they gain and their statements tend to be more memorable than those of their opponents. despite negative responses to vpr, there are important reinforcers. zeitzoff also reports the results of several empirical investigations of the phenomenon of vpr, including frequencies of various forms of name-calling, and frequencies of tweeted vpr by prominent politicians and the ensuing rates of retweets of this vpr by persons on what was then called twitter as a function of violent versus non-violent rhetoric. the reader is encouraged to read their recently published book (zeitzoff, 2023), for a deeper understanding of the phenomenon of vpr in the u.s. as well as in ukraine. methods institutional review board this research was determined by the university of tennessee institutional review board to not involve human subjects. hypothesis the current study augments research on police violence against, and killings of, civilians by focusing on variables not included in prior research, and augments research on the relationship between vpr and mass shootings by investigating the relationship between vpr and fcewp, the first study to do so. the hypothesis tested was that vpr is positively associated with mean monthly daily rates of fcewp, controlling for temperature, murder rate, and gun ownership. given the recent findings (cabrera & kwon, 2018; kwon & cabrera, 2019) of a relationship between income inequality and mass shootings, it is important to note that the u.s. income inequality level remained constant across the 69-month time period covered in the current study, january 2014 through september 2019, changing for the first time since 2011 in 2021 (united states census bureau, 2022). this variable, income inequality, was therefore constant during the current study. advances in social work, spring 2024, 24(1) 70 research design this study was an ex post facto analysis of publicly available online accessible data. measures counts of police violence killings. the dependent variable in this study was the mean monthly daily rate of fcewp during such events as traffic stops, chases of persons suspected of criminal activity, and other interactions between police and civilians. two raters independently counted the monthly numbers of police violence killings as reported at the online sites fatal encounters (2024) and mapping police violence (mpv, 2024a). fatal encounters has a very broad case definition that includes all deaths during encounters with the police, with no requirement of police culpability. the mpv definition of police violence is any incident where a law enforcement officer (off-duty or on-duty) applies, to a civilian, lethal force resulting in the civilian being killed whether it is considered “justified” or “unjustified” by the u.s. criminal legal system. data from these two sources were used given their use and evaluation in the global burden of diseases (gbd) 2019 police violence u.s. subnational collaborators (2021) study. a recent study found evidence supporting a strong association between the data from these two sources (comer & ingram, 2023). the weighted kappa inter-rater agreement for the counts from fatal encounters was 1.0, z = 13.64, p < 0.001. the agreement between counts from the mapping police violence data was 0.995, z = 13.48, p < 0.001, and the disagreements that reduced this kappa were resolved, so the final kappa was 1.0. the average across the raters’ counts of monthly police violence killings from both data sources, divided by the number of days in the month, was used as the dependent variable. this averaging was done given the gbd 2019 police violence us subnational collaborators (2021) finding that the data in the fatal encounters database may be overestimates of the number of persons killed by police, while the data in the mapping police violence database may be underestimates. the reliability, as estimated using cronbach’s coefficient alpha for this dependent variable, was 0.93. violent political rhetoric. zeitzoff (2019) looked for news articles reporting vpr by politicians in eight national newspapers, usa today, the washington post, the new york post, the wall street journal, the boston globe, the san francisco chronicle, the houston chronicle, and the chicago tribune using proquest. the numbers of articles found that reported vpr each month were counted and converted to a rate of vpr per 10,000 articles published per month from january 2014 through september 2019. the results of these counts are shown in figure 3 of zeitzoff (2019, p. 17). the vpr data for the current study were extracted, with permission, from this figure. temperature. as noted earlier, recent research has found temperature associated with gun violence (lyons et al., 2022; reeping & hemenway, 2020). monthly average u.s. temperatures were obtained from the national centers for environmental information (2024). nugent & khalil/violent political rhetoric & guns 71 gun ownership. monthly gun ownership numbers were not available. a proxy variable was used to represent monthly gun ownership. the monthly numbers of background checks for obtaining a firearm were obtained from the federal bureau of investigation (2024). homicide rate. the annual homicide rate for the years 2014 through 2019 was used as an independent variable, given the previous findings that violent crime rates such as murder have been found to be related to fcewp. these data were obtained from macrotrends llc (2024). income inequality. as noted earlier, income inequality was constant during the time period covered in this study. data analysis a time series methodology was used to analyze the data. time series analyses assume stationarity of the time series. a unit root in a time series is a characteristic that causes problems with statistical analyses (wooldridge, 2020). the phillips-perron test (phillips & perron, 1988) for unit roots was used to assess the plausibility of unit roots in each of the time series in this study. this test was for a unit root with or without a random drift. the biggest advantage of this test is that it is known to correct for autocorrelation and heteroskedasticity (wooldridge, 2020). however, wooldridge (2020) cautions that the results of tests for unit roots can be erroneous for a number of reasons. given this possibility, an auto-regressive distributed lag-error correction (ardl-ec) time series analysis was used to test for a long-run relationship between police violence killings of civilians and vpr. this method was used given that the ardl-ec method is appropriate for data with or without unit roots (kripfganz & schneider, 2018, 2023). results unit roots the results of a phillips-perron test for a unit root in the monthly numbers of police violence killings of civilians’ time series were consistent with the absence of a unit root, with a test of random walk with or without drift having statistically significant results rejecting the null hypothesis for a unit root, with test statistic of -8.55, p = .0001. the results for a test of unit root in the vpr time series were statistically significant, test statistic = 5.28, p = .0001, results consistent with absence of a unit root. the results of a phillipsperron test for a unit root in the average monthly temperature time series were statistically significant, with test statistic = -3.53, p = .0362, for random walk with or without drift. the results of a phillips-perron test for a unit root in the gun ownership time series were consistent with the absence of a unit root, with test statistic of -4.21, p = .0044. the results for a unit root in the murder rate time series were statistically nonsignificant, with test statistic = -1.43, p = 0.85, for random walk with or without drift. the null hypothesis of a unit root in the murder rate time series could not be rejected. these findings suggested an ardl-ec analysis procedure was appropriate. advances in social work, spring 2024, 24(1) 72 rates of fatal civilian encounters with police the monthly mean daily rate of fcewp is shown in figure 1. the solid curve shows the mean monthly daily rates of police violence killings of civilians, and the dotted line shows the statistically significant linear trend across time in these events. the dashed curve is discussed below. the results of a shapiro-francia test for normality of the distribution of rates of police violence killings of civilians were consistent with normality, z = -1.48, p = 0.93 (wooldridge, 2020). figure 1. graph of rate of police killings of civilians across time from january 2014 through september 2019. note. graphic plot showing monthly mean daily rates of police violence killings of civilians (solid curve), and the model predicted monthly rates of fatal civilian encounters with police (fcewp) (dashed curve). the dotted black line shows the statistically significant (p < 0.05) linear trend across the 69-month time period of the rate of fcewp. results of ardl analysis the full results of the ardl analysis are shown in table 1. the results of a pesaran et al. (2001) bounds test were, f = 14.86, p < .001, and t = -8.35, p < .001. since both were statistically significant, these findings were consistent with a long run relationship between nugent & khalil/violent political rhetoric & guns 73 police violence killings and at least one of the independent variables. the r-squared values were r2 = 0.56, and adjusted r2 = 0.52. as can be seen in table 1, the evidence suggested a possible short-run relationship between increases in monthly mean temperatures and greater numbers of police violence killings, t = 2.66, p = .01. there was no evidence of long-run relationships between either gun ownership, murder/homicide rate, or mean monthly temperature and police violence killings. the results were consistent with a longrun relationship between vpr and fcewp, b = 0.006, t = 2.40, p = 0.02. controlling for other independent variables, as vpr increased the number of police violence killings increased. the error correction term, -1.00, t = -8.31, p < .001, indicated short term deviations from the long-term relationship between vpr and fcewp dissipated within a one-month period (kripfganz & schneider, 2018, 2023). table 1. results of ardl-ec time series analysis variable b standard error t p 95% ci error correction -1.00 0.120 -8.35 < 0.001 -1.24, -0.76 long run relationships monthly average temperature 0.005 0.0038 0.18 0.18 -0.0025, 0.013 gun purchases 0.269 0.172 1.55 0.127 -0.08, 0.61 vpr 0.006 0.0024 2.39 0.020 0.0009, 0.01 murder/homicide rate -0.301 0.189 -1.60 0.116 -0.68, 0.08 short term relationships first difference monthly average temperature 0.016 0.006 2.66 0.010 0.004, 0.03 constant 4.14 0.980 4.23 < 0.001 2.16, 6.09 these results are shown graphically in figure 1 above. as already noted, the solid curve shows the monthly mean daily rates of police violence killings of civilians. the dashed curve shows the model predicted mean monthly daily rates. the lag-0 correlation between the actual and model predicted mean daily rates was +0.48, p < .001. tests of assumptions. the ardl-ec analysis assumes normality of residuals, absence of heterogeneity and autocorrelation in residuals, and stability of model coefficients across time. the results of a test for skewness in the residuals were statistically non-significant, χ2(6) = 6.83, p = 0.34, as were the results for a test of kurtosis in the residuals, χ2(1) = 0.03, p = 0.86. the results of white’s test for unrestricted heteroskedasticity were χ2(27) = 31.9, p = 0.24, results consistent with the absence of heteroskedasticity in the residuals. these results converged to suggest there were no significant violations of the assumption of normality of residuals, χ2(34) = 38.8, p = 0.26. the results of a breusch-godfrey test for autocorrelation in residuals at the 16 lags of 1 through 16 were statistically non-significant, results consistent with the absence of autocorrelation. the results of a recursive cumulative sum test for structural breaks were consistent with parameter stability across the 69month time period (wooldridge, 2020). a final assumption is that there can be, at most, one cointegrating relationship involving the dependent variable, the monthly daily average rate of fcewp (kripfganz & schneider, 2018, 2023). results of tests of this assumption by fitting alternate ardl-ec advances in social work, spring 2024, 24(1) 74 models were consistent with the absence of other long-run relationships involving the dependent variable, as required. all these results of tests of assumptions came together to suggest the assumptions of the ardl analysis were valid. alternate analysis it can be argued that there most likely is no unit root in the murder rate data given that the result of the unit root test was based on only six years of data, making this a very low power test, and given the results of the cook and cook (2011) study of unit roots in annual crime rate data. it can also be argued that the annual murder rate data is a different kind of variable than the other independent variables, which are all monthly data, and that the annual murder rate variable is a cluster variable representing a violent crime context for the year the data are from (garson, 2020). in this case, the number, a count of civilians killed by police each month, can be analyzed in a poisson time series regression with cluster robust standard errors (abadie et al., 2022) with the number of days in each month as an exposure variable. the smallest monthly count was 82, the largest 148, and the mean 117. there were no cases near or at 0. with monthly counts such as these, the distribution of counts approached a symmetric bell shape. the results of a test for clustering gave an estimated intra-class correlation of 0.00002, χ2(1) = 0.65, p > 0.50, results inconsistent with clustering, so a poisson time series regression, with robust standard errors, was conducted as a sensitivity check on the ardlec results to determine if the findings of a relationship between vpr and police violence killings of civilians was analysis method dependent. the model fitted in this poisson analysis was parallel in form to that found in the ardl-ec analysis. the overall model chi-square for this analysis was χ2(5) = 26.39, p < 0.0001. the full results are shown in table 2. the relationship between vpr and fcewp was statistically significant, regression coefficient = 0.0016, χ2(1) = 8.36, p < 0.004. similar to the results from the ardl-ec analysis, increases in monthly mean temperature were also associated with fcewp, with the overall temperature variable statistically significant, χ2(2) = 15.2, p = 0.0005. the total temperature effect was 0.002. table 2. results of poisson time series regression with robust standard errors variable b standard error χ2(1) p 95% ci gun purchases 0.065 0.034 3.61 0.058 -0.002, 0.133 temperature 0.0057 0.0014 15.2 0.0001 0.003, 0.009 first difference temp. -0.004 0.0015 9.01 0.003 -0.007, -0.001 murder rate -0.064 0.041 2.48 0.11 -0.144, 0.016 vpr 0.0016 0.0006 8.36 <0.004 0.0005, 0.003 constant 1.33 0.187 50.43 <0.001 0.963, 1.70 the fit of this model to the police killing of civilian data is shown in figure 2. in this figure, the solid black curves show the actual monthly numbers of fcewp, while the dashed black curves show the poisson time series predicted monthly counts. the lag-0 correlation between the actual counts and the predicted counts was 0.57, p < .001. the nugent & khalil/violent political rhetoric & guns 75 deviance goodness of fit for this model was, χ2(62) = 68.5, p = 0.27, and the pearson goodness of fit was, χ2(62) = 68.2, p = 0.27. these results were consistent with good model fit. they were also consistent with the absence of over-dispersion in the poisson regression model, as were the results of a negative-binomial analysis. figure 2. fit of poisson model predicted rates of police killings of civilians with actual rates. note. graph showing monthly numbers of fcewp (solid black curves) and poisson model predicted monthly numbers of fcewp (black dashed curves). tests of assumptions. poisson regression assumes independent observations. in a time series, this is essentially the assumption of absence of autocorrelation. the results of this assumption using the box-ljung statistic in spss showed no evidence of autocorrelation through 16-time lags (wooldridge, 2020). since this was a time series analysis, the results of a shapiro-francia test for normality of residuals were, z = -0.28, p = 0.61, findings consistent with normality of residuals. the results of white’s test for unrestricted heteroskedasticity of residuals were χ2(2) = 0.41, p = 0.81, results consistent with homoscedasticity of residuals. the results of a breuschgodfrey test for autocorrelation in residuals across 16 lags were χ2(16) = 15.3, p = 0.50, results consistent with the absence of autocorrelation in residuals. the results of a cumulative recursive sum of residuals test were consistent with parameter stability across time. advances in social work, spring 2024, 24(1) 76 strengths and limitations the ardl-ec results and the above results from the poisson time series regression were consistent with a positive relationship between vpr and police violence killings of civilians. these results need to be interpreted within the context of study limitations. the main limitation of this study was the relatively short time series, 69 months. longer time series would enable short-term trends and patterns in the data to dissipate and more longterm trends and patterns to become more manifest. future studies of the relationships between vpr and fcewp should involve analyses of longer time series. a second limitation was the narrow measure of vpr, the numbers of news articles containing reports of vpr in the eight national newspapers. more comprehensive measures of vpr need to be developed and used in future research. these measures should include counts from news and opinion shows on television and radio, hate radio broadcasts, and social media, such as facebook and twitter. another limitation is omitted variables. there are likely important variables not included in analyses, the inclusion of which could in principle have changed results. the principal strengths of the study were the analysis methods used. the ardl-ec approach is appropriate for time series with or without unit roots. the tests for unit roots are known to be fallible, being usually of low power and valid only if the lag-1 autoregressive parameter is 1.0 (wooldridge, 2020). should the results of the tests for unit roots in the current study have been erroneous, the results of the ardl-ec analyses would remain correct since ardl analyses can be conducted with or without unit roots (kripfganz & schneider, 2018, 2023). however, a poisson time series regression was also done as a sensitivity check, treating the annual murder rate as a cluster variable and with cluster robust standard errors. the results of this analysis were consistent with the ardlec analysis, an outcome consistent with the study results being consistent across data analysis methods. a final strength of the current study is that it is, as far as the authors are aware, the first to investigate the relationship between vpr and police violence killings. the study thus addresses an important gap in the research on fcewp. the current study also extends research on the relationship between vpr and mass shootings by focusing on the possible relationship between vpr and police violence killings of civilians. implications for social work the results were consistent with a long-run relationship between vpr and fcewp. the results suggested that as vpr increased the rate of fcewp increased, controlling for murder rates, gun ownership, and temperature. income inequality was constant during the time period studied; hence variation in income inequality could not have influenced rates of police violence killings of civilians. thus, the results were consistent with increases in vpr being associated with increased fcewp, holding constant income inequality as well. this conclusion should not be interpreted to mean that vpr causes fcewp. the correlational nature of the research design in this study precludes causal inference. further research is needed to replicate the current study's findings and, secondly, further clarify the nugent & khalil/violent political rhetoric & guns 77 relationship between vpr and fcewp. future research should employ longer time series to reveal further and clarify possible relationships between vpr and fcewp. the results, however, do support the hypothesis that as vpr increases, so does fcewp. this consistency suggests that vpr may facilitate creation of a social environment that increases and supports the use of deadly violence by police against civilians during policecivilian encounters. the results also support further research on this possibility. a graph of the mean monthly temperature across the 69 months showed a sinusoidal pattern with sine and cosine periodicity values consistent with the periodicity in mass shooting events found in the nugent et al. (2022) study. thus, the possible relationship between fcewp and the mean monthly temperature found in the current study may reflect an annual periodicity associated with changes in temperature due to the changing seasons. the statistically significant relationship between fcewp of civilians and temperature increases may reflect the fact that during warmer months, there are more civilians out and about involved in numerous activities than during colder months and, consequently more police-civilian encounters. future research should help clarify this relationship and whether higher temperature is responsible for any relationship between temperature and fcewp, or whether it is a seasonality effect associated with persons engaging in more activities outside the home during warmer months. future research should also include variables not included in the current study. multilevel studies could be especially informative, including individual-level variables associated with both police and civilian characteristics, including race and gender variables, and cluster variables such as regional variables representing strictness of gun ownership laws, levels and types of police training programs, and other legal and policyrelated variables (garson, 2020). these studies could help bring to light multilevel relationships and cross level interactions. future research should also focus on developing more comprehensive measures of vpr in line with the taxonomy of hate speech developed by kennedy and colleagues (kennedy et al., 2018). neither the current study nor its findings should be interpreted in any way as passing or expressing any judgments on the legitimacy of the actions of the police officers involved in these events that were fatal for civilians. the purpose of this study was to test the hypothesis, arising from the recent findings of a positive relationship between vpr and mass shootings (nugent et al., 2022; nugent & conway, 2021), that a relationship exists between vpr and fcewp. the results of the current study add to our growing knowledge about factors associated with fcewp by indicating the possible role that violent political rhetoric may play. this finding, in one sense, should not be surprising given the evidence that hate speech has been found to be associated with hate crimes and other forms of violence (kennedy et al., 2018; relia et al., 2019; soral et al., 2018) and that violent political rhetoric can be conceptualized as a special case of hate speech (murphy, 2021; piazza, 2020). future research also needs to investigate the interplay between vpr, mass shootings, and police violence killings of civilians. important questions for future research include: (1) are mass shootings and fcewp related? as police killings of civilians increase, do mass shootings tend to increase, or vice versa? advances in social work, spring 2024, 24(1) 78 (2) what role does vpr play in a possible relationship between fcewp and mass shootings? (3) what roles do variables such as gun ownership, temperature, crime rates, and income inequality play in relationships between fcewp, mass shootings, and violent political rhetoric? and (4) do fcewp and/or mass shootings influence gun ownership? inclusion of other relevant variables in these studies can further elucidate the interrelationships between fcewp, mass shootings, and other important variables. the results of this study have implications for social workers. first, certificate programs could be developed that train social workers to work with police, as is currently being done in some cities (patterson, 2008). the education of social workers to be police social workers should include training in how to help police officers develop de-escalation skills in dealing with confrontations with civilians that are fraught with the potential for violence. the goal of this training would be to reduce the probability of police use of deadly violence with civilians in a wide variety of confrontational situations. this suggestion dovetails with approaches to help reduce police violence towards civilians, most importantly towards persons of color, recommended by justice in public safety project: framework for public safety (naacp legal defense fund and educational fund, 2024). these include the use of restorative justice approaches, increasing investments in community resources, and creation of groups of unarmed civilian responders. these civilian responders could include social workers trained in a variety of non-violent deescalation techniques and who work collaboratively with police in a range of circumstances involving encounters between police and civilians. while some may find the idea of social workers being a part of this trained group objectionable and distasteful, it is important to keep in mind the importance of social work skills such as active listening in the implementation of de-escalation (oliva et al., 2010). social workers can bring valuable knowledge and skills to bear in crisis confrontations between police and civilians. social workers, and the social work profession, could play a critically important role in the training of, and actions of, a corps of unarmed civilian responders working collaboratively with police. we do not mean to underestimate the obstacles, challenges, or risks involved in implementing such a policy and approach; we do want to emphasize the potential benefits. another implication is for social workers to develop ways to reduce the use of violent political rhetoric not only by politicians, but others as well who have the opportunity to use various media outlets to spread information and messages. one possibility is collaborating with ethicists to develop ethical guidelines for those who use various media platforms for communication, in particular politicians and political candidates. the ethical guidelines would constrain the forms of speech used, most specifically forms of violent rhetoric and hate speech. social workers could also advocate at local, state, and national levels for adopting these ethical guidelines by media, political parties, and other leaders. the goal would be the reduction of, if not the elimination of, the use of violent political rhetoric. while we suggest social workers endeavor to find ways to influence politicians, media figures, and others to avoid use of vpr, we also recognize that such an endeavor has a low nugent & khalil/violent political rhetoric & guns 79 probability of succeeding. the payoffs for using vpr are likely to be felt to be too great to be abandoned by many who use such rhetoric, especially during a high-stakes presidential election. the us population is currently in a highly polarized state, and zeitzoff (2023) has noted how vpr increases as polarization increases. consequently, it can be expected that as of the time this is being written there will be significant vpr for the foreseeable future. thus, a more immediate course for social workers is to develop and implement programs designed to humanize the persons who might encounter police officers in their role as law enforcement, especially groups that have been marginalized and/or minoritized and are the current targets of vpr. one example would be empathy programs. social workers might create such programs and then collaborate with various local, state-level, and national media to disseminate these programs. these programs could be a part of normal daily programming by local media to humanize and inculcate a sense of empathy for persons targeted by vpr and who encounter police who are engaged in their daily roles as law enforcement officers. efforts by social workers to train police in use of de-escalation techniques, and even assisting police in de-escalating high risk encounters between civilians and police, might also be of value in preventing civilian deaths at the hands of police. conclusion in conclusion, the results of the current study are consistent with a positive relationship between vpr and fcewp, controlling for gun ownership, temperature, and murder rate. these results also appear to be uninfluenced by income inequality since it was essentially constant during the period of this study. the results also appear to be consistent across data analysis approaches. these findings suggest further research into the relationship between vpr and fcewp is warranted. the findings also serve as a call to social work to engage in efforts to reduce the use of vpr, and develop policies and methods to reduce fcewp by assisting police during civilian encounters with police using de-escalation techniques and other communication skills and methods. references abadie, a., athey, s., imbens, g., & wooldridge, j. 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(2023). nasty politics: the logic of insults, threats, & incitement. oxford university press. author note: address correspondence to william r. nugent, college of social work, university of tennessee, knoxville, tn, 37996. email: wnugent@utk.edu https://doi.org/10.1371/journal.pone.0229686 https://doi.org/10.1371/journal.pone.0229686 https://doi.org/10.1111/socf.12361 https://doi.org/10.1111/socf.12361 https://doi.org/10.1002/ab.21737 https://doi.org/10.1002/ab.21737 https://doi.org/10.1080/07418829300091911 https://doi.org/10.1080/07418829300091911 https://www.theguardian.com/us-news/ng-interactive/2015/jun/01/the-counted-police-killings-us-database https://www.washingtonpost.com/context/dec-17-19-2021-washington-post-university-of-maryland-poll/2960c330-4bbd-4b3a-af9d-72de946d7281/?itid=lk_inline_manual_2 https://www.washingtonpost.com/context/dec-17-19-2021-washington-post-university-of-maryland-poll/2960c330-4bbd-4b3a-af9d-72de946d7281/?itid=lk_inline_manual_2 https://www.census.gov/library/publications/2022/demo/p60-276.html https://sites.lsa.umich.edu/dcc-project/policing-social-justice-historylab/ https://sites.lsa.umich.edu/dcc-project/policing-social-justice-historylab/ https://doi.org/10.1007/s11524-020-00430-0 https://doi.org/10.1007/s11524-020-00430-0 https://doi.org/10.1007/s11524-020-00430-0 https://doi.org/10.1177/1525107118759900 https://doi.org/10.1177/1525107118759900 https://doi.org/10.1177/1525107118759900 https://doi.org/10.1177/0011128718756038 https://politicalviolenceataglance.org/2018/08/17/what-violent-rhetoric-does-and-does-not-do/ http://www.zeitzoff.com/uploads/2/2/4/1/22413724/zeitzoff_nastystyle_violentrhetoric_draft_nov2019.pdf mailto:alex.redcay@millersville _________ joonmo kang, phd, ma, assistant professor, school of social welfare, university of kansas, lawrence, ks. babu gounder, doctoral student, school of social work, university of illinois urbana-champaign, champaign, il. chris weatherly, phd, lcsw, assistant professor, school of social work, university of georgia, athens, ga. aliya jankowski, msw, school of social welfare graduate, university of kansas, lawrence, ks. lisa reyes mason, phd, msw, professor, graduate school of social work, university of denver, denver, co. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 219-230, doi: 10.18060/28138 this work is licensed under a creative commons attribution 4.0 international license. rethinking academic conferences: carbon footprints and sustainable alternatives in the climate crisis era joonmo kang babu gounder chris weatherly aliya jankowski lisa reyes mason abstract: in the era of the climate crisis, academic conferences, while crucial for knowledge exchange, present a dilemma due to their significant carbon emissions from air travel. this commentary examines the environmental impact of attending academic conferences, focusing on the carbon footprint of traveling to the annual society for social work and research (sswr) conference to begin to shed light on our field’s contribution to climate change. we estimate that the average air travel carbon footprint for an individual who presented at sswr 2023 was 0.82 tonnes of carbon emissions. furthermore, we explore alternative conference models, such as virtual and hub and node models, highlighting their potential to reduce carbon emissions while enhancing accessibility. as climate change requires collective global efforts and systemic change, we argue that the field of social work, with its commitment to social justice and activism, has a crucial role to play in driving these changes within academia and beyond. reflecting on our part in climate change, initiating dialogue, and creating a strategic roadmap for alternative conference formats is an essential step for our field to contribute to a more sustainable and equitable future. keywords: carbon footprint; climate change; climate justice; ecosocial work; sustainability academic conferences play a vital role in continuing the development of disciplines and fostering growth and community by sharing knowledge, exchanging ideas, and engaging in intellectual and robust conversations. however, in an era where climate change threatens all aspects of life and strongly impacts community health and well-being, academic conferences pose a dilemma for climate-conscious researchers and educators. inperson academic conferences can entail thousands of scholars and practitioners traveling from different parts of the world, resulting in significant carbon emissions from air travel (tao et al., 2021). as such, a growing number of scholars have documented the consequences of academic flying (bjørkdahl et al., 2022; leochico et al., 2021) and started to explore possibilities for envisioning alternative conference modes (flying less, 2025; hiltner, 2016). we also have seen initiatives at the university level to curb carbon emissions. for example, in 2019 the university of sheffield hosted a hybrid symposium called “reducing academic flight.” the eth zurich also launched the air travel project that focused on reducing the greenhouse gas emissions from work-related air travel by about:blank advances in social work, summer 2025, 25(2) 220 university affiliates through a participatory, evidence-based and solution-oriented approach (kreil, 2021). academia has been closely entwined with air travel since the 1960s (bjørkdahl & duharte, 2022). flying is so deeply embedded in academic culture and identity to the point that frequent travel has become a marker of academic success and prestige (bjørkdahl & duharte, 2022; hopkins et al., 2019). many academics consider conference-related air travel necessary for career success; however, an increasing number are expressing concerns and recognizing a culture of silence around how this travel contributes to climate change. (eriksson et al., 2020). moreover, kreil (2021) has shown that, contrary to the dominant assumption that reducing air travel negatively impacts academic work, such work would either benefit from or remain unaffected by using alternative conference methods. since the covid-19 pandemic, which forced many conferences to shift online, a growing number of scholars in other fields are beginning to challenge the tradition of air travel within academia and reflect on their practice and roles in curbing emissions (crumleyeffinger & torres-olave, 2021; moss et al., 2021). in social work, there has been a notable absence of discourse around critically reflecting on how our professional practices and lifestyles may contribute to perpetuating the reliance on and systems of carbon emissions. given that our field is intricately intertwined with climate justice (alston, 2015; dominelli, 2011; mason, 2021) and that we are a practice-oriented profession that upholds reflexivity and social action, it is imperative that we take proactive steps to develop comprehensive and effective strategies for promoting sustainable practices, fostering climate consciousness, and setting a precedent for a more ecologically sustainable future within our field and beyond. through this commentary, we aim to reflect on this issue and initiate a dialogue by exploring the issue of air travel to academic conferences. moreover, we will examine the practices of other disciplines and begin to consider alternative approaches. first, to begin reflecting on our profession’s climate impact, we estimated the carbon emissions of the 2023 conference for the society for social work and research (sswr), which is one of the largest social work conferences that brings together researchers, scholars, practitioners, educators, and students. then, we summarize alternative conference models that have been explored as well as measures adopted to diminish the impacts of conferences on climate change. we conclude by urging the field to mobilize to take action. measuring the carbon footprint of attending sswr since conference-related travel constitutes a significant portion of the carbon emissions associated with an academic profession, a growing number of fields are beginning to scrutinize the climate ramifications of academic conferences by calculating their carbon footprint. while various disciplines are beginning to contemplate their environmental impact, we have not observed a similar initiative within the field of social work. this is concerning considering social work’s commitment to climate consciousness, which was reflected in the 2022 sswr conference’s emphasis on environmental justice. to address this gap, we have taken the initiative to calculate the carbon footprint of sswr 2023. kang et al./sustainable conference travel 221 using publicly available information about presenters and their institutions from sswr’s online conference program, we estimated the carbon emissions from air travel of the presenters. we utilized the carbon footprint online calculator created by carbon footprint ltd., an environmental consulting firm based in england. carbon footprint calculators assess an individual’s carbon footprint by gathering data on energy use and transportation methods, including flights, cars, motorbikes, buses, rail, and household consumption. among the many online calculators available, we selected this tool based on a study by mulow et al. (2019), which identified it as one of the most comprehensive options among 31 online carbon footprint measurement tools. by inputting the airport code of the closest airport to each presenter’s institution and the conference location in phoenix (phx), this calculator estimates the carbon footprint of air travel by analyzing the distance traveled, type of seats (e.g., economy class, business class), and the radiative forcing factor, which accounts for the emissions resulting from high-altitude impacts, to compute the total emissions generated. presenter information was collected from sswr’s online conference program. initially, we identified a total of 3,901 presenters listed in the program. we then narrowed this to presenting authors, resulting in a final count of 1,677. to calculate the carbon footprint for each presenting author, we determined the closest airport to each presenter’s institution using google maps. we assumed that each presenter took a round-trip, direct economy flight to phoenix. for those whose institutions were within 300 miles of phoenix, we assumed they drove to the conference and did not include them in the carbon footprint calculation. carbon footprint of attending sswr and its implications the 1,677 presenting authors from the sswr 2023 conference comprised 1,512 domestic travelers and 165 international travelers. based on assumptions described above, we estimate that these presenters collectively emitted over 1,383.17 tonnes of co2 through air travel, resulting in an average emission of 0.82 tonnes per presenting author. this is a conservative estimate because not all participants may have chosen direct flights, and those who took a flight instead of driving while located within 300 miles of phoenix were excluded from our calculations, as we assumed they were commuting by car. overall, these results fall within the range of estimates from other studies that have calculated the carbon footprints associated with air travel for academic conferences. for instance, jäckle (2019) estimated the carbon footprint of europe’s largest political science conferences between 2013 and 2020, revealing that average emissions per attendee ranged from 0.5 to 1.3 tonnes of co2. similarly, milford et al. (2021) estimated that attendees at the annual meeting of the societies for pediatric urology traveled a total of 4,034,964 miles, resulting in 912.47 tonnes of co2 emissions, with a median emission of 0.61 metric tonnes per attendee. conferences with larger participant numbers, particularly those with a more global attendance, exhibit higher carbon emissions. for example, bousema et al. (2020) estimated that the 4,834 participants of the american society of tropical medicine and hygiene conference, which attracted attendees from 110 countries, generated a total of 8,646 tonnes advances in social work, summer 2025, 25(2) 222 of co2. the annual meeting of the european astronomical society, which draws more than 25,000 participants from over 100 countries, was estimated to have a carbon footprint of 1.5 tonnes per participant in 2019 (burtscher et al., 2020). klöwer et al. (2020) calculated that the carbon footprint of the 2019 annual meeting of the american geophysical union (agu) was 3 tonnes per participant. furthermore, the annual meetings of the society for neuroscience, hosting 30,000 attendees from around the world, were estimated to emit 22,000 tonnes of co2, an amount that the authors equated to the annual carbon footprint of operating 1,000 medium-sized laboratories (nathans & sterling, 2016). compared to major conferences in other fields, sswr is relatively modest in scale and does not attract as many international participants, which might explain the lower total carbon emissions as well as the 0.82 tonne carbon footprint per presenting author compared to the other conferences mentioned above. yet this is still high when considering that this is just a flight for one conference. for each presenter, this is more than the yearly emissions of individuals living in sub-saharan africa, which is 0.7 tonnes, and more than double the yearly emissions of individuals from “the least developed countries,” as categorized by the united nations, which is 0.3 tonnes according to data from the world bank (2023). our finding reflects “the great carbon divide,” which describes the extreme inequality of carbon emissions between the rich and the poor (watts, 2023; khalfan et al., 2023). attending a single conference emits more carbon than the average person in some parts of the world produces in a whole year. this stark contrast puts into perspective what brand and wissen (2021) described as the imperial mode of living, a concept that critiques the everyday life and the norms of production and consumption that are built into the political, economic, and cultural structures in the global north. the imperial mode of living is characterized by excessive consumption, reliance on high levels of resource extraction, and a significant ecological footprint at the expense of marginalized communities (brand & wissen, 2021). what many in the global north consider a “normal” lifestyle, such as flying as part of their work, plays a significant role in climate injustice, where the world’s poorest and most vulnerable populations experience the most impacts of climate change despite being the least responsible for it. furthermore, it highlights the significant distance many academics may have from the realities of global inequality. the world’s richest 10% of people were responsible for more than 50% of the carbon emissions produced between 1990 and 2015. moreover, the emissions based on consumption of the richest 1%, which according to samuel (2023) is a person without children who earns at least $60,000 a year, are more than 100 times higher than the poorest 50%. to avert the worst impacts of climate change, the paris agreement set a target of limiting global average temperature increase to 1.5°c above pre-industrial levels by 2030. to meet this goal, global emissions must decline by 43% by 2030 and the average emission per capita, globally, should not exceed 2.3 tonnes (khalfan et al., 2023). with most emissions linked to consumption by the world’s richest people, the role of people with financial means and resources are vital to meeting the paris agreement’s 1.5°c goal (khalfan et al., 2023). reducing carbon emissions requires a systemic transformation from carbon-intensive practices, as carbon emissions are deeply interconnected with the systems that govern our kang et al./sustainable conference travel 223 societies and economies. while much of this transformation requires political action and policy change, there is also a role for addressing the lifestyles and consumption patterns of individuals, particularly those living in the global north with financial means and resources. the people driving these systems can recognize their own roles in perpetuating carbon emissions through their everyday behaviors and practices, which requires a fundamental shift in societal values and individual lifestyles. in this context, reflecting on our own carbon emission practices, particularly regarding attendance at conferences, prompts us to consider what role we can play in driving meaningful change. this serves as an example of one approach to questioning and potentially redefining our norms. with the emergence of ecosocial work, which represents a paradigm shift in the traditional frameworks of social work by advocating for transformative practices that emphasize ecological sustainability and social equity (boetto, 2017; coates, 2003; dominelli, 2012) as well as the pivotal role of social workers in facilitating a just transition (forbes et al., 2024), it is increasingly vital to take proactive measures to reflect on our current practices and create strategies that encourage sustainable practices, establishing a standard for a more ecologically sustainable future both within our field and in broader society. as academics, particularly in social work—an applied field and one focused on social justice—we must model sustainable practices in our own lives and advocate for changes that demonstrate our commitment to climate/environmental justice and sustainability. assessing our air travel practices should be an integral part of this effort; our calculations indicate that attending the sswr conference accounts for nearly 36% of the maximum carbon emissions a person should emit annually to meet the 1.5°c target. air travel is deeply embedded in the culture of academia, where it is considered a necessity for performing well and is often seen as beneficial to one’s career (kreil, 2021; schrems & upham, 2020). therefore, a system-wide shift away from air travel in academia requires a change in cognitive norms and culture (tseng et al., 2022). to be sure, changes to systems via policies, regulations, and institutional frameworks are undoubtedly necessary to create broader structural shifts that can lead to reduced carbon emissions. for example, systemic change could involve increasing public transportation options, such as high-speed rail, which can provide alternatives to domestic air travel. at the same time, a change in society’s values is needed to drive progress. reflecting on individual values and making lifestyle changes are important steps that should go hand-in-hand with systemic efforts to reduce emissions in the near future. considering that a full discussion of the tension and interplay between systemic drivers of emissions and the potential and limitation of individual changes are beyond the scope of this commentary, we focus the remainder of this paper on immediate implications for social work academics to consider, for alternative conference formats that would reduce air travel related emissions. alternative formats of academic conferences: from virtual to hybrid, embracing climate sustainability when considering how to reduce the carbon footprint associated with air travel for attending academic conferences, there are several alternatives. these include a complete shift to virtual conferences or options that fall somewhere in between. one such option is advances in social work, summer 2025, 25(2) 224 a hub model, which minimizes air travel by hosting events in multiple locations while still providing the in-person benefits of conferences, such as networking, collaboration, and direct engagement with peers. other alternatives involve rotating conferences between virtual formats or fully transitioning to online platforms. in this section, we will examine the benefits and limitations of these alternatives. well before the worldwide covid-19 pandemic, which forced many to shift from inperson formats to digital ones, virtual conferences had been developing since 1992 (anderson, 1996). these virtual events already demonstrated an ability to deliver a highquality and engaging professional experience (anderson, 1996). yet it was during the pandemic that a growing number of academics began to recognize the advantages and feasibility of participating in conferences online, with some starting to call for a complete transition to virtual formats (e.g., achakulvisut et al., 2020; moss et al., 2021; periyasamy et al., 2022; tao et al., 2021). for example, periyasamy et al. (2022) showed that a physical conference emitted 55 times more co2 compared to a virtual conference. tao et al. (2021) estimated that transitioning from a traditional in-person to an online format would substantially reduce the carbon footprint of conferences by 94% and energy use by 90%. in addition to minimizing the environmental impact, virtual conferences have advantages such as extending their reach to a broader audience and enhancing accessibility (le quéré et al., 2015; raby & madden, 2021), particularly for individuals with fewer resources and care responsibilities, including female researchers with caregiving and parental responsibilities (jöns, 2011), scholars from the global south (albayrak-aydemir, 2020), and people with disabilities (de picker, 2020). however, virtual conferences still have challenges including technical issues, time zone differences, lack of engagement and interaction compared to in-person events, and screen fatigue (moss et al., 2021). many people have concerns about going completely virtual as there is still a strong belief that physical attendance is more engaging and facilitates better networking (bousema et al., 2020). being physically present in a conference encourages active participation where one can have face-to-face interactions, chance encounters in hallways and breaks, and build meaningful and spontaneous connections that can be more challenging to achieve or replicate in a virtual setting. those who recognize both the advantages and disadvantages of virtual and in-person conferences are increasingly considering the hybrid format that combines virtual and inperson aspects of a conference as a viable alternative. often called the “multi-hub conference,” this format significantly reduces a conference’s emissions by hosting the conference simultaneously in a few locations to accommodate the multiple geographical areas where most academic members cluster. for example, klöwer et al. (2020) estimated that agu would experience a 79% reduction in emissions if it shifted its typical conference location of san francisco to a multi-hub conference in chicago, paris, and tokyo. bousema et al. (2020) calculated that shifting the conference for the american society of tropical medicine and hygiene from a single location in maryland, u.s., to a conference venue per region in washington, dc, lima, bangkok, nairobi, and amsterdam would reduce emissions by 60%. similarly, the international society for industrial ecology estimated an 82% reduction in emissions with the three-hub multi-conference format combined with land transportation (van ewijk & hoekman, 2020). kang et al./sustainable conference travel 225 with the multi-hub conference, the program is split across the hubs to cultivate interactions among participants on a single site and across multiple sites (parncutt et al., 2021). for example, each hub holds its own in-person keynote and sessions, which are also broadcasted, live-streamed, and connected to other locations for virtual discussions (sarabipour et al., 2021). the multiple sites are virtually linked up for participants at any location to attend and participate in any session. two-way video systems are set up to enable cross-location discussions (abbott, 2020). conference programs include virtual socializing events such as specific topic discussions and prearranged network opportunities (parncutt et al, 2021). each conference site organizes and holds its own in-person social events to foster new connections and allow friends in the field to catch up (abbott, 2020). furthermore, it provides an opportunity for local engagement, which can benefit local communities and economies (rosen, 2017). integrating pure virtual and in-person has been explored with various hybrid “hub and node” models (fraser et al., 2017). the hub represents the site coordinating the virtual technical elements of the conference and streaming the conference presentations and proceedings, while the nodes are local areas where participants gather at smaller venues to view the same virtual conference in real-time and have the benefit of face-to-face interaction. these hybrid conference formats with decentralized nodes can be set up with a single hub, multiple hubs, or multilateral hubs that span multiple international locations and time zones (fraser et al., 2017). compared to multilateral hub models, single-hub or multiple-hub models act as a central point that is more practical in reducing time and resource requirements for organizing and coordinating between hubs (fraser et al., 2017). by having hubs and nodes, participants have the choice to attend in person, without having a format that excludes those who may not have the necessary resources or desire to attend in person (fraser et al., 2017). however, the hybrid hub and node models are not without their flaws. most notably, these hybrid models essentially create two classes of attendees as those joining virtually often have a secondary or less immersive experience (moss et al., 2021). moss et al. (2021) strongly advocate prioritizing virtual participation in a hybrid space, which implies that even when individuals are physically present, they should participate virtually, irrespective of the existence of an in-person aspect in the event. moreover, hybrid models double the workload for organizers to maintain a well-synchronized event (moss et al., 2021). aside from these alternatives, some have suggested scheduling conferences biannually (see zoloth, 2014) and holding in-person meetings every other year and replacing one year with a virtual one. alternatively, if the decision is to continue hosting conferences inperson, it may be beneficial to select cities with nearby major airport hubs to reduce extensive travel. for example, klöwer et al. (2020) demonstrated that holding a conference in chicago, illinois, compared to coastal cities, could save 12% in emissions. redefining academic conferences in the face of the climate crisis: a call to action for social work and beyond with climate change amplifying and making worse the existing inequities and disparities of vulnerable and underserved populations, our professional commitment to advances in social work, summer 2025, 25(2) 226 marginalized and at-risk groups embedded within our code of ethics necessitates the profession to be at the forefront of addressing the climate crisis by forging meaningful changes within existing systems. these discussions are still just emerging within the realm of social work. lowering the carbon footprint of the most prominent event in the field of social work research will represent an important step in raising awareness and modeling future events both within and beyond our profession. while there are various ways to lower conference-related carbon emissions—such as food and lodging choices—this commentary focused on the air travel aspect of academic conferences, as air travel to conferences, meetings, and talks accounts for more than one-third of carbon emissions in higher education (hiltner, 2016). we are calling for our field to contemplate the traditional model of academic conferences that necessitate frequent air travel and to think about alternatives as a collective practice. by advocating for a reduction in carbon footprint, we are not placing blame on individual scholars or discouraging their participation in academic conferences. instead, we are addressing this matter in line with other climate change concerns, emphasizing the need for reflection on cultural norms and comprehensive systemic changes. moreover, such changes are likely to falter if they are not accompanied by a fundamental shift in societal values and individual lifestyles. to achieve this, we must initiate a collective discussion within our field, recognizing the need for both systemic change and individual introspection and behavioral adjustments. addressing the root causes of carbon emissions requires a collective commitment to reevaluating how we live, consume, and interact with our environment. other disciplines have acted more than social work in this regard. for example, the american anthropological association (aaa)’s global climate change task force published a report in 2014, which called for the aaa’s executive board to aggressively reduce the carbon footprint from association-wide activities (fiske et al., 2014). in 2018, the society for cultural anthropology experimented with hosting a hybrid conference creating a carbon-conscious international conference (pandian, 2018). also in 2019, the american association for geographers (aag) introduced the climate action task force and petitioned the council of aag to reduce emissions from their annual meeting by 45% by 2030 and by 100% by 2050 (langham, 2022). these are a few of many examples that we can learn from. whether it involves adopting a multi-hub or virtual format, scheduling conferences biannually, or selecting venues near major airport hubs to cut extensive travel, it is imperative that we begin to develop a strategic roadmap to ensure that our intellectual interactions prioritize sustainability, equity, and inclusivity. however, lowering the carbon footprint of one academic conference will not, in the grand scheme of things, significantly impact the challenge of climate change. according to a report by the intergovernmental panel on climate change (ipcc, masson-delmotte et al., 2018), given the shared nature of the climate change issue, one sector’s contributions will be insignificant without an interconnected approach and response. additionally, while written recommendations are easy to produce and disseminate, making sustained changes for a conference that provides the largest platform for social work researchers, scholars, practitioners, and students will be met with multiple real barriers and difficult kang et al./sustainable conference travel 227 conversations. nevertheless, the field of social work by the very nature of its purported ethos, spirit, and philosophy has a necessary role to play in this process. sustained systemic change can only occur through taking important first steps, and we urge our colleagues to collectively embark on this path. references abbott, a. 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(2016). 2014 aar presidential address: interrupting your life: an ethics for the coming storm. journal of the american academy of religion, 84(1), 3-24. author note: address correspondence to joonmo kang, school of social welfare, university of kansas, green hall, 338, 1535 w. 15th street, lawrence ks 66045. email: joonmo@ku.edu https://www.vox.com/future-perfect/2023/9/15/23874111/charity-philanthropy-americans-global-rich https://www.vox.com/future-perfect/2023/9/15/23874111/charity-philanthropy-americans-global-rich https://doi.org/10.1101/2020.04.02.022079 https://doi.org/10.1101/2020.04.02.022079 https://doi.org/10.3390/su12051837 https://doi.org/10.3390/su12051837 https://doi.org/10.1038/s41467-021-27251-2 https://doi.org/10.1038/s41467-021-27251-2 https://doi.org/10.1016/j.trd.2022.103504 https://doi.org/10.1016/j.trd.2022.103504 https://doi.org/10.1111/jiec.13079 https://doi.org/10.1111/jiec.13079 https://www.theguardian.com/environment/ng-interactive/2023/nov/20/the-great-carbon-divide-climate-chasm-rich-poor https://data.worldbank.org/ https://doi.org/10.1093/jaarel/lfv093 https://doi.org/10.1093/jaarel/lfv093 mailto:alex.redcay@millersville _________ anayeli lopez, phd, msw, assistant professor, school of social work, new mexico state university, las cruces, nm. rene galindo, phd, associate professor, and ruben p. viramontez anguiano, phd, professor, school of education and human development, university of colorado, denver, co. marianna corkill, msw student, school of school work, new mexico state university, las cruces, nm. jennifer jacob-bellowe, graduate student, school of education and human development, university of colorado, denver, co. yesenia weaver, nurse, madison, wi. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 46-66, doi: 10.18060/25397 this work is licensed under a creative commons attribution 4.0 international license. de la iglesia a servir el pueblo*: the role of religious leaders in serving latino immigrant families anayeli lopez rene galindo ruben p. viramontez anguiano marianna corkill jennifer jacob-bellowe yesenia weaver abstract: without initial resources and support in place for newcomer immigrant families, municipalities and service providers in new destination communities struggle to address social, economic, and educational needs of latino immigrants and their families. the present study explored the role of churches and religious leaders in addressing the social, economic, and educational needs of latino families in an emerging immigrant destination community. the study draws from in-depth interviews with five latino religious leaders (e.g., catholic priests and evangelical pastors) and catholic laity. thematic analysis was used to identify themes in the narrative data. results illustrate latino churches and religious leaders provided religious social capital (e.g., information, social and spiritual support) and served as cultural and language brokers (e.g., interpreter of language and culture). this study provides important implications and recommendations for social workers on how they can partner with religious leaders to serve latino immigrant families in a timely, effective, and culturally sensitive manner. keywords: latino immigrant families, latino religious leaders, emerging immigrant destinations, functions of the latino church, religious social capital, covid-19 the recent migration shift of latino immigrants in the united states spurred the growth and mobility of people from traditionally established immigrant communities to new destinations. definitions of immigrant destinations range in the literature, with different geographic and demographic factors used to determine such communities. traditional immigrant, or gateway destinations, are those with a longstanding presence of immigrants since the 1970s (brown et al., 2018; singer, 2004; turner et al., 2016). new-growth, or emerging latino destinations, are umbrella terms referring to places in which the ethnic and racial composition of the population changed due to a rapid growth in the latino community in the last two decades (brown et al., 2018; singer, 2004; turner et al., 2016). trends in migration show a significant increase in latino immigrants settling in u.s. cities without any previously established latino community presence, particularly in southern, northeastern, and midwestern states (ennis et al., 2011; lichter & johnson, 2009). the geographical distribution of latino immigrants across less-populated states is attributable to the evolving demographics of the nation, influenced by immigration, migration, and childbearing factors (turner et al., 2016). north carolina, georgia, and tennessee had about:blank lopez et al./de la iglesia 47 some of the fastest latino immigrant growth between 1990 to 2010 (turner et al., 2016). the small city in this study, located in northern indiana, reflected similar demographic shifts, with a steady increase in the latino population from 24% in 2010 to 26.7% in 2019 (u.s census bureau, 2019). congruent with previous findings, about 50% of the adults who immigrated to this city in northern indiana were young couples between 24-40 years old, many with u.s.-born children in their homes (u.s census bureau, 2019). student demographic profiles significantly shifted in the school district in the last ten years due to this mobilization. student profiles went from 40% latino children in 2010 to 54.5% hispanic in 2020 and within this latino population nearly a quarter were english learners in 2019-2020 (indiana department of education, 2020). economic opportunities, specifically the recreational vehicle manufacturing industry, attracted immigrant families to this region, further “browning the midwest” a term describing a simultaneous decline of the european-american population and an increase of latinos (guzman et al., 2011). despite growing economic prosperity in these regions, often due to the influx of latinos that allows for cheaper labor, latino immigrants in emerging cities are still at higher risk of poverty than u.s.-born latinos. this is partly due to limited english literacy, low formal education levels, and a lack of documentation, which allows for exploitation (crowley et al., 2006; lichter & johnson, 2009). research documents that, although half of latino immigrants who move to emerging communities come from traditional gateway destinations, new-growth settlements often lack the social service infrastructure to provide support and security to the influx of the latino population (negi et al., 2013; turner et al., 2016). without initial resources and support in place to offer this incoming population, municipalities and service providers struggle to address social, economic, and educational needs of latino immigrants and their families (sanchez et al., 2019). previous studies found that religious institutions play an important role in providing tangible and intangible resources (e.g., financial resources, translation, transportation, information, etc.) to newcomer latino immigrant families when local social services are unavailable or insufficient (coddou, 2017; sanchez et al., 2019). however, there is a lack of research available that describes the specific roles churches and religious leaders play in emerging immigration destinations with minimal service infrastructure. similarly, little is known about the unique roles of the church which shifted as the emerging immigrant destination developed stronger social service infrastructure and immigrant families became more established in the community. the present study contributes to the limited body of knowledge concerning the role of latino churches and religious leaders in addressing the social, economic, and educational needs of latino immigrant families in an emerging immigrant destination community in the midwest and how the role has changed. this study provides important implications for social workers about partnering with religious leaders to serve latino immigrant families in a timely, effective, and culturally-sensitive manner. advances in social work, spring 2022, 22(1) 48 literature review emerging latino communities and social service infrastructure a wealth of literature points to structural and environmental barriers, such as documentation status and language disparities, as continuous challenges that discourage latino newcomers from seeking and receiving social services, and likewise deter service providers from otherwise engaging with this population (negi et al., 2018a; raffaelli & wiley, 2012). latino communities often fear detainment, deportation, and separation of family members when seeking out social and health systems for support (ayon, 2013; negi et al., 2018a; potok, 2017). in addition, the previous administration of president trump exacerbated these fears and barriers (negi et al., 2018a; potok, 2017). although immigrants nationwide are impacted by these policies, the fear and barriers provoked by these policies may be exacerbated in new destination places that have not been a home to immigrant populations, particularly latino immigrants (lichter & johnson, 2009). research on the impact of increased latino populations on emerging immigrant destinations is limited. however, previous studies highlight a multitude of socioeconomic, cultural, and historical factors that differentiate between emerging and established immigrant communities. higher poverty rates and lower education levels exist in emerging destinations which is congruent with the profile of new immigrants seeking low-skill opportunities (shihadeh & winters, 2010). immigrants arriving in emerging destinations may settle in outside neighborhoods, invisible to institutions that govern the city’s social services (winders, 2012). institutional visibility or awareness of immigrants contributes to the decision-making and responsiveness from local government and non-government officials in immigrant communities (winders, 2012). without an established immigrant community, these cities may not offer social services accessible to immigrants and may endorse restrictive immigration policies (negi et al., 2018b). immigrant-serving organizations often serve as a protective factor for newcomer immigrants; however, they are often not established in emerging latino communities. previous research recommends that in the absence of immigrant-serving organizations, social workers should identify community stakeholders who have already earned the trust of immigrants. local congregations across different faith traditions are one of the stakeholder groups latino immigrants trust in new destinations and that have previously partnered with social workers to provide services to immigrants (negi et al., 2018a). the social work profession has a long history of supporting immigrant and refugee populations, which was established during the u.s. settlement house movement in the late 1800s (rine, 2018). this focus has become formalized through different iterations of the code of ethics of the national association of social workers (nasw). faith-based organizations also have a long history in the united states in supporting immigrant communities, most notably through the sanctuary movement (stolz chinchilla et al., 2009). thus, a partnership between these entities is natural for strengthening the safety net available to immigrants in emerging immigrant communities. lopez et al./de la iglesia 49 the role of the latino church religious social capital the latino church functions as a highly effective service provider, safety net, and networking center in emerging immigrant communities. it functions as both a conservative organization that provides a connection to cultural and religious norms, rituals, and traditions, as well as an adaptive one that provides access to social and human capital spanning beyond the boundaries of the institution (cadge & ecklund, 2007; cnaan et al., 2003; enriquez, 2011; tsang & tsang, 2015). latino churches help new immigrants, especially non-english speakers, meet their social, spiritual, and cultural needs. these needs range from communicating in one’s first language, having access to spiritual affiliation and belonging, and providing a protected space to perform cultural traditions, rituals, and holidays (coddou, 2017; delgado & humm-delgado, 1982; enriquez, 2011; sanchez et al., 2019; tsang & tsang, 2015). they provide settlement services such as needs assessments, orientation, referral information and assistance, as well as crisis intervention and other emergency services (tsang & tsang, 2015). latino churches also provide tangible and intangible resources such as adaptation support, leadership opportunities, emotional and legal sanctuary, and access to cultural brokers that help them navigate the realities of dealing with racism (tsang & tsang, 2015). cultural brokers are leaders within the community who have strong ties to outside organizations and systems and help local communities and new members adapt to the influx of latino and hispanic immigrants to rural communities (akkerman & bakker, 2011; shiffman, 2019). specific examples of adaptation support provided by churches include providing food, clothing, furniture, childcare, and assistance with college scholarships; visiting people in their homes; helping them find work; navigating immigration paperwork; caring for the sick, elderly, and disable;, providing financial assistance, housing, and rehabilitation services; providing access to transportation; and providing pastoral counseling and other mental health services (delgado & hummdelgado, 1982; sanchez et al., 2019). access to these supports and services may improve the lives of latino immigrants as they adapt to their new, often unwelcoming, destination environments in the united states. the distribution of religious social capital within the latino church is quite apparent in latino communities. religious social capital is defined as social resources gained from being a member of a religious community (sanchez et al., 2019). the social resources provided by religious institutions often result from the dedication and outreach of religious leaders. religious leaders include priests, deacons, vicars, pastors, and lay leaders (coddou, 2017). lay leaders may be volunteers or church staff such as administrative assistants and religious education coordinators who take on a leadership role (coddou, 2017). effective religious leaders in the latino community are often bilingual, making them well-suited to develop connections and relationships with both the latino community and community organizations. they act as cultural brokers for both members and nonmembers and often serve as community liaisons who bridge gaps between the needs of the community and available services (coddou, 2017; delgado & humm-delgado, 1982). advances in social work, spring 2022, 22(1) 50 these partnerships are especially beneficial for under-resourced emerging latino communities and were even more important during the covid pandemic (cadge & ecklund, 2007; sanchez et al., 2019; sobon sensor, 2019). in short, the latino church continues to be a beacon in helping latino families adapt to their new environments. another aspect of religious social capital is that it can be a vessel for political mobilization (cadge & ecklund, 2007; coddou, 2017). leaders and members within the latino church often advocate and empower immigrants by teaching them about policies that impact them, how to organize for social change, and how to take civic actions through advocacy and volunteer work (cadge & ecklund, 2007; coddou, 2017; tsang & tsang, 2015). this type of religious social capital can provide leadership opportunities that create a renewed sense of self-worth along with opportunities to function as cultural brokers (tsang & tsang, 2015). cultural brokers the cultural needs of bilingual or spanish-speaking latino community members are often met through the boundary spanning abilities of cultural brokers. without cultural brokers, integration is often delayed. new members of supportive ethnic churches are often hesitant to venture beyond the boundaries of the institution and tend to self-segregate, which can lead to prolonged marginalization (tsang & tsang, 2015). cultural brokers help facilitate the difficult transitions many first-generation latino immigrants experience as they integrate from the safe space of the latino church into often inhospitable systems. a cultural broker’s ability to navigate systems within and outside of the latino church can empower new members to take on leadership roles of their own and find greater footholds in society that go beyond the influence of the church (tsang & tsang, 2015). cultural brokers make the invisible visible by helping community members span the boundaries from no services to services, and from the strange to the familiar. this literature review was critical to understanding the lack of research on the importance of the role latino religious leaders and serving latino families and communities in the midwest. the current study focused on understanding the intersections of latino religious leaders and the needs of latino immigrant communities. methods the present study utilized a qualitative research design with the aim of understanding religious leaders’ role in serving immigrant latino families. the guiding questions for this study were : 1) what is the role of latino churches and religious leaders in addressing the social, spiritual, economic, and educational needs of latino immigrant families? and 2) how has the role of the church and religious leaders changed over time? sample and procedures the sample in this study consisted of five latino religious leaders: two catholic laity, one catholic priest, and two evangelical pastors. the profiles below summarize their pivotal role in the reception and adaptation of latino immigrants with the variety of lopez et al./de la iglesia 51 supports they provided. the profiles provide information regarding the religious leaders’ own background as immigrants and how it has helped them connect to the situations of the latino immigrants in the northern indiana area. pseudonyms were used to maintain the confidentiality of the participants. snowball sampling was used to recruit study participants. the first step in the recruitment process involved the researchers developing relationships with community members, who then identified who should be interviewed. thus, the community informed which religious leaders and lay leaders, both protestant and catholic of latino descent, should be part of the study. the interviews took place in june 2020. pastor lara pastor lara and his wife were born in mexico and moved to northern indiana in 1988. pastor lara had a vision and felt a calling to start a church that would serve the latino community in the region. in 2003 he founded a radio station ministry to serve god by serving the latino community. in addition to transmitting spanish christian music and programming, they also transmitted other educational programming to inform the latino community about other topics including education, immigration policies and law, health, mental health, and social services. pastor lara played a crucial role in providing basic supportive services to newcomer latino families when they first arrived. father hernandez father hernandez’s family immigrated from mexico to indiana in 1999. he transferred to a seminary in indiana in 2000 to join his family and complete his studies for the priesthood. father hernandez arrived in indiana with permanent resident status as a green card holder. he later moved to boston to take english language classes and complete his seminary studies. he studied english for three years and found learning the language a challenge. he was ordained as a priest in 2009. father hernandez later pursued a master’s degree at notre dame in non-profit management in the business administration program. his immigration story contrasted with those of many latino immigrants in indiana for whom getting to indiana and adapting to life in the us had been a struggle. father hernandez learned about those struggles through the stories of his parishioners. pastor martinez pastor martinez moved to northern indiana in 1987, when the latino population numbered approximately 1,000. he was familiar with the area because he had previously visited the city where the study took place on several occasions to visit his in-laws. pastor martinez worked for a year before he was selected to be pastor of a church in northern indiana. he lived there from 1998 to 2004. he moved to northern indiana in 2004 and started another church there. his church membership is comprised of latino immigrants from various countries. advances in social work, spring 2022, 22(1) 52 esperanza esperanza is a lay leader who has lived in northern indiana for 33 years. she immigrated with her husband to the united states from mexico in 1986. esperanza and her husband were dentists and esperanza had practiced dentistry in mexico for ten years. esperanza learned humility, faith, and mercy from the immigrants she worked with in northern indiana who came from small villages in mexico. she empathized with the immigrants from small villages because she lived and worked as a dentist in several rural clinics in mexico. much like them, esperanza arrived in the u.s. without english language skills. but unlike mexican immigrants from the rural areas, she did not arrive with undocumented status and has not faced similar struggles. esperanza used her english language skills to support immigrants and employed her organizing skills to make the church a welcoming place for immigrants sofia sofia was born in mexico and immigrated with her family to northern indiana when she was 11. she was unaware of her undocumented status growing up and only learned about it when she applied to college. she qualified for deferred action for childhood arrivals status (known as daca) and graduated from a catholic college in the region in may 2012 with a bachelor’s degree in communications. like other dreamers, she did not receive public financial aid and paid for college with a private scholarship, her own work, and the support of her parents. all of her 14 siblings are also college graduates. after sofia graduated from college she commuted to chicago on a weekly basis to complete a master’s degree. sofia’s experience as a youth lay leader helped her develop leadership skills she later used in college. she continued her service in the catholic church when she attended college where she served as a lector and eucharistic minister. on her return trips to her hometown as an undergraduate student, sofia shared with her former youth group her college experiences, explained the college application process, and encouraged them to accomplish their goals. data collection and protocol the researchers used an ethnographic study design to conduct the study with religious leaders serving latino families in the region. the focus of the larger study was to understand the family life and the role of families in education of their children. n this inquiry thei focus was to understand the role of leaders in the latino community, especially religious leaders. the interviews were semi-structured, individual interviews and lasted approximately one hour. due to the covid-19 pandemic restrictions, the interviews were conducted over zoom. the protocol was based on the previous literature that focused on immigrant latino families and school systems (delgado-gaitan, 1992). the larger ethnographic study addressed the relationship between the school, community, and the immigrant latino families, cultural and language issues affecting the families and the schools, parental involvement, visibility of the schools in the latino community, and the strengths and lopez et al./de la iglesia 53 challenges of the families. specifically, in this part of the study the interviews addressed the role of latino religious leaders with immigrant latino families and communities. the interview protocol was also based on the authors’ combined over 60 years of research experience with latino communities. five of the authors are of latino background, biliterate in spanish and english, and with extensive experience working with latino families and communities in numerous states in the united states, mexico, and central america. the fifth author had also worked with latino communities and is semi-bilingual in spanish. all these factors provided a foundation to conduct a culturally and linguistically responsive research study. participants were provided with informed consent forms that stated their voluntary participation and right to stop the interview at any time. the interviews were conducted in the preferred language of the participant (spanish or english). all interviews were transcribed, coded, and analyzed by bilingual spanishspeaking researchers and translated to english for publication purposes. participants did not receive any material incentives for their collaboration. the study was approved by the university’s and school district’s institutional review board. data analysis the researchers used a thematic approach to analyze the narrative data from the indepth interviews. one of the first steps of the analysis process was to identify a preliminary list of codes during the initial reading of the transcripts. the researchers categorized the data into codes to create a manual codebook, recording the definition of the code and memo notes as an audit trail. in the second step, one of the researchers reviewed the data and codebook, evaluating the preliminary coding category system (abbott, 2004). this methodical process and trail supported transparency, trustworthiness, and transferability (padgett, 2008). the researchers used an iterative and inductive team process to determine themes that emerged across the multiple interviews. the themes and concepts emerged from the pattern codes. the team of researchers provided meaning to themes by analyzing the primary and contextual data and reviewing memo notes to ensure key points and/or overemphasized points were not missed. findings the findings are presented under two overarching themes. the first, religious social capital: refugio, revealed the role of religious leaders in providing refuge and social support, leadership development, and advice. the second theme, padrinos de la comunidad, examined the role of religious leaders as cultural and language brokers who provided supportive services and partnered with organizations to help latino immigrant families access additional resources. the second theme includes a section that specifically examined religious leaders as cultural and language brokers during the covid-19 pandemic in 2020. advances in social work, spring 2022, 22(1) 54 religious social capital: refugio (refuge) and social support religious social capital is defined as the resources resulting from membership in a religious community (sanchez et al., 2019). latino churches (both catholic and evangelical) were acknowledged as one of the first places where latino families gained membership regardless of their immigration status. esperanza, a lay leader who resided in northern indiana for over 30 years noted that latinos were not originally welcomed. some people were particularly prejudiced against mexicans and catholics. she stated: when i told the people “oh, i'm from mexico,” because i'm so proud to be mexican and they would said “ugh, are you from mexico?”. and then when i would tell them “oh i'm catholic, i go to (name of church)”. and they said, “ohhh you are catholic”. so i didn't have an idea that catholics and mexicans were not very welcomed in this area. through the years, i noticed that the people here in this area are very conservative and prejudiced to this thing. not all of them. according to esperanza, during the 1980s, catholic churches made membership difficult for latino immigrants due to the absence of spanish-language masses in the area. however, through esperanza’s efforts, 100 signatures were collected at bailes (dances) or other social gatherings to obtain permission from the bishop for a cuban priest to celebrate mass in spanish. spanish masses have now been available to latino parishioners in the county for over 30 years. esperanza described the church as a second home. she invested immense time and effort to make the church a welcoming place for other mexican immigrants through her organizing skills and english abilities. so for me, the church was my second house. it was my home and where i could connect with other latinos. so i did that. i participated in the festival, committees, the pastoral council, and the health committee from the church. esperanza’s networks among service providers grew because of her work for the dioceses which took her across northern indiana. she gained the social capital necessary to advocate for latino immigrants and to connect them to different resources. it was the pastoral leadership training that gave me the opportunity to know more latinos in the northern part of indiana state. i used to go to different cities in northern indiana to have those bible studies and retreats. and as a result of that opportunity, i met a lot of people, and because before i was a director for the hispanic outreach program, i had a lot of connections, so i could advocate for the latino population in this area to get connected with social services. sometimes it was hard because some of the people did not and don’t have legal documentation, so it was hard. but thanks to the connections i made, sometimes these people would get help. pastor martinez also described his church’s role in providing social support and basic resources to latino immigrant families. he considered his church a safe place for latino immigrants which was reflected in its name, “refugio” (refuge). he discussed the role of his church in providing hope and support to latino immigrants in need regardless of their immigration status: lopez et al./de la iglesia 55 for example, with food, many people would ask, “why don’t latino families go to the salvation army to get food, why don’t they go to the food banks?” number one, because of the language; there are people who don’t speak english. number two, because they are afraid that they will be told, “show me your papers; if you don’t show me your papers, i won’t give you anything.” they know that the church is a refuge; we won’t ask them for papers, we speak the same language, we have the same culture; thus, we create more trust. this example illustrates how the church served as a refuge for mixed-status families. families knew they could obtain resources at the church without having to present proof of citizenship. leadership development sofia, a lay leader, noted that the leadership skills she used in college originally resulted from volunteering at her catholic church. she started volunteering during her freshman year of high school. she volunteered in the choir, served as a lector, and helped clean the building. she also served as the lay leader in her church youth group, organizing fund-raising activities such as selling food and organizing car washes. sofia was inspired by her experiences to share her knowledge with other undocumented high school and college students in her church: it was definitely great. it was just an amazing experience to be able to develop skills that i was later on able to use in college. it just gave me a lot of empowerment, it gave me a lot of confidence, and definitely increased my faith. i became a lot more grateful for what i was accomplishing and receiving. it also inspired me to not only keep it to myself, but also relay that to other individuals, especially in my situation, not having a legal status and then wanting to accomplish so much. so it gave me a sense of encouragement, strength, i wanna say, confidence definitely. on her return trips to her hometown as an undergraduate student, sofia shared her college experiences with her former church youth group. she explained the college application process and encouraged them to accomplish their goals. sofia was an example of a latina from the area that developed leadership skills in church and used that religious social capital to support other latino youth in their college aspirations. as a first-generation college graduate who was educated in the region, she served as a role model for other latino youth. advice fr. hernandez, a priest in a catholic parish, provided spiritual support and advice to latino families in his church. latino parishioners trusted priests and opened their hearts to them. they shared their concerns with them even when the concerns were not religious. for example, families sought advice on important matters such as buying a house. advances in social work, spring 2022, 22(1) 56 so i always tell them when you go to buy your house. i try to direct them and the little things that i have learned is that first you get to know the person that will help you buy the house, but then i go through the little details, when you get a loan, make sure that it is a loan that will be, oh man, i forgot the word right now. that the rate will not change, that the interest will stay the same. fixed rate. that means that you will always pay the same. otherwise, you can get a very low rate right now, like one or two, but if it is variable, it can happen that in two or three years it will move from one to 18 for example. latino churches were one of the first places families gained membership and developed social connections. churches offered refuge to latino families and they felt comfortable seeking advice and resources from religious leaders. thus, refugio did not solely refer to a physical space, but to religious social capital made available to latino immigrants regardless of their immigration status. padrinos de la comunidad: cultural and language brokering the second theme that emerged from the study identified latino religious leaders as the padrinos de la comunidad, or as the godparents of the community. as godparents, they supported latino newcomers during their transition by serving as language and cultural brokers. they assisted newly arrived immigrants in adapting to their new surroundings by providing both supportive services such as translation and serving as liaisons and advocates to help families secure resources. supportive services religious leaders provided supportive services including translation, transportation, employment assistance, lodging, and financial assistance. religious leaders also served as cultural language brokers by providing interpretation and other services to latino families when they first arrived. for example, pastor lara and his wife described how they interpreted for many immigrant latino families in different settings including the local jail, court hearings, and hospitals. esperanza, a lay leader in a local catholic parish, also interpreted for people seeking public assistance, social services, or during doctor’s appointments. i started with the father of the church. he put me as a volunteer to translate for the welfare office. so when someone had an appointment in the welfare office, they would give them a list of people, among them was me. that's where i started, helping people translate, as a volunteer in 2000 with social services. in the morning, i went to court with a lady to place a restraining order on her partner, and i accompanied her, but i did not charge her, she is in the shelter, she does not work. in addition to providing interpretation, religious leaders also provided transportation to recently arrived immigrant families who lacked a car or did not have a driver’s license. esperanza also provided transportation to families seeking social services and other basic needs. pastor lara provided transportation to families seeking employment and drove them lopez et al./de la iglesia 57 to work. he also provided transportation within indiana and occasionally out of state for immigration appointments or when someone had been detained by immigration authorities. pastor lara specifically discussed how he provided a range of supportive services to newcomers including helping them find employment and housing. this particular pastor provided housing to recently arrived families until they could transition to their own apartment. he drove them to work and provided food until they were able to make it on their own. well, here at home we have someone every year or every 6 months. people who have nowhere to stay here, we have had them. we have helped them get a job or get an apartment to keep them going. but we are always here at home helping people to live with us, who have nowhere to stay. people who have been thrown out of the house who have lost their apartment where they lived or who cannot pay the rent of an apartment. so we have a big house and here they come while they regain their strength. we help them to get a job, we get up at dawn to take them to their jobs. we pick them up from their jobs and we have their food ready for them and we do not charge them anything but we do hope that they can move on and can work and have their own apartment. then they leave our home when they have their own apartment, they have a car, they have something to be able to make it on their own. and they can make it on their own. so that's what we have done. it’s not just about having pity or praying for them…. so what we have been doing for them to this day. this type of support was not uncommon among religious leaders. other pastors also spoke about providing financial assistance to recently arrived latino families who lacked basic necessities. in addition to providing support services to newly arrived families, religious leaders were also cultural brokers who served as liaisons between families and service providers, non-profit organizations, or law enforcement agencies. pastor lara spoke of how local law enforcement officers trusted him and his wife and even called them to help resolve domestic disputes among immigrant families. pastor lara also had a radio station that belonged to the church. they used this radio station to provide families information in a culturally relevant and safe space. on one occasion pastors, lawyers, and law enforcement officers provided information and made it possible for families to ask questions in a safe context. a lawyer went to the church to let church members know that if anyone has a need for this, i am here to help them, or to answer questions such about what can we do if we get stopped by a policeman…. what they should say and what not to say. there are many ways of how to help …. and right now, last week a person spoke to me who wants to bring a police officer to the radio so that he can be on the radio and latino families can ask questions. in her role as a cultural broker, esperanza advocated for undocumented immigrants so they could obtain resources. sometimes they received them “under the table” after esperanza’s intervention on their behalf: advances in social work, spring 2022, 22(1) 58 but for our people without that state id it’s very hard, so we have to organize ourselves to help them, to see how we’re going to do it all together…for example, in the salvation army, to get some christmas baskets or some help, they always ask for a state id, so one of the persons who works in there was my co-worker, at (name of organization), and she knew how we struggle and she knew how most of the latinos are hard workers. she said, “okay we are going to make an exception, we are going to help the people, we only need a matricula, the mexican id, or passport, or another different id, because they don't have a state id.” so that was very good. it was a good opportunity to help the latino population in this area. esperanza helped organizations understand the legitimacy of the alternative documents latinos used. due to her advocacy, some organizations eventually accepted the other forms of identification that latinos carried. continuing needs in an established immigrant community the types of language and cultural brokering services religious leaders provided to the latino community has evolved over the years. in the early years, much of the assistance was interpretation, transportation, and other basic needs. presently, latino families have older children who can interpret for them and public offices have bilingual personnel. latino families also tend to be doing better off financially now and some are even buying their own homes. the number of bilingual latino leaders and professionals in the community has grown. pastor martinez pointed out the example of a latino school board member and a city council member. latinos also now occupy positions in non-profit organizations, public education, and in local law enforcement. pastor martinez testifies to that change: there has been change because the people used to seek a lot of help: “send me someone who can translate or who can interpret for me.” this has changed because if the families need help, they will take their children. in addition, there are many places that already have bilingual people such as doctors and dentist offices and in the license branch to get a license there are bilingual people. all of that helps so that people don’t ask us for help in translation. esperanza also noted that in contrast to the past, latino students from the area now have bachelor’s and graduate college degrees and occupy professional and civic positions in the area. in the past, religious and lay leaders served as interpreters. now, different organizations such as hospitals, clinics, and schools have translators on staff. one of the biggest changes father hernandez saw across time is the positive economic, educational, and cultural adaptation of the second and third generation of latino young people. he pointed to their bilingualism, biculturalism, higher education achievements, and careers as professionals as examples: one of the big changes that i have noticed is that this second or third generation has adapted much better to the united states in every respect. financially, culturally, academically, everything. for example, most of the families are from jalisco, and they are now second or third generations and of the changes i have lopez et al./de la iglesia 59 seen is that kids are now educated, they speak english, and they grew up in this culture. so they embrace both cultures. they speak spanish, they speak english. despite the positive changes father hernandez and other religious leader have seen, one challenge that has remained constant is the undocumented immigration status of many latino immigrants. religious leaders identified the lack of driver’s licenses as an example of the struggles undocumented immigrants continue to face. in another example of cultural brokering, father hernandez hosted community meetings with the police department to address the lack of trust between the latino community and the police. latino immigrants did not feel safe reporting crimes to the police, particularly undocumented immigrants because they were afraid of being found out and deported. as a result, a network of latino and english-speaking churches was established to address police discrimination against latinos. father hernandez spoke about the distrust and discrimination that occurred in 2006: but years ago, there was also the feeling that the community were not trusting the police. and so that there was a big problem, especially when there are crimes that need to be reported and some immigrants were afraid to do that or they thought that they needed to have a green card or a license to report a crime. so we had a workshop in which the police came and explained everything. you know how they all work, how they operated, to grow trust in the community, but also in the police. sofia also served as cultural and linguistic broker due to her own experience as a firstgeneration student who had graduated from college. she figured out how to navigate the higher education system and her bilingualism positioned her well to become a link between the latino immigrant community and the area of education. her experience was especially relevant since she had been undocumented when she applied to college: we did organize different workshops to educate families mainly parents about resources available and scholarships available for their kids to attend college. especially, undocumented individuals to allow them to know that there were plenty of pathways, or resources for their children to attend college if that was one of their goals. and since i was able to, i guess, open that path, or not, i wasn’t the first one to be able to go to college without a residency or social security number, any of that. so i was able to kind of relay information of resources that were available for them to be able to accomplish that if they wanted to. sofia benefited from a k-12 education in the small city in northern indiana, but encountered limited information regarding college access as a high school student. she had to seek out this information on her own from school counselors and became a groundbreaker as a first-generation college student who was undocumented and eventually received daca status. sofia contrasted the college access workshops she helped organize with the lack of information she encountered as a high school student: when i started looking into opportunities for higher education, to attend college, i myself did not find that information fully through community workshops, or events. it was mainly through our high school counselor that guided me, but now everybody was as you know, coming together as a community or let’s share this advances in social work, spring 2022, 22(1) 60 information. we just found this scholarship, let's send it to the families most in need or what not…. i’ve seen a lot more of, okay, let’s put a college night together. across time, college-access community workshops in the region where local universities directly communicated with parents and students became regular events and were supported by community groups such as a radio station. sofia stated: one of the things that [a small college in northern indiana] and other universities did was to bring all these resources to the families that didn’t have that information, empowered them, or motivated them to help their students … and opened that information channel to the parents. it started as a latino college night and then it later on developed to having a radio segment, or an episode of informing the community about all the requirements, the resources, and the process to apply to college, and obtain all kinds of scholarships available. latino religious leaders continued to serve as cultural and language brokers, particularly for undocumented immigrant families. they were able to provide information to families particularly related to sensitive issues related to undocumented status since latino families felt safe receiving this information from the church. cultural and language brokering during the covid-19 pandemic during the covid-19 pandemic, pastor martinez and his church served as cultural brokers by delivering important information to the latino immigrant community. for example, they provided public health information in spanish on face masks to encourage the use of face masks in the latino community. pastor martinez felt that the church had a common culture and language with the latino immigrant community and would be considered a more trustworthy source of information than a law enforcement or public health agency: if neither of the two people wears a face mask, we have 90% possibilities of getting infected. if one of the two wears a face mask, it decreases to 60% -70%. but if both of them are wearing a mask, there is only a 5% probability that one will become infected. we have been sharing this information with the hispanic community, and it is better well received from the church than law enforcement or a doctor, because the doctors say the same thing, but the hispanic community says that doctors say it because they are doctors. but if they receive this information from the hispanic church, it is better received since we share the same language and culture. the covid-19 pandemic showed that even though latino immigrant families had adapted well over the years and there was a more established infrastructure in the community, undocumented status continued to make immigrant families very vulnerable during these types of crises. churches and religious leaders still played an important role in responding to the unique needs of immigrant families during the pandemic. specifically, churches were relaying information in a culturally relevant manner and providing basic necessities to mixed-status families who did not qualify for cares act benefits and other lopez et al./de la iglesia 61 government assistance (e.g., unemployment benefits and stimulus checks). they were able to help many latino immigrant families access resources: there is a new spanish radio station here in the city. the radio station started a food and supply drive to distribute to people who were unemployed, because a lot of people lost their jobs and the factories closed. those who are documented were receiving assistance from the government, but the undocumented they did not qualify for it, nor for unemployment, so really more than 50% of the people were in need. we prepared for 8 families the first saturday, to give them food; however, 50 families showed up looking for food. so for the second saturday, we prepared for 50 and 70 families appeared looking for food, for the third, we prepared for 70, and 75 showed up. we were only one of the distribution points. a church network was also established to distribute food and face masks during the covid 19 pandemic. father hernandez described the work of this network in providing support during the covid 19 pandemic: we created a compound for people who are in need, to support their pantry. we created a facebook page with all the information and especially telling people, those who are isolated, praying with them over the phone. or we also offered services, and okay, someone, especially the elders, who need groceries or help picking up their medicine, we offer that service to them. it was kind of an association that we created with a few churches in town to have sufficient resources for the food pantry, but also to provide the spiritual help that our parish, our people would need during uncertain times. so that was something that i was very active because i saw a great need in that. the assistance to the latino community during the covid-19 pandemic was facilitated by networks comprised of latino and english-speaking churches. pastor martinez and father hernandez recruited network partners from english-speaking churches and were better able secure resources through these partnerships. as illustrated through these examples, religious leaders played a pivotal role as language and cultural brokers over the years. they supported families when they first arrived in the small city in northern indiana by interpreting for families in different settings including court hearings, department of motor vehicles, doctor’s appointments, and applying for social services. over the years, these city and state agencies developed an infrastructure to serve latino families in culturally and linguistically supportive ways. more bilingual latino leaders and professionals in the community now work for organizations that provide services to latino families. latino parents also now rely on their grown children who are bilingual to provide interpretation. thus, the need for religious leaders to provide interpretations services has decreased substantially over the years. however, latino religious leaders continue to provide information to families that is more well-received due to sharing a common language and culture in a church setting where families feel safe. finally, religious leaders continue to play a crucial role in providing services during specific crises such as the covid-19 pandemic for families who experience many challenges due to their undocumented immigration status. advances in social work, spring 2022, 22(1) 62 discussion and implications the findings of this study supported previous findings that latino churches were one of the first places where latino immigrant families felt a sense of belonging (delgado & humm-delgado, 1982; sanchez et al., 2019). latino churches were especially important in the city where the study took place since it was an emerging community that lacked supportive latino community groups and bilingual and culturally responsive communitybased social service organizations. religious leaders had to identify the gap in the emergent latino community and locate resources and assistance normally provided by non-profits or other community organizations. latino religious/lay leaders located additional resources beyond those provided by their churches by acting as cultural and language brokers (shiffman, 2019). they networked and partnered with community organizations, and helped latino families navigate organizations. the importance of religious social capital for latino communities had been previously noted, and in the current study supported the development of lay leaders who expanded the work of the religious leaders (sanchez et al., 2019). the lay leaders in this study were effective as cultural brokers because they were bilingual latinos from the region and represented the work of churches (shiffman, 2019). while the role of religious social capital in the latino community has been previously noted, its unique role in fostering the development of lay leaders of emergent communities was illustrated by the stories of sofia and esperanza. these findings suggest latino churches and religious leaders play an important role in providing support to latino families in emerging latino immigrant communities as well as the need to build their capacity. even though the need for services such as translation and basic resources might decrease over time, latino churches and religious leaders continue to play a critical role in providing information, advocacy, and resources during crises such as the covid-19 pandemic. they also help meet the specific needs of mixed-status families who are not eligible for governmental resources. in particular, social workers employed by community-based, non-profit, and faith-based organizations are encouraged to work with latino churches and religious leaders to identify and address challenges immigrant families experience, including linguistic and cultural factors that shape the effectiveness of different interventions (sherr & wolfer, 2003, 2004). social workers, with their expertise in providing case management, can also offer churches assistance in organizing cases and making referrals. social work professionals can also support religious leaders in providing leadership development training and other types of workshops to lay leaders and church members/parishioners, strengthening their capacity to reach immigrant families. the interviews with religious leaders also suggest that latino immigrant families are sometimes hesitant to seek resources from community organizations due to cultural barriers and fear of being asked about their immigration status. immigrant families seem to trust latino churches, suggesting that community organizations must increase their collaborations with latino churches and religious leaders to overcome this hesitancy and help provide information, resources, and trainings to latino immigrant families in a timely, culturally sensitive, and effective manner. this is consistent with previous research that recommends that social workers in new destination communities that lack immigrantlopez et al./de la iglesia 63 serving organizations, should partner with community stakeholders trusted by immigrants including local congregations of different faith groups (negi et al., 2018a). new destination communities often lack linguistically and culturally relevant services. social workers who have linguistic skills to meet the needs of the immigrant community are frequently overworked (negi et al., 2018b). to maximize the few existing resources in new destination cities, partnerships between social workers and local congregations might be particularly helpful. future research is needed to specifically explore how social workers, faith-based leaders, and other community stakeholders can collaborate to increase the access of immigrant families to social services in new destination communities in the greater midwest. conclusion in this study the role of religious leaders as cultural brokers and sources of cultural capital were used to address the social, economic, and educational needs of the latino community. latino churches provided the types of assistance normally associated with houses of worship such as food pantries. but equally important was providing a welcoming place of refuge at a time when few public gathering places existed for latinos. churches provided a sense of community and belonging without regard to immigration status, language, and culture that was not available in the broader region. the welcome and support offered by latino churches was received by latino immigrants at a time when many faced discrimination in the community, including from the police. different types of assistance and support were provided by ordained religious leaders as well as lay leaders with a long history in the community. as a lay leader, esperanza had extensive networks due to her work with the diocese and non-profits. sofia had a different type of network due to her public school and university education in the community. the religious leaders had their own networks due to their work as pastors. the religious leaders played a role by developing a welcoming church climate as well as providing spanishlanguage ministries. their contacts with other church leaders, including pastors of englishspeaking congregations, proved invaluable in defending the latino community as well as locating additional assistance and support during the covid-19 pandemic. in contrast to the religious leaders, the lay leaders operated as volunteers and were able to expand support and assistance for latino immigrants. the generational, educational, and occupational differences of the religious/lay leaders helped ensure a broad-based network of contacts and relationships that provided needed assistance and support for the latino immigrant community. in summary, this paper sought to understand the role of latino religious leaders with latino families and communities in the midwest. specifically, it is critical for social workers to build partnerships with latino religious leaders to ensure culturally-responsive outreach and service in latino communities. through such partnerships social workers, faith-based leaders, and other stakeholders will be better able to work towards improving the quality of life of latino immigrant families. advances in social work, spring 2022, 22(1) 64 references abbott, a. 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(2012). seeing immigrants institutional visibility and immigrant incorporation in new immigrant destinations. annals of the american academy of political and social science, 641, 58-78. https://doi.org/10.1177/0002716211432281 author note: address correspondence to anayeli lopez, school of social work, new mexico state university, las cruces, nm, 88005. email: alopez85@nmsu.edu https://www.brookings.edu/wp-content/uploads/2016/06/20040301_gateways.pdf https://doi.org/10.1177/1043659618801967 https://www.jstor.org/stable/20684688 https://doi.org/10.1007/s12134-014-0380-2 https://doi.org/10.13140/rg.2.2.24337.84320 https://data.census.gov/cedsci/table?q=goshen%20city%20indiana&t=hispanic%20or%252.%20%200latino&tid=acsdp5y2018.dp05&hidepreview=true https://data.census.gov/cedsci/table?q=goshen%20city%20indiana&t=hispanic%20or%252.%20%200latino&tid=acsdp5y2018.dp05&hidepreview=true https://doi.org/10.1177/0002716211432281 mailto:alopez85@nmsu.edu _________ amy fisher, j.d., lcsw, associate professor, susan c. allen, ph.d., lcsw, associate professor, and brittany l. washington, lcsw, former graduate assistant, the university of mississippi, lafayette county, ms. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 105-122, doi: 10.18060/27250 this work is licensed under a creative commons attribution 4.0 international license. how do first-year msw students perceive anti-oppressive theory and practice? an exploration amy fisher susan c. allen brittany l. washington abstract: little information exists about how msw social work students perceive oppression and anti-oppressive theory and practice, especially in the united states. this case study describes a qualitative exploration of msw student perceptions of oppression and anti-oppressive practice. content was infused into a one-semester foundation-level course covering direct practice with individuals in an institution located in the southeastern united states. thematic analysis of written reflections and focus group responses revealed changes in preand post-course knowledge and skills, as well as five themes: the normality of oppression, the desire for change, practice application at micro and macro levels, optimism for change and personal growth, and recognition of the difficulties and discomfort of engaging in the conversation. recommendations for social work educators include infusing anti-oppressive practice throughout the curriculum while utilizing inclusive course materials; facilitating self-reflection by students, faculty, and programs; and taking intentional steps to respond to discomfort in discussing these issues. keywords: msw, anti-oppressive practice, curriculum, course materials, reflection a focal point of social work education in the united states is the understanding of and ability to work to dismantle forces of oppression within our society. until relatively recently, anti-oppressive practice (aop) was not embraced as a means to achieve this in the united states (see morgaine & capous-desyllas, 2015). anti-oppressive theory has recently received renewed attention by united states social work educators in response to the shifting discourse on social justice in the profession (hudson et al., 2017), along with increasing criticism of cultural competency and multicultural frameworks (abrams & gibson, 2007; abrams & moio, 2009; gottlieb, 2020; mehrotra et al., 2019; nguyen et al., 2020; smith et al., 2022), and finally, its inclusion in the 2022 educational policy and accreditation standards (epas; council on social work education [cswe], 2022). each student who graduates from an accredited school of social work is expected to demonstrate the ability to engage in anti-racist and anti-oppressive social work practice at the individual, family, group, organizational, community, research, and policy levels (cswe, 2022, p. 10). furthermore, all social workers are now ethically mandated to “take action against oppression” (national association of social workers [nasw], 2021, ethical standard 1.05 (b)). anti-oppressive practice was developed to contribute to social work’s agenda of social justice and change (amadasun & omorogiuwa, 2020; dominelli, 2017; sinha, 2020). the practice seeks to support and emancipate people who have been oppressed by systemic injustices such as racism, poverty, and sexism, and works to aid with the reversal of a about:blank advances in social work, spring 2024, 24(1) 106 disadvantaged social positioning (amadasun & omorogiuwa, 2020; bilotta, 2020; dominelli, 2017). dominelli (2017) identified the role of anti-oppressive social work practice as one of highlighting social injustice and finding ways of eradicating at least those forms of it which are reproduced in and through social work practice. internationally, social work educators have long embraced anti-oppressive theory and practice (amadasun & omorogiuwa, 2020; campbell, 2003; caron et al., 2020). even so, there have been few studies that have explored student learning of anti-oppressive practice even outside the united states. a central theme in the existing studies is the perceived gulf between macro-level awareness and micro-level practice. sakamoto and pitner (2005) suggest that critical conciousness, or the “process of continuously reflecting upon and examing how our own biases, assumptions and cultural worldviews affect the ways we perceive difference and power dynamics” (p. 441), is an essential bridge between a macro-level understanding of oppression and micro-level practice. a social work program in greece analyzed social work students' views in relation to anti-oppressive practice at the beginning and the end of the entire program (dedotsi et al., 2016). it found that the specific social work curriculum used did not raise the critical consciousness of students nor did it create a grassroots understanding of social structures of power, oppression and the political nature of social work within it (dedotsi et al., 2016). the authors called for the addition of an explicit antioppressive curriculum focus to remedy this situation. this theme is reflected in the findings of bhuyan et al. (2017), who explored canadian msw students’ experiences with social justice education, including anti-oppressive practice, and how they incorporated it into practice once in the practice setting. most respondents saw social justice and clinical practice as distinct (bhuyan et al., 2017). furthermore, students in the study criticized the program for not teaching practical skills that would facilitate advancing social justice. similarly, amadasun and omorogiuwa (2020) explored reflections by nigerian students to understand how their education prepared them to apply an anti-oppressive approach to practice. results suggested that students were able to define the approach and were willing to challenge oppressive practices. however, they were not equipped to apply the approach in practice (amadasun & omorogiuwa, 2020). one approach that was successful in bridging the perceived micro/macro gap was pedagogical modeling (campbell et al., 2008). the authors explored the impact that pedagogical modeling practices grounded in anti-oppressive theory had on students’ ability to transfer classroom learning to practice. they analyzed a canadian msw course entitled “the theory and practice of anti-oppressive social work” through use of student reflections and survey responses. results showed that parts of the explicit modeling processes, co-constructing the course outline, self-disclosure, and critical reflection, were significant to student learning (campbell et al., 2008). this research suggests that using a pedagogical model that itself incorporates anti-oppressive practice would have a positive impact on social work students’ understanding of oppression and social justice in the field due to thorough classroom learning. fisher et al./1st-year msw & anti-opression education 107 the course in the present study, the instructor infused anti-oppressive theory and practice into an existing msw foundation-level course entitled social work practice with individuals. the course began with a review of the social work profession, social worker roles, and ethics. traditional theories for practice were introduced (e.g., systems theory, strengths perspective), along with anti-oppressive theory. the instructor used morgaine and capousdesyllas’s 2015 text, anti-oppressive social work practice: putting theory into action, in which the authors note that part of their aim was to bring aop to the united states. they defined aop as embodying lena dominelli’s three core concepts. first, aop is “[a] form of social work practice which addresses social divisions and structural inequalities in the work that is done with people whether they be users (‘clients’) or workers” (morgaine & capous-desyllas, 2015, p. 24). second, social workers need to both provide direct assistance while also seeking to change oppressive systems. third, all levels of social work practice (micro, mezzo, macro) are “interconnected and interdependent” (morgaine & capous-desyllas, 2015, p. 25). the discussion of oppression was augmented with selected episodes of the 1619 project (hannah-jones, 2019) and the seeing white (biewen, 2017) podcasts. the discussion of these podcasts continued throughout the course of the semester. following the introduction of theories, the course turned to an examination of the planned change process. each week, through readings, videos, and classroom discussion and activities, the students identified what that week’s stage might look like using the lens of traditional social work theories as well as what the stage might look like using aop. the morgaine and capous-desyllas text includes a separate chapter on practice with individuals, and includes specific techniques and processes for each stage of the planned change process when working with individuals. students were asked to compare and contrast how both traditional theories and anti-oppressive practice would affect their work in each stage. there were two major assignments based on case studies: a role play/paper and a final direct practice analysis paper. for both assignments, students chose a theory to guide their actions and decision-making in each stage of the planned change process—antioppressive theory was an acceptable choice for both assignments. the aim of this study is to explore how students in the united states understand aop and theory. because so little is known about how students learn about aop in the united states, it is critical to start with an exploration of student’s perceptions and understanding of this theory and practice approach. methods because research on how students learn anti-oppressive practice and theory is limited, we used a qualitative descriptive case study design to explore msw student reactions to the course content. the research question was, “how will msw students understand antioppressive practice and theory as it relates to social work?” after receiving exemption status from the appropriate institutional review board, the research team used both written reflections and a focus group to explore student perceptions of the course material. advances in social work, spring 2024, 24(1) 108 the research team for this study consisted of one msw student (washington) and two social work educators (allen and fisher). washington was an msw student when this data collection began (not a participant in the study), but has since graduated and is currently employed in a mental health facility providing clinical services. washington identifies as a black, cisgender, middle-class, able-bodied female with master’s level education. allen identifies as a white, cisgender, woman who has taught bsw and msw classes across the curriculum for over 20 years. fisher identifies as a white, cisgender, middle class, ablebodied straight woman who has been teaching mainly msw practice courses since 2012. our research team is an outgrowth of shared experiences at our institution (washington had been enrolled in classes taught by both allen and fisher previous to this study) as well as through a shared commitment to disrupting oppression in social work education. we acknowledge the potential for the privileged aspects of our positionalities to reify oppressive ideologies and have worked to remain vigilant while completing this project. washington enjoys a career as a clinical practitioner, and allen and fisher have extensive clinical practice experience. all authors have some exposure to anti-oppressive social work practice and theory. fisher was the students’ teacher for the course. washington and allen analyzed the preand post-assessments, conducted, and analyzed the focus group results. allen has conducted numerous focus groups. we have foregrounded washington’s voice in the implications section. participants participants were a purposive sample consisting of a cohort of foundation-level msw students enrolled in a course focused on direct practice with individuals. nine students participated in this exercise. the median participating age was 23. because of the group’s small size, other demographic information such as gender and ethnicity may put participants at risk of being identified. we will not disclose that information, except to note that the majority of students embodied socially privileged positionalities. procedure the institutional review board for the institution granted exemption status for this study protocol. per the exempted protocol, at the beginning of the semester and prior to completion of the reflection assignment included in the study, fisher (course instructor) recruited students for participation in the study via email. because the students were enrolled in one member of the research team’s class, precautions were employed to protect the students (e.g., comer, 2009). students were assured that whether or not they chose to participate in the study, their grades would not be impacted: their reflections would not be collected and de-identified for data analysis until after final grades were entered and the focus group would not be held until after the beginning of the following semester. no incentives were offered for participation. at the beginning of the following semester, participants for the focus group were recruited via email sent by allen (not the course instructor for this class). informed consent was confirmed for all participants via an information sheet. again, there were no incentives fisher et al./1st-year msw & anti-opression education 109 offered for participant engagement. in addition, students were asked if they were sure of their decision to participate before the focus group occurred. all students agreed to proceed. data was collected through audio and video recording of the focus group. the recording was imported into nvivo software package 11 (qsr international, 2015) for transcription and assignment of participant codes to protect identity. fisher (course instructor) was not involved in the recruiting, facilitation, or transcription of the focus group. written reflections data were collected from written reflections. as part of the course assignments, students were asked to reflect on their knowledge and understanding of anti-oppressive social work practice both at the beginning of the fall semester prior to the introduction of course materials, and at the conclusion of the semester as a final reflection of knowledge and understanding. after a review of the relevant literature, the instructor developed questions for the reflections. for both reflections, the students were asked: 1) “please write a paragraph describing your understanding of oppression in the united states”; 2) “please write a paragraph describing your understanding of oppression and social work”; 3) “please write a paragraph describing your understanding of anti-oppressive social work.” the reflections were matched and de-identified following the end of the semester (after grading) and prior to washington and allen’s analysis. focus group there was one focus group conducted at the beginning of the semester following the course under review. the focus group moderators, washington and allen (not the course instructor), asked participants specific questions or implemented specific verbal prompts about their experience with anti-oppressive practice learning that were developed after a review of the relevant literature. some examples are: “talk about last semester and what learning about oppression was like for you.” “what if anything did you learn?” “what else do you think you need to know about oppression and working with survivors of oppression?” “what, if any, skills or competencies do you think you have developed as a result of this exercise?” fisher (course instructor) was not involved in the recruiting, facilitation, or transcription of the focus group. analysis data were analyzed using miles and huberman’s (1994) interactive model to reduce, display, and draw conclusions from the raw data. first, the deidentified responses of students as transcribed were independently evaluated by washington and allen to designate a coded summary for what was represented in the response of each participant. for example, student 1 reported the experience of “raised awareness” and “realized the pervasiveness” of oppression and this was coded as awareness of reality and pervasive by allen. however, washington coded it as heightened awareness and realization of oppression. discussion following independent coding involved clarifying what each coder advances in social work, spring 2024, 24(1) 110 saw as the essence of the meaning, and whether the interpretation was similar or different. student 3 reported “surrounded by pretty much all the same…everyone was the same” and that “coming to college…makes you more aware”. washington coded this as brought up in homogenous community and college exposed to diversity while allen coded it as surrounded by sameness and awareness my experience was not everyone’s. through the process of coding independently and then discussing each interpretation, washington and allen came to agreement regarding the essential interpretation of what was represented by the statement. these were entered into a columned matrix in order to visualize whether the responses indicated general themes. using saldaña’s (2013) approach, after entering responses and codes into a matrix, fisher was involved for final triangulation of interpretation of codes and themes. these themes were then categorized for additional themes and clustered into matrices (miles, huberman, & saldaña, 2014). the authors reflected, compared, and discussed interpretations of the data. following the iterative process of description, review and revision, conclusions were reached in each of the units of analysis: written pre-course and post-course reflections, and subsequent focus group interview responses. data display was entered into table format using saldaña’s process for “findings at-a-glance” (2013, p. 255) as a means of providing a general overview of findings prior to additional discussion. this data reduction is useful to focus and organize data to illustrate conclusions through extended text that provides context for decisions and choices in describing the outcome (miles & huberman, 1994). findings findings are categorized into each of the units of analysis to aid in understanding the experience of the participants. this section will identify an overall summary for each unit of analysis, present a “findings at-a-glance” table for further clarification and to aid in telling the story, and conclude with descriptors of the themes that were most useful in interpreting and understanding the experience. written reflections summary this section is divided into three areas that track the reflection questions: 1) the student’s understanding of oppression, 2) the student’s understanding of social work and oppression, and 3) the student’s understanding of anti-oppressive social work. according to the written reflections at the beginning of the course, the students had little understanding of oppression and its impact. they also showed a lack of knowledge or awareness of anti-oppressive social work practice or awareness that social work as a profession could be oppressive. this was not unexpected given that five of the nine students did not have undergraduate social work degrees. students who did describe their understanding of anti-oppressive practice expressed it more in line with the expected behavior or values of the profession, rather than specifically relating it to theory or practice. the areas of commonality included: the belief that oppression was deliberate action fisher et al./1st-year msw & anti-opression education 111 intended to harm, that oppressed persons were unable to take action on their own behalf, and that oppression was systemic, culturally transmitted, and generally ignored. however, students did have some familiarity with social work values embodied in the code of ethics (nasw, 2021), and a general belief about social work roles, such as projects or initiatives to end oppression or change policies. invoking aspirational values, student 6 stated, as we live out the value of the importance of human relationships, according to the nasw code of ethics, we are to engage people as partners in the helping process, whether fighting oppression within families, social groups, organizations or communities. we value the dignity and worth of the person, so we promote their socially responsible self-determination as agents of change. at completion of the course, respondents were able to identify increased awareness about anti-oppressive social work. there was still a lack of certainty and they expressed hopefulness of learning more. students did not achieve major leaps in knowledge or understanding in this area but they were able in some instances to expand on the understanding from the beginning of the semester. for example, student 7 indicated learning appropriate non-oppressive terms for individuals, learning about self-awareness and knowing one’s own bias, and identified specific parts of the course content that enabled that awareness: oppression is systematic and nothing is without fault. the very foundations that social work has been built on has to be challenged when needed, as the rules needed and the rules that are in place do not always align. being willing to adjust what is needed is anti-oppressive as a profession, but using anti-oppressive practice is different than that. there are certain skills needed within this practice, such as being accepting and open-minded no matter what the client brings to the table or displaying a kind of warmth and honesty as they give you the privilege of listening to their story. treating that individual with value and knowing that they have the ability to make changes within their life while still respecting selfdetermination can be a balance, but it is one that must be learned. the students did express knowing more about anti oppressive practice from the precourse reflection, however. for example, student 6 wrote, an example of anti-oppressive social work might be the feminist approach which questions and confronts the patriarchal system of government which has excluded women from certain jobs, or legislated women’s reproductive rights. we are seeing this in advocates for planned parenthood. i hope to see more anti-oppressive social work in our current state of political affairs. advances in social work, spring 2024, 24(1) 112 table 1. findings from the focus group emerging theme datum supporting theme interpretive summary • normality of presence of oppression • ubiquitous presence • not openly discussed • mindset that individuals have choice • homogenous environment • “there’s such a level of indoctrination to it. it was commonplace to have the mentality growing up you just don’t discuss it.” • “i grew up in a very homogeneous community. with oppression, i thought someone in that situation could change themselves.” • “i’ve lived in the same neighborhood for 20 years of my life. that was my whole world and there’s so much that you were just blind to, and you get stuck in that.” • exposure to difference and diversity is linked to change in perceptions or reality • desire for change • awareness is not sufficient • complicity in inaction • “you know it’s one thing being aware and learning you know and it’s there, but now i’m at a point where what are we going to do about it?” • “we can’t be complacent in it. by not doing anything you are letting it happen.” • questioning how to create change is linked to taking action • practice application at micro and macro levels • understanding resilience and using strengths perspective • importance of practical experience • assessing systems and access • “knowing how they made it through it; where did they get that strength and what can we do to feed on that?” • “it’s one thing to read about the oppression that exists in textbooks or something, but it’s another thing when you listen to people who have actually gone through it.” • “look at what’s keeping them from being able to have access, looking at the system of the individual because we grew up—many of us did—being poor is the poor person’s fault. it’s kind of like really nailing home you have to look at it from the other angle, because the majority of the time, it is from that angle.” • seeing the work on an individual level is linked with greater practice relevance for students • recognizing the value in understanding the lived experience is linked with growing awareness that oppression is systemic • optimism for change and personal growth • self-assessment and examination • realization it is present, not just past • “it’s made me look at myself and realized how i played a part in it. it makes me look at everything differently and i think these conversations are really important. it allows a safe space for everybody to talk about it openly and without judgment and it furthers education in my opinion.” • “it’s been important for me to be able to see who is doing the oppression when it comes up—to see that it is very much…it’s not a part of our history, it is a part of our present. i think we have that opportunity for change that we would not have had if we hadn’t been made aware of the problem and the widespread nature of it.” • understanding and examining privilege is linked with selfawareness and personal responsibility • awareness of difficulty and discomfort of engaging • requires willingness and effort to become aware and face own bias and action • “the will to understand there are people around you who face different things.” • “i think sometimes it’s also hard to talk about because as you talk about it you realize that you have done little things that are oppressive to other people, and you are not even realizing it. a lot of times people think it’s just like the really big stories on the news that are someone doing something that’s really racist but it’s not just that. it’s the little things, too.” • discussion is linked to growing recognition of our own bias and oppressiveness and can be linked to potential for denial or selfblame fisher et al./1st-year msw & anti-opression education 113 focus group the focus group occurred at the beginning of the semester following the course. participants were asked about their experience of anti-oppressive practice during the previous semester and what they learned. five themes emerged from the focus group: the normality of oppression, desire for change, practice application at micro and macro levels, optimism for change and personal growth, and recognition of the difficulties and discomfort of engaging in the conversation. table 1 provides findings-at-a-glance (saldaña, 2013), with examples of the datum supporting the theme, followed by the researchers’ interpretive summary of how the students linked their learning to cognitive and affective change and action (saldaña, 2021). the following discussion of findings provides more detailed support for the interpretation of the datum as related to student learning and the identified themes of the focus group and demonstrates the analytic process as indicated in the “findings at-a-glance” table. normality of oppression. it was clearly difficult for students to openly discuss this question, and yet they grappled with the discomfort. for example, student 3 said having grown up in a community where everyone was the same, that sameness seemed normal. going to college and being around others who were not the same assisted student 3 in realizing “my experience was not everyone’s experience” and it “took me out of my little bubble.” students' thoughts and perceptions changed to an increased understanding about their responsibility for recognition of those different realities, and how their lack of knowledge and exposure to oppression affected their viewpoint. two examples of this were most illustrative. student 3 expressed this by saying, i said earlier i grew up in a very homogeneous community. with oppression there were little bits and pieces of it that i thought that someone in that situation could change themselves. going through this class, learning about white privilege, knowing that i don’t face some of the challenges others face, that just changed and shifted my opinion. student 4 added, i don’t know if this is a misperception...not that i thought wrong about something, but i feel like i didn’t know or didn’t realize the extent that oppression affects people. i’ve just lived in the same neighborhood for 20 years of my life. that was my whole world and there’s so much that you were just blind to, and you get stuck in that. this exposure to difference and diversity within the university was a new experience for most students. the deeply rooted social segregation in mississippi leaves students with little interaction across racial and socio-economic groups. this is particularly true for students from regions of the state where social and school segregation is still typical, and where students have different experiences related to public or private school attendance. desire for change. students also struggled with the lack of knowing what to do. understanding the difference between knowing and doing was described by student 5 as, advances in social work, spring 2024, 24(1) 114 i think it’s given me a drive to figure out how to change it. you know it’s one thing being aware and learning you know and it’s there, but now i’m at a point where what are we going to do about it? how can we go out into the community and educate others and start making that change in society one community at a time? it’s kind of given me this little impatient feeling…it’s good to know and good to talk about it and be aware of it but now what are we going to do about it? they were beginning to question how to create change and recognize that inaction is complicity. it seemed as if the more they questioned how to create change, the more they desired to learn how to create interventions that resulted in social and economic change. practice application at micro and macro levels. when asked what else they needed to know about oppression and working with survivors of oppression, they identified the importance of understanding resilience and using strengths. students still tended to see the work on a personal and individual level through engaging with others to learn and understand, rather than at the macro, systemic and societal levels. however, as they continued to grapple with how to learn from individuals, they also began to express awareness that experiences from past trauma would continue to affect individuals. this level of thinking indicates students did recognize the value of understanding the lived experience. this was also expressed through growing awareness that oppression is systemic, and not solely individual. optimism for change and personal growth. students primarily saw the experience as helpful to realize and recognize oppression, gain confidence, and get to know others through interaction to create growth. they saw educating themselves and others about oppression as necessary. one student acknowledged growth in self-confidence to help others understand “why the situation might be this way and what we can do to improve it.” the exposure also enabled students to look at varying aspects of their privilege differently, and express the importance of examining the layers of privilege as a personal responsibility, yet with opportunity to create change. for example, student 7 said, it’s made me look at myself and realize how i played a part in it. like even though i am [described racial and gender identity], you know we can still be oppressive to other people, like the homeless. it makes me look at everything differently and i think these conversations are really important. it allows a safe space for everybody to talk about it openly and without judgment and it furthers education in my opinion. in discussing the need to learn practice intervention methods, they were eager to have more experiential learning, such as the poverty simulation they had participated in, in order to “put you in those people’s shoes.” this indicated they were growing in the experience of social empathy (segal, 2018) by having a greater understanding of the lived experience of different groups. awareness of the difficulties and discomfort of engaging. one of the frequently mentioned aspects of grappling with this issue was that the discussion helped students increase recognition of their own bias and potential to oppress, which can lead to denial or self-blame. several students expressed that the lack of comfort was from fear of offending fisher et al./1st-year msw & anti-opression education 115 or hurting people’s feelings because they had not had that experience themselves. while discussing their fears and growing awareness, they could agree that the realization they might have done something offensive or hurtful could result in avoiding the conversations altogether. discussion the findings illuminate the students’ level of understanding of oppression, its relationship to social work, and how to practice anti-oppressive social work. while there was a burgeoning awareness of the systemic structure of oppression among the students in the present study, it was clear that they were struggling the most with their own beginning awareness of the pervasive presence of oppression and their own complicity in the system, however unintentional it may have been. in contrast to dedotsi et al. (2016), the students in this study did experience some level of consciousness raising in that they learned new terms and understood more about culture, cultural humility and the need to acquire more knowledge. both knowing that they did not know and achieving greater self-awareness were present at the end of the course. they could identify the importance of learning to understand themselves and their biases in order to avoid unintentional oppression and keep bias from interfering in practice. nonethess, students still tended to describe oppression as people being unable to do for themselves, without voice, access, or power rather than reflecting the key concept that social workers empower participants to address barriers. there seemed to be some movement toward this understanding, however, as evidenced by one student’s awareness of the ethical duty to engage participants as partners. a striking result is that the students seemed to grow in their understanding of oppression and anti-oppressive practice over the winter break (between the post-course reflection and the focus group). consistent with the findings of strier and binyamin (2014) and others (e.g., finn & molloy, 2021) our students struggled with the ability to “both provide direct assistance while also seeking to change oppressive systems” (morgaine & capous-desyllas, 2015, p. 25). it was evident that students care about these issues, along with their own responsibility. they just do not know what to do about it. this is consistent with bhuyan et al.’s (2017) findings that most students saw social justice and clinical practice as separate domains and, furthermore, expressed that the curriculum was lacking in content about how to transfer “macro” knowledge to skill implementation with clients. one of the key concepts of aop is critical self-reflection. perhaps what was most illustrative was how the students struggled with “muddling through,” and in the unspoken dynamics that were present in the focus group, which are consistent with findings that discussions about oppression can generate anxiety and tension in students (wilson & beresford, 2000). our students also experienced tension and anxiety during the discussions, generally expressed as fears of doing or saying something insensitive or oppressive through not having known or understood and thus harming someone rather than helping. advances in social work, spring 2024, 24(1) 116 awareness of the potential for social work practice itself to reproduce oppression was evident in some student reflections in which they expressed the desire to guard against themselves being oppressors. similar to dedotsi et al. (2016), however, most students did not seem to increase understanding of the relationship between the social work profession and oppression. students expressed increased understanding of the relationship, but all did not show that they understood the need for and willingness to engage critical selfreflection.the lack of progress in this area for some was indicated by the discomfort and reluctance to experience that discomfort caused by participating in the discussion during the focus group. in fact, the present authors acknowledge that the possibility exists that the exercise itself reproduced oppression. in 2000, wilson and beresford had questioned whether anti-oppressive practice could exist in its then-current structure. they asserted that there was little evidence that those who argued for, taught, and claimed to practice the concept considered or questioned their role in the structure of social services, thus, oppressing service users by their very definition and practice. it is possible that educators and students may have become more cognizant of this potential in light of the more recent research and the focus on deconstructing and dismantling whiteness as the basis of social work knowledge (abrams & gibson, 2007; almeida et al., 2019; beck, 2019; longres, 1972; tascón & ife, 2020). limitations this study has several limitations. first, the sample size was small, and the study was conducted with a purposive sample of students who were enrolled in a single course contained in a program located in a university town in the southeastern united states. as with all qualitative studies, these findings are not generalizable. additionally, over threequarters of the students in this study were white and were discussing their experience in a predominantly white institution (pwi). social identity and context undoubtedly influenced our findings. further, focus group responses are prone to group opinion and responses keyed to social desirability more than individual interviews, which might have particular impact in this study due to the discomfort with the topic. we hope this was balanced by the use of the individual, anonymous reflections. however, because the instructor in this class was a member of the research team, there is a chance that social desirability was still an influence due to the students’ concerns over their grades being affected by their responses. implications the students in this study demonstrated beginning knowledge of oppression and its relation to social work, but also revealed gaps in knowledge and skills. as these students’ perceptions were explored after only one semester of exposure to anti-oppressive practice, one approach to increasing their knowledge and skills could be to infuse anti-oppressive material throughout the program curriculum. for example, the students in the current study were in the first semester of their foundation year of the msw program. future courses include foundation-level practice with families, groups, communities, and organizations. the morgaine and capous-desyllas (2015) text contains chapters on each of these practice fisher et al./1st-year msw & anti-opression education 117 levels that could be used as a base for continued learning about aop at a generalist level. in addition, the program under review has a clinical concentration. aop materials for clinical classes are available, such as jemal’s (2022) model of critical clinical social work practice and slater’s (2020) suggestions for integrating social justice into clinical practice. the students in this study also expressed the desire to translate what they saw as macrolevel knowledge into micro-level aop skills. addressing the artificial separation created between the micro, mezzo, and macro levels of practice has long been identified as a potential intervention point for social work curricula (abramovitz & sherraden, 2016; jemal, 2022; slater, 2020). the potential to bridge the artificial gap is present in both curricular design and in specific models. in the present institution, curricular design results in practice with individuals being taught in fall, while practice with communities is taught in spring. by the very nature of social work education practice classes, students learn discrete steps in skill building at the individual level and then macro level, with relatively little attention to helping students connect the two. one example of a program that brings the two together can be found at the university of montana. finn and molloy (2021) describe in great detail that program’s process of developing a program curriculum to support students’ engagement in advanced integrated practice—masters-level social work that bridges the macro-micro divide. models that tie micro to macro practice are available in the social work literature (avruch & shaia, 2022; jemal, 2022; slater, 2020). jemal (2022) and slater’s (2020) models are described above. another potentially useful example can be found in avruch and shaia’s (2022) macro motivational interviewing (mi) model, which is designed to address socially engineered trauma. the authors suggest not only a overall model for embracing context in clinical practice, but also modifications of esssential techniques of mi such as accurate empathy, providing feedback, and asking open-ended questions. thyberg (2023) investigated the knowledge, needs, and learning of msw students regarding oppression and diversity and concluded that social work students are interested in a uniform approach to learning about these topics to better prepare them for field practice. one such approach is critical social work, defined as including both an understanding of the structural nature of inequity coupled with an understanding of the potential of social work to enforce the status quo by managing behaviors rather than seeking social change. thyberg (2023) argued that critical social work starts the process of infusing anti-oppressive education into the social work profession. the author suggests the expansion of and further research on the effects of critical social work on students learning. the use of inclusive learning materials is critical (abrams & moio, 2009). learning material within the social work curriculum should not be dominated by authors of a certain race, sex, or any other demographic; otherwise, social work education remains complicit in maintaining oppression (ortega-williams & mclane-davison, 2021; swcares, 2020). one central aspect of white supremacy is the unnamed presence of white voices in educational materials, which can marginalize people of color’s knowledge about their own lived experiences when it comes to learning (almeida et al., 2019; longres, 1972; ortiz & jani, 2010; snowden et al., 2021; tascón & ife, 2020). in the current study, students expressed that the 1619 project podcast developed and authored by nikole hannah-jones advances in social work, spring 2024, 24(1) 118 had a positive impact on the students’ ability to recognize and understand others’ experiences of oppression. a key concept highlighted by this study’s findings is the program’s need to facilitate self-reflection as well as increase comfort in discussing oppression. one result of fear and anxiety about discussion of oppression can be that social workers focus on what to do, instead of a deep examination of self and the issue (wilson & beresford, 2000). this can be further complicated by social work education’s focus on outcomes (in the united states, competencies), which can foster more concern with students demonstrating knowing what to do, and little about students doing the hard work of self-reflection on how ingrained experiences and socialization might be impacting one’s ability to actually be with the lived experience of the service user. this was reflected in students in this study—the expression of “we know what oppression is, so now, what should we do about it?” this is precisely the reason that the educators in the current study implemented reflective social work and pre-course and post-course reflective self-assessments for students: to introduce them to the importance of self-reflection in practice. deeper reflection might be needed. to encourage deeper critical self-reflection on privileges and social locations and the ability to discuss oppression, as well as help students learn how to assess participants’ experiences of oppression, social work education must address white supremacy along with all forms of oppression (abrams & gibson, 2007; almeida et al., 2019; beck, 2019; longres, 1972; tascón & ife, 2020). although exposed to the concept, the students in this study did not mention it—the closest they came was white privilege. when many students, especially those who are not of color, hear this concept they do not know what to do with it and cannot link it to their personal identity. there needs to be a thorough understanding of what white supremacy is, what it looks like, and what can be done about it. if this does not happen, white fragility can create a barrier to teaching and learning (lerner, 2022). lerner (2022) proposes a detailed approach to facilitating conversations on white supremacy grounded in acceptance and commitment therapy. approaches to facilitating these conversations abound and can be found with a quick google search. finn & molloy’s 2021 article also contains specific examples of how programs can facilitate this deep work. perhaps the first step for encouraging aop learning is for programs to engage in their own critical self-reflection. with a topic as complex as oppression, schools must ensure that the educators have what they need in order to tackle it – whether it be materials or training that they can take back to students. students reported wanting action steps, but little is known about how prepared educators feel to provide that (goode et al., 2021). future research should focus on the feelings and needs that educators have when trying to teach about something so large and personal to diverse students. one final implication is the need to emphasize the role of social workers as empowering others, rather than doing for others. students were likely to describe social work’s role as one of advocacy and challenging social injustice, and they were seemingly unaware that anti-oppressive theory is built on the historical social justice movements that were formed and led by marginalized groups, such as the civil rights, women’s rights, chicano movimiento (gutiérrez, 1999), lgbtq, and disability activism for access (campbell, 2003). it was also interesting, if not indicative, that in the midst of the black fisher et al./1st-year msw & anti-opression education 119 lives matter movement in fall/winter 2019/2020, none of the students mentioned it or its contributions in centering the voices of the oppressed and their allies. at completion of the course, they were still likely to see anti-oppressive practice as individual rules for conduct, (e.g., treating others with dignity and respect, or implementing aop models and theories), but were unable to define it clearly. conclusion overall, the findings of this study provide important insights into these msw students’ understanding of oppression, its relationship to social work, and how to practice antioppressive social work. it is clear that the students learned, but that one semester provided only beginning levels of understanding for most students. students were open to further learning. the findings highlight the need for both intentional curricular design around aop and further research in this area. references abramovitz, m., & sherraden, m. s. 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(2020). private practice social workers’ commitment to social justice. clinical social work journal, 48, 360-368. smith, c. f., aguilar, j. p., kozu, s., keenan, e. k., & tomczak, s. m. (2022). if antiracism is the goal, then anti-oppression is how we get there. advances in social work, 22(2), 758-778. snowden, f., tolliver, w., mcpherson, a. (2021). needing, kneading, and eating black bodies: the history of social work and its concern for black citizenship in the united states. advances in social work, 21(2/3), 217-240. strier, r., & binyamin, s. (2014). introducing anti-oppressive social work practices in public services: rhetoric to practice. the british journal of social work, 44(8), 2095-2112. swcares. (2020, june 30). social work so white with rachel cargle. youtube. tascón, s. m., & ife, j. (2020). disrupting whiteness in social work. routledge. thyberg, c. t. 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(2000). “anti-oppressive practice”: emancipation or appropriation? the british journal of social work, 30(5), 553-573. author note: address correspondence to amy fisher, department of social work, university of mississippi, p.o. box 1848, university, ms 38677. email: afisher@olemiss.edu https://doi.org/10.1007/s10615-020-00746-z https://doi.org/10.18060/24646 https://doi.org/10.18060/24646 https://doi.org/10.18060/24469 https://doi.org/10.18060/24469 https://doi.org/10.18060/24469 https://doi.org/10.1093/bjsw/bct049 https://doi.org/10.1093/bjsw/bct049 https://www.youtube.com/watch?v=wa5zwkfhlca https://doi.org/10.4324/9780429284182 https://doi.org/10.1080/10437797.2022.2119060 https://doi.org/10.1080/10437797.2022.2119060 https://doi.org/10.1093/bjsw/30.5.553 https://doi.org/10.1093/bjsw/30.5.553 mailto:afisher@olemiss.edu _________ rebecca g. mirick, phd, licsw, associate professor, school of social work, salem state university, salem, ma. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 993-1005, doi: 10.18060/25991 this work is licensed under a creative commons attribution 4.0 international license. are social work students being adequately prepared to intervene with suicide? results of a national survey of bsw and msw programs rebecca g. mirick abstract: suicide is a major public health issue in the united states, but it is unknown how many social work programs have courses specializing in this topic. the purpose of this study was to establish baseline knowledge of suicide-focused course offerings in social work programs in the united states. a survey of cswe-accredited programs (n=151) in the united states was used to collect data on social work programs’ suicide content in their curricula at three levels: baccalaureate, graduate, and continuing education. while only 6% of programs offered a required course on suicide, 13.9% offered an elective focused on suicide, and courses with substantial suicide content were available in 25.2% of programs. continuing education offerings with a focus on suicide were present at 26.5% of programs. the implications for social work education are discussed, including the need for more courses specializing in suicide, especially within msw programs, and for future research to better understand the factors which limit the development of such courses. keywords: suicide; social work education; suicide prevention; msw programs; bsw programs historically, social work students have received limited education about suicide (osteen et al., 2014; ruth et al., 2012), creating a situation in which graduating social workers lack an understanding of suicide and do not have the skills to effectively conduct a suicide assessment or intervene with individuals with suicidal thoughts and behaviors (feldman & freedenthal, 2006; sanders et al., 2008; schmidt, 2016; schmitz et al., 2012; singer & slovek, 2011). in the united states, the rate of suicide deaths has increased 30% since 2000, with 45,979 suicide deaths in 2020 (garnett et al., 2022) and 1.4 million adult suicide attempts (cdc, 2020). although the overall suicide rate decreased during the covid pandemic, the suicide rate continued to increase for some vulnerable groups, such as youth of color and adolescent girls (bray et al., 2021; bridge et al., 2018; cdc, 2020;yard et al., 2021). suicide affects many individuals in the united states, with almost 6.5 million individuals bereaved by a suicide death each year (cerel et al., 2018). suicide education is an urgent issue facing many social workers. being prepared to engage in suicide prevention, intervention, and postvention work is essential for all mental health professionals (schmitz et al., 2012). currently, there are 549 bsw and 311 msw accredited programs in the united states (cswe, 2021). these programs graduated 19,474 baccalaureate and 31,750 graduate students in 2020 who entered the workforce as practicing social workers (cswe, 2021). practicing social workers frequently encounter individuals with suicidal thoughts and behaviors, and often work with individuals who are at high risk of dying by suicide. sanders et al. (2008) surveyed msw-level social workers and found that 55% had had a client make a suicide attempt and 31% had lost a client to suicide. practicing social workers must be prepared to work with individuals with suicidal thoughts and behaviors (almeida about:blank about:blank advances in social work, fall 2022, 22(3) 994 et al., 2017; schmitz et al., 2012) and schools of social work must provide opportunities for this training. little is known about the learning opportunities available in schools of social work at the baccalaureate, graduate, and continuing education level, including the availability of required courses on suicide, electives focused on suicide prevention and intervention, or courses with substantial suicide content (sanders et al., 2008). literature review historically, social work graduate programs have provided minimal instruction on suicide assessment and intervention to their students (feldman & freedenthal, 2006; kourgiantakis et al., 2020; osteen et al., 2014; quest et al., 2019; ruth et al., 2012). the two surveys that examined practicing social workers’ perceived exposure to suicide content in their social work programs are both older studies which focus on experiences of individuals in msw programs (feldman & freedenthal, 2006; sanders et al., 2008). feldman and freedenthal (2006) found that only 59.2% of msw-level social workers had learned suicide-related content in class, and of this group, 46.3% spent two hours or less on suicide, with over two-thirds (67.4%) saying they were insufficiently prepared to work with clients with suicidal thoughts and behaviors. in a survey of practicing social workers, sanders et al. (2008) found that less than 50% had been taught in their graduate program to work with clients with suicidal thoughts and behaviors. minimal time is spent on teaching suicide assessment and intervention to graduate students, with many students reporting estimates of 2-4 hours on suicide content (feldman & freedenthal, 2006; quest et al., 2019; ruth et al., 2012). in a scoping review of social work education in mental health, substance use disorders, and suicide, kourgiantakis and colleagues (2020) reported a need for more consistency in terms of suicide content and suicide risk assessment across undergraduate and graduate social work programs. there is some support for the integration of suicide content across the curriculum, with particular attention to its inclusion in practice courses (ruth et al., 2012). however, this requires a sustained commitment and level of expertise required from faculty – both of which are sometimes unavailable in a social work program (ruth et al., 2012). as with topics such as substance use and gerontology, many social work students want to advance their knowledge of suicide by enrolling in a semester-length course on the topic (almeida et al., 2017; quest et al., 2019; scott, 2015). quest et al. (2019) surveyed three cohorts of msw students about their training on suicide content, finding that more than half believed that the two hours spent on suicide in their advanced practice course was inadequate preparation for practice and in fact, raised additional questions for them about working with individuals experiencing suicidality. consistently, research on social work education has shown that students are enthusiastic and supportive of suicide-focused electives and identify a need for this content (almeida et al., 2017; quest et al., 2019; scott, 2015), even sometimes supporting a required suicide-focused course (almeida et al., 2017; scott, 2015). suicide content is not included in cswe’s annual survey of schools of social work (cswe, 2020), so there have been no national analyses of social work curricula or course offerings that support students’ achievement of suicide-related competencies. therefore, it mirick/are swk students 995 is unknown how many social work programs offer courses on suicide. a survey of bsw and msw courses in accredited u.s. social work programs found health and health-related courses in 72% of bsw programs and 92.4% of msw programs (ruth et al., 2017). of these courses, 71% focused on three areas: mental health/behavioral health, abuse and trauma, and substance use/addictions, with only 2% focused on suicide (ruth et al., 2017). a survey of instructors teaching practice courses in accredited bsw and msw programs found that of the 289 practice instructors, 2.4% reported their program had a required course on suicide, 10.0% said their program offered a suicide elective, and 14.5% said their program offered an elective on a topic related to suicide (e.g., crisis intervention; mirick, 2022). although this was a national sample, it is unknown how many distinct programs are represented. while there is no available data on the frequency and prevalence of suicide-focused courses in social work programs, the social work education literature provides some examples of elective courses on suicide. most are graduate-level clinical practice courses (almeida et al., 2017; quest et al., 2019; ruth et al., 2017), but there is one example of a macro msw course (scott, 2015) and one generalist bsw course (mirick, 2019). some practice electives also include macro content. for example, almeida et al. (2017) describe a practice elective for msw students that focuses primarily on clinical skills such as screening, assessment, and management of suicidal clients, but also includes postvention and a public health perspective. nedegaard et al. (2019) developed a course titled suicide prevention and intervention for second-year graduate students. this course included clinical topics such as assessment and evidence-based interventions, but also covered theory, traditionally marginalized and oppressed populations, and postvention. continuing education courses on suicide are more common in social work education than undergraduate or graduate courses (ruth et al., 2017). several continuing education programs have been developed for social work students and/or practicing social workers (kourgiantakis et al., 2020). these include question, persuade, refer (qpr; jacobson et al., 2012b; sharpe et al., 2014), suicide assessment and intervention training (sait; mirick et al., 2016), counseling for access to lethal means (calm; almeida et al., 2017), recognizing and responding to suicide risk (jacobson et al., 2012a), and assessing and managing suicide risk (scott, 2015). some of these courses use clinical suicide competencies (rudd et al., 2008), while others, such as qpr, are designed for gatekeepers, not mental health professionals. there is no data available on how frequently these trainings are used as one component of a practice course or offered in continuing education programs associated with schools of social work. the most common practice for teaching suicide content has been to integrate it into coursework and field instruction (quest et al., 2019; ruth et al., 2012). ruth et al. (2012) surveyed social work faculty, finding that 83.8% agreed that field and classroom instructors should be responsible for student education on suicide. a survey of 225 bsw and msw practice instructors found that 54.7% included suicide content in all their practice courses and 37.3% in some of their practice courses, with 87.0% teaching assessment and risk formulation, 52.7% intervention, and 50.2% safety planning (mirick, 2020). lecloux (2021) described the inclusion of suicide content in an advanced practice course via an asynchronous online module used across all courses, regardless of instructor. advances in social work, fall 2022, 22(3) 996 when suicide content is integrated into a practice course instead of being offered as a full course, students wanting to engage more deeply with the content must enroll in a continuing education course or read independently if they would like to expand their knowledge on the topic. other areas of learning, such as mental health, trauma, or substance use disorders, are more commonly offered as full courses (ruth et al., 2017), and students who wish to learn more about the topic can register for a semester-long course. suicide content within practice courses tends to focus on risk and protective factors, assessment, safety planning, and intervention, while topics such as management of emotional responses to suicide, culture, racism and oppression, legal issues, and means of safety are often omitted (kourgiantakis et al., 2020; mirick, 2020). practice courses typically devote only a few hours to suicide content (quest et al., 2019; ruth et al., 2012), so instructors are limited in the depth and breadth of content covered. this paper describes a survey designed to provide foundational information on the current state of education about suicide within undergraduate and graduate social work programs. at this point in time, the field of social work education has no information on the number of programs offering a course that specializes in suicide, either at the macro or clinical level, or focusing on individual work with clients with suicidal thoughts and behaviors. this research project is a first step in filling that gap in the social work education literature. methods overview the salem state university institutional review board reviewed this project and determined it to be an exempt project. a list of cswe-accredited social work programs (bsw & msw) was created from data available on cswe’s website of accredited programs including the contact person for each program, typically the program coordinator or chairperson. in april 2021, emails were sent to all accredited bsw (n=531) and msw (n=296) programs with a link to a brief anonymous survey using survey monkey online survey software. a reminder was sent two weeks after the initial email. measures to increase the rate of survey completion, the survey was purposely kept brief. participants were asked five dichotomous (yes/no) questions to determine if their program had a required course on suicide, an elective on suicide, or an elective with substantial suicide content. participants were asked to specify the topic of the elective. in addition, participants were asked if their program offered continuing education courses and if so, did they offer courses specific to suicide or with significant suicide prevention content. in an open-ended question, participants were asked to provide the title of the continuing education course. finally, an open-ended question asked participants to share any additional relevant information about suicide prevention education in their program. mirick/are swk students 997 data analysis data were uploaded to ibm spss version 27 and analyzed using descriptive statistics. open-ended responses were coded using thematic analysis (braun & clarke, 2006). two members of the research team initially coded all the responses, creating initial codes. these responses were then compared, with a discussion around areas of disagreement, creating a final set of codes. the data was then recoded using this final set of codes. then, similar codes were collapsed into larger themes to create the final themes. findings responses were returned from 88 bsw programs and 63 msw programs. the overall response rate was 18.1%, with a 16.6% response rate for bsw programs and a 21.3% response rate for msw programs. courses about suicide few bsw or msw programs offered a required course on suicide (5.7%, n=5 and 6.4%, n=4, respectively) or an elective on suicide (10.2%, n=9, 20.6%, n=13, respectively). however, 20 bsw programs (22.7%) and 18 msw programs (28.6%) had an elective with substantial suicide content, although suicide was not the focus of the course. more than half of programs who responded to the survey (61.3%, n=92) offered no courses about suicide or electives with substantial suicide content, including 56.5% of bsw programs (n=35) and 64.8% of msw programs (n=57). there was no significant difference between program level and required courses (χ2 (1)=0.038, p=0.845), suicide electives (χ2 (1)=3.353, p=0.067), suicide-related electives (χ2 (1)=0.764, p=0.382), or continuing education offerings about suicide (χ2 (2)=1.904, p=0.386). see table 1. table 1. differences between bsw, suicide-focused courses and msw programs in the availability of courses about suicide (n=151) n (%) χ2(df) p bsw (n=88) msw (n=63) required course yes 5 (5.7%) 4 (6.4%) 0.038(1) 0.845 no 83 (94.3%) 58 (93.5%) elective yes 9 (10.2%) 13 (21%) 3.353(1) 0.067 no 79 (89.8%) 49 (79%) related course yes 20 (22.7%) 18 (28.6%) 0.764(1) 0.382 no 68 (77.3%) 44 (71%) any course about or related to suicide yes 31 (35.2%) 27 (43.5%) 1.062(1) 0.303 no 57 (64.8%) 35 (56.5%) continuing education suicide course yes 13 (14.8%) 12 (19.4%) 1.904(2) 0.386 no 62 (70.5%) 37 (59.7%) not sure 13 (14.8%) 13 (21%) advances in social work, fall 2022, 22(3) 998 courses with substantial suicide content in bsw and msw programs included courses on crisis intervention (12.5%, n=11 and 15.9%, n=10, respectively), trauma (1.1%, n=1 and 3.2%, n=2), and mental health/substance use (2.3%, n=2 and 9.5%, n=6, respectively). eight programs identified additional courses that contained significant suicide content. see table 2. table 2. suicide focused or suicide-related electives suicide focused or related electives n (%) bsw msw total understanding suicide/suicide prevention 2 (2.3%) 3 (4.8%) 5 (3.3%) suicide assessment and intervention 1 (1.1%) 7 (11.1%) 8 (5.3%) courses with substantial suicide content crisis intervention 11 (12.5%) 8 (12.7%) 18 (11.9%) mental health & substance use disorders 2 (2.3%) 6 (9.5%) 8 (5.3%) trauma 1 (1.1%) 2 (3.2%) 3 (2%) other related electives* 2 (2.3%) 6 (9.5%) 8 (4.6%) hbse 1 (1.1%) 1 (1.6%) 2 (1.3%) *e.g., older adults, grief & loss, dbt, military social work, end-of-life, family violence, resilience, at-risk youth continuing education about suicide eighty-six programs offered continuing education programming – 46 (52.3%) bsw programs and 40 (64.5%) msw programs. twenty-five (16.7%) had programming related to suicide on topics such as suicide assessment and intervention (14.0%, n=12), awareness and understanding of suicide (9.3%, n=8), and crisis intervention (4.7%, n=4). see table 3. table 3. continuing education on suicide continuing education courses n (%) no continuing education program 65 (43%) total offering continuing education 86 (57%) no, no suicide related courses 42 (48.8%) don’t know if there is a suicide related course 4 (4.7%) yes, suicide related course 40 (46.5%) suicide awareness & understanding 8 (9.3%) suicide assessment & intervention 12 (14%) crisis intervention 4 (4.7%) related course (borderline personality disorder) 1 (11.6%) no title given 15 (37.5%) additional information about suicide prevention education in response to an open-ended question asking for additional relevant information related to suicide prevention education in the program, several respondents described noncredit options for suicide education and resources that made educational opportunities available to students. nine (10.2%) bsw programs and 3 (4.8%) msw programs described mirick/are swk students 999 non-course related training and workshops that are available to their students. these included examples such as “intensive suicide workshop off-campus as part of their course work”, safe talk training, qpr training, mental health first aid certification, and biannual suicide workshops for students. these opportunities were often supported by individuals or programs outside of social work, such as the counseling center on campus, a continuing education program, institutional diversity, and the title ix center. some of these trainings were embedded in practice and/or field courses. some program directors perceived these learning opportunities as relevant information when considering their programs’ suicide prevention educational activities. several program directors identified resources that support and facilitate suicide prevention education on their campuses. one described funding, saying, “this course is offered through a samhsa gls [garrett lee smith] campus suicide prevention grant, and we hope to continue to offer this course after the duration of the grant.” two program directors highlighted the role of faculty expertise. for example, one said, “our school has two suicidologists on faculty… [ one of them] headed the mental health concentration for ten years and built suicide-related content into numerous classes and created a class on suicide assessment and intervention…. our school may be a bit of an outlier.” some program directors indicated that their campus’ access to resources was important information for understanding suicide prevention education in their program. discussion these findings provide a description of suicide education within a sample of social work programs in the united states, adding new information to the knowledge base about the prevalence of suicide and suicide-related courses in bsw and msw programs. while required courses on suicide were uncommon among the responding schools, many programs offer an elective course on suicide or with substantial suicide content. the numbers of required courses and electives focused on suicide suggest an increase over time, at least for msw programs. a previous survey of deans and directors found that only one (1.9% of the sample) reported their msw program had a course on suicide (ruth et al., 2012), compared to the current study’s 6.4%. the current findings suggest that education about working with clients with suicidal thoughts and behaviors is still more likely to be integrated into existing courses instead of being covered in a free-standing suicidology course, with more than half of program directors (56.4% msw and 64.8% bsw) reporting no course about suicide or with significant suicide content (ruth et al., 2012). courses on suicide were more likely to have a clinical focus, teaching how to work individually with clients with suicidal thoughts and behaviors, than a more macro focus, such as prevention, policy, systemic issues, or social determinants of health, reflecting previous research on social work curricula across multiple mental health topics (ruth et al., 2017). to note, in this study, even the suicide-related electives were primarily clinical in nature, with courses focusing on crisis intervention, trauma, and dialectical behavioral therapy (dbt). surprisingly, the msw programs in this study were no more likely than bsw programs to offer courses on suicide, although the suicide education literature has often assumed that suicide is graduate-level content, with more education available on the topic in msw advances in social work, fall 2022, 22(3) 1000 programs (almeida et al., 2017; jahn et al., 2017; quest et al., 2019; ruth et al., 2012; scott, 2015). the current findings suggest that, at least among the surveyed programs, required courses and suicide-specific electives are just as common in undergraduate social work programs as graduate programs. the reasons behind these findings are unknown. it may be that the programs that responded are different in some way than programs that did not respond. it does appear that clinical courses focused on suicide assessment and intervention may be more common in msw programs (n=7) than bsw programs (n=1). although there is only one example of a bsw-level course on suicide in the literature (mirick, 2019), there are several examples of undergraduate courses on suicide in fields outside of social work (cramer & long 2018; muehlenkamp & thoen, 2019). undergraduate courses covering suicidality are infrequently discussed in the literature but may be more common than is suggested by the literature. in this study, the number of programs offering suicide-specific continuing education was lower than expected based on previous research on the topic (ruth et al., 2017). at the surveyed programs, university-affiliated continuing education on suicide does not seem to be an option for the majority of individuals working, studying, or graduating from social work programs, as only about a quarter (26.5%) of the programs surveyed in this study offered suicide-specific continuing education. previous research has suggested that “the relationship of social work continuing education to social work higher education is varied and ambivalent, and it is difficult to discern whether schools of social work view continuing education as relevant to their mission” (gianino et al., 2016, p. 344). cswe began to include a need for “life-long learning” in their educational policy and accreditation standards (epas) in 2015 (cswe, 2015). gianino et al. (2016) have suggested this may lead to increased feelings of relevance and commitment to continuing education from schools of social work, yet our findings suggest this may not be the case, at least not for suicide education. limitations there are several limitations to this research study that should be noted. the response rate of 18%, while typical and expected for an online survey suggests some limitations with external validity. this is particularly true for bsw programs, with a lower response rate of 16.6%, compared to msw programs, which had a response rate of 21.3%. as a nonrandom sample, these findings cannot be generalized to all social work programs. in addition, there may have been a response bias. for example, programs with a strong commitment to suicide education may have been more likely to respond than those without this focus. as a quantitative survey that was intentionally designed to be brief to encourage the completion of the survey by program directors, there is a lack of depth and explanation in the responses. in response to the final question, some program directors provided additional detail that they saw as relevant to suicide education in their programs, such as information about available resources and training for their students. as specific questions about funding, resources, and workshops were not included in the survey, it is unknown how other programs in this sample would respond to these questions. however, these findings do suggest additional considerations to expand our understanding of suicide education and frame future research questions. despite these limitations, this study adds to the existing knowledge base by providing information about the prevalence of courses on mirick/are swk students 1001 suicide within a sample of social work programs, especially in undergraduate programs which have not been previously studied and suggests additional topics to explore in future research on this topic. implications consensus is lacking in social work programs about how best to infuse suicide content across the curriculum. these findings suggest that while many programs include some suicide content in courses (mirick, 2020), most programs do not have opportunities for students to develop a more comprehensive understanding of the topic through a class focused only on suicide. within social work education, there need to be more discussions and exploration of this issue to develop a better understanding of the implications for students to learn suicide prevention knowledge and skills through content integrated into their practice courses versus in a course devoted to the topic. apparently, there is agreement in the field that these are essential skills for social work students to develop and for programs to support (ruth et al., 2012; schmitz et al., 2012) and that is a good start. based on data from 151 social work programs, many social work students at the undergraduate and graduate levels lack access to opportunities to take a course dedicated to enhancing knowledge about suicide and expertise in working with individuals with suicidal thoughts and behaviors. macro courses on suicide focused on systemic issues seem to be particularly scarce (ruth et al., 2017), as most examples of courses focused on clinical practice. macro education on mental health topics, including suicide, is beneficial to social work students, providing them with essential knowledge to intervene at systemic levels, such as addressing social determinants of health (ruth et al., 2017; scott, 2015). schools of social work should consider the development of an elective in suicide if one does not already exist. this meets an identified need in the field (feldman & freedenthal, 2006; schmitz et al., 2012) and is often supported and desired by faculty (ruth et al., 2012) and students alike (almeida et al., 2017; quest et al., 2019; scott, 2015). conclusion to support more social work programs’ development of a suicidology course or courses that integrate substantial suicide content into a mental health course, it is necessary to understand the factors that prevent or facilitate the development of such a course. for example, the role of faculty expertise, while assumed to support the development of a suicide-focused course (ruth et al., 2012) is not well understood. future research should explore this topic, as there is a lack of knowledge of how prepared faculty are to teach this content or the prevalence of faculty with a specialization in suicidology. previous research has identified other concerns, including the impact of the content on students (kodaka et al., 2018) and the issue of a course on suicide conflicting with the values of the university, such as at a faith-based institution (jahn et al., 2017). funding may also help support the creation of a course, as in the example provided by almeida et al. (2017). it is important to better understand these issues to continue to develop more opportunities for social work students to develop expertise in working with individuals with suicidal thoughts and behaviors. advances in social work, fall 2022, 22(3) 1002 currently, as suicide education is not required content, social work students’ opportunities to develop skills through an independent course on suicide depends on the university at which they are enrolled. many social work programs, both bsw and msw, do not offer a course on suicide or one with substantial suicide content. therefore, schools of social work must evaluate their curriculum to ensure that suicide content is wellintegrated across the curriculum, from assessment and intervention skills in practice courses to suicide prevention policy in policy courses and theories of suicide in human behavior courses. suicide prevention, intervention, and postvention cannot be optional topics but must be taught to all social work students. references almeida, j., o’brien, k. h., gironda, c. m., & gross, e. b. 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(2011). school social workers’ experiences with youth suicidal behavior: an exploratory study. children & schools, 33(4), 215-228. https://doi.org/10.1093/cs/33.4.215 yard, e., radhakrishnan, l., ballesteros, m.f., sheppard, m., gates, a., stein, z., hartnett, k., kite-powell, a., rodgers, l., adjemian, j., ehlman, d.c., holland, k., idaikkadar, n., ivey-stephenson, a., martinez, p., law, r., & stone, d. (2021). emergency department visits for suspected suicide attempts among persons aged 1225 years before and during the covid-19 pandemic-united states, january 2019may 2021. morbidity and mortality weekly report, 70(24), 888-894. https://doi.org/10.15585/mmwr.mm7024e1 author note: address correspondence to rebecca g. mirick, school of social work, salem state university, salem, ma, 01970. email: rmirick@salemstate.edu https://doi.org/10.1111/j.1943-278x.2012.00090.x https://doi.org/10.1111/j.1943-278x.2012.00090.x https://doi.org/10.1080/10437797.2015.979095 https://doi.org/10.1080/15332985.2013.848831 https://doi.org/10.1093/cs/33.4.215 https://doi.org/10.15585/mmwr.mm7024e1 mailto:rmirick@salemstate.edu microsoft word 09_beasley_et_al_25311_apply_swk _________ lauren beasley, lmsw, ms, doctoral candidate, department of kinesiology, recreation and sport studies, university of tennessee, knoxville, tn. tarkington newman, phd, msw, ms, assistant professor, department of social work at the university of new hampshire, durham, nh. robin hardin, phd, professor, department of kinesiology, recreation, and sport studies, university of tennessee, knoxville, tn. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1212-1228, doi: 10.18060/25311 this work is licensed under a creative commons attribution 4.0 international license. applying social work values to practice in sport: perspectives of licensed social workers employed in collegiate athletics lauren beasley tarkington j. newman robin hardin abstract: social workers are beginning to be hired in collegiate athletic departments to meet the holistic needs of student-athletes. the limited research that has examined social work practice in sport has not explicitly explored ways in which social work values manifest in practice. the current study explored how the values of the social work profession are applied when providing mental and behavioral health services in collegiate athletics. using a qualitative design, nine licensed social workers employed in athletic departments were interviewed. data were deductively coded using the nasw (2017) code of ethics’ six values: service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. social workers recognized studentathletes as a vulnerable population, worked on social justice issues, placed an emphasis on the diversity of student-athletes, built relationships with both student-athletes and sport staff, and advocated for social work values in athletics. they also called for more opportunities to increase knowledge of social work practice in sport settings. results support the need for social work programs to prepare students for careers in sport through efforts such as offering elective courses related to social work practice in sport and providing sport-specific practicum opportunities. keywords: social work values; social work in sport; collegiate athletics; social work education; competence sport “represents a microcosm of societal issues, a platform to advocate for awareness of pertinent social justice issues, and a tool that can be used to promote the well-being of individuals and groups” (newman et al., 2019, p. 160). there has been increased visibility of mental and behavioral health needs (henriksen et al., 2019), as well as a variety of social justice issues (love et al., 2019) within a variety of sport systems and settings. for instance, star tennis player, naomi osaka, withdrew from the french open citing the need to protect her mental health related not only to the pressure of elite athletics but also the heightened pressure of being a female athlete of color, and star gymnast simone biles chose to not compete in several olympic events during the 2021 toyoko games due to mental health and mental performance concerns (silva, 2021). societal awareness has led to a paradigmatic shift in the provision of athlete care. sport organizations once favored treatment through a traditional medical model, but there has been a transformation towards the use of holistic care to effectively serve the diverse needs of athletes (waller et al., 2016). holistic care considers not only the physical health, but also the mental, emotional, social, and spiritual health of athletes. this comprehensive model of care requires an interdisciplinary team. social workers, who often take an ecological systems perspective beasley et al./sport as a swk speciality 1213 (ungar, 2002) and biopsychosocial approach (saleebey, 2001), are optimally educated and trained to work in holistic care teams within diverse systems and settings. indeed, the national association of social workers (nasw, 2017) recognized the defining feature of the professional as being focused on “individual wellbeing in a social context and the wellbeing of society” (para. 2). newman et al. (2019) discussed the potential for interprofessional collaboration between social workers and other professionals within sport systems and settings. in fact, social workers are being hired as youth sport program administrators, high school and collegiate coaches, and mental health providers in professional sport leagues. however, one of the most visible roles for social workers in sport are those who work within collegiate athletic departments providing mental and behavioral healthcare services (beasley et al., 2021; newman et al., 2021b). for example, findings from a survey administered through the alliance of social workers in sports email listserv indicated that among social work participants who responded (n = 84), 45.2% indicated that they worked in the area of collegiate athletics (newman et al., 2020). even so, much remains unknown about the roles of social workers and the services they provide within sport settings, particularly collegiate athletic departments. therefore, the purpose of the current study was to explore how the values of social work are applied by licensed social workers to the scope of practice in collegiate athletics. emergence of social work in sport the social work profession aims to enhance the wellbeing and basic needs of all people, but there is particular attention given to populations that are vulnerable, oppressed, and marginalized (nasw, 2017). the case for recognizing athletes—of all levels—as being a vulnerable population, for which social workers should provide services, has been established within the social work literature (dean & rowan, 2014; gill, 2008). for instance, research in youth sport has indicated that sport itself can act as a catalyst for not only positive (e.g., life skills) developmental outcomes (newman & anderson-butcher, 2021), but also behavioral health problems, such as aggressive and violent behaviors (newman et al., 2021a). athletes at the collegiate level also face many risk factors. student-athletes in revenueproducing sports (i.e., football and basketball), and student-athletes of color in particular (hawkins, 2010), face economic exploitation as an unpaid labor force that is denied the right to unionization. this has had heightened health and safety implications during the covid-19 pandemic (edelman et al., 2020), as many student-athletes continued to compete for their schools without the safety precautions taken by many professional teams, such as creating a bubble for athletes or not allowing fans into stadiums. there are also ongoing congressional conversations about student-athletes’ right to profit off of their name, image, and likeness, which many have argued is in contrast to the national collegiate athletic association’s (ncaa) notion of amateurism (o’brien, 2020). due to advocacy efforts of many stakeholders and student-athletes themselves, the ncaa recently adapted a temporary name, image, and likeness policy allowing student-athletes to profit from their personal brand, contingent on the specifics of state laws (hosick, 2021). due to these advances in social work, fall 2021, 21(4) 1214 varying pressures, elite athletes at all levels are at an elevated risk for anxiety, suicidal ideation, substance abuse, and eating disorders (moore & gummelt, 2019). taken together, research suggests the needs of athletes are often dynamic and complex. historically, social workers have been working in and engaging with sport since jane addams and the hull house settlement. in the 1890s, the hull house sponsored both boys’ and girls’ basketball teams and used sport and recreation programs as interventions (reynolds, 2017). eunice kennedy shriver, who founded the special olympics in 1962, began her career as a social worker (mcnamara, 2019). additionally, there is evidence that social workers have been providing services to student, olympic, and professional athletes since the 1980s (chengelis, 2020; goldaper, 1981; hanna, 1993). for instance, hanna (1993) explored the use of psychodynamically-oriented clinical social workers as sport consultants. lawson and anderson-butcher (2000) wrote about the social work of sport, both as a profession that can serve vulnerable, oppressed, and marginalized communities through sport, as well as a form of social praxis. in 2013, the social work and sport association at the university of michigan school of social work hosted a conference dedicated to exploring the intersection between sport and social work (newman et al., 2016). further, research by anderson-butcher et al. (2018), newman and andersonbutcher (2021), and others have demonstrated how a sport-based positive youth development program, as a social work intervention, is capable of promoting the healthy development of all youth, a goal set forth by the grand challenges for social work (2021). applying the code of ethics to social work practice in sport at the heart of the social work profession is the nasw code of ethics, which identifies six social work values, or beliefs, and their accompanying ethical principles, which guide the standards of the profession (nasw, 2017). the social work values are service, social justice, dignity and worth of a person, importance of human relationships, integrity, and competence. newman et al. (2019) outlined how—through the nasw code of ethics— social workers can enhance human well-being and help meet the basic needs of participants involved in sport. similarly, moore et al. (2018) empirically examined whether studentathletes believed their existing behavioral health services embodied the values of the social work profession. study results indicated that student-athletes believed social work values were moderately prevalent. for instance, 32% of student-athletes did not report a sense of importance of human relationships, and 30% of student-athletes did not feel that service and social justice were readily present. these results should not be a surprise given the research by beasley et al. (2021), which demonstrated that even though the presence of social workers in collegiate athletics was recognized, other professionals lacked understanding about the profession. although there is some literature looking at the experiences of licensed social workers in collegiate athletics (e.g., beasley et al., 2021; newman et al., 2021b), there remains a gap in the literature considering social workers’ specific perspectives on what social work practice in collegiate sport entails. beasley et al./sport as a swk speciality 1215 current study even with the emergence of social workers working in sport, there is limited literature related to the practice of social work in sport, particularly within collegiate athletics. previous social work literature has suggested how the nasw code of ethics can be used to guide social work practice in a variety of sport systems and settings (newman et al., 2019). however, to advance the social work profession, newman et al. (2021b) recently called for research to explicitly explore social work practice within specific sport systems and/or settings, such as collegiate athletics. therefore, the current study takes a step forward and explores how social workers who provide services within collegiate athletics actually apply the profession’s values. methods data collection procedures potential participants for this study were identified through review of online university staff directories of ncaa division i (di) athletic departments. social workers employed at di universities were chosen as di athletics are the highest level of competition at the collegiate level and offer the most athletic scholarships to student-athletes (ncaa, 2020). to yield rich qualitative data (patton, 2015), purposive sampling criteria included licensed social workers who were embedded within a di athletic department. in total, 15 licensed social workers were identified, representing nine different di institutions that were primarily located in the northeast, midwest, and southeast regions of the united states. each of the 15 licensed social workers were recruited via email, with nine social workers initially responding and providing consent to participate in the study. in an effort to maintain confidentiality—due to the limited population of participants—demographic information is reported as a group (streubert & carpenter, 2011). the majority of the participants self-identified as white and female and were an average age of 40 years. all the study participants held a master’s degree in social work, were licensed to practice in the state in which they were employed, and all had been in practice in collegiate sport, as a social work intern or licensed social worker, for a minimum of one year. semi-structured qualitative interviews were used for data collection. a semi-structured interview guide with 21 questions related to the participants’ career paths and professional experiences was created to guide the conversation with the goal of facilitating an in-depth discussion of the social worker’s experience (merriam & tisdell, 2016). questions included, “what does your average workday look like?” and “what prior training, if any, did you have to work specifically with athletes?” two questions specifically touched on the values of competence and service, but no questions explicitly addressed how social work values and ethics manifest in practice. consent forms were signed by each participant before participating in the interview. interviews were conducted by the lead researcher inperson (n = 2) and via telephone (n = 7). saturation of themes was determined to be met after the ninth interview, so the researchers chose to not continue to follow-up with the remaining identified participants(merriam & tisdell, 2016). interviews ranged from 30 to 60 minutes with an average length of 43 minutes. advances in social work, fall 2021, 21(4) 1216 data analysis interviews were transcribed by the lead researcher onto a microsoft word document, which helped to manage the data during the iterative analytical process. member-checking was also employed as participants were sent a copy of the initial transcript to check for errors and verify its accuracy (merriam & tisdell, 2016). three participants returned the initial transcript with edits, and one participant requested that no direct quotes be used in dissemination of results for confidentiality reasons. additionally, the lead researcher kept a researcher’s journal to remain reflexive during the interviewing and data analysis process (jasper, 2005). three main processes were conducted when performing the data analysis. first, interviews were reviewed through a close reading, and initial/open coding was completed by the lead researcher (saldaña, 2016). the lead researcher, due to their positionality as a licensed social worker, was sensitized to the presence of experiences related to the six core social work values. thus, “social work values” was one of the initial codes of the complete data set. data that did not fit into this constructed theme were ultimately coded in a separate analysis and were not included as a part of this study. second, the data coded in the initial “social work values” code were then deductively categorized by the lead researcher using the six core values of social work. third, the lead researcher engaged in a peer debriefing session with the other members of the research team. specifically, the research team discussed the construction of themes within each category until agreement was reached to ensure investigator triangulation (saldaña, 2016). positionality statement due to the constructivist epistemology of the study, acknowledging the research team’s positionality related to the research topic was needed, as the researchers themselves are the primary instrument of data collection, transcription, and analysis (denzin & lincoln, 2011; merriam & tisdell, 2016). in this way, the researcher’s interpretation of participants’ experiences is the base of qualitative methodology. none of the authors were collegiate athletes themselves, but all have professional knowledge and experience in elite athletics, ranging from coaching experience to working with administration in athletic departments. the lead researcher is a licensed social worker, has a graduate degree in sport psychology and motor behavior, and is pursuing graduate work in sport management. the second author earned graduate degrees in both social work and kinesiology. the third author has a graduate degree in sport studies and an academic background in sport management. together, the researchers approached the research with a critical, transdisciplinary perspective. they remained aware of their unique and intersectional positionalities related to the study’s topic and participants through reflexive discussions during peer-debriefing (saldaña, 2016). beasley et al./sport as a swk speciality 1217 findings and discussion findings from the current study are presented in six sections which align with the core values of the social work profession: service, social justice, dignity and worth of a person, importance of human relationships, integrity, and competence. service the value of service refers to the social work profession’s ethical principle to “help people in need and to address social problems,” particularly populations that are vulnerable (nasw, 2017, para. 22). participants commented that many of their peers (both in and out of social work) did not view student-athletes as a population that could benefit from this social work perspective. participant 3 summarized, “unfortunately, even in social work, there are a lot of people who don’t think they [student-athletes] are vulnerable, so they don’t take the time to learn [about] the population.” however, contrary to this notion, the social workers involved in this study described many different vulnerabilities of this population. further, participants discussed vulnerability as being related to the high demands and immense pressures on student-athletes. participant 8 stated the student-athlete population is at a particularly high-risk for adverse outcomes due to “the demand, the attention, the pressure to perform at a really high level, and the lack of free time that they have.” participant 7 mirrored this sentiment detailing the risk of over-identifying with one’s athletic identity: just the pressure of youth sports now is insane, and in eighth grade, you are being recruited, and mom and dad, whoever, put all this money into you, so you have to go to school, and by the time you get to college, you hate your sport….and yet you feel like you don’t have any other choice, you don’t have any identity, you don’t have any other friend outside of sport, because you have been doing it every day for the last ten-years. additionally, participants pointed to how the collegiate athletic culture can limit the development of interpersonal skills and put student-athletes at risk of abuse. participant 8 stated, “[student-athletes] can sometimes be in situations where coaches are [pause] are not coaching them in the appropriate way.” participant 4 further described this issue: they are a population that has been really primed to do what they are asked to do, follow directions, and that…we see from a sexual predator perspective puts them at risk. you know, they don’t know how to advocate for themselves, they often take abuse, and then it’s interesting because when they are in interpersonal relationships, they have some really unhealthy interpersonal relationships, because they have a lack of healthy experiences with being valued for having a different opinion: you don’t talk back to your coach, right, you just line up and do what you need to do otherwise you are going to work out more. the social workers in this study maintained the social work profession’s ethical principle of providing services to populations in need with attention to the various advances in social work, fall 2021, 21(4) 1218 vulnerabilities of the student-athlete population. their statements further the call from other social work scholars that, contrary to popular belief, student-athletes are a vulnerable population who could benefit from social work services (dean & rowan, 2014). specifically, the social workers in this study provided case management, clinical, and advocacy services to empower student-athletes and enhance their overall well-being. social justice the value of social justice relates to social workers’ ethical principle to challenge social injustice in any form (nasw, 2017). sport has long been a space of social justice advocacy (love et al., 2019), even predating kathrine switzer competing in the boston marathon in 1967, tommie smith and john carlos at the 1968 olympics, and billie jean king’s victory in the “battle of the sexes” in 1973. more recently, athletes have used their platform to advocate for racial equity and anti-racism (e.g., colin kaepernick, lebron james, bubba wallace, etc.), equal pay for women (e.g., the u.s. women’s national soccer team, allyson felix, venus and serena williams, etc.), lgbtq+ inclusion (megan rapinoe, hudson taylor, breanna stewart, etc.), and mental health and mental illness awareness (e.g., simone biles, kevin love, michael phelps, aly raisman, etc.), among other social justice issues. reflecting this movement, social workers in the study described how they have challenged social injustices on their campuses. as participant 1 explained, they intentionally make their office a “really different kind of space” than the athletic department and athletic culture as a whole by having a large “black lives matter sign right out front” and “me too things up on the wall.” participant 8 described a moment wherein they had to advocate to let an opposing team peacefully protest in their university’s gym, although administration ultimately did not allow the protest: “as a social worker, i’m like let these young men, who are mostly black, come into our gym and talk about why they kneel.” attention to the intersection of race and college athletics is an important social justice issue. specifically, scholars have examined the many ways in which college sport exploits the physical labor of studentathletes of color, many of whom are black athletes in the sports of football and basketball, to make money for coaches, athletic directors, and university administrators who are predominantly white, cisgender men (hawkins, 2010; rhoden, 2006). this has become even more apparent during the current covid-19 pandemic, as some universities have decided to continue to play both football and basketball, even at the risk of the health of student-athletes, almost certainly to maintain revenue (edelman et al., 2020). thus, advocating for the right of these student-athletes to have a platform and voice to fight this injustice is an important role not only for the social workers in this study, but also for the social work profession as a whole, especially in athletic organizations that generally lack diversity. general demographic data at all di institutions indicate that 60% of administrative positions are held by men, and only 15% are held by people of color (ncaa, 2019). by comparison, the student-athlete population of di institutions are 55% male, and 33% of student-athletes throughout the ncaa identify as persons of color. indeed, moore and gummelt (2019) point specifically to social work’s value and belief in social justice as a unique contribution to the care and support of athletes. beasley et al./sport as a swk speciality 1219 dignity and worth of the person the value of dignity and worth of the person distinguishes two primary beliefs that are the foundation to ethical social work practice: (a) social workers honor individual and cultural differences, and (b) social workers work to empower clients’ self-determination (nasw, 2017). social workers in the current study described specific ethical practice behaviors that support the value of dignity and worth of the person. concerning diversity, many of the participants described the importance of recognizing the individual outside of their athletic identity. participant 8 stated, “student-athletes’ identity of being an athlete is so profound, [so what] does it mean [for them] to explore other identities…i feel like it’s one of my roles to support them [in this].” similarly, participant 5 spoke about how cultural differences, especially for the international student-athletes at their institution, was a major consideration in their work around supporting student-athletes’ through transitions. as participant 5 explained: we get lots of people who have come from sun-shiny places and we start getting into seasonal changes with weather here…it can be quite the shock…if you have not been around seasons and rain and darkness and not seeing the sun…it has its own adjustment period. in response, this social worker described working to connect the students to resources to adapt to change in climate. thus, in work with student-athletes, social workers are not only offering clinical therapeutic services, but some also work in a case management role, connecting student-athletes to needed resources. social workers also described how they honor student-athletes’ cultural difference in their clinical work. for example, participant 1 developed a course on resilience for black male student-athletes. the creation of the course grew out of their frustration with the medical model approach to mental health, which dominates sport, and that many times ignores cultural issues (roderick et al., 2017). as this social worker explained: half of the black men [on campus] are in the athletic program…and the level of interest in traditional clinical services is the lowest among any [other] population on campus. so, its unethical to continue to insist that these students stay within that box [of traditional therapy] … but it serves the needs of the institution and the clinicians to adhere to that, and i am all about blowing that up. this point is especially important considering the aforementioned social justice issues facing black student-athletes. by conforming to traditional institutional standards and culture, student-athletes’ worth as a human with intersectional identities, not just as an athlete, may be diminished. thus, attention specifically to how these macro-level factors impact the mental health of these student-athletes is important to maintain the value of dignity and worth of the person as the foundation to ethical clinical practice behaviors, which may be lost in traditional clinical services, as participant 1 laments. self-determination work was usually centered around empowering student-athletes to speak to those in authority, such as coaches. social workers also spoke about how studentathletes would raise issues that they had with their coaches in therapy sessions. thus, much advances in social work, fall 2021, 21(4) 1220 of the work centered on empowering the student-athletes to work through conflicts with coaches one-on-one. as participant 4 described their approach to such conflict, “i will try to get them to talk to each other [student-athlete and coach] and say, ‘that sounds like something your coach would want to know.’” in this way, the social worker empowered the student-athlete to make their own decisions and validated the student-athlete’s decision to speak to their coaches, upholding the value of dignity and worth of the person by promoting the client’s self-determination. social work’s emphasis on diversity, cultural competence, and empowerment offers a unique approach to practice that may be missing from student-athlete care (moore et al., 2018). indeed, roderick and colleagues (2017) observed that sport research has somewhat neglected the mental health of athletes from a cultural perspective. recently, there has been a turn towards cultural sport psychology that emphasizes the need to attend to the sociocultural factors impacting athletes (ryba et al., 2013), which social workers are trained to do (council on social work education [cswe], 2015). in fact, one of the competencies of social work education is understanding that diversity and difference shape the human experience (cswe, 2015). importance of human relationships the value of importance of human relationships acknowledges the centrality of human relationships as a change agent (nasw, 2017). the social workers in this study described the importance of two distinct relationships: relationships with the student-athletes and with other members of the athletic department. both relationships were central to effective practice. in line with previous literature on the therapeutic dyad (ackerman & hilsenroth, 2003), the social workers consistently cited the need to build positive relationships with the student-athletes. the building of this relationship seems to be especially important when working with student-athletes, as help-seeking behavior in the population is low, many times due to the culture of elite sport that teaches student-athletes to “tough it out” (putukian, 2015, p. 147). for instance, the social workers pointed to the importance of getting to know the non-athlete identity of their clients as central to building the therapeutic relationship. as participant 3 explained, “people forget they [student-athletes] are just people.” when asked in what ways they build and maintain these relationships, participant 4 summarized the thoughts of many of the participants that “it just…very, very, very much depends upon the person…honestly, a lot of trust building.” additionally, participants discussed the importance of building relationships with other members of the athletic staff as key to providing effective services for student-athletes. the primary reason for developing these relationships were for referrals. social workers in the study indicated that they gained the most referrals from coaches, athletic trainers, and academic support staff. specifically, participants stated that they could get important collateral information from coaches and athletic trainers, as they spend the most time with the student-athletes. the social workers stated that much of their time, especially when they first took the position, was dedicated to establishing these relationships with other athletic support staff. furthermore, participants highlighted the importance of their office beasley et al./sport as a swk speciality 1221 being located within the athletic department. for example, participant 1 explained that having their office near the training room helped build positive relationships with other athletic staff, because they “interact with athletics people every day.” the importance of have trusting relationships with not only the student-athletes themselves, but also with other members of the student-athletes’ care team has been documented with social workers (beasley et al., 2021), but also in general literature concerning other professionals’ work in collegiate athletic settings (arvinen-barrow & clement, 2017). research consistently points to the need for interdisciplinary care teams in sport (waller et al., 2016), and, as the participants in this study reiterate, social workers working in collegiate sport should spend time developing these relationships. integrity integrity is the belief that social workers behave in a trustworthy manner (nasw, 2017), which encompasses maintaining a commitment to the values and ethics of the social work profession in one’s practice. participants pointed to the athletic departments’ commitment to the mental well-being of the student-athletes as being in line with the values of the social work profession. for example, participant 8 stated: it’s so important to us that we are going to have it [mental health programming] in the athletic department. that to me is the most important—what that means and what that says about your values and our ethics around student-athlete development and student-athlete support. participants also gave examples of advocating for and maintaining social work values, which in turn supported the ethical standards and principles of the profession. this advocacy is especially important because sport professionals are unfamiliar with the social work profession due to the fact that mental health programing in collegiate sport settings is dominated by clinical psychologists (moore & gummelt, 2019; newman et al., 2019; sudano & miles, 2017). for example, participant 8 described their experiences speaking to other members of the athletic staff about social justice issues in college sport, “i’m not saying my colleagues [non-social work colleagues] aren’t completely on the same page, it’s just a lot of conversations.” participant 1 also discussed similar ethical issues that present because mental health programming in college sport is overly dominated by psychologists. specifically, this social worker described a situation where they were advocating for structural change in the athletic department: my boss, a psychologist and counseling center director, said, “look you are not there to do advocacy, that is not what they are paying you for, you have to stop doing it. they [the athletic department] get to say what they want.” and i said, “this [advocacy] is in the nasw code of ethics.” overall, although participants pointed to a shift in the ethical commitment of many athletic departments, they still had to consistently advocate for and reinforce social work values in their own work and within the broader athletic department to maintain the integrity of their practice as consistent with the ethical standards of the profession. education and promotion of social work values and ethics seems especially important in advances in social work, fall 2021, 21(4) 1222 the setting of college sports, which is dominated by the medical model, and where mental health programming is most commonly provided by licensed psychologists (sudano & miles, 2017). consequently, many athletic professionals and student-athletes may be unfamiliar with social work. social workers in these settings must stay steadfast to their commitment to the nasw code of ethics and be willing to educate others about the social work profession. competence the value of competence guides the ethical principle that “social workers practice within their areas of competence and develop and enhance their professional expertise” (nasw, 2017, para. 37). the value of competence was somewhat contested among the participants. participants argued that specific training in sport—either through field placements, specialized courses, or even separate degrees in sport-related fields—is needed to become a competent practitioner in collegiate sport, especially if the social worker also provides performance enhancement services. for example, participant 9 pointed to the importance of having their field placement in an athletic department: “[it] really [was] an opportunity for me to gain some of that competence, because i was having the hands-on experience while still in school.” similarly, participant 2 did their master’s in social work, but their phd in sport psychology: i did my phd in sport psychology, so i got all the training in that field in addition to the clinical training…if you look at the ncaa best practices [for mental health programming], that’s what they recommend for mental health providers to really have that dual background. however, participants also felt their general social work education prepared them to work with the student-athlete population. for example, participant 3 discussed how their initial anxiety of working with student-athletes diminished when they realized the presenting issues were the same as issues they saw in their previous positions. they explained, “i realized it’s just anxiety, it’s just depression, it’s just transitions.” participant 4 pointed to how their prior work with non-athlete clients in private practice prepared them to work with the student-athlete population. participant 4 explained, “my private practice is mostly focusing on tbis [traumatic brain injuries] and has a sexual health component;” therefore, they had previous experience implementing interventions to address these issues. yet, participants still discussed that some experience with the sport culture, such as sportspecific courses and field placements, would have been beneficial in preparation for working with the student-athlete population. there were different opinions on the type of training needed to work with studentathletes. this tension is similar to conversations occurring in the psychology profession specifically around which professionals are best suited to provide performance enhancement services (beasley et al., 2021; mchenry et al., 2021). some argue that a sport psychology consultant with a masters or doctorate in sport psychology or related field from a kinesiology department is best suited to provide performance services, and others argue for a psychologist with a doctorate in counseling/clinical psychology who is a licensed mental health practitioner to provide these services (wrisberg & dzikus, 2016). to avoid beasley et al./sport as a swk speciality 1223 similar confusion, the social work profession can benefit from outlining sport as a subspecialty, similar to other nasw social work credentials. at minimum, as some social work programs are beginning to do (newman et al., 2020), incorporating sport courses into baccalaureate and masters-level social work programs and establishing sport-based field placements can better prepare social workers to work in sport settings. implications for the social work profession despite the growing demand for social workers in sport, little is known about what social work practice in sport looks like, particularly within collegiate athletics. this current study, through the lens of the nasw code of ethics, provides one of the first discussions of how the values of social work are applied to the scope of practice in collegiate sport. as some professionals, including some social workers, may not recognize student-athletes as a population in need of social work services, the participants in this study described the ways in which their work fits the ethical base of the social work profession. specifically, they identified student-athletes as a vulnerable population (service), worked on social justice issues (social justice), placed an emphasis on the diversity of student-athletes that is many times lost in athletics (dignity and worth of the person), built relationships with both student-athletes and support staff (importance of human relationships), and consistently advocated for social work values in athletics to maintain trustworthiness in their practice (integrity). in these ways, social work practice in sport can be considered a subspecialty. however, although competent social workers, the majority of participants did not have a sport-related social work field placement, and none had sport-specific social work courses. to fill this need and uphold the value of competence, social work programs should include specialized classes to teach students about the culture and ethical considerations of social work in sport, and field departments should create sport-specific field placements. furthermore, the social workers involved in this study described case management roles (i.e., connection to other university resources), clinical issues (i.e., identity issues), and social justice issues (i.e., black lives matter) that appear in work with student-athletes, as well as challenges they may face addressing them. these descriptions of social work practice in sport may be used to inform the development of specialized courses on social work in sport. limitations and future research a few limitations of this study should be noted. first, due to the qualitative and constructivist nature of the current study, findings are not meant to be generalized to all areas of social work practice in sport. however, findings do provide novel insight into social work practice within collegiate athletics, a recognized gap in the literature. second, potential participants were limited to social workers who were explicitly listed as being social workers on athletic department websites. therefore, social workers who do not use their credentials and/or those who may be contracted or working part-time were not recruited. third, it is important to note that the sample in the current study was not diverse (the majority were white females) and may not fully represent the intersectional identities advances in social work, fall 2021, 21(4) 1224 of social workers who are employed in this field. fourth, because only licensed social workers were included in the current study, the diverse perspectives of other stakeholders within college athletics were not captured. future research should consider engaging coaches, student-athletes, athletic administrators, and other athletics staff members. finally, as the intersection of social work and sport is ever-growing, new opportunities to gain sport competence are also becoming available, a trend that may not have been captured with these participants. thus, more empirical work on the roles of social workers working in collegiate sport is needed. future research can also consider taking different theoretical perspectives (e.g., career construction theory, see savickas, 2005) to further understand the emergence of sport as a social work subspecialty. conclusion despite these limitations, the social workers involved in this study offer key insights about how they maintained the core values of the profession when serving the needs of student-athletes involved in collegiate athletics. this information should be used to inform the development of specialized curriculum, education, and training opportunities for future social workers. for example, social work programs should include information about careers in sport as a professional track at student orientations and job fairs. moreover, programs should consider offering elective courses related to providing mental and behavioral health services in a variety of sport systems and settings. field placement opportunities also should exist for students interested in this subspecialty of social work practice, and social work departments can consider working with their university’s or college’s athletic department to establish practicum opportunities. furthermore, as many sport professionals have misconceptions about what social workers actually do (beasley et al., 2021), the information in this study can be used to educate sport administrators who are making hiring decisions to better understand what services social workers can provide to student-athletes. as this subspeciality of social work practices continues to grow and evolve, sport administrators should consider including social work as a preferred educational background when creating hiring announcements for their athletic departments. overall, social workers, with a practice foundation in the nasw code of ethics, have the opportunity to enhance the holistic well-being of student-athletes. references ackerman, s., & hilsenroth, m. 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(2016). the united states. in r. schinke, k. mcgannon, & b. smith (eds.), routledge international handbook of sport psychology (pp. 20-35). routledge. author note: address correspondence to lauren beasley, department of kinesiology, recreation, and sport studies, the university of tennessee, knoxville, tn, 37996. email: lauren.beasley@utk.edu _________ charla cannon yearwood, mssw, lsw, connected in community, indianapolis, in. rosemary a. barbera, ph.d., mss, associate professor, chair and bsw program director, la salle university, philadelphia, pa. amy k. fisher, j.d., lcsw, department of social work, university of mississippi, university, ms. carol hostetter, msw, phd, professor and bsw program director, indiana university, bloomington, in. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), i-vii, doi: 10.18060/25652 this work is licensed under a creative commons attribution 4.0 international license. editorial dismantling white supremacy in social work education: we build the road by walkingi charla cannon yearwood rosemary a. barbera amy k. fisher carol hostetter we are excited to share this special edition of advances in social work with you. when we distributed a call for abstracts, we were inundated – in a good way – with proposals. the need for social workers to discuss the role that white supremacy occupies within our history, education, and practice was obvious. because of the number of abstracts received, we made the decision to publish a double edition so that the important information contained in these articles can be widely shared. the submissions fell into three general themes--historical, instructional, and institutional examinations. each set of articles offers much for us to reflect and act upon moving forward. there is a reckoning happening and we are thrilled that this special edition is part of that reckoning. the purpose of this issue is to spark curiosity and critical thought around the ways white supremacy permeates our profession and our teaching. the black lives matter movement, along with other movements, have increased our awareness of how white supremacy invades all aspects of our society and the systems that govern it. social workers claim to make use of systems theory and to adhere to a code of ethics (nasw, 2021) that includes the values of social justice, integrity, and the dignity and worth of all as central to social work practice. given these values and the use of systems theory, the focus on understanding the pervasiveness of white supremacy should not be a new idea for social work. however, it is important for us to slow down enough to consider our blind spots and reevaluate our complacency in the structures we claim to resist. while it is true that there has a been racial reckoning of sorts in the united states since the ongoing and despicable murders of black people by the police, very few concrete changes have happened, even within social work. for example, the council on social work education created a task force that examined the proposed 2022 educational and policy statements (epas). the very first competency in the proposed epas called on social workers to be anti-racist, to go beyond non-racism to actively fight against racism. in the same competency, however, cswe continued to center gatekeeping – a white supremacist concept – and to prioritize “professional” communication, which really means white forms of communication (gray, 2019). this centering of white norms is often carried over to discuss “professional” dress and hair styles within our profession. social work has a stated commitment to social justice. at the same time, social work practice and education have a long history of engaging in practices that are racist and that perpetuate white supremacy. the roots of social work in the united states are tied to the about:blank advances in social work, summer 2021, 21(2/3) ii eugenics movement (gregory, 2020) and the theories used in social work are theories based on white, cisgender, heterosexual, patriarchal, capitalist worldviews. all of this is to say that social work does not live up to that expressed commitment to social justice. some ways that social work practice and education must interrogate themselves include the following: • epistemology: that is, how do we know what we know? or better said, what kinds of theories are we perpetuating? do we examine those theories closely to make sure they are not based on a white worldview? • history: whose history is taught? when we speak about the roots of social work there is often a good deal of focus on settlement house leaders like jane addams as well as charity organization societies leaders like mary richmond. both of these leaders ignored the needs of black and other people of color. and whose history has been left out (day & schiele, 2013)? • research: how do we conduct research? what are the frameworks we use? do we look to indigenous knowledge and accept non-white ways of knowing? often these ways of knowing are considered “non-scientific” (almeida et al., 2019). • community: do we prioritize individuals when in most of the world, community is more important? for example, jerome schiele (1997) points out that if we were to use an afrocentric framework we would always consider the community implications of our practice since people exist only in communities. how do we incorporate this in our teaching and in the assignments we give students? • boundaries: in social work in the u.s. there is an emphasis on boundaries, but for people whose roots are in the global south, this notion of boundaries is not only unknown, but it also does harm. • human development: how do we understand human development? which theories are we using to explain how humans exist and grow in the world? • white supremacy: do we explicitly name white supremacy in social work and call out the ways that social work continues to perpetuate white supremacy today? • disproportionality: are we addressing disproportionality in the child welfare system (lash, 2017; roberts, 2008)? all of this demonstrates how we prioritize whiteness and white ways of being in the world within social work. even how we teach and learn – the emphasis on the written word over the spoken word, for instance – perpetuates whiteness. the guest editors of this special edition of advances in social work were organized through the social work coalition for anti-racist educators (swcares). swcares has a mission to dismantle white supremacy in social work education (www.swcares.org). with this mission in mind, we set out to stir up conversation and challenge ourselves and our colleagues to assess and understand the past and current impacts white supremacy has had on social work practice, research, and education. if we take an honest look at our practices, our theories, our policies, and our underlying worldview, we must admit that social work is guilty of perpetuating white supremacy. we call on social work to decenter whiteness and eurocentric ways of seeing and being in the world from the curriculum. yearwood et al./editorial iii as guest editors, we made several efforts to resist unnecessary procedures which have been historically used to police the expression and dissemination of research. for example, all proposed manuscripts which met our requirements were offered the opportunity to present their full piece for publication. this allowed us to provide feedback and support for new authors, and met our desire for a diverse representation of authors. we asked our authors to follow the most recent guidelines of the associated press and capitalize the letter “b” when using “black” to describe the cultural group, black people (associated press, 2020). we also remained open to various methodologies that might challenge our traditional research or practice methodologies, since most research and forms of research are firmly entrenched in eurocentric thinking. the special double issue we divided the abundance of this special issue into three sections. in section i, we begin at the beginning—a foundation built from the true history of social work along with current-day lived experiences of bipoc social work students and teachers with racism in the academy and professional settings. section ii contains a wealth of instructional approaches, along with outcome evaluations that point to how to begin to know if these approaches aid in the goal of dismantling white supremacy in social work education. section iii includes institutional and extra-curricular approaches to dismantling white supremacy. we wrap this special issue up with several articles that issue a clear call to the profession for re-envisioning everything that we do. section i—begin at the beginning we begin with a series of articles that provide recommendations for infusing an accurate history of social work into the curriculum so as to disrupt the dominant white narrative of social work history while lifting and celebrating contributions of social workers of color. snowden details how social work needs, kneads, and eats black bodies in the way its concern for black citizenship waxes and wanes depending on the profession’s needs. shepherd and pritzker challenge the existing historical narrative by focusing on the history of african american political social work. mccleary and simard contribute to the critique by discussing frameworks for decolonizing social work pedagogy through a reconciliatory practice that aims to dismantle white supremacy. wright, akin, and carr provide a review of the literature on social work history to reveal how it is whitewashed, and write about notable bipoc social welfare leaders who should be added to the canon. next, we turn to the lived experiences of students and faculty of color. intentional, unwavering, and enduring attention to the experiences of bipoc students and faculty is essential to dismantling white supremacy in social work education. three articles offer insight into experiences of students of color, along with recommendations for future action. fussell-ware present six challenges for black, first-generation research doctoral students in social work programs. gooding and mehrotra detail results of a qualitative study of racial microaggressions as experienced by bipoc students and field instructors in advances in social work, summer 2021, 21(2/3) iv placement settings, while johnson, archibald, estreet, and morgan-henry conduct a critical analysis of challenges for black social work students created by white supremacy during field education. turning to experiences of faculty, fields and cunningham-williams provide a qualitative exploration of black women faculty members’ sense of self through the lenses of imposter syndrome and authenticity. king-jordan and gil explore the experiences of faculty of color when interacting with white colleagues, their students, and administration. azhar and deloach mccutcheon contribute personal narratives regarding their own marginalization within white spaces and the emotional labor that bipoc faculty are often asked to carry. duhaney and el-lahib elaborate on resistance from within—some of the ways in which they disrupt white supremacy and racist classroom dynamics. we end this section with rodgers’ qualitative investigation of black professional womens’ experiences within the academy using the lens of post-traumatic slave syndrome as well as post-traumatic growth. hipple, reid, williams, gomez, peyton, and wolcott explore experiences of the impact of white supremacy in classroom spaces using principles of griot storytelling, while bryant and kolivoski offer a mixed method investigation of faculty and administration’s perceptions of the impact of whiteness and white supremacy within the profession. perez investigates the experiences of faculty from different backgrounds teaching about race and racism in social work programs, while massey and johnson contribute an integrative literature review to see how recent literature characterizes “white ally” educators and explores concepts designed to prepare white educators for purposive action to dismantle white supremacy. section ii--instructional approaches this special issue contains a wealth of information on instructional approaches to dismantling white supremacy in social work education. mak, mucina, and ferguson offer a vignette to explore politicizing seemingly benign moments in the classroom, along with an analysis of classroom dynamics and practical suggestions to enact change. ortegawilliams and mclane-davis present their critical pedagogical approaches as black social work educators committed to liberation and healing. hanna, garza, and arnold-renicker outline a curriculum on crt and critical white studies used to both de-center whiteness and attend to the needs of bipoc students, and gregory provides a critical whiteness curriculum for social work. del-villar provides comprehensive definitions of key terms used in teaching social work practice from an antiracist lens and argues for the use of an anti-racist social justice pedagogy. several articles focus on specific theories and models. crudup, fike, and mcloone use the pyramid of white supremacy framework to critique social work and deconstruct post-racial fallacies ascendant within the profession. dagar, maglalang, and rao present theories written by bipoc scholars that can be used to raise the critical consciousness of social work students—kapwa, compa love, racial triangulation theory, cultural wealth, and breath of life theory. fisher focuses on the 7e model for cultural humility yearwood et al./editorial v and anti-oppressive practice. jemal and frasier describe an elective course in critical social work that uses the critical transformative potential development framework. other articles provide an in-depth look at specific pedagogical techniques. curiel explores interracial team teaching. riquino, nguyen, reese, and molloy describe the use of a transdiagnostic perspective of the dsm-5 to disrupt white supremacy. turning to outcome evaluation, copeland and ross investigate assessing antiracism as an educational outcome through a systematic review. although those authors found nothing in previous literature, several of the articles in this issue provide evaluations of instructional approaches designed to dismantle white supremacy. fulambarker buehler, rogerson, and gushwa provide a qualitative exploration of student experiences with racebased caucusing at a predominantly white institution (pwi). odera, wagaman, staton, and kemmerer used collaborative autoethnography to explore a racial justice practice course framed by crt and liberation theory. king keenan, kozu, mayhew, saitermeyers, meggett, and reynolds identify six core areas of learning following an intersectional experiential activity to address white supremacy, the starpower simulation. finally, tillotson, smith, and brewer describe an audit of required readings to assess the race and gender of authors as a tool for assessing bias in the curriculum. perhaps these articles can serve as the foundation for assessing antiracist outcomes in the future. section iii—institutional/extracurricular approaches and a call to the profession we begin the final section with a wealth of institutional-level and extracurricular approaches to dismantling white supremacy in social work education. bailly, brumley, mraz, morgan, o'neal, radis, wysor nguema, keeler, ocean, and spencer describe their experiences forming and reflecting on an anti-racism working group formed at a pwi. polk, vazquez, kim, and green detail their five-year systematic campaign to move all levels of their social work program from a multicultural orientation to a crt focus. riley, bewley, butler-king, byers, miller, dell, and kendrick describe the adoption of undoing racism principles in a pwi school of social work. calvo and bradley provide a narrative analysis of a school of social work’s adoption of two strategies to deconstruct the hidden nature of whiteness in theories, methods, and practices of education—the latinx leadership institute and the equity, justice and inclusion initiative. albritton, watkins, de marco, przewoznik, and heil detail the process of a school of social work re-visioning the way it approaches generalist practice through leadership, strategic planning, and initiatives. frey, mann, boling, jordan, lowe, and witte describe the space for uprooting whiteness, where white social work students examine and uproot their relationship to white supremacy and domination. we end the final section with a set of articles addressing the complicity of the social work profession as a whole in maintaining white supremacy, and calling for changes in the profession. two articles make the case for centering the experiences and knowledge of bipoc. rangel considers the characterization of social workers of color as outside agitators when dispelling myths and practices used in and for communities of color. stevenson and blakey discuss how social work history and anti-blackness highlight the advances in social work, summer 2021, 21(2/3) vi need for divesting the profession from systems of social control and anchoring social work in theories articulated by black people. three articles consider the particular role of white women within the profession in upholding white supremacy. plummer, crutchfield, and stepteau-watson detail examples of the ways white women, including those in social work, use emotionality, bureaucracy, and the law to control black bodies. aguilar and counselman-carpenter explore challenges to dismantling white supremacy faced by heterocentric white female social workers. donohue-dioh, wilson, and leota call for white social workers to be woke disruptors, rather than the liberal enemies described by malcolm x. in all, we hope that this special issue will help advance our conversations in social work education around white supremacy and how it influences our practice, research, and education. recognizing that our code of ethics calls us to “pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups” (nasw, 2021, para. 21), we believe it is important for social work as a profession to consistently evaluate its own institutions for ways we can practice what we preach. as social work educators, we have the ethical and moral responsibility to learn, grow, and challenge ourselves. we can do better. we must do better (swcares, n.d.)ii. references almeida, r. v., werkmeister rozas, l. m., cross-deny, b., kyeunghae lee, k., & yamada, a. m. (2019). coloniality and intersectionality in social work education and practice. journal of progressive human services, 2, 148-164. https://doi.org/10.1080/10428232.2019.1574195 associated press. (2020, july 20). explaining ap style on black and white. associated press. https://apnews.com/article/archive-race-and-ethnicity-9105661462 day, p., & schiele, j. (2013). a new history of social welfare (7th ed.). pearson. espoesía. (n.d.). caminante no hay camino: antonio machado. https://www.espoesia.com/poesia/antonio-machado/caminante-no-hay-caminoantonio-machado/ gray, a. (2019, june 4). the bias of ‘professionalism’ standards. stanford social innovation review. https://ssir.org/articles/entry/the_bias_of_professionalism_standards gregory, j. r. (2020). social work as a product and project of whiteness, 1607-1900. journal of progressive human services, 32(1), 17-36. https://doi.org/10.1080/10428232.2020.1730143 lash, d. (2017). when the welfare people come: race and class in the us child protection system. haymarket books. national association of social workers [nasw]. (2021) code of ethics. https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://doi.org/10.1080/10428232.2019.1574195 https://apnews.com/article/archive-race-and-ethnicity-9105661462 https://www.espoesia.com/poesia/antonio-machado/caminante-no-hay-camino-antonio-machado/ https://www.espoesia.com/poesia/antonio-machado/caminante-no-hay-camino-antonio-machado/ https://ssir.org/articles/entry/the_bias_of_professionalism_standards https://doi.org/10.1080/10428232.2020.1730143 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english yearwood et al./editorial vii roberts, d. (2008). the racial geography of child welfare: toward a new paradigm. child welfare, 87(2), 125-150. schiele, j. h. (1997). the contour and meaning of afrocentric social work. journal of black studies, 27(6), 800-819. https://doi.org/10.1177/002193479702700605 swcares. (n.d.). social work coalition for anti-racist educators. https://www.swcares.org/ i from a poem written by antonio machado. he worked for the opposition to the dictator franco in spain and had to flee the country (espoesía, n.d.). ii follow swcares on facebook and twitter (https://www.facebook.com/swcares/ and @swcares2) https://doi.org/10.1177/002193479702700605 https://www.swcares.org/ https://www.facebook.com/swcares/ _________ sarah ross bussey, phd, lcsw, director of care management, mount sinai health systems, new york, ny, and cofounder of (de)liberate, llc. aitan eliach, lmsw, behavioral health social worker, new york. alexis d. jemal, phd, lcsw, jd, lcadc, ma, associate professor, silberman school of social work, hunter college, city university of new york (cuny), new york, ny. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 321-343, doi: 10.18060/27593 this work is licensed under a creative commons attribution 4.0 international license. cultivating critical consciousness: ways to support and/or constrict the magic of critical dialogue sarah ross bussey aitan eliach alexis d. jemal abstract: anti-black racism, rooted in white supremacy, is a public health crisis in the us that infects and affects every aspect of life. critical consciousness (cc) and its derivatives, such as transformative potential, have been elucidated as the antidote to the disease of white supremacy. further, with the current focus on anti-racism and diversity, equity, inclusion, and belonging (deib) initiatives, strategies aimed at raising cc are becoming the norm. one strategy to develop critical consciousness is engaging in critical dialogue, difficult conversations that connect macro and micro contexts by exploring issues of power, privilege, and oppression. this paper considers a case study of participant data obtained from the critical dialogue component of community wise, an innovative, multilevel, behavioral health, group intervention grounded in critical consciousness theory. the purpose of the paper is to identify and discuss the best practices for critical dialogue facilitation that emerged via a qualitative analysis of the selected community wise sessions. keywords: critical dialogue, critical consciousness, facilitation, anti-black racism, qualitative research white supremacy perpetuates dehumanization by upholding a constructed racialized hierarchy that places white-presenting individuals at the top—as the norm, those deserving of power—and everyone else as “less than” (billings, 2016; daniels, 1997; mills, 2014), and thus, unworthy of humane treatment (jemal, 2021). persistent race-based disparities in health/mental health, educational attainment, wealth, and employment, as well as hypersurveillance by law enforcement and subsequent overrepresentation in the legal/carceral and “family policing” (roberts, 2022) systems demonstrate the perniciousness of antiblack racism (alexander & west, 2012; bailey et al., 2017; bonilla-silva, 2017; carratala & maxwell, 2020; hill, 2004; oliver & shapiro, 1995). anti-black racism, rooted in white supremacy, has been recognized as a public health crisis in the us that infects and affects every aspect of life (center for disease control and prevention, 2021; jee-lyn garcía & sharif, 2015). in response to the racial justice uprisings after the murder of george floyd in may 2020, as of august 2021 there were 209 declarations of racism as a public health crisis made by public health boards and/or government entities within 37 states in the us (american public health association, 2021, p. 1). the disproportionate violence against people of color by law enforcement, characterized as modern-day lynching (goffe, 2014) and the perpetuation of race-based health inequities necessitate a public health intervention to address systemic racism (bailey et al., 2017; carratala & maxwell, 2020; hudson & about:blank advances in social work, summer 2024, 24(2) 322 gehlert, 2015; jee-lyn garcía & sharif, 2015). however, these trends of racial disparities are too often understood as individual deficits, which fail to connect the individual experience to the systemic structures of inequity. individuals are blamed for their own oppression and this focus on individual-level causal factors leads to individual-level solutions. when determining interventions to address race-based health disparities, solely focusing on the individual (intrapersonal and interpersonal) level ensures dehumanization will continue, as anti-black racism is structural and systemic (feagin & bennefield, 2014). critical consciousness (cc) and its derivatives, such as transformative potential (tp) (jemal, 2021; jemal & bussey, 2018), have been elucidated as the antidote to the disease of white supremacy. while critical consciousness interventions can occur at the intraand interpersonal levels, their focus is multi-level (micro-macro), highlighting how individual experiences are a microcosm of larger, systemic forces at work (e.g., interpersonal racism is rooted in a historic racist structure in which individuals are socialized and through which racist outcomes persist). further, with the current focus on anti-racism, diversity, equity, inclusion, and belonging (adeib) initiatives, approaches aimed at raising cc are becoming more prevalent (binkley, 2016; corneau & stergiopoulos, 2012; nichol, 2004; pender greene, 2007). given structural racism continues to plague the united states, it is enmeshed in social work’s history and clinical practice (bussey, 2019). thus, at times social work practice has acted to expand social rights, and at other times constrained them (ehrenreich, 1985; thompson, 2002; walter et al., 2017). paradoxically, social justice is integral to social work practice and professional identity. the national association of social workers (nasw, 2021, paragraph 2) code of ethics preamble states, “social workers promote social justice and social change with and on behalf of clients…and strive to end discrimination, oppression, and other forms of social injustice.” for the social work profession to make consistent adeib progress, which includes interrogating its oppressive history and contemporary practices, the field must be intentional about how it educates future social workers. according to kang and o’neill (2018), oppressive dynamics “are inevitably embedded in all interactions and conversations, including those in social work classrooms” (p. 187). social work students must confront structural, relational dynamics that impact their practice and orientation of the profession. ideally, social work education should incorporate critical conversations on structural racism and other forms of oppression. gutierrez, for example, highlighted the personal-social action link, stating that “the development of a group consciousness...results in a critical perspective on society that redefines individual, group, or community problems as emerging from a lack of power. this consciousness allows students (or those engaged in cc raising efforts) to focus their energies on the causes of their [service users’] problems rather than changing their subjective internal states” (gutiérrez & ortega, 1991, pp. 26-27). further, in social work practice and in tandem with cc development, these cc approaches aid workers and service users in countering oppressive forces through individual and collective actions (fay, 2011). accordingly, social work theorists have promoted critical consciousness and critical dialogue as integral components of social work education and practice (knipe, 2020). circle et al./cultivating critical consciousness 323 critical dialogue one strategy to develop critical consciousness is engaging in difficult facilitated conversations known as critical dialogue. critical dialogue may consist of group meetings in which participants reflect on historical/sociopolitical contexts and engage in dialogue to develop a deeper understanding of how marginalizing processes (e.g., racism, sexism, classism) impact their lives and behavior (diemer et al., 2006). the critical dialogue components in group work might incorporate pictographs, reflective questioning, and colearning in the group process. although useful for professionals engaging in group work, it is also relevant to difficult conversations on a stoop, on a street corner, within families, and across community groups. further, critical dialogue is beneficial for individuals committed to anti-racism and anti-oppressive work as one method to bridge divides, as discussions are had without feelings of judgment or alienation of those involved. meaningful dialogue creates space for individuals to examine and critique different perspectives, narratives, and engrained beliefs through the framework of love and respect. as such, the authors view critical dialogue as a tool that can help us reclaim our humanity, dismantle white supremacy, support our healing process from dehumanization, and move us forward in the journey towards liberation. different from discussion (wherein the purpose is to voice thoughts, beliefs, and opinions) or debate (wherein the purpose is to convince others that a certain perspective is right), critical dialogue promotes critical analysis and questioning. this questioning occurs within a power analysis, challenging how thinking and believing certain ideas and in certain ways benefits/disadvantages various groups/statuses and serves to maintain a hierarchical status quo. paulo freire’s (1970/2000) critical pedagogy theory is foundational to critical dialogue as it fosters a rigorous interrogation of the relationships in peoples’ lives and their oppressive potential (jemal, 2017). freire promoted knowledge-sharing within democratic spaces where questioning is encouraged and where expertise is spread amongst all the participants (freire, 1970/2000), decentering the teacher as the bearer of truth and expertise. as such, critical dialogue is about creating democratic spaces and processes, and “examin[ing]… differences, which are embedded in privilege and power, and work[ing] toward shared meanings and actions for social justice” (laman et al., 2012, p. 198). respectful argumentation and disagreement can lead to meaningful social analysis and understanding of self and others. critical dialogue promotes critical introspection via the awareness of power relations and dynamics among participants and society (kang & o’neill, 2018). through consciousness raising and locating oneself within social relationships, an individual’s identity can no longer be separated from the environment or relational networks (corrigan & leonard, 1978/1983; dominelli, 2002). concerningly, numerous scholars highlight that social work professors may not be prepared to effectively facilitate critical dialogue and self-reported discomfort with leading critical conversations (finn, 2020; garcia & van soest, 2000, 2006; goldingay, 2020; sue et al., 2009). initiating or compounding this issue of comfort and preparedness is a lack of support, resources, training, cultural norms, and workable strategies for incorporating critical dialogue in many academic institutions. further, depending on the level of support of the academic institution, critical dialogue may make faculty the object of exclusion or advances in social work, summer 2024, 24(2) 324 retribution. more specifically, faculty of color face a disproportionate burden of addressing issues of race, power, and oppression, which make them the target for micro-aggressions and structural violence (particularly in historically/predominantly white institutions). potential micro-level consequences include not getting tenure, decreased productivity, increased stress, and decreased health/wellness. so, although researchers found that social work academics from disenfranchised social or ethnic groups were better equipped to respond to uncomfortable but essential conversations on racism, doing so may be detrimental to their career and/or physical/mental health (garcia & van soest, 2000, 2006). the facilitator’s role: supporting a culture of critique a potential key aspect of critical dialogue is the presence of a facilitator. facilitators have a unique opportunity to support the cc-development process. if done poorly, however, facilitation may cause individuals’ critical consciousness to not develop or regress. problematic facilitation can lead to confrontation (calling out individuals with no opportunity to hear countering points/different perspectives); and/or debate (power struggles in which each party is trying to win/convince others that their side/position is “right”). of note, facilitation is a role that is presented in different ways across groups, communities, professions, and spheres. facilitators come from all walks of life and the facilitated critical dialogue skill is not limited to “trained professionals,” such as social workers or group counselors. a group engaged in facilitating critical dialogue functions as a microcosm of broader societal trends and power dynamics (gregory & philosophy documentation center [pdc], 2007). consequently, facilitators' social identities impact group dynamics and power relations and must be deconstructed. critical conversations are more than likely to be difficult and challenge the core assumptions of participants. the facilitator’s role is to normalize critique, foster reflections, model dialogic etiquette, promote questioning, and help participants communicate constructively (gregory & pdc, 2007). although critical dialogue requires open and transparent communication, the facilitator should not be overly permissive (guilar, 2006). as such, the facilitator’s expertise is not in the substantive parts of the conversation as subject matter experts but rather in supporting the conversation flow and ensuring the dialogue is constructive. the facilitator’s role is to steer the conversation away from inflammatory or provocative remarks (guilar, 2006). facilitators promote critical introspection and help participants identify underlying assumptions. the conversation should invite participants to be critical of each other and themselves while being respectful and open to changing their thoughts or beliefs. this does not mean the facilitator acts as a censor or autocrat but rather helps the participants learn to listen and foster mutual respect. accordingly, nagda and roper (2019) state that facilitators are “bridge-builders, border-crossers, and boundary-challengers. intergroup dialogue facilitators work to build bridges of communication, understanding, and collaborative action across divides marked by social identities and status” (p. 124). unlike other pedagogical approaches, critical dialogue is non-hierarchical; therefore, everyone in the room is equal, contributes to the power dynamics, and their roles require exploration. as an extension of this work, facilitators respect the autonomy of participants circle et al./cultivating critical consciousness 325 and are encouraged to ask open-ended questions to help the group identify social problems, focus on structural inequities, and be sources of information and knowledge. with this approach, facilitators may “identify important alternative views not raised by the group” but refrain from telling participants how to think (gregory & pdc, 2007, p. 61). importantly, critical dialogue participants learn critical reflection over time and should not be coerced in adopting the facilitator’s ideology or position (gregory & pdc, 2007). in other words, the trajectory of a critical dialogue cannot be predetermined. still, the facilitator should be open about time allotment and constraints, and participants should feel free to critique those boundaries while respecting them (guilar, 2006). gregory and the philosophy documentation center (2007) posit that a core goal of dialogical facilitation is to lead the group to self-management. eventually, participants in critical dialogue groups will learn to supportively question each other, interrogate the group's power dynamics, and collectively self-manage. participants are learning experientially how to facilitate critical dialogue, which increases opportunities for more people to engage in critical dialogue in various settings. social work and critical dialogue facilitation one strategy that may disarm or circumvent defense mechanisms is for social work practitioners and educators to facilitate critical questioning (with service users or students, respectively). this entails encouraging participants to think about the socio-political construction of their situation and address internalized oppression (allan et al., 2003) or establish connections between their challenges and their socio-political context via the constant reflection on these issues (heron, 2005). these methods have been supplemented with a realization that critical practice can sometimes move forward only in small steps through conversations that honor service users’ perspectives as constitutive and primary (gallop, 2018). contextual constraints it is probable that many formal critical dialogue facilitators operate within oppressive institutions imbued in white supremacist tenets, which constricts effective critical dialogue as challenging these norms is dangerous (golden & jorgenson, 2022; dismantling racism [dr], 2016). golden and jorgenson (2022) purport that employees are never relationally or ideologically separated from their employer’s identity or structure. in other words, the employing institution confines and greatly determines the actions of the employees. similarly, academics and non-profit workers are employees and subject to material precarity, which can be enacted in the classroom and with service users. for example, zembylas (2018) argued that power dynamics in the classroom could never be overcome; egalitarianism in the classroom was impossible. the existing power dynamics must be highlighted during critical dialogue facilitation. in summary, existing scholarship points to the value of facilitating critical dialogue— how it creates a space for participants to identify, critique, and develop collective action to counter oppressive dynamics. while critical dialogue is crucial to challenging dominant oppressive social frameworks and imagining more inclusive and equitable spaces, the advances in social work, summer 2024, 24(2) 326 existing scholarship does not specify whether structured critical dialogue, the facilitation approach, or both, promote critical consciousness amongst a heterogeneous population. one central barrier to successful critical dialogue is effective facilitation within a context where liberatory thinking is possible. existing literature highlights that the quality of facilitation may be critical to the success of critical dialogue. experimentation around and assessment of facilitation methodologies are needed. this research addresses this gap by exploring effective and ineffective facilitation approaches for efficacious critical dialogue. this paper offers a case study of session data obtained from the facilitated critical dialogue component of community wise, an innovative, multilevel, behavioral health, group intervention grounded in critical consciousness theory (see jemal et al., 2022; l. windsor et al., 2014; l. c. windsor et al., 2014) for in depth discussions of the community wise intervention). the purpose of the paper is to better understand, discuss, and identify the best practices for critical dialogue facilitation that emerged via a qualitative analysis of this session data. the findings will help inform critical dialogue facilitation both in social work classrooms and in the field. methods the parent study this study derives from a parent study (for further details see windsor et al., 2018) that was grounded in critical consciousness theory, community-based participatory research principles (cbpr), and the multiphase optimization strategy (most). the parent study used a 2 × 2 × 2 × 2 factorial design to build out the community wise intervention in an efficient and effective manner, with scalability in mind. this approach enabled the intervention to be provided for no more than $250 per participant. the study was tailored to serve a sample of men (n=528) residing in newark, nj, usa with legal and substance misuse histories. additional inclusion criteria included being 18 years or older; being english-speaking; having been released from a closed-custody facility in the past four years; willingness to be audio recorded throughout the community wise sessions (audio recording occurred for the purpose of assessing intervention fidelity); and having the capacity to provide consent. a primary aspect of the study design was the capacity to detect changes in the participant’s alcohol and/or injection drug use. randomized assignment stratified participants into 16 conditions comprised of some combination of these intervention components: peer or licensed facilitator, group dialogue, personal goal development, and community organizing. the study setting was a community-based agency (also in newark) that offered services including but not limited to medical and behavioral health services. the project had one peer facilitator and two licensed facilitators. the number of attendees in each session varied from week to week with an average of two participants. circle et al./cultivating critical consciousness 327 current study to select the groups from the parent study for this analysis, the authors used the cumulative critical consciousness (cc) scores of the group members assessed by an 11item assessment tool with a 6-point likert scale of agreement that was developed by the newark community collaborative board (nccb) in 2014. the score was calculated as a summation of individual item scores that ranged from 12 (lowest cc) to 72 (highest possible cc). the measure has recently undergone exploratory factor analysis (efa) and confirmatory factor analysis (cfa) testing, but those results are forthcoming. efa results suggested a bifactor model with one general cc factor and two specific subfactors (i.e., knowledge and action). based on cfa fit indices, the hypothesized bifactor model provided a very good fit for the data. as examples, two items on the measure are “i challenge the oppressive culture under which we live (messages, images, and language) by learning about the issues that affect my community” and “i attend meetings where we discuss issues about my community.” to explore the facilitation of the critical dialogue component of community wise as a tool for developing critical consciousness, two voice-recorded community wise sessions were selected, transcribed, and analyzed. the authors used quantitative methods to determine which two of the 16 community wise groups (comprised of service users) had the greatest increase in critical consciousness. a phd-level statistician provided descriptive statistics for the intervention (individual components and their combinations): a comparison of means of critical consciousness score at baseline, and results of repeated measure anova and manova using the number of interventions as the independent variable. the preliminary results suggested no significant differences between the 16 treatment groups (p=0.5464, including between those facilitated by peer versus licensed facilitators, as both were offered). the statistician then did a subset analysis which excluded those individuals who started with high baseline values (~ >=60) since these individuals were not expected to have significant changes in their critical consciousness. the summary of the analysis comparing the critical consciousness scores at different time points for the sixteen intervention groups showed no significant differences in mean critical consciousness scores between the 16 groups. four potential groups were identified as having the biggest increases in mean cc scores. the two with the greatest increase in mean cc scores were selected for the qualitative analysis included in this paper. the data analyzed were transcripts from the community wise intervention completed by the two groups identified as described above. each group session ran from one-two hours. one group ran for nine sessions and the second group ran for 12 sessions. using dedoose (sociocultural research consultants, llc, 2023), a web-based data analysis program, the three co-authors of the paper coded the data independently. predetermined codes consisted of concepts related to critical consciousness development identified in the literature (e.g., critical thinking, action, blame, denial). the authors also completed in-vivo coding when a theme emerged related to critical consciousness development. accompanying the in-vivo coding process, the coders composed coding memos to detail their thinking and explain their interpretations of the data. when comparing codes, the coding team noted the difficulty each person had with coding participants’ manifestations advances in social work, summer 2024, 24(2) 328 of critical consciousness. in contrast, the in-vivo codes appeared with ease when predominantly focused on the facilitator and the facilitation of the critical dialogue. in other words, the richness of the transcript data offered descriptive codes that captured themes across sessions and most often related to the approach to facilitation. during this time, third author jemal (who facilitated critical dialogue sessions of the community wise intervention in 2012 and co-authored the community wise facilitator manual) found that the community wise dose (attendance) did not have a positive correlation with the measure of participants’ critical consciousness. this result seemed to explain why there were no significant differences between the 16 community wise groups and why the coders were having difficulty coding the data for critical consciousness development. it is very hard, potentially impossible, to code the absence of some phenomena in the data. with this new information in mind (and considering the contrastive experience of coding cc development versus facilitation approaches), the coders decided to pivot focusing on facilitation approaches and potential impact. common codes and agreed upon codes were identified, discussed, and added to the code book. the coders determined and confirmed that they reached saturation when new codes ceased to emerge (and by spot-checking additional data for potential new codes). the team exported codes and memos to an excel sheet. team debriefing sessions involved discussions of each code, memo, the relationships between codes, any convergences (when raters applied the same code to the same parts of the transcript), and any divergences (when raters applied different codes to the same section). this process led to findings that examine critical dialogue and critical dialogue facilitation. this investigation could shed light on why attending more of the community wise groups did not increase critical consciousness while also providing potential facilitation strategies for critical dialogue facilitation. findings there is a gap in knowledge regarding effective critical dialogue facilitation. as introduced above, during data analysis the role of the facilitator and facilitation skills emerged as impacting the potential for participants to engage effectively in critical dialogue (and therefore engage in critical consciousness development). through the authors’ shift to focusing on facilitation instead of participant cc development, the research question became what is the impact of the facilitator/facilitation approach on critical dialogue facilitation; which facilitation strategies might constrict, and which might enhance, critical consciousness development? the authors offer these exploratory findings as a window into understanding the practice of critical dialogue facilitation. excerpts from the data revealed facilitation strategies that supported transformative critical consciousness development. in contrast, other excerpts provided key moments when facilitation appeared to shut down critical consciousness development. the findings are presented within these two buckets for the purpose of illustration but are not mutually exclusive—in the same interaction, examples of both forms could be found. in addition, these approaches exist on a continuum and these examples are meant to exemplify the findings and are offered as teachable moments. this section opens with a discussion of contextual variables that likely impacted circle et al./cultivating critical consciousness 329 facilitation. next, supportive facilitation strategies are discussed, followed by constricting facilitation approaches. implications are explored in the discussion section. table 1. themes and subthemes that emerged from the data theme subthemes brief description problematic contextual variables for facilitation manualized impact of using a manual when aiming to develop cc time scarcity pressure created by a sense of limited time and with end goals prescribed identified as nontherapy lost opportunities for connection created when personal histories and emotive reactions cannot be explored cc supportive facilitation clarification seeking more information about and clarity around participant experience creativity using creative approaches to engage content with participants flexibility the capacity to prioritize connection and relationshipbuilding within the intervention curiosity leading with a curious mind and being responsive; fewer assumptions use of humor infusing humor to aid in joining with participants instilling hope bringing optimism and possibility into engagement constricting facilitation one-track mind hyperfocus on the manual and intervention lost opportunities failure to explore, examine, or expound on the participant experience when offered an inroad distancing creating a rupture through expressed judgement or assumptions confrontation failure to explore the “why” behind a participant’s perspective and instead engaging in a power struggle binary thinking working from a framework based in mutually exclusive and opposing definitions of a concept or experience problematic contextual variables for facilitation aspects of the design of the community wise intervention had the potential to constrict cc development via the limitations it placed on the facilitators. these include it being manualized, time-limited, and identified as non-therapy. some facilitation strategies mitigated these problematic contextual variables (outlined in “cc supportive facilitation” section below), while other strategies exacerbated them. how the facilitator viewed their role or understood their function within these external confines had the potential to negatively impact the group dynamic. manualized at multiple points the facilitator shut down the conversation by referencing the program manual. although not the intent by the program developers in having a manual as a guide for the training, if the facilitator interpreted that the participants were not getting the “take home message” intended by the curriculum, the facilitator would have the advances in social work, summer 2024, 24(2) 330 participants read it from the manual. this created the impression that the facilitators prioritized the manual content and not the experience of, input from, or feedback from the participants. facilitator: do you see a lot of happy families in inner city communities? participant 2: only when they drinking. facilitator: only when they under substance use. okay. how would you define a family? in addition, one facilitator consistently corrected participants as they read aloud from the manual, which could be experienced as disrespectful (creating distance). this finding raises the question, beyond the scope of this analysis, of how the manual content could be improved to reduce the likelihood of such interactions, versus what was an issue of facilitator training/interpretation. time scarcity a sense of time scarcity was reinforced by a manualized and time-limited approach. it resulted in the facilitator making the “connections” for the participants and them simply acquiescing and agreeing. facilitator: so, in this picture right here, do you see any of that happen in 2017? do you see any black people being sold? participant 1: no. participant 2: no. facilitator: any forms of being sold, i mean in any way. maybe being on a stand, maybe it's just a man in shackles, hands, and feet. he's about to see the judge. maybe. participant 1: that's a form of being sold? participant 2: yeah, that's a form of being sold. participant 1: yeah. we get incarcerated facilitator: so, this is still happening. identified as non-therapy throughout the sessions, minimal space was made, or time allocated, for participant emotions to be processed in the group setting. when participants mentioned traumatic events (i.e., their first experience using a substance, history of molestation), the facilitator moved away from those topics quickly or ignored them entirely. in this way, they kept the group process as an intellectual experience, which reinforced the dis-membering of dehumanization (disconnection from the body and humanity). cc supportive facilitation the themes explored below (clarification, creativity, flexibility, curiosity, use of humor, instilling hope) encapsulate facilitation strategies that enhanced and/or encouraged cc development. circle et al./cultivating critical consciousness 331 clarification clarification involved facilitators eliciting more information from the participants about their experience or perspective. it allowed for open-ended discussion and for participants to describe their own reality. like active listening, it created space for participants to clarify what they meant if the facilitator’s interpretation was off (finn, 2020). this generated a shift whereby the participants’ expertise in their life experience was given weight. facilitator: who's in your social support? participant 1: my two sisters, my god-brother. i got a god-brother he'd been driving for [large state transit system] for three years now. he calls me, come over and that's all he talk about. facilitator: really? participant 1: yeah. he don't even take the transit clothes off. he's riding around, he goes south with his transit clothes on. yeah, that's how much he was just...i had class b and he had got his class b. he's younger than me, he's like 37. and he was like, "i'm about to get my class b license." because, he ain't know what he wanted to do. he worked for...what was the airline that went out? [large airline company]. facilitator: [large airline company]? participant 1: yeah, he was with [large airline company] when he went out. after that, when they went out he got a good piece of money because he's been there for a long time. he ain't know what he wanted to do. this is what he decided to do was drive buses. he got his license like that. working mad hours and he's still doing a lot of hours. he's been working out there three years. they got him on a 76, [bus route name]. he been doing the [bus route name] for a while. he's been doing that for a while, like four months now. he love that route. so this is what we talk about. facilitator: all right now. the facilitator’s use of open-ended questions and affirmation allowed for greater rapportbuilding and connection. creativity creativity of facilitation gave room for nuance, which helped the discussion content fit the needs and interests of the participant group. further, imaginative examples resonated more effectively with the participants. in moments when the facilitator went off script, group connection, relationship-building, and critical dialogue occurred. facilitator: so, let me change my hat [go off script]. i want to be devil’s advocate. participant 1: i see that today, yeah. advances in social work, summer 2024, 24(2) 332 facilitator: however, if i'm a white woman, upper. we all from the same... we're all born...today. my name is sally... no. matter of fact, i want to be bill. my name is bill. i'm a white man. we're all born together. do we all have the same opportunity? participant 1: no. as this excerpt demonstrates, the facilitator’s ability to pivot from the manual and reframe the discussion helped illuminate the social analysis within the group exercise. this made the content more accessible to the participants and engendered greater cc-development. flexibility flexibility in facilitation was evident when facilitators put energy towards relationshipbuilding and drawing connection to the humanity of all involved in the group, thus building a foundation of trust. in one instance, a participant relayed the need to get a colonoscopy, but that he had trepidation. the facilitator drew a connection between this experience and historic distrust in the medical system due to the exploitation of african americans. following the topic brought forth by the participant and demonstrating critical thinking in this way, validated the participant’s emotional state while offering a structural explanation for his micro-level experience (metzl & hansen, 2014). curiosity curiosity allowed the facilitator to explore participants’ thinking and perspective in place of seeking out a “right or wrong” answer. further it helped avoid engaging in a power struggle, which inadvertently causes people to dig in their heels, reinforcing their own perspectives/opinions (dr, 2016; miller & rollnick, 2013). facilitator: who do you think benefits when you are... when a person is backed against the wall and they're forced to sell drugs, who do you think benefits? participant 1: the person that's selling the drugs. facilitator: the person that's selling the drugs? even though they may go to jail? they have no retirement. participant 2: either go to jail or get killed. facilitator: so, who benefits from selling drugs? participant 1: the dealer still benefits. facilitator: the dealer. participant 1: he still benefits. ain't nobody else benefiting but him. facilitator: even when he gets caught? participant 1: that's the chance he's taken. facilitator: so that's his benefit? participant 1: he already know the consequences. circle et al./cultivating critical consciousness 333 use of humor humor was used to break the ice and join with the participants. humor reduced the intellectualizing of the experience and got participants back into their bodies. of note, this approach was delicate, because when the joke did not land, it created distance (i.e., in some encounters, the facilitator attempted to joke with the participants, but the jokes didn’t resonate, and this strained the group dynamic.). the following example demonstrates banter in which it appears the facilitator was trying to employ humor that did not resonate for the participants. facilitator: so, next week we could agree. i could bring coffee. if you guys...if you want to leave here early and go get some coffee and come back. so, at least it's still hot. participant 1: [inaudible] been stressing over the coffee. facilitator: you seem like you're stressing over the coffee. you asked and you talked about the coffee. participant 2: as soon as you seen her, "you got coffee?" facilitator: as soon as you seen me, "where's the coffee?" participant 1: yeah, but see, you came in, so i just say, "we ain't really stressing over the coffee." facilitator: no, because i thought about that. i said, "if i get the coffee, it's not going to be hot by the time they get here at three o'clock." so that's why i said, "no, i don't think they're going to enjoy the coffee." instilling hope freire (1970/2000) believed that hope was needed for building the foundation of cc (followed by love for self and own/other’s humanity). the following excerpt demonstrates facilitation skills employed by the participants to one another. it highlights this strategy and serves as a reminder that facilitation does not only occur by professionals. in this excerpt, one participant aimed to instill hope in the mind of the second participant by suggesting they avoid focusing on the negative: participant 1: could be better, but it always could be better. facilitator: what could be better? participant 2: ain't no use in complaining about it. facilitator: complaining about what exactly? participant 1: the way it is. facilitator: the way life is or where you are in it? participant 2: ain't no use in complaining about it. constricting facilitation constriction via facilitation, or “shutdowns,” related to the facilitator (e.g., facilitator’s personality or style), to the facilitation strategies or techniques, and to the environment or advances in social work, summer 2024, 24(2) 334 impediments of the environment (discussed above in problematic contextual variables for facilitation section above). the themes explored below include one-track mind, lost opportunities, distancing, confrontation, and binary thinking. it is important to note that these findings are not a reflection on the facilitator training process, the intervention, or the manual. these findings do not suggest why these constricting facilitation encounters occurred (e.g., the training endorsed certain practices, facilitators need more training, or facilitator’s interpretation of implementation and how they enacted the sessions), only that they did come through in the findings. one-track mind the “one-track mind” approach came through when the facilitator was hyper-focused on the way in which information was presented in the manual. this resulted in overgeneralizations about content, which was counter to cc-development and missed the nuances and complexities of societal forces. for example, when speaking about employment opportunities and race, the facilitator attempted to drive home the point that racism makes employment more difficult for african americans than white people. unfortunately, the example offered by the facilitator remained at the individual level, failed to account for systemic oppressive dynamics, and offered a reductionistic (as opposed to intersectional and macro-informed) perspective. a one-track mind approach also appeared when the facilitator attempted to counter presumed distorted thinking on the part of the participant(s). although prior scholarship notes the importance of challenging cognitive distortions to develop cc (jemal et al., 2022), the one-track mind response created a power struggle with the participant(s) which inadvertently compounded the constriction of ccdevelopment. lost opportunities a heightened focus on sticking to the manual and curriculum led to many lost opportunities wherein the facilitator failed to explore, examine, or expound upon what the participants were bringing to the discussion and/or their experiences of being in the group (e.g., being asked to do homework or having a manual that is different than the facilitator’s). in one session when the topic was disproving conspiracy theories about the origin of hiv/aids, a participant intimated a story about sexual violence leading to false accusations, incarceration, further sexual assault during incarceration, hiv diagnosis, and substance misuse. after sharing this, the facilitator responded with: facilitator: don't go to world news. i want to see if you could just type it in a word search and see what comes up. participant 2: how did hiv begin? facilitator: yes. the opportunity to explore a traumatic memory and connect it to concerns about public health, sexual wellness, healing etc., was lost. instead, the facilitator directed the participant back to an internet search on conspiracy theories. evident in this dialogue was how the outcome or product of the curriculum derailed the process of cc development and circle et al./cultivating critical consciousness 335 blinded the facilitator. it was unclear if the facilitator was skirting the topics raised due to the pressure to stick to the manual, a lack of clinical skill, or other anxiety. regardless, the outcome was the silencing of the participant and a failure to create connection. distancing distancing occurred when the facilitator did or said something that created a rupture between them and participants, between participants, or between participants and others. this exemplifies the opposite of relationship-building. in one instance, the facilitator approached sobriety from an abstinence-only framework. this precluded the participant’s ability to define their own form of success in relation to substances and countered any potential benefit of a harm reduction approach. participant 1: every time i wake up in the morning i'm better because i'm going to be able to see another day. and every day that i can stay sober, i'm better. facilitator: how many days sober? participant 1: hm? facilitator: how long sober? participant 1: how long sober? i haven't been counting. well, lately i haven't gotten drunk, so...but i do good. i go to [outpatient clinic], i take my 3 days at [outpatient clinic], and i come here on saturdays. i don't hang out...i be where i stay all the time. i don't do nothing, i just get tired of being in the streets. this excerpt shows the facilitator (potentially inadvertently) policing the participant’s behavior after the participant put up a particular façade around sobriety. confrontation with confrontation, the facilitators pitted themselves against the participants (intentional or not). for example, in a discussion around sexuality and parenting, one of the participants stated views about being gay in an apologetic way (gay parents “don’t mean to be this way”). the facilitator attempted to unpack this perspective, but it came across in a prosecutorial style, whereby the facilitator fell into a question-and-answer trap (miller & rollnick, 2013). eventually a second participant disclosed “despising gay men.” instead of exploring and trying to understand the “why” beneath that statement, the facilitator responded, “why are you being biased?” this eliminated the possibility for the participant to interrogate the source of their sentiment (labeling it as wrong) and removed the potential for dialogue and/or evolution of perspective. while the facilitator stated that the group was an open space with no judgment, their confrontational approach instead shut the participants down and skewed the group dynamic. advances in social work, summer 2024, 24(2) 336 binary thinking binary thinking is counter to critical analysis and reinforces white supremacist notions of ways of being/knowledge (hardy, 2022; dr, 2016; okun, 2010). one example of this occurred when the facilitator recreated racist narratives, categorizing all people of a particular racial identity as uniform, and bolstering the idea of racial groups as monoliths. facilitator: so, do you think this is, so is this yes or no? doesn't know history, doesn't know self. we're talking about the whole black community. you think that's a, yes? participant 1: they don't know their history. facilitator: so that's a check for that one. binary thinking seemed to shut down critical dialogue whereas expansive thinking may help to open the dialogue to include more perspectives and the potential discovery of the ways in which white supremacy operates. this finding leads to more questions: 1) how could the facilitator have challenged the notion that individuals within one racialized group are a monolith, and 2) would exploration along those lines have benefited participants engaged in critical dialogue? discussion community wise serves as a case study for this exploration of facilitation. as a manualized intervention intended to develop critical consciousness and engage its participants in collective community action, one of its main components is facilitated critical dialogue. however, the goal of this analysis was not to evaluate the community wise manual or intervention efficacy. instead, it was to provide exploratory findings around effective facilitation strategies for engaging in critical dialogue. this analysis revealed that the approach of the facilitator has great potency, and that potency lies not so much in their formal education (as there was no difference in outcomes for the groups facilitated by peers versus licensed professionals), but in the facilitation strategies employed within each critical dialogue opportunity. in other words, facilitation effectiveness may be due to expertise in techniques and strategies of facilitation and not intervention content. in addition is the consideration of how dynamics such as race, gender identity, socioeconomic status, and sexuality come into play within group development and critical dialogue (carastathis, 2014; crenshaw, 1991). an earlier paper on facilitation practices for this and similar interventions identified traps that facilitators can fall into that counteract the potential impact of the intervention (i.e., the question answer/trap, the expert trap, the confrontation/denial trap; jemal et al., 2022). the findings of this analysis identified times when the facilitators fell into these traps (similar to these codes in this analysis: as confrontation, binary thinking, and onetrack mind). our findings indicate how these traps created lost opportunities for cc growth and increased distance between facilitators and participants. given that facilitators of critical dialogue are not experts or teachers who have hierarchical roles in the traditional ways that many are educated, practice guidelines could support critical dialogue facilitators circle et al./cultivating critical consciousness 337 in implementing this practice and evaluating their work. for example, practice guidelines on how to avoid binary thinking (e.g., discussing racial groups as a monolith) and engage expansive thinking-wherein facilitators identify the gray area or available options (e.g., by exploring the nuances within racialized groups) could be helpful. jemal et al. (2022) suggest a suite of facilitation skills to avoid facilitation pitfalls— socratic questioning, developing discrepancy, rolling with resistance, reframing, and summarizing. the aspects of supportive facilitation that promoted critical consciousness found through this data analysis (creating connections/relationship building, clarification, creativity, use of humor, and instilling hope) align with these protective facilitation strategies and are necessary components for employing them. in other words, curiosity makes possible engagement in socratic questioning, flexibility, and humor to be able to clarify meaning to reframe content and instill hope. further, connection and relationshipbuilding deepen the impact of these skills. relationship-building aims to create a brave space for dialogue and vulnerability while considering and working through fears. additional effective strategies involved allowing ideas that arose in the discussion to guide the conversation, which offered participants the opportunity to be the leaders and fostered a learning community (smith-maddox & solórzano, 2002). in this way, facilitators modeled how to think critically (as opposed to identifying the “correct” answer). the findings indicate that the goal of facilitated critical dialogue may be to create a liminal space between structure and flexibility in which critical thinking, growth, transformative healing, community-development, and risk-taking might occur (see figure 1). figure 1. proposed space for effective facilitated critical dialogue growth-promotion through critical questioning, transformative healing, & community-mindedness, using a both/and approach advances in social work, summer 2024, 24(2) 338 social work educators, and practitioners in various fields might use critical dialogue in the classroom with students, in private practice with clients, and in institutions with coworkers, collaborators and other service providers, with these facilitation strategies as a guide. while the findings from this analysis point to the critical role of the facilitator in supporting or constricting the development of critical consciousness, they also serve as a reminder that external variables (e.g., context, training, limitations of intervention framework, time scarcity, professional pressure) have great impact. specifically, and deserving of further research, manualized interventions with fidelity concerns may pose a hindrance for some facilitators. in community wise, the manual provided exercises and takeaway messages, but this approach may not have provided sufficient flexibility for facilitators and participants to engage with the ideas meaningfully or critically or to spontaneously follow the group’s interests (perhaps one solution would be to make clearer within a manual where a facilitator has more discretion). whether due to their perceived pressure to perform, deliver the “right” message to participants, or reach a particular final takeaway, the facilitators potentially lost sight of the dialogic process (and the process itself is where cc cultivates as it allows participants to arrive at their own conclusions in their own way). more research is needed to understand whether the manualized approach undermined the creation of an egalitarian learning community, which placed limits on the potential for co-learning and the deconstruction of larger societal oppressive systems (freire, 1970/2000; gutiérrez & ortega, 1991). future research and limitations it is important to note that community wise was a research project in which the facilitators were receiving supervision with regards to fidelity to the model. moreover, the supervisor was the employer of the facilitators. the impact that these factors had on the data and, thus these findings, is unknown and difficult to measure. in addition to being part of a research study, only two of forty-eight groups were selected for study based on the critical consciousness scores as described in the methods section. further, given this was a case study, the findings may be hard to replicate, and the transferability of the findings are limited. in addition, the dual role of the third author leaves room for increased researcher bias. additional intervention research would be beneficial to identify alignment with and/or divergences from these findings. in addition, future scholarship could further evaluate forms and methods for cultivating critical dialogue (including the qualitative aspects of effective critical dialogue). such research may help elucidate how much flexibility to bake into intervention design to allow for organic group development via the discretion of facilitators. such an understanding is important due to the need for fidelity in intervention analyses. formal research inquiries could explore if and how facilitators interrogate their own appropriated racial oppression (versey et al., 2019) and whether alignment is needed between facilitator and participants with regards to race, ethnicity, language, and/or lived experience. future research could also study the efficacy of a train-the-trainer approach for facilitators. furthermore, examining supervisory impact on facilitation would be useful. the authors assume that facilitators are influenced by the clinical practice style of their trainer(s)/supervisor(s) (i.e., based on how the trainer would facilitate groups). research circle et al./cultivating critical consciousness 339 could unearth how facilitation changes when having supervisors with different practice styles. last, future research could explore the collaborative development or revision of the manual informed by graduates of the intervention. those who have experienced the facilitation methods firsthand have invaluable insight. this could inform the development of a facilitation guide that describes processes and strategies for creating the liminal space between structure and flexibility outlined above. references american public health association. 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(2018). reinventing critical pedagogy as decolonizing pedagogy: the education of empathy. review of education, pedagogy, and cultural studies, 40(5), 404-421. author note: address correspondence to sarah r. bussey; 646-413-2295; one gustave l. levy place, box 1252, new york, ny 10029; sbussey@gradcenter.cuny.edu orchid id: 0000-0001-7702-5538 author note: sarah r. bussey and alexis d. jemal were funded by a grant from nimhd. research reported in this publication was supported by the national institute on minority health and health disparities of the national institutes of health under award number r01md010629. the content is solely the responsibility of the authors and does not necessarily represent the official views of the national institutes of health. https://doi.org/10.1186/s13063-018-2624-5 https://doi.org/10.1186/s13063-018-2624-5 https://doi.org/10.1186/s13063-018-2624-5 https://doi.org/10.1016/j.ijlp.2014.02.023 https://doi.org/10.1016/j.ijlp.2014.02.023 https://doi.org/10.1080/10714413.2019.1570794 https://doi.org/10.1080/10714413.2019.1570794 mailto:sbussey@gradcenter.cuny.edu cultivating critical consciousness: ways to support and/or constrict the magic of critical dialogue abstract: anti-black racism, rooted in white supremacy, is a public health crisis in the us that infects and affects every aspect of life. critical consciousness (cc) and its derivatives, such as transformative potential, have been elucidated as the a... social work and critical dialogue facilitation methods the parent study discussion _________ michael campbell, phd, lcsw, associate professor, robert lucio, phd, lcsw, associate professor, khalilah louiscaines, lcsw, instructor, and courtney wiest edd, msw, assistant professor, graduate social work department, saint leo university, st leo, fl. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 318-337, doi: 10.18060/24865 this work is licensed under a creative commons attribution 4.0 international license. the role of residencies in promoting student engagement in online pedagogy michael campbell robert lucio khalilah louis-caines courtney wiest abstract: the covid-19 pandemic has fractured social connections across all industries, including higher education. some social work departments were forced to shift from traditional on-ground learning to adopt virtual delivery methods, while others voluntarily made this shift to join the emerging online education trends. when the pandemic restrictions abate, online programs may seek to promote social connections through targeted activities such as adopting a grounded residency. online programs in social work and other fields have varied application in using residencies to bridge the online and onground modalities for learning. students often report asynchronous online platforms foster a reduced sense of engagement in learning and low levels of connected engagement with faculty and peers. in social work programs, these residencies build on explicit and implicit curricular aims and have an argued externality of building engagement. this paper explores data collected from students (n=131) in a master's in social work program before the initiation of pandemic social distancing protocols and their perceptions of engagement related to their grounded residency experience in one online social work program in the southeastern united states. results of survey data (quantitative and qualitative) are presented and analyzed with a discussion of the relative impact residency efforts may have on students' reported levels of engagement and opportunities to increase social connection in a post-pandemic environment. keywords: social work, grounded residency, online education, student engagement, social connection over the last two decades, higher education has shifted learning offerings to multiple platforms. research has examined learning outcomes, community, and engagement in online platforms versus grounded counterparts. various studies have demonstrated online platforms' ability to provide similar learning goals and outcomes to traditional delivery methods (rovai, 2002; thompson & yuku, 2006). furthermore, the research has highlighted the benefits of technological advancements with learning online. lastly, online learning platforms during the pandemic have allowed many students to continue their education. with the learning platform's shift, examining student engagement and pedagogical strategies becomes paramount for educators in every discipline. about:blank campbell et al./role of residencies 319 literature review implicit curriculum and social work accreditation social work education utilizes a competency-based framework to assess student learning outcomes (council on social work education [cswe], 2015). as a result, social work programs must evaluate their explicit and implicit curriculum for accreditation purposes. the explicit curriculum pertains to the "formal educational structure" (p. 11), including coursework and field education. the implicit curriculum is related to the "learning environment" (p. 14) or the context where students encounter the explicit curriculum. this context includes diversity, policies, procedures, resources, administrative structure, advising, and governance (cswe, 2015). accreditation standards provide clear expectations for measuring explicit curriculum; however, there has been little guidance on measuring and operationalizing the implicit curriculum of social work programs (bogo & wayne, 2013). understanding implicit curriculum in recent years, increased attention has been invested in exploring the implicit curriculum of social work programs. the implicit curriculum is described as a "culture of human exchange" (cswe, 2015, p. 14), which bogo and wayne (2013) suggested must be reinforced throughout every student interaction within an educational program. they further assert that the entire educational experience in a program, which extends beyond the classroom and field, socializes students to the profession. miller (2013) further suggested that the implicit and explicit curricula impact social work students' professional socialization to social work. the student's experience in education programs serves as a "bridge" (p. 384) between the formal education structure (explicit curriculum) and the learning environment (implicit curriculum), which prepares students for the profession. grady and colleagues (2020) provided an excellent review of the existing literature surrounding implicit curriculum and social work education. grady et al. (2011) identified six domains of implicit curriculum to include community, diversity, faculty advising, support services, field, and academic experiences. the authors note field and academics are primarily considered explicit curriculum, with experiences in these settings contributing to a student's learning environment. in their pilot study utilizing a mixed-methods approach, 64 graduating msw students were surveyed to measure each domain's positive and negative aspects. results suggested that each of the six domains contributed to the student learning environment and student engagement. the implicit curriculum survey (ics) was further tested and validated through a multi-program study involving four accredited msw programs and further confirmed the impact of the implicit curriculum on the student experience (grady et al., 2018). in this study, two cohorts of graduating msw students (n=262) identified positive and negative aspects of each domain. in addition to validating the psychometric properties of the ics, it provided the first validated instrument for measuring the implicit curriculum. qualitative responses from this multi-program study were further analyzed in a 2020 study to understand student perspectives on the implicit curriculum (grady et al., 2020). overall, students reported advances in social work, summer 2022, 22(2) 320 positive and challenging aspects of each domain, providing insight on ways programs can attend to the implicit curriculum to improve the student experience. more specifically, students identified faculty support and presence, interactions with peers, and opportunities to engage with faculty outside the classroom as factors that strongly influenced their experience. students also reported additional challenges such as fatigue, limited time, and lack of quality supervision which served as distractors during their time in the program, further identifying ways to improve learning outcomes. although the findings of this study were limited to msw students in traditional brick-and-mortar onground programs, it provides insight into the impact that specific aspects of the implicit curriculum can have on the learning environment. student responses reflected mixed results about the impact implicit curriculum had on program selection. for example, some students reported location was the primary determining factor for which social work program they applied to; however, several students acknowledged aspects of the implicit curriculum that influenced their decision to enroll in a program. peterson and colleagues (2014) utilized an empowerment framework to conceptualize how experience with aspects of the implicit curriculum contributes to professional empowerment. using a pilot survey administered to 423 msw students, their study evaluated the impact of the implicit curriculum on professional empowerment. four measures of implicit curriculum were used, which included diversity of faculty and staff, supportive faculty, opportunity role structure (involvement with the decision-making process and extracurricular activities), and access to information. findings from this study showed opportunity role structure, meaning student involvement with decision-making processes and extracurricular activities, and access to information directly impacted empowerment and a sense of community. these studies have contributed to operationalizing and measuring the implicit curriculum; however, all have been conducted with on-ground programs. the measurement of implicit curriculum may differ depending upon modality – face-to-face compared to online or hybrid (grady et al., 2018). implicit curriculum in online programs due to the increased use of digital technologies in social work education, quinn and barth (2014) examined implicit curriculum for blended and online social work programs. in their msw distance education programs study, the implicit curriculum was operationalized as diversity, student development, faculty, administrative structure, and resources. sixteen msw programs responded to a cross-sectional survey and provided examples of how they attend to the various aspects of the implicit curriculum. findings from this survey suggest that while there is an increase in the use of digital technologies in social work education, many schools continue to utilize traditional methods of communication to engage with distance education students. additionally, while many programs utilized a blended approach to instruction, most included some face-to-face components that required faculty and/or students to travel. although quinn and barth (2014) did not provide insight into measuring implicit curriculum in distance education programs, they identified unique opportunities to contribute to the implicit curriculum. for example, digital technologies were reported to campbell et al./role of residencies 321 create a more diverse student body with more rural, nontraditional, and marginalized students enrolled in distance education programs, which further impacted student diversity. the authors also noted unique challenges such as faculty preparedness and training, technical support, and administrative coordination for online learning. the authors also noted that although schools incorporated digital technologies, many continued to rely upon traditional methods of communication such as face-to-face or phone conversations. morton and colleagues (2019) further examined the impact of social media on implicit curriculum, and student engagement for 80 msw students enrolled in on-ground and online programs. this is the first study to include online programs in assessing the impact of implicit curriculum on student outcomes. literature on social media and educational engagement suggests that using social media and other technology improves learning outcomes, student experience, and student engagement (morton et al., 2019). students who found the use of social media to be positive in improving communication with peers and faculty also reported higher levels of engagement with the program and decision-making processes. additionally, students in the online program reported higher levels of engagement, suggesting that technology can be used to enhance the learning environment, foster implicit curriculum participation, and enhance the overall student experience. the study's findings suggested that social media and other digital technology tools can increase connection with peers and faculty, which literature has shown is an important component of implicit curriculum. theoretical frameworks: social learning and engagement theories social learning theory (bandura, 1977) provides a framework for understanding the active and reciprocal nature of the learning process, which is influenced by internal and external factors such as motivation and environment. according to this theory, learning is seen as an exchange of ideas and knowledge, resulting in greater knowledge for all participants (vygotsky, 1978; wiest, 2015). online education creates a new environment for learning and engagement, which can directly impact the learning process (bernard et al., 2004; dumford & miller, 2018). engagement theory evolved from online education to examine the level of student engagement in the learning process. kearsley and shneiderman (1999) emphasized the principles of engagement theory that students need to be meaningfully engaged in the learning process through challenges, activities, and peer interaction. furthermore, engagement theory explores using technology to promote student engagement through various tools such as discussion boards, group projects, videos, web tours, web-live classrooms, problem-based learning, and implicit curriculum activities (wiest, 2015). through these activities and tools, students with varied learning styles can engage in the learning process (kearsley & shneiderman, 1999). conversely, the emerging theory differs from past technology theories where the importance was on the individual learning process or instruction method, while this theory emphasizes the group process (kearsley & shneiderman, 1999; wiest, 2015). prior research on student engagement identified six dimensions or themes to promote a sense of connection in higher education learning environments (campbell et al., 2019). these six dimensions (behavioral, cultural, advances in social work, summer 2022, 22(2) 322 emotional, intellectual, physical, and social) will serve as the themes used to code the qualitative data for this study. student engagement online challenges online education has become the norm and even a necessity during the pandemic. however, skeptics have challenged the effectiveness of online education in producing similar outcomes to the traditional platform. along with performance outcomes, skeptics have questioned the online platform's ability to provide the same level of connection, engagement, and community as the traditional learning environment (thompson & yuku, 2006; wiest, 2015). for years, instructors have valued the need to foster connection, community, and engagement in the learning environment to promote social learning. video conference challenges instructors are faced with additional challenges in promoting and providing equal participation for all students in the online environment. as online technology has evolved, video conferencing has aided in developing connection and engagement. students can participate in various activities to promote engagement, such as small groups, case studies, presentations, and small group discussions. along with video conferencing, researchers have noted the benefits of using social networking in the online environment to foster a connection with peers in a low-stakes arena (amador & amador, 2014). when students are connected and engaged in the collaborative process, they can develop skills, think critically, and acquire new knowledge among peers (bell et al., 2010; wiest, 2015). however, the cameras can be an additional obstacle to navigating the virtual classroom due to disparate access (reamer, 2013), increased anxiety and isolation (gillett-swan, 2017), and increased responsibilities (stoessel et al., 2015). instructors must be well trained in the tools available in the online platform to provide these learning opportunities, which foster engagement and connection (shirvani, 2014; wiest, 2015). several researchers noted an additional challenge in the online platform to promote engagement and connection was the lack of social interaction outside of the classroom or traditional learning time (drouin &vartanian, 2010; exter et al., 2009; rabe-hemp et al., 2009). participants in the study mentioned this as a significant barrier. a recommendation to alleviate this barrier was for the program to provide alternative opportunities such as social groups or clubs, residency events for networking or collaboration, and mentoring or buddy partnering. this effort may well serve to underscore that the concern for engagement of online learning is one of the 12 grand challenges for the field of social work, noted by the american academy of social work and social welfare, which calls for social workers to find effective ways to harness technology for social good (coulton et al., 2015). bridging the gap finding a balance in the online learning platform to enhance and develop connections is challenging. instructors and students are faced with physical barriers, the need to balance competing priorities, and time differences across the world. several researchers have campbell et al./role of residencies 323 explored learning tools and pedagogy practices to foster connection and engagement. many options have emerged to bridge the gap. some of these are: (1) hybrid programs with grounded learning dates; (2) synchronous and asynchronous learning platforms; and (3) a grounded residency requirement during the program. a few studies examined the use of a hybrid format to foster community and engagement. the studies have noted that using a hybrid format provides an optimal learning environment and flexibility for all students. these platforms allow students to have autonomy in their learning and engage with peers to foster connection (solimeno et al., 2008; wiest, 2015). kazmer (2007) examined the use of a residency offering in a master's program for librarians. residencies are defined as time-limited education sessions to provide in-depth training on key components in a field of study. the study found that students who participated in the residency program had a deep sense of community and connection with their peers and faculty that extended beyond graduation. the participants noted that this connection made group work and collaboration easier with their peers and faculty throughout the program. the students without the residency option developed peer relationships that were limited to specific classes and shorter in duration. the research suggested that providing face-to-face opportunities for students to connect with peers and instructors is an effective way to bridge the online environment gap. current study overview innovation has provided the opportunity for traditional and nontraditional students to pursue their learning goals. using technology, students can attend school anywhere. even more recently, during the covid-19 pandemic, the education and business sectors could utilize innovative technology to provide valuable services. while technology is an invaluable tool, there are barriers to promoting engagement, community, and connection. the literature suggested several strategies to address the gaps to provide the optimal learning experience. this study will examine the use of a program residency to foster engagement and connection to bridge the online learning environment gap and enhance the social work student learning experience. the residency is a blend of the explicit and implicit curriculum, fostering a connection between students, with faculty, and their peers. this paper will examine the pedagogical strategies and use of a residency in an online master social work (msw) program to foster student engagement and bridge the virtual environment gap. the study will examine the benefits of a one-time residency in the msw program to connect the students with peers and instructors via students' perceptions of engagement and connection during the residency. method this study utilized a qualitative approach to data collection and analysis. qualitative data were collected from a series of open-ended questions that explored the respondent's perceptions of academic engagement's six dimensions (behavioral, cultural, emotional, intellectual, physical, and social). advances in social work, summer 2022, 22(2) 324 study design this study was approved by the university's institutional review board and employed a cross-sectional design leveraging an electronic survey administered via qualtrics that asked students about their experience in the onsite residency. in addition to base demographics items, the study survey incorporated open-ended questions that expanded the learning from the structured questions. lessons learned are summarized and explored in the discussion section of this paper. on-ground residency experience the msw program at a small catholic liberal arts university in the southeastern region of the u.s. has built-in an academic expectation for all its students to participate in one oncampus intensive learning experience. this experience extends classroom-based learning through a series of interactive exercises that aim to amplify learning and promote student integration of key concepts in the profession of social work. this master's in social work (msw) program requires students to attend an annual residency event offered one time per year. at the time of the residency, some students were enrolled in the three-year part-time program, some were in the two-year full-time program, and others were in the one-year advanced standing cohort. table 1 provides a breakdown of demographics by cohort. students from all three cohorts were enrolled in the same course throughout the semester and attended the residency together. the residency extends the interactive nature of their online program with this in-person event to apply their learning outside of the classroom (implicit learning) and to develop a collegial network aimed at student success. for this study, the grounded residency focuses on leadership skills and invites the students to apply their prior virtual class learning through a group project in which they create the framework for a program aimed to promote social change. the student groups create, define, and present these program concepts to an expert panel for review. the panel provides feedback and applies a defined criterion/rubric to decide on the best project. this event is a highlight in the msw program and provides a venue for students to display the university's core values of excellence, community, respect, personal development, responsible stewardship, and integrity. data collection and instrumentation students were asked to provide anonymous qualitative feedback about their residency experience. students were asked to answer nine questions related to their experiences during the residency event. these included three open-ended questions about (1) the strengths of the event, (2) the least helpful components of the event, and (3) suggestions for improvement. the next three items asked about their experiences around the group project, such as (4) what were the strengths of participating in the project, (5) what areas could be improved upon, and (6) what could have been done differently. the final three items asked about the event's impact on their (7) connection to the msw program, (8) connection to their peers, and (9) connection to their faculty members. campbell et al./role of residencies 325 sample this study was conducted with two cohorts of msw students attending a residency weekend during the summer of their advanced clinical practice year. the program routinely has an active student body of more than 200 students who learn in a cohort model with full-time, part-time, and advanced standing tracks. a total of 164 students participated in the two residency events. most students were female (86.0%), and the mean age was 37.7 (sd = 10.02). white students made up 42.1% of all students, followed by black or african american (34.2%) and hispanic (14.6%). the plurality of students were full-time nonadvanced standing students (42.1%), followed by part-time (31.1%) and advanced standing (26.4%). the demographics of the students attending the leadership residency are consistent with the program demographics. overall, 131 students responded to the qualitative portion of the study, creating a response rate of 79.9%. table 1 provides full sample demographics. table 1. sample demographics (n=164) n (%) gender male 23 (14.0 %) female 141 (86.0%) race/ethnicity white 69 (42.1%) black or african american 56 (34.2%) hispanic 24 (14.6%) unknown 13 (7.9%) two or more races 2 (1.2%) asian program type full-time 69 (42.1%) part-time 51 (31.1%) advanced standing 44 (26.8%) mean (sd) age 37.7 (10.02) data analysis spss (version 26.0.0.1) was used to analyze all descriptive information, including frequencies, percentages, means, and standard deviations. all open-ended responses were coded using maxqda (version 12.3.3) using an a priori coding tree developed based on modes of engagement (campbell et al., 2019). these included behavioral engagement, cultural engagement, emotional engagement, intellectual engagement, physical engagement, and social engagement. see table 2 for a definition of the themes used. after identifying the initial themes, a second axial coding pass was used to identify subthemes. research team members completed the coding and met to discuss the themes and subthemes until consensus was reached. advances in social work, summer 2022, 22(2) 326 table 2. definition of themes engagement definition in the context of the residency perceived connection… behavioral through activity cultural through clarified identity emotional with faculty intellectual to academics physical by proximity social with peers results the results of these data are presented and analyzed in this next section. the qualitative responses are offered to help frame context for the student's perceptions on how the residency impacts their experience with the six dimensions (behavioral, cultural, emotional, intellectual, physical, and social) of academic engagement. table 3. distribution of themes and subthemes (n=523) theme and subtheme n (%) emotional 153 (29.3%) deeper connection 55 (36.0%) meeting in person 52 (34.0%) investment in student 40 (26.1%) connection in program 6 (3.9%) social 105 (20.1%) peer friendships 70 (66.7%) faculty relationships 27 (25.7%) professional networking 8 (7.6%) physical 100 (19.1%) connection to person 76 (76.0%) virtual program connection 15 (15.0%) connection by location 9 (9.0%) cultural 57 (10.9%) university/program 27 (47.4%) profession 13 (22.8%) cohort 12 (21.1%) self 5 (8.8%) intellectual 56 (10.7%) programmatic information 21 (37.5%) knowledge & skills 17 (30.4%) assignment 7 (12.5%) team 7 (12.5%) dedicated time and space 4 (7.1%) behavioral 53 (9.9%) structure of activities 25 (48.1%) class activity time 10 (19.2%) get to know you activities 9 (17.3%) motivational activities 6 (11.5%) capstone activity 2 (3.9%) campbell et al./role of residencies 327 a review of student feedback to open-ended survey questions was conducted to explore how students perceived the role of the residency in relation to the six dimensions (behavioral, cultural, emotional, intellectual, physical, and social) of academic engagement. within each of the major dimensions of academic engagement, additional subthemes were identified, which provided context to the overall theme. these will be discussed in detail below, and an overview can be found in table 3. emotional engagement (n coded segments =153; 29.3%) the theme most frequently identified by students was emotional engagement. these made up 29.3% of all comments. students defined four major subthemes related to emotional engagement, which were described as developing a deeper connection (36.0%), meeting in person (34.0%), faculty investment in students (26.1%), and connection to the program (3.9%). the greatest area within emotional engagement was related to students developing a deeper connection and feeling closer to their classmates and professors. they noted that while they see each other weekly via web cameras, meeting in person created a stronger connection. while there has been constant class interaction across their time in the program through emails, texts, and telephone calls, the meeting in person created a bond that was not established through communication alone. this bond was enhanced as students shared time together both socially and academically. even though they knew each other through synchronous online classes, the weekend created a connection they felt would last a long time as friends and future colleagues. they also mentioned the ability to meet in person was beneficial. while previously they noted the face-to-face engagement gave them an opportunity to develop a deeper connection, a few students mentioned they enjoyed finally meeting people face-to-face that they had seen only in an online setting. sometimes this was just a general statement that they enjoyed meeting in person with their faculty and peers. others expanded on this to note that sometimes in-person meetings provided them with a better understanding. one student reiterated this by stating that "being from virginia makes me feel very disconnected from the school, faculty, fellow students, and school activities …. but putting actual people to the names and faces we see regularly via webcam makes everyone real." a few students also noted that they felt more connected to the program. students expressed this as feeling more included and having a sense of pride in the program. the other major subtheme in emotional engagement was the students commenting that they saw a faculty commitment to the program and the students putting so much effort into the residency event. overall, there were numerous comments about how the faculty showed an interest in them and sacrificed by traveling and engaging in the event. this was illustrated in student comments about how they felt cared about by the faculty who were invested in them as students and making sure students were successful in their careers. overall, this theme was summed up by one student who noted: the amount of positive energy and support that i have received from msw students and professors is unconditional. it provided me a chance to meet everyone and advances in social work, summer 2022, 22(2) 328 actually talk in person. i realized how different it is to talk to a person through media technology. i also observed how passionate all [university name] professors are. absolutely enjoyed. i feel valued and loved. social engagement (n coded segments =105; 20.1%) the second most frequently identified theme was social engagement which accounted for 20.1% of all comments. students defined three major subthemes in social engagement, which were described as peer friendships (66.7%), faculty relationships (25.7%), and professional networking with aims both in the near and far terms of their professional development (7.6%). social engagement, through peer friendship, was the overwhelming theme in these student comments. many of the students attending the residency had been taking classes together for years, further connecting with peers in person at the residency. one student summarized the sentiment involved in social engagement by noting they "…deeply enjoyed finally getting the opportunity to meet my classmates that i have been interacting with for two years now." they acknowledged how the residency offered some perspective on their academic progress, and the residency confirmed their online relationships. one student said they had "…been each other's biggest cheerleaders at times, so to see them face to face was great." connections with faculty was also a subtheme. the students reported that the residency gave them a chance to network "…with classmates and professors [which] was beneficial." some commented that the in-person residency allowed the students to see the humanity in the faculty and staff. this can be seen in this comment where the student remarked about how much they enjoyed that, stating, "i have never seen faculty (even during my time on campus) joke and laugh with each other like this weekend." they noted the opportunity for an in-person residency increased the possibility of professional networking. as one student stated, the residency gave them a chance for "…professional development in areas of group cohesion, structure, and development," while another said the residency stretched their professional horizons, and they are "…thinking about getting my ph.d." overall, social engagement was encapsulated in this student's comment: the ability to meet with one's cohort brings a sense of connection. the original members i started with the first semester, built a good rapport with one another. meeting in person, feeling the energy of others is essential; it lets you know you indeed are not alone. these people you are surrounded by are going through it all with you. with the rigorous schedule from semester to semester, it is easy to feel a little burn-out, [the residency] helped connect and bring a spark and strength to continue forward. campbell et al./role of residencies 329 physical engagement (n coded segments =100; 19.1%) nineteen percent of students defined three major subthemes related to physical engagement, which were described as a connection to a person (76.0%), through an extension of the virtual program connection (15.0%), and a connection by location (9.0%). physical engagement through a connection to a person was the overwhelming theme in this category. one student said it felt "… like you are actually classmates not just pictures on a screen [which] made this program 10x better." students noted a sense of camaraderie and connection with their peers through in-person networking, active learning with projects, and socialization and downtime. one student noted that at the onset of the residency, they "...thought meeting my classmates would be awkward, but it was amazing." the extension of the virtual classroom into physical engagement was a highlight for many students. they mentioned how the onsite residency was a direct extension of their synchronous virtual classes. one student put it this way. "i got the chance to see my classmates and professors in person and not just on a screen. this created a sense of unity i had not felt." they also commented about the many ways that being in the same physical place led to a connection by location. one student comment summed up the overall sense of physical engagement through the residency in this way: we took pictures, laughed together, cried together, etc. it was awesome. it's strange, you'd think the atmosphere would be weird since, up until this point, we've always interacted via webcam, but when we saw each other in person, it honestly felt like we'd known each other for years. it was an amazing feeling. cultural engagement (n coded segments =57; 10.9%) students defined four major subthemes related to cultural engagement, which were described as the university and msw program (47.4%), the social work profession (22.8%), their cohort (21.1%), and self (8.8%). the most frequently mentioned area of cultural engagement was student's connection to the institution and the program. students talked about having more profound knowledge and understanding of the university system and program requirements. they also noted that the residency helped them create a stronger sense of affiliation and connection to the university and the msw program. some students even emphasized the sense of pride and belonging that was engendered during this weekend. not surprisingly, some students overtly talked about their resistance to attending (investment of energy, time, money) but were surprised how the residency overcame those challenges and created a sense of connection. the next area that students commented about was how the residency promoted a deeper understanding and appreciation for the profession of social work generally. students talked about how they experienced a sense of belonging to a group of others who shared similar ideals and values related to caring for vulnerable populations and one another. one student framed this in the context of how residencies can work "… towards the higher notions of what social work is and what all of us are working towards and hope to achieve." advances in social work, summer 2022, 22(2) 330 the final two subthemes were related to cultural engagement with their academic cohort and their own personal growth. students talked about how the residency promoted a sense of commitment to their teammates and themselves in general professional development and the execution of specific tasks. one student remarked that the residency helps with fostering an environment that promotes community and support among cohorts. a student said they were academically focused before the weekend but now they "feel emotionally attached" to the program. overall, students summed up cultural engagement in the residency as: [through the residency] i was able to connect my heart. for me, it has and always will be the heart! not just talent!! ... this weekend gave me the feeling like i was a part of something much more than a digitally-driven entity. this weekend fostered a sense of belonging… [i have] reassurance that some of the professors, providing golden nuggets of wisdom in person. being on campus and connecting to the school's core values was felt so strongly walking on the grounds. it's a very special place. intellectual engagement (n coded segments =56; 10.7%) intellectual engagement accounted for 10.7% of comments. within intellectual engagement, students identified four major subthemes, which were described as programmatic information (37.5%), knowledge and skills (30.4%), assignments (12.5%), team (12.5%), and dedicated time and space (7.1%). the highest subtheme within intellectual engagement was related to programmatic information. in this area, students remarked how the weekend setup provided information about the program and specific aspects of their learning experience. this might include their faculty advisor's role, activities, or events available to them and that the breakout sessions provided during the event were beneficial to them. these breakout sessions covered various faculty-led topics around issues such as organizations, student groups, field experiences, and an opportunity to engage with the program director. another subtheme in intellectual engagement was the knowledge and skills students reported learning or practicing during the residency event. students reported learning new skills and being able to practice other skills during this event. these might be soft skills such as working with peers, engaging with colleagues, or specific mental health treatment or suicide prevention skills. these were combined with tips and tricks during the weekend that provided a stronger knowledge base for students moving forward in the program. the other areas that students mentioned were the assignments, teams, and having dedicated time and space for learning activities. for assignments, students talked about collaborating, learning while working as a team, and having the dedicated time and space to practice their skills. interestingly, some students noted that some of the skills they learned were about how to interact with a team as they worked on a project together. overall, the notion of intellectual engagement was summed up by a student who stated: the class, its content, and structure were confusing, and its inclusion in the social work curriculum made absolutely no sense to me until [the residency] weekend. campbell et al./role of residencies 331 the venture project seemed like a complete waste of time, but in order for social workers to affect change on the micro, mezzo, and macro level, there needs to be the comprehension and composition of the communities and organizations that will be our conduits to creating necessary change. behavioral engagement (n coded segments =52; 9.9%) almost ten percent of comments were related to behavioral engagement. students defined five major subthemes related to behavioral engagement, which were described as the structure of activities (48.1%), time-related to explicit learning activities (19.2%), "get to know you" activities (17.3.%), motivational activities (11.5%), and capstone activities (3.9%). when discussing the structure of activities, the students discussed how the residency weekend was crafted to encourage engagement and learning. they noted that the residency structure allotted time to spend with peers and program faculty, which further promoted behavioral engagement. the students also specifically mentioned the breakout sessions, which were individualized small group sessions facilitated by faculty which covered aspects of the program, ways for students to be involved in explicit learning activities, the profession of social work, and the student's ability to be successful in graduate education. students also mentioned they appreciated the dedicated time to work on their projects with their teammates. some said they had anxiety about presenting and having the time to work on the class assignment was appreciated. this helped them feel supported in this assignment as a student-led project, and faculty gave them the time to prepare their "shark tank" capstone activity. finally, students mentioned additional activities that allowed them to get to know each other and their professor. other activities enhanced their motivation to engage in personal and professional growth. one student spoke about how one session inspired them to be more actively involved in social justice: lead [legislative education advocacy day] and the [programs] academic excellence virtual conference … inspired me to continue to go strong in wanting to pursue my career in advocacy. i decided to take part in the lead initiative this year. another student summed up the residency experiences as: every aspect of the weekend contributed to my personal and professional growth. although the anticipation of experiencing the shark tank was a bit [un]nerving, the outcomes of the experience were amazing. once our team began the presentation, all of our hard work and preparation came together. we created a solid presentation. i enjoyed every moment. discussion since march 2020, more than 1,400 schools have had to close their doors in response to the covid-19 pandemic (kelly & columbus, 2020). with the outbreak of the pandemic and increased social distancing protocols, universities transitioned to various modes of advances in social work, summer 2022, 22(2) 332 teaching such as e-learning and hybrid instruction to minimize safety risks for students and faculty. although critics of online learning question the quality of online education compared to traditional learning (thompson & yuku, 2006; wiest, 2015), the literature supports the impact that online learning can have on student diversity, engagement, and community (drouin & vartanian, 2010; shirvani, 2014). unfortunately, for many schools, the swift transition to online learning presented additional challenges for many students, such as increased isolation (son et al., 2020), environmental distractors (kanik, 2021), increased responsibilities (horowitz, 2020), and emotional and psychological distress (kee, 2021) which can have a direct and indirect impact on social connections. as schools make decisions about the return to on-ground learning, many academic programs will have to pivot to incorporate increased flexibility in teaching modes while striving to maintain academic rigor and student engagement (kelly & columbus, 2020). for social work programs, this includes an emphasis on explicit and implicit curricula in both on-ground and online programs. engagement theory highlights the impact of technology on fostering various forms of student engagement (campbell et al., 2019; kearsley & shneiderman, 1999), which can be particularly beneficial for online social work programs. this article highlights the potential impact of an on-ground residency in promoting student engagement in a fully online msw program. although students were enrolled in an online program, the opportunity to come together for an on-ground residency fostered emotional engagement. students reported feeling a deeper connection to their peers and faculty members. during a time when many students report increased anxiety and emotional distress due to covid-19 (gonzalez et al., 2020; kapasia et al., 2020), the findings of this study support the need for programs to incorporate activities that can promote emotional engagement for students. additionally, the shift to online education has resulted in many students reporting dissolved or reduced social connections (finnegan-kressie et al., 2020). the findings of this study highlight the impact that face-to-face interactions can have on increasing social connections for many students. these results support existing literature that highlights how student encounters with both the explicit and implicit curriculum can enhance student connections and professionalization (miller, 2013; peterson et al., 2014). lastly, findings from this study emphasize the importance of physical engagement for students regardless of the learning modality. although students reported developing connections in an online setting, being in a physical space extends existing connections and allows for enhanced connection in an online space. the students noted a deeper connection to the program. students reported a sense of pride in being in the program. students expressed the social benefits of meeting in-person to build relationships and network opportunities not always available in the virtual classroom. moreover, the residency allowed the ability to physically meet and foster relationships that developed long-lasting friends in the professional arena. overall, the students expressed appreciation for participating in a program that enhances their learning experience. students cherished the commitment the faculty demonstrated to the program, event, and students' learning. campbell et al./role of residencies 333 the event appears to have provided an enriching experience to heighten the virtual classroom. with an increase in online social work education programs, residencies can serve as an opportunity to bridge the gap for online students to enhance a sense of community (kazmer, 2007). many times, residencies are built around academic content to extend the classroom. however, this study reveals that students appreciate the opportunity to learn collaboratively, allowing them to develop a sense of a shared culture with their peers, program, and university. this is important for programs to consider as they make decisions for the return to campus. additionally, programs should consider how shifts in social work education will meet accreditation standards and assessments for online instruction, instructional design, and technological capability, which can enhance the student experience in a virtual landscape (horowitz, 2020). limitations as with all studies, this study has a few limitations that should be noted. first, the sample came from a specific group of students in one msw program. the absence of a comparable control group limits the generalizability of the study results and the complicating fact that students in this study attended the residency as a requirement of their msw program participation further challenges any confirmatory findings. students are enrolled in this program with the awareness that all the classes would be virtual and synchronous in nature. it is possible that the nature of these synchronous classes contributed to the report of a high sense of cohesion or that students self-selected this type of program and naturally have a high sense of cohesion. to address these limitations in the future, we recommend looking across multiple universities, varied cohort models, and divergent online modalities (synchronous and asynchronous). future studies should consider collecting data at program entry, immediately prior to the residency, and then again upon completion of the residency. this could provide valuable information about engagement and the importance of cohesion across the program. it is important to note that these data are derived from an msw program built around a cohort model for student learning. it is unclear how a residency may impact programs with less emphasis on student cohorts as an organizing structure with implicit expectations of group cohesion. similarly, self-selection bias may be present with students attending a cohort model because they seek cohesion; further research in programs with and without cohort models would add knowledge in this area. given the impact of covid-19 on social isolation and the move of many students online, it is possible that since the data were collected pre-covid-19, these results might underreport many of the impacts of engagement. this study offered a cross-sectional view of one cohort's responses. future research would benefit from exploring a longitudinal approach to data that allows a deeper analysis of engagement over time. finally, the response rates to the survey were almost 80%. we recognize that there was no ability to follow up with additional questions or clarification to the open-ended items. using student interviews or focus groups could shed additional context about their engagement, challenges, or positives. advances in social work, summer 2022, 22(2) 334 implications as covid-19 social distancing restrictions are lifted, there will be ample consideration for efforts and events that leverage social connections. one area for this consideration will be in higher education programs that deliver primarily online content and may be considering the impact of grounded residencies to augment virtual learning. based on these data, grounded residencies demonstrate tangible value to graduate social work students in an online program and promote a high level of engagement across multiple stakeholder groups. the pandemic experience has promoted a radical shift in business delivery, especially in the social work and social service sectors. prior to the pandemic, social work educators were wrestling with the market forces pushing toward the increased use of online platforms to deliver higher education to social work students. those pressures are likely to intensify in a post-pandemic space. even though many programs are adopting some aspect of online delivery, these data suggest they should also consider strategic opportunities, such as grounded residencies, to keep students engaged in person. these grounded residencies can be resource-intensive (time, energy, money). students in this program had to take time away from family, work, and other commitments to attend this residency over the weekend. graduate students have a considerable amount of pressure on their time and energy resources which can add stress, and the financial cost of managing their own travel for transportation, lodging, and housing are additional burdens. despite these known stressors, these data indicate that the students saw this residency as an investment that creates a new opportunity for learning and a profound sense of connectedness. these outcomes should translate into improved results with student learning, retention, and the recruitment of future students and emotional connection to the program and the institution garnered from an in-person/grounded connection which could yield potential philanthropic giving from alumni. future research will benefit from exploring these indirect benefits. references amador, p., & amador, j. 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"sense of classroom community" in online social work education. journal of education and human development, 4(2), 22-49. http://dx.doi.org/10.15640/jehd.v4n2_1a3 author note: address correspondence to michael campbell, graduate social work at saint leo university, 33701 state rd 52, st leo, fl 33574. email: michael.campbell03@saintleo.edu https://www.learntechlib.org/p/103633/ https://doi.org/10.1080/08841233.2013.828669 https://doi.org/10.24059/olj.v7i1.1864 https://doi.org/10.1016/s1096-7516(02)00102-1 https://doi.org/10.1016/j.iheduc.2004.09.001 https://eric.ed.gov/?id=ej952275 https://doi.org/10.1016/j.compedu.2007.04.003 https://doi.org/10.2196/21279 https://doi.org/10.1007/s11162-014-9343-x https://eric.ed.gov/?id=ej875042 http://dx.doi.org/10.15640/jehd.v4n2_1a3 mailto:michael.campbell03@saintleo.edu method discussion limitations implications references _________ rocío calvo, phd, associate professor, and samuel l. bradley jr. dsw, msw, assistant professor, school of social work, boston college, newton, ma. copyright © 2021 authors, vol. 21 no. 2/3 (summer 2021), 920-933, doi: 10.18060/24466 this work is licensed under a creative commons attribution 4.0 international license. the good, the bad, and the ugly: lessons learned dismantling white supremacy in a school of social work rocío calvo samuel bradley abstract: for the last several years, the boston college school of social work (bcssw) has worked to deconstruct the hidden nature of whiteness rooted in theories, methods, and practices of education. to that end, the bcssw created two strategies designed to foster systemic change: the latinx leadership initiative and the equity, justice, and inclusion initiative. this study uses narrative analysis to examine these initiatives as catalysts of sustainable change. we dive deep into: (1) strategies designed to disrupt a white supremacy approach to the explicit and implicit curriculums; (2) activities to engage stakeholders on dismantling institutional racism. our ultimate goal is to draw lessons that may be useful to the profession. to that end, we discuss knowledge gained concerning academic innovation, shared governance, and alternatives to an eurocentric epistemological approach to social work. we also include implications for the profession concerning the incorporation and validation of non-white ways to understand human development, health, disease, diagnostics, and interventions; and present some of the strategies we developed to de-center whiteness and support bipoc students in a whitemajority institution of higher education. keywords: white supremacy, academic innovation, positive education disruption white supremacy is a thought system that advances the attitudes, beliefs, and values of white individuals (fleming, 2019). white supremacy abounds in social work. this framework of understanding drives pedagogy, curriculum, research and manifests in the profession's practice. through this approach to the discipline, universal values such as rigor, independence, work ethic, or intelligence suddenly become white. higher education institutions sustain and reproduce this approach to the profession by normalizing the knowledge, experiences, and values associated with whiteness. non-white ways of knowing are not only undervalued but perceived as illegitimate, with the resulting penalization of individuals who bring these alternative forms of knowing to the educational system (almeida et al., 2019; ayala & contreras, 2018). when education centers on the experiences of white bodies, histories, cultures, and languages, it overlooks powerful perspectives and communities; leading to an educational system of oppression that betrays social work values, specifically the importance of self-determination and social justice. an example of this white-centering in the social work curriculum is the predominance of the bio-medical health and mental health model that focuses on diagnosis and interventions based on a western-only understanding of human development (fennig & denov, 2019). this model is normative in the profession, making alternative understandings of health, disease, and treatments, such as folk healers or natural remedies invalid, and therefore absent from the curriculum (figuereo & calvo, 2018). to disrupt these values, schools of social work must continuously analyze and question the historical, educational, and about:blank calvo & bradley/the good, the bad, & the ugly 921 epistemological roots of the profession, the social sciences, and higher education. critical to this analysis is incorporating and validating non-white ways to understand human development, health, disease, diagnostics, and interventions. white supremacy at the roots of the social work profession at the inception of its early roots in late 19th century america, social workers, often deemed "friendly visitors," would go from home to home as a means of impacting the poor through moral persuasion and personal example (rausch, 1978). this moral persuasion against pauperism's character flaws promoted assimilation ideas concurrent with the legally enforced idea that whiteness was valued over all others. forerunners of the social work profession, like charity organization societies and the settlement house movement, rested upon the pillars of social darwinism. this philosophy suggests that one group's social dominance over another is due to the dominant group's natural superiority, evidenced by white phenotypic characteristics (gregory, 2020). social work has failed to challenge this epistemological approach in which racial inequity and white supremacy are maintained in the profession (cardoza, 2020). instead, it ascribes to a cluster of vaguely defined character traits regarding the ideal worker, client, and society intended from the profession's outreach. these vague ideas of whiteness have been encoded into the law and other systems of oppression (rothstein, 2018), like in professional standards, which use white values of dress, communication, accent, efficiency, perfectionism, and boundaries for hiring metrics and promotions (gray, 2019). almeida and colleagues (2019) discuss the colonizing effect of white supremacy over time, and its impact on the social work profession: the natural intrusion of white supremacy into the initiative of social work, not unlike other social sciences, requires analysis that has eclipsed the profession for generations. the analysis necessitates inquiry and action on social, political, and economic problems that result from white supremacist manifestations of racialization with all of its subjugated markers of gender and calls for interventions organized around deracializing society. in fact, it is an important strategy to uproot coloniality. (almeida et al., 2019, p. 151) for social work in the modern era, white supremacy manifests in the enforcement of current laws that strip black and brown communities of their fundamental rights. for instance, black children represent 14% of the total population of children in the u.s. but comprise almost a fourth of all children in the foster care system (annie e. casey foundation, 2020). this practice, while state-sanctioned and legally encouraged and admissible, goes against the profession's ethical obligation to promote the right to selfdetermination as well as the promotion of social justice. therefore, social work, while publicly promoting racial equality and openly condemning other forms of discrimination, actively teaches these practices to its students. even unwitting students who believe in social justice and the right to self-determination find themselves replicating systems of white supremacy due to the centralization of western values, including the lack of antiracist teachings in the curriculum (hackett, 2019). one way to understand how social work perpetuates systemic racism in education is by examining our curriculum. rosales and colleagues (2018) analyzed to what extent courses, concentrations, and certificate advances in social work, summer 2021, 21(2/3) 922 programs of 262 msw accredited programs integrated latinx content in the curriculum. findings revelated the dearth of latinx-focused materials in social work education. a fundamental organizing principle of anti-racist practice necessitates understanding the history of white supremacy, racism, and race-based concepts co-created to justify the existence of oppression through chattel slavery in the united states. this critical point highlights how racism was designed as economic exploitation and still operates to that effect today. an example of this in everyday life is the overrepresentation of black and latinx hourly workers struggling to make ends meet (martin, 2015). this systemic racism system that promotes unearned advantages for white social workers is also easily found in our profession. we only need to look at the absence of black and brown students in our schools (bowie et al., 2018) and to the challenging careers of non-white professionals and academics across the country, plagued with a lack of opportunities for advancement and promotion (calvo et al., 2018; mbarushimana & robbins, 2015). using narrative inquiry to gain understanding narrative inquiry is a dialectic and interpretative research approach. the collection and analysis of qualitative data are informed by how people engage in the process of telling their own stories (earthy & cronin, 2008). the main characteristics of narrative analysis are that it focuses on the meaning people assign to their own experiences, that it occurs in collaboration among all the people involved in research, and that stories are informed by their context (moen, 2006). narrative analysis has helped analyze change management processes in organizations (clandinin & connelly, 2000). we used narrative analysis to reflect on the process of systemic transformation to dismantle white supremacy at the bcssw. a myriad of data sources informed our study. for instance, students created their stories in the classroom, particularly latinx leadership initiative (lli) students who follow a cohort model and take classes independently. outside the classroom, we engaged students in creating narratives through advising pods and learning communities, which are integral components of our equity, justice, and inclusion strategic priorities. students who wish to participate in these spaces engage with faculty in interdisciplinary forums that revolve around various topics, such as the pervasive nature of colorism and its implications for social work or anti-racism and anti-oppressive social work practice. to engage faculty, staff, and alumni in this process, we created a series of focus groups, held town hall meetings, and deployed surveys in which individuals had the opportunity to share their stories and their aspirations to dismantle white supremacy systemically. during these processes, participants often validated other members' accounts and added to them by offering examples of their own stories. we collated and analyzed the bcssw narratives, focusing both on content and on structure, to determine the presence of common themes. what follows is a summation of the themes that emerged from our analysis. disrupting white supremacy at boston college school of social work dismantling white supremacy requires an intentional approach to create systems of decolonization and decoloniality in our profession. besides a profound analysis of the myriad ways in which white supremacy impacts the education, pedagogy, and practice of calvo & bradley/the good, the bad, & the ugly 923 the social work profession; it needs a thorough examination about how the history, policy, and traditions of social work that have promoted whiteness, and as a result, racism as the normative practice within the profession. located at boston college school of social work (bcssw), a team of faculty, staff, and students has endeavored to undertake a transformation concerning how the school approaches researching, teaching, and understanding anti-racist practice in the context of social work. bcssw provides instruction in support of master of social work and ph.d. programs. understanding boston college's history, a university with the carnegie designation of r1, or high research activity institution, is a central concept to this article. its original roots were in the training and support of poor, irish, catholic, male immigrants. today, boston college has grown to become a top 50 nationally ranked university with a billion-dollar annual budget and a 2.2-billion-dollar endowment. though boston college is not the wealthiest institution in america, it certainly ranks among the most affluent. it is reasonable to assume that the very students bc was initially founded to support (poor immigrants) do not comprise most of its student body today. within this context, the bcssw designed a strategy to increase the number of black and latinx students within its walls and an alternative structure that ensured their success in a white-majority institution of higher education. the latinx leadership initiative (lli) latinxs account for 18% of the current u.s. population. by 2060 it is estimated that 30% of the total u.s. population, or around one in three americans, will be of latinx descent (vespa et al., 2020). while latinxs are extremely diverse concerning country of origin, language, race, migratory status, generations in the u.s., socioeconomic status, and degree of acculturation, they tend to share systemic discrimination experiences and the resulting blocked access to education, healthcare, housing, and the job market. there is evidence that latinxs are more likely than other groups to report discrimination experiences when dealing with social services (lauderdale et al., 2006). latinxs tend to experience a better quality of care when paired with ethnic and languageconcordant providers (ortega et al., 2007; rodriguez et al., 2009). yet, social workers are not equipped to work effectively with latinx communities (furman et al., 2013). the lli started in 2013 with two aims, to increase the number of latinx social work practitioners and scholars, and to equip social workers with the skills needed to work effectively with latinx communities by deploying a strengths-based educational approach to support their formation as clinicians and scholars. departing from a white-supremacists approach to social work education in which the lived experiences of minoritized communities are poorly understood – most often through a culturally competent framework (almeida et al., 2019) – the lli proposes a counternarrative understanding to social work with latinxs based on latinxs' cultural capital (ayala & contreras, 2018; yosso, 2005). cultural capital is the knowledge, skills, and values that allow people to successfully navigate social institutions (bourdieu & passeron, 1977). in traditional higher education institutions, whiteness is the dominant cultural capital that validates access to resources and legitimizes ways of knowledge. as a result, advances in social work, summer 2021, 21(2/3) 924 despite the profession’s emphasis on cultural competence or humility, it is difficult for social workers to engage with latinxs meaningfully unless they understand and appreciate their values, culture, and world views. we expect social workers to engage diversity and difference in practice, yet we do not teach non-white paradigms of understanding human behavior, making this worthy goal challenging to achieve. while latinxs' college enrollment has increased in the last few years, they have lower graduation rates than other groups in the united states (lopez & fry, 2013). for instance, only 5% of latinxs received a graduate diploma in the u.s. 2016. that same year, 13% of non-latinx whites received a graduate degree (schak & nichols, 2017). a white supremacy approach to social work understands latinxs' underperformance in education as a deficit-based perspective that places the responsibility in the individual rather than in systemic inequities. unfortunately, this deficit-based perspective of latinxs in higher education permeates much of the educational policy and practices across the u.s. (ayala & contreras, 2018). to dismantle this white supremacist approach, the lli created a pedagogical model that countered the institutional structures and processes that sustain a deficit-based approach to social work with latinxs. understanding that latinxs are not monolithic and that racially minoritized students bring their forms of capital to the educational setting, the lli created a paradigm for educating social workers that legitimates latinxs' ways of knowing (yosso, 2005) over the normative white approach to social work. a critical component of this alternative paradigm is a cohort model of education that allows latinx students to feel safe as they navigate a white-majority institution of higher education. lli students enter the school as a cohort already formed, which increases their support throughout the educational experience. classes are taught in spanish, not because students do not speak english, but because it emphasizes and validates students' lived experience and counters the negative impact of latinxs’ racialization based on language. in the whitesupremacist american society, colorism or skin color stratification places latinx, whose skin tones and phenotypic features indicate black or indigenous ancestries, at the bottom of the racial hierarchy (hunter, 2007, 2013). latinxs' racialization, however, occurs via multiple pathways, including language. racialization in this context "signals the processes by which ideas about race are constructed, come to be regarded as meaningful, and are acted upon" (murji & solomos, 2005, p. 1). one of these ideas is that spanish, an indicator used to racialize latinxs as non-white, is inferior to english. since the 1970s, englishonly policies have been pushed as a mechanism to facilitate the incorporation of immigrants (wiley & wright, 2004), despite evidence that spanish is a prime indicator of identity and culture and that bilingualism is beneficial for latinx children's development. in the u.s. white supremacist landscape, policies that discourage latinxs from preserving their language reposition latinx identity and culture as inferior. this systemic othering increases latinxs' risk of exclusion and highlights the need for professionals prepared to work with this population (calvo et al., 2018). the lli paradigm to de-centers whiteness from the curriculum is also reflected in the syllabus, in field education, and in the doctoral program. concerning content, the lli curriculum focuses on latinx cultural capital and evidence-based interventions that teach students to capitalize on latinxs' assets and ways of knowing when working with diverse calvo & bradley/the good, the bad, & the ugly 925 latinx communities. regarding field education, the lli only partners with agencies that appreciate the work that bilingual/bicultural latinxs do and that support their educational aspirations. the latinx research seminar supported the formation of latinx doctoral students with shared interest on research topics pertaining to latinx communities (see calvo et al., 2018 for further details about the lli). the lli has over 180 graduates in 23 states who have partnered with latinx communities in innovative practices that address complex problems. another vital element of the strengths-based cultural paradigm that characterizes the lli is that alumni are actively involved in the formation of current students. some of its graduates serve as field supervisors of its current students. others serve as mentors. a student-led initiative called unidos (together), pairs current lli students with alumni to help them navigate higher education and the job market as latinx professionals. the lli received national recognition as an example of excelencia from excelencia! in education in cooperation with the congressional hispanic caucus. excelencia! in education is the only national effort that identifies and promotes evidencebased practices for accelerating latinxs' educational success in the united states. equity, justice, and inclusion at bcssw for the last three years, boston college has endeavored to enhance the student experience through the equity, justice, and inclusion (eji) initiative. this strategic direction was chosen following student focus groups, faculty feedback, and administrative planning to enhance the student experience through curriculum and pedagogy reforms, training, and development, and to create a systematized process for measuring success in this area. this initiative is driven by over 100 faculty, staff, and student volunteers, and focuses on finding creative anti-racist solutions to complex problems that plague social work schools. next steps: setting new goals for social work programs in the wake of the unjust and state-sanctioned murders of breonna taylor, george floyd, ahmaud arbery, and so many more, we found that we could no longer remain quiet about the needs of our black students and our community. situated in boston, a city with a long history of racism, our silence indicated our complacency and our assent to the deadly realities of black lives. moreover, leading up until this moment, we had reflected on the need to create a program that would enhance innovation in services to black americans and pursue strategic policy changes to support the community—explicitly focusing on criminal justice, economics, and urban development and planning. this radical view of a social work practice crafted by black social workers and for black social workers is not new; however, our focus is a cadre of leaders from across the world who might first, using boston as a laboratory, learn a crucial mix of micro and macro skill sets, return to their homes to pursue careers in advocacy, politics, and organizational management. and although this is not exclusively a macro social work program, the authors believe that disrupting white supremacy requires an interrogation of all past forms of social work, including the history, tools, and onto-epistemological social work approaches to practice. advances in social work, summer 2021, 21(2/3) 926 a historical perspective allows social workers to perceive trends that affect social work currently. it also allows professional social workers to see how black social workers created this profession, their original intentions, and the focus we should all take to secure a more equitable profession and society. understanding the tools of social work allows professionals to see both the benefits and the disadvantages of historical practices of social work. for far too long, social workers have focused on clients' therapeutic outcomes without an intensive understanding of how racism has framed both therapeutic practices and the directions that clinical work needs to take to de-center approaches that frame white cultural expectations. black leadership initiative since the conceptualization of a professionalized social work, many researchers, activists, and community leaders have speculated on the need for black social workers and the unique approach those workers could bring to supporting the black community (washington, 1935). among these discussions was first, the needs of the black community, and second, the idea that training black social workers creates a ladder into economic mobility for many with college educations. finally, the idea that black social workers, as representatives of the communities they serve, might contribute valuable insights into effective interventions in black communities. the black leadership initiative will be designed to askew the specific focus on deficits concerning the black community. this program's focus will be to build a cadre of leaders who focus on understanding and navigating the black community through an anti-racist and strengths-based approach. the students selected will be expected to move beyond the typical focus of problematizing clients. these future colleagues in training will learn approaches to social work practice that de-center whiteness and promote frameworks of knowledge beyond western thinking, specifically the afrocentric paradigm, which centers the rich onto-epistemological approaches of africa. specifically, this means centering the stories, perspectives, and values of african people and the people of the african diaspora. as bent-goodley et al. (2017) note, "afrocentricity utilizes african philosophies, history, and culture as a starting place of interpreting social and psychological phenomena" (p. 1) a further breakdown of this perspective in social work practice frames individual identity as synonymous with collective identity and positions the import of affective knowledge. simply put, in an afrocentric frame, one cannot exist without one's community, and emotions are an essential and central component to knowing and methods of knowing (schiele, 1997). this social work perspective is helpful for its ability to help refocus social work pedagogy and practice into non-dominant views in the u.s. context for practice. students prepared in this innovative new program will be able to identity missteps in eurocentric paradigms that do not benefit black clients and reorient their interventions to center the needs of black communities. calvo & bradley/the good, the bad, & the ugly 927 leaders for equity and justice in the workplace it has been predicted that by 2060 america will be a majority-minority nation. while the workforce expands to include more black, indigenous, people of color (bipoc), issues of fairness and organizational justice will become extremely important to social work practice (sabbath, 2019). moreover, in the face of an aging workforce, many firms may seek an opportunity to reduce instances of discrimination in the workplace. these key factors have prompted the creation of academic programs focused on diversity, equity, and inclusion in the workplace. given social work's historical involvement in supporting employment through worker assistance programs, management and administration course work, child labor protection, and crisis counseling, the profession has developed a robust set of practice tools that can be utilized to enhance fairness and promote a sense of inclusion at the organizational level. the bcssw has endeavored to create a unique new program, called “leaders for equity and justice in the workplace”. the focus of this program is on preparing social workers to disrupt white supremacy and other forms of oppression at the organizational level. students interested in the program are recruited through various admission strategies and told that the program is meant to situate both micro and macro-focused students on key concepts in organizational change management. organizational change management is a crucial business tactic that focuses on preparing businesses for the future by assessing all business functions, capacity building, and workforce development. this focus on organizational change and transformation is critical, as the students who embark on this training are prepared to focus on all levels of business practice and decision making. furthermore, starting in fall 2021, graduate msw students will be given a chance to practice these skills in internships throughout new england. the creation of this program seeks to expand traditional diversity, equity, and inclusion work by focusing on key concepts such as social innovation, alternative methods of inquiry and research, and foundational business practices. moreover, the leaders for equity justice and inclusion (leji) program will support students who are interested in a broad range of equity, justice, and inclusion issues such as disrupting racism, sexism, ableism, ageism, homophobia, and transphobia wherever they occur. this important group of future practitioners is meant to bridge to a new social work practice that focuses on well-being at work. recommendations for social work education: generalizing our results though one may like to believe that innovation is a process borne out of random chance, the authors take the approach that innovation is a process that must continuously exist to challenge the status quo. these inherited ideas around social work practice and social work education reflect the white supremacist cultures that oversaw the development, professionalization and mainstream acceptance of social work as a form of social control. to undo this reality, it is vital to take the next step of troubling, disrupting, and dismantling the profession as we know it by creating a new curriculum altogether – not merely an evolution of the existing one. advances in social work, summer 2021, 21(2/3) 928 focus on administrative process. a key barrier to disrupting white supremacy at boston college was the disrupting administrative barriers that focused on process rather than content. the authors found that well-meaning administrators that focused on fulfilling traditional methods of administering social work programs would often conflict with the need to create innovative practices in school administration. this problem, though prevalent, was overcome with high communication and relationship-building across administrative silos. deconstructing white supremacy in pedagogy. given the professional nature of social work schools, some instructors did not have formal training in education techniques and pedagogy. instructors frequently approach bipoc students from a deficient perspective without viewing their lived experiences as assets in the classroom. though this problem persists, at the writing of this paper, we have created several pedagogy-focused training experiences designed to prepare instructors to not only view students experiences as valuable, but also to prepare the instructor to decolonize the classroom through course materials, activities, and experiences that focus on a variety of learning styles. in particular, the authors have focused on reducing an overreliance on the written word and the english language. we provide more details about these actions in the section below. focus on the bipoc student experience. for the authors, focusing on the bipoc student experience has allowed limited resources to flow towards students who need the support. moreover, this program it utilized to support student services, augment learning in the classroom, and enhance the student experience. a significant barrier to this community-building work has been limited resources and staff who are well-trained and prepared to take on the work. anti-racist actions to the curriculum, pedagogy, and student mentorship to dismantle white supremacy to implement the above recommendations the authors proposed three main actions to the bcssw community: decolonize the curriculum, use a pedagogical approach that includes all students while protecting bipoc students, and create a wide system of support for bipoc students to process microaggressions. these actions may be adapted to other educational contexts. action one – decolonize the curriculum. our curriculum relies heavily on a western, anglo-saxon understanding of the profession. as a result, our syllabus mostly reflects the experiences of those groups racialized as white and uses a medical model as the main approach for the delivery of services. some suggestions to decolonize the curriculum are making sure that a variety of epistemological and cultural frameworks are included. the authors encouraged bcssw faculty that at least half of their required course materials should be focused on historically marginalized communities. they also encouraged faculty to use theoretical perspectives from non-western cultures and to include the work of black, indigenous, latinxs and other people of color (bipoc) authors, artists, and researchers. questions to facilitate this process that faculty may use are: “what is the epistemological approach of the author?” “what cultural values does it represent?” “does the content of the curriculum reflect the experiences of historically calvo & bradley/the good, the bad, & the ugly 929 oppressed populations?” “does the content of the curriculum take into consideration theories and perspectives of women of color?” “do assignments focus on anti-racist competencies?” additionally, to help decolonize the curriculum authors suggested faculty to check if their syllabus relied heavily on the written word. while students should strive to have strong writing and reading skills, there are other important methods of learning and communicating knowledge that are valued in other cultures. diversified methods for students to learn include podcast, documentaries, music, and experiential activities. some questions that may help faculty to incorporate these innovations are: “how might i use other forms of communication for learning, such as podcasts, videos, movies, songs, or other visual and auditory materials?” “can my assignments take the form of a public presentation, op eds, poetry, poster, art project or group problem-solving activity? “ another action to decolonize the curriculum is to use rubrics for grading and providing feedback. the authors encouraged faculty to include rubrics that detail exactly how students will be graded and to provide written feedback on all assignments so students are aware of how they might improve their work. some questions that help faculty to incorporate these changes are: “is it clear to students exactly how they will be graded?” “are you expecting students to just know that certain things are automatically graded (such as apa formatting)?” “did you tell them in the rubric?” “do students know students know exactly why points were deducted?” “do students know how they might improve their grade on the next assignment?” “are you open to students approaching assignments from a cultural/theoretical approach that is not included in the syllabus, especially those that pertain to bipoc?” “do your students know this?” action two – use a pedagogical approach that includes all students while protecting bipoc students. engaging in anti-racist work and dismantling white supremacy must include all voices and perspectives. unfortunately, our students of color are often placed in the position to educate their peers and the faculty on issues that concern bipoc students. they are also the ones that bear the burden of speaking up when they witness or experience microaggressions. the authors encouraged the bcssw faculty and administrators to consider investing in their own formation to ensure that the onus of anti-racist conversations does not fall onto bipoc students. the movement for black lives and other collectives doing anti-racist work have made available a myriad of free materials related to justice and inclusion. the authors suggested the bcssw community to consider attending professional development opportunities put on by the university, cswe, and other groups on issues of racism, discrimination, etcetera. authors asked faculty not to rely on students to raise these issues, but to be proactive. some questions authors proposed to faculty are: “have you recently read on antiracism and classroom pedagogy?” “do you rely on your students to do the labor of teaching about the issues of marginalized students, or do you lead discussions in this area?” “do you put students of color on the spot when race comes up?” action three – create a wide system of support for students of color to process microaggressions. in a white-dominant institution of higher education like the bcssw, bipoc students often experience microaggressions in the classroom from faculty and advances in social work, summer 2021, 21(2/3) 930 peers. it is left to the student to communicate to the faculty and to other students what happened or to look for informal systems of support to process such experiences. the authors suggested the bcssw to consider creating an intentional network of advisors for bipoc students. while all students are assigned an advisor, the process does not usually consider the intentional matching of bipoc students with faculty that have an advanced understanding of the needs of students of color in white-dominant institutions. some questions that helped the bcssw to implement this actions are: “what are the criteria to assign advisors to bipoc students?” “what are the criteria to become an advisor in the institution?” “are advisors of color overtaxed with providing support to bipoc students?” “are there system-wide criteria of the advisory role?” “what do the criteria entail?” “how are the criteria monitored?” “do advisors reach out to bipoc students to discuss their positionality in the school from an assets-based perspective, or is their role mostly associated to administrative tasks and procedures?” conclusions and limitations disrupting white supremacy in the profession is more important now than ever. achieving disruption requires interrogating all aspects of social work schools’ functions including, but not limited, to curriculum and coursework, support programs for bipoc students, and addressing research gaps. these areas have direct implications of social work practice, such as the readiness of social workers to address how structural racism impacts the lives of clients and communities. equally important is to address the on-going needs and histories of marginalized communities through evidenced-based approaches stemming from the very communities that are served by the profession. to that end, it is crucial to legitimize non-white ways of knowing by forming future professionals on epistemological frameworks that challenge the predominant bio-medical model based on a western-only understanding of human behavior. there are no recipes to dismantle white supremacy in social work institutions of higher education, which is a limitation of this study. our actions and processes cannot be generalized because they stem and are sustained by the bcssw community. this stewardship is key to the sustainability of our initiative because the whole community is accountable of its success. nevertheless, we hope that our experience concerning academic innovation, shared governance, and alternatives to an eurocentric epistemological approach to social work are helpful to our shared goal of dismantling white supremacy in the profession. 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(2005). whose culture has capital? a critical race theory discussion of community cultural wealth. race ethnicity and education, 8(1), 69-91. https://doi.org/10.1080/1361332052000341006 author note: address correspondence to rocío calvo, school of social work, boston college, newton, ma, 02467. email: rocio.calvo@bc.edu https://doi.org/10.1080/08841233.2018.1472175 https://doi.org/10.1093/sw/swz031 http://hdl.voced.edu.au/10707/538288 https://doi.org/10.1177/002193479702700605 https://www.census.gov/library/publications/2020/demo/p25-1144.html https://doi.org/10.2307/2292089 https://doi.org/10.1177/0895904803260030 https://doi.org/10.1080/1361332052000341006 mailto:rocio.calvo@bc.edu _________ sarah c. johnson, mlis, lmsw, assistant professor and social sciences librarian, margaret bausman, lcsw-r, mslis, associate professor and head of the social work & urban public health, and sarah laleman ward, mlis, ma, associate professor and outreach librarian at hunter college, new york, ny. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 1-25, doi: 10.18060/24697 this work is licensed under a creative commons attribution 4.0 international license. fostering information literacy: a call for collaboration between academic librarians and msw instructors sarah c. johnson margaret bausman sarah laleman ward abstract: genuine collaboration between academic librarians and social work faculty in which information literacy is embedded in social work education is lacking. drawing from the results of the authors’ 2016 quantitative study surveying academic social work librarians across the united states, this qualitative follow-up uses data from 27 semistructured interviews concerning the prevalence and nature of information literacy instruction (ili) in social work education, how ili is introduced and sustained in social work curricula, and the alignment between ili efforts with institutional goals, guidelines from accreditation authorities, and professional social work practice standards. the literature review engages the reader in a robust definition of “information literacy” as applied to social work practice and its connection to social justice and anti-oppressive pedagogy. the findings and subsequent discussion center on current systemic obstacles in ensuring social work graduates enter the profession with sufficient information literacy (il) skills for an ethical, research-informed, data-driven practice and conclude with recommendations for the evolution of integrated ili at a local level within social work curricula. collaborative and sustainable partnerships among academic librarians and social work faculty are essential for educating information literate social work practitioners of tomorrow. keywords: information literacy, social work education, academic librarians, social work librarians, social work curricula, social justice, relationships with faculty social workers should strive to become and remain proficient in professional practice and the performance of professional functions. social workers should critically examine and keep current with emerging knowledge relevant to social work. social workers should routinely review the professional literature and participate in continuing education relevant to social work practice and social work ethics (national association of social workers [nasw], 2018, ethical standards, 4.01(b)). information literacy is the set of integrated abilities encompassing the reflective discovery of information, the understanding of how information is produced and valued, and the use of information in creating new knowledge and participating ethically in communities of learning (association of college and research libraries framework [acrl], 2016, para. 6). the information universe is fierce and ubiquitous, replete with a 24-hour news cycle, trolls, bots, fake news, predatory publishers, and paywalls. its exponential growth during these nascent years of the 21st century can be framed as running the gamut from a victory about:blank advances in social work, spring 2021, 21(1) 2 for egalitarianism and promotion of socially equitable access to knowledge to a daunting hotbed for scurrilous information emanating from obfuscated sources. in other words, it requires consumers to possess discerning and supple information literacy (il) skills to efficiently and effectively navigate an ever-burgeoning wealth of information. if, as the above quotations imply, life-long learning and contribution to the knowledge foundation is an ethical standard for professional social workers and the related pursuant activities are facilitated by information literacy skills, what does this mean for social work education now and in the future? among them, the authors of this study have three master’s degrees in library and information science, two master’s of social work, a master of educational psychology, 20 years of combined social work practice, and 29 years of combined practice in collegiate education. from this unique vantage point, the authors are well-versed in the information literacy needs of social work professionals and the challenges facing schools of social work to meaningfully integrate information literacy instruction (ili) into an already rigorous course of study. the present study is the third in a broad examination of the status of and needs for ili in graduate social work education (bausman & ward, 2015, 2016). drawing on the findings and conclusions of the authors’ previous scholarship, this study uses an irb approved, qualitative protocol to investigate the location and conduction of ili and reference services within institutional goals in general and social work curricula in particular, the relational mechanisms that sustain or derail the provision of ili in social work education, and optimal pedagogic practices specific to ili for social work students. while the authors’ scholarship and instruction practices are recognized within the discipline of librarianship and by local social work colleagues, to date there has been little cross-over of scholarship about ili for social work education and practice into the community of social work educators. by offering this scholarship in a social work-specific press, the authors invite their social work colleagues to consider the roles of ili in social work education and practice, to examine where and how it may fit into their curricula and pedagogic practice, and to join with academic librarians as instructional consultants and collaborators. review of the literature defining and positioning information literacy for social work education and practice accepted by the association for college and research libraries (acrl) in 2016, the framework for information literacy in higher education (the framework) is the guiding document that broadly defines information literacy and sets forth a series of principles, or frames, governing the purpose and practice of ili by academic librarians. the framework’s predecessor, the information literacy standards for higher education (in use from 2000-2015), were found lacking in their usefulness as a pedagogic guide by being overly prescriptive and rigid for universal application across disciplines. the framework represents an endeavor to capture a range of interrelated precepts regarding research and discovery, with non-linear, flexible, and transdisciplinary applicability. johnson et al./collaborating with academic librarians 3 the framework is based upon the notion of threshold concepts, a paradigm which posits that once intellectually absorbed, some ideas or pieces of knowledge precipitate an irreversible transformation in the learner’s understanding of their discipline. threshold concepts are often described as one-way portals: once passed through, one cannot return to the previous state of understanding (land et al., 2010). evolving from a delphi study intended to identify threshold concepts relative to information literacy (townsend et al., 2016), each of the framework’s core precepts, or frames, is supplemented by a set of knowledge practices and dispositions. the six frames for information literacy are: • authority is constructed and contextual; • information creation as a process; • information has value; • research as inquiry; • scholarship as conversation; • searching as strategic exploration. like social work, the professional evolution of librarianship in the united states emerged from the transformational societal churn of the progressive era (1900-1920) with deep roots as a social justice-oriented profession and a central focus on the well-being of marginalized communities. just as the settlement house workers of the early 20th century viewed social ills such as poverty as a form of oppression remediated by social justice efforts, librarians sought to ameliorate public strife through a holistic, in-situ practice. thus, progressive era librarians, often alongside their social work counterparts, created a broad array of community-based services far beyond the provision of books including educational, social, and cultural programs, access to kitchens, bathrooms, leisure activities, children’s services, and evening and weekend hours (bausman, 2016; garrison, 2003). also, like social work, despite its noble intent, librarianship struggles with a history replete with elements of institutionalized oppression, social control, heterogeneity, and racism (bausman, 2016; chapman & withers, 2019; garrison, 2003). academic social work librarians are deeply invested in promoting the framework’s efforts to redress this legacy through their creation of a companion document which outlines the shared values and ethics of social justice by social work educators and practitioners (acrl ebss [education and behavioral sciences section] social work committee, 2020). the framework is, of course, not without controversy, as elegantly laid forth by saunders (2017) in connecting information literacy to social justice: why and how: some librarians suggest that by intertwining information literacy and social justice, we are giving up our core value of neutrality and objectivity, while others have argued that we do not go far enough, and that information social justice could be made an even more explicit part of our conceptualization of information literacy. (p. 56) saunders extends this discourse by exploring library practices based in heteronormative, patriarchal structures and suggesting that institutions and their members must continue to engage in reflective praxis geared towards the recognition and amelioration of systemic bias and oppression. she concludes by offering a proposal to advances in social work, spring 2021, 21(1) 4 amend the framework with a seventh frame: information social justice. indeed, this runs parallel to the construct of “critical information literacy,” a praxis approach with significant traction among academic librarians. mindful of libraries’ social justice roots, gregory and higgins (2013) query: the values of our professional organizations articulate an activist perspective inclined toward social justice. how then has the concept of information literacy and the work of instruction librarians come to be treated as ahistorical, as well as atomistic and mechanistic? (p. 2) based upon the core tenets of postmodernism, an anti-oppressive pedagogy as put forth by paulo freire, critical information literacy extends traditional definitions of ili as it “...takes into consideration the social, political, economic, and corporate systems that have power and influence over information production, dissemination, access, and consumption” (gregory & higgins, 2013, p. 4). the authors previously posited that the “information literate social worker possesses the capacity to traverse [the] churn [of the information universe], identify the need for information, discover and evaluate the resources available, and integrate new knowledge into practice” (bausman & ward, 2016, p. 112). a subsequent deepening of the notion of the information literate social worker additionally draws from the fluidity of the acrl framework with a clear social justice orientation. thus, the information literate social worker possesses the agency, capacity, and critical thinking to reflectively negotiate the information universe; to ethically discover, evaluate and integrate new knowledge into practice; and to apply an anti-oppressive, social justice foundation to their use and dissemination of information on behalf of their practice, communities of service, and profession. information literacy instruction in social work education there is a small but growing body of research concerning information literacy instruction specific to social work education (bingham et al., 2016; doney, 2018; magliaro & munro, 2018; pendell & kimball, 2020). at the heart of these inquiries exists a growing consensus around three recurrent themes: in aggregate, incoming social work students lack the information literacy skills required for graduate level education; the provision of ili in schools of social work is primarily reliant on individual relationships between librarians and social work instructors; and formal social work education would benefit from a broad inclusion of ili at critical junctures in the curricula designed and implemented in collaboration with information literacy specialists (librarians) on the local level. what some might consider a seminal item in this literature is a brief piece published in health & social work in 2007. speaking directly to their colleagues, wheeler and goodman (2007), two well-established social work educators, directly address the lack of information literacy in social work education and practice compared to related disciplines. they note the schism between what researchers determine to be best practices and what is actually applicable in health and mental health social work service settings. they posit that information literacy as a foundational skill would serve as a cohesive agent toward a more johnson et al./collaborating with academic librarians 5 unified process of knowledge creation with efficient and effective applicability to social work practice. while not an ili-oriented piece of scholarship, teater’s (2017) exploration of the academic understanding of research within the discipline and its impact on social work practice is a noteworthy sidebar. contrasting the “crisis” in social work research since the 1980’s to their findings, teater (2017) concludes that “...the gap between research and practice continues to be wide and the extent to which social work research has contributed to a knowledge and scientific base for the social work profession remains inadequate” (p. 562). as noted above, this is the third in a series of studies completed by the authors to examine the landscape of ili in social work education. the first study used an irb approved quantitative online survey, completed annually for three years by social work students at the researchers’ home institution, concerning their awareness and use of library resources and services. during that time span, significant development of the ili program began, moving it from a limited, procedurally-oriented model to a universal, conceptoriented model. the findings included a moderate but statistically significant increase in first-year students’ awareness and use of library resources and services, suggesting that sanctioned and embedded ili correlates to library engagement (bausman & ward, 2015). the second study invited social work librarians to participate in an irb-approved quantitative online survey investigating their professional experience of providing ili in graduate level social work education. with a 58% response rate (n=145), several findings point to a need for further study concerning existing curricular and pedagogic approaches to ili in social work education, the use of curriculum mapping on the local level, and assessment strategies for the student acquisition of information literacy competencies (bausman & ward, 2016). implications for social work educators the issue of ili as a component of anti-oppressive pedagogy holds gravitas for social work educators. yet the links connecting these seemingly disparate facets are not fully articulated in the literature and nascent attempts to do so are, of necessity, typically focused on one aspect of social work education or practice rather than a holistic overview of its fuller landscape. one such focus has been the connection between ili and evidence-based practice (ebp). observant of the increasing emphasis placed on ebp in the curriculum at boston college during the mid-2000s, silfen and zgoda (2008) studied students’ abilities to retrieve peer-reviewed research through citation analysis of references that students used in a literature review required for their social work research course. their findings suggest that students would benefit from ili geared towards the development of search skills needed to retrieve evidence-based, peer-reviewed research. more recently, bingham and colleagues (2016) describe collaborative efforts between il professionals and social work instructors at the university of auckland. beginning with a discussion about the acknowledged research-practice gap in social work in tandem with advances in social work, spring 2021, 21(1) 6 the increasing, albeit at times contentious, emphasis on professional adherence to ebp, bingham et al. (2016) position ili as a mechanism that actively threads the needle required to mend the division between research and practice. one key point is advocating for early introduction of ili so as not to relegate it as a sidebar in research courses but to establish it as a curricular component, integrated into appropriate junctions across coursework and field placement. from a different direction, bradley (2013) approaches the question of il as a professional competency by examining the accreditation standards for nursing, social work, and engineering vis-à-vis the five primary elements of the acrl (2000) information literacy standards. among her findings, bradley concluded the professional competency standards in the us and canada lack integration of il as compared to those of the uk and australia. similarly, adams (2014) constructs a crosswalk between the evidence-based paradigm and the acrl literacy standards. positing that both promote the requisite conceptual skills to locate, select, and integrate research into practice, she identifies corollaries and departures between models providing direction for instructional librarians in the social sciences. it is noteworthy that since the publication of these studies (2013 and 2014), the council on social work education (cswe) revised its educational policy and accreditation standards (epas) (cswe 2015) and the acrl (2016) information literacy framework supplanted the standards for higher education (acrl, 2000). one might therefore dismiss adams’ and bradley’s findings as outdated. alternatively, one might embrace both studies as elements in a living scholarly narrative that deserve revisiting through the lens of the revised epas and the acrl framework. moreover, this example serves as testimony for the need of interdisciplinary engagement among higher education information professionals and social work educators to reciprocally adjust instructional efforts, accounting in real time for the ever-evolving knowledge base and practice of both disciplines. lastly, there is recent focus on life-long learning and related professional behavior among social work practitioners (jivanjee et al., 2015; pendell, 2018; pendell & kimball, 2020). in a turn that at the least seems short-sighted and at worst is undermining, the transition from student to professional is frequently accompanied by losing access to scholarly literature necessary to support research-informed practice. such information sources that are primarily available through subscription resources in an academic library are typically inaccessible in a preponderance of social work practice settings. jivanjee et al. (2015) note that “social work literature addresses aspects of the learning needed for contemporary social work practice but to date, there has been little attention as to how social workers engage as life-long learners throughout their professional life” (p. 261). using a qualitative protocol, their study’s cohort noted obstacles to accessing research literature and applying some research to practice settings, both of which could necessitate input from information sources outside of the research arena. drilling down further on the issue of access to research, pendell (2018) reports only 48% of a random sample of articles (n=638) published in the top 25 social work journals are fully available johnson et al./collaborating with academic librarians 7 in the open access environment, an unknown quantity of which are likely vulnerable to copyright violations and take-down notices. stemming from their librarian/social work educator collaboration, pendell and kimball (2020) report on a national survey of social work professionals assessing their use of ebp models, of research literature as well as other information sources, and their exposure to ili during their graduate studies. respondents (n=123) ranked the use of peer-reviewed research a close second (out of nine) of the most important information sources but only 60% of the cohort reported adequate access to it, citing cost as the primary obstacle. a key take-away from this study is the need for social work librarians and educators to address this divergence in access to information between academic and practice settings with both instructional and advocacy implications. in aggregate, the extant study concerning life-long learning and social work practice suggests the need for more social work research to exist in the open access environment. moreover, it calls for social work professionals to develop a broad understanding of the information universe as it applies to their practice setting, including a baseline knowledge concerning access issues and resources (subscription versus open access) as well as the discovery, evaluation, and synthesis of grey literature and other information sources created outside the world of academic publishing. rather than viewing discrete segments of the information landscape via social work education and practice, it may be useful to visualize these connections through the timehonored social work approach of diagrammatic representations such as the ecomap (hartman, 1995), the genogram (mcgoldrick et al., 2008), and the cultural ecogram (yasui, 2015; see figure 1). using such an approach, the interconnectedness between information literacy, educational and professional standards, and social work values becomes increasingly clear. without ili as a component of the curricular foundation, the ability to meet educational and accreditation standards falter. moreover, absent il competencies, new social workers may enter professional practice lacking the skills necessary to engage in life-long learning and to maintain an ethical, research-informed practice. this study targets the aforementioned dearth of research around il and social work practice, and especially its absence in social work specific literature, in such a way as to draw together seemingly disparate facets of the educational and professional landscapes into a comprehensive and inter-related context. advances in social work, spring 2021, 21(1) 8 figure 1. social work information literacy ecomap johnson et al./collaborating with academic librarians 9 methods building on the findings of the authors’ previous work, the goal of this qualitative study was to gather and analyze information about where and how ili and reference services fit into institutional goals generally and into the social work curricula specifically. to that end, the authors divided questions about information literacy into two sections pertaining to ili in the classroom and individual research consultations. with an interest in “how different people experience particular situations and how issues might affect practices across sites” (trainor & graue, 2012, p. 56), the researchers examined the experiences of various librarians in similar positions across the united states. the researchers determined it was important to conduct multiple interviews of social work librarians as experiences may vary greatly depending on the context of their faculty status, university size, and relationship with their respective schools of social work. sample following approval from the authors’ institutional review board, a two-week recruitment period commenced in may 2017. the authors used a method of purposive sampling of over 250 academic librarians in the united states: specifically, university librarians designated as subject liaisons at accredited graduate social work programs in the united states. as mentioned earlier, two of the three researchers hold both msw and mlis degrees and work as librarians in the same social work library. thus, their professional connections and relationships to the social work librarians’ community provided the opportunity to generate a purposive sample. librarians working strictly with bachelorslevel students were omitted, as were librarians working with online-only programs. the authors sent a recruitment email to over 250 social work librarians, including three professional listservs, and within two weeks finalized a list of 27 respondents. nearly all interviews were conducted over the phone with the exception of one, which was held in person. prior to each call, respondents completed a written consent form and granted permission to be audio-recorded. quotes from interviews are cited anonymously with the following naming convention: p1 for “participant one”, p2, p3, etc., throughout this paper in order to maintain confidentiality. protocol two of the three authors interviewed the participants. the researchers followed a semistructured interview protocol (appendix) with 29 questions about il as it relates to both classroom instruction and reference consultations with msw students. additionally, the interviewers asked seven questions to gather descriptive information about the respondents’ education and careers. both interviewers worked from the same set of questions to ensure consistency in the information they gathered. however, the semistructured approach allowed the interviewers flexibility to ask probing questions, as well as the possibility to change the order in which the questions were asked to maintain the natural flow of the interviews. the 27 interviews generated nearly 40 hours of recorded audio content. six interviews did not record properly, so handwritten interviewer notes advances in social work, spring 2021, 21(1) 10 were used to document these responses. the researchers obtained a grant in july 2018 to digitally transcribe all audio and handwritten interviews and hire a graduate student to assist with coding. analysis the research team employed an inductive approach (saldaña, 2014) to analyze the interview transcripts and notes; seeking themes and meaning that emerged from various rounds of coding and discussion. the first pass of open coding generated more than 20 possible themes and categories. the researchers coded a sample of three transcripts, then met to discuss the emergent themes. during that discussion, the team developed a framework for categories that were used for the next round of coding. through a series of subsequent meetings to discuss and refine the groupings, the researchers arrived at three main categories: relational, programmatic, and characteristics, which are depicted in figure 2 along with their attendant sub-categories that capture nuances from the interviews. the relational category includes any mention of relationships with different groupings of people, both inside and outside of the institution. to further refine this category, the “within institution” relationships are divided to indicate whether they exist inside or outside the library department, and with colleagues or with students. programmatic groupings include content specific to the institution (i.e., msw program, libraries, assessment, etc.), and the characteristics category includes respondents’ descriptions of people, typically librarians or students. once the research team solidified this framework for coding, each team member coded interview transcripts independently. the researchers met regularly to discuss thematic findings within each of the categories and sub-categories. for this manuscript the team decided to focus on the ili component of the protocol (see appendix, part 1). findings demographics of respondents within the participant sample (n=27), respondents had an average of 21 years of experience as an academic librarian, with 10 years involved with social work curriculum. most respondents worked in libraries that employed a liaison model where librarians were attached to various academic departments rather than being designated as a singular, subject specialist. including social work, respondents liaised with an average of five departments at their respective universities. in addition to their master’s in library science degree, 41% (n=11) had an additional graduate degree and two respondents earned a ph.d. therefore, most social work librarians (swls) in this cohort were highly educated and committed decades of their professional careers to multi-disciplinary academic librarianship. johnson et al./collaborating with academic librarians 11 figure 2. coding categories and subcategories coding categories rela�onal professional (faculty, staff, colleagues) outside library within ins�tu�on outside ins�tu�on within library programma�c ins�tu�on msw library tenure status ins�tu�onal informa�on literacy reference/ consulta�on instruc�on assessment professional standards physical loca�on characteris�cs librarian students advances in social work, spring 2021, 21(1) 12 relationships with social work faculty so much of it is tied to the individual professor...i will spend time seeing what courses are being taught in an upcoming semester, seeing who’s teaching them, and then reaching out to those professors...with social work, it's usually people i know (p7). the central theme that emerged from the interviews was the importance of quality, working relationships among swls and department faculty, as illustrated by the quote above. regardless of participation in programmatic outreach, most swls found alliances with particular social work faculty as the determining factor that influenced the quality of their connections with the school and its msw students. most respondents found their successful working relationships with faculty to be largely dependent on individuals and many swls faced barriers to connecting due to fluctuations in social work faculty across semesters, especially if the bulk of classes were taught by adjunct instructors (p22). informal networking and visibility beyond the classroom, the study’s respondents sought to connect with faculty through formal events such as department meetings, service committees, professional development workshops, and–while rare–curricular planning. the bulk of interactions, however, existed by way of informal social events and incidental meetings. one participant repeatedly emphasized the importance of librarians making their presence known: the library’s participation in providing instruction and, by extension, instilling the concepts of information literacy are always a challenge that should never rest on the notion that you have been accepted and are part of the academic teaching mission of a department...you should always every year go back and knock-on doors and say, ‘hi. remember me? what can we do together?’ (p1). library location and visibility physical proximity between librarians and social work faculty, their offices, and the school itself also influenced the degree to which collaboration occurred. some respondents claimed their visibility determined the strength of their working relationships with social work professors more than their faculty status. others agreed with the importance of optics, particularly if the campus library and social work department existed at a significant distance from one another. one participant observed her library’s separate location from the school of social work most likely contributed to the department being “a little bit more distant from some [other departments], and i don’t think it's a matter of ignoring. it's more a matter of just that we’re not there for them to see” (p2). service-provider versus collaborator when asked to discuss their involvement with faculty research, the majority of swls found their provision of service-oriented research or “secondary research” occurred far more frequently than equal, partnered collaborations. service-delivery for faculty generally johnson et al./collaborating with academic librarians 13 entailed locating scholarly materials and ascertaining the quality of journals for publication. for some, engagement with faculty was “incidental and minimal compared to the work i do with the students” (p10). one participant said her formal interactions with social work faculty were “extremely rare...the reality is that if they reach out to me at all, it's because they need something from the library and they can't figure out how to do that” (p2). another surmised that social work faculty viewed academic librarians as service providers rather than as collaborators. nonetheless, most respondents continued to make themselves available to faculty and recognized “there’s the people that get it and there’s people that don’t get it... so, [i] just keep trying to connect” (p7). faculty status even if i did have faculty status, they'll still just see me as a librarian, not as a peer…they respect me more for my knowledge base…it doesn’t matter whether i'm faculty or not, it just mattered that i helped them (p15). the researchers collected information about swls’ faculty status and if they thought their rank impacted their ability to connect and collaborate with social work faculty. responses were split in that 44% (n=12) of respondents had faculty status whereas 48% (n=13) did not. two respondents (n=2 or 7%) did not answer this question. some demarcations do not align clearly between faculty/non-faculty status. other respondents’ titles included numeral ranks such as “librarians i-iv” while others had “academic” but not “faculty status.” perceptions of whether one’s faculty rank–or lack thereof–affected the quality of their connections with social work professors were also mixed. some stated their rank matters (p5; p8) while others were unsure (p10). some believed that while having faculty status helped to collaborate with faculty (p1), they surmised it was their research experience and knowledge base that elevated them rather than their professorial rank (p4). some swls with faculty status noted their rank and subsequent responsibilities generated respect from social work faculty (p1; p16), yet others felt respected by faculty regardless of status (p3). others conceded while faculty rank did not affect their ability to collaborate with social work faculty “it does affect how we are perceived” [emphasis added] (p10). echoing the central finding in this research, many respondents determined the chief factor to linking with social work professors was through individual connections. curriculum mapping though most social work librarians were not formally involved in curriculum planning, nearly all claimed to be “fairly” conversant with social work curricula. swls maintained familiarity with curricular content through reviewing syllabi and providing one-shot instructional sessions with specific social work professors or courses. several respondents mentioned requesting or examining course syllabi to familiarize themselves with assignments. in each instance, the librarian proactively tracked down information about the course and the assignments, attempting to discuss with the instructor the expectations for their students, and to identify how a one-shot library instruction session fit into the advances in social work, spring 2021, 21(1) 14 trajectory of the course or the course sequence. this holistic approach is illustrated by a respondent who explained: i will ask the professor if they’ll share the syllabus with me, so i understand what the goals of the entire course are so that i’m not leaving anything out that needs to be addressed…i try to gather as much information as i can to be able to address all of their needs (p15). this respondent also discussed familiarity with the overall mission and goals of the broader social work program, which allowed them to tailor and focus their work with students to contribute to the larger goals of the program. librarians’ attentiveness to curriculum, course content, and assignments enabled them to act as a bridge between students and faculty when more clarity was needed, or when various students sought help with the same question. this proactive approach, and the attention to both course details and programmatic goals to help students succeed, positioned librarians as advocates for students who may not have felt they had the agency or knowledge to know what questions to ask of their professors. such an advocacy role, however, required diplomacy and tact on the part of the librarian, and were not always welcomed, as another respondent indicated: as i was working with a couple of the students, i realized that some of the things they were required to do weren’t adequately explained in the syllabus…we’re not telling the students what they need to hear the way they need to hear it. so, it's an ongoing effort...it can get in the way of the students being successful (p7). while a few respondents participated in university-wide curriculum mapping or served on social work curriculum review boards, most noted that, regardless of the quality of the relationships they had with social work faculty, they rarely received an invitation to participate in curricular planning. one respondent noted that even though he reached out to his departmental faculty, “i didn’t even get a response” and reasoned that “eventually they’ll see a need for it just like they’ve incorporated ‘writing across the curriculum’” (p10). conversely, one librarian generated buy-in while meeting with the social work curriculum planning committee and “when i provided a map of all the different things that [the library] could cover...they were sort of blown away, like, ‘oh, we had no idea that the library could do all that. we thought library instruction was just come in and show them how to use social work abstracts or whatever’” (p4). some respondents determined the perceived resistance from social work faculty to ili was not to the one-shots per se but attempts to formalize it into the curriculum. one swl bemoaned the rigidity of the social work curriculum as “trying to get my way into [the curriculum] is basically fighting tooth and nail” (p2). another concurred she and her fellow swls: ...have been trying to implement the process to get ourselves inserted into the curriculum. the reason is, we want there to be consistency as lots of the faculty are new. they come and go as adjuncts, but they’ll know that there's a library instruction in there, and the idea being that we then would be able to kind of scaffold learning and information literacy throughout the courses, throughout the curriculum...but the faculty are not having it. i asked, even though i have a good johnson et al./collaborating with academic librarians 15 relationship with people, i asked them informally…i nudged, and then i asked specifically, and then i sent out an email, and i got nothing back. so, the only institutional challenge that i've come up against is the idea of putting us in the curriculum (p10). no doubt some social work librarians have good relationships with social work faculty, yet the bulk of efforts to initiate collaboration tends to be one-sided, stemming from librarians rather than social work faculty proactively reaching out to them on equal footing. such instructor-reliant relationships are further discussed below. assessment with the formal [assessment] that i send out...i don’t get a lot of response. i would have to look back and see if any of the social work faculty have responded to me. maybe one or two, but they're generally like, ‘everything’s wonderful’ (p2). assessment of ili was another major theme emerging from this research. interviewers asked respondents about what assessment approaches, if any, they used with msw students. specifically, the researchers inquired if swls assessed skills acquisition through graded or non-credit bearing assignments and if this occurred during or after an ili session. findings showed respondents rarely conducted assessments using formal or systematic measurements, either for actual or perceived skills acquisition. some tried in the past though efforts were generally unsuccessful due to time constraints and lack of support from instructional faculty. however, there were some exceptions. three respondents used grading rubrics such as non-credit-bearing quizzes or brief surveys immediately following an information literacy session. one used “three very general questions at the end of each session such as ‘can you name three things you learned today?’” (p5). another provided students with index cards to gauge the usefulness of ili and to generate follow-up questions but conducted no formal assessment (p25). many respondents offered their perceptions on the usefulness of ili to students. some highlighted a notable difference between students who sought research help from librarians, while others cited student emails expressing gratitude to librarians. one respondent sensed students “perceive it as helpful because they usually give me positive comments at the end of the ili session. if i don’t hear from them again, to me that’s a positive thing” (p23). thus, when conducted, swls assessments of ili were “more intuitive and informal in planning and evaluation” (p26) and based on librarians’ perceptions of its effectiveness. some participants voiced concerns about assessment in general: they questioned the content of what was being assessed and wonder if swls are measuring actual skills attainment or simply librarians’ perceptions of students’ capabilities (p22). advances in social work, spring 2021, 21(1) 16 discussion the findings described above offer two clear and intertwined discussion points concerning ili in social work education: first, the current relational nature of ili in schools of social work and, second, the need for curricular integration and assessment. information literacy instruction: relational versus integrated one of the most prominent themes emerging from interviews with social work librarians concerns the strength of the collegial relationship between social work librarians and instructors. this relationship is often the primary determinant of whether or not ili is delivered. while social work librarians value their interdisciplinary relationships with instructional faculty for many reasons, their reliance upon these relationships as the primary vehicle for the provision of ili is fraught with pedagogic and sustainability shortcomings. as a result, many librarians find themselves in a course-related or courseadjacent position with ili, rather than integrated into the course or curriculum. the concept of course-related instruction dates back to the 1970s and is described by kirk (1999) in his review of course-related bibliographic instruction in the 1990s. drawing upon decades of instruction at earlham college (kennedy et al., 1971), kirk differentiates course-related instruction from library orientation or bibliographic instruction. rather than teaching the mechanics of using the library in the most general sense, kirk presents courserelated instruction as a discipline-specific approach that engages students through active learning. further, the creation of instructional content is a collaborative process between librarians and instructors. instructional librarianship’s continued evolution over the last 20 years folds these general tenets into ili pedagogies that align with institutional goals and are delivered in collaborative and sustainable ways through course, program, and curriculaintegrated models. the respondents in this study, however, relate little success engaging social work colleagues in integrated pedagogical approaches. indeed, the data suggest a pattern in which ili in social work education is at times neither course-related nor course-integrated but is instead entirely instructor-reliant. this is consistent with the findings of other researchers. meulemans and carr (2012) note “it is the quality of relationships that individual librarians have with their faculty [that] is the major driver of an instruction program’s success” (p. 84). reale (2018) laments this failure of departmental faculty to use academic librarians as genuine partners in education rather than as providers of one-off instructional sessions. likewise, pendell and kimball (2020) note the dearth of discussion specifically in the social work literature concerning ili. this instructor-reliant trend presents a number pedagogic obstacles. first, it leaves ili vulnerable to turnover among librarians and social work instructors, changes in leadership, and loss of institutional knowledge. in turn, this curtails the provision of ili in sustainable ways and eliminates the opportunity to intentionally and collaboratively provide it at key points in the curriculum when ili is meaningful to students and absorbed into their academic and professional information-seeking repertoire. in short, it leaves swls in an johnson et al./collaborating with academic librarians 17 endless cycle of re-creating the wheel while furthering inconsistencies and inequalities in the type of education students receive within the same program. educational partners: curriculum and assessment there is growing consensus among those engaged in research concerning ili in social work settings (doney, 2018; johnson et al., 2011; magliaro & munro, 2018) that it is optimally effective when embedded within the social work curriculum. particularly for social work education, which frequently stresses the importance of evidence-based practice, bingham et al. (2016) argue that, …rather than relegating ebp concepts and practices to research courses, they should be integrated throughout the entire [social work] curriculum both in coursework and field work. this would embed the importance of the researchpractice connection across the curriculum more forcefully and facilitate the development of more information literate ebp practitioners. (p. 209) likewise, the authors posit that critical ili that is strategically scaffolded into the curriculum is more effective towards molding research-informed practitioners as compared to piece-meal, one shot ili sessions incidentally offered to some students but not to others. further, an intentionally integrated approach would make way for meaningful assessment of il practices which both the literature and the participants of this study highlight as lacking. this aligns with bausman and ward’s (2016) study which reports only 11 percent of social work academic librarians use formal assessment tools and acknowledges the limitations of assessment when subjective perceptions of librarians are largely based on students’ feedback. a targeted approach to developing an integrated ili program requires inclusion of academic librarians in curriculum planning committees as educational partners. bringing librarians into this arena would provide local, curricula-specific opportunities for jointly identifying the critical junctures at which to embed ili, to discern discreet il learning objectives, and to flexibly adjust embedded ili components in response to curricular evolution. without such institutional support, assessment is meaningless and nearly impossible to conduct. this assertion is supported by cswe (2015) which requires assessment of student learning outcomes as one of its accreditation standards. although the current epas does not use the term “information literacy,” it clearly outlines an educational competency that students learn how to “engage in practice-informed research and research-informed practice” (p. 8). as such, swls and social work faculty have an obligation to forge efforts to uphold such educational standards through the active engagement of the cswe epas with the acrl framework. case example the partnership between swls and social work faculty at the authors’ institution is an example of such an integrated approach. at the time of this writing, students enrolled in the msw program view a brief pre-orientation welcome video from the library and partake in a first-year workshop with an online, asynchronous component followed by an hour of face-to-face instruction with a faculty librarian. thereafter, students receive one hour of advances in social work, spring 2021, 21(1) 18 instruction from a faculty librarian embedded into core classes in their second through fourth semesters. each module covers distinct areas of il required for social work practice, links to a real-time class assignment, and contains content guided by specific learning objectives, epas practice behaviors, and the acrl framework. this program is made possible through the collaborative efforts of the swls and social work faculty, the social work curriculum committee, and social work student services department contextualized within the sanction of the program leadership. over the years, the shape and scope of the program has been flexibly adjusted in response to the evolution of the curriculum and the needs of the students (bausman & ward, 2016). study limitations while the researchers are pleased with the number of respondents who participated in this study, it quickly became apparent that coding 27 qualitative interviews averaging 90 minutes each was a massive undertaking. the sheer amount of data collected is a goldmine, yet it considerably slowed the process of generating scholarship, far longer than the researchers intended. in the future, we suggest aiming for a smaller sample size of approximately 10 participants which still has the potential to generate equally valid and worthwhile content. additionally, as noted earlier, two of the three researchers hold both msw and mlis degrees and work as librarians in the same social work library. therefore, their values and experiences as social workers and librarians play into the interpretation and analysis of the data from this study. implications for social work education as helping professionals with deeply intertwined evolutionary roots and commitment to social justice, the foundation for the partnering of social work educators and academic librarians already exists. following the lead of our colleagues in public libraries who abide by trauma-informed library practices (zettervall & nienow, 2019) and our partners in field education departments who nurture public libraries as venues for social work field placements (johnson et al., 2019), social work educators and academic librarians should leverage our shared values around social justice as expressed in the acrl framework and cswe epas in service of promoting the information literate social worker (acrl ebss social work committee, 2020). in closing, the authors offer two overarching recommendations. the first is to release ili in social work education from dependence upon individual librarian-instructor relationships in favor of a curriculum integrated approach. action items toward such an evolution include: • including instructional social work librarians on curriculum committees and other departmental entities governing curriculum content and delivery; • evaluating existing curricula on a local level to determine: 1. natural junctures in which ili supports completion of course requirements and development of professional practice skills; and 2. appropriate program-centric delivery johnson et al./collaborating with academic librarians 19 modalities such as flipped classrooms, face-to-face instruction, and online asynchronous and synchronous instruction; • identifying opportunities for embedding assessment of il skills acquisition within local curricula; • including swls in student orientations and new faculty onboarding processes; • reviewing and consulting the social work committee’s companion document to the acrl framework to examine how the values and ethics pertaining to social justice are aligned between both academic librarianship and social work (acrl ebss social work committee, 2020). the second recommendation is for the cswe to include information literacy, as defined in the above discussion and not in its current iteration provided in their recommended changes for the 2022 educational policy and accreditation standards (cswe, 2020). we strongly encourage cswe to partner and consult with academic social work librarians and scholars so this critical concept of information literacy is properly defined and understood. conclusion the current study aimed to listen to and learn directly from social work librarians across the united states about their experiences providing ili in graduate schools of social work. findings demonstrate that the relational-dependent nature of social work librarians on social work faculty is insufficient to meaningfully integrate ili into curricula and accurately assess its impact. highly collaborative, sustainable working partnerships among academic librarians and social work faculty situated within the local mechanisms of curricula 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(2019). whole person librarianship: a social work approach to patron services. libraries unlimited. author note: address correspondence to sarah c. johnson, library department, hunter college, new york, ny, 10065. email: sjo0034@hunter.cuny.edu https://doi.org/10.1080/01488376.2017.1340393 https://doi.org/10.15760/comminfolit.2016.10.1.13 https://doi.org/10.1093/hsw/32.3.235 https://doi.org/10.1080/15313204.2014.991980 mailto:sjo0034@hunter.cuny.edu johnson et al./collaborating with academic librarians 23 appendix social work librarian interview form protocol the goal of this interview is to gather information about where and how information literacy instruction and reference services fit into your institution’s goals generally and in the social work curricula specifically. demographic profile 1. how long have you been an academic librarian? how many of these years have you been involved with social work curriculum? 2. how many departments/programs are you responsible for? how is subject specialization handled in your library? 3. did you train specifically for instructional and/or reference services? how? part 1: information literacy instruction 1. please share with me a general overview of your role as an information literacy instructor in the social work program. how closely aligned are your instructional responsibilities to your job description? 2. have your responsibilities as an instructor changed over time? how? relational factors 1. how do you connect / collaborate with the social work faculty? a. formal opportunities: faculty meeting, service committees, governance bodies, etc. b. informal opportunities: professional development activities, social networking activities, incidental meeting, etc. 2. do you have faculty status? a. how does this impact connecting and collaborating? 3. what is your level of involvement in faculty research? a. consultation, co-author, systematic review, etc. curriculum mapping 1. how familiar are you with social work curricula? i. review syllabi? ii. familiarity with scaffolding of courses in the program? familiar with the program's pedagogy? 2. how familiar are you with cswe epas, acrl standards for higher ed, acrl framework? i. do you use any of these benchmarks in designing instruction sessions? 3. have you engaged in any curriculum mapping activities in service of information literacy instruction? assessment 1. what assessment approaches do you use? a. skills acquisition 1. skills assessment during or after session? advances in social work, spring 2021, 21(1) 24 2. graded, credit/no credit, extra credit 3. specific library assignment 4. element in a grading rubric b. perception i. student survey, session feedback ii. pros iii. cons best practices 1. generally, what should information literacy for social work education and practice include? a. is there a "universal" baseline? b. or is baseline localized adaptable from program to program? c. is baseline static or in flux? d. impact of student body, methodology, institutional values and goals part 2: reference and research consultations 1. please share with me a general overview of your role as a reference librarian with social work students. how closely aligned are your reference responsibilities to your job description? 2. have your responsibilities as a reference librarian changed over time? how? effectiveness 1. how do reference consultations [rc] benefit social work students? a. is this / how is this different from other groups of students? b. how can librarians maximize the potential benefits? 2. how do you measure reference service? a. quantity, type of interview, length, etc.? b. how do you measure efficacy? c. do/how do reference services increase information literacy? d. do/how do you assess this? 3. how do you promote rc? a. during class, signage, social media, outreach, etc.? b. as part of the curriculum? c. as a professional competency? 4. does/how does rc dovetail with instruction? a. equally weighted group vs. individual instruction? b. an opportunity to fill instructional gaps? 5. do you tailor rc for social work students? a. social work students vs students in other disciplines? b. graduate vs undergraduate students? c. diversity within social work cohort (age, experience, library anxiety, technophobes, etc.) 6. is rc obsolete? a. do students use it? johnson et al./collaborating with academic librarians 25 b. does it need fixing, transformation? c. how and why? librarian role 1. in addition to your mlis, what other higher education degrees have you obtained? a. is librarianship a first or second career path? b. other professional training? 2. with regard to social work students, have you had experiences in the context of rc that called upon a supportive role beyond reference services? a. student need for other academic services? b. student need for concrete services (housing, insurance, etc.)? c. student need for emergency, behavioral, mental, physical health services? 3. how comfortable are you with your capacity to meet non-reference needs if indicated? a. support of library and/or social work department b. access to resources to facilitate linkage c. institutional policies, procedures, training d. access to institutional public safety and behavioral health teams pedagogic fit 1. how might rc promote evidence-based practice social work? 2. how do you see rc fitting with best practices for il instruction? 3. how might rc fit into an anti-oppressive pedagogy? 4. how might rc fit with acrl framework, cswe standards, nasw values and ethics? 5. what are the institutional challenges in promoting rc? information literacy instruction in social work education implications for social work educators figure 1. social work information literacy ecomap sample protocol analysis demographics of respondents figure 2. coding categories and subcategories relationships with social work faculty informal networking and visibility library location and visibility service-provider versus collaborator faculty status curriculum mapping assessment case example study limitations implications for social work education _________ cynthia mackey, msw, graduate student and cswe mfp fellow, nidia hernandez, lcsw, msw, mpa, graduate student and cswe mfp fellow, stephanie lechiga-peña, phd, assistant professor, and felicia mitchell, phd, school of social work at arizona state university, phoenix, az. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 647-679, doi: 10.18060/24776 this work is licensed under a creative commons attribution 4.0 international license. disrupting white supremacy: testimonios to reveal the experiences of women of color in social work doctoral education cynthia mackey nidia hernandez stephanie lechuga-peña felicia mitchell abstract: social workers must participate in ongoing anti-racist and culturally attuned approaches to disrupt white supremacy in our profession, institutions, and society. our social work mission, values, and ethics demand that we engage in social work education, practice, and scholarship that seeks social justice for all people. in line with these expectations, social work doctoral education is tasked with training the next generation of social work scholars by providing doctoral education that is responsive to society's most pressing social problems. while disrupting white supremacy is an aspirational goal, we argue that white supremacy infiltrates social work education, manifests itself in diverse ways over time, often isolating black, indigenous, and people of color (bipoc). we use testimonios to explore these issues and describe four bipoc women’s experiences navigating their social work doctoral programs. from these insights, we contend that social work doctoral education continues to uphold white supremacy by promoting western epistemologies and theories above other equally valid forms of knowledge, including non-western schools of thought created by and for bipoc scholars. we provide recommendations for alternative theories and epistemologies for social work curricula and offer implications to support bipoc students in social work doctoral education. keywords: white supremacy, social work doctoral education, bipoc, testimonios, antiracism as outlined in the nasw code of ethics (henceforth, the code), social workers are expected to participate in ongoing anti-racist efforts to disrupt white supremacy in our profession and society. the code is the driving force of social work, laying out shared values and principles we, as a collective, are taught and expected to adhere to as social workers. at its core, our profession and the code emphasize the fundamental belief that oppressed and marginalized groups are entitled to equal respect, dignity, and treatment as anyone else, regardless of their socially constructed racial identities (national association of social work [nasw], 2020a). we are called to dismantle oppressive systems, such as white supremacy, in the code, as follows: social workers should act to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical ability. (nasw, 2021, ethical standards, sec.6.04(b)) about:blank advances in social work, summer 2022, 22(2) 648 the code is not limited to clients but extends to our conduct with our colleagues and educational spaces, including doctoral education. thus, as social work doctoral students will be responsible for teaching the next generation of social workers, they play an important role in advancing the spirit of the code, including dismantling oppressive systems. in academia, the modern-era of white supremacy manifests through whiteness, a social concept that perpetuates systemic racism and ultimately benefits white people (bonilla-silva, 2006; cabrera & franklin, 2016; feagin, 2006; kincheloe, 1998; leonardo, 2009; omi & winant, 1994). following many anti-racist scholars emphasizing the power of language and using literary advocacy to elevate racial inequities within social, economic, and political systems, the authors capitalize bipoc social identities (such as black, women of color, people of color, colonized/indigenous people, and students/faculty of color) and lower case white and whiteness to adopt this movement (appiah, 2020). the authors use bipoc, people of color and communities of color interchangeably cabrera and franklin (2016) offer five core areas in which whiteness is practiced in higher education – colorblindness, epistemologies of ignorance, ontological expansiveness, property, and racial comforts (see table 1 for a brief description of each area). these descriptions add to our understanding of how white supremacy is perpetuated, protected, and reinforced by white people and bipoc alike who engage within white academic spaces and provide an unfair advantage to white scholars over scholars of color. therefore, while white supremacy is “a sociopolitical economic system of domination” that serves to favor white people and exclude bipoc (diangelo, 2018, p. 30), whiteness are the complex ways in which white supremacy is upheld through the actions, behaviors, and beliefs by those who engage in white spaces that consciously or unconsciously preserve the white experience as the norm (cabrera & franklin, 2016). for the remainder of this paper, the authors use bipoc, people of color and communities of color interchangeably. we argue that doctoral social work education upholds white supremacy in numerous yet subtle ways throughout policy, practice, and discourse. by not taking an explicit stance against racism, one becomes complicit in perpetuating racism and harming communities, as our social work history demonstrates (bussey, 2020). dismantling white supremacy in doctoral education requires honest and direct discussions about race and racism (davis & francois, 2021). the absence of these discussions has several implications. first, it creates psychological, emotional, and physical damage to bipoc scholars by tasking them with managing how to confront racism while also managing their role as a student – an additional burden coined racial battle fatigue, that their white peers do not have to endure (gildersleeve et al., 2011; rogers et al., 2019; smith et al., 2011). second, it fosters an invisible expectation that bipoc scholars will assume the role of representatives of their communities, calling out racism, taking the leadership role in anti-racist initiatives, and mentoring upcoming scholars of color another burden known as cultural taxation, which follows bipoc scholars throughout their careers (canton, 2012). third, the lack of discussion of race and racism in doctoral education creates an illusion that racism does not exist, thus legitimizing white supremacy in schools and making it more difficult for systemic change to occur (castagno, 2008). furthermore, a lack of discussion prevents us from preparing future social workers to be culturally responsive to the needs of our racially and ethnically diverse communities, thus impeding our profession from fulfilling our mission statement (calvo et al., 2018; nasw, 2020b) and being culturally responsive to mackey et al./disputing white supremacy 649 the needs of racially and ethnically diverse communities. as highlighted by dr. larry davis (2016), presidential plenary lecturer at the 20th annual conference of the society for social work and research, "…a discussion on race draws attention to the ongoing problems of bias and inequality – especially our own bias and prejudice – which is clearly a more emotional and painful discussion" (p. 398). white supremacy, however, does not operate in isolation – rather, it is a system through which other forms of oppression, be it social, political, and/or economic, exist (beliso-de jesus & pierre, 2019; hall, 1980). one notable connection relevant to this paper is the intersection of racial and gender oppression. bipoc women scholars (students and faculty) are often faced with being doubly harmed through the reinforcement of whiteness and patriarchal systemic norms in academia (morris, 1993). their marginalization and oppression can multiply depending on the multiple intersecting inequities bipoc women experience based on their social identities (e.g., class, sexual orientation, immigration status, etc.; collins, 2000; crenshaw, 1989). bipoc women entering “white spaces” (anderson, 2015) often find themselves in a sort of performative role to combat the negative stereotypes and tropes that white peers use to question the credibility and value of their nonwhite peers. bipoc women endure being tokenized, dealing with daily microaggressions, silencing their voice for fear of retaliation, taking on extra workloads, and monitoring their body language and communication styles (arnold et al., 2016; azhar & mccutcheon, 2021; lewis et al., 2016; mclane-davidson et al., 2018). for bipoc women, racism and sexism cannot be separated – so doing only “creates a distorted analysis of racism and sexism because the operative conceptions of race and sex become grounded in experiences that actually represent only a subset of a much more complex phenomenon” (crenshaw, 1989, p. 140). to ensure social work doctoral students exercise good judgment and proficiency in their work, we must deliver a system of support and education that equips students to be culturally attuned throughout their academic journey and imparts a desire for continued learning in their professional careers (nasw, 2020a). jackson and samuels (2019) require social workers to be reflexive, recognize and challenge manifestations of power and privilege used against historically oppressed populations, and engage in continuous learning as the meaning of race and culture evolves over space and time. the absence of perspectives from black, indigenous, and people of color (bipoc) in research and practice often inspires future social work doctoral students of color to pursue their degrees (cosgrove et al., 2020; santa-ramirez, 2021). however, to retain racially and ethnically diverse students, “…institutions need to recognize systemic exclusion and take concreate actions to create structures that will create systemic opportunity for all” (calvo et al., 2018, p. 266). advances in social work, summer 2022, 22(2) 650 table 1. major theoretical components of whiteness and their manifestations in higher education component definition examples of manifestations whiteness as colorblindness racial inequities are masked and therefore unaddressed due to avoidance of labeling whiteness as racism and seeking other possible reasons for inequity to avoid the subject and maintain white supremacy. avoiding discussions about racism in the classroom; focusing instead on cultural differences rather than systemic (bonilla-silva, 2006); not connecting racially different experiences to racism in research (harper, 2012). whiteness as epistemologies of ignorance encompass an attitude of not knowing (ignorance) the harmful effects of racism and falling back on the ignorance to avoid action to redress harms. commonly described as “ignorance is bliss.” distracting energy to address systemic racism by highlighting beliefs of “reverse racism,” regardless of the lack of evidence (mills, 1997); dismissing the existence of racism if it does not affect the life of white students; limiting associations of racism to radical groups, such as the kkk (cabrera, 2014a) whiteness as ontological expansiveness white entitlements over space – the belief that all spaces (physical, cultural, linguistic, economic, etc…) are accessible to white people, and they can freely enter and exit any space as they please. meanwhile, not all these spaces are freely available and accessible to people of color. academic institutions are predominantly white spaces, normalizing whiteness within these systems and sending messages to bipoc scholars of their minority status in these spaces (gusa, 2010; harper & hurtodo, 2007; sullivan, 2006). whiteness as property whiteness is viewed as a commodity. it contains rights, privileges, and protections that give it social value. laws and policies protect the value of whiteness by excluding nonwhite racial groups from accessing the same privileges and rights, thus normalizing whiteness. normalizing whiteness makes it seemingly invisible and difficult to challenge. racist behaviors on college campuses are controlled in racially diverse settings (such as the classroom) but exposed in predominantly white environments, through racial slurs and racial joke-telling between white peers, examples of white racial bonding (cabrera, 2014a, 2014b; lensmire, 2011; picca & feagin, 2007). arguments to undo affirmative action serve to limit access to higher education for people of color (santos et al., 2010); disguising property value of whiteness as meritocracy (guinier, 2015). whiteness as assumed racial comfort/safety spaces, like the classroom, are presumed to be “safe” spaces, without consideration of the existence of linguistic violence (such as microaggressions) and the long-term damage this causes on students of color (coined racial battle fatigue; smith et al., 2011). avoiding calling out microaggressions out of worry it will make white students uncomfortable, thereby preventing them to work on their “racial selves” (cabrera et al., 2016; leonardo & porter, 2010) (cabrera & franklin, 2016) mackey et al./disputing white supremacy 651 in this paper, we discuss the impact of white supremacy and whiteness in social work doctoral education in two ways: 1) we review the literature on doctoral students' experiences of racism in academia, and 2) we analyze personal testimonios to explore the consequences of whiteness in social work doctoral education from the views of four bipoc women in social work two who are currently doctoral students and two who are faculty in a school of social work at a large public institution. through our testimonios, we highlight the shared experiences of many bipoc students in doctoral education and examine common western social work theories used in doctoral education. we then discuss the consequences of excluding alternative theories that speak to race and racism and suggest alternative theories and frameworks that align with the authors' values and experiences as bipoc women serving bipoc communities. finally, we conclude with recommendations to support bipoc students in social work doctoral education. racism and sexism in academia racism as kendi (2019) informs us, the opposite of racist isn't not racist, but the act of being anti-racist. to be anti-racist, one must first acknowledge that racism exists and work at understanding how we each are part of the problem and the solution to ending racism. in 2016, the american academy of social work & social welfare (aaswsw) announced the grand challenges of social work. the challenges are progressive and include networks on social responses to a changing environment and smart decarceration, among others. however, many bipoc faculty were disappointed that racism was not designated as a stand-alone grand challenge nor explicitly included as part of each of the 12 grand challenges. undeterred, bipoc faculty led by martell teasley, ph.d., msw, and michael s. spencer, ph.d., mssw, pushed for the inclusion of a grand challenge to address racism. on june 26, 2020, four years after the grand challenges were announced, and in the wake of undeniable assaults on black americans and anti-racism protests across the u.s., the aaswsw (2020) announced its 13th grand challenge – eliminate racism. while our profession has been making slow and incremental efforts to address racism through policy recommendations by way of the grand challenges, in practice, there remain many disparities. a common challenge among bipoc doctoral students is the ability to engage in the educational process through unbiased socializing. socialization is the process of learning academic norms and practices through mentorship (bieber & worley, 2006) and participating in academic activities, such as research, teaching, and publication, as a means of preparing students to become ideal candidates for the job market (petr et al., 2015; turner & thompson, 1993). bipoc doctoral students are at a particular disadvantage and, thus, limited in their ability to successfully engage in the socialization process in academia because traditional academic norms and practices are centered around the white experience (cabrera & franklin, 2016; turner & thompson, 1993). it can also be challenging for bipoc doctoral students to find mentorship from a cultural peer or network due to the underrepresentation of bipoc faculty in the academy. the lack of cultural peers/networks has severe implications for bipoc scholars in higher education, especially for first-generation students, as these networks play a significant role in the advances in social work, summer 2022, 22(2) 652 success of bipoc students in obtaining a doctoral degree (gildersleeve et al., 2011; howard, 2017). for example, gildersleeve et al. (2011) highlight the importance of peer support networks for black and latino/a doctoral students, not simply to form a group of shared identity but to process the racialization that exists within the normative structure of higher education. these networks also serve to identify safe spaces to express frustrations and create supportive networks that can affirm these experiences, champion their accomplishments, and offer strategies to navigate academia based on their shared experiences. for students who lack social capital upon entering academia, meaning they may not have family or friends who have obtained a doctoral degree and can share their experiences, cultural peers/networks are an invaluable and essential resource (howard, 2017; ramirez, 2017). in many cases, the lack of intentional efforts to address racism in academia leaves bipoc students feeling frustrated and unappreciated. shotton (2017) revealed the frustrations of american indian doctoral students expected to carry the role of ambassador of all american indians and having to lead the charge of calling out racism when white students and non-native faculty perpetuate stereotypes through outdated images of american indians. ramirez (2017) also highlights bipoc students' feelings of frustration over being insufficiently financially supported during their studies and inadequately prepared for their academic careers, including “…teaching, grant-writing and/or qualitative research; insufficient feedback from faculty; lack of courses focused on academic/scholarly writing; and/or poor instruction” (p. 34). further, their experiences of low expectations from white peers and faculty (dade et al., 2015; ramirez, 2017; shotton, 2017) and the devaluation of their achievements (gildersleeve et al., 2011; patton, 2004; ramirez, 2017; shotton, 2017) leaves bipoc students to question if doctoral education is right for them (dade et al., 2015; davis & livingstone, 2016; gildersleeve et al., 2011). sexism the marginalization of people of color can be heightened for those with multiple intersecting identities, such as gender and race (crenshaw, 1989). the intersection of gender and race in academia is critical to understand, as misogynistic and sexist norms are additional barriers for bipoc women trying to navigate within a system that was initially designed by and for white cis-gender men (gonzales & terosky, 2020). in other words, and as evidenced by the 40% of white men and 35% of white women who constitute the majority of all university full-time faculty positions (national center for education statistics, 2018), bipoc women are less likely to hold power and influence under this system. in social work, most faculty (74.3%) and enrolled students (bachelors, 87%; masters, 85.1%; dsw, 81.2%; phd 75.3%) are women (council on social work education [cswe], 2021). while social work is a female-dominated profession, positions of power and influence are largely reserved for men (mcphail, 2004). bipoc women in academia continue to have minimal faculty representation nationally (social sciences feminist network research interest group [ssfnrig], 2017). in social work, there is a much greater representation of full-time white faculty, “…59.5% were white (non-hispanic), 26.8% were african-american/black (non-hispanic), and 7.8% were hispanic/latinx” (cswe, 2020, p. iv). as pointed out in the grand challenge to eliminate racism (teasley mackey et al./disputing white supremacy 653 et al., 2021), the issue here is that “the majority of social workers have historically and continue to identify as white, whereas the majority of those they serve typically identify as black, latinx, indigenous, and other people of color” (p. 6). these statistics highlight the national need for more representation from women of color within academia and the social work profession. representation plays a role in ensuring everyone has an opportunity to thrive in academia. in a white, cis-woman dominated space, we risk further harming bipoc women when we only center white feminism and fail to acknowledge diverse gender experiences and needs (lugones, 2003). for example, bipoc women faculty face “unequal standards of having to work harder and prove themselves more” in the academy (corley, 2020, p. 1). they are often “assumed incompetent, until they prove they are competent” (mitchell & miller, 2011, p. 198), as they are expected to handle gender and racial inequities dually (ssfnrig, 2017). such unequal standards often leave bipoc women faculty feeling isolated and pressured to perform at higher levels than their white peers (turner, 2002). the lack of attention to women of color faculty and students' unique needs can also add to the alienation in academic spaces. for example, rogers et al. (2019) highlight the difficulties black mothers encountered when trying to combat racist and sexist norms within their institution while also trying to avoid labels intended to demean and discredit (i.e., “angry black woman” trope). further, as mothers, the lack of recognition of intersectional experiences of women of color forced women to feel as though they had to choose between family or their academic careers (rogers et al., 2019). therefore, bipoc women scholars are often expected to exceed expectations within an unsupportive academic culture through additional unpaid labor. racism and sexism in social work racist and misogynistic norms prevent bipoc students from fully participating in the academic experience. bipoc students regularly encounter micro and macro aggressive behavior in academia (osanloo et al., 2016), which force them to make the hard decision of either leaving academia or developing coping strategies, such as self-censorship (ramirez, 2017) and relying on bipoc peers and faculty within and outside their departments (lechuga-peña & lechuga, 2018; dade et al., 2015; gildersleeve et al., 2011; ramirez, 2017; williams et al., 2018) to work within these white spaces. however, modern-day white supremacy is a detriment to everyone in higher education. whiteness limits diversity of thought within academia and therefore prevents the advancement of the social work profession in developing creative solutions that effectively meet the needs of all communities (calvo et al., 2018). in so doing, it therefore prevents social workers as a collective from reaching our mission to “…enhance human well-being and help meet the basic human needs of all people…” (nasw, 2021, para. 1). thus, exposing and redressing systemic racism within the social work profession cannot be understated. the absence of such actions risks delegitimizing our profession among bipoc communities by demonstrating through our silence and inactions that “all people” in our mission statement is reserved for white people. as ortega and busch-armendariz (2013) argue, “the presence of racially, ethnically, and culturally diverse people continues to be a thorn in the side of advances in social work, summer 2022, 22(2) 654 social work theory, research, and practice… therefore it is not a surprise that much of our knowledge base is tainted by hegemony, although benevolent in nature” (pp. 113-114). method researcher positionalities at the time of this manuscript, the authors were at different points in their careers two were amidst their second year of course work within a social work doctoral program, and two were early-career social work faculty. this article shares their experiences, whether currently or retrospectively, as bipoc women and doctoral students. the authors represent a diverse segment of the social work profession. all authors identify as cisgender women of color and are pursuing, or graduated with, a ph.d. from a research 1 (r1) university. three of the authors are first-generation college graduates, and all authors are firstgeneration graduate and doctoral students. two of the authors identify as chicana, and two identify as mixed-race (black and south asian; black, white, and indigenous). testimonios as personal narratives drawing on lechuga-peña and lechuga (2018) approach, we first utilized testimonios or personal narratives to elucidate the challenges we endure/d during our social work doctoral programs. testimonio, as a methodology, developed from latin american human rights struggles and gives voice to injustice and resiliency (pérez huber & villanueva, 2019). one of the most notable testimonios is that of rigoberta menchú, an indigenous human rights activist from guatemala, who wrote about her experiences during her country’s civil war (menchú & burgos-debray, 1984). menchú (menchú & burgosdebray, 1984, p. 1) states, “my story is the story of all poor guatemalans. my personal experience is the reality of a whole people.” testimonios are used to center marginalized people’s experiences and explore and share their perspectives from their viewpoint (latina feminist group, 2001). pérez huber (2010) states testimonio "validates and centers the experiential knowledge of people of color, recognizes the power of collective memory and knowledge, and is guided by the larger goals of transformation and empowerment for communities of color" (p. 83). like anzaldúa (2012), who wrote from her own lived experiences, which helped her construct her view of the world, our testimonios helped us describe, reflect, and make sense of our experiences as bipoc social work doctoral students. collectively, we developed the following three questions to guide our inquiry: (1) “what were your expectations of social work doctoral education before entering your ph.d. program?” (2) “how did you experience social work doctoral education as a female student of color?”, and (3) “how did you respond to or adjust the mismatch of these two experiences?” these questions were developed based on initial informal conversations about our experiences within social work doctoral education. once we developed these questions, we each took time to reflect on our own experiences before writing our testimonios to share with one another. next, we read through each other's responses and provided written and verbal feedback on how the responses aligned or deviated from our personal social work doctoral education mackey et al./disputing white supremacy 655 experiences. after reviewing each other's testimonios, we agreed it was important to share our experiences while maintaining the anonymity of each author's responses. as an alternative to providing our full testimonios, as is typically true to the method, we agreed to conduct a thematic analysis and share the collective themes from our testimonios. to determine the initial themes, we created a table to capture our combined responses to each question using the "in vivo" coding method, which includes words or short phrases in our own words (saldaña, 2013). we then met to discuss the themes each of us identified for the questions, and from these discussions, the final themes and subthemes emerged. findings while there may have been differences in our experiences noted in our testimonios, we only provide the themes collectively agreed upon for this paper. we identified the following themes and subthemes: regarding question one, we anticipated meeting "likeminded people" in the social work doctoral program and finding others with shared values. we all had a desire to provide additional resources for our communities, and we all wanted to "learn at a higher level" while acquiring new knowledge. regarding question two, white supremacy shaped all authors’ experiences during our doctoral education and we all agreed that a lack of racial diversity among doctoral students and faculty created an "all-white space." we also shared feelings of "living in two worlds," imposter syndrome, isolation and disconnection, while two authors identified misogyny, and sexism. regarding question three, we all agreed there was a mismatch between our expectations and our actual experiences in our respective social work doctoral programs. we attributed this incongruity as contributing to the decline in our mental and physical well-being, disengagement, and use of self-preservation coping strategies. to counter the mismatch, we all sought out theories and approaches to research outside of our respective fields that were more inclusive of bipoc. we each found meaningful connections to larger national and local networks outside of our school or departments that focused on supporting bipoc students. we all also found bipoc faculty to mentor us, whether in our departments or elsewhere. finally, while we all experienced personal challenges in our doctoral programs, we used our privileges as doctoral students to strategically advocate for ourselves and other bipoc. question 1: what were your expectations of social work doctoral education prior to entering your ph.d. program? working with like-minded people before starting our respective social work doctoral programs, we were excited and optimistic about potential opportunities to work amongst some of the brightest minds in social work. we imagined we would find others that shared similar values and wanted to make a difference for the most vulnerable populations. as one of us stated, "i was excited about the possibilities of meeting like-minded people that wanted to fight for social justice to dismantle and create better systems for the most vulnerable populations." another one advances in social work, summer 2022, 22(2) 656 of us noted, "i thought social work graduate education would be a utopia where people were like-minded in the pursuit of knowledge and social justice." desire to provide additional resources for our communities our desire to support others and give back to our respective communities was a critical component in our decisions to pursue a doctoral degree in social work. we all believed we could make a more significant impact in our communities if we acquired further education and training tailored to the needs of our communities. this sentiment is reflected in the following responses from two of us, i had anticipated my doctoral education would be a space where i could develop my research and teaching skills further, centralized on the communities i wished to serve. this included learning theories and research methods that would better serve my community. in my mind, research should always be tailored around what best suits your client/community. i could develop my research and teaching skills further, centralized on the communities i wished to serve. i loved my work directly with latinx communities and families and i believed that doctoral education would help me find ways to provide more resources for them, learn how to advocate on a macro level by changing and creating policies that aligned with their needs and create interventions that made a real impact on their lives. learning at a higher level while acquiring new knowledge to provide better resources and responses to the communities we serve, acquiring further education and access to resources was essential. we all assumed we would receive this in our doctoral programs, "prior to starting the doctoral program my expectations were based on my assumptions of the social work profession, its ethical foundations and the assumed higher level of knowledge that academia held in my first-generation student lens." similarly, another one of us noted, "i also believed that returning to school would be an agreeable experience, given that i have always been someone who enjoyed a challenge and learning new things." question 2: how did you experience social work doctoral education as a female student of color? this question garnered long reflections from each of us regarding our racial identities in social work doctoral education. however, the intersections of our racial and gender identities were hard to disentangle for two of us. therefore, we provided the most salient themes that emerged regarding our racial identities, followed by the themes that included the intersections of race and gender and our experiences in social work doctoral education. in our analyses and multiple discussions, we all agreed that these various experiences are/were a manifestation of whiteness, and therefore, white supremacy within academia. mackey et al./disputing white supremacy 657 lack of racial diversity among doctoral students and faculty one of our main observations was the lack of diversity among our doctoral student cohorts and the faculty within our respective academic institutions. we believed this lack of representation contributed to our social isolation and feelings or experiences of otherness. one of us shared, "the representation of people of color was even lower at this [referring to ph.d.] level, which made it challenging for me to learn how to comfortably and safely share my experiences from a cultural lens without seeming annoying or angry to my white peers." as first-generation doctoral students, we all felt isolated by being either the only bipoc student or one of a few bipoc students. additionally, many of our peers were not the first in their family to pursue a doctorate, as was the case for all four authors. this is evidenced by one of our responses, i was the only person of color in my cohort, and that in itself was a lonely and challenging position. the other members of my cohort, for the most part, split off into cliques or twosomes that i never felt a part of. “all-white space” white dominance was not only represented in a physical context. our discussions also highlighted the amplification of the dominant white narrative and the suppression and lack of equal consideration of theories that value the ideals of bipoc communities. as demonstrated in two quotes from two different authors below, the burden was on students of color to speak up on issues of race and ethnicity to ensure there was a diversity of thought and, thus, putting themselves in a vulnerable position, … these conversations relied heavily on students of color to contribute their thoughts and perspectives and only came up during classes where the discussion was required. furthermore, these important conversations always appeared to be an afterthought rather than a priority. when i attempted to speak out against them or share my lens it was countered with commonly dismissive and defensive statements such as invoking the first amendment right, aka freedom of speech, all lives matter, and the ever-popular devil's advocate. the one thing that was obvious was the level of discomfort that my presence and opposition to negative bipoc rhetoric caused among my white peers. "living in two worlds" white supremacy presented itself in our conversations about balancing our community's requests and needs with that of academia. we spoke of our struggles to adapt to white spaces, sometimes noted as “living in two worlds” as described by one of the authors, "i was on a path of living in two worlds that i had to learn to navigate simultaneously – the academic world and that of my family and culture – to find balance in my life." furthermore, we recognized that our pursuit of academic achievement often conflicted with our bipoc identity. we frequently encountered moments in which our advances in social work, summer 2022, 22(2) 658 communities were misrepresented, and stereotypes were reinforced in classroom settings, as noted in the quote below, navigating a predominantly white space such as academia has been something that i have to a certain extent gotten used to throughout my educational experience. as a bipoc social worker, it is like navigating two worlds. one world seemingly accepts your diversity as it is often dissected in doctoral courses highlighting the stereotypes of my culture (e.g., gangs, poverty, crime, helplessness) under the white savior guise that somehow "they" have the answers and a better understanding of what my people need. imposter syndrome navigating a predominantly white space was new to some of us. this culture shock led to various barriers to assimilating to academia due to having to deal with white rhetoric that was not inclusive of bipoc. the assumption and expectation that we all came into the doctoral program with equitable knowledge, skills, and abilities contributed to the difficulty of adjusting to a new academic environment and its demands. imposter syndrome was highlighted by all authors, although not meant in its traditional sense. while imposter syndrome implies fear of lacking the appropriate skills, being perceived as lacking, and being exposed to such inadequacies, the authors used this term to describe self-doubt due to the lack of representation in white spaces. for one of our authors, they described being "the only [bipoc] in my program at a predominately white, upper social class, exclusive university. therefore, my imposter syndrome was felt from the start." the absence of bipoc in leadership and the graduate student body left another author to describe imposter syndrome as "constantly questioning where i fit within a white space, if i belonged, and if this direction was where i wanted to go to achieve my goals and address my community's needs." isolation and disconnection as a result of the white dominance within our academic experiences, socio-cultural and linguistic isolation was experienced due to having limited access to diverse cultures or bipoc communities with which we could relate. this also contributed to feelings of disconnection within predominantly white-dominant spaces. while i was very fortunate to have mentors that supported me and guided me throughout my education, i didn't realize how lonely and isolating my experience would be, not only because i was one of two students of color (the only female of color) in my program and across campus but because i was a first-generation graduate student. disconnection surfaced again during discussions surrounding the lack of opportunities and supports for students of color, such as financial resources and network opportunities that could benefit their careers. mackey et al./disputing white supremacy 659 it has been my experience that some schools trouble themselves over the first year of funding for doc students, but do not have long-term plans for their retention and funding of an entire degree program. this is problematic for students in general, and students of color in particular, as we are less likely to have the resources and network to secure funding on our own. this was my experience, and i believe that never being funded thoroughly to work with faculty or a research center placed me at a disadvantage. i did not publish as much as some of my peers. misogyny and sexism the experiences of oppression resulting from the intersections of gender and race were most poignant for two of the authors. in addressing the unique ways in which race shapes the experiences of bipoc women in academia, two of the author’s experiences aligned based on their similar identities. they both identified as chicana and found it hard to separate their intersectional identities. that is, they centered race, gender, and class while negotiating their place in academia. to provide some context, pursuing higher education as a chicana is often seen as a radical act due to challenging gendered norms within chicanx culture and societal gender roles for chicanas (cuádraz, 2005). furthermore, chicana roles and social expectations have been homogenized by white women. stevens and pescatello (1973) characterized chicanas as devoted, nurturing, passive, and sexually pure, which stereotyped the chicana women based on colonized ideas of the coined term marianismo. these misogynistic perspectives are upheld and perpetuated through patriarchal structures that contributed to the additional barriers for the lived experiences of the two chicana authors. the following are two examples of their experiences that reflect these social expectations, as i reflect on my first time teaching independently, as a woman of color instructor, i believe i was held to a different standard, my expertise was questioned more and my grading was challenged more often. this class was my introduction to these experiences in the classroom and academia in general. these behaviors from students still continue today now that i am an assistant professor. i thought adding three letters to my name (phd) would change this, it did not. although it is well known that social work is a female dominant profession, male social workers throughout the profession always tend to hold higher-ranking positions. from my perspective this contributed to views that were not necessarily welcoming of feminist theories or more specifically bipoc feminist epistemologies were not presented as comparable to those that were defined by white males. advances in social work, summer 2022, 22(2) 660 question 3: how did you respond to or adjust the mismatch of these two experiences? decline in mental and physical well-being the weight of white supremacy had a significant impact on our mental and physical health. one author noted, "the constant advocacy throughout my experience to counter racist and systemic racist beliefs from peers and educators was taxing." in our discussions, we recognized that if we did not speak out on race issues, putting ourselves in a vulnerable position, the perspectives of our communities would not be considered. relying on students of color to speak on race had repercussions on the student, as described below. … instead of being present and participating in learning, students of color had to decide to either participate in educating their white peers and thus carry the mental burden and emotional exhaustion that comes with the reactions from their peers, or disengage from the discussion if they did not want to “carry the race torch.” decline in physical health was also a byproduct of trying to navigate the demanding terrain of academia. due to the lack of a support network early on, one author shared, i internalized a lot of the negative experiences (microaggressions) and imposter syndrome feelings i had. like many graduate students, my mental health declined. during my ph.d. studies, i was diagnosed with [stress-induced] shingles following the disastrous ending of a faculty relationship that i had originally thought supportive. later in the program, i was diagnosed with generalized anxiety and ppd [postpartum depression]. disengagement and us of self-preservation as articulated in the previous theme, white supremacy in academia manifests in multiple ways and, unfortunately, takes a mental toll on students of color. left to their discretion, bipoc students often have to be selective in deciding when they want to advocate for their community within this environment or disengage for mental and emotional safety. i have learned to sit, engage in grounding exercises such as drinking water and engaging in mindfulness exercises to avoid the pitfall of always having to clap back. it is a skill to consistently find a balance to avoid the burnout that students of color face when having to sit through false narratives against communities of color that are based on white lenses that have yet to engage with the communities they critique or research from a privileged distance. the decision to disengage does not come easy. it often comes with feelings of guilt that you are perpetuating or condoning racist rhetoric within academia. because of the scarcity of bipoc in these environments, the authors felt that racial advocacy was often on them. mackey et al./disputing white supremacy 661 i experienced classes where i had to intentionally disengage in discussions as a means of protecting myself because the burden of constantly speaking out on issues of race/ethnicity and culture were too much to bear and were impacting my mental well-being. those days were often the worst for me because while i was disengaging as a coping mechanism, i was still experiencing the guilt of not speaking out on behalf of my community and allowing stereotypes and oppressive ideologies to exist. seeking outside theories and approaches in our research as a form of resistance to a system built on white supremacy, we sought theories and epistemologies that applied to bipoc in our research rather than utilizing the common theories based on white western perspectives. this pursuit required more resources from us, i found if i needed to find theories and epistemologies that made sense for my community, i had to go the extra lengths to find it. i had to seek authors and experts outside of the school of social work. i put a lot of work into learning and researching authors who were representative of my community. i found myself ... working with less resources at my disposal in order to keep up with my peers. despite the extra effort, finding theories that represented our communities helped cement the necessity for diverse perspectives in academia. as one of us noted, … discovering critical theories, such as crt, latcrit and chicana feminism, and learning research methods that focused and centered community voices; i realized there was a place for me in the academy and i deserved to be here. it is my form of resistance. connecting to larger networks outside of our school or department seeking out meaningful networks that supported underrepresented bipoc students was crucial to our ability to endure the isolation of academia. we frequently searched for support and mentorship through student groups, national fellowships, and family and friends. while these networks provided reassurances that we could succeed in academia despite its demands and challenges, some of us also sought mental health support to supplement our self-care needs, as highlighted in the commentary below. i was faced with the choice of withdrawing or continuing to stand my ground and keep my eye on the proverbial prize of attaining my doctoral education to be able to advocate and engage in social justice research. i chose the latter and sought individual therapy and began to network with bipoc faculty and allies that could support me in navigating this white space. advances in social work, summer 2022, 22(2) 662 mentorship from bipoc faculty seeking mentorship from faculty of color and other supportive spaces was an essential strategy used by all authors. one author noted, "i have reached out for more support from faculty and students of color within and outside of my program, participating in groups that are specifically tailored for students and faculty of color. this has provided some comfort." mentorship offered guidance on "navigating this white space" and affirming their place within the social work profession. recognizing the scarcity of faculty of color, two of the authors currently in leadership positions ensure they offer safe spaces and collaboration opportunities to current and future generations of bipoc scholars to reduce the weight of white supremacy and its impact on bipoc academic achievements. as one author stated, i find brown spaces in the academy or create them, i.e. women faculty of color caucus, writing and conducting research with bipoc colleagues and students. i also make time for my students of color and ensure i provide mentorship to my doctoral students of color. strategically advocate for ourselves and other bipoc when we decide to speak up on issues of race, we recognize we put our careers at risk, a concern our white peers do not have to experience. however, the decision to speak up and resist the system is less about our comforts and protections and more about making room for future generations of bipoc scholars to ensure bipoc representation and influence in research, policy, and practice, as noted in the two quotes below, i am also fully aware that to be bold is putting myself at risk of losing opportunities to work with certain teams because i am unwilling to be complacent to a system of oppression. this could even impact my opportunities to obtain a professorship in certain universities down the road. but while it is exhausting to be a woman of color calling out racism and discrimination in a male and european-centric environment, i believe it to be more harmful not only to myself but to communities of color more generally to be silent and conform to the traditional norms of academic culture. while i was ph.d. student, i promised myself that if i was ever in a faculty position i would stay true to myself by advocating for communities of color, teaching critical theories outside of social work while writing and pushing our field to use more critical theories, not only writing and publishing in academic journals but accessible formats for communities and finally using alternative research methods to truly capture people's experiences. additionally, i find brown spaces in the academy or create them, write and conduct research with bipoc colleagues and students, centering their voices and experiences. finally, i make time for my students of color and ensure i provide mentorship to doctoral students of color. mackey et al./disputing white supremacy 663 discussion social work is founded on the belief that all people, including the most vulnerable and oppressed, have a right to individual and community well-being (nasw, 2021). social workers are tasked with ensuring this right is met through practice, advocacy, and policy reforms (bishop et al., 2018; nasw, 2021). although there is no singular definition of well-being, we align with a more holistic focus that is mindful of factors affecting perceptions of individual self-worth (case & hunter, 2012) in combination with the “…social, economic, environmental, cultural, and political conditions identified by individuals and their communities…” (wiseman & brasher, 2008, p. 358) within the measures of this construct. thus, the academic conditions, including representation of diverse racial/ethnic backgrounds, worldviews, and practices, play a role in the overall perception of health and well-being among doctoral students of color. as a profession, we publicly defend our values and ethical principles. however, we privately reinforce white supremacy by purposely ignoring factors that threaten bipoc doctoral students' wellbeing, thereby suggesting a willful denial of equal opportunity to their academic achievements. by extension, we risk harming bipoc communities by inadequately equipping doctoral graduates across the profession with theories and epistemologies that enrich understanding of what systems and practices contribute to their oppression and offer ways to build trusting partnerships to address these social injustices. using testimonios or personal narratives of four women of color in the academy to document our experiences, we provided insight into the various ways in which white supremacy manifests within social work doctoral education. using three guiding questions, we detailed our high regard for professional practice, our shared commitment to the code that embodies social justice, and a desire to increase our knowledge base to serve our communities. to our disappointment, contradictions between our expectations and realities of social work doctoral education surfaced when we identified shared feelings of isolation and disconnectedness as we attempted to navigate a system that was undoubtedly designed for and by white membership. our stories demonstrated how doctoral social work education often lacks content on non-western ideology; maintains a clear underrepresentation of bipoc students and faculty; excludes intentional and meaningful discussions of race; and ultimately leads to questions of personal inadequacy resulting from this exclusive environment that upholds white supremacy. as a result of these experiences, we endured mental and physical health declines, sometimes simultaneously, during our struggle to find balance within the academic system. we also intentionally disengaged for self-preservation and strategically advocated for ourselves and other bipoc when appropriate. to cope with these experiences, we found alternative theories and perspectives outside of social work that speaks to our worldviews and the communities we work with; we sought out national, local, and academic organizations that support bipoc students and relied on mentorship from bipoc faculty. unfortunately, our shared experiences are not unique to doctoral education. ghose et al. (2018) examined barriers to recruitment and retention of bipoc doctoral students. their work advocated for mechanisms to address racism, financial constraints, limited representation among academic leadership, and the lack of mentorship to create an advances in social work, summer 2022, 22(2) 664 equitable environment for bipoc students. similar experiences have been described by social work students and faculty scholars of color. tijerina and deepak (2014) noted perceived structural barriers among latinx msw students limited their desire to pursue doctoral studies, recognizing the institutional culture within academia as isolating, unsupportive, and culturally insensitive. many of the prevalent social work theories commonly taught in social work education have been criticized for centering a whitedominant, western perspective and inadvertently raising the risk of harm among bipoc communities. these theories often prioritize cost-effectiveness over client-centered approaches (dominelli, 1996) and pursue politically correct, outcome-driven, and individualistic solutions, thereby supporting a neoliberal agenda that is not conducive to bipoc communities (dominelli, 1996; gray, 2011). they also fail to address racism within the profession, inhibiting meaningful partnerships with bipoc communities (wakefield, 1996). the cultural competency framework, popular within many social work schools, has been criticized for lacking cultural humility and reflexive practice within its framework, minimizing the unique needs of people of color by attempting to equalize all forms of oppression and subsequently promoting colorblindness and a lack of accountability within the profession (abrams & molo, 2009; fisher-borne, 2014; jackson & samuels, 2019; schiele, 2007). furthermore, the lack of guidance and support on race and diversity discussions often leads to their inclusion as a single add-on course rather than integrated throughout the curricula (ortiz & jani, 2010). to this end, we provide inclusive theoretical frameworks and perspectives and implications for supporting bipoc students in social work doctoral education (see table 2). alternative theoretical perspectives for social work doctoral education there is a mismatch in instruction on the best ways to serve communities of color when only western theoretical perspectives are centered. prioritizing theories designed from a white lens reinforces white supremacy in social work and doctoral social work education and consequently produces an exclusionary and hostile environment for doctoral students of color. if social work is genuinely committed to anti-racist practice, we must disclose (publicly acknowledge the existence), denounce (disprove of its power and authority), and dismantle (completely eradicate) white supremacy in our profession and doctoral education. centering bipoc voices through alternative theories and epistemologies in social work doctoral education is essential to ensure the inclusion of latinx, indigenous and afrocentric ways of knowing and honors knowledge produced by non-european scholars (maglalang et al., 2021). so doing challenges myths and stereotypes about bipoc that currently occupy space in academia by elevating our voices and perspectives. while many theories center the experiences of bipoc, we share theoretical frameworks and perspectives that resonate with us to ground our work. these include critical race theory (crt), latina/o critical race theory (latcrit), tribalcrit, indigenist stress-coping model, intersectionality, and black and chicana feminism. advances in social work, summer 2022, 22(2) 665 table 2. core tenets of seven alternative theories theory main concepts/tenets focus of theory contributing authors black feminist thought (bft) • matrix of domination • lived experience as a criterion of meaning • use of dialogue in assessing knowledge claims • ethics of caring • ethics of personal accountability rooted in critical social theory & afrocentric feminism, bft recognizes complex intersecting oppressions of gender, race, & class, & impacts experiences of oppression & the shared wisdom that provide context to black women’s standpoint. it advocates for the recognition of black ways of knowing & knowledge production, grounded in lived experiences, expressed & validated through community dialogues, self-expression, & accountability. collins, 1998, 2000 chicana feminism • limited opportunities for higher education • school pushout • counter-narrative • critique of misogyny & homophobia • health care • bilingual education • immigration reform • prison reform • welfare • u.s. policies in central america a feminist theory that centers the experiences of indigenous-mexican women who live in the united states. chicana feminism uncovers the effects of colonization that continue to influence border politics. further, it challenges dominant narratives rooted in machismo, racism, classism, & heterosexism. mexican & american identities are interconnected & cannot be separated. anzaldúa, 2012; garcia, 1989 critical race theory • racism as the norm • value of storytelling • critique of liberalism • recognizing power & privilege • critique of whiteness • integrating anti-racist discourse • legitimizing race scholarship • globalized understanding of race • interest convergence highlights how white supremacy is maintained & the oppression of people of color continues as the understanding of racism & political dimensions change over time. initially developed under the black/white binary, centering race & racism. brown & jackson, 2013; ladson-billings, 2013; ladson-billings & tate, 1995; razack & jeffery, 2002 indigenist stress-coping • native women’s health outcomes • life stressors, including historical trauma, discrimination, traumatic life events, physical/sexual assaults, abuse • culture as a stress buffer (identity attitudes, enculturation, spiritual coping, traditional health practices) the indigenist perspective provides a more comprehensive understanding of women’s health. it recognizes the role of colonization, poverty, geography, racism, & discrimination on women’s physical & mental health outcomes. furthermore, culture can play a significant role in serving as a buffer to life stressors. walters & simoni, 2002 advances in social work, summer 2022, 22(2) 666 theory main concepts/tenets focus of theory contributing authors intersectionality • recognizes multiple intersecting identities existing within groups • identities are interconnected & cannot be separated • power, privilege, & oppression can all be experienced • acknowledges complexity • connected to social justice/transformation initiatives recognizes that individuals & communities can simultaneously experience oppression & privilege based on the multiple intersecting identities, which vary across context & time. crenshaw, 1989, 2005; patterson et al., 2016; phoenix & pattynama, 2006 latina/o critical race theory • intersectionality • nativity • generational status • language • socioeconomic status • gender • sexuality follows many of the tenets of crt, however, enhances it further by challenging the black/white racial binary, including perspectives of the latinx community with multiple intersecting identities and, therefore, multiple dimensions of oppression. delgado bernal, 2002; fernández, 2002; kiehne, 2016; lechuga-peña & lechuga, 2018; moldonado & moldonado, 2012; solόrzano, 2013; solórzano & delgado bernal, 2001; tribalcrit • colonization is endemic to society • u.s. policies toward indigenous peoples are rooted in imperialism, white supremacy, & a desire for material gain • indigenous peoples occupy a liminal space that accounts for both the political & racialized natures of our identities • sovereignty, tribal autonomy, self-determination, & selfidentification • culture, knowledge, & power through an indigenous lens • governmental & educational policies toward indigenous peoples are rooted in assimilation • tribal philosophies, beliefs, customs, traditions, & visions are central to understanding the lived realities of indigenous peoples • stories are real & legitimate sources of data & ways of being • theory & practice scholars must work together for social change emerged from crt & follows many of the tenets, including storytelling. however, enhances crt to include perspectives of first nations people. brayboy, 2005 advances in social work, summer 2022, 22(2) 667 critical race, latino critical race theory, and tribal critical race theory crt explains how white supremacy and the oppression of people of color has been created and maintained in america while also providing ways to change it (brown & jackson, 2013, p. 12). using crt techniques, such as chronicles, storytelling, and counternarratives to document the oppression bipoc face allows for critical reflection and the opportunity for dialogue to learn more about these experiences (ladson-billings, 2013; ladson-billings & tate, 1995). while the initial focus of crt was to demonstrate how white supremacy and the oppression of people of color is created and maintained in america, the white/black binary served to increase the invisibility of other groups of color and reproduced racism and oppression in other ways. in response to this black/white binary, latinx and indigenous scholars recognized these gaps and responded by developing new forms of critical race theory such as latcrit and tribal critical race theory (tribalcrit). two of the authors use latcrit in their research as it provides the lens to examine experiences unique to the latinx community, including ethnicity, language, and culture. latcrit supports researchers to better articulate latinx individuals' experiences, specifically through a more focused examination of the unique forms of oppression they encounter (delgado bernal, 2002; fernández, 2002; moldonado & moldonado, 2012; solόrzano, 2013; solórzano & delgado bernal, 2001;). one of the authors ground their work in tribalcrit, which examines the multifaceted relationship between american indians and the federal government in the united states and centering the pervasiveness of colonization and imperialism asserted in u.s. policies intended to normalize white settler colonial norms for materialistic gain (brayboy, 2005). thus, the authors use crt and its extensions to understand how systemic racism and historical context continue to impact the lives of bipoc and educate and transform the relationship between race, racism, and power in society. indigenist stress-coping model when considering theoretical models developed in part by social workers, the "indigenist" stress-coping model of american indian women's health provides a stresscoping paradigm that situates american indian women's health within the broader context of their status as a colonized people (walters & simoni, 2002). walters and simoni (2002) recognize that american indian women's health is not solely a consequence of their genetics, culture, or lifestyle, but rather their physical and mental health is a response to their sociodemographic contexts that often include poverty, racism, and discrimination that influence their health outcomes. converse to many mainstream theories that focus on pathology, the indigest stress-coping model highlights protective or buffering factors to build upon the strengths and resilience of native women (walters & simoni, 2002). for one author, focusing on protective factors rather than pathology is essential to effectively understanding and responding to health inequities in indigenous communities. advances in social work, summer 2022, 22(2) 668 intersectionality, black feminist thought, and chicana feminism crenshaw (1989) initially coined the term "intersectionality" (p. 141) to help explain the oppression that african american women experience. while the concept has existed in feminist scholarship, intersectionality has been used as an all-inclusive term to refer to the multiple identities that coexist (or intersect), creating simultaneous experiences of oppression and privilege within the context of space and time (crenshaw, 2005; phoenix & pattynama, 2006). recognizing multifaceted identities expands our understanding of diversity within groups, thus challenging homogenous discourses. intersectionality and other theories that recognize multiple positionalities and privilege, such as black feminist thought and chicana feminism, counteract the dominant “elite white male” positionality and positivistic lens that dominates academia and silences other perspectives (patterson et al., 2016). black feminist thought challenges the homogeneous assumptions of the black community and recognizes the collective wisdom of black women’s standpoint that stems from their shared experiences of oppression based on their gender, class, and african descent encountered within spaces that they live and work and dating as far back as slavery (collins, 1989; harding, 2004). chicana feminism examines and elevates the critical need to address how structures of racism, capitalism, and patriarchy impact latinx communities and chicanas more specifically (anzaldúa, 2012; garcia, 1989). each of these theories are used by the authors in solidarity with community to challenge historical and political practices used to silence, discredit, exploit, and reduce women of color by centering their lived experiences, ways of knowing and understanding, and forms of expression (anzaldúa, 2012; collins, 2000). these theoretical frameworks and perspectives offer insight into the worldviews of bipoc communities, recognizing the historical and generational oppression that have shaped their experiences and interactions with systems that have promoted white supremacy. understanding these contexts and continuing dialogue about their lasting effects in bipoc communities is necessary for social work doctoral education to prevent further injustices caused by academia and graduates from the profession. we recommend including theories like these that represent bipoc in social work doctoral education, not as a singular course, but embedded throughout the curricula, as an effort to dismantle white supremacy at the doctoral level. we also recommend removing contradictions of inclusivity within the profession and ensuring all doctoral students are sufficiently equipped with resources to guide their collaborative efforts with communities of color. although not an exhaustive list, theories that speak to bipoc experiences should be embedded within social work doctoral education to dismantle white supremacy. this inclusion will further the code's principle of ensuring students have a knowledge base sensitive to the social, historical, and cultural needs of the populations they aim to support. mackey et al./disputing white supremacy 669 implications for supporting bipoc students in social work doctoral education it is important to understand the factors that provide some insight into why bipoc students choose their doctoral programs. while research on bipoc students’ college choice processes has been well studied, more recent studies have examined the factors influencing bipoc students’ selection of their graduate programs, several of which were the same factors that helped determine which doctoral programs we, the authors, attended. for example, barr et al. (2007) found that latino and african american students selected the school they attended based on their perceived quality of the interpersonal environment and sense of inclusion. additionally, ramirez (2013) examined the latino/a graduate school choice processes of doctoral students and found students chose their program based on the following five factors; (a) a desire to stay close to home, (b) to study with faculty at a particular institution, (c) financial considerations, (d) campus climate concerns, and (e) circumscribed choices (p. 27; i.e., it was the only program that accepted them). regardless of the program bipoc students choose, we argue that bipoc students are still forced to navigate within an academic system that supports and maintains white supremacy, and in our case, within social work doctoral education. to this end, we offer the following implications for supporting bipoc students in social work doctoral education. first, a physical and mental space for bipoc students in social work programs, such as cswe’s minority fellowship program and student organizations for bipoc students within our institutions, was an essential means of coping with white supremacy for each of us. mclane-davison et al. (2018) detail the development of a collaborative community as a means to create a safe space where bipoc doctoral students, administrators, and faculty can find support, feel empowered, and reaffirm their value within academia. this validation and support assist in cultivating a culture of inclusion. second, mentorship, particularly from faculty of color, was essential in our academic journey. mentorship is a critical component for student success, particularly for underrepresented students (lechuga-peña & lechuga, 2018). in their review of social work doctoral education over the last four decades, chin et al. (2018) noted some schools' efforts towards addressing diversity needs, particularly for bipoc doctoral students. their report highlighted critical areas that needed improvement to ensure bipoc doctoral students were prepared for the job market, including mentorship, more extensive support networks, promoting critical reflexivity, increasing financial support, and a clear understanding of post-graduation processes. additionally, chin et al. (2018) raised concern that few studies have thoroughly examined and discussed methods to address racial and ethnic diversity disparities within schools of social work. third, while social work education has typically followed a cultural competency framework, as we noted earlier, the consolidation of all forms of oppression tends to minimize the unique and pressing concerns of bipoc students (abrams & molo, 2009; schiele, 2007). jackson and samuels (2019) highlight the word 'competence,' which implies that social workers can become an expert in a cultural experience or perspective other than their own by merely studying it. alternatively, they propose a culturally attuned advances in social work, summer 2022, 22(2) 670 framework that offers a more critical examination of power, privilege, and oppression, centers intersectionality and multidimensionality to address complexities of disadvantage, and advocates for more accountability of social workers to recognize and work to dismantle structures that foster oppression, such as racism (jackson & samuels, 2019). incorporating alternative non-western theories and epistemologies is a step towards the goals of this framework. finally, we recommend further recruitment and retention of bipoc doctoral students and faculty as this underrepresentation was frequently highlighted throughout our findings. increasing representation in the classroom and within curricula fosters a space of inclusion and makes it easier to have shared conversations about race and racism in education, and subsequently reduces the burden of racial battle fatigue (arnold et al., 2016; hubain et al., 2016). similarly, increasing diversity and creating a supportive culture for faculty of color reduces burnout caused by cultural taxation (ssfnrig, 2017). recruitment and retention emphasize the need to consider the needs of bipoc students and faculty to be successful throughout the course of their academic journey. limitations this paper speaks to the lived experiences of four bipoc women and their lived experiences navigating their social work doctoral program. given the small sample size and engagement at a select number of schools of social work, we recognize that our testimonios cannot be generalized across the social work profession or representative of all bipoc scholars. however, our experiences reflect the collective scholarship on antiracism in social work education, particularly from the lens of women of color. furthermore, they enforce the need for more examination of modern-day white supremacy within the social work doctoral education and the intentional efforts to create culturally attuned academic spaces for bipoc scholars with multiple intersecting identities. conclusion while the nasw (2021) code of ethics does not explicitly condemn white supremacy, its mission, values, and principles encourage a professional practice that pursues equality and social justice for all society's members, with a particular focus on vulnerable populations. we argue that white supremacy manifests itself in bipoc social work doctoral students' experiences and cannot be dismantled if we only elevate theories and epistemologies developed from a white, western perspective. the unbalanced attention to these theories contradicts the social work profession's vision of an inclusive profession that prepares its students to work in diverse communities impacted by systemic oppression. it is essential to find ways to support bipoc social work doctoral students and create a more inclusive space in the academy. references abrams, l., & molo, j. 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(2008). community well-being in an unwell world: trends, challenges, and possibilities. journal of public health policy, 29(1), 353-366. https://doi.org/10.1057/jphp.2008.16 author note: address correspondence to cynthia mackey, school of social work, arizona state university, phoenix, az, 85004. email: cynthia.m.mackey@asu.edu https://grandchallengesforsocialwork.org/wp-content/uploads/2021/05/eliminate-racism-concept-paper.pdf https://grandchallengesforsocialwork.org/wp-content/uploads/2021/05/eliminate-racism-concept-paper.pdf https://doi.org/10.1080/10437797.2014.885277 https://doi.org/10.1353/jhe.2002.0013 https://doi.org/10.1353/rhe.1993.0017 https://doi.org/10.1086/604179 https://doi.org/10.2105/ajph.92.4.520 https://doi.org/10.1177/1521025116657834 https://doi.org/10.1057/jphp.2008.16 mailto:cynthia.m.mackey@asu.edu _________ tara milligan, msw, researcher, kimberly bender, phd, msw, philp d. & eleanor g. winn endowed professor for children & youth, and kate saavedra, msw, researcher, graduate school of social work, university of denver, denver, co. danielle maude littman, phd, lcsw, college of social work, university of utah, salt lake city, ut. annie zean dunbar, phd, am, clinical professor, college of public service, university of colorado, colorado springs, co. maveryck boyett, msw, lcsw, researcher, karaya morris, lmsw, university of new mexico hospital, and sophia sarantakos, phd, msw, assistant professor, graduate school of social work, university of denver, denver, co. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 695-711, doi: 10.18060/27607 this work is licensed under a creative commons attribution 4.0 international license. creating ecosystems of care through mutual aid: flattening hierarchal aid in the early months of covid-19 tara milligan kimberly bender kate saavedra danielle maude littman annie zean dunbar maveryck boyett karaya morris sophia sarantakos abstract: as covid-19 (coronavirus disease) spread in the united states in spring 2020, conventional safety nets were overwhelmed and unable to meet widespread and growing needs. mutual aid practices proliferated as an essential form of resource provision and community care, including exchanges of food, financial assistance, and social connection. our qualitative study interviewed 25 individuals engaged in mutual aid in colorado, usa to investigate the perceived benefits of providing and receiving care through mutual aid in the early months of the covid-19 pandemic. we found that nonhierarchical care offered entry points to equitable ways of supporting communities through and beyond crisis. the non-hierarchical approach to care described in our study illustrated redistributed power and agency to meet community needs, and decentering institutional decision making. the experiences of mutual aid participants propose a significant ideological shift regarding our sense of care and community when conventional systems are insufficient to meet collective and individual needs, and suggest a need for future expansions of and changes to social work practice to embrace non-hierarchical care. keywords: covid-19, mutual aid, collective care, non-hierarchical structures in the spring of 2020, covid-19 (coronavirus disease) entered the united states and spread quickly, growing from just a handful of identified cases at the start of march and surpassing 100 million confirmed cases by the end of 2021 (world health organization, 2021). rapid spread resulted in increasingly complex needs, including delays in testing, contact tracing, and treatment across the united states (sharfstein & marx, 2020). it was not long before economic and social consequences of the pandemic also became widespread, with increased reports of unemployment, millions of americans at risk of eviction, and reduced access to basic needs of housing and food (bender et al., 2020). this burden was disproportionately experienced by communities of color who, due to existing health and social inequities, had higher rates of employment as “essential workers” (fehr et al., 2020; rollston & galea, 2020). the u.s. government preparation and response to covid-19 has been widely criticized, with accusations of inadequate planning for the degree of coordination and collaboration required across the complex systems involved, failure to provide sufficient resources, and failure to share information (silver & hyman, 2020). government aid fell about:blank advances in social work, fall 2024, 24(3) 696 particularly short, failing to deliver necessary and immediate resources to those who needed them (office of inspector general, 2021). as covid-19 threatened safety nets, and conventional systems were overwhelmed, mutual aid (community-driven, informal exchange of assistance and care) proliferated as an essential form of resource provision and community care. mutual aid practices that stem from long-standing traditions across identity boundaries, time, and political cartographies now grew quickly to provide food, financial assistance, and social connection amidst isolation (bender et al., 2021; fernandes-jesus et al., 2021). amidst these contexts of widespread distress–and widespread care–our research team aimed to explore mutual aid, the informal care structures which filled voids amidst insufficient institutional care. in doing so, we offer an opportunity to understand the potential individual and community benefits of collective care during times of acute crisis and beyond. as world crises continue to compound, our findings from the early months of the covid-19 pandemic continue to shape our understanding of mutual aid, social work practice, and safety nets more broadly. literature review conventional, vertical aid in crisis response conventional mechanisms of aid, such as governmental crisis response, are one of the primary means for creating vertical links to resources between community members and those in power to respond to humanitarian needs in times of crisis. by way of example, federal government-centered emergency response systems, such as the federal emergency management agency (fema), are designed under the assumption that crises will emerge in a consolidated, geographically localized manner and resources are to be allocated accordingly through grant processes (fema, 2024). yet a report from the office of inspector general describes how, in the early months of the covid-19 pandemic, fema had challenges distributing and allocating various aid (e.g., personal protective equipment, ventilators) and lacked strategic documents to lead pandemic response efforts leading to confusion of agencies’ roles and responsibilities (office of inspector general, 2021). rather than respond with a sense of equitable distribution, efficiency, and agility to a rapidly changing crisis, federal response institutions were ineffectual in providing basic needs. the failure of fema to adequately address the covid-19 pandemic reflects how the design of the system addresses the desires of power consolidation over equitable distribution (hodge et al., 2007). rather than effectively address the needs which emerged from the effects of the covid-19 pandemic, public health officials had to establish orders to control public behavior to reduce risk of transmission as a reactive measure to address the snowballing effects of the pandemic, leading to a proclivity of political and social challenges and a failure to meaningfully address the pandemic. theorists posit that linking social capital, or the transfer of resources from those in authority to those in need, can create connection and shared sense of responsibility between those in disparate levels of power (szreter, 2002), yet previous research has documented failures in providing such social capital to communities post-disaster, even prior to covid-19. trust between communities and institutional authorities is often lacking postmilligan et al./mutual aid & covid 697 disasters, particularly when authorities discount or fail to consider local community knowledge as decisions are made (castro-correa et al., 2020). lo and fan (2020) highlight how, in moments of crisis when individuals and communities are in need and seeking help from authorities, people in power often act as gatekeepers to necessary resources, a process referred to as elite domination. the challenges faced in actualizing the productive link of disparate power structures are exasperated by lack of accountability between those in power and those in the community (lo & fan, 2020). social support organizations, frequently part of the vertical linkage system, often tout strict eligibility criteria concerning who is “deserving” and “undeserving” of care (see, e.g., beito, 2000; katz, 1990), leading to exclusive criteria and inextricable power dynamics in determining who is worthy of being helped and what that help may entail. as such, conventional authoritative aid (e.g., fema) may often be positioned as the first source of relief, but it has struggled during crises (covid-19 and other crises) to understand and meet the needs of community members. this challenge extends to the broader care and service system, including social work and non-profit organizations, that is known to restrict and constrain care to communities via strict eligibility requirements, silo care, and focus on capitalist-oriented outcomes during and beyond crisis (adler-bolton & vierkant, 2022; incite! women of color against violence, 2017). abolitionist scholars like ruth wilson gilmore, and others, have argued that the “[non-profit industrial complex] … [functions] as a ‘shadow state’ constituted by a network of institutions that do much of what government agencies are supposed to do with tax money in the areas of education and social services” (incite! women of color against violence, 2017, pp. 8-9). further, it is critiqued that this complex was borne out of a desire to fill in and step up where government was failing yet mimicked many of the same processes and has since failed in many of the same areas (incite! women of color against violence, 2017). mutual aid as horizontal care amidst failure of conventional hierarchical aid, mutual aid is one model of community care that may arise to replace or supplement governmental and non-profit delivered resources (which we refer to as “horizontal” and “flattened” approaches to care interchangeably throughout this paper). mutual aid broadly refers to practices of people caring for one another by building "new social relations that are more survivable” than those (un)available by formal government supports (spade, 2020, p. 136). nelson et al. (1998) defines mutual aid organizations as “settings in which people with a problem in living, or a common experience, come together on a voluntary and equal basis to share their experiential knowledge and to provide and receive informal social support” (p. 889). within the context of social work, mutual aid practices–for example, through peer-to-peer support–have filled in the gaps when professionalized social work has fallen short (loumpa, 2012; nelson et al., 1998). further, mutual aid has centuries-old roots among marginalized communities and often proliferates broadly out of necessity during crises (aldrich, 2012), resulting in “post-disaster trust” among communities (lee, 2020; solnit, 2009). while mutual aid efforts are working to meet people’s survival needs, often in moments of crisis, spade (2020) repeatedly highlights how one of the key components of advances in social work, fall 2024, 24(3) 698 mutual aid work is engaging in collective political education to “build a shared understanding of why people don’t have what they need” (p. 9). because mutual aid work necessitates reeducation and cogent structural analyses of social problems, the promise is great for mutual aid offering sustainable, alternate ways of caring for one another, with unique benefits and advantages over conventional aid or hierarchical resource allocation. an emerging literature has examined mutual aid during the covid-19 pandemic, and how it impacted those organizing and participating in mutual aid. in the united kingdom, for example, a researcher found that mutual aid groups developed trust and found joy in their collective work, sustaining them through a unique crisis (fernandes-jesus et al., 2021). as such, engaging in mutual aid in covid-19 increased participants’ localized sense of community cohesion, resulting in an “irreversible change” towards collectively caring for their community (fernandes-jesus et al., 2021). for example, landau (2022) provides a case study of the role of mutual aid group occupy sandy which provided disaster relief to community members during the 2012 hurricane sandy. the group which was part of a coalition of others in a network called mutual aid disaster relief (madr), would later pivot when covid-19 became the disaster of the moment, sharing insights and best practices, and shaping how other community groups organized and met the pressing and ever-expanding chasm between government intervention and direct aid. these findings mirror research prior to covid-19 which found that, along with a high degree of hope, taking collective action toward change led to a more solid belief in group efficacy while sustaining individuals and groups to continue through change agendas (cohen-chen & van zomeren, 2018). together, these findings suggest that engaging in mutual aid is an important part of building community in crisis and beyond. mutual aid during covid-19 also amplified political resistance. jun and lance (2020) described how existing mutual aid groups increasingly resisted reliance on government aid during the covid-19 pandemic, highlighting how mutual aid organizations center nonhierarchical structures, and trust for neighbors over capitalist governments. similarly, springer (2020) suggests that the pandemic helped more people understand mutual aid as a natural human action, while also affirming participation in mutual aid as an act of political resistance against capitalist structures. current study focus the emerging literature suggests mutual aid may have important benefits to those involved, and that participants develop strength and motivation to resist oppressive power structures through engaging in mutual aid. thus, while there are dire consequences to the failure of traditional/governmental aid during covid-19 (and beyond), mutual aid may have benefits or advantages that countervail deficits of traditional aid and create opportunities for deeper, non-hierarchal forms of collective support and care. with the understanding that conventional aid from government failed to meet community needs in the early months of the covid-19 pandemic, our paper explores colorado, u.s.-based organizers’ perceived advantages of building nonhierarchical care structures through mutual aid during this time. we consider what our findings may mean for shifting conventional helping professions’ approaches to care far beyond the covid-19 pandemic. milligan et al./mutual aid & covid 699 method positionality statement this work brings the radical praxis of mutual aid into the academic sphere and, as its authors, we understand the complexity and conflict of this. we (black, white, queer, questioning, straight, nonbinary, and cisgender) come to this work with the aim of deepening our collective understanding of how mutual aid emerges and transpires, as well as the complex politics that drive this care work. while this research was in part an intellectual pursuit, each author is also dedicated to deepening and strengthening their commitment to a politic of collective care. some members of the team have engaged in mutual aid for many years, and others have stepped into this praxis more recently. all team members are embedded in the social work profession (as educators, practitioners, researchers), and recognize how the professionalization of care is often in direct conflict with the ethos of mutual aid. we are committed to practicing and teaching a way of social working that is in solidarity with people, communities, and social movements. these experiences with mutual aid, our social identities, and our ties to professionalized social work, shaped how we approached this work–with commitment, care, and the understanding that our present social structures are limited in meeting our needs (while we work to survive and care for one another within them). study overview and design the present study uses a phenomenological approach (creswell, 2013) to understand the specific ways mutual aid participants experienced benefits from engaging in nonhierarchical collective care during the early months of the covid-19 pandemic. a team of researchers conducted qualitative, semi-structured interviews with participants and facilitators in mutual aid groups and intentional communities. sample and recruitment our team aimed to understand a variety of experiences from mutual aid groups who formed in response to the pandemic, as well as those who had been practicing mutual aid for quite some time. in the early months of the covid-19 pandemic (june-august 2020), we recruited members of mutual aid groups (i.e., those who defined themselves with mutual aid in the title or description of the group) as well as intentional communities where mutual aid was integrated into residential spaces in more informal ways. these groups were identified through google searches and through word-of-mouth networks confined to the state of colorado where our team was located (with the rationale that early responses to covid-19 varied considerably by state). interviewees had to be 18 years or older and identify as a part of a mutual aid network or intentional community in colorado. it is helpful to share a bit about colorado and its early response to the covid-19 pandemic. colorado has a population of over 5 million people, over 80% of whom identify as white and 40% as democratic-leaning and republican leaning, respectively (pew research center, 2014; u.s. census bureau, 2019). after announcing its first covid-19 cases in advances in social work, fall 2024, 24(3) 700 early march 2020, the state exercised a range of stay-at-home orders and nonessential business lockdowns in spring 2020 (roberts, 2020). for both mutual aid and intentional community recruitment, potential participants were invited to an hour-long interview focused on understanding the unique ways that mutual aid has emerged during covid-19 as a form of collective care. interviews took place via video conference (zoom) or phone (if preferred and/or to increase accessibility). participants were asked to share our study description and invitation with others in their networks who might be interested in being interviewed. our resulting sample (n=25) included mutual aid (n=17) and intentional community (n=8) members that spanned a wide age range (26-70) and shared the following identities/experiences most commonly: straight (50%), white (80%), women (60%), and living in urbanized areas (72%). examples of mutual aid practiced by participants included organizing meal and grocery deliveries, sharing food and supplies among networks, making and distributing masks, facilitating cash transfers to cover basic needs, and offering caretaking to neighbors. data collection semi-structured interviews began with eliciting verbal informed consent, followed by participation in a brief online demographic survey, and then proceeding with the semistructured conversation. participants were assigned an identification code to connect demographic data with qualitative interview data. interviews lasted approximately one hour and were audio recorded and transcribed with participant permission. interviews were conducted by a human-subjects trained researcher, and all protocols were approved by our university internal review board. participants were sent a $20 gift card to honor their time participating. measures the demographic survey collected the following: participants’ age, gender, race, ethnicity, sexual orientation, country of origin, marital status, education level, employment status, whether one was considered an essential worker, housing situation, household composition, and length of involvement in mutual aid work. the semi-structured interviews asked participants about a variety of experiences related to their mutual and collective care (e.g., mutual aid functions; mutual aid engaged in during the coivd-19 pandemic; mutual aid benefits and byproducts; mutual aid beyond covid-19). our analysis for this paper focused on questions specific to the benefits and byproducts of engaging in mutual aid: • “how does giving/receiving through mutual aid feel different than charity?” • “what makes you show up in this work?” • “what are the tangible and intangible benefits and impacts of participating in mutual aid?” • “what does it look/feels like to go beyond ‘the transactional’ in this work?” milligan et al./mutual aid & covid 701 data analysis interview transcripts were analyzed in their entirety with two researchers excerpting all content relevant to the research question at hand, first co-excerpting to establish consistency and then dividing remaining transcripts to be excerpted by the primary coders. excerpts relevant to the research question were then inductively coded using a values coding frame (saldaña, 2021). an iterative process was used to develop a codebook. the first quarter of the excerpts were coded independently by the two primary coders who then met to clarify, combine or delete codes as needed to develop consensus and a draft codebook. the two coders then used the draft codebook to code another quarter of the excerpts, met to establish coding consistency and make final revisions to the codebook, and then used the final codebook to individually recode the first quarter of the excerpts and code the second half of the excerpts. upon completing coding, the two primary coders met with a third research team member to review coded data, and group codes into patterns that became themes. an initial summary description of each theme was brought to a fourth and fifth research team members for revisions and adjustments to framing before the entire team met to reconcile and refine a final set of results and generate discussion points and implications. please note that “...” in findings indicates that participant text was omitted for clarity. findings our findings help to illustrate the experiences of mutual aid organizers and participants during the early months of the covid-19 pandemic. participants shared collective care when conventional governmental care fell short, and, in doing so, perceived benefits of engaging in non-hierarchical care in communities. four themes were developed through our analysis: destigmatizing receiving of aid; expanding what is offered and who contributes; developing a sense of meaning and hope; and the spiritual benefit that comes with liberation. themes destigmatizing receiving of aid. mutual aid offers resources and care to people without requiring them to show or prove a need to anyone. this accessibility and normalizing of the need for support is described in contrast to conventional need-based aid. one participant described how people often fall through the bureaucratic cracks of the current governmental care system. this participant finds mutual aid to be successful by providing care without recipients having to ask or jump through hoops; they state: "because it's peer to peer...it ought to feel less paternalistic to the recipients, more of an equal exchange. it has more dignity to it. " (white straight man in carbondale involved in mutual aid for 4 months). several participants described the fundamental notion that everyone has the possibility of being a recipient of aid, which breaks down the more conventional giver and receiver hierarchy of care often seen in social service and charity structures. reconceptualizing advances in social work, fall 2024, 24(3) 702 “need” in this way means providing equitable community care; as one participant states "we know that we’re all here for each other...if somebody needs more help than somebody else, that's fine, because we're all, we're just in this together and our journeys are going to be different" (white straight woman in fort collins involved in mutual aid for 3 years). needs are not placed in a hierarchy, but instead met collectively and simultaneously, given the resources and capacity of the mutual aid network. this philosophy of care was destigmatizing for participants and those who were involved in their mutual aid networks. as mutual aid networks support individual community members based on need and an aim for equity, they remove power structures that require proof of need. as such, mutual aid was noted to be a “positive environment, very non-judgmental” and the support provides care from the community “in a way that is not shameful” (multiracial straight woman in grand junction involved in mutual aid for 5 months). this approach creates a network that reduces “embarrassment” and “disgrace” in the process of receiving aid, feelings commonly associated with receiving conventional hierarchical forms of aid. expanding what is offered and who contributes. participants in our study described how mutual aid practices often involved sharing resources that extended beyond and decentered money. participants described exchanging various assets and raw materials already on hand in the community, such as meals and rides. these resources were exchanged individual to individual or individual to organizing entity outside of payment or financial contribution. these non-monetary acts of care allowed more people to be involved in contributing to solutions to the challenges at hand. doing so strengthened the resources and support available to the individual, and consequently the larger societal ecosystem (rather than necessitating reliance on money handed down through traditional means, such as government aid). one participant reflects how much easier it is for individuals to make a difference compared to common structures of aid, "you're building relationships with people in your neighborhood for when something comes up in the future and then like building relationships, building social capital” (white queer woman in denver involved in mutual aid for 2 years). holding ideals that anyone can make a difference and flattening aid structures offers greater opportunities for more individuals to have agency to create change in their communities. developing a sense of meaning and hope. a sentiment, among participants, that there was no action, idea, or resource too small to contribute, offered some an opportunity for “fighting against hopelessness.” during a walk home early in the covid-19 pandemic, one participant struck up a conversation with a community member who was making a living structure for themselves by the river. the participant reflects on the decision to bring this community member food and water, noting that it can feel “really hopeless” to think that a non-profit or a police unit might be unhelpful or (likely) harmful; this participant forged hope through their ability to make an immediate difference via an individual sharing of resources (in this case, food and water). engaging in person-to-person mutual aid by providing even small things was described as “more meaningful” than traditional forms of aid; the care was coming from another human being who was “compelled to…first of all, milligan et al./mutual aid & covid 703 see you as another human being” (multicultural straight man in littleton involved in mutual aid for 3 years). this sense of hope sustained those involved in mutual aid. mutual aid was described as “a reason to get up for a lot of us, for a really long time. and it was something to stay grounded and stay present” (white nonbinary pansexual participant in golden involved in mutual aid for 1 year). after experiencing several challenges through the pandemic, one participant describes mutual aid as pulling them through this difficult time; they shared: "i was in such a dark hole for a second. and then i started volunteering. and i was like, ‘whoa, this is really cool’" (multiracial straight woman in grand junction involved in mutual aid for 5 months). another participant noticed a shift in others in their mutual aid network: "i've seen some people that, when i first met them early on at the distribution stuff, they looked like they didn't have a hope left in the world. today, their eyes are bright, and they have a purpose" (white straight woman in grand junction). bringing a sense of hope and providing meaningful engagement provided several participants with a sense of purpose. pathways to liberation. by engaging a mutual aid praxis and making necessary resources more accessible, less hierarchical, and less stigmatized, participants understood that when individuals come together, they can build power and make meaningful change; it was described as a pathway to liberation. participants gave examples of how mutual aid leads to liberation by filling in the gaps and easing oppression of those most impacted by our current systems of imperialism and capitalism. one participant remarked: …no plan works without mutual aid…we will never find liberation through capitalism, through communism, or socialism without mutual aid...it fills the gaps. it finds the need and…identif[ies] the need, and then fills it no matter what. and like that's, that's it. we won't have liberation as people, as oppressed people under u.s. imperialism and capitalism and then the patriarchy without mutual aid. (black/multiracial nonbinary/two-spirit participant in grand junction involved in mutual aid for 7 months) this pathway to liberation required personal growth and political awareness. one participant outlined their personal journey, attributing much of their growth to acknowledging their own privilege in society. they describe: "that's where mutual aid happens, is where there is the destruction of privilege. so, here we are” (white nonbinary pansexual participant in golden involved in mutual aid for 1 year). through the experience of losing their job, for reasons related to the pandemic, this participant began to understand how certain societal privileges enabled them to be more comfortable or secure. the participant described an empathetic response and noted a decrease in their sense of judgment towards others; they also noted that sharing that experience in a mutual aid setting led to “huge” personal growth and an acknowledgment that more people should have access to these same privileges. our findings describe how mutual aid replaces notions of conventional aid, as care is exchanged through non-hierarchical sharing of needs and resources outside conventional power structures. these sentiments were summed up by one participant: advances in social work, fall 2024, 24(3) 704 i think for most of us that is, that is a very important outcome of just that we are, we're organizing people, we're mobilizing people, we're giving people a way to help and empowering them and helping them understand that they don't need to like go through a nonprofit or a soup kitchen or a government program or anything formal in order to make difference in their community. (white queer man in wheat ridge involved in mutual aid for 5 months). mutual aid may be a means to flatten the vertical transfer of aid and resources from authorities to those in need and to instead subvert conventional power structures by creating what participants describe as an “ecosystem for all people” (black/multicultural nonbinary/two-spirit pansexual participant in grand junction involved in mutual aid for 7 months). in doing so, participants recognize the reality that we all may receive aid at times, that there are many things we may offer and many people who may contribute. acknowledging we are all connected offered a sense of meaning and hope for many participants; for some, the personal growth experienced through engaging mutual aid led towards the recognition that liberation for all people from capitalist structures may be possible. discussion our study investigated the perceived benefits of providing and receiving care through mutual aid during an acute widespread time of governmental failure in the early months of the covid-19 pandemic. our findings suggest that this nonhierarchical care offered certain windows into more equitable ways of being which may sustain beyond crisis. the non-hierarchical approach to care decentered state and federal agencies and institutions, lessened gatekeeping, and instead, out of necessity, redistributed power and agency among community members left to meet one another's needs. this horizontal care was described as destigmatizing; there was no shame in having needs because mutual aid did not discriminate givers from receivers. mutual aid practitioners asserted that regardless of background or proof of need, everyone could be both a recipient and provider of care. our study also finds the flattened care structure of mutual aid enabled participants to center autonomy and voice to respond equitably to individual and community needs. this community-driven care overcame limits of more conventional aid offered by those in power which has been critiqued as out of touch with local knowledge of the community, leading to distrust and power divides (castro-correa et al., 2020). assuming resources are available, there is an advantage to communities guiding and responding to needs within, rather than requiring communities to appeal to a government authority (and imposed eligibility requirements) to meet needs. engaging in non-hierarchical care was also a conduit for fostering hope and meaning among participants, with mutual aid feeling generative and sustaining for many. in a very challenging time, the sense of shared purpose helped participants move through the crisis and think about how to continue their care work beyond it. this finding is promising in light of previous research that finds when hope for social change is high, group efficacy can predict collective action (cohen-chen & van zomeren, 2018). thus, prioritizing community-level horizontal care structures may create opportunities for effective milligan et al./mutual aid & covid 705 collective action quite different from the experience of being involved in governmental and charitable aid. for example, colting-stol (2022) discusses how mutual aid practitioners took their work after the initial crisis of covid-19 and transformed it into further grassroots organizing and community engagement, allowing some people who had previously felt disenfranchised to develop a sense of political education and advocacy. furthermore, rankins (2023) described how the distribution of funds by mutual aid networks is shaping policies about banking and taxes in unique ways that have long-term implications for fundraising and formal organizing. the positive impact of collective hope and enfranchisement seen within the proliferation of mutual aid during this acute period may signal shifts in how care systems adapt to reflect a more empathetic model. finally, participants described mutual aid as leading towards liberation. through their mutual aid engagement, participants felt connected to individuals they had not previously been in community with; they subsequently felt prompted to tie their individual sense of well-being to a larger sense of community health. this is an important contribution to extant literature, as a common critique of rapid mutual aid proliferation is that its practice can become divorced from its political underpinnings (o’taylor, 2020). while explicit political education was not mentioned as part of the mutual aid groups in our study, this finding suggests that shifts in ideals – around who has needs and deserves support and how our needs can be met – may develop through involvement in mutual aid structures. partelow (2021) describes a similar phenomenon during earthquake recovery in indonesia, where disasters created collective action problems that reshaped social relationships and capital exchange; those involved were able to be more reflective of their own positionality within the community and felt deeper ties to their community. similarly, mississippi-based organizer kali akuno shares that offering and receiving mutual aid can be a catalyst for shifting political-ideological frameworks, suggesting that wholistic change models which aim to enlist and empower as many participants into the change cycle as possible is how transformation will come to be (shear, 2021). our study similarly finds that because mutual aid destigmatizes care, more individuals feel welcome to participate as both givers and receivers. this disrupts conventional emphasis on individualism and limited worthiness. this participation, which welcomes everyone, all needs and all offerings, flattens care structures to create equitable sharing of resources. a greater sense of hope develops as participants realize they are living within a shared ecosystem of care and can thus be a part of collective liberation. limitations certain study limitations should be considered as readers interpret our findings. we sampled mutual aid groups across the state of colorado. because states vary in their politics, demographics, geography, and covid-19 response it is important that readers consider the transferability of our findings to their contexts. within colorado, we sought to capture diverse experiences, yet some voices such as indigenous communities were underrepresented in our sample. an urgent desire to capture a unique time point limited the ability to build longer-term relationships in these communities, and these voices will be critical to center through future research that allows for deeper community engagement. advances in social work, fall 2024, 24(3) 706 furthermore, our work represents the early months of a much longer ongoing disaster. this potentially limits the transferability of our findings to more acute post-disaster responses and means our data, at one timepoint, does not capture shifts in perspectives that may have occurred as the pandemic continued. longer-term analysis of mutual aid work and experiences – the expectation of participant burnout and the difficulty of sustaining this work while under oppressive systems – is needed. implications for social work given our findings of the benefits and advantages of providing care through mutual aid – including flexibility, responsiveness, reduced stigma, and a sense of liberation and hope – what can (and should) our current hierarchical care structures learn from mutual aid? our previous work, which explores the values and beliefs underlying mutual aid in the early months of the covid-19 pandemic, acknowledges there is both convergence and divergence in the values and practices of mutual aid and those of professionalized helping structures (littman et al., 2022). while nonprofit and governmental organizations may be attempting to meet similar community needs to those of mutual aid networks (e.g., providing tangible resources and social support), there is significant contrast between mutual aid and the constraints of our more rigid and exclusive formal institutions of care which prioritize “deservingness” in allocating care (beito, 2000; katz, 1990). it is also important to recognize the inherent and perhaps irreconcilable tensions between the capitalist undergirding of nonprofit and governmental aid organizations and mutual aid, which is firmly rooted in an anti-capitalist, abolitionist politic (kim et al., 2024). research has demonstrated that human service workers employed in agencies with commitment to market-based managerialism (emphasis on productivity, accountability & efficiency) found it more difficult to adhere to the mission and values of their profession, including caring for the most vulnerable and working toward social change (zelnick & abramovitz, 2020). thus, decades of defunding, and austerity of rigid conventional care structures based on offering services through a market-based transactional approach, likely diverge from the values and principles mutual aid groups exemplified in their care (woodly et al., 2021). joining the voices of other social workers, we call for critical dialogue among helping professional organizations, in social work and other allied helping professions, to reckon with how to live into our mission to care for community while fighting for social and racial justice (toraif & mueller, 2023). as a profession, we must grapple with the benefit of dismantling the giver/receiver binary, broadening who can and should be part of offering care, and how that care should be provided. one way to attend to this tension is to do as bell (2021) describes, by decentralizing giver/receiver professional identities in care systems and decentralizing ways of meeting community needs which can create opportunities for community members that often experience marginalization. however, this would require a paradigm shift for most nonprofit, governmental, and charity social work organizations and reinvestment in the care economy broadly (marcil, 2023; sonsterng-person et al., 2023). many of these organizations are invested in neoliberal capitalist norms of professionalism, credentialing, liabilities, and eligibility, often addressing individual deficits rather than garnering collective action for structural milligan et al./mutual aid & covid 707 change (finley et al., 2012). this would require de-emphasizing professionalism and credentialled care providers and instead elevating localized knowledge and resources among those with shared lived experiences. for example, in the state of colorado, new legislation has removed barriers to clinical licensure by removing the provisional license requirement, increasing the possibility of diversity within the profession and allowing for more social workers from marginalized racial backgrounds to receive licenses (nienow et al., 2023) as well as those who provide peer support without professional credentials (haubner, 2024). our calls for significant rethinking of how our social work profession provides care align with other recent calls in the wake of the covid-19 pandemic and racial injustice uprisings. elkassem and murray-lichtman (2022) similarly urge our profession to take an explicitly anti-racist stance and eradicate coloniality in the profession; such work involves reconceptualizing care and practice through critical race and anti-colonial lenses. this time period, in coming through global crisis and racial reckoning, has opened critical dialogues long overdue about the work of social work and the harmful origin and practices of the white lineage of the profession these dialogues also cover what can be learned based on care models driven by and in solidarity with community. beyond shifting formal care systems, our findings offer a call to individuals interested in collective liberation to consider ways to catalyze opportunities for collective care and mutual aid. popular media has documented growing involvement in mutual aid (and other forms of horizontal care such as community fridges, time banks, and tool sheds) which have become more accessible through digital organizing (bender et al., 2021). considering the anticipated demands of the growing climate crisis (brulle and norgaard, 2019) alongside racial justice movements and ongoing stressors of covid-19, liberatory practices that organize for justice, meet community needs, foster hope, and create space for all members to contribute and receive will be essential to ensuring our collective safety and security. for those social workers interested in joining the movement, there are ample opportunities to begin their mutual aid education. we offer a few suggestions for getting started including developing a deeper understanding of mutual aid as a social justice project by exploring a tool kit created by sustainable economies law center (2020). individuals can also find their local mutual aid group by visiting the website mutual aid hub (n.d.). in tandem, mutual aid begins in the simplest ways through shared trust and connection. individuals can cultivate interdependent relationships by convivially connecting with their neighbors and others in close physical proximity to them, as well as groups with shared affinity and connection – this relationality is the cornerstone of mutual aid practice and central to collective striving and community care. finally, we offer some critical considerations to accompany these implications: 1) to what extent do mutual aid networks and practitioners wish to inform versus dismantle or replace conventional care structures in imagining and working towards these changes? 2) further, what, if any, role is there for social work scholars, trained in researching social change and educating a workforce in care provision, when considering or supporting “alternative” horizontal care structures? these will be important questions to consider as care landscapes continue to shift and adapt amidst ongoing and compounding crises; we urge those in similar positions of privilege to listen carefully, and act caringly, in these advances in social work, fall 2024, 24(3) 708 conversations and aligned actions. finally, we invite social work students, educators, practitioners, and scholars to bring their colleagues and communities into dialogue about these key questions as we collectively work towards ‘doing care’ in an ever-changing social landscape. conclusion our study describes how mutual aid – a form of care that offers mutuality, reciprocity, inclusion, and a sense of liberation – proliferated in the context of the early months of covid-19. yet, mutual aid has existed for centuries in communities at the margins (spade, 2020) due to government failures that span well beyond acute crises. with the growing complex crises of the future, mutual aid will likely be needed on broader scales. in an interview with shear (2021), jackson, mississippi-based organizer kali akuno suggests we need “maximum participation from as many folks as can be involved” and this widespread participation “is where the real political education is going to come from” where widespread community action, political education, and transformation is possible (p. 24). the experiences of mutual aid participants shared here propose a significant ideological shift regarding our sense of care and community. this shift is echoed eloquently by roy (2020) who, early in the pandemic, proposed that the pandemic may be a “portal” from one way of being to the next; roy writes: “in the midst of this terrible despair, [the pandemic] offers us a chance to rethink the doomsday machine we have built for ourselves. nothing could be worse than a return to normality” (para. 47). mutual aid organizers in our study describe a liberatory horizontal care system that values dignity and mutuality and generates hope – an approach we should collectively consider fostering considering government failure in acute crises and beyond. references adler-bolton, b., & vierkant, a. 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(2020). the perils of privatization: bringing the business model into human services. social work, 65(3), 213-224. author note: address correspondence to tara milligan, graduate school of social work, university of denver, denver, co, 80210. email: tara.milligan@du.edu https://doi.org/10.1177/0890117120930536b https://www.cato.org/pandemics-policy/covid-19-case-study-government-failure https://www.nytimes.com/2020/03/30/opinion/coronavirus-testing.html https://www.nytimes.com/2020/03/30/opinion/coronavirus-testing.html https://doi.org/10.1080/08935696.2020.1844541 https://doi.org/10.1080/08935696.2020.1844541 https://doi.org/10.52713/apsw.v1i1.18 https://doi.org/10.52713/apsw.v1i1.18 https://doi.org/10.1177/2043820620931277 https://doi.org/10.1177/2043820620931277 https://doi.org/10.1023/a:1021300217590 https://doi.org/10.1023/a:1021300217590 https://oxfordre.com/socialwork/display/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-1553 https://www.census.gov/quickfacts/co https://doi.org/10.1057/s41296-021-00515-8 https://doi.org/10.1093/sw/swaa024 https://doi.org/10.1093/sw/swaa024 mailto:tara.milligan@du.edu _________ kendall morris, phd, assistant professor, school of social work, michigan state university, east lansing, mi. linda sprague martinez, phd, professor and director of health disparities institute, school of medicine, university of connecticut, hartford, ct. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 252-268, doi: 10.18060/27394 this work is licensed under a creative commons attribution 4.0 international license. “we continue to keep this crisis in the forefront”: women survivors of homicide advancing justice kendall morris linda sprague martinez abstract: homicide has an effect on the community, as family members are left to grapple with the loss. the women survivors of homicide movement (wsohm), based in boston, ma, is a grassroots effort aimed at empowering women of color to advocate for themselves as a homicide survivor. a systematic analysis was conducted to examine how power and privilege impact the groups’ approach to change-making. mixed research methods were employed including key informant interviews and document review. findings indicate wsohm employs multiple strategies to achieve its goals, which are focused on bringing attention to unsolved murders in boston and ensuring survivors and victims are given respect from law enforcement and city leaders. implications for social workers working with community organizations are also discussed. keywords: unsolved homicide, grassroots action, community empowerment, community violence, macro social work in 2016 there was an increase in organizing efforts in response to the murder of black people by police (brunson & wade, 2019). this has led to questions about the role of the police in public safety. in this paper we explore community organizing for the issue of homicide in predominantly black neighborhoods in boston, ma. the washington post reports that of the 54,868 homicides in 55 cities in the united states over the past ten years, 50 percent did not result in an arrest and remain unsolved (rich et al., 2018). almost three quarters of the victims in these cases were black. due to the high homicide rates in black communities, there are also several family members and friends left behind to deal with the aftermath of the murder, these individuals are the survivors of homicide victims (sharpe, 2015). moreover, urban cities with high concentrations of killings have the lowest arrest rates (rich et al., 2018). there are also pronounced racial inequities in arrest rates, whereby homicides with a white victim are more frequently being solved (rich et al., 2018). the failure of the police to investigate and address homicide in communities of color and the criminalization of homicide survivors (rich et al., 2018), further brings into question the role of police in communities of color. we explore the role of grassroots organizing in homicide response through an illustrative case study of the women survivors of homicide movement (wsohm). wsohm is a local community organization based in boston, ma, founded in 2014 by a black woman who wanted to have a purpose behind the pain of her husband being killed thirty years ago. the organization focuses on providing resources (i.e., financial support, mental health) to women of color (mainly black women) who have had loved ones killed and empowering them to advocate for their loved ones’ murder being solved. wsohm is the focus of this study because although it is at the grassroots level, it has had tremendous about:blank morris & martinez/women survivors of homicide 253 success leveraging support from key stakeholders to raise awareness about the issues black survivors of homicide face in boston. this paper will highlight how this organization brings their members together to effect change on the issues surrounding homicide and community violence in black communities in the boston area, and how their efforts can be a model for social workers to follow when trying to effect change on a major social issue. employing case study methodology, we examine the development of wsohm as a local community agency, strategies and tactics employed and their impact on local law enforcement practice related to homicide investigations. we also explore the impact of their efforts on the experiences of survivors of homicide victims in boston. wsohm is described in detail and discussed in the context of the literature and implications are explored. the case of wsohm illustrates the power of community action in advancing local change. we discuss the ways in which social workers can support these efforts, namely because they are an organization committed to supporting underrepresented minorities who are not receiving adequate, equitable support from key stakeholders such as the police department. background criminologists have estimated that over 200,000 murders have gone unsolved nationally since the 1960s (kaste, 2015). unsolved homicides leave families with uncertainty about what happened to their loved one and not knowing if their loved one’s killer is still in the community. after a homicide case has been unsolved for a year, the chances of it becoming solved decrease drastically. this leaves the family members and friends of the victim uncertain if their loved one’s case will be solved, which can be frustrating. unsolved homicides have important implications for the relationship between police and the public which further complicates matters when it comes to investigations and obtaining witnesses (kaste, 2015). stigma surrounding the reason homicide victims die can cause tension between the community and the police department (sharpe, 2015). boston, ma is one of the cities where this is the case. the majority of homicides occur in predominantly black neighborhoods in boston, which are dorchester, mattapan, and roxbury (planas, 2015). many of the women who are affiliated with wsohm live in one of these communities and their loved ones’ murders remain unsolved. the focal points of the organization are teaching women and their families to advocate for their loved ones' cases to be solved, and engaging city leaders in caring about the high numbers of homicide in their communities. homicide has been described as having a ripple effect on community well-being, as family members and friends are left to grapple with the loss of loved ones. in the literature, those who experience the homicide of a loved one are referred to as the survivors (hertz et al., 2005). this is the preferred identification because it reflects how individuals and families are left behind to carry on after the murder has occurred. surviving the homicide of a loved one is a complex process which involves inevitability (the death is unexpected) which can cause feelings of loss of control (sharpe, 2015; sharpe et al., 2014). those in black communities who have lost someone to homicide must navigate life after loss in the context of stigma, a lack of resources, and distrust of systems and practitioners due to advances in social work, summer 2024, 24(2) 254 historical oppression (piazza-bonin et al., 2015; sharpe, 2015). this process is further complicated in the case of unsolved homicide because the surviving family members may feel a lack of justice and perceive law enforcement as failing to protect the community (sharpe, 2015). grappling with the reality of their loved one not getting justice can contribute to feelings of anger and hurt. it also further adds to the racially based inequities that only black survivors of homicide victims go through, such as being doubly stigmatized by society because they are already marginalized as black people, and stereotypes are placed on the victim as to why they were killed (sharpe, 2015). for example, police may assume that the victim was involved in gang activity. the members of wsohm are an example of a group of people dealing with navigating the aftermath of the homicide of a loved one. they are chosen as the case study for this paper as an example of taking a social issue and using advocacy to both raise awareness and demand attention and solutions from their city leaders and stakeholders, which is something that social workers do all the time. homicide in black communities in 2015, there were over 15,000 homicide-related deaths in the united states (us) (thompson & tapp, 2023). black communities, specifically, are disproportionately impacted by homicide violence (sharpe, 2015). the national homicide rate in 2010 was 2.92 per 100,000 for whites compared to 17.90 per 100,000 for blacks (thompson & tapp, 2023). moreover, homicide is the leading cause of death among black males ages 12-17 (johnson, 2014), who for the last 100 years have been more impacted by homicide than any other us racial group. homicide-related violence has far-reaching impacts, beyond the victims, their family members, and the broader community must bear the consequences (hernandez, mcdaniel & bradshaw, 2024; perez-sastre et al., 2024). for example, it is estimated that over 50% of urban youth have been exposed to community violence (borg, rabinak, & marusak, 2023; rajan et al., 2019; brady et al. 2008), which has been linked to a number of adverse health outcomes including post-traumatic stress disorder (ptsd; brady et al. 2008; buka et al., 2001; king, 1997; ozer & weinstein, 2004), and depression (smith et al., 2020; fitzpatrick et al., 2005; ozer & weinstein, 2004; overstreet, 2000). in boston specifically, the homicide rate was at its peak in 1991 with over 44,000 violent crimes and 243 murders reported that year (massachusetts crime rates, n.d.). since that point it has declined fairly steadily for the past 20 years. of note, boston is a city of neighborhoods, and the rate is not consistent across neighborhoods. between 2015 and 2024 most homicides in the city of boston occurred in the roxbury, dorchester, and mattapan neighborhoods (boston police department crime hub, 2024), which are all areas within which most residents are people of color. additionally, boston, despite its relatively low number of homicides, boasts the highest percentage of unsolved homicides nationally. over 1,000 homicides in the city between 1970 and 2016 remain unsolved (planas, 2015). this issue has gained national attention because of the huge impact it has had on families (sharpe, joe & taylor, 2013). with the majority of these unsolved homicides being black victims, this has created a lot of anger and frustration in black communities who are grappling with the murders of their loved ones. many of the individuals and families who wsohm work with have loved ones whose homicides are currently unsolved. their work aids in holding the boston police department accountable and coming up with actionable morris & martinez/women survivors of homicide 255 steps to decrease the high unsolved rate. the issue of unsolved homicides in boston disproportionately impacting black communities is highlighted in this paper because the wsohm specifically targeted this issue through the work their organization does. method a qualitative instrumental case study design, in which cases are selected to understand a specific issue (creswell, 2007; yin, 2008), was used to examine wsohm. this approach is common in social science research and focuses on the study of a case in a real-life, present-day setting (creswell, 2007). in this case, the strategies used by members of wsohm to improve police response to homicide and homicide survivors were explored. in addition, community change associated with wsohm strategies was examined. data included a document review, media scan and key informant interviews (creswell, 2007). an initial meeting was conducted with wsohm to explore the goals of the organization and determine primary media outlets as well as to gather key program documents. documents included organizational mission and vision statements. media sources included the boston herald, as well as the social media sites of wsohm including facebook and x, formerly twitter. first, a search was performed to identify media articles. the keywords “homicide,” “violence,” “unsolved,” and “murder” were used to search herald archives. once article titles were identified, they were reviewed with the founder of wsohm to determine their relevance. fulltext articles were then obtained from microfilm at the boston public library and stored on a secure server. second, the most recent facebook and x posts from the organization’s social media pages were downloaded and stored on a secure server. third, working with the director, videos about the organization were identified online and downloaded to a secure server. finally, a semistructured interview was conducted with the founder of wsohm at the organization’s headquarters to gather additional information about the organization such as the history, the mission, and the activities. this was a onetime interview that lasted for an hour and a half. this interview was considered one of the key informant interviews that is discussed in more detail below. the case was first analyzed, then specific parts of the case were assessed (creswell, 2007). a chronology of events and key themes were examined to explore the complexity of the case (creswell, 2007), a member of the research team coded the documents and met with a second researcher to process the themes and to develop a codebook. each data source was coded inductively, focusing on the data itself without preconceived categories (braun & clarke, 2006). the researcher read each document multiple times to immerse herself in the data, to search for meaningful patterns (braun & clarke, 2006), and to reflect on questions and reactions to the codes. using nvivo, text from each document was labeled with codes. the codes were sorted into possible themes based on the six strategies of change (braun & clarke, 2006). for this paper, three of those strategies will be focused on because those were the most relevant to the work that wsohm does. the themes were reviewed by the team to ensure the data within each was cohesive (braun & clarke, 2006). the larger story advances in social work, summer 2024, 24(2) 256 within the data was identified (braun & clarke, 2006), and key informant interviews were conducted with stakeholders (n=3) to further inform the narrative. key informant interviews were conducted with the wsohm founder, boston police department and boston herald representatives to contextualize themes that emerged during the document analysis and media scan. interviews were conducted in person at a location identified by the participant and lasted approximately 90 minutes. all interviews were recorded and transcribed. transcripts were then coded thematically using the same process that was used to analyze the documents (braun & clarke, 2006). a second researcher also coded the interviews to check for coding discrepancies. if any arose, the researchers discussed in a meeting and came to consensus about the final codes that would be used in analysis. themes from the interviews were used to contextualize the larger story within the data. in the final phase of analysis, the researchers selected illustrative quotes to produce a succinct, cogent story of the data within and across the identified themes from all of the data sources (braun & clarke, 2006). findings a total of 170 artifacts were collected and analyzed. as noted in table 1 artifacts included boston herald articles, facebook and x posts and videos featuring wsohm. additional documents included the organizational mission and vision as well as the organizational webpage. findings indicate wsohm employs multiple strategies and tactics such as mass mobilization and popular education to achieve its goals. the overall objective of wsohm is to bring attention to unsolved murders in boston and to ensure the survivors and victims are treated with dignity and respect. this organization is an example to the social work profession as to how to advocate for a particular issue and raise awareness about it to stakeholders effectively. table 1. types of artifacts examined type of wsohm artifact # analyzed for case study boston herald articles referencing them 50 facebook &twitter posts from their social media pages 100 videos featuring them 20 in the sections that follow we present an analysis of the wsohm, the strategies and tactics they have employed and their overall impact. women survivors of homicide movement (wsohm) founded in 2014, wsohm was launched by a local community leader ms. mary franklin whose passion for solving homicides is fueled by the tragic murder of her husband, melvin bernard franklin on october 15, 1996, in dorchester, ma. twenty-five years later, his murder remains unsolved. wsohm originated from a program called melvin’s mission, a day program (also founded by ms. franklin) that offered resources morris & martinez/women survivors of homicide 257 including a weekly support group for women survivors of homicide. at the time, melvin’s mission was the only available support group for women survivors, other community programs focused solely on mothers. ms. franklin, however, recognized the need for programs to support women survivors more broadly, such as daughters, spouses, aunts, grandmothers and friends. over time, it became clear that women survivors of homicide did not have a voice when it came to decisions related to the investigations of the homicides of their loved ones. in 2014, wsohm was founded to build capacity among women survivors to play a larger role in addressing unsolved murders, while healing from the trauma they have experienced. organizational structure and target wsohm does not have a formal membership structure, instead they have an opendoor policy in that all survivors are welcome to get involved. more importantly, if survivors feel they need a break, the door is always open for them to come back. currently there is a core group of ten active members who spearhead the group’s activities. these ten members are focused on building momentum around addressing the large numbers of unsolved homicides in boston for black victims by attending all wsohm sponsored events and demonstrations. wsoh focuses its efforts on multiple targets. internally, wsohm is focused on women of color in boston who have lost a loved one to murder. in the key informant interview with ms. franklin, she states that many of the women are very low income and experience structural barriers when it comes to accessing resources. she also notes that accessing needed resources can be further complicated by ptsd (often undiagnosed) that the women are living with. externally, wsohm is focused on systems change and creating the conditions that support women survivors as they seek justice. much of this work has been building relationships and serving as a bridge between law enforcement and families. as such, the external targets include homicide detectives and the assistant district attorney’s office. a third external target the wsohm has focused on is elected city officials. wsohm recognizes that politicians 1) play a significant role in what they refer to as the “epidemic” of unsolved murders, 2) have the power to pass laws, secure funding for program, initiatives and infrastructure and 3) can pass new legislation related to unsolved homicide. wsohm strategy in his seminal work six strategies for community change, checkoway (1995) outlines methods employed by action groups to catalyze change which include: mass mobilization, social action, citizen participation, public advocacy, popular education and local services. in order to enact these changes, communities and/or organizations are operating under the fact that politics have an influence on outcomes, final decisions are most likely in the hands of other people, and that in order to influence decisions that cause changes, they must adapt methods that are appropriate for the particular context (checkoway, 1995). our qualitative analysis of wsohm indicates that they are employing three of the six strategies: public advances in social work, summer 2024, 24(2) 258 advocacy, mass mobilization and popular education. these themes were the most salient in nvivo and will be described below. the primary strategy employed by wsohm is public advocacy which is both legislative and administrative. legislative advocacy has focused on educating the public, elected officials and their constituents about the impact of unsolved murders in the boston area. they strive to bring attention to the fact that there are thousands of unsolved murders dating back to 1970. in the key informant interview with ms. franklin, she stated that, they continue to keep this crisis in the forefront. they have done this in several ways. one way is through the use of media campaigns. they partnered with the massachusetts bay transportation authority (mbta) and launched a campaign that included posters placed in every train and bus in boston with messages about the impact of homicide in majority minority communities. this campaign was a major undertaking; however, it was difficult for them to measure impact due to the nature of individuals riding the train not being able to report their reaction to the posters. more importantly they advocated for legislative action designed to support women survivors and to reduce the rate of unsolved murders. meanwhile, administrative advocacy has targeted the local police department and district attorney’s office. this work has also included education, but more importantly has been focused on the revision of policies and procedures. in the case of the police department this work has focused on intake and follow-up procedures. a second strategy employed by wsohm is mass mobilization. this involves bringing together large numbers of people to work on an issue as well as engaging partners on all different levels to raise awareness and demand change. in the interview with ms. franklin, she stated that using mass mobilization, wsohm unites women survivors, as she believes that survivors, are every woman. they are wives, mothers, sisters, daughters, schoolteachers and preachers. wsohm uses social media to enhance their mobilization efforts. six years ago, they released a music video, “the circle we share,” which highlights that it is the responsibility of all people, not just black people, to ensure that the murders of black people are solved (boston herald, 2018). beyond mobilizing via social media, wsohm work through local non-profit organizations, city institutions, businesses in the black community and religious institutions. drawing in those impacted, in addition to supporters and stakeholders from across these multiple sectors, has helped wsohm to gain a great amount of support for their work in boston and beyond, shining a bright light on unsolved homicides nationwide. recently, ms. franklin, the founder of wsohm, was featured in the washington post. this article feature was expected to help her garner national visibility and additional support. however, to date, she has not received substantial financial support to be able to continue to advance her work on a larger scale. while people recognized that unsolved homicides and the cyclical violence in her neighborhood are a problem, no one individual or agency took the opportunity to offer her support. however, wsohm mobilization efforts together with their advocacy has provoked a reaction locally, which has led to a survivors’ room at the police station, a public response from elected officials related to unsolved homicides in the city, and new data collection strategies that allow survivors to update their family members’ files in real time. finally, wsohm has employed elements of popular education as a strategy for change. in order to get the community involved to support a particular issue, they need to morris & martinez/women survivors of homicide 259 be educated on the state of the problem, the historical background, and the progress that has been made to date. they then can decide how or whether they want to get involved. wsohm used small meetings to provide education on the issues around both homicide in black neighborhoods and the ways that people can get involved in advocating for their deceased loved ones. convening small groups of survivors, wsohm catalyzes dialogue among women on a topic, in which they are often encouraged to remain silent. as they come together and share their stories, the women learn from one another, critically examine their circumstance and confront the inequity embedded in their experience. for example, there was a meeting held at headquarters (ms. franklins’ apartment) with four women who have lost loved ones to murder in the past five years. the women received advice about how to interact with the detective assigned to their case and how to work with the newspaper to put information in an article to help witnesses come forward for a monetary reward. through this process of individual advocacy, women come to see structural factors or the root causes of circumstance that negatively impact their daily lives. collectively, as part of wsohm, they can begin to act, advocating for change. checkoway (1995) describes the aim of this process as “alter[ing] consciousness from conforming to reforming to transforming” (p. 12). wsohm provides a space for individual and community transformation. their other goal is to educate people about ptsd that survivors face and how it is under-diagnosed and not recognized enough amongst this population. the above strategies are aspects of community organizing, which enables the organization to achieve its goals. community organizing is a form of collective action through which individuals build a shared understanding of issues and seek to catalyze positive change within their communities (rubin & rubin, 2007). wsohm achievements since its beginnings in 2014, wsohm has made great strides with respect to their primary goals, which are to raise awareness about unsolved murders in boston and ensure that women survivors are treated with dignity and respect by law enforcement and local officials. the timeline seen in figure 1 highlights critical successes of the action group. in 2014, they implemented a survivor’s room located in a community center in one of the predominantly black neighborhoods in boston. the room is designed to be a calm space in the community where families of unsolved murders meet with their detectives. it is also located in the community where many of the survivors live, which makes it more convenient for travel purposes and is more familiar to community members. before the survivor’s room was established, families had to meet with detectives in interrogation rooms. for many, this was a traumatic experience because of the setup of the room and the location. this one-of-a-kind room was created with support from the boston police department, as the homicide detectives had to agree to come to the survivor room to meet with families. it is a significant step in the right direction for both catering to the needs of survivors and improving relationships between the black community and the police department in boston. odera et al./de-centering whiteness 260 figure 1. organizational timeline with women survivors of homicide movement achievements advances in social work, summer 2024, 24(2) 261 wsohm also focused on establishing a media presence in 2014, which led to the development of a partnership with the boston herald (herald). the herald is a local boston-based media outlet that has an online reach of millions and a paper market that extends to many new england area states (e.g., new hampshire and vermont). what started as a story about a passionate activist trying to bring awareness to unsolved murders of men of color in boston has led to strong support from the paper. the paper’s coverage of wsohm keeps the organization's mission at the forefront of community issues, serving as a reminder to organizational leaders and public officials. in addition, wsohm has established a giving back project where they offer financial support to survivors in the form of bill payment, groceries, cards for the train, and schools supplies for children. this program is funded by both the founder herself and community fundraisers that she has led over the years. in 2015, the organization successfully lobbied for funding to the suffolk county district attorney’s witness protection services to be tripled, moving the budget up significantly. the goal behind this action was to strengthen the relationship between the da’s office and the community. ms. franklin described how many of the cases can be solved because members of the community have information on the perpetrators, however they are afraid to come forward because of fear of retaliation. wsohm believed that if witnesses have a better experience, it might increase their trust and encourage them to give more accurate information concerning a case to the police, which will in turn help the unsolved rate decrease dramatically. another important success for the movement was the declaration of october 15th as “unsolved homicides awareness day” by boston mayor marty walsh in 2015. the goal of establishing the day was to shine a spotlight on the city’s high volume of cold cases, thereby increasing awareness of unsolved homicides in the broader community (planas, 2015). the day is commemorated by a flag raising ceremony where the mayor and other officials make remarks. there is also a public prayer vigil. this day is important because city leaders have pledged to take more direct action in dealing with both the high homicide rates in majority black neighborhoods and the high rates of unsolved homicide cases. being in solidarity with the community members gives them hope that issues will actually be dealt with. more recently, wsohm has focused their efforts on data collection practices at the boston police department. through their work with women survivors the movement discovered inaccuracies in police department data, (i.e., victims’ names spelled wrong and incorrect locations of deaths). this realization catalyzed their 2017 data initiative, the unsolved murders questionnaire (umq). umq is an online survey tool that allows survivors to update their loved ones’ case. serving as an intermediary, wsohm provides updated case information to the police department, which then updates official case records. in 2018 the movement aimed its efforts on community education related to unsolved homicide and ptsd. they partnered with the ashley stewart clothing store located in the roxbury area of boston in 2018. ashley stewart is a plus size modern women’s clothing store with locations all over the united states. together they hosted a fashion show event called “slay for justice.” in addition, they staffed an educational table in the store at which advances in social work, summer 2024, 24(2) 262 women were provided with both informational materials and community resources. at the event they collected data from women to explore the extent to which patrons were impacted by murder. they found that of the 200 black women who entered the store during the data collection period, 150 of them had been impacted by murder. over the last ten years the movement has made significant accomplishments drawing attention to unsolved homicides in boston and the impact of homicide on women survivors. in an effort to inform grassroots efforts and social work practice, we sought to examine tactics and strategies employed by the movement. discussion there have been a number of forces that have influenced the work of the movement, some posing challenges and others facilitating success. the passion of one homicide survivor sparked a movement to effect change in the way that unsolved murders of people of color are addressed in an urban community. a number of lessons can be learned through the examination of wsohm and the various successes and struggles they have had as an organization. one of their biggest successes has been leveraging the media in developing a strong relationship that has given wsohm a platform to raise awareness about both the issues of unsolved murders in boston and the needs of homicide survivors. since the inception of the movement in 2014, the herald has written over a hundred articles about the movement and the work they are doing. these range from smaller articles to a whole front page and a subsequent three-page spread highlighting the purpose of the organization and the work that they do. this amount of coverage has definitely raised awareness and additionally helps to hold elected officials and other entities (such as the boston police department) accountable to the demands that the movement has publicly made. by using this media outlet to raise awareness, it can help to build capacity for this small grassroots organization. capacity building can strengthen the infrastructure of smaller organizations with fewer resources. in a study of 125 grassroots organizations done by sobeck (2008), it was found that investments in building capacity can increase the success of smaller organizations. however, those efforts were more focused on operational funding, peer networking and technical assistance (sobeck, 2008). while wsohm was effective in raising awareness through their partnership with the herald, they may have been targeting the wrong audiences, as a different audience may have connected them to individuals or agencies that could have helped grow their organization. another huge success that the organization has had is their ability to develop relationships with key stakeholders, and then use those relationships to effect change with the issues that wsohm is passionate about. for example, ms. franklin has been very strategic about the people that she chooses to engage with for the sake of raising awareness about the issue of unsolved homicide in boston. she has developed a close relationship with the district attorney of suffolk county (the county in which boston is located) and had many meetings with him and other staff in his office. since developing this relationship, she was able to get them to approve an increase in the budget for the witness protection program. this direct example of impacting policy change is consistent with morris & martinez/women survivors of homicide 263 grassroots organizations and macro social workers who have the ability to be effective in advocating for social change (jackson-elmoore, 2005). many witnesses do not come forward when they have information because they are afraid of retaliation and do not feel that they will be provided with quality protection. an increase in witness protection funds will allow the office to provide better options to keep community members safe and prevent further violence. those who have information to solve the cases can help decrease the large number of open cases. secondly, ms. franklin has developed a relationship with the boston mayor and his office. this relationship has caused him to institute a “unsolved homicide awareness day” on october 15th, where a flag is raised at city hall to raise more awareness about the issue. the city holding a public rally and vigil in the downtown area makes a huge statement that this issue deserves attention from the top leadership. her relationship with the mayor also allows her to call the city out for not being more responsive and action oriented when it comes to trying to solve the murders that are still not. this relationship has provided direct support to her organization and its membership and has helped raise awareness in greater boston about the issues surrounding homicide. furthermore, by establishing an annual day, it shows that the leadership of the city feels unsolved homicides are an important enough issue to raise attention to. they have committed both personnel and money to making real change in the high number of unsolved homicides in boston. this is a direct example of advocacy to action that social workers can learn from. along with the many successes of the organization, there have also been challenges and lessons learned worth noting. one is the lack of support that the organization sometimes struggles with. most often the bulk of the work being done with the movement is by ms. franklin herself, or the same few women that she is able to mobilize. while having a leader in a grassroots organization who possesses some of the characteristics of a strong leader, such as being actively involved, having confidence, and being individually motivated, fisher (2013) says that is often not enough on its own to propel an organization forward. most of the events planned by the organization struggle to get the numbers they need to be able to make a statement to elected officials and other stakeholders that this is an issue they should care about. in the key informant interview with ms. franklin, she said that if she could get 100 women affected by homicide to stand with her, that could really make a statement she believes the lack of involvement from the communities who are affected by this issue is one of the reasons that there are still so many unsolved murders in boston. another issue that the organization has struggled with is sometimes having a lack of sufficient funds. many of the events and community outreach that the organization puts on are oftentimes funded out of the pocket of the founder. many of the organization’s community outreach events are paid for out of pocket by the founder. this group has struggled financially because they do not have the financial capital to get the widespread traction that they need. additionally, the office of the organization is a home office, in which ms. franklin has converted her one-bedroom apartment into a space that functions as the “headquarters.” the financial limitations of the organization make it hard to both hold larger events and make a substantial impact in helping survivors in the community with what they have need of. for example, if the homicide victim was the primary income advances in social work, summer 2024, 24(2) 264 earner in the home and that income is now lost, the remaining family members may need immediate financial support to hold them over until other arrangements can be made. this is the type of support that ms. franklin would like to be able to provide, but her small grassroots effort does not have the resources to do so. these financial issues that wsohm faced are consistent with other grassroots organizations, as many of them are doing critical work in the community, but struggle to gain access to the financial capital they need to do the work on the scale it is needed (aydin, 2022; dana et al., 2021; flores & samuel, 2019; jumaagaya, 2021; sobeck et al., 2007). finally, this organization has learned that to hold city officials and key stakeholders accountable on community issues, it sometimes must take drastic measures that will be risky to embark on. when members of the organization staged a protest in the mayor’s office, it lasted for many days and required members to sleep in the office, which brought police presence. however, they did not waver in their efforts, even though it posed a risk to their safety and freedom. they learned that if you are passionate about something, you have to put effort into convincing others to care. what this organization has done over the years serves as an example to the macro social work world of how to advocate for change on an issue that heavily impacts the community on multiple levels. it represents the fact that advocacy work can be long and hard but making small steps towards a larger goal overtime can help keep momentum and in the long run facilitate systems changes, which is one crucial thing that social workers strive to do. limitations this analysis is not without limitations and one of those is the scope. this study only interviewed the founder and a few entities that have worked with the organization. further study on this organization would include interviews with more of the members or women who have been involved with the organization at some point in time. interviewing more parties would increase the view from which this study discusses the organization. another limitation is that all artifacts that were gathered were the ones that could be found. there were some newspaper articles and videos that could not be located due to the date they were originally published. conclusions and implications for social work the story of wsohm highlights the important ways in which community members can challenge systems to catalyze change. it is often the case that systems are not designed with input from impacted populations that they are serving, as such well-intended individuals can do harm. grassroots efforts like wsohm are critical for systemic change. the wsohm represents an example of an organization that was started by a community member whose loved one's homicide is unsolved, and her work has made substantial changes to the way homicides are investigated in boston and has raised awareness on the issues for those dealing with the aftermath of homicide in these communities. social workers should work to partner with organizations such as this one to provide clinical and financial support that will continue to advance the work still needed to be done to eradicate homicide in black urban neighborhoods in the united states. morris & martinez/women survivors of homicide 265 the case of wsohm has important implications for social workers, who are well poised to engage with grassroots leaders such as wsohm to advance change. organizations such as this one are poised to work together with macro social workers, who in recent years have a call to assert themselves more in the work they are doing in the community (sousa et al., 2019). social workers can support such efforts through community practice partnerships. for example, social work clinicians are trained to support individuals suffering from the aftereffects of trauma experiences, such as the development of ptsd symptoms. the members of wsohm are in desperate need of culturally aware clinical support, and clinicians could partner with this organization to provide resources in a variety of ways, such as individual counseling and support groups. in addition, social workers are well poised to bridge institutions and grassroots efforts to advance changes that community members would like to see. moreover, social workers can advocate for the inclusions of impacted groups and residents in the design of programs and policies as well as for the reallocation of law enforcement funding to a grassroots community program that support community well-being and healing. wsohm represents an organization that advocates for a marginalized population, which is in line with the mission of the social work profession. this organization would benefit from partnering with social workers because they can help develop programming that will meet the needs of the individuals and families receiving services. social workers can assess the strengths and needs of the community, identify areas for improvement, and develop strategies to improve the condition of the community. there are many social work institutions that have existing partnerships with entities such as the police department and criminal justice system, placing them in a good position to be a bridge between community and stakeholder. by improving the relationship between the two, real change can be made, and the issue of cyclical community 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(2008). case study research: design and methods (4th ed., vol. 5). sage. author note: address correspondence to kendall morris, school of social work, michigan state university, east lansing, mi, 48824. email: morri937@msu.edu https://doi.org/10.1080/10437797.2019.1656686 https://doi.org/10.1080/10437797.2019.1656686 https://doi.org/10.1080/10437797.2019.1656686 https://bjs.ojp.gov/violent-victimization-race-or-hispanic-origin-2008-2021 https://bjs.ojp.gov/violent-victimization-race-or-hispanic-origin-2008-2021 mailto:morri937@msu.edu _________ karen randolph, phd, evaluator, florida institute for child welfare, college of social work, don latham, phd, professor, and melissa gross, phd, professor, school of information, and christopher constantino, phd, assistant professor, school of communication science and disorders, college of communication and information, florida state university, tallahassee, fl. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 916-935. doi: 10.18060/25651 this work is licensed under a creative commons attribution 4.0 international license. information communication technology and the social worker-client relationship: lessons from communication theory karen randolph don latham melissa gross christopher constantino abstract: a core value in social work is the importance of the worker-client relationship. communication is a key factor in this relationship. the pandemic, marked by a dramatic, rapid increase in communication through information communication technology (ict), has underscored both challenges and benefits for the worker-client relationship. informed by communication theories, this paper provides a conceptual framework for examining ict interactions between workers and clients at the generalist practice level. the review revealed four challenges (e.g., more permeable worker-client boundaries) and five benefits (e.g., increased opportunities for social presence). factors to be considered in guiding tool selection are: (1) communication medium “bandwidth”, (2) mutual directionality, (3) privacy and confidentiality, (4) message formality, and (5) complexity of message content. implications for practice, education, and research emerged from this framework. for instance, increased methods of communication via technology can enhance social workers’ social presence in relating to clients. however, social workers must know how and when to use which tools. finally, evidence is needed regarding how ict use affects the workerclient relationship. moving forward, we recommend applying communication theories to guide research on the impact of ict on the worker-client relationship with the goal of establishing best practices for ict use. keywords: communication; generalist practice; pandemic; social worker-client relationship; technology social work is a relationship-based profession. the importance of the human relationship is a core value of the profession (murray, 2021; national association of social workers, 2017). social workers seek to build and maintain relationships with clients as partners in the helping process. this relationship is critical in providing a sense of connection and serving as the “communication bridge” (kadushin & kadushin, 1997) or vehicle through which clients and social workers develop the client’s plan of change. clients seek relationships with social workers to help them confront and work through difficult issues (bryan et al., 2016). the social worker-client relationship provides the foundation for successful outcomes and, in many cases, is the most important aspect of the change process (falkenstrom et al., 2014; rollins, 2020). as trevithick (2012) observes, “the quality of the interaction and the trust and understanding that are held within the relationship can act as a vital thread toward achieving results” (p. 13). an important feature of the social worker-client relationship is the social worker’s ability to communicate. social workers’ primary responsibilities and activities involve about:blank randolph et al./technology & swker-client relationship 917 communication in some form or another. communication is a foundational skill in engaging, building, and maintaining the relationship at the generalist practice level and is the basis of all client-based interactions throughout the change process. communication can be categorized into three types—verbal, non-verbal, and fixed format (e.g., text, images). verbal communication involves transmitting information orally via words. in this context, listening is an important component of verbal communication. non-verbal communication is the process of conveying messages through body language such as facial expressions, posture, hand gestures, eye contact, and voice tone. this can be more subtle than verbal communication. since culture and context are crucial in understanding non-verbal messages, they can be easily misinterpreted. fixed format communication involves information exchange in a way that creates an artifact and may include text or images. while verbal communication is immediate, communication in fixed format often involves a time delay in sending and receiving messages. thus, fixed format communication can be considered more formal than verbal communication, partly because fixed format exchanges can become permanent records. the 2020 pandemic completely transformed how social workers and clients communicated with one another (conrad & magsamen-conrad, 2022). due to the need for physical distancing, new modes of communication as well as different ways to use existing communication tools became paramount, with a focus on the use of electronic forms of communication (funk, 2021; goldberg et al., 2021). this communication process is referred to as electronically-mediated communication and is defined as: ….any type of communication that occurs between two or more people and is made possible through the use of electronic devices, such as (cell) phones, pagers, computers, etc. it follows that electronically mediated interpersonal communication is what results when the same devices are utilized in creating and maintaining an interpersonal relationship. (păstae, 2016, p. 178) rather than in-person and paper-based modes of message exchange, electronicallymediated communication occurs via the use of information communication technology (ict) tools (i.e., email, text messaging, social media, and video conferencing) through the internet. these tools provide opportunities for verbal, non-verbal, and fixed format (e.g., text-based, photos) exchange between social workers and clients in both real-time (i.e., synchronous) and delayed (i.e., asynchronous) processes. given the importance of communication in the social worker-client relationship, particularly during the pandemic, understanding how electronically-mediated communication via the use of icts has affected this relationship is paramount. the use of icts presents challenges in the communication process between social workers and clients. for instance, some forms of electronically-mediated communication (e.g., email) lack non-verbal cues to help with monitoring the mutual understanding of the exchanges. this can lead to misinterpretation, which, if left uncorrected, can harm the developing relationship (mishna et al., 2012). further, the “24/7” context within which electronic communication occurs as well as the ubiquitous nature of social media presents an ethical dilemma about professional boundaries between social workers and clients (reamer, 2015). another ethical dilemma faced by social workers is manifested in the advances in social work, fall 2022, 22(3) 918 tension between agency expectations about use of technology and “good practice.” for instance, the use of certain types of technology (e.g., email or text messaging) may hinder information gathering and interfere with rapport-building during the assessment phase. yet, social workers are increasingly expected to incorporate ict tools to complete assessments. electronically-mediated communication also offers opportunities to enhance the worker-client relationship (e.g., dienger, 2019). the use of ict can strengthen the relationship (mishna et al., 2012) by serving as a vehicle for connection in new and different ways (e.g., text messaging) and providing opportunities for more frequent interactions (mishna et al., 2014). some electronic tools (e.g., text messaging) may provide more efficient and effective ways to communicate by increasing the availability, timing, and extent of worker-client interactions (berzin et al., 2015; nesmith, 2018). further, the impact of ict use on relationship boundaries can prompt a re-conceptualization of the role of the social worker as “builder” or “facilitator” of multifaceted service structures in a virtual environment, thus expanding networks of support for clients who are often isolated (berzin et al., 2015). finally, because ict has become so ubiquitous in society, social workers have a professional obligation to build their ict skills in order to work successfully within this dimension of the client’s environment (hitchcock et al., 2019). what impact is the pandemic having on these opportunities? in this paper, we propose a conceptual framework for conducting theoreticallyinformed investigations that ict presents to the social worker-client relationship within a generalist practice context. our inquiry includes a review of emerging knowledge about ict interactions between social workers and clients during the pandemic. while others have examined the therapist-client relationship via e-therapy (e.g., markowitz et al., 2021), our interest is on foundational communication skills in the relationship between social workers and clients via ict. first, we present theoretical support for relationship development in an online environment via social information processing (sip) theory (walther, 1992). we then examine research on the benefits and challenges of electronically-mediated communication on social worker-client relationships, including studies conducted during the pandemic. third, we consider five keys factors— communication medium, mutual directionality, privacy and confidentiality, formality, and information complexity—to guide a critical evaluation and selection of particular tools for particular purposes. the paper concludes with a presentation of the implications for social work practice, education, and research. the social work relationship in the digital age without question, particularly during the pandemic, electronically-mediated communication has fundamentally altered the interactional aspects of relationships in social work. this transformation presents challenges and benefits to the worker-client relationship. to more fully understand its implications, examining the theoretical foundation of relationship development in an online environment is useful. in this section, we review theory that supports electronically-mediated relationship development, identify the basic features of the social worker-client relationship at the generalist level, and then randolph et al./technology & swker-client relationship 919 examine current knowledge about the challenges and benefits of ict use on the social work relationship. electronically-mediated relationships: a social information processing perspective there is theoretical support for relationship development in an online environment. one of the most well-known theories in this regard is the social information processing (sip) theory. this theory was developed by walther in 1992 to explain how relationships develop via computer-mediated communication (cmc). at the time, the prevailing belief was that cmc impedes the development of relationships, as posited by cues-filtered-out theories (e.g., media richness theory [daft & lengel, 1984]; social presence theory [short et al., 1976]). this idea was based on the premise that the lack of access to nonverbal cues in cmc served as a barrier to relationship development. walther (1992) refuted this premise and posited that people can develop relationships in an online environment. his argument was based on two factors. first, conclusions about cues-filtered-out theories were based on cross-sectional studies that did not account for the development of social presence, social context, and relational qualities over time. also, cues-filtered-out research did not recognize the adaptation processes engaged in by cmc users to make up for the lack of non-verbal cues in online communication. social information processing theory is based on two major assumptions. first, while cmc lacks the nonverbal cues that accompany in-person interactions, the notion that this impedes relationship development is rejected. walther (1992) posits that cmc users are motivated to develop online relationships, just as they are in in-person interactions. as a result, cmc users adapt to and use tools that are available in the online environment— language and interaction frequency and timing—to create relationships. the second assumption is that, due to the lack of nonverbal cues in an online environment, it takes longer to develop relationships that are similar to in-person relationships. in essence, cmc users get less information than what is available in in-person interactions and thus find ways to compensate for this difference. support for the sip theory is strong and wide-ranging (e.g., sumner & ramirez, 2017). in fact, in one study, researchers found that people shared more personal information in an on-line environment compared to face-to-face interactions (tidwell & walther, 2002). thus, as helton (2003) suggests, given the evidence presented by walther and others about the ability to develop online relationships that are similar to in-person relationships, a reasonable conclusion is that a worker-client bond is entirely possible in the virtual environment. basic features of the social worker-client relationship at the generalist practice level the relationship between social workers and their clients is professional and exists solely to attain client-based outcomes. thus, some features vary depending on the needs of particular clients at any given point during the helping process (proctor, 1982). advances in social work, fall 2022, 22(3) 920 nonetheless, davidson (2005) identifies the following as basic features that are generally present in most social worker-client relationships at the generalist practice level: • the relationship is based on the client’s needs, not those of the social worker. its purpose is to promote positive change in the client. • the relationship is based on a power imbalance due to the social worker’s authority, knowledge, influence, and access to privileged information about the client. also, the social worker is remunerated to provide services. • because the focus is on achieving client outcomes, the relationship is timelimited (p. 529) • the social worker is responsible for establishing and maintaining professional boundaries, regardless of the client’s boundaries. challenges to the relationship information communication technology brings with it many challenges to the workerclient relationship. four major challenges are presented in table 1 and are described in detail below. table 1. ict and the social worker-client relationship: challenges, benefits, and selection factors challenges benefits selection factors worker-client boundaries • increased methods of communication • communication medium bandwidth technological competence and digital literacy • ease and efficiency • mutual directionality use of ict for surveillance • increased opportunities for social presence • confidentiality and privacy communication misunderstandings in messaging • fixed record of communication • responsiveness to client preferences • formality of the interchange • complexity of the message content boundaries one of the most pressing challenges in cmc is the impact of ict use on the professional boundaries of the worker-client relationship concerning how workers can navigate this in a way that sustains the relationship. the relationship between the social worker and the client is defined by boundaries. establishing and managing clear professional boundaries with clients is a basic social work skill (trevithick, 2012). professional boundaries are the limits or parameters within which the worker and the client interact with one another. the intention is to establish and maintain roles and interactional patterns within the relationship that will meet the client’s needs. these boundaries are often key to successful client outcomes. boundary issues occur when the worker-client relationship expands beyond its purpose of facilitating client change, resulting in dual or multiple relationships between the worker randolph et al./technology & swker-client relationship 921 and client (e.g., friend, teacher; reamer, 2003). dual or multiple relationships become a conflict of interest for the social worker. regardless of the type of relationship that evolves, the power differential between the worker and the client remains. interactions outside of the professional relationship can compromise the client’s interests (kagle & giebelhausen, 1994). the online environment can present challenges to worker-client boundaries beyond what has been traditionally understood. lines of communication are more permeable in an online environment, and clear expectations about availability, timing, and intensity of professional interactions in this virtual world have not been settled. these permeable boundaries can lead to what davidson (2005) calls “professional boundary grey zones” in which “boundaries with clients can be difficult to identify, yet easy to cross” (p. 511). reamer (2015) identifies several dilemmas that social workers may confront related to boundaries in an online environment. communication via email, text messaging, or other venues outside of normal business hours may reduce the perception of the professional nature of the relationship and become confusing for the client. requests from clients to be social network “friends” can also lead to boundary blur about the professional nature of the relationship. finally, for those social workers who maintain a personal social networking site, clients can learn personal information about the social worker which may complicate professional interactions. as reported by misha and colleagues (2020), the pandemic exacerbated the workerclient boundary issues in the online environment. for instance, with the inability to see clients in person due to lockdowns, workers were immediately confronted with two competing ethical issues on how to continue providing services (barsky, 2020). on the one hand, social workers are to maintain professional boundaries; on the other hand, social workers are not to abandon clients in need. further complicating this tension is the nasw core value of service. workers reported increased difficulties in retaining pre-covid boundaries with clients (mishna et al., 2020). examples include the use of electronic communication with clients via email or text messaging outside of traditional work hours and/or providing personal cell numbers to clients. workers also reported that, in response, some clients had difficulty understanding workers’ not responding 24/7. technological competence and digital literacy professional competence is a core value of the social work profession. in this context, it is examined across two dimensions—technological competence and digital literacy. technological competence involves developing and maintaining skills in the use of various electronic tools (perron et al., 2010). the types of electronic tools entering the market are growing rapidly. a concerted effort is needed to stay informed about new tools that become available. workers are obligated to develop and maintain the knowledge and skills required to claim technological competence as it interfaces with the social work relationship. with the pandemic came challenges in meeting the ethical standard of professional competence related to ict use (barsky, 2020). due to the inability to see clients in person, workers were immediately confronted with the need to figure out different ways to maintain contact so as not to abandon clients and adhere to the professional value of advances in social work, fall 2022, 22(3) 922 service. online communication tools became the obvious choice. however, some workers were not trained in the use of tools such as video conferencing. this created an ethical dilemma that had to be resolved quickly. at the agency level, the availability of online tools became a resource issue for managers to ensure that these tools were available to workers. also, managers were faced with developing policies on the acceptable use of these tools. finally, workers had to ensure that clients had access to these tools (funk, 2021). beyond simply knowing how to use electronic tools, perron and colleagues (2010) recommend that social workers become digitally literate. the american library association digital literacy task force’s (as cited by heitin, 2016) defines digital literacy as “the ability to use information and communication technologies to find, evaluate, create, and communicate information, requiring both cognitive [emphasis added] and technical skills” (para. 4). social workers must not only know how to use electronic tools, but also be able to critically assess which tools to use under what circumstances in order to communicate most effectively, particularly as it affects the worker-client relationship. digital literacy has implications at the macro level in terms of worker cultural competence. given that ict has become a central part of the culture, worker cultural competence must include adapting to changes in cultural norms brought about in response to the digital age (smyth, 2010). as such, the call to cultural competence in the digital age goes beyond just knowing how to use the tools. as hitchcock and colleagues (2019) observe: one cannot be considered culturally competent without understanding the digital environment. social workers must become digitally literate to stay culturally competent; it is vital that social workers understand digital technologies so that clients’ environments can also be understood. and digital technologies need to be understood deeply enough that social workers can help clients navigate the challenges in their worlds. (p. 33) surveillance a third challenge related to the use of ict on the social worker-client relationship is the increased surveillance capabilities that social media-related technology offers. tools such as facebook can be used by social workers to search for clients and vice versa. in this case, transparency is critical in terms of disclosure to clients about both the use of social media for information gathering and how this information will be used. further, the use of social media for surveillance highlights the tension between care and control as a dimension of the power imbalance in the worker-client relationship (byrne et al., 2019). message misunderstanding a final challenge of ict use in relation to the worker-client relationship is the potential damage that message misunderstandings can cause. as reder and duncan (2003) observe, “monitoring of mutual understanding is more readily accomplished during direct conversations. indirect and non-face-to-face communications [e.g., text messaging] introduce additional complexities” (p. 88). electronic communication, particularly with randolph et al./technology & swker-client relationship 923 asynchronous tools, may result in lack of clarity about the message’s intent and misinterpretation of the intended meaning (byrne & kirwan, 2019). this can harm the relationship, especially early on. however, as ict-based exchanges increase over time, misinterpretation challenges are likely to diminish due to knowledge-building experiences between the communication partners (carlson & zmud, 1999). benefits to the relationship clearly, the use of ict presents challenges to the social worker-client relationship. however, there are also benefits (see table 1). research on the impact of technology in interpersonal relationships suggests that the use of ict can enhance interactions (tidwell & walther, 2002) through different methods of interchange (tregeagle & darcy, 2008). while more needs to be done to strengthen this evidence, several benefits to the workerclient relationship can be experienced. methods of communication one major benefit of electronic communication as it relates to the worker-client relationship is simply the number of additional ways to communicate beyond in-person and telephone methods. with electronic tools comes the opportunity for increased communication in new ways. in their study about client views on relationship-based social work, simpson (2017) reported that participant clients believed that social workers need to use a variety of communication methods, including ict. during the pandemic, ict options were expanded and new ict practices (e.g., use of personal cellphones for phone calls or texting; video-conferencing; formal use of email) were quickly adopted so that workers could stay in contact with clients (markowitz et al., 2021; mishna et al., 2020). for instance, in one study, workers reported replacing in-person contact with conferencing, phone work, email, and text messaging as mechanisms for service provision (mishna et al., 2020). having more methods of communication aligns with the core social work value of maintaining the best interests of clients as a priority and not abandoning them in their time of need. ease and efficiency some social workers report increased ease and efficiency in communicating electronically (byrne & kirwan, 2019). using one’s mobile phone to send a text message or email, or to make a call while out of the office is easier and more time-efficient (rettie, 2008). in particular, the use of text messaging may result in more immediate responses compared to email or phone messages (berzin et al., 2015). this sentiment was recently echoed by social workers who adopted icts during the pandemic (cook & zschomler, 2020). quicker response times, especially from workers to clients, may help to build a sense of availability and trust in the relationship. advances in social work, fall 2022, 22(3) 924 social presence building on the benefits of quicker response times, other features of some ict tools (particularly text messaging) can result in (1) increased availability of both worker and client to one another (mishna et al., 2014), (2) increased frequency of communication (berzin et al., 2015), and (3) increased flow of interactions (byrne & kirwan, 2019). these features can serve to strengthen the sense of connection, referred to as “social presence” in online interactions (e.g., lamendola, 2010). social presence is defined as “the degree to which a person is perceived to be a ‘real person’ in their computer-mediated communication or virtual environments” (bickle et al., 2019, p. 383; gunawardena, 1995, p. 151). social presence as a theory was developed before the internet, based on communication methods available at the time (short et al., 1976). scholars have since used this theory to untangle the nuances of interpersonal relationships in an online environment (e.g., rettie, 2008). evidence suggests that social presence, or the sense of connection in electronically-mediated communication, can strengthen relationships (rettie, 2008), including the worker-client relationship (simpson, 2017). the sense of connection, or social presence, via ict has been reported during the pandemic. cook and zschomler (2020, p. 403) found that workers engaged in what they referred to as the “little and often” approach—frequent electronic contact of short duration. the workers reported that families were amenable to this approach. in fact, workers noted an enhanced closeness in relationships with families due to workers’ increased knowledge of families’ day-to-day lives. according to mishna et al. (2020), the use of video conferencing in particular enhanced feelings of intimacy due to being able to see each other’s homes. mitchell (2020) reported similar findings and suggested that this may reflect a shift in the power balance between workers and clients due to workers being in their own homes rather than in an office. fixed format another benefit of some forms of ict (e.g., email, text messaging) is that they provide a fixed record of communication between workers and clients in a way that can be easily accessed and reviewed after the exchange. fixed formats allow both clients and workers to revisit the text and more fully reflect upon the messages rather than rely on the memory of a verbal interaction. this can reinforce and enhance feelings of support and social presence for the client. further, some evidence indicates that fixed format messages may result in increased client openness to address issues that are difficult to discuss in person. clients seem to have an easier time sharing difficult information via text or instant messaging, rather than in person (cook & zschomler, 2020). responsiveness to client preferences one of the most important practice tenets in social work is to start where the client is. as such, some clients may prefer or require electronically-mediated communication as opposed to more traditional methods (mishna et al., 2012); thus, workers need to respond accordingly. for instance, as early adopters in the use of technology, many young people randolph et al./technology & swker-client relationship 925 prefer communication by electronic methods (mishna et al., 2012). they may be less likely to respond to more traditional methods such as telephone and even email (schelbe et al., 2018). tregeagle and darcy (2008) expand on the notion of client preference by speculating that replacing “paper-based technology” with “an interactive web page” may increase client engagement (pp. 1487-1488). such approaches could enhance the workerclient relationship. evidence generated during the pandemic supports this premise. in one study, workers observed that many clients, particularly adolescents, preferred to interact virtually (cook & zschomler, 2020). in this same study, workers also noted improved participation among young people during virtual family meetings and case reviews. cook and zschomler (2020) speculate that, because of their technological expertise, this “altered the power dynamics within meetings” for young people, perhaps leading to increased self-confidence and engagement (p. 4). one of the major themes of the study conducted by mishna and colleagues (2020) was that workers took a client-driven approach in selecting particular icts. icts were selected based on the unique needs and preferences of clients. to support this approach, agency leaders became more flexible toward worker ict selection and encouraged them to honor client preferences. key factors in selecting communication tools effective electronically-based communication requires digital literacy—knowing which ict tools to use under what circumstances (cook & zschomler, 2020; mishna et al., 2020). as such, social workers must understand the nuances or key features of the various tools, critically evaluate the type of communication that is needed to best get the message across to the client, and then select the tool or set of tools that help accomplish this. in making these decisions, at least five factors should be considered—1) the “bandwidth” of particular communication mediums, 2) the need for interchange (i.e., mutual directionality) with the client, 3) the confidential nature of the message such that privacy is paramount, 4) the level of formality of the interchange, and 5) the complexity of the message content. these factors are supported in part by research guided by electronic propinquity theory (ept; korzenny, 1978; walter & bazarova, 2008). a key concept of the ept is propinquity, or psychological closeness between the sender and the receiver. ept is based on the premise that it is possible to experience psychological closeness in an online environment, similar in nature to physical closeness via proximity of in-person interactions. communication medium bandwidth a communication medium is the means by which information is exchanged between the parties engaged in the communication process. in this context, a communication medium’s bandwidth is the number of cue systems (e.g., verbal, non-verbal, fixed format [i.e., text or images]) that it supports. communication mediums vary in their bandwidth, differentially affecting the exchange. generally, the greater the bandwidth, the stronger the propinquity between the sender and receiver (walter & bazarova, 2008). in making decisions about which ict to use based on a medium’s bandwidth, the extent to which the advances in social work, fall 2022, 22(3) 926 communication exchange would benefit from opportunities for propinquity should be considered. for instance, at the point when the worker-client relationship is just starting to develop, the use of a communication medium with high bandwidth and thus greater opportunities for propinquity is called for (cook & zschomler, 2020; mitchell, 2020). mutual directionality another feature to consider in ict tool selection is whether a tool allows for mutual directionality, or synchronous exchanges between the worker and the client. mutual directionality has been shown to increase propinquity (walter & bazarova, 2008). synchronous icts (e.g., video conferencing) offer exchanges that are simultaneous, occurring in real-time, and provide opportunities for immediate feedback. asynchronous tools such as email do not provide opportunities for mutual directionality. in determining the need for mutual directionality in the communication process, workers should evaluate whether simultaneous interaction and feedback with the client is important. for instance, if the intent of the communication is to simply inform a client of an appointment, this does not require mutual directionality. using an electronic written communication tool such as a text message can suffice. privacy and confidentiality a third feature in tool selection is the sensitivity or the level of privacy of the information to be shared. ensuring a client’s right to privacy and confidentiality is part of the nasw code of ethics. if the information is sensitive such that it should be private, then workers should select a tool that offers privacy and confidentiality. for instance, if the content is sensitive, then communication through social media such as facebook is contraindicated. as an example, a major concern that has emerged among social workers during the pandemic is being able to protect clients’ confidentiality and privacy during video conference meetings in their own homes since others in the home may be able to hear the exchange (cook & zschomler, 2020; mishna et al., 2020). level of formality the level of formality of the message is a fourth factor to consider in selecting the most appropriate tool. questions to ask are, “how official is the communication?” and “does this exchange need to be part of a client’s permanent record?” if the content to be shared is formal and/or part of a client’s permanent record, then a fixed format electronic communication tool is the most appropriate choice here. for instance, if the purpose of the exchange is to share the results of a psychological examination (which is a formal report that is part of the client’s permanent record), an email message sent via a secure server would serve this purpose. randolph et al./technology & swker-client relationship 927 information complexity finally, the complexity of the information to be shared is an important consideration in ict tool section. sharing complex information is negatively related to propinquity such that the exchange of less complex information increases propinquity (walter & bazarova, 2008). thus, this should be considered when the exchange of complex information is intended. if the information to be shared is complex, it might be useful to select a communication medium with greater bandwidth (e.g., video conferencing). discussion the availability of electronic technology, especially during the pandemic, has transformed how social workers and clients communicate with one another. not surprisingly, this comes with many challenges in building and maintaining the social worker-client relationship. however, the use of icts can also benefit the relationship. factors such as increased communication methods, ease and efficiency in communication, and social presence can have a positive impact on the relationship. further, the availability of documented exchanges via fixed format and responsiveness to client preferences can positively impact the relationship. as emerging pandemic-related evidence suggests (cook & zschomler, 2020; mishna et al., 2020), thoughtful and strategic selection of icts as it affects the worker-client relationship is paramount. as such, five factors should be considered—a communication medium’s bandwidth, allowable mutual directionality, the level of privacy afforded by a tool, the level of formality, and the complexity of the information being exchanged. implications for social work practice social presence. information communication technology has significant implications for social work practice—the use of ict can clearly enhance the worker-client relationship. for instance, the use of ict has been shown to increase the worker’s social presence in the client’s world as a result of increased opportunities for interaction through both synchronous and asynchronous methods of communication (e.g., cook & zschomler, 2020; mishna et al., 2020; mitchell, 2020). importantly, barsky (2020) notes that use of ict during the pandemic aligns ethically with not abandoning clients. some interactions call for synchronous communication methods (e.g., when presence is needed); asynchronous ict methods (e.g., text messaging) can be used to enhance other aspects of social presence (e.g., being available and accessible). hill and shaw (2011) advocate for a practice-led technology approach that is client-friendly. further, beresford and colleagues (2008) found that clients seek relationships with workers who are perceived as reliable, available, and accessible, and that they preferred workers to use both traditional and virtual communication methods. asynchronous ict methods (e.g., text messaging) can be used to enhance these client perceptions. finally, the use of an electronic case management software system to manage paperwork can have an indirect positive impact on social presence by reducing time spent on paperwork, freeing up time for worker-client interactions (dienger, 2019). advances in social work, fall 2022, 22(3) 928 boundaries. increased social presence has implications for worker-client boundaries because these new methods of communication are easily available any time of day. thus, providing services via electronic communication methods calls for a realignment of worker-client boundaries. setting boundaries with clients early on in the relationship is still of the utmost importance. boundaries serve to avoid conflicts of interest and possible exploitation (reamer, 2003). further, as misha et al. (2014) observe, workers need to protect their time away from work and to practice self-care. however, o’leary et al., (2013) note that worker-client boundaries have been traditionally defined using a separation lens—separating the worker from the client. they propose conceptualizing the worker-client boundaries in a way that embraces electronic technology. they argue for more open and flexible boundaries that promote worker-client connection “rather than separation and professional distance” (p. 143). this idea aligns with clients’ desire for workers to have more flexible professional boundaries (beresford et al., 2008). emerging lessons from the pandemic include: 1) the use of risk reduction strategies if it becomes necessary to use personal devices to communicate with clients (barsky, 2020), 2) establishing electronic communication protocol at the beginning of the relationship, and 3) not compromising on self-care (e.g., turning phones off) as needed (mishna et al., 2020). surveillance. another implication of ict use on the worker-client relationship is when ict is used for surveillance. in this context, surveillance typically occurs via online searching activities through social media (e.g., facebook). surveillance can be reciprocal with the worker conducting online searches of the client or the client conducting online searches of the worker. if searches are done without prior informed consent, this violates one of the nasw code to ethics’ principles (i.e., s.1.03) and can harm trust within the relationship. from the client’s perspective, surveillance may highlight the power imbalance in the relationship (la rose, 2019). also, online searching used for assessment may result in erroneous conclusions about the client (e.g., byrne & kirwan, 2019), particularly if this information is not verified. social justice. finally, ict has implications for social justice in social work practice. on the positive side, the use of ict in worker-client interactions may redistribute power in the relationship by fostering client empowerment through increased mechanisms in which clients can initiate contact with workers (parrott & madoc-jones, 2008; tregeagle & darcy, 2008). further, ict use among clients in worker-client interactions may reflect clients’ increased engagement in their own well-being (mishna et al., 2014). however, social workers need to account for social justice issues created by the digital divide, such as equal access to ict (e.g., mobile phones) and a reliable internet connection, particularly for clients living in rural environments (conrad & magsamen-conrad, 2022; funk, 2021). in their studies on worker experiences in the pandemic, a major theme reported by both mishna et al. (2020) and cook and zschomler (2020) was increased awareness among workers regarding lack of access to a reliable internet connection. implications for social work education information communication technology also has significant implications for social work education in both preparing the next generation of social workers and facilitating ict randolph et al./technology & swker-client relationship 929 skill development among current practitioners. social work education in the technological era presents a unique opportunity for training students and others in the use of an expanded repertoire of practice tools, coupling in-person and telephone strategies with virtual strategies to enhance the social worker-client relationship. from an ethical perspective and to ensure cultural competence, both students and practitioners have a professional obligation to not only develop ict skills, but also remain current on the effective use of new tools as they become available. recognizing the need to develop technology skills, opportunities have begun to emerge. for example, the indiana university school of social work now offers technology-oriented training geared toward practice with clients in remote areas, as well as a free introductory course entitled, "telebehavioral practice basics for social work educators and clinicians responding to covid-19" (indiana university school of social work, n.d.). however, this raises issues about learning how to use these new tools effectively to get desired outcomes. as wolf and goldkind (2016) state, “the goal of technology-infused pedagogy is to foster professionals who can critically assess ict tools and strategies and match the necessary tool to the task” (p. s102). the nuances and complexities of electronic tools need to be accounted for. not only must students know how to use tools, they must also know when to use them. they must know which tools to use under what circumstances. as such, perron et al. (2010) call for educational strategies that ensure students’ digital literacy and technological competence. digital literacy “equips social workers with the capacity to innovate, adapt, and scrutinize the implications of the technologies they use” (wolf & goldkind, 2016, p. s102). technological competence ensures that students know how to use existing tools. beyond the worker-client relationship, training students and practitioners in how to incorporate ict tools can enhance their virtual membership in the social work profession. as an example, hitchcock and sage (2018) propose the use of what they call professional learning networks, in which social workers can connect in an online environment to exchange ideas and resources. implications for research on the impact of ict on the worker-client relationship finally, ict use has implications for social work research. investigation is needed to build evidence of the impact of ict use on the worker-client relationship. as such, efforts should be directed at determining the current impact of icts from both worker and client perspectives and then using this evidence to establish best practices. for instance, in using ict during the pandemic, workers have raised concerns about the effectiveness of ict in building relationships with new clients, conducting initial assessments, and working with high-risk cases (cook & zschomler, 2020; mitchell, 2020). these issues need to be examined further, especially from the clients’ perspective. there is also a need for theoretically-driven inquiry. our review has shown the usefulness of communication theories in guiding ict-related studies in social work, summarized in table 2. in particular, social information processing theory (walther, 1992) supports relationship development in an online environment. further, social presence theory (short et al., 1976) has emerged as a way to frame and interpret the impact advances in social work, fall 2022, 22(3) 930 of connectedness in online relationships (byrne & kirwan, 2019; lamendola, 2010; rettie, 2008). finally, electronic propinquity theory (korzenny, 1978; walter & bazarova, 2008) can help guide the tool selection process. table 2. contributions of communication theories to the social worker-client relationship theory source contribution social information processing walther, 1992 relationships can be developed in an online environment. social presence short et al., 1976 social presence (i.e., the sense of connection in electronically-mediated communication) can strengthen relationships in an online environment. electronic propensity korzenny, 1978 psychological closeness can be experienced in an online relationship, similar in nature to physical closeness via proximity of in-person interactions. channel expansion carlson & zmud, 1999 increased knowledge and experience in an online relationship can enhance perceptions of the richness of the relationship. going forward, one important next step is to acknowledge and account for the dynamic process of ict use over time as it impacts the worker-client relationship. one theory shows promise for this line of inquiry—channel expansion theory (cet; carlson & zmud, 1999). channel expansion theory recognizes the importance of increased knowledge and experience as these factors affect user perceptions of icts. as knowledge and experience increase, so too do perceptions of richness of the interchange. this raises the question of the impact of ict use on the worker-client relationship over time. finally, empirically untangling the impacts of different types of tools based on their features (i.e., communication medium, mutual directionality, level of privacy, level of formality, and information complexity) and determining when it is best to use which type of tool is important. some circumstances require in-person contact; others do not. for instance, allegations of child or elder abuse and neglect must be done in person to thoroughly evaluate client safety. as another example, synchronous tools such as video conferencing may be accompanied with technology failures, environmental distractions, or physical discomfort depending on the length of the session (cook & zschomler, 2020; markowitz et al., 2021). understanding the unique features of different types of technology relative to the worker-client relationship is important. thus, knowledge about which set of tools to use across different client circumstances is vital. conclusion information communication technology is a relatively new dimension of the personin-environment perspective embraced by the social work profession. the use of ict in social work practice, especially during the pandemic, is transforming how we relate to our clients. there is increasing evidence of the positive impacts of ict on the worker-client randolph et al./technology & swker-client relationship 931 relationship (e.g., byrne & kirwan, 2019; simpson, 2017). new icts provide opportunities to understand the “granular texture of interpersonal interactions” (byrne & kirwan, 2019, p. 221) and then use this knowledge to enhance worker-client relationships. yet, many questions are left to be answered. moving forward, practice recommendations include: reconceptualizing worker-client boundaries in a way that is compatible with the digital world, resolving ethical issues around client surveillance via social media, and advocating for equal access to ict. in terms of social work education, we support the recommendation of perron et al. (2010) to expand ict teaching strategies to cover the development of both technical competence and digital literacy. finally, research-based recommendations are to apply existing communication theories to guide research on the impact of ict on the worker-client relationship, especially in investigations that lead to establishing best practices for ict use. in conclusion, we reflect upon the struggles encountered by pioneering social workers in navigating the unknown impacts of the basic telephone on the worker-client relationship in the early 20th century. as we did back then, the social work profession is embracing ict and finding ways to harness its opportunities to enhance the worker-client relationship. references barsky, a. 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(2016). digital native meet friendly visitor: a flexner-inspired call to digital action. journal of social work education, 52(51), s99-s109. https://doi.org/10.1080/10437797.2016.1174643 author note: address correspondence to karen randolph, florida institute for child welfare, college of social work, florida state university, tallahassee, fl, 32306. email: krandolph@fsu.edu https://doi.org/10.1177/25161032211045257 https://doi.org/10.1080/02650533.2019.1597693 http://ew.edweek.org/nxtbooks/epe/ew_11092016/index.php https://doi.org/10.1007/s10615-020-00780-x https://doi.org/10.1080/15228835.2017.1277908 https://doi.org/10.1177/1523422319851477 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://doi.org/10.1080/0312407x.2019.1669687 https://doi.org/10.18060/241 https://ejqrp.org/index.php/ejqrp/article/view/111/74 _________ vickie harden, ph.d., associate professor and msw program coordinator, department of social work, middle tennessee state university, murfreesboro, tn. v. nikki jones, assistant professor and dsw program director, school of social work, spalding university, louisville, ky. copyright © 2022 authors, vol. 22 no. 1 (spring 2022), 145-162, doi: 10.18060/25142 this work is licensed under a creative commons attribution 4.0 international license. applying the principles of brain-based learning in social work education vickie harden v. nikki jones abstract: this paper contributes to social work education by presenting brain-based learning as a theoretical framework to understand the impact of brain development and brain processes on learning and teaching. historically, brain-based learning was adopted in elementary and secondary educational settings to assist educators in determining the pedagogical strategies most salient to supporting cognitive processes. however, in recent years, emphasis on brain-based learning has also emerged in higher education. it is more imperative than ever that faculty rely on evidence-based methods and models of teaching in the learning environment given the life stressors and trauma experienced by college students, including the coronavirus pandemic. brain-based learning is a well-developed approach informed by theoretical constructs in neurology, psychology, biology, education, and medical science. implementation of the key principles of brain-based learning are associated with improved academic performance, positively influenced motivation, and supported retention of knowledge. brain-based learning is a model well-suited for implementation in social work education and supports the experiential practices embedded in social work pedagogy. keywords: brain-based learning, higher education, social work education, academic performance, adverse childhood experiences, pedagogy, scholarship of teaching and learning, experiential learning brain-based learning has gained traction in recent years for providing a conduit to understanding the impact of brain development and brain processes within the framework of the learning environment (caine & caine, 1990; jensen, 2008a; kahveci & ay, 2008). greater understanding of how humans make meaning of experiences and how the acquisition of knowledge translates to learning has become the work of researchers and practitioners from multiple disciplines including neuroscience, cognitive neuroscience, psychology, biology, and education. using the brain-based learning approach, caine and caine (1990) framed several neuro-biological concepts of brain science into classroom strategies, bridging research-based constructs with practical application. brain-based learning moves from traditional learning styles such as rote memorization into a process in which the application of knowledge through problem-solving and experience-based opportunities are used to optimize the student’s capacity to learn (caine & caine, 1990; gozuyesil & dikici, 2014). brain-based learning takes into account the various environmental influences on brain development and cognitive processing, including adverse childhood experiences and other experiences that manifest chronic stress. utilization of a brain-based learning model in higher education settings can have a positive impact on learning. this review explores how brain-based learning is sensitized to the impact of trauma on academic performance and can enhance the use of experiential about:blank advances in social work, spring 2022, 22(1) 146 activities, particularly in social work programs. college students come to the academic setting with a myriad of strengths, including life experiences that inform their own scholarly work. in recent years, scholarship has increased our understanding of how negative experiences, such as trauma, poverty, racism, and toxic stress, can shape development and learning outcomes for students (merians et al., 2019; mersky et al., 2013; metzler et al., 2017; montez & hayward, 2014; pascoe et al., 2020). the current coronavirus pandemic has further deepened our understanding of the influences of stress on psycho-emotional states and academic performance across disciplines (romash, 2020). therefore, it is imperative that educators understand how these potential developmental injuries can create academic barriers for adult learners, including traditional college students and older adults engaged in higher education. educators can augment their teaching processes by incorporating brain-based learning as a foundational framework for learning in order to better equip adult learners, including those entering the college setting, to achieve their academic goals. brain-based learning supports several important concepts of adult learning specifically related to experiential learning through community service and internships. this model identifies meaningful learning opportunities using real-life experiences to enhance academic performance (winter, 2019). experiential learning, such as service learning and internships, are noted as reparative in addressing trauma-related learning difficulties as well as enhancing scholarly activities. the emerging dialogue around the impact of brainbased learning to improve academic achievement (duman, 2010; gozuyesil & dikici, 2014) and the implications for adult learning make this theoretical framework useful in social work education. understanding brain-based learning caine and caine (1990) identified twelve core principles related to brain-based learning and classroom application of the theory (see table 1). these principles incorporate complex brain processes that implicate the capacity for learning among students. for example, according to principle one, the brain is a parallel processor with thoughts, emotions, and imagination functioning interactively and simultaneously. therefore, learning actively engages the body’s physiological response to environmental factors, emotions, stressors, nutrition, and multiple other factors. every brain simultaneously perceives and creates parts and wholes where information is organized separately but understood within or as a whole. for this reason, learning involves both focused attention and peripheral perception where information is assimilated in the brain via direct attention and through peripheral sources. learning always involves conscious and unconscious processes with the brain absorbing much more than is realized with peripheral information entering at the unconscious level. the brain understands and remembers best when facts and skills are embedded in natural spatial memory, such as with high impact practices where students learn by doing followed by reflection on actions (dufour et al., 2006; miller at al., 2011). furthermore, learning is enhanced by challenging experiences and inhibited by threats or perceived threats, such as stress, which inhibits our ability to learn. learning changes the structure of the brain; however, because the brain is unique, experiences and emotions are integrated differently for each person. these principles from harden & jones/brain-based learning 147 caine and caine (1990) provide a framework for operationalizing brain-based learning into a classroom setting. table 1. principles of brain-based learning (caine & caine, 1990) principle brief description 1. the brain is a parallel processor. processes are interactional & concurrent. thoughts, emotions, memory, imagination interact with other brain processes, social & cultural knowledge. 2. learning engages the entire physiology. learning can be facilitated or inhibited by physiological processes, including neural development, nutrition, synaptic interactions, & life experiences such as stress, trauma, as well as safety, peace, happiness, contentment. 3. the search for meaning is innate. the ability to make sense out of our experiences includes processes that latch onto the familiar & search for the unfamiliar as part of human survival. meaning-making is part of the human experience. 4. the search for meaning occurs through patterning. patterning is part of the brain’s meaning-making process. the brain integrates & generates patterns in its resistance to meaninglessness. 5. emotions are critical to patterning. emotions & mind-set affect learning. bias, prejudice, selfesteem, social interaction & expectancy influence the organization of information, recall, & memory. 6. every brain simultaneously perceives & creates parts & wholes. the hemispheres of the brain are interactive with separate but simultaneous information processing. 7. learning involves both focused attention & peripheral perceptions. information that is paid attention to & that the brain is directly aware of is absorbed as well as information that is “out of the side of the eyes.” 8. learning always involves conscious & unconscious processes. learning goes behind what we consciously understand. we learn from & remember experiences as well as what we are told. 9. we have two types of memory: spatial memory systems & rote memory systems. spatial memory allows for “instant” memory without the need for rehearsal. this is always engaged & enriches over time. facts & specific skills are part of the rote memory, requiring rehearsal to retain. 10. the brain understands & remembers best when facts & skills are embedded in natural spatial memory interactive experiences shape internal processes & the social context of learning. meaning-making occurs via ordinary experiences. embedding novel with the ordinary enhances learning. 11. learning is enhanced by challenge & inhibited by threat. optimal learning occurs via appropriate challenge, but when overstressed, learning is impeded. 12. each brain is unique. the integration of emotions, senses, & our understanding of experiences is unique to the person. the process of learning changes the structure of the brain. advances in social work, spring 2022, 22(1) 148 fogarty (2009) recommended four cornerstones of brain-compatible classrooms: teaching for thinking, teaching of thinking, teaching with thinking, and teaching about thinking. this framework addresses climate, instructional skills, interactions, and reflection. all of these elements are critical to teaching and learning. ozden and gultekin (2008) further explicate that in brain-based classrooms students learn about the thinking process and how to use thinking through three phases: orchestrated immersion, related alertness, and active processing. in immersion, students learn how to make the gist of a topic meaningful while active processing speaks to meaningful learning experiences. active processing also includes students’ evaluation of context, emotions, physical environment, process, and organization. relaxed alertness involves challenging students to take risks within a safe learning environment in order to establish connections between old and new knowledge. all three of these processes encourage exploration and inquiry among students (ozden & gultekin, 2008). the incorporation of brain-based learning can be accomplished in a variety of ways. this includes written reflection papers, small group collaborations, service activities that connect to course topics, and self-care modules to encourage the reduction of anxiety and production of a safe learning environment (winter, 2019). stress and the learning environment students bring the residual effects of adverse childhood experiences and chronic stress into the classroom, and these stressors contribute to difficulty engaging students in learning activities and may contribute to poor academic achievement. the recent pandemic has exacerbated the already demanding lives of college students, and possibly impacted cognitive functioning (boals & banks, 2020). students reported numerous stress-related issues such as social isolation, job loss, abuse from family members upon returning home from college, added caregiving responsibilities, and worries about their own health (chierichetti, 2021; mahdy, 2020; thukral et al., 2020). specific to social work students, many chose the profession due to their own trauma-related life experiences (copeland et al., 2021). social work students have a higher rate of adverse childhood experiences than students in other majors (branson et al., 2019; thomas, 2016). social work students may be exposed to trauma vicariously via classroom role-plays, case scenarios, and through the practicum experience. while these in-vivo experiences are cornerstones to social work education, they can also serve as vicarious trauma experiences for some students (knight, 2010; zosky, 2013). this, in turn, adds to emotional, physical, and psychological risk factors experienced by students with adverse childhood experiences, including early burnout (copeland et al., 2021). given the prevalence of stressors and academic demands faced by 21st century college students, the concept of relaxed alertness, which is a key process of brain-based learning that identifies moving the brain’s activity from survival mode to a calm, adaptive state imperative to the learning process, is of particular relevance to the higher education setting (caine, 2000; pascoe et al., 2020). students struggle with attaining relaxed alertness for several reasons. sleep deprivation, depression, anxiety, and stress are common, cooccurring psychosocial issues that can negatively influence alertness, academic performance, well-being, and field performance (hershner & chervin, 2014; song & harden & jones/brain-based learning 149 lindquist, 2015). mitigating these psychosocial issues, particularly anxiety and stress, that sometimes accompany the academic environment, especially for students with negative classroom experiences or significant life stressors, increases opportunities for learning. gozuyesil and dikici (2014) further explained that relaxed alertness encourages a safe emotional and social space that reduces brain activity related to potential threats and opens the brain up for intellectually challenging learning opportunities. promoting academic rigor in the classroom in a manner that does not induce unwarranted stress and fear can shape successful academic performance and provide an enriched classroom experience where prior acquired knowledge is reinforced and novel concepts are introduced (samur & duman, 2011). creating meaningful learning experiences the development of meaningful learning experiences underpins brain-based learning as a model relevant to higher education settings, particularly when an experiential approach is warranted as with social work education (caine & caine, 2006a; jensen, 2008b). from the brain-based learning perspective, meaningful experiences are embedded into curriculum. the result for students is an enriched understanding of course content from an operational, or skill-based perspective (caine & caine, 2006b). purposeful construction of meaningful learning involves delivering new information or knowledge in a way that connects to previous experiences and supports a shift in perception about how a student sees and experiences the world (caine & caine, 2006b; kahveci & ay, 2008). a clear example of meaningful learning is service learning in which students complete community service projects connected to course content. for example, a study of geriatric caregiving might be accompanied by a community-based project in which students shadow home health workers. as described by nwokah and leafblad (2013), service learning enables students to benefit from “new and multisensory experiences” and participate in activities to acquire new skills (e.g., “social skills, higher order conceptualization, and information processing”) in a novel environment that is more likely to increase memory and consolidate learning experiences (p. 71). other options to increase engagement and motivation are integrative learning or the inclusion of course learning objectives that advance reflective thinking about lived experiences. the interdisciplinary nature of integrative learning makes it both relevant and appealing to social work educators and students, particularly non-traditional students who have life experiences to bring into the classroom (dinmore, 1997). adult learners do not come to the classroom as a blank slate. rather, they build upon constructed knowledge informed by experiences. these experiences are a vital starting point for the educator and engage the learner in the process more readily than a lecture style of imparting knowledge onto the learner (taylor, 2006). in this process, the integrative learning process takes place. a crucial part of meaningful learning is the immersion process that occurs when the realworld is integrated into the learning environment (caine & caine, 1990; samur & duman, 2011). duman (2010) explained that through experiences and physical activity synaptic links between neurons are strengthened, causing physical changes to the brain. these changes involve basic stimulus response systems, and are, at their very essence, the process of learning. advances in social work, spring 2022, 22(1) 150 learning and the neurobiology of the brain fundamentally, learning is biological and connected to physical changes in the brain, including the strengthening of neural networks within the brain (zull, 2002). learning is a process in which connections are made within the brain’s networks and information is synthesized and stored (moffett & fleisher, 2013). the learning process occurs with initial arousal via the brainstem, which governs the flow of information within the body. further involved in the learning process is the limbic system including the hippocampus, which controls emotions, generates meaning-making, and influences memory origination. another area implicated in this process is the prefrontal cortex that controls executive functions including higher-order thinking, problem-solving, planning, and purposeful action (caine & caine, 2006a; schreiner et al., 2013). the cerebellum functions as the motor area of the brain where actions are controlled, including writing and speaking. connections between learning processes and the outside world occur through this region of the brain. neural networks help the brain to make transitions and assign meaning to experiences. two unique aspects of brain functioning related to learning include pruning and plasticity. while pruning involves the deletion of unused synapses to make room for new connections, plasticity allows for adaptations and change (schreiner et al., 2013). all of these functions impact the learning process. injury to any of these brain areas can negatively impact learning, including the ability to acquire new knowledge, build upon current knowledge, and relate knowledge to experience. the brain continues to change into adulthood, and the process of learning continues to shape neurological changes to the brain. these changes include strengthening and forming neurological connections between cells that shape the brain’s structure. this, in turn, serves to shape and modify behavior (dam, 2013). understanding brain processes is pivotal to human learning. today’s world is fast-moving and rapidly changing, requiring that knowledge adapt to this rapid pace (fischer, 2009). the brain-based learning approach can aid educators in understanding how the brain is naturally constructed to optimally learn, such as helping educators discern which teaching strategy is best suited for a particular learning objective based on our knowledge of how the brain works (jensen, 2008b). additionally, understanding the influence of trauma and toxic stress on brain development and students’ reception to instructional scaffolding can assist educators in shifting the classroom environment to mitigate undue stress or triggering events. providing feedback on low-impact assignments early in the semester from which students can build into more complex work is one example of using scaffolding that can serve to reduce stress related to academic performance. adverse childhood experiences, toxic stress, and learning according to jensen (2008a), social conditions impact brain development and brain activity. for example, childhood trauma can lead to maladaptive behavioral manifestations that impact health and learning (bethell et al., 2014). adverse childhood experiences can negatively impact adult health (bryan, 2019; montez & hayward, 2014) as well as decrease academic achievement due to worsening mental health (karatekin, 2018) and substance misuse (loudermilk et al., 2018). the adverse childhood experiences (aces) study harden & jones/brain-based learning 151 (felitti et al., 1998) set the stage for a deeper understanding of the effects of childhood trauma and toxic stress on multiple domains, including physical health, mental health, and cognitive development (dunn et al., 2016; merrick et al., 2017; mersky et al., 2013). toxic stress is of particular concern to the learning process and negatively affects healthy development in children due to the long-term activation of the stress-response system. the toxic stress response is directly connected to adverse childhood experiences and prolonged exposure to adverse conditions, such as physical and emotional abuse, chronic neglect, caregiver substance misuse and mental illness, and family violence without the balance of supportive adults (center on the developing child, n.d.). chronic stress may or may not be connected to adverse childhood experiences but has an even deeper effect on the learning environment and students’ cognitive abilities, concentration, and engagement in positive social and academic experiences (jensen, 2008a). chronic stress is triggered by exposure to long-term environmental factors such as combat, caring for a chronically ill family member, or threats experienced over a long period of time (miller et al., 2007). emotional responses such as fear and helplessness influence executive functioning, namely reducing the learner’s decision-making capacity and ability to problem-solve and attain goals (caine & caine, 2006a). these responses are particularly concerning as universities and students maneuver within the sociocultural shifts precipitated by life stress such as the coronavirus pandemic. the social environment in which the academic experience is couched influences students’ capacity to engage in the learning process. these interactions and experiences are expressly influenced by and influence brain development and activity. in other words, prior experiences help shape the brain, current circumstances reinforce the neuro-biological processes within the brain, and the brain is altered daily by every experience encountered (jensen, 2008a). however, through responsive educational practices, such as brain-based learning, the life trajectory of students can be positively changed. for example, montez and hayward (2014) found that higher levels of education extended life expectancy for adults from disadvantaged backgrounds comparably or better than adults from advantaged childhoods with low education levels. effectiveness of the brain-based learning model brain-based learning is a model with scholarly support, further concretizing its potential role in contemporary academic environments. researchers have found that brainbased learning contributed to significant differences or higher mean scores on retention tests between a brain-based learning group and a control group (ozden & gultekin, 2008); improved student learning outcomes in a sample of high school seniors (lidiastuti et al., 2020); increased listening and vocabulary skills and retention among business students (salem, 2017); and was more effective in increasing high school students’ achievement, attitude, and motivation in comparison to the control group (uzezi & jonah, 2017). a metaanalytic review of 31 research studies on brain-based learning found a medium effect size and noted that the model produced better results related to academic achievement than traditional teaching methods (gozuyesil & dikici, 2014). a study of 102 students randomly assigned to a brain-based learning group or traditional teaching methods noted that brainbased learning, which included relaxed alertness, immersion and active processing, advances in social work, spring 2022, 22(1) 152 improved academic achievement and promoted a positive attitude about learning among participants (samur & duman, 2011). a study by akyurek and afacan (2013) further indicated that brain-based learning activities positively influenced motivation among a cohort of eighth-grade students where brain-based learning methods were employed. results indicated that students’ motivation and attitude toward science and technology were positively impacted. however, in a personal reflection on classroom experiences, caine (2000) noted that “taking neuroscience into the classroom is challenging…people are too complex, individuals too unique, and contexts too unpredictable” (p. 61). the author further postulated that an integrated approach that included brain research coupled with instructional models provided a positive teaching approach. specific to higher education settings, an interest in the concepts related to brain-based learning has reemerged. the transition to online instruction has been accelerated by the pandemic. winter (2019) found that brain-based learning provided a framework for online teaching. however, faculty in higher education may not be as informed about the brainbased learning approach as elementary and secondary educators. using concepts related to brain-based learning in an asynchronous setting provides additional engagement opportunities. this includes using collaborative groups to complete tasks, using discussion boards as safe zones in which students can share ideas, and providing consistent feedback to alleviate stress or anxiety related to performance in online courses (winter, 2019). in online and traditional higher education settings, brain-based learning moved faculty from the role of lecturer to a partner in the learning process (sesmiarni, 2015). coupled with the experiential aspects and emphasis on motivation, brain-based learning is well-suited for higher education. three specific areas of brain-based learning that complement teaching in the college classroom includes the incorporation of life experiences, motivation, and service learning. life experiences, motivation, and experiential learning brain-based learning offers implications for student life experiences and motivations toward learning and experiential learning. meaningful learning experiences, motivation, and the incorporation of experiential learning play a role in successful academic performance among adult learners and are core to social work education. each of these aspects of the learning environment are influenced by prior life experiences of the learner. additionally, attuning to motivation and including meaningful learning can help students improve opportunities for academic performance, in spite of the manner in which traumatic events may have affected their ability to successfully maneuver the academic environment. in delivering course material, educators should consider the uniqueness of each student’s learning capacity, how the brain processes information, and how individual life experiencessuch as trauma impact students’ capacity to process information and engage in the process of learning (caine & caine, 2006a; cozolino & sprokay, 2006; taylor, 2006). environmental stress, including stress related to the academic setting, affects students’ ability to learn new information and assimilate knowledge. while brain development is a life-long process and learning increases synaptic activity, the prefrontal cortex of young harden & jones/brain-based learning 153 adults has not fully formed and executive functioning has not reached an optimal state (kolb et al., 2012). furthermore, negative life experiences can delay the development and maturity of young brains. exposure to environmental events including alcohol and drug use, stress, and relationship discord impact the development of the prefrontal cortex (kolb et al., 2012). additionally, adverse childhood experiences impact motivation, self-esteem, and education attainment into adulthood (arnekrans et al., 2018; merians et al., 2019; metzler et al., 2017; tetzner et al., 2016). these negative early childhood exposures negatively impact healthy brain development and the capacity to learn. two key findings that influence motivation specific to learning among college students are a sense of control and personally important content (moffett & fleisher, 2013). from the context of brain processes, information that is perceived as important receives attention, and information perceived as unimportant is culled out (moffett & fleisher, 2013). adult learners appreciate teaching and learning when they feel a sense of ownership. providing students with some control over their choices and having a personal connection to those chosen experiences enhances motivation to learn in and outside of the classroom. motivation is further enhanced by the use of experiential activities endorsed within a brainbased learning environment, which can mitigate the negative effects of chronic stress and build resilience. for example, motivation among adult learners is heightened through curiosity and through making connections across past, present, and future experiences and individualized feedback (bărbieru, 2019). the development of meaningful learning experiences (i.e., immersion) has been noted as a key concept in brain-based learning (nwokah & leafblad, 2013). service learning combined with classroom instruction provides a practical application of immersion. experiential learning, such as practicums and internships prevalent in social work education, are often chosen by students due to a personal connection to the mission of the organization or a particular client population. as askeland (2003) described, experiential learning bridges the knowing what (i.e., theories) and applying how (behaviors) that is essential to adult learners. service learning is optimal for creating new learning experiences and destabilizing existing knowledge, which further challenges the student (nwokah & leafblad, 2013). service learning for college students brings about novel situations in which brain development can thrive and supports the core concepts of brain-based learning (nwokah & leafblad, 2013). experiential learning provides an opportune medium by which to integrate brain-based learning concepts. brain-based learning considers the integration of strategies that deepen learning. for example, findlay (2012) proposed a brain-based learning approach that entailed 14 factors to consider when attempting to design a technology-based environment for millennial students. technology-based learning has become a mainstay as a result of modifications to the learning environment due to covid-19. some of these cognitive neuroscience learning factors include using cognitive neuroscience learning theories to inform teaching, designing instruction based on brain research, recognizing the multitasking abilities of students, and using mnemonic devices in instruction (winter, 2019). findlay (2012) also recommended nano-teaching with student-teacher role reversal, as well as using students’ mobile technology in order to facilitate motivation and learning. experiential and brain-based learning may also serve as a restorative or reparative process for students who have experienced toxic stress. educators cannot ignore the advances in social work, spring 2022, 22(1) 154 potential impact of chronic stress, anxiety, or toxic stress brought on by adverse childhood events on students’ academic performance. in light of the negative impact of stress on learning, freeman and wash (2013) offer strategies for college teaching using brain-based learning approaches that emphasize safety, relevance, and an enjoyable experience as primary to the learning experience. additionally, experiential learning was identified as key to successful teaching using brain-based learning approaches (freeman & wash, 2013). implications for social work education this article reviews the core components of brain-based learning theory and contributes to research and methods by which to implement the concepts of this theory within a framework for higher education, and more specifically, social work education. social work education relies on immersive service learning and internship experiences. the brain-based learning approach provides faculty with tools to remediate specific stressors and burnout inherent in the helping professions and experienced by social work students. based on the core principles of the approach, the classroom setting itself, stability of the learning environment, and the way information is presented become part of the instructor’s tools to encourage balance between academic challenge and the “down-shifts” described by caine and caine (1990). the brain-based learning approach within an academic environment, when attuned to the effects of adverse childhood experiences and toxic stress, provides educators with an opportunity to better prepare to teach students with various learning capacities, strengths, and limitations. this level of preparation by faculty is necessary to address students’ stressors that increased dramatically during covid-19. students are experiencing higher levels of psychosocial stress related to normative life events and the uncertainty introduced by the pandemic (chierichetti, 2021). attuning to students who are impacted by chronic stress via adverse childhood experiences or modern-day life circumstances via brain-based learning techniques fits within the social work education pedagogy. brain-based learning can be incorporated into social work education in numerous ways. the foundation of experiential learning via internships, practicums and volunteerism embedded into social work education complements the core concepts of brain-based learning. additional ways brain-based learning can be incorporated into social work education includes the use of individual and small group reflective exercises, role plays that immerse students through simulations of real-life case studies, and projects that connect course content to community-based experiences. the brain-based perspective provides a framework for instructors to incorporate an understanding of the ways in which students experience triggers and toxic stress as part of experiential work inherent in social work education. from a social justice perspective, these experiences can serve as macro-level change activities benefiting the student as well as the community. the real-life scenarios often incorporated into social work classroom settings are fundamental to the brain-based learning approach and help students with retention of new material, practice of specific skills, and build on current knowledge (winter, 2019). recommendations for online and traditional classroom interactions include mixing short, 15-minute lectures with role plays harden & jones/brain-based learning 155 or tactile activities (freeman & wash, 2013; nwokah & leafblad, 2013). while these types of activities are common in the social work classroom, instructors may not recognize the ways in which chronic and toxic stress impede student achievement and performance in field and experiential activities. brain-based principles and potential learning activities from a social work education perspective are described in table 2. table 2. application of brain-based learning in social work education principle application in social work education 1. the brain is a parallel processor. teaching of theory is operationalized into techniques & experiences specifically orchestrated by the instructor & followed into the field education experience. role plays & simulations are followed by reflective exercises in which students explore their own emotional responses to activities. 2. learning engages the entire physiology. self-care is actively embedded into the learning environment. developmental stages of students is viewed from a life-span perspective & incorporates all phases of adult development as part of course delivery. 3. the search for meaning is innate. educators should provide stability & a culture of safety balanced with newness & novelty. activities must be meaningful & provide opportunities for students to connect classroom activities, field experiences & their own life experiences to the learning process. taking field cases into the classroom for dissection from student & educator perspectives provides this opportunity. 4. the search for meaning occurs through patterning. course content is delivered that provides opportunities for patterning. this means that students have opportunities to create meaning through themes that resonate with their own lives & experiences. student-developed case scenarios & problem-solving activities provide these opportunities. 5. emotions are critical to patterning. educators should incorporate ways in which students explore their own reactions & responses to material, activities & experiential learning. establishing a learning environment that encourages curiosity, mutual respect, & cooperative learning is paramount. this includes embracing the students’ professional & personal experiences as important to the learning process. learning from students as well as teaching promotes a mutually reciprocal learning environment. 6. every brain simultaneously perceives & creates parts & wholes. field / internship experiences provide an excellent opportunity for engaging students in interactive brain processing. the cumulative effect of classroom instruction coupled with experiences in the field make these connections. however, the process must be encouraged & supported by the field instructor & field supervisor working in sync to support the operationalization of skills practiced in the classroom setting. advances in social work, spring 2022, 22(1) 156 principle application in social work education 7. learning involves both focused attention & peripheral perceptions. supporting the peripheral learning process may include using creative & interdisciplinary activities that stretch beyond the traditional curriculum. an interdisciplinary example was a partnership between social work & media arts in which social work students engaged in reflections of their reactions to photographs related to social justice issues in the community. educators can also initiate check-in processes in which students make connections between their emotional state, physical state, & cognitive readiness for class. 8. learning always involves conscious & unconscious processes. ensuring that activities are embedded in which students process their own behavior, how they are interacting in the learning environment, & learning style. providing opportunities for students to guide the learning process, encourage meaning-making, & ownership of academic success. activities to promote this may include the use of metaphors to recapitulate course content, & developing course content that students present to the class or field agency. 9. we have two types of memory: spatial memory systems & rote memory systems. connect fact with experiences & emotions. adding queries related to how the student experienced the classroom activity, and examining their impressions & emotional responses to case studies framed by theory & factual information to solidify the spatial & rote memory processes. 10. the brain understands & remembers best when facts & skills are embedded in natural spatial memory experiential learning via simulations that are close to real-life situations, demonstrations & field experiences promote spatial memory. educators & students can engage in role plays, watch enactments of treatment sessions, attend community action events, participate in policy & advocacy activities, & connect these to curriculum. 11. learning is enhanced by challenge & inhibited by threat. educators should encourage relaxed alertness in the classroom setting. challenging material is best learned when balanced by the capacity to think clearly. high stress settings promote the down-shift or narrowing of the perceptual field, lessening the opportunity for learning. settings that are not challenging enough also lessen the opportunity for learning. this balance between too much & not enough challenge can be difficult to meet. educators should strive for high challenge, low threat classroom environments. 12. each brain is unique. educators should prepare to teach using a multi-faceted approach. integrating an individualized teaching practice is complex. however, using multiple methods of exploring material, engaging students, & presenting course curricula supports a brain-based approach. this should be underpinned by reflective practice, attunement to student’s emotional states, readiness for learning, & triggers that may coincide with experiential learning practices. allowing room for exploration of the emotional aspects of social work education promotes the brain-based approach & uniqueness of each student. harden & jones/brain-based learning 157 the concept of a safe learning environment can readily be operationalized in the social work classroom as well as in online courses. providing specific instructions, guidelines, and expectations to students can reduce anxiety and stress and promote a safe environment (freeman & wash, 2013). availability of the instructor is another way to enhance feelings of safety among students. ultimately, the instructor is responsible for the climate of the classroom setting. this includes setting standards of respectful interactions among students and between faculty and students, holding students accountable when disrespectful behavior is witnessed or experienced by fellow students, and setting up an atmosphere in which students feel open to asking questions and seeking feedback (freeman & wash, 2013; moffett & fleisher, 2013). one key barrier to the implementation of brain-based learning in higher education and specifically in social work education is the lack of knowledge instructors have about brainbased learning (winter, 2019). offering workshops on brain-based learning to social work faculty may be one way to encourage incorporation of these concepts into the classroom setting. additionally, the connection between trauma, chronic stress, and learning has been established. however, the ways in which brain-based learning can mitigate these conditions requires continued research. future research on the positive and negative influences of mitigating stressors such as adverse 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(2002). the art of changing the brain: enriching the practice of teaching by exploring the biology of learning. stylus. author note: address correspondence to vickie harden, department of social work, middle tennessee state university, murfreesboro, tn, 37132 email: vickie.harden@mtsu.edu https://doi.org/10.1016/j.nedt.2014.06.010 https://doi.org/10.1002/ace.221 https://doi.org/10.1002/per.2066 https://doi.org/10.1080/08841233.2016.1182609 https://doi.org/10.18653/v1/2020.nlpcovid19-2.23 https://doi.org/10.9734/jesbs/2017/34266 https://doi.org/10.9743/jir.2019.1.8 https://doi.org/10.1080/08841233.2013.795923 mailto:vickie.harden@mtsu.edu _________ daphne c. watkins, phd, emba, letha a. chadiha collegiate professor of social work, university diversity and social transformation professor, university of michigan, ann arbor, mi. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 197-218, doi: 10.18060/28545 this work is licensed under a creative commons attribution 4.0 international license. executive coaching for social work faculty: a framework for enhancing leadership and impact in the academy daphne c. watkins abstract: executive coaching considers the challenges and opportunities of leaders and organizations. social work faculty face unique challenges that require academic expertise, leadership acumen, and management skills. while executive coaching has been a longstanding practice in the corporate world, its relevance to social work faculty is relatively unrecognized. this paper examines the science of executive coaching and its alignment with the research, teaching, and service responsibilities of social work faculty. it also presents a framework for how executive coaching can align with professional development for social work faculty. while not all social work faculty aspire to someday hold administrative roles, there may be opportunities for leadership throughout their careers for which executive coaching can position them for success. the implications of executive coaching for social work faculty include the opportunity to examine their potential leadership capabilities, enhance job satisfaction, and serve as social impact leaders for students, colleagues, and the profession. keywords: executive coaching, faculty, leaders, leadership, social impact, social work executive coaching has emerged as a powerful tool for professional development across various sectors, and its application in higher education is gaining significant traction (athanasopoulou & dopson, 2018; hill & kutsyuruba, 2024). distinguished from other interventions by its focus on the individual leader's development within the context of their organizational role and responsibilities, executive coaching is a highly contextualized process that considers the specific challenges and opportunities faced by the leader and the broader organizational environment (bachkirova et al., 2020; katz, 2021). for social work faculty at colleges and universities, this specialized form of coaching offers a unique opportunity to enhance leadership skills and transform the quality of social work education. social work faculty face a multifaceted set of obstacles in their roles. they must balance teaching responsibilities with research demands, engage in community service, mentor students, and often take on administrative duties to offset the workloads of their colleagues (holley & young, 2005; simmons et al., 2022; smith & johnson, 2018). additionally, the field of social work itself is constantly adapting to address changing societal needs, requiring faculty to stay current with both theoretical advancements and practical applications (mccoyd et al., 2023). as the demands on social work educators continue to evolve, incorporating executive coaching into faculty development has become increasingly relevant and transformative (boyatzis et al., 2013; de haan et al., 2016; huston & weaver, 2008; mukherjee, 2012). executive coaching offers a customized approach to help faculty members manage their diverse responsibilities, excel in their roles, and advance their careers. about:blank advances in social work, spring 2025, 25(1) 198 implementing executive coaching programs for social work faculty represents a strategic investment in the future of social work education. by enhancing the leadership capabilities of faculty members, institutions can foster more effective department management, improve student outcomes, and contribute to the overall advancement of the social work profession (holcomb, 2024; ross-sheriff & orme, 2017). this paper examines the value of executive coaching for social work faculty, exploring its primary goals and key components. it then presents a framework for how executive coaching can align with professional development for social work faculty, enabling them to make strategic decisions that impact their individual career trajectories and institutional success. what is executive coaching? executive coaching is a personalized, goal-oriented process designed to develop leadership skills and improve professional performance (gan et al., 2021). it typically involves one-on-one sessions between a trained coach and a leader, focusing on specific objectives and actionable strategies (clutterbuck & spence, 2017; the conference board, 2023; hackel & samson, 2023). in recent years, executive coaching has expanded beyond corporate settings to include academia, where it has shown promise in supporting faculty development, student success, and institutional effectiveness (iordanou et al., 2016). from an organizational development perspective, executive coaching is a targeted and personalized intervention designed to enhance leadership effectiveness and organizational performance. its collaborative, solution-focused process involves a professional coach working one-on-one with leaders or high-potential employees to achieve specific professional goals and improve overall leadership capabilities (athanasopoulou & dopson, 2018; chen & rodriguez, 2020; katz, 2021). this process typically involves the coach serving as a facilitator of learning and development and creating a supportive environment for the leader to grow (ely et al., 2010; möeller & kotte, 2022). the primary objectives of executive coaching in organizational development include improving individual performance, enhancing leadership skills, facilitating successful transitions into new roles, and aligning individual behaviors with organizational goals and culture (the conference board, 2023; hopkins & meyer, 2019; jones et al., 2016; offstein et al., 2020; vito, 2018). when held regularly, coaching sessions encourage leaders to reflect on their experiences, challenge their assumptions, and develop new perspectives and strategies for addressing leadership challenges. effective coaching can also lead to increased self-awareness, improved decision-making skills, and more effective interpersonal relationships within the organization (de haan et al., 2019; jones et al., 2016). furthermore, research suggests executive coaching can also benefit the coaches themselves (mukherjee, 2012). the coaching relationship is typically time-bound and goal-oriented, with clear objectives established and progress measured throughout the engagement. research has demonstrated the effectiveness of executive coaching in promoting leadership development and organizational performance (gan et al., 2021; kibe & muathe, 2018). for example, a meta-analysis by jones and colleagues (2016) found significant positive effects of workplace coaching on individual learning, skills, work attitudes, and goaldirected self-regulation. meanwhile, athanasopoulou and dopson (2018) demonstrated watkins/executive coaching for swk faculty 199 that executive coaching can improve job performance, increase job satisfaction, and enhance organizational commitment. as organizations face complex challenges in a rapidly changing business, economic, and socio-political environment, executive coaching has emerged as a valuable tool for developing agile, resilient, and influential leaders who can drive organizational success. key components of executive coaching the key components of executive coaching include (1) setting clear, measurable goals, (2) identifying strengths and areas for improvement, (3) developing action plans, (4) providing ongoing feedback and support, and (5) encouraging self-reflection and personal growth (figure 1). below, i outline each component and provide additional context as to what it entails. figure 1. key components of executive coaching setting clear, measurable goals effective coaching begins with establishing specific, achievable goals aligned with a leader's aspirations and the organization's strategic priorities. these measurable goals must provide a clear direction for the coaching engagement and a benchmark for measuring 1 set clear, measurable goals 2 identify strengths and areas for improvement 3 develop action plans 4 provide ongoing feedback and support 5 encourage self-reflection and personal growth key components of executive coaching advances in social work, spring 2025, 25(1) 200 progress (pandolfi, 2020). clarity is necessary when it comes to setting clear, measurable goals. therefore, in the most effective coaching settings, a coach and a leader co-create the coaching goals (passmore et al., 2020). by collaborating with a leader to define concrete, time-bound goals, coaches create a focused framework for development that motivates action and enables the tracking of tangible improvements over time (panchal & riddell, 2020). as a coach and leader co-create and agree upon the goals, accountability is easier to achieve and maintain throughout the coaching relationship. identifying strengths and areas for improvement a comprehensive assessment of a leader's current capabilities, including leadership style, skills, and behaviors, forms the foundation for targeted coaching interventions (ellinger & ellinger, 2021). a comprehensive assessment can underscore areas of excellence and leverage growth opportunities. in any coaching relationship, self-awareness is crucial for both the coach and the leader (carden et al., 2022). through assessment tools (e.g., 360-degree feedback, leadership assessments, strengths-finders, etc.) and in-depth discussions, coaches help leaders gain valuable insights into their strengths, weaknesses, and biases. over time, this fosters a realistic self-image and illuminates where to focus development efforts. developing action plans coaching relationships rarely thrive without an action plan (boysen-rotelli, 2020; pandolfi, 2020; vito, 2018). once goals are set and areas for improvement identified, coaches work with their leaders to create detailed, strategic action plans that outline specific steps, resources, and timelines for achieving desired outcomes and bridging skill gaps. these plans must be customized to individual leaders and can be revised over time (gormley & van nieuwerburgh, 2014; pandolfi, 2020). it is best to think of these tailored plans as roadmaps for personal and professional growth, as they usually incorporate a mix of learning experiences, practical assignments, and behavioral changes designed to stretch the leader's capabilities and drive meaningful progress (boysen-rotelli, 2020). providing ongoing feedback and support regular check-ins, progress reviews, and constructive feedback sessions are essential to the coaching relationship (boysen-rotelli, 2020; gan, chong, yuen, et al., 2021). a coach's responsibility to the leader is to offer continuous guidance, encouragement, and accountability as they work toward their goals (gan, chong, yuen, et al., 2021; plotkina & sri ramalu, 2024). consistency is essential, so many coaches have regular meeting times with leaders and a format for every meeting. despite this, meeting formats are sometimes unplanned and focus on new, emerging, or urgent topics that the leader is facing at that moment. through these ongoing interactions, coaches help leaders reflect on their day-today leadership experiences, overcome obstacles, and refine their approaches, ensuring sustained momentum and adaptation to changing circumstances (plotkina & sri ramalu, 2024). watkins/executive coaching for swk faculty 201 encouraging self-reflection and personal growth the coaching process is set against the backdrop of self-reflection and personal development. therefore, executive coaches must strongly emphasize cultivating a mindset of continuous improvement and self-awareness (greif & rauen, 2022; offstein et al., 2020). this can take several forms. for example, some coaches actively encourage leaders to regularly examine their thoughts, actions, and the impact they have on others (knowles & knowles, 2021; pandolfi, 2020). introspection leads to insight, so by promoting practices such as journaling, mindfulness exercises, and reflective questioning, coaches help leaders develop a deeper understanding of their values, motivations, and leadership philosophies (greif & rauen, 2022). effective coaching fosters personal growth among leaders that extends beyond the immediate coaching goals and contributes to long-term professional success (boysen-rotelli, 2020; pandolfi, 2020). the science of executive coaching and its connection to social work the science of executive coaching has evolved significantly in recent years, incorporating findings from psychology, business, organizational studies, and leadership studies to enhance its efficacy. executive coaching involves a professional relationship between a coach and a leader to improve performance, personal development, and leadership skills (the conference board, 2023; hopkins & meyer, 2019; offstein et al., 2020). recent studies emphasize the importance of using evidence-based practices to ensure that coaching interventions lead to measurable improvements in outcomes such as leadership effectiveness, organizational performance, and employee well-being (onyishi et al., 2021). self-awareness and self-regulation are two primary mechanisms through which executive coaching occurs and are skills frequently developed during social work education (the conference board, 2023; hopkins & meyer, 2019; offstein et al., 2020; vito, 2018). coaches employ various techniques to help leaders gain insights into their behaviors, attitudes, and decision-making processes. these reflective practices, also present in social work training programs, enable leaders to recognize their strengths and areas for development, fostering a growth mindset. research suggests that coaching interventions can significantly improve leadership development, competencies, and organizational outcomes, particularly when tailored to a leader's needs and within the organization’s context (möeller & kotte, 2022). the effectiveness of executive coaching is also contingent upon the quality of the coach-leader relationship. trust, mutual respect, and open communication are critical not only for social work faculty, their students, and clients, but also for facilitating a productive coach-leader relationship. leaders are more likely to engage fully in the coaching process when these elements are present, leading to better outcomes. this is akin to social work practitioner-client, faculty-student, and faculty-faculty engagements. recent trends in executive coaching emphasize the integration of technology and data analytics to enhance the coaching process. digital platforms and tools are increasingly used to track progress, gather feedback, and provide real-time insights. this technological advances in social work, spring 2025, 25(1) 202 integration not only makes coaching more accessible and scalable but also allows for a more data-driven approach to measuring the effectiveness of coaching interventions. these advancements are particularly relevant in today's dynamic, high-paced environments where, like social work, continuous improvement (i.e., continuing education) and adaptability (i.e., to social, economic, or political shifts) are crucial (the conference board, 2023). the future of executive coaching lies in its ability to adapt to the changing needs of organizations and leaders. as organizational landscapes become more complex and volatile, executive coaching must evolve to address emerging challenges such as remote leadership, digital transformation, and greater diversity and inclusion in leadership roles. by staying abreast of these trends and continuously incorporating new research findings, executive coaching is vital for developing effective and resilient leaders, especially in social work. the profile of a social work faculty member social work faculty members navigate a multifaceted environment that blends academic demands with the ethical and practical considerations inherent in social work practice. these professionals must skillfully balance the teaching, research, and service triad, often with constrained time and resources (holcomb, 2024; holley & young, 2005). the nature of social work education frequently involves engaging with sensitive topics, requiring faculty to navigate complex emotional and ethical landscapes skillfully (raveis et al., 2014). additionally, these educators are tasked with bridging the gap between theoretical knowledge and practical application, ensuring their teaching remains both relevant and applicable to real-world scenarios. social work programs typically attract a diverse student body with varying levels of experience, necessitating faculty to employ adaptable teaching strategies to meet these diverse needs (garran et al., 2015). furthermore, in an increasingly competitive academic landscape, faculty members often must seek external funding and resources to support their research endeavors and programs (pinto et al., 2016). these responsibilities collectively contribute to faculty member's complex and demanding roles in higher education. social work faculty members often find themselves at the intersection of academia and social justice, facing unique challenges stemming from the dual nature of their roles. on one hand, they are scholars expected to contribute to the academic body of knowledge through rigorous research and publications. on the other, they are practitioners and educators tasked with preparing the next generation of social workers to address complex societal issues (holcomb, 2024). this duality can create tension as faculty members strive to meet the traditional metrics of academic success while maintaining a solid connection to the field and its evolving practices. furthermore, the pressure to publish in high-impact journals may conflict with the need to produce research that has immediate, practical applications for social work practitioners (bent-goodley, 2017). social work faculty often engage in community-based research and interventions, which can be time-intensive and may only sometimes align with traditional academic reward structures, creating additional stress and potential career obstacles. the ethical considerations inherent in social work practice add another layer of complexity to the watkins/executive coaching for swk faculty 203 faculty role. social work educators must teach ethical decision-making and model it in their research, teaching, and service activities. this includes navigating complex issues related to client confidentiality, informed consent, and cultural sensitivity in research and practice settings. faculty members may find themselves in situations where academic pursuits intersect with ethical dilemmas, requiring careful consideration and, often, innovative solutions (bent-goodley, 2017). for instance, when conducting research with historically underrepresented populations, faculty members must strike a balance between the need for scientific rigor and the imperative to protect participants from harm. social work faculty are often called upon to address controversial social issues in their classrooms and research, leading to challenging discussions and potential conflicts with students, colleagues, or institutional policies (funge, 2011; simmons et al., 2022). these ethical challenges require faculty to maintain a high level of self-awareness and engage in ongoing professional development to ensure they are equipped to handle such situations effectively. social work faculty face the ongoing challenge of keeping their curriculum relevant in a rapidly changing social and political landscape. the field of social work is inherently responsive to societal shifts, requiring faculty to continuously update their knowledge and teaching materials to reflect current issues and best practices (funge, 2011; smoyer et al., 2020). this may involve incorporating emerging topics such as the impact of technology on social services, the evolution of lgbtqia2s+ rights, or the effects of global events on local communities. faculty members must also adapt their teaching methods to accommodate diverse learning styles and increase the integration of technology in education. the covid-19 pandemic, for example, accelerated the need for social work educators to develop proficiency in online and hybrid teaching modalities, adding another skill set to their already demanding repertoire (smoyer et al., 2020). additionally, as social work programs increasingly emphasize interprofessional education, faculty members must collaborate across disciplines and develop curricula that prepare students for integrated practice environments (holcomb, 2024). these ongoing adaptations require significant time and effort, often stretching already limited resources and adding to the ever-increasing workload of social work faculty. a framework for aligning executive coaching with social work faculty development the primary goals of executive coaching in social work are to help faculty members improve and maintain good habits associated with their responsibilities. the duties of social work faculty are so closely aligned with constructs of executive coaching that it makes sense to map them onto a framework for how executive coaching can be applied and measured in professional development for social work faculty. here, i present ten constructs of an executive coaching framework for social work faculty development (see figure 2) that can influence their leadership journeys in meaningful ways. using these constructs to guide the professional development of social work faculty will benefit not only them but also their social work students, colleagues, individuals, and communities. advances in social work, spring 2025, 25(1) 204 figure 2. a framework for aligning executive coaching with social work faculty development the first construct, leadership development, is an essential initiative to cultivate the talents and abilities of high-potential individuals within an organization (boysen-rotelli, 2020; pandolfi, 2020). effective leadership development can equip leaders and highachieving colleagues with the necessary tools and knowledge to effectively guide teams, make strategic decisions, and drive overall success (gan et al., 2021). studies on leadership development suggest it is a continuous process involving carefully designed mentorship programs and experiential learning opportunities (pandolfi, 2020; plotkina & sri ramalu, 2024). social work schools and departments can use executive coaching to cultivate a cadre of skilled leaders equipped to navigate the complexities of today's rapidly evolving sociopolitical landscape and inspire their teams to achieve exceptional results. by investing in executive coaching as a source for leadership development, social work deans and department chairs not only enhance the capabilities of key individuals but also create a robust pipeline of future leaders, fostering a culture of growth, innovation, and adaptability that can propel the field forward in the face of ever-changing market dynamics and competitive pressures. notably, not all social work faculty aspire to administrative or leadership roles. considering this, the leadership skills developed during executive coaching can benefit all social work faculty, regardless of their career trajectories. performance improvement is a systematic approach to analyzing current processes, workflows, and individual contributions within an organization to identify inefficiencies, bottlenecks, and areas where productivity and effectiveness can be enhanced (wang et al., 2024). by leveraging data-driven insights, employee feedback, and industry best practices, organizations can develop targeted strategies to address performance gaps, streamline operations, and empower individuals and teams to reach their full potential (plotkina & sri ramalu, 2024; ramirez, 2024). through a combination of tailored training programs, technology upgrades, process redesigns, and continuous feedback loops, social work 1 leadership development 2 performance improvement 3 organizational alignment 4 succession planning 6 conflict transformation 8 emotional intelligence 9 stress management 10 organizational culture 5 change management 7 decision making skills watkins/executive coaching for swk faculty 205 schools and departments can use executive coaching to create an environment that fosters continuous improvement, encourages innovation, and ultimately drives better results across all levels of the organization, from individual contributors to high-level teams (lawton-smith & cox, 2007; onyishi et al., 2021). organizational alignment is a critical process that involves synchronizing the efforts, goals, and decision-making of leaders and key stakeholders. by utilizing the company's overarching mission, vision, and strategic objectives, a unified direction and purpose can be created throughout all levels of the organization, which is of primary importance (fergnani & sweeney, 2021). by fostering open communication channels, implementing robust performance management systems, and regularly revisiting and reinforcing the company's core values and long-term goals, organizations can ensure that leaders’ actions and initiatives are consistently driving toward the desired outcomes and creating value in line with the school or department's strategic vision (cahyono, 2024). misalignment can be costly, so when executive coaching helps social work faculty and their high-performing teams fully align with the organization's objectives, it leads to more efficient resource allocation (kulshrestha, 2022), faster decision-making (away et al., 2021), increased employee engagement (narmadha & vinayagam, 2024), and ultimately, improved performance and competitive advantage in the field (septia & shafiyah, 2024). succession planning is a strategic process that identifies, develops, and nurtures highpotential employees within an organization. this can ensure a robust talent pipeline is ready to step into key leadership roles as they become available, thereby maintaining continuity and preserving institutional knowledge (septia & shafiyah, 2024). after systematically assessing the skills, experiences, and leadership qualities of current social work faculty against future organizational needs, schools and departments can use executive coaching to create targeted development plans that provide aspiring leaders with the necessary exposure, training, and challenging assignments to prepare them for increased responsibilities and complex decision-making scenarios (away et al., 2021). effective succession planning mitigates the risks associated with unexpected departures or retirements of social work faculty and fosters a culture of growth and opportunity within the organization (cahyono, 2024). this can lead to increased employee engagement, retention of top talent, and a smoother leadership transition that maintains organizational momentum and strategic direction in the face of change. change management is a valuable skill for leaders in today's dynamic organizational environment, encompassing the strategies and techniques needed to guide an organization and its people through transitions, whether structural reorganizations, technological implementations, or shifts in company culture. adaptability is crucial; therefore, effective change management requires leaders to communicate a compelling vision for the future (cahyono, 2024; fergnani & sweeney, 2021), address concerns and resistance from stakeholders (plotkina & sri ramalu, 2024; ramirez, 2024) and provide the necessary support and resources to facilitate a smooth transition while maintaining operational efficiency and employee morale (wang et al., 2024). utilizing executive coaching to enhance the change management capabilities of social work faculty, schools, and departments increase the likelihood of successful transformations (pandolfi, 2020), minimize disruptions to productivity (smith & johnson, 2018), and foster a more agile and advances in social work, spring 2025, 25(1) 206 resilient social work workforce. ultimately, this workforce will be better equipped to thrive in an ever-evolving societal landscape (the conference board, 2023; offstein et al., 2020), driving innovation and maintaining competitive advantage. conflict transformation is a concept that reframes potentially destructive situations as opportunities for systemic change and personal development, leading to more resilient and understanding exchanges among team members (miall, 2004; turbanti, 2023). unlike conflict resolution, transforming conflict enables leaders to address and navigate disagreements, competing interests, and interpersonal tensions that inevitably arise within teams and across organizational boundaries, ultimately fostering a more harmonious and productive work environment. by developing leaders' conflict transformation abilities, organizations can create a culture where differences are addressed constructively, innovative solutions are generated through healthy debate, and collaborative relationships are maintained even in challenging situations (turbanti, 2023). when equipped with enhanced conflict transformation skills through executive coaching, social work faculty can defuse existing conflicts among faculty, staff, and students, and proactively identify potential sources of tension. this skill leverages their ability to implement strategies that prevent escalation and foster trust and open dialogue, encouraging diverse perspectives while maintaining team cohesion and organizational alignment (turbanti, 2023). enhancing decision-making skills at the executive level is crucial for organizational success. decision-making empowers leaders to navigate complex organizational landscapes, evaluate multifaceted problems, and make informed choices that can significantly impact the company's direction and performance (cahyono, 2024; de haan et al., 2019; garvey et al., 2014). by using executive coaching to develop critical thinking skills, social work faculty can more effectively synthesize vast amounts of information, consider diverse perspectives, and anticipate potential outcomes. this leads to more robust and strategic decision-making processes that align with long-term departmental goals and broader professional objectives (jones et al., 2016). improved decision-making skills result in better outcomes and foster a culture of accountability. it also builds confidence as social work faculty become more adept at balancing risk and reward, adapting to rapidly changing circumstances, and articulating the rationale behind their choices across multiple stakeholders (i.e., department, university, community, and government). emotional intelligence is a critical component of effective leadership, encompassing the ability to recognize and manage one's own emotions while also understanding and influencing the feelings of others, which can significantly impact team dynamics, communication, and overall organizational culture (nesbit, 2012). by developing leaders' emotional intelligence, organizations can foster more empathetic, adaptable, and resilient leaders better equipped to navigate complex situations. the ability to handle complex situations builds stronger relationships across diverse teams and creates a positive work environment that encourages open communication and collaboration (knowles & knowles, 2021). emotionally intelligent social work faculty are not only more effective in motivating and inspiring their students, but they are also better positioned to handle conflicts, manage stress, and make balanced decisions that consider both the rational and emotional aspects of a situation and its potential impact on the school, department, and field. ultimately, social work faculty who work with an executive coach learn how to watkins/executive coaching for swk faculty 207 leverage emotional intelligence in their leadership to improve team performance, engagement, and organizational success in an increasingly complex and interconnected world (nesbit, 2012). stress management is crucial for leaders who face high-pressure situations, demanding workloads, and the need to make critical decisions that can significantly impact their organizations and teams (de haan et al., 2019; garvey et al., 2014). leaders can maintain their mental and physical well-being by developing effective stress management techniques, such as mindfulness practices, time management strategies, and healthy coping mechanisms while improving their overall performance and decision-making capabilities (cahyono, 2024; jones, 2016). social work faculty members benefit individually and collectively by working with an executive coach to implement a comprehensive approach to stress management. it also sets a positive example for the school or department, fostering a culture that values well-being, promotes work-life balance, and ultimately leads to increased productivity, creativity, and job satisfaction across all levels of the organization. organizational culture is the lifeblood of any workplace (hopkins & meyer, 2019). it shapes employee behaviors, attitudes, and overall performance through shared values, beliefs, and practices, which are influenced mainly by leadership at all levels. organizations can create a more cohesive and engaged workforce aligned with their company's mission and goals by developing leadership practices that embody and reinforce desired cultural elements, such as transparency, innovation, and collaboration (narmadha & vinayagam, 2024). by working with an executive coach to model desired behaviors, implement supportive policies, and foster open communication channels, social work faculty can effectively shape and nurture a positive organizational culture that not only attracts and retains top talent but also improves student outcomes, faculty and staff satisfaction, and long-term sustainability in an increasingly competitive higher education landscape. in summary, this ten-construct framework can guide an executive coach’s work with social work faculty members, helping them enhance their leadership skills, navigate the complex academic environment, and improve their effectiveness in their multifaceted roles. executive coaching develops leadership competencies in various professional fields, including academia (de haan et al., 2019). for social work faculty, who often transition into leadership positions without formal management training, coaching can provide vital support in developing the skills (i.e., strategic planning, team management, and organizational leadership) they need for their role and overall career success (nesbit, 2012). implications for social work practice and leadership development this article outlines how social work faculty members can use executive coaching to contribute more effectively to their institutions and communities. here, i illustrate two ways in which executive coaching aligns with current social work values. the first way highlights the connection between executive coaching and the core competencies and principles of the national association of social workers (nasw). a study by bachkirova and colleagues (2020) found that coaching can enhance a professional’s ability to navigate advances in social work, spring 2025, 25(1) 208 ethical dilemmas and improve decision-making processes, aligning with the nasw's emphasis on ethics and values. in addition, coaching can help faculty members develop strategies for conducting more impactful research and translating findings into practice, supporting the nasw's focus on research-informed practice (garvey et al., 2014). there are other ways executive coaching aligns with the nasw competencies and principles (see table 1 for a list), demonstrating that it is the kind of faculty leadership development that can advance individual careers and the profession as a whole. table 1. how executive coaching connects to key nasw competencies and principles nasw competencies & principles the connection to executive coaching ethics & values nasw emphasizes ethical decision-making & conduct. executive coaching can help social work faculty navigate ethical dilemmas across multiple settings. coaches can assist in developing frameworks for ethical decision-making aligned with nasw's code of ethics. diversity & difference nasw stresses the importance of understanding diversity & differences in practice. executive coaching can help faculty develop greater cultural humility, address unconscious biases, & create more inclusive learning environments & research practices. human rights & social, economic, & environmental justice executive coaching can support faculty in aligning their teaching, research, & service activities with these core social work values. coaches can help faculty members strategize, incorporating these principles into curriculum development & research agendas. practice-informed research & researchinformed practice nasw emphasizes the integration of research & practice. executive coaching can help faculty develop strategies to conduct more impactful research, translate findings into practice, & engage in community-based participatory research. policy practice executive coaches can help faculty develop skills to engage in policy practice, including effectively advocating for policy changes & teaching students to do the same. engagement, assessment, & intervention executive coaching can help faculty improve their engagement with students, colleagues, & community partners. it can also aid in developing more effective assessment techniques & interventions for both student learning & program effectiveness. professionalism nasw emphasizes professional conduct & growth. executive coaching supports this by providing a structured approach to personal & professional development. interdisciplinary collaboration executive coaching can help faculty members develop skills for effective interdisciplinary collaboration, a skill that is increasingly important in social work research & practice. technology in social work as technology becomes increasingly integral to social work practice & education, executive coaching can help faculty members adapt to & effectively use new technologies in their teaching & research. the second way executive coaching aligns with current social work values is based on the notion that many social work faculty members want to incorporate social justice principles more effectively into their teaching, research, and service activities. by investing in executive coaching, faculty members can further enhance their performance and watkins/executive coaching for swk faculty 209 strengthen their ability to uphold the social justice principles of our profession. below, i outline ten tangible ways executive coaching can help social work faculty uphold core social justice values in social work. coaching programs can achieve this by enhancing the aspirations of social work faculty members toward broader goals of career navigation, strategic career development, professional development, and personal growth (figure 3). figure 3. ten tangible ways social work faculty can benefit from executive coaching 1. academic leadership: social work faculty often transition into leadership roles without formal training in leadership or management. an executive coach can help develop essential skills such as strategic planning, team management, and organizational leadership. they can provide guidance on how to effectively lead departments, manage budgets, and implement program changes should faculty members assume more administrative roles. if faculty choose not to take on formal leadership roles, executive coaching can still help them navigate professional relationships, hold difficult conversations, and reflect on the day-to-day activities associated with their jobs. 2. balancing multiple roles: the diverse responsibilities of social work faculty—teaching, research, service, and administration—can be overwhelming. an executive coach can help develop effective time management strategies, prioritization techniques, and delegation skills. they can also assist in creating a sustainable work plan that allows faculty members to excel in all areas without burning out. coaches can help faculty learn to say “no” to less essential tasks and focus on the high-impact activities of their roles. career navigation strategic career development professional development personal development • enhancing interpersonal skills • managing stress & burnout • personal growth & self-reflection • adapting to change • improving grant writing & fundraising skills • enhancing research impact • navigating academic politics • career advancement • academic leadership • balancing multiple roles advances in social work, spring 2025, 25(1) 210 3. navigating academic politics: academia can be a complex political environment. an executive coach can offer social work faculty an outside perspective on institutional dynamics and help them develop strategies for building alliances, managing conflicts, and advocating for their programs or research. coaches can also provide valuable perspectives on navigating sensitive situations, such as the tenure and promotion process or taking a stance on interdepartmental politics. 4. career advancement: executive coaching is invaluable for social work faculty members aspiring to higher positions, such as department chairs, deans, or provosts. coaches can help identify and hone the necessary skills for these roles, create career development plans, and provide guidance on building a competitive leadership profile. coaches can also assist in preparing social work faculty for interviews, developing compelling vision statements, and learning to think more strategically about higher education administration. 5. improving grant writing and fundraising skills: securing funding is crucial for many social work faculty members, especially those in tenure-track positions. an executive coach with experience in this area can provide strategies for enhancing grant proposals, developing relationships with funders, and creating compelling narratives for research projects. they can also offer support for building and managing research teams, budgets, students, and multiple projects, as well as disseminating research findings. 6. enhancing research impact: an executive coach can help social work faculty develop strategies to increase the visibility and impact of their research. this may include guidance on publishing in high-impact journals, presenting at key conferences, engaging with the media, and utilizing social media and other platforms to disseminate findings for maximum research impact. executive coaches can also help social work faculty think more broadly about the practical applications and policy implications of their research. 7. enhancing interpersonal skills: effective communication is crucial in academia. an executive coach can help social work faculty strengthen their interpersonal skills, improving their ability to communicate effectively with administrators, teach and mentor students, collaborate with colleagues, and engage with community partners. communication coaching can involve developing better listening skills, learning to provide constructive feedback, and enhancing public speaking abilities for both academic and professional audiences. 8. managing stress and burnout: the pressures of academia can lead to high stress and potential burnout, especially as social work faculty positions become increasingly competitive to obtain and maintain. an executive coach can help social work faculty develop personalized stress management techniques, establish healthy boundaries, and create self-care routines. they can also help identify sources of job satisfaction and align work with personal values, thereby increasing overall fulfillment and resilience. watkins/executive coaching for swk faculty 211 9. personal growth and self-reflection: arguably, the most important advantage of having an executive coach is they can provide a confidential space for self-reflection and personal development. they can help social work faculty identify their core values, long-term career goals, and areas for personal growth. this process can lead to greater self-awareness, improved decision-making, and a clearer sense of purpose in both personal and professional life. 10. adapting to change: as higher education evolves in response to technological advances, economic and political shifts, evolving student demographics, and changing educational approaches, an executive coach can help social work faculty develop the adaptability and change management skills necessary for success. these skills are essential for finding peace and satisfaction in constantly changing and high-paced academic environments. coaches offer support when implementing new teaching methodologies, adapting to online or hybrid learning environments, or leading departmental charges in response to institutional or societal shifts. executive coaching can significantly enhance the effectiveness, satisfaction, and impact of social work faculty in their multifaceted roles. when implemented successfully, executive coaching can provide social work faculty with personalized support beyond traditional professional development offerings. this tailored and targeted professional development opportunity can help social work faculty navigate the unique challenges of academia while continually growing as scholars, teachers, and leaders in their field. potential challenges with executive coaching for social work faculty and how to overcome them despite its benefits, implementing executive coaching programs for social work faculty may not be a straightforward initiative to launch across social work schools and departments. for example, budget constraints may prevent institutions from obtaining resources for faculty development, such as executive coaching. one solution is for schools and departments to explore cost-sharing models, grant funding, or alumni donations to support coaching initiatives (huston & weaver, 2008). additionally, institutions could develop internal coaching capacity by training select faculty members or administrators in coaching techniques, creating a more sustainable and cost-effective model. also noteworthy is that many social work schools and departments offer macro courses that cover topics such as management and leadership. there may be opportunities to further develop the coaching skills of the faculty who teach these courses. they could then partner with the associate dean of faculty affairs or other faculty development offices to offer coaching to social work faculty colleagues. partnering with other departments or institutions to develop a shared coaching program could also help distribute costs while fostering interdisciplinary collaboration. another approach might involve leveraging technology to offer virtual coaching sessions, reducing travel expenses, and increasing accessibility for faculty. additionally, institutions can explore tiered coaching models, advances in social work, spring 2025, 25(1) 212 offering group coaching sessions for broader topics and reserving individual coaching for specific leadership development needs, thus maximizing the impact of available resources. second, the time constraints of social work faculty may influence their likelihood of participating in an executive coaching program. faculty members often need help finding time for additional commitments. still, a solution to this challenge is to offer flexible scheduling and integrate coaching into existing faculty development programs at the school or department level (grant, 2014). this integration could incorporate coaching sessions into regular department meetings or retreats, making them a natural part of the academic calendar. additionally, institutions can offer asynchronous coaching options, such as email or message-based coaching, allowing faculty to engage at their own pace. implementing a micro-coaching approach with brief, focused sessions spread over time could also help address time constraints while maintaining program effectiveness. furthermore, providing incentives, such as workload releases or recognition during tenure and promotion processes (simmons et al., 2022), could encourage faculty participation and demonstrate institutional commitment to professional development. third, resistance to change must be acknowledged. some faculty may be skeptical of coaching's value or be reluctant to participate. however, this resistance can dissipate if institutions communicate clear information and expectations about the benefits of coaching and share success stories from peer institutions (de haan et al., 2016). social work schools and departments could offer pilot executive coaching programs or trial sessions to address this challenge, allowing faculty to experience coaching firsthand without a long-term commitment. engaging respected faculty leaders as early adopters and advocates for coaching programs could help build credibility and encourage participation. creating a supportive community of practice among coached faculty members, who may someday wish to become coaches themselves, could also foster a culture of continuous improvement and peer learning. additionally, framing coaching as a strategic investment in faculty success rather than a remedial measure helps shift perceptions and reduce resistance. fourth, demonstrating the return on investment for coaching programs can be challenging. still, one solution is to develop clear metrics for success, such as improvements in teaching evaluations, research output, or leadership advancement (mukherjee, 2012). social work schools and departments could implement a comprehensive evaluation framework to enhance this approach, including quantitative and qualitative measures (watkins, 2017). this might involve conducting regular surveys to assess faculty satisfaction, self-efficacy, and the perceived impact of the coaching program on their professional development. longitudinal studies tracking the career trajectories of faculty members who are coached compared to those who are not could provide valuable insights into the program's long-term benefits. schools and departments can utilize 360degree feedback assessments both before and after coaching interventions to gain a more comprehensive understanding of faculty performance and changes in leadership skills. furthermore, analyzing department-level indicators such as faculty retention rates, successful grant applications, or improvements in departmental climate could help demonstrate the broader impact of the executive coaching program on the organization. watkins/executive coaching for swk faculty 213 finally, finding qualified coaches is essential. identifying coaches with the right mix of executive coaching skills and understanding of social work in academia can be difficult. however, schools and departments have a choice in how to combat this challenge. one option is to partner with external coaching organizations to develop internal coaching capacity (iordanou et al., 2016). schools and departments can establish a rigorous selection process for external coaches, incorporating criteria specific to social work faculty, such as experience in higher education, an understanding of social work ethics, and familiarity with current trends in social work research and practice. a second, more cost-efficient option is for schools and departments to invest in the professional development of their faculty members, sponsoring them to obtain coaching certifications from reputable organizations, thus building a pool of internal coaches who already possess deep knowledge of the academic context. establishing a mentorship program where experienced faculty coaches can guide junior faculty colleagues could also help bridge the gap between coaching skills and academic expertise. furthermore, institutions could explore collaborative partnerships with other social work programs or schools to share coaching resources and expertise, creating a network of qualified coaches familiar with the unique demands of social work faculty. these trained coaches could assemble at the annual society for social work and research (sswr) conference and the council on social work education (cswe) annual program meeting for annual check-ins and professional development opportunities, as well as to compare notes on their ongoing coaching programs at their respective schools and departments. conclusion executive coaching represents a powerful tool for enhancing the effectiveness, satisfaction, and impact of social work faculty in higher education. this article presented the science of executive coaching and how it aligns with social work faculty's research, teaching, and service responsibilities. it also provided a framework for applying and measuring executive coaching in professional development for social work faculty. executive coaching can address the unique challenges faced by social work faculty by enhancing leadership, teaching, and research productivity, ultimately improving faculty, student, and institutional outcomes. as social work schools and departments continue to navigate the complex academic landscape, investing in executive coaching for faculty should emerge as a strategic initiative. the benefits of such programs extend beyond individual faculty members to encompass entire schools, departments, institutions, and, ultimately, the field of social work as a whole. by equipping faculty with enhanced leadership skills and strategic thinking capabilities, executive coaching helps ensure that social work education remains vibrant, relevant, and impactful in 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(2017). mixed methods research. in in f. ross-sheriff & j. orme (eds.), encyclopedia of social work (online). nasw press and oxford university press. author note: daphne c. watkins, social work, university of michigan, 1080 s. university avenue #60 ann arbor, mi 48109-1106. phone: 734.647.0161 fax: 734.763.3372 email: daphnew@umich.edu https://www.conference-board.org/publications/global-executive-coaching-survey-2023-report https://www.conference-board.org/publications/global-executive-coaching-survey-2023-report https://doi.org/10.1007/978-3-031-12463-1_11 https://doi.org/10.1080/23303131.2017.1421284 https://doi.org/10.1080/23303131.2017.1421284 https://doi.org/10.1108/bpmj-11-2023-0869 https://doi.org/10.1108/bpmj-11-2023-0869 https://doi.org/10.1108/bpmj-11-2023-0869 https://doi.org/10.1093/acrefore/9780199975839.013.989 mailto:daphnew@umich.edu _________ michael gearhart, phd, associate professor, school of social work, university of missouri-st. louis st. louis, mo. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 639-656, doi: 10.18060/27431 this work is licensed under a creative commons attribution 4.0 international license. injustice is ahistorical: a case study of st. louis michael gearhart abstract: the purpose of this paper is to demonstrate the importance of historical context in social work practice, research, and teaching. understanding the evolution of racist policies and practices is necessary for developing antiracist practices that promote racial equity. using st. louis as a case study, the manuscript describes how racist policies and practices evolved over time between the 1900s and 1970s. these policies and practices will be examined at three levels: individual, local governance, and federal policy. the discussion section describes the implications of this history for contemporary social work research, practice, and education. in practice, understanding our history is necessary so we can identify when we are using racialized practices and hoping for different results. understanding the historical context of our research can identify when our results provide support that racist policies and practices are working as designed. the interconnectedness of racist policy and practice necessitates re-thinking social work education, particularly as it relates to the divide of micro and macro social work practice. keywords: st. louis; antiracism; history; racism; social work antiracist practice values not only teaching about and addressing oppressive systems in the present day, but also understanding the historical development of these systems (kendi, 2016, 2023). failing to learn from the history of racist policies and practices will at best limit the effectiveness of social work practice. at worst, it will cause social workers to perpetuate racial inequality. as kendi (2023) suggests, there is no such thing as being “not racist”—there is only racist and antiracist. not teaching history to social workers perpetuates racism in our profession. thus, it is necessary for social work to not only teach that systems of oppression exist, but also how they have evolved over time in order to create equitable practices that create a more just world (uehara et al., 2013). this manuscript provides a brief overview of how racist policies and practices affected racial segregation in st. louis between 1900s and the 1970s. these policies and practices will be examined at three different levels: individual, local government, and federal policy. the manuscript is not meant to be an exhaustive discussion on racist policy and practice in st. louis (see johnson, 2020 or kendi, 2016; rothstein, 2017 for in-depth accounts of st. louis and the united states respectively). rather, the purpose of the paper is to use st. louis as a case study to show why social work needs to root contemporary research, practice, and education in historical context. st. louis: overview given the unique geopolitical environment of st. louis, it is important to first discuss terminology that plays a key role in racist policy and practice. the first is that st. louis city and st. louis county are two distinct counties (johnson, 2020). the shaded area in figure 1 is st. louis county whereas the teardrop shaped area between st. louis county and the mississippi river is st. louis city (also known as st. louis city county). the dotted lines in st. louis city represent the central corridor, a about:blank advances in social work, fall 2024, 24(3) 640 roughly one-mile-wide strip that contains major attractions and amenities including forest park, major hospitals and universities, downtown st. louis, and the mayor’s office. the central corridor is also home to the central west end, a historically wealthy area in st. louis city (mallach, 2020). though not a formal municipal border, the central corridor divides north city and south city. the northern border of the central corridor is delmar boulevard, a highly publicized symbol of racial segregation in st. louis and the country (rigel hines, 2019). as represented by the municipal borders in figure 1, the city-county divide resulted in massive suburbanization and institutional fragmentation within st. louis county (swanstrom, 2019). the following sections will highlight how the fragmentation between st. louis city and county, north city and south city, as well as within st. louis county are key drivers of racial segregation in the region (swanstrom, 2019). early segregation efforts focused on concentrating black residents in north st. louis city. as the power behind segregation weakened, segregationist efforts were aimed at preventing the expansion of black residents into st. louis figure 1. map of st. louis city and st. louis county figure created using google maps gearheart/injustice is ahistorical 641 county. eventually, these efforts evolved into attempts to limit black residents’ home ownership to north st. louis county. st. louis racial segregation 1900s-1970s the role of individuals discussions of racial zoning, racism, and segregation tend to focus on specific individuals or groups. narrowing the focus of racism to select individuals minimizes how common racist beliefs were among the general public (jeffries, 2019). racist sentiments may not have been universal among st. louisans. however, the examples discussed in this section demonstrate that racist beliefs among individuals were both prevalent and persuasive in terms of establishing and maintaining racial segregation in the region. zoning ordinances played a key role in driving racial segregation across the united states, including in st. louis (rothstein, 2017). for example, a racially exclusive zoning ordinance in st. louis stated that black individuals could not buy a home on a block that was at least 75% white (johnson, 2020). geographically, these ordinances zoned black residents into neighborhoods located almost exclusively in north city and north county (gordon, 2008). in many cities, such ordinances were created by elected officials. however, st. louis’ racial zoning is relevant to a discussion of the importance of individuals in promoting segregation because zoning ordinances were enacted by voters through popular referenda (johnson, 2020). thus, racially exclusive zoning ordinance was developed by people, successfully circulated via petition, and the majority of voters approved racial segregation in the voting booth. the supreme court of the united states ruled that racially exclusive zoning was unconstitutional in buchanan v. warley (1916). in response, the real estate industry in st. louis promoted segregation through realtors’ agreements. a precursor to racial steering, realtors agreed to show homes in certain neighborhoods to potential homebuyers of a specific race (rothstein, 2017). though realtors’ agreements covered a slightly larger geographic area for black prospective homebuyers compared to racial zoning ordinances, realtors’ agreements still concentrated black residents in north city (gordon, 2008). restrictive covenants, a practice where homeowners stipulated in their deed whether black people were excluded from purchasing the property, were another powerful tool for reinforcing segregation through the real estate market. for example, a 1940 area description of ferguson, missouri, conducted by the home owners loan corporation (holc, 1940), concluded that ferguson “is restricted to prohibit residence of negroes in its limits” (b-27). although ferguson did not have a municipal ordinance restricting home ownership to whites, restrictive covenants were so common in ferguson that the holc reviewer assumed there was a blanket restriction in place (holc, 1940). ferguson was not an anomaly. over 80% of st. louis county homes built by 1950 had a deed restriction (gordon, 2023). in other words, 80% of homeowners in the st. louis region played a direct role in driving racial segregation by actively choosing to put restrictive language in their deeds. a variety of social pressures reinforced segregation. a news story from the st. louis star and times (1924) blamed “unscrupulous real estate agents of both races” advances in social work, fall 2024, 24(3) 642 for the expansion of black residents into a larger section of north city. in 1949, the missouri supreme court ruled that sellers could sue real estate agents for damages if they sold their home to black homebuyers (this ruling was declared unconstitutional in 1953). news stories reported violence against black homebuyers in diversifying areas ranging from vandalism to physical violence (johnson, 2020). the cities of creve coeur and black jack provide staggering examples of the lengths white residents were willing to go to in order to reinforce racial segregation. in the 1950s, dr. howard venable bought land, obtained permits, and began construction on a home in creve coeur, an all-white municipality in the western section of st. louis county. dr. venable was head of the department of ophthalmology at homer g. phillips hospital, a professor at the st. louis university school of medicine, and was active in terms of community service, earning the outstanding humanitarian service award from the american academy of ophthalmology in 1944 (johnson, 2020). dr. venable was also black. white residents, upon discovering the race of their new neighbor, attempted to buy the property from dr. venable, who declined the offer. in response, white residents pressured the local government and elected a new mayor. the newly elected government had the property condemned so that the municipality could build creve coeur park. these actions were declared constitutional in 1959 by the missouri appeals court because race was not explicitly mentioned in the justification for purchasing the land (johnson, 2020). unfortunately, stories like dr. venable’s (and the white residents who prevented him from moving into creve coeur) are not uncommon in st. louis. in 1968, st. mark’s united methodist church received funding to construct a racially integrated apartment building in black jack, which was an unincorporated area in north county. upon hearing about the mixed-race development, white residents organized, incorporated as the city of black jack, and re-zoned the site of the proposed development (johnson, 2020). a missouri district court would later rule these actions unconstitutional because “racial criticism [of the development] was made and cheered at public meetings. the uncontradicted evidence shows that, at all levels of opposition, race played a significant role in both the drive to incorporate and the decision to rezone” (united states v. city of black jack, missouri, 1974, p. 5). the term “structural racism” typically causes people to equate racism with institutions (jeffries, 2019; kendi, 2023). institutions play a vital role in promoting racist policies and practices, but focusing too narrowly on institutions removes people from the discussion. minimizing the role of people in the creation and maintenance of racist policies and practices distorts the pervasive reality of racist beliefs and minimizes responsibility of all people to address the impact of these beliefs (kendi, 2023). in terms of racial segregation, st. louisans were not passive bystanders. though racist sentiments may not have been universal, restrictive language was found in 80% of deeds from homes built by 1950. people did not always perpetuate racial segregation using highly visible means (e.g., the east st. louis massacre) and racist sentiment was not just practiced by subgroups of people who were overtly racist (e.g., the veiled prophet; jeffries, 2019; johnson, 2020). rather, racist policies and practices were often a collective effort. thus, contemporary efforts to reverse the impact of racist policies and practices must be an equally collective effort. gearheart/injustice is ahistorical 643 the role of local government as seen in the examples above, individuals played a key role in pressuring local government officials to maintain racial segregation. however, local government also had a direct role in creating and maintaining racial segregation without public pressure. when examining red lining maps (gordon, 2008) or blight maps in city plans (st. louis city plan commission, 1947), north city and south city appear similar in terms of economic struggles. however, racial zoning ordinances combined with realtors’ agreements and deed covenants concentrated black residents in the northern part of st. louis city. as a result, north and south st. louis received very different responses from local government despite facing similar challenges. for example, the 1907 city plan called for creating linkages between various immigrant communities including italian, german, russian, and jewish residents. but the plan recommended that chestnut valley, a predominantly black section of st. louis, be turned into a public park (johnson, 2020). the 1907 plan created the blueprint of demolishing black neighborhoods for “public” amenities that was used by creve coeur residents to condemn dr. venable’s home nearly fifty years later. harland bartholomew served as the st. louis city planning commissioner from 1919 to 1950 and was a key figure in st. louis’ segregationist efforts (johnson, 2020). he also had a profound impact on segregation across the country; he created plans for kenosha, wisconsin; peoria, illinois; newark, new jersey and other cities. bartholomew’s greatest contribution to racial inequality was understanding the importance of language. he used seemingly “race neutral” language to promote racial segregation. for example, bartholomew believed that “zoning is a justifiable use of the police power in the interests of health, safety, and the general welfare” (johnson, 2020, p. 292). health, safety, and social welfare were frequently used, racially coded terms that drove segregation in local policy. a major reason why “race neutral” narratives reinforce racist policies and practices today is that they are rooted in racist sentiment. one of bartholomew’s early acts as city planning commissioner was the 1919 city plan (johnson, 2020). in the plan, north city was zoned for high density housing (johnson, 2020). conversely, south city was repeatedly zoned and rezoned for low and medium density housing. high density housing served two primary purposes. first, high density housing meant that more black families could occupy a smaller geographic footprint in north city. second, “high density” became a commonly used “race neutral” term to drive racial segregation and disinvestment in st. louis city (cambria et al., 2018). by bartholomew’s own admission, his approach to zoning would “preserve those districts [i.e., north and south city] in their present condition” (johnson, 2020, p. 293). in short, the city of st. louis was intentionally preserving racial segregation. in many areas of north city, white landlords bought homes and rented them to black families, but did not typically update the properties to accommodate the new zoning. homes that were originally oneor two-family units now held four or five families (johnson, 2020). this meant that some families did not have access to a kitchen, bathroom, or other amenities within their rental unit. families often built outbuildings such as exterior stairs and outdoor plumbing to make their homes habitable (johnson, 2020). these adaptations, which were necessary for the survival of black families being exploited by landlords and city zoning, would come back to haunt black residents of north city in the 1947 comprehensive city plan. advances in social work, fall 2024, 24(3) 644 the 1947 comprehensive city plan was one of harland bartholomew’s last major acts as city planning commissioner. it also highlights the intersection of racism, economics, and local policy. according to the assessment in the 1947 plan, blighted and obsolete buildings were fairly evenly distributed across the city (city plan commission, 1947). once again, the plan had very different responses for north and south city despite similar conditions. north city was zoned for high density units whereas south city was zoned to preserve medium and low density units (city plan commission, 1947). as we will see in the following section, the 1947 city plan was instrumental in determining which sections of st. louis would be demolished for subsidized housing and “urban renewal” programs in the following decades. these programs would have a disproportionate, negative impact on the predominantly black residents in north city. like many zoning documents in st. louis, the 1947 city plan rarely mentioned race explicitly (city plan commission, 1947). instead, the city focused on economic factors to justify preserving south city and demolishing north city. for example, up to 60% of the homes in the predominantly black north city neighborhood of desoto-carr did not have access to indoor plumbing. increasing access to indoor plumbing is a worthy and seemingly race neutral goal. however, overt racial exclusion in the early 1900s meant that black st. louisans were concentrated in north city. north city was rezoned for higher density homes in the 1920s, 1930s, and 1940s. landlords did not typically update their properties to accommodate the influx of predominantly black residents. as a result, black families were considerably more likely to live in a housing unit that did not have indoor plumbing. therefore, black families were compelled to adapt by building exterior structures including toilets. these survival mechanisms were used as a justification to demolish predominately black neighborhoods. though the 1947 city plan primarily relied on economic justifications to continue driving racial segregation, race and racism still mattered. ladue, a wealthy municipality in st. louis county, was green-lined because it contained “not a single foreigner or negro” (johnson, 2020, p. 317). the holc’s (1940) description of ferguson stated that “an outlying section [of ferguson is] about 30% built up and abutting a large red (colored) area to the west” (c-25). the proximity to black residents was viewed as a threat to development. there is a tendency to treat race and income as two competing explanations for inequality. the 1947 comprehensive city plan shows that, though race and socioeconomic status are not interchangeable, they can both be used to drive racial segregation. focusing exclusively on economics as a justification for “community development” made north city a target for urban renewal programs that decimated predominantly black neighborhoods in north city through land clearance, the concentration of subsidized housing, and highway construction (gordon, 2008; swanstrom, 2019). these programs will be described in the following section because they illustrate how local application of federal programs perpetuated racial inequality. however, local governments did more to promote racial inequality than the biased application of federal programs. one of the most infamous examples is the team four plan (team four inc., 1976). the underlying philosophy of the plan was triaging the region by conserving areas that were already “nice,” redeveloping areas that had, “the potential to attract and improve,” and depleting areas by implementing a “no growth policy until firm market and public resources are available” (team four inc., 1976). gearheart/injustice is ahistorical 645 not surprisingly, the majority of areas marked for depletion were concentrated in north city whereas areas slated for conservation or redevelopment were located in south city (team four inc., 1976). the plan built upon the unequal and racially biased foundation that was created in the preceding decades. it is fair to state that st. louis city never formally adopted the team four plan (johnson, 2020). however, there is a tendency to raise this point and end the conversation as though the team four plan was the only policy affecting st. louis city. there were other problematic practices that capitalized on and exacerbated racial inequality. prior to the team four plan, alderman richard gephardt and alderman john roach introduced alderman bills 19 and 20. these bills proposed preserving 74,000 buildings in south city and demolishing 70,000 buildings in north city where “rehabilitation would be uneconomical” (olson, 2016, p. 337). much like the team four plan, these bills were never enacted (olson, 2016). but gephardt would later guide federal policy as a us congressman, house majority leader, and even as a democratic presidential candidate. john roach would later resign from the board of alderman and head the st. louis community development agency. research highlighting the unequal development of north and south city (mallach, 2020; swanstrom et al., 2015) suggests that community development in st. louis mirrored the philosophical underpinnings behind alderman bills 19 and 20, and the team four plan. much like the 1947 plan, team four, inc. and the alderman behind bills 19 and 20 used seemingly race neutral justifications for their bills. minimizing the harsh reality that local government created and reinforced multiple racist policies and practices prevents us from authentically learning from our history (jeffries, 2019). overt racial zoning was preserved in the 1919 city plan through seemingly race neutral zoning. this zoning, combined with disinvestment and neglect in north city, had a profound impact on which neighborhoods were selected for demolition in the 1947 city plan. this pattern of disinvestment would continue and ultimately determine which areas were “insignificant and not worthy of special maintenance effort” in the 1970s (olson, 2016, p. 337). the belief that development in north city is “uneconomical” (olson, 2016, p. 337) persists. this philosophy is also part of the reason why the region continues to struggle today both in terms of economic recovery and racial disparities (cooper-mccann, 2016; el-khattabi & lester, 2019; fetter, 2023; luce, 2003; mason & thomas, 2010). today, local government is not overtly intentionally driving racial inequality in the region. however, creating stronger linkages between our past and present would identify that we inherited a racialized philosophy of community “development” and racial inequality. the role of federal government the new deal, president franklin d. roosevelt’s domestic policy during the 1930s, aimed to lift the united states out of the great depression (rothstein, 2017). among other measures, the new deal created the public works administration in 1933 to address the housing shortage and create construction jobs across the country. a racebased component of the legislation was the neighborhood composition rule, which stated that urban renewal projects should not drastically alter a neighborhood’s racial composition. the neighborhood composition rule had two major flaws. the first is that the overtly racial practices that concentrated black residents in north city made it easy for local governments to use “race neutral” language to prioritize authentic advances in social work, fall 2024, 24(3) 646 development in white neighborhoods because officials like harland bartholomew could use “south city” as a constitutional substitute for “white.” federal policy created a dynamic of unequal quantity and unequal quality of opportunities for black individuals. the unequal application of the new deal can be seen across the country. of the 26 development projects completed in the northeast and midwest, 6 were for white residents, 8 were for black residents, and 2 were mixedrace, but segregated by neighborhood (rothstein, 2017). thus, white residents in need of housing had more opportunities created for them by the new deal, and white housing developments were typically in desirable areas and closer to amenities compared to developments built for black residents (rothstein, 2017). a second flaw with the neighborhood composition rule is that developers still managed to find ways to drive segregation despite the rule. desoto-carr was an integrated neighborhood in the 1930s. developers originally proposed clearing the land and building low-rise apartments for white residents. the federal government correctly objected to the plan. then, developers created a new plan to for a “mixed race” neighborhood that segregated black and white residents by building. not only is it problematic that developers attempted to impose racial segregation on the smallest scale within their power (i.e., building), but many white residents fled these neighborhoods during development and especially after buildings began desegregating (johnson, 2020). given the immense social, political, and legal pressures described in the previous sections, black residents had considerably fewer housing options outside of north city. another new deal era federal-level driver of racial segregation was the federal housing administration (fha), established in 1934. the first fha underwriting manual provided that “if a neighborhood is to retain stability it is necessary that properties shall continue to be occupied by the same social and racial classes” (rothstein, 2017, p. 65). as was the case with many other policies, overt references to race would evolve into racially coded language. for example, the 1952 underwriting manual focused on “compatibility among neighborhood occupants” (rothstein, 2017, p. 65). though the words in the underwriting manual changed, the fha continued to drive segregation. between 1934 and 1960, the fha covered five times as many home loans in increasingly white st. louis county compared to st. louis city, and only 3.3% of fha-insured mortgages in the city and county went to black residents (johnson, 2020). the fha’s practices affected other federal programs as well. for example, one of the many goals of the g.i. bill was to help veterans buy homes. the veterans administration (va) used the fha’s underwriting manual for granting loans to veterans. because of this, the va denied mortgage assistance to black veterans at a higher rate (rothstein, 2017). this is particularly troubling considering that fha and va loans comprised 50% of the home loans in the 1950s (rothstein, 2017). because home ownership played an important role in wealth accumulation, denying black home buyers loans would have inter-generational economic consequences (sharkey, 2014). though the fha affected segregation by denying loans to black homebuyers, the fha’s real power was in its ability to fund the construction of new developments (rothstein, 2017). much like their lending practices for homebuyers, the fha granted loans to white developments. in 1943, charles vatterot obtained fha funding to create st. ann, a development that would attract white catholics in st. louis. vatterot gearheart/injustice is ahistorical 647 then tried to build de porres, a subdivision for black homebuyers a few miles down the road from st. ann. the fha refused to finance the development, which had a cascading effect on the project. without fha financing, vatterot had to build cheaper units and could not incorporate the same amenities in de porres as he had in st. ann. further, the fha would not finance black homebuyers, which meant that black st. louisans had to rent the housing units (rothstein, 2017). this resulted in a persistent pattern of expanding white st. louisans’ access to home ownership and restricting the quantity (and quality) of home ownership options for black st. louisans. the desire to segregate is also apparent in one of the most popular urban renewal projects of the 1950s: subsidized housing. st. louis government chose to concentrate subsidized housing in north city despite the federal government’s recommendation to use a scatter-site approach (gordon, 2008; rothstein, 2017). eventually, these practices would result in pruitt-igoe, which is one of the most infamous subsidized housing projects in the history of the united states. though it is widely remembered as a failure of public housing, the reality is that pruitt-igoe is a success story in terms of how racist policies and practices on the individual, local, and federal levels intersect. pruitt-igoe was first occupied in 1954, and was the largest subsidized housing project in the city. it was originally a mixed-race complex that was segregated by building. the buildings were integrated in 1955 as the result of a u.s. district court ruling (johnson, 2020). even before the ruling in davis et al. v. st. louis housing authority (1952), white st. louisans opted to not live in pruitt-igoe and instead were part of white flight to the suburbs in st. louis county (swanstrom, 2019). despite white flight, pruitt-igoe was 91% occupied in 1957 and a majority of tenants were black (johnson, 2020). black residents were more likely to live in pruittigoe because of the limited quantity of housing available to black homebuyers as a result of individual (e.g., deed covenants), local (e.g., zoning), and federal practices (e.g., fha lending). despite these challenges, black residents in pruitt-igoe did well in the early years of the complex’s existence (johnson, 2020). however, a combination of factors including cost-saving shortcuts during construction and dehumanizing federal requirements to live in subsidized housing limited the quality of living in pruittigoe. in addition, the city of st. louis did not continue investing in the maintenance of pruitt-igoe. as noted by johnson (2020), the money that could have gone to maintain pruitt-igoe instead went to revitalize downtown st. louis because the city housing authority and city land clearance authority shared a budget. in other words, money that could have been invested in black st. louisans instead was diverted to the central corridor. the discussion of the federal government reveals the myth of “race neutral” policies. though the neighborhood composition rule was designed to preserve the racial composition of neighborhoods, the rule was used to concentrate community development efforts in white neighborhoods and ways were found around the rule to create white enclaves across the region (johnson, 2020). federal agencies like the fha included overt segregationist language in its underwriting manual. though these policies would evolve and adopt seemingly race neutral language, race neutral language was not enough to change the fha’s practice of driving racial segregation. grafting this racialized language onto other polices affected multiple federal programs (rothstein, 2017). our history shows that racial disparities are not the result of race neutral development. thus, policies and practices must explicitly address racial disparities if they are to promote equitable outcomes. advances in social work, fall 2024, 24(3) 648 discussion community development is essential for the prosperity of st. louis. a key question for social work practice is: what does community development look like when we’ve learned from our history? racist policies and practices at the individual, local, and federal levels had compounding effects on each other, creating a robust, multifaceted system of racialized development that still affects st. louis today (mallach, 2020; swanstrom, 2019). understanding that present day disparities are the result of an evolution of racist policy and practice is important. however, understanding how racist policy and practice evolved over time is necessary to dismantle the systems created by racist policies and practices (kendi, 2023). the team four plan is a testament to the impossibility of doing equitable community development while minimizing the reality of historical racism. the plan acknowledged the importance of developing what it called “depletion areas” without harming the people already living there (team four inc., 1976). the plan also acknowledged that “the forces causing [depletion areas] are extremely complex,” and disproportionately affect black residents (team four inc., 1976, p. iii). however, team four inc. (1976) chose to focus on the present realities of depletion areas such as “abandoned buildings, vacant lots, and economic collapse” (p. iii), as opposed to unpacking the racist policies and practices that created depletion areas to begin with. persistent disinvestment in predominantly black neighborhoods prior to 1975 meant that home values were lower in these areas (swanstrom et al., 2015). property taxes and by extension, funding for schools and other amenities were lower in predominantly black neighborhoods as well. over time, the property values of homes in predominately white neighborhoods increased more rapidly than in predominately black neighborhoods, widening the gap between white and black neighborhoods in st. louis (johnson, 2020) and america (rothstein, 2017; sharkey, 2014). as a result, racial segregation was reinforced by focusing on the present realities of depletion, rather than tackling the legacy of racist policies and practices that created depletion areas. some practitioners in the region are challenging the cycle of repeating the past and expecting different results, and addressing underlying issues as opposed to symptoms of deeper problems (krehmeyer, 2022). but what is too often missing from this discussion is an explicit accounting of the “deeper issues” – particularly as it relates to the evolution of racial inequality in the region. the following sections discuss the importance of placing social work practice, research, and education in historical context, particularly in terms of how racist policies and practices shape present day disparities. implications for practice explicitly creating linkages between modern day social work practice and the historical evolution of racist policies and practices is a critical step in antiracist social work (kendi, 2023). while it is particularly important to incorporate historical context in community practice because of the well-established history of discrimination in zoning, real estate, housing, and urban renewal; the history of racist policies and practices in the united states affects all aspects of social work practice (johnson, 2020; kendi, 2016; rothstein, 2017). the belief that development in north city is gearheart/injustice is ahistorical 649 uneconomical persists in st. louis. as a result, the region continues to invest in already thriving areas (fetter, 2023; luce, 2003; mason & thomas, 2010). as made apparent in the historical overview of st. louis, investing in areas with “the potential to attract continued investment” (team four inc., 1976, p. 3) is a consistent, racially coded philosophy of community development. investing funds in vibrant areas has a questionable impact on economic outcomes in st. louis (elkhattabi & lester, 2019; luce, 2003; mason & thomas, 2010). further, it is likely part of the reason why racial disparities persist in the region (cooper-mccann, 2016; elkhattabi & lester, 2019; fetter, 2023; luce, 2003; mason & thomas, 2010). creating stronger linkages between our past and present would identify that st. louis is using a racialized philosophy of community investment and expecting different results. understanding the history of racial segregation is important for clinical social workers as well because racist policies and practices touch nearly every topic related to social justice. in the case of st. louis, challenges in terms of access to healthcare (yearby, 2018); increased rates of police contact, police brutality, and an overreliance on the police to generate municipal revenue (arch city defenders, 2014; u.s. department of justice, 2015); voter disenfranchisement (okonta, 2017), and substance use and mental health issues (st. louis department of health, 2023) are all concentrated in north st. louis county and north st. louis city. because st. louis is not an outlier in terms of racist policy and practice, it is reasonable to suggest that the racialized concentration of social injustice is similar in other areas (rothstein, 2017). rooting contemporary practice in historical context reveals that social workers are more likely to practice in areas that are shaped by racism. because of this, we are also in a unique position to simultaneously provide social services that address the immediate needs of individuals affected by racist policies and practices, and promote broader social change that addresses oppressive structures (wolff, 2013). it is important for social workers to meet people where they are and work to address their immediate needs. however, social workers can also anchor the immediate needs of people seeking services in the broader forces that create and maintain injustices (baines, 2011). incorporating practices like consciousness raising in social work practice can identify shared issues, common interests, and empower individuals to pursue broader structural changes (freire, 2020; pitner & sakamoto, 2016). social workers can assist in these efforts by facilitating opportunities for civic engagement such as voter registration and leveraging organizational relationships to connect individuals with key groups like policymakers (abramovitz et al., 2019). there is an increasing focus on the role of professionals in creating and influencing policies (apgar, 2021; baines, 2011; costa et al., 2021; wolff, 2013). as a profession dedicated to advocating for human rights at both the individual and systems level, all social workers are called to engage in this work (apgar, 2021). despite social work’s foundation in social justice, social workers only engage in moderate levels of activism (krings et al., 2020; mattocks, 2018). however, social workers also engage with people and places often ignored by society or worse, dehumanized and politicized as social problems. as such, social workers are in a position to challenge these highly racialized, dehumanizing narratives at multiple levels (costa et al., 2021). in the civic arena, social workers can expand access to voting; share their experiences with elected officials; and connect policymakers with stories, experiences, and people that are often ignored (apgar, 2021; costa et al., 2021). advances in social work, fall 2024, 24(3) 650 outside of politics, social workers are able to increase the visibility of people and injustice in the general population (costa et al., 2021). increasing our understanding of the historical evolution of racist policies and practices, combined with our proximity to individuals disproportionately affected by structural racism, creates opportunities for social workers to make the contemporary effects of structural racism more tangible to people in our personal and professional networks. by extension, social workers can use this increased awareness to mobilize these networks (costa et al., 2021). americans, particularly white americans, are more likely to deny the existence of structural racism and avoid talking about race or racism in the united states (sullivan et al., 2021). though white individuals with higher levels of educational attainment are more likely to identify as allies, they are less likely to support racial equity in practice (wodtke, 2016). the history of st. louis shows how widespread racist practices were among the population. social workers can play an important role in mobilizing an equally large countermovement. implications for research explicitly situating our research in historical context is necessary if we wish to interpret our work in a way that actively stands against racist policies and practices (kendi, 2023). in social science research methods, “history” typically refers to events, other than the intervention, that may have occurred between the pretest and post-test observations and how these events may have affected the study’s findings (rubin & babie, 2016). based on this definition, history threatens the internal validity of experimental and quasi-experimental research. while this issue is important in terms of causal inference, this definition of history limits our ability to have deeper conversations about how social work can promote equity and inclusion through our research. history, defined as the study of change over time, includes the events that occurred before pre-test observations which can have an impact on findings as well. studies exploring neighborhood development in st. louis utilize datasets that begin in a particular decade (e.g., the 1950s: swanstrom et al., 2015; 1970s: webber & swanstrom, 2014; 1990s: mallach, 2020; or 2000s: fetter, 2023) and assess changes over time. the authors clearly state that racial and economic factors may have affected the relationships under study (mallach, 2020; swanstrom et al., 2015; webber & swanstrom, 2014). however, these data are also biased by the years and decades that precede them. datasets starting in 1950 were affected by harland bartholomew’s 31year career. all told, bartholomew’s reign as planning commissioner included the demolition of over 100 square blocks containing the homes of 100,000 residents. nearly all (95%) of the residents in these neighborhoods were black (johnson, 2020). though this history occurred before the periods under study, it most likely had an impact on studies’ findings because st. louis was already repeating a pattern of racialized “development.” an analysis of st. louis city and st. louis county neighborhoods between 1970 and 2010 (swanstrom et al., 2015) showed that the vast majority of declining, or consistently low-income neighborhoods are located in north city and north county whereas consistently wealthy neighborhoods are concentrated in west county and south county. middle income neighborhoods that are potentially rebounding economically are concentrated in south city (swanstrom et al., 2015). this pattern of rebounding versus declining neighborhoods mirrors the historical pattern of preserving gearheart/injustice is ahistorical 651 and investing in predominately white south st. louis and disinvesting in the predominately black north st. louis. an examination of st. louis city’s black, middle neighborhoods (i.e., neighborhoods that aren’t distressed or thriving) from 1990 to 2015 showed that middle neighborhoods in north city declined considerably more compared to peer neighborhoods in south city (mallach, 2020). mallach (2020) states that the unequal development between black neighborhoods in north and south city may be due to subprime lending. however, subprime lending is not a new or race neutral phenomenon (faber, 2013). the fha’s practice of denying home loans to black homebuyers meant that black individuals were historically more likely to obtain subprime loans (rothstein, 2017). further, unequal investment between north city and south city means that lenders like the fha are less likely to grant loans to homebuyers in north city (johnson, 2020). an examination of tax increment financing (tif) projects in st. louis city from 2010-2020 (fetter, 2023) demonstrates that, although the goal of tif projects is intended to stimulate economic development in distressed neighborhoods, st. louis city concentrates tif funds in low poverty areas like the central corridor (fetter, 2023; luce, 2003; mason & thomas, 2010). the findings of fetter (2023) and others (luce, 2003; mason & thomas, 2010) provide quantitative evidence that st. louis is continuing the pattern of diverting funds from predominately black spaces in favor of investing in places like the central corridor. this pattern of development is limited in terms of its economic impact on the region and may be a reason why racial disparities persist in st. louis (cooper-mccann, 2016; el-khattabi & lester, 2019; fetter, 2023; luce, 2003; mason & thomas, 2010). it is important for researchers to understand how neighborhoods can rebound economically (swanstrom et al., 2015), diagnose the presence and evolution of racial disparities (mallach, 2020), and explore why the pressures of gentrification appear weaker in places like st. louis (fetter, 2023; swanstrom & plöger, 2022). the authors of these studies acknowledge that racial and economic factors influence the relationships under study (mallach, 2020; swanstrom & plöger, 2022; swanstrom et al., 2015). in academic outlets with higher word counts such as dissertations (fetter, 2023) and book chapters (swanstrom, 2019) authors are able provide more historical context. however, the history of racist policies and practices needs to be an explicit part of the interpretation of our findings in all outlets because the findings of contemporary research can be partially attributable to the racialized context of community development over the past century. more importantly, explicitly linking present day research in historical context can inform discussions on how we can develop innovative and equitable practices that end these racialized patterns of development (swanstrom, 2019). implications for education the history of st. louis shows that present day racial disparities were created and are maintained by a complex, multi-level system of beliefs, behaviors, policies and practices. explicitly linking our present to our past is a vital step in antiracist education because these issues are an extension of historical racist policies and practices (johnson, 2020; kendi, 2023; u.s. department of justice, 2015). for example, this manuscript describes how black individuals were concentrated in north city and north advances in social work, fall 2024, 24(3) 652 county and the lack of investment in these areas. as a result, these neighborhoods are still predominately black and have lower property values and by extension, lower property taxes today (johnson, 2020; rothstein, 2017; sharkey, 2014). many municipalities, including ferguson, generate the vast majority of their revenue from traffic fines and court fees (arch city defenders, 2014; u.s. department of justice, 2015). thus poverty at the municipal government level creates a system that incentivizes increased police contact in predominately black neighborhoods. this system is an obstacle to promoting racial equity regardless of police intent. in the words of a ferguson resident, “even if race didn’t matter, it’s gonna look racist if you have police pulling over people for every little thing in a black neighborhood” (gearhart, 2019, p. 73). in addition, using law enforcement to generate revenue perpetuates a cycle where individuals are incarcerated for living in poverty (arch city defenders, 2014). in the words of another resident of ferguson, “you pay $75 of a $300 ticket, miss a payment, then get fined. then there’s a warrant out for your arrest. it’s a crushing system” (gearhart, 2019, p. 73). whether students plan to challenge oppressive systems through policy change, or providing direct care to people caught in these systems, it is important that we place our curricula is historical context so we create explicit linkages between classroom content and antiracist practice. history also highlights the futility of mono-level approaches. simply put, micro or macro practice alone is unable to address the issues facing st. louis or the united states. though there is value in specialization, treating micro and macro practice as competing concentrations is a false dichotomy that undermines the profession’s collective power (rothman & mizrahi, 2014). skills and modalities typically associated with micro practice like active listening, trauma informed care and motivational interviewing play an important role in inclusive, equitable, and effective macro practice (dungy & krings, 2023; finn & molly, 2021; lombard & viviers, 2020). similarly, skills associated with macro practice can help clinicians “shift from social service to social change” (wolff, 2013, p. 10). reconciling the divide between micro and macro practice is a grand challenge of social work because both approaches have value in antiracist practice (rothman & mizrahi, 2014). yet, as a profession, there is a disconnect between micro and macro interventions, and macro practice is marginalized (krings et al., 2020; rothman & mizrahi, 2014). surveys of social work students suggest that, regardless of concentration, students view macro social work as important, so this division is not driven by student interests (krings et al., 2020). shifting away from macro practice limits social work’s ability to change the status quo, which runs contrary to antiracist practice (kendi, 2023). there are multiple resources to help social work educators develop pedagogical approaches that bridge the micro-macro divide (e.g., apgar, 2021; finn & molly, 2021; gates et al., 2023) and i encourage readers to engage with those readings. social work must approach education in a manner that prepares all social workers to practice social change at multiple levels including individual, group, neighborhood, and policy (lombard & viviers, 2020). conclusion the history of st. louis demonstrates the widespread, multilevel, and enduring nature of racist policies and practices. though not an exhaustive recounting of the region’s history, it is apparent that individuals, local governments, and federal policy gearheart/injustice is ahistorical 653 all played a part in creating and maintaining racial segregation in the region. these policies and practices reinforced each other, for example when new deal policies were applied unequally by st. louis government in the 1950s. in addition, they compounded inequality over time. high density zoning in the 1919 city plan contributed to the economic disparities that were used to demolish predominately black neighborhoods in the 1947 city plan. these disparities persist today (johnson, 2020). more importantly, unpacking our history shows how separating research, practice, and education from historical context can result in repeating the same racist policies and practices while hoping for different results. as social workers, we need to situate our work in historical context so we not only understand that racism is a root cause for many of the social injustices we face today, and we can use our knowledge of how racist policies and practices evolved (kendi, 2023). doing so is necessary for developing practices that actively combat the lingering effects of our history and create a more just world (uehara et al., 2013). references abramovitz, m., sherraden, m., hill, k., smith, t. r., lewis, b., & mizrahi, t. 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(2018). racial disparities in health status and access to healthcare: the continuation of inequality in the united states due to structural racism. american journal of economics and sociology, 77(3-4), 1113-1152. author note: address correspondence to michael c. gearhart, 492 ssb, one university blvd. university of missouri st. louis, st. louis, mo 63121. email: gearhartm@umsl.edu https://doi.org/10.5243/jsswr.2013.11 https://law.justia.com/cases/federal/district-courts/fsupp/372/319/1421602/ https://www.justice.gov/sites/default/files/opa/press-releases/attachments/2015/03/04/ferguson_police_department_report.pdf https://openscholarship.wustl.edu/cgi/viewcontent.cgi?article=1837&context=csd_research https://openscholarship.wustl.edu/cgi/viewcontent.cgi?article=1837&context=csd_research https://doi.org/10.1093/socpro/spv028 https://doi.org/10.1093/socpro/spv028 https://doi.org/10.7728/0402201304 https://doi.org/10.7728/0402201304 https://doi.org/10.1111/ajes.12230 https://doi.org/10.1111/ajes.12230 mailto:gearhartm@umsl.edu _________ allison berkowitz, dsw, assistant professor, university of north alabama, florence, al. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 123-140, doi: 10.18060/27271 this work is licensed under a creative commons attribution 4.0 international license. increasing political practice and policy practice in social work students allison berkowitz abstract: political practice and policy practice are critical components of the social work profession, yet social workers and social work students do not fully engage in them. bachelor and master of social work programs (bsw and msw) cover these topics, often through lecture-based instruction; however, a growing body of literature suggests experiential learning is better for building efficacy and interest in them. this article reviews the literature on political practice and policy practice in social work (including teaching approaches), discusses the implications for social work of a decreased emphasis on macro social work, and then explores the results of a new study attempting to address this issue. a one-group, pretest-posttest study was conducted with bsw students (n=66) to evaluate the possible effectiveness of a new training. key findings yielded an increase in the likelihood of the students engaging in political and policy activities in the future (with the most significant effect size related to the likelihood of sending a letter to the editor). based on the literature review and study results, recommendations, with an emphasis on experiential learning activities, are offered for social work educators looking to increase the likelihood of political practice and policy practice engagement in their students during and after going through social work programs. keywords: macro social work; political practice; policy practice; social work education; legislative advocacy; political participation public policies can have life-or-death consequences for social work clients. at the micro level, whether or not a state chooses to expand medicaid can determine whether a client can access needed health care. at the mezzo level, the funding a county allocates to its schools can dictate teacher hiring practices, which can lead to negative ripple effects. for example, a teacher shortage can yield class crowding, learning disruptions, and unmet needs for students with disabilities (lieberman, 2022). or at the macro level, a country’s immigration policies can determine whether young people can be deported to a country their parents fled. these policies–and the elected officials who craft them–are highly relevant to the social work profession and those we serve. nevertheless, social workers and social work students are not as interested in political practice and policy practice as they are in other social work subjects (hill et al., 2017; pawar, 2019). the disinterest is problematic since the public safety net, a set of policies on which social workers and their clients depend, is quickly degrading in the united states (abramovitz, 2020). the degradation makes educating and activating social work students in political practice and policy practice all the more urgent. the present article reviews the literature surrounding political practice and policy practice in social work, mainly related to social work education, then shares the results of a study conducted to evaluate a political practice and policy practice training program. about:blank advances in social work, spring 2024, 24(1) 124 literature review social workers and social work students are uniquely qualified to engage in political and policy realms due to the intimate nature of their relationships with clients and the profession’s mission of attending to the vulnerable, oppressed, and impoverished (national association of social workers [nasw], 2021). the profession believes in this calling so strongly that engaging in political practice is included in the national association of social workers’ code of ethics (nasw, 2021). additionally, policy practice is one of the few core competencies set by the profession’s educational accrediting body (council of social work education [cswe], 2022). formal definitions will be given for political practice and policy practice since they can at times overlap or seem overly similar; however, in plain language this writer thinks of political practice as action taken to affect elections or elected officials and policy practice as action taken to affect policies directly. the formal definition being used here for political practice is the practice of political social work, or “social work practice that explicitly attends to power dynamics in policy-making […] expanding political participation, influencing policy agendas, working on campaigns or in electoral offices, and holding elected office” (lane & pritzker, 2018, p. 4). the definition being used here for policy practice is “using social work skills to propose and change policies in order to achieve the goal of social and economic justice” (cummins et al., 2023, p. 5). lastly, policy activity by social work students is considered here to be under the umbrella of the gal and weissgal (2023) term academic policy involvement. political practice and policy practice of social workers and social work students findings on the political practice of social workers have variability, particularly when looking over decades, but tend to show that social workers engage in higher levels of political activity than the general public (felderhoff et al., 2015; hamilton & fauri, 2001; parker & sherraden, 1992; wolk, 1981). the most common political practice activity among social workers is voting (ostrander et al., 2021). to a lesser extent, other political practice activities by social workers include voter engagement (abramovitz et al., 2019), campaigning (mcclendon et al., 2020), and running for elected office (lane et al., 2018). social work students tend also to show higher levels of political activity engagement than the general public, and similar to social workers, their most common political practice activity is voting (bernklau halvor, 2012; wright, 2019) as well as news-watching and voter engagement (ostrander et al., 2018). less is known about the policy practice activity of social workers, due to research explicitly on policy practice being rare (gal & weiss-gal, 2023). research tends to show low engagement in policy practice among social workers (weiss-gal, 2017) as well as social work students (schwartz-tayri, 2021). one meta-analysis of the social work literature found only 51 studies on policy practice since the 1980s and noted that the studies reported low or very low levels of social worker policy practice engagement (weiss-gal, 2016). this trend of moderate to low engagement in policy practice, while showing some variations, has been observed in studies of countries such as australia, canada, china, berkowitz/political & policy practices in swk students 125 finland, germany, israel, portugal, sweden, and the united states (cai et al., 2022; gal & weiss-gal, 2017; gottwald & sowa, 2019; mendes et al., 2015; ostrander et al., 2021; shewell et al., 2021; tham & thorén, 2020; weiss-gal et al., 2020). regarding which policy practice activity types are engaged in, contacting policymakers is one of the most common among social workers (mendes et al., 2015; ritter, 2007) and students alike (bernklau halvor, 2012; wright, 2019). when looking at more nuanced activity though, with a more significant time commitment, levels of engagement tend to be extremely low. for instance, in reference to testifying before a public hearing, two studies of social workers found only 3-5% of their samples had done so (hamilton & fauri, 2001; ritter, 2007) with similar results among social work students (bernklau halvor, 2012). declining emphasis of macro social work low levels of political practice and policy practice engagement could be partly due to a declining emphasis on macro social work in the overall profession. this could be particularly true of the sometimes-complex legislative advocacy activities needed to impact the creation of laws. for decades academics and practitioners have had concerns about the social work profession focusing far more on individual issues (micro practice) than on systemic ones (macro practice) (apgar & nienow, 2023; reeser & epstein, 1987; reisch, 2016; reisch & andrews, 2002; rothman & mizrahi, 2014; specht & courtney, 1995). micro practice is more popular than macro practice among social workers and social work students (pritzker & lane, 2014; segal-engelchil & kaufman, 2008). furthermore, social workers do not see macro activities as critical to their work (hill et al., 2010) and students do not see them as relevant to their goals (amerman goerdt et al., 2019; anderson & harris, 2005). even social work educators emphasize micro work more than macro (hill et al., 2017; pawar, 2019). one of the ways this depoliticization shows up in the field is the pervasive stigma in social workers being perceived as “being too political” at work (i.e., engaging with clients in simple, permissible, civic discussions, such as encouraging them to vote; hylton et al., 2018). rome et al. (2010) found that over half of the sample of professional social workers never engage in these kinds of discussions with clients. macro work is missing from many social workers’ employers and many social work students’ field placements. one study found that only 2% of the social workers in their sample spent time each week engaging in macro tasks (rothman & mizrahi, 2014). another study, with a sample of almost 40,000 master of social work students, found that only 6% of them were in macro placements (mcbeath, 2016). the implications of this decline in promoting macro social work are severe and far-reaching. thankfully, the picture is not all bleak. in recent years, this trend has been acknowledged as problematic by a number of social workers and they have been taking exciting, organized steps to help turn the tide. three projects which demonstrate this point well are: campaign school for social workers, the special commission on macro practice, and the national social work voter mobilization campaign (nswvmc). first, the university of connecticut’s nancy a. humphreys institute for political social work advances in social work, spring 2024, 24(1) 126 (nahipsw) regularly holds trainings for social workers interested in running for office or working on campaigns (mcclendon et al., 2020). this training has been found to increase participants’ likelihood to engage in political practice (lane et al., 2018). anecdotally, this writer finds these trainings to be incredibly efficacious, as she attended one in 2017 and was running for state office in a matter of months. next, the special commission on macro practice is a highly dynamic group seeking to promote macro social work and rebalance the profession’s current “micro-macro divide” (bailey et al., 2022). lastly, the national social work voter mobilization campaign (nswvmc) works to educate social workers on how they can empower clients with non-partisan voter engagement (hylton et al., 2022). this is just a glimpse of the phenomenal work being done to increase macro practice, but may offer optimism that there is indeed hope. implications for the social work profession at this time in the united states, there is an insufficient number of people-centered policies in place and a dearth of voices calling for them. this is reflected by startling statistics on vital social issues. for example, the united states is experiencing the highest wealth gap since before the great depression (keshner, 2019). with income inequality greater than almost any other industrialized nation (siripurapu, 2022), 43% of americans have recently postponed health care they need (brenan, 2023), 10% of americans are food insecure (u.s. department of agriculture, 2023), and half of american families have inadequate child care (igielnik, 2022). increased political practice and policy practice engagement of social workers and social work students could have untold, positive benefits for the profession and those we serve. as representative ayanna pressley said, “the people closest to the pain should be closest to the power, and […] a diversity of voices in the political process is essential to crafting more effective public policy” (committee to elect ayanna pressley, n.d., para. 1). greater engagement in political practice and policy practice is needed by social workers and social work students to ensure that public policies address the profession’s mission of enhancing human well-being and meeting the basic human needs of all people (nasw, 2021). social workers prefer micro practice over macro, but the two are inextricably linked (rothman & mizrahi, 2014) as many academics argue that all social work is inherently political (lane & pritzker, 2018; reisch, 2016). through this lens (and as echoed by nasw and cswe), the ability to effectively engage in political practice and policy practice is vital for all social workers and social work students. theoretical framework experiential learning theory (elt) denotes a process of activity involving learning while doing (kolb, 1984). researchers in social work have found that experiential learning is effective in teaching political practice and policy practice (apgar & parada, 2018; beimers, 2016; lim et al., 2018; street et al., 2022; wang et al., 2020; weaver, 2005; witt et al., 2020). social work students who took policy courses with experiential learning methods were found to engage in greater levels of advocacy after graduation than those taught with traditional methods (mink & twill, 2012; rocha, 2000; weiss-gal & savaya, berkowitz/political & policy practices in swk students 127 2012). significantly, this pedagogy has also been found to facilitate greater feelings of selfefficacy in social work students (bernklau halvor, 2016; nowakowski-sims & kumar, 2020; weaver, 2005). traits of effective political and policy trainings social work students perceive political practice (meehan, 2021) and policy practice instruction as dry and abstract (heidemann et al., 2011; henman, 2012). trainings must be efficacious to ensure that social workers are competent and confident to engage in political practice and policy practice. historically, social work programs have taught political practice and policy practice courses with a heavy emphasis on theory and lecture (apgar & parada, 2018; ritter, 2013) and as previously stated, this has not resulted in the level of political and policy engagement needed. what makes for effective political practice and policy practice training? critical, evidence-based components are discussed below. individualized students can have trouble seeing the impacts of policies on their clients (sherraden et al., 2015). offering students the flexibility to learn about policy practice through the lens of an issue they care about is valuable and efficacious (henman, 2012; pawar & nixon, 2020). realistic as important as knowledge is, understanding how the system works is useless if participants cannot act. the resource of time is a major determining factor in whether or not a social worker will participate in political activities (verba et al., 1995). social work students have little free time (diebold et al., 2018), thus effective training must be practical and instruct participants in activities that will be accessible in their day-to-day lives. tone/humor policy practice can often seem dense, so using a light-hearted and humorous tone can be helpful. humor helps to learn complex subjects (berk, 2002) and aids learners to be less tense and reactive (lujan & dicarlo, 2016). one researcher found replicable findings that humor helped increase students’ final exam grades by 10% (ziv, 1988). there is sometimes a fear that using humor in the classroom can threaten credibility, but students perceive educators with high humor as more competent than those with low humor (wanzer & frymier, 1999). passionate passion is a critical component of political activity, as passion for an issue helps develop feelings of political efficacy (beaumont, 2011). thus, effective training must tie in with the learners’ passions. grounding a learning activity in a so-called “generative theme,” or something an individual has strong feelings about, helps to break through apathy advances in social work, spring 2024, 24(1) 128 and generate energy and hope (hope & timmel, 1996, as cited in bernklau halvor, 2012). secondary passion can also be beneficial. students find instructors’ passion for policy to be influential and helpful in expanding their appreciation for political advocacy (bernklau halvor, 2016). supportive even if a training contains all the factors listed above, students will not participate politically if they do not feel confident in their abilities (schwartz-tayri et al., 2020). to help increase feelings of confidence and self-efficacy, effective trainings should help students feel supported. bernklau halvor (2016) found that students benefit from having instructors who believe their students can successfully impact the political system in a positive way. about the present study and its aims social workers and social work students are under-engaged in political practice and policy practice. considering the evidence-based qualities of effective trainings described above, a training was designed and implemented to increase political and policy engagement among social work students. the present study sought to evaluate this training. research question: “what is the effect of a short, experiential training using evidencebased qualities towards increasing students’ intent to engage in greater levels of political practice and policy practice?” about the training this training is, by design, introductory and brief. its total duration is about one and a half hours. the training starts with a quick review of some basic political and legislative processes in the united states, but spends the bulk of time on specific political and legislative advocacy skills, such as (1) connecting one’s overall life interests with specific public policy areas, (2) finding organizations to collaborate with on legislative advocacy in areas of students’ interests, (3) finding one’s policymakers, (4) calling policymakers, (5) writing to policymakers, and (6) finding new political candidates who align with one’s values. each skill is briefly introduced and modeled, and then participants are invited to practice the skill. for example, the facilitator discusses the importance of elected policymakers hearing from their constituents. the facilitator then calls a legislator’s office on speakerphone, shares the reason for calling, and describes the action being sought (e.g., “i want the representative to vote yes on…”) before ending the call. participants are then invited to call one of the elected officials whose contact information they looked up earlier in the training. the training strongly emphasizes evidence-based qualities (e.g., using students’ interests, instructor humor, providing support, etc.) to optimize student engagement. while designed and pilot tested as an in-person training, it should be noted that this study was berkowitz/political & policy practices in swk students 129 facilitated virtually due to the timing being early in the covid-19 pandemic. all six trainings were facilitated by the same macro social work instructor and with the same content. methods irb approval this study received institutional review board (irb) approval to be conducted confidentially. students were informed that participation was voluntary, that they could withdraw at any time, that there was no compensation, and that there was little risk. study design this was a one-group, pretest-posttest design. while trainings were facilitated with six different groups of bsw students, between august and october 2020, analyses were done with an aggregate of all participants’ data so this is not being considered a multi-group design. pre-tests assessed students’ levels of attitudes and behaviors using qualtrics software. post-tests were given immediately after trainings, then assessed for potential changes. post-tests also were facilitated with the qualtrics software. recruitment and sampling social work department faculty were contacted to determine interest in having a training facilitation done during one of their classes. this process yielded six groups of students to participate in trainings virtually (classes were being conducted online at this time, as this was in fall of 2020, early in the covid-19 pandemic). the sample was comprised of 66 bsw students at a public regional university in the southern united states. one student (1.5%) identified as nonbinary, four students (6.1%) identified as men, and the remaining 61 (92.4%) identified as women. regarding race, one student (1.5%) identified as asian, 13 students (19.7%) identified as black or african american, and the remaining 52 students (78.8%) identified as white or caucasian. one student (1.5%) was older than 45 years old, seven students (10.6%) were in the 25-34 age range, and the remaining 58 (87.9%) were in the 18-24 age range. measures the pre-test survey first solicited demographic information. likert scales then measured students’ political and policy activity level. the post-test used the same format but omitted demographics and added one optional, open-ended question asking if there was anything participants would like to share about the training or related topics. the main instrument adapted for the preand post-test was the individual orientation toward engagement in social action scale (iotesa). the iotesa, which leans more towards measuring political practice than policy practice, and exhibits strong reliability and advances in social work, spring 2024, 24(1) 130 validity. cronbach’s alpha (α) for the scale was .96 and the coefficient of determination (r-squared) was .364 (corning & myers, 2002). while the scale has 35 questions, only 10 were used in the survey (possible implications on validity are discussed in the “limitations” section). the 10 questions asked how likely participants were to engage in activities like campaigning for a candidate, voting, and emailing a public official. these questions were posed with options: “extremely unlikely,” “unlikely,” “likely,” and “extremely likely.” for analysis, these were recoded from 0 (extremely unlikely) to 3 (extremely likely). in light of the pre-test and post-test being taken so closely together, measures were taken to help strengthen the validity of the study and its questionnaire. those measures included basing the survey on an established instrument (corning & myers, 2002), pilot testing the survey prior to giving it to students, and using a standard measurement procedure with each of the six cohorts. analysis data were analyzed using the statistical package for the social sciences (spss) version 27. a total of 90 pretests and 75 posttests were recorded. pre-test and post-test data were paired, and unpaired test data were discarded. in total, 66 complete sets of data were viable. analyses were conducted to determine the difference in participants’ likelihood to engage in activities between before and after they received the training. because the data are ordinal (questions had options such as likely and unlikely), a wilcoxon signed-rank test was conducted instead of a paired samples t-test. the level of significance was set at p < .05. effect sizes for each item were calculated as r = z / n½, with z being the wilcoxon signed-rank statistic and n being the number of paired samples (rosenthal, 1994). the values 0.1, 0.3, and 0.5 were considered the cut-off for small, medium, and large effects. results for nine of the ten questions, participants were more likely to engage in political and policy activity after receiving the intervention. question 6 (“how likely are you to send a letter or e-mail expressing a political opinion to the editor of a periodical or television show?”) had the most significant effect size (r = .75, p < .001). questions 2 (“how likely are you to organize a political event [e.g., talk, support group, march]?”), 4 (“how likely are you to campaign door-to-door for a political candidate?”), and 8 (“how likely are you to send a letter or e-mail about a political issue to a public official?”) also had large effect sizes (rs > .50, ps < .001). questions 1, 3, 7, 9, and 10 had moderate effect sizes (rs > .30, ps < .01). question 5 (“how likely are you to vote in a non-presidential federal, state, or local election?”) did not have a statistically significant effect size (r = .17, p < .165); however, participants reported a high likelihood for this question on the pretest, indicating a potential ceiling effect and leaving little opportunity for growth as a result of the training. see table 1 below for full results. one optional, open-ended question was asked at the end of the participant post-test inviting students to share any thoughts they had on the training or related topics. nine of berkowitz/political & policy practices in swk students 131 the 66 participants answered this question substantively (five additional answers were recorded saying some version of “n/a”). seven of the nine responses were positive and were either directly about the training (e.g., “this was a great overview training of basic knowledge social workers should be aware of and more proactive things we can do to get involved”) or shared something the student learned in the training (e.g., “i did not know that it was so easy to advocate on behalf of a law by simply calling or emailing an official.”) two responses were neutral and about students’ thoughts more broadly (e.g., “i think politics are most of the time a game of who is popular but legislation is very important. the general public just needs more education.”) table 1. change in likelihood to engage in political and policy practices question mb ma w r p q1: how likely are you to purchase a poster, tshirt, etc. that endorses a political point of view? 1.11 1.38 241.5 .44 <.001 q2: how likely are you to organize a political event (e.g., talk, support group, march)? 0.92 1.31 313 .57 <.001 q3: how likely are you to go out of your way to collect information on a social or political issue? 1.68 1.94 322 .37 .002 q4: how likely are you to campaign door-todoor for a political candidate? 0.70 1.08 253 .58 <.001 q5: how likely are you to vote in a nonpresidential federal, state, or local election? 2.11 2.20 114 .17 .165 q6: how likely are you to send a letter or e-mail expressing a political opinion to the editor of a periodical or television show? 0.89 1.65 741 .75 <.001 q7: how likely are you to distribute information representing a particular social or political group’s cause? 1.52 1.77 230 .39 .002 q8: how likely are you to send a letter or e-mail about a political issue to a public official? 1.27 1.71 520 .51 <.001 q9: how likely are you to attend a talk on a particular group’s social or political concerns? 1.65 1.91 315 .33 .005 q10: how likely are you to keep track of the views of members of congress regarding an issue important to you? 1.71 2.05 334 .44 .002 note. total participants (n) was 66. mb represents the mean before and ma represents the mean after. w stands for the wilcoxon signed-rank statistic and r denotes the correlation coefficient. the probability value is represented by p. questions were posed with answer options: extremely unlikely, unlikely, likely, and extremely likely. for analysis, these responses were recoded from 0 (extremely unlikely) to 3 (extremely likely). effect sizes for each item were calculated as r = z / n½, with z being the wilcoxon signed-rank statistic and n being the number of paired samples (rosenthal, 1994). cut-off values of 0.1, 0.3, and 0.5 were used for interpreting small, medium, and large effects. the significance level was set at p < .05. advances in social work, spring 2024, 24(1) 132 discussion students participated in a brief, experiential training to increase their likelihood of engaging in political practice and policy practice in the future. before and after the training, students completed questionnaires about levels of related activity engagement. students expressed a greater likelihood of engaging in political practice and policy practice after the training than before for nine of the ten items, indicating that this training effectively increased students’ desire and intent to engage in political practice and policy practice. the findings are consistent with previous research showing that experiential learning is very effective. notably, the one question that showed no significant improvement following the training (i.e., likelihood to vote in a non-presidential election) is the question that appeared to be near the ceiling on the pretest. this finding is consistent with previous research indicating that most social workers (ostrander et al., 2021) and students (bernklau halvor, 2012) already vote in high numbers. student insights one optional, open-ended question was asked at the end of the participant post-test inviting students to share any thoughts they had on the training or related topics. nine of the 66 participants answered this question and three key themes emerged. first: students found that having complex systems explained simply, and being given concrete advice on meaningful engagement, was extremely helpful (e.g., “i am interested in taking more action in politics because i was given practical ways that i can help make change.”) second, students expressed surprise and/or relief having seen legislative advocacy skills modeled (e.g., “i did not know that it was so easy to advocate on behalf of a law by simply calling or e-mailing an official.”) third was feelings of confidence and/or empowerment (e.g., “i now have a new outlook on what i can do to help better the community we live in.”) recommendations social workers and social work students increasingly perceive politics and policy as something disconnected from or not applicable to them (amerman goerdt et al., 2019; meehan, 2021). we must find ways to break through and help them make these crucial connections. based on the literature presented here, and supported by the findings from the present study, social work programs are encouraged to evaluate their political practice and policy practice curriculum and teaching methods, and ensure that they are utilizing experiential components. doing this can help reframe political practice and policy practice much more actively and strategically than classes taught without experiential learning (schwartz-tayri et al., 2020). utilizing experiential activities can also promote future political practice and policy practice engagement (nowakowski-sims & kumar, 2020; street et al., 2022; wang et al., 2020). experiential learning activities for political practice and policy practice need not be grand. simple tasks can be beneficial such as signing up to receive action alerts (tower & hartness, 2010). a variety of writing activities can be effective too, such as policy briefs (sundet & kelly, 2002), social media posts (derigne et al., 2014; rocha, 2000), blogs (derigne et al., 2014), and authoring letters to the editor or to legislators (derigne et al., 2014; rocha, 2000). this is particularly true as related to areas of students’ interests berkowitz/political & policy practices in swk students 133 (henman, 2012). these activities can be easily interspersed throughout the curriculum and spread over a semester as appropriate (zubrzycki & mcarthur, 2004). experiential activities can also be more expansive and involved, like conducting student debates (keller et al., 2001); visiting a legislative office (manalo, 2008); spending a whole day learning and advocating in a state capitol (beimers, 2016; nowakowski-sims & kumar, 2020); or spending additional time explicitly preparing for these events at the capitol (kilbane et al., 2013). these activities can be particularly engaging when using cases in students’ own communities and states (wolfer & gray, 2007). to end this section, some additional recommendations are being shared from the academic literature regarding helping to promote macro work in social work educational programs. reisch (2016) noted that much of this work can be done outside of bsw and msw curricula. partnerships outside of academia can reinforce this change in culture by working with various stakeholders in the community (weiss-gal, 2017). reisch (2016) suggested building an appreciation of macro social work, particularly the profession’s role in policy change, into the culture of programs through informal activities like orientations and lunchtime talks. we can also make sure to bring political practice and policy practice up when discussing topics related to human rights (mcbeath, 2016). one last valuable resource is educators themselves. instructors’ excitement and enthusiasm can be a helpful tool for engaging students’ interests in policy practice and political social work (pritzker & lane, 2014). study limitations this study was done virtually with undergraduate students in the first year of the covid-19 pandemic, which understandably was found to increase stress among this population (wilson et al., 2021). this heightened stress may have impacted students’ answers on preand post-tests. it is also possible that social desirability impacted how students answered questions, biasing students’ responses towards those that appear more socially acceptable. another limitation is that the study used convenience sampling, which yielded a relatively homogenous group (most students identified as white women in the 18-24 age range). future studies should endeavor to do random sampling where possible and for greater generalizability. the pre-test and post-test relevant to this article was adapted from the individual orientation toward engagement in social action scale. while this scale has substantial levels of reliability and validity, the preand post-tests only used 10 of the scale’s 35 items; the reliability and validity of partial use of this scale have not been researched. additionally, given that the preand post-tests were given in such close proximity, the validity of the measure of changes in students may be limited. lastly, while the results of the present study alluded to a strong potential for behavior change, one study showed that similar interventions may not have a long-lasting impact (segal-engelchin et al., 2017). in addition to getting students more engaged, how to keep them engaged over time needs further study. advances in social work, spring 2024, 24(1) 134 further research the training described in this article was designed to have social work students meaningfully and personally engage in political and policy skill-building and to increase their interest in these activities. it may be worth doing additional research on this training to see if the results are replicable and to determine why some elements showed more change from preto post-test than others. future qualitative research could also be useful to better understand fears or misconceptions which may contribute to the lack of full engagement in political practice and policy practice of social workers and social work students. understanding these attitudes and experiences in greater depth may help researchers determine best practices to move social work students from anxieties and misunderstandings, closer to confident action. conclusion the intervention described in this paper increased students’ intent to engage in political practice and policy practice. the research adds to a growing body of scientific literature, reinforcing that experiential learning is helpful for training social work students on the topics of political practice and policy practice. this research is timely, given that the social work landscape 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(2004). preparing social work students for policy practice: an australian example. journal of social work education, 23, 451-464. author note: address correspondence to allison berkowitz, department of social work, university of north alabama, una box 5029, florence, al, 35632. email: aberkowitz@una.edu https://doi.org/10.1300/j067v25n03_07 https://doi.org/10.1300/j067v25n03_07 https://doi.org/10.1111/ijsw.12239 https://doi.org/10.1111/ijsw.12239 https://doi.org/10.1080/13691457.2018.1499614 https://doi.org/10.1080/13691457.2018.1499614 https://doi.org/10.1080/15588742.2012.655550 https://doi.org/10.1080/15588742.2012.655550 https://doi.org/10.1123/jpah.2020-0325 https://doi.org/10.1123/jpah.2020-0325 https://doi.org/10.1123/jpah.2020-0325 https://doi.org/10.1300/j067v27n01_03 https://doi.org/10.1300/j067v27n01_03 https://doi.org/10.1007/s42972-020-00009-8 https://doi.org/10.1007/s42972-020-00009-8 https://scholarworks.lib.csusb.edu/etd/815 https://scholarworks.lib.csusb.edu/etd/815 https://doi.org/10.1080/00220973.1988.10806492 https://doi.org/10.1080/0261547042000245044 https://doi.org/10.1080/0261547042000245044 mailto:aberkowitz@una.edu _________ matthew p. decarlo, phd, assistant professor, school of education and human development. saint joseph’s university, philadelphia, pa. mary nienow, phd, lisw, associate professor, school of social work, new mexico state university, las cruces, nm. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 515-532, doi: 10.18060/28574 this work is licensed under a creative commons attribution 4.0 international license. in pursuit of the status quo: aswb's research, grantmaking, and regulatory practices matthew p. decarlo mary nienow abstract: the association of social work boards (aswb) examination program is used in all 50 states to regulate the practice of clinical social work and in the majority of states to regulate the practice of master’sand bachelor’s-level social work. after releasing descriptive data demonstrating biases in exam pass rates by race, age, and dominant language, aswb engaged in research and regulatory actions that violate social work ethics and psychometric best practices. this article will critique the research, grantmaking, and regulatory practices that support the aswb examination program, using extensive citations to psychometric standards. the article will also critique aswb’s publications and exam documentation and the researchers’ experiences engaging with aswb to study the cause of exam score disparities. the analysis will reveal how, after their 2022 release of data demonstrating exam bias with respect to race, age, and language, aswb funded researchers already affiliated with aswb to support what it already tells test takers in its exam guidebook–only structural factors bias exam scores, not psychometric flaws internal to the examination. moreover, aswb implemented solutions to exam bias without proper investigation and psychometric support. because of aswb’s position as the sole publisher and purchaser of licensing examinations, individual state boards are unable to make incremental changes to prevent biased aswb examinations from closing the profession of social work to groups for whom the exam is invalid, unreliable, and unfair. keywords: aswb, licensure, exams, ethics, psychometrics, regulation controlling the message despite decades-long demands to produce validation and equity data (e.g., albright & thyer, 2010; garcia, 1990), the association of social work boards (aswb) has refused to produce data demonstrating its claim that their social work examinations are “statistically free from race and gender bias” (aswb, 2022a, p. 3). in an open letter to social work educators, aswb’s ceo dwight hymans (2020) stated, “aswb does not collect and thus does not release exam outcomes based on demographics. it is the written policy of aswb as directed by the aswb board of directors” (para. 5). during a later facebook live panel, he clarified that the data being sought by the national association of deans and directors (nadd) and the council on social work education (cswe) existed, but the “board of directors, at this time, has taken the position that we are not able to share that data” (nasw, 2020, 53:00). when advocates pushed back again, ceo hymans and aswb senior director of examination services, lavina harless, explained that the aswb board of directors policy against sharing such data was due to “legal, privacy types of issues” (nasw-minnesota, 2021, p. 6). only with the 2022 publication of the exam pass rate analysis (aswb, 2022e) did aswb verify that this information about:blank advances in social work, summer 2025, 25(2) 516 existed and revealed the massive disparities that many in the social work community had experienced for decades. aswb does not publish its examination's technical specifications, and it has not published information about exam validation since 2010. thus, stakeholders must derive psychometric properties of the examinations from the limited public statements made by aswb–none of which are subject to peer review. first-time vs. eventual pass rates to manage the public perception of inequitable exam outcomes, aswb selectively reported more favorable statistics in its infographics. although factual, the infographics present the least representative portrait of exam equity, according to aswb’s methodology section, which stated: more emphasis will be placed on the presentation of first-time participant counts and pass rates than eventual counts and pass rates [because,] despite being lower overall for all groups, [it] reflect[s] the most methodologically “clean” data [and] allows for the most equivalent comparisons across groups [and] for making the most direct comparisons…with respect to how demographic groups are performing on the exam. (aswb, 2022e, p. 5) yet, in its scholarly communications with the public, its infographics contained eventual pass rates, which are 10-13% higher than first-time pass rates for all groups. a corrected infographic for the clinical examination is shown in figure 1. aswb shared similarly misleading infographics via email and social media for the bachelor’s and master’s examinations, leaving a more positive view of aswb exams in the profession than would be gleaned from reading the full report and attending closely to the methodology section. although pass rates for white social workers were only overstated by 7% from first-time to eventual pass rates, the scores for black and latine social workers were overstated by 12% and native american/indigenous by 11%. this deliberately misleading scientific communication obfuscates decades of legal precedent in examinations, a record aswb has an ethical responsibility to state accurately. legal precedent states that “adverse impact is appropriately measured by the first time a candidate sits for the [employment exam] and fails it” (gulino v. board of education, 2015, p. 19). misleading communications such as these violate standard 1.01 ethics and values in the standards for technology in social work practice–which aswb helped to develop (nasw et al., 2017). such violations are particularly egregious, given aswb’s conflict of interest in preserving the examination program that drives its 17% average annual profit margin (decarlo & nienow, 2025). the nasw code of ethics specifically requires “social workers engaged in evaluation or research should be alert to and avoid conflicts of interest” (nasw, 2021, sec. 5.02p). otherwise, a test-maker like aswb, could use its data monopoly to control the release of unfavorable information. decarlo & nienow/in pursuit of status quo 517 figure 1. corrected aswb infographic comparing groups by first-time pass rates aswb changes the examination guidebook to create empirical need prior to publishing the exam pass rate analysis (aswb, 2022e), aswb (2022a) changed how they talked about bias in the examination. from 2014 to june 2022, every social worker taking an aswb exam was told that “results over several years have shown that aswb exams are statistically free from race and gender bias” (aswb, 2022a, p. 3). quietly, aswb replaced the untenable untruth with a new one: “there may be differences in exam performance outcomes for members of different demographic groups because exam performance is influenced by many factors external to the exams” (aswb, 2023a, p. 12). aswb cites no data to support their contention that variation in exam scores is entirely due to external factors and not internal psychometric flaws in the exam. in an attempt to provide credibility to its claims, aswb used its regulatory and research position to fund favorable research projects that match what they already tell test-takers is true about exams–biases in scores are society’s fault or the individual’s fault, not aswb’s fault. advances in social work, summer 2025, 25(2) 518 an unethical request for proposals to explain the cause and solution to the exam score disparities from the exam pass rate analysis (aswb, 2022e), aswb distributed a request for proposals (rfp), regulatory research proposal to advance equity. aswb promised the rfp would “support the association and the entire social work profession in gaining a deeper understanding of the causes and impacts of various forces on racial disparities and other disparities present within the licensing exam pass rate data” (aswb, 2023d, p. 1). in contrast to the stated purpose, eleven of the twelve focus areas in the rfp were unrelated to the exam (e.g., telehealth, enforcement, supervision), indicating research on exam equity was not the main priority for the rfp. even more troublingly, aswb managed the rfp internally. email announcements from aswb to researchers seeking to apply for the rfp indicated the rfp would be managed by the regulatory research committee (rrc), members of which are appointed by the president of aswb’s board of directors. other public announcements stated the american foundation for research and consumer education in social work regulation would “provide data sets and limited funding for approved proposals” (aswb, 2023b, para. 8). while this would appear to be a neutral third party, the foundation is actually aswb’s “research arm,” (para. 8) having been absorbed formally into aswb in 2017 under both organizations’ ceo, mary jo monahan. regardless of which internal organ aswb used, the aswb volunteers who evaluated applications were furthering their organization’s interest, an act prohibited by the nasw (2008) code of ethics (section 5.02, para. p). these conflicts of interest could have been avoided by using a multistakeholder process with psychometric expertise to address the equity concerns of stakeholders and the social work community as a whole. aswb controls dissemination aswb has historically ignored calls from the community to be forthcoming with data regarding the validity, reliability, and fairness of its exams (e.g., albright & thyer, 2010; biggerstaff, 1994; cherry et al.,1989; woodcock, 2015). by controlling access to exam data, aswb can censor research findings which conflict with their rhetoric that the exams are psychometrically sound. dissemination of research findings using aswb exam data is governed by aswb bylaws which restrict researchers from publishing their findings without aswb’s final edit. aswb “reserves the right to require review and approval of any research product developed under [the research support] policy prior to the product’s dissemination” (aswb, 2022c, p. 23). because aswb controls and directs the flow of research on its exams, it can direct support of millions of dollars in funding and access to exam data to serve its financial interest over the public interest. this was stated clearly by the previous ceo, dwight hymans, at the mn state board of social work meeting in which he answered calls for accountability by clarifying that aswb is not a social work advocacy organization…aswb is a private not-for-profit organization. the exam program is proprietary. aswb can make decisions about their information/data within that context. we will exercise rights within certain decarlo & nienow/in pursuit of status quo 519 parameters to do what is right for the organization (minnesota board of social work, 2021, pp. 8-9) aswb also required any applicants to the rfp to share intellectual property with aswb, as all proposals were “considered proprietary to aswb and the bidder” and could not be discussed “with any other parties, including competitors, at any time” (aswb, 2023d, p. 8). when the second author of this article proposed a collaborative project for this rfp, aswb rejected the proposal because they lacked coordinating agreements with proposed partners, agreements they were contractually forbidden from engaging in prior to aswb awarding the grant. of the 13 proposals submitted, 3 were funded, and the community does not know which empirical questions were rejected by aswb and why. aswb unethically dictates hypotheses for researchers aswb exercised monopoly control over the research proposal and selection process, ensuring only its preferred question was answered: what is the impact of external factors on exam outcomes? in an apparent breach of research and social work ethics, aswb’s rfp suggested hypotheses for researchers which absolved aswb created exams of any responsibility for disparate outcomes. all proposals funded by aswb through this rfp adhered to the suggested research questions, helping aswb manifest an empirical record that matches what aswb already states to test takers in their guidebook (aswb, 2023a). aswb’s public statements demonstrate their clear intention to manufacture a scientific consensus on external factors to the exclusion of other explanations. the rfp states “research proposals might address correlating external [emphasis added] variables that may influence the disparities in the licensing exam pass rate data…includ[ing] upstream factors [emphasis added]'' (aswb, 2023d, p. 4). the exam guidebook states: “there may be differences in exam performance outcomes for members of different demographic groups because exam performance is influenced by many factors external to the exams [emphasis added]” (aswb, 2023a, p. 12). in their testing experience webinar, aswb specified the purpose of the rfp was to “look at upstream factors [emphasis added] and relevant correlations we might make with test scores and the larger society [emphasis added]” (aswb, 2023g, 30:03). while hypotheses suggested in the rfp include upstream factors such as “life experiences from ‘early childhood’” (aswb, 2023d, p. 2), not included are more obvious explanations such as the psychometric tests and procedures, test validation and fairness analysis, all required by the joint standards (american educational research association [aera] et al., 2014)–such as differential test functioning, small sample methodologies, and cognitive tryouts. despite these compliance gaps, aswb states they follow the joint standards (aswb, 2023c). aswb rejects measurement equivalence study nevertheless, two psychometricians and the first author submitted a proposal to aswb to assess the test information curve, test characteristic curve, and dependability indices for pass/fail decisions. the proposal did not ask for any funding, just access to exam equity data to perform the analyses required by the joint standards and best practices in advances in social work, summer 2025, 25(2) 520 psychometric testing. following open scientific practices, the researchers proposed analyzing aswb’s confidential test data in the open-source statistics software r. aswb could check the authors’ analysis, confirm results, and, if insightful, implement it for free in examinations moving forward. the proposal was difficult to fit into the rfp’s funding language; however, researchers were hopeful the analysis would investigate these previously unexplored, yet legally and methodologically required test-level psychometric specifications. aswb first rejected the proposal because it did not ask for money. upon pointing out the proposal asked for data, aswb then clarified the proposal was rejected for not specifying which data were requested for analysis. a full summary and demonstration can be found in decarlo and bean (2024). aswb ignores required psychometric tests the joint standards identify several other methodological tools that test developers should use when the fairness of examinations is in question. contrary to the funding priorities in the rfp, the joint standards require aswb to test hypotheses internal to the examination. specifically, the joint standards state: “especially where credible evidence of potential bias exists, small sample methodologies should be considered. for example…small-scale tryouts that use cognitive labs and/or interviews or focus groups [emphasis added] to solicit evidence on the validity of interpretations made from test scores” are indicated (aera et al., 2014, p. 52). cognitive labs would: use approaches involving structured interviews or think-aloud protocols with selected test takers…to identify irrelevant barriers to responding correctly that might limit the accessibility of the test content [and] provide evidence that the cognitive processes being followed by those taking the assessment are consistent with the construct to be measured. (aera et al. 2014, p. 82) aswb has never publicly reported conducting such studies nor considering them in response to exam score inequities. biased focus groups on external factors one research practice aswb has implemented in response to their release of the exam disparity data is focus groups. as a participant in those groups, the first author can summarize their experience with the unethical practices contained within the protocol. the groups focused heavily on one’s long-term “social work journey” with no questions about the validity or cultural sensitivity of the examination. other participants publicly reported being told by facilitators that “we are not here to talk about” exam pass disparities, chiding participants’ “strong opinions” and questioning why they attended (kays, 2023). when recruiting participants, aswb publicly maintained focus group “data will be reported alongside the august 2023 publication of pass rate data and used as we evaluate…potential modifications to exam delivery” (aswb, 2023e, para. 7). contrary to the promise of open data, focus group results were published in a cursory report with no access to the underlying data. as of the writing of this article in the fall of 2025, aswb has not published exam equity data for 2022 or 2023. decarlo & nienow/in pursuit of status quo 521 in the focus group session attended by the first author, participants were told the facilitators from humrro were not associated with aswb prior to helping them produce the exam pass rate analysis. however, after participating, the first author discovered they had mistakenly consented to having their data collected by the consultants responsible for aswb’s “third-party” psychometric consulting since 2014 (aswb, 2023f). after filing an ethical complaint, the consent form was changed to reflect that the consultants responsible for the focus groups also oversaw the questionable psychometric practices of aswb exams. the conflict of interest was manifest when, rather than directing focus groups towards the examination itself, aswb and their long-time consultants unnecessarily broadened the conversation to participants’ “journey through licensure” which explored the external factors that shaped people’s examination experiences. it was not the role of focus group participants to talk about difficulties in the examination, but it was “the role of a community conversation participant…to share their lived experiences, providing information about their careers, educational backgrounds, and current circumstances” (aswb, 2023f, para. 4). focus groups were conceptualized and analyzed using aswb’s preferred hypothesis that exam bias is caused by inequities in the workforce pipeline, ignoring questions that could elucidate psychometric flaws in the examinations. aswb funds only internal researchers to investigate equity three research teams won the rfp process–all of which were previously affiliated with aswb. the first team was from the utah division of professional licensing, which is using computer modeling to estimate the impact of policy changes on licensure, inviting social workers to “turn the knobs and see the impact” (aswb, 2023h, para. 10). as they are professional regulators in utah, they are aswb members. the second team from western kentucky university (wku, 2023) included an “external consultant” who was a former member of the aswb committee providing the grant and had served in senior roles at aswb for two decades (starks, 2019). this person’s role was not external. she facilitated focus groups at social work conferences, and recruited participants with a form listing aswb as the primary organization, as indicated in figure 2. the final team is led by a researcher funded through aswb’s previous rfp in 2020, dr. joy kim. in personal communication with the first author, she confirmed that her research project would assume aswb examinations are psychometrically sound and subject to industry-standard scrutiny (j. kim, personal communication, march 14, 2024). as a result, kim and joo’s reports ignore internal psychometric validity and reliability entirely, focusing instead on the “individual, institutional, and community factors that testtakers carry with them throughout their lives” (aswb, 2024a, para. 1). because these reports follow aswb’s preferred hypotheses, this research project was the only team permitted to access aswb’s exam equity data. nevertheless, the team revealed how little “external factors” impact exam outcomes. far worse than the descriptive disparities reported in aswb’s 2022 exam pass rate analysis, black social workers are 6.5x more likely to fail the exam than white social workers, latine social workers are 2.8x more likely to fail the exam, and “the odds of exam advances in social work, summer 2025, 25(2) 522 failure for asian examinees were 2.055 times higher than the odds for white examinees” (kim & joo, 2024, p. 28). controlling for external factors in the workforce pipeline reduced these disparities by a mere 10-30%, according to the report. kim and joo’s report is published by aswb and featured prominently on its webpage for understanding aswb exam pass rates. its results indicate that external factors are a small factor in exam score inequities across racial, linguistic, and age groups. figure 2. consent form from a social work conference indicating primary role of dr. starks and aswb the team’s qualtrics survey asked for the level of agreement to the team’s six focus group questions and omitted the “external” consultant’s role from the consent form. no questions addressed problems in the examination itself. aswb paid the researchers $160,000 (wku, 2023). wrong solutions for the wrong problems because it did not fund studies examining the true psychometric causes of exam biases, aswb has implemented solutions, without attention to psychometric standards, that give decarlo & nienow/in pursuit of status quo 523 the appearance of solving the problem of inequitable pass rates on the licensure exam. some of these solutions have included test prep resources, reducing the number of answer responses, and remote proctoring. each of these solutions creates its own set of negative consequences, and none of them has been introduced with any published evidence supporting their efficacy. unhelpful test prep resources acknowledging the impact of test effects on passing aswb exams, aswb now offers all test-takers the option of completing a free “test mastery” curriculum, developed by fifththeory. according to the test mastery inclusion manual (dages & jones, 2024), fifththeory provides many services to employers to “promote a strong customer experience,” and for professional disciplines like education and social work, “offers educational and career assessments…related to high-stakes test taking and occupational interests” developed by industrial organizational psychologists (dages & jones, 2024, p. 2). starting in 2023, everyone who failed an aswb examination received an optional “brief, online assessment of…test mastery mindset” measured by 16 competencies, including how “mentally tough,” “internally controlled,” and “self-disciplined” a test-taker is (aswb, 2022b, p. 1). fifththeory and aswb’s program is a purportedly race-neutral program whose racial impact was never tested by aswb prior to implementation, leaving open the possibility that the test mastery curriculum is orthogonal or in opposition to progress on exam equity. in fifththeory’s promotional literature, it explains lower exam scores might be caused by test takers’ “basic mindset” as defined by a “tendency to lack a driving force to prepare, carelessly prepare for tests, lack confidence within tests, and be negative and worried when completing tests” (fifththeory, 2022, p. 3). according to these resources, a test taker who questions whether the examination is flawed is exhibiting negative, pessimistic thinking. biases in scores are not the result of shoddy psychometrics but test takers “struggling with their poise, as evidenced by a loss of self-confidence and increased feelings of stress and worry” who need to adapt and “self-manage their competencies so that they can increase their levels of motivation, responsibility, selfconfidence, and resiliency when preparing for and taking high-stakes exams” (aswb, 2022b, p. 3). these explanations appear to gaslight and blame the victim for their own oppression by situating the “many factors external to the exams,” that aswb admits are there, within the control of the individual test taker (aswb, 2023a, p. 12). fifththeory touts its curriculum as “valid, reliable…and meets apa and professional standards” (fifththeory, 2022, p. 2); however, aswb and fifththeory provide neither scholarly citations nor industry studies for users of the service to assess the scientific merit of the test mastery curriculum. fifththeory and aswb test mastery products provide no supporting evidence with a footnote disclaiming: is important to note that research studies do not exist for all of the test taker coaching interventions…on the fifththeory testprep profile [emphasis in original] report… published research exists for certain types of recommended interventions (e.g., shifting from rational to irrational self-talk and learning advances in social work, summer 2025, 25(2) 524 relaxation skills), while some interventions are based on case study reports. (aswb, 2022b, p. 18) in addition to the lack of evidence underlying the program or efficacy in changing social workers’ test mastery, it should be noted that the cost of fifththeory’s services for 7,500 test takers is $15,000 per year (fifththeory, 2022), a fraction of aswb’s overall wealth (propublica, n.d.). the utility of the resources was panned by social workers who used the program and responded to the aswb evaluation. only 11% of users responded to the evaluation and nearly half of these social workers disagreed or strongly disagreed that the resources “helped them understand their test mastery mindset.” a majority of social workers disagreed or strongly disagreed that the resources helped them feel “better prepared to retake the exam” (aswb, 2024b para. 3). despite the fact that most social workers disagreed fifththeory resources were helpful, and only 11% of those who used the services provided feedback, aswb declared the pilot study successful and now provides test mastery resources to all test-takers. this to worsen stereotype threat, as these materials problematize the person’s self-efficacy rather than systemic biases in the exams (steele, 2010). make items easier to guess correctly aswb also recently announced that they are transitioning to using three-answer items, increasing the likelihood respondents can guess the correct answer by eliminating an incorrect option (aswb, 2022f). although the joint standards require aswb to collect test-level statistics when important changes are made as part of the psychometric specifications, they have not done so (aera et al., 2014; aswb, 2022f). aswb’s public statements announcing 3-option items state only that “this change follows psychometric expertise that confirms the validity of three-option multiple-choice questions” (aswb, 2022f, para. 2). aswb believes an improved experience will not change the statistical performance of the examination enough to require a new round of validation to remain legally defensible. aswb’s examination guidebook states that “no test-taker receives an advantage or disadvantage because of the version of exam received” (aswb, 2023a, p. 26); yet it would seem unavoidable that test takers with one fewer distractor would guess more accurately, and this would vary based on the number of three-answer questions received. social work boards must deny this logic and rely on aswb’s vague assurances of test validity and fairness. moreover, there are no empirical studies from aswb demonstrating scores collected from january 2023 through the full rollout–which contain an uneven number of 3-option and 4-option questions–are equivalent to exams with a fixed number of answers per question. aswb blocks incremental changes by state boards social workers serving on state boards have attempted to reduce the exclusionary impact of examinations through moderate policy changes. however, state boards are required to use the examinations as aswb intended. deviating, for example, by allowing decarlo & nienow/in pursuit of status quo 525 recent msw graduates to take the clinical exam, would require boards to “justify the new interpretation [of the exam] for that use, providing a rationale and collecting new evidence, if necessary” (aera et al., 2014, p. 24)–a costly endeavor. exceptions to aswb exam use policy exceptions to aswb exam policies are allowed. many states allow test takers to sit for examinations while enrolled in their last semester of a bsw or msw program, relying on the rationale that soon-to-graduate students are virtually identical to recently graduated students. however, when florida, north carolina, and other states allowed recent master’s graduates to sit for the clinical examination, aswb used their power as exam developer to stop that practice. they justified the enforcement decision by pointing out that “allowing licensure candidates to take the exam before [two years of clinical supervision] can erode the exam’s reliability, and consequently its validity” (aswb, 2019, para. 3). the psychometric methodology aswb uses to develop its exams, in turn, provides the exam’s “legal defensibility as a fair and consistent tool helping boards make minimum competence decisions as part of the licensure process” (aswb, 2021, p. 17). this action was part of the 2016-2021 exam use policy enforcement campaign which saw 28 states and provinces flagged for implementing examinations in potentially invalid ways (aswb, 2016). as aswb said to boards, “enforcing appropriate use of the exams helps maintain the highest psychometric and legally defensible standards on behalf of our members that use the exam(s) as part of their licensing process” (p. 2). aswb’s enforcement highlights how subaltern boards are in their relationship with aswb and how the logic underlying aswb’s examination program becomes enshrined in state law. as part of the enforcement campaign, aswb gave its members (i.e., state boards) three options: “change the necessary jurisdictional laws/regulations/policies; request an exception; [or] cease using the exam(s) for the noncompliant purpose” (aswb, 2016, p. 2). state boards are also discouraged from any reform efforts because, according to aswb: examination programs…are highly complex, expensive operations that require constant maintenance. for most boards, mounting a defensible examination program would be impossible. through aswb…boards can have access to and control over a valid and defensible examination program, a program that provides consistency that strengthens regulation. (aswb, 2021, pp. 9-10) slow-walking exceptions for test-takers facing unemployment social workers not in their last semester of school find exceptions to aswb’s exam use policy difficult to procure. california’s 2021 contract with aswb tried to create another exception. it specified that a candidate who fails an examination “within five (5) test items of the passing score” may retest within the normally prohibited 90-day window “when a candidate’s employment is in jeopardy…documented in writing by the employer, and…approved by the member board” (california board of behavioral sciences [ca bbs], 2021, p. 13). this option was foreclosed during a january 2023 meeting of the california bbs because: advances in social work, summer 2025, 25(2) 526 after several meetings, it was determined that the aswb database could not meet the board’s current re-exam system parameters and that the process for managing these waivers would have to be a manual process performed by board staff. managing and monitoring these requests has become a significant workload for exam staff…to allow for the 90-day waiver option, aswb would need to take over the reexam approval process. for this service, aswb would require a $60 fee from each requesting candidate. based on the volume of approved 90-day waivers, the amount of candidates that utilized their waiver, and the possible added cost to each candidate, staff determined it was not a feasible option. the board will continue to approve candidates for the re-exam once the 90-day waiting period passes. (atkins, 2023, p. 1) as california’s experience demonstrates, even when required by contracts and member boards to provide exceptions to exam use policies, aswb can make compliance infeasible for its member boards. state boards are deeply overworked and under-resourced; made up of volunteers and a small number of paid staff. in contrast, aswb is an immensely profitable company with over $40 million in net assets (decarlo & nienow, 2025). bearing the additional cost and staffing would not be an unreasonable expectation for an organization serving its member boards. aswb: we will leave if you change ultimately, it is aswb who determines whether states can regulate social workers because they are the monopoly provider of licensing exams, in some cases codified in statute as the only provider of social work exams in a state (e.g., pennsylvania, delaware). without aswb’s exam program, state boards could not license new social workers. moreover, many states require that social workers pass the examination within a set time period or lose their ability to practice social work, as governed by title protection and licensure statutes (landsman & rathman, 2023). if boards wish to modify exams to ease workforce challenges, they erase the validation that accompanies aswb exams (aera et al., 2014). aswb: evidence for public protection is “bleaker than aswb expected” the empirical and policy data demonstrate that examinations gatekeep the workforce. data from the social workers for equity & anti-racism (swear) in the greater washington, dc area noted that if non-white social workers passed lbsw, lmsw, and lcsw exams at the rate of white social workers, an additional 1,227 social workers in maryland and 474 social workers in dc would have been licensed over the past decade (doyle, 2023a, 2023b). perhaps even inequitable gatekeeping would be partially justifiable if exams contributed to public safety. however, although aswb’s public statements proclaim the efficacy of exams at gatekeeping unethical social workers, a comprehensive review funded by aswb and reported by kim (2023a, 2023c) demonstrates aswb’s core claim of public protection lacks supporting evidence. decarlo & nienow/in pursuit of status quo 527 previously, when asked for evidence of public protection, aswb cited the number and type of complaints and enforcement actions. once they commissioned a researcher to “present a summary of empirical evidence (or lack thereof)” of aswb's regulations, aswb found “the reality was much bleaker than aswb expected” (aswb, 2022d, para. 2). kim’s (2023a) aswb-sponsored research found that data are not available at the national and regional levels regarding the proportions of social worker degree holders who practice social work but are exempt from licensure requirements. second, perhaps most importantly, it is unknown if and to what extent public health and safety are compromised by licensure exemptions. it is even difficult to find empirical evidence supporting that social work licensure protects the public from harm. (p. 113) aswb’s research communications clearly state there is “very little documentation and research” on any “specific regulatory practices in social work,” (aswb, 2022d, para. 2) and $107,799 in aswb funding (kim, 2023b) and an accomplished regulatory researcher could only find one study out of the 400 examined by kim and colleagues (2023c) that provides “evidence supporting the use of a standardized licensure exam” for public protection (p. 11). this dissertation and pilot study from 1995 surveyed decades of kansas social work disciplinary records but did not measure race. this is the only study, according to aswb’s own research, that supports the contention that social work examinations fulfill their express purpose: public protection. implications unjust restrictions in the supply of social workers cause 163 million americans to live in a mental health professional shortage area as defined by the health resources & services administration (hrsa, 2023). this paper demonstrated how the association of social work boards uses its regulatory and testing monopoly position to shape the narrative about its examinations and maintain the regulatory status quo. aswb negotiates with itself, hires itself to produce examinations, and funds internal researchers to pursue hypotheses, prioritizing the regulatory status quo over rigorous science. social work board & employer liability aswb regularly claims its examinations provide a legally defensible measure of entrylevel competency. however, its practices mirror problems with examinations that courts have found discriminatory and have led to billions of dollars in payments to test takers by human service employers. a recent federal court decision in gulino v. board of education (2015) held that the liberal arts and sciences test, which was required for all public school teachers by new york city department of education, violated title vii of the civil rights act because: (a) the pass rate for many minoritized groups of test takers was “at most 80% of the pass rate” (p. 2) for white test takers; (b) it was not properly validated according to professionally acceptable methods; and (c) it was not manifestly related to legitimate employment goals (croft, 2017). the class action lawsuit included over 32,000 claims filed by new york city teachers who were denied promotions and lost their employment due to failing a biased examination. advances in social work, summer 2025, 25(2) 528 after the new york city department of education finally lost the 27-year-old case, it set aside $1.35 billion to pay the anticipated claims over the next few years (new york city comptroller; lander, 2023). individual teachers are receiving multi-million-dollar payments, underscoring the devastating impact biased exams have on occupational, financial, and life trajectories. a future court decision testing aswb examinations will likely make the same determination. when aswb was sued by three test-takers in new york, its entirely reasonable defense was that aswb was not an employer like in gulino. thus, if social work exams go to court, state boards, government agencies, and social work organizations may face liability for requiring biased examinations, particularly when they are unrelated to job tasks. worsening the workforce crisis the impact of keeping an exam with no reported validity that systematically excludes minority graduates of accredited social work programs is felt by both clinicians and communities. examinations impact the supply of social workers. when illinois removed the examination requirement for pre-clinical licensure, they saw an over 700% increase in the number of licensed social workers (decarlo, 2022). although aswb stated that these changes were “fraught with public protection peril” (atkinson, 2021, para. 19), naswillinois noted that there was no accompanying increase in licensure complaints (decarlo, 2022). indeed, nasw-illinois’ and nasw-minnesota’s presidents emphasized that public safety was threatened by the status quo. aswb’s biased exams kept qualified clinicians in positions and paraprofessional roles unregulated by the licensing board (decarlo, 2022). creating an alternative pathway to licensure increased the number of social workers whose practice was now supervised by the social work board’s public protection mission (skeen & goodenough, 2023). we cannot rely on aswb to police itself. now that the 2024 practice analysis has concluded, the results should be published openly so that the community can probe the data for potential sources of invalidity during item generation. open scientific practices and the joint standards require aswb to document its sample size, statistical procedure, and outputs as well as share its data so community researchers could validate exam scores and probe for sources of biased functioning. the second author attempted to work with aswb leadership to form a regulatory community of practice whose purpose would be to fill the dearth of empirical research on social work regulation. however, when it was discovered the second author was presenting data to stakeholders on the exam disparities (with the first author), the initial meeting of the group was canceled by the aswb director of research, jennifer henkel, due to “the misalignment of values surrounding entry to practice” (personal communication, march 26, 2024). as the researchers’ experiences demonstrate, aswb will not produce the psychometric documentation and statistics needed for impartial psychometricians to evaluate aswb exams or create alternative national qualifying examinations (nqe), as the social work licensing compact calls them. the production of the nqe should be subject to an open and competitive bidding process in which the psychometric qualities of each examination are evaluated by qualified professionals unaffiliated with the exam developer. decarlo & nienow/in pursuit of status quo 529 furthermore, states looking to address exam equity should look towards the oregon board of licensed social workers’ alternative pathways to social work licensure committee. although the alternative pathways implemented by illinois and minnesota relieve the bottleneck of broken exams in the workforce pipeline, they unjustly impose additional years of supervision on groups for whom the examination does a poor job of measuring competence. the direct financial penalty of paying for hourly supervision is compounded by lost job opportunities and delaying the post-licensure increase in income of 10.6% (kim et al., 2021). policy compromises and incremental changes are laudable and worthy outcomes. however, farr et al. 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(2015). abuses and mysteries at the association of social work boards. research on social work practice, 26(2), 225-231. author note: address correspondence to matthew p. decarlo, school of education and human development, saint joseph’s university, philadelphia, pa 19131. email: mdecarlo@sju.edu orcid: matthew p. decarlo https://orcid.org/0000-0002-6326-1780 mary nienow https://orcid.org/0000-0001-9269-0122 https://www.socialworkers.org/linkclick.aspx?fileticket=bq9jrb-ovm4%3d&portalid=0 https://www.socialworkers.org/linkclick.aspx?fileticket=bq9jrb-ovm4%3d&portalid=0 https://www.facebook.com/naswsocialworkers/videos/777132846159200 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english/social-workers-ethical-responsibilities-to-the-social-work-profession https://projects.propublica.org/nonprofits/organizations/222414510 https://fieldeducator.simmons.edu/article/the-conversation-the-aswb-licensing-exam-pass-rates-and-bias/ https://fieldeducator.simmons.edu/article/the-conversation-the-aswb-licensing-exam-pass-rates-and-bias/ https://www.wku.edu/socialwork/documents/cv/starks_saundra_2019.pdf https://www.wku.edu/socialwork/documents/cv/starks_saundra_2019.pdf https://www.wku.edu/news/articles/index.php?view=article&articleid=11486 https://www.wku.edu/news/articles/index.php?view=article&articleid=11486 https://doi.org/10.1177/1049731515574346 https://doi.org/10.1177/1049731515574346 mailto:mdecarlo@sju.edu https://orcid.org/0000-0002-6326-1780 https://orcid.org/0000-0001-9269-0122 controlling the message first-time vs. eventual pass rates aswb changes the examination guidebook to create empirical need an unethical request for proposals aswb controls dissemination aswb unethically dictates hypotheses for researchers aswb rejects measurement equivalence study aswb ignores required psychometric tests biased focus groups on external factors aswb funds only internal researchers to investigate equity wrong solutions for the wrong problems unhelpful test prep resources make items easier to guess correctly aswb blocks incremental changes by state boards exceptions to aswb exam use policy slow-walking exceptions for test-takers facing unemployment aswb: we will leave if you change aswb: evidence for public protection is “bleaker than aswb expected” implications social work board & employer liability worsening the workforce crisis _________ mary nienow, phd, lisw, director and associate professor, school of social work, new mexico state university, las cruces, nm. dawn apgar, phd, lsw, acsw, director and associate professor, department of social work, seton hall university, south orange, nj. alex fink, phd, lgsw, faculty director and assistant professor, sabo center for democracy & citizenship, department of social work, augsburg university, minneapolis, mn. juan quiñonez, msw, lgsw, lssw, school social worker, forest hills elementary school, eden prairie, mn. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 651-671, doi: 10.18060/28617 this work is licensed under a creative commons attribution 4.0 international license. examining state policy responses to racial disparities in social work licensure exams mary nienow dawn apgar alex fink juan quiñonez abstract: this study explored how states responded to the release of the 2022 aswb exam pass rate analysis, which revealed significant disparities in pass rates between black, indigenous, and people of color (bipoc) test takers and their white counterparts on the association of social work boards’ social work licensure exams. using the conceptual framework of policy advocacy developed by gen and conley wright (2013) to assess the inputs, activities, and outcomes associated with these state-level initiatives, national association of social workers’ state chapter directors were interviewed to better understand how different states worked to rectify inequities in licensure outcomes. findings showed the political landscape, resources and stakeholder investment were key to progress on expressed outcomes. while the policy advocacy framework helped to elucidate the different inputs and activities between states, it was not found to be predictive of the expected outcomes associated with those identified variables. keywords: aswb, nasw, licensure, exams, racial disparity, policy, advocacy on august 5, 2022, the association of social work boards (aswb) released the aswb exam pass rate analysis, which revealed significant disparities in pass rates between black, indigenous, and people of color (bipoc) test takers and their white counterparts on the aswb social work licensure exams. the release of this data had been advocated for many years by a variety of stakeholders (albright & thyer, 2010; decarlo, 2022; dettlaff, 2021; garcia, 1990), but pressure for the data significantly increased after the murder of george floyd on may 25, 2020 (nienow et al., 2023). as states began to analyze and make sense of this data, subsequent discourse, policy and legislative actions emerged in response to the reported disparities. leveraging the conceptual framework of policy advocacy developed by gen and conley wright (2013) to assess the inputs, activities, and outcomes associated with these state-level initiatives, the authors interviewed nearly half of all nasw chapter directors to understand how different states responded to the data and what initiatives they were undertaking. this research project sought to answer two key questions: 1. what are the specific state responses to the racial disparities within the pass rates of the aswb licensure exams? 2. does the policy advocacy framework developed by gen and conley wright (2013) explain how the different inputs and activities between states lead to the expected outcomes? about:blank advances in social work, summer 2025, 25(2) 652 the conceptual framework guiding efforts to analyze the differing state responses was selected after careful examination of the literature on theoretical approaches to policy advocacy. this review revealed several key models such as the social action model (zeltman et al., 1973); the movement action plan (moyers, 1987); multiple streams theory (kingdon, 1984) and the policy advocacy framework (gen & conley wright, 2013). each of these models offered a different way of describing and analyzing the policy advocacy approaches happening among the states. the social action model (zeltman et al., 1973), provides a strategic framework for addressing systemic inequities through four key approaches: educational, persuasive, facilitative, and power strategies. the model allows researchers to develop a broad overview of the political landscape but fails to allow for deeper investigation into specific issues. unfortunately, the model lacked actionable strategies; while it discusses advocacy efforts and challenges, it fails to provide concrete recommendations for overcoming barriers to reform. a model that includes specific, actionable steps would better inform stakeholders on how to effectively engage in advocacy and push for systemic change. due to these limitations, the social action model did not provide a full theory of change by which to trace action and inputs to outputs and outcomes. bill moyer's (1987) movement action plan (map) provided another perspective on how social movements evolve. moyer (1987) outlined eight stages that successful movements typically pass through, starting with "normal times” (p. 9), where the public remains largely unaware of the issue, to the later stages where movements gain traction and eventually succeed. while this model has been applied to contemporary movements such as black lives matter, scholars have identified several limitations. christiansen (2011) notes that social movements often do not follow linear progression models, as they may experience periods of emergence, coalescence, bureaucratization, and decline in varying orders depending on contextual factors. cox (2018) emphasizes that social movement theories must account for diverse cultural and political contexts. these complexities present challenges when applying traditional social movement frameworks to social work licensure reform, where efforts must navigate varying licensure models, regulatory bodies, governmental makeup, and legislation across different states. kingdon’s (1984) multiple streams theory offers a way of considering the multiple factors influencing upon policy change. the streams include: the problem stream in which an individual condition becomes a social problem capturing the attention of policymakers and the public; the policy stream in which experts, stakeholders, and advocates develop suggested solutions to the problem; and finally, the political stream in which the political environment is responsive to the solutions developed in response to the problem. when the multiple streams come together, a “policy window” (p. 20) is said to have opened. while this model is useful for understanding key factors leading to policy change, it does not help to explain what actions are most useful to successfully achieving the intended advocacy goals. cairney and jones (2016) argue this framework lacks specificity regarding the mechanisms connecting the streams, making it difficult to predict when and how policy windows will open. béland and howlett (2016) critique its limited applicability beyond nienow et al./state responses to racial disparities 653 agenda-setting, thus while it offered some analytic value to understanding policy windows within states, it did not offer a comprehensive framework for understanding the work and outcomes of policy advocacy. the conceptual framework by gen and conley wright (2013) was ultimately chosen as the one that best aligned with the research questions central to this study. this framework provides a logic model illustrating links within the policy advocacy process. the model helps to explain the inputs, activities, and outcomes associated with specific policy advocacy efforts, facilitating a comprehensive understanding of how various advocacy components are interconnected. key components of the model include inputs, which encompass the necessary resources, relationships, and support for initiating advocacy efforts, such as personnel, funding, and organizational capacity. activities comprise concrete actions to promote policy changes, including coalition building, public engagement, information campaigns, and lobbying decision-makers. the resulting outcomes are shifts in public opinion, influencing decision-makers, and policy changes that benefit target populations. this framework highlights theoretical linkages, suggesting how inputs foster activities leading to distinct outcomes. it outlines two primary advocacy goals: first, promoting public-centered policymaking by engaging and mobilizing the public to build political influence; and second, targeting population changes through strategies such as public pressure, direct influence on decision-makers, direct reform initiatives, and implementation changes that necessitate knowledge of bureaucratic processes. this conceptual framework helps to outline the landscape for policy reforms related to pass rate disparities in each state. the logic model provides a clear framework for examining the different components of policy advocacy. by categorizing inputs, activities, and outcomes, the authors systematically assessed how state-level initiatives are designed to address the disparities revealed by the aswb report. additionally, this logic model allows researchers to identify what resources and relationships (inputs) states are leveraging to tackle inequities in licensure. method this exploratory study used interviews to answer the research questions posed. this study was reviewed and considered exempt by the first author’s institutional review board. participant selection the purposive sample was chapter directors of nasw, as they are leaders of the largest social work advocacy organization within each state and most likely to understand the political landscape, strategies and activities happening in response to disparities within the exams. while a great deal of the information provided during the interviews with these chapter directors could have been found through review of websites, reports or other informational sources, interviewing nasw chapter directors was chosen because of the efficiency of gathering the desired information along with a more emic perspective of the meaning behind particular decisions or activities. advances in social work, summer 2025, 25(2) 654 the first two authors began the recruitment process by presenting on a nasw monthly chapter/national government relations call. the target was to collect data from all nasw chapter directors to learn about the differences in approaches between the jurisdictions. approximately 15 people attended the meeting in which the authors outlined the study. the authors then compiled and emailed all nasw chapter directors (n=44) explaining the study. some nasw chapter directors covered more than one state chapter, so while 52 states (including d.c. and the virgin islands) were represented, only 44 directors were contacted. ultimately, study data came from a total of 24 separate respondents (including 2 non nasw chapter directors who served as proxy respondents as their respective chapter directors were not available) covering 26 states and jurisdictions. eight states were located on the east coast (me nh, ny, ct, pa, wv, va), nine states in the midwest (mn, wi, ia, il, in, mi, in, oh, ky), four in the southeast (nc, sc, ga, al) and five from the west (wa, mt, wy, co, az) (see figure 1). figure 1. states participating in study data collection methods nasw chapter directors were asked to participate in a 45-minute semi-structured interview with one of the study authors. three nasw chapter directors were not able to meet with study authors, so they typed and submitted their responses. the interview schedule was developed using the gen and conley wright (2013) framework. participants were asked about their activities as they related to the exam disparity data, the perceived inputs available for such activities and what they saw as their short, medium and long-term goals. qualitative data were collected over a three-month period (march to june 2024) with each author conducting virtual interviews based upon availability. nienow et al./state responses to racial disparities 655 interviews lasted between 20-45 minutes, with an average of 30 minutes. the interviews were conducted over zoom, recorded, and transcribed using zoom software. prior to data collection, participants were sent interview consent forms explaining the study. at the start of interviews, researchers confirmed receipt of the consent forms, gained verbal consent, and asked respondents to explain their understanding of the study’s purpose. online respondents electronically affirmed their understanding and participation in the study. data analyses thematic analysis of the data proceeded in phases, with all authors coding narrative responses inductively as follows: after familiarizing themselves with the data (phase 1), the transcripts were divided with each transcript assigned to two authors who generated initial codes and grouped them according to the key domains in the gen and conley wright (2013) framework independently (phase 2). these codes were then collated into potential themes, first independently by each author, then in a conversation with the other assigned author to reconcile differences (phase 3). in phase 4, the themes and subthemes were differentiated by reviewing the codes and accounting for the entire analytic dataset (equivalent to saturation in braun and clarke’s [2006] thematic analysis). themes and subthemes were then named (phase 5) in several meetings with all authors participating until agreement was reached about the final findings. results gen and conley wright’s (2013) framework provides a useful way to analyze the nasw chapter responses to the racial disparities in pass rates. additionally, the data helped to identify ways in which the framework can be modified to be more useful to social workers and others who are interested in policy advocacy. an examination of proximal and distal outcomes yielded results with broader implications for policy advocacy. an examination of the distal outcome of policy adoption and each of the proximal outcomes demonstrates commonalities and distinctions in approaches. a summary of the results is seen in table 1 and described in the results section using gen and conley wright’s (2013) framework. distal outcomes/impacts policy adoption in each state where policy reform was achieved, advocacy by nasw chapters played a critical role. there were no policy reforms or adoptions identified on the issue of social work licensure not directly related to activities organized and conducted by nasw. there was a wide variety of policy adoptions with some states imposing temporary moratoriums on testing, others eliminating testing at the non-clinical categories and others creating alternate pathways in lieu of testing. advances in social work, summer 2025, 25(2) 656 table 1. summary of national change effort to address racial disparities in pass rates on aswb social work licensing exams using gen and conley wright’s (2013) framework summary key considerations/activities distal outcomes/ impacts policy adoption nasw chapter advocacy was critical with tailored approaches based on state’s political environment. moratoriums on testing; eliminating testing; alternative pathways proximal outcomes democratic environment efforts focused on giving underrepresented voices (i.e., those who had not passed the licensure exams) representation in the change process. generational differences between social workers & political barriers were present. open discussions & listening sessions as empowerment methods changes in public views many were unaware of problems, so the education of key stakeholders & social workers generally was a key focus. concerns focused on decreased credibility & further deregulation. focus on workforce shortages & a perceived lack of transparency in aswb changes in decisionmakers’ views key decision-makers varied between states with targets in both the executive & legislative branches. political capital & funds for lobbyists were used with less resistance in states that already had social workers or other mental health workers practicing without testing. nasw chapter directors’ roles varied between leaders & facilitators with varying activities based on role definition activities engaging & mobilizing public collaborative approach was employed, with efforts to engage allied professional groups who also wanted to make changes to their licensure laws. town halls; listening sessions; surveys; providing support to social workers pursuing licensure coalition building strong past relationships with other social work relationships made coalition building easy & efficient. common focus equity & inclusion resulted in support for marginalized groups impacted by disparate pass rates engaging decisionmakers competing priorities, such as the social work compact, needed to be considered with regard to “asks.” political tensions about the need for reform due to racial justice were considered in the engagement strategy. lobbyists; simplifying complex message information campaigning both aswb & scholarly data on racial disparities in testing were used in carefully crafted messages. briefings; presentations; social media campaigns reform efforts test elimination at the master’s category was seen as a compromise & a pseudo pilot for further elimination at the clinical category in the future. further reforms focus on aswb policies such as retesting fees & other administrative issues defensive activities aswb’s financial resources posed challenges as funds were used to hire lobbyists with nasw state chapter budgets having fewer financial resources. nasw chapter director relationships with state policymakers were important assets. limited communication with aswb precluded compromise discussions inputs sense of agency consensus about reasons for the racial disparities in testing guided paths forward with nasw chapter director tenure & skill in organizing critical to making changes. lack of consensus about the root cause of the problem resulted in an inability to effect change people & relationships internal & external relationships were critical to policy reform. relevant for all chapters specialized knowledge & skills limited knowledge by nasw chapter directors about exam psychometrics posed challenges. need for workforce & regulatory data coupled with concern about efficacy of accredited social work educational programs material resources lack of financial resources for lobbying was seen as an impediment with other legislative priorities (social work compact) being a priority. financial strain on repeat test takers was major driver for change nienow et al./state responses to racial disparities 657 nasw chapter directors mentioned that the path to policy adoption could not fit a “one size fits all” approach. some bills came close to passing, but ultimately failed for a variety of reasons, many of which did not directly relate to the substantive issue. in these states, there was optimism for future success, with plans to reintroduce failed legislation. advocates were determined to push forward in future sessions. in these states, there were increased efforts for policy alternatives such as offering provisional licensure and financial support for test preparation. one chapter tried to work on the periphery by making it easier to apply for a license, helping test takers access non-standard testing arrangements (i.e., accommodations) and issuing temporary permits allowing for one year to pass the exam while still practicing. states said that they will continue to monitor what other states are doing and share information/work with stakeholders. a lot of hope was expressed that things will change due to aswb efforts or nasw stepping up to provide additional resources. upcoming elections were anticipated to change the political climate and influence next steps with policy actions. proximal outcomes democratic environment the original gen and conley wright (2013) model viewed a democratic environment as a proximal outcome aimed at public-centered policymaking. all interviews with nasw chapter directors indicated the desire to ensure underrepresented voices (i.e., those who had not passed the licensure exams) were represented throughout the process. while a more inclusive policymaking process can be an outcome, ensuring “safe spaces” for those impacted to share their stories was also seen by nasw chapters as critical to all activities and a driving force. all nasw chapter directors felt that their mission was to ensure there was greater accessibility into the profession. critical to the proximal outcome of creating a democratic environment is the activity of engaging and mobilizing the public. interviews indicated a generational divide in what mobilized social workers on the issue of eliminating the licensure exam. older social workers and those providing clinical supervision tended to oppose eliminating the exam, while younger professionals supported elimination or alternatives to the standardized test. for example, in one state, the nasw chapter director relayed: our board was divided on what to do about the exam. we had members that truly believed in the exam. and we had some board members that think they should be eliminated. some of our older, long-time licensed clinical social workers were very strongly opposed to elimination of an examination. we had agencies that want to get rid of the exam. these were people, agencies that were having trouble hiring… according to the model, engaging and mobilizing members through open discussions and listening sessions was seen as the key activity. nasw chapter directors in some states mentioned low participation and lack of consensus among stakeholders as a challenge, reflecting the difficulty in mobilizing civic engagement. for example, in describing why a advances in social work, summer 2025, 25(2) 658 particular initiative to eliminate the exam was unsuccessful, one nasw chapter director said, “it is harder to get to consensus as there are fewer people and cannot (sic) have different coalitions so need everyone to agree.” smaller chapters faced resource limitations and imbalanced partnerships which served as barriers to mobilizing membership and allied stakeholders. leadership was focused on addressing racial disparities and promoting inclusion, but political and resource barriers existed. the political landscape, especially in conservative states, further complicated the passing of reforms, especially those perceived to be linked to racial justice. for example, the nasw chapter director in one such state said, …if we were to try to do exam removal, it's how would you talk about that in a way that doesn't have anything to do with racial disparities because that would just make them, like dig in their dirt even more because they're just like, we don't believe in racism, i guess. the choice of democratic environment as a proximal outcome seemed to stem from sentiments by nasw chapter leadership that it was not realistic to view policy adoption as a distal outcome given the political landscape in some states. in some states, testing is in statute so removing it would require “opening up” licensing laws which was perceived as much riskier than changing state statute. the nasw chapter director in another state explained, “opening up the statute even to try to make positive change is absolutely terrifying…the entire profession can get deregulated if we open that statute up right now, and so we didn't try to run anything this legislative session.” thus, for some nasw chapters, promoting a democratic environment in which those impacted are centered in the discussions was the outcome. nasw chapter directors noted that this outcome is particularly aligned with social work values, which ensure that those who are marginalized are represented. interestingly, several nasw chapter directors mentioned that groups that were impacted did not take a stand, or social workers of color were not necessarily advocating for change in the exam or licensure process. changes in public views gen and conley wright’s (2013) model focused on changes in public views as directly related to the third proximal outcome of changing decision-makers’ views, which ultimately leads to policy reform. changing public views was the outcome of many nasw activities as nasw chapter directors indicated there appeared to be little knowledge of this issue outside of the profession. additionally, nasw chapter directors in some states reported that social workers were also unaware even after the aswb report about the disparities was released. for example, one nasw chapter director shared that results from a survey showed most members did not know about the reported racial disparities in the exam but still supported elimination of the exam for a variety of other reasons. in some states, changing public views were targeted at external stakeholders while in other states the outcome was to gain consensus among social workers. interviews revealed there was greater consensus about making changes in some states as opposed to others, with social workers divided about the need to reform. central to these concerns about nienow et al./state responses to racial disparities 659 eliminating the exam was a fear of reduced credibility for social workers as compared to other behavioral health providers, such as psychiatric nurses, or other allied professions which are often a part of composite boards which regulate social work. much of the messaging about the need for reforms was focused on the ongoing workforce crisis, particularly in rural areas, which underscored the need for more diverse professionals, adding urgency to licensure reform discussions. nasw chapter directors indicated that changing public views had to be approached carefully in states that were already fighting deregulation and there were questions about how policy adoption would impact on other legislative initiatives such as the social work compact. for example, one nasw chapter director said, “you know we can't get the compact and get rid of…the exam and so we have to pick; the compact is the easier lift you know versus the fight that getting rid of an exam would take.” many nasw chapter directors also indicated ongoing concerns about aswb’s data and other materials, given a perceived lack of transparency, further fueling skepticism about the exam's fairness. loss of trust in aswb and the exam remains challenging for many chapter directors. additionally, delays in license processing and workforce shortages created frustration which helped fuel reform efforts. changes in decision-makers’ views a critical proximal outcome was garnering support among key decision-makers. who these decision makers were varied between states. according to nasw chapter directors, in some states, the targets were rule-makers in the executive branch, while in most states, key decision-makers were found in the legislative branch. interestingly, the role of nasw chapter directors, themselves, seemed to vary across states. some saw themselves as leaders in changemaking while others deferred to their boards and acted more as facilitators. policy advocacy focused on promoting democracy or policy adoption was almost always driven by an a priori assessment of whether decision-makers were likely to be influenced or swayed. for example, a nasw chapter director talked about the role their board of social work has in influencing any legislative proposals, in order to even bring forth any of these changes, they're gonna have to accept them or say yes or no, because to be quite frank, they are the ones behind the scenes that go to the legislators. say, this isn't gonna work for us, or this is gonna work. so they would have to be on board. states faced mixed reactions from legislators when it came to alternative pathways to licensure. some showed support or neutrality while others dismissed it as politically unviable. many of the activities engaged in by nasw chapters were focused on education about social work and how it is regulated. many nasw chapter directors mentioned needing to “pick their battles,” with states prioritizing the social work compact over exam elimination or alternative pathways because this seemed more politically viable. many nasw chapter directors indicated that influencing decision-makers was expensive (due to the need to hire lobbyists) and resulted in the use of political capital. advances in social work, summer 2025, 25(2) 660 in virtually all states, the desired outcome was to create alternative pathways or eliminate examination for non-clinical licenses. several nasw chapter directors mentioned that changing decision-makers’ views about testing was easier in states that already had social workers practicing without testing due to exemptions or policies allowing those who were already in practice to continue to do so without testing when state licensing laws were passed. for example, one nasw chapter director explained, …so around one-third of our licensed social workers in our state didn't take the exam…so we're not getting as much pushback directly from our social workers as saying, yeah, well, i understand the necessity for this because i had to do it or that's just been the way it is. we hear a little bit of that, but we also have a lot of these experienced supervisors, agency directors, clinicians who don't have any larger amounts of ethical issues. licensure by other mental health professionals without testing also helped to change the views of decision-makers. nasw chapter directors mentioned that, in some states, licensing boards (focused on enforcement rather than broader diversity issues) are another barrier to reform, especially when they have power or influence with state officials and legislators. activities engaging and mobilizing public interviews revealed that advocacy activities used by nasw chapter directors were more collaborative approaches as opposed to rallies and protests. letter writing, which is often used in mobilization, was not a main strategy, according to nasw chapter directors. most of the work focused on convening. the majority of engaging and mobilizing the public related to addressing racial disparities in licensure exams was done through town halls, listening sessions, surveys (data collection), providing services (supervision, test prep, etc.) and public comment at social work board meetings. broad community engagement efforts included both social workers and allied professionals who were also trying to make changes to their licensure laws. work with allied professionals was more geared to leveraging political capital than the need to change the views of these professionals. concerns about licensure fairness and the qualifications of mental health professionals were the main themes to spark engagement. despite efforts to engage and mobilize, a large majority of those attending events or completing surveys showed ambivalence or even opposition to eliminating the licensure exam. coalition building coalition building was one of the primary activities of the nasw chapters. nasw chapter directors relied on the assistance of other social work entities, such as the society of clinical social work, and the national association of deans and directors, as well as allied individuals and disciplines, which were part of mental health coalitions. coalition building was prominent, with partnerships formed across organizations with diverse nienow et al./state responses to racial disparities 661 professional groups and stakeholders, such as tribal units, universities, unions, clinical societies and bipoc social work associations. equity and inclusion emerged as central themes, particularly through leadership by people of color and the support of marginalized communities like black social workers. nasw chapter directors mentioned that many coalition partners emerged from existing relationships and affiliations which made organizing much easier and more efficient as parties had worked together in the past, for example, one nasw chapter director described how their past efforts led to success in passing significant licensure legislation, now, pre-aswb data coming out…several others had brought to our attention that there were pretty significant disparities going on, and we heard lots of anecdotal evidence wanting to receive the data like, let's see the data. so once we knew that was like a push that people were trying, you know, trying to access this data. so our policy committee…and our board discussed it, as did the coalition of [name omitted for confidentiality] and [name omitted for confidentiality] and [name omitted for confidentiality]...and we worked together to write a couple of letters to ask for meetings with our board of social work and do public comment at our board of social work meetings and really try to shake it up…alongside many of the other efforts that were happening across the country…so that’s how it’s going through right now. engaging decision-makers engaging decision-makers is an activity that directly relates to changes in public views and decision-makers’ views, according to the gen and conley wright (2013) model. this activity did not relate to the proximal outcome of creating a democratic environment according to these scholars. several nasw chapter directors mentioned using lobbyists and having to pick their priorities. there was a strong emphasis on the need for clear and persistent communication with policymakers and legislators, as efforts to explain complex issues are often met with resistance or misunderstanding. several mentioned the social work compact as a significant competing priority, which impacted the scope of their change efforts, as engaging decision-makers was also impacted by the number of “asks.” there was also a telehealth bill in at least one state that was seen as a priority competing with testing and other reforms aimed at disparities. several nasw chapter directors tried to put a bill forward or discussed the possibility with legislators “behind closed doors.” many were told not to pursue because of the political climate, or if they pursued, not to use a “racial justice” lens, focusing instead on workforce development or access issues (e.g., in rural areas). several nasw chapter directors mentioned having their licensing board support was critical for moving legislation forward, but others stated that this entity had little to no influence with legislators. advances in social work, summer 2025, 25(2) 662 information campaigning educating policymakers was a significant activity by nasw chapters. a lot of effort was put into refining and framing messages. briefings/presentations were used, while media advocacy was not mentioned. nasw chapter directors identified gathering feedback through town halls, surveys, and listening sessions. communication through social media and creating educational materials was important. most nasw chapters used the aswb data which included the report that highlighted the disparities and the pass rates by state/social work program. several nasw chapter directors mentioned using scholarly research which criticized testing or the psychometric properties of the aswb exams. however, nasw chapter directors also mentioned limited resources and funding, which prevented more elaborate or comprehensive information campaigning. one chapter director commented, …i think we just need to increase our staff capacity. we have three of us right now and we are so so busy with what we currently have going on. but um getting the funding for this other staff member would help that if there were any other ways to get staff capacity built in our chapter through other funding…i don't know how any chapter smaller than us would ever pull this off. it's an incredible amount of work. reform efforts many nasw chapter activities focused on framing the reform efforts and some approached test elimination at the master’s category as a pseudo pilot, with such framing needed to garner support. reform efforts focused on balancing desires for broad-scale changes by eliminating testing altogether with the need for compromise, as there was a lack of support and consensus for such a drastic approach. eliminating the master’s test was coined by one chapter as eliminating “entry-level” testing. some nasw chapter directors also mentioned focusing on reforms related to retesting fees and other administrative issues, but these items were solely under the purview of aswb, so they were not successful in making these changes. defensive activities the data highlights divisions between social workers with regard to the need for reforms. many were greatly divided with few seeing both sides or the need for compromise. in some states, starting with racial bias was a non-starter because there was so much anti-dei rhetoric happening in their state. data were collected prior to a presidential election in which partisan politics centered on differing approaches to the appropriateness of policy reforms that are based on equity and broad-based inclusion. many nasw chapter directors mentioned a lack of incentive for institutional reform, suggesting inertia within decision-making bodies. they also brought up the amount of money aswb raises through testing and the lobbying budget used to thwart policy advocacy in opposition to testing. states mentioned not getting enough financial or lobbying support resources for them to even engage in defensive (or offensive activity). nienow et al./state responses to racial disparities 663 mounting any kind of offensive activity would mean having to defend additional efforts to deregulate licensure and was not something any of the nasw chapter directors wanted or could afford to risk. according to the nasw chapter directors, communication with aswb seemed to be limited. focusing on changing the test seemed not to be a focus of reform. an interesting point was that aswb’s perceived lack of relationships with state regulators seemed to be a weakness in countering policy change. the state presence of the nasw chapters made coalition building easier. inputs sense of agency the tenure of the nasw chapter directors appeared to be important as it was indicative of professional relationships in the states and the degree to which nasw chapter directors felt empowered to make change. with testing disparities, there was some disagreement between and across states regarding the problem (i.e., preparation, language, skill set needed to test versus practice, etc.). the ability to gain consensus about the problem was deemed essential to defining a path forward. the efforts of the nasw chapters were driven by the “outcry” of others – for example, if there was not a sentiment that there was a problem, little action occurred. most nasw chapter directors wanted to work on the issue of alternative pathways and mentioned adopting nasw’s national stance on the issue, but did not seem to know what or how to move toward this kind of change, and what they should be advocating for specifically. interviews highlight significant frustration and a sense of being overwhelmed by the challenges faced by some nasw chapters, particularly regarding heavy workloads and limited support. one nasw chapter director summarized this frustration by stating, "i'm a one-woman show, and there's not enough of me to go around." this frustration was exacerbated as nasw chapter directors mentioned that collectively they could influence the practices of aswb. for example, one nasw chapter director stated, “if (state) stopped requiring the exam, this would bankrupt aswb.” there is a clear recognition of the need for systemic change, particularly through advocacy and lobbying, but the resources are unavailable to effect policy change directly related to the level of activity and eventual outcome. leadership and decision-making are further complicated by the difficulty in achieving consensus within the profession, as highlighted by quotes reflecting the challenges of navigating diverse opinions. having a consensus and support of nasw chapter boards and politically savvy nasw chapter directors resulted in a strong sense of agency and more activity focused on the proximal outcomes. people and relationships all states were scanning the political environment and aware of strategic partnerships. staffing resources of the nasw chapters also appeared to be important. this input seems advances in social work, summer 2025, 25(2) 664 to be particularly relevant for reform efforts and was noted by nasw chapter directors as key in social work policy practice, perhaps because there is less money for hired lobbyists or campaign materials. there was a concerted effort to ensure that nasw activities were consistent with those of others and relationships with others were mentioned in nearly every interview. interviews highlighted the importance of internal relationships. internal support within the organization was seen as essential for driving initiatives and sustaining momentum in advocacy efforts. many nasw chapter directors mentioned efforts to include bipoc professionals in decision-making processes but also acknowledged gaps in leadership representation, particularly in mentoring roles. specialized knowledge and skills many nasw chapter directors spent time trying to understand the aswb report and communicate its results. several said they were not an “expert” on the issue of exam psychometrics and did not know what the impact of alternative pathways would be. two nasw chapter directors conducted workforce research which leant some legitimacy for exploring alternative pathways. there was a call among nasw chapter directors for updated data and research, especially regarding ethical complaints, workforce studies, and demographic disparities in licensure outcomes, as data is critical for informing policy reforms. concerns were raised about the effectiveness of current education systems and materials, with mentions of students not being adequately prepared for exams and issues with the structure and fairness of tests. there was also discussion of different programs having varying rates of passage and not understanding why these differences existed. material resources financial resources came up repeatedly as a justification for the change efforts (cost of preparation, test, etc.). chapters seemed to expend primarily energy and time on these efforts. there was a mention of aswb (the perceived opposition) having more financial resources and being able to hire lobbyists. many nasw chapter directors stated they could not afford to work on both alternative pathways and the social work compact. most chose the social work compact because it was easier politically and would take up less of their financial resources. nasw chapter directors also stated that taking on alternative pathway advocacy work would mean having to oppose aswb, which is better funded. nasw chapter directors stated that if nasw-national wanted them to work on alternative pathways, then they would need to provide much more financial support. one nasw chapter plans to use its fiscal reserves to hire a lobbyist next session to work on both the social work compact and alternative pathways to licensure. this will be the first time that the chapter uses its reserves for such an expense. many nasw chapter directors mentioned the value of prior relationships as critical in changing the views of decision-makers. also getting support from constituency groups was essential to impacting the views of decision-makers. social resources appeared to be nienow et al./state responses to racial disparities 665 more salient inputs than fiscal ones in this area of policy advocacy. limitations limitations of the study include potential selection bias as participants were not randomly selected and opted into participation in the study. approximately half of the state chapters participated in the study, so it is difficult to know if the findings are transferable to other states. finally, the study relied upon the perspectives and viewpoints of the nasw chapter directors. their points of view were not triangulated and may not present a holistic picture of what or why particular inputs, activities, or political context are present. discussion state responses to aswb exam disparities were classified into three major groups, those that made: (1) some or significant changes to licensure policies, (2) progress toward changes in licensure policies with no current outcomes, and (3) no changes regarding licensure policies. some or significant changes some states passed significant changes to licensure policies. these included removing the exam from licensing processes entirely, or making changes to provisional licensing, offering options to skip the exam in favor of additional supervision requirements. the political environment in states which made significant changes was perceived as generally favorable to social work licensure, and therefore unlikely to use the opportunity to destabilize or undermine licensing practice. state legislatures were often willing collaborators with advocates for change. this did not necessarily make change work a smooth process, as aswb lobbyists, social work licensing boards, clinical social work organizations, and other mental health providers, defended the status quo. other states made smaller changes to licensure policies on a permanent and temporary basis. for example, one state temporarily suspended the exam as a requirement for licensing, to be reinstated in a few years, with hopes that aswb would work to correct issues with the exam. nasw in these states did some significant work to promote changemaking. most nasw chapter directors engaged in conversations with constituents, through public forums, one-on-one conversations, surveys, and social media. in states with multiple affinity groups and professional organizations, nasw chapter directors worked with these organizations to develop policy positions and sometimes coalitions for advocacy. nasw chapter directors used this information to determine policy positions and organize. in some states, there was a consensus that the exam was problematic, and change needed to be made. other states faced significant opposition from some parties, including social work licensing boards, and negotiation, advocacy, and lobbying work were necessary to move policy change forward. the number of social work professionals in a state was often a key determinant: states with more nasw members had more resources advances in social work, summer 2025, 25(2) 666 and involved constituents. progress toward changes many states in this category had not yet passed licensing changes but implemented other meaningful changes or were making progress toward licensing change. many states in this category suggested they were waiting to see what other states would do – usually specific states – looking for models they felt would reflect their own political environment or be desirable in their states. some of these states suggested the social work compact was the highest priority for practitioners, and once this was passed, they would work on the exam disparities. several states expressed a desire to keep the exam, but then pressure aswb to make changes that would make the exam more inclusive. no changes states in this category were not engaged in efforts to make changes to licensing policy. there were three primary reasons that states were in this category. some states did not have consensus regarding licensing change, with some factions in support of retaining status quo. for example, there were factions in some states that understood the exam as essential for maintaining professional standards of practice or perceptions of professional capabilities. other states were working on the social work compact in parallel with concerns about the exam. in these situations, some nasw chapters did not have the resources to advance policy about the exam simultaneously. others did not want to distract from, or complicate, efforts to pass the social work compact. many states could not begin efforts toward licensure policy change because the political environment was not conducive or even perceived as dangerous to licensure more broadly. this was most frequently the case in states where the legislature and executive branch were primarily led by republicans. in many of these states, nasw chapter directors were concerned that bringing forward any changes to licensure might involve “gutting” the entirety of licensure or changing it in significantly detrimental ways. in these cases, nasw chapters conducted public forums or educational efforts with their constituents about the exam or worked with schools of social work to enhance exam preparation efforts. empirical testing of the policy advocacy framework gen and conley wright (2013) synthesize broad and robust literature on policy advocacy, attempting to build a conceptual framework and theory of change for the ways inputs, widely conceived, support advocacy activities, and result in shortand long-term outcomes. gen and conley wright describe two broad goals and five strategies, tracing specific connections between particular inputs, activities, and desired outcomes. this study empirically utilized their framework and theorized linkages, asking whether there was evidence to support connections between inputs and activities, or between activities and outcomes. as they note, nienow et al./state responses to racial disparities 667 these five strategies resulted from our linking of the composite logic model to relevant academic literature in policy studies, and they establish testable hypotheses for future empirical research. such research would likely observe policy advocacy organizations and their actions, test for the practice of these strategies, and also look for other strategies that are not captured in this study. (gen & conley wright, 2013, p. 186) data from this study highlights significant themes related to legislative advocacy, organizational challenges, and policy evaluation mechanisms, which support, extend, and complicate elements of their policy framework. as a nationwide sample of diverse, statelevel policy advocacy work, the data in this study provided a good test of this framework. goal 1: public-centered policymaking the first broad goal gen and conley wright (2013) articulate is public-centered policymaking. this goal does not aim for specific policy outcomes but is “meant to build the political influence of a group or the public in the policymaking process, thereby resulting in public policies that better represent their interests” (gen & conley wright, 2013, p. 182). the desired impact is a more democratic environment, in which target and future public policies better represent the interests of those they impact. goal 1 inputs were: sense of agency, people and relationships, and specialized knowledge, leading toward engaging and mobilizing the public (in this case, mostly social workers). all inputs were observed to be present, though to varying degrees. in states where opportunities to make change were foreclosed by the political environment, nasw chapter directors and social workers had a much lower sense of agency. nasw chapter directors are embedded in relationships with members and the broader social work public through direct and indirect means (for example, through relationships with schools of social work, they are connected to students). engaging and mobilizing the public was a response in almost every state. efforts were made to invite a general audience of social workers through social media, public forums, and surveys. more specific efforts included nasw chapter directors meeting with advocacy and affinity groups, school directors and faculty, and social work licensing boards. nasw chapters used workshops, seminars, social media, and publications to educate the social work public. it is less clear whether the work of engaging and mobilizing the public leads to a more democratic policy environment. in part, this is due to a lack of evidence. many states were in the process of working toward reforms but foresaw a lengthy process toward any legislative change. even in states that passed reforms, it is difficult to measure the impact of these reforms on the democratic environment around policy in social work, partly due to lack of evidence, as many of these projects were in progress currently, and did not yet lead to a sense that there were new outcomes about democratic environment. the authors suspect that democratic environment could be empirically tested by comparing participation with other similar kinds of legislation (even with efforts for the social work compact, for example). one could also test to see if more inclusive policy practice will be advances in social work, summer 2025, 25(2) 668 done in the future because of this work. however, this would also be difficult to study, as different issues result in different involvement and interest from various coalitions. goal 2: changes for target populations and systems that serve them the second broad goal is changes for target populations and the systems that serve them. gen and conley wright (2013) list four strategies used here: (1) public pressure, (2) decision-makers, (3) direct reform, and (4) implementation change. the overall inputs used toward goal 2 across all four strategies were examined, as well as their connection to the activities and outcomes for each strategy. all inputs recognized by the gen and conley wright (2013) model were present in states that made progress toward change. for example, many nasw chapter directors approached the change effort with a “sense of agency,” meaning that their activities and outcomes were shaped by their perceived political power, given the other driving and restraining forces. people and relationships were critical, as the nasw chapter directors who had been in their positions for longer periods and had existing coalition partners mentioned the value of using these assets. contrarily, the ones who were not were at a disadvantage. media, public relations, and finances (“material resources”) did not appear to be significant inputs in most cases. most chapters suggested they did not have many resources or even the “people power” to organize significant efforts. strategy and research were important ways to counteract a lack of material resources. several chapters mentioned doing a survey or collecting data, as well as using the aswb report and research, to fuel policy reforms. knowing the political landscape and having specialized skills, such as understanding legislative processes, were important. several nasw chapter directors mentioned being lobbyists or having relationships with legislators who were sensitive to the issue as they themselves were social workers or people of color. participants in the study readily acknowledged that their responses to exam disparities were highly driven by what was politically and otherwise feasible within their states. while the framework might suggest this is a part of the input sense of agency, the political environment or context appears to be an essential element of sense of agency and may be worth considering as its own category of input. the first strategy, public pressure, involves activities that change public views in ways that lead to influencing decision-maker views (strategy 2). this strategy was key in all states that made meaningful progress toward policy change. decision-makers, namely legislators and governors, were not otherwise invested in making changes to licensing laws, until the proposed policy reforms were brought forward by constituents or lobbyists. in most states, nasw chapter directors and allies participated in activities of engaging and mobilizing publics, coalition building, information campaigns, and attracting smaller decision-makers (such as licensing boards and schools of social work) to develop a shared policy agenda, promote a new licensing policy that changed exam requirements, and then influence lawmakers. nasw chapter directors also engaged directly with decisionmakers to influence their views. some nasw chapter directors had relationships with numerous legislators, some hired lobbyists, and some combined both tactics. there are legislative committees that maintain relationships with nasw chapter directors, in which nienow et al./state responses to racial disparities 669 decision-makers were partly influenced without significantly engaging public views. in this study, there was difficulty drawing a strong distinction between the final impacts of efforts to change public views and decision-maker views. strategies 3 (direct reform) and 4 (implementation change) were not as readily observed. among participants, none had yet engaged in attempts at policy reform through litigation, nor through attempts to alter the implementation of existing policies. there was no evidence of any efforts to approach policy advocacy through these methods. there were several states hoping that aswb would make substantive changes to the exam that would result in reduced disparities, which would count as an implementation change (strategy 4); however, none were involved in actively pressuring aswb in this direction. implications several implications can be drawn from this study. first, nasw has a structure which is centralized for some functions but decentralized for others. despite the national office indicating the need for exam elimination, there is no way to realize these efforts without strong legislative presence in each state. many chapter staff are also part-time and have competing priorities so nasw-national would need to examine its staffing structure in light of the importance of “people and relationships” as inputs for policy change if a similar call to action by the national office is made in the future. in instances in which the same nasw chapter director was overseeing more than one state, the strategy and outcomes were usually consistent. nasw has supported a more unified approach to licensure to adopt legislation related to the social work compact. however, the patchwork approach to state responses to aswb disparities appears counter to this approach. allowing each state to determine its own policy priorities resulted in greater variation between nasw chapter actions. nasw did not publicly put pressure on aswb to immediately make changes to the test, including smaller reforms, such as retesting fees, which may have changed the trajectory in some statesnasw did issue a public statement for such changes nearly two years after the release of the aswb exam disparity data. several chapters mentioned bipoc social workers did not take a stand on or advocate for change when it came to proposals for eliminating or developing alternatives to the exam. the explanation most often shared was that focusing on the racial disparities made these bipoc social workers feel like they were “less qualified” and/or damaged their credibility. the profession needs to take these concerns seriously and potentially focus less on the racial disparities and more on the validity of a standardized exam to measure “minimal competence” and protect the public. policy advocacy framework more work may be needed to use the gen and conley wright (2013) framework reliably in policy analysis. while this study offers an empirical grounding of gen and conley wright’s model, there were some limitations, including that some parts of the framework were much less available than others. while this study extended the framework advances in social work, summer 2025, 25(2) 670 in a few small ways, in general, the framework could be reliably used with data collected and proved a useful way to understand the complexity and intricacies of policy practice across a comparative sample. the data also indicates a pressing need for mechanisms to continuously evaluate policy impacts and document interactions with policymakers, revealing difficulties in tracking engagement and outcomes. the organizational landscape appears unstable, with staff movements potentially affecting policy initiatives and creating uncertainty about responses from state agencies. this case study also highlights the complexity of policy practice and questions the linear nature of the model used. changes in public or decision-maker views, both defined as outputs, can serve as inputs for eventual policy adoption or implementation change. there was no indication that the outcomes were decided by the input or activities; meaning, the environment in which these inputs and activities occurred needs further explanation. just as social workers use a person-in-environment perspective – there is a need to consider the larger cultural and political systems at play. perhaps using a genogram approach to policy analysis may be more consistent with social work theory as the profession draws importance on the larger systems in which processes occur. for example, states may be operating with one political party in power or in an environment which is legislatively contentious given different parties in power in different bodies. states also have different legislative sessions which may delay or expedite policy reforms. many nasw chapter directors also spoke about what other states were doing, using their efforts as models and additional pressures for change. for example, the nasw chapter director of a small northeastern state indicated that if a larger state were to eliminate the exam it may result in a significant financial impact for aswb given the number of test-takers, whereas in smaller states it would have little impact, given the limited number of potential licensees. ultimately, the profession of social work remains in flux and without a singular organizing model to move it forward. nasw, as the profession’s national practice organization, could take steps to help coordinate and support the efforts for a more uniform response to the disparity in licensure data, as they did with the social work compact. the model by gen and conley wright (2013) could be used to inform the specific inputs and activities necessary to achieve this outcome. however, the absence of consensus among stakeholders about the value of testing as part of licensing, the differing state political environments and lack of any agreed upon solution will continue to hinder progress toward the desired goal. references albright, d. l., & thyer, b. a. (2010). a test of the validity of the lcsw examination: quis custodiet ipsos custodes? social work research, 34(4), 229234. association of social work boards [aswb]. (2022). 2022 aswb exam pass rate analysis. author. https://doi.org/10.1093/swr/34.4.229 https://doi.org/10.1093/swr/34.4.229 https://www.aswb.org/wp-content/uploads/2022/07/2022-aswb-exam-pass-rate-analysis.pdf https://www.aswb.org/wp-content/uploads/2022/07/2022-aswb-exam-pass-rate-analysis.pdf nienow et al./state responses to racial disparities 671 braun, v., & clarke, v. (2006). using thematic analysis in psychology. qualitative research in psychology, 3(2), 77-101. béland, d., & howlett, m. (2016). the role and impact of the multiple-streams approach in comparative policy analysis. journal of comparative policy analysis: research and practice, 18(3), 221-227. cairney, p., & jones, m. d. (2016). kingdon's multiple streams approach: what is the empirical impact of this universal theory? policy studies journal, 44(1), 37-58. christiansen, j. (2011). four stages of social movements. in the editors of salem press (eds.), sociology reference guide: theories of social movements (pp. 1425). salem press. cox, l. (2018). why social movements matter: an introduction. rowman & littlefield. decarlo m. (2022). racial bias and aswb exams: a failure of data equity. research on social work practice, 32(3), 255-258. dettlaff, a. [@alandettlaff]. (2021, august 9). did you know the @aswb refuses to release any data on pass/fail rates of their social work licensure exam by race? [post]. x. garcia, a. (1990). an examination of the social work profession’s efforts to achieve legal regulation. journal of counseling & development, 68(5), 491-497. gen, s., & conley wright, a. (2013). policy advocacy organizations: a framework linking theory and practice. journal of policy practice, 12(3), 163-193. kingdon, j. w. (1984). agendas, alternatives, and public policies. tbs the book service ltd. moyer, b. (1987). the movement action plan: a strategic framework describing the eight stages of successful social movements. social movement empowerment project. nienow, m., sogabe, e., & husain, a. (2023). racial disparity in social work licensure exam pass rates. research on social work practice, 33(1), 76-83. zeltman, g., duncan, r., & holbek, j. (1973). innovations and organizations. wiley. author note: address correspondence to mary nienow, new mexico state university, las cruces, nm. email: mnienow@nmsu.edu orcid: mary nienow https://orcid.org/0000-0001-9269-0122 dawn apgar https://orcid.org/0000-0002-5474-1811 https://doi.org/10.1191/1478088706qp063oa https://doi.org/10.1080/13876988.2016.1174410 https://doi.org/10.1080/13876988.2016.1174410 https://doi.org/10.1111/psj.12111 https://doi.org/10.1111/psj.12111 https://doi.org/10.1177/10497315211055986 https://x.com/alandettlaff/status/1424713235790548995?s=08 https://x.com/alandettlaff/status/1424713235790548995?s=08 https://doi.org/10.1002/j.1556-6676.1990.tb01396.x https://doi.org/10.1002/j.1556-6676.1990.tb01396.x https://doi.org/10.1080/15588742.2013.795477 https://doi.org/10.1080/15588742.2013.795477 http://www.historyisaweapon.com/defcon1/moyermap.html http://www.historyisaweapon.com/defcon1/moyermap.html https://doi.org/10.1177/10497315221125885 https://doi.org/10.1177/10497315221125885 mailto:mnienow@nmsu.edu https://orcid.org/0000-0001-9269-0122 https://orcid.org/0000-0002-5474-1811 method participant selection figure 1. states participating in study data analyses results distal outcomes/impacts policy adoption table 1. summary of national change effort to address racial disparities in pass rates on aswb social work licensing exams using gen and conley wright’s (2013) framework proximal outcomes democratic environment changes in public views changes in decision-makers’ views activities engaging and mobilizing public coalition building engaging decision-makers information campaigning reform efforts defensive activities inputs sense of agency people and relationships specialized knowledge and skills material resources limitations discussion some or significant changes no changes empirical testing of the policy advocacy framework goal 1: public-centered policymaking goal 2: changes for target populations and systems that serve them implications policy advocacy framework _________ kim m. anderson, phd, lcsw, professor, school of social work, university of central florida, orlando, fl copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 423-441, doi: 10.18060/27237 this work is licensed under a creative commons attribution 4.0 international license. past suffering and current caring: a comprehensive picture of adverse childhood experiences among social work students kim m. anderson abstract: this article aims to provide a comprehensive picture of research on the prevalence and impact of adverse childhood experiences (aces) among social work students. in doing so, we highlight where ace research with social work students is most robust and point out gaps that need further inquiry. this article is organized into four parts, each summarizing pertinent ace research for that section, limitations, and next steps for further inquiry. part 1 offers an overview of the operational definitions of aces within the context of general population studies. part 2 reviews foundational studies of childhood adversity with social work students that explored prevalence and influences on career choice. part 3 provides a composite profile of current ace prevalence studies with social work students and compares them to non-majors to describe differing trends and patterns. part 4 presents empirical research on the impact of aces on social work students’ wellbeing and professional development. implications for social work educators are included. keywords: adverse childhood experiences (aces), social work students, wounded healer adverse childhood experiences (aces) denote potentially traumatic events that occur during childhood and may have lasting effects on an individual’s physical, mental, and emotional well-being. aces encompass a range of stressful events, such as child abuse and neglect, along with family challenges regarding domestic violence, substance abuse, mental illness, incarceration, and parental divorce/separation (dong et al., 2004; felitti et al., 1998). as future practitioners in the field, social work students may bring their own ace-related experiences into their professional practice. recognizing the prevalence and impact of childhood adversity in the lives of social work students may serve as a guide for social work programs in developing explicit and implicit curricula that fit their unique needs (educational policy and accreditation standards [epas], cswe, 2022). furthermore, providing bsw and msw students with scholarly and practical applications of adverse childhood experiences may increase the likelihood of understanding the academic elements of trauma exposure and aftermath, along with the normality of emotional reactions to clients’ disclosure of such events. this article aims to provide a comprehensive picture of the conceptual landscape of ace research as it relates to social work education, summarizing and clarifying past and present investigations to date. in doing so, we highlight where ace research with social work students is most robust and point out gaps that need further inquiry. although we know that social work students may experience more childhood adversity than non-majors (branson et al., 2019), we do not know how much they recognize this in their own lives or have connected it to impacts on their career choice and professional development (kremer et al., 2023). answering such questions may better inform curriculum development for meeting social work students’ personal and professional needs. integrating ace research throughout the curriculum may also help social work students with firsthand knowledge of about:blank advances in social work, summer 2024, 24(2) 424 the topic to normalize their experiences while creating opportunities to address the possible negative aftermath of one’s childhood adversity. even though adverse childhood experiences may increase the risk of negative outcomes in adult life, they do not determine the future. how such experiences are processed and made sense of may be critically important for social work students. this article is organized into four parts, each summarizing pertinent ace research for that section, limitations, and next steps for further inquiry. part 1 offers an overview of the operational definitions of aces within the context of general population studies. part 2 reviews foundational studies of childhood adversity with social work students that explored prevalence and influences on career choice. part 3 provides a composite profile of current ace prevalence studies with social work students and compares them to non-majors to describe differing trends and patterns. part 4 presents empirical research on the impact of aces on social work students’ well-being and professional development. lastly, the conclusion offers a synopsis of implications for social work education. 1. part 1: overview of ace population studies in the u.s. 1.1. ace study origins and current population ace research studies in patient samples and the general population show that the cumulative effect of adverse childhood experiences is a predictor of poor physical (felitti et al., 1998) and mental health in adulthood (merrick et al., 2018). wave i of the original ace research was conducted between 1995 and 1996 by the centers for disease and control (cdc) and kaiser permanente, where adults enrolled in the health plan network in san diego, ca, were surveyed (n = 9,508, felitti et al., 1998). the original ace research showed that as the number of aces increased, so did the propensity of illness; however, this association was not significant for patients with three or fewer types of aces (felitti et al., 1998). in contrast, patients with four or more aces were associated with higher incidences of poor health and addiction, showing a dose-response pattern. wave ii of the cdc-kaiser permanente ace study was conducted in 1997 with adults enrolled in the health plan network in san diego, ca (n = 8,629, dong et al., 2004). patient records were reviewed along with subsequent waves of interviews and data collection. ace types were highly correlated, and exposure to one predicted the likelihood of another (dong et al., 2004). findings from a composite of ace data (waves i and ii) from kaiser permanente health records (n = 18,137) found that 64% had encountered at least one ace, and 13% reported four or more (anda et al., 2007). current general population studies of aces use the behavioral risk factor surveillance system (brfss), a multi-state inventory that tracks retroactive childhood maltreatment and informs public health priorities (giano et al., 2020; merrick et al., 2018). these studies are more diverse than the original ace studies (i.e., 65-68% caucasian vs. 74%-84%) and indicate that females, younger adults, sexual minorities, and multiracial individuals experience higher rates of childhood adversity. giano et al.’s (2020) study of 211,376 adults reported that 12% had four or more aces, which was similar to the original ace studies of 13%, while merrick et al.’s (2018) results of 16% (n = 214,157) was anderson/swk students’ aces experiences 425 slightly higher. these studies, comparable to original ace research, found an association of four or more ace scores with increased behavioral health problems and mortality. 1.2. adverse childhood experiences questionnaire (ace-q) the adverse childhood experiences questionnaire (ace-q) was developed and validated in the original ace studies in collaboration with the cdc (dong et al., 2004; felitti et al., 1998). the ace-q has subsequently been validated in samples of college students (windle et al., 2018), social work students (kremer et al., 2023), and licensed social workers (steen et al., 2021). the ace-q consists of ten items inquiring about different adverse childhood experiences. one point is assigned for each category endorsed as “yes.” the total range of scores is between 0-10. the ten ace items include emotional, physical, and sexual abuse; emotional and physical neglect; domestic violence (i.e., violence against one’s mother); parental divorce or separation; household substance abuse (i.e., alcohol or drug use); mental illness (i.e., depression or suicide), and incarceration (i.e., a household member in jail or prison). 1.3. summary of lessons learned over the past 25 years, ace general population studies have indicated a dose-response pattern, where increased levels of aces are associated with a greater risk for physical illness, psychological distress, and mortality. this relationship, however, is not found to be significant for individuals with three or fewer aces. study participants of ace research in the 1990s were limited to adults with kaiser permanente health insurance coverage within one city in a westcoast state. moreover, 62% were 50 or older, and sample diversity was lacking as 84% of respondents identified as caucasian in wave i and 74% in wave ii. in contrast, more current general population ace studies encompass data collection from multi-state inventories with diverse samples. as a result, the data is more robust and has provided empirical evidence of ace disproportionality for young adults, females, and minoritized individuals (racial and sexual). for a quarter of a century, the prevalence rate of four or more aces in the general population has been consistent, ranging from 12%16%. the ace questionnaire was developed in the 1990s and validated in several general population and college studies. however, the original ace wave i and ii studies represent a different time, where, for example, parental divorce was not even included in wave i and, when measured in wave ii, was present in less than a quarter of the sample (23%). in contrast, current statistics of parental divorce in the u.s. are at approximately 40-50% for first-time marriages (mayol-garcía et al., 2021). as divorce is much more prevalent now, we need to consider whether it still represents an uncommon adverse experience in the lives of children. 1.4. limitations a limitation of using general population ace studies as a comparison group for social work students is that those between the ages of 18-24 are underrepresented in current advances in social work, summer 2024, 24(2) 426 (giano et al., 2020, and merrick et al., 2018, each 12%) and past studies (dong et al., 2004, and felitti et al., 1998, each m = 56 years old). therefore, ace studies conducted among college students provide a more age-suitable comparison group for social work trainees. aces and exposure to potentially traumatic events are shown to be widespread among college student populations. estimates range from 22% to 75% of college students have experienced at least one ace before college (hinojosa et al., 2019; park et al., 2021), with between 8% and 22% having experienced four or more (park et al., 2021). additionally, ace research among young adults indicates lingering aftereffects into adulthood (park et al., 2021). 1.5. steps forward part 2 explores pioneering studies of childhood adversity in the lives of social work students conducted during the 1990s-2000s. although the ace-q has existed for 25 years, its use to collect such data from social work trainees only occurred more recently, with the first published study using the ace questionnaire in 2015 (gilin & kauffman, 2015). before the implementation of the ace-q, the few studies that investigated rates of childhood adversity in social work students’ lives lacked definitional consistency (e.g., ace types varied across studies) and, therefore, could not be compiled for an overall composite profile. empirical evidence from these early studies, however, does provide a foundation for examining patterns of aces over the years to determine which ones remain relevant in the lives of current social work students as denoted with more recent studies (2015-2023) that used the ace-q. 2. part 2: childhood adversity and social work career choice 2.1. pioneer studies of childhood adversity and majoring in social work evidence from four seminal studies is presented that examines the relationship between a student’s history of family problems and its influence on majoring in social work (black et al., 1993; rompf & royse, 1994; russel et al., 1993; sellers & hunter, 2005). early investigations were concerned about the impact of childhood adversity on students’ career choices, development of professional relationships, and the ability to practice effectively. these studies examined the prevalence and career influence of different types of childhood adversity for social work trainees compared to non-majors. thirty years ago, black and colleagues (1993) led a call to action for social work educators in the united states to investigate the extent of childhood trauma among social work students. they underscored the need for further inquiry regarding the potential impact of students’ psychosocial background on the helping process. black et al. (1993) investigated the incidence of childhood trauma among master’s level social work students (msw, n = 116) compared to master’s level business majors (mba, n = 46) who attended a private college in northeastern pennsylvania. msw students reported a significantly higher frequency of childhood adversity in early life compared to business students in the areas of alcohol abuse (55% vs. 13%), drug abuse (27% vs. 0%), emotional abuse (38% vs. 4%), physical illness (56% vs. 17%), mental illness (28% vs. 4%), and death of a family member (72% vs. 39%). although the authors anderson/swk students’ aces experiences 427 did not analyze the association between a history of psychosocial trauma and professional impacts, they underscored how a problematic background might result in a wounded healer phenomenon in students, thereby, creating possible countertransference biases in their practice. psychologist carl jung was the first to use the term wounded healer in the early 1950s; this term continues to be used today (newcomb et al., 2015). the authors cautioned social work educators to provide student support rather than sanctions when addressing such issues. in the early 1990s the professional vernacular often referred to families as pathological or dysfunctional. the strengths perspective in social work practice was published in 1992 (saleebey, 1992), which overtime led to a helping paradigm shift from problem-oriented to strengths-based. russel et al. (1993) identified how pathology in candidates for admission to msw programs was a growing concern at the time; however, research on the issue was minimal. the authors, therefore, set out to investigate the incidence of traumatic events between graduate students in social work (n = 181), guidance and counseling (n = 100), business (n = 100), and education (n = 100) at a midwestern state university. study findings indicated that 73% of social work students had experienced one or more problems that defined a dysfunctional family (e.g., substance abuse, mental illness, violence, among others). additionally, they had a significantly greater incidence of family dysfunction than education (45%) and business students (37%), but not so with guidance and counseling trainees (68%). for example, nearly 50% of msw students reported that alcohol abuse was a problem, in contrast to 23% of business students. russel et al. (1993) concluded that many msw students may have encountered family challenges growing up. they recommended that social work educators pay close attention to those with considerable childhood adversity to support and advise them appropriately for professional development. rompf and royse (1994) also investigated how early trauma influenced the selection of social work as a career choice. the authors compared social work students (bsw n = 243; msw n = 172) from five public universities in kentucky to first-year english majors (n = 203) at one university. statistical differences were found between social work students and english majors on experiences of child abuse and neglect (17% vs. 8%), family emotional problems (37% vs. 25%), alcoholism or drug addiction in the family (32% vs. 21%), and parents unhappily married (44% vs. 30%). additionally, they found a significant difference between the level of social work students (71%) who had experienced one or more family stressors during childhood compared to english majors (58%). when asked how such experiences influenced their career choice, social work trainees were approximately three times (39%) more likely to view it as impactful than english majors (14%). the authors recommended additional research on student motivators for entering the profession and, if a driving force is to help others, to delineate further why they selected social work rather than another applicable field of practice such as psychology, nursing, or family studies. sellers and hunter (2005) conducted a study with 126 msw students at a midwestern university to investigate types of childhood adversity and how these impacted their decision to pursue a career in social work. they found that 69% of respondents indicated one or more problems in their immediate family or among other family members who were advances in social work, summer 2024, 24(2) 428 close to them. logistic regression analysis showed that having more indicators of a family history of psychopathology (i.e., clinically diagnosed mental illness, suicide, depression) and violence (i.e., domestic violence, child abuse, a victim or perpetrator of violence) increased the likelihood that students perceived problems in the family of origin as influential in their decision to pursue a career in social work. additionally, students who reported family problems and indicated that this history was influential to their career choice had increased odds (2.98:1) compared to students who reported no history of family problems of selecting mental health/health as a practice area concentration (versus gerontology, children and families, or macro practice). the authors concluded that although social work students may acknowledge the effect of family history on their career choice, they may be less aware of the implications for their professional development. thus, they recommended further examination of the relationship between social work trainees’ origins and practice effectiveness. 2.2. summary of lessons learned thirty years ago, social work researchers and educators were interested in examining the relationship between a history of family problems and its influence on career choice for social work trainees. levels of adverse childhood events were assessed and compared to non-majors to determine differing patterns and possible associations with vocational selection. research findings indicated that 69-73% of social work students reported one or more adverse childhood experiences in their families of origin (russel et al., 1993; sellers & hunter, 2005). such rates were comparable to guidance and counseling majors (68%) but significantly higher than non-social science majors (i.e., english, 58%; business, 37%; education, 45%). these earlier studies suggested that life experiences can shape social work students’ career interests and postsecondary coursework. for example, rompf and royse (1994) found that social work majors were likelier to view problems in their family of origin than english majors as influencing their career choice (39% vs. 14%, respectively). additionally, sellers and hunter (2005) identified how specific indicators of psychopathology and violence in the family influenced social work trainees’ decision to pursue a career in social work. furthermore, they found that a substantial history of family problems increased one’s odds of selecting a practice concentration in mental health/health versus other areas of practice. 2.3. limitations as the ace questionnaire was not developed until the late 1990s and empirical studies that used the ace-q with social work students were not published until 2015, previous studies lacked a consistent means of measuring childhood adversity and compiling an overall interpretation of its prevalence and impact. additionally, investigations of ace scores among social work majors were often compared to non-science majors (e.g., english, business), even though the fields of study are dissimilar, and thus, motivations for selecting a major differ. a more relevant comparison student group would be those enrolled in the social sciences (e.g., psychology, sociology, criminology). recent social work student investigations implementing the ace-q have addressed these methodological and design gaps. for example, kremer et al. (2023) explored how aces may shape anderson/swk students’ aces experiences 429 undergraduates’ (n = 722) selection of college majors that commonly lead to social service jobs. study findings indicated that social work students reported the highest prevalence of childhood sexual abuse, emotional neglect, physical neglect, familial substance use, and familial mental illness compared to non-social science and other social science majors (e.g., sociology, psychology, economics, anthropology, and political sciences). furthermore, their findings indicated that students who reported three or four aces were approximately three times more likely to major in social work than non-social science majors (e.g., stem, business). kremer et al.’s (2023) findings are comparable to the ace pioneer social work student studies of 30 years ago. 2.4. steps forward part 3 provides a composite profile of social work student ace research studies from 2015-2023. all selected studies used the ace-q for data collection. a synthesis of social work student sample characteristics is presented, followed by a composite profile of ace categories and total scores. next, findings of a descriptive comparison of ace research studies are presented for students majoring in social work versus a health profession. as social work education has continued to expand its focus on integrative behavioral health, comparing ace scores with students in these disciplines may provide fruitful insights regarding interprofessional similarities and differences. a catalyst for preparing students to work in integrative behavioral health settings has been the health resources and service administration (hrsa) grants awarded to social work programs (cswe, 2020). ace research to date has done a thorough job of documenting differences between social work students and those majoring in social sciences or non-social sciences. however, such comparisons are lacking with students majoring in health professions. 3. part 3: composite profile of social work student ace-q research 3.1. method: study selection of social work student ace research an electronic search of four databases (i.e., apa psycinfo [ebscohost], social work abstracts [ebscohost], social sciences premium collection [proquest], and google scholar) was used to detect empirical studies that used the ace-q for data collection with social work students in the united states. search terms included: 1) childhood adversity/adverse childhood experiences/ace/aces/ace questionnaire, and 2) bsw/msw/social work students/majors/trainees. inclusion criteria were 1) quantitative empirical studies, 2) bsw/msw students enrolled in schools of social work, 2) original data (i.e., unduplicated samples), 3) ace-q noted as a data collection measure, and 4) published peer-reviewed articles or thesis/projects/dissertations (i.e., scholarworks). eight studies met inclusion criteria (see table 1). all studies executed a cross-sectional research design. a composite profile of aces in social work students was calculated from this data. this included summing frequencies across the eight studies for each ace type, and each was then divided by the sum of the total sample (n = 831) and multiplied by 100 to determine percentages. the same procedure was used to determine the percentage of ace levels (i.e., 0 ace, 1 ace, 1+ aces, and 4+ aces) and percentages of gender (female/male) and race/ethnicity (bipoc, caucasian). anderson/swk students’ aces experiences 430 author (year) population/sample size age: range, m(sd) measure(s) results 1 kremer et al. (2023) bsw students (n = 135) & nonmajors (n = 587, social science [socsci] & non-socsci.) 3 midwestern & southern universities, n = 722 age not reported ace-q sw students significantly ↑ aces in child sexual abuse (csa), emotional neglect (en), physical neglect (pn), substance abuse (sa), mental illness (mi) vs. socsci. & non-socsci. majors. students with 3-4 aces, were 2-3 times more likely to major in sw than non-socsci majors. 2 mclean & delacey (2022) bsw (n = 15) & msw (n = 74) students at a california state university, n = 89 21-65 m = 32.1 (sd=8.59) ace-q, warwick-edinburgh mental well-being scale (wemwbs, tenant et al., 2007) no significant relationship between aces & levels of well-being in sw students. 3 lyter (2021) bsw (n =69) & msw (n = 45) students at pennsylvania state university, n = 114 18-51+ 18-50 (96%) 51+ (4%) ace-q, brief resilience scale (brs, smith et al., 2008), life satisfaction scale (lss, kuroki, 2016) no significant relationship between aces & levels of resilience or life satisfaction. 4 branson et al. (2019) bsw (n = 81) & non-majors (n = 269) at a public midwestern university, n = 350 age not reported ace-q sw students ↑ on all ace items than non-majors, statistical differences on ea, parental divorce/separation (di), domestic violence (dv), sa, mi, incarceration (inc). one or more aces, 2.88 x more likely to major in sw. 5 conrad (2020) bsw (n = 51) & undergraduate non-majors (n = 134) at a public michigan university, n = 185 age not reported ace-q sw students ↑ on scores on 8 aces, statistical differences on: ea, physical abuse (pa), csa, di, & sa. non-majors’ significant difference ↑on dv, 23.5% vs. 4.5%. 6 negrete (2020) msw students, n = 60 18-65 18-35 (68.4%) ace-q, categorical measures of practice area, therapy involvement, & internship challenges significant association of ace mi & mental health specialization. significant association of ace en & participation in personal therapy. no statistical difference between aces & countertransference while interning. 7 thomas & beecher (2018) msw students at a california state university, n = 139 <=34 (82%) 35+ (18%) ace-q, conner-davidson resilience scale (cd-risc, conner & davidson, 2003), perceived stress scale (pss10, cohen et al., 1983), brief santa clara strength of religious faith questionnaire (bscsrfq, plante et al., 2002), acceptance & action questionnaire ii (aaq ii, bond et al., 2011), mindful attention awareness scale (maas, brown & ryan, 2003) ↑ aces were associated with ↑ resilience & avoidance. perceived stress & avoidance negatively associated with resilience. mindfulness not significantly associated with resilience. 8 gilin & kauffman (2015) msw students at a private northeastern university, n = 162 20-60 ace-q sw students had ↑ aces in ea, csa, di, sa, mi, & inc than general population. statistical differences were not computed. advances in social work, summer 2024, 24(2) 431 3.2. synthesis of sample demographics the majority of social work students (n = 831) identified as female (84.9% vs. 14.4% male) and as black, indigenous, or people of color (bipoc 58.3% vs. 46.8% white or caucasian). a composite age was not calculated as studies varied on how it was reported via age range, age categories, or age m (see table 1). most participants were msw students (61.4% vs 38.6% of bsw). sample collection occurred at universities located in various regions in the u.s., including the west coast (n = 4), the midwest (n = 4), the northeast (n = 2), and the south (n = 1). 3.3. prevalence of aces in social work students the prevalence of ace types among social work students is represented in table 2, ranked from highest to lowest. the top three ace categories included parental divorce/separation, substance abuse, and mental illness. the next highest ace categories were forms of childhood maltreatment; approximately 30% of social work students reported enduring emotional abuse and neglect, while 25% reported histories of physical and sexual abuse. the lowest types of familial adversity included the incarceration of a family member (16%), domestic violence (15%), and childhood physical neglect (11%). additionally, 32% of social work students reported four or more aces while 19% indicated zero aces. 3.4. method: study selection of health professions student ace research an electronic search of three health-related data bases (ovid medline, pubmed/central and cochrane library) uncovered a lack of ace-q research with college students in the health professions apart from nursing. search terms included: 1) childhood adversity/adverse childhood experiences/ace/aces/ace questionnaire, and 2) students in nursing, medicine, physical therapy, dentistry, pharmacy, or respiratory therapy. inclusion criteria were 1) quantitative empirical studies, 2) students enrolled in a health profession, 3) ace-q noted as a data collection measure, and 4) published peer-reviewed articles between 2015-2023. articles that met eligibility criteria were reviewed. as nursing was the only discipline with more than one ace study, an investigation including a nationally representative student sample was selected for comparison purposes (clark & aboueissa, 2021). the only other studies included one in oral health and one in medicine. a general student sample of undergraduate students was also added to facilitate additional comparisons among social work and health professions students regarding the distribution of ace scores. age of participants across study samples ranged between 18 and 29 years old (see table 2). advances in social work, summer 2024, 24(2) 432 table 2. comparison scores of social work student composite with other ace student samples (%) ace type social worka (n = 831) f = 85% nursingb (n = 1,094) f = 93% oral healthc (n = 66) f = 82% medicald (n = 98) f = 51% undergraduatee (n = 2,969) f = 64% 1 parental divorce/ separation 46 48 38 12 33 2 household substance abuse 40 40 35 15 16 3 household mental illness 37 51 30 29 16 4 emotional abuse 37 44 41 21 19 5 emotional neglect 31 39 24 8 15 6 physical abuse 25 26 15 13 10 7 child sexual abuse 25 28 17 15 8 8 household incarceration 16 17 3 7 8 9 parental domestic violence 15 11 9 7 6 10 physical neglect 11 15 8 6 3 ace score 0 ace 1 ace ≥ 4 19 17 32 16 16 41 24 naf 26 49 20 12 47 21 12 a ace type rank order from highest to lowest % for social work student composite, f = female. b 72% bsn, 60% age range 18-29; clark & aboueissa (2021) c undergraduates, 73% age range 19-24; haslam et al. (2023) d 3rd year medical students, age not reported, although on average medical students graduate in their mid-20s; sciolla et al. (2019) e undergraduates, age range 18-25; windle et al. (2018) f na = data not reported advances in social work, summer 2024, 24(2) 433 3.4. prevalence of aces in social work students compared to other student samples descriptive comparisons indicate that social work and nursing students have higher rates for each ace type and total ace score than the other student samples. the top four ace types were the same for all student samples except for medical students, whose rates of 12% for parental divorce/separation were three to four times less than the others. although physical neglect rates were low for all student samples, the proportions for social work and nursing trainees were still two to three times higher than the others. regarding rates of childhood physical and sexual abuse, approximately 25% of social work and nursing students reported experiencing such maltreatment, which was double the rate for the general sample of undergraduate students. furthermore, the overall proportion of “0” aces was comparable for medical (49%) and undergraduate students (47%), which was double the rate for oral health students (24%) and triple for social work (19%) and nursing (16%) students. a similar pattern was found regarding the overall proportion of four or more aces, where medical and undergraduate students’ rates were 12%. in contrast, the rate for oral health students was two times higher (24%), and the rates for social work students (32%) and nursing students (41%) were three times higher. differential amounts of adverse childhood experiences may be associated with the sample gender composition of ace student studies, as participants in social work, nursing, and oral health were primarily female (82%-93%) compared to medical (51%) and undergraduate students (64%). further exploration of aces among student samples of medical trainees and undergraduates was done to explore possible gender differences within overall results. sciolla and colleagues (2019) found that female medical students reported higher rates than males for each ace category, and three reached statistical significance: emotional abuse (32% vs 10%), physical abuse (11% vs. 5%), and domestic violence (14% vs. 0%). although females comprised only 51% of the medical student sample, those with an ace score of four or more were 100% female (sciolla et al., 2019). similar patterns of gender differences were also found in the general sample of undergraduate students (windle et al., 2018). females were found to have higher ace rates than males for all categories except for physical neglect (males = 3%; females = 2%). females also had higher scores of four or more aces than males (14% vs. 9%). statistical differences were not assessed. a further look at gender differences in oral health students also revealed that females reported a higher incidence than males for each ace type with significant differences for emotional and physical abuse (haslam et al., 2023). 3.5 summary of lessons learned our composite demographic profile of bsw/msw ace studies found participants to have similar characteristics to those with the highest ace rates in general population studies: females, younger adults, and multiracial individuals (merrick et al., 2018). these population characteristics are also represented in social work trainees in the u.s., particularly for undergraduates (cswe, 2020). information on the nature of educational advances in social work, summer 2024, 24(2) 434 institutions (public vs. private) and their regional location indicated broad sample representation from public universities throughout the u.s. albeit differing levels, the top four ace types (parental divorce/separation, substance abuse, mental illness, and emotional abuse) were the same across student samples apart from medical students, whose rates for parental divorce were much lower than the others. the least endorsed ace categories across all college students were childhood physical neglect and incarceration of a household member. social and economic status may be a reason for a lack of such exposure, as those attending four-year colleges are more likely to be from middle to high-income households (zhou, 2019). additionally, individuals exposed to childhood poverty are underrepresented in higher education and overrepresented in cases of child physical neglect and adult incarceration (western, 2019; yang & maguire-jack, 2018). results of the descriptive comparison suggest that social work and nursing trainees are characterized by childhood adversity (≥ 4 aces) rates almost three times that of medical and undergraduate students. even when the sample composition in ace studies is more gender-balanced (e.g., college student population studies), research shows that females report higher ace levels than males, specifically in child sexual and physical abuse. this helps to recognize that female-dominated helping professions (e.g., social work, nursing) are likely to have trainees with high cumulative adverse life events due to the prevalence of victimization of girls and women in the u.s. (e.g., childhood sexual abuse). 3.6. limitations empirical articles that assess childhood adversity for students majoring in a health profession are minimal, and studies that use the ace-q are even more limited. no published student studies were found in the health professions except those in nursing, medicine, and oral health. although trauma-informed care is a standard of practice in the health professions (burns et al., 2023), assessing childhood adversity among students entering these fields appears to be less common. except for this article, descriptive comparisons among social work students and health profession majors regarding ace prevalence and prominent types are lacking. this area is ripe for investigation, particularly as health-focused interprofessional education (ipe) continues to grow as part of social work programs. a composite profile of social work student ace research allows for understanding the prevalence of ace types among social work trainees; however, it does not provide a clear picture regarding their impact on student well-being and professional development. black et al. (1993) cautioned that social work students with histories of childhood adversity (i.e., wounded healers) may have different orientations toward clients and be at risk for countertransference biases and other professional impacts (e.g., professional-client boundary issues). thirty years later, whether such histories increase professional (and personal) vulnerabilities for social work students remains largely unanswered. anderson/swk students’ aces experiences 435 3.7 steps forward part 4 encompasses inquiry into the effects of aces on social work students’ personal and professional development. four studies from the composite profile of ace-q studies explore such outcomes (see table 1). social work is a challenging profession, and a central issue is the influence of personal hardship on professional relationships and effectiveness with clients. among such discourse is whether histories of childhood adversity may increase vulnerabilities for student wounded healers. part 4 reviews empirical evidence on whether childhood wounds (i.e., aces) are found to present as risk factors, trauma assets, or a non-variable in relationship to adult well-being and professional development for social work students. 4. part 4: the impact of aces on well-being for social work students 4.1. impact of aces on student personal and professional outcomes although the ace-q was first used in 2015 with social work students, only four studies have analyzed their impact, two of which are student theses (mclean & delacey, 2022; negrete, 2020). mclean and delacey (2022) explored the relationship between ace scores and levels of well-being among bsw (n = 15) and msw (n = 74) students. the authors used the warwick-edinburgh mental well-being scale (wemwbs, tenant et al., 2007), a 14-item likert scale (1 to 5) with a minimum score of 14 and a maximum score of 70. participants reported comparable levels of well-being (m = 46.8, sd = 8.6) to the general population (m = 51.0, sd = 7, tenant et al., 2007). the most common wellbeing responses were, “i have been feeling optimistic about the future” and “i have been feeling loved,” both with 71% of participants answering “often” or “all of the time.” no significant relationship was found between the number of aces and social work students’ well-being levels. lyter (2021) investigated ace scores and levels of resilience (i.e., brief resilience scale/brs, smith et al., 2010) and life satisfaction (i.e., life satisfaction scale/lss, kuroki, 2016) among bsw (n = 69) and msw (n = 45) students. despite relatively high levels of aces (32% > 4 or more aces), participants’ resilience and life satisfaction scores were positive. the five-item brs mean was 3.12 (sd = 0.67, range 1 to 5). more than half of the respondents (63.4%) chose “strongly agree” and “agree” for the statement, “i tend to bounce back quickly after hard times.” furthermore, participants were generally satisfied with their lives. the mean for the single-item lss was 3.2 (sd = 0.67, range 1 to 4); 89% of respondents chose “satisfied” or “very satisfied” with their lives. no significant relationship was found between the number of aces and levels of resilience or life satisfaction. negrete (2020) examined the relationship between ace scores and field specialization, engagement in personal therapy, and internship challenges (e.g., countertransference) among msw students (n = 60). a statistically significant association was found for those who had reported childhood exposure to mental illness in the household and current specialization in mental health (as opposed to child welfare, advances in social work, summer 2024, 24(2) 436 substance abuse, medical social work, or macro practice). no relationship was found between participation in personal therapy and ace scores. of those who reported experiencing childhood emotional neglect in childhood, 93% also revealed that they had engaged in personal therapy. this relationship was statistically significant. regarding challenges experienced during an internship, the most frequently cited were time management/balancing duties (27%), self-doubt (13%), a lack of guidance or supervision (13%), and countertransference (12%). no significant associations were found between these internship challenges and ace scores. thomas and beecher (2018) found with their msw student sample (n = 139) that higher ace scores were associated with higher rather than lower levels of resilience (i.e., conner-davidson resilience scale/cd-risc, conner & davidson, 2003). msw ace scores were higher on average than those of human service providers (m = 3.04, sd = 2.51 vs. m = 2.18, sd = 2.13). their average perceived stress score (m = 18.29, sd = 6.19) indicated moderate stress levels (range 14-26). resilience scores for msw students (m = 77.46, sd 9.88, range 0-100) were comparable to norms found in studies of the general population (m = 80.04, sd = 12.8) and college students (m = 72.9, sd = 13.5). participants’ ages, along with levels of aces, perceived stress, religious faith, experiential avoidance, and mindfulness, were also examined as predictors of resilience. all the variables in the final model except age and mindfulness were found to significantly contribute to the model predicting resilience (r2=39.2%). furthermore, higher ace scores and stronger religious faith were associated with increased resilience, while higher scores of experiential avoidance and perceived stress were associated with lower levels of resilience. 4.2. lessons learned findings from these studies indicate that social work students experience moderate stress during their academic journeys and that many come into social work education with considerable histories of childhood adversity. student results also underscore how such wounds (aces) may positively contribute to students’ well-being and practice efficacy, thus challenging social work educators to rethink assumptions that such histories are necessarily problematic. furthermore, student ace scores were not associated with practice challenges like countertransference. paradoxically, thomas and beecher (2018) found that average ace scores were associated with higher rather than lower levels of resilience, while the other investigations found no relationship with well-being, resilience, or life satisfaction. compared to general population studies, social work students have higher ace scores and stress levels yet comparable levels of well-being and resilience, scoring particularly high on optimism, feeling loved, and the ability to bounce back from hard times (mclean & delacey, 2022; thomas & beecher, 2018). negrete (2020) highlights that social work students recognize the need for personal therapy, and many have engaged in it (68%), particularly those experiencing childhood emotional neglect (93%). an ability to face difficult or painful experiences with awareness and acceptance rather than engage in experiential avoidance strategies may be important to strengthen resilient responses (thomas & beecher, 2018). anderson/swk students’ aces experiences 437 4.3. limitations the main limitation is the need for ace impact studies conducted with social work students. the disproportionate focus of ace prevalence studies rather than impact investigations limits what can be learned concerning mitigating aftereffects on social work students’ academic performance and professional development. further inquiry is needed on the impact of aces on student practice effectiveness; apart from negrete’s (2020) investigation of ace scores and their association with internship challenges (e.g., countertransference), little is known. this does not infer that ace impact research is nonexistent. however, it does highlight a lack of published studies that implement the ace-q for assessing the influence of childhood adversity on personal and practice outcomes for social work majors. 4.4. steps forward although adverse life experiences may contribute to career choices for social work students, further exploration is needed regarding motivating factors from such experiences and their implications for practice (lyter, 2021). negrete (2020) asked social work students about their influences on majoring in social work. the highest reported factors were “utilize my past experiences to help others” (27%), “helping others” (18%), “previous personal experience with social services” (17%), and “passion for human rights and social justice” (17%). further exploration would be fruitful in discovering how one’s past experiences may impact students’ motivation to help others. for instance, perhaps social work students construe purpose from their suffering and, as a result, make deliberate choices to want to help rather than harm others. engaging in positive meaning-making may be an essential aspect of coping and, consequently, in advancing student resilience. as indicated in table 2, 32% of social work students experience four or more types of aces. additionally, bsw (and many msw students) engage in post-secondary education during a critical period of mental health development as they transition from late adolescence to early adulthood (18 to 25 years of age). the social work student impact studies reviewed in this section indicated that ace scores were not correlated with resilience, well-being, or life satisfaction (lyter, 2021; mclean & delacey, 2022; thomas & beecher, 2018). however, we do not know if this is the case regarding associations with psychological distress (e.g., depression, anxiety, post-trauma symptoms). examining the level of ace scores (four or more versus three or less) or type of aces (e.g., childhood sexual and physical abuse versus parental divorce) may further differentiate who is more at risk for problematic psychological and professional outcomes. acknowledging and addressing the implications of aces in the lives of student social workers is crucial to providing adequate support and promoting resilience within this population. more research is needed to understand the aftereffects of childhood adversity on professional development for social work students. students with a history of aces may find motivation and fulfillment in their work, have enhanced empathy and sensitivity to the feelings of others, and leverage their personal experiences to connect with individuals advances in social work, summer 2024, 24(2) 438 facing similar challenges, offering a sense of understanding and validation. simultaneously, they may face challenges in maintaining objectivity, setting boundaries, and managing their emotional well-being, leading to compassion fatigue and burnout if not properly managed. negrete (2020) concluded that social work students need to be mindful of their influences for entering the field of social work and choosing their field specialization to ensure that they take the appropriate measures to reduce the risk of vicarious trauma and ensure ethical practice. social work educators may equip students with the necessary tools to support and navigate these complexities. social work students are not expected to be free of psychosocial problems; 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(2019). equalization or selection? reassessing the “meritocratic power” of a college degree in intergenerational income mobility. american sociological review, 84(3), 459-485. author note: address correspondence to kim m. anderson, phd, lcsw, school of social work, university of central florida, hs1-212, 12805 pegasus drive, orlando, fl 32816-3358. email kim.anderson@ucf.edu https://doi.org/10.1186/1477-7525-5-63 https://doi.org/10.18060/21589 https://doi.org/10.18060/21589 https://doi.org/10.1017/s1742058x19000225 https://doi.org/10.1080/07448481.2018.1431892 https://doi.org/10.1080/07448481.2018.1431892 https://doi.org/10.1111/fare.12310 https://doi.org/10.1111/fare.12310 https://doi.org/10.1177/0003122419844992 https://doi.org/10.1177/0003122419844992 mailto:kim.anderson@ucf.edu _________ aubrey lynne sejuit, msw, med, phd, assistant professor of social work, and anthony james hill, msw, phd, department chair & professor of social work, winthrop university, rock hill, sc. katherine howell dewitt, phd, program director & assistant professor of clinical mental health counseling, south university-columbia, columbia, sc copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 594-619, doi: 10.18060/28624 this work is licensed under a creative commons attribution 4.0 international license. licensure and gatekeeping in the helping professions: a comparative study of social work and counseling in south carolina aubrey lynne sejuit anthony james hill katherine howell dewitt abstract: since the early 1900s, the regulation of social work practice has been a contested topic of discussion and debate in the social work profession. one of the ways in which social work and other helping professions can be regulated is through obtaining a license. oftentimes, a license for social work, as well as for other helping professions, includes a licensure examination. due to racial disparities found in licensure passage rates, researchers have asked questions of importance and relevance to the social work profession. this article examines the accreditation of the council on social work education (cswe) social work programs alongside the council for accreditation of counseling and related educational programs (cacrep) counseling programs. it also addresses the licensure policies and procedures for social workers and counselors in south carolina, providing a comparative and contrasting analysis. recommendations include streamlined licensure processes for sw and counseling, greater transparency in exam passage by demographic and training specializations and supporting social work and counseling students and alumni effectively. keywords: accreditation, licensure, council on social work education (cswe), council for accreditation of counseling and related educational programs (cacrep) in both social work and counseling, the processes of licensure and gatekeeping are critical for ensuring the competence and ethical standards of practitioners. gatekeeping serves as a proactive mechanism for maintaining the integrity of the profession by regulating entry, education, and subsequent licensure, with unique implications for each field. street (2021) explains that professional gatekeeping is the process of “assessing and screening students’ professional suitability for social work practice” (halaas et al., 2020, p. 417), and occurs through activities such as selective admission practices, coursework, student reviews, and academic advising (elpers & fitzgerald, 2013). many different professions—especially the helping professions—have implemented gatekeeping practices. in counseling, we argue that training institutions are the gatekeepers who play an essential role in identifying the students who are fit to join the profession. in their work, burkholder and hall (2014) state that teacher-counselors determine the academic and practical aptitude of the students and their professional aptitude and ethical insight. this gatekeeping role is to protect clients and to ensure the standards of the profession, as seen in the complexities in determining who should and should not advance through training programs (burkholder & hall, 2014). different studies have called for more rigorous selection procedures, which may include competency tests at both entry to and throughout about:blank sejuit et al./licensure & gatekeeping 595 the courses (swank, 2014; ziomek‐daigle & christensen, 2010). using the counseling competencies scale can also help ensure objectivity in the assessment process, sustaining the role of the gatekeeper in educators (swank & lambie, 2012). the entry into the social work profession, therefore, is also subjected to rigorous gatekeeping practices in social work education. the literature reveals that social work educators bear a considerable burden in shaping who gets to enter the profession at the beginning of the pipeline as they grapple with students’ ethical and applied skills (elpers & fitzgerald, 2013; haski‐leventhal et al., 2010). social work programs are typically the first point of contact for people who want to work in the field, so it is crucial to have proper gatekeeping in social work to protect the profession (elpers & fitzgerald, 2013). as emphasized in the literature, the pressure of the state policies and the economy/volume of work against the background of limited resources for these policies present a challenge to this role and thus cast doubt on the social work educators’ capacity to enforce strict gatekeeping without affecting the quality of service delivery (haski‐leventhal et al., 2010). one way some of these helping professions gatekeep is through licensure. “the central purpose of licensure and regulation is to protect the public, the consumers of social work services…licensure and regulation also distinguish the practice of social work as unique to qualified professional social workers” (morrow, 2023, p. 9). the social work and counseling professions use licensure to ensure ethical treatment of clients. morrow (2023) noted that, in the united states, state-level statutory laws are shaped by the social work licensure and practice regulations which are in place in all 50 states and the district of columbia. the regulation of social work and counseling in south carolina is overseen by two distinct licensing boards. the south carolina board of social work examiners, created under title 40, chapter 63 of the south carolina code of laws, is composed of a diverse group of seven members appointed by the governor. its members include two licensed baccalaureate social workers, two licensed master social workers, two licensed independent social workers, and one lay member (s.c. code ann. § 40-63-10). similarly, the south carolina board of examiners for professional counselors, marriage and family therapists, addiction counselors, and psycho-educational specialists is established under title 40, chapter 75 of the south carolina code of laws. this board consists of eleven members appointed by the governor, including nine licensed professionals from the respective disciplines and two members from the general public (s.c. code ann. § 40-7510). the composition of these boards allows for the regulation of each profession by its peers, ensuring that licensing requirements and disciplinary actions are both professional and relevant. the role of licensure exams as gatekeeping mechanisms while academic gatekeeping focuses on the evaluation of students' suitability throughout their program, licensure exams act as the final, standardized gate. this mechanism is crucial because it ensures a minimum level of competence for all who enter the profession, regardless of their university, instructor, or program of study. the core argument for licensure testing is that it protects the public by ensuring that all practitioners advances in social work, summer 2025, 25(2) 596 possess a foundational body of knowledge and the necessary skills to practice safely and ethically. this is especially important in helping professions, where client well-being and safety are paramount. the emphasis here is on standardization. while a university's accreditation ensures a quality curriculum, the specific learning outcomes and rigor of a program can still vary. a licensure exam provides a uniform measure of knowledge across all graduates. for instance, in social work, the association of social work boards (aswb) exams are designed to test a candidate's mastery of the core competencies necessary for practice. passing this exam is a non-negotiable step to becoming a licensed social worker in the state of south carolina. the same principle applies to counseling, where the national counselor examination (nce) or other state-specific exams act as the final barrier to entry. the gatekeeping processes in both fields are not only based on competence and fitness but also on ethical decision-making, which is influenced by the students’ backgrounds. in counseling, there is a need for culturally appropriate interventions that highlight the challenging dynamic between the two categories of variables: the person and the situation (goodrich & shin, 2013). goodrich and shin (2013) mention that multicultural factors should be taken into consideration when evaluating students’ readiness for practice and their performance, which reflects the broader social reality that counseling educators have to consider. in social work, there is also recognition of the diverse students’ characteristics that determine their learning and future practice. however, there is a view that prevalent practices that deny people opportunities based on their criminal history are inconsistent with the social work practice beliefs of recovery, dignity, and the value of people’s experiences (duvnjak et al., 2021). it is for this reason that educators in social work programs face ethical dilemmas in their gatekeeping roles as they attempt to balance the ideals of inclusion and exclusion in the profession. it also has its challenges in terms of professional ethics and client safety. both fields support the idea of clear definitions of what constitutes “problematic behaviors” in students and the need for detailed standards in program handbooks to avoid ambiguities (foster et al., 2014). such documentation also benefits students by providing a better understanding of what is expected of them in terms of professional behavior. it thus makes the gatekeeping process more credible by providing clear standards against which performance can be measured. the consequences of gatekeeping are not only related to individual fitness but also to the general structure. in both social work and counseling, these gatekeeping procedures can be ineffective and affect the quality of service provided in the community in the future. thus, in the absence of proper gatekeeping procedures, client safety is at risk, and the professionals’ credibility may be compromised (burkholder & hall, 2014). this underscores the importance of further research in this area, which the literature calls for (elpers & fitzgerald, 2013; foster et al., 2014; swank, 2014). as the research is still ongoing, it is crucial to note the significance of the need for continual training of educators who are in the position of gatekeeping. educators must also sejuit et al./licensure & gatekeeping 597 receive training in effectively assessing student competencies and engaging in reflective practice as gatekeepers (swank, 2014). counselors and social workers acting as gatekeepers must continually learn and adapt because environmental factors, especially social change, impact gatekeeping in complex and dynamic ways. there is still much to be gained from the cooperation between the educators of these two disciplines, which may open new possibilities for sharing experiences and approaches to gatekeeping (aaltonen & kivijärvi, 2018). gatekeeping in social work and counseling offers a way to ensure that practitioners meet certain standards of conduct. the area of licensure and education is a significant area of focus, and those who are involved in defining the standards of practice for the next generation of practitioners must deal with ethical, practical, and operational issues to strengthen their fields. in the end, as these fields develop, so must the gatekeeping mechanisms that support them. conceptual approach and data sources this article employs a comparative and contrasting analytical approach to examine the accreditation standards and licensure policies of social work and counseling professions. the primary data sources include official accreditation documents from the council on social work education (cswe) and the council for accreditation of counseling and related educational programs (cacrep). additionally, current statutory laws and regulatory policies pertaining to social work and counseling licensure in south carolina are analyzed. the discussion is further informed by existing academic literature on gatekeeping, professional education, and licensure within the helping professions. nature of the article: a conceptual analysis this paper is structured as a conceptual article, which differs from empirical research that generates new data through experiments, surveys, or direct observation. instead, a conceptual article synthesizes and analyzes existing information, theories, and frameworks to develop new insights, propose new models, or offer a fresh perspective on a particular topic. the aim is to advance understanding through interpretation and integration of established knowledge. our approach to this article aligns with the characteristics of a conceptual analysis in several key ways. first, we do not present original empirical data collected from primary sources (e.g., interviews with practitioners, surveys of students). instead, our analysis is built upon a thorough examination of publicly available, authoritative documents and existing scholarly literature. this includes the accreditation standards set by cswe and cacrep, specific program requirements from universities in south carolina, and relevant state licensure statutes. second, the core of this article involves a comparative and contrasting analysis. by systematically reviewing and synthesizing the distinct yet overlapping frameworks of social work and counseling education and licensure, we aim to highlight critical similarities and differences. this process of comparison and synthesis allows for a deeper advances in social work, summer 2025, 25(2) 598 understanding of the unique professional identities, educational pathways, and regulatory landscapes of each field, particularly within the context of south carolina. finally, the article culminates in the development of implications and recommendations. these are not derived from new data but rather emerge as logical conclusions and actionable suggestions based on the comprehensive conceptual synthesis of the existing information. this approach allows the paper to contribute to the ongoing discourse by providing a structured overview and critical assessment of current practices, thereby informing future directions for policy, education, and professional practice in the helping professions. council on social work education accreditation plays a vital, multi-layered role in professional education, ensuring academic quality and protecting the public. however, the varying types of accreditation can sometimes be a source of confusion. to clarify this, it's essential to understand the distinct functions of the regional, programmatic, and federal accreditation bodies that govern both social work and counseling programs. this tiered system provides a comprehensive framework for educational oversight, which ultimately impacts a student's eligibility for professional licensure. both the cswe and cacrep have rigorous accreditation processes that ensure programs meet high standards for student training and program quality. this oversight provides a layer of public protection by ensuring that graduates are prepared to enter the workforce. it is important to distinguish between three levels of academic accreditation that govern professional programs. regional accreditation, such as through the southern association of colleges and schools (sacs), applies to the university as a whole and ensures the institution meets general academic standards. programmatic accreditation, provided by bodies like the cswe and cacrep, focuses specifically on the curriculum and standards of a single professional discipline. finally, the department of education (doed) and the council for higher education accreditation (chea) serve as overarching federal bodies that officially recognize and oversee both regional and programmatic accrediting agencies, ensuring a consistent standard of quality across the united states. according to the cswe (2025a), the accreditation of a program covers all approved locations and delivery methods, as long as the degree is a recognized social work program. all accredited programs in the directory are reviewed periodically and are assigned one of five statuses: accredited, accredited (conditional), accredited (withdrawal in progress), candidacy, and pre-candidacy. the cswe's standards define these statuses. accredited programs are fully accredited, while accredited (conditional) programs have documented noncompliance that must be addressed within a year. an accredited (withdrawal in progress) program is accredited with a planned closure date. candidacy status indicates a program has completed at least one year of the candidacy process and is moving toward full accreditation within two years. finally, pre-candidacy programs have had standards approved in draft form and are scheduled to be reviewed for candidacy status within one year. sejuit et al./licensure & gatekeeping 599 graduate level accreditation in south carolina currently, there are only two cswe-accredited master of social work (msw) programs in the state of south carolina. previously, limestone university held the distinction of being the third cswe-accredited program in south carolina. however, the university ceased operations in 2025 due to financial difficulties. the two programs still operating today include the university of south carolina with an initial accreditation date of 1969 and winthrop university with an initial accreditation date of 2005 (cswe, 2025a). both programs offer an online option for students as south carolina has many rural areas. the university of south carolina’s main program is based in the capital, columbia, south carolina, with two other campus locations to include charleston and greenville (cswe, 2025a). winthrop university’s program is in rock hill, south carolina (cswe, 2025a). the university of south carolina has a full-time and an extended-time student program where students must complete 60 credit hours. advanced standing students, who hold a cswe-accredited bsw degree, must complete 42 credit hours (university of south carolina, n.d.-b). winthrop university’s msw offers a 60-credit traditional program for students who do not hold a cswe-accredited bsw and a 39-credit hour advanced standing program for students who do (winthrop university, 2025b). for cswe, programs can be online or hybrid, micro/macro, clinical, generalist, or have other specialty tracks. the cswe sets the educational policy and accreditation standards (epas) to guide and accredit baccalaureate and master's level social work programs. the evolution of epas reflects a shift in social work education, moving from a content-focused approach to a more outcomesand competency-based framework (cswe, 2025b). while various standards have been in place since the mid-20th century, the modern epas iterations have seen three major revisions since the early 2000s. the 2001 epas consolidated curriculum policies and accreditation standards into a single document, emphasizing efficiency and integrating baccalaureate and master's mandates (queiro-tajalli et al., 2001). this was followed by the 2008 epas, which represented a significant shift to a competency-based approach, outlining measurable practice behaviors as the organizing principle for curriculum design (holloway et al., n.d.). the 2015 epas continued to refine this competency-based framework, introducing concepts like multi-dimensional assessment (cswe, 2025b). the most recent iteration, the 2022 epas, further develops the standards, incorporating current understandings of professional competence and social work values (cswe, 2022). the cswe does not accredit doctoral-level education in social work (cswe, 2025a). for some doctoral programs, students can only be admitted with a master’s degree from a cswe-accredited social work program. students pursuing a doctoral degree in social work can choose to earn either a doctor of social work (dsw) or a doctor of philosophy (ph.d.) in social work (social work license map, 2020). there are currently no dsw programs in south carolina and the university of south carolina offers the only ph.d. in social work (university of south carolina, n.d.-b). it is the cswe-accredited msw degree that is the foundational educational requirement for licensure in many states, including south carolina. advances in social work, summer 2025, 25(2) 600 council for accreditation of counseling and related educational programs graduate level accreditation in south carolina in the counseling field, there are multiple graduate degree designations. in south carolina, students can earn an educational specialist (ed.s.) degree, a master of arts (m.a.), master of education (m.ed.), or a master of science (m.s.) in different areas of counseling (northern illinois university [niu], 2025). it should be noted that clemson university only accepts students into the ed.s. degree program after they complete a minimum of 48 credit hours from a cacrep-accredited program, and it requires a completion of 30 more credit hours, once admitted (clemson university, 2025). the university of south carolina, on the other hand, accepts students from undergraduate studies into one of their three ed.s. programs and requires a completion of 66 credit hours, once admitted (university of south carolina, n.d.-a). table 1. cacrep programs in south carolina university &/or school degree specializations year introduced university of south carolina, college of education eds school counseling marriage, couple, and family counseling clinical mental health counseling 1983 1997 2019 phd counselor education and supervision 1983 clemson university med or eds school counseling clinical mental health counseling 1998 2019 winthrop university med school counseling clinical mental health counseling 1999 2015 south carolina state university med school counseling rehabilitation counseling 2004 2017 the citadel med school counseling 2004 south university columbia ma clinical mental health counseling 2013 columbia international university ma clinical mental health counseling 2014 university of south carolina, school of medicine ma rehabilitation counseling 2017 webster university ma clinical mental health counseling 2018 abbreviations: eds=educational specialist, phd=doctor of philosophy, ma=master of arts, med= master of education similarities and differences of social work and counseling accreditation and coursework similarities and differences there are several similarities in social work and counseling programs. first, aside from overall accreditation standards that must be met through the council for higher education (chea) and the u.s. department of education (doed), along with regional standards for all of the universities in south carolina through the southern association of colleges and schools (sacs), both social work and counseling have even more stringent accreditation sejuit et al./licensure & gatekeeping 601 standards that must be met through cswe and cacrep. this can add another layer of protection that consumers of a social work or counseling program are getting a quality education. in south carolina, social work and counseling programs differ in degree offerings, credit-hour requirements, and curricular structures, reflecting variations in professional training and gatekeeping. social work provides an undergraduate bsw, which can allow advanced standing or expedited completion of an msw, with cswe-accredited programs ranging from 36 to 60 credits depending on prior coursework (cswe, 2022; university of south carolina, n.d.-b; winthrop university, 2024b, 2025b). faculty in social work programs are not always required to hold a doctorate, and doctoral degrees do not need to be cswe-accredited, although a minimum number of faculty with doctorates is required to launch an msw program (cswe, 2022). counseling programs, by contrast, include eight cacrep-accredited programs in south carolina, with master’s programs typically requiring 60 credits and ed.s. programs ranging from 60 to 91 credits, depending on prior coursework, while doctoral programs require 52 to 96 credits (cacrep, 2024b; clemson university, 2025; columbia international university, 2024; south carolina state university, 2024; south university, 2025; the citadel, 2025; university of south carolina, n.d.-a; winthrop university, 2025a). these differences in foundational training, along with disparities in licensure reporting, such as the nbcc not publishing first-time nce pass rates versus the aswb reporting a 74% first-time pass rate at the graduate level (aswb, 2024) may contribute to observed variations in licensure outcomes between the disciplines. a cacrep-accredited program employs no more than 10% of faculty without a cacrep-accredited doctoral degree, which is why many master’s, educational specialist, and doctoral programs choose to only hire cacrep-accredited degree holders (cacrep, 2024a). there are no undergraduate cacrep-accredited programs currently (cacrep, 2024a). the qualifications of a program's faculty are a direct gatekeeping mechanism, as a program cannot achieve or maintain accreditation without faculty who meet the strict standards set by accrediting bodies. this, in turn, directly impacts students because graduation from an unaccredited program can prevent them from even being eligible to sit for their state's professional licensure exam. a key difference between social work and counseling is the varying requirements for faculty qualifications, which can influence a program's ability to maintain its accreditation and, therefore, its graduates' eligibility for licensure. while both msw and master of counseling degrees prepare graduates for impactful roles in helping professions, a key distinction lies in the foundation philosophical approach and the resulting array of distinct disciplines within counselor training that are less emphasized in social work education. counseling programs, particularly those accredited by cacrep, often focus intensely on specific theoretical orientations and intervention modalities designed for direct clinical practice with individuals, couples, families, and groups. this leads to specialized tracts in addiction, career, clinical mental health, clinical rehabilitation, college counseling and student affairs, marriage, couple, and family, and school counseling, each with highly focused curriculum on diagnostic assessment, treatment planning, and evidence-based therapeutic techniques tailored to those populations and settings. advances in social work, summer 2025, 25(2) 602 in contrast, while msw programs offer clinical concentrations, their curriculum often maintains “person-in-environment” perspective, integrating micro, mezzo, and macro practice and emphasizing social justice, policy, and advocacy alongside direct service. this broader focus means that social work education, while robust in clinical preparation, may not offer the same depth of distinct, highly specialized counseling disciplines with dedicated accreditation standards that are a hallmark of professional counseling training. this fundamental difference in clinical training can impact the approach to discipline specific and interdisciplinary supervision in the mental health community. social work programs include nine competency areas noted in the epas (cswe, 2022) and counseling programs include eight competency areas (cacrep, 2024a). social work and counseling programs both expect students to complete certain coursework that aligns with competencies and a field education/internship experience of varying hours (cacrep, 2024a; cswe, 2022); however, social work students in bsw or msw programs must be supervised in the field by someone who holds a cswe-accredited degree (cswe, 2022) while counseling students can be supervised by someone who either holds a cacrep-accredited degree or a related profession (cacrep, 2024a). this means that while a cacrep-accredited degree holding counselor license could not supervise a social work student in field, a cswe-accredited degree holding social worker license could supervise a counseling student in an internship. it is clear that the social work profession has worked hard for title protection—an area many counselors feel the profession of counseling is lacking. this includes state-level legislation that protects social worker identity and title (s.c. code ann.§40-63-30, 2024). the cswe's 2022 educational policy and accreditation standards (epas) are built on nine core competencies that guide social work education and practice. these include: 1. demonstrate ethical and professional behavior. 2. advance human rights and social, racial, economic, and environmental justice. 3. engage anti-racism, diversity, equity, and inclusion (adei) in practice. 4. engage in practice-informed research and research-informed practice 5. engage in policy practice. 6. engage with individuals, families, groups, organizations, and communities. 7. assess individuals, families, groups, organizations, and communities. 8. intervene with individuals, families, groups, organizations, and communities. 9. evaluate practice with individuals, families, groups, organizations, and communities. (pp. 8-13) social work students in a bsw program must complete a minimum of 400 hours of field education and master’s program students must complete a total of 900 hours of field education (cswe, 2022). in section b3.3.6 of the epas for 2024, it is noted that field supervisors of baccalaureate students must hold a baccalaureate or master’s degree in social work from a cswe-accredited program and have at least two years of post-social work degree practice while section m3.3.6 of the same standards note that all master’s students receive field supervision from an individual who holds a master’s degree in social work from a cswe-accredited program and who has at least two years of post-master’s social work degree practice experience in social work (cswe, 2022). sejuit et al./licensure & gatekeeping 603 the cacrep's (2015) core standards are organized around eight core areas that guide professional counseling education. these standards are: 1. professional counseling orientation and ethical practice 2. social and cultural diversity 3. human growth and development 4. career development 5. counseling and helping relationships 6. group counseling and group work 7. assessment and testing 8. research and program evaluation. (counseling curriculum, f1-8) like social work, counseling students must also complete a practicum/internship with qualified supervisors. counseling fieldwork site supervisors must have a minimum of a master’s degree, preferably in counseling or a related profession; active certifications and/ or licenses in geographic location where the student is placed; a minimum of two years post-master’s professional experience; relevant training for in-person and/ or distance counseling supervision; relevant training in the technology utilized for supervision; and knowledge of the program’s expectations, requirements, and evaluation procedures for students (cacrep, 2024a). doctoral students who do not have those qualifications can still serve as practicum/internship supervisors for students in entry-level programs but, must: have completed entry-level counseling degree requirements consistent with cacrep standards; have completed or are receiving preparation in counseling supervision, including instruction for in-person and/or distance supervision; and be under supervision on a regular schedule that averages one hour a week from a qualified core or affiliate counselor education program faculty supervisor (cacrep, 2024a). students in cacrep-accredited programs must complete an internship of 600 supervised hours with a minimum of 240 hours of direct service contact with actual clients (cacrep, 2024a). both social work and counseling programs have courses in psychopathology, diagnostics, human behavior and the social environment/lifespan development, diversity, research, and program evaluation (cacrep, 2024a; cswe, 2022). though course names may be different in either program, it is expected that students are educated in these areas and must show competency in them. this shows that both cswe and cacrep take note of the importance of understanding human development, cultural competence, diagnosis, assessment, research, and program evaluation. they also recognize the importance of hands-on experience through internship and field education. both accrediting bodies demonstrate that social work and counseling are much more similar than different. beyond the specific competency alignments, four general overarching differences distinguish cswe-accredited social work education from cacrep-accredited counseling programs (cacrep, 2016; cswe, 2022). first, a fundamental distinction lies in their foundational philosophical approaches: social work emphasizes a holistic "person-inenvironment" perspective, while counseling maintains a more targeted clinical and therapeutic orientation. advances in social work, summer 2025, 25(2) 604 table 2. similarities and differences of cswe and cacrep program standards cswe (2022) epas cacrep (2016) counseling core standards compare & contrast similarities differences demonstrate ethical & professional behavior (competency 1) professional counseling orientation & ethical practice both emphasize ethical decision-making, professional conduct, legal standards, & self-care. cacrep explicitly includes orientation to professional organizations & advocacy (cacrep, 2016) while cswe focuses more broadly on anti-racism/anti-oppression lenses & lifelong learning within the profession's mission. advance human rights & social, racial, economic, & environmental justice (competency 2) social & cultural diversity both highlight understanding diversity, oppression, privilege, & advocating for marginalized groups. cswe explicitly links these to human rights & broad social, racial, economic, & environmental justice (cswe, 2022) emphasizing systemic issues more directly. cacrep focuses on multicultural counseling competencies & help-seeking behaviors within a counseling context. engage anti-racism, diversity, equity, & inclusion (adei) in practice (competency 3) (integrated within social & cultural diversity & other standards) core themes of diversity, equity, & inclusion are present in both frameworks. cswe has this as a distinct, central competency, explicitly calling for anti-racist & anti-oppressive practice, reflecting a specific & prominent commitment in social work education. cacrep integrates these concepts throughout various standards, particularly social & cultural diversity (cacrep, 2016). engage in practiceinformed research & research-informed practice (competency 4) research & program evaluation both require understanding & applying research methods, evaluating findings, & using research to inform practice. cswe explicitly frames it as a two-way street: practice-informed research & research-informed practice (cswe, 2022). cacrep includes program evaluation, which is also implicitly covered in cswe but explicitly named here. engage in policy practice (competency 5) (not a distinct core area; integrated within other standards) counselors engage with policy, particularly in advocacy for clients. cswe dedicates an entire competency to policy practice (cswe, 2022) emphasizing understanding policy formulation, analysis, & implementation, & advocating for policies that promote social well-being. this reflects social work's historical macro focus. cacrep integrates policy considerations within advocacy & professional identity. engage with individuals, families, groups, organizations, counseling & helping relationships both focus on building rapport, communication skills, & establishing cswe's competency is broader, encompassing engagement at all system levels (micro, mezzo, macro). cacrep specifically emphasizes counseling theories, case conceptualization, & sejuit et al./licensure & gatekeeping 605 cswe (2022) epas cacrep (2016) counseling core standards compare & contrast similarities differences & communities (competency 6) professional relationships with clients. developmentally relevant intervention plans within therapeutic relationships. assess individuals, families, groups, organizations, & communities (competency 7) assessment & testing both involve assessing client strengths, needs, & challenges. cswe's assessment is holistic, drawing on multidisciplinary frameworks like person-in-environment across all system levels (cswe, 2022). cacrep has a dedicated assessment & testing standard, focusing on standardized & non-standardized tools, psychometrics (reliability, validity), & using assessments for diagnosis & intervention planning, reflecting a more explicit psychological testing component (cacrep, 2016). intervene with individuals, families, groups, organizations, & communities (competency 8) counseling & helping relationships (specific intervention content also in specialty areas) both involve developing & implementing intervention strategies to achieve client goals. cswe emphasizes interventions across all system levels, including interprofessional collaboration & advocacy. cacrep focuses on counseling theories, crisis intervention, & specific therapeutic techniques relevant to individual & group counseling within its counseling & helping relationships & specialty area standards (cacrep, 2016). evaluate practice with individuals, families, groups, organizations, & communities (competency 9) research & program evaluation both involve evaluating practice outcomes & using findings to improve effectiveness. cswe emphasizes evaluation across all system levels, including culturally responsive methods. cacrep links evaluation directly to research & program evaluation, often with an emphasis on datadriven outcomes in counseling settings. abbreviations: cswe=council on social work education, cacrep=council for accreditation of counseling and related educational programs, epas=educational policy and accreditation standards advances in social work, summer 2025, 25(2) 606 holistic vs. clinical focus cswe's framework (epas) is rooted in social work's holistic "person-in-environment" perspective, encompassing micro, mezzo, and macro practice, with a strong emphasis on social justice and advocacy. cacrep standards, while acknowledging social context, are more intensely focused on the development of highly skilled counseling practitioners and counselor educators with a clinical, diagnostic, and therapeutic orientation. system levels cswe explicitly delineates competencies across individual, family, group, organizational, and community levels. cacrep's core areas are often implicitly applicable across these levels but are primarily framed from the perspective of direct counseling relationships and interventions. policy and advocacy social work (cswe) explicitly dedicates a core competency to policy practice and advocacy, reflecting its historical mission of societal change. while advocacy is present in cacrep standards (e.g., in professional counseling orientation and ethical practice), it's not a standalone core competency with the same depth of policy analysis. distinct specializations cacrep's structure includes distinct sets of standards for various specialized counseling areas (e.g., clinical mental health, school, career, marriage/family, rehabilitation, addiction), ensuring specific training for these roles. while social work has concentrations (e.g., clinical, macro), the core competencies apply broadly across all social work practice, without the same granular, distinct accreditation standards for subdisciplines that cacrep maintains. these foundational differences in philosophical grounding, system-level engagement, policy focus, and disciplinary specialization are crucial for understanding the unique professional contributions and collaborative potential of social workers and counselors in the broader landscape of helping professions. licensure similarities and differences though an msw degree heavily involves a systems approach to include family systems, a counseling degree in some states, such as south carolina, can prepare a clinician for licensure as a licensed marriage and family therapist (lmft) with the proper classes and time in the field working with families (labor, licensing, and regulation [llr], 2024a). it is important to note that advanced generalist social work programs may not consistently include coursework in psychopathology. students pursuing micro social work degrees should verify the inclusion of such courses, while those focusing on mezzo or macro practice will typically cover more management, organizational, and policy content. sejuit et al./licensure & gatekeeping 607 despite these specialized tracks, a licensed master of social work (lmsw) generally retains the flexibility to pursue either clinical or macro-level roles. this inherent career pivot potential is a distinct advantage that some other licensed professional programs often do not provide. in all cswe-accredited programs, students must demonstrate proficiency in working with families. this is integral to the "person-in-environment" framework and the comprehensive nature of social work practice. the 2022 epas of the cswe explicitly require this. while there is not one single competency solely dedicated to "families," the ability to engage, assess, intervene, and evaluate practice with families is woven throughout multiple core competencies. for instance, competency 6, "engage with individuals, families, groups, organizations, and communities," clearly includes families. similarly, competency 7 (assess), competency 8 (intervene), and competency 9 (evaluate practice) also specify that students must be able to perform these actions with "individuals, families, groups, organizations, and communities." this integrated approach ensures that social work graduates are prepared to work effectively with families as a fundamental unit of intervention within their practice (cswe, 2022). while a licensed independent social worker-clinical practice (lisw-cp) and an lmft pursue distinct educational and licensure pathways, both are qualified independent practitioners capable of providing comprehensive mental health assessment, diagnosis, and psychotherapy services to individuals, couples, and families. students who would like to become licensed clinicians who provide services to clients can earn a degree in counseling or social work. it is imperative to understand that, in the state of south carolina, in order to become a licensed clinician in social work, counseling, marriage and family therapy, addictions, and as a psycho-educational specialist, an examination to gatekeep the profession is required (llr, n.d.-a, n.d.-b). as noted earlier, in order to get licensed in many states, to include the chosen state to review, south carolina, a social worker must graduate from a cswe-accredited program (llr, n.d.-b) and there do not appear to be any dsw or ph.d. programs in social work which are cswe-accredited, at the moment (cswe, 2024). this means that in order to earn licensure in social work, the cswe-accredited master’s degree is needed, irrespective of holding a dsw or ph.d. in social work. unlike social work, in counseling, a degree in a counseling field or a master’s in psychology can lead to clinical licensure. for instance, the citadel (2025) offers a master’s in psychology that may be accepted if its coursework is demonstrated to be similar to cacrep-accredited classes, even if accredited by the american psychological association (apa; llr, n.d.-a). a social work license can only be obtained with a social work-specific, csweaccredited degree, while a counseling license can be pursued with a degree in a related field. another area of interest regarding the licensure procedures for counseling includes that a doctorate from a cacrep-accredited program, without the need for a cacrepaccredited master’s degree, can result in getting a license to practice clinically. advances in social work, summer 2025, 25(2) 608 in social work, a person can hold a master’s degree in something other than social work but, if accepted to a dsw or ph.d. program in social work, still not be eligible to earn licensure to practice because a cswe-accredited program is necessary for a license, as in the case of south carolina (llr, n.d.-b). in counseling, a person can hold a master’s degree in something other than counseling and, if accepted into a ph.d. program in counselor education and supervision or other cacrep-accredited program, still earn a clinical counseling license (llr, n.d.-a.). cswe's accreditation scope does not extend to dsw programs, although it does issue standards for them. likewise, ph.d. programs in social work are not subject to cswe's practice regulations. thus, the msw is recognized as the terminal degree for social work practice. for example, one of the authors of this article holds an msw from a cswe-accredited program, which is why she can be licensed as a social worker while her ph.d. in counselor education and supervision from a cacrep-accredited program allows her to earn licensure as a licensed professional counselor in south carolina. conversely, if a colleague held a master’s degree from a cacrep-accredited program and was accepted into a dsw or ph.d. in social work, a license to practice as a social worker, in south carolina, would be denied. south carolina social work licensure in south carolina, a social worker with a cswe-accredited bsw can become a licensed bachelor of social work (lbsw). for those with a master's degree, there are three distinct licenses: the licensed master social worker (lmsw), the licensed independent social worker-clinical practice (lisw-cp), and the licensed independent social worker-advanced practice (lisw-ap). the lisw-ap is specifically for social workers who practice at the macro level. additionally, both the lisw-cp and lisw-ap can earn a supervisor designation, denoted by an "s" at the end of their credential (e.g., lisw-cp/s or lisw-ap/s), with extra continuing education. these supervisors are qualified to provide the necessary supervision for lmsws to earn either their clinical or advanced practice independent license (llr, n.d.-b). these licenses, with the exception of the lisw-cp/s and lisw-ap/s require an examination (llr, n.d.-b). those interested in a license as an lbsw, lmsw, lisw-cp, or lisw-ap must have the requisite education and take an examination. to earn advanced licensure of lisw-cp or lisw-ap, 4,500 clinical or advanced hours must be completed and 100 hours under the supervision of an lisw-cp/s and/or lisw-ap/s must be obtained (llr, n.d.-b). to become an lisw-cp/s and/or an lisw-ap/s, licensure recipients must already hold the lisw-cp/lisw-ap and complete an additional 45 continuing education units (ceus) in supervision but, no other exam is required. south carolina counseling licensure in south carolina, there are multiple clinical degrees one can hold after earning a cacrep-accredited degree (llr, n.d.-a). degree recipients of cacrep-accredited programs can earn the licensed professional counselor associate (lpca), which is a provisional license, a licensed professional counselor (lpc) which is the equivalent of sejuit et al./licensure & gatekeeping 609 an lisw-cp in south carolina, and a licensed professional counselor supervisor (lpcs) (llr, n.d.-a). to become an lpc-a and then an lpc, aside from holding a degree from a cacrep-accredited program, a passing score must be earned on the national counselor examination (nce). in order to become a lpcs, those with a graduate-level degree of either a master’s or educational specialist must already hold an lpc for three years and take a supervision class as part of their program or complete 3 semester hours of supervision continuing education (llr, n.d.-a). those with a cacrep-accredited doctoral degree, which requires supervision as part of the program, can become an lpcs shortly after earning an lpc without the required three years holding the initial lpc license (llr, n.d.-a). aside from coursework completed, in order to become an lpc in south carolina, cacrep-accredited degree recipients must complete 1,500 hours of postmaster’s clinical experience and post master’s supervision in the practice of professional counseling performed over a period of not fewer than two years. of the 1,500 hours documented, there must be a minimum of 1,380 hours of direct client contact and a minimum of 120 hours of supervision by an lpcs (llr, n.d.-a). in south carolina, transitioning from a lpc to a lpcs does not require an additional examination, mirroring the social work progression. nevertheless, applicants for lpcs must hold a current, active, and unrestricted south carolina lpc license. furthermore, they must either have a doctoral degree in counselor education and supervision, or provide evidence of at least five years of continuous clinical experience, complete a minimum of thirty-six (36) hours of individual/triadic supervision from an lpcs, and submit proof of at least three semester hours of graduate study in supervision or board-approved training (llr, n.d.-a). in south carolina, a cacrep-accredited graduate can earn a license as a licensed addiction counselor (lac) if they meeting the following requirements: 1,120 hours of post-master’s clinical experience in the addictions field; 120 hours of supervision from an addiction counselor supervisor; passing an addictions examination; and forty (40) hours of continuing education in addictions (llr, n.d.-a). to become an addiction counselor supervisor, one must hold a current, active, and unrestricted south carolina addiction counselor, known as an lac and be either a lpcs or licensed marriage and family therapist-supervisor (lmft-s; llr, n.d.-a). no further examination is required to become an addiction counselor supervisor after initial licensure has been acquired (llr, n.d.-a). a graduate of a cacrep-accredited program in south carolin has the opportunity to earn licensure as a lmft with the completion of 1,500 post-master’s clinical experience in marriage and family therapy. of those 1,500 hours, a total of 1,380 hours must be in direct contact with a client, with a minimum of 120 documented supervision hours from either a lmft-s or a qualified licensed mental health practitioner (qlmhp), which includes a person licensed as a professional counselor supervisor, addiction counselor supervisor, a psychologist or a medical doctor (llr, n.d.-a). the eligibility of lmft in south carolina also requires the passage of the national marital and family therapy examination (llr, n.d.-a). to become a licensed marriage and family therapist supervisor (lmft-s) in south carolina, a current, active, and unrestricted south carolina marriage and family therapy license must be held with evidence of at least five (5) years of continuous clinical experience, a minimum of thirty-six (36) hours of individual/triadic advances in social work, summer 2025, 25(2) 610 supervision by an lmft-s or qlmhp, and three semester hours of graduate study in supervision or other training approved by the board are required but, no further examination is needed (llr, n.d.-a). professional affiliation similarities and differences regardless of license status, both social work and counseling are considered professions, which have their own professional organizations to join. social workers can join the national association of social workers (nasw, 2025) while counselors can join the american counseling association (aca, 2024). the state chapter of the nasw is known as the nasw-south carolina (nasw-sc) and membership in the overall nasw makes a person an automatic member of the nasw-sc if living in south carolina (nasw, 2025). the state chapter of the aca is known as the south carolina counseling association (scca) and membership in the scca is separate of the aca (2024). there is a separate fee to join the scca after becoming a member of the aca (2024). to run for office of either professional organization, even at the state level, membership in the overall organization is required with an added scca membership to be eligible for leadership roles in counseling (aca, 2024; nasw, 2025). another thing to consider is that both organizations also have their own code of ethics, by which members must abide, and they offer a discounted student membership (aca, 2024; nasw, 2025). nasw and aca codes of ethics the nasw (2021) code of ethics and the aca (2014) code of ethics both serve as comprehensive frameworks guiding ethical practice in the fields of social work and counseling. they emphasize key principles such as client dignity, professional integrity, confidentiality, and cultural competence. both codes are intended to help professionals navigate ethical dilemmas and uphold responsible standards of care. each emphasizes the importance of maintaining professional boundaries, advocating for clients, and ensuring practitioners work within their areas of competence. additionally, both codes provide decision-making frameworks to support ethical conduct in challenging situations. however, notable differences reflect the distinct priorities of each profession. the nasw code of ethics focuses heavily on social justice, advocacy, and systemic change, urging social workers to address broader societal inequalities and work toward equity for marginalized populations (nasw, 2021). in contrast, the aca code of ethics is more clinically centered, with detailed guidance on issues such as therapeutic relationships, assessment, informed consent, and the use of technology in counseling settings (aca, 2014). the aca code tends to offer more explicit direction on clinical and mental health issues, while the nasw code maintains a broader emphasis on community and policylevel advocacy. these differences underscore the unique ethical landscapes within which social workers and counselors operate. sejuit et al./licensure & gatekeeping 611 program specific licensure preparation apgar (2021) asserted that cswe educational competencies are based on what educators believe students should be able to do, whereas the aswb exam content is based on what social work practitioners actually do (as cited in morrow, 2023).while it is important to provide resources to current students, research shows that those who have already graduated may benefit from being targeted for licensure exam preparation (arndt et al., 2021). the vast majority of people who choose to get licensed, when the option of licensure is available…do so in the first three years after graduation…focusing on outreach to social workers who are three years or more postgraduation to invest or reinvest in pursuing licensure seems to be a more promising strategy than focusing on recent graduates who may already be in the process of fulfilling licensure requirements (p. 365). it may be of importance for programs that offer examination preparation to include alumni who have graduated more than three years prior. though the authors of this paper cannot speak to the program specific licensure preparation of schools for which they did not attend or work, the value of providing students and alumni with resources at their respective schools can be promoted. it may be important for programs that offer licensure examination preparation to include alumni who graduated more than three years prior, as providing ongoing access to these resources supports professional growth and community engagement. while the authors of this paper cannot speak to the specific licensure preparation practices of programs with which they are not affiliated, the value of institutions offering such support to both students and alumni is clear. for example, the authors who are faculty at winthrop university voluntarily offer social work students and alumni the opportunity to attend a free two-day online and in-person preparation session for the lmsw exam each fall and spring semester. this training draws upon information from the south carolina llr website regarding licensure standards, coursework, textbooks, ethical standards from the nasw, and aswb examination guides. students completing their field experience may, with supervisor approval, earn up to ten field hours for attending and receive a certificate of completion. similarly, the authors who are faculty at south university voluntarily provide students and alumni with an all-day, in-person training each quarter to prepare for the nce in pursuit of lpc licensure. internship students may, with supervisor approval, earn internship hours for attending and receive a certificate of completion. the faculty member responsible for this training receives course release to refine and update the material, as the administration recognizes it as equivalent to a course in faculty workload. such practices could be beneficially adopted by both cswe-accredited social work and cacrep-accredited counseling programs to enhance licensure readiness and promote continued professional development among students and alumni. advances in social work, summer 2025, 25(2) 612 gatekeeping in social work and counseling efforts to improve gatekeeping in the social work profession encompasses a range of recommendations. morrow (2023) outlines several key areas, such as narrowing the discrepancy between cswe educational standards and aswb exam content, bolstering licensure preparation within social work education, and addressing macro practice issues inherent in social work licensure. further recommendations from morrow (2023) involve standardizing license titles, establishing inclusive licensure pathways, promoting practice mobility, and expanding empirical research on social work licensure and regulation. complementing these insights, apgar (2022) highlights three crucial ways to strengthen the profession’s support system. these involve utilizing licensure examination pass rates for benchmarking to align with cswe’s emphasis on competency-based learning, enhancing transparency around critical student outcomes like examination pass rates both internally and externally, and improving access to licensure data to stimulate further research on social work regulation. since social work practice is regulated in all states, students are very aware of the centrality of licensure for employment and advancement after graduation. however, despite its importance, research in this area has not kept pace and there are few examples of curricular innovations in literature to assist students with passing licensure exams (miller et al., 2015, as cited in apgar, 2022, pp. 336-337). limited faculty knowledge of social work licensure and regulation can diminish their commitment to preparing students for these processes (morrow, 2023). this highlights the importance of greater collaboration between cswe and aswb in developing effective licensure education. with both social work and counseling interstate compacts now in activation for south carolina, these professions are poised to achieve greater reciprocity of licensure across state lines. this development underscores ongoing discussions among clinicians regarding the need for title consistency. “greater consistency in license titles would benefit the public in better understanding the professional identity of licensed social workers. title consistency would also facilitate the ease of social workers seeking licensure at an equivalent level from one state to another” (morrow, 2023, p. 11). why should social workers or counselors be expected to fulfill completely different or more stringent requirements from one state to the next? an advanced or independently licensed social worker or counselor in south carolina may be expected to take additional coursework or complete more hours of work in the profession with more supervision hours in another state to do the same job. this can present frustration for clinicians in both professions. previous social work research (apgar, 2022) has drawn the parallel between helping professionals in marriage and family therapy, nursing, and pharmacy, with social work as it relates to exam passage for credentialing. like social work and counseling accrediting bodies the commission on accreditation for marriage and family therapy education (coamfte), the commission on collegiate nursing education (ccne), and the accreditation council for pharmacy education (acpe) have created standards that define program effectiveness through their licensure passage rates. sejuit et al./licensure & gatekeeping 613 alternative pathways to licensure could be more inclusive as the research has shown racial disparities in social work licensure (morrow, 2023). data on the national counselor examination (nce) and the national clinical mental health counselor certification examination (ncmhce) from the national board of certified counselors (nbcc) was unable to be found by authors of this article due to this information not being publicly released and available with a demographic breakdown. while an examination may be useful to some, morrow (2023) suggested that alternatives to standardized exams could include portfolios, supervision, and case analysis as a way to indicate practice competency. it was also noted that while all u.s. states require passing a national exam for clinical licensure, most canadian provinces do not require one for those who want to become a registered social worker (rsw; morrow, 2023). “it is empirically unknown whether passing a national exam predicts greater social work practice competence. similarly, the impact of racial, ethnic, and gender differences in exam pass rates remains unknown” (morrow, 2023, p. 12). questions have arisen in both the social work and counseling circles as to whether or not licensure was necessary to provide care to clients after completion of rigorous program accreditation standards when earning a degree. although many helping professions, such as social work, counseling, nursing, and pharmacy, are not always federally mandated to hold a license, several factors nonetheless dictate its necessity. specifically, state regulations and the ability to bill for services rendered largely control the requirement for licensure. until certain federal and state agencies do not require a license to work for them and managed care organizations (mcos) do not expect a license to provide reimbursement, licensure of particular professions will remain intact. as gatekeepers of our professions, it is now on us to find ways to help make licensure much more accessible without lowering our standards. after all, we can maintain a high level of respectability as we abide by our code of ethics to engage in cultural competence. implications for practice, education, and/or licensure policy the comparative analysis of cswe and cacrep accreditation standards, coupled with south carolina's licensure policies, reveals several key implications. for practice, greater collaboration between social workers and counselors in interdisciplinary settings is encouraged, leveraging the unique strengths of both professions. educational institutions should consider opportunities for shared foundational courses where competencies overlap, fostering a more unified understanding of core helping skills while maintaining distinct specializations. regarding licensure policy, the differing supervision requirements for field placements warrant further examination to ensure equitable opportunities and consistent quality across both professions. policymakers may also explore avenues to harmonize aspects of licensure where possible, particularly in areas of shared practice, while preserving the distinct identity and scope of each profession to enhance public protection and streamline professional mobility within the state. advances in social work, summer 2025, 25(2) 614 recommendations for professional practice and policy comparing social work and counseling licensure and education in south carolina reveals both a shared commitment to public protection and training and areas where improvement is needed. the following recommendations are proposed to address the systemic challenges highlighted throughout this paper, including barriers to professional mobility, disparities in licensure, and opportunities for greater interprofessional collaboration. streamline pathways to licensure for professional mobility a detailed comparison of licensure requirements has helped highlight a significant barrier to professional mobility: the disparate, and sometimes confusing, state-specific requirements. to address this, south carolina should work toward adopting and implementing interstate licensure compacts for both social work and counseling. these compacts, such as the social work interstate licensure compact and the counseling compact, are designed to create a clear, reciprocal pathway for licensed practitioners to practice in multiple states without having to undergo a separate, lengthy licensure process for each one. by joining these compacts, the state would not only make it easier for qualified professionals to move to and work in south carolina but also support the state's own professionals in serving populations across state lines, particularly in border regions or via telehealth. this would ultimately help to meet the increasing demand for mental health services. address disparities in licensure exam passage rates it was noted earlier that there is a presence of racial disparities in licensure exams. while an overview of the educational and programmatic differences was provided, it is recommended that south carolina's licensing boards (such as the llr board of social work examiners and the board of examiners for licensure of professional counselors, marriage and family therapists, and psycho-educational specialists) take a proactive stance in investigating and addressing these disparities. this includes: • transparency: publicly releasing demographic data on exam passage rates for social workers and counselors. • review: conducting a review of the exams for potential cultural or racial bias in question content. • support: developing and funding free or low-cost test preparation resources specifically targeted toward students from marginalized backgrounds. • alternative pathways: exploring alternative methods for assessing competence, such as portfolio reviews or supervised practice evaluations, that could supplement or, in some cases, replace the reliance on a single standardized exam. sejuit et al./licensure & gatekeeping 615 foster greater interprofessional collaboration and education a distinct philosophical and educational framework of social work and counseling, noting their similarities and differences, has been highlighted. to leverage their unique strengths and improve client care, a key recommendation is to foster greater interprofessional collaboration starting at the academic level. graduate programs in both social work (cswe-accredited) and counseling (cacrep-accredited) in south carolina should be encouraged to create joint training opportunities, shared courses, and interprofessional workshops. this could include topics such as co-occurring disorders, telehealth ethics, and integrated behavioral health models. by fostering a shared understanding of each other's roles and a respect for their unique competencies, future professionals will be better prepared to work together in integrated healthcare settings, ultimately providing more holistic and coordinated care for the public. this recommendation aligns with the growing emphasis on integrated care models in the health and human services sectors. conclusion this conceptual article has explored the intricate landscape of accreditation and licensure within the social work and counseling professions, particularly focusing on the distinctions and commonalities between cswe and cacrep standards and their manifestation in south carolina's regulatory environment. our comparative analysis revealed that while both professions are diligently gatekept to ensure competent and ethical practice, notable differences exist in their foundational philosophical approaches, educational structures (e.g., the bsw pathway in social work), and specific fieldwork supervision requirements. the emphasis on a "person-in-environment" perspective and broader policy engagement in social work contrasts with counseling's more concentrated focus on distinct clinical modalities. despite these divergences, both fields share core commitments to understanding human development, cultural competence, ethical practice, and the importance of supervised experiential learning. the presented implications underscored the potential for enhanced interdisciplinary collaboration, the utility of exploring shared foundational coursework, and the need for ongoing review of licensure policies to ensure equity and professional clarity. ultimately, by understanding these nuanced similarities and differences, stakeholders in social work and counseling can better navigate professional boundaries, optimize educational pathways, 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(2010). an emergent theory of gatekeeping practices in counselor education. journal of counseling & development, 88(4), 407415. author note: address correspondence to dr. aubrey l. sejuit, department of social work, winthrop university, rock hill, sc, 29733. email: sejuita@winthrop.edu https://law.justia.com/codes/south-carolina/title-40/chapter-75/section-40-75-10/ https://law.justia.com/codes/south-carolina/title-40/chapter-75/section-40-75-10/ https://law.justia.com/codes/south-carolina/title-40/chapter-75/section-40-75-10/ https://law.justia.com/codes/south-carolina/title-40/chapter-75/section-40-75-10/ https://law.justia.com/codes/south-carolina/title-40/chapter-75/section-40-75-10/ https://scsu.edu/academics/programs/med-in-counselor-education.php https://www.southuniversity.edu/columbia/clinical-mental-health-counseling-ma#course-requirements https://fieldeducator.simmons.edu/article/field-instructors-as-professional-gatekeepers-a-qualitative-study-of-gatekeeping-influences/ https://fieldeducator.simmons.edu/article/field-instructors-as-professional-gatekeepers-a-qualitative-study-of-gatekeeping-influences/ https://doi.org/10.1177/2150137814529147 https://doi.org/10.1177/2150137812452560 https://doi.org/10.1177/2150137812452560 https://www.citadel.edu/counselor-education/graduate-programs/med-counselor-education/ https://sc.edu/study/colleges_schools/education/study/areas/counseling/ https://sc.edu/study/colleges_schools/socialwork/ https://www.webster.edu/catalog/current/graduate-catalog/degrees/counseling-ma.html https://www.winthrop.edu/sgco/graduatestudies/master-of-education-in-counseling-and-development.aspx https://www.winthrop.edu/sgco/graduatestudies/master-of-education-in-counseling-and-development.aspx https://www.winthrop.edu/sgco/graduatestudies/master-of-social-work.aspx ttps://doi.org/10.1002/j.1556-6678.2010.tb00040.x ttps://doi.org/10.1002/j.1556-6678.2010.tb00040.x mailto:sejuita@winthrop.edu sejuit et al./licensure & gatekeeping 619 appendix. acronyms acpe accreditation council for pharmacy education aca american counseling association adei anti-racism, diversity, equity, and inclusion aswb association of social work board bsw bachelor of social work coamfte commission on accreditation for marriage and family therapy education ccne commission on collegiate nursing education ceus continuing education units cacrep council for accreditation of counseling and related educational programs chea council for higher education cswe council on social work education ph.d. doctor of philosophy dsw doctor of social work epas educational policy and accreditation standards ed.s. educational specialist llr labor, licensing, and regulation lac licensed addiction counselor lbsw licensed bachelor of social work lisw-ap licensed independent social worker-advanced practice lisw-cp licensed independent social worker-clinical practice lmft licensed marriage and family therapist lmft-s licensed marriage and family therapist-supervisor lmsw licensed master social worker lpc licensed professional counselor lpca licensed professional counselor associate lpcs licensed professional counselor supervisor lpes licensed psycho-educational specialist lisw-ap/s licensed independent social worker-advanced practice supervisor lisw-cp/s licensed independent social worker-clinical practice supervisor mcos managed care organizations m.a. master of arts m.ed. master of education m.s. master of science msw master of social work nasp national association of school psychologists nasw national association of social workers nasw-sc national association of social workers-south carolina nbcc nce national board of certified counselors national counselor examination ncmhce niu national clinical mental health counselor certification examination northern illinois university qlmhp qualified licensed mental health practitioner rsw registered social worker scca south carolina counseling association sacs southern association of colleges and schools us doed u.s. department of education ________ courtney d. cogburn, phd, associate professor, chelsea a. allen, lcsw, phd student, william r. frey, phd candidate, prema filippone, phd candidate, school of social work, columbia university, new york, ny. brittany r. brown, phd student, school of social work, department of psychology, university of michigan, ann arbor, mi. susan witte, professor, school of social work, new york, ny. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 574-604, doi: 10.18060/24151 this work is licensed under a creative commons attribution 4.0 international license. the racial projects of white social work students courtney d. cogburn chelsea a. allen william r. frey prema filippone brittany r. brown susan witte abstract: despite a theoretical shift toward anti-racism, racial projects within social work assert public positions against structural racism, while upholding mechanisms that perpetuate its existence. analyzing the perceptions and intentions of incoming white liberal social work students is necessary for any effort to deconstruct racial projects in the social work profession. the sample used in the present study is composed of a white (n = 139), mostly liberal-identified (84%) group of incoming first year msw students. students were asked to provide open-ended responses to a vignette about a black mother engaging with child protective services (cps). the vignette was designed to assess structural analysis and decision-making in response to real-world examples of racism and anti-blackness. the study employed semantic thematic analysis to describe the ways social work students make meaning of the vignette and how this process informs their proposed actions. students varied significantly on the level of analysis they provided in response to the vignette. the analysis examines patterns of racial projects across 3 main response categories: 1) descriptive, 2) analytical, and 3) action. this analysis is important for informing pedagogical innovations aimed at training anti-racist and anti-oppressive social workers. keywords: anti-racism, liberalism, whiteness, social work education social work education, practice, advocacy, and research are deeply rooted in a legacy of white supremacy and coloniality (almeida et al., 2019; gregory, 2021; lerner, 2021; maree, 2020; singh, 2014; teasley et al., 2021). increasingly, social work scholars and practitioners are calling for anti-racist, anti-oppressive, and anti-colonial social work education and practice (absolon, 2019; mccoy, 2020; powell & kelly, 2017; singh, 2014; tamburro, 2013). these calls are not new (mcmahon & allen-meares, 1992; national association of black social workers, 1968), but are growing as part of a global movement in social work to take ownership of our commitments to racial justice (american academy of social work and social welfare [aaswsw], 2021; nasw [code of ethics], 2020; rao et al., 2021) and to move beyond superficial solutions to racial inequities in our societies (absolon, 2019; coxshall, 2020; lerner, 2021; social work policy institute, 2014). calls for a reckoning with whiteness have also become more central in the discourse championing an anti-racist evolution in social work (frey et al., 2021; singh, 2014). gregory (2021) specifically calls for social work in the united states to take “an honest, rigorous, critical account of its own whiteness” (p. 33). advances in social work, summer 2022, 22(2) 575 the current study, part of a larger research project with a multi-racial sample, focuses specifically on whiteness (as a positionality, ideology, and structure) within social work. we leverage the concepts of racial projects (ifitikar, 2017; omi & winant, 2014; rhee, 2013; williamson, 2017) and racial ideologies and frames (feagin, 2020; bonilla-silva, 2003) to evaluate patterns of racial meaning-making among white social work students. racial projects are the tools used to construct meaning and value related to race. this includes structural and cultural tools, such as educational or media systems (cogburn, 2019; omi & winant, 2014) as well as individual-level processes, such as identity and personal racial ideologies (omi & winant, 2014). racial projects in social work, or the ideological maps used to guide meaning-making and practices related to race and racism in social work, are important to identify and reimagine as a part of the process for deepening social work’s engagement with racial justice. the ability to critically evaluate and engage systemic racial oppression is a type of racial project and a critical developmental task for all social workers. social workers’ racialized positionalities, ideologies, and histories vary widely and should be considered when developing social work curricula aiming to support racial project development. members of actively constructed and brutally maintained dominant groups (e.g., white people) may practice and conceptualize social work, race, and racism differently than people who experience the brunt of that social domination. these differences in social position have implications for the types of racial projects that undergird our education and training, the ways social work is practiced and in turn, the specific educational and training tasks that need to be engaged (dyer, 1997; frey et al., 2021; morrison, 1992; roediger, 1998). our analysis focused on understanding the racial projects white social work students bring to their social work training, which can help to inform the development of decolonized and anti-racist social work curriculum. we contend that this type of analysis is foundational to the development of anti-racist social work education and practice. racial projects and whiteness race is a constructed, dynamic, and ubiquitous social phenomenon that intersects with all major social conflicts. regarding race, omi and winant note “that no other social conflict –– not class, not sex/gender, not colonialism or imperialism –– can ever be understood independently of it” (omi & winant, 2014, p. viii). from this perspective, race functions (though not inherently) as a fundamental organizing principle in society. in their theory of racial formation, the authors forward the concept of racial projects to represent the social processes that inform the racialization of people and social structures and the exchange between these systems that embed racial meaning and value (omi & winant, 2014). racial projects are the processes through which race is constructed, maintains dynamism, and sustains relevance across social structures, societal domains, and social interactions. whiteness functions independently as a racial project and is also embedded at the roots of all contemporary racial projects and in turn, all racial projects are fundamentally tied to whiteness (ifitikar, 2017; mills, 1997/2014; omi & winant, 2014). we use the phrase white cogburn et al./ racial projects 576 racial projects to emphasize the ways in which whiteness functions as an independent racial project. an analysis of whiteness as a specific racial project forces visibility and accountability of whiteness. using white racial projects as a frame also supports our engagement of a targeted interrogation of whiteness, which we argue is necessary to any effort to establish anti-oppressive and anti-racist practices in social work. the construction of whiteness and white hegemony rely upon and have value that is sustained through the myth of white supremacy and distorted assessments of social reality (bonilla-silva, 2015; feagin, 2020; mills, 1997/2014; omi & winant, 2014). we focused specifically on conceptual models that help us understand how the myth of white supremacy functions as a cultural and belief system. white supremacist ideology is commonly (and mistakenly) reduced to a belief system that includes the espousal of white superiority (genetic, cultural, etc.) and ordained dominance often symbolized through clandestine codes and meetings, burning torches, and polo shirts (dyer, 1997). white supremacy also functions as a cultural system, often invisibly shaping social norms and values as well as collective racial ideologies and frames––the tools used to rationalize, make meaning of and maintain material hierarchies around race in society (okun, 2021; zuberi & bonilla-silva, 2008). we contend that white racial projects are: a) fundamental to social work education and practice and b) inform the perceived roles and intentions of white social work students. it is important to note, however, that we do not assume that the use of white racial projects is exclusive to white students or that white students exclusively rely on white racial projects who may also employ alternative frames, such as anti-racism and critical race consciousness. in order to observe racial projects operating in these ways we merely need to “examine the many ways in which we ‘notice’ race” (omi & winant, 2014, p. 126). building a social work curriculum and training model that responds to this need depends on a clearer understanding of the ways students employ white (and other) racial projects as it relates to the function of racism in society and the practice of social work. the language of race (blauner, 1994) varies considerably between minoritized (particularly black) and white students. black students, for instance, may be more likely to centralize the significance of race in everyday experience (e.g., blauner, 1994; hope & bañales, 2019) and locate the source of racial inequities in the histories and contemporary functioning of social systems and structures (e.g., eschmann, 2021). in contrast, white students may be more likely to dismiss the central importance of race (blauner, 1994; rucker et al., 2019), which can render the realities of racism as relatively invisible or exceptions rather than rules. omi and winant (2014) describe these discordant views on racism as a “crisis of meaning” (p. 71). the unique positionality of whiteness (and in turn white social workers) is also reflected in what feagin and colleagues describe as "social alexithymia" or "the sustained inability to relate to and understand the suffering of those who are oppressed" (feagin, 2013, pp. 27-28). accurate assessments of the degree and mechanisms that sustain racial inequities across social domains is critical to decision making, policy and behavior. white americans are less likely to employ structural (vs. interpersonal) frames for evaluating racism (nelson, et al., 2013; rucker et al., 2019; unzueta & lowery, 2008). in one study, 70% of white participants endorsed interpersonal beliefs about racism (e.g., individuals own beliefs advances in social work, summer 2022, 22(2) 577 cause them to treat other races poorly), while black participants were equally divided in their endorsement of interpersonal and structural beliefs (e.g., discrimination is historically built into our society and institutions; rucker et al., 2019). likewise, white americans also substantially underestimate racial economic inequality (kraus et al., 2019; rucker et al., 2019) and are resistant to data or information aimed at correcting their misperceptions (onyeador et al., 2021). the psychology underlying these stubborn misperceptions lies partly in commitments to seeing society as just, fair and merit-based, which leads to granting greater credence to information that confirms those beliefs and paying less attention to data that are inconsistent with those beliefs (kraus et al., 2019). when structural framings of racism are more prominent (i.e., focusing on the role of systems, structures, policies in producing racial inequity), individuals are more likely to understand the cause of racial inequities as being structural in nature (o’brien & major, 2009; richeson & sommers, 2016) and are less likely to support policies known to exacerbate racial inequities (e.g., habitual offender laws, rucker et al., 2019). racial ideologies and frames racial ideologies and frames arguably form the bedrock of white racial projects. patterns between white people (social position), their assessments of racial inequity in society, and their resistance to correct data and frames are manifestations of whiteness as a racial project. these ideologies and frames reflect how reality is being assessed and serve as guides for meaning-making and action (bonilla-silva, 2015; feagin, 2020). there are several frames that align with what we have described as “white racial projects.” similarly, neoliberal frames privatize and individualize understandings of race, while fashioning structural racism––such as inequitable resource distribution––as unrecognizable (giroux, 2003; martin, 2013). colorblindness and neoliberal ideologies are also core to white racial projects (feagin, 2020; bonilla-silva, 2015; omi & winant, 2014). white racial projects benefit from whiteness being an invisible, hegemonic organizing structure in society. colorblindness and neoliberalism serve as ideological foundations of “white invisibility” through a) rejecting the social significance of race and whiteness in society, b) emphasizing the role of economic systems (divorced from an analysis of “race”) in the production of social inequality, and c) an idealistic urging to see people as individuals and humans unencumbered by race, functionally ignoring the realities of racial oppression. another frame is the reliance on paternalism (e.g., restricting client agency through authoritative control; reamer, 1983) and white saviorism (e.g., a sense of self-serving charity to help or fix oppressed groups that are undergirded by notions of white superiority, e.g., values and norms; sondel et al., 2019). these frames all function as key features of white racial projects. anti-racist projects racial projects serve a sociological function in shaping policy and practice, and a psychological function in helping to shape our understanding of how racism operates in everyday life (omi & winant, 2014). we have provided conceptual grounding for features of white racial projects which inform racial meaning-making processes, such as cogburn et al./ racial projects 578 neoliberalism and colorblindness, among white students. in addition to racial projects, antiracist projects (omi & winant, 2014), which include combinations of seeing, engaging, and aiming to transform the conditions of racial oppression, can also be employed for meaning making. racial frames that are consistent with this type of critical assessment and action include critical race consciousness and anti-racism. critical race consciousness references awareness, evaluation, and action in response to oppressive social conditions (godfrey et al., 2019), and similarly, anti-racism uses reparations as a guidepost, while also calling humanity to action against the throes of racial oppression to design a fully inclusive social, economic, and political democracy (androff, 2010; omi & winant, 2014). in contrast to colorblindness, for instance, each of these frames requires the explicit engagement of racism in social analysis, policy, and practice in order to address racial inequities (feagin, 2020; kennedy, 2013; omi & winant, 2014). the present study the present study assessed structural analysis and decision-making in response to realworld examples of racism and anti-blackness in a sample of white social work graduate students. the study was organized around three premises. the first premise is that racial projects (specifically various characteristics of white racial projects) are foundational to social work education and practice. the second premise is that understanding the ways white social work students build and employ these projects is essential for designing social work curriculum and training that prepares them for engaging in an anti-racist and antioppressive practice. the third premise is that the education and training of white social workers to engage in an anti-racist and anti-oppressive practice is particularly important for diminishing the role of social work in perpetuating racial oppression. building on these premises, patterns in ideologies among an incoming graduate student class of selfidentified white social work students (referred to as “baseline racial projects”) in response to a social work case vignette were analyzed to a) evaluate patterns in their description and use of racial projects, b) the ways they position themselves in relation to those projects and c) perceptions regarding their responsibilities (as social workers) for responding to those projects or systems. methods sample the sample utilized in this study was entirely composed of white-identifying social work students. these participants were a part of a 2019 incoming cohort of msw students at a northeastern region university (n = 139). the majority of participants in the sample identified their political affiliation as liberal (84%) and 2.9% of the sample identified their political leanings as conservative. the remaining 7.9% of students identified as neither liberal nor conservative. the average age of students in the sample was 27 years old (sd = 7). the sample was primarily composed of students who self-identified as female (87%; n = 121). ninety-two percent of students were born in the united states. advances in social work, summer 2022, 22(2) 579 research design procedures the current study presents an analysis of qualitative data taken from a larger multimethodological study focused on examining the effects of an immersive virtual reality experience. the larger study employed longitudinal data to explore topics related to antiblack racism, structural analysis, and decision making. in the current analysis, we focus on a subset of the data collected during baseline (responses provided prior to the start of their graduate program). we analyze open-ended responses to a narrative vignette detailing a fictional account of a black mother’s experience with child protective services using the racial projects framework to examine how they “notice” race within the vignette (omi & winant, 2014, p. 126). whiteness is embedded at the root of all contemporary racial projects but also functions independently as a project (omi & winant, 2014). we use the phrase white racial projects to organize our targeted (though not exclusive) consideration of whiteness as a specific form of racial project, which we argue forces visibility and accountability of whiteness. table 1. narrative vignette and response prompt a few days after an argument with her boyfriend led to a 911 call made by a neighbor, ms. l, a black mother of two young boys, received an unexpected visit from child protective services (cps). the caseworker asked her if she used drugs, and ms. l truthfully responded that she smoked marijuana from time to time. according to ms. l’s attorney, the admission led to a child neglect proceeding against her in which the state claimed that ms. l did not properly care for her children. the only evidence presented on the petition was ms. l’s admission that she smoked marijuana. the court adjudicated her as “neglectful” and implemented a “family service plan,” a combination of ongoing state surveillance and mandatory “services.” her family service plan included the following: parenting classes; anger management classes; parenting classes for children with special needs; participation in a drug treatment program; submission to drug testing; submission to unannounced visits from cps, including full access to the apartment for inspection; and participation in all family court conferences and hearings, regardless of her work schedule. when ms. l was unable to comply with all these demands on her time while maintaining her job, her children were taken from her and placed in foster care. the state then added individual and family counseling services to her service plan, along with supervised visits with her children. ms. l eventually quit her job in order to comply with the plan. yet, despite her efforts to comply, ms. l still faced termination of her parental rights. her children have rotated through different foster care placements, and the emotional stress of separation from their mother has taken its toll. response prompt: you are a social worker who has recently been assigned to ms. l's case. please briefly describe your thoughts based on the information you've been provided above. the present study was approved by the university’s institutional review board as a part of the broader study’s protocol. prior to beginning the fall semester, all incoming students completed an online survey as part of their onboarding for the program. the cogburn et al./ racial projects 580 students in the current sample completed all study protocols after enrolling but before beginning any coursework. students provided informed consent and were given the option to decline participation. in the survey, students were asked to respond to a narrative vignette detailing the experience of a black mother engaging with child protective services (cps; table 1). after reading the vignette, students are provided the following prompt: “you are a social worker who has recently been assigned to ms. l's case. please briefly describe your thoughts based on the information you've been provided above”. the students were not provided any further instructions on how to respond, beyond this prompt. the narrative vignette utilized for this study (table 1) was designed to assess the racial project themes employed among incoming, white-identifying sw students. we were particularly interested in the analysis students would volunteer with minimal guidance from the vignette text. the vignette text did not explicitly identify the race of any actors aside from the mother, ms. l, who was identified as a black woman. the vignette described how the individual actions, as well as cps and judicial protocols, contributed to the outcome of the case without explicitly making connections between individuals and systems. the construction of the vignette text deliberately avoided guiding students to an anti-racist or structural analysis, which supported unaffected responses from students and undoubtedly led to a range of interpretations of appropriate responses to the vignette. data analysis semantic thematic analysis was used to assess the use of white (and other) racial projects in their analysis of the vignette. the analysis focused on the interpretive frames students used, the basis upon which these understandings were grounded, and how this framing informed (if at all) their proposed actions as social workers. as this study was interested in exploring themes related to anti-black racism, thematic analysis was selected due to its ability to allow for social and psychological patterns and themes in the data (braun & clarke, 2006). assuming that white-identifying social work students begin their programs carrying a set of worldviews and beliefs around justice and equity, this analysis assumes a contextualist perspective that acknowledges the ways individuals make meaning of their experiences and the ways the broader societal context influences this process (braun & clarke, 2006). the data analysis team consisted of four trained graduate research assistants and the principal investigator (pi). first, the analysis team familiarized themselves with the data through several rounds of immersive reading. during this time, the team individually recorded initial ideas and reflections about the vignette responses. next, the team met collectively to discuss reflections and aggregate these findings into preliminary categories. collective team meetings were utilized to discuss observations made during individual readings and draw comparisons between coders. initial categorizations generated from this round of analysis include codes (e.g., focus on individuals or structures, naming racism or gender). once codes were developed, refined, and clearly exemplified in the coding frame, the analysis team looked to determine agreement amongst coders. two members of the analysis team independently re-coded a subset of the data in order to gauge correspondence between coders. when a disagreement between coders occurred, a advances in social work, summer 2022, 22(2) 581 collective discussion was held with the analysis team and pi to further define and operationalize respective codes. from these discussions, a new coding frame and refined codes were developed. after a final list of codes was generated, the team worked collectively to identify dominant themes within the dataset by distinguishing types of responses, as well as exploring the significance of overlaps between codes. while codes were identified based on their existence within the dataset, final themes were identified based on an aggregation of these codes, their prevalence within the data set, and their relevance to the present research interests. results the student responses are first organized and described according to three overarching categories that were identified during the final phase of coding: 1) descriptive, 2) analytical, and 3) action. in the following section, we outline and provide examples of the main categories as well as the sub-themes and racial projects employed within each of these categories. descriptive responses descriptive responses (table 2) focused on relatively superficial explanations of the events in the vignette as well as responses that focused on personal, emotional reactions to the vignette. these responses did not seek to analyze or propose actions in response to the problem. prominent sub-themes included in this response category are sympathetic, empathetic, or personal feelings focus. the descriptive assessments utilize racial projects that employed neoliberal and white saviorism frames, particularly through an emphasis on individual levels of analysis and centering of personal emotions. table 2. descriptive responses theme definition example sympathetic, empathetic, or personal feelings focused (n = 42) students who expressed emotional reactions in response to the vignette. students might describe negative emotional reactions such as guilt, shame, disgust, grief, stress, or anger, as well as, positive emotional reactions such as hope and empathy. wow, this is awful. i feel so bad for ms. l and her kids. what she experienced was unfair and racist. ms. l worked her hardest to comply, but the system was stacked against her. (participant #160) sympathetic, empathetic, or personal feelings focused some students (n = 42) focused on their emotional reactions to the vignette, which is an analytical approach consistent with neoliberalism. responses in this category included negative (e.g., guilt, shame, grief, stress, or anger) and positive emotional reactions (e.g., hope, empathy). even in naming unfairness or injustice, these responses centered on cogburn et al./ racial projects 582 emotional reactions and ms. l’s individual traits (e.g., seems like an honest woman) rather than any analysis of why systemic “failures” had occurred. one student expressed feeling bad about the circumstances (while also generically identifying “the system” as being inequitable or unfair). wow, this is awful. i feel so bad for ms. l and her kids. what she experienced was unfair and racist. ms. l worked her hardest to comply, but the system was stacked against her. (participant #160) another student commented: my initial response was one of empathy. ms. l seems like an honest woman who has been dealt an unfair hand. (participant #122) in the second example, the student has emphasized an individual and interpersonal framing in focusing on their emotional reaction (i.e., claiming empathy) and in their focus on ms. l’s personal attributes (i.e., honest woman). the student’s reference to ms. l being “dealt an unfair hand” seems to imply that the vignette events are a series of unfortunate, irregular circumstances rather than predictable and inequitable systemic features. the student’s emotional reaction to the circumstances of the vignette are arguably irrelevant and should raise questions about why personal emotions are being introduced. the use of emotion in this case may reflect an attempt by the student to more closely align themselves with the experience of oppression rather than the role of oppression. the practice of centering personal emotions (and in turn centering the self) in response to racism may reflect attempts by students to remove or minimize their proximity to the source of harm and may also undermine the possibility of fostering a trusting relationship with ms. l (e.g., frey et al., 2021). analytical responses to varying degrees, the analytical responses (table 3) focused on identifying underlying reasons for problems evident in the vignette, and, in only one instance (n = 1), did a student also provide an analysis of their own positionality in relation to a problem. prominent themes that emerged from these responses were positioning race, racism and whiteness and situations, systems, and self. in comparison to the descriptive responses, the analytical responses provided more substantive assessments. elements of white racial projects were still evident as many of these responses continued to ignore structural and systemic issues (e.g., thinking of the challenges faced by ms. l as abnormalities in the system) or did not provide any specific analysis around race or racism. responses in this category may be described as embodying burgeoning consciousness. the language used in these responses, for instance, suggests an awareness of certain terminology but lacked evidence of an ability to meaningfully describe how the system was functioning to produce inequity, which is critical to identifying possibilities for change or intervention. advances in social work, summer 2022, 22(2) 583 systems glitch vs. system intention in response to the vignette, some students (n = 87) chose to explicitly analyze the role of the cps system and other broad governing bodies often referred to as “the system” but varied in the conclusions drawn about the functioning of these systems. when characterizing the role and behaviors of cps, some students framed the actions and subsequent outcome of the case as an unfortunate consequence or “glitch” in the system. in these responses, students are moving beyond an individual-level analysis but are not acknowledging the systemic nature of the problems faced by ms. l. other students characterized cps’ actions and associated outcomes as an expected intention of the system. in the latter set of responses, students are implying that structural racism is both embedded and intentional (e.g., the system is working as designed), which suggests a higher level of critical consciousness. we have categorized this dichotomy as: system glitch and system intention. system glitch. these responses characterized the case outcomes as unfortunate but uncommon or counter to the system’s intended function. when employing this frame students often sought to situate what happened to ms. l as a rare occurrence and as a failure or mistake made by the system, which suggests a limited understanding of structural racism and an ability to engage in structural analysis. in the following response, the student fails to reconcile the stated contradiction between the intention of cps to “protect children” and implicating cps policies in “ensuring” failure, which suggests systemic failures: cps is supposed to protect children, but by creating a situation in which the mother will be unable to fulfill what is demanded of her cps is ensuring that the children will be separated from their mother and will suffer as a result. (participant #44) system intention. conversely, some students characterized the outcome of ms. l’s case as an expected result of such an interaction with “the system.” these students described the behaviors and impact of cps as intentional. some of the responses in this category explicitly identify anti-black racism as a system feature, noting that interactions with the system often lead to negative outcomes for black people, and more acutely black women. in the following example, the student response identifies specific processes (e.g., not accommodating ms. l’s work schedule) that contributed to negative outcomes and also implies that there are fundamental flaws embedded within the system design (e.g., saviorism orientation in “fixing” “problems”): ms. l and her family were forced to endure invasion of privacy and required to use services that did not accommodate her work schedule or what she wanted. i suspect it is because the cps and the foster care system was created with the intention of "fixing" a family and removing "problems" instead of supporting individuals and their specific needs. (participant #190) advances in social work, summer 2022, 22(2) 584 table 3. analytical responses theme definition example systems glitch vs. systems intention (n = 87) systems glitch students characterized the outcome of ms. l’s case as unfortunate, but described it as an unintentional outcome of how systems, like child protective services, traditionally operate. ms. l was put in a position where she would be guaranteed to fail because the "punishment" did not fit the "crime". while smoking marijuana is illegal and not something that should be done around children, forcing ms. l to participate in classes within her family service plan that had nothing to do with her admittance to marijuana use (i.e., anger management classes, classes for children with special needs) is only setting her up to fail. cps is supposed to protect children, but by creating a situation in which the mother will be unable to fulfill what is demanded of her cps is ensuring that the children will be separated from their mother and will suffer as a result. (participant #44) systems intention students characterized the outcome of ms. l’s case as an expected result of such an interaction with “the system”. i think that the neighbor may have called the police because of racial bias and stereotypes of domestic violence and unmarried women. then, these stereotypes in addition to stereotypes of black women not parenting well and that all drug-use leads to abusive, neglectful, or otherwise dangerous households forced ms. l and her children into a system that set them up to fail. ms. l and her family were forced to endure invasion of privacy and required to use services that did not accommodate her work schedule or what she wanted. i suspect it is because the cps and the foster care system was created with the intention of "fixing" a family and removing "problems" instead of supporting individuals and their specific needs. (participant #190) neutral critiquer (n = 61) students spoke with clarity about themselves having a definitive understanding of the situation, but also refrained from speaking explicitly about what they would do as the social worker in this situation. this is blatant and disgusting discrimination, and illustrates perfectly how one seemingly "well meaning" or "concerned" neighbor's prejudice can start a chain reaction. it demonstrates how microaggressions are not just annoying, small detours in a day, but rather legitimately damaging actions that have long-term consequences for the wellbeing of ethnic and racial minorities. this situation is blatantly hypocritical, as countless white people smoke marijuana and parent their children and are never questioned for it. some of them now are even making millions of dollars profiting off of the relatively new marijuana industry, while black individuals are still having their families torn apart because of it.” (participant #18) no mention of race, racism or whiteness (n = 36) students did not mention or grapple with themes related to race, racism or whiteness in their response to the vignette. the initial case workers seemed to have jumped to conclusions about ms. l's ability to care for her children. did they seem neglected? afraid of their mother or her boyfriend? how were they performing in school? without looking deeper into the state of their wellbeing, the initial case workers set ms. l impossible standards. the cumbersome assignment of the family service plan appears to be the cause of her separation from her children, not possible neglect of my occasional marijuana smoking. (participant #136) positioning race/racism (n = 103) one-off comment students made seemingly surface level references to race or racism, by mentioning it once but not elaborating on its connection to their broader response or explanation. i feel frustrated that she is being treated so unfairly. people shouldn’t feel like they need to lie about their experiences because there is a real possibility it will be taken out of context and turned against them. though it made me feel frustrated it isn’t a surprising story. it is a good example of what the cyclical racism within supposedly supportive institutions so often leads to. (participant #181) advances in social work, summer 2022, 22(2) 585 theme definition example individual traits/actions students situated race and racism as individual level traits and action. i think that ms. l was unfairly treated by the criminal system. i think because of her gender and race she was given a harsher sentence than someone who wasn’t a single mom or black. i think it is sad that this happens because the children were much better off with their mother than in the system. (participant #255) connecting individual racial positionality to group position students situated their analysis of race and racism by connecting individuals to group level treatment. i feel shocked and enraged that a parent could loose their rights over their children for an admission of smoking marijuana. why was a cps case worker even brought to ms. l? this action sounds racist at its core, destroying a black mother's life because she had an argument with her boyfriend and smoked marijuana how often does this occur and does this occur at the same rate as white mothers? how does taking about ms. l's parental rights help her children or society? (participant #331) race and racism as systems students situated their analysis of race and racism within a structural or systemic context. i think this is a classic example of the way various systems interact to specifically target black women in this country. young, wealthy white people (especially men) are more likely to use drugs, and far less likely to ever face the consequences. having to quit her job to keep up with the demands of proving to the state that she's able to be a good provider (aka keep a job) and having her children taken away so she can prove she's a good mother? these things are hypocritical and unjust. one of the great devastations caused by slavery was the destruction of the black familypulling parents apart and away from their childrenbecause you can diminish a person's power by isolating them. this is continuing in the way black families are targeted by mass incarceration, cps policies, school to prison pipeline, surveillance, and more. ms. l should be reunited with her family as quickly as possible and compensated for the losses she suffered as a result of this unjust treatment. (participant #33) multiple frames students utilized multiple of these framings to position their analysis of race and racism. reading through the details of the case affirms to me that black people, especially black women, are judged more harshly than white women or white people more generally. there are plenty of television shows today about young white women who smoke pot and have children and it's seen as trendy. these racist prejudices set into motion the racist policies meant to uphold institutionalized racism and criminalize and punish black people. the reaction to ms. l's honest answer was harsh and severe, and instead should have been met with further questioning and investigation. this case is an example of how racism is pervasive even within the social work field. the caseworker clearly had racist prejudice within her that then changed the course of ms. l's life. (participant #235) situations, systems, self (n = 1) students reflected on their own positionality in relationship to the vignette. it makes my blood boil that such injustice is possible and that such a tragedy can befall someone trying to do the right thing. it also makes me reflect on whether or to what extent i am complicit in this and similar injustices being facilitated by the civil structures i am working within. my immediate question now is what steps i can take to resolve this injustice and improve the lives of ms. l and her family. i also want to be very cognizant of any aspect of my role in her case that may unintentionally further perpetuate injustice, despite my best efforts and goals. i also can imagine how wary ms. l must be to yet another government representative involving myself in her life without her invitation. (participant #195) advances in social work, summer 2022, 22(2) 586 neutral critiquer another analytical response that emerged from students was the theme of neutral critiquer (n = 61). these students spoke with clarity about themselves having a definitive understanding of the situation but refrained from speaking explicitly about what they would do as the social worker in this situation. one student responded: this is blatant and disgusting discrimination, and illustrates perfectly how one seemingly "well meaning" or "concerned" neighbor's prejudice can start a chain reaction. it demonstrates how microaggressions are not just annoying, small detours in a day, but rather legitimately damaging actions that have long-term consequences for the wellbeing of ethnic and racial minorities. this situation is blatantly hypocritical, as countless white people smoke marijuana and parent their children and are never questioned for it. some of them now are even making millions of dollars profiting off of the relatively new marijuana industry, while black individuals are still having their families torn apart because of it.” (participant #18) at the end of the vignette, students were prompted to communicate their thoughts as if they were a social worker in the case. within this theme, students offered elaborate critiques of various actors within the vignette without identifying any definitive actions. meaningful reflection on the actions one would take as a social worker should involve careful consideration of the problem being addressed as well as reflection about one’s own positionality (frey et al., 2021). no mention of race, racism, or whiteness. even in responses providing assessments that identified structural or system issues, it was common for students to not mention or grapple with themes related to race, racism, or whiteness (n = 36) in their responses to the vignette. notably, these students did not mention race or racism but offered otherwise thoughtful inquiry regarding the mandated family services plan created for ms. l. one student noted: the initial case workers seemed to have jumped to conclusions about ms. l's ability to care for her children. did they seem neglected? afraid of their mother or her boyfriend? how were they performing in school? without looking deeper into the state of their wellbeing, the initial case workers set ms. l impossible standards. (participant #136) the consistent avoidance of naming racism or whiteness is a typical characteristic of neoliberal (giroux, 2003; martin, 2013) and colorblindness (bonilla-silva, 2015) frames. namely, rendering racism and whiteness invisible or ambiguous sustains both denial and the functioning of racially oppressive systems (feagin, 2013). this pattern in our data is also consistent with previous research documenting the tendency for white students to dismiss the central importance of race and whiteness (blauner, 1994; rucker et al., 2019). even in the few instances when students explicitly identify whiteness (n = 46), none (n = 0) of the student responses offered an analysis that considered their own positionality as white social workers. on the contrary, several student responses suggested attempts to advances in social work, summer 2022, 22(2) 587 distance or failing to include oneself in whiteness (e.g., see participant #18’s example in the neutral critiquer category: “countless white people” “their children” “some of them”). this suggests that white social work students can employ racial frames that seemingly acknowledge structural inequity, allude to anti-blackness and the function of whiteness all while completely ignoring their role as white social work students in upholding whiteness and racist systems (abrams & gibson, 2007; frey et al., 2021). positioning race and racism when responding to the vignette, most students (n = 103) offered explicit assessments of how they were situating and understanding race, anti-blackness, and systemic racism but clearly varied in their understanding and application of these constructs. for example, some students characterized race as an individual-level trait, while other students discussed how an individual’s race might relate to group-level treatment. other students situated race and racism within systemic structures, while others identify systems without mentioning race at all. our analysis was explicitly interested in the ways students analyze and position concepts of race and racism in relation to the vignette, if at all. one-off comment. in some responses, students would reference race or racism but not elaborate on its connection to their broader response or their understanding of the circumstances of the case. one student commented: though it made me feel frustrated, it isn’t a surprising story. it is a good example of what the cyclical racism within supposedly supportive institutions so often leads to. (participant #181) in this example, the student comments that the vignette is an example of “cyclical racism'' but does not elaborate on what is meant by this phrase and how this manifested within the vignette. this example is also demonstrative of a broader pattern of what might be described as performative language in which white students use phrases to signal an understanding that may be superficial or not actually possessed at all or to position themselves as a “good” white person (frey et al., 2021). individual traits and actions. several of the responses emphasized individual-level traits and actions when identifying racism in relation to the vignette. this type of response is consistent with neoliberal frames (giroux, 2003; martin, 2013) and empirical evidence of white adults relying on interpersonal beliefs about racism (e.g., rucker et al., 2019). responses in this category often describe race as something a person has that can lead to “negative experiences” (i.e., being black is associated with the negative outcome as opposed to identifying systems of racism as leading to negative outcomes). similarly, racism was also a characteristic attributed to individual-level actors in the vignette such as the police officer, caseworker, or her neighbor. a participant responded: i think that ms. l was unfairly treated by the criminal system. i think because of her gender and race she was given a harsher sentence than someone who wasn’t a single mom or black. (participant #255) cogburn et al./ racial projects 588 in this example, the student is positioning race as an individual trait but does not provide an analysis that suggests an understanding of the structural context that constructs race, racial meaning, and value and in turn renders racial positions so highly consequential to life outcomes. connecting individual racial positionality to group positions. there were also some examples of students focusing not only on ms. l and ways her racial position contributed to the outcomes in the case but also reflected on white positionality. a frequently employed phrase used by students was “if she were white...” to describe how ms. l might have been treated differently if she were not a black woman. one student stated: i have a hard time believing that ms. l's family service plan would have been so extensive if she were white. (participant #39) another participant commented: i feel shocked and enraged that a parent could lose their rights over their children for an admission of smoking marijuana. why was a cps case worker even brought to ms. l? this action sounds racist at its core, destroying a black mother's life because she had an argument with her boyfriend and smoked marijuana how often does this occur and does this occur at the same rate as white mothers? (participant #331) in these examples, students identify how individual-level characteristics, like race and social position, can impact group-level treatment by reflecting that a white person likely would have not faced the same consequences in this case. this type of response is notable because the analysis does not imply something essential about ms. l’s race (e.g., being black) that contributes to the case outcomes. by identifying whiteness or being white as a possible factor in the case, these responses suggest some understanding of race as a group level factor rather than individual characteristic. race and racism as systems. some students situated their analysis of race and racism within a structural or systemic context. in some instances, the role of systems was not only named but the response also included applications of intersectional frameworks by identifying intersecting positionalities (e.g., young, wealthy, white) and systems (e.g., criminal systems and social services). the following example also considered the historical context in relation to contemporary racial subjugation: i think this is a classic example of the way various systems interact to specifically target black women in this country. young, wealthy white people (especially men) are more likely to use drugs, and far less likely to ever face the consequences... one of the great devastations caused by slavery was the destruction of the black familypulling parents apart and away from their childrenbecause you can diminish a person's power by isolating them. this is continuing in the way black families are targeted by mass incarceration, cps policies, school to prison pipeline, surveillance, and more. ms. l should be reunited with her family as quickly as possible and compensated for the losses she suffered as a result of this unjust treatment. (participant #33) advances in social work, summer 2022, 22(2) 589 in this response, the participant identifies the influence of race and racism within various governing bodies. specifically, the participant identifies the historic relationship between slavery and the present-day surveillance and separation of black families by cps. further, the participant notes the criminalization of marijuana within black communities and its relationship to policing and mass incarceration. while the student employs an anti-racist frame in identifying anti-blackness and calling for reparations, the student does not address the prompt asking what they would do as a social worker or otherwise offer reflections on their own positionality in relation to the themes of the vignette. multiple frames. lastly, a few students integrated multiple frames to position their analysis of race and racism. in these responses, students characterized race and racism as individual traits and actions but also positioned race and racism in a structural or systemic context. for example, one participant reflected: reading through the details of the case affirms to me that black people, especially black women, are judged more harshly than white women or white people more generally. there are plenty of television shows today about young white women who smoke pot and have children and it's seen as trendy. these racist prejudices set into motion the racist policies meant to uphold institutionalized racism and criminalize and punish black people. the reaction to ms. l's honest answer was harsh and severe, and instead should have been met with further questioning and investigation. this case is an example of how racism is pervasive even within the social work field. the caseworker clearly had racist prejudice within her that then changed the course of ms. l's life. (participant #235) in this response, the student names the caseworkers “racist prejudice” as well as structural characteristics (intersectional positionality of race and gender, racism in social work, “racist policies”) as key factors in the outcomes of ms. l’s case. it is not clear from the response, however, if the student is simply naming multiple factors or if they also understand how individual and structural factors intersect to patterns of racial inequity. the student also does not identify their own positionality in relation to the vignette, which is consistent with the student responses overall. many of these students exhibit an understanding of the “right” words or phrases but consistently fall short of demonstrating an understanding of how structures function or the relevance of their whiteness to the systems and events being identified. situations, systems, and self rather than proposing action directed toward actors in the vignette, markedly only one student (n = 1) reflected on their own positionality in relation to this situation. this student seemed to be thinking about the present case, the systems involved in that case, and how they may be positioned in relation to those systems. this student often expressed concerns about further perpetuating harm: it makes my blood boil that such injustice is possible and that such a tragedy can befall someone trying to do the right thing. it also makes me reflect on whether or to what extent i am complicit in this and similar injustices being facilitated by the cogburn et al./ racial projects 590 civil structures i am working within. my immediate question now is what steps i can take to resolve this injustice and improve the lives of ms. l and her family. i also want to be very cognizant of any aspect of my role in her case that may unintentionally further perpetuate injustice, despite my best efforts and goals. i also can imagine how wary ms. l must be to yet another government representative involving myself in her life without her invitation. (participant #195) in this example, the participant not only acknowledges that they may be in a position to further perpetuate injustice but recognizes that they will likely work within systems and organizations that commonly perpetuate harm against black communities. this response provides a clear example of a participant grappling with positionality in relation to the vignette. which positionalities, however, are being deemed most relevant? again, whiteness is never explicitly identified by any student as a self-position relevant to the analysis being provided. in the above example, the student is notably aware that they may be “complicit” but references the role as a worker and “government representative” and does not demonstrate any understanding of their influence as a white social worker. action themes in this final set of themes, action responses focused on proposing actions or behaviors in response to the case presented in the vignette. the action roles that students proposed were investigator, advocate, educator, compliance officer, counselor, service provider, and a mixture of many roles. most commonly, students proposed behaviors that focused on individual-level solutions and again, did not include any references to their own white positionality. the responses in this theme typically engaged three frames: neoliberalism, white saviorism and paternalism. see table 4. investigator a common action theme was that of the investigator. these students commented on the need for more information to make an appropriate decision or to move forward with ms. l’s case. these students proposed actions that would allow them to access further information. one student noted: there are many missing pieces to the information givenand without them, the precautions taken by cps seem rash. marijuana and a fight with a boyfriend are being treated as related and dealt with as so, as opposed to each isolated incident being investigated. it seems at first glance that the emotional toll of separating a family could have been easily avoided through proper investigation and counseling if found necessary. (participant #161) in this example, the participant notes that they need further information to make an accurate assessment of ms. l’s case, and without this information, cps’ response was unwarranted. advances in social work, summer 2022, 22(2) 591 table 4. action responses theme definition example investigator students were analytically focused and commented on the need for more information. there are many missing pieces to the information givenand without them, the precautions taken by cps seem rash. marijuana and a fight with a boyfriend are being treated as related and dealt with as so, as opposed to each isolated incident being investigated. it seems at first glance that the emotional toll of separating a family could have been easily avoided through proper investigation and counseling if found necessary. (participant #161) advocate students frequently noted the need or desire to advocate on behalf of ms. l to cps. ms. l’s case is heartbreakingly common. too often, african american families face separation and subsequent overreach of government programs that tear loved ones apart and introduce trauma. while social work services we provide are extremely necessary in confirmed cases of abuse and neglect in order for families to heal, the system is far from perfect. bias from on-lookers surrounding members in the community too often feeds into creating cases like ms. l’s that inflict unnecessary pain and trauma on minority families. it is our responsibility as advocates for social justice to continue cultivating positive, constructive conservations about today’s racial divides and educate society on the dangers of stereotypes and prejudice. only then can we ensure the services we provide do exactly as they are intended: to heal. (participant #162) fantasy advocate students who employed this lens situated themselves to have the power and ability to influence ms. l’s circumstances. my thoughts are that ms. l's situation is horrific and completely unacceptable. i'd work on helping her launch a combination legal and public pressure campaign immediately and try to get ms. l and her attorney to work with a community and/or racial/gender justice organization to get full custody of her children restored as soon as possible. i would also suggest individual counseling for her children in addition to the family counseling to try to mitigate as much of this trauma as possible. finally, i would like to insist the caseworker that began proceedings against her take an unpaid leave in order to take unconscious bias and racial justice trainings. (participant #189) educator students described the need to educate individual actors in the vignette; these might include ms. l or the cps worker. the criminalization of marijuana use has created a downward spiral that has unfairly punished and separated a black family. ms. l is likely feeling anger at the system treating her unfairly, which would interfere with her ultimate goal of challenging the system in order to get her children back. i would advise her through an rebt lens, if she demonstrated beliefs that were counterproductive to this goal. this would entail encouraging a support network and coping skills, including breathing techniques to help her maintain calm in the face of the racist system. (participant #142) compliance officer students proposed actions with the goal of supporting ms. l maintain compliance with child protective services demands. based on the information provided, i do not believe that ms.l had realistic expectations set forth by the state. it is understandable that she could not meet all the requirements set forth while also caring for her children and working full time. as an alternative, i would recommend giving her one last to complete at a time so that she has a more feasible schedule. this would still require her to complete all classes and requirements set forth by the state, but also gives her time to work and care for her children. (participant #19) case manager students were mainly focused on technical or procedural aspects of the case. ms. l had been asked to comply with a great deal of services by acs. as a cps who works in the family services unit, many of these services could have been combined (individual therapy with an anger management component, one parenting course instead of two) and the services plan should have been discussed with her to make it manageable for her with her work schedule to ensure family reunification or to prevent the removal of her children. if ms. l was cogburn et al./everyday racial projects 592 theme definition example trying her hardest to keep her kids in her care, testing negative on drug screenings and there were no further incidents, a tpr would not be necessary or appropriate.” (participant #213) counselor students described their primary response would be to serve as an emotional support to various actors in the vignette. as a social worker i would want to attend to ms l’s mental health including how she may perceive her own agency or lack there of in the situation. it seems important that ms. l feel empowered to take actions to get her family back on its feetregain full custody of her children and her own employment. this might start with making sure she has an understanding of how/why this situation snowballed and then working on tools for herboth psychological and practicalto start rebuilding her life. (participant #156) service provider students described their primary role would be to connect the client to appropriate services. i feel as though the reference to drug use was influenced heavily by ms. l's race. there is no reason to believe that an argument with her boyfriend has a direct link to validating that ms. l is a neglectful mother. when ms. l believed she was complying, she was actually giving cps exactly what they needed to place her on this downward path. while counseling services and family plans can be useful for those who need the support, such programs must ensure that the individual is able to keep a job, care for children, and maintain a level of freedom that is relative to the offense committed. in this case, the required classes did not properly reflect the offense committed, an offense that has no real basis as cps did not actually witness ms. l smoking marijuana. ms. l has been complying and it is unfortunate that aspects of her ascribed status have created this current reality for her. as a social worker, i would work with ms. l to secure new employment, inspect her housing, and support her in receiving back her children from cps. i would offer counseling for the emotional and mental stress accompanying ms. l, working together to execute a plan to effectively complete all required service demands. (participant #296) multipronged response students proposed they would serve, in not one, but several of the previously described themes. this is an example of system failure. ms. l and her children's lives have been overturned and hurt by too much organizational involvement. the social worker took an extreme approach to a minor concern. children's health, safety, and happiness should be a social worker's first priority. the social worker setting up so many classes and programs took away time and effort ms. l could have spent with her family or providing for her family. i would try to get ms. l back on track to be able to work again. i would lessen if not completely remove the classes and programs she has been assigned to. the only one that seems applicable is a drug treatment program. i would start the efforts to put her children back in her care and figure out if i could provide her with any compensations for the difficult situations herself and her children have been put through. i would try to provide them with therapeutic assistance and spend time asking her (and her children) what she believed she and her children needed. (participant #178) unsure or does not know students expressed that they did not know or were unsure of what to do in order to address the situation or assist ms. l. this case seems to be racially biased. ms. l seems to be forced into worsening conditions by unrealistic expectations the court system has forced on to her. i am unsure where to start with assisting her. (participant #111) advances in social work, summer 2022, 22(2) 593 advocate in response to the vignette, many students proposed actions related to advocacy. these students frequently noted the need or desire to advocate on behalf of ms. l or her family, to cps. for example: i would act as an advocate for ms. l in order to help her appeal her case, get visitation with her children, and argue that her family service plan is not only a disproportionate response to her honesty about recreational drug use, but is breaking up a family that may be more successful together. (participant #326) another student commented: as a social worker, i think the correct thing to do is to advocate for a timely reunification plan, and to advocate that any additional parenting requirements be made with consideration to ms. l’s work schedule, because taking away the family’s income is not a good outcome for any member of the family, and especially not the children. (participant #239) in both of these responses, participants situate their primary role as ms. l’s social worker as that of an advocate for some more desirable outcome. fantasy advocate. an important sub-theme that emerged under advocate is the notion of a fantasy advocate. students who employed this theme seemed to have an outsized sense of power to influence ms. l’s circumstances. for example: i'd work on helping her launch a combination legal and public pressure campaign immediately and try to get ms. l and her attorney to work with a community and/or racial/gender justice organization to get full custody of her children restored as soon as possible…finally, i would like to insist the caseworker that began proceedings against her take unpaid leave in order to take unconscious bias and racial justice training. (participant #189) another participant commented: as the social worker on this case, i would want to work closely with ms. l to prove she is not a neglectful parent so her children could be returned home. i would recommend that the children are returned, and that the family participates in inhome counseling if it's available. i would also want to work with ms. l to find another job or perhaps rejoin her previous employer. (participant #186) notably, both participants propose actions that would not likely be possible given their limited power and influence as social workers in this case. these actions include partnering with a racial justice organization to legally act on behalf of ms. l, forcing ms. l’s social worker to undergo unpaid leave and racial justice training, as well as, helping her get her old job back. although these actions are amicable and seek to support ms. l and her family, they are not realistic or practical expectations of their abilities and influence. while we should encourage social workers to be bold and creative advocates, these responses may be more indicative of the white saviorism frame (sondel et al., 2019). in order to effectively advocate for equity, white social workers must have a clear sense of their own whiteness cogburn et al./ racial projects 594 and the implications for their social position and social work (helms, 1996; sondel et al., 2019; spanierman & smith, 2017). in these response categories, students seem to be positioning themselves as heroes or saviors (e.g., launching campaigns, insisting on particular actions) and do not pair their grandiose visions of advocacy with any expressed understanding of whiteness and one’s own positionality. helms (1996) argues that white allies cannot be motivated by guilt or self-aggrandizing but rather by an understanding and commitment to equity. white social workers cannot hope to fix problems when they fail to acknowledge their own proximity to those problems. educator other students characterized themselves as educators. these students believed their role was to educate individual actors in the vignette (e.g., ms. l, the case worker, or large groups of people). one student suggested: as a social worker, it would be my calling and my duty to educate and raise consciousness when implicit bias is a used claim in child welfare, such as in ms. l's case. (participant #65) another student commented: i would advise her through an rebt lens, if she demonstrated beliefs that were counterproductive to this goal. this would entail encouraging a support network and coping skills, including breathing techniques to help her maintain calm in the face of the racist system. (participant #142) in both examples, participants propose actions that involve teaching various actors in the vignette some sort of skills. in the first example, this involves education around implicit bias; while in the second example, this involves education regarding coping strategies. each of these responses exemplify ideological frames that characterize white racial projects. paternalism manifests as both students propose actions that require compliance by ms. l or other individual actors within the vignette. further, fashioning individual interventions, like education, to address systemic issues like those reflected in this vignette highlight neoliberal notions that individualize racial issues, while minimizing systemic causes. lastly, both of these responses reflect ideals of white saviorism. in each response, students assume that they have knowledge that ms. l does not already have or have access to. further, each student implies that by providing this knowledge to ms. l, they can somehow affect ms. l’s status as an oppressed individual. compliance officer several students situated their role in ms. l’s case as a compliance officer whose responses suggested a more passive and non-critical acceptance of ms. l’s circumstances and factors contributing to the outcomes. some of the responses in this category focused on actions they would take to help or support ms. l in maintaining compliance with cps’ demands, frequently the family services plan. although these students also made critiques advances in social work, fall 2021, 21(4) 595 of the proposed family services plan, they ultimately focused on ensuring ms. l remained compliant. one student described: as an alternative, i would recommend giving her one task to complete at a time so that she has a more feasible schedule. this would still require her to complete all classes and requirements set forth by the state, but also gives her time to work and care for her children. (participant #19) in this example, the participant acknowledges that that family services plan is unrealistic considering ms. l’s role as a mother and full-time employee. although they propose limiting the plan requirements to ensure the demands are “more feasible” for ms. l’s schedule, their ultimate goal is ensuring she can continue to maintain compliance with the family services plan. this action theme most strongly reflects ideological frames like paternalism. through positioning themselves as compliance officers students are suggesting actions that continue to restrict ms. l’s personal agency and maintain authoritative control on behalf of a state-sanctioned agency. case manager. in another example emphasizing compliance, the student mainly focused on technical or procedural aspects of the case: as a cps who works in the family services unit, many of these services could have been combined (individual therapy with an anger management component, one parenting course instead of two) and the services plan should have been discussed with her to make it manageable for her with her work schedule to ensure family reunification or to prevent the removal of her children. (participant #213) this participant proposed the need to restructure ms. l’s family service plan through combining therapeutic services and collaborative consultation with ms. l. they suggest several procedural steps that could have been taken to ensure ms. l has better success in meeting the demands of the family services plan. counselor. in some instances, students emphasized their primary responsibility to serve as emotional support to various actors in the vignette. these students focused on the emotional states of actors like ms. l, “the family”, or her children. these students prioritized therapeutic services and ensuring emotional well-being. one student noted: as a social worker, i would want to attend to ms l’s mental health including how she may perceive her own agency or lack thereof in the situation. it seems important that ms. l feel empowered to take actions to get her family back on its feetregain full custody of her children and her own employment. this might start with making sure she has an understanding of how/why this situation snowballed and then working on tools for herboth psychological and practicalto start rebuilding her life. (participant #156) in this example, the participant suggests they would first focus on ms. l’s mental health. they propose that their ongoing goal would be to provide both “psychological and practical” tools to help ms. l get her life back on track. service provider. similarly, some students expressed their primary role would be to connect the client to appropriate services. one student described: cogburn et al./ racial projects 596 as a social worker, i would work with ms. l to secure new employment, inspect her housing, and support her in receiving back her children from cps. i would offer counseling for the emotional and mental stress accompanying ms. l, working together to execute a plan to effectively complete all required service demands. (participant #296) in this example, the participant suggests that their “primary role” is to connect ms. l to multiple services including employment, housing, and counselor. in each of these examples, the student responses emphasize following the rules and positioning ms. l as the critical point of intervention rather than proposing system-level changes. responses in this category reflect a combination of paternalism, white saviorism and neo-liberalism given the non-critical emphasis on personality responsibility and fixing ms. l while seemingly ignoring structural culpability in any form. multi-pronged response several students provided a multi-pronged action response that combined characteristics of the previously identified categories. one student commented: i would try to get ms. l back on track to be able to work again. i would lesson if not completely remove the classes and programs she has been assigned to. the only one that seems applicable is a drug treatment program. i would start the efforts to put her children back in her care and figure out if i could provide her with any compensations for the difficult situations herself and her children have been put through. i would try to provide them with therapeutic assistance and spend time asking her (and her children) what she believed she and her children needed. (participant #178) the participant suggested actions consistent with the advocate, service provider, and compliance officer categories. the student proposed working to limit ms. l’s family service plan to include only substance abuse treatment services, suggesting some disagreement or criticism with the original response. they also propose that they would like to help ms. l seek compensation during this difficult time as well as therapeutic services. similar to the previous themes discussed, this action theme reflected some criticism of the system without explicitly identifying any racial inequities. these responses also included advocacy for ms. l within the existing system and largely focused on adhering to the authority and protocols subscribed by cps. unsure or does not know lastly, a small group of students expressed that they did not know, or were unsure of, what to do to assist ms. l. one student expressed: this case seems to be racially biased. ms. l seems to be forced into worsening conditions by unrealistic expectations the court system has forced onto her. i am unsure where to start with assisting her. (participant #111) in this example the student described the outcome of the case as racially biased and honestly communicated their hesitancy to intervene. interpreting this hesitancy is tricky advances in social work, fall 2021, 21(4) 597 given the typical brevity and lack of specificity of responses in this category. the hesitation to specify action could be interpreted as an unwillingness to take a clear stance, perhaps especially in response to a case involving racism. alternatively, these responses may reflect a thoughtful and practical position given that a) the student respondents in this category may not yet have any academic or professional training in social work or b) there are details missing from the case that needed to determine an effective course of action. unlike the investigator category, however, responses in this category do not offer reflections on information needed to make an informed decision. discussion the present study used racial projects (omi & winant, 2014) as a conceptual and analytical frame to examine language and meaning-making that white social work students employ at the beginning of their graduate training. we contend that social workers’ racialized positionalities, ideologies, and histories vary widely and should be considered when developing social work curricula aiming to support racial project development. we focus on white social work students following the premise that they may practice and conceptualize social work, race, and racism differently than people who experience the brunt of that social domination. these differences in social position and the types of racial projects that are employed should inform the specific educational and training tasks that need to be engaged (dyer, 1997; frey et al., 2021; morrison, 1992; roediger, 1998). the phrase white racial projects is used to emphasize ways in which whiteness functions independently as a racial project and the use of related racial frames in the study sample. our analysis revealed that in response to a vignette focused on a black mother’s experience with cps, white students in this sample consistently employed white racial projects or racial frames such as neoliberalism and colorblindness in their analysis. most students in the sample were explicit in identifying the possibility of race being a factor in how the vignette events unfold. fewer students, however, directly identify racism as a key factor or meaningfully engaged in an analysis of structural racism. no one in the sample identified their own positionality as white social workers as a factor in how they interpreted and responded to the vignette scenario. white racial projects. a common feature of white racial projects is an emphasis on individual traits and actions as key factors in shaping life outcomes. the reliance of individual frames emerged in several ways, including descriptions of race as an individual trait rather than as a structurally grounded social position, attributing outcomes to race as an individual trait and notions that ms. l could have received different treatment if she had acted or performed differently. saviorism and paternalism, which fundamentally rely on white supremacy or whiteness as the metric for “good” or the ideal source of being rescued, were also evident in many of the responses. in making recommendations (e.g., “breathing techniques”) for how ms. l should cope with the systemic racism being faced, students are implying that they understand something about ms. l’s position and experience and are thus in a position to suggest ways to effectively cope. it is not evident, however, that most students in this sample understand how structural racism and whiteness are functioning in relation to ms. l’s experience or their own whiteness and white positionality—thus, they cogburn et al./ racial projects 598 are certainly not in a position to offer insight, advocacy or support for how ms. l should or should not respond. additionally, by emphasizing an individual frame in their analysis, many students chose to center the point of accountability on ms. l as opposed to the systems she encountered. even when identifying structural racism, ms. l commonly remained the focus of intervention. naming versus knowing. it is noteworthy that there were also several students who used the language of frames) that reflect aspects of racial conscious projects. these students used language and terminology that may signal a level of competency in response to the vignette that is not necessarily grounded in a substantive understanding. it appeared that students were using language, phrases and constructs that they did not necessarily know how to apply to an analysis of the vignette. many of these statements read as performances of “good” responses rather than exhibiting a substantive understanding of the issues being raised. this is evident, for instance, in naming structural racism and then focusing on individual level interventions and in general avoidance of addressing whiteness as both a social and personally relevant construct. identifying the subtle indicators that students have learned to use particular codes to signal socio-political preferences or being “woke” as opposed to possessing a meaningful understanding of how systems of racial oppression function, is critical to effective critical race pedagogy in social work. good white people. perhaps one of the more striking findings in our analysis is the complete absence of white positionality being identified or interrogated. the practice of white liberalism is often guilty of observing the atrocities of racial oppression while failing to accept culpability, specifically the role of whiteness and white people in designing, upholding and benefiting from the very systems of oppression being identified as harmful. the option for whiteness to remain invisible or unclaimed is a mechanism of privilege (dyer, 1997) and a signal of flawed understandings of systems of racial oppression. instead of holding whiteness accountable, white liberals are often deeply invested in seeing themselves as “good white people” who exist as observers outside of and separate from racist systems while actively resisting the reality that they are completely embedded within and uphold these systems (e.g., frey et al., 2021). implications for social work research, pedagogy, and practice our research suggests several potential directions for the development of pedagogical interventions that propel students from reflecting the white racial project to embodying racial projects more closely aligned with racially-conscious and anti-racist frames. social work programs may benefit from providing students with historical knowledge about race and racism and its impact on current socio-political issues. in addition to developing content knowledge, it is important to employ a pedagogical approach that centers whiteness, anti-racism and structural analysis as core competencies. the ability to critically analyze structural dimensions of racial inequality will support transferable skills and knowledge. for white social work students specifically, there is a need for them to establish the ability to interrogate whiteness in terms of their own positionality (within social work, structures, and intuitions) as well as challenge their use of whiteness as an analytical frame (white racial projects). the space for uprooting whiteness (frey et al., 2021), for instance, advances in social work, fall 2021, 21(4) 599 employs critical intra-group dialogue for white social workers to engage whiteness, their relationships to whiteness and to others who are positioned as white. there are also numerous methodological considerations that would promote empirical research aiming to establish a deeper understanding of the ways racial projects are developed and employed. in particular, methods that allow for differentiation between a student’s ability to “know the right answer” versus their ability to engage in a deeper level of analysis would be valuable. this is exemplified in the one-off comment sub-theme in which students are able to mention race or racism but do not elaborate on its significance. this pattern may indicate manifestations of neoliberalism which aim to individualize understandings of race and racism while ignoring the need for structural level analysis (giroux, 2003; martin, 2013). further, future research efforts should consider the impact of the rapidly shifting sociopolitical context and public discourse surrounding race and racism (blitz, 2008). particularly within the united states, national attention has turned to focus on issues such as police brutality within black communities, historic disparities in marijuana legislation and policing, and even, the utility of teaching critical race theory in elementary school classrooms. future research efforts should account for how shifts in sociopolitical context will likely influence incoming social work students' understandings of race and racism before they enter their graduate program. in addition to these considerations, future research should also explore the longitudinal impact of graduate school education on students’ racial projects. specifically, future analyses might explore the impact of graduate-level coursework, such as a first-year, social work course covering issues related to power, racism, oppression, and privilege. technological innovations like virtual reality, designed to immerse individuals in the experiences of others, may also be used to support the development of empathy, structural competency and more complex social analysis for students’ responses over time (cogburn et al., 2018; roswell et al., 2020). lastly, manifestations of the white racial project do not just exist within white-identifying students but permeate every level of society including those who occupy minoritized social positions (cogburn, 2019; feagin, 2020; fields & fields, 2014; mills, 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(2008). white logic, white methods: racism and methodology. rowman & littlefield publishers. author note: address correspondence to courtney d. cogburn, school of social work, columbia university, new york, ny 10027. email: cc3803@columbia.edu https://doi.org/10.1177/0011000017717712 https://scholarspace.manoa.hawaii.edu/bitstream/10125/29814/1/v2i1_02tamburro.pdf https://scholarspace.manoa.hawaii.edu/bitstream/10125/29814/1/v2i1_02tamburro.pdf https://vc.bridgew.edu/cgi/viewcontent.cgi?article=1930&context=jiws mailto:cc3803@columbia.edu the racial projects of white social work students courtney d. cogburn chelsea a. allen william r. frey prema filippone brittany r. brown susan witte abstract: despite a theoretical shift toward anti-racism, racial projects within social work assert public positions against structural racism, while upholding mechanisms that perpetuate its existence. analyzing the perceptions and intentions of incom... _________ nickolas b. davis, phd, lcsw, assistant professor, aloha vancamp, phd, lmsw, associate professor (retired), department of social work, university of detroit mercy, detroit, mi. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 186-196, doi: 10.18060/28439 this work is licensed under a creative commons attribution 4.0 international license. culture wars in the classroom: perceptions of social work faculty at public and private institutions nickolas b. davis aloha vancamp abstract: social work educators engage with students from diverse political and personal backgrounds, often facing culture wars within the classroom. the council on social work education emphasizes academic freedom in higher education. this study surveyed 35 social work educators to examine their perceptions of culture wars' effects on programs, students, and faculty. using a nonexperimental, causal-comparative design, it compared these perceptions between faculty at public and private institutions. demographic data were analyzed using crosstabulations and descriptive statistics. public institution faculty (m = 3.64, sd =.58) reported lower faculty scores than private institution counterparts. private institution faculty felt their institutional culture conflicted more with nasw policies but had more positive perceptions of culture wars. findings indicate significant implications for teaching where social work values clash with institutional values or political influences. keywords: culture wars, social work education, academic freedom social justice is one of the core values embedded in the profession of social work. social workers enter the profession due to their commitment to addressing social justice issues, eradicating social injustices in society, and advocating for the marginalized and oppressed (nasw, 2021). challenges in today’s times lend themselves to divisive thinking and group polarization. many would say that these issues are reflective of what is referred to as culture wars conflicts that reflect changing times and societal differences in ideals, beliefs, and values. social work education prepares future professionals for conflicts and conflict resolution, including preparation on the theoretical underpinnings of karl marx and conflict theory. marx, a political philosopher of the 19th century, proposed conflict theory that was based on his belief that society was in a constant state of flux due to scarcity of resources and unequal distribution of those resources. he believed that society’s social order was reached by power and wealth rather than consensus and conformity (garret, 2018). when conflict occurs in wealth, values, and social norms, justification is socially constructed by those who are in power. in the case of current culture wars, tensions are increasing among individuals in workplace and educational settings. attacks on education are reflective of the broader culture wars phenomenon. though heightened by the covid-19 pandemic, culture wars have been present in american society for some time (darbyshire et al., 2020; hartman, 2015). the term “culture war,” popularized in the u.s. in the 1990s by sociologist james davison hunter, referred to tensions between the orthodox and progressive worldviews. this tension could be described as conflict between those with traditional values and those with more progressive about:blank davis & vancamp/classroom culture wars 187 or nontraditional values (hartman, 2015). culture wars describe the political struggle over cultural issues; as well as the “meaning of america”—who we are now and who we aspire to become (hartman, 2015; hunter, 1992). the concept of culture wars gained mainstream attention at the 1992 republican convention when pat buchanan said that they were wars “for the soul of america” (voices of democracy: the u.s. oratory project, 1992, para. 39) more recently, the concept of culture wars broadened to include topics, such as religion, marriage and family, social behavior, sexuality, and gender identity, as well as other issues that separate people and their beliefs (castle, 2018; liechty, 2006; perry et al., 2020; ulrich, 2024). notably, culture wars may not be seen as a real phenomenon but rather as a result of belonging to different political or social groups. while culture wars are often found in educational settings, they may manifest in a variety of other settings, such as the therapeutic relationship (farrar & hanley, 2023). nonetheless, culture wars reflect a crossroads of cultural transformation (duffy & hewlett, 2021), with experiences and differences of opinion and/or political affiliation underlying the idea that culture wars have emerged in the experience of education, at both the k-12 level and higher education (smagorinsky & taxel, 2005). for example, a new wave of legislation in k-12 education is attempting to limit the breadth and depth of teaching and learning based on cultural beliefs and values. in k-12 education, legislators have introduced and passed legislation to support parents who wish to have the right to restrict the kinds of education available to their children. in 2022, 25 states passed 64 laws that restricted or limited what k-12 teachers could say about race, racism, gender identity, sexuality, and lgbtq issues. these laws provided parents with the right to influence what their children learn (natanson et al., 2022). teachers, caught in the crosshairs of political and cultural conflicts, are challenged in their ability to educate and simply do their work (hess, 2009). higher education is faced with similar challenges. the term culture war began in higher education on campuses in the 1980s when worry about campus political correctness appeared (roth, 2022). campuses often have been criticized for being havens for ideas that were outside the mainstream. state boards of education have responded with threats of defunding and challenging tenure policy. according to roth (2022), preserving traditions of intellectual freedom is best done by promoting what he referred to as cultural peace. practical idealism must be defended from threats of violence or being marginalized to preserve intellectual diversity (roth, 2022). several states have introduced or passed legislation limiting academic freedom within higher education (maxwell & sonenshine, 2022). this type of legislation, typically introduced in politically conservative states, poses various limits to academic freedom ranging from banning the inclusion of critical race theory in the state of tennessee to selectively teaching aspects of american history in south carolina to broadly limiting the inclusion of diversity, equity, and inclusion (dei) related content into the curriculum in florida (briscoe & jones, 2024; cineas, 2023; maxwell & sonenshine, 2022). the attacks on academic freedom in higher education are so widespread that in march 2023, the council on social work education (cswe) issued a call to protect academic freedom. in 2021, cswe, along with several other organizations, condemned legislation advances in social work, spring 2025, 25(1) 188 that “violates the first amendment and principles of academic freedom through state censorship of teaching, research, and public speech” (cswe, 2023, para. 5). since then, more states have introduced legislation aimed at limiting academic freedom in many ways. the issue is so prevalent that social work education may be at risk in some areas, which may harm vulnerable communities (cswe, 2023). freedom of thought and expression are the cornerstones of higher education and intellectual life. over 80 years ago, the american association of university professors (aaup) highlighted the importance of freedom of thought and expression in their 1940 statement of principles on academic freedom and tenure (aaup, 2022). these rights and responsibilities are central to higher education and social work education. social work educators must inform their students of evidence-based practices that help others. social work also has a responsibility to raise, discuss, and challenge new and existing ideas. the social work profession has never been apolitical, and many would say that social work should be even more visible and prominent in responding to political discourse and differences. however, inherent risks exist in social work and social work education while exploring tensions between truth and ideology, especially in the classroom. among the core values of the social work profession are respect and the dignity of the person, integrity, and the importance of human relationships (nasw, 2021). historical and cultural implications of current shifts in society and dynamics of power are at the core of conflict in the classroom. social work educators and practitioners frequently find themselves at the intersection of these conflicts, as their work often involves advocating for marginalized communities that may be targeted in culture war disputes. nasw policies have strong stances on many issues central to culture wars, which sometimes draw support or criticism depending on the political context (hartman, 2015; nasw, 2015) previous research few studies have been done on the prevalence or impact of recent culture wars in educational settings. in 2021, broćić and miles studied whether educational institutions could influence moral relativism. they found that colleges in the humanities were most influential, but they were most influenced by moral absolutism rather than moral relativism. the authors suggested that more work is needed on political conflict and moralization. while nasw policies, namely the code of ethics, do not explicitly discuss moral absolutism or moral relativism, they are implicitly noted through the values and principles these policies promote such as dignity and worth of the person, cultural competence, and social justice (nasw, 2021). in 2023, the pew research center compared private and public k-12 mission statements to determine if any difference existed in attitudes toward education about dei. the study indicated differences along the partisan divide in topics that parents thought were appropriate for their children to learn about in school (odabaş & aragão, 2023). although there is a paucity of research on culture wars in higher education, there is an indication of beginning research on the influence of dei in higher education. dei has davis & vancamp/classroom culture wars 189 evolved since the 1960s after the civil rights movement and the development of laws pertaining to affirmative action and an inclusive work environment (patton, 2015). these laws were aimed at eliminating discrimination in the workplace based on gender, race, and ethnicity. marchiondo et al. (2023) researched the impact of leadership’s attitudes on the success of institutional diversity on faculty. in the study, men experienced more perceived bias when their leaders held more positive attitudes toward diversity. yet perceived bias predicted faculty endorsement of institutional diversity two years later, thus mediating the relationship. despite deep roots in american society, culture wars are not a uniquely american phenomenon, as higher education institutions across the globe are increasingly impacted by this phenomenon. in canada, research has demonstrated how racialization and colonialism influence the graduate classroom experience (park & bahia, 2022). in australia, culture wars are manifested by dwindling federal funding for higher education, leading to an increased reliance on international student fees (welch, 2022). in hungary, the intersection of culture wars and higher education reached a climax when central european university was required to relocate to austria due to the revocation of its operational licenses. the relocation and ensuing discourse highlighted the intersection of culture wars and broader society (enyedi, 2022). similar to funding issues experienced by australian universities, budget cuts were also used as a tool for culture wars in brazil. these budget cuts aligned with former president jair bolsonaro’s attack on higher education in the nation to eliminate “cultural marxism” (lima & iamamoto, 2022). the influence of culture wars on higher education is not limited to a specific national context, as it manifests in various forms worldwide. in the united states, these conflicts often center around debates on curriculum content, diversity initiatives, and free speech, which may pose challenges for social work educators who attempt to navigate these in the classroom. understanding the global dimensions of culture wars may allow for a broader framework for examining how social work education in the u.s. is influenced by similar pressures, as educators contend with external political forces that shape educational priorities and practices (giroux, 2020). the purpose of this study is to examine social work educators who are working in public and private institutions and their perceptions of culture wars on programs, students, and faculty. the hypothesis that was tested is social work educators in public and private institutions will not differ in their perceptions of culture wars on programs, students, and faculty. methods a nonexperimental, causal-comparative research study was used to compare differences in social work educators’ perceptions of the effects of culture wars on students, classrooms, and university levels in public and private institutions. the institutional review board (irb) at the university of detroit mercy approved this study. advances in social work, spring 2025, 25(1) 190 table 1. demographic characteristics by type of university/college n (%) type of university/college total (n = 35) public (n = 17) private (n = 18) age (years) 22 to 30 1 (7.7%) 1 (3.4%) 31 to 40 4 (25%) 3 (23.1%) 7 (24.1%) 41 to 50 5 (31.3%) 2 (15.4%) 7 (24.1%) 51 to 60 5 (31.3%) 4 (30.7%) 9 (31.1%) over 60 2 (12.5%) 3 (23.1%) 5 (17.3%) missing 1 5 education msw 5 (31.3%) 5 (3.8%) 10 (33.5%) dsw 8 (50%) 7 (50%) 15 (42.9%) phd 3 (18.7%) 1 (7.1%) 4 (13.3%) other 0 (0%) 1 (7.1%) 1 (3.3%) missing 1 4 position administration 5 (29.4%) 1 (5.6%) 6 (17.1%) faculty 12 (70.6%) 17 (94.4%) 29 (82.9%) rank lecturer 2 (11.1%) 2 (5.7%) asst. professor 3 (17.6%) 5 (27.8%) 8 (22.9%) assoc. professor 1 (5.9%) 1 (2.8%) professor 6 (35.3%) 8 (44.4%) 14 (40%) adjunct 6 (35.3%) 2 (11.1%) 8 (22.9%) other 1 (5.9%) 1 (5.6%) 2 (5.7%) mean [sd], range years at present program 9.2 [5.77], 1-17 10.4 [10.54], 0.5-33 9.8 [8.46], 0.5-33 years in higher education 15.2 [9.45], 4-30 14.1 [9.08], 1-33 14.6 [9.18], 1-33 students in program 184.5 [114.64], 24-400 259.9 [609.53], 28-2100 225.6 [452.41], 24-2100 participants social work educators who are members of the baccalaureate program directors (bpd) listserv were asked to participate in this study. participants working in public and private universities/colleges in bsw programs were invited to participate. thirty-five participants completed and submitted their surveys. the participants ranged in age from 22 to over 60 years of age, with most indicating their ages were between 51 and 60 years of age (n = 9, 31.1%). most participants (n = 15, 42.9%) had earned doctor of social work (dsw) degrees, with 10 (33.4%) indicating a master of social work (msw) as their highest degree. the majority of participants were faculty (n = 29, 82.9%), with 6 (17.1%) reporting they were in administrative positions. fourteen (40.0%) participants held the rank of professor, followed by 8 (22.9%) assistant professors. the years in their present program ranged from 0.5 to 33 years, with a mean of davis & vancamp/classroom culture wars 191 9.80 (sd = 8.46). the mean number of students in their institutions’ social work programs was 225.61 (sd = 452.41) and ranged from 24 to 2,100. the demographic characteristics are presented in table 1. instrument an original survey was developed by the researchers to obtain information regarding the perceptions of bsw faculty regarding culture wars. the first section of the survey provided information on the participants and their demographic characteristics. the second section of the survey used three questions to determine the conflicts between personal and professional beliefs and nasw policies. these items were answered yes or no. the third section of the survey used 25 items to measure the perceptions of social work educators on their beliefs regarding culture wars. these items were rated using a 5-point likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). the items were divided into three subscales: program, student, and personal. the responses to each item were summed to obtain a total score, which was divided by the number of items on the subscale to provide a mean score. the use of a mean score allowed comparison among the subscales using the original scale of measurement. cronbach alpha coefficient was used to determine the internal consistency of the survey items. the obtained alpha coefficient of .77 was considered adequate for the study. data analysis the data were downloaded from the lime survey platform. the data were cleaned by removing all incomplete cases. tests for normality were used to determine if the 25 items measuring perceptions of culture wars were normally distributed. the results of the kolmogorov-smirnoff tests for normality were not statistically significant, indicating the data were normally distributed. the demographic data were summarized using crosstabulations and descriptive statistics to provide a comparison of the sample between public and private universities. the research question was addressed using multivariate analysis of variance, with the mean scores for the three subscales measuring culture wars used as the dependent variables and the type of university/college, public or private, used as the independent variable. all decisions on the statistical significance of the findings were made using an alpha level of .05. results the participants were asked to answer three questions regarding conflict with nasw policies. when asked if their school’s mission conflicted with some nasw policies, 1 (5.9%) participant from public institutions and 4 (22.2%) participants from private institutions answered yes. four (23.5%) from public institutions and 10 (55.6%) from private institutions indicated that the culture of their university conflicted with some nasw policies. none of the participants from public institutions and 4 (26.7%) from private institutions indicated that their personal beliefs conflicted with nasw policies. these findings are outlined in table 2. advances in social work, spring 2025, 25(1) 192 table 2. conflicts with nasw by type of university/college some nasw policies conflict with… n (%) type of university/college total (n = 35) public (n = 17) private (n = 18) the mission of my university yes 1 (5.9%) 4 (22.2%) 5 (14.3%) no 17 (94.1%) 14 (77.8%) 30 (85.7%) the culture of my university yes 4 (23.5%) 10 (55.6%) 14 (40%) no 13 (76.5%) 8 (44.4%) 21 (60%) my personal beliefs yes 4 (26.7%) 4 (12.9%) no 16 (100%) 11 (73.3%) 27 (87.1%) missing 1 a one-way multivariate analysis of variance (manova) was used to determine if the perceptions of the participants regarding experiences with culture wars involving the program, students, and faculty differed between public and private institutions. the results of the manova were statistically significant (f (3, 31) = 3.90, p = .018), indicating a difference in perceptions of culture war by type of institution. when the between-subject tests were compared between the two types of institutions, significant differences were found for faculty, f (1, 33) = 4.86, p = .035. participants in public institutions (m = 3.64, sd = .58) had lower scores regarding culture wars for faculty than participants in private institutions (m = 4.00, sd = .37), indicating that participants in private institutions had more positive perceptions of faculty’s experiences regarding culture wars than those in public institutions. the differences between program and student by type of institution were not statistically significant. based on these results, participants in public and private institutions appear to differ in their perceptions of faculty’s experiences regarding culture wars. table 3 presents the manova results. table 3. one-way multivariate analysis of variance perceptions of culture wars by type of college/university perceptions of culture wars type of college/university [m (sd)] df f p public (n= 17) private (n = 18) program 4.3 (0.40) 4.2 (0.38) 1, 33 0.44 .514 student 3.4 (0.56) 3.9 (0.33) 1, 33 0.33 .517 faculty 3.6 (0.58) 4.0 (0.37) 1, 33 4.86 .035 multivariate statistics were generated from wilk’s lambda f = 3.90, df = 3, 31, p = .018 discussion this study explored social work educators’ perceptions of culture wars on programs, students, and faculty. the results of this survey may serve as a sign of this conflict in practice. although the sample size in this study is relatively small (n = 35), the results suggested differences between public and private higher education social work program faculty and their experiences of culture wars both in the classroom and in their davis & vancamp/classroom culture wars 193 university/college institutions. faculty teaching in private institutions reported more positive perceptions of their experiences regarding culture wars, suggesting that they are more comfortable with the internal experience of cultural wars differences whereas those teaching in public institutions reported fewer positive perceptions, suggesting more dissatisfaction or dissonance with the climate of the institution and classroom experience. while the exact reasons for the differences are unclear, it is known that there is pressure on many learning institutions due to the culture wars phenomena. recalling the foundations of marx’s conflict theory, values and norms are socially constructed by those in power. these differences may be a product of restrictive state policies towards higher education that have been widely reported in the media. these policies, often set by state legislatures, have an outsized impact on public institutions when compared to private institutions. current governmental influences and/or policies may be endangering the experience or spirit of academic freedom within higher education. the results also suggested that social work faculty at private institutions feel their culture conflicts more with some nasw policies than those at public institutions. while the specific reasons for this are ambiguous; some private institutions may be traditional in their beliefs. religiously affiliated colleges and universities may not embrace the professional values and ethical norms held by social workers. implications for social work practice and education previous research highlights the influence of culture wars on educational institutions and emphasizes the impact on higher education policies and practices. this study extends these insights by exploring how social work educators perceive culture wars within their professional context, specifically in relation to programmatic, faculty, and student experiences across public and private institutions. the findings, which highlight significant differences in perceptions, suggest that institutional type may play a role in shaping educators' experiences with cultural conflicts. these results have important implications for social work education, particularly in preparing faculty and students to navigate ideological tensions while upholding the core values of social work. this study’s outcomes underscore the need for more targeted strategies to support educators in institutions where political pressures may threaten academic freedom and the integrity of social work values. limitations a limitation of this study is the small sample size and gathering data through only one data source. although the survey was made available to the approximate 800 bpd listserv members, only 35 chose to submit completed surveys. a larger sample size could yield more accurate results. a second limitation was the combining of parochial and for-profit private institutions into one group. as the participants were not required to include the name of their college/university, it was not possible to segregate the parochial and for-profit institutions. future research should include a question as to the governance of the institutions, public, private nonprofit, and private for-profit. care must be taken when interpreting the results, as some participants’ responses may reflect social desirability to align with their institutions’ or programs’ stance on culture wars. advances in social work, spring 2025, 25(1) 194 future research additional research is needed to explore the underlying factors that influence the differences in perceptions of social work faculty regarding their experiences with culture wars. completing a comparative analysis of social work faculty’s experiences with culture wars in different states, for example, those that have passed legislation restricting aspects of higher education versus those that have not would be beneficial. moreover, future researchers may wish to examine the impacts of culture wars on other stakeholders in higher education, such as social work administrators, students, practicum instructors, and support staff. future research could involve longitudinal studies that track changes in social work educators' perceptions of culture wars over time, especially in response to shifts in state or federal policies. this would provide insight into how evolving political climates and legislative actions affect academic freedom and pedagogical practices in social work education. qualitative approaches could also be advantageous as the culture war phenomenon is a lived experience and adding a “voice” to the data may allow for a deeper exploration of the strategies used by social work educators to address conflicts and how these strategies impact student learning and program outcomes. references american association of university professors. 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(2022). a plague on higher education? covid, camus and culture wars in australian universities. higher education quarterly, 76(2), 213-229. author note: address correspondence to nickolas davis, department of social work, university of detroit mercy, detroit, mi, 48221. email: davisnb@udmercy.edu author orcid: nickolas b. davis, university of detroit mercy https://orcid.org/0000-0002-8921-670x aloha vancamp, university of detroit mercy https://orcid.org/0000-0002-5061-0937 https://www.insidehighered.com/views/2022/06/01/contemplating-higher-eds-role-culture-war-opinion https://doi.org/10.4324/9781410613011 https://doi.org/10.4324/9781410613011 https://doi.org/10.1056/nejmp2313283 https://doi.org/10.1056/nejmp2313283 https://voicesofdemocracy.umd.edu/buchanan-culture-war-speech-speech-text/%c2%a0 https://voicesofdemocracy.umd.edu/buchanan-culture-war-speech-speech-text/%c2%a0 https://doi.org/10.1111/hequ.12377 https://doi.org/10.1111/hequ.12377 mailto:davisnb@udmercy.edu https://orcid.org/0000-0002-8921-670x https://orcid.org/0000-0002-5061-0937 _________ megan e. gilster, msw, phd, associate professor, social work, university of iowa, iowa city, ia. allison a. hein, msw, grants and communications coordinator, willis dady homeless services, cedar rapids, ia. gabrielle m. perruzzi, msw, midwest regional development coordinator, parkinson’s foundation, chicago, il. aislinn conrad, msw, phd, assistant professor, social work, university of iowa, iowa city, ia. catherine a. croft, lmsw, clinical therapist, tanager place, cedar rapids, ia. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 148-165, doi: 10.18060/25521 this work is licensed under a creative commons attribution 4.0 international license. food and housing insecurity among social work students: consequences for academic achievement megan e. gilster allison a. hein gabrielle m. perruzzi aislinn conrad catherine a. croft abstract: we know little about social work students’ experience with financial hardship, especially food and housing insecurity, during their academic programs. this knowledge gap is problematic because food and housing insecurity negatively impact student success. in response, we surveyed 125 social work students of a public, midwestern u.s. university in 2019 to investigate students’ experience with food and housing insecurity, as well as the factors associated with food and housing insecurity. we conducted descriptive and multivariate analyses, finding that 56% of students reported food or housing insecurity. student financial characteristics, such as filing a fafsa and taking out loans, were associated with food and housing insecurity. students who identified as female and nonbinary were more likely to experience housing insecurity. finally, we found that food and housing insecurity were each associated with lower reported grade point averages. suggestions for intervention include schools of social work offering paid practica and emergency funds as well as advocating for improved student loan forgiveness programs at the national level. keywords: food insecurity, housing insecurity, grade point average, social work students, social work education nearly 80% of social work students at the bachelor’s and master’s level graduate with student loan debt (cswe, 2019, 2021). the average loan debt among social work graduates rose between 2010 and 2020 for both bachelor’s and master’s graduates—by 10% and 50%, respectively (cswe, 2021). student loan debt accumulation among social work students is problematic because the wages of newly graduated social workers have not grown at the same pace as debt burdens have increased (cswe, 2019). while students are still in their educational programs, student loan debt accumulation is problematic because many students decide between accruing more debt or working extensive hours to cover their educational costs, which include tuition, fees, as well as housing, food, and transportation. students report that working more hours negatively affects their learning experience (gair & baglow, 2018) as does balancing the competing demands of classes, practicum, and work (benner & curl, 2018). together, the extent of student loan accumulation and work hours suggests that social work students may struggle with financial hardship during their education. financial hardship includes having insufficient money for necessities, including food and housing. facing financial hardship during about:blank glister et al./student food & housing insecurity 149 students’ programs of study also inhibits learning (johnstone et al., 2016). miles and colleagues (2017) reported high rates of food insecurity among social work students at one university in the pacific northwestern united states. however, little research has examined social work students’ ability to securely afford the basic needs of both food and housing. this knowledge gap is problematic given undergraduate and graduate students’ experience with food and housing insecurity. a sizeable number of postsecondary students are estimated to have food and housing insecurity (goldrick-rab et al., 2018). food insecurity is defined by economic research services (ers; coleman-jensen et al., 2021) as uncertain access to adequate food due to insufficient financial resources. housing insecurity is defined by goldrick-rab and colleagues (2018) as unaffordable, unstable, or inadequate housing. without knowledge of social work students’ experiences of food and housing insecurity, interventions to improve educational outcomes of struggling students will be less effective. in response to this knowledge gap, we 1) describe the prevalence of food and housing insecurity, 2) examine predictors of food and housing insecurity, and 3) investigate the association between food and housing insecurity and academic achievement as indicated by final grades among the bachelorand masters-level social work students at one midwestern public university. the impact of food and housing insecurity on academic outcomes university administrators are increasingly seeking to ameliorate student food and housing insecurity (us government accounting office, 2018). schools of social work have begun examining this issue but have been less involved than university-level administration in mitigating food and housing insecurity among their students. for example, student efforts at portland state university’s school of social work to assess student food insecurity led university administration to develop university-level interventions (mcbeath & austin, 2021). crutchfield and colleagues (2020) found that social work students reported classes and school structures reinforced stigma and hindered their academic progression, resulting in the authors’ call for social work programs to expand their role in addressing students’ insecurity. postsecondary students have worse academic outcomes when they experience food and housing insecurity, yet we know little about the impacts of food and housing insecurity among social work students. in the following review of the literature, we synthesize research on food and housing insecurity, common predictors of insecurity, and evidence of the effects of insecurity on academic achievement. food insecurity although there is limited research on food insecurity among social work students, there is growing research documenting the enormity of food insecurity among college students in general (nazmi et al., 2019; nikolaus et al., 2020). in a systematic review, nikolaus et al. (2020) found that 36% of students at 4-year postsecondary institutions reported experiencing food insecurity. the only published research on food insecurity among social work students found that 43% reported food insecurity in the previous year (miles et al., 2017). these rates of food insecurity are especially remarkable when compared to the u.s. advances in social work, spring 2023, 23(1) 150 population, among whom 10.5% of households experienced food insecurity in 2020 (coleman-jensen et al., 2021). researchers have identified several risk factors for food insecurity among samples of postsecondary students, including financial status, housing location, and demographic factors (broton et al., 2018; el zein et al., 2017). the following financial statuses were associated with food insecurity among postsecondary students: low income (broton et al., 2018; patton-lópez et al., 2014), pell grant receipt (el zein et al., 2017), receiving multiple forms of financial aid (payne-sturges et al., 2018), any food assistance receipt (pattonlópez et al., 2014), and childhood food insecurity (broton et al., 2018). concerning housing, postsecondary students who resided off campus or attended college in an urban area (broton et al., 2018) were at increased risk for food insecurity compared to students living on-campus or attending suburban and rural colleges. payne-sturges and colleagues (2018) likewise found that experiencing housing problems was associated with a greatly increased risk for food insecurity. demographic factors associated with students’ food insecurity included low parental education (el zein et al., 2017) and non-white race and ethnicity (broton et al., 2018). to date, one published study examined social work students’ risk factors for food insecurity. miles et al. (2017) reported that debt burden and higher medical and transportation costs among undergraduate and graduate social work students were linked to food insecurity. further, social work students identifying as persons of color, female, or first-generation college students experienced greater food insecurity. miles and colleagues also found a higher proportion of bsw students were food insecure than msw students. postsecondary students who experience food insecurity have poorer academic outcomes than food-secure students. food insecurity negatively impacts students’ concentration (henry, 2017), class attendance (silva et al., 2017), performance (henry, 2017; silva et al., 2017), and grade point average (gpa; el zein et al., 2017; morris et al., 2016; patton-lópez et al., 2014; van woerden et al., 2019). gpa has been found to be linked to student persistence, and a pathway through which food insecurity may influence retention (van woerden et al., 2019). many of the factors that put students at risk for food insecurity are also related to gpa, suggesting that multivariate analysis is a necessary step forward. we do not know the academic consequences of social work students’ food insecurity; understanding their experiences may help programs ameliorate student food insecurity. housing insecurity nearly half of postsecondary students, and about 36% of four-year institution students, report housing insecurity (broton, 2020). students reported increasing rent and not having enough money for rent as the most common housing difficulty (goldrick-rab et al., 2018; tsui et al., 2011). some demographic groups have an increased risk for housing insecurity, namely, students who are female or non-binary (goldrick-rab et al., 2018; tsui et al., 2011), persons of color, lgbt (goldrick-rab, 2016), parents, over 25 years old, residing off campus, working more than 20 hours a week, and not supported by their parents (goldrick-rab, 2016; tsui et al., 2011). students with food insecurity are more likely to glister et al./student food & housing insecurity 151 face housing insecurity, with an estimated 22% of students at 4-year institutions experiencing both insecurities (goldrick-rab et al., 2018). no published studies examined the prevalence of social work student housing insecurity. to date, there is little research on the association between housing insecurity and academic outcomes. we found only one related quantitative study of students at 4-year institutions. in a study of the california state university system, students facing homelessness had lower grade point averages, especially when they also faced food insecurity, than those who were food and housing secure (crutchfield & maguire, 2018). importantly, there is qualitative evidence that experiencing homelessness has immediate and lasting negative effects on social work students’ stress, mental health, and social support (crutchfield et al., 2020). however, findings were mixed as to the academic consequences of homelessness—while it created stress that has negative effects on executive functioning, some social work students reported that they spent more time on campus and in the library studying because they had nowhere else to go, which may have improved academic outcomes (crutchfield et al., 2020). researchers have not yet examined the consequences of a broader range of student housing insecurities, such as unaffordability, on academic outcomes. we, therefore, examined the relationship between housing insecurity and gpa as an indicator of academic achievement. methods we conducted a cross-sectional study to investigate the rates and predictors of food and housing insecurity among social work students attending a public university in the midwest. we hypothesized that students with more food and housing insecurity would report lower gpas. the lead author’s institutional review board (irb) approved this project. per irb, we protected the identity of respondents by not reporting findings for indicators with sample sizes of 5 or less. sample and context this study sought to survey all 361 undergraduate and graduate social work students enrolled in a midwestern public university’s school of social work in 2019. the school of social work at the time was composed of 72% graduate students and 78% white students. about half of social work students attended the main campus (47%) with the remainder attending three satellite learning centers or one hybrid online learning center. the university is large (over 15,000 students), with three-quarters of undergraduate and graduate students identifying as white in 2019. undergraduate students may apply to major in social work starting in their junior year, so all were upper level. data collection from march to april 2019, we surveyed undergraduate and graduate social work students. we recruited students via email invitations to an online survey using qualtrics. we screened students’ eligibility to take the survey by asking age, program of study, and learning center location and type. students were eligible to participate if they 1) were at advances in social work, spring 2023, 23(1) 152 least 18 years old, 2) were students in the bachelor’s or master’s social work program at our university, and 3) completed the survey between march and mid-april 2019. of the 156 students who we screened, five did not meet the eligibility criteria. twenty-six students dropped out before completing the gpa question, our primary dependent variable. because those 26 students had comparable rates of food and housing insecurity to the full sample, we removed those participants, resulting in an analytic sample of 125 students. the data collection instrument was reviewed by master’s students in a research class. although changes were made to the full instrument based on this feedback, no changes were required for the measures used in this paper. measures all measures were collected via the self-reported, 57-item online survey described above. in this section, we describe the dependent variable, independent variables, and covariates used in our analysis. grade point average (gpa) gpa is a frequently measured academic outcome in studies of student success (kuh et al., 2007). a low gpa can be grounds for academic probation (and potentially dismissal) and termination of financial aid. at this university, social work students would be placed on academic probation for a gpa under 2.0 for undergraduate and under 3.0 for graduate students. respondents self-reported their december 2018 gpa. self-reported gpa is highly correlated with actual gpa (kuncel et al., 2005). gpa ranges from 0 to 4.33 at this midwestern university, with 4.33 representing an a+. food insecurity we created two food insecurity variables following usda economic research service (ers; 2012) guidelines for the six-item short form of the household food security survey module (usda ers, 2012), which assesses household food insecurity during the last 12 months. this short form was chosen to minimize survey burden and has been validated for use in classifying food security in the general population (blumberg et al., 1999). food insecurity captures uncertain access to adequate food due to inadequate financial resources. the six items of the scale address distinct aspects of food insecurity. example items include, “the food that we bought just didn’t last, and we didn’t have money to get more,” and “we couldn’t afford to eat balanced meals.” for the first measure, per the usda ers (2012) measurement guidelines, we created levels of food insecurity, an ordinal variable with three categories (0 = no food insecurity, 1 = low food security, 2 = very low food security). for the second measure, food insecurity was recoded into a dichotomous variable by combining low food security and very low food security into one category, food insecure (1= low food security or very low food security) and retaining food security as the reference category (0 = no food insecurity; usda ers, 2012). glister et al./student food & housing insecurity 153 table 1. matrix of levels of food insecurity and food insecurity indicator variables (usda ers, 2012) food security (“0”) food insecurity (“1”) food security (“0”): affirmative answers to 0-1 items x low food security (“1”): affirmative answers to 2-4 items x very low food security (“2”): affirmative answers to 5-6 items x housing insecurity measures of housing insecurity have not been consistent among studies of college students (broton, 2020). we selected a measure of housing insecurity that goldrick-rab and colleagues (2018) created to assess housing insecurity specifically in samples of students in higher education across the u.s. eight survey items assess housing insecurity in the last 12 months—a seven-item checklist of experiences and one additional question about the number of moves (goldrick-rab et al., 2018). the 7-item checklist included whether the respondent had to “not pay or underpay your rent or mortgage?” and “move in with other people, even for a little while, because of financial problems?” following goldrick-rab et al. (2018), we created a binary housing insecurity variable to indicate students who did not experience any housing insecurity as “0” and any checklist item or at least two moves as “1.” the measure had sufficient internal reliability with a cronbach’s alpha of α = 0.70 in this sample. covariates we collected data on demographic and program characteristics to examine their association with food and housing insecurity in bivariate analysis and as covariates in regression models. students’ race and ethnicity was an identifier of students of color, which included students who checked african american/black, native american, asian, pacific islander, latinx, mixed race, and other. gender identity was assessed with an item with three response options—female, male, and non-binary. loans was an indicator variable that students selected loans from a list of funding sources they used to pay for their education, regardless of the use of any other funding sources. learning center was a nominal, 5-category variable indicating which online or place-based learning centers students attended. degree program was an indicator of enrollment in the bachelor of arts in social work (basw) or msw program. analysis we conducted data analysis in stata 16. using chi-square tests of independence, we investigated the association between demographic and program characteristics and food and housing insecurity. for parsimony and to avoid small cell size, we report the results of bivariate analyses with the second, dichotomous indicator of food insecurity. we also tested associations with ordinal levels of food insecurity to check for consistency. to test advances in social work, spring 2023, 23(1) 154 our hypothesis, we conducted ols regression predicting gpa with ordinal levels of food insecurity and binary housing insecurity. both were treated as categorical variables using an indicator approach (kutner et al., 2004, p. 319). we note that categorical independent variables, though not typical of ols models are appropriate predictors for ols (e.g., kutner et al., 2004). we controlled for other variables related to food and housing insecurity and gpa. for instance, we controlled for degree program because the minimum gpa for academic probation varies by program and the grade required to pass an undergraduate class is lower than that for a graduate class (i.e., dvs. c-, respectively), both of which could result in higher graduate student gpas. we controlled for learning center because we suspected that instructors in each center may grade differently. results respondents were primarily female, white msw students. nearly three-quarters of students filed a fafsa, and 68% had taken out loans to cover their educational costs (see table 2). more than three-quarters of students were employed—35% in full-time and 42% in part-time employment. over half of students rented their homes, with about a third owning, and a small minority in another living situation (e.g., with family). table 2. univariate analysis of characteristics of social work student respondents (n=125) indicator n (%) levels of food insecurity food security 67 (53.6%) low food security 31 (24.8%) very low food security 27 (21.6%) housing insecurity housing security 69 (55.2%) housing insecurity 56 (44.8%) race and ethnicity white 102 (81.6 %) student of color 23 (18.4%) gender identity female 114 (91.2%) malea - non-binarya - fafsa filed filed 91 (72.8%) not filed 34 (27.2%) employment part-time 53 (42.4%) full-time 44 (35.2%) choose no employment 14 (11.2%) not employed 14 (11.2%) loans for education costs yes 85 (68.0%) no 40 (32.0%) glister et al./student food & housing insecurity 155 tenure rent 69 (55.2%) own 41 (32.8%) neither 15 (12.0%) household composition alone 16 (12.8%) with roommates 39 (31.2%) with parents/guardians 11 (8.8%) with significant other 50 (40.0%) with children (and no other adult) a - university or greek housing a - degree program ba 32 (25.6%) msw 93 (74.4%) indicator m (sd) grade point average (0-4.33) 3.69 (.39) a statistics suppressed because fewer than 10 respondents per group to mask ns of groups fewer than 5 about 46% of students experienced any food insecurity. more specifically, 24.8% of students experienced low food security, and 21.6% experienced very low food security (see table 2). similarly, 45% experienced housing insecurity. in additional analysis not reported in table 2, we found that over half of the students experienced at least one type of food or housing insecurity (56%). bivariate analyses according to results from our chi-square tests, there were statistically significant group differences in food insecurity based on employment, student loans, housing, and program of study (table 3). respondents who were unemployed, had student loans, rented their home, resided with roommates, or were basw students were more likely to be food insecure. not presented in table 3, we tested these characteristics with the usda’s threecategory measure of food insecurity. we found that results were similar to those of the binary indicator, except for msw students being more likely to experience very low food security compared to basw students. respondents who were female or nonbinary, took out student loans, and rented their homes were all more likely to be housing insecure. surprisingly, neither employment nor household composition was significantly associated with housing insecurity. advances in social work, spring 2023, 23(1) 156 table 3. bivariate associations of demographic and program characteristics with food or housing insecurity (n=125) food insecurity housing insecurity % insecure p-value % insecure p-value race and ethnicity .133 .454 white 43.1% 43.1% person of color 60.9% 52.2% gender identity .231 .034 female 46.5% 46.5% male 33.3% 11.1% nonbinarya - - fafsa .002 .016 filed 55.0% 51.6% not filed 23.5% 28.6% employment .008 .074 part-time 50.9% 41.5% full-time 47.7% 50.0% choose no employment 7.1% 21.4% not employed 65.3% 64.3% loans for education costs <.001 <.001 yes 58.8% 56.5% no 20.0% 20.0% tenure <.001 .017 rent 65.2% 56.5% own 19.5% 29.3% neither 33.3% 33.3% household composition <.001 .198 alone 56.3% 56.3% with roommates 76.9% 56.4% with parents/guardians 18.2% 18.2% with significant other 26.0% 36.0% with children (and no other adult) 42.9% 57.1% university or greek housing a - - degree program .109 .143 ba 59.4% 56.3% msw 42.9% 40.8% a. statistics suppressed because fewer than 5 respondents per group food and housing insecurity were significantly associated with each other χ2=(1, n=125)=42.92, p<.001. more than three-quarters of students who were housing insecure were food insecure; likewise, more than 75% of students experiencing food insecurity also experienced housing insecurity. this association was more pronounced among students experiencing very low food security, the most severe level of food insecurity, of whom nearly 90% were housing insecure χ2(2, n=125) = 45.7, p<.001. there were statistically significant group differences in gpa between food insecure (m=3.56) and food secure (m=3.81) students, t(123)=3.87, p<.001. most of this difference was attributed to students experiencing very low food security having the lowest average gpa (m=3.36), f(2,122)=16.20, p<.001. housing-secure students had a significantly glister et al./student food & housing insecurity 157 higher average gpa (m=3.82) than did housing-insecure students (m=3.54), t(123)=4.38, p<.001. multivariate analyses results from our regression model supported both of our hypotheses (table 4). our model explained 29% of the variation in gpa, with statistically significant associations between degree program, food insecurity, housing insecurity, and gpa. as expected, msw students had higher gpas than bsw students. no other covariates were significant in the multivariate model. after controlling for covariates, experiencing very low food security was associated with a -.23 lower gpa than was food security (the reference category). experiencing housing insecurity was associated with a -.21 lower gpa than was experiencing housing security. taken together, predicted gpas for students experiencing both very low food security and housing insecurity would be nearly half a grade point lower than students experiencing no such hardship. for example, msw students in program majority groups (white, female, main campus) experiencing very low food security and housing insecurity would have a predicted gpa of 3.41 compared to 3.85 for msw students in majority groups with no insecurity, which translates to the difference between an a and a b+. table 4. ols regression model predicting gpa (n=125; adjusted r2 = .29)a b (se) levels of food insecurity food security ref low food security -0.02(0.08) very low food security -0.23(0.10)* housing insecurity housing security ref housing insecurity -0.21(0.08)** degree program ba ref msw 0.17(0.07)* constant 3.68(0.08)*** * p<0.05; ** p<0.01; *** p<0.001 a. controls for learning center, gender, and race/ethnicity discussion to date, researchers have not examined social work students’ food and housing insecurity and the effect of insecurity on their academic achievement. in response, we studied the prevalence of food and housing insecurity, demographic and program characteristics associated with food and housing insecurity, and the association of food and housing insecurity with gpa. we found that filing a fafsa, taking out student loans, and advances in social work, spring 2023, 23(1) 158 renting one’s home were all associated with both food and housing insecurity. we found support for our hypotheses, finding that housing insecurity and extreme food insecurity (i.e., very low food security) predicted lower gpa. our study contributes to the limited research on food and housing insecurity among social work students. our results suggest that food and housing insecurity are widespread and often co-occur for social work students at this institution. the high rates of food insecurity in our study were in line with a previous survey of social work students (miles et al., 2017). these findings reflect the social work student experience before the covid-19 pandemic. evidence is beginning to suggest that the pandemic worsened food insecurity among college students in general (glanstman et al., 2022), which might suggest that our rates undercount the proportion of students experiencing insecurity. remarkably, 34% of our study respondents experienced both types of insecurity, which is much higher than the roughly 22% of students across 4-year institutions (e.g., goldrick-rab et al., 2018). our findings of high rates of food, housing, and compound insecurities suggest that social work students may be uniquely vulnerable to insecurities. social work students may be more at risk for insecurity, may be less likely to use food and housing supports, or their unique educational experiences (e.g., unpaid practicum) may contribute to their high rates of insecurities. future research on social work student insecurity should investigate these possibilities. findings suggest differences between students at the ba and msw level in the extent of food insecurity but no differences in housing insecurity. we found that ba students were somewhat more likely to have been food insecure than msw students, consistent with a previous study of social work students (miles et al., 2017). however, when we examined levels of food insecurity, more msw students experienced very low food security, the most extreme form of food insecurity more so than ba students. with our study’s findings of higher rates of both housing insecurity and very low food security among msw students, we solidify the need for additional research on graduate students. while there is a larger field of research investigating college food and housing insecurity, the samples of these studies are overwhelmingly undergraduate students, whose experiences may be notably different from those of graduate students. before implementing interventions, programs should examine whether msw students may have disparate risk factors (e.g., receipt of multiple sources of financial aid, financially independent of parents), coping mechanisms (e.g., self-care practices honed in practice experience before returning to school), and institutional supports (e.g., graduate students may have little access to undergraduate student services staff) and, therefore, may need different interventions than bachelor’s students. our finding that both housing insecurity and very low food security predicted lower gpa among social work students in multivariate analysis is consistent with existing quantitative literature on food insecurity (el zein et al., 2017; morris et al., 2016; pattonlopez et al., 2014) and homelessness (crutchfield & maguire, 2018). because gpa might indicate the extent of a students’ learning, may impact their relationship with faculty (perceived or otherwise), can disqualify students from merit-based financial assistance when below required thresholds, and might lead to removal or dropout, our findings highlight the potential consequences that students’ experiences of insecurity might have on glister et al./student food & housing insecurity 159 meeting their academic and career goals. however, qualitative studies have found a more mixed effect of homelessness and housing insecurity on academic achievement (crutchfield & maguire, 2018), especially among social work students (crutchfield et al., 2020). variation in the impact of insecurity on gpa and associated academic outcomes may be attributable to faculty support of students (crutchfield et al., 2020), putting schools of social work in an essential position for interrupting these cumulative disadvantages. future research might investigate both the mechanisms through which insecurity impacts grades and the consequences of lower grades on other student outcomes. implications for practice and research our findings have implications for universities, schools of social work, students, and researchers. our results demonstrate a need for more research on food and housing insecurity among all students, including social work students. the dearth of literature on food and especially housing insecurity is problematic because, although universities must continue to intervene to address insecurity, they may be acting without a clear understanding of the problem or the appropriate level of intervention. in response, we suggest that universities and schools of social work prioritize research on food and housing insecurity to better understand the depth and breadth of the problem. in particular, researchers could study the impact of employment, financial aid, loans, academic requirements, and practicum on social work students’ experience with food and housing insecurity and subsequent personal well-being and academic performance. understanding how students manage competing demands and financial stressors may help illuminate the realities of attending 4-year or graduate programs for many students. in the absence of this knowledge, interventions may be poorly aligned with students’ needs and may not change systemic issues. schools of social work should consider offering emergency funds in the short-term and paid practicum placements in the long-term. social work programs require practicum, yet practica are time-intensive, and most are unpaid, inhibiting students’ ability to hold fulltime jobs outside of school, in turn, generating financial stress (johnstone et al., 2016; ryan et al., 2011). these stressors negatively impact students’ ability to buy food, pay rent, and, ultimately, learn (gair & baglow, 2018; johnstone et al., 2016). as we do not yet understand the ramifications of paid practicum on students’ basic needs, researchers should evaluate whether paid practicum decreases student food and housing insecurity. if the evidence supports paid practicum, schools of social work could fundraise for student stipends and seek school-agency partnerships to facilitate paid placements. because fundraising for and establishing school-agency partnerships for paid practica might take years to establish at scale (see payment for placements [p4p], n.d.), schools of social work should consider two alternative interventions—a case management approach to refer to university and community resources and an emergency fund that would be available to social work students as a short-term solution for housing and food insecurity. as universities grow their response to student food and housing insecurities, social work students should be encouraged and supported in the use of both university and community food and housing resources. for instance, in the years following this study, the university advances in social work, spring 2023, 23(1) 160 implemented a one-stopmodel where both graduate and undergraduate students could get help meeting their food and housing needs (price & umaña, 2021), including a food pantry and emergency funds. however, students may not be eligible for all services because of their student or unpaid practicum statuses, if, for example, the usda reverts to prepandemic snap policies (usda, 2021). furthermore, with growing online social work education programs, online students may experience barriers to accessing the resources of a university’s main campus. emergency funds could be awarded monthly to students expressing a substantial unmet financial need, providing help for things such as rent, groceries, and utility bills, which some social work programs have implemented (simmons et al., 2018). access to emergency funds would allow social work students to fulfill their program requirements while still being able to afford to pay their bills and feed themselves. both students and instructors within schools of social work can work together to make changes within their institutions. due to the lack of research on food and housing insecurity among social work students, instructors may not realize their students are facing these challenges. one suggestion is that instructors incorporate material about food and housing insecurity into their lectures and assignments while acknowledging the pervasiveness of student food and housing insecurity within their school. inclusively teaching about food and housing insecurity will help raise awareness about the problem and also normalize the experience for students which might encourage them to reach out for assistance. by raising awareness, students may come together to advocate for themselves and their fellow students, collectively organize through student groups, and educate other students about what they can do to improve their programs (goldrick-rab et al., 2018). because social work classes are focused on required competencies of social justice, policy advocacy, and planned change, social work classes are ideal for project-based assignments to address food and housing insecurity. through class assignments and honest conversations about food and housing insecurity, students and instructors can find creative solutions that improve students’ and community members’ ability to meet their basic needs. students, instructors, and the broader social work community should also advocate for student loan forgiveness and lower tuition rates, which commonly increase every year (goldrick-rab, 2016). loan forgiveness programs were intended to promote degree earners to choose public service careers. loans cover the cost of attendance, which includes tuition and fees as well as costs of living like food and housing, during their educational program. thus, loans are one way in which students meet their basic needs during their undergraduate and/or graduate social work education. however, despite nearly 3 million public service loan forgiveness forms submitted, only about 2% have been forgiven as of march 2023 (federal student aid, 2023). the current structure of loan repayment programs burdens all students, including students of social work programs (kastner, 2019), adding to students’ financial stress. because loan repayment programs are burdensome and uncertain, students may choose to take out fewer loans, creating more financial insecurity during their program. in the absence of changes to the u.s. student loan forgiveness programs, social work students will continue feeling stressed and unable to afford basic necessities like food and shelter. finally, although gpa is commonly used to measure academic success (e.g., patzer et al., 2017; simmons et al., 2018), gpa may be most important in its relationship to degree glister et al./student food & housing insecurity 161 persistence (stewart et al., 2015), and, for undergraduate students, continuation to an msw program. research on social work student food and housing insecurity conducted with larger samples and longitudinal designs may be able to detect the impacts of insecurity and of the potential interventions suggested above on these important transitions across semesters, to graduation, and to future study. limitations our study’s limitations pertain to our sampling strategy, sampling bias, and an inability to capture all relevant characteristics associated with food and housing insecurity and gpa. first, we used a small convenience sample. our final sample size (n=125) compromised about 35% of social work students in our program. the small convenience sample means that this study’s findings cannot be generalized to all social work students within the studied university. nor can findings be generalized to other social work programs across the united states. this was a single university, and students in the program live across this midwestern state and in neighboring states; the state has less racial and ethnic diversity than other states. second, we do not know why some students opted to take the survey while others did not. student interest or experience with food and housing insecurity may have motivated students to complete the survey. this motivation might upwardly bias our estimates of food and housing insecurity. third, in bivariate analysis, we examined whether fafsa completion was associated with food and housing insecurity. increasingly, states are requiring fafsa completion as a graduation requirement. while none of those state laws were in effect when our population would have been high school seniors (the earliest was alabama whose policy went into effect in the 2018-2019 academic year (cameron & lacy, 2020), which is the same year data was collected), schools or districts may have had policies or practices that emphasized universal application. if the fafsa was required or expected of all students, rather than those anticipating financial aid need, it would have confounded the meaning of the measure. certainly, future research should not consider the fafsa as a marker of socioeconomic status. fourth, we did not include some items in the survey that might impact food and housing insecurity and gpa, and therefore could not control for them. unaccounted for items include age, hours of employment, household size, whether in practicum, year in program, and full-time enrollment status. those choices were primarily made to limit survey burden. we do, however, know that a sizable portion of students would have been in both courses and practicum. at the school of social work under study, full-time msw students are in courses and practicum concurrently in the spring of both their first and second years. undergraduate social work students typically complete generalist practicum in the spring or summer of their senior year. as noted above, future research examining these characteristics may elucidate moments when food and housing insecurity are most felt by social work students. despite these limitations, our study provides new insights into social work students’ experiences, particularly their experiences of housing insecurity. advances in social work, spring 2023, 23(1) 162 conclusion the field of social work is grounded in ethical principles to assist those in need, including social work students, and to challenge social injustice. our findings suggest that many social work students cannot afford food and housing and suffer academic consequences as a result. if social work students are preoccupied with food and housing insecurity, they may be missing vital content in class. our profession’s ethical principles urge us to address the social injustice at the root of food and housing insecurity and to help social work students meet their basic needs. until we meet students’ basic needs, students will struggle to learn, which impairs their future capacity to practice social work. by investing in social work students’ food and housing needs, schools of social work can graduate more competent and better educated social workers, leading to better outcomes for social workers, 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(2021, march). supplemental nutrition assistance program (snap): students. https://www.fns.usda.gov/snap/students van woerden, i., hruschka, d., & bruening, m. (2019). food insecurity negatively impacts academic performance. journal of public affairs, 19, 1-10. https://doi.org/10.1002/pa.1864 author note: address correspondence to megan gilster, school of social work, university of iowa, iowa city, ia. email: megan-gilster@uiowa.edu acknowledgements: the authors wish to thank the students in the first author’s msw research classes who helped shape the larger survey. we also wish to thank sara sanders, then director of the school of social work and current dean of the college of liberal arts and sciences and john keller, then associate provost for graduate education and dean of the graduate college and current special assistant to the provost at the university of iowa for influential conversations about interventions at our university that shaped our recommendations. the content of this article, however, is the sole responsibility of the authors. https://doi.org/10.1080/0312407x.2010.538420 https://doi.org/10.1177/1521025115621918 https://doi.org/10.1080/10437797.2018.1434436 https://eric.ed.gov/?id=ej1092649 https://www.gc.cuny.edu/sites/default/files/2021-05/cunyhousinginstability.pdf https://www.gao.gov/products/gao-19-95 https://www.ers.usda.gov/media/8282/short2012.pdf https://www.fns.usda.gov/snap/students https://doi.org/10.1002/pa.1864 mailto:megan-gilster@uiowa.edu __________ caroline campbell, lsw, phd, assistant professor, jennifer cullen, lsw, phd, associate professor, rebecca vlam, lcsw, clinical assistant professor, and matthew a. myrick, lsw, phd, assistant professor, center for social work education, widener university, chester, pa. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 672-686, doi: 10.18060/28548 this work is licensed under a creative commons attribution 4.0 international license. barriers to licensure: an innovative program to address social injustice in social work professional development pathways caroline campbell jennifer cullen rebecca vlam matthew a. myrick abstract: this article describes the current barriers that exist for master of social work (msw) graduates when obtaining the advanced clinical social work licensure. disparities that exist in pass rates based on demographic factors, the lack of social work roles that provide clinical supervision, and the economic costs to obtaining outside supervision deeply impact social workers, the profession, and ultimately, client care. these barriers to both professional licensure and advanced clinical licensure comprise a workforcecentered social justice issue that has broad implications for practitioners, organizations, and vulnerable communities. in this article, we describe a pilot project called the clinical supervision program at a school of social work in pennsylvania, launched to address social justice needs through an innovative and guided pathway that will result in clinical social worker licensure. the pilot project is a collaboration of faculty and clinical practitioners that provides supervision, mentorship, sustainability, and support to practitioners with the aim of enhancing equity within the social work profession. in doing so, this project strives to address both the economic and societal costs of gatekeeping the social work profession via licensure through the strategy of supported and relational mentorship as a core part of the licensing and credentialing process. keywords: social work licensure, supervision program, barriers to supervision the hallmark of the social work profession is empowerment and voicing the challenges of vulnerable and marginalized groups. beginning in 1960, the national association of social workers (nasw) created the first version of a professional code of ethics that has become the standard for guiding values and behaviors of the profession. one of the most significant guiding principles is “social workers challenge social injustice” (nasw, 2021, section 3.02). the purpose of this article is to call attention to social injustices within our profession: barriers to professional licensure and workforce development. the clinical license represents multiple prospects for an emerging social worker such as (1) greater economic advantages through job opportunities, particularly lucrative ones that involve more leadership roles within organizations that have competitive benefits; (2) the capacity to contract with insurance companies for reimbursement; and (3) the ability to provide supervision to other staff members. outside of organizations, clinically licensed professionals can also obtain higher pay, increased autonomy, and the capacity to pursue reimbursement from insurance as a private practitioner and pursue entrepreneurship. because of these benefits, many recent graduates intend to gain their clinical license. this was confirmed in the results of a three-year survey conducted by nasw, where about:blank advances in social work, summer 2025, 25(2) 673 approximately 80% of new master of social work (msw) graduates stated that they planned to seek their clinical license within the next five years (salsberg et al., 2020). despite the clear benefits to pursuing clinical licensure, there are systemic barriers that exist to obtaining clinical licensure that impact all msw graduates and yet have had a disproportionate impact on those developing social workers with both diverse and marginalized identities, and who already face barriers that impact people of color, socioeconomic status, age and learning differences. we propose that these significant barriers include but are not limited to disparities in licensure exam pass rates, availability of social work roles that provide supervision, and the economic costs of clinical supervision. disparities in exam pass rates one of the first barriers that msw graduates encounter in the pathway toward obtaining their clinical social work licensure is the licensure exam. considering regulatory practices within a profession, there are typically varying degrees of certification, from least to most restrictive. according to the council on licensure, enforcement, and regulation these categories are registration, title protection, certification, and licensure, with licensure being the “the most restrictive type of state occupational regulation” (zajicek-farber, 2024, p. 373). in the united states, each state has developed regulatory boards that monitor the processes for certification and licensure in the various professions operating in that state. each regulatory board determines its own requirements for each level of licensure. additionally, while there is no standardization in the requirements, the one common requirement is passing the association of social work boards (aswb) exam as the first step in the process of obtaining a social work license. the licensed social worker exam (lsw), which can be taken near or upon graduation from an accredited social work program, has been recently highlighted as having significant limitations and possible glaring inequities in the exam process. the purpose of the standardization of the profession through examination as the first level of licensure is to ensure the competency of licensed social workers to protect clients. this exam is administrated and overseen by the aswb in the united states, its territories, and some parts of canada (aswb, 2022). however, a recent release of the report 2022 aswb exam pass rate analysis highlighted troubling gaps in passing rates concentrated among those with diverse and marginalized racial identities, and particularly for black social workers, and social workers who were older or non-native english speakers (aswb, 2022). these disparities were seen as indicative of potential bias inherent in the exams and found at both the lsw level and the clinical exam levels (lcsw-licensed clinical social worker). specifically, according to joseph (2024), the aswb released information reporting that of the over 50,000 candidates taking the licensure exam, “candidates from disadvantaged backgrounds—particularly those who identify as african american, are older, and for whom english is not their first language—have more difficulty passing the clinical exam” (p. 395). the nasw released a statement calling attention to “racial disparities” and lobbied the aswb to release data about who passes the test and who does not. aswb released this data, revealing inequities among first-time test-takers of the campbell et al./liscensure barriers 674 clinical exam with 83.9% of white test-takers passing, compared to 45% of black testtakers (mina, 2022). this disparity was not limited to black, older, and non-native english speakers as evidenced by the variation in pass rates based on demographic groups, clinical exam data from 2018 to 2021 showed that african american examinees had a first-time pass rate of approximately 40% compared with white and multiracial (approximately 80%), asian american (approximately 70%), and native american and hispanic (approximately 60%) examinees. (joseph, 2024, p. 396) these racial disparities in pass rates are alarming and highlight how social and economic injustices may be embedded within the foundations of advancement of the profession and current workforce dynamics. the nasw (2021) code of ethics identifies that a primary focus for social workers is that of social change, particularly for vulnerable groups that experience various oppressions. this requires that social workers have both a strong awareness and consideration of how sociocultural factors impact the experiences of individuals, especially concerning race and class discrimination and barriers. the racial disparities identified in the pass rates of the aswb exam create barriers for black, indigenous, and people of color (bipoc) from proceeding to the next level of social work practice by prohibiting them from obtaining licensure which is required in most states to practice as a professional social worker. thus, the very process developed to ensure the competency of social workers is marred by racial disparities in access to this licensure process by virtue of the testing process. castex et al. (2018) address the microaggressions that exist in the absw exam itself as well as the perpetuation of white privilege within the profession because of using the exam as a gatekeeping mechanism in the workforce. a study in 2023 was conducted to assess the reliability of social work licensure exam questions. the study sought to determine a connection between the social work competencies as defined by the council of social work education (cswe) and social work educators’ ability to assess exam questions for knowledge, skills, and abilities. the study found “weak reliability,” and they further shared that “without greater reliability between the cswe and aswb assessment approaches, the path to licensure will remain difficult and obscure for many social work graduates” (apgar & luquet, 2023, p. 74). thus, due to the reported disparities aligned with demographic factors and potential inherent test unreliability and bias, many in the social work profession have called for reform, and the abolition of the exam as a strategy of professionalism and pathway to workforce development. as one can see, there are problems within the social work profession that must be addressed from the stance of social and economic justice, which has driven our call to action. the literature on exam disparities represents foundational barriers and disparities in becoming a licensed clinical social worker. even if individuals can overcome barriers inherent in the exam, there remains another layer of deterrents to the process of licensure: supervision. advances in social work, summer 2025, 25(2) 675 barriers to supervision available and adequate supervision if a master level social work graduate moves past the initial hurdle of the lsw exam to successfully pass, they may face other systemic barriers that are specific to the supervision process. as previously explained, most states have varying levels of licensure, one of which is the licensed clinical social worker (lcsw). this level of credentialing is often the “highest” level, which garners more job opportunities, higher paying jobs, and the possibility of job autonomy. each state determines through their social work board the number of supervised clinical hours a social worker must attain (for example, pennsylvania requires 3000 clinical hours of experience and 150 clinical supervision hours postgraduate), before being granted permission to sit for the aswb clinical license exam. there is inconsistency across states as to how many hours of supervised clinical experience is required to begin the process of seeking advanced licensure within the social work profession. the process of securing supervision to attain the next level of licensure presents added barriers that include the availability of a clinically focused social work position, and employer provided supervision by a qualified licensed clinical social worker. this supervisor must meet strict criteria and follow guidelines set forth by the licensing bodies, which vary from state to state, and must certify the needed hours toward the clinical license. clinical supervision provides a vital role in the social work profession aside from the previously discussed requirement for continued licensure. supervision serves a role in the profession by creating a space to enact our code of ethics and explore social injustices within our communities and profession. supervision can be a place to explore social justice issues such as oppression, diversity, and the impact of policies and practices that perpetuate social inequities (chang et al., 2009; hair, 2015; hair & o’donoghue, 2009). a survey of 636 social workers in canada indicated that 70% agreed that the “purpose of supervision is to help social workers promote social justice” while 13.5% disagreed and another 13.1% stated they were not sure (hair, 2015, p. 359). broadly, these reviews suggest that clinical supervision enhances clinicians' treatment knowledge, adherence, competence, self-confidence, ethics, and the clinician-client relationship (e.g., the therapeutic alliance and satisfaction). further, clinical supervision has been associated with a reduction in clinicians' emotional exhaustion and intention to quit their jobs (knudsen et al., 2008). thus, supervision is vital given the complex needs that are present within highly vulnerable and marginalized groups that new msws are often working within, especially if this emerging msw is part of a diverse and marginalized group. in a 2019 nasw workforce report, it was identified that “new msws who were black/african american were more likely to be serving high-need populations than new msws who were white” (salsberg et al., 2020, p. 16). https://link.springer.com/article/10.1007/s10615-018-0667-4#ref-cr13 https://link.springer.com/article/10.1007/s10615-018-0667-4#ref-cr27 campbell et al./liscensure barriers 676 recent statistics on the newly emerging msw workforce identify the following scopes of practice: two-thirds (68.5%) of new msws in direct social work positions indicated that more than half of their clients were people below federal poverty level. similar proportions of respondents said many of their clients were medicaid eligible and people with mental health disorders (66.9% and 65.8% of respondents, respectively). one-third said a majority of their clients were people with substance abuse disorders and with people involved with the child welfare system (35.1% and 34.4%, respectively), and almost a quarter indicated a majority of their clients were seriously ill and people in need of assistance with activities of daily living. (24.1% and 23.2%, respectively; salsberg et al., 2020, p. 15) anti-racism, diversity, equity, inclusion, and supervision given the likelihood of msws working with diverse population and the need for adequate supervision, it is important for social work education programs, and supervision to be representative of the wide diversity of social workers, as well as that of clients. access to social workers who have achieved clinical licensure is limited by the disparities inherent in the pass rates of the lsw and lcsw exam, yet our call for “cultural awareness and social diversity” demands this (nasw, 2021). it can be challenging to identify a readily available list of licensed, black, indigenous, and people of color-identifying (bipoc) clinical supervisors for emerging msws to consider. according to the bureau of labor statistics (2024), there were over 750,000 social work jobs in the united states in 2023. yet only 200,000 are clinically trained social workers (nasw, 2021). zippia (2024), a career building platform founded in 2015, designed as a compilation of job postings and government data of the over 187,000 licensed social workers indicates that: 83.9% of all licensed social workers are women, while 16.1% are men. the average licensed social worker age is 44 years old. the most common ethnicity of licensed social workers is white (58.5%), followed by black or african american (19.9%), hispanic or latino (12.3%) and unknown (5.4%) and 13% of all licensed social workers are lgbtq. (para. 1) as one can see from the data, there is a lack of qualified supervisors to provide clinical supervision to the growing number of social workers in the u.s. (a 7% increase by 2033 according to the bureau of labor statistics) in a way that is representative of the diversity of the larger social work profession. the cost of supervision a third barrier to the licensure process in addition to the difficulty in passing the licensure exam and finding adequate, diverse supervisors is the cost of supervision. the low pay scale for roles, and the high amount of educational debt with which many social workers are emerging from their msw programs, create challenges for social workers to advances in social work, summer 2025, 25(2) 677 access supervision. while our profession outlines clear guidelines for values and principles and each state outlines the requirements for licensure down to the number of supervised hours, there are no standard guidelines for an equitable rate per hour charged to social workers to obtain supervision. there is a gap in the literature that addresses the economic injustice that is created by the cost of securing clinical supervision to support the hours required to advance to the next level of licensure despite this being an ongoing discussion among practitioners. additionally, as of this publication, the writers were unable to find any research addressing this cost disparity or the economic disadvantage it poses for individual social workers from diverse and marginalized populations other than anecdotal experiences and conversations with supervisees. to move toward the clinical licensure process, supervision may be in the form of individual supervision or a combination of individual supervision and group supervision, however, all group supervision must be in conjunction with individual supervision. at least 50% of all hours must be provided by a licensed clinical social worker (the lcsw), and the remaining hours may be provided by another licensed professional. utilizing other disciplines for supervision allows for more options for clinical supervision to be provided as part of the social worker’s role and in their workplace. these hours are typically obtained through full-time clinical work at a social work organization, and yet there is a scarcity of lcsw social workers, or those with training in supervision, within many social service organizations. particularly in areas of nonprofit, or community-based organizations, there is a lack of lcsws, since it is not required for employment. instead, lcsws will be concentrated in organizations that both require and hire and compensate for this advanced clinical licensure accordingly. since it may be a requirement of hiring, it can be challenging for a new msw or lsw to have an opportunity in this arena. access to an lcsw trained supervisor may be non-existent unless the organization itself decides to intentionally invest in contracting an outside individual and group supervisor. thus, the social worker is left to identify an external supervisor to contract with at rates that are highly variable. according to our own experiences and research through publicly available information via a google search, these rates may range from a minimum of $25 an hour and up to a standard private practice rate ($160) per hour depending on the clinical supervisor. as described previously, this barrier may be especially concentrated in social workers who may be underemployed or have obtained a less competitive role. if a new msw graduate has had difficulty in passing the first lsw level, there may be even less options for employment, and these roles may be even more concentrated among low paying, and highly vulnerable and marginalized communities. therefore, securing an external supervisor is often not feasible given the low pay scale salary for roles upon msw graduation. while the median annual wage for graduate level social workers has been reported by the bureau of labor statistics (2024) to be $58,380, the range is between $40,000 and $60,000. the highest reported earnings by type of employer were in hospital inpatient facilities (bureau of labor statistics, 2024). higher earnings were also reported by those in school systems, medical institutions, and government agencies. incidentally, these sectors typically require the advanced clinical licensure level, an lcsw, due to the requirements set by insurance companies for reimbursable clinical activities. emerging campbell et al./liscensure barriers 678 graduate social workers with limited previous experience beyond their required 900 total field placement hours established by cswe and their university will likely only qualify for lower paying positions. in addition to salary, student loan debt should be considered as a potential major factor in a new graduate’s finances. given the high educational debt held by social workers with both graduate and undergraduate loan debt of approximate $60,000 on average (wylie, n.d.), it can be economically impossible to afford clinical supervision. this recent figure is a stark contrast with a previous study done on educational debt, where just 12 years earlier, msw participants reported borrowing $30,000 in loans for their msw (yoon, 2012). loan repayment commitment impacts the social worker’s ability to afford weekly clinical supervision. hughes and colleagues (2018) noted the average debt for social workers with their master's degree was $38,159 to be paid in 9.76 years. according to findings from a three-year survey of new social workers, the social work profession: findings from three years of surveys of new social workers (salsberg et al., 2020), social workers who responded to the survey reported a high debt amount from their degree, often compounded by previous debt from the bachelor’s degree. this higher debt was concentrated among women and african american social workers, as well as those in the 31-35-year-old range (koeske & krowinski, 2004; salsberg et al., 2020). this may be especially true for new social workers who are the first generation to graduate from a college program, as the study in 2019 revealed that almost half of 2019 msw graduates in the study were first-generation college students (the first ones in their families to graduate college); this was higher for hispanic/latinos (73%) and black/african american individuals (57%; salsberg et al., 2020). model clinical supervision program the barriers addressed above--disparities in licensure exam pass rates, availability of social work jobs that provide clinical supervision, and the economic costs of securing private supervision--create significant disadvantages to marginalized groups of social workers and pose a serious injustice within the profession. to attempt to address those barriers, a university in southeast pennsylvania has created a model clinical supervision program for recent social work graduated seeking advancement in our profession (see figure 1). the model includes eligibility, group and individual supervision, and program evaluation. the program will be staffed by lcsws in good standing, representing multiple cultures, ethnicities, identities, and backgrounds. the pilot program will have two cohorts, beginning with 12 advanced-standing, on-ground, full-time students, entering in fall of 2025. upon graduation, these post-graduates, having maintained their status of students-in good standing, and meeting all requirements, including full-time work and passing the lsw exam, will receive pro bono, clinical supervision for 2 years, accruing the required number of hours as defined by the pa state board of social workers, marriage and family therapists and professional counselors. at that time, the second cohort of 12 full-time, onground students will be graduating, and will receive the same supervision with the same requirements. advances in social work, summer 2025, 25(2) 679 the clinical supervision pilot program is led by two experienced lcsws, who will each have 6 students and will provide both individual and group supervision for licensure. because this is a pilot program with 2 cohorts, master’s students must meet certain criteria until graduation and after graduation to take part in the program. figure 1. model of southeast pennsylvania university clinical supervision program eligibility eligibility requirements include remaining a student in “good standing” which entails completing the program with no academic issues. participants must obtain their lsw through successfully passing the aswb exam and have a clinical position in the field of social work. they must complete the required clinical supervision hours in the designated time. lastly, they must agree to return to the clinical supervision program post-licensure, to contribute a reciprocal exchange of clinical supervision for a specific number of hours to new graduates as part of their pro bono commitment. all participants accepted in the clinical supervision program pilot will be students from the full-time, on-campus program, residing with intent to practice in the state of pennsylvania (home site of the university), remain a community member in good standing through completion of their msw program on time, and have a full-time social work position within 6 months of graduation. participants who can adhere to these requirements will participate in the supervision program, including both individual and group supervision as defined below. group supervision group supervision will be comprised of six individuals. participants will meet and work with all group members during the sessions. group supervision is intended to provide a collective learning environment, rich with different experiences guided by different clinicians with diverse backgrounds and qualifications. as outlined earlier, social workers program evaluation individual supervision group supervision eligibility campbell et al./liscensure barriers 680 have seen a recent change in our code of ethics which places group supervision as a possible conduit for learning a deeper level of cultural humility, awareness, and selfawareness. a study in hong kong examining 91 master’s-level counselors from 18 supervision groups found an increased level of “group cultural humility” associated with a deepened awareness of other cultures and more self-awareness of their own backgrounds (chong et al., 2024). therefore, group supervision will include guest supervisors and whole group clinical trainings that focus on trauma-informed work and self-awareness. within this framework, the program will add the “standards and indicators for cultural competence in social work practice,” which includes working with concepts of ethics, values, self-awareness, cross-cultural knowledge and skills, language communication, and leadership to advance cultural competence and advocacy (nasw, 2021). this program intends to invite different guest supervisors who introduce diverse practices and ways in which to practice, giving supervisees the opportunity to expand their connections within the field. these experiences not only expand knowledge and skills, but open communication and engage relationships, which may help with a path forward to connecting systems that are traditionally silo-ed and have little to no communication. it is also the intent of this program to ensure that supervisees feel represented within the people from whom they learn. supervisees should get to hear about diverse perspectives and practices and should learn from people with whom they relate. bringing in additional guest supervisors to support both the individual and the group supervision process brings a realworld practice orientation and variety of experiences interfacing with the licensure process. it is the hope and long-term plan to utilize the continuity of the group supervision to create a space for those preparing for their clinical exam to study and support each other in the preparation process. also, it is hoped that the diversity of supervisors recruited for this program and the environment of support created by the group process will enhance exam preparation. while individual test-taking skills or the exam questions themselves cannot be accounted for or changed, the hope is to influence their experience of preparing for the exam through supported collaboration and mentorship. individual supervision while group supervision opens the possibility to a wider continuum of clinical experiences and sectors of practice with different providers, individual supervision offers a designated consistent mentor/supervisor with their own clinical practice “style.” the individual supervisors will be central to the pilot program. all supervisees and supervisors will be required to complete a “basic supervision” course by the end of the first month of the program. this supervision development course for social workers in clinical supervision equips social workers with the foundational supervision skills required by all social workers to understand their own work and to effectively mentor and guide less experienced clinicians. the course focuses on the very core components of supervision models and practices, enhancing supervisory techniques, addressing ethical and legal considerations, and fostering a supportive environment for professional growth and development. advances in social work, summer 2025, 25(2) 681 the pilot program will contain traditional supervision education including regulations, theory, practice areas, legal concepts, evaluation, ethics, documentation, and clinical decision making. it will also provide clinical supervision from a trauma-informed and psychodynamic perspective, keeping transference and countertransference in the supervision conversation. in recognition of the concept of parallel process, it is recommended that the clinical supervisors have their own personal support as they go through this process. pro bono service all participants who have benefited from the clinical supervision pilot will be required to engage in a reciprocal exchange to provide pro bono clinical supervision. the nasw code of ethics (nasw, 2021) outlines as an ethical principle that social workers should provide time and service in a volunteer capacity, “with no expectation of significant financial return (pro bono service)” (nasw, 2021, section 3.01). while this is a principle of service, how this is enacted in social work practice may look different depending upon the context and skill. however, these interpretations in contributing to the provision of supervision can have a direct impact upon recent graduates who are seeking a social worker who can provide the clinical guidance that will support their work. this will present an opportunity for the licensed clinical social work supervisors in our clinical supervision pilot. while providing clinical supervision to new and emerging msws, licensed clinical social work supervisors will have access to continuing education opportunities and ongoing mentorship with other clinical supervisors. at the same time, this reciprocal exchange may create a sustainable pathway of supervision and mentorship that could be adopted by other organizations and educational institutions. this process reflects the values and quality of social work supervision. program evaluation the clinical supervision pilot program will be evaluated through a comprehensive shortand long-term assessment of the pilot program's impact and its implications on social workers’ abilities to achieve clinical licensure, their professional growth, and the broader profession. this evaluation will provide critical insights into the effectiveness of the clinical supervision pilot program in considering disparities in licensure pass rates, reducing economic barriers, and enhancing workforce development in social work. by identifying the successes and areas for improvement in the pilot program, this evaluation will contribute to broader efforts to promote equity and social justice in the profession, benefiting both social workers and the vulnerable communities they serve. demographic data on participants will be collected and compared to national pass rates on the lsw and lcsw exams among program participants versus non-participants. program participation rates and the number of participants who successfully complete the program, attain clinical licensure, increase salary rates, move into supervisory roles, and overall career progression will be tracked throughout. additionally, a supervision cost analysis will be done on the availability of supervised roles locally, versus the costs associated with external clinical campbell et al./liscensure barriers 682 supervision (e.g., fees, travel costs, and time) to analyze the financial barriers faced by participants (student debt, salary, and positions held). in addition, in-depth interviews will be completed with program participants, social work practitioners, and supervisors to gather insights on the perceived barriers to licensure, the quality of supervision, and the impact of the program on professional growth. finally, focus groups will be conducted to explore participants’ experiences with the licensure process and the support they received through the pilot program. implications for future research, education, advocacy, and practice it is the hope that the supervision clinic will provide a resonant call to our profession, to help widen the path to accessible, quality, and affordable supervision, provided by social workers who represent the many communities which are served. clinical licensure in social work is still a new phenomenon over the last two decades and as such, has been the subject of limited focus in literature. at the time of writing, this gap in information regarding the economic costs of supervision and the disparities inherent in the process for those who are seeking clinical licensure was apparent. more research on the experiences of practitioners who have gone through the licensure process, and the challenges and barriers they have faced along the way is needed to inform the profession. continued research should focus on the importance of clinical supervision and its impact on both practitioner competence and client outcomes. finally, research should examine the value of a mentorship pathway from msw degree completion to clinical licensure, and how this may impact both the process as well as experience of professional development in terms of both wellbeing and longevity in the field. early in the msw program, educational programs can support the development of peer-based mentorship and the utilization of supportive groups that can be a resource during the transition from degree to career and licensure. such programs and initiatives can be part of the implicit curriculum of a college or university program. similarly, creating opportunities for licensed clinical social workers to speak about their pathway toward both licensure and career options available could be helpful to students. educational institutions can work to support students in their guidance around career options, with preference on obtaining job opportunities that invest in clinical supervision for their employees regardless of the goal of clinical licensure. we believe that every social worker should have sound clinical supervision to engage their multifaceted knowledge and skill base, whether they are in roles that require clinical work, or they have leadership roles that will influence the services that are provided. universities can influence organizations to increasingly offer clinical supervision as part of standard practice and encourage current organizations to fund external supervision if this is not part of the organization and require that all clinical supervisors take a basic supervision course. the social work program at the university referred to in this article hopes to partner with nasw-pa and local workforce groups to obtain funding and open discussions with other universities and internship sites, helping to create a stronger behavioral health workforce. through efforts such as those described in the pilot program, departments of social work education can begin to correct some of the social and economic injustices perpetuated within our profession. advances in social work, summer 2025, 25(2) 683 an area of educational advocacy would be working with the accrediting bodies of msw programs, cswe, and the aswb to ensure there are implicit connections and alignment with curricular content and practice standards. this is a call for social work guiding bodies to address the inconsistencies of the social work code of ethics with reference to the needs of social workers from diverse and marginalized populations. with the emergence of the social work interstate licensing compact legislation (general assembly of the commonwealth of pennsylvania, house bill 1841, 2023), where currently several states have agreements in place, there is a need for updated and perhaps universalized expectations of required hours, supervision standards, and processes across states. these policies should address the quality of supervision, as well as accessibility and provision within social work organizations, to reduce barriers of cost for entry into the profession. advocacy efforts should aim to ensure that all social workers, especially those from diverse and marginalized communities, have access to quality supervision and mentorship. social work organizations and professional bodies can push for policy changes that support fair compensation for supervisors, ensure mentorship programs for earlycareer social workers, and reduce the administrative burden on clinical supervisors. trauma-informed and culturally responsive supervision have emerged as best practices (archibald & johnson, 2021). clinical supervisors today must be well-versed in addressing socioeconomic inequities that affect both social workers and clients. this approach ensures that supervision addresses power dynamics, implicit biases, and systemic inequalities, promoting equity in practice. through this, we hope that social workers will have a deeper understanding of their biases and that meaningful and brave conversations in these spaces will allow for a parallel process, helping to shift views in workspaces and create spaces for clients to be their authentic selves, unapologetically. peer mentorship structures can be considered in practice, where social workers at similar career levels can mentor each other horizontally, as a supplement to clinical supervision. this model encourages collaborative learning, reduces power imbalances, and promotes mutual support. peer supervision is particularly beneficial for fostering reflective practice and maintaining ethical standards among early-career social workers. ultimately, it is our hope that this project will shed light on the glaring inequity within the world of clinical supervision and serve to create guidelines for similar programs in other universities and institutions to put time and energy and effort into the people who engage in challenging work with fragile communities. conclusion the model of clinical supervision presented in this article seeks to address the barriers in the social work licensure process through clinical supervision, by addressing a plan to support access to clinical supervision with equity and inclusion, to grow a deeper understanding of pass rate disparities and barriers to finding clinical supervisors, and to create a cost-effective program for obtaining the required clinical supervision hours. this model is aligned with the need for clinical social workers to routinely challenge injustice within our profession, including workforce development and educational pathways along with policies that may impact client care through its limitations on social workers. campbell et al./liscensure barriers 684 clinical social workers are called on to address the ways in which structural inequalities affect the clients’ everyday lives, mitigate further harm, and promote social justice within the clinical space. a growing body of literature emphasizes social justice in the delivery of clinical services (asakura et al., 2019; baines, 2006, 2011; chen et al., 2025; fook, 2012; larson, 2008), yet there is a paucity of literature on how to address social justice in clinical supervision (asakura & maurer, 2018, p. 289). the proposed clinical supervision model addresses the three barriers to licensure by addressing and gathering data for exam-based disparities, looking at the cost of clinical supervision and access to a qualified and affordable clinical supervisor. programs such as the one presented in this article demonstrate an effort to correct the social injustice and hypocrisy rampant in our profession which continues to marginalize social workers from diverse populations by prohibiting access to career advancement. universities can find ways to support students without grants to create similar programs using pro bono services. this is a call for social work guiding bodies to address the inconsistencies of the nasw code of ethics with reference to the needs of social workers from diverse and marginalized populations. the social work education program identified in this article hopes to partner with nasw-pa and local workforce groups to obtain funding to develop similar programs to help to create a stronger behavioral health workforce. through efforts such as those described in the pilot program, departments of social work education can begin to correct some of the social and economic injustices perpetuated within our profession. references apgar, d., & luquet, w. 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(2024 august 31). licensed social worker demographics and statistics in the us. author. author note: address correspondence to jennifer cullen, center for social work education, associate professor widener university, one university place, chester, pa 19013. email: jacullen@widener.edu orcid: caroline campbell https://orcid.org/0009-0002-8241-5746 jennifer cullen https://orcid.org/0000-0001-7692-753x rebecca vlam https://orcid.org/0009-0004-0197-2001 matthew a. myrick https://orcid.org/0000-0002-9276-3341 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.cswe.org/cswe/media/workforce-study/the-social-work-profession-findings-from-three-years-of-surveys-of-new-social-workers-dec-2020.pdf https://www.cswe.org/cswe/media/workforce-study/the-social-work-profession-findings-from-three-years-of-surveys-of-new-social-workers-dec-2020.pdf https://www.socialworktoday.com/archive/exc_051515.shtml https://doi.org/10.5175/jswe.2012.201000058 https://doi.org/10.1007/s10615-024-00953-y https://www.zippia.com/licensed-social-worker-jobs/demographics/ mailto:jacullen@widener.edu https://orcid.org/0009-0002-8241-5746 https://orcid.org/0000-0001-7692-753x https://orcid.org/0009-0004-0197-2001 https://orcid.org/0000-0002-9276-3341 microsoft word 06_bishop_24620_she_is_always_doing_the_work _________ christine bishop, phd, lmsw, social worker, étoile academy charter school, houston, tx. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1161-1177, doi: 10.18060/24620 this work is licensed under a creative commons attribution 4.0 international license. “she is always doing the work": perspectives of latino adolescent males about their single mothers christine bishop abstract: marianismo refers to the prioritization of latina mothers concerning their children and families. this term acknowledges the selflessness of latina mothers. this study explored the perceptions of thirteen latino adolescent participants following their experiences of being raised by a single mother. to study this relationship, an adapted version of narrative analysis was used. while the analysis focused on participants’ relationships with their mothers, relationships with their biological fathers and other father figures (i.e., natural mentors) in their lives were explored. the study’s findings are contextualized through the lens of attachment theory, social learning theory, and the relevant literature. this study shines light on the important impact of mothers and natural mentors on the lives of latino male adolescents. social workers from varying professional domains who are working with latino families can take the marianismo cultural value into account in their own interactions and services with their clients. additionally, just as the latino adolescents in this study were keenly aware of their mothers’ many positive values, strengths, and contributions to their lives, it is vital for social workers to do the same. keywords: culture; family; male adolescents; marianismo; mothers; narrative research by 2060, 40% of the children in the united states will be latino (kapke & gerdes, 2016; kapke et al., 2017). the pew research center (2018) reported that in 2017, 23% – nearly one-quarter of the hispanic children in the united states lived with a single mother. the latino population in the united states faces unique challenges due to systemic inequality and discrimination that are embedded in the country. latinos experience many forms of discrimination, including prejudice against their physicality, cultural background, and abilities or potential difficulties with speaking english (arellano-morales et al., 2016; block & tietjen-smith, 2016; cobb et al., 2017). latinos are typically portrayed in a negative light in the media. specifically, the population is often pigeon-holed in a specific job sector, or commonly casted as unauthorized residents in the united states or as criminals. these negative images and stereotypes further perpetuate fear and bigoted views of the population (steinberg, 2004; tukachinsky et al., 2017; vasquez-tokos & nortonsmith, 2016). in contrast to negative media images, latino families exhibit many strengths. marianismo is a term that is sometimes applied to acknowledge the great lengths that latina mothers go for their family members. simply put, this word refers to how selfless latina mothers are for their families (piña-watson et al., 2014; rodriguez et al., 2013). according to this cultural value, latina mothers put their family members’ needs before their own, regardless of whether it is for their spouses, their parents, (mendez-luck & anthony, 2016), or their children (piña-watson et al., 2014). the mother-son relationship is crucial and unique, considering the cultural relevance of family and the maternal role in latino households. advances in social work, fall 2021, 21(4) 1162 in alignment with the marianismo cultural value, ceballo and colleagues (2012) found that latina mothers placed a lot of emphasis on having good communication with their children, as well as building trust with them. vargas et al. (2016) completed a qualitative study via individual interviews to better understand the experiences of male adolescents who were growing-up with single mothers. the participants shared about their mothers’ heavy workloads, the fact that their mothers served as the sole caregiver at home, as well as feelings of jealousy when witnessing fathers and sons in public spaces (vargas et al., 2016). the adolescents provided rich information, as they were willing to be open and vulnerable in order to share difficult emotions. these types of first-hand accounts are not prevalent in the social work literature with this population. natural mentoring like mothers, natural mentors can be beneficial assets to adolescents’ lives. a natural mentor is an informal mentoring arrangement that does not necessarily stem from a formal mentoring program; rather, they occur from organic relationships that adolescents build with adults (hagler & rhodes, 2018; sáenz et al., 2015; vandam et al., 2018). regardless of what part of the adolescent’s life a mentor comes from the natural mentor serves as a source of guidance and support for adolescents (hagler & rhodes, 2018; sáenz et al., 2015; vandam et al., 2018). mentors can come in the form of extended family members, teachers, coaches, or neighbors. according to barron-mckeagney et al.’s (2000) description, the family mentoring program (a community-based program that strives to address adolescent violence) aims to mentor children and to include parents in their program’s services and interactions with the adolescents. in a similar vein with the inclusion of trusted adult support and guidance, sánchez and colleagues (2011) conducted a longitudinal mixed-methods sequential explanatory study to assess the access of impoverished latino adolescents to natural mentoring relationships (nmrs) during their transition from high school. overall, the mentees (94%) reported that they received various types of support from their mentors, including emotional support, directive guidance, and informational support (e.g., assistance with homework and financial advice; sánchez et al., 2011). attachment theory attachment theory provided relevant context about the life-altering influences that primary caregivers can have on a child's development. the inclusion of this theory was useful prior to the development of the study’s methods and supported a deeper understanding of the importance of adult relationships in latino youth’s lives. developed by john bowlby (1988), attachment theory espouses the idea that a child’s attachment with their parents can impact their decisions, behaviors, emotional regulation, and future relationships throughout their lives. bonding with one’s caregiver in childhood is crucial to be able to depend on others (bowlby, 1988; peacock et al., 2003). an ongoing relationship presents the opportunity for strong emotional connectivity, allowing adolescents to view their caregiver as a safety net during difficult times (gross et al., 2017). bishop/latino adolescent mentees’ 1163 according to this theory, adolescents who have a sensitive and responsive caregiver view that figure as a dependable person in their life and are more likely to have a secure sense of self (bowlby, 1988; o’connor et al., 2013). adolescents’ attachment with their caregiver is impacted by the care and consistency the adolescent is shown with regard to their needs (bowlby, 1988; gross et al., 2017). insecure attachments between adolescents and their caregivers are linked to weak bonds, a lack of a consistent reaction when the child feels distressed, and a lack of physical closeness between the adolescents and their caregivers (gross et al., 2017). when there are weak bonds between the adolescents and their caregiver, acting-out behaviors can occur during adolescence, including drug use, violent behaviors, and problems at school (peacock et al., 2003). many adolescents do not have secure attachments with their caregivers. in this circumstance, it is possible that they will seek attachments outside the home (hurd et al., 2009). if these adolescents seek out a role model elsewhere, it is more likely that the adolescents will be exposed to unfavorable influences (hurd et al., 2009). zilberstein and spencer (2017) integrated attachment theory in their literature review with attention to mentor-mentee relationship endings. specifically, they discuss how mentees develop attachments with their mentors, which leads to beneficial outcomes in many domains. from their assessment of the literature, they found that premature endings to relationships with mentors lead to adolescents feeling lost, disappointed, and rejected. adolescents can have a decreased inclination to continue mentoring services if their services cease prematurely (zilberstein & spencer, 2017). dallos and comley-ross (2005) incorporated attachment theory in their qualitative study of six young people who were involved with mentoring. they report attachment theory was directly related to adolescents’ relationships outside of their home (i.e., with mentors) and ultimately, their establishment of trusting relationships with others. based on interviews with adolescents and two focus group discussions with mentoring program mentors and staff, dallos and comley-ross (2005) found that the adolescents felt that mentoring positively impacted their lives. some saw their mentors as additional parental figures. social learning theory as with attachment theory, social learning theory was applied to gather deeper knowledge surrounding the impact of an adolescent’s relationships, regardless of whether or not they are primary caregivers. children’s behavior is significantly impacted by their life experiences, depending on what they are directly or indirectly exposed to within their homes, schools, and communities (aschenbrener & johnson, 2017; bandura, 1977; brauer & tittle, 2012; chavis, 2011; o’connor et al., 2013). children model what they see and hear in their environments and imitate behaviors that result in rewarding experiences (aschenbrener & johnson, 2017; bandura, 1977). adolescents can learn desirable or undesirable behaviors (bandura, 1977; brauer & tittle, 2012; kelley & lee, 2018). specifically, adolescents can learn how to manage their emotions, resolve disputes, and engage with other people in a healthy manner (o’connor et al., 2013). these skills are needed during adolescence as youth prepare for future developmental stages. culture also advances in social work, fall 2021, 21(4) 1164 shapes individuals when it comes to their beliefs and norms (chavis, 2011). the available literature is sparse on the narratives from the latino adolescent population, and particularly those who reside with a single mother. method using an adapted version of narrative analysis, this study aimed to shine light on the perspectives of adolescent latino males in regard to their experiences growing-up with single mothers as well as other supportive figures in their lives. in a larger study, participants were asked to share about their experiences in a formal mentoring program. during the interviews the participants frequently mentioned their highly supportive single mothers. thus, this analysis focused on the latino adolescent males’ views of their mothers who, for the most part, raised them as single parents. narrative research is considered to be a strong approach for collecting information about people’s experiences throughout their lives (creswell, 2013). based on participants’ testimonies, the researcher can uncover how the participants assign meaning to their experiences, which can allow for unique experiences and perceptions as they relate to one’s unique cultural heritage or upbringing. this framework takes into account the participants’ perceptions of their lived experiences (wertz et al., 2011). though oral or written materials can be used within this approach (creswell, 2013; mcalpine, 2016; wertz et al., 2011), this study examined the participants’ responses to the interview protocol for meaningmaking, as they were given the opportunity to explain their experiences in-depth. a midwestern urban university institutional review board (irb) approved this study. thirteen latino adolescents participated in this study. the eligibility criteria for this study were:  self-identify as male,  self-identify as latino,  attended the boys & girls club for at least two months prior to the interview,  lived with a single mother for longer than two years (if living with their father, there was a partial custody arrangement, i.e., living primarily with a single mother),  between the ages of 12 and 18. when working with human participants in the research process, ethical considerations and standards must be observed (drewry, 2004). an assent form was available for children ages 12-14 and a study information sheet was provided for adolescents ages 15 (+). the study information sheet was also made available for both english and spanish-speaking parents. the adolescents’ participation was strictly voluntary. prior to the recorded individual interview process at a boys & girls club site located in central florida, the researcher provided a reminder of the purpose of the study to all participants. this information was also explained to parents/guardians. participants were assured that their involvement in the study was voluntary, that they were not required to answer every question that was asked, and that they could withdraw from the study at any time. bishop/latino adolescent mentees’ 1165 recruitment the larger study focused on the mentoring services for latino adolescents provided by the boys & girls club, thus contact was made with the president/ceo at the boys & girls clubs of central florida. the ceo was provided a copy of the study materials, including the study information sheets, assent form, and recruitment emails. the researcher submitted the study information for program staff to share with the participants and their guardians prior to making contact with them, which was primarily done via phone. as part of the assent process, the researcher shared aloud at the start of each interview: i am interested in learning about you and your experiences with your family, as well as your mentoring program. remember that your input is voluntary. you are not required to answer any questions that you feel uncomfortable with. also, you may end your participation in the interview at any time. participant demographics thirteen participants ranging in age from 12 to 17 took part in this study. each participant self-identified as a latino male and was in either middle or high school. pseudonyms were used to preserve participants’ confidentiality. a summary of the participants’ demographic information regarding their ethnicity, age, how often they attended the club, etcetera, can be found in table 1. instruments participants were asked for basic demographic information (e.g., age, grade level, and who they lived with) via a written survey. the semi-structured interview protocol included questions about the participants’ relationships with their mothers, biological fathers, and other natural mentors in their lives. questions included: 1. tell me a bit about your family. 2. can you tell me about your dad? 3. can you tell me about whether there is another man in your life who is like a fatherfigure to you? 4. was your mother included in your mentoring services in any way? 5. how was she included? 6. what are your thoughts on her involvement with your services? 7. would you have preferred for her to have been more involved? how might your experiences have been different if she was able to be more involved? advances in social work, fall 2021, 21(4) 1166 table 1. participant demographics pseudonym ethnicity age school level parental/caregiver structure # of siblings club involvement days per week duration aaron puerto rican 14 9th mother full-time 5 or 6 (unsure) 5 2 years brandon puerto rican 15 10th mother full-time 4 4 4 years christopher puerto rican 17 12th mother full-time 1 5 6 years david puerto rican 13 8th mother full-time 1 5 3 years evan puerto rican 13 8th mother full-time 9 5 1 year flynn puerto rican 17 12th mother full-time 11 1-2 1 year gregory mexican & cuban 14 9th mother 5 days & father 2 days/ week 2 5 2 years henry puerto rican 12 7th grandmother fulltime 1 5 1 year ignacio spanish, irish, & africanamerican 13 7th mother full-time 2 5 6 months juan puerto rican 16 10th mother & stepfather 2 4 5 years karl puerto rican, cuban, italian, & africanamerican 14 7th mother full-time 1 5 1 year lenny puerto rican 13 8th mother & stepfather 0 5 4 years michael puerto rican 14 10th mother & stepfather 3 5 7 months data tracking and coding the narrative data from this study, the coding documents, and the list of themes, subthemes, and their categories were maintained electronically on google drive via password protection. as an initial step of the coding process, the researcher completed a step called unitizing, meaning the simple bits of information pertaining to the studies’ questions and its purposes were simply noted (rodwell, 1998). units could range from words, sentences, or paragraphs. the next step of the process was sorting. in this phase, each of the units were compared with one another and based on their commonalities and distinctions, relevant themes were identified. similar units were combined into their own corresponding themes, a process known as lumping. the individual themes, sub-themes, and categories have their own distinctions and definitions. any “miscellaneous” items were initially noted, then placed in any corresponding themes that might be relevant (rodwell, 1998). after this step, all themes, sub-themes, and categories were reviewed to ensure they are non-redundant and conceptually make sense. per rodwell’s (1998) recommendation, the number of themes was intentionally limited. bishop/latino adolescent mentees’ 1167 for this study, three overall themes were identified. each unit was re-reviewed to ensure its unit assignment was correct, as well as to confirm its theme, sub-theme, and when applicable, category assignments were accurate and conceptually sound (rodwell, 1998). ultimately, the potential relationships between the differing participants’ narratives were identified and compared to each other, leading to the study’s themes, sub-themes, categories, and the overall findings. member-checking study participants were invited to participate in a member-checking process after the individual interviews were completed, transcribed, and analyzed. they were given the opportunity to approve or if needed, correct the researcher’s interpretation of the specific information they provided during their interviews (carlson, 2010). a total of nine participants participated in member checking. each of the nine participants confirmed the findings based on their interviews as accurate. reflexivity the researchers’ demonstration of reflexivity in narrative research is vital (carlson, 2010; etherington, n.d.). an audit trail consisting of a detailed account of the research process was maintained throughout the study (carlson, 2010; etherington, n.d.). the study’s audit trail consisted of the list of themes, sub-themes, categories, and each of their definitions from the data analysis process. the researcher participated in reflexive journaling regularly during each phase/step of the research and analysis processes, as well as when emerging thoughts occurred regarding the research process, which could include new ideas, beliefs, confusion, or concerns (carlson, 2010; cope, 2014; rodwell, 1998). this study’s reflexive journal contains a variety of information, such as activities that were conducted from day-to-day, plans for the study for the upcoming days, weeks, etcetera, the researcher’s understanding of the interviews that took place, contacts made via phone, email, or texts during the study process for recruitment, and member-checking. throughout the process of engaging in reflection, the researcher came to important realizations about the research process. specifically, it appeared as though the generally negatively-toned social sciences published literature regarding latinos was impacting this author's own emphases, writing style, etcetera. upon this realization, the author made a concerted effort to acknowledge the study participants and their mothers' many strengths. results three main themes were identified within the narrative data: positive relationships with mothers, varied relationship dynamics with fathers, and supportive relationships with varying types of father figures. advances in social work, fall 2021, 21(4) 1168 family and other supportive relationships the participants described their mothers as hard-working, steadfast supporters of their homes, as well as of their lives. regardless of situations that can occur in life, the participants felt they could depend on their mothers. their fathers’ level of contact and involvement varied. some participants were not familiar with their fathers, whereas others had a relationship with their fathers. several participants have step-fathers who had really shown an interest and dedication in serving in a father-like role for them. aside from stepfathers, other participants reported that they have father figures who are relatives (e.g., a grandfather) and non-relatives (e.g., a friend of their mother’s) who provide that type of role for them. a visual representation of the findings can be found in figure 1. figure 1. family and other supportive relationships positive relationships with mothers the participants’ mothers demonstrate various maternal aspects in their relationships with their sons, such as being protective, having a strong connection, tending to the family’s responsibilities, etcetera. there were a few reports of mothers and providing a non-relative father figure   relatives and step-fathers family and other supportive relationships hard-working and responsibilities positive relationships with mothers protective strong connection always there for me mother as a father figure limited involvement fathers some connection discord with mothers  financial support providing encouragement involvement bishop/latino adolescent mentees’ 1169 fatherly role for them as well. the participants repeatedly expressed that they could depend on their mothers to provide and care for them. hard-working and responsible. several participants spoke about how hard-working their mothers were, such as when david (age 13) stated, “she achieves her goals” or when aaron (age 14) said, “my mom’s always doing the work.” these participants’ mothers do what needs to be done in order to maintain their families and household. protective. the notion of their mothers being protective was brought up by several participants. comments about protection ranged from gregory (age 14) stating, “...if i cut myself, it's a baby cut, she'll still make it a big deal…” to aaron’s comment about “...she really don't want me walking around at 2 o'clock in the morning.” these participants’ mothers are looking out for them, regardless of the level of danger. strong connection. several participants spoke about the strong connections they share with their mothers. michael (age 14) stated, “... to get to see my mom happy. yeah. cause if she is not happy, i'm not happy. if she's mad, i'm mad.” aaron (age 14) said, “my mom's really special to me. i think, if it's not my brothers, then it's my mom.” several participants described how special their mothers were to them. always there for me. karl (age 14) and david (age 13) reported about how their mothers were always there for them, such as by karl stating, “well my mom has always been there for us. she's been the person who has always done things for us,” or david stating, “...she's always there for me, and for my little brother, always caring, and she's always working hard.” brandon (age 15) spoke about how his mother provides him with encouragement with sports when he stated, “she would motivate me to do better and not give up, like usually i would get mad and stop playing half the game.” he also stated, “but if she was to watch me play, she would tell me to not give up. just keep playing that you try and get the win.” the participants described their mothers as relentless and caring sources of support and stability. mothers as a father figure. a few participants spoke about their mothers playing a fatherly role for them. aaron (age 14) said, “my mom's really like a father figure. and she also acts like a dude and stuff, but mainly my mom's like my father figure and my mother figure, as well – a father figure to me, that i look up to and stuff...” michael stated something similar when he said, “but, my mom is, she's being like a dad and a mom to us. and that's what i like, what i really want to do. i want her to do like that with us.” thus, some mothers exhibited a caring presence that expanded to play fatherly roles for their sons. fathers fathers’ involvement varied as can be seen from this theme’s varying sub-themes. some participants’ fathers provided them with support and a certain level of connection, whereas other fathers were not involved. advances in social work, fall 2021, 21(4) 1170 limited involvement. many participants reported that their fathers had limited involvement in their lives. christopher (age 17) reported, “he likes to spend time with us, but he'd preferred if we do his hobbies at the same time with him, other than just spending time with us as a major point of his day.” aaron (age 14) stated, “while i was near my dad still, he would not come to my basketball games or any of that.” flynn (age 17) said, “i know who he is, i just couldn't do that if i wanted to” (regarding talking about his father). these quotes are emblematic of the participants’ fathers’ limited attention and time spent with them. some connection. some participants did have a connection with their fathers, as described by lenny (age 13) when he said, “my dad, he's moving here. we have a good relationship.” henry (age 12) spoke about his father’s involvement in his life on the weekends saying, “oh, yeah, he's a good dad. he takes care of me weekends because he works every day, every day. and yeah, he… takes me only weekends.” these participants, as well as some others, maintain some level of a relationship with their biological fathers. discord with mothers. a few participants’ fathers have discord with the participants’ mothers, as demonstrated by evan (age 13) who said, “...like when it comes to like my mom, that he's was not very nice. so that's why my mom and him don't talk.” financial support. a few participants’ fathers contribute financially, as christopher (age 17) reported, “but my dad also contributes to the house” and aaron (age 14) stated, “but then, he would try, and he would pay for the stuff that i did, too.” father figures aside from their mothers or fathers, multiple participants mentioned varying types of father figures. some of the participants’ father figures are relatives, whereas others stem from outside of the family. non-relative. several participants have father figures from outside of the family unit. when speaking about his karate instructor, aaron (age 14) said, “...and that man is very special to me. if something happens to him, i don't know. he's very important.” when discussing his mother’s friend, ignacio (age 13) stated, “he was a good friend and he was like... he was a friend of my mom, but i was closer to him than she was to him.” relatives and step-fathers. regarding his grandfather, henry (age 12) said, “yeah, he was like a dad to me, like a second dad.” regarding his brother, christopher (age 17) stated, “i mean, my brother tries to fill in the father role…” flynn (age 17) mentioned his uncle when discussing father figures. three of the participants have step-fathers who are described as being like a father figure for them, or who provide financial contributions to the participants’ lives. ignacio stated his step-father has “...always been there for me to give me advice. he's helped me through school, everything. he's been there supporting me.” juan (age 16) spoke about bishop/latino adolescent mentees’ 1171 being able to depend on his step-father when he stated, “my stepdad is just always there and he just supports and helps…” three participants’ step-fathers contributed financially, such as when lenny (age 13) stated, “he's a hard worker and every time we need something, he always provides,” or when aaron (age 14) said, “...and he bought me basketball equipment and stuff, as well.” discussion this study focused on the experiences of latino adolescent participants growing-up with a single mother. regarding the participants’ mothers, there was a sweeping shared positive perception toward them, including reports of their mothers being protective and supportive, as well as having strong connections with their sons. this finding aligns with the positive findings surrounding the mothers from ceballo et al.’s (2012) study, who value good communication and trust with their children. given the strong attachments between the participants and their mothers, attachment theory importantly accounts for the wellbeing of latino adolescents. for example, many participants’ mothers provide a muchneeded base of security and stability (gross et al., 2017). this ongoing relationship was consistently described by participants as their mothers providing a caretaking role, consistent with existing literature (bowlby, 1988; gross et al., 2017). the care and consistency that the participants’ mothers provided to their sons correspond to the behaviors associated with secure attachment as noted in attachment theory (bowlby, 1988; gross et al., 2017). these participants’ mothers have clearly been vital, steadfast figures in their lives, which relates to the cultural notion of marianismo (piña-watson et al., 2014; rodriguez et al., 2013) as well as attachment theory (bowlby, 1988; o’connor et al., 2013; peacock et al., 2003; santos et al., 1998). in alignment with social learning theory, parenting quality and techniques (bandura, 1977; o’connor et al., 2013) were described by the participants. participants discussed their mothers’ thorough and consistent involvement in their lives, both within and outside of their involvement with the boys & girls club. the participants also spoke about their mothers modeling dependability throughout their lives, such as serving as a general source of support. consistent with vargas et al.’s (2016) findings, the participants also expressed how their mothers worked hard to provide for the family. the findings are reflective of the marianismo cultural value (piña-watson et al., 2014; rodriguez et al., 2013). in addition, a few participants described their mothers as father figures. the closeness of the participants with their mothers is an important protective factor, especially considering many of these adolescents’ biological fathers have limited involvement in their lives, which can result in a higher susceptibility to social-emotional problems (huang et al., 2017; langton & berger, 2011). when a father and son do not have consistent contact or reside in the same home, it can be more difficult to maintain a bond (bachman et al., 2009). findings from this study regarding participants’ perceptions of their fathers seem to align with this notion. two participants reported that though their fathers still contribute financially, their involvement with them is limited. these findings corroborate literature regarding how fathers leaving advances in social work, fall 2021, 21(4) 1172 the home tend to have minimal contact (amato & sobolewski, 2001), and can lead to detachment from their adolescent sons (moore & hotch, 1982). some examples of the testimonies that led to the depictions of these weak relationships were a lack of financial support, fathers not engaging in a participant’s and his other family members’ preferred activities, and inconsistent or no communication. as for the participants who spoke about their fathers’ apparent violence/discord with their mothers, it is anticipated that there could be some discord between a mother and a father post-divorce or separation. however, some fathers maintained a peaceful relationship with the mothers. some participants maintained relationships with their biological fathers, which appeared to be due to their fathers’ involvement in their lives (plunkett et al., 2007). in addition to their parents, study participants have many different supportive figures in their lives with whom they have close relationships. both relative, and non-relative father figures took on roles that could be compared to an organic, natural mentoring relationship (hagler & rhodes, 2018; sáenz et al., 2015; vandam et al., 2018). for instance, some step-fathers, based on the participants’ accounts, have really stepped-up in terms of providing a protective factor by serving as caring, supportive adults. study limitations like any study, there were limitations within this particular study. with one researcher being involved (and bringing an “outsider” perspective), this was a subjective process, particularly because this was a qualitative study and there was no formal study auditor. in terms of representation among the participants from the study, this was limited, as there was a common cultural background among the participants. the participants from the study are also living in the same geographic area. the researcher was able to review individual study findings (based on the individual interviews) with nine of the study participants. unfortunately, the researcher was not able to get in touch with four of the participants to review their findings (multiple attempts were made to reach them via phone). additionally, in terms of eligibility criteria, some alterations were made, as it was uncovered that one participant’s parents have joint custody. several other participants have step-fathers who are currently living in the home. since these participants lived with single mothers for several years, it was determined that they would still be included in the study. for juan in particular, this researcher was not able to determine when his step-father moved into the family’s home. lastly, though efforts were made to ensure the participants were aware their participation was voluntary and confidential, they might not have felt comfortable with being completely transparent because of the nature of the questions asked, thus, some responses might reflect social desirability bias (king & bruner, 2000). future recommendations future studies may include the perspectives of latino adolescents from a wider range of ethnic backgrounds. it is clear that the mother-son bond across the participant pool was extremely strong and deep. similar studies on latino adolescents grounded in strengthsbased theory are needed. in future research regarding this population, there should be more bishop/latino adolescent mentees’ 1173 emphasis on the many strong, positive roles that single mothers and natural mentors can provide for latino adolescents. from a practice perspective, this author recommends considering the marianismo cultural value when it comes to social workers striving to engage in culturally-relevant practice with their clients. in individual and family therapy settings, when advantageous, social workers/therapists should consider the strong mother-son and natural mentoring bonds latino adolescents have to clients' advantages, as this inclusion could help enhance culturally-relevant practice. where needed, social workers can play an influential role in arranging natural mentoring relationships, as well as arranging connection to youth development agencies, which can serve as protective factors for latino adolescents. mothers can be invited to be included in the aforementioned process by providing recommendations (as available) for natural mentoring relationships that can be fostered through their own networks or by being included in youth development agencies’ planning, and events. school social workers can include students’ mothers and natural mentors in the educational setting where needed and appropriate. if students are in need of further support, school social workers can help to identify natural mentors to bolster academic skills and resources where needed. schools of social work should evaluate the degree to which their curriculum focuses on the values and strengths of this population in terms of the transformational influences of single mothers and natural mentors in latino adolescents’ lives. further emphasis should be placed on the cultural relevance of attachment theory and social learning theory in applications to latino culture. conclusion the types of strengths shared by latino adolescents about their single mothers are not emphasized in the available literature. this study aimed to give latino male adolescents who have grown-up with their single mothers the opportunity to voice their perceptions on how they have been impacted by their upbringing. using narrative research, this study explored the participants’ experiences to discover themes and sub-themes describing latino adolescent males’ views of their mothers. the participants shared sweepingly positive attitudes and perceptions of their mothers, describing their mothers as protective, supportive, and hard-working. participants shared strong connections with their mothers. though the participants have an array of different types of relationships with their biological fathers, they do have other supportive male figures (i.e., natural mentors) in various parts of their lives. participants from this study demonstrated maturity, critical thinking skills, integrity, and keen observations about their own social circles and the environments they surround themselves with. this study’s participants demonstrated these positive traits during the interview process, such as openness to discuss various situations and challenges in their lives. participants were willing to speak openly and directly. these adolescents are motivated and demonstrated gratitude for the supportive adults in their lives. based on their supportive mothers, their mentors, and their impressive individual traits, it is anticipated that the participants from this study will continue to develop into wise, mature, and advances in social work, fall 2021, 21(4) 1174 impressive young men. just as the latino adolescents in this study were keenly aware of their mothers’ many positive values, strengths, and contributions to their lives, it is vital for social workers to do the same. references amato, p. r., & 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(2018). does natural mentoring matter? a multilevel meta-analysis on the association between natural mentoring and youth outcomes. american journal of community psychology, 62(1-2), 203-220. https://doi.org/10.1002/ajcp.12248 vargas, a. p., park-taylor, j., harris, a., & ponterotto, j. g. (2016). the identity development of urban minority young men in single-mother households. journal of counseling & development, 94(4), 473-482. https://doi.org/10.1002/jcad.12106 vasquez-tokos, j., & norton-smith, k. (2016). talking back to controlling images: latinos’ changing responses to racism over the life course. ethnic and racial studies, 40(6), 1-19. https://doi.org/10.1080/01419870.2016.1201583 wertz, f. j., charmaz, k., mcmullen, l. m., josselson, r., anderson, r., & mcspadden, e. (2011). five ways of doing qualitative analysis. guilford press. zilberstein, k., & spencer, r. (2017). breaking bad: an attachment perspective on adolescents mentoring relationship closures. child and family social work, 22(1), 67-76. https://doi.org/10.1111/cfs.12197 author note: address correspondence to christine bishop, social worker, étoile academy charter school, houston, tx, 77074. email: cbishop@etoileacademy.org _______ arturo carrillo, phd, lcsw, deputy director of health and violence prevention, brighton park neighborhood council, chicago, il. catherine pichardo, cancer research training award postdoctoral fellow, national cancer institute. caitlin o’grady, phd, lcsw, evaluation manager, brighton park neighborhood council, chicago, il. kevin rak, ma, data specialist, chicago, il. cindy berumen, mph, graduate student, university of illinois at chicago, chicago, il. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1141-1161, doi: 10.18060/25270 this work is licensed under a creative commons attribution 4.0 international license. uplifting voices to create new alternatives: a critical assessment of mental health needs and access barriers among mexican community members in chicago arturo carrillo catherine m. pichardo caitlin o’grady kevin rak cindy berumen abstract: the present study used a structural social work theoretical lens to undertake a systematic mental health needs assessment. using a community-based participatory research approach and a two-phase mixed methods design, the researchers assessed mental health needs and barriers to care among 2,556 adults of primarily mexican background from ten economically marginalized communities in chicago’s southwest side. findings indicated that mental health concerns including depression, anxiety, and traumarelated symptoms were prevalent among community members and stemmed from the oppressive national and local level structural contexts in which they lived. furthermore, data demonstrated that research participants overwhelmingly identified structural and programmatic barriers, rather than social barriers such as stigma, as posing the greatest challenges to mental health service access. among the structural and programmatic barriers identified were service cost, lack of insurance coverage, and limited availability of services that were culturally affirming and responsive to context-specific service needs. this study has far-reaching implications for understanding the impact of structural factors on mental health. we recommend that social workers advocate for organizational and policy changes that address these structural barriers. keywords: critical theory; mental health; adults of mexican background; access barriers; structural social work a growing body of literature documents mental health needs and access barriers among the u.s. population of mexican background. critical theoretical frameworks provide a lens for understanding how u.s. social institutions are intentionally designed to perpetuate systems of power, privilege, and oppression that limit access to resources and opportunities among populations who are not members of the dominant cultural group (mullaly, 2007). nativist rhetoric and anti-immigrant state and federal policies negatively impact the emotional well-being of both the immigrant and u.s.-born latinx population (garcini et al., 2016; hatzenbuehler et al., 2017; raymond-flesch et al., 2014; salaset al., 2013; szkupinski quiroga et al., 2014; torres et al., 2018; vargas et al., 2017). not only does anti-immigrant legislation undermine emotional well-being, but it also limits the extent to which latinx immigrants can access insurance coverage, mental health services, and other health-promoting resources (santiago-rivera et al., 2011). in an effort to build upon this body of critical scholarship, the present study sought to explore how structural factors impacted mental health and mental health service access about:blank advances in social work, fall 2022, 22(3) 1142 among latinx adults in the local community context of chicago, illinois. more specifically, we used a structural social work (ssw) theoretical framework (mullaly, 2007) to assess mental health needs and service access barriers among a predominantly mexican-origin adult population on chicago’s southwest side. using a community-based participatory research approach and a mixed methods design, this study sought to understand community members’ most pressing mental health needs and access barriers, as well as how national and local level structural contexts shaped residents’ needs and experiences. structural social work theory structural social work (ssw) theory offers a useful framework for helping researchers and practitioners understand how individuals are shaped through their interactions with social, political, and economic systems (mullaly & dupré, 2019). ssw conceptualizes society as a bridge structure, where the foundation on which the bridge is built is the ideology underpinning society (mullaly, 2007). just as the foundation of the bridge is essential to sustain the structure on which it is built, so too are society’s ideologies. economic, political, and social systems, which can be understood as the pillars of the bridge, reinforce dominant ideologies and transmit these ideologies to members of society. in turn, members of society reciprocally reinforce dominant ideologies through their social relations. when members of marginalized populations are harmed through social relations and through interactions with oppressive social systems, they suffer from what mullaly (2007) defines as structural violence. figure 1. mullaly’s (2007) structural view of society not only does ssw provide a descriptive understanding of how social institutions perpetuate structural violence, but it also offers a prescriptive call for practitioners to challenge oppressive systems that impact well-being (carrillo & o’grady, 2018). ssw theory posits that there is a need to both provide immediate support to individuals who carrillo et al./uplifting voices 1143 have been harmed by structural violence and to transform the systems that harm marginalized populations (mullaly, 2007). thus, the ssw theoretical perspective provides a lens to explore the impact of structural violence on mental health and mental health service access, as well as to identify strategies for addressing service access barriers. mental health needs and access barriers within the local chicago context population-based studies have found that approximately 27% of hispanic/latinos had a serious mental illness (substance abuse and mental health services administration, 2020) related to poverty and the immigration system. immigrant legislation and national and state legislation that labels the immigrant population in reference to categories of legality and illegality is associated with chronic trauma and poor mental health outcomes. the current mental health and social service landscape in chicago provides an important opportunity to explore mental health needs and access barriers among chicago’s latinx population from a critical lens. between fiscal years 2009 and 2012, the state cut $113.7 million in mental health service funding, making it the third highest state in the nation for mental health funding cuts during this period (national alliance on mental illness chicago, 2015). furthermore, in 2012 the city of chicago began to disinvest in publicly funded mental health services, from 12 chicago department of public health (cdph) public mental health clinics to five currently operating clinics (lowe, 2015; spielman, 2017). on the other hand, expenditures on policing drastically outweigh expenditures in health and social welfare. in fiscal year 2017, the city of chicago allocated 38.6% of its general fund budget ($3.7 billion) to the department of police ($1.46 billion). in comparison, only 0.9% of expenditures ($32 million) were allocated to the cdph, the department where public mental health centers are housed (center for popular democracy et al., 2017). the impact of this disinvestment in mental health services is particularly pronounced within chicago’s high economic hardship and underserved communities of color (acostacordova, 2017; henricks et al., 2017). among the high economic hardship communities on chicago’s southwest side that are home to a predominantly mexican population (acosta-cordova, 2017), availability of mental health services is limited compared to more affluent white chicago communities. cdph clinic closures have restricted community members’ options for accessing free mental health services in close proximity to where they live (fecile, 2012). methods in order to systematically assess mental health needs and service access barriers, this study used a community-based participatory research (cbpr) approach and a two-phase mixed methods design. cbpr is an approach to research rather than a method in itself (leung et al., 2004). a central tenet of cbpr is that community members have true decision-making power in all stages of the research, from setting the agenda and planning through implementation and sharing findings. relatedly, the community should see real benefits from the project beyond simple knowledge generation (israel et al., 1998). advances in social work, fall 2022, 22(3) 1144 wallerstein et al. (2018) also argue that changing the standard power dynamic, seeking to “eradicate the distinction between who does the studying and who gets studied (or decides what gets studied)” (p. 4) is central to cbpr. in many ways, this study turns the traditional academic-community dynamic even further on its head. the genesis of this study was a smaller study in one neighborhood that grew out of conversations between two employees of mexican background at community-based organizations in these neighborhoods. community members and staff members of a community-based organization drove all phases of the research. university-based students and researchers followed their lead. phase one consisted of quantitative data collection, while qualitative methods were used to further explore and expand upon quantitative findings during phase two. phase one: quantitative methods a questionnaire was developed to assess community members’ desire for mental health services and access barriers. the initial draft of the questionnaire was designed based on programmatic experience in offering free mental health services to uninsured adult immigrant community members (carrillo, 2014). meetings were held in which community members and staff members of community-based organizations (cbos) provided input and feedback. their input helped ensure the instrument was accessible and culturally appropriate to both english and spanish speakers. the survey was designed to be brief and administered in a public setting independently or with minimal assistance. the questionnaire focused on basic demographics, mental health concerns, attitude towards seeking professional support, and barriers to accessing services (questionnaire is available in appendix a). this article reports on the attitudes and barriers to services. questions were based on straightforward phrasing. for example, the question on stigma as a barrier was asked as, “i would feel judged as ‘crazy’ or ‘weak’ or something else. el qué dirán (loco/a o débil o algo así).” access barriers can be categorized into three groups: structural, programmatic, and social. the barriers related to cost, lack of insurance, services not being in their area, and not knowing where to go reflect larger structural factors. problems with when services are available, services not being in a respondent’s language, lack of childcare while receiving services, and lack of transportation to get to services reflect programmatic barriers that one organization could ameliorate but does not or does not do so on the scale needed. finally, barriers of stigma, believing counseling would not help, and fears of family disapproval reflect social barriers stemming from one’s self and social circle. data collection, sampling, and analysis procedures. survey responses were collected between may 2016 and february 2017 via purposive sampling, defined as a strategy that uses non-probability sampling of cases to ensure representativeness of particular categories in the final sample (robinson, 2014). a total of 2,556 (male = 611; female = 1,945) community members were recruited across nine community areas. this strategy strengthened the contextualization of findings with the use of a homogenous sample (robinson, 2014). “the rationale for employing a purposive strategy is that the researcher assumes, based on their a-priori theoretical understanding of the topic being carrillo et al./uplifting voices 1145 studied, that certain categories of individuals may have a unique, different or important perspective on the phenomenon in question and their presence in the sample should be ensured” (robinson, 2014, p. 32). prospective survey respondents were recruited via direct person-to-person encounters in public spaces, including schools, churches, community events, laundromats, grocery stores, and sports programs. staff members at community-based organizations, primarily community organizers, explained the importance and goals of the project, as well as information about confidentiality, to all prospective survey respondents. the surveys were completed anonymously and took approximately 5 to 15 minutes to complete. respondents were given the option of completing the survey on paper or having the survey collector ask the questions and record their answers. this study focused on ten community areas on the southwest side of chicago: archer heights, back of the yards/new city, brighton park, chicago lawn, gage park, little village/south lawndale, mckinley park, pilsen/lower west side, west elsdon, and west lawn. the population of these areas is 74% hispanic or latino, of which 93% are of mexican background (us census bureau, 2020). this study used a homogeneous purposive sampling strategy to invite respondents who were latinx and living in one of the ten community areas of interest to complete the survey (etikan et al., 2016). a total of 2,987 surveys were collected. records were excluded if respondents were not latinx (the phrasing on the questionnaire), if community area or gender were missing, if they did not respond to any substantive questions, or if the survey was identified as a duplicate entry. the final sample was 2,556. nearly all surveys (90.5%) were completed in spanish. most respondents were born outside the united states (73.0%), with 16.2% born in the us and 10.8% not reporting their nativity status. age was not recorded. post-hoc weighting was applied to better approximate the gender breakdown among the mexican population on the southwest side because females were overrepresented in the sample, 76.1% versus 48.7% in the population (using data from 2010 us census, 2011). frequencies were calculated for the substantive and demographic questions (the language and place of birth data above reflect weighted demographics). analysis was completed in spss statistics 26. phase two: qualitative methods informed by phase i of the study, phase ii used qualitative methods to supplement the quantitative data. semi-structured individual interviews and community forums were employed to amplify community perspectives and gain additional insight (harvey-jordan & long, 2001) into mental health needs, access barriers, and recommendations for facilitating service access. from the narrative data, we allowed themes to develop within these topics. additionally, we used community forums because they promote “active voices from participants” and empower community members to voice their concerns (baroutsis et al., 2016). eight community forums with 190 participants were held in accessible public spaces across six of the ten community areas where quantitative surveys were administered. each forum was held in a community setting easily accessible to the public and lasted no more advances in social work, fall 2022, 22(3) 1146 than an hour and a half. unfortunately, demographic information was not collected for participants at these meetings. while authors cannot verify participants' demographics, the authors can report that the community demographics across the communities were 75% mexican, 13% black non-hispanic, 9% white non-hispanic, 3% asian, and <1% other (chicago metropolitan agency for planning data hub, 2022). these forums were facilitated by the lead author of this manuscript. at each forum, quantitative findings were presented and community members were asked to offer additional context on mental health needs and access barriers. during the final member checks, the quantitative and qualitative methods were presented to community members in order to triangulate findings. triangulation is defined as a comparison of quantitative data and qualitative methods to ensure validity of findings during member checks (denzin & lincoln, 1994; harvey-jordan & long, 2001). participants were also asked to provide recommendations for addressing community members’ mental health needs and decreasing service access barriers. as community forums unfolded, 1-3 members of the research team wrote field notes on the content of the discussion. additionally, live emerging themes from discussions were written on a board for all community members to approve or challenge. purposive sampling was adapted to identify nine community leaders (n = 4 female, 5 male; n = 6 mexican, 3 white) who met the requirements of a minimum 5-year history of involvement in community initiatives with a long-standing relationship with residents in the surveyed community areas and an understanding of community members’ psychosocial needs. these community leaders were invited to participate in semi-structured individual interviews to explore topics including the community and societal contexts impacting mental health, commonly encountered service access barriers, and their vision for promoting positive mental health outcomes among community members. from february to october of 2017, nine interviews (each averaging 15 to 20 minutes) were conducted in english and audio-recorded by the lead author. analytic method. qualitative data were analyzed by three coders, using a grounded theory approach, to conduct a thematic analysis (chapman et al., 2015). such an approach enabled us to build upon our understanding of the mental health needs and barriers to mental health services (glaser & strauss, 1967; strauss & corbin, 1990). audio-recorded interviews were transcribed verbatim using trint, while written field notes were typed by the second author (cp) and study research assistants. all documents were assigned an id number and organized within a primary file, according to the date and setting where the data were collected; files were then stored in an encrypted database. because this project was conducted without any external funding and financial resources were limited, transcripts and typed field notes were manually coded, without the assistance of a qualitative data analysis software program. a systematic inductive and deductive method of grounded theory approach was used to identify concepts and for theory development (corbin & strauss, 2008; foley & timonen, 2015). first, the researchers developed codes from previous literature and the quantitative aspect of the study and additional codes that emerged from qualitative data analysis were included. interview transcripts were independently coded by two coders and carrillo et al./uplifting voices 1147 community forum field notes were independently coded by one coder, who each performed open coding as the first coding step. open coding allowed for initial codes to be identified, organized, and selected based on repetition and constructed meaning. coders then met with the third author to collaboratively perform axial and selective coding, which involved grouping initial codes to build sub-themes, and organizing these to interpret themes (see table 2). in line with the grounded theory approach, such coding steps were foundational in generating theory from the collected data, as data were rigorously compared and reduced (williams & moser, 2019). following all independent coding, the three coders met to review and compare the initial codes, then group similar codes into themes, as well as check for wild-codes and consistency, aligned with grounded theory methods. to validate, verify, and assess the credibility of results, an important component of qualitative work and grounded theory, member checking methods were used (birt et al., 2016). as described by birt et al. (2016), “member checking is a means of enhancing rigor in qualitative research, proposing that credibility is inherent in the accurate descriptions or interpretations of phenomena” (p. 1803). they further note that focus groups can be used in member checks to explore the attitudes, opinions, and beliefs of participants. to ensure that the themes aligned with community members’ observations and lived experiences, community members were invited to participate in a group member check interview. member check participants confirmed and clarified preliminary findings and expanded on themes specifically related to understanding the experiences of latinx subgroups on chicago’s southwest side. results phase one: quantitative results a large majority of respondents (76.6%) said they would consider seeking emotional support by a professional as a way of dealing with their emotional problems. survey respondents identified structural and programmatic barriers as posing the greatest challenge to mental health service access (see table 1). cost was the most frequently cited barrier, noted by 59.9% of respondents. conversely, smaller percentages reported social factors such as stigma (12.7%), believing that services would not help (11.7%), and fear of family disapproval (8.7%). respondents could choose multiple barriers, so percentages add up to greater than 100. advances in social work, fall 2022, 22(3) 1148 table 1. questionnaire results category response n (%) willingness to seek services no 295 (11.6%) probably no 255 (10.0%) probably yes 937 (36.7%) yes 1020 (39.9%) missing 48 (1.9%) total 2556 (100%) barriers to accessing services* cost 1451 (59.9%) lack of insurance 1001 (41.3%) don't know where to go 989 (40.9%) services not near 825 (34.1%) hours not convenient 591 (24.4%) language 589 (24.3%) lack of childcare 495 (20.5%) lack of transportation 489 (20.2%) stigma 307 (12.7%) wouldn't help 283 (11.7%) none selected (not included in total) *multiple responses could be selected, so % do not add up to 100 phase two: qualitative results data from individual interviews and community forums provided insight into community members’ mental health needs, service access barriers, and community-driven solutions for decreasing service access barriers and addressing mental health needs. data indicated that community members’ mental health needs stemmed primarily from the structural context in which they lived. in particular, respondents described the ways national policies reinforce local policies that foster and exacerbate systematic oppression (see table 2). table 2. mental health needs, service access barriers, and community-driven solutions: themes, sub-themes, and initial codes theme sub-theme initial codes 1. mental health & well-being a) mental health b) social environment c) legal violence d) lack of access to basic needs aa) depressive symptoms ab) anxiety ac) acculturative stress ad) trauma ae) anger control af) isolation ag) substance abuse & dependence ba) social support bb) violence within communities bc) disconnectedness within communities ca) documentation status cb) limited employment opportunities cc) deportation & family separation carrillo et al./uplifting voices 1149 theme sub-theme initial codes da) difficulty with family provisions db) food insecurity 2. structural & programmatic service access barriers a) geographic location b) logistics c) stigma d) cost e) funding allocations & cuts f) lack of community outreach g) culturally inappropriate services h) power dynamics aa) safety concerns ab) proximity ac) services not within community ba) childcare bb) transportation bc) inconvenient hours ca) family disapproval cb) stereotypes cc) helpfulness cd) negative perceptions of diagnosis ce) consider seeking services cf) gender dynamics da) underinsured db) uninsured ea) wait list for services eb) funding allocations ec) funding cuts to mental health & physical health clinics fa) lack of knowledge about services ga) language gb) lack of services that account intersecting cultural identities ha) voiceless in policy decisions 3. community-driven solutions a) policies b) community-led intervention c) community outreach d) community partnerships e) infrastructure development aa) increase funds ab) stakeholder inclusion in policy-making decisions ac) youth involvement ba) address community needs bb) address emotional wellness bc) redefine mental health bd) raise awareness of racism be) address men & lgbtq community wellness/ mental health needs bf) reflections of experiential knowledge/ storytelling bg) use of “promotora model” bh) youth involvement bi) mental health & legal rights education bj) services informed by community needs ca) referrals of services informing of resources/services da) collaborations with police department db) collaborations with community-based organizations that address material resource & social needs dc) collaborations with community leaders & members, including those of other racial/ethnic groups dd) collaborations with politicians advances in social work, fall 2022, 22(3) 1150 theme sub-theme initial codes de) identify community priorities ea) cost-free services eb) extend hours of operation ec) transportation & childcare services ed) physical space carrillo et al./uplifting voices 1151 mental health and well-being respondents conceptualized their interactions with the immigration, criminal justice, and healthcare systems to explain the manner in which these affected their mental health. they indicated that the immigration system’s classification of human beings by legal status limited undocumented community members’ opportunities for social mobility and led to poor mental health outcomes. one respondent described that undocumented community members were primarily confined to employment in the low wage sector and burdened with significant financial stressors: ...there are many who have the ability to work hard but not having insurance, not being able to have food affects us and many [migrants] have been lost...and even though i do not do drugs, drink, or smoke i still have problems... respondents further described that the immigration system’s process of legally marginalizing and economically exploiting undocumented community members affected their experiences within the criminal justice system. in particular, respondents identified that all of their interactions with the criminal justice system, including situations involving redress for exploitation that they had experienced, led to fear of familial separation and deportation. additionally, respondents shared that they observe the criminal justice system to be used as a first course of action among youth who are demonstrating behavioral challenges that could be addressed through an alternative avenue. youth involvement with the criminal justice system in turn impacts the entire family system. and we see an immigrant family going through the court system, especially during this time...on its own is a very traumatic experience. and you know, we’ve seen issues in schools that ended up unnecessarily [in] court...use and misuse of the judicial system, right. i mean, talk about how the youth oftentimes [are] criminalized. community stakeholders described that experiences of marginalization within aforementioned social systems led to poor mental health outcomes, including: trauma, depressive symptoms, anxiety, isolation, anger-related problems, substance abuse and dependence, and acculturative stress. respondents additionally described how the impact of oppressive social systems is manifested within the local context of chicago. respondents identified violence within communities resulting from limited opportunities to establish enriching social and interpersonal connections as being a prevalent concern. they explained that when families have a lack of safe spaces for emotional support and are coping with relational conflict, youth may turn to gangs as a way of establishing a connection. as one interviewee explained: the biggest problem is that parents need mental health services, and they don’t even know it. and they are not receiving it. so now you have young people...get[ting] pushed into the streets, and then they get into gangs. and now you have these kids killing each other. another interviewee spoke about the way that violence within communities is manifested in the form of shootings, and spoke about the traumatic impact of witnessing these events: advances in social work, fall 2022, 22(3) 1152 i have to be comfortable to recover and heal sometimes from situations that are extremely uncomfortable and traumatizing. i mean, somebody sent me the picture of that guy with his brains blown out...…that picture got around the community. …when you see something like that it traumatizes, right. additionally, respondents reported that a lack of social connectedness resulted from physical fragmentation within communities that are divided by rival gang activity, as community members are unable to move freely within neighborhoods. the inability to travel without fearing for their safety restricted community members’ access to mental health services in other communities. respondents further described that violent responses from the police perpetuate trauma: …the way we respond to violence is we call the police and the police come in and they use their force and, you know, we hammer things out. structural and programmatic service access barriers in line with the quantitative findings, respondents noted that within communities affected by poverty and community violence, there is limited public investment—thus impeding access to mental health services. as illustrated in the following quote, respondents stated that due to funding limitations, neighborhood public schools are restricted in the range of supportive services and health-promoting opportunities (e.g., mental health clinics, health educators) that they are able to offer students. there were counselors in the schools but those were being cut because of funding for cps. and so there’s only like once a week that it’s available and that addresses the whole school and so it wasn’t really a space the parents felt comfortable...i think, you know, when the city of chicago takes it upon itself to close mental health clinics and in the back of the yards they closed a mental health clinic and, you know, people were upset... and it was not only an issue of access, but it was an issue of, i mean, physical access because it was in the neighborhood. respondents further described that undocumented community members do not have a social security number, limiting their access to social services and public benefits, such as health insurance. participants identified cost as a barrier to mental health, as demonstrated below: ...a lot of the people don’t have the means to be able to go to mental health services sometimes because of the cost and also because they don’t have health insurance...there’s always folks [undocumented community members] that are going to be left out of policy that we also need to consider. respondents also identified a range of access barriers connected to the city’s mental health service landscape, including a lack of available services within close proximity to their homes. in addition to the structural barriers noted above, respondents identified a range of barriers associated with limited organizational infrastructure to address community members’ context-specific needs. organizational barriers included a lack of services carrillo et al./uplifting voices 1153 outside of traditional business hours and limited outreach. moreover, respondents explained that the language and framing around mental health and treatment can serve as a deterrent for community members seeking services, as there is a focus on reducing symptoms rather than promoting holistic wellness. further, challenges related to service access included lack of culturally appropriate mental health services that take into account intersecting cultural identities. lastly, respondents confirmed that in accordance with the survey data, they viewed social and interpersonal barriers as being less of an impediment to service access than the structural and programmatic barriers. while respondents did acknowledge that community members may be hesitant to access services due to concerns about being labeled as “crazy,” they also noted that this hesitancy stems from the way in which organizations frame mental health treatment in relation to diagnoses and symptomatology. in comparison to barriers related to cost, geographic proximity, and organizational infrastructure, respondents attributed less weight to interpersonal factors in influencing community members’ decisions to seek professional support. community-driven solutions when offering recommendations for addressing the mental health service access barriers identified above, respondents identified the need to reframe mental health in relation to holistic wellness rather than focusing on symptomatology: ... [mental health] means an appreciation of who you are as a person...that you appreciate who you are, that you [are] a treasure to society and to the community.... so, i think mental health encompasses relationships that are understanding and free flowing and supportive and trusting...i think mental health is around connecting the story and bringing meaning. moreover, respondents recommended that practitioners partner with community members to identify community-informed interventions that promote healing from trauma and address a range of psychosocial needs. as suggested by a respondent: ...people are experts in their own lives. experts within their own community. and so how can we uplift those voices of a lot of the community members to really lead us into what is possible…when conversation and dialogue begins to happen, people start really demanding more change and then coming up with solutions....so that we can really create new alternatives. respondents suggested addressing programmatic barriers in order to ensure that services are accessible and aligned with community needs. for example, they suggested that community-based organizations develop the infrastructure to extend hours of operation beyond traditional business hours, offer assistance with transportation and childcare, and tailor services to be culturally and linguistically appropriate. to address structural barriers, respondents highlighted the importance of offering services that are free of charge and advocating for the city to increase its investment in free, long-term, community-based mental health services. advances in social work, fall 2022, 22(3) 1154 discussion a synthesis of quantitative and qualitative data indicates that among community members of mexican background on chicago’s southwest side, mental health needs stem from the structural context in which community members live. in describing the structural context that impacts well-being, respondents emphasized the interplay between oppressive interactions with the immigration, healthcare, and criminal justice systems and experiences of oppression and marginalization in local community contexts. respondents additionally described how national and local level structural contexts pose barriers to accessing the services necessary to promote well-being. structural barriers, primarily cost of services, lack of insurance coverage, and lack of services in close geographic proximity, were identified as playing a larger role in impeding service access than were social barriers such as stigma. community members also identified programmatic barriers related to limited infrastructure to provide culturally and linguistically appropriate services as impeding service accessibility. respondents emphasized that providing culturally appropriate services does not simply entail that providers can communicate with community members in their native language and articulate an understanding of their cultural values. instead, culturally appropriate service delivery requires a commitment to understanding community members’ experiences in the context of their environment. community-identified solutions for facilitating mental health service access further indicated that organizational efforts to decrease structural and programmatic barriers, as well as efforts to advocate for funding for free, long-term, trauma-focused mental health services, are key to promoting structural transformation. implications for mental health practice although this study was conducted in the local context of chicago, it still has important implications for more broadly understanding barriers to mental health service access. our data demonstrate that we must look beyond social barriers such as stigma to truly understand deterrents to mental health service access. in addition, this study contributes to the literature by conceptualizing access barriers from a critical perspective and recognizing the need to challenge oppressive social systems that impede service access among the mexican population. mental health practitioners and program administrators can play an invaluable role in promoting structural transformation by driving change within their organizations. it is essential that organizations develop the infrastructure to deliver culturally appropriate services that recognize the impact of structural context on well-being and address structural and programmatic access barriers. considering that service cost, inconvenient hours of operation, and difficulties with childcare and transportation were identified as posing barriers to care, organizations can develop the infrastructure to deliver culturally appropriate services by providing free, long-term services regardless of insurance and immigration status; offering services outside of traditional business hours; offering free, on-site childcare; providing transportation assistance; and increasing access to telehealth services (including access to internet connection), when clinically appropriate. carrillo et al./uplifting voices 1155 furthermore, recognizing the interplay between national and local level structural contexts in this study, organizations can benefit from working in partnership with mexican communities to assess local context-specific needs and tailor their programs accordingly. implications for mental health policy this study identifies the need for policies that can facilitate mental health service access in mexican communities impacted by high economic hardship. assessing mental health needs and access barriers through a critical lens exposes the structural challenges to accessing care that are often overlooked when the emphasis is on stigma and other social barriers. our research recommends the expansion of policies that can establish access to care that is not impeded by cost or lack of health insurance and instead can promote emotional wellness through a community-centered, holistic approach. various examples of public policy campaigns have demonstrated the public support for tax-funded strategies to financially sustain and develop mental health centers to benefit communities of high need. among these examples are ballot initiatives such as california’s proposition 47, passed in 2014, which lowers sentencing of non-violent crimes, allows for resentencing, and uses savings to fund mental health among other priorities (alliance for safety and justice, 2016). additionally, the passage of the community expanded mental health services act of 2011 in illinois allowed community members to establish a binding referendum, giving them the ability to raise property taxes in order to fund community mental health centers to serve those within the designated service area. since its passage, three mental health centers have been created through this legislation in chicago (coalition to save our mental health centers, n.d.). finally, the findings from this study have led to the passage of a resolution in the city council of chicago calling for the creation of a public mental health clinic service expansion task force. the purpose of this task force is to reexamine the re-opening of public mental health clinics in chicago and identify budgetary and operational recommendations for expanding and improving services at existing facilities. such campaigns to expand safety net services are critical to facilitating service access among mexican community members who encounter structural barriers to care such as cost and lack of insurance coverage. finally, social workers are ethically obligated to engage in social and political action “to advocate for living conditions conducive to the fulfillment of basic human needs” under section 6 of the social work code of ethics (national association of social workers code of ethics, 2021). specifically, section 6.04 calls for social workers to …engage in social and political action that seeks to ensure that all people have equal access to the resources… social workers should be aware of the impact of the political arena on practice and should advocate for changes in policy and legislation to improve social conditions to meet basic human needs and promote social justice. (para. 1) several social workers, including some authors of this article, were involved in various capacities throughout the long arc of this research initiative and subsequent policy advances in social work, fall 2022, 22(3) 1156 campaign to increase public investment in mental health services as a basic human right through the collaborative for community wellness. efforts through this coalition have resulted in significant gains and pushed for equity in funding and investment in the rebuilding of the decimated public system through neoliberal policies of current and past mayoral administrations. the campaign #treatmentnottrauma has also forced the current administration to implement a non-police crisis response pilot in chicago, when only a coresponder model (where social workers and police officers work together) was proposed by mayor lightfoot (collaborative for community wellness, n.d.). implications for future research findings from this study highlight the importance of conducting research on mental health needs and access barriers among mexican communities from a critical perspective. as our data demonstrated, national and local level structural contexts have a profound impact on the well-being of mexican communities and influence the extent to which individuals can access the services necessary to heal from structural violence. to truly identify healing interventions, researchers must conceptualize the challenges that mexican community members experience in relation to the larger structural context in which they are situated. this study also demonstrates the power of community-driven research initiatives in promoting structural transformation. through our cbpr approach, researchers and community members collaboratively identified solutions for facilitating mental health service access, and have additionally initiated a public campaign to engage in city-wide reform. future research efforts can benefit from implementing similar community-driven, action-oriented approaches that leverage community members’ expertise to identify innovative solutions for transforming oppressive national and local contexts. limitations the study has several key limitations that should be considered. first, even though our sample may have been heterogeneous, we did not examine differences by latinx background. prior work shows that social groups' experiences with racial marginalization (molina et al., 2013) and mental health varies by latinx background (cook et al., 2009; lorenzo-blanco & cortina, 2013). however, given the community makeup of the latinx population being 93% mexican, the authors believe it is appropriate to describe the sample as predominantly mexican. secondly, the instrument used to examine barriers and access to services and mental health has not been psychometrically tested and validated. however, the study authors developed the survey collaboratively with community organization staff and neighborhood residents. finally, the use of purposive sampling limits generalizability of results to other latinx subgroups in the us. conclusion recognizing the shortcomings in the literature to date in analyzing mental health needs and access barriers among the u.s. population of mexican background from a critical perspective, this study used ssw to explore mental health needs and access barriers among predominantly mexican adult community members on chicago’s southwest side. findings carrillo et al./uplifting voices 1157 indicated that community members’ mental health concerns stemmed from the oppressive national and local level structural contexts in which they lived. furthermore, data demonstrated that research participants overwhelmingly identified structural and programmatic barriers, rather than social barriers such as stigma, as posing the greatest challenges to mental health service access. this study has far-reaching implications for understanding the impact of structural violence on mental health and recognizing that efforts to facilitate service access among the population of mexican background must be focused on the systemic rather than individual level. to truly promote structural transformation, mental health practitioners, program administrators, policy makers, and researchers must collectively advocate for increased investment in free, long-term mental health services that are aligned with the cultural values and context-specific service needs of mexican communities. references acosta-cordova, j. a. 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(2019). the art of coding and thematic exploration in qualitative research. international management review, 15(1), 45-55. http://www.imrjournal.org/uploads/1/4/2/8/14286482/imr-v15n1art4.pdf author note: address correspondence to arturo carrillo, brighton park neighborhood council, chicago, il, 60632. email: acarrillo@bpncchicago.org acknowledgement: catherine pichardo collaborated on this work during her time at the university of illinois at chicago. the participation of this individual or the materials should not be interpreted as representing the official viewpoint of the u.s. department of health and human services, the national institutes of health, or the national cancer institute, except where noted. https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases https://doi.org/10.1177/0002764214537270 https://doi.org/10.1037/amp0000184 https://www2.census.gov/census_2010/04-summary_file_1/ https://data.census.gov/table?q=hispanic+or+latino+by+specific+origin&tid=acsdt5y2019.b03001 https://data.census.gov/table?q=hispanic+or+latino+by+specific+origin&tid=acsdt5y2019.b03001 https://doi.org/10.1215/03616878-3802940 http://www.imrjournal.org/uploads/1/4/2/8/14286482/imr-v15n1art4.pdf mailto:acarrillo@bpncchicago.org carrillo et al./uplifting voices 1161 appendix a _________ joan m. blakey, phd, lmsw, gamble skogmo endowed chair, department of social work, university of minnesotatwin cities, saint paul, mn. emmanuel ngui, drph, msc, bs, associate professor and master of public health director, zilber school of public health, university of wisconsin-milwaukee, milwaukee, wi. labibah m. buraik, msw, doctoral student, and houa vang, msw, doctoral student, school of social work, university of minnesota-twin cities, saint paul, mn. gary williams, phd, professor emeritus, school of education, university of wisconsin-milwaukee, milwaukee, wi. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 512-534, doi: 10.18060/27551 this work is licensed under a creative commons attribution 4.0 international license. “why are you here?”: black students’ perceptions of the achievement and discipline gap in a predominantly white urban-suburban high school joan m. blakey emmanuel ngui labibah m. buraik houa vang gary williams abstract: though significant gains have been made in academic achievement in the last 45 years, these gains have not been realized for all students in the united states. consistently, research has shown significant differences in reading and math scores along with disparate disciplinary sanctions between black and white students. using grounded theory methodology, this study aimed to understand factors that, through students’ voices, they believed contributed to their lower academic achievement and disproportionately higher disciplinary sanctions while attending a predominantly white school. data analysis revealed that a sense of belonging affected black students academically and contributed to disciplinary sanctions resulting from disgruntled reactions toward teachers, administrators, and staff who they believed did not want them in the crest academy high school (i.e., grades 9–12). a lack of belonging had four primary components: an unwelcoming environment, lack of mattering, racial insensitivity, and not seeing themselves reflected. this study illuminated the importance of belonging among black students. culturally responsive educational practices have the potential to create a welcoming environment, generate feelings of mattering, saturate school culture with racial sensitivity, allow each student to see themselves reflected, and ultimately provide children with opportunities to feel a sense of belongingness in their schools and communities. keywords: belonging; black students; academic achievement though significant gains have been made in academic achievement in the last 45 years, these gains have not been realized for all students in the united states (bohrnstedt et al., 2015). consistently, research has shown significant academic-related differences and disparate disciplinary sanctions between black and white students (bohrnstedt et al., 2015). according to the children’s defense fund’s (cdf, 2023) state of america’s children annual report-education, black children often enter school behind their wealthier, white counterparts. black children tend to have lower test scores, are given lower grades, and have higher failure and dropout rates than all other student groups (johnson, 2018). more than 79% of black children, compared to less than 60% of white children, were not proficient in reading or math in 2019 (cdf, 2021). black children are less likely to be recommended or enrolled in honors or advanced placement classes (darling-hammond, about:blank blakey/black students’ perceptions of achievement 513 2010; johnson, 2018). in the 2017-2018 school year, 19% of black students did not graduate on time, compared with 11% of white students (cdf, 2021). black students are less likely to apply and be accepted to competitive 4-year colleges (darling-hammond, 2010; johnson, 2018). finally, suspension rates for black students are 2-4 times that for white students (chu & ready, 2018; gregory et al., 2010; huang, 2018). although education is supposed to be the great equalizer (hung et al., 2020), johnson (2018) noted, “our national data on the academic achievement of african american students is telling us that african american students are being eaten alive…in our nation’s schools” (johnson, 2018, p. 35). this study explored the factors that black students attending an urban-suburban high school identified as affecting their academic experience, contributing to lower academic achievement, and leading to disproportionately higher disciplinary sanctions. the literature review will examine previous research that identifies micro, mezzo, and macro factors that influence academic achievement. finally, we highlight four factors (i.e., unwelcoming environment, lack of mattering, racial insensitivity, and not seeing yourself reflected) that created a lack of belonging among black high school students. literature review there are myriad explanations for the significant differences in achievement and discipline between black and white students (gregory et al., 2010; sulé et al., 2018). many studies have identified factors at the micro (i.e., individual), mezzo (i.e., family and school), and macro (i.e., community) levels that contribute to the differential rate of achievement and disciplinary sanctions between black and white students. micro level factors: student related studies have identified student-related factors, including student behaviors relating to their academic performance, student effort, parent-child discussions, interpersonal relationships, and extracurricular activities (assari et al., 2021; rowley & wright, 2011). high frustration and low self-confidence in students also contribute to lower academic achievement (martin et al., 2007; miles & stipek, 2006). rowley and wright (2011) suggested lower self-confidence and self-esteem with respect to their studies may stem from black students spending less time on homework than white students. tus (2020) reports that “self-concept, self-esteem, and self-efficacy are significant determinants of the students' academic performance” (p. 56). additionally, black men and special education students have higher rates of suspension than any other group of students (chu & ready, 2018; owens & mclanahan, 2020; skiba et al., 1997). chu and ready (2018) found that black students comprised more than half of the suspensions despite being less than one-third of the sample. skiba et al. (2011) shared that black students are more likely to be expelled or receive out-of-school suspensions for the same infractions as white students. owen and mclanahan (2020) found that “black children are four times more likely than white children to report having ever been suspended or expelled by age 9 (28% of black children as compared to 7% of white advances in social work, fall 2024, 24(3) 514 children)” (p. 1563). according to chu and ready (2018), “suspended students had weaker attendance, course completion rates, and standardized test scores; were more likely to drop out; and were less likely to graduate within 4, 5, or 6 years” (p. 479). mezzo level factors: family, peer, and school related in terms of family-related factors, studies have reported that students who come from families with low socioeconomic status are more likely to struggle academically because these households tend to have fewer resources; often, parents may be unable to be as involved in helping with homework and other school-related activities as other parents due to demanding work schedules in low-wage jobs (assari et al., 2021; bohrnstedt et al., 2015; gregory et al., 2010; rowley & wright, 2011). students from families of low socioeconomic status are also more likely to attend schools with lower-quality resources and facilities and higher teacher turnover rates with a lower quality teacher. however, black students are at a higher risk of suspension in more richly resourced suburban schools than white students (gregory et al., 2010). finally, assari et al. (2021) found parents’ educational attainment was related to academic achievement, with higher educational attainment correlated with higher math and reading scores. as for peer-related factors, students’ peer groups often played a role in dropout rates and lower academic achievement. for example, students with friends who dropped out of high school were at a higher risk of dropping out, while those who were achieving academically may have felt the need to hide their academic achievements to fit in with peers (rowley & wright, 2011). victimization by peers was also related to lower academic achievement (wang et al., 2014). additionally, ngui et al. (2024) found that racial microaggressions, such as using the “n” word, were harmful and stress-inducing experiences that impacted black students’ mental well-being, academic achievement, and engagement. in terms of school-level factors, several factors contribute to the achievement gap, including lack of access to resources like technology-assisted instruction, less-qualified teachers, lack of feelings of safety at school, and the lack of rigor in school curriculum (barton, 2003). staff members’ implicit biases, perceptions, and low expectations of students also contribute to the differences in achievement rates (card & giuliano, 2016). studies have found that school and district racial climates, particularly in recently desegregated schools, contribute to the achievement gap (rowley & wright, 2011; wang et al., 2014). black students’ willingness to question classroom practices or challenge teachers’ authority has led to disproportionate discipline up to and including suspension (owens & mclanahan, 2020; skiba et al., 2012). moreover, relationships with black students were an important factor that contributed to academic achievement. baker et al. (2008) found that failing to establish positive relationships with black students affected their ability to engage fully in the educational process. blakey/black students’ perceptions of achievement 515 macro level factors: community and systems related students living in impoverished neighborhoods are more likely to attend schools with fewer resources (reardon et al., 2019). because schools are still primarily funded by property taxes (smith & campbell, 2022; wen et al., 2020), schools in resource-poor communities often have lower achievement and wider opportunity gaps than higherresourced communities. moreover, many schools in poor communities also have higher exposure to violence, which may necessitate that students prove they are tough. some researchers have indicated students needing to prove they are tough may partly explain the disproportionate disciplinary outcomes (gregory et al., 2010; rowley & wright, 2011). structural racism also plays a role in the achievement gap. merolla and jackson (2019) found structural racism is the fundamental cause of the achievement gap. systems have historically and continually privileged white students and disadvantaged black students. other systems intersecting with the educational system have impacted achievement rates. for example, according to barton (2003), health-related factors such as higher rates of low birth weight, higher rates of lead poisoning, and poor health and nutrition among black students are contributing factors to the differential achievement of students. according to ladson-billings (2006), addressing structural inequalities stemming from discrimination and racism is critical to addressing the achievement gap. gaps in literature a great deal of studies have identified student, peer, family, community, and structural factors that contribute to the achievement gap. understanding what black students believe affects their ability to excel in school is necessary. a dearth of empirical studies has privileged black students’ perceptions of school-based factors that influence their academic achievement. hearing from black students about their experiences interacting with school personnel, navigating the curriculum, engaging in extracurricular activities, and attending schools in predominantly white communities is critical to addressing the problem. the research question guiding this study was: what factors influence academic achievement among black students attending an urban-suburban, predominantly white high school? methods this study used grounded theory, which is used to develop a broad conceptual theory to explain a phenomenon, process, action, or interaction (oktay, 2012). grounded theory is used to construct a theory emerging from data to highlight participants’ experiences and generate, inform, extend, expand, and refine knowledge in various fields (charmaz, 2014; gilgun, 1994; orlikowski, 1993). grounded theory methodology is ideal with theory-topractice gaps, particularly related to processes or actions (oktay, 2012; orlikowski, 1993). filling a major theory-to-practice gap, this study identified theoretical concepts that operationalize a sense of belonging. given the overall goal of this study, a grounded theory approach was appropriate because it gives voice to the voiceless by privileging the advances in social work, fall 2024, 24(3) 516 participants’ experiences, placing value on their experiences, and including them in the process to ensure the theory accurately captures their experience (oktay, 2012). sample the crest community (pseudonym) is the first suburb north of a large midwestern city. crest is self-described as an urban-suburban village with a european flair. the community is known for its liberal arts education. the school district in the crest community serves around 2,000 students annually spread across its four schools: two primary schools (grades k-6), one junior high school (grades 7 and 8 primary), and one high school (i.e., grades 9-12). the school district is ranked among the top public schools in the state, with almost 90% of its students going to colleges and universities across the country after graduation. this study used a criterion sample, a type of purposive sample. to participate in this study, students had to be black, attend crest academy high school (i.e., grades 9-12), have parental consent (if under 18 years old), and voluntarily agree to participate in the study. table 1 contains the study participants’ demographics. the entire sample reported being black, but 23% reported being multiracial, and 8% reported hispanic ethnicity. of the 38 students, 60.5% were female students, and 39.5% were male students. the mean age of the sample was 16 years old, with students ranging from 15-18 years old. over half (52.6%) lived with both parents, 44.7% lived with their mothers, and less than 3% lived with their fathers only or in foster care. study participant demographics table 1. student demographic characteristics (n=38) demographic characteristics n (%) gender female 23 (60.5%) male 15 (39.5%) age in years (mean = 16.2) 15 10 (26.3%) 16 13 (34.2%) 17 12 (31.6%) 18 3 (7.9%) race/ethnicity black 26 (68.4%) black & hispanic ethnicity 4 (10.5%) multi-racial 8 (21.1%) school attended crest academy high school (grades 9-12) 38 (100%) family structure: lived with… both parents 20 (52.6%) mother 17 (44.7%) father only or foster care 1 (2.6%) blakey/black students’ perceptions of achievement 517 recruitment students were recruited for the study using a flyer mailed to the homes of all black students who attended crest academy high school. school staff collected consent forms after they were completed. focus group sessions were scheduled once five or more students submitted consent forms. the sessions were held in an available room or classroom, and the only black counselor working at the high school identified them. all focus groups were held over the lunch period, as this period was identified by the superintendent as the least disruptive time. the research team gave a brief overview of the study and answered any questions before each focus group started. all focus group interviews were conducted in person, audiotaped using a digital recorder, and professionally transcribed. the sessions lasted 45-60 minutes. students received a $20 walmart gift card, and we ordered pizza for their participation. all study protocols were approved by the university of wisconsinmilwaukee’s institutional review board (irb), which oversees research with human subjects. study protocols consisted of a complete explanation of the study, consent forms, recruitment materials, and interview guides. data collection methods focus groups were used for three primary reasons. focus groups are an efficient way of collecting a lot of information on perceptions, opinions, beliefs, and attitudes in a short time (leung & savithiri, 2009). the research team could only meet with students during their lunch periods because many students had practice or school-related commitments before and after school. some issues are better suited for group dialogue as they tend to create rich information and insights, which may be triggered by something someone else says (leung & savithiri, 2009). finally, researchers can pick up on nuances, competing perspectives, and conflicting tensions, which may be more difficult to obtain in individual interviews. there were eight focus groups conducted. three focus groups were with grades 7-8 primary school students, and five were with high school students. the findings of this manuscript focus on the high school student participants. in the focus groups, students were asked to reflect on their experiences at crest academy high school and how these experiences impacted their educational experiences. an approved (irb) list of a priori interview questions was used; however, each focus group differed slightly because participants highlighted the issues and concerns they deemed relevant based on the subject matter. data analysis data analysis of the focus group interviews included the following steps. the first step involved taking memos or notes about early impressions and possible topics participants raised in subsequent interviews were noted. keeping memos is a technique that documents early analytic reflections, examines data from multiple vantage points, links the data conceptually, and identifies potential new insights to incorporate into subsequent interviews (qureshi & unlu, 2020). second, researchers reviewed transcripts to begin to advances in social work, fall 2024, 24(3) 518 generate codes. according to charmaz (2014), “coding is the pivotal link between collecting data and developing an emergent theory to explain the data” (p. 113). next, similar codes were combined to develop categories using the constant comparison method (birks & mills, 2015). linkages made between categories included looking for relationships between the data and following hunches against the data. finally, theoretical coding—a continuous process of refining hypotheses until a theory reflective of the data is developed—was used to establish connections between categories of codes (charmaz, 2014). all research team members identified as persons of color and had either gone through the u.s. educational system or had offspring who had gone through the u.s. educational system. this situatedness provided a sense of safety for the youth in the focus groups, allowing them to see themselves reflected in the research team. although the students were not previously known to the research team, the identification of the research team members as people of color provided a sense of understanding and perspective that may not have been otherwise available to nonpersons of color in research settings with students of color. rigor and trustworthiness two strategies—triangulation and member checking—were used to increase the rigor and trustworthiness of the study (lincoln & guba, 1985; padgett, 2008). triangulation, which uses two or more ways to obtain a complete picture of the topic of interest, provides a more robust substantiation of constructs and hypotheses (padgett, 2008). in this study, triangulation consisted of multiple researchers from different disciplines (i.e., social work, public health, and education) gathering data, conducting interviews, and analyzing data (denzin, 1978). triangulation challenges researchers to analyze data from various perspectives and look for plausible reasons for discrepancies (padgett, 2008). the second strategy to increase rigor included member checking. we presented the overall findings to a subset of students who participated in the study (lincoln & guba, 1985). the subset of students reported that the data presented accurately reflected their experience and encouraged us to share the findings with the school board and parents. the research team members’ identities as persons of color provided insider perspectives, which may have increased bias in data analysis and rigor; however, member checking decreased the risk of bias in data analysis and ensured the perspectives and words of the youth were centered in the research. findings the purpose of this study was to explore the factors black students attending an urbansuburban high school identified as contributing to lower academic achievement and disproportionately higher disciplinary sanctions. data analysis revealed four prevailing experiences black students attributed to having lower academic achievement and higher disciplinary sanctions: unwelcoming environment, lack of mattering, racial insensitivity, and not seeing themselves reflected. blakey/black students’ perceptions of achievement 519 table 2 illustrates key themes related to black students' experiences within crestview high school, highlighting feelings of exclusion, lack of significance, and cultural dissonance. each theme is paired with representative examples that capture the types of statements or attitudes encountered by black students, illustrating the unwelcoming environment, racial insensitivity, and challenges of motivation when students do not see themselves reflected. this table underscores the impact of these themes on black students' sense of belonging and identity within the school environment. table 2. themes and examples theme example unwelcoming environment “why are you here?” lack of mattering “go! get out. go to the office!” racial insensitivity “you should reconsider how you feel about the confederate flag” not seeing themselves reflected “it takes a lot to be motivated when you don't see yourself” unwelcoming environment — “why are you here?” an unwelcoming environment was described by black students as not feeling like they belonged, even though many of them have grown up in the crest community all or most of their lives. amara confirmed this sentiment by saying, i feel like a guest in this school versus it being my school. i even feel like that, and i have lived in crest most of my life…i'm still looked at differently regardless because they don't know where we're coming from. they assume that we come from somewhere else, that's not here. amara’s quote highlighted the fact that no matter what black students did, they always felt like outsiders. amara had grown up in this community, which meant that this school was just as much her school as any other student. yet, many black students did not feel that way. crest academy high school is patterned after a college environment. it is an open campus where students can come and go based on their class schedules. students who live in the community can go home or visit local establishments for lunch or during their free periods. however, many black students noted that leaving school was not an option, particularly if they did not live in the crest community because the community was not a welcoming environment. according to kellan, a male: when you have open periods, sometimes, you know, you think twice about whether or not you wanna go out, because, you know, you don’t wanna deal with being stopped [by the police], stares or made to feel of “why are you here?” students described encountering the police frequently or experiencing racism in nearby stores. abena, a biracial high school student, indicated her experiences of harassment were dependent on whether she was with her black or white friends. she stated: because i’m mixed. i just blend in with my white friends. but, if i’m walking with jabari, kellan, and kwame, we get stopped by the police...and they ask us what advances in social work, fall 2024, 24(3) 520 we are doing and where we are going. it’s like crest police really don’t have anything better to do than harass black students. many black students described experiences of being racially profiled by community members as well. haji, a male high school student, confirmed feeling unwelcomed by crest residents. in reference to the crest community, he stated: “there have been instances where friends of mine and i are walking down the street, and a lady calls the cops on us because we looked suspicious.” the students also discussed incidents in school that made them feel unwelcome. amina, a female high school student, shared: “my hand can be raised, and i can be the only person raising my hand, and the teacher will be like, ‘anyone else?’ she’ll go to another problem.” unwelcoming behavior also involved teachers not getting to know their black students personally. black students felt the onus for a relationship was on them. abdullah, a male high school student, remarked, “i think they should stop this one-sided approach...i notice that—like a lot of teachers won’t try to get personal with their black students.” students identified a variety of things that made them feel unwelcome in the school and surrounding community, such as the inability to move freely in the community without being stopped and harassed by the police, having the police called because of their mere presence, and being asked to leave stores. the teachers also contributed to creating an unwelcoming environment by (a) not calling on the black students despite their hands being raised and (b) not trying to develop a relationship with them in the same ways they did with white students. the behaviors exhibited by school personnel contributed largely to the students feeling unwelcome in this school, which impacted their school experiences. lack of mattering — “go! get out. go to the office!” mattering is the extent to which individuals believe their experiences, beliefs, and perspectives are important and listened to by authority figures (rosenberg & mccullough, 1981). black students described several instances when administrators and teachers treated them disrespectfully, did not listen to them, and disregarded their feelings or what they had to say. jamilia explained how black students believe teachers looked for any excuse to send black students to the office. they noted that teachers often refused to listen or allow them to explain themselves. if they tried to ask questions or defend themselves, they were seen as being disrespectful and sent to the office. once in the office, administrators also tended not to let them explain themselves. jamila stated: the teacher just assumes, “you were doing something bad! they say, go! get out. go to the office. i don’t care.” and then when you get to the office, you don’t get to explain why you’re out of class…i have never seen them treat white students that way. they get to explain themselves. they even talk crazy to them, and nothing happens to them. teachers and administrators had no tolerance for what they perceived as disrespect by black students, even though they tended to view the same behaviors by white students differently and often overlooked their behavior. blakey/black students’ perceptions of achievement 521 according to the participants, teachers and administrators would only listen to the black students if their parents came to school and demanded administrators listen to their children. rashid said, “i was about to get suspended, but i didn’t get to tell my side of the story. my dad came in, he said, ‘you’re gonna listen to my son, and you’re gonna listen to what he has to say.’ i didn’t get suspended. but why does my dad have to come up here to get respect?” since this incident happened, rashid indicated he ensures he gets respect. other ways black students felt they did not matter were related to the lack of support they received from the school. diallo, taraji, femi, and zuri discussed how the school supports white activities and programs but often fails to provide the same level of support to black activities and programs. they said: we had a black history month program that was terrible. it just didn’t go well. all of a sudden, the lights stopped working as soon as we got on stage. i was performing, and then my microphone didn’t work…the school did not let us rehearse during school hours. they provided no tech support. students were allowed to be on their phones and not paying attention. but white organized activities are not like that. they are so professional, they get time to rehearse during school, and everybody must pay attention…it feels like the stuff that is important to us does not matter. black history month events were not the only time black students felt unsupported or like things that affected them did not matter. for example, during the height of police shootings of black people in 2020, the school did not acknowledge nor ask the school community to pause for a moment of silence once. zane, lulu, asha, and haji recalled how the school reacted to the mass school shooting in florida. zane shared: you know how we did the walkout for the school shootings. i feel like we should do walkouts when a black guy or person gets shot by the police. i feel like we should be able to, like, protest that stuff too…i feel like that was unfair. how come we can acknowledge one and not the other? black students did not feel that the school acknowledged public events that affected them or downplayed these incidents, but they felt events for white students were acknowledged and celebrated. there were many instances that made the black students feel like they did not matter. black students described instances when their events were not supported in the same way as the white-initiated events. racial insensitivity — “you should reconsider how you feel about the confederate flag” according to laszloffy and hardy (2000), racial sensitivity is a step beyond awareness in that it requires individuals to try and imagine what it is like to be someone else and understand how race and racism shape reality for black, indigenous, and people of color (bipoc) communities. many black students described instances where teachers and advances in social work, fall 2024, 24(3) 522 administrators lacked racial sensitivity. some black students identified experiences of explicit bias when teachers and staff were blatantly racist or discriminatory. zoya described what happened when a teacher taught a unit on slavery and said: we had a discussion about the confederate flag of which i’m very much against. she said, i think you should reconsider your position. she gave me three articles— laminated articles—of why the confederate flag is important and why it’s a symbol of heritage and all that. i should have spoken up, but i don’t like being controversial with my teachers. the blatant racism did not just come from teachers but also from staff. jabari, a male high school student, remarked how a staff member called the police on him as he waited for his mother to pick him up. he stated: after a game, i was waiting on my mom. i was one of the last people to get picked up. it was cold outside…the janitor was like, “can you please leave?” i told him, “my coach said it’s okay for me to stay.” he actually called the police on me for waiting on my mom in the hallway…as my mom and i were pulling off, three cop cars actually showed up. black students also described more subtle or indirect experiences of racism. lehana, a biracial student, said: “i am very smart. teachers make assumptions that i must have cheated when they see my black dad. but when they see my mom, they assume i got my brilliance from my mom because she is white.” hadiza also described a similar experience. she shared: well, i get told by a lot of teachers that tell me i talk very educated. that’s basically telling me, “i expected you not to talk that way. i expected you to talk like a black person.” like, that’s basically what they’re saying when they’re like, “oh, well, you talk very educated!” so, i feel their expectations are not for me to sound very smart or whatever. many black students felt teachers made assumptions about their intelligence based on their race. kofi, a male high school student, described an experience with a teacher who insisted on “helping” his friend kendi despite a lack of indication or need for help. kofi stated: she struck me as a little racist because she asked kendi if she could help him with his homework. she’s like, “let me see what you’re doing, just in case you need help.” he got out his english book and he was gonna fill out his vocabulary words or whatever. he put his book away…she said, “come out in the hallway with me.” … all you could hear is him saying, “i didn’t ask for your help.” she sent him to the office. she does that a lot. the black students expressed that these racist incidents made them feel disrespected, frustrated, and angry, often resulting in being sent to the office and suspended. they described the toll constantly having to deal with differential treatment, racism, and implicit and explicit bias had on them. binta expressed that the racism and microaggressions she blakey/black students’ perceptions of achievement 523 felt limited her ability to excel in school. additionally, binta did not feel there was any place she could go in school to feel safe. she said: i feel like abena, and i experience it every day, and it makes me not wanna come back to class. but it’s like—i don’t have anywhere else to go...there really is no safe place in the school.” this lack of safety contributed to the anger black students felt toward the injustices they endured consistently, which often contributed to increased suspensions among black students. not seeing themselves reflected — “it takes a lot to be motivated when you don't see yourself” seeing oneself reflected involves seeing some representation of who they are and the culture from which they come in their environment. seeing oneself reflected in their environment can include a variety of ways that influence individuals’ experiences, such as pictures on the walls and artwork by people of color, ensuring the presence of administrators, teachers, and staff of color, reflective curriculum, library books, and school practices. many black students strongly desired to have at least one black teacher or teacher of color. azibo stated: i’ve never had a black teacher. i think that’s like so messed up, because like we can do a lot more than people think we can……i don’t think a lot of black students have motivation, and it takes a lot to be motivated when you don’t see yourself in the environment. all you see is just like white people. according to participants, the curriculum was also woefully inadequate and did not reflect the rich history of black people or other people of color. black people often were either excluded, superficially covered, or shown in a negative, racist light. abena remarked, “our textbooks do not include anything about black history in general. it’s the same story over and over in textbooks. like george washington carver, that’s it...we should be learning about more than american (white) history.” kwame talked about how a mural created by black students was destroyed. the school chose to take the mural down and thought it was best not to replace it. additionally, the students identified several examples where teachers and staff were oblivious to issues of race. for example, all the black students were cast as animals in a school play. high school students kalifa, taj, and kasim stated: there have just been like many issues with race…i asked him [the director] if we could change a part in the play about feeding monkeys. most of the black people were monkeys, and the white people were like throwing food. so, i brought it to his attention. he’s like, “yeah, okay, we’ll see. i’ll think about it.” yet, a white girl said that something in the play was sexist, and he literally changed it like on the spot. she’s like, “i don’t like that—” changed it on the spot, but i had to write a whole email, i had to bring my mom in, all type of stuff just so you could change the word monkey to crab. advances in social work, fall 2024, 24(3) 524 the next year, there was another incident with the school play where the “n-word” was used, and the school decided to move forward with the play. they met with some black students and asked if they were comfortable with the use of the n-word. even though students were uncomfortable, they ran the play because of all the hard work and time white students put into preparing for their roles. instead of canceling the play, the school shortened the time the play would run and offered a talk-back discussion after the first night to discuss the implications of using the “n-word.” students not seeing themselves reflected in the curriculum, having experiences with school plays in which all black students were cast as animals, and never having a black teacher were just some of the experiences identified where black students did not see themselves reflected in their school environment. discussion black students identified four prevailing experiences as contributing to their lower academic performance and disproportionately higher disciplinary sanctions: unwelcoming environment, lack of mattering, racial insensitivity, and not seeing themselves reflected in the environment. these four factors were components of a sense of belonging. belonging is defined as “the extent to which students feel that they are personally accepted, respected, included, and supported in the school environment” (goodenow & grady, 1993, p. 61). black students felt like they were allowed to attend crest academy high school, but the school failed to make them feel a sense of belonging or as included, important and vital parts of the school; instead, they were made to feel like interlopers and inconsequential to their white counterparts. unwelcoming environment an unwelcoming environment in this study pertained to the racial profiling black students described encountering in the broader crest community. including the surrounding community as an extension of the school is an important study contribution because there is a dearth of knowledge regarding the communities where schools are located and the ways these communities might influence academic achievement and a sense of belonging among students. additionally, black students felt like their teachers were not interested in getting to know them personally, and failing to call on them when their hands were raised negatively affected their relationships with school personnel and overall academic achievement, and contributed to them feeling like they did not belong. baker et al. (2008) found that black students need positive relationships with their teachers and school personnel to engage fully and flourish in educational environments. lack of mattering a lack of mattering was the second component that black students identified as contributing to lower academic achievement and higher discipline rates. mattering is defined as “the feeling that others depend on us, are interested in us, are concerned with our fate, or experience us as an ego extension exercises a powerful influence on our blakey/black students’ perceptions of achievement 525 actions” (rosenberg & mccullough, 1981, p. 165). many black students felt they did not matter to administrators and teachers because they were treated differently than white students. black students were sent to the office and suspended, whereas nothing happened to white students for the same behavior. skiba et al. (2011) and owens and mclanahan (2020) confirmed these results, finding black students were disproportionately referred to the office more than any other group of students. overusing disciplinary action against black children appears rooted in discrimination along the disciplinary process. a lack of mattering also included students being treated disrespectfully because they were not listened to unless their parents intervened. participants also reported a lack of support and acknowledgment regarding what mattered to them. mattering is an important part of belonging and contributes to academic achievement (balfanz & byrnes, 2006; bjorklundyoung & plasman, 2020; macneil et al., 2009; tucker et al., 2010). tucker et al. (2010) found that when black male students felt valued and were given support at school, they succeeded in significant ways. according to okello and stewart (2021), showing black students that they matter is humanizing, liberating, and life-giving for those students. racial insensitivity black students described implicit and explicit racist experiences and comments made by school personnel. for example, josiah, a black student, said, i'm all for you being who you want to be and all that stuff, but before you decide to address lgbtq students’ safety, i just feel like you should address the racial issues. they made an announcement saying in every school 45 percent of lgbt people don't feel comfortable-are being bullied. what about black students? never once have they addressed the fact that many black students don’t feel comfortable in this school. white people will bring attention to a situation that applies to them before they look at a situation that just applies to us. students also described remarks about their intelligence and academic ability based on their race. additionally, black students were given material to read that they felt was racist or racially insensitive. these kinds of interactions have been found to adversely affect black students’ educational experiences and contribute to a lack of belonging (grace & nelson, 2019). racial insensitivity also included black students being singularly and exclusively cast as animals in a school play and other racially insensitive experiences (e.g., being asked to tell the class what it was like to be on welfare and how welfare works, as the educator presumed all black people were or had been on welfare). similar racially insensitive racial epithets by peers have also adversely impacted black students’ educational experience (ngui et al., 2024). when black students became frustrated, upset, or challenged these racist beliefs and interactions, they often were considered disrespectful and sent to the office. skiba et al. (1997) similarly found that black students were disproportionately sent to the office and suspended for noncompliance, defiance, and what teachers perceived as disrespect. a similar finding was more recently confirmed by welsh and little (2018), who reported, “black students are disciplined more irrespective of behaviors, and the vast majority of disciplinary infractions for which students receive a disciplinary consequence are advances in social work, fall 2024, 24(3) 526 subjective” (p. 780). a no-tolerance stance tended to be taken with the black students, whereas white students routinely refused to comply with requests and “talked back” to teachers, staff, and administrators with little to no consequences. moreover, white students often were allowed to explain themselves and were given the benefit of the doubt. this differential treatment reportedly angered black students, sometimes to the point of wanting to lash out. kwame reported being so mad that he wanted to turn over their desks. these experiences also affected black students’ desire and ability to excel in the classroom with teachers and administrators they deemed as racist or, at the very least, felt they did not care about them. not seeing themselves reflected in the school environment finally, findings suggested that black students did not see themselves reflected at school, whether such representation included the art on the wall, the curriculum, the vantage point from which topics were discussed, critical events recognized, and interactions with administrators, teachers, and staff of color. failing to see themselves reflected in a place where black students spent a significant amount of time negatively impacted their desires to achieve and contributed to a lack of belonging. whether students described the larger community, curriculum, or interactions with administrators, teachers, and staff, all factors contributed to and reinforced a lack of belonging, influencing black students’ academic achievement. abena noted: i was in 8th grade and a teacher went around—it was science, and she was trying to figure out who should go into bio (ap) or physical science (regular), and she just said, “you should go into physical science.” like, i have excelled at science, she just said, “hey, you physical science.” i told my mom and she made them test me. so, now i'm in bio, but last year, when i was a freshman, i started off in physical science…they make it difficult [for black students] to be able to take ap classes that would boost your gpa, it makes it more difficult to be on par with my white peers who have access to those classes. chenzi, a black student, indicated that if he could do it all over again he would have chosen a different school. his experience made him dislike school. he said: if i could rewind time, i would do my high school career over if i could choose to not go here, i would. honestly, i would press that button and go to a different high school in a jiff, because i hate school, like it was just school. it was not fun. do i feel like it prepared me for college? no! i feel like i was just here. chenzi's quote reflected how black students’ experiences in school made them dislike school, affecting their current experience and influencing whether they pursued education post-high school. the results of this study are important for three primary reasons. this study privileges black students’ voices and perspectives as to why they believed they were less likely to perform academically and more likely to be suspended. the findings increase our understanding of how lacking a sense of belonging might contribute to lower academic blakey/black students’ perceptions of achievement 527 achievement and disproportionately higher disciplinary sanctions among black students. this study operationalized a sense of belonging into four critical components, which can serve as a guide to increasing belonging in schools. increasingly, research has shown that a sense of belonging is a powerful predictor of students’ success in academic environments (booker, 2006; mccabe, 2009; smith et al., 2020). fong lam et al. (2015) reported that higher rates of belonging increased feelings of happiness, hope, and relaxation among students, contributing to high rates of academic achievement. belonging is a fundamental basic need that must be fulfilled for students to thrive academically and socially (finn, 1989; fong lam et al., 2015). research has found students who do not feel a sense of belonging will have: (a) diminished motivation; (b) limited achievement; (c) poor academic performance; (d) feelings of alienation and isolation; (e) mental and physical impairments such as unhappiness, depression, and anxiety; (f) increased behavioral problems; (g) feelings of helplessness, fatigue, and boredom and (h) limited involvement in extracurricular activities (faircloth & hamm, 2005; fong lam et al., 2015; ma, 2003; osterman, 2000, 2023; saleem et al., 2022). increasingly, studies have suggested a sense of belonging is more predictive of academic achievement than individual, family, peer, and community-level factors (montoro et al., 2021; neel & fuligni, 2013; rouse & kemple, 2009). sense of belonging is believed to be important because when students feel connected to their academic environments, their learning is maximized, and they have increased motivation and engagement (fong lam et al., 2015; fredricks et al., 2004; osterman, 2000, 2023). though no single factor influences academic success, teachers, administrators, and school personnel must bear some responsibility for these outcomes (pitre, 2014; quinn et al., 2019). a sense of belonging is something the school and school personnel must value. thus, schools and school officials must review policies and practices that contribute to black students not feeling like they belong or matter and work to increase a sense of belonging among black students. limitations although this study has significant findings and implications for social work practice, some limitations should be considered. if a larger proportion of students had been interviewed, the findings might have been different. although we are grateful to students for sharing their experiences with us, these experiences may not be representative of all students’ experiences. the study did not include all black students who attended crest academy. approximately 202 black students were enrolled in the high school at the time of this study, and we interviewed 40 students, which is about 20% of the black student population. it is also possible that those who chose to participate may differ in perceptions from those who chose not to participate, given that individuals who choose to participate in studies may have strong feelings about the subject matter. it is worth noting that many students who chose to participate had strong negative feelings about their experiences at school. we had a larger proportion of female students in the sample than male students. research has found that black male students have different educational experiences than advances in social work, fall 2024, 24(3) 528 female students (chu & ready, 2018; howard, 2013). the findings might have been different if we had more male student participation. according to howard (2013), “loathed in various environments, applauded in others, perhaps no other group of people are emulated yet despised simultaneously to the extent that black men are today” (p. 55). another limitation of the study is that the school is predominantly white and located in the midwest. though a sense of belonging is important no matter the school, what it looks like might differ slightly based on the school's racial makeup and whether the school is in another part of the country. implications for practice much time, money, and effort have gone into equalizing educational opportunities; however, those investments have failed to reduce educational disparities as intended (hung et al., 2020). furthermore, current education policies and practices have not only failed to support children personally and academically, but they also have served as barriers to forging a sense of belonging. the findings from our study suggest culturally responsive educational practices have the potential to (a) create a welcoming environment, (b) generate feelings of mattering, (c) saturate school culture with racial sensitivity, (d) allow each student to see themselves reflected, and (e) ultimately provide children with opportunities to feel a sense of belongingness in their schools and communities. in turn, this can positively impact students’ outcomes, improve academic achievement, and capture the attention of students who often disengage from the learning process (gay, 2000; howard & terry, 2011; nasir et al., 2009). previously, the goal of education has been to provide students with the skills needed to succeed in white mainstream society, not realizing that academic success came at the expense of their cultural and psychosocial well-being (richards et al., 2007; vavrus, 2008). it is imperative to move away from traditional practices that hinder, oppress, and perpetuate deficit narratives and move toward culturally responsive education. culturally responsive education focuses on addressing the needs of all culturally and linguistically diverse students (ladson-billings, 1995) and contributes to students’ sense of belongingness, which, in turn, contributes to improved academic achievement. this work has implications for social workers, school psychologists, school staff, administration, and teachers, specifically the need to provide culturally responsive education, which in turn “provide[s] a way for students to maintain their cultural integrity while succeeding academically” (ladson-billings, 1995, p. 476). when students are provided with optimal educational experiences, have high standards set for them, and are accountable to themselves and others, students excel regardless of their social class, race, gender, and family background (mcdonald & farrell, 2012). this can be achieved through more hands-on cultural responsivity training that focuses on increasing belongingness through community building, relationship building, and racial sensitivity. moreover, schools must increase both the hiring and retention of diverse teachers. greater diversity among teachers, staff, and administration will allow a greater number of students to see themselves reflected. programs such as the innocent classroom (innocent technology, 2024), which have been implemented in minneapolis, st. paul, and omaha, have shown blakey/black students’ perceptions of achievement 529 improvement in educator job satisfaction, less frequent exclusionary discipline, increased individual attention, stronger relationships, and greater academic growth in teachers leading to better relationships between students and teachers. implementation of policies that require partnership with agencies such as the innocent classroom would not only serve to alleviate the disparities experienced by black students but would also alleviate disparities among other students of color and improve the educational system. the implications for social work include greater education on cultural responsiveness through more specific cultural sensitivity training for school social workers, continuing education requirements for school social workers and child welfare workers, and cultural sensitivity training in social work programs. in order to uphold the core values of social work, social workers need a foundational understanding of the disparities students of color experience and ongoing continuing education to ensure the emotional safety of our children while ensuring an improved educational experience for students and teachers. lastly, social worker practitioners should also ensure they are well trained in cultural sensitivity, specifically with students of color, in order to best support students in advocating for their emotional and educational needs and support them in coping with and managing stressors related to systemic oppression both inside and outside the classroom. references assari, s., mardani, a., maleki, m., boyce, s., & bazargan, m. 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(2020). starving counties, squeezing cities: tax and expenditure limits in the us. journal of economic policy reform, 23(2), 101119. author note: address correspondence to joan m. blakey, phd, lmsw, is the gamble skogmo endowed chair at the university of minnesota-twin cities, school of social work, saint paul, mn 55108. email: blak0014@umn.edu https://doi.org/10.5330/prsc.14.2.k215671rj018g134 https://doi.org/10.5330/prsc.14.2.k215671rj018g134 https://doi.org/10.5330/prsc.14.2.k215671rj018g134 https://doi.org/10.4135/9781412964012.n56 https://doi.org/10.1037/spq0000084 https://doi.org/10.1037/spq0000084 https://doi.org/10.3102/0034654318791582 https://doi.org/10.3102/0034654318791582 https://doi.org/10.1080/17487870.2018.1509711 https://doi.org/10.1080/17487870.2018.1509711 mailto:blak0014@umn.edu _________ inger christensen, dsw, lcsw, lecturer school of social work, california state university, los angeles, ca. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 436-453, doi: 10.18060/28122 this work is licensed under a creative commons attribution 4.0 international license. critical reflections on clinical supervision: a social justice issue for social workers inger christensen abstract: clinical supervision, a central experience for social workers, is a requirement for clinical licensure in all 50 states, making it an essential component of social work practice. clinical licensure indicates a higher level of expertise and provides more job opportunities and a higher professional status for social workers. when social workers encounter challenges to obtaining clinical licensure, professional inequities are perpetuated. this is a social justice issue for the social work profession. this paper explores clinical supervision in the context of clinical licensure. a discussion of the social work regulation system, functions of supervision, and factors influencing clinical supervision is presented. recommendations for addressing social justice in clinical supervision are identified, including more emphasis on social work research, inclusion of leadership and supervision curricula in schools of social work, strategies to reduce costs of supervision, and implementation of supervisor training. keywords: clinical supervision, clinical licensure, social work regulation, clinical social work practice, social justice six core values guide social work practice: service, dignity and worth of the person, importance of human relationships, integrity, competency, and social justice. for social workers, the value of social justice is foundational when engaging with clients, communities, and society (national association of social workers [nasw], 2021). however, while striving for social change in society, the profession has also neglected injustices within its membership. the united states has faced a reckoning of its history of racism and oppression, forcing people and institutions to acknowledge, address, and change oppressive practices. the social work profession is not immune to this reckoning. the profession has historically been primarily white and female. a recent survey of new social workers shows that the profession remains predominantly female (salsberg et al., 2020). although the majority of new social workers are white, they are increasingly diverse in race and ethnic identities (salsberg et al., 2020). the social work profession ensures that social workers are properly trained and competent to practice through regulation by state licensing boards. regulating social work practice protects the public by setting practice standards (reay et al., 2022). clinical licensure is a part of the regulatory process to ensure competent social workers (nienow et al., 2023). today, licensure has become nearly universal for social workers (grise-owens et al., 2016). requirements for clinical licensure vary by each state’s licensing board. however, commonalities across jurisdictions in all states include graduating from an accredited university, supervised post-graduate work, and passing a clinical licensing examination (donaldson et al., 2014; morrow, 2022; reay et al., 2022). about:blank christensen/clinical supervision 437 in the united states, every state uses the association of social work boards (aswb) clinical licensing exam. the aswb (2024) explains that regulation through licensing examinations ensures that a social worker has the knowledge and practice competencies necessary for safe practice. taking and passing the aswb clinical licensing exam is the final step to obtain clinical licensure. according to aswb (2022b), in 2021, 63% of clinical licensing test takers were white. this same group also had the highest pass rate for first-time test takers at 83.9% and an overall eventual pass rate of 90.7% (aswb, 2022b). in comparison, black social workers had a 45% pass rate for first-time test takers, native americans 62.9%, hispanic/latino 65.1%, asian 72%, and muti-racial social workers 79.9% (aswb, 2022b). eventual pass rates followed this same trend (aswb, 2022b). the aswb recently acknowledged racial bias in its exams (aswb, 2022a). these results are concerning for a profession that professes to strive for social justice. nienow et al. (2023) argued that these disparities deny social workers of color the opportunity to become licensed and even deny job opportunities. in addition, a bias in the licensure process unduly burdens social workers of color emotionally and financially (nienow et al., 2023). according to nienow et al. (2023), a deeper examination of the relevance and role of licensure examinations in the profession is necessary. the social work profession must face systemic racism in the profession and its regulatory boards (nienow et al., 2023). senreich and dale (2021) also urged the social work profession to address the disparities in licensure in order to uphold its social justice value. while the aswb has stated its commitment to addressing inequities and making changes, the social work profession must continue to examine its policies, educational settings, and practice experiences, including clinical supervision, which perpetuate and maintain inequities and exclusion of its members. problem statement clinical supervision is a key component in preparing social workers for competent practice and licensure; therefore, supervision is a central experience for all social workers. as clinical supervision is a core element of social work practice and for clinical licensure, it is imperative to examine its role in promoting equity and inclusion in the profession. clinical supervision is also a critical practice area to address social justice issues (asakura & maurer, 2018; o’neil & del mar farina, 2018). studying the impact of clinical supervision on passing the clinical licensing exam will elucidate any social justice implications for social workers. professional standards for social work supervision put forth jointly by the nasw and the aswb state, that in the context of licensing, supervision aids in protecting the public, and that the supervisory evaluation is a gatekeeping mechanism for competent practice (nasw & aswb, 2013). clinical supervision promotes professional development and learning and imparts ethical standards (pack, 2015; strickler et al., 2018). clinical supervision also protects clients' safety (pack, 2015). kadushin and harkness (2014) delineate the objectives of supervision to include increasing social workers’ knowledge and skills, with an end goal of providing effective social work services to clients. clinical licensure is a pathway to career advancement for social workers, including professional status, job opportunities, and leadership roles. frequently, new master of advances in social work, spring 2025, 25(1) 438 social work (msw) graduates take the initial steps toward licensure shortly after graduating. arndt et al. (2021) found that social workers pursuing licensure do so in the first three years after graduation. similarly, a survey of the social work workforce found that nearly 80% of new msw graduates intended to seek clinical licensure within five years (salsberg et al., 2020). these trends illustrate the emphasis placed on clinical licensing. nevertheless, there is a lack of research about licensing in the social work profession (grise-owens et al., 2016; miller et al., 2022; reay et al., 2022) and a lack of discussion in the literature on the role, if any, that supervision plays in preparing social workers for taking and passing the licensing exam (reay et al., 2022). furthermore, reay et al. (2022) note that prior entreaties for research on licensure and its surrounding factors have not been heeded. the lack of research heightens the need for further attention to the relationship of clinical supervision in clinical licensure. social justice is integral to the social work profession. however, despite social justice being a core value, the profession still needs to clearly demonstrate this commitment in its practice (asakura & maurer, 2018). o’neil and del mar farina (2018) emphasize that clinical supervision is not exempt from acts of racial and social injustices in the supervisory relationship. allowing social injustices in the supervisory relationship leads to negative consequences that not only impair learning but also perpetuate inequities and injustices (o’neil & del mar farina, 2018). in addition to weighing social justice issues in clinical supervision, inequities in clinical licensing must also be considered. senreich and dale (2021) discovered racial disparities in licensed social workers. in their study of licensure rates in new york, white graduates were more likely to be licensed than those from minority groups (senreich & dale, 2021). considering this in light of recent revelations of racial bias in the aswb licensing exam, it is imperative to examine the factors related to disparities in licensing (senreich & dale, 2021). as supervision is a crucial part of social work regulation, it is necessary to understand its significance to clinical licensure, and its underlying relationship to the regulation of social work. if supervision influences a social worker’s self-efficacy and contributes to positive client outcomes (morrison & lent, 2018), then it is reasonable to contemplate the implications of clinical supervision on a social worker taking and passing the clinical licensure exam, and importantly, to understand its role in professional achievement. barriers to clinical supervision can lead to barriers to clinical licensure and, ultimately, barriers to career advancement. social workers will be discouraged from career advancement if these barriers become insurmountable. in the current climate of addressing historical inequities, the regulation of the profession through clinical supervision and licensure is a prime target for scrutiny and re-imagining. this discussion addresses the problem of the paucity of literature exploring the role of clinical supervision in the context of clinical licensing. this paper contributes to the limited knowledge on the relationship between clinical supervision and clinical licensure through an exploration of the contributing factors with a social justice lens. recommendations for ameliorating barriers and supporting social workers’ professional attainment are offered. christensen/clinical supervision 439 social work regulation the regulation of social work practice has evolved throughout the profession’s history. the initial move toward supervision occurred due to the practical need to train new social workers in apprenticeship programs (kadushin & harkness, 2014). although the movement toward regulation began in the profession's early years, it has been a slow process, and it was not until the 1990s that all 50 states and u.s. territories adopted some form of regulation (nienow et al., 2023). nasw advanced regulation and licensure to protect the interests of the social work profession (kadushin & harkness, 2014). as the social work profession worked to legitimize social work, it aligned with other health professionals by developing mechanisms for regulation. passing a licensing exam is one of the mechanisms of regulation (nienow et al., 2023). regulation of social work with professional licensure enhances the profession’s reputation as being legitimate (thyer, 2011). arndt et al. (2021) identified licensure as a form of title and practice protection for social workers. moreover, arndt et al. (2021) argued that clinical licensure policies essentially prioritize clinical social workers as more advanced, while those who choose not to pursue licensure are perceived as not as skilled, despite the lack of data to suggest this is the case. donaldson et al. (2014) also suggested that the trend toward clinical social work licensing creates a perception that clinical social work is the only legitimate practice. one aspect of licensure to consider is how social workers view licensure and the licensing process. miller, deck et al. (2015) determined in their study of graduate students’ views of licensing that nearly all of the participants planned to seek licensure. they cited employment factors as an incentive to seek licensure (miller, deck et al., 2015). the participants also indicated that they valued obtaining a social work license. the study highlighted a need for more preparation about the licensing process in graduate programs, as the participants indicated this was lacking. however, they felt the education they received would help them to pass the exam (miller, deck et al., 2015). in a complementary study, miller, grise-owens et al. (2015) implemented a licensure preparation initiative at a graduate school. the preparation program included the integration of licensure content throughout the curriculum, such as in tests and quizzes, and an overall emphasis within the program on licensure preparation. the preparation program also offered an academic seminar to students that focused on three pillars: licensing exam process, content of the exam, and study and test-taking strategies (miller, grise-owens et al., 2015). the authors discovered that after completion, students felt more knowledgeable about the licensing exam process and more confident in their ability to pass the exam. miller, grise-owens et al. (2015) followed up by analyzing student exam pass rates and found an increased pass rate. the authors recommended that graduate programs pay more attention to licensure preparation in their curriculum to increase students’ confidence and competence to pass the exam. postgraduate social workers’ perceptions of the licensing process are also essential to examine due to the trend toward licensing. reay et al. (2022) surveyed participants after a training to educate social workers and other mental health professionals on nebraska’s updated regulations. the 1,143 participants included 519 social workers and 624 other mental health professionals. all social workers in this study reported they understood the advances in social work, spring 2025, 25(1) 440 purpose of licensure, and nearly all (99%) believed that all mental health professionals should have a license (reay et al., 2022). other mental health professional participants responded similarly to these queries. there was a disparity in responses between the two groups when comparing perceptions of the licensing process. more social workers found the licensing process confusing compared to other mental health professionals (reay et al., 2022). related to this, fewer social workers reported that their university prepared them for licensure compared with other mental health professionals (reay et al., 2022). social workers were also less likely to believe that passing the exam reflects the quality of their education than their counterparts (reay et al., 2022). in addition, reay et al. (2022) noted a significant difference in the perceptions of social workers of color regarding their university preparing them for licensure. social workers of color were less likely to report feeling prepared by their university than white social workers and other mental health professionals (reay et al., 2022). their research prompted reay et al. (2022) to recommend further research on the role of social work education and clinical supervision in preparing social workers for licensing. clinical supervision the functions of supervision occur through the relational dynamics between the supervisor and the supervisee. the nature of the supervisory relationship is mysterious yet significant (miehls et al., 2013). strickler et al. (2018) contended that there is limited available knowledge about the mechanisms that establish a working alliance between supervisors and supervisees. kadushin and harkness (2014) described the supervisorsupervisee relationship as partially reenacting the parent-child relationship and potentially triggering anxiety associated with the parental relationship. however, empathy by the supervisor can alleviate this anxiety (kadushin & harkness, 2014). trust is crucial in cultivating a working alliance within the supervisory relationship. ketner et al. (2017) identified trust as necessary for supervision. rankine (2019) examined factors related to successful supervision outcomes by comparing internal and external supervision models. participants indicated that a good connection between the supervisor and supervisee was crucial whether the supervisor was internal within the organization or located externally from the organization (rankine, 2019). participants identified attributes in the supervisor, such as honesty and trustworthiness, as the most important to success (rankine, 2019). the participants also identified the supervisor’s ability to facilitate critical thinking and reflection as necessary (rankine, 2019). finally, rankine (2019) observed that the relationship was essential to the success of supervision and recommended an ongoing examination of relational dynamics in supervision to understand the skills and knowledge necessary for the supervisor to be successful in supervision. a strong working alliance between supervisor and supervisee can contribute to successful supervision outcomes. strickler et al. (2018) created a study to test a feedback tool to facilitate conversations about the working alliance in the supervisory relationship. the researchers concluded that the tool could be helpful in relationship building and urged the social work profession to make an effort to study ways to strengthen working alliances. christensen/clinical supervision 441 strengthening the working alliance in the supervisory relationship can also be a protective factor in coping with stress (strickler et al., 2018). in a survey of counseling graduate students, supervisees who reported a stronger working alliance with their supervisor were more likely to report positive self-efficacy beliefs (morrison & lent, 2018). these researchers also suggested that supervisors play an essential role in supervisees’ confidence and, ultimately, in positive client outcomes (morrison & lent, 2018). these findings testify to the significance of the relational aspects of supervision and a social worker’s success. figure 1. components of clinical supervision impacting social workers factors impacting clinical supervision the supervisor-supervisee relationship is a significant factor in positive supervision outcomes. this working alliance creates a mechanism for the supervisee to develop professional skills, knowledge, and competence. trust and rapport are necessary for a strong working alliance. however, there are impediments to establishing a relationship. furthermore, even if there is potential for a strong working relationship, social workers also encounter substantial challenges to accessing competent and affordable clinical supervision. •costs of supervision •salary •cultural competency training •power •quality of supervision •training of supervisors •clinical licensure policies regulation of practice supervisory relationship financial burdencultural responsiveness advances in social work, spring 2025, 25(1) 442 cultural responsiveness the social work profession has emphasized the importance of having knowledge of culture and its influence in practice with clients. logically, this should extend to valuing culture within its professional ranks, including supervisory relationships. cultural humility is a part of cultural responsiveness and a part of competent supervision. vandament et al. (2022) described cultural humility, such as being humble and acknowledging limitations, as an important factor in developing a working alliance and creating conditions for successful supervision outcomes. in their research, vandament et al. (2022) studied the experiences of 87 counseling supervisees of color who were supervised by white supervisors. they found that the supervisory working alliance was a mechanism to support the supervisee’s counseling selfefficacy. a supportive environment allows the supervisee to develop their professional identity (vandament et al., 2022). the researchers also determined that the cultural humility of the supervisor contributed to the working alliance. furthermore, cultural humility helps supervisors initiate discussions about culture in supervision and allows supervisees to feel supported and respected (vandament et al., 2022). if a supervisee experiences a lack of cultural responsiveness, this will hinder the working alliance and the supervisee’s professional development. a commitment to cultural humility is imperative in the supervisory relationship. according to lusk et al. (2017), most social workers in their study perceived their supervisors as culturally responsive. however, some participants reported that they experienced incompetent social work supervision, 7.3% reported that their supervisors had made disparaging remarks about other cultures, and 14.5% perceived their supervisors as not adjusting supervision to meet their cultural needs (lusk et al., 2017). in addition, participants reported that some supervisors lacked any knowledge of their supervisees’ culture (lusk et al., 2017). that this is even occurring is concerning, given the social work profession’s values and ethics (lusk et al., 2017). also noted was a lack of professional licensure by the supervisor was associated with participants reporting incompetent supervision (lusk et al., 2017). supervisees must feel supported and welcomed in their work environment, including respect for, and understanding of, their cultural needs (lusk et al., 2017). these are essential conditions for developing a working alliance in supervision. lusk et al. (2017) asserted that supervisors are leaders and role models for culturally responsive practice. vandament et al. (2022) stress that cultural humility is the supervisor’s responsibility. supervisors should seek to understand the cultures and identities of their workers and engage in self-reflection of their own experiences and power to increase competent supervisory practice (lusk et al., 2017; vandament et al., 2022). power in supervision in order to achieve the objectives of clinical supervision, discrimination in supervision must be addressed. attending to social justice issues within the social work profession will increase equity and inclusion, which ultimately helps the profession fulfill its mission of christensen/clinical supervision 443 service to vulnerable populations. considering the power differentials in supervisory relationships, the interaction of social identities, and the fact that clinical supervision is required for professional licensure and advancement, supervisees are in a vulnerable position ripe for discriminatory treatment (howard et al., 2023). blalock et al. (2021) affirmed that exploitation and abuse of power by the supervisor are possibilities in supervision. analyzing power in the supervisory relationship provides insights into relationship dynamics. power differentials are inherent in the clinical supervisory relationship (o’neil & del mar farina, 2018). the supervisor and supervisee bring their own social identities to the relationship, influencing the supervision’s relational dynamics and outcomes (asakura & maurer, 2018). the supervisor’s multiple roles, such as manager, teacher, expert, and licensure gatekeeper, contribute to power differentials in supervision. in addition, social power and privilege conferred on individuals also add to the complex nature of the supervisory relationship (o’neil & del mar farina, 2018). conversations about race in supervision provide opportunities for critical reflection on power and social justice in supervision and client relationships. schen and greenlee (2018) agreed that it is essential for discussions of race to occur in supervision, proclaiming that if these conversations cannot be undertaken among professionals, how can clinicians be expected to conduct these same conversations with clients? additionally, when professionals cannot face acts of racism, institutional racism is maintained (schen & greenlee, 2018). white-davis et al. (2016) stressed the importance of supervisors creating a safe relationship where supervisees are comfortable engaging in discussions of race. rapport and a sense of safety in clinical supervision are factors for successful supervision (white-davis et al., 2016). supervisors must develop knowledge and skills to facilitate safe relationships and difficult discussions (white-davis et al., 2016). moreover, supervisors should acknowledge and value differences in personal, cultural, and racial identities in supervision (schen & greenlee, 2018). discussions about race in supervision contribute to establishing safe supervisory relationships, and discussions about sexual diversity are also meaningful to a supervisee’s sense of safety. supervisees with diverse sexual identities reported that safety in the supervisory relationship was elemental to the working alliance (mauer, 2023). mauer (2023) explored the postgraduate clinical supervision experiences of gay men in a qualitative study. participants reported that experiencing discrimination by supervisors was a barrier to successful supervision. discrimination by supervisors resulted in fewer gains in supervision and affected participants' mental well-being (mauer, 2023). however, supervisees who described a stronger working alliance reported that supervisors were affirming and respectful of sexual diversity (mauer, 2023). similar to other findings about race and cultural discussions in supervision, participants experienced fewer discussions of sexual diversity with their heterosexual supervisors and expressed that they wished their supervisors had more knowledge about sexual diversity issues and culture (mauer, 2023). another aspect of power dynamics in supervision is how the profession responds to discriminatory acts. howard et al. (2023) examined the scholarship addressing discrimination in clinical supervision. in a review of literature from medicine, psychology, counseling, sociology, and social work disciplines, the authors found that the social work field was one of the least represented in the literature on addressing discrimination in advances in social work, spring 2025, 25(1) 444 supervision. the research reflected a lack of regulatory frameworks for addressing discrimination and no clear structures for reporting discriminatory treatment (howard et al., 2023). furthermore, anti-discrimination language was absent in clinical supervision guidance (howard et al., 2023). these findings show how inequalities are reinforced and perpetuated in the workplace for social workers (howard et al., 2023). the profession has a duty to protect social work colleagues from social injustices in the workplace (howard et al., 2023). for their part, howard et al. (2023) echoed the call for cultural responsiveness training for supervisors and stress that supervisors should implement a cultural humility approach. quality of supervision when securing clinical supervision, the quality of the supervision is an important factor for social workers seeking licensure. social workers may lack choices in the availability or accessibility of competent supervision to match their needs. whether the supervisor is located internally or externally, the quality of supervision is a factor in successful supervision (rankine, 2019). mauer (2023) explains that selecting a quality supervisor is a challenge faced by social workers with diverse sexual identities. when assigned an employer-provided supervisor, the supervisee has limited choice for a supervisor. a clinical supervisor in the agency may also be responsible for managing the supervisee, rendering supervision to be agency-oriented and even perceived as a form of surveillance (newcomb, 2022). on the other hand, it can be challenging to locate an external supervisor to match the supervisee’s needs (mauer, 2023; newcomb, 2022). a supervisor located external to the supervisee’s agency may not have the necessary knowledge about the specific agency, which can jeopardize the quality of supervision (blalock et al., 2021). in either case, the supervisee is disempowered in obtaining quality supervision to match their needs. the repercussions of poor-quality supervision can affect supervisees’ pathway to licensure. supervisees can be harmed by the action or inaction of the supervisor or by inadequate supervision (beddoe, 2017). according to beddoe (2017), harmful supervision, such as inappropriate behavior and microaggressions by supervisors, caused distress and affected the well-being of the supervisees. the quality of supervision impacted supervision satisfaction but blalock et al. (2021), also warned that incompetent supervisors modeled inappropriate professional behavior to supervisees. when supervisees emulate the behavior, they risk losing their license (blalock et al., 2021). in another study, bolandprom (2009) analyzed data from 27 state licensing boards of social workers who were sanctioned. although state boards differ on sanctioning policies and practices, social workers were sanctioned for offenses such as unprofessional behavior, practice deficiencies, and licensure-related problems. boland-prom (2009) suggested that this type of data analysis can be helpful for social work educators and regulators by informing them about policies and procedures. for clinical supervision, this data reinforces the importance of the supervisory relationship as a vehicle to impart ethical and professional practice. moreover, experiencing harmful or incompetent supervision could impede a supervisee’s ability to pass a licensing exam successfully. christensen/clinical supervision 445 training of clinical supervisors clinical supervision is a requirement in all 50 states as a component for clinical licensure. the requirements for a social worker to be deemed a clinical supervisor vary across states. some states mandate a certain number of years of practice experience, define professionals who can supervise, or require specific training. not all states require clinical supervisors to have training in supervision. many social workers have not been trained in supervision and thus tend to model their supervisory approach based on their own supervision experiences (kadushin & harkness, 2014). lack of training in supervision can impact supervisory experiences and outcomes. social work educators have a role in preparing social workers to be supervisors. a lack of preparation and training to be supervisors leaves social workers without the knowledge and skills for competent supervision. a comparison of online and in-person graduate social work courses on leadership and supervision observed that students reported an increased interest in leadership and supervision as a part of social work practice (vito & hanbridge, 2021). social workers have not historically been trained in leadership roles, leaving them unprepared to take on these roles. a lack of leadership training impacts their ability to provide quality supervision. vito and hanbridge (2021) advocated for a greater emphasis on leadership and supervision in education to prepare social workers to be more effective leaders and supervisors. skilled supervision leads to positive supervisory relationships and satisfaction (morrison & lent, 2018; rankine, 2019). financial burden new social workers weigh job opportunities and career options upon graduation. requirements for a job, such as holding a clinical license, are part of social workers’ decision-making in career pathways. social workers will consider the costs and benefits of licensure when weighing career options (arndt et al., 2021). securing a job as a new graduate without a clinical license may limit job choices. some employers provide clinical supervision as an employment benefit, rendering the cost of supervision free (mauer, 2023; reay, 2023). if their employer does not provide it, a social worker must find a supervisor and bear the costs on their own (reay, 2023). social work is reported to be a low-paying profession (zhao & zhang, 2023). a low salary coupled with a new graduate likely at an entry-level pay scale further burdens the new social worker with the financial costs of supervision. an examination of pay in the social work profession by zhao and zhang (2023) illustrated the racial disparity in pay, finding that social workers of color were paid less than white social workers. racial pay disparities increase the financial barriers for social workers of color to obtain clinical supervision and clinical licensure. clinical supervision is one of many costs social workers encounter in seeking licensure. depending on each state’s licensing board’s policies, potential costs for licensing include fees for registering with the licensing board, required training courses, exam study materials, and licensing exam fees. social workers of color have lower exam pass rates (aswb, 2022b), meaning advances in social work, spring 2025, 25(1) 446 if they do not pass the first time, they will have to pay again to take the licensing exam. again, this only adds to their financial costs. social workers who cannot bear the costs of supervision and licensure may not only lose career opportunities but also are prevented from achieving equity and inclusion in their profession. discussion this overview of the multiple aspects of clinical supervision and licensure illustrates their complex nature. the intersection of the social work profession’s mission, code of ethics, values, university education programs, and state regulation boards interact to shape the context of clinical supervision and licensing. analyzing the forces impinging on clinical supervision and licensure provides an understanding of potential barriers for new social workers. the literature demonstrates the importance of clinical supervision in training social workers for competent and ethical social work practice. supervision increases practice knowledge and skill attainment and socializes the social worker to the profession’s ethics and values (kadushin & harkness, 2014; ketner et al., 2017; pack, 2015; strickler et al., 2018). examining the role of the regulatory system in social work practice is necessary to understand the context in which clinical supervision occurs. clinical licensing is a part of social work regulation and is recognized in the literature as essential to the licensing process (donaldson et al., 2014; morrow, 2022; reay et al., 2022; thyer, 2011). several researchers have studied trends in clinical social work licensing, seeking to understand the state of social work regulation (arndt et al., 2021; donaldson et al., 2014; morrow, 2022; reay et al., 2022). the literature provides a broad picture of social workers’ career choices and pathways. however, it needs to provide a more nuanced understanding of the factors contributing to or impeding career pathways. the literature noted that licensing boards have a powerful influence over social workers and the public’s perceptions of what is deemed advanced practice (arndt et al., 2021; donaldson et al., 2014). reay et al. (2022) recognized that state regulation is a part of social work practice; thus, it is necessary to investigate the licensing process, including clinical supervision. clinical supervision is a common experience in social work practice. exploring the nature of the supervisory relationship is critical to understanding the factors that influence outcomes. the centrality of the supervisory relationship to positive supervision outcomes has been demonstrated repeatedly (morrison & lent, 2018; rankine, 2019; vandament et al., 2022; vassos et al., 2018). the importance of safety, trust, and comfort in the supervisory relationship has been identified (ketner et al., 2017; lusk et al., 2017; mauer, 2023; rankine, 2019; vandament et al., 2022; white-davis et al., 2016). understanding the relationship dynamics through research can aid supervisors and supervisees in investing more in clinical supervision. brooks et al. (2012) found that supervisees expressed negative attitudes toward supervision, such as taking time away from their clients and not feeling the need for supervision. this indicates a need for more understanding of supervision and its functions. christensen/clinical supervision 447 in other studies of the supervisory relationship, some researchers considered the impact of a supervisor’s cultural competence on the supervisory relationship (lusk et al., 2017; vandament et al., 2022). cultural competence and cultural humility were found to influence positive supervision outcomes. several authors emphasized that cultural competence was the supervisor’s responsibility and urged supervisors to engage in training to increase their competence (lusk et al., 2017; mauer, 2023; vandament et al., 2022). this knowledge can better inform social work educators, regulatory boards, and supervisors to develop best practices for supervision. another layer of clinical supervision examined in the literature was the role of social justice issues. several authors noted that the social work profession needs to address social justice issues in its workforce, including within the supervisory relationship (asakura & maurer, 2018; mauer, 2023; o’neil & del mar farina, 2018). the influence of power and social identities on the supervisory relationship was identified frequently in the literature (asakura & maurer, 2018; howard et al., 2023; lusk et al., 2017; o’neil & del mar farina, 2018; vandament et al., 2022). discrimination and bias in the supervisory relationship were experienced by supervisees (lusk et al., 2017; vandament et al., 2022). significantly, the social work profession professes to work toward ending injustices. however, in fact, howard et al. (2023) found that the field of social work was least represented in the literature in addressing discrimination in supervision compared to other disciplines. furthermore, racial bias has been found in social work licensing exams (nienow et al., 2023), heightening the call for social work to address racism in the profession. experiences of discrimination, bias, and incompetent supervision impact a supervisee’s professional growth and development. training of supervisors was noted as an important factor in supervision experiences. schools of social work lack sufficient attention to the study of leadership and supervision (vito & hanbridge, 2021). state regulatory boards do not consistently require specialized training for clinical supervisors across states. supervisors who do not have the necessary skills for supervision may engage in incompetent practice, which impacts supervisory outcomes. lastly, a significant barrier to clinical supervision and, subsequently, clinical licensure is the financial costs associated with it. if clinical supervision is not an employment benefit, the social worker must shoulder supervision costs on their own (reay, 2023). this cost is on top of the burdens already carried by social workers in this low-paying profession and for social workers of color who are subjected to racial disparities in pay (zhao & zhang, 2023). financial costs may become so great as to be insurmountable for some social workers to obtain clinical licensure, thus denying them equity and inclusion in their profession. gaps in the literature significant gaps in the literature on clinical supervision and clinical licensure were identified in this discussion. a dearth of literature on social work licensing and clinical supervision leaves a significant void in understanding the role of clinical supervision in taking and passing the clinical licensure exam. although licensing has become central to a social worker’s practice experience, there is a paucity of literature on licensing in social advances in social work, spring 2025, 25(1) 448 work (grise-owens et al., 2016; miller et al., 2022; reay et al., 2022). notably, there is a lack of specific research on the role of clinical supervision in preparing social workers to take and pass the clinical licensing exam (reay et al., 2022). research has studied the supervisory relationship and its relation to positive supervision outcomes; however, there needs to be more knowledge on the mechanisms involved in establishing a strong working alliance (miehls et al., 2013; strickler et al., 2018). additional research on the impact of the working alliance on a social worker’s learning and preparation for taking the clinical licensing exam will enhance supervisory practices. furthermore, research on racism and discrimination in clinical supervision and the licensing process is warranted to address social justice issues in the profession. attention in the literature will inform strategies to increase equity and inclusion in the profession. however, reay et al. (2022) observed that prior calls for research on clinical supervision and licensure have not been answered. neglecting this aspect of social work practice omits a central social work experience. this paper aims to contribute to the limited literature on clinical supervision’s role in clinical licensure and offer recommendations to address this issue. implications for social work clinical supervision and clinical licensure are realities in a social worker’s professional experience. examining the experiences of social workers is crucial in supporting social justice values in the profession. regulation of practice through clinical licensure is the current model in the united states. senreich and dale (2021) called for the involvement of the profession’s stakeholders in addressing disparities in the licensing process. multiple entities are involved, schools of social work, nasw, aswb, and state licensing boards all have roles in promoting a more just and equitable profession. professional organizations and state licensing boards are instrumental in advocating for social workers while also protecting the public through regulation of practice. state boards have the power to determine the requirements for licensing, and these may vary by state; however, clinical supervision as a condition to qualify to take the licensing exam is a common requirement (donaldson et al., 2014; morrow, 2022; reay et al., 2022; thyer, 2011). the trend towards clinical licensure is a common pursuit among social workers (arndt et al., 2021; donaldson et al., 2014; salsberg et al., 2020). this trend emphasizes the importance of professional organizations and state licensing boards to undertake measures to foster supportive and accessible clinical supervision in clinical licensure. social work researchers also have a critical and an ethical responsibility to study the relationship between clinical supervision and clinical licensure to shed light on the challenges faced by social workers. gaps in the literature surrounding clinical supervision and clinical licensure, specifically their impact on a social worker taking and passing the licensing exam, were noted. future research exploring clinical supervision and clinical licensing will be a step toward closing this gap. analyzing factors that enhance or impede career advancement will provide a greater understanding and inform supervision practices, social work education, and regulatory policies. christensen/clinical supervision 449 schools of social work are critical entities in improving supervisory practices. universities could be places to increase opportunities to train supervisors (newcomb, 2022). for most social workers the msw is their terminal degree and likely their last opportunity for formal social work education. schools of social work focus on training novice social workers in the multitude of required competencies. this may leave little room for instruction on supervisory and leadership skills (vito & hanbridge, 2021). social workers are then deprived of formal instruction on supervisory skills and unprepared to be future leaders (vito & hanbridge, 2021). recommendations social work researchers can affect change through greater attention to clinical supervision and clinical licensure. clinical supervision that is supportive is key to a social worker’s professional development. in addition, supportive supervision is an important part of a social worker’s well-being (newcomb, 2022). engaging in more research will lead to the identification of clinical supervision practices in the context of clinical licensing that provide safe and trusting spaces for social workers to learn and prepare for clinical licensing exam. in schools of social work, potential target areas are incorporating leadership and supervision curricula in social work education to prepare social workers to be supervisors (vito & hanbridge, 2021). supervision and leadership instruction can be integrated into existing practice courses or be a fully developed stand-alone course. supervision and leadership skills will not just train social workers to be supervisors, but educating social workers-to-be on the dynamics of the supervisory relationship will also empower them as supervisees. another recommendation is to include licensing preparation in schools of social work. licensing preparation courses increase social workers’ confidence to take and pass the exam (miller, grise-owens et al., 2015). cultural responsiveness is essential to cultivating safe supervisory spaces. culturally responsive supervisors deepen connections with supervisees. a strong supervisory relationship will promote learning and professional growth. cultural responsiveness training needs to be a part of preparing social workers to be supervisors (lusk et al., 2017; mauer, 2023; o’neil & del mar farina, 2018; vandament et al., 2022). cultural responsiveness training that emphasizes a cultural humility approach should be a mandatory requirement for supervisors prior to engaging in clinical supervision. licensed clinical social workers are required to obtain continuing professional education to maintain licensure status. cultural responsiveness training can be mandated when obtaining continued education hours. additionally, consistent requirements for clinical supervisors should be implemented across all state regulatory boards. the nasw and aswb can jointly advocate for the adoption of training policies. furthermore, regulation boards can re-imagine the licensing process and examinations to reduce disparities (nienow et al., 2023). the nasw, aswb, and state licensing boards can collaborate to promote equity and inclusion in clinical licensure. a recent illustration of re-imagining licensing occurred in illinois. the passing of legislation in illinois establishing an alternative to aswb licensing to counteract barriers to licensing was advances in social work, spring 2025, 25(1) 450 lauded by the nasw illinois chapter as a step toward a more equitable profession (naswil, 2023). innovating new ways to increase accessibility to supervisors, such as creating a registry of qualified clinical supervisors, is another way to re-imagine clinical supervision. developing a network of qualified clinical supervisors that can be accessed through a registry with state licensing boards would help connect supervisees to supervisors and allow greater choice in selecting a supervisor. furthermore, properly trained and experienced clinical supervisors could be solicited to offer lowor no-cost supervision. the nasw code of ethics directs social workers to fulfill their ethical responsibility to the profession, including contributing time and expertise to the profession (nasw, 2021). state licensing boards in collaboration with the nasw could offer an incentive program for clinical supervisors to provide lowor no-cost supervision for reduced or waived license renewal fees. lastly, nasw advocacy for higher salaries and title protection for social workers will increase the financial capacity for social workers to obtain supervision and licensure. innovative efforts from professional entities working together will break down barriers to professional equity and inclusion. conclusion this exploration of clinical supervision and the licensing process sought to uncover their relationship and influencing factors. clinical supervision is inextricably linked to licensing regulation. as the profession moved to legitimize its work, practice regulation became more institutionalized by state licensing boards. clinical supervision has been used throughout the social work profession’s history to train new social workers. today, supervision is fundamental in social work education to support practicum and classroom learning. importantly, in the context of this discussion, clinical supervision is component in postgraduate training and licensure. while many new social workers plan to pursue licensure, some encounter barriers to licensure. discrimination, bias, and incompetent supervision experiences deter social workers from pursuing licensure and may hamper their success in passing the licensing exam. some social workers face a challenge in accessing a supervisor who meets their needs. additionally, the financial costs of supervision and licensing can be a significant burden for social workers to carry. disparities apparent in licensing exam pass rates and licensed social workers provide a picture of the effects of these barriers. recommendations for improving access to quality clinical supervision, include supervisory and leadership curriculum in social work education, cultural responsiveness training for supervisors, low or no cost supervision, and standard requirements for supervisors across state boards were offered in this discussion. in addition, the multiple entities involved in the regulation of social work practice are called upon to work together for a more equitable profession. understanding the connection of clinical supervision to the licensing process is imperative for ensuring competent social work practice. even more pressing is to christensen/clinical supervision 451 understand the role of clinical supervision in the regulatory system and its impact on creating and maintaining inequities in the social work profession. the social work profession needs to challenge these injustices in its midst. social work means social justice. references arndt, r. g., kreif, t. m., & stotzer, r. l. 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(2023). racial pay disparity of social workers in nonprofit, forprofit, and government human services organizations. human service organizations: management, leadership & governance, 48(4), 455-473. author note: address correspondence to inger christensen, school of social work, california state university, los angeles, los angeles, ca, 90032. email: ichrist2@calstatela.edu https://doi.org/10.11157/anzswj-vol31iss3id646 https://doi.org/10.11157/anzswj-vol31iss3id646 https://doi.org/10.1007/s10615-023-00879-x https://doi.org/10.1007/s10615-023-00879-x https://doi.org/10.1177/10497315221118110 https://doi.org/10.1177/10497315221118110 https://www.cswe.org/cswe/media/workforce-study/the-social-work-profession-findings-from-three-years-of-surveys-of-new-social-workers-dec-2020.pdf https://www.cswe.org/cswe/media/workforce-study/the-social-work-profession-findings-from-three-years-of-surveys-of-new-social-workers-dec-2020.pdf https://doi.org/10.1521/pdps.2018.46.1.1 https://doi.org/10.1093/sw/swaa045 https://doi.org/10.1093/sw/swaa045 https://doi.org/10.1007/s10615-018-0684-3 https://doi.org/10.1007/s10615-018-0684-3 https://doi.org/10.1007/s10615-009-0253-x https://doi.org/10.1037/tep0000370 https://doi.org/10.1037/tep0000370 https://doi.org/10.1037/tep0000370 https://doi.org/10.1037/tep0000370 https://doi.org/10.1080/02615479.2017.1406466 https://doi.org/10.1080/02615479.2017.1406466 https://doi.org/10.1080/10437797.2021.1932650 https://doi.org/10.1080/10437797.2021.1932650 https://doi.org/10.1177/0091217416659271 https://doi.org/10.1177/0091217416659271 https://doi.org/10.1080/23303131.2023.2227231 https://doi.org/10.1080/23303131.2023.2227231 mailto:ichrist2@calstatela.edu ________________ deborah thibeault, phd, lcsw, associate professor, department of social work, east tennessee state university, johnson city, tn. jamie m. clem, phd, msw, assistant professor of instruction, school of social work, university of south florida, tampa, fl. donna cherry, phd, lcsw, professor, department of social work, east tennessee state university, johnson city, tn. copyright © 2024 authors, vol. 24 no. 2 (summer 2024), 403-422, doi: 10.18060/27382 this work is licensed under a creative commons attribution 4.0 international license. awareness, attitudes, and actions about environmental southern appalachia deborah thibeault clem jamie donna cherry abstract: the council on social work education (cswe) requires social work programs to integrate environmental justice into their programming. the purpose of this study is to determine if undergraduate and graduate social work students at a southern appalachia university had an increase in awareness, a shift in attitudes, and a rise in action related to environmental justice since starting their program. this study also sought to identify where students felt environmental justice content would best fit in the social work curriculum. participants completed a semi-structured focus group or an open-ended survey answering identical questions. findings indicate the need for social work educators to provide students with clarification of environmental conservation and environmental justice; an understanding of the breadth of environmental justice across the micro, mezzo, and macrolevels; and the opportunity to have direct practice experiences and reduce feelings of being overwhelmed by the enormity of environmental justice. participants endorsed the importance of environmental justice content in the curriculum. keywords: environmental justice; environmental conservation; social work curriculum the person-in-environment perspective, a pillar of social work, dates to the early days of the profession. shaw (2013) explains that the broad view of person-in-environment expects that social workers take a holistic approach, looking at the physical, social, and natural environments and the client's connection with each. the broader context of personin-environment was prevalent in early social work. however, the last century led many social workers to focus on the social environment and social relationships (chonody et al., 2020; hawkins, 2019; shaw, 2013) which shaw (2013) describes as a “narrower conceptualization” (p. 4). naranjo (2020) claims, “social workers have generally been silent on serious issues that threaten the well-being of humans and our continued survival” (p. 448). as environmental issues and injustices continue to rise, drastically impacting vulnerable populations, social workers have come to understand the importance of environmental justice work in the profession (dominelli, 2014; gray & coates, 2015; hawkins, 2019; naranjo, 2020). nesmith and smyth (2015), view environment justice as two-fold: first that “the burden of environmental hazards or degradation is shared equally across all demographic groups or communities,” and second, “there is equal inclusion in decision-making processes that result in environmentally related policies and actions” (p. 485). the social work profession has formally prioritized the importance of environmental justice which is evidenced across social work organizations. the national association of social workers’ (nasw) list of social justice priorities includes environmental justice and about:blank advances in social work, fall 2024, 24(2) 404 provides many resources on environmental justice and climate change (nasw, n.d.). the international federation of social workers (ifsw) has a climate justice program designed to educate social workers about climate justice, advocate for environmental justice and sustainability, and fund projects to combat environmental injustices (ifsw, n.d.). what’s more, addressing the “changing environment” has been identified as one of social work’s grand challenges (american academy of social work and social welfare [aaswsw], 2022; uehara et al., 2013); and the council on social work education (cswe) began recognizing its relevance by integrating environmental justice into two of the educational policy and accreditation standards (epas) competencies in 2015 (cswe, 2015): competency 3: advance human rights and social, racial, economic, and environmental justice, and as a bullet point in competency 4: engage in policy practice. further, the cswe 2022 epas have now integrated environmental justice into competency 1: demonstrate ethical and professional behavior; and it is noted under three educational policies: program mission, generalist practice, and signature pedagogy: field education. social workers have a responsibility to play a role in addressing environmental injustices. to assist educators with incorporating and increasing content about the physical and natural environment, the cswe released the curricular guide for environmental justice in 2020. in addition, programs can review recently published manuscripts to determine how to best meet this environmental justice educational requirement. these studies focus on students' “perspectives,” “perceptions,” and “attitudes” about environmental justice (chonody & sultzman, 2022; nesmith & smyth, 2015; sparks et al., 2019). building on past research, this study goes further by examining students' awareness (i.e., what they know), attitudes (i.e., what they think and feel), and actions (i.e., what they do) about environmental justice. additionally, researchers collected feedback from participants about where environmental justice content best fits within the curriculum, given their experience in the program. this enabled participation in the “development and delivery of the explicit and implicit curriculum” as outlined in the 2022 epas standard 4.1 student development (cswe, 2022, p. 24). literature review in previous studies social work practitioners endorse the importance of environmental justice. marlow and van rooyen (2001) surveyed nasw members in new mexico (n = 61). the majority (70%) reported that environmental issues were important to social work but only 46% addressed environmental justice in their practice, citing lack of education as a barrier to its inclusion. similarly, 90% of nasw respondents in a california study (n = 373) by shaw (2013) supported the inclusion of environmental justice in practice but only 32% reported receiving any education on this topic. finally, in a study of 373 licensed practitioners in a midwestern state, 92% reported that they had a client facing environmental injustice and felt that environmental justice should be integrated into social work education to better prepare graduates for practice (nesmith & smyth, 2015). given that environmental justice issues may surface when practitioners are working with clients, the importance of including environmental justice in education is recognized by the profession, and it is therefore important to understand how and where to integrate thibeault et al./environmental justice 405 environmental justice into the social work curriculum. chonody et al. (2020) contend that the first step is to understand social work students’ attitudes about the environment. however, it is suggested that attitudes and actions can only be shaped when awareness is present; thus, the first step is to understand social work students’ awareness. this perspective mirrors the transtheoretical model (ttm) or stages of change framework which posits that behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination (prochaska et al., 1993). the first stage of ttm (preparation) is defined by lack of awareness of the negative consequences of behavior. consistent with this stage, chonody et al. (2020) found, while graduate and undergraduate students (n = 724) only mildly to moderately believed that environmental issues are pertinent to practice, students who showed greater concern were influenced by taking a university course that included environmental injustice. faver and muñoz (2013) similarly found that students who felt moderately informed on the environment (2.69 on a 4-point scale), held moderately high levels of concern for the environment (3.07 on 4-point scale). findings suggest that providing education on environmental issues is an effective intervention to address lack of awareness and move students to awareness and concern, where they are considering changing their behavior (contemplation). awareness about the environment may or may not translate into commitment to action. the ttm framework acknowledges that, even with knowledge, there may be ambivalence in attitude or intention to address the issue, especially during the contemplation stage, which is often related to a lack of self-efficacy. sparks et al. (2019) found that students reported difficulty in understanding what environmental justice is and how environmental justice is connected to people. identified barriers included feeling overwhelmed by the magnitude, breadth, and complexity of the problem; a lack of personal connection between environment and environmental injustices; and a lack of understanding of dynamic feedback loops between environment and people. similarly, chonody and sultzman (2022) reported that students primarily defined “environmental justice” within the context of general environmental harm; and only 15% connected this term with oppressed and marginalized populations. these themes illustrate the need for social work educators to not only provide environmental justice content (increasing awareness and concern) but help students make connections to gain self-efficacy (resolving ambivalence). consistent with the tmm framework, heightened awareness of environmental issues and injustices may shape (or clarify and reify) social workers’ attitudes which, given growing self-efficacy, can help them shift to preparation, where they have made a commitment to change and then to action with, or on behalf of, clients and client systems. although the curricular guide for environmental justice (cswe, 2020) holds value for its recommendations for placement about environmental justice across the social work curriculum, this study is designed to include input of students by exploring the topic with study participants as a method to see where in the program they were exposed to environmental justice. soliciting feedback about the placement of environmental justice could be useful in deciding the most appropriate time and place to introduce or reinforce these concepts. in addition to this approach aligning with the cswe 2022 epas, this advances in social work, fall 2024, 24(2) 406 student-focused approach provides participants with the ability to actively engage in program development and learning outcomes. by seeking input from participants, they are more likely to feel invested during their time in the program and after they graduate (mccuddy et al., 2008). the institutional review board-approved objectives of this study are: a) to determine if students in the [bsw and msw] social work program have had an increase in awareness about environmental justice issues, b) to determine if students’ attitudes about environmental justice and conservation shifted since enrolling in the social work program, c) to determine, if awareness and attitudes have shifted, if students are taking action to support the shift, and d) to determine students’ level of interest in environmental justice and where students feel environmental justice would fit best in the social work curriculum. methods both bachelor of social work (bsw) and master of social work (msw) students from one university in southern appalachia were recruited to participate in this qualitative case study. the university represents a medium-sized, teaching-focused institution, with a high proportion of traditional students. it is considered a commuter campus, with most students being from the region. recruitment criteria included participants graduating with a social work degree in 2020 or 2021 from any of the four campus locations where the programs operate. a recruitment announcement along with incentive information (a drawing to win a $35 gift card to an eco-friendly merchant) was made in social work classes and emailed to upcoming graduates. in accordance with university’s institutional review board guidelines for protecting human subjects, participants were provided a consent form that clearly described the study expectations, potential benefits, and possible risks. sampling and recruitment for focus groups focus groups were originally planned to be program and location specific and to take place in-person during the last month of the semester, immediately after a class, where food and refreshments would be provided as incentive. during the spring of 2020, however, the covid-19 pandemic began; and university activities shifted online. the scheduled focus groups for 2020, therefore, were postponed until after graduation, moved to an online video conferencing platform, and were open for either bsw or msw students. the number of participants who agreed to these interviews was significantly less than researchers anticipated. it is suspected that moving from in-person to online had a significant impact on participation. this led researchers to continue to gather data for an additional academic year. thibeault et al./environmental justice 407 sampling and recruitment for survey despite moving from in-person to online focus groups, students reported that scheduling limitations and increased burden imposed by covid-19 (for example, childcare, caring for loved ones, or being sick themselves) limited their participation. therefore, researchers created an electronic open-ended, qualitative survey containing the same six questions that were asked in the focus groups. criteria for participation and recruitment replicated that of the focus groups: bsw or msw students in their final semester received an announcement during a core class as well as an email. using a survey provided an opportunity for more students to participate because they could do so individually, from home, and in their own time instead of during a specific focus group session. study questions study questions were designed to be as broad and non-directive as possible. the following research questions were used in the focus groups and surveys: 1. what does environmental justice mean to you? 2. since being in the social work program do you feel you have had an increase in awareness about environmental justice issues? if so, explain. 3. how have your attitudes about environmental justice and conservation shifted since enrolling in the social work program? 4. if awareness and attitudes have shifted, how have your actions changed to support the shift? 5. what is your level of interest in environmental justice? 6. where do you feel would be the most appropriate place or places in the social work curriculum to cover environmental justice? data collection five focus groups were held via zoom, lasting on average 60 to 90 minutes (about one and a half hours). participants could select whichever group fit their schedule. to help ensure confidentiality, the meeting was closed, and only pre-registered participants were provided with the meeting link. two of the three investigators were present during focus groups. investigators took turns asking the six open-ended questions (above). the five focus groups consisted of seven bsw and 11 msw participants. an additional 19 participants (10 bsw; nine msw) completed the open-ended survey. focus groups were recorded on the zoom platform which provides a transcript of the session. the only identifying information retained was the participants’ program level (bsw or msw) and campus location. although data were collected remotely, it was intended for results to be compared by program location. however, findings were similar across program locations and therefore aggregated and presented together. participants who wanted to be considered for the incentive drawing also provided their email addresses advances in social work, fall 2024, 24(2) 408 for later contact. email addresses were not connected to focus group responses. transcriptions, contact information, survey results, and data analyses were all stored in a password-protected electronic file and shared only between investigators. data analysis the purpose of phenomenological research is to explore a specific experience, then attempt to describe that experience from an individual’s perspective (lester, 1999; wilson, 2015). this study was guided by the phenomenological approaches to analysis as outlined by hycner (1985). according to hycner (1985), following transcription, researchers should review the data and bracket or suspend meanings and interpretations. next, researchers delineate units of meaning relevant to the research question. hycner (1985) recommends verifying the units with a research team to ensure adherence to bracketing or the suspension of assumptions, then eliminating redundancies. from there, clusters of units or themes can be developed and modified based on context and summarized as general themes or those unique to specific interviews. using hycner’s (1985) guidelines, first, each interview was transcribed. the transcription was provided from the zoom platform and was crosschecked and revised for accuracy by the lead researcher. written responses on the electronic surveys were downloaded into excel and reviewed. despite a difference in data collection methods, responses on five of the six questions were very similar, therefore it was decided to combine responses from the virtual interviews and electronic surveys so they could be analyzed together. for the question where responses differed, responses were analyzed and reported separately. next, each investigator independently reviewed responses and developed units of meaning. similar words and phrases used more than once by participants were grouped together to develop categories of themes. outliers were identified and noted. next researchers collaboratively examined the raw data and units of meaning. patterns were identified across the combined interviews and surveys, themes were developed, and redundancies were eliminated. after discussing the observed patterns and categories of similar concepts, researchers agreed on the themes that emerged. findings during data analysis, researchers discovered that participant responses to the questions were similar among both collection methods. the only difference was how participants answered the first question “what does environmental justice mean to you?” focus groups provided examples of environmental injustice, while survey participants attempted to define it. awareness, attitudes, and actions fell within two domains: environmental justice and environmental conservation. when attempting to define environmental justice, researchers first went to the cswe’s (2020) definition in the curricular guide for environmental justice, which starts by addressing equitable environmental protection and participation. further in the definition, however, cswe (2020) touches on environmental conservation, thibeault et al./environmental justice 409 environmental justice occurs when all people equally experience high levels of environmental protection and no group or community is excluded from the environmental policy decision-making process, nor is affected by a disproportionate impact from environmental hazards. environmental justice affirms the ecological unity and the interdependence of all species, respect for cultural and biological diversity, and the right to be free from ecological destruction. this includes responsible use of ecological resources, including the land, water, air, and food. (p. xvi) while environmental justice and environmental conservation have some overlap, they are distinct. to have clarity between the two, researchers utilized the following definitions when reviewing the data. environmental conservation, according to the journal of geography & natural disasters (n.d), is the protection, preservation, management, or restoration of natural environments and the ecological communities that inhabit them” (para. 1). they also state that conservation “include the management of human use of natural resources for current public benefit and sustainable social and economic utilization (para. 1). environmental justice is the idea that “(1) the burden of environmental hazards or degradation is shared equally across all demographic groups or communities, and (2) there is equal inclusion in decision-making processes that result in environmentally related policies and actions” (nesmith & smyth, 2015, p. 485). while conservation is important to the sustainability of the planet, it is not the same as environmental justice. therefore, for each study objective awareness, attitude, and action the overall findings are presented, followed by environmental conservation and environmental justice themes, with the understanding that there is some overlap. awareness participants began the study by answering, “what does environmental justice mean to you?” this is the only question where participants’ approach to responding differed between the focus group and the survey. all survey participants attempted a definition of environmental justice in answering this question. each focus group touched on environmental justice having to do with equitable burdens and provided examples of environmental injustice. each focus group presented cases of environmental injustice such as the dakota access pipeline and the flint, michigan water crisis, and discussed how the examples impact marginalized populations the most. some participants shared personal experiences with environmental injustice such as having health issues due to water contamination in their community. during these conversations, participants identified their privilege and impacts that marginalized communities experience due to environmental issues. an msw student explained, “we've come to see how that impacts different communities based on the color of their skin and sometimes their income level and things of that nature.” participants were asked, “since being in the social work program do you feel you have had an increase in awareness about environmental justice issues? if so, explain.” when advances in social work, fall 2024, 24(2) 410 developing this question, researchers did not include asking about environmental conservation, as the intention was to begin with a broad question to understand students' awareness and knowledge about the subject. eighty-four percent of survey participants and 72% of focus group participants expressed an increase in awareness about the environment and environmental issues since starting the social work program. one participant explained that before coming into the program they “saw only the tip of the environmental justice iceberg.” “the msw program and the professors have brought [environmental justice] to my attention.” another participant said, “i think the majority of the education has come from the msw program.” three participants out of 19 from the survey and six participants out of 18 from the focus groups noted that the exposure they received was limited, and they did not feel an increase in awareness. eight participants from the focus group expressed that though they reported an increase in awareness, it was slight and acknowledged they would have liked more education and exposure to environmental justice. “throughout my whole four years in the bsw program, i only got exposed twice.” three msw participants stated their awareness about environmental justice did not increase during the program. these were all advanced standing student participants who came to the msw program from another institution. furthermore, participants expressed there was a lack of required learning about environmental justice. while they were able to explore it in assignments where participants were allowed to select a topic, these assignments did not inform those who were not already interested in environmental justice. environmental conservation: participants discussed sustaining the planet and the human population. they provided examples of individual tasks they do, or can do, such as reusing materials, recycling, paying attention to food waste, and changing their eating and driving habits. these themes revolved around sustainability and protecting and preserving the planet, which fell into the definition of conservation. participants discussed individual pro-environmental behaviors; however, they did not discuss any other areas that fall under the scope of conservation, such as management or restoration. environmental justice: when participants in the focus groups were asked about environmental justice, they provided examples of environmental injustices they have seen in the media. they discussed being more cognizant of how government and the corporate world play a role in issues that create environmental injustices, needing to combat environmental issues through advocacy and policy efforts, and recognizing that environmental justice is social justice. by contrast, survey participants provided a statement defining environmental justice. themes from these statements included “taking care of the planet” and “everyone having equal rights to basic needs.” attitudes participants were then asked, “how have your attitudes about environmental justice and conservation shifted since enrolling in the social work program?” participants across the focus groups and most surveys reported caring more about the environment than they did when they first came into the social work program. seventeen survey participants thibeault et al./environmental justice 411 expressed having a shift in their attitudes about environmental justice. of these, 30% of participants' remarks were related more to environmental conservation; 16% of participants specifically identified issues relating to environmental justice. for example, one participant said, “i guess in a way, like i do feel more influence. to get up and say stuff and do stuff on a macro level. i feel like my attitude about conservation has really changed.” two survey participants were the exception and reported not feeling a shift in their attitude about environmental justice. one said, “i have always cared about the environment!...it was just how my mom raised me.” environmental conservation: when researchers explored participants’ shift in attitudes about environmental justice, each focus group presented issues that pertained to environmental conservation. two survey participants mentioned conservation when asked about a shift in their attitude. each focus group noted the importance of conservation to save the planet, and that they could do more to educate friends and family members. one participant explained that when people mentioned recycling and conservation efforts in the past, they thought, “here we go again.” this participant reported they now listen to others and investigate what they can do for the planet. environmental justice: while no survey participants reported feeling overwhelmed by the topic of environmental justice, some participants in the focus groups did. one participant summarized, “yeah, it's, it's definitely something i'm interested in, but it's also, to me...this big concept, you know, this insurmountable mountain...” both focus groups and survey participants expressed interest in making a difference, feeling empowered, and understanding that although movement may be slow, action needs to be taken. one focus group participant reported, “and so i feel like now that i've gone through this program, and i am seeing it creeping up into my backyard. it's like, hey, we need to do something about this… that’s where i’m at.” and a survey participant described, “i have been more passionate in environmental justice, and it makes me want to spread awareness and be more involved.” participants expressed that they understood this is not just something they “should” do, but that it is an obligation as a social worker. two participants explained that by learning about environmental justice issues, they could be less judgmental of people who lack resources and now look at the systemic issues that impact them. for example: i am a lot more aware, and i was never really judgmental before but definitely less judgmental now seeing people that don’t have access to resources and why that may be. i think we just assume that they are lazy, that’s why they don’t have a job and stuff like that. action when asked, “if awareness and attitudes have shifted, how have your actions changed to support the shift?” participants shared about past, present, and future actions. three focus group participants (16%) and two survey respondents (11%) expressed that, while being in school, it was unrealistic for them to make significant changes in personal habits or to be involved in macro efforts relating to the environment. ten focus group participants advances in social work, fall 2024, 24(2) 412 (56%) and five survey participants (26%) discussed considering changing personal behaviors. one group used the “planting the seed” adage to describe what the social work program has done for them when it comes to environmental issues, and what they need to do when they go into the field. environmental conservation: action themes that emerged started with discussing personal habits that can make a difference, such as using eco-friendly products, reusing, repurposing, and recycling. four focus group participants (22%) and six survey participants (32%) noted how they began implementing these changes since being in the social work program; and one focus group participant and two survey participants, a total of 8%, mentioned needing to begin or to do a better job with environmental conservation. examples included, “i started recycling and i pretty much only buy secondhand clothes now...and i have switched almost all of my skin care, cleaning products, laundry to cruelty free options.” additionally, one participant voiced that she and her husband have explored converting their home to solar power and purchasing an electric vehicle. environmental justice: participants reported understanding they have a responsibility as social workers to work toward equitable resources and environmental justice. all groups discussed the importance of advocacy and education. one participant explained that because of the social work program she is now able to “identify it” and can talk with others about environmental justice and conservation. participants also explained the action they have taken. one participant reported that since being in the program they began attending local council meetings to hear about what is going on in the community. one participant mentioned making donations to the water protectors for the no dakota access pipeline movement. another participant, who was involved in environmental activism in their home community to address pollution from the local pork plants, explained their efforts to address environmental issues: i'm vegan ...i was telling people, if you want to make a dent towards them, you're going to have to stop financing your own genocide. stop buying pork products because if you're telling them on one hand you don't want them to do this to you, but you are at the same time giving them the resources to kill you, what you're saying really doesn't mean anything. so, that's the reason why mlk always spoke about economic boycotts. participants lumped environmental justice and conservation together and identified it on micro or mezzo levels. furthermore, most participants expressed that prior to the program they mistook environmental conservation for environmental justice and did not recognize that, while there is overlap, the scope of environmental justice goes beyond conservation. for instance: i think if i were to hear the term environmental justice and how it related to me before the master’s program, i would be like, ’i like recycling and i try to use reusable bags when i go to the grocery store,’ it was more like, ’what are some small things that i can do’ and like vote for people that want to protect water ways and clean the air. i saw it as more of like, it reflected personal decisions that i could make. i didn’t think of it on a macro level in terms of how it was affecting large groups of people… thibeault et al./environmental justice 413 interest prior to discussing curriculum placement participants were asked, “what is your level of interest in environmental justice?” for focus groups participants, only one out of 18 participants expressed a lack of interest in environmental justice. all other students expressed a high interest since being in the program. participants in the survey varied and most answered the question using a scale of one to ten, or “medium” or “high.” using the language of “medium” (scale ranging between 4 and 7), and “high” (scale ranging 8 to 10) 32% of participants expressed medium interest, 58% of participants expressed high interest, and 10% expressed no interest. one participant who expressed no interest explained, “to be honest, it’s something i don’t think about until a need arises for either me or my client.” curriculum placement lastly, participants were asked where they felt environmental justice should be embedded into the curriculum. nine participants reported that content should be embedded throughout the curriculum. one explained that, like cultural diversity, it should be included in all courses. six participants stated that it should be a stand-alone core course. all participants agreed the topic of environmental social work and environmental justice should be required in the curriculum. participants in the undergraduate program identified the following as courses that should highlight environmental justice: interviewing and recording, policy, human behavior and the social environment, practice with communities, and research. participants also suggested “planting the seed” early by including content on environmental justice in their required pre-social work courses such as cultural diversity and professional values and ethics. msw traditional standing student participants suggested incorporating environmental justice into policy and research. advanced standing student participants recognized that these courses are not part of their curriculum because they have already taken them during the undergraduate program. many advanced standing participants also noted how they either completed their bsw long ago (prior to the environmental justice requirements) or attended a program that did not discuss it. one participant explained: i have become way more inclined to view the social work profession as obligated to social justice. it no longer appears to be just an interest or concentration that social workers can have, but rather it is a duty to have environmental justice at the forefront of the profession. this university’s msw program has a clinical concentration. because of this, participants stated that to ensure that environmental justice is included in the curriculum, case examples should be embedded in practice courses and a macro assignment could be provided in advanced practice with human service organizations. participants emphasized the need for environmental justice content to be included in both msw concentration and foundation-level courses. advances in social work, fall 2024, 24(2) 414 limitations there are several limitations to this study, and findings should be interpreted within their context. first, demographic information was not collected. researchers are, therefore, unable to describe the sample in terms of race, gender, age, or other features beyond their program status. the only criteria for participation in the study was being a social work student in 2020, who graduated from the program, and in 2021 were scheduled to graduate. it is important to note that it is possible that participants in the study already had an interest in environmental justice. for example, several participants revealed they had taken an elective focused on environmental justice. this means their responses may have differed from participants who did not take the said elective. similarly, while investigators indicated that participation in this study would not impact their gradesand investigators committed to the integrity of maintaining this ethical obligationit is possible that participants hoped it could earn them favor with faculty in the future. the informed consent explained the benefits and risks of participating in the study which did not identify grades or future favors, yet simply identified the benefits as an increase in awareness about the natural environment and social work skills, as well as assisting the department. the risks were identified as minimal with the only potential risk being loss of confidentiality for focus group participants due to lack of control of what members of the group share outside of the group. the interview questions used in this study were drafted by the lead researcher, who has expertise in teaching about environmental justice, and finalized by the research team. they were designed to capture information about students’ “awareness,” “attitudes,” and “actions”; and therefore, used that verbiage specifically. while this may offer initial evidence for face validity, the questions were not previously validated or tested for reliability. during the data analysis, researchers recognized that responses from students vacillated between justice, conservation, and sustainability. cswe’s curricular guide for environmental justice (2020) provides a definition of environmental justice where conservation and sustainability lie within environmental justice. however, researchers recognized the need to pull these apart to examine the data. in hindsight, it would have been better to conduct the study with questions pertaining to each area such as asking participants, “what’s the difference between environmental justice, conservation, and sustainability?” all researchers were faculty members in the programs being studied. although the original plan was for the bsw faculty to conduct interviews with participants from the msw program, and the msw faculty to conduct interviews with participants from bsw program to decrease the likelihood of skewed answers from participants, the need to adjust recruitment and interview methods changed due to the covid-19 pandemic. two researchers were present for each interview. in some cases, participants may have had one or more of the researchers as an instructor or advisor. similarly, participants may have known other participants in the group, if they were from the same location or program. while the closed format of the group was decided on intentionally as a method of enhancing feelings of safety and openness, we cannot rule out the possibility of social thibeault et al./environmental justice 415 desirability bias. researchers agreed that since participants had graduated or were close to graduation, and that the questions were related to the program in general and not specific courses taught by the researchers, participants would be less likely to provide biased responses. when the university suspended in-person operations due to covid-19, it required shifting to an online video conferencing platform. while this shift did provide the opportunity for some students to participate, because of constraints associated with the pandemic, other students were still not able to attend virtual interviews. researchers therefore opened another avenue for data collection, an electronic qualitative survey, where respondents were asked identical questions and allowed to type their responses. surveys were anonymous and completed individually. while the questions and response options were identical, it may be possible that participants responded differently depending on the data collection methodology. for example, survey participants may have been less likely to be impacted by the professor/interviewer and other participants than focus group participants. there is also less opportunity to gain clarity or to ask follow-up questions in surveys (jain, 2021). social work implications this case study was conducted with students immediately after graduation or in their final semester. the purpose of this research study was to explore the environmental awareness, attitudes, and actions of graduating undergraduate and graduate social work students and to what extent their social work education played a part in their growth. data analysis led to the identification of three main issues: (1) clarification of environmental conservation vs environmental justice; (2) an understanding of environmental justice at micro, mezzo, and macro-system levels; and (3) the opportunity to have a direct practice experience and reduce feelings of being overwhelmed by the enormity of environmental justice concerns. environmental conservation vs. environmental justice the cswe prioritizes environmental justice in the epas competencies. consistent with prior research (chonody et al., 2020; faver & muñoz, 2013), students who have educational opportunities to learn about the importance of environmental issues respond with greater understanding (awareness) and concern (attitudes). some of these concerns appeared to be related to socialization into the social work profession and accepting that environmental justice is part of the scope of being a social worker. some participants appeared to move from awareness to attitude and action quickly during their social work education. participants who noted minimal action explained that they do have a sense of responsibility to environmental justice and that they would explore how to act once they enter the field. an important finding in this study was that participants often confused environmental conservation and environmental justice. this was shown by the type of conservation examples provided in response to the prompt, “what does environmental justice mean to advances in social work, fall 2024, 24(2) 416 you?” notably, this blurring of concepts and definitions is also problematic in prior writings where environmental issues and environmental justice are often discussed interchangeably. the lesson learned for social work education is that students (and faculty) may already think they are aware while not realizing they lack precision of what environmental justice means. that said, it is critical for social work programs to have environmental justice embedded in the course curriculum and for social work programs to build environmental justice into their faculty development. much like one of limitations of this study where it was suspected that participants joined the study because of their interest in environmental justice, while students who did not have an interest chose not to participate, faculty members who do not have an interest in environmental justice may not attend trainings that would increase their knowledge. this echoes previous research on the predictors of integration of environmental justice concepts into social work curriculum, where faculty familiarity and knowledge of environmental justice significantly predicted the likelihood that it was infused into teaching (strayer et al., 2022). environmental justice at the micro, mezzo, and macro-systems level most participants in this study reported a high level of awareness, positive attitude, and were already taking some degree of personal micro-level environmental conservation action, as well as advocating to others to do likewise. these participants had already attained self-efficacy in their actions. however, comments suggested some participants were experiencing environmental conservation fatigue before starting the program. for these participants, the conversations and exposure during the program brought a new level of awareness which, in turn, revitalized their attitudes and actions. this phenomenon is important to remember and is consistent with the sixth stage of change (maintenance) in the transtheoretical model (ttm) where it is important to reinforce habit change and selfefficacy (diclemente & velasquez, 2002). commitment to conservation and having a sense of environmental conservation competence may be an important precursor to moving students to understand that conservation is an act that falls within the realm of environmental justice. therefore, environmental conservation must be discussed in the curriculum. participants reported micro-level action as environmental conservation (i.e., recycling, repurposing, switching to solar energy), and viewed mezzo and macro actions as environmental justice examples (i.e., dakota access pipeline, climate justice). possibly because focus groups defined environmental justice by example and not by definition, their ability to see environmental justice issues as micro, mezzo, or macro is compromised; and they do not see the possibilities for environmental conservation and justice across all levels. few participants had awareness of environmental justice issues in their own backyard and focused mainly on issues that were in the national news. the issues were “out there” and not close to home. this is consistent with findings by sparks et al. (2019), who found that students struggled to both understand what environmental justice is and how it connects to people. educators must be able to help students understand that environmental justice spans across all levels and recognize how this global issue impacts regions, communities, families, and individuals; along with how the environmental action of an individual can impact families, communities, regions, and the globe. thibeault et al./environmental justice 417 overwhelmed by environmental justice practice participants reported feeling overwhelmed by the enormity of environmental justice issues and reported feeling helpless to act. although they were effectively made aware of, and experienced a cognitive attitude shift, their affective attitude shift also included a sense of overwhelm, thwarting movement toward action. this reaction is similar to that of community samples in climate change studies, where helplessness leads to ecological anxiety and even grief (ojala et al., 2021; soutar & wand, 2022). while large events and media may be effective in gaining the attention of students, environmental justice education needs to address the micro to macro spectrum so that students can appreciate how environmental justice takes place in every community. they may also benefit from seeing themselves as partners with their clients, where they disseminate knowledge, raise awareness, and encourage their clients to identify their needs and solutions (heflinger & christens, 2006; wu et al., 2022). further research during this study, the need for further research was recognized and a pre/post quantitative validated survey was developed to be given to students during a core course in their first and last semesters in the program. researchers also identified many areas which could be further explored such as students' views about environmental issues that impact marginalized populations, students' firsthand experiences with environmental injustices, and exploring student changes in awareness, attitudes, and actions throughout the program rather than only upon entry and exit. this type of study can be done in social work programs across the globe. additionally, it would be helpful to the social work profession to conduct studies for social workers in the field to determine their level of environmental justice awareness, attitudes, and actions. a comparison of social workers who entered the field from the various epas would help to see if social workers across the profession have prioritized environmental justice. lastly, comparing this study with similar studies, from the same and other regions, could provide a sense of where our program strengths and areas for growth lie. it may also shed light on how geographic location can impact students’ views of environmental justice. for example, this study was based in southern appalachia which is known for its unique environmental and conservation issues of coal mining and mountain-top removal, which are both important to the economic livelihood of the local communities and, by contrast, has led to high rates of health problems. environmental justice in social work curriculum participants’ opinions about the placement of environmental justice in curriculum varied widely (required vs elective course, cross-curriculum immersion, etc.), yet all endorsed the importance of environmental justice education. lee et al. (2022) reviewed pedagogies for teaching social justice and found the most utilized approach in social work education was “real or simulated ‘experiential learning’ to increase students’ direct and/or indirect exposure to diverse lived experiences and to have students critically reflect on their advances in social work, fall 2024, 24(2) 418 privileges and biases through teaching methods” (p. 774). activities that fall within experiential learning include, “igd [intergroup dialogue], talking circles, inter-/intragroup journal writing, online discussion boards, guest speakers, simulated vignettes, role plays, community-engaged activities on site, and simulated online community building gaming” (lee et al., 2022, p. 774). other writers have made suggestions for and referenced resources for course outlines (bartlett, 2003; lucas-darby, 2011; sparks et al., 2019) or placement into existing courses (faver & muñoz, 2013) or field education (hayward et al., 2013; rogge, 1993). holbrook et al. (2019) articulate frameworks and application strategies for micro, mezzo, and macro practice, and field education practicums. they also propose a train-the-trainer approach to prepare social work educators and field instructors. additionally, the curricular guide for environmental justice (cswe, 2020) addresses the integration of environmental justice across the generalist social work curricula and the nine generalist-level competencies of the cswe epas. resources and practice suggestions are provided to address awareness, attitudes, and actions. a foundation for educating social work students about environmental justice is ensuring that students understand the overlap between environmental justice and environmental conservation; as well as how they span across the micro, mezzo, and macro practice in social work (naranjo, 2020). after reviewing the work of the red campus sustentable (a professional organization whose mission is to promote sustainability in higher education), naranjo (2020) claims, “sustainability is an area in which social workers can collaborate and suggest community strategies” (p. 450). to understand sustainability, social work students must examine and consider how individual behaviors impact the world and its species. other examples on how to integrate environmental justice into the micro to macro spectrum in the social work curriculum is in field education. experientially, students might connect their education to the direct practice of environmental justice through working with clients (beltrán et al., 2016) and/or as part of a class project. at the micro level, for example, students can learn about the environmental hazards of mold and advocate or mediate with property owners on behalf of vulnerable families who may not have the resources to act on their own behalf (anderson et al., 2020; choi et al., 2021). mezzo-level policy education can include sources found on the environmental protection agency (epa) environmental justice webpages, such as environmental justice in your community (epa, 2024) and the environmental justice video challenge for students (epa, 2023) which encourages mezzo-level practice wherein students work with communities to identify and develop strategies to address local environmental justice issues. beltrán et al. (2016) also suggested similar but less elaborate mezzo-level class project practice ideas, such as partnering and participating with a river cleanup coalition. conclusion in recent years, environmental issues have highlighted how vulnerable people disproportionately experience consequences of environmental problems. the covid-19 pandemic, a public health issue, brought to light how environmental conditions differentially impact marginalized communities, poor communities, and communities of thibeault et al./environmental justice 419 color, as evidenced by higher rates of infection and where disease prognosis is often worse (powers et al., 2021). it has also been documented that marginalized communities access medical care, including vaccinations, at lower rates than their counterparts putting them at higher risk (baah et al., 2019). at the same time, problems associated with the climate crisis are devastating communities already experiencing hardships. the social work code of ethics calls social workers to serve and advocate for marginalized people and their needs (nasw, 2021). as the social work profession becomes increasingly aware of the complex relationship between environmental health equity, economic insecurity, and environmental justice, it is crucial for social workers to pay attention to, and develop strategies for, working with people experiencing these issues (watson et al., 2020). as cswe (2020) notes, social work curriculum, therefore, should lay out a pathway for students to critically consider and understand the nuances of environmental conservation versus environmental justice and how to work with clients directly experiencing environmental injustice. similarly, there may be ways to provide direct practice opportunities for students to work with environmental justice across the micro, mezzo, and macro-systems levels, which can improve self-efficacy and reduce feelings of being overwhelmed. infusing social, economic, and environmental justice into all levels of social work practice is needed when so many clients are impacted by injustice every day. references american academy of social work and social welfare. 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(2022). promoting environmental justice and sustainability in social work practice in rural community: a systematic review. social sciences, 11(8), 1-22. author note: address correspondence to deborah thibeault, department of social work, east tennessee state university, johnson city, tn, 37614. email: thibeault@etsu.edu https://doi.org/10.1080/10705422.2019.1655124 https://doi.org/10.1080/10705422.2019.1655124 https://doi.org/10.1080/02615479.2022.2050895 https://doi.org/10.1080/02615479.2022.2050895 https://doi.org/10.1080/02615479.2022.2050895 https://doi.org/10.5243/jsswr.2013.1 https://doi.org/10.1111/famp.12 https://doi.org/10.1111/famp.12 https://doi.org/10.7748/ns.29.34.38.e8821 https://doi.org/10.3390/socsci11080336 https://doi.org/10.3390/socsci11080336 mailto:thibeault@etsu.edu awareness, attitudes, and actions about environmental southern appalachia _________ shamsun nahar, phd, associate professor, school of social work, psychology, and philosophy, texas woman's university, denton, tx. beverly wagner, edd, lcsw, bsw program director, social work, university of maine at presque isle, presque isle, me. alex colvin, phd, lmsw, associate professor chair of undergraduate program, school of behavioral health and human services, university of north texas, dallas, tx. nila ricks, phd, lcsw, associate professor and director, school of social work, psychology, and philosophy, texas woman's university, denton, tx. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 128-148, doi: 10.18060/27746 this work is licensed under a creative commons attribution 4.0 international license. understanding the covid-19 impacts on social work learning through the lens of planned behavior theory shamsun nahar beverly wagner alex colvin nila ricks abstract: covid-19 was a global pandemic that caused higher education to enter emergency distance learning. students experienced a myriad of emotional and psychological stressors during this pandemic. while the demand for online learning has been steadily increasing, even in the field of social work, it has nonetheless lagged behind other disciplines due to concerns about limited interpersonal interactions. we attempted to understand students’ intentions, behaviors, and outcomes related to the distance learning method during the covid-19 pandemic through the lens of planned behavior theory. we used a cross-sectional qualitative study containing some quantitative questions. study data was drawn from 13 interviews conducted at two hispanic serving institutions (hsis) in north texas. findings of our study included three major themes: challenges and stressors; attitudes, subjective norms, and perceived behavioral control that increased intentions and adaptive behaviors; and resource gaps that interfered with adaptive behaviors. exploring students’ perceptions and behavioral responses to learning provides identification of new or hidden pedagogical obstacles and novel approaches to address the challenges in social work education. the study findings can contribute to improving resources and addressing gaps in the curriculum as we continue to think critically and creatively about virtual education in the future. keywords: distance learning; planned behavior theory; covid-19 pandemic; online learning; social work in march 2020, covid-19 was declared a global pandemic (lee et al., 2021). similar to many communities across the nation, north texas began closing all non-essential businesses and organizations in an effort to reduce the spread of the virus. higher education was no exception. indeed, higher education institutions were forced to quickly adapt to remote and/or hybrid learning formats which impacted students significantly (centers for disease control [cdc], 2021). social work programs were also affected. due to social work programs' historical emphasis on “hands on learning” (shklarski & ray, 2021, p. 506), transitioning all coursework to distance formats was particularly challenging for both students and faculty. moreover, although the us council on social work education (cswe) offered guidance on modified field education hours and virtual formats, issues of technological deficits and/or lack of computers negatively impacted learning (cswe 2025 melero et al., 2021). these challenges compounded other pandemic related stressors of emotional and psychological hardships from the loss of finances and employment, lack of resources, isolation, fear of the unknown, the sudden transition to online learning, and about:blank nahar et al./covid-19 & planned learning behavior 129 subsequent depression, and anxiety (brooks et al., 2020). the combination of these sudden forced adaptations and losses affected individuals emotionally, socially, physiologically, and psychologically (lee et al., 2021). this article explores the impact of covid-19 on social work students at two mid-sized hispanic serving institutions (hsis) in the north texas, united states and examines what occurs when there are sudden shifts in educational delivery. hsis are one category of united states (us) minority serving higher education institutions that serve underrepresented populations (us department of the interior, n.d.). hsis are higher education institutions where at least 25% of undergraduate student enrollment are hispanic students. the universities in this study were located in a residential area within a larger urban metroplex. the majority of students at both campuses were black, indigenous, and persons of color (bipoc), 57% and 59%, respectively and close to half were first generation students 54% and 41.5% (texas woman’s university [twu], 2024; university of north texas [unt], 2023, 2024). students attending hsis during the pandemic were more likely to experience economic hardships, isolation, food insecurity, and financial stress due to persistent us structural and social inequalities exacerbated by covid-19 (ibarra-mejia et al., 2022; manboard et al., 2021). thus, an understanding of internal and external factors that influenced learning responses during a crisis such as a global pandemic, can provide valuable information to both universities and social work programs regarding novel barriers and effective actions. the lens of the theory of planned behavior is used to explore students’ intentions, behaviors, and outcomes related to factors that influenced learning responses, such as the immediate integration of technology. literature review background the outbreak of sars-cov-2 began in wuhan, china in december of 2019. by january 2020, the world health organization (who) identified this virus as the one responsible for a highly infectious respiratory virus called covid-19 (marinoni et al., 2020). within a few short months, the who declared covid-19 a pandemic that triggered lockdowns worldwide in which all non-essential businesses, organizations, and human service organizations were closed to face-to-face transactions (dutta et al., 2023; lee et al., 2021). higher education was also adversely affected. by april of 2020, institutions in 185 countries were closed, classroom teaching had been replaced by distance learning, and in the us, 1,100 colleges and universities within all 50 states canceled face-to-face classes (marinoni et al., 2020; national association of college and university business officers [nacubo], 2021). impact of the covid-19 pandemic on higher education worldwide, higher education institutions were faced with the challenges of shifting immediately from face-to-face to virtual learning (cdc, 2021; khan, 2021). challenges included both student and faculty access, proficiency, and support for complete virtual or technology-mediated learning (berger et al., 2022, p. 43; f). these shifts to remote learning advances in social work, spring 2025, 25(1) 130 could have exacerbated stress and anxiety already present due to the uncertainties and health-related worries due to the virus, sudden social changes, isolation and loneliness, subsequent economic interruptions, and job loss among educators and students (dempsey et al., 2022; fox, 2021; khan, 2021; lee et al., 2021). as the pandemic continued, institutional enrollments and retention of students were impacted. hsis like other universities around the country also experienced a drop in enrollment, however, the most significant drops were reported among hispanic, undergraduate females (mshigeni et al., 2022). a combination of issues appeared to impact enrollment. the nacubo (2021) reported that in the fall of 2021, enrolments were impacted by an inability to pay due to pandemic-related job loss or changes in income, students contracting the covid-19 virus, and/or students who had to care for others. additional issues related to enrolments included student fatigue and frustration learning and focusing in remote environments (bullock et al., 2022). these enrollment declines impacted institutional budgets, which limited program or course offerings in some cases and in some cases threatened the financial sustainability of programs and/or institutions (blankenberger & williams, 2020; farnell et al., 2021). however, disparities caused or exacerbated by the pandemic affected some more than others. for example, even before the pandemic, degree completion rates remained low among hispanic students: 16% compared to 40% among their caucasian counterparts (arbelo et al., 2019; johnson & galy, 2013). additionally, in a document analysis of 39 manuscripts studying the effect of the pandemic on higher education, one third of first generation college students reported experiencing anxiety, and one quarter reported more difficulties completing studies at home (khan, 2021). the sudden shift to remote learning may have compounded these issues. indeed, diverse learners’ historically have lower enrollment rates in fully online courses (arbelo et al., 2019; johnson & galy, 2013). reasons may include learner anxiety and lack of training, particularly among first generation college students who may have primarily used technology recreationally, and perceptions of lack of online instructor attention and support (arbelo et al., 2019; lu & vela, 2015). lee et al. (2021) adds that students of color carried an unequal burden of financial stress, limited healthcare resources, illness and death impacting them, their families, and their communities. in some cases, these issues were compounded by a lack of institutional support such as a lack of empathy, unclear financial aid, and work-study policies during the height of the pandemic (berger et al., 2022). impact of the covid-19 pandemic on social work discipline social work like other academic disciplines faced the challenge of adapting almost immediately to fully remote learning. however, social work education programs typically have both practical and clinical components often taught as experiential face-to-face components, and as berger et al. (2022) suggests “is a cornerstone in social work courses” (p. 43). wilkerson et al. (2020) go further and emphasize that social work education as well as social service organizations have historically had an uneasy relationship with technology and limited technological training. although there has been development in the last two decades of online social work programs that demonstrated equitable outcomes, in a survey of 126 us social work faculty, 65% reported they had never taught remotely (shklarski & nahar et al./covid-19 & planned learning behavior 131 ray, 2021). thus the required virtual teaching adaptations presented particular challenges for social work education administrators and faculty (shklarski & ray, 2021). impact on students being overwhelmed and anxious were common emotions experienced by students during the pandemic, as were confusion, fear, anger and sadness (berger et al., 2022; dempsey et al., 2022). indeed, even before the pandemic, social work students historically might have experienced more issues with anxiety and emotional regulation due to preexisting mental health issues, vicarious (field-related) trauma, field education challenges such as decision making and confidence in use of skills (dempsey et al., 2022). students already working in the social work field reported the stress of dual adaptations to online learning and facilitating telehealth practices. work adaptations often called for longer hours in which student practitioners reported being on call 24/7 (berger et al., 2022). specific learning issues included access issues to reliable internet service, equipment such as laptops, and/or a safe and quiet space to join classes (keesler et al., 2022; shklarski & ray, 2021). the intersection of student diversity and the pandemic created additional layers of stress. for example, compared to other disciplines, social work u.s. student composition is diverse (i.e., about 30% are non-white and about 20% lgbtq+; berger et al., 2022). thus, as berger et al. (2022) argue, students were more likely to experience multiple traumatizing events. the killing of george floyd, for example, an unarmed black man killed by a white police officer, occurred during the pandemic; an intersecting traumatic event fueled by racism. additionally, many social work students are non-traditional students and have family and added caregiving responsibilities (berger et al., 2022). mshigeni et al. (2022) provides examples of adult, hispanic students attending california hsi institutions, half of whom worked more than 30 hours a week. other research indicated that students attending an hsi during the pandemic were more likely to experience increased levels of stress related to limited resources and economic disparities as well as higher levels of anxiety and depression (ibarra-mejia et al., 2022; manboard et al., 2021; mshigeni et al., 2022). these structural barriers were echoed by fariña et al. (2021) who noted that some social work students at an hsi did not have access to computers, internet, a quiet place to study or in some cases, housing or food resources. finally, demsey et al. (2022) noted “lapses of empathy” (p. 18) experienced and documented by students as part of their covid experiences which could be attributed to the complex needs of all players during a pandemic crisis, but also a need for increased resources and staffing to support students. thus, students experienced inconsistent support. theoretical framework the theory of planned behavior was used to understand students’ intentions and behaviors in regard to learning and teaching adaptations necessitated by the pandemic. as a framework to study attitudes toward behaviors, the theory of planned behavior suggests that the stronger a person’s intention to perform a particular behavior, the more likely the behavior will be performed (ajzen, 1991). advances in social work, spring 2025, 25(1) 132 three core constructs that predict behavioral intentions are attitude toward the behavior, subjective norms, and perceived behavioral control. the first construct, attitude, is the degree to which an individual has a favorable or unfavorable evaluation of the behavior of interest (ajzen, 1991). subjective norms refer to whether most people approve or disapprove of the behavior. subjective norms relate to a person’s perceptions about the social pressures associated with carrying out the behavior. perceived behavioral control indicates that a person’s motivation is influenced by their perception of the ease or difficulty of performing the behavior of interest (ajzen, 1991). essentially, the theory of planned behavior contends that high levels of intention to perform a behavior are connected with positive attitudes, subjective norms regarding a behavior, and heightened perceived behavioral control (sheeran et al., 2001). correspondingly, the stronger the intention to take part in a behavior, the more likely the behavior will be performed (ajzen, 1991; see figure 1). several similar studies have applied the theory of planned behavior to explore various aspects of covid-19 intentions and behaviors. for instance, wollast et al. (2021) used this model to explore the health behaviors that can slow the spread of the virus. mao et al. (2021) investigated the factors that influence preventive behaviors. dou et al. (2022) and reyes et al. (2023) used the framework to predict people’s covid-19 vaccination intentions. lastly, jilani (2024) applied the model to explore social distancing behaviors during the pandemic. thus, for the purpose of this study, the theory of planned behavior will serve as a framework to identify perceived behavioral control or lack of control, adaptive attitudinal and behavioral changes, and obstacles to behavior change experienced during a pandemic. figure 1. theory of planned behavior adapted from ajzen (1991) attitude subjective norm intention behaviour percieved behaviroal control nahar et al./covid-19 & planned learning behavior 133 figure 2. the theory of planned behavior (ajzen, 1991) as a framework for understanding online learning during covid-19 methods design and data collection we used an exploratory, cross-sectional qualitative study containing some quantitative questions to understand the impact of social work students’ perceptions and responses to distance learning during the covid-19 pandemic. two hsis in north texas were selected to recruit social work students. these hsis were selected purposely due to ease of access to the population. all of the researchers were also from these two institutions. although these institutions are hsis, they serve more than just hispanic or latinx students. these institutions offer both bsw and msw degrees using traditional in-person teaching methods. however, during the pandemic, both institutions offered a combination of synchronous and asynchronous course delivery. upon securing university institutional review board approval, we used a flier to recruit bsw and msw students between august 2021 and february 2022. we specifically sought students who were enrolled during the pandemic and thus had distance learning experiences, and were willing to share these experiences. a total of 13 students participated in this study. eight students participated from one institution and five from the other. these students were recruited based on their availability and willingness to participate. virtual interviews were conducted in english using a semistructured questionnaire (appendix a) to collect qualitative data. these semi-structured questions were aligned with the planned behavior theory. we used questions that aligned with perceptions of control or lack of control, and adaptive behaviors. examples included, “what challenges did participants perceive as beyond their control?” “what behaviors and intentions did participants use that increased control?” “what resource gaps did participants identify that were obstacles to adaption or coping?” most of the participants in advances in social work, spring 2025, 25(1) 134 our study were hispanic (85.6%) and from bsw programs (76.9%). interviews were approximately sixty minutes long. the sample size and length of the interviews were aligned with qualitative methodological standards, as we used a homogeneous sample and continued data collection until data saturation was achieved (creswell & poth, 2018; draucker et al., 2007; guest et al., 2006). secured virtual interviews were conducted through zoom using the participant's pseudonym and audio record option only. researchers used their office space to conduct the virtual interviews, and participants chose the best location for them to join the interview. numeric data were also collected through a psychdata survey and consisted of demographic, categorical, and likert questions regarding learning resources, behaviors, and perceptions. recruited participants received the survey link via email to complete it before joining the virtual interview. participants provided written consent before participating in this study. each participant received a $20 gift card as compensation for their time. data analysis audio-recorded interviews were transcribed into word document files. transcripts were considered written representations of the students’ oral stories of their learning experiences. this study was conducted by six social work researchers. among them, four researchers independently coded (appendix b) the data using a deductive, thematic approach or a top-down approach that aligned with and used a theory of planned behavior framework to code themes across the data (braun & clarke, 2006; creswell & clark, 2017). among these four researchers, two are experts in conducting qualitative study and publishing their work regularly. other two coders were trained to work on this. we viewed each student’s story as a whole and emphasized knowing each student’s experience and behavioral adaptations. we relied on core tenets of planned behavior theory: attitudes, norms and perceived behavioral control and intention (ajzen, 1991), to analyze the data. in this study, perceived control was control that students believed they had or did not have during the pandemic. intention was their intent to perform a behavior. consistent with planned behavior theory, we pointed out areas of perceived lack of control and shifts stemming from different attitudes, norms and intentions that led to behavioral adaptation. we focused our analysis on three categories: challenges and stressors; attitudes, subjective norms, and perceived behavioral control that increased intentions and adaptive behaviors; and resource gaps that interfered with adaptive behaviors. numeric data was also analyzed using descriptive statistics. validity was established through the triangulation of the quantitative and qualitative data. reliability was demonstrated through establishing coding protocols and having independent researchers check the transcripts. findings quantitative results the average age of the participants was 19 which ranged from 19 to 28 years (see table 1). although 53.8% of the participants resided in their own place, 92.3% of the participants mentioned that they had to share their living space. scholarship (46.2%) was the primary nahar et al./covid-19 & planned learning behavior 135 source to pay the tuition fees for most of the participants. over three-fifths (61.5%) of the participants mentioned the face-to-face learning method as their preferred method. it was interesting to find that more than half of the participants mentioned their gpa was about the same before and during covid-19. more than three-fourths (76.9%) of the participants mentioned distance learning course instruction during covid-19 was “somewhat clear” whereas only 7.7% mentioned, “not clear”; and 30.1% informed they were dissatisfied with the distance learning experience (see table 2). also, most of the participants confirmed that they experienced moderate disruption in their learning process during covid-19. most of the participants experienced mental health problems (61.5%) and financial crises (23.1%) during this period. table 1. demographic description of the study sample (n = 9-13) median age (range = 19-28 years) 19 n (%) academic programs bsw 10 (76.9%) msw 3 (23.1%) hispanic students hispanic 11 (84.6%) non-hispanic 2 (15.4%) reside student housing 2 (15.4%) own home/apartment 7 (53.8%) other 4 (30.76%) living arrangement do not share space 1 (7.7%) share space 12 (92.3%) way of managing tuition fee student loan /financial aid 2 (15.4%) scholarship 6 (46.2%) parent(s)/partner paid 1 (7.7%) savings 1 (7.7%) other 3 (23.1%) gpa before covid-19 much better 1 (7.7%) better 3 (23.1%) about the same 8 (61.5%) worse 1 (7.7%) the learning method like most face-to-face 8 (88.9%) online 1 (11.1%) advances in social work, spring 2025, 25(1) 136 table 2. learning experiences during covid-19 (n = 13) learning experience n (%) the distance learning experience during covid-19 satisfied 6 (46.1%) neither satisfied/ dissatisfied 3 (23.1%) dissatisfied 4 (30.8%) impacts of covid-19 on learning major disruption 4 (30.8%) moderate disruption 8 (61.5%) no disruption 1 (7.7%) clarity of online course instructions during covid-19 learning very clear 2 (15.4%) somewhat clear 10 (77.0%) not clear 1 (7.7%) barriers experienced to completing courses during covid-19 unable to get access to resources 1 (7.7%) unclear instruction 2 (15.4%) mental health problem 8 (61.5%) financial/job crisis 3 (23.1%) qualitative findings we used our theory of planned behavior framework to identify and examine challenges or stressors experienced by social work students during the pandemic as well as shifts in attitudinal, normative, and perceived control that increased adaptive behavioral responses to these challenges. we also examined stressors that interfered with adaptive responses. emergent subthemes in the category of challenges and stressors included learning challenges, mental health challenges, and environmental challenges. table 3. themes and subthemes theme and subtheme brief examples challenges and stressors • learning • mental health • environmental “i needed to really concentrate, but there was no quiet place.” “my anxiety so high because, when it started …” “the boundaries between schoolwork and home life were blurred.” attitudes, subjective norms, and perceived behavioral control that increased intentions and adaptive behaviors “recognizing you know this is a humbling experience for everyone.” resource gaps that interfered with adaptive behaviors “it was so unorganized and it was so hard to know what was going on.” nahar et al./covid-19 & planned learning behavior 137 challenges and stressors learning challenges. learning challenges were those areas in which participants noted significant and unavoidable challenges to learning. workspace was a common issue. for example, one participant noted “i needed to really concentrate, but there was no quiet place.” additional issues highlighted included family distractions when members walked in and out of workspace as well as the number of persons living in the household. as noted by a participant: “i live with a lot of other people.” while some participants noted they had taken online courses previously, the abrupt transition and transition of all courses to a distance format, in which students had no choice, interfered with focus. participants described fears of “because everything was online, am i really grasping my information?” as well as additional time needed to grasp information: “it felt like i had to learn how to comprehend all over again.” one student described an unaddressed need as a “space even after class with one another to talk about what we just learned...make sure that each one of us understood.” finally, motivation to learn and succeed in online settings was described as one of the biggest challenges. mental health challenges. this lack of motivation was noted as an outcome of mental health challenges experienced during the pandemic. one participant described this as, “a big decline in my mental health… i guess i got unmotivated and i felt like there was no reason to really look forward to learning honestly. it all felt the same every day.” yet similar to other studies, anxiety was a common mental health challenge experienced by participants as they attempted to navigate sudden changes within school and work (berger et al., 2022; brooks et al., 2020). stressors were described by one participant as “i got laid off from my job because they didn’t need me anymore ‘cause i was a part time student so that was hard for me and then with that my mental health kind of got lower and lower...and then because my siblings came and i had to take care of them.” other participants described having to work during the pandemic, “my anxiety so high because, when it started, i was also working...so it's just a lot of people all the time; a lot of us were getting sick and like nobody knew what to do.” pandemic related isolation was also emphasized as a reason for mental health decline, particularly at the beginning of the pandemic. severed connections with family and friends were described, “it did impact my family's relationship for one, like my immediate family, they live further away. so i wasn't able to go see them...and that really messed with my emotional health because i'm close to them,” and as another participant described, suddenly their bedroom became “every place.” environmental challenges. blended boundaries between home and school, caring for family members, lack of consistent wi-fi, and unemployment were some of the environmental challenges described by participants as beyond their control. blended boundaries created a sense of never having time to relax. “the boundaries between schoolwork and home life were blurred...i wish i could have just left school stuff at school so it doesn’t, you know, eat away at my personal life.” caring for children and extended family members were also described as stressful when learning and attempting to work advances in social work, spring 2025, 25(1) 138 online. participants who were forced to take employment outside the home described anxieties of bringing covid home to loved ones. although social work programs at both universities attempted to provide consistency through using the same learning management system (lms), canvas, to deliver curriculum, zoom to deliver synchronous courses, and lms and a variety of online training for both faculty and students, inconsistencies in internet access were issues for some students. lack of consistent wi-fi was a problem, and one participant described going to a local fast-food restaurant for their synchronous online courses. indeed, mshigeni et al. (2022) noted that the digital divide was amplified during the pandemic for hispanic and black students. perhaps the biggest stressor, however, was unavoidable job loss and having to find other employment. participants described their own job loss, loss of work study positions at universities, loss of spousal employment, and loss of other family members’ employment, for example, “other members of my household, lost employment. so i had to start helping with my personal money.” attitudes, subjective norms, and perceived behavioral control that increased intentions and adaptive behaviors as the pandemic progressed, some participants’ attitudes shifted which increased perceived control, motivation, focus, and in turn, increased behaviors that encouraged academic success in online learning environments. subjective norms as well as external pedagogical practices also supported these online learning related behavioral intentions. participants described how linking social work values and knowledge to their own experiences encouraged an attitude and behavioral shift. for example, one participant explained how they reevaluated the self-care ethic within the nasw code of ethics and made intentional choices to practice self care. others noted that knowledge of mental health issues assisted them in identifying their own mental health needs, and adapting new coping behaviors. these included intentional behaviors to set communication boundaries with family members as well as seeking support in alternative ways. in some cases this included social work professors and classmates. as one participant described, “knowing that your classmates are kind of going through the same situation and knowing you're all kind of struggling together, like the sense of community still, you're not completely alone.” participants also noted that some professors did group “mental health checks” at the beginning or end of class and reminded them of campus resources, which increased awareness of mental health needs and encouraged intentional self-care behaviors. subjective norms for academic success were also emphasized. these included norms of openness such as professors sharing their own difficulties which assisted participants, “recognizing you know this is a humbling experience for everyone.” encouraging open communication led to behaviors that supported academic success. as one participant explained, “talking to my classmates and being in constant communication with my professor for clarification” and “utilize my cohort more. it just made things easier since they were just as lost as we… like i was. we kind of collaborated on ideas.” nahar et al./covid-19 & planned learning behavior 139 through these attitudinal and normative shifts, participants perceived more control over their behaviors and “figured out” new ways of utilizing coping behaviors. examples included “locating a designated workspace,” and “became more organized with time management.” other behaviors included ways to complete work such as use of mobile devices to listen to classes, using background music to focus, and figuring out what work could be completed on phone and what needed to be done on laptops. resource gaps that interfered with adaptive behaviors despite adaptive attitudes that increased behavioral adaptions to online social work learning, resource gaps created some insurmountable barriers. these included gaps in university support services, social work department, and social work course levels. hours of operation and extent of services offered were common issues. for example, campus food pantries were limited due to decreased hours of operation. additionally, campus counseling services were noted as not consistently accessible. as described by one participant, i was getting really depressed. it was when we… i transferred over here and everything was online basically but when i went to the university counseling center, i got interviewed and they were like oh yeah sounds like your anxiety is like at 100%...but i have no one to offer. other issues included needs for technological support such as students living in rural areas with inconsistent wi-fi or need or access (rent or buy) to low-cost laptops. finally, loss of work-study income was another issue with one participant describing how they first lost work-study and then lost their other part-time employment. gaps at the social work department level included collective interactions and other forms of mentoring that took place prior to the pandemic. participants noted that spaces to share were missing and one participant explained that “i was bottling in because everyone else was going about life like things were normal.” others emphasized the lack of department level celebrations and made suggestions for some form of peer mentoring during future collective crises. participants highlighted many issues related to the individual course level. these included technological knowledge gaps of some professors which led to poorly organized courses, and weak personal connections with students. as one participant described, some professors had limited knowledge about the learning management system “it was so unorganized and it was so hard to know what was going on.” additional issues included a lack of feedback on assessments and inconsistent zoom office hours. field education courses were also mentioned by some students as offering less online than if students could be present on site. finally, students noted a lack of understanding and or lack of connection, which made the transition to online learning particularly challenging, “some teachers… not all…just acting like it was going to be a smooth transition… there was gonna be no bumps in the road,” and “my professor cared more before covid.” advances in social work, spring 2025, 25(1) 140 discussion this study provided the unique perspectives and voices of social work students whose learning was impacted by covid-19 and their transition from a face-to-face model to an online learning environment. approximately 190 countries implemented school/university closures, impacting 1.57 billion students (xiao & fan, 2020). college campuses quickly pivoted to remote or online learning to minimize disruptions to students (leblanc, 2020). nevertheless, disruptions in normal instructional plans significantly affected students and their abilities to connect with one another and create meaningful interactions in and out of the classroom (das et al., 2021). hsi institutions were no different, however, similar to findings in this study, research suggests that hsi students experienced more complex issues such as financial stress, mental health issues, limited places to study, and inconsistent access to technology (farina et al., 2021; ibarra-mejia et al., 2022; manboard et al., 2021; mshigeni et al., 2022; rahman et al., 2023). the theory of planned behavior provided a framework to understand social work students’ perceptions, adaptations, and obstacles that prevented adaptations. as suggested by the theory of planned behavior, motivation is influenced by perceptions of the ease or difficulty in performing a behavior and the degree of perceived control. participants in the present study indicated a lack of control and high degrees of difficulty engaging in learning behaviors. although students transitioning from traditional face-to-face to online learning are often at a disadvantage when it comes to creating meaningful connections with faculty and student colleagues, participants in this study faced unique challenges due to the sudden and uncontrollable shift to a distance format. these challenges included isolation, motivation, focus, support and lack of access to important mental health resources. without adequate support, resources and mentorship, students lacked the information they needed to navigate distance education, and these challenges were exacerbated by the pandemic. earlier research reported that prior to the covid-19 pandemic, one in five college students experienced one or more mental health disorders (auerbach et al., 2016; zhai & du, 2020). however, the psychological effects of covid19 increased this number and compounded collegiate mental health issues (rahman et al., 2023; zhai & du, 2020). similar to the present study, college students experienced increased anxiety, increased risk for suicide and substance abuse (zhai & du, 2020). in a study conducted by lee et al. (2021), 60% of college students reported an increase in anxiety, 54% reported increased depression, and nearly 60% reported increased feelings of loneliness. it is notable that participants were able to use their social work knowledge and skills to navigate and adapt to learning challenges. subjective norms for collective academic success were also noted by participants as helpful. these included increased reliance on members of their cohort. wilke et al. (2009) also noted a related dynamic among online social work classes and the increased mutual aid students offered to one another. finally, similar to keesler et al. (2022) findings that students in synchronous, online classes appeared to desire affective focused teaching, participants in this study also indicated that openness, transparency, and affect of some professors reinforced the collective nature of nahar et al./covid-19 & planned learning behavior 141 the pandemic which assisted students in both sharing their experiences and building a sense of collaboration and community. implications for social work, pandemic related, online teaching and learning although student adaption to online learning improved, gaps were noted by students that interfered with their learning. these gaps included challenges at the course, department, and university levels. bridging these gaps have implications for future social work teaching and learning particularly during times of high stress such as a pandemic. a key gap at both the course and departmental levels were opportunities to seek mentorship and build a sense of community. at the course level, key issues included experiencing online learning as truly remote in some courses, with limited interactions or sense of community among learners and the instructor. this concern was echoed at the department level where students noted gaps in opportunities to collectively socialize and receive support. an option that could have been considered was described by melero et al. (2021) as the implementation of a weekly zoom support meeting where social work students at an hsi university could ask questions, receive information, and gain support from faculty and peers. this provided an opportunity for the student population, comprised of mostly latinx and first-generation college students, to destress and address complex issues exacerbated by the pandemic. other approaches can include utilizing traumainformed teaching methods throughout the curriculum, or understanding ways that trauma impacts all members of a community and using this knowledge to inform curriculum, and department policies (hitchcock et al., 2021). this knowledge includes using trust and transparency in online teaching to build safe and consistent learning environments for students (hitchcock et al., 2021). because of the impact of covid-19 on the behaviors and outcomes of students who transitioned to an online learning environment, institutions should make a concerted effort to be intentional about how to introduce resources and interventions to remote students that help support them as they attempt to continue to navigate the challenges presented by the pandemic. these can include addressing biopsychosocial needs brought on by the covid19 pandemic (gross, 2021). for example, it’s important for institutions to prioritize their approach to addressing the availability of essential support and resources for vulnerable college students. this might include institutions using data to track physical, emotional, and psychological health symptoms of impacted youth along with identifying vulnerable students in need of assistance. additionally, institutions can partner with community providers to offer services to students using a telehealth model. this includes having virtual therapy session options and virtual group meetings available for students in need. at hsi institutions, it is essential to continually ensure that services are culturally relevant and effectively promoted (ibarra-mejia et al., 2022). universities can also support students by ensuring that they have adequate tools to contact institutional resources in their times of crisis. this includes having access to wraparound services, addressing food insecurities, housing, rent, and other basic support needs such as funds to assist with rent payments, utilities, and cell phone and cellular services. additionally, formal academic support that includes tutoring services, academic advising, writing centers and faculty office hours advances in social work, spring 2025, 25(1) 142 should be available in online formats. implementing these measures will aid students and demonstrate the commitment by institutions that they care about their students’ well-being. limitations this study had several limitations. the generalizability of the study is limited, due to the small sample size. thus, readers should use caution when applying these findings to their contexts as the findings of the study cannot be generalized to all hispanic or latinx student communities or all social work students at hsis. future studies could utilize aspects of this study, such as the exploration of challenges, adaptations and gaps in social work online teaching, but use an anonymized online survey instead of focus groups to increase the sample size. another limitation was the use of a deductive analysis approach in which the themes and subsequent meaning were linked to a preexisting framework, thus specific perspectives of participants could be missed. future research should continue to investigate the use and impact of technology on social work teaching and learning. the use of a longitudinal design could provide relevant information on trends, best practices, and gaps. additional considerations should include understanding the technological impact among various racial, ethnic, and gender groups by exploring interactions among demographic variables to identify potential disparities within the long-term trends. conclusion this study explored the learning experiences of social work students during their abrupt transition to online learning during the covid-19 pandemic. the theory of planned behavior provided a framework to understand student perceptions, adaptions, and obstacles that prevented adaptions. we found significant early disruptions but also adaptions in which students were able to use social work knowledge and values to cope with the transition and other environmental stressors. despite their adaptions, some environmental challenges specific to the learning environments created significant impediments. thus higher education institutions generally, and social work programs specifically, should continue to intentionally monitor and provide contextually relevant support and resources for remote student learning and emergent student learning needs. references ajzen, i. 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learn from your home during covid-19? a. what was your experience with internet access to learn from your home during covid-19? b. how did you manage to adjust with new changes/challenges? 3. what barriers to learning, if any, did you face through online courses during covid-19? a. what strategies, if any, helped you to adjust with the online courses during covid-19? b. what types of resources, if any, would have helped you to learn online more effectively during covid-19? 4. have you taken an online course before covid-19? if so, what was your experience? a. how did your experience taking online courses before covid-19 compare with taking online courses after covid-19? 5. what were the biggest challenges, if any, to learning that you experienced during covid-19? a. how could it have been a better experience? 6. what university online resources, if any, did you use during covid-19? a. how did you find out about these resources? b. what types of resources, if any, would have helped you in your academic success during covid-19? c. how, if at all, could faculties have been more resourceful in this type of challenging situation such as covid-19? 7. how, if at all, did covid-19 impact you financially? 8. how, if at all, did covid-19 impact your personal life (relationship with spouse/partner/children/ family members/ friends/community members? a. how, if at all, did it impact your mental health? 9. in future, what resources, if any, can help students to continue their academic success during this type of disaster such as covid-19? advances in social work, spring 2025, 25(1) 148 appendix b coding tree context of covid-19, lockdown and online learning in social work. challenges and stressors were identified and coded. the theory of planned behavior was applied. based on the framework of planned behavior, attitudes, perceived behavioral control, and subjective norms that increased intentions of adaptive behaviors as well as interferences to adaptive behaviors were analyzed and coded. covid 19 online learning learning challenges mental health stressors perceived behavioral control attitudes interferences resource gaps intentions to increase adaptive behaviors adaptive behaviors subjective norms lock-down environmental challenges ________ premela deck, jd, phd, licsw, family law attorney, clinical and forensic social worker, sd family services, canton, ma. sarah eisensmith, phd, lcsw, med, researcher, academic consultant, and clinical and forensic social worker, ahb forensics and consulting, durham, nc. jacqueline cafaro, msw, lcsw, forensic and clinical mental health professional, sd family services, canton, ma. copyright © 2022 authors, vol. 22 no. 3 (fall 2022), 1174-1193, doi: 10.18060/26385 this work is licensed under a creative commons attribution 4.0 international license. the parents divorcing conflict scale: initial tool development and exploratory factor analysis premela deck sarah eisensmith jacqueline cafaro abstract: practical measures to screen for high levels of pre-divorce conflict offer a unique opportunity for early intervention by forensic social work professionals in divorces where children are at risk of being exposed to high levels of interparental conflict and subsequent maladjustment. there is a lack of validated short screening instruments specifically addressing pre-divorce conflict for parents with at least one minor child. an instrument of this nature would support those in the forensic social work field in identifying families that may be at risk for a high-conflict divorce process. accordingly, this study describes the development of a self-report measure to assess conflict in parenting couples who are in the process of divorce. an exploratory factor analysis (efa) was conducted with data from a sample of parents in the process of divorce (n=114), and multiple factor structures were examined. the efa confirmed that a one-factor model offered the best fit. the short 8-item parents divorcing conflict scale (pdcs) is a promising measure for use in forensic social work, research, and clinical and policy settings as it captures pertinent themes of conflict, including communication, social network, parent characteristics, satisfaction with agreements, and mistrust, and can inform early intervention strategies that will serve to support healthy communication practices amongst divorcing couples throughout the marriage dissolution process. keywords: forensic social work, conflict scale, factor structure, divorce and separation interparental conflict is a complex construct. researchers find that high conflict often results in adverse effects on the family as a unit or individual members, most notably the children (anderson et al., 2010). children with divorced parents in high-conflict dynamics have an increased risk of substance use, mental health and behavioral problems, poor academic performance, and social adjustment issues (amato, 2001; arbuthnot et al., 1997; bacon & mckenzie, 2004; pedro-carroll et al., 1999). families experiencing high conflict can also pose additional burdens on the court and child welfare resources (saini & birnbaum, 2007). although the relationship between high-conflict post-divorce and child maladjustment is well-documented, the extant social science and legal literature do not clearly define what behaviors or indices indicate high interparental conflict (birnbaum & bala, 2010; haddad et al., 2016). as such, forensic social work professionals are often reactive in their assessment and treatment approach rather than being able to identify and preemptively intervene with families who pose a risk for high-conflict divorce proceedings. there is a meaningful difference between pre-divorce conflict, defined as conflict occurring after the decision to separate but before a judgment of divorce, and post-divorce conflict. interparental conflict immediately following the decision to separate is considered about:blank deck et al./parents divorcing conflict scale 1175 normative and is expected to subside within two years, which may explain why much of the divorce conflict literature focuses on the prolonged conflict or conflict lasting after the divorce (buchanan & heiges, 2001; emery, 1994; johnston, 1994; ponzetti & cate, 2008). however, improved understanding and assessment of pre-divorce interparental conflict – that is, the conflict that exists during the divorce process from the decision to separate through negotiations, but before a legal judgment of divorce—is essential for efficient dispute resolution during the divorce process and effective service delivery by legal, forensic social work, clinical mental health, and policy professionals addressing the family during and after this often-stressful family transition (salts, 1985). notably, those in highconflict marriages are likely to continue with prolonged conflict after the divorce as they have evidenced an inability to employ successful dispute resolution tactics (johnston, 1994). this prolonged conflict after divorce is a significant contributing factor to child maladjustment (emery, 1994; johnston, 1994). the divorce conflict literature draws a further distinction between highand low-conflict pre-divorce (during the marriage), with children appearing to benefit from the divorce of parents in high-conflict marriages and suffer from the divorce of parents in low-conflict marriages (booth & amato, 2001; joyce, 2016). this distinction between pre-and post-divorce conflict suggests that a forensic social worker’s ability to understand and assess pre-divorce conflict may be essential to identifying effective interventions for parents who may have the potential for lingering conflict after the divorce. however, the research on conflict assessment with this population overwhelmingly focuses on identifying and assessing post-divorce conflict. this paper sought to fill this gap in the research by developing and testing a short assessment tool for pre-divorce interparental conflict, known as the parents divorcing conflict scale (pdcs). existing tools measuring interparental conflict one of the most frequently used and more widely adapted measures of co-parenting quality is the quality of co-parental communication scale (qccs), which captures the dimensions of support and conflict in divorced parents (ahrons, 1981). however, as researchers continue to study interparental conflict, it is clear that it is a multidimensional construct, which may require consideration of various factors, including the co-parenting relationship, communication styles, interpersonal conflict, and violence or aggression (ferraro et al, 2016). therefore, researchers continue to employ a number of scales to measure interparental conflict, many of which focus on post-divorce conflict. in considering post-relationship conflict, frequently used measures include the postdissolution relational communication index (pdrci), which specifically evaluates antagonistic and reassuring communication between former romantic partners (lambert south & hughes, 2018); the post-divorce parental conflict scale (pdpc), which measures parental conflict from the perspective of the child (morris & west, 2000); and the psychological adjustment to separation test (past) which assesses parental psychological well-being post-divorce (sweeper & halford, 2006). more recently, the divorce conflict scale (dcs) was developed to fill the need for a short screening advances in social work, fall 2022, 22(3) 1176 instrument to measure post-divorce conflict (hald et al., 2020). although these tools have proven validity and reliability in post-divorce populations, they have not been used in separated couples who are not legally divorced. this gap leaves legal and forensic social work practitioners without means of assessing the conflict levels in these divorcing parents. in addressing the lack of pre-divorce assessment tools, practitioners may consider the several tools that serve to measure conflict in romantic relationships. these romantic relationship assessment tools, however, do not specifically consider divorce conflict. these tools include the frequently used 39-item revised conflict tactics scale (cts2; straus et al., 1996) and the romantic partner conflict scale (rpcs; zacchilli et al., 2009). the literature is insufficient on pre-divorce conflict measurement tools. the 25-item level of conflict assessment of divorcing or separating couples (loca) was the only identified instrument specific to pre-divorce or separation conflict (langenbrunner et al., 2013). given that there are stressors that are unique to divorcing couples, rather than just separating couples, a specific tool for pre-divorce conflict is missing from the literature. stressors that may exist for a divorcing parent but not a separating parent may include role clarification (e.g., from spouse to now ex-spouse) or the insertion of the adversarial legal system. further, in developing a pre-divorce-specific tool, there are benefits to developing a short screening instrument for this population as well. a short screening tool may be used in court, either at the time of filing for divorce or as the case moves through the legal process of divorce. practically speaking, a short screening tool that takes little time to complete, little physical space to store (many courts still use paper filings), and is less burdensome to participants will be most effective in these cases, particularly when considering the complex nature of defining conflict. as conflict is a complex construct, a single instrument may not capture the many nuances and variations of conflict—rather, information gathered from a short screening tool can help flag cases that may need further assessment and possible early intervention. as such, a short screening tool that is made easily available to the court could be considered another data point when addressing the greater question of what, if any, family intervention plan is needed to facilitate successful adjustment post-divorce. for example, if the conflict is exceptionally high and parents are unable to communicate, the court may consider an intervention where only one parent holds decision-making power. alternatively, in cases where collaboration may be possible, the parents may benefit from psychoeducation or the assistance of a parenting coordinator. it is worth noting that the decision to include a short screening tool rather than a longer measurement tool may mean the complexity of conflict as a variable is oversimplified. however, if the survey results are considered another data point, a shorter screening instrument may offer more flexibility in identifying conflict. with the specificity of a more extensive multi-item scale, practitioners and researchers may over-rely on an instrument that may inadvertently exclude key facets of conflict, particularly given that there is seldom a perfect measure of an abstract concept (mcdonald, 2005). these instruments, compared in table 1, are not an exhaustive list of available instruments but are a representation of instruments for various conflict assessments. to these authors’ knowledge, no published short-form validated measures specifically addressing and measuring pre-divorce interparental conflict exist. deck et al./parents divorcing conflict scale 1177 table 1. comparison of prevalent conflict measurement tools instrument pre/post dissolution intended respondent # of items construct measured reference qccs post divorced parents 10 support; conflict ahrons, 1981 pdrci post previous partners 25 communication lambert et al., 2018 pdpc post child of divorce 82 conflict morris & west, 2000 past post previous partners 32 negativity; attachment; conflict sweeper & halford, 2006 dcs post divorced parents 6 conflict hald et al., 2020 cts2 n/a romantic partners 39 conflict straus et al., 1996 rpcs n/a romantic partners 39 conflict zacchilli et al., 2009 loca pre divorcing parents 25 conflict langenbrunner et al., 2013 note: n/a indicates scales used for in-tact relationships as well as post-dissolution theoretical components for interparental conflict pre-divorce the first step in developing a short-form measurement tool for pre-divorce conflict was to identify predictors for high interparental conflict in divorcing couples by reviewing the theoretical and empirical social science literature. notably, a review of the extant theoretical literature on high-conflict divorcing parents revealed wide variability in the definition of “high-conflict” with researchers continuing to publish new conceptualizations of the topic as recently as 2019 (smyth & moloney, 2019). the variability in defining “high-conflict” contributes to the difficulty in identifying ” high-conflict “ predictor variables and subsequently measuring the construct. further complicating matters, the literature denotes significant attention to post-divorce conflict rather than pre-divorce conflict, as evidenced by the assessment tools described in table 1. however, the systematic review conducted by these authors that informed the current study, titled “identifying high-conflict divorcing parents: a systematic review of the literature,” (under review) identifies possible pre-divorce predictors and categorizes them into one of five themes: conflict resolution/communication, social network, satisfaction with agreements, parent characteristics, and pervasive mistrust. the systematic review initially yielded 4,126 articles for a title and abstract screen, of which 78 articles were advanced to a full-text screen review. ultimately, 11 articles were included in the review. these 11 articles were thematically reviewed and coded to create the final five themes of pre-divorce predictors as derived from theoretical and empirical literature. the first theme, conflict resolution/communication, refers to a couple’s communication practices and their tendency to either decrease conflict by employing negotiation tactics (cohen & finzidottan, 2012), or increase conflict, by not communicating at all (bergman & rejmer, 2017). in differentiating between high conflict and normative conflict, anderson et al. (2010) noted that couples who were more successful in conflict resolution engaged in issuefocused discussions, rather than person-focused attacks that are frequently seen with highconflict couples. the social network theme pertains to the influence that surrounding friends, family, or communities may have on the couple’s conflict, particularly when a parent may feel that their community is not supportive of the co-parenting relationship (finzi-dottan & cohen, 2012; polak & saini, 2018). social networks may have a protective or risk factor influence advances in social work, fall 2022, 22(3) 1178 on a couple’s conflict. social networks may be imperative to supporting a parent and encouraging a co-parenting relationship that ultimately reduces conflict. however, if the social network is not supportive, or if triangulation occurs when a third party becomes involved in the couple’s dynamic through gossip and/or venting, the conflict may be increased or prolonged (anderson et al., 2010). research also notes that a parent’s satisfaction with underlying agreements pertaining to custody and finances decreases interparental conflict (bergman & rejmer, 2017; johnston, 1994; malcore et al., 2010; polak & saini, 2018). financial disagreements may pertain to child support but also to property division or an equitable division of financial obligations for the child’s medical or extracurricular activities. the next predictor category, parent characteristics, pertains to character traits that may influence the conflict, for example: hatred for the other parent (smyth & moloney, 2017); immature defense mechanisms (cohen & finzi-dottan, 2012); or personality disorders (finzi-dottan & cohen, 2012; malcore et al., 2010; polak & saini, 2018). ultimately, with these parent characteristics, the conflict is not discussed in an issue-focused manner but rather in a person-focused manner. the individual may be motivated by self-protection rather than by issue resolution (cohen & finzi-dottan, 2012). for example, for those with mature defense mechanisms, such as humor, an issue may be resolved quickly rather than prolonged with an increase of anxiety or mistrust. the final theme, perceived mistrust, pertains to a parent’s perception of a justified reason for mistrusting the other parent, perhaps due to violence (anderson et al., 2010; bergman & rejmer, 2017; johnston, 1994; polak & saini, 2018; smyth & moloney, 2019); substance use (bergman & rejmer, 2017; polak & saini, 2018; smyth & moloney, 2019), or unfitness (bergman & rejmer, 2017; polak & saini, 2018; smyth & moloney, 2019). dyadic trust between the divorcing couple is greatly compromised as conflict increases, negatively impacting the divorce process (ponzetti & cate, 2008). these five themes developed from a systematic review of the theoretical and empirical social science literature pertaining to divorce and family law informed the development of the pdcs. we hypothesized that all five of these themes represent a singular underlying construct: conflict. it is possible that several of these themes may be more closely related than others and that a twoor three-factor model may present itself. for example, if one is satisfied with an agreement, this may be the result of a successful conflict resolution or communication style. similarly, one may have pervasive mistrust as a result of some parenting characteristics. this would mean that these four themes could collapse into two themes such that (1) conflict resolution and (2) satisfaction with agreements align to create a new theme (e.g., “resolution”) and (3) parent characteristics and (4) perceived mistrust align to create a new theme (e.g., “parent attributes”). in this instance, with the addition of the final theme of social network, we may see a three-factor model. it is also possible that social network may align with either of these two collapsed themes, such that the social network influences whether conflict is resolved or perhaps the social network is a source of mistrust. in that instance, we would see a two-factor model. ultimately, these themes seem to group together in a number of ways, indicating that a one-factor model may be most applicable as the underlying theme would simply be conflict. deck et al./parents divorcing conflict scale 1179 current study the purpose of this study was to develop and determine the factor structure and describe the scale development process of the pdcs measure, which captures the primary construct of pre-divorce conflict for parents with at least one minor child. this information can then be used by forensic social work professionals when engaging with families during the “pre-divorce” process so that appropriate conflict-reducing interventions can be introduced, and long-term court involvement ultimately avoided. the “pre-divorce” timeframe is defined as the time after the decision to separate as a couple but before the judgment of divorce is rendered. this study follows the guidelines proposed by experts in psychometrics (see cabrera-nguyen, 2010; devellis, 2017; muthén & muthén, 2007; worthington & whittaker, 2006). more specifically, this paper presents: (1) the procedures used to develop a new scale of conflict for divorcing parents; (2) efforts toward identifying the factor structure of the pdcs; and (3) an exploration of the hypothesized one-factor structure of the pdcs. methods sampling method instrument development through a systematic review of the theoretical and empirical literature—the results of which are reported in a prior study (under review)—an initial list of 30 items was generated. the items were generated from a thematic coding procedure in which articles were reviewed for salient themes: conflict resolution/communication, social network, satisfaction with agreements, parent characteristics, and pervasive mistrust. from these salient themes, 30 items were generated for possible use in a screening tool. following devellis’ (2017) recommendations, feedback was solicited at several time points during the instrument development through review from seasoned professionals in the field and pilot testing. after seasoned professional review, these 30 items were condensed to 10 items (displayed in table 2) and were then piloted on a small sample of participants (n=9). field professional review field professionals (n=9) were consulted to identify possible issues with conceptualizing the primary construct of interest. the 30-item pool was submitted to content and measurement seasoned practitioners (bradburn et al., 2004; devellis, 2017). these professionals included judges (n=2), mental health professionals in the field of family law (n=2), family law attorneys (n=3), and measurement professionals (n=2). modifications made to the measure based on professional feedback included: a change in response format (i.e., changing from an agree-to-disagree scale to a frequency scale); elimination of redundant questions (i.e., expressing a similar idea in somewhat different ways through multiple items); rewording of misleading or ambiguous phrasing (e.g., changing “my co-parent and i can have a conversation on problems concerning our advances in social work, fall 2022, 22(3) 1180 children” to “my co-parent and i can have a civil conversation on problems concerning our children”); and improvement in clarity (e.g., double-barreled items or unnecessary wordiness). from this feedback, the 30-item instrument was synthesized into a 10-item instrument. for example, there were four items originally generated to address pervasive mistrust: 1) i am concerned my co-parent cannot adequately care for my child(ren); 2) i am concerned my co-parent exposes our child(ren) to violence, substances, or inappropriate conduct; 3) my co-parent is appropriate with my child(ren); and 4) my child(ren) and i are safe with my co-parent. these four items were collapsed into two items: 1) i am concerned my coparent cannot adequately care for my child(ren), and 2) my child(ren) and i are safe around my co-parent. piloting sample the 10-item instrument was then entered into qualtrics, an online survey platform. instructions for completion of the instrument and questions to collect demographic data were added. a self-administered pilot test of the 10-item instrument was conducted with parents (n=9) in the process of divorce. these participants were selected by convenience due to their similarity with the instrument’s target population, namely being in the process of divorce and having at least one minor child. these nine parents also participated in cognitive interviews, a method for scale revision to detect discrepancies between participant and researcher understanding of survey items, to provide validity evidence that explains how respondents interpret and respond to the 10-item pdcs. following recommendations from willis (1999) and boeije and willis (2013), participants were asked to rephrase survey questions in their own words, provide their understanding of specific words, and note any confusing or unclear terminology. overall, pilot participants had a high level of understanding of the survey items. some formatting suggestions were adopted, instructions were clarified, and specific terms (e.g., “benefit”) were interpreted in ways that were different from what was intended were altered (e.g., the actual observed benefit versus the overall assumption of a benefit to having two involved parents). thus, modifications to the instrument following the completion of the pilot test included: clarifying that the measure is concerned with the respondent’s perception of events and adding additional page breaks to the online instrument. table 2 shows the final pdcs items after expert review and pilot testing and further indicates items that eventually dropped from the scale. all items use a 4-point likert scale set of response options (1= never, 2= rarely, 3= often, 4= always). advances in social work, fall 2022, 22(3) 1181 table 2. pdcs item iterations conflict dimension original items final items conflict resolution/ communication 1. i can explain my side of a disagreement to my co-parent. 2. my co-parent shows respect for my feelings on a disagreement 3. my co-parent can explain their side of a disagreement to me. 4. i can agree to try a solution to a disagreement relating to our children that my coparent suggests. 5. my co-parent and i communicate well. 6. co-parent’s personality is extremely different from mine. 7. i can negotiate with my co-parent. 8. my co-parent and i can have a conversation on problems concerning our children. 1. my co-parent and i communicate well. 2. i can negotiate with my co-parent. 3. my co-parent and i can have a conversation on problems concerning our children. social network 9. my close friends and family support my co-parenting relationship. 10. my close friends and family speak negatively about my co-parent. 4. *my close friends and family support my relationship with my coparent. parent characteristics 11. my co-parent and i share in childrearing tasks. 12. my co-parent and i can attend an event for our child(ren) at the same time. 13. my child(ren) benefit from a relationship with my co-parent. 14. my co-parent puts my child’s well-being first. 15. i can remember good times in my marriage. 16. i am able to laugh at myself pretty easily. 17. people tend to mistreat me. 18. i respect my co-parent. 19. my co-parent helps me see different perspectives in childrearing. 20. i have forgiven myself for the breakup of the marriage. 21. i have forgiven my co-parent for the breakup of the marriage. 22. i trust my co-parent. 23. my co-parent caused the breakup of the marriage. 5. my co-parent and i share in childrearing tasks. 6. my child(ren) benefit from a relationship with my co-parent. satisfaction with agreements 24. i feel satisfied with the agreement to divide our property, assets, and debts. 25. i feel satisfied with our agreement to financially support our child(ren). 26. i feel satisfied with our agreement on parenting time. 7. i feel satisfied with our agreement on parenting time. * 8. i feel satisfied with our agreement on financial matters. pervasive mistrust 27. i am concerned my co-parent cannot adequately care for my child(ren). 28. i am concerned my co-parent exposes our child(ren) to violence, substances, or inappropriate conduct. 29. my co-parent is appropriate with my child(ren). 30. my children and i are safe around my co-parent. 9. i am concerned my co-parent cannot adequately care for my child(ren). 10. my child(ren) and i are safe around my co-parent. note: * indicates items dropped from the final model deck et al./parents divorcing conflict scale 1182 final sample one hundred and fourteen divorcing parents provided responses on the pdcs instrument. this sample size was deemed adequate as each item had approximately eleven responses (worthington & whittaker, 2006). there was nearly an even split between male (n=54, 47.4%) and female (n=57, 50%) participants. on average, participants were 36.8 years old (sd = 6.8 years). most participants had two or fewer children with their former partners (n=98, 86%), and were employed full or part-time (n=100, 87%). forty-two participants (36.8%) earned a combined household income of at least $100,000 in 2019. forty-two (37%) participants described their relationship with their co-parent as hostile, 47 participants (41%), reported that their relationship with their co-parent was civil, while 22 participants (19%) categorized their relationship with their co-parent as friendly or very friendly. twenty-four participants (21%) reported that a restraining order between them and their co-parent had been applied for. of these, a restraining order was put in place between 19 participants and their co-parents (79% of participants who reported that a restraining order was applied for, 17% of total participants). a full description of the sample is presented in table 3. table 3. sample description variable frequency (%) relationship with co-parent hostile 42 (36.8%) civil but not friendly 47 (41.2%) friendly 15 (13.2%) very friendly 7 (6.1%) restraining order with co-parent no 89 (78.1%) no, but one was applied for 5 (4.4%) yes 19 (16.7%) gender male 54 (47.4%) female 57 (50.0%) another 2 (1.8%) country of residence usa 97 (89.0%) non-usa 12 (11.0%) m (sd) age (years) 36.8 (6.78) average number of children 1.7 (.72) average age of children (years) 7.4 (4.31) data collection the final step in the scale development process was to complete an exploratory factor analysis of the 10-item version of the instrument iteratively developed through research and expert and cognitive interviews. exploratory factor analysis empirically explores the scale's properties, including the number and meaning of the constructs that underlie the deck et al./parents divorcing conflict scale 1183 instrument and the individual item quality (devellis, 2017). muthén and muthén (2007) advise a small instrument pilot for exploratory factor analysis. since a convenience sample was used here, further testing will be needed to address generalizability. the revised pdcs was entered into qualtrics—a user-friendly survey platform, and a convenience sample of 114 parents of minor child(ren) in the divorce process was recruited through reddit, a social networking website where communities, or “subgroups,” are created on interests, so as to reach a wide population of potential participants. the qualtrics survey was also sent to divorce and family law-related subgroups. potential subjects were informed that their participation was voluntary, and the irb reviewed the study at the university of north carolina—chapel hill, irb #20-2379. data analysis descriptive analysis distributional properties of the items and correlations, which were polychoric correlations, between items were reviewed to confirm linear relations among observed variables (table 4 and 5). minimal missing data was observed. table 4 shows that, per item, the maximum missing data was one response (0.88 of the sample). as the missing data stemmed from one instrument, it is assumed that participants began the survey and did not complete it. as a result, that participant’s data was removed from all analyses. exploratory factor analysis all analyses were conducted in mplus version 8.4 (muthén & muthén, 2007). the mplus method for weighted least squares means and variance adjusted (wlsmv) was used, as it provides accurate parameter estimates and a model fit that is more robust to ordinal data due to the use of polychoric correlations to assess model fit (li, 2016; muthén & muthén, 2007). mplus’ default oblique rotation method was retained, as it is less restrictive (cabrera-nguyen, 2010; devellis, 2017). decisions about determining the number of factors were made after attending to multiple pieces of information, including scree plots of eigenvalues, communality estimates (i.e., values > .5), rotated factor loadings (i.e., values > .3; costello & osborne, 2005), the presence of a simple solution of interpretable factors, and model fit measures (i.e., chi-square; rmsea: mediocre if 0.8 to 10, good if < .05; cfi/tli, acceptable if > .90, excellent if > .95; hu & bentler, 1999; kline, 2005). deck et al./parents divorcing conflict scale 1184 table 4. distributional properties of pdcs items response options n (%) item 1 item 2 item 3 item 4 item 5 item 6 item 7 item 8 item 9 item 10 1 22 (19.3%) 29 (25.4%) 23 (20.2%) 10 (8.8%) 31 (27.2%) 16 (14.0%) 23 (20.2%) 45 (39.5%) 19 (16. 7%) 12 (10.5%) 2 55 (48.3%) 46 (40.6%) 41 (36.0%) 23 (20.2%) 32 (28.1%) 31 (27.2%) 20 (17.5%) 25 (21.9%) 29 (25.4%) 22 (19.3%) 3 29 (25.4%) 24 (21.1%) 28 (24.6%) 46 (40.6%) 24 (21.1%) 30 (27.2%) 43 (37.7%) 29 (25.4%) 36 (31.6%) 29 (25.4%) 4 8 (7.0%) 15 (13.2%) 22 (19.3%) 34 (29.8%) 25 (22.8%) 36 (31.6%) 27 (23.7%) 14 (12.3%) 29 (25.4%) 50 (43.9%) missing 1 (0.88%) 1 (0.88%) 1 (0.88%) 1 (0.88%) 1 (0.88%) 1 (0.88%) 1 (0.88%) m(sd) 2.2 (.87) 2.2 (.98) 2.4 (1.00) 2.9 (.93) 2.4 (1.12) 2.8 (1.05) 2.7 (1.06) 2.1 (1.07) 2.7 (1.04) 3.0 (1.03) table 5. correlations among pdcs items m (sd) item 1 item 2 item 3 item 4 item 5 item 6 item 7 item 8 item 9 item 10 item 1 2.20 (.87) 1.00 item 2 2.22 (.98) .77* 1.00 item 3 2.43 (1.0) .77* .76* 1.00 item 4 2.92 (.93) .44* .44* .40* 1.00 item 5 2.40 (1.12) .56* .59* .63* .43* 1.00 item 6 2.76 (1.05) .52* .48* .57* .23* .53* 1.00 item 7 2.65 (1.06) .29 .33* .34* .14 .17 .29* 1.00 item 8 2.10 (1.07) .60* .59* .58* .33* .44* .50* .52* 1.00 item 9 2.66 (1.04) .61* .51* .64* .33* .67* .67* .27* .52* 1.00 item 10 3.03 (1.03) .60* .54* .61* .36* .50* .54 .11 .42* .66* 1.00 note: * indicates that correlations were statistically significant (i.e., p<.05) deck et al./parents divorcing conflict scale 1185 results exploratory factor analysis (efa) results the initial efa (i.e., version 1) included all 10 piloted pdcs items and explored whether a one, two, or three-factor model was the best fit. despite the rmsea improving in the twoand three-factor models, the decision to move forward with a one-factor solution was supported by the scree plot of eigenvalues as well as review of the eigenvalues for each factor, communality estimates (i.e., values > .5), rotated factor loadings (i.e., values > .3), the presence of a simple solution of interpretable factors for a one-factor model, and in consideration of the other model fit measures. additionally, a review of the relevant literature led to a one-factor model hypothesis. ultimately, the one-factor version 1 of the pdcs demonstrated high reliability (α = .90). two items with communalities less than .5 were removed for subsequent analyses because low communalities indicate that the latent construct accounts for only a small proportion of variation in the measured variable responses (fabrigar & wegener, 2011). factor loadings and communality estimates for the one-factor solution of all piloted pdcs items can be found in table 6. model fit measures can be found in table 7. the decision to drop two items is supported based on a theoretical and empirical review of the literature, including an extensive systematic review described in a prior study. it is posited that these items (#4 and #7) may reflect circumstances that increase conflict postdivorce but may not have the same effect pre-divorce. these items, one pertaining to social network support for the co-parenting relationship and the other related to satisfaction in parenting schedule, both reflect circumstances likely to change after divorce. for example, a couple still married but in the process of divorce may continue to live together, which may mean that a couple’s social network is still supportive of the relationship and that access to children is unfettered. furthermore, item number 4 was a double-barreled question which may have impacted the results. a subsequent efa (i.e., version 2; final version) included 8 pdcs items. multiple factor-structure models were run to confirm findings that a one-factor model provided the simplest solution (i.e., from version 1). the version 2 efa produced a one-factor solution as evidenced by the scree plot of eigenvalues, the presence of a simple solution of interpretable factors, and model fit measures. more specifically, rotated factor loadings ranged from 0.71 to 0.92, well above the 0.3 threshold, and all communalities were ≥ 0.5. although the rmsea indicated mediocre (at best) fit to the data, other fit indices indicate very good fit to the data (χ2 =60.32; df= 20; rmsea [90%ci]= .133 [095, .172]; cfi= .985; tli= .979). a review of communality estimates and rotated factor loadings confirmed that all eight items met the criteria for inclusion in the final version. version 2 (the final version) of the pdcs demonstrated high reliability (α = .92). factor loadings and communality estimates for the final pdcs items can be found in table 6, and model fit measures can be found in table 7. advances in social work, fall 2022, 22(3) 1186 table 6. communalities and rotated factor loadings for pdcs items item version 1 version 2; final version communalities rotated factor loadings communalities rotated factor loadings 1 0.84 .92 0.84 .92 2 0.79 .89 0.79 .89 3 0.83 .91 0.83 .91 4 0.28 .53 na na 5 0.61 .78 0.61 .78 6 0.54 .73 0.55 .74 7 0.17 .42 na na 8 0.54 .73 0.50 .71 9 0.74 .86 0.75 .87 10 0.62 .79 0.63 .79 table 7. model fit indices for pdcs efa χ2(df) rmsea [90% ci] cfi tli eigenvalues explained variance one factor 110.57(35)*** .138 [.109, .167] 0.972 0.964 6.14 0.61 two factor 65.65(26)*** .116 [.081, .151] 0.985 0.975 6.14, 1.06 .54, .40 three factor 20.25(18) .033 [<.001., .092] 0.999 0.998 6.14, 1.06 .84 .53, .52, .49 reduced (final) 60.32(20)*** .133 [.095, .172] 0.985 0.979 5.67 0.7 *p < .05; **p < .01; ***p < .001 discussion this study's goals were to develop and determine the factor structure and describe the scale development process of the pdcs measure, which captures the primary construct of pre-divorce conflict for parents with at least one minor child. this instrument is scored by collecting a total cumulative score for all items, where the higher the score, the greater the conflict. this study followed the scale development guidelines proposed by experts in the field of psychometrics (devellis, 2017; fabrigar & wegener, 2012). to test the hypothesis of a one-factor construct, three separate efas were conducted using the data collected as part of the pdcs measure's small pilot. efas were conducted to evaluate the factor structure of pdcs as well as to explore the psychometric properties of specific items. efa provides a statistical method for construct identification, allowing researchers to rely on more than intuition and theory in developing and evaluating new measurement instruments (fabrigar & wegener, 2012). ultimately, two items were dropped as they did not meet the communality estimates cutoff criteria (i.e., >.50). the first dropped item (“my close friends and/or family support my co-parenting relationship”) is reflective of the robust research naming the contributions that social networks, including family and friends, can have on the well-being of divorced individuals (cohen & savaya, 2000; finzi-dottan & cohen, 2012; mccurdy, 2005). however, there is divergent research about the role that social networks play in divorce conflict as they can impede or support harmonious co-parenting (johnston & campbell, 1988). finally, like the deck et al./parents divorcing conflict scale 1187 majority of research on interparental conflict and divorce, this research focuses on postdivorce. it is possible that the variable of social networks functions differently for conflict preand post-divorce. furthermore, this item was phrased as a double-barreled question, with friends and family included in the item. further research could delineate these as two separate items. for now, this efa supports removing this item. similarly, the second item dropped from the pdcs instrument due to lack of fit (“i feel satisfied with our parenting time schedule”) may also be because of this scale’s specific focus on pre-divorce conflict during which parents may still be litigating and/or determining what a parenting time schedule will look like post-separation. further, bergman and rejmer (2017) found that pre-divorce disputes relating to the scarce resource of time with the child amounts to a conflict of interest, and in their analysis of 33 cases, they found that conflict of interest is less common than conflict of values, or differences in opinions. the remaining eight items of the pdcs represent four of the five themes identified in the systematic review: conflict resolution/communication (items 1-3), parent characteristics (items 5-6), satisfaction with agreements (item 8), and pervasive mistrust (items 9-10). the fifth theme, social network, did not fit in the model, and the lack of fit, as discussed above, may be supported by the theoretical literature, both as it pertains to the stage of divorce (pre-divorce) and the ambiguity around the significance of social network on divorce conflict. the four remaining themes create the final eight-item instrument, showing a one-factor model with high reliability (α =.92). the significance of the onefactor finding shows that these four themes speak to the singular underlying construct of pre-divorce conflict. this study was a pilot study of the factorial structure of a scale using a convenience sample. this study aimed, in part, to begin the development of a pragmatic instrument for use by forensic social work professionals and clinicians engaged with divorcing families. in developing the pdcs, several criteria were considered to support the practical use of the instrument, but further research is needed, including a confirmatory factor analysis, before further use (powell et al., 2017). at eight items, the pdcs is brief relative to any existing instrument measuring interparental conflict and significantly shorter than the loca, the only other known divorcing conflict scale (langenbrunner et al., 2013). furthermore, the pdcs and loca have comparable high reliability at (α =.92) and (α =.94), respectively. the pdcs does not require multiple steps for scoring and merely totals a cumulative score with higher numbers indicating a higher conflict level. when considering this instrument's ease, the pdcs may be administered by pen and paper or through electronic means. limitations the current study has several limitations pertinent to external validity worth noting. this study's convenience recruitment strategy does not ensure that the participants represent the entire population, eliminating generalizability claims. additionally, participant selection bias may exist as the study was posted on social media, and participants volunteered to take the survey. therefore, those who responded to the survey may have a predisposition to continued discussions around their divorce, which may be advances in social work, fall 2022, 22(3) 1188 indicative of high-conflict behavior. similarly, as the pdcs is a self-report measure, it is prone to the participants' social desirability, which may have led to bias in their reporting. worth considering is whether participants would consider scoring high or low on the pdcs as being more socially desirable. some participants may wish to score high on the scale to validate their decision to divorce or to access interventions. other participants may want to score low on the scale to avoid interventions, as many may require collaboration with an ex-partner. as this study was a pilot test, it is unlikely that these social desirability considerations exist, but future research should consider these possibilities. finally, the sample was recruited via an electronic survey published in a number of subgroups on reddit. it is possible that people responded to the instrument more than once, which would violate the independence of observation assumption. despite these limitations, this study's results represent significant progress towards understanding pre-divorce conflict in parents with at least one minor child, and leveraging that understanding to inform forensic social work professionals in identifying effective, proactive interventions through assessment of risk factors identified on the pdcs. this analysis provides statistical insight into defining the construct of pre-divorce conflict. prior to developing the pdcs, there has not been a validated short screening instrument that captures pre-divorce conflict, with prior measures overwhelmingly focused on postdivorce conflict. this study helped close this research gap, though future psychometric research is needed to replicate the present study's findings. future research although this efa has promising results, the pdcs is a new instrument that requires further evaluation. the pdcs should be investigated through confirmatory factor analysis, instrument validation efforts, and additional reliability testing. further, additional assessment of the pdcs as a pragmatic instrument will require legal and mental health professionals to assess whether the pdcs is compatible with their needs and whether its results are helpful in decision-making. with continued development and future implementation, the pdcs may strengthen its claim as a pragmatic instrument. conclusion this study's findings provide preliminary evidence of the internal reliability and factorial validity of the eight-item parents divorcing conflict scale for evaluating predivorce conflict. the pdcs is highly applicable in forensic social work, research, clinical, and policy settings and merits further investigation of its reliability and validity with a larger sample size. the pdcs has significant implications for legal and forensic social work practitioners as a short screening 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(2009). the romantic partner conflict scale: a new scale to measure relationship conflict. journal of social and personal relationships, 26(8), 1073-1096. https://doi.org/10.1177/0265407509347936 author note: address correspondence to premela deck, sd family services, inc., 793 washington street, canton, ma, 02021. email: pdeck@sdfsmass.com https://tspace.library.utoronto.ca/bitstream/1807/95335/1/unraveling%20the%20label%20of%20high%20conflict_saini.pdf https://tspace.library.utoronto.ca/bitstream/1807/95335/1/unraveling%20the%20label%20of%20high%20conflict_saini.pdf https://doi.org/10.1300/j287v01n03_03 https://doi.org/10.1111/fcre.12294 https://doi.org/10.1002/anzf.1346 https://doi.org/10.1177/019251396017003001 https://doi.org/10.1037/0893-3200.20.4.632 https://www.hkr.se/contentassets/9ed7b1b3997e4bf4baa8d4eceed5cd87/gordonwillis.pdf https://www.hkr.se/contentassets/9ed7b1b3997e4bf4baa8d4eceed5cd87/gordonwillis.pdf https://doi.org/10.1177/0011000006288127 https://doi.org/10.1177/0265407509347936 mailto:pdeck@sdfsmass.com deck et al./parents divorcing conflict scale 1193 appendix parents divorcing conflict scale (pdcs) directions: indicate how often the statements listed below occur by checking off one of the following. (1=never; 2=rarely, 3=often, 4-always) 1) my co-parent and i communicate well. ☐ never ☐ rarely ☐ often ☐ always 2) i can negotiate with my co-parent. ☐ never ☐ rarely ☐ often ☐ always 3) my co-parent and i can have a conversation on problems concerning our children. ☐ never ☐ rarely ☐ often ☐ always 4) my co-parent and i share in childrearing tasks. ☐ never ☐ rarely ☐ often ☐ always 5) my child(ren) benefit from a relationship with my co-parent. ☐ never ☐ rarely ☐ often ☐ always 6) i feel satisfied with our agreement on financial matters. ☐ never ☐ rarely ☐ often ☐ always 7) i am concerned my co-parent cannot adequately care for my child(ren). ☐ never ☐ rarely ☐ often ☐ always 8) my child(ren) and i are safe around my co-parent. ☐ never ☐ rarely ☐ often ☐ always _______ zachary p. pierce, ma, stm, msw, lcsw, research associate, and jessica m. black, phd, associate professor, the cell to society lab, school of social work, boston college, chestnut hill, ma. copyright © 2023 authors, vol. 23 no. 2 (summer/fall 2023), 425-453, doi: 10.18060/26331 this work is licensed under a creative commons attribution 4.0 international license. introducing the theory of neurosocial interdependence: moving beyond the person-in-environment perspective in social work zachary p. pierce jessica m. black abstract: thoughts, emotions, and behaviors are linked fundamentally to the environments one inhabits. the person-in-environment perspective effectively captures these three aspects of the human experience and serves as a central fixture within social work research and practice. many social workers use this perspective to guide every facet of the work they undertake, from case conceptualization to ethics of human subject research. at the same time, recent advancements in human neuroscience research and neuroimaging technologies have inspired social workers to embrace how the nervous system is integrally interconnected with one’s environments. in turn, human neuroscience has catalyzed more biologically-informed practice and research in the field of social work, centered on elucidating social and psychological developmental domains within systems. the popularity of the person-in-environment perspective and the integration of human neuroscience in the field of social work has created a nexus that heretofore has not been adequately integrated into the literature. the present paper addresses this gap with a novel theory known as neurosocial interdependence, which integrates insights from human neuroscience into the framework of the person-in-environment perspective. this paper also bolsters the development of the theory of neurosocial interdependence by introducing a novel testing instrument and measurement scale, exploring how these tools might be used to implement the theory of neurosocial interdependence within social work research and clinical settings. keywords: neuroscience, person-in-environment, social work, brain, nervous system social workers tend to view their clients as individuals firmly rooted in their social, cultural, perceptual, and political environments, with thoughts, feelings, and behaviors intimately connected to these environments (germain & gitterman, 1980; gordon, 1969; rodwell, 1990). this perspective of social work practice has been informed by years of theoretical research in the fields of biology and social science (bowen, 1993; bronfenbrenner, 1981; mckenzie, 1984; park, 1915; thomas & znaniecki, 1958; von bertalanffy, 1969). this perspective took shape from the seminal work of mary richmond (1917) who championed what would later be called the person-in-environment perspective (pie). pie uses the contexts in which one is situated as a lens through which to view and understand an individual’s behaviors (richmond, 1917). pie also introduces a notion of “reciprocity” to the relationship between a person and their environments: an individual can impact their environments in many ways, just as these environments can levy numerous influences on an individual (richmond, 1917). pie remains a popular perspective for social work clinicians and researchers (kondrat, 2013; schalock et al., 2020). about:blank advances in social work, summer/fall 2023, 23(2) 426 since the “decade of the brain” in the 1990s, human neuroscience has been used as a language, method, and tool with which to conduct novel research and perform novel interventions in the field of social work (farmer, 2009; levine, 2015; miehls & applegate, 2014; porges, 2003; schore & schore, 2011; shapiro & applegate, 2018; siegel, 2001; van der kolk, 2014; van cleave, 2016). in social work practice, for example, developmental theory uses phases of neuroanatomical growth in children and adolescents to conceptualize stages of cognitive development and patterns of behavior to enhance goal attainment (arsalidou & pascual-leon, 2016). the clinical application of attachment theory has expanded from research into autonomic nervous system (ans) function, emotional dysregulation, and fear/stress stimuli experienced during childhood to modify how individuals conceptualize the link between social relationships and their bodies (cozolino, 2014). theories of trauma have also begun to incorporate insights about the function of the amygdala in the human fear response, ans dysregulation, and volumetric alteration of the hippocampus to help individuals conceptualize and moderate the physiological impacts of traumatic stress (levine, 2015). in social work research, human neuroscience has been used as a tool to compare brain area activity during the implementation of different trauma therapies (pierce & black, 2023b; pierce et al., 2023). additionally, human neuroscience has aided social workers with identifying optimal interventions for children with different math performance and reading challenges (ashkenazi et al., 2013). research into the clinical treatment of addiction as well as complex presentations of childhood trauma exposure have also been enhanced by the introduction of research outcomes from human neuroscience (cross et al., 2017; klorer, 2005; koob & volkow, 2016; volkow & boyle, 2018). human neuroscience has also helped inform policy makers around providing quality resources for adolescents experiencing adverse events within their home environments (weems et al., 2021). overall, the introduction of human neuroscience to the field of social work has presented many benefits to researchers, clinicians, and the clients they aim to impact. despite these benefits, researchers have addressed in a limited capacity how pie might be used when filtered through the lens of human neuroscience. additionally, this burgeoning interest in human neuroscience among social workers has not been thoroughly integrated into theories, frameworks, and perspectives important to research and practice. thus, one might observe a tension that has formed at the nexus between social work theory and human neuroscience research. the present paper addresses this tension by proposing a novel theory that merges pie with current insights from human neuroscience: the theory of neurosocial interdependence. this paper will briefly outline the contexts where neurosocial interdependence can fit into research and clinical discourse, briefly outline the theoretical framework of neurosocial interdependence, and discuss future directions for how this theory might be applied in clinical practice and research. theoretical frameworks and human neuroscience human neuroscience is the study of the human nervous system and biological bases of various cognitive, affective, and behavioral processes and mechanisms (oktar, 2006). neuroscientists typically conduct their research using neuroimaging technologies, source separation techniques, and electrochemical methodologies (cichocki et al., 2009; pierce & black/theory of neurosocial interdependence 427 ganesana et al., 2017). human neuroscience research is validated, like other scientific disciplines, through the process of replicating study designs, procedures, and results (gutzen et al., 2018). neuroscientists also rely on theories to direct their research endeavors and interpret evidence from prior studies (levenstein et al., 2020). theories provide frameworks through which studies can be designed and results can be analyzed. despite the utility of theoretical frameworks, neuroscience researchers have devoted little attention to the process of theory creation and implementation (levenstein et al., 2020). to be sure, literature has covered an area that has been termed the “philosophy of neuroscience,” including discussions about how neuroscientific research interacts with philosophical questions and frameworks (bickle et al., 2019). while important work has been done in this area (see churchland, 1986), neuroscientists have yet to formally construct a theory that conceptualizes the work they conduct. neuroscientists often employ theories to help them frame their scientific procedures (bello-morales & delgado-garcía, 2015; frank & badre, 2015; timme & lapish, 2018), but neuroscience has been and continues to be as a discipline of scientific methodology, where theory does not apply to the discipline itself. without theory neuroscientists face potential challenges, such as lacking conceptual clarity to guide the work they do. “conceptual clarity” in this case means the ability of a researcher to distinguish between or relate certain concepts within the field. when conducting a region of interest (roi) analysis of the basal ganglia in substance use disorders, for example, neuroscientists observe that the ventral tegmental area (vta) produces hormones that facilitate emotions of contentment and euphoria (e.g., serotonin, dopamine, and γ-aminobutyric acid). the release of these hormones contributes to patternbased learning of substance use implicated in the orbitofrontal cortex (ofc; bouarab et al., 2019; natarajan & yamamoto, 2011; schoenbaum & shaham, 2008). while researchers observe these functions occurring in the basal ganglia, they do not know why these functions work together to create the specific phenomenon known as addiction. there is no concept of why these rois in the basal ganglia work together this way, and thus there is no theoretical framework with which researchers might understand the neural processes underlying substance use and dependence. the paucity of theory in human neuroscience lends also to a diminished capacity to standardize research procedures—such as studies implicating the use of neuroimaging technologies—that can be applied within the discipline. functional magnetic resonance imaging (fmri) or electroencephalography (eeg) are two of the most common neuroimaging methodologies that are used by neuroscientists. there are a plethora of articles that explain how these machines work (glover, 2011; thakor & sherman, 2012), but no theoretical frameworks exist for how a researcher ought to operate one of these imaging machines to collect data about the human brain both effectively and ethically. this challenge limits neuroscientists’ attempts to implement standards of practice for using these technologies and to establish ethics around neuroimaging (eglen et al., 2017; garnett et al., 2011; illes & racine, 2005; moss et al., 2021; white, 2010). when applied to the discipline of itself, theory would help avoid such pitfalls. strengths and shortcomings of pie advances in social work, summer/fall 2023, 23(2) 428 unlike human neuroscience, the field of social work has embraced the process of theory creation and implementation for many years. indeed, the field of social work has incorporated many theoretical perspectives such as behaviorism (bronson & thyer, 2001), the strengths perspective (saleebey, 1996), and the biopsychosocial-spiritual framework (berzoff & drisko, 2015). the concept of intersectionality, for example, has greatly enriched social work practice by inviting clients and clinicians to explore how different areas of oppression (e.g., racism, heterosexism, homophobia, etc.) impact the individual and their relationships to the environments they inhabit (almeida et al., 2019; matsuzaka et al., 2021). social work has also come to use feminist theory and critical race theory (crt) toward breaking down patriarchal constructs of mental health and centering communities of color in discussions of resource provision and acquisition (constancehuggins, 2012; kolivoski et al., 2014; sands & nuccio, 1992; saulnier, 2000). alongside these frameworks, pie has increased in popularity across the field of social work and has brought many unique strengths to clinical practice and research (engel & schutt, 2016; hepworth et al., 2016; hutchinson, 2017; kondrat, 2013; reisch, 2019; rogers, 2022; rogge & cox, 2001; zastrow et al., 2018). pie is a theoretical framework that holistically conceptualizes an individual’s lived experience within many areas of the environments they inhabit (akesson et al., 2017; bogo, 2021; craik, 2000; lei et al., 2021; mathende & nhapi, 2017; murphy et al., 2022; pitt, 2013; richmond, 1917; saleebey, 1992; weick, 1981). this orientation is particularly useful for providing mental health services to clients and communities because mental health challenges occur in an interdependent relationship with one’s environments (guloksuz et al., 2016; monroe, 1988; mueller, 1980; rice et al., 2010). in other words, thoughts, feelings, and behaviors can be influenced by many factors in one’s environment, just as these same psychosocial features can impact one’s environment. take, for example, post-traumatic stress disorder (ptsd): a condition with an onset linked to events in the environment (e.g., natural disasters, community violence, sexual assault, child abuse, etc.). these environmental factors directly connect to the severity and duration of the onset, like how someone who survives a single car crash might develop ptsd, and someone who survives years of abuse from caregivers, across multiple developmental periods, might develop more complex ptsd features (briere & scott, 2015; elliott et al., 2021). with recent research into complex ptsd, it has been observed how these impacts can occur in reverse as well; namely, that single events can produce complex ptsd, and individuals who experience chronic exposure can produce ptsd (cloitre, 2020). while some research has been conducted into the neural substrates implicated in resilience and post-traumatic growth (pierce et al., 2023), more work is needed to understand how environmental impacts of trauma lead to different mental health challenges. on the other hand, individuals living with major depressive disorder (mdd) might exhibit, among other symptoms, a marked disinterest in activities they previously enjoyed (kennedy, 2008). an example of how this symptom might manifest is when an individual elects to socially withdraw (teo et al., 2020), shrinking their sphere of social interaction and activity. because the symptomological impacts of mdd can be incredibly burdensome to endure due to its chronicity, some individuals might also not have enough energy to pierce & black/theory of neurosocial interdependence 429 engage in activities of daily living (adls), such as cleaning their homes (ojagbemi et al., 2018; park & jung, 2019), bathing (shevchuk, 2008), or eating (ljungberg et al., 2020). the draining effect of mdd might then spill over into other areas of one’s life, such as commitments to attending work or school, spending time with friends or family, and so on (askeland et al., 2020; elmer & stadtfeld, 2020; lamichhane et al., 2018). the psychosocial impacts of the covid-19 pandemic also come to mind, which brought about depressive symptoms in many populations due to prolonged social isolation, among other factors (renaud-charest et al., 2021). one might observe here how the person and their environments interact in complex ways, across various different levels with respect to mdd. using pie, social workers can conceptualize how one’s environment impacts mental health as well as how mental health impacts one’s environments. accordingly, this perspective has led to various clinical interventions that factor in how person and environment interact. consider, for example, prolonged exposure (pe), which is regarded as a frontline intervention for treating ptsd (foa, 2011). pe like other exposure therapies (deffenbacher & suinn, 1988; noordik et al., 2010; pitman et al., 1991; sars & van minnen, 2015) implicates the gradual desensitization of the fear stimulus in one’s environment so that the survivor might be able to encounter this stimulus without experiencing distressing ptsd symptoms (peterson et al., 2019). one might also consider aymer (2016) who offers a case example of how psychoeducation in the framework of cognitive behavioral therapy (cbt) can be used to help people of color reframe the impacts of racism from a personal level to a systemic level. using this technique allows these individuals to shift away from self-blame and other negative self-directed symptoms toward an externalized conception of systemic racism against which they might feel empowered to push back (aymer, 2016). beyond therapeutic modalities, social workers often provide case management services for their clients, such as connecting individuals with housing, legal, food, and health resources (green & ellis, 2017; lukersmith et al., 2016). the positive psychological impacts correlated to integrating these environmental needs are numerous (ziguras & stuart, 2000). for all its benefits, however, pie exhibits a limitation: it does not clearly emphasize how the human brain is implicated in this interdependent relationship with the environment. some researchers in the field note the importance of the link between one’s neurophysiology and their environments (black & conway, 2018; farmer, 2009; hutchinson, 2017; miehls, 2014; shapiro & applegate, 2018). however, researchers have not made a sufficiently strong link to pie. hutchinson (2017), for example, includes helpful sections on basic brain structures, the endocrine system, the cardiovascular system, the musculoskeletal system, and the reproductive system. however, when integrating what hutchinson (2017) terms as “the biological self” and the environment, attention is given to “environmental factors and exposures” and not the guiding framework itself (pp. 228–230). and when addressing “stress exposures,” hutchinson generally indicates negative biological impacts of environmental stress (hutchinson, 2017, p. 230), but does not directly discuss the theoretical implications behind how the human brain relates to pie. additionally, shapiro and applegate (2018) present a thorough, user-friendly text that outlines clinical advances in social work, summer/fall 2023, 23(2) 430 implications of neuroscience research for social workers, but they appear to miss how the human brain relates to a perspective as crucial to social work as pie. it is essential for social work theory to bridge with neuroscience because the structure and function of the brain serve as the bedrock for the interdependent relationship between a person and their environment. to bridge social work theory and human neuroscience, therefore, requires theory development that will enhance both fields and have the potential for adaptation beyond them. constructing the theory of neurosocial interdependence it has been observed that scientific theories require several key characteristics to be considered “high quality.” the theory must be 1) consistent in empirical observations, 2) precise, 3) parsimonious, 4) explanatorily broad, 5) falsifiable, and 6) promote scientific progress (chijioke et al., 2021; gieseler et al., 2019; higgins, 2004; payne, 2021; robbins et al., 2011). observing these characteristics, shoemaker and colleagues (2004) devised a procedure for constructing a scientific theory that meets the criteria for “high quality.” this procedure includes the following steps: 1) define the theory; 2) identify core concepts associated with the theory; 3) find causes and effects for these core concepts; 4) specify theoretical and operational definitions for all concepts; 5) link concepts to create a hypothesis; 6) define rationale for this hypothesis; and 7) fit the hypothesis into a systemic framework (shoemaker et al., 2004). these steps will be used to outline the theory of neurosocial interdependence. defining neurosocial interdependence the first step involves creating a definition of the theory of neurosocial interdependence. neurosocial interdependence is defined as the mutual reciprocity of processes and functions of the human brain with one’s environments. the phrases “processes and functions of the human brain” and “one’s environments” were included in this definition because the theory conceptualizes the human brain and the various environments in which one operates as a primary nexus through which to conceptualize cognition, affect, and behavior. considering the relationship between these two components of the definition, the adjective “reciprocity” was used to capture the interdependent aspect of the relationship between one’s brain and their environments. core concepts of neurosocial interdependence from this definition two core concepts were derived: efferent reciprocity and afferent reciprocity. efferent reciprocity relates to how one’s environments impact their sense of self. afferent reciprocity relates how one’s sense of self impacts their environments. these concepts were derived from human neuroscience where efferent and afferent refer to neural signals that are sent toward or away from an indicated brain region, respectively (gautam, 2017). in the present context, however, efferent and afferent indicate the directionality of connection that one experiences to themselves (inward) and to their environments (outward). research on perception of internal self-states and external environments from pierce & black/theory of neurosocial interdependence 431 cognitive neuroscience was also incorporated to frame the concepts of efferent and afferent reciprocity. for example, when one perceives social support from others and assess the emotional value of that support, there is increased functional connectivity between the amygdala and the hippocampus, which informs the person that this social support is either helpful or unhelpful for their safety and wellbeing (lu et al., 2018; piretti et al., 2020). additionally, the anterior cingulate cortex helps individuals to construct and act upon their worldviews, an internal narrative of who they are and how they might impact the people, places, and systems around them (morita et al., 2014; stevens et al., 2011). lastly, the ventromedial prefrontal cortex (vmpfc) is responsible for self-referential processing of internal states of awareness and has been observed to play a key role in social relationship building and operationalizing desires for external change based on self-concept (d’argembeau, 2013; kim & johnson, 2015; moneta et al., 2023). as one might observe, the present theoretical model provides neural and social bases upon which inward and outward connection to oneself and their environments might be discussed and studied (adolphs, 2003; cacioppo et al., 2010; cordeiro et al., 2021; han et al., 2021; heatherton, 2011; ladouce et al., 2017; park & huang, 2010; taylor et al., 2015). see figure 1 for a model of the theory and these core concepts. figure 1. basic framework of the theory of neurosocial interdependence advances in social work, summer/fall 2023, 23(2) 432 it should be noted that these concepts are not mutually exclusive, as functions of conceptualization of self and environment often overlap in the brain (montemayor & haladjian, 2017). it is posited, therefore, that these concepts can be measured on a spectrum, where increased reciprocity is indicated by the term conjunctive, and decreased reciprocity is indicated by the term disjunctive. figure 2 represents our conjunctivedisjunctive scale of reciprocity (cdsr) which measures levels of conjunction or disjunction relative to one’s score on the checklist of efferent and afferent reciprocity (clear; see figure 3). levels of conjunction and disjunction are qualified by the categories “mild,” “moderate,” and “marked.” the term “marked” was used instead of “severe” to prevent individuals from experiencing stigma associated with the negative connotation of a “severe” result on a psychometric instrument. figure 2. conjunctive-disjunctive scale of reciprocity for mental health practitioners to measure these elements of reciprocity in a clinical setting, the authors of this paper have devised what is called the checklist of efferent and afferent reciprocity (clear). the clear is a 20-item self-reporting checklist that measures various features associated with efferent and afferent reciprocity. items 1–10 measure features germane to efferent reciprocity, and items 11–20 measure features germane to afferent reciprocity. items on the scrc are structured using 6-point likert scales, where the individual is asked to rate how their lived experience correlates with each item. item response options range from 0 or “not at all” to 5 or “very often.” the clear can be administered by clinicians using a short-term or long-term format. in the short-term format, the individual is asked to rate their experiences of efferent and afferent reciprocity during the past week. in the long-term format, the individual is asked to rate their experiences of reciprocity during the past month. these two formats were used to account for micro and macro changes that might occur with an individual’s experiences of reciprocity (walentynowicz et al., 2018). figure 3 below presents all questions delivered in the clear, irrespective of time-dependent format. the clear has yet to undergo reliability and validity testing and thus requires further assessment before implementation in clinical settings. figure 3. the checklist of efferent and answer each question according to your lived experience within the past (week/month). pierce & black/theory of neurosocial interdependence 433 circle the number most accurately represents your answer below. 0 = not at all | 1 = not often | 2 = sometimes | 3 = somewhat often | 4 = often | 5 = very often in the past week/month ... efferent reciprocity 1. my communities helped me feel like i belong. 0 1 2 3 4 5 2. my communities provided me with emotional support. 0 1 2 3 4 5 3. my communities validated my gender and/or sexual identities. 0 1 2 3 4 5 4. my communities encouraged body positivity. 0 1 2 3 4 5 5. my communities encouraged me to solve problems effectively. 0 1 2 3 4 5 6. my communities encouraged me to think creatively. 0 1 2 3 4 5 7. my communities informed me about what was ‘right’ and ‘wrong’. 0 1 2 3 4 5 8. my communities informed me how to care about the wellbeing of others. 0 1 2 3 4 5 9. my communities encouraged me to pursue my goals. 0 1 2 3 4 5 10. my communities encouraged me to better myself. 0 1 2 3 4 5 afferent reciprocity 11. i helped others in my communities feel like they belong. 0 1 2 3 4 5 12. i provided emotional support to others in my communities. 0 1 2 3 4 5 13. i validated the gender and/or sexual identities of others in my communities. 0 1 2 3 4 5 14. i regard others in my communities with body positivity. 0 1 2 3 4 5 15. i effectively solved a problem in my communities. 0 1 2 3 4 5 16. i thought creatively about how to better my communities 0 1 2 3 4 5 17. i addressed an issue in my communities using what i know as ‘right’ and ‘wrong’. 0 1 2 3 4 5 18. i demonstrated care for the wellbeing of others in my communities 0 1 2 3 4 5 19. i pursued my goals in my communities. 0 1 2 3 4 5 20. i encouraged others in my communities to better themselves. 0 1 2 3 4 5 as has been discussed, efferent reciprocity indicates how one’s environments impact their sense of self. for example, an individual who says, “i need to take care of myself tonight because i had a rough day at work” might be exhibiting conjunctive efferent reciprocity. the assumption here is that this person engages in self-care because they recognize the psychological impact of their work environment on their sense of self. on the converse, if the same individual with the same work day says, “i am feeling stressed out and i don’t know why,” they might be exhibiting disjunctive efferent reciprocity. here, the individual is aware of their sense of self via their stress response, but they are unaware of the role of the environment in their stress response. there is also afferent reciprocity, which indicates how one’s sense of self impacts their environments. conjunctive afferent reciprocity might be present if someone recognizes that they were raising their voice at a business meeting due to stress and apologizes to their colleagues for their behavior. in this example the individual recognizes the impact of their sense of self on the environment around them and engages in social advances in social work, summer/fall 2023, 23(2) 434 cognition to repair ruptured relationships with others in that environment (zaki et al., 2010). on the converse, disjunctive afferent reciprocity might be indicated if this same individual expressing stress via a raised voice were to comment later on, “i know i yelled because i was stressed, but i don’t get why everyone avoided me after that business meeting.” here, the individual was aware of their sense of self but did not recognize the impact of their sense of self on the surrounding environment. of course, these examples are hyperbolic to emphasize the full scope of conjunctive and disjunctive aspects of efferent and afferent reciprocity. causes and effects for core concepts to further illustrate these core concepts of the theory of neurosocial interdependence, several vignettes will be presented, identifying possible causes and effects in which conjunction and disjunction might be observed for these concepts. first, consider a white male military service person named michael. michael was diagnosed with ptsd by a social worker at the veterans administration for trauma exposure during his military service. michael is enjoying breakfast in his apartment on a saturday morning. suddenly, a news helicopter flies over his apartment, and the sound of the helicopter’s blades reverberate throughout michael’s apartment. the noise of the helicopter blade’s reminds michael of a traumatic event that occurred during service, where a close friend in his battalion was shot down while riding a blackhawk helicopter. the sound of the helicopter blades functions as a trauma trigger for michael. unfortunately, this trigger caused michael to experience an episode of dissociation, where he was perceptually transported to the day of his close friend’s tragic passing. then, michael’s limbic system activates and causes his body to tense up, produce sweat, and experience harrowing feelings of panic (pierce & black, 2023a, 2023b; pierce et al., 2023; sherin, 2011). if the theory of neurosocial interdependence were applied to michael’s episode of dissociation, he might be experiencing both disjunctive efferent and afferent reciprocity. michael’s episode of dissociation caused him to disconnect from his sense of self and his immediate environment due to the overwhelming nature of his trauma trigger, which included hearing a news helicopter flying over his residence. the effects of this trigger were the resultant episode of dissociation and limbic system response. studies have shown that during a dissociative episode, functional brain activity is concentrated on emotion processing centers in the limbic system—principally, the amygdala—which produce concomitant neurotransmitter impulses that trigger the body to fight, run away, or freeze in a manner similar to the traumatic event (kozlowska et al., 2015; morey et al., 2012). within these activated areas is the hippocampus, or the primary memory encoding center in the human brain. during dissociation the hippocampus activates, and this activation is correlated with the experience of one being immersed in the time and place of a vivid traumatic memory (bourne et al., 2013). with these neurological phenomena, michael’s nervous system was perceptually disconnected from his sense of self and his environment around him during this episode of dissociation because he was immersed in the experience of a vivid traumatic memory (yrondi et al., 2020). thus, with respect to the theory of neurosocial interdependence, michael’s episode of dissociation indicates that he might be experiencing disjunctive efferent and afferent reciprocity because he experienced pierce & black/theory of neurosocial interdependence 435 disconnection from how his environment impacted him and how he potentially impacted his environment. consider a second example, where a black female named danielle is journaling on a back porch with a picturesque woodland view in the background. danielle thoroughly enjoys journaling because this exercise prompts her to reflect on all that she did in a given day. she sees the mountain she hiked yesterday in the distance and reflects on the various thoughts, feelings, and body sensations that arise when recounting the momentous accomplishment of summiting its peak. this moment, in part, inspires danielle to volunteer with a local environmental conservation organization to ensure that others might be able to share in her experience of admiring this woodland view and hiking that mountain for generations to come. using the framework of the theory of neurosocial interdependence, one might observe that danielle is experiencing both conjunctive efferent and afferent reciprocity. she identified the impact of her environment on her sense of self by journaling and then observing the mountain she hiked the previous day, where she reflects on thoughts and feelings she experienced during her hike. what is more, danielle identified how her sense of self was connected to her environment by not only recognizing but also catalyzing her sense of self to give back to her environment through conservation efforts. accordingly, danielle’s robust interdependent connection between her sense of self and her environment indicates conjunctive efferent and afferent reciprocity. lastly, consider a latinx female basketball player named samantha. samantha plays the power forward position on her high school basketball team, which requires her to shoot layups while drawing foul contact from opposing players, thus leading to opportunities for foul shots. samantha has been practicing her foul shots consistently to ensure that she is able to maintain a high level of accuracy when the game is close to finishing and the score is close or tied. samantha practices her foul shots wearing a pair of headphones that play the noises of a jeering crowd to desensitize and disconnect herself from the disorientation of an opposing team’s fanbase. several days later, samantha’s team is playing an away game, and they are down 70–72 with 7 seconds to play in the game. samantha is calm and focused, and she uses her sense of self to spot an open section of court near the hoop to move toward. her teammate passes her the ball as opposing players converge. samantha goes up for a layup and is fouled. she scores the basket. the game is now tied 72–72 with 3 seconds left to play. samantha walks to the free-throw line to shoot one basket to put her team ahead by one point. having prepared for this moment, samantha tunes out the opposing crowd and focuses on her shooting form. samantha shoots and scores the free throw. samantha’s team ended up winning 73–72. referring back to the theory of neurosocial interdependence, samantha’s performance in this basketball game might have demonstrated conjunctive afferent reciprocity but disjunctive efferent reciprocity. samantha was aware of her sense of self at the end of the game and leveraged it to find an open position from which to score a basket and draw a foul from an opposing player. when it came time to shoot her free throw, however, samantha disconnected from the potential impacts of his environment by focusing on her shooting form, which led to her sinking the game-winning basket (purcell et al., 2019). advances in social work, summer/fall 2023, 23(2) 436 theoretical and operational definitions according to criteria outlined by shoemaker and colleagues (2004) about creating strong theory, the concepts of efferent reciprocity and afferent reciprocity require theoretical and operational definitions. first, efferent reciprocity is theoretically defined as the recognition of the impact of one’s environments on their sense of self. one might recall how danielle identified her thoughts, feelings, and bodily sensations in her journal from the previous day’s hike to signal that she recognized the impact of the environment on her sense of self. similarly, a theoretical definition of afferent reciprocity implicates the recognition of the impact of one’s sense of self on their environments. consider how samuel’s sense of calm and focus led him to move through his environment to find an advantageous position from which to shoot the basketball on the court. next, there are operational definitions of efferent and afferent reciprocity. efferent reciprocity measures how brain regions of perception and self-concept formation are impacted by stimuli from one’s environments. efferent reciprocity can be measured in clinical settings using the clear as well as other psychometric self-concept instruments like the five-factor selfconcept questionnaire (af5; garcia et al., 2018), the robson self-concept questionnaire (scq; addeo et al., 1994), or rosenberg’s self-esteem scale (rses; park & park, 2019). afferent reciprocity, on the other hand, measures how brain regions of perception and selfconcept formation react when impacting one’s environments. afferent reciprocity might also be measured using the clear, as well as other instruments like a sociometric test (sabin et al., 2014) or one of numerous community engagement surveys (attree et al., 2011; cyril et al., 2015; hood et al., 2010). in laboratory settings, both forms of reciprocity can be measured with an electroencephalography (egg) or fmri (glover, 2011; thakor & sherman, 2012). create a hypothesis and define its rationale having theoretically and operationally defined efferent reciprocity and afferent reciprocity, these concepts will be synthesized to create a working hypothesis for the theory of neurosocial interdependence. the hypothesis is as follows: how someone perceives their sense of self can impact, and be impacted by, their environments. people experience various cognitions, sensations, and affects in response to stimulus cues from their environments, and people can similarly impact their environments by using these cognitions, sensations, and affects as guides for response (beer, 2008; dotov, 2014; pretty et al., 2017; see will et al., 2021). this phenomenon is captured in the core concepts of the theory of neurosocial interdependence: the human nervous system and one’s external environments are in a commutual relationship where one’s self-concept is informed by cues from the environment (efferent reciprocity), and one’s self-concept can be used to impact the environment (afferent reciprocity). these core concepts from which this hypothesis was derived can be measured using the clear instrument described above. the general format of the clear is structured in a way that will maximize the potential for both high internal validity and reliability, considering that the number of items in the checklist can account for nuances in participant responses (chang, 1994; deniz & alsaffar, 2013; taherdoost, 2019) therefore, the hypothesis presents promise for accurate predictive value pierce & black/theory of neurosocial interdependence 437 for measuring what it intends to measure (heston & king, 2017). further testing of the clear is needed, however, to validate these initial claims. proposing a systemic framework for neurosocial interdependence the present hypothesis might best fit into a systemic framework like the ecological systems model posed by bronfenbrenner (1981; see figure 4). bronfenbrenner’s fourtiered model represents different levels of environmental contexts in which one might engage in their daily life (e.g., microsystem, mesosystem, exosystem, and macrosystem). this model provides a framework for which aspects and outcomes from the theory of neurosocial interdependence might best be observed and measured. for example, social workers might use this framework to compare efferent and afferent reciprocity for a teenager who lives in a home with two siblings and two parents (e.g., a microsystem) versus the same teenager once they begin taking classes at a large state university (e.g., an exosystem). social workers might also compare efferent and afferent reciprocity among members of a friend group hailing from different neighborhoods (e.g., a microsystem) with their sociopolitical beliefs about what it means to be part of a community (e.g., a macrosystem). overall, the ecological systems model (bronfenbrenner, 1981) serves as a useful tool to help clinicians and researchers situate individuals’ neurosocial interdependence within their respective environments. figure 4. bronfenbrenner’s ecological systems model advances in social work, summer/fall 2023, 23(2) 438 limitations for all of the helpful insights and provocative questions that the theory of neurosocial interdependence may bring to the field of social work, there are some limitations worth consideration. first, it should be stressed that the clear has not yet undergone formal testing and validation. once this instrument has been sufficiently assessed with various populations, then the discussion can be enriched with respect to its validity and reliability for assessing concepts germane to the theory of neurosocial interdependence. second, the implementation of the clear instrument might present some challenges to accurately measuring efferent and afferent reciprocity considering the nature of the instrument. the clear instrument was designed to be a self-report assessment. unfortunately, self-report assessments introduce a number of potential biases that could skew results. for example, individuals who fill out the clear with their clinician might avoid answering questions that demonstrate either efferent or afferent disjunction because they might infer that there is a deficit with how they interact with the environment, thus engaging in a social desirability bias (bergen & labonté, 2020; larson, 2018; latkin et al., 2017). like social desirability bias, participants in a neurosocial interdependence study might fill out answers on the clear that are generally more affirmative in nature to indicate that they agree, for pierce & black/theory of neurosocial interdependence 439 example, that they have marked conjunction in both efferent and afferent reciprocity, which is defined as acquiescence bias (kreitchmann et al., 2019; lelkes & weiss, 2015). another limitation of neurosocial interdependence might implicate cross-cultural transferability. one might imagine that the western, empirical, and neuroscientific framework of the theory of neurosocial interdependence might not resonate with cultures for whom ways of being and knowing do not implicate these above-mentioned perspectives. indeed, the western foundation of neurosocial interdependence might preclude individuals from cultures impacted by western colonialism from receiving the full benefits of this framework in both research and treatment. one possible avenue with which to navigate this limitation might include changing the language and adapting the format of the theory for use within non-western cultures with different ways of knowing (al-krenawi & graham, 2001; graham et al., 2009; marsiglia & booth, 2015). indeed, it is necessary to support efforts to adapt and decolonialize western research in a way that includes the voices of those silenced and marginalized along the imperial periphery. future directions for clinicians and researchers from this introduction of the theory of neurosocial interdependence and its related concepts, there are several implications that this theory holds for clinical practice and research in the field of social work. efferent and afferent reciprocity address the interdependent relationship between the person’s perception of themselves and their environments. additionally, the clear instrument is designed to measure how efferent and afferent reciprocity figure in one’s capacity to notice how they impact, and are impacted by, the spaces they occupy. therapeutically, the theory of neurosocial interdependence could be applied to interventions involving mindfulness. mindfulness exercises implicate the practice of noticing the impact of stimuli in one’s environment and avoiding judgment of those stimuli and their impacts (hofmann et al., 2010). the conceptual framework of efferent and afferent reciprocity invites individuals to notice how their nervous systems interact with their environments in a way that harmonizes with the goals of mindfulness exercises. concepts from neurosocial interdependence also hold import for practice with dialectical behavioral therapy (dbt). distress tolerance interventions, for example, are used during the course of dbt and often implicate mindfulness exercises (elices et al., 2017; lothes et al., 2021). efferent and afferent reciprocity could serve as useful concepts for framing treatment outcomes with respect to managing distress tolerance, since introducing mindful awareness of how nervous system interacts with their environments has been shown to aid with increasing distress tolerance (navarro-haro et al., 2019). additionally, the clear instrument and the conjunctive-disjunctive scale of reciprocity (cdsr) could be used to measure efferent and afferent reciprocity, and then introduce psychoeducational and empowering conversations between client and clinician that gives new perspective to everything from distress tolerance to resilience and growth. efferent and afferent reciprocity likewise dovetail with interventions designed for individuals living with ptsd, such as cognitive processing therapy (cpt), eye movement desensitization (emdr), and prolonged exposure (pe). these interventions, among others, advances in social work, summer/fall 2023, 23(2) 440 help individuals manage the sense of overwhelm associated with traumatic stress symptoms and rebuild their sense of self after a traumatic event has occurred (gallagher & resick, 2012; hendriks et al., 2018; pierce et al., 2023; valiente-gomez et al., 2017). concepts undergirding the theory of neurosocial interdependence explore how the human brain impacts, and is impacted by, one’s environments. reframing how the nervous system interacts with one’s environments can be useful for helping individuals not only manage distressing symptoms but also cognitively restructure unhelpful beliefs about the world and oneself associated with the trauma, thus potentially refining or reinforcing action plans and clinical interventions (wilkinson, 2017). lastly, clinicians might find purchase within the theory of neurosocial interdependence during interventions with individuals who live with attention deficit hyperactivity disorder (adhd). while adhd might present vastly different strengths and challenges for individuals who live with the condition, a hallmark feature of adhd implicates varied challenges associated with attention (depue et al., 2010; lenartowicz et al., 2018; mette et al., 2013). the theory of neurosocial interdependence might help provide space for clinicians and clients to explore how attentional skills might be enriched by engaging one’s brain with their environments in new ways, such as “sensory breaks” introduced throughout a long, contiguous project (herbert & esparham, 2017). with respect to social work research, the theory of neurosocial interdependence maintains several implications for systems-related studies. one might recall the two examples provided above that addressed the utility of bronfenbrenner’s (1981) ecological systems model within the theory of neurosocial interdependence. reciprocal impacts of the brain’s perception of self on the environment can be compared between different levels of this model, particularly using large research cohorts or discrete experiment and control groups (gilleard, 2004; manson, 2008; stokols et al., 2013). findings from studies that apply the theory of neurosocial interdependence in this way could help expand the knowledge base concerning how the brain reacts within, and responds to, disparate environmental contexts. one might also consider how to combine assessments of efferent and afferent reciprocity using the clear assessment and neuroimaging technologies. for example, research teams could compare efferent and afferent reciprocity among children who are receiving treatment for sensory processing disorder (spd). an example study might employ a control group and experimental group with spd. both groups would undergo preand post-test fmr imaging as well as completing of the clear before and after the experiment. a study using this design would be able to show which brain areas might be implicated in attentional and sensory aspects associated with neurosocial interdependence and compare how neurosocial interdependence might figure differently for individuals who live with sensory conditions like spd. overall, the theory of neurosocial interdependence shows promise for a variety of settings 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(2000). a meta-analysis of the effectiveness of mental health case management over 20 years. psychiatric services, 51(11), 1410-1421. author note: address correspondence to zachary pierce, riverside community care, community behavioral health center, milford, ma 01757. email: zapierce11@gmail.com https://doi.org/10.1111/1468-5922.12335 https://doi.org/10.1038/s41467-021-24290-7 https://doi.org/10.1038/s41467-021-24290-7 https://doi.org/10.3389/fpsyt.2020.00351 https://doi.org/10.3389/fpsyt.2020.00351 https://doi.org/10.1523/jneurosci.0382-10.2010 https://doi.org/10.1523/jneurosci.0382-10.2010 https://doi.org/10.1176/appi.ps.51.11.1410 https://doi.org/10.1176/appi.ps.51.11.1410 mailto:zapierce11@gmail.com _________ dawn apgar, phd, lsw, acsw, associate professor, department of social work at seton hall university, south orange, nj. lori zerrusen, msw, lsw, adjunct faculty, department of social work at seton hall university, south orange, nj, and full-time clinician with adults and children. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 175-186, doi: 10.18060/26953 this work is licensed under a creative commons attribution 4.0 international license. examining the views of master of social work (msw) graduates on the grand challenges for social work and society dawn apgar lori zerrusen abstract: despite the social work profession’s unified commitment to identify and address widespread societal problems, there have been few scholarly articles that have focused on the grand challenges for social work and society (“grand challenges”). while half of social work academic programs have reported incorporating content about the grand challenges initiative into curricula, there have not been any known empirical studies about whether graduates have interests in these areas or feel prepared to address the identified concerns. this quantitative study of master’s-level social workers indicates that the vast majority are unaware of the grand challenges and are not working on most social problems identified. despite strong interest in addressing the grand challenges generally, the primary professional foci of social workers are limited to a few issues. there are significant overall relationships between professional interests, perceived competency to work on the problems, and views on the likelihood of the profession making progress on addressing the grand challenges. results have significant implications for social work education as practicum placements and work opportunities need to be developed in key areas if the profession wants to have desired societal impacts. keywords: grand challenges, professional interests, competency, knowledge, curriculum, msw, social work, social problems, practicum in 2012, the american academy of social work and social welfare (aaswsw) envisioned the grand challenges for social work and society (“grand challenges”). the aaswsw identified 12 consequential societal dilemmas that the profession should address within the next decade, including ensuring healthy development for all youth, closing the health gap, stopping family violence, advancing long and productive lives, eradicating social isolation, ending homelessness, creating social responses to a changing environment, harnessing technology for social good, promoting smart decarceration, reducing extreme economic inequality, building financial capability for all, and achieving equal opportunity and justice (barth et al., 2022). since this original announcement, aaswsw has acknowledged the ills of systemic racial discrimination and firearm-related assaults by adding eliminating racism and preventing gun violence as additional grand challenges (grand challenges for social work, 2023a). the aaswsw viewed the grand challenges as an opportunity to uphold and promote the social work profession and to create innovative forms of practice and problem-solving (ferraro, 2015). the original, and current, grand challenges leadership group includes some of the nation’s leading scientists, educators, and policy experts in social work who have worked to develop strategic partnerships with social work’s national organizations, interest groups, and academic entities (grand challenges for social work, 2023b). about:blank advances in social work, spring 2024, 24(1) 176 addressing the grand challenges necessitates creativity, shared effort, and enthusiastic participation by social workers, in conjunction with engagement of their colleagues in education, psychology, sociology, health, medicine, engineering, environmental studies, and governmental affairs to research, advocate for, make policy recommendations for, and design curricula to solve some of the most consequential problems affecting society (eisenhardt et al., 2016; nurius et al., 2017). the grand challenges are formidable but obtainable goals. although difficult to achieve, the grand challenges aimed to motivate and excite social workers and others to formulate comprehensive and coordinated responses to these global concerns (bentgoodley, 2016). the social work profession is unique as its practitioners operate in numerous systems, in a variety of roles and diverse communities, with individuals as they move through the life course (cederbaum et al., 2018). as a result, social workers obtain a comprehensive understanding of the significant issues affecting individuals, families, and communities using both biopsychosocial and ecological perspectives (cswe, 2022). additionally, social workers are trained to comprehend the impact of current policies, regulations, and laws on human well-being and act as change agents to create a just society (gehlert et al., 2017). social workers have the opportunity to significantly impact the grand challenges and be leaders in interdisciplinary collaborations to solve problems that negatively affect people, especially those who are marginalized and oppressed (ferraro et al., 2015). this article fills a gap in the existing literature as it provides quantitative data from master of social work (msw) graduates on their knowledge about, interests in, and perceived competency to work on the grand challenges. additionally, it examines their optimism about the profession’s likelihood of making progress on addressing these social problems in the next five years. ensuring adequate numbers of graduates are committed to and proficient in working in these areas is essential if social work is going to have a significant impact in remedying the social problems that it has identified as most detrimental to societal well-being. literature review grand challenge movements during the last century, interdisciplinary partnerships have been used to address intractable problems that have severe consequences for society. in 1900, german mathematician david hilbert first conceptualized grand challenges when he unveiled 23 unsolved math problems, which would absorb mathematicians’ attention across the next century and inspire advancement in mathematics (barth et al., 2022). since this time, grand challenges initiatives have been used to call out critical issues and priorities within professions that need solutions and require concentrated effort and strategies (baron & mclaughlin, 2017). many professions, companies, and foundations have initiated grand challenges to work on serious issues that impact target populations and communities (teixeira et al., 2021). these efforts have typically been inclusive, engaging researchers, providers, educators, and apgar & zerrusen/ grand challenges perceptions 177 advocates in comprehensive planning to work toward ameliorating these concerns. for example, the bill & melinda gates foundation used grand challenges—open requests for grant proposals—in 2003 to focus attention and effort on pressing global health and development problems for those most in need (bill & melinda gates foundation, 2023). in 2008, the national academy of engineering (nae) spearheaded a grand challenges initiative seeking to energize and entice a new generation of engineering students into the profession (mote et al., 2016). specifically, the nae wanted the profession to become more inclusive and diverse, as well as close the gap between academia and engineers working in the discipline. members of nae and deans of engineering schools identified a collection of priorities affecting the engineering profession (mote et al., 2016). ensuing work on these concerns assisted in narrowing the gap between practice and research within educational institutes by having students and researchers collaboratively find creative solutions (mote et al., 2016). through the years, private and public organizations have identified grand challenges as a mechanism to encourage a discipline to take on society's greatest needs (barth et al., 2022). grand challenges initiatives further encourage interdisciplinary collaboration as a way to stimulate innovation and solve long-standing problems with the goal of achieving the fullest impact (bent-goodley, 2016). organizations, including governments, the united nations, academies, and foundations, have sponsored grand challenges initiatives (cederbaum et al., 2018). current grand challenges initiatives can be found in medicine, science, and economic and social advancement. grand challenges in social work the goal of the grand challenges is to unify, galvanize, and mobilize those within and outside the social work profession to elevate consciousness about serious issues that affect society (eisenhardt et al., 2016). to achieve this objective, the social work profession must enhance the way it communicates its current and potential influence on communities to the public (ferraro et al., 2015). social work professionals have firsthand understanding of the underlying contributors to the grand challenges, making them essential in design of the remedies (gehlert et al., 2017). the grand challenges initiative gives social workers a language to instruct individuals regarding the profession's benefit to the most pivotal issues facing society (nurius et al., 2017). social workers need to work to increase community awareness of these social problems and clearly define the importance of prioritizing them in order to eradicate widespread and longstanding challenges such as crime, poverty, and violence (bent-goodley, 2016). the grand challenges initiative highlights the importance of social work and the valuable role that social workers can and do play in addressing social problems. the grand challenges initiative also provides an opportunity to dialogue with students who are entering the profession so that they can see how their professional practice connects to others to address broader social problems (gehlert et al., 2017). this initiative charges social workers with being change agents within communities and not accepting the status quo (baron & mclaughlin, 2017). social work’s leadership in identifying the most urgent and important societal concerns demonstrates profession-wide resourcefulness and the advances in social work, spring 2024, 24(1) 178 capacity of the profession to understand the complexity of social, psychological, and economic issues that result in disparities and dysfunction (rine, 2016). to ensure that all those entering the profession are knowledgeable about and prepared to tackle the grand challenges, there is a need for early career support (nurius et al., 2017). social workers, especially those new to the profession, must have a clear call to action as well as access to leadership development to collaboratively address the grand challenges (gehlert et al., 2017). progress made to date since 2016, significant progress in addressing the grand challenges has been made in the areas of training, practice, research, and policy. for example, approximately 60 social work schools have designed and executed novel teaching advancements and imaginative classroom ideas focused on addressing these pressing issues. major initiatives in the united states and other countries have been shaped by research conducted and policies recommended by members of the grand challenges’ community (barth et al., 2022). for example, a co-leader of the grand challenge to reduce extreme economic inequality has advocated for baby bonds legislation, which authorizes the establishment of state-funded trusts for children in families with low income; such legislation was passed in dc and connecticut in 2021 (grand challenges for social work, 2022). additionally, a lead researcher for the grand challenge to create social responses to a changing environment has worked in india to help women build, repair, and sell solar-powered lamps given the country’s inconsistent electricity access and the disproportionate impact of climate change on women and girls (snyder, 2023). since early 2020, the covid-19 pandemic has exacerbated the problem of social isolation. to combat this issue, multiple educational offerings, such as workshops and symposiums, have been held to discuss the impact of covid-19 on human well-being with substantial resources devoted to remedying its effects (barth et al., 2022). workforce implications to address the grand challenges, the social work profession needs to develop and implement a strategy to prepare incoming social workers with the skills necessary to confront these issues (eisenhardt et al., 2016; flynn, 2017). specifically, social workers need to lean more heavily on research to find solutions, work collaboratively on interdisciplinary teams, and learn to put the knowledge gained from research into practice (cederbaum et al., 2018). researchers from social work and other disciplines need to collaborate in a more significant way to fully understand the intersectionality of critical social issues (ferraro et al., 2015). additionally, social work researchers need to share ideas with practitioners to ensure that findings are rapidly put into practice (bent-goodley, 2016). researchers must also be careful to structure their work with an understanding of the realities faced by communities experiencing these issues in more significant ways (nurius et al., 2017). to make progress, researchers, practitioners, and policymakers need to increase communication, collaboration, and teamwork (eisenhardt et al., 2016). presently, training of master’s and apgar & zerrusen/ grand challenges perceptions 179 doctoral-level social workers is deficient in ensuring that social workers have the transdisciplinary science skills needed to design and execute the research required to address these complicated problems (gehlert et al., 2017). social workers should engage in the grand challenges effort as their clients are likely to be significantly impacted by one or more of these problems. the grand challenges provide an opportunity for the social work profession to expand society’s understanding of its work by engaging in transdisciplinary teams and ensuring that social work values are central to developed interventions (teixeira et al., 2021). through the work on transdisciplinary teams, social workers gain understanding of theories and techniques used by other disciplines, adding to their skillset (cederbaum et al., 2018). these theories and techniques strengthen social workers’ perspectives and enable social workers to leverage these approaches to positively impact the health and welfare of individuals, families, and communities (eisenhardt et al., 2016). essential to realizing this vision is ensuring that social workers at all stages of career progression are engaged in addressing the target social problems. particularly important is making certain that those entering the profession have interest in and competency to address the grand challenges, as the strong commitment and skillset of early career social workers will be needed if real world change is to occur in the future. method data were collected from 102 msw graduates who attended one of six different licensure preparation programs in june 2021 sponsored by the national association of social workers. these programs were virtual and hosted by six different states across the united states. representation included a program in each of the regions: pacific, north central, midwest, southeast, mid-atlantic, and northeast. while registration was not limited to only social workers in the states of the sponsoring organizations, the vast majority resided and worked in these states as program advertising was targeted to these areas. a total of 145 attendees completed the survey, but the 33 students who attended were excluded as the focus of the study was on those who had already obtained their graduate degrees. twenty-nine of the excluded students were enrolled in msw programs, while four were working to obtain bsw degrees. another ten social workers were excluded as they were not msw graduates: nine had bsws as their terminal degrees and one had a doctorate in social work and it was unknown if the individual possessed a msw. thirty-eight percent of msws in the final sample (n=102) had bsws in addition to their msw degrees. in their graduate programs, the majority (66%) focused on working with individuals or families as a specialization, and a quarter (24%) reported an advanced generalist course of study, with the remainder (10%) educated on working on the mezzo or macro levels exclusively. additional demographic data were not collected from attendees so there is no way to know the age and racial/ethnic diversity of the sample, despite the broad geographic representation. the target audience for these licensure preparation courses were those studying for the association of social work boards (aswb) masters exam or those with at least two years post-master’s experience studying for the clinical exam. a total of 70% were employed as advances in social work, spring 2024, 24(1) 180 social workers at the time of the survey. the employment foci for those who were employed as social workers are seen in table 1. the practicum placement foci for these employed social workers are also depicted. correlational analyses shows statistical significance between practicum and employment foci of social workers when using the 13 grand challenge domains. the 14th grand challenge, to prevent gun violence, was not included as it was announced after the completion of the study and, therefore, had not been formally incorporated into aaswsw publications, with only topic lead investigators identified at the time of this writing (grand challenges for social work, 2023a). table 1. distribution of employment and practicum placement foci of employed social workers in rank order of employment focus (n=65)1 grand challenge focus n (%) current employment practicum placement2 advancing long and productive lives 22 (34%) 19 (30%) ensuring healthy development for all children 18 (28%) 23 (36%) closing the health gap 7 (11%) 6 (9%) creating social responses to a changing environment 4 (6%) 5 (8%) stopping family violence 4 (6%) 0 (0%) achieving equal opportunity and justice 3 (5%) 4 (6%) ending homelessness 3 (5%) 2 (3%) eradicating social isolation 2 (3%) 0 (0%) promoting smart decarceration 1 (1%) 2 (3%) reducing extreme inequality 1 (1%) 0 (0%) building financial capability for all 0 (0%) 1 (2%) harnessing technology for social good 0 (0%) 0 (0%) eradicating racism 0 (0%) 2 (3%) 1 4 social workers who were employed as social workers were excluded from the analysis as they had missing data or indicated more than one focus. 2 1 social worker was missing a response (n=64). survey social workers were asked to complete a brief survey that assessed their knowledge about the grand challenges, as well as identified their practicum and work experience addressing one or more of 13 social problems. questions on the survey focused on determining the professional interests and perceived competency of social workers to address the grand challenges. additionally, social workers were asked their opinions about the likelihood of the profession to make progress on tackling each of the grand challenges in the next five years. first, social workers were asked their levels of interest in working to achieve each of the 13 grand challenges. interest was assessed on a four-point likert scale with values of 1 (not interested at all), 2 (slightly interested), 3 (somewhat interested), and 4 (very interested). reliability testing indicated that all 13 items were interrelated and created a strong index of professional interest with a cronbach alpha of α=.882. social workers then selected one grand challenge as a primary career focus. apgar & zerrusen/ grand challenges perceptions 181 next, social workers rated the extent to which they felt that the social work profession could make progress toward addressing each of the 13 grand challenges. opinions were assessed on a three-point likert scale with values of 1 (no progress), 2 (some progress), and 3 (significant progress) could be made. reliability testing indicated that all 13 assessments of progress were interrelated and created a strong index of optimism about the ability of the profession to address the grand challenges with a cronbach alpha of α=.897. lastly, social workers were asked about their perceived competency to address each of the grand challenges. perceived competency was assessed on a four-point likert scale with values of 1 (not competent at all), 2 (a little competent), 3 (somewhat competent), and 4 (very competent). reliability testing indicated that all 13 assessments about perceived competency were interrelated and created a strong index of competency to address the grand challenges with a cronbach alpha of α=.904. human subjects approval the study was approved by the university’s institutional review board (protocol #2021-188) in march 2021. study limitations there are limitations to the study as findings are limited to the experiences of a convenient sample of social workers who attended six licensure preparation programs virtually sponsored by six different state chapters of a professional organization. research with larger samples is needed in the future. results descriptive statistics indicate that the vast majority of social workers (86%) were unaware of the grand challenges. more than half of those who were aware of the grand challenges (57%) had learned about them as part of their formal social work education. more than a third (36%) had heard about them via social media or the internet. fourteen percent were informed of the grand challenges by a social work supervisor or colleague. only one social worker had attended a continuing education program on the grand challenges. as depicted in table 2, the primary professional interest of the majority of social workers (68%) was addressing one of three grand challenges – ensuring healthy development for all children, achieving equal opportunity and justice, and advancing long and productive lives. far fewer (1-6%) were interested in eight of the remaining challenges. none of the social workers sampled wanted to focus their professional careers on building financial capacity for all or eradicating social isolation. however, there was moderate to strong interest overall to work on 11 of the 13 grand challenges. harnessing technology for social good and promoting smart decarceration did not meet the threshold for some interest overall. advances in social work, spring 2024, 24(1) 182 table 2. descriptive statistics on the professional interests of social workers in rank order by primary professional interest (n=93) 1 grand challenges primary professional interest general interest in working to address2 n (%) mean (sd) ensuring healthy development for all children 26 (28%) 3.4 (0.87) achieving equal opportunity and justice 19 (21%) 3.7 (0.61) advancing long and productive lives 17 (19%) 3.5 (0.72) closing the health gap 6 (7%) 3.3 (0.79) ending homelessness 6 (7%) 3.3 (0.80) eradicating racism 5 (5%) 3.7 (0.63) creating social responses to a changing environment 5 (5%) 3.3 (0.76) stopping family violence 3 (3%) 3.6 (0.63) reducing extreme inequality 2 (2%) 3.4 (0.75) promoting smart decarceration 2 (2%) 3.0 (0.99) harnessing technology for social good 1 (1%) 2.8 (0.90) building financial capability for all 0 (0%) 3.4 (0.76) eradicating social isolation 0 (0%) 3.3 (0.82) 1 nine social workers were missing data for these questions. 2 interest was assessed on a four-point likert scale with values of 1 (not interested at all), 2 (slightly interested), 3 (somewhat interested), and 4 (very interested). table 3 indicates the perceived professional competencies (in rank order) and beliefs that the profession can make progress to address the issue in the next five years. social workers indicated little to some competence in addressing all 13 grand challenges. they had the least reported competence in promoting smart decarceration and the most perceived ability in ensuring healthy development for all children. with regard to social workers’ opinions about the likelihood that the profession would make progress on achieving the grand challenges, there was some, but little, overall variability. overall assessments indicated the belief that some progress would be made with the least optimism associated with building financial capacity for all and the most linked to ensuring healthy development for all children. relationship between interest, perceived competency, and making progress indexes to assess professional interest, perceived competency, and the likelihood of the social work profession making progress towards achieving the grand challenges, were strongly related to one another. the strongest relationships were between perceived competency and the likelihood that the profession would make progress, r (86) = .48, p = .001, and professional interest and perceived competency to address an issue, r (86) = .45, p = .001. a weaker positive relationship, though still statistically significant, was found between professional interest and optimism about the profession making progress, r (88) = .29, p = .02. apgar & zerrusen/ grand challenges perceptions 183 table 3. descriptive statistics on perceived professional competencies (in rank order) and beliefs that the profession can make progress to address the issue in the next five years grand challenges mean (sd) professional competency1 profession’s ability to make progress2 ensuring healthy development for all children 3.0 (0.91) 2.3 (0.53) advancing long and productive lives 2.9 (0.87) 2.1 (0.62) achieving equal opportunity and justice 2.8 (0.86) 2.2 (0.56) stopping family violence 2.8 (0.89) 2.1 (0.20) creating social responses to a changing environment 2.7 (0.81) 2.3 (0.56) eradicating racism 2.6 (0.90) 2.1 (0.64) eradicating social isolation 2.6 (0.87) 2.0 (0.56) closing the health gap 2.5 (0.88) 2.1 (0.57) ending homelessness 2.4 (0.97) 2.0 (0.56) reducing extreme inequality 2.4 (0.98) 2.0 (0.67) harnessing technology for social good 2.3 (0.94) 2.1 (0.68) building financial capability for all 2.3 (0.95) 1.9 (0.63) promoting smart decarceration 2.2 (0.95) 2.0 (0.55) 1 fourteen social workers were missing data for these questions (n=88). perceived competency was assessed on a four-point likert scale with values of 1 (not competent at all), 2 (a little competent), 3 (somewhat competent), and 4 (very competent). 2 twelve social workers were missing data for these questions (n=90). opinions were assessed on a three-point likert scale with values of 1 (no progress), 2 (some progress), and 3 (significant progress) could be made. examination of the relationships between professional interest, perceived competency, and optimism about making progress for each of the 13 grand challenges yielded interesting results. for all 13 grand challenges, there were significant positive relationships between professional interest and perceived competency to address the concern. for all but one – creating social responses to a changing environment – perceived competency was positively related to beliefs that the profession would make progress to address the concern in the next five years. however, for 7 of the 13 grand challenges – achieving equal opportunity and justice, eradicating racism, creating social responses to a changing environment, stopping family violence, reducing extreme inequality, harnessing technology for social good, and building financial capability for all – professional interest was not significantly related to optimism that the profession would make progress on addressing the problem in the next five years. discussion study findings indicate a lack of knowledge about the grand challenges initiative by the vast majority of social workers, even among those who also possessed undergraduate social work degrees. data collected on the employment foci of those working after graduation indicates about half are focused on ensuring healthy development for all children or advancing long and productive lives. closing the health gap was also a focus for about ten percent of those working in the profession. many grand challenge areas had advances in social work, spring 2024, 24(1) 184 no or few graduates addressing them. since employment foci were significantly related to practicum experiences, schools of social work should ensure sufficient numbers of students have training in the identified underrepresented areas. expanding practicum experience opportunities in these chosen areas may increase social workers’ interests in working on these issues professionally. the current ability of the social work profession to engage adequate numbers of practitioners to address many of the identified social problems is questioned by these data. social workers had moderate to strong professional interest in all but two of the grand challenges – promoting smart decarceration and harnessing technology for social good. the vast majority were dedicated primarily to focusing their professional careers on three issues – ensuring healthy development for all children, achieving equal opportunity and justice, and advancing long and productive lives. research indicates that innovative pedagogy focused on the grand challenges can increase interest in reducing the number of people who are imprisoned and embracing a more effective and just approach to public safety (apgar & zerrusen, 2024). social work curricula, including practice placement availability, must be examined to raise student interest in smart decarceration and harnessing technology for social good. additionally, the predominant desire of social workers to focus their professional work on only a few major concerns identified by the profession must be examined. there is broad interest in the other areas but social workers may be limiting their primary focus due to awareness of professional positions, advancement opportunities, professional status, or other factors. research into the reasons that social workers choose to primarily focus their careers on only a few grand challenges, despite strong interest in others, needs to be conducted. particularly interesting was the discovery that professional interest, perceived competency, and optimism that the profession can make a difference in a chosen area were significantly related to one another. perceived competency of all problems (except creating social responses to a changing environment) was related to optimism about the profession to make progress in the chosen areas. these associations may result from social workers generalizing their own competencies to others, resulting in optimism about the profession to make progress toward achieving desired aims overall. it is interesting that there was not a significant linkage between perceived professional competency and views about the profession to make progress in creating social responses to a changing environment. social workers felt somewhat competent in working on this problem and very optimistic about the profession making progress in this area, despite the lack of a significant relationship between the two. further investigation into this anomaly is needed. the direction of the causal relationships between professional interest, perceived competency, and optimism about making changes are unknown as interest may drive perceived competency or vice versa. however, social workers’ interests were not related to their views about whether progress by the profession would occur in seven of the 13 areas. social workers have been trained to work on systemic, longstanding societal problems so their professional interests in these areas appeared not to be deterred by their lack of optimism. apgar & zerrusen/ grand challenges perceptions 185 findings have significant implications for social work graduate education. there is a consistent significant relationship between interest and perceived competency of msw graduates. msw programs can focus on educational specializations or concentrations as per the council on social work education (cswe, 2022) accreditation standards. the profession may be wise to encourage and provide pedagogical resources to programs choosing to focus on one of the social problems identified by the grand challenges. currently cswe allows programs to choose their own foci, resulting in a broad range of specializations (i.e., geographic areas, populations, methods, and so on). linking these specializations to the grand challenges thorough accreditation policy would likely increase knowledge about this initiative, as well as further strengthen the relationship between social work education and practice priorities. while there has been criticism in the literature about the uncontrolled growth of msw programs (apgar, 2020), there are many grand challenges that have little or no interest as primary professional foci despite social workers being somewhat interested in addressing them. a concerted effort should be made to attract social workers into these practice areas as they have been identified as critical problems facing society. while professionals are interested and appear competent to tackle serious societal ills, this study highlights the need to make them aware of the grand challenges initiative and create strategies to enhance the profession’s workforce in these areas if social work is going to make the impact that it desires. references apgar, d. 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(2021). opportunities to “make macro matter” through the grand challenges for social work. families in society: the journal of contemporary social services, 102(3), 414-426. author note: address correspondence to dawn apgar, department of social work, seton hall university, south orange, nj, 07079. email: dawn.apgar@shu.edu https://doi.org/10.5465/amj.2016.4004 https://doi.org/10.1177/0170840614563742 https://doi.org/10.1177/0170840614563742 https://doi.org/10.1086/690564 https://doi.org/10.1086/690564 https://doi.org/10.1086/690659 https://doi.org/10.1086/690659 https://grandchallengesforsocialwork.org/webinar/baby-bonds-in-context-a-systems-approach-to-closing-the-racial-wealth-gap/ https://grandchallengesforsocialwork.org/webinar/baby-bonds-in-context-a-systems-approach-to-closing-the-racial-wealth-gap/ https://grandchallengesforsocialwork.org/grand-challenges-for-social-work/announcing-the-grand-challenge-to-prevent-gun-violence/ https://grandchallengesforsocialwork.org/grand-challenges-for-social-work/announcing-the-grand-challenge-to-prevent-gun-violence/ https://grandchallengesforsocialwork.org/about/history/ https://doi.org/10.1016/j.eng.2016.01.025 https://doi.org/10.1016/j.eng.2016.01.025 https://doi.org/10.1086/690562 https://doi.org/10.1086/690562 https://doi.org/10.1086/690562 https://doi.org/10.1093/hsw/hlw028 https://doi.org/10.1093/hsw/hlw028 https://nihrecord.nih.gov/sites/recordnih/files/pdf/2023/nih-record-2023-10-13.pdf https://doi.org/10.1177/1044389420972488 https://doi.org/10.1177/1044389420972488 mailto:dawn.apgar@shu.edu _________ christopher simmons, phd, associate professor of instruction, school of social work, university of south florida, tampa, fl. amy fisher, jd, associate professor, department of social work, university of mississippi, university, ms. roxann mcneish, phd, research assistant professor, child and family studies, university of south florida, tampa, fl. karah y. greene, msw, research assistant, school of social work, university of south florida, tampa, fl. and melissa thompson, msw, associate instructor, school of social work, university of south florida, tampa, fl. jerome t. galea, phd, associate professor, school of social work, university of south florida, tampa, fl and courtesy assistant professor, department of global health and social medicine, harvard medical school, boston, ma. copyright © 2023 authors, vol. 23 no. 2 (summer 2023), 337-353, doi: 10.18060/26621 this work is licensed under a creative commons attribution 4.0 international license. enhancing competency-based social work skills through service learning and interprofessional education in a student-run free healthcare clinic christopher simmons amy fisher roxann mcneish karah y. greene melissa thompson jerome t. galea abstract: student-run free clinics (srfc) offer students the opportunity to learn and work with students from other disciplines; however, there is very little research on the benefits of srfc to social work students. the purpose of this article is to describe the qualitative student outcomes of a service learning (sl) and interprofessional education (ipe) experience in a srfc designed to enhance the interprofessional competencies of bsw social work students. students (n=38) enrolled in a service-learning course and participated in a semester-long sl and ipe experience at a university-affiliated interdisciplinary srfc. qualitative findings from student reflections indicated that students perceived that the overall experience facilitated the development of written and verbal communication skills, confidence, and professional identity. the research suggests that sl and ipe were beneficial to student development. we, therefore, recommend that other programs consider exposing bsw students to these experiences early in their program to enhance their educational experience. keywords: interprofessional education, service learning, social work education the development of interprofessional competencies among social work students is essential to effective professional practice in healthcare as well as other settings. one way to ensure that students are able to demonstrate “the integration and application of competencies in practice” (council on social work education [cswe], 2022, p. 7), is to increase opportunities for hands-on experiences early in their program (simmons & fisher, 2016). field education provides the ideal environment for teaching and learning social work practice skills; however, the field semester is usually at the end of the baccalaureate social work (bsw) program. bsw students’ educational experience might be enhanced if students had more opportunities for interprofessional education and experiential learning in healthcare settings before the field placement which in turn would allow for more complex engagement with their field internship. to engage students in experiential learning before their field semester, we developed a service-learning course designed to give students an interprofessional educational experience in a university-affiliated student-run free clinic (srfc). srfcs were helpful in about:blank advances in social work, summer 2023, 23(2) 338 improving the health outcomes of underserved patients (broman et al., 2022) and have served as an effective pedagogical tool to enhance students’ learning (ko et al., 2019; mohammed et al., 2018); however, few studies have been conducted exploring how social work students benefit from such an experience. the purpose of this study was to explore whether service learning (sl) and interprofessional education (ipe) in a student-run free clinic (srfc) were beneficial to social work students. we used qualitative data from student reflection papers in a service-learning course to explore the following research question: do social work students benefit from sl and ipe in a srfc? relevant literature student-run free clinics (srfcs). in the united states, underserved communities experience multiple social, economic, and cultural barriers to accessing healthcare services (centers for disease control and prevention, 2022). this lack of access results in lower overall health-related quality of life and suboptimal health outcomes (whitman et al., 2022). the u.s. healthcare system, however, is ill-equipped to meet the needs of underserved populations, particularly uninsured individuals living in areas with a shortage of health professionals (pittman et al., 2021). this problem is projected to worsen as the shortage of health professionals increases (gbd 2019 human resources for health collaborators, 2022). to address these challenges, universities are providing direct care to underserved populations through student-led initiatives, such as student-run free clinics (nagel et al., 2022; stuhlmiller, & tolchard, 2018). srfcs are often interdisciplinary and promote interprofessional collaboration to address the healthcare needs of vulnerable community members. many of srfc patients lack health insurance, are from racial/ethnic minority groups, may lack u.s. citizenship, have limited english proficiency, and are unable to access health care through programs like medicaid (darnell, 2010; smith et al., 2014). consequently, srfcs serve as a crucial safety net for these communities. these clinics not only serve vulnerable communities, but they also use service learning and interprofessional education to help students develop practice skills and promote collaboration among disciplines (nagel et al., 2022; seif et al., 2014; smith et al., 2014). service learning (sl). sl combines learning goals and community service in ways that promote both student development and community well-being (higbea et al., 2020). in general, sl courses have been used in multiple disciplines to reinforce and build skills that may not be acquired in the classroom setting, while providing needed service to the community. although sl is in line with the council on social work education competencies for generalist practice (cswe, 2022), it is important to note that sl is different from volunteering, nor is it field education. petracchi and colleagues (2016) found that cswe programs that did not have sl courses were more likely to see sl as indistinguishable from field education or volunteering. nonetheless, sl is an academic approach designed to reinforce classroom instruction while simultaneously addressing community-identified needs (petracchi et al., 2016). gerstenblatt and gilbert (2014) discussed the strengths of sl through three outcomes – student learning, reflection, and reciprocity. student learning and reflection are learning outcomes emphasized in field simmons et al./competency-based skills & service learning 339 education; however, reciprocity – the creation of bi-directional relationships between community members – distinguishes sl from field education (gerstenblatt & gilbert, 2014, p. 1049). there are several benefits to sl for social work students in developing competencybased skills. students are able to link theory to practice (fraher et al., 2018; gruslyte, 2021), demonstrate increased perceived self-efficacy (williams et al., 2002), and develop professionally (levy & edmiston, 2015; mcnaughton, 2018; nino et al., 2011). levy and edmiston (2015) found that students enrolled in 30 hours of sl showed an increase in core values of service and competence (national association of social workers [nasw], 2021). students cited working with real clients and guided reflection as being the most beneficial in developing core values. another study suggested students were better able to make connections with social work ethics and values through the utilization of sl (irvine et al., 2015). students in this study reported having a greater emotional experience and a greater impression from sl than from the classroom experience. students’ perception of themselves in their practice as social workers also improved. other studies have found that students participating in sl demonstrated increased awareness of social justice and cultural issues (augustin & freshman, 2016; belliveau, 2011). for example, in a content analysis study, researchers investigated the impact of sl on students’ attitudes toward older adults, finding that students who engaged with older adults at healthcare facilities reported increased positive perceptions toward older clients (augustin & freshman, 2016). in addition, students were able to discover and explore their own ageist stereotypes and identified different interests in careers related to older adult care. interprofessional education (ipe). ipe is an educational approach that occurs when two or more professions learn about, from, and with each other to improve collaboration between the disciplines and improve health outcomes (world health organization, 2010). the interprofessional education collaborative (ipec), a national assembly of health professions (e.g., medicine, public health, pharmacy, nursing, social work), promotes efforts to advance interprofessional learning experiences that lead to improved health outcomes (ipec, 2016), they developed four core competencies for interprofessional collaborative practice (see table 1). ipec competencies are congruent with the values, ethics, and standards of social work practice (nasw, 2016, 2021) and the social work education competencies (cswe, 2022). the nasw standards for social work practice in health care settings holds that social workers should engage in collaborative practice to deliver healthcare services (nasw, 2016). the cswe educational policy and accreditation standards hold that social workers engage in interprofessional collaboration to assess, intervene, and evaluate individuals, families, groups, organizations, and communities (cswe, 2022). ipe has been instrumental in helping develop students’ knowledge, skills, and values (cramer et al., 2019), self-efficacy (keshmiri & ghelmani, 2023; nurumal et al., 2020; williams et al., 2017), communication skills (bell et al., 2019; kermani et al., 2022), and advances in social work, summer 2023, 23(2) 340 interprofessional collaboration (adamson et al., 2020; kermani et al., 2022; rubin et al., 2020; testa & renwick, 2020; wilson et al., 2021) that lead to improved health outcomes (cramer et al., 2019; mckinlay et al., 2019; pittenger et al., 2019). in addition, students can acquire greater knowledge of their own discipline while learning and understanding the professional roles and responsibilities of other professionals as part of an interprofessional healthcare team (bridges et al., 2011; van diggele et al., 2020). table 1. ipec competencies competency description values and ethics work with individuals of other professions to maintain a climate of mutual respect and shared values. roles and responsibilities use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of patients and to promote and advance the health of populations. interprofessional communication communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease. teams and teamwork apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable. note. adapted from ipec (2016) professional identity in ipe. professional identity formation continues to be an important aspect of ipe. professional identity in social work refers to the internalization of norms and values of the profession, personal identification with the profession, and the process involved in seeing oneself as a social worker (wiles, 2013). while ipe experiences may have several benefits, it is important that students’ professional identity formation is a part of the educational experience (haugland et al., 2019; rishel et al., 2020). social work students must understand their role, as well as the unique contributions they bring to the team (cf. ciani et al., 2023). rishel and colleagues (2020) examined social work professional identity of 61 msw students who took part in an ipe training program designed to prepare students for practice in integrated health. they found that the ipe experience enhanced professional identity development as students developed a greater understanding of their professional roles and the roles of others. this development does not occur by chance in health settings. educators must help students develop a social work professional identity, which can be challenging in health settings where historically social work has not been seen as important as medicine or nursing. theoretical framework using kolb’s (1984) experiential learning model, students in health profession programs can learn how to effectively collaborate with colleagues from other disciplines and develop interprofessional competencies prior to graduating and joining the workforce (fewster-thuente & batteson, 2018; meyer et al., 2021). kolb’s experiential learning simmons et al./competency-based skills & service learning 341 model is a four-stage learning cycle where the learner encounters a new concrete experience, the learner reflects on the new experience, the reflections then give way to new concepts, and the learner starts to experiment with these new concepts by applying them to new situations. applying kolb’s experiential learning model to ipe and sl, students applied what they have learned in the classroom (abstract conceptualization) to their interactions with other students across disciplines (concrete experience), and then they were asked to reflect on their service-learning experience with their instructors (reflective observation) and then apply their experience in other setting such as field (active experimentation). the clinic experience bsw students participated in a service-learning experience at a university-affiliated, student-run interprofessional free healthcare clinic. like many other srfcs, this clinic provides comprehensive health care to the local community delivered by physicians, as well as medical, pharmacy, physical therapy, public health, and social work students. social work students who participated in the service-learning course were required to participate in an online training session and an in-person orientation before beginning their ipe education experience, and were required to complete 20 service-learning hours at the clinic. during clinic hours, which were held weekly (tuesday nights from 5:30 pm 9:30 pm), students participated in a pre-clinic meeting where each discipline (i.e., social work, medicine, pharmacy, physical therapy, and public health) presented their respective roles in the clinic and were assigned to interprofessional teams. at the end of the pre-clinic meeting, students met with their team to discuss patients. after the team saw the patient, social work, medicine, and pharmacy students met with the patient individually. social work students used this time to gather more information to assess the patient’s needs using a brief psychosocial assessment tool. the tool was constructed by the students in consultation with the social work faculty director in the clinic. after conducting the brief interview, students met with the student patient coordinator (first-year msw student) or the social work student director (second-year msw student), and the social work faculty supervisor (a licensed clinical social worker) to discuss patient issues, the patient’s psychosocial barriers to health, and a potential action plan. these brief supervisory sessions focused on helping the student identify relevant cultural considerations and examination of ethical concerns, especially with respect to working with patients who are underserved. students were encouraged to explore their cognitive and emotional reactions to their patients, attend to the sensitivity of a patient’s individual circumstances, and navigate appropriate community referrals that ensured that the patient received quality care. after the brief meeting with the student leader and the faculty supervisor, students then returned to the patient to formulate an action plan and assist with community resource referrals based on the identified needs. each student saw an average of one to two patients per clinic shift and then wrote soap (subjective, objective, assessment, and plan) notes which were entered into the electronic medical records system to be reviewed and signed by the faculty supervisor. the faculty supervisor reviewed the note with the student. the advances in social work, summer 2023, 23(2) 342 soap was electronically signed by the faculty supervisor if no major edits were needed. if major edits were required, the student had to go through a second review by the faculty supervisor. finally, students participated in a debriefing led by the student director and the social work faculty supervisor. in addition to receiving supervision at the clinic, students participated in weekly, guided reflection sessions in class, in which they were encouraged to reflect on their clinic experiences. at the end of the semester, students wrote a reflection paper detailing their learning experience with specific attention to the social work skills and values that were developed through participating in the ipe experience via the sl course. methods as this was an initial attempt to understand how bsw students experienced the sl project, the researchers employed qualitative methods to understand the benefits of sl and ipe experience to students. specifically, we sought to answer the question: in what ways do social work students benefit from sl and ipe in a srfc? after obtaining exemption status from the appropriate institutional review board, the research team used reflection papers submitted by bsw students at the end of the clinic experience described above. as exemption status was granted, recruitment and consent procedures were not required by this institution. participants reflections from a convenience sample of 38 bsw students in their second semester of a cswe-accredited baccalaureate social work program and enrolled in the program’s sl course were used. thirty-four students were female, four were male. twenty-eight students were caucasian, five students were african american, and five students were hispanic or latino/a/x. qualitative analysis analysis was conducted following braun and clarke’s (2006) six-step process for thematic analysis: 1) familiarizing ourselves with the data; 2) generating initial codes; 3) searching for themes; 4) reviewing themes; 5) defining and naming themes; and 6) producing the report. we integrated miles and huberman’s (1994) interactive model into steps two to five, using ongoing dialogue and reflection and referring back to the original data. the research analysis was conducted by two members of the research team. the two team members were one black male and one white female, both with multiple years of experience in teaching and in social work practice. the male member of the research team was the students’ social work supervisor at the clinic. he also taught one section of the course. the reflection papers were de-identified and imported into atlas.ti software package 8 (scientific software development gmbh, 2016) for text retrieval and flexibility of organization and linking after completing initial coding. as this was an initial attempt to simmons et al./competency-based skills & service learning 343 understand how bsw students experienced the service-learning project, we elected to initially focus on skills they learned and how the learning was connected to what was being taught in the course. following the steps outlined by braun and clarke (2006) for thematic analysis, each author first became familiar with the data by reading and re-reading the reflection papers as a whole, then we independently generated initial codes in atlas (braun & clarke, 2006). the two authors then met to reflect, compare, and discuss our codes and interpretations using miles and huberman's (1994) interactive model of data analysis. once we developed “candidate themes” (step three in braun and clarke’s (2006) process) we reviewed them using two steps—ensuring the coded data assigned to each theme truly fit, then reviewing the entire data set to both ensure the trustworthiness of our analysis as well as code any additional data that was missed (braun & clarke, 2006, p. 91). once we were sure our themes were satisfactory, we named them and completed the final step of the braun and clarke (2006) process—creating a framework for which a general inductive approach using thematic analysis was employed (thomas, 2006). following the six-step process outlined in braun and clarke (2006) helped to bolster the trustworthiness of our analysis since we followed a systematic plan, which supports triangulation and evaluation by the reader (connelly, 2016). we then illustrated the framework using excerpts from the raw data (fereday & muir-cochrane, 2006), further bolstering the trustworthiness of the analysis (connelly, 2016). results we sought to answer how social work students would benefit from sl and ipe in a srfc. four prominent themes emerged from the analysis: interprofessional communication, documentation skills, confidence, and professional identity within interprofessional education. each theme is presented with illustrative quotes. interprofessional communication: the most important thing you can do for them is just listening. students reflected on their communication skills. while some comments were more general (e.g., “clients are a lot easier to talk to than what i previously thought”), three primary areas of improvement were identified: direct communication skills with clients, communication using an interpreter, and communication with other disciplines. within the area of direct communication, students identified the impact of having seen in action the importance of basic communication skills taught in the classroom. as one student wrote, “when working with clients, i learned the most important thing you can do for them is listening…..” many students described learning how to ask “better” questions; for example, one student described her experience seeing open-ended questions work to elicit valuable information regarding family stressors. students also noted seeing nonverbal skills at work. a student described having a better understanding of “the importance of having sufficient distance between myself and the client to ensure an adequate comfort level.” another wrote, “i learned that i am good at reading facial cues.” advances in social work, summer 2023, 23(2) 344 because many of the clients at the clinic did not speak english, students reflected on the use of an interpreter in client sessions. some students struggled with the implications of using an interpreter. one wrote extensively about the social justice implications of not having spanish-speaking social workers available. another reported, “providing her resources for spanish services…were probably the most appreciated as they resulted in tears.” other students worked to understand how to build rapport despite the language barrier. for example, “[w]hen working with the spanish-speaking patients, it was beneficial for the patients to see the social work student excel in positive non-verbal cues.” another noted, “it was critical to have patience when the translator would speak to the client and would then relay the response in english.” the third sub-theme that arose within the larger theme of communication was learning how to communicate with non-social work professionals. students expressed initial nervousness about interacting with other professions, but many expressed quickly learning how helpful it was to listen to the medical assessment prior to the students’ psychosocial assessment. others reported that seeing the importance of the social work assessment helped them learn to communicate with students from other disciplines. one wrote, “i gained experience in communicating with other disciplines in a group setting to better analyze and interpret the problems and needs of the clients.” one student summed it up as follows: learning to use my communication skills to discuss medical concerns with a multitude of disciplines, especially those who see the social work aspect of [the clinic] as less than necessary to the successful running of the clinic, was an interesting task. however, i quickly learned that as long as you treat everyone with dignity and respect and realize that your profession is important and validated by having a presence at [the clinic], you will cease having communication issues. documentation skills: this skill is beneficial to better service the patient for their future visits. regarding documentation skills, many students expressed that writing notes for actual clients helped them see the importance of clear documentation of patient interactions. “i didn’t really realize before doing this how important soap notes were…turning the notes and the information i take during the time with the client and turning it into soap notes got drastically better just from the few time[s] that i did them.” another wrote, “writing soap notes and having the directors go over them was super helpful. their critiques and helpful hints allowed all of us to learn the best way to communicate what needed to be said about the client.” the students were better able to conceptualize the need for good notes for future services by working with the clients. for example, one student stated, “before volunteering at [the clinic], writing case notes was just something that professors talked about in lecture,” but, as another student wrote, “this skill is beneficial to better service the patient for their future visits.” confidence: it affirmed for me that i was on the right path. another theme that emerged was how the experience resulted in more confidence. students discussed how the experience increased their overall confidence in their ability as simmons et al./competency-based skills & service learning 345 helpers. comments ranged from the very specific (“clients are a lot easier to talk to…[and] they are more open than how i thought they would be”), to the more general (“it was nice learning something and then applying it right away and…realizing i do it well and [having] other social workers telling me i do this well”). students also reported greater confidence in knowing that social work was the right profession for them. one stated, “it gave me confidence in my abilities and affirmed for me that i was on the right path.” another wrote, “i was provided with a greater conviction than ever before about my purpose in life.” as students gained experience working in the clinic and became less anxious, they were able to have a good balance of self/other focus. students reported being able to focus on clients despite their own initial anxiety: “i learned that when i am dealing with a client all of the nerves melt away when i actually start talking to them.” another reported a session in which “the [interpersonal] relationship that had formed allowed for a continual flow of open communication between the patient and myself as i lost all track of time and engaged myself in the present.” one student summed up the experience as follows: “at first, the strongest feeling i had was nervousness but after doing my first assessment, i became more comfortable and by the time i was at my last clinic, i was not nervous at all, only excited.” students attributed much of their increased confidence to the experiential nature of sl. “being able to learn the material and then being able to apply it right away in a real-life setting was very nice. i have never been able to do that before in school.” many students noted the benefit of the class-to-experience connection. for example, “all of the role plays that were done in class are now being done in real life.” a repeated sentiment was summarized by one student in this way: the service-learning experience incorporates what was learned in class and furthers the learning process. a student cannot gain the same experience from class role plays as they can through the service-learning at the bridge clinic. role plays are a good starting point, but the lessons learned from service-learning are a humbling and once-in-a-lifetime opportunity for social work students. professional identity within interprofessional education: being able to exchange ideas as a team made us feel like we were providing the best service possible for the client. in addition to working with patients, students saw the team approach as an important part of their experience. many students commented on how watching the medical team members perform their assessment was helpful in pointing the way to the social worker to begin assessing client needs. other students noted a general appreciation of the team approach: “working in a setting that has such a variety of disciplines was a great experience. at any point, my client could be working with me, a medical team, and someone from public health or physical therapy.” a common positive conceptualization was “being able to exchange ideas as a team made us feel like we were providing the best service possible for the client.” being part of the interprofessional team helped give students a deeper understanding and appreciation for the role of social work in the clinic. a common observation was that the social workers helped connect the clients to resources that reduced barriers to improved advances in social work, summer 2023, 23(2) 346 physical health. one student said, “…your objectives for the client should be specific, measurable, achievable, and realistic. having this knowledge allowed me to better help my client by pointing out to the medical team that it is not realistic for her to eat expensive healthy food without some help.” beyond the immediate goals of the client, the students readily identified the role of social work in the larger society: “as social workers it is our responsibility to work on behalf of individuals who find themselves oppressed, defeated, and marginalized.” one student summed up her perception as follows: at a time when we are being taught to fear immigrants for being rapists, murders (sic), and drug lords, social workers such as myself working with these at-risk communities can help provide a different light, the true realities of our immigrant population. i have taken to doing just that on social media, among friends and family and acquaintances, adding my own voice of dissent against the hostility and dissonance, against the cry to build a wall and send them all home. discussion the goal of this study was to explore how sl and ipe in a srfc could benefit social work students. there is broad extant literature on sl and ipe highlighting the benefits of these approaches in developing interprofessional competencies. however, few studies have explored how social work students may develop these competencies through applied experiences prior to field placement. furthermore, srfcs have been found to provide many benefits to underserved communities and their members (e.g., nagel et al., 2022), though the impact of srfc on social work student learning has been understudied. this study contributes to these knowledge gaps by examining the enhancement of social work competency-based skills of bsw students participating in sl, which included ipe, in a srfc. our findings demonstrate that students perceived that their sl and ipe experiences were important to improving communication skills, documentation skills, confidence, and professional identity. in addition, students’ reflections demonstrated that they were addressing the ipec competencies (ipec, 2016). students were clear about their improvement in interprofessional communication. many noted how their verbal and written communication skills (i.e., documentation) were enhanced as the semester progressed. students had to communicate in a variety of ways during their sl experience. they often communicated with faculty and students from other disciplines, as well as with patients of diverse cultures. they also had to enter soap notes into electronic health records, thereby learning to communicate necessary details that would be relevant to multiple disciplines in the clinic. having these opportunities enabled students to learn, practice, and improve not only their communication but also their interpersonal skills (mcnatt, 2020). in many instances, patients were of a different culture, gender, and/or age than the students. these factors, combined with the fact that students are still in the process of actively learning social work skills, can be challenging for students at the beginning of simmons et al./competency-based skills & service learning 347 their learning experience (simmons & fisher, 2016). however, students became more confident in their ability to work with patients as the semester progressed. this finding is consistent with previous research which found that social work students engaged in sl showed increased confidence in their ability to work with vulnerable populations (williams et al., 2002). much of the development in terms of interprofessional competencies may be directly linked to increases in student confidence. as students became comfortable with the process, they were more likely to report an enhancement of confidence in their ability to perform social work tasks in the clinic. confidence, therefore, might be the catalyst driving students’ development of interprofessional competencies including documentation, communication, and self-efficacy skills, as well as professional identity. an interesting finding was the students’ focus on writing soap notes. one potential explanation could be that the students were relatively early in their social work education sequence. research has shown that students who are early in their social work programs possess less cognitive complexity than advanced students and may focus on more concrete, less nuanced skills (simmons & fisher, 2016). it is, therefore, possible that the students’ focus on documentation was a result of their relative comfort in discussing a concrete skill like documentation. it is also possible that the students’ focus on soap notes was a result of the emphasis on documentation by social work faculty supervisors and the interprofessional team because of its importance in preventing medical errors and improving patient continuity of care. students’ development of their professional identity was another key area of perceived growth. these are consistent with research findings that both sl (levy & edmiston, 2015; long & gummelt, 2020; nino et al., 2011) and ipe (ciani et al., 2023; haugland et al., 2019; rishel et al., 2020) were related to social work students’ professional identity development. an oft-repeated sentiment by students was their appreciation of being an essential part of the interprofessional team. limitations because this study was qualitative, the results represent the experiences of the participants in this study; however, findings are not generalizable to other settings. moreover, students' reflections were self-reported; therefore, it is difficult to determine objectively if students made measurable gains in interprofessional competencies. although students were observed and evaluated by faculty social work supervisors, this process was not used as a formal measurement of student development. evaluating student skills on specific competencies and practice behaviors using multiple measures might be a more effective means of measuring development. in addition, students’ ability to reflect on their experience may be determined by their ability to articulate the development of complex thinking skills (i.e., critical thinking). having students practice reflective writing throughout the course may be helpful in this regard. while students' reflections demonstrated that they had developed ipec competencies, upon reflection, our clinic’s approach to ipe had a couple of noteworthy limitations. the advances in social work, summer 2023, 23(2) 348 students engaged in cross-discipline education; however, the faculty’s instruction was limited to their own disciplines. students could have benefited from learning from more experienced practitioners in other disciplines. in addition, although students were assigned to interprofessional teams, they spent most of the time interacting with members of their own discipline. we believe that this contributed to a strong professional identity; however, both patients and students may have benefitted from increased interprofessional collaboration between disciplines. implications for social work education despite the limitations, the research adds experiential knowledge to an emerging field. it is, therefore, important for educators to provide students with more sl and ipe opportunities early in their training as a way of helping them gain confidence in their ability to work with different populations. early training in a srfc might help students become more confident in working with underserved populations and prepare them for fieldwork in underserved communities. in addition, it provides students with critical opportunities to build confidence in interacting with students and healthcare professionals from other disciplines before going into the healthcare field. this may aid in the development of social work professional identity, which is essential in interprofessional healthcare settings. finally, teaching students how to accurately document patient encounters can greatly enhance their education and prepare them for professional practice where documentation skills are highly valued. conclusion through this sl experience, in an interprofessional environment, students reported learning several important practice skills that were linked to ipec competencies. they learned to communicate with clients directly and by using an interpreter. they learned to communicate with students from other disciplines, improved documentation skills, and reported increased confidence. finally, they developed a deeper understanding and appreciation for the role of social work within the clinic. these findings suggest that sl and ipe in a srfc may provide students with learning opportunities that can enhance their overall educational experience and better prepare them for future social work practice. we, therefore, recommend that schools of social work engage with existing srfcs on their college or university campuses. the most recently published survey from the association of american medical colleges indicates there are srfcs in more than 75% of u.s. medical schools, and this number continues to grow (smith et al., 2014). engaging with srfcs can be a valuable experience for both faculty supervisors and students. faculty supervisors get to teach outside of the classroom and students will learn valuable competency-based skills working as a part of an interprofessional team while providing needed assistance to the local community. when students work collaboratively to address the healthcare needs of underserved populations, they learn to appreciate the effectiveness of collaborative practice (zechariah et al., 2019), and they are more likely to simmons et al./competency-based skills & service learning 349 continue working with the same 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(2019). interprofessional education and collaboration in healthcare: an exploratory study of the perspectives of medical students in the united states. healthcare, 7(4), 1-11. author note: address correspondence to christopher simmons, school of social work, university of south florida, tampa, florida 33612. email: csimmon4@usf.edu https://doi.org/10.5539/hes.v10n3p123 https://doi.org/10.5539/hes.v10n3p123 https://doi.org/10.1177/1098214005283748 https://doi.org/10.1177/1098214005283748 https://grandchallengesforsocialwork.org/wp-content/uploads/2015/12/wp3-with-cover.pdf https://grandchallengesforsocialwork.org/wp-content/uploads/2015/12/wp3-with-cover.pdf https://grandchallengesforsocialwork.org/wp-content/uploads/2015/12/wp3-with-cover.pdf https://doi.org/10.1186/s12909-020-02286-z https://doi.org/10.1186/s12909-020-02286-z https://doi.org/10.1080/02615479.2012.705273 https://doi.org/10.1300/j067v22n03_05 https://doi.org/10.1300/j067v22n03_05 https://doi.org/10.1080/13561820.2017.1286637 https://doi.org/10.1080/13561820.2017.1286637 https://doi.org/10.1080/13561820.2017.1286637 https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/sdoh-evidence-review.pdf https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/sdoh-evidence-review.pdf https://doi.org/10.1016/j.cptl.2020.11.011 https://doi.org/10.1016/j.cptl.2020.11.011 https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice https://doi.org/10.3390/healthcare7040117 https://doi.org/10.3390/healthcare7040117 mailto:csimmon4@usf.edu enhancing competency-based social work skills through service learning and interprofessional education in a student-run free healthcare clinic christopher simmons amy fisher roxann mcneish karah y. greene melissa thompson jerome t. galea relevant literature theoretical framework the clinic experience methods participants qualitative analysis results discussion limitations implications for social work education _________ jimmy a. young, phd, msw, mpa, associate professor, department of social work, california state university, san marcos, ca. shane r. brady, phd, msw, associate professor, anne & henry zarrow school of social work, university of oklahoma, norman, ok. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 270-286, doi: 10.18060/24947 this work is licensed under a creative commons attribution 4.0 international license. re-imagining digital and new media literacies in social work education: a critical framework for overcoming #fakenews, divisiveness, and injustice jimmy a. young shane r. brady abstract: social unrest and division within the united states has become more visible and magnified since the 2016 election of former president trump. this unrest has been amplified by the covid-19 pandemic and white supremist attacks across the country. throughout this era, information has been perpetuated through systemic and cultural networks promoting pseudoscience, #fakenews, misinformation, and explicit marginalization of racial, gender, ethnic, and cultural minorities. during this time, social work practitioners and educators have struggled to counter misinformation in classrooms and practice contexts. this paper proposes a newly re-imagined framework for addressing misinformation and civil discourse in social work education through the adoption and infusion of digital and new media literacies from within a critical theory driven epistemological framework. recommendations are provided for incorporating tools, skills, and competencies throughout the curriculum in a more meaningful way that will help the profession combat misinformation, promote civil discourse, and utilize best practices in a digitally augmented society. only then will the social work profession be able to meet the current and future challenges and opportunities that will undoubtedly accompany the expansion of digital technologies throughout our society. keywords: digital literacies, critical thinking, new media literacies, misinformation, disinformation in the 2004 book post-truth era, ralph keyes argues that deception is a major part of modern life. lies and dishonesty have been gamified by those who compete for news coverage and keyes further contends that dishonesty may be acceptable in certain situations. reality tv, satirical and opinion news programs, conspiracy theories, as well as the rise of social media may be contributing factors to a post-truth era (sismondo, 2017). propaganda, fake news, and misinformation have historically been sown throughout the world, but never with such speed and quantity as we see today (boyd, 2018; rushkoff et al., 2018). since the 2016 election of president trump, disinformation campaigns and social unrest have risen across u.s. society. the covid-19 pandemic further amplified this division along with attacks by white supremists and the explicit marginalization of racial, gender, ethnic, and cultural minorities (mar fariña et al., 2021). during this time, social work practitioners have struggled to learn and use new technologies that serve the needs of clients, while educators, students, and practitioners struggle to create spaces for civil discourse and progressive change (banks et al., 2020; bhatt & mackenzie, 2019; mishna, milne et al., 2021). as a result of these challenges, social work has been limited in its role for social change in society. in a post-truth era, how are social workers supposed to address about:blank young & brady/re-imagining digital & new media literacies 271 these problems? where do we begin? what is truth, how is it constructed, and who creates it? what are the specific competencies social workers need to empower, intervene, and advocate for positive social change amidst a sea of misinformation? disinformation and misinformation are two sides of the same coin that present fake news, alternative facts, or other misleading information. the main difference between the two terms is that disinformation is misleading information that is created and shared with the specific intent to deceive or mislead for the purposes of causing harm, political or personal gain, whereas misinformation is often shared without such intent (buchanan, 2020). the challenges of misinformation and disinformation cannot be blamed solely on the ultra-right or on digital and mainstream media. most of us who have grown up and attended school in the u.s. were presented with histories, narratives, and subjects as “truth” or “facts” that should be accepted without question. consider that many young people are still taught that christopher columbus “discovered” america or that early european settlers and indigenous peoples embraced each other during the first thanksgiving. additionally, most americans were taught that the civil war was not primarily about slavery and that abraham lincoln was a hero to blacks (bohan et al., 2020; heimlich, 2011). while there may be some truths in these narratives of history, there are also inaccuracies, false narratives, and misinformation (angell, 2019; crenshaw, 1989; gray et al., 2013). the presence and perpetuation of disinformation is found not only in our written, collective history as a nation, but in what is often omitted from that history or in the framing of historical events, which may be as damning to the literacy of our society as what is written. consider the framing of colonialization as a land rush or the establishment of a free nation, rather than the stealing of land and the enslavement and genocide of people (angell, 2019). why do most historical texts still call the tulsa race massacre, one of the most egregious examples of white supremacy in u.s. history, the tulsa race riots? while we provide only a few examples for the sake of brevity here, there are numerous examples of such disinformation that far pre-date the election of president donald trump and the digital age. these symbolize a greater issue in our society that foucault (1980) refers to as the “archaeology of knowledge and genealogy of power” (p. 129) or how societal elites utilize power to create, frame, and disseminate knowledge to the people as a means of social control, while rejecting the legitimacy of counter narratives and critical accounts of historical events, figures, and practices (reisch, 2019). in today’s digitally mediated environment, we must discern information, intentions, motivations, and the epistemology of ignorance (bhatt & mackenzie, 2019) to move forward in a way that deconstructs systems of power or oppression in order to benefit everyone more equitably. the protection of the status quo through the continued perpetuation of disinformation is not isolated to historical documents and texts but is also found in existing policies. currently, more than 20 states have passed or introduced laws banning public institutions from teaching perspectives or theories deemed as threatening to the whitewashed narratives of history or that make any reference to a specific group of people as racist or otherwise oppressive (ray & gibbons, 2021). these policies enhance the existing divide among americans and generate confusion for social work students about what is considered legitimate knowledge or facts and greater complexities for social work educators trying to advances in social work, summer 2022, 22(2) 272 dispel disinformation and helping students discern misinformation, disinformation, and critical perspectives. it is also important to note that social work education is culpable in spreading misinformation through the whitewashing and colonizing of its own professional narrative. social work students are often taught about the progressiveness of major reform movements and social work pioneers such as jane addams and mary richmond. while there are undoubtedly truths embedded in these narratives, educators and scholars often neglect important details about the history of social work that leave students with a limited and misinformed perspective. social work educators and scholars regularly omit the segregated nature of settlement houses and historical professional organizations. most students do not realize the importance and necessity of professional associations such as the association of black social workers or the association of latino/a social workers. students are seldom taught about the role the profession played in the removal of indigenous children from their homes or wwii internment camps (brady et al., 2019; mullaly & dupré, 2018; reisch, 2019). if social work education is to truly reimagine itself and better prepare students to practice in a digitally mediated world of rampant misinformation, we must not only inculcate digital and new media literacies across competencies and curriculums (young et al., 2018), but also imbue a critical perspective that encourages the appraisal and analysis of all forms of information. the main objective of this paper is to propose a new epistemological framework for the social work profession that combats disinformation, divisiveness, injustice as well as build capacity among social workers in attaining digital competencies. this framework infuses contemporary critical theories and perspectives with digital and new media literacies to provide social workers, educators, and others with the analytical tools and skills necessary to face the challenges of the modern era and shape the future in a more positive direction. through this framework we posit four interrelated questions grounded in critical theory to help re-imagine social work education and how digital and new media literacies can be embedded throughout the curriculum to prepare social workers for a future profession that will undoubtedly be digitally mediated, complex, and offer new opportunities for change. theoretical framework philosophy of science the area of inquiry known as philosophy of science analyzes the underlying values related to ontology, epistemology, human nature, and social change across diverse social science disciplines including social work (fay, 1996; guba, 1990; kuhn, 1996). it provides a path that implicitly guides how scholars think about legitimate knowledge within the social environment (ontology), how knowledge should be created and appraised (epistemology), and the nature of social justice and change (fay, 1996). when applied to social work, the philosophy of science provides educators, practitioners, and students with a critical lens to underlying assumptions and values related to human nature, society, and the process of creating and appraising knowledge. young & brady/re-imagining digital & new media literacies 273 one of the most relevant perspectives in the philosophy of science was provided by guba (1990), who discussed three major worldviews for understanding the formation and legitimization of knowledge and the nature of social change. guba described a postpositivist worldview through objectivity and a belief that knowledge should be produced through the traditional scientific method. postpositivism embraces social control and assumes that existing societal structures and systems are functioning to promote the greater good for the most people. many scholars have connected postpositivist values to ideologies and practices related to neoliberalism, which embraces maintaining the status quo and social order of societies through controlling economic and political systems (brady et al., 2014; kuhn, 1996). additionally, guba’s (1990) framework identified social constructivism and critical paradigms as alternative worldviews to postpositivism. the social constructivist worldview emphasizes that truth and knowledge are bound by the subjectivity of lived experiences and, as a result, alternative truths and understandings are necessary to avoid hegemony and promote incremental levels of social change. finally, within guba’s critical worldview, there is an assumption that the status quo found in societal structures and dominant cultures is problematic, hegemonic, and in need of transformation. therefore, it is imperative for social work scholars, professionals, and consumers of knowledge to have the critical thinking and analytic skills necessary to effectively discern the quality, legitimacy, and importance of knowledge, while also considering the legitimacy of alternative positions and perspectives. these skills and knowledge are essential to bringing about transformative and/or innovation within social work and society (guba, 1990). within guba’s critical paradigm is a mutual respect for both structurally oriented critical theories, often rooted in the works of marx, weber, gideons, mullaly, and others, along with social constructivist critical theories rooted in the works of nietzsche, gramsci, foucault, and habermas. in this paper, we position our framework for applying digital and new media literacies within the social constructivist critical perspectives to emphasize the subjective and dynamic nature of information in the digital age, while working diligently to avoid hegemony with regards to any utopian vision of society or all encompassing “truth.” we seek to build the capacity of social work educators and students to be equipped with the digital and new media literacy tools needed to properly assess and appraise all forms of information through both a rational and critical lens. critical theory while philosophy of science frameworks do not preference some theories over others, it is a useful tool for understanding how to select an appropriate theory and practice tool(s) for a specific context, aim, and assumption (brady et al., 2014). given the current paper’s focus on critically analyzing how social workers, students, and educators come to understand, use, interact with, and create knowledge in an increasingly digital and virtual society, the authors selected critical theory as the most useful tool for critiquing existing practices and pedagogies for teaching digital and new media literacies. critical theory is especially important given recent state-level policies banning the use and teaching of critical viewpoints and theories such as, marxism, critical race theory, and anticolonialist perspectives (constance-huggins, 2019; sawyer & brady, 2020). advances in social work, summer 2022, 22(2) 274 origins and evolution. critical theory derives from marxist and neo-marxist perspectives about power, oppression, injustice, and social change (fook, 2002). it provides an integral lens for critiquing inequality and questioning the legitimacy of maintaining the status quo (dominelli, 2010; fenton, 2014; fook, 2002). critical theory seeks to accomplish this through deconstructing hegemonic structures and systems to identify the underlying values and power that upholds social control (constance-huggins, 2019; crenshaw, 1989). rather than maintaining the existing social order through incremental changes, critical theory seeks transformative and innovative changes in communities, social structures, and systems by providing individuals with the tools to deconstruct societal systems of knowledge and truth, to critically analyse and appraise existing information, and to understand how to generate authentic, trustworthy knowledge (dominelli, 2010; fook, 2002; gray et al., 2013; habermas, 1984). first generation critical theory. the origins of critical theory are often attributed to philosophers of the frankfurt school that include horkheimer, adorno, marcuse, fromm, and habermas (fook, 2002). although most major work in critical theory is accredited to the frankfort school, two distinct branches of critical theory (first and second generation) are rooted in the seminal work of karl marx and friedrich nietzsche (fook, 2002; marx & engels, 1848/1967). first generation critical theory is more structural in nature and thus emphasizes and builds upon constructs and perspectives from karl marx. the most salient of these marxian perspectives includes an understanding of false consciousness and consciousness raising, along with accepting that society’s ruling classes benefit from maintaining hegemony and social order by oppressing and marginalizing groups with fewer resources and power (marx & engels, 1848/1967; mullaly & dupré, 2018). first generation critical theorists often focused transformative change strategies on radically altering existing societal structures and systems and replacing them with more socially just ones that benefit society’s most marginalized groups (fook, 2002). while many critical social work scholars and educators still embrace this focus on structural transformation, others find fault with many of its tenets (fook, 2002; levin, 1995). second generation critical theory. critics of first-generation critical theory see it as overly hegemonic and simply replacing one hegemonic system for social order with another (mullaly & dupré, 2018). second generation critical theorists believe it is problematic to assume marginalized groups are more socially just and less oppressive than the existing government or privileged class, thus creating a more subjective oriented branch of critical theory during the postmodern era. postmodernism is loosely defined as a framework in which absolute truths and widely accepted assumptions of society, science, history, arts, and culture are critically questioned and alternative perspectives are given more legitimacy in many dimensions of society (crenshaw, 1989; fay, 1996). this branch of critical theory was established by the work of german philosopher friedrich nietzsche and later advanced by postmodern thinkers such as habermas, freire, agger, derrida, and foucault (agger, 1992; foucault, 1980; habermas, 1984). given their belief in questioning what is seen as objective reality, postmodernists deconstruct (unpack) language and knowledge by asking what systems of power affect interpretation or meaning. as one of the major postmodern thinkers, derrida argued for the need to deconstruct the ways young & brady/re-imagining digital & new media literacies 275 subjective western values or hegemony underpin the knowledge base of society (levin, 1995). applying second generation critical theory. given the emphasis of secondgeneration critical theorists on reducing hegemony and power differentials as well as decolonizing teaching and research methods to innovate and transform society, the authors identify it as the most applicable lens for analyzing challenges to learning and using digital and new media tools and literacies in social work practice and its curriculum. it is through a second-generation perspective that this paper identifies contemporary challenges in social work to accessing, utilizing, and interrogating digital information, utilizing best practices in virtual spaces, and understanding how to incorporate digital and new media literacies into professional practice and social work education. the following questions are rooted in a critical analysis of power, knowledge creation, social change, and applies the philosophy of science lens to understand the competing values and assumptions of how social work embraces and/or hinders digital and new media literacies. we infuse digital and new media literacies into this framework to re-imagine the future of social work education, inform professional practice, and conceptualize how digital and new media literacies can promote broad, innovative, and positive impacts on our global society. 1. what constitutes legitimate knowledge in a digitally mediated society? 2. who are considered legitimate creators of digital information? 3. how do educators prepare social workers to practice within a digitally mediated and technology driven society? 4. how do social workers leverage digital technologies to create innovative change that makes broader impacts in society? the immense and rapid flow of information through our global society, aided by digital spaces and technology, necessitates these critical questions. these provide social workers and educators with a framework for building their capacity to implement and infuse digital and new media literacies throughout curriculums and practice to prepare students to serve clients, communities, and society more effectively both now and in the future. digital and new media literacies digital and new media literacies (dnml) is a term that evolved with technology and encompasses the technical knowledge, social, cultural, and emotional skills necessary to participate in the modern digitally mediated era. this era is characterized by the ubiquitous use of smartphone technology and internet devices in the home, work, and public spaces which have dramatic impacts on human beings and society (hedberg, 2011; jenkins et al., 2006; rheingold, 2012; twenge, 2017). the term digital literacies is often used as a generic synonym encapsulating media literacy or the ability to access, analyze, evaluate, and communicate messages in a wide variety of forms (hobbs, 1998). digital competence is possessing the skills and knowledge to understand and utilize information communication technologies (perron et al., 2010; young, 2015). digital and media literacies are well advances in social work, summer 2022, 22(2) 276 researched in the disciplines of education, media studies, and communications (belshaw, 2011; hobbs, 2011; laar et al., 2017; rheingold, 2012) but are still emerging in the field of social work (lens, 2002; young, 2015; young et al., 2018; young & glennon, 2021; young & ronquillo, 2021). belshaw (2011) contends the multitude of definitions presents difficulties for effectively employing digital literacies yet the process of developing a definition is just as important as its outcome and relies on contextual factors. we agree that context is important, but the challenge remains that technology and human behavior are in constant flux and we need to recognize that despite the continual change, digital literacies need to incorporate the participatory aspects of new media along with critical thinking, socio-cultural awareness, and participatory culture (jenkins et al., 2006; young, 2015). digital and new media literacies build upon the traditional definition of media literacy that uses critical thinking while also incorporating social and cultural competencies needed to participate in and understand the digital world. additionally, dnml recognize the importance of participatory culture, technical knowledge and skill, critical perspectives, communication, collaboration, creativity, ethics, and the evolution of new media technologies along with their impact on individuals, institutions, and communities online and in the real world (young & glennon, 2021; young & ronquillo, 2021). by recognizing the convergence of these societal intersections, social workers can leverage dnml to better understand, intervene, empower, and create social innovations which contribute to social justice and positive social change (young & glennon, 2021; young & ronquillo, 2021). the question of what constitutes legitimate knowledge in a digitally mediated society is central to the premise of digital and new media literacies and also asks how all sources of knowledge are portrayed and represented in classrooms, across media sources, and throughout societal institutions (bhatt & mackenzie, 2019). the underlying skill here is one of judgement and critical appraisal of the information searched for and consumed online. we live in a world dominated by algorithms that promote information and influence decision making from online shopping to news consumption on social media (noble, 2018). indeed, what you “like” is altering the world you see online and impacting real-life interactions. artificial intelligence, big data, and algorithms are both a solution to and a problem of what constitutes knowledge and information. the challenge with these tools relates to algorithmic bias, misinformation, and privacy (boyd & crawford, 2011; eubanks, 2018; gillingham & graham, 2017; learned-miller et al., 2020; noble, 2018). these tools have inherent limitations that can promulgate ignorance and sustain oppression or exploitation (eubanks, 2018; bhatt & mackenzie, 2019). therefore, social workers need to be aware of such limitations if they are going to shape future use or critique information conveyed via these mechanisms. a philosophy of science and critical theory lens may suggest multiple ways of knowing but ultimately what constitutes legitimate knowledge must be scrutinized to ensure information is not constructed by powerful elites as a means to marginalize the voices of individuals facing oppression or as a method to whitewash history or current events (constance-huggins, 2019). one challenge to this idea is that misinformation and identity politics infused with biased algorithms can constantly propagate misinformation and the weaponization of memes (noble, 2018; rushkoff et al., 2018). internet users may young & brady/re-imagining digital & new media literacies 277 succumb to the fallacies of conspiracy theories or discover information that aligns with their core beliefs or fears. for some, they may disagree with the information they encounter yet the sheer volume and veracity of it makes for an overwhelming argument dissuading users against their better judgement. this is why we see issues like pizza gate (kennedy, 2017) and q-anon becoming as popular as some major religions in the united states (russonello, 2021). in practice, exit counsellors and clinicians work with individuals that succumb to the online misinformation (smith, 2020) and social workers contend with fake news, misinformation, and disinformation as data and technology transcend large swaths of the population. naturally, this leads us to discuss the second question regarding who are considered legitimate creators of digital information. these two questions align well within a digital and new media literacies perspective to help someone discern the truth of information. a facebook user may come across content that appears to lack authority or credibility, but they are unsure as to its truthfulness. examining who or what entity created the information in question can help one determine whether it is verifiable or false. there are several skills and techniques that can be used to analyze information. one popular technique is mike caulfield’s (2019) sift method that involves four moves including: stop and ask what the reputation is of the source; investigate the source more closely; find better coverage of the issue from more reputable sources; and trace the claims, quotes, or media to the original context. caulfield’s method incorporates some of the new media literacies skills identified by jenkins et al. (2006) such as transmedia navigation, which is the ability to follow the flow of stories and news across multiple platforms. new media literacies (nml) represent a framework of social skills and cultural competencies needed to navigate our digitally mediated world (young, 2015; young & ronquillo, 2021). another nml skill is networking, or the ability to search for, synthesize, and disseminate information. paramount to the sift method is the nml skill of judgement, which is the ability to evaluate the reliability and credibility of different information sources (jenkins et al., 2006). the craap method (currency, reliability, authority, accuracy, and purpose) is another approach first developed within the library sciences to help students apply critical thinking to discern or judge the credibility of information online (blakeslee, 2004). although this method is useful, it fails to recognize the constant stream of misinformation across a variety of websites and social media. for example, when utilizing the craap method a user could conclude a source has relevant authority but yet that authoritative source is still sharing fake news or misinformation. this presents unique challenges for the user to discern between factual news or data and misinformation when that information is presented elsewhere online (fielding, 2019). just because a source seems like it can be trusted does not mean it has accurate information. remixing, integrating, and utilizing specific techniques from the broader digital literacies’ paradigm can provide social workers with the digital competency necessary to critique and construct knowledge, empower, advocate, and transform the profession, and impact the broader society (young & glennon, 2021; young & ronquillo, 2021). however, more needs to be done to prepare social workers to encounter disinformation, intervene in an appropriate way, and reimagine social work education and professional development. advances in social work, summer 2022, 22(2) 278 how do educators prepare social workers to practice within a digital and technology driven society? the concise answer is we must incorporate digital competencies into social work education. many scholars and educators have been arguing for this increased attention to information communication technologies and the need for digital competencies for more than two decades (mishna, sanders et al., 2021; perron et al., 2010; young, 2015; young & glennon, 2021; young & ronquillo, 2021). the 2015 education policy and accreditation standards (council on social work education [cswe], 2015) addresses the ethical and appropriate use of technology, the grand challenges for social work discuss harnessing technology for social good (american academy of social work & social welfare, 2016), and the literature on technology in social work education has increased sharply with books, articles, and conference presentations devoted to the subject. however, not enough has been done to integrate specific knowledge and skills into social work education, therefore digital and new media literacies must be the foundation upon which digital competence is built. digital and new media literacies (dnml), as described previously, encompasses the technical knowledge, social, cultural, and emotional skills necessary to participate in the modern digitally mediated era (young, 2015; young & ronquillo, 2021). developing dnml and related competencies ought to be integrated throughout social work education from clinical practice to research and policy to community and organizational practice to advocacy and activism (brady et al., 2015; young & glennon, 2021). we need the skills of dnml embedded at every corner of social work practice, even when no technology is present. it is likely most social work practitioners will have a client with challenges stemming from the influence of digital technology: whether it is a relationship that ended because of social media, cyberbullying, telehealth, searching for research online, contributing to a cause via social media, or promoting an organization’s programs and services. technology initially crept into social work practice (mishna et al., 2012) but now it is transforming practice in every sphere. social work education can prepare future professionals with digital competencies by infusing dnml throughout the curriculum. this can include using social media to instruct on human behavior and the social environment (baker & hitchcock, 2017), using twitter in macro practice and policy classes (hitchcock & young, 2016; teixeira & hash, 2017), examining the benefits and challenges of big data, data visualization, and data science in research (cariceo et al., 2018; perron et al., 2020), and using a variety of technologies for students to develop their digital competence (gilster et al., 2020; mcinroy, 2021; young & ronquillo, 2021; young et al., 2018). by infusing digital literacies within social work education, we equip students with the necessary critical theoretical perspective to unpack the sources of information, the credentials and motivations of knowledge creators or influencers, and who benefits from information as well as who may be harmed as a result of the narrative being promoted. in reality, most information transmitted through any source is seldom completely accurate or entirely false, nor can individual epistemological values and views be discounted for how people decipher information (foucault, 1980; habermas, 1984). such skills are not meant to discredit one ideology over another (e.g., discrediting right-wing conservatism in favor of leftist progressiveness), but encourages social workers to critique and appraise all forms of information. embedding digital and young & brady/re-imagining digital & new media literacies 279 new media literacies throughout the curriculum does not need to supplant but rather complements other methods of instruction used to enhance students’ knowledge and skills. given that social work is filled with its own legacy of supporting and even promoting oppression and marginalization, it is important for practitioners to scrutinize their own knowledge base and institutions (mullaly & dupré, 2018; reisch, 2019; sawyer & brady, 2020). in this way, reimagining social work education will directly impact future social work practice. the fourth question related to reimagining social work education asks how social workers leverage digital technologies to create innovative change and make broader impacts on society. leveraging digital technologies and social media begins with social work education and continues through one’s career with professional development opportunities and lifelong learning. for example, the use of professional collaboration networks, which allow social workers to engage in participatory spaces such as twitter, can help one to continue learning through a distributed network, participate in informal mentoring, and acquire specific skills (sage et al., 2020). in the classroom we need better integration of technology – specifically digital and new media literacies – to encourage, motivate, and help students learn and apply their new digital competencies in the field (hitchcock et al., 2019; mishna, sanders et al., 2021; young et al., 2018; young & ronquillo, 2021). this includes the use of technology, and at times specifically not using technology, to apply digital and new media literacies (dnml) skills such as play for students to experiment with their surroundings as a means of problem solving (jenkins et al., 2006; young, 2015; young & ronquillo, 2021). playing card and board games with different sets of rules and transitioning students in and out of game play can help them understand the importance of negotiation as a new media literacy skill, which is the ability to travel across diverse communities, discerning and respecting multiple perspectives while grasping and following alternative norms (young & ronquillo, 2021). engaging students in a process of learning that connects them to their interests while being academically oriented and maintaining a shared purpose allows the educator to use dnml, technology, and social work knowledge to help students think critically, collaborate effectively, and ultimately accomplish the task at hand (young, 2020). once students understand there is a method of using social media and digital technologies that benefit them and their clients, we will witness a new transformation in the social work profession. within macro practice contexts, social work students and practitioners must learn how to critically select and effectively apply digital and virtual tools in complex practice environments, while also understanding how to utilize traditional best practices in virtual and digitally mediated environments. for example, ascertaining the credentials and qualifications of the persons or institutions behind twitter profiles teaches social workers and students ways to access accurate information about current events, best practices, and professional networks. although twitter can be a tool for practitioners and students seeking legitimate perspectives on current events and best practices, social media in general poses challenges that might make it less useful due to the widespread use of fake profiles, specific community guidelines, and the influence of algorithms that mediate user engagement. nevertheless, some social media platforms have value and benefits to many social workers. mobile phone chat applications and geographic information system (gis) advances in social work, summer 2022, 22(2) 280 software are other promising tools that may help community organizers and activists stay abreast of social unrest and rapidly mobilize others; however, these applications may not be the ideal choice for organizers seeking to build community or local capacity (brady et al., 2015). the subtle yet important differences between different types of digital technology and associated tools – along with the ongoing challenge of appraising the accuracy, trustworthiness, and credibility of information – makes it imperative for current and future generations of social workers to be equipped with the dnml necessary to navigate the ever changing digitally mediated practice context. finally, one of the most important aspects of infusing dnml within social work education and practice is to understand, through a philosophy of science and critical theory lens, that technology has inherent challenges which preserve the status quo and may further harm marginalized populations (bhatt & mackenzie, 2019; eubanks, 2018; noble, 2018). social workers need to utilize these skills to inspire oppressed groups and embolden them with the same technologies to empower themselves. some may argue the master’s house will never be dismantled with the master’s tools while others contend that before structural transformation can occur, individuals must be equipped with the tools and experiences to promote consciousness raising and the ability to analyze the legitimacy or hegemony of systems and structures of knowledge and power (foucault, 1980; freire, 1968/1996). conclusion although the authors began collaborating and drafting this paper during the final days of president trump’s administration, the onset of covid-19, and an era of deep social, racial, cultural, economic, and political unrest, these issues remain salient themes. while many people, including social workers and others in helping professions had a moment of respite and optimism with the election of president biden, little has changed regarding the widespread use of misinformation, disinformation, and social unrest. the concept of “community” has altered quite a bit over the past 20 years, with more individuals identifying and interacting with community through digital and virtual platforms and spaces. given that these trends are unlikely to change anytime soon, it is important for social workers and educators to consider the necessity and role that digital and new media literacies must have in any new vision of social work. although we do not support any singular ideal vision for societal or professional transformation since utopian perspectives can be as hegemonic as the ones they seek to displace. we do however believe it is essential for social work to embrace its position within a digitally mediated society and its responsibility to prepare practitioners to critically navigate the complexities of virtual spaces. this can be done by selecting and applying best practices, and critically appraising the legitimacy, authenticity, and trustworthiness of digitally and non-digitally mediated information. we believe dnml must be integrated throughout the core competencies and standards of social work education, along with adequate training for educators and professionals who may also struggle with understanding these skills and tools, to realize the holistic competence described in the 2015 cswe educational policy and accreditation standards. schools of social work must focus on building critical digital and new media literacies among their departments through policies that promote critical thinking, collaboration, and innovation rather than those rooted in risk management and fear. in order young & brady/re-imagining digital & new media literacies 281 for social work to reimagine itself as a more progressive profession, it must prioritize building social workers’ capacity to effectively utilize digital and new media literacies in practice. references agger, b. 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(2021). social media in social work: research, education, and practice. in d. a. gonzález, a. a. astray, & a. a. puelles (eds.), social work in digital societies (pp. 95-113). mcgraw-hill. young, j. a., mcleod, d. a., & brady, s. r. (2018). the ethics challenge: 21st century social work education, social media, and digital literacies. journal of social work values and ethics, 15(1), 13-22. https://jswve.org/download/15-2/bookreviews152/15-1-articles/13-the-ethics-challenge-15-1.pdf young, j. a., & ronquillo, r. (2021). enhancing new media literacies of social work students through a participatory learning environment. journal of technology in human services, 40(1) 58-78. https://doi.org/10.1080/15228835.2021.2004572 author note: address correspondence to jimmy a. young, department of social work, california state university – san marcos. email: jyoung@csusm.edu https://doi.org/10.1080/10437797.2017.1287025 https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/ https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/ https://doi.org/10.1080/15228835.2014.998577 https://doi.org/10.4337/9781788118675.00021 https://jswve.org/download/15-2/bookreviews15-2/15-1-articles/13-the-ethics-challenge-15-1.pdf https://jswve.org/download/15-2/bookreviews15-2/15-1-articles/13-the-ethics-challenge-15-1.pdf https://doi.org/10.1080/15228835.2021.2004572 mailto:jyoung@csusm.edu _________ christopher j. heckert, dsw, licsw, assistant professor, and erica k. pence, phd, msw, assistant professor, school of social work, eastern washington university, cheney, wa. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 533-546, doi: 10.18060/28521 this work is licensed under a creative commons attribution 4.0 international license. comparing social work program specialization and board exam pass rates: preparing social workers for success christopher j. heckert erica k. pence abstract: a critical yet contemporary step towards establishing one’s identity as a social worker is through licensure. professional licensure is a culminating result of education, practice experience, supervision, and a board exam. when evaluating board exam pass rates, we must consider the role that education has in preparing social workers for exam success. this study evaluates the relationship between msw programs with an advanced generalist (ag) and/or clinical and direct practice (cdp) specialization and 2022 board exam pass rates. using data from the council on social work education (cswe) and the association of social work boards (aswb), 2022 exam pass rates were compared between a random sample of cswe-accredited ag and cdp programs. results indicate no significant difference in exam pass rates across social workers who complete an ag program and those who complete a cdp program. this applies to both the aswb master’s exam and the clinical exam. study findings suggest that specialized programs based on a specific social work function may not be as impactful on exam preparation as might be assumed. recommendations include re-merging microand macro-based social work education programming, streamlining exam options, and shifting educator discourse when discussing and promoting specializations. keywords: social work licensure, social work education, professional board examination the release of the social work board exam pass rates analysis from the association of social work boards (aswb) in 2022 spurred considerable interest, evaluation, and conflicting opinions on how to move forward with the use of licensure within the profession of social work. this is not an entirely new phenomenon; social work licensure has been debated, for multiple reasons, for over three decades (e.g., apgar, 2022b; cherry et al., 1989; thyer, 2011). despite an increase in exam attempts by persons of color between 2011 and 2021, aswb’s (2022) analysis revealed disproportional exam pass rates between white individuals and individuals from “historically marginalized communities” (p. 11), with black individuals receiving the lowest exam pass rates. additionally, the analysis highlighted age-related disparities, as individuals between the ages of 18 and 29 typically have higher pass rates than those who are older, particularly those older than 50 (aswb, 2022). historically, these disparities have often been attributed to a racially biased exam and questioning of the reliability and validity of the exam (albright & thyer, 2010; castex et al., 2019; woodcock, 2016). more recently, a three-part series of reports further analyzing the 2022 aswb data by kim and joo (2024a, 2024b, 2024c) convey a multitude of individual, community, and institutional factors that may influence how one performs on the social work licensure exam. these reports suggest focusing beyond that of the reliability, validity, and bias of the exam itself to a systems-based approach to address these about:blank advances in social work, summer 2025, 25(2) 534 disparities. hesitation of these findings is warranted, however, given that these reports were developed in collaboration with aswb, de-emphasize the inherent disparities within the exam structure and its content, consider first-time pass rates only, and exclude data related to native american/indigenous peoples. concurrently, nonetheless, others have also considered systemic forces impacting exam success as critical to the conversation and solution (apgar & nienow, 2024; bloxom & anderson, 2023). one key finding by kim and joo (2024c) is that the first-time clinical exam pass rate was associated with characteristics of the educational institution where test-takers received their master of social work (msw) degree. test-takers who attended smaller msw programs had lower exam pass rates than those who attended larger msw programs. also, test-takers who attended universities that primarily served students from lower socioeconomic backgrounds and had less restrictive admissions had lower board exam pass rates (kim & joo, 2024c). while these findings offer valuable considerations to the conversation regarding licensure, the reports acknowledge limited data from aswb related to critical predictor variables. thus, more detailed information about the msw programs test-takers attend, such as program specialization and curriculum, can highlight additional insights. to learn more about program specialization impacts on board exam pass rates, we seek to answer this question: are there significant differences in social work board exam pass rates across msw programs that specialize in the areas of advanced generalist (ag), clinical and direct practice (cdp), and combined ag/cdp programs? literature review following abraham flexner’s 1915 presentation “is social work a profession?” in which he questioned the professional conceptualization of social work, decades’ worth of efforts to align social work practice with other professions emerged in multiple ways. one key strategy was to mirror regulated practice, which was already established among some professions (e.g., law) and began to emerge among others (e.g., psychology). the initial regulation of social work practice began in the 1940s; by 1992, all jurisdictions in the u.s. regulated the practice of social work (cooper-bolinskey, 2019). by 2004, more defined statutes that declare who can use the title of “social worker,” an examination board, requirements for continuing education, and procedures for disciplinary hearings existed in all 50 states and d.c. (dyeson, 2004). regulation historically occurs in one of three credentials: registration, certification, or licensure. according to kim (2023), registration assesses provider qualifications but does not restrict the scope of practice. with certification, a provider’s education is assessed, but their scope of practice is not restricted by the certification itself. licensure, however, defines a scope of practice, includes practice restrictions, includes title protection, and serves as a gateway into the occupation. while licensure is the most contemporary, there is variation in social work licensure categories, and social work practice varies across state regulations (cooper-bolinskey, 2019). assuming a traditional pathway to a professional license, the process includes four key components: education in social work, practice experience, social work supervision, and a board exam. thus, education initiates the licensure process, and board examination typically concludes it. heckert & pence/swk specialization & exams 535 role of social work education completing education is the first step towards obtaining a professional license to practice social work. formal education serves as a prerequisite for licensure, while other requirements may occur concurrently with one another (e.g., practice experience and supervision). through formal education, a degree in social work from a council on social work education (cswe) accredited program is expected. according to cswe (2024a), as of june 2024, there are 550 accredited baccalaureate programs and 340 master’s programs. cswe (2024d) states that accredited programs “… [provide] assurance that the program in which a student enrolls is committed to quality and educating students on social work competencies necessary to enter practice” (para. 2). education sets the foundation for how social workers should practice (apgar, 2021). therefore, quality education serves as an initial determinant in one’s professional competence and ultimate capacity for licensure. program specialization continuing its professionalization, social work’s broad scope of practice became more defined. to navigate this complexity and competing practices, social work programs developed and expanded possible specializations (sometimes referred to as an emphasis, track, or concentration) to offer students an option to pursue a specific function within the continuum of practice. within the cswe directory of accredited programs, msw programs self-identify one or more areas of specialized practice that align with its program focus and curriculum. according to cswe (2024b), common msw program specializations at the micro level include health social work; children, youth, and families; school social work; and clinical social work. specializations at the macro level include administration, community development, leadership, research, and social policy. an additional area of program specialization is the advanced generalist emphasis, which embraces both the micro and macro components, understanding that these are inseparable. cswe (2024b) identifies advanced generalist and clinical as the two most common program specializations. advanced generalist practice. derezotes (1999) describes advanced generalist practice as an inclusive approach, grounded in ecology and diversity, that values both direct and indirect practices as interrelated processes. acknowledging this intricate relationship, dran (2014) depicts an advanced generalist as being prepared to tackle “chaos” in complex systems that may require one to work within multiple dimensions of practice simultaneously. compared to a generalist, an advanced generalist social worker practices in a broader yet more in-depth manner, which prepares one for independent practice and leadership in organizations (dakin et al., 2015). programs utilizing advanced generalist models, then, educate students through a range of advanced courses focusing on assessment, intervention, research, policy, leadership, and aspects of diversity. this makes an advanced generalist more versatile in working with individuals, families, groups, communities, and organizations. it is important to acknowledge that while categorized as a specialty, advanced generalist practice is more reflective of higher-level knowledge and skill that extends advances in social work, summer 2025, 25(2) 536 beyond the generalist education achieved during the first year of a non-advanced standing msw program. in other words, it is less indicative of a specific role or function within social work practice and is more broadly applicable across practice settings, as “…the advanced generalist goes beyond the problem at hand to see opportunities to solve other problems at other times and places” (dran, 2014, p. 577). thus, advanced generalist practice is, at times, difficult to differentiate and is therefore inconsistently regulated across jurisdictions. this is a stark comparison to clinical social work. clinical practice. the national association of social workers (nasw, 2024) defines clinical social work as a practice specialty that provides assessment, diagnosis, and treatment of behavioral health conditions (e.g., mental, emotional, behavioral), noting that common treatment interventions include individual, group, and family therapy. this is further supported by views from practitioners that mental health treatment is a core of clinical social work (raine et al., 2023). clinical social workers embrace an ecological, or person-in-environment, perspective and are present in several practice settings (nasw, 2025), which is similar to advanced generalists. this allows social work to bring a unique perspective to mental health services when compared to allied professions. clinical practice is a healthcare profession, and clinical social workers represent the largest group of mental health providers in the u.s. (american board of clinical social work [abcsw], 2022), highlighting the important role that clinical social workers hold in healthcare settings. since it is a healthcare profession, clinical social work is consistently regulated across jurisdictions and primarily lends itself to micro practice. specialized practice controversy discourse exists within the academy and the larger social work community as to the overall usefulness of specialized practice that differentiates microand macro-oriented practices. for instance, specializations contribute to the fragmentation of roles and tasks. harris and white (2018) describe this as a method of separating out specific social work tasks—especially at the micro and macro levels. this is markedly controversial among programs offering a clinical emphasis, as both advantages and disadvantages are evident when compared to advanced generalist practice. abcsw (2022) describes clinical social work as being “very different in their services and professional attainments [compared to other types of social work]” (para. 7). although a micro practice specialty, concepts of anti-oppression and social justice remain capable of being integrated into clinical program curriculum (kang, 2022). this demonstrates capacity to maintain key concepts, values, and ethical standards of social work as a whole, while still offering a unique, social work view and role in clinical practice. reisch and andrews (2002), however, express concern about a trend in practice to emphasize clinical perspectives in social work. more recently, cooper-bolinskey (2019) iterates confusion that exists between advanced generalist and clinical practice and notes an ongoing debate about whether including the clinical function was ever helpful to social work. blom (2004) discusses difficulties that occur when attempting to help people whose problems are complex and intertwined, yet a specialty limits the degree to which effective heckert & pence/swk specialization & exams 537 support can be offered. austin et al. (2016) furthermore argues that “decades of specialization have driven micro and macro practice further apart” (p. 271). according to cswe (2025) and several education programs (e.g., baylor university, 2023; mount vernon nazarene university [mvnu] communications, 2024; widener university, 2024), students should choose a program that offers a specialization aligning with specific functions of social work and career interests. however, austin et al. (2016) states: for many students, choosing between specializing in micro or macro practice can be a painful choice when they seek a valued professional identity and want to become social workers capable of using multiple practice tools. they find themselves contending with licensing demands, getting ready for a changing job market, facing faculty and peer pressure, and planning for ways to manage their student debt. (p. 275) since social work practice is inherently neither one specialty nor another, the relationship between specialized programming and exam pass rates is unclear. role of board exam board examination is intended to assess knowledge, skills, and the overall competence of practitioners (aswb, 2025b; association of marital & family therapy regulatory boards [amftrb], 2024; association of state and provincial psychology boards [asppb], n.d.; national board for certified counselors [nbcc], 2025). the use of examination is not unique to social work, although the specific exams themselves are. for social work, aswb owns and oversees the administration of board exams. this includes all five exam categories: (1) associate; (2) bachelor; (3) master; (4) advanced generalist; and (5) clinical. aswb exams contain 170 multiple choice questions, of which only 150 count towards the pass/fail outcome. according to aswb (2025b), exams are grounded in a practice analysis, which surveys social workers in a range of settings and locations; these findings identify the knowledge and skills needed to be assessed through examination. the bachelor exam assesses generalist practice (morrow, 2023). the master exam is intended for nonclinical practice and entry-level into the profession at the graduate level. the advanced generalist exam is targeted towards those interested in pursuing practice areas in administration, policy, and other macro-oriented roles, and the clinical exam is intended to assess competence for independent clinical practice. with practice analysis, aswb exams reflect what social workers actually do in practice (apgar, 2021). with educational programming being created by social work educators, programs focus on what social workers should do (apgar, 2021). thus, a gap exists between social work education content and exam content (morrow, 2023). to contribute to a systematic understanding of pass rate disparities, our study approaches this gap from a perspective centered on the concept of social work specializations. advances in social work, summer 2025, 25(2) 538 methodology we sought to determine if there are significant differences in social work board exam pass rates across msw programs that specialize in the areas of advanced generalist (ag), clinical and direct practice (cdp), and combined ag/cdp programs. we intended to examine whether there are differences in 2022 ag and clinical pass rates across ag and cdp programs; however, ag pass rate data were limited, with data available for only 12 programs within our sample. since ag exam data were largely absent across sampled programs, we were unable to use this data for consideration in our study. instead, we utilized master’s exam data, which reflects preparation for entry-level social work rather than advanced practice. therefore, we decided to examine if there are differences in 2022 clinical exam pass rates and master’s exam pass rates across ag, cdp, and combined ag/cdp programs. sample and sampling procedures the study sample consisted of 57 cswe accredited msw programs with an ag area of specialization, 52 msw programs with a cdp area of specialization, and nine programs that have both ag and cdp (ag/cdp) specializations. there were 332 total accredited msw programs as of may 2024 in cswe’s directory of accredited programs (cswe, 2024b), which is when the data were collected. we filtered the list of 332 programs to include only those that identified as having an ag and/or cdp area of specialization. one hundred thirty-six (136) programs identified as ag, 109 programs identified as cdp, and nine programs identified as having an ag/cdp area of specialization. many programs identified other areas of specialization in addition to ag and/or cdp; however, we included the programs that identified ag or cdp as at least one of its specializations. results of the search returned 254 programs specializing in ag, cdp, or ag/cdp. to obtain a random sample, we divided the 254 programs into three lists by program type in excel. for each list, programs were listed alphabetically by university name as they appeared in the cswe directory (cswe, 2024b). a sample size calculator was used to determine the appropriate sample size needed for each type of program. using a confidence interval level of 95% and a 10% margin of error, a random sample identified 57 ag programs, 52 cdp programs, and nine ag/cdp programs, totaling 118 programs. data collection and analysis aswb (2025a) has an exam report depository on its website which contains a 2022 pass rate summary report for each social work program. each program’s report provides bachelors, master’s, clinical, and advanced generalist exam pass rates for candidates who took any of these exams at any time during 2022. for each program in our sample, we pulled the master’s and clinical first-time, repeat, and total exam pass rates from this report. data were input into spss version 29 for analysis. program type served as the independent variable and had three categories: ag, cdp, and ag/cdp, coded as 0, 1, and heckert & pence/swk specialization & exams 539 2, respectively. exam pass rate percentages (i.e., master’s first-time, master’s repeat, master’s total, clinical first-time, clinical repeat, clinical total) served as the six dependent variables. box plots showed non-normal distribution, and because there were only nine programs in the ag/cdp program type category, the assumptions needed for one-way anova were not met (kent state university, 2024; ostertagova et al., 2014). instead, we ran kruskal-wallis tests to determine if there are significant differences in master’s and clinical exam pass rates across ag, cdp, and cdp/ag programs. results results of the kruskal-wallis tests indicated no significant differences in master’s and clinical board exam pass rates across msw programs with ag, cdp, and ag/cdp specializations (an alpha level of .05 was used). see table 1. master’s exam a kruskal-wallis test indicated that there was no significant difference in master’s first-time exam pass rates across the three msw program specializations, h(2) = 3.90, p = .142. the mean rank first-time exam pass rates were 50.41% for ag programs, 62.31% for cdp programs, and 49.17% for ag/cdp programs. a kruskal-wallis test indicated that there was no significant difference in master’s repeat exam pass rates across the three program specializations, h(2) = 2.03, p = .363. the mean rank repeat exam pass rates were 48.33% for ag programs, 52.84% for cdp programs, and 37.88% for ag/cdp programs. a kruskal-wallis test indicated that there was no significant difference in master’s total exam pass rates across the three program specializations, h(2) = 2.67, p = .264. the mean rank total exam pass rates were 52.05% for ag programs, 61.54% for cdp programs, and 49.11% for ag/cdp programs. table 1. kruskal-wallis results and mean rank across msw program specializations master’s clinical first-time repeat total first-time repeat total kruskal-wallis (h) 3.90 2.03 2.67 3.08 1.55 2.35 df 2 2 2 2 2 2 asymp. sig .142 .363 .264 .215 .460 .309 mean rank (%) ag 50.41 48.33 52.05 47.69 52.07 48.31 cdp 62.31 52.84 61.54 57.18 44.8 56.81 ag/cdp 49.17 37.88 49.11 62.29 47 60.36 note. ag = advanced generalist, cdp = clinical direct practice, ag/cdp = combined advanced generalist and clinical direct practice clinical exam a kruskal-wallis test indicated that there was no significant difference in clinical firsttime exam pass rates across the three msw program specializations, h(2) = 3.08, p = .215. advances in social work, summer 2025, 25(2) 540 the mean rank first-time exam pass rates were 47.69% for ag programs, 57.18% for cdp programs, and 62.29% for ag/cdp programs. a kruskal-wallis test indicated that there was no significant difference in clinical repeat exam pass rates across the three program specializations, h(2) = 1.55, p = .460. the mean rank repeat exam pass rates were 52.07% for ag programs, 44.8% for cdp programs, and 47% for ag/cdp programs. a kruskal-wallis test indicated that there was no significant difference in clinical total exam pass rates across the three program specializations, h(2) = 2.35, p = .309. the mean rank total exam pass rates were 48.31% for ag programs, 56.81% for cdp programs, and 60.36% for ag/cdp programs. discussion information on if and how master’s level social work program specialization impacts board exam pass rates, and ultimately professional licensure, is absent from the literature. the results of our study add preliminary knowledge to help begin to close this gap. our findings indicate that program specialization, at least those of an advanced generalist or clinical specialization, has no significant effect on master’s and clinical aswb exam pass rates. these findings add support to how test-takers using apgar’s exam prep guides are advised to approach the master’s and clinical exams. in her guides, apgar (2015, 2024) advises test-takers to approach the exam without consideration for their specific role and setting. rather, she recommends answering the questions as ‘“any social worker” would. for example, if a test-taker pursued a school social work practice specialization during their msw program, they should not think like a school social worker, but as a social worker practicing in any setting regardless of function. additionally, our findings underpin the debate regarding the absence of a linkage between social work program accreditation and exam pass rates (apgar, 2022a; apgar & luquet, 2023; morrow, 2023). our findings suggest that prospective students should give broader consideration when choosing an msw program, rather than placing too much emphasis on exam preparation. for example, students may select a clinical program believing it will increase their chances of passing the clinical exam, only to find that it does not. students can evaluate programs based on other factors that are important to them, such as geographic location, program cost, faculty demographics, and student resources that support the diverse needs of students; this may encourage students to choose a program that best fits their overall needs. this certainly is a warranted consideration, as cost is the top enrollment factor among prospective graduate students in general (bryant, 2024), and geographic location was identified by bowie et al. (2005) as the top enrollment factor among african american msw students. however, ultimately, we support a way forward that prioritizes a social work educational experience that balances competent, ethical practice and exam preparation with other student considerations, such as cost and location. a traditional pathway to licensure involves numerous key stakeholders, which further complicates the process and ability to address the “root of the problem.” key stakeholders on this topic include cswe, aswb, nasw, state governments, and social work programs. heckert & pence/swk specialization & exams 541 with each bearing a critical role in the licensure process, the degree to which these parties engage in active and intentional collaboration is paramount to effectively resolving barriers to the profession. although apgar (2021) notes that some of these stakeholders “have worked hard to carefully respect and not intrude on each other’s unique missions” (p. 519), the systematic breadth of this issue requires substantial partnership and joint efforts. one important consideration that stems from our study is to what extent the complexity of social work education (i.e., multiple specializations and tracks within these specializations, specifically at the master’s level) is necessary. our findings suggest that specializations might not be sufficiently relevant at the master’s level when considering how they impact exam pass rates. however, it is worth noting that, with the re-emergence of the practice doctorate in social work (dsw), specializations may serve another purpose in education and the practice continuum. when aswb and cswe begin to work more collaboratively and with greater intention, alignment between curriculum, competencies, and exam preparation will likely affect program specialties. for instance, will clinical practice and clinical licensure remain the status quo? can a fresh, and highly deserved, perspective on micro-to-macro practice be revitalized, more formally confronting this divide? if aswb and cswe collaboratively, alongside clinical practice and licensure processes, promote and prioritize advanced generalist practice and licensure, it could strengthen professional outcomes (e.g., exam pass rates, job role, pay, career prestige) for social workers primarily practicing in macro settings. this specifically has the potential to support black and african american social workers, as they more often choose macro-oriented practice settings over their counterparts (apgar, 2020). as a next step in addressing licensure disparities, we call upon aswb and cswe to fund more research opportunities to strengthen the profession’s understanding of best strategies to improve exam pass rates. one such opportunity may be to experiment with integrating exam and licensure preparation materials into social work curricula. this will assist in cross-system collaboration and joint efforts to more wholly fuse the four components of licensure so that each one builds upon and within the other. implications for social work one primary distinction between state licensure requirements is the timeline by which exams are taken. for instance, some states require examination following degree conferral but prior to engaging in practice (e.g., colorado), while others do not allow examination until all practice experience is completed (e.g., washington state). the impact of this warrants consideration when discussing pathways to licensure and aswb exam pass rates by program, as this may impose a greater expectation for social work education than it does for practice experience and supervision, unintentionally creating a hierarchy of what effectively prepares social workers for professional success. current discourse primarily focuses on master’s level licensure and examination. with bachelor’s-level and associate-level licensure grossly inconsistent across states, scholarship is warranted to further evaluate the role of examination on these respective advances in social work, summer 2025, 25(2) 542 credentials. this includes the role of the associate exam, as it is intended for non-social workers (aswb, 2017), and cswe does not accredit non-social work degree programs. this raises uncertainty as to the relevance of the associate exam and benefits of aswb investing resources into its development and administration. divesting in the associate exam may offer aswb additional opportunity and resources to focus more on addressing issues of equity pertaining to the other exams and working with cswe to address education-to-examination pathways. as demonstrated in our study, the overall lack of data on advanced generalist exam pass rates by program raises concern for this exam’s usefulness in evaluating social worker competence and preparation for licensed practice. this is further compounded by concerns such as morrow (2023) reports, that the pass rate for the advanced generalist exam is relatively low compared to the other exams; this is attributed, in part, to the exam not being solely reflective of macro practice. in a conversation that already lacks certainty around how to best prepare social workers for licensure, the use of three different graduate-level exams with similar formatting and delivery methods may no longer be warranted. similar to the associate exam, aswb may benefit from eliminating the advanced generalist exam, acknowledging that the master’s exam may be more reflective of one component of competence in advanced generalist practice. streamlining the exams offered may, in turn, offer social work programs, practice settings, and supervisors an opportunity to be more intentional in preparing social workers for success in passing any necessary board examination. recent initiatives to develop a licensure compact introduce additional areas of inquiry. for instance, apgar (2022b) states that proponents of interstate licensing identify completion of requisite examination as one of four criteria when considering who may be approved for compact participation. thus, the development of a compact may be hindered if exam disparities are not resolved. with education serving as the preliminary step in the licensure process, resolution to exam disparities begins there. limitations this study focuses on ag and cdp programs—the two largest categories of specialization. however, cswe identifies 28 different areas of specialized practice. social workers may not identify which graduate program they completed when taking the exam, preventing their pass status from being included in the respective program’s data. at least one program sampled was not able to be located through aswb resources, leading to its exclusion. additionally, some programs have missing data or small numbers of graduates who completed specific exams. within its directory, cswe uses the term “clinical and direct practice” to describe one area of specialized practice; however, it is unclear the degree to which these are perceived as different categories. lastly, programs self-identify their specializations during the initial accreditation and reaffirmation processes. thus, if a program changes its curricular focus between reaffirmations, updates to specialization may not be immediately reflected in the cswe directory. heckert & pence/swk specialization & exams 543 conclusion professional licensure is a controversial topic, more so in the field of social work than in its allied professions. the complexity of licensing warrants investigation of all components—education, practice, supervision, and examination. finding no significant difference in how advanced generalist and clinical education supports social workers in passing board exams, this study suggests that streamlining an alignment between social work programs and aswb exams offers one path forward in preparing social workers for success. references albright, d. l., & thyer, b. a. 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(2016). abuses and mysteries at the association of social work boards. research on social work practice, 26(2), 225-231. author note: address correspondence to christopher j. heckert, school of social work, eastern washington university, 915 n. broadway, everett, wa 98201. email: checkert@ewu.edu christopher j. heckert https://orcid.org/0000-0001-9159-2096 erica k. pence https://orcid.org/0000-0003-2279-8984 https://doi.org/10.1007/s10615-009-0253-x https://doi.org/10.1007/s10615-009-0253-x https://socialworkonline.widener.edu/msw/resource/choosing-the-right-msw-program https://doi.org/10.1177/1049731515574346 mailto:checkert@ewu.edu _________ kristin funk, lcsw, lcac is a doctoral student at the indiana university school of social work, indianapolis, in. copyright © 2021 authors, vol. 21 no. 1 (spring 2021), 45-58, doi: 10.18060/24844 this work is licensed under a creative commons attribution 4.0 international license. the last mile: covid-19, telehealth, and broadband disparities in rural indiana kristin funk abstract: this critical review of literature evaluates the impact of covid-19 on health and mental health care delivery in rural indiana, specifically the move to increased telehealth services. telehealth has been a mostly positive experience for patients and providers. however, many indiana residents are without the option of telehealth due to underdeveloped infrastructure that is necessary to support broadband access. this disparity is evidence of a larger social and health justice issue and illuminates a call to action for social workers on all levels to collaborate with community members, government agencies, and local programs to push the issue towards the public health arena and to promote broadband access as a human right. keywords: covid-19; telehealth; broadband; access; rural; indiana; infrastructure; disparities people living in rural america often lack accessible health and mental health care (centers for disease control and prevention [cdc], 2017a; probst, 2020). specialty care is over 60 miles away for more than half of rural patients (morgan, 2020). facilities that do exist in rural areas are frequently underfunded and understaffed (indiana state rural health plan [isrhp], 2012; morgan, 2020). the covid-19 pandemic has been calling attention to the question of access to healthcare and mental health services, both for mitigation concerns, and especially for protecting higher-risk patients. indiana has made a rapid and strong mobilized effort to address these concerns, with telehealth being the predominant response (cohen & monte, 2020). however, due to the lack of access to reliable, affordable, and fast enough internet, rural patients have not been receiving all of the intended benefits of telehealth. this exposes rural patients to concerning situations such as not having adequate access to care due to some providers going fully virtual during the pandemic, or having to potentially risk their health by needing to find a face-to-face care provider. telehealth is illuminating a lack of equitable internet access and infrastructure in rural areas, which needs to be addressed as a social and health justice issue. the current national ratio for mental health providers to residents is 30 psychologists per 100,000 residents and 15.6 psychiatrists per 100,000 residents (good therapy, 2020). in rural areas, this average drops to 9.1 psychologists (resnick, 2020) and 3.4 psychiatrists (good therapy, 2020). the state of indiana is experiencing rural healthcare discrepancies. to put indiana in perspective, 72 out of 92 counties in the state are rural and 34% of the population live in these counties (prior, 2014). additionally, the isrhp (2012) reported “26 rural counties in indiana are partially or completely medically underserved or have shortages of health professionals” (p. 9). indiana is medically underserved in general, as the physician-to-patient ratio is 66.9 physicians per 100,000 residents for the entire state, which is less than the national average of 75 per 100,000 residents (federal communications commission [fcc], 2017). most of the physicians in the state are about:blank advances in social work, spring 2021, 21(1) 46 concentrated in larger, metropolitan areas (isrhp, 2012), leaving a large gap in care for rural patients. method this research was conducted primarily from august to december, 2020. ebsco databases were used and searches included the terms “rural,” “telehealth,” “covid-19,” and “indiana.” the rural health information hub database (2021) was also used and included searches through the database state guide for indiana and by topic under “rural response to covid-19” and “telehealth.” due to the emerging nature of the topics in this paper, grey literature was also reviewed. the grey literature included federal and state government websites, community organization websites, and webinars and trainings for communities and practitioners. the rise of telehealth in indiana telehealth is defined by the center for connected health policy (cchp) as "a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies” (cchp, 2018, para. 1). the center expands this definition further by stating, “while ‘telemedicine’ has been more commonly used in the past, ‘telehealth’ is a more universal term for the current broad array of applications in the field. its use crosses most health service disciplines, including dentistry, counseling, physical therapy, and home health, and many other domains” (para. 2). the state of indiana defines telehealth as “the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across a distance” (upper midwest telehealth resource center [umtrc], 2020, p. 1). the governor of indiana, eric holcomb, declared a public health emergency on march 6, 2020, after the first official covid-19 diagnosis in the state. he also mandated stay-athome orders on march 24. by april 3, the national association of social workers’ indiana chapter (nasw-in) had already put together a comprehensive webinar training on how social workers and healthcare providers could respond to these situations with the expedited legislative changes that had been made in the state (cohen & monte, 2020). this mobilization demonstrated the ability of advocates to be informed about the changes and to get the information out to providers and communities quickly. some of the legislative changes include the indiana family and social services administration (fssa) suspending the requirement for services being delivered face-to-face and allowing for the “increased use of telehealth for statewide services such as medicaid-covered services, mental health services, and substance use disorder treatment and prescribing” (cohen & monte, 2020, slide 10). another major change relates to professional licensure of providers. the public health emergency provisions for indiana include the state’s professional licensing agency suspending requirements for healthcare practitioners to have indiana state licensure. practitioners may provide services to indiana residents, as long as the practitioners are licensed and in good standing in another state (cohen & monte, 2020). funk/last mile 47 additionally, indiana code 27-13-7-22 requires telehealth parity from insurance providers. this means telehealth services are to be reimbursed at the same rate as face-toface services (cohen & monte, 2020). when originally written, indiana telehealth law did not include telephone services. this element was overruled by state emergency covid19 legislation. verbal (not text or email) telephone communication with patients is now a temporarily covered service that is reimbursed at a reduced rate by insurance (indiana health coverage program [ihcp], 2020; umtrc, 2020). however, phone-only services are limited in providing context for the patient and provider, including body language and other cues, as well as the human connection that video services attempt to create (kennedy et al., 2020). these legislative changes are meant to reduce, if not eliminate, barriers for practitioners to conduct telehealth services regardless of location or patients’ insurance provider. common telehealth approaches during covid-19 have been using internet video platforms (e.g., webex and doxy) to conduct assessments, counseling and physician appointments, covid-19 symptom evaluation, and other telehealth services. other platforms that are more familiar to people who are already using the internet, such as zoom, facetime, and skype, have also been used. these platforms were previously prohibited for telehealth use due to confidentiality concerns. they have been temporarily allowed as part of the covid-19 response, as long as providers put forth a good faith effort to maintain confidentiality (fishpaw & zawada, 2020). “good faith effort” in this case indicates providers must inform patients of potential privacy risks, must use privacy modes and encryption settings, and must use non-public facing platforms (i.e., those that cannot be publicly broadcast; us department of health and human services [usdhhs], 2020b). funding telehealth in the pandemic and beyond the rise in telehealth services, and the pandemic response in general, has not been without financial burden on healthcare providers and facilities. to address this, the federal government passed some of the fastest relief legislation in history, with only two months from appropriation to money being awarded (martinsen, 2020). for rural areas, this is being addressed on the federal level by the health resources and services administration’s federal office of rural health policy (martinsen, 2020; morgan, 2020). relief legislation includes $10 billion for rural healthcare facilities through the coronavirus aid, relief, and economic security (cares) act, the paycheck protection program, and the health care enhancement act (martinsen, 2020). at least $500 million has been designated specifically for enhancing telehealth in rural areas, including expanding infrastructure (morgan, 2020). on march 31, 2020, the fcc established a $200 million emergency covid-19 telehealth program (fcc, 2020) to “help eligible health care providers purchase telecommunications services, information services, and devices necessary to provide critical connected care services” (p. 3). the usda also allocated $125 million for rural telehealth development (morgan, 2020). other federal funding streams and programs beyond pandemic allocations address telehealth expansion. one program is project overcome, funded by the national science foundation (nsf) in october 2020. project overcome provided $1.945 million advances in social work, spring 2021, 21(1) 48 to bring broadband to underserved areas, including rural areas (us ignite, 2020). the united states agricultural department (usda) also has a rural development grant that offers “telecommunications infrastructure loans & loan guarantees funding” (usda, n.d.). the fcc offers rural broadband funding through various programs, including the rural health care program and the rural digital opportunity fund. in a joint effort, the united states department of health and human services (usdhhs), usda, and the fcc all signed a memorandum of understanding for planning a rural telehealth initiative on august 31, 2020, stating they will work together to expand broadband to rural communities (usdhhs, 2020a). in the state of indiana, programs have been created to increase broadband access in rural areas. next level connections is an infrastructure program put into place by governor holcomb. the program offers $70 million in grant funding to improve rural broadband capacity and will be overseen by the office of community and rural affairs (ocra). the program recognizes that “affordable, high-speed broadband has become a business, educational, and personal necessity” (ocra, 2020, para. 2). additionally, the indiana rural health association (irha) is currently working to expand telehealth to rural communities through the crossroads partnership for telehealth. this program partners with the richard g. lugar center for rural health and four rural hospitals in southern indiana to assist patients with access to care through telehealth services (irha, 2019). benefits of telehealth during the pandemic, telehealth services have increased in healthcare systems across the united states exponentially. some reports found increases up to 845% (jaffe et al., 2020) and even 4,300% (fishpaw & zawada, 2020). while many providers did not know what to expect with the increase in telehealth, it has actually shown great promise. as telehealth use increased, many practitioners observed a decrease in no-show rates (resnick, 2020). some practitioners reported the temporary eases in telehealth regulations made it easier to reach underserved populations (glenn, 2020). telehealth eliminated the transportation barrier for patients, which contributed to the ability to reach more people (dearinger, 2020; resnick, 2020). providers also found that patients with anxiety and depression were more likely to use telehealth services during the covid-19 pandemic (jaffe et al., 2020). this may be due to many clients feeling more comfortable getting services while staying in their own home (resnick, 2020). in indiana specifically, sklar and colleagues (2020) surveyed 93 practitioners across six community mental health centers throughout the state. the cmhcs were contracted through the indiana division of mental health and addiction to provide evidence based practices (ebps). because of the covid-19 pandemic, ebps became telehealth appointments. per the results of the surveys, providers found more willingness from clients to engage in telehealth instead of in-person appointments. the majority of providers found their organizations’ transitions to telehealth to be positive and felt confident in their ability to provide services via telehealth (sklar et al., 2020). funk/last mile 49 not only has telehealth use for previously existing services increased dramatically, but the types of services now being delivered have also expanded. in neighboring michigan, a rural hospital system has been using telehealth to provide triage, assessments, and opportunities for employees to work from home (hirko et al., 2020). this both prevented unnecessary face-to-face contact and saved the use of personal protection equipment (ppe). to the south of indiana in rural kentucky, dearinger (2020) reported local health departments were forced to reduce in-person services during covid-19. through telehealth and innovative thinking, the local health departments diversified and expanded the types of services they provided, including smoking cessation, diabetes management, and health education. the health departments were able to reach more residents with these services. several providers share the perspective that returning to the pre-pandemic/pretelehealth status quo would be unacceptable, especially because so many more people have been able to access services via telehealth during the temporary pandemic legislation (resnick, 2020). initial suggestions for how to maintain current pandemic-level telehealth services are offered by fishpaw and zawada (2020). these suggestions include a push to continue temporary pandemic legislation that has been enacted, such as cross-state licensure portability, insurance reimbursement, and good faith use of potentially nonconfidential platforms. glenn (2020) echoes concerns about the temporary nature of the regulatory changes: when temporary allowances due to covid are over and regulations are tightened, we can’t revert back to large underserved and rural populations of people not having access to the technology, the adequate internet access, or telehealth benefits through their insurance policies again. this is a prime opportunity to advocate for everyone to have equitable access to mental health care. (p. 27) equitable access is a key concept in this statement and warrants attention. broadband disparity technology and internet access have been recent topics of serious discussion for service providers. at the indiana school health network annual conference held on june 29-30, 2020, mark fairchild (2020) from covering kids and families of indiana presented updates on school health legislation. during this presentation, he used the term “broadband disparity” to discuss the lack of equal internet access for everyone. in another presentation at the same conference, rural mental health providers discussed using rural schools as sites for micro clinics and telehealth (crume & willis-gidley, 2020). as further confirmation of broadband disparity, the presenters reported having issues with internet connectivity for many of their students and families, especially outside of the schools. practitioners have also noticed issues with internet access for their patients as healthcare services transitioned from in-person to telehealth appointments during the pandemic (dearinger, 2020; glenn, 2020; hirko et al., 2020; jaffe et al., 2020; resnick, 2020; sklar et al., 2020). some mental health providers throughout rural indiana reported being unable to participate in telehealth with every client because the clients lived in rural advances in social work, spring 2021, 21(1) 50 areas without access to a stable internet connection, did not have access to internet services with enough capacity for telehealth platforms, or had no access to the internet (sklar et al., 2020). sharon cooley, an outpatient medical nurse practitioner serving patients in cass and miami counties located in rural, north central indiana, discussed the covid-19 response at her clinic and the use of telehealth services, stating: they wanted me to do telehealth from my house once a week. i had to laugh because i don’t have internet where i live! i came here to the office instead and tried to do telehealth with my patients, but most of them don’t have internet either. i ended up calling them on the phone and doing telehealth that way. (s. cooley, personal communication, september 25, 2020) in 2004, healthcare providers had already found that rural residents did not have sufficient broadband to effectively engage in telehealth services and medical professionals were advocating for better rural internet access (schopp et al., 2006). this deficit was still being observed in 2018 (o’dowd, 2018). a major reason for the deficit is the lack of broadband availability. availability is reported by the fcc, which is the united states government agency tasked with regulating broadband internet. the agency currently has interactive maps available on their website that demonstrate internet access and can break the data down into rural versus urban, and most interestingly, broadband access overlaid with health issues and physician access (fcc, 2017). according to this map, only 50.8% of residents in rural areas of indiana have access to fixed broadband service. this refers specifically to broadband speed that is at least 25/3 megabits per second (mbps), which is 25 mbps for download and 3 mbps for upload. this is considered the minimum broadband speed to support video teleconferencing (carey, 2020). the other 49.2% of rural residents in indiana might have access to weaker, slower internet, but unless they have the minimal capabilities, they will not have the necessary broadband to use streaming or video services. the fcc estimates there are just over 1,700,000 rural residents in indiana (fcc, 2017). when only roughly half of them have sufficient internet access, several hundred thousand residents are left without telehealth options. lacking access to telehealth is not the only issue with broadband disparity that rural residents are facing. hirko and colleagues (2020) noted that during the covid-19 pandemic and the physical distancing and mitigation strategies that come along with it, the massive shift to telehealth and reliance on virtual connections in these times of social isolation may have created an additional health disparity for the millions of rural americans without access to necessary broadband to deploy digital technologies…in a time of widespread social distancing, the lack of broadband access prevents individuals from connecting online with family and friends, and thus may contribute to other adverse health outcomes in rural regions. (p. 1817) the pandemic has highlighted the broadband disparity experienced by rural residents with consequences likely to continue beyond covid-19. funk/last mile 51 broadband access as a public health right although the covid-19 pandemic intensified the issue, broadband disparity has been on the radar of global leaders for years. in 2016 “the united nations general assembly declared access to the internet a basic human right” (sanders & scanlon, 2021, p. 1). the concept of internet access being a right has been the topic of some research discussions (bauerly et al., 2019), but there are significant barriers to actualizing universal broadband access in the us. if internet access does become a right, it could be costly to bring improved broadband to rural areas. the material needed for it, fiber optic cable, “is fast and pretty much limitless in capacity, but it is also expensive to install — especially in the last mile, the final bit of connection to a business or home” (stewart, 2020, para. 11). in rural areas that are geographically spread out, there are often miles between homes and buildings — much of the space between rural buildings and homes is that “last mile.” the majority of broadband infrastructure is left to the private sector, which has often considered it unprofitable to connect broadband to rural areas (duffy & tappe, 2020; hovis et al., 2020). while this could change with the plans president biden has suggested for bolstering infrastructure (the white house, 2021), privatized broadband currently can leave out homes that corporations find to be too expensive to connect (duffy & tappe, 2020; hovis et al., 2020), furthering rural disparities. pandemic mitigation includes reduced face-to-face contact. this has consisted of using telehealth for health and mental health services more than before, as well as working from home, attending school through virtual and hybrid lessons, and purchasing goods online. rural residents cannot benefit from these options if they do not have access to strong enough broadband connections. this reduces their ability to engage in mitigation practices and unjustly puts them at higher risk during a pandemic. with government legislation, providers and patients who do have adequate internet access are all rallying around the services offered by telehealth. telehealth is obviously significant and helpful. lacking infrastructure should not have to be a reason rural residents cannot access such services. in the 21st century digital world, both information and many vital services such as telehealth are now online. adequate access to the internet has become critical. equitable access is not only a timely public health issue, but also the “civil rights issue of the 21st century” according to the late congressman john lewis (sallet, 2020; washington post live, 2020). implications for social workers social workers are integral to addressing civil rights issues. championing internet access as a civil rights issue is no exception. the national association of social workers (nasw) and association for social work boards (aswb) released a standards for technology and social work practice guide dating back to 2005 (nasw & aswb, 2005). including standards for access (standard 2) and community practice (standard 9-2), this publication addressed both the digital divide and the call to action for social workers to advocate on behalf of “all members of the community” (nasw & aswb, 2005, community practice section) to have equitable access to technology. nasw and aswb updated these standards in 2017, featuring more organizations and technological advances in social work, spring 2021, 21(1) 52 advancements (nasw et al., 2017). this update addressed equitable access in standard 2.21, access to technology, stating: “advocating for access to electronic services is part of social workers’ commitment to social justice” (nasw et al., 2017, p. 26). these publications are just one indication that social work as a profession is and has been committed to promoting broadband equity. although the impact of covid-19 on internet access for healthcare is still being assessed, it is imperative to not simply wait for all the research to be collected and analyzed before taking action. the data already indicates this is a critical time to drive local, state, and federal policy to place importance on developing infrastructure and improving broadband access for rural communities. existing programs and current funding streams lay some groundwork to bridge the digital divide found in rural broadband access. this work needs a push to move it further into the realm of public health and even into public utilities, as broadband access is becoming as essential to modern life as other public services. government officials often make policies and programs from where they are positioned, which is not always directly involved in the situations their legislation impacts. they need input from communities and help from grassroots organizations in those communities to deploy rural broadband improvement ideas. this is a situation ideally suited for social workers, especially those in macro and policy work who can come alongside their mezzo and community-based colleagues as well as their micro and practitioner colleagues to forge real change. social workers can join government agencies, non-profits, community organizations, and service providers to address broadband disparity as a significant social and health justice issue. for example, macro-level social workers involved in policy can work with legislators to identify and eliminate laws that potentially inhibit rural broadband growth (e.g., internet services being predominantly in the private sector). social workers can promote sound and just policies that include community collaboration to build infrastructure. at least one county in indiana is already doing this. through their rural electric membership cooperative (remc), jasper county is working to increase broadband infrastructure and is doing so as a non-profit agency (pete, 2020). this is an emerging issue that warrants further exploration, especially for social work involvement. macro-level social workers also have a prime opportunity to advocate for making temporary pandemic telehealth legislature more permanent, as researchers have advised (fishpaw & zawada, 2020; glenn, 2020). mezzo-level social workers can use their community-based organization skills to collaborate with broadband expansion program administrators and the communities these programs serve. one example of this is the regional telehealth resource center program, overseen by the us health resources and services administration (hrsa). this program is designed to provide federal and regional support to rural communities regarding telehealth implementation (usdhhs, 2020c). mezzo-level social workers are an excellent resource for this type of project, as their training and experience help them bridge potential gaps in communication, education, and action between government and communities. social workers can advocate for equitable internet access by identifying and joining such funk/last mile 53 projects. clinical social workers and others who are in micro-level social work practitioner roles are the ones on the ground who intimately know what is happening with clients and telehealth. by providing direct services, these practitioners know what is working and what is not. unfortunately, it is the experience of some clinical social workers that they are left out of conversations regarding policies and programs that affect their clients. amanda mckinley, a licensed clinical social worker (lcsw) serving in east central indiana, reported: social work practitioners are often hidden and unseen. we show up, do our job, and make a difference. policies often stifle our ability to help people. the temporary pandemic legislation made telehealth easier, and my patients have not only liked it, but have needed it. this is a golden opportunity to advocate for permanent policy changes that allow us to help our patients. (a. mckinley, personal communication, december 11, 2020) mckinley also stated macro, mezzo, and micro social workers need to work together to advocate for such changes, but that she has not been approached by any macroor mezzolevel social workers, and would not know who to connect with to start such conversations. this is a considerable lapse in intra-professional communication that social workers can remedy. it is important for social workers on all levels to work together. macro and policy level social workers can do more to actively seek out and collaborate with their community-based and practitioner counterparts to determine how to best support communities, clinicians, and clients. cooperation of this kind could be especially helpful to address broadband disparity in light of covid-19. conclusion rural health disparities are nothing new. over the past few years, several studies have revealed that residents in rural areas of the united states tend to be sicker, older, poorer, less educated, and have less access to healthcare than their urban counterparts (cdc, 2017a, 2020; dearinger, 2020; fairchild et al., 2020; hirko et al., 2020). in fact, the cdc reported in 2017 that rural residents die more often from leading causes of death (cdc, 2017b). these findings were all pre-pandemic. many of the reasons for the disparities include lack of infrastructure, such as transportation and nearby facilities (cdc, 2020; morgan, 2020). covid-19 is a major event that is illuminating these issues, especially the disparities in internet access. as covid-19 has taught us, telehealth has been a robust answer to providing outpatient medical and mental health care in underserved rural areas; however, telehealth can only be as robust as infrastructure and access allow it to be. while this research focused mainly on indiana, the issue of broadband disparity is certainly not exclusive to just one state. these examples of social work involvement could be applied to various states and, in some cases, on the federal level as well. the national quality forum (nqf; 2020) started a rural telehealth and healthcare system readiness committee that is scheduled to meet throughout 2021. this committee indicated it will seek input from community members and service providers, including social workers (nqf, 2020). with advances in social work, spring 2021, 21(1) 54 input and collaboration from social workers on all levels, perhaps the committee will determine that it is worth the necessary funding to publicly expand infrastructure into the last miles of the old dirt roads in rural america. this could allow rural communities to have internet access as a public utility – and a modern human right. references bauerly, b. c., mccord, r. f., hulkower, r., & pepin, d. 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(2020, september 30). rep. donna shalala says rep. john lewis called internet access a civil rights issue. https://www.washingtonpost.com/video/washingtonpost-live/wplive/rep-donnashalala-says-rep-john-lewis-called-internet-access-a-civilrightsissue/2020/09/30/30f8dbb2-a97f-424e-880e-b27f23554df6_video.html author note: address correspondence to kristin funk, iu school of social work, indianapolis, in, 46202. email: krisfunk@iu.edu https://www.umtrc.org/clientuploads/reimbursement/umtrc_in_reimbursement_0612020.pdf https://www.umtrc.org/clientuploads/reimbursement/umtrc_in_reimbursement_0612020.pdf https://www.prnewswire.com/news-releases/us-ignite-launches-project-overcome-funded-by-the-national-science-foundation-to-accelerate-novel-broadband-deployments-in-underserved-communities-301145289.html https://www.prnewswire.com/news-releases/us-ignite-launches-project-overcome-funded-by-the-national-science-foundation-to-accelerate-novel-broadband-deployments-in-underserved-communities-301145289.html https://www.prnewswire.com/news-releases/us-ignite-launches-project-overcome-funded-by-the-national-science-foundation-to-accelerate-novel-broadband-deployments-in-underserved-communities-301145289.html https://www.washingtonpost.com/video/washington-%20post-live/wplive/rep-donna-shalala-says-rep-john-lewis-called-internet-access-a-civil-%20rights-issue/2020/09/30/30f8dbb2-a97f-424e-880e-b27f23554df6_video.html https://www.washingtonpost.com/video/washington-%20post-live/wplive/rep-donna-shalala-says-rep-john-lewis-called-internet-access-a-civil-%20rights-issue/2020/09/30/30f8dbb2-a97f-424e-880e-b27f23554df6_video.html https://www.washingtonpost.com/video/washington-%20post-live/wplive/rep-donna-shalala-says-rep-john-lewis-called-internet-access-a-civil-%20rights-issue/2020/09/30/30f8dbb2-a97f-424e-880e-b27f23554df6_video.html mailto:krisfunk@iu.edu _________ susan glassburn, phd, lcsw, associate professor, school of social work, indiana university, indianapolis, in. joellen henson, dhsc, msw, lsw, m.s.ed., assistant professor and field director, college of health and human sciences, indiana state university, terre haute, in. robin miller, msw, lcsw, acsw, clinical assistant professor and director of practicum education, and pamela saylor, msw, lcsw, clinical assistant professor, department of behavioral sciences, purdue university northwest, hammond, in. shannon staton, msw, lsw, associate professor of practice and director of field education, department of social work, ball state university, muncie, in. matthew a. walsh, phd, msw, lsw, assistant professor, department of applied social sciences, marian university, indianapolis, in. summer wilderman, dsw, lcsw, msw, assistant professor, department of social work, university of southern indiana, evansville, in. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 702-720, doi: 10.18060/28618 this work is licensed under a creative commons attribution 4.0 international license. it means everything…and it means nothing: new social worker views on taking the master’s licensure exam susan glassburn joellen henson robin miller pamela saylor shannon staton matthew a. walsh summer wilderman abstract: in order to call oneself a social worker in the united states, an individual must not only complete the required coursework and degree program, but also, in many states, pass a licensure exam. recent discussion has centered around the efficacy of using an examination as a regulatory tool for licensure, particularly following the association of social work board’s (aswb) report identifying bias with the licensure exam itself, and indicating specific demographic characteristics including race, age, and english as a second language, as having an impact on the pass rate of test-takers (aswb, 2022). this qualitative study specifically highlighted the experiences of 22 participants with an msw degree who were preparing for or had taken the licensure exam. five themes emerged through an analysis of the data: meaning everything and nothing, hoops and barriers, emotional responses, learning the tricks, and setting aside practice wisdom. this study reflects the ambivalence of new social workers toward the licensing exam and the disconnect between education and practice in what the test is actually measuring. recommendations and implications for social work educators include advocating for a reevaluation of social work licensure exams as proof of competence. keywords: licensure exam, qualitative, new social workers in order to call oneself a social worker in the united states, certain criteria must be met, including the completion of a higher education degree program, demonstration of practice skills and competencies, and in some states, the ability to pass a licensure exam and pay the associated examination fees (torres et al., 2024). recent discussion has centered around the efficacy of using the association of social work board (aswb) examination as a regulatory tool for social work licensure (torres et al., 2024; ricciardelli et al., 2024). in 2022, the aswb released a report identifying bias with the licensure exam itself, and indicating specific demographic characteristics including race, age, and english as a second language, as having an impact on the pass rate of test-takers (kim & joo, 2024b). in a profession which values diversity, equity, and inclusion, and is founded on the about:blank glassburn et al./it means everything & nothing 703 principle of social justice, the concern can be raised that the examination required for social work licensure may have a negative impact on the overall diversity of the profession. this in turn impacts the services provided to social work clients, many of whom are identified as being society’s most vulnerable members. the primary function of social work licensure is to protect the public as well as provide a measure of safety in terms of the delivery of competent and ethical social work services (aswb, 2025a). additionally, the social work licensure examination tests an individual social worker’s competence in terms of ethical and safe practice (aswb 2025a). torres et al. (2024) in a large master’s level licensure study identified that participants felt the exam was developed for white-identifying test takers with a primary language of english. torres et al. (2024) noted that “several bipoc [black, indigenous, and people of color] participants reported being told to ‘think like a white person’ when taking the exam” (p. 191). furthermore, participants identified experiencing a disconnect between exam content/correct answers and actual social work practice, particularly practice taking place in communities with diverse population groups or immigrant communities (torres et al., 2024). licensure exams are not unique to the profession of social work, and similar examinations serve as a “prerequisite to practice” in many other professions, including education, medicine, nursing, and law (nienow et al., 2023, p. 76). the significance of licensure exams as an indicator of professional social work competency has been endorsed by the council on social work education (cswe), the aswb, and the national association of social workers (nasw; apgar, 2022). however, if the profession’s regulatory system, namely the social work licensure exam, is found to be biased, having disparities in pass rates (kim & joo, 2024b), this questions the validity of the exam. concerns are raised, not only about the individual experience of taking the examination, but also the subsequent impact on the profession as a whole (joseph, 2024). at the time of this writing, there were 11 states not requiring master of social work (msw) graduates to take an exam to obtain a master’s level license, with several others considering removing their exam requirement as well. state licensure fees also vary greatly according to the aswb, ranging from $0 – $375. a total of three states had no fee but four states charged over $300; over half the states had a fee over $100 (aswb, 2025b). in a comprehensive literature search, only three studies were found that privileged the voices of those contemplating taking a social work licensure exam. miller et al. (2015) surveyed undergraduate students about their perceptions about licensure. using a survey with some open-ended questions, they found that these undergraduate students were planning on taking the exam and felt confident in their ability to pass, but at the same time were unsure about the exam requirements and process for application. walker and bruhn (2024) interviewed 20 african american social workers with an msw who were interested in obtaining or had obtained licensure at the clinical level. they found that many of the participants felt disadvantaged due to their race when taking the test. participants also encountered challenges in preparing for the test including a lack of financial resources and the extensive time demands required for studying. broader concerns were voiced as to difficulty finding supervision for clinical licensure, the time gap between msw completion advances in social work, summer 2025, 25(2) 704 and licensure, and a lack of information about the scope and procedures for obtaining licensure. as referenced above, torres and colleagues (2024) surveyed 1,481 social workers and students who had taken the master’s level licensure exam at least once, with participants evidencing disproportionate pass rates. researchers analyzed open-ended survey questions using grounded theory, finding that participants cited challenges that included financial and time limitations, emotional distress from knowing the test is biased, past negative standardized test-testing experiences, english as a second language, and experiencing the questions as confusing (torres et al., 2024). gaps in the literature and purpose of this article only two studies to date have explored the voices of those sitting for a social work licensure exam, with only one focusing on the initial master's level licensure exam. this study seeks to further explore the lived experiences of those taking the master's licensure exam. this qualitative study uses reflexive thematic analysis to explore and understand the feelings and perspectives of 22 msw graduates preparing for and/or taking the exam. methods research team and positionality all authors are social work faculty teaching at six different universities in indiana. six of the seven authors are female, one author is male, and one of the females is a person of color. ages of the authors ranged from 39 to 69. four of the authors have taken the initial master’s level licensure exam, three have taken the lcsw, two took the acsw and one was grandfathered into licensure. this research grew out of the author’s collective concern of being unsure about how to best prepare social work our students for the licensure exam, especially in light of the release of the aswb report showing widespread disproportionality in passing rates for multiple groups (kim & joo, 2024b). the authors also felt a qualitative approach would shed more light on the actual experience of taking the exam and could inform our mentoring and support of students. prior to and during the coding process the research team spent time reflexively discussing their own experiences with the licensure process, the experiences of their students, as well as reflecting upon how those experiences have given the research team their own unique perspectives. method and data analysis qualitative research is the methodology of choice for issues in which not much is known. this study used reflexive thematic analysis (braun & clark, 2022) to analyze the data. reflexive thematic analysis (rta) focuses on the reflexivity of the researcher as they work to understand and question the data, holding their hypotheses lightly. rta uses a six-step process to examine the data: 1) familiarizing oneself with the dataset, 2) coding, 3) generating initial themes, 4) developing and reviewing themes, 5) refining, defining, and naming themes, and 6) writing up. for this study, the research team each read the results from multiple interviews to familiarize themselves with the data. each glassburn et al./it means everything & nothing 705 researcher then coded the same participant interview, and then met to discuss the codes and what stood out to each researcher. the research team began to make lists of preliminary themes for this single interview. each member of the team then read multiple interviews, coded three to five individually, and collaborated on themes across interviews. the research team read and re-read data, agreeing upon five overarching themes. to ensure trustworthiness and resonance of the findings, one researcher met with a small group of participants and discussed preliminary themes. participants all agreed that study themes reflected their thoughts and feelings about the exam experience, in particular the article title. participant recruitment and data collection methods participants were recruited via social work alumni lists, prior academic connection with the interviewers, and a post-msw support group. irb approval was received from three midwestern universities and those researchers completed all the interviews, but the entire research team was involved in data analysis. participants were recruited who were preparing for the exam, who had already taken the exam, and six were interviewed both before and after they took the exam. while researchers tried to interview participants pre/post, many participants were giving themselves an extended timeline for exam prep. interviews were conducted virtually, and all interviews were recorded, transcribed by the researchers, and de-identified before sharing with the other members of the research team. participants were offered a $10 amazon gift card per interview. two semi-structured interview guides were used for participants, one before and one after they took the exam (appendix). sample demographics there were a total of 22 participants in the study representing four universities. nine participants had taken the licensure exam and 13 had not yet taken it but were actively preparing. six participants were interviewed both before and after taking the exam. the average age for participants was 31, with the range from 22 to 57 years of age. there were 19 participants identifying as white (86%), two identified as african american (9%), and one that preferred not to say (5%). for gender, there were 18 females (82%), one male, one trans male, one nonbinary person, and one that did not specify. the majority of participants attended msw level courses in a hybrid format, defined as at least some courses offered partially online, while three students completed a totally online program. ten of the participants had a bachelor of social work degree (43%). participants were asked about the time and money involved in test preparation, not including the costs of the test itself. the average amount spent was $130, with a few spending as high as $500. the estimated hours spent preparing for the test ranged widely, with the average being 93 hours at the time of the survey. while preparing to take the test, 88% had a full-time job, and 43% were providing care for a child under the age of 18. advances in social work, summer 2025, 25(2) 706 findings five themes emerged through the analysis of the data: it means everything and nothing, hoops and barriers, emotional responses to the process, learning the tricks, and setting aside practice wisdom (see figure 1). participants were assigned unique initials to protect their confidentiality. figure 1. themes and subthemes theme 1: it means everything… and it means nothing when asking participants what it means to them to be licensed, the research team received opposing views. there was a polarity between the test not holding meaning yet also providing a sense of legitimacy and validation. some stated passing the licensure exam makes you “legit” and confirms your skills, giving “a level of validity” (im), while others felt having new letters behind your name does not make a statement about your abilities as a social worker. a young, white female who had yet to take the exam said, “i want to be a better social worker, but in practicality i don't know if passing a test makes me a better social worker” (pd). it means everything participants that felt licensure is important often experienced a strong emotional response at passing the test with some being moved to tears at their passing score, “i was about to cry right there, because i didn't believe it” (im). these feelings of relief and legitimacy have also been supported by others, sharing that being licensed “gives me that security that i know the knowledge” (ec). perception from others weighed heavily on the participants as well, expressing concern over how others might perceive them. te even theme 1: •it means everything… & it means nothing •it means everything •it means nothing theme 2: •challenges: so many hoops & barriers •registration •preparedness •financial concerns •accommodations •confidence in the exam itself theme 3: •all the feels….stress, shame, anger, & anxiety: •emotional responses to the testing process theme 4: •learning the tricks of the test theme 5: •setting aside practice wisdom glassburn et al./it means everything & nothing 707 went as far as stating that “my parents don’t know when i’m taking it” precisely for that reason. im stated that “everything i learned was for nothing if i can't pass because it gives us respect as a profession and it means you've hit a standard and have proven that.” being licensed has provided job security for some, “it's important to me, because i have to get it, and i need it for jobs” (ga), while opening doors for others, “growth within my career is what that means to me. the world is your oyster in social work when you have your lcsw and the pay is better too” (te). not passing comes with the steep consequence of not being able to perform at your full capacity and having to remain working at a bachelor's level (bd). even major life decisions, such as where to live, are affected. there is variability that different states have with some requiring the exam while others do not. i have to make a grown adult decision about where i want to live, based on where i'm licensed, asking myself questions like “can i get licensed here and then move and then keep my supervision to work towards the lcsw? does it not work?” because i want to move somewhere else. that's been an obstacle for me. (pd) overall, many participants agreed that even if the test has issues it is meaningful. they know, understand, and accept that becoming licensed is “like you're just playing to the system to just get ahead and kind of hit that work and your dream job or whatever you desire to be” (we). they do not always agree with the rules of the system, but also feel proud after passing. “i think that we should have a standard to adhere to, and i mean, the test has its own issues. but, i think that there needs to be some sort of standard. so i'm happy that it does exist” (tm). it means nothing participants questioned if passing the exam and obtaining a license is a true measure of your social work skills or just a person’s test-taking savvy. “some people say the test doesn't really actually measure your competence in the field, you just have to learn how to take the test” (mw). “i thought it would feel like a bigger deal. but i'm no different than i was. i'm not going to do anything different in my practice than i did a minute ago when i didn't have my license” (te). “i think that sometimes people put so much emphasis on the test, where there’s a sense of if you don't pass it, you don't know how to be a social worker, and that's definitely not the case” (ec). passing the exam has also lost some meaning because it is no longer required in all states. “honestly, i don't really think it has much meaning [because] in other states, you just get it without even taking an exam… so really, what's the point?” (mw). all the requirements and sacrifices placed on test takers’ time and finances by their state, the aswb, testing center hoops, and the licensure board were also questioned. bd summed it up: i personally feel like it's just kind of a money grab from the boards. you show up to the testing facility and you're treated like a prisoner. it's just a lot of frustration, a lot of money, [and] when i go to practice the test, it's just like you have to forget advances in social work, summer 2025, 25(2) 708 everything you know, everything you've been taught. i think a lot of people are just talking about how it's a waste of time, and how it never used to be this way. (bd) other participants agreed, stating “i've heard that it was pointless, so i didn't want to waste my money” (hs). te also added, “there's no difference between the social worker i was before i took it and now.” “it means that you passed a test that doesn't really prove anything other than it allows you to do the job you've been working towards” (dn). participants were generally disappointed about the amount of time, money, and anxiety they had to endure for something that does not have a bearing on their effectiveness as a social worker. theme 2: challenges: so many hoops and barriers participants expressed multiple perspectives on the challenges and barriers of taking the exam with the main concerns focused on registration, preparedness, financial concerns, accommodations, and confidence levels. registration participants felt there were multiple barriers to registering for the exam with additional accessibility barriers for those with different lived experiences and backgrounds. we're supposed to advocate for vulnerable populations and accessibility. and yet we're putting an undue burden on [us]. and it almost feels intentional… if you’re not the most typical like “sally, social worker,” there is an extra burden put on you. (dn) participants who requested special accommodations experienced additional registration barriers. multiple participants stated the exam processes and hoops were too stringent and they relayed a mistrust of the process and the system. preparedness participants expressed it was a major time commitment to prepare and take the exam and voiced uncertainty as they believed there is an extra layer of knowledge required after earning their msw degree. bd stated, “… if i fail, then it’s going to devalue the past three years, and not allow me to practice at my full capacity.” test anxiety was common amongst participants with thoughts that the stakes are high even though you can take the exam multiple times. multiple participants expressed they didn’t share about taking the exam because it would be shameful if they didn’t pass. te stated, “i’m worried about how others will perceive me… i don't want people asking me about it and possibly having to say, ‘oh, i failed.’ it’s just embarrassing.” some participants developed plans to take the exam multiple times, if needed. hl expressed deep anxiety about being prepared for the exam, i spent most of the time prepping how i was gonna cope with not passing, i didn't want to tell anyone i was taking the test…and i already had mapped out how many times i was willing to pay for the test and take it. glassburn et al./it means everything & nothing 709 time management was also a challenge for many participants balancing work, studying, and their personal lives. and, participants experienced a disconnect between the educational knowledge, what you study, and what’s actually on the exam. financial concerns multiple participants noted financial barriers to taking the exam because of the registration requirements (i.e., test fees, fingerprinting and background checks). participants expressed it was a “money grab,” as they had already paid for their education and there was the potential of additional expenses if you failed the exam and needed to take it multiple times. accommodations participants in need of ada accommodations identified additional barriers. options for testing centers and testing times were limited, and multiple participants with accommodation requirements noted the process for requesting accommodations was complex and time consuming, posing an additional barrier to taking the exam. multiple participants felt their need for accommodations was not respected, as pt shared, “i have adhd, but i was not going to challenge it on the test, i was not dealing with this. i have heard how it’s handled.” one participant noted requesting the accommodation of a “low distraction environment” for the exam. the social work board replied this is how the testing center is designed so this request was denied. one participant persevered through the process of getting an accommodation and said that she wasn’t going to be defeated by the process. i've gotten pretty good at applying for accommodations, because you have to redo the whole process [she attended three universities], and when i looked into how to apply, i was a little bamboozled at how extra it was compared to every other testing arrangement i've ever had to do it for. i was like, is this right? and reddit is full of people talking about how ridiculous the accommodations were…. but i matched their extraness with my extraness. (dn) confidence in the exam itself several recurring themes emerged for participants: feeling powerless over the system and exam process, mistrust of the power and control of the aswb, and test anxiety. bd stated, “i think i’m extremely frustrated with how it feels like the whole ability to practice as a social worker rests on my ability to pass this test.” questions and concerns were common regarding the validity of the licensure exam. multiple participants also noted concerns regarding the exam questions as stated by bd, “… you just never know what you’re going to get on test day, and that doesn’t alleviate any of the anxiety.” advances in social work, summer 2025, 25(2) 710 theme 3: all the feels….stress, shame, anger, and anxiety: emotional responses to the testing process participants identified experiencing several strong emotions in response to preparing for the social work licensure exam, actually taking the licensure exam, and just generally reflecting on the licensure exam itself. for example, some participants reported experiencing high levels of stress due to the perceived high stakes associated with passing the licensure exam. one participant (jm) stated that if they did not pass, “i guess i would have to do something that doesn’t require a license, there are other opportunities here, but i guess i wouldn't be able to do therapy.” for some participants, it was critical that they pass the exam in order to maintain employment or to secure an increase in pay. participants identified feelings of shame associated with the potential of failing the licensure exam. participants identified additional negative feelings such as anxiety, doubt, uncertainty, and fear when reflecting on their ability to pass the licensure exam. as pd stated, “…as clinicians [we] can't legally call ourselves therapists without the licensing. and honestly. i just want to be able to call myself a therapist.” a particularly interesting emotional reaction identified by participants was resentment, especially directed at being required to take a licensure exam; in other words, the participant questioned “haven’t i proven myself already?” (te). this was accompanied by frustration in terms of the amount of anxiety and stress a participant experienced when they “already knew they were good at what they do” (te). those participants who had completed the licensure exam and passed typically expressed relief along with a sense of validation, but also dread in terms of the next step on their journey, the lcsw. fear and anxiety permeated the experiences of many of the participants. these feelings revolved around the participants’ sense of preparedness for the exam, the expenses affiliated with the exam, the high stakes associated with passing the exam, the licensure requirements for employment, just to name a few. feelings related to fear and anxiety are particularly evident in the following participant quote: so it was scary and very intimidating for me, when i knew that after not taking tests and not having to necessarily show my knowledge as a social worker; my four and five years of education and social work. it was extremely intimidating and worrisome and anxiety provoking to know that there was a test at the end of it. because it just filled me with a lot of fear and kind of took me back to the person i was before i started college. i just have to try so hard to get good grades and what if i don't pass? and so i just feel like as social workers, that's not how we have learned to express our knowledge. (te) passing the exam is high stakes, so emotions run high. ga was very worried about the outcome of the test and said, "i guess the fear of not passing, and then having to tell my boss, or the fear of people thinking i'm not smart." ec also talked about test anxiety. managing the emotions around the test presents a burden that the participants had to manage on top of everything else in their lives. clearly, i have terrible test anxiety. going through the msw program, we were more fixated on doing research and papers rather than doing testing. so this is glassburn et al./it means everything & nothing 711 something that's been quite foreign to me for quite some time. i believe in grad school i may have only taken a total of maybe two or three exams maybe, and those are exam quizzes. yeah, i've taken a few of those, but a quiz is just that… a quiz, you know, 10 points. and i'm trying to get out of my head that oh, my gosh! i can't do this! participants expressing fear and anxiety regarding the licensure examination process raised additional troubling questions about who is in “control” of the process. i don't like it. i think it's just a way for the government to impose itself on how social workers interact and treat (clients). i think sometimes it limits our scope of practice, because now there's too much anxiety around us practicing instead of delivering good care. (lc) lc worked in a clinic with transgender youth seeking care and said that being licensed meant that he could face sanctions if he did not follow state mandates. each state enforces its own additional regulations, creating a scenario where “the state is more limiting than the actual test itself” (lc). as a result, he believes that not becoming licensed may become an act of social justice on behalf of client care. theme 4: learning the tricks of the test many wondered if their exam score was a true statement of their readiness for practice. the general belief was that it is more important to know the test logic (i.e., how the questions work) than to know the actual content and practice wisdom related to the question. learning the “tricks” of the exam was a common thread among participants. popular study resources, such as dawn apgar’s study guide (apgar, 2024) and raytube youtube videos (ledet, 2025), encouraged participants to “forget what you know” and focus instead on the timing/sequencing of each question, such as what to do first, what to do next in a given social work practice scenario. one participant stated: you have to read the questions a certain way with a completely blank slate every single time. you can't come in with any assumptions about anything, like you don't know this person. you don't know their situation unless it's in the script. (am) another participant (hl) stated that it was important to know the steps and not just knowledge, “... so flashcards wouldn't work.” participants appreciated free internet resources as they prepared for the exam. hl also said: raytube would break down a question …that was really helpful for me, knowing why my answer wasn't the best answer, because sometimes it wasn't even that the answer was wrong. it's just not what you're supposed to do in the right order or what you're supposed to do first ….in the hospital we should collaborate with the team first, because it could be really important to my client’s care. another trick to passing the exam relates to having some degree of privilege. participants suggested that being a good test-taker, having financial means, having educational opportunities and coaching, and having the privilege of time to study set them up for a much greater likelihood of passing the exam. advances in social work, summer 2025, 25(2) 712 theme 5: setting aside practice wisdom the participants in this study expressed that they were grateful for taking a test prep course, as their initial approach to the questions might have otherwise led them in the wrong direction. many participants received advice from others who had passed the test that they should take off their social work hat and try to approach the questions context-free. one participant stated that one of the test prep leaders also said to forget your education and just approach the test from a blank slate. however, participants indicated that approaching the questions in a context-free way felt inauthentic and antithetical to what social work teaches regarding the importance of context. social work is all about the context, including practice setting, cultural background of both client/provider, client and provider values, the client’s history, and the quality of the therapeutic relationship, among many other variables. one participant (bd) worried that her extensive practice experience could actually be a hindrance. she said, “and even when i took the practice thing that was offered through school, it's just like you have to forget everything you know and everything you've been taught. and so what's the point?” another participant (lt) echoes this feeling saying, “so, i wanna make sure that i'm not thinking about all of the things that i've learned to do in my career in the real world versus what the test is asking me about.” participants felt that in order to pass the test, they needed to set aside their practice wisdom so they could focus solely on the test logic, and while that was frustrating, they were also uncomfortable with ignoring this advice when so much was hanging in the balance. another concern was that test scenarios differ from real life, where clients are often complex and present with multiple issues. answering a test question about a scenario felt reductionist to the participants as there wasn’t enough detail to make a thoughtful decision. several participants also mentioned that they heard the test questions were created in such a way that people of color are disadvantaged, so they wondered if passing the exam was only a reflection of their privilege. this disconnect between their personal and professional values and the test created dissonance for participants. discussion five themes emerged from interviews completed as part of this study with new social workers who were preparing for or had taken the master’s licensure exam: meaning everything and nothing, hoops and barriers, emotional responses, learning the tricks, and setting aside practice wisdom, with the most prominent finding being that social workers held two opposing views at the same time. on one hand they felt that licensure exams are biased and may not be evidence of competence, on the other they felt that being licensed means being legitimate or being perceived as a more competent and respected professional. beyond the disconcerting revelation by the aswb of pass rate disparities, this research has uncovered additional unsettling dilemmas related to the licensure process for social workers with important implications for educators. in 2008 cswe shifted its accreditation standards from a curriculum focus to a student outcomes focus (apgar, 2021). in response to this, programs of higher education shifted away from traditional testing methods to assessments focused more on student demonstration of social work competencies. glassburn et al./it means everything & nothing 713 unfortunately, the exam process from aswb did not shift, creating a misalignment between education, regulation, and practice, which are three very important pillars of social work (apgar, 2022). our participants felt this disconnect between their own practice wisdom, what they learned in school, and the test questions. students reported many concerns, barriers, challenges and frustrations with preparing for and taking the test, consistent with torres et al. (2024). in order to provide ethical and professional services, social workers should engage with clients and constituents in alignment with their training. however, new social workers are required to pass an exam that may not align with that training. for students, the test may breed distrust in their education as they do not feel that school prepared them for the exam (reay et al., 2023). students have been trained to “do the work,” but their training doesn’t align with the test. as participants said, the test means everything, as passing the test gives social workers a sense of legitimacy. passing the exam not only means legitimacy, it is also required by many jobs. in fact, social workers with a license earn on average $5,500 more per year than those without a license (kim et al., 2023). for many participants, passing the exam seemed to be “playing the game” or “jumping through the hoops.” they felt the test was not evidence of their competence, which supports the notion that it means nothing. participants expressed feeling bound by the extensive, confusing, and one-sided processes mandated by a bureaucratic system that was also misaligned with the values of our profession. participants in our study and that of torres et al. (2024) expressed fears about being granted ada accommodations for the exam and shared hearing from others that they did not apply for accommodations for legitimate needs as the process seemed too onerous. for all the participants, whether they felt the test was legitimate or not, taking the test was high stakes. many accepted jobs with a temporary license requiring them to pass the exam within a year or face losing their job. participants invested considerable time, money, and emotional energy preparing for the test while the vast majority were working full-time, and almost half had caregiving responsibilities. most of them expressed intense anxiety and worry about not passing, how that would be perceived by their family, colleagues, and employers, and how that would make them feel about themselves. many participants reported the scenario-based questions on the licensure exam provide limited information and context with the expectation that the test-taker will be able to determine the “best” intervention or the “first” step to take. this is contrary to participants’ educational preparation and to the practice of social work in general. as a group, participants were conflicted about the validity of the exam. many felt that social work needs licensure for gatekeeping, while others felt that gatekeeping is antithetical to social work values, as people are deemed illegitimate because they cannot pass a biased test. in addition to the concerns raised in this study by the participants, we as social work educators became even more aware of the disconnects created by the test. social work educators are tasked with preparing students to work with individuals, families, groups, organizations, and communities, incorporating best practices, evidenced-based interventions, and strong theoretical frameworks. students are taught to consider personin-environment with their unique strengths, resources, and challenges, causing the issue advances in social work, summer 2025, 25(2) 714 stated above regarding scenario-based questions with limited information. other researchers have noted this conflict between teaching via experience to master cswe’s competencies and taking the aswb licensure exam as well (morrow, 2023; victor et al., 2024). apgar (2021) eloquently states this dilemma: licensure examinations are based on assessing knowledge for tasks that licensed social workers actually do in their jobs. thus, there is a disconnect, with educators on one side asserting competency can only be assessed through behavioral observation of what social workers should be doing and regulators on the other focusing on knowledge that is driven by real world market conditions. (p. 519) this raises questions about what msw programs should do about this disconnect between what is being asked on the licensure exam versus teaching their students the practice of social work, creating a dilemma for social work educators who have moved away from traditional testing and test preparation strategies in their pedagogy, preferring experienced-based learning and competency development to comply with cswe regulation. grise-owens et al. (2016) suggest “recasting social work’s professional paradigm in the common framework of competency, with licensing part of the continuum of professionalization” (p. s126). incorporating licensure testing into the full scope of education and professional development versus being two separate things. does this mean social work educators should teach to the test so students can gain employment or continue to focus on experiential skill building so students learn how to be a good social worker? are both true? this creates an ethical dilemma for the educator. if we teach our students how to pass a biased test, we violate the ethical values of social justice, dignity and worth of the person, integrity, and competence (nasw, 2023; senreich & dale, 2021). if we do not teach students how to pass the test, we may limit them from being able to provide future service to clients. as these concerns are considered, the researchers propose this status quo be challenged. in the field of nursing, the percentage of nurses passing their licensure exam for rns (nclex) is tied to the accreditation of the schools. schools with low passing rates risk losing their accreditation (mahmoud et al., 2024). social work currently does not have any link between passing rates on exams and their accreditation, the merit of which has been debated in the literature (apgar, 2022; morrow, 2023). faculty could support students by doing things such as requiring comprehensive exams before graduation, offering a licensure prep class, or providing discounted study materials. requiring and assisting in studying and preparing for the licensure exam may eliminate some of the barriers related to finances, access, and knowledge that recent graduates may face as they attempt to register and pass their required licensure exam. while the above are good suggestions, they ignore the elements of test anxiety and practice ability, something social work has put a large emphasis on both in professional and educational settings. the anxiety experienced is understandable due to the exam length, testers being several years removed from standardized testing, and its high stakes nature (ricciardelli et al., 2024). nob et al. (2018) note the importance of passing a high-stakes licensure exam translating to potential career success. failure will have a significant impact on testers’ optimum performance. to address test anxiety, coohey et al. (2023) developed a free, synchronous, online, non-credit glassburn et al./it means everything & nothing 715 course to help students understand the test logic, and utilized a combination of mind-body strategies to reduce test anxiety. results showed the combination of test and anxietyreducing strategies had a significant effect on anxiety for participants and could potentially increase pass rates. implications for social work education several key implications for social work education and the field of social work emerged when examining the findings of this study. multiple participants raised the point that their msw programs did not prepare them for the exam. it should be noted that participants did not state they felt unprepared to do social work but felt unprepared for the actual test and high-stakes nature of taking the licensure exam. this may be due to students not taking many actual exams in their msw programs, instead being evaluated by papers, practicum, and simulations. it may also be due to the fact that when they were provided case studies in class, they were given an abundance of backstory and information on the client and situation as opposed to the minimalist approach of the licensure exam. their education is preparing them for practice, but the exam is not testing this skill set. either the test or the education needs adjustment. helpful resources for test preparation the researchers were impressed with the diverse array of helpful test prep resources shared by the participants and wanted to offer those here for other educators. some of these included specific study resources such as: the dawn apgar study program (apgar, 2024), raytube on youtube (ledet, 2025), the aswb practice test (aswb, 2025c), study.com (2025), quizlet (2025), and pocket prep (2025). other resources helped more with anxiety management and support. these included: social media groups for those taking the licensure exam (r/socialworklicensure [reddit], 2017; indiana social workers [facebook], n.d.), practicum supervisor mentors, test-taking buddies, and colleagues and peers that had successfully completed the process. recommendations in response to workforce issues and the disclosure of pass rates, many states are no longer requiring the initial master’s degree licensure exam (aswb, 2021). instead, students are automatically granted licensure by virtue of completing their msw degree or offered the opportunity to opt out of the test by engaging in additional supervision hours. one solution involves using an alternative pathway to licensure, taking only a jurisprudence test which covers applicable laws in a state (hirsch et al., 2024). joseph (2024) advocates for letting social workers retake only the modules they failed and not the entire test, using only a subset of the test to determine passing instead of the 170 questions that include research questions. as of this writing, only illinois has implemented a pathway for social workers who fail the exam by having them receive extra years of clinical supervision (connolly, 2024). however, obtaining clinical supervision is not always available or free (walker & bruhn, 2024). many social work educators are calling for a advances in social work, summer 2025, 25(2) 716 moratorium on the exam until better options for assessing competence can be determined (torres et al., 2024; victor et al., 2023; victor et al., 2024). in indiana, the exam is still required. prior to completing this study, this group of researchers had concerns about the disparity in exam pass rates. hearing the participants’ lived experiences only reinforced significant ethical concerns with the current master’s exam. the licensing exam has been touted as a vital way to protect consumers of social work services, specifically guarding against those who will not uphold our ethical standards and/or those who lack competency, but in reality, it does not weed out those who are unfit for the profession. one participant said: there are a lot of people who are awful at their jobs, who can pass a test. and there's a lot of people who would be amazing at their jobs, who aren't great at taking tests, especially when you take into consideration that the tests are written in a very black and white way, and like in every social worker or psychology class, ever the answer to things is usually it depends, and it's somewhere in like the gray. nothing's ever black and white. (dn) those who have difficulty achieving licensure are actually our most vulnerable students, those who are living in poverty, are marginalized by race, age, or first language, and those who experience test-anxiety or struggle with standardized tests. we encourage immediate consideration of alternative pathways to licensure to remedy this ethical issue. in the interim, we also encourage offering one exam fee for unlimited opportunities to take the exam, as this would decrease financial burden and anxiety for applicants. when privilege is a part of being able to pass, of being able to serve vulnerable populations, how can the profession of social work stand in alignment with this process? bloxom and anderson (2024) state that the aswb is a monopoly, calling for nasw to advocate about the race disparities present in exam outcomes. joseph (2024) takes this a step further suggesting that social work fully “remove its coupling with aswb” (p. 6). apgar and luquet (2023) take a middle approach and recommend that aswb and cswe work to bridge the divide between competency-based evaluation and the exam. if these two parties were aligned, it could eliminate dilemmas for social work educators and may decrease many student concerns and fears. limitations the researchers chose qualitative methods to seek a rich description from the participants. while this approach helped achieve that goal, it does mean the findings presented here should not be generalized to a larger population. while the sample size is on par with other studies of this nature, our sample does not have any participants who failed the exam on their first attempt. their opinions and experience would have added greater depth to these findings. these researchers recommend a future study on this topic so it can be added to the literature. another important drawback relating to the demographics of this sample is the minimal representation of minority voices. this is of interest, since black/african american graduates, older social workers, and those for whom english is a second language have significantly lower pass rates than their white glassburn et al./it means everything & nothing 717 counterparts (kim & joo, 2024a; nienow et al., 2023). again, a study similar to this one could and should be done with a stronger focus on those social workers from populations with lower pass rates to add their voices and experience to the literature. conclusion our study reflects the ambivalence new social workers have toward the msw licensure exam. if it simultaneously means everything and nothing, those are confusing polarities to hold in tension for those preparing for the exam as well as those who have taken it. on one hand, social workers must pass the test in order to get or keep a job; on the other hand, they are well-aware of the inherent bias and the large role that learning the test logic plays in passing it. participants expressed both viewpoints that having a professional standard with a licensure exam is important, and, at the same time, that the exam appears to be a gatekeeping mechanism for those seemingly disadvantaged, which is antithetical to social work values. while passing the test was a huge relief and a validation of their efforts, participants felt the test was disconnected from practice, too expensive, manifests privilege and bias and is not an adequate measure of professional competence. the authors recommend seeking alternatives to licensure due to the multitude of dilemmas for social workers and for educators. references apgar, d. 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(2024). perspectives of african american social workers regarding clinical licensure. journal of evidence-based practice, 21(2), 145-161. author note: address correspondence to susan glassburn, school of social work, indiana university, indianapolis, in 46202. email: susglass@iu.edu orcid https://doi.org/10.1177/10497315221114175 https://doi.org/10.1177/10497315221114175 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://doi.org/10.1177/10497315221125885 https://doi.org/10.1177/10497315221125885 https://www.pocketprep.com/exams/aswb-msw/ https://quizlet.com/ https://www.reddit.com/r/socialworklicensure/ https://doi.org/10.1177/10497315221118110 https://doi.org/10.1177/10497315221118110 https://doi.org/10.1080/26408066.2023.2285887 https://doi.org/10.1080/26408066.2023.2285887 https://doi.org/10.1093/sw/swaa045 https://doi.org/10.1093/sw/swaa045 https://study.com/aswb/masters-social-work-licensing-exam.html https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231166125 https://doi.org/10.1177/10497315231188305 https://doi.org/10.1177/10497315231188305 https://doi.org/10.1177/10497315231188305 https://doi.org/10.1093/sw/swae001 https://doi.org/10.1093/sw/swae001 https://doi.org/10.1093/sw/swae001 https://doi.org/10.1080/26408066.2023.2276117 https://doi.org/10.1080/26408066.2023.2276117 mailto:susglass@iu.edu advances in social work, summer 2025, 25(2) 720 susan glassburn https://orcid.org/0000-0001-7727-5713 glassburn et al./it means everything & nothing 721 appendix semi-structured interview guide – pre-test • what do you know or what have you already heard about the licensure exam? • what are you doing to prepare for the exam? • what are you using to prepare – app, books, workshops? study materials? buy/borrow? • how many weeks or months have you studied? • how much money, if any, have you spent to date preparing for the licensure exam? • tell me about your stress level when thinking about taking the exam? what specific things are stressful? • what does being licensed mean to you at this level? • how important is it to you? • what barriers or obstacles are you encountering when preparing to take the test? or what barriers or obstacles are you encountering in actually taking the test? • what other supports are you using in preparing to take the test (peers, supervisors, mentors, online apps)? • how confident do you feel going into taking this test? (1 – 100% and why) semi-structured interview guide for after participants have taken the licensure exam • were you surprised at the result? • what do you make of your score? • knowing what you know now, do you wish you had done something different while preparing? if so, what? • what does the result mean for you? (i.e., being licensed or having to take it again)? • how does this result impact your career plans? • what advice do you have for others preparing to take the licensure exam? • what barriers do you anticipate if you have to take the exam again? _______ christine velez, phd, msw, assistant professor, department of social work, maria mercedes avila, phd, msw, professor, department of pediatrics, and esther doh, msw, a program coordinator, department of pediatrics, university of vermont, burlington, vt. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 628-638, doi: 10.18060/27630 this work is licensed under a creative commons attribution 4.0 international license. lessons learned from the implementation of a federal behavioral workforce diversity grant at a predominantly white institution christine velez maria mercedes avila esther doh abstract: the health resources services administration’s (hrsa) behavioral health workforce education and training (bhwet) grant program is a unique opportunity for social work programs, as well as other disciplines such as counseling, to address shortages in the behavioral health workforce and support integrated care approaches and interprofessional collaboration. bhwet programs support anti-racist, diversity, equity and inclusion and justice (adeij) goals through recruitment and training of historically underserved and underrepresented students. in this preliminary program review, we explain program structure, institutional context, and demographic data to share lessons learned after 3 years of program implementation. we provide specifics on financial institutional policies which created financial barriers to underserved and underrepresented students, particularly students of color, participating in this federally funded training grant program. keywords: health resources services administration’s (hrsa) behavioral health workforce education and training (bhwet), social work, anti-racist, diversity, equity and inclusion and justice (adeij) there is a national shortage of behavioral health providers across the united states (us), as more than half of the us population resides in a mental health professional shortage (mhps) area (counts, 2023; health resources services administration [hrsa], 2023). there has been a historical underinvestment in behavioral health programs (counts, 2023; stuart et al., 2009). the affordable care act of 2010 acknowledged these shortages, however, the opioid epidemic, housing, and climate crises to name a few, all exacerbated by the covid-19 pandemic, have contributed to rising rates of suicide, overdoses, and depression (hrsa, 2023; padykula et al., 2020). provider shortages and lack of access are driving mental health disparities. a lack of racial and ethnic diversity persists amongst behavioral health providers, as the majority of clinicians in the us identity as white and female (hrsa, 2023). social workers and mental health counselors make up the majority of the behavioral health workforce. with rising costs of higher education and provider burnout, recruitment and retention efforts are one strategy to address provider shortages, especially in rural areas. this article describes the lessons learned in the first three years of implementation of a federally-funded workforce diversity development training grant for graduate students in social work and counseling programs at a predominantly white institution (pwi) in the northeast, which also happens to be the state’s flagship institution. our program focuses on building a diverse workforce through training and financial support. the behavioral about:blank velez et al./federal workforce diversty grants 629 health workforce education and training (bhwet) program, funded by the health resources and services administration (hrsa), aims to address the national shortage of “youth focused behavioral health providers within integrated care teams” (hrsa, 2023 para. 1). one bhwet program goal is to train a more diverse workforce. bhwet programs are aimed at addressing the need for high quality behavioral health care, particularly in integrated health settings, by providing specialized training in integrated and interprofessional team-based approaches to service provision (kepley & streeter, 2018). eligibility requires that trainees be in their second-year internship, in settings serving historically underserved populations. research has identified that significant exposure to unserved and underserved populations while as a student can influence a student’s desire to work in those settings post-graduation (kepley & streeter, 2018). in this paper we reflect on the challenges faced implementing this hrsa workforce development grant that centers interprofessional collaboration and diversity of the behavioral health workforce. we identify our grant funded program structure and discuss specific challenges faced in the first three years of program implementation. we reflect on structural hurdles we faced within the context of a pwi, and as a group of social workers and academics invested in equity and disparity issues impacting racially and ethnically diverse students. we present strategies employed to counter some of the challenges we faced. although no formal evaluation documents were reviewed for this analysis, we do present demographic data of our student trainees to underscore the challenge in recruiting diverse student trainees as well as the dire need for more providers. we assert that we have valuable contributions to share regarding the implementation and execution of anti-racist, diversity, equity, inclusion and justice (adeij) work in the context of a predominantly white institution (pwi). since adeij is an explicit component in the educational policy and accreditation standards outlined in the 2022 epas, hrsa bhwet programs have considerable potential in advancing said work as hrsa asserts that the lack of diversity amongst providers contributes to behavioral health disparities amongst racial and ethnic groups (council on social work education, 2022; hrsa, 2023). hrsa bhwet funding also brings unique opportunities to strengthen social work education and teaching in integrated and interprofessional care approaches. the principles of adeij, which emphasize representation, inclusivity, and affirmation of one’s identities, align with anti-oppressive and anti-racist frameworks and focus on equity. we employ a framework of anti-oppressive practice to guide our assessment of program challenges we have encountered. an anti-oppressive informed approach centers equitable and collaborative approaches that have the potential to promote action-oriented responses at an institutional and systemic level (danso, 2015; mattson, 2014; morgaine & capous-desyllas, 2014). an anti-oppressive approach also helps illuminate the pwispecific challenges we encountered related to racial and ethnic diversity, as well as how we did our best to address them. this analysis, informed by anti-oppressive and anti-racist frameworks, acknowledges that provider shortages in behavioral health significantly impact communities of color and perpetuate mental health disparities. inclusivity, diversity and representation matter and advances in social work, fall 2024, 24(3) 630 have real life impacts. the following tenets of anti-oppressive approaches (morgaine & capous-desyllas, 2014) guide our analysis: • we seek to avoid contributing to patterns of helping systems which might replicate/promote inequity and/or oppression (smith et al., 2022). • anti-oppressive frameworks use critical self-reflection as a tool of inquiry; as racially and ethnically diverse scholars ourselves, critical self and group reflection and discussion significantly guide this analysis. • we strongly believe that diversifying the behavioral health workforce can help to address mental health disparities, especially amongst racially and ethnically diverse groups. • education and consciousness raising are vital components of anti-oppressive approaches (smith et al., 2022). federal behavioral health workforce diversity funding the us faces an ever-increasing mental health crisis amongst people of all ages, particularly among children and youth (white house, 2022). placing social workers in integrated behavioral health settings is one approach to address a rising national mental health workforce shortage. although social workers are already important parts of the healthcare workforce, there is a continued need to expand and improve training and service delivery, which is often driven by cost saving measures aimed at simultaneously improving health outcomes (fraser et al., 2018; padykula et al., 2020; zanskas et al., 2022). the patient protection and affordable care act (ppaca) is focused on prevention and adeij work both at our institution and in our state. we work and live in a predominantly white state, in a predominantly white institution, in predominantly white academic programs. institutional context demographics of our institution and educational programs reflect demographics of our city and state: the state of vermont is considered to be 92.9% white, our student population is 80.6% white, and faculty are 80.5% white (university of vermont, 2023). racially and ethnically diverse service users in our state are served by mostly white, female practitioners (vermont department of health, 2023) and our social work and counseling programs reflect this demographic, despite previous efforts to racially and ethnically diversify both graduate programs. of course, we understand the meaning of “diversity” as broad and one that includes more than race and ethnicity, although those are certainly important when considering structural inequities that perpetuate the oppression of marginalized communities. our institution and state, like many others, have also made many commitments to improving and expanding adeij related work. the support to pursue this hrsa grant, including structural support, is evidence of increased consideration to matters of diversity, inclusion and belonging. increased attention to issues of representation, recruitment and retention are reflected in our own positionalities as women of color and scholars on our campus and in leadership positions. we leveraged these contextual factors and applied and were approved for a federal behavioral workforce training program funded by hrsa. velez et al./federal workforce diversty grants 631 overview of grant program structure our program is one of 82 funded bhwet projects in 2021; there are similarities and differences amongst all programs. this training grant is for 29 graduate social work and/or counseling students each year of the grant, in their second year of study, and entering their second-year internship. eligibility requirements also include that students must selfidentify as historically underrepresented in the following categories: racial, ethnic, cultural, geographic, religious, linguistic, gender and sexual orientations (hrsa, 2021). students’ second year internship placement must meet the requirement of an integrated and/or behavioral health setting, which includes k-12 school settings. students were tasked with taking additional coursework and training in trauma-informed and resiliency specific practices. all trainees received a $10,000 stipend for participating in these training activities, paid directly to student accounts. table 1, adapted from sampson et al. (2020), identifies program goals and related activities. table 1. program goals and corresponding activities all trainees must be msw or counseling students in their second year of study and must be completing their second-year field placement in an integrated behavioral health setting program goals program activities goal #1: increase the diversity, skills, and professional self-efficacy of the behavioral health workforce activities: (1) provided a meaningful financial stipend in the amount of $10,000 to reduce education-related expenses and (2) all recruited trainees identified as historically underrepresented in one or more of the following categories: racial, ethnic, cultural, geographic, religious, linguistic, gender and sexual orientations goal #2: enhance partnerships with community-based agencies that can serve as experiential training sites across vermont activities: (1) established new community partnerships sites in community-based integrated behavioral health settings serving high needs/high demands populations and (2) enhanced current partnerships by expanding internship positions and opportunities through already established relationships goal #3: enhance collaborative trauma-informed, culturally responsive didactic training/education activities: (1) all trainees completed additional training in trauma-informed and resiliency-based content implementation challenges we experienced several noteworthy challenges in implementing this program; we assert that these insights could be helpful for other professionals interested in expanding and enhancing adeij focused work. additionally, for early career scholars on tenure track and/or pursuing tenure and promotion, these reflections can be useful in understanding the nuances and complexities of applying for and implementing federal grant programs, especially within the context of a pwi. advances in social work, fall 2024, 24(3) 632 our program was approved with funding in summer 2021, during a spike of covid-19 infections in our state, nationally and globally. agencies and organizations locally struggled with staff shortages and turnovers during this time, and many internship sites decided not to host students due to capacity issues around supervision. our program also experienced challenges related to differing understandings around interprofessional and integrated care in field settings (padykula et al., 2020). what follows are lessons learned as well as strategies for how we addressed them. recruitment of historically underrepresented students in our small state in the northeast, there is an established lack of racial and ethnic diversity within the behavioral health workforce, which perpetuates racial and cultural inequities (richards, 2017). our institution is in a city that is 91.9% white (us census bureau, 2024). since one of the goals of bhwet funds is to diversify the behavioral health workforce, one aim is to recruit diverse and historically underrepresented students. while we succeeded in recruiting the necessary number of students over the course of three years, few of these students identified as students of color. ultimately, there is very little racial and/or ethnic representation amongst our student trainees in both years of implementing this grant (table 2), and we do not think this is likely to change very much in coming years for several reasons. eighty-seven percent of students in the sample identified as white, with no representation in any of the 3 years of hispanic/latina/o/x or native american students. black and african american and asian students represented 4% and 3% of the sample respectively. we also believe the recruitment efforts, grants and scholarships availability, and application processes to attract diverse students need to be reassessed and implemented in meaningful ways to lead to recruiting students that reflect local and national demographic changes. table 2. sociodemographic characteristics of students characteristic n (%) year 1 (n=22) year 2 (n=29) year 3 (n=36) full sample (n=87) graduate program social work 11 (50%) 22 (76%) 22 (39%) 55 (63%) counseling 11 (50%) 7 (24%) 14 (61%) 32 (37%) sex female 18 (82%) 25 (86%) 28 (78%) 71 (82%) male 2 (9%) 4 (14%) 4 (11%) 10 (11%) non-binary 1 (3%) 1 (1%) none or a combination of these 2 (9%) 3 (8%) 5 (6%) race white 20 (91%) 29 (100%) 27 (75%) 76 (87%) black or african american 4 (11%) 4 (4%) asian 2 (9%) 1 (3%) 3 (3%) white/more than one race 4 (11%) 5 (6%) note. n = 87. participants were on average 32.7 years of age. velez et al./federal workforce diversty grants 633 however, this lack of racial and ethnic diversity meant higher rates of inclusion of other intersecting social locations and experiences that render individuals and communities “historically marginalized and underserved.” as such, our student trainees are “diverse” in many other identities and experiences such as first-generation college students, students with disabilities, religious minorities, students who have experienced adversity such as homelessness, substance use, and sexual and gender-based trauma, lgbtqia students and veterans. this is consistent with adeij initiatives which focus on broadening definitions of diversity (nivet, 2015). kirby et al. (2023) establish in their research that broadening the definition of diversity in this way might unintendedly contribute to what the authors identify as a “diluting of diversity initiatives” (p. 1) and potentially detract from the original purpose of efforts to diversify: these broad definitions omit or downplay demographic subgroups legally protected from discrimination, such as ethnic and religious minorities. instead, they focus on differences related to personal perspectives and personalities qualities that any individual may hold. although this might seem more inclusive of a wider range of individuals, does it simultaneously erase oppressed groups? (p. 1). while it is certainly valuable to include the wide array of experiences and identities that categorize people as marginalized or underrepresented, we address the reality that students of color remain underrepresented and underfunded in most helping professions. despite our efforts with this program, we have made no real inroads in diversifying race and ethnicity of our state’s behavioral health workforce. the lack of racial and ethnic diversity remains problematic and highlights the ways in which whiteness continues to dominate despite efforts to diversify (kirby et al., 2023). when only one trainee who identifies as racially and/or ethnically diverse is at the table, it creates a dynamic in which the group will struggle to have meaningful engagement and conversations around complex topics such as race-based trauma (which is a topic covered in this training program) (adams & mcbrayer, 2020; de saxe zerden, 2016; gershenson et al., 2021). the few racially and/or ethnically diverse trainees who are part of a grant centering interprofessional collaboration through learning and internship experiences shoulder the heavy burden of being the only one in the room with personal experiences with racism and racial/ethnic discrimination (adams & mcbrayer, 2020; de saxe zerden, 2016; gershenson et al., 2021). this is not an ideal pathway forward for program implementation of a grant intended to support diversifying efforts of a behavioral health workforce to reflect growing racial and ethnic diversity trends amongst the population being served. another troubling aspect is that while racial and ethnic diversity remains low in our state and at our institution, these demographics are slowly changing which increases the need for helping professionals to share demographics of those being served. additionally, because this grant program used federal funds, we had to turn away international students who were interested in being a part of this training opportunity. lastly, one of the most challenging aspects to navigate was the issue of white men applying on the basis that men as a category, are underrepresented in social work programs. advances in social work, fall 2024, 24(3) 634 stipend disbursement and subsequent impact on student financial aid like most institutions of higher education, to disburse stipends to students, we are required to adhere to financial policies that are undergirded by federal policies. as much as we would have liked to have been able to simply write a check to each student, disbursing federal funds to students is a more complicated process. the disbursement of the $10,000 to students had to be managed by our institution’s student financial services office. thus, once the funds were released by our grants manager through our institution’s special projects administration (spa), student financial services applied the funds directly to a student’s account. the accounting process considers the amount of aid a student is already receiving into the financial aid award offered to them. as a result, the stipend is counted as income, and loan offers are recalibrated through an algorithm. in many cases, students who took out the most loans received less in that the accounting office applied the stipend to the total loan amount, leaving the student with no cash in hand to offset living expenses while completing their graduate studies. another way to understand this is that graduate students essentially were forced to use funds to pay off student loans before they even graduate. the intention of a stipend is to offset the cost of living (jimenez-ekman & gilmore, 2024), which is becoming increasingly expensive for graduate students. whereas the average cost of a one-bedroom apartment nationally is around $1,000, the average cost of a one-bedroom apartment where our institution is located is around $1,500 (brumer-smith, 2024) and the cost of food, gas and other goods continues to increase. additionally, students in the social work and counseling professions are required to complete two internships during their education. this usually amounts to an average of 600 hours an academic year in an unpaid internship. ten thousand dollars has the potential to make a significant impact on the livelihoods and wellbeing of graduate students in helping professions, especially students who identify as marginalized and historically underrepresented. an unintended consequence of this financial policy was that some students declined the opportunity to participate in the program, as this approach to disbursement did not make sense for them financially. a major concern is that these types of financial barriers are likely discouraging students of color in social work and counseling (ecton et al., 2021). all the students who declined happened to be students of color, once again perpetuating educational inequalities experienced primarily by racial and ethnic minorities and affirming findings from other scholars about students of color and financial aid access’s impact on graduate studies (ecton et al., 2021). although certainly we had trainees in our program who received the stipend in full, these were students who had taken out less in loans, or who had other tuition support (e.g., participant in child welfare title iv-e, recipient of gi bill funding, etc.) a major concern is how these financial policies mirror welfare and public assistance programs, also through use of federal funds, that essentially keep people in cycles of poverty and financial insecurity through making sure that people don’t ever get “too much,” expecting them to thrive off of meager amounts of support. our only recourse to addressing this challenge with stipend disbursement was to make future trainees aware of the potential impact of the $10,000 stipend disbursement and to velez et al./federal workforce diversty grants 635 encourage them to seek guidance from the student financial offices about the potential impact of this stipend on their overall award amount. additionally, as many social justicefocused educators address economic injustice in their work, unfortunately, federal funds of this nature are unlikely to significantly impact income inequality. future hrsa bhwet grantees should consider working with hrsa program officers to consider alternate ways of disbursing stipend funds to students. although, technically, this approach to stipend disbursement might end up being applied to student loan debt amounts, when this occurs, it does little to relieve financial burden of students in the moment while they are trying to complete their graduate degrees. it furthermore perpetuates historical inequities disproportionately affecting racially and/or ethnically diverse students defeating the main goals of these programs. hrsa is clear that these funds should be used to offset the cost of living for current graduate students; if institutions and programs can find legal ways to disburse the entire stipend amount to students directly and allow students the choice to use funds in whatever way they need or to apply the stipend funds to their loans. this should ideally be the choice of the trainee, not dictated by institutional financial policies which operate to protect organizations and do not always have the best interests of students and student needs. concluding remarks and implications for social work programs such as hrsa’s bhwet can support efforts to address behavioral health provider shortages and diversity in the workforce. however, calling for more funding is simply not enough, as principal investigators, we must continue to disrupt the distributional policies and practices that curtail and restrict use of these funds (laird, 2020). we support ongoing critical examination of how best to implement federal funds to address needs of underserved and underrepresented individuals and communities (laird, 2020), especially for students of color. and we ultimately feel that schools of social work should continue to pursue this type of funding to support targeted, population specific training opportunities for students to continue to address the shortage of qualified behavioral health providers in underserved communities. it is also important to help improve the quality of care that vulnerable youth are receiving to address existing behavioral health disparities that persist in many marginalized communities (held et al., 2019; sampson et al., 2020). in our attempt to support efforts to increase diversity diversifying efforts of the behavioral health workforce in our state, we are concerned that we may be complicit in sustaining systems that benefit from whiteness (kirby et al., 2023; lerner, 2021). although technically we met the requirements around recruiting a diverse group of students, racial and ethnic representation remains very low, cannot be overlooked, and has encouraged us to consider the impact of broadening the definition of diversity (kirby et al., 2023). in a world where income inequality is exacerbated by sociopolitical structures benefiting from capitalism and neoliberalism. those with the most financial need received the least amount from this stipend. in effect, it was difficult to attract and retain racially and/or ethnically diverse students to be a part of this program. we managed these challenges as best we could despite knowing our efforts were somewhat futile. we concur that a rigorous program evaluation design is needed on our part to be able to assess the impact and efficacy of this program (sampson et al., 2020) and to structurally address the inclusion of racially advances in social work, fall 2024, 24(3) 636 and ethnically diverse students in helping professions such as social work and counseling in predominantly white contexts. the covid-19 pandemic and concurring workforce shortages made creating new internship placements, as well as enhancing existing ones, challenging. despite these disruptions, we successfully navigated these obstacles and worked with our community partners to strengthen, innovate and improve existing internship sites. we conclude with insights into the demand for a diverse and skilled behavioral health workforce. we have to start a pathway to get historically underserved and marginalized students into the behavioral health field by first getting them into undergraduate programs and finding financial resources so professional degrees such as social work and counseling can be more accessible to underrepresented students broadly, and students of color specifically. we also believe meaningful efforts must be made to recruit, and more importantly, retain faculty from racially and/or ethnically diverse backgrounds. these efforts have proven futile in many pwi’s (settles et al., 2022; zambrana et al., 2017) and demand perseverance and accountability. in a country that is becoming majority racially/ethnically diverse (jensen et al., 2021) it is imperative to support students in 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(2022). interprofessional training: preparing graduate counseling and social work students for integrated behavioral healthcare settings. journal of evidence-based social work, 19(3), 314-330. author note: address correspondence to christine velez, department of social work, university of vermont, burlington, vt 05405. email: cvelez@uvm.edu https://doi.org/10.1080/10437797.2021.1943585 https://doi.org/10.1080/10437797.2021.1943585 https://doi.org/10.1080/00221546.2021.1914494 https://doi.org/10.1080/00221546.2021.1914494 https://doi.org/10.1080/00221546.2021.1914494 https://doi.org/10.1080/10437797.2021.1943585 https://doi.org/10.2753/imh0020-7411380104 https://doi.org/10.2753/imh0020-7411380104 https://doi.org/10.2753/imh0020-7411380104 https://www.census.gov/quickfacts/fact/table/vt/pst045224 https://www.uvm.edu/oira/enrollment https://www.healthvermont.gov/sites/default/files/document/hsi-stats-prov-sw22-report.pdf https://www.healthvermont.gov/sites/default/files/document/hsi-stats-prov-sw22-report.pdf https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/ https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/ https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/ https://doi.org/10.1111/soin.12147 https://doi.org/10.1111/soin.12147 https://doi.org/10.1080/26408066.2022.2049944 https://doi.org/10.1080/26408066.2022.2049944 mailto:cvelez@uvm.edu _________ siham elkassem, phd candidate, rsw, adjunct professor, department of social work, kings university college, london, ontario, canada. andrea murray-lichtman, phd candidate, lcsw, clinical associate professor, school of social work, university of north carolina, chapel hill, nc. *authors intentionally did not capitalize the term ‘white’ throughout this paper as a symbolic way to protest the power of whiteness in discourse. copyright © 2022 authors, vol. 22 no. 2 (summer 2022), 628-646, doi: 10.18060/24952 this work is licensed under a creative commons attribution 4.0 international license. mapping an integrative critical race and anti-colonial theoretical framework in social work practice siham elkassem* andrea murray-lichtman* abstract: the social inequities highlighted by the racial injustice protests of 2020 and the covid-19 pandemic challenge the social work profession to respond to the past and present social consequences that disproportionately impact black, indigenous, and people of color (bipoc). we argue that social work's commitment to social justice has not taken up an explicit anti-racism mission to eradicate white supremacy, racism, and coloniality in the profession. we further argue that although social service agencies often include a commitment to cultural competence/humility, practices continue to be rooted in color-blind approaches to service and treatment. social work's failure to address racism poses challenges for those from racialized backgrounds experiencing psychological distress due to racism and other inequities. building upon the theoretical foundations of critical race theory (crt) and anti-colonialism, we provide a conceptual framework for practice and service delivery with bipoc clients through social work praxis. this conceptual framework offers three overarching directives that include integrated critical race and anti-colonial theoretical concepts for social work practice and service delivery. we discuss the implications for application of this conceptual framework in practice and service delivery. keywords: critical race theory, anti-colonial, racism, social work, white supremacy the social inequities highlighted by the racial injustice protests of 2020 and the covid-19 pandemic challenge the social work profession to respond to the past and present social consequences that disproportionately impact racialized black, indigenous, and people of color (bipoc). bailey et al. (2021) offer the following summary of the lingering social inequities that are “historically grounded,” interlocked across institutions, and continue to perpetuate racial inequities: “redlining and racialized residential segregation, mass incarceration, and police violence, and unequal medical care” (p. 768). the police murders of george floyd, breonna taylor, and other unarmed black people in the united states and the disproportionate number of covid-19 deaths among bipoc sparked a global response to structural racism (haynes, 2020). by the end of 2020, there were over 10,000 protests in the united states, with over 80% related to the black lives matters movement (armed conflict location & event data project [acled], 2020). according to the covid tracking project (2020), a research hub gathering data on race, ethnicity, and covid data, the pandemic has disproportionately impacted people of color; in particular, black people have died at 1.4 times the rate of white people, accounting for 15% of deaths in the united states. about:blank elkassem & murray-lichtman/mapping 629 during the pandemic crises, social work was called to fight against structural racism (abrams & dettlaff, 2020; roberts, 2020). the cswe task force for antiracism (cswe, 2021) indicated that before the profession can respond to the structural racism undergirding the pandemic crises, social work must first examine its own house for institutionalized racism. this paper challenges the social work profession to engage in transformative anti-racism and anti-colonialism action in practice and service delivery to eradicate racism, white supremacy, and coloniality. we begin by defining racism, white supremacy, and coloniality. next, we examine 1) social work's harms against bipoc, 2) present examples of racism, white supremacy, and coloniality, and 3) the incongruencies of social work's commitment to social justice. the discussion concludes with recommendations for an integrated critical race theory (crt) and anti-colonial conceptual framework, which offers three overarching directives for social work practice and service delivery. in the following section, we offer the definitions of racism, white supremacy, coloniality, anti-racism, and anti-colonialism to establish a shared understanding for this discussion. although race is a social construct, it is used as an ideological position in society to ascribe the dominance of one group over others enacted through racism. racism is perpetuated and institutionalized through acts of power over marginalized racial groups through mechanisms such as white supremacy and coloniality (omi & winant, 1994). white supremacy refers to the positioning of whiteness as a social location and ideological viewpoint that is normalized as default, perpetuating the idea that white culture and people are inherently superior to other ethnic or racial groups (omi & winant, 1994). like white supremacy, colonization of the past has also morphed into what theorists refer to as a modern form called coloniality (maldonado-torres, 2007). coloniality refers to the positioning of white/eurocentric ways of knowing, which are embedded within culture and ideology, and often seen as normative and supreme (maldonado-torres, 2007). antiracism is an ideological approach that actively seeks to identify and counter individual, societal, systemic, and institutional forms of racism (dominelli, 2017). in comparison, anticolonialism is a philosophical orientation that recognizes and responds to contemporary white/eurocentric domination embedded in society, structures, and institutions (maldonado-torres, 2007). together, anti-racism and anti-colonialism create a powerful approach to challenge and eradicate racism, coloniality, and white supremacy. there have been many calls for social work to examine racism, white supremacy, and coloniality (abrams & moio, 2009; lavalette & penketh, 2014; pon et al., 2016); yet the profession has been slow to adopt anti-racism and anti-colonialism in practice and service delivery. in 1992, macmahon and allen-meares conducted a content analysis of social work literature, revealing very few articles addressing institutional racism and other structural inequities. almost 30 years later, corley and young (2018) replicated this study demonstrating a similar result: the profession's literature still fails to substantively address racism, white supremacy, coloniality, and its impact on bipoc. as the following discussion reveals, social work must examine and improve its practice and service delivery with bipoc to gain legitimacy and genuine results in the struggle against racial injustice, future challenges, and opportunities. advances in social work, summer 2022, 22(2) 630 harms against racialized people from the early formalization of social work in the 19th century, mainstream social work practice has been embedded with racism (carlton-laney, 2001; chapman & withers, 2019; margolin, 1997). “it is racism that has shaped the attitudes and assumptions we hold about the poor, people of color, and other marginalized populations that are the primary consumers of the health and human services” (james, 2016, p. ix). the social work profession has a long history of harms committed against bipoc populations, both past and present. social work's history of involvement in national tragedies such as japanese internment camps (park, 2008), removal of indigenous children from their homes (blackstock, 2009), overrepresentation of black children in child welfare (dettlaff et al., 2020), and the foster care to prison pipeline (calero et al., 2017) suggest de jure racism may be challenged by a few. however, racism is upheld within service provision by colorblind policies and practices claiming to provide equal opportunity and to be raceneutral. these policies and practices disproportionately harm certain groups and are maintained by the silence and inaction of the majority. reviewing the role of theory and practice in the early development of social work, seltzer and haldar (2015) found that social work saw black people's suffering and poverty as individual deficits. yet, social work addressed the needs of white immigrant children, lest white immigrant children become influenced by people from “lower cultures.” according to varghese (2013), early social work approaches and interventions were used to “collude with, aid, or support the efforts of the [w]hite elite to pathologize and consequentially marginalize, the experiences of communities of color” (p. 4). additionally, as social work sought professional recognition (chapman & withers, 2019), mainstream social welfare services excluded black people (carlton-laney, 2001; carten, 2016; este et al., 2017). present racism, white supremacy, and coloniality social work literature reveals that the institutional practice of racism is still very present within the profession (badwall, 2014; craig de silva, 2007; dominelli, 2017; gosine & pon, 2011; lavalette & penketh, 2014; pradia, 2013; varghese, 2013). the national association of social workers (nasw; 2021) determined that bipoc service recipients experience over-identification in the child welfare system, under-resourcing of social support services, and over-diagnosing of certain mental illnesses. these factors contribute to present harms such as mental health clinician's over-diagnosis of disruptive behaviors and schizophrenia amongst black male clients (gara et al., 2019; merino & hall, 2018) and bipoc children with psychological disorders (mayes & rafalovich, 2007; ramirez, 1999), and the mistreatment of bipoc families in child welfare (clarke, 2015; saraceno, 2012). although recorded social work history does not always emphasize this fact, white supremacy is a contemporary and historical feature that helps maintain racism in the profession (gregory, 2020). social work is built upon the professionalization of white femininity (fellows & razack, 1998) and consists of a white majority within education and service organizations (salsberg et al., 2017), with most deans of the top 50 schools of elkassem & murray-lichtman/mapping 631 social work across the united states identifying as white (banks et al., 2018). white supremacy ideology has become normative and embedded in social work practice (badwall, 2014), research, and education (corely & young, 2018; mcmahon & allenmeares, 1992). for example, in child welfare bipoc child protection workers report daily encounters of racist comments by white colleagues and service users (gosine & pon, 2011). in field placement settings, there is evidence to show that white social work students perpetuated racist logic through damaging stereotypes (becker & paul, 2015) and racial stereotyping, particularly against african american people assuming this group is less intelligent than their white counterparts (lo et al., 2016). in education little attention is paid to bipoc social work pioneers and the under-development of interventions for people of color by people of color (beck, 2019). indeed, unless social work addresses the existence of white supremacy in its practice approaches and service delivery models, the profession will continue to receive indictments of complicity in health and social inequities for both bipoc professionals and service users (cswe, 2021). coloniality is another oppressive feature embedded within the social work profession and supported and maintained by racism and white supremacy (almeida et al., 2019; saraceno, 2012). coloniality occurs in social work when white western or eurocentric forms of knowledge are centered as universal and objective in service delivery and practice (almeida et al., 2019; saraceno, 2012). the primary focus of coloniality is to control and discipline minds and bodies to, “comply with the interests of the nation, the corporation, the family, or the agency… the task of forced assimilation is embedded within the dominant euro western paradigm of the help” (skott-myhre, 2004, p. 90). coloniality is also visible in social work through the adoption of the eurocentric idea of the primacy of the nuclear family. in addition, social work assessments are “steeped in coloniality,” through the language of the “western psychological project,” which is highly deficit-focused and othering through the descriptions of presenting problem, diagnosis, planning of treatment, and prediction of outcomes (almeida et al., 2019, p. 156). this becomes particularly harmful when social services or child welfare service delivery explicitly or implicitly are impacted by this idea (gerstel, 2011; peterson, 2013). coloniality ultimately subjugates bipoc's social values and lived experiences, thus normalizing racism and rendering white supremacy invisible (almeida et al., 2019). while the profession emphasizes educating or training social workers to become sensitive to bipoc struggles through cultural competence and multi-cultural models, these approaches often leave racism, white supremacy, and coloniality unchallenged. such strategies were designed to help social workers reflect on their positionality as antioppressive practitioners (sakamoto & pitner, 2005) through understanding the cultural norms of “othered” groups (abrams & moio, 2009) and engaging with difference through a multi-cultural umbrella (constance-huggins, 2019). these approaches have been widely criticized for reinforcing a color-blind paradigm, ignoring racial disparities, and limiting social work’s ability to adequately address racism, white supremacy, and coloniality in practice and service delivery (abrams & moio, 2009; campbell 2015; constance-huggins, 2019; pon et al., 2016; schiele, 2007; stephens & rock-vanloo, 2020; yee, 2005). according to campbell (2015), these approaches omit “whiteness” from racial analysis and promote an “otherness” to identities among bipoc populations. numerous studies advances in social work, summer 2022, 22(2) 632 examining white social work students' and practitioners' racial attitudes reveal an overrepresentation of color-blind attitudes, racial microaggressions, and complacency about the role of racism in society (bridges, 2020; danforth et al., 2020; juliá, 2000; lo et al., 2016). for example, weng and gray (2020) conducted a study on racial microaggressions amongst social work practitioners, which revealed an emphasis on color-blind attitudes in many of their responses, claiming the importance of seeing service users as equal regardless of bipoc identities and inequities. the inequities that continue to thrive in the profession and society will not be resolved through social work approaches that examine another person's “culture” through a multi-cultural lens shrouded in color-blindness. instead, this furthers a system of “othering” and ignores the systemic nature of these systems of power and oppression, doing very little to unseat white supremacy, racism, and coloniality within the profession of social work. the incongruency: social work's expressed values and actions as outlined in the preceding discussion, from social work practice to service delivery, the profession has perpetuated harm against bipoc (dettlaff et al., 2020; kolivoski et al., 2014; murray-lichtman et al., 2022; murray-lichtman & elkassem, 2021; santiago & ivery, 2020). racism, white supremacy, and coloniality within the profession sets the stage for social work practice that also denies the impact of racism on bipoc service consumers through race-neutral policies that devastate communities (dettlaff et al., 2020) and the marginalization of voices that speak against such practices (bryant & kolivoski, 2021). though blatant racial inequities compounded in 2020 and social work was being called on for solutions, abrams and dettlaff (2020), roberts (2020), and the cswe (2021) task force for antiracism quickly reminded social work that the profession had internal work to do before we could be a solution to racism in other institutions. however, professional bodies and associations in the u.s. and canada quickly issued statements of solidarity and called for change in response to acts of violence committed against bipoc (casw, 2020; nasw, 2021). the exposed tragedy of circumstances and pressure from bipoc and allies within the profession pressed institutional bodies like the council on social work education (cswe) and the canadian association of social work educators (caswe) to issue statements of condolences and solidarity (caswe, 2020; cswe, 2020). cswe, whose vision is professed as ensuring a “…social work profession equipped to promote health, well-being, and justice for all people in a diverse society” (cswe, n.d, para. 4), called for social work educators to move “beyond teaching an appreciation for physical or cultural diversity and empower the next generation of social work practitioners to dismantle institutional racism” (cswe, 2020, para. 2). similar calls for action were heard by caswe in their motion that included substantive steps to address anti-black racism in the profession. these statements were in line with the profession's expressed values of social justice, with explicit language that calls upon social workers to actively… “prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class” (nasw, 2017, p. 36). solidarity statements and calls for change reflect social work's expressed commitment to social justice; however, the historical and present harms against bipoc populations and elkassem & murray-lichtman/mapping 633 ongoing commitment to multi-culturalism and cultural competency are evidence of the incongruency between the profession's expressed values and the ongoing issues of white supremacy, racism, and coloniality embedded within all levels of the profession, practice, and service delivery. brown et al. (2019) argue that social work has “explicit and encompassing values commitment to social justice as a construct; however, in practice, the intersection of the profession's historical and current structural relationship with oppressive systems cannot be ignored” (p. 621). nasw (2021) demonstrates decades of anti-racism pledges and convenings. yet, despite the knowledge of the disproportionality of outcomes in practice and service delivery, child welfare statistics continue to reflect that black children are “over surveilled and over-policed” (dettlaff et al., 2020, p. 500). in social work leadership and education of future practitioners, the acknowledgment of institutionalized white supremacy and actions to dismantle structural racism within social work education and practice are, at best, inconsistent (bryant & kolivoski, 2021). while social work's directives for equity and inclusion and global human rights are noble, atteberry-ash et al. (2019) argue that there is no consistent evidence that social work education uniformly teaches our emerging leaders and practitioners what those values look like in action. our history of involvement in the anti-racism fight has largely been left to individual efforts. banks et al.'s (2018) research of the low numbers of bipoc in leadership and brown et al.'s (2019) assessment of racism that bipoc students and practitioners face within the profession are further evidence that individualizing efforts for anti-racism will not disrupt racism, white supremacy, and coloniality. anti-racism and anti-colonialism must be engaged with policies that re-envision accountability and take bold actions to hold entities that continue to perpetuate racist practices accountable such as social work schools which do not interrogate and challenge anti-racism in field education curricula or which engage and rely on field practicums that perpetuate racist practices. social work and the path forward how do social work practice and service delivery systems come to embody anti-racism and anti-colonial action? to borrow from ahmed (2006), how will these “speech acts” (p. 198) move beyond non-performative condolences and anti-racism talk? park (2006, 2008) demonstrates that social work historically has not led in anti-racism efforts; instead, social work has mirrored and (co)constructed within practice the accepted conventions of society. the inaction and ineffectiveness of past anti-racism efforts lend urgency to social work's current embrace of anti-racism lest it also joins the past calls in social work and society, which amounted to little change. as spivak (as cited by wade, 2021) cautions us, “while 'revolutionary time' is very intense, it has no capacity to last; nor can you base a permanent political structure of change on this enhanced time” (para. 24). social work's “sense of urgency” created by the pandemic crises of 2020 and the subsequent speech acts will not produce permanent political change. instead, history demonstrates that “actions” that dismantle systemic white supremacist structures and antiracism approaches to practice are the only hope for permanent change and are needed to meet this historical moment (abrams & dettlaff, 2020). years of solidarity statements and convenings (nasw, 2021) create expressions of non-racism and feelings of “goodness.” still, the evidence articulated by scholars cited within this article demonstrates the advances in social work, summer 2022, 22(2) 634 inadequacy or absence of anti-racism action. we submit social work's actions should include policy-driven strategies to dismantle white supremacy, racism, and colonial structures in practice and service delivery. the final section of this discussion outlines an integrated critical race and anti-colonial conceptual framework that could be systematized within practice and service delivery models to advance a direct practice approach with bipoc communities. first, we frame our discussion with an overview of critical race theory (crt) and anti-colonialism theory. next, we outline an integrated critical race and anti-colonial conceptual framework that could be systematized throughout practice and service delivery models to enhance direct practice with racialized people. this integrated critical race and anti-colonial approach provides a conceptual framework for practitioners to adopt and apply in practice and service delivery to interrogate white supremacy, racism, and coloniality. finally, we will demonstrate how this framework can be used as an effective direct practice tool for assessments and interventions with racialized people that incorporate the lived experiences of bipoc into practice modalities. we conclude our discussion by examining the impact of this approach on social work practice with bipoc. critical race and anti-colonial conceptual framework for social work practice this section presents an overview of critical race and anti-colonial core principles. theoretical concepts are integrated with each other to provide social workers with a critical lens in analyzing white supremacy, racism, and coloniality. we suggest this conceptual framework be systematized within practice and service delivery models to investigate the links between these systems of oppression and their impact on the wellness of bipoc. critical race theory critical race theory (crt) was established by american legal scholars in the 1980s (bell, 2018; crenshaw, 1995), with its philosophical foundations rooted in early abolitionist and civil rights movements of the 19th and 20th centuries (douglas, 1881; du bois, 1903). crt scrutinizes the hegemonic systems of white eurocentrism and its constructs of race and racism in social structures, institutions, and discourses in society. the following crt principles are adopted as part of the proposed conceptual framework for social work practice. racial realism is a theory that claims the reality of race and racism is a normalized and endemic feature within society, maintained by the system of whiteness/white supremacy (bell, 2018; delgado & stefanic, 2001). racialization is a process where individuals and groups are racially essentialized by markers of identity that are positioned against whiteness as the norm. this process can occur differently at the intersections of race, gender, class, sexuality, and ability determining multiple factors of privilege and oppression (crenshaw, 1995). color-blindness is a tool that upholds ideologically rooted claims of equal opportunity and race-neutral politics in society (delgado & stefanic, 2001). lived experience is centralized in this approach to reveal the realities of people who are oppressed, to give “voice” to their knowledge, and to respond to these issues (delgado, 1990). these tenets provide an analysis of the lived realities of bipoc and can be used to challenge white supremacy as a system of power that supports the maintenance of racism. elkassem & murray-lichtman/mapping 635 anti-colonialism anti-colonialism is an action-oriented approach that challenges the contemporary persistence of coloniality that negatively impacts bipoc (kempf, 2009; maldonadotorres, 2007). the following anti-colonial principles are used as part of the proposed conceptual framework for social work practice. positional superiority is employed to situate white western worldviews as dominant while simultaneously ascribing bipoc worldviews as barbarity and atheoretical (said, 1978). other/othered occurs through the process of positioning western white knowledge as superior while subordinating atheoretical ideologies, “other” and thus “othered” (spivak, 1988). writing back refers to the act of challenging dominant notions, discourse, and ideas about colonized people that were defined through positional superiority. this process is done through writings that center the lived realities of colonized people and their local knowledges as a tool to disrupt the label of subalternity ascribed to their societies through white eurocentric writings (ashcroft et al., 2003). for example, baskin (2016) shares the value of indigenous knowledges in helping professions such as social work (chapman & withers, 2019). by sharing their local ways of knowing and rewriting their realities, bipoc communities can take back their histories and culture. critical race and anti-colonial theories share similar worldviews making it possible to amalgamate concepts (fanon, 1967; memmi, 1965/1991). critical race foregrounds race, racism, and white supremacy in theorizing (bell, 2018), while anti-colonial theory challenges white eurocentric ways of knowing and centers local knowledges of bipoc (maldonado-torres, 2007). both approaches are guided by the knowledge of bipoc populations and interrogate systems of power and oppression embedded in culture, society, and institutions while explicitly committing to action-oriented responses (morris, 2006). integrative critical race and anti-colonial conceptual model in this section, critical race and anti-colonial principles will be integrated and presented as a conceptual model for social work. regardless of the practice or service delivery modality you choose, we propose this model as a starting point and guide for working with bipoc impacted by white supremacy, racism, and coloniality. direct practice and service delivery can be submerged into this model to respond to social and material implications of racial inequities. the model has three overarching directives for application in practice and service delivery. figure 1 is an illustration of this conceptual model. in the first directive, the authors propose practitioners should interrogate systems of whiteness as dominant and normalized and the perpetuation of white supremacy as positional superiority. the second directive suggests social workers must center racial and colonial realisms and refute color-blind approaches. the third directive proposes practitioners center the lived realities and local knowledge of bipoc populations to promote bipoc-centered care. in adopting this model, practitioners are asked to take on these three directives in practice and service delivery with bipoc clients. the following section outlines the implications for applying these directives in social work practice with bipoc populations. advances in social work, summer 2022, 22(2) 636 interrogate systems of whiteness/white supremacy as best practice with bipoc communities, we propose social workers refute colorblindness and interrogate systems of white supremacy as positional superiority in practice and service delivery. as mentioned previously, white supremacy is embedded in social work policies and practices and need to be addressed to achieve substantive change in the profession (beck, 2019; gregory, 2020). color-blind approaches uphold race neutrality and are insufficient in their attempts to unseat white supremacy, thus requiring social workers to adequately examine systems of whiteness embedded in the profession. for example, in social work practice, psycho-dynamic models rein superior, maintained through the entrenchment of best practice and evidence-based approaches (ebp; crampton, 2015; fortier & hon-sing wong, 2019; humphries, 2003), even though their effectiveness for non-white groups remains unclear (norcross et al., 2006; sue & zane, 2006). relying solely on evidence-based models may not be effective for bipoc populations dealing with the harms of racism, white supremacy, and coloniality. therefore, we propose assessing interventions commonly used in mental health services for their congruence with the integrative critical race and anti-colonial conceptual model. for instance, a practitioner using cognitive behavioral therapy (cbt) informed by this approach could examine how white supremacy, racism, and coloniality inform and exacerbate cognitions, feelings, and ensuing behaviors discussed in therapy with their bipoc client. this may strengthen the outcomes for bipoc clients who may be challenged by overwhelming negative thoughts related to their social location and harms perpetuated by society through racial micro-aggressions and overt racism. similar to trauma-informed cbt, this model may also strengthen the efficacy of this intervention. directives whiteness/white supremacy must be examined racism and coloniality must be examined lived realities and local knowledge of racialized populations must be centered •theoretical concepts •white supremacy •positional superiority •racial realism, racialization •coloniality, othering •lived experience •counterstories figure 1. integrative critical race and anticolonial conceptual model elkassem & murray-lichtman/mapping 637 adopting racial and colonial realisms individuals, groups, and communities who are racialized and othered through markers of physical identity and social locations are the recipients of racial and colonial violence and discrimination (khan, 2019; knowles, 1997). social workers should adopt racial and colonial realisms to interrogate people's experiences of race, racialization, racism, and othering within personal exchanges and systems in society. this can include interrupting deficit-focused ideology to explore how implicit and explicit forms of racism and coloniality are experienced personally and structurally. for example, although there is an over-representation of black and indigenous children in care in canada, child welfare agencies continue to use the lens of cultural competency/humility, which results in the maintenance of racism, white supremacy, and coloniality in the system (pon et al., 2011). practice, service delivery, and assessment with bipoc are often deficit-focused and do not include or value the family's local knowledges in planning and treatment (crampton, 2015). this may impede parents' ability to rely on these practices in the context of racism and coloniality that has subordinated their family knowledge. for example, adjei and minka (2018) revealed black parenting experiences are often shaped and hindered by negative cultural knowledge about child welfare and perceived anti-black racism. if social workers adopt racial and colonial realism, they can interrupt harmful race and colonial-based deficit determinants heavily embedded in the institution, respond to the structural racism that has contributed to their involvement with child welfare, and center local knowledges of families with whom they are partnering to improve treatment outcomes. centering lived realities and local knowledge social work requires practitioners to produce assessments and treatment plans by gathering medical, educational, and family history and presenting concerns (harms & pierce, 2020). although assessment and intervention highlight the importance of understanding the context of oppression related to individuals, groups, and communities, white supremacy, racism, and coloniality in the lives of bipoc are not explicitly taken up in treatment planning (harms & pierce, 2020). across modalities and within service delivery, bipoc's perspectives and lived realities should be the central axis around which assessment and intervention are produced. social workers must prioritize capturing bipoc's experiences through their own words as a practice of writing back to the positional superiority of white supremacy entrenched in institutionalized social work that is often deficit focused. writing back can include helping a bipoc client not only capture how their experiences with oppression across social locations contribute negatively to their health but also how their local knowledge and practices can contribute to their wellness and success. social workers must create a space where bipoc can express their perceptions about their lives and responses outside of the dominant psychological scripts of diagnosis and treatment to promote racialized centered care in practice (levine & ghezzi, 2022). advances in social work, summer 2022, 22(2) 638 conclusion social workers will reveal contemporary social, material, and discursive oppression through white supremacy, racism, and coloniality by foregrounding critical race and anticolonial approaches in practice and service delivery. these directives should be adopted through social work practice as part of a central social work ethic and institutionalized into service delivery models as best practice with bipoc populations. specifically, social work's failure to actively mandate anti-racist and anti-colonial practices and to adopt evaluative processes to measure growth poses challenges for bipoc experiencing psychological distress due to white supremacy, racism, and coloniality. nasw deemed that this failure to act is harmful for healthcare, mental health, and social service delivery and an enduring challenge to anti-racism practice. “bias among social work professionals negatively influences health care, mental health and social service delivery for people of color” (nasw, 2021, p. 4). approaches to service delivery across systems must include understanding the lived experiences of bipoc individuals, families, groups, and communities who face marginalization and adopt practices to challenge white supremacy, racism, and coloniality. the systems include but are not limited to child welfare, education, mental health, health, and justice systems. anti-racist and anti-colonial practice cannot be accomplished without interrogating the personal ideologies and institutionalized processes that perpetuate these inequities. social work practice and service delivery that adopts colorblind approaches perpetuate white supremacy. they do not highlight the social and material impact of endemic racism and coloniality in the lives of bipoc populations. there may be tensions and questions about fidelity in applying this conceptual framework; further research can respond to this dilemma. however, adopting these directives can only enhance the effectiveness of practice and service delivery with bipoc populations who are negatively impacted by white supremacy, racism, and coloniality. as bipoc continue to face these forms of oppression at all levels of society and within the context of covid-19, this will have an adverse impact on their health and psychological well-being, leaving communities at risk for racial trauma. egede and walker (2020) describe a meta-analysis of 293 studies that demonstrate the negative impact of racism on mental and physical health. they further explain the dangerous convergence that the pandemic creates for black people. indeed, both historically and contemporarily, racial trauma needs to be addressed within the social work profession. if we do not act to dismantle racism, coloniality and white supremacy in the profession, the ongoing perpetual nature of these oppressive systems and implications for psychological injury will remain unchecked (murray-lichtman & elkassem, 2021). by centering lived realities of bipoc and writing back (ashcroft et al., 2003) to positional superiority in social work assessments, diagnoses, and interventions, social workers enable a launching pad for a new oppositional stance and the construction of new narratives of best practice with bipoc communities. the counter-narrative that unfolds by centralizing the lived experiences of bipoc, adopting racial and colonial realisms, and interrogating the systemic inequities perpetuated by white supremacy can lead to a transformative social work praxis. elkassem & murray-lichtman/mapping 639 references abrams, l. s., & dettlaff, a. 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(2013). transformation in action: approaches to incorporating race and racism into social work practice and curriculum (dissertation, university of massachusetts amherst). https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1741&context=open_acc ess_dissertations wade, f. (2021, july 6). gayatri spivak: 'the subaltern speaks through dying'. the nation. https://www.thenation.com/article/culture/interview-gayatri-chakravortyspivak/ weng, s. s., & gray, l. (2020). racial microaggressions within social work: perceptions of providers. journal of social work practice, 34(1), 67–80. https://doi.org/10.1080/02650533.2018.1553871 yee, j. y. (2005). critical anti-racism praxis: the concept of whiteness implicated. in hick, s., fook, j., & pozzuto, r. (eds)., social work: a critical turn. thompson educational publishing. author note: address correspondence to siham elkassem, rsw, department of social work at kings university college london, ontario, canada, 17551. email: selkasse@uwo.ca https://doi.org/10.1007/978-1-4419-8975-8_13 https://doi.org/10.1080/02615479.2020.1841155 https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1741&context=open_access_dissertations https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1741&context=open_access_dissertations https://www.thenation.com/article/culture/interview-gayatri-chakravorty-spivak/ https://www.thenation.com/article/culture/interview-gayatri-chakravorty-spivak/ https://doi.org/10.1080/02650533.2018.1553871 mailto:selkasse@uwo.ca _________ ijeoma nwabuzor ogbonnaya, msw, phd, associate professor, stephanie lechuga-peña, msw, phd, associate professor, tina jiwatram-negrón, msw, phd, assistant professor, felicia m. mitchell, msw, phd, watts endowed coordinator of indigenous scholarship & associate professor, chandra crudup, msw, phd, associate dean of inclusive design for equity and access & clinical associate professor, matt ignacio, mssw, phd, assistant professor, shanondora billiot, msw, phd, assistant professor, natasha s. mendoza, msw, phd, research director & associate professor, school of social work, arizona state university, phoenix, az. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 36-50, doi: 10.18060/28037 this work is licensed under a creative commons attribution 4.0 international license. improving hiring, retention, and promotion of bipoc faculty ijeoma nwabuzor ogbonnaya stephanie lechuga-peña tina jiwatram-negrón felicia m. mitchell chandra crudup matt ignacio shanondora billiot natasha s. mendoza abstract: social workers are responsible for dismantling systems of oppression, promoting equity and inclusion, and creating and implementing just systems. yet, the structural inequities that disadvantage historically marginalized populations, including bipoc (black, indigenous, and people of color) populations, continue to be embedded into the very thread of social work practice, education, and research. using critical race theory, we discuss how race and racism lead to the undervaluing of bipoc scholarship and how bipoc scholars with intersecting identities are doubly undervalued. we provide empirical evidence and case examples that illustrate undervalued bipoc scholarship and its ongoing impact on the oppression and disempowerment of bipoc scholars within academia, specifically in the areas of hiring, retention, and promotion of bipoc faculty. we end with recommendations for addressing these areas of oppression, such as convening a multi-university effort to rethink promotion criteria for scholars engaged in diversity, equity, and disparity work. such an effort could have implications for promoting social work scholars, many of whom are bipoc. we hope this paper initiates timely and essential discussions, leading to new, anti-racist practices in hiring and retaining bipoc faculty and evaluating bipoc scholarship and related teaching and service. keywords: bipoc, racism, critical race theory, intersectionality, racial/ethnic disparities, tenure and promotion research demonstrates glaring disparities in rates of white and bipoc (black, indigenous, and people of color) faculty by academic rank. these disparities are even more apparent as faculty move across the tenure line and when disaggregated by gender. in fall 2022, among full-time faculty in postsecondary institutions with reported race/ethnicity, black and latina women represented 5% and 4% of assistant professors, respectively, and each represented only 2% of full professors (institute of education sciences, 2025). black and latino men each comprised 3% of assistant professors; black men represented 2%, and hispanic men represented 3% of full professors. asian men and women each comprised 7% of assistant professors, and 9% and 4% of full professors, respectively. regardless of gender, pacific islander, american indian/alaska native, and mixed-race (two or more races) faculty made up 1% or less of assistant and full professors. conversely, white men and women comprised nearly three-quarters or more of tenure-line faculty positions: 30% of assistant professors were white men, and 38% were white women; 49% of full professors were white men, and 28% were white women. about:blank ogbonnaya et al./improving retention 37 despite emphasizing social justice and equity (council on social work education [cswe], 2021), schools of social work (ssw) are beset with similar racial disparities. the most recent available cswe (2023) estimates revealed that more than half (59.1%) of fulltime faculty members are white, 19.5% african american/black, 1.2% american indian/alaska native, 7.8% asian, 8.3% hispanic/latinx, and 1.4% two or more races. although these data were not disaggregated by tenure-line/status group or gender, given the disparities in the larger context of academia described above, we argue that similar racial/ethnic disparities also exist in ssw when comparing tenure-line faculty by tenure status and gender. the disproportionally lower rate of bipoc faculty relative to white faculty in academia leads to tokenism (niemann, 2016), helping to maintain racial and ethnic disparities in ssw (azhar & mccutcheon, 2021) and silencing or excluding the voices of bipoc scholars (molina, 2008). when tokenized, bipoc faculty are seen first for their race/ethnicity and second as peers or academics (mcgee et al., 2021). furthermore, as tokens, bipoc faculty members must work harder to gain recognition and respect from their white colleagues and prove their qualifications for promotion and tenure (niemann, 2016). tokenism experienced by bipoc faculty may result in feelings of isolation, alienation, and resentment (antonio, 2002; brayboy et al., 2012; porter et al., 2020) and impact bipoc faculty’s recruitment and retention, preventing them from entering or eventually leaving academia altogether (baez, 1998; griffin et al., 2011). tokenism affords racial stereotypes and microaggressions (azhar & mccutcheon, 2021). constant exposure to racism and racial microaggressions can produce race-related stress or “racial battle fatigue” among bipoc faculty (arnold et al., 2016; louis et al., 2016). the high effort exerted by bipoc faculty to actively cope with chronic exposure to racial discrimination, also known as john henryism (james, 1994; rolle et al., 2021), comes at the expense of their mental (e.g., depression) and physical (e.g., hypertension) health. john henryism also promotes imposter syndrome, a feeling of “being an imposter in higher education” (woldai, 2021, p. 1), and can lead to burnout or loss of focus (rolle et al., 2021). these effects can be more debilitating when one is of solo status or the only member of one’s racial group in a department (sekaquaptewa, 2014). applying the double or triple jeopardy hypothesis (king, 1988), the adverse effects of racism experienced by bipoc faculty in predominantly white institutions (pwis) increase if occupying two or three marginalized statuses than if occupying one. thus, to help combat the racism experienced by bipoc faculty, we, a group of bipoc faculty, school, and college leaders who primarily identify as women, offer a paper discussing the critical need for ssw to better support bipoc faculty throughout their careers. drawing on critical race theory’s (crt; bell, 1995; crenshaw, 1989; ladsonbillings, 2013; ladson-billings & tate, 1995) tenets of racism as endemic, intersectionality, and counter-narratives, we provide examples based on our personal experiences and research evidence (see table 1) of how race and racism impact bipoc faculty, and particularly, tenured/tenure-track (t/tt) faculty in pwis (i.e., the academy) and lead to being undervalued and overburdened. we end with recommendations for addressing these areas of oppression by improving the hiring, retention, and promotion of bipoc t/tt faculty. advances in social work, spring 2025, 25(1) 38 table 1. examples of how race and racism impact bipoc faculty in pwis and recommendations to address these areas of oppression examples recommendations h ir in g ● indirectly excluding bipoc scholars from hiring, promotion, & tenure decisions due to policies that do not allow non-tenured faculty to be part of these decisions ● hiring bipoc faculty to fulfill diversity initiatives without providing retention support ● low rates of bipoc scholars in high-ranking social work positions (e.g., few bipoc deans, directors, & journal editors) ● create job announcements that are transparent about why bipoc faculty are needed (e.g., “seeking faculty who have extensive lived, practice, & research experience with populations of the southwest"). do not use coded language such as “diversity.” ● hire more bipoc faculty across all rankings & levels, not solely as assistant professors. such constellation hires go one step further than cluster hires by creating webbed support systems for bipoc faculty. ● hire an external advisory board composed of bipoc scholars & community representatives to inform hiring decisions & hold ssw accountable for decisions r et en tio n ● tokenismseen first for race/ethnicity & second as academics; attributed to historic exclusion of bipoc faculty o leaving the academy o silenceddifficulty speaking out or going against social (white) normative expectations in academia; if they do, they face taxation ● john henryismhigh effort exerted by bipoc faculty to actively cope with chronic exposure to racial discrimination o poor physical & mental health o burnout o imposter syndrome ● design formal, structured, & strong mentoring programs designed for bipoc faculty, including racial/ethnic-specific programs ● require ongoing training on racism & contending with its effects on well-being & equitable practices in academia, including implementation of ongoing evaluation & performance systems that examine their impacts. ● educate doctoral students on the “taxation” bipoc scholars encounter when matriculating & working in a pwi ● educate doctoral students on how to navigate pwis as a bipoc ● provide bipoc faculty a safe space (virtual or physical) to discuss racial discrimination & stress & rejoice in bipoc success te ac hi ng ● lack of bipoc scholarship & writings used in social work courses ● student evaluations consisting of gender & racial bias, especially when teaching race-focused courses ● require pedagogical development to facilitate teaching outside of traditional white-centric perspectives, including how to engage in critical conversations using scholarship produced by bipoc scholars ● adjust teaching evaluation scores by giving less weight to scores associated with race-focused courses & instructors with one or multiple marginalized identities (e.g., bipoc & women) ● do not overburden faculty of color with race-focused courses. rotating how often & how many race-focused courses bipoc faculty teach can help to account for the emotional/psychological tax & evaluation consequences associated with teaching these critical courses se rv ic e ● overburdening bipoc faculty with diversity, equity, & inclusion-related work yet failing to recognize and/or credit this work in tenure or promotion review ("invisible labor") ● disproportionate bipoc faculty: bipoc student ratio, despite bipoc students’ desire for culturally similar faculty ● use a standard set of questions to engage in self-reflection & critical thinking (e.g., via written/video entries, group discussions) about biases at the intersection of race & gender & examine how these biases might have influenced their decisions, developing practices & policies to mitigate such harm ● use a team mentoring approach, including one bipoc faculty & one non-bipoc faculty member when mentoring students to help disperse labor r es ea rc h ● failing to recognize the effort & time associated with community-based research & the impact it may have on promotion-related timelines ● prioritizing the number of publications in hiring, promotion, & tenure decisions over the time needed to engage bipoc populations in research due to historical, ethical, & cultural issues ● undervaluing publications in journals with "low" impact scores, even though journals may focus on specific bipoc populations with open access to communities & practitioners ● replace or supplement white-centric measures as indicators of scholarly success (e.g., h-index, impact factor) with metrics that account for diversity work (e.g., publications focused on race, ethnicity, racism, & diversity science; community experts; bipoc scholar mentor) ● increase the number of reviewers, including editors-in-chief, editorial board members, & ad hoc reviewers, who are bipoc & experts in bipoc-focused research ● create pilot funding to invest in bipoc scholarship note: bipoc = black, indigenous, and people of color; ssw = schools of social work; pwi = predominantly white institution ogbonnaya et al./improving retention 39 crt and bipoc tenured and tenure-track faculty the first tenet of crt we present, racism as endemic, acknowledges that race continues to be a significant factor in determining inequity in the united states (bell, 1995; ladson-billings & tate, 1995). for example, delgado bernal and villalpando (2002) argue that bipoc faculty are undervalued as a strategy to support and maintain the historical (male) white dominance and supremacy in academia. the second tenet, intersectionality, considers multiple identities such as race, gender, and class (crenshaw, 1991). it is widely accepted that bipoc women scholars experience a “double jeopardy;” they are expected to handle gender and racial inequities (turner, 2002). bipoc women faculty frequently encounter “unequal standards of having to work harder and prove themselves more” in the academy (corley, 2020, p. 1). they are presumed incompetent and must continuously demonstrate their competence and contributions (flaherty, 2019; mitchell & miller, 2011; niemann et al., 2020). the last tenet, counter-narratives, documents how oppression operates in the everyday lives of bipoc (ladson-billings, 2013; ladson-billings & tate, 1995) and how bipoc faculty experience invisibility and hypervisibility within the academy (settles et al., 2019). in particular, bipoc women faculty members have shared their experiences with microaggressions and tokenism, finding the academic environment to be competitive, isolating, and lacking a sense of community (cooke, 2014; jackson et al., 2022; ponjuan et al., 2011). tenure and promotion issues related to problematic and pathological environments are compounded when bipoc faculty seek promotion and tenure (pt). t/tt faculty are expected to fulfill teaching, service, and research obligations to achieve pt. many schools use student evaluations to assess teaching. however, these evaluations consist of gender and racial bias (anderson & smith, 2005; huston, 2005), contributing to the career advancement gaps between bipoc and white faculty (mendez & mendez, 2018). biased student evaluations are particularly risky for bipoc social work faculty who teach race-focused courses (perry et al., 2015). students, especially white students, are more likely to prefer white faculty and assume they are more competent than bipoc faculty (mendez & mendez, 2018). although teaching is not always heavily weighted in pt decisions, particularly at researchintensive universities, bipoc faculty members might face a “retaliation tax,” in which their teaching evaluations are weighted more heavily than those of white faculty and used to retaliate by denying tenure or merit-based raises (arnold et al., 2021). additionally, bipoc faculty, especially women, are frequently overburdened with service responsibilities (domingo et al., 2020) compared to their white male colleagues (social sciences feminist network research interest group, 2017). bipoc faculty must manage the cultural taxation (padilla, 1994) associated with being one of the few or sole bipoc faculty members identified to address their school’s diversity-related issues and the growing diverse student body (hirshfield & joseph, 2012; law et al., 2019; rideau, 2021; sekaquaptewa, 2014). this extra work often becomes "invisible labor,” unaccounted for in pt decisions (beeman, 2021; porter et al., 2020; reid, 2021; rucks-ahidiana, 2019). bipoc faculty who decline excess service incur a “group status tax” (arnold et al., 2021); advances in social work, spring 2025, 25(1) 40 they are viewed as not being “nice” or “collegial,” and those who participate may still be marginalized for speaking their mind rather than passively accepting their white colleagues' idea (molina, 2008), which serves to silence bipoc colleagues. moreover, some bipoc faculty opt not to decline additional service roles for fear of retaliation (arnold et al., 2021). research productivity is judged on quality, quantity, and visibility (hodge et al., 2020). the assumption is that more citations indicate better quality work, and one's work is more likely to be cited if published in prestigious or highly visible ("high impact") journals (hodge et al., 2021). pt and hiring committees use citation-based metrics to assess research quality and visibility (e.g., h-index, impact factors; allen et al., 2017; seipel, 2003). however, citation-based metrics may undermine bipoc scholarship, hindering the success of bipoc faculty in the pt process. bipoc scholars have fewer publications and lower h-index figures than white scholars due to systemically racist practices, such as not being cited as frequently or included as an author in publications, limited funding, and lack of mentorship (hopkins et al., 2013; mcfarling, 2021). further, many bipoc faculty engage in research focused on bipoc communities (madyun et al., 2013; matthews et al., 2021). however, bipoc-focused journals (e.g., journal of indigenous social development, hispanic journal of behavioral sciences) are typically not considered "high impact" or prestigious (hall & maramba, 2001). thus, bipoc faculty must sometimes choose between publishing in more mainstream journals versus those more relevant to their work (arnold et al., 2021). scholars conducting bipoc-focused research might also face a “leading edge tax,” receiving fewer rewards for their research if it is bipoc-focused (e.g., less funding). further, they may incur a “credibility tax,” in which the credibility or legitimacy of their research is questioned due to their epistemological perspectives (arnold et al., 2021). the dominant view is that the most rigorous science is objective, using methods aligned with causal principles (e.g., randomization) and testing the cause-and-effect relationship between variables (granger, 1980; langley et al., 2019). although some bipoc faculty conduct research aligned with these epistemological assumptions, many use methods that give voice to marginalized populations (e.g., qualitative methods, community-based participatory research; delgado bernal & villalpando, 2002; matthews et al., 2021). these methods require more time and effort due to the historical, ethical, and cultural issues faced by marginalized groups, as well as the complexities involved in community-research partnerships (wilson et al., 2018). furthermore, social bounds define white men as the prototype full professor (reid & curry, 2019), privileging them as gatekeepers and supporting their conscious and unconscious exclusion of bipoc scholars from positions of power (gonzales, 2018; lamont & molnár, 2002). for example, researchers with a history of funding are more likely to get funded than those without (ginther et al., 2012). consequently, white researchers have an advantage over bipoc scholars when competing for funding, particularly funding from the national institutes of health (nih). white researchers are twice as likely to receive nih funding as black researchers (ginther et al., 2011; hoppe et al., 2019). new initiatives must address this disparate treatment and the other forms of ogbonnaya et al./improving retention 41 systemic racism that permeate academia and negatively influence bipoc faculty careers. as such, we provide the following recommendations for ssw. recommendations for decreasing racial and ethnic inequities among ssw faculty although the social work field has acknowledged the disparate treatment and outcomes of bipoc scholars (e.g., holosko et al., 2018; mcmahon & allen-meares, 1992; schiele & hopps, 2009; university of houston, 2021), we are a long way from addressing these inequities. as teasley et al. (2021) state, “the grand challenge to eliminate racism calls for the social work profession to focus on the centrality of racism and white supremacy. . .” (p. 1). institutional-level efforts to eliminate racism (e.g., changes in productivity metrics, recruitment, and pt guidelines) are necessary for long-lasting changes that support the hiring, retention, and promotion of bipoc faculty (bryson et al., 2024; diaz et al., 2020; rabinowitz & valian, 2022). one hurdle to eliminating racism is using white-centric measures as indicators of scholarly success. such measures often discount bipoc scholarship. ssw must make the "invisible labor" of bipoc faculty visible by transforming how decisions are made regarding what constitutes valuable scholarship. in addition to recognizing and weighing invisible labor with students and diversity-related initiatives, indicators of research quality should account for bipoc-related domains, including time-intensive research methods often used by bipoc scholars and work published in bipoc-focused journals. other disciplines have already begun discussing ways to redesign scientific assessments to account for diversity work. for example, buchanan et al. (2020) propose using a diversity accountability index for journals. this index includes benchmarks for ensuring that psychology journals promote bipoc research (e.g., publications focused on racism and diversity science; bipoc scholar mentor). building on buchanan and colleagues’ (2020) idea, we propose that social work researchers develop and test diversity metrics to assess research productivity and that social work journals report these metrics. the social work research community can utilize these metrics in place of, or in combination with, existing measures to assess scholarly impact in more culturally responsive ways (huggins-hoyt, 2018). however, similar to what happened when nih increased funds for health equity research (mcfarling, 2021), we caution that these diversity metrics could inadvertently lead to social work scholars who never focused on bipoc populations doing so solely to advance their careers. thus, if using these metrics, it is imperative that social work journals also increase the number of reviewers, including editors-in-chief, editorial board members, and ad hoc reviewers, who are bipoc and experts in bipoc-focused research (watts, 2021). additionally, social work journals can require authors to include a “community statement.” this statement or letter of support should describe the potential impact of the bipoc-focused research from the perspective of a bipoc community member sharing characteristics like those of the participants involved in the research. doing so could further help validate the research's impact on bipoc populations. ssw must also employ an intersectional lens to account for the disparities between bipoc t/tt women faculty and their white counterparts. for example, if using student advances in social work, spring 2025, 25(1) 42 evaluations, ssw pt committees should adjust evaluation scores, giving less weight to scores associated with race-focused courses and instructors with one or multiple marginalized identities (e.g., bipoc and women). additionally, using standard questions, ssw pt and hiring committee members should engage in self-reflection and critical thinking (e.g., via written/video entries, and group discussions) about their biases at the intersection of race and gender and examine how these biases might have influenced their decisions, developing practices and policies to mitigate such harm. finally, ssw must value the lived experiences and narratives of bipoc t/tt faculty who have historically been marginalized and excluded in the academy. while counternarratives highlight our own racial and gender oppression in the academy, they are provided to address broader social justice issues in social work to help our profession consider how to value and honor bipoc faculty. to give voice to bipoc faculty, ssw must hire and retain more bipoc faculty across all rankings, not solely as assistant professors (watts, 2021). doing so can also reduce the burdens associated with tokenism and the burden of being solo status. being hired with tenure, especially as a full professor or dean/director, gives bipoc faculty more power and may have significant implications for the career progression of bipoc tenure-track faculty (ogbonnaya et al., 2023). with more power comes more opportunities to lead decision-making bodies (e.g., chair hiring committees). additionally, given the job security associated with tenure, bipoc faculty may feel safer speaking out against school policies and practices that negatively impact the bipoc community. ssw aiming to hire more bipoc faculty should avoid inherently biased recruitment strategies (e.g., based on the number of publications, funding, and graduate school). for example, in addition to using a diversity metric like the one described above, hiring committees should hire an external advisory board composed of bipoc scholars and community representatives to inform hiring decisions and hold them accountable for their choices (campos, 2021). further, job announcements should avoid coded language such as “diversity” (sensoy & diangelo, 2017). rather, announcements should speak to the merit and qualifications of potential bipoc candidates. for example, highlight the diverse perspectives that are missing at the school and explain why these perspectives are necessary. being transparent about why bipoc faculty are needed can help candidates assess the potential diversity-related challenges they may experience if hired and, based on this assessment, determine if the school is a good fit for them. it may also help current faculty value the open position more, improving their chances of respecting the bipoc candidate as someone qualified and vital, rather than as merely hired to fulfill a diversity need. to appropriately support bipoc faculty once hired and improve their long-term retention chances, ssw must also transform their organizational culture into one that is supportive of bipoc faculty. supporting bipoc faculty means taking active steps to tangibly value and promote their scholarship, while also improving school culture, practices, and policies. “diversity” hires are not enough to shift the racial and gendered power dynamics in academia from one that favors whiteness and maleness /misogyny to one that is inclusive (smith & mayorga-gallo, 2017). ogbonnaya et al./improving retention 43 standardized anti-racist policies and practices are essential for holding ssw and their employees accountable for racism. for example, all employees should be required to participate in ongoing training on racism and contending with its effects on well-being and equitable practices in academia (watts, 2021). to ensure that what is taught is implemented, this training should be paired with ongoing, annual performance evaluations related to the training content. additionally, pedagogical development is required to facilitate teaching outside of traditional white-centric perspectives, including how to engage in critical conversations using scholarship produced by or about bipoc. doctoral students should be taught to navigate pwis based on their race/ethnicity and educated on the “taxation” bipoc scholars encounter when matriculating and working in a pwi (jackson et al., 2022; outlaw, 2021). recognizing that racial inequalities exist in federal grant funding distribution, ssw should create a pilot funding program to invest in bipoc scholarship and mechanisms for ongoing support, thereby increasing the chances that larger funding agencies will fund and continue funding this work after the pilot is complete. such support may include assistance with marketing and promoting the pilot work, cultivating relationships with funders, identifying potential co-investigators, and framing or reframing research that is typically resisted by white academics, without altering or compromising the primary research interests and aims. ssw must not confuse john henryism with resilience or strength, as the long-term health effects of john henryism are detrimental and could lead to premature death (zambrana, 2018). thus, prevention and intervention are necessary to address john henryism. at the institutional level, ssw can help bipoc faculty cope with john henryism by providing a safe space (virtual or physical) to discuss racial discrimination and stress (palfrey, 2017). we define safe spaces as environments where bipoc faculty are comfortable sharing their experiences because they trust that what is shared in the space will not lead to negative repercussions and will remain confidential. recognizing that trust is something that is developed over time and dependent on past experiences, ssw may help foster this trust by creating policies that protect bipoc scholars against potential retaliation associated with sharing their experiences of racism in academia and hiring leaders who are willing to address concerns of racism or discrimination shared by bipoc faculty (e.g., lin & kennette, 2022). disclosing experiences of racism can improve physical health, especially among black women (lu et al., 2019). additionally, azhar and mccutcheon (2021) recommend creating a space to celebrate the success of bipoc faculty. this form of recognition may help bipoc faculty cope with impostor syndrome. at the individual level, bipoc faculty can cope with racism in the academy by being resilient; challenging ways of thinking about race; mentoring doctoral students and junior faculty of color to help their future success; finding internal and external support from other faculty of color; separating personal from professional life; and praying and seeking spirituality and faith-based support (baez, 1998; griffin et al., 2011; louis et al., 2016; mcgee et al., 2021). bipoc faculty also need to be self-reflective of their own needs and aware of ways internalized racism may develop. ssw should incorporate formal mentoring programs designed for bipoc faculty to support these coping mechanisms. mentorship is a prominent theme in the success of bipoc faculty, increasing research productivity and bicultural competence (allen et al., advances in social work, spring 2025, 25(1) 44 2017; mendoza et al., 2019). thus, social work researchers might consider designing and testing bipoc faculty mentoring programs to ensure they are evidence-based and effective. recognizing that not all bipoc faculty experience the same challenges (e.g., anti-blackness, anti-asian, first-generation) and coping mechanisms for dealing with racism and stress differ culturally (mcgee et al., 2021), raceor ethnicity-specific mentoring programs could assist bipoc faculty with approaches for navigating pwis while simultaneously staying true to one’s identity. such programs may be even more impactful if, in addition to race/ethnicity, bipoc faculty are matched with mentors based on other shared identities (e.g., gender, sexual orientation) and interests (e.g., research topic). regarding student mentoring, we suggest a team mentoring approach involving bipoc and white faculty to help alleviate and better disperse the considerable amount of time spent by bipoc faculty mentoring bipoc students (brunsma et al., 2016). if this approach is used, mentor training is also imperative to help faculty understand the unique challenges and barriers that bipoc students face in academia, primarily those in pwis (ocampo & blackdeer, 2022), and prevent the backlash sometimes experienced by bipoc faculty after white faculty attempt to mentor students of color (mustafa, 2023). in conclusion, a collective, multisystemic, and inter-institutional effort is needed to instill change. without critically examining and changing ssw policies, practices, and values responsible for racial/ethnic disparities in hiring, promotion, and tenure, we allow the foundation of racism to remain intact and, thereby, risk being unable to make long-term progress towards improving the experiences of bipoc faculty. organizational and institutional change must 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(2018). toxic ivory towers: the consequences of work stress on underrepresented minority faculty. rutgers university press. author note: ijeoma nwabuzor ogbonnaya, arizona state university, school of social work, university center 411 n central ave #800 phoenix, az 85004. email: iogbonna@asu.edu, fax: (602) 496-0960 acknowledgments: we wish to acknowledge drs. kelly f. jackson and david becerra for earlier insights on conceptualizing this paper. https://doi.org/10.1080/10437797.2003.10779120 https://doi.org/10.1057/9781137456069_4 https://doi.org/10.1016/j.jvb.2018.06.003 https://doi.org/10.1016/j.jvb.2018.06.003 https://doi.org/10.1177/0731121417719693 https://doi.org/10.1177/0731121417719693 https://digitalcommons.humboldt.edu/cgi/viewcontent.cgi?article=1016&context=hjsr https://digitalcommons.humboldt.edu/cgi/viewcontent.cgi?article=1016&context=hjsr https://digitalcommons.humboldt.edu/cgi/viewcontent.cgi?article=1016&context=hjsr https://doi.org/10.1093/oso/9780197608043.003.0027 https://doi.org/10.1080/00221546.2002.11777131 https://www.youtube.com/watch?v=ouh2drnzpne https://www.youtube.com/watch?v=ouh2drnzpne https://www.healthaffairs.org/do/10.1377/forefront.20210125.666787/full/ https://www.healthaffairs.org/do/10.1377/forefront.20210125.666787/full/ https://doi.org/10.1177/1049732317690721 https://doi.org/10.1177/1049732317690721 https://emorywheel.com/black-women-in-higher-education-a-reflection-on-inequity-and-injustice/ https://emorywheel.com/black-women-in-higher-education-a-reflection-on-inequity-and-injustice/ https://doi.org/10.36019/9780813593012 https://doi.org/10.36019/9780813593012 mailto:iogbonna@asu.edu _________ alicia tetteh, dsw, lcsw, assistant professor, school of social work, norfolk state university, norfolk, va. kalisha smith, dsw, lcsw, casac-m, doctoral lecturer, lehman college, city university of new york, bronx, ny. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 640-650, doi: 10.18060/28625 this work is licensed under a creative commons attribution 4.0 international license. enhancing belonging, access and opportunity in the social work licensing and credentialing process alicia tetteh kalisha smith abstract: this paper examines the critical need for enhancing belonging, access, and opportunity within the social work licensing and credentialing process. recent analyses have revealed significant disparities in pass rates for licensing exams among underrepresented groups, including african american, latinx, and older social work candidates. these inequities raise ethical concerns and challenge the foundational values of the social work profession, which is rooted in principles of social justice and empowerment. by analyzing structural barriers and biases within the licensing process, this paper identifies key areas for reform, including the need for inclusive exam content, cultural competence training for test developers, and comprehensive support systems for non-traditional candidates. furthermore, the paper explores how technology and artificial intelligence can play a transformative role in addressing dei issues, such as bias detection, personalized learning experiences, and improved accessibility for diverse candidates. ultimately, the paper argues that a commitment to dei in the licensing process is not only a moral imperative but also essential for fostering a social work profession that truly reflects and serves the diverse communities it aims to support. by implementing targeted reforms and leveraging technological innovations, the profession can advance its ethical mission and promote equity on the path to licensure. keywords: social work licensure, licensure reform, equity and inclusion, ethics licensing and credentialing of social workers has been an ongoing topic of discussion since the release of the association of social work boards (aswb) pass rate analysis in 2022. according to the aswb 2022 report, the overall pass rate for the social work licensing exam was 75% for first-time test-takers (aswb, 2022). however, pass rates varied significantly among racial and ethnic groups, with african american candidates having a pass rate of around 60%, while white candidates passed at a rate of approximately 82% (aswb, 2022). while the social work profession is grounded in principles of social justice, equity, and inclusion, more recent research has challenged the profession's stance. significant concerns have been raised regarding the social work licensing and credentialing process, particularly its impact on underrepresented groups. the social work profession is responsible for holding all relevant stakeholders accountable for their participation in structural systems of oppression. it is the goal that the social work profession will work persistently to address these challenges. research indicates that african american, latinx, and older social work candidates have lower pass rates on licensing exams compared to their white counterparts, highlighting potential inequities in the system (kim, 2022). furthermore, microaggressions and racial privilege in the exam process contribute to these disparities, further about:blank tetteh & smith/dei in swk licensing & credentialing 641 marginalizing candidates from underrepresented backgrounds (castex et al., 2018). ethical concerns surrounding these inequities call for a re-examination of the licensing process to ensure integrity and fairness (joseph, 2024). there is an urgent necessity to investigate methods for revealing these discrepancies and to analyze solutions that promote reassurance in deconstructing the injustices associated with social work licensing examinations. ethical implications the commitment to diversity and inclusion in the social work licensing and credentialing process is deeply rooted in the core ethical principles and values outlined by the national association of social workers (nasw) code of ethics (nasw, 2021). these principles not only guide practitioners in their daily work but also serve as a foundation for creating a more equitable and just system within the profession. the ethical principle of service emphasizes the importance of putting others’ needs first, particularly those who are vulnerable or oppressed (nasw, 2021). in the context of the licensing exam, this principle calls for a process that acknowledges and supports candidates from diverse backgrounds, ensuring they have the resources and opportunities to succeed. by prioritizing the needs of underrepresented groups, the profession can better fulfill its mission of serving all individuals and communities. a cornerstone of social work ethics, the principle of social justice, compels social workers to challenge social injustices and advocate for marginalized populations (nasw, 2021). the licensing exam should reflect this commitment by eliminating biases and barriers that disproportionately affect candidates of color, economically disadvantaged individuals, and other marginalized groups. ensuring fair access to licensure is a critical step in promoting equity within the profession and the communities it serves. this ethical value underscores the importance of respecting the inherent dignity and worth of all individuals. in the licensing process, this principle supports the need for a fair evaluation that recognizes the diverse experiences and backgrounds of candidates. a culturally competent examination process respects candidates as whole individuals and affirms their right to equitable treatment and opportunity. social workers are expected to act with integrity, demonstrating honesty and transparency in their practices. the current disparities in licensing exam pass rates raise ethical concerns about the fairness and transparency of the exam process. by addressing biases and ensuring that the exam accurately measures competence, licensing boards can uphold the integrity of the profession and the trust placed in it by society. the principle of competence requires social workers to maintain and enhance their professional knowledge and skills. in the context of the licensing process, this entails ensuring that the exam adequately prepares candidates to meet the needs of diverse populations. by incorporating culturally relevant content and assessing real-world skills, the exam can better evaluate candidates' readiness to serve in a diverse society (nasw, 2021). advances in social work, summer 2025, 25(2) 642 disparities in the licensing process although the social work profession is grounded in principles of empowerment of individuals who are oppressed, the licensing exam contradicts these sentiments. social work students that come into the field from communities that are disproportionately affected by poverty often seek social work licensure to escape oppression. unfortunately, for many the licensing exam exists as another roadblock due to bias and various disparities. according to joseph (2024), it is critical to address not only the structural barriers that create inequities in the licensing process, but also the ethical obligations of licensing bodies to maintain fairness, transparency, and integrity in the development of exams. social work graduates from communities that are economically disadvantaged are repeating the licensing exam multiple times and consequently bear the financial burden of the cost each time (nienow et al., 2022). many of these individuals are from specific racial and ethnic minority groups which are already plagued with societal challenges. the lack of fairness in access to licensure undermines the ethical foundations of the profession, and it calls for reforms that prioritize equity for all candidates. historically, restrictions on the licensing exam pass rate data have sparked concerns about racial inequities due to the lack of transparency (nienow et al., 2022). we cannot address inequities without understanding their underlying causes. social workers of color are experiencing challenges at an alarming rate, as the licensing exam pass rate data revealed (bloxom & anderson, 2024). individuals from traditionally marginalized communities continue to face barriers due to racially biased licensing exams. beyond culturally biased exam questions, additional barriers and challenges exist, including stereotyping, limited access and limited means to afford test preparation resources, and systemic educational inequities (wasserberg, 2017). additionally, according to the research, the aswb licensing exam is implicitly traumatizing and oppressing individuals from under-resourced communities who strive to obtain a college degree and pass the required exams to improve their circumstances (bloxom & anderson, 2024). specifically, black social workers experience racism at an alarming rate in the profession and have been met with ongoing workplace inequities, even with the attainment of a college degree (beadlescomb, 2019; obasi, 2021). although students from diverse backgrounds complete their social work degrees, there is still a hurdle to overcome with the licensing exam. apgar and nienow (2023) acknowledge the licensing examination for social workers as a mechanism for gatekeeping in the social work profession, however, the aswb falls short at ensuring the exam is adequately measuring competence of individuals who pass. castex et al. (2018) discusses the licensing exam through the lens of a critical race theorist and acknowledges the aswb licensing exam as a “racial societal barrier” (p. 215). the aswb is tasked with ensuring exam questions are analyzed for bias and any potentially biased questions are supposed to be removed (nienow et al., 2022). beadlescomb (2019) encourages empowerment theory as a means of fostering inclusion in social workspaces, particularly in academia. however, it is important to also recognize areas of professional development, including licensing test preparation, as a space to foster inclusion in navigating differences in learning styles and testing styles (beadlescomb, 2019). tetteh & smith/dei in swk licensing & credentialing 643 licensing remains a hindrance for social workers who graduate from accredited institutions but are unable to perform in the field without passing the requisite examination for licensed status (apgar, 2022). moreover, the ongoing investigation into the disparities between social work educational programs accredited by the council on social work education (cswe) and the licensing examination endorsed by the aswb underscores the inconsistencies within the profession, as graduates of accredited programs may not be adequately prepared to succeed in their licensing examination. regrettably, it remains true that there is no clear correlation between the accreditation of social work education and social work licensure examinations (nienow et al., 2022). social work programs require enhanced checks and balances to establish criteria pertinent to the social work exam, thereby adequately preparing graduates for licensure, as this remains a prerequisite for demonstrating minimum proficiency in the profession. alternative measures are needed to address the continued disparities in the licensing and credentialing process for social workers. practice implications while the emergence of research related to bias in the social work licensing and credentialing process continues to reinforce structural concerns in the social work profession, reformation is essential. one of the most critical areas of reform is ensuring that the content of social work licensing exams reflects the diverse populations social workers serve. current exams often emphasize western models of practice and theory, which may not resonate with candidates from different cultural or socioeconomic backgrounds. using an intersectional lens can aid test takers in becoming more aware of inequities that are based on intersecting experiences of oppression and begin deconstructing oppressive systems (bloxom & anderson, 2024). as addressed below, various scholars explore strategies that support the enhancement of diversity, equity and inclusion in the social work licensing and credentialing process. diversifying test content one strategy for licensing bodies is to diversify exam content to ensure it is more inclusive by incorporating questions that reflect the diverse cultural, racial, and socioeconomic contexts in which social workers practice. this could include scenarios that explore different cultural approaches to mental health, family dynamics, and community support. additionally, the exam can incorporate scenarios that align with social justice concerns that may be unique to specific communities that have experienced disadvantages due to racial or economic injustices. such inclusiveness in exam content would not only make the exam more relevant for a broader range of candidates, but also better prepare social workers to address complex social justice issues and serve diverse clients (quzack et al., 2021). advances in social work, summer 2025, 25(2) 644 cultural competence training for test developers ensuring that test developers and item writers are trained in cultural competence is another important strategy. having exam questions written and reviewed by individuals with expertise in diversity, equity and inclusion is one step in the process towards potentially reducing biased or culturally insensitive questions. this could help eliminate test items that unfairly disadvantage candidates from underrepresented groups (castex et al., 2018). individuals from communities that are traditionally marginalized may be plagued with trauma that impacts their ability to test or may encounter triggers during testing due to stigmatizing or discriminatory test questions. therefore, by ensuring test developers are culturally aware of bias and microaggressions that could develop during the creation of test items, these questions and answers can be acknowledged as inappropriate and removed. ethical concerns arise when licensing exams fail to account for the diverse realities of practice. the aswb has an ethical obligation to ensure equity in licensure exams and to ensure exam content is relevant, accessible, and fair to all candidates, regardless of their background (joseph, 2024). support for non-traditional and underrepresented candidates non-traditional students and those from underrepresented groups often face unique barriers in preparing for and passing the social work licensing exam (miller et al., 2015). these candidates may include older individuals, people of color, immigrants, and firstgeneration college students, all of whom may face financial, technological, or linguistic challenges. offering test preparation and licensing examinations in additional languages will aid in the expansion of accessibility and inclusivity. currently, the aswb only offers the social work licensing examination in english. test takers can complete an accommodation form for additional exam testing time and to allow the use of a bilingual word-to-word dictionary without definitions (aswb, 2025). however, if diversity and equity are to be respected, the exam should be available in other languages. for candidates for whom english is not a first language, offering exams in multiple languages or providing linguistic support could significantly improve access. similarly, accommodating individuals with disabilities through specialized testing environments or extended time limits is essential for ensuring fairness and equity in the licensing process (lovett, 2021). ethically, ensuring that all candidates have access to the resources they need to succeed in the licensing process is a core principle of fairness. without this support, many candidates from underrepresented backgrounds are unfairly disadvantaged (joseph, 2024). affordable and accessible test preparation the financial obligation of funding licensing examination preparation and the licensing process several times per licensure level can result in an overwhelming load. wilfong (2024) discussed the pay inequalities in the social work profession and need for reform. an individual who has been in the field for several years may have the financial resources to cover the cost of the exam. however, the cost could be a barrier for new graduates and tetteh & smith/dei in swk licensing & credentialing 645 entry level social workers. there could be a scholarship offering if test takers are experiencing financial hardship. providing affordable and accessible test preparation resources is crucial for leveling the playing field. licensing boards, social work organizations, and nonprofit organizations could partner with educational institutions to offer low-cost or free study materials, tutoring, and workshops specifically geared toward candidates from underrepresented groups and integrated into the social work curriculum (miller et al., 2015). this will also eliminate the need for external funds to pay for test preparation as it will be embedded in the current tuition cost. online resources and virtual preparation programs would also ensure that individuals from rural areas or those with time constraints can access support. ultimately, exploring various methods of test preparation and funding to alleviate the financial burden for those with financial based needs provides equitable options to address licensing and credentialing concerns. mentorship and peer support networks mentorship is defined as a two-way relationship and type of human development in which someone invests personal knowledge, energy, and time to help another person grow and develop and improve. this process is beneficial to the mentee and the mentor. the mentee can experience personal growth and development, career guidance and satisfaction, and increased academic productivity (henry-noel, 2018). mentorship programs that pair experienced licensed social workers with candidates from underrepresented groups can provide valuable guidance, emotional support, and practical tips for navigating the exam process. peer support networks, where candidates can share resources, study together, and offer mutual encouragement, can also help reduce the isolation and stress often associated with exam preparation. beadlescomb (2019) acknowledges the perspective of social work students who have experienced leaders in the social work field as mentors. black students traditionally report feeling supported having instructors and mentors that are from similar racial backgrounds and being motivated to continue towards completion of their social work degrees and licensure (beadlescomb, 2019). developing mentorship programs that pair seasoned professionals with entry-level social workers pursuing licensure can facilitate a smoother navigation of the licensing and credentialing process for unlicensed social workers. addressing bias and structural inequities the council on social work education (cswe) has standards for every accredited social work education program in order to ensure consistency across the profession with what each social worker should learn. surveying past test takers to explore their experiences and understand their needs can be helpful in ensuring the strategies and solutions to address some of the systemic barriers are impactful. research shows that structural inequities, including racial bias and socioeconomic barriers, disproportionately affect candidates from marginalized groups. addressing these issues requires a comprehensive review of both the exam itself and the broader credentialing process. since 2022, three states have eliminated examinations as a prerequisite for social work license, advances in social work, summer 2025, 25(2) 646 and research has not indicated an increase in ethical violations among social workers who attained licensure without passing the aswb exam (apgar & nienow, 2023). this means, there is room to explore shifting from capitalistic ideals that reinforce structures of oppression and navigating towards true competency-based assessments that acknowledges application of social work skills in real time. bias audits of licensing exams licensing bodies should regularly conduct bias audits of their exams to identify and eliminate any questions or formats that disproportionately disadvantage candidates from certain backgrounds. these audits could involve analyzing pass rates by race, gender, and socioeconomic status, as well as reviewing the exam content for potential bias (m. p. decarlo, 2021). additionally, when adding new exam content writers, there should be a process developed to ensure the individuals self-assess their individual biases and are committed to creating examination questions that do not continue to reinforce structural bias. by using data-driven approaches to detect inequities, licensing organizations can develop more inclusive and fair exams. competency-based assessments the aswb has professed the disconnect between the licensing exam and the cswe social work competencies, admittedly stating the lack of a correlation between social work competencies and examination questions. in addition to modifying the current exam structure, there has been growing advocacy for moving toward competency-based assessments that prioritize practical, real-world skills over memorization of theoretical knowledge (apgar & luquet, 2022).competency-based evaluations would focus on how well candidates can apply their social work training in diverse settings, ensuring that future social workers are equipped to meet the complex needs of their clients. like validity testing of evidenced based practices using recording and consultation, the profession can require validity testing of concepts, theories and interventions learned in academic social work programs. building a more inclusive profession the goal of enhancing diversity, equity, and inclusion in the licensing and credentialing process is to create a more inclusive and representative social work profession. by addressing barriers to licensure, we can ensure that social workers from all backgrounds are given an equal opportunity to enter the field and contribute to the profession. efforts to reform the licensing process should be part of a broader commitment to promoting equity within the profession, including recruitment, mentorship, and ongoing professional development opportunities for social workers from underrepresented groups. as highlighted by joseph (2024), a profession that upholds integrity, fairness, and equity at every step of the credentialing process is essential for advancing social justice. as a profession, it is the ethical duty to ensure inequities are challenged, including within the tetteh & smith/dei in swk licensing & credentialing 647 licensing and credentialing process. curriculum, practicum experiences, and ongoing professional development opportunities are all opportunities for this to take place. insight from other disciplines muirhead et al. (2022) explored diversity in nursing and challenges in their licensure exam. it was identified that not only in nursing but also in the medical licensing exam and in the pharmacist exam, white students score consistently higher than non-white students. a recommendation provided was to compare curriculum and licensure preparation at historically black colleges and universities (hbcus) and predominantly white institutions (pwis) to help target and explore the inequities. there is also the identification of generational patterns of systemic barriers, upward mobility and inequity when analyzing scores of standardized testings. specific factors impacting disparate test scores that are more connected to the mental health of examination takers include testing anxiety, test taking ability, not having the time to prepare due to other life commitments, and a tendency for students to perform based on the expectations of themselves. research from the journal of teaching and learning indicates that 15-22% of students experience test anxiety, with a greater risk on first generation students, which can significantly impact performance on standardized tests (spadafora et al., 2020). the nursing profession has implemented several reforms to address disparities in licensure exams. for example, the national council of state boards of nursing has introduced alternative pathways to licensure for candidates who may struggle with traditional testing methods. this has resulted in improved pass rates among diverse candidates (muirhead et al., 2022). a study analyzed the pharmacy licensing exam and found that providing exam preparation resources tailored to underrepresented groups improved pass rates by 15% among these candidates (rashrash et al., 2024). this included mentorship programs and culturally relevant study materials. in california, reforms in the counseling licensure process included the introduction of competency-based assessments that focus on realworld scenarios rather than solely theoretical knowledge. these changes were shown to reduce disparities in pass rates among minority candidates, leading to a more diverse licensed workforce (caldwell, 2023). leveraging ai and technology technology and artificial intelligence (ai) could address security for the licensure exam. mueller (2023) proposes that since manually writing questions is an extensive process, ai tools may assist in writing test items. the ai algorithms could be employed to analyze exam content for potential biases. by reviewing test questions and pass rates across different demographic groups, ai could also be employed to identify patterns that suggest unfair advantages or disadvantages. this type of analysis could allow licensing boards to efficiently refine exam questions, ensuring that they are culturally sensitive and relevant to diverse populations. regular bias audits facilitated by ai might also help maintain fairness in the testing process over time. advances in social work, summer 2025, 25(2) 648 technology can provide tailored study resources that cater to the unique needs of diverse candidates. ai-driven platforms can assess an individual's strengths and weaknesses, creating personalized learning plans that address knowledge gaps and provide targeted practice questions. this level of customization can help candidates from various backgrounds prepare more effectively for licensing exams, ultimately improving pass rates and reducing disparities. online platforms can facilitate mentorship opportunities between experienced licensed social workers and candidates from underrepresented groups. through virtual meetings, mentorship programs can offer guidance, emotional support, and practical advice on navigating the licensing process. this connection can help alleviate feelings of isolation and provide candidates with valuable insights from those who have successfully navigated similar challenges. additionally, the creation of online forums and support networks where candidates can connect, share resources, and discuss their experiences can develop communities that can provide a sense of belonging and solidarity, helping to empower individuals from diverse backgrounds as they prepare for licensure. such platforms can also serve as a space for sharing best practices and strategies for overcoming common challenges (reamer, 2023). technology can also improve accessibility for candidates with disabilities or those who are non-native english speakers. ai can enable the development of adaptive testing environments that accommodate individual needs, such as real-time translation to offer exams in multiple languages, or utilizing speech recognition for candidates with writing difficulties. these enhancements ensure that all candidates have equitable access to the licensing process. furthermore, advanced data analytics can help licensing boards track trends and outcomes related to dei initiatives. by collecting and analyzing demographic data on exam candidates, boards can identify disparities in pass rates and tailor interventions accordingly. data-driven approaches enable ongoing evaluation of the effectiveness of dei strategies, fostering accountability and continuous improvement. it is hopeful that in the future ai can be proven to be helpful in these ways. conclusion enhancing diversity, equity, and inclusion in the social work licensing and credentialing process is not merely an ethical obligation, it is essential for the integrity and future of the profession. as the social work field grapples with systemic disparities that disproportionately affect underrepresented groups, it is critical to implement meaningful reforms. by addressing the biases inherent in the licensing exams, diversifying exam content, and providing accessible resources for all candidates, we can cultivate a more equitable pathway to licensure. such efforts will not only empower aspiring social workers from diverse backgrounds but also enrich the profession, ultimately leading to more culturally competent practitioners who can better serve the communities in need. call to action we call upon policymakers, licensing boards, and educational institutions to collaborate in re-evaluating and reforming the licensing process. it is time to prioritize equity and justice in social work, ensuring that every candidate has a fair opportunity to tetteh & smith/dei in swk licensing & credentialing 649 succeed. together, let us dismantle the barriers to entry, champion inclusive practices, and commit to a future where the social work profession reflects the diversity of the populations it serves. our action today can pave the way for a more inclusive and just tomorrow in social work. references apgar, d. 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(2024). deconstructing social work exam bias: advocacy practice guidelines to close the gap. journal of evidence-based social work, 21(2), 236-264. caldwell, b. e. (2023). mental health clinical exams’ evident adherence to industry standards for testing. journal for mental health and clinical psychology, 7(3), 9-18. castex, g., senreich, e., phillips, n. k., miller, c. m., & mazza, c. (2018). microaggressions and racial privilege within the social work profession: the social work licensing examinations. journal of ethnic & cultural diversity in social work, 28(2), 211-228. decarlo, m. p. (2021). racial bias and aswb exams: a failure of data equity. research on social work practice, 32(3), 255-258. henry-noel, n., bishop, m., gwede, c. k., petkova, e., & szumacher, e. (2018). mentorship in medicine and other health professions. journal of cancer education, 34, 629-637. joseph, r. 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(2022). racial disparities in social workers’ licensing rates. research on social work practice, 32(4), 374-387. https://doi.org/10.1080/08841233.2022.2112809 https://doi.org/10.1080/08841233.2022.2112809 https://doi.org/10.1177/10497315221116123 https://doi.org/10.1177/10497315221116123 https://doi.org/10.1080/26408066.2023.2265911 https://doi.org/10.1080/26408066.2023.2265911 https://www.aswb.org/wp-content/uploads/2022/07/2022-aswb-exam-pass-rate-analysis.pdf https://www.aswb.org/wp-content/uploads/2022/07/2022-aswb-exam-pass-rate-analysis.pdf https://www.aswb.org/wp-content/uploads/2024/06/aswb-nonstandard-testing-arrangements-handbook.pdf https://doi.org/10.1080/10437797.2018.1544522 https://doi.org/10.1080/10437797.2018.1544522 https://doi.org/10.1080/26408066.2023.2278691 https://doi.org/10.1080/26408066.2023.2278691 https://doi.org/10.29245/2578-2959/2023/3.1283 https://doi.org/10.29245/2578-2959/2023/3.1283 https://doi.org/10.1080/15313204.2018.1555498 https://doi.org/10.1080/15313204.2018.1555498 https://doi.org/10.1177/10497315211055986 https://doi.org/10.1007/s13187-018-1360-6 https://doi.org/10.1093/sw/swae037 https://doi.org/10.1093/sw/swae037 https://doi.org/10.1177/10497315211066907 advances in social work, summer 2025, 25(2) 650 lovett, b. j. (2021). educational accommodations for students with disabilities: two equity-related concerns. frontiers in education, 6, 1-5. miller, j. j., grise-owens, e., & escobar-ratliff, l. (2015). preparing msw students for social work licensure: a curricular case example. journal of teaching in social work, 35(3), 296-316. mueller, l. (2023). at, chatgpt, and licensing exams. federation of state boards of physical therapy. muirhead, l., cimiotti, j. p., hayes, r., haynes-ferere, a., martyn, k., owen, m., & mccauley, l. (2022). diversity in nursing challenges with the nclex-rn. nursing outlook, 70(5), 762-771. national association of social workers. (2021). code of ethics of the nasw. author. nienow, m., sogabe, e., & husain, a. (2022). racial disparity in social work licensure exam pass rates. research on social work practice, 33(1), 76-83. obasi, c. (2021). black social workers: identity, racism, invisibility/hypervisibility at work. journal of social work, 22(2), 479-497. quzack, l. e., picard, g., metz, s. m., & chiarelli-helminiak, c. m. (2021). a social work education grounded in human rights. journal of human rights and social work, 6(1), 32-40. rashrash, m., faruk khan, m. o., & sawesi, s. (2024). impact of curricular and institutional factors on pharm.d. students’ naplex success: a comprehensive analysis of us pharmacy programmes. pharmacy education 24(1), 22-28. reamer, f. g. (2023). artificial intelligence in social work: emerging ethical issues. international journal of social work values and ethics, 20(2), 52-71. spadafora, n., murphy, e. l., molnar, d. s., & zinga, d. (2020). test anxiety in potential first-generation students: a longitudinal examination of the role of psychological needs. journal of teaching and learning, 14(2), 33-49. wasserberg, n. m. j. (2017). high-achieving african american elementary students’ perspectives on standardized testing and stereotypes. the journal of negro education, 86(1), 40-51. wilfong, j. (2024). low pay for social workers is a human rights violation, and social work professors must help to change it. journal of human rights and social work,. 9, 10-14. author note: address correspondence to alicia tetteh, school of social work, norfolk state university, norfolk, va. email: aotetteh@nsu.edu https://doi.org/10.3389/feduc.2021.795266 https://doi.org/10.3389/feduc.2021.795266 https://doi.org/10.1080/08841233.2015.1039160 https://doi.org/10.1080/08841233.2015.1039160 https://www.fsbpt.org/free-resources/fsbpt-forum/forum-2023/ai-chatgpt-and-licensing-exams https://doi.org/10.1016/j.outlook.2022.06.003 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://doi.org/10.1177/10497315221125885 https://doi.org/10.1177/10497315221125885 https://doi.org/10.1177/14680173211008110 https://doi.org/10.1177/14680173211008110 https://doi.org/10.1007/s41134-020-00159-5 https://doi.org/10.1007/s41134-020-00159-5 https://doi.org/10.46542/pe.2024.241.2228 https://doi.org/10.46542/pe.2024.241.2228 https://doi.org/10.46542/pe.2024.241.2228 https://doi.org/10.55521/10-020-205 https://doi.org/10.22329/jtl.v14i2.6202 https://doi.org/10.22329/jtl.v14i2.6202 https://doi.org/10.22329/jtl.v14i2.6202 https://doi.org/10.7709/jnegroeducation.86.1.0040 https://doi.org/10.7709/jnegroeducation.86.1.0040 https://doi.org/10.1007/s41134-023-00285-w https://doi.org/10.1007/s41134-023-00285-w mailto:alex.redcay@millersville _____________ margaret e. adamek, phd, professor and editor, advances in social work, indiana university school of social work, indianapolis, in 46202, madamek@iupui.edu copyright © 2021 author, vol. 21 no. 1 (spring 2021), i-iii, doi: 10.18060/25450 this work is licensed under a creative commons attribution 4.0 international license. editorial spring 2021: emerging arenas in social work education and practice margaret e. adamek given our commitment to highlighting current issues, challenges, and responses within social work practice and education globally, the spring 2021 issue of advances in social work is pleased to present 11 full-length papers written by 40 authors from across the u.s. and canada. we begin with four papers calling for greater involvement of social work educators and practitioners in arenas including information literacy, dyslexia, digital equity, and independent living. these papers are followed by reports on seven empirical studies in areas of practice as diverse as kinship care, legal representation, collaboration in a dental clinic, and dance and mindfulness. we hope you find these selections on emerging areas of social work practice and education to be informative and inspiring. each contribution to this issue is introduced below. based on their findings from interviews with social work librarians across the country, johnson, bausman, & laleman ward call for social work faculty to partner with librarians in developing the information literacy skills of social work students. to prepare practitioners who remain informed about best practices, johnson and colleagues call for genuine partnerships between social work instructors and librarians. we must go beyond one-time information sessions about library resources and work collaboratively to incorporate information literacy throughout the social work curriculum. citing a study from texas, garner reports that nearly half of incarcerated people may have dyslexia. imagine a world where dyslexia, rather than being viewed as a limitation, was widely recognized as a form of neurodiversity that included unique strengths and abilities. drawing on cutting-edge research in disciplines such as neurobiology, education, and psychology, garner exposes pervasive negative myths about dyslexia and calls for social workers to become informed advocates who promote positive outcomes with and for individuals with dyslexia. an unexpected positive outcome of the covid-19 pandemic was the opportunity to reach more clients using telehealth. however, as funk elucidates, many individuals are not able to access telehealth due to broadband disparities, especially in rural areas. funk calls for social workers on all levels to collaborate with community members, government agencies, and local programs to promote broadband access so that all community members can benefit from mental health interventions delivered via telehealth. janich, mendoza, mackey, hernandez, henderson, reily, & lundwall describe an innovative service learning program involving students from multiple disciplines at arizona state university. based on a range of assessments, interdisciplinary teams developed creative ways to meet the needs of older and disabled adults in an independent living community adjacent to campus. the authors share lessons learned in the process of developing and implementing this unique university-community partnership and offer key https://creativecommons.org/licenses/by/4.0/ advances in social work, fall 2019, 19(2) ii insights and recommendations for other schools of social work interested in creating similar interprofessional learning opportunities. a primary goal of the fostering connections to success and increasing adoptions act was to promote kinship care for children entering foster care. recognizing that not all states have leveraged this federal funding for kinship navigator programs, koh, ware, & lee surveyed state representatives to learn about their state’s response to the federal legislation. the results indicate that more support and oversight from the national level are needed to promote sharing of knowledge about successful kinship navigator programs between states. to promote the well-being of children and their kin caregivers, social workers are called upon to advocate for innovative approaches to kinship care in all 50 states. another way to enhance the well-being of children involved in the child welfare system is by pairing social workers with public defenders to better represent the needs of families within the judicial system. jaggers, wilford, anderson & bettmann evaluated a parent representation pilot program in utah by interviewing family court attorneys and judges. study participants reported that having social workers partner with public defenders helped to bring about more positive outcomes for families facing removal of their children. in another study involving social workers partnering with another profession—in this case, dentists at a university dental clinic--lyons, schrader, galyean, romito, everidge, smith & mandapati surveyed dental faculty, students, staff, and patients to document the barriers and challenges faced by low-income patients. based on their findings, lyon and her colleagues recommend involving licensed social workers in interprofessional collaborative practice in university-based dental clinics to better identify and address barriers to care experienced by low-income patients. to enhance the empowerment of adults experiencing serious mental illness, clarksonhendrix & peters piloted a weekly workshop that combined dance movements and mindfulness meditation. a social worker facilitated the mindfulness aspects of the workshop in conjunction with a dance instructor leading participants through basic dance movements designed to help participants connect with their physical bodies. comparisons of preand post-test data revealed that participants experienced increased optimism and feelings of empowerment. much of the current attention on race relations in the united states focuses on interactions with people outside of one’s own family and community. saviet & greif conducted a study that examined racial differences within families and in particular, the impact of those differences on in-law relationships. parents whose son or daughter married a person of another race share the transitions they went through from initial hesitation to eventual acceptance and embracing of their racially different sonor daughter-in-law. the journey to acceptance across racial lines within families brings hope for greater acceptance across racial lines between families. in their work with low-income mothers of color receiving care at a federally qualified health center in new york, keefe, rouland, lane, howard, brownstein-evans, wen & parks were curious to learn from the mothers themselves about how they persevered through not only postpartum depression, but also challenging circumstances and living adamek/editorial iii environments. their findings call for social workers to take the time needed to build trusting relationships that recognize and honor the mothers’ inner strengths. the involvement of men in violence issues is primarily as perpetrators; however, there is an increasing realization that men need to be a part of the solution. using semi-structured interviews with a sample of canadian practitioners working mostly in domestic violence shelters, hansen, wells & claussen explored challenges faced in engaging men in violence prevention efforts. their findings point to the need for focused capacity-building around emerging research, strategies, and tools in engaging men in violence prevention. just a heads up that our next special issue, dismantling white supremacy in social work education, will be released in late summer 2021. with over 100 abstracts submitted, this special issue has garnered incredible interest. we are looking forward to bringing you 35+ original papers (our largest issue to date!) addressing ways that social work education can move forward positively and intentionally in ways that acknowledge the damage wrought by white privilege, promote racial justice and anti-racist practice, and embrace new ways of knowing, teaching, and learning. the indiana university school of social work, through publishing advances in social work as an open access scholarly journal, is grateful to play a role in knowledge production and dissemination in social work. we are continually amazed at the dedication and hard work of our social work colleagues globally who work tirelessly to advance social and economic justice. marshall on, colleagues! tribute to retiring board members before closing, i would like to take this opportunity to express sincere appreciation to three outgoing aisw board members who recently retired from the indiana university school of social work: dr. karen allen, dr. larry bennett, and dr. bob vernon. your contributions to not only advances in social work but to the iu school of social work and to the social work profession at large are very much appreciated. special accolades to dr. vernon who has served on the aisw editorial board since its inception in 1999. best wishes to each of you in your next adventures! microsoft word 03_funk_and_shaw_25184_i_remember_when _________ mallory funk, msw graduate, and stacey a. shaw, msw, phd, assistant professor in the school of social work, brigham young university, salt lake city, ut. copyright © 2021 authors, vol. 21 no. 4 (fall 2021), 1100-1123, doi: 10.18060/25184 this work is licensed under a creative commons attribution 4.0 international license. “i remember when donald trump was elected. it broke a lot of refugees’ hearts”: refugee perspectives on the post-2016 u.s. political climate mallory funk stacey a. shaw abstract: recent u.s. refugee policy and political rhetoric have sanctioned anti-refugee sentiment, fostering beliefs of refugees as other, threatening, or less than. following the transition into the trump administration, interviews with 88 refugees resettled long-term in the u.s. were conducted to examine the impact of the post-2016 political climate. major themes included feelings of uncertainty regarding refugee status and stability, changes in perception of u.s. citizenship, and a sense of unwelcome. the harmful effects of political environments must be recognized in order to appropriately support refugee communities through social service programming and advocacy. social workers can elevate refugee voices while working to improve resettlement services and enhance supportive social policy. increased attention to refugee perspectives may facilitate understanding and decrease stigma moving forward in a new political era. keywords: refugee, forced migration, resettlement, political climate, united states as forced migration increases globally, options for resettlement are declining. the world is experiencing a record number of people fleeing violence (cumming-bruce, 2019). nearly 80 million people are forcibly displaced, of whom 26 million are designated refugees (united nations high commissioner for refugees [unhcr], 2021a). as established by the united nations 1951 convention and the 1967 protocol, the latter ratified by the united states (u.s.) in 1968, nations agreed people should not be forced to return to countries where their lives and freedoms are threatened (unhcr, 2011). moreover, nations agreed upon who qualifies for refugee status and what legal protections and rights refugees should consequently receive (unhcr, 2011). despite this global agreement, many nations are cutting assistance to refugees. borders are closed due to perceptions of financial, security, and cultural risks (betts, 2015; long, 2013). the global north dominates discourse regarding how and by whom refugees should be aided, maintaining an emphasis on border protection at the expense of those who are displaced (besteman, 2016; oelgemoller, 2017). in recent years, refugee resettlement to the u.s. has reduced drastically. prior to 2017, the u.s. led the world in refugee admittance numbers (radford & connor, 2019). though the number of those admitted comprised only a fraction of the world’s forced migrants, this legal immigration pathway authorized those admitted to obtain permanent residence after one year and citizenship after five years. in fiscal year (fy) 2016, the u.s. resettled 84,994 refugees (u.s. department of state, 2018). beginning in the summer of 2017, an executive order suspended the refugee admissions program for 120 days for the stated purpose of protecting national security (nauert, 2017). in fy 2017, refugee admissions decreased to 53,716 refugees (u.s. department of state, 2018). the number of resettled refugees funk & shaw/i remember when 1101 continued to decrease in fy 2018 to 22,491 people, less than half of the admissions ceiling (u.s. department of state, 2019). the admissions ceiling was reduced again to 18,000 people for fiscal year 2020, a record low since the formal creation of the u.s. resettlement program in 1980 (krogstad, 2019; u.s. department of state, 2019). due to political restrictions and covid-19 related suspensions (chishti & pierce, 2020), the number of people resettled in fy 2020 was only 11,814 (rush, 2020). this rapid reduction in the u.s. resettlement program resulted from intentional political decisions driven by anti-immigrant ideology. beginning with his campaign and extending into his presidency, donald trump targeted and excluded refugees. candidate trump described aims to limit syrian refugee admissions and prohibit groups based on religion, seeking “a total and complete shutdown of muslims entering the united states” (khan et al., 2019; taylor, 2015, para. 1). in 2017, the trump administration banned residents of seven predominantly muslim countries from entering the u.s. (gökarıksel, 2017; pierce et al., 2018; thurish, 2017), leading to a 91% decline in the number of muslim refugees accepted into the u.s. over the next two years (bier, 2018). in february of 2020, an expanded travel ban further restricted refugee access by limiting immigration from additional countries in africa and asia (kanno-youngs, 2020; krogstad, 2019). since the 2016 election, refugee access to the u.s. has decreased, one of many outcomes resulting from executive orders and legislation that expanded reasons for deportation, tightened criteria for asylum, slowed visa processing, and increased screening procedures, detention, and deportation (american civil liberties union [aclu], 2020; american immigration council, 2020; pierce et al., 2018; thurish, 2017). the antagonism embedded in anti-immigrant legislation affects refugees through all stages of migration. since 1980, over 3 million refugees have resettled in the u.s. (u.s. department of state, 2019). recent political changes may adversely affect those who previously resettled in the u.s. through promoting a hostile, anti-immigrant environment. derogatory political discourse and anti-immigrant policies portray refugees as different, unwelcome, and threatening (grove & zwi, 2006; hogan & haltinner, 2015). limited resources and a lack of community support in host countries negatively impact refugees beyond the initial resettlement period, leading to poverty and psychological distress (kim, 2016). environmental factors impact refugees’ ability to successfully navigate a new culture (sangalang et al., 2019). concern for safety and wellbeing in the u.s. among resettled refugees has increased as a result of anti-immigrant policy, specifically antagonistic sentiment and policies targeting syrians and muslims. upon initial resettlement in the u.s., syrian refugees reported feeling well-received (gowayed, 2020). over time, however, exposure to u.s. discourse led to recognition of anti-immigrant racialization (gowayed, 2020). in the post-2016 u.s. political climate, harsh antiimmigrant conditions affected resettled and resettling refugees in terms of safety, acceptance, and opportunities for success. this study further examined how refugees who resettled to the u.s. were affected by this antagonistic u.s. political climate. moreover, this study explored how refugees have responded to the post-2016 political climate, with implications for social workers in areas including resettlement services and policy advocacy. advances in social work, fall 2021, 21(4) 1102 theory: othering of refugees othering occurs when groups of people are seen as inferior or different based on particular characteristics, such as refugee status. with roots in post-colonial theory, theories of othering point to implicit messages regarding race, ethnicity, religion, and socio-economic status that reinforce concepts of belonging for some while setting others apart (borrero et al., 2012). through societal narratives and social classification, refugees are disenfranchised and considered other by majority groups (borrero et al., 2012; brons, 2015; hatoss, 2012; massey, 2007). othering towards refugees in the u.s. occurs when people are stigmatized with negative labels in political and social rhetoric, with refugees described as being different, less than, or dangerous. labels used to other people with a refugee background include terms such as alien, helpless, dependent, and needy, or terms that over-emphasize an aspect of identity such as ethnic, black, or muslim (baak, 2019; grove & zwi, 2006; hatoss, 2012; ludwig, 2016). such terms are often collapsed into over-simplified notions and loaded with derogatory meanings. societal narratives regarding group characteristics contain messages and assumptions that are circulated and absorbed by the public. both intentionally and unintentionally, people form classifications that categorize people into groups of societal relevance based on these narratives (massey, 2007). when faced with threat or uncertainty, people are more likely to classify and categorize others in a way that produces prejudice towards particular groups (massey, 2007). for refugees resettling to locations where a threat mentality is common, members of host communities may meet newcomers with a sense of fear and distrust, further setting them apart as other (hogan & haltinner, 2015; massey, 2007; weis, 1995). anti-refugee narratives and labels are embedded within recent u.s. refugee policy and suffuse far-right nationalist rhetoric. the trump administration’s emphasis on linking refugees to national security risks without merit reinforced a threat mentality regarding refugees. intensified screening processes foster suspicion (grove & zwi, 2006; massimino, 2017; merheb, 2005), where those who pass strict hurdles to resettle in the u.s. are still deemed dangerous and criminal (grove & zwi, 2006; ratnam, 2019). intensified vetting and control efforts also solidify power disparities created through othering, where the outgroup is considered inferior and dependent on in-group approval (brons, 2015). in addition to prioritization of border control, former president trump fomented a culture of anti-minority rhetoric. in a quest to “make america great again,” trump insinuated that minority groups, including refugees, threaten the country and stand in the way of america achieving greatness (gökarıksel, 2017; gökarıksel & smith, 2017; grove & zwi, 2006). additional trumpian rhetoric that served to other and diminish refugees included reference to people originating from “shithole countries,” conflation of syrian refugees with isis (the islamic state), and stating a preference for white immigrants from europe (chiu, 2019; scott, 2018, para. 1). such rhetoric sanctioned racism, stereotyping, and discrimination against minority groups (konrad, 2018), and may translate to othering at the local, individual level. when refugees are seen as other, they may be racially profiled, kept at the borders of u.s. communities, and depicted as lucky but unworthy recipients of u.s. charity (grove & zwi, 2006). discrimination on the basis of gender, nationality, religion, and race places funk & shaw/i remember when 1103 refugees in multiple minority out-groups. thus, many refugees in the u.s. face discrimination because of their status both as refugees and as racial minorities. moreover, muslim refugees face additional prejudice due to religious affiliation (fiddian-qasmiyeh & qasmiyeh, 2010; gökarıksel, 2017; gökarıksel & smith, 2017). though anti-muslim sentiment is not new (adida et al., 2019), trump invited and encouraged islamophobia by targeting predominately muslim countries in speech and legislation. since trump’s election, anti-muslim sentiment increased (mogahed & mahmood, 2020), as did muslimdirected hate crimes (jamal, 2017). refugees face barriers to belonging and acceptance when they are perceived as different or unwelcome by the receiving society. refugee individuals and groups manage and respond to othering behaviors in diverse ways. despite long-standing practices of othering towards minority groups in the u.s., intensified under the trump administration, resettled refugees find ways to assert and create belonging. many newly-resettled americans, or new americans, declare their claim to american ideals, even under an administration that worked to limit access to such ideals (interiano-shiverdecker et al., 2020; rizvi, 2017; unhcr, 2018). refugee narratives highlight the injustice of othering and call for a recognition of refugee rights to belonging and participation in host-country societies (interiano-shiverdecker et al., 2020; rizvi, 2017; unhcr, 2018). these same narratives assert a deep understanding of the founding premises of the u.s. and u.s. politics, in addition to the assertion of refugees’ own social capital. these new americans highlight the impermanence of refugee status, which serves as a vehicle for resettlement and belonging in a new nation (rizvi, 2017; unhcr, 2018; zetter, 2007). this mindset recognizes the refugee experience not as leading to permanent marginalization but to legal migration, and eventual citizenship. although refugees have been socially marginalized, the legal nature of their migration to the u.s. therefore grants them a form of insider status. while trumpian rhetoric has increased othering in u.s. society, many new americans resist othering and push back against politicized boundaries. in addition to the power of refugee narratives in fighting against othering, many in the u.s. reject anti-immigrant narratives. an estimated half of americans (51%) support refugee resettlement (hartig, 2018), prioritizing a humanitarian responsibility to resettle displaced people (garinther et al., 2019). many social workers and others within refugee resettlement organizations have responded to political legislation, sharing facts, stories, and research in opposition to the trump administration’s stance (amnesty international usa, n.d.; center for migration studies, 2020; international rescue committee, 2020; schacher, 2019). social service agencies remain committed to expanding and improving services provided to resettling refugees (douglas et al., 2017; mcneely & morland, 2016; mendenhall et al., 2017; ross et al., 2019). despite this advocacy and commitment, trump’s deliberate effort to disrupt resettlement systems (beers, 2020), alongside reductions in admissions and funding, led to agency closures and a scale back of services (darrow & scholl, 2020). the voices and narratives of refugees, including those who push back against othering, are rarely heard within u.s. political discourse and some majority communities. a lack of proximity promotes perceptions of refugees as distant foreigners, contributing to an “us” versus “them” mentality (grove & zwi, 2006). such cognitive distancing enables negative rhetoric from political figures to dominate narratives regarding refugees circulated advances in social work, fall 2021, 21(4) 1104 throughout u.s. media. to overcome this gap in understanding, this study examined the perspectives and experiences of people resettled as refugees in the u.s. within an antiimmigrant political climate. method participants and procedures various sampling methods were used to identify participants for this study. to be eligible, participants had to be 18 years of age or older and havemigrated to the u.s. as refugees at least five years prior. participants were purposively sampled based on gender, national origin, and age from multiple agency and community settings located within the central capital area of one state in the intermountain west region of the u.s. (creswell, 2013; miles & huberman, 1994). refugee social service agencies also assisted with recruitment by sharing informational flyers about the study with potential participants. additionally, some social service agencies allowed research assistants to share information about the study with clients in their offices, at local events, and in classes serving refugees. convenience and snowball sampling methods were also used, in that people were referred to the study through word-of-mouth and community networks, with refugee community leaders and interview participants recruiting most participants. the resulting sample was comprised of participants with diverse demographic characteristics including nationality, gender, religious affiliation, educational attainment, age, length of time in the u.s., and english language proficiency. refugee service agencies as well as a project community advisory board, composed of refugee community leaders and service providers, contributed to the project design and methods. the advisory board was comprised of five individuals who reviewed project protocols, design, and findings throughout the duration of the project, typically meeting during each transition phase of the project. the research team involved trained graduate and undergraduate students, including some with refugee backgrounds who themselves resettled in the u.s. institutional review board approval was obtained for all study procedures. interviews were conducted at a location of the participant’s choosing, including service agencies, community centers, libraries, and participants’ homes. interviews were conducted in locations where participants could not be overheard or influenced in a way that would restrict responses. if family members or others were present at the location of the interview, research assistants inquired about participants’ comfort and preference with continuing the interview or identifying a more private location. each participant was assigned an id number that was attached to their data and interview content, thus assisting in protecting confidentiality. the option for interpretation was made known to potential participants during the introduction of the study and initial scheduling of the interview. in some instances, interpretation was used for the scheduling of interviews. interviews were conducted by research assistants in english, through trained interpreters for interviews when needed; 23 interviews were conducted with an interpreter. interpreters were accompanied by research assistants when conducting interviews both in person or over the phone. prior to beginning the interview, research assistants provided participants a consent form reviewing the purpose of the study, confidentiality, and potential harms of funk & shaw/i remember when 1105 participation, such as sensitive questions that may bring discomfort. research assistants reiterated that participation was voluntary and that participants could decline to answer any interview questions. participants were also provided a list of mental health and other relevant resources when needed. all interviews were audio-recorded. interviews lasted approximately 75 minutes, and participants were compensated $20. interviews were conducted between june 2017 and november 2018. interview content the interview began with a series of questions regarding demographic characteristics and experiences in the u.s. participants described their age, gender, marital status, birth place, and length of time since initial resettlement. safety was examined using one question from the world health organization brief quality of life assessment (who, 2012), where participants described how safe they felt in daily life using a five-point likert scale with response options from 1 (very unsafe) to 5 (very safe). open-ended questions then examined perspectives on resettlement and the contemporary political climate. to explore the impact of the political climate on the lives of participants, interviewers asked, “how has the current political and social situation related to refugees in the u.s. affected you?” three additional probes were used as needed to further explore potential areas of impact, including, “have you felt an increase or decrease in your safety?,” “can you provide any examples of how things have changed recently?,” and “can you describe any experiences you’ve had with law enforcement?” data analysis all english language content of the interviews was transcribed verbatim, including the english translations of the 23 interviews conducted using interpretation. the research team conducted line-by-line coding to identify key themes emerging from the interviews until saturation was reached and no new codes emerged from the narrative data (braun & clarke, 2006). the research team then analyzed the codes to determine the most prominent themes in the interviews, ultimately resulting in major themes and related sub-themes. second cycle coding methods then involved two research team members coding each transcript for major themes and related sub-themes within nvivo. the two major thematic categories examined in this paper include “political climate” and “citizenship.” sub-themes related to political climate included “worsened political climate,” “fear and safety in the political climate,” and “mixed feelings regarding the political climate.” sub-themes related to citizenship included “benefits of citizenship,” “practicality of citizenship,” and “personal meaning of citizenship.” after completing the coding process, major categories and subthemes were reviewed, alongside immersion within the original transcripts, to summarize views and experiences related to the political climate (charmaz, 2006; saldaña, 2012). member checking was used to increase trustworthiness of the study findings (sandelowski, 1993). after coding was completed, findings were summarized in presentation form. using contact information provided by participants during the interview process, participants were contacted by research team personnel and invited to review the summative findings from the interviews and give feedback. these meetings took place at advances in social work, fall 2021, 21(4) 1106 a local social service agency. prior to beginning each meeting, the purpose of the member checking process, in addition to confidentiality, was reviewed. additionally, participants provided consent for their participation in this portion of the study. research assistants then presented the project findings, after which participants were divided into smaller groups to discuss whether they approved of the summative findings and if major themes were missing. in total, 34 participants participated in five focus group discussions. on average, the presentation and focus group discussions lasted one hour. compensation of $10 was provided for attending. no changes to themes regarding political climate or citizenship emerged as a result of these member checking discussions. when quoting participants, general demographic details are provided. to ensure participant anonymity, only characteristics that applied to multiple participants are provided. results the sample (n=88) included an equal number of male and female participants. a majority of participants were originally from africa (58%). participants’ age ranged from 18 to 84 years. over half (52%) of participants were married. on average, participants had lived in the u.s. for 10.8 years. on a five-point likert scale from 1 (very unsafe) to 5 (very safe), the average rating of participants’ safety in their daily lives was 4.1. additional participant demographics are presented in table 1. table 1. characteristics of study participants n (%) gender male 44 (50%) female 44 (50%) regional nationality middle east 21 (23.9%) africa 51 (58.0%) south/southeast asia 16 (18.2%) marital status married 46 (52.3%) widowed 4 (4.6%) divorced or separated 11 (12.6%) never married 27 (30.7%) mean (sd), range age (years) 38.6 (14.5), 18-84 time in the u.s. (years) 10.8 (5.4), 5-34 safety in daily life* 4.1 (0.9), 2-5 *1 (very unsafe) to5 (very safe), participant responses regarding the political climate covered a range of issues. many spoke about the impact of the political climate on their personal lives and on the lives of their family members, including those living in the u.s. and those living abroad. some participants indicated a general unawareness or disinterest in politics, with few comments on this topic. others reflected on the 2016 election and the trump administration with a range of judgements including dislike and distrust, neutrality, or support. funk & shaw/i remember when 1107 while most participants said they had not been physically harmed, they had observed a shift in u.s. society towards unacceptance and intolerance. three primary sub-themes related to the political climate and the trump administration emerged. first, respondents alluded to an overall feeling of uncertainty about their status in the u.s. and the status of family members seeking to join them. second, participants spoke about changes in their perceptions of u.s. citizenship. lastly, participants described an overarching sense of unwelcome, manifest through discrimination and fear-filled rhetoric. these three central themes are examined below. uncertainty “their mind is not peaceful at all. government bringing the changes every day, and what is… next?” respondents experienced uncertainty and concern regarding their standing in the u.s. after the 2016 election. referencing trump’s campaign promises to ban muslims from entering the u.s., build a wall along the u.s.-mexican border, and deport “illegal immigrants,” participants observed negative sentiments directed at non-citizens. for many, this created an air of uncertainty about their own status in the u.s. as explained by a female participant who migrated from burundi, “i thought he was going to kick me out too. because i don’t have, like, the right document. i mean, i have my green card and social security, but i don’t have my citizen[ship].” as in this example, many respondents felt vulnerable to changes regarding immigration policies made by the trump administration because of their refugee backgrounds. multiple participants touched on the dilemma of not knowing where to call home. in response to a question regarding what worried him the most, a male participant who had been in the u.s. for approximately nine years reported, “…departure from the country. going back to home. we don’t have a home if we go back.” after making the u.s. their home, many feared being sent back to their countries of origin due to trump’s influence. many remarked that their countries of origin would no longer feel like home, and they feared for their safety should they be sent back. for example, a male originally from somalia said: people start to question. like is this the place i want to be or should i go back home? and they can’t go back home because like they know there [are going to] be the issues back there…far more so [worse] than here. a female participant who migrated from iraq described the psychological nature of such insecurity. she said, “it did have an effect on us psychologically and we’re not sure what’s going to happen in the future with the new situation.” overall, respondents reported living in a state of fear-induced unknown, wondering what changes would come next. “it didn’t just affect us, it affected a lot of people overseas.” fear of the unknown and of the future not only affected participants’ lives, but paused the plans of family members and friends waiting to come to the u.s. president trump’s advances in social work, fall 2021, 21(4) 1108 orders to suspend refugee admissions for 120 days and later to ban admission from specific countries alarmed, confused, and saddened respondents. as explained through an interpreter by a male participant who had lived in the u.s. for about 8 years, “when he heard about that law preventing refugees to come to the united states from certain countries, he said that was not right in his mind.” participants knew the need for resettlement remained, as a female who migrated from rwanda said, “families are still trying to come, like [to] see if things can be better….” additionally, participants voiced uncertainty about how long the ban would last and wondered whether their family members would ever be able to join them in the u.s. participants expressed fear and concern for loved ones who remained in countries affected by conflict and were prohibited from seeking safety in the u.s. as a female participant originally from iraq described: …these people are not safe now. they are outside, the presidential administration has stopped them from coming to the u.s. they are in war zones. they are suffering, they are dying. but if [those] changes [had] not been in place, we would have been able to help more people. thus, in addition to worrying about their own status in the u.s., respondents described uncertainty about how others would fare as a result of delayed or cancelled family reunification and resettlement opportunities. altered perceptions of citizenship “i applied for citizenship, just to be on the safe side.” numerous participants spoke about pursuing citizenship as a protection against the trump administration’s immigration changes. a male who migrated from myanmar/burma described the sense of immediacy he felt surrounding citizenship when he said, “as soon as you reach five years, don’t wait. apply for u.s. citizen[ship]…i’m okay because i’m a u.s. citizen, so i feel more secure than someone who is stay[ing] [a] refugee.” like this participant, others felt citizenship provided more permanency in the u.s. than refugee status or permanent residence. a female originally from sudan explained a shift in the meaning of citizenship following trump’s election. she said, “it used to be about pride that i am a u.s. citizen…because of the political situation right now, it’s more about feeling safe and secure. because of the administration we have right now, you could be deported for whatever reason.” for many, the fear of being deported because of a refugee background was assuaged by security obtained through citizenship. referring to president trump, a young adult originally from rwanda said, “i kinda dodged that bullet…because i am a citizen now, which means he can’t do anything to me.” these respondents felt immune to policy changes because of their status as citizens. as a male originally from bhutan said placing citizenship in opposition to refugee status and/or identity, “i was tagged as a refugee for so long. today i am a citizen.” comments on this topic also indicated the derogatory nature of the refugee label, which could be mitigated by the label of citizen. funk & shaw/i remember when 1109 “i just felt like it didn’t mean a thing.” while some respondents perceived citizenship as a safeguard, others felt that citizenship lost meaning in the trump era. a young adult who migrated from somalia explained: …all that chaos was happening and everybody was freaking out who wasn’t a citizen. and i realized [citizenship] didn’t really mean anything to me because i had the same fears…for me it’s more of a paper and in all honesty, it doesn’t help me in any way…once donald trump was elected. for many, having citizenship was overshadowed by minority or refugee status. as described by a male participant who had lived in the u.s. for approximately 12 years, “donald trump always say[s]…you [weren’t] born here. even if you get [citizenship], you [are] still gonna go back where you came from. so what’s the point?” similarly, a female originally from the democratic republic of the congo (drc) said, “no matter [if] you are a citizen. you started as still a refugee.” regardless of efforts undertaken to obtain citizenship, some participants felt they continued to carry stigma as foreigners subject to deportation and separate from the broader community. essentially, citizenship became tainted within an environment that indicated newcomers did not belong. unwelcoming atmosphere “…they say go back to your country.” negative messages about immigrants and refugees from president trump, the media, and society led participants to question their sense of belonging. respondents explained that they came to the u.s. in search of a new, safe home; however, within this political climate, they received messages of rejection due to nationality, race, or religion. a male originally from iraq explained his experience of feeling unwelcome in the u.s., like if you ask me what home is, home is where you work, where you have your wife, where you have your memories, where you have your house. and i have that here. and i was like, okay i’m starting and everything was going right and i was shocked really…i feel like i am an american…and people are like, no you are not. participants felt unwelcome because of their backgrounds, with some respondents internalizing negative messages. a female college student said, “i will never fully belong here.” additionally, some respondents explained they felt ostracized by people who voted for trump because of his views regarding immigrants. such beliefs were explained by a young adult male who said, “[this state] selected, i mean, it was the majority of people that voted for trump. so the refugee community felt that everybody in [this state] was for him and not for [us] ...they're against refugees and they're against immigration.” for many respondents, the political choice of a community to elect a leader such as trump denoted a broader social culture of unwelcome rejection. advances in social work, fall 2021, 21(4) 1110 “yeah, i think there is a lot of fear mongering going on…just kind of spreading fear.” in addition to feeling like outsiders or perpetual foreigners, participants described a growing sense of fear in response to unaccepting, pejorative societal narratives. respondents mentioned discriminatory rhetoric in the media alongside negative portrayals of refugees. as described by a female who migrated from nepal, “i can see… some of the news and all, like they hate immigrant[s] or they hate refugees.” comments addressed threatening rhetoric from political leaders and citizens through the media that led participants to question their safety. as described by a female participant with children: i don’t watch tv and sometimes i can’t read the news on my phone and whenever i see a lot of things happening, especial politically… it can make someone go crazy because you feel like, “oh my god,” this is the country that i thought i was supposed to settle, and now there [are] so many things going around. you [are] very scared. noting the plethora of unwelcoming messages from many sources that target refugees, participants also reported fearing for their safety because of race or religion. a black male participant described the fear he felt as a muslim: sometimes when i see the things that are happening on tv, it just basically makes me feel like i need to watch out, you know. i need to be aware of my surroundings because sometimes…people do things that you’re not expecting [them] to do. and then all this politics that’s going on…just brings out a different person…like i said, i’m muslim. and it just makes [muslims] feel like if they go outside, they’re being targeted because… [of] all the things that they see in the news. in addition to messages of fear spread through the news and media, participants described fear within religious or ethnic communities. multiple participants referenced “talk” where community members circulated concerns. a female who had been in the u.s. for 9 years reported, “i even heard that…if i leave the house because i’m covered with hijab they might abuse me or shoot me or kill me, so i’ve gotta stay in the house.” additionally, a female who migrated from iraq commented on her fear of violent acts against muslims when she said, “i hear it through whatsapp groups that we have or some girlfriends…they send these messages: ‘on a certain day they’re gonna do this and on this day they’re gonna do that.’” as a result of political, media, and community commentary, many participants feared for their wellbeing. “ever since he became a president…people are racist. they can even show it now.” participants relayed numerous experiences of discrimination in a country where white individuals comprise the majority in-group and maintain a stronghold of power as opposed to racial minority, out-group individuals. when speaking about the shift to trump’s presidency, a male participant originally from iraq stated, “the first thing we started feeling [was] racism.” referencing discrimination, a black female participant added, “i think it’s always been there…after this last election it’s really increased.” moreover, participants felt this behavior was sanctioned by the president of the u.s. and emulated by citizens. funk & shaw/i remember when 1111 describing racism, a female originally from sudan observed, “nobody hides anything [any] more. because the president is doing it…so people are doing the same thing.” this quote indicates that while othering views existed in the past, people were emboldened to follow trump’s lead in othering or discriminatory behaviors. respondents described feeling discriminated against both in word and in action. a male who migrated from iraq shared: …you feel it when you’re out on the road, when you’re out doing your own thing on a daily basis. you feel that you’re not really that comfortable...sometimes it’s people’s looks and sometimes you can tell when somebody’s looking at you…like they’re welcoming you here. and sometimes they’re looking at you like you’re not welcome. others recounted inappropriate stereotyping or prejudiced remarks. a female originally from afghanistan said, “some people see us as the bad humans…i’ve had people say something really rude and disgusting…i am a good person. i am not a terrorist.” another muslim female described her experience through an interpreter, “on the bus stop where she’s waiting for the bus with her kids…people would call her ‘isis, isis.’” discriminatory remarks such as these left participants feeling afraid, misunderstood, and set apart. for many respondents, racism and discrimination led to risks in their day-to-day lives. a female originally from vietnam said, “i felt a bit unsafe when i [went] run[ning]. if i [saw]…a truck with [the] american flag, then i got really nervous because i really don’t know what they are going to do.” american symbols took on new meanings in the trump era, where a flag may indicate white nationalist beliefs and anti-immigrant views, leading to uncertainty regarding who can be trusted. a lack of safety was experienced by many racially black participants who spoke of police brutality and fears regarding law enforcement. a young adult who migrated from sudan said, “[i’ve] felt a decrease for my safety…how we [are starting] to see more and more black people getting shot by people who are supposedly there to protect you.” a female participant with two children explained, “nowadays the streets [are] really dangerous…the president came, everything change[d]. now people [are] killing other people for no reason on the street because of their race.” as this participant expressed, many indicated that racism seemed to increase as a result of the trump election. a young participant originally from sudan recognized that experiences with racism, prejudice, and fear were not limited to refugees, saying, “it’s funny because the political situation, when it gets worse… you could say it targets everybody else too. as a black person, it would affect me regardless if it talked about refugees or not.” these experiences and sentiments indicate the intersectionality and widespread effects of discrimination in a political and social climate perpetuating othering. a middle-aged participant from iraq expressed a hope for more positive political leadership in the u.s. when he commented, “i wish that our president would not say those things, and see everybody as one. and encourage people to…love each other. respect each other. respect is important because together we can make a better place to live.” participants recognized the potential for good that could come from a political platform focused on uniting rather than othering. advances in social work, fall 2021, 21(4) 1112 contrasting views while the findings described above address perspectives and experiences of the majority of participants, a few respondents had different views about the political climate under the trump administration. some remained unaffected or had not experienced changes in safety. a female originally from the drc described her neutral stance, “i [don’t] have any bad thing about government. for me, i’m safe. i [do] not have any battle with the government because i [do] not do anything bad. i just raise my kids.” others made similar comments, emphasizing a focus on family, life, or appreciation for relative safety found in the u.s. compared to their country of origin. additionally, a few participants said their specific community or state was welcoming. a male participant who migrated from bhutan explained: personally, i would say i’m not seeing a big impact [of trump’s election] yet. luckily, i know it’s a dominantly republican state, but we are still lucky enough our governor [is] supporting [and] welcoming refugees here. a lot of our great organizations are helping refugees here. for these respondents, the services and efforts of local politicians and organizations offset the potentially deleterious effects of the trump administration. additionally, two participants specifically spoke in support of trump for reasons of economic growth and the belief that trump was acting to keep the u.s. safe. discussion this study analyzed the post-2016 political climate experiences and perspectives of 88 individuals resettled as refugees in the u.s. all participants had lived in the u.s. for at least five years at the time of the interviews and had experienced the 2016 election and subsequent political changes. a few respondents did not share thoughts on the political climate or expressed support for president trump. however, the majority highlighted increased uncertainty, changes in perceptions of citizenship, and a sense of rejection. findings illustrate how the political climate during the trump administration reinforced othering of people who migrated to the u.s. as refugees. the findings inform policy and practice for social workers and others promoting wellbeing and access among refugees and displaced persons. political rhetoric contributed to a felt sense of being othered for most refugee participants. overt and covert messages elevated by the trump administration promoted perceptions that ostracized refugee and other minority populations (gökarıksel, 2017; gökarıksel & smith, 2017; grove & zwi, 2006). resettled individuals experienced these negative narratives through portrayals in the media, community discussions, and day-today interactions. experiences of discrimination and racism were recounted by many. participants also spoke about fear in their communities given unreceptive messages in the media and in their social circles. while antagonistic rhetoric targets refugees, religious minorities, and others in broad categories, these messages were personalized and experienced by individuals and families. discriminatory labels and acts led refugees to question their personal safety and their sense of home. however, refugees also funk & shaw/i remember when 1113 acknowledged their disapproval of such othering and discrimination, noting their lack of control over their status as refugees and their rightful claim to resettlement in the u.s. in the aftermath of the 2016 election, participants observed increased antagonism towards immigrants and refugees. the choice of u.s. voters to elect donald trump indicated to refugee participants that anti-immigrant sentiment was common, if not universal. far-right rhetoric and nationalist narratives that portrayed refugees and immigrants as outsider threats (hogan & haltinner, 2015) were perceived as acceptable to the majority of the country. as participants lived with this new reality in the u.s., symbols such as the american flag took on new meaning. in effect, growing perceptions of refugees as dangerous served to jeopardize the safety of refugees, rather than the majority community (amuedo-dorantes et al., 2021; masterson & yasenov, 2018; sakib & ishraque osman, 2019). identities are intersectional, with race and religion influencing othering experiences in addition to refugee status. fears of being targeted and experiences with discrimination were particularly pronounced for participants who were muslim or black. those with these racial and religious identities in particular experienced losses of freedom, belonging, and safety. increases in islamophobia (jamal, 2017; mogahed & mahmood, 2020) involve not only othering attitudes but behaviors that could lead to physical and emotional harm. additional research could examine how aspects of identity intersect and amplify vulnerability. most participants had some marker of difference from the white, christian, english-speaking majority populations residing in the u.s. many participants, however, indicated that refugee status became an increasingly salient out-group categorization in this political environment. tied to the meanings associated with refugee status, such as dependency, race, and danger (baak, 2019; grove & zwi, 2006; hatoss, 2012; ludwig, 2016), some participants verbalized personal distancing from the refugee label, for example, by speaking about how they had obtained citizenship and found more belonging and safety in doing so. as such, refugees fought back against othering and prejudice by leveraging citizenship status. the meanings of resettlement and citizenship shifted as a result of growing hostility towards refugees. though all participants came to the u.s. legally with eventual access to permanent residence and citizenship, the 2016 election led many to question their immigration status and ability to remain in the country. participants were also troubled by bans on refugee admittance. as nations reduce access to resettlement in the face of increased need (betts, 2015; cumming-bruce, 2019; krogstad, 2019; long, 2013; u.s. department of state, 2019), possibilities for acceptance and security become tenuous. former refugees questioned their own place of home as well as possibilities for others, while maintaining the belief that they should belong and obtain acceptance within american society. for some, citizenship became a protection from immigration policy changes. participants who saw citizenship as a marker of safety noted that citizenship indicated a change in their identity that perhaps spared them from restrictive policies targeting foreigners. citizenship ideally signifies belonging, in that it facilitates access to universal values of liberty, democracy, and mobility (haggis & schech, 2010); however, such values were not felt by all participants. for some, citizenship became tainted in an environment consistently indicating they did not belong. similar sentiments regarding the advances in social work, fall 2021, 21(4) 1114 meaninglessness of citizenship were found among liberian refugees resettled in new york (ludwig, 2016). these refugees from liberia felt the refugee label remained their primary ascribed identity, regardless of other markers of identity such as u.s. citizenship. findings indicate the role of power in shaping resettlement discourse and policy. refugee communities have little to no influence on which countries will provide resettlement opportunities and what related services will entail. resettlement processes are guided by nations in power and focus on border maintenance in ways that further disenfranchise and other refugee communities (besteman, 2016; brons, 2015; darrow & scholl, 2020; oelgemoller, 2017). in this study, participants recognized the power of othering attitudes and rhetoric in reduced resettlement opportunities (bier, 2018), fearing further restrictions based on these attitudes. a shift in discourse and policy can occur as refugee voices are prioritized, including the voices of refugees advocating for their rights to safety and belonging in u.s. society. study findings have implications for social work practice. attention to refugee experiences and concerns is essential, particularly during times of change and stress. social workers can ensure that refugees are aware of their legal rights and opportunities for change of legal status, including those regarding permanent residence status, citizenship, and family reunification. care can be taken to ensure false assurance is not provided when uncertainty surrounds potential policy changes. further, opportunities for ongoing dialogue with affected communities can be maintained as policies are challenged within court systems or evolve through local implementation. social workers can ensure relevant information is accessible across communities where fears and rumors may jeopardize wellbeing and safety. additionally, social workers and others working in resettlement can recognize information and service gaps, responding through promoting legal, translation, health, economic, or other services where needed. social work practitioners can also recognize the detrimental effects of toxic political environments and respond in ways that promote safety, understanding, and belonging. community-wide efforts that enhance social connection are needed (welcoming america, 2020), and interactions across differences may reduce far-right tendencies (steinmayr, 2016). for non-refugee communities, opportunities to learn from and connect socially with people who have come to the u.s. as refugees can de-mystify and personalize the resettlement process. shared public spaces, even in areas where segregation is common, promote togetherness and cross-culturalism among people with diverse backgrounds (anderson, 2004). practitioners may play a role in raising awareness among non-refugee communities, seeking to educate and connect those with diverse backgrounds and create communities that are safe and welcoming. additional strategies include messaging campaigns, training for clients regarding how to respond to discriminatory actions, provision of safe spaces or emergency contact information, and training regarding legal rights and access. multiple approaches and strategies are needed to ensure refugees can speak out regarding injustices and have the tools necessary to protect themselves from othering attitudes and behaviors. social workers and social service agencies can collaborate with refugee communities in efforts to reject othering behaviors and attitudes. narratives that contradict antifunk & shaw/i remember when 1115 immigrant sentiment are essential (krumer-nevo & benjamin, 2010), promoting the development of empathy (ghidina, 2019). growing support for movements such as black lives matter in the u.s. indicates many residents reject long-held racist beliefs and practices such as the over-policing of black communities (guskin et al., 2020). the black lives matter movement also demonstrates the power of recognizing individual experiences, with attention to the names of people killed at the hands of police (black lives matter, 2020). attention to refugee experiences within community events, sport, education, and other avenues may create opportunities for understanding and celebration of refugees. while immigrants have often been pitted against other minority groups in the u.s., black communities in particular (tang, 2015), solidarity and partnership with related movements for social justice may empower refugee communities and create space for their unique voices and realities. social workers can promote these opportunities, recognizing that shared experience and commonalities related to race and religion may also fuel united social action. at the policy level, social workers can promote opportunities for increased refugee resettlement and improvements in conditions for those who have previously resettled. the biden administration’s commitment to increase and improve resettlement opportunities is a critical and life-saving step (unhcr, 2021b; white house, 2021). with the expanding numbers of forcibly displaced persons worldwide (unhcr, 2021a), increased advocacy is needed, including attention to reducing conflicts, promoting options for permanent resettlement, and improving the circumstances of those seeking asylum. post-resettlement advocacy is needed to expand resettlement services, promote access to education, and address wellbeing. in these efforts, people who have experienced resettlement bring needed perspectives and must be included in discourse and leadership. efforts of social workers and other providers to elevate refugee voices and experiences within policy and media discourse may bring needed recognition of potential solutions and a shared humanity. increasing proximity to the refugee experience and highlighting a common ground may reduce tendencies to other those from minority or refugee status. further research regarding the refugee resettlement experience is needed. additional qualitative studies examining the needs and experiences of refugees would assist in hearing, understanding, and elevating refugee voices. furthermore, studies examining the experiences of refugees in other areas of the u.s. could provide needed insight into the effects of the post-2016 political climate on refugees resettled throughout the u.s. as this study was conducted during the trump administration, studies examining the effects of the biden administration and post-2020 policies can bring additional insight to the ongoing experience of refugees amidst changes in u.s. policy and discourse. limitations this study has limited generalizability due to study context and implementation. the sample included participants who resided in the intermountain west region of the u.s. while many participants discussed perspectives regarding the national political climate, further research is needed to examine how contexts vary across the u.s. procedural barriers included the one-time interview. approaching the sensitive issue of politics may have been advances in social work, fall 2021, 21(4) 1116 easier for some participants to do after multiple meetings, or with more time to reflect. though interviewers and interpreters were diverse in terms of racial and refugee status background, some participants may have been uncomfortable sharing views and experiences with those from different backgrounds. moreover, given the nature of refugees’ cultural and political backgrounds in their countries of origin, discussion of political topics during the interview may have been especially sensitive. as such, some participants may have filtered their answers, sharing only commentary they felt was safe in response to questions surrounding politics. additionally, although interpreters were offered and frequently used, varying degrees of english language proficiency among participants may have inhibited understanding of interview content and participant answers. moreover, the full depth of interview content may have been altered through translation. despite these limitations, the large sample provided access to a diverse group of participants. as all participants had been in the u.s. for more than five years, this study provides a unique perspective on how the political climate influenced refugee adjustment and wellbeing in the aftermath of the 2016 election. conclusion while racism, religious discrimination, and anti-refugee sentiment are not new, antagonistic attitudes and behaviors increased post-2016. among people who have resettled in the u.s. as refugees long-term, these changes are apparent and difficult to navigate. study respondents noted an increased sense of uncertainty, changes regarding the meaning and value of citizenship, and an unwelcome environment associated with fear and discriminatory acts. despite this unwelcoming environment, many resettled refugees are working to successfully navigate u.s. society and push back against societal norms that other minorities, including refugees. attention to these voices and experiences is critical, as u.s. society considers when and how to respond to forced migration and social inequities. the u.s. resettlement program provides a necessary opportunity for safety and legal status for a small number of forced migrants globally. as refugees become permanent residents and citizens, a climate of welcome, safety, and certainty is needed. 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(2007). more labels, fewer refugees: remaking the refugee label in an era of globalization. journal of refugee studies, 20(2), 172-192. https://doi.org/10.1093/jrs/fem011 author note: address correspondence to stacey shaw, school of social work, 2175 jfsb, brigham young university, provo, utah, 84602. email: stacey_shaw@byu.edu acknowledgments: funding for this study was received from a mentoring environment grant and a graduate mentoring assistantship grant at brigham young university. we are grateful to participants who graciously shared their experiences and time, student research assistants who conducted interviews and analysis, and community partners who assisted with recruitment. ___________ evelyn p. tomaszewski, msw, acsw, divisional director for graduate programs, associate professor, college of public health, department of social work, george mason university, fairfax, va. lisa e. cox, phd, lcsw, msw, professor of social work, stockton university, galloway, nj. brahmpreet kaur, bs, msw, college of public health, department of social work, george mason university, fairfax, va. copyright © 2025 authors, vol. 25 no. 2 (summer 2025), 566-575, doi: 10.18060/28623 this work is licensed under a creative commons attribution 4.0 international license. leveraging a social justice focus on social work education and licensure evelyn p. tomaszewski lisa e. cox brahmpreet kaur abstract: while msw students are increasingly interested in attaining social work licenses, social work educators vary in their understanding of state licensure and regulations and how to best prepare graduate students. opportunities exist along a pathway to licensure to honor social work’s professional commitment to social justice by teaching relevant course content that includes direct clinical practice and macro level practice, ideally bridging the knowledge to collectively work to facilitate the passing of state aswb exams and secure professional licensure. a brief overview of the challenges that exist as social work programs strive to meet cswe requirements and competencybased course content, in the context of acknowledging the disparities noted in the aswb licensure exams, and while educating the growing number of students striving to seek professional licensure. opportunities for msw programs to identify the role and use of course content, pre-service development, marketing, and recruitment content designed to support students’ efforts to pass aswb licensure exams and obtain credentials are presented. finally, implications and recommendations for social work programs and faculty to enhance their recruitment, teaching, and licensure preparation endeavors to best assist students and graduates. keywords: aswb exams, cswe competencies, msw curriculum, social work licensure increasingly, masters social work (msw) students are interested in obtaining social work licenses. in a 2018 council on social work education (cswe) survey of over 1,600 msw graduates, roughly 80% indicated they planned to get their clinical license within five years (salsberg et al., 2019). the vast majority of social work students indicated their desire to work in a clinical setting and/or in private clinical practice, thereby making licensure essential. simultaneously, social work educators vary in their understanding of state licensure and regulations and how to best prepare graduate students. social work programs/departments of social work must meet the cswe accreditation of nine core competencies based on actual performance in coursework assignments and practicum (cswe, 2022a). programs also want to support and prepare students to pass their state association of social work boards (aswb) licensure exam, and often find a conundrum where prioritizing course offerings. aswb licensure exams tend to rely on knowledge and cognitive processes; cswe accreditation requires coursework to map the integration and accomplishment of nine core competencies based upon performance in coursework assignments and actions in practicum(cswe, 2022a). hence, educators base cswe competencies on the history and roots of the social work profession, and the nine competencies are not necessarily ranked by importance. about:blank tomaszewski et al./leveraging social justice in licensure 567 there exists scant evidence to illustrate that social work programs consistently require courses or program content that addresses social work licensing and regulation. while there is a strong interest shown by social work students, the integration of licensure and regulation content into social work education has received sparse attention in the social work curriculum, in textbooks, and in research (grise-owens et al., 2016). the result is often a great disconnect between those who license or grant credentials to professional social workers and those who educate bsw/msw social work students (grise-owens et al., 2016). in a 2016 online survey of macro social work practitioners and educators, findings revealed how interest does exist in advanced licensure for macro social work practice; however, much ambivalence exists regarding elevating such licensing to the next level (plitt-donaldson et al., 2016). background early literature related to social work education and licensure has identified barriers to obtaining social work licensure (boutte’-queen, 2003), the relevance of cswe curriculum policy (black & whelley, 1999), the dilemma of “grandparenting” in state licensure when non-degreed workers are involved (cohen & deri, 1992), and the issue of continuing education requirements once licensed (dietz, 1998). more recent literature related to social work licensure addresses content about regulatory boards (boland-prom et al., 2018), considers the implications of requiring licensing for macro social work practice (donaldson et al., 2014), provides insights from community practice social workers on professional identification (lightfoot et al., 2016), and provides future directions related to continuing education requirements to maintain licensure (kurzman, 2016). cswe’s (2018) curricular guide for licensing and regulation is yet another rich resource that provides detailed information about social work licensing in conjunction with regulation issues across states, credentials licensing types, and educational requirements. current licensing regulations are part of a long history of dialogue and debate that has created a rather “dynamic tension for social work professionals” (miller et al., 2015, p. 296), including if social work requires licensure (morrow, 2023). some educators argue that social work programs have ignored how important clinical social work examinations are to the careers of their alumni, to the public, and clients (thyer, 2011). in 2022, cswe educational policy and accreditation standards (epas) specifically included licensing exam pass rates as an optional post-graduation program outcome in accreditation standards, with (5.03) noting that social work programs monitor their program outcomes through graduation rates and at least one additional outcome (i.e., employment rates, licensure pass rate, higher education acceptance rates, time to program completion). the annual collection period and benchmarks for graduation rates and the chosen outcome(s) are determined by the program (cswe, 2022a). that same year, in response to advocacy efforts from social work practitioners, the association of social work boards (aswb) published their inaugural data on awsb pass rates (kim & joo, n.d.; national association of social workers [nasw], 2022). subsequently, in response to the asbw analysis of licensure pass rates that noted disparities in pass rates for latino, black and social workers age 50 older (as compared to white test takers), the cswe’s commission on accreditation voted to remove licensing exam pass rates from the 2022 epas accreditation standards. advances in social work, summer 2025, 25(2) 568 this change “reinforces the 2022 epas’ emphasis on anti-racism, diversity, equity, and inclusion” (cswe, 2022b, para. 2). social work educators’ role in conveying knowledge social work educators play a vital role in preparing students and graduates to pass licensure exams, and there remains the inference that from recruitment and admission through graduation day and beyond, what students are taught creates the foundation of knowledge that can affect licensure failure or passing rates. across regions, states, and social work programs, social work educators are tasked with teaching their students competencies that ensure a student’s ability to practice at the micro, mezzo, and macro levels. knowledge, skills, and abilities (ksas) are listed on professional job descriptions and serve to guide applicants, employees, and departments to evaluate and assess a person’s readiness for success in a job. a social work professional is expected to possess certain ksas to perform the duties of their position. hopefully, knowledge of ksas will enhance a test taker’s ability to pass licensure exams. knowledge statements refer to factual or procedural information, a body of information required to directly perform job functions. skill statements refer to verbal or mental manipulation of data or items that are measured via a test where competency and/or of performance are assessed, typically within an established time limit. ability statements refer to the power to perform an observable activity at the present time. this means that abilities have been evidenced through activities or behaviors that are like those aptitudes, and aptitudes are only the potential for performing the activity. ksas require attention because they are job related and tied to questions one might see on a licensure exam or job performance evaluation. aswb exams contain content areas, competencies, and ksas. for instance, in the clinical examination (lcsw), for a content area that includes human development, diversity, and behavior in the environment, the competency would be human behavior in the social environment, and the ksa would be the effects of addiction and substance use on individuals, families, groups, organization, and communities (aswb, 2018). licensure examinations licensure varies across states and territories. for bsw graduates, some require licensure exams for social workers who have graduated from cswe accredited baccalaureate programs (cummings, 2019). licensure for macro and/or administrative practice is available in twenty states, with far fewer states offering licensure specific to macro level practice (e.g., the licensed advanced macro social worker license in missouri) or “ambiguous titles” such as certified master social work manager in north carolina (cummings, 2019; morrow, 2022). attaining professional social work licensure requires time and money; the lcsw exam is four hours long, and the fee is, on average, $260.00. therefore, passing licensure exams on the first try is important because of cost, time, and possible testing fatigue. the five categories of social work licensing exams are: associate, bachelors, masters, advanced tomaszewski et al./leveraging social justice in licensure 569 generalist, and clinical. competencies measured in the aswb clinical exam include the following: 1) human development, diversity, & behavior in the environment (24%); 2) assessment, diagnosis, and treatment planning (30%); 3) psychotherapy, clinical interventions, and case management (27%), and professional ethics and values (19%) (aswb, 2018). to prepare student or graduate test takers, prep courses and materials are available. these range from the purchase of online practice tests (offered by aswb or private businesses) to online resources to help those taking or considering taking the national social worker-clinical exam and the purchase of exam guides. apgar (2019) examined the great divide between social work’s cswe educational policy and licensure examinations, for example, roughly half, or 54%, of social work faculty members were licensed social workers. further, the aswb exams do not impact curriculum or coursework as regulators focus on consumer protection, so competency is based on what social workers do (apgar, 2019). consequently, regulators and aswb exams stress direct practice wherein “only two of the 46 ksa statements in ‘human development, diversity, and behavior in the environment’ focused on larger systems or social justice” (p. 527). in reality, 32% of a licensure exam focuses on “interventions and techniques used across systems,” while all ksa statements relate to micro level practice. no ksa statements have to do with macro social work on larger systems (aswb, 2018). social justice and social work education, licensure and regulation social justice, framed as a core foundation of the profession, is rooted in the idea that all people have equal rights, opportunities, benefits, and treatment, and includes necessary advocacy to address and reduce inequalities, oppression, and discrimination (barker, 2014; finn, 2021; nasw, 2021). cswe’s (2022a) epas states that msw programs’ “describe how the program’s mission statement is consistent with the profession’s purpose and values;” including “social justice….and the quest for social, racial, economic, and environmental justice” (p. 14). in accredited msw graduate schools and programs, faculty are tasked to deliver course content guided by and structured to adhere to the cswe epas, with the core competencies the defining baseline of measurement of student learning in both coursework and practicum. the profession’s historical roots of the commitment to social justice, reflected in both the cswe (2022a) epas and nasw (2021) code of ethics, ensure that msw programs include courses that address the knowledge and skills and experiences necessary to work in communities or mezzo and systems or macro level policy practice. increasingly, msw graduate schools and programs find more students drawn to clinical practice, leading to a growing interest for coursework that focuses on individual or micro level practice; resulting in programs offering limited course content that focuses on policy practice courses. programs can use cswe competency 3: engage anti-racism, diversity, equity, and inclusions (adei) in practice and cswe competency 2: advance human rights, social, racial, economic, and environmental justice (cswe, 2022a), as an opportunity to include course content that can help students connect and build skills that bridge the micro-macro divide. for example, macro level policy courses can include course assignments directly related to the specialization area and/or the student’s clinical advances in social work, summer 2025, 25(2) 570 practicum population, while clinical courses can expand to include content that looks at the regulatory and/or policy implications of the specialization’s practice focus and/or population. doing so can serve to meet the values and purposes as outlined by cswe’s (2022a) epas, and meet the requirements for a clinical course of study necessary to apply for state-level licensure that includes advanced coursework focused on diversity and social justice (virginia department of health professions [va dhp], 2024). highlights and conclusions by apgar (2019, 2020) note the disconnect between what cswe accreditors versus aswb licensures require as measures for readiness to practice competent and effective social work are cited and considered. the authors posit that a social justice lens considers balancing social work policy-practice and direct clinical practice be used when comparing educational curricula and state licensure requirements and regulations. how do social work programs recruit, teach, and prepare students to be licensed? teaching relevant course content, focused on direct practice, may work to help msw students pass the necessary aswb state licensure exam(s). yet, course content is (appropriately so) unique to each school or department, and licensure exam pass rates vary across states and schools. for instance, there are msw programs seeking to create a curriculum and practicum-based pathway to clinical licensure; others are focused on supporting a student’s goal to pass the aswb exam, each working within cswe accreditation requirements. teaching the core competencies can help students bridge micro/individual and macro/community practice. msw generalist year coursework provides students with the generic knowledge, values, and social work skills necessary for ethical professional practice across micro, mezzo, and macro levels of practice. to better address the coursework requirements for licensure, and the growing interest in clinical practice, an increasing number of msw programs have incorporated clinical courses that are specifically listed in state licensure requirements (e.g., psychopathology). very broadly, msw programs take one or two paths forward after the generalist year core curriculum, such as: 1) a population or practice-area program specialization (e.g., behavioral health/mental health, school social work, aging/gerontology, military and veterans, children, youth, and families, social work with organizations and communities), or 2) an advanced generalist approach with tracks defined by electives (e.g., clinical social work, leadership and management, substance use and recovery; cswe, 2023). preparation for state aswb licensure exams social work faculty who are licensed tend to spearhead exam preparation initiatives and/or include exam materials in their weekly or semester lectures. social work faculty formally and informally educate students about the licensure process, the requirements, where to receive more information, as well as the very purpose of licensure and consumer protection. to prepare for the state aswb exam, during the academic year, programs offer tomaszewski et al./leveraging social justice in licensure 571 information sessions for students. often this preparation is accomplished through close collaboration with professional associations and/or state social work boards. programs may offer test prep sessions to help students prepare to take aswb exams, accessing test questions from previous aswb exams, thereby allowing students to be exposed to question types, formats, and wording; and receive general tips on test taking. a central part of facilitating the pathway for students planning to apply for licensure is to ensure the completion of a clinical practicum that provides the requisite minimum (600 hours) of advanced clinical practice hours (va dhp, 2022). however, it is noteworthy that students wishing to pursue macro level practice may complete a non-clinical practicum (e.g., policy analysis or program development) while also taking both macro and clinical electives. general lessons learned the authors of this paper propose there is a lack of conformity that often exists in social work programs (both institutionally and regionally) regarding social work licensure. this reality is interesting from the perspective of how programs vary in their adherence to cswe standards. to retain accreditation, social work programs uniformly address the specific competencies and practice areas mandated by cswe. yet, students’ mastery is assessed through methods created by each program and, if successful, graduate students are issued an irrevocable msw degree at the end. the educational process is facilitated by faculty and program administration, as well as clearly communicated intentions found among program marketing materials, websites and in program mission statements and goals. because social work licensure is a tangible method of holding practitioners accountable and regulating their ability to practice ethical and competent social work, it would stand to reason that the degree and the license would be more closely linked, or at least conceptually so. there is no consistent messaging regarding the connection of social work licensure (clinical and/or macro) to program curriculum. rethinking the micro/macro dichotomy realistically, many professional social workers realize how viewing education as either “micro or macro” is a false dichotomy. social workers cannot help an individual without considering the larger environment and, likewise, there is no ability to create change in communities or organizations without understanding and advocating for the individual. applying the term “social justice” to only macro work serves to further splinter the profession. in a private clinical social work practice, an lcsw may have a client who is experiencing the debilitating effects of a major depressive episode. the client, who identifies as a gay male, discloses repeated comments at their workplace, including homophobic statements and “jokes” that leave them feeling powerless, embarrassed, and isolated. the lcsw who recognizes the importance of interventions that acknowledge and explore internalized oppression, the impact of systemic inequities, and the historical discrimination of lgbtq persons, is drawing upon the profession’s social justice roots advances in social work, summer 2025, 25(2) 572 similarly to a social worker who is engaging in macro practice (e.g., community organizing or policy advocacy). adopting a broader social justice application in licensure preparation for lsws or lcsws may benefit students and programs, demonstrating a commitment to social justice across all levels of practice (micro, mezzo, macro). social work educators are tasked with challenging the framing that clinical practice (especially private practice) and social justice are mutually exclusive. this commitment will move the needle towards support for licensure being an end-product of social work education. implications for practice to prepare students for social work licensure, and in efforts to bridge the micro-macro divide, concluding implications note opportunities for programs/departments, schools, and faculty to enhance recruitment, teaching, and the licensure preparation of msw candidates. 1. provide social work students with licensure information at the beginning of their educational journey. both bsw and msw programs can proactively provide resources, contacts, career options, and/or state regulations about social work licensure. because the types of licensures vary in each state, schools should be able to provide information about their state (or region in certain cases) that will help students know their options and plan their career trajectories. in one author’s work as a bsw educator, she incorporates group activities in which students research licensure criteria in multiple states and conduct job searches for jobs requiring licensure to better understand what those roles entail. she also has the class view the social work licensing board website together and reviews the necessary criteria and application instructions. 2. in teaching social work ethics and the social work core value of competency, educators can promote licensure as one of the most visible ways social workers are held accountable for their work. licensure is a method of prioritizing public protection. social workers have a vital role in the health and well-being of individuals, organizations, and communities. assuring consumers and the public that social work professionals are competent and ethical in fulfilling this role is important to public confidence and our professional identity. 3. in creating or revising course curricula, programs can assess how to support the cswe competencies by integrating or reflecting the ksas found in the licensure exam topics and sample questions. trevino et al. (2024) noted that changes made to the aswb licensing exam now include ksas drawn from practice analysis of three content areas: values and ethics, assessment and planning, and interventions and practice. integration of the three areas will allow the instructor to further illustrate the competencies and provide continued context for social work skills. 4. social work program course development or redesign could assess and modify course readings, assignments, and classroom or group assignments with social justice as the core foundational framing, seeking to bridge policy and clinical tomaszewski et al./leveraging social justice in licensure 573 practice skills through defining the historical roots of macro/community practice and individual/clinical practice. 5. social work programs ought to continue to initiate research on social work licensure, including furthering qualitative exploration of social work programs across the country and the nature of their curriculum and licensure preparation. 6. social work programs can make study materials readily available for students. examples found in other programs include purchasing and loaning materials to students, facilitating access to websites or practice questions, and offering frequent formal or informal study sessions. 7. in marketing and recruitment materials, programs could clarify the differing levels of state licensure available (because they differ between states) and specify the course and practicum requirements that prepare students to apply for clinical, macro, or other licenses. examples of “frequently asked questions” about licensure are found on numerous msw program websites. 8. programs can build and grow available resources (e.g., alumni) and collaborative relationships with professional associations and societies to augment available departmental expertise to provide both information about licensing options and facilitate opportunities for students to access and practice licensure exams. 9. aswb can engage social work faculty members and practitioners as advocates and paid volunteers to review and modify exam content. community social work practitioners (clinical and macro) bring expertise and awareness of which competencies and ksas are truly valuable in everyday practice; while faculty with practice experience (licensed or not) can serve as reviewers and writers for aswb. ksas are valuable and cswe core competencies ought to work to further align knowledge, skills, values and affective and cognitive processes. conclusion we conclude that social work programs ought to be prepared to discuss the role and impact of the pursuit of licensure, course content, and how to best reflect program and community needs. the changes in cswe competency measurements call for programs to dialogue about the use of licensure requirements to define curriculum, including the infusion of macro-clinical content rooted in promoting social justice and equity. msw programs would be prudent to prepare for possible dilemmas by considering the following questions: (1) what would be the effect if social work programs are pressured to post licensure scores, (2) how would a decision to post or not to post scores reflect on schools/programs (3) does the use of pass/fail rates measure and reinforce clinical practice at the expense of macro practice?, and (4) how might decisions of the aswb 2026 standard setting panel (2025) reflect on the use of macro policy practice and social justice as measurements of competence for safe practice? while social work licensure and regulation only partly define social work as a profession, the ultimate purpose of licensure is to protect public consumers of social work services through ethical and competent practice, for which educators play a vital role. advances in social work, summer 2025, 25(2) 574 references apgar, d. 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(2024). verification of education & field placement/practicum hours social work-lcsw. author. author note: address correspondence to evelyn p. tomaszewski, college of public health, department of social work, george mason university, 4400 university drive, msw 1f8, fairfax, va 22030. email: etomasze@gmu.edu orcid evelyn p. tomaszewski https://orcid.org/0000-0001-9774-8805 lisa e. cox https://orcid.org/0000-0003-4553-6741 brahmpreet kaur https://orcid.org/0000-0003-0336-5286 https://www.aswb.org/wp-content/uploads/2024/08/1.-kim-joo-2024-profile-of-social-work-license-examinees-07-30-2024.pdf https://www.aswb.org/wp-content/uploads/2024/08/1.-kim-joo-2024-profile-of-social-work-license-examinees-07-30-2024.pdf https://doi.org/10.1080/08841233.2016.1214041 https://doi.org/10.1080/08841233.2016.1214041 https://doi.org/10.1080/10705422.2016.1165328 https://doi.org/10.1080/10705422.2016.1165328 https://doi.org/10.1080/10705422.2016.1165328 https://doi.org/10.1080/08841233.2015.1039160 https://doi.org/10.1080/08841233.2015.1039160 https://doi.org/10.1177/10497315221114175 https://doi.org/10.1177/10497315221114175 https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english https://www.socialworkers.org/news/news-releases/id/2531/aswb-social-work-licensing-exam-pass-rate-data-confirm-concern-over-racial-disparities https://www.socialworkers.org/news/news-releases/id/2531/aswb-social-work-licensing-exam-pass-rate-data-confirm-concern-over-racial-disparities https://doi.org/10.1080/10705422.2015.1127864 https://doi.org/10.1080/10705422.2015.1127864 https://www.cswe.org/getattachment/863919d8-ace7-4e9c-9602-f1a221062a07/2018-social-work-workforce-report-executive-summary-(2).pdf?lang=en-us https://www.cswe.org/getattachment/863919d8-ace7-4e9c-9602-f1a221062a07/2018-social-work-workforce-report-executive-summary-(2).pdf?lang=en-us https://doi.org/10.1007/s10615-009-0253-x https://doi.org/10.1007/s10615-009-0253-x https://www.aswb.org/wp-content/uploads/2025/02/2024-analysis-of-the-practice-of-social-work.pdf https://www.aswb.org/wp-content/uploads/2025/02/2024-analysis-of-the-practice-of-social-work.pdf https://www.dhp.virginia.gov/boards/socialwork/practitionerresources/applicationsandforms/ https://www.dhp.virginia.gov/media/dhpweb/docs/sw/forms/educationverification_practicumhours.pdf https://www.dhp.virginia.gov/media/dhpweb/docs/sw/forms/educationverification_practicumhours.pdf mailto:etomasze@gmu.edu https://orcid.org/0000-0001-9774-8805 https://orcid.org/0000-0003-4553-6741 _________ berg miller, phd, lmsw, ma, assistant professor, department of social work, buffalo state university, buffalo, ny. annahita ball, phd, msw, school of social work, university at buffalo, buffalo, ny. copyright © 2023 authors, vol. 23 no. 1 (spring 2023), 26-43, doi: 10.18060/26018 this work is licensed under a creative commons attribution 4.0 international license. “if another person says, ‘you’re so articulate,’ so help me”: microaggressions experienced by employees of human service agencies berg miller annahita ball abstract: few studies have examined the nature of microaggressions experienced by employees of human service agencies. this exploratory study identified the types of microaggressions that women and non-binary people of color experience within their agency settings. narrative data were collected using a web survey. the survey consisted of two instruments, both developed by the researcher--a non-categorical demographic questionnaire and a survey that asked participants about their experiences of four types of workplace microaggressions. the sample consisted of 52 self-identified women and nonbinary people of color employed by non-profit agencies or governmental departments providing human services in the united states. data were analyzed by applying interpretive phenomenological analysis (ipa) and a constant comparative approach, generating three overarching themes: (a) misperceptions of identity or circumstances, (b) navigating racial stereotypes, and (c) racialized objectification. findings stress the importance of addressing microaggressions among employees to foster inclusive workplaces and the salience of race/ethnicity as a targeted identity in the human service professions. recommendations include the development of workplace policies that create clear and effective avenues for addressing subtle discrimination. individual social workers can effectively implement these policies by acknowledging, validating, and ultimately reducing unintended harm to colleagues. keywords: microaggressions, intersectionality, organizations, women of color, nonbinary people microaggressions are defined in the literature as slights or subtle insults towards a person’s marginalized identity that are often perceived as harmless by their perpetrators (sue et al., 2007). microaggression research examines the impact of these insults, shifting attention away from the intentions of perpetrators to a focus on measuring the consequences of covert discrimination (fleras, 2016). while perpetrators of subtle discrimination may be well-meaning, these acts are not inherently less damaging than blatant and malicious discrimination (cortina, 2008). findings of a meta-analysis by jones et al. (2013) comparing effect sizes in 90 studies found that subtle discrimination generally had a slightly greater effect than overt discrimination on psychological and physical health as well as work performance. within the human service sector, there is a responsibility to maintain socially-just organizations that address microaggressions, consistent with the formalized ethics of these professions. human service employees who receive education in serving diverse client populations also ought to be able to demonstrate cultural humility towards colleagues and recognize their role in creating an inclusive workplace. about:blank miller & ball/microaggressions in human services 27 microaggressions and the role of organizations sue et al.’s (2007) taxonomy of microaggressions, which originally defined microaggressions as racial slights towards people of color, catalyzed a body of scholarship primarily focused on counseling practice as it related to client outcomes. the literature has since expanded to study the impact of subtle discrimination on a wide range of oppressed and marginalized groups. however, studies remain centered on the harmful psychological impact of microaggressions on individuals. this study examined the microaggressions that occur among employees of human service agencies within the context of organizations. a lesser explored feature of microaggressions is their role as a vehicle for maintaining patterns of discrimination within organizations. organizations perpetuate the effects of macroaggressions, or large-scale inequities, through microaggressions (huber & soloranzo, 2015). organizations, which routinely bring people into relationships with one another, have a responsibility for the quality of human interactions among their employees (gonzalez & denisi, 2009). workplaces can either interrupt systemic oppression by setting standards of equitable employee relationships as a condition for employment or produce systemic oppression by normalizing oppressive behaviors (proudfoot & kay, 2014). while there are not yet prevalence rates for either microaggression or workplace microaggression, a nationally representative study conducted by the workplace bullying institute in 2014 (n=1000) on workplace bullying, a serious form of non-physical workplace violence, found that 72% of american employer reactions either implicitly condoned or explicitly sustained bullying behaviors. among witnesses to bullying in this same study, only 29% made some attempt to intervene or help the target; 38% did not respond, while 7% ostracized the target, and another 4% sided with the perpetrator (namie et al., 2014). the pervasiveness of workplace cultures that normalize bullying indicates the need for interventions that address microaggressions. findings from an emergent workplace microaggression literature highlighted that the harm of microaggressions to individuals is interconnected with systemic disadvantage. shoshana’s (2016) study about palestinian professionals in israel found that microaggressive comments and language in the workplace evoked distressing thoughts about oppressive systems, and about one’s powerlessness to effect a change in those systems. similarly, a study of workplace microaggressions experienced by people with multiple sclerosis indicated that microaggressions prompted anxiety about job security (lee et al., 2019). recent scholarship has further explored connections between subtle discrimination towards individuals and large-scale inequities. for example, studies with native americans (senter & ling, 2017) and chinese migrant workers (li, 2019) suggest that microaggressions functioned to maintain macro-level discrimination. legal scholars have concluded that there is a discrepancy between employee experiences of workplace discrimination and u.s. law (jones et al., 2013). in a random sampling of 219 legal cases filed for workplace discrimination between 2000 and 2008, king et al. (2011) ascertained that unintentional microaggressions were frequently a part of discrimination claims yet did not impact court case outcomes. according to the findings of this study, microaggressions were not relevant in court, although people filing advances in social work, spring 2023, 23(1) 28 discrimination claims saw them as part of larger patterns of discrimination. subsequently, microaggressions can be overlooked as minor or well-intended even while targets recognize them as having significant consequences in perpetuating systemic oppression. human service organizations have stated missions to provide compassionate and empowering services to underserved populations. organizations are accountable for fostering equitable workplace environments where all employees can thrive and achieve the aims of these missions (majiros, 2013). an agency-level commitment to acknowledge and reduce microaggressions among employees is needed to foster social justice at the level of individuals and organizations across the whole of the human service professions (gómez, 2015). furthermore, research exploring the phenomenon of microaggressions within these settings would potentially allow for the development of evidence-based interventions. research is needed to assess the occurrence of microaggressions within the human services. feminist intersectionality theory feminist intersectionality theory asserts that a paradigm focused on multiple marginalization is key to comprehensively addressing systems of oppression (bowleg, 2012). the concept of “multiple marginalization” or of being “multiply-marginalized” refers to the complex position of holding an underserved identity or status in more than one category. intersectionality was first formally theorized in the scholarship by black feminists as a means of asserting their multidimensional experiences of systemic oppression based on combined racism, classism, and sexism (collins, 1990; crenshaw, 1989). this theoretical approach was further elaborated by a broad base of women of color who developed a conceptual framework to account for their lived experiences (hulko, 2009). feminist intersectionality theory has remained mostly open-ended and inherently interdisciplinary. it does not have one established and agreed-upon set of tenets. instead, intersectional scholars across disciplines have implemented an intersectional lens within their respective fields of expertise to challenge existing paradigms (collins, 2015). this study applied feminist intersectionality theory to explore microaggressions between employees in the human services, with a focus on self-identified women and non-binary people of color. we applied three guiding concepts of intersectionality outlined by bowleg (2012) that are relevant to an organizational context. first, social identities are multiple and interact with one another. this served as an underlying premise of all stages of the research. second, an issue of relevance to a broader population is most effectively addressed by accounting for the needs of people who face barriers based on having multiple marginalized identities. our examination of microaggressions towards self-identified women and nonbinary people of color did not systemically disadvantage white, male, or cisgender people but, instead, accounted for the needs of human service agency employees representing oppressed groups. third, individuals with marginalized identities are delegitimized in daily life when they encounter systemic barriers, with agency operations and service providers themselves often functioning as a barrier for clients to receive adequate care. this study miller & ball/microaggressions in human services 29 took the perspective that microaggressions between employees are indicative of greater gaps in organizational policies overall and are inextricably linked to the quality of services. current study research exploring the phenomenon of microaggressions in human service organizations is needed for the development of evidence-based interventions. this study addressed that need with the application of feminist intersectionality theory to an exploratory analysis of microaggressions experienced by women and non-binary people of color employed by human service agencies. methods positionality statement data analysis in this study was a collaboration between the principal investigator (pi) and a research assistant (ra). the pi was a phd student conducting the study as part of their dissertation. their research interest was informed by the experience of developing and facilitating trainings on microaggressions for social service settings. the pi identified as a white, non-binary woman. the ra was an msw student hired to conduct a comparative analysis and to provide a final audit of themes. the ra identified as a cisgender woman of color. this collaboration between the pi and the ra aimed to increase the reliability of the study by bringing two perspectives to the process of data analysis, inclusive of a researcher reflective of the participant demographics. procedures we used qualitative analysis to explore text submitted on an online survey for women and non-binary people of color employed by human service agencies. participants were recruited using purposive and snowball sampling techniques through the facebook group for the national organization for human services (nohs). a response rate cannot be calculated due to the nature of the snowball sampling technique since it is unknown how many people received the survey. each participant received a $5 gift card to starbucks, and the first 100 participants were given the option to enter a drawing for one of two $50 amazon gift cards. text responses to open-ended questions were used for data analysis. this research was approved by the institutional review board at the university at buffalo. sample the sample consisted of 52 self-identified women and non-binary people of color employed by human service agencies or governmental departments in the united states with at least five staff. the study excluded people under the age of eighteen. the largest racial group of participants, representing two-thirds of the total sample (n = 35), identified as either black or african american. the second-largest group was participants who identified as either biracial or multiracial (n = 9). the majority of the sample was cisgender advances in social work, spring 2023, 23(1) 30 women, who made up nearly 95% of the participants in the study (n = 49). over two-thirds of participants identified as heterosexual (n = 38), with bisexual or pansexual representing the second largest group (n = 6). the age of participants spanned from 18 to over 65 years old. instruments the survey consisted of two self-developed instruments: a population-specific noncategorical demographic questionnaire and the women of color workplace microaggressions survey. the non-categorical demographic questionnaire was specific to the population and the purposes of the study. the questionnaire had a total of 41 closed and open-ended questions to collect both quantitative and narrative data. questions asked participants about their age, religious or spiritual identity, financial situation during childhood, current financial situation, immigration status, race/ethnicity, biological sex or gender assigned at birth, gender identity, sexuality, physical disability, mental illness, and body size. every demographic question about identity or status gave participants the option of filling in a blank text box, to recognize the non-categorical experience of having marginalized identities (mccall, 2005). the 28-item women of color workplace microaggressions survey had 4 sets of questions about the 4 types of workplace microaggressions identified by van laer and janssens (2011), followed by 7 open-ended questions. each of the 4 sets of questions about the types of workplace microaggressions asked participants if they experienced these microaggressions and offered an open-text box that allowed participants to provide a description of their experiences. the 7 additional open-ended questions gave participants the opportunity to further elaborate on their experiences. example questions included: “please describe a microaggression that you have experienced,” “how did you respond to the above microaggression or to microaggressions in general?” and “do you have any supports at your agency that have helped you to cope with microaggressions?” a final survey question asked participants to choose a pseudonym, which was used to de-identify each piece of datum. analysis an interpretive phenomenological approach (ipa) examines how individuals perceive their own lives and allowed this study to elevate participants’ voices, especially because experiences of microaggressions are often invalidated (smith et al., 2009). two researchers used ipa to conduct a comparative analysis of the brief text responses. the use of a comparative analysis between the two researchers improved the rigor of the analysis by reducing the potential for bias (morse, 2015). first, we independently read all the data at once to get a broad overview of its content. afterward, we did independent interpretive analyses using microsoft word. once we completed separate interpretive analyses, we continued to the second stage of ipa, initial noting (smith et al., 2009). for initial noting, we first independently conducted line-byline readings to identify meaning units, or specific segments of data, that helped to explore miller & ball/microaggressions in human services 31 the research aim. we made line-by-line comparisons of our separate interpretative analyses and completed the initial noting. we then conducted a line-by-line comparative analysis to develop a list of emergent themes using atlas.ti. during this process, we engaged in another aspect of ipa, referred to as psychological reflection, which consisted of assigning a code to each meaning unit as well as reflecting on individual instances of the phenomenon of workplace microaggressions. at this point, the pi developed superordinate and subordinate themes. the second researcher took the role of an auditor to review the development of themes by the pi. memoing was done throughout the course of analysis as a bracketing technique. we practiced reflexivity by openly addressing and documenting personal biases throughout the duration of the study (tufford & newman, 2010). results the first superordinate theme, misperceptions of identity or circumstances, explored three primary types of misperceptions, or assumptions, that participants experienced as an insult to their identities. the second superordinate theme, navigating racial stereotypes, described two means by which participants negotiated assumptions about their racial group. the third superordinate theme, racialized objectification, addressed the two ways that participants’ physical characteristics were evaluated through a lens of race. themes are summarized in table 1. table 1. superordinate and subordinate themes for types of workplace microaggressions groupings themes superordinate subordinate types of workplace microaggressions misperceptions of identity or circumstances • assumptions of poverty • assumptions of financial stability • racial or ethnic ambiguity navigating racial stereotypes • stereotyped one-dimensionally • exception to group racialized objectification • skin color • hair misperceptions of identity or circumstances. the first superordinate theme- misperceptions of identity or circumstances--had three subordinate themes: (a) assumptions of poverty, (b) assumptions of financial stability, and (c) racial or ethnic ambiguity. assumptions of poverty. participants described assumptions of financial instability or poverty, both past and present. some implicitly linked these false conjectures to racial stereotypes of dependence on government welfare systems. leticia, an administrator (1829-year-old, latina, heterosexual, cisgender woman), wrote, “people often think my whole childhood was on food stamps when, in fact, my father worked hard to ensure that was not always the case.” keisha, a social worker in foster care (50-64-year-old, black, heterosexual, cisgender woman), relayed similar presumptions of childhood poverty: advances in social work, spring 2023, 23(1) 32 sometimes people assume i had a poor or harsh childhood. in fact, my parents worked hard and bought a home. i grew up in a nice home with hardworking parents. i always had food, and there were no instances of utilities being shut off. keisha also experienced stereotyping about her current income based on race and neighborhood of residence: “i think that people shouldn't assume they know your background or your present situation based on knowing your address and that you're black.” assumptions of financial stability. in contrast to assumptions of financial insecurity, participants also wrote of mistaken conceptions about financial stability. although some held a title at their agency suggesting to colleagues that they had an income sufficient for a sense of economic stability, the financial responsibilities in participants’ lives were sometimes significant enough to cause strain despite their holding a position of status. rachel, a program manager (40-49-year-old, biracial black and native american, heterosexual, cisgender woman), described, “people assume that i make more than i do because i'm a manager. but, with childcare costing $800 a month, school fees, food, transportation, car maintenance, etc., i'm struggling as a single mother of four.” ava, a quality assurance analyst, alluded to having a childhood where her family had lower socioeconomic status than she did at present and stated that although her income was comparable to her colleagues, she did not share their financial security: there's a disconnect between where i've been and where i am financially. i'm not one to share my past financial status as finances aren't ever a topic we were allowed to discuss. although, because i have a similar income to others in my department, it is assumed that i don't have financial burdens that weigh heavily on my mind in the workplace. i'm highly dependent on getting an annual raise and bonus check every year to keep up with my student debt and the student debt of my family. these raises and bonus checks aren't guaranteed and don't match the increased cost of living. i find myself constantly assessing my finances in my spare time and meticulously monitoring my payroll. (18-29-year-old, biracial black and white, bisexual, cisgender woman) miranda m., a frontline provider with muscular dystrophy, shared that her income level was often assumed to be higher than it was because she owned a vehicle with costly modifications to accommodate her disabilities: i think that because i'm able to drive my own modified vehicle, people think i'm well off. half of my vehicle was paid for by state vocational/rehabilitation department for aging and rehabilitative services (dars) in virginia, and i was denied three times for funds before getting a new case manager. i live at home and pay little rent, because the area is much too expensive and because i need assistance. i have had new aides who come work for me also ask me for money when they start after seeing where i live. most of my aide’s salary is also paid for by state vocation/rehabilitation (dars), and i may pay a small co-pay depending on my income. (40-49-year-old, black, heterosexual, cisgender woman) miller & ball/microaggressions in human services 33 most participants depicted presumptions of financial well-being as a source of distress. however, queen e, a frontline provider, stated that she is perceived as having more economic resources than she does due to successful money management: “i’m frugal and perceived as far more well off than i am. i buy quality, classic clothes and shoes that last a long time, and i live pretty simply” (50-64-year-old, black, heterosexual, cisgender woman). racial or ethnic ambiguity. participants were also misperceived based on racial and ethnic identity. some appeared racially or ethnically ambiguous, to which others made inaccurate judgments about their background. sarah, a frontline provider, said, “people know i’m asian but often assume i’m chinese” (30-39-year-old, asian american, heterosexual, cisgender woman). brenda, a director, wrote, “some think, at least in this area, that i am puerto rican because they look at my hair texture and length. but i have deep native american and creole roots” (30-39-year-old, black, heterosexual, cisgender woman). janilys, a frontline provider, wrote that she was repeatedly told her physical appearance did not match her ethnicity: “i have been told: ‘you don't look hispanic’” (3039-year-old, latina, heterosexual, cisgender woman). several participants shared challenges resulting from being mistaken as either biracial or monoracial. keily, generally assumed to be biracial, listed several incredulous remarks that frequently accompanied this misperception: “i’m often asked if i’m mixed, and when i say i’m not, the response is always, ‘are you sure?’ or ‘you’re lying’ or ‘you can’t have good hair without being mixed’” (40-49-year-old, black, heterosexual, cisgender woman). these comments about keily’s hair had the underlying connotation that physical traits associated with her racial group were unattractive. ava elaborated upon a demoralizing microaggression she commonly encountered as a biracial person: navigating the world as biracial (black and white), i've found the black community to be more accepting and supportive of my struggles in social and professional settings. i'm fairly light-skinned, but not enough to fully pass in white spaces. due to this, i am eventually asked the most dehumanizing question of “what am i.” although i, at all times, work to keep an open heart and offer a helping hand when facing unintentional racism, it still cuts deeply to hear these types of microaggressions. (18-29-year-old, biracial black and white, bisexual, cisgender woman) in contrast, christina f., a program manager, wrote about being inaccurately perceived as biracial: “i present as racially ambiguous. most people perceive me as biracial because of my physical features, but i am not biracial. both of my parents and both sets of grandparents are african american” (30-39-year-old, black, heterosexual, cisgender woman). in the context of a racialized society, false assumptions about racial and ethnic identity sometimes held great weight for participants regarding feeling understood and appreciated in their interactions. navigating racial stereotypes. the second superordinate theme of navigating racial stereotypes had two subordinate themes: (a) stereotyped one-dimensionally and (b) exception to group. the first subordinate theme, stereotyped one-dimensionally, encompassed being perceived as a person who confirmed stereotypes of their racial group advances in social work, spring 2023, 23(1) 34 and was consequently reduced to a stereotype rather than being seen for their whole humanity. the second subordinate theme, exception to group, included situations in which participants were regarded as having commendable qualities incongruent with their racial and ethnic identity, and consequently viewed as superior to their group. being perceived as an exception to their racial group implicitly degraded that racial group while simultaneously denying that participant recognition of their racial identity. stereotyped one-dimensionally. the experience of being stereotyped onedimensionally was tied to false presumptions about multiple aspects of participants’ lives. terry t., an audit manager, wrote of the myriad stereotypes prescribed to her: it is often assumed that i am a single parent when i have been married to the father of both of my children for 16 years. it is also assumed that i live in an apartment in the city when my family lives in an affluent suburb in a top-performing school district. (40-49-year-old, black, heterosexual, cisgender woman) michelle b., a clinical supervisor, likewise described a wide range of conjectures made about her based on racial stereotypes: people have asked to touch my hair, assumed i know about hip-hop music, are surprised that i am married, are surprised that i am the supervisor, and over the phone have assumed that i am white because of my position and presentation. (3039-year-old, black, heterosexual, cisgender woman) the comments suggest that these participants were sometimes a point of curiosity and represented identities for which colleagues had gaps in knowledge about how to interact in a considerate and respectful manner. several participants wrote about being stereotyped one-dimensionally within their agency setting. queen e, describing the similarity between overt and subtle discrimination, wrote: “similarities include things like assuming all black women can cook, or that we’ll bring fried chicken to the company potluck!” (50-64-year-old, black, heterosexual, cisgender woman). anastasia b., a frontline provider, said that people sometimes drew inaccurate conclusions about the languages that she spoke and her role at the agency. her examples of microaggressions included, “oh, you do speak english” and “oh, you’re not an interpreter” (18-29-year-old, latina, bisexual, cisgender woman). these instances may have reminded participants that their race was highly salient to others and that racial stereotypes led to false conceptions about their professional capabilities and their lives in general. comparable assumptions came up for participants around race or ethnicity paired with religion. rowan, a program manager who identified as agnostic, wrote, “some think latina and automatically think i'm catholic. i was brought up catholic and southern baptist and am neither since high school” (40-49-year-old, biracial latina and white, queer-identified, non-binary woman). rose, a counselor who identified as both christian and spiritual, wrote, “white people assume i'm baptist, they think all blacks are baptist” (18-29-year-old, black, heterosexual, cisgender woman). exception to group. for the second subordinate theme, exception to group, participants who were perceived as superior to their racial group had their identities dismissed or overlooked. in some instances, participants were denied acknowledgment of miller & ball/microaggressions in human services 35 their expertise as a person of color with knowledge based on lived experience. sarah g. wrote, “i have been told by a supervisor that because i don’t look like a native american, i must not know as much as those who ‘look’ native” (30-39-year-old, biracial native american and white, bisexual, non-binary woman). violet, a program manager, described a situation in which, “[my colleagues] talked about asking certain other black people who did not work for us to read over something, to make sure they hadn’t missed any biased language. as if i was not a person of color who worked there already” (18-29-year-old, biracial black and white, heterosexual, cisgender woman). she explained, “my coworkers treating me as though i wasn’t a person of color when we were serving mainly people of color added another layer of difficulty to my job.” some participants recounted surprise from others in response to their intellect and competence. tee, a mid-level supervisor, listed among her experiences of microaggressions presumptions of ineptness, “‘i don't see color’; ‘you are not like the rest of them’; ‘you don't talk ghetto’; assumptions that i grew up poor or in the ghetto; visibly surprised by my intellect” (30-39-year-old, black, heterosexual, cisgender woman). queen e wrote: i have varied interests, and white people are clearly surprised when they see me at a concert or event that is attended by predominantly them. they’re also surprised by my knowledge of so many things, and the fact that i write and speak well! if another person says, “you’re so articulate,” so help me. what an insult! english is my native language; i read; i’m educated. what did they expect, for me to grunt?! (50-64-year-old, black, heterosexual, cisgender woman) others wrote of colleagues explicitly stating their speech was inconsistent with their race. brenda wrote, “i have been told that i am ‘not like other black people’ or that i seem white because of my speech and mannerisms” (30-39-year-old, black, heterosexual, cisgender woman). these responses communicated biases to participants about their racial group which reflect larger societal patterns. rose said, “people tell me that i ‘talk white’ (18-29-year-old, black, heterosexual, cisgender woman). elaine, a frontline provider, described a situation in which someone over the phone expressed bewilderment at learning of her race: i was speaking to someone on the phone at work, and the person made a comment about not knowing that i was black. it wasn’t a negative comment necessarily, but they did not know they were speaking to a black woman due to my professionalism over the phone. (40-49-year-old, black, heterosexual, cisgender woman) although the participant believed that the comment was not intended as an insult, it nevertheless revealed a bias about her racial group. kim, a program manager, shared a microaggression that explicitly linked the disproving of stereotypes to perceptions of being an exception to their group: “i have been told, ‘you're not like a stereotypical black person or woman. when i see you, i don't see race or gender’” (50-64-year-old, black, lesbian, non-binary woman). such remarks conveyed a prejudiced view of the participants’ race and sex or gender identity. advances in social work, spring 2023, 23(1) 36 racialized objectification. the third superordinate theme of racialized objectification had two subordinate themes: (a) skin color and (b) hair. the first subordinate theme, physical appearance, captured comments on the attractiveness of participants, as seen through a lens of race paired with gender. the second subordinate theme, hair, encompassed a range of attention towards participants’ hair that included both statements and unwanted touch, which were felt to be intrusive. the superordinate theme of racialized objectification shared patterns similar to navigating racial stereotypes, in which participants were either stereotyped one-dimensionally or praised as an exception to their group. as compared to the navigating racial stereotypes theme, the microaggressions in the racialized objectification category were an intersectional experience based on race interacting with gender, and sometimes additional identities. skin color. compliments about physical appearance referenced a standard of femininity in which light skin was upheld as a beauty norm. these inadvertent slights were analogous. asia b., a recreation aide, was told, “you’re so pretty for a black girl” (24-29year-old, black, lesbian, cisgender woman). kc, a frontline provider, very similarly was told, “you’re cute to be dark-skinned” (30-39-year-old, black, lesbian, cisgender woman). rachel, who identified as biracial, also received the insulting praise, “you're pretty for a black woman” (40-49-year-old, biracial black and native american, heterosexual, cisgender woman). terry t., when providing an example of a microaggression, shared a compliment with multiple connotations: “often told that i am a beautiful dark-skinned woman,” (40-49-year-old, black, heterosexual, cisgender woman). this remark could have been either an evaluation of terry t.’s beauty as an exception to her race or the sexualization of her race. it is unclear whether this comment was made by her clients, colleagues, or both, or if it also extended beyond the workplace. hair. another aspect of the racialized objectification of participants were statements about their hair and the touching of their hair. comments implied that participants’ hair had a novel quality which led to a diminishment of their professionalism and seriousness. samantha, a training coordinator, wrote, “i change my hair frequently. co-workers often comment on that, saying things like, ‘you look different every day!’ or ‘i never know which version of you i'm going to get,’ and other comments that make me feel uncomfortable” (30-39-year-old, black, queer-identified, cisgender woman). respondents also shared about intrusive questions about the characteristics of their hair. mary d., a clerical staff and frontline provider, wrote that she was asked, “is that your real hair?” and “are you mixed? because you have curly hair” (40-49-year-old, biracial black and native american, queer-identified, cisgender woman). mimi, a frontline provider, offered the following instance of a microaggression: “asked to tone down my appearance in terms of my hair texture” (18-29-year-old, black, heterosexual, cisgender woman). in addition to remarks about hair, participants also stated that colleagues would reach for their hair without permission, or otherwise ask to feel its texture, incidents which were a transgression of personal boundaries. samantha elaborated on her experience: “i've had people ask to touch my hair and actually reach out and touch it” (30-39-year-old, black, queer-identified, cisgender woman). kayk, a frontline provider in foster care, gave the following example: “‘i love how your hair springs back’ as they reach out to touch it” (3039-year-old, multiracial black, native american, and white, heterosexual, cisgender miller & ball/microaggressions in human services 37 woman). christina f. described how a coworker touched her hair within the presence of several colleagues, none of whom attempted to help or intervene: “at that agency, a white colleague actually touched my hair while i was in a crowded elevator without my permission. there was no support [emphasis in original]” (30-39-year-old, black, heterosexual, cisgender woman). when the other employees did not intervene, the participant was additionally subjected to a bystander microaggression in which the offensive behavior was tolerated. discussion this study addresses gaps in the scholarship about microaggressions while contributing to an emergent workplace microaggression literature. the findings show that, among participants in the sample, race/ethnicity was the most salient aspect of identity in their environments. participants most often reported in the narrative data that their race was targeted for microaggressions, even though the demographic questionnaire asked about twelve different aspects of identity, and the women of color workplace microaggressions survey asked participants to choose which identities were targeted by microaggressions from among the same twelve categories. navigating racial bias was consistent across all themes while other forms of discrimination received little or no mention. these findings suggested that for women and non-binary people of color in the human services, subtle discrimination based on race is an area in particular need of attention for increased equity in the workplace. participants described either being reduced to a racial stereotype by colleagues, or alternately, being seen as someone for whom racial or ethnic identity was not relevant. some experienced false assumptions made about them in the workplace based on stereotypes of their racial groups. inversely, those participants who were perceived as having behaviors inconsistent with racial stereotypes were sometimes seen as exceptional to their racial group. these results build on van laer and janssens’ (2011) four categories of workplace microaggressions. the findings about racial stereotypes are congruent with two of the workplace microaggression categories; normalization, in which an individual is expected to be open about their identity while they are simultaneously judged for that identity, and legitimization of only the individual, in which an individual is seen as superior to others in their racial group. when the race/ethnicity of participants stood out above other qualities, particularly in environments with very few visible people of color, colleagues and supervisors sometimes deferred to racial stereotypes about incompetence rather than familiarizing themselves with an individual’s skills and job performance. the experience of being highly visible as a member of one’s racial group while simultaneously devalued due to racial group membership is a distinct form of alienation. women of color also experienced microaggressions at the intersection of race and biological sex paired with gender identity. many are objectified and perceived as exotic in comparison to conventional white feminine beauty ideals (schaper et al., 2020). participants, primarily black cisgender women, wrote of attention to their hair, with colleagues touching it, asking to touch it, or otherwise making comments suggesting that advances in social work, spring 2023, 23(1) 38 its texture and style were not consistent with professional dress attire. they also offered instances of microaggressive compliments that they were attractive despite their skin color, which is often explicitly referred to as dark. implications the study fills gaps in research that have implications for practice, organizational policy, education, and research. the human service professions should place an increased emphasis on reducing racial microaggressions as part of creating inclusive, nondiscriminatory workplaces. it is vital that self-identified women and non-binary people of color be treated as employees valued for their work performance rather than their visible racial difference. at all levels, administrators, direct service providers, and clients ought to remain cognizant of the indirect relationship between inequities in agency environments and disparate outcomes for client populations who are often underrepresented by agency staff. addressing subtle discrimination among agency employees is integral to just operations of human service organizations. at the agency level, organizations need to acknowledge that microaggressions occur within the workplace environment and are even perpetrated by well-intended and highperforming employees. findings about the occurrence and impact of microaggressions ought to inform policies aimed at workplace equity and the enhancement of human service provision. non-discrimination statements need to be modified to openly recognize that subtle forms of bias pervade society and do not stop within the agency context, despite organizational missions that promote social justice. instead, non-discrimination statements can make an explicit commitment to addressing implicit bias and microaggressions between employees as they arise. the implementation of modified policy statements should include simultaneously critical and supportive responses from management to microaggressions as they occur, holding employees accountable for demonstrating growth in needed areas. workplace policies that create clear and effective avenues for addressing subtle discrimination could be used by women and non-binary employees of color, serving individual career advancement and well-being, to the overall betterment of these professions. after explicit acknowledgment that microaggressions occur, agencies can make reducing microaggressions among employees a priority. a focus on the reduction of workplace microaggressions ought to be reflected in human resource policies. workplace microaggressions can become part of new employee orientations to establish an expectation that part of each person’s job responsibilities is to create an inclusive environment by actively acknowledging and reducing microaggressions. policies should clearly outline processes for remediation that hold employees accountable for subtle discrimination while also making clear that admitting fault does not immediately put an employee on the path to termination. internal or external assessment of the agency environment should consider that an initial increase in formal and informal complaints is a positive sign, which indicates that employees may feel newly empowered to exercise channels for remediation. assessments of the agency ought to include attention to which employees are most vulnerable to bias miller & ball/microaggressions in human services 39 and marginalization within a given agency setting. depending on the organizational culture, the history of the organization, and the groups most represented at levels of power and influence, specific groups are most likely to experience microaggressions, with people from racial and ethnic minority groups often facing nuanced forms of subtle discrimination. a commitment to reducing microaggressions can be explicitly included among participants’ job responsibilities as part of maintaining relationships with colleagues. some organizations have invested in implicit bias training, for example, yet this is supported by mixed research results (fujimoto & härtel, 2017). other options may include one-to-one supervision for staff perpetuating microaggressions, agency assessments of dynamics and climate among employees to identify specific issues, and the implementation of targeted team-building techniques that address gaps in inclusion and foster greater cultural humility. a recommendation for organizational policies is that employees targeted for microaggressions can witness critical responses to these incidents. even though certain administrative actions need to happen in privacy with respect to confidentiality and staff development, microaggressions need to be publicly addressed as they occur to create more inclusive and non-discriminatory environments. furthermore, managers should be held accountable for neglecting to provide a timely, visible response to microaggressions. employees are not entitled to perpetuate microaggressions in a group setting without also receiving a critical response in that same group setting. in social work curricula, diversity courses can foster greater cultural humility in students by dispelling racial stereotypes and with explicit education about microaggressions perpetrated by human service providers and more generally throughout society (fisher, 2021). a commitment to the reduction of microaggressions can be part of formal training for developing an identity as a helping professional. microaggressions that occur between students in the classroom should be framed as essential opportunities for learning and professional preparation, integral to the implementation of best practices within the human services (thurber & diangelo, 2018). student orientations can inform students of the human service professions of a department’s commitment to reducing microaggressions among its students, faculty, and staff. future research with larger sample sizes is needed to advance research about workplace microaggressions within human service agencies. we recommend that studies explore the impact of microaggressions on organizations more broadly, with measures focused on agency functioning, beyond the experiences of individual employees. larger studies could also examine the generalizability of the finding that racial/ethnic identity was, by far, the most salient identity that this population experienced as a target of discrimination. to improve upon the application of intersectionality theory to the research process, purposive recruitment techniques could be used to recruit larger samples that more broadly and evenly reflect the wide range of groups who are subsumed under the umbrella of “self-identified women and non-binary people of color.” inversely, studies explicitly focused on subpopulations therein, such as indigenous women, would allow for greater precision in studying the needs of specific marginalized groups. advances in social work, spring 2023, 23(1) 40 limitations targeting the national organization for human services for recruitment led to an overrepresentation of people who are members of such organizations, and who subsequently have higher income and possibly also greater career ambition than average among the broader demographic of human service employees. additionally, snowball sampling is a form of convenience sampling which limits the generalizability of the sample. however, recruitment based on existing relationships between those participants recruited via purposive sampling and their own contacts was a valuable strategy for increasing the sample size of a population underrepresented in scholarly research (valerio et al., 2016). lastly, the sample represented those who self-selected to participate in the study with limited incentives and was likely biased towards those with a greater interest in the focus of the study (brick & tourangeau, 2017). conclusion human service organizations must treat workplace microaggressions as serious gaps in their operations. patterns of subtle discrimination that occur in agency settings serve to maintain large-scale social inequities. subtle discrimination can have severe consequences at all levels of administration and service provision, despite perceptions of microaggressions as harmless by many people in positions of privilege. organizational structures that do not address microaggressions inadvertently allow inequities to persist by covert means. to foster inclusion across the human service professions, organizations need to both acknowledge and reduce workplace microaggressions among employees. it is vital that human service organizations not only attract and retain employees of color but also offer opportunities for professional development and resources for navigating subtle discrimination. self-identified women and non-binary people of color are belittled when not valued primarily for their skills and job performance. multiplymarginalized human service professionals are alienated when colleagues’ stereotypes distort perceptions of their identities and actions. when seen through a lens of racial stereotypes, many self-identified women and non-binary people of color are either valued for their visible racial difference while seen as incompetent or recognized for their competency yet perceived as unrepresentative of their racial group. patterns of subtle discrimination that denigrate employees prevent professional growth and stymie potentially rich dialogues about socially-just practices. the advancement of knowledge about workplace microaggressions has great potential to foster social justice in the human services. empirical research would aid in the development of evidence-based organizational practices to increase accountability for employees who perpetuate microaggressions. employees who are otherwise high performing may need additional incentives and guidance to make these seemingly small but impactful changes to their behavior. studies about workplace microaggressions can be applied to promote socially-just workplace environments, in which organizations aspire towards culturally humble 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(2011). ethnic minority professionals’ experiences with subtle discrimination in the workplace. human relations, 64, 1203-1227. https://doi.org/10.1177/0018726711409263 author note: address correspondence to berg miller, department of social work, buffalo state university, 1300 elmwood ave., caudell hall 361, buffalo, ny 14222. email: millerbk@buffalostate.edu acknowledgments: thanks are due to dr. hilary weaver for her guidance on this study and to sahar fathi for her collaboration on data analysis. this study received funding from the susan m. nochajski grant through the buffalo center for social research within the school of social work at the university at buffalo. https://doi.org/10.1080/01419870.2015.1081965 https://doi.org/10.1037/0003-066x.62.4.271 https://doi.org/10.1080/15313204.2017.1417941 https://doi.org/10.1177/1473325010368316 https://doi.org/10.1186/s12874-016-0242-z https://doi.org/10.1177/0018726711409263 mailto:millerbk@buffalostate.edu _________ susan l. glassburn, phd, lcsw, associate professor, kathy lay, phd, msw, faculty emeritus, and meredith canada, msw, mpa, doctoral candidate, school of social work, indiana university, indianapolis, in. copyright © 2025 authors, vol. 25 no. 1 (spring 2025), 418-435, doi: 10.18060/28019 this work is licensed under a creative commons attribution 4.0 international license. the lived experience of compassion fatigue and burnout in social workers: the role of moral distress and shame susan l. glassburn kathy lay meredith canada abstract: compassion fatigue and burnout evoke a professional and often personal crisis. this interpretative phenomenological analysis explored the lived experience of these phenomena for twelve social work professionals who self-identified as having an episode of compassion fatigue and/or burnout. while the literature is replete with many of the tangible factors that can lead to compassion fatigue and burnout, such as a toxic workplace, emotionally challenging clients/client stories, and personal vulnerabilities, few studies have explored the qualitative lived experience. during data analysis, two salient themes emerged from the stories of the participants: moral distress and shame. these concepts are explored in order to deepen the understanding and complexity of compassion fatigue and burnout. the implications of this study suggest that social work education, selfcare, and supervision may not adequately prepare or buffer social workers from these phenomena. keywords: compassion fatigue, burnout, moral distress, shame, professional development at some point in their careers, many social workers will find that the demands of their work exceed their emotional or physical capacity. compassion fatigue (cf) and burnout are well-documented phenomena within the helping professions. social work is renowned for its empathy and engagement with clients and their systems, and the emotional demands of those connections may set the stage for cf or burnout to occur; therefore, understanding both phenomena is critical for social work practitioners. compassion fatigue and burnout are often used as overarching terms, encompassing other constructs such as secondary traumatic stress and vicarious traumatization, although they are often conflated together (sutton et al., 2022). although often used interchangeably, cf and burnout represent distinct yet overlapping constructs. both are considered umbrella terms that encompass related experiences such as secondary traumatic stress (sts) and vicarious traumatization (vt), though they are frequently conflated (sutton et al., 2022). compassion fatigue has been described as “the cost of caring” (figley, 2002). as figley explains, “the very act of being compassionate and empathic exacts a cost under most circumstances. in our effort to view the world from the perspective of the suffering, we suffer” (p. 1434). gustafsson and hemberg (2022) evoke the emotional toll of cf by referring to it as “bruises in the soul.” cf is a stress response that can result in feelings of helplessness, confusion, and isolation (figley, 1995). about:blank glassburn/burnout, moral distress, & shame 419 burnout, in contrast, is more closely associated with chronic workplace stressors than with direct emotional labor. it is marked by emotional exhaustion, cynicism, a sense of ineffectiveness, depersonalization, and reduced professional satisfaction (lim et al., 2019; maslach & leiter, 2016). while cf arises primarily from empathic engagement, burnout stems from the broader organizational and structural contexts in which social workers operate. despite these different origins, both conditions can produce similar outcomes— including anxiety, exhaustion, and physical illness (singh et al., 2020). secondary traumatic stress (sts) and vicarious trauma (vt) are often seen as expressions of cf. sts is characterized by intrusive thoughts, numbing, and avoidance of reminders that cause arousal because of exposure to information about a traumatic event, such as a client story (figley, 2002). recent research has indicated that those practitioners who develop sts are often those whose cf is triggered by their own personal traumatic experiences (turgoose & maddox, 2017). vt is caused by repeated exposure to traumatic information such as violent images, repeatedly hearing traumatic stories, or seeing graphic images. vt, meanwhile, involves enduring changes in one’s cognitive schemas—shifts in beliefs about safety, trust, control, intimacy, and self-worth—resulting from repeated exposure to others’ trauma (mccann & pearlman, 1990). the definitions of cf, burnout, sts, and vt have become increasingly intertwined, with overlapping and sometimes conflated meanings (choi, 2017). additionally, people who experience one of these are likely to experience another, further complicating discrete definitions and experiences (cummings et al., 2018). no single concept analysis has definitively differentiated cf from these related constructs, perhaps because emotional exhaustion lies at the core of each (maddock, 2024; turgoose & maddox, 2017). while conceptual distinctions are important, the personal and professional consequences of these phenomena—regardless of label—are profound and demand attention. compassion fatigue and burnout in social work social work is a profession characterized by high emotional labor, intensive job demands, and frequent exposure to distressing human experiences—all of which contribute to significant risk for cf and burnout (maddock et al., 2023; stanley & sebastine, 2024). several studies have documented the prevalence of cf and burnout in the profession. in a sample of 77 social workers in spain, 37.6% reported burnout (caravaca-sánchez et al., 2019). in a large study of 3,421 social workers in the uk, ravalier et al. (2020) found that stress levels of social workers were very high, with 50% of them being dissatisfied in their roles citing working conditions, lack of autonomy, and lack of managerial support as particularly problematic. maddock (2024) found that a significant proportion of social workers reported mild to severe levels of anxiety and depression related to work stress. diaconescu (2015) found in a systematic review of social work and burnout that several factors contributed: a large amount of work, time pressure, management, conflict in the work climate, ethical/moral dilemmas, and a disconnect between values and policy at the micro and macro levels. notably, early-career social workers are especially vulnerable to burnout (benner & curl, 2018; pretorius, 2020), and even msw students report symptoms advances in social work, spring 2025, 25(1) 420 of burnout and sts while in field placements due to competing role demands (butler et al., 2017). due to their proximity to client trauma, social workers are also at heightened risk for cf (caringi et al., 2017; barrera-algarín et al., 2023). the profession inherently requires compassionate engagement, making cf an occupational hazard (ramiro, 2014). several studies have investigated the incidence of cf in social work. barrera-algarín et al. (2023) found that despite social workers having higher than average levels of emotional intelligence, more than 90% were still evidencing higher than average levels of cf (barrera-algarín et al., 2023). denne et al. (2019) found a link between cf and impaired clinical judgment among child welfare social workers, highlighting the direct professional implications. pelon (2017) found social workers in hospice experienced moderate to high levels of cf, balanced by moderate to high levels of compassion satisfaction, which is the pleasure and fulfillment derived from helping others through their work (stamm, 2010). jiang and jiang (2024) found that for social workers working in areas with violence, turnover intention was predicted by the predominance of either compassion fatigue or compassion satisfaction. qualitative research offers further insight into how social workers experience and cope with cf and burnout. kapoulitsas and corcoran (2015) looked at compassion fatigue and resilience for six social work participants. they found that all the participants experienced emotionally intense feelings, such as anxiety, stress, and even nightmares. supervision, when available and perceived as supportive, was a resilience factor, as was debriefing with colleagues and continuously monitoring their own personal and professional well-being. yi et al. (2018) interviewed twelve oncology social workers and found that they experienced cf when their ability to help was limited or when they were not able to meet the tangible needs of patients. in a related study, yi et al. (2016) found that for pediatric oncology social workers, both professional and personal strategies were essential to mitigating the impact of compassion fatigue, which manifested in their ability to attend to patient’s feelings, their own physical and mental well-being, and decreased ability to participate in family life. in sum, cf and burnout in social work stem from an interaction of personal, contextual, and organizational factors (yi et al., 2018). these experiences are not uncommon and are increasingly recognized as significant occupational risks (maddock, 2024). the covid19 pandemic has only exacerbated these issues (deluca et al., 2024), bringing renewed urgency to the need for prevention and support (watson & begun, 2025). this study seeks to deepen understanding of the lived experiences of social workers who have endured compassion fatigue or burnout. despite growing interest in these topics, few qualitative studies have explored their personal and professional toll in depth. by interviewing twelve social workers who have navigated such episodes, this research aims to illuminate how practitioners experience, cope with, and make meaning of these pivotal moments in their professional lives. glassburn/burnout, moral distress, & shame 421 method methods interpretative phenomenological analysis (ipa; smith et al., 2009) was employed to understand the lived experience of social workers experiencing an episode of cf and/or burnout. ipa seeks to understand how someone makes sense of an experience, such as a significant event or transition in their lives; as such, it was deemed an appropriate method to examine the meaning of cf and burnout to participants. ipa utilizes the double hermeneutic, which means researchers interpret how the participants make sense of the experience. “ipa wants to know in detail what the experience for this person is like, what sense this particular person is making of what is happening to them” (smith et al., 2009, p. 3). ipa involves multiple philosophical traditions, including phenomenology, hermeneutics, and idiography, which combine to focus on the interpretation of experience in its many layers and complexities (smith et al., 2009). participants after approval from the university irb, social workers were recruited via alumni listservs, social media, and snowball sampling. the recruitment email asked for bsw or msws who had experienced a significant episode of cf and/or burnout. participants were not asked to decide whether they had cf or burnout or both since colloquially they are often used interchangeably, and we did not want to constrain their stories in order to meet our definitions. they told their story as they defined the constructs. there was no time limit on when the episodes had occurred, so some were recent and some remote. participants were interviewed just prior to the covid 19 pandemic. interviewers used a semistructured interview guide and began with the prompt, “tell me about a time in your social work career when you experienced an episode of compassion fatigue or burnout.” additional questions asked were about the effects of the episode on their personal and professional life, how they tried to mitigate their cf/burnout, and how they make sense of it now. seventeen social workers responded and reported a self-defined episode of cf and/or burnout, and twelve agreed to be interviewed. of the 12 social workers who participated in this study, two had obtained bachelor of social work (bsw) degrees, and 10 had a master of social work (msw) degree. there were three males and nine females ranging in age from 27 to 57. ten participants identified as white, one as african american, and one as mixed race. participants were given a nominal gift card for participation. data analysis/procedure/credibility of the research interviews were conducted in person at a private location convenient for the participant. each author did multiple interviews, which were audio recorded, transcribed, and organized in tables in microsoft word documents, with columns for first and second level codes. transcripts were de-identified by the interviewer prior to analysis by the other researchers, and each participant was given a pseudonym. each researcher coded all of the interviews independently, following the interpretive phenomenological analysis (ipa) advances in social work, spring 2025, 25(1) 422 method outlined in smith et al. (2009). in ipa, data analysis is iterative and dynamic and “moves from the particular to the shared, and from the descriptive to the interpretive” (smith et al., p. 79). there are six steps involved in ipa and the research team followed them closely. for analysis, we: 1) read and reviewed a single interview individually, 2) made notes on the interview to identify concepts in a line-by-line fashion, and 3) met as a group to collaborate on coding and began to label preliminary themes. 4) together, we reorganized the themes. several themes were prominent from the start, and others increased in prominence through discussion. 5) we then repeated this process with each interview, continuing to code individually, and then met to discuss the presence of the more prominent themes and additional emerging themes. this required re-reading previous interviews and re-coding for newly understood concepts. we developed summaries of each interview around the specific themes that were identified. 6) finally, we established linkages between interview themes and condensed the findings into two main findings: shame and moral distress. findings this study's findings suggest multiple factors come together for an experience of cf/burnout. these factors are often a complex mix of job or professional environment, personal characteristics, and pre-existing risk factors. while some of the factors for cf/burnout have been identified in the literature, as previously stated, this study focuses on two unique themes that emerged from the participants’ lived experience: moral distress and shame. these phenomena existed for almost all participants in some fashion and surprised the researchers with their prevalence. moral distress our participants evidenced what manifested as moral distress in many of their stories, although none of them mentioned this term directly. we will define moral distress here briefly but will elaborate upon this phenomenon in the discussion section. moral distress is an “integrity compromising experience” resulting from value conflicts among personal, professional, and institutional domains (fantus et al., 2017, p. 2274). our participants gave evidence of four situations that evoked moral distress, and each will be discussed along with exemplar quotes given: 1. moral distress caused by the disconnect between the agency mission and how that mission is operationalized; 2. the moral distress of feeling you have to do things that feel unethical in order to meet productivity or please management; 3. seeing clients get less than adequate service because of factors seemingly beyond one’s control; and 4. a sanctioned erosion of personal boundaries. glassburn/burnout, moral distress, & shame 423 1) disconnects with the agency mission and how it is operationalized several participants noted that what an agency purports to do versus what it really does was distressing to witness. as mary said about the dysfunction within her large agency: like the whole system is just insane. just insanity – that’s the way i felt. but yeah,…...there’s so many levels that prevent people from being able to do their actual job. i just – like it doesn’t surprise me that people don’t stay in this job. i don’t know how they can. in a field where we care for others, not valuing the social worker and caring for them when they are distressed is also a big disconnect. olivia says that while working in child welfare, her distress responses to the horrible things that she saw were downplayed. “there was no recognition of what that did to case managers and when i would bring things up....[management] just saw me as being dramatic.” kristin recounts: …and she [supervisor] also said at one point just kinda talking – this isn’t a place for people who are right fighters or who want to honor values and ethics because that’s just not how this place works and i was like, ‘oh, you’re really talking to somebody that is a right fighter and somebody that honors my values and the ethics of social work,’ and …she said people don’t last here if they value those things and i was just like whoa! that’s pretty disheartening. 2) feeling you have to do things that are unethical in order to meet productivity or please management several participants discussed situations in which they were asked to provide services to clients that were not needed to meet productivity expectations and the agency’s fiscal needs. mary was put on a performance improvement plan at work due to not billing enough client hours, and felt that she was blatantly asked to alter the assessment so that clients would qualify for more services: i said, ‘well, how am i supposed to fix this?’ and i said, ‘do you have more cases for me?’ and she said, ‘no.’ and then she tried to tell me that i needed to see clients who didn’t need to be seen even more often. at that point in time, morally i was like i cannot justify doing that, like that’s being dishonest and that’s not ok. kristin echoes this by saying, “i struggle at this job because i want to empower people and encourage them to take control of their own medical care and teach them to be independent, and that is not what the director wants.” brenda talked about the no-win binds that agencies put you in. she said, ... you’re basically asking me to provide more services than what i think that they need...and it took the moment of me saying ‘medicaid fraud’ for them to put a red flag on me and make my life a complete living hell. justin also had to provide service to clients who did not need it and felt that he was just wasting his time by policing people who were simply arrested for occasional marijuana use. daisy also felt she was being asked to provide services to youth who did not need advances in social work, spring 2025, 25(1) 424 them. “that system of billing, having to bill, having to associate these kiddos [with] these heavy diagnoses that i just didn’t feel like were appropriate.” on a supervisory level, renee, a former manager, talked about writing up staff for underperforming even though the caseloads were ridiculously high and they could not make the required productivity due to job constraints. 3) seeing clients get less than adequate service and have that be beyond one’s control a few participants talked about how difficult it was to see clients not get the services they deserved. one participant shared, “that’s really hard! i mean, how do you manage 175 people and really give them the attention that they deserve and do what is respectful?” another participant, wendy, said that giving excellent service to her clients means that her family suffers as there is not enough time to do both, so she often gives less than she would like, which feels bad to her. renee talked about feeling so responsible for client outcomes as a manager: i would be working ten-hour days, go home, take my work home, work at home, get called on-call in the middle of the night, work again, i wouldn’t be able to sleep because i was so stressed about bad outcomes, and i’d be blamed because i was at the top. 4) sanctioned erosion of personal and professional boundaries some participants expressed distress at having their personal boundaries erode over time. carl talked about noticing that he was working too much: “i didn’t really realize what was going on at first. it took a while for it to kinda all sink in that, wait a minute -this is way too much and i’m getting paid a salary.” wendall, who worked well above the expected hourly requirement, said, “you can’t put a price on not being able to enjoy your life.” one participant said that they saw mixed messages about work-life balance. on the one hand, supervisors said you should do good self-care; on the other, supervisors worked 24/7. some supervisors will say that, but then they’re doing the things that they don’t expect you to do and then you feel kinda this, well, everybody in the organization feels this way that from the top down they’re not following the expectations, then they may view me as an inferior worker and that i better adapt to this work culture. so then they’re 24/7 doing all this stuff. professional boundaries guide how we practice, and participants observed how those boundaries became relaxed for themselves and others in difficult workplaces. participants saw peers talking negatively about clients or taking shortcuts when doing their work and “relying on old tricks and stuff that just comes naturally to you and that kind of stuff that – where you’re not wanting to enhance your skills.” glassburn/burnout, moral distress, & shame 425 shame shame is “an intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging” (brown, 2006, p. 45). gibson (2016) has written extensively about shame and social work practice and says that it is often related to an experience of failure in a particular context (gibson, 2016). when the context is related to one’s professional life, it can cause an individual to question their professional competence and identity (murphy & kiffin-peterson, 2017). dana’s experience led her to believe she was not cut out for working in mental health, although she had felt a strong calling to work with youth who were involuntary clients. a client injured her, and the crisis made her question her ability to stay in the profession. … i was going what have i done? why have i even wasted all of my time and effort to get my master’s degree for nothing? for nothing and that’s how i – i just feel like in that moment, like i can’t do this anymore, i cannot do this… i felt like this is what i was called to do and here i am uncertain of what i’ve done… at no point did she reflect on the possibility that the system in which she was working was flawed or even toxic. kristin was very invested in fixing a broken system, and later she felt embarrassed about her optimism as she realized that she had taken on too much. “i’ve been a program manager …but i really thought i saw a place that i could make change and saw some divisions that i thought i could help build – bridge the gap – such a silly, hopeful girl i am!” carl was in an agency and was expected to see a huge number of clients. he talked about feeling overwhelmed and burned out but saw his exhaustion as his fault. “ i guess my stamina was not what i thought it was...clients are getting added and added and added…” he attributed his inability to keep up due to personal deficiency and poor time management. wendall expressed a sense of failure because he left the profession due to burnout and felt guilt and embarrassment about his need to leave the field for a while to regroup. …there’s a guilt factor for me because my burnout contributed to me leaving the profession, that there’s some guilt that i left the profession and that i could be contributing in more important ways than what i’m doing right now. secrecy often accompanies shame (brown, 2015) and may serve to intensify the feeling. mary worried her co-workers would find out how she was feeling, thus acknowledging that her experience must be kept from others. “so there was a part of me that was like i don’t know how much i could let him [co-worker] know how much i was struggling just because i was worried he would go back and tell his co-workers.” additionally, she identified how feelings of “not good enough” got triggered and perhaps exacerbated, “… but i just never felt like i was good enough, so here i am trying to serve people and doing this job and doing the best that i can, but never feeling like you’re good enough…” advances in social work, spring 2025, 25(1) 426 renee expressed feeling shamed/blamed for staying at an overwhelming job as an attack on her professional integrity. a person close to her told her to get out and implied she would be the problem if she stayed in the job. i’m also trying to be very careful because i know when people were – when (person named) was like you need to get out of there! you need to get out of there! that wasn’t really helpful to me because i was in survival mode and i wanted to stick my time out for the vested part…yeah, i mean, it’s like an attack to your integrity. renee had a professional identity and a strong commitment to her job, which she felt was being labeled as problematic. the simplistic suggestion to leave was not experienced as helpful and was perceived as shaming. rarely did individuals in this study hold the system or agency culture responsible for work environments where expectations were unrealistic and where there was a lack of supervision or appropriate role modeling. more often, individuals blamed themselves for their actions in a way that induced shame and cast doubt on their competence. shame and altered professional identity professional identity can be a blessing and a curse. kristin and dana described the costs of over-identifying as a social worker. kristin has worked in the field for many years. she reflected that over time, the stress of the work, compounded with an unsupportive work environment, wore her down. she stated that while she had good insight into her wellness needs, at some point, she no longer actively engaged in helpful self-care and began to withdraw. she said that she had a one-dimensional identity. “if my good friends that call me for help or something, i can come out of it, like i can identify as a helper and that is it. i’ve lost any other identity over the years.” in some instances, ongoing work stress and hostile work environments eroded their self-confidence and made the individual question their ability to be an adequate social worker. after brenda left an agency with a challenging supervisor, she identified herself as a “walking rug.” she stated: i will say in my job now, i am petrified to stand up for myself – i won’t do it just because i’ve done it once before and it backfired, so a lot of the time i have been the walking rug. even after brenda left the agency and was working in a new, supportive agency, she was hesitant to assert herself and felt powerless as a social worker. while not all participants expressed an altered professional identity due to the shame of having cf/burnout, several questioned their ability to be a social worker, with many needing to change jobs to escape their situation; several even left the field altogether for a while until they could heal. discussion glassburn/burnout, moral distress, & shame 427 in the perfect storm, junger (1997) wrote about the convergence of several weather systems that came together to create the perfect storm. a cold front, extratropical low, and a hurricane brought lethal rough seas, strong winds, and high crashing waves, leading to the term, “perfect storm” (junger, 1997). even though forecasting provides us with the ability to have some sense of what is to come, it does not fully prepare us for the consequences of trying to navigate a nearly impossible situation with factors beyond our control. like the perfect storm, contributing factors to cf and burnout are complex, intertwined, and uniquely experienced by individuals depending on their own personal and professional histories. the stories that the participants told in this study were highly emotional; many cried during the retelling of their experiences, and they often blamed themselves for their situations. they told stories of survival in difficult situations, often feeling caught between agency policies, client needs, and personal well-being. for many, their cf/burnout was evidence of their personal failure, poor performance, or lack of fit with the profession. a few participants were able to see how the bigger system issues had put them in a difficult position and did not self-blame; however, many of the participants described and mourned their own culpability to some degree. while coding and analyzing participant stories, the researchers were struck by the emergence of two unanticipated constructs that were a part of the majority of participant accounts – moral distress and shame. moral distress the social workers in this study experienced multiple constraints, such as pressure to bill over providing quality service, overwhelming workloads, and supervision that did not provide clinical debriefing of difficult client stories and personal trauma triggers. they worked in agencies where they were asked to do things they did not agree with, such as see clients who did not need service. they saw vulnerable clients experience difficult things and held their stories of trauma. at times, their feelings of distress were minimized or stigmatized. moral distress was identified in the nursing field in the 1980s (jameton, 1984) but has emerged in the social work literature only in the mid-2000s (fantus et al., 2022; weinberg, 2009). like nursing, social workers are at the mercy of agency-wide and systemic constraints such as value conflicts, poor staffing, and large workloads (weinberg, 2009). moral distress is the “physical or emotional suffering that is experienced when constraints (internal or external) prevent one from following the course of action that one believes is right” (pendry, 2007, p. 217). mccarthy and gastmans (2015) and fantus et al. (2022) believe that moral distress operates across multiple areas: clinical situations, working conditions, limited resources, structural conditions, and moral sources. social workers are well-acquainted with ethical dilemmas, which are conflicts between competing values (virginia commonwealth university [vcu] school of social work, 2020). when social workers feel that their professional values about what is right are violated, they can begin to feel a disconnect with their work, and perhaps a disconnect with their professional identity. overtime, this disconnect could manifest in significant burnout or cf. while it is not the goal of this research to determine the causal relationship advances in social work, spring 2025, 25(1) 428 between moral distress and cf/burnout, the prevalence of moral distress in social work is an emerging factor in the cf/burnout literature. in nursing, cf has already been linked to moral distress and is associated with poorer outcomes for patients (lamoureux et al., 2024). the common thread is “that moral distress occurs when professionals are unable to do what they believe is the right thing” (attrash-najjar & strier, 2020, p. 23). the distress from moral distress can be conceptualized as a complex interplay between external constraints and the individual characteristics of the social worker (van der kuip, 2020). social workers often find themselves working inside systems guided by policies that force them to compromise to provide the best care possible in light of significant constraints. shame social workers in this study often blamed themselves or felt embarrassed for having an episode of cf or burnout. while most of them knew that they had been put in difficult or untenable situations, they still felt that they should have been able to cope better, set better boundaries, or had an earlier awareness of the problematic situation. these “shoulds” brought about a sense of disappointment in themselves that they were unable to avoid having cf/burnout. in social work, we preach self-care as both a prevention and a remedy for cf/burnout (lombardero-posada et al., 2022), and to become burned out could be interpreted as a sign of failure, which brings a sense of shame. gibson (2014) writes extensively about shame in the social work profession. shame refers to an individual viewing themselves negatively following a mistake or incident and thinks, “i am bad” instead of “i did a bad thing” (gibson, 2014). professional social work identity is associated with a “professional self-concept based on attributes, beliefs, values, motives, and experiences” (webb, 2016, p. 355). situations where practitioners feel they are not doing “good social work” may produce shame (gibson, 2014). shame is experienced as an overwhelming assault on self-concept and identity, how individuals define themselves and who they perceive themselves to be. the primary means of assault are negative judgments, whether these judgments originate from others or oneself (van vliet, 2009). in this study, getting burnout or cf was incongruous with the kind of social worker that participants saw themselves to be. gibson (2014) says that for social workers, “shame can be seen as a reaction to a threat to the social worker’s sense of personal or professional identity” (p. 421) which can be an assault to their personal integrity. finnan et al. (2021) reported that psychotherapists, similar to social workers, reported burnout eroding their sense of identity and resulting in feelings of inadequacy, shame, self-criticism, and feeling like a fraud. feeling burned out was embarrassing to therapists, complicated by the fact that they could not express these feelings to others for fear of being labeled inadequate (finnan et al., 2021). as in our study, participants questioned whether they should remain in the field and felt that as helpers, they should not need help. is there a connection between moral distress and shame? gibson (2014) points out that social workers can experience difficult situations in which they have to choose what is required from their organization or job versus what is right or needed for the client. this moral dilemma/distress may produce shame as they choose between disappointing self/ glassburn/burnout, moral distress, & shame 429 personal integrity and disappointing supervisors who will judge them for their deficits. both situations can produce shame in a social worker. an organisational culture that promotes conformity, secrecy and denial of human experiences may result in an environment of shame where practitioners blame themselves for poor practice feeling stressed and ultimately feeling like they are not helping service users. (gibson, 2014, p. 423) in our study, many participants talked about the conflict between conforming to the norms and expectations of the agency and doing good social work as they perceived it to be. in toxic workplaces, conformity to those ideas can feel like a betrayal of self and bring about personal and professional shame (gibson, 2019). the connection between shame and burnout has been noted in the literature (barr, 2020; finnan et al., 2021), and while the relationship is not necessarily directional (i.e., shame causes burnout or burnout causes shame), they are intertwined (figure 1). social workers in our study felt shame about getting burnout, but the reverse could also be the case in that their repeated sense of shame of not meeting their own or others’ standards caused them to withdraw energy and become burned out. figure 1. possible relationship between moral distress, shame and compassion fatigue and burnout moral distress -poor client services -feeling unethical -disconnect with agency mission -erosion of personal & professional boundaties shame -altered professional identity compassion fatigue burnout advances in social work, spring 2025, 25(1) 430 limitations this study invited participants to be interviewed if they felt they had experienced an episode of cf or burnout. the authors did not ask participants to determine which category applied to them, as the constructs are overlapping for professionals let alone study participants. we also did not specify a timeframe for when they experienced the episode of cf/burnout, so while most of the experiences occurred within the past year or two, others were more remote and that could affect recall. our sample was predominantly female and white, which are also limitations. we interviewed participants just prior to covid-19, and other studies have shown that the pandemic did bring about intense experiences of moral distress, cf, and burnout related to the distress of caring for patients during that time (latimer et al., 2022; tritt, 2022). whether the pandemic exacerbated existing feelings of cf and burnout is unknown. moreover, as a qualitative study, the results are not generalizable; however, they may bring a richness to and a deeper understanding of these experiences. implications for practice and social work education there are many important implications from this study for practice and for educators. a social worker can experience moral distress as a part of their work, contributing to burnout. in addition, feeling burned out can evoke feelings of intense shame and even lead a social worker to question their professional goals and career choice. the person-inenvironment lens is particularly salient in cf/burnout. the dynamic interaction between the practice environment and the social worker constantly impacts the social worker’s feelings about themselves and their effectiveness, as well as their identity as a social worker (tham & lynch, 2021). while supervision can help mitigate burnout (caringi et al., 2017; finnan et al., 2021), a supervisor colluding or enmeshed with a dysfunctional agency is unlikely to provide the counsel needed for someone experiencing moral distress in that same setting. social workers may be unable to articulate their sense of shame at experiencing burnout as they may see personal inadequacy as the root of the issue when embroiled in a dysfunction system, especially absent of validation in supervision. supervisors can also see a social worker’s emotional distress as a personal or professional deficiency (kapoulitsas & corcoran, 2015) and not normalize those feelings as a part of working with challenging situations. the importance of self-care should not be minimized; however, it cannot transcend a toxic environment. the insidious nature of cf/burnout may make it difficult for social workers to identify toxic environments until they are consumed by them, and self-care strategies may be inadequate at that point to remediate the toxic effects. salloum et al. (2015) advocate that social workers would benefit from trauma-informed self-care, which encompasses emotional self-awareness, and actively engaging in strategies such as supervision, and attending trainings on avoiding secondary traumatization and work/life balance. self-care may mean leaving a position harmful to the social worker, although this glassburn/burnout, moral distress, & shame 431 may not be possible due to economic constraints and feelings of commitment to client’s wellbeing. tham and lynch (2021) observed that social work education may not adequately prepare social workers for these moral discrepancies. it seems too simplistic to tell social work students that if they do “good” self-care, they can prevent burnout. it is important to consider the complexities of agency and business models that do not support social work values and ethics. these sorts of moral dilemmas cannot be transcended by an individual’s self-care. discussions with social work students about the importance of self-care should also include more depth and nuance about the potential for cf, burnout, moral distress, and shame to prepare them more thoroughly, and to also let them know that becoming burned out or developing compassion fatigue does not mean they are a “bad” social worker. preparing social work students to understand and identify burnout, compassion fatigue, moral distress, and shame are essential for self-awareness and self-care. because moral distress and shame may be normative experiences in social work, discussing shame resilience could be helpful to social work students and practitioners. brown (2006) discusses shame resilience theory as important to the recovery from shame. in this theory, people need to find a way to connect with others, experience empathy, and “speak the shame,” which allows externalization, thus giving them freedom from being trapped in it. conclusion this interpretive phenomenological study sought to understand the lived experience of social workers who self-identified as having an episode of cf and/or burnout. participants in this study felt responsible for their burnout and, over time, came to see the perfect storm that produced it, and gained some distance from the experience. all of them were engaged in social work at the time of the interview, although several had to take less stressful jobs, or a non-social work job for a while to recover. two salient themes emerged as participants discussed their episodes of cf or burnout moral distress and shame. the authors were surprised by the prevalence of moral distress and shame woven throughout the stories of cf and burnout and believe that a recognition of the prevalence of moral distress and shame in social work careers adds to a richer understanding of the complexity of burnout and compassion fatigue and subsequently their remediation. references attrash-najjar, a., & strier, r. 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(2016). when does compassion fatigue hit social workers? caring for oncology patients in korea. qualitative social work, 17(3), 337-354. author note: address correspondence to susan l. glassburn, school of social work, indiana university, indianapolis, in, 46202. email: susglass@iu.edu https://doi.org/10.1080/20008198.2021.2022278 https://doi.org/10.1080/20008198.2021.2022278 https://doi.org/10.1080/20008198.2021.2022278 https://doi.org/10.1080/13691457.2020.1760793 https://doi.org/10.1080/13691457.2020.1760793 https://doi.org/10.1080/13691457.2020.1760793 https://research.library.kutztown.edu/cgi/viewcontent.cgi?article=1020&context=socialworkdissertations https://doi.org/10.1037/trm0000116 https://doi.org/10.1037/trm0000116 https://doi.org/10.1093/bjsw/bcz034 https://doi.org/10.1093/bjsw/bcz034 https://doi.org/10.1348/147608308x389391 https://doi.org/10.1348/147608308x389391 https://onlinesocialwork.vcu.edu/blog/ethical-dilemmas-in-social-work/#:%7e:text=what%20is%20an%20ethical%20dilemma,of%20all%20members%20of%20society https://onlinesocialwork.vcu.edu/blog/ethical-dilemmas-in-social-work/#:%7e:text=what%20is%20an%20ethical%20dilemma,of%20all%20members%20of%20society https://doi.org/10.1080/19371918.2024.2427759 https://doi.org/10.1080/19371918.2024.2427759 http://ethicsinthehelpingprofessions.socialwork.dal.ca/wp-content/uploads/2019/07/moral-distress-copy.pdf http://ethicsinthehelpingprofessions.socialwork.dal.ca/wp-content/uploads/2019/07/moral-distress-copy.pdf https://doi.org/10.1080/07347332.2018.1504850 https://doi.org/10.1080/07347332.2018.1504850 https://doi.org/10.1177/1473325016670484 https://doi.org/10.1177/1473325016670484 mailto:susglass@iu.edu __________ carol hostetter, lcsw, phd., editor and professor emerita, school of social work, indiana university, bloomington, in. valerie d. decker, msw, assistant and managing editor, school of social work, indiana university, indianapolis, in. copyright © 2024 authors, vol. 24 no. 3 (fall 2024), i-vi. doi: 10.18060/28814 this work is licensed under a creative commons attribution 4.0 international license. fall 2024 editorial: examining social work education carol hostetter valerie decker this issue contains 11 articles by 40 authors, both national and international. the majority are empirical papers, using qualitative, quantitative, or mixed methods. more than one article presents a case study, which gives me an opportunity to promote this methodology. one of my first research projects was a case study of the child welfare system in the state of indiana, as we were asked to focus only on indiana’s system (barton et al., 2006). in my role as editor of advances in social work, i see many manuscripts that are indepth studies of a department, classroom, or grant program, for example. these provide detailed information about a particular context in a “real-world” setting, thus receive the designation of case study. in their oft-cited work, feagin at al. (2016) provide a broad definition: “a case study is here defined as an in-depth, multifaceted investigation, using qualitative research methods, of a single social phenomenon” (p. 2). the authors, as well as other authors (thomas, 2011) understand that other methodologies may be used; the essential factor in the definition is the “single social phenomenon” aspect. an early, classic example is the middletown study of muncie indiana, by lynd and lynd (1929). thomas (2011) asserts this definition, “case studies are analyses of persons, events, decisions, periods, projects, policies, institutions, or other systems that are studied holistically by one or more methods. the case that is the subject of the inquiry will be an instance of a class of phenomena that provides an analytical frame—an object—within which the study is conducted and which the case illuminates and explicates” (p. 513). in my opinion, case study program evaluations are important in social work practice and education. i encourage researchers to frame their studies this way. of course, one case study is not generalizable, but it can be added to a body of research that builds to broader understandings. social work is in a prime position to contribute greatly through the use of case studies. finally, we take this opportunity to thank the 141 reviewers from 102 universities and institutions, 7 countries, 39 states and territories, who completed 183 reviews of 90 submissions in 2024 and along with the authors, editors, and board, make advances in social work possible. research benefitting young people blakey, ngui, buraik, vang, and williams conducted a case study using grounded theory methodology which illuminated the words of black high school students who felt marginalized and alienated in their school. students identified the feeling of not mattering in a cold, racially insensitive environment that didn’t reflect their identities, and connected the dots to the achievement gap and disciplinary sanctions. about:blank hostetter & decker/fall 2024 editorial ii in examining the assessment and referral practices of school social workers, loveschropshire, hicks, johns, keys, and wade surveyed over 3700 school social workers. this case study of michigan’s school social work system revealed that material needs were the focus of the majority of referrals, with mental health needs trailing far behind. concerningly, very few of the school social workers actually screened for firearm access, due to feeling unprepared to do so. a study featuring semi-structured interviews with black and latine youth recently released from the juvenile justice system, by mei, bondoc, meza, bosco, and barnert, provided insights into how they are affected by systems such as their home, school, and neighborhood. these systems affect their health and well-being as the youth negotiate relationships, physical space, and resources. the authors provide suggestions for social workers to remedy health disparities and provide more support. critical race theory pajak connected social work practice with critical race theory, in order to aid our understanding of how this important theory can shape the work we do. this conceptual paper explained the legal origins of critical race theory and outlined the major principles of the theory. through a careful literature search, and a consideration of the critiques of critical race theory, the author asserted that it is a strong framework for meeting the council on social work’s educational policy and accreditation standards on antiracist and anti-oppressive practices. social work education in the case study conducted by moore, young, and gray, the implicit curriculum of a bsw/msw program examined the policies, procedures, advising, student participation, and commitment to inclusive excellence, among other issues. the likert-style survey was distributed to graduating bsw and msw students. an important aspect of the findings was that the majority of students believed the programs allowed them to speak up about diversity issues important to them, with no significant difference based on based on race/ethnicity, online versus face-to-face, or first-generation student status. however, a significant difference did exist in relation to a student’s sexual orientation, with students from diverse sexual orientations feeling less comfortable about speaking up. boyce, clockston, sullivan, and cottrell conducted an autoethnographic study of their curriculum development process. they provide an in-depth exploration of their own educational experiences, which uncovered their own biases and helped them work towards more progressive and equitable models of education. they learned new ways of sharing content, grading, and accepting the expertise of others. the authors assert that design justice can increase students’ engagement, sense of belonging, and ultimately degree completion. another case study of social work education, by velez, avila, and doh, evaluated the processes and pitfalls of implementing a federal behavioral workforce grant. the goal of training historically underserved and underrepresented students in a predominantly white advances in social work, fall 2024, 24(3) iii institution located in a predominantly white state was a good one, but was challenging to execute. readers will benefit from information about program structure, institutional context, and demographic data. in particular, the lessons learned about the barriers to recruiting financially strapped students of color, barriers created by the institution’s financial policies, will be illuminating to those seeking to enact similar programs. gearhart uses st. louis as a case study in order to understand the racist policies of the 1900s that contributed to the decline of black neighborhoods and the detriment of the city overall. social work education should be examined for racist policy and practice, particularly in the divide of micro and macro social work practice. antiracist practice and education can begin only when we understand the institutional racism we have condoned. from the start of graduate social work education ethiopia’s addis ababa university in 2004, a tremendous amount of research has been conducted through master’s and phd theses. mehari, butterfield, and kebede provide a quantitative case study examining the methodology and subject matters of the research conducted. they found that 81% employed qualitative methods, since thesis advisors were well-educated in qualitative methodology. the most-researched thematic areas addressed issues dealing with children, women, gender, health and healthcare services, families, marriage, divorce, and community development. while the effects of the covid-19 pandemic on educational delivery is often discussed, its effects on formal faculty mentoring are less well known. holcomb used a narrative methodology to learn the experiences of 10 social work faculty who were teachers and mentees during that challenging time. participants, who were located across the united states, reported four main themes: four themes: 1) framing professional development during the pandemic, 2) shifting focus and deepening of mentoring relationship, 3) adjusting to virtual mentoring, and 4) impact of faculty and leadership attrition. many found that while their mentoring relationship was professional in beginning, a friendship formed to help them through this time of collective trauma. covid-19 and mutual aid the paper by milligan, saavedra, littman, dunbar, boyett, morris, and sarantakos focused on people helping people during the covid-19 pandemic, outside of social work education. their qualitative study interviewed 25 individuals engaged in mutual aid in colorado, examining the perceived benefits of providing and receiving care through mutual aid in the early months of the pandemic. they found that nonhierarchical care offered entry points to equitable ways of supporting communities through and beyond crisis. the decentered institutional decision making provided redistributed power and agency to meet community needs. the experiences of mutual aid participants propose a significant ideological shift, and suggest a need for future expansions of and changes to social work practice to embrace non-hierarchical care. hostetter & decker/fall 2024 editorial iv 2024 reviewer appreciation we would like to acknowledge the contributions of the following individuals who reviewed manuscripts for advances in social work in 2024. without their time, commitment, and expertise, advances in social work would not be possible. margaret e. adamek, indiana university susan allen, university of mississippi juan carlos araque, university of southern california paul archibald, college of staten island sara s. bachman, university of pennsylvania caroline ban, valparaiso university rosemary barbera, la salle university lauren beasley, georgia state university amber bell, lincoln university of missouri natalie bembry, rutgers university amy benton, texas state university hanif bey, east stroudsburg university tonya bibbs, erikson institute daniel boamah, western kentucky university valerie borum, ryerson university (2) kassandra botts, independent researcher erin boyce, metro state university (2) stephanie bryson, portland state university jamie burgess-flowers, university of north carolina (2) jessica cahill hughes, university of kentucky jesse capece, rhode island college jean carruthers, queensland university of technology jill m. chonody, boise state university michael clarkson-hendrix, fredonia state university of new york (2) laurene clossey, east stroudsburg university jo ann coe regan, catholic university of america (2) jessica cole, tulane university susan a. comerford, university of vermont dennis cornell, indiana university carole cox, fordham university tianca crocker, university of north carolina (2) donnamaria culbreth, metro state university jennifer cullen, widener university dale dagar maglalang, new york university (2) ashley davis, boston university jennifer davis, university of akron nickolas davis, university of detroit mercy bertha dejesus, millersville university hannah dickey, west chester university dana dillard, mississippi state (2) danny dixon, carl vinson va medical center jessica donohue-dioh, university of houston paul duongtran, california state university saadet durmaz, indiana university michele eggers, california state university rafael jacob engel, university of pittsburgh (4) nina esaki, springfield college aidan ferguson, southern illinois university joseph ferrandino, indiana university northwest fran franklin, delaware state university (2) advances in social work, fall 2024, 24(3) v dashawna fussell-ware, university of kentucky carolyn s. gentle-genitty, butler university lara gerassi, university of wisconsin susan l. glassburn, indiana university seth gurell, utah valley university (2) alicia hatfield, university of maryland alicia hawley-bernardez, our lady of the lake university christopher heckert, eastern washington university (2) anthony j. hill, winthrop university ariel hooker jones, southern illinois university (2) carol hostetter, indiana university (8) john c. h. hu, university of alberta ran hu, ohio state university bassima hussein schbley, washburn university emily ihara, george mason university jennifer lee isenberg hammond, indiana university dorothea ivey, university of southern maine (2) elena izaksonas, metro state university (2) alexandra jacobs, university of houston andrea joseph-mccatty, university of tennessee brian kelly, loyola university amy killen fisher, university of mississippi m. killian kinney, pacific university eric kyere, indiana university walter la mendola, university of denver stephanie lechuga-pena, arizona state university charles leung, beijing normal university kristen faye linton, california state university diane nicole loeffler, university of kentucky (2) mavis major, walden university james marley, loyola university stephen marson, university of north carolina allison mason, northeastern state university jennifer mcchristian, indiana university (2) kristin mccowan, university of missouri john g. mcnutt, university of delaware kelly melekis, university of vermont stacy c. moak, university of alabama (2) matt moore, university of kentucky mohammad mostafizur rahman khan, indiana university addie mungen, albany state university amy b. murphy-nugen, western carolina university laura mutrie, quinnipiac university gerald myers, simmons university lirio k. negroni, florida gulf coast university tammi l. nelson, indiana university mina margaret ogbanga, university of port harcourt erica pence, eastern washington university lujie peng, university of maryland ebony n. perez, saint leo university katherine perone, western illinois university cathryn c. potter, rutgers university gerald t. powers, indiana university brie radis, west chester university michael rangel, skyart mary e. rauktis, university of pittsburgh susan reay, university of nebraska at omaha kelley reinsmith-jones, east carolina university hostetter & decker/fall 2024 editorial vi lynette reitz, montclair state university dasha rhodes, university of south florida jacoba rock, boise state university jennie ryding, university west (2) alice schmidt hanbidge, university of waterloo elizabeth sharda, hope college (2) ruth shefner, columbia university dee ann sherwood, western michigan university (2) tyson singh kelsall, simon fraser university fabienne snowden, medgar evers college andrea stallworth, tuskegee university april steen, warner university nathan stephens, illinois state university anne l. stewart, james madison university (2) paul h. stuart, florida international university sabrina sullenberger, belmont university (2) michelle sunkel, colorado mesa university (2) tayon swafford, indiana university (3) phu tai phan, california state university (4) lauren terzis, tulane university (2) jelena todic, university of texas alison updyke, west chester university quenette walton, university of houston lisa werkmeister rozas, university of connecticut amanda west, univeristy of the pacific sandra wexler, university of pittsburgh (2) l. justin wheeler, ohio university (2) tiffany wigington, tarleton state university shanika wilson, north carolina central university heather witt, boise state university aaron wyllie, university of essex joanne yaffe, university of utah jimmy young, california state university (2) references barton, w. h., folaron, g., busch, m., & hostetter, c. (2006). satisfaction of contract provider agencies with a state's child welfare agency. children and youth services review, 28(3), 275-291. https://doi.org/10.1016/j.childyouth.2005.03.008 feagin, j. r., orum, a. m., & sjoberg, g. (eds.). (2016). a case for the case study. unc press books. lynd, r. s., & lynd, h. m. (1929). middletown; a study in contemporary american culture. harcourt, brace. thomas, g. (2011). a typology for the case study in social science following a review of definition, discourse, and structure. qualitative inquiry, 17(6), 511-521. https://doi.org/10.1177/1077800411409884 https://doi.org/10.1016/j.childyouth.2005.03.008 https://doi.org/10.1016/j.childyouth.2005.03.008 https://doi.org/10.1016/j.childyouth.2005.03.008 https://doi.org/10.1177/1077800411409884 https://doi.org/10.1177/1077800411409884 https://doi.org/10.1177/1077800411409884 _________ eugenia l. weiss, phd, lcsw, associate professor, school of social work, university of nevada, reno, nv. juan carlos araque, phd, teaching professor, annalisa enrile, phd, msw, teaching professor, and renee smith-maddox, phd, teaching professor, suzanne-dworak peck school of social work, university of southern california, los angeles, ca. danielle cohen, phd, research consultant, danielle cohen, llc, los angeles, ca. catherine davis, msw student, school of social work, university of nevada, reno, nv. copyright © 2024 authors, vol. 24 no. 1 (spring 2024), 187-204, doi: 10.18060/26720 this work is licensed under a creative commons attribution 4.0 international license. societal perceptions and developmental assets of latina youth from lowincome schools: implications for social work prevention efforts eugenia l. weiss juan carlos araque annalisa enrile renee smith-maddox danielle cohen catherine davis abstract: ensuring healthy development for youth is one of the grand challenges of the social work profession. this grand challenge seeks to reduce behavioral health problems in youth through prevention efforts. this paper presents a mixed-methods study of sixty latina adolescents from low-income schools to better understand their perceptions of what it is like to be a girl in u.s. society and explore their strengths through their developmental assets. understanding their assets rather than deficits would allow social workers as program developers, practitioners, and researchers as well as educators, to be able to focus on prevention. overall, the study participants showed a strong foundation of assets reflecting personal development along with perceived support from family, school, and other social aspects of their lives. some of the girls exhibited developmental vulnerability in terms of positive identity and constructive use of time. additionally, findings from focus groups suggested four themes, including feeling external pressure from both other girls and boys to meet societal beauty ideals, gender-based norm disparities and double standards, desire for reliable support systems, and belief in self about achieving their goals. based on the findings, implications for social workers engaging in positive youth development and preventative programming for latina adolescents are provided through intersectionality and equity. keywords: latinas; healthy youth development; societal perceptions; behavioral health; positive youth development the grand challenge to ensure healthy development for youth, as originally described by hawkins et al. (2015) and recently updated by shapiro et al. (2022), speaks to addressing one of the grand challenges for the social work profession, namely reducing behavioral health problems of youth while addressing the racial, gender and socioeconomic disparities for youth in this country. preventative approaches, as described by hawkins et al. (2015), are considered the keys to ensuring healthy youth development by reducing the adversities faced by youth that lead to behavioral health problems. additionally, youth of color (and those that identify with multiple social identities, i.e., intersectional) are more often disproportionately affected in terms of social determinants of health in comparison to other youths. although there are a few evidence-based prevention intervention programs (see blueprints for healthy youth development, 2024), there is much more to be learned on promoting positive youth development, particularly for ethnic communities, such as the latinx and those with intersecting identities. about:blank advances in social work, spring 2024, 24(1) 188 it is widely known that latinx populations are one of the fastest-growing demographics within the united states (act for youth [act], 2021; noe-bustamante et al., 2020; u.s. census bureau, 2021), however, the specific strengths and challenges that hispanic/latina adolescents face are still areas in need of greater study and research. with an increased understanding of the importance of an intersectional approach to research, it is becoming clear that individuals experience life differently based on their various social identities. as defined by mehrotra (2010), an intersectional approach to research is one in which race, gender, class, and privilege are recognized as “interlocking and interdependent oppressions that are simultaneously experienced” (p. 418). based on this definition, there are risk factors that disproportionately impact latina youth. for instance, teenage pregnancy rates among latina adolescents in the u.s. remain significantly higher than those seen among their white counterparts (barber et al., 2008; berg & nelson, 2016; centers for disease control and prevention [cdc], 2021). for instance, from 2018 to 2019, birth rates for latina adolescents were 25.3 births per 1,000 girls (between the ages 15-19), almost two times higher than those of non-hispanic white females (11.4; cdc, 2021). pregnant latina adolescents are 4.5 times more likely than their white counterparts and 1.5 times more likely than black girls to drop out of school (berg & nelson, 2016). this has far-reaching implications for latinx communities, such as poorer general health, higher incidents of drug abuse, and higher rates of incarceration when compared to those who completed high school (berg & nelson, 2016; peguero et al., 2016). arguably, one of the most troubling threats to youth of color, such as latinas, is that of sexual exploitation and abuse. todres and diaz (2019) contend that while there is no singular profile of the diverse range of youth who fall subject to abuse and exploitation, there are clear individual, relational, and communal factors that contribute to individual risk. most notably, young girls from marginalized and low socio-economic groups are consistently the most vulnerable to sex and labor trafficking. past research efforts have played an important role in uncovering the health and wellbeing disparities that exist for often disenfranchised populations, giving shape to systems of oppression that can otherwise be hard to grasp. despite this research being critically important in validating and conceptualizing the experiences of underserved populations, focusing entirely on deficits and risk factors overlooks the areas of strength and resilience that can also comprise parts of their experience. this emphasis on deficits can be harmful to underrepresented individuals, perpetuating narratives of damaged communities in need of dominant culture/settler interventions (wood et al., 2018). in their study centralizing empowerment theory, a modality defined by enhancing wellness, identifying strengths, and searching for environmental influences instead of fixing problems and cataloging risk factors, lardier et al. (2018) found that psychological empowerment and a strong sense of ethnic identity act as a buffer against risky behaviors. similarly, motti-stefanidi (2014) determined that immigrant adolescents with higher self-efficacy beliefs were often protected from a number of the risk factors isolated in previous research. this led the researcher to conclude that the way young people see the world can greatly influence how they experience their surroundings, and this subjective perspective often has a greater impact on their ability to adjust than the objective environment itself. by shifting the focus weiss et al./latina youth 189 from what is not working to what is working, we reinforce narratives of communal and individual strength in the face of limiting environmental realities. the study on latina youth which will be described in the next section, uses the developmental assets profile (dap; search institute, n.d.) as a way to measure in a more balanced manner the positive ingredients needed for successful youth development. one of the major strengths of this tool is the practical findings that can empower youth and their support systems to take meaningful action (benson et al., 2011). in the 40-plus decades since its inception, the dap has shown that positive outcomes (e.g., social and emotional health, the absence of health-compromising behaviors such as alcohol use, drug use, violence, and antisocial behavior, school success, contribution, and caring) increase as developmental assets increase, positioning itself as an important complement to understanding and reducing risk factors (benson et al., 2011). thus, the purpose of this study is to contribute to the knowledge base on the grand challenge of ensuring healthy development for youth, specifically latina adolescents from low-income schools. by utilizing a mixed-methods approach, the study aims to comprehensively understand these adolescents' perceptions of girlhood in u.s. society and explore their strengths through developmental assets. social workers, educators, and researchers can emphasize prevention efforts by shifting the focus from deficits to assets. the study given their demographic prominence, latina youth in the u.s. are relatively understudied, but the few statistics that have been reported often depict them as an at-risk population. to address the research gaps, this exploratory study applied a cross-sectional and mixed-methods approach and focused on discovering the societal perceptions and developmental assets of latinas attending middle and high schools in low-income neighborhoods. the mixed-method approach allowed the researchers to collect quantitative data to empirically understand latina youth's functioning. to supplement the quantitative results, a qualitative component of the study produced rich descriptions underlying the analytic results that provided meaning that latina youth make of their supports and developmental assets. a positive youth development approach provides the potential for examining the growth and adaptive functioning of latina youth rather than a problem or deficit-focused approach (benson et al., 2011). in this study, it should be noted that the terms hispanic and latina/x will be used interchangeably. latina students from southern california middle and high schools participated in a one-day positive youth development convening titled “keepin’ it 100,” a slang phrase that refers to one’s own integrity or to being one hundred percent real or true to who you are (urban dictionary, 2017). during the convening, before any positive youth development activities took place, participants engaged in focus groups and completed the developmental assets profile (dap; search institute, n.d.). the purpose of the study was to add to the knowledge base about latina adolescents’ perceptions of what it is like to be a girl in u.s. society today, including what is important to them, as well as to explore their developmental assets as part of what hawkins et al. (2015), describe in their discussion paper titled, unleashing the power of prevention. advances in social work, spring 2024, 24(1) 190 procedures a convenience sample was used to recruit 61 girls who volunteered for the convening and the research study. the girls were recruited from public middle and high schools located in southern california from the santa ana school district, a predominantly hispanic school district that has over 80% of students receiving free or reduced meals (education data partnership, 2024). all the youth participated in the girls' convening, a one-day event on a university campus where girls were transported by school buses and exposed to talks from inspirational young female leaders of color. girls participated in guided expressive arts activities meant to be self-affirming and empowering. data collection occurred on june 17, 2017, during the convening. before the youth development activities began, the girls were randomly assigned to nine focus groups of 57 girls in each group. the focus groups asked them to identify what it is like to be an adolescent girl in the 21st century, among other questions. each focus group was led by a female educator and lasted 45 minutes to 1 hour. the educators were given an hour of training before the convening on data collection, and the lead author provided them with a semi-structured interviewing protocol. each session was audio recorded by a master of social work level student who later transcribed the recordings. immediately following the focus groups, the youth were administered the dap, which they completed with brief instructions provided by a female educator. the participants were provided 30 minutes to individually complete the dap via paper/pencil format. the data was then transferred onto an excel sheet for analysis. the university of southern california's institutional review board deemed the study exempt. both parent/guardian consent and youth assent were obtained as part of the research study. no financial compensation was provided for study participants; however, they all received free breakfast and lunch along with a copy of a poetry book written by a young female poet who read her poetry as part of the convening. the girls were also given a gift bag with inspirational writings and college paraphernalia. measures demographics this study sought demographic information about the participants, such as age, grade level, race/ethnicity, and gender identity. race/ethnicity was described through several categories such as black or african american; asian; american indian or alaska native; native hawaiian or other pacific islander; white; hispanic or latina; and other. developmental assets the developmental assets profile (dap) for youth ages 11-18 was used in the study (search institute, n.d.). the dap is comprised of 8 subscales that measure the following developmental assets: internal assets (or character strengths), including a commitment to learning, positive values, social competencies, and positive identity; the external assets (or weiss et al./latina youth 191 social relationships and opportunities) include, support, empowerment, boundaries and expectations, and constructive use of time. the instrument is composed of 58 items on a 4point likert scale (where 0= not at all or rarely; 1= somewhat or sometimes; 2= very or often; 3= extremely or almost always). additionally, the participant responses to the list of assets (or “positive things”) also comprise five asset-building context measures that they might have in themselves, “now or within the past 3 months,” as it regards their family, friends, neighborhood, school, and community. higher asset levels correlate with increased youth well-being across gender, race/ethnicity, urbanicity, and socioeconomic status (benson et al., 2011; scales et al., 2006). scales (2011) provides a composite of scores for each dap asset category that are interpreted as developmental experiences that are “challenged” (with scores of 0-14), “vulnerable” (represents scores of 15-20), “adequate” (scores between 21-25) or “thriving” (scores of 26-30). scale ratings are also used for the overall composite asset, which includes both internal and external scores, measured out of a total score of 60. the interpretive ranges for the total composite asset are: “excellent” (with scores 51-60), good (with scores 41-50), “fair” (with scores 30-40), and “low” (with scores 0-29). the dap has an internal consistency average estimate of .81 for the eight asset category scales and 0.88 for the five context subscales (rand corporation, 2018). with respect to validity, wilson-ahlstrom et al. (2011) found validity evidence to be moderate, and haggerty et al. (2011) determined the dap has significant criterion, convergent, and discriminant validity. the dap has also been adapted and tested on international samples with acceptable reliability and validity estimates for the total dap and most of the subscales (scales, 2011; scales et al., 2017). thus, it is considered a cross-culturally reliable and valid instrument. for this study, the cronbach alpha coefficient calculated for the dap was excellent (α =.94). qualitative approach using an inductive, comparative, and emergent approach based on grounded theory, finding the girls’ voices was of utmost importance (corbin & strauss, 2014). the following four questions were addressed through the focus groups: (1) “what are the challenges girls face today?” (2) “what resources do they need?” (3) “what are your aspirations?” and (4) “what is it like to be a girl in the 21st century?” these questions were derived from an examination of the literature and informed by the researchers’ work in gender studies and women’s rights advocacy. thematic analysis was used to analyze the focus group data from verbatim transcripts of audio recordings. this involved independent coding of all responses by one of the study’s senior investigators through the nvivo software package (qsr international, 2020) and then compared by another study investigator until consensus was reached. constant comparative methods were used by the researchers to determine analytic distinctions (glaser & strauss, 1967). participants overall, less than 0.2% of data on the dap assets were missing. the researchers used a screening criterion that omitted any dap respondent that had more than 10% of missing advances in social work, spring 2024, 24(1) 192 data (i.e., greater than six or more missing items), which could lead to questionable validity and potentially significantly impact the results. one respondent had 11 items missing (19% of responses were left blank) and so was removed from the data, leaving 60 respondents. of the remaining respondents, 90.2% had no missing items, and 100% had three or fewer missing items. youth self-reported identifying in various racial and ethnic groups for this study. most of the girls identified as latina (73.3%), eight (13.3%) did not report their race/ethnicity, and four (6.7%) identified as “other” (table 1). the mean age for the sample was 15.64 (sd= 1.12), ranging from 14-18 years. the 10th grade represented both the mean and median grade, with 23 (36.7%) of the sample, and 8 participants (13.3% of the sample) did not respond. all of the girls self-identified as female. table 1. sample characteristics (n=60) characteristic n (%) race/ethnicity number asian 2 (3.3%) white 1 (1.7%) hispanic/latina 44 (73.3%) american indian 1 (1.7%) other 4 (6.7%) did not respond 8 (13.3%) grade level 9th 17 (28.3%) 10th 23 (36.7%) 11th 11 (18.3%) 12th 3 (5.0%) did not respond 7 (11.7%) results quantitative composite scores for each of the assets were obtained by creating scaled variable responses to items for each asset, context, and internal/external asset. the eight individual asset categories were scaled by averaging the scores for items in each asset and multiplying by 10. external and internal asset scores were scaled out of 30 by averaging the internal asset categories. for instance, the external asset score is the average of the scale scores of support, empowerment, boundaries and expectations, and constructive use of time. similarly, for the internal asset scores, the commitment to learning, positive values, social competencies, and positive identity scores are averaged. the total composite score is the sum of the internal and external asset scores. reliability analysis was conducted to assess the consistency of the composite variables and the extent to which they operationalize the assets. this study focused on the results of the latina participants, who comprised the majority of the study population (roughly 74%). due to the small number of participants who identified their race/ethnicity and were non-hispanic/non-latina (only four students identified as either asian, white, or american indian), data for these participants were combined with data from respondents who either identified as other or left the race/ethnicity blank to create two categories: latina (n=44) and non-hispanic/latina (n=16). weiss et al./latina youth 193 as shown in table 2, the overall composite asset for all participants, comprised of all items on the questionnaire, was found to be highly reliable (α=.94). reliability analysis for the two individual racial/ethnic groups was equally as high in reliability. internal and external assets also had excellent reliability for the groups separately as well as altogether. of the eight assets, all had acceptable (.6 ≤ α ≤ .7) to very good reliability (α > .8) with the exception of two variables. empowerment for the latina group was borderline acceptable (α = .59), but the reliability for this variable was in the acceptable range for the nonhispanic/non-latina group. constructive use of time had poor internal consistency over all subjects (α = .31) driven mostly by the latina group (α = .27), while the non-hispanic/nonlatina group was higher but still poor (α = .46). the interpretation for a low cronbach’s alpha is that the items that are used in the constructive use of time variable are weakly related and, for this group of participants, the composite does not adequately represent constructive use of time for either group. the context assets were all in the “very good to excellent” range of reliability. table 2. reliability all participants, latina, and non-hispanic/non-latina groups results reliability [cronbach’s α] all participants (n=60) latina (n = 44) non-hispanic/ non-latina (n = 16) composite asset .94 .94 .95 internal assets .89 .88 .93 positive values .75 .71 .87 positive identity .74 .75 .69 social competencies .66 .61 .73 commitment to learning .81 .70 .90 external assets .90 .89 .92 support .83 .77 .89 empowerment .58 .53 .67 constructive use of time .31 .27 .46 boundaries & expectations .84 .81 .89 context areas .94 .94 .95 personal .77 .80 .76 school .85 .73 .92 social .80 .73 .84 family .89 .89 .92 community .75 .73 .77 the researchers compared differences between the two racial/ethnic groupings by first testing for normality of the composite variables using the shapiro-wilk test and determined that some of the variables were not normally distributed (table 3). the mann-whitney test is a nonparametric test to compare means of samples that is similar to the t-test but does not assume normality in the data, thus it was used to compare differences in means between the latina group and the non-hispanic/latina group. results showed that there were no statistically significant differences between the groups on the composite variables with the exception of the constructive use of time variable (table 3). this result may not be reliably interpretable since the constructive use of time variable had very poor internal consistency. advances in social work, spring 2024, 24(1) 194 table 3. test for normality, and mean comparison between latina and non-hispanic/ non-latina groups results (n=60) shapiro-wilk test wilcoxon rank sum test p-value z-value p-value composite asset .04 1.51 .13 internal assets .18 1.09 .28 positive values .82 1.13 .26 positive identity .08 1.69 .09 social competencies .12 1.55 .12 commitment to learning <.01 .66 .51 external assets .02 1.15 .14 support <.01 .95 .34 empowerment .60 1.57 .12 constructive use of time .24 2.44 .01 boundaries & expectations <.01 0.84 .40 context areas .04 1.56 .12 personal .65 0.87 .38 school <.01 1.20 .23 social .01 1.77 .08 family <.01 0.83 .41 community .30 1.75 .08 the composite asset score gives a sense of the strength of the developmental assets (see table 4). on average, the latina girls in this study scored 44.6 (out of 60; sd = 7.12), which is associated with an adequate foundation level. non-hispanic/non-latina girls scored lower, 40.74 (sd = 7.60) on average, indicating a vulnerable foundation level. the data show that 80% of the latina respondents are either adequate or thriving overall, and 7% are in the lowest category, challenged. these results suggest that overall, the latina girls in this study have a very strong foundation of assets; 20% of the respondents have room for improvement. the non-hispanic/non-latina group also had a strong foundation, with 75% in the adequate or thriving level, but 13% were challenged. the latina girls scored, on average, in the adequate range for four of the five asset-building contexts, reflecting high levels of support in personal, social, family, and community areas of their lives and, on average, are thriving in school. non-hispanic/latina girls were found to have adequate levels in social, family, and school but were found, on average, to be vulnerable in their personal and community assets. few of the latina respondents were found to be in the challenged level for personal support (5%) and community support (5%), but 36% were found in the vulnerable range for personal support (44% for non-hispanic/non-latina) and 45% for community support (56% for non-hispanic/non-latina). these vulnerability scores in personal and community support for the non-hispanic/non-latinas could be explained by their smaller numbers in their communities than the latina youth who are a majority, however, this interpretation would require further investigation. external assets include students' support from their families, schools, and communities and incorporate a sense of support, empowerment, boundaries, expectations, and constructive use of time. internal assets include the categories of commitment to learning, positive values, social competencies, and positive identity. internal and external assets are weiss et al./latina youth 195 measured on a scale from 1 to 30. this group of latina girls scored in the adequate range for both internal (22.44) and external (22.11) assets, while non-hispanic /non-latina students were vulnerable in these areas (external, 19.76 and internal, 20.93). latina girls scored consistently with adequate levels on most of the eight asset categories but had vulnerabilities in two categories. among the external assets, the latina adolescents scored highest on boundaries and expectations (23.99) and were found to be vulnerable in their constructive use of time (19.80). further inspection revealed that 40% of the latina respondents were vulnerable, while 18% were challenged in their constructive use of time. non-hispanic/non-latina girls were similarly vulnerable in their constructive use of time (16.73). constructive use of time was the only variable in which the two racial/ethnic groupings had a statistical difference, but this variable should be interpreted with caution as the reliability was found to be poor. table 4. means and standard deviations of dap scores mean (sd) latina participants (n=44) non-hispanic/non-latina participants (n=16) total composite asset 44.63 (7.12) 40.74 (7.60) external assets 22.11 (4.04) 19.76 (4.60) support 22.01 (3.91) 20.66 (4.88) empowerment 22.84 (2.53) 20.38 (2.65) boundaries & expectations 23.99 (4.68) 22.91 (5.03) constructive use of time 19.80 (2.30) 16.73 (1.55) internal assets 22.44 (3.46) 20.93 (4.00) commitment to learning 23.75 (2.75) 22.75 (4.54) positive values 23.17 (3.75) 21.12 (4.57) social competencies 23.78 (3.19) 22.12 (3.68) positive identity 19.19 (3.54) 16.28 (2.80) context areas 22.75 (3.55) 20.93 (3.97) personal 21.04 (5.88) 19.47 (4.63) social 23.93 (4.52) 21.89 (5.56) family 23.76 (5.45) 22.69 (6.33) school 24.73 (3.92) 22.69 (5.79) community 20.27 (5.54) 17.88 (4.58) on internal assets, both groups had the highest foundational asset scores in commitment to learning, positive values, and social competencies but had vulnerable levels of positive identity (19.19 for latina girls and 16.28 for non-latina girls). sixty percent of latina respondents had challenged or vulnerable positive identity levels, and just over onefourth were in the adequate range, while 75% of the non-hispanic/non-latina were challenged or vulnerable, and close to one-fifth were in the adequate range. the latina students were, on average, committed to learning, with 73% at the adequate (30%) or thriving level (43%). a similar result was found for the non-hispanic/non-latina group, with 25% in the adequate range and 38% thriving. overall, these results reflect strong personal and psychological development in this group of girls on most assets. however, the results also indicate that a sizable portion of both groups of girls are at increased risk advances in social work, spring 2024, 24(1) 196 for negative outcomes in positive identity and constructive use of time, where preventative interventions would be highly recommended. qualitative data findings theme 1. fitting in: external pressure to fit in and meet societal standards for beauty and the influence of social media one of the most common challenges discussed by these girls was their awareness of external pressure from both other girls and boys to meet the beauty ideals and standards of dominant groups. more often than not, this awareness manifested itself as a feeling of needing to be perfect, as well as a perception of one's own lack of traditional beauty when compared to others, as demonstrated in the following quote: society makes it seem like...the perfect body, the nice lips, natural face or stuff like it’s just like put it out there for guys to see and girls be like that, “oh i want to be like that girl because she has this and i don’t, and i want to have that.” a perceived inability to meet these standards often made them feel like they did not fit in with the other girls at their school. as demonstrated in the comment below, many participants credited other girls with policing one another's physical appearance: it’s cuz everyone wants you to be like, like, so pretty and, like, just like a certain weight and put this pressure on you, like, like, some girls they try so hard, but you can’t reach that level. um, some girls even, “oh, you’ll never get a boyfriend, you’re ugly.” like, that gets me so mad. like, why are you putting another girl down? social media was discussed as harming their perceptions of self due to their near-constant exposure to unrealistic and often manufactured representations of beauty. the participants also attributed the unachievable beauty expectations they experience from boys to their generations' access to and participation in social media. when discussing kylie jenner (social media influencer) and the impact that her surgically altered appearance has on other adolescents her age, one participant said, “if we don’t look like that, we doubt ourselves because that is what guys look for into [sic] girls. that nice hourglass figure, perfect skin and we don’t have that.” another participant conceptualized the negative impact of social media as a series of ever-changing trends and pressures when she said, “they used to be, ‘oh, you have to be skinny’. now it’s like, thick. it’s like what’s next?” these perceptions are substantiated by the quantitative findings that reflect, on average, a vulnerability in the latina girls’ positive identity, which includes self-esteem and anxiety. theme 2: gender norm disparities and double standards by far the most pervasive theme among the focus groups was that of awareness of gender-based disparities in the treatment and overall expectations for success and capability when compared to their male counterparts. according to the girls, these differences were experienced at multiple levels (i.e., in school and family). they felt weiss et al./latina youth 197 negatively judged by boys and other adults. in a school setting, these differences often presented themselves as an expectation of modesty that did not apply to the boys in their school. for example, one of the girls stated, “like we [girls] can't wear shorts, jeans that are ripped because our knees and shoulders will provoke guys.” and another example is, “i saw this one girl she had ripped jeans and she was in the nurse's office, and she got a dress code (demerit). but i saw some guy, like, literally the next day in ripped jeans, yeah, the entire day nobody said anything.” in relation to their families, these disparities and double standards most often took the form of differing expectations around the house and pressure to conform to gender stereotypes, such as participating in traditionally feminine activities (e.g., cooking and shopping). for example, a participant indicated, like, my mom treats me very differently than my brother because she expects me to know how to cook, how to do everything, how to clean the house. when it comes to my brother, he can be asleep the whole day and it would be fine. if i take a little nap, it’s like: “what are you doing? you’re supposed to be helping, making food’ and i feel like these roles are expected of you.” theme 3: desire for reliable support systems throughout the focus groups, the girls expressed a desire for and an emphasis on the importance of reliable support systems. these experiences are consistent with the quantitative results that showed a large percentage of girls of both groups at the vulnerable level in their personal and community assets. at times, this want was expressed in terms of connections to their female peers in order to foster supportive relationships between girls. support within the family was also frequently discussed, although this topic more often than not led to expressions of feeling pressure from the family system, rather than love and support. in each group, a wish was communicated for a mentor, either within or outside of the school system. many of the girls seemed to believe that having external encouragement and guidance would help them develop more self-confidence and navigate systems in which their families of origin may lack experience. for instance, one participant noted: “i think girls need more girls that will help them and not bring them down, like, help them bring their self-esteem up and like someone whom they can talk to.” another stated, “yeah, in school, yes, like i feel like we need more people to like, you know, like encourage us and like support us into like our dreams, you know? yeah, counselors? they could tell us like, you know, the steps we need to take to accomplish them.” theme four: belief in self many of the girls throughout the focus group sessions expressed strong beliefs in their ability to accomplish the particular goals that they had set for themselves. for most, these beliefs took the form of faith in their ability to accomplish goals set with respect to work or study, with many girls vividly describing their desires to become teachers, lawyers, veterinarians, creative people (like artists), and doctors. when asked about her aspirations, advances in social work, spring 2024, 24(1) 198 one of the participants stated, “like, people laugh at that when you say, ‘oh, i want to be president [of the u.s.]’...but they can actually do it if, like, you have the motivation, determination…you can do it. for sure. that’s what i believe.” this idea of being able to accomplish anything with enough hard work and desire came up throughout the group discussions. for many participants, self-belief also functioned as an antidote to the external doubt they came up against from family, peers, and society at large. a number of the participants shared sentiments along the lines of wanting to “prove everyone wrong, like the ones that would tell me i couldn’t do it.” one of the other participants remarked that she would like to accomplish her goals in order to “show her family that she can move forward, that she’s somebody that’s always gonna achieve her goals.” a number of the girls viewed belief in self and striving as a way to overcome the gender norm disparities which prohibit them from acting in certain spaces, with one girl stating, “a girl can be a mechanic. you can drive [pilot] an airplane if you wanted to, it's like you can do the same thing a guy can do.” in respect to perceived barriers, another shared, “not being able to [sic] a boy’s standard of what is um…is supposed to be right…you probably think, ‘oh i can’t do that, i am a girl’...but in reality, you can do it, you just have to put your mind to it.” discussion the purpose of this study was to highlight the perceptions, experiences, and developmental assets of latina youth in order to discover areas for preventative work. there were several limitations in this study, namely a small sample, reliance on a sample of convenience, and the participation of non-latina/non-hispanic students in focus groups. participants were recruited from only one school district connected to one of the researchers, thus limiting the representativeness of the study. the self-report nature of the dap instrument is another limitation, as social desirability can result in biased responses. additionally, age was not analyzed in terms of the dap, as the literature points out that younger people tend to score higher (scales et al., 2017). although the researchers did not have racial/ethnic data on the focus group respondents that specifically mapped to the responses participants gave, the researchers estimate that the results reflect the lived experience of the latina respondents as a group for two reasons. first, close to threequarters of the sample were latina making them the majority of the focus groups. second, the quantitative variables do not reflect significant differences between the latina group and the non-hispanic/latina respondents; thus, the two groups reflect similar experiences on the items of interest in the study. the findings from this regional sample suggest that building a positive identity, having support systems, and reducing gender-based inequities for latina adolescents in the u.s. are needed to develop important assets such as self-actualization, sense of belonging, motivation, engagement, and well-being. the quantitative results on vulnerabilities in positive identity lend further support for this need. peer relationships also play an important role in fostering a sense of belonging at school and in other environments. in addition, adults at home and in school environments are instrumental in shaping the gender identity weiss et al./latina youth 199 of latina youth. overall, the results reflect high levels of school, family, personal, and social assets. as social norms are embedded in a web of beliefs, values, practices, and other norms (bicchieri, 2016), a collective commitment is needed in order to socialize girls to be empowered when cultural norms collide with social norms (frese, 2015). an important finding from this research was the power of narrative storytelling, especially in their uniquenessevery latina youth expressed authentic ways of articulating what is important to them (fernández-garcía, 2020; miville et al., 2017). the intergroup dialogue about their self-perceptions and aspirations reaffirmed that they are not alone. when positive youth development is the goal, it is essential to create programming for targeted participants (e.g., by age, gender, sexuality, and/or race/ethnicity) and type of prevention program (e.g., empowering, mentoring, family or peer-based, parenting, etc.). furthermore, capitalizing on these differences by hosting creative expression showcases could create a space for spotlighting important issues affecting girls (barron, 2016; flores, 2021). for example, flores (2018) demonstrates a family-based program that used creative expression, where latina girls and their mothers used writing and visual arts as the primary artistic mediums to create art forms from their own individual perspectives and even to highlight differences shared with each other. the author found a deeper understanding and appreciation of perspectives, not just what important issues were but how they were being experienced by each. specifically, anzaldua’s (2002) description of the liminal spaces that are navigated by the girls and also their mothers theorize that creative expression programs are spaces of transformation that can be showcased. in addition, exposing them to a diverse array of positive youth development activities (i.e., finding commonalities, gaining selfconfidence, taking action through self-expression, and using positive affirmations) could help them share areas of hope, tension, confusion, and doubt. self-perception can also shape personal and professional trajectories. helping latina girls notice their emotions and the language used to describe their experiences and perceptions may be necessary healing and coping strategies (flores, 2021). this point is important because it recognizes how essential it is to intentionally design an interactive space for artistic expression, making connections, and facilitating creative interactions to empower girls with the knowledge, skills, and supports necessary to identify their strengths and work through barriers to their sense of belonging, being valued, and being respected. social workers acting as program developers, practitioners, and researchers as well as educators should focus on prevention. developing prevention programs for empowering girls could also foster a sense of belonging that can benefit their growth and development and potentially prevent behavioral health problems as well as their involvement in sex trafficking, intimate partner violence, and the juvenile justice system. furthermore, genderspecific prevention programming grounded in culturally relevant and evidence-based approaches can contribute to positive youth development. thus, in any program, explicitly addressing persistent social determinants of health, including poverty and racial inequities among marginalized communities, through effective preventive interventions is needed (shapiro & bender, 2018). shapiro et al. (2022) note that any prevention program would benefit from “directly addressing oppressive social structures as well as the implicit biases advances in social work, spring 2024, 24(1) 200 and social norms that sustain them” (p. 38). furthermore, the authors note that the registry of preventative intervention programs (i.e., blueprints for healthy youth development, n.d.) for the most part does not include prevention programs that examine specific group differences based on racial or ethnic identities. in searching through this registry, there is one prevention program, generationpmto (a family management skills training), that is considered a best practice or one that falls under the “model plus” certification (i.e., scientifically proven effectiveness, generationpmto, para. 1) that is effective across race/ethnicity and gender (male/female). a culturally adapted parent management training has also been previously found to be effective specifically for latinx youth at risk for problem behaviors (martinez & eddy, 2005). the other program that is listed as promising in the blueprints registry (which, as defined by the registry, demonstrates promise in terms of efficacy, but requires further study) is the familias unidas (n.d., para. 1). for example, familias unidas (originally developed by pantin et al., 2003) is a multi-level family-based empowerment program for latinx immigrants to foster healthy youth development in their children. there is another “model plus” evidence-based prevention program such as multisystemic therapy for juvenile crime prevention (originally developed in the 1990s, see henggeler, 1999 for an overview), however, this is not specific to latinx youth. conclusion further research studies on gender identity formation among adolescent girls from different racial and ethnic groups using an intersectional approach are recommended. given the realities of social and economic vulnerabilities, studies are also needed that address the impact of covid-19 on teen behavioral health, isolation, social exclusion, and the adverse impacts of social media, sexual assault, intimate partner violence, human trafficking, and community violence. this research agenda will help in understanding how to support latina youth and perhaps other youths of color to prevent behavioral health problems and achieve their career and education goals and help them during stressful times (such as developing coping strategies to grow in confidence, develop socially, deal with social isolation and maintain a positive mindset). gender differences should also be more widely studied for those that identify as nonbinary or transgendered (shapiro et al., 2022). thus, gender (graham et al., 2020) and race/ethnicity (i.e., intersectionality) need to be further examined by social work practitioners and researchers in any prevention efforts to foster healthy youth development. one of the issues here, as eloquently described by shapiro et al. (2022), is that prevention programs may be able to help youth cope, but they do not address the underlying societal structures (including gender norms) that perpetuate inequities for diverse and marginalized populations. developing practices and programs that address individual development as described above is important, but addressing underlying social structures emphasizes the need for programs/interventions that build communities or increase capacity with the goals of transformation and empowerment. for instance, photovoice is a community-based participatory research model that uses the creative medium of photography to engage latina adolescents in documenting their community, and then sharing their findings weiss et al./latina youth 201 (hannay et al., 2013. through a non-threatening, easily understood form (photography), parents and latina girls are able to define the problem and barriers and shape the community’s policy agenda from their understanding. similarly, a study of latina girls in stem programs reveals that it is their cultural assets that influence successful outcomes, and not just individual constructs (rincón & rodriguez, 2021). young adult poet and novelist elizabeth acevedo powerfully demonstrates the integral relationship between personal empowerment and changes in societal structure through her work which implicitly suggests the need for decolonial mindsets to combat xenophobia, racism, gendering, and othering (lópez, 2021). given the growing latinx population in the u.s., latina youth have the potential to become the next generation of leaders. by empowering latina adolescents through prevention programs that also challenge institutional and oppressive practices, there is the potential to foster a new generation of powerful, inclusive women leaders who break the chain of abuse and are unafraid to pursue their dreams and reach their full potential. stronger girls can result in strong women building equitable and just communities and giving back to their own communities. references act for youth. 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(2018). being a latinx adolescent under a trump presidency: analysis of latinx youth's reactions to immigration politics. children and youth services review, 87, 192-204. author note: address correspondence to eugenia l. weiss, school of social work, university of nevada, reno, building 058, reno, nv 89557. email: eugeniaw@unr.edu https://doi.org/10.1086/700395 https://doi.org/10.1086/700395 https://doi.org/10.1093/oso/9780197608043.003.0003 https://doi.org/10.1093/oso/9780197608043.003.0003 https://doi.org/10.1093/oso/9780197608043.003.0003 https://doi.org/10.1353/book.71298 https://www.urbandictionary.com/define.php?term=keep+it+100 https://www.census.gov/library/stories/2021/08/2020-united-states-population-more-racially-ethnically-diverse-than-2010.html https://www.census.gov/library/stories/2021/08/2020-united-states-population-more-racially-ethnically-diverse-than-2010.html https://www.search-institute.org/wp-content/uploads/2017/11/dap-ready-by-21-review.pdf https://www.search-institute.org/wp-content/uploads/2017/11/dap-ready-by-21-review.pdf https://doi.org/10.1016/j.childyouth.2018.02.032 https://doi.org/10.1016/j.childyouth.2018.02.032 mailto:eugeniaw@unr.edu _________ edward mei, md, research assistant, department of medicine, and christopher bondoc, msw, research coordinator, department of pediatrics, david geffen school of medicine at university of california, los angeles [ucla], los angeles, ca. jocelyn i. meza, phd, assistant professor, department of psychiatry, ucla, los angeles, ca. john bosco, md, research assistant, department of emergency medicine, harbor-ucla medical center, los angeles, ca. elizabeth s. barnert, md, mph, ms, associate professor, department of pediatrics, david geffen school of medicine at ucla, los angeles, ca copyright © 2024 authors, vol. 24 no. 3 (fall 2024), 554-579, doi: 10.18060/28082 this work is licensed under a creative commons attribution 4.0 international license. how ecological systems impact black and latine youths’ health during reentry after confinement: implications for social work edward mei christopher bondoc jocelyn i. meza john bosco elizabeth s. barnert abstract: reentry after confinement is a critical juncture for youth, and the environmental contexts they return to post-release play a crucial role in shaping their health. this qualitative secondary analysis explores the perspectives of black and latine youth and their parents/caregivers on how specific microsystems influence youths’ health during reentry. we completed two-staged thematic analysis of longitudinal semi-structured interviews with recently released black and latine youth (n = 27) and their parents/caregivers (n = 34) to examine how the home, school, and neighborhood microsystems impact youths’ health and well-being during community reentry. participants described three environmental features across the identified microsystems as impacting the health and well-being of youth undergoing reentry: 1) relationships, 2) physical space, and 3) resources. participant perspectives suggest that social workers can potentially leverage existing strengths within each microsystem to promote the health and desistance of black and latine youth during reentry. in addition, participants described health-detracting features within specific microsystems that social workers can aim to remedy to redress health disparities among black and latine youth undergoing reentry. using participants’ insights to optimize youths’ environment for health promotion, desistance, and service utilization may facilitate long-term health and well-being for black and latine youth post-release. keywords: reentry, juvenile justice, aftercare, qualitative research while the overall number of youth confined in the united states has declined in recent decades, racial disparities have continued to increase. black and latine youth account for a disproportionately high number of youth impacted by the juvenile legal system (rovner, 2021; sickmund & puzzanchera, 2014). the experience of confinement also leads to worse physical and behavioral health outcomes (barnert et al., 2017). as such, youth involved in the juvenile legal system have higher unmet health needs than their non-involved peers, with stark health disparities observed among black and latine youth (braverman et al., 2010; cocozza & skowyra, 2000; teplin et al., 2002). the same populations that are unjustly affected by the u.s. juvenile legal system, black and latine youth, also disproportionately live in environments with additional health barriers, such as neighborhood violence, poverty, limited providers, transportation difficulties, and lack of insurance (crouch et al., 2000; golzari & kuo, 2013; schwartz et al., 2022). the about:blank mei et al./health after reentry 555 environmental inequities that negatively impact the health of black and latine youth also increase their risk for confinement and recidivism, which then creates and exacerbates health problems—trapping black and latine youth in cycles of worsening health and increasing marginalization (woods et al., 2013). environmental differences interrelate with health disparities among black and latine youth involved in the juvenile legal system, signifying an important focus for social work (de coster et al., 2016). youth reentry and health reentry, often defined as the 6 months following release from confinement , is a critical juncture for shaping youths’ health trajectories (altschuler & brash, 2004). youth experience high disease burden upon release, including high rates of sexually transmitted infections, psychiatric disorders, and substance use disorders (altschuler & brash, 2004; teplin et al., 2002). moreover, health behaviors or health-related behaviors post-release relate to risk for recidivism and adverse health (freudenberg et al., 2005). generally, health behaviors include individual actions that affect health, such as smoking, substance use, diet, physical activity, sexual activity, and treatment seeking (armstrong, 2009). during reentry, youth often engage in behaviors that can harm their health and increase risk for recidivism, such as substance use, risky sexual behavior, and low service utilization (freudenberg et al., 2005). like confinement, the reentry experience exacerbates health needs and widens health disparities (barnert et al., 2016). prior research has established a dose-dependent relationship between youth confinement and adult health such that more contact with the juvenile legal system and increased time in confinement relate to worse long-term health (barnert et al., 2017). thus, youths’ desistance and risk for recidivism carry significant implications for their health trajectories. notably, youth show high risk for recidivism during the reentry period with up to 46% returning to confinement within 2 years of release (altschuler & brash, 2004; mendel, 2011). however, the extant literature indicates that health and social service interventions during reentry can improve youths’ health and promote desistance (bullis et al., 2004; burns et al., 2000; teplin et al., 2002). as such, supporting youth during the reentry period interrelates to their long-term health and wellbeing. reentry and health disparities the juvenile legal system disproportionately confines and impacts black and latine youth (corbit, 2005; kakade et al., 2012; rovner, 2016; sickmund et al., 2021; starr & rehavi, 2013). black and latine youth are also at a higher risk to recidivate and face additional environmental challenges post-release (mendel, 2011). given the dosedependent relationship between youth confinement and adverse health (barnert et al., 2017), racial disparities in rearrests and sentencing indicate that the juvenile legal system disproportionately harms the health of black and latine youth (rovner, 2021; starr & rehavi, 2013). additionally, black and latine youth involved in the juvenile legal system experience higher rates of physical health concerns, behavioral health challenges, and exposure to stressors, which are all exacerbated by confinement and increase risk for advances in social work, fall 2024, 24(3) 556 recidivism (boyd & clampet-lundquist, 2019; teplin et al., 2002). thus, differential treatment and racial inequities widen health disparities among black and latine youth that keep them in cycles of repeat confinement and worsening health (rovner, 2021; starr & rehavi, 2013). while prior work indicates that environmental context influences the health of black and latine youth during reentry, the mechanisms behind how reentry environments influence health are not fully understood. thus, it is crucial that social workers understand how environments shape black and latine youths’ health during reentry. social-ecological perspective on youths’ health during reentry bronfenbrenner's social-ecological model (sem) provides a useful framework for conceptualizing the impacts of environment on the health of black and latine youth undergoing reentry (bronfenbrenner, 1979; eriksson et al., 2018). the sem asserts that youth are rooted in multiple interconnected ecologies, or systems, which affect their health, well-being, and development. from the sem's perspective, environmental factors and processes at multiple levels interact with black and latine youth directly and indirectly to shape their health during reentry. interrelated factors can range from specific stressors in youths’ immediate environments (e.g., food insecurity) to larger scale influences (e.g., systemic racism). after release, black and latine youth transition from confinement to interface with numerous settings that influence health and risk for recidivism. prior qualitative studies indicate that youth face stressors in their environments that influence their health during reentry and that youth view their homes, schools, and neighborhoods as the primary contexts that impact their health and risk for recidivism post-release (barnert et al., 2015). microsystem influences on health the microsystem includes the individual and ties to their immediate surrounding people, places, and structures (bronfenbrenner, 1979). black and latine youth involved in the juvenile legal system face challenges at the microsystem level from an early age, including high rates of adverse childhood experiences (aces), such as experiencing abuse, witnessing violence, or living with someone struggling with substance misuse (baglivio et al., 2014; felitti et al., 1998; owen et al., 2020). the reentry period is no different in that black and latine youth return to microsystems fraught with difficulties (baglivio et al., 2014). black and latine youth face additional environmental barriers to their health and desistance during reentry, including living in areas with fewer providers, encountering providers with limited cultural responsiveness, and having less access to resources (centers for disease control and prevention [cdc], 2020; laub, 2014) the current literature illustrates a robust understanding of environmental impacts on reentry from a socioecological perspective (bronfenbrenner, 1979; eriksson et al., 2018). individual-level risk factors impacting reentry include mental illness, substance use, academic performance, and relationships (bullis et al., 2002; oembo et al., 2009; sullivan, 2004). features of youths’ environments, such as neighborhood violence, have also been connected to reentry outcomes (abrams & freisthler, 2010; alaniz et al., 1998; freisthler mei et al./health after reentry 557 et al., 2008). moreover, environmental features specific to the marginalization of black and latine youth can affect reentry. for example, compared to white youth, black and latine youth receive harsher punishments for similar behavior and are more often criminalized for mental health symptoms. differences in school discipline impact rates of arrest that contribute to the school-to-prison pipeline (crawley & hirschfield, 2018; lau et al., 2018; laub, 2014; mowen et al., 2020). current study while many environmental features likely affect health and risk for recidivism for black and latine youth undergoing reentry, the extant literature has not identified which environments or features exert the most influence (abram et al., 2008; altschuler & brash, 2004; udell et al., 2017). moreover, research on the health of youth involved in the juvenile legal system often overlooks the important reentry period (altschuler & brash, 2004). while prior work has demonstrated that parents/caregivers help youth overcome adversity and access needed services during reentry, few studies on reentry have explored the perspectives of youth and their parents/caregivers (barnert et al., 2020). the mechanisms underlying reentry’s contribution to poor health remain largely unknown, despite the observed environmental impacts on youths’ health during reentry (freudenberg et al., 2005; todis et al., 2001). though black and latine youth are disproportionately involved in the juvenile legal system, experience high vulnerability to adverse health and recidivism, and face additional environmental barriers, few studies on reentry have centered and explored their perspectives. stark health disparities and vulnerability to recidivism highlight the importance of exploring the perspectives of black and latine youth and their parents/caregivers on how microsystems impact youths’ health during reentry (freudenberg et al., 2005; todis et al., 2001). understanding and integrating perspectives from black and latine youth and their parents/caregivers may help social work improve the delivery of health and social services and ultimately promote positive health trajectories for black and latine youth post-release. method study design we performed an in-depth qualitative secondary analysis of longitudinal semistructured interviews from a larger mixed methods study conducted with agencies from the los angeles county juvenile legal system, the largest county juvenile legal system in the united states (barnert et al., 2020). our university institutional review board and the focal county juvenile courts approved the study procedures. recruitment and enrollment between november 2016 and march 2018, the larger study's research team recruited youth newly released from confinement. other eligibility criteria included age greater than or equal to 12 years, fluency in english or spanish, and no severe cognitive delay. initial advances in social work, fall 2024, 24(3) 558 recruitment was conducted by distributing study flyers to youth exiting confinement and inviting youth and their families to contact the study team via telephone if they were interested in participating. in addition, the study team received the names and contact information of recently released youth from county probation weekly and subsequently telephoned families for study recruitment. during encounters, the research team iterated to youth and families that participation was confidential, voluntary, and would not impact youths’ probation status. the larger study experienced a 44% youth response rate, comparable to other work with youth involved in the juvenile legal system recruited in the community (abrams, 2010). fifty youth agreed to participate in the larger study, which included completing a close-ended survey 1-month post-confinement to assess youth sociodemographic information, family factors, physical and behavioral health status, and utilization of healthcare and social services during reentry. participants received a $30 gift card for completing the survey. qualitative interviews all 50 youth who completed quantitative surveys in the larger study were invited to complete longitudinal interviews. youth who agreed to additional interviews were invited to interview at 1-, 3-, and 6-month post-release. parents/caregivers of youth were also invited to complete interviews at the same intervals. youth whose parents/caregivers declined interviews were still able to complete interviews. similarly, parents/caregivers whose children declined interviews could still participate in interviews. prior to interviews, assent and consent were obtained from youth and parents/caregivers, respectively. youth and parent/caregiver interviews were completed separately, such that youth and parents/caregivers were not present during each other's interviews. all participants chose the language of interviews (english or spanish) and how interviews were conducted (i.e., in-person or via telephone). interviews were conducted in a private location and lasted 30 to 60 min. researchers recorded audio during the interviews and then used a professional service to create the transcripts. participants received a $30 gift card for each interview completed. qualitative sample twenty-seven unique youth completed longitudinal semi-structured interviews, resulting in 40 total youth interviews: 25 at 1-month post-confinement, 10 at 3-month postconfinement, and five at 6-month post-confinement. table 1 presents the sociodemographic characteristics of 26 of the 27 interviewed youth; one youth participated in interviews but did not complete a close-ended survey in the larger study. youth were aged 15-19, mostly male (85%), and born in the united states (92%). despite not purposively sampling by race or ethnicity, all interviewed youth were black or latine, reflecting the demographics of the focal county and the overrepresentation of black and latine youth in the juvenile legal system (herz et al., 2015). mei et al./health after reentry 559 table 1. youth demographic characteristics (n = 27) demographic characteristics n (%) agea 15-17 15 (57.7%) 18-19 11 (42.3%) gender male 23 (85.2%) female 4 (14.8%) race/ethnicityb latine 23 (85.2%) black 4 (14.8%) country of birtha united states 24 (92.3%) mexico 2 (7.7%) number of times confineda once 5 (19.2%) two or three times 10 (38.5%) four or more times 11 (42.3%) highest grade completeda 8th or less 1 (3.8%) 9th 2 (7.7%) 10th 7 (26.9%) 11th 10 (38.5%) 12th 6 (23.1%) language spoken at home only english 8 (29.6%) english more than my other language 5 (18.5%) both equally 9 (33.3%) my other language more than english 4 (14.8%) only my other language (spanish) 1 (3.7%) a twenty-seven unique youth were interviewed. however, one youth interviewee did not participant in close-ended surveys and thus did not report data for the following variables: age, country of birth, number of times confined, and highest grade completed. b one latine youth identified as latine and white. thirty-four unique parents/caregivers participated in longitudinal semi-structured interviews, resulting in 51 total parent/caregiver interviews: 33 at 1-month follow-up, 13 at 3-month follow-up, and five at 6-month follow-up. twenty-nine parent/caregiver interviews (57%) were conducted in spanish by a spanish-speaking researcher; transcriptions were subsequently translated into english by a spanish-speaking member of the research team. table 2 summarizes sociodemographic data on parents/caregivers. for simplicity, we will herein refer to parent/caregiver participants as "parents." advances in social work, fall 2024, 24(3) 560 table 2. parent/caregiver demographic characteristics (n = 34) demographic characteristic n (%) caregiver role mother 28 (82.4%) father/stepfather 5 (14.7%) grandmother 1 (2.9%) race/ethnicity latine 19 (55.9%) black 11 (32.4%) race/ethnicity unavailablea 4 (11.8%) country of birth united states 13 (38.2%) mexico or central america 13 (38.2%) country of birth unavailable 8 (23.5%) household structure two-parents (at least one is not the biological parent) 8 (23.5%) biological mother and biological father 8 (23.5%) single parent 7 (20.6%) household structure unavailablea 11 (32.4%) language of interview english 18 (52.9%) spanish 16 (47.1%) asome data are not available for parents whose children did not participate, as youth self-reported the demographic characteristics of their parents. qualitative analysis we conducted two-staged thematic analysis (braun & clarke, 2022) of youth and parent interview transcripts using dedoose software (version 8.3.35, 2020). first, we selected the home, school, and neighborhood microsystems as the basis of our analysis, reflecting prior research where youth undergoing reentry identified their homes, schools, and neighborhoods as the environments most impacting pathways toward re-confinement (barnert et al., 2015; bronfenbrenner, 1979). we defined home as the youths' primary residence, school as the school’s youth attended before and after confinement, and neighborhood as all other community spaces where youth reported spending time during reentry (e.g., parks, community centers, and public spaces). aligned with the broader values of social work and typical aims of social work intervention (council on social work education [cswe], 2016; national association of social workers [nasw], 2021.), our analysis used a broad definition of health as, "a state of complete physical, mental, and social well-being and not merely the absences of disease or infirmity" (world health organization [who], 2020). given the dose-dependent health impacts of confinement and recidivism, we also considered risk for recidivism in our definition of health, as increased exposure to the juvenile legal system adversely impacts health trajectories. in addition, we included risk for recidivism when considering health and health-related behavior, which mei et al./health after reentry 561 aligned with how participants often framed health during reentry in the context of risk for recidivism. table 3. environmental influences on youths’ health during reentry microsystem feature example* representative quote home relationships (+) supportive adults well, [my parents are] supporting me in everything i’m doing right now —15-yearold latine male physical space (-) crowded home i live in a small house so i get stressed a lot and i can't go anywhere to relieve my stress — 16-year-old latine female resources (-) financial instability i did not have insurance…if you are not insured you [have to] pay. nobody [wants] to pay $250 for a hospital bill just to be told [that they] are sick — 16-year-old latine female school relationships (+) supportive adults i feel like i don’t need to [speak with my therapist], but it’s always good… even my teacher told me, ‘that’s a real man.’ — 18year-old latine male physical space (-) conducive to risks high school is too big, that’s why he could never be in a high school setting, he always [needs] to be in a small setting — mother resources (+) attendance incentives they pay you to go to school — 16-year-old latine male neighborhood relationships (+) supportive adults [his probation officer] was able to take him to get [what] was required, like special shoes and clothing, so she is very helpful — mother physical space (-) proximity to drugs later i got involved with drinking and smoking…when i got into that, i would not come home at all — 16-year-old latine male resources (-) limited parent support a lot of parents don't know [what a mental health facility is] or where they're located or the services that they have to offer. — mother note. examples of health-promoting sub-features are signified by “+” and examples of health-detracting subfeatures are signified by “-.” we first open-coded interviews to determine features within the identified microsystems that youth and parents perceived as influencing youths’ health during reentry. after open-coding, we developed a preliminary codebook with three prevailing environmental features described as impacting youths’ health across the identified microsystems during reentry: relationships, physical space, and resources. next, we developed a final codebook through regular team meetings centered on the identified advances in social work, fall 2024, 24(3) 562 features across the key microsystems. in our subsequent and final round of coding, we applied the final codebook to all interviews to extract sub-features specific to the identified microsystems. youth and parent interviews across all timepoints were analyzed using the finalized codebook. sub-features described as facilitating health and desistance during reentry were coded as health-promoting, and features reported as impeding health and desistance were coded as health-detracting. finally, the study team met to extrapolate features and sub-features into themes regarding the effects of environmental features on the black and latine youths’ health during reentry across the home, school, and neighborhood microsystems (table 3). results the black and latine youth and their parents described their home, school, and neighborhood microsystems as both health-promoting and health-detracting, with influences on health reportedly operating through three prevailing features across the identified microsystems: relationships, physical space, and resources (table 3). home microsystem relationships in the home microsystem participants viewed relationships within the home microsystem as generally healthpromoting, chiefly through supportive parents. participants reported parents as instrumental in facilitating health-promoting behaviors, such as helping youth maintain sobriety and meet related probation requirements. one parent stated, "i tell [my son] that he can't let [drugs] hold him back or let them take over his life." participants also described parents as facilitating the utilization of needed health and social services; participants reported that parents scheduled appointments, provided transportation, and encouraged youth to engage with treatment and providers. finally, some of the youth discussed parents as supporting their health more directly, such as caring for them when ill. for example, one youth explained that his mother provided food-based remedies and shared, "my mother [gave] me oil, lemon, and salt to make my stomach stop hurting." youth and parents included other supportive family members who promoted youths’ health during reentry. for example, participants discussed siblings helping youth engage in physical activity by providing encouragement, equipment, and transportation. overall, participants perceived relationships within the home microsystem, particularly parents, as mainly healthpromoting. while youth and parents typically described parents as health-promoting, some youth explained that parental substance use in the home microsystem negatively affected their health during reentry. the black and latine youth reported direct health impacts, such as secondhand smoke, as well as experiencing increased temptations or decreased resistance to substance use. for example, one youth shared, "my parents smoke cigarettes or drink beer… that affects me." however, concerns over parental substance use in the home were limited to a small number of youth, and parents did not describe any health-detracting aspects of their relationships with their children. despite some of the youth reporting mei et al./health after reentry 563 concerns about parental substance use, participants described parents as health-promoting relationships within the home microsystem. physical space of the home microsystem participants described the physical space of the home microsystem as promoting youths’ health by protecting them from health-detracting features of the neighborhood microsystem. participants discussed how their homes sheltered youth from perceived threats to health and desistance, such as neighborhood violence. for example, one youth stated, "staying at home helped [me] stay off the streets [and] out of trouble." as such, most of the black and latine youth described intentionally spending more time at home to avoid features they viewed as potentially harming their health or increasing their risk for recidivism, namely exposure to negative peer influences and risky behaviors like substance use. similarly, parents reported fewer concerns about youth engaging in substance use or health-detracting behaviors when youth were at home. thus, youth and parents understood the physical space of their home microsystems as health-promoting by acting as a buffer between the black and latine youth and health-detracting features in the neighborhood microsystem. participants also viewed their homes as a safe and accessible place for youth to engage with needed services, particularly home-based reentry programs and behavioral health treatment. several parents described using their homes as a space to facilitate youths’ service utilization during reentry (e.g., behavioral healthcare). many parents reported a preference for home-based services, as the convenience allowed youth to circumvent accessibility and safety barriers. for example, one parent shared, "the home-based [mental health] program makes a world of difference." another parent explained how the option to receive services at home facilitated treatment engagement and said, “my son was more comfortable being in his own space during therapy." youth and parents perceived their homes as health-promoting physical spaces that facilitated youths’ treatment engagement and protected youth from potential risks and harm. while many participants viewed the physical space of their homes as protective, some of the black and latine youth described their home microsystems as causing distress and negatively impacting their well-being during reentry. when naming challenges at home, youth discussed crowding and lack of physical space. for example, one youth explained that having to share beds with siblings diminished his quality of sleep. another youth described the lack of physical space as negatively affecting their mental health and said, "i prefer being out in the streets [rather than] being home, having to deal with my emotions." though a few youth described concerns about reportedly cramped spaces, most expressed excitement about returning home and a desire to increase time spent at home during reentry. most participants saw youth spending time at home as health-promoting because they viewed the physical space of home as limiting youth from engaging in risky or healthdetracting behaviors, protecting youth from exposure to health-detracting features of the neighborhood microsystem, and providing a safe and accessible space to utilize services. advances in social work, fall 2024, 24(3) 564 resources in the home microsystem youth and parents spoke about resources within the home microsystem as healthdetracting during reentry. in general, participants described insufficient resources to meet their basic needs and reported returning to resource-scarce homes. for example, several of the black and latine youth described food insecurity and poor nutrition as negatively impacting their health during reentry. one youth stated, "[there is] not a lot of food to eat." in contrast, most parents highlighted their efforts to provide youth with healthy foods despite reported resource constraints, such as by cooking at home and limiting the availability of highly processed foods. in addition to food insecurity, participants discussed how lack of insurance coverage prevented and deterred youth from seeking routine healthcare or other needed services. instead, participants reported that youth primarily relied on emergency care, which they viewed as more costly and less effective. finally, the black and latine youth expressed a pressure to “start working and helping out” during the already stressful reentry period. despite often needing to resume their education, meet probation requirements, or attend mandated treatment, youth described feeling pushed to prioritize financial stability over their health and well-being. participants reported experiencing a range of resource-related challenges (e.g., food insecurity) and viewed resource scarcity as an overwhelmingly health-detracting feature of the home microsystem during reentry. school microsystem relationships in the school microsystem the black and latine youth perceived supportive adults, particularly teachers and counselors, within the school microsystem as promoting their health during reentry. youth shared how school staff facilitated health-promoting behaviors, such as encouraging youth to connect and engage with behavioral healthcare. youth also reported that school staff helped them address barriers to health and desistance by providing linkages and referrals to needed resources, such as employment opportunities to help them meet their basic needs. while youth described teachers and counselors as supporting their health and desistance during reentry, most did not discuss adult relationships in the school microsystems and instead focused on peer relationships. the black and latine youth shared concerns about how negative peer influences and stigma within the school microsystem negatively affected their health, well-being, and desistance during reentry. youth discussed feeling pressured by peers to engage in risky behaviors that could negatively impact their health and risk for recidivism, such as substance use and truancy. for example, when asked about the biggest challenge of going back to school during reentry, one youth said, "just trying to focus on myself more and not do the things i used to do." another youth shared concerns about perceived negative influences within the school microsystem and explained, "i would have been back in the [juvenile legal] system if i [returned to the same school i attended before confinement]." youth also expressed how efforts to avoid negative influences led to isolation and distress, as youth reportedly minimized social interactions. in addition, other youth described mei et al./health after reentry 565 feeling stigmatized by peers due to their confinement. for example, one youth stated, "i feel weird because everybody would look at me, and they would just look at me, and i would turn to look at them like, saying like, 'hi. what's up?' then they would just turn away." while the black and latine youth perceived adults within the school microsystem as health-promoting, their discussions of school relationships centered mostly on their peers who they generally viewed as health-detracting. notably, parents did not comment on youths’ peer relationships at school and instead focus their concerns on potentially criminogenic peers within the neighborhood microsystem. physical space of the school microsystem youth and parents perceived the physical space of the school microsystem as generally health-promoting. participants described schools similarly to homes such that schools provided a physical space that protected youth from health-detracting features in the neighborhood and facilitated engagement in health-promoting behaviors. while parents endorsed schools as a health-promoting space, they shared concerns about the limitations of school. for example, one parent stated, "school itself is not enough. there are no programs that [my child] is looking for [outside of school]." parents shared worries that, without structured programming or supervision, youth might engage in risky or healthdetracting behaviors in the neighborhood. additionally, parents viewed school as a space where youth could safely engage in physical activity and avoid potential safety concerns in the neighborhood. as such, parents often spoke about wanting afterschool programing and other reason for youth to spend more time at school. despite the youths’ concerns about negative peer influence, youth and parents generally viewed schools as physical spaces that promoted health and protected youth from risks during reentry. resources in the school microsystem many parents described a lack of reentry-specific resources as health-detracting for youth. for example, several parents reported difficulties enrolling youth in school postrelease, which they attributed to a lack of reentry-specific support. one parent shared, "the school is giving us a really hard time to take [my son] back. it took him approximately 3 months to get him back, and he wasn't fully enrolled yet." one mother explained that her son’s school failed to receive verification of the academic credits her son completed while confined, rendering him ineligible for enrollment despite meeting the requirements. in addition to simply wanting their children to receive education, parents expressed concerns that gaps in school enrollment might lead youth to spend more time in their neighborhood microsystems and engage in risky or health-detracting behavior. moreover, parents perceived gaps in school enrollment as preventing youth from accessing resources and health-promoting features within the school microsystem. overall, parents described a lack of reentry-specific support and perceived gaps between systems of care as negatively affecting youths’ health during reentry. advances in social work, fall 2024, 24(3) 566 neighborhood microsystem relationships in the neighborhood microsystem youth and parents perceived adult relationships within the neighborhood microsystem as promoting youths’ health during reentry. for example, participants generally described probation officers as health-promoting because probation often served as a connection to needed services and assistance, including help with school enrollment, employment, and resource referrals. participants also viewed adult neighbors and older family members in the neighborhood as supporting youths’ health during reentry, such as by providing supervision or transportation. thus, youth and parents identified relationships in the neighborhood microsystem as health-promoting when discussing adults. while youth and parents perceived adults in the neighborhood as health-promoting, they described youths’ peers in the neighborhood microsystem as health-detracting. like school peers, participants shared concerns about criminogenic peers in the neighborhood pressuring youth to engage in risky or health-detracting behaviors. for example, one youth stated, "my old friends smoke and ditch class, [which] was kind of the biggest distraction being out in the streets." another youth said, "when i'm around my friends, i just want to get into trouble." as such, participants generally described neighborhood adults as healthpromoting but viewed neighborhood peers as increasing youths’ risk for recidivism and worse health. physical space of the neighborhood microsystem youth and parents perceived the physical space of the neighborhood microsystem as containing both health-promoting and health-detracting features. participants said the neighborhood microsystem provided space for health-promoting behaviors, such as physical activity and relaxation. for example, some of the black and latine youth reported playing sports and exercising in their neighborhoods. one youth shared that they enjoyed playing soccer at a community park, and several youth reported exercising at local gyms. additionally, several of the black and latine youth who discussed concerns about living in a crowded or stressful home reported that they went into the neighborhood to avoid stressors at home, despite perceived risks. while participants identified some healthpromoting features, they overwhelmingly discussed the neighborhood microsystem as dangerous and health-detracting. participants generally viewed the neighborhood microsystem as having several factors that could increase youths’ risk for recidivism and worse health during reentry. for example, participants shared concerns about the presence of drugs within the neighborhood microsystem. one parent shared, "where we live at, the population of young kids [are all] on crystal, xanax bars, and all kinds of other drugs." participants reported worries that the presence of drugs might push youth to resume substance use during reentry, which could result in recidivism and worse health. for example, one youth described an instance when he walked by someone smoking and felt "the urge to go over [to the person smoking] and go, 'excuse me, do you have another [cigarette]?'" other participants discussed safety concerns and fear of violence, which deterred youth from exercising in community spaces mei et al./health after reentry 567 or accessing community-based resources. notably, participants’ neighborhood safety concerns related to their views of the home and school microsystems as health-promoting, as they described school and home as sheltering youth from the neighborhood. while some participants identified health-promoting features of the neighborhood microsystem, they overall viewed the neighborhood as negatively affecting youths’ health during reentry. resources in the neighborhood microsystem youth and parents cited insufficient resources to meet their needs and inaccessible services as health-detracting features of their neighborhood microsystems during reentry. parents focused on a lack of reentry-specific resources. many parents described feeling confused with how to help youth navigate reentry challenges, such as helping youth resume education, meet probation requirements, achieve desistance, and connect to needed services. for example, one parent shared: as a parent [of a youth undergoing reentry] for the first time, it’s like, you feel like you’re locked up and you don’t know where to turn, or who to talk to regarding whatever needs that [youth] need… so, they need to have more information for parents. given that most participants viewed parent support as instrumental in promoting youths’ health, well-being, and desistance during reentry, participants described inadequate support for parents as negatively impacting youth. in addition, participants explained how inaccessible services and convoluted systems of care made it difficult for youth to utilize needed support during reentry. for example, one youth stated, “most [youth] do not know where to go [for healthcare]. unless it is the emergency room, they do not know.” another youth discussed transportation barriers and said, “i hate waiting [for the] bus. sometimes i get some rides, but when i can’t, i’ll just be like, ‘oh well.’” overall, youth and parents described insufficient resources, particularly ones specific to reentry and health, in the neighborhood microsystem as detracting from the health of the black and latine youth during reentry. discussion participant perspectives suggest that the home, school, and neighborhood microsystems contain similar features (i.e., relationships, physical space, and resources) that have meaningful influences on the health of black and latine youth undergoing reentry. participants perceived the identified features as health-promoting, healthdetracting, or both depending on the specific microsystem. in interviews, participants explained how specific sub-features, such as insufficient resources within their microsystems, influenced health trajectories for the black and latine youth undergoing reentry by limiting service utilization, increasing distress, and facilitating high-risk behaviors (abrams & freisthler, 2010; altschuler & brash, 2004; freudenberg et al., 2005; krisberg et al., 1987). perspectives shared in the interviews indicate various ways specific microsystems influence youths’ health during reentry. advances in social work, fall 2024, 24(3) 568 service utilization the participants named specific strengths and challenges in each microsystem as influencing youth service utilization during reentry. participants reported various barriers to service utilization and treatment engagement faced by the black and latine youth undergoing reentry. participant perspectives reflect known barriers to care, such as logistical obstacles, financial constraints, structural barriers (e.g., providers’ lack of cultural responsiveness), and youths’ skepticism towards treatment (abrams & freisthler, 2010; altschuler & brash, 2004; gupta et al., 2005; udell et al., 2017). the black and latine youth and their parents repeatedly shared concerns about neighborhood safety and inaccessible systems of care, which they said could be remedied with the availability of homeand school-based programs. additionally, parents highlighted a lack of reentryspecific assistance and support for parents. the parents expressed confusion related to helping their children meet probation requirements, attend needed services, and meet other reentry-related responsibilities. given how barriers in the environment shape youth behavior during reentry and the essential role of parents in helping youth overcome reentry adversity (bondoc et al., 2021), participant perspectives suggest an urgent need to improve connections to needed support. social workers can aim to advocate for and implement the practices participants identified as effective or needed, including in-home service delivery, warm handoffs, and reentry-specific supports. future efforts might also explore ways to make services more accessible to black and latine youth during reentry, such as providing care in additional settings or languages, utilizing lay providers, and integrating systems of care—signifying an opportunity for social work to lead innovations that redress longstanding inequity. participants also highlighted environmental features within the identified microsystems that facilitate service utilization during reentry. again, participants emphasized the importance of parents in helping youth navigate challenges during reentry. participants reported parents as promoting service utilization through transportation, encouragement, and guidance. however, participant discussions about insufficient resources in the home microsystem signaled a need to mobilize other supportive adults (i.e., non-parents) to support black and latine youth during reentry. accordingly, when discussing health-promoting features of the school and neighborhood microsystems, participants identified other supportive adults as facilitating youths’ service utilization during reentry, including teachers, probation officers, and extended family. given prior studies indicating teachers and school staff have limited reentry-specific skills and knowledge, future efforts can aim to train or support school staff to help youth address reentry difficulties rather than having youth rely solely on parents and probations officers (sinclair et al., 2016; sullivan, 2004). notably, the parents did not comment on adults within the school microsystems despite youth seeing school staff as potentially helpful. still, parents emphasized concerns about continuity gaps between education and other systems of care. as such, social workers might leverage their unique multidisciplinary position to improve collaboration across microsystems to support youth during reentry. moreover, efforts to increase the availability of needed services (e.g., mental healthcare) in schools, particularly continuation schools, might align with participant perceptions of schools as health-promoting and the reality of inaccessible services. future work to mei et al./health after reentry 569 implement the participant perspectives into practice, such as through integrated care and collaborative service models, might improve youth service utilization, health, and desistance during reentry (mathur & clarke, 2014; stroul & friedman, 1986). engagement in health-related or risky behaviors stemming from multiple risk factors, including high rates of aces and systemic racism (baglivio et al., 2014; crawley & hirschfield, 2018; felitti et al., 1998; lau et al., 2018; laub, 2014), black and latine youth undergoing reentry face increased risks for engaging in health-detracting behaviors, such as substance use and risky sexual behaviors (campbell et al., 2016; kumpfer et al., 2003; quinn et al., 2019). participant perspectives echoed research indicating youth undergoing reentry face increased pressure to engage in risky behaviors as they return to criminogenic contexts post-release (abrams, 2006; altschuler & brash, 2004; sampson et al., 2002). the youth and their parents emphasized how peers in the school and neighborhood microsystems (i.e., “old friends”) can act as obstacles to health and desistance during reentry. however, participant perspectives also suggest that adults across the identified microsystems can help youth overcome reentry challenges, reflecting prior work showing that prosocial relationships promote health and desistance (kumpfer et al., 2003; quinn et al., 2019; todis et al., 2001). the interviews indicate supportive adults as a potential strength in all identified microsystems. participants shared how supportive adults encouraged youth to utilize behavioral healthcare, maintain sobriety, attend school, and engage in other health-promoting behaviors. as recent studies have shown early promise in leveraging supportive adults to prevent substance use among youth undergoing reentry (knight et al., 2021), future research might examine how supportive adults can best increase health-promoting behaviors and decrease risky behaviors among youth undergoing reentry. efforts to connect youth with more prosocial adults and leverage existing supports during reentry might help black and latine youth break the vicious cycle of worsening health and repeat recidivism (abrams, 2006; woods et al., 2013). participants identified crowded physical spaces and resource scarcity across their microsystems as negatively impacting youths’ health during reentry. importantly, participant perspectives align with a large body of evidence connecting racial marginalization to health and social disparities among black and latine communities (cdc, 2020; massoglia, 2008; schwartz et al., 2022). for example, participant perspectives reflect prior work linking perceived neighborhood violence to worse health trajectories; participants explained how neighborhood safety concerns impeded youth from engaging in health-promoting behaviors during reentry, such as physical exercise and accessing needed behavioral healthcare (meza et al., 2023). similarly, participants repeatedly shared worries about how the presence of drugs in their neighborhoods might increase youths’ likelihood of substance use despite desires or mandates to maintain sobriety, which they linked to risks for worse health and recidivism. finally, participants’ discussions about insufficient resources across the identified microsystems align with the extant literature on poverty acting as an instrumental and negative social determinant of health, especially in black and latine communities (crouch advances in social work, fall 2024, 24(3) 570 et al., 2000; schwartz et al., 2022). for example, participants described how poverty prevented the black and latine youth from engaging in health-promoting behaviors and accessing needed services that could support their health and desistance. overall, participants highlighted specific features across the home, school, and neighborhood microsystems that social work interventions can aim to leverage (e.g., supportive adults) or address (e.g., accessibility barriers) to facilitate the health and desistance of black and latine youth undergoing reentry. strengths and limitations the current study offers several strengths. first, the study centers and explores the perspectives of black and latine youth and families directly impacted by the juvenile legal system, whose voices are underrepresented in research, policy, and treatment planning (bondoc et al., 2023). participant perspectives provide firsthand insight from vulnerable youth and families undergoing reentry. the study also highlights the important yet often overlooked reentry period, a critical juncture for breaking cycles of repeat confinement and escalating health needs (woods et al., 2013). in addition, the current study’s use of the sem (bronfenbrenner, 1979) considers the contexts youth return to during reentry rather than viewing youth as “criminals.” rather than default to an implicit deficit lens, the current study also views youth through a strengths-based framework that considers youths’ assets and protective factors. overall, participant insights provide important implications for social work intervention, programming, and policy to move away from unjust practices that punish individuals to more effective strategies that change the systems around youth. while the study shares important insights and has several strengths, it still presents limitations. though interviews originally focused on youths’ health and well-being during reentry, the current study’s secondary analysis approach means interviews were not explicitly framed around specific microsystems or their features. as such, participant responses may lack helpful details and additional nuance, such as the degree to which participants felt their schools can adequately meet youths’ needs or how police presence influences youths’ reentry experience. similarly, parents may have avoided discussing the negative impacts of their behaviors due to social desirability or fear of judgment. in addition, attrition at the 3and 6-month interviews may relate to an overrepresentation of positive perspectives, as individuals experience optimism to start reentry (phillips & lindsay, 2011). despite the importance of exploring and centering the voices of those directly impacted by the juvenile legal system, framing interviews around youths’ health during reentry may have caused participants to focus on micro-level challenges rather than macro-level ones. because our sample was entirely black and latine, their perspectives cannot be separated from institutionalized racism, punitive policies, and other oppressive systems that drive mass confinement, racial stratification, and health inequity. interviews and analyses did not explicitly investigate how aspects of identity (i.e., race, gender, age) affected participants’ perspectives and reentry. analyses organizing environmental features as either health-promoting or health-detracting may have overlooked more nuanced interactions between environment and health. given that many factors impact health during reentry, future social work research might explore each feature’s relative health promotion or health detraction within and across different microsystems. finally, mei et al./health after reentry 571 while participants’ releases from juvenile detention suggest most were adjudicated for less serious offenses, we do not have data on the offenses participants were adjudicated for, which carries implications for how their perspectives relate to future research and intervention. still, the current study offers needed insights into how environments impact the health and desistance of black and latine youth during the important reentry period. conclusion reentry is an especially tumultuous and important time for black and latine youth, who disproportionately come from and return to marginalized and underserved communities, placing already vulnerable youth at risk for recidivism and poor health. participants described their home, school, and neighborhood microsystems as promoting and detracting from youths’ health across three prevailing features: relationships, physical space, and resources. specifically, participant perspectives underscore the power of supportive adult relationships within the home, school, and neighborhood microsystems to facilitate treatment utilization and minimize risky behaviors. moving forward, social workers can aim to leverage and support features that promote health, such as by implementing and expanding practices identified as improving service accessibility (e.g., homeand school-based programming), while advocating for policies and reform that address features that impede health and desistance (e.g., insufficient resources and safety concerns). future research and advocacy may also focus on developing opportunities and pathways for collaboration between supportive adults within and across microsystems to help youth overcome reentry challenges. finally, understanding how microsystems impact black and latine youth undergoing reentry can inform future social work intervention, programming, and policy to create environments that foster health and desistance for youth harmed and impacted by the u.s. juvenile legal system. references abram, k. m., paskar, l. d., washburn, j. j., & teplin, l. a. 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(2020). preamble to the constitution of who as adopted by the international health conference. author. author note: christopher bondoc; david geffen school of medicine at ucla; 10833 le conte ave, los angeles, ca 90095, cbondoc@mednet.ucla.edu acknowledgements: the authors have no known conflicts of interest to disclose. this work was supported by the national institutes on drug abuse [k23 da045747-01], california community foundation [bapp-19-154836], and ucla clinical and translational science institute [nih kl2u000124]. we thank our study participants and community partners. we also thank nathalie lopez, bria pettway, and marisela aguilar for their intellectual contributions. https://repository.law.umich.edu/cgi/viewcontent.cgi?article=2497&context=articles https://repository.law.umich.edu/cgi/viewcontent.cgi?article=2497&context=articles https://www.ojp.gov/pdffiles1/digitization/125081ncjrs.pdf https://www.ojp.gov/pdffiles1/digitization/125081ncjrs.pdf https://doi.org/10.1177/1541204003260047 https://doi.org/10.1001/archpsyc.59.12.1133 https://doi.org/10.1177/001440290106800107 https://doi.org/10.1177/001440290106800107 https://doi.org/10.1016/j.drugalcdep.2018.12.029 https://doi.org/10.1016/j.drugalcdep.2018.12.029 https://doi.org/10.1177/0743558416653219 https://doi.org/10.1177/0743558416653219 https://doi.org/10.2105/ajph.2012.300961 https://doi.org/10.2105/ajph.2012.300961 https://apps.who.int/gb/bd/pdf_files/bd_49th-en.pdf#page=6 https://apps.who.int/gb/bd/pdf_files/bd_49th-en.pdf#page=6 mailto:cbondoc@mednet.ucla.edu mei et al./health after reentry 577 appendix. youth interview guide: baseline interviews we are conducting a research study. there are 4 fundamental domains (overall wellness, health status and beliefs, accessing care during reentry, and recommendations). these are exemplar questions we will ask during the semi-structured interviews to probe the topics covered below. we will use the same interview script for parents; however, instead of saying “you” in each instance, we will substitute this to ask about “your child.” for the parent interviews, all questions will reflect back to the experiences of their child. for example: “how are things at school for your child.” similarly, the questions about health appointments will refer to health appointments of the child and recommendations will ask about how to improve care access for the child. script for youth: i would like to hear from you about your experiences with health and health care. i will ask you about your health and how easy or hard it has been for you to get to the doctor. by health, i mean when your body, mind, emotions, and your relationships feel strong. health also means not have diseases or conditions like infections that make your body or mind feel bad or weak. i would specifically like to understand how things have been for you since you have been home from camp. i’d like to remind you that participation is completely voluntary. if you feel uncomfortable at any point we can skip questions or stop completely. your participation and the answers to your questions in no way affect your standing with the court or with probation. there are no right or wrong answers. simply tell me what is true for you. your responses are confidential and i will not share your responses with your parents or probation officer. in order to protect your privacy, please do not give me additional information beyond what i ask for. everything you say is confidential, meaning that we will not link your name or identity to anything you say and we will not tell others that you participated in this study. however, it is important that you are aware that there are two limits to this confidentiality. first, if you give me information that a child or elderly person is being abused or may be being abused, i may report it to the authorities. second, if you tell me that you plan to harm yourself or others, i may report it to the authorities or a health staff member. ultimately, the purpose of this project is so that doctors and other adults can learn how to do a better job of helping kids feel healthy after they go home from camp. we appreciate your participation. do you have any questions before we begin? [answer any questions. when no more questions and participants demonstrate understanding of the preamble, then begin]. let’s get started. i. reentry experience/ overall wellness to start off, i want to get a sense of where you’re at. i’d like to understand how you have been doing since you have been home from camp. 1. how are things going for you since you left camp? a. __ well? b. __ poorly? 2. how are things at: a. home? i. __ relationships? ii. __ conflicts? b. school? 3. how is your health? [[get diagnosis here.]] a. __ physical b. __ reproductive health c. __ mental/emotional d. __ addictions advances in social work, fall 2024, 24(3) 578 e. __ social/relationships ii. health status & health beliefs in this next set of questions, i’d like to understand a little bit more about your health and how you think about it. camp: 1. besides a pediatrician, what health professionals did you see while you were at juvenile hall or camp? (e.g., psychiatrist, counselor) 2. were you on medications while you were at camp? if so, which ones and what were they for? 3. did the doctors or mental health providers give you any diagnoses or names of specific conditions that you have, such as asthma or depression? if so, what conditions? a. what do you understand about these conditions? 4. what did the health professionals at camp recommend you do to take care of your health once you got home? now let’s switch to talking about how you’ve been since you got back home from camp. home: 1. how do you think your health conditions are affecting other things in your life, such as going to school)? a. __ home b. __ school 2. which recommendations were you able to follow through with and why? a. __ physical health b. __ reproductive health c. __ substance abuse treatment d. __ mental health e. __ medications iii. accessing health care during reentry i know there’s a lot to adjust to when you come home from camp. the purpose of this next set of questions is to understand what is hard and what is easy about accessing care in the period after you left camp. i’d first like to understand what it’s like to get to a health appointment. went 1. what was your last health appointment (when, with home, for what)? 2. can you walk me through the process of getting and going to your last health appointment (outside of camp or juvenile hall). a. __ knowing where to go /call b. __ scheduling the appointment c. __ getting to the appointment d. __ insurance and payment e. __ other stuff you needed to happen to get you to a health appointment? 3. what role did you and others play the appointment? a. __ you b. __ parents c. __ your probation officer 4. what was the experience of the appointment like? a. __ good b. __ bad mei et al./health after reentry 579 didn’t go 1. what happened? a. __ previous bad experience or priors b. __ scheduling c. __ getting there d. __ insurance and cost e. __ other 2. who could have helped and how? a. __ you b. __ parents c. __ your probation officer d. __ other person iv. recommendations in the last few questions, i’d like to understand what you think kids need during reentry to get to health care. you’ve known a lot of kids and you probably know some kids that would go to all the appointments that doctors recommend and some that don’t go to any. 1. what types of kids are likely to get to their appointments and which ones are not? where do you fall in that? 2. for kids who are not likely to get to appointments: a. what do you think they need in order to get to health care? b. what about: i. __ text messaging ii. __ coach iii. __ probation officer more involved iv. __ other 3. for kids who are likely to get to appointments? what could help them get to health care after they get home from camp? why are they able to get to their appointments? 4. what messages would you like me to tell people that would help kids coming home from camp be healthy? __ court and probation __ parents __ teachers __ health providers __ other those were my last questions for the interview. do you have anything else you’d like to add? ***future contact info 1. is the number that we reached you at today still the best phone number to reach you at? 2. are there other phone numbers for you that we can keep on file in case the number we used today changes? ________________________________